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NURS 364 - Final Exam Study Guide.
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NURS 364 - Final Exam Study Guide.College of Nursing
NURS 364
Final Exam Study Guide for Comprehensive Portion
*Note: This study guide is not inclusive of all content on exam
Cell Adaptation, Injury, and Death
-Be able to define and know examples of: Atrophy, Hyperplasia, Hypertrophy, Metaplasia, and Dysplasia
• Atrophy
o A decrease in cell size and a more efficient level of function
▪ Examples
• Disuse: Reduced skeletal muscle use -> Broken Arm
• Denervation: More extreme disuse in paralyzed limbs or muscle groups
with decreased innervation
• Loss of endocrine stimulation: Reduced activity from reduced stimulation
e.g. estrogen in menopause
• Inadequate nutrition: Triggers decreased activity as means of survival
• Ischemia/Decreased blood flow: Decreases nutrient and oxygen availability
• Hyperplasia
o Increase in the number of cells
▪ Examples
• Physiologic
o Hormonal: Breast and uterine enlargement in pregnancy
o Compensatory: Liver regeneration
• Non-Physiologic
o BPH: Linked to changes in testosterone
o Endometrial hyperplasia: Estrogen
o Warts: Growth factor from viruses (sometimes dysplastic)
• Hypertrophy
o Increased cell size and ultimately tissue mass
▪ Examples
• Normal Physiologic
o Weight-baring exercise: Depletes ATP and stretches muscle fibers,
triggers hypertrophy for additional actin and myosin filaments and
increased ATP synthesis
o Organ/Tissue removal (Kidney removal)
• Abnormal Pathologic
o Long-standing hypertension
▪ Increased workload required to pump blood against elevated
arterial pressure
▪ Progressive concentric increase in left ventricular muscle
mass
▪ Increased oxygen demand
▪ Perpetuated by decreased end diastolic volume/decreased
stroke volume
• Metaplasia
o One mature cell (epithelial or mesenchymal) type is replaced by another cell type
▪ Example
,NURS 364 - Final Exam Study Guide.
• Patients with chronic GERD: normal squamous epithelium of lower
esophagus are replaced with columnar epithelium
o Barrett’s Esophagus
o Gastric reflux
• Dysplasia
o Cell growth in a tissue that varies in cell size, shape, and organization
▪ Examples
• Cervical cell dysplasia
o Pap smear
o Infection with human papilloma virus
-What occurs to a cell during a hypoxic injury? Why does cell swelling occur?
• Causes: Ischemia, decreased oxygen in the air, decreased production of RBCs,
Cardiovascular diseases, and Respiratory Diseases
• Swelling: Lacking ATP the sodium-potassium pump shuts down which causes swelling due to
the excess sodium because sodium follows water
-What is the difference between apoptosis and necrosis?
Apoptosis Necrosis
Cell Size Reduced (Shrinkage) Enlarges (Swelling)
Cell Nucleus Fragmentation Nuclear Dissolution
(Karyolysis)
Plasma Membrane Intact Disrupted
Cell Content Intact or Apoptotic bodies May leak out of cell
Presence of adjacent No Frequent
inflammation
Physiologic or Pathologic Role Often Physiologic Pathologic
Genetics
-What is the difference between expressivity and penetrance? What are some examples of each?
• Expressivity is the degree to which a gene is expressed in the phenotype
o Marfan Syndrome
• Penetrance is the ability of a gene to express its function
o Huntington’s disease
-What is trisomy? Monosomy? What are examples of each? What is the risk of trisomy (i.e. Down
syndrome) related to?
• Trisomy
o More than 2 chromosomes in a pair
▪ Ex. Down Syndrome (Trisomy 21)
• Risks
o Intellectual Disability
o Congenital Heart Defects
o Increased Risk of Alzheimer’s disease
o Characteristic Physical features
• Monosomy
o Only one chromosome present in a chromosome pair
▪ Ex. Turner Syndrome
-Autosomal Dominant Disorders: What are the chances of inheritance?
• 50% chance of inheritance
, NURS 364 - Final Exam Study Guide.
o Ex. Marfan Syndrome
o Ex. Neurofibromatosis Type 1 (von Recklinghausen disease)
-Autosomal Recessive Disorders: What are the chances of inheritance? What is a carrier status?
-Example: CF
• 25% chance of inheritance
• Carrier status means that you carry the gene
o Ex. Cystic Fibrosis
o Ex. Phenylketonuria (PKU)
o Ex. Tay-Sachs Disease
-X-linked Disorders: What is the inheritance pattern of sons? Of daughters?
• 50% chance of Male offspring
• 50% chance of Female offspring as carriers (assuming father is unaffected)
Inflammation and Immune Response
-What is the function of the inflammatory response?
• A response to a tissue injury or infection
-Mast cells: What do they release and what does this substance do?
• In response to cell injury or infection the degranulation release histamine
• Histamine causes vasodilation, increased capillary permeability, smooth muscle
contraction, released scent to single neutrophils so they are able to find injury site
-Be able to describe the stages of inflammation:
-The vascular stage
• Initially there is a very brief vasoconstriction -> vasodilation and increases capillary permeability
o Vasodilation causes redness and warmth
• Increased capillary permeability causes protein rich exudate to leak into intravascular space
resulting in swelling, and pain
o Enhances the amoebic movement of macrophages
o Exudate also helps dilute microorganisms
▪ Exudate: may be serous, hemorrhagic, fibrinous, purulent etc. depending on
components
o Vascular stage also includes clotting which can stop bleeding and trap microorganisms
-The cellular stage
• Movement of immune cells into the are of injury from the blood vessels, chemotaxis, and
phagocytosis
o Circulating neutrophils progressively adhere to the endothelium (margination)
▪ Due to adhesion molecules on endothelium
▪ At sites of endothelial retraction the neutrophils migrate through the vessel wall
(diapedesis)
o Chemotaxis: The neutrophils are attracted by high concentrations of chemotactic factors
▪ Opsonized bacteria are recognized by the neutrophils for phagocytosis
(opsonization) and exposed to enzymes or reactive oxygen species, killed, and
digested
-What are the cardinal signs of inflammation?
• Redness: Vasodilation
• Warmth: Vasodilation
• Swelling: Increased Vascular permeability
• Pain: Caused by Prostaglandin and Bradykinin
• Loss of Function: This is resulted from the following above
-What is the role of prostaglandins in the inflammatory response?
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