Pathophysiology Deck Flashcards
Elevated oxygen levels result in this condition
bronchopulmonary dysplasia (BPD)
The human body is composed of approximately ___% water
60% water
Three fluid compartments in the body
Intracellular fluid (ICF)
Extracellular fluid (ECF)
Interstitial fluid (ISF)
Two-thirds of the body’s water content is contained mainly within the ___ fluid
ICF - Intracellular fluid
High osmotic pressure in the bloodstream favors fluid movement from the _____ into _____
From ICF and ISF into the bloodstream (ECF)
Oncotic pressure, also called colloidal osmotic pressure, is a type of osmotic pressure exerted specifically by _____ in the bloodstream
Albumin
What is osmolality is based on?
1 mole (gram) of a substance dissolved in 1 kilogram of water
What is osmolarity based on?
The number of particles suspended in a solution.
A solution often used as a temporary replacement for blood
LR - lactated Ringers
Starling’s Law of Capillary Forces
Two major opposing forces at every capillary membrane: hydrostatic pressure + osmotic pressure (and oncotic pressure)
Stimulates the release of ADH
High plasma osmolarity
Blocking ACE in the RAAS prevents WHAT?
Angiotensin I from becoming angiotensin II. This prevents vasoconstriction and adrenal stimulation.
The net effect of the RAAS is…
Raise blood volume and increase blood pressure
Produced in response to fluid volume overload stretching the heart’s ventricles
BNP (B-type natriuretic peptide)
Both BNP and ANP promote what
Natriuresis - increasing glomerular filtration rate
Edema is excess fluid in what compartment(s)
ISF and ICF
Two causes of edema (types of pressures)
Elevated hydrostatic pressure in bloodstream or diminished osmotic force in bloodstream
What are the major solutes in the body?
Potassium, magnesium, phosphates, and protein
In the RAAS, adrenal gland produces _____ and _____
Aldosterone and ADH
Key cell type in blood vessels of the kidneys which are part of RAAS and are the first trigger for releasing renin
Juxtaglomerular (JG)
In a pt with pulmonary edema in respiratory acidosis, ___ is elevated because, as H+ moves inside of cells in an attempt to get it out of the bloodstream, ___ moves from cells into the bloodstream.
K+
In diabetic ketoacidosis, _____ is consumed by the additional keto acids present in the bloodstream. Because it is one of the measured anions, its consumption _____ the anion gap.
HCO3-
Increases
Two cations used to measure anion gap
Na+ and K+
Two anions used to measure anion gap
Cl- and HCO3-
Dialysis relies on _____ to remove solutes
diffusion
If a patient’s pH and PCO2 levels move in opposite directions, their disruption is _____ in nature. If a patient’s PCO2 is normal, or if it is moving in the same direction as pH, the patient’s disruption is _____ in nature.
respiratory, metabolic
Outer most part of your innate immunity
Skin and mucous membranes
Innate immunity also includes the _____ system - a set of protein that set to dice or break foreign cells.
complement (“That’s a nice virus you’ve got there, would be a shame if something happened to it!”)
Before a particular B or T cell is exposed to antigen, it is referred to as _____.
naive
B cells divide into ___ and ___ after attaching to an antigen.
Memory cells and antibodies
This makes phagocytic cells more likely to engulf pathogens (like salting peas - it makes them tastier)
Antigens
3 things that antibodies do
- Neutralize viruses
- Increase phagocytic cell activity against viruses
- Recruit the complement system (innate immunity)
Two types of T cells
Helper T cells and cytotoxic T cells
Selective (Helper) T cells divide into ___ and ___
Memory cells and de facto cells
Helper T cells produce proteins called ___
cytokines
Cytokines activate ___ and ___
B cells and cytotoxic T cells
_____ are what make secondary immune responses stronger and more prolonged than primary responses.
Memory cells
Eldery individuals have decreased population of ___ (in their immune systems)
naive T cells
Near skin surface, there are phagocytic cells called ___
dendritic cells
capillaries are made of ___ cells
endothelial cells
Skin cells release ___ to signal when there is an “invasion”
chemokines (chemical + kinetic)
Mast cells release ___ in response to a threat
histamine
Histamine acts on endothelial cells (capillaries) and causes ___ leading to ___
vasodilation, swelling
Neutrophils act on bacteria using ___
phagocytosis
A congenital abnormality is one that is ___.
present at birth
For two parents who are carriers of a recessive trait, what are the odds of producing offspring that have that condition? Odds of being carriers? Odds of no disease/not carrier?
1:4 Will get the condition (and receive both recessive genes)
2:4 (50/50) Will be a carrier
1:4 Will neither have the disease nor be a carrier
The four DNA nitrogen bases are ___.
adenine (A), thymine (T), guanine (G), and cytosine (C)
DNA base pairings
A+T and G+C
In RNA, ___ replaces ___ as a base.
uracil (U) replaces thymine (T)
RNA base pairings
A+U and G+C
The human genome is estimated to contain ___ genes.
20,000 - 25,000
An arrangement of three specific DNA bases is called a ___
codon
Common changes in DNA sequence are called ___
polymorphisms
A ___ occurs when a gene is damaged or changed in such a way that it alters the genetic code carried by that gene.
mutation
Each chromosome is divided into two sections, based on a point of narrowing of the linear chromosome, called the ___. The shorter segment, relative to the centromere, is known as the “___” arm, while the longer segment is known as the “___” arm.
centromere, P arm (short), Q arm (longer)
A ___ is an organized arrangement of all the chromosomes within a cell. The human one of these has ___ pairs of chromosomes.
karyotype, 23 pairs
DNA is copied to messenger RNA (mRNA) in the ___ in a process known as ___.
In the nucleus by transcription
mRNA moves to the ___ and then ___ occurs.
ribosomes, translation
Everyone has __ copies of each gene. Each individual gene is an ___ that is inherited from each parent.
2 copies, allele
T/F: Gene alleles must match
False - you can receive dominant and recessive alleles for each gene (i.e., no sickle cell, but are a carrier)
Genotype of Pp is called ___
heterozygous
Genotype of PP or pp is called ___
homozygous
CO2 mixes with water in the blood via a chemical reaction and forms ___.
bicarbonate (HCO3-) and a proton
What is the purpose of a buffer?
Prevents radical change in pH
Buffers are typically a ___ or a ___
weak acid or a conjugate base
The buffer that maintains the pH of human blood involves a ___ - ___ system.
carbonic acid (H2CO3) - bicarbonate ion (HCO3-)
When any acidic substance enters the bloodstream, the bicarbonate ions neutralize the hydronium ions forming ___
carbonic acid and water
When a basic substance enters the bloodstream, carbonic acid reacts with the hydroxide ions producing
bicarbonate ions and water
Third-spacing occurs due to decreased ___ pressure in the ___ space
oncotic, intravascular
If the anion gap is too high, your blood is more ___ than normal. If the anion gap is too low, your blood is more ___ than normal.
acidic, alkaline
In mild to moderate acidosis, treatment could be limited to supportive measures including ___ and ___.
IV fluids and respiratory support
Healthcare providers most commonly use anion gap to identify cases of ___.
metabolic acidosis
DKA occurs when glucose is unable to enter cells resulting in the ___ breaking down fat into ___.
liver, ketones
An elevated anion gap metabolic acidosis can be caused by ___ toxicity, ___, and ___ (MUDPILES). Non-Gap metabolic acidosis is due to GI loss of ___ or a failure of kidneys to ___.
elevated: salicylate toxicity, DKA, uremia
no-gap: bicarbonate (diarrhea), excrete acid
Normal PCO2
35-45 mmHg
Normal blood pH
7.35-7.45
Normal PaO2
75-100 mmHg
Normal HCO3-
22-26 mEq/L
Normal SaO2
(saturation) 95-100%
The central chemoreceptors, located on the ventral aspect of the medulla, are activated by an increase in ___ or ___.
CO2 or acidity
Kidneys compensate for hypercapnia by reabsorbing more ___ and excreting more ___
absorb HCO3-, excrete H+
The kidney compensates for respiratory alkalosis by reducing the amount of new ___ generated and by excreting ___. The process of renal compensation occurs within ___. The stimulus for the renal compensatory mechanism is ___ (not ___).
HCO3−/HCO3−
Occurs within 24 to 48 hours
Stimulus is PCO2, not pH
___ determines whether an acidosis is respiratory or metabolic in origin.
PCO2
Metabolic acidosis is due to alterations in ___, so the ___ is less than ___ since it _____ (is/is not) the cause of the primary acid-base disturbance
bicarbonate
pCO2 is less than 40
For a respiratory acidosis, the pCO2 is ___ due to ___.
greater than 40 to 45
decreased ventilation
How can hyperkalemia develop in metabolic acidosis?
H+ moves into the cells resulting in K+ moving into the extracellular fluid
A fall in pH is much LESS likely to raise the plasma potassium concentration in patients with ___ or ___
lactic acidosis
ketoacidosis
In metabolic alkalosis, PCO2 would ___. This is SECONDARY to ___.
PCO2 increases secondary to HCO3- increasing.
The kidneys can help combat alkalosis by ___. This process is slower than ___.
Increasing the excretion of bicarbonate ions through the urine. Slower than respiratory compensation.
A hereditary disease, presents as an enlarged heart chamber and decreased blood-pumping efficiency, leading to heart failure. ___ chance of passing on to children.
familial dilated cardiomyopathy, 50%
Where would you find gene locus 3p22.1
3 = Chromosome 3
p = P-arm (petit arm)
The standard number of chromosomes in a human cell is __
46 (23 pairs)
How many chromosomes would need to be in one ovum and one sperm to create the first cell of the embryo?
23 - one from each parent to total 46 in a cell
Distinguish between gene and allele
Genes are DNA sections that code for specific proteins or functional RNA, playing a crucial part in biological functions. Alleles, however, are variations of these genes, leading to diverse traits such as eye color.
A condition in which a baby is born with one or more extra fingers.
Polydactyly
If one biological parent carries the genetic code for polydactyly, their babies have a ___ chance of being born with polydactyly.
50% (some forms are dominant)
Why are males more likely to have x-linked traits?
The Y chromosome is the other half of the XY gene pair in the male. However, the Y chromosome doesn’t contain most of the genes of the X chromosome. Because of that, it doesn’t protect the male.
What is meant by sickle cell trait vs sickle cell genotype?
Sickle cell trait = carrier
Sickle cell genotype = has the disease
Red-green colorblindness is a ___ trait
x-linked recessive trait
What is genotype of red-green colorblind father?
XcY (c is recessive)
Genotype of mother who is homozygous at the colorblind locus
XcXc
What is aneuploidy
(AN-yoo-PLOY-dee) - The occurrence of one or more extra or missing chromosomes leading to an unbalanced chromosome complement, or any chromosome number that is not an exact multiple of the haploid number (i.e., 23)
3 types of down syndrome
Complete, mosaic, translocation
An error during the formation of the egg or the sperm results in either one having an extra chromosome. The resulting cells will also have three copies of chromosome 21. Constitutes almost all Down syndrome cases.
Complete trisomy 21
Type of down syndrome that occurs when an error in cell division takes place early in development but after a normal egg and sperm unite. It can also occur early in development when some cells lose an extra chromosome 21 that was present at conception. Symptoms vary based on number of affected cells.
Mosaic trisomy 21
Type of down syndrome that occurs when only part of an extra copy of chromosome 21 is in the cells and gets “stuck” to another chromosome and transmitted as cells divide. Presentation is the same as complete trisomy 21.
Translocation trisomy 21
Main cause of death in down syndrome
Congenital heart disease (CHD)
Congenital heart defects occur in approximately ___ of live-born infants with Down syndrome (DS).
50%
Most common heart condition that occurs with down syndrome.
Atrioventricular septal defect (AVSD) is the most common congenital heart disease
…followed by isolated tetralogy of Fallot (TOF), AVSD with TOF, and isolated ventricular septal defect
What does ND-PAE stand for
Neurobehavioral disorders associated with prenatal alcohol exposure (ND-PAE)
What are some common findings in children with neurobehavioral disorders associated with prenatal alcohol exposure (ND-PAE)
- Thinking and memory
- Behavior problems
- ADLs (playing with others, dressing, bathing, etc.)
Changes that have been observed in brains of those exposed to prenatal alcohol
Reduced brain volume
Altered cortical thickness
Altered white matter connectivity
Deficiency of this is thought to be a risk factor for spina bifida
Folic acid (B9)
Most severe form of spina bifida
Myelomeningocele is the most severe form of spina bifida. A portion of the spinal cord or nerves are exposed in a sac through an opening in the spine that may or may not be covered by the meninges.
Condition in which brain tissue extends into the spinal canal. (Congenital)
Arnold Chiari II malformation
Most common form of spina bifida. What does it affect?
Spina bifida occulta. Affects nerves, resulting in (possible) incontinence, constipation, back pain, muscle weakness.
Another name for vitamin B9
folate, folic acid
It is recommended that women take folic acid ___ pregnancy to help prevent ___
Before or during early pregnancy to help prevent spina bifida or other neural tube defects
Differentiate between a strain and a sprain.
A sprain is an injury to the ligaments and capsule of a joint in the body. A strain is an injury to muscles or tendons.
Differentiate between a spiral fracture and a transverse fracture.
Spiral Fracture: one part of the bone has been twisted at the break point. Transverse Fracture: the broken piece of bone is at a right angle to the bone’s axis.
How is PTH related to bone degeneration?
When dietary calcium intake is insufficient, PTH stimulates bone resorption.
An insufficient intake of dietary calcium can lead to what hormone being increased in the body? What other vitamin might be used to counter this?
PTH - parathyroid hormone. Hyperparathyroidism is countered with calcitriol (active vitamin D)
Differentiate between osteoblasts and osteoclasts
Osteoblasts form new bones (“BAM! New bones!”)
Osteoclasts dissolve old and damaged bone tissue
What is calcitriol?
Increases absorption of dietary calcium and phosphate from GI tract and promotes renal tubular reabsorption of calcium in the kidneys.
Opposes the action of parathyroid hormone.
Calcitonin (“Oh NO you don’t, calcium!”)
What condition might someone have if you are giving them calcitonin? Why?
Osteoporosis. It counteracts PTH, which breaks down bones.
Back problem caused by overuse
Back strain
Back problem caused by an external force or shock
Back sprain
A back sprain is usually felt where
thumbs, wrists, knees, and ankles (joints)
A back strain is usually felt where
In the back, legs, feet, and arms
Type of back pain that develops over times is
Back strain
Most common etiology of bursitis
The most common etiology is prolonged pressure, whereby the bursa is stressed between a hard surface and bony prominence. (e.g., students who frequently rest their elbows on their desks and people who work on their knees without adequate padding)
Cells that play a role in the development of bursitis
Synovial cells
What is a “hip fracture”
A break in the upper quarter of the femur
Where is an intracapsular hip fracture?
The “neck” of the femur
Type of hip fracture that results from a traumatic hip dislocation
Head fracture
Where does a femoral neck fracture occur
1-2 inches from the hip joint