Pathophysiology

Pathophysiology Study Guide 2nd Edition 11/5/2018

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Pathophysiology Study Guide

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Pathophysiology Study Guide

Table of Contents Chapter 1: Cell Biology, Mechanisms of Cell Injury, and Neoplasia...................................................10 1.1 Cellular Adaptation.................................................................................................................................................. 10 Atrophy............................................................................................................................................................................................... 10 Hypertrophy ..................................................................................................................................................................................... 10 Hyperplasia....................................................................................................................................................................................... 11 Metaplasia ......................................................................................................................................................................................... 11 Dysplasia............................................................................................................................................................................................ 11 1.2 Cellular Injury............................................................................................................................................................ 11 Reversible Cell Injury ................................................................................................................................................................... 12 Irreversible Cell Injury................................................................................................................................................................. 12 Mechanisms of Cell Injury........................................................................................................................................................... 13 Intracellular Accumulation......................................................................................................................................................... 13 1.3 Genetic Disorders ..................................................................................................................................................... 14 Chromosomal Abnormalities..................................................................................................................................................... 14 Mutations........................................................................................................................................................................................... 15 1.4 Neoplasia ..................................................................................................................................................................... 15 Nomenclature/Classification/Naming of Neoplasias...................................................................................................... 15 Mechanism of Oncogenesis ........................................................................................................................................................ 17 Tumor Markers ............................................................................................................................................................................... 18 Effects of Tumors on the Host................................................................................................................................................... 19 Chapter One Practice Exam.......................................................................................................................................... 20 Chapter 2: Host Defense/Hematology .........................................................................................................21 2.1 Alterations in Integument Function .................................................................................................................. 21 Mechanical Barriers ...................................................................................................................................................................... 21 Burns ................................................................................................................................................................................................... 22 Skin Disorders.................................................................................................................................................................................. 24 Allergic Response ........................................................................................................................................................................... 25 Neoplastic .......................................................................................................................................................................................... 25 2.2 Inflammation.............................................................................................................................................................. 26 Local Manifestation ....................................................................................................................................................................... 26 Systemic Manifestation:............................................................................................................................................................... 27 2.3 Alterations in Wound Healing.............................................................................................................................. 28 Dysfunction in Inflammatory Response................................................................................................................................ 28 Nutritional Factors......................................................................................................................................................................... 29 Congenital Factors ......................................................................................................................................................................... 29 Complicating Factors .................................................................................................................................................................... 29 Impaired Infusion........................................................................................................................................................................... 30 2.4 Alterations in Immune Function......................................................................................................................... 30 Primary Immune Deficiencies................................................................................................................................................... 30 Secondary Immune Deficiencies .............................................................................................................................................. 31

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Pathophysiology Study Guide

©2018 of 131 Auto-Immunity Disease ............................................................................................................................................................... 32 Hypersensitivity Reactions ........................................................................................................................................................ 34 Immunization/Vaccination ........................................................................................................................................................ 35 Immuno-Compromised Host ..................................................................................................................................................... 36 Transplantation Reactions ......................................................................................................................................................... 37 2.5 Alterations in the Hematological System......................................................................................................... 38 Disorders of Red Blood Cells ..................................................................................................................................................... 39 Disorders of the White Blood Cells ......................................................................................................................................... 39 Disorder of Platelets...................................................................................................................................................................... 42 Disorders of Plasma and Metastasis....................................................................................................................................... 42 Chapter Two Practice Exam ......................................................................................................................................... 45 Chapter 3: The Cardiovascular System........................................................................................................46 3.1 Cardiac Excitation/Rhythmic Disturbances.................................................................................................... 46 Action Potentials............................................................................................................................................................................. 46 Disorders of Conduction.............................................................................................................................................................. 46 Enhanced Automaticity................................................................................................................................................................ 47 Reentry ............................................................................................................................................................................................... 48 Abnormal Conduction Pathways ............................................................................................................................................. 48 3.2 Valvular Function/Dysfunction........................................................................................................................... 49 Mitral Stenosis/Regurgitation .................................................................................................................................................. 49 Aortic Stenosis/Regurgitation .................................................................................................................................................. 49 Tricuspid/Pulmonic Disease ..................................................................................................................................................... 50 3.3 Cardiac Mechanisms/Heart Failure................................................................................................................... 50 Congestive Heart Failure............................................................................................................................................................. 50 Cardiogenic Shock.......................................................................................................................................................................... 52 Transplant ......................................................................................................................................................................................... 52 3.4 Atherosclerosis.......................................................................................................................................................... 53 Risk Factors ...................................................................................................................................................................................... 53 Vascular Disease ............................................................................................................................................................................. 53 Coronary Artery Disease ............................................................................................................................................................. 54 3.5 Hypertension.............................................................................................................................................................. 56 Renin-Angiotensin-Aldosterone System............................................................................................................................... 56 Risk Factors ...................................................................................................................................................................................... 56 Classification .................................................................................................................................................................................... 57 End Organ Effects ........................................................................................................................................................................... 57 3.6 Congenital Heart Disease....................................................................................................................................... 58 Acyanotic Defects ........................................................................................................................................................................... 58 Cyanotic Defects.............................................................................................................................................................................. 58 3.7 Pericardial Disease .................................................................................................................................................. 59 Effusion............................................................................................................................................................................................... 59 Pericarditis........................................................................................................................................................................................ 59 3.8 Peripheral Vascular Disease................................................................................................................................. 60 Arterial................................................................................................................................................................................................ 60 Achieve Page 4

Pathophysiology Study Guide

©2018 of 131 Venous................................................................................................................................................................................................. 61 3.9 Embolic Disease ........................................................................................................................................................ 62 Etiology............................................................................................................................................................................................... 62 Sequelae ............................................................................................................................................................................................. 62 3.10 Shock .......................................................................................................................................................................... 62 Hypovolemic Shock ....................................................................................................................................................................... 63 Septic ................................................................................................................................................................................................... 63 3.11 Infection .................................................................................................................................................................... 63 Rheumatic Heart Disease ............................................................................................................................................................ 63 Infective Endocarditis................................................................................................................................................................... 63 Chapter Three Practice Exam...................................................................................................................................... 64 Chapter 4: The Respiratory System..............................................................................................................65 4.1 Obstructive Diseases ............................................................................................................................................... 65 Chronic Obstructive Pulmonary Disease (COPD) ............................................................................................................. 65 Asthma ................................................................................................................................................................................................ 65 Chronic Bronchitis ......................................................................................................................................................................... 66 Emphysema ...................................................................................................................................................................................... 66 Bronchiectasis.................................................................................................................................................................................. 66 Cystic Fibrosis.................................................................................................................................................................................. 66 4.2 Restrictive Diseases................................................................................................................................................. 67 Extrinsic ............................................................................................................................................................................................. 67 Intrinsic .............................................................................................................................................................................................. 69 4.3 Cardiovascular Diseases of the Lung ................................................................................................................. 69 Pulmonary Embolism ................................................................................................................................................................... 69 Pulmonary Hypertension............................................................................................................................................................ 70 Cor Pulmonale ................................................................................................................................................................................. 70 4.4 Alterations in Gas Exchange ................................................................................................................................. 70 Hypoxemia ........................................................................................................................................................................................ 70 Hypoxia............................................................................................................................................................................................... 71 Hypercapnia ..................................................................................................................................................................................... 71 Ventilation-Perfusion Mismatch .............................................................................................................................................. 71 4.5 Respiratory Failure.................................................................................................................................................. 71 Acute Respiratory Failure........................................................................................................................................................... 71 Adult Respiratory Distress Syndrome ................................................................................................................................... 72 Infant Respiratory Distress Syndrome.................................................................................................................................. 72 4.6 Infection....................................................................................................................................................................... 72 Atelectasis.......................................................................................................................................................................................... 72 Pneumonia ........................................................................................................................................................................................ 73 Tuberculosis ..................................................................................................................................................................................... 73 4.7 Neoplasia ..................................................................................................................................................................... 73 Small (Oat) Cell................................................................................................................................................................................ 73 Large Cell ........................................................................................................................................................................................... 74 Squamous Cell.................................................................................................................................................................................. 74 Achieve Page 5

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©2018 of 131 Adenocarcinoma............................................................................................................................................................................. 74 Oral Laryngeal Cancer .................................................................................................................................................................. 74 Chapter Four Practice Exam ........................................................................................................................................ 75 Chapter 5: The Renal System/Fluids and Electrolytes/Acid-Base.....................................................76 5.1 Fluid Imbalance......................................................................................................................................................... 76 Control of Fluid Volume............................................................................................................................................................... 76 Deficit .................................................................................................................................................................................................. 76 Excess .................................................................................................................................................................................................. 76 5.2 Electrolyte Imbalance ............................................................................................................................................. 76 Potassium .......................................................................................................................................................................................... 77 Sodium ................................................................................................................................................................................................ 77 Calcium ............................................................................................................................................................................................... 77 Magnesium........................................................................................................................................................................................ 78 Phosphate .......................................................................................................................................................................................... 78 Chloride .............................................................................................................................................................................................. 79 5.3 Acid-Base Imbalance ............................................................................................................................................... 79 Acidosis............................................................................................................................................................................................... 80 Alkalosis ............................................................................................................................................................................................. 80 Buffers................................................................................................................................................................................................. 80 Compensatory Mechanisms ....................................................................................................................................................... 81 5.4 Acute Renal Failure.................................................................................................................................................. 81 Prerenal Acute Renal Failure..................................................................................................................................................... 82 Intrarenal Acute Renal Failure.................................................................................................................................................. 82 Postrenal Acute Renal Failure................................................................................................................................................... 82 5.5 Chronic Renal Failure ............................................................................................................................................. 82 Electrolyte Imbalances................................................................................................................................................................. 83 Physiological Changes .................................................................................................................................................................. 83 Dialysis................................................................................................................................................................................................ 83 Transplant ......................................................................................................................................................................................... 84 5.6 End Stage Renal Disease......................................................................................................................................... 84 5.7 Infection....................................................................................................................................................................... 84 Pyelonephritis.................................................................................................................................................................................. 85 Urogenital Infections .................................................................................................................................................................... 85 Glomerulonephritis ....................................................................................................................................................................... 85 5.8 Disorders of the Bladder........................................................................................................................................ 85 Cystitis................................................................................................................................................................................................. 86 Neurogenic Bladder....................................................................................................................................................................... 86 5.9 Nephrotic Syndrome................................................................................................................................................ 86 5.10 Neoplasia................................................................................................................................................................... 86 5.11 Stone Formation..................................................................................................................................................... 87 Chapter Five Practice Exam ......................................................................................................................................... 88 Chapter 6: Neurology and the Musculoskeletal System ........................................................................89 6.1 Traumatic Injury....................................................................................................................................................... 89 Achieve Page 6

Pathophysiology Study Guide

©2018 of 131 Head ..................................................................................................................................................................................................... 89 Spinal Cord........................................................................................................................................................................................ 91 Autonomic Dysreflexia................................................................................................................................................................. 91 6.2 Seizure Disorders ..................................................................................................................................................... 92 Epilepsy .............................................................................................................................................................................................. 92 Non-Epilepsy.................................................................................................................................................................................... 93 6.3 Vascular Insult........................................................................................................................................................... 93 Cerebrovascular Accident........................................................................................................................................................... 93 Transient Ischemic Attack (TIA).............................................................................................................................................. 95 6.4 Infections/Inflammation ....................................................................................................................................... 95 Meningitis .......................................................................................................................................................................................... 95 Guillan-Barre Syndrome.............................................................................................................................................................. 95 Encephalitis ...................................................................................................................................................................................... 96 Reye’s Syndrome ............................................................................................................................................................................ 96 Polio ..................................................................................................................................................................................................... 96 Abscess ............................................................................................................................................................................................... 97 6.5 Alterations in Neural Psychological Function................................................................................................ 97 Alzheimer’s Disease....................................................................................................................................................................... 97 Psychotic Illness.............................................................................................................................................................................. 98 Non-Psychotic Illness.................................................................................................................................................................... 98 6.6 Alterations in Neuromuscular Functions......................................................................................................... 99 Parkinson’s Disease....................................................................................................................................................................... 99 Multiple Sclerosis ........................................................................................................................................................................... 99 Myasthenia Gravis........................................................................................................................................................................100 Amyotrophic Lateral Sclerosis (ALS) ...................................................................................................................................100 6.7 Pain ............................................................................................................................................................................. 101 Types of Pain ..................................................................................................................................................................................101 Pain Assessment ...........................................................................................................................................................................101 Pain Mechanism (Pathway) .....................................................................................................................................................101 Endorphins-Opioid Receptors ................................................................................................................................................102 Management of Pain....................................................................................................................................................................102 6.8 Alterations of the Musculoskeletal System .................................................................................................. 102 Muscles Disorders........................................................................................................................................................................102 Joint Disorders...............................................................................................................................................................................104 6.9 Bone Disorders....................................................................................................................................................... 106 Osteomyelitis..................................................................................................................................................................................106 Paget’s Disease ..............................................................................................................................................................................106 Osteoporosis...................................................................................................................................................................................106 Osteomalacia ..................................................................................................................................................................................107 Rickets...............................................................................................................................................................................................107 Trauma..............................................................................................................................................................................................107 6.10 Neoplasia................................................................................................................................................................ 108 Tumors of the Brain and Spinal Cord...................................................................................................................................108 Tumors of the Skeletal System................................................................................................................................................109 Achieve Page 7

Pathophysiology Study Guide

©2018 of 131 Tumors of the Muscular System.............................................................................................................................................110 Chapter Six Practice Exam......................................................................................................................................... 111 Chapter 7: The Gastrointestinal, Endocrine, and Reproductive Systems .................................... 112 7.1 Disorders of Motility ............................................................................................................................................ 112 Vomiting and Nausea..................................................................................................................................................................112 Achalasia ..........................................................................................................................................................................................112 Reflux Esophagitis/Gastroesophageal Reflux Disease (GERD) .................................................................................113 Hiatal Hernia ..................................................................................................................................................................................113 Irritable Bowel Syndrome ........................................................................................................................................................113 7.2 Disorders of Absorption...................................................................................................................................... 113 Malabsorption Syndrome .........................................................................................................................................................114 Sprue/Celiac Disease ..................................................................................................................................................................114 7.3 Peptic Ulcer Diseases ........................................................................................................................................... 114 Types .................................................................................................................................................................................................114 Pathogenesis...................................................................................................................................................................................115 Clinical Manifestations ...............................................................................................................................................................115 7.4 Inflammatory Bowel Disease ............................................................................................................................ 115 Ulcertaive Colitis/ Crohn’s Disease.......................................................................................................................................115 Pathogenesis...................................................................................................................................................................................115 Clinical Manifestations ...............................................................................................................................................................115 7.5 Hepatic/Gallbladder Disorders........................................................................................................................ 116 Jaundice ............................................................................................................................................................................................116 Viral Hepatitis ................................................................................................................................................................................116 Cirrhosis ...........................................................................................................................................................................................117 Cholecytisis .....................................................................................................................................................................................117 7.6 Clinical Manifestations ........................................................................................................................................ 117 Liver Diseases ................................................................................................................................................................................117 Gallbladder Diseases ...................................................................................................................................................................118 Alcoholism.......................................................................................................................................................................................118 7.7 Disorders of the Pancreas .................................................................................................................................. 118 Exocrine............................................................................................................................................................................................118 Endocrine.........................................................................................................................................................................................119 7.8 Alterations of Hypothalamic-Pituitary Function ....................................................................................... 120 Panhypopituitarism.....................................................................................................................................................................120 Pituitary Adenoma.......................................................................................................................................................................121 Acromegaly and Galactorrhea/Amenorrhea ....................................................................................................................121 Diabetes Insipidus........................................................................................................................................................................122 7.9 Alterations of Thyroid Function and Parathyroid Function .................................................................. 122 Hyperthyroidism ..........................................................................................................................................................................122 Grave’s Disease..............................................................................................................................................................................123 Toxic Nodular Goiter...................................................................................................................................................................123 Hashimoto’s Thyroiditis ............................................................................................................................................................123 Complications Resulting from T4/T3 Excess and Deficiency ....................................................................................123 Achieve Page 8

Pathophysiology Study Guide

Hyperparathyroidism.................................................................................................................................................................123 Hypoparathyroidism...................................................................................................................................................................124 7.10 Alterations of Adrenal Function .................................................................................................................... 124 Cushing’s Syndrome....................................................................................................................................................................124 Addison’s Disease.........................................................................................................................................................................125 Primary Aldosteronism..............................................................................................................................................................125 Androgen Excess...........................................................................................................................................................................125 Pheochromocytoma ....................................................................................................................................................................126 Drug-Induced Alteration ...........................................................................................................................................................126 7.11 Female Reproduction System......................................................................................................................... 126 Endometriosis................................................................................................................................................................................126 Amenorrhea/Dysmenorrhea...................................................................................................................................................127 Leiomyomas ...................................................................................................................................................................................127 Fibrocystic Breast Disease........................................................................................................................................................127 Infertility ..........................................................................................................................................................................................128 Ovarian Cysts .................................................................................................................................................................................128 7.12 Male Reproductive System .............................................................................................................................. 128 Hypogonadism...............................................................................................................................................................................128 Cryptorchidism..............................................................................................................................................................................129 Benign Prostatic Hyperplasia..................................................................................................................................................129 Infertility ..........................................................................................................................................................................................129 Chapter Seven Practice Exam................................................................................................................................... 130 Appendix A: Answer Keys ............................................................................................................................. 131

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