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Study Guide for

Understanding
Pathophysiology

Sue E. Huether, MSN, PhD

Professor Emeritus
College of Nursing
University of Utah
Salt Lake City, Utah

Kathryn L. McCance, MSN, PhD

Professor
College of Nursing
University of Utah
Salt Lake City, Utah

Section Editors
Valentina L. Brashers, MD
Professor Nursing and Attending Physician in Internal Medicine
University of Virginia Health System
Charlottesville, Virginia

Neal S. Rote, PhD

Academic Vice-Chair and Director of Research
Department of Obstetrics and Gynecology
University Hospitals of Cleveland;
Professor of Reproductive Biology and Pathology
Case School of Medicine
Case Western Reserve University
Cleveland, Ohio

Prepared by
Clayton F. Parkinson, PhD
Professor Emeritus
College of Health Sciences
Weber State University
Ogden, Utah

  
3251 Riverport Lane
St. Louis, Missouri 63043

STUDY GUIDE FOR UNDERSTANDING PATHOPHYSIOLOGY, ISBN: 978-0-323-08489-5

5TH EDITION

Copyright © 2012, 2008, 2004, 2000, 1996 by Mosby, an imprint of Elsevier Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge
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Senior Editor: Sandra Clark
Senior Developmental Editor: Charlene Ketchum
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Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2

 Reviewers

Mandi Counters, RN, MSN, CNRN

Assistant Professor
Nursing Department
Mercy College of Health Sciences
Des Moines, Iowa

Bradley R Harrell, DNP, ACNP-BC, CCRN

Assistant Professor of Nursing
School of Nursing
Union University-Germantown
Germantown, Tennessee

Jane Cross Norman, Ph.D., R.N., CNE

Professor of Nursing
MSN Program Director
Tennessee State University
Nashville, Tennessee

Marylou Virginia Robinson, PhD, FNP-C

Assistant Professor
College of Nursing
University of Colorado
Aurora, Colorado

v
    Reviewers
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 Preface

The study of pathophysiology is complex, ever expanding, and challenging. It requires correlations between normal and
abnormal anatomy and physiology as well as the processes resulting in the manifestations of disease.
This Study Guide is designed for students as an adjunct to Understanding Pathophysiology, fifth ­edition, by Sue E.
Huether and Kathryn L. McCance. It is intended to facilitate an understanding of the consequences of pathologic proc-
esses on the structure and function of the human body.
The Study Guide contains 40 chapters, each following the organization of the textbook. The Guide’s chapters have
two different formats—one for normal anatomy and physiology and another for anatomic and physiologic alterations.
For the normal anatomy and physiology chapters, it is assumed that the student possesses foundational ­knowledge of
anatomy and physiology; therefore, no supplemental narrative is provided.
n These chapters have foundational objectives that direct review of the information, principles, and ­concepts that are
essential for understanding the specific ­diseases that follow in the next chapter. Chapters five and six depart from the
usual normal anatomy and ­physiology chapter’s format. This departure is because ­inflammation and immunity con-
cepts are frequently referenced throughout the following text and study guide ­chapters.
n Each chapter has a practice examination to give ­students an opportunity to assess their understanding of normality.
The chapters on alterations direct the learner’s study of abnormal anatomy and physiology.
n These chapters include 1) foundational objectives for review and 2) learning objectives for study with ­narrative, charts,
and tables.
n Each chapter has a practice examination requiring factual and conceptual knowledge related to disease mechanisms.
n Each chapter includes one or two case studies linking fact and concept to reality that require analysis and applica-
tion.
The objectives for all chapters are referenced to ­corresponding pages in the fifth edition of Understanding
Pathophysiology. Huether and McCance’s philosophy that students need to grasp basic laws and principles to understand
how alterations occur led them to develop an understandable and conceptually integrated textbook.
I enjoyed working with Mosby, particularly with Charlene Kechum and Jeanne Genz. All of Mosby’s staff ensured
that my efforts were developed into a creative, professional, and pleasing style for student learners. I wish to dedicate
my efforts during the preparation of this Study Guide to students who inspired me to search for a better way to convey
information to them.

Clayton F. Parkinson

vii
    Preface
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 Contents

Part One Basic Concepts of Pathophysiology

Unit 1 The Cell
1. Cellular Biology, 1
2. Genes and Genetic Diseases, 5
3. Altered Cellular and Tissue Biology, 11
4. Fluids and Electrolytes, Acids and Bases, 17

Unit 2 Mechanisms of Self-Defense

5. Innate Immunity: Inflammation and Wound ­Healing, 25
6. Third Line of Defense: Adaptive Immunity, 33
7. Infection and Defects in Mechanisms of Defense, 39
8. Stress and Disease, 47

Unit 3 Cellular Proliferation: Cancer

9. Biology, Clinical Manifestations, and Treatment of Cancer, 53
10. Cancer Epidemiology, 63
11. Cancer in Children, 69

PART TWO BODY SYSTEMS AND DISEASES

Unit 4 The Neurologic System
12. Structure and Function of the Neurologic System, 73
13. Pain, Temperature, Sleep, and Sensory Function, 77
14. Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function, 85
15. Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction, 95
16. Alterations of Neurologic Function in Children, 107

Unit 5 The Endocrine System

17. Mechanisms of Hormonal Regulation, 113
18. Alterations of Hormonal Regulation, 117

Unit 6 The Hematologic System

19. Structure and Function of the Hematologic System, 131
20. Alterations of Hematologic Function, 135
21. Alterations of Hematologic Function in Children, 147

Unit 7 The Cardiovascular and Lymphatic Systems

22. Structure and Function of the Cardiovascular and Lymphatic Systems, 153
23. Alterations of Cardiovascular Function, 157
24. Alterations of Cardiovascular Function in Children, 177

Unit 8 The Pulmonary System

25. Structure and Function of the Pulmonary System, 183
26. Alterations of Pulmonary Function, 187
27. Alterations of Pulmonary Function in Children, 199

ix
    Contents
Unit 9 The Renal and Urologic Systems
28. Structure and Function of the Renal and Urologic Systems, 205
29. Alterations of Renal and Urinary Tract Function, 209
30. Alterations of Renal and Urinary Tract Function in Children, 219

Unit 10 The Reproductive Systems

31. Structure and Function of the Reproductive Systems, 225
32. Alterations of the Reproductive Systems, Including Sexually Transmitted Infections, 229

Unit 11 The Digestive System

33. Structure and Function of the Digestive System, 243
34. Alterations of Digestive Function, 247
35. Alterations of Digestive Function in Children, 261

Unit 12 The Musculoskeletal and Integumentary Systems

36. Structure and Function of the Musculoskeletal System, 267
37. Alterations of Musculoskeletal Function, 271
38. Alterations of Musculoskeletal Function in Children, 285
39. Structure, Function, and Disorders of the Integument, 291
40. Alterations of the Integument in Children, 303

Answers to Practice Examinations, 309

x
Contents
 SECTION ONE UNITE TITLE
UNIT
ORONE
SECTION
THE TITLE
CELL

1 Cellular Biology

FOUNDATIONAL OBJECTIVES 10. Identify the phases of mitosis and cytokinesis.

After reviewing this chapter, the learner will be able to Review pages 22-23; refer to Figure 1-26.
do the following:
11. Describe the stimulation of cell proliferation by
1. State the functions of a typical eukaryotic cell. growth factors.
Review pages 2-3. Review pages 23-24; refer to Figure 1-27 and Table 1-5.

2. Describe the structure and function of the nucleus 12. Characterize pattern formation.
and identify the cytoplasmic organelles. Review page 24.
Review page 3; refer to Figures 1-1 and 1-2 and
Table 1-1. 13. Identify the location and a major function for
each type of tissue: epithelial, connective, muscle,
3. Describe the structure and function of the plasma and nervous.
membrane. Refer to Boxes 1-3 through 1-5.
Review pages 3 and 5-7; refer to Figures 1-3 through
1-5 and Tables 1-2 and 1-3. PRACTICE EXAMINATION

4. Describe cellular receptors. Multiple Choice

Review pages 7-8; refer to Figure 1-6. Circle the correct answer for each question:

5. Identify the three mechanisms that bind cells 1. Which are principal parts of a eukaryotic cell?
together. a. fat, carbohydrate, and protein
b. minerals and water
Review pages 8-9; refer to Figures 1-7 and 1-8. c. organelles
d. phospholipids and protein
6. Describe the primary modes of chemical signaling. e. protoplasm and nucleus
Review pages 9, 11, and 13 refer to Figures 1-9
through 1-12 and Table 1-3. 2. The cell membrane is described as a fluid mosaic.
Some proteins have a degree of mobility within the
lipid bilayer. (More than one answer may be correct.)
7. Describe cellular catabolism and the transfer of
a. The first sentence is true.
energy to accomplish other cellular processes.
b. The first sentence is false.
Refer to Figures 1-13 through 1-15. c. The second sentence is true.
d. The second sentence is false.
8. Differentiate between passive and active e. The second sentence is relevant to the first.
transport, between endocytosis and exocytosis, f. The second sentence is irrelevant to the first.
and between phagocytosis and pinocytosis.
Refer to Figures 1-16 through 1-24 and Table 1-4.

9. Describe the changes in the plasma membrane

that result in an action potential.
Review pages 21-22; refer to Figure 1-25.
1
Copyright © 2012, 2008, 2004, 2000, 1996 by Mosby, an imprint of Elsevier Inc. All rights reserved. Chapter 1  Cellular Biology
 3. Which particle can penetrate cell membranes most 11. Which are characteristic of epithelial tissue? (More
easily? than one answer may be correct.)
a. lipid soluble, transport protein present a. elasticity
b. neutral charge, water soluble b. protection
c. smaller, water soluble c. fills spaces between organs
d. uncharged, larger d. secretion

4. For a cell to engage in active transport processes, it 12. Signaling molecules cause all of the following
requires: except:
a. mitochondria. a. acceleration/initiative of intracellular protein
b. appropriate fuel. kinases.
c. ATP. b. arrest of cellular growth.
d. enzymes. c. apoptosis.
e. All of the above are correct. d. conversion of an intracellular signal into an
extracellular response.
5. Which is inconsistent with the others?
a. diffusion 13. Ligands that bind with membrane receptors include
b. osmosis which of the following? (More than one answer
c. filtration may be correct.)
d. phagocytosis a. hormones
e. facilitated diffusion b. antigens
c. neurotransmitters
6. Which can transport substances uphill against the d. drugs
concentration gradient? e. infectious agents
a. active transport
b. osmosis 14. The products from the metabolism of glucose
c. dialysis include which of the following? (More than one
d. facilitated diffusion answer may be correct.)
e. None of the above is correct. a. kilocalories
b. CO2
7. Caveolae: c. H2O
a. serve as repositories for some receptors. d. ATP
b. provide a route for transport into a cell.
c. relay signals into cells. 15. Identify the correct sequence of events for initiation
d. All of the above are correct. and conduction of a nerve impulse.
1. Sodium moves inside.
8. Which statement is true for cytoplasm? 2. Potassium leaves cell.
a. It is located outside the nucleus. 3. Sodium permeability changes.
b. It provides support for organelles. 4. Resting potential is reestablished.
c. It is mostly water. 5. Potassium permeability changes.
d. a, b, and c a. 1, 3, 2, 5, 4
e. a and b b. 3, 1, 5, 2, 4
c. 5, 2, 3, 1, 4
9. The retinoblastoma (Rb) protein: d. 4, 5, 2, 3, 1
a. is a brake on the progress of the cell cycle.
b. binds to gene regulatory proteins. 16. Increased cytoplasmic calcium:
c. slows cell proliferation. a. causes one cell to adhere to another.
d. a and c b. increases permeability at the junctional complex.
e. a, b, and c c. decreases permeability at the junctional complex.
d. None of the above is correct.
10. A major function of connective tissue is:
a. to form glands. 17. Cell junctions:
b. support and binding. a. coordinate activities of cells within tissues.
c. covering and lining. b. are an impermeable part of the plasma
d. movement. membrane.
e. to conduct nerve impulses. c. hold cells together.
d. Both a and c are correct.
e. Both b and c are correct.

2
Chapter 1  Cellular Biology Copyright © 2012, 2008, 2004, 2000, 1996 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Matching
Match the term with its descriptor:
18. Anaphase a. 75% to 90% H2O, lipids, and protein
b. within the nucleus, stored RNA
19. Chromatin c. compartmentalizes cellular activity
20. Metaphase d. single strand of DNA, nondividing cell
e. “generation plant” for ATP
21. Mitochondria f. centriole migration
22. Prophase g. chromatid pair alignment
h. chromatid migration
23. Ribosome i. daughter nuclei
j. protein synthesis site

Match the location with the tissue type found:

24. Lining of the kidney tubules a. simple squamous
b. simple cuboidal
25. Lining of the upper respiratory tract c. simple columnar, ciliated
d. stratified squamous
e. transitional

Fill in the Blank

Complete the following table identifying membrane transport of cellular intake or output:

Membrane Transport

Transport Mechanism Description

Diffusion

Filtration

Osmosis

Mediated transport Two molecules move simultaneously in one direction

(symport) or in opposite direction (antiport) or a single
molecule moves in one direction (uniport)

Passive mediated transport/facilitated diffusion Does not require the expenditure of metabolic energy (ATP)

Active mediated transport Requires the expenditure of metabolic energy (ATP)

Endocytosis

Pinocytosis

Phagocytosis

3
Copyright © 2012, 2008, 2004, 2000, 1996 by Mosby, an imprint of Elsevier Inc. All rights reserved. Chapter 1  Cellular Biology
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