Pathophysiology Flashcards

Terms Definitions
thin and flat
squamous
Autocrine?
affect own activity
site of protein synthesis
ribosomes
epidermis of skin
stratified squamous kertinized
not transmitting impulses -70 -85
resting
Anaerobic
without oxygen, gylcolic pathway occuring in the cytoplasm
How much protein is protoplasm?
10-20%
Palliation
increase survival and decrease symptoms
Premalignant conditions – remove the “at risk” tissue or organs
Prophylaxis
diffusion
GREATER TO LESSER SOLUTES MOVE, greater the difference the faster the diffusion, larger particles move slower,
Aerobic
with oxygen, in the mitochodriac, citirc acid cycle
Primary Tumor (T), Regional Lymph Nodes (N), Distant Metastasis (M)
staging
metastatic calcification
normal tissue, elevated calcium levels, immobilization, renal failure, pagets disease
EXCESSIVE ESTROGEN AND HYPERPLASIA
ABNORMAL MENSTRAL BLEEDING
Transformation of normal cells to cancer cells by carcinogenic agents is a multistep process, divided into three stages:
InitiationPromotionProgression
This tells how the disease progresses
Pathogenesis
Protoplasm is how much of water?
70-85%
This is avascular, receiving nutrition from capillaries from underlying connective tissue
epithelial tissue
Six hallmarks of cancer
Self-sufficiency in growth signalsInsensitivity to antigrowth signalsEvading apoptosisLimitless replicative potentialSustained angiogensisTissue invasion and metatasis
The study of underlying changes in physiology that results from disease or injury
Pathophysiology
spread depends on
Rate of growthDegree of differentiationPresence or absence of anatomic barriersVarious biological factors
Alopecia (hair loss)
emporary, hair re-growth 1 month
50 chemotherapeutic drugs in useAt the cellular level they prevent cell growth and replicationEffective in treating tumors that have a high growth fractionClassified as cell cycle specific or cell cycle nonspecificMethotrexate interrupts S phaseCombinatio
chemo
This is strongly indicated as a precursor to cancer
dysplasia
Angiogenic factors
Increase in angiogenic factors or a loss of angiogenic inhibitors
Endocrine chemical signaling?
they secrete hormone chemicals that travel thru blood stream to produce a response in other cells
smooth involuntary muscle
may undergo mitotic division and proliferate
What is M phase?
nuclear and cytoplasmic division, pro,meta,ana,telephase
tissue renewal and repair involve cell
proliferation and differentaition
skin warts and hyperplasia
growth factors produced by hpv
Affects one half of the worlds populationCause peptic ulcer disease, gastric lymphoma, and gastric carcinoma
Helicobacter pylori
According to the clinical spread of the diseaseDetermining the size of the tumor The degree to which it has locally invaded The extent to which it has spread
staging cancer
largest repository of enery in the body
adipose tissue
what is a permanent cell?
unable to divide and reproduce...nuerons, muscle and cardiac cells
The disease process includes 6 things....EPMCDC
etiology, pathogenesis, morpholoic changes, clinical manifestations, diagnosis, and clinical course
Cure- cure rate 25-30%
Local excision, wide local excision, wide excision, extended radical excision
What is Histology?EXample?
Study of cells and extra cellular matrix of body tissues; biopsy tissue to identify cancer cells
What is dysplasia?
deranged cell growth of a specific tissue that results in cells that vary in shape, size, and appearance
What is tRNA?
moves into cytoplasm where it moves amino acids to the elongating proteins
The lipid bilayer provides a basic structure and impearmable to most water soluble molecules
fluid mosaic model
There are many electrolytes in the protoplasm and what is the purpose ?
generate electrical impulses
4 functions of fluid mosaic model
1. separates intracellular and extracell 2. provides receptors for hormones and other active subtances 3. particpates in electronic events that occur in nerve and muscle cells 4. aids in regulation,growth, proliferation
Glycolosis- anaerobic activity
1. energy is liberated from glucose 2. important source of energy for cells that lack mitochondia
Interleukins – help body recognize and destroy abnormal body cells - IL-1, IL-2, and IL-6Interferons – protect non-infected cells from virusesMonoclonal antibodies – Herceptin (breast cancer) and Rituxan (non-Hodgkins’s lymphoma)â€
Cytokines – enhance effectiveness of immune system
Name the four different types of tissues?
epithelial, connective, muscle, and nerve
What does Pathophysiology deal with exactly?
cellular and organ changes that occur with diseases and with effects these changes have on toatal body function...an example would be Type 1 Diabetes
single layer epithelium
single
EReticulum
extensive intracellular membrane network...makes and moves proteins
Used for:Diagnosis - biopsyStagingTumor removalPalliation – relief of symptoms
surgery
Facilitated diffusion
HIGHER TO LOWER CONCENTRATION
mitochondria
transforms organic compounds into energy, contains enzymes of the kreb cycle, which requires aerobic metabolism
stratified epithelium
2 or more layers
resting membrane is
-70 to -85
what is S phase?
DNA replication
necrosis
pathological form of cell injury
radiation
Rationale – destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiationTypes of gamma radiation:Gamma rays – most common type used in treating cancerBeta rays – use in some types of diagnostic tests and in the body for radiation therapyAlpha rays – used in laboratory tests
Androgens and antiestrogensFemale – masculinization - chest and facial hair appear, menstrual periods stop, breast tissue shrinks, fluid retentionMan – acne may develop, hypercalcemia, liver dysfunction may occur after prolonged use
hormone side effects
End product is NAD and pyruvate
Glycolsis
Osmosis
passive movement of water across semipermeable membrane, GREATER TO LESSER WATER AND LESSER TO GREATER PARTICLES, OSMOTIC PRESSURE
Cancer compresses other structures
Compression = pain
mouth and tounge
stratified squamous non kertinized
Benign
cells are microscopically similar to their tissue and are clustered in a single mass
Oncogenesis
genetic mechanism where normal cells are transformed into cancer cells
PNervous System
fibers and ganglia outside CNS
cellular waste disposal, the digestive system
lysosomes
cellular swelling and fatty changes
reversible cell injury
lines most of upper respiratory tract
psudostratified epithelium
HYPERPLASIA- NON PHYSIOLOGICAL
DUE TO EXCESSIVE HORMONAL STIMULATION
minor degrees that are seen with chronic irritation and inflammation
dsyplasia
Initiation
Exposure of cells to appropriate dose of a carcinogenic agentPermanent changes resulting in DNA damage at cellular level may become neoplastic if not repaired
Control (Cytoreductive surgery)
“Debulking” remove part of tumor to enhance other therapies
Increases in cancer seen:
With immunodeficiency diseases (HIV)Aging – decrease in immune system = increase in cancersTransplant patient receiving immunosuppressive therapy
pap test
Cytological method used to detect cancerSince cancer cells lack the cohesive properties of normal cells, so cancer cells tend to exfoliate and mix with secretionsIt can also be performed on other body secretions:Nipple drainagePleural fluidsPeritoneal fluidsGastric washings
According to histological or cellular characteristics of the tumorGraded I to IV with increasing anaplasia or lack of differentiation
grading cancer
Go phase
cells that have left the cycle
Filtration
movement of water and solutes thru membrane bc of a force
ROugh ER
studded and assists with protein making
hypertrophy
increase in cell size with increase in functional mass tissue
Two Perspectives:of cancer cause
Molecular origin within the cellExternal origin in which factors such as age, heredity, and environmental agents influence the inception and growth
Promotion or tranformation
Continual stimulation of carcinogen on abnormal cell still reversible
decrease in cell size or cell number due to decrease in work demand or adverse conditions in environment
atrophy
increase function demand- parathyroid hormone in chronic renal failure
HYPERPLASIA OF PARATHYROID GLAND
golgi apparatus
like the UPS, refines and sorts material for export from cell...example would be insulin
Lipids form cell membrane and are how much of protoplasm?
2-3%
Small changes in DNAFound in many cancers, especially pancreatic and colorectal cancer
point mutations
apperas to have more than one layer
psuedostratified epithelium
DNA contains what?
essential genes with essential info for the making of protein
Cancer compresses and erodes blood vessels, causing ulcerations and necrosis along with frank bleeding and sometimes hemorrhageSign of cancer = bleeding
signs of cancer
what does cancer result from?
process of altered cell differentiation and growth
These cells in the liver that are normally renewed more slowly but can become more rapid after tissue loss
stable cells
what is pathology?
study of structual changes in cells tissues and organs of the body caused by disease
Can cause excess production of a proliferation factorCan lead to production of novel proteins with growth-promoting properties
chromosome translocation
explain growth of neoplasm
uncoordinated and autonomous in that it lacks normal regulatory controls over cell growth and division
These cells are in the GI tract and hemopoietic system and are in a constant state of renewal
liable cells
gi, bone marrow, lymphs, fetus, ovarian follicles
cells that are susceptible to damage
Inactivation of tumor suppressor gene
Mutations of P53 gene on chromosome 17 (tumor suppressor gene) = lung, breast, bowel cancer
What are 6 functions of cell membrane?
1. separates cells from fluid around cell 2. controls enter and exit 3. receptor sites for getting messages 4. flexible and capable of movement 5. molecules extending from surface that help it be recognized as belonging to that person 6. capacity in some cells to send an electrochemical signal
Restrictive Cardiomyopathy
HEREDITARY
CONGENITAL ETIOLOGY
livor mortis
purple discoloration
Anoxia
total lack of oxygen
angiogensis
growth of new vessels
ABNORMAL EMBRYO DEVELOPEMENT
NORMAL GENES
Serum Sickness
Rash, lymphadenopathy, arthralgias, neurological disorders
What does Hypogonadism lead to?
Amenorrhea
Pathology
structural alterations in cells, tissues, and organs that can aid in identifying causes of disease
Mitral Valve Regurgitation
Causes:
Rheumatic heart disease
Dilation of left ventricle
Prolapse
Mitral Valve Regurgitation
Symptoms/Manifestations:
↑ Arteriole pressure
Pulmonary congestion
↓ CO
Intracellular Accumulation
Normal body substancesLipids, proteins, CHO, melanin, bilirubinTriglyceride deposits can lead to fatty liversAbnormal endogenous productsInborn errors of metabolism - Tay-SachsLipofuscin (Alzheimer's) Exogenous productsCoal dust, lead
Certain individuals that are genetically predisposed to develop allergies are called?
atopic
Puncture Wounds
penetrating wounds caused by instruments or objects with sharp points but without sharp edges
Sarcoma
A malignancy that originates in connective tissue.
What is the immunological/inflammatory significance of interleukins?
stimulate immune reaction
carcinoma in situ
preinvasive epithelial malignant tumors of glandular or epithelial origin that have not broken through the basement membrane or invaded the surrounding stroma
Best kind of cancer to have
Explain Non-Hodgkin's Lymphoma.
Nodular-cohesive aggregation of cells
Diffuse-absence of aggregation
Manifestations-painless diffuse lymphadenopathy, NO hilar adenopathy, GI symptoms, immunocompetence
diagnosis-lymph node biopsy
Secrete local chemical mediators and only affect nearby cells
Autocrine
Symptoms
subjective feelings such as nausea, pain, anxiety
What type of tumor grows rapidly?
Malignant
forces opposing filtration
capillary oncotic pressure and interstitial hydrostatic pressure (water is moving into capillary space)
Type 2
Tissue Specific Antigens ( platelets, RBC)medications/ chemicals bind to antigens and change them antibody binds to specific antigens --> Ig M or IgG
Adhesions
The binding together of two surfaces by scar tissue.
A client with underlying Addison's disease is experiencing an acute adrenal crisis. What manifestations would the nurse expect to see? a. fluid overload b. hypernatremia c. hypokalemia d. hypotension
D. Hypotension
controllable risk factors
obesity/ overweight (very strong correlation)high salt intakehigh alcohol consumptionphysical inactivity (independent of weight)stresshigh cholesterol
consanguinity makes ______ more likely
autosomal recessive traits
epidemiology
study of disease trends in a population
huntingtons disease
presents with choriform movements in the upper body and decreased ability to concentrate
The diagnosed impairment of health or a condition of abnormal functioning.
PATHOGENESIS
Peroxisomes
Break down peroxide and break down fatty acids
dehiscence
the release of materials by the splitting open of an organ or tissue.
What type of tumor is not encapsulated?
Malignant
Genotype vs Phenotype
Genotype- genetic composition of person, phenotype- expressions of phenotype
Fat Necrosis
This is specific type of cellular dissolution caused by powerful enzymes (lipases) that breakdown triglycerides, releasing fatty acids. The fatty acids combine with calcium, magnesium and sodium ions to create "soaps." Name this type of necrosis.
Polycythemia
excess of RBC- secondary caused by : high altitudes, smokers, COPD --> risk for clotting
Genetic
A disease, condition, or trait that is inherited as a result of a single gene.
Common causes of peritonitis?
Bacterial invasion or chemical irritation -> perforated peptic ulcer, ruptured appendix, perforated diverticulum and gangrenous bladder, pelvic inflammatory disease, gangrene bowel, gangrene gallbladder
what causes thrombus?
plaque because the fibrous cap destabilized over time
infections that can be spread from one person to another
Communicable
risk factor/predisposing factor
increases the probability of disease but does not cause it
which of the following iscontained in pancreatic exocrine secretions
bicarbonate ion
tRNA (transfer RNA)
moves into cytoplasm where it transports amino acids to the elongating proteins
leukocytosis with a shift to the left, elevated erythrocyte sedimentation rate malaise, nausea, anorexia, increased pulse and respiratory rate, fever, lymphadenopathy
Leukocytosis
Patient #2 is admitted with acute pain in the right upper quadrant, the KUB shows stenosis and congestion in the renal pelvis and claces (tubes), the patient is diagnosed with
Hydronephrosis
Cancer is derived from the Greek word?
Crab (karkinoma)
hyperplasia
increase in organ and tissue size due to increase in # of cells. Must be capable of mitosis for this to occur. Compensatory- enables certain organs to regenerate. Hormonal- estrogen dependent organs. Pathologic- abnormal due to excessing growth hormone or
Gas Gangrene
This type of gangrene is a special type of gangrene caused by anaerobic bacteria. The bacteria produces an exotoxin and hydrolytic enzyme that destroys connective tissue and cellular membranes. Gas bubbles are a common place in the muscle. The treatment is by way of anti-toxin medication. Name this type of bacteria.
Disrupting the cell to cell relationship is what type of cellular injury?
physical....hit by a car
Factors that seem to contribute to ascites are INCREASED capillary pressure due to portal hypertension & obstruction of venous flow through the liver and ________ & ________ retention by the kidney.
Salt & Water
What two cell structures are most immediately and directly involved with a macrophage's protective role?
lysosome, cell membrane
Define metabolic alkalosis
Alkalinity caused by an increase in plasme bicarbonate resulting from causes including diuresis, vomiting, or ingestion of too much sodium bicarbonate.
what physiological changes occur with aging? (4)
atrophy
decreased function
loss of cells
compensatory cellular changes (hypertrophy and hyperplasia -> metaplasia, dysplasia and neoplasia)
vitamin k is required by the liver to synthesize
prothrombin
3+ MAJOR ETIOLOGIES OF DISEASE
1. GENETIC2. CONGENITAL3. ACQUIRED4. OTHER a) nosocomial b) latrogenic (benefit vs. risk) c) idiopathic
what is the second most secretory cell in the body? how many different products does it create?
MP 50
What are types of reactions that are caused by the formation of immune complexes in the blood and their subsequent generalized deposition in target tissues. Typically affected tissues are the blood vessels, joints, and kidneys.
Serum sickness
wound healing- granulation tissue
grows into wound from surrounding tissue. Epithelial cells migrate under scab and use MMPs to unravel.
Microcytic Hypochromic
# of cells ok, but too small and little Hgb
List the dominant clinical manifestation of hypothyroidism...
decreased heart rate, muscle weakness, coarse brittle hair, loss of lateral eyebrows, lethargy/impaired eyebrows, edema, puffy face, pallor, large tongue, hoarsness, COLD INTOLERANCE, constipations, skin changes to coarse/dry, "MYXEDEMA" madness, "MYXEDEMA" heart (cardiomegaly)
Name three secondary sexual characteristics present at the onset of puberty
Male pattern of hair growth
Deeper voice
Increased Muscle Growth 
What is the cause of hypoperfusion dealing with the blood (fluid)?
Hypovolemia, abnormally low circulating blood volume.
what are 5 systemic manifestations?
1) fever
2) increased HR
3) increase in leukocytes
4) pain
5) presence of cellular enzymes
Atrioventricular defect
a condition in which a large hole is present in the center of the heart where the wall between the upper chambers joins the wall between the lower chambers, and the tricuspid and mitral valves are formed into a single layer valve that crosses the defect.
The KUB scans of patient #2 shows an increased size of the left kidney, and also the glomeruli and tubules, the diagnosis for this is
Compensatory Hypertrophy
acute inflammation- cellular response: Chemotaxis
white cells signaled by chemical messengers in the inflamed tissue. The tissue monocytes change to macrophages. Secrete cytokines, which act as chemical messengers
Who does the myxedematous coma occur in most frequently?
elderly women w/ chronic hypothyroidism
What other effects does Estradiol and Progesterone have on the Uterus?
Estradiol - Increase Follicular Development, Increase Bone Density
Progesterone - Increase Basal Body Temperature 
What are the four cardinal signs and symptoms of inflammation?
redness, heat, pain, swelling
what is the recurrence risks for autosomal recessive traits?
1/4 normal homozygote
1/2 carriers phenotypically normal
1/4 homozygote with disesase
ANP – atrial natriuretic peptideBNP – brain natriuretic peptide
Hormones produced by the heart, brain, and kidney which decrease blood pressure and increases urinary excretion of sodium and water
When telomeres wear down, it falls off & stops the replicating process, but cancer turns off this process so it can?
keep growing & growing
What is Grave's Disease & what is it characterized by?
state of hyperparathyroidism accompanied with a goiter, exophthalmos (bulging eyes) or thick skin in pretibial area
What are the two different estrogen hormones?
Estradiol (E2) - Physiologically most important
Estriol (E3) - Produced by Placenta 
STATS: huge cost to society
direct costs $183 billion per year in US#1 reason for hospitalization
Which statement does not apply to the patho of multiple sclerosis
Progressive random degeneration of peripheral nerves
What virus has been linked to B cell lymphomas and is usually seen in HIV patients?
Kaposi's sarcoma herpesvirus (KSHV)
What does the first, Intraluminal Maldigestion, involve and what are its causes?
It is a defect in processing nutrients in the intestinal lumen, caused by pancreatic insufficiency, helpatobiliary disease and intraluminal bacterial growth
What 5 virus' can cause cancer?
1) hep B and C
2) Epstein-Barr virus (EBV)
3) Kaposi's sarcoma herpesvirus (KSHV)
4) Human papillomavirus (HPV)
5) Human T cell Leukemia-lymphoma virus (HTLV)
What are the most coommon forms of cellular degenerative changes?
The accumulation of water in the cytoplasm, or the accumulation of fat in the cytoplasm.
True or false: By itself the process of glycolysis is an ineffective utilization of glucose because very little energy is produced.
True. There is very little energy produced during glycolysis, or the first phase of glucose metabolism. During shock, or other conditions where cells are not adequately oxygenated, only the first stage is completed and the pyruvic acid degrades into lactic acid.
What is a situation in which a benign neoplasm might require medical attention?
Location, can put pressure and stop blood flow
HCO3
Acid
Phenylketonuria
Autosomal Recessive
Prokaryotes
Nucleus-single circular chromosomeslacks histonesEx: cyanobacteria, bacteria, and rickettsiae
Alkalosis
Greater than 7.45
secondary hypertension
malignant hypertension
purpura
larger areas of bleeding
review types of tissues
Complete compensation
pH is normal
Punnett Square
Shows genetic information
Normal Values - PaCO2
35-45
chronic aterial insufficiency
intermittent claudication
transduate
fluid with low protein content
arthus phenomenon
Arthus phenomenon, Polyarteritis nodosa and SLE all result in antigen-antibody (AgAb) complexes being deposited in the tissues
 
a) Arthus: involves injection of foreign Ag, Abs are formed to this Ag, with subsequent Ag injection at another site Ab in blood travel to site and complex with Ag, these complexes become stuck in walls of blood vessels in the area and activate complement, which then attacts leukocytes including PMNs and sets up acute inflammation in blood vessels.
 
This can cause fibrinoid necrosis of blood vessel walls and fibrin forms at this injured area, which can lead to localized clotting blood vessel walls.
 
This is a localized reaction similar to naturally occurring autoimmune disease polyarteritis nodosa.  Unlike autoimmune polyarteritis nodosa, this is temporary and is resolved with discontinuation of foreign Ag
Partial compensation
All three are abnormal
Osmotic pressure pulls fluid (IN/OUT)
In
Gonorrhea
Neisseria gonorrohoeae, incubation 2-5 days to 3 weeks. PID pelvis inflammatory disease. signs: urethritis, cervicitis, proctitis, pharyngitis, conjunctivitis. shedding of fluids, mucosa, pathogen. direct contact with epithelial surfaces.
Buerger's disease
thromboangiitis obliterans, thrombus formation...occurs in lower leg and foot. sensitive to cold and shinny thin skin
chronic inflammation
lasting more than 6 weeks
 
 
liquefactive necrosis

characterized by dissolution of tissues, which become soft and diffluent, usually soft semifluid


mush ultimately transformed into a soft fluid-filled cavity


most often occurs in brain with brain injury
keloids
protrusion of irregular scar tissue from skin surface due to overproduction of collagen
 
excessive production or sensitivity to TGF-B
 
Describe polymyositis-dermatomyositis
Chronic inflammation of multiple skeletal muscles (polymyoitis), sometimes skin is also involved (dermamyoitis)
 
Symtoms: Pain, weakness, impaired movement: All of this is more prominent in proximal rather distal part of limbs, difficulty in swallowing
 
If skin is involved: heliotropic rash of eyelids and extensor surfaces of skin & muscles symptoms.
 
This disease usually has a prolonged course.
Neurotransmitter
-secreted by neurons-fast travel to chemical synapses
what are peripheral proteins?
allow extracellular space
what are transmembrane proteins?
extracellular thru intracellular
Trisomy
Have three chromosomes (should have two)
Normal allele is ______________ in Autosomal Dominant (Dominant/Recessive)
Recessive
Edema
Accumulation of fluid in the interstitial spaces (between cells)
atherosclerosis
risk factors: high blood cholesterol and/ or dislipidemia
Uremia
refers to the accumulation of nitrogenous wastes from protein metabolism as well as the system symptoms caused by decline in renal function w/ the accumulation of toxins in the plasma.
empyema
accumulation of pus in a preformed cavity
karyolysis
lysis of nucleus and chromatin with dispersal of fragments throughout the cell
What diseases involve Type IV hypersensitivity reaction?
TB
leprosy
fungal infections
sarcoidosis
contact dermatitis
syphilis
petechiae
pinpoints of hemorrhage, seen in skin, brain
Adenosine Triphosphate
-used in synthesis of organic molecules, muscle contraction, and active transport-stores and transfers energy-created from the chemical energy contained within organic molecules
Autosomal Recessive has an ______ age of onset and ______ sees new gene mutation
early/rarely
chronic arterial insufficientcy
PAOD, atherosclerosis in popliteal, femoral
cardiac output
volume of blood out per min
Hydronephrosis
Dilation of the renal pelvis and calyces proximal to a blockage leads to this condition, the enlargement of the relan pelvis and calyces.
Nephrotic Sediment
contains massive amounts of protein and lipids and either a microscopic amount of blood or no blood
Postobstructive Diuresis
Elevated urine following surgery to remove an obstruction that causes the renal tubules to be unable to reabsorb water and electrolytes normally
Define inflammation
nonspecific response of the body to injury and only occurs in living, vasculariuzed connective tissues.
Give example of serous inflammation
herpes sores
2nd degree burns
serosal surfaces affected by rheumatoid arthritis
serous pericarditis
serous pleuritis
early pneumonia
serous peritonitis
 
chemotaxis
active movement of of PMNs along a concentration gradient of chemicals
 
chemicals are derived from bacteria, dead cells and tissues, activated complement
diapedesis
movement of RBCs out of blood vessels, only if endothelial cells are severely damaged
Describe the essential components of a typical cell and functions
plasma membrane
lipid bilayer, proteins, and carbohydrate
forms the outer surface of cell
site of contact between cell and environment
 
nucleus
within cell surrounded by nuclear membrance
contains genetic material (DNA), RNA, and proteins
essential for survival of most cells
 
cytoplasm
matrix of cell
contains hyaloplasm, cytoskeleton, organelles
 
What does the following clinical monitoring parameters indicate: Altered O2 and CO2 in blood
lung cell injury
Nonspecific/Natural Immunity
Defense mechanisms that do not depend on prior exposure include:
 
1. physical barriers: skin, mucus
 
2. antibacterial agents: GI acid, lysozyme in tears, vagina, urinary tract
 
3. commendal microorganism
 
4. phagocytes: macrophages, natural killer (NK) cells
 
5. inflammatory reponse
 
6. fever
 
hematoma
large volume of blood trapped in a soft tissue
List “thrombolytic” drugs used in therapy for thrombosis and thromboembolism and how do they work?
These include

t-PA (Alteplase)


rt-PA (Retavase)


streptokinase


urokinase


others

         

These drugs are used to treat existing thrombi and emboli, they work by converting plasminogen to plasmin, which breaks down fibrin, which breaks up thrombus or embolus.  These actually break down clots
What are two eukaryotic organelles?
ribosomes and endoplasmic reticulum
what is oxidative phosphorylation?
-occurs in the mitochondria-aerobic glycolysis (citric acid cycle)-requires ATP
Protein buffers
Hemoglobin can bind with H+ and CO2
pregnancy induced hypertension
PIH or GHTN, without proteinuria(blood vessels leak)
90-95% of all cases of chronic HBP
primary hypertension
Chronic Pyelonephritis
a persistent or recurrent infection of the kidney leading to scarring. One or both may be involved. More likely to occur in pt. with renal infections assoc. w/ some type of obstructive pathologic condition, i.e. renal stones & vesicoureteral reflux. S/S: minimal, may include hypertension, frequency, dysuria, and flank pain.
Prostate Enlargement
enlargement of the prostate caused by acute infection, benign prostatic hyperplasia, or prostate cancer. Each of these disorders can cause encroachment on the urethra w/ obstruction to urine flow
Describe pathological findings of purulent inflammation
accumulation of pus
abcess can form
sinus/fistula can form
empyema can form
granulomatous chronic inflammation
a focal response leading to formation of granuloma
 
a type IV hypersensitivity reaction
 
not preceeded by acute inflammation
Explain the cytoplasmic changes in reversible cell injury
1. Hydrophic changes/vascuolar degeneration: Increased water entry into cell
 
If an injury decreases cell ability to make ATP, the Na+, K+, ATPase pump of a cell cannot pump Na+ out of the cell, therefore creating increase of osmotic pressure, causing water to enter the cell. 
 
Increase water causes swelling of cell, increased number of vacuoles, formation of blebs, swelling of organelles.
 
2. Cell cannot get rid of inclusions, may accumulate fat, lipofuscin
 
3. Other structural changes: Formation of myelin figures
Acute transplant rejection
more usual, within days, first few weeks, or later
 
involves Type II antibody, mediated immune reactions and/ or type IV cell-mediated as follows:
 
1. cellular-cell mediated-Type IV:
Ag-APC-Th1 cells activated, attract and activate Ts/c cells, Ts/c travel to graft and kill graft cells
 
2. cellular-cell mediated-Type IV:
Ag-APC-Th1 cells activated and travel to graft, release cytokines, attract and activate Ts/c cells and macrophages, kill graft cells
 
3. rejection vasculitis: Type II
Ab formed to graft Ag, attach to vascular endothelial cells out of graft blood vessels, complement or ADCC damage to blood vessels
 
What is the difference between myeloblastic/granulocytic leukemia and lymphocytic/lymphoblastic leukemia?
a. In myeloblastic/granulocytic leukemia  - neoplastic cells develop from precursors of granulocytes (such as neutrophils, PMNs)  

b. In lymphocytic/lymphoblastic leukemia, neoplastic cells develop from precursors of lymphocytes (such as T and B cells)
List “antiplatelet” drugs that are used to prevent thrombi and emboli and how do they work?
The drugs include

aspirin


clopidogrel (Plavix)


ticlopidine (Ticlid)    


Aspirin inhibits COX 1, which decreases formation of TXA2, which inhibits platelet activation and aggregation, which prevents thrombi and emboli   

Clopidogrel (Plavix) or ticlopidine (Ticlid) – block platelet ADP receptors which prevents platelet aggregation, which prevents thrombi and emboli.
what does the structure of the plasma membrane consist of?
- caveolae-lipids-carbohydrates-proteins????
what are some important components of cellular enenrgy or examples?
-digestion-glycolysis-citric acid cycle-oxidative phosphorylation
chronic venous insufficiency
can lead to edema and stasis ulcers
Postrenal Acute Renal Failure
A condition characterized by an obstruction that affects the normal flow of urine out of both kidneys and causes pressure to build in the nephrons that eventually shuts them down.
Painful Bladder Syndrome/ Interstitial Cystitis
a condition that includes non-bacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal), non-infectious cystitis (radiation, chemical, autoimmune, hypersensitivity), and interstitial cystitis; occurs most commonly in women ages 20-30 who have symptoms of cystitis, such as frequency, urgency, dysuria, and nocturia, but w/ negative urine cultures and no other known etiology.
Acute Tubular Necrosis
A condition in which the kidney undergoes ischemic or nephrotoxic injury because of severe hypotension, aminoglycosies, or radiocontrast agents; produces granular and epithelial cell casts in urine.
Give an example of purulent inflammation
staph and strep infections
acne pustules
What monitoring is done by means of the following measurements of electrical activity: EMG
electromyogram: neuromuscular function
Describe the process of revascularization/angiogenesis
Regeneration of blood supply to injured area, whether healing by regeneration or by repair.
 
endothelial cells from undamaged vessels form buds that elongate.-may contact parent vessel to form new channel
-may contact bud from another parent to form new channel
-may become isolated and degenerate.
 
new blood vessels are slowly modified into arterioles, venules, capillaries
 
healing region needs more blood vessels, after healing reabsorption of blood vessels and paler appearance of tissue 
 
Innervation by vasomotor neurons
 
Lymphatic vessels similarly regenerate
Describe functions of lymphokines
Lymphokines produced by APCs and T cells include Interleukins (ILs), interferons (IFNs), tumor necrosis factors (TNFs) and colony stimulating factors (CSFs).
 
These all regulate and promote the interaction of cells of the immune system
How do immunization and use of antisera produce therapeutic effects in treatment or prevention of diseases
a) Immunization: prophylactic induction of immune response to prevent an infection by virus, bacteria, etc., involves preparation of antigens (Ag) of a microorganisms or its toxins and introduction into a body called a vaccine
 
vaccine: induces active immunity, Ab are formed against Ag
 
examples: flu vaccine, strep vaccine
 
b) use of antisera: involves injection of ready-made Ab from outside of the body, injected serum containing these outside Ab is called antiserum
 
examples:
rabies antiserum: to neutralize rabies virus before it can replicate
 
antibotulinum toxin antiserum: to neutralize toxin before neuromuscular effects occur
What is the difference between absolute and relative polycythemia? 
Polycythemia is increased RBC concentration in blood.

Absolute polycythemia is increased RBC numbers with normal plasma volume.  

Relative polycythemia is due to plasma deficiency (lower volume) with normal RBC numbers. 

Both types result in increased hematocrit values.
what is mitosis?
cell division in which the two daugter cells receive the same number of chromososomes as the parent cell (both daughters and parent are diploid)
Down Syndrome Trisomy 21 symptoms
flat nasal bridge, eyes narrow, epicample fold, single crease in hand
Acid-Base Regulatory Mechanisms (KIDNEYS)
Kidneys retain or excrete H+ and bicarbonate
Intrarenal Acute Renal Failure
A type of acute renal failure characterized by renal parenchymal damage that disrupts glomerular filtration and eventually destructs the glomeruli.
Uric Acid Stone
A conditoin in which uric acid levels in urine are elevated, preventing the uric acid from dissolving and causing uric acid stones to form.
Formation of leukotrienes in acute inflammation
The lipoxygenase pathway leads to formation of leukotrienes.
 
Leukotrienes are active in chemotaxis and increased vascular permeability.
 
Leukotrienes are also known as slow acting substance of anaphylaxis
 
How do PMNs emerge from blood vessels toward bacteria in tissue?
1. adhesion
 
2.insertion of pseudopods between endothelial cells
 
3.passage through basement membrane
 
4. movement towards source of chemotactic stimuli
 
5. phagocytosis of bacteria
Describe healing of a bone fracture
Bone is a connective tissue, therefore, prolonged healing due to limited blood supply
 
Medical intervention for reduction and immobilization of fracture site.
 
1st stage of healing: 4-5 days after fracture
-removal of blood and debris between bone ends
-formation of granulation tissue, blood vessels, activation and migration of osteoblasts to fracture area
 
2nd stage of healing: occurs over next 3 weeks
-osteoblasts make collagen and cartilage, stabilizes fracture, tissue is called osteoid/soft callus
-osteoid is ossified by osteoblasts to form hard callus (healing area is now enlarged but structurally weak)
 
3rd stage of healing: extends over months - years
-osteoblasts and osteoclasts remodel hard callus to restore normal bone structure
What are the 2 basic mechanisms of Type II hypersensitivity?
1st mechanism: Cytotoxic antibody-mediated reactions: antibodies attach to antigens on body cell surfaces forming AgAb complex on cell surface, IgG or IgM Abs are involved, cells are then susceptible to phagocytosis or lysis.
 
Possible results: Either or Both of the following:
a) complement is activated: binds to exposed Fc part of Ab attached to Ag on cell surface, lysis of cell
 
b) Antibody-dependent, cellular, cytotoxic (ADCC) reaction is initiated: IgG Abs involved, Fab end binds to Ag on cell, Fc end binds to macrophages, PMNs, NK cells or others, phagocytosis or lysis of cell
 
2nd mechanism: antibody mediated cellular dysfunction, no cell injury but disrupted function of cell due to bonding of Ab
 
examples: Graves' disease, myasthenia gravis
What are clinical characteristics of  ALL, AML, CLL, CML
a. acute lymphocytic leukemia (ALL)  -  mainly in children and adolescents, prognosis – good in children due to chemotherapy and BM transplants, poorer in adults                 

b. acute myeloblastic leukemia (AML) -  mainly in adults >55 years old, there are  specific chromosomal abnormalities seen on biopsy,  prognosis – good, high remission rate with therapy     

c. chronic lymphocytic leukemia (CLL) – usually excessive, non-functional B cells,  mainly in adults > 50 years old, prognosis – fair,
chemotherapy to prolong  survival    

d. chronic myeloblastic leukemia (CML) -  mainly in adults 25 to 60 years old, patients often have hepatomegaly, splenomegaly, blast crisis late in disease, 90% of patients have “Philadelphia chromosome”, prognosis – poor, treatments do not prolong survival
List and describe the possible sequelae (consequences) of thrombosis.
a.     resolution – thrombi are broken down by normal body mechanisms; exercise and cardiopulmonary fitness increases probability of this good outcome

b.     organization – after 2 or 3 days, phagocytic digestion of thrombus à  becomes granulation tissue àreplaced with fibrous connective tissue à endothelial cells grow over this tissueà becomes part of blood vessel wall

c.      recanalization – channels form in thrombus during organization (described above), allowing
blood to flow through the thrombus or new fibrous tissue

d.     propagation – occurs mostly in veins – red cap builds up and extends within lumen

e.      Infarction – thrombus blocks blood flow to a certain portion of tissue, this tissue dies and becomes necrotic
what are the types of cell junctions?
desmosomes, tight junctions, gap junctions...considered a type of cell-to-cell adhesion
List the principal cells of chronic inflammation
Macrophages are main cells involved, kill bacteria, release cytokines, long life

Eosinophils and lymphocytes (T and B cells, plasma cells)
What are the differences between classic and exertional heatstroke and how are both treated
Classic: Usually in young or old, debilitated individuals traveling to hot area without water or shade
 
Predisposing factors: dehydration, humidity, poor ventilation
 
Symptoms: Hot dry skin, elevated temperature (>40.5C/155F), tachycardia, confusion, delirium, seizures, coma
 
Exertional: usually seen in young male athletes with intense activity in hot environment
 
Symptoms: Hot clammy skin, elevated temperature (>40.5C/155F), tachycardia, confusion, delirium, seizures, coma
 
Treatment (both): Medical Emergency! Physical cooling, rehydration
What are the microscopic signs of irreversible injury?

distortions and gaps in cell membrane


myelin figures


decreased numbers of lysosomes


nuclear changes which may be either: pyknosis, karyorrhexis, or karyolysis
Describe the process of surface restoration for a skin or organ wound
zone of active mitosis of epithelial cells develops at edge of wound
 
these cells migrate across surface of granulation tissue or in case of minor skin abrasion, across surface of intact dermis
 
these cells secrete new basement membrane
 
after closing of gap, new cells move vertically to surface to restore normal arrangement
Describe the antibody/humoral response when APC presents antigen
-only Th2 cells and Ts/c cells with receptors specific for the antigen will bind to APC (clonal selection)
 
-Binding of Th2 cells involves Type II MHC-Ag complex on APC cells, Ag binds specific T cell receptor for antigen (TCR) PLUS CD4 on Th2 cell
 
-Binding of Ts/c cells involves Type I MHC on APC cells-Ag binds to specific T cell receptor for antigen (TCR) PLUS CD8 on Ts/c cell
 
-Binding of B cell to APC involves IgD on B cell, Fc portion on IgD binds to Fc receptor on B cell and eventual antibody production
 
-B cell divides into antibody producing plasma and memory B cells
 
primary challenge: plasma cell makes IgM, switches to IgG
 
secondary challenge: plasma cell makes mainly IgG
What is anaphylactic shock and what is its pathogenesis?
Anaphylactic shock is life threatening, severe systemic response to an allergen to which the body has been previously sensitized.
 
medical emergency
 
type I hypersensitivity
 
a) first exposure to antigen: Ag-APC-B cells-plasma cells-IgEAb-Fc attaches to mast cells
 
b) second exposure: Fab part of IgEAb-Ag attaches to IgE Ab on mast cells, histamine and other mediators
 
Shock develops as a result of massive release of histamine and other vasoactive mediators into the circulation, which causes vasodilation.  Histamine also causes other effects such as bronchspasm.  Typical symptoms of anaphylaxis include choking secondary to laryngeal edema; wheezing and shortness of breath resulting from bronchospasm; and pulmonary edema and systemic shock and leakage of fluid from the hyperpermeable blood vessels.  Extreme vasodilation occurs in anaphylactic shock.
 
What is chronic HIV encephalopathy/AIDS dementia complex?, when does it occur, and how does this progress during the course of HIV infection?
This is a decline in CNS and neuromuscular function and the cause is not understood.
 
First appears in 2-3% of asymptomatic HIV+ patients during chronic phase and 50% of pateints with lymphadenopathy in chronic phase.  Symptoms are difficulty concentrating, slowing of verbal and motor responses.
 
With progression of HIV, increasing symptoms withdrawal, personality changes, mutism, psychosis, partial paralysis, seizures, incontinence, unresponsiveness
How does thalassemia cause anemia, and what is the difference between thalassemia major/Cooley’s anemia and thalassemia minor? 


Thalassemia is a genetic disorder causing impaired Hb synthesis. 




This looks like iron deficiency anemia (also causes impaired Hb synthesis) and is microcytic (low MCV), and hypochromic (low MCHC) anemia. 




Occurs mainly in Mediterranean ethnic groups.  



In thalassemia major/Cooley’s anemia – patient has 2 defective genes, a  severe condition, patient needs frequent blood transfusions. 

In thalassemia minor, patient has one defective gene and is asymptomatic
When can venous thromboemboli cause significant problems?
If venous thromboemboli are very large or numerous, there can be blockage of large pulmonary orteries or many small
pulmonary arteries. This can result in significant loss of lung function, death.  

Most large venous thromboemboli  arise in deep veins of leg.  This is called deep vein thrombosis (DVT) – the
thromboemboli can be long, cordlike masses.     These travel to lungs à can become trapped at pulmonary valve of heart or in large pulmonary arteries.    This is called pulmonary embolism (PE), and can cause  hemorrhage in pulmonary tissue. 

Also, the high blood pressure in lungs due to occlusion by the embolus can lead to right ventricular failure
what are peroxisomes? Are they located in Eukaryotic orgganelles or Prokaryotic?
they are located in eukaryotic organelles and they contain oxidative enzymes and break substances down into harmless products
What is pus and how is it formed
Dead and dying leukocytes (PMNs), admixed with tissue debris and lytic enzymes released from their granules form a viscous yellow fluid.
What are oxygen radicals and how do they damage cells
Oxygen radicals are oxygen compounds with an extra electron in their orbital.
 
Oxygen radicals include superoxides and peroxide which causes cellular damage to DNA, cell membrances, and proteins
 
They can be formed by normal metabolism, by radiation, chemicals, NO.
 
Vitamins C and E and other antioxidants are thought to be protective against these
What is a traumatic neuroma
If larger nerve is severed and if ends remain seperated, THEN regenerating processes may grow into new scar tissue to form traumatic neuroma.
Describe how Type II hypersensitivity induces hemolytic anemia, myasthenia gravis, and Graves' disease
a) hemolytic anemia: can be caused by foreign chemicals or Ag.  Ag on RBCs activates complement and/or ADCC reaction
 
b) Graves' disease: antibody mediated cellular dysfunction: no cell injury but cell function is disrupted: Ab are formed to TSH receptors (acting as self Ag) on thyroid cells, Ab binding stimulates excessive production of T3, T4.
 
c) myasthenia gravis: antibody mediated cellular dysfunction-no cell injury.  Ab are formed to N2 Ach receptors (acting as self Ag) at NMJ on skeletal muscle cells, receptors are blocked, muscles cannot contract when Ach is released.
How does anemia of chronic disease occur? 
 In chronic disease states, anemia is believed to occur due to a variety of mechanisms.
Why is damage due to venous thromboemboli in liver usually not significant?
Venous thromboemboli that may arise in the portal veins travel to the liver. Damage is usually not significant since the liver has a double blood supply – from the portal veins and also the systemic arteries. 

If a portal vein in the liver is blocked, the affected tissue can usually still be supplied by a systemic artery
after 20 weeks...of pregnancy induced hypertension
gestation values of 140 systolic or 90 diastolic. proteinuria= preeclampsia
How does HIV replicate in host cells
-core of HIV contains RNA and 2 molecules of reverse transcriptase
 
-in host cell, reverse transcriptase converts HIV RNA to HIV DNA, this becomes incorporated into host DNA and starts making parts of the HIV virion
 
-HIV-1 protease cleaves proteins to final form
 
-Virion is shed from cell by "budding", assembled viral core forms sheath of host cell membrance studded with GP120
What is the APTT and what is it used for
This is activated partial thromboplastin time (APTT) –

Used to monitor activity of heparin.  

Calcium and activating agent added to patient blood sample, time to form fibrin clot is measured 

1) normal baseline time to clot is 25 to 40 sec  

2) therapeutic range for heparin is 1.5 to 2.5 X baseline

3) assesses function of intrinsic and common pathways
What are lysosomes and where do they come from?
originate from the golgi and catalyze proteins, lipids, nucleic acids, and carbohydrates-role in autodigestion
What are fat emboli, how do they occur and what are the possible consequences?
Fat emboli consist of fatty yellow bone marrow  


They occur especially with fracture of femur  or tibia, within 12 to 48 hours  


Consequences    
1) can lodge in small arterioles or capillaries – if in lung à dyspnea, possibly respiratory failure           

2) sometimes can pass through pulmonary circulation to systemic arteries à can lodge in   blood vessels of skin à petechiae
      
3) sometimes can lodge in blood vessels of the brain à numerous petechiae, numerous small infarcts of brain tissue à possible coma, death
How does the HIV-1 virus bind to host cells
GP 120 knbs on surface of HIV particle bind to CD4 protein on surface of Th and some other cells: monocytes, macrophages, microglia of nervous system, follicular dendritic cells in lymph nodes, langerhans cells
 
GP 120 knobs also bind to chemokine receptors (R5 and R4) on the above cells
 
GP 120 binds to CD4 , another GP120 knob binds to R5 or R4, close interaction enables merging with host cell and emptying of viral contents into host cell
 
Early in detection, HIV is mostly R5 selective and infects monocytes, spreading the HIV, later HIV is mostly R4 selective and infects Th cells
 
This probably accounts for delay between HIV infection and AIDS
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