Patho Final Practice Questions

The principle Ig mediator of type I hypersensitivity reactions is

IgE Immunoglobulin E (IgE) is the principal antibody mediating type I hypersensitivity reactions. IgA is not the primary Ig mediator of type I hypersensitivity reactions. IgG is involved in type II hypersensitivity reactions. IgM is involved in type II hypersensitivity reactions.

Allergic (extrinsic) asthma is associated with

IgE-mediated airway inflammation

Multiple sclerosis and Guillain-Barre syndrome are similar in that they both

Result from demyelination by an autoimmune reaction

After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence of

Right-sided heart failure The backward effects of right-sided heart failure are due to congestion in the systemic venous system and lead to lower extremity edema. Arterial obstruction is not associated with dependent edema of the lower extremities. Left-sided heart failure is associated with pulmonary symptoms. Edema may be associated with peripheral vascular disease, but dependent edema over a 1-hour period is related to right-sided heart failure.

A patient who reports dizziness and who has absent P waves, wide QRS complexes, and a heart rate of 30 bpm on an EKG is most likely in which rhythm

Ventricular escape rhythm A ventricular escape rhythm originates in the Purkinje fibers, has a rate of 15 to 40 beats/minute, and is characterized by a wide QRS complex. An important clue to identifying escape rhythms is the absence of normal P waves and PR intervals. The rhythm involved in third-degree heart block includes regularly occurring P waves. Junctional tachycardia has a heart rate between 70 to 140 beats/minute. P waves are preceding, following, or buried in the QRS complex. Sinus bradycardia has a normal pattern on the ECG, but with a rate of less than 60 beats/minute.

Clinical manifestations of a stroke within the right cerebral hemisphere include

left-sided muscle weakness and neglect Manifestations of ischemic stroke are related to the cerebral vasculature involved and the area of brain tissue the vessel supplies. Contralateral hemiplegia is a usual finding. Contralateral hemiplegia, hemisensory loss, and contralateral visual field blindness are usual manifestations of stroke. Left visual blindness would be more indicative of a stroke affecting the right cerebral hemisphere. Aphasia is an integrative language disorder that occurs with brain damage to the dominant cerebral hemisphere (usually left) and involves all language modalities.

Clinical manifestations of inspiratory crackles, increased tactile fremitus, egophony, and whispered pectoriloquy are indicative of

pneumonia

The hyper-secretion of mucus resulting for chronic bronchitis is the result of

recurrent infection. Mucus provides a hospitable environment for bacterial colonization and recurrent infection. Destruction of alveolar septa and reduced inflammation are not complications of chronic bronchitis. Hypersecretion of mucus does not contribute to barrel chest.

A patient is diagnosed with heart failure with normal ejection fraction. the patient is most likely characterized by an:

elderly woman without previous history of a MI Heart failure with normal ejection fraction is particularly likely to develop in the elderly, in women, and in those without a history of MI. A middle-aged man with a previous history of MI may have heart failure, but the older woman fits the criteria of heart failure with normal ejection fraction. A young female athlete with cardiomegaly may experience heart failure, but is not the normal patient profile for this condition. A young sedentary male with a high-stress job may experience heart failure, but this patient does not fit the normal profile for this condition.

Patients who experience anemic episodes when exposed to certain drugs most likely have

glucose-6-phosphate dehydrogenase deficiency Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a RBC intracellular defect. Usually this anemia is first recognized during or after an infectious illness or exposure to certain drugs. Thalassemia does not carry a manifestation associated with pharmacologic agents. Spherocytosis is a hereditary anemia with manifestations of jaundice. Episodes of sickle cell anemia are associated with recurrent painful episodes related to organ dysfunction.

Pulmonary edema usually begins at a pulmonary capillary wedge pressure or left atrial pressure of ____ mm Hg

20

Normal intracranial pressure is ____ mm Hg

5 to 15 mm Hg

A deficiency of which of the following may result in hypothyroidism?

Iodine

Which disorder is caused by hypersecretion of the growth hormone (GH) in adults?

Acromegaly

Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen?

Active acquired Active acquired immunity (active immunity) is produced by an individual after natural exposure to an antigen or after immunization, whereas passive acquired immunity (passive immunity) does not involve the host's immune response at all.

Risk factors for hemorrhagic stroke include

Acute hypertension Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often long-standing hypertension. Risk factors for stroke are similar to those for other atherosclerotic vascular disease. Cardiac disease complicated by atrial fibrillation is an important risk factor for embolic stroke. Sedentary lifestyle is not a risk factor for hemorrhagic stroke.

Which neurologic disorder is characterized by cortical nerve cell processes that have become twisted and dilated?

Alzheimer's disease Cortical nerve cell processes become twisted and dilated because of accumulation of the same filaments that form tangles resulting in Alzheimer disease.

Which anemia produces small, pale erythrocytes?

Iron deficiency The microcytic-hypochromic anemias, which include iron deficiency anemia (IDA), are characterized by erythrocytes that are abnormally small and contain abnormally reduced amounts of hemoglobin.

In which dysrhythmias should treatment be instituted immediately?

Atrial fibrillation with a ventricular rate of 220 Beats/min Atrial fibrillation is a completely disorganized and irregular atrial rhythm accompanied by an irregular ventricular rhythm of variable rate. Atrial fibrillation causes the atria to quiver rather than to contract forcefully. This allows blood to become stagnant in the atria and may lead to formation of thrombi. This condition requires resuscitation because of the reduction in cardiac output. The cause of the bradycardia should be investigated, but is not treated emergently when an individual is not exhibiting any symptoms. Fever-induced tachycardia will correct itself once the fever is lowered. Dysrhythmias are treated if they produce significant symptoms or are expected to progress to a more serious level.

What pathologic alteration produces tremors at rest, rigidity, akinesia, and postural abnormalities?

Atrophy of neurons in the substantial nigra that produce dopamine The hallmark characteristics of Parkinson disease are a result of a loss of dopaminergic pigmented neurons in the substantia nigra (SN) pars compacta with dopaminergic deficiency in the putamen portion of the striatum (the striatum includes the putamen and caudate nucleus).

What is the pathophysiologic process of aplastic anemia?

Autoimmune disease against hematopoiesis by activated cytotoxic T cells Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Cytotoxic T cells (Tc cells) appear to be the main culprits.

If a boy inherits a disease that is autosomal recessive, he inherited it from his

Both parents In most cases of recessive disease, both parents of affected individuals are heterozygous carriers.

HIV infection of T-helper cells is facilitated by attachment of the viral envelope protein gp120 to

CD4 proteins on helper cells The HIV envelope protein gp120 specifically binds to the CD4 receptor. The receptor cells of the CD4 cells are attracted to virus changes. Reverse transcriptase is not found to be attracted to the gp120 protein at this time. The macrophage lipid bilayer is not associated with the CD4 receptor.

The cause of pulmonary edema in ARDS is the result of increased

Capillary permeability Increased capillary permeability, a hallmark of ARDS, allows fluids, proteins, and blood cells to leak from the capillary bed into the pulmonary interstitium and alveoli. The resulting pulmonary edema and hemorrhage severely reduce lung compliance and impair alveolar ventilation.

Low cardiac output in association with high preload is characteristic of _____ shock

Cardiogenic In cardiogenic shock, preload is high and cardiac output is low. In hypovolemic shock, preload and cardiac outputs are both low. In anaphylactic shock, blood volume may be normal. Septic shock is associated with infections.

It is true that epidural bleeding is

Characterized by a lucid interval immediately after injury The source of bleeding in most epidural hematomas is arterial. The patient may suffer only a brief period of disturbed consciousness followed by a period of normal cognition (lucid interval). Then consciousness rapidly deteriorates as the epidural hematoma expands and compresses brain structures. As the epidural hematoma expands, pressure is placed on the brain structures. The bleeding associated with an epidural hematoma occurs between the inner surface of the skull and the dura mater. The source of bleeding in most epidural hematomas is arterial.

What are clinical manifestations of hypothyroidism?

Constipation, decreased heat rate, and lethargy

A man with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; urine glucose and ketones positive; serum K+ 2 mEq/L; serum Na+ 130 mEq/L. He reports that he has been sick with the "flu" for 1 week. What relationship do these values have to his insulin deficiency?

Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis, which has resulted in the symptomatology referred to in the stem.

What is the usual source of pulmonary emboli

Deep vein thrombosis

the immune system disorder associated with HIV is

Deficiency of T-helper lymphocytes HIV has been identified as a type of retrovirus associated with a disorder of the T-helper lymphocytes. T-cells have an interaction with B-cells, but this relationship is not associated with HIV. Immature blast cells are not the deficiency that contributes to HIV. Cancerous growths of lymphatic tissue have not been found to be the source of HIV.

what is the central component of the pathogenic model of multiple sclerosis?

Demyelination of nerve fibers in the CNS

Clinical manifestations of parkinson disease are caused by a deficit in which neurotransmitter?

Dopamine

The parents of a child with PKU are concerned about the risk of transmitting the disorder in future pregnancies. The correct assessment of the risk is

Each child has a 25% chance of being affected As an autosomal recessive disorder, the mating of two carriers (heterozygous) results in a 1 in 4 chance of producing an affected offspring and a 2 in 4 chance of producing an offspring who carries the disease. The mating of two carriers (heterozygous) results in a 2 in 4 chance of producing an offspring who carries the disease. The mating of two carriers (heterozygous) results in a 1 in 4 chance of producing an affected offspring and a 2 in 4 chance of producing an offspring who carries the disease. One can predict the risk of future pregnancies.

Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke?

Embolic High-risk sources for the onset of embolic stroke are atrial fibrillation (15% to 25% of strokes), left ventricular aneurysm or thrombus, left atrial thrombus, recent myocardial infarction, rheumatic valvular disease, mechanical prosthetic valve, nonbacterial thrombotic endocarditis, bacterial endocarditis, patent foramen ovale, and primary intracardiac tumors.

Seizures that involve both hemispheres at the outset are termed

Generalized Episodes in which the entire brain is involved from the onset of the seizure are referred to as generalized seizures. Partial seizures are those in which activity is restricted to one brain hemisphere. Complex partial seizures are restricted to one area of the brain. Focal seizures are classified as partial.

In contrast to all other types of shock, they hyper dynamic phase of septic shock is associated with

High cardiac output In the hyperdynamic stage of septic shock, blood pressure falls because of the decreased systemic vascular resistance and decreased venous return. The heart rate and stroke volume increase and cardiac output is higher than normal. In the hyperdynamic phase of septic shock, afterload is not high. Cardiac output is high in the hyperdynamic stage of septic shock. The heart rate and stroke volume increase during the hyperdynamic stage of septic shock.

If a boy has hemophilia A, he inherited it from

His mother Because a father can give a son only a Y chromosome, the trait is never transmitted from father to son

Which inflammatory mediators are produced in asthma?

Histamine, prostaglandins, and leukotrienes

In ARDS, alveoli and respiratory bronchioles fill with fluid as a result of the

Inactivation of surfactant and the impairment of type II alveolar cells Lung inflammation and injury damages the alveolar epithelium and the vascular endothelium. Surfactant is inactivated, and its production by type II alveolar cells is impaired as alveoli and respiratory bronchioles fill with fluid or collapse.

Which Clinical finding is most indicative of an acute bacterial infection?

Increased (band) neutrophils Neutrophils are early responders and most active in bacterial infections, and the number of neutrophil bands indicates the severity of the infection. Elevated temperature can occur in infection caused by any organism. The erythrocyte sedimentation rate is non-specific for the type of organism causing an infection. The total WBC count can increase in any infection. The specific type of WBC that is elevated indicates the type of organism involved.

Dramatic hypotension sometimes accompanies type I hypersensitivity reactions because

Massive histamine release from the mast cells leads to vasodilation Hypotension can occur in type I hypersensitivity due to massive histamine release leading to vasodilation. Toxins are not released during type I hypersensitivity reactions. Sweating occurs as a reaction to shock from severe hypotension; the hypotension occurs first and is due to histamine release. Hypoxia occurs in anaphylaxis due to shock from severe hypotension; the hypotension occurs first and is due to histamine release.

Left sided heart failure is characterized by

Pulmonary congestion Left-sided heart failure is characterized by pulmonary congestion and edema. Right-sided heart failure is characterized by congestion in the systemic venous system that increases systemic vascular resistance. Jugular vein distention is a classic sign of right-sided heart failure. Peripheral edema is seen in right-sided failure.

A college student living in a dormitory reports a stiff neck and headache and is found to have a fever of 102F. this information is most consistent with

Meningitis The combination of headache, fever, stiff neck, and signs of confusion are classic symptoms of meningitis. Clinical manifestations of encephalitis include fever, headache, and confusion that evolve over several days. Symptoms of a skull fracture are unrelated to fever and headache. Fever is not associated with cerebral ischemia.

Open-angle glaucoma occurs because of ____ humor

Obstructed outflow of aqueous Open-angle glaucoma is characterized by intraocular pressures above the normal pressures of 12 to 20 mmHg maintained by the inadequate outflow of aqueous fluid.

Which of the following is classified as a macrocytic-normochromic anemia?

Pernicious Pernicious anemia (PA), a form of macrocytic-normochromic anemia, is the most common type of megaloblastic anemia, caused by vitamin B12 deficiency.

First-degree heart block is characterized by

Prolonged PR interval First-degree block is generally identified by a prolonged PR interval (more than 0.20 second) on ECG. P waves are not absent in first-degree heart block. A widened QRS complex is associated with a particular dysrhythmia, but not first-degree heart block. A variable PR interval is found in type I second-degree block.

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what?

Septic Patients presenting with septic shock may have fever and hypotension. In addition, lactic acidosis may be present because of tissue hypoxemia. Presentation of cardiogenic shock is not inclusive of fever or lactic acidosis. Patients in anaphylactic shock do not have fever or lactic acidosis, and may have normal vital signs initially. Neurogenic shock may result from depression of the vasomotor center in the medulla.

Which of the following laboratory values would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)?

Serum Na+ 120 and serum hypo-osmolality A diagnosis of SIADH requires a serum sodium level less than 135 mEq/L, serum hypo-osmolality less than 280 mOsm/kg, and urine hyperosmolarity. Potassium levels are not considered a factor.

Functions of B cells include

Synthesizing antibodies B lymphocytes mature into plasma cells and synthesize antibodies. B cells do not secrete cytokines, kill antigen-presenting cells, or kill virally infected cells; T cells do these.

Which pleural abnormality involves a site of pleural rupture that act as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration

Tension pneumothorax

The primary reason that prolonged seizure activity predisposes to ischemic brain damage is that

The lack of airway maintenance can lead to hypoxia Status epilepticus is a continuing series of seizures without a period of recovery between seizure episodes. Irreversible brain damage and possible death from hypoxia, cardiac arrhythmias, or lactic acidosis can occur if the airway is not maintained and seizure activity is not halted. Prolonged seizure activity is unrelated to glucose transportation by neurons. Status epilepticus can cause cardiac arrhythmias, but the primary concern of prolonged seizure activity is maintaining a proper airway. Brainstem depression is not the primary reason that prolonged seizure activity causes ischemic brain damage.

What alteration occurs in injured endothelial cells that contributes to atherosclerosis?

They are unable to make the normal amount of vasodilating cytokines

Type 2 diabetes mellitus is best described as:

a resistance to insulin by insulin-sensitive tissues.

Parkinson disease is a degenerative disorder of the

basal cell ganglia

Dementia is characterized by

loss of recent and remote memory Memory is the most common cognitive ability lost but the dementias are all characterized by reduction in cognitive functions (intellectual function). Mental abilities are impaired, with a decrease in orienting, recent memory, remote memory, language, executive attentional functions, and alterations in behavior.

Emphysema results from destruction of alveolar walls and capillaries, which is due to

release of proteolytic enzymes from immune cells. The pathologic changes leading to alveolar destruction are associated with the release of proteolytic enzymes from inflammatory cells such as neutrophils and macrophages. While air trapping occurs in emphysema, the destruction of alveolar walls and capillaries is due to release of proteolytic enzymes. Lack of α1-antitrypsin can result in emphysema. Autoantibodies are not involved in destruction of alveolar walls and capillaries in emphysema.

Cognitive operations cannot occur without the _____ functioning

reticular activating system Awareness encompasses all cognitive functions that embody awareness of self, environment, and affective states (i.e., moods). Consciousness often is viewed as having two distinct components: arousal and awareness. Arousal, an attentional system, is the state of awakeness that an individual exhibits. Level of arousal is mediated by the reticular activating system.

Graves disease develops from a(n):

thyroid-stimulating immunoglobulins that causes overproduction of thyroid hormones. The pathology of Graves disease indicates that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms that result in the stimulation of excessive TH.