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Advanced Pathophysiology Exam 1 (Latest
Update) Questions and Answers (GRADED A)
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 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 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 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 100,000 population) at the end of 1992 for AIDS? a. 6 b. 25 c. 88 d. 116 B What level of prevention is a blood pressure screening program for high school students who are pregnant? a. primary b. secondary c. tertiary 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 C
The accumulation of lactic acid that occurs with impaired energy production results from which of the following? a. increased intracellular glucose b. increased anaerobic metabolism c. decreased metabolic rate d. increased oxidative phosphorylation B A mountain climber is stranded at 23,000 feet in the Swiss Alps and has lost all his equipment and supplies in an avalanche. Subsequently, he suffers cell injury due to impaired ATP production. The reason for the decrease in ATP is which of the following? a. enzyme inhibition b. uncoupling c. hypoxia d. none of the above C An elderly patient develops an obstruction in his left middle cerebral artery. The brain tissue supplied by this artery becomes hypoxic. The best explanation for this is which of the following? a. the obstruction results in decreased blood flow b. the obstruction results in decreased hemoglobin in the blood c. while blood flow stays the same, the obstruction reduces oxygen content in the blood d. none of the above explain the reason for the hypoxia A
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 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 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 A Your body has developed an increased demand for thyroid hormones. This will lead to ____________ of the thyroid gland. a. atrophy
Insufficient blood flow to a part of the body is defined as: a. hypoxia. b. hypoxemia. c. necrosis. d. ischemia. D A cellular change, which is often precancerous, is called: a. hyperplasia. b. metaplasia. c. dysplasia. d. hypertrophy. 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 D Which of the following best describes reperfusion injury? a. The increased blood pressure in the area of reperfusion causes rupture of small arterioles and release of free radicals.
b. The return of blood flow to the area results in a burst of free radical production from neutrophils that accumulated in the area. c. Reperfusion injury results from restoration of the function of the sodium-potassium pump. d. Reperfusion of the area results in apoptosis of the previously ischemic cells. B Which of the following best describes free radicals? a. stable molecules not normally found in the body, but introduced exogenously during ischemia b. unstable molecules that are normal products of oxidative metabolism and are removed by endogenous antioxidants c. stable molecules that have an affinity for iron in the cytoplasm of the cell d. none of the above B The usual fate of apoptotic cells is which of the following? a. metaplastic transformation b. calcification c. hypertrophy d. phagocytosis e. neoplastic transformation D Which of the following statements is true regarding the difference between cell necrosis and apoptosis? a. Apoptosis is a more rapid process. b. Apoptosis is usually initiated by ischemia-induced cell injury. c. Apoptosis is genetically controlled.
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 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 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 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 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. E Which of the following components is not involved in apoptosis? a. Bcl- 2 b. apaf- 1 c. caspase 9 d. cytochrome c e. HLA 2 E Some cancer-causing viruses are able to protect the cells that they transform from undergoing apoptosis by interfering with the action of the apoptosis promoter called:
c. Free radicals produced via dopamine synthesis are neutralized by glutathione. d. Glutathione is needed for entry of dopamine into the cerebral circulation. C 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 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. D Etiology Causative factors in a particular disease Iatrogenic produced by treatment
Epidemiology risk factors and distribution in populations Incidence number of new cases Prevalence number of existing cases both new and old clinical manifestations signs, symptoms, and diagnostic criteria how are symptoms and signs different symptoms are what the patient reports signs are objective or measurable outcomes cure, remission, chronicity, or death primary prevention Efforts to prevent an injury or illness from ever occurring.
physiologic hypertrophy 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. pathologic hypertrophy results from chronic hemodynamic overload. Ex. Hypertension or heart valve dysfunction. Hypertrophic cells have increased accumulation of ER, plasma membrane, myofilaments, mitochondria (not cellular fluid). Nucleus is also hypertrophic with increased DNA synthesis. Triggers for cardiac hypertrophy include mechanical signals (stretch) and trophic signals (growth factors and vasoactive agents). Hyperplasia increase in number of cells in an organ/tissue as a response to injury that results from an increased rate of cellular division compensatory Physiologic hyperplasia is an adaptive mechanism that enables certain organs to regenerate. Occurs in skin, intestines, hepatocytes, bone marrow, and fibroblasts. Ex. Is when skin gets callus in response to mechanical stimulus. Hormonal physiologic hyperplasia Hormonal occurs mainly from estrogen dependent organs such as uterus and breasts.Ex- after ovulation estrogen stimulates endometrium to grow/thicken for fertilized ovum. Pathologic hyperplasia
he abnormal proliferation of normal cells and can occur as a response to excessive hormonal stimulation or the effects of growth factors on target cells. These cells have enlargement of the nucleus, clumping of chromatin (package and protect DNA), and the presence of one or more large nucleoli. Ex. Benign prostatic hyperplasia (BPH) and endometriosis-both the result of hormonal imbalance. Metaplasia reversible replacement of one mature cell type (epithelial or mesenchymal) by another, sometimes less differentiated, cell type. Cause of metaplasia develops from reprogramming of stem cells. Found in association with tissue damage, repair, and regeneration. pathophysiology of metaplasia 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 Can be reversed if stimulus is removed. If continues, can cause malignant transformation. Dysplasia abnormal changes in the size, shape, and organization of mature cells. mostly found in epithelia Significance of dysplasia
Cell injury: ATP depletion 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 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 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
- Decrease in oxygen reaching the cell
- decrease in ATP production within mitochondria
- failed NA+/K pump
- Na, Ca enter cell, K leaves
- organelle swelling
- protein synthesis stops
- ATP via oxidative phosphorylation declines, glycolysis increases
- glycogen stores depleated
- lactic acid produced
- decrease in intracellular Ph declines
- rupture of lysosomes
- autodigestion of the cell contents and membrane Deleterious effects of free radicals on cells
- unstable compounds with an unpaired electron in outer ring
- anxious to "mate" with other substances affinity for lipid substances (there is a phospholipid bilayer membrane around cell)
- combine avidly with cell and organelle membranes
- lipid peroxidation - dissolution of the membrane
- "drills a hole" examples o diseases linked to oxygen-derived free radicals aging atherosclerosis brain disorders Cancer Cardiac myopathy Diabetes Eye disorders inflammatory disorders iron overload emphysema
