Advanced Pathophysiology Nurs 5315 Exam Questions with
Answer Graded A+ 2025/2026
Metaplasia - E: reversible change, one type of cell changes to another type
for survival
P: reversible; results from exposure of the cells to chronic stressors, injury,
or irritation; Cancer can arise from this area, stimulus induces a
reprogramming of stem cells under the influence of cytokines and growth
factors
Ex: Patho: Columnar cells change to squamous cells in lungs of smoker or
normal ciliated epithelial cells of the bronchial linings are replaced by
stratified squamous epithelial cells.; Phys: Barrett Esophagus- normal
squamous cells change to columnar epithelial cells in response to reflux,
aka intestinal metaplasia
Hypoxia injury - E. inadequate oxygenation of tissues
P. decrease in mitochondrial function, decreased production of ATP
increases anaerobic metabolism. eventual cell death.
C.M. hypoxia, cyanosis, cognitive impairment, lethargy
Free radical and ROS - E. normal byproduct of ATP production, will
overwhelm the mitochondria- exhaust intracellular antioxidants
P. lipid peroxidation, damage proteins, fragment DNA
C.M. development in Alzheimer's, heart disease, Parkinson's disease,
Amyotrophic Lateral Sclerosis
Ethanol - E. mood altering drug, long term effects on liver and nutritional
status
P. metabolized by liver, generates free radicals
C.M. CNS depression, nutrient deficiencies-Mag, Vit B6, thiamine, PO4,
inflammation and fatty infiltration of liver, hepatomegaly, leads to liver
failure irreversible
Oncosis - Na and H2O enter cell and cause swelling. Organ increases in
weight, becomes distended and pale. Associated with high fever,
hypocalcemia, certain infections
Fatty Infiltration - intracellular accumulation of lipids in the liver
liver fails to metabolize lipids. usually from ETOH or high fat diet. can lead
to cirrhosis
,dystrophic calcification - accumulation of Ca in dead or dying tissues
calcium salt clump and harden- interfere with cellular structure and function
r/t pulmonary TB, atherosclerosis, injured heart valves, chronic pancreatitis
metastatic calcification - accumulation of Ca in normal tissue
result of hypercalcemia r/t hyperparathyroidism, hyperthyroidism, toxic
levels of Vit D. Can also r/t hyperphosphatemia in renal failure
urate accumulation - sodium urate crystals are deposited in tissues- group
of disorders collectively called gout- acute arthritis, chronic gouty arthritis,
tophus, nephritis
Coagulative Necrosis - kidneys, heart, adrenals- secondary to hypoxia
Liquefactive Necrosis - nerve cells- brain- accumulation of pus
Caseous Necrosis - lung disease- usually TB- tissue looks like clumped
cheese
Fat Necrosis - breast, pancreas, abdominal structures- creates soaps
Gangrenous Necrosis - Dry- dark shriveled skin
Wet- internal organs- can lead to death
Gas- from clostridium- antitoxins and hyperbaric therapy
Gout - E. disturbances in serum urate levels. uncommon for < 30 years old.
P. uric acid is deposited in the tissues of kidney, heart, earlobes, and joints.
C.M. inflammation, painful joints. result of diuretic use or diet high in cream
sauces, red wine, or red meat
Rhabdomyolysis - E. cell hypoxia caused by severe muscle trauma,
hyperthermia, crush injuries, or severe dehydration
P. hypoxia to cell causes failure of the Na-K pump, causing accumulation of
intracellular sodium, oncosis, and eventual cell death. Cell death releases
enzymes such as CK, uric acid, LDH, AST, etc.
C.M. Causes: trauma, hyperthermia, crush injuries, severe dehydration;
s/s: CK is 5x upper normal limit, muscle pain, weakness, dark, reddish-
brown urine, hypercalcemia, renal failure
,Alpha Fetoprotein Origin - Liver and germ cell tumors
Carcinoembryonic Antigen - GI, pancreas, lung, breast tumors
Prostate Specific Antigen - prostate tumors
Carcino- - from epithelial tissue- renal cell carcinoma
Sarco- - from connective tissue- chondrosarcoma
Carcinoma in situ - preinvasive epithelial malignant tumors of glandular or
squamous cells- cervix
Lung ca metastasis - Multiple organs including brain
Colorectal ca metastasis - Liver, lungs
Testicular ca metastasis - Liver, lungs, brain
Prostate ca metastasis - Bones (especially lumbar spine), liver
Head and neck ca metastasis - Liver, bones, lymphatics
Ovarian ca metastasis - Peritoneal surfaces, diaphragm, omentum, liver
Sarcoma metastasis - Lungs
Melanoma metastasis - In transit lymphatics, lung, liver, brain, GI tract
Mechanisms of ca metastasis - Local invasion, followed by invasion of
surrounding tissues. Cells then may invade blood and lymphatic vessels.
They must survive in circulation, then enter and survive in a new location.
Then the cells can multiply and form a new tumor.
TNM staging system - T= tumor size >/= correlates with metastatic ability
N= whether lymph nodes are involved
M= extra nodal involvement (liver, lungs)
Intravascular fluid compartment - In venous system- 20%
, Osmolality - The measure of solute concentration in a fluid.
280-295 mOsm
Interstitial fluid compartment - Surrounds the cells and bathes them in
nutrients- 20%
Intracellular fluid compartment - Within the cells- 40% uk
Osmosis - Passive- the movement of water from an area of low
concentration of solute to one of higher concentration
Osmotic pressure - Pulling- the amount of pressure or force that is exerted
by solute molecules of a given compartment
Hydrostatic pressure - Blood pressure- pushes fluid outside of the vessels,
the force of fluid against the walls of a compartment- venous obstruction,
Na and water retention
Oncotic pressure - Colloid pressure keeps water inside the compartment,
attracts water from interstitial space back into the capillary- losses or
diminished albumin
Effective arterial blood volume - The amount of blood within the arterial
space- ECF changes will cause changes in the EABV in the same direction
Renin Angiotensin Aldosterone System - Activated by low blood volume,
triggers release of renin which converts angiotensinogen to angiotensin 1.
ACE converts angiotensin 1 to angiotensin which causes arterial
vasoconstriction and stimulates release of aldosterone. Aldosterone
stimulates renal Na reabsorption and K+ excretion. Water is retained, less
urine is produced, blood volume increases.
Natriuretic hormones - ANP and BNP- released by heart- works opposite
RAAS to decrease blood volume, promotes urinary excretion of Na and
water
Fluid volume deficit - Dehydration- intake is not enough for body's needs
C.M. Poor skin turgor, dry mucous membranes, sunken eyes, sunken
fontanelles, decreased urine output, fatigue
Answer Graded A+ 2025/2026
Metaplasia - E: reversible change, one type of cell changes to another type
for survival
P: reversible; results from exposure of the cells to chronic stressors, injury,
or irritation; Cancer can arise from this area, stimulus induces a
reprogramming of stem cells under the influence of cytokines and growth
factors
Ex: Patho: Columnar cells change to squamous cells in lungs of smoker or
normal ciliated epithelial cells of the bronchial linings are replaced by
stratified squamous epithelial cells.; Phys: Barrett Esophagus- normal
squamous cells change to columnar epithelial cells in response to reflux,
aka intestinal metaplasia
Hypoxia injury - E. inadequate oxygenation of tissues
P. decrease in mitochondrial function, decreased production of ATP
increases anaerobic metabolism. eventual cell death.
C.M. hypoxia, cyanosis, cognitive impairment, lethargy
Free radical and ROS - E. normal byproduct of ATP production, will
overwhelm the mitochondria- exhaust intracellular antioxidants
P. lipid peroxidation, damage proteins, fragment DNA
C.M. development in Alzheimer's, heart disease, Parkinson's disease,
Amyotrophic Lateral Sclerosis
Ethanol - E. mood altering drug, long term effects on liver and nutritional
status
P. metabolized by liver, generates free radicals
C.M. CNS depression, nutrient deficiencies-Mag, Vit B6, thiamine, PO4,
inflammation and fatty infiltration of liver, hepatomegaly, leads to liver
failure irreversible
Oncosis - Na and H2O enter cell and cause swelling. Organ increases in
weight, becomes distended and pale. Associated with high fever,
hypocalcemia, certain infections
Fatty Infiltration - intracellular accumulation of lipids in the liver
liver fails to metabolize lipids. usually from ETOH or high fat diet. can lead
to cirrhosis
,dystrophic calcification - accumulation of Ca in dead or dying tissues
calcium salt clump and harden- interfere with cellular structure and function
r/t pulmonary TB, atherosclerosis, injured heart valves, chronic pancreatitis
metastatic calcification - accumulation of Ca in normal tissue
result of hypercalcemia r/t hyperparathyroidism, hyperthyroidism, toxic
levels of Vit D. Can also r/t hyperphosphatemia in renal failure
urate accumulation - sodium urate crystals are deposited in tissues- group
of disorders collectively called gout- acute arthritis, chronic gouty arthritis,
tophus, nephritis
Coagulative Necrosis - kidneys, heart, adrenals- secondary to hypoxia
Liquefactive Necrosis - nerve cells- brain- accumulation of pus
Caseous Necrosis - lung disease- usually TB- tissue looks like clumped
cheese
Fat Necrosis - breast, pancreas, abdominal structures- creates soaps
Gangrenous Necrosis - Dry- dark shriveled skin
Wet- internal organs- can lead to death
Gas- from clostridium- antitoxins and hyperbaric therapy
Gout - E. disturbances in serum urate levels. uncommon for < 30 years old.
P. uric acid is deposited in the tissues of kidney, heart, earlobes, and joints.
C.M. inflammation, painful joints. result of diuretic use or diet high in cream
sauces, red wine, or red meat
Rhabdomyolysis - E. cell hypoxia caused by severe muscle trauma,
hyperthermia, crush injuries, or severe dehydration
P. hypoxia to cell causes failure of the Na-K pump, causing accumulation of
intracellular sodium, oncosis, and eventual cell death. Cell death releases
enzymes such as CK, uric acid, LDH, AST, etc.
C.M. Causes: trauma, hyperthermia, crush injuries, severe dehydration;
s/s: CK is 5x upper normal limit, muscle pain, weakness, dark, reddish-
brown urine, hypercalcemia, renal failure
,Alpha Fetoprotein Origin - Liver and germ cell tumors
Carcinoembryonic Antigen - GI, pancreas, lung, breast tumors
Prostate Specific Antigen - prostate tumors
Carcino- - from epithelial tissue- renal cell carcinoma
Sarco- - from connective tissue- chondrosarcoma
Carcinoma in situ - preinvasive epithelial malignant tumors of glandular or
squamous cells- cervix
Lung ca metastasis - Multiple organs including brain
Colorectal ca metastasis - Liver, lungs
Testicular ca metastasis - Liver, lungs, brain
Prostate ca metastasis - Bones (especially lumbar spine), liver
Head and neck ca metastasis - Liver, bones, lymphatics
Ovarian ca metastasis - Peritoneal surfaces, diaphragm, omentum, liver
Sarcoma metastasis - Lungs
Melanoma metastasis - In transit lymphatics, lung, liver, brain, GI tract
Mechanisms of ca metastasis - Local invasion, followed by invasion of
surrounding tissues. Cells then may invade blood and lymphatic vessels.
They must survive in circulation, then enter and survive in a new location.
Then the cells can multiply and form a new tumor.
TNM staging system - T= tumor size >/= correlates with metastatic ability
N= whether lymph nodes are involved
M= extra nodal involvement (liver, lungs)
Intravascular fluid compartment - In venous system- 20%
, Osmolality - The measure of solute concentration in a fluid.
280-295 mOsm
Interstitial fluid compartment - Surrounds the cells and bathes them in
nutrients- 20%
Intracellular fluid compartment - Within the cells- 40% uk
Osmosis - Passive- the movement of water from an area of low
concentration of solute to one of higher concentration
Osmotic pressure - Pulling- the amount of pressure or force that is exerted
by solute molecules of a given compartment
Hydrostatic pressure - Blood pressure- pushes fluid outside of the vessels,
the force of fluid against the walls of a compartment- venous obstruction,
Na and water retention
Oncotic pressure - Colloid pressure keeps water inside the compartment,
attracts water from interstitial space back into the capillary- losses or
diminished albumin
Effective arterial blood volume - The amount of blood within the arterial
space- ECF changes will cause changes in the EABV in the same direction
Renin Angiotensin Aldosterone System - Activated by low blood volume,
triggers release of renin which converts angiotensinogen to angiotensin 1.
ACE converts angiotensin 1 to angiotensin which causes arterial
vasoconstriction and stimulates release of aldosterone. Aldosterone
stimulates renal Na reabsorption and K+ excretion. Water is retained, less
urine is produced, blood volume increases.
Natriuretic hormones - ANP and BNP- released by heart- works opposite
RAAS to decrease blood volume, promotes urinary excretion of Na and
water
Fluid volume deficit - Dehydration- intake is not enough for body's needs
C.M. Poor skin turgor, dry mucous membranes, sunken eyes, sunken
fontanelles, decreased urine output, fatigue
