Study Guide for Understanding Pathophysiology

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Cellular Biology

UNIT ONE THE CELL

State the functions of a typical eukaryotic cell
Describe the structure and function of the nucleus and identify the cytoplasmic organelles
Describe the structure and function of the plasma membrane
Describe cellular receptors
Identify the three mechanisms that bind cells together
Describe the primary modes of chemical signaling
Describe cellular catabolism and the transfer of energy to accomplish other cellular processes
Differentiate between passive and active transport, between endocytosis and exocytosis,
Describe the changes in the plasma membrane that result in an action potential
Identify the phases of mitosis and cytokinesis
Describe the stimulation of cell proliferation by growth factors
Characterize pattern formation
Identify the location and a major function for each type of tissue: epithelial, connective, muscle,

None of the above is correct. serve as depots for several receptors. provide a pathway for transport in a cell. None of the above is correct. coordinate the activities of cells within tissues. are an impermeable part of the plasma membrane.

Genes and Genetic Diseases

Characterize the chromosome and its aberrations
Cite examples of chromosome disorders
Characterize single-gene disorders
Cite examples of single-gene disorders
Characterize multifactorial inheritance, and cite examples

Cri-du-chat (“cry of the cat”) syndrome is one such extinction and is manifested by the high-pitched cat-like cry of an affected child. Union of the extra chromosome female gamete with a normal sperm produces a 47-chromosome zygote, or trisomy 21.

Altered Cellular and Tissue Biology

Describe the cellular adaptations occurring in atrophy, hypertrophy, hyperplasia, dysplasia, and
Identify the mechanism of cellular injury from hypoxia, free radicals, chemicals, unintentional and
Identify various cellular accumulations occurring in response to injury and the subsequent
Identify the major types of cellular necrosis and cite examples of the tissues involved in each type
Describe the biology of aging; characterize frailty
Characterize somatic death and its manifestations

Membrane changes are accompanied by rapid leakage of potassium from the cell and rapid influx of water. Rigor mortis gradually decreases as the body becomes flaccid due to the release of enzymes and the dissolution of lytes.

Fluids and Electrolytes, Acids and Bases

Identify the mechanisms causing edema
Define isotonic, hypertonic, and hypotonic water and solute alterations and imbalances
Identify the major manifestations of abnormal levels of sodium, potassium, calcium, phosphate,
Differentiate between metabolic/respiratory acidosis and metabolic/respiratory alkalosis

Hypernatremia > 147 mEq/L Hyponatremia < 135 mEq/L Cellular shrinkage due to hypertonic extracellular. liquid; can cause central nervous system irritability, convulsions, tachycardia, dry and flushed skin, hypervolemia, hypertension, thirst, elevated. temperature, rapid pulse, weight loss, oliguria, anuria. Hypercalcemia > 10 mg/dL Hypocalcemia < 8.5 mg/dL Decreased neuromuscular excitability, muscles. weakness, central nervous system depression, stupor to coma, increased risk of bone fracture, vomiting, constipation, kidney stones.

Innate Immunity: Inflammation and Wound Healing

The most important function of the complement cascade is the activation of complement components C3 and C5, which results in a variety of molecules that are: (1) opsonins, (2) chemotactic factors, or (3) anaphylatoxins. As with the complement cascade, activation of the coagulation cascade produces fragments known as fibrinopeptides (FPs) A and B that enhance the inflammatory response.

Third Line of Defense: Adaptive Immunity

Lymphocytes recognize and produce specific antibodies or lymphokines, which help the phagocytes to fight the antigen. Neonates are often transiently deficient in neutrophil chemotaxis and alternative complement pathway activity; T-cell-independent immunity is sufficient in the fetus and neonate, but T-cell-dependent immunity develops slowly during the first 6 months of life; maternal IgG antibodies cross the placenta to fetal blood to protect the neonate for 6 months, after which the child's own antibodies develop.

Infection and Defects in Mechanisms of Defense

Describe the relationships between humans and microorganisms
Describe the mechanisms of infection and cellular injury by bacteria, viruses, fungi, and parasites
Characterize immune deficiencies; describe examples of congenital or primary diseases
Cite causes of secondary or acquired immune deficiencies
Describe acquired immune deficiency syndrome (AIDS)
Indicate some replacement therapies and laboratory tests for immune deficiencies
Compare the four hypersensitivities
Describe the likely causes of autoimmune and alloimmune diseases; cite examples

Some immunodeficiencies involve a defect that leads to depressed development of a small portion of the immune system. Viral proliferation can occur, leading to the lysis and death of the infected cell.

Stress and Disease

Define stress, identify stressors, and state the effects of stress
Describe Selye’s original general adaptation syndrome; cite its stages
Identify current concepts that modify Selye’s work
Summarize the major interactions of the nervous, endocrine, and immune systems in the stress
Distinguish between ineffective and effective methods of coping with stress
Cite examples of stress-related diseases

Selye later defined three successive stages in the development of GAS: (1) the alarm stage, (2) the resistance or adaptation stage, and (3) the exhaustion stage. Selye identified three components of physiological stress: (1) the exogenous or endogenous stressor that initiates the disturbance, (2) the chemical or physical disturbance produced by the stressor, and (3) the body's counteractive (adaptation) response to the disturbance.

Biology, Clinical Manifestations, and Treatment of Cancer

Define tumor, neoplasia, and cancer
Name and classify tumors; distinguish between benign and malignant tumors
Describe tumor cell markers; cite marker examples that suggest the existence of cancer
Postulate a model for the causes and sequence of carcinogenesis
Identify some changes that occur in cancerous cells and their functional significance
Identify the genetic events occurring within cancer-prone families
Describe the mechanisms involved in metastasis
Describe the diagnosis and staging of cancer
Describe the clinical manifestations of cancer
Compare the modalities for the treatment of neoplasms
AFP 23. CEA

Tumor cell markers can be used in three ways: (1) to identify individuals at high risk for cancer, (2) to help diagnose a specific type of tumor in an individual with clinical manifestations of cancer, and (3) to observe the clinical course of cancer. The reason is both in the "seed" and in the "fingers". Cancer cells (seeds) must overcome many physical and physiological barriers to spread, survive, and reproduce in distant locations (grounds) that must be receptive to cancer cells. When a cancer diagnosis is suspected or established, tumor tissue must be obtained to make a definitive diagnosis and correctly classify the disease.

10 Cancer Epidemiology

Generalize gene-environment-lifestyle interactions
Describe the relationship between epigenetics and genetics
Indicate the role of in utero and early life conditions in cancer development
Describe tobacco use as a carcinogenic agent
Relate diet and obesity to carcinogenesis
Relate alcohol consumption to carcinogenesis
Identify the carcinogenic risks to individuals of ionizing, ultraviolet, and electromagnetic
Identify behaviors and environment agent exposures associated with carcinogenesis

Cigarette smoking is responsible for one in five deaths each year in the United States. It is known that radiation can induce a type of genomic instability in the progeny of the directly irradiated cells over many generations of cell irradiation. Benzol inhalation is linked to leukemia in shoemakers and in workers in the rubber cement, explosives and dye industries.

11 Cancer in Children

Describe the incidence and types of childhood cancers
Describe the genetic etiologic factors for childhood cancers
Describe environmental factors for childhood cancer
Indicate the prognosis for childhood cancers

Individuals in these families are at risk for soft tissue sarcoma, breast cancer, leukemia, osteosarcoma, melanoma, and cancer of the colon, pancreas, adrenal cortex, and brain. Some of the factors in improving the cure rate in pediatric oncology are the use of combination. A much greater environmental and lifestyle causal relationship is found in adult than in childhood cancers.

Structure and Function of the Neurologic System

Identify the structural and functional subdivisions of the nervous system
Compare the functions of neurons with those of neuroglia; identify the parts of neurons
Describe the circumstances under which nervous tissue can regenerate
Describe transmission of impulses by neurotransmitters
Identify the three main divisions of the brain;
Identify the significance of contralateral control of motor fibers
Describe the location and structure of the spinal cord; define reflex arc
Identify the structures responsible for
Identify the route of blood circulation within the central nervous system; note the significance of
Describe the structure of cranial and spinal nerves; locate plexuses
Name the cranial nerves and state functions of each
Identify the subdivisions of the autonomic nervous system, their origins, and their general
Identify the type of neurotransmitter secreted by preganglionic and postganglionic fibers in the
Identify the structural, cellular, vascular, and functional changes that occur with aging

A function of the somatic nervous system that is not performed by the autonomic nervous system is conduction of impulses:. to involuntary muscles and glands. to the central nervous system. between the brain and the spinal cord. A neuron with a single dendrite at one end of the cell body and a single axon at the other end of the cell body would be classified as:. Which contains the thalamus and hypothalamus. programs for fine repetitive motor movements. affects the position of the head to improve hearing.

Pain, Temperature, Sleep, and Sensory Function

Describe clinical categories of pain; characterize pain threshold and pain tolerance
Describe the alterations occurring in fever, hyperthermia, and hypothermia
Describe sleep disorders; cite examples
Identify common diseases that are associated with the special senses and describe their etiologies and

Projections from the reticular formation and other areas of the mesencephalon and brainstem give rise to non-REM sleep. The optic tracts connect to the primary visual cortex in the occipital lobe of the brain. Hypothermia (significant cooling of body temperature) causes depression of the central nervous and respiratory systems.

Vision

Identify common diseases associated with the special senses and describe their etiologies and the special senses and describe their etiologies and manifestations.

Hearing

Olfaction

Taste

Touch

Proprioception

Although non-REM sleep and REM sleep are defined by electrical recordings, they are characterized by physiological events. Her husband, a successful dentist, became more involved in various men's organizations than he had been in the past. At the second appointment, which lasted 1 hour, she said, "My sleep patterns have improved." She was able to articulate that she felt unnecessary, incompetent, and old.

Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function

Describe the outcomes for alterations in arousal
Relate clinical manifestations to levels of consciousness and characterize rostral-caudal
Describe alterations in awareness
Describe seizure and cite conditions associated with seizure disorders
Differentiate between partial and generalized seizures
Define the descriptive terms of processing deficits
Describe features of dementia and Alzheimer disease
Characterize the stages of increased intracranial pressure, herniation syndrome, and cerebral
Describe hydrocephalus
Define terms that describe alterations in motor functions
Describe amyotrophies
Compare Huntington disease to Parkinson disease
Describe disorders of posture-stance
Describe disorders of gait
Describe disorders of expression

It is caused by the increased permeability of the capillary endothelium of the brain after damage to the vascular structure. Interstitial edema is caused by movement of cerebrospinal fluid from the ventricles to the extracellular spaces of the brain tissues. It is believed that a decorticate posture occurs when the brain stem is not inhibited by the motor function of the cerebral cortex.

Motor Syndrome Types

Show the relationships between pyramidal (upper) and extrapyramidal (lower) motor

Hospital studies showed routine laboratory work within normal limits (WNL), lumbar puncture (CSF) was WNL, no evidence of skull fracture was detected on X-ray study, and an electroencephalograph (EEG) showed no abnormalities. When the cashier declared the cost, she objected, saying, "You charged me 23 cents." The boy tried to convince his mother that the cashier was correct, but she insisted that he was right. I will stay here tonight, but you must take me home tomorrow.” The next day, Monday, her son took her to a trusted doctor who knew that L.B.

Differentiate between focal and diffuse brain trauma
Discuss the pathogenesis and manifestations of spinal cord injuries
Describe degenerative disorders of the spine
Compare and contrast cerebrovascular accidents (stroke syndromes)
Describe intracranial aneurysm and vascular malformations
Describe chronic, recurring headaches
Compare meningitis to encephalitis
Characterize CNS abscesses
Identify the neurologic complications of AIDS
Distinguish between the demyelinating disorders multiple sclerosis and amyotrophic lateral
Describe myasthenia gravis
Describe the pathophysiology, manifestations, and treatment of CNS tumors; classify common

The most common sites of hypertensive hemorrhages are in the putamen of the basal ganglia and hypothalamus. In Brudzinski's sign, neck pain and increased stiffness occur with passive neck flexion. Primary extracerebral tumors originate outside the brain substance and include meningiomas and neurofibromas.

16 Alterations of Neurologic Function in Children

Describe the major forms of central nervous system(CNS) malformation
Describe the static encephalopathic processes
Characterize childhood seizures
Describe the acute encephalopathic processes
Describe cerebrovascular disease in children
Describe the types of brain tumors in children and characterize their presentation

Tay-Sachs disease is a fatal autosomal recessive disorder caused by a disorder of the lysosomal enzyme hexosaminidase A. Bacterial meningitis refers to inflammation of the meningeal coverings of the brain and spinal cord. Encephalocele is the result of herniation of the brain and meninges due to a defect of the lower vertebrae.

17 Mechanisms of Hormonal Regulation

Identify the functions of the endocrine system, and describe the regulation of hormone

Classify the types of hormones, their receptors, and proposed mechanisms of action

State the relationship between the hypothalamus and the pituitary; identify the hormones of the

Identify the thyroid hormones and state their functions

Cite the physiologic effects of parathyroid hormone and the variables that affect its

Identify the production sites of pancreatic somatostatin, insulin, and glucagon, and state

Describe the effects of the adrenal cortical glucocorticoids, mineralocorticoids, and

TRF 21. prolactin

18 Alterations of Hormonal Regulation

Identify the mechanisms causing hormonal alterations
Distinguish between syndrome of inappropriate ADH secretion (SIADH) and diabetes insipidus
Describe the disorders of the anterior pituitary as either hypofunctions or hyperfunctions of the
Describe the disorders of hyperthyroidism; note the progressive states of severity
Describe the disorders of hypothyroidism; describe thyroid cancer
Distinguish between primary and secondary hyperparathyroidism and hypoparathyroidism
Describe the similarities and differences between insulin-dependent (type 1) and non–insulin-
Identify the acute complications of diabetes mellitus; describe the features of each
Describe the chronic complication of diabetes mellitus
Describe the etiology, pathogenesis, and manifestations of hyperfunction and
Characterize adrenal medulla hyperfunction

SIADH is associated with several types of cancer due to the ectopic secretion of ADH by tumor cells. Sex steroid replacement may be required, depending on individual needs and desires. Pheochromocytoma causes excessive production of epinephrine and norepinephrine due to the autonomic function of the tumor.

Structure and Function of the Hematologic System

Identify the components of blood plasma
Identify the structural characteristics, normal values, functions, and life span of the cellular
Describe lymphoid organs and the mononuclear phagocyte system (MPS)
Describe the development of erythrocytes, leukocytes, and platelets; identify the CSFs and
Describe the mechanisms and the sequence of events in hemostasis; note the blood tests for
Diagram the fibrinolytic system
Identify various hematologic tests and value changes for different age groups

If an individual's total leukocyte count were 7000/mm3, approximately how many neutrophils would normally be present in 1 mm3 of blood.

20 Alterations of Hematologic Function

Define and classify anemia
Describe the pathophysiology of the clinical manifestations of anemias
Develop a comparative table of the macrocytic- normochromic, microcytic-hypochromic, and
Describe the types, causes, manifestations, and treatment of polycythemia
Describe terms associated with high and low leukocyte counts and the causes of the alterations
Describe the pathogenesis of infectious mononucleosis
Classify, contrast, and describe the manifestations of leukemia
Differentiate multiple myeloma from the leukemias
Compare Hodgkin to non-Hodgkin lymphomas
Describe thrombocytopenia and thrombocythemia
Identify the causes of coagulation disorders;
Characterize thromboembolic disorders

A reduction in the number of circulating erythrocytes after bleeding affects the consistency and volume of the blood. Describe terms associated with high and low leukocyte counts and the causes of the changes. A person with chronic gastritis and tingling in the fingers requires which of the following for treatment.

21 Alterations of Hematologic Function in Children

Describe the etiology of childhood iron deficiency anemia and identify appropriate diagnostic and
Compare and contrast the two major causes of hemolytic disease of the newborn
Describe childhood sickle cell disease
Describe the thalassemias
Describe childhood hemophilias and their complications
Describe the pathophysiology of idiopathic thrombocytopenic purpura and identify its most
Describe childhood leukemias
Distinguish between non-Hodgkin lymphoma and Hodgkin lymphoma

Sickle cell disease is an inherited, autosomal recessive disorder most common in the United States in blacks. The appearance of blast cells in the bone marrow with a reduction in RBCs and granulocytes is the hallmark of acute leukemia. Painless lymphadenopathy in the lower cervical chain, with or without fever, is the most common symptom.

22 Structure and Function of the

Cardiovascular and Lymphatic Systems

Describe the function of the circulatory system;
Describe the heart and its wall, chambers, fibrous skeleton, valves, and great vessels; trace the blood
Describe the coronary and lymphatic vessels
Describe the initiation and conduction sequence of electrical impulses through the heart; identify
Identify the structure and characteristics of myocardial cells
Describe myocardial contraction and relaxation in relation to the calcium-troponin-tropomyosin
Use the Frank-Starling law and Laplace law to demonstrate interrelationships that affect
Describe the determinants of heart rate
Contrast the structure and function of arteries, capillaries, and veins within the systemic
Describe the determinants of blood flow
Identify the factors that regulate arterial and venous blood pressure
Describe the autoregulation of coronary circulation
Describe the normal structure and function of the lymphatic system
Describe cardiovascular function in the elderly

Blood pressure is measured as: the pressure exerted on the walls of the ventricle during systole. the pressure exerted by blood on the wall of a blood vessel. the pressure exerted on the artery by the blood. product of stroke volume times heart rate. If stimulation of the sympathetic nervous system of the heart prevails over stimulation of the parasympathetic nervous system, the heart will: it contracts with greater force and at a slower rate. reduce its speed and contraction force. contract with less force and with a higher degree. When the blood shows a cloudy flow: greater blood viscosity is present. fluids have a higher velocity than with laminar flow. hydrostatic pressure is greater than when fluids demonstrate laminar flow.

23 Alterations of Cardiovascular Function

Describe venous occlusive diseases
Describe primary, secondary, complicated, and malignant hypertension
Define and identify the causes of orthostatic or postural hypotension
Define aneurysm and list the types
Distinguish between a thrombus and an embolus
Describe arterial occlusive disease
Describe the development of atheromatous plaque and its manifestations. (See atherogenesis flow
Describe peripheral artery disease
Characterize coronary artery disease (CAD); distin- guish between myocardial ischemia and myocardial
Characterize the terms associated with pericardial disease
Compare the cardiomyopathies
Identify the causes and manifestations of valvular dysfunction
Distinguish between rheumatic heart disease (RHD) and infective endocarditis
Generalize dysrhythmias of the heart
Discuss contractility, preload, and afterload as mechanisms for left heart failure
Differentiate between left and right heart failure; describe high-output heart failure

These aneurysms are caused by a rupture in the wall or a dissection of the layers of the arterial wall. In the arteries, activation of the coagulation cascade is usually caused by coarsening of the tunica intima by atherosclerosis. Pulmonary embolism usually arises from the deep veins of the legs or in the right heart.

Left Side Failure (Congestive Heart Failure*)

Characterize impaired cellular metabolism due to shock

The end result of any form of shock is decreased cellular metabolism and cellular lysis. Shock is a condition in which the cardiovascular system fails to adequately perfuse the tissues.

Shock's Impairment of Cellular Metabolism

Briefly diagram the common events found in all types of shock, and relate the events to the signs

Illustrate the pathogenic sequence of MODS due to shock

Pathogenesis of Multiple Organ Dysfunction Syndrome (MODS)

A 76-year-old man came to the emergency room after experiencing chest pain while shoveling snow. This usually damages the mitral valve. occurs when infarction is limited to part of the heart wall. In congestive heart failure, the pump or myocardium itself fails due to which of the following.

24 Alterations of Cardiovascular Function in Children

Characterize congenital heart disease
Identify the most common congenital defects that obstruct ventricular outflow and describe their
Describe the congenital defects with increased pulmonary blood flow and their pathophysiology
Describe the congenital defects with decreased pulmonary blood flow and their pathophysiology
Describe defects that permit mixing of pulmonary blood and systemic blood
Summarize the causes and consequences of blood flow defects in congenital heart disease (see
Describe childhood CHF and its manifestations
Describe the pathophysiology related to Kawasaki disease
Describe susceptibility to and manifestations of systemic hypertension (HTN) in children

Maintaining patency of the duct allows blood to flow from the aorta with higher pressure to the pulmonary artery with lower pressure, creating a left-to-right shunt. Ventricular septal defect (VSD) is essentially a defect in the intraventricular septum that leads to blood flow between the ventricles of the heart. Complete transposition of the great vessels results in the effective switching of the aorta and pulmonary arteries so that the pulmonary artery leaves the left ventricle and the aorta leaves the right ventricle.

25 Structure and Function of the Pulmonary System

Identify the sequence of structures of the pulmonary system as air moves into and out of
Describe lung volumes and capacities
Describe the neurochemical control of ventilation;
Relate changes in the thoracic volume to muscular contractions, alveolar surface tension, elastic
Identify the factors in oxygen transport to the cells of the body, and describe oxyhemoglobin
Identify the normal values for arterial and venous blood gases
Describe the factors controlling pulmonary vasodilation and vasoconstriction
Note the pulmonary changes that occur with normal aging

Given that the oxygen content of blood is equal to 1.34 ml of O2 per gram of hemoglobin times the arterial oxygen saturation percentage, what is the arterial oxygen content if the hemoglobin concentration is 15 g/dL and the arterial saturation is 98%. Alveolar macrophages Phagocytosis ingests and removes particles and bacteria from the alveoli Irritant receptors in nostrils.

26 Alterations of Pulmonary Function

Define the terms used in describing the signs and symptoms of pulmonary disease