PATHOPHYSIOLOGY  EXAM IV        Updated 11/8/07
Fluid and Electrolyte Balance:
Who has the greatest percentage of body water, a man, a woman, or an infant? Who has the least?
What are the water compartments of the body? Where would you find the most water?
What is meant by a neutral balance? A positive balance? A negative balance?
What are the sources of water intake? Water loss?
What is an electrolyte? An anion? A cation? What ions are important for the functioning of the body?
How does our body maintain a balance of charge and osmolarity?
Understand the terms isotonic, hypertonic, hypotonic and how these solutions would affect cells.
What forces influence water movement in the body?
Where sodium goes.....?
What hormones influence sodium (Na+)? Water ? What causes these hormones to be released, and what do they do?
What is diabetes insipidus? Diabetes mellitus? How would they affect water balance?
What conditions might cause edema?
What conditions could increase hydrostatic pressure? What effect would this have on body water?
What other factors would cause water to move from one compartment to another?
Why is fluid accumulation (edema) in the tissues a bad thing?
What ions are predominantly extracellular? Intracellular?
What would be the causes, manifestations and treatment of hypernatremia? Hyponatremia? Hyperkalemia? Hypokalemia?
Use your textbook to answer the following questions:
What is meant by "a third space"? Why is water accumulation here not good for the body?
What is usually the cause of generalized edema? What is meant by dependent edema?
What are some ways to assess edema?
Why are infants more vulnerable to dehydration than older children or adults?
How does metabolic rate affect water loss?
What effect does epinephrine and beta-adrenergic drugs have on potassium? What effect could exhaustive exercise have?
What could cause hypocalcemia? What changes in the body would you see with chronic hypocalcemia?
What are Chvostek's sign and Trouseau's sign? What do they test for?
What is hypercalcemic crisis? How is it treated?
What imbalance might you see in persons that are anorexic or are laxative abusers?.
Hypersecretion of adolsterone would cause hyper        and hypo          .
Of the four electrolyte imbalances mentioned in class, which is the most life-threatening? What conditions could cause it?
What changes would you expect to see in the ECG with hypokalemia and hyperkalemia.
What is the typical cause of hyponatremia?
How is calcium regulated in the body? What hormones are involved? What signs and symptoms would you expect to see in hypercalcemia? What would cause it? How is it different from hypocalcemia? What causes hypocalcemia? What electrolyte shows an inverse relationship to calcium?

Acids and Bases
Be sure you understand what pH is, and the pH scale. What is an acid?  A base?
What is the normal range for blood pH? Can a person be in a state of acidosis if their blood pH is above a neutral pH?
What three mechanisms does the body use to control pH? Which is the fastest? The most effective? How does respiration rate affect pH? What ratio is maintained between bicarbonate ion and carbonic acid? What other buffers are used by the body? Where are they located? Why is K+ important in pH balance? How is K+ affected by pH?
What are some of the causes of respiratory acidosis? Respiratory alkalosis? How would you recognize and treat these conditions? Why are these solutions used in treatment?
What are some of the causes of metabolic acidosis? Metabolic alkalosis? How would you recognize and treat these conditions?
I will give you lab results and normal values. Be able to tell me the cause of the problem ( e.g. metabolic acidosis), and whether the patient is compensating (partially) or not at all.

Musculoskeletal review:
What are the functions of bone?
Describe the matrix of bone.
What are the three cells associated with bone? What does each do?
Calcitonin and parathyroid hormone affect what bone cell? How? How do these hormones affect blood calcium levels?
Describe the osteon or Haversian system.
How does compact or dense bone differ from spongy or cancellous bone?
What are the two ways bone is formed? Most bones are formed which way?
Where does a long bone increase in length? How can you tell when someone is done growing?
What is remodeling?
Be able to name the parts of a long bone.
Be able to identify the bones of the axial and appendicular skeleton.
Describe a typical synovial joint.
Define a motor unit. What is recruitment?
How does a muscle cell contract?
What happens at the neuromuscular junction? What neurotransmitter is used here?

Musculoskeletal Pathophysiology (extensively revised):
What is Osteogenesis imperfecta? What is aspect of bone is affected? What does this cause? How long do these individuals live? How do you get this disease?
What is achondroplasia? What would a person with this disease look like? How long would they be expected to live? How do you get this disease?
What is the most common disease affecting the bones?
What does the World Health Organization use to define the disease? Is this the only factor involved?
When do we hit peak bone mass? Why are men affected later than women? What race is most commonly affected?
What are some of the risk factors? How is remodeling involved? Osteoclasts and osteoblasts?
What is kyphosis? Why does it occur? What are the symptoms in the early stages of the disease? What seems to influence the progression of the disease?  What can we do to treat it? Prevent it? Why can it be fatal?
What causes rickets and osteomalacia? How are they different from each other? What is the cause of these diseases? What can be done to treat them? Where are they mostly likely to be seen? Can osteoporosis and osteomalacia affect the same individual at the same time?
What is the most common joint disease in North America?
What causes osteoarthritis? What causes rheumatoid arthritis?  How are these conditions the same? Different? Who is more commonly affected? Which joints are commonly affected in each disease? How does osteoarthristis begin? Progress? What are osteophytes? What are joint mice?  What over-the-counter remedy has been shown to be helpful? Which has not? What other treatment can be done?
What is the typical age of onset for Rheumatoid arthritis? What infectious diseases have been implicated? What are rheumatoid factors? Rheumatoid nodules? What organs besides the joints are affected? What drug therapy is used? Other treatments?
What is Duchenne muscular dystrophy? How is it inherited? What gene is it located on? Which sex is most commonly affected? Can you have a child with muscular dystrophy if neither parent has a defective gene ?
What is the problem at the cellular level? What is the the course of the disease? What typically causes death of these patients?  Why is breathing impaired? What, other than skeletal muscle, is affected? What can we do to treat the disease?
What is myasthenia gravis? What are the symptoms of myasthenia?
In most cases we see pathological changes in what organ?
When does a patient experience the first symptoms?
What kind of infections are common in these patients ?
What muscles are most commonly affected? Next? how doe these patients appear? Sound?
How does the disease progress?
What would you see with a patient in myasthenic crisis?
What happens in a cholinergic crisis? It mimics the effects of what part of the nervous system?
How do we test for myasthenia? How is it treated?