Pathophysiology Final Exam

A patient with shortness of breath, orthopnea, dyspnea on exertion, and a long history of COPD is being evaluated. The patient has JVD which is significant, bilateral pleural effusions on chest x-ray, ascites and hepatic congestion on physical examination and BLE pitting edema. BNP is elevated significantly, but troponin Tis negative. EKG has no new changes from prior. An echocardiogram is ordered and shows LVEF that is 45 percent. What is the diagnosis and the cause of this?

Right sided heart failure from cor pulmonale of long standing COPD

A patient's pulse oximetry reading is 100%; however, the hemoglobin level is only 8.5 g/dL (normal is 13.5 to 17.5 grams per deciliter) due to a recent surgery. The patient's spouse asks you what activities the patient can safely carry out. Which activity would you recommend?

Road trip

Which is the laboratory definition of hypocalcemia?

Serum calcium less than 8,7 mg/dL

You are examining a patient with headache and fever and they have increased maxillary tenderness to palpation and a sense of fullness in that area if they lean forward. What is the most likely diagnosis?

Sinusitis

Loss of muscle support in the pelvic floor due to childbirth and aging can cause this especially when women cough, laugh or sneeze:

Stress incontinence

Which type of stone in the case of urolithiasis is associated with indwelling catheters?

Struvite

What is the microscopic study of tissues?

histology

Which deficiency causes Tay-Sachs disease?

lysosomal enzymes

Which cell organelles differ in their number according to the cell's energy needs?

mitochondria

What are pyrogens?

substances that cause fever

A male patient presents with severe costovertebral angle (CVA) tenderness and pain which is intermittent. Urinalysis and blood work findings show macroscopic hematuria and large proteins but no WBCs or nitrites. What condition is most likely present?

ureterolithiasis or urolithiasis

Systolic pressure refers to the pressure in the arteries when the:

ventricles contract

A patient's laboratory results come in and their physician notices a hemoglobin of 20 g/dL (normal is 13.5 to 17.5 grams per deciliter). Which factor below would allow a patient to have a hemoglobin like this?

Being located in high altitudes

Which is the most common cause of urinary obstruction in men over 60?

Benign prostate hyperplasia

Which of the following is NOT one of the 3 main stages of acute inflammation?

Granulomatous changes

A female patient presents for pre-surgical screening and admits to heavy menses each month. She also admits to easy bruising. Her labs show a remarkably low von Willebrand factor level. What should the surgeon be aware of for this patient?

Increased bleeding tendency during surgery

You have a patient who is a type 1 diabetic on insulin who has new renal failure with a decreased GFR. What should you as the provider be aware of when it comes to insulin and renal failure?

Insulin will build up quickly as it is really eliminated and lower doses of insulin are needed now.

Tetracycline antibiotic is prescribed for an adult client with chlamydia infection. Which is the mechanism of action of the drug if it is able to interfere in the protein synthesis within a bacterium?

It interferes with the function of bacterial ribosomes.

Which of the following would be a disease vector?

A living being such as a mosquito, fly, or tick carrying but not infected by a pathogen

A school-age child presents to the hospital with lymphocytopenia. Based on this diagnosis, which lab finding would BEST fit this condition?

A lymphocyte count less than 3,000/microliter

The infectious disease nurse is teaching student nurses about the criteria to distinguish between just HIV positive, HIV positive with seronegative viral load and AIDS. Which of the following statements is TRUE about this subject?

"A CD4 count below 200 along with an opportunistic infection like Pneumocystis jirovecii or an AIDS related cancer like Kaposi's sarcoma is an AIDS defining diagnosis"

Which of the following is TRUE about CD4 cells?

"The CD4 cells take part in cell-mediated immunity."

Which is a characteristic of adrenoleukodystrophy which is an X-linked genetic disorder causing demyelination of nerves at the adrenal glands and other areas?

Accumulation of long-chain fatty acids in the nervous system from defective peroxisomes no longer breaking them down.

Which one of the following types of leukemia is the most common in children?

Acute lymphocytic leukemia

A patient who recently underwent an abdominal surgery is scheduled for an immediate surgery due to a wound- healing complication where the wound tore open from the suture line but also went farther to expose some bowel. Which complication of healing is the client likely to have developed? (Best Answer)

Adhesions

A patient presents with dyspnea, chest pain, and cough. No fever is reported. Which of these complaints could be a cardiovascular cause rather than a respiratory cause?

All of these could be signs of a cardiovascular cause and not just respiratory.

Postrenal dysfunction is caused by:

An obstruction of urine outflow

What is the term that refers to the genetically programmed degenerative changes that result in cell death?

Apoptosis

While examining a client, the primary health-care provider finds that the patient has symptoms that include cough, fever, and sore throat, and general malaise for two weeks. Physical assessment findings include greenish to yellow mucus production and wheezing and rhonchi as well as dullness to percussion around the right lower lobe of the lung along the back. Which treatment should the primary health-care provider administer to the client?

Bronchodilator and antibiotics

Which is an equation one can use to find cardiac output (CO) in a patient where you know the blood pressure (BP) and the peripheral vascular resistance (PVR)?

CO = BP/PVR

A 75 year old man with bone pain in the lower back presented to the ER and was found to have multiple myeloma or MM from biopsy of lesions in his lumbar spine and high levels of m-proteins in his urine. Which of the following treatments below, would NOT be a possible therapy he would receive for MM?

Cadaver liver transplant

Which statement is TRUE concerning cardiac afterload?

Cardiac afterload is the amount of resistance that the ventricle must overcome.

A nurse observes that a client has developed a foul odor in the spots where necrosis of tissue has developed. What organism causes the emission of this foul odor?

Clostridium perfringens

A female patient in the ICU with sepsis due to pneumonia begins to have bleeding from all IV and central line sites and easily bruising of the skin. The morning labs reveal that the platelets are severely low, PT, PTT, d-dimer and IN are elevated significantly. A blood smear shows hemolysis of RBCs. The patient had normal labs just yesterday, what is the diagnosis?

Disseminated intravascular coagulation

Which disease is a trisomy of chromosome 21 and causes decreased mental ability?

Down syndrome

Which statement regarding rough endoplasmic reticulum (ER) stress is correct?

DuringERstress,proteinsarerapidlydegraded

A patient has a pneumothorax found on chest x-ray and examination, they are having some shortness of breath, what is the treatment?

Either needle insertion to the affected side or chest tube insertion.

Which pathology is a medical emergency where the pharynx is visibly inflamed and presents with the steeple sign on X-ray?

Epiglottitis

A 40 year old patient presents with mild chorea that seems to be progressing. Genetic testing revealed a defect of the HTT gene, What is the patient's diagnosis?

Huntington's disease

The physician assistant is assessing a patient who has been a butcher for an extensive period, making the patient subject to a prolonged and intense exposure to inhaled organic dust in the form of animal protein. Which disorder, according to the PA, is a probable cause of the patient's respiratory problem?

Hypersensitivity pneumonitis

When viewing the recent CT scans of the thorax of a patient with a restrictive lung disease, the NP finds nodules and honeycomb lung patterns. The health-care provider points out the patient's previous chest x-ray report identifying diffused "ground glass" markings in the lower lung fields. Which condition does the NP conclude from this information?

Idiopathic pulmonary fibrosis

Which insidious restrictive lung disease has no known cause and has "honey combing" seen on CT scan of the lungs?

Idiopathic pulmonary fibrosis

A patient presents reporting left sided chest pain that radiates down their left arm, dyspnea, and excessive diaphoresis. You notice pallor. The patient's electrocardiogram shows new atrial fibrillation. Which would be a sign that the patient has unstable angina or a myocardial infarction as opposed to stable angina?

Pain continued after three doses of nitroglycerin.

A patient presents with stridor, fever, productive cough with "greenish" sputum, and sore throat for three days. On examination they have a mildly erythematous pharynx and course sounding lungs. You suspect acute pharyngitis and acute bronchitis. Which of the following would NOT be a reasonable next step for this patient?

Mantoux tuberculin skin test

A non smoking patient with frequent cough and shortness of breath, which is now beginning to interfere in their everyday life, undergoes a pulmonary function test or PFT. Their FEV1 is 70% of expected and after albuterol treatment it is 80% of expected. They had a slightly low FEV1/FVC ratio but it increased by 5% or back to normal upon treatment. The patient is getting daily symptoms, but never has to go into a hospital. On examination, the patient has bilateral wheezing which improves with albuterol treatment, no nail clubbing seen. Which is the most likely diagnosis given this information?

Moderate persistent asthma

A 16 year old male reports myalgia and fever. He recently had a viral infection with mononucleosis which got better. He presents today following an episode of syncope. On physical examination, an Sg gallop rhythm was heard on auscultation. Labs and diagnostics reveal an elevated ESR and CRP, EKG shows mild elevations in the ST segments of some leads, and a cardiac Cardiac MRI ordered shows inflammation of the heart muscle. What is the most likely diagnosis?

Myocarditis

Which is a key symptom of meningitis found on physical examination?

Nuchal rigidity (Neck stiffness)

Which of the following statements is TRUE regarding urodynamic studies used to help diagnose urinary incontinence?

Observes the actual process of voiding with both filling and emptying and thus the bladder's neuromuscular status

A patient has severe emphysema and has the following ABG: pH 7.30, PCO2 55, PO2 77. She has a SpO2 on pulse oximetry of 88 to 92 percent. She is currently not on oxygen therapy. You want to make sure she is on the best therapy possible, which of the following would NOT be ideal for this patient.

Oxygen therapy to keep her 02 saturations at 98 to 100 percent.

Which of the clients below is taking a medication that has shown to improve the LVEF in left sided heart failure and known as the "cornerstone of heart failure treatment"?

Patient 4 Angiotensin- converting enzyme inhibitors

A young adult male patient presents to your clinic and has a tall, lanky body and sparse facial hair. The patient reports decreased physical endurance. Which assessment will confirm a diagnosis of Klinefelter syndrome in the patient?

Perform genetic testing and hormone analysis

An older male patient with advanced renal failure but not on dialysis, presents with a sharp pain in the chest with fever and dyspnea. The patient states that this pain worsens with deep breaths, coughing or swallowing. They have jugular venous distension present bilaterally. The heart sounds are muffled on auscultation but a friction rub is heard. The electrocardiogram shows an elevated ST segment in multiple leads, and the laboratory report shows an increase in the serum creatinine and blood urea nitrogen. Which diagnosis is most likely here?

Pericarditis

A 35 year old patient presents with nausea, vomiting and diarrhea for several days. He feels weak and has not been able to take in fluids very well. He has no history of kidney disease and is very healthy. His blood pressure is 100/65 mmHg and his pulse is 105 bpm. He has decreased skin turgor on exam and his mucus membranes are dry. His labs reveal serum BUN of 40 and creatinine of 2.4. Urinalysis is normal. What type of renal failure is most likely here.

Prerenal failure due to dehydration.

Which of the following is a noninvasive continuous monitoring of a patient's oxygen level by measuring the oxygen saturation of their hemoglobin using a device that clamps over their finger?

Pulse oximetry

Which term below mean a heart rate great than one hundred beats per minute?

Tachycardia

A 30 year old Asian American female presents to your clinic with flu like symptoms with fever, malaise, and fatigue. She is diagnosed with the flu and sent home. She comes back to see you not feeling any better after two weeks with pain all over, arthralgias, dyspnea, palpitations, headache, a rash, and hemoptysis. Physical exam shows an elevated blood pressure much higher than the patient's baseline. Lab data shows, elevated ESR and CRP, a normochromic normocytic anemia is present on peripheral smear, you order CT scan of the aorta and it shows inflammation and vasculitis. You prescribe her to take corticosteroids for the next several weeks and start methotrexate as well. Which disease process below BEST fits this clinical scenario?

Takayasu's arteritis

You are a nurse recording the blood pressure of four patients on your floor and you are ordered to report any patients with orthostasis or orthostatic hypotension. Which patient below has orthostatic hypotension?

The client with 140/90 mm Hg while lying and 110/80 mm Hg upon standing

You are volunteering in a third world country free clinic. Many of the young patients are diagnosed with kwashiorkor. Which condition do you equate with the diagnosis?

The condition is seen in individuals suffering from severe protein starvation

What is the normal level for central venous pressure?

The normal range for central venous pressure is 1 to 5 mm Hg.

Which statement is TRUE regarding megakaryocytes?

They mature into platelets

What is the lab test for Goodpasture's syndrome?

anti-GBM antibodies

A genetically programmed cell death is a process that can destroy cells that are no longer needed. Which term applies to this biological process?

apoptosis

Where is interstitial fluid found?

between cells