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Advanced Pathophysiology Exam
Cellular Physiology - Prokaryotes - Answer -• Prokaryotes [only cells for 3 billion years]
- single cell organism
- Cyanobacteria [blue-green algae]
- Bacteria
- Rickettsia
- [Rocky Mountain Spotted Fever]
- Bound by cellular membrane that carries out all activities
- Single circular chromosome for genetic information Eukaryotes - Answer -eu = good karyo = nucleus [large) -complex intracellular anatomy -organelles = membrane bound compartments of specialized function within the cell
- histones - bind with DNA
- chromosomes
- cell plasma membrane/cytoplasm carries organelles Eukaryotes - Answer -Found in :
- Higher organisms/plants {people}
- Fungi
- Protozoa
- Most algae Cellular Communication - Answer -Chemical messenger systems :
- move from cell to cell through channels in the membrane
- move into extracellular fluid
- bind to receptors on or near cell surface {first messenger) Cellular Communication - Answer -There are external signals converted to internal signals carried by second messenger = Epigenetics: The cells do not interact just among themselves, they interact within the environment - cell adaptation, evolution
- second messenger triggers change Plasma Membranes Magic mem-BRAIN - Answer -1. Structure
- Protection
- Activation
- Transport
- Cell to Cell interaction Plasma Membranes Magic mem-BRAIN - Answer --Membrane "interacts intelligently" with environment to produce behavior of other cellular components making it.... -The true brain of the cell = not the nucleus *nucleus is just the microprocessor making copies of itself Integral Membrane Proteins - IMPs - Answer -A. Imbedded into the membrane-cell's "sense organs" - Based inside the cell membrane. Integral Membrane Proteins - Answer -Phospholipids - contain polar and non-polar molecules)
- Action proteins conducting business of cell membrane and cell membrane function. . Nucleus -Transcription of genetic information by RNA = messenger to organells and directs cellular activities-foremen to accomplish healthy living organism. - Answer --double membrane-nuclear envelope -Histones bind with DNA and cause it to fold into -chromosomes - prevent breakage) -stores genetic information - blueprints) -repair and replication of DNA Organelles - Answer -A. Surrounded by individual biologic membranes allowing for different biochemical environments - small city
- synthesize proteins & hormones
- transport proteins
- isolation/elimination of waste
- metabolic processes
- Breakdown antigens
- Maintain cellular structure & motility Types of Organelles - Answer -B. Endoplasmic Reticulum -membrane factory that synthesizes/transports protein & lipid components of organelles - membrane fatty for transprt C. Golgi Complex
- director of macromolecular traffic Types of Organelles - Ribosomes - Answer -A. Ribosomes -site for cellular protein synthesis -Cellular respiration =Krebs cycle - responsible for oxidative phosphorylation to produce ATP Krebb's or Citric Acid Cycle - Answer -36 mols ATP produced.
-Oxidative phosphorylation is product of Kreb's cycle and glycolysis.
- ATP is much greater product in citric acid cycle compared to glycolysis. Glycolysis - Answer -Net 2 mols ATP per glucose - pyruvate cycle Types of Organelles continue - Lysosomes - Answer -A. Lysosomes contain digestive hydrolases -lack of lysosomal alpha-q, 4-glucosidase yields accumulation of glycogen in lysosomes or Pompe Disease
- Tay-Sacks- accumulation of GM2 ganglioside
- Gout- uric acid accumulates within lysosomes = Both belong to the lysosome disease process Types of Organelles continue -Perioxisomes*, Mitochondria, Cytoskeleton, Microtubules - Answer -A. Perioxisomes
- cause metabolic oxidation of H2O2 "bubbling"- leads to free radicals that damage cells. B. Mitochondria
- oxidative phosphorylation yielding ATP C. Cytoskeleton
- maintain cell structural shape D. Microtubules
- add strength to the cytoskeleton Intercellular Communication :Hormonal communication,Paracrine, - Answer -aHormonal communication - carried in blood to cells throughout body - thyroid stimulating hormone b. Paracrine - chemical mediators rapidly metabolized so exert a more local action on tissue Intercellular Communication - Autocrine,Neural - Answer -Autocrine* - chemical released inside own cell - secreting cell targets itself - cancer cells Neural- synaptic signaling / neurotransmitters between nerves
- Unpaired electrons
- Unstable molecule
- Either donates electron or steals one to gain homeostasis
- Injures other chemical bonds
- Robbing Peter to Pay Paul
- Some free radicals arise normally during metabolism Free Radicals - Answer -• Body's immune system's cells purposefully create them to neutralize viruses and bacteria
- Environmental factors such as pollution, radiation, cigarette smoke and herbicides can also spawn free radicals. Free Radicals - Answer -• Normally, the body can handle free radicals, but if antioxidants {vitamins}are unavailable, or if the free-radical production becomes excessive,damage can occur. Of particular importance is that free radical damage accumulates with age. Free Radical continue - Answer -•May initiate chain reaction •initiated by : x-rays, endogenous oxidative reactions, metabolism of exogenous chemicals & drugs •Methods to Terminate Free Radicals - Answer -1. Antioxidants - vitamins) •Vitamin E, C -Omega-3 fatty acids, fish oil, walnuts •2. Enzymes in the body To prevent aging you would have to control or limit the amount of free radicals produced in the body. Hypoxia - Answer -•Causes membrane damage to mitochondrial cells •Role of antioxidants is to decrease damage •If swelling continues-mitochondria swell yielding no ATP and cell death •Ischemia
Chemical Injury to cells - Answer -•1. Carbontetrachloride- detoxified in liver with cytochrome P- enzyme system + chlormethyl-highly toxic free radical destroying liver {used to clean clothes} •2. Alcohol, Pollutants, Insecticides, carbon monoxide, Lead -Fatty liver is a chemical injury of its own that can lead to cirrhosis. Infections by Microbes - cellular injury - Answer -•1. Invade & destroy cells •2. Produce toxins - E-Coli 0157 especially in meat not fully cooked •3. Hypersensitivity - Inflammation and immunity responses Immunologic/Inflammatory Injury - Answer -•Systemic lupus erythamotosis •Vasculitis •Rheumatoid arthritis -Immune diseases that cause tissue damage and organ damage itself. Genetic Factors - Answer -Contribute to a disease that causes cellular death and tissue injury: •Huntington disease •Sickle cell •Sensorineural -hearing loss : The hair cells fall over and become dysfunctional in the cochlea Nutritional Imbalances -cellular and tissue injury - Answer -•Malnutrition : •Vitamin & mineral deficiency - Beriberi), protein deficiency - Kwasiorker's), and fluid/electrolyte imbalances •Hypervitaminosis - too many •Enzymatic deficiencies: Sprue or Celiac's Disease - malabsorption syndrome Injurious Physical Agents - hypothermia - Answer -•a. Hypothermia - chilling or freezing) •high intracellular sodium concentrations from formation and dissolution of ice crystals •increased membrane permeability
Ionizing Radiation - tissue injury - Answer -- Younger tissue with a fast metabolism is more affected - Classed as carcinogenic •Epigenetic effects : the cell RNA / DNA malfunction leading to cancer from ionizing radiation. Illumination - cellular injury - Answer -•Fluorescent lighting: eyestrain, decreased vision, Ionizing radiation leads to cataracts •Halogen: benign growths, skin cancer -cover light Mechanical Stresses cause injury - Answer -•Physical impact: low back pain, contusion •Irritation: shearing effect on skin cells •Vibration: carpal tunnel, synovitis •Extremes in Joint Maneuvers •Shoulder Abduction / Torn rotator cuff Noise - cellular injury - Answer -•Hearing impairment •acoustic trauma (gunfire) •sensorineural with prolonged decibel increases {EPA warnings and regulations} -Kids and earbuds may lead to increase in sensorineural hearing loss Volume Composition - Answer -Body Fluids -water -electrolytes -non electrolytes: dextrose, urea, creatinine Fluid Compartments - Answer -A. Intracellular - within the cell membrane B. Extracellular : Plasma, Interstitial, Lymphatics
Fluid Movement - Osmosis - Answer -A. Permeability of cell membrane Osmosis = movement of fluid from an area of higher water concentration to lower water concentration [particles low to hight] B. Terms Applied to Particle Concentration: Hypertonic Hypotonic Isotonic Molecule/Particle Movement A. Diffusion B. Facilitated diffusion - Answer -A.Diffusion = disperse and reach uniform concentration [high particle concentration to low particle concentration] - Equilibrium B. Fascilitated diffusion - carrier molecule [lipid] moves particle Mediated Active and Passive transport - Answer -A. Passive Mediated requires no ATP : Glucose in RBCs requires protein transporter) B. Active Mediated requires ATP: ions cross influenced by chemical or electrical gradients - electrochemical gradients Active transport - Answer -requires energy primary requires ATP directly secondary involves co-transport or counter-transport
Hyperkalemia- Causes, S/S, Treatment - Answer -Greater than 5 mEq/L Causes: increased dietary intake, decreased renal output S/S: muscle weakness, N/V, diarrhea, peaked T waves, dysrhythmias TX: dietary restriction, Kayexalate, CA gluconate, NaHCO3 - Force potassium back into the cell - temporary fix. Hyponatremia : Causes, S/S, Treatment Severe -lethargy, confusion, muscle twitching, convulsions, sternal edema, decreased BP, increased Pulse - Answer -Less <135 mEq/L Cause: is Dilutional Perception of Body, NG suction -depletes chloride ions with water replacement, diuretics, D5W only, sweating S/S: Anxiety, anorexia, muscle cramps, exhaustion Hyponatremia : Treatment - Answer -Tx: Normal volume or hypervolemia -water restriction and diuretics Neurologic symptoms -3% NaCL IV Hypernatremia: Causes, S/S, Treatment - Answer -Greater >145 mEq/L Causes : deprivation of water, patients cannot perceive or respond to thirst S/S: restlessness, weakness, disorientation, hallucinations, swollen tongue, sticky mucosa, increased Temp, increased BP, increased weight, increased urine SG, rubbery firm skin Hypernatremia: Treatment - Answer -TX: Gradual decrease in Na, D5W or D5 1/4NS
- as brain shrinks away from its subarachnoid space = subarachnoid hemorrhage. SIADH: Causes, S/S, Treatment - Answer -Cause : neurologic, pulmonary, excess hypotonic IV fluids, stress, medications, psychogenic polydipsia, edematous states [ CHF] S/S: Same as Dilutional Hyponatremia Tx :underlying cause, TX for hyponatremia Hypocalcemia: Causes, S/S, Treatment - Answer -Less 8.5 mg/dl serum Ca
Causes: parathyroid disease, thyroid disease: Taken the calcium from the blood serum and placed it into storage such as the teeth and bones. S/S : positive Chvostek's and Trousseau's TX : Calcium replacement vitamin D Hypercalcemia: Causes, S/S, Treatment - Answer -Greater > 10.5 mg/dl Causes : parathyroid adenoma :Calcium taken from the bones and teeth now in the serum in high concentrations S/S : N/V, muscle weakness, lethargy, confusion, stupor, coma, sinus brady, AV block, kidney stones TX : surgery, NaHCO 3 , phosphates, saline IV, steroids Hypermagnesemia: Causes, S/S, Treatment - Answer -Greater than 2.5 mEq/L Causes : Rare: excessive intake, impaired excretion with renal failure S/S : Nausea/vomiting, muscle weakness, hypotension, bradycardia, respiratory depression T/X : withhold source, promote excretion, calcium salts, hemodialysis Hypomagnesemia: , Causes - Answer -< 1.5 mEq/L Causes : impaired absorption, increased loss, renal, diuretics, alcoholism, endocrine disorders [Diabetes) , metabolic acidosis Hypomagnesemia: sign/symptoms, Treatment - Answer -S/S : much like hypocalcemia, Depression, irritability, increased muscle reflexes, tetany, convulsions, muscle weakness, tachyarrhythmias, ataxia, nystagmus, hypokalemia, TX : Magnesium salts Cellular Housekeeping : A. Endocytosis B. Exocytosis - Answer -A. Endocytosis - cells engulf materials from surroundings
- pinocytosis -small particles "drinked"
Respiratory Acidosis High PCO 2 - Answer -Causes : retention of CO 2 S/S : lethargy, decreased respirations cold clammy skin, disorientation TX : increase respiratory rate or efficiency Respiratory Alkalosis Low PCO 2 - Answer -Causes : Decreased CO 2 in the blood S/S : numbness, tingling..may progress to tetany and convulsions TX : decrease respiratory rate and/or Re-breathe exhaled air Metabolic Acidosis Base deficit + low pH Tx: underlying cause, increase respiratory rate, NaHCO3 - Answer -Causes : Diarrhea, Addison's disease, diabetic ketoacidosis, fat metabolism, protein breakdown for ATP production, increased CL - chloride [ DM drugs cause acidosis] S/S: Kussmaul breathing [compensatory] cold, clammy, coma, respiratory arrest Metabolic Alkalosis Base Excess + high pH - Answer -Causes: Nausea, vomiting, ingestion of sodium bicarbonate S/S : numbness, tingling, tetany, convulsions TX : treat cause Examples of Acid/Base Management - Answer -C/C: 26 YOM C/O indigestion, burning in stomach, waking with mucus in back of throat, "feeling full" in his esophagus. "Eats Tums all day" without relief. -PE: Tender in epigastric area -Diagostics: EGD reveals diffuse esophagitis and gastritis
- Assessment: GERD Examples of Acid/Base Management Plan - Answer -Assessment: GERD Plan: 1st line: H2 Blockade {Zantac, Tagamet, Pepcid 2nd line: Proton Pump Inhibitor {Prilosec, Prevacid, Nexium...}(more complete H+ blockade STRESS - Answer -Physiologic stress is a chemical or physical disturbance in the body produced by change that requires a response *in turn that response over time causes chronic disease through altered chemical states *may precipitate some disease [cardiac] and `worsen symptoms and outcomes in others Homeostasis - Answer -- Homeostasis: balanced physiological and psychological state of an organism, "steady state" -As a transactional concept, stress initiates a demand on an organisms resources Demand>coping abilities= stress reactions=alterations in cognition and behavior! GENERAL ADAPTATION SYNDROME (ARE) - Answer -Stages 1.Alarm-CNS aroused and body's defenses initiated 2.Resistance or adaptation initiates fight or flight 3.Exhaustion becomes progressive breakdown of compensatory mechanisms Hypothalmic-pituitary-adrenal (HPA) axis and Stages : Alarm, Resistance or adaptation, Exhaustion - Answer -A. Alarm =stressor triggers hypothalamus and sympathetic nervous system B. Resistance=adrenal hormones : cortisol, norepinephrine, epinephrine c. Exhaustion=impaired immune response and chronic disease PSYCHOLOGICAL RESPONSES TO STRESS:
- Locus Coeruleus = Releases norepinephrine: increased arousal, vigilance, and anxiety Real Stressors = Reactive Response - Answer -Limbic to the paraventricular nucleus leads to reactive response from : Stimulate the locus coeruleus, central response, endocrine response. Central nervous system response : Sympathetic nervous system - adrenal gland - Answer -Adrenal gland : secretes epinephrine 80% [Fight or flight] and norepinephrine 20% [arousal] Central nervous system response : Sympathetic nervous system - Hypothalamic corticotropin releasing hormone - Answer -Posterior Pituitary -Antidiuretic hormone & oxytocin Anterior Pituitary -Prolactin, endorphins, GH, ACTH ACTH -adrenals release cortisol Physiological Actions of alpha Receptors : Alpha 1 - Answer -Alpha-1 : Increase Glycogenolysis [breakdown glycogen in liver to make glucose] , * increase Smooth muscle contraction [CV & GI] Physiological Actions of alpha Receptors : Alpha 2 - Answer -Alpha 2 : Decrease Smooth muscle relaxation [GI] Smooth muscle contraction [some vascular beds] Inhibition of Lipolysis [Breakdown of fat], Renin release [Lower blood pressure], Platelet aggregation and decrease Insulin secretion Physiological Actions Beta Adregenic Receptors : Beta 1 - Answer -Beta 1: Increase Lipolysis [breakdown fat], Myocardial contraction, Rate, Force Physiological Actions Beta Adregenic Receptors : Beta 2 - Answer -Beta 2:Increase* hepatic gluconeogenesis, hepatic glycogenolysis [Increase breakdown of glycogen to make glucose for energy], muscle glycogenolysis, release of insulin, glucagon, renin, *Smooth muscle relaxation of bronchi, blood vessels, GI, GU *Selective beta blockers - asthmatics
Physiological effects of cortisol *Stress hormone to keep you alive such as prednisone which produces a period of wellness until the reason for sickness is corrected - Answer -Cortisol: Increases serum lipid levels, Increases protein synthesis in liver; and therefore increases serum amino acids BUT Decreases it everywhere else
- Anti-inflammatory -suppression [Asthma]
- Pro-inflammatory-increases - Inside the blood vessel can adhere to the lumen of the vessel Physiological effects of cortisol - Answer -3. Decreases lipids in extremities ; Increases it in the trunk [central obesity]Extra cortisol in the system Cushing's disease
- Immune suppression [Th1 and increase Th2 shift]
- GU-enhances excretion of Calcium Physiological effects of cortisol continued : Connective , Bone, Vascular/myocardial - Answer -1. Connective tissue- decreases fibroblasts = delay healing
- Bone-decreases bone formation = osteoporosis)
- Vascular/myocardial-maintains normal blood pressure, increased responsiveness, optimizes CV function Physiological effects of cortisol continued : CNS, Estrogen/pregnancy, Muscle - Answer -4. CNS- modulates perceptual /emotional functioning, essential for normal arousal/activity
- Estrogen/pregnancy-possible synergism
- Muscle-maintains contractility and maximal work output for skeletal and cardiac Stress and coping If you can't decide if the rash is fungal, then you put a steroid on a fungal infection and it will exacerbate the fungal infection. However, if you put antifungal on a rash that is causing inflammation it will not respond. - Answer -1. Effective coping: Effective Coping Transient effect return to homeostasis
- Ineffective coping : Distress/illness
