Advanced Pathophysiology Final

In teaching a women's community group, which risk factor does the healthcare professional teach is related to high morbidity of cancer of the colon, uterus, and kidney? a. Women older than 45 years of age b. Women who have never had children c. Women who have a high body mass index d. Woman who have smoked for more than 10 years

C. A recent hypothesis states that the observed increased incidence of such cancers as breast, endometrium, colon, liver, kidney, and adenomas of the esophagus may be associated with obesity. No current research supports the remaining options.

Considering the mediating factors of premenstrual syndrome (PMS), which medication may be used either continually or only during the menstrual period as a treatment for the condition? a. NSAIDs b. Estrogen c. SSRIs d. Progesterone

C. A selective serotonin reuptake inhibitors (SSRI) (an antidepressant) relieves symptoms in approximately 60% to 90% of women and may be continually administered or only prescribed during the premenstrual period. Oral contraceptive pills that contain estrogen and progesterone also can be continuously used for up to 3 months to decrease the frequency of menstrual periods, PMS, and premenstrual dysphoric disorder (PMDD). Nonsteriodal antiinflammatory drugs (NSAIDs) would not be continually administered.

The basis of the specificity theory of pain is that: a. Injury to specific organs results in specific types of pain. b. Chronic pain is generally less intense than acute pain. c. The greater the tissue injury, the greater the pain. d. Acute pain is specific only to certain injuries.

C. According to the specificity theory, a direct relationship exists between the intensity of pain and the extent of tissue injury. The remaining options are not accurate statements regarding this pain theory.

Pricking one's finger with a needle would cause minimal pain, whereas experiencing abdominal surgery would produce more pain. This distinction is an example of which pain theory? a. Gate control theory c. Specificity theory b. Intensity theory d. Pattern theory

C. According to the specificity theory, a direct relationship exists between the intensity of pain and the extent of tissue injury. The remaining options are not related to the intensity of perceived pain.

Pain that warns of actual or impending tissue injury is referred to as what? a. Chronic b. Psychogenic c. Acute d. Phantom

C. Acute pain is a protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body. The remaining options do not fulfill this objective.

In acute hypothermia, what physiologic change shunts blood away from the colder skin to the body core in an effort to decrease heat loss? a. Hypotension b. Peripheral vasoconstriction c. Voluntary muscle movements d. Shivering

B. Tissue hypothermia slows the rate of chemical reactions (tissue metabolism), increases the viscosity of the blood, slows blood flow through microcirculation, facilitates blood coagulation, and stimulates profound vasoconstriction. The remaining options do not fulfill this objective.

Clinical manifestations that include irregular or heavy bleeding, the passage of large clots, and the depletion of iron stores support which diagnosis? a. Premenstrual syndrome b. Dysfunctional uterine bleeding c. Polycystic ovary syndrome d. Primary dysmenorrhea

B. Unpredictable and variable bleeding, in terms of amount and duration, characterize dysfunctional uterine bleeding. Especially during perimenopause, dysfunctional bleeding also may involve flooding and the passage of large clots, which often indicate excessive blood loss. Excessive bleeding can lead to iron-deficiency anemia. This option is the only answer that demonstrates the clinical manifestations described.

A heat stroke is characterized by: a. Core temperatures usually reaching approximately 39.9° C (103.9° F) b. Sweat production on the face occurring even during dehydration c. A rapidly decreasing core temperature as heat loss from the evaporation of sweat ceases d. Symptoms caused by the loss of sodium and prolonged sweating

B. When the core temperature reaches or exceeds 40.5° C (104.9° F), the brain may be preferentially cooled by maximal blood flow through the veins of the head and face, specifically the forehead. Sweat production on the face is maintained even during dehydration. The remaining options do not occur during heat stroke.

What is the leading cause of infertility in women? a. Pelvic inflammatory disease b. Endometriosis c. Salpingitis d. Polycystic ovary syndrome

D. Polycystic ovary syndrome remains one of the most common endocrine disturbances affecting women, especially young women, and is a leading cause of infertility in the United States.

What is a long-term complication of rewarming as a treatment for hypothermia? a. Acidosis b. Dysrhythmias c. Shock d. Renal failure

D. Rewarming can result in long-term complications that include congestive heart failure, hepatic and renal failure, abnormal erythropoiesis, myocardial infarction, pancreatitis, and neurologic dysfunctions. Short-term complications of rewarming include acidosis, rewarming shock, and dysrhythmias.

Lead poisoning affects the nervous system by A. Interfering with the function of neurotransmitters B. Inhibiting the production of myelin around nerves C. Increasing the resting membrane potential D. Altering the transport of potassium into the nerves

A

Water movement between the intracellular fluid (ICF) compartment and the extracellular fluid (ECF) compartment is primarily a function of: A. Osmotic Forces B. Plasma Oncotic Pressure C. Antidiuretic hormone D. Hydrostatic forces

A

What are the clinical manifestations of testicular cancer? a. Firm, nontender testicular mass b. Painful, mobile, firm testicular mass c. Painful fluid-filled testicular mass d. Soft, nontender testicular mass

A. Of the options available, a firm, painless testicular enlargement is commonly identified as the first sign of testicular cancer.

The professor explains to students that oncogenes are genes that are capable of what? a. Undergoing mutation that directs the synthesis of proteins to accelerate the rate of tissue proliferation b. Directing synthesis of proteins to regulate growth and to provide necessary replacement of tissue c. Encoding proteins that negatively regulate the synthesis of proteins to slow or halt the replacement of tissue d. Undergoing mutation that directs malignant tissue toward blood vessels and lymph nodes for metastasis

A. Oncogenes are independent of normal regulatory mechanisms; thus the cell is driven into a state of unregulated constitutive expression of proliferation signals and uncontrolled cell growth.

Which factor increases the risk for ovarian cancer after the age of 40 years? a. Use of fertility drugs b. Oral contraceptive use c. Multiple pregnancies d. Prolonged lactation

A. Ovarian cancer in women older than 40 years of age is associated with early menarche, late menopause, nulliparity, and the use of fertility drugs. The other options are not necessarily related to women older than the age of 40 years.

What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding? a. Tolerance b. Perception c. Threshold d. Dominance

A. Pain tolerance is the duration of time or the intensity of pain that an individual will endure before initiating overt pain responses. The other options are not related to the duration or intensity of pain endured before the pain is recognized.

The size of benign uterine tumors, such as leiomyomas, is thought to be caused by the influence of which hormone? (Select all that apply.) a. Progesterone b. Estrogen c. Luteinizing hormone d. Gonadotropin-stimulating hormone e. Growth factors

A, B, E. The cause of uterine leiomyomas is unknown, although their size appears to be related to only estrogen, progesterone, growth factors, angiogenesis, and apoptosis.

A reduction in an individual's number of natural killer (NK) cells appears to correlate with an increased risk for the development of what? a. Depression b. Type 1 diabetes c. Obsessive compulsive disorder (OCD) d. Gastroesophageal reflux disorder (GERD)

A. A meta-analysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural killer cell activity. Currently, no research supports correlations between the number of NK cells and type 1 diabetes, OCD, or GERD.

Why are two "hits" required to inactivate tumor-suppressor genes? a. Each allele must be altered, and each person has two copies, or alleles, of each gene, one from each parent. b. The first hit stops tissue growth, and the second hit is needed to cause abnormal tissue growth. c. Tumor-suppressor genes are larger than proto-oncogenes, requiring two hits to affect carcinogenesis. d. The first hit is insufficient to cause enough damage to cause a mutation.

A. A single genetic event can activate an oncogene, acting in a dominant manner in the cell. However, each person has two copies, or alleles, of each gene, one from each parent. Therefore two hits are required to inactivate the two alleles of a tumor-suppressor gene, allowing the process to become active. The remaining options do not describe the reason two hits are required.

Which substance has been shown to increase the risk of cancer when used in combination with tobacco smoking? a. Alcohol b. Steroids c. Antihistamines d. Antidepressants

A. Alcohol interacts with smoke, increasing the risk of malignant tumors, possibly by acting as a solvent for the carcinogenic chemicals in smoke products. No current research supports steroids, antihistamines, or antidepressants as having an increased effect on the incidence of cancer when used in combination with tobacco smoking

What effect does the process of histamine binding to the histamine-2 (H2) receptor have on inflammation? a. Inhibition b. Activation c. Acceleration d. Termination

A. Binding histamine to the H2 receptor is generally antiinflammatory because it results in the suppression of leukocyte function. Binding to H2 receptors does not cause activation, acceleration, or termination of the inflammatory process.

Which cancer originates from connective tissue? a. Osteogenic sarcoma b. Basal cell carcinoma c. Multiple myeloma d. Adenocarcinoma

A. Cancers arising from connective tissue usually have the suffix -sarcoma. Carcinomas arise in epithelial tissue. Myeloma arises in the bone marrow.

What is the role of caretaker genes? a. Maintenance of genomic integrity b. Proliferation of cancer cells c. Secretion of growth factors d. Restoration of normal tissue structure

A. Caretaker genes are responsible for the maintenance of genomic integrity. The other options are not roles assumed by caretaker genes.

A healthcare professional is caring for a patient undergoing chemotherapy. What is the skin-related health risk the professional should assess the patient for and be prepared to treat? a. Infection b. Ultraviolet damage c. Pain d. Erythema

A. Decreased renewal rates of the epidermal layers in the skin may lead to skin breakdown and dryness, altering the normal barrier protection against infection. The healthcare professional should assess the patient for infection regularly and be prepared to treat any infection noted. Radiation therapy may cause skin erythema (redness). Pain and ultraviolet damage is not related to chemotherapies.

Massage therapy relieves pain by closing the pain gate with the stimulation which fibers? a. Ab b. Ad c. B d. C

A. Massaging stimulates different Ab fibers to close the pain gate. The remaining options do not fulfill this objective.

What is apoptosis? a. Normal mechanism for cells to self-destruct when growth is excessive b. Antigrowth signal activated by the tumor-suppressor gene Rb c. Mutation of cell growth stimulated by the TP53 gene d. Transformation of cells from dysplasia to anaplasia

A. Normal cells have a mechanism that causes them to self-destruct when growth is excessive and cell cycle checkpoints have been ignored. Unchecked proliferation could lead to malignancy.

Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction? a. Modulation b. Antibody-dependent cell-mediated cytotoxicity c. Neutrophil-mediated damage d. Complement-mediated lysis

A. The antibody reacts with the receptors on the target cell surface and modulates the function of the receptor by preventing interactions with their normal ligands, replacing the ligand and inappropriately stimulating the receptor or destroying the receptor. For example, in the hyperthyroidism (excessive thyroid activity) of Graves disease, autoantibody binds to and activates receptors for thyroid-stimulating hormone (TSH) (a pituitary hormone that controls the production of the hormone thyroxine by the thyroid). Graves disease is not a result of cell-mediated cytotoxicity, neutrophil-mediated damage, or complement-mediated lysis.

Where in the CNS does a person's learned pain response occur? a. Cerebral cortex b. Frontal lobe c. Thalamus d. Limbic system

A. The cognitive-evaluative system overlies the individual's learned behavior concerning the experience of pain and can modulate the perception of pain and is mediated only through the cerebral cortex.

What part of the brain provides the emotional response to pain? a. Limbic system b. Parietal lobe c. Thalamus d. Hypothalamus

A. The limbic and reticular tracts are involved in alerting the body to danger, initiating arousal of the organism, and emotionally processing the perceived afferent signals, not just as stimuli, but also as pain. The remaining options do not fulfill this objective.

The majority of the small percentage of ovarian cancers that are associated with a known pattern of inheritance are associated with: a. Susceptibility of the BRCA1 gene b. Mutations of the BRCA2 gene c. Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome d. Low progesterone levels

A. The majority (approximately 90%) of ovarian cancers are sporadic and not associated with a known pattern of inheritance. Of the 5% to 10% that have a familial component, the majority are associated with the breast cancer susceptibility gene 1 (BRCA1) and a smaller number with mutations of the BRCA2 or mismatched repair genes (HNPCC syndrome). Low progesterone levels are not associated with ovarian cancers.

Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? a. Norepinephrine b. Epinephrine c. Cortisol d. Adrenocorticotropic hormone (ACTH)

A. The release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. Epinephrine's effects are primarily on the cardiovascular system. Cortisol's chief effects involve metabolic processes. By inhibiting the use of metabolic substances while promoting their formation, cortisol mobilizes glucose, amino acids, lipids, and fatty acids and delivers them to the bloodstream. ACTH binds with specific receptors on the adrenal glands which causes the release of the glucocorticoids.

The gate in the GCT of pain is located in the: a. Substantia gelatinosa b. Marginal layer c. Nucleus proprius d. Dorsolateral tract of Lissauer

A. The synaptic connections between the cells of the primary- and secondary-order neurons located in the substantia gelatinosa and other Rexed laminae function as a pain gate. The remaining options do not act in this function.

Based on an understanding of the physiologic process of nociceptors, the nurse expects which surgical procedure to create more pain? a. Repair of several crushed fingers b. External fixation of a dislocated shoulder c. Cyst removal on the internal surface of an ovary d. Repair of a ruptured spleen

A. The variable nature and distribution of nociceptors affect the relative sensitivity to pain in different areas of the body; the tips of the fingers have more nociceptors than the skin on the back, and all skin has many more nociceptors than the internal organs including bone.

What are tumor cell markers? a. Hormones, enzymes, antigens, and antibodies that are produced by cancer cells b. Receptor sites on tumor cells that can be identified and marked c. Cytokines that are produced against cancer cells d. Identification marks that are used in administering radiation therapy

A. Tumor (biologic) markers are substances produced by both benign and malignant cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine. Tumor markers may include hormones, enzymes, genes, antigens, and antibodies. Tumor markers are not receptor sites, cytokines, or identification marks for radiation.

A healthcare professional is caring for four patients. Which patient should the professional assess for hypermagnesemia as a priority? a. Hepatitis b. Renal failure c. Trauma to the hypothalamus d. Pancreatitis

B

A patient has a history of excessive use of magnesium-containing antacids and aluminum-containing antacids. What lab value does the healthcare professional correlate to this behavior? a. Magnesium 1.8 mg/dL b. Phosphate 1.9 mg/dL c. Sodium 149 mEq/L d. Potassium 2.5 mEq/L

B

People diagnosed with neurofibromatosis have varying degrees of the condition because of which genetic principle? a. Penetrance b. Expressivity c. Dominance d. Recessiveness

B

When cellular damage occurs and regeneration is minor with no significant complications, what is the process of returning the cells to preinjury function referred to as? a. Restoration b. Resolution c. Regrowth d. Replacement

B If damage is minor with no complications and destroyed tissues are capable of regeneration, then returning the injured tissues to an approximation of their original structure and physiologic function is possible. This restoration is called resolution. Resolution is the restoration of the original tissue structure and function. Regrowth and replacement are not part of resolution.

Dysfunctional uterine bleeding (DUB), secondary to ovarian dysfunction, is abnormal uterine bleeding resulting from: (Select all that apply.) a. Endometriosis b. Progesterone deficiency c. Sexually transmitted infections d. Congenital abnormalities in the uterine structure e. Estrogen excess

B, E. Of the options available, DUB, secondary to ovarian dysfunction, is a result of either progesterone deficiency or unopposed estrogen excess.

What does activation of the classical pathway begin with? a. Viruses b. Antigen-antibody complexes c. Mast cells d. Macrophages

B. Activation of the classical pathway begins only with the activation of protein C1 and is preceded by the formation of a complex between an antigen and an antibody to form an antigen-antibody complex (immune complex). Infection with a virus can lead to the start of the inflammatory process, but is not the specific activation factor. Mast cells release the contents of their granules to initiate synthesis of other mediators of inflammation among other actions. Macrophages are one cell type involved in phagocytosis.

Which statement is true concerning the differences between stress-induced hormonal alterations of men and women? a. After injury, women produce more proinflammatory cytokines than men, a profile that is associated with poor outcomes. b. Androgens appear to induce a greater degree of immune cell apoptosis after injury, creating greater immunosuppression in injured men than in injured women. c. Psychologic stress associated with some types of competition decreases both testosterone and cortisol, especially in athletes older than 45 years of age. d. After stressful stimuli, estrogen is increased in women, but testosterone is decreased in men.

B. Androgens appear to induce a greater degree of immune cell apoptosis after injury, a mechanism that may elicit a greater immunosuppression in injured men vs. injured women. Men produce more proinflammatory cytokines. Competitive stress increases testosterone and cortisol. Estrogen is not increased in women after stressful stimuli.

Burkitt lymphomas designate a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. This is an example of which mutation of normal genes to oncogenes? a. Point mutation b. Chromosome translocation c. Gene amplification d. Chromosome fusion

B. Chromosome translocations, in which a piece of one chromosome is translocated to another chromosome, can activate oncogenes. One of the best examples is the t(8;14) translocation found in many Burkitt lymphomas; t(8;14) designates a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. A point mutation is the alteration of one or a few nucleotide base pairs. Gene amplification is the result of repeated duplication of a region of a chromosome, so that instead of the normal two copies of a gene, tens or even hundreds of copies are present. Chromosome fusion occurs during translocation.

A student asks the healthcare professional how immunity is decreased by stress. The professional responds that during a stress response, the helper T (Th) 1 response is suppressed by which hormone? a. ACTH b. Cortisol c. Prolactin d. Growth hormone

B. Cortisol acts to suppress the activity of Th1 cells, which leads to a decrease in innate immunity and the proinflammatory response. Cortisol also stimulates the activity of Th2 cells, which increases adaptive immunity and the antiinflammatory response. ACTH binds with specific receptors on the adrenal glands which causes the release of the glucocorticoids. Prolactin is secreted in response to a variety of stressful stimuli and acts as a second messenger for IL-2 and has a positive influence on B-cell activation and differentiation. Growth hormone affects protein, lipid, and carbohydrate metabolism; counters effects of insulin; and is involved in tissue repair.

After sexual transmission of HIV, how soon can lab results detect the infection? a. 1 to 2 days b. 4 to 10 days c. 4 to 8 weeks d. 2 to 4 months

B. HIV RNA may be detected in the plasma by about 4 to 10 days after an acute infection and HIV.

A severely stressed patient has cold, clammy skin. The healthcare professional quizzes the student about this effect. The student correctly answers that this effect is directly from which action? a. Epinephrine dilating blood vessels leading to the vital organs b. Norepinephrine constricting blood vessels in the skin c. Dilating the airways to increased oxygenation of the tissues d. Dysfunctional temperature regulation from cortisol secretion

B. In a stress response, the actions of norepinephrine and epinephrine are complementary. While epinephrine dilates blood vessels to the vital organs (among other things), norepinephrine constricts blood vessels in the viscera and skin, providing more blood supply for those vital organs. The clinical result is cold, clammy skin. Epinephrine can also dilate airways, but this does not produce the skin changes as described. Temperature dysregulation is not the cause of the cold, clammy skin.

What theory is used to describe the cause of endometriosis? a. Obstruction within the fallopian tubes prevents the endometrial tissue from adhering to the lining of the uterus. b. Endometrial tissue passes through the fallopian tubes and into the peritoneal cavity and remains responsive to hormones. c. Inflammation of the endometrial tissue develops after recurrent sexually transmitted diseases. d. Endometrial tissue lies dormant in the uterus until the ovaries produce sufficient hormone to stimulate its growth.

B. It has been proposed that endometriosis is caused by the implantation of endometrial cells during retrograde menstruation, during which menstrual fluids move through the fallopian tubes and empty into the pelvic cavity (see Figure 24-16). Similar to normal endometrial tissue, the ectopic (out of place) endometrium responds to the hormonal fluctuations of the menstrual cycle. Of the available options, this answer is the only accepted theory for the cause of endometriosis.

Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer? a. Cancer cells accumulate slower than non-cancer cells. b. An accumulation of mutations in specific genes is required to develop cancer. c. Tumor invasion and metastasis progress more slowly in the gastrointestinal tract. d. Apoptosis is triggered by diverse stimuli, including excessive growth.

B. Multiple genetic mutations are required for the evolution of full-blown cancer. This sequential development of cancer has been well documented in the transformation of benign colon polyps to colon cancer.

Carcinoma refers to abnormal cell proliferation originating from which tissue origin? a. Blood vessels b. Epithelial cells c. Connective tissue d. Glandular tissue

B. Only cancers arising from epithelial cells are called carcinomas. Connective tissue cancers are called sarcomas. Glandular tissue cancers are named adenocarcinomas. Malignant cancers can invade blood vessels.

When considering the risk factors for the development of phantom limb pain, the nurse recognizes which as a primary contributing factor? a. Age, with adolescent patients being at a higher risk than adults b. Presence of pain in the limb before amputation c. Patient's previous experience with managing pain d. Cultural views regarding the acceptance of pain

B. Phantom limb pain is pain that an individual feels in an amputated limb after the stump has completely healed. It is more likely to appear in individuals who experienced pain in the limb before amputation. The other options would not be considered a primary contributing factors.

The release of which chemical mediator causes primary dysmenorrhea? a. Leukotrienes b. Prostaglandins c. Bradykinin d. C-reactive protein

B. Primary dysmenorrhea is painful menstruation associated with the release of prostaglandins in ovulatory cycles. This option is the only answer that accurately identifies the chemical mediator associated with dysmenorrhea.

A healthcare professional student is learning about fungal infections. What information should the student use to help another student understand? a. Fungal infections occur only on skin, hair, and nails. b. Phagocytes and T lymphocytes control fungal infections. c. Fungal infections release endotoxins. d. Vaccines prevent fungal infections.

B. The host defense against fungal infection includes the fungistatic properties of neutrophils and macrophages. T lymphocytes are crucial in limiting the extent of infection and producing cytokines to further activate macrophages. Fungi infect other tissue types such as vaginal or gastrointestinal. Fungi do not release endotoxins; they reside in the cell walls of gram-negative bacteria. Fungal infections are not prevented by current vaccines.

What is the consequence for cells when the functioning TP53 gene is lost as a result of mutation? a. Cells undergo apoptosis. b. Cells escape apoptosis. c. Cells receive less oxygen. d. Cells adhere more readily.

B. The most common mutations conferring resistance to apoptosis occur in the TP53 gene. The remaining options do not accurately describe the effect when the functioning TP53 gene is lost as a result of mutation.

Which cells are primary targets for HIV? a. CD4+ Th cells only b. CD4+ Th cells, macrophages, and dendritic cells c. CD8-positive cytotoxic T (Tc) cells and plasma cells d. CD8-positive Tc cells only

B. The primary cellular targets for HIV include CD4+ Th cells, macrophages, and dendritic cells. The other cell types are not the primary target cells of HIV.

Which endogenous opioid is located in the hypothalamus and pituitary and is a strong m-receptor agonist? a. Enkephalins b. Endorphins c. Dynorphins d. Endomorphins

B. The synthesis and activity of b-endorphin is concentrated in the hypothalamus and the pituitary gland and act as strong µ-receptor agonist. The remaining options do not fulfill this objective.

A healthcare professional is caring for four patients. Which patient should the professional assess for hyperkalemia? a. Hyperparathyroidism b. Vomiting c. Renal failure d. Hyperaldosteronism

C

Two thirds of the body's water is found in its a. Interstitial fluid spaces b. Vascular system c. Intracellular fluid compartments d. Intraocular fluids

C

What is the most common cause of Down syndrome? a. Paternal nondisjunction b. Maternal translocations c. Maternal nondisjunction d. Paternal translocation

C

How does the ras gene convert from a proto-oncogene to an oncogene? a. Designating a chromosome that has a piece of one chromosome fused to a piece of another chromosome b. Duplicating a small piece of a chromosome, repeatedly making numerous copies c. Altering one or more nucleotide base pairs d. Promoting proliferation of growth signals by impairing tumor-suppressor genes

C A point mutation is the alteration of one or a few nucleotide base pairs. This type of mutation can have profound effects on the activity of proteins. A point mutation in the ras gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation. Fusion, duplications, and proliferation of growth signals are not the cause of a ras gene converting to an oncogene.

When antibodies are formed against red blood cell antigens of the Rh system, how are the blood cells destroyed? a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Phagocytosis in the spleen d. Neutrophil granules and toxic oxygen products

C Antibodies against platelet-specific antigens or against red blood cell antigens of the Rh system coat those cells at low density, resulting in their preferential removal by phagocytosis in the spleen, rather than by complement-mediated lysis. These blood cells are not destroyed by complement-mediated cell lysis, phagocytosis by macrophages, neutrophil granules, or toxic oxygen products

In childhood neuroblastoma, the N-myc oncogene undergoes which type of mutation of normal gene to oncogene? a. Point mutation b. Chromosome fusion c. Gene amplification d. Chromosome translocation

C. Amplifications are the result of the duplication of a small piece of a chromosome over and over again; consequently, instead of the normal two copies of a gene, tens or even hundreds of copies are present. The N-myc oncogene is amplified in 25% of childhood neuroblastoma.

What effect do androgens have on lymphocytes? a. Suppression of B-cell responses and enhancement of T-cell responses b. Suppression of T-cell responses and enhancement of B-cell responses c. Suppression of B- and T-cell responses d. Enhancement of B- and T-cell responses

C. Androgens suppress T- and B-cell responses. Androgens do not enhance either B- or T-cell responses

Frequently when H1 and H2 receptors are located on the same cells, they act in what fashion? a. Synergistically b. Additively c. Antagonistically d. Agonistically

C. Both types of receptors are distributed among many different cells and are often present on the same cells and may act in an antagonistic fashion. For instance, neutrophils express both types of receptors, with stimulation of H1 receptors resulting in the augmentation of neutrophil chemotaxis and H2 stimulation resulting in its inhibition. The two receptors do not act synergistically, additively, or agonistically.

Autocrine stimulation is the ability of cancer cells to do what? a. Stimulate angiogenesis to create their own blood supply b. Encourage secretions that turn off normal growth inhibitors c. Secrete growth factors that stimulate their own growth d. Divert nutrients away from normal tissue for their own use

C. Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. The other options describe other activities of cancer cells, but not autocrine stimulation.

Carcinoma in situ is characterized by which changes? a. Cells have broken through the local basement membrane. b. Cells have invaded immediate surrounding tissue. c. Cells remain localized in the glandular or squamous cells. d. Cellular and tissue alterations indicate dysplasia.

C. Carcinoma in situ (CIS) refers to preinvasive epithelial malignant tumors of glandular or squamous cell origin. These early stage cancers are localized to the epithelium and have not broken through the local basement membrane or invaded the surrounding tissue. Dysplasia refers to changes in mature cell structure.

Which gastrointestinal tract condition can be an outcome of both chemotherapy and radiation therapy? a. Increased cell turnover b. Constipation c. Stomatitis d. Bloody stool

C. Chemotherapy and radiation therapy may cause a decreased cell turnover, thereby leading to oral ulcers (stomatitis), malabsorption, and diarrhea.

When comparing the effects of acute and chronic pain on an individual, chronic pain is more often: a. The external event that results in a sense of fear b. Viewed as being meaningful but undesirable c. A factor that contributes to depression d. A sense of internal unease

C. Chronic pain is often associated with a sense of hopelessness and helplessness as relief becomes more elusive and the time frame more protracted. The pain is perceived as meaningless, and depression is often a concomitant finding, as either a result of the chronic pain state or as a contributor to its development. Individuals often psychologically respond to acute pain with fear (e.g., fear of diagnosis, fear of continued pain), anxiety, and a general sense of unpleasantness or unease.

Cytokines are thought to cause fevers by stimulating the synthesis of which chemical mediator? a. Leukotriene b. Histamine c. Prostaglandin d. Bradykinin

C. Cytokines seem to raise the thermoregulatory set point through stimulation of prostaglandin synthesis and turnover in thermoregulatory (brain) and nonthermoregulatory (peripheral) tissues. Leukotrienes, histamine, and bradykinin are not directly related to fever production

Enkephalins and endorphins act to relieve pain by which process? a. Inhibiting cells in the substantia gelatinosa b. Stimulating the descending efferent nerve fibers c. Attaching to opiate receptor sites d. Blocking transduction of nociceptors

C. Enkephalins and endorphins are neurohormones that act as neurotransmitters by binding to one or more G protein-coupled opioid receptors and thus relieving pain. The other options are not accurate descriptions of how enkephalins and endorphins relieve pain.

Research has shown a link between cancer and which sexually transmitted disease? a. Syphilis b. Gonorrhea c. Human papillomavirus d. Pelvic inflammatory disease

C. Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. High-risk, or oncogenic, HPVs can cause cancer. A persistence of infection with high-risk HPV is a prerequisite for the development of cervical intraepithelial neoplasia (CIN) lesions and invasive cervical cancers. No research supports such a link between syphilis, gonorrhea, or pelvic

What is the major virus involved in the development of cervical cancer? a. Herpes simplex virus type 6 b. Herpes simplex virus type 2 c. Human papillomavirus d. Human immunodeficiency virus

C. Infection with specific subtypes of human papillomavirus (HPV) causes virtually all cervical cancers. The remaining options are not known to be associated with cervical cancer.

Inherited mutations that predispose to cancer are almost invariably what kind of gene? a. Proto-oncogenes b. Oncogenes c. Tumor-suppressor genes d. Growth-promoting genes

C. Inherited mutations that predispose to cancer are almost invariably in tumor-suppressor genes. At present, no research supports the other options as factors related to how inherited mutations cause cancer.

Which term is used to identify benign uterine tumors that develop from smooth muscle cells in the myometrium and are commonly called uterine fibroids? a. Endometrial polyps b. Myometrial polyps c. Leiomyomas d. Myometriomas

C. Leiomyomas, commonly called myomas or uterine fibroids, are benign smooth muscle tumors in the myometrium (see Figure 24-14). The other terms do not accurately identify the tumors described.

Which type of nerve fibers transmits pain impulses? a. A-alpha (Aa) fibers b. A-beta (Ab) fibers c. A-delta (Ad) fibers d. B fibers

C. Of the available options, only medium-sized Ad fibers transmit pain impulses.

Released stress-induced cortisol results in the stimulation of gluconeogenesis by affecting which structure? a. Adrenal cortex b. Pancreas c. Liver d. Anterior pituitary

C. One of the primary effects of cortisol is the stimulation of gluconeogenesis through stimulation of the liver. The adrenal cortex, pancreas, and anterior pituitary do not produce stimulation of gluconeogenesis when exposed to cortisol.

Using a fan to reduce body temperature is an example of which mechanism of heat loss? a. Evaporation b. Radiation c..Convection d. Conduction

C. Only convection causes the transfer of heat through currents of gases or liquids.

What statement concerning the pathogenetic mechanisms of polycystic ovarian syndrome (POS) is true? a. POS causes a decrease in leptin levels; this decrease reduces the hypothalamic pulsatility of gonadotropin-releasing hormone, which reduces the number of follicles that mature. b. POS is a result of a disorder in the anterior pituitary that increases the follicle-stimulating hormone, which reduces the luteinizing hormone released. c. POS is a result of a combination of conditions that include oligo-ovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. d. POS inhibits testosterone, which stimulates androgen secretion by the ovarian stroma and indirectly reduces sex hormone-binding globulin.

C. POS has at least two of the following conditions: oligo-ovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. Of the options available, only this answer accurately defines the pathogenetic mechanisms of POS.

A healthcare professional is caring for four patients with cancer. Which patient does the professional educate about brachytherapy? a. Lung b. Colon c. Cervical d. Brain

C. Radiation sources, such as small 125I-labeled capsules (also called seeds), can also be temporarily placed into body cavities, a delivery method termed brachytherapy. Brachytherapy is useful in the treatment of cervical, prostate, and head and neck cancers. Brachytherapy is not used in the treatment of the other cancers.

Research has supported that alcohol consumption has a convincing impact on increasing the risk of which cancer? a. Lung b. Breast c. Pharynx d. Pancreas

C. Research had shown that alcohol consumption has a convincing positive impact on the risk of developing pharynx cancer. No research supports such a connection with the remaining options.

The Papanicolaou (Pap) test is used to screen for which cancer? a. Ovarian b. Uterine c. Cervical d. Vaginal

C. The Pap test, an examination of cervical epithelial scrapings, readily detects early oncogenic human papillomavirus (HPV) infection. The Pap test is not used for screening the other cancer sites listed.

In the coagulation (clotting) cascade, the intrinsic and the extrinsic pathways converge at which factor? a. XII b. VII c. X d. V

C. The coagulation cascade consists of the extrinsic and intrinsic pathways that converge only at factor X.

Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of what? a. Epinephrine and aldosterone b. Norepinephrine and cortisol c. Epinephrine and norepinephrine d. Acetylcholine and cortisol

C. The sympathetic nervous system is aroused during the stress response and causes the medulla of the adrenal gland to release catecholamines (80% epinephrine and 20% norepinephrine) into the bloodstream. Sympathetic stimulation of the adrenal medulla does not cause the secretion of aldosterone, cortisol, or acetylcholine.

A student studying biology asks the professor to describe how the ras gene is involved in cancer proliferation. What explanation by the professor is best? a. It suppresses the action of the tumor-suppressor genes. b. It changes the way the growth promotion genes work. c. A mutation in this gene allows continuous cell growth. d. It activates a cell surface receptor that allows signaling to the nucleus.

C. Up to one-third of all cancers have an activating mutation in the gene for an intracellular signaling protein called ras. This mutant ras stimulates cell growth even when growth factors are missing. The remaining options do not describe how ras contributes to cancer formation and growth.

Cystic fibrosis is caused by what type of gene? a. X-linked dominant b. X-linked recessive c. Autosomal dominant d. Autosomal recessive

D

Which term is used to describe a cell showing a loss of cellular differentiation? a. Dysplasia b. Hyperplasia c. Metaplasia d. Anaplasia

D Anaplasia is defined as the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and the loss of normal tissue structure. In clinical specimens, anaplasia is recognized by a loss of organization and a significant increase in nuclear size with evidence of ongoing proliferation. Dysplasia is the presence of an abnormal cell type within a tissue and often is called "precancerous." Hyperplasia is an enlargement of an organ or tissue due to increased production of its cells, also often considered precancerous. Metaplasia is an abnormal change in the characteristics of a tissue.

What are characteristics of benign tumors? a. Benign tumors invade local tissues. b. Benign tumors spread through the lymph nodes. c. Benign tumors cause systemic symptoms. d. Benign tumors include the suffix -oma.

D Benign tumors are usually encapsulated and well-differentiated. They retain some normal tissue structure and do not invade the capsules surrounding them or spread to regional lymph nodes or distant locations. Benign tumors are generally named according to the tissues from which they arise and include the suffix -oma. Benign tumors do not cause systemic symptoms

How do cancer cells use the enzyme telomerase? a. To repair the telomeres to restore somatic cell growth b. As an intracellular signaling chemical to stimulate cell division c. To switch off the telomerase to enable cells to divide indefinitely d. To switch on the telomerase to enable cells to divide indefinitely

D Cancer cells, when they reach a critical age, somehow activate telomerase to restore and maintain their telomeres and thereby make it possible for cells to divide over and over again.

In a normal, nonmutant state, what is an oncogene referred to as? a. Basal cell b. Target cell c. Caretaker gene d. Proto-oncogene

D In its normal nonmutant state, an oncogene is referred to as a proto-oncogene. A basal cell is in the innermost surface of epithelial tissue. Target cells are the recipients of mutations or substances. A caretaker gene is responsible for the maintenance of genomic integrity.

What is one function of the tumor cell marker? a. To provide a definitive diagnosis of cancer b. To treat certain types of cancer c. To predict where cancers will develop d. To screen individuals at high risk for cancer

D Screening and identifying individuals at high risk for cancer are ways tumor markers can be used. The two other uses for these markers are to help diagnosis a specific type of cancer (not give a definitive diagnosis) and to follow the clinical course of a tumor.

What does the health professions student learn about benign tumors? a. The resulting pain is severe. b. Benign tumors are not encapsulated. c. Benign tumors are fast growing. d. The cells are well-differentiated.

D. A benign tumor is well-differentiated with its tissue appearing similar to the tissue from which it arose. The other options are characteristic of a malignant tumor.

Symptoms of benign prostatic hyperplasia (BPH) are a result of which pathophysiologic condition? a. Infection of the prostate b. Obstruction of the urethra c. Ischemia of the urethra d. Compression of the urethra

D. BPH becomes problematic as prostatic tissue compresses the urethra, where it passes through the prostate. Of the selections available, only this option accurately describes the pathophysiologic condition behind the symptoms of BPH.

What is the inflammatory effect of nitric oxide (NO)? a. Increases capillary permeability, and causes pain b. Increases neutrophil chemotaxis and platelet aggregation c. Causes smooth muscle contraction and fever d. Decreases mast cell function, and decreases platelet aggregation

D. Effects of NO on inflammation include vasodilation by inducing relaxation of vascular smooth muscle, a response that is local and short-lived, and by suppressing mast cell function, as well as platelet adhesion and aggregation. NO does not increase capillary permeability and cause pain, increase neutrophil chemotaxis and platelet aggregation, or cause smooth muscle contraction and fever.

A student asks the healthcare professional to describe exotoxins. Which statement by the professional is best? a. Exotoxins are contained in cell walls of gram-negative bacteria. b. Exotoxins are released during the lysis of bacteria. c. Exotoxins are able to initiate the complement and coagulation cascades. d. Exotoxins are released during bacterial growth.

D. Exotoxins are proteins released during bacterial growth. Exotoxins are not contained in cell walls of gram-negative bacteria, released during lysis of bacterial, or able to initiate the complement and coagulation cascades.

In a normal, nonmutant state, what is an oncogene referred to as? a. Basal cell b. Target cell c. Caretaker gene d. Proto-oncogene

D. In its normal nonmutant state, an oncogene is referred to as a proto-oncogene. A basal cell is in the innermost surface of epithelial tissue. Target cells are the recipients of mutations or substances. A caretaker gene is responsible for the maintenance of genomic integrity.

Which spinal tract carries the most nociceptive information? a. Archeospinothalamic b. Paleospinothalamic c. Dorsal spinothalamic d. Lateral spinothalamic

D. Most nociceptive information travels by means of ascending columns in the lateral spinothalamic tract (also called the anterolateral funiculus). The other tract options do not carry the most nociceptive information.

When soluble antigens from infectious agents enter circulation, what is tissue damage a result of? a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Phagocytosis in the spleen d. Neutrophil granules and toxic oxygen products

D. Of the options available, only the components of neutrophil granules as well as the several toxic oxygen products produced by these cells, damage the tissue.

Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation? a. Heat cramps b. Heat stroke c. Malignant hyperthermia d. Heat exhaustion

D. Of the options presented, only heat exhaustion, or collapse, is a result of prolonged high core or environmental temperatures resulting in dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia.

Which cytokine is produced and released from virally infected host cells? a. IL-1 b. IL-10 c. TNF-α d. IFN-α

D. Only interferons (IFNs) are produced and released by virally infected cells in response to viral double-stranded ribonucleic acid (RNA). IFN-α and IFN-β induce the production of antiviral proteins, thereby conferring protection on uninfected cells. IFN-α or IFN-β is released from virally infected cells and attaches to a receptor on a neighboring cell. IFNs also enhance the efficiency of developing an acquired immune response. IL-1 is a proinflammatory interleukin. IL-10 plays a critical role in wound healing. TNF has several systemic effects but is not released from virally infected host cells.

Which statement regarding pelvic inflammatory disease (PID) is true? a. An episode of mild PID can decrease the possibility of a successful pregnancy by 80%. b. Such an inflammation results in temporary changes to the ciliated epithelium of the fallopian tubes. c. PID has not been associated with an increased risk of an ectopic pregnancy. d. Contracting this infection increases the risk of uterine cancer.

D. PID infection results in permanent changes to the ciliated epithelium of the fallopian or uterine tubes. A recent study has found that one episode of mild, subclinical PID resulted in a 40% decrease in later pregnancy rates, and multiple episodes of PID further increase the risk of infertility. Scarring caused by PID greatly increases the risk of a later ectopic pregnancy by up to tenfold. Scarring and adhesions also can result in chronic pelvic pain and, potentially, an increased risk of later uterine cancer.

What term is used to identify a fibrotic condition that causes lateral curvature of the penis during erection, which is associated with a local vasculitis-like inflammatory reaction and decreased tissue oxygenation? a. Phimosis b. Lateral phimosis c. Lateral paraphimosis d. Peyronie disease

D. Peyronie disease (bent nail syndrome) is a fibrotic condition of the tunica albuginea of the penis, resulting in varying degrees of curvature and sexual dysfunction (see Figure 25-2). Although the exact cause is unknown, a local vasculitis-like inflammatory reaction occurs and decreased tissue oxygenation results in fibrosis and calcification. Peyronie disease is the only term used to identify the pathophysiologic condition described.

What term is used to identify a condition in which the foreskin cannot be retracted over the glans penis? a. Paraphimosis c. Prephimosis b. Priapism d. Phimosis

D. Phimosis is the only term used to identify the condition in which the foreskin cannot be retracted back over the glans.

What does the phagosome step result in during the process of endocytosis? a. Microorganisms are ingested. b. Microorganisms are killed and digested. c. Phagocytes recognize and adhere to bacteria. d. An intracellular phagocytic vacuole is formed.

D. Small pseudopods that extend from the plasma membrane and surround the adherent microorganism, forming an intracellular phagocytic vacuole or phagosome, carry out engulfment (endocytosis). The membrane that surrounds the phagosome consists of inverted plasma membrane. After the formation of the phagosome, lysosomes converge, fuse with the phagosome, and discharge their contents, creating a phagolysosome.

A healthcare professional advises patients to exercise because it has a probable impact on reducing which cancer? a. Liver b. Endometrial c. Stomach d. Colon

D. The expert panel report on exercise of the World Cancer Research Fund/American Institute for Cancer Research found a convincing impact of exercise on risk of colon cancer.

Which statement is true regarding the gate control theory (GCT) of pain? a. The pain gate is located in the brain. b. A closed gate increases pain perception. c. The brain primarily controls the pain gate. d. An open gate facilitates the brain in processing the pain.

D. The open gate in the spinal cord regulates the transmission of pain impulses that ascend to the brain for further processing and interpretation, thus leading to the management of pain. The remaining statements are not true when discussing the GCT of pain.

How does the B-cell receptor (BCR) complex function? a. Communicating information about the antigen to the helper T cell b. Secreting chemical signals to communicate between cells c. Releasing histamine and other vasoactive substances d. Communicating information about the antigen to the cell nucleus

D. The role of the BCR is to recognize the antigen; however, unlike circulating antibodies, the receptor must communicate that information to the cell's nucleus. The BCR does not communicate information about the antigen to the helper T cell or secrete chemical signals to communicate between cells. The release of histamine and other vasoactive substances is part of inflammation, not adaptive immunity.