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Pathophysiology Exam 1 Questions &
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Etiology - ANSWERSthe cause of the disease Pathogenesis - ANSWERSthe start of development of disease evolution of disease Development or evolution of disease, from initial stimulus to ultimate expression of manifestations of disease Clinical Manifestations - ANSWERSsigns or symptoms Nosocomial - ANSWERSinfection r/t exposure in healthcare environment Ex: pt that developed UTI from catheter Idiopathic - ANSWERSunknown cause Iatrogenic - ANSWERSCause results from unintended or unwanted medical treatment (EX: hypothyroidism after thyroid surgery; alopecia [hair loss] after chemotherapy). Risk factor (predisposing factors) - ANSWERSA factor that when present increases the likelihood of disease: increases/risk probablity of contracting illness ex: smoking increases risk of lung cancer Precipitating factor - ANSWERSCauses pathologic event Ex: if someone is exposed to allergic event (bee sting) causes anaphylactic shock Etiology Disease Classification - ANSWERS symptoms - ANSWERSsubjective feeling of abnormality in the body Signs - ANSWERSobjective or observed manifestation of disease
Acute - ANSWERSdisease that comes on quickly/suddenly- usually more severe but short lasting Chronic - ANSWERSdevelops slower-over months or years and can last a life time Exacerbation - ANSWERSwhen you have a sudden increase in signs/symptoms of disease or severity Ex: asthma- can live with it but if exposed to allergen can flair up Remission - ANSWERSDecline in severity of sign and symptoms of the disease More than 5 years= permanent remission Sequela - ANSWERSunwanted outcome of condition that is associated with an acute illness -paralysis from stroke what can cause red blood count would be higher - ANSWERShigh altitude The medical examiner report states that the etiology of the disease is overexposure to radiation. Etiology refers to - ANSWERSthe cause A person experiences stress when: - ANSWERSwhen a demand exceeds a person's coping abilities resulting in: - ANSWERSreactions such as disturbances of cognition, emotion, and behavior that can adversely affect well-being Individualized Influences on Stress Response: - ANSWERSAge: due to lifetime experiences- person can react different in different parts of life Gender? A lot of gender responses are due to hormonal level differences Biological Cycles: Culture: Personality characteristics: type A higher levels of stress Who Worked to discover a new sex hormone by Injecting ovarian extracts into rats - ANSWERSDr. Hans Selye He Witnessed structural changes in stress conditions such as: - ANSWERSEnlargement of the adrenal gland Thymic and other lymphoid structure atrophy got smaller- help body to maintain WBC response and immunity Development of bleeding ulcers in the stomach and duodenal lining General Adaptation Syndrome (GAS) is used to - ANSWERS
Hands get sweaty Anticipatory response - ANSWERSEx: anticipation of homeostasis disruption Stomach clenches, heart pounds, etc Psychologic Mediators and Specificity***** - ANSWERS Psychoneuroimmunologic Regulation - ANSWERSNeuropeptide Y (NPY): some in lymphatic tissue. * Promotes vasoconstriction * Released/Produced with chronic stress Immune modulation by psychosocial stressors leads directly to ____ outcomes - ANSWERSHealth; The more stress the PT has, the harder it is for wound to heal Neuropeptide Y (NPY) - ANSWERSa sympathetic neurotransmitter- recently shown to be a stress mediator *because NPY is a growth factor for many cells, it is implicated in atherosclerosis and tissue remodeling NPY promotes - ANSWERSvasoconstriction NPY is released/produced with - ANSWERSchronic stress The more NPY you have the more stressed you are and more likely you are to produce neurosclerosis ??****CHECK PAGE 215 - ANSWERS Hormones that influence stress response **Table 8-4 - ANSWERS Psychologic distress - ANSWERSGeneral state of unpleasant arousal after life events that manifests as physiologic, emotional, cognitive, and behavior changes Ex: divorce may leave you at risk for illness or depression FIGURE 8-8 PAGE 218**** - ANSWERS Stress-age syndrome - ANSWERSExcitability changes in the limbic system and hypothalamus Increased: - ANSWERScatecholamines, ADH, ACTH, and cortisol Decreased: - ANSWERStestosterone, thyroxine, and other hormones Immunodepression - ANSWERSDecreased response to viral, fungal, and bacterial antigens Decreased speed of tissue damage repair
Which of the following is responsible for elevation of heart rate due to stress? - ANSWERSEpinephrine degenerative - ANSWERSResults from the degenerative changes that occur in tissue and organs (EX: osteoporosis, osteoarthritis). Neoplastic - ANSWERSDue to abnormal or uncontrolled growth of cells. (EX: cancer) (Neo= new; Plasm= cancer). Congenital - ANSWERSDue to a defect in the development, hereditary factors, or prenatal infection; present at birth (EX: cleft lip, cleft palate). Corticotropin-releasing hormone (CRH) is released by the - ANSWERSHypothalamus Stress may defined as any factor that stimulates the - ANSWERSHypothalamus to release CRH Which of the following is true? a. Stressors initially stimulate the adrenal cortex b. Stressors stimulate immunity c. The emotions, fear, anxiety, and grief can act as stressors d.Stressors are the same for all individuals - ANSWERSC Glucocorticoids are highest during the stage of - ANSWERSresistance The physiologic response to the stress of a students final exam may be - ANSWERSReactive The production of cortisol in response to stress can be initiated by - ANSWERSthe hypothalamus, anterior pituitary, and adrenal cortex. Cortisol - ANSWERSaffects protein catabolism What can occur in response to stress? - ANSWERSincreased systolic blood pressure In response to stress, the adrenal cortex secretes - ANSWERScortisol and aldosterone Coping - ANSWERSmanages stressful demand exceeding an individuals resources Biochemicals secreted by the adrenal cortex in response to stress are ___________________ - ANSWERScorticoids ____________ cause disturbances in cognition, emotion, and behavior. - ANSWERSstressors
How does stress affect the Growth Hormone (Somatotropin) and what was it originally supposed to do? - ANSWERS-Produced by the anterior pituitary and by lymphocyte and mononuclear and phyocytic cells -Affects protein, lipid, and carbohydrate metabolism and counters the effects of insulin -Enhances immune function -Chronic stress decreases growth hormone Endorphins - ANSWERSreleased in traumatic stews and acute stress situation such as parachute jumping Sex hormone - ANSWERStestosterone suppresses immune activity (decrease during stress), estrogen seems to produce more robust immune profile in females How does stress affect the Testosterone Hormone and what was it originally supposed to do? - ANSWERS-Secreted by the Leydig cells in the Testes -Regulates male secondary sex characteristics and libido -Levels decrease because of stressful stimuli -also decreases with aging -exhibits immunosuppresive activity What does Aldosterone do? - ANSWERS-water retention -maintains blood volume -angiotensin vasocontricts What do Beta-Endorphins do? What are they? - ANSWERS-Proteins found in the brain that have pain-relieving capabilities -Released in response to a stressor -Enflamed tissue activates endorphin receptors -Hemorrhage increases levels, which inhibits blood pressure increases and delay compensatory changes -Interacts with immune system -Endogenous opiates What does Estrogen do during stress? - ANSWERSExerts a calming affect What does Melatonin do in response to stress? - ANSWERSincrease List all the stuff Norepinephrine does - ANSWERS1) Increase pupil dilation
- Increase blood pressure
- Increase sweat gland action (arm pits and hands)
- Piloerection
- Increase arteriole smooth muscle contraction Adaptation - ANSWERSThe ability to respond to physical and psychologic stressors to return to and maintain homeostasis
What is Problem Focused Coping? What does it involve? - ANSWERSThe attempt to actively change one's own mental reaction to stress by conscious intellectual actions or by changing the condition in the environment that is causing the stress It involves: Seeking information or advice, taking problem solving action, and developing alternative rewards Morphology - ANSWERSChanges in the body/organs that reflect the disease Sensitivity - ANSWERSproportion of people who are positive on a test who truly have the disease, 'if condition present, how likely is it that the person will test positive?' specificity - ANSWERSpercentage of people who test negative on the test who are truly negative, 'if the person tests pocitive, how likely is it that they really have the condition? ELISA test - ANSWERSfor HIV, good sensitivity but bad specificity, may have false positive Western Blot test - ANSWERSpoor sensitivity but good specificity-done on positive ELISAs and those who are still positive on this test are diagnosed predictive value - ANSWERSability of a test to predict the presence of a condition in a population, positive means proportion of true positives and negative means proportion of true negatives mammogram - ANSWERSbetter negative predictive value than positive biopsy - ANSWERSbetter negative and positive predicitve value preclinical state - ANSWERSdisease present but no signs and sx, will progress at some point subclinical state - ANSWERSdisease present but no signs and sx and will not necessarily progress carrier state - ANSWERSperson harbors organism but does not show any signs of the disease, may pass it on acute - ANSWERSsevere, ofton self limiting, shows s and sx chronic - ANSWERScontinuous, long-term process (not curable, may be controlled, exacerbations and remissions) subactue - ANSWERSintermediate between chronic and acute terminal - ANSWERSwill lead to death
necrosis - ANSWERScommon type of cell death with severe cell swelling and breakdown of organelles hypoxia - ANSWERSlack of sufficient O2 is the single most common cause of cellular injury atrophy - ANSWERSdecrease or shrinkage in cellular size ischemia - ANSWERSreduce blood supply resulting in lack of O2 to cells irreversible (lethal) - ANSWERSpoint of no return structurally for a cell when severe vacuolization occurs coagulative - ANSWERSType of necrosis commonly occurring in heart/kidneys hyperplasia - ANSWERSan increase in the number of cells resulting from an increased rate of mitosis ____ death of the entire person - ANSWERSsomatic hypertrophy - ANSWERSan increase in cell size and consequently in size of affected organ fat - ANSWERStype of necrosis commonly occuring in the pancreas/breasts dysplasia - ANSWERSabnormal size, shape and organization of mature cells Usually transforms to different tissue type **May be reversible anoxia - ANSWERSacute lack of O2 to cells EX: when arm is left with Tourniquet on vacuoles - ANSWERSdevelop in cell's cytoplasm when oxygenation is not restored muscle stiffening occurring within 6 hours of death - ANSWERSrigor frailty - ANSWERSCommon clinical syndrome in elderly leading to falls, functional decline, disease and death Etiology of Cell Injury - ANSWERSDisease Poor nutrition- to maintain proper functioning Hypoxia/Ischemia: need O2 (powers ATP) Genetics Physical/Mechanical: Physical: frostbite, car accident, burns Chemical (drugs are chemicals)
Aging Process Cellular Function is altered by: - ANSWERSCellular Adaptation Cellular Injury Cellular Neoplasia Aging Cellular Adaptation - ANSWERSbodys response to either normal or physiological condition/pathological disease state Ex: Breast feeding a child, breast enlarge for lactation- this is a cellular function that occurs for a normal state cellular injury - ANSWERSmay or may not be reversible. If injury is too severe to prolonged- likely to not recover from it aging - ANSWERSCan cause changes in how cells adapt Cellular Death All disease occur at _____ level - ANSWERScellular causes of cell atrophy - ANSWERSDisuse Cellular injury If not enough blood/O2 to cells they will get smaller: (ischemia) Aging do not want hypertrophy of ____ cells - ANSWERScardiac metaplasia - ANSWERSis when cells are not what they should be and: Replace of one differentiated cell type with another Cell retains same basic tissue type Reversible if injury is removed Ex: Smoking will cause bronchial cells to become tougher to tolerate injury; if continued, will turn into dysplasia If metaplasia injury persist it leads to ____ - ANSWERSdysplasia dysplasia cells like to turn into ___ - ANSWERScancer A patient has an arm cast removed and the casted arm is somewhat smaller. What type of cellular adaptation has occurred? - ANSWERSatrophy PAGE 81 FIGURE 3-18 - ANSWERS Cellular Injury Mechanisms - ANSWERS-Hypoxic injury: -Free radical/reactive oxygen species injury -Chemical injury
Laceration - ANSWERSdeeper cut- usually with more bleeding Oncosis - ANSWERSwhen cell fills with water, swells (reversible- if persists can lead to ccellular death) Organomegaly - ANSWERSthe swelling caused by oncosis Manifestations of Cellular Injury: - ANSWERSCellular accumulations (infiltrations) Necrosis ***not good - ANSWERSSum of cellular changes after cell death Damages surrounding area that are healthy Apoptosis **Good - ANSWERSActive process of self destruction, programmed cell death When body has used cell as much as it needs to, it destroys cells and rids of them Body creates 10 billion new cells every day If cell is injured body tells it to destruct it Coagulative necrosis - ANSWERSTypically occurs in Kidneys, heart, and adrenal glands -Protein denaturation Type of necrosis: - ANSWERSCoagulative Liquefactive Caseous Fat Gangrenous Liquefactive necrosis: - ANSWERSTypically seen in Neurons and glial cells of the brain Are rich in Hydrolytic enzymes: when they escape cellular walls they digest surrounding tissues into liquid Leads to area becoming walled off like a cyst Bacterial infection Staphylococci, streptococci, and Escherichia coli Caseous necrosis: (Clumped cheese) - ANSWERSGranular soft areas of tissue, often walled off Tuberculous pulmonary infection (TB infections) Combination of coagulative and liquefactive necrosis Fat necrosis - ANSWERSseen in area with high fat tissue content Breast, pancreas, and other abdominal organs Action of lipases Break down triclygerides Tissue becomes white, chalky looking
Gangrenous necrosis - ANSWERS****more common Death of tissue from severe hypoxic injury Dry vs. wet gangrene Dry cogulative nicrosis (shrunken head) (ischemia-tissue below will be black) Wet; area will swell up, become cold, very foul odor, greenish black color, can lead to death) Gas gangrene Clostridium (bacteria) Anaerobic bacteria producing gas bubbles Large tissue area dies off Apoptosis - ANSWERSProgrammed cellular death is regulatory mechanism All cells are constantly undergoing apoptosis Physiologic vs. pathologic - ANSWERSPhysiologic: what body needs to maintain normal cell turnover Pathologic: deficiency in enzymes or cellular event that causes process Apoptosis vs. Necrosis IN BOOK* - ANSWERS ____ is normal, inevitable process - ANSWERSaging ____ always abormal, despite age - ANSWERSdisease Normal life span - ANSWERSgenerally 80- Varies by region Hawaii has lowest mortality MS has one of the highest mortality rates Gender differences - ANSWERS80 for men, 75 for women Cellular aging - ANSWERSAtrophy, decreased function, and loss of cells Tissue and systemic aging: - ANSWERS-Progressive stiffness and rigidity -Sarcopenia Sarcopenia - ANSWERSloss of muscle mass and strength If pt is active physically they will show much less of these aging - ANSWERSProgressive stiffness and rigidity Frailty - ANSWERSputs pt at high risk for falls, fractures, disease and death
Approximately __% of American hospital patients (about 2 million every year) acquire a clinically significant nosocomial infection. - ANSWERS Nosocomial infections are responsible for ____ deaths annually in the US - ANSWERS]about 20,000 deaths What protective mechanisms do our body are in place to prevent infection? - ANSWERSInnate immunity- cells that protect skin, hair, nails (physical barriers) Adapt immunity Lifestyle behaviors- healthy diet, physical activity, water, sleep, low stress What risk factors predispose someone to an infection? - ANSWERSNutrimental deficits- vit D or C Chronic illness pt Diabetics- sugar is great breeding ground for bacteria Age High stress Break in skin (burn, etc) Surgery/drugs that suppress immune response (prednisone) Smoking/ drug abuse immunosuppression - ANSWERSsomeone with low immune response systemic disease - ANSWERSif body is fighting infection/surgery they are susceptible to disease transplant drugs - ANSWERS(this purposely reduce immune response to prevent transplant rejection) What reduces the body's immune system? - ANSWERSsystemic disease, stress, medications (steroids) TABLE 5- ******* - ANSWERS Why babies are more at risk for infections: - ANSWERS-Just born- immature immunity (Decreased) -Impaired IgM activity- immunoglobulin that protects body from disease -Temperature control is impaired (temp can change quickly) -Impaired Communicated (hasn't developed) Why elderly are more at risk for infections: - ANSWERS-Impaired immunity (decreased phagocytic activity- they consume/digest cells in body) -Febrile response blunted (its slower, not as efficient- not up as much as it should be etc)
-Impaired communication- confusion is an early sign First line of defense - ANSWERSNatural barriers: physical, chemical, mechanical Normal flora, skin, nail, hair If first line of defense is breeched: - ANSWERSSecond line takes action Second line of defense - ANSWERSinflammation Third line of defense - ANSWERSAdaptive/acquired immunity adaptive immunity - ANSWERSBody has to make a memory- to make response faster next time of exposure- after exposed to particular germ ***slower First Line of Defense Physical and mechanical barriers: *Skin/ mucous membrane - ANSWERStightly packed epithelial cells- has high content of fat cells- inhibits grows of bacteria/fungi Bacteria and organisms don't like growing in fat Don't like dry skin cells- need moisture to grow First Line of Defense: Physical and mechanical barriers: *Linings of the gastrointestinal, genitourinary, and respiratory tracts - ANSWERSorganisms like to stick to it Sloughing off of cells Coughing and sneezing: does this to expel anything it sees as invader Flushing: effort of body to kill pathogen Vomiting: expels pathogens/invaders Mucus and cilia(lungs/nasal passages)- has glycoproteins to help kill Skin membranes of vaginal/stomach prevents bacteria growth- highly acidic environment- if it passes through that- vomiting First Line of Defense: Biochemical Barriers - ANSWERS-Synthesized and secreted: saliva, tears, ear wax, sweat, mucus- has enzymes that fight against bacteria (Can break down walls of bacteria) -Antimicrobial peptides: -Normal Bacterial Flora What things impair the hospitalized patient's first line of defense? - ANSWERSMedications: Prolonged antibiotics/ steroids -interfere with immune health Iv/catheter= portal of entry
When stimulated- bags burst and balls in bag fall out- histamine is released When these bursts, the others are released or synthesized (increased vascular permiability, vasovilation, hive formation, bronchoconstriction- increases stomach acid production) - ANSWERSHistamine Mast cells synthesized other mediators of inflammation such as: - ANSWERSLeukotrienes Prostaglandins Platelet-activating factor: activated platelets Leukotrienes - ANSWERS-Similar effects to histamine in later stages -Increase vascular permeability **Work slower Prostaglandins - ANSWERS-Similar effects to leukotrienes; they also: induce pain -Work directly to nerve cells -Aspirin works to inhibit these prostaglandins Platelet activating factor: activated platelets - ANSWERSSimilar effect to leukotrienes and platelet activation Increased vascular permeability Chemical Mediators of Immune Function: - ANSWERS Clotting Mechanisms - ANSWERS-starts a another barrier to infection -Is signal to body for neutrophils -Provides frameworks for healing Cytokines and Chemokines - ANSWERS-mediators of inflammation -Released by: t cells, immune cells, macrophages -Mediation of immune response **Increased release of WBC and induce inflammation Kinins - ANSWERSVasodilation and increased in inflammatory process Complement system: - ANSWERSSystem of 20 proteins that promote lysis (consumption) of target cells and inflammation FIGURE 5-4 - ANSWERS FIGURE 5-10 - ANSWERS Phagocytosis - ANSWERSProcess by which a cell ingests/exposes of foreign material
Margination (pavementing) - ANSWERSWBC move across vessel walls and Adherence to endothelial cells Diapedesis - ANSWERSEmigration of cells through the endothelial junctions Chemotaxis - ANSWERSMacrophages are strong long term defenders- eat invadors Macrophages are strong long term defenders that eat ___ - ANSWERSinvaders Neutrophils - ANSWERScirculate in body for 6 hr- if not needed they go through body destruction (apoptosis) ***Also referred to as PMN: polymorephonuclear neutrophils Ingest bacteria, dead cells, and cellular debris Neutrophils are produced in ____ - ANSWERSProduced in bone marrow Predominate in first response- early inflammatory response - ANSWERSneutrophils Bans - ANSWERSstore baby neutrophils n bone marrow for when they are needed Neutrophils cells are short lived and become a component of the ____ ______ - ANSWERSpurulent exudate Purulent Exudate - ANSWERSpus Monocytes are immature - ANSWERSmacrophages Monocytes - ANSWERSare produced in the bone marrow, enter the circulation, and migrate to the inflammatory site, where they develop into macrophages Macrophages are highly efficient ____ ____ - ANSWERSimmune cells Macrophages typically arrive at the inflammatory site ___ hours or later after _____ - ANSWERS24; neutrophils macrophages are capable of ____ _____ - ANSWERScellular division **Once they get there they can grow What are the main phagocytes? - ANSWERSMacrophages, monocytes Eosinophils - ANSWERS-Mildly phagocytic -Help defend body against parasites/ allergies -Contain histaminase- which breaks down/mediates histamine **Ex: if asthma attack- will have high eosinophils Histaminase break down/mediates ____ - ANSWERShistamine
