Exam 1 study checklist main points

Question 1

Actions of Chemical Mediators

Answer 1

-Histamine, Serotonin, Cytokines
a. Causing MORE vasodilation
b. Causing capillary permeability (“leaky capillary syndrome”) (contributes to swelling).
c. Causing blood flow to slow down so clotting can begin
d. Chemical mediators signal WBCs to congregate in the area of damage (contributes to
swelling).

Question 2

Atrophy

Answer 2

REDUCED SIZE of cell due to disuse, decreased blood flow, malnutrition, etc.

Question 3

Dysplasia

Answer 3

Abnormal cell growth of specific tissue resulting in abnormal SIZE, SHAPE, or APPEARANCE. Often precedes cancerous changes.
*NOTE: Hyperplasia and Hypertrophy often often precedes cancerous changes

Question 4

Hypertrophy

Answer 4

INCREASED SIZE of cell due to increased workload (weight training to build muscle) or a pathological condition (cardiomyopathy = enlarged heart). Most common in cardiac and skeletal muscle tissue

Question 5

Metaplasia

Answer 5

REPLACEMENT of one cell type with another that can better endure the stress (but usually
doesn’t work as well as the original tissue). Caused by chronic inflammation or irritation, i.e., a callous or scar tissue.

Question 6

Endothelial cells produce chemicals that

Answer 6

a. vasodilates or vasoconstrict
b. cause blood thinning/prevent clotting (to keep vein open)
c. allows entrance/exit into and out of the blood vessel (vessel wall permeability)
d. control inflammatory response chemical mediators

Question 7

Fever/chills

Answer 7

HYPERTHERMIA the most common objective sign of systemic inflammation, especially during the acute response phase.
chills do not indicate getting better

Question 8

Reversible cell injuries

Answer 8

Water: Na K pump breaks, sodium builds up, water follows, intracellular swelling.

Lipids: Lipid collects, impairs cell functions, FATTY LIVER, MOR OMINOUS SIGN, can be reverse with dietary changes

Calcium: Ca Mg pump breaks, Ca builds up, inappropriate activation of cellular enzymes

Question 9

Irreversible cell injurys

Answer 9

Apoptosis: controlled cell death

Necrosis: uncontrolled cell death (explosion, causes inflammatory response)

Question 10

Telomeres

Answer 10

Outermost tails of the chromosome arms that are shortened during each replication of a cell. When the telomere is too short to replicate, the cell dies because it cannot reproduce itself any more = “Replicative Senescence.”

Question 11

WBC lab value range

Answer 11

5,000 - 10,000

Question 12

Acute vs Chronic

Answer 12

Acute: short period of time, heals itslef, doesn’t come back: neutrophils

Chronic: last for many weeks or years, permanent damage recurrent and persistent exacerbations and remissions: lymphocytes

Question 13

Local vs Systemic

Answer 13

Local: one area, SHARP
Systemic: body wide, system wide, heightened CRP, Fever, Heightened WBC

Question 14

cellular aging:

Answer 14

1. Decrease in elasticity of blood vessels→atherosclerosis (“hardening of the arteries”] and high blood pressure
2. Loss of bowel motility due to aging or medications→Chronic constipation
3. Loss of muscle mass due to aging, malnutrition, eating disorders, etc.→muscle weakness, problems with balance
4. Loss of subcutaneous fat due to aging or extreme dieting, cancer, malnutrition, etc.→problems regulating
   temperature, and skin breakdown over bony areas especially if bed-bound

Question 15

Benign

Answer 15

-Well differentiated
-stays together
-expands and pushes surrounding tissue
-encapsulated
-generally slow
-does not metastasize
-movable

Question 16

Malignant

Answer 16

-poorly differentiated
-breaks apart
-infiltrates into tissue
-usually rapid
-eventually metastasizes
-fixed

Question 17

Blood Dyscrasias

Answer 17

Blood component disorders. Can be caused by the primary tumor but is usually caused by bone marrow damage from various cancer treatments.

Question 18

Types of blood dyscrasias

Answer 18

Anemia: Low RBC: fatigue and low O2

Leukopenia: Low WBC: prone to infections

Thrombocytopenia: Low platelet count: bleeding disorders

Leukocytosis: High WBC: common indicator of infections

Question 19

Fetal alcohol syndrome effects and causes

Answer 19

Effects:
#1 cause of mental retardation in children
Irreversible defects
developmental delays
physical defects
seizures- withdrawal
behavioral problems
intellectual impairment
brain malformation
Causes:
one drink = 10 for baby
no safe amount to drink during pregnancy

Question 20

Healing intentions

Answer 20

Primary: Wound margins are brought together by any means, low infection risk ex. incisions, cuts, and puncture wounds

secondary: Missing tissue requires margins to contract, and then fills-in, resulting in a large scar. Cannot be sutured closed because too much tissue is missing. High infection potential. ex. bike crash, and pressure ulcers.

tertiary: Wound margins either separate after
being closed (surgery incision dehisces) or are intentionally
left open (to allow infection to drain out of the wound), then
brought together (and closed with stitches) after granulation
tissue appears ex. dog bites, and wound dehiscence

Question 21

Metastasis by circulation

Answer 21

(through blood and/or lymph) – a secondary tumor develops in a site distant from the primary tumor.

Question 22

metastasis by direct contact/ extension

Answer 22

tumor cells spreads to tissues adjacent to the primary tumor by sending out projections (tentacles) into the surrounding tissue or growing pseudopodia to “walk” to the nearest cells.

Question 23

Metastasis by seeding

Answer 23

tumor cells slough off from primary tumor and develop into more tumors.
Example #1 – during surgery to remove a tumor, some tumor cells remain in the tissue after the main tumor is removed and provide the “seed” for more tumor cells to grow. Example #2: Tumors erode and shed cells into body cavities.

Question 24

Sentinel node

Answer 24

is the initial lymph node to which the primary tumor drains. Once the sentinel node is identified, it is examined to determine the presence or absence of cancer cells which indicates how far the cancer has spread.

Question 25

Summary staging system

Answer 25

Stage 1 In situ: Abnormal cells are present only in the layer of cells in which they developed Stage 2 Localized: Cancer is limited to the organ in which it began – no evidence of spread Stage 3 Regional: Cancer has spread beyond the primary site to nearby lymph nodes or tissues and organs Stage 4 Distant/ Metastatic: Cancer has spread from the primary site to distant tissues or organs or to distant lymph nodes Unk Unknown: There is not enough information to determine the stage

Question 26

Teratogens

Answer 26

chemical, biological or physical factors that might cause an abnormal development of a fetus in the mother’s womb three to eight weeks of pregnancy is considered to be the most critical.

Question 27

Tumor grading system

Answer 27

NOT THE SAME AS THE STAGE OF CANCER. GX: Grade cannot be assessed (undetermined grade) ❖ Grade I: Well differentiated, least aggressive ❖ Grade II: Moderately differentiated ❖ Grade III: Poorly differentiated ❖ Grade IV: Very poorly differentiated. More likely to progress quickly, highly malignant

Question 28

Teratogens examples

Answer 28

Diseases (Maternal illness): Chicken pox, Herpes virus, German measles, Cytomegaly Virus, HIV, AIDS (see T.O.R.C.H. Infections (see below) ❖ Drugs/chemicals: Tetracycline, acne medication, aspirin, antacids, diet pills, alcohol*, tobacco, marijuana, cocaine, methamphetamine, heroin. ❖ Environmental: Mercury (even small amounts in fish), lead, radiation (like x-rays)

Question 29

TORCH

Answer 29

* Toxoplasmosis (avoid undercooked meat & kitty litter) * Other (syphilis, varicella-zoster, parvovirus B19) * Rubella (German Measles) * Cytomegalovirus (CMV) * Herpes

Question 30

TNM staging system

Answer 30

Tumor (T) size of tumor Lymph nodes (N) node involvement Metastasis (M) metastatic spread

Question 31

Primary Tumor (T) staging

Answer 31

 TX: Primary tumor cannot be evaluated  T0: No evidence of primary tumor  Tis: Carcinoma in situ  T1, T2, T3, T4: Size and/or extent of the primary tumor

Question 32

Regional Lymph Nodes (N)

Answer 32

 NX: Regional lymph nodes cannot be evaluated  N0: No regional lymph node involvement  N1, N2, N3: Degree of regional lymph node involvement (number and location of lymph nodes)

Question 33

Distant Metastasis (M)

Answer 33

oMX:Distant metastasis can not be evaluated oM0:No distant metastasis o M1: Distant metastasis is present

Question 34

affects on wound healing

Answer 34

1. Nutritional Status - 2. Blood Flow/O2 delivery - 3. Impaired Inflammatory/Immune Response 4. Infection - 5. Wound Separation - 6. Foreign Bodies -

Question 35

How Respiratory regulates

Answer 35

First response is by lungs Acidotic: raises pH by “blowing off” CO2 (which makes a weak acid in the body – carbonic acid). This results in a KUSSMAUL breathing pattern - deep rapid breathing). Alkalotic: The body will try to compensate by reducing ventilations to conserve CO2.

Question 36

How metabolic regulates

Answer 36

slower response acidotic: he kidneys will excrete hydrogen ions [H+] to get rid of acid and retain Bicarbonate (a base) to neutralize acid. Alkalosis:The kidneys will retain H+ excrete bicarb.

Question 37

Causes of acid/ base imbalances Respiratory

Answer 37

~ Acidosis – RETAINED CO2 (lung insult/illness/injury – infection, COPD, trauma to lungs, etc.) ~Alkalosis - CO2 is too low (caused by hyperventilation)

Question 38

Causes of acid/ base imbalances metabolic

Answer 38

~Acidosis – Retained H+ or other acid (Chronic Renal Failure or Diabetic Ketoacidosis-DKA), crush injury that releases potassium into the blood stream (K+ becomes an acid), or in diarrhea (“base-out-the–butt”). ~Alkalosis – Loss of H+ or other acid as in vomiting

Question 39

Effects of acid/ base imbalances Acidosis

Answer 39

Principal effect of ACIDOSIS is DEPRESSION of the Central Nervous System (decrease in synaptic transmission). ❑ Deranged CNS function is the greatest threat ❑ Generalized weakness ❑ Severe acidosis causes: Disorientation - Coma - Death

Question 40

Effects of acid/ base imbalances Alkalosis

Answer 40

Principal effect of ALKALOSIS is EXCITATION of the Central Nervous System. ❑ S/s initially are numbness/lightheadedness ❑ Severe Alkalosis causes: Muscle spasms or tetany - Convulsions - Death

Question 41

BP for low fluid balance

Answer 41

low bp

Question 42

Bp for high fluid balance

Answer 42

high Bp

Question 43

Sodium lab value and effects

Answer 43

135-145 Extracellular Excites nervous syst LOC and seizures - lower Na+ same s/s as fluid overload - higher Na+ same s/s as dehydration

Question 44

Potassium lab value and effects

Answer 44

3.5-5.0 Intracellular Excites Cardiac tissue and Gi tract when elevated -lower K+ cause dysrhythmias, N/V, paresthesia, SZs. -higher K+ causes diarrhea (excites GI) - lower K+ causes constipation (calms GI)

Question 45

Calcium lab values and effects

Answer 45

8.5-10.5 extracellular calms muscles and nerves -lower Ca++ Causes tetany because muscle cannot calm down [positive Chvostek’s sign; Severe lower Ca= laryngeal spasm. -higher Ca++ →muscle weakness

Question 46

Magnesium lab values and effects

Answer 46

1.5-3.0 intracellular calms smooth muscle and DTRs - Smooth muscle = lungs/ uterus/ heart/ intestines) - lower Mg+ → hyperreflexia [DTRs cannot relax]. -higher Mg+ → Resp. failure. - Milk of Magnesia = laxative

Question 47

ADH effect

Answer 47

Retains water and sodium in kidneys to raise bp AND Vasoconstriction which helps to increase BP

Question 48

Effects of prolonged stress

Answer 48

Cardiovascular: Hypertension Immune system; prone to infections (decreased Tcell activity) Gastrointestinal system: ulcers Endocrine system: Hyperglycemia, obesity CNS: insomnia Cancer Autoimmune disorders

Question 49

General adaption syndrome

Answer 49

Alarm stage:aware of the stress, CNS aroused. Body defenses mobilized, cortisol response--> SNS or flight or fight phenomena. Release of catecholamine and cortisol. Resistance/ adaption:full mobilization of all body resources allow the individual to cope (maintain homeostasis) despite being in a stressed condition. Stage of exhaustion: continuous stress causes the progressive breakdown of compensatory mechanisms & homeostasis. This stage marks the onset of certain diseases.

Question 50

Isotonic

Answer 50

MOST COMMONLY USED use first if you aren't specified otherwise moves equally back and forth across a membrane without increasing or decreasing the cell size. Preferred for fluid replacement since the tonicity (sodium concentration) is similar to blood. When infused into the blood stream (by I.V.) isotonic fluids “Stay where I put it.” EX: 0.9% normal saline (NS) and lactated ringers (LR).

Question 51

Hypertonic solutions

Answer 51

The “E” in hyper reminds you that fluid “ENTERS” the blood stream. Fluid is attracted from the tissue into the blood stream by the high concentration of solutes in hypertonic fluid. molecules like Proteins and Glucose attract water RAPID FLUID REPLACEMENT (emergency when lots of blood was lost or low bp) TISSUE IS OVER HYDRATED Examples: Albumin, D50, hetastarch, 3% saline, 6% saline, etc.

Question 52

Hypotonic solution

Answer 52

The “O” in hyper reminds you that fluid “Goes OUT” of the blood stream. Fluid moves from an area of low solute concentration to an area of higher concentration TISSUE IS DEHYRDATED *Diabetes ketoacidosis* Examples: 0.45% NS; 0.225% NS; or D5W (dextrose 5% and water).

Question 53

D5W

Answer 53

isotonic in bag and then once in blood stream it is hypotonic

Question 54

Kussmaul respirations

Answer 54

deep rapid breathing, caused by respiratory regulation trying to blow off CO2

Question 55

Lab values of WBC

Answer 55

5,000-10,000

Question 56

Normal PH

Answer 56

7.34-7.45

Question 57

Normal PCO2

Answer 57

35-45

Question 58

Normal HCO3

Answer 58

22-26

Question 59

Normal Platelet count

Answer 59

150,000-400,000

Question 60

RBC count

Answer 60

3.6-5.4