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ADVANCED PATHOPHYSIOLOGY ACTUAL EXAM 1
A certain disease is currently found in 1 of every 10 people in the country and 1,000 people contract the disease yearly. The population of the country is 4,500,000. Which of the following statements is correct? a. The prevalence of the disease is 10% and the incidence is .02%. b. The prevalence of the disease is .02% and the incidence is 10%. c. Neither is correct. d. There is insufficient data - Solution A In relation to disease development, the term "etiology" refers to which of the following? a.number of people with the disease b. cause of the disease c. definition of the disease d. outcome of the disease - Solution B Which of the following is(are) true about "symptoms"? a. objective and measurable b. the same as "signs" c. both of the above d. neither of the above - Solution D In 1992, there were 980 deaths in a Midwestern city with a population of 1,000,000. At the beginning of that year, 900 cases of AIDS existed in this population. During the year, 250 new cases of AIDS were diagnosed, and 75 people died of the disease in 1992. Using the data given above, what was the incidence rate (per 100, population) at the end of 1992 for AIDS? a. 6 b. 25 c. 88
d. 116 - Solution B What level of prevention is a blood pressure screening program for high school students who are pregnant? a. primary b. secondary c. tertiary - Solution B Mr. Forbes complains of "indigestion" and becomes sweaty and pale. His wife takes him to the Emergency Department at Northwestern Memorial Hospital. A cardiac catheterization 2 days later shows partial blockage of his right coronary artery (RCA). Blockage of the right coronary artery can lead to myocardial cell injury because it results in which of the following? a. bilirubin accumulation in myocardial cells b. alteration in the genetic material of myocardial cells c. reduced energy production in myocardial cells d. activation of the complement system - Solution C When myocardial cells are injured, the function of the Na-K membrane pump may be impaired. Which of the following may then result? a.intracellular sodium will increase b. extracellular potassium will decrease c. cell volume will decrease d. all of the above - Solution A Mr. Forbes is being prepared for open heart surgery when he suffers a myocardial infarction in which a large part of his left ventricle has suffered lethal cell injury. Mr. Forbes' CPK-MB and LDH1, enzymes associated with myocardial cells, are significantly elevated. What is the best explanation for this? a. It is a sign that necrotic myocardial cells have released their cytoplasmic contents into the blood. b. It is a sign of reversible fatty accumulation in the myocardial cells c. It is a sign that the myocardial cells are undergoing hypertrophy.
Increased mobilization and delivery of free fatty acids to liver cells can result in fat accumulation. Which of the following problems results in increased mobilization of free fatty acids? a. anemia b. hepatic toxins c. starvation d. hypoxia - Solution C Generalized hypoxia results in a switch to anaerobic metabolism in cells. Anaerobic metabolism results in which of the following? a. decreased lactic acid inside cells b. decreased arterial pH c. more effective ATP production d. increased pH inside cells - Solution B There is a disease of the spleen, which results in an excessive destruction of RBCs. This increase in RBC destruction can lead to which of the following? a. hypoxia b. hypobilirubinemia c. an increase in platelets d. all of the above - Solution A Your body has developed an increased demand for thyroid hormones. This will lead to ____________ of the thyroid gland. a. atrophy b. hypertrophy c. dysplasia d. metaplasia - Solution B You palpate a gangrenous leg and note the presence of crepitus. Crepitus is associated with which of the following? a. wet gangrene b. dry gangrene c. gas gangrene
d. all of the above - Solution C Direct cell membrane destruction may result from which of the following? a. complement activation b. bacterial enzymes c. free radicals d. all of the above - Solution D Which of the following is true regarding apoptosis? a. It occurrence may be physiological or pathological. b. It does not stimulate the inflammatory process. c. It results in phagocytosis of the apoptotic cell. d. all of the above. - Solution D Insufficient blood flow to a part of the body is defined as: a. hypoxia. b. hypoxemia. c. necrosis. d. ischemia. - Solution D A cellular change, which is often precancerous, is called: a. hyperplasia. b. metaplasia. c. dysplasia. d. hypertrophy. - Solution C Which of the following changes is indicative of irreversible cell injury? a. sodium influx into the cytoplasm b. glycolysis (anaerobic metabolism) c. detachment of ribosomes from rough endoplasmic reticulum d. release of lysosomal enzymes - Solution D Which of the following best describes reperfusion injury?
the aortic valve). You know that the stenotic valve creates an increased resistance against which the left ventricle contracts. The cellular adaptation most likely to occur in the left ventricle is which of the following? a. atrophy b. hypertrophy c. hyperplasia d. metaplasia - Solution B Select the condition that is an example of physiologic hyperplasia. a. breast enlargement during puberty b. endometrial hyperplasia from excessive estrogen stimulation c. prostatic hyperplasia occurring as men age d. none of the above are physiologic - Solution A Your patient has a long history of mitral stenosis (narrowing of the mitral valve). As the years go by, the left atrium, which contracts against the increased resistance of the stenotic valve, begins to fail--and output from the left ventricle begins to decline. If the left ventricle were to undergo adaptation, what would it most likely be? a. atrophy. b. hypertrophy. c. hyperplasia. d. metaplasia. - Solution A Which of the following is not characteristic of cellular dysplasia? a. variation in size and shape of cells b. small, pale nuclei c. disorderly arrangement of cells d. preneoplastic change - Solution B If a normal individual began to take cortisol 100 mgs. every day as a medication, which of the following would result? a. hypertrophy of the adrenal gland b. hyperplasia of the adrenal gland
c. atrophy of the adrenal gland d. hypertrophy and hyperplasia of the adrenal gland - Solution C If a normal individual began to take thyroid hormone 100 mcgs. every day as a medication, which of the following would result? a. hypertrophy of the thyroid gland b. hyperplasia of the thyroid gland c. atrophy of the thyroid gland d. hypertrophy and hyperplasia of the thyroid gland - Solution B Chronic alcoholism can result in the development of a fatty liver because it results in which of the following? a. increased production of free fatty acids b. increased conversion of free fatty acids to triglycerides c. decreased oxidation of cholesterol, triglycerides, and phospholipids d. decreased binding of cholesterol, triglycerides, and phospholipids to apoproteins - Solution A Which of the following is the primary difference between wet and dry gangrene? a. Infection and inflammation are present in wet gangrene. b. Wet gangrene results from arterial occlusion and dry gangrene from venous stasis. c. Dry gangrene involves the presence of Clostridium perfringens. d. Wet gangrene occurs only in internal organs. - Solution E Which of the following components is not involved in apoptosis? a. Bcl- b. apaf- c. caspase 9 d. cytochrome c e. HLA 2 - Solution E
Which of the following is(are) true regarding aging? a. may involve an increase in autoantibodies b. may result from damage accumulation c. both are true d. neither is true - Solution C In theories of aging, cross-linking implies which of the following? a. The lifespan and number of times a cell can replicate are preprogrammed. b. The number of cell doublings is limited. c. There is oxygen toxicity. d. Cell permeability decreases. - Solution D Etiology - Solution Causative factors in a particular disease Iatrogenic - Solution produced by treatment Epidemiology - Solution risk factors and distribution in populations Incidence - Solution number of new cases Prevalence - Solution number of existing cases both new and old clinical manifestations - Solution signs, symptoms, and diagnostic criteria how are symptoms and signs different - Solution symptoms are what the patient reports signs are objective or measurable outcomes - Solution cure, remission, chronicity, or death primary prevention - Solution Efforts to prevent an injury or illness from ever occurring.
secondary prevention - Solution -focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status -examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail Tertiary prevention - Solution -aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury Atrophy - Solution Decrease or shrinkage in cellular size.Most common in skeletal muscle, heart, secondary sex organs, and brain. Physiologic atrophy - Solution occurs with early development. Ex. Thymus gland gets physiologic atrophy during childhood. pathologic atrophy - Solution occurs as a result of decreases in workload, pressure, use, blood supply, nutrition, hormonal stimulation, and nervous stimulation hypertrophy - Solution Increase in the size of the cells that increase the size of the affected organ. Heart and kidneys (responsive to enlargement) and skeletal muscle. physiologic hypertrophy - Solution occurs with increased demand, stimulation of hormones, and growth factors. Ex. Pregnancy causes hormone induced hypertrophy of the uterus, in skeletal muscle occurs as a response to heavy workload.
pathophysiology of metaplasia - Solution Adaptive replacement cell may be more suitable to the changed conditions in the surrounding environment. Ex. GERD damages squamous epithelium of the esophagus, cells are replaced by glandular epithelium which may tolerate the acid better. Not always beneficial. Ex. Smoking causes changes in bronchi cells, which don't have cilia or secrete mucus, causing loss of protective mechanism. What is the significance of metaplasia - Solution Can be reversed if stimulus is removed. If continues, can cause malignant transformation. Dysplasia - Solution abnormal changes in the size, shape, and organization of mature cells. mostly found in epithelia Significance of dysplasia - Solution can be reversed if it does not involve the entire epithelium. When dysplastic changes penetrate the basement membrane it is considered a preinvasive neoplasm (carcinoma in situ) mechanisms of cell injury - Solution ATP depletion, mitochondrial damage, accumulation of oxygen and oxygen-derived free radicals membrane damage protein folding defects DNA damage defects calcium level alterations reperfusion injury - Solution injury to tissue that occurs after blood flow is restored restoration of needed oxygen is accompanied by oxidative stress with the generation of toxic oxygen radicals which damage cellular membranes and mitochndria What helps reperfusion injury? - Solution antioxidants and anti- inflammatory drugs
examples of cell injury - Solution ischemic and hypoxic injury ischemia-reperfusion injury oxidative stress or accumulation of oxygen-derived free radicals induced injury chemical injury Cell injury: ATP depletion - Solution loss of mitochondrial ATP and decreased ATP synthesis results include: cellular swelling decreased protein synthesis decreased membrane transport lipogenesis all changes that contribute to loss of integrity of the plasma membrane Cell injury: Oxygen and oxygen-derived free radicals - Solution lack of oxygen is key in progression of cell injury in ischemia (reduced blood supply) activated oxygen species (free radicals) cause destruction of cell membranes and cell structure Cell Injury: Intracellular calcium and loss of calcium steady state - Solution Normally intracellular cytosolic calcium concentrations are very low; ischemia and certain chemicals can cause an increase in cytosolic Ca concentrations sustained levels of Ca continue to increase with damage to plasma membrane Ca causes intracellular damage by activating enzymes Cellular events that occur with ischemia-hypoxic injury - Solution - Decrease in oxygen reaching the cell -decrease in ATP production within mitochondria -failed NA+/K pump -Na, Ca enter cell, K leaves -organelle swelling
Most types of cellular accumulations occur as a result of what 4 mechanisms - Solution 1 - insufficient removal of normal substance because of altered packaging/transport 2-abnormal substance (result of mutated gene) accumulated because of deficits in protein folding, transport, or abnormal degredation 3 - endogenous substance not effectively catabolized because of lack of vital lysosomal enzyme 4 - harmful exogenous materials such as heavy metals, dusts, microorganisms that accumulate because of inhalation, ingestion, or infection normal substances that cause cell accumulation - Solution water protein lipid carbs abnormal substances that cause cell accumulation - Solution - endogenous: product of abnormal metabolism synthesis -exogenous: infectious agent or material pathophysiology of reperfusion injury - Solution -generation of highly reactive oxygen intermediates (oxidative stress) -these radicals cause further membrane damage and mitochondrial calcium overload what does reperfusion cause - Solution -causes creation of free radicals, pH alterations, inflammatory signaling, osmotic changes, gap junction changes, calcium overload, apoptosis 7 possible mechanisms of fatty accumulation - Solution -increased movement of free fatty acids into the liver -Failure of metabolic process that converts fatty acids to phospholipids resulting in the preferential conversion of the fatty acids to triglycerides -increased synthesis of triglycerides from fatty acids -decreased synthesis of apoproteins (lipid acceptors)
-failure of lipids to bind with apoproteins and form lipoproteins -failure of mechanisms that transport lipoproteins out of the cell -direct damage to the ER by free radicals released by alcohol's toxic effects pathogenesis of bilirubin - Solution -released when RBCs break down -released into blood (unconjugated) -fat-soluble, cannot be elimintated through urine -unconjugated is taken up in the liver cells, bound to glucuronic acid, becomes conjugated bilirubin -can now be eliminated through the kidney -some becomes part of bile, some is eliminated in urine and feces giving yellow and brown color (bilirubin is a pigment) What is jaundice caused by - Solution excess bilirubin what is excess bilirubin caused by - Solution -diseases that cause destruction of RBC (hemolytic jaundice) -Diseases affecting the metabolism and excretion of bilirubin in the liver -diseases that can obstruct the common bile duct (gallstones/pancreatic tumors) Effects of free cytosolic calcium - Solution -normally removed by ATP dependent calcium pumps -If abnormal permeability of calcium ion channels, direct damage to membranes, or depletion of ATP (i.e. hypoxic injury) -then calcium level increases -if not buffered or pumped out, uncontrolled enzyme activation takes place -leading to: phosphorylation of protein and chromatin fragmentation, membrane damage, cytoskeletal disassembly (damage), nucleus chromatin damage -often final pathway in many causes of cell death
break down triglycerides releasing free fatty acids which combine with calcium, magnesium, and sodium ions, creating soaps necrotic tissue appears opaque and chalk white Gangrenous necrosis - Solution refers to death of tissue and results from severe hypoxic injury commonly occurring becasuse of arteriosclerosis especially in lower leg with hypoxia and subsequent bacterial invasion, the tissues undergo necrosis dry gangrene - Solution an area that is free of infection and in which the line of demarcation between live and dead tissue is apparent tissue becomes dry and shrunken - mummified wet gangrene - Solution often malodorous and the line of demarcation between live and dead tissue is unclear until the infection is arrested gas gangrene - Solution wet gangrene caused by clostridium perfringes, an organisms that produces gas within the destroyed tissue. This accumulation of gas produces a distinctive sound on palpation of the area called crepitus systemic manifestations of cellular injury - Solution fever increased heart rate increase in number of leukocytes pain presence of cellular enzymes in extracellular fluid lactate dehydrogenase CK AST ALT ALP amylase aldolase tropinins
cellular processes involved in necrosis - Solution -caused by an injurious agent, or -cells are induced to commit suicide -a disorganized sequence of events that stimulates the inflammatory process -cellular changes after cell death and process of cellular autodigestion -membrane integrity is lost and necrotic tissue leaks out causing inflammation in the surrounding tissue apoptosis - Solution -event that results in cell death -quiet, organized, programmed process resulting in elimination of individual cells Example of physiologic apoptosis - Solution removal of webbing between fingers in human fetus example of pathologic apoptosis - Solution AIDS when the HIV induces T-cell apoptosis T/F Apoptosis is associated with inflammation - Solution False What is apoptosis initiated by - Solution activation of capase enzymes what is necrosis initiated by - Solution ischemia toxins physical stimuli what is the time course for apoptosis - Solution 12 - 24 hours what is the time course for necrosis - Solution 20 - 30 minutes cell characteristics of apoptosis - Solution shrinkage of the cell condensation of the cytoplasm detachment of cell from ECM membrane budding
