NUR 631 MIDTERM EXAM 2025

NUR 631 MIDTERM EXAM 2025 The PT time and INR measure what? - -extrinsic pathway The extrinsic pathway is initiated by - -tissue factor III Breast cancer in women who have the breast cancer gene - -occurs at an earlier age Which leukemia demonstrates the Philedelphia chromosome? - -CML Which leukemia has the best prognosis? - -ALL What causes a hypermetabolic state leading to cachexia? - -TNF (tumor necrosis factor) What are proto-onocogenes? - -Normal cellular genes that promote growth What is the major cause of death from leukemic disease? - -Infection The primary source of erythropoietin is... - -The kidney What is the largest cyctoplasmic organelle? - -Nucleus Which organelle contains the DNA? - -Nucelus Where is the nucleolus? - -In the nucleus Where is RNA stored? - -Nucleolus What is known as the GI tract of the cell and is coated with ribosomes? - -Rough endoplasmic reticulum What do the ribosomes do? - -Make proteins Which organlle is responsible for lipid metabolism?****** Abdundant in the muscle for calcium release - -Smooth ER Which organelle stores calcium and detoxes alcohol from the cell? ****** - -Smooth ER Which organelle is responsible for folding proteins and has cisternae? - -Golgi apparatus Nur 631 Nur 631 Nur 631 Which organelle is the garbage collector and uses enzymes to digest cellular waste? - Lysosomes What organelle is located in the cytoplasm and is responsible for ATP production? - Mitochondria What are the functions of the plasma membrane? - -transport nutrients and waste products; generate membrane potentials, recognition, communication and growth regulation of cells What composes the phospholipid bilayer? - -Hydrophobic head and hydrophillic tail What can pass the bilayer by simple diffusion? - -Gases, fat soluable vitamins and water What cant pass by simple diffusion? - -glucose, sucrose and ions (hydrogen, sodium, potassium, chloride and calcium) What must polar charged molecules use to cross the bilayer? - -carriers, proteins or pumps What is facilitated diffusion? - -diffusion (high concentration to low concentration) but with transmembrane proteins What is a GLUT protein transporter to transport glucose an example of? - -Facilitated diffusion Uses combined effects of concentration and electrical gradients - -Electrochemical gradient What kind of cellular receptor is the sodium potassium pump? - -Na K Pump The three types of carrier proteins are - -Symporter, antiporter and uniporter Moves molecules against concentration gradient using energy - -Primary active transport Uses primary active transport as a tool - -secondary active transport Resting membrane potential - --70mV Action potential steps: - -1. resting potential 2. sodium rushes into cell (depolarization) 3. absolute refractory point is hit 4. potassium rushes out of cell to lower concentration (repolarization) 5. Na K pump pumps out 3 Na and 2 K to restore RMP Nur 631 Nur 631 Cell signaling occurs through three methods: - -Gap junctions Cell to cell (antigen presentation) Ligand (vessicles) Ligands can be one of three: - -Autocrine, paracrine, synaptic intercellular channels that permit cell to cell transfer of ions and molecules - -gap junctions Gap junctions found often in which type of cells? - -cells where synchronized functions occur: Cardiac cells, vascular tone and peristalsis What do proteins do? - -made up of amino acids, execute most membrane functions including transport and signal transduction When does cell replication occur? - --Protein mitogens and growth hormone regulated -when factors are favorable Stages of Mitosis (PMAT) - -prophase, metaphase, anaphase, telophase What is the end result of mitosis - -each daughter cell receives 46 chromosomes (23 pairs) (23 chromosomes from each parent Chromatin condenses into chromosomes in what phase - -prophase In which phase of mitosis do the chromosomes align 1/2 way between spindle poles? - metaphase In which phase of mitosis do the centromeres divide? - -anaphase In which phase of mitosis do the separated daughter cells arrive at spindle poles? - Telophase Phase of mitosis where cells cleave off into new cells: - -Cytokinesis What cells does meiosis occur in? - -Sex cells (gametes) Which protein releases E2F transcription factors to begin cell division? - -Rb protein What triggers Rb to release E2F? - -Cyclins How many genes are in the genome? - -20,000 What does DNA compose of? - -5 carbon sugar, phosphate group and 4 bases What does G pair with? - -C Nur 631 Nur 631 What does A pair with? - -T (or U in RNA) What is a pneumonic to remember which bases pair? - -Together At the Grand Canyon DNA is wrapped around histones called? - -Chromatin This protein binds new strands together forming complementary strands - -DNA polymerase This protein unzips the DNA strand from 5' to 3' - -Helicase This protein lays down primers to code RNA strands: - -Primase This protein glues together okazaki fragments on the RNA strand - -Ligase This protein keeps DNA from coiling during transcription process - -Topoisomerase What is translation and where does it occur? - -the process in which ribosomes in a cell's cytoplasm create proteins, following transcription of DNA to RNA in the cell's nucleus. It occurs in cytoplasm What is transcription and where does it occur? - -the process by which the information in a strand of DNA is copied into a new molecule of messenger RNA (mRNA). It occurs in the nucleus where the DNA cells are located. Cells shrink and reduce their differential functions in response to normal and injurious factors***** - -Atrophy causes of cell atrophy**** - -1. Disuse 2. Ischemia 3. Endocrine Dysfunction 4. Persistent cell injury 5. Aging increase in cell mass accompanied by an augmented functional capacity***** - -cell hypertrophy causes of cell hypertrophy***** - -response to increased physiologic or pathophysiological demands working out and cardiomegaly are examples of which type of cellular adaptation?***** - cell hypertrophy increasing functional capacity by increasing the number of cells***** - -cell hyperplasia Nur 631 Nur 631 causes of cell hyperplasia:***** - -increased physiologic demands, cell injury or hormonal demands ex. lining of uterus, increased RBC in elevation replacement of one differential cell type with another***** - -cell metaplasia causes of cell metaplasia:***** - -adaptation to cell injury ex. converting fibrous tissue into bone smoke irrutation in nose-- will change cells Is metaplasia reversible or irreversible?*** - -reversible which cellular adaptation has the potential to turn into cancer?*** - -dysplasia Disorganized appearance of cells because of abnormal variations in size, shape, and arrangement adaptive effort is gone*** - -Dysplasia what is a common presentation of dysplasia? *** - -hyperplastic squamous epithelium severe dysplasia is callled? **** - -carcinoma in situ lack of differentiated features in cancer cell - -anaplasia malignant tumor is associated with which cellular adaptation process? - -anaplasia causes base damage, single strand damage and double strand DNA breakage, can cause mutations - -radiation type of necrosis that causes denaturation of proteins from gel to firm state, most often seen in KIDNEYS, most common**** - -coagulafactive necrosis type of necrosis where cells are digested by their own hydrolases forming CYSTS, typically seen in GLIAL CELLS OF BRAIN**** - -liquefactive type of necrosis of death of adipose tissue from trauma or pancreatitis*** - -fat necrosis fat melting by burns, appears as chalky white area of tissue*** - -saponification type of necrosis seen in TB or in LUNGS*** - -caseous necrosis type of necrosis that is a combo of liquefactive and coagulative*** - -caseous necrosis what are the two forces that move fluid from the capillary to the interstitial space? - hydrostatic and osmotic pressure Nur 631 Nur 631 outward push of vascular fluid against capillary walls (straw) - -hydrostatic pressure water flows towards area of the body with higher solute concentration - -osmosis fluid flows back into cells driven by protein albumin circulating in blood - -colloid oncotic pressure if you have lots of solute in the blood will oncotic pressure increase or decrease? - increase movement of molecules from higher to lower concentration not requiring energy - simple diffusion facilitated diffusion, simple diffusion and osmosis encompass what type of transport? - passive transport what are types of active transport? - -primary active, secondary active, endocytosis, exocytosis, antiport, phagocytosis Ions with higher concentration outside the cell: - -Cl-, Na+ and HCO3- Ion with greater intracellular concentration - -K+ Hormone that increases sodium and water reabsorption - -Aldosterone Hyperaldosteronism - -excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium Hypoaldosteronism - -hyposecretion of aldosterone ECV deficit - -removal of sodium containing fluid from the body can excrete fluid from three methods - -urine, sweat and third spacing GI excretion methods causing ECV deficit - -emesis, diarrhea, GI suction, fistula drainage renal excretion methods causing ECV deficit - -adrenal insufficiency, salt wasting renal disorders, excessive diuretic use and bed rest Misc. methods of ECV deficit - -hemorrhage, diaphoresis, 3rd spacing, paracentesis, burns TBW of newborn infant - -75% TBW of adult male - -60% Nur 631 Nur 631 TBW of adult female - -50% TBW in liters - -44L (28L ICF, 16L ECF) How much ECF volume can you lose before your heart stops? - -2L clinical manifestations of hypovolemia: - --Thirst -Dry mucous membranes, flat neck veins -Decreased skin turgor/delay return/tenting -Hypotension, tachycardia -Weight loss -Decreased urine output, concentrated urine, no tears -Restless, drowsy, confused, dizzy, weak causes of hypervolemia: - -excessive aldosterone secretion, addition or retention of saline, CHF Clinical manifestations of hypervolemia - -•Weight gain •Ascites •Edema •Increased urine output •Cardiac symptoms- JVD •Respiratory symptoms- difficulty breathing CM of hypervolemia in an infant - -bulging fontanelle causes of hyponatremia - -increased ADH, SIADH, excessive D5W, tap water enema, excessive water or beer consumption, near drowning in fresh water, SSRIs, thiazide diuretics, replacement of water not salt CM of hyponatremia**** - -lethargy, confusion, apprehension, seizures treatment of hyponatremia - -increase salt in diet, restrict fluids, give hypertonic solutions, decrease thiazide diuretics clinical signs of dehydration - -thirst, oliguria, tachycardia, hypotension aka water deficit or. hyper-osmolality - -hypernatremia causes of hypernatremia - -corticosteroids, cushings disease, hyperaldosteronism, dehydration, DI, hypertonic solution excess clinical manifestations of hypernatremia**** - -Thirst, weight gain, bounding pulse, and increased blood pressure, confusion, lethargy, seizures Nur 631 Nur 631 FRIED: hypernatremia -Fever, flushed skin -Restless, irritable -Increased fluid retention -Edema -Decreased urine output and dry mouth - -pneumonic for hypernatremia increased corticosteroids and cushings can cause what electrolyte imbalances - hypernatremia, hypokalemia What does potassium regulate in the body? - -Smooth muscle contraction causes of hypokalemia: - -decreased potassium intake, lasix, corticosteroids, cushings (cortisol excess), hyperaldosteronism, diarrhea, excessive diarphoresis, emesis, GI suction CM of hypokalemia**** - -•General Weakness •Muscle Cramps and Spasms •Constipation, decreased bowel sounds •Polyuria •Dysrhythmias •Glucose intolerance •Impaired urinary concentrating ability -U waves on EKG*** cardiac arrest occurs when potassium - -is IV pushed or in excess, relaxes cardiac muscle too much normal potassium levels - -3.5-5 normal sodium levels - -135-145 normal calcium levels - -9-11 hyperkalemia causes: - -increased potassium intake, acidosis, insufficient insulin, crushing injury, burns, renal disease, spironolactone, adrenal insufficiency, nephrotoxic drugs why do potassium levels increase when there are crush injuries or burns? - -potassium is highly concentrated inside the cell slow muscles and nerves - -hypo K also called water intoxication and hypo-osmolality - -hyponatremia Nur 631 Nur 631 hyper K - -excited muscles and nerves why is sodium bicarb given in cardiac arrest - -to lower blood pH caused by high levels of potassium why is calcium gluconate given in cardiac arrest - -stabilizes cardiac cell membranes by restoring RMP and threshold CM of hyperkalemia**** - -•Bilateral ascending flaccid muscle weakness •Cardiac Dysrhythmias •Cardiac arrest if severe •Nausea/Vomiting •Oliguria -T waves -diarrhea, increased bowel sounds -parasthesias T/F: vitamin D helps the body absorb calcium - -True hyperparathyroidism - -stimulates increased absorption of calcium from the bone into the blood stream hypoparathyroidism - -stimulates decreased absorption of calcium from the bone into the blood stream T/F: potassium and calcium have an inverse relationship - -True causes of hypocalcemia: - -hypoparathyroidism, low magnesium levels, CKD (deficient vitamin D), pancreatitis, chronic diarrhea, insufficient diet T/F: magnesium helps produce PTH - -true hypocalcemia is related to: - -increased neuromuscular excitability T/F: trousseau and chvosteks signs are signs of increased neuromuscular excitability - True carpal spasm after occlusion of the arterial blood flow for 3 mins - -Positive Trousseau sign spasm of muscles in the cheek and corner of mouth produced by tapping facial nerve in front of ear - -Positive Chvosteks sign CM of hypocalcemia**** - -•↑ neuromuscular excitability •(+) Chvostek's and Trousseau's •Muscle cramps Nur 631 Nur 631 •seizures -ricketts, osteomalacia Causes of hypercalcemia: - -CHIMPANZEES: Calcium ingestion, Hyperparathyroid, Hyperthyroid, Iatrogenic, Multiple myeloma, Paget's disease, Addison's disease, Neoplasms, Zollinger-Ellison syndrome, Excess vitamin D or A, Sarcoidosis CM of hypercalcemia:*** - -decreased neuromuscular excitability, constipation, muscle weakness, diminished reflexes, decreased LOC, KIDNEY STONES normal magnesium levels - -1.5-2.5 can you see a positive chvosteks and trousseau sign in hypomagnesemia? - -yes what does magnesium do in the body? - -relaxes smooth muscle causes of hypomagnesemia - -Insufficient magnesium intake ~Malnutrition and starvation ~Vomiting diarrhea ~Malabsorption syndrome ~Celiac disease ~Crohn's disease -alcoholism***** Increased magnesium secretion ~Meds such as diuretics ~Chronic alcoholism Intracellular movement of magnesium ~Hyperglycemia ~Insulin administration ~Sepsis CM of hypomagnesemia - -INCREASED deep tendon reflexes, confusion, tremors, seizures, cardiac changes causes of hypermagnesemia (MAG) - --Mag containing antacids & laxatives -Addison's disease -Glomerular filtration insufficiency CM of hypermagnesemia - -decreased neuromuscular excitability, flushing, diaphoresis, hypotension, bradycardia treatment of hypermagnesemia - -Monitor reflexes Avoid magnesium-based antacids and laxatives Nur 631 Nur 631 Restrict diet, give calcium gluconate Normal phosphate levels - -2.5-4.5 cause of hypophosphatemia - -parenteral nutrition w/o adequate phosphate replacement, glucose/insulin therapy, chronic alcoholism, use of antacids CM of hypophosphatemia - -muscle pain, weakness, bone pain, confusion Does hyperphosphatemia cause hypocalcemia? - -yes bc hyperphosphatemia can decrease vitamin D production cause of hyperphosphatemia - -too much phosphate, crush injury, rhabdo, ESRD why can crush injuries and rhabdo cause hyperphosphatemia - -bc phosphate is a major intracellular anion treatment of hyperphosphatemia - -give vitamin D, antacids, manage hypocalcemia what does low pH indicate - -alot of hydrogen ions what does a high pH indicate - -very little hydrogen ions what acid-base imbalance is caused by impaired gas exchange (COPD, bact pneumonia, asthma, ARDS)? - -respiratory acidosis what acid-base imbalance is caused by impaired neuromuscula