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 Contents

Unit I: The Cell 29. Alterations of Leukocyte, Lymphoid, and

Hemostatic Function, 139
1. Cellular Biology, 1
30. Alterations of Hematologic Function in Children, 145
2. Altered Cellular and Tissue Biology, 5
3. The Cellular Environment: Fluids and Electrolytes, Unit IX: The Cardiovascular and Lymphatic Systems
Acids and Bases, 11 31. Structure and Function of the Cardiovascular and
Unit II: Genes and Gene-Environment Interaction Lymphatic Systems, 151
32. Alterations of Cardiovascular Function, 158
4. Genes and Genetic Diseases, 17
33. Alterations of Cardiovascular Function in
5. Genes, Environment-Lifestyle, and Common
Children, 167
Diseases, 22
6. Epigenetics and Disease, 25 Unit X: The Pulmonary System
Unit III: Mechanisms of Self-Defense 34. Structure and Function of the Pulmonary System, 171
35. Alterations of Pulmonary Function, 177
7. Innate Immunity: Inflammation, 28
36. Alterations of Pulmonary Function in Children, 186
8. Adaptive Immunity, 34
9. Alterations in Immunity and Inflammation, 38 Unit XI: The Renal and Urologic Systems
10. Infection, 43 37. Structure and Function of the Renal and Urologic
11. Stress and Disease, 49 Systems, 192
Unit IV: Cellular Proliferation: Cancer 38. Alterations of Renal and Urinary Tract Function, 198
39. Alterations of Renal and Urinary Tract Function in
12. Cancer Biology, 53
Children, 204
13. Cancer Epidemiology, 59
14. Cancer in Children, 62 Unit XII: The Digestive System
Unit V: The Neurologic System 40. Structure and Function of the Digestive System, 208
41. Alterations of Digestive Function, 215
15. Structure and Function of the Neurologic System, 64
42. Alterations of Digestive Function in Children, 223
16. Pain, Temperature Regulation, Sleep, and Sensory
Function, 71 Unit XIII: The Musculoskeletal System
17. Alterations in Cognitive Systems, Cerebral 43. Structure and Function of the Musculoskeletal
Hemodynamics, and Motor Function, 78 System, 227
18. Disorders of the Central and Peripheral Nervous 44. Alterations of Musculoskeletal Function, 233
Systems and the Neuromuscular Junction, 84 45. Alterations of Musculoskeletal Function in
19. Neurobiology of Schizophrenia, Mood Disorders, Children, 242
and Anxiety Disorders, 90
20. Alterations of Neurologic Function in Children, 95 Unit XIV: The Integumentary System
Unit VI: The Endocrine System 46. Structure, Function, and Disorders of the
Integument, 247
21. Mechanisms of Hormonal Regulation, 98 47. Alterations of the Integument in Children, 254
22. Alterations of Hormonal Regulation, 103
Unit XV: Multiple Interacting Systems
Unit VII: The Reproductive Systems
48. Shock, Multiple Organ Dysfunction Syndrome,
23. Structure and Function of the Reproductive and Burns in Adults, 260
Systems, 109 49. Shock, Multiple Organ Dysfunction Syndrome,
24. Alterations of the Female Reproductive System, 113 and Burns in Children, 266
25. Alterations of the Male Reproductive System, 120
26. Sexually Transmitted Infections, 123 Answer Key, 271
Unit VIII: The Hematologic System
27. Structure and Function of the Hematologic
System, 128
28. Alterations of Erythrocyte Function, 133

vii

Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Contents
This page intentionally left blank
 UNIT ONE THE CELL

1 Cellular Biology

MATCH THE FUNCTIONS

Match the cellular functions below with their location in the picture. Hint: Identify the structure first and then consider
its function.

H
G

C
F

���� 1. Generates ATP by oxidative phosphorylation

���� 2. Synthesizes proteins

���� 3. Processes and packages proteins for delivery

���� 4. Serves as repository of genetic information

1

Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 1 Cellular Biology
 ���� 5. Synthesizes steroid hormones

���� 6. Synthesizes ribosomes

���� 7. Delivers synthesized proteins to their destinations

���� 8. Contains digestive enzymes

DESCRIBE THE DIFFERENCE

Describe the difference between each pair of terms.

9. What is the difference between a eukaryote and a prokaryote?

10. What is the difference between the nucleolus and the nucleus?

11. What is the difference between microtubules and microfilaments?

12. What is the difference between hydrophilic and hydrophobic?

13. What is the difference between a lysosome and a peroxisome?

COMPLETE THESE SENTENCES

Write one word in each blank to complete these sentences.

14. Proteins in the nucleus that bind DNA and help regulate its activity are called _______________.

15. Cells such as neutrophils that use hydrogen peroxide as a defensive weapon synthesize it in their _______________.

16. A section of a membrane that is rich in cholesterol and helps organize membrane proteins is called a _______________
_______________.

17. The cells that secrete the extracellular matrix are called _______________.

18. The mechanical force of water pushing against cellular membranes is called _______________ pressure.

19. An _______________ solution has the same osmolality as normal body fluids.

Chapter 1 Cellular Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
20. In a simple epithelium, the epithelial cells are in contact with a _______________ membrane that provides support.

21. _______________ tissue is characterized by only a few cells surrounded by a lot of extracellular matrix.

22. A myocyte is a _______________ cell.

ORDER THE STEPS

Sequence the events that occur during a neuronal action potential.

23. Write the letters here in the correct order of the steps: _______________________________
A. Sodium ions move into the cell.
B. Potassium ions leave the cell.
C. Sodium permeability increases.
D. Resting membrane potential is reestablished.
E. Potassium permeability increases.

CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

24. The main difference between cells that divide rapidly and those that divide slowly is the amount of time they spend
in the (S, G1) phase of the cell cycle.

25. Cells develop specialized functions through the process of (differentiation, intermediary metabolism).

26. A particle that is dissolved is called a (solvent, solute), and the medium in which it is dissolved is called the (solvent,
solute).

27. Mitochondria need a lot of (glucose, oxygen) to function normally.

28. During osmosis, (particles, water molecules) move across the plasma membrane.

29. (Autocrine, Paracrine) signals act on nearby cells by (diffusion, active transport) through interstitial fluid.

30. A cell that has an insufficient oxygen supply will not be able to perform the chemistry of (the Krebs cycle,
glycolysis).

31. (Active transport, Facilitated diffusion) can move substances against their concentration gradients.

32. Receptors are (proteins, lipids) that bind specific small molecules.

WRITE YOUR DEFINITIONS

Test your understanding by defining each term using your own words.

33. Ligand

34. Caveolae

35. Mechanotransduction

Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 1 Cellular Biology
36. Amphipathic molecule

37. Endocytosis

CHOOSE THE DIRECTION

For each situation, choose the direction that the items will move. Choose A or B from the figure.

A. From ECF into the cell

B. From the cell to ECF

���� 38. If the ECF becomes hypotonic, in which direction will water move?

���� 39. If the concentration of substance X in the ECF is higher than its concentration inside the cell, in which direc-
tion will active transport move substance X?

���� 40. If the glucose concentration in the ECF is higher than its concentration inside the cell, in which direction will
facilitated diffusion move glucose?

���� 41. In which direction does Na1, K1-ATPase move sodium ions?

���� 42. In which direction does Na1, K1-ATPase move potassium ions?

PROVIDE THE EXPLANATION

Use appropriate technical terms to explain these events.

43. A mutation affecting what function would cause a lysosomal storage disease?

44. How does the presence of gap junctions in cardiac muscle facilitate cardiac function?

45. Explain why intracellular receptors do not use second messengers, but many cell surface receptors do.

46. What happens during the interphase portion of the cell cycle? Why are those events important?

Chapter 1 Cellular Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
 2 Altered Cellular and Tissue Biology

MATCH THESE DEFINITIONS

Match the word on the right with its definition on the left.

���� 1. Stiffening of skeletal muscles after death A. Apoptosis

���� 2. Unintentional decrease of core body temperature below 35° C B. Free radical
(95° F)

���� 3. A type of cellular housekeeping in which a cell digests some of C. Livor mortis
its own components

���� 4. Area of cell death in which dead cells disintegrate, but the D. Accidental hypothermia
debris is not digested completely by enzymes

���� 5. Area of cell death in which denatured proteins appear firm and E. Rigor mortis
opaque

���� 6. An atom or group of atoms having an unpaired electron F. Coagulative necrosis

���� 7. Purple discoloration of dependent tissues after death G. Autophagy

���� 8. Cell death that involves orderly dismantling of cell components H. Caseous necrosis
and packaging the remainders in vesicles

CATEGORIZE THESE CLINICAL EXAMPLES

Write the type of cellular adaptation beside its clinical example. Possible choices: atrophy, hypertrophy, hyperplasia,
metaplasia.

�������������� 9. Lining of uterus thickens after ovulation because of increased amounts of estrogen.

�������������� 10. Man who lifts weights regularly develops larger biceps.

�������������� 11. Thymus gland decreases in size during childhood.

�������������� 12. Columnar epithelium in bronchi of cigarette smoker is replaced by stratified squamous
epithelium.

�������������� 13. Captain of roller derby team has greater thigh diameter on left than right from skating
clockwise.

�������������� 14. Left calf is smaller than right calf when cast is removed from it.

�������������� 15. Liver regenerates after surgical removal of damaged portion.

Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 2 Altered Cellular and Tissue Biology
CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

16. Cell death by (necrosis, apoptosis) causes inflammation, but cell death by (necrosis, apoptosis) does not.

17. Dysplasia also is called (normal, atypical) hyperplasia.

18. Release of (potassium, calcium) ions from intracellular stores into the cytoplasm during ischemia damages the cell.

19. Compared with normal aerobic metabolism, cells that use anaerobic metabolism produce (more, less) ATP and
(more, less) lactic acid.

20. The most important way to prevent medication-related poisoning deaths in children is safe (storage, prescribing) of
medications.

21. Reactive oxygen species, such as (superoxide radicals, superoxide dismutase), damage cells by attacking their
(potassium, membranes).

22. Postmortem changes (involve, do not involve) the inflammatory response.

DESCRIBE THE DIFFERENCE

Describe the difference between each pair of terms.

23. What is the difference between hypertrophy and hyperplasia?

24. What is the difference between suffocation and strangulation?

25. What is the difference between an abrasion and a laceration?

26. What is the difference between dystrophic calcification and metastatic calcification?

27. What is the difference between a penetrating gunshot wound and a perforating gunshot wound?

Chapter 2 Altered Cellular and Tissue Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
ORDER THE STEPS

Beginning with the acute obstruction of a coronary artery, sequence the events that occur during necrosis of a myocardial cell.

28. Write the letters here in the correct order of the steps: _______________________________
A. ATP supply decreases within the cell.
B. Acute obstruction of coronary artery cuts off arterial blood supply to myocardium.
C. Cell runs on anaerobic metabolism because of lack of oxygen.
D. Cell bursts and spills its contents into the interstitial fluid.
E. Active transport of ions across the cell membrane slows.
F. Lysosomal enzymes destroy components of their own cell.
G. Osmosis causes cell swelling, and calcium accumulates in the cell.
H. Organelles, including lysosomes, swell and rupture.

COMPLETE THESE SENTENCES

Write one word in each blank to complete these sentences.

29. Active enzymes that dismantle the cellular components during apoptosis are called _______________.

30. Acute cellular swelling during ischemia is reversible if _______________ is supplied quickly.

31. Active tuberculosis disease is characterized by _______________ necrosis, whereas death of brain cells is character-
ized by _______________ necrosis.

32. During apoptosis, cell contents are contained in vesicles called _______________ _______________, which are
removed by _______________.

33. Liver enzymes metabolize most blood ethanol to _______________, which damages tissues.

34. When excessive reactive oxygen species overwhelm the endogenous antioxidant systems, _______________
_______________ occurs.

35. Death of the entire person is called _______________ death.

36. Melanin is synthesized by epidermal cells called _______________ and accumulates in epidermal cells called
_______________.

RESPOND TO THESE CLINICAL SITUATIONS

Place yourself in these situations and write your responses in the spaces provided.

37. Mr. Turin had severe crushing injuries of both lower extremities when his house collapsed on him during an earth-
quake. Among other abnormal values, his laboratory tests show elevated creatine kinase in his blood. Why is his
blood creatine kinase high?

38. Mrs. Montoya died peacefully in her sleep at home while lying prone. When her relatives discovered her body and
rolled her over, they saw purple discoloration of half of her face and of her abdomen. They are very concerned that
she might have been beaten the night before she died. What factual information do they need to relieve their concern?

Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 2 Altered Cellular and Tissue Biology
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39. The entire Berg family was in the hospital room when Mrs. Berg died quietly from terminal cancer. As the family
is preparing to leave, Kevin Berg, age 10, says to his mother, “I don’t think grandma is really dead. She’s just sleep-
ing. Dead people are stiff as boards. I saw that on TV. Grandma’s hands are cold, but her arms aren’t stiff.” His
mother looks at the nurse for help. In addition to addressing the emotional issues, what factual information should
be provided?

40. Two of your colleagues are discussing the effects of reactive oxygen species on cells. “Too many ROS cause necro-
sis,” says one. “But I read that too many ROS cause apoptosis,” says the other. What information should be explained
to them to clarify that both are correct?

DRAW YOUR ANSWERS

Read the questions and draw your answers.

These are normal cells that are capable of cell division and normally receive basal levels of hormonal stimulation.

Normal
(From Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing: assessment and management
of clinical problems, ed 6, St Louis, 2004, Mosby.)

41. Draw what these cells would look like after their hormonal stimulation has been reduced substantially for several
weeks.

42. Draw what these cells would look like after receiving excessive hormonal stimulation for several weeks.

IDENTIFY THE CHARACTERISTICS

Which of the following are characteristic of apoptosis? You may select more than one answer. Choose all that apply.

43. Write the letters of your choice(s) here: _____________________

A. Cell is damaged by its own lysosomal enzymes.
B. Cell shrinks when its cytoskeleton is dismantled.
C. The cell injury is reversible if nutrients are restored in time.
D. Process causes inflammation.
E. Sections of the cell bud off into vesicles.
F. Cell swells when osmosis occurs.
G. Process occurs when caspases are inactivated.

Chapter 2 Altered Cellular and Tissue Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
TEACH THESE PEOPLE ABOUT PATHOPHYSIOLOGY

Write your response to each situation in the space provided.

44. Kenesha Francis, age 9, broke her arm 6 weeks ago, and the cast will be removed today. Before the cast is removed,
teach her about the expected appearance of her arm in words appropriate to her age.

45. “The doctor said my heart enlarged because my blood pressure is high,” says Mr. Hendricks. “Please explain that!”

46. Mr. Bax has diabetes and will have amputation of toes shown in the photograph.

(From Damjanov I: Pathology for the health professions, ed 4, Philadelphia, 2012, Saunders.)

He says, “Why did my toes get black and hard rather than swollen and mushy like my dad’s toes did before surgery?”

Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 2 Altered Cellular and Tissue Biology
PUZZLE OUT THESE TECHNICAL TERMS

Use the clues to complete the puzzle, demonstrating your knowledge of important technical terms.

1 2

7 8

10

11

Across Down
1. Adaptive increase in the number 1. Adaptive increase in cell size
of cells 2. Adaptive decrease in cell size
7. Shrunken nucleus appearing as a 3. Loss of skeletal muscle mass and strength
small dense mass 4. Lack of oxygen to tissues caused by insufficient blood supply
10. Adaptive replacement of one ma- 5. Goes with mortis to denote postmortem reduction of body temperature
ture cell type by another normal 6. Abnormal change in size, shape, and organization of mature tissue cells
cell type 8. Nuclear dissolution and lysis of chromatin
11. Yellow-brown age pigment 9. Partial deprivation of oxygen

10

Chapter 2 Altered Cellular and Tissue Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
 The Cellular Environment: Fluids and
3 Electrolytes, Acids and Bases

CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

1. The osmolality of the intracellular fluid normally is (higher than, the same as, lower than) the extracellular fluid
because water crosses cell membranes (with difficulty, freely) through aquaporins.

2. (Sodium, Albumin) is primarily responsible for the plasma oncotic pressure.

3. Thirst prompts fluid intake through action of (baroreceptors, osmoreceptors) located in the (hypothalamus, posterior
pituitary).

4. Isotonic fluid excess causes (hypernatremia, hypervolemia).

5. Renal compensation for an acid-base balance is (fast, slow); pulmonary compensation for an acid-base balance is
(fast, slow).

6. Fluid moves out of capillaries by (osmosis, filtration) and into or out of cells by (osmosis, filtration).

7. Hypercapnia means an excess of (metabolic acid, carbon dioxide) in the blood.

8. The most dangerous effect of hyperkalemia is its action on the (kidneys, heart).

CATEGORIZE THESE CAUSES OF EDEMA

Write the major cause of the edema beside each clinical situation. Possible choices include: increased capillary hydro-
static pressure, decreased plasma oncotic pressure, increased capillary permeability, lymphatic obstruction.

�������������� 9. Tumor grows in lymph node

�������������� 10. Right heart failure

�������������� 11. Infected wound

�������������� 12. Clot in a vein

�������������� 13. Protein malnutrition

�������������� 14. Bee sting

�������������� 15. End-stage kidney disease

SELECT THE GREATER

Consider the pairs and select the one that is greater.

16. Who has a greater percentage of body weight as water: a lean woman or an obese woman?

17. Who has a greater percentage of body weight as water: an infant or an adolescent?

18. Who has a greater percentage of body weight as water if both persons weigh the same: a woman or a man?

11

Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 3 The Cellular Environment: Fluids and Electrolytes, Acids and Bases
19. Who has a greater percentage of body weight as water if both persons weigh the same: a 56-year-old man or a
78-year-old man?

20. Where is the potassium ion concentration greater: extracellular fluid or intracellular fluid?

21. Where is the sodium ion concentration greater: extracellular fluid or intracellular fluid?

22. Which is greater: the pH of an acid solution or the pH of an alkaline solution?

23. Which is greater: the respiratory rate during metabolic acidosis or the respiratory rate during metabolic alkalosis?

EXPLAIN THE PICTURES

Examine the pictures and answer the questions about them.

Na+ Na+
H2O H2O Na+
H2 O
Na+ H2O
Na+
Na+ Na+
Na+
Na+
Na+ H2O
H 2O Na+ Na+

Neuron Neuron Neuron

A B C

24. Compare the sodium concentration in panels A and B. Panel B shows isotonic fluid, so the fluid in A
is ______________, and the fluid in C is ______________.

25. Why did the neuron in panel A swell?

26. What cerebral clinical manifestations occur when neurons swell as in panel A?

27. Why are the cerebral clinical manifestations of the situation in panel C very similar to those in panel A?

12

Chapter 3 The Cellular Environment: Fluids and Electrolytes, Acids and Bases Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
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