NUR 4125

Exam 1 Objectives

These questions are at the basic level of understanding.

1. Review citric acid cycle with respect to aerobic and anaerobic metabolism. Remember if you
don’t have oxygen then pyruvate doesn’t enter the citric acid cycle and instead produces lactic
acid. Lactic acid burns the nerve endings and creates pain (heart attack), produces free radical
damage, and leads to metabolic acidosis. Keep this concept in mind as you balance a patient’s
capacity to get oxygen with their oxygen demands (consider how increased activity plays a role
in patients with lung disease where oxygen levels may be low already).

anerobic: no oxygen. Create energy from the sugar. Electrons movement. Lactic acid due to no
oxygen, leads to acidosis in body and poor cell function, body makes the most lactic acid during
cardiac arrest and intense exercise

aerobic: Krebs cycle. Pyruvate. Yes oxygen. 90% energy created in mitochondria. In process of
creating energy, carbon produced and water produced. ATP production. (energy metabolism)

2. Review cell organelles/structures. What do they do? (smooth and rough endoplasmic
reticulum, golgi apparats, cytoplasm, mitochondria, cell membrane, lysosomes, cytoskeleton,
nucleus. Depending on the type of tissue some cellular components may be more or less active.
Remember a large portion of the inner cell is composed of water.

 The nucleus contains DNA, which contains the genetic code that contains the
information that controls cells.
 Ribosomes synthesize protein.
 Mitochondria transform organic compounds into cellular energy. Mitochondria require
oxygen for aerobic metabolism, using hydrogen and carbon combined with oxygen
molecules to form carbon dioxide and water as energy is released.

The cytoplasm includes the fluid and organelles outside the nucleus but within the cell
membrane surrounding the cell. Cytoplasm is a solution that contains water, electrolytes,
proteins, fats, and carbohydrates.1 Pigments may also accumulate in the cytoplasm. Some
pigments are normal parts of cells. One example is melanin, which gives skin its color. Some
pigments are not normal parts of cells. For example, when the body breaks down old red blood
cells, pigments in red blood cells are changed to the pigment bilirubin, which the body can
excrete; some conditions cause bilirubin to build up in cells to cause jaundice, which is seen
clinically by a yellowish discoloration of the skin and sclera (normally the white part of the eye).
Embedded in the cytoplasm are various organelles that function as the organs of the cell. In
addition to the nucleus, which was discussed in the previous section, these organelles include the
ribosomes, the endoplasmic reticulum (ER), the Golgi complex, lysosomes, peroxisomes,
proteasomes, and mitochondria.1
Rough ER has ribosomes attached, and the ribosomes appear under a microscope as “rough”
structures on the ER membrane. Proteins made by the rough ER usually become parts of
organelles or cell membranes, or are secreted from cells as a protein. For example, the rough ER
makes (1) digestive enzymes found in lysosomes and (2) proteins that are secreted, such as the
protein hormone insulin.

The smooth ER is free of ribosomes and has a smooth structure when viewed through a
microscope. Because it does not have ribosomes attached, the smooth ER does not participate in
protein synthesis. Instead, the smooth ER is involved in the synthesis of lipids including steroid
hormones. The sarcoplasmic reticulum of muscle cells is a form of smooth ER; calcium ions are
stored in and then released from the sarcoplasmic reticulum to stimulate muscle contraction. The
smooth ER of the liver is involved in storage of extra glucose as glycogen as well as metabolism
of some hormone drugs.

The Golgi apparatus, sometimes called the Golgi complex, consists of four or more stacks of
thin, flattened vesicles or sacs. Substances produced in the ER are carried to the Golgi complex
in small, membrane-covered transfer vesicles. The Golgi complex modifies these substances and
packages them into secretory granules or vesicles. For example, insulin is synthesized as a large,
inactive proinsulin protein that is cut apart to make smaller, active insulin proteins within the
Golgi complex of the beta cells in the pancreas. Insulin is then packaged into vesicles ready for
secretion from the cell when blood sugar is increased (e.g., after a meal). In addition to making
secretory granules, the Golgi complex is thought to make large carbohydrate molecules that
combine with proteins produced in the rough ER to form glycoproteins. Recent data suggest that
the Golgi apparatus has yet another function: it can receive proteins and other substances from
the cell surface by a retrograde transport mechanism. Several bacterial toxins, such as Shiga and
cholera toxins, and plant toxins, such as ricin, that have cytoplasmic targets have exploited this
retrograde pathway.

Lysosomes can be thought of as the digestive system or the stomach of the cell. These small,
membrane-enclosed sacs contain powerful enzymes that can break down excess and worn-out
cell parts as well as foreign substances that are taken into the cell (e.g., bacteria taken in by
phagocytosis). All of the lysosomal enzymes require an acidic environment, and the lysosomes
maintain a pH of approximately 5 in their interior (similar to how the stomach maintains a low
pH). The pH of the cytoplasm, which is approximately 7.2, protects other cellular structures from
being broken down by these enzymes if they were to leak from the lysosome. Primary lysosomes
are membrane-bound intracellular organelles that contain a variety of enzymes that have not yet
entered the digestive process. They receive their enzymes as well as their membranes from the
Golgi apparatus. Primary lysosomes become secondary lysosomes after they fuse with
membrane-bound vacuoles that contain material to be digested. Lysosomes break down
phagocytosed material by either heterophagy or autophagy.

The mitochondria are the “power plants” of the cell because they contain enzymes that can
change carbon-containing nutrients into energy that is easily used by cells. This multistep
process is often referred to as cellular respiration because it requires oxygen. Cells store most of
this energy as high-energy phosphate bonds in substances such as adenosine triphosphate (ATP)
and use the ATP as energy in various cellular activities. Mitochondria are found close to the site
of energy use in the cell (e.g., near the myofibrils in muscle cells). The number of mitochondria
in a given cell type varies by the type of activity the cell performs and the energy needed for this
activity. For example, a large increase in mitochondria occurs in skeletal muscle repeatedly
stimulated to contract. Mitochondria contain their own DNA and ribosomes and are self-
replicating. Mitochondria also function as key regulators of apoptosis, or programmed cell death.
Too little or too much apoptosis has been implicated in a wide range of diseases, including
cancer, in which there is too little apoptosis (i.e., less cell death leads to increased cell numbers),
and neurodegenerative diseases, in which there is too much apoptosis.

The cytoplasm contains a cytoskeleton, or the skeleton of the cell. The cytoskeleton is a network
of microtubules, microfilaments, intermediate filaments, and thick filaments (Fig. 2.5).5 The
cytoskeleton controls cell shape and movement.

3. Describe what happens with phagocytosis.

Phagocytosis (cell eating) involves the engulfment and then killing or degrading of
microorganisms or other particulate matter. During phagocytosis, a particle contacts the cell
surface and is surrounded on all sides by the cell membrane, forming a phagocytic vesicle or
phagosome. The phagosome fuses with a lysosome, and the ingested material is broken down by
lysosomal enzymes. Certain white blood cells, such as macrophages and neutrophils, use
phagocytosis to dispose of invading organisms, damaged cells, and unneeded extracellular parts.

4. Cells make up tissues that have specialized function. Some have to do with communication,
support, structure, contractility. Identify where some of these tissues might be located (i.e. heart,
muscle..etc.)

5. What is the difference between endocrine, exocrine, apocrine?

Endocrine: ductless, secrete hormones into blood stream. Endocrine system: signal
transduction, resulting from ligand-receptor binding has the potential to produce effects on the
entire endocrine system.

Exocrine: use ducts, secrete outside of body or inside body cavities- sweat, lactating

Apocrine: secrete oily substance located near hair follicle, body odor

autocrine signaling occurs when a cell releases a chemical into extracellular fluid that affects its
own activity

6. Cellular adaptations happen for a variety of reasons identify reasons for atrophy, hypertrophy,
dysplasia, and metaplasia. What happens with bedrest? What happens when cells are deprived of
oxygen and nutrients?
7. Describe examples of cellular injury (biologic, chemical, physical/mechanical, etc.) What is
the impact of ultraviolet radiation on the skin?

 The ultraviolet rays of sunlight have the potential for directly damaging skin cells,
accelerating the effect of aging on the skin, and predisposing to the development of skin
cancer. Prolonged pressure can interrupt blood flow, causing pressure ulcers

8. What is apoptosis?

 Apoptosis is a highly selective process that eliminates injured and aged cells in a manner
that maintains the integrity of the plasma membrane and does not initiate inflammation
 Cancer is a condition in which cells experience dysregulated apoptosis as the cells fail to
age and die.

9. Review DNA/RNA… Remember DNA is the genetic code and lies within the nucleolus of the
nucleus. What are the types of RNA? Describe transcription/transduction (basic concepts).
Define chromosomes…function and number. Describe differences between meiosis versus
mitosis.

 Males get an X chromosome from their mother and a Y chromosome from their father. If
the father transmits an X chromosome, then the fetus would develop into a female (XX).
 Part of the DNA of a cell resides in the mitochondria. Mitochondrial DNA is inherited
from the mother by her offspring.
 Transcription occurs in the cell nucleus and involves the synthesis of RNA from a DNA
template. The process of transcription is initiated by RNA polymerase Translation
occurs in the cytoplasm of the cell and involves the synthesis of a protein using its
messenger RNA (mRNA) template.

10. Review Punnett square. What is meant by phenotype, genotype, genome, recessive and
dominant traits, allele, and teratogenic. What is meant by x-linked, what does sickle cell carrier
mean? What is the problem in children born with Down’s syndrome?

 Phenotype: the set of observable characteristics of an individual resulting from the

interaction of its genotype with the environment.
 Genotype: the genetic composition of a person
 Genome: the haploid set of chromosomes in a gamete or microorganism, or in each cell
of a multicellular organism
 Alleles: the two members of a gene pair, one inherited from the mother and the other
from the father.
 Teratogenic agent is a chemical, physical, or biologic agent that produces abnormalities
during embryonic or fetal development.
 Sickle cell carriers are able to transmit the disorder but do not exhibit signs and
symptoms of that disorder.
  X-Linked is a trait where a gene is located on the X chromosome. Humans and other
mammals have two sex chromosomes, the X and the Y. In an X-linked or sex linked
disease, it is usually males that are affected because they have a single copy of the X
chromosome that carries the mutation.
 A dominant trait is one expressed in either a homozygous or a heterozygous pairing. If
the trait is phenotypically seen in the heterozygote, the allele is said to be dominant. If it
is phenotypically seen only in the homozygote, the allele is recessive
 Of the 23 pairs of human chromosomes, 22 are called autosomes and are alike in both
males and females. The double helix is the shape of the DNA molecule.
 Down syndrome has specific physical characteristics, congenital heart defects and an
increased risk of gastrointestinal malformations as well as an increased risk of Alzheimer
disease among older people. Down syndrome increases the risk of acute lymphoblastic
leukemia (ALL) and acute myeloid leukemia (AML)

11. What kind of problems result from congenital anomalies (i.e. cleft palate)? What kind of
problem is Marfan’s syndrome what are the manifestations of the problem?

 Marfan syndrome is an autosomal dominant disorder of the connective tissue.

- Affects several organ systems(eyes, cardiovascular system, skeletal system
- long, thin body ,long extremities long, tapering fingers, kyphosis and scoliosis.
- most life-threatening aspects :the cardiovascular defects (mitral valve prolapse,
progressive dilation of the aortic valve ring, and weakness of the aorta.
 Cleft lip and cleft palate is one of the most common birth defects.
- The immediate problem in an infant with cleft palate is feeding
- speech may be impaired because of these issues.Rubella

12. Which cancers are the most prevalent, what are risk factors. What are the implications or
what are we looking for with screening (i.e. colonoscopy, PSA, pap smear, mammogram, genetic
predisposition).

 Lung and breast cancers were the most prevalent worldwide followed by
colorectal cancer.
 Risk factors that have been linked to cancer are heredity, hormonal factors,
immunologic mechanisms, and environmental agents such as chemicals,
radiation, and cancer-causing viruses.
 Screening:

13. How does cancer spread? What is the difference between a malignant and benign neoplasm?
What is a paraneoplastic syndrome?

 Cancer cells spread to other parts of the body, They break away from the original
(primary) tumor and get into the bloodstream or lymph system, which can carry them to
another part of the body.
  Benign neoplasms. Benign neoplasms are well-differentiated tumors that resemble the
tissues of origin but have lost the ability to control cell proliferation. They grow by
expansion, are enclosed in a fibrous capsule, and do not cause death unless their location
is such that it interrupts vital body functions.
 Malignant neoplasms, are less well-differentiated tumors that have lost the ability to
control both cell proliferation and differentiation. They grow in a disorganized and
uncontrolled manner to invade surrounding tissues, have cells that break loose and travel
to distant sites to form metastases, and inevitably cause suffering and death unless their
growth can be controlled through treatment. The symptoms may be endocrine,
neuromuscular or musculoskeletal, cardiovascular, cutaneous, hematologic, renal,
gastrointestinal, or miscellaneous in nature
 Paraneoplastic syndrome are rare disorders that are triggered by an altered immune
system response to a neoplasm. They are defined as clinical syndromes involving
nonmetastatic systemic effects that accompany malignant disease

14. What is focus of chemotherapy, radiation, targeted therapy in treatment of cancer? Why do
we need multiple strategies for cancer? What is the purpose of palliative surgery in cancer?

 Chemotherapy is a systemic treatment that enables drugs to reach the site of the tumor
as well as other distant sites. It is the primary treatment for most hematologic and some
solid tumors.
 Radiation therapy is one of the most commonly used methods of cancer treatment.6 It
can be used alone as a primary method of therapy or as an adjuvant treatment with
surgery, chemotherapy, or both. It can also be used as a palliative treatment to reduce
symptoms such as bone pain resulting from metastasis in people with advanced cancers.
Radiation is used to treat oncologic emergencies such as superior vena cava syndrome,
spinal cord compression, or bronchial obstruction.
 Targeted therapy is a type of cancer treatment that uses drugs designed to "target"
cancer cells without affecting normal cells.
 Treatment plans that use more than one type of therapy, often in combination, are
providing cures for a number of cancers that a few decades ago had a poor prognosis, and
in turn are increasing the life expectancy.
 The purpose of palliative surgery in cancer is mainly to reduce pain for the patient.

15. Review General adaptation syndrome (GAS). What are signs and symptoms, why are those
things happening (epinephrine, cortisol, RAAS, ADH)? If you understand the expected responses
and why they are happening you will be able to better pick up the maladaptive response that
identifies where the problem with a patient might be (if B/P is expected to be high in stress, and
your patient’s B/P is low…you better see what the priority problem might be).

16. Purpose for universal precautions. What factors would you consider to determine how
dangerous an organism might be?
17. How does age affect the immune system? What is the body’s first line of defense against
infection?

 The effects of aging on the immune system are manifest at multiple levels that
include reduced production of B and T cells in bone marrow and thymus and
diminished function of mature lymphocytes in secondary lymphoid tissues. As a
result, elderly individuals do not respond to immune challenge as robustly as the
young.
 The skin and its epithelial layers in conjunction with the body’s normal
inflammatory processes make up the first line of the body’s defense and confer
innate or natural immunity to the host.

18. What’s the difference between natural/native immunity and acquired immunity? What is the
difference between active and passive? Where do immunizations fit in? What is rubella
(rubella)?

 Innate immunity, the body’s first line of defense, occurs early and more rapidly
in response to foreign substances
 Adaptive immunity is usually delayed unless the host has been exposed before
 The immunization process makes use of the primary and secondary phases of the
humoral immune responses. The initial vaccination causes production of both
plasma cells and memory cells. The plasma cells destroy the invading organism or
toxin, and the memory cells provide defense against future exposure. “Booster”
immunizations produce an immediate antigen–antibody response that simulates an
immediate rise in antibody levels.

19. What is the basic purpose of IgM, IgG, IgE…. When do they respond?

IgM is the first circulating immunoglobulin that is produced by the developing fetus. It is
instrumental in the ultimate lysis of microorganisms. It also is an effective agglutinating
antibody.

IgA prevents the attachment of viruses and bacteria to epithelial cells.

IgE is involved in inflammation, allergic responses, and combating parasitic infections. It binds
to mast cells and basophils.

IgD serves as an antigen receptor for initiating the differentiation of B cells.

IgA is primarily a secretory Ig that is found in saliva, tears, colostrum, and bronchial,
gastrointestinal, prostatic, and vaginal secretions. Because it is found in secretions, its primary
function is in local immunity on mucosal surfaces. IgA prevents the attachment of viruses and
bacteria to epithelial cells.
20. What is the difference between B and T lymphocytes?

21. What are the signs and symptoms of inflammation? What role do neutrophils play? What is
the difference between autocrine and paracrine function?

 The cardinal signs of inflammation: are rubor (redness), tumor (swelling), calor
(heat), and dolor (pain).
 The neutrophil is the primary phagocyte that arrives early at the site of
inflammation, usually within 90 minutes of injury. Neutrophils are able to
generate oxygen (hydrogen peroxide) and nitrogen products (nitric oxide [NO])
that assist in destroying the engulfed debris.
 Paracrine signaling: a cell targets a nearby cell (one not attached by gap
junctions). The image shows a signaling molecule produced by one cell diffusing
a short distance to a neighboring cell. Autocrine signaling: a cell targets itself,
releasing a signal that can bind to receptors on its own surface.

22. Review pituitary and hypothalamus related to endocrine function. What is their role? What’s
secreted from where?

23. How do hormone receptors work?

 Hormone receptors are complex molecular structures (usually proteins) that are
located either on the cell surface or inside target cells.3 The function of these
receptors is to recognize a specific hormone and translate the hormonal signal into
a cellular response. The structure of these receptors is specific to a particular
hormone, which allows target cells to respond to one hormone and not to others

24. Review pathophysiology, signs and symptoms for hypo and hyperthyroidism? What do labs
show related to the diagnosis of each?

25. How are hormone levels regulated in the body?

 The levels of many of the hormones are regulated by feedback mechanisms that
involve the hypothalamic–pituitary target cell system.

26. What are the labs used for diagnosis and management of diabetes?

27. Describe pathophysiology, signs and symptoms, treatment for diabetes insipidus, Graves,
Cushings.

28. How does stress affect blood sugar?

 mental stress can affect your blood sugar levels

 It causes the body to produce especially high levels of stress hormones, which drive
blood sugar levels up.

29. What is happening in insulin resistance?

  Insulin resistance is when cells in your muscles, fat, and liver don't respond well to
insulin and can't use glucose from your blood for energy. To make up for it, your
pancreas makes more insulin.

30. What are complications associated with diabetes?

31. What happens in diabetic ketoacidosis, how do you treat the problem?

 Diabetic ketoacidosis (DKA) is a serious condition that can lead to diabetic coma
(passing out for a long time) or even death. When your cells don't get the glucose they
need for energy, your body begins to burn fat for energy, which produces ketones.
 Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and
chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic
ketoacidosis are related to this lifesaving treatment.

32. How does parathyroid hormone affect the bone?

 Bones – parathyroid hormone stimulates the release of calcium from large calcium stores
in the bones into the bloodstream. This increases bone destruction and decreases the
formation of new bone