Pathophysiology 5500 Exam One

Differentiate acute inflammation from chronic inflammation by matching each condition to its correct characteristic manifestation(s). 1. Infiltration of macrophages, lymphocytes, and fibroblasts 2. Influx of inflammatory cells; i.e., neutrophils 3. Immediate vascular changes with vasodilation and increased capillary permeability 4. Inflammatory processes lasting days to years 5. Tissue necrosis and fibrosis 6. Widespread effects of inflammatory mediators, producing fever, leukocytosis, and other systemic manifestations

*ONLY RECEIVED 2/3 CREDIT* 1. Acute inflammation 2. Acute inflammation 3. Acute inflammation 4. Chronic inflammation 5. Chronic inflammation 6. Chronic inflammation

Cancer cells demonstrate genetic instability and chromosomal abnormalities. ____ is an abnormal number of chromosomes.

Aneuploidy

____ changes the immune response to cancer via immunotherapy or biologic response modifiers.

Biotherapy

During the inflammatory process, histamine and serotonin _____.

Dilate arterioles and increase permeability of venules

Children >6 years of age that are exposed to lead in the environment may develop mental and growth retardation. Lead poisoning results from ______.

Exposure to lead over a period of time causing an abnormal accumulation of this exogenous substance in the body cells including nerve cells, which affects nerve transmission and brain development

Plasma-derived mediators include (select all that apply):

Fibrinolysis system that contributes to the vascular phase and produces fibrin products during the final steps of clotting Proteins of the complement system that 1) cause vasodilation and increased vascular permeability; 2) promote leukocyte activation, adhesion, and chemotaxis; and 3) augment phagocytosis Kinins that increase capillary permeability

___ of tumors is based on a I-IV scale dependent on microscopic determination of the level of diffferentiation and the number of mitoses. ____ in the AJC system is from 0-IV with determination dependent on size of primary lesion(s) as well as the extent and spread of the cancer.

Grading; Staging

Cell-derived mediators are released from the cells at the site of inflammation and include (select all correct mediators):

Histamine and serotonin Cytokines and chemokines Platelet-activating factor (PAF) Nitric oxide Arachidonic acid metabolites Omega-3 polyunsaturated fatty acids

The extracellular matrix (ECM) is important for tissue regeneration and repair. The ECM occurs in two basic forms. _________ is the space between cells in connective tissue and epithelium and the supporting cells of blood vessels. _______ surrounds epithelial, endothelial and smooth muscle cells.

Interstitial matrix; Basement membrane

Common causes of fatty liver disease are uncontrolled diabetes mellitus, starvation, or alcoholism. This condition results from ____.

Intracellular accumulation in the liver cells of triglycerides that are unable to be used or eliminated

Screening is important for early identification and treatment of cancers. The American Cancer Society and other agencies recommend types of screening based on age, sex, and certain risk factors. Select all routine methods of cancer screening.

Laboratory tests and procedures at specified intervals including PAP smear, PSA, fecal occult blood test, colonoscopy, mammography Palpation of breast, thyroid, rectum, anus, prostate, and lymph nodes Inspection and observation of skin, mouth, external genitalia

Cleft lip and cleft palate are examples of a/an ________ that may be due to hereditary ________ disorders or environmental influences from _______.

Multifactorial inheritance disorder; chromosomal abnormalities; teratogens

_______ is a pregnancy screening test performed after 16 weeks gestation to diagnose hemoglobinopathies, coagulation disorders, metabolic and cytogenic disorders, immunodeficiencies, or fetal infections.

Percutaneous umbilical cord blood sampling

Cancer cells are anaplastic in that they "form backward" to an earlier de-differentiated state. The cells have nuclei that vary in size and shape, termed ___.

Pleomorphism

Cellular swelling due to impairment of the (Na+/K+)-ATPase membrane pump or fatty changes in the liver due to cell injury interfering with normal metabolic pathways are examples of _______ that may impair cell function, but do not cause cell death.

Reversible cell injury

Marfan Syndrome is an autosomal dominant disorder characterized by _____ (select all correct responses).

Skeletal deformities may include changes in chest shape, kyphosis, scoliosis, long arms, and joint hypermobility. Each child has a 50% chance of inheriting the disorder. Most life-threatening conditions arise from defects in the cardiovascular system, including mitral valve prolapse, progressive dilation of the aortic valve ring, and/or weakness of aorta and other arteries. This syndrome is characterized by dysfunction of the gene that codes for fibrillin I in the ECM. Deformities may occur in 1 or all 3 systems: ocular, cardiovascular, and/or skeletal.

Systemic manifestations of cancer include ____ (select all that apply).

Anorexia and cachexia Paraneoplastic syndromes Fatigue and sleep disorders

The tissue growth and repair process occurs in steps. Select all the major steps in this process.

Apoptosis - programed cell death occurs to eliminate senescent cells and cells injured by DNA damage or hydrogen peroxide-induced injury Cell proliferation - tissues acquire new/replacement cells through mitotic division Cell-differentiation - proliferating cells transformed into different or more specialized cell types

Injurious agents (e.g., heat, genetic-causing metabolic disturbances, or altered immune responses) exert negative effects on the cell. What are the mechanisms that can result in cell injury or death? Mark all that apply.

Hypoxia or ischemia Impaired calcium homeostasis Free radical formation

Cancer can metastasize from primary to secondary sites distant from the original tumor by cellular invasion of lymph nodes draining the tumor site, known as ____ spread and by invasion of capillaries and venules, known as ____ spread.

Lymphatic; hematogenous

In the inflammatory response, _______ have an anti-thrombotic and anti-inflammatory action, which reverses the effects of omega-6 polyunsaturated fatty acids; while ____ causes platelet aggregation and granulation effects, enhancing serotonin release and stimulating leukocytes, connective tissue response, endothelial cells, and vascular smooth muscles.

Omega-3 polyunsaturated fatty acids; PAF

Free radicals form in cells as a product of mitochondrial respirations as reactive oxygen species (ROS). What do you know about free radicals? Select all true statements.

Oxidative stress from free radicals results when the generation of ROS exceeds the ability of the body to eliminate and neutralize these reactive chemical species. Free radicals are a reactive chemical species with an unpaired electron in the outer orbit of the molecule causing a chain reaction that creates new free radicals. Free radicals react with proteins, lipids, and carbohydrates resulting in damage to the cell membrane, inactivation of enzymes, and damage to DNA. Antioxidants, occurring as endogenous enzymes or ingested from supplements or food sources, inhibit the reactions of ROS,

Serum tumor markers are used for screening, establishing a prognosis, monitoring treatment, and detecting recurrent disease. Which fetal antigens have been proven to be among the most useful in clinical practice?

Alpha-fetoprotein and carcinoembryonic antigen

The restoration of injured tissues occurs by proliferation of the adjacent surviving cells. There are 3 phases in the repair process. Match the phases with the correct description. There may be more than one response per phase. 1. Growth factor mediates release of fibroblasts into the injury site. 2. Metalloproteinases effect degradation of collagen and other proteins. 3. Endothelial cells are fused and remodeled into capillary tubes that promote formation of granulation tissue. 4. Vasodilation occurs in response to nitric oxide and increased permeability of preexisting vessels. 5. Increased synthesis and deposition of collagen strengthens the healing wound site. 6. Granulation tissue evolves into a scar comprised of inactive fibroblasts, dense collagen fibers, fragments of elastic tissue, and other ECM components. 7. Vascular degeneration occurs transforming the tissue from highly vascular granulation tissue to a pale, avascular scar.

*ONLY RECEIVED 6/7 CREDIT* 1. Emigration of fibroblast and deposition of ECM 2. Maturation and reorganization of fibrous tissue 3. Angiogenesis and ingrowth of granulation tissue 4. Angiogenesis and ingrowth of granulation tissue 5. Emigration of fibroblast and deposition of ECM 6. Maturation and reorganization of fibrous tissue 7. Maturation and reorganization of fibrous tissue

Apoptosis regulates certain cells by balancing proliferation and cell death, selectively eliminating injured and aged cells, and controlling regeneration. There are 2 apoptotic pathways: extrinsic and intrinsic. Match the processes to the correct pathway. 1. Extracellular signaling proteins, TNF and Fas ligand, trigger apoptosis 2. Death cell receptor independent 3. Death cell receptor dependent 4. Triggered by DNA damage with activation of p53 protein, ROS, hypoxia, decreased ATP, or cellular senescence 5. Fas ligand binds to its receptor forming the death-initiating complex by converting procaspase-8 to caspase-8 and activating endonucleases that cause DNA fragmentation 6. Bc12 protein regulators insert into the mitochondrial membrane opening channels for protein release into the cytoplasm 7. Mitochondria releases cytochrome c into the cytoplasm resulting in binding to caspace-3 allowing for bridging of the pathways and activation of caspase-8

1. Apoptosis extrinsic pathway 2. Apoptosis intrinsic pathway 3. Apoptosis extrinsic pathway 4. Apoptosis intrinsic pathway 5. Apoptosis extrinsic pathway 6. Apoptosis intrinsic pathway 7. Apoptosis intrinsic pathway

What are the sources of cell injury? Match the example of a cellular injury to one of five categories. 1. Ingestion of long-lived fish that concentrate mercury by a pregnant woman resulting in central nervous system and renal damage to the fetus 2. Bacterial exotoxins interfere with ATP production and cellular protein synthesis 3. Protein-calorie deficiency resulting from starvation causing widespread tissue damage 4. Severe heat stroke inducing vascular injury, increasing cell metabolism, inactivating temperature-sensitive enzymes, and disrupting cell membrane 5. Ionizing radiation hitting target molecules or producing free radicals that destabilize molecules in critical cell components

1. Chemical cell injury 2. Biologic agent 3. Nutritional imbalance 4. Physical agent 5. Radiation injury

There are several cell types involved in the inflammatory process. Match the cell type to its descriptor(s) - there may be more than one match per descriptor. 1. Produce antiplatelet and antithrombotic agents to regulate vessel patency and blood flow 2. Small membrane-bound disks circulating in blood that release inflammatory mediators to increase vascular permeability and alter chemotactic, adhesive, and proteolytic properties of endothelial cells 3. Provide selective permeability barrier to exogenous and endogenous inflammatory stimuli 4. Scavenger cells with cytoplasmic granules containing enzymes and other antibacterial substances (short lifespan of 24-48 hours) 5. Participate in allergic reactions by controlling release of chemical mediators; may also be present in chronic inflammation

1. Endothelial cells 2. Platelets 3. Endothelial cells 4. Neutrophils 5. Eosinophils

Single-gene disorders are caused by a defective or mutant gene. Link each single-gene disorder to its inheritance pattern. 1. Atypical patterns of inheritance 2. Each child has 50% chance of being affected 3. Sons have 50% chance of being affected; daughters have a 50% chance of being carrier 4. Each child has 25% chance of being affected, 25% chance of being unaffected, or 50% chance of being a carrier

1. Genomic imprinting, triplet repeat mutations, or mitochondrial gene mutations 2. Autosomal dominant disorders 3. X-linked disorders 4. Autosomal recessive disorder

Match the definition to the correct genetic terminology. 1. Identical members of a gene pair 2. Genetic composition of a person 3. Two different members of a gene pair 4. Different forms of DNA sequences that a gene may have in a population 5. Mitotic error occurring cleavage causing 2 or more cell lines with distinctive karyotypes

1. Homozygous 2. Genotype 3. Heterozygous 4. Allele 5. Mosaicism

Cutaneous wound healing occurs in 3 well-defined phases. Match the phase with its correct desciptor(s) . There may be more than one match to a phase. 1. Blood clot formation 2. Decreasing vascularity; scar tissue develops from simultaneous synthesis of collagen by fibroblasts and lysis by collagenase enzymes 3. Macrophages ingest cellular debris and produce growth factors 4. Fibroblasts fill wound space; epithelization results in new surface layer 5. Architecture of scar reoriented to increase tensile strength followed by shrinkage and decreasing visibility 6. Migration of neutrophils to ingest and remove bacteria and cellular debris

1. Inflammatory phase 2. Remodeling phase 3. Inflammatory phase 4. Proliferative phase 5. Remodeling phase 6. Inflammatory phase

Match the screening and diagnostic procedures with the correct descriptor(s). There may be more than one descriptor for a procedure. 1. Amniocentesis to detect Down syndrome or genetic defects 2. Use of high-frequency sound waves to visualize deep, soft tissue structures; may detect fetal anomalies 3. Chorionic villus sampling for fetal chromosomal studies, DNA analysis and biochemical studies 4. Determine number of fetuses, fetal size and position, amount of amniotic fluid, and placental location 5. Evaluation of alpha-fetoprotein, HCG, unconjugated estriol, PAPP-A or inhibin A to detect genetic defects; e.g, Down syndrome 6. Fetal biopsy to detect skin defects or sample muscle tissue to diagnose muscular dystrophy

1. Invasive testing 2. Ultrasonography 3. Invasive testing 4. Ultrasonography 5. Maternal serum marker 6. Invasive testing

There are several cell types involved in the inflammatory process. Match the cell type to its descriptor(s). There may be more than one match to a cell type. 1. Produce cytokines to activate macrophages and increase antigen presentation and cytokine production 2. Contain cell family adhesion molecules; selectins, integrins, and the immunoglobulin superfamily that mediate leukocyte recruitment 3. Provide vasoactive mediators that produce prostaglandins, leukotrienes, PAF, inflammatory cytokines and growth factor 4. Granulocytes that bind IGE; release histamine and vasoactive agents from granules 5. Develop plasma cells and produce antibodies against persistent antigens at the inflammatory or altered tissue site

1. Lymphocytes and plasma cells 2. Extracellular matrix 3. Connective tissue cells - monocytes and macrophages 4. Basophils and mast cells 5. Lymphocytes and plasma cells

Neoplasms are new growths characterized by uncoordinated and autonomous cell changes that lack normal regulatory controls over growth and division. Differentiate between benign and malignant neoplasms by matching the descriptor to the type of neoplasm. There is more than one descriptor per type. 1. Less well-differentiated tumors with inability to control cell proliferation and differentiation 2. Slow, progressive growth by local expansion with encapsulation 3. Well-differentiated tumor resembling tissues of origin 4. Invades surrounding tissues; can break loose and travel to distant sites forming new metastases 5. Rarely fatal, but may cause death if tissue growth interferes with vital body function 6. Lethal unless controlled by treatment

1. Malignant neoplasm 2. Benign neoplasm 3. Benign neoplasm 4. Malignant neoplasm 5. Benign neoplasm 6. Malignant neoplasm

Contrast metaplasia and dysplasia by matching the characteristic to the correct abnormal cellular adaptation. 1. May result from the replacement of a fragile cell type by a cell better able to survive 2. A type of cellular adaptation that causes derangement of cell growth in a specific tissue resulting in variations of cell size, shape, and organization 3. May result from replacement of epithelial or mesenchymal adult cell type by another adult cell type of the same kind 4. This type of cellular change can become a pathological condition and a precursor to cancer such as what may occur in tissues of the uterine cervix or respiratory tract due to chronic irritation or inflammation 5. An example of this type of cellular adaptation is the replacement of ciliated columnar epithelial cells in the respiratory tract by stratified squamous epithelial cells due to irritation caused by cigarette smoking

1. Metaplasia 2. Dysplasia 3. Metaplasia 4. Dysplasia 5. Metaplasia

Chromosomal disorders are a major category of genetic disorders accounting for early gestational abortions, congenital malformation and mental retardation. Differentiate between structural and numeric abnormalities. 1. Change involving aneuploidy or failure of chromosomes to separate during oogenesis or spermatogenesis 2. Break in one or more of the chromosomes followed by rearrangement or deletion of chromosome parts

1. Numeric disorders involving autosomes 2. Structural chromosomal abnormality

Inflammation produces various types of exudate. Match the exudate cause and characteristics to its type. 1. Watery fluids from plasma enter the inflammatory site 2. Severe tissue injury with damaged blood vessels or significant leakage of red blood cells 3. Large amounts of fibrinogen forming thick, sticky meshwork 4. Pus from degraded white blood cells, proteins, and tissue debris

1. Serous 2. Hemorrhagic 3. Fibrinous 4. Purulent

Body tissues are divided into 3 types depending on the ability of parenchymal cells to undergo regeneration. Match the type of tissue to its description. 1. Stops dividing when growth ends; may undergo regeneration in presence of appropriate stimuli; capable of reconstituting tissue of origin (e.g., liver) 2. Does not proliferate; terminally differentiated and does not undergo mitotic division postnatally (e.g., nerve cells) 3. Continues to divide and replicate throughout life, replacing cells that are destroyed (e.g., epidermis)

1. Stable tissue 2. Permanent tissue 3. Labile tissue

Congenital disorders may occur due to environmental influences or exposure to harmful agents. Match the term related to disorders from environmental influences with its descriptor. 1. Environmental agents produce abnormalities during embryonic or fetal development 2. Ionizing radiation causing teratogenic and/or mutagenic effects resulting in microcephaly, skeletal malformations, and/or mental retardation 3. Constellation of physical, behavioral, and cognitive abnormalities related to maternal alcohol consumption 4. Deficiency that may cause anencephaly, spina bifida, or encephalocele 5. Exposure to agents such as varicella-zoster, listeriosis, leptospirosis, Epstein-Barr virus, and syphilis that may result in microcephaly, hydrocephalus or defects in vision and hearing 6. Organ development occurs at different periods into the 2nd trimester of pregnancy during which development is highly susceptible to environmental derangements

1. Teratogenic agents 2. Radiation 3. FAS 4. Folic acid deficiency 5. Infectious agents 6. Organogenesis

There are 2 stages in the acute inflammatory response that act to remove the injurious agent and limit the extent of tissue damage. Contrast these stages by matching the activities to the correct stage of the acute inflammatory process. 1. Extravasation of exudate, RBCs, leukocytes, platelets, and clotting factors into the extravascular spaces causing swelling, pain, and impaired function 2. Chemotactic cytokines direct leukocytes to site of early inflammation/injury 3. Vasodilation of arterioles and capillary beds at the site of injury causing erythema and warmth 4. Leukocytes slow migration, adhere to endothelium, and move along periphery of blood vessels 5. Response patterns include immediate-transient in minor injuries; immediate-sustained in severe injury; and delayed-hemodynamic in radiation injury 6. Neutrophils, monocytes, and tissue macrophages engulf and degrade bacteria and cellular debris 7. Endothelial cells separate, extend pseudopodia and cross through the vessel wall

1. Vascular stage 2. Cellular stage 3. Vascular stage 4. Cellular stage 5. Vascular stage 6. Cellular stage 7. Cellular stage

What are stressors and how do cells respond to protect normal structure and function? Select all true statements.

At times the cellular stressors become so overwhelming that maladaptive changes occur resulting in disease and/or death. Signals transmitted by chemical messengers affect molecular mechanisms causing adaptations that alter cell function. Cellular stressors include changes to the internal environment as well as intracellular accumulations. Often cells adapt to stress by altering expression of differentiation genes, but leaving functional genes unaffected.

_______ are abnormalities of body structure, function, or metabolism present at birth. A subset of this category of defects occurs as a discrete event affecting gene expression in a group of cells related to each other by gene linkage, termed ______.

Congenital defects; genetic disorders

A malignant neoplasm originating in epithelial tissues is a ____; while a malignant neoplasm originating in mesenchymal tissues is a _____.

Carcinoma; sarcoma

During the inflammatory process, cytokines and chemokines _______ (select all that apply).

Cause priming and aggregation of neutrophils Cause endolithial cells to express adhesion molecules Are activated by TNF-alpha and IL-1 when stimulated by bacterial toxins, immune cells, injury, and other inflammatory stimuli

Chemotherapy may be the primary treatment or part of a multimodal cancer treatment regimen along with radiation and/or surgery. Select all true statements regarding cancer chemotherapy.

Chemotherapy involves the use of several drugs that have different mechanisms of action, metabolic pathways, times of onset of action and recovery, side effects, and onset of side effects. Chemotherapy is the use of drugs that are toxic to rapidly proliferating cells and may be cell-cycle specific or cell-cycle nonspecific. Chemotherapy is the primary treatment for hematologic cancers and some solid tumors. Because chemotherapy causes exponential killing of cells, multiple courses of treatment are necessary.

The elderly are more vulnerable to chronic wounds, such as pressure injury and diabetic and ischemic ulcers. What are the age-related changes that affect wound healing in the elderly? Select all that apply.

Decreased dermal thickness Decline in collagen content Loss of elasticity

Cancers may have both a genetic and molecular etiology. Select all correct responses about cancer etiology.

Epigenetic mechanism that silences tumor-suppressor genes causing non-production of cancer-suppressing proteins Oncogene formation from proto-oncogenes, which may result in point mutation or gene amplification Homologous loss of p53 gene activity Disorder of growth factor signaling pathways resulting in cancer cell growth and proliferation Evasion of apoptosis by damaged cancer cell

Clinical manifestations of cancer are dependent on location. Select from the list all those manifestations that might occur.

Impairment of respiratory function due to pulmonary airway and tissue involvement Bowel obstruction due to malignant growth and/or compression by abdominal viscera into the intestinal tract Pleural, pericardial or peritoneal effusions caused by direct involvement of the serous surface or obstruction of lymphatic flow to the area Anemia due to blood loss, hemolysis, or impaired red cell production

Calcium provides cytosolic signals for many cell responses including mediation of calcium effect on smooth muscle contractions and glycogen breakdown. The (Ca++/Mg2)-ATPase exchange system maintains normal intracellular Ca++ levels. Cell injury due to ischemia or toxins can result in ______.

Increased cytosolic calcium into the intracellular membrane causing the release of calcium from intracellular stores and inappropriate activation of enzymes, which can damage the cell membrane and cytoskeleton and cause ATPase breakdown of ATP

Chronic inflammation is self-perpetuating and may last for weeks, months, or years. Select all characteristics of chronic inflammation.

Infiltration with mononuclear cells and attempted connective tissue repair involving angiogenesis and fibrosis Insidious, low-grade and often asymptomatic Cause of tissue damage in atherosclerosis, COPD, RA, and IBS Infectious causative agent may increase susceptibility to cancer (e.g., H.pylori, HPV, hepatitis B & C)

Disorders of phagocytic functions can impair the inflammatory response in wound healing. _____ phagocytic disorders, such as granulomatous disease in an X-linked genetic disorder, results in deficiency of the NADPH-dependent oxidase enzyme, which prevents generation of hydrogen superoxide and hydrogen peroxide needed for killing bacteria. ______ phagocytic disorders impair attraction of phagocytic cells to the wound site and prevent engulfment of bacteria and foreign agents by phagoctyic cells.

Intrinsic; Extrinsic

Select all systemic manifestations of inflammation in the acute-phase response.

Liver increases synthesis of protective and defense proteins - including fibrinogen, C-reactive protein, and serum amyloid A Leukocytosis and, in severe infections, bone marrow production of immature neutrophils to keep up with the inflammatory response May progress to uncontrolled inflammatory response with production and release of inflammatory cytokines causing SIRS that can lead to circulatory shock Response results from a bacterial sepsis

Phenylketonuria is an autosomal recessive disorder. Select all true statements about this condition.

PKU is a deficiency of PAH, which is a liver enzyme that converts the amino acid phenylalanine to tyrosine. PKU is is a metabolic disorder caused by elevated levels of phenylalanine that is toxic to the brain. In order to prevent manifestations of PKU, the condition must be treated within the first 7-10 days of life by restricting dietary protein. The deficiency of PAH causes increased levels of PKU that can result in mental retardation, microcephaly, and/or impaired neurological functions leading to seizures.

About 50% of males over age 60 develop benign prostatic hyperplasia as a result of the excessive release of androgens. The hyperplasia may increase to such an extent that the prostate, which encircles the urethra, can cause urethral narrowing resulting in a slow or weak urine stream, hesitancy in starting urine flow, and frequent urge to urinate. What are the characteristics of hyperplasia? Select all correct responses.

Physiologic hyperplasia occurs in response to a stimulus and ends after the stimulus is removed; i.e., removal of the stimulating hormone. Hyperplasia can only occur in cells capable of mitotic division. Cellular hyperplasia is an increase in number of cells in a tissue or organ. Cellular hyperplasia occurs when there is activation of the genes controlling cell proliferation and the intracellular messengers that control cell replication and growth.

There are many factors that affect healing of tissue. Healing depends on adequate stores of proteins, carbohydrates, fats, vitamins, and minerals. Select all correct statements about the contribution of these nutrients to the healing process.

Protein deficiency can prolong the inflammatory phase and impair the remaining 2 phases. Zinc is a co-factor in enzyme systems that are responsible for cell proliferation. Fats are constituents of cell membranes and important in the synthesis of new cells. Carbohydrates are a source of energy for leukocytes and promote amino acid use in the healing process.

Inflammation is a complex response to minimize effects of injury or infection, remove damaged tissue, and generate new tissue. Select the cardinal signs of inflammation.

Redness Loss of function Swelling Discomfort/pain

Stem cells may become involved in the tissue proliferation cycle in wound healing. Select all correct statements about stem cells.

Remain quiescent until there is a need for cell replenishment, then the cells begin to divide and produce. May be incompletely differentiated throughout cell life. Properties may include self-renewal, asymmetric replication, or differential potential. May produce other stem cells or cells that carry out the functions of a differentiated cell.

Cutaneous wound healing is the process of epithelial cell regeneration and formation of connective tissue scar formation. Healing by _____ intention occurs when the wound covers a large surface area (e.g., burns). Healing by _____ intention occurs when sides of the wounds can be approximated (i.e., surgical wound, laceration).

Secondary; primary

Upon chest x-ray, it was noted that a 36-year-old woman, who was exposed to tuberculosis had several small lesions in her lung due to granulomatous inflammation. What are the characteristics of granulomas? Select all correct responses.

Several conditions may cause granulomatous inflammation including splinters, sutures, silica, asbestos, syphilis, sarcoidosis, deep fungal infections, brucellosis, and TB. Epithelioid cells clump forming a multinucleated giant cell by surrounding the foreign agent, which is then encapsulated by connective tissue; often termed foreign body giant cells. Granulomas are 1-2 mm lesions resulting from the amassing of macrophages surrounded by lymphocytes.

A 21-year-old man was playing intramural football. As he was running into the end zone with the football, he was tackled from behind causing the football to travel under his chin resulting in a fulcrum effect when he fell forward. He suffered a severing of his spinal cord between cervical vertebrae 4 and 5. What is the cellular response to this type of injury? Select all true statements.

Severing the spinal cord at that level resulted in quadriplegia and denervation atrophy to the muscles below the level of injury. Insulin and IGF-1 are produced to maintain muscle mass; however when cells reduce in size, proteolysis and apoptosis occur. Oxygen consumption and protein synthesis decline to preserve cell survival resulting in cellular atrophy.

There are 2 major phases in the cell cycle. The _____ phase occurs with DNA synthesis and replication of chromosomes; while the ______ phase is characterized by the formation of the mitotic spindle and cell division with formation of daughter cells.

Synthesis; mitosis

A 78-year woman, with poorly-controlled diabetes mellitus and chronic asthmatic bronchitis, is admitted to the hospital in acute respiratory distress due to exacerbation of her asthma. She has an ulceration on her right anterior lower leg due to venous stasis and peripheral neuropathy. She is on corticosteroids for bronchodilation, antibotics to prevent pneumonia and sliding scale insulin to control her blood sugar. A consultant is scheduled to evaluate her leg ulceration. Select all correct statements about impaired inflammatory and immune responses in the healing of this patient's leg ulceration.

Therapeutic administration of corticosteroids decrease capillary permeability during the early stages of inflammation, impair the phagocytic properties of leukocytes, and inhibit fibroblast proliferation and function. Hyperglycemia causes neutrophils to have diminished chemotactic and phagocytic function, including engulfment and intracellular killing of bacteria. Small blood vessel disease is common among people with diabetes, which can impair the delivery of inflammatory cells, oxygen, and nutrients to the wound site.

Which type of chromosome alteration generally results in normal offspring?

Translocation

A 13 y/o male presents with testicular dysgenesis and upon genetic analysis is found to have a chromosomal abnormality (47,XXY). Select all true statements about his condition.

Treatment involves androgen therapy beginning at time of diagnosis (usually ages 12-14). He will be tall and exhibit abnormal body proportions due to female distribution of subcutaneous fat. He will experience breast enlargement, sparse facial and body hair, and inability to produce sperm. His diagnosis is Klinefelter Syndrome, and typically, the signs of the condition will not be noticeable until puberty.

A critical process in wound healing involves cell-matrix interactions causing shifts in composition within the extracellular matrix.

True

A young female presents with short stature but normal body proportions, absent ovaries, webbing of the neck with skin folds, nonpitting lymphedema of hands and feet, bicuspid aortic valve, changes in nail growth, strabismus, and normal intelligence, but difficulty with visuospatial organization. Genetic analysis demonstates that she has an absence of an X chromosome. Her condition is likely ________ and will be treated with ________.

Turner Syndrome; growth hormone and estrogen therapy

Hemophilia A is an example of a/an ________ associated with the female chromosome, in which an unaffected mother carries one normal and one mutant allele resulting in a ___ chance of transmitting the affected gene to sons and daughters; daughters have a ____ chance of being a carrier, while affected males have a ___ chance of transmitting the defect.

X-linked disorder; 50%; 50%, 0%