Pathyo exam 2

In sickle cell disease, the characteristics/outcome of the sickled cells include all of the following EXCEPT:

Genetic disorder Abnormal hemoglobin (Hgb S)- Inherited autosomal recessive Red cell deforms into a sickle shape as a result of- Dehydration, extreme stress, decreased oxygenation Sickled cells- loss of elasticity, move slow, increase blood viscosity, undergo hemolysis in the spleen

A newborn baby named Jason is found to have PKU. Which of the following describes this condition?

Genetically determined metabolic disorder. Phenylalanine is an amino acid we obtain from diet to make proteins that code for DNA. Tyrosine is needed to produce neurotransmitters (dopamine, epinephrine, norepinephrine) a rare inherited disorder that causes an amino acid called phenylalanine to build up in the body.

What risk factors are considered the 5 major risk factors for developing CAD?

Hyperlipidemia Tobacco use HTN Diabetes Estrogen Obesity Inactivity

You are caring for an individual with the following blood pressure readings on 3 consecutive days. This patient will likely be diagnosed with what condition? Day 1- 148/95; Day 2- 155/91; Day 3- 151/98

Hypertension Stage 2

A patient is admitted to the emergency department in acute pulmonary edema. Symptoms that the nurse would expect would include all of the following EXCEPT:

Result of LV Systolic or Diastolic dysfunction, LV overload, or LV outflow obstructionà transudation of protein-poor fluid into the alveolià ↓ diffusion capacity, hypoxemia, and dyspnea Rapid, extreme, terrifying S/S- Extreme breathlessness Anxiety Cough Sputum is pink and frothy Sensation of drowning

Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following can result in both valvular stenosis and regurgitation?

Rheumatic heart disease Connective tissue disorders Syphilis infection Heart failure.

Briefly discuss the essential components of stroke volume, defining each, (2 points) and how decreased stroke volume impacts heart performance (2 points). Be sure to include how these result in the manifestations that you see with heart failure.

Stroke volume depends on three factors: preload, contractility, and afterload Preload—amount of blood in the ventricle at the end of diastole Afterload—resistance or impedence to ejection of blood Contractility—determined by stretching of the myocardium and sympathetic activation of the ventricles Decreased cardiac output leads to reduced blood flow and oxygen delivery to the tissues, which can result in manifestations of heart failure such as fatigue, shortness of breath, edema, and reduced exercise tolerance.

A client is admitted with left sided congestive heart failure. Which of the following would you expect to find?

Systolic or Diastolic Dysfx Characterized by: Systolic failure and/or diastolic failure ¯'d contractility/ Ventricular remodeling ↑'d preload (LVEDV) ↑'d afterload (LVEDP) ¯'d renal perfusion ↑'d renin and angiotensin. Shortness of breath with activity or when lying down Constant coughing or wheezing Fatigue and weakness Rapid or irregular heartbeat Swelling in the legs, ankles and feet

Which of the following is NOT a phenotype that you would find in Marfans syndrome?

Tall, slender Arm spam exceeds height Sunken or protruding chest Vision problems Palpitations Hypermobility of joints Leaky heart valves (heart murmur) Weakened vessel walls (aneurysm)

Cancer cells have the ability to divide indefinitely and become immortal due to:

Telomerase, which prevents telomeres from shortening.

When considering the automaticity of cardiac cells, which of the following sites of cardiac conduction fires normally at 60-100 beats per minute?

The sinoatrial node

The ductus arteriosus is present in the fetus to allow communication between the and the

aorta and pulmonary trunk

Tetralogy of Fallot includes all of the following defects EXCEPT:

¯'d pulmonary blood flow 4 characteristic defects VSD Pulmonic stenosis Overriding aorta Right ventricular hypertrophy Hemodynamic effects depend on the extent of the defects CXR—"boot shaped" May have acute hypoxic episodes "tet spells"- significant right-to-left shift—life threatening emergency

Which of the following manifestations would be expected for a child who has complete Trisomy 21 (Down's Syndrome)?

•Growth failure •Flat facial profile •Small nose •Wide set eyes with deep epicanthal folds and upward slanting •Small and low set ears •Increase fat on the back of the neck •Large protruding tongue •Life span 30-50 years

You are creating a punnet square for a family where the father has a dominant disorder, and mom is "healthy" (does not have the disease and is not a carrier). Which of the following statements should you include in your genetic counseling of this family?

50% chance of child with disorder and 50% chance of child is healthy.

You are caring for an individual diagnosed with Grade I lung cancer. What does this mean?

A Small tumor has not spread to any lymph nodes. They are well differentiated, and they are mostly like normal cells.

Congenital heart defects that cause a cyanotic congestive heart failure usually involve:

Acyanotic (Left to Right Shunt)

Select the CORRECT response regarding x-link disorders:

All x-linked disorders are recessive inheritance Associated with X or female chromosome Due to presence of normal X gene with paired mutated X gene in females, female heterozygotes rarely experience effects of defective gene All males who receive the mutated X gene are effected When the affected sons has children, he passes on the mutated X gene to his daughters who become carriers Due to genes of Y chromosome being unaffected, males do not transmit the defect to their sons The sons will not be carriers or transmit the disorder to their children

Mr. S.H., a 51-year-old salesman, is at his health clinic for a routine physical exam. After walking the distance from the car to the clinic, he developed substernal pain and mild discomfort in his left shoulder and his jaw, lasting approximately 2 to 3 minutes and then subsiding with rest. His wife indicated that this is not unusual and has occurred on and off the past year with similar exertion. Mr. H. is most likely experiencing:

Angina

Cardiac cells can withstand ischemic conditions and still return to a viable state for no more than minutes

Approximately 20 minutes

Which of the following occurs in arteries that can contribute to atherosclerosis?

Artery wall thickens as result of build-up of fatty materials such as cholesterol Systemic disease Chronic disease. High blood pressure High cholesterol High triglycerides Smoking Obesity Diabetes Inflammation

Match the following neoplasm characteristics with the correct type of neoplasm (0.5 points each): Benign Malignant

Benign Slow grow Well-defined capsule Well-differentiated low mitotic index Do not spread to distant sites (metastasis ) Not invasive Malignant Grow rapidly Not encapsulated Poorly differentiae High mitotic index Can spread to distant sites (metastasis) invasive

Manifestations of disseminated intravascular coagulation (DIC) include: (select all that apply)

Bleeding from venipuncture sites, invasive lines Purpura, petechiae, and hematomas Symmetric cyanosis of the fingers and toes Elevated D-dimer. Bruising, Blood clots, Confusion, memory loss, or change of behavior. Difficulty breathing. Fever.

Cardiomyopathies are categorized as:

Cardiomyopathy: ventricle becomes enlarged, thickened, or stiff. As a result, the heart's ability to pump is reduced Dilated- an enlarged, weakened ventricle struggles to pump enough blood to meet demands Hypertrophic- LV cannot fully relax between contractions results in less blood being ejected Restrictive- stiff ventricles, but not thickened- resists normal filling

A woman who is pregnant for the first time asks the nurse about the safe use of alcohol during pregnancy and the risk of developing Fetal Alcohol Syndrome (FAS). Which of the following statements by the nurse is the most appropriate:

Category X- Studies in animals or human beings have demonstrated fetal abnormalities, or there is evidence of fetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.

Erythropoiesis is triggered by a decrease in:

Erythropoietin- Hormone excreted by kidney in response to decreased oxygen (hypoxemia) in blood. Stimulated by hypoxia

Risk factors for development of primary HT include:

Family history Advanced age Cigarette smoking Obesity Heavy alcohol consumption Gender (men < 50, women > 50 years) High dietary sodium intake Low dietary intake of potassium, calcium, magnesium Glucose intolerance

Which of the following conditions most commonly results in coronary artery disease (CAD)?

Family history Age Gender Race, it results in Altherosclerosis

Risk factors for breast cancer include all of the following except:

Increased age Race/ethnicity Geography Family history BRCA1 and BRCA2 mutations Diet Obesity Smoking

Which of the following could be a contributing factor in the development of hypertension?

Increased renal sodium retention

Angina is a manifestation of coronary artery disease and occurs primarily when:

Infarction—unless ischemia is relieved: death of myocardial tissue

Hemophilia A is an x-linked recessive disease that is characterized by:

Klinefelter Syndrome

All of the following terms are used to describe symptoms of venous insufficiency EXCEPT

Manifestations (see handout comparing arterial and venous disease) Hyperpigmentation of skin Edema Pain (e.g. dull aching, heaviness) Increased calf size Ulcer formation

Spread of cancer from the primary site of origin to a distal location is called:

Metastasis

All of the following are considered teratogens except.

Most vulnerable time period in fetal development is 2-8 weeks after missed period Teratogen (teratogenic) An environmental agent that produces abnormalities in fetal development Fetal Alcohol Syndrome Infectious Agents and Pregnancy-----------------cigar smoke, maternal stress, alcohol, drugs, paternal age T - toxoplasmosis O- Other-- R - rubella C - cytomegalovirus H - Herpes

People with neurofibromatosis have varying manifestations of the disease. The only sign some people with the disease manifest is multiple café au lait spots, while others experience multiple nodules or tumors. These differences in disease manifestation are due to which one of the following genetic principles:

Neurofibromatosis type 2 by the growth of benign tumors on the nerves responsible for hearing and balance.

In cancer, angiogenic factors stimulate:

New blood vessel growth

All of the following can be a sign/symptom of all anemias EXCEPT:

Physiologic manifestation- Reduced oxygen carrying capacity Classic anemia symptoms Fatigue Weakness Dyspnea Pallor Tachycardia Changes in shape and thickness of fingernails Dizziness Fainting New onset heart murmur Cyanosis , expect Bradycardia

The major pathophysiological difference between unstable angina and an acute myocardial infarction (MI) is that with a MI there is:

The distinguishing feature between unstable angina and non-STEMI is the presence of elevated cardiac markers, such as troponin, which implies myocardial damage. is that with a MI there is detectable myocardial necrosis1, which means death of heart tissue due to lack of blood supply. and Unstable angina does not cause permanent damage to the heart and does not release cardiac biomarkers into the circulation.

A couple comes to the clinic for genetic counseling and testing determines that mom is a carrier of an autosomal recessive disorder. Which of the following statements is correct?

They will have 0% of having disease, 50% chance that the child will be carrier. And 50% healthy.

Which of the following statements regarding cholesterol levels is correct?

Total Cholesterol (<200) LDL (<100) HDL (>60) Triglycerides (<150)

Which of the following labs, when elevated, is most indicative of and specific to cardiac damage?

Troponin blood test.

Manifestations for prostate cancer include all of the following, EXCEPT:

Urinary changes- Dysuria, frequency, urgency, dribbling, hesitancy, hematuria Blood in the urine or semen Erectile dysfunction DRE: hard, nodular prostate, painless

A female patient complains of chronic gastritis, fatigue, and tingling in her fingers. Laboratory findings show low hemoglobin, low hematocrit, and high mean corpuscular volume (MC). These findings are consistent with which type of anemia?

Vitamin B12 deficiency (pernicious anemia)

The most common form of a gene in a population is called:

Wild type allele

Pericardial effusion can cause a life-threatening cardiac compression known as:

cardiac tamponade.

Consequences of decreased stroke volume include all of the following, EXCEPT:

in patients with severely decompensated heart failure includes certain tell-tale signs and symptoms.

You were told that your new patient from the emergency room is an anemic woman. In preparation for your new patient, you check her labs and find: Hemoglobin 9.6 (low) and Hematocrit 31.1 (low), MCV 72 (low), and MCHC 25 (low). What type of anemia does she have?

iron deficiency anemia-------microcytic anemia

When looking at the size of the red blood cell (RBC), which word describes a small appearance?

microcytes

Erythrocytes of a person with sickle cell anemia may become sickled if:

oxygen tension is low

A patient presents to the emergency room complaining of pain in her left lower extremity, occurring when she walks for long distances. On assessment you notice the patient has a pale and cold left foot, a weak dorsalis pedis pulse, and increased pain with elevation of the extremity. The most likely diagnosis for this patient is:

peripheral artery disease (PAD)