1. What is metabolic absorption?

(2)
Cells take in and use nutrients and other substances from their surroundings
Cells of intestine and kidney are specialized to carry out absorption
Cells of kidney tubules reabsorb fluids and synthesize proteins
Cells of epithelial in the intestine reabsorb fluids and synthesize protein
enzymes

2. What uses oxygen to remove hydrogen atoms in an oxidative reaction? (8)

Peroxisomes are the component of the cell that produces hydrogen peroxide
(H2O2) by using oxygen to remove hydrogen atoms from specific substrates in
an oxidative reaction
Peroxisomes (microbodies) are membrane bound organelles that contain
several oxidative enzymes such as catalase and urate oxidase
They detoxify compounds, fatty acids; are major sites of oxygen utilization
They usually contain enzymes that use oxygen to remove hydrogen atoms
from specific substrates in an oxidative reaction that produces hydrogen
peroxide (H2O2)
Hydrogen peroxide is a powerful oxidant (it is destructive if it accumulates or
escapes from peroxisomes)
Peroxisomes also play a special role in nerve cell mylenation and detoxifying
wastes, so impairment of them can lead to disease.

3. During cell injury what is released that is capable of cellular auto digestion?
(7)
Lysosomes are the cell component that is capable of cellular autodigestion
when it is released during cell injury
Disruption of the lysosomal membrane by injury or different treatments leads
to a release of the lysosomal enzymes, which then react with their specific
substrates, causing cellular autodigestion.
Lysosomes are sac-like structures that originate from the Golgi Complex
They function as the intracellular digestive system
Lysosome enzymes- capable of digesting most cellular elements completely
to their basic components (ex: amino acids, fatty acids, carbs)
Lysosomal storage diseases- result of a genetic defect or lack of lysosomal
enzymes (ex: Pompe disease, Tay-Sachs, Gout)

4. Where is the genetic info contained in the cell? (2)

The Nucleus contains control of genetic info
The nucleus also contains the nucleolus- small dense structure composed
mainly of RNA
Most cellular DNA and histones (DNA binding proteins) regulate activity of
nucleolus
 Primary function of nucleus- cell division and control of genetic info,
replication and repair of DNA, transcription of info stored in DNA
Most of the processing of RNA occurs in nucleolus

5. Cell membranes contain which major chemical components? (12)

Lipids and proteins are the major components of the plasma membrane
Lipid- A bilayer that is a major component of plasma membrane
Lipids and proteins act as molecular glue for the structural integrity of the
membrane
Each lipid is polar or amphipathic- one part (head) is hydrophilic (water
loving, water soluble, charged) and other part (tail) is hydrophobic (scared of
water, fat soluble, uncharged). This allows the membrane to organize itself
into a bilayer
Protein- made from a chain of amino acids known as polypeptides, 20 types
of amino acids in proteins, each type has unique sequence

6. What allows potassium to diffuse in and out of cells? (32)

The NA-K antiport system (Na moves out, K moves in) uses the direct energy
of ATP to move these cations.
The transporter protein is an enzyme, (ATPase), which has a requirement for
Na, K, and Mg ions.
For every 1 ATP hydrolyzed, 3 Na move out of cell, 2 K move into cell
The concentration of ATPase in plasma membranes is directly related to Na-K
transport activity.
It is found in nearly all mammalian cells

7. How is the cell protected from injury?

Cell membrane and lipid bilayer
It controls what comes in/out of cell, gives structure, it is a barrier to toxic
Hypoxic injury is the single most common cause of cellular injury
8. In cirrhosis, what does cholesterol have to do with the erythrocytes?
Cholesterol decreases the membrane fluidity of the erythrocyte, which
reduces its ability to carry oxygen.
9. What is platelet-derived growth factor?
The action of platelet-derived growth factor is to stimulate production of
connective tissue cells.
10. What is cell communication? How does it occur?

11. What is chemical signaling?

12. How is glucose transported from the blood to the cell?
By passive-mediated transport (facilitated diffusion)
13. Understand the transportation of potassium and sodium across plasma
membranes.
 Potassium is able to diffuse easily in and out of cells because the resting
plasma membrane is more permeable to potassium
Sodium
14. What is active transport?

15. What are cytokines?
The role of cytokines in cell reproduction is to provide growth factor for
tissue growth and development.

16. Do all cells continue to replicate and divide?

17. When normal columnar ciliated epithelial cells of the bronchial lining are
replaced by stratified squamous epithelial cells, the process is called?

18. What is the relation between ischemia and ATP?
During ischemia, the effect of the loss of adenosine triphosphate (ATP) level
causes cells to swell because of the influx of sodium chloride (NaCl).
19. When does sodium enter the cell and cause swelling?
20. What are free radicals in relation to cell damage? Progression of diseases?
Free radicals are highly reactive chemicals with unpaired electrons that can
scramble the structure of proteins and nucleic acids
They are normal byproducts of cellular metabolism, but if allowed to
accumulate they have devastating effects of the cells
Free radicals play a major role in the initiation and progression of
cardiovascular diseases such as hypertension and ischemic heart disease

21. Know all about lead poisoning. How does it cause damage within the cell?
Lead causes damage within the cell by interfering with the action of calcium
Nerves and blood-forming organs are affected by lead consumption
Lead poisoning affects the nervous system by interfering with the function of
neurotransmitters.

22. Know about the effects of fetal alcohol syndrome on infants.

23. How does alcohol affect the nervous system?
24. Where do lipids accumulate?
The liver is the most common site of lipid accumulation
The mechanisms that occur in the liver after lipid accumulation in liver cells
is increased synthesis of triglycerides from fatty acids and decreased synthesis
of apoproteins.
25. What is hemosiderosis?
Hemosiderosis is a condition in which excess iron is stored as hemosiderin in
cells of many organs and tissues.
26. What causes free calcium in the cytosol?
 Depletion of ATP (which normally pumps calcium from the cell) is the cause
of free calcium in the cytosol that damages cell membranes by uncontrolled
enzyme activation.
27. What happens to sodium and water during cell injury?
28. During cell injury caused by hypoxia, what happens to osmotic pressure?
During cell injury caused by hypoxia, there an increase in the osmotic
pressure within the cell because sodium chloride enters the cell
29. What causes mammary glands to enlarge in pregnancy?
Physiologic hypertrophy increases the size of breasts and uterus during
pregnancy
30. After ovulation what happens to uterine endometrial cells?
After ovulation, the uterine endometrial cells divide under the influence of
estrogen; this is an example of hormonal hyperplasia
31. What happens to liver cells when a portion of the liver is removed?
Removal of part of the liver leads to compensatory hyperplasia of the
remaining liver cells.
32. Understand necrosis in relation to pulmonary TB and gangrene.
33. Infants are susceptible to significant total body water loss, why?
34. Why are obese people at greater risk for dehydration?
35. With low plasma albumin you have edema, why?
36. Retention of sodium and water causes edema because of an increase in?

37. What causes hypernatremia?

Hypernatremia is an acute gain in sodium (can be inappropriate
administration or over secretion of aldosterone
Causes: net loss of water, fever, respiratory infections, profuse sweating,
diarrhea, polyuria, diabetes
38. Can insulin be used to treat hyperkalemia?
Yes, insulin administered with glucose facilitates the uptake of glucose into
the cell, which bring potassium with it

39. What does hyperaldosteronism cause in relation to fluid and electrolyte
balance?
 Too much aldosterone (such as in Addisons disease) causes hyperkalemia
because aldosterone is the hormone responsible for controlling absorption of
K from the kidneys
40. What causes the neuron symptoms in hypernatremia, hyponatremia?
41. Why does a pt. have decreased urine output with SIADH?
42. During acidosis how does the body compensate for increase in hydrogen
ions?
43. What is the significance of deep, rapid breathing in metabolic acidosis?
44. What causes hyperkalemia?
Over ingestion of potassium containing foods (Salt substitutes)
Renal failure or insufficiency (acute or chronic, different kidney diseases,
rejection of kidney implant)- decreased renal excretion of K
Glomerulonephritis- kidneys ability to filter blood
Adrenal insufficency (Addisons disease, adrenalectomy).
Addisons disease- condition in which body fails to produce enough
aldosterone- the hormone responsible for controlling the absorption of
potassium from the kidneys,
Potassium-sparing diuretics- they are used to regulate BP by increasing
excretion of fluids and electrolyes in urine
Transfusions of whole or packed RBCs
Bolus IV injections or rapid infusuion of potassium containing IV solution
45. What causes hypermagnesemia?
Renal failure or insufficiency- decreased renal excretion of Mg
Parathyroid dysfunction
Mg containing antacids and laxatives
IV Mg replacement
46. What influences calcium and phosphate balances?
47. What are Chvosteks and Trousseaus signs?
Chvosteks sign is the twitching of facial nerves in response to tapping the
area over the facial nerve or angle of the jaw (masseter muscle). It indicates
hypocalcemia. It is found in tetany.
Chvosteks sign is a clinical sign of existing nerve hyperexcitability (tetany)
seen in hypocalcemia (i.e. from hypoparathyroidism, pseudo-
hypoparathyroidism, Vit D deficiency)
Chvoseks sign may also be encountered in respiratory alkalosis, (seen in
hyperventilation) which causes decreased serum Ca with a normal calcium
level due to a shift of Ca from the blood to albumin, which has become more
negative in the alkalotic state.
Chvoseks sign is frequently seen in alcoholics, people with diarrhea, pts
taking diuretics or aminoglycosides because hypomagnesemia can cause
hypocalcemia.
Trousseaus sign- A condition marked by intermittent muscle spasms, caused
by malfunction of parathyroid glands and a consequence of hypocalcemia.
 Trousseaus sign- To check, put a BP cuff on, inflate to greater than pts
systolic pressure, keep inflated 1- 4 mins. Upon these hypoxic conditions, it
causes palmar flexion (Or carpopedal spasm- severely painful cramps of the
muscles in your hands and feet.)
Trousseaus sign- a sign of latent tetany- usually used to detect early tetany.
Tetany is caused by conditions that increase action potential frequency of
muscle cells or the nerves that innervate them.
Tetany- overstimulated neuromuscular activity (nerve excitability).
Tetany is usually caused by electrolyte imbalance, particularly hypocalcemia,
But, it can also be caused by hypomagnesaemia or hypokalemia. Having too
much acid (acidosis) or too much alkali (alkalosis) in the body can also result
in tetany.
48. What causes hypocalcemia?
Parathyroid dysfunction, Vit D deficiency, pancreatitis
Chronic kidney disease
Inadequate intake of potassium in diet or starvation- usually only seen in
anorexic patients or pts on a ketogenic diet
Diuretics (loop diuretics, e.g. furosemide, thiazide diuretics e.g. HCTZ)
Diabetic ketoacidosis
Primary aldosteronism
Cushings syndrome - Excess cortisol binding the Na+/K+ pump and acting
like aldosterone
Diseases leading to hyperaldosteronism or high aldosterone levels; i.e
Cushings syndrome
Dialysis
Diabetes inspidius (polyuria- loss of K in urine)
Hypomagnesemia
Diarrhea
Vomiting
Excessive sweating
Excessive alcohol use
Excessive laxative use (leading to diarrhea)
Folic acid deficiency
Alkalosis- increase of pH in blood
Too much water
Some antibiotic use
49. When someone vomits extensively, what causes the metabolic alkalosis?
Vomiting causes a loss of acid
Metabolic alkalosis is caused by too much bicarbonate in the blood.
Vomiting causes an acute rise of plasma bicarbonate (HCO3) concentration,
which causes an increase of pH in blood (alkalosis).
It exceeds the capacity of the renal proximal tubule to reabsorb this anion
Potassium is excreted as an obligate cation partner to the bicarbonate

50. What causes edema during inflammation? What is the purpose of
inflammation?
Edema during inflammation is caused primarily by the accumulation of fluid
outside the blood vessels
The purpose of the inflammatory process is to prevent infection of the injured
tissue and promote healing
Inflammation is a vital part of the bodys immune response. It is the body's
attempt to heal itself after an injury; defend itself against foreign invaders,
such as viruses and bacteria; and repair damaged tissue.
Without inflammation, wounds would fester and infections could become
deadly.
During inflammation,arteries dilate, blood flow increases, and capillaries
become more permeable so that white blood cells, hormones and nutrients can
move into the spaces between cells. White blood cells swarm the injured area
and ingest germs, dead or damaged cells and other foreign materials to help
heal the body.
Hormones called prostaglandins create blood clots to try to heal the damaged
tissue and remove them when healing is finished; they also trigger pain and
fever as part of the healing process.
Swelling happens because fluid accompanies the white blood cells, hormones
and nutrients.

51. What causes the erythema and induration during inflammation?
Vasodilation (increased blood flow and increasing concentration of red blood
cells at site of injury) causes erythema (heat and redness) that occur during
the inflammatory process
Accumulation of cells causes induration (hardness) during inflammation
52. After prolonged antibiotic therapy, what bacterium grows in the intestines?
Clostridium difficile is the bacterium that grows in the intestines after
prolonged antibiotic therapy
53. When histamine is released from mast cells, what is the vascular effect?
It causes a temporary, rapid constriction of the large vessel walls and dilation
of post capillary venues, both which result in increased blood flow into the
microcirculation
It also causes vascular permeability resulting from the retraction of
endothelial cells lining the capillaries
54. Which leukocyte elevates when there is an early, acute inflammatory
reaction?
Neutrophils elevate within 6-12 hours after initial injury
Neutrophils ingest bacteria, dead cells, and cellular debris
55. What produces fever?
Endogenous pyrogens act directly on the hypothalamus (the portion of the
brain that controls the bodys thermostat
56. What is the process of repair after tissue damage?
 1. Fill in
2. Seal
3. Shrink
Destroyed tissue is replaced by non-functioning scar tissue during the process
of repair after tissue damage.
(Acute inflammation, wound closure, scar tissue, reconstruction phase,
maturation phase)
57. How do vaccinations work to provide protection against certain
microorganisms?
58. Bacteria cannot multiply without?
59. How do bacteria become resistant to antibiotics?
60. How would you clean a wound that is healing by epithelialization?
61. What is a keloid?
62. Why do some neonates have a transient depressed inflammatory response?
Adults?
63. After the initial infection with herpes, why is the virus inaccessible to
antibodies?
64. Which type of immunity is produced after natural exposure to an antigen?
65. Where are antibodies produced? Which one is detected to indicate a typical
primary immune response?
66. What is hypersensitivity?
67. During an IgE hypersensitivity reaction, which leukocyte is activated?
68. What reverses the effects of histamine during an anaphylactic reaction?
69. Understand Graves disease and myasthenia gravis.
70. A patient reacts to a blood transfusion, what is this an example of?
71. What is the positive reaction to a Tb skin test?
72. Understand the characteristics of HIV.
73. What is the role of reverse transcriptase?
74. What are the primary target cells for HIV?
75. What acts as a reservoir in which HIV can be relatively protected from
antiviral drugs?
76. Which cells are decreased in AIDS?
CD 4 and T cells
The decrease in CD4+ cell numbers results in a reversal of the normal
CD4/CD8 T-cell ratio (normally about 1.9) to lower than 0.9 and often near
zero page 327 (at or below 200cells/UL)
77. How long does it take for HIV antibodies to appear after infection thru blood
products?
4-7 weeks
78. After sexual transmission of HIV, a person can be infected yet seronegative
for how long?
6-14 months
79. What is colonization?
80. How are vaccines against viruses made?
81. What is the general adaptation syndrome?
82. How is the limbic system stimulated when there is an anticipatory response
to stress?
83. Which hormone causes anxiety and arousal during a stress response?
84. During the response to stress what decreases lymphocytes, eosinophils,
macrophages and prostaglandin?
85. How does epinephrine affect the immune system during stress?
86. What catecholamines are secreted during stimulation of the adrenal
medulla?
87. Is norepinephrine involved in the stress response?
88. How is stress, cortisol, the adrenal cortex and hyperglycemia related?
89. When you have increased epinephrine, glucagon and growth hormone
secretion what happens?
90. Which hormone helps to explain the mood cycles, anxiety, and eating
disorders in women?
91. Does estrogen affect lymphocytes?
92. Do androgens affect lymphocytes?
93. Hydrostatic pressure, osmotic pressure-understand both.
94. Nutritional deficiencies and the immune system.
95. Know the stress-age syndrome.
96. Know what causes the rapid change in the resting potential that initiates an
action potential.
Sodium gates open and sodium rushes into the cell changing the membrane
potential from negative to positive.
96. Know the action of natriuretic peptides.
97. Know chemical mediators which induce pain during inflammatory process.
98. Know enzyme secreted in kidney when blood volume is decreased.
99. Know the difference between osmolarity and osmolality.
Osmolality is the total number of dissolved particles of osmotic activity
expressed as # of osmoles of solute per kg of solute (usually refers to fluids
inside the body
Normal serum osmolality is 275-295 mOsm/kg (milliosmoles per kilogram)
Because more of the weight of plasma is influenced by solutes (such as
protein and glucose, rather than by water) osmolality is preferred over
osmolarity as the measurement of osmotic activity in the clinical
assessment of individuals.