Pathophysiology Study Guide 1

Based in the name, which of the following cancers are malignant? A. Adenoma B. Fibrosarcoma C. Lymphangioma D. Rhabdomyoma E. Liposarcoma

B and E. A. Adenoma - a benign glandular tumor B. Fibrosarcoma - malignant fibrous tissue C. Lymphangioma - benign tumor of lymph vessels D. Rhabdomyoma - benign tumor of striated muscle E. Liposarcoma - malignant adipose tissue.

A 25-year-old male develops a tumor of the breast glandular tissue. This type of tumor is classified as a(n): A. Carcinoma. B. Adenocarcinoma. C. Sarcoma D. Lymphoma.

B. Adenocarcinoma.

How does hypoxia cause cell damage? A. Directly damages DNA. B. Diminishes ATP production. C. Forms free radicals. D. Increases intracellular calcium.

B. Diminishes ATP production. • Feedback: Oxygen is a key ingredient for the majority of ATP production. With less oxygen, less ATP is produced, and the cell cannot function at the same level. If hypoxia is severe or prolonged, the cell will die.

Polydipsia refers to: A. Reduced secretion of ADH. B. Excessive thirst. C. Increased interstitial fluid. D. Inability to sense thirst.

B. Excessive thirst.

The mammary glands enlarge during pregnancy primarily as a consequence of: A. Hormonal anaplasia. B. Hormonal hyperplasia. C. Compensatory hyperplasia. D. Hormonal dysplasia.

B. Hormonal hyperplasia.

A 52-year-old diabetic male presents to the ER with lethargy, confusion, and depressed reflexes. His wife indicates that he does not follow the prescribed diet and takes his medication sporadically. Which of the following is most likely to occur? A. Hypoosmolar hyponatremia. B. Hypertonic hyponatremia. C. Decreased urine formation. D. Decreased extracellular fluid osmolality.

B. Hypertonic hyponatremia. • Feedback: Hypertonic hyponatremia is an interesting condition in which high blood glucose levels increase the osmolality of the extracellular fluid (ECF) and thus draw out of the cells by osmosis. This causes a type of dilutional hyponatremia.

John developed Cushing's syndrome as the result of excessive exogenous glucocortoid use. The cause of John's Cushing's syndrome is: A. Idiopathic. B. Iatrogenic. C. Both A and B. D. Cannot be determined.

B. Iatrogenic.

Cancer-causing mutations to proto-oncogenes result in: A. Conduction of monoclonal antibodies. B. Increased cell division. C. Apoptosis D. All of the above.

B. Increased cell division.

Which of the following is the most common cause of cell injury? A. Microorganisms. B. Ischemia. C. Excessive heat. D. Nutritional deficits.

B. Ischemia.

When a well-differentiated cell mutates, is it more or less likely to become a malignant tumor? A. More. B. Less. C. Degree of differentiation has no bearing on whether a tumor is malignant or benign.

B. Less • Feedback: The more differentiated a cell is when it mutates, the more likely it is to become a benign tumor. If poorly differentiated cells mutate, the tumor is more likely to become malignant.

Which is true of all cancers? A. They are caused by viruses. B. They are caused by chemical carcinogens. C. They are caused by changes in DNA. D. They are inherited. E. They all respond in the same way to treatment.

C. They are caused by changes in DNA.

Benign tumors are: A. Parenchymal cells. B. Labile tissues. C. Well-differentiated.

C. Well-differentiated. • Feedback: cells that look and act like normal tissue cells. Can perform the normal function of the tissue.

True or False? If a cell does not make adaptive changes as a result of stress, it will die.

True • Feedback: Adaptive changes allow the cell to survive and maintain some degree of function. If the cell makes no changes or makes maladaptive changes as a result of stress, the cell will die.

How is necrosis different from apoptosis?

• A group of cells in the body dies as a result of tissue injury instead of a programmed cell death. • The cell membrane is ruptured and contents ARE released into the intracellular space and initiates inflammatory response.

A 30-year-old woman has experienced heavy menstrual bleeding and is told she has a uterine tumor called a leiomyoma. She is worried she has cancer. What is the difference between a leiomyoma and a leiomyosarcoma? How would you explain the difference to her?

• A leiomyoma is a benign tumor of smooth muscle. A leiomyosarcoma is a malignant tumor of smooth muscle connective tissue. • You should explain the difference between benign and malignant tumors regarding cell characteristics, rate of growth, capacity to metastasize and potential for causing death.

Define Prognosis.

• A prediction of the probable course and outcome of a disease.

Define Intracellular Accumulations and list the 4 causes.

• Abnormal buildup of endogenous (lipids, glycogen, abnormal proteins, bilirubin, calcium salts) or exogenous substances (coal dust, tattoo) within the cells. • Causes: 1. Abnormal metabolism of endogenous substances. 2. Abnormal folding, transport, or degradation of endogenous proteins. 3. Storage diseases: Defect in enzymes that metabolize lipids and carbohydrates. 4. Ingestion of indigestible materials - cell takes in exogenous substances that it can't metabolize or transport elsewhere.

Define paraneoplastic syndrome and give a(n) example(s) of paraneoplastic disorders in cancer.

• Additional problems associated with certain tumors • Examples: SIADH Cushing's Syndrome Lambert-Eaton syndrome

Describe how ATP depletion damages a cell. How does it cause cellular swelling.

• Aerobic metabolism stops -> less ATP is produced • NA+/K+ ATPase cannot run fast enough -> • Cells swell up with water and sodium • Anaerobic metabolism used -> lactic acid produced and cellular pH falls. • Acidic environment damages cell membranes, intracellular structures, and DNA -> increased membrane permeability and cellular swelling.

Every day blood cells in our body become senescent and die without producing any signs of inflammation; yet, massive injury or destruction of tissue, such as occurs with a heart attack, produces significant signs of inflammation. Explain.

• Aged red blood cells undergo programmed cell death or apoptosis. This is a controlled type of cell destruction and is a normal part of cell deletion and renewal. Apoptosis eliminated cells that are worn out, have been produced in excess, have developed improperly, or have genetic damage. Apoptic cell death is characterized by controlled autodigestion of cell components and there are no signs of inflammation or injury while this process is occurring. In contrast, with necrosis, cell contents are released causing a damage to the surrounding tissue and an inflammatory process.

Define Sequelae and give an example.

• An unwanted outcome or abnormal condition as a result of a disease, treatment, or injury. • Examples: Paralysis after a stroke. Scarring after an injury.

Define Idiopathic.

• Cause of disease unknown.

Define etiology.

• Cause of disease.

How does cancer spread into body cavities?

• Cells break off from primary tumors, travel along serous membranes and invade body cavities. • Example: Spread of ovarian cancer

Describe how Increased intracellular calcium damages a cell. How does it cause cellular swelling.

• Cells usually maintain a low intracellular calcium. • Calcium acts as a second messenger in the cell and turns on intracellular enzymes that can damage the cell (proteins, DNA and phospholipids). • Can open more calcium gates in the cell membrane letting in more calcium and causing a calcium cascade. • This leads to increased membrane permeability and cellular swelling.

Define Iatrogenic.

• Condition caused by medical treatment or procedure.

Describe cell changes that occur with Atrophy and state why these changes occur and the purpose for such changes.

• Decrease in size of cells and tissue. • Result of decreased work demand or adverse conditions. • Examples: Disuse (ex. leg in a cast) Denervation Loss of endocrine stimulation Inadequate nutrition Ischemia • Cells conserve energy by reducing size and number of organelles.

Describe cell changes that occur with Dysplasia and state why these changes occur and the purpose for such changes.

• Deranged cell growth that results in abnormal changes in size, shape and organization of cells. • Caused by chronic irritation and/or inflammation. • Precursor to cancer, however is adaptive and potentially reversible.

How does cancer spread to distant regions of the body?

• Development of secondary tumor in a location distant from the primary tumor. • Cancer cells travel through lymphatic (most common route) and blood systems.

How does cancer spread locally?

• Direct invasion of contiguous organs. • Cancer cells secrete enzymes and toxins to breakdown neighboring tissues.

Differentiate between dystrophic and metastatic calcifications.

• Dystrophic: Occurs in dead or dying tissue (advanced artherosclerosis, damaged heart valves, areas of injury in aorta or other large vessels. • Metastatic: Occurs in normal tissues as the result of hypercalcemia (Hyperparathyroidism, Renal failure, Metastatic bone lesions, immobilization, Vitamin D intoxication)

Define and describe caretaker genes.

• Encode for proteins that are involved in repairing damaged DNA when cells duplicate DNA prior to division. • They help prevent cancer by helping reduce the formation of oncogenes.

Define Risk Factors and give an example.

• Factors that put you at risk for developing a disease. • Example: Smoking is a risk factor for coronary artery disease.

Describe how free radicals damage a cell. How does it cause cellular swelling.

• Free radicals are molecules with an unpaired electron in the outer electron shell causing it to be extremely unstable and reactive. • They can react and damage normal cell components and turn them into more free radicals. • Normally removed from the body by antioxidants • Excessive free radicals can lead to lipid peroxidation and increased membrane permeability leading to cellular swelling.

What's the difference between grading and staging of cancers?

• Grading - involves microscopic examination of cancer cells to determine level of differentiation of cancer cells (I-V). • Staging - Measures extent and spread of the cancer.

Define Diagnosis.

• Identification of disease by examination of the signs and symptoms.

Describe cell changes that occur with Hyperplasia and state why these changes occur and the purpose for such changes.

• Increase in cell number. • Only occurs in cells capable of mitotic division (epithelial, smooth muscle, connective) Examples: • Physiologic (Compensatory) - regeneration of liver. (Hormonal) - multiplication of milk producing cells with pregnancy. • Non physiologic/pathologic Excessive hormonal stimulation of growth factors. Endometrial, benign prostatic hyperlasia.

Describe cell changes that occur with Hypertrophy and state why these changes occur and the purpose for such changes.

• Increase in cell size and tissue mass. • Result of increased workload or hormonal stimulation Examples: • Physiologic response (normal): Uterine smooth muscle with pregnancy, skeletal muscle growth with weight training. • Pathologic adaptation (abnormal): Thickening of urinary bladder smooth muscle from long-term obstruction. Hypertrophy of cardiac muscle due to hypertension.

Define Local Manifestations and give an example.

• Limited to the area of injury. • Examples: Pain, redness.

Name other types of cancer manifestations.

• Local effects of tumors (compression). • Anemia. • Leukopenia & thrombocytopenia. • Fatigue & sleep disorders. • Changes in organ function (damage, inflammation, and failure). • Paraneoplastic syndromes

Define and describe oncogenes.

• Mutated proto-oncogenes. • Oncogenes can lead to cancer by turning abnormal cell growth on. • Protein abnormalities.

Describe the characteristics of benign neoplasms.

• NOT cancer. • Contain well-differentiated cells. • Can perform the normal function of the tissue (like secreting hormones). • Usually have a capsule around them. • Usually do not invade neighboring tissues. • Can damage nearby organs by compressing them and can be life threatening (if in the brain).

Define Complications and give an example.

• New or separate process that arise secondarily because of the change produced by the original problem. • Examples: Development of gestational diabetes during pregnancy. Heart failure following a heart attack.

Define and describe tumor suppressor genes.

• Normal genes that code for proteins which control the checkpoints of the cell cycle. • The proteins keep most mutations from developing into cancer. (P53, transcription factor regulation cell division & death; Rb, alters activity of transcription factors).

Define Signs and give an example.

• Objective, observable/measurable to another person. • Examples: Fever, swelling, redness.

Mr. X had a stroke... Blood flow to part of his brain was cut off. His wife can understand why they gave him an anticoagulant, but she does not comprehend why he was also put on: • Oxygen • A calcium channel blocker What is the explanation?

• Oxygen - increase ATP production. • A calcium channel blocker - decrease Ca2+ influx into the cells.

Describe cell death by apoptosis.

• Programmed cell death. • Damaged or worn out cells commit "suicide". • Turn on their own enzymes inside the cell. • Digest their own cell proteins and DNA • Destroyed by white blood cells • Cell contents are NOT released.

Describe cell changes that occur with Metaplasia and state why these changes occur and the purpose for such changes.

• Reversible replacement of one mature cell type with another within the same tissue class. • Occurs in response to chronic irritation and inflammation. • Allows for substitution of cells which are able to tolerate environmental stresses. • May lead to dysplasia and neoplasia if stimulus not removed.

Define Syndrome.

• Set of signs and symptoms that are characteristic of a disease and tend to occur together.

What are clinical manifestations?

• Signs & Symptoms.

Betty comes into the clinic complaining of body aches, chills and a sore throat. You take her temperature and find it to be 101F. Upon examination of her throat, you find her tonsils to be enlarged, red and edematous. A throat culture determines she has strep throat. Apply the following terms to her clinical manifestations of strep throat: sign, symptom, local, systemic.

• Signs: 101F temperature/Fever; enlarged, red and edematous tonsils, throat culture. • Symptoms: body aches, chills and a sore throat. • Local: Sore throat; enlarged, red and edematous tonsils. • Systemic: Body aches, chills, 101F temperature/Fever.

Define Symptoms and give an example.

• Subjective, not observable/measurable to anyone but the patient. • Examples: Pain, tingling, numbness.

Describe the basic types of cancer treatment and their common side effects.

• Surgery (curative, debulking and pallative) - Risk of infection. • Radiation - affects cancer cells & healthy cells, bone marrow depression, epithelial cell damage, infertility, fatigue and lethargy. • Chemotherapy - bone marrow depression, epithelial cell damage, damage to specific areas.

What do the "T", "N", "M" represent when referring to staging?

• T1-T4 - increasing size of tumor. • N0, N1, N2, N3 - advancing node involvement. • M0, M1 - absence or presence of distant metastasis.

Define Pathogenesis.

• The development or progression of the disease. • Sequence of cellular and tissue events (how the disease evolves) that occur following exposure to the etiologic agent.

Define differentiation.

• The maturation of tissue stem cells into more specialized cells. • Cells acquire characteristics of the cells they replace.

Define proliferation.

• The process of cell division to increase the number of cells present. This results in cell replacement when old cells die or additional cells are needed.

Describe the characteristics of malignant neoplasms.

• This is cancer. • Contain undifferentiated cells. • Cells divide rapidly so tumors grow quickly. • Cells mutate faster and can change type. • The tumor does not have clear boundaries and typically invades neighboring tissues. • Do NOT perform normal functions of the organ. • May secrete hormones associated with other tissues. • Can metastasize to distant regions.

State the importance of angiogenesis in cancer growth and metastasis.

• Tumor cells secrete angiogenesis factors that enable the development of new blood vessels within the tumor. The process of metastatic tumor development depends on the establishment of blood vessels and specific growth factors that promote proliferation of the tumor cells.

Define Systemic Manifestations and give an example.

• Whole body manifestation. • Example: Fever.

List 3 main mechanisms of cellular injury.

1. Hypoxic cell injury (ATP depletion) 2. Free radical formation 3. Increased intracellular calcium (impaired calcium homeostasis) • Ultimately the above all result in [increased] membrane permeability, cellular [swelling] and if it becomes irreversible, necrosis.

Which of the following is the most likely cause of atrophy when a leg has been in a cast for two months? A. A decrease in the number of myofilaments in the leg muscle cells. B. Replacement of muscle cells with scar tissue in the leg. C. A decrease in the number of muscle cells in the leg. D. An increase in the growth rate of the leg muscle cells.

A. A decrease in the number of myofilaments in the leg muscle cells.

Cells of malignant tumors exhibit: A. Anaplasia. B. Differentiation. C. Proliferation.

A. Anaplasia (loss of differentiation). • Feedback: cells that do not look like normal adult cells and divide rapidly.

Which of the following factors is necessary for metastasis to occur? A. Decreased cell adhesion. B. Proximity to body cavities. C. Decreased cellular motility. D. Temporary cessation of cell division.

A. Decreased cell adhesion.

The less differentiated a cancer cell is, the more: A. Embryonic it will appear. B. Benign it will be. C. All of these choices are correct. D. Similar it appears to its tissue of origin.

A. Embryonic it will appear.

Which of the following is considered a systemic sign of disease? A. Fever B. Swelling of the knee C. Pain in the neck D. Red area on the face

A. Fever

As a result of circulatory patterns, cancer cells often first metastasize to the: A. Lung. B. Skeletal muscles. C. Vertebral column. D. Brain.

A. Lung.

When a group of cells in the body dies, the change is called: A. Necrosis. B. Ischemia. C. Hypoxia. D. Gangrene.

A. Necrosis.

Which of the following is NOT a pressure that influences the exchange of fluids at the capillary? A. Partial pressure of oxygen. B. Capillary hydrostatic pressure. C. Capillary oncotic pressure. D. Interstitial fluid oncotic pressure.

A. Partial pressure of oxygen.

The following systemic clinical manifestations of cancer indicates ___________. • Weight loss • Muscle Wasting • Weakness • Anorexia

Anorexia - Cachexia Syndrome.

Cellular atrophy involves: A. A decrease in the number of cells. B. An increase in the number of cells. C. An increase in cell size. D. A decrease in cell size.

D. A decrease in cell size.

Hypertrophy of the heart would be related to: A. Replacement of normal cells by a different type of cell. B. A decrease in the size of the individual cells. C. An increase in the number of cells in an area. D. An increase in the size of the individual cells.

D. An increase in the size of the individual cells.

Lack of exercise during an illness may cause skeletal muscle to undergo: A. Dysplasia B. Hypertrophy C: Regeneration D. Atrophy

D. Atrophy

Which of the following is a typical characteristic of benign tumors? A. Cells in the tumor occasionally metastasize to lymph nodes. B. Benign tumors have a tendency to invade surrounding tissue. C. Cells in the tumor are undifferentiated. D. Benign tumors are surrounded by a capsule.

D. Benign tumors are surrounded by a capsule.

Dysplasia is recognized by abnormal changes in all of the following except: A. Cell shape. B. Cell organization. C. Cell size. D. Cell secretions.

D. Cell secretions.

Cervical carcinoma in situ: A. Usually progresses to cervical cancer even after treatment. B. Cannot be detected using available medical tests. C. Refers to cervical cancer that has metastasized to the liver. D. Contains cancer cells that have not invaded the surrounding tissue.

D. Contains cancer cells that have not invaded the surrounding tissue.

Sarcomas are cancers that arise from: A. Germ cells. B. Connective tissues. C. Glandular tissues. D. Epithelial tissues.

D. Epithelial tissues.

The cause or origin of a disease or disorder as determined by medical diagnosis. A. Iatrogenic. B. Symptom. C. Risk Factor. D. Etiology.

D. Etiology

Which of the following changes in a cell might lead to a loss of function without necessarily leading to necrosis? A. Disintergration of the nucleus. B. Cell lysis. C. Release of lysosomal enzymes. D. Insufficient oxygen

D. Insufficient oxygen

Determining the size of the tumor, the degree of node involvement, and the extent of distant metastasis is called: A. Factoring. B. Processing. C. Categorization. D. Staging.

D. Staging.

What kinds of cell and tissue adaptations occur in this case? A woman broke her left leg; 3 weeks later you find: The left leg is smaller than the right leg.

Disuse Atrophy

True or False? Oncogenes code for the normal proteins used in cell division.

False • Feedback: The statement describes proto-oncogenes. Oncogenes are mutated proto-oncogenes that code for abnormal proteins.

True or False? Necrotic tissue may be reversed using high concentrations of oxygen.

False. • Feedback: Necrotic tissue is already dead so it can't be restored to functional tissue.

What kinds of cell and tissue adaptations occur in this case? A woman broke her left leg; 3 weeks later you find: New calluses on the right foot.

Hyperplasia

What kinds of cell and tissue adaptations occur in this case? A woman broke her left leg; 3 weeks later you find: The circumference of the right calf has increased by 2 cm.

Hypertophy

Which of the following is NOT part of the extracellular fluid compartment? A. The serous fluid in body cavities. B. Interstitial fluid between cells. C. The cytoplasm inside the cells. D. Plasma in the blood vessels.

C. The cytoplasm inside the cells.

Which of the following is an example of metaplasia? A. An increase in the thickness of the heart wall in response to increased workload. B. The formation of calluses on the hands as a result of work with the hands. C. The transitional epithelium of the bladder is replaced by stratified squamous epithelium due to irritation by a parasite. D. The appearance of abnormal cells on the cervix.

C. The transitional epithelium of the bladder is replaced by stratified squamous epithelium due to irritation by a parasite.

Put the stages in the development of cancer in the correct order. A. Failure to repair damaged genes leads to activation of growth-promoting oncogenes, inactivation of tumor suppressor genes and alterations in genes that control apoptosis. B. Leads to unregulated cell differentiation, growth and malignant neoplasm. C. Carcinogenic agent damages DNA.

C, A, B. C. Carcinogenic agent damages DNA. A. Failure to repair damaged genes leads to activation of growth-promoting oncogenes, inactivation of tumor suppressor genes and alterations in genes that control apoptosis. B. Leads to unregulated cell differentiation, growth and malignant neoplasm.

Elderly Individuals are at a higher risk for developing dehydration because they have: A. A higher total body water volume. B. A decreased intravascular volume. C. A decreased lean body mass. D. An increased tendency towards developing edema.

C. A decreased lean body mass.

After cancer cells metastasize into lymphatic vessels, which of the following events occur(s)? A. Cancer cells lodge in the lymph node and proliferate. B. Cancer cells are killed by immune cells in the lymph nodes. C. All of these choices can occur. D. Cancer cells continue past the lymph nodes to distant organ sites.

C. All of these choices can occur.

The wasting syndrome associated with cancer and cancer treatment is called: A. Anabolism. B. Cushing syndrome. C. Cachexia. D. Anemia.

C. Cachexia.

Why are infections of such concern in cancer patients? A. Cancer patients often have anemia. B. Cancer patients often of thrombocytopenia. C. Cancer patients often have leukopenia. D. Bacteria stimulate tumor angiogenesis.

C. Cancer patients often have leukopenia.

How does radiation therapy provide an effective means for treating some forms of cancer? A. High energy waves cause all cell membrane injury. B. The resulting inflammatory response destroys the tumor. C. Ionizing radiation damages the cancer cell's DNA. D. Heat generated by radiation is thermally toxic to cancer cells.

C. Ionizing radiation damages the cancer cell's DNA.

Which of the following cancers always arises from an initial mutation in the blood-forming cells of the bone marrow? A. Sarcoma. B. Lymphoma. C. Leukemia. D. Carcinoma.

C. Leukemia.

A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance. Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have replaced the normal columnar ciliated cells. The type of cellular adaptation is called: A. Hypertrophy B. Hyperplasia C. Metaplasia D. Dysplasia

C. Metaplasia

The process of muscle hypertrophy involves an increase in: A. Water accumulation. B. Cell division. C. Protein synthesis. D. Plasma membrane thickness.

C. Protein synthesis.

Which of the following changes in a cell specifically indicates necrosis? A. Altered metabolic function. B. Insufficient oxygen. C. Rupture of the cell membrane. D. Accumulation of abnormal metabolites in the cell.

C. Rupture of the cell membrane.

The body compensates for loss of fluid by: A. Vomiting. B. Increasing the respiratory rate. C. Secreting ADH. D. Inhibiting the thirst mechanism.

C. Secreting ADH.

"Seeding" involves the spread of cancer cells to: A. Blood vessels. B. Fascia surrounding muscles and bones. C. Serrous membranes of body cavities. D. Dermis and subcutaneum of the skin.

C. Serrous membranes of body cavities.

The difference between signs and symptoms is: A. Symptoms refer to the cause of the disease whereas signs are the clinical manifestations of the disease. B. Symptoms can be observed whereas signs cannot. C. Signs are objective whereas symptoms are subjective.

C. Signs are objective whereas symptoms are subjective.