NUR 2063 Essentials of Pathophysiology

Exam 1 Study Guide – Chapters: 1, 2, 6, 12, 13, 14

1) Define a symptom
Symptom: clinical manifestations that are described by the patient.
Symptom are subjective evidence of a disease; it is a feeling people other
than the patient cannot see/fell it.
Signs are objective evidence of disease; it is something that can be seen.

2) Describe homeostasis
Homeostasis: equilibrium, balance, consistency, or stability; in the body, this self-
regulating, give-and-take system responds to minor changes in the body’s status
through compensation mechanisms. Compensation mechanisms attempt to
counteract those changes and return the body to its normal state.

3) Be able to apply the concept of homeostasis

 Negative Feedback System: most common type, works to maintain a deficit
in the system/resist any change from normal. Examples are temperature and
glucose regulation.
 Positive Feedback System: fewer in number, move the body away from
homeostasis. Example are childbirth, sneezing, and blood clots.

4) Know the function of mitochondria

Mitochondria: primarily responsible for cellular respiration and energy
production. Act much like the digestive system, by consuming nutrients, breaking
them down, and creating energy-rich molecules for the cell. Complete the
breakdown of glucose, producing nicotine adenine dinucleotide and adenosine
triphosphate (ATP) for cellular energy.

5) Know the function of endoplasmic reticulum

Endoplasmic Reticulum (ER): network of membranous tubules in the cytoplasm
of the cell that is a continuation or extension of the nucleus.
Smooth Endoplasmic Reticulum (SER): produces lipids and hormones,
stores and metabolizes calcium ions, and performs a variety of other
functions depending on the cell type.
Rough Endoplasmic Reticulum (RER): the site of the synthesis and
transport of lysosomal enzymes and proteins for intracellular and
extracellular use.
6) Define atrophy
Atrophy: state that occurs because of decreased work demands on a cell. When
cellular work demands decrease, the cells decrease in size and number.

7) Know the effectiveness of the RAAS system – vasoconstriction, increased

blood pressure.
Renin-Angiotensin-Aldosterone System (RAAS): a vital control and
compensatory mechanism that is activated when renal blood flow is decreased,
often in hypotensive states. When blood flow is decreased to the kidneys, renin is
released from the kidneys, which in turn activates angiotensin I to become
converted to angiotensin II (a vasoconstrictor) and stimulates aldosterone
secretion.
 In hypotensive states, this mechanism raises blood pressure and maintains
vital organs.
 In chronic disease states such as hypertension, it is inappropriately
activated because of vasoconstriction to the kidneys, further contributing to
the hypertension.

8) Know the function of hormone renin

Renin: rate limiting in the production of angiotensin II, a hormone that ultimately
integrates cardiovascular and renal function in the control of blood pressure as well
as salt and volume homeostasis.

9) Define hyperplasia
Hyperplasia: an increase in the number of cells in an organ or tissue. This
increase occurs only in cells that can perform mitotic division, such as
epithelial cells. Usually the result of normal stimuli, such as menstruation, liver
regeneration, would healing, and skin warts. Can also be abnormal, especially
when caused by excessive hormone or growth factors.
10) Increased hydrostatic capillary action causes edema
Edena: excess fluid in the interstitial space. A problem of fluid distribution, not
necessarily of fluid overload.

11) What body functions cause fluid volume deficits?

Common causes of deficient fluid volume are diarrhea, vomiting, excessing
sweating, fever, and poor oral fluid intakes.

12) What electrolyte is associated with muscular tetany?

Hypocalcemia: when ionized calcium levels fall below 4 mEq/L.

13) Know the symptoms of dehydration

Dehydration: fluid deficit, occurs when total body fluid levels (mostly water) do
not meet the body’s needs.
Hypovolemia: fluid deficit of the intravascular compartment.
 Thirst, altered level of consciousness, hypotension, tachycardia, weak,
thready pulse, flat jugular veins, dry mucous membranes, decreased skin
turgor, oliguria, weight loss, and sunken fontanelles (in infants)

14) Know the clinical manifestations (symptoms) of fluid excess

Fluid Excess: condition that occurs when total body fluid levels are greater than
the body’s needs.
Edema: excess fluid in the interstitial space.
Hypervolemia: excess fluid in the intravascular compartment; due to
excess sodium, water intake, or insufficient loss.
Water Intoxication: fluid excess that occurs in the intracellular space.
 Peripheral edema (pitting), periorbital edema (swelling around the eyes),
anasarca (generalized edema; the skin may begin to weep fluid),
cerebral edema( causes headache, confusion, irritability, anxiety, nausea,
and vomiting), dyspnea, bounding pulse, tachycardia, jugular vein
distention, hypertension, polyuria (large amounts of pale-yellow urine),
rapid weight gain (3 pounds in a week or 1-2 pounds in a day; 1 pound =
 500mL of fluid), crackles (abnormal lung sound), and bulging fontanelles
(in infants)

15) Define osmosis

Osmosis: passive movement of water/solvent across the cellular membrane from
an area of low solute concentration to an area of higher solute
concentration. The membrane is permeable to the solvent (liquid) not solute
(dissolved particles).

16) Extracellular fluid contains higher levels of these 2 electrolytes?

Extracellular Fluid (ECF): fluid found outside the cells. Approximately 80% of the
ECF is found in the interstitial compartment; other 20% is found in the
intravascular compartment and is made of plasma. Rich in sodium, chloride,
−¿ ¿
and bicarbonate ( HCO3 ).
 Interstitial (ISF): fluid between the cells.
 Intravascular: inside the blood vessels.
 Cell membrane is the barrier through which substances and water must pass
to move to or from the intracellular compartment.

17) Intracellular fluid contains higher levels of which electrolyte?

Intracellular Fluid (ICF): fluid found inside the cell. Comprises 2/3rd of the body’s
water and is rich in potassium, magnesium, phosphate, and proteins.

18) Fluid loss from the body occurs in which ways?

Your body is constantly losing water through breathing, sweating, and urinating.

19) High fluid loss occurs via which body system?

Water loss from the body occurs predominantly through the renal system (urine,
stool and sweat); a person produces an average of 1.5 liters of urine per day.

20) Hyponatremia can result in what fatal action?

Hyponatremia: condition that results from low serum sodium levels (less than
135 mEq/L). Serum osmolality levels also fall below 275 mOsm. As sodium levels
 decrease, water shifts into cells. Brain cells are especially susceptible to this
cellular swelling, which causes cerebral edema.

21) Bones are a reservoir for what electrolyte?

Calcium: the most abundant mineral in the body; found in bones and teeth (99%)
and is necessary for bone and teeth formation, muscular contractility, coagulation,
and other body processes. The remaining stored (1%) are largely found in an
ionized (unbound) form in the blood that can be used for physiological processes.

22) Know the normal lab value range for potassium, sodium,
calcium/what happens to the body when outside this range?
 Sodium( Na+¿¿): normal levels are 135-145 mEq/L.
o Hypernatremia: above 145 mEq/L. Causes neuromuscular
dysfunction (muscle cramps and weakness), and hypovolemia (thirst,
hypotension, decrease urine).
o Hyponatremia: below 135 mEq/L. Causes neuromuscular dysfunction
(muscle cramps and weakness), gastrointestinal disturbances (nausea,
vomiting and diarrhea) and hypovolemia (thirst, hypotension, decrease
urine).
 Chloride(Cl−¿¿):normal levels are 98-108 mEq/L.
o Hyperchloremia: above 108 mEq/L. Causes no direct clinical
symptoms; symptoms generally associated with underlying cause,
metabolic acidosis, or hyperkalemia.
o Hypochloremia: below 98 mEq/L. Causes no direct clinical symptoms;
symptoms generally associated with underlying cause, metabolic
acidosis, or hyperkalemia.
 Potassium( K +¿ ¿): normal levels are 3.5-5 mEq/L.
o Hyperkalemia: above 5 mEq/L. Causes cardiovascular dysfunction
(peaked T waves and cardiac arrest), neuromuscular dysfunction
(muscle cramps and weakness), gastrointestinal disturbances (nausea
and diarrhea) and
o respiratory dysfunction (respiratory depression).
o Hypokalemia: below 3.5 mEq/L. Causes cardiovascular dysfunction
(flattened T waves and cardiac arrest), neuromuscular dysfunction
(muscle cramps and weakness), and gastrointestinal disturbances
(anorexia and nausea).
 Calcium(Ca++¿¿): normal levels are 4-5 mEq/L.
o Hypercalcemia: above 5 mEq/L. Causes neuromuscular dysfunction
(decreased memory and headache), cardiovascular dysfunction
(shorten QT interval and hypotension), gastrointestinal disturbances
(constipation and pancreatitis), and renal issues (renal calculi and renal
insufficiency).
o Hypocalcemia: below 4 mEq/L. Causes neuromuscular dysfunction
(confusion and fatigue), cardiovascular dysfunction (prolonged QT
interval and hypotension), gastrointestinal disturbances (increased
bowel sounds and diarrhea), hematologic dysfunctions (increased
bleeding tendency), and skeletal issues (fractures).
  Phosphorus( P−¿ ¿):: normal levels are 2.5-4.5 mEq/L.
o Hyperphosphatemia: above 4.5 mEq/L. Similar to manifestations
associated with hypocalcemia.
o Hypophosphatemia: below 2.5 mEq/L. Similar to manifestations
associated with hypercalcemia.
 Magnesium( Mg ++¿¿):: normal levels are 1.8-2.4 mEq/L.
o Hypermagnesemia: above 2.4 mEq/L. Similar to manifestations
associated with hypocalcemia.
o Hypomagnesemia: below 1.8 mEq/L. Similar to manifestations
associated with hypercalcemia.
 Bicarbonate ( HCO3 ): normal levels are 22-26 mEq/L.
o Metabolic Acidosis: below 22 mEq/L. Causes neuromuscular
dysfunction (lethargy and coma), cardiovascular dysfunction
(hypotension and shock), gastrointestinal disturbances (nausea and
vomiting), and respiratory dysfunction (Kussmaul depression).
o Metabolic Alkalosis: above 26 mEq/L. Causes neuromuscular
dysfunction (paresthesia and hyperactive reflexes), cardiovascular
dysfunction (dysrhythmias), and respiratory dysfunction (respiratory
depression).

23) Know ABGs

Arterial Blood Gas (ABG): the principal diagnostic tool for evaluating acid-base
balance.
1. The pH measures the hydrogen concentration in the plasma.
2. PaCO2 (the partial pressure of carbon dioxide) indicates the adequacy of
pulmonary ventilation.
3. HCO3 (bicarbonate) indicates the activity in the kidneys to retain or excrete
bicarbonate.
4. PaO 2 (the partial pressure of oxygen) indicates the concentration of oxygen in
the blood.
5. Base excess/deficit indicates the concentration of bugger—in particular,
bicarbonate. Positive values indicate an excess of base or a deficit of acid.
Negative values indicate a deficit of base or an excess of acid.
 When interpreting an ABG result, focus on the pH, PaCO2, and HCO3
 Recall that PaCO2 is an acid and is a base
 More acid will lower the PH, whereas less acid will raise the pH
 More base will raise the PH, whereas less base will lower the pH

24) Know cause of metabolic alkalosis

Metabolic Alkalosis: results from excess bicarbonate or deficient acid, or both.
These conditions cause the pH to rise above 7.45

25) Define active transport

Active Transport: the movement of a substance from an area of low
concentration to an area of higher concentration, against a concentration gradient.
 Facilitated Diffusion: substances move from an area of higher
concentration to an area of lower concentration with the assistance of a
carrier molecule; does not require energy.

26) Define hypertonic, hypotonic, isotonic solutions

Hypertonic Solution: an intravascular solution that has a higher concentration
of solutes than those in the intravascular compartment; causes fluid to shift
from the intracellular space to the intravascular space.
Hypotonic Solutions: an intravascular solution that has a lower concentration
of solutes than that found in the intravascular compartment;
administration causes fluid to shift from the intravascular space to the intracellular
space.
Isotonic Solutions: an intravascular solution that has concentrations of
solutes equal to those in the intravascular compartment; allow fluid to
move equally between compartments.
27) An imbalance of this ion causes an imbalance in acid and bases
pH Balance: the measure of hydrogen; the higher the hydrogen concentration,
the lower the pH number.

28) Know Chvostek’s sign and cause

Chvostek’s Sign: an indicator of hypocalcemia (occurs when ionized calcium
levels fall below 4 mEq/L) in which a spasm or brief contraction of the corner of the
mouth, nose, eye, and muscles in the cheek results from tapping the facial nerve in
front of the ear.

29) Know the clinical manifestations of cellulitis

Cellulitis: an infection deep in the dermis and subcutaneous tissue. Usually
results from a direct invasion through a break in the skin, especially those
breaches where contamination is likely. Appear as a swollen, warm, tender
area of erythema; additionally, systemic manifestations of infections are
usually (fever, leukocytosis, malaise, and arthralgia).

30) This organ is the first barrier to microbes and pathogens

Skin: thick, impermeable layer of epidermal cells overlying a rich vascular layer;
 endodermis, dermis, and epidermis. Produces slight acidic substance (hyaluronic
acid) and proteins (cathelicidins and defensins) that inhibit bacterial growth.

31) Know the role of tears, saliva, mucous membranes in the human
body
Mucous Membranes: part of the skin; made up of epithelial cells that are
produced in the inner layer and rapidly push their way to the outer layer; the
continuous shedding of this top layer prevents microorganisms from remaining on
these surfaces.
Tears and Saliva: contain lysozyme, an enzyme that dissolves bacterial cell walls.

32) Know cell type associated with adaptive immunity

Adaptive Immunity: body’s own individual immune system that recognizes and
attack antigens that make it through the innate defenses. Key players are:
 T Cells: produced in the bone marrow and matures in the thymus; two types
are regulator cells and effector cells.
 B Cells: mature in the bone marrow, where they differentiate into memory
cells or immunoglobulin-secreting (antibody) cells. They eliminate bacteria,
prevent viral reinfection, and produce immediate inflammatory response.

33) Know passive immunity

Passive Acquired Immunity: refers to immunity gained by receiving antibodies
made outside the body by another person, animal , recombinant DNA. The person
is not actively producing antibodies, and protection is short lived.

34) Examples of passive immunity

Examples are mother-to-fetus transfer of antibodies via breastmilk or placenta. It
can also occur when a person receives an injection of antibodies to protect against
the effects of a toxin such as snake venom.

35) Examples of body’s adaptive immune response

Adaptive immunity include an immature B cell becoming a plasma cell and
producing antibodies to bind to and neutralize a specific antigen, or an immature T
cell becoming a cytotoxic T cell and hunting down infected cells based on a specific
antigen.

36) Define active immunity and be able to apply

Active Acquired Immunity: immunity gained by actively engaging with the
antigen via invasion or vaccination. The person makes his or her own antibodies,
and protection is usually long term. Examples are vaccinations (COVID vaccine).

37) Examples of artificial adaptive immunity

Artificial Active: vaccine (live or attenuated organisms) is injected into the body.
No illness results, but antibodies form.
Artificial Passive: antibodies are injected into the body (antiserum) to provide
temporary protection or to minimize the severity of an infection.
38) Know the effect of histamine on the body
Histamine: released by mast cells and basophils, especially during allergic
reactions, trigger the inflammatory response. Histamine increases the permeability
of the capillaries to white blood cells and other proteins, allowing them to engage
foreign invaders in the infected tissues.

39) Know what macrophages do

Macrophages: white blood cells within tissues, produced by differentiation of
monocytes; they phagocytize and stimulate lymphocytes and other immune cells
to respond to pathogens.

40) Basophils are in high concentration during an allergic reaction

Basophils: white blood cells that bind immunoglobulin E (IgE) and release
histamine into anaphylaxis.

41) Know the importance of hand washing

Proper hand washing remains the long-standing cornerstone of prevention because
the hands are a significant source of transmission.

42) This white blood cell creates antibodies

B Cells: mature in the bone marrow, where they differentiate into memory cells or
immunoglobulin-secreting (antibody) cells. They eliminate bacteria, prevent viral
reinfection, and produce immediate inflammatory response.

43) What immunoglobulin is most abundant and responsible for eating

bacteria?
Immunoglobulin A (IgA): cells that prevent the attachment and invasion of
bacteria and viruses though mucous membrane.

44) IgA antibodies are secreted by what in the human body?

IgA: found in membranes of the respiratory and gastrointestinal tracts, tears,
saliva, mucus, and colostrum; important in local immunity.

45) Know the clinical manifestations of the inflammatory system?

Inflammatory Response: damage/trauma to the body tissue, regardless of
cause, triggers a series of reactions.; non-discriminatory, same sequences every
time.
1. Acute Phase: inflammatory response starts immediately after the injury
and continues until the threat is eliminated (hours to days)
2. Chronic Phase: initiated if the acute phase fails to resolve the issues; it
lasts until healing and repair completed (weeks to months)
Steps:
1. Erythema (redness)
2. Edema (swelling)
3. Heat
 4. Pain at the site of injury

46) Know the role of mast cells

Mast Cells: a type of cell (granulocyte) that is found in connective tissue
throughout the body. Following the activation of cell surface receptors on mast
cells, performed mediators are released through degranulation (cellular release of
molecules from secretory vesicles), including histamine, which stimulates
vasodilation. Mast cells also promote the synthesis of new mediator which
stimulate pain receptors and vasodilation as well as increase permeability, and
leukotrienes, which stimulate vasodilation and increase permeability.

47) Define the function of interferons

Interferon: small proteins release from virus-infected cells; molecules diffuse
away from the site of invasion through the interstitial tissue and bind to receptors
on the plasma membrane of uninfected cells.

48) Know the iconic presentation of SLE

Systemic Lupus Erythematosus (SLE): a chronic, autoimmune, inflammatory
disorder that can affect any connective tissue. It is thought that B cells are
activated for unknown reasons to produce autoantibodies and autoantigens that
combine to form immune complexes.
49) Know the presentation of rheumatoid arthritis
Rheumatoid Arthritis: a systemic, autoimmune condition involving multiple
joints. The inflammatory process primarily affects the synovial membrane, but it
also affects other organs.
 Fatigue, anorexia, low-grade fever, lymphadenopathy, malaise, muscle
spasms, morning stiffness lasting longer than 1 hour,
warmth/tenderness/stiffness in the joints when not used for as little as 1-
hour, bilateral joint pain, swollen and boggy joints, contractures and joint
deformity, unsteady gait, depression, and anemia.

50) Know the outcome of elevated eosinophils

Eosinophils: swarm an inflamed site when needed to fight diseases. However too
much can cause more discomfort or even tissue damage.

51) Know the outcome of elevated neutrophils

Neutrophils: white blood cells that act as your immune system’s first line of
defense. If there are too many in your bloodstream, you may develop leukocytosis,
or a high white blood cell out; resulting in fevers or recurring infections.

52) Know which patient population would be most at risk for

opportunistic infection?
Opportunistic Infection: an infection caused by pathogens that do not normally
cause disease in healthy individuals; immunodeficiency predisposed
individuals (HIV).

53) Know what immunoglobulin is associated with Type I

hypersensitivity and action, examples?
Type I Hypersensitivity: immunoglobin E (IgE)-mediated type of hypersensitivity
in which an allergen activates T cells that then bind to mast cells. Repeated
exposure to relatively large doses of the allergen is usually necessary to cause this
response. Immediate or delayed.
 Allergic rhinitis, asthma, and systemic anaphaylaxis.
54) Know what immunoglobulin is associated with Type II
hypersensitivity and action, examples?
Type II Hypersensitivity: tissue-specific type of hypersensitivity that generally
involves the destruction of a target cell by an antibody-directed cell-surface
antigen. Immunoglobulin G or M (IgG or IgM) reacts with an antigen on the cell,
activating the complement system. The effects reactions include cell lysis and
phagocytosis. 5-8 hours.
 Transfusion reactions and hemolytic disease of newborn.
55) Know what immunoglobulin is associated with Type III
hypersensitivity and action, examples?
Type III Hypersensitivity: immune complex–mediated type of hypersensitivity in
which circulating antigen–antibody complexes accumulate and are deposited in the
tissue. This accumulation triggers the complement system, causing local
inflammation and increased vascular permeability, so more complexes accumulate.
Immunoglobulin G (IgG) and 2-8 hours.
 Serum sickness, SLE, Arthus phenomenon, rheumatic fever and rheumatoid
arthritis.
56) Know what immunoglobulin is associated with Type IV
hypersensitivity and action, examples?
Type IV Hypersensitivity: cell-mediated type of hypersensitivity that involves a
delayed processing of the antigen by the macrophages. Once processed, the
antigen is presented to the T cells, resulting in the release of lymphokines that
cause inflammation and antigen destruction. 1-3 days.
 Contact dermatitis, infection, allergy, Crohn disease.

57) What lab tests measure inflammation?

Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT)
 and plasma viscosity (PV) blood tests are commonly used to detect increase in
protein in the blood.

58) Know the complications of stress

Diseases and ailments that have been attributed to stress include anxiety,
depression, headaches, insomnia, infections, and cardiovascular disease.

59) Epinephrine is released during the alarm phase of the general

adaptation syndrome
General Adaption Syndrome: a cluster of systemic manifestations resulting
from body modifications made in an attempt to cope with a stressor.
1. Alarm: characterized by the stimulation of the sympathetic nervous
system (SNS), resulting in release of catecholamines and cortisol (fight-or-
flight)
2. Resistance: body chooses the most effective and advantageous defense.
Cortisol levels and the SNS return to normal, causing the flight-or-fight
symptoms to disappear. The body either adapt or alter its mechanisms to
limit problems or become desensitized to the stressor.
3. Exhaustion: initiated if the stressor is prolonged or overwhelms the body.
The body becomes depleted, and damage can arise. Homeostasis no
longer maintained through compensatory mechanisms. As the body’s
defenses are utilized, disease or death results (anxiety, depression,
headaches, insomnia, infections, and cardiovascular disease).
60) Know the bodily responses of the fight or flight response
Fight-or-Flight Response: the alarm stage that is generalized stimulation of
sympathetic nervous system, resulting in the release of catecholamines and
cortisol.

61) Know the cardinal signs of the inflammatory process for

transplant/acute tissue rejection
Inflammatory Process: include fever, redness, swelling and tenderness at the
graft site. Additionally, the individual may experience impaired functioning of the
transplanted organ.

62) These cells are invaded by HIV and can lead to AIDS
+¿¿
CD 4 Cells: are proteins in T-Helper (Th) cells. Once HIV gains access to the body,
+¿¿
the virus invades the CD 4 cells, using an enzyme, reverse transcriptase, to
convert the viral RNA to DNA and integrate it into its own DNA.

63) Describe cachexia

Cachexia: a generalized wasting syndrome in which the person appears
emaciated, often occurs due to malnutrition. Fatigue, or feeling or weakness,
results from parasitic nature of a tumor, anemia, malnutrition, stress, anxiety, and
chemotherapy.

64) Define metastasis

Metastasis: the spread of cancer cells from the place where they first formed to
another part of the body; cancer cells break away from the original tumor, travel
through the blood or lymph system, and form a new tumor in other organs or
tissues of the body.
65) Know the properties of cancer cells
Cancer Cells: differ from normal cells in size, shape, number, differentiation,
purpose, and function. The less the cell resembles the original cell, the more
anaplastic the cell is.
 Anaplastic Cells: begin functioning as completely different cells, often
producing hormones or hormone-like substances. This uncontrolled
proliferation and changes in differentiation are a result of genetic, epigenetic
(gene expression), and environmental factors. Such changes result from a
series of events or factors, not just one.

66) Know the 3 steps of carcinogenesis

Carcinogenesis: the process by which cancer develops. It occurs in three phases:
 Initiation: exposure of the cell to a substance or event causes DNA damage
or mutation.
 Promotion: the mutated cells are exposed to factors that promote their
growth. It may occur just after initiation or years later, and it can be
reversible if the promoting factors are removed.
 Progression: the tumor invades, metastasizes, and becomes drug resistant.
The final phase and it is irreversible.

67) Define anaplastic cells

Anaplastic Cells: cancer cells that divide rapidly and have little or no
resemblance to normal cells.
68) This tool is used to screen for breast cancer
Mammogram: diagnostic procedure to screen for breast cancer; not perfect as
most (95%) of the 10% of women who have abnormal mammograms do not have
cancer.
 Clinical breast examination, breast self-examination, or BRCA1 and BRCA1
genetic testing.

69) What do you do a colon screen?

Fecal occult blood test, fecal immunochemical test, stool DNA test, flexible
sigmoidoscopy, barium enema, and colonoscopy.

70) Define neoplasia

Neoplasia: the uncontrolled, abnormal growth of cells or tissues in the body; a
tumor. It can be benign or malignant.

71) What causes contact dermatitis?

Contact Dermatitis: an acute inflammatory reaction triggered by direct exposure
to an irritant or allergen-producing substance.
 Irritant Contact Dermatitis: accounts for 80% of cases. Chemicals, plants,
body fluids, rubber gloves, and soaps may all cause this condition. Irritant
contact dermatitis produces a reaction similar to a burn, with its
manifestations typically including erythema and edema and sometimes pain,
pruritus, and vesicles (blisters).
 Allergic Contact Dermatitis: results from contact with substances such as
metals, chemicals, adhesives, cosmetics, and plants. The reaction is usually
delayed, with manifestations appearing 24–48 hours after exposure.
Typically, manifestations of allergic contact dermatitis include pruritus,
erythema, and edema at the site, but small vesicles may also be present.

72) Know presentation of scabies

Scabies: a result of a mite’s infection. The male mites fertilize the females and
then die; the female mites burrow into the epidermis, laying eggs in a series of
tracts over a period of several weeks. When the larvae hatch from the eggs, they
migrate to the skin’s surface. This burrowing appears as small light brown streaks
on the skin.

73) This hypersensitivity reaction results in urticaria

Urticaria: raised erythematous skin lesions that are a result of a type I
hypersensitivity reaction; also known as hives.

74) Define ALL burn types and be able to differentiate among them
Burn: a skin injury that can result from a thermal or nonthermal source. These
sources may include dry head, wet head, radiation, friction, heated objects, natural
or artificial ultraviolet light, electricity and chemical.
 First-Degree (superficial) Burns: affect only the epidermis. These burns
cause pain, erythema, and edema.
  Second-Degree (partial-thickness) Burns: affect the epidermis and
dermis. These burns cause pain, erythema, edema, and blistering. Deep
partial-thickness burns involve hair follicles, and scarring is common.
 Third-Degree (full-thickness) Burns: extend into deeper tissues (e.g.,
fat). These burns cause white or blackened, charred skin that may be numb.

75) Know the etiology of hemangiomas

Hemangiomas: referred to as strawberries, are birthmarks that appear as a bright
red papule, a plaque, or a nodule of extra blood vessels in the skin. They may be
either superficial or deep. Many are found on the head or neck, although they can
appear anywhere on the body.

76) Know food source for lice

Pediculosis: a lice infestation that can take three forms—Pediculus humanus
corpus (body louse), Pediculus pubic (pubic louse), and Pediculus humanus capitis
(head louse). Lice are small, brown, parasitic insects that feed off human blood and
cannot survive for long without the human host.

77) Know the clinical manifestations of tinea fungi

Tinea: causes several types of superficial fungal infections that are described
based on the area of the body affected. Theses fungi typically grow in warm, moist
places and manifest as circular, erythematous rash, which is usually associated
with pruritis and burning.
 Tinea Capitis: an infection of the scalp along with a typical rash associated
with hair loss at the site.
 Tinea Pedis: also, ringworm; an infection of the body.
 Tinea Corporis: also, athlete’s foot; involves the feet, especially the toes.
 Tinea Ungunim: an infection of the nails, typically the toenails. Begins at
the top of one or two nails and then usually spreads to other nails, turning
white and then brown; causing it to thicken and crack.

78) Which bacteria type is associated with skin infections?

Bacteria in the Staphylococcus and Streptococcus genera are common culprits
in integumentary infections. Herpes simplex is the most common viral skin
disease.
79) Know the clinical manifestations of shingles
Herpes Zoster: also called shingles; a viral infection caused by the varicella-
zoster virus. The condition appears in adulthood years after a primary infection of
varicella (chickenpox) in childhood. The virus lies dormant on a cranial nerve or a
spinal nerve dermatome until it becomes activated years later; it affects this nerve
only.
 A vesicular rash develops in a line over the area innervated by the affected
nerve. The rash may appear red or silvery, and it occurs on one side of the
head or torso depending on the nerve attached. The skin often becomes
extremely sensitive, and pruritus may be present. The rash may persist for
weeks to months.

80) Know the ABCDs of skin infection

A – Asymmetry: part of the lesion is different from the other
B – Borders: irregular
C – Color: varies from one area to another with shades of tan, brown, or black
(sometimes white, red or blue)
D – Diameter: usually (but not always) larger the 6mm in size (the diameter of a
pencil eraser)

81) What are the most common body areas of skin cancer
Skin cancer develops primarily on areas of sun-exposed skin, including the scalp,
face, lips, ears, neck, chest, arms and hangs, and on the legs in women. But it can
also form on areas that rarely see the light of day—your palms, beneath your
fingernails or toenails, and your genital area.

82) Define/identify Mongolian spots

Mongolian Spots: flat bluish-gray patches often found on the lower back or
buttocks. These birthmarks are most common on individuals with darker
complexions.

83) Know presentation and effects of albinism

Albinism: a recessive condition that results in little or no melanin production.
 Causes lack of pigment in the skin, hair, and iris of the eye; all forms of
albinism causes problems with eye development and function.

84) Be able to identify presentation of molluscum contagium

Molluscum Contagiosum: a poxvirus infection that is characterized by clusters
of pink, cone-shaped, smooth waxy, or pearly papules 2 to 5 mm in diameter.

85) Describe a furuncle

Furuncle: an infection that begins in the hair follicles and then spreads into the
surrounding dermis. The lesion stats as a firm, red, painful nodule that develops
into a large painful mass, which frequently drains large amounts of purulent
exudate; also called boil.
86) Describe and identify ALL pressure ulcers
 Stage 1: the skin remains intact, and nonblanchable erythema, usually over
a bony prominence, is present.
 Stage 2: an erosion or blister with or without true ulceration (defect beyond
the level of the epidermis), but subcutaneous tissue is not exposed. The
ulcer is superficial with a pink or red wound bed. No slough (layer of dead
tissue) or necrotic tissue is present.
 Stage 3: full-thickness skin loss with damage to subcutaneous tissue down
to the underlying fascia is present.
 Stage 4: full-thickness skin loss with extensive destruction, tissue necrosis,
and damage to muscle, tendon, bone, or other exposed supporting
structures.
 Suspect Deep Tissue Injury: skin may or may not be intact, and
underlying tissue is damaged.
 Unstageable: full-thickness skin and tissue loss in which the extent of
damage cannot be determined because it is hidden by slough or eschar.

87) Know the clinical manifestations of rosacea

Rosacea: a chronic inflammatory skin condition that typically affects the face.
Poorly understood, but it is prevalent in persons who are fair skinned, persons who
bruise easily, and women.
 It may present as erythema, prominent spiderlike blood vessels
(telangiectasis), swelling, or acne like eruptions.

88) Know the causes of gout

Gout: an inflammatory disease resulting from deposits of uric acid crystals in
tissues and fluids within the body; results from an overproduction or
underexcretion of uric acid (urate) as well as an increased in purine intake.
89) Know effects of muscular dystrophy
Muscular Dystrophy (MD): a group of inherited disorders characterized by
degeneration of skeletal muscle. Muscles become weaker as damage worsens.
There are nine different forms of MD.
 Intellectual disability, muscle weakness that slowly worsens to hypotonia,
muscle spasms, delayed development of muscle motor skills, difficulty using
one or more muscle groups, poor coordination, drooling, ptosis (eyelid
drooping), frequent falls, problems walking (e.g., delayed walking), gowers
maneuver (an affected child pushes to an erect position by using his or her
hands to climb the legs), progressive loss of joint mobility and contractures
(e.g., clubfoot and footdrop), unilateral calf hypertrophy, and scoliosis or
lordosis

90) Define osteoporosis

Osteoporosis: a condition characterized by a progressive loss of bone calcium
that leaves the bones brittle.

91) These cells undergo rapid proliferation in psoriasis patients

Keratinocytes, or skin cells

92) This disease is associated with psoriatic arthritis

Psoriasis: a common chronic inflammatory condition that affects the life cycle of
skin cells, specifically keratinocytes.
 As many as 30% of persons with psoriasis also have a combination of
psoriatic arthritis. May be servere in persons who have a weakened immune
system (AIDS).

93) Know lordosis, scoliosis, kyphosis

Lordosis: an exaggerated concave of the lumbar spine; also called swayback.
Scoliosis: a lateral deviation of the spine. This lateral curvature may affect the
thoracic or lumbar area or both. Scoliosis may also include a rotation of the
vertebrae on their axis.
Kyphosis: an increase in the curvature of the thoracic spine outward; also called
hunchback.

94) Know cause and manifestations osteoarthritis

Osteoarthritis (OA): known as wear-and-tear arthritis and degenerative joint
disease; a localized joint disease characterized by deterioration of articulating
cartilage and its underlying bone as well as bony overgrowth. The surface of the
cartilage becomes rough and worn, so that it interferes with joint movement.
Tissue damage triggers the release of enzymes from local cells that accelerate
cartilage disintegration. Eventually, the subchondral bone is exposed and
damaged, and cysts and osteophytes (bone spurs) develop as the bone attempts
to remold itself.
95) Know when pain is caused for osteoarthritis patients
Disease onset is gradual and usually begins after the age of 40.
 Joint pain that is exacerbated during or after movement or weight bearing,
joint tenderness with light pressure, joint stiffness, especially upon rising in
the morning or after a period of inactivity, enlarged, hard joints, joint
swelling, limited joint range of motion, crepitus, and hard nodules around the
affected joint (bone spurs)

96) Know cause and manifestations osteomyelitis

Osteomyelitis: an infection of the bone tissue; often goes undetected and can
take months to resolve, delays healing, and can result in bone or tissue necrosis. Is
treated with potent antibiotic therapy and surgery.

97) Know cause and manifestations osteomalacia, rickets, fibromyalgia,

osteogenesis imperfecta, osteosarcoma tumors, ankylosing spondylitis,
scleroderma,
Osteomalacia: a softening and weakening of bones in adults, usually because of
an extreme and prolong vitamin D, calcium, or phosphate deficiency.
Rickets: a softening and weakening of bones in children, usually because of an
extreme and prolong vitamin D, calcium, or phosphate deficiency.
 (Osteomalacia and Rickets): skeletal deformities, fractures, delayed
growth in height or limbs, dental problems, bone pain, muscle cramps or
weaknesses, and difficulty with ambulation or waddling gait.
Fibromyalgia: a syndrome predominantly characterized by widespread muscular
pain and fatigue; affects muscles, tendons, and surrounding tissue but not the
joints.
 In this condition, the brain’s pain receptors seem to develop a sort of pain
memory and becomes more sensitive to pain signals; disruption of stage 4
sleep, physical or emotional trauma, sleep disturbances, altered skeletal
muscle metabolism, infection, and genetic predisposition.
Osteogenesis Imperfecta: or “brittle bone disease”, a genetic collagen disorder
that causes diffuse abnormal bone fragility.
 Sensorineural hearing loss, blue sclerae, dentinogenetic imperfecta, and joint
hypermobility are seen with this condition.
Four Main Types of Osteogeneses Imperfecta:
o Type I is autosomal dominant and the mildest form.
 o Type II is autosomal recessive, is the most severe form and is lethal.
o Type III is autosomal recessive and is the most severe nonlethal form.
o Type IV is autosomal dominant, is moderately severe, and has a high
survival rate.
Osteosarcoma Tumors: an aggressive tumor that begins in the bone cells,
usually in the femur, tibia, or fibula. It occurs most often in children and young
adults.
Ankylosing Spondylitis: a progressive inflammatory disorder affecting the
sacroiliac joints, intervertebral spaces, and costovertebral joints. The exact cause
is unknown, although genetic factors seem to be involved.
 The inflammation associated with this condition starts in the vertebral joints.
It continues with new bone forming in an attempt to remodel the damage;
fibrosis and calcification, or fusion, of the joints follow. Then vertebral joints
become fixed, or ankylosed, and lose mobility; inflammation begins in the
lower back and progresses up the spine.
Scleroderma: an autoimmune disease that causes inflammation and fibrosis in
the skin and other areas of the body.
 When an immune response tricks tissue into thinking they are injured, it
causes inflammation, and the body makes too much collagen; as well as
Raynaud’s phenomenon, digestive problems, heart and lung problems.

98) Define dislocation, sprain, amputation, stress facture

Dislocation: the separation of two bones where they meet at a joint.
Sprain: an injury to a ligament that often involves stretching or tearing of the
ligament.
Amputation: the loss or removal of a body part.
Stress Facture: type of fracture that occurs from repeated excessive stress; also
called fatigue fracture.

99) Increased capillary permeability is a clinical manifestation of a sprain

 Grade I: minimal damage or disruption; microscopic tearing of collagen
fiber, joint is stable.
o Tender without swelling, no bruising, active and passive range of
motion is painful, prognosis is good with no expectation of instability or
functional loss.
 Grade II: moderate damage; complete tears of some but not all collagen
fibers in the ligament.
o Moderate swelling and bruising, very tender with more diffuse
tenderness than grade I, range of motion is very painful and restricted,
joint may be unstable and functional loss may result.
 Grade III: complete disruption of the ligament; complete tear or rupture of
ligament.
o Prognosis is variable injury may require surgery), requires a prolonged
healing/rehabilitation period.
100) Know ALL fracture types and be able to differentiate between them
Simple Fracture: a fracture with a single break in the bone and in which bone
ends maintain their alignment and position.
 Transverse Fracture: a fracture straight across the bone shaft.
 Oblique Fracture: a fracture at an angle to the bone shaft.
 Spiral Fracture: a fracture that twists around the bone shaft.
Comminuted Fracture: a fracture characterized by multiple fracture lines and
bone pieces.
Greenstick Fracture: an incomplete fracture in which the bone is bent and only
the outer curve of the bend is broken; commonly occurs in children because of
minimal calcification and often heals quickly.
Compression Fracture: a fracture in which the bone is crushed or collapses into
small pieces.

Other Terms for Fractures

 o Complete Fracture: the bone is broken into two or more separate
pieces.
o Incomplete Fracture: the bone is partially broken.
o Open Fracture: compound fracture, the skin is broken; bone fragments
or edges may be angled and protrude out of the skin. Characterized by
more damage to soft tissues and are at risk for infection.
o Closed Fracture: the skin is intact.
o Impacted Fracture: one end of the bone is forced into the adjacent
bone.
o Pathologic Fracture: a weakness in the bone structure secondary to
conditions such as bone tumors or osteoporosis.
o Stress Fracture: or fatigue fractures, occur from repeated excessive
stress.
o Depressed Fracture: occur in the skull when the broken piece is forced
inward on the brain.

101) Know the complications of bone fracture, compartment syndrome

Compartment Syndrome: a serious condition that results from pressure
increases in a body compartment, usually the muscle fascia in the case of
fractures. The pressure impinges on the nerves and blood vessels contained within
the compartment, potentially compromising the distal extremity.
Fat Embolism: occurs when fat has an opportunity to enter the bloodstream, such
as during surgery. Fatty marrow can also enter the bloodstream after a fracture to
one of the long bones or pelvis. The outcome can be fatal if emboli travel to vital
organs.
Osteomyelitis: an infection of the bone tissue. If undetected, can take months to
resolve, delays healing and can result in bone or tissue necrosis.
Osteonecrosis: or avascular necrosis, is the death of bone tissue due to a loss of
the blood supply to that tissue. It can result from displaced fractures or
dislocations. Often requires surgical replacement of the necrotic bone and/or joint.

102) Know the 5 Ps of compartment syndrome

Pain, Pallow (pale skin tone), Paresthesia (numbness feeling),
Pulselessness (faint pulse), and Paralysis (weakness with movements).

103) Know what takes place with a herniated disc

Herniated Intervertebral Disk: a state in which the nucleus pulposus (the inner
gelatinous component of the intervertebral disk) protrudes through the annulus
fibrosus; also called slipped disk or ruptured disk.
104) Know etiology of hip dysplasia
Developmental Hip Dysplasia (DDH): a continuum of abnormalities in the
immature hip that can range from subtle dysplasia (abnormal development) to
dislocation. It can be unilateral or bilateral; the condition can develop after birth in
early infancy or childhood.

105) Know the clinical manifestations of Paget disease

Paget Disease: a progressive condition characterized by abnormal bone
destruction and remodeling, which results in bone deformities.
 Results in fragile, misshapen bones; often involves the pelvis, long bones,
skull, and vertebrae.

106) Know the complications of bone fractures

Fracture: a break in the rigid structure of the bone. Most common type of
traumatic musculoskeletal disorder.
 Multiple complications can result from fractures. Delayed union, malunion, or
nonunion may occur due to poor nutrition, inadequate blood supply,
malalignment, and premature weight bearing. Other fracture complications
may include compartment syndrome, fat embolism, osteomyelitis, and
osteonecrosis.