Exam 2 Questions
In the context of a workshop on rheumatoid arthritis, a clinical educator is teaching a group of nurses about autoimmune diseases. Which of the following statements by an attendee would the educator most likely want to follow up with further teaching? A) "Introduction of a foreign antigen can sometimes induce a cascade of immune response that is not self-limiting" B) "Often the problem can be traced to antigens that sensitize T cells without the need for presentation." C) "In some cases, the body attacks its own cells that are chemically similar to those of infectious organisms." D) "Sometimes when the body's own cells are released after a long time, they are interpreted as being foreign."
Ans: A Feedback: Autoimmune responses are not considered to be uncontrolled cascades of immune response that are catalyzed by introduction of an antigen. Superantigens are able to forego the normal antigen presentation process and directly stimulate T-cell response, resulting in overactivation of T cells. Molecular mimicry involves the misidentification of somatic cells as similar foreign cells, and self-antigens that have been sequestered for long periods can invoke an immune response.
All antiretroviral medications interfere with some stage of the HIV life cycle. What stage do protease inhibitors prevent? A) Cleavage of the polyprotein chain into the individual proteins that will be used to make new virus B) Addition of more nucleosides to the DNA chain C) Killing of the CD4+ T cell to release virions into the bloodstream D) Attachment of the virus to CD4+ cell receptors
Ans: A Feedback: By binding to the protease enzyme and inhibiting its function, protease inhibitors prevent cleavage of the polyprotein chain into individual proteins. Virions are still released into the body, but they are immature and noninfectious.
A 67-year-old patient diagnosed with myasthenia gravis will likely display which clinical manifestations as a result of autoantibodies ultimately blocking the action of acetylcholine, resulting in destruction of the receptors? A) Weakness of the eye muscles; difficulty in swallowing and slurred speech; impaired gait B) Tremor of hands/arms; rigidity of the arms; shuffling gait C) Short-term memory lapses; problems with orientation; a lack of drive or initiative D) Facial droop; slurred speech; weakness on one side of the body
Ans: A Feedback: Myasthenia gravis ultimately results in destruction of receptors in the neuromuscular junction leading to a decrease in neuromuscular function. Answer B relates to s/s of Parkinson disease; answer C relates to Huntington disease; and answer D relates to classic s/s of CVA.
A school nurse is teaching high school students about HIV and AIDS in the context of the school's sexual health curriculum. Which of the students' following statements would the nurse most likely want to correct or clarify? A) "They have to take a blood sample from you in order to test you for AIDS." B) "Drugs for AIDS reduce the virus in your body, but they don't get rid of it." C) "Lots more heterosexual people get HIV these days than they used to." D) "Condoms provide really good protection from AIDS."
Ans: A Feedback: Oral tests now exist for preliminary diagnosis of HIV. Medications for AIDS do not cure the disease, and incidence is increasing among heterosexuals. Condoms provide effective protection from the virus.
After several months on a waiting list, a 44-year-old male received a liver transplant 5 days ago. In the last 36 hours, he has developed a rash beginning on his palms and soles, along with abdominal pain and nausea. It has been determined by his care team that the immune response that is causing his symptoms originates not with his own compromised immune components but with those introduced with his new organ. This man's most likely medical diagnosis is A) graft versus host disease (GVHD). B) acute transplant rejection. C) hyperacute organ rejection. D) T-cell-mediated graft rejection.
Ans: A Feedback: Rash, gastrointestinal involvement, and pernicious activity by donor immune cells are the hallmarks of GVHD. The description does not suggest acute or hyperacute transplant rejection, and T-cell-mediated rejection is not a diagnosis in and of itself, but rather one of the mechanisms of transplant rejection.
A 40-year-old male who has been HIV positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which of the following aspects of his immune system is likely to remain most intact? A) Presentation of major histocompatibility molecules on body cells B) Orchestration of natural killer cells as part of cell-mediated immunity C) Activation of B lymphocytes D) Phagocytic function of monocytes and macrophages
Ans: A Feedback: The expression of MHC on various cells of the body is not noted to be directly influenced by HIV. However, infected CD4+ cells are compromised in their ability to guide the action of NK cells, to direct phagocytic function of macrophages, and to present antigens that activate B cells.
2. A 2-year-old girl has had repeated ear and upper respiratory infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child's recurrent infections? A) The child's immune system is unable to synthesize adequate immunoglobulin on its own. B) The child had a congenital absence of IgG antibodies that her body is only slowly beginning to produce independently. C) The child was born with IgA and IgM antibodies, suggesting intrauterine infection. D) The child lacks the antigen-presenting cells integral to normal B-cell antibody production.
Ans: A Feedback: Transient hypogammaglobulinemia of infancy is characterized by inadequate communication between B and T cells. IgG would be inherited through placental blood, and an intrauterine infection is neither causative or nor synonymous with transient hypogammaglobulinemia of infancy. The diagnosis does not include a lack of antigen-presenting cells.
A patient diagnosed with a primary immunodeficiency disorder has asked his siblings to be tested as possible stem cell donors. When discussing this procedure with his family, the nurse emphasizes that stem cells can be harvested from: Select all that apply. A) bone marrow. B) peripheral blood. C) skin tissue harvesting. D) mouth swabs. E) tears.
Ans: A, B Feedback: Hematopoietic stem cells can be harvested from either the bone marrow or the peripheral blood and also from the umbilical cord blood. From sibling donors, the results are effective with improved survival in approximately 90% of people.
A patient comes into a clinic complaining of cough, fever, and shortness of breath. The patient informs the health care provider that he is HIV positive. Upon physical exam, the family nurse practitioner (FNP) may note which of the following clinical manifestations of suspected Pneumocystis jiroveci pneumonia (PCP)? Select all that apply. A) Interstitial infiltrates on chest x-ray B) Respiratory rate of 32 with normal breath sounds C) Stridor when taking a deep breath D) Use of abdominal muscles to breathe while sitting on the exam table E) Night sweats that require clothing changes frequently throughout the night
Ans: A, B Feedback: PCP is a common presenting manifestation of AIDS or people with compromised immune systems. The symptoms include cough, fever, shortness of breath, and weight loss. Physical exam demonstrates only fever and tachypnea (elevated respiratory rate) and normal breath sounds. Chest x-ray shows interstitial infiltrates. Night sweats are usually associated with tuberculosis infection.
When counseling a male patient with suspected HIV, the nurse informs him that if the enzyme-linked immunosorbent assay (ELISA) comes back positive, then A) no further testing is required since this confirms HIV infection. B) a second test known as the Western blot assay will be ordered to confirm positive HIV status. C) he will be sent to an infectious disease physician for a tissue biopsy to confirm infection. D) if the second test, the Western blot, returns negative, he has not developed a case of full-blown AIDS.
Ans: B Feedback: If ELISA is positive, his blood sample is then sent for Western blot assay. If the Western blot is positive, diagnosis of HIV is confirmed. If the Western blot is negative, then the person is not infected with HIV.
A male elementary school student has a severe allergy to peanuts and is displaying the signs of anaphylactic shock after inadvertently eating a peanut-containing candy bar. Which of the following statements best captures the boy's current status and preferred treatment? A) He is experiencing shortness of breath caused by potent vasoconstriction that can be relieved by epinephrine injection. B) He is approaching vascular shock and developing edema due to actions of IgE antibodies, situations that can be reversed by administration of epinephrine. C) His mast cells and basophils have been sensitized, but systemic effects can be mitigated by administration of bronchodilators. D) He is likely in a primary- or initial-stage allergic response that can be relieved by antihistamine administration.
Ans: B Feedback: Anaphylactic reactions are often accompanied by vascular shock and edema, and the normal treatment is epinephrine injection. Symptoms are caused by vasodilation, not vasoconstriction; bronchodilators are not the ideal treatment.
Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? A) A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use B) A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM C) A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells D) A 9-year-old girl who has a diagnosis of IgA deficiency
Ans: B Feedback: Decreased IgA, IgE, and IgG with increased IgM levels are characteristic of X-linked immunodeficiency with hyper-IgM, a primary cell-mediated immunodeficiency that would respond to thymic tissue transplantation and MHC-compatible bone marrow. Low IgG levels secondary to phenytoin use, X-linked hypogammaglobulinemia, and selective IgA deficiency are unlikely to be treated with the T-cell-focused treatments like thymic tissue transplantation and MHC-compatible bone marrow.
A nurse has just learned that her child has a life-threatening complement disorder known as hereditary angioneurotic edema (HAE). Due to deficiency in C1-INH, the nurse needs to be prepared for which possible life-threatening clinical manifestation? A) Bulging eyeballs B) Swelling of the airway C) Compressed carotid arteries D) Compression of brachial nerves
Ans: B Feedback: HAE is a rare, life-threatening complement disorder that results from deficiency of C1-inhibitor (HAE-C1-INH). It is an inherited autosomal dominant trait that causes mutation in the 11th chromosome. Deficiencies in C1-INH result in uncontrolled release of vasoactive substances that promote vascular permeability. The net result is the development of swelling in the subcutaneous tissues of the extremities, face/torso, or upper airway and GI tract. Laryngeal edema is a life-threatening manifestation that can lead to complete airway obstruction and death without interventions.
While teaching about HIV/AIDS to a group of high school seniors, the school health nurse will begin by explaining the basic facts that will likely include which of the following information? A) Like all viruses, HIV is a genetic material made from DNA with long molecules that carry genetic information. B) HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells. C) There are two types of HIV, but the one that is endemic to the United States is HIV type 2. D) HIV type 1 for some reason rarely develops into full-blown AIDS.
Ans: B Feedback: HIV is a retrovirus that selectively attacks the CD4+ T lymphocytes, the immune cells responsible for orchestrating and coordinating the immune response to infection. It must change from RNA to DNA through a series of stages in order to get in a cell and begin replication. HIV type 2 is endemic in West Africa but is rarely seen in other parts of the world. People with HIV-2 tend not to develop AIDS.
Which of the following patients would be considered to be in the latent period of HIV infection? A) A 16-year-old prostitute who has open sores on her labia that drain purulent secretions B) A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months C) A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood that started 2 weeks ago D) A 24-year-old college student who has developed a chronic cough that will not go away, even after taking two courses of antibiotics.
Ans: B Feedback: In the latent period, which can last up to 10 years, the CD4+ count falls gradually to approximately 200 cells/µL. Some people experience swollen lymph nodes that are chronically swollen for more than 3 months in at least two locations, not including the groin. The lymph nodes may be sore or visible externally.
17. A female dental assistant has developed signs and symptoms of a latex sensitivity and is undergoing allergy testing as well as blood work. Which of the following components of the assistant's blood work would most likely be the focus of her health care provider's analysis? A) Analysis of class II MHC antigens B) Serum IgE immunoassays C) Serum B-lymphocyte levels D) Serum CD8+ levels
Ans: B Feedback: Latex sensitivity can be either a type I or type IV reaction. Though Th1 levels are relevant in a type IV reaction, IgE analysis is the most common component of relevant blood work. MHC and CD8+ levels are unlikely to be considered.
Following a spider bite she received while camping, a 20-year-old female presented to the emergency department with rash, edema, and fever and was subsequently diagnosed with serum sickness. Which of the following statements best conveys the physiological rationale for the broad systemic effects of this event? A) The woman is experiencing diffuse tissue necrosis as a consequence of an Arthus reaction. B) Antigen-antibody complexes have been deposited in a variety of locations throughout the body. C) Antibody binding to specific target cell receptors is bringing about a change in cell function. D) Deposited antibodies are activating her complement system.
Ans: B Feedback: Serum sickness is characterized by the deposition of antigen-antibody complexes in blood vessels, joints, heart, and kidney tissue. The deposited complexes activate complement, increase vascular permeability, and recruit phagocytic cells, all of which can promote focal tissue damage and edema. Serum sickness is not synonymous with an Arthus reaction. Antibody binding to specific target cell receptors causing a change in cell function is characteristic of antibody-mediated cellular dysfunction. Serum sickness is not associated with the activation of the complement system.
A 48-year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which of the following facts most accurately conveys an aspect of his diagnosis? A) An opportunistic Epstein-Barr virus underlies the man's KS. B) He is likely to have lesions on his skin, mouth, or GI tract. C) Intense pain was probably his first manifestation of KS. D) Heterosexual contact most likely underlies his HIV and subsequent KS.
Ans: B Feedback: The lesions of KS can be found on the skin and in the oral cavity, gastrointestinal tract, and the lungs. More than 50% of people with skin lesions also have gastrointestinal lesions. It is linked with a herpes virus and can often be painless, especially in early stages. Men who have sex with men are at a higher risk of developing KS.
An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which of the following statements best reflects an accurate understanding of their son's health situation? A) "We read that gene therapy could cure our son; we'd like you to look into that option." B) "Our son likely has a deficiency of B lymphocytes and can't produce antibodies." C) "We feel guilty, because dietary and environmental factors have been shown to contribute to SCID" D) "The antibodies that our son produces are mismatched to the infections that he was born with and encounters."
Ans: B Feedback: The pathophysiology of SCID involves normal B cells but a lack of antibody production because of inadequate T-cell help. Gene therapy is not yet a realistic treatment option, and the disease has a genetic basis. Antibodies are not incorrect but rather inadequate in number.
As part of her prenatal education, a 29-year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which of the following statements by the woman reflects an accurate understanding of HIV transmission? A) "I know my baby is safe from HIV while in the womb, but the delivery will place him or her at real risk." B) "It's discouraging to know that my breast milk can pass on HIV to my baby." C) "I know it's possible, but it's comforting that the chances of my child contracting my HIV are actually very low." D) "I'm relieved to learn that a caesarean delivery will protect my baby from being born HIV positive."
Ans: B Feedback: Transmission from mother to infant is the most common way that children become infected with HIV. HIV may be transmitted from infected women to their offspring in utero, during labor and delivery, or through breast-feeding. Ninety percent of infected children acquired the virus from their mother. The risk of transmission of HIV from mother to infant is approximately 25%, with estimates ranging from 15% to 45%, depending on what country they live in.
After years of going to different physicians with vague symptoms, a 55-year-old client with a history of Hodgkin disease has been diagnosed with a secondary immunodeficiency syndrome. The client asks the nurse what this means. The nurse knows from the following list of characteristics that secondary immunodeficiency disorders: Select all that apply. A) may be inherited as a sex-linked trait. B) usually develop later in life. C) may be a result of chemotherapy being used to treat a cancer. D) can result from frequent recurring Staphylococcus aureus infections. E) can occur in a chronic obstructive pulmonary disease patient taking corticosteroids daily.
Ans: B, C, E Feedback: Secondary immunodeficiency disorders develop later in life as a result of other pathophysiologic states such as malnutrition, disseminated cancers, infection of the cells of the immune system, and treatment with immunosuppressive drugs, such as chemotherapeutic agents. Primary disorders may be congenital or inherited as sex-linked, autosomal dominant, or autosomal recessive traits. Humoral (B-cell) immunodeficiencies are primarily associated with recurrent infections like Staphylococcus aureus.
Which of the following individuals would most likely be placed on highly active antiretroviral therapy (HAART) if he or she were not yet receiving the treatment? Select all that apply. A) A 35-year-old female sex trade worker who is HIV negative but who has a documented history of sharing needles for heroin use B) A 46-year-old male with long-standing HIV and a CD4+ count of 125 cells/mL C) A 16-year-old female who was diagnosed with HIV 2 days prior and is asymptomatic with normal CD4+ levels D) A 38-year-old woman who has a CD4+ count of 250 cells/mL and is keen to begin HAART E) Prophylactically to a health care worker who incurred a laceration from a scalpel used in surgery but has no abnormal lab results
Ans: B, D Feedback: All symptomatic patients should be treated with antiretroviral therapy. If the individual is asymptomatic, therapy is recommended for CD4+ cell counts less than or equal to 160/mL. For those who have a CD4+ cell count greater than 350 cells/mL, antiretroviral therapy is generally not recommended. For those whose CD4+ cell count is 160 to 350 cells/mL, then antiretroviral therapy should be considered, and a decision individualized to the patient should be made. HAART is not begun prophylactically in the absence of HIV.
Utilizing the World Health Organization (WHO) framework of clinical categories for persons with acquired immunodeficiency syndrome (AIDS) over 15 years of age, a visitor to the United States goes to a city clinic complaining of diarrhea, weight loss of 20 lb, and feeling like he is running a temperature. These manifestations have been occurring for the past 5 weeks. The nurse would identify this patient to be in which clinical stage? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4
Ans: C Feedback: Clinical stage 3 includes unexplained chronic diarrhea for greater than 1 month, persistent oral candidiasis, oral hairy leukoplakia, TB, neutropenia, anemia, and thrombocytopenia.
While undergoing a kidney transplant from a nonfamily member, the patient's transplanted kidney has just had the arterial clamps removed. The OR staff notice that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement? A) Obviously, there has been a mismatch during the human leukocyte antigen (HLA) testing. B) The circulating B and T lymphocytes are just doing their job. C) Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels causing necrosis. D) Previous exposure to the HLA antigens is responsible for the high titers of complement fixing antibodies that cause the rejection.
Ans: C Feedback: Antibody-mediated rejection can be hyperacute, which occurs almost immediately after vascular reperfusion to graft tissue occurs. Performed antibodies against HLA antigens are deposited in the tissue endothelium and microvasculature where they activate the classic complement pathway causing tissue necrosis and graft injury.
When explaining what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction? A) Tree pollen B) Mold dust C) Histamine D) T-lymphocyte proliferation
Ans: C Feedback: Asthma response begins within 5 to 30 minutes of exposure to an allergen. It is mediated by mast cell degranulation and the release of preformed and/or enzymatically activated mediators. These mediators include histamine, serotonin, and acetylcholine. Histamine is the most recognized mediator of type I hypersensitivity reactions and ultimately results in bronchial constriction.
A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess, and that he also has a recurring fungal skin condition. Which of the following is his most likely diagnosis? A) Selective IgA deficiency B) A deficiency in IgG2 subclass antibodies C) Chronic granulomatous disease D) Ataxia-telangiectasia
Ans: C Feedback: Chronic granulomatous disease, because it affects phagocytic function, increases susceptibility to soft tissue infections, particularly of the skin, lungs, lymph nodes, and liver. Selective IgA deficiency and deficient IgG2 subclass antibodies can predispose people to infection, but those infections respond readily to antibiotic treatment. Ataxia-telangiectasia can cause skin and liver problems, but its primary manifestations are ataxia and telangiectasia.
A new nursing student is taking a tuberculin (TB) skin test as part of her preparation for beginning clinical placement in the hospital. The student is unclear of the rationale or physiology involved in this test. Which of the following is the correct explanation? A) The cell-mediated hypersensitivity associated with Mycobacterium tuberculosis remains detectable for several years. B) Formation of contact dermatitis lesions confirms prior TB contact. C) Previous TB exposure forms sensitized Th1 cells that are long-lived. D) This type of delayed-type hypersensitivity (DTH) is a response to latent Mycobacterium tuberculosis bacteria.
Ans: C Feedback: Sensitized Th1 cells form DTH response to introduced antigens. This is not an example of cell-mediated hypersensitivity or contact dermatitis, and it is not a response to latent Mycobacterium tuberculosis.
A 23-year-old HIV-positive woman in the United States with routinely low viral loads and robust CD4+ cell counts is planning to get pregnant. Which precaution would her care giver eliminate from her care? A) Offer her HAART that includes zidovudine B) Counsel her not to breast-feed C) Give her single-dose perinatal nevirapine D) Give the infant trimethoprim-sulfamethoxazole, starting at 4 to 6 weeks of age
Ans: C Feedback: Single-dose nevirapine is an appropriate alternative when zidovudine is not available. However, HAART-containing zidovudine is readily available in the United States. Avoiding breast-feeding will reduce the client's chances of transmitting HIV to her infant. Because the risk of transmission is not zero, prophylaxis with trimethoprim-sulfamethoxazole will protect her infant from PCP until its serostatus is known.
A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobulins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy's most likely diagnosis? A) X-linked hypogammaglobulinemia B) Transient hypoglobulinemia C) Common variable immunodeficiency D) IgG subclass deficiency
Ans: C Feedback: The lack of a terminal differentiation from B cells into plasma cells is the hallmark of common variable immunodeficiency. Recurrent infections, enlarged lymph nodes and tonsils, and IVIG therapy are also commonly associated.
A potential donor is angry at the personal nature of the questions about HIV risk factors that he is required to answer at a blood collection center and states that simple blood testing should suffice. How can the nurse at the center best respond? A) "There are some very uncommon subtypes of the HIV virus that are not detectable by current testing methods." B) "There's a chance that persons who are asymptomatic, but HIV positive can have their antibodies missed by serum testing." C) "There's a period shortly after someone is infected with HIV when blood tests might still be negative." D) "Even though blood tests are completely accurate, the high stakes of blood donation and transfusion mean that double measures are appropriate."
Ans: C Feedback: The time after infection and before seroconversion is known as the window period, during which HIV antibody screening may be negative. Potential donors are thus screened to identify potential risk factors. Undetectable subtypes of HIV do not exist, and individuals who are asymptomatic are still able to be accurately tested.
A 39-year-old female with HIV infection has been characterized as a typical progressor by her care team and is experiencing an increase in her manifestations and health complaints as her CD4+ count declines. Which of the following health problems would her care team most likely attribute to a cause other than her HIV? A) Her recent diagnosis of bacterial pneumonia B) Her esophagitis that has been linked to herpes simplex infection C) Her decreased bone density and recent fractures D) Her increasing confusion and disorientation
Ans: C Feedback: While pneumonia, esophagitis, and cognitive deficits are all well-documented manifestations of HIV, changes in bone density are less likely to be a direct result of the virus.
While volunteering in an HIV clinic in a big city, the nurse notices a new mom and her baby (a 6-month-old male) in the waiting room. Upon assessing the infant for possible HIV infection, the nurse will be assessing for which of the following clinical manifestations of HIV infection? Select all that apply. A) Weighing him to determine if he is gaining 1.5 to 2 lb/month B) Observing to see if he can roll over from back to stomach C) Lack of coordination to play with toys/stuffed animals D) History of repeated episodes of bacterial pneumonia and ear infections E) Listlessness and poor eye contact
Ans: C, D, E Feedback: Children differ as to their clinical presentation of HIV infection when compared to adults. Failure to thrive (gain weight/height), CNS abnormalities (listlessness), and developmental delays are the most prominent primary manifestation of HIV infection in children. Answers A and B are normal growth and developmental tasks of a 6-month-old.
A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which of the following short-term and longer-term treatment plans? A) Transfusion of clotting factors XII and XIII and serum albumin; splenectomy B) Neutropenic precautions; fresh frozen plasma transfusions; treatment of gastrointestinal symptoms C) Intravenous immunoglobulin (IVIG) treatment; thyroidectomy D) Treatment of eczema; management of bleeding; bone marrow transplant
Ans: D Feedback: Common interventions for Wiskott-Aldrich syndrome involve controlling eczema, managing bleeding due to low platelets, and ultimately bone marrow transplant. The other noted interventions are not associated with the treatment of Wiskott-Aldrich syndrome.
A 19-year-old intravenous drug user was exposed to the HIV 3 weeks ago and is experiencing a rapid proliferation in viral load. Which of the following statements best captures an aspect of the process of HIV replication that underlies this proliferation? A) Free HIV RNA is able to attach to the cell coat of CD4+ cells. B) The cytoplasm of CD4+ cells provides a protected environment for the replication of RNA by HIV. C) Expression of reverse transcriptase by CD4+ cells allows replication of HIV cells rather than new lymphocytes. D) HIV is able to change its RNA into DNA to allow for replication by CD4+ cells.
Ans: D Feedback: In order for the HIV to reproduce, it must change its RNA into DNA. It does this by using the reverse transcriptase enzyme. Reverse transcriptase makes a copy of the viral RNA and then in reverse makes another mirror-image copy. The result is double-stranded DNA that carries instructions for viral replication. HIV RNA does not directly attach to CD4+ cells, and RNA is not replicated by HIV itself in the CD4+ cytoplasm. Reverse transcriptase is not produced by CD4+ cells, and CD4+ cells do not directly produce new lymphocytes.
A 24-year-old woman has gone to the OB-GYN clinic for her first visit since she found out she was pregnant. The clinician tested her blood type along with the usual prenatal testing. On a follow-up visit, the woman was told that she is Rh negative. When asked what that means for her baby, the nurse explains that Rh-negative women lack RhD antigens on their erythrocytes but produce anti-D antibodies. As a result of this blood type, A) "If you and your baby have mismatched blood, it can invoke anaphylaxis in the baby." B) "If the types are incompatible, severe antibody-mediated inflammation occurs." C) "If blood types do not match, the baby's liver will produce extra cells to replace RBCs needed to oxygenate organs." D) "If the fetus is Rh positive, maternal anti-D antibodies can coat fetal RBCs resulting in severe anemia."
Ans: D Feedback: In utero, the development of erythroblastosis fetalis (Rh incompatibility) results when Rh-negative women produce anti-D antibodies. In Rh-positive fetus, maternal anti-D antibodies will coat fetal RBCs containing RhD, allowing them to be removed from the fetal circulation by macrophage- and monocyte-mediated phagocytosis (destroying RBCs). RBCs are produced in the bone marrow, not the liver; therefore, answer C is incorrect.
A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? A) Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response. B) Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response. C) Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response. D) Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.
Ans: D Feedback: Repeated exposure to allergens causes an increase in IgG, which binds with antigens before they can stimulate IgE. It does not bind mast cells or basophils, nor does it overwhelm the IgE antibodies to stimulate epinephrine production.
A 37-year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that the man now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which of the following classes of medications addresses this component of the HIV replication cycle? A) Entry inhibitors B) Protease inhibitors C) Integrase inhibitors D) Non-nucleoside reverse transcriptase inhibitors
Ans: D Feedback: Reverse transcriptase inhibitors inhibit HIV replication by acting on the enzyme reverse transcriptase. Non-nucleotide reverse transcriptase inhibitors block the copying of RNA into DNA. Entry inhibitors, protease inhibitors, and integrase inhibitors do not address this aspect of the HIV replication cycle.
A person who has been diagnosed with HIV infection 12 years ago and still has a CD4+ cell count of 800 cells/µL and a low viral load is considered clinical to be a A) rapid progressor. B) typical progressor. C) slow progressor. D) long-term nonprogressor.
Ans: D Feedback: There is a subset of slow progressors: the long-term nonprogressors, who account for 1% of all HIV infections. These people have been infected for at least 8 years, are antiretroviral naive, have high CD4+ cell counts, and usually have very low viral loads. They are being investigated to determine how they maintain viral suppression of HIV.
Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the member's statements is most accurate? A) "One of the scariest things out there now is the huge increase in drug-resistant tuberculosis." B) "The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend the life expectancy of a lot of persons living with AIDS." C) "Those of us with HIV are so much more prone to loss of vision and hearing." D) "As people with HIV live longer, most of us are eventually succumbing to the cancers that are asscoiated with HIV"
Ans: D Feedback: There is an increased risk of AIDS-associated cancers as persons with age live longer. Drug resistance in tuberculosis is on the decline in recent years, and PCP has not been eradicated. Sensory loss is not a noted HIV-related manifestation.
Which of the following signs and diagnostic findings are recognized components of the metabolic and morphologic changes that occur with HIV infection accompanied with lipodystrophy? Select all that apply. A) Hyperlipidemia B) Insulin resistance C) Deficiencies of anterior pituitary hormones D) Increased abdominal girth E) Breast enlargement Ans: A, B, D, E
Feedback: Hyperlipidemia and insulin resistance are aspects of lipodystrophy, a phenomenon that also frequently includes breast enlargement and increased abdominal girth. Pituitary hormone deficiencies are not a noted component of HIV-related metabolic changes.