Study Guide Unit 1

NU 545

1. What is metabolic absorption? Page 2 cellular functions Metabolic Absorption. Cells take in and use
nutrients. Cells of the kidney and intestine are specialized to carry out absorption. EG Kidney tubules reabsorb
fluids and synthesize proteins. Intestinal epithelial cells reabsorb fluids and synthesize protein enzymes. All cells
take in and use nutrients and other substances from the surroundings. The ability of cells to take in nutrients. The
eight specialized cellular functions are movement, conductivity, metabolic absorption, secretion, excretion,
respiration, reproduction, and communication.
2. During cell injury what is released that is capable of cellular autodigestion? Lysomal enzymes figure
page 64 page 63 info. Page 7. As cells complete their life span and die, lysosomes digest the resultant debris or
obsolete parts by autophagy. Lysosomes involved in this process, which is called autodigestion, are called
autolysosomes, or autophagosomes
3. Where is the genetic info contained in the cell? Chromosomes are found within the nucleus and store
genetic information of the cell. Page 2 The nucleus is the largest membrane-bound organelle and is
usually found in the cell's center. The chief functions of the nucleus are cell division and control of genetic
information
4. Cell membranes contain which major chemical components? Page 12. Table 1-1 Lipids and proteins.
Page 11.
5. Know the 4 phases of the cell cycle. (1) the G1 phase (G = gap), which is the period between the M phase
and the start of DNA synthesis; (2) the S phase (S = synthesis), in which DNA is synthesized in the cell nucleus;
(3) the G2 phase, in which RNA and protein synthesis occurs, the period between the completion of DNA
synthesis and the next phase (M); and (4) the M phase (M = mitosis), which includes nuclear and cytoplasmic
division. Page 37.
6. What allows potassium to diffuse in and out of cells? Sodium potassium pump page 29 bottom right.
Potassium and sodium transported across plasma membrane by a carrier mechanism adenosine triphosphate
enzyme (ATPase) Potassium can flow easily because the resting membrane is most permeable to K+.
7. How is the cell protected from injury? Plasma membrane page 12. Page 54
8. What is platelet-derived growth factor? growth factor stimulates the production of connective tissue cells.
Hematoma formation occurs when damaged vessels hemorrhage. Fibrin and platelets within the hematoma form a
meshwork. Hematopoietic growth factors, such as platelet-derived growth factor and transforming growth factor,
are involved in this stage. Table 1-6 page 39.
9. What is cell communication? How does it occur? Page 20, Cell junctions - form of cell communication is
used to relate to other cells in direct physical contact through cell junction holds cells together Gap junctions
allow cells to communicate inside one cell to inside of another, etc… page 45 summary
10. What is chemical signaling? Page 20 Paracrine, Autocrine, Hormonal, Neurohormonal Figure 1-20.
Paracrine signaling cells secrete local chemicals mediators that are quickly destroyed. Ligands are chemical
messengers that help cells receive communication from the extracellular fluids surrounding them.
11. How is glucose transported from the blood to the cell? the sugar glucose is transported by active
transport from the gut into intestinal epithelial cells, but by facilitated diffusion across the membrane of red
blood cells. Table 1-5 page 33 passive mediated transport- red blood cells
12. Understand the transportation of potassium and sodium across plasma membranes. Page 29, page 32
figure 1-32, page 36
13. Understand membrane transport summary review page 46
14. Understand the function of cAMP. Page 24 cAMP is an intracellular second messenger triggering the
cellular response by activating the cAMP dependent protein kinase.
15. Know causes of electrolyte abnormalities (hypermagnesemia, hypomagnesemia, hypokalemia,
hyperkalemia, hypocalcemia) In acidosis, ECF hydrogen ions shift into the cells in exchange for ICF potassium
and sodium; hyperkalemia and acidosis therefore often occur together. Elecrolytes are electronically charged
molecules. Page 114.
16. What is active transport? Active transport can occur across membranes that have receptors that are capable
of binding with the substances to be transported. Protein carrier.
17. What are cytokines? The role of cytokines provide growth factor for tissue growth and development. Page
39 table 1-6
18. When normal columnar ciliated epithelial cells of the bronchial lining are replaced by
stratified squamous epithelial cells, the process is called? Page 54. Metaplasia.
19. What is the relation between ischemia and ATP? The loss of the adenosine triphosphate (ATP) during
ischemia causes cells to cell due to the influx of sodium chloride. Pg 56.
20. When does sodium enter the cell and cause swelling? During cell injury caused by hypoxia when an
increase in osmotic pressure occurs. Page 57
21. What are free radicals in relation to cell damage? Progression of diseases? Free radicals play a major
role in the initiation and progression of of cardiovascular disease htn, ischemic heart disease. Page 60. Can
produce chemical induced cell injury. Form within lipid bilayer of cell membranes and steal electrons.
22. Know all about lead poisoning. How does it cause damage within the cell? Lead causes injury to the cell
by interfering with calcium which interferes with neurotransmitters. Page 65 and 66. Lead can mimic other metals
and act as a cofactor in several enzymatic reactions. It also interferes with the synthesis of hemoglobin. Nerves
and blood organ damage. Exposure in children can result in learning/behavior problems, speech/hearing problems,
brain/nervous system damage, and slowed growth and development
23. Know about the effects of fetal alcohol syndrome on infants. 68-69 cognitive impairment and facial
anomalies.
24. How does alcohol affect the nervous system? Page 67 & 68. Causes CNS depression. Sedation,
drowsiness, loss of coordination, delirium, altered behavior. Loss of consciousness and with high amounts coma
or respiratory arrest. Results in major nutritional deficiencies, especially folate. Blocks potassium channels to
being open and leaking.
25. Where do lipids accumulate? Liver, spleen CNS. P 84-85
26. What is hemosiderosis? A condition in which excess iron is stored in cells of many organs or tissues. p 86.
27. What causes free calcium in the cytosol? Depletion of ATP, which normally pumps calcium from the cell,
and damages cell membranes. Page 87 figure 2-24
28. What happens to sodium and water during cell injury? They move into the cell because the pump that
transports sodium out cannot function due to decrease ATP. Pg 84 figure 2-21
29. During cell injury caused by hypoxia, what happens to osmotic pressure? It increases because sodium
chloride enters.
30. What causes mammary glands to enlarge in pregnancy? Hormonal dysplasia, review pg 97. The
hormones responsible are progesterone, prolactin and estrogen. Alveoli proliferate and develop membrane bound
vacuoles containing fat and milk proteints.
31. After ovulation what happens to uterine endometrial cells? They divide under the influence of estrogen
from hormonal hyperplasia. Page 53.
32. What happens to liver cells when a portion of the liver is removed? Compensatory hyperplasia pg 53
33. Understand necrosis in relation to pulmonary TB and gangrene. The type of necrosis associated with
pulmonary TB is caseous necrosis. Liquefactive gangrene is associated with wet gangrene. Hypoxia and ischemia
necrosis effects heart and kidneys.
34. Infants are susceptible to significant total body water loss, why? P 104. Kidneys are not mature enough
to counter fluid losses.
35. Why are obese people at greater risk for dehydration? Adipose cells contain little water because fat is
water repelling. P 104
36. With low plasma albumin you have edema, why? Decrease in interstitial hydrostatic pressure, Decrease in
plasma oncotic pressure. Losses or diminished production of plasma albumin is the only option that contributes
to a decrease in plasma oncotic pressure. P 106-107 Liver failure leads to lost or diminished plasma albumin
production, and this contributes to decreased plasma oncotic pressure.
37. Retention of sodium and water causes edema because of an increase in? capillary hydrostatic pressure,
capillary permeability. Increased capillary hydrostatic pressure can result from venous obstruction or sodium and
water retention. P 107 see figure 3-2 Increased capillary hydrostatic pressure would facilitate increased movement
from the capillary to the interstitial space, leading to edema.
38. What causes hypernatremia? Aldosterone promotes renal sodium and water reabsorption and excretion of
potassium, thus increasing blood volume. Hypersecretion of aldosterone. Hypernatremia occurs because of (1)
inadequate free water intake, (2) inappropriate administration of hypertonic saline solution (e.g., sodium
bicarbonate for treatment of acidosis during cardiac arrest), (3) high sodium levels as a result of oversecretion of
aldosterone (as in primary hyperaldosteronism), or (4) Cushing syndrome (caused by the excess secretion of
adrenocorticotropic hormone [ACTH], which also causes increased secretion of aldosterone). Pg 108, pg 111.
Table 3-7
39. Can insulin be used to treat hyperkalemia? Yes it transports potassium from the blood to the cell along
with glucose. Insulin contributes to the regulation of plasma potassium levels by stimulating the Na+, potassium-
adenosine triphosphatase (K+-ATPase) pump, thereby promoting the movement of potassium simultaneously into
the liver and muscle cells with glucose transport after eating. Pg 117. Pg 119.
40. What does hyperaldosteronism cause in relation to fluid and electrolyte balance? Hypernatremia.
Table 3-7 pg 111. Leads to HTN, water retention and hypokalemia.
41. What causes the neuron symptoms in hypernatremia/hyponatremia? Brain volume decreases from
dehydration. Behavioral and neurologic changes characteristic of hyponatremia include lethargy, headache,
confusion, apprehension, seizures, and coma. Pg 113.
42. Why does a pt. have decreased urine output with SIADH? Water is moving into cells resulting in
decrease of urine output pg 113.
43. During acidosis how does the body compensate for increase in hydrogen ions? Pg 127-128. Pg 125
buffering. The respiratory system compensates for metabolic acidisos as reduced pH makes you hyperventilate
lowering the PaCO2 and amount of bicarb in the blood. It is the lungs hyperventilating that would compensate for
metabolic acidosis by blowing off CO2, not any function associated with the kidneys.
44. What is the significance of deep, rapid breathing in metabolic acidosis? Pg 127 the respiratory system is
compensating for the reduced pH and stimulates hyperventilation lowering Paco2 and bicarb in the blood.
45. What causes hyperkalemia? Pg 117-118. Extracellular fluid potassium increase. Table 3-9.
46. What causes hypermagnesemia? Pg 133. Renal failure. Table 3-10
47. What influences calcium and phosphate balances? Pg 119. Three hormones parathyroid hormone,
vitamin D and calcitonin. They determine the amount of dietary calcium and phosphate that is absorbed from the
intestine.
48. What are Chvostek’s and Trousseau’s signs? Sign of hypocalcemia. Chvostek sign is elicited by tapping
on the facial nerve just below the temple, a positive is a twitch of the nose or lip. Trouseau sign is contraction fo
the hand and fingers when the arterial blood flow in the arm is occluded for 5 minutes. Pg 120.
49. What causes hypocalcemia? Inadequate intestinal absorption or decrease levels of PTH and vitamin D or
deposition of ionized calcium into bones or tissue. Pg 120.
50. When someone vomits extensively, what causes the metabolic alkalosis? Pg 128. Excessive loss of
metabolic acids. by the loss of gastric secretions, which are rich in hydrochloric acid (HCl).
51. What causes edema during inflammation? What is the purpose of inflammation? arterioles near the site
of infection or injury constrict briefly then vasodilation causes slower blood velocity and increases local blood
flow to the injured site increased blood flow and capillary permeability result in leakage of plasma from the
vessels, causing swelling or edema in the surrounding tissue. Pg 107.
52. What causes the erythema and induration during inflammation? vasodilation and swelling;
accumulation of debris and fluid at site. Pg 195.
53. After prolonged antibiotic therapy, what bacterium grows in the intestines? clostridium
difficile. Pg 310.
54. When histamine is released from mast cells, what is the vascular effect? Rapid mast cell degranulation
and the release of histamine causes vasodilation, and increased capillary permeability, bronchodilation. Pg 206
55. Which leukocyte elevates when there is an early, acute inflammatory reaction? During many
infections. The number of circulating leukocytes primarily neutrophils increase. Pg 204
56. What produces fever? Partially induced by specific cytokines released from neutrophils and
macrophages known as endogenous pyrogens. They act directly on the hypothalamus portion of the brain
that controls the body's temperature. Caused by exogenous and endogenous (IL-1) pyrogens. Pg 213.
57. What is the process of repair after tissue damage? 1. The skin consists of the dermis and epidermis that
exist in equilibrium. Once the skin is broken the process of wound healing begins by the aggregation of platelets
to the injury site to form a fibrin clot done by phase one inflammation. The purpose of the clot is to control
bleeding. 2. Phase 2 is reconstruction. Wound healing is the process in which the skin repairs itself after injury.
Phase 3 is remodeling and maturation. 3.Proliferative phase contains revascularization/angiogenesis, granulation,
epithelialization, and contraction. 4. Collagen deposition is fundamental to wound healing because it adds strength
to the wound. 5. Wound healing is divided into four sequential and overlapping states: 1) hemostasis, (2)
inflammatory, (3) proliferative and (4) remodeling. 6. This process is called hemostasis. It involves three
concepts: vasoconstriction, platelet activation and coagulation. 7. Proliferative phase contains
revascularization/angiogenesis, granulation, epithelialization and contraction. Pg 215
58. How do vaccinations work to provide protection against certain microorganisms? Pg 332.
Inducing active immunologic protection before exposure. Because of the level of protection provided
by immunoglobulin G (IgG)
59. Microorganisms undergo rapid multiplication do to what? To produce new infectious progeny and be
able to spread. They are able to rapidly multiply due to the warm nutrient rich environments.
60. How do bacteria become resistant to antibiotics? -MRSA- Methicillin-resistant Staphylococcus aureus -
VRE- Vancomycin-Resistant Enterococcus. -Antibiotics kills bacteria but also kill "good bacteria" that protects
the body. -Some bacteria transfer their resistant to other bacteria. Pg 330. Antibiotic resistance is usually a result
of one of four general mechanisms resulting from genetic mutations that can be transmitted directly to
neighboring microorganisms by plasmid exchange. The bacteria secrete and enzyme that inactivates the antibiotic,
it can change wall structure to resist the antibiotic.
61. How would you clean a wound that is healing by epithelialization? Page 219. Cleaned by clinically
debrided and dressed. Normal saline can be used to cleanse and irrigate a wound healing by epithelization. Iodine
and peroxide should be avoided. Keep wound moist to avoid clot. The ideal dressing is one that absorbs some
drainage without being incorporated into the clot or granulation tissue.
62. What is a keloid? Pg 219. A raised scar that extends beyond the original boundaries of the wound. It
invades surrounding tissue and is likely to recur after removal.
63. Know the functions and characteristics of immunoglobulins. Pg 229. They are all molecules that are
known to have specificity for antigen, whereas the term antibody is generally used to denote one set of
immunoglobulins with specificity against a known antigen.
64. Why do some neonates have a transient depressed inflammatory
response? In some infants the development of antibodies is delayed. Because of a deficiency in complement and
chemotaxis as well as antimicrobial peptide deficiency. Page 290. Adults? Decreased production of T cells,
depressed responses to new and recall antigens. Chronic illnesses, anti-inflammatory steroids, impaired sensations
and decreased mobility. Skin changes, less protection.
65. Be familiar with blood transfusions and reactions. Surface antigens of RBC knowns as blood group
antigens become targets of alloimmune reactions. Page 278.
66. Be able to explain the characteristics of viruses. Pg 317. The basic viral structure consists of nucleic acid
protected by a protein shell the capsid. It can take many shapes. Some have a protective envelope surrounding the
capsid which consists of plasma membrane. Table 10-8
67. After the initial infection with herpes, why is the virus inaccessible to antibodies? Prevents
binding of the antigenic peptide to MHC class1. Inhibition of antigen presentation by MHC class 1
prevents the generation of effective t cell immune responses. They don’t circulate in the blood stream they
remain inside infected cell. Page 320.
68. Which type of immunity is produced after natural exposure to an antigen? Pg 227. Active acquired.
69. Where are antibodies produced? Page 252. Plasma cells of the secretory immune system.
Which one is detected to indicate a typical primary immune response? IgM> followed by IgG. Page
253.
70. What is hypersensitivity? Page 262. Altered immunologic response to an antigen that results in disease or
damage to the host. Can be classified in 2 ways: by the source of the antigen that the immune system is attacking
(allergy, autoimmunity, alloimmunity), and by the mechanism that causes disease (table 3-9).
71. During an IgE hypersensitivity reaction, which leukocyte is activated? Type 1 mast cells, the leukocytes
take up permanent residence, example allergies and anaphylactic shock. Most commonly from allergies. Page 263.
72. What reverses the effects of histamine during an anaphylactic reaction? Epinephrine increases blood
pressure and dilates and opens airway. Pg 272, Epi is an autonomic nervous system mediator and binds to specific
receptors in smooth muscle and reverse effects of histamine and results in muscle relaxation.
73. Understand Graves disease and myasthenia gravis. Graves excess thyroid hormone, goiter (enlarged
thyroid), sleep troubles, irritability, nervous, heat sensitive, increased sweating, hand tremors, rapid heartbeat,
autoimmune. It is an autoimmune disease in which maternal antibody against the receptor for TSH causes
neonatal hyperthyroidism. MG is an autoimmune disease which maternal antibody binds with receptors for neural
transmitters on muscle cells (acetylcholine receptors) causing neonatal muscular weakness, antibodies block or
destroy some acetylcholine receptor sites. Progressive weakness. Page 277.
74. A patient reacts to a blood transfusion, what is this an example of? Alloimmunity. Hypersensitive
reactions, pg 294.
75. What is the positive reaction to a Tb skin test? Page 270 Type 4 delayed cell mediated hypersensitivity
reaction
76. Understand the characteristics of HIV. Lentivirus leads to aids. Transmitted through body fluids. Found
as free particles. HIV is a member of the retrovirus family, which carries genetic information in the form of two
copies of RNA. Retroviruses use a viral enzyme, reverse transcriptase, to convert RNA into double-stranded
DNA (it creates a dsDNA version of the virus). Page 324.
77. What is the role of reverse transcriptase? Page 324, HIV and other retroviruses use a viral enzyme called
reverse transcriptase to convert RNA into a double stranded DNA. Using a second viral enzyme integrase the new
DNA is inserted in the infected cells genetic material where it may remain dormant.
78. What are the primary target cells for HIV? Infect CD4+ cells present on helper T lymphocytes, dendritic
cells, CD8 positive tc cells, double positive thymic cells, NK cells, monocytes, macrophages, lymph nodes and
within the CNS. Page 325.
79. What acts as a reservoir in which HIV can be relatively protected from antiviral drugs? Cells within
the CNS the GI tract and other anatomic sites. Page 325
80. Which cells are decreased in AIDS? CD4 and T helpers TAH cells. Page 327.
81. How long does it take for acute HIV infection to progress to AIDS? As long as 10 years page 327
82. What is colonization? When bacteria finds a good host environment and can proliferate and then invade.
1st progressive stage of an infection - how the microorganism is exposed and enters the host (human to human,
zoonosis, vectors, etc.) Page 300.
83. How are vaccines against viruses made? Inactivated virus. No replication. Or attenuated, replicates at low
rate, not for immunosuppressed. Page 332.
84. What is the general adaptation syndrome? Physiologic response to stress.Theory developed by Selye
that says a persons response to a stressor consists of alarm and mobilization (fight or flight), resistance or
adaptation, and exhaustion. Page 339, 358. The alarm stage, the initial reaction, is manifested by arousal of the
body's defenses that prepare the body to fight or flee from threat. This stage involves the secretion of hormones
and catecholamines to support physiologic/metabolic activity and boosts the immune system to thwart infection.
The stage of resistance/adaptation is the second step as the body attempts to sustain the challenge. Exhaustion
marks the breakdown of compensatory mechanisms, when the response can no longer be sustained.
85. How is the limbic system stimulated when there is an anticipatory response to stress?
Regulates emotional activity fear, anxiety, anger, excitement, stimulates reticular activating system
norepinephrine. In response to stress, the limbic system is stimulated by paraventricular nucleus of the
hypothalamus. Pg 343.
87. Which hormone causes anxiety and arousal during a stress response? Page 343. norepinephrine is
released promoting arousal and anxiety.
88. How does epinephrine affect the immune system during stress? Increase in lymphocytes such as T cells
and NK cells. Page 346.
89. What catecholamines are secreted during stimulation of the adrenal medulla? Epinephrine, norepi, pg
345
90. Is norepinephrine involved in the stress response? yes it enhances, excitability of other neurons and
accelerates sensory and motor functions and info processing, influences K channels, It regulates BP by
constricting smooth muscle, so during stress it raises blood pressure due to constricted vessels. Page 345
91. How is stress, cortisol, the adrenal cortex and hyperglycemia related? Stress induced cortisol released
from the adrenal cortex causes stimulation of glucogenesis or the formation and increases blood glucose. Page
345.
92. When you have increased epinephrine, glucagon and growth hormone secretion what happens?
Hyperglycemia occurs.page 347
93. Which hormone helps to explain the mood cycles, anxiety, and eating disorders in women?
Estrogen and estradiol. Pg 350
94. How do nutritional deficiencies impact immune cells? Page 290. Malnutrition is the predominant cause of
secondary immune deficiencies. Calorie and protein deficits lead to deficiencies in t cell function and numbers.
95. What antibody indicated a typical immune response? IgM. It is the first antibody produced during the
initial, or primary, response to antigen. Page 229
96. Effect hypertonic IV fluid will have on the cell. Page 110, cells shrink, water loss.
97. Does estrogen affect lymphocytes? Yes, it created depression of T cells and enhancement of B cells.
98. Know how antigens produce immunity. Why would different routes be used? Antigen Is a molecule
that can react with antibodies or receptors on B and T cells. It is mostly protein but can be other molecules as well.
Immunogenic antigen: An antigen that can trigger an immune response. Antigen’s binding site: antigenic
determinant (epitope) Antibody or lymphocyte’s binding site: Antigen-binding site (paratope)Certain criteria
influence the degree to which an antigen is immunogenic. These include (1) being foreign to the host, (2) being
appropriate in size, (3) having an adequate chemical complexity, and (4) being present in a sufficient quantity.
page 229
99. Do androgens affect lymphocytes? Androgens suppress T and B cell responses. Page 353
100. Hydrostatic pressure, osmotic pressure-understand both. Page 29-30 Hydrostatic pressure: the
mechanical force of water pushing against cellular membranes. In the vascular system, hydrostatic pressure is the
blood pressure generated in vessels by the contraction of the heart (blood capillary bed 25-30mmHg, which is
sufficient force to push water across the thin capillary membranes into the interstitial space). Osmotic pressure:
the amount of hydrostatic pressure required to oppose the osmotic movement of water. Factors that determine
osmotic pressure include the type and thickness of the plasma membrane, the size of the molecules, the
concentration of molecules or the concentration gradient, and the solubility of molecules within the
membrane. Hydrostatic pressure is partially balanced by osmotic pressure, whereby water moving out of the
capillaries is partially balanced by osmotic forces that tend to pull water into the capillaries. 
102. Know the stress-age syndrome. Stress age syndrome results in decreased immune system. Page 358
103. Know what causes the rapid change in the resting potential that initiates an action potential. P 36
Sodium gates open, and sodium rushes into cell which changes membrane potential from negative to positive.
104. Know the action of natriuretic peptides. Page 109. Natriuretic hormones are sometimes called a "third
factor" in sodium regulation but have no influence on calcium, magnesium, or potassium balance. Are released
when there is an increase in transmural atrial pressure caused by increased atrial volume during heart failure. It
increases sodium and water excretion by the kidneys which lowers blood volumes and pressure.
105. Know chemical mediators which induce pain during inflammatory process. bradykinin,
serotonin, and the prostaglandin, Kinin system page 201
106. Know enzyme secreted in kidney when blood volume is decreased. Renin: when circulating blood
pressure and renal blood flow, or serum sodium concentrations, are reduced, renin, an enzyme secreted by the
juxtaglomerular cells of the kidney, is released. Renin stimulates the formation of angiotensin I, an inactive
polypeptide. Angiotensin-converting enzyme (ACE) in pulmonary vessels converts angiotensin I to angiotensin II.
Page 108
107. Know age related concerns regarding wound healing. Page 222 review Increased age is associated with
diminished T-cell function, decreased immune function, diminished production of antibody responses, decreased
circulating immune complexes, and decreased ability to fight infection.
108. Know the difference between osmolarity and osmolality. Page 30, Osmolality is measure of the number
of milliosmoles per kilo and osmolarity is a measure of the number of milliosmoles per liter of solution or the
concentration of molecules per volume solution.