NURS 5315 Advanced Pathophysiology
1. Ovarian cancer site of metastasis?
Answer Peritoneal surfaces, omentum (fold of peritoneum connecting the
stomach with other abdominal organs), *liver*
2. The increased NADH/NAD+ ratio in the liver from ethanol causes
Answer 1. Pyru- vate --> lactic acid, causing lactic acidosis
2. Oxaloacetate --> malate. This prevents gluconeogenesis and leads to hypo-
glycemia
3. Glyceraldehyde-3-phosphate --> glycerol 3- phosphate and combines with fatty
acids to form triglycerides in the liver, known as hepatosteatosis
4. Decreases citric acid cycle production of NADH and leads to using Acetyl-CoA for
ketogenesis and lipogenesis
3. What can Reactive Oxygen Species cause?
Answer Heart disease, Alzheimers, Parkinsons, Amyotrophic Lateral Sclerosis
(ALS), CV disease, HTN, HLD, DM, ischemic heart disease, HF, OSA. Lipid
perioxidation, damage proteins, fragment DNA, less *protein synthesis*, chromatin
destruction, damage mitochondria
4. What is the body's defense against ROS?
,Answer Antioxidants (Vitamin E, Vitamin C, cysteine, glutathione, albumin,
ceruloplasmin, transferrin)
5. How are free radicals produced?
Answer 1. Normal cellular respiration
2. Absorption of extreme energy sources (radiation, UV light)
3. Metabolism of exogenous chemicals, drugs, and pesticides
4. Transition of metals
5. Nitric oxide acting like a chemical mediator and a free radical
6. action potential
Answer Process of conducting an impulse. Activates the neuron --> the neuron
depolarizes --> then repolarizes
7. Threshold potential
Answer Point at which depolarization must reach in order to initiate an action
potential
8. Hypokalemia and action potentials
Answer HYPERpolarized (more negative, ex.
-100). Less excitable. Decreased neuromuscular excitability
weakness, smooth muscle atony, paresthesia, cardiac dysrhythmias
9. Hyperkalemia and action potentials
,Answer HYPOpolarized (more positive, ex
closer to 0). More excitable. Peaked T waves.
When resting membrane potential=threshold potential, it is BAD = cardiac standstill,
paresthesia, paralysis
10. Hypocalcemia and action potentials
Answer Increased permeability to Na+. More excitable. Tetany, hyperreflexia,
circumoral paresthesia, seizures, dysrhythmias.
11. Hypercalcemia and action potentials
Answer Decreased permeability to Na+. Less excitable. Weakness, hyporeflexia,
fatigue, lethargy, confusion, encephalopathy, depressed T waves
12. Atrophy
Answer Occurs as a result of decrease in work load, pressure, use, blood supply,
nutrition, hormonal stimulation, or nervous stimulation. Once the cell has
,decreased in size, it has now compensated for decreased blood supply, nerve supply,
nutrient supply, hormonal supply, and has achieved new homeostasis. Cells are alive bu
have diminished function and may lead to cellular death.
13. Atrophy examples
Answer Physiologic atrophy- shrinking of the thymus gland during childhood.
Disuse atrophy- someone that ends up being paralyzed
14. Hypertrophy
Answer Increase in SIZE of cells, which will lead to increase in size of organ.
Caused by hormonal stimulation or increased functional demand.
15. Hypertrophy examples
Answer physiologic hypertrophy- skeletal hypertrophy when a person does heavy
work or weight lifting / when a kidney is surgically removed, the other kidney
increases in size
pathologic hypertrophy- cardiomegaly results from an increased workload in hyper-
tensive patients / *left ventricular hypertrophy*
16. Hyperplasia
Answer Increase in NUMBER of cells. Results from increased rate of mitosis. Can
ONLY happen in cells that are capable of mitosis (cell division).
17. Hyperplasia examples
,Answer 1. Thickening of skin because of hyperplasia of epider- mal cells.
2. Hormonal hyperplasia- occurs in estrogen dependent organs like uterus and
breast.
3. Compensatory hyperplasia- liver regenerates, callus on skin
4. Pathologic hyperplasia- estrogen is unopposed by progesterone and the endome-
trial lining undergoes hyperplasia and increased risk for endometrial cancer
18. Dysplasia
Answer abnormal changes in the size, shape, and organization of mature cells due
to persistent, severe cell injury or irritation
19. Dysplasia examples
Answer Pre cancer pap smears often show dysplastic cells of the cervix that must
undergo treatment.
20. Metaplasia
Answer Changed cell that is REVERSIBLE (one cell is replaced by another cell).
Exposure to chronic stressors, injury or irritation, like smoking or hydrochloric acid
from heart burn
21. Metaplasia examples
Answer Most common is change from columnar cells to squa- mous cells (chronic
smokers).
,Less common is change from squamous to columnar cells, like in Barrett Esophagus
caused by heart burn.
22. Carcinoma in situ
Answer Pre-invasive epithelial malignant tumors of glandular or squamous origin.
Sites including cervix, skin, oral cavity, esophagus, and bronchus
23. Hypoxic injury
Answer 1. Decrease in oxygen in the air (high altitudes, asphyxiation, drowning)
2. Loss of hemoglobin function (hemorrhage or sickle cell anemia)
3. Decrease in production of red blood cells (anemia or leukemia)
,4. Diseases of cardiopulmonary systems (ischemia, blood supply loss, arterioscle-
rosis)
24. Hypoxic injury clinical manifestations
Answer 1. Increased CK (muscle and heart)
2. Increased LDH (muscle, liver, lung, heart, RBC, brain)
3. Increased ALT and AST (liver)
4. Increased troponin (heart)
25. Reperfusion injury
Answer Oxygen supply is restored to ischemic tissues. Triggers oxygen
intermediates which causes cell membrane damage and mitochondrial calcium
overload.
Xanthine dehydrogenase --> xanthine oxidate. This makes large amounts of free
radicals, superoxide, and hydrogen peroxide. Causes cell membrane damage and
*mitochondrial calcium overload*
26. Reperfusion injury clinical manifestations
Answer White blood cell count is impaired. Seen in tissue transplantation, ischemic
syndromes of the heart, liver, intestines, kidneys, and cerebrum.
27. Free Radical
, Answer Molecules that have an unpaired electron on its outer shell. This makes the
molecule unstable.
Cause cellular injury, aging, and disease to occur.
28. Reactive Oxygen Species (ROS)
Answer Produced as a normal byproduct of ATP production in mitochondria. ROS
can overwhelm the mitochondria and exhaust intracellular antioxidants. Also
produced by absorption of high energy sources like radiation or UV light.
29. Ethanol
Answer Acute affects in the liver include inflammation, fatty infiltration, he-
patomegaly, acute liver necrosis, suppressed fatty acid oxidation. Chronic ethanol
use is mainly seen in the stomach and liver, and is caused by free radicals.
*Elevated anion gap and osmolar gap >10 is diagnostic*
30. Infarct
Answer Form of necrosis that is a SUDDEN insufficiency of arterial blood flow. (ie
Answer heart attack, cold leg, MI)
31. Apoptosis
Answer Programmed cell death (normal). Needed to prevent cellular prolif- eration
that would result in a large body.
1. Ovarian cancer site of metastasis?
Answer Peritoneal surfaces, omentum (fold of peritoneum connecting the
stomach with other abdominal organs), *liver*
2. The increased NADH/NAD+ ratio in the liver from ethanol causes
Answer 1. Pyru- vate --> lactic acid, causing lactic acidosis
2. Oxaloacetate --> malate. This prevents gluconeogenesis and leads to hypo-
glycemia
3. Glyceraldehyde-3-phosphate --> glycerol 3- phosphate and combines with fatty
acids to form triglycerides in the liver, known as hepatosteatosis
4. Decreases citric acid cycle production of NADH and leads to using Acetyl-CoA for
ketogenesis and lipogenesis
3. What can Reactive Oxygen Species cause?
Answer Heart disease, Alzheimers, Parkinsons, Amyotrophic Lateral Sclerosis
(ALS), CV disease, HTN, HLD, DM, ischemic heart disease, HF, OSA. Lipid
perioxidation, damage proteins, fragment DNA, less *protein synthesis*, chromatin
destruction, damage mitochondria
4. What is the body's defense against ROS?
,Answer Antioxidants (Vitamin E, Vitamin C, cysteine, glutathione, albumin,
ceruloplasmin, transferrin)
5. How are free radicals produced?
Answer 1. Normal cellular respiration
2. Absorption of extreme energy sources (radiation, UV light)
3. Metabolism of exogenous chemicals, drugs, and pesticides
4. Transition of metals
5. Nitric oxide acting like a chemical mediator and a free radical
6. action potential
Answer Process of conducting an impulse. Activates the neuron --> the neuron
depolarizes --> then repolarizes
7. Threshold potential
Answer Point at which depolarization must reach in order to initiate an action
potential
8. Hypokalemia and action potentials
Answer HYPERpolarized (more negative, ex.
-100). Less excitable. Decreased neuromuscular excitability
weakness, smooth muscle atony, paresthesia, cardiac dysrhythmias
9. Hyperkalemia and action potentials
,Answer HYPOpolarized (more positive, ex
closer to 0). More excitable. Peaked T waves.
When resting membrane potential=threshold potential, it is BAD = cardiac standstill,
paresthesia, paralysis
10. Hypocalcemia and action potentials
Answer Increased permeability to Na+. More excitable. Tetany, hyperreflexia,
circumoral paresthesia, seizures, dysrhythmias.
11. Hypercalcemia and action potentials
Answer Decreased permeability to Na+. Less excitable. Weakness, hyporeflexia,
fatigue, lethargy, confusion, encephalopathy, depressed T waves
12. Atrophy
Answer Occurs as a result of decrease in work load, pressure, use, blood supply,
nutrition, hormonal stimulation, or nervous stimulation. Once the cell has
,decreased in size, it has now compensated for decreased blood supply, nerve supply,
nutrient supply, hormonal supply, and has achieved new homeostasis. Cells are alive bu
have diminished function and may lead to cellular death.
13. Atrophy examples
Answer Physiologic atrophy- shrinking of the thymus gland during childhood.
Disuse atrophy- someone that ends up being paralyzed
14. Hypertrophy
Answer Increase in SIZE of cells, which will lead to increase in size of organ.
Caused by hormonal stimulation or increased functional demand.
15. Hypertrophy examples
Answer physiologic hypertrophy- skeletal hypertrophy when a person does heavy
work or weight lifting / when a kidney is surgically removed, the other kidney
increases in size
pathologic hypertrophy- cardiomegaly results from an increased workload in hyper-
tensive patients / *left ventricular hypertrophy*
16. Hyperplasia
Answer Increase in NUMBER of cells. Results from increased rate of mitosis. Can
ONLY happen in cells that are capable of mitosis (cell division).
17. Hyperplasia examples
,Answer 1. Thickening of skin because of hyperplasia of epider- mal cells.
2. Hormonal hyperplasia- occurs in estrogen dependent organs like uterus and
breast.
3. Compensatory hyperplasia- liver regenerates, callus on skin
4. Pathologic hyperplasia- estrogen is unopposed by progesterone and the endome-
trial lining undergoes hyperplasia and increased risk for endometrial cancer
18. Dysplasia
Answer abnormal changes in the size, shape, and organization of mature cells due
to persistent, severe cell injury or irritation
19. Dysplasia examples
Answer Pre cancer pap smears often show dysplastic cells of the cervix that must
undergo treatment.
20. Metaplasia
Answer Changed cell that is REVERSIBLE (one cell is replaced by another cell).
Exposure to chronic stressors, injury or irritation, like smoking or hydrochloric acid
from heart burn
21. Metaplasia examples
Answer Most common is change from columnar cells to squa- mous cells (chronic
smokers).
,Less common is change from squamous to columnar cells, like in Barrett Esophagus
caused by heart burn.
22. Carcinoma in situ
Answer Pre-invasive epithelial malignant tumors of glandular or squamous origin.
Sites including cervix, skin, oral cavity, esophagus, and bronchus
23. Hypoxic injury
Answer 1. Decrease in oxygen in the air (high altitudes, asphyxiation, drowning)
2. Loss of hemoglobin function (hemorrhage or sickle cell anemia)
3. Decrease in production of red blood cells (anemia or leukemia)
,4. Diseases of cardiopulmonary systems (ischemia, blood supply loss, arterioscle-
rosis)
24. Hypoxic injury clinical manifestations
Answer 1. Increased CK (muscle and heart)
2. Increased LDH (muscle, liver, lung, heart, RBC, brain)
3. Increased ALT and AST (liver)
4. Increased troponin (heart)
25. Reperfusion injury
Answer Oxygen supply is restored to ischemic tissues. Triggers oxygen
intermediates which causes cell membrane damage and mitochondrial calcium
overload.
Xanthine dehydrogenase --> xanthine oxidate. This makes large amounts of free
radicals, superoxide, and hydrogen peroxide. Causes cell membrane damage and
*mitochondrial calcium overload*
26. Reperfusion injury clinical manifestations
Answer White blood cell count is impaired. Seen in tissue transplantation, ischemic
syndromes of the heart, liver, intestines, kidneys, and cerebrum.
27. Free Radical
, Answer Molecules that have an unpaired electron on its outer shell. This makes the
molecule unstable.
Cause cellular injury, aging, and disease to occur.
28. Reactive Oxygen Species (ROS)
Answer Produced as a normal byproduct of ATP production in mitochondria. ROS
can overwhelm the mitochondria and exhaust intracellular antioxidants. Also
produced by absorption of high energy sources like radiation or UV light.
29. Ethanol
Answer Acute affects in the liver include inflammation, fatty infiltration, he-
patomegaly, acute liver necrosis, suppressed fatty acid oxidation. Chronic ethanol
use is mainly seen in the stomach and liver, and is caused by free radicals.
*Elevated anion gap and osmolar gap >10 is diagnostic*
30. Infarct
Answer Form of necrosis that is a SUDDEN insufficiency of arterial blood flow. (ie
Answer heart attack, cold leg, MI)
31. Apoptosis
Answer Programmed cell death (normal). Needed to prevent cellular prolif- eration
that would result in a large body.
