ADVANCED PATHO NURS 5315 UTA EXAM 1

ADVANCED PATHO NURS 5315 UTA EXAM 1 QUESTIONS & VERIFIED CORRECT ANSWERS UPDATED & ALREADY PASSED!! "In order for the action potential to be sucessful - CORRECT ANSWER t has to depolarize by 15-20 mV (threshold potential) to reach -55 to -65 mV." "An alteration in action potential may result from - CORRECT ANSWER neurologic diseases, muscle disease or electrolyte imbalances." "What is the main protein responsible for maintaining the correct balance of extracellular Na and intracellular K, which is needed for cellular excitation and membrane conductivity. - CORRECT ANSWER Na+-K+ ATPase" "Resting membrane potential - CORRECT ANSWER when the cell is in a nonexcited state and is at -70 to -85 mV." "Refractory Period - CORRECT ANSWER is a period of time during most of the action potential which the cell membrane resists stimulation and it cannot depolarize" "Physiologic Example of Hyperplasia - CORRECT ANSWER -Occurs when there is an increase in tissue mass after damage or partial resection, allowing the organ to regenerate Ex - removal of part of the liver and the cells regenerating, uterine and mammary gland enlargement occur during pregnancy to meet the demands of the increased work load, callus on foot Ex: (Hormonal) Breast and uterine enlargement during pregnancy." "Pathological Example of Hyperplasia - CORRECT ANSWER -Is an abnormal proliferation of normal cells usually caused by increased hormonal stimulation Ex - endometrial hyperplasia (imbalnce in estrogen & progesterone with increase in estrogen - risk for cancer), Benign prostatic hyperplasia (BPH), thyroid enlargement - thyroid goiters" "Pathological Example of Hypertrophy - CORRECT ANSWER left ventricular hypertrophy cardiomegaly" "Physiological Example of Hypertrophy - CORRECT ANSWER Skeletal muscle, when a kidney is removed and the other kidney steps in to function as both and increases in size" "Physiological Example of Atrophy - CORRECT ANSWER Shrinking of the thymus gland during childhood, uterus decreasing in size after childbirth Disuse - skeletal muscle atrophy that occurs from a person being immobilized or bed ridden for a period of time (arm in a cast," "Pathological Example of Atrophy - CORRECT ANSWER Decrease in workload, pressure, use, blood supply, nutrition, hormonal stimulation, or nervous stimulation" "Cellular Injury - CORRECT ANSWER -Occurs when the cell is no longer able to maintain homeostasis with the result being disease. May or may not be reversible. This is dependent on the type of cell, level of differentiation, ability to adapt and the type, severity and duration of the injury." "Reactive Oxygen Species (ROS) - CORRECT ANSWER -Chemically reactive molecules from molecular oxygen formed as natural oxidant species in cells during mitochondrial respiration & energy generation. -This form of injury is called oxidative stress" "Cellular Effect on Necrosis - CORRECT ANSWER -Characterized by rapid loss of plasma membrane structure, organelle swelling, mitochondrial dysfunction. Leads to local cell death and autolysis. Outcome for common injuries (ischemia, toxin exposure, infections, trauma). Swelling, accidental cell death Cell Size - Swelling Nucleus - Pyknosis, karyorrhexis, Karyolysis Plasma Membrane -Disrupted Cellular Contents - Enzymatic digestion; may leak out of cell Adjacent inflammation - Frequent Physiologic or pathologic role - usually pathologic (culmination of irreversible cell injury)" "Cellular Effect on Apoptosis - CORRECT ANSWER -Regulated/programmed cell process, "dropping off" of cellular fragments (apoptotic bodies). Reduced (shrinking), plasma membrane intact Cell Size - Shrinking Nucleus - Fragmentation into nucleosome-size fragments Plasma Membrane - Intact; altered structure, especially orientation of lipids Cellular Contents - Intact; may be released in apoptotic bodies Adjacent inflammation - No Physiologic or pathologic role - often physiologic, means of eliminating unwanted cells; may be pathologic after some forms of cell injury, especially DNA damage" "Adeno refers to - CORRECT ANSWER the glandular epithelial tissue (deeper epithelial tissue or glands)" "Carcino- - CORRECT ANSWER Cancer arising in the epithelial tissue" "Sarco- - CORRECT ANSWER Cancers arising from mesenchymal tissue (connective tissue, muscle, bone)" "Oma- - CORRECT ANSWER Tumor or Mass Ex: lipoma" "Carcinoma in Situ - CORRECT ANSWER Very early and preinvasive carcinoma of the glandular or squamous epithelial tissue, it has not broken through the basement membrane" "-blastoma - CORRECT ANSWER Malignant tumors of nervous tissues are based on the nerve cell type" "Site of Metastasis for Lung Cancer - CORRECT ANSWER Multiple organs including brain, adrenal glands" "Site of Metastasis for Colorectal Cancer - CORRECT ANSWER Liver, Lungs" "Site of Metastasis for Testicular Cancer - CORRECT ANSWER Liver, Lungs, Brain" "Site of Metastasis for Prostate Cancer - CORRECT ANSWER Bones - especially lumbar vertebrae, Liver" "Site of Metastasis for Breast Cancer - CORRECT ANSWER Bones, Liver, Lung, Brain" "Site of Metastasis for Head and Neck Cancer - CORRECT ANSWER Lymphatics, Liver, Bones" "Site of Metastasis for Ovarian Cancer - CORRECT ANSWER Peritoneal Surfaces, Diaphragm, Omentum, Liver" "Site of Metastasis for Sarcoma Cancer - CORRECT ANSWER Lungs" "Site of Metastasis for Melanoma - CORRECT ANSWER Lymphatics, Lung, Liver, Brain, GI Tract" "Metastasis - CORRECT ANSWER is the spread of cancer cells from the site of original tumor to distant tissues and organs through the body." "Metastasis occurs when - CORRECT ANSWER the tumor environment has changed to allow for the transposition of the cancer cells" "Epithelial mesenchymal transition (EMT) - CORRECT ANSWER process by which a cancer cells changes to one which can metastasize" "IL-8 - CORRECT ANSWER is a potent stimulus for cancer cells to undergo EMT" "TNM - CORRECT ANSWER Tumor spread Node Involvement Presence of Distant Metastasis" "Autocrine stimulation - CORRECT ANSWER Oncogenes provide a cancer cell with the ability to secrete growth factors that stimulate their own growth which is known as" "Genetic Events that activate oncogenes - CORRECT ANSWER point mutations, translocations, gene amplification" "Oncogenes - CORRECT ANSWER -Proto-oncogenes produce proteins that regulate cellular proliferation -These are proto-oncogenes that have mutated -Cancer cells contain these" "Tumor Suppressor Genes - CORRECT ANSWER -inactivation contributes to the unregulated growth and proliferation of cancer cells -Stop cell division in damaged cells & prevent mutations" "Known as anti-oncogenes - CORRECT ANSWER Tumor Suppressor Genes *2 of these genes in each cell must be turned off by the cancer to halt their effects" "P53 Tumor Suppressor Gene - CORRECT ANSWER -monitors cellular stress and activating caretaker genes, maintain integrity of the genome. -Produces proteins that repair damaged or mutated DNA. Controls initiation of cellular senescence (stop cell division), apoptosis, and suppresses cell division until DNA is repaired" "BRCA gown increases the risk of - CORRECT ANSWER ovarian, breast, and prostate cancer" "BRCA gene in men increases risk of - CORRECT ANSWER prostate, melanoma, colon, pancreatic, breast cancer" "Paraneoplastic Syndromes - CORRECT ANSWER -Are a constellation of symptoms which are ignited by cancer but are not caused by direct local effects of tumor mass -Typically triggered by the release of substances from a tumor" "These patients have an increase in apoptosis and impaired ability to regenerate cells - CORRECT ANSWER Cachexia" "Is a catabolic process and results in a wasting syndrome - CORRECT ANSWER Cachexia" "S/S of Cachexia - CORRECT ANSWER -Loss of appetite, cardiac atrophy and dysfunction, gut barrier dysfunction, the release of proinflammatory mediators, release of acute thermogenesis, weight loss and muscle wasting" "Na is important in maintaining - CORRECT ANSWER -Neuromuscular Nerve Impulse Conduction -Acid Base Balance -Cellular Chemical Processes -Cell Membrane Transport Systems" "Sodium is regulated by - CORRECT ANSWER ADH, RAAS, Kidneys" "Hydrostatic Pressure - CORRECT ANSWER Force within a fluid compartment - the mechanical force of fluid against the walls of a compartment (blood pressure)" "Oncotic Pressure - CORRECT ANSWER Force that helps to keep water/fluid in a compartment Contributes to osmotic pressure and exerted by plasma proteins (Albumin is the main plasma protein)." "Effective Arterial Blood Volume - CORRECT ANSWER -Amount of blood within arterial space which perfuses organs and tissues. -Volume changes in the extracellular fluid compartment will cause changes to this" "Antidiuretic Hormone (ADH) - CORRECT ANSWER Secreted by pituitary gland d/t water deficit, sodium excess or ↓ BP Causes kidneys to reabsorb water to ↑ plasma volume" "renin-angiotensin-aldosterone system (RAAS) - CORRECT ANSWER Activated by low blood volume (BV) -> Triggers release of renin -> Renin converts angiotensinogen (plasma protein) to angiotensin I -> ACE convert angiotensin I to angiotensin II -> Angiotensin II causes arterial VC -> release of aldosterone -> stimulates renal Na reabsorption and K excretion. Water is retained with the Na ->Patient produces less urine and BV ↑." "Natriuretic Hormone - CORRECT ANSWER Hormones released from the atria or ventricles of the heart -Work opposite of RAAS to ↓ BV -Promote urinary excretion of Na and water -> ↓ BV -Ex: ANP and BNP" "Urea - CORRECT ANSWER is a solute that freely diffuses through cell membranes but has NO effect on osmolality!" "Isotonic - CORRECT ANSWER Has the same osmolality or concentration of particles as the ICF and ECF Ex: NS, D5W" "Hypotonic - CORRECT ANSWER Will cause intravascular space to become more dilute =↓ solute concentration -> ↓ osmolality Water will move from intravascular space to extracellular space -> dilution of extracellular space -> water will move to intracellular space -> cell will swell. Ex: water" "Hypertonic - CORRECT ANSWER Will ↑ solute concentration in the intravascular space =↑ osmolality Water will flow into intravascular space from extracellular space -> extracellular space will have more solutes -> water to move from intracellular space to extracellular space -> cell will shrink. Ex: 3% saline" "Diffusion - CORRECT ANSWER Movement of solute molecule from an area of great solute concentration to an area of lesser solute concentration" "Mechanisms to maintain acid-base balance - CORRECT ANSWER -Physiologic (chemical) buffer systems (plasma carbonate, phosphate, hemoglobin, and protein) - 1st line of defense -Respiratory acid-base control - 2nd line of defense -Renal acid-base control - 3rd line of defense" "Chemical Buffer System - CORRECT ANSWER Bicarbonate Phosphate Plasma Proteins Hemoglobin" "Metabolic Acids - CORRECT ANSWER Carbonic Acid Lactic Acid Sulfuric Acid Phosphoric Acid Ketone Bodies" "Carbonic Acid - CORRECT ANSWER H2CO3 Is a byproduct of aerobic metabolism" "Lactic Acid - CORRECT ANSWER Byproduct of anaerobic metabolism of glucose" "Sulfuric Acid - CORRECT ANSWER Results from oxidation of sulfur containing aminoacids" "Phosphoric Acid - CORRECT ANSWER Results from metabolism of phosphoproteins and ribonucleotides which are used as an energy source" "Ketone Bodies - CORRECT ANSWER Acids that result from breakdown of fats" "pH - CORRECT ANSWER -Is the measure of the body alkalinity and acidity. -The value is inversely proportional to the concentration of hydrogen ions in the blood." "Total Body Weight decreases as we age due to - CORRECT ANSWER -Increase in body fat -Decrease in muscle mass -Decrease in ability to regulate sodium and water balance -Decrease in renal function -Elderly are very susceptible to dehydration d/t increased insensible water loss" "PCO2 - CORRECT ANSWER -Measures the partial pressure of arterial CO2 in the blood (dissolved in the blood) and reflects ventilation. -The higher this level is, the faster the respirations are and vice versa." "HCO3 - CORRECT ANSWER -Is a direct measurement of the amount of bicarbonate in the blood. -It reflects the metabolic component of acid base balances, specifically the kidney." "PaO2 - CORRECT ANSWER Is a measure of the partial pressure of arterial O2, which is the amount of oxygen content that is dissolved in the arterial blood." "Base Excess/Deficit - CORRECT ANSWER -Is a value which is calculated from the pH, PCO2, and the hematocrit. -It represents the amount of anions available for buffering." "A negative base excess represents - CORRECT ANSWER metabolic acidosis" "A positive base excess represents - CORRECT ANSWER metabolic alkalosis or compensation for respiratory acidosis" "Clinical Manifestations of Respiratory Acidosis - CORRECT ANSWER Hypercalcemia, Hyperkalemia, Vasodilation, tremors, disorientation, restlessness, muscle twitching, and seizures, H/A, blurred vision, hypotension" "Respiratory Alkalosis - CORRECT ANSWER Results from a deficiency of PaCO2. Occurs when there is an increase in alveolar hyperventilation - lungs are blowing off too much CO2." "Clinical Manifestations of Respiratory Alkalosis - CORRECT ANSWER Irritating to the CNS and PNS - neuro s/s: dizziness, confusion, paresthesia's, seizures, and coma" "Causes of Respiratory Alkalosis - CORRECT ANSWER Hypoxemia, pulmonary embolism, congestive heart failure, high altitudes, fever, gm negative sepsis, or severe anemia, psychogenic hyperventilation, hepatic failure, salicylate overdose, drugs such as catecholamines, methylphenidate3, nicotine, progesterone, or mechanical ventilation." "Genotype - CORRECT ANSWER is a persons genetic composition Actual genes specific to the individual" "Phenotype - CORRECT ANSWER Expression of the gene is a persons observable characteristics" "Carrier - CORRECT ANSWER is a person who has a diseased gene but is phenotypically normal" "Will a person carrying a recessive diseased allele have s/s of disease - CORRECT ANSWER No" "DNA is composed of - CORRECT ANSWER nucleotides (adenine, thymine, guanine, cytosine)" "What is the difference is DNA and RNA - CORRECT ANSWER RNA contains uracil instead of thyamine" "Translation - CORRECT ANSWER process of protein synthesis" "Transcription - CORRECT ANSWER process where RNA is formed from DNA and requires the RNA enzyme polymerase" "Autosomal Chromosomes - CORRECT ANSWER all chromosomes which do not have any relation to gender" "Clastogens - CORRECT ANSWER harmful agents which damage chromosomes Ex: radiation" "Polyploidy - CORRECT ANSWER State of having 1/more extra sets of chromosome pairs. E.g. 3 sets of chromosomes, incompatible with life, fetuses are often miscarried." "Aneuploidy - CORRECT ANSWER Alteration in chromosomal number Results in a Single missing or one extra chromosome. Caused by nondisjunction, failure of chromosomes to divide properly. Uneven number of chromosomes, most are spontaneously aborted. Two main types: monosomy & trisomy" "Monosomy - CORRECT ANSWER state of having one chromosome in a pair missing Ex: Turner Syndrome" "Trisomy - CORRECT ANSWER state of having more than two chromosomes to a pair Ex: Down Syndrome (3 chromosomes)" "Autosomal Aneuploidy - CORRECT ANSWER Disorders linked to the first 22 same pair of chromosomes. Ex: Down syndrome - 3 chromosomes on 21st pair" "Sex Chromosome Aneuploidy - CORRECT ANSWER Sex linked chromosome disorder (23rd chromosome) Klinefelter's syndrome - xxx/y" "Deletion - CORRECT ANSWER Chromosomes broken & DNA is lost. Ex: Cri du chat "cry of the cat" disorder of chromosomal deletion. Distinct cry of the baby, developmental delays, low birth weight, mental retardation, heart defects, & missing kidneys." "Inversions - CORRECT ANSWER 2 breaks of chromosome followed by reinsertion of missing fragment at original site, but inverted. ABCDE would be ABDCE. No apparent physical effect; but off spring may have genetic issues (chromosomal deletions or duplications)." "Translocation - CORRECT ANSWER an exchange of genetic material btwn non- homologous chromosomes. Usually no physical problems, but offspring can have genetic problems." "Reciprocal Translocation - CORRECT ANSWER When breaks take place in 2 different chromosomes & the material is exchanged. Carrier's gametes can be normal, carry the translocation, or have duplications & deletion." "Fragile Sites - CORRECT ANSWER When chromosomes develop microscopically observable breaks & gaps d/t cultured in folate deficient medium. No apparent relationship to disease. Except fragile X syndrome - substantial cognitive impartment" "Locus - CORRECT ANSWER position along a chromosome" "Polymorphic - CORRECT ANSWER occurring in several different forms" "Polymorphism - CORRECT ANSWER presence of genetic variation within a population" "Homozygous - CORRECT ANSWER when the genotypes of two alleles are identical for a particular trait Ex: two dominant or two recessive alleles (EE or ee)" "Alleles - CORRECT ANSWER paired genes. one dominant/one recessive" "Heterozygous - CORRECT ANSWER when a dominant and recessive allele are present Ee" "Recessive - CORRECT ANSWER both alleles must be recessive, and both alleles must be affected by the mutation (for the person to actually have the disease) if only one , then they are a carrier and will not manifest the disease" "Homozygote - CORRECT ANSWER for a recessive allele to be expressed, it must be homozygote aa" "Codominance - CORRECT ANSWER herozygote that are both dominate, ABO blood group" "Sex linked chromosome - CORRECT ANSWER the 23rd chromosome that determines sex" "Autosomal Chromosomes - CORRECT ANSWER the first 22 chromosomes" "Recessive Allele - CORRECT ANSWER Cystic fibrosis, 1/25 Caucasians are carriers." "Dominant Allele - CORRECT ANSWER Huntinton's disease" "Sex Limited Trait - CORRECT ANSWER one that can occur in only one of the sexes, often because of anatomic differences. Uterine & testicular defects." "Sex influenced trait - CORRECT ANSWER occurs much more often in one sex than the other. Male pattern baldness, breast cancer." "Difference in the transmission of autosomal and sex linked genetic diseases - CORRECT ANSWER sex linked - recessive traits males are more affected autosomal - both sexes have equal chances of being affected" “Steps of the Action Potential - CORRECT ANSWER Depolarization Repolarization Hyperpolarization" "Depolarization - CORRECT ANSWER movement of the intracellular charge towards zero (more positive charge) Voltage gated Na channels open and allow Na to enter the cell -> voltage inside the cell moves towards zero" "Repolarization - CORRECT ANSWER Once the intracellular charge reaches zero, the negative polarity of the inside of the cell is restored back to its baseline of -70 to -85 mV -Na channels close, K channels open" "Hyperpolarization - CORRECT ANSWER when the cell's resting membrane potential is greater than -85mV. Is less excitable, because there is a greater distance between the resting membrane potential and the threshold potential." "Absolute refractory period - CORRECT ANSWER occurs when the membrane will not respond to ANY stimulus no matter how strong." "Relative Refractory Period - CORRECT ANSWER occurs when the membrane is repolarizing and will only respond to a very strong stimulus." "Hyperpolarized - CORRECT ANSWER when the cell's resting membrane potential is greater than -85mV. Is less excitable, because there is a greater distance between the resting membrane potential and the threshold potential." "Hypopolarized - CORRECT ANSWER when the cell's resting membrane potential is closer to zero, for instance it is -65mV. Is more excitable because the resting membrane potential is closer to the threshold potential, there is less distance between them." "Action potential altered by hypokalemia - CORRECT ANSWER (serum outside of cell is low) -Hyperpolarized (cell becomes more negative, ex: -100) -Affects the resting membrane potential of cells -The cell is less likely to depolarize and transmit impulses Can cause a decrease in neuromuscular excitability and leads to weakness, smooth muscle atony, paresthesias, and cardiac dysrhythmias" "Action potential altered by hyperkalemia - CORRECT ANSWER Hypopolarized -Also has an effect on the resting membrane potential -If the ECF potassium increases without any change in the ICF potassium levels, the resting membrane potential of the cell becomes more positive. -The cells are more excitable and conduct impulses more easily and more quickly because the resting membrane potential is closer to the threshold potential. Therefore, the person will have peak T waves on EKG. -As potassium rises, the resting membrane potential will continue to become more positive and it will eventually become equal to the threshold potential. As this happens the EKG will show a widening QRS complex. If the resting membrane potential equals the threshold potential, an action potential will not be generated and cardiac standstill will occur. Paralysis and paresthesias may also occur." "Action potential altered by hypocalcemia - CORRECT ANSWER -Causes an increase in the cell permeability to Na causing a progressive depolarization -Causes the RMP and the TP to be closer to one another & making it easier to initiate an action potential - the cells are more excitable. -Results in tetany, hyperreflexia, circumoral paresthesias, seizures, dysrhythmias" "Action potential altered by hypercalcemia - CORRECT ANSWER -Causes a decrease in cell permeability to Na -Causes the RMP and the TP to increase in distance - the cells are less excitable and requires more of a stimulus to initiate an action potential. -Leads to weakness, hyporeflexia, fatigue, lethargy, confusion, encephalopathy, a shortened QT segment and depressed widened T waves on EKG." "Atrophy - CORRECT ANSWER decrease or shrinkage in the size of the cell -Imbalance between protein synthesis and degradation, , reduction of the intracellular contents, also includes a self-eating process called autophagy. -Example: aging brain cells, malnutrition, uterus decreasing in size after childbirth" "Hypertrophy - CORRECT ANSWER increase in the size of cells, which ultimately increases the size of the organ -Etiology: triggers include repetitive stretching, chronic pressure, volume overload -Pathophysiology: hormonal stimulation or increased functional demand, which increases the cellular protein in the plasma membrane, endoplasmic reticulum, myofilaments, and mitochondria" "Hyperplasia - CORRECT ANSWER -increase in number of cells, not the size of the cell, which results from an increased rate of cell division, it can only happen in cells that are capable of mitosis * -Etiology: results from the production of growth factors which stimulate cells to produce new cellular contents and divide" "Dysplasia - CORRECT ANSWER -abnormal changes in the size, shape, and organization of mature cells due to persistent, severe cell injury or irritation -Disordered cell growth and is mainly found in epithelial tissue of the uterine cervix, the endometrium, GI and respiratory tract mucosa, -Ex: pap smears often show dysplastic cells of the cervix, uterine cells" "Referred to as atypical hyperplasia - CORRECT ANSWER dysplasia - abnormal changes in size, shape, and organization of mature cells due to persistent, severe cell injury or irritation" "Metaplasia - CORRECT ANSWER -reversible change in which one adult cell is replaced by another adult cell -Etiology: found in tissue damage, repair, and regeneration -Results from the exposure of the cells to chronic stressors, injury, or irritation. If the influences that cause the cellular changes remain present, they can induce a malignant change in the cells -Ex: most common is the change from columnar cells to squamous cells - this occurs in chronic smokers or gastroesophageal reflux (GERD)" "Causes of cellular injury - CORRECT ANSWER hypoxia, free radicals, chemicals, radiation, direct mechanical trauma, genetics, nutrition, infections, immunologic reactions and inflammation." "Mechanisms of Cellular Injury - CORRECT ANSWER -ATP Depletion -Oxygen and Oxygen derived free radicals -Intracellular Calcium and loss of calcium steady state" "Cellular Injury (partially ischemia) triggers an increase in - CORRECT ANSWER Iintracellular calcium -The more damage which is done, the higher the calcium concentration becomes. The elevated calcium level causes damage to the cell membrane. It also causes damage to the intracellular contents by activating enzymes which cause the damage directly." "ATP Depletion - CORRECT ANSWER results from the loss of mitochondrial production of ATP. This contributes to cellular swelling, decreased protein synthesis, and impairs cellular membrane transport systems. All of these changes impair cellular membrane integrity." "Oxygen and Oxygen derived free radicals - CORRECT ANSWER decrease oxygen delivery to cells results in the production of activated oxygen species (free radicals, H2O2, NO) which destroy the cell membranes and structures." "Most common cause of cellular injury - CORRECT ANSWER Hypoxic Injury" "Clinical Manifestations of Hypoxic Injury - CORRECT ANSWER Reduced ischemia, loss of hemoglobin, diseases, etc. Heart attack, etc" "Pathophysiology of Hypoxic Injury - CORRECT ANSWER Ischemia - ↓ mitochondrial oxygenation, ↓ATP, Na-K & Na-Ca pumps fail -> ↑ intracellular Na & Ca -> K to diffuse out of cell -> acute cellular swelling (from ↑ Na in cell), anaerobic glycolysis, ↑Lactate, necrosis" "Reperfusion Injury - CORRECT ANSWER Reoxygenation, Tissue transplantation, ischemic syndromes of heart, liver, GI, kidneys, and cerebrum." "Clinical Manifestations of Reperfusion Injury - CORRECT ANSWER Neutrophils especially affected, causing neutrophil adhesion to endothelium Serious complication in transplantation and ischemic diseases" "Patho of Reperfusion Injury - CORRECT ANSWER -Triggers the production of highly reactive oxygen intermediates (hydroxyl radical & hydrogen peroxide -> cell membrane damage & mitochondrial Ca overload). -WBC function is impaired as result of injury. * Xanthine dehydrogenase -> converts to xanthine oxidate -> creates massive amounts of free radicals, superoxide & hydrogen peroxide -> etc... apoptosis" "Free Radical - CORRECT ANSWER Any molecular species capable of independent existence that contains a single unpaired electron in an outer orbit Highly reactive" "Clinical Manifestations of Free Radical - CORRECT ANSWER -Redox reactions in normal metabolic processes (respiration) -Absorption of extreme energy sources (UV light, radiation) -Enzymatic metabolism of exogenous chemicals, drugs, and pesticides -Process of transition metals (iron, copper) (fenton reaction) -Nitric oxide (NO) acting as an important chemical mediator, colorless gas" "Autophagy - CORRECT ANSWER "eating of self" self-destructive process & survival mechanism -When cells are starved/nutrient deprived, autophagic process institutes cannibalizations & recycles digested contents. Maintains cellular metabolism under starvation conditions, remove damaged organelles & misfolded proteins under stress conditions, improves survival of cells During times of metabolic stress, autophagy provides ATP & other macromolecules for energy and cell survival, however as the stress progresses autophagic cell death will occur. When cells lack nutrition, autophagy is triggered. If stress is excessive, autophagic programmed cell death Can suppress & facilitate tumor development Process decelerates" "Body changes occur with aging - CORRECT ANSWER -Thymus atrophy, loss of ova in women, decreased spermatogenesis, decreased gastric emptying -Muscle atrophy/sarcopenia, ↓height, neck, high, & arm circumference -Weight gain occurs up until age 50 in men & 70 in women -Central fat accumulation increases ↑ the risk for insulin resistance & heart disease" "Cellular aging results in - CORRECT ANSWER telomere erosion, DNA damage, epigenetic stress, ROS accumulation, and endoplasmic reticular stress." "Extracellular changes associated with aging - CORRECT ANSWER binding of collagen, ↑ free radical damage, structural changes of fascia, tendons, ligaments, bones, joints, & development of arteriosclerosis. The extracellular matrix is affected by decreased synthesis and increased degradation of collagen. These changes result in dehydration and wrinkling of the skin." "What are the labs that are elevated as we age and are markers of increased risk for morbidity and mortality - CORRECT ANSWER Interleukin 6, Interleukin 1, tumor necrosis factor -alpha and C-reactive protein" "Frailty - CORRECT ANSWER is a condition of vulnerability and debility which occurs after one has experienced a health stressor and has not recovered from it completely" "ETOH in blood metabolizes to - CORRECT ANSWER Acetaldehyde in cytoplasm of cell -> Pyruvate to be changed to LA, Oxaloacetate -> malate, this prevents gluconeogenesis -> fasting hypoglycemia. Also Glyceraldehyde-3-phosphate -> glycerol 3- phosphate combines with fatty acides to form triglycerides -> hepatosteatosis. Also ↓ citric acid cycle production of NADH -> utilization of Acetyl-CoA for ketogenesis -> ketoacidosis & lipogenesis -> hepatosteatosis" "Hepatic Changes in ETOH - CORRECT ANSWER (inflammation, deposition of fat, enlargement of liver, interruption of microtubular transport of proteins & their secretions, ↑ intracellular water, ↓ fatty acid oxidation in mitochondria, ↑ membrane rigidity, development of liver necrosis." "Ketogenesis - CORRECT ANSWER is the formation of ketone bodies and occurs mostly in the mitochondria of the hepatocytes. Occurs as a result of the unavailability of glucose." "Role of the Hepatocytes in Ketogenesis - CORRECT ANSWER The major parenchymal cells in the liver: metabolism, detoxification, and protein synthesis" "Role of the mitochondria in ketogenesis - CORRECT ANSWER Membrane-bound cell organelles (mitochondrion, singular) that generate most of the chemical energy needed to power the cell's biochemical reactions. Chemical energy produced by the mitochondria is stored in a small molecule called adenosine triphosphate (ATP)" "Triggers for ketogenesis - CORRECT ANSWER starvation, lack of glucose" "Effect on oxaloacetate in ketogenesis - CORRECT ANSWER -Is used in gluconeogenesis. During starvation & uncontrolled diabetes, these levels are insufficient bc it is completely used by gluconeogenesis- The depletion of ______________ increases the amount of acetyl-CoA -> acetyl-CoA is processed by hepatocytes -> undergoes transformation to 3 ketone bodies: acetoacetate, acetone, β-hydroxybutyrate = basis for ketoacidosis" "Tumor Markers - CORRECT ANSWER are substances produced by the cancer cells that are found on tumor plasma membranes or in the blood, spinal fluid, or urine. An elevated tumor marker may suggest a specific diagnosis, but it is not used alone as a definitive diagnosis test." "Alpha Fetoprotein (AFP) tumor marker can be found in - CORRECT ANSWER liver or germ cell cancers" "Carcinoembryonic Antigen (CEA) tumor marker can be found in - CORRECT ANSWER GI, Pancreatic, Lung, and Breast cancers" "Beta Human Chorionic Gonadotropin (Beta HCG) tumor marker can be found in - CORRECT ANSWER germ cell cancers or choriocarcinoma" "Prostate Specific Antigen (PSA) tumor marker can be found in - CORRECT ANSWER prostate cancer" "Benign Tumors - CORRECT ANSWER a nonmalignant new growths, slow growing, do not spread locally or to distant sites and are well encapsulated." "Malignant Tumors - CORRECT ANSWER rapidly growing and poorly differentiated, do not look like the tissue or origin, rapid cell growth, and can metastasize to local tissues or distant sites. Not encapsulated, anaplasia, pleomorphic (various shapes/sizes). Are named after the cell of origin but in addition to the "oma" they have the root words "carcino" or "sarco"." "This type of syndrome is most commonly found in the GI tract or lungs - CORRECT ANSWER paraneoplastic syndromes" "What is responsible for shifting potassium intracellularly - CORRECT ANSWER Insulin" "What shifts potassium extracellularly - CORRECT ANSWER -Insulin Deficiency -Aldosterone Deficiency -Acidosis -Strenuous Exercise" "Alpha adrenergic antagonists will cause K to shift - CORRECT ANSWER into the cell" "Beta 2 antagonist (Beta Blockers) causes K to shift - CORRECT ANSWER extracellularly" "Intracellular - CORRECT ANSWER All fluids contained inside the cells by their plasma membrane. Consists of cytosol and fluid in cell nucleus." "Interstitial fluid - CORRECT ANSWER Extracellular space Tissue space that surrounds cells in body Contains 20% of body water" "Intravascular - CORRECT ANSWER Blood. Mixture of blood cells, colloids and solutes (glucose and ions). It's the fluid inside blood cells and blood plasma. Contains 20% of body water" "What happens to the BP when fluid moves out of the intravascular compartment - CORRECT ANSWER BP drops" "Intravascular Volume is regulated by - CORRECT ANSWER hydrostatic pressure and reabsorption by kidneys" "When excessive fluid accumulates in this space, edema, develops and fluid shifts into brain cells causing high cranial pressure - this is called - CORRECT ANSWER interstitial space Allows for movement of ions, proteins and nutrients across cell barrier." "When fluid shifts out of cells, cellular processes slow down or cease from - CORRECT ANSWER dehydration" "Osmolality - CORRECT ANSWER The measure of solute concentration in a solution (Concentration of plasma)." "Plasma Osmolality value is - CORRECT ANSWER 280-295 mOsm/kg" "Osmosis - CORRECT ANSWER -Movement of water between compartments from areas of low concentration of solutes to areas of high concentration of solutes (areas of high water to low water). Passive Force -> does not require energy" "Osmotic Pressure - CORRECT ANSWER Amount of pressure or force that is exerted by solute molecules of a compartment. ↑ osmolality = ↑ this This pulling force will pull water into a compartment. This pulling force must be overcome by hydrostatic pressure to oppose osmosis." "A-a Gradient - CORRECT ANSWER -Measures the differences between the alveolar (A) to arterial (a) O2. -It is a calculated value which indicates the difference between alveolar and arterial O2 content." "An elevated A-a gradient can happen in such diseases such as - CORRECT ANSWER pulmonary edema, pulmonary fibrosis, and ARDS." "Roles of the kidney in maintenance of acid base balance - CORRECT ANSWER Reabsorption of Bicarbonate Renal Excretion of Hydrogen Excretion of Hydrogen as Ammonium" "What inhibits HCO3 reabsorption - CORRECT ANSWER Acetazolamide (carbonic anhydrase inhibitor): blocks the action of carbonic anhydrase" "Order of RAAS - CORRECT ANSWER -release of renin -renin -> angiotensin -angiotensin -> angiotensin 1 -ACCE converts angiotensin1-> angiotensin II -> causes art VC -> release of aldosterone -> stimulates renal Na reabsorption and K excretion" "Works opposite of RAAS to decrease blood volume - CORRECT ANSWER ANP and BNP Natriuretic Hormones -promote urinary excretion of Na and water" "may be used interchangeably with osmolality - CORRECT ANSWER tonicity" "What causes an increase in hydrostatic pressure - CORRECT ANSWER venous obstruction or retention of Na & water" "what causes a decrease in oncotic pressure and osmotic pressure - CORRECT ANSWER decreased plasma protein production" "ECF overload manifestations - CORRECT ANSWER HCO3 reabsorption inhibited in proximal tubule" "ECF deficit manifestations - CORRECT ANSWER increase HCO3 absorption stimulates RAAS" "Reabsorption of bicarbonate occurs with - CORRECT ANSWER loop or thiazide diuretics volume replacement with NaCl" "Renal excretion of H+ ions occurs mostly in - CORRECT ANSWER distal tubule & collecting ducts" "What assists with renal excretion of H+ ions - CORRECT ANSWER inorganic phosphates" "Where does excretion of hydrogen as ammonium occur - CORRECT ANSWER proximal tubule, loop of henle, and distal tubules (proximal tubule cells produce NH4+)" "What blocks the actions of carbonic anhydrase to inhibit HCO3 reabsorption - CORRECT ANSWER Acetazolamide" "High Anion Gap metabolic acidosis is likely caused by - CORRECT ANSWER lactic acidosis ketoacidosis acute or chronic renal failure" "Normal anion gap metabolic acidosis is likely caused by - CORRECT ANSWER GI losses from diarrhea large volumes of saline admin medications such as NSAIDS, ace inhibitors, trimethoprim" "Clinical Manifestations of Metabolic Acidosis - CORRECT ANSWER Headache and lethargy, which progresses to confusion and coma in severe, Kussmauls respirations (form of hyperventilation that are deep and rapid), anorexia, N/V, diarrhea, abd discomfort" "Pathological Consequences of Metabolic Acidosis - CORRECT ANSWER decreased myocardial contractility, decreased CO, and catecholamine resistant hypotension, and hyperkalemia" "Pathological Mechanisms that cause Metabolic Acidosis - CORRECT ANSWER -increased acid production -loss of bicarbonate -diminished renal excretion of hydrogen." "Metabolic Acidosis - CORRECT ANSWER Reduction of serum bicarbonate concentration and a low arterial pH." "Metabolic Alkalosis - CORRECT ANSWER Results from an excess of HCO3 or deficiency of H ions. High pH, high HCO3" "Causes of Metabolic Alkalosis - CORRECT ANSWER Gastric stomach contents (vomiting or gastric suctioning), diuretic use (thiazide diuretics), diarrhea (laxative abuse), antacid ingestion, excess aldosterone" "Clinical Manifestations of Metabolic Alkalosis - CORRECT ANSWER Hypokalemia, hypocalcemia, cardiac arrhythmias from hypokalemia, hypoventilation, and a elevated PCO2, tetany, paresthesias" "Contraction Alkalosis - CORRECT ANSWER Results in an increased production of aldosterone and consequently increased reabsorption of Na+ and HCO3- in the proximal tubule in response to the hypovolemia and hypokalemia. -occurs with diuretic use" "In order for metabolic alkalosis to occur - CORRECT ANSWER a process that causes a rise in serum bicarbonate and a process which prevents the renal excretion of serum bicarbonate must both occur." "Respiratory Acidosis - CORRECT ANSWER Results from an excess of arterial carbon dioxide (PaCO2), a decrease in alveolar ventilation in relation to the metabolic production of carbon dioxide. Lungs aren't blowing off enough CO2." "Causes of Respiratory Acidosis - CORRECT ANSWER -Medullary respiratory center depression from opiates, barbiturates, anesthesia, PCO2 retention, or a head injury -Impaired respiratory musculature from Guillain-Barre' syndrome, polio, amyotrophic lateral sclerosis, multiple sclerosis -Airway obstruction aspiration, obstructive sleep apnea, laryngospasm and asthma -Impaired gas exchange from acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease, pneumonia and pulmonary edema"