APNC 520 Test 1

autophagy

"Recycling center" Eats itself Self-destructive process Survival mechanisms

Function of Golgi apparatus

- "Refining plant" and directs traffic - Processes, secretes, and releases substances, especially protein from cells

Active Transport requires

- ATP (energy) to moving up gradient - receptors capable of recognizing and binding with specific molecules

In the absence of a signal from the SA node, what are the rates at which the atria will fire, what are the rates at which the ventricles contract in the absence of a signal from the SA node?

- AV node (atria and ventricles) (40-60bpm) - Perkinje Fibers (ventricles) (20-40bpm)

what role do membrane bound signaling molecules play?

- Determine with which ligands a cell will bind. - Determine how the cell will respond to the binding. - Ligand-receptor complex initiates interactions, causing adenylyl cyclase to transform adenosine triphosphate (ATP) to messenger molecules that stimulate specific responses in the cell.

Peroxisomes

- Detoxify compounds and fatty acids. - Break down substances into harmless products. - Synthesize specialized phospholipids for nerve cell myelination. -contain oxidative enzymes - Major site of oxygen utilization

What do Golgi apparatus contain?

- Flattened, smooth membranes - Secretory vesicles and cisternae - Proteins from the endoplasmic reticulum that are packaged in the ______ complex Clathrin-coated vesicles

cytosol

- Intermediary metabolism involving enzymatic biochemical reactions - Ribosomal protein synthesis Storage 55% of cell volume

mitochondria

- Is responsible for cellular respirations and energy production. - Participates in oxidative phosphorylation.

Function of epithelial tissue

- Protection, absorption, secretion, and excretion - have cilia and microvilli

What do ribosomes contain?

- Ribonucleic acid (RNA) protein complexes - free vs. attached _____

Function of ATP

- Storage and transfer of energy - When molecules of carbohydrate, lipid, and protein are catabolized, this energy is transferred to ATP. - Is used in the synthesis of organic molecules, muscle contraction, and active transport.

What do lysosomes contain?

- These vesicles may contain concentrated lytic enzymes (primary______) that may be utilized by the cell to break down (digest) materials. - Secondary________result from the fusion of primary_____ with phagosomes - Typical enzymes found within________ are acid hydrolases that act in hydrolysis reactions.

How do cells communicate with their external environment

- Via Cell signaling protein cell receptors on the plasma membrane, cytoplasm, or nucleus - detect and respond to cues in their environment - bind with ligands (smaller molecules) - Must fit together TURN ON AND OFF COORDINATE ACTIVITIES

mitosis

- a type of cell division that results in two daughter cells each having the same number and kind of chromosomes as the parent nucleus - typical of ordinary tissue growth

Function of lysosomes

- membrane bound vesicles originating from the Golgi apparatus FUNCTION: - intracellular digestive system - hydrolases: 40 digestive systems -autodigestion and autophagy - excretory systems of the cell.

Klinefelter syndrome

- sex chromosome aneuploidy - Individuals with at least two X chromosomes and a Y chromosome in each cell -Y chromosome is present so they are male in appearance but with gynecomastia, small testes, sparse body hair

Turner's syndrome

- sex chromosome aneuploidy - the presence of a single X chromosome and no homologous X or Y chromosome, resulting in a total of 45 chromosomes. -Absence of ovaries (sterile), short stature, webbing of the neck, widely spaced nipples, high number of aborted fetuses -usually inherited via mom -teens need estrogen shots

translocation of genes

---Is the interchange of genetic material between nonhomologous chromosomes. ----Types of translocation 1. Robertsonian: Long arms of two nonhomologous chromosomes fuse at the centromere, forming a single chromosome; is common in Downs syndrome. 2. Reciprocal: Breaks take place in two different chromosomes, and the material is exchanged. Implicated in: schizophrenia, Burkitt's lymphoma

Thirst perception baroreceptors

---Stimulated from: depleted plasma volume ---Causes release of ADH

Thirst perception osmoreceptors

---Stimulated from: hyperosmolality dry mouth plasma-volume depletion Increases water intake

How is an antibody protective?

---antibody will bind specifically to the antigen (of pathogen) that initially activated the precursor B lymphocyte. ---thus marking pathogen for destruction by other mechanisms

Posterior MI

---cannot see on regular 12 lead ---V1-3 ST may be initially horizontally depressed ---eventually tall broad R waves on V1-V3 (dominant in V2) ---r/o if pt symptomatic and 12 lead looks normal: ------To confirm need 15-lead EKG ----------V7, V8 and V9 horizontally placed from V6 on the back - will show ST elevations

2 types of type 1 hypersensitivity reactions

-H1: Bronchial constriction, Edema, Vasodilation -H2: Increases gastric secretions

function of cytosol

-Intermediary metabolism involving enzymatic biochemical reactions -Ribosomal protein synthesis -Storage

Causes of endothelium injury?

-Smoking -HTN -DM -Inc LDL -dec HDL -autoimmunity -infection -inflammation

Depolarization occurs when

-Threshold potential is reached when potential is depolarized by 15-20 millivolts (from Na+ leaking into cell) -Voltage-dependent sodium channels open and allow rapid entry of Na+ into the cell. - The depolarized cell is more positively charged, and its polarity is neutralized.

Fragile X

-X linked dominant syndrome -sex chromosome abnormality - Site is on the long arm of the X chromosome; has an elevated number of repeated DNA sequences. - Is associated with being mentally challenged; is second in occurrence to Down syndrome

Define oncogenes

-a gene that in certain circumstances can transform a cell into a tumor cell. -mutated version of Proto-oncogenes -increased cell division, decreased cell differentiation, and inhibition of cell death; taken together, these phenotypes define cancer cells.

R on T phenomenon

-a premature ventricular (QRS) complex in the electrocardiogram interrupting the T wave of the preceding beat -ventricular stimulus causes premature depolarization of cells that have not completely re-polarized -often predisposes to serious ventricular arrhythmias (v-tach/v-fib) -indicates a need to ↑ antiarrhythmics-eg, lidocaine

Volume depletion produces

-an increase in renin secretion and initiates the renin angiotensin aldosterone system. --an increase in aldosterone secretion -reduced secretion of natriuretic peptides.

Normally, endothelium is (pro-/anti-) coagulant, but damaged endothelium is (pro-/anti-) coagulant.

-anti- -pro-

hypertrophy

-increase in cell size -Caused by increased work demand or hormones --Physiologic --Pathologic

Pathologic hyperplasia

-may occur in response to hormones or growth factors -produces an abnormal proliferation of normal cells -not normal -increases cell number

PR interval:

-onset of the P wave to the start of the QRS complex.

Decreased plasma Oncotic Pressure

-results from losses or diminished production of plasma albumin. -Will attract fluid within capillary and move into the interstitial space, resulting in edema. -Decreased synthesis of plasma protein and decreased oncotic pressure -occurs with liver disease, protein malnutrition, nephrotic syndrome, hemorrhage, serous drainage from open wounds or burns.

Proteins

1. Are made from a chain of amino acids known as polypeptides. 2. Are the major "workhorses" of the cell. 3. Include integral, peripheral, and transmembrane. 4. make structure

Describe four types of necrosis and have a specific disease example for each

1. Coagulative necrosis - 2.Liquefactive necrosis - 3.Fat necrosis 4. Fibrinoid necrosis Caseous necrosis=combo coag and liquefactive Gangrenous necrosis - not really separate type, but is used clinically

The Plasma Membrane is

1. Composed primarily of amphipathic molecules. These molecules are polar with a hydrophobic (uncharged, water hating) portion and a hydrophilic (charged, water loving) portion. 2. impermeable to the movement of water-soluble molecules into the cell. 3. dimpled because of the presence of caveolae, cave-like indentations.

development of atherosclerosis

1. Endothelial injury & dysfxn 2. Smooth muscle migration 3. Smooth muscle & macrophages engulf lipid 4. Smooth muscle proliferation 5. Collagen deposition

Be prepared to describe the development of atherosclerosis. Step by step.

1. Endothelium (smooth inner lining) injury in artery walls 2. Inflammation and dysfunction of the Endothelium 3. Cytokines are released 4. Cellular proliferation (body trying to heal) 5. Macrophage migration (into area): release enzymes and toxic oxygen radicals 6. Toxic radical cause Low-density lipoproteins (LDL) oxidation (foam cell formation) with oxidative stress which further injures the vessel wall 7. Leads to fatty streak within the vessel walls 8. Forming fibrous plaque (from scarring in an attempt to heal) - thrombosis 9. Complicated plaque: can rupture and form clot(s)

Sequence of events in the inflammatory process

1. Microorganisms invade damaged tissue 2. Basophils release heparin and histamine. Kinin production occurs. 3. Vasodilation occurs along with increased capillary permeability 4. Blood flow increases to the affected tissues and fluid collects within them. 5. Neutrophils flock to the invasion site to engulf and destroy microorganisms from dying cells. NEXT STAGE: PROLIFERATION

3 hormones that regulate calcium and phosphate

1. Parathyroid hormone (PTH) 2. Vitamin D 3. Calcitonin

Proteins are

1. Receptors 2. Transporters 3. Enzymes 4. Surface markers 5. Adhesion molecules 6. Catalysts

Describe in-utero testing in relation to the detection of specific abnormalities

1. genetic abnormality - AFB-alpha fetal protein-neural tube defect: spina bifida, anencephaly 2. chromosomal abnormality - Trisomy 21, Turners, Klinefelter syndrome

Tx myocardial ischemia

12 lead EKG - comparison with old Trans echo

ratio

1:1, 1:2. Degree between two things

Chronic inflammation is inflammation that lasts __ weeks or longer.

2

CO's affinity for hemoglobin is ____ times greater than that of oxygen;

200

Virchow's Triad

3 factors that contribute to thrombosis 1.venous stasis 2. hypercoagulability 3. injuries to the endothelial cells that line vessels

What does the absence of a signal from the SA node cause?

3rd degree HB:

Describe ECG patterns for 3rd degree HB

3rd degree heart block - there is complete absence of conduction of AV node QRS complexes being conducted at their own rate and totally independent of the P waves

____ glucose molecules per ATP

6

signal transmission without a ligand

A cell may receive the signal, but if the complimentary receptor protein is not found on that cell, there will be no response.

Typical enzymes found in lysosomes

A. Proteases B. Nucleases C. Glycosidases D. Lipases, and others

An individual has primary hypertension and recurrent strokes. Which drug should the nurse prepare to administer?

ACE inhibitors Individuals with heart failure, have chronic kidney disease, are postmyocardial infarction, or have had recurrent stroke should begin antihypertensive treatment with an ACE inhibitor, angiotensin receptor blocker (ARB), or aldosterone antagonist.

autosomal recessive

Abnormal allele is recessive, and the person must be homozygous to express the disease. Condition is expressed equally in males and females. Is observed in siblings but not in parents. Approximately one-quarter of offspring will be affected. Consanguinity may be present. (Marriage between related individuals) Carrier detection tests are available. i.e. cystic fibrosis

4 biochemical themes of cell injury

Adenosine triphosphate (ATP) depletion Oxygen and oxygen-derived free radicals Intracellular calcium and loss of calcium steady state Defects in membrane permeability

Who is at least risk for dehydration?

Adults: water is 60% of body weight

Stimulates reabsorption of sodium, chloride, and water to increase blood volume and stimulate thirst

Aldosterone

Type 1 hypersensitivity reaction

Allergy (immediate -IgE)-H1/H2 Bee Sting, Latex, PCN, Peanuts -H1: Bronchial constriction, Edema, Vasodilation -H2: Increases gastric secretions Decreases the release of histamine from mast cells and basophils

Capillary Hydrostatic Pressure

An Increase can be from venous obstruction or sodium and water retention. Such as venous blood clots, hepatic obstruction, right heart failure, tight clothing around extremities, prolonged standing. Sodium and water retention to volume overload, increased venous pressure and edema.

A person with an MI is releasing angiotensin II. How should the nurse interpret this finding.

Angiotensin II is released during myocardial ischemia and is counterproductive because it causes the heart to work harder d/t the systemic effects of peripheral vasoconstriction and fluid retention. It also exacerbate the effects of loss of myocyte contractility,

Treatment Systolic HF

Apply oxygen Administer nitrates, morphine, diuretics, ACE inhibitors, aldosterone blockers, and/or beta-blockers Increase contractility Reduce preload and afterload

Growth factors

Are also called cytokines. Platelet-derived growth factor stimulates connective tissue growth. Several other types of growth factors are identified.

Be prepared to discuss the relative pressures in each chamber of the heart from least to greatest

As a chamber fills with blood, the pressure is going to rise. When a chamber contracts, the pressure is going to rise. Changes in pressure affect whether a valve is open or closed. Fluids always move from areas of high pressure to areas of low pressure.

Describe why two identical twins can develop different disease states. What specifically happens to the DNA leading to this?

As twins age, they demonstrate increasing differences in methylation patterns of DNA sequences of their somatic cells; these changes are reflected in increasing style differences. Increases phenotype differences

Describe the different types of lymphocytes

B cells ----humoral immunity (bacteria, microorganisms or activation of inflammatory mediators). - differentiated B cell becomes a plasma cell and differentiates into long-lived memory cells. Memory cells can circulate for decades-->factory for IgG production T cells: ------cell mediated immunity (viruses and cancer)--->Direct killing of foreign or abnormal cells and regulates the immune response to avoid attacking "self."

plasma cells are derived from

B lymphocytes

Women who inherit a mutation in ______experience a _________ lifetime risk of developing breast cancer.

BRCA1 or BRCA2 50% to 80% If a woman has one affected first-degree relative, her risk of developing breast cancer doubles.

Second stage of inflammatory process (of 5)

Basophils release heparin and histamine. Kinin production occurs.

Importance of abumin

Because it is large and cannot easily cross through the capillary walls, it's effect on the osmotic pressure of the capillary interiors will to some extent balance the tendency for fluid to leak from the capillaries. If not enough of it in bloodstream, edema happens

Arterial clot from peripheral extremities

Blockage of arteries that supply arms or legs may result in necrosis and gangrene.

Fourth stage of inflammatory process (of 5)

Blood flow increases to the affected tissues and fluid collects within them.

Cytoskeleton

Bones and muscles" of the cell Maintains the cell's shape and internal organization Permits movement of substances within the cell and movement of external projections Microtubules—provides strength: Centrioles Microfilaments: Actin

Epinephrine and norepinephrine

Both are catecholamines Epi is 10x more potent than norepinephrine both are part of flight/fight response to stress - immediate arousal

Causes of HF

CAD Pulm HTN A previous heart attack Prolonged high blood pressure Cardiomyopathy Abnormal heart valves Congenital heart disease Alcohol and drug abuse Certain kinds of infections

Tx hyperkalemia

Calcium gluconate insulin and/or glucose Na+ bicarbonate cation exchange resins dialysis kayexelate

tx hypocalcemia

Calcium gluconate, calcium replacement, decrease phosphate intake

causes of hypercalcemia

Calcium levels >12 mg/dl Causes: Hyperparathyroidism Bone metastasis Excess vitamin D Immobilization Acidosis

What forces favor filtration?

Capillary hydrostatic pressure (blood pressure) Interstitial oncotic pressure

Main types of malignancy

Carcinoma Sarcoma Leukemia Lymphoma and multiple myeloma Central nervous system (brain/spinal cord)

ex of connective tissue

Cartilage, bone, vascular, adipose, and organs

Activation of the RAAS (Renin-angiotensin-aldosterone system)

Causes not only increases in preload and afterload but also direct toxicity to the myocardium.

Manifestations water excess

Cerebral edema muscle twitching headache, weight gain

What color is present when fat necrosis occurs?

Chalk-white, opaque

risk factor

Chance of developing a disease relative to an exposure Recurrence risk: Is the probability that a family member will have a genetic disease. ---When one parent is affected by an autosomal dominant disease and the other is normal, the occurrence and recurrence risks for each child are one half. ---Each birth is an independent event. Chromosomal: Chance of developing a disease in relative to an exposure. ----i.e.: downs syndrome/Trisomy 21 - risk increases with maternal age

Caseous necrosis

Combination of coagulative and liquefactive necroses Cheese-looking substance that is walled off Tuberculosis pulmonary infection

What happens if part of one's liver gets removed?

Compensatory hyperplasia of remaining hepatocytes

During and inflammatory response, the complement cascade is activated leading to mast cell degranulation, describe this process as it relates to the vasculature.

Components of the complement cascade, when activated, may destroy pathogens directly and can collaborate with other components of the inflammatory response mast cells are the most important activator of the inflammatory response -filled with granules and located in the loose connective tissues close to blood vessels near the body's outer surfaces -distributed in important positions between host and environmental antigens (skin, GI tract, resp. tract) -release potent chemical soluble inducers of inflammation by degranulation and synthesis VASOCONSTRICTION: Changes in microcirculation begin almost immediately, triggered by momentary vasoconstriction -Vasodilation of arterioles/venules (brings more blood in): redness, heat -increase in vascular permeability; edema, pain, decreased function -WBCs adhere to inner walls of vessels and migrate to site of injury through vessel wall (WBCs and fluids leak out to make inflammation) -THREE RESPONSE PATTERNS

water excess

Compulsive water drinking, causing water intoxication Decreased urine formation Syndrome of inappropriate ADH (SIADH) ADH secretion causes water reabsorption Manifestations:

Genetic Testing

Confirm the diagnosis of a genetic disease. Identify carriers of recessive diseases. Presymptomatically identify individuals who are at risk for inheriting a disease with delayed age of onset.

Function of muscle tissue

Contractile tissue, enabling both voluntary and involuntary movement -smooth, cardiac, musculoskeletal composed of myocytes

plasma membrane (cell membrane)

Control the composition of the space or compartment they enclose. Enclose the cell. Provide the selective transport system. Provide cell-to-cell recognition. Provide cellular mobility and shape.

Describe the role of cortisol in the stress response.

Cortisol provides the body with glucose by tapping into protein stores via gluconeogenesis in the liver. This energy can help an individual fight or flee a stressor. However, elevated cortisol over the long term consistently produces glucose, leading to increased blood sugar levels.

Type II hypersensitivity reaction

Cytotoxic, antibody-dependent- IgM or IgG (Complement) MAC -tissue/cell targeted Hemolytic reactions, Myasthenia gravis, Graves Disease

S phase

DNA synthesis

Sources of PE

DVT (extremities), A. Fib (heart), arteries (atherosclerosis)

manifestations of hypercalcemia

Decreased neuromuscular excitability Muscle weakness Manifestations (cont'd): Kidney stones Constipation Heart block

Calcitonin

Decreases plasma calcium levels.

Type IV hypersensitivity reaction

Delayed-type hypersensitivity cell-mediated immune memory response, antibody-independent- T-cells ------Destruction of the tissue is usually caused by direct killing by toxins from cytotoxic T cells -------Helper T cells produce cytokines that recruit phagocytes, especially macrophages -----------EX:Acute graft rejection, Type I DM, skin test for tuberculosis (TB), contact allergic reactions, and some autoimmune diseases

Tx hyponatremia

Depends on underlying disorder Restrict water intake Administer intravenous (IV) fluids

dysplasia

Deranged cellular growth; is not a true cellular adaptation but rather an atypical hyperplasia does not indicate cancer can be called atypical

What do kinins do?

Dilates blood vessels induces pain vascular permeability

manifestations of hypophosphatemia

Diminished release of oxygen, osteomalacia (soft bones) muscle weakness bleeding disorders (platelet impairment) leukocyte alterations

Be prepared to describe the makeup, structure and function of the pericardium

Double-walled membranous sac Parietal: Surface layer Visceral: Inner layer; also called epicardium Pericardial cavity Space between the parietal and visceral layers - Contains pericardial fluid (20 ml)

ex's of gangrenous necrosis

Dry: caseous - leave alone Wet: liquefactive - amputate

Complications of Anterior MI

Dysrhythmias -2nd degree AVB Type II -3rd degree AVB -BBB -CHF -V-fib/V-tach (put to 1-2 weeks post MI)

Causes of edema

Edema may be caused by: ----Increased capillary hydrostatic pressure (as occurs when venous pressures become elevated by gravitational forces -----volume expanded states, in heart failure or with venous obstruction) -----Decreased plasma oncotic pressure (as occurs with hypoproteinemia) -----dysfunction of lymphatic vessels

Cause vasoconstriction

Epinephrine norepinephrine angiotensin II

What 3 species can cause liquefactive necrosis

Escherichia coli, Staphylococci, Streptococci

causes hyperphosphatemia

Exogenous or endogenous addition of phosphate to ECF long-term use of phosphate enemas or laxatives renal failure High phosphate levels, related to low calcium levels

Active immunity

Exposure to an antigen

Regulate cell growth, movement, and differentiation

Extracellular matrix

During an ischemic event, what role does the depletion of ATP have on the intracellular environment?

Failure of active transport mechanisms (sodium-potassium [Na+/K+] pump) and sodium-calcium exchange Sodium in call causing cellular swelling - cell bursts

What are the risk factors in order of importance for hyperlipidemia (examples of modifiable and non-modifiable)?

Family history (non-mod) age men>45, women>55 (non-mod) Diets high in total fat, saturated fat, and cholesterol (modifiable) inactivity (modifiable) smoking (modifiable) Diabetes mellitus (modifiable-associated with low HDL) metabolic syndrome Chronic renal failure is associated with hypertriglyceridemia.

atherosclerosis

Fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes resulting in progressive damage to the vessel wall. At this point, smooth muscle cells proliferate, produce collagen, and migrate over the fatty streak forming a fibrous plaque.

Thick, clotted exudate is called ________. Its presence is indicative of _______ inflammation.

Fibrinous; advanced

Treatment for water excess

Fluid restriction may need hypertonic sodium chloride IV solution

Function of connective tissue

Framework for forming organs, binding, supporting them in their location, and storing excess nutrients i.e.: cartilage, bone, vascular, adipose, organs

treatment hypovolemia

Give water stop fluid loss Hypotonic saline solutions or 5% dextrose in water

How would a colloidal type infusions affect interstitial oncotic pressures, plasma oncotic pressures, capillary hydrostatic and interstitial hydrostatic pressures?

Given to keep fluid in the intravascular space and correct intravascular volume deficits Plasma oncotic pressure increases (increase resorption) and pulls fluid from intravascular spaces into the capillaries. With the fluid in the capillaries, the interstitial hydrostatic pressure decreases (decreases filtration) while the capillary hydrostatic pressure increases. The interstitial oncotic pressure is decreased.

Where are proteins from the endoplasmic reticulum packaged?

Golgi complex

Fat necrosis

Happens in breast, pancreas, other abdominal organs Done by action of lipases Gross: chalky, white areas from the combination of the newly-formed free fatty acids with calcium (saponification)

Symptoms of respiratory acidosis

Headache muscle twitching elevated carbon dioxide levels

A person with heart failure has edema in the lower legs and sacral area. The nurse suspects this condition is due to a(n):

Heart failure produces salt and water retention and subsequent volume overload increases capillary hydrostatic pressure which leads to edema.

Diastolic heart failure

Heart failure with preserved ejection fraction Decreased compliance of the left ventricle and abnormal diastolic relaxation (lusitropy)

Describe the pathophysiology behind why obesity increases the likelihood that an individual will go on to develop the above diseases

Heart needs to work harder, insulin resistance. Increases glucose load. THE HEART HAVE TO WORK HARDER, GLUCOSE LOAD AND INSULIN RESISTANCE Obesity (fat Infiltration) causes: -↑inflammation -↑Angiotensin II -↓HDL -Insulin resistance -↑NA retention -↑circulating free fatty acids -↑plasma volume

Describe the oxygen carrying capacity of hemoglobin, what proteins make up its structure

Hgb, is the iron-containing oxygen-transport in the red blood cells around body to permit aerobic respiration Proteins: 4 heme and globin - globular proteins. Each heme group contains one iron atom that can bind to one O2 molecule

What is the difference between osmotic pressure and hydrostatic pressure?

Hydrostatic pressure is the pressure pushing the fluid out favoring filtration, which is higher at the arterial end of the capillary. Osmotic pressure is the pressure pushing the fluid in favoring absorption, which is higher at the venous end of the capillary

If someone has hypertension, their heart has to work harder than normal. What might this lead to?

Hypertrophy in the heart

If someones heart valves are diseased, their heart has to work harder than normal. What might this lead to?

Hypertrophy in the heart

Lateral infarct

I + aVL, V5-6 ST elevation reciprocal ST depression in lead III

Inferior MI

II, III, aVF ST elevation

Immunoglobulin responsible for secretory immune system?

IgA

The secretory piece of ______ immunoglobulin protects it against ________

IgA enzyme degradation

Immunoglobulin predominantly in blood

IgA1

Immunoglobulin predominantly in normal body secretions

IgA2

Immunoglobulin associated mainly with allergic reactions (when the immune system overreacts to environmental antigens such as pollen or pet dander).

IgE

first immunoglobulin to be made by the body to fight a new infection

IgM

largest of the immunoglobulins

IgM

Type III hypersensitivity reaction

Immune complex disease- IgG (Complement) Neutrophils Lupus Serum Sickness - blood vessels, joint,kidney ---- Raynauds Arthus reaction -----Localized response causes increased vascular permeability, an accumulation of neutrophils, edema, hemorrhage, clotting, and tissue damage (after injection of foreign protein into the skin)

What is the difference between oncotic (osmotic) pressure and hydrostatic pressure?

In the capillaries hydrostatic pressure increases filtration by pushing fluid and solute OUT of the capillaries, while capillary oncotic pressure decreases filtration (also known as colloid osmotic pressure) pulls fluid into the capillaries and/or prevents fluid from leaving. Hydrostatic pressure-pushes water Oncotic (Osmotic) pressure-pulls water

causes of hypocalcemia

Inadequate intake or absorption Decreases in PTH and vitamin D Blood transfusions

A person reports severe diarrhea for 2 days. The nurse understands this stimulates a(n):

Increase in antidiuretic hormone secretion.

hyperplasia

Increase in cell number Compensatory: Allows organs to regenerate Hormonal: Replaces lost tissue or supports new growth

What causes accumulation of fluid in the interstitial spaces

Increased capillary hydrostatic pressure (venous obstruction) Decreased plasma oncotic pressure (losses or diminished production of albumin) Increased capillary permeability (inflammation and immune response) Lymph obstruction (lymphedema) Sodium retention

Aging is associated with

Increased cross-linking of collagen. decreased synthesis collagen increased degradation of collagen. decreased elasticity increased fluid filtration

Causes hyperkalemia

Increased intake Shift of K+ from ICF to ECF Decreased renal excretion Hypoxia Acidosis Insulin deficiency Cell trauma

manifestations of hypocalcemia

Increased neuromuscular excitability (partial depolarization) Muscle spasms Chvostek and Trousseau signs Convulsions Tetany

What role does cortisol play in the stress response?

Increases blood glucose by decreasing insulin release promotes gluconeogenesis by liver increases protein and lipid synthesis for energy acts with glucagon and epinephrine to produce a greater response, anti-inflammatory effects.

Parathyroid Hormone

Increases plasma calcium levels via kidney reabsorption.

Be prepared to compare and contrast the interleukin system, the kinin system, the complement system and their role during inflammation.

Interleukin 6 (IL-6) acts as both a pro-inflammatory cytokine and an anti-inflammatory myokine. It's secreted by T cells and macrophages to stimulate immune response, e.g. during infection and after trauma, especially burns or other tissue damage leading to inflammation. IL-6 also plays a role in fighting infection IL-6 is an important mediator of fever and of the acute phase response.

5 clinical manifestations of atherosclerosis

Intermittent claudication skin color changes (pale to reddened) cold sensitivity diminished pulse angina

causes of hypophosphatemia

Intestinal malabsorption and renal excretion vitamin D deficiency antacid use alcohol abuse

Manifestations hypernatremia

Intracellular dehydration convulsions pulmonary edema hypotension tachycardia

Coagulative necrosis

Involves kidneys, heart, and adrenal glands Protein denaturation Abnormality in intracellular calcium

Liquefactive necrosis

Involves neurons and glial cells in the brain Hydrolytic enzymes form liquid-filled cysts or forms pus brain infarct

Vitamin D

Is a fat-soluble steroid; increases calcium absorption from the gastrointestinal (GI) tract.

Why is CO so dangerous in relation to hemoglobin?

Is colorless and odorless. Produces hypoxic injury. Directly reduces the oxygen-carrying capacity of blood, and promotes tissue hypoxia. it quickly binds with the hemoglobin, preventing oxygen molecules from doing so.

osmosis

Is how water moves between the ICF and ECF compartments.

Net filtration:

Is the movement across the capillary wall. As described according to the Starling law or hypothesis Net filtration=forces favoring filtration minus forces opposing filtration

penetrance

Is the percentage of individuals with a specific genotype who also express the expected phenotype. ==Incomplete penetrance I------ndividual who has the gene for a disease but does not express the disease --------------Example: Retinoblastoma (eye tumor in children) (90%) ==Age-dependent penetrance --------Does not express a disease until a certain age is reached --------------Example: Huntington disease

Chloride

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

Sodium

Is the primary ECF cation. Regulates osmotic forces. Roles include: --Neuromuscular irritability ---acid-base balance --cellular reactions --transport of substances

hypochloremia

Is usually the result of hyponatremia or elevated bicarbonate concentration. Some causes are: Vomiting Metabolic alkalosis Cystic fibrosis Treat the underlying cause.

Myocardial necrosis

Ischemia and injury continue to be uncorrected tissue begins to sustain irreversible damage :: infarct necrotic tissue :: scar :: no response to electrical stimulus and no contractile functions

Tx hypernatremia

Isotonic salt-free fluids

Clinical manifestations of right heart failure

Jugular venous distension, peripheral edema, hepatosplenomegaly

Total Cholesterol lab

LDL + HDL Ideal<200 Ideal high HDL, low LDL

Causes of cell injury

Lack of oxygen (hypoxia) Free radicals Caustic or toxic chemicals Infectious agents Unintentional and intentional injury Inflammatory and immune responses Genetic factors Insufficient nutrients Physical trauma from many causes

Tombstone

Lateral MI means ischemia injury is massive massive ST elevation with shape of tombstone (not peaked like hyperkalemia) No T wave

Blood flows from the pulmonary veins into the:

Left atrium (From the left atrium the blood passes through the left AV valve (mitral valve) into the left ventricle.)

X linked dominant

Less common The X-linked dominant muta on appears to override or dominate the unchanged informa on in the working copy of the gene. If mother has 1 dominant x ->child has 50% chance If mother has 2 dominant x ->child 100% Father has dominant x ->female child 100% chance, male child 0% chance Ie: Fragile X (mild to moderate intellectual disability, ADHD, autism, seizures, anxiety, elongated face, big ears, flat feet - affects boys more severely since they only have 1 X chromosome)

Manifestations Hyponatremia

Lethargy headache confusion apprehension seizures coma

Manifestations hyperkalemia

MILD: Tingling of lips and fingers, restlessness, intestinal cramping and diarrhea, T waves on the ECG SEVERE: Muscle weakness, loss of muscle tone, flaccid paralysis, cardiac arrest

What are the risk factors in order of importance for hypertension (examples of modifiable and non-modifiable)?

MODIFIABLE: obesity physical inactivity high salt/low K+/high sugar/ high sat fat diet too much alcohol consumption smoking stress insulin resistance NONMODIFIABLE age gender - until age 45, men more likely family hx race - African-American

Manifestations of hypokalemia

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

Protease functions

Metabolic - food digestion blood coagulation fight infections maturation of prohormones bone formation programmed cell death recycling of cellular proteins that are no longer needed.

Gary has smoked a pack of cigarettes a day for ten years. What could be going on in his bronchial (airways) lining?

Metaplasia of normal, ciliated columnar epithelial cells to stratified squamous epithelial cells

First stage of inflammatory process (of 5)

Microorganisms invade damaged tissue

A person has atherosclerosis. Which pathophysiologic process has occurred?

Monocytes transform into Macrophages. Macrophages engulf lipids (cholesterol/cholesterol esters) Macrophages release cytokines such as IL-1 & TNF (increase adhesion of leukocytes). These enzymes released and toxic oxygen radicals create oxidative stress causes oxidize of LDLand further injures the vessel wall.

IgG

Most abundant of the immunoglobulins

What is the main determinant of water distribution

Na+

Cause loss of sodium, chloride, and water through their effects on kidney function, decreasing blood volume

Natriuretic peptides

Fifth stage of inflammatory process (of 5)

Neutrophils flock to the invasion site to engulf and destroy microorganisms from dying cells.

Who is most at risk for dehydration?, who is least at risk?

Newborn: water is 75% to 90% of body weight

incidence

Number of new cases

What are the risk factors in order of importance for type 2 diabetes (examples of both modifiable risk factors and non-modifiable)?

Obesity(modifiable) and positive family hx (non modifiable)

causes of pulmonary emboli

Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipid, or air bubble.

X linked recessive

Occurs significantly more often in males than in females. Females must inherit two copies of the recessive allele (one from each parent) to express the disease, whereas males need only one copy (from the mother) to express the disease. Because a father can give a son only a Y chromosome, the trait is never transmitted from father to son. Example: Duchenne muscular dystrophy (DMD) Occurs 1 in 3500 males. Exhibits progressive muscular degeneration. Deletion of DMD gene causes dystrophin not to work properly; consequently, muscle cells do not survive.

Hyperchloremia

Occurs with hypernatremia or a bicarbonate deficit. Is usually secondary to pathophysiologic processes. Is managed by treating the underlying disorders.

tx hypercalcemia

Oral phosphate IV normal saline Bisphosphonates Calcitonin Corticosteroids Mithramycin

the mechanism by which energy produced from carbohydrates, fats, and proteins is transferred to ATP.

Oxidative phosphorylation

L atrium-

Oxygen Rich blood flows from the left atrium → left ventricle (mitral valve is open, aortic valve closed) during diastole (ventricles relaxed)

R atrium-

Oxygen-poor blood flows from the right atrium → right ventricle (tricuspid valve is open, pulmonic valve is closed) during diastole (ventricles relaxed)

A nurse is looking at an ECG and is measuring the time interval from the onset of atrial electrical activity to the onset of ventricular electrical activity. What is the nurse measuring?

PR interval

represents the time necessary to travel from the sinus node through the atrium, AV node, and His-Purkinje system to activate ventricular myocardial cells.

PR interval

Phases of cardiac cycle

Phase 1: Atrial systole or ventricular diastole Phase 2: Isovolumetric ventricular systole Phase 3: Ventricular ejection (semilunar valves open) Phase 4: Isovolumetric ventricular relaxation (aortic valve closes) Phase 5: Passive ventricular filling (mitral and tricuspid valves open)

Treatment diastolic HF

Physical training (aerobic and weight training): Improves endurance and quality of life Beta-blockers, ACE inhibitors, ARBs, and aldosterone blockers

What forces oppose filtration?

Plasma oncotic pressure Interstitial hydrostatic pressure

movement from the interstitium into the plasma is favored by:

Plasma oncotic pressure and interstitial fluid hydrostatic pressure.

Types of Active transport

Potassium sodium pump endocytosis exocytosis

apoptosis

Programmed Cell Death -No inflammatory changes -Type 1—cell death (caspases) -Type 2—autophagic cell death Can occur normally or pathologically.

4 phases of mitosis

Prophase Metaphase Anaphase Telophase

What cytokine in particular gets released from inflammatory cells to initiate a fever?

Prostaglandin E2

Antibody function

Protects against infection. Direct Neutralization: Inactivates or blocks the binding of an antigen to a receptor. Agglutination: Clumps insoluble particles in suspension. Precipitation: Makes a soluble antigen into an insoluble precipitate. Indirect Complement and phagocytes

Active transport is

Protein mediated

represents the sum of all ventricular muscle cell depolarizations

QRS complex

is sometimes called the "electrical systole" of the ventricles

QT interval

G2 phase

RNA and protein synthesis

Function of neural tissue

Receive and transmit electrical impulses very rapidly across junctions called synapses Neurotransmitters

Function of protein in cell

Receptors Transporters Enzymes Surface markers Adhesion molecules Catalysts

generation skipping

Recessive genes, usually X-linked recessive disease. Gene can be transmitted through a series of female carriers, causing the appearance of a skipped generation Because a father can give a son only a Y chromosome, the trait is never transmitted from father to son. Occurs significantly more often in males than in females. Females must inherit two copies of the recessive allele (one from each parent) to express the disease, whereas males need only one copy (from the mother) to express the disease. IE: Duchenne muscular dystrophy (DMD)

Causes Hypokalemia

Reduced potassium intake Increased potassium entry into cell Increased potassium loss

What is the function of compensatory hyperplasia

Regeneration of certain organs

causes hypernatremia

Related to Na gain or water loss Water movement from the ICF to the ECF Intracellular dehydration

Tx Hypokalemia

Replace orally and/or intravenously

meiosis

Reproduction of gametes

A person with a history of chronic lung disease arrives in the clinic with a 1-week history of a productive cough, hypoventilation, headache, and muscle twitching. The nurse suspects the person is experiencing:

Respiratory acidosis

produced by alveolar hyperventilation and reduction in carbon dioxide concentration.

Respiratory alkalosis

metaplasia

Reversible replacement of one mature cell type by another less mature cell type reprogramming of stem cells

Sx of myocardial ischemia

S/S pain fatigue diaphoresis anxiety

Describe ECG patterns for MI and define

ST elevation (STEMI) - immediate intervention Smaller infarcts: Non-STEMI - Suggest that additional myocardium is still at risk for recurrent ischemia and infarction

Fibrin necrosis

See this in immune reactions in vessels Immune complexes (antigen-antibody complexes) and fibrin are deposited in vessel walls Gross: changes too small to see grossly Micro: vessel walls are thickened and pinkish-red (called "fibrinoid" because the deposits look like fibrin deposits)

gangrenous necrosis

See this when an entire limb loses blood supply and dies (usually the lower leg) Gross: skin looks black and dead; underlying tissue is in varying stages of decomposition Micro: initially there is coagulative necrosis from the loss of blood supply (this stage is called "dry gangrene"); if bacterial infection is superimposed, there is liquefactive necrosis (this stage is called "wet gangrene")

Trisomy X

Sex chromosome aneuploidy -Female has 3X (XXX) chromosomes in each cell -Sterility, menstrual irregularity and/or cognitive defects -Symptoms worsen with each additional X chromosome

Endoplasmic reticulum

Site of Protein Synthesis Senses Cellular Stress

ex of muscle tissue

Smooth Skeletal Cardiac

Describe the movement of intra and extracellular ions across the membrane.

Sodium chloride is found mostly in extracellular fluid, while potassium and phosphate are the main ions in the intracellular fluid.

What are stem cells and why are they important.

Stem Cells are cells with the potential to develop into many different cell types during early development and growth. Not differentiated Pluripotent- potential to develop into whatever cells - Multipotency Self renewal

A person's heart rate is reduced. What is happening physiologically?

Stimulation of the parasympathetic nervous system

Function of Calcium

Structure of bones and teeth Blood clotting Hormone secretion Cell receptor function Muscle contractions

S/S myocardial necrosis

Substernal/Epigastric Chest Pain Diaphoresis/Anxiety/SOB N/V/pallor/Weakness

Cytoplasm

Synthesis and transport Eliminates wastes Metabolic processes Maintenance Motility Storage

Ribosomes are nucleoproteins that...

Synthesize a signal recognition sequence recognized by particles in the cytosol RNA--->DNA

ribosomes

Synthesize proteins

Describe the different stages of cancer

TNM Staging (Tumor, node, metastasis) -----T=size 1-4 (4 largest) -----N 0-3 (lots of nodes carrying cancer) -----M 0-1 (spread to another part of body) Number Staging System -----I - cancer is relatively small and contained within the organ it started in. -----II - cancer has not started to spread into surrounding tissue but the tumour is larger than in stage 1, -----III - cancer is larger. It may have started to spread into surrounding tissues and there are cancer cells in the lymph nodes in the area -----IV - cancer has spread from where it started to another body organ.

Manifestations of hypovolemia

Tachycardia weak pulse postural hypotension Elevated hematocrit and serum sodium levels Headache dry skin and dry mucous membranes

A nurse observes a "hot spot" from the injection of a radioactive solution. Which test is the nurse reviewing?

Technetium scanning Technetium pyrophosphate (99mTcPYP) is injected intravenously into a resting individual during a imaging examination. Two hours after injection the distribution pattern of the radioactive solution is recorded by nuclear scan

During depolarization

The Na+ - K+ pump removes Na+ from the cell The depolarized cell is more positively charged, and its polarity is neutralized.

Gary quits smoking, what happens to his bronchial lining?

The cells that had transformed into squamous stratified epithelial cells will return back to their normal state because metaplasia is reversible.

The function of lipids specifically in relation to moving substances into and out of cells

The plasmas membrane is made up a phospholipid bilayer that is Hydrophilic and hydrophobic Lipid-soluble molecules like oxygen, water, and CO2 diffuse readily through the plasma membrane

The function of proteases specifically in relation to moving substances into and out of cells

The protease would degrade transmembrane proteins leading to cell injury/inflammation/lysis

A person has a diagnosis of valvular regurgitation. What pathophysiologic process is the person experiencing?

The valves fail to shut completely, permitting the backflow of blood

When you're wearing shoes that rub against your foot all day, what happens to the epithelial cells on the spot that's rubbed?

They undergo hyperplasia

L axis deviation causes

Think cardiac: Ischemic Heart Dz Systematic HTN Aortic Stenosis LV disorders (LVH) Aortic Valve Dz WPW LBBB Inferior MI

R axis deviation causes

Think pulmonary: COPD Pulm Embolism Pulm HTN Cor Pulmonale Congenital Heart Dz RBBB RVH- d/t pulmonary conditions Anterior MI

DNA polymerase function

This enzyme functions to add correct nucleotides to the DNA strand, to edit incorrect nucleotides, and enhance the accuracy of DNA replication.

Where do T cells mature

Thymus (they originate in the bone marrow)

prevalence

Total number of cases in a specified population. Ex. # Aids cases in Africa

tx hypophosphatemia

Treat underlying condition such as respiratory alkalosis and hyperparathyroidism

Tx hyperphosphatemia

Treat underlying condition, aluminum hydroxide dialysis

Granuloma formation is a classic characteristic of ___________.

Tuberculosis

ex of caseous necrosis

Tuberculosis pulmonary infection

Bee Sting Allergy

Type I hypersensitivity Rxn H1: bronchial constriction, edema, vasodilation

Hemolytic reactions

Type II hypersensitivity reaction

Graves Disease

Type II hypersensitivity reaction patient makes antibodies that bind to the TSH

Myastenia Gravis

Type II hypersensitivity reaction patient makes antibodies that bind to the acetylcholine receptor

Type 1 DM

Type IV hypersensitivity Cytotoxic T cells kill pancreatic islet cells

Acute Graft reaction

Type IV hypersensitivity reaction

Autoimmune diseases

Type IV hypersensitivity reaction

Contact allergy reaction

Type IV hypersensitivity reaction

Describe right heart failure, causes and treatments

Usually occurs as a result of left sided heart failure. When the left ventricle fails, increased fluid pressure is transferred back through the lungs, ultimately damaging the heart's right side.

Anterior infarct

V3-V4 ST elevation

Third stage of inflammatory process (of 5)

Vasodilation occurs along with increased capillary permeability

Movement across capillary membrane

Water, sodium, and glucose redily move across capillary membrane plasma proteins do not cross cap membrane and maintain effective osmolality by generating plasma oncotic pressure (albumin) Capillary pressures cause fluid movement by net filtration Cell fluid movement by osmosis (water)

malignancy

abnormal cells divide without control and can invade nearby tissues.

When blood pressure falls, the baroreceptor reflex ________ heart rate and causes _________ of arterioles in the systemic circulation.

accelerates constriction

Immunizations produce __________ immunity

active acquired

ex of fat necrosis

acute pancreatitis also involves breast, abdominal organs

Epi and norepinephrine are released by

adrenal gland into blood stream

Hormones that regulate sodium

aldosterone natriuretic peptides.

What does it mean to describe and individual as atopic? What is different about them?

allergy prone have high eosinophil counts induced by IgE mediated hypersensitivity reactions

Natural killer cells can work _____ or with ____

alone IgG

Axis deviation:

alteration of normal flow of current that represents an abnormal depolarization pathway and may signify death or disease of the myocardium

Increases blood volume by reabsorption of water from tubular fluid in the distal tubule and the collecting duct of the nephron

antidiuretic hormone

paratope

antigen binding site The part of an antibody that binds to the epitope When an antibody binds to a protein, it isn't binding to the entire full-length protein. Instead, it is binding to a to a segment of that protein known as an epitope.

NK cells lack

antigen-specific receptors.

epitope

antigenic determinant part of an antigen that is recognized by the immune system, specifically by antibodies, B cells, or T cells

The PR interval is the time from onset of _______ to the time of onset of ________

atrial activation ventricular activation

Trisomy 21

autosomal aneuploidy Mental challenges, low nasal bridge, epicanthal folds, protruding tongue, flat low-set ears, poor muscle tone Has increased risk of congenital heart disease, respiratory infections and leukemia

Desmosomes

bands or belts

Tight junctions

barriers to diffusion

IgM is mainly found in

blood and lymph fluid

What happens when the right side of the heart loses its pumping power?

blood backs up in the body's veins. This usually causes swelling or congestion in the legs, ankles and swelling also can cause swelling within the abdomen such as the GI tract and liver (causing ascites).

Treatment PE

blood thinners (anticoagulation): heparin, Coumadin, LMWH

Where do B cells mature

bone marrow (they originate in the bone marrow too)

NK cells are known to differentiate and mature in the ________ where they then enter into the circulation

bone marrow, lymph nodes, spleen, tonsils and thymus

ex of liquefactive necrosis

brain infarct brain infection injury to neurons and glial cells

Short term cortisol

breaks down fatty acid for energy

The function of carbohydrates in relation to moving substances into and out of cells

carbohydrates attached to the integral proteins Intercellular recognition

Stimulation of the ________ system increases the rate of depolarization of the SA node and increases heart rate.

cardioexcitatory

Myocardial Stunning

caused by the alterations in electrolyte pumps, calcium homeostasis, and the release of toxic oxygen radicals

Venous obstruction causes

causes an increase in hydrostatic pressure behind an obstruction, such as a venous blood clot, right heart failure, tight clothing and prolonged standing.

increase in lymph obstruction

causes edema occurs when the lymphatic channels are blocked due to infection or tumor.

What do fatty streaks cause

changes in the vessel wall ------- produce more toxic oxygen radicals and cause immunologic and inflammatory changes -------results in progressive damage to the vessel wall and will eventually form fibrous plaques.

Raynaud disease

characterized by attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, the toes. Blood vessels in affected individuals with Raynaud disease demonstrate endothelial dysfunction with an imbalance in endothelium-derived vasodilators (e.g., nitric oxide) and vasoconstrictors (e.g., endothelin-1).

gap junction

clusters of communicating channels

Protein denaturation

coagulative necrosis

Framework for forming organs, binding, supporting, and storing excess nutrients

connective tissue

Platelet-derived growth factor stimulates

connective tissue growth

Fluoroscopic visualization of the coronary arteries and left-heart structures using contrast dye

coronary angiography or arteriography

Ribosomal protein synthesis takes place in

cytosol

atrophy

decrease in cell size Pathologic Results from decreases in workload, use, pressure, blood supply, nutrition, hormonal stimulation, and nervous stimulation Disuse Decreased protein synthesis, increased protein catabolism, or both (protease)

osmotic pressure ______ reabsorption by ______ water_____ the capillaries

decreases pulling into (or prevents it from leaving)

Causes of Hyponatremia

decreases the ECF osmotic pressure, and water moves into the cell could be caused by free water excess Sodium deficits cause plasma hypoosmolality and cellular swelling Pure sodium deficits low intake dilutional

A reduction in capillary hydrostatic pressure

decreases the force for filtration of fluid from the capillary which would decrease edema.

P wave

depolarization of atria + the rate

QRS wave

depolarization of ventricles

What do histamines do?

dilate blood vessels

The osmotic pressure of a solution is _________ proportional to the concentration of the solution

directly

Natriutetic peptides are ________ which would make more ________ of fluid.

diuretics loss

Symptoms of respiratory alkalosis

dizziness, confusion, paresthesia, convulsions, and coma.

Why is passive immunity short lived?

donor antibodies or T lymphocytes are destroyed

placed over the vessel to be studied, and sounds related to obstructions to flow, vessel wall mobility, and heart murmurs are transmitted through a lubricating gel to the microphone.

doppler

What is a precursor to cancer

dysplasia

the most effective and widely used noninvasive modality for evaluating the structures of the heart.

echocardiography

Compensatory hyperplasia

enables organ regeneration and is a normal process.

locations on females where hyperplasia often occurs

endometrium cervix

Site of protein synthesis

endoplasmic reticulum

Dysregulated apoptosis

excessive or not enough programmed cell death Can lead to cancer, autoimmune disorders, neurodegenerative diseases, and ischemic injury.

non-disjunction

fFailure of homologous chromosomes to separate during meiosis. Non-disjunction results in aneuploidy, which is the condition of having an abnormal amount of chromosomes. Results in a 1:1 ratio of daughter cells with an extra chromosome to those with a loss of a chromosome

A protein transporter moves solute molecules through cellular membranes without expending metabolic energy.

facilitated diffusion

Describe left heart failure

failure to pump blood throughout body, backs up into lungs. Congestive systolic heart failure or diastolic heart failure

Foam cells

fat-laden (LDL filled) macrophages seen in atherosclerosis - localize to fatty deposits on blood vessel walls

Cisternae

flattened membrane disk of the endoplasmic reticulum and Golgi apparatus.

The function of phosphate specifically in relation to moving substances into and out of cells

found in phospholipids, such as those that make up the cell membrane, and in ATP, nucleotides, and buffers. (more than 85% found in bones)

Increased capillary permeability

from Inflammation and immune response especially w/trauma (burns or crushing injuries, neoplastic disease, allergic reactions); proteins escape from vascular space and produce edema through decreased capillary oncotic pressure and interstitial fluid protein accumulation

G1 phase

gap

Clot from carotid arteries

go to brain: stroke TIA

Clots from the L atria

go to the brain and cause stroke

Clots from DVT

go to the lungs and cause PE

Clots from the R atria

go to the lungs and cause PE

blood hydrostatic pressure is _______ then interstitial fluid pressure. This results in _____________

greater Movement from the bloodstream into the interstitium

Define pro-oncoges

group of genes that cause normal cells to become cancerous when they are mutated Mutations in proto-oncogenes are typically dominant in nature, and the mutated version of a proto-oncogene is called an oncogene proto-oncogenes encode proteins that function to stimulate cell division, inhibit cell differentiation, and halt cell death.

systolic HF

happens when the heart doesn't pump out blood the way it should. Reduced EF enlarged LV chamber Stiff heart The heart can't properly fill with blood during the resting period between each beat.

symptoms of metabolic acidosis

headache lethargy Kussmaul respirations anorexia nausea and vomiting dysrhythmias coma.

diastolic HF

heart doesn't fill back up with blood as it should increased filling pressures The left ventricle loses its ability to contract normally. preserved EF

Epi and norepinephrine signal the ______

heart to pump harder, increasing blood pressure, opening airways in the lungs, narrowing blood vessels in the skin and intestine to increase blood flow to major muscle groups, and performing other functions to enable the body to fight or run when encountering a perceived threat.

The function of calcium specifically in relation to moving substances into and out of cells

helps to stabilize cell membranes and is essential for the release of neurotransmitters from neurons and of hormones from endocrine glands. More than 99% found in bones

type 1 hypersensitivity reactions ______ release of histamine from _______

histamine mast cells and basophils

When describing the stress response, what roles does ACTH have on the body?

hormone produced in response to biological stress. Its principal effects are increased production and release of cortisol by the cortex of the adrenal gland. ACTH is also related to the circadian rhythm in many organisms.

What two cellular adaptations often occur in conjunction with one another?

hypertrophy and hyperplasia

ex fibrinoid necross

immune reaction in vessels

antibodies are also called

immunoglobulins

Aldosterone agonists

increase the concentration of aldosterone and concentration of sodium. People with hypertension should take aldosterone antagonist.

Increased hydrostatic pressure _______ filtration by ______ water _____ the capillaries

increases pushing solute and out of

LBBB

indicates significant myocardial dx ---5%-30% MI patients with new onset LBBB will developed 3rd degree AVB ---30%-70% of these will developed cardiogenic shock (85% mortality) requires a big lesion impulse- RV towards LV Characteristics wide QRS (>0.12 secs) QRS axis-nml or left obscure ischemic changes associated with MI therefore localizing MI may be greatly hampered

The first response to cell injury

inflammation

Increased capillary permeability is associated with

inflammation and the immune response. This is a result of trauma such as burns, allergic reactions and infection

The function of chloride specifically in relation to moving substances into and out of cells

is the predominant extracellular anion. major contributor to the osmotic pressure gradient between the ICF and ECF, and plays an important role in maintaining proper hydration. Follows sodium to maintain maintaining the electrical neutrality.

Describe ECG patterns for ischemia and define

ischemia - ST depression, peaked T wave Develops if the supply of coronary blood cannot meet the demand of the myocardium for oxygen and nutrients. - Temporary shortage of Oxygen at the cellular level Transient absence of blood supply Stable angina: Causes predictable chest pain. Prinzmetal angina (variant): Causes unpredictable chest pain. Silent ischemia: Causes no detectable symptoms. Angina pectoris: Causes transient substernal chest discomfort.

hypovolemia

isotonic depletion

hypervolemia

isotonic excess

Anterior MI

knock out AV node get 3rd degree block need to pace them immediately, then get AICD, pacemaker. Need to stimulate SNS: HTN, tachycardia V3 and V4 Reciprocal (II/III/aVF) changes are rare

Why would the leakage of the contents of a lysosome within a cell cause damage and where.

leakage into the cytosol would cause apoptotic cell death basically causes auto digestion of intracellular structures (eats its own).

Most people with heart failure have _______

left sided Heart Failure

Lateral Wall MI may be associated with

left ventricular dysfunction and conduction defects. Usually the prognosis is poor and hospital complications are significant.

What are fatty streaks

lesions formed by a significant accumulation of foam cells (macrophages filled with LDL).

Role of ligand in receiving messages

ligand specifically binds to another molecule (often larger) causing the protein to undergo a change in shape. The conformation of a receptor protein creates the functional state.

Active immunity is ______ lived

long

decreased oncotic pressures result from

losses or diminished production of plasma albumin. This is most commonly associated with liver disease, glomerular disease, hemorrhage, and protein malnutrition.

Decreased Plasma Oncotic Pressure

lost or diminished plasma albumin production (eg. from liver disease or protein malnutrition) fluid remains in interstitial space, resulting in edema

Water percentage as people age

lowers

3% NS effects on plasma oncotic pressure

lowers give - cell dehydration, increases ECF

The function of sodium specifically in relation to moving substances into and out of cells

major cation of the extracellular fluid. It is responsible for one-half of the osmotic pressure gradient that exists between the interior of cells and their surrounding environment

The function of potassium specifically in relation to moving substances into and out of cells

major intracellular cation. It helps establish the resting membrane potential in neurons and muscle fibers after membrane depolarization and action potentials. In contrast to sodium, potassium has very little effect on osmotic pressure.

Lymphoma and multiple myeloma

malignancies that begin in the cells of the immune system.

Sarcoma

malignancy that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

Carcinoma

malignancy that begins in the skin or in tissues that line or cover internal organs.

Leukemia

malignancy that starts in blood-forming tissue, such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood.

Histamines are released by

mast cells basophils

hydrostatic pressure

mechanical force of fluid pushing against cell membranes can exist in the tissue or in capillaires (aka capillary filtration pressure) main determinant of pushing pressure is fluid volume. Also affected by heart pumping and gravity

produced by an increase in noncarbonic acids and/or a decrease in bicarbonate ion.

metabolic acidosis

A person arrives in the emergency department after a loss of consciousness and the develop-ment of Kussmaul respirations. The individual has a history of diabetes and 2 days of vomiting and diarrhea. The nurse suspects the person has:

metabolic acidosis. Diabetic ketoacidosis results in an increase in noncarbonic acids and a decrease in bicarbonate ion which produces metabolic acidosis.

produced by an excess of bicarbonate ion.

metabolic alkalosis

Catabolism

metabolic breakdown of complex molecules into simpler ones, often resulting in a release of energy.

set of life-sustaining transformations within cells of living organisms

metabolism

Where does Oxidative phosphorylation occur?

mitochondria

M phase

mitosis

IgG

most protective activity against bacterial and viral infections transported across plasma

Filtration

movement of proteins or other large molecules from the blood into the interstitium.

Reabsorption

movement of proteins or other large molecules from the interstitium into the blood.

hydrostatic pressure gradient

moves water by passive transport via pores in cell membrane

Contractile tissue, enabling both voluntary and involuntary movement

muscle tissue

symptoms of metabolic alkalosis

muscle weakness, muscle cramps, hyperreflexia, paresthesias, tetany, and seizures.

Inside of the cell is more _________ charged than the outside.

negatively

4 types of tissues

neural epithelial muscle connective

Receive and transmit electrical impulses very rapidly across junctions called synapses

neural tissue/neurotransmitters

autosomal dominant

no generation skipping Approximately one-half of children of an affected heterozygous parent will express the condition (all or none of the children may have the condition). passed equally among gender i.e.: von Recklinghausen disease ------Expressivity varies from brown spots on the skin to malignant tumors, scoliosis, gliomas, and neuromas.

Ribosomes are synthesized in the.....

nucleolus

polyploidy

number of chromosomes is a multiple of 23 and greater than 46; fertilized egg by 2 sperm - accounts for 20% of abortions and babies usually die within year (Triploid syndrome)

Each plasma cell synthesizes and secretes...

one type of antibody

Hypovolemia stimulates ________ receptors and _______ receptors and results in secretion of __________ to increase water reabsorption.

osmoreceptors baroreceptors antidiuretic hormone

Water moves between the plasma and interstitial fluid through ______ and ______ pressure, which occur across the capillary membrane.

osmosis hydrostatic

represents atrial depolarization

p wave

Myocardial Ischemia on 12 lead

pathologic Q waves > 0.04 secs (width) and >25% of the height of the succeeding R wave

12 lead EKG changes in everything (ST elevation)

pericarditis - viral/bacterial infection

antibodies are produced by

plasma cells

12 lead EKG normal, but pt with significant symptoms

posterior MI have to change the view to capture back

interstitial oncotic pressure

pressure exerted by proteins in interstitial fluid.

Passive immunity

produced when antibodies formed by one individual are transferred to another individual.

Increase in interstitial oncotic pressures

produces movement of fluid from the interstitial space into the vascular space which would decrease edema

Long term cortisol

promotes fat distribution and lipogenesis

major workhorse of the cell

protein

oncotic pressure exerted by proteins in the blood plasma tend to ________

pull water into the circulatory system/plasma

R ventricle-

pumps the oxygen-poor blood to the lungs. The right ventricle pumps oxygen poor blood into the pulmonary arteries (pulmonic valve is open, tricuspid valve is closed) ----> lungs during systole (ventricles contracted)

L ventricle-

pumps the oxygen-rich blood to the body. The left ventricle pumps oxygen-rich blood into the aorta (aortic valve is open, mitral valve closed)---> to the body. during systole (ventricles contracted)

angiotensin II

released locally, where it is a growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts - it is involved in remodeling promotes catecholamine release causes coronary artery spasm causes peripheral vasoconstriction causes fluid retention

Angiotensin II mediates

remodeling of the ventricular wall, contributing to sarcomere death, loss of the normal collagen matrix, and interstitial fibrosis. This leads to decreased contractility, changes in myocardial compliance, and ventricular dilation.

produced by alveolar hypoventilation and increase in carbon dioxide concentration.

respiratory acidosis

produced by alveolar hyperventilation and reduction in carbon dioxide concentration.

respiratory alkalosis

IgA are found in

saliva and other secretions

How long does it take for the body to form antibodies?

several days to build to maximum intensity, peaks in the blood at about 14 days.

Passive immunity is ______ lived

short

The function of proteins specifically in relation to moving substances into and out of cells

some exist permanently within and span the membrane across which they transport substances. They may assist in the movement of substances by facilitated diffusion or active transport.

During endothelial injury, endothelium _______ making ______ and ______ substances such as _______ and __________

stops antithrombotic and vasodilatory nitric acid and prostaglandins

Physiological stress, body produces

stress hormones like cortisol, which are able to trigger interleukin-6 release into the circulation.

Ligands include

substrates, inhibitors, activators, and neurotransmitters.

What is chronically activated with heart failure

sympathetic nervous system

Sequence of steps of protein synthesis starting in the nucleus and ending at the cell membrane for protein synthesis

takes two steps: transcription and translation. Transcription takes the information encoded in DNA and encodes it into mRNA, which heads out of the cell's nucleus and into the cytoplasm (site of protein synthesis). During translation, the mRNA works with a ribosome and tRNA to synthesize proteins.

Left bundle branch issues on 12 lead

the ST segments and T waves show "appropriate discordance" ---they are directed opposite to the main vector of the QRS complex. ----This produces ST elevation and upright T waves in leads with a negative QRS complex (dominant S wave), while producing ST depression and T wave inversion in leads with a positive QRS complex (dominant R wave).

aneuploidy

the presence of an abnormal number of chromosomes in a cell associated with increased maternal age Downs (47 chromosomes), Turner's syndrome (45 chromosomes)

IL-6 plays a major role in

the process of acute or chronic stress (e.g. depression, anxiety) suppressing the immune system.

Potassium sodium pump each cycle

the pump exchanges three Na+ ions from the intracellular space for two K+ ions from the extracellular space.

Metaplasia

the reversible replacement of one mature cell by another less mature cell type.

Ex of coagulative necrosis

tissue infarct i.e. MI, kidney, adrenal glands not brain

Use for osmotic diuretic

to increase ICP

Give hypotonic solutions to:

treat intracellular dehydration: diabetic ketoacidosis (DKA), hyperosmolar hyperglycemia, true dehydration (pt lost H20 only) shifts fluid from vascular bed into cells and interstitial spaces can cause increased ICP/cerebral swelling (avoid in trauma/burn pt/liver)

What is the function of the NK cell, where do they mature?

type of cytotoxic lymphocyte critical to the innate immune system - provide rapid responses to viral-infected cells, acting at around 3 days after infection, and respond to tumor formation.

Septal infarct

v1-v2 ST elevation

Pathologic causes for increased capillary hydrostatic pressure

venous obstruction: thrombophlebitis, hepatic obstructions, tight clothing, prolonged standing Congestive heart failure, renal failure and cirrhosis of liver associated with excessive salt and water retention which causes plasma volume overload One cause of EDEMA

Persistent ST elevation after an MI may indicate

ventricular aneurysm

ST interval

ventricular myocardium depolarized. If elevated ---> myocardial infarction, pericarditis (all leads), LBBB, L ventricular hypertrophy (V1-V3 with deep S waves) If peaked ----> hyperkalemia If depressed ---> myocardial ischemia, reciprocal changes, hypokalemia

T wave

ventricular repolarization

RBBB

very common caused by anteroseptal MI Impulse- LV towards RV Characteristics wide QRS (>0.12 secs) QRS axis- nml or right

Give hypertonic solution to:

water excess: compulsive water drinker SIADH (failure of distal tubules to reabsorb sodium) Draws water out of the intracellular space, increasing extracellular fluid volume. Because of this property, hypertonic solutions are used as volume expanders. can cause pulmonary edema/fluid overload (avoid in renal/CHF/DKA pt, do in ICU/monitored setting)

Describe ECG patterns for bundle branch blocks

wide QRS (>0.12 secs) LBBB-QRS axis-nml or left - triangle down RBBB-QRS axis- nml or right-J point-triangle up

Type II DM is often treated with

with lifestyle modification, including diet and exercise