NURS 208A Pathophysiology Exam 1 Study Guide PDF

**[PATHOPHYSIOLOGY EXAM 1 STUDY GUIDE]** **[WEEKS 1 AND 2 (Ch. 1-12)]** **[Chapter 1]** **Pathophysiology** -- the study of the underlying changes in the body physiology that result from disease or injury and the body's response to dysfunction or disease - Molecular, cellular, and organ system...

**[PATHOPHYSIOLOGY EXAM 1 STUDY GUIDE]** **[WEEKS 1 AND 2 (Ch. 1-12)]** **[Chapter 1]** **Pathophysiology** -- the study of the underlying changes in the body physiology that result from disease or injury and the body's response to dysfunction or disease - Molecular, cellular, and organ systems - Science of pathophysiology seeks to provide an understanding of disease mechanisms **Pathology** -- investigation of structural alternations in cells, tissues, and organs to identify cause of disease **Pathogenesis** -- process by which a disease or disorder develops - Sequence of cellular and tissue events that take place from the time of initial contact with etiologic agent until ultimate expression **Etiology** -- study of the cause of disease - Biologic agents (bacteria, viruses) - Physical forces (trauma, burns, radiation) - Chemical agents (poisons, alcohol) - Nutritional excesses or deficits **Idiopathic** -- diseases with no identifiable cause Iatrogenic -- diseases as a result of medical treatment Nosocomial -- disease acquired due to being in hospital environment Disorder -- abnormality of function; can refer to illness or particular problem Syndrome -- compilation of signs and symptoms of a specific disease state Sequelae -- lesions or impairments that follow or are caused by disease [Types of Disease?] Prognosis -- expected outcome of disease Acute disease -- the sudden appearance of signs and symptoms - Brief - Immediate - Subacute: intermediate between acute and chronic Chronic disease -- develops more slowly, signs of symptoms last long time - May have pattern of remission and exacerbation - Remission -- periods when symptoms disappear or diminish significantly - Exacerbation -- periods when symptoms become worse or more severe Preclinical -- not clinically evident but will eventually progress Subclinical -- not clinically apparent and not destined to progress Clinical disease -- manifested by signs and symptoms Congenital defect/condition -- [present at birth]; occur as a result of neonatal factors - "birth defect" Acquired defect -- caused by events that [occur after birth] - Ex. infections agents, injury, lack of oxygen, neoplasia [Difference between signs and symptoms?] **Signs** are **objective** alterations that can be observed by someone. **Symptoms** are **subjective** experiences reported by the person with the disease. **Subjective** -- what the patient is experiencing - SYMPTOMS - Ex. pain, nausea, shortness of breath **Objective** -- what the nurse can see/identify - SIGNS - Ex. redness, swelling, fever Clinical manifestations -- signs and symptoms or evidence of disease - How disease arises - Ex. signs and symptoms [ASPECTS OF DISEASE PROCESS] 1. Etiology 2. Pathogenesis 3. Morphologic changes -- anatomic and microscopic changes a. Ex. exams and biopsies 4. Clinical Manifestations 5. Diagnosis 6. Clinical Course [Disease Diagnosis and Predictive Factors] Diagnosis -- naming or identification of a disease - Compiles signs and symptoms, health history, tests to make conclusion \*Reliability -- extent to which an observation, if [repeated], gives [same result] - \*Validity -- extent to which a [measurement tool measures what it is intended to measure] Compares measurement method with best possible method - Ex. using two different tests Sensitivity and specificity: determining the likelihood or how well the test or observation identifies people with or without a disease Prediction value -- extent to which an observation or test result can predict the presence of a given disease or condition [Epidemiology and Disease Frequency] Epidemiology -- study of disease occurrence in human populations - Epidemiologic Methods - How disease is spread - How to control disease - How to prevent disease - How to eliminate disease Incidence -- [number or rate of new disease] cases in an at risk population - Helps predict the risk of being diagnosed with a certain condition in a population Prevalence -- [measure of an existing disease] in a population at a given point in time Morbidity -- functional effects - i.e. symptoms, what happens to body Mortality -- death producing Natural history of a disease -- used as a predictor of outcome for diseases for which there is no effective treatment TYPES OF PREVENTION 1. **Primary prevention** -- preventing disease from occurring - Removing risk factors; no disease - Ex. immunizations 2. **Secondary prevention** -- disease detected early; treatment can effect a cure or stop disease progressing a. Ex. Pap smears 3. **Tertiary prevention** -- prevent further deterioration; reduce complications of present disease b. Help return to highest level of functioning **[CHAPTERS 2 and 3]** Process of Cell Cycle: - G0 -- cell cycle begins - G1 -- cell grows and performs its cellular functions, cell begins to prepare for mitosis - S- synthesis phase, cell begins to prepare for mitosis - G2 -- premitotic phase, cell prepares to divide - M -- cell division (mitosis) Difference between Mitosis and Meiosis? Mitosis -- Meiosis - [Movement of substances across the Cell Membrane] - Diffusion -- movement of molecules in solution to **high to low concentration**; widely dispersed - Passive transport -- transport of substances across cell membrane without the input of energy - Facilitated transport/diffusion -- passive movement of molecules along the concentration gradient with help of membrane proteins; selective process - Active transport -- movement of molecules from an area of **low concentration to higher concentration** with the use of energy (ATP) Osmosis -- net movement of water moving from **low concentration to high concentration** [Body Tissues] What are the four categories of tissues? 1. Epithelial tissue 2. Connective tissue 3. Muscle tissue 4. Nervous tissue Epithelial tissue -- covers the body's outer surface and lines internal closed cavities - Lining of blood vessels, body cavities, alveoli of lungs - Develops from all three embryonic layers - Joined to neighboring cells by cell-to-cell adhesion molecules - Ex. simple epithelium, squamous, cuboidal, columnar Connective tissue -- connects and binds or supports the various tissues - Most common tissue in body - Two types: - \(1) Loose (areolar), adipose, reticular - \(2) specialized connective tissue: (cartilage, bone, RBCs) Muscle tissue -- main function is contraction - Two fibers: - Thin (actin) and thick filaments (myosin) - Different types - Skeletal -- skeletal muscles - Most abundant in body; attached to bones - Cardiac -- heart muscles - Smooth -- GI tract, blood vessels, bronchi, bladder - Involuntary muscle Nervous tissue -- distributed throughout body as a communication system - Neurons (CNS and PNS) - Supporting cells Cell differentiation -- formation of different types of cells and the placement of these cells into tissue types - Controlled by system that switches genes on (increase transcription) and off (decrease transcription) Stem cells -- cells that serve as a reserve source for specialized cells, make regeneration possible in some tissues [Cellular Adaptation] Phagocytosis -- ingestion of other cells Atrophy -- decrease in cell size - Decreased work demands on cell - Oxygen consumption reduced due to decreasing size of organelles - Causes: - Disuse - Denervation atrophy - Ischemia - Loss of endocrine function Hypertrophy -- increase in cell size Hyperplasia -- increase in cell number - Increased workload increases organelle size - Seen in cardiac and skeletal muscle tissue - Occurs in tissues with cells capable of mitotic division (ex. epidermis, intestinal epithelium, glandular tissue) - Physiologic: hormonal or compensatory - Ex. wound healing, liver regeneration (compensatory) - Nonphysiologic: from excessive hormonal stimulation or GF effects - Ex. endometrial hyperplasia - Skin warts Metaplasia -- replacement of adult cells with another - Causes: chronic irritation, chronic smoker, Barrett's esophagus - Reversible when irritant is removed Dysplasia -- deranged cell growth of a specific tissue; cells vary in size, shape, organization - Reversible - Occurs: reproductive & respiratory tract - Precursor to cancer [Cell Injury and Death] Apoptosis -- programmed cell death Necrosis -- cell death in an organ or tissue in a living person - Different types: - Liquefaction necrosis -- some cells die but catalytic enzymes are not destroyed - Caseous necrosis -- cell death that cause tissues to have "cheese-like" appearance - Coagulative necrosis -- cell death when blood flow stops or slows - **Gangrene --** when a considerable mass of tissue undergoes necrosis - dry or moist; affected tissue becomes dry and shrinks - Skin wrinkles, turns brown or black - Gas gangrene -- special type of gangrene that results from *Clostridium* bacteria - Wet gangrene -- interference with venous return - Dry gangrene -- confined exclusively to extremities Ischemia -- impaired oxygen delivery and impaired removal of metabolic end products such as lactic acid Most diseases begin with cell injury: ischemia, necrosis, free radicals Causes of cell injury: - Physical agents -- mechanical forces - Radiation -- ionizing, uv radiation - Chemical -- drugs, lead toxicity, mercury - Biologic -- virus, parasites, bacteria Mechanisms of Cell Injury: - Free radical and reactive oxygen species (ROS) formation - Calcium homeostasis disruption - Hypoxia and ATP depletion **CHAPTERS 4 and 5** Genotype -- genetic information stored in the cells Phenotype -- recognizable traits (physical or biochemical) associated with specific genotype Genetic Mutation - Substitution of one base pair for another, the loss or addition of one or more base pairs, or rearrangements of base pairs - Occurs spontaneously Chromosomes - Genetic information in a cell is organized and stored in chromosomes - 46 chromosomes in humans, arranged into 23 pairs - Of 23 pairs, 22 are *autosomes* - Males are XY, females XX - Two chromatids are connected by a centromere - At the end of each chromosomes are DNA sequences called *telomere*s - Telomeres allow the end of the DNA molecule to be replicated completely Single Gene Disorders (Autosomal) - Single-gene disorders are caused by a single defective or mutant gene. - Defects follow the mendelian patterns of inheritance - Usually obtained through a family genetic history - Results of single gene disorders: - Virtually all single gene disorders lead to the formation of an abnormal protein or the decreased production of a gene product. - Defects in receptor proteins and their function - Defective or decreased amounts of an enzyme **Autosomal DOMINANT** -- a single mutant allele from an affected parent is transmitted to an offspring regardless of sex - Affected parent has 50% CHANCE of transmitting disorder to offspring - Can be wide variation in gene penetrance and expression - **EXAMPLES OF AUTOSOMAL DOMINANT DISORDERS:** - **Marfan Syndrome** -- autosomal dominant; connective tissue disorder manifested by changes in the skeletal system, eyes, and cardiovascular system - Result is long thin body, long extremities, hyperextensible joints, spinal deformities - Affects *fibrillin I*, major component of microfibrils in extracellular matrix - Coded by *FBNI* gene - **Neurofibromatosis (NF)** -- autosomal dominant; condition that causes tumors to develop from the Schawnn cells of the neurologic system - Symptoms: headaches, hearing loss, tinnitus - Two types: - Type 1 NF (NF-1) -- cutaneous and subcutaneous neurofibromas; soft pedunculated lesions that project from the skin (cutaneous; most common type, firm and round) - Type 2 bilateral acoustic (NF-2) -- tumors of acoustic nerve - Both result from genetic defect in a tumor suppressor gene that regulates cell differentiation and growth - **Autosomal RECESSIVE** -- manifests when both members of gene pair are affected (homozygous). - Parents are unaffected but are carriers. - Affects both sexes - Age onset is frequently early in life - Include almost all inborn errors of metabolism - **EXAMPLES OF AUTOSOMAL RECESSIVE DISORDERS:** - **Phenylketonuria (PKU)** -- a rare metabolic disorder caused by a deficiency of the liver enzyme phenylaniline hydroxylase - Allows toxic levels of phenylalanine to accumulate in tissues and the blood - Affects 1 in every 10,000 to 15,000 [infants] - Can result in mental retardation, microcephaly, delayed speech - **Tay-Sachs Disease** -- inherited disorder that destroys nerve cells in the brain and spinal cord - Variant of lysosomal storage diseases known as gangliosidoses - Results in progressive destruction of neurons in cerebellum, brainstem, spinal cord - Infants can appear normal at birth but will begin to manifest weakness over time Chromosomal Disorders Aneuploidy -- abnormal number of chromosomes Monosomy -- presence of only one member of a chromosome pair Polysomy -- presence of more than two chromosomes to a set - **TYPES OF CHROMOSOMAL DISORDERS:** - All three are "alternations in chromosome number" - **Down Syndrome** -- [tri]somy 21; - Most common chromosomal disorder - 95% of cases caused by nondisjunction or an error in cell division during meiosis resulting in a trisomy of chromosome 21 - Results in intellectual disability, characteristic facial features - Small square head, small folds on inner corners of eyes (epicanthal), upward slanting of eyes, large protruding tongue, single palmar crease (simian) - **Turner Syndrome** -- [mono]somy X, absence of all or part of X chromosome - Most frequently occurring genetic disorder in women - Results in short stature - Lose all oocytes by age 2; do not menstruate - Can result in cardiac abnormalities with valves - Diagnosis is delayed - **Klinefelter Syndrome** -- [poly]somy X, condition of testicular dysgenesis; presence of one or more extra X chromosomes in the normal XY complement of males - Most males have one extra X chromosome - Happens due to nondisjunction during meiotic division in one of the parents - Results in enlarged breasts, sparce facial and body hair, small testes, inability to produce sperm - Often goes undetected at birth **CHAPTER 6** Characteristics of Cancer - Disorder of altered cell differentiation and growth - Neoplasia -- new growth - Tumor -- a mass of cells that arises because of overgrowth - Named by adding suffix *-oma* to the parenchymal tissue type from which growth originated - Neoplasm -- abnormal mass of tissuein which the growth exceeds and is uncoordinated with that of normal tissues - Can be classified as **benign** or **malignant** - Growth is uncoordinated and relatively autonomous. - Can't control cell growth and division - Tends to increase in size and grow after stimulus ceases or needs of the organism are met - Cell proliferation -- process of cell division Benign and Malignant - **Benign** -- not malignant or of the character that does not threaten health or life - Containing well-differentiated cells that are clustered together in a single mass - Slow and expansive - Cannot metastasize to distant sites - Do not cause death usually - **Malignant** -- less well differentiated and have the ability to break loose - enter the circulatory or lymphatic system, and form secondary malignant tumors at other sites - Tend to grow rapidly - Can potentially kill - Rob normal tissues of essential nutrients - Anaplasia -- describes the loss of cell differentiation in cancerous tissue, cell is growing in "reverse", losing morphological characteristics - Metastasis -- cells detach from original tumor mass, invade surrounding tissue, and enter blood and lymph systems to spread to distant sites How does cancer spread? - Cancer spreads by [direct invasion and extension]. - Seeding of cancer cells in body cavities - Metastatic spread through the blood or lymph pathways - Most cancers synthesize and secrete enzymes that break down proteins and contribute to infiltration, invasion, and penetration of surrounding tissues. - To metastasize, a cancer cell must be able to break loose from the primary tumor, invading the surrounding extracellular matrix, gain access to a blood vessel, survive its journey through the bloodstream, emerge out to a favorable location, invade the surrounding tissue, begin to grow, and establish blood supply. Factors that lead to cancer: - Heredity - Hormones - Carcinogens - Chemical - Radiation - Oncogenic viruses - Stem cells - Angiogenesis - Microenvironmental effects - Multiple cell types, cytokine, and growth factors **CLINICAL MANIFESTATIONS** of Cancer - Tissue Integrity -- compressed and eroded blood vessels; [ulceration] and necrosis; frank bleeding and hemorrhage - Cancer Cachexia -- weight loss and wasting of body fat and muscle tissue; profound weakness, anorexia, and anemia - Paraneoplastic Syndromes -- inappropriate hormone release, circulating hematopoietic, neurological, and dermatological factors Mechanisms of anorexia-cachexia in cancer: - The mechanism of cancer cachexia appear to reside in a hypermetabolic state and altered nutrient metabolism that are specific to the tumor-bearing state. - The production of glucode (glucogenesis) from lactate contributes to the hypermetabolic state of cachectic people. - The increased expression of mitochondrial uncoupling proteins that uncouple the oxidative phosphorylation process in energy being lost as heat. - The acute-phase response is activated by cytokines such as TNF-a and IL-1 and IL-6.