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PathoPhys > Midterm Blueprints > Flashcards

Midterm Blueprints Flashcards

1
Q

ABG interpret

A

Normal pH 7.35-7.45
Acidosis <7.35
Alkalosis >7.45
Respiratory acidosis
Elevated pCO2
Ventilation depression
Respiratory alkalosis
Depressed pCO2
hyperventilation
Metabolic acidosis
Depression of HCO3
Increase in non carbonic acid
Focus on uremia
Metabolic alkalosis
Elevated HCO3
Excessive loss of metabolic acids

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2
Q

Hypocalcemia presentation

A
  • normal range 8.5-10.2;
    Blood transfusions are common cause
    Citrate solution

symptoms muscle cramps,
twitching, tingling, numbness, spasms;
Seizures
Tetany
Involuntary contraction of muscles that leads to painful muscle cramps, spasms, and overactive neurological reflexes

Parentheses
Pins and needles

Psychiatric manifestations
Anxiety, depression, emotional lability

Carpopedal spasm/Trousseau’s sign
Involuntary contraction of muscles in hand and wrist

Chvostek’s sign
Tapping of the facial nerve in front of the ear causes ipsilateral contraction of the facial muscles

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3
Q

Buffers

A

Buffers can absorb excessive H+ ions (acid) or hydroxide ions (OH-) (base) to minimize
fluctuations in pH;

located in ICF and ECF compartments

Principle plasma buffers: bicarb, protein, phosphate
Bind to hydrogen ions

Central elements for how drugs work

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4
Q

Intracellular vs Extracellular volume (dehydration)

A

decrease in both IC/EC fluid;

concentration of ions in IC fluid becomes more concentrated;
Hypotonic ECF causes intracellular water gain and swelling

Water moved from intravascular space to interstitial space into cell
Causes cell to swell

Moves by osmosis
**Dehydration causes extracellular change NOT intracellular

EC fluid loses volume but increases ions = osmotic balance

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5
Q

Components of the cell membrane- phospholipids, proteins, cholesterol, carbohydrates

A

Plasma membrane
Lipid bilayer
Studded with proteins
Carbs bound to glycoproteins & glycolipids

Phospholipids, cholesterol, glycolipids

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6
Q

Why is there a difference in ion composition between intracellular and extracellular compartments?

A

Potassium levels inside the cell

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7
Q

Endoplasmic reticulum

A

Network of cisternae extend throughout the outer nuclear membrane

Cell injury can lead to cell death by detachment of ribosomes from ER

RER
Synthesis, folding, and transport of protein components

SER
Synthesis of steroid hormones
Remove toxic substances

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8
Q

Hypomagnesemia also causes what other electrolyte finding?

A

Hypomagnesemia also causes hypokalemia due to impaired cell uptake of K+
Hypocalcemia and hypokalemia
Muscle changes
Found in chronic ETOH

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9
Q

Sexual abuse by first degree relative yields =?

A

rare recessive genetic disorders
* AKA: Consanguinity
Mating of two related individuals
Offspring are inbred
Important for recessive diseases

ex: Royal disease

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10
Q

Nondisjunction
(true/false question)

A

Causes Aneuploidy

error in which homologous chromosomes or sister chromatids fail to separate

normally during meiosis or mitosis

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11
Q

Transcription- facts

A

Process with DNA template synthesizes an RNA, forming mRNA

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12
Q

Down syndrome

A

most common chromosomal condition; two copies of chromosome
Trisomy 21
Low nasal bridge, epicanthal folds, protruding tongue, flat low-set ears

Increased risk of congenital heart disease, respiratory infections, leukemia

Three copies of chromosome 21

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13
Q

Turner’s syndrome

A

affects females only;

occurs when one of the X chromosomes is fully or partially missing;

Tx = growth hormone, estrogen, maintaining heart health

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14
Q

Fragile X syndrome

A

FMRI gene makes little to no FMRP, so brain development does not occur;

many learning disabilities.

social/behavioral problems

Second MC cause of intellectual disability
1:7000 males 1:11000 females
Large ears, long face, prominent jaw and forehead, flat feet

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15
Q

Expressivity 

A

Variation in phenotype associated with a particular genotype

Caused by modifier genes, environmental factors, and mutations

Ie. von Recklinghausen disease, type 1 neurofibromatosis

Autosomal dominant

Brown spots on skin to malignant tumors, scoliosis, gliomas, and neuromas

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16
Q

Praeder-Willi syndrome

A

caused by a genetic abnormality that occurs due to the deletion or dysfunction of gene 4Mb on chromosome 15q;

affects multiple aspects of physical, mental, and behavioral development;

constantly hungry = obesity

Inherited from father

Short, obese, hypogonadism

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17
Q

Incidence rate

A

number of new cases of a disease that are reported (typically over one year course)

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18
Q

Colorectal cancer

A

affects 1 in 21 Americans;

familial clustering; one affected first-degree relative that has CRC increases ; inherited APC gene mutation

risk 2-3 times

Second to lung cancer un number of deaths annually

Somatic mutations
High-fat, low-fiber diet, red meat, processed meat

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19
Q

Methylation = ? 

A

= Methylation occurs through the process of turning genes “off”

Can lead to silencing of tumor-suppressor genes in the development of cancer
Causes gene to become transcriptionally inactive/silent
DNA less likely to transcribe into mRNA
Key component of x-inactivation

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20
Q

Sickle Cell Anemia - autosomal recessive

A

needs two copies of gene (one from each parent) to have SCD;

only one from each parent = sickle cell trait

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21
Q

Autosomal dominant disorders versus Autosomal recessive disorders - what similarity do they have?

A

both types can be inherited from parents who are carriers;

pattern of inheritance differs; dom (50%) ; recess (25%)

both types of disorders result from genes on autosomes

(non-sex)

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22
Q

DNA polymerase function

A

DNA replication and repair;

binds to DNA template strand and synthesizes new strand by adding nucleotides;

also helps in removing damaged nucleotides

Travels along the single DNA strand to add nucleotides

Primary enzyme involved in replication

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23
Q

Familial HLD
autosomal dominant

A

most significant genetic predisposition

incr risk for: CAD, HTN, mi, stroke, etc

Alteration in ABCA1 or APOA1 gene

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24
Q

Breast Cancer

A

Affects 12% of american women
If first degree relative with breast cancer, risk doubles
Recurrence risk increases if the age of onset in the affected relative is early and is the cancer is bilateral
Autosomal dominant 5-10%
Linked to chromosomes 13 and 17
Increases risk for ovarian cancer

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25
Q

IgE

A

E: primarily associated with the allergy and defense against parasites;

binds to high-affinity receptors on mast cells and basophils;

upon allergen exposure, IgE cross-links with allergens, leading to mast cell or basophil degranulation (H2 inhibitors)

Type 1 hypersensivity reaction
mediated by histamine
seen w/ asthma resp.

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26
Q

IgM

A

M: first immunoglobulin produced in response to an infection;

is present as a pentamer and can activate complement;

IgM plays a crucial role as a mediator of the early immune response to newly introduced pathogens;

can neutralize pathogens directly or guide immune cells to remove them via phagocytosis

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27
Q

IgG

A

G: most abundant immunoglobulin in the circulation and

plays an essential role in long-term immunity against pathogens; (2nd stage)

provides protection by recognizing and binding to pathogens directly, promoting phagocytosis or complement activation

When an immunoglobulin crosses the placenta

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28
Q

Staphylococcus -why is it common in wounds? What is it?

A

common in wounds because it naturally colonizes skin/mucous membranes without causing harm= Normal flora

Gram + cocci

facultative anaerobic;

extracellular

Need to know difference b/w strep/staph-for correct antibiotic rx

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29
Q

Benefits of a fever (more from m5 lecture)

A

stimulates immune system;

increases the performance of immune cells
aids infectious response
kills many organisms
decr serum levels of: iron, zinc, copper
deprives bacteria of food
promotes lysosomal breakdown & apoptosis
incr lymphocytic transformatino & phagocyte motility

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30
Q

Innate immune response

A

the first line of defense against invading pathogens; natural barriers
Inflammatory resp.
non-specific, & faster than adaptive immunity

also required to initiate specific adaptive immune responses

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31
Q

Primary lymphoid tissue example

A

bone marrow and thymus gland;

where lymphocytes are produced and mature

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32
Q

Inflammation - describe definition 

A

Local manifestations of inflammation
Vascular changes and leakage of circulating components into the tissue

Nonspecific

Prevents and limits infection and further damage

Limits and controls inflammatory process
Interacts with components of the adaptive immune system

Prepares the area of injury for healing

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33
Q

Hypersensitivity reactions- Type 1

A

1: also known as immediate hypersensitivity or environmental allergies,

involve the rapid release of histamine and other chemicals in response to an allergen;
H1 receptors
Bronchial constriction
Edema
Vasodilation
H2 receptors
Increased gastric secretions
Decreased histamine release
Tissue damage from mast cells

IgE antibodies;

examples are allergic reactions and anaphylaxis

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34
Q

Hypersensitivity reactions- Type 2

A

2: also called cytotoxic hypersensitivity;

TIssue specific

involves the destruction of target cells by antibodies;
5 mechanisms
NK cells recognize antibodies and release toxic substance to destroy target cell
Phagocytosis
Cell eating
Neutrophils release granules
Antibody-dependent cell-mediated cytotoxicity
Target cell malfunction

examples include autoimmune hemolytic anemia and blood transfusion reactions, Graves DS

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35
Q

Hypersensitivity reactions- Type 3

A

3: occur when there is an excess deposition of immune complexes composed of antibodies and antigens;

Immune complex mediated
Antigen-antibody complexes
Not organ specific
Large - macrophages
Medium - deposited in tissues
Small - renal clearance

ex: systemic lupus erythematosus and certain forms of vasculitis; Reynauds phenomenon

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36
Q

Hypersensitivity reactions- Type 4

A

4: also known as delayed-type hypersensitivity,
cell mediated

are mediated by T cells rather than antibodies;
cytotoxic lymphocytes

typically develops several hours to days after exposure to an antigen;

delayed-type hypersensitivity reactions are involved in conditions such as:

contact dermatitis, TB tests, and certain forms of allergic and autoimmune diseases

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37
Q

Endotoxins & Exotoxins

A

Endotoxins and exotoxins are two types of toxins produced by bacteria;

endotoxins are composed of lipopolysaccharides found in the cell wall of Gram-negative bacteria and are only released upon cell lysis;

exotoxins are usually proteins produced and secreted by Gram-positive and Gram-negative bacteria and are released into the surrounding environment;

exotoxins carry out specific functions, such as inhibiting host protein synthesis or causing cell lysis,

VS

endotoxins primarily cause non-specific immune system activation and inflammation

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38
Q

Acute bacterial meningitis - lab findings

A

Cerebrospinal fluid (CSF) analysis is the cornerstone for diagnosing bacterial meningitis;

typically shows an elevated white blood cell (WBC) count, >2,000

predominantly consisting of neutrophils (a type of WBC); >1180

CSF glucose levels are usually decreased <34, while the protein levels are significantly elevated >220

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39
Q

Severe neutropenia - why isolate the patient?

A

characterized by abnormally low levels of neutrophils;

isolated to protect them from potential infections;

neutrophils play a crucial role in defending the body against bacterial and fungal infections;

when someone has neutropenia, their immune system becomes compromised, and they are more susceptible to infection

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40
Q

Alloimmunity example

A

person receives a tissue transplant or organ transplant from a donor who has different histocompatibility antigens = transplant rejection;

during blood transfusion, where the recipient’s immune system reacts to the different blood group antigens of the donor blood = transfusion reaction

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41
Q

Acute inflammation line of defense 

A

Elevated neutrophils
Fever that is produced by hypothalamus
Endogenous pyrogens

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42
Q

SLE-Lupus

A

exact cause of lupus is unknown, but it is believed to result from a combination of genetic, environmental, and hormonal factors;

diagnosing lupus can be challenging because its symptoms can mimic those of other conditions;
Butterfly rash
+ANA

treatment aims to manage symptoms, prevent disease flares, and minimize organ damage

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43
Q

MHC’s facts

A

Major histocompatibility complexes
Glycoproteins on surface of all human cells
Except RBCs
Recognize foreign substances

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44
Q

Humoral immunity

A

component of adaptive immunity that involves the production of antibodies by B lymphocytes (B cells);

these antibodies, also known as immunoglobulins, are proteins that can recognize and bind to specific foreign substances called antigens

Two phases
Primary
Secondary
Higher proportion of IgG
More rapid due to memory cells
Does not kill, target, or stimulate other leukocytes
Directly inactivates microorganisms

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45
Q

Adaptive immunity

A

complex defense system that involves the coordination of humoral and cellular responses to specific antigens

Slower to develop, more specific, longer memory

Antigens are the molecules that react with components of adaptive immune system

Antibodies and lymphocyte surface receptors

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46
Q

Cellular immunity,

A

also known as cell-mediated immunity,

involves the activation of T lymphocytes (T cells);

T cells recognize antigens presented on the surface of infected cells or antigen-presenting cells

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47
Q

Innate Immune system: (PAMP’s) and DAMP’s 

A

(PAMPs) are molecular structures commonly found on pathogens such as bacteria, viruses, and fungi;

structures are recognized by pattern recognition receptors (PRRs) expressed by cells of the innate immune system;

examples of PAMPs include lipopolysaccharide (LPS) on the outer membrane of Gram-negative bacteria and lipoteichoic acid (LTA) on Gram-positive bacteria

Pathogen associated molecular patterns (PAMP’s)

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48
Q

Innate Immune system: PAMP’s and (DAMP’s) 

A

(DAMPs) are endogenous molecules that can be released from damaged or dying cells;

DAMPs are recognized by PRRs and can activate innate immune responses similar to PAMPs;

can include various molecules such as ATP, DNA, RNA, heat shock proteins, and extracellular matrix components

Danger-associated molecular patterns (DAMP’s)

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49
Q

Dysfunctional wound healing during the inflammatory response

A

Ischemia
Hemorrhage
Hypovolemia
Fibrous adhesions
Excessive scar formation
Infection
Wound sepsis
Hypoproteinemia
Medications

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50
Q

Innate immunity -inflammatory process

A

first line of defense against pathogens and other foreign substances that enter the body;

is a rapid, non-specific immune response that serves to contain and eliminate the invader;

*A cell mediated system response that provides a mechanical barrier against invading pathogens that is a concurrent activated system and involves biochemical mediators for defense

composed of physical barriers such as the skin and mucous membranes, as well as phagocytes, natural killer cells, complement proteins, and cytokines

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51
Q

Metastasis features 

A

cancer cells acquire the ability to invade nearby tissues and migrate to distant sites;

they detach from the primary tumor and invade the surrounding tissue, eventually entering the bloodstream or lymphatic system (invasion/migration); cancer cells in the bloodstream or lymphatic system can travel to distant organs or tissues (circulation);

Once cancer cells reach a distant site, they must establish a new tumor in that location;

involves survival in a foreign environment, evasion of the immune system, and the ability to stimulate the growth of blood vessels to support tumor growth (colonization)

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52
Q

Reasons for cancerous growth

A

Genetic mutations,

Environmental factors,

Lifestyle factor,

Age,

Immune system dysfunction,

Infection

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53
Q

Dysplasia 

A

the abnormal development or growth of cells within a tissue or organ;

considered a precancerous condition because dysplastic cells have the potential to progress into cancer if left untreated

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54
Q

Carcinoma in Situ

A

refers to a stage of cancer where abnormal cells are found only in the tissue where they originated and have not spread to nearby tissues;

considered “non-invasive”

often referred to as stage 0 cancer

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55
Q

Malignant tumor

A
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56
Q

Malignant tumors facts

A
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57
Q

Human carcinogenesis - key genetic mechanisms

A
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58
Q

Describe oncogene capability

A

The capability of oncogenes is to drive the

uncontrolled growth and division of cells,

inhibit apoptosis, and

promote tumor formation;

oncogenes are involved in various types of cancers and can contribute to the development of cancer in different ways, depending on the type of oncogene and its cellular location

59
Q

Where does hematopoiesis occur? 

A

Hematopoiesis, the process of blood cell production,

begins in the yolk sac and later progresses to the fetal liver and spleen (primitive hematopoiesis);

as the fetus continues to develop, hematopoiesis transitions to the bone marrow;

bone marrow becomes the primary site for hematopoiesis in adults;

in certain situations, extramedullary hematopoiesis (hematopoiesis outside the bone marrow) can occur;

usually happens under conditions where the bone marrow cannot adequately support normal blood cell production

60
Q

HIV = patients are more at risk for what?

A

infection

61
Q

Macrocytic normochromic anemias are caused by? 

A

red blood cells are larger than normal but have a normal amount of hemoglobin;

two main causes of macrocytic normochromic anemias are :

megaloblastic and non-megaloblastic anemias;

Megaloblastic anemias are caused by vitamin B12 or folate deficiencies;

Non-megaloblastic macrocytic anemias can be caused by a variety of factors, including liver disease, hypothyroidism, myelodysplastic syndromes, medications, and chronic

62
Q

Non-Hodgkins lymphoma

A

a type of cancer that originates in the lymphatic system, which is part of the body’s immune system;

can involve abnormal growth of white blood cells called lymphocytes, leading to the formation of tumors throughout the body;

certain risk factors have been identified (age, weakened immune system, exposure to certain chemicals or radiation, infections such as Epstein-Barr virus or HIV, and autoimmune disease)

63
Q

TNM staging

A

TNM staging is a system used to describe the extent and spread of different types of cancer; 0-4

acronym stands for Tumor, Node, Metastasis; based on three categories:

Tumor (T) - The degree to which the primary tumor has grown and spread within the original site.

Node (N) - The degree to which the cancer has spread to nearby lymph nodes (part of the immune system).

Metastasis (M) - The degree to which the cancer has spread to other organs or tissues of the body

64
Q

Viruses linked to cancer: what are they? 

A

Some of the viruses linked to cancer include:

Human papillomaviruses (HPVs);

Hepatitis B and C viruses (HBV and HCV);

Epstein-Barr virus (EBV); nasopharynx and stomach, hodkins

Herpes 8 - Kaposi Sarcoma

Human T-cell lymphotropic virus-1 (HTLV-1);

Merkel cell polyomavirus (MCPyV)

65
Q

Obesity facts

A

Is associated with endometrial, colorectal, kidney, esophageal, breast (postmenopausal), pancreatic, and several other cancers.
- Correlates with the body mass index (BMI)
- Energy expenditure involves resting metabolic rate, thermic food effects, and physical activity.
- Causes a poorer outcome for some cancers.
- Increases insulin resistance–producing

hyperinsulinemia.
- Insulin promotes insulin-like growth factor 1.
- Adipose tissue secretes adipokines.
- Circadian disruptions may affect cancer growth

66
Q

Granulocytes 

A

Granulocytes are a type of white blood cell that play a crucial role in the body’s immune response;

include three main types:

neutrophils, eosinophils, and basophils

67
Q

Granulocytes-Neutraphils

A

Neutrophils - most numerous type of granulocyte and are responsible for fighting bacterial infections;

have a multilobed nucleus and are often the first cells to arrive at the site of infection

68
Q

Granulocytes: eosinophils

A

Eosinophils - involved in the immune response against parasitic infections and allergic reactions;

contain granules that release substances to destroy parasites and modulate inflammation

69
Q

Granulocytes-Basophils

A

Basophils - involved in allergic reactions and play a role in regulating the immune response through the release of histamine and other substances

70
Q

Anemia of Chronic disease – causes

A

also known as anemia of inflammation or ACD, is a

type of anemia that occurs in individuals with conditions that cause inflammation;

some of the conditions that can lead to anemia of chronic disease include

infections,

autoimmune diseases,

cancer, and

chronic kidney disease

71
Q

Sign of splenic sequestration after sickle cell crisis

A

Splenic sequestration is a potential complication of sickle cell disease where

a large number of sickle cells get trapped in the spleen, causing it to enlarge;

signs and symptoms of splenic sequestration are sudden onset of severe abdominal pain on the left side,

fatigue and weakness,

anemia, pale skin and lips,

tachycardia, dizziness or lightheadedness

72
Q

How do cancer cells use the enzyme telomerase?

A

maintain the length of their telomeres, which are the protective caps at the ends of chromosomes;

by activating telomerase, cancer cells can prevent the progressive shortening of telomeres and maintain their ability to divide and proliferate indefinitely

73
Q

Monocytes become what?

A

Monocytes have the ability to differentiate into different cell types depending on the
microenvironment and signals they receive;

upon tissue damage or infection, monocytes are rapidly recruited to the affected tissue, where they can differentiate into tissue macrophages or dendritic cells

MACROPHAGES

74
Q

ITP

Idiopathic Thrombocytopenic Purpura,

A

which is also known as Immune Thrombocytopenic Purpura.

it is a bleeding disorder characterized by low levels of blood platelets, which are important for blood clotting.

in ITP, the immune system destroys platelets, leading to thrombocytopenia (low platelet count) and an increased risk of bleeding.

symptoms of ITP may include easy bruising and bleeding, nosebleeds, bleeding gums, prolonged bleeding from cuts, and heavy menstrual periods

75
Q

Contributors to hemostasis

A

Hemostasis is a complex process involving multiple factors that work together to prevent excessive bleeding and promote blood clotting;

some of the key factors that contribute to hemostasis include

vascular factors (when a blood vessel is damaged, vasoconstriction occurs to reduce blood flow to the site of injury, minimizing bleeding),

platelets (adhere to the damaged site to form plug),

Plasma Coagulation Factors (factors are proteins present in the blood plasma that facilitate the formation of a stable blood clot;

convert fibrinogen into fibrin), and

regulatory mechanisms (anticoagulant proteins and fibrinolytic system, help control clot formation and prevent the formation of unwanted clots)

76
Q

Iron deficiency anemia: lab findings

A

decreased hemoglobin/hematocrit,

low MCV/MCHC,

decreased iron, transferrin;

elevated TIBC/ferritin

77
Q

Glandular Epithelial Malignancy example

A

Glandular epithelial malignancies, also known as adenocarcinomas,

can arise from various glandular tissues in the body;

examples of glandular epithelial malignancy are breast adenocarcinoma, lung adenocarcinoma, prostate adenocarcinoma, colon adenocarcinoma, pancreatic adenocarcinoma

78
Q

Calcium ion causes what in the presynaptic membrane?

A

Calcium ions play a crucial role in neurotransmitter release at the presynaptic membrane;

influx of calcium ions into the presynaptic terminal triggers the fusion of neurotransmitter-containing vesicles with the presynaptic membrane, which allows for the transmission of signals from one neuron to another;

without calcium ions, neurotransmitter release would not occur efficiently, leading to impaired neuronal communication

79
Q

Acute Otitis Media- typical presentation and patho findings

A

Acute otitis media (AOM) is an infection of the middle ear space;

commonly seen in children

characterized by symptoms such as ear pain, irritability, fever, and sometimes decreased hearing;

pathophysiology of AOM involves the blockage of the Eustachian tube, which connects the middle ear to the back of the throat; this blockage prevents equalization of pressure in the middle ear, leading to the accumulation of fluid and buildup of bacteria or viruses

80
Q

Cause of global cerebral ischemia

A

Global cerebral ischemia refers to a severe reduction or complete cessation of blood flow to the brain, leading to widespread brain tissue damage;

Causes: heart attack, hypotension, respiratory arrest, carbon monoxide poisoning, and severe blood loss

81
Q

Cause of focal cerebral ischemia

A

Focal cerebral ischemia refers to a localized reduction in blood flow to a specific area of the brain, leading to brain tissue damage;

C/B: blockage of a blood vessel by a blood clot (thrombus),

a traveling blood clot (embolus), or

a narrowing of the blood vessel (stenosis)

82
Q

Temporal arteritis

A

Temporal arteritis, also known as giant cell arteritis or Horton’s arteritis, is a

form of vasculitis that involves inflammation of the blood vessels, specifically the temporal arteries;

Typically considered an autoimmune condition;

symptoms are headaches, tenderness or pain in the temples, vision changes, jaw pain, fever, and fatigue;

prompt diagnosis and treatment of temporal arteritis are essential to prevent serious complications such as vision loss or stroke;

treatment often involves the use of corticosteroid medications

83
Q

Spinal cord injury with dermatome analysis of findings

A

Spinal cord injury (SCI) dermatome analysis is a neurological examination that assesses the sensory function in different regions of the body;

it evaluates which dermatomes, or region of the skin supplied by a single spinal nerve, may be affected by a spinal cord injury;

injuries at higher levels of the spinal cord, C-Spine, can result in sensory deficits in the upper extremities, neck, and potentially the head and face;

injuries at the thoracic levels may lead to sensory deficits in the trunk and abdominal region;

injuries at the lumbar or sacral levels can affect the lower extremities and the genital area

84
Q

Cranial nerves: III, IV, VI

A

Oculomotor nerve (III):

Controls most of the eye movements, including

constriction of the pupils and

control of the eyelid muscles

Trochlear nerve (IV):

Innervates the superior oblique muscle of the eye,

allowing for downward and inward eye movements

Abducens nerve (VI):

Controls the lateral rectus muscle of the eye, which is

responsible for outward eye movements

85
Q

Cataracts vs Retinal detachment vs Glaucoma processes

A

Cataracts affect the lens of the eye (cloudy, blurred/hazy vision, photosens., faded colors, double vision, poor noc vision )

retinal detachment affects the retina, (sudden onset of floaters, light flashes, shadlow/curtain over portion of visual field

glaucoma affects the optic nerve

86
Q

Epidural hematomas

A

Epidural hematoma (EDH) is a type of traumatic brain injury that occurs when blood accumulates between the skull and the outer covering of the brain, called the dura mater;

typically results from blunt force trauma to the head;

symptoms of EDH may include THUNDERCLAP headache, nausea, vomiting, drowsiness, confusion, and loss of consciousness;

MIDDLE MENINGEAL

87
Q

Multiple Sclerosis presentation - what is a finding in their CSF? (Think Ig’s)

A

In CSF analysis, several findings are associated with MS, reflecting the inflammatory nature of the disease;

these include mild pleocytosis (an increased number of white blood cells in the CSF),

mild protein increase, and

intrathecal synthesis of immunoglobulin G

88
Q

Anxiety disorders 

A

Prev: 10-30%, MC mental health disorder in US
C: idiop. genetic factors, stress, chem/phys alt.,
ex: hypothyroid

Panic-psychosomatic manif.
diaphor, incr HR, HEAT, N, disassociation

GAD- excessive worry, continuous; norepinephrine/serotonin abnormal;
acute stress d/o
agora-, social-, specific phobias
OCD
PTSD

TX:
80% respond to CBT
hypnosis
expertise
antidepressants (SSRI’s)
Benzo if not responsive

89
Q

Parkison disease exam findings

A

bradykinesia (slowness of movement and

difficulty initiating and executing voluntary movements),

rigidity (characterized by increased resistance to passive movement in the muscles often presented as a “cogwheel” or “lead pipe”),

resting tremor (a prominent feature that typically begins in one hand or foot and disappears during voluntary movement and

postural instability (impaired balance a can become more apparent - patients may have difficulty maintaining their balance and may be prone to falls)

90
Q

Cheyne-Stokes respirations

A

an abnormal breathing pattern
characterized by cycles of gradually increasing and then decreasing depth and rate of breathing,

followed by a period of apnea where no breathing occurs;

some of the primary causes include heart failure, stroke, traumatic brain injury, brain tumors, and elevated intracranial pressure

91
Q

Neurogenic fever

A

Neurogenic fever refers to a type of fever that is caused by

dysfunction or damage to the nervous system,

particularly the hypothalamus, which is responsible for regulating body temperature;

primarily occurs in conditions such as subarachnoid hemorrhage and traumatic brain injury

92
Q

Pain perception and sensation includes what anatomy?

A

Pain perception and sensation involve various anatomical structures in the nervous system, including nociceptors,

the ascending pathway (spinal cord, thalamus, and cortical areas),

the descending pathway and

the brain regions involved in the emotional aspect of pain include the amygdala and the prefrontal cortex

93
Q

Older adult temperature management changes in physiology

A
  • Blood circulation and vasoconstriction/vasodilation or responses are slowed.
  • Metabolic rate is decreased.
  • Shivering is decreased and ineffective.
  • Sweating and the perceptions of heat and cold are decreased
94
Q

Efferent pathways carry ____________

A

Efferent pathways carry motor signals away from the central nervous system to muscles,
glands and organs of the body, enabling these structures to respond appropriately

95
Q

Neuropathic pain

A

Neuropathic pain refers to a type of pain that arises from damage or dysfunction in the somatosensory nervous system, which includes the peripheral nerves , spinal cord, and brain;

C/B: factors such as nerve injury, nerve compression, nerve diseases, or abnormal functioning of the nervous system

96
Q

NT changes in Depression 

A

Deficit in concentration of serotonin,dopamine and norepinephrine (depleted monoamine levels)

97
Q

Cholinergic NT = ?

A

uses acetylcholine (ACh) to send messages between nerve cells in the nervous system;

cholinergic neurotransmitters play a vital role in various functions of the body, including

muscle movement,

memory

,attention, and regulation of the autonomic nervous system

ACETYLCHOLINE*

98
Q

Depression facts, etiology 

A

most occurrence is white females
- 10-15% attempt suicide
- Neurotransmitter changes – all depressed of serotonin, norepinephrine, and dopamine

99
Q

Paranoid delusion

A

Anosognosia is ignorance or denial of the existence of disease.

100
Q

Most common type of stroke 

A

Acute ischemic stroke

101
Q

Glial cells responsible for myelinating neurons in the PNS = ?

A

Schwann cells are the glial cells in the PNS responsible for myelinating neurons;

wrap around axons in the PNS, forming the myelin sheath

102
Q

Broca’s aphasia - which artery most likely involved?

A

Broca’s aphasia is usually caused by damage to the left hemisphere of the brain, particularly in the frontal lobe;

most common vascular cause of Broca’s aphasia is a blockage or damage to the

*LEFT middle cerebral artery

103
Q

What are the five functions of a cell?

A

Movement
* Conductivity
* Metabolic absorption
* Secretion
* Excretion
* Respiration
* Reproduction
* Communication

104
Q

A nurse practitioner knows that active transport requires:
1. receptors capable of
recognizing and binding with specific molecules.
2. a hydrostatic pressure
gradient between intracellular and extracellular regions.
3. a molecule bound to a ligand that moves the substance down the gradient.
4. the presence of pores in the cell membrane with no energy expenditure.

A

ANS: 1
* Active transport requires the use of specific receptors matched with molecules and the expenditure of energy.
* 2. A hydrostatic pressure gradient moves water by passive transport.
* 3. Molecules bound to a ligand may use active transport, but ligand
binding is not mandatory and it moves it up the gradient, not down.
* 4. Passive transport occurs through pores in the cell membrane and active transport requires energy.

105
Q

Endoplasmic reticulum

A

– Structure: Network of tubular or saclike channels;
smooth vs. rough endoplasmic reticulum
– Function: Site of protein synthesis; senses cellular
stress

106
Q

Immunologic and inflammatory injuries
* Phagocytic cells
* Immune and inflammatory substances
* Histamine
* Antibodies
* Lymphokines
* Complement
* Proteases
* Cause membrane alterations

Injurious genetics and epigenetic factors
* Nucleus alterations
* Alterations in the plasma membrane structure, shape,
receptors, or transport mechanisms
* Example:
* Sickle cell anemia

A

Temperature extremes and climate change
* Hypothermic injury
* Slows cellular metabolic processes.
* Produces reactive oxygen species.
* Hyperthermic injury
* Heat cramps, heat exhaustion, heat stroke
* Malignant hyperthermia, neuroleptic malignant syndrome
* Drug-induced hyperthermia
* Burns
* Overheating, sudden infant death syndrome

Sudden increases or decreases in atmospheric pressure
* Blast injury
* Decompression sickness or caisson disease
* “The bends,” diver disease
* High-altitude illness
* High-altitude pulmonary edema (HAPE)
* High-altitude cerebral edema (HACE)
* Acute mountain sickness (AMS)

107
Q

Discuss Na+/Cl- Balance

A

Sodium
* Is the primary ECF cation.
* Regulates osmotic forces.
* Roles include:
* Neuromuscular irritability, acid-base balance, cellular reactions, and transport of substances
* Is regulated by aldosterone and natriuretic peptides.

Chloride
* Is the primary ECF anion.
* Provides electroneutrality.
* Follows sodium.

Renin-angiotensin-aldosterone system
* Aldosterone
* Increases excretion of potassium by the distal tubule of the kidney
Natriuretic peptides
* Decreases tubular resorption, and promotes urinary excretion of sodium
* Atrial natriuretic peptide
* Brain natriuretic peptide
* Urodilatin (kidney)

108
Q

What are 3 HYPERTONIC alterations?

A
  1. Hypernatremia
    * Serum sodium >145 mEq/L
    * Related to sodium gain or water loss
    * Water movement from the ICF to the ECF
    * Intracellular dehydration
    * Manifestations: Intracellular dehydration, seizures, muscle twitching, hyperreflexia
    * Treatment: Isotonic salt-free fluids
  2. Water deficit
    * Dehydration
    * Both sodium and water loss
    * Manifestations: Low blood pressure, weak pulse, and postural hypotension, Elevated hematocrit and serum sodium levels
    * Headache, dry skin, and dry mucous membranes
    Treatment:
    * Oral fluids
    * Hypotonic saline solution (5% dextrose in water)
  3. Hyperchloremia
    * Occurs with hypernatremia or a bicarbonate deficit.
    * Is usually secondary to pathophysiologic
    processes.
    * Is managed by treating the underlying disorders.
109
Q

Normal Sodium labs

A

135-145

110
Q

Tell me about Potassium?

A

*ECF concentration: 3.5–5.0 mEq/L
*Is the major intracellular cation.
*Aldosterone, insulin, and epinephrine facilitate K+ into the cells.
*Insulin deficiency, aldosterone deficiency,
acidosis, and strenuous exercise facilitate K+
out of the cells.
*The sodium-potassium (Na+ /K+) pump
maintains concentration.
*Is essential for the transmission and conduction of nerve impulses, normal cardiac rhythms, and skeletal and
smooth muscle contraction.
*Regulates ICF osmolality and deposits glycogen in liver and skeletal muscle cells.
*Kidneys, aldosterone and insulin secretion,
and changes in pH regulate K+ balance.
*K+ adaptation allows the body to accommodate slowly to
increased levels of K+ intake.

111
Q

Hypokalemia
Potassium level <3.5 mEq/L
Causes
* Reduced potassium intake
* Increased potassium entry into cell
* Increased potassium loss
Treatment
* Replace potassium orally and/or
intravenously.

Manifestations
* Membrane hyperpolarization
causes:
* Decreased neuromuscular excitability
* Skeletal muscle weakness
* Smooth muscle atony
* Cardiac dysrhythmias
* U wave on electrocardiogram (ECG)

A

Hyperkalemia
Potassium level >5.0 mEq/L
Rare as a result of efficient renal excretion
Causes
* Increased intake
* Shift of K+ from ICF to ECF
* Decreased renal excretion
* Hypoxia
* Acidosis
* Insulin deficiency
* Cell trauma
* Digitalis overdose
Mild attacks
* Tingling of lips and fingers, restlessness, intestinal cramping and diarrhea, T waves on the ECG
Severe attacks
* Muscle weakness, loss of muscle tone, paralysis
Treatment
* Calcium gluconate, insulin and/or glucose, buffered solutions, dialysis

112
Q

Calcium and Phosphate
CA: Ionized form is 5.5–5.6 mg/dL.
Most calcium is located in the bone as
hydroxyapatite.
* 99% in bone
* 1% in plasma and body cells
Is necessary for
* structure of bones and teeth.
* blood clotting.
* hormone secretion.
* cell receptor function.
* muscle contractions.
PHOS:
Serum levels: 2.5–4.5 mg/dL (adults)
Similar to calcium, most phosphate (85%) is also located in the bone.
Is necessary for high-energy bonds located in creatine phosphate and adenosine triphosphate (ATP) and acts as an anion buffer and needed for muscle contraction energy.

A

Calcium and phosphate concentrations are rigidly controlled.
* Ca++ × HPO4= = K (K is a constant)
* If the concentration of one increases, the
concentration of the other decreases.

Regulated by three hormones:
1. Parathyroid hormone (PTH)
* Increases plasma calcium levels via kidney reabsorption.
2. Vitamin D
* Is a fat-soluble steroid; increases calcium absorption from the gastrointestinal (GI) tract.
3. Calcitonin
* Decreases plasma calcium levels.

113
Q

Magnesium: (1.5-3.0)
Is an intracellular cation.
Is stored most in the muscle and bones.
Interacts with calcium.
Is a cofactor in intracellular reactions, protein synthesis, nucleic acid stability, and
neuromuscular excitability.

A

Hypomagnesemia
* From malabsorption
* Associated with hypocalcemia and
hypokalemia

  • Neuromuscular irritability
  • Tetany, convulsions
  • Increased reflexes
    Treatment: Magnesium sulfate

Hypermagnesemia
* From renal failure
* Skeletal muscle depression
* Muscle weakness
* Hypotension
* Respiratory depression
* Bradycardia
Treatment: Avoid magnesium; dialysis

114
Q

Acid-Base Balance (pH=potential for Hydrogen) norm: 7.35-7.45
if H+ is high in number, pH is low (acidic).
If H+ is low in number, pH is high (alkaline).

Acids are formed as end products of protein,
carbohydrate, and fat metabolism.
To maintain the body’s normal pH (7.35–7.45) the H+ must be neutralized by the retention of bicarbonate or excreted.

Bones, lungs, and kidneys are major organs
involved in the regulation of acid-base balance.
pH below 6.8 = death.
pH above 7.8 = death.

A

Normal arterial blood pH
* 7.35–7.45
* Obtained by arterial blood gas (ABG) sampling

Acidosis
* pH is less than 7.35.
* Systemic increase in H+ concentration

Alkalosis
* pH is greater than 7.45.
* Systemic decrease in H+ concentration or excess of base

115
Q

Buffering Systems: Chemical that can bind excessive H+ or OH− without a significant change in pH

A

Most important plasma buffering systems:
carbonic acid-bicarbonate system and hemoglobin
Operates in the lung and the kidney.
The greater the partial pressure of carbon dioxide (pCO2), the more carbonic acid is formed.
* At a pH of 7.4, the ratio of bicarbonate to carbonic acid is 20:1.
* Bicarbonate and carbonic acid can increase or decrease, but the ratio must be maintained.
Lungs can decrease carbonic acid.
Kidneys can reabsorb or regenerate bicarbonate but do not act as fast as the lungs.

If bicarbonate decreases, then the pH decreases and can cause acidosis.
pH can be returned to normal if carbonic acid also decreases.
* This type of pH adjustment is called compensation.
The respiratory system compensates by
increasing or decreasing ventilation.
The renal system compensates by producing
acidic or alkaline urine.

Other types:
Protein buffering
* Proteins have negative charges; as a result, they can serve as buffers for H+; mainly intracellular buffer with hemoglobin.

Respiratory and renal buffering
* Respiratory: Acidemia causes increased
ventilation; alkalosis slows respirations
* Renal: Secretion of H+ in urine and reabsorption of HCO3−; dibasic phosphate and ammonia

Cellular ion exchange
* Exchanges of K+ for H+ in acidosis and alkalosis

116
Q

Acid-Base Imbalances-4 types:

A

Acid-Base Imbalances (Cont.)
Four categories
1. Respiratory acidosis—elevation of pCO2 as a result of ventilation depression
2. Respiratory alkalosis—depression of pCO2 as a result of hyperventilation
3. Metabolic acidosis—depression of HCO3− or an increase in noncarbonic acids
*causes:
* Lactic acidosis, Renal failure, Diabetic ketoacidosis, Diarrhea, Starvation
* Manifestations:
* Headache
* Lethargy
* Kussmaul respirations
Treatment:
* Buffering solution administration
* Treat the underlying cause(s)
* Base administration
* Correct sodium and water deficits

  1. Metabolic alkalosis—elevation of HCO3−, usually as a result of an excessive loss of metabolic acids
117
Q

Metabolic acidosis?

A

Metabolic acidosis—depression of HCO3 (bicarb)− or an increase in noncarbonic acids
pH drops below 7.35.
* HCO3− drops: less than 24 mEq/L
* Compensation: Hyperventilation and renal excretion of excess acid

*causes:
* Lactic acidosis, Renal failure, Diabetic ketoacidosis, Diarrhea, Starvation
* Manifestations:
* Headache
* Lethargy
* Kussmaul respirations
Treatment:
* Buffering solution administration
* Treat the underlying cause(s)
* Base administration
* Correct sodium and water deficits

Anion gap
* Used cautiously to distinguish different types of metabolic acidosis.
* By rule, anions (−) should equal cations (+).
* Not all normal anions are routinely measured.
* Represents unmeasured negative ions.
* Normal anion gap is 10–12 mEq/L.
* Normal anion gap or elevated anion gap with metabolic acidosis may help determine the cause.

118
Q

metabolic alkalosis:

Bicarbonate concentration is increased, usually from excessive loss of metabolic acids (Cl −)
* pH is elevated.
* HCO3− is elevated.

A

Causes
* Prolonged vomiting
* Gastric suctioning
* Excessive bicarbonate intake
* Hyperaldosteronism with hypokalemia
* Diuretic therapy
Manifestations: Weakness, muscle cramps, and hyperactive reflexes with signs of hypocalcemia

Treatment: Sodium chloride, potassium, chloride IV (chloride replaces HCO3−)

119
Q

Respiratory Acidosis
Occurs with alveolar hypoventilation
* pH is below 7.35.
* CO2 elevates from hypercapnia.
* Compensation: Is not as effective since kidneys take time but conserve bicarbonate and eliminate H+

A

Causes
* Depression of the respiratory center (brainstem trauma, oversedation)
* Respiratory muscle paralysis
* Disorders of the chest wall (kyphoscoliosis, pickwickian syndrome, flail chest)
* Disorders of the lung parenchyma (pneumonitis, pulmonary edema, and chronic obstructive lung
disease)
Manifestations: Headache, restlessness, blurred vision, apprehension, lethargy, muscle twitching, tremors, convulsions, coma
Treatment: Restore adequate ventilation; may need
mechanical ventilation; oxygen therapy

120
Q

Respiratory Alkalosis
Occurs with hyperventilation and decreased plasma CO2 (hypocapnia).
* pH above 7.45
* CO2 is decreased less than 38 mmHg.

A

Causes
* High altitudes
* Hypermetabolic states, such as fever, anemia, and thyrotoxicosis
* Early salicylate intoxication
* Anxiety or panic disorder
* Improper use of mechanical ventilators
Manifestations: Dizziness, confusion, tingling of extremities (paresthesias), convulsions, and coma with signs of hypocalcemia

Treatment: Paper bag; treat hypoxemia and hypermetabolic states

121
Q

A person arrives in the
emergency department after a loss of consciousness and the
development of Kussmaul respirations. The individual has a history of diabetes and 2 days of vomiting and diarrhea. The nurse practitioner suspects the
person has which of the
following primary disorders?
1.Respiratory alkalosis
2.Respiratory acidosis
3.Metabolic alkalosis
4.Metabolic acidosis

A

ANS: 4
* Diabetic ketoacidosis results in an increase in noncarbonic acids and a decrease in bicarbonate ion which
produces metabolic acidosis.
* 1. Respiratory alkalosis is produced by alveolar hyperventilation and
reduction in carbon dioxide
concentration.
* 2. Respiratory acidosis is produced by alveolar hypoventilation and
increase in carbon dioxide
concentration.
* 3. Metabolic alkalosis is produced by an excess of bicarbonate ion.

122
Q

Abnorms of Chrom. Structure
*Fragile Sites-Fragile X Syndrome

A

Fragile sites
* Chromosomes develop breaks and gaps when the cells are cultured in a folate-deficient medium. (see on microscope)
* Most have no apparent relationship to disease.

**Fragile X Syndrome can occur here
long arm of the X chromosome; has an elevated number of repeated DNA sequences.
O: 1:400 male and 1:8000 female
* Is associated with being mentally challenged;
*is second in occurrence to Down syndrome.
if female inherits, trait may be expressed or passed on
if male, it WILL be expressed

123
Q

Punet Sqaure’s

A

if 2 dom traits = new cell w/ dom traits exp.
if 1 dom/1 ress= new cell w/ dom traits exp
if 2 ress= ress trait expressed

124
Q

Autosomal vs Recessive

A

Single gene-disease mode of inheritance

Autosomal dominant (involves genes known to occur on the 22 pairs of autosomes)
A Single mutation located on one of the nonsex chromosomes (autosome) that causes disease
Equal impact on sexes affects every generation, usually an affected parent
Transmit to approx half of children (fluctuations)
EX: Huntington’s, Marfan syndrome

Autosomal recessive (involves genes known to occur on the 22 pairs of autosomes)
Two copies of the mutated gene (one from each parent) on an autosome to cause disease
ex: Cystic fibrosis, sickle cell anemia

X linked dominant: a single copy of the mutated gene on X chromosome
F>M affected fathers cannot pass to their sons but will pass it to all daughters
ex: Rett syndrome, Fragile X syndrome

X linked recessive: two copies of the mutated gene are required for a female to express this disease but only one for a male
M>F; female carriers usually don’t show symptoms but may pass to offspring; fathers cannot pass to their sons but may pass to their daughters (fathers only pass X to daughters)

125
Q

Staphylococcus Aureus

A

-bacterial
-Gram +
-Cellulitis, toxic shock syndrome, food poisoning, impetigo, wound and medical device infections
‒Major cause of hospital-acquired (nosocomial) infections and antibiotic resistance
-β-lactamase, an enzyme that destroys penicillin; more recently, bacteria developed a resistance to methicillin, called methicillin-resistant S. aureus (MRSA)
-staph is an infection of the skin –> portal of entry from a skin agent that enters a broken skin area

126
Q

Rheumatoid Arthritis

A

-Autoimmune d/o Affects Joints and Collagen
-Probable Self-Antigen: immunoglobulin G (IgG)
-T cells against type II collagen (a protein present in joint tissues) contribute to the destruction of joints in rheumatoid arthritis
-Rheumatoid arthritis causes damage mediated by cytokines, chemokines, and metalloproteases.
-DX: specific clinical, lab, & imaging
-TX: DS-modifying antirheumatic meds, physical measures (pt/ot), surgery
-Incidence-1%; F 2-3x M
-Onset: 35-50 years, but can be childhood

127
Q

IgE: –> ALLERGY RESPONSES !!!!

A

igE inserts itself into mast cells and eosinophils

Is the least concentrated of the immunoglobulin classes in the circulation
.
Acts as a mediator of many common allergic responses.

Defends against parasites.

128
Q

??Antigens Vs. Antibodies

A

Antigens (anything that can produce an immune response AGAINST) have haptin and epitope (epitope that is recognized on the cell by the B or T cells; rest of antigen is HAPTEN!!!)-

🡪 multivalent (some cells have more than one epitope on them) proteins are recognized by other t or B cells)

Antibodies

129
Q

Innate (resistance) vs Adaptive Immunity (acquired) AKA: Lines of Defense

A
  1. Inate: present at birth, and include the surface barriers skin and mucous membranes; Biochemical barriers; prevent damage from enviorn. and infection; epithelial cells on skin, GI/GU and resp.
    –Normal flora
  2. Inflammation: activated with injury or infectious disease. aka: first responder
    -Complement system; Clotting, Kinen
    -Mast Cells-degranulation;
    -Macrophages: tumor-necrosis factor-a; ILL, IFN, antiinflamm cytokines
  3. Adaptive: specific to particular antigens, and has memory.
    -lymphocytes and antibodies (serum proteins)
    -process starts after external barriers and inflam. activated
    -slowly augments initial defenses and promote processes against re-infection
130
Q

Inflammatory Process: vasodilation, increased vascular permeability, and migration of leukocytes to the affected tissues.

A

Second line of defense

Protects the body from injury, fight infection, and promote healing

Plasma protein systems and inflammation
Complement system
Clotting
Kinin system
Control and interaction of plasma protein systems

Initial cellular responders in inflammation
-Cellular receptors
-Mast cells
-Degranulation
-Synthesis of mediators
-Macrophages
-Tumor necrosis factor-alpha
-Interleukins
-Interferons
-Antiinflammatory cytokines
Dendritic cells

The vascular response in inflammation

The cellular response in inflammation
Neutrophils
Monocyte-derived macrophages
Phagocytes
Other cells of inflammation

Acute and chronic inflammation
Manifestations of local and systemic acute inflammation
Fever
Leukocytosis
Plasma protein synthesis
Chronic inflammation

131
Q

Alloimmunity vs Autoimmunity

A
  • Autoimmunity: Is a misdirected response against the host’s own cells.
    -Alloimmunity: Is directed against beneficial foreign tissues (e.g., transfusions, transplants) or in preg w/ diff Rh types b/w mother and fetus–anemia/fetal death
132
Q

Benefits of Fever (choose 3 correct answers on quiz)

A

-Enhanced Immune Cell Function:
-Inhibition of Pathogen Growth
-Improved T-Cell Activation
-Increased Production of Immune Proteins
-Stressful Conditions for Pathogens
-Evolutionary Defense Mechanism
-Inhibits growth of microbial agents
-Enhanced Local Heat Generation-inhospitable
-Reduction of Pathogen Transmission
-Improved Immune System Coordination (IFn production)
-Natural Defense Activation: stims prod of cytokines and mediators=fight infection

133
Q

Cytokines-interleukins (ILs)

A

-Produced by macro & lympho in response to microorg/stim by other products of inflamm
-Help regulate inflamm

IL-1: proinflam—causes fever
IL-6: proinflam–helps w/ healing
IL-10: antiinflam:
TGF-b: (transforming growth factor)-antiinflam

134
Q

Dysbiosis-associated diseases

A

defined as an “imbalance” in the gut microbial community that is associated with disease. This imbalance could be due to the gain or loss of community members or changes in relative abundance of microbes.

Negative changes in the Microbiome

Mental health disorders, obesity, hypertension, heart, failure, asthma, emphysema, rheumatologic, disorders, diabetes, bowel, disease, and cancer

135
Q

(Cancer cell properties), autocrine stimulation, tumor cell markers, telomerase-1

A

Cancer Cell Properties:

Avoid immune destruction

Enable replicative immortality

Activate invasion and metastasis

Induce angiogenesis

Resist cell death

Deregulate cellular energetics

Sustain proliferative signaling

Evade growth suppressors

Possess genome instability and mutation

Mediate a tumor-associated inflammatory response

136
Q

Cancer cell properties, autocrine stimulation, tumor cell markers, (telomerase)

A

also called terminal transferase, is a ribonucleoprotein that adds a species-dependent telomere repeat sequence to the 3’ end of telomeres. A telomere is a region of repetitive sequences at each end of the chromosomes of most eukaryotes.

What does a telomerase do?

Maintain telomere length

Affects DNA replication

Affects cellular apoptosis

Affects tumorigenesis

Affects resistance to therapy of cancer cells

Telomeres: Are protective caps on each chromosome that are held in place by a telomerase.

Telomeres become smaller and smaller with each cell division. Then apoptosis is triggered when it can not divide anymore and cell death occurs.

In tumors, they provide their own telomeres or telomerase: INDEFINITE DIVISION/IMMORTALITY. 85-95% of cancers provide their own telomerase. New cancer growth is repeated.

Cancer cells can activate telomeres, leading to continued division.

Cancer stem cells are a subpopulation of tumor cells that have replication immortality. They arise from tissue resident stem cells or develop from transformed differentiated cells.

137
Q

Benign Vs Maligant

Growth: Slow
Well-defined capsule
Non-invasive
Well Differentiated
Low mitotic index
DOES NOT METs

A

malignant

Rapid growth
no capsule
invasive
poorly differentiated: Anaplasia
High mitotic index
can metastasize

138
Q

What is paraneoplastic syndrome? (more)

A

tumor marker w/ biologic activity
can affect every system
Paraneoplastic syndromes are a group of rare disorders that occur when the immune system has a reaction to a cancerous tumor (neoplasm)

ex: neuropathies, GBS, cushings
MC: Lung, liver, renal, leukemias, breast,

139
Q

Breast cancer- Mutation in the TP53 or APC gene

A

In breast cancer, production of the human epidermal growth factor receptor 2 (HER2) is upregulated and is hyperresponsive to low levels of EGF. Some breast cancers are treated by inhibitors of HER2 and other ECR receptors that block this pathway.

Chromosome translocation
* Large changes in chromosome structure
* Piece of one chromosome is translocated to another chromosome.
Affiliated with b cells cancers and lymphomas (breast cancer: example)

Genomic Instability
Results from epigenetic silencing (modulation of gene).
Mutations in caretaker genes that protect genome and DNA repair increase genomic instability and risk of cancer

BRCA 1 and BRCA 2 (breast cancer risk) – lead to ovary, prostrate, pancreas and bile duct cancers

Alcohol consumption
* Is classified as a human carcinogen.
* Increases the risk for oral cavity, pharynx, larynx, esophageal, liver, colorectal, and breast cancers.

Mutation in the TP53 gene (tumor-suppressor gene) (lung, breast, & colon cancer)
Mutations of the APC gene have close to a 100% lifetime risk of colon cancer: Colectomy.

  • Women with BRCA1/2 mutations have a significantly increased risk of breast and ovarian cancer: Prophylactic mastectomy or bilateral salpingo-oophorectomy or both.
140
Q

Ensure you know how to APPLY the TNMO system

A

0-4 (higher the # =more advanced/spread

T=Primary tumor size & Spread

N= Describes spread to lymph nodes

M= degree of metastasis

141
Q

Hallmarks of Cancer: (lecture)

A
  1. Self sufficiency in growth signals/overexpressed
  2. Evasion of cell death
  3. Genonme Instability:
    evade host immune sys w/ both innate & adaptive
  4. Limitless replication potential
  5. Angiogenesis
142
Q

Sequela of cigarette smoking

A

Tobacco use
* Cigarette smoking is carcinogenic and the most important risk factor for cancer.
* Is linked to cancers of the lung, mouth, lips, nasal cavity and sinuses, larynx, pharynx, esophagus,
pancreas, kidney, uterus, cervix, colon and rectum, liver, and acute leukemia.
* Secondhand smoke: Environmental tobacco smoke (ETS) increases the risk for lung cancer.

  • A combination of cigarette smoking and alcohol consumption increases a person’s risk for malignant tumors.
143
Q

Carcinoma in situ (CIS)

A

Are preinvasive epithelial malignant tumors of glandular or squamous origin.
Have not broken through the basement membrane or invaded the surrounding stroma.

Are not malignant.

Three prognoses:
Can remain stable for a long time.

Can progress to invasive and metastatic cancers.

Can regress and disappear.

PathoPhys (14 decks)

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