Week 2 Patho Study Questions Cellular Responses and Adaptions to Injury

A nurse practitioner is quizzing her students about rheumatoid arthritis (RA), she asks them to compare RA with osteoarthritis (OA), which student has the BEST understanding of both disease processes?

"The patient with RA will need methotrexate as first line therapy while the patient with OA needs an anti-inflammatory medication like an NSAID"

Hyperbaric oxygen therapy helps to increase oxygenation to various difficult-to-heal wounds. Which patient below would NOT benefit from hyperbaric oxygen therapy? - A patient with osteoarthritis of the hands - A patient with a skin graft - A patient with diabetic foot ulcers - A patient with gangrene in the toes

A patient with osteoarthritis of the hands Osteoarthritis is characterized by pain and inflammation of the joints. Hyperbaric oxygen therapy is not used to treat osteoarthritis.

A toddler is brought to the hospital with fever of 101 degrees Fahrenheit. Reports reveal the patient has developed an acute bacterial infection. Which is the BEST course of treatment for this child?

Administer the prescribed antibiotic therapy. This would be the appropriate intervention, acetaminophen or Tylenol would be given for the fever and not the others mentioned here

Which of the following are associated with inflammation? Select all that apply. - Swelling - Increased blood flow - Increased vascular permeability - Redness - Warmth

All

A patient was brought to the hospital with wounds sustained from a bicycling accident. He is seen and the wound is cleaned, sutured, and dressed. Which of the following factors are essential to aid in wound healing for this patient? - Circulation - Contamination - Nutrition - All of these are factors involved in wound healing.

All of these are factors involved in wound healing.

Which component enables the blood vessels to dilate and become more permeable during the vascular phase of inflammation (increase vascular permeability)? - Kinins - Platelet activating factor - Histamine - All of these increase vascular permeability.

All of these increase vascular permeability. This is true, they all increase vascular permeability.

Which medication can cause Reye's syndrome in children when used to control a fever?

Aspirin Aspirin or ASA has been known to rarely cause Reye's syndrome.

Which of the following cells are not created in the thymus?

B cells

A patient with scleroderma has painful hard deposits on their fingers, what is the diagnosis?

Calcinosis

A patient with scleroderma reports painful calcium deposits on the fingertips. Which condition is this called?

Calcinosis

Which term refers to the release of chemicals that dispatch white blood cells and platelets to areas of injury?

Chemotaxis

Which organism releases a toxin that causes muscle paralysis?

Clostridium botulinum

A 50 year old female presents to the ER with profuse diarrhea. She was just in the hospital for an atypical pneumonia where she was given CIPRO or ciprofloxacin for an antibiotic. Since being home, she has had an uncontrollable diarrhea that is watery and foul smelling along with abdominal pain and swelling. What is the most likely cause of this diarrheal illness based on her history?

Clostridium difficile

Which bacterium proliferates quickly due to ischemia and is associated with infected gangrene?

Clostridium perfringens Thrives in gangrenous conditions.

Which bacteria creates a toxin that blocks inhibitory neurotransmitters causing hyperactivity of neurons that leads to uncontrollable muscle spasms and it exists as a spore that is found in the soil and environment entering puncture wounds and deep lacerations?

Clostridium tetani

_________________ are inflexible shrinkages of wound tissue as the body closes the wound.

Contractures

You believe John is suffering from poor wound healing and inflammation due to infection of the surgical wound site. This does not appear to be a long-term, or chronic, inflammatory response, but rather an acute response to an infectious agent. Thus, anti-microbial medications, rather than long-term anti-inflammatory agents such as________________, are prescribed.

Corticosteroids Corticosteroids are prescribed to reduce chronic inflammation associated with certain diseases, such as asthma. Corticosteroids work by suppressing inflammatory gene expression and inflammatory mediators. Opioids are used to relieve pain, while beta blockers are used to manage cardiac arrhythmias. Analgesics lessen pain.

To reduce pain and swelling, John had been taking an anti-prostaglandin medication. Which enzyme is involved in the formation of prostaglandins associated with pain and swelling?

Cyclooxygenase- 2 Cyclooxygenase- 2 is an enzyme that converts arachidonic acid into prostaglandins. The prostaglandins formed are associated with inflammation and swelling.

Although John's medication reduces swelling and inflammation, he is complaining that it is hurting his stomach. Which enzyme is involved with the production of protective prostaglandins that help maintain the health of the gastric mucosa?

Cyclooxygenase-1 Cyclooxygenase-1 is involved with prostaglandin synthesis that stimulates the formation of mucus in the GI tract. If this pathway is disrupted, for example by anti-prostaglandin medications, patients may complain of GI upset.

In addition, mediators of inflammation, including C-reactive protein (CRP) and _________________, were shown to be elevated.

ESR ESR, or erythrocyte sedimentation rate, along with CRP are generic markers of inflammation. Although they are not specifically diagnostic, elevation in these factors can be used to assess the presence of inflammation due to infection or autoimmune diseases. PT refers to "prothrombin time" and is used to assess blood clotting. ALT and AST are liver enzymes that may elevate in the blood with liver damage.

Which of the following viruses is a severe hemorrhagic virus, spread by person to person blood or body fluid contact, a member of the family of filoviruses, and has high virulence with mortality rates up to 90%?

Ebola virus

Which lab result would be most likely TRUE if a patient has SLE or systemic lupus erythematous?

Elevated CRP or C-reactive protein

What common virus causes infectious mononucleosis?

Epstein Barr 93% of mononucleosis is from EBV but 7% comes from CMV.

When you examine the wound, you note the appearance of redness and warmth. Fluid appearing to contain cells and proteins, known as _________, is seeping from the edges of the wound.

Exudate Exudate is fluid that contains proteins and cells. Transudate is clear fluid, as found in a blister. Eschar is dead tissue that falls off from healthy skin. An abscess is a walled-off area of infection.

T/F All patients with HIV infection have AIDS.

False

T/F Patients with suspected hypogammaglobulinemia can be tested for this disease immediately after birth.

False

You have a 75 year old cachectic female patient as a patient in the nursing home you are working at. She has a stage 4 pressure ulcer along with hypertension, dementia and urinary incontinence. What is the BEST of the following orders to help in the healing and prevention of further pressure ulcers?

Frequent repositioning of the patient

Which diagnosis does the nurse recognize as a protozoan infection that can lay dormant for years then yielding a terrible dysentery?

Giardiasis

A 5 year old child is on your hospital ward with a fever of 102 degrees Fahrenheit, what is the BEST way to break the fever for this patient?

Give acetaminophen or Tylenol

Streptococcus pneumoniae is BEST described as?

Gram positive diplococci

Which is not an inflammatory mediator that is released from white blood cells (WBCs)? - TNF-alpha - Interleukins - Granuloma - Leukotrienes

Granuloma Prostaglandins (PGs), leukotrienes, TNF-alpha, and ILs are inflammatory mediators released from WBCs. Leukotrienes provoke bronchiole inflammation in asthma.

Which of the following statements about HIV is TRUE?

HIV infection is called AIDS when the CD4 count is below 200

A 55 year old female wants to know her risk for having an MI in the next five years, what lab test would help to assess this patient's risk for coronary artery disease and atherosclerosis?

HS-CRP or high sensitivity C reactive protein

Which of the following statements from a malnourished patient with a large wound is the BEST nutrition plan for wound healing?

I will need dietary supplements like Ensure, Enlive or Carnation Instant Breakfast for healing.

Which immunoglobulin is found most abundant in sweat and tears?

IgA

A 27-year-old patient is pregnant. The blood group of the patient and the fetus are incompatible. Which antibodies produced by the mother against the fetus's blood cells do not affect the fetus as they are too large to cross the blood-brain barrier?

Immunoglobulin M (IgM)

You inform John that you are not surprised his wound is healing slowly. Which of the following is the most important cause of delayed healing?

Infection Infection is the single most important cause of delayed healing. A wound's susceptibility to infection is influenced by the patient's immune strength, the type of wound present, and conditions of injury. The presence of infection perpetuates the inflammation phase and delays the formation of granulation tissue and collagen synthesis.

The wound care nurse is performing a prescribed dressing change on an abdominal incision that is 2 days postoperative. The nurse notices the incision is dry, well approximated, and pink in color, no scab has formed as of yet and only clotted blood remains at the incision site. A slight warmth is detected when the incision is touched. Which phase of wound healing is occurring here as this is the stage where vasodilation occurs along with increased vascular permeability and chemotaxis?

Inflammation

Cholera is a bacterial infection that causes profuse, watery diarrhea. What is the primary vector of disease transmission?

Ingesting food/water contaminated by the feces of an infected person This is indeed a fecal/oral organism.

Which of the following statements about Fifth disease is CORRECT? - It is deadly and has a high mortality - It is caused by Parvovirus B-19 - It is the leading cause of renal failure in children - It is caused by giving children aspirin

It is caused by Parvovirus B-19

Laboratory analysis of John's blood reveals an elevated white blood cell count of 12,000 cells per microliter, known as ___________.

Leukocytosis Leukocytosis is an elevation in total white blood cell number. This often occurs with illness and infection. Leukopenia is a reduction in total white blood cell number. A leukemoid reaction is extremely elevated WBC levels (above 50,000 cells/microliter).

Which of the following inflammatory mediators is NOT a pyrogen (causes fever)? - Interleukins - TNF-alpha - Leukotrienes - Prostaglandins

Leukotrienes

Which of these cells contain cytoplasmic granules, but are not considered typical granulocytes and are the first-line of defense and are considered part of the innate immune system, they also can kill tumor cells and viral infected cells without any previous exposure?

Natural killer cells

Which is a predisposing factor that can cause and infection with Pseudomonas aeruginosa while as a patient in the hospital?

Nebulizer use

Which is an example of passive acquired adaptive immunity?

Newborns receiving immunity through breast milk This is an example of passive acquired adaptive immunity as this is not a permanent immunity and will wane after a time.

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

Nuchal rigidity (Neck stiffness)

You are a nervous intern physician who is about to present a case of a patient with chronic mucocutaneous candidiasis or CMCC to a room full of other physicians, but you dropped your patient files and cannot remember which one has this disease. Based on a quick look at the patient's symptoms, exam, and labs, which patient has chronic mucocutaneous candidiasis? - Patient 1 - A 2-year-old female with oral thrush repeatedly, a positive mutation of the AIRE gene, and cutaneous fungal infections. - Patient 2 - A 25-year-old female with a malar or butterfly rash, joint inflammation, and a positive ANA and anti-double stranded DNA test. - Patient 3 - A 75-year-old female with joint destruction of the MIP and PIP joints of the hands, rheumatoid nodules present on the elbows bilaterally, and a positive rheumatoid factor and anti-CCP antibody. - Patient 4 - A 55-year-old male with joint pain in the hands particularly in the thumbs, he has Heberden's nodes present, no joint destruction, and labs are all normal.

Patient 1 - A 2-year-old female with oral thrush repeatedly, a positive mutation of the AIRE gene, and cutaneous fungal infections.

The Tdap vaccination helps to immunize against all of the following pathogens EXCEPT: - Pertussis - Polio - Tetanus - Diphtheria

Polio Tdap is a combination vaccine that protects against three potentially life-threatening bacterial diseases: tetanus, diphtheria, and pertussis (whooping cough).

Which of the following is NOT a classic sign of inflammation? - Purulence - Redness - Heat - Loss of function

Purulence

John's body temperature is slightly elevated. You know that fevers are a common sign of infection caused by ___________, chemical signals that reset the hypothalamic thermostat.

Pyrogens Pyrogens are exogenous or endogenous chemical signals that cause fever. Chemotaxis refers to the movement towards a chemical signal, whereas leukotrienes are inflammatory mediators released by white blood cells.

Which pathogen is a rod-shaped, gram negative bacteria with a flagella and causes a bacterial gastroenteritis?

Salmonella

A patient has a systemic (all over the body) bacterial infection of unknown origin with no specific area of infection identified by imaging studies. You need to know what bacteria is causing this sepsis, what would be the BEST method to determining the bacterial cause?

Serological testing

You have a severely septic patient in the ICU and cannot find the source of infection. Which of the following labs would be most helpful to identify the specific pathogen if all cultures have been negative thus far?

Serology testing

Which of the following is NOT an example of our innate immunity? - Anatomical barriers - Alveolar macrophages - T and B lymphocytes - Acute inflammation

T and B lymphocytes

Which type of WBC arrives first at an acute injury and is the most predominate?

The neutrophils These WBCs are going after bacteria and foreign particles and margination from nearby vessels along with their sheer numbers make them the first on the scene in acute inflammation.

Why is it important for women who plan to become pregnant to make sure they are immune to rubella?

There could be teratogenic effects on the fetus from this virus.

You are the attending physician on the ward and are speaking to four medical students about the use of COVID-19 monoclonal antibody therapy IV infusions for COVID-19 patients. Which of the students below is CORRECT in their statement about this therapy?

This therapy is an example of passive immunity

In which location does the maturation of T lymphocytes occur?

Thymus gland

A patient comes to the urgent care center with a very pruritic rash on their legs. They had just been hiking in a forest three days ago and it appeared recently. Which type of hypersensitivity reaction does this BEST describe?

Type 4

A patient develops an erythematous rash on the hands 2 days after working in the garden. Which type of hypersensitivity reaction has the client developed?

Type IV delayed

A 45 year old male presents with symptoms of pneumonia and on CBC, the differential of the WBCs show mostly lymphocytes known as lymphocytosis, what is the likely cause of this man's pneumonia?

Virus

Which of the following organisms CANNOT replicate on their own without a host cell?

Virus

The first stage of an infectious disease in which the microbe is present but symptoms have not appeared.

incubation

Increased epithelial formation may result in scars or _________________.

keloid formation

Which is the most devastating protozoal disease worldwide?

malaria

The DTaP vaccine protects against ________________. Select all that apply. - pertussis - diphtheria - meningitis - strep throat - tetanus

pertussis diphtheria tetanus

John, age 37, appears at your clinic complaining of pain and soreness in his knee. Several days prior, John had undergone knee surgery to repair a tear in the medial meniscus. The surgical laceration is considered a _________________ intention.

primary In a primary intention, the wound edges are close together and scarring is minimal. In a secondary intention, the wound is allowed to granulate, and wound care is needed daily. The wound may be packed with gauze or allowed to drain. In tertiary intention, delayed wound closure often results in significant scarring.

Which chemical resets the hypothalamic thermostat, causing fever?

pyrogen

What is the most common means of transmission of infectious diseases?

respiratory