Exam 1 Flashcards
Define disease.
any distrubance of structure or function of the body
Define acute disease.
sudden and rapid onset
(Blank) is the most useful way to assess acute diseases.
Prevalence
Frequency of acute illness (increases/decreases) with age.
decreases
Define chronic disease.
long term
Chronic disease (increases/decreases) with age.
increases
What are examples of chronic disease?
- heart disease
- cancer
- chronic lung disease
- stroke
- Alzheimer’s
- diabetes
Define idiopathic disease.
a disease that occurs spontaneously; no known causes
Define etiology.
cause of disease
Define pathogenesis.
history and development of illness
Define nosocomial.
disease originating within a hospital
Define iatrogenic.
disease caused by medical treatment
Define incidence.
the # of individuals who develop a specific disease during a particular time period
Define prevalence.
total # of individuals in a population who have a disease
Define sensitivity in regards to testing.
the probability of a test to be positive in the presence of a disease
Define specificity in regards to testing.
the probability of a test to be negative in the absence of a disease
Define a sign.
measurable, objective
Give examples of signs.
- fever
- weight loss
- blood tests/levels
Define a symptom.
reported by the patient, subjective
Give examples of symptoms.
- sore throat
- feelings of discomfort
- reported pain/tenderness
What does this phrase mean?
“Structural and functional disorders are intimately related.”
alterations of one results in alterations of the other
Define a syndrome.
collection of clinical signs and symptoms
Give examples of syndromes.
- Down’s syndrome
- IBS
- Turner syndrome
- Asperger syndrome
T/F: A sick patient can have normal test results.
TRUE – normal test results can have crossover with abnormal test results, meaning normal test results ARE NOT a definitive absence of disease
Define sickness.
presence of disease
Define healthy.
absence of disease
T/F: When talking about sickness and health, signs and symptoms are considered.
FALSE – sickness and health DO NOT involve signs/symptoms; absence/presence of disease if the only factor
Define a qualitative test.
describes the quality; positive or negative
Define a quantitative test.
tests that have numerical results
How is the “normal” established for test results?
Normal = Mean (+/-) 2 Standard Deviations
What does this phrase mean?
“The extent of abnormality.”
that disease is a continuum; not just a black and white answer
What is the importance of the ‘Degree of Abnormality’ ?
greater variance from normal, more likely disease is present
What are 6 characteristics of a good screening test?
- safe
- low cost
- easy to administer
- minimal discomfort
- valid
- reliable
Define valid.
does the test actually measure what it is supposed to be measuring
What are the 2 components of validity?
sensitivity and specificity
Define reliable.
results of a test are considerably the same after multiple different tests were ran; consistency
What source of unreliability is natural blood pressure variability?
- biological variability
What source of unreliability is it when there are multiple arm cuffs in a room to read blood pressure?
- instrument variability
What source of unreliability is it when one person gets different results for after doing multiple readings?
- intra-observer variability
What source of unreliability is it when multiple people have different results for one reading?
- inter-observer variability
Define a screening test.
a test that detects early disease or risk factors for disease in asymptomatic, or healthy people
What do screening test results mean?
indicates probability for disease
T/F: Screening tests are chosen for high sensitivity situations.
TRUE – want the results for a disease early, so you’d want the test to be sensitive
Define a diagnostic test.
a test that establishes the presence or absence of disease as a basis for treatment
What do diagnostic test results mean?
provides a diagnosis
T/F: Diagnostic test are chosen for high specificity situations.
TRUE
T/F: Tests can be both specific and sensitive.
FALSE – most tests are one or another, but NOT BOTH
Define Positive Predictive Value.
among people who truly have the disease, what is the probability that the test will identify them as diseased
Define Negative Predictive Value.
among people who don’t have the disease, what is the probability that the test will identify them as being negative
If a screening test is available for a disease, should it always be employed because it might detect disease early?
NO, b/c it is a waste of materials if the incidence of a certain disease is low for a specific population
Define palliative care.
specialized medical care for people living with serious illness; person can still receive treatment
Define hospice care.
comprehensive comfort care; final answer; no attempts to cure illness
Define prognosis.
predicted course and outcome of disease
What does prognosis include?
- chances for complete recovery
- prediction of permanent loss of function
- probability of survival
- terminal = diseases that end with death
Define remission.
signs and symptoms subside
Define exacerbation.
increases the severity of signs/symptoms
Define relapse.
disease returns after it’s apparent cessation
Define complication.
an abnormal state that develops in a person
Define pathophysiology.
functional changes
Define epidemiology.
study of disease in populations
Define mortality rate.
number of deaths that occur in a population
Define morbidity.
degree of disability; heath problems that interfere with the normal physical, mental, or emotional functioning
Define survival rate.
% of people who survive within a given time period after diagnosis
Define totipotent stem cells.
cells that can differentiate into any cell type, including embryonic & extra embryonic cell types
Define pluripotent stem cells.
can differentiate into cells of all 3 germ layers
- ectoderm
- mesoderm
- endoderm
What does the ectoderm become anatomically?
skin, hair, spinal cord
What does the mesoderm become anatomically?
muscles, organs, glands
What does the endoderm become anatomically?
inner linings like respiratory and digestive tract
Define multipotent stem cells.
more specialized compared to the other 2, but they have a limited range of cells they can differentiate into
What are characteristics of labile cells?
- constantly dividing and proliferating throughout life
- high regenerative capacity and ability to quickly replace damaged cells
Give examples of labile cells.
- skin
- mucous membrane in GI tract
- hematopoietic cells in bone marrow
What are characteristics of stable cells?
- normally in a non-dividing state but can re-enter cell cycle and proliferate in response to injury or damage
- moderate regenerative capacity and can repair tissues when needed
Give examples of stable cells.
- liver cells
- pancreatic cells
- kidney cells
What are characteristics of permanent cells?
- limited or no ability to undergo cell division and proliferation
- low regenerative capacity and do not regenerate after significant damage
Give examples of permanent cells.
neurons, cardiac muscle, skeletal muscle
What is it called when cells actively control their internal environment within a narrow range of physiological parameters?
homeostasis
What are the 3 levels of injury that cause disease?
- molecular
- cellular
- tissue
What are 10 ways cells can become injured?
- inadequate oxygenation
- physical, thermal, chemical
- ionizing radiation
- toxins/poisons
- microorganisms
- inflammation/immune reactions
- nutritional imbalance
- genetic defects
- trauma
- aging
What are the targets for cell injury?
- cell membranes (plasma and organelle membranes)
- DNA
- proteins (structural and enzymes)
- mitochondria (oxidative phosphorylation)
T/F: There is a decline in proliferative and reparative capacity of cells with age.
TRUE – exposure to environmental factors that cause accumulation of cellular and molecular damage
T/F: Telomeres lengthen with age, increasing protection of DNA during replication.
FALSE – telomeres shorten after every cell division; they are crucial in protecting ends of DNA during replication
T/F: Hypoxia is the most common cause of acute cell injury.
TRUE – damage is reversible if O2 is restored, but death if not
What is 5 things is hypoxia due to?
- decreased oxygen in air
- decreased oxygen transport to cells
- diseases of respiratory or cardiovascular system
- poisons
- suffocation/drowning
What is the pathophysiology of hypoxia?
- loss of ATP due to failure of Na/K pump and hydropic changes
- increased anaerobic metabolism which leads to increased lactic acid
Mild injuries produce what 2 visible and reversible changes:
- hydropic change (swelling)
- steatosis (fat buildup in an organ)
What are the 2 types of changes with prolonged injury/stress?
- intracellular accumulations
- altered growth and differentiation
What are 6 molecule examples of intracellular accumulations?
- cholesterol
- mis-folded proteins
- pigments
- glycogen
- fat
- environmental particles
What is the benefit of altered growth and differentiation after chronic cell injury?
allows the stressed tissue to survive or maintain function
What type of changes occur for altered growth and differentiation?
- change in size
- change in # of cells
- change into another type of cell
Define atrophy.
shrinkage, decrease in cell size
Atrophy is due to what physiologically?
aging
Atrophy is due to what pathologically?
- decreased blood supply
- decreased nutrition
- lack of neural or hormone support
Define hypertrophy.
increase in cell size
Hypertrophy is due to….
- hormonal stimulation
- increased functional demand
Hypertrophy results in…
- increased protein synthesis within cell
- decreased protein breakdown
Define hyperplasia.
increase in cell number
Hyperplasia is due to…
- hormonal stimulation
- increased functional demand
- chronic stress
Hyperplasia results in…
increased cell division (if division can occur)
Define metaplasia.
replacement of one cell type with another
Where is metaplasia most common?
Is it reversible?
- epithelium
- yes, when stress is removed
Define dysplasia.
change in cell resulting in abnormal cell size, shape, or organization
Is dysplasia reversible?
yes, to an extent
Define apoptosis.
programmed cell death or ‘cell suicide’
What are functions of apoptosis?
- removes cells that are ‘worn out’
- removes unwanted tissue
- normal process or pathological
T/F: Apoptosis involves activation of caspases.
TRUE
What are causes of apoptosis?
- signaling factor attached to “death domains” of cell surface receptors
- mitochondrial damage inside the cell
- DNA damage
Define necrosis.
- unregulated cell death in tissue or organ
- cell swells and ruptures
- inflammation results
What are the 4 types of necrosis?
- Liquefaction
- Coagulation
- Fat
- Caseous
Describe coagulative necrosis.
- cells have died, but shape and architecture remain
- maintains solid consistency
When is coagulative necrosis typically seen?
infarcts; NOT in the brain
T/F: The dead cells from coagulative necrosis may be replaced.
TRUE – regeneration from neighboring cells, or by scar (fibrosis).
Describe liquefactive necrosis.
- complete dissolution of necrotic tissue
When is liquefactive necrosis typically seen?
- with infections (infiltration by neutrophils)
- brain infarcts
Describe caseous necrosis.
- accumulation of amorphous (no structure) debris within an area of necrosis
- tissue architecture is abolished
- viable cells are no longer recognizable
When is caseous necrosis typically seen?
- associated with tuberculosis
- some seen with fungal infections
Describe fat necrosis.
- fat tissue
- damaged cells release lipase
- released fatty acids react with calcium (creates chalky white areas)
When is fat necrosis typically seen?
- mechanical trauma
Define gangrene.
large mass of tissue undergoes necrosis
T/F: Gangrene is its own special type of necrosis.
FALSE – its a term for necrosis that is advanced and highly visible
Define dry gangrene.
lack of arterial blood supply, but venous flow can carry fluid out of tissue
- tissue tends to coagulate
Define wet gangrene.
lack of venous flow lets fluid accumulate in tissue
- tissue tends to liquefy and infection is likely
Define gas gangrene.
clostridium infection produces toxins and bubbles
What are the 4 hallmarks of inflammation after an injury?
- Swelling
- Redness
- Pain
- Heat
Inflammation is a response to cell injury that:
- neutralizes harmful agents
- removes dead tissue
What are the 4 stages of Acute Inflammation?
- Vascular Stage
- Cellular Movement of WBC into tissue
- Elimination of pathogen
- Repair
Vascular Stage: Injury to a blood vessel triggers…
the clotting system
Vascular Stage: The clotting system forms fibrinous meshwork at injured/inflamed site to….
(4)
- prevent spread of infection
- keep microorganisms and foreign bodies at the site of greatest inflammatory cell activity
- form a clot
- provide framework for repair/healing
Vascular Stage: Main substance involved in clotting system is….
fibrin; an insoluble protein
Vascular Stage: Explain the purpose of “brief vasoconstriction, followed by vasodilation.”
vasoconstriction:
- prevents spread of pathogen/stops blood loss
- hyperemia in injured area
vasodilation:
- increased blood flow (mediated by vasoactive amines)
- capillaries become more permeable to allow WBCs to site of irritation)
Vascular Stage: What are the side effects of permeable capillaries?
- edema (swelling)
- exudate (movement of cells and fluid out of vasculature)
Cellular Movement: What is the most involved cell during inflammation?
- neutrophils (also most abundant WBC)
Cellular Movement: What is the function of WBCs during inflammation?
- destroying infective organsims
- removing damaged cells
- releasing more inflammatory mediators
Cellular Movement: What adhesion proteins allow leukocytes to enter an injured area?
- selectins: rolling
- integrins: complete stop, adhesion
What mediates changes seen in inflammation?
plasma-derived
- clotting system
- complement system
- kinin system
cell-derived
- vasoactive amines
- membrane factors
- cytokines
- reactive O2 compounds
Mediators of Inflammation: What cell releases vasoactive amines, like histamine and serotonin?
What is the function?
- mast cells
- vasodilation and vascular permeability
Mediators of Inflammation: Function of the complement system.
activates or collaborates with every other component of the inflammatory response
Mediators of Inflammation: Function of the Kinin system.
- activate and assist inflammatory cells
- primary kinin is bradykinin
- causes dilation of blood vessel, pain, smooth muscle contraction, vascular permeability and leukocyte chemotaxis
Define serous exudate.
watery exudate: indicates early inflammation
- low in protein and inflammatory cells
Define fibrinous exudate.
thick, clotted exudate: indicate more advanced inflammation
- more severe
- high vascular permeability (passage of fibrinogen into tissues
- inflammation of linings
Purulent exudate (supperative).
pus: indicates a bacterial infection
- severe acute injury
- liquefactive necrosis
- associated with pus (large number of neutrophils
Define empyema.
collection of pus in body cavity
Anatomic characteristics of chronic inflammation
- less intense cardinal signs
- macrophages accumulate in the damaged area, releasing inflammatory mediators
- lymphocytes
- granulomatous inflammation
What is granulomatous inflammation?
- macrophages mass together around foreign bodies
- connective tissue surrounds and isolates the mass
Consequences of chronic inflammation
- persistent chronic inflammation
- fibrosis = resolution to scar
- fibroblasts and collagen result in fibrous repair
Define lymphangitis.
red streaks, usually due to infection
Define lymphadentis.
enlarged tender lymph nodes
Define lymphadenopathy.
enlarged tender lymph nodes all over the body
What are systemic effects of chronic inflammation?
- fever (pyrogens act directly on the hypothalamus)
- malaise
- drowsiness
- liver = acute phase response
During acute-phase response, leukocyte cytokines….
- affect thermoregulatory center –> fever
- affect CNS –> lethargy
Liver makes fibrinogen and C-reactive protein…..
- facilitate clotting
- bind to pathogens
- moderate inflammatory responses
T/F: A higher Erythrocyte Sedimentation Rate (ESR) means higher inflammation and RBC count.
TRUE
When is inflammation considered to be over?
at the beginning of repair
Define regenerative.
nearly complete restoration
Define healing.
regeneration and scarring
Define fibrous repair.
scar formation
What are the 3 phases of wound healing?
- inflammation
- proliferation
- remodeling and maturation
More about the proliferative phase.
- cell migration into wound
- angiogenesis and in growth of granulation tissue
- fibroblast migration and deposition of extracellular matrix
