Cumulative 504 Review Questions

How do free radicals cause cell damage?

By giving up an electron, causing injury to the chemical bonds of the cell membrane. A free radical is an electrically uncharged atom or group of atoms having an unpaired electron. Having one unpaired electron makes the molecule unstable; thus to stabilize, it gives up an electron to another molecule or steals one. Therefore, it is capable of injurious chemical bond formation with proteins, lipids, carbohydrates—key molecules in membranes and nucleic acids.

In which disorder is a specific protein longer than normal? And the longer it is, the earlier the onset? Answers: A. Alzheimer's B. Parkinson's C. Huntington's D. Seizures.

C - Huntington's Disease In Huntington Disease, the Huntingtin (htt)protein is longer than normal which will cause accumulations within the axons of neurons and within the synaptic terminals. The longer the protein, the earlier the onset.

What will cause a patient's glomerular filtration rate (GFR) to decrease? A - Constant glomerular filtration rate B - Increased net filtration pressure C - Increased glomerular capillary oncotic pressure D - Constriction of the efferent arteriole

C - Increased glomerular capillary oncotic pressure

A pathology report stages a tumor as T2, N1, M0. What is the meaning of this finding? Answers: A. There is a tumor with no spread to surrounding lymph nodes and no metastasis. B. There are two malignant tumors and one involved lymph node with metastasis. C. There is a tumor with spread to surrounding lymph nodes and no metastasis. D. There is no tumor after two biopsies and one lymph node biopsy and no metastasis.

C - There is a tumor with spread to surrounding lymph nodes and no metastasis. T2, = lesion 2 to 5 cm in size; N1, = mobile nodes involved; M0 = no metastases.

What are characteristics of cancer in situ? Answers: 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 changes indicate dysplasia.

C - cells remain localized in the glandular or squamous cells Carcinoma in situ (often abbreviated 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.

A patient cuts his finger. Which fibers transmit the pain signal? Answers: A. Aα fibers B. Aβ fibers C. A-delta fibers D. B fibers

C. A-delta fibers Pain from mechanical deformation and extremes of temperature are associated with lightly myelinated, medium-sized A-delta (Aδ) fibers. Other types of mechanical, thermal, and chemical nociception are transmitted by excitation of polymodal nociceptors and are carried on small, unmyelinated C fibers.

Which neurologic disorder is characterized by cortical nerve cell processes that have become twisted and dilated? Answers: A. Dementia syndrome B. Huntington's disease C. Alzheimer disease D. Parkinson disease

C. Alzheimer disease

Many cancers create an activating mutation of the ras gene. What is the function of the RAS protein? A. A tumor-suppressor gene B. An enzyme involved in methylation C. An intracellular signaling protein that regulates cell growth D. A cell surface receptor that allows signaling to the nucleus about cell growth

C. An intracellular signaling protein that regulates cell growth Up to one third of all cancers have an activating mutation in the gene for an intracellular signaling protein called ras. This mutant rasstimulates cell growth even when growth factors are missing. The remaining options do not describe ras.

What pathologic alteration produces tremors at rest, rigidity, akinesia, and postural abnormalities? A. Atrophy of neurons in the caudate that produce serotonin B. Atrophy of neurons in the putamen that produce gamma-aminobutyric acid (GABA) C. Atrophy of neurons in the substantia nigra that produce dopamine D. Atrophy of neurons in the hypothalamus that produce acetylcholine

C. Atrophy of neurons in the substantia nigra that produce dopamine The hallmark characteristics of Parkinson disease are a result of a loss of dopaminergic pigmented neurons in the substantia nigra (SN) pars compacta with dopaminergic deficiency in the putamen portion of the striatum (the striatum includes the putamen and caudate nucleus).

A patient has hematuria with casts and proteinuria exceeding 3 to 5 g/day with albumin as the major protein. This data suggest the presence of which disorder? A. Cystitis B. Chronic pyelonephritis C. Glomerulonephritis D. Nephrotic syndrome

C. Glomerulonephritis Two major changes distinctive of more severe glomerulonephritis are (1) hematuria with red blood cell casts and (2) proteinuria exceeding 3 to 5 g/day with albumin as the major protein.

Which of the following is not a contributing factor to the development of hypertension? Answers: A. Increased sympathetic activity B. Increased angiotensin II C. Increased naturetic peptide D. Insulin resistance

C. Increased naturetic peptide Naturetic peptides function to increase sodium excretion (which water will follow) to reduce blood volume and therefore blood pressure. It is the dysfunction of these hormones that contributes to hypertension.

The most common route of lower respiratory tract infection is: A. aspiration of oropharyngeal secretions. B. inhalation of microorganisms. C. microorganisms spread to lung via blood. D. poor mucus membrane protection.

A - aspiration Aspiration of oropharyngeal secretions is the most common route of lower respiratory tract infection; thus the nasopharynx and oropharynx constitute the first line of defense for most infectious agents.

In a type II hypersensitivity reaction, when mismatched blood is administered causing an ABO incompatibility, the erythrocytes are destroyed by: A. complement-mediated cell lysis. B. phagocytosis by macrophages. C. phagocytosis in the spleen. D. natural killer cells.

A - complement-mediated cell lysis Erythrocytes are destroyed by complement-mediated lysis in individuals with autoimmune hemolytic anemia (see Chapter 26) or as a result of an alloimmune reaction to ABO-mismatched transfused blood cells.

What are tumor cell markers? Answers: A. Hormones, enzymes, antigens, and antibodies produced by cancer cells B. Receptor sites on tumor cells that can be identified and marked C. Cytokines produced against cancer cells D. Identification marks used in administering radiation therapy

A - hormones, enzymes, antigens, and antibodies produced by cancer cells Tumor markers (biologic markers) are substances produced by cancer 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.

Stress-induced cortisol released from the adrenal cortex results in: A. stimulation of gluconeogenesis. B. increased lipolysis. C. stimulation of glycogenolysis. D. increased peripheral uptake and use of glucose.

A - stimulation of gluconeogenesis One of the primary effects of cortisol is the stimulation of gluconeogenesis, or the formation of glucose from noncarbohydrate sources, such as amino or free fatty acids in the liver.

What is the cause of familial hypercholesterolemia (FH)?

A reduction in the number of LDL receptors on cell surfaces FH is caused by a reduction in the number of functional LDL receptors on cell surfaces. Lacking the normal number of LDL receptors,cellular cholesterol uptake is reduced and circulating cholesterol levels increase

How does the loss of chloride during vomiting cause metabolic alkalosis? A. Loss of chloride stimulates the release of aldosterone, which causes the retained sodium to bind with the chloride. B. Loss of chloride causes hydrogen to move into the cell and exchange with potassium to maintain cation balance. C. Loss of chloride causes retention of bicarbonate to maintain the anion balance. D. Loss of chloride causes hypoventilation to compensate for the metabolic alkalosis.

C. Loss of chloride causes retention of bicarbonate to maintain the anion balance. When acid loss is caused by vomiting with depletion of ECF and chloride (hypochloremic metabolic alkalosis), renal compensation is not very effective because the volume depletion and loss of electrolytes (Na+, K+, H+, Cl-) stimulate a paradoxical response by the kidneys. The kidneys increase sodium and bicarbonate reabsorption with excretion of hydrogen. Bicarbonate is reabsorbed to maintain an anionic balance because the ECF chloride concentration is decreased.

In hypoxic injury, why does sodium enter the cell and cause swelling? Answers: A. Because the cell membrane permeability increases for sodium during periods of hypoxia B. Because there is insufficient ATP to maintain the pump that keeps sodium out of the cell C. Because the lactic acid produced by the hypoxia binds with sodium within the cell D. Because sodium cannot be transported in the cytosol to the cell membrane during hypoxia

B. Because there is insufficient ATP to maintain the pump that keeps sodium out of the cell

Of the following people, who is at highest risk for a cerebrovascular accident (CVA)? Answers: A. White women older than 65 years of age B. Black women older than 70 years of age C. Black men older than 65 years of age D. White men older than 70 years of age

B. Black women older than 70 years of age Fifty percent of CVAs occur in persons older than 70 years. Strokes, however, do occur in a 3:10 ratio (28%) in individuals younger than 65 years. Stroke tends to run in families. The incidence of stroke is 2.5 times higher in blacks than whites. Stroke prevalence in 2005 for black men was 2.3 million compared to 3.4 million in black women. The risk of first ever stroke in blacks is almost twice that of whites.

Which cells are primary targets for HIV? A. CD4+ Th cells only B. CD4+ Th cells, macrophages, and NK cells C. CD8-positive Tc cells and plasma cells D. CD8-positive Tc cells only

B. CD4+ Th cells, macrophages, and NK cells

In systolic heart failure, what effect does angiotensin II have on stroke volume? A. Increases preload and decreases afterload B. Increases preload and increases afterload C. Decreases preload and increases afterload D. Decreases preload and decreases afterload

B. Increases preload and increases afterload

What is the expected electrocardiogram pattern for a person when a thrombus in a coronary artery lodges permanently in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium? A. Prolonged QT interval B. ST elevation (STEMI) C. ST depression (STDMI) D. Non-ST elevation (non-STEMI)

B. ST elevation (STEMI)

An individual who is demonstrating elevated levels of troponin, creatine kinase (CK), and lactic dehydrogenase (LDH) is exhibiting indicators associated with: A. Myocardial ischemia B. Hypertension C. Myocardial infarction D. High-output heart failure

C. Myocardial infarction Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. Other biomarkers released by myocardial cells include CK-MB (creatine kinase-MB) and LDH.

During acidosis, the body compensates for the increase in hydrogen ions in the blood by shifting hydrogen ions into the cell in exchange for which electrolyte? A. Oxygen B. Sodium C. Potassium D. Magnesium

C. Potassium In states of acidosis, hydrogen ions shift into the cells in exchange for ICF potassium; hyperkalemia and acidosis therefore often occur together.

Which pleural abnormality involves a site of pleural rupture that act as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration? Answers: A. Spontaneous pneumothorax B. Tension pneumothorax C. Open pneumothorax D. Secondary pneumothorax

B. Tension pneumothorax In tension pneumothorax the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing up during expiration. As more and more air enters the pleural space, air pressure in the pneumothorax begins to exceed barometric pressure.

What alteration occurs in injured endothelial cells that contributes to atherosclerosis? A. They release toxic oxygen radicals that oxidize low-density lipoproteins (LDLs). B. They are unable to make the normal amount of vasodilating cytokines. C. They produce an increased amount of antithrombotic cytokines. D. They develop a hypersensitivity to homocysteine and lipids.

B. They are unable to make the normal amount of vasodilating cytokines. Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines.

Hyperkalemia develops in the presence of diabetic ketoacidosis because: A. serum sodium is low stimulating aldosterone to retain sodium and potassium. B. hydrogen ions shift into the cell in exchange for potassium to compensate for metabolic acidosis. C. phosphorus shifts into the cell in exchange for potassium due to the lack of insulin. D. the blood is concentrated due to the loss of water from polyuria.

B. hydrogen ions shift into the cell in exchange for potassium to compensate for metabolic acidosis.

The most common cause of pulmonary edema is: Answers: A. right-sided heart failure. B. left-sided heart failure. C. mitral valve prolapse. D. aortic stenosis.

B. left-sided heart failure. The most common cause of pulmonary edema is heart disease (see Chapter 32). When the left ventricle fails, filling pressures on the left side of the heart increase and cause a concomitant increase in pulmonary capillary hydrostatic pressure.

Alveolar dead space is a result of: A. pulmonary edema. B. pulmonary emboli. C. atelectasis. D. pneumonia.

B. pulmonary emboli.

Which statement is false about the skeletal alterations caused by chronic renal failure? When the glomerular filtration rate (GFR) declines to 25% of normal A. parathyroid hormone (PTH) is no longer effective in maintaining serum phosphate levels. B. insufficient parathyroid hormone (PTH) may result in osteodystrophies. C. there is impaired synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium. D. there is impaired synthesis of 1,25-vitamin D3, which impairs the effectiveness of calcium and phosphate resorption from bone by parathyroid hormone (PTH).

B. insufficient parathyroid hormone (PTH) may result in osteodystrophies.

During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? A. Bronchial edema caused by chemotactic factor of anaphylaxis B. Bronchial edema caused by binding of the cytotropic antibody C. Smooth muscle contraction caused by histamine bound to H1 receptors D. Smooth muscle contraction caused by histamine bound to H2 receptors

C. Smooth muscle contraction caused by histamine bound to H1 receptors Acting through the H1 receptors, histamine contracts bronchial smooth muscles, causing bronchial constriction; increases vascular permeability, causing edema; and causes vasodilation, increasing blood flow into the affected area

Hypersensitivity is best defined as a(n): A. disturbance in the immunologic tolerance of self-antigens. B. immunologic reaction of one person to the tissue of another person. C. altered immunologic response to an antigen that results in disease. D. undetectable immune response in the presence of antigens.

C. altered immunologic response to an antigen that results in disease. Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host.

The cause of pulmonary edema in ARDS is the result of increased: A. levels of serum sodium and water. B. capillary hydrostatic pressure. C. capillary permeability. D. oncotic pressure.

C. capillary permeability.

Increased RAAS, obesity, dysfunction of naturetic peptides, genetics, and increased SNS activity all contribute to which of the following? A. increased blood pH B. baroreceptor stimulation at low blood pressure C. decreased sodium excretion D. deep vein thrombosis

C. decreased sodium excretion

The signs of thyroid crisis resulting from Graves disease include: A. constipation with gastric distention. B. bradycardia and bradypnea. C. hyperthermia and tachycardia. D. constipation and lethargy.

C. hyperthermia and tachycardia.

A person with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: A. hyperglycemia caused by incorrect insulin administration. B. dawn phenomenon from eating a snack before bedtime. C. hypoglycemia caused by increased exercise. D. Somogyi effect from insulin sensitivity.

C. hypoglycemia caused by increased exercise.

Cigarette smoking contributes to atherosclerosis by A. increasing blood HDL levels. B. increasing anti-inflammatory cytokine release. C. increasing blood LDL levels. D. stimulating the release of angiotensin II.

C. increasing blood LDL levels.

Aortic and mitral regurgitation as well as mitral stenosis are caused by: Answers: A. congenital malformation. B. cardiac failure. C. rheumatic fever. D. coronary artery disease.

C. rheumatic fever.

The "hygiene" hypothesis A. states the detrimental effects of other children (siblings, daycare, etc.) on the predisposition to asthma. B. shifts the immune system to more of a Th1 phenotype. C. states that excessive use of antibiotics, the immune system shifts to a more Th2 phenotype. D. states that maintaining a clean environment and use of antibiotics decreases the likelihood of developing asthma.

C. states that excessive use of antibiotics, the immune system shifts to a more Th2 phenotype.

In nephrotoxic acute tubular necrosis (ATN), the kidneys are especially affected by certain toxins due to A. ischemia causing release of free radicals. B. the ability of the nephron to secrete acid. C. the kidney's ability to concentrate toxins. D. the kidney's production of toxins in response to post-renal kidney injury.

C. the kidney's ability to concentrate toxins. In nephrotoxic ATN, necrosis and tubular cell apoptosis caused by nephrotoxins (i.e., aminoglycosides, radiocontrast media, cisplastin, etc.) decreases the kidney's ability to concentrate toxins in the proximal tubules. This is different from Post-ischemic ATN where persisitent hypoperfusion, hypotension, and hypoxia caused reduced levels of ATP production and the generation of toxic oxygen free radicals with loss of antioxidant protection.

Acetylcholineesterase (AChE) inhibitors are an effective treatment for myasthenia gravis because A. they have anti - inflammatory effects. B. they immunosuppression drugs. C. they contribute to an increased concentration of acetylcholine in the neuromuscular junction. D. they sensitize the motor neuron so it releases more acetylcholine into the neuromuscular junction.

C. they contribute to an increased concentration of acetylcholine in the neuromuscular junction. AChE inhibitors prevent the degradation of ACh in the neuromuscular junction; therefore, contributing to an increased concentration of ACh.

What is the initiating event that leads to the development of atherosclerosis? A. Release of the inflammatory cytokines B. Macrophages adhere to vessel walls. C. Injury to the endothelial cells that line the artery walls D. Release of the platelet-deprived growth factor

C. Injury to the endothelial cells that line the artery walls

Parkinson's disease A. correlates with tau and beta amyloid deposits. B. is a genetic disorder. C. results from degeneration of dopaminergic neurons. D. always has lewy bodies.

C. results from degeneration of dopaminergic neurons.

Why are two "hits" required to inactivate tumor-suppressor genes? Answers: A. Because the first hit stops tissue growth and the second hit is needed to cause abnormal tissue growth B. Because they are larger than proto-oncogenes requiring two hits to effect carcinogenesis C. Because the first hit is insufficient to cause enough damage to cause a mutation D. Because each allele must be altered and each person has two copies, or alleles, of each gene, one from each parent

D. Because each allele must be altered and each person has two copies, or alleles, of each gene, one from each parent A single genetic event can activate an oncogene, acting in a dominant manner in the cell. However, we have two copies, or alleles, of each gene, one from each parent. It therefore takes two hits to inactivate the two alleles of a tumor-suppressor gene, allowing the process to become active. The remaining options do not describe why two hits are required.

Which description is consistent with a complex partial seizure? A. Focal motor movement without loss of consciousness B. One seizure followed by another in less than 1 minute C. Alternative tonic and clonic movements D. Consciousness is impaired as well as the ability to respond to exogenous stimuli

D. Consciousness is impaired as well as the ability to respond to exogenous stimuli

What are clinical manifestations of hypothyroidism? A. Intolerance to heat, tachycardia, and weight loss B. Oligomenorrhea, fatigue, and warm skin C. Restlessness, increased appetite, and metrorrhagia Correct D. Constipation, decreased heat rate, and lethargy

D. Constipation, decreased heat rate, and lethargy

The true statement in regards to ischemic penumbra (IP) is A. IP is an area of massive neuronal death that results from a global reduction in cerebral blood flow B. cerebral blood fliow in the IP is usually above 50% of normal C. auto regulatory mechanisms are preserved in the IP D. IP is a potentially salvageable area of marginal blood flow that surrounds a core of ischemic brain tissue

D. IP is a potentially salvageable area of marginal blood flow that surrounds a core of ischemic brain tissue Blood flow is reduced (25-50% of norm) in the IP and cells are salvageable in this area if blood flow is resumed. During ischemia, neurons will not synapse.

Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary arteries? Answers: A. Unstable B. Stable C. Silent D. Prinzmetal

D. Prinzmetal

All of the following contribute to deep venous thrombosis except Answers: A. heart failure B. dehydration C. high estrogen oral contraceptives D. anaerobic metabolism

D. anaerobic metabolism Heart failure and dehydration contribute to venous stasis and high estrogen oral contraceptives contribute to hypercoagulability.

Palpation of the neck of a person with Graves disease would detect a thyroid that is: A. left of midline. B. small with discrete nodules. C. normal in size. D. enlarged diffusely.

D. enlarged diffusely.

Anemia of chronic renal failure can be successfully treated with: Answers: A. intrinsic factor. B. vitamin B12. C. Vitamin D. D. erythropoietin.

D. erythropoietin.

Insulin resistance or relative insulin deficiency contributes to atherosclerosis by Selected Answer: D. increasing cell adhesion molecules on the surface of endothelial cells. Answers: A. increasing the concentration of circulating HDL. B. increased efflux of cholesterol from macrophages. C. reducing the size of endothelial cells. D. increasing cell adhesion molecules on the surface of endothelial cells.

D. increasing cell adhesion molecules on the surface of endothelial cells. Insulin directly affects the size, number and composition of lipoproteins. These changes induce macrophages to retain cholesterol and present a proinflammatory phenotype. These changes also induce endothelial cells to increase adhesion protein expression on the cell surface and shift to a proinflammatory phenotype. In arterial smooth muscle, the extracellular matrix composition changes.

In ARDS, inflammatory mediators such as proteolytic enzymes, oxygen free radicals, prostaglandins, leukotrienes, and platelet-activating factor are released by: A. complement cascade. B. mast cells. C. macrophages. D. neutrophils.

D. neutrophils. The role of neutrophils is central to the development of ARDS. Activated neutrophils release a battery of inflammatory mediators, among them proteolytic enzymes, oxygen free radicals (superoxide radicals, hydrogen peroxide, hydroxyl radicals), arachidonic acid metabolites (prostaglandins, thromboxanes, leukotrienes), and platelet-activating factor. These mediators cause extensive damage of the alveolocapillary membrane and greatly increase capillary membrane permeability

Autocrine stimulation is the ability of cancer cells to: Answers: A. stimulate angiogenesis to create their own blood supply. B. stimulate secretions that turn off normal growth inhibitors. C. divert nutrients away from normal tissue for their own use. D. secrete growth factors that stimulate their own growth.

D. secrete growth factors that stimulate their own growth. 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 remaining options do not describe autocrine stimulation.

In a reperfusion injury: A. production of superoxides begin at the onset of hypoxia. B. hydrogen peroxide can dissolve the clot; thus, leading to the reperfusion. C. xanthine and hypoxanthine can directly damage the membrane and other cellular structures. D. superoxides are produced upon restoration of oxygen and can damage the cell after oxygen is restored.

D. superoxides are produced upon restoration of oxygen and can damage the cell after oxygen is restored.

Which urine characteristics below are indicative of acute tubular necrosis (ATN) caused by intrinsic (intrarenal) failure? A. Urine sediment has no cells, some hyaline casts B. Urine osmolality >500 mOsm C. Fraction excretion of sodium (FENa) <1% D. Urine sodium >30 mEq/L

D. Urine sodium >30 mEq/L

In tuberculosis, macrophages and lymphocytes release ______ to prevent bacterial replication within macrophages. A. TNF-α B. anti-inflammatory cytokines C. immunoglobulin G D. interferon

D. interferon

Conditions that adversely influence progression and extent of ischemic injury include all of the following except: A. Systemic hypotension B. hypercoaguable states C. subnormal body temperature D. rapid development of an ischemic event

C. subnormal body temperature Hypothermia has been shown to be beneficial in attenuating effects of brain ischemia.

In a reperfusion injury: A. production of superoxides begin at the onset of hypoxia. B. hydrogen peroxide can dissolve the clot; thus, leading to the reperfusion. C. xanthine and hypoxanthine can directly damage the membrane and other cellular structures. D. superoxides are produced upon restoration of oxygen and can damage the cell after oxygen is restored.

D - superoxides are produced upon restoration of oxygen and can damage the cell after oxygen is restored

Physiologic pH is maintained around 7.4 because bicarbonate (HCO3-) and carbonic acid (H2CO3) exist in a ratio of: (HCO3- : H2CO3) A. 1:20 B. 1:10 C. 15:1 D. 20:1

D. 20:1

Which of the following are autoimmune disorders? A. multiple sclerosis B. myasthenia gravis C. osteoporosis D. A and B only

D. A and B only

Which of the following is a clinical manifestation of aortic stenosis? A. Jugular vein distention B. Bounding pulses C. Peripheral edema D. Angina

D. Angina

What part of the nephron is the site of fluid filtration from the blood? Tubule Podocyte Glomerulus Slit membrane

Glomerulus

Which condition may result from pressure exerted by a pituitary adenoma? Hypothyroidism Hypercortisolism Diabetes insipidus Insulin hyposecretion

Hypothyroidism

A patient who is diagnosed with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, no change in his polyuria level has occurred. These symptoms support a diagnosis of: Neurogenic diabetes insipidus Syndrome of inappropriate antidiuretic hormone Psychogenic polydipsia Osmotically induced diuresis

Neurogenic diabetes insipidus

What is the primary effect of antidiuretic hormone (ADH) in the kidneys? Stimulates sodium reabsorption Stimulates water reabsorption Stimulates hydrogen ion excretion Stimulates urine excretion

Stimulates water reabsorption

True or False: Some tumors initially described as benign can progress to malignant tumors.

True

Which laboratory value is consistently low in a patient with diabetes insipidus (DI)? Urine-specific gravity Serum sodium Urine protein Serum total protein

Urine-specific gravity

What does the Loop of Henle produce to prevent urinary tract infections? Hydrogen and ammonium Uromodulin Antidiuretic Hormone Urodilatin

Uromodulin

Which of the following is a characteristic of HIV? A. It only infects T helper cells. B. The virus is a retrovirus. C. It carries genetic information in DNA. D. Five strains have been identified.

b - the virus is a retrovirus One particular family of viruses, retroviruses (e.g., HIV) carries an enzyme reverse transcriptase that creates a double-stranded DNA version of the virus.

A 24-year old previously healthy male is admitted to the emergency room unconscious, smelling of alcohol, with an empty bottle of narcotic pills clenched in his hand. Physical exam finds him unresponsive and with a significantly decreased respiratory rate. Arterial blood gases show a very high PaCO2, a low pH, and a normal PaO2. The most important physiologic support that is needed by this patient is: A. oxygenation B. ventilation C. perfusion D. shunting

b - ventilation

Which is a characteristic of brainstem death? A. Vegetative state B. Comatose C. Apnea D. Locked-in syndrome

c - apnea Apnea is viewed as a criterion of brainstem death, whereas the remaining options reflect cerebral death.

A major immunologic finding in AIDS is the striking decrease in the number of which cells? A. Macrophages B. CD8+ T cells C. CD4+ Th cells D. Memory T cells

c - cd4+Th cells The major immunologic finding in AIDS is the striking decrease in the number of CD4+ Th cells

A blunt force injury to the forehead would result in a contrecoup injury to the _____ region. A. frontal lobe B. temporal Lobe C. occipital lobe D. parietal lobe

c - occipital lobe

Where is the gate located that is referred to in the gate control theory of pain? Answers: A. Nucleus proprius B. Marginal layer C. Substantia gelatinosa D. Dorsolateral tract of Lissauer

c - substantia gelatinosa

When the heart's workload increases, what changes occur to the myocardial cells? Answers: A. They undergo metaplasia B. They divide C. They increase in size D. They increase in number

c - they increase in size Myocardial cells do not have the ability to divide; thus, they under go hypertrophy.

Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke? Answers: A. Hemorrhagic B. Thrombotic C. Embolic D. Lacunar

c- embolic High-risk sources for the onset of embolic stroke are atrial fibrillation (15% to 25% of strokes), left ventricular aneurysm or thrombus, left atrial thrombus, recent myocardial infarction, rheumatic valvular disease, mechanical prosthetic valve, nonbacterial thrombotic endocarditis, bacterial endocarditis, patent foramen ovale, and primary intracardiac tumors.

What organs are affected by the type of necrosis that results from hypoxia caused by severe ischemia or caused by chemical injury? Answers: A. Lungs and pulmonary vessels B. Brain and spinal cord C. Kidneys and heart D. Muscles and bones

c. Kidneys and Heart Response Feedback: Coagulative necrosis, which occurs primarily in the kidneys, heart, and adrenal glands, commonly results from hypoxia caused by severe ischemia or hypoxia caused by chemical injury, especially ingestion of mercuric chloride

Removal of part of the liver leads to ________________ of the remaining liver cells.

compensatory hyperplasia Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate. For example, removal of part of the liver leads to hyperplasia of the remaining liver cells (hepatocytes) to compensate for the loss.

HIV associated weight loss is caused by: A. increased resting energy expenditure. B. malabsorption in the GI. C. hypogonadism. D. anorexia. E. All of the above.

e - all of the above

In addition to malnutrition, people with chronic alcoholism may also suffer from:

pancreatitis

What type of necrosis is associated with wet gangrene? A. Coagulative necrosis B. Liquefactive necrosis C. Caseous necrosis D. Fat necrosis

b - liquefactive necrosis

Which is a description of Cheyne-Stokes respirations? A. A smooth increase in rate and depth followed by a gradual smooth decrease in rate and depth B. A completely irregular breathing pattern with random shallow, deep breaths and irregular pauses C. A sustained deep rapid, but regular pattern of breathing D. A prolonged inspiratory period followed gradually by a short expiratory period

A. A smooth increase in rate and depth followed by a gradual smooth decrease in rate and depth Cheyne-Stokes respiration is an abnormal rhythm of breathing (periodic breathing) that alternates between hyperventilation and apnea. Cheyne-Stokes respirations: Breathing pattern has a smooth increase (crescendo) in the rate and depth of breathing (hyperpnea), which peaks and is followed by a gradual smooth decrease (decrescendo) in the rate and depth of breathing to the point of apnea when the cycle repeats itself. The hyperpneic phase lasts longer than the apneic phase (represents an amplitude change).

Massage therapy relieves pain by stimulating the _____ that close the pain gate. A. A-beta fibers B. A-delta fibers C. B fibers D. C fibers

A. A-beta fibers Afferent A-beta (Aβ) fibers carry non-noxious low-threshold mechanical information gained by touch, vibration, and pressure.

What is the usual source of pulmonary emboli? A. Deep venous thrombosis B. Athersclerosis C. Left heart failure D. Valvular disease

A. Deep venous thrombosis

What damage is most likely to occur to the brain in a classic cerebral concussion (grade IV)? Answers: A. Diffuse cerebral disconnection from the reticular activating system B. Cerebral edema throughout the cerebral cortex C. Cerebral edema throughout the diencephalon D. Disruption of axons extending from the diencephalon and brainstem

A. Diffuse cerebral disconnection from the reticular activating system Classic cerebral concussion (grade IV) involves diffuse cerebral disconnection from the brainstem reticular activating system.

Which abnormal lab value is found in glomerular disorders? A. Elevated plasma creatinine B. Low blood urea nitrogen (BUN) C. Elevated immunoglobulin A (IgA) D. Low serum complement

A. Elevated plasma creatinine

Which of the following best describes multiple sclerosis (MS)? A. It is a central nervous system (CNS) demyelination, possibly from an immunogenetic virus. B. It is an inadequate supply of acetylcholine at the neurotransmitter junction as a result of an autoimmune disorder. C. It is a depletion of dopamine in the central nervous system as a result of a virus. D. It is a degenerative disorder of lower and upper motor neurons caused by viral-immune factors.

A. It is a central nervous system (CNS) demyelination, possibly from an immunogenetic virus. MS is an autoimmune disorder diffusely involving degeneration of CNS myelin and loss of axons. MS is described as occurring when a previous viral insult to the nervous system has occurred in a genetically susceptible individual with a subsequent abnormal immune response in the CNS.

Which of the viruses below are oncogenic DNA viruses? A. Papillomaviruses, adenoviruses, and herpesviruses B. Reoviruses, papovaviruses, and adenovirus C. Togaviruses, herpesviruses, and retroviruses D. Hepadnaviruses, retroviruses, and papovaviruses

A. Papillomaviruses, adenoviruses, and herpesviruses

A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures may result from this condition? A. Right heart failure B. Left heart failure C. Low-output failure D. High-output failure

A. Right heart failure Right heart failure is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure. It most often results from left heart failure when the increase in left ventricular filling pressure that is reflected back into the pulmonary circulation is severe enough. As pressure in the pulmonary circulation rises, the resistance to right ventricular emptying increases.

Hypertension has been associated with altered A. angiotensin receptors. B. adrenergic hormone structure. C. nitric oxide degradation. D. calcium sequestering organelles.

A. angiotensin receptors. Genetic alterations of angiotensin receptors have been associated with hypertension. Other genetic modifications associated with hypertension include adrenergic receptors, nitric oxide synthetase and calcium transporters.

The kidney disorder characterized by hypoalbuminemia, edema, hyperlipidemia and lipiduria is: A. nephrotic syndrome. B. acute glomerulonephritis. C. chronic glomerulonephritis. D. pyelonephritis.

A. nephrotic syndrome.

Angiotensin II increases the workload of the heart after a myocardial infarction by: A. increasing the peripheral vascular resistance. B. causing dysrhythmias as a result of hyperkalemia. C. reducing the contractility of the myocardium. D. stimulating the sympathetic nervous system.

A. increasing the peripheral vascular resistance.

Hypertension may result in Answers: A. vascular remodeling. B. retinopathy. C. peripheral artery disease. D. A and B only. E. A, B, and C.

E. A, B, and C: - vascular remodeling - retinopathy - peripheral artery disease

Which hormone inhibits the reabsorption of sodium and water at the distal convoluted tubule? Atrial natriuretic peptide (ANP) Angiotensin Aldosterone Angiotensin II

Atrial natriuretic peptide (ANP)

Cardiac cells remain viable for approximately ______ minutes under ischemic conditions. If blood flow is restored, aerobic metabolism resumes, contractility is restored, and cellular repair begins. Answers: A. 5 B. 20 C. 30 D. 45

B - 20 Cardiac cells remain viable for approximately 20 minutes under ischemic conditions. If blood flow is restored, aerobic metabolism resumes, contractility is restored, and cellular repair begins. If the coronary artery occlusion persists beyond 20 minutes, myocardial infarction occurs.

A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20 serum glucose 500 mg/dl positive urine glucose and ketones serum potassium (K+) 2 mEq/L serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the "flu" for 1 week. What relationship do these values have to his insulin deficiency? A - Increased glucose use causes the shift of fluid from the intravascular to the intracellular space. B - Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. C - Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis. D - Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.

B - Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis.

When caring for a patient in pain , what physiologic signs of pain would a nurse expect to find? Answers: A. Decreased blood pressure or reports of nausea and vomiting B. Increased heart rate and respiratory rate with diaphoresis C. Irritability and depression or reports of insomnia D. Fever and muscle weakness or reports of fatigue

B - Increased heart rate and respiratory rate with diaphoresis

The hypersensitivity reaction that occurs after a person who is allergic to bee stings is stung by a bee is called: Answers: A. hemolytic shock. B. anaphylaxis. C. necrotizing vasculitis. D. systemic erythematosus.

B - anaphylaxis Examples of systemic anaphylaxis are allergic reactions to bee stings, peanuts, and fish.

The level of thyroid-stimulating hormone (TSH) in Graves disease is usually: A - high. B - low. C - normal. D - in constant flux.

B - low

The scar tissue that is formed after a myocardial infarction (MI) is most vulnerable to injury between days: A. 5-9 B. 10-14 C. 20-25 D. 42-56

B. 10-14

Mr. J. is found to have emphysema. Measurement of arterial blood gases for this patient would most likely reveal: A. hypocapnia B. hypercapnia C. hypoxemia D. a and c E. b and c

E. b and c (hypercapnia and hypoxemia)

Which hormone stimulates the production of red blood cells in the bone marrow? Renin Creatinine Aldosterone Erythropoietin

Erythropoietin

What term is used to describe the elimination of a substance in the final urine? Excretion Tubular secretion Glomerular filtration Tubular reabsorption

Excretion

Perceived stress elicits an emotional, anticipatory response that begins where? Prefrontal cortex Anterior pituitary Limbic system Adrenal glands

Limbic System The limbic system is a group of forebrain structures that includes the hypothalamus, the amygdala, and the hippocampus. These are involved in motivation, emotion, learning, and memory. The limbic system is where the subcortical structures meet the cerebral cortex.The limbic system operates by influencing the endocrine system and the autonomic nervous system. In the alarm stage or reaction stage of the general adaptation syndrome, the central nervous system is aroused and the body's defenses are mobilized (e.g., "fight or flight").

In which stage of HIV is viral load in the blood kept in check by production of CD4+ Tcells? Early phase Middle phase Late phase Chronic phase

Middle Phase Early phase is marked by a rapid increase in HIV load Middle phase is marked by a maintenance of a relatively stable viral load Late phase is marked by the destruction of the lymph nodes and CD4 + Tcells are no longer sufficiently produced\

The effect epinephrine has on the immune system during the stress response is to increase which cells? (Select all that apply.) NK cells Immunoglobulins Cytokines T cells Th cells

NK Cells T Cells Catecholamines (including epinephrine) can modify the numbers of cells of the immune system circulating in the blood. Injection of epinephrine into healthy human subjects is associated with a transient increase in the number of lymphocytes (e.g., T cells and natural killer [NK] cells) in the peripheral blood. Specifically, the levels of T cytotoxic and NK cells increase, whereas little change occurs in the B lymphocytes. The main change involves the NK cells. However, these effects are short-lived, lasting only about 2 hours.

What is the primary function of the proximal tubule? Dilutes urine Reabsorbs sodium Produces uromodulin Filters plasma at the glomerulus

Reabsorbs sodium

Which vessel supplies blood to the lower, middle, and upper thirds of the kidney? Renal veins Renal arteries Interlobar arteries Glomerular capillaries

Renal arteries

How does the proximal tubule reabsorb the majority of fluids into the patient's vascular system? The tubule is 40 mm long, which increases the surface area There is a negative charge to the proteins that line the tubule Microvilli or a brush border increase the surface area of the tubule Water and other organic substances are co-transported with sodium.

Water and other organic substances are co-transported with sodium.