Advanced Pathophysiology Exam 1
Solved 100%
7 possible mechanisms of fatty accumulation - ANSWER--increased movement of free
fatty acids into the liver
-Failure of metabolic process that converts fatty acids to phospholipids resulting in the
preferential conversion of the fatty acids to triglycerides
-increased synthesis of triglycerides from fatty acids
-decreased synthesis of apoproteins (lipid acceptors)
-failure of lipids to bind with apoproteins and form lipoproteins
-failure of mechanisms that transport lipoproteins out of the cell
-direct damage to the ER by free radicals released by alcohol's toxic effects
A cellular change, which is often precancerous, is called:
a. hyperplasia.
b. metaplasia.
c. dysplasia.
d. hypertrophy. - ANSWER-C
A certain disease is currently found in 1 of every 10 people in the country and 1,000
people contract the disease yearly. The population of the country is 4,500,000. Which of
the following statements is correct?
a. The prevalence of the disease is 10% and the incidence is .02%.
b. The prevalence of the disease is .02% and the incidence is 10%.
c. Neither is correct.
d. There is insufficient data - ANSWER-A
A mountain climber is stranded at 23,000 feet in the Swiss Alps and has lost all his
equipment and supplies in an avalanche. Subsequently, he suffers cell injury due to
impaired ATP production. The reason for the decrease in ATP is which of the following?
a. enzyme inhibition
b. uncoupling
c. hypoxia
d. none of the above - ANSWER-C
abnormal substances that cause cell accumulation - ANSWER--endogenous: product of
abnormal metabolism synthesis
-exogenous: infectious agent or material
acute tubular necrosis - ANSWER-damage to the renal tubules due to presence of
toxins in the urine or to ischemia
most common cause of hospital acquired ARF
,An elderly patient develops an obstruction in his left middle cerebral artery. The brain
tissue supplied by this artery becomes hypoxic. The best explanation for this is which of
the following?
a. the obstruction results in decreased blood flow
b. the obstruction results in decreased hemoglobin in the blood
c. while blood flow stays the same, the obstruction reduces oxygen content in the blood
d. none of the above explain the reason for the hypoxia - ANSWER-A
apoptosis - ANSWER--event that results in cell death
-quiet, organized, programmed process resulting in elimination of individual cells
Apoptosis - mitochondrial pathway - ANSWER--healthy cell - protein Bcl-2 on surface -
inhibits apoptosis
-internal damage to cell
-protein Bax migrates to the surface of the mitochondria where it inhibits protective
effect of Bcl-2
-inserts self into outer mitochondrial membrane punching holes in it
-cytochrome c leaks out
-cytochrome c binds to the protein Apaf-1
-complexes aggregate to form apoptosomes
-bind to and activate caspase-9
-cleaves and activates other caspases (executioner ones)
-digestion of structural proteins in the cytoplasm
-degradation of chromosomal DNA
-phagocytosis of the cell
Apoptosis death-receptor pathway - ANSWER--Fas and TNF receptor are integral
membrane proteins with their receptor domains exposed at the surface of the cell
-binding of the complementary death activator (FasL and TNF) transmits a signal to the
cytoplasm
-actiavation of caspase 8
-initiates cascade of caspase activation
-phagocytosis of cell
apoptosis-inducing - ANSWER--neurons have another way to self-destruct that does not
use caspases
-AIF is a protein that is normally located in the intermembrane space of mitochondria
-when cell receives death signal, AIF:
-released from mitochondria
-migrates to nucleus
-binds to DNA
-triggers destruction of the DNA and cell death
Atrophy - ANSWER-Decrease or shrinkage in cellular size.Most common in skeletal
muscle, heart, secondary sex organs, and brain.
,calculate the anion gap - ANSWER-AG = (Na + K) - (Cl + HCO3)
calculation for corrected serum sodium - ANSWER-G= (pt. glucose - 100)/100
(1.6 mEq/L x G) + (serum sodium)
calculation for ideal TBW - ANSWER-(current Na X TBW)/140
Calculation for serum osmolality - ANSWER-OSM = 2 X [sodium concentration] +
[glucose concentration/18] + [BUN/2.8]
calculation for water deficit - ANSWER-((current Na X TBW)/140) - TBW
calculation for water excess - ANSWER-the difference between current TBW and ideal
TBW
water excess =
weight (kg) x (0.5 F) x (1 - (Na/125))
(0.6 M)
(0.7 infants)
calculation of water def - ANSWER-the difference between ideal TBW and current TBW
=
weight in kg x (0.4 F)
(0.5 M)
(0.6 infants)
caseous necrosis - ANSWER-commonly results from tuberculous pulmonary infection
combination of coagulative and liquefactive
the dead cells disintegrate but the debris is not digest completely by hydrolases
tissues appear soft and granular and resemble clumped cheese
Cause of metaplasia - ANSWER-develops from reprogramming of stem cells. Found in
association with tissue damage, repair, and regeneration.
causes of hypervolemia - ANSWER-Heart failure
Kidney disease
Cirrhosis
Overdose of sodium concentrated fluids
Fluid shifts in burns
Prolonged use of corticosteroids
Severe stress
Hyperaldosteronism
weight gain
causes of hypovolemia - ANSWER-- loss of fluids from anywhere (thoracentisis,
paracentisis, vomiting, diarrhea, hemorrhage, suction)
, - Third spacing (burns, ascites)
- diseases with polyuria (polyuria > oliguria > anuria > renal failure)
causes of metabolic acidosis related to bicarbonate loss (normal anion gap) -
ANSWER--diarrhea
-uterosigmoidoscopy
-early renal failure
-proximal renal tubule acidosis
causes of metabolic acidosis related to increased non-carbonic acids (elevated anion
gap) - ANSWER--overproduction of ketoacidosis (diabetes, alcohol excess, stavation
-lactic acidosis (shock)
-ingestions
-advanced renal failure
-distal renal tubule acidosis
cell characteristics of apoptosis - ANSWER-shrinkage of the cell
condensation of the cytoplasm
detachment of cell from ECM
membrane budding
phagocytosis by neighboring cells
nuclear DNA fragmentation
activation of capases and DNAses
cell characteristics of necrosis - ANSWER-cell swelling and rupture of cell membrane
clumping of nuclear chromatin
swelling of intracellular organelles
calcium and other electrolyte overload
Cell injury: ATP depletion - ANSWER-loss of mitochondrial ATP and decreased ATP
synthesis
results include:
cellular swelling
decreased protein synthesis
decreased membrane transport
lipogenesis
all changes that contribute to loss of integrity of the plasma membrane
Cell Injury: Intracellular calcium and loss of calcium steady state - ANSWER-Normally
intracellular cytosolic calcium concentrations are very low; ischemia and certain
chemicals can cause an increase in cytosolic Ca concentrations
sustained levels of Ca continue to increase with damage to plasma membrane
Ca causes intracellular damage by activating enzymes
Cell injury: Oxygen and oxygen-derived free radicals - ANSWER-lack of oxygen is key
in progression of cell injury in ischemia (reduced blood supply)
Solved 100%
7 possible mechanisms of fatty accumulation - ANSWER--increased movement of free
fatty acids into the liver
-Failure of metabolic process that converts fatty acids to phospholipids resulting in the
preferential conversion of the fatty acids to triglycerides
-increased synthesis of triglycerides from fatty acids
-decreased synthesis of apoproteins (lipid acceptors)
-failure of lipids to bind with apoproteins and form lipoproteins
-failure of mechanisms that transport lipoproteins out of the cell
-direct damage to the ER by free radicals released by alcohol's toxic effects
A cellular change, which is often precancerous, is called:
a. hyperplasia.
b. metaplasia.
c. dysplasia.
d. hypertrophy. - ANSWER-C
A certain disease is currently found in 1 of every 10 people in the country and 1,000
people contract the disease yearly. The population of the country is 4,500,000. Which of
the following statements is correct?
a. The prevalence of the disease is 10% and the incidence is .02%.
b. The prevalence of the disease is .02% and the incidence is 10%.
c. Neither is correct.
d. There is insufficient data - ANSWER-A
A mountain climber is stranded at 23,000 feet in the Swiss Alps and has lost all his
equipment and supplies in an avalanche. Subsequently, he suffers cell injury due to
impaired ATP production. The reason for the decrease in ATP is which of the following?
a. enzyme inhibition
b. uncoupling
c. hypoxia
d. none of the above - ANSWER-C
abnormal substances that cause cell accumulation - ANSWER--endogenous: product of
abnormal metabolism synthesis
-exogenous: infectious agent or material
acute tubular necrosis - ANSWER-damage to the renal tubules due to presence of
toxins in the urine or to ischemia
most common cause of hospital acquired ARF
,An elderly patient develops an obstruction in his left middle cerebral artery. The brain
tissue supplied by this artery becomes hypoxic. The best explanation for this is which of
the following?
a. the obstruction results in decreased blood flow
b. the obstruction results in decreased hemoglobin in the blood
c. while blood flow stays the same, the obstruction reduces oxygen content in the blood
d. none of the above explain the reason for the hypoxia - ANSWER-A
apoptosis - ANSWER--event that results in cell death
-quiet, organized, programmed process resulting in elimination of individual cells
Apoptosis - mitochondrial pathway - ANSWER--healthy cell - protein Bcl-2 on surface -
inhibits apoptosis
-internal damage to cell
-protein Bax migrates to the surface of the mitochondria where it inhibits protective
effect of Bcl-2
-inserts self into outer mitochondrial membrane punching holes in it
-cytochrome c leaks out
-cytochrome c binds to the protein Apaf-1
-complexes aggregate to form apoptosomes
-bind to and activate caspase-9
-cleaves and activates other caspases (executioner ones)
-digestion of structural proteins in the cytoplasm
-degradation of chromosomal DNA
-phagocytosis of the cell
Apoptosis death-receptor pathway - ANSWER--Fas and TNF receptor are integral
membrane proteins with their receptor domains exposed at the surface of the cell
-binding of the complementary death activator (FasL and TNF) transmits a signal to the
cytoplasm
-actiavation of caspase 8
-initiates cascade of caspase activation
-phagocytosis of cell
apoptosis-inducing - ANSWER--neurons have another way to self-destruct that does not
use caspases
-AIF is a protein that is normally located in the intermembrane space of mitochondria
-when cell receives death signal, AIF:
-released from mitochondria
-migrates to nucleus
-binds to DNA
-triggers destruction of the DNA and cell death
Atrophy - ANSWER-Decrease or shrinkage in cellular size.Most common in skeletal
muscle, heart, secondary sex organs, and brain.
,calculate the anion gap - ANSWER-AG = (Na + K) - (Cl + HCO3)
calculation for corrected serum sodium - ANSWER-G= (pt. glucose - 100)/100
(1.6 mEq/L x G) + (serum sodium)
calculation for ideal TBW - ANSWER-(current Na X TBW)/140
Calculation for serum osmolality - ANSWER-OSM = 2 X [sodium concentration] +
[glucose concentration/18] + [BUN/2.8]
calculation for water deficit - ANSWER-((current Na X TBW)/140) - TBW
calculation for water excess - ANSWER-the difference between current TBW and ideal
TBW
water excess =
weight (kg) x (0.5 F) x (1 - (Na/125))
(0.6 M)
(0.7 infants)
calculation of water def - ANSWER-the difference between ideal TBW and current TBW
=
weight in kg x (0.4 F)
(0.5 M)
(0.6 infants)
caseous necrosis - ANSWER-commonly results from tuberculous pulmonary infection
combination of coagulative and liquefactive
the dead cells disintegrate but the debris is not digest completely by hydrolases
tissues appear soft and granular and resemble clumped cheese
Cause of metaplasia - ANSWER-develops from reprogramming of stem cells. Found in
association with tissue damage, repair, and regeneration.
causes of hypervolemia - ANSWER-Heart failure
Kidney disease
Cirrhosis
Overdose of sodium concentrated fluids
Fluid shifts in burns
Prolonged use of corticosteroids
Severe stress
Hyperaldosteronism
weight gain
causes of hypovolemia - ANSWER-- loss of fluids from anywhere (thoracentisis,
paracentisis, vomiting, diarrhea, hemorrhage, suction)
, - Third spacing (burns, ascites)
- diseases with polyuria (polyuria > oliguria > anuria > renal failure)
causes of metabolic acidosis related to bicarbonate loss (normal anion gap) -
ANSWER--diarrhea
-uterosigmoidoscopy
-early renal failure
-proximal renal tubule acidosis
causes of metabolic acidosis related to increased non-carbonic acids (elevated anion
gap) - ANSWER--overproduction of ketoacidosis (diabetes, alcohol excess, stavation
-lactic acidosis (shock)
-ingestions
-advanced renal failure
-distal renal tubule acidosis
cell characteristics of apoptosis - ANSWER-shrinkage of the cell
condensation of the cytoplasm
detachment of cell from ECM
membrane budding
phagocytosis by neighboring cells
nuclear DNA fragmentation
activation of capases and DNAses
cell characteristics of necrosis - ANSWER-cell swelling and rupture of cell membrane
clumping of nuclear chromatin
swelling of intracellular organelles
calcium and other electrolyte overload
Cell injury: ATP depletion - ANSWER-loss of mitochondrial ATP and decreased ATP
synthesis
results include:
cellular swelling
decreased protein synthesis
decreased membrane transport
lipogenesis
all changes that contribute to loss of integrity of the plasma membrane
Cell Injury: Intracellular calcium and loss of calcium steady state - ANSWER-Normally
intracellular cytosolic calcium concentrations are very low; ischemia and certain
chemicals can cause an increase in cytosolic Ca concentrations
sustained levels of Ca continue to increase with damage to plasma membrane
Ca causes intracellular damage by activating enzymes
Cell injury: Oxygen and oxygen-derived free radicals - ANSWER-lack of oxygen is key
in progression of cell injury in ischemia (reduced blood supply)
