HSC214 Exam 1 HW/Class Discussions

Which of the following are symptoms? a. low back pain reported by the patient b. rash evaluated by the physician c. patient exhibiting diaphoresis d. anxiety e. nausea f. vomiting

A D E

Match the following: use answers ONLY once a. palliative 1. the cause of disease b. congenital 2. error in prenatal development c. etiology 3. a prediction of disease outcome d. prognosis 4. care aimed at reducing suffering e. treatment 5. the identification of disease f. diagnosis 6. ultimate goal is to offer a cure

A-4 B-2 C-1 D-3 E-6 F-5

Jo (28) just ran 15 miles on a hot day in AZ. Her body temperature is elevated. She is still sweating and feels quite unwell. She has become nauseated and has a severe headache. She is tachycardic and dizzy. She has increased her water intake greatly post exercise but continues to feel very ill. Select the true statements: A. This patient is experiencing heat exhaustion B. This person is at high risk of cerebral edema C. This person needs to have electrolytes replaced D. The osmotic pressure in her blood is too low and as a result fluid is shifting into the tissue spaces and into the cells

ABCD

A 68 year-old female with decompensated alcoholic liver cirrhosis and refractory ascites, initially presented to the Clinic in June 2020. She was an alcoholic for 40 years and quit just a few years ago. Cirrhosis was diagnosed in 2011, and fluid began building in her abdomen approximately 4 years ago. Physical examination revealed a blood pressure of 110/64 mm/Hg, temperature of 97.7°F, and pulse of 68. Bilateral edema was present on both legs (+3) and there was a notable absence of peripheral pulses - dorsalis pedis and posterior tibial. Auscultation revealed clear respiration in posterior fields, with no wheezing, rhonchi, or accessory muscle use upon respiration. Chest X-ray was unremarkable. Patient's abdomen showed severe ascites. Bowel sounds were present in all 4 quadrants. Her abdomen was dull to percussion. Hepatomegaly was present, and the right-upper quadrant was tender to palpation. The patient reported poor dietary habits. She usually had 2 meals per day, with large gaps in between. Her diet was characterized by poor nutritional variation and occasional wine consumption. KM's medication list included furosemide 20 mg/day, along with the spironolactone 50 mg/day, to control her ascites. Dietary corrections were discussed and implemented. Select the correct statements with regards to this case study: (Select ALL that apply) a. cirrhosis is the etiology b. alcoholism is the etiology c. cirrhosis is the diagnosis

B and C

Which of the following are thermoregulatory mechanisms the body employs to reduce body temperature? (Select all that apply) A. Shivering B. Flusing (turning red) C. Sweating D. Wrapping up in a blanket E. Vasoconstriction of peripheral blood vessels F. Vasodilation of peripheral blood vessels G. Removing clothes/blankets

B. Flusing (turning red) C. Sweating F. Vasodilation of peripheral blood vessels G. Removing clothes/blankets

The NFL and more than 4,500 former players want to resolve concussion-related lawsuits with a $765 million settlement that would fund medical exams, concussion-related compensation and medical research. Concussions are thought to result in the delayed onset of a variety of neurological difficulties (impaired memory, changes in muscle tone etc) later in life. These deficits that occur as the aftermath of concussion injuries would be an example of: a. exacerbation b. idiopathic c. sequela d. symptoms

C

Classical heat stroke is the type of heat stroke that occurs in an overworked athlete

False

True or False: In medical intervention, inactivation of the etiological agent must occur before the treatment can begin

False

hippocrates

Father of medicine

Framingham Study

In 1948, the Framingham, Massachusetts, cardiovascular disease study was launched Prospective cohort study design

Levels of prevention

Primary: prevent/promotion Secondary: screen-early detection Tertiary: treat- to prevent further deterioration, rehab

T or F During fever, heart rate and metabolic rate increase.

True

True or false: Iron deficiency anemia resulting from an inadequate diet would be an example of a primary nutrient deficiency

True

A 38-year-old man has a health screening examination. He has a routine chest x-ray that shows a 2 cm nodule in the right lower lobe. The nodule has focal calcifications. A wedge resection of the nodule is done. On microscopic examination the nodule shows caseous necrosis and calcification. Which of the following processes explains the appearance of the calcium deposition: A Dystrophic calcification B Apoptosis C Hypercalcemia D Metastatic calcification E Excessive ingestion of calcium

a

Which of the following forces would increase the formation of fluid in the tissue spaces? Select ALL that apply. A. vessel injury allowing escape of albumin into the tissue spaces B. increased capillary permeability C. local histamine release D. increased blood flow to the tissue/increased tissue perfusion

a b c d

Which of the following could lead to hypoxic cell injury: Select ALL that apply. 2 points possible. A. chronic obstructive pulmonary disease (obstruction of air ways or impaired air exchange) B. congestive heart failure (failure of the heart to pump efficiently) C. atherosclerosis (build up of fatty plaque in the vessels of the body) D. low hemoglobin levels (not enough hemoglobin is on the RBC that binds oxygen) E. pneumonia (fluid in the alveoli interfering with gas exchange) D. hypovolemic shock (loss of perfusion due to lack of blood)

a b c d e d

gangrenous necrosis

a complication of necrosis characterized by decay (not a completely different type)

sequela

a condition resulting from a disease ex: lesions

John, 65 years old, presents to your GP branch surgery at 0830. He reports that he had chest pain last night, which woke him from his sleep. The pain started at around 0200. He thinks it lasted about 20-25 minutes. He reports that he felt sweaty during the pain. An ECG is run and blood work confirms he has had a heart attack. Part of his heart has suffered from ischemia and has died. Which of the following occurred while he was experiencing ischemia that lead to the death of cells in his heart. Select ALL that apply. A. Na+/K+ membrane pumps fail B. Na+ concentration rises outside of the cell. C. anaerobic metabolism resulted in elevated intracellular pH. D. ATP production via aerobic metabolism ceases. E. lysosomes rupture, speeding cellular destruction F. the cell swells as intracellular osmotic pressure rises. G. None of the above

a d e f

ischemia

a decrease in blood supply due to either occlusion or loss of pressure

caseous necrosis

a form of coagulation necrosis seen most often in tuberculosis pale yellow, granular, cheese-like appearance

irreversible injury and cell death

a result of extreme membrane distortions, increased permeability, or lysosomal liberation

dry gangrene

affected area dries and shrinks (coagulation)

best indicator of irreversible injury is an

altered nucleus

Cellular adaptations:

altered size or number altered functional capabilities

organelle changes

altering the complement of organelles to better meet a demand ex: the liver responds to increased levels of toxic chemicals by increasing amount of smooth ER with contains degradative enzymes ex: increased numbers of mitochondria result from increased energy demand

diagnosis

analysis of signs and symptoms, coupled with knowledge of pathogenesis leads to (diagnosis) or the identification of patient's disease

2 patterns of cell death

apoptosis and necrosis

signs

are detected by observer, emerge during physical examination easily measure or observed e.g. pallor, cyanosis, fever, vomitting, diaphoresis, erythema, shortness of breath

toxins

are injurious substances that interfere with normal function

prognosis

assessment of body's response to therapy, knowledge of pathogenesis, and clinical experience all combine for a prediction of patient's outcome

A 55-year-old man has a 30-year history of poorly controlled diabetes mellitus. He has had extensive black discoloration of skin and soft tissue of his right foot, with areas of yellowish exudate, for the past 2 months. Staphylococcus aureus is cultured from this exudate. A below-the-knee amputation is performed. The amputation specimen received in the surgical pathology laboratory is most likely to demonstrate which of the following pathologic abnormalities? A Metaplasia B Gangrene C Hypertrophy D Caseation

b

Cervical cancer can be one of the most successfully treated cancers if it is detected early.. Now that you are 21, you decide it is time to schedule a pap smear for the early detection of the often asymptomatic,cervical cancer. This action is an example of which of the following levels of prevention? (If you want extra clarity, you can google the levels of prevention. This is good https://www.iwh.on.ca/wrmb/primary-secondary-and-tertiary-prevention) a. primary prevention b. secondary prevention c. tertiary prevention d. none of these

b

Mechanism of action

bits of DNA or RNA (not alive) host cell integrate normal DNA take over/destroy cell

assessment of functional loss functional deterioration of internal organs can be assessed by measuring subtle changes in ______?

body fluids

karyorrhexis

breaks up into small, dispersed fragments

A 77 year old female with a past history of myocardial infarction expires while at home alone. Autopsy is performed to confirm cause of death. A large brain lesion is detected in the left hemisphere frontal lobe. Gross and microscopic evidence suggests a severe hypoxic lesion aged several hours. What did the pathologist find that confirmed this finding? A. ghost cells retaining the outline of the tissue B. Acute meningitis with hyperplasia of neuroglial cells C. loss of neurons and neuroglial cells with complete loss/dissolution of tissue architecture D. Dysplasia indicating cancerous transformation of neuronal cells E. Infection with clostridium perfringrens and release of noxious gas

c

When a person begins an exercise program, we see a steady improvement in their exercise tolerance. This is in part due to an increases in mitochondrial number in response to the increase in cellular energy requirements. This type of adaptation is known as: a. atrophy b. hypertrophy c. organelle change d. ischemia

c

Which of the following is NOT an example of a non biological exogenous toxin: a. lead in drinking water b. mercury from a broken thermometer c. E.coli in contaminated drinking water d. alcohol poisoning

c

Which of the following statements are true regarding free radicals? Select all that apply a. free radicals have an extra proton that increases the atomic weight of cell membrane phospholipids c. free radicals can cause DNA damage d. free radicals can be produced during normal metabolic processes e. free radicals can be produced during radiation exposure f. antioxidants act as free radical scavengers by either donating or accepting electrons

c d e f

Injured cells lose cell membrane integrity. elevated plasma levels of certain cell constituents may indicate

cell injury

apoptosis

cell suicide or controlled cell death. can be normal or pathological eliminates cells that are worn out, overproduced, or genetically damaged, is organized triggered by gene activation p.53 (guardian angel gene)

metaplasia

change from one cell type to another- a response to chronic irritation/inflammation

necrosis

characterized by cell membrane breakdown and tissue death always pathological and unregulated and always triggers inflammatory response

if enough water enters, cell (and ER, Golgi, mito) swells and cytoplasm gets paler, this condition is known as

cloudy or hydronic degeneration

types of necrosis

coagulative, liquefaction, caseous, gangrenous

syndrome

combination of signs, and symptoms associated with a specific disease ex: down syndrome

Ms. Dawson (92) and Ms. Waters (88) live in a house that has no air conditioning. The temperature outside has reached 101 degrees F. Ms Waters calls 911 to say that her roommate has fallen. When paramedics arrive they find that Ms. Dawson's body temperature is 105.6 degrees F, her blood pressure is 80/60 and her skin is hot and dry. What can you conclude? A. Ms. Dawson is suffering from hypovolemic shock B. Mr. Dawson is suffering from heat stroke C. Ms. Dawson has had failure of her thermoregulatory heat loss homeostatic mechanisms as evidenced by her lack of sweating. D. All of the above

d

local lesion

damage is confined to one region of body

systemic lesion

damage is more widely distributed

hydronic change

damage leads to water entering cells to be sequesterd into vacuoles (like hypoxia steps to swelling)

atrophy

decrease in cell size due to disuse, ischemia, lack of neural or hormonal input bigger cell to smaller cell

genetic etiology

defective genes are responsible for structural/functional defect ex:cystic fibrosis, sickle cell, colorblindness, PKU

Causes of cell injury

deficiency, intoxication, trauma

medical history

description of nature and timing of patient's abnormalities

dysplasia

disordered growth (precancerous)

disease

disruption in homeostasis-unhealthy state of body part, system, or body as a whole

hypothermia

due to extreme cold ex: frostbite

A 43-year-old man has complained of mild burning substernal pain following meals for the past 3 years. Upper GI endoscopy is performed and biopsies are taken of an erythematous area of the lower esophageal mucosa 3 cm above the gastroesophageal junction. There is no mass lesion, no ulceration, and no hemorrhage noted. The biopsies show the presence of columnar epithelium with goblet cells instead of the usual stratified squamous epithelium. Which of the following mucosal alterations is most likely represented by these findings? A Dysplasia B Hyperplasia C Carcinoma D Ischemia E Metaplasia

e

two major origins of toxins

exogenous or endogenous

hyperthermia

extreme heat damages cells by disrupting and coagulating (denaturing) proteins (like cooking eggs)

T or F Neutrophils are the main cell to produce histamine in the setting of acute inflammation.

false

virchow

father of pathology

mechanical pressure

forces cell membrane to explode or degenerate

acquired etiology

genes and development are normal, however, factors encountered later produce the disease ex: tuberculosis, emphysema, and hepatitis, abdominal aortic aneurysm, osteoarthritis

Three categories of etiology

genetic congenital acquired

congenital etiology

genetic info intact, other factors of embryo's intrauterine environment interfere with normal development ex: fetal alcohol syndrome, spina bifida, anencephaly

alternative metabolism (altered functional capabilities)

hypoxia can cause cells to switch from oxidative phosphorylation to glycolysis or if there is a disruption of glucose, cells can switch to fat/protein metabolism

idiopathic

if cause is unknown ex: Alzheimers, multiple sclerosis, cancer

diffuse lesion

if lesions are more uniformly distributed throughout organ ex: entire lung full of cancer

hypoxia

inadequate oxygenation due to failure of respiratory or cardiovascular systems, or RBCs

gas gangrene

infection of the necrotic area with clostridium perfringens--may produce a foul smelling gas

non-biological exogenous toxin

injurious chemicals that originate outside the body (drug overdoses or mercury)

fatty change

injury interferes with a cells ability to metabolize or export lipids. seen in organs that process lipids. ex: steatosis

what happens to alcohol tolerance with an increase in smooth endoplasmic reticulum?

it increases

nutritonal

lack of nutrient can be primary (not enough) or secondary (has enough but body can't utilize it)

deficiency

lack of substance necessary to cell many factors play a role in deficiencies ex: ischemia, hypoxia, nutritional

trauma

loss of cell's structural integrity, physical injury ex: hypothermia, hyperthermia, mechanical pressure, infection

infection

microorganisms infect cells or damage cell membranes and lead to immune attack

wet gangrene

necrosis superimposed with a bacterial infection (liquefaction)

does hypoxia lead to ischemia?

no

`essential concepts

normal anatomy and physiology: (e.g. liver detoxifies and produces bile and plasma proteins; cirrhosis--> hepatic encephalopathy and jaundice structure dictates function: disease of one --> disease of the other homeostasis: maintain relatively stable internal environment outside of homeostasis is diseased state

karyolysis

nucleus seems to fad and melt into cytoplasm

endogenous toxins

originate inside the cell

exogenous toxins

originate outside the body biological or non-biological

pathogenesis

pattern of disease development clinical course of disease

what can indicate large-scale rupture of cells

potassium

intoxication

presence of substance that interferes with cell function. Poisoning

hypertrophy

process of cell and organ enlargement due to increased demands ex: myocardial cells enlarge due to valvular stenosis small cell to bigger cell

hyperplasia

process of producing new cells by mitosis in response to increased demand ex: livers used for transplant will regrow missing part ex: 3 cells to 9 cells

biological exogenous toxin

produced by microorganisms (e.coli, collegenase, lipase, phospholipase)

endogenous genetic defect

produces toxins ex: huntingtons, CF, PKU

acute

rapid onset, develop quickly, and usually are short duration

chronic diseases are often characterized by

remission-signs and symptoms subside exacerbation-signs and symptoms return

findings

results from lab tests, Ct imaging, or exploratory surgery that clarify clinical picture

coagulation necrosis

retains outlines of cells, firm and relatively intact region of necrosis with relatively normal architecture "default"

pyknosis

shrink and condense

endogenous free radicals

single unpaired electron produced by normal cellular processes, interacts to gain stability, can cause widespread damage (enzymes, cell membranes, DNA), normally scavenged by antioxidants (ACE)

high levels of creatine phosphokinase (CPK) indicates

skeletal, cardiac, or brain tissue damage

dystrophic calcification

slow, gradual accumulation, of Ca2+ leads to rigidity and brittleness in necrotic tissue ex: calcified arteries

lesions

somatic derangement ex: rash, cut, inside or outside the body

pathophysiology

study of abnormal functioning of diseased organs with application to diagnostic procedures and patient care

etiology

study of disease causation

pathology

study of disease, all aspects of disease

symptoms

subjective evidence as described by patient hard to measure and hard to observe e.g. pain, fatigue, nausea, pruritus, anxiety, vertigo

therapy

treatment of the disease with aim of cure or reducing signs and symptoms to level where near normal functional capacity can be restore

T or F If BHP increases and TOP increases, (with THP and BOP remaining the same) the net movement of fluid is out of the capillary.

true

True or False. Ischemia leads to hypoxia, but hypoxia can occur with no evidence of ischemia.

true

chronic

usually are longer durations. onset can be sudden or insidious--onset is slow and concerns are not immediate ex: ms is sudden and a high bp is insidious

health

when our physical and mental capabilities can be fully utilized

liquefaction necrosis

when phagocytes secrete enzymes that liquefy tissue

focal lesion

within disease organ, damage is confined to one or more distinct sites ex: bronchopulmonary segments of lungs

does ischemia lead to hypoxia?

yes