Immune and Genetics
What is the name of the immune process that is responsible for anaphylactic reactions? a) IgE-mediated reaction b) IgG-mediated reaction c) Antibody reaction d) Atopic reaction
A - Anaphylaxis is an immunoglobulin E (IgE)-mediated reaction (also known as IgE-mediated type 2). IgE immediate reactions, such as anaphylaxis, trigger mast cell degranulation and release of potent mediators, such as histamines, leukotrienes, and prostaglandins, that immediately induce constriction of smooth muscle, swelling, vasodilation, and other pathological changes in the body that may be fatal.
A male adolescent presents to the nurse practitioner for a wellness exam. The patient's face is long and narrow with a prominent forehead and chin, and he has large ears. The mother reports that her son has intellectual disabilities and autistic disorder. Which of the following conditions is being described? a) Fragile X disorder b) Marfan's syndrome c) Turner's syndrome d) Down syndrome
A - Fragile X syndrome is the most common form of inherited intellectual disability. The disorder is associated with a higher incidence of autism (especially boys). Males are affected more severely than females. The facial features can vary. The classic facie is long and narrow with a prominent forehead and chin and large ears. Other features include hyperlaxity of the joints, flat feet, high arched palate, and others. Definitive diagnosis is by genetic testing.
Which of the following is considered by Latinos/Hispanics to be a spiritual illness that can cause symptoms such as loss of appetite, crying, diarrhea, and weakness or death among infants and small children? a) Mal ojo or mal de ojo b) Chronic nightmares c) Trabajo d) Malo
A - Mal ojo or mal de ojo is a spiritual illness that can cause symptoms such as loss of appetite, crying, diarrhea, colic, fear, weakness, or death. A curandero or curandera is usually consulted and does spiritual cleansing of the patient. It may take several cleansings (limpia) to cure the patient. Trabajo means "work" and malo means "bad" in Spanish; these are included as distractors.
Which of the following foods would you advise a new mother to introduce to her 6-month-old infant first? a) Iron-fortified rice cereal b) Plain rice cereal c) Iron-fortified pureed chicken meat d) Plain pureed carrots
A -At 6 months of age, it is recommended that the infant be fed iron-fortified rice cereal. Introducing only one new food at a time is recommended; in case an allergy does develop, you will be able to identify which food caused the allergy.
All of the following statements are correct regarding the Td vaccine except: a) Fever occurs in up to 80% of the patients b) A possible side effect is induration on the injection site c) The Td is given every 10 years d) The DPT and DT should not be given beyond the seventh birthday
A -Side effects of the Td vaccine include induration at the injection site. Td is given in adults every 10 years. The DPT and DT should not be given beyond 7 years of age. Fever may occur, but studies do not support 80% of patients having fever.
Which chronic illness disproportionately affects the Hispanic population? a) Diabetes mellitus b) Hypertension c) Alcohol abuse d) Skin cancer
A -The risk of diabetes mellitus is two to three times higher in Mexican Americans than in non-Hispanic Americans.
What is the pedigree symbol for a diseased male? a) A filled-in circle b) A filled-in square c) An empty circle d) An empty square
B - A filled-in square is a diseased or affected male and a filled-in circle is a diseased or affected female. An empty square is a healthy male and an empty circle is a healthy female.
What is the gold-standard test for alpha thalassemia minor and sickle cell anemia? a) Ferritin b) Hemoglobin electrophoresis c) Total iron-binding capacity (TIBC) d) Folate level
B - Alpha thalassemia and sickle cell anemia are both conditions that affect the hemoglobin molecule. The gold-standard test for these types of diseases (hemoglobinopathies) is the hemoglobin electrophoresis.
During a well child visit, a new father wants to know whether he can give fresh whole milk to his 6-month-old son. The nurse practitioner would recommend that: a) He can start giving whole milk but not skim milk by 6 months of age b) He should not give whole milk to his son until the boy is at least 12 months of age c) He can give whole milk to his son at anytime d) He should not give whole milk to his son without diluting it with water
B - The American Academy of Pediatrics does not recommend offering whole milk to children younger than 12 months of age.
A newborn's mother is discovered to be HBsAg (hepatitis B surface antigen) positive. Which of the following would you recommend for this infant? a) Give the infant hepatitis B immunoglobulin b) Give the infant both hepatitis B vaccine and hepatitis B immunoglobulin c) Give the infant hepatitis B vaccine only d) Send the infant home because he is not infected
B -For a mother who tests positive for HBsAg, the newborn infant should be given hepatitis B vaccine and hepatitis B immunoglobulin for protection
A newborn's mother is discovered to be HBsAg (hepatitis B surface antigen) positive. Which of the following would you recommend for this infant? a) Give the infant hepatitis B immunoglobulin b) Give the infant both hepatitis B vaccine and hepatitis B immunoglobulin c) Give the infant hepatitis B vaccine only d) Send the infant home because he is not infected
B -For a mother who tests positive for HBsAg, the newborn infant should be given hepatitis B vaccine and hepatitis B immunoglobulin for protection.
Which of the following individuals is more likely to be affected by alpha thalassemia anemia? a) 53-year-old Greek patient b) 25-year-old Chinese patient c) 62-year-old Russian patient d) 38-year-old African American patient
C - Alpha thalassemia minor/trait or disease is more prevalent among Asians such as Chinese and Filipinos. Beta thalassemia minor/trait or disease is more common in the countries in the Mediterranean area, such as Greece and Italy.
The mother of a 13-year-old boy with Down syndrome is in the family nurse practitioner's office and wants to schedule a sports physical for her son. She reports that he wants to join the football team at his school. You would tell the mother that her son: a) Can play a regular football game as long as he wears maximum protective football gear b) Cannot play some contact sports because of an increased risk of cervical spine injury c) Can play certain contact sports after he has been checked for cervical instability d) None of the above
C - Atlantoaxial instability (AAI) denotes increased mobility at the articulation of the first and second cervical vertebrae (atlantoaxial joint). The American Academy of Pediatrics issued a position statement in 1984 on AAI and Down syndrome (DS): All children with DS who wish to participate in sports should have cervical spine x-rays. Repeated x-rays are not indicated for children with DS who have had a previously normal neck x-ray. Persons with DS who have no evidence of AAI may participate in all sports.
A 19-year-old woman has recently been diagnosed with acute hepatitis B. She is sexually active and is monogamous. She reports that her partner uses condoms inconsistently. What would you recommend for her male sexual partner who was also tested for hepatitis with the following results: HBsAg (-), anti-HBs(-), anti-HCV (-), anti-HAV (-)? a) Hepatitis B vaccination b) Hepatitis B immunoglobulin c) Hepatitis B vaccination and hepatitis B immunoglobulin d) No vaccination is needed at this time
C - Hepatitis B surface antigen (HBsAg) is a marker of infectivity. If positive, it indicates either an acute or a chronic hepatitis B infection. Antibody to hepatitis B surface antigen (anti-HBs) is a marker of immunity. Antibody to hepatitis B core antigen (anti-HBc) is a marker of acute, chronic, or resolved hepatitis B virus (HBV) infection; it may be used in prevaccination testing to determine previous exposure to HBV. The hepatitis B panel results for the individual in this question (negative HBsAg, anti-HBc, and anti-HBs) indicates the partner is susceptible (not immune), has not been infected, and is still at risk of future infectionand thus needs vaccine. Interpretation of the negative hepatitis C anti-HCV and negative Hep Ascreening test indicates that the partner is not infected. Hepatitis B immunoglobulin contains antibodies that provide "instant" immunity against hepatitis B, but its action lasts for several days, only. It is not a vaccine. It is given to infants and others who are at high risk of becoming infected and are not immune. The hepatitis B vaccine stimulates the body to make its own antibodies, which are permanent. A total of three doses are needed to gain full immunity against hepatitis B.
The nurse practitioner suspects that a middle-aged woman may have systemic lupus erythematosus (SLE). Which of the following laboratory tests is most specific for this disease? a) Erythrocyte sedimentation rate (ESR) b) C-reactive protein (CRP) c) Antinuclear antibody (ANA) d) IgG antibody
C - The ANA test is usually positive in lupus patients. Other types of autoantibody testing recommended for these patients, in addition to ANAtests, are antiphospholipid antibodies, antibodies to double-stranded DNA, and anti-Smith (Sm) antibodies. Patients with suspected lupus should be referred to a rheumatologist. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) are nonspecific findings of inflammation and are elevated in patients with autoimmune diseases, infections, and others.
A 36-year-old woman is seen by the nurse practitioner for a Pap smear and gynecological exam. The patient is of Ashkenazi Jewish ethnicity. Her mother died of breast cancer at age 50 years. Her 57-year-old sister has recently been diagnosed with breast cancer. The breast exam is negative for a dominant mass and the axillae do not contain any masses. All of the following are appropriate measures for this patient except: a) Mammogram and MRI of the breast b) Referral to a breast specialist c) Check serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels d) Genetic counseling and BRCA testing
C - The patient is a woman who is of Ashkenazi Jewish background with a positive family history of breast cancer (mother, sister). She is at very high risk for BRCA1 or BRCA2 mutations (hereditary breast cancer). The U.S. Preventive Services Task Force (2013) recommends that primary care providers screen women for a family history of breast, ovarian, tubal, or peritoneal cancer. Women with positive screening results should receive genetic screening, and, if indicated after counseling, BRCA testing. These high-risk women are screened with a mammogram and breast MRI and are best managed by breast cancer specialists.
A 13-year-old adolescent girl is brought to the health clinic by her mother for a sports physical. The mother reports that the teen's last vaccines were given at the age of 6 years. Which of the following vaccines is recommended by the Centers for Disease Control and Prevention (CDC) for this patient? a) Td and HPV vaccines b) Tdap, MCV4, and the HPV vaccines c) DTap and the flu vaccine d) DT and MCV4 vaccines
C - Vaccine questions usually are not this complicated, but there are several lessons that can be learned with this question. The 2017 Centers for Disease Control and Prevention (CDC) recommendations for individuals 13 to 18 years of age are the Tdap catch-up (if not received at age 11-12 years), human papillomavirus (HPV) catch-up (if not received at age 11-12 years), and the MCV4 or meningococcal conjugate vaccine (Menactra). Thereafter, the Td form of the vaccine is indicated every 10 years. The DTaP (diphtheria-tetanus-acellular pertussis) and DT (diphtheria-tetanus) forms of the tetanus vaccine are not given after the age of 7 years.
A faun tail nevus is a sign of which of the following? a) Down syndrome b) Infantile scoliosis c) Congenital heart disease d) Spina bifida
D - A faun tail nevus is an abnormal tuft of hair in the lumbosacral area, which can be a sign of spina bifida. If found, order an ultrasound of the lesion to rule out an opening in the lower spine (spina bifida).
Systemic lupus erythematosus (SLE) is more common among patients from all of the following ethnic and racial backgrounds except: a) African American b) Asian c) Hispanic d) Caucasian
D - Lupus is two to three times more prevalent among women of African American, Asian, Hispanic, and Native American backgrounds than in Caucasian women.
Which type of hepatitis virus infection is more likely to result in chronic hepatitis and increased risk of developing hepatocellular carcinoma? a) Hepatitis A virus b) Hepatitis B virus c) Hepatitis C virus d) Both hepatitis B and hepatitis C
D - Of the primary hepatitis viruses, only B and C are associated with hepatocellular cancer. Chronic hepatitis B and C infection often results in cirrhosis of the liver, which increases the risk of liver cancer.
You would recommend the pneumococcal vaccine (Pneumovax) to patients with all of the following conditions except: a) Sickle cell anemia b) Splenectomy c) HIV infection d) G6PD-deficiency anemia
D - Pneumococcal vaccine is not indicated for glucose-6-phosphate dehydrogenase (G6PD)-deficiency anemia. There two types of pneumonia vaccine for adults: PPSV23 (Pneumovax 23) and PCV13 (Prevnar 13). Pneumococcal vaccine is recommended for individuals beginning at age 65 years, but the two types should not be given together. The Centers for Disease Control and Prevention (CDC) recommends administering Prevnar 13 first, then waiting at least 1 year (12 months) and giving the Pneumovax. The immunogenic response is better using this method. Prevnar 13 is recommended for all infants and children younger than 2 years of age, all adults aged 65 years or older, and people (2 to 64 years old) with certain medical conditions that increase risk of pneumococcal disease, such as functional or anatomic asplenia (sickle cell), HIV infection, chronic renal failure, leukemia, heart failure, cyanotic congenital heart disease, chronic lung disease (asthma, chronic obstructive pulmonary disease [COPD]), diabetes, and others.
An 18-year-old male patient is found to have a 47,XXY karyotype and is diagnosed with Klinefelter's syndrome. The patient is most likely to have all of the following physical characteristics except: a) Gynecomastia b) Long limbs c) Lack of secondary sexual characteristics d) Large testes
D - Signs and symptoms of Klinefelter's syndrome include gynecomastia, long limbs, and lack of secondary sexual characteristics. Testes are usually small. Infertility is a major concern for these boys. If treated early, they may have a normal sexual/reproductive system in the future.
All of the following statements about common health beliefs of many traditional Asian cultures are true except: a) An imbalance of the hot and cold (yin/yang) vital forces can cause illness, and treating a hot disease with a "cold" treatment (i.e., certain foods/herbs) can help to restore balance and cure the illness b) If the patient is very ill or dying, immediate family and extended family members will visit the patient daily in shifts to provide emotional support c) Infants and small children may wear an amulet such as a red string on the wrist or a piece of cloth on the neck or the wrist d) Surgical procedures are regarded as important treatment for many illnesses
D - Some Asian cultures regard surgery as a last resort and consider loss of blood as depleting the vital forces of the body and causing illness. Western medicine is considered to be "hot," and patients may discontinue or reduce the doses of their medicine without asking. An imbalance of the hot and cold (yin/yang) is believed to cause illness. Treating a "yin" disease (common cold) means avoiding eating yin foods (melons, cucumbers) because they will worsen it. Instead, yin diseases are treated with yang foods (meat, spicy foods) so that the body becomes more balanced.
What is the pedigree symbol for a diseased or affected female? a) An empty square b) An empty circle c) A filled-in square d) A filled-in circle
D -A filled-in circle indicates a diseased or affected female and an empty circle indicates a healthy female. A tip to remember is that females make eggs (or follicles), which resemble a circle. By default, the square symbol is the male.
Patients with Down syndrome are at higher risk for all of the following except: a) Atlantoaxial instability b) Congenital heart disease c) Early onset of Alzheimer's disease d) Melanoma
D -Patients with Down syndrome are at higher risk for atlantoaxial instability, congenital heart defects, and early onset of Alzheimer's disease. Children with Down syndrome who participate in certain sports activities must be carefully examined for an unstable neck and heart disease prior to participation to prevent injury.
A 15-year-old boy has just moved into the community and is staying in a foster home temporarily. There is no record of his immunizations. His foster mother wants him to be checked before he enters the local high school. Which of the following immunizations does this patient need? a) Meningococcal vaccine b) Measles-mumps-rubella (MMR) vaccine c) Tdap vaccine d) All of the aboveubmit Answer
D -This 15-year-old teenage patient will follow the Centers for Disease Control and Prevention (CDC) "catch-up" schedule (CDC, 2017) and needs the meningococcal vaccine, MMR vaccine, and Tdap vaccine. In addition to these three vaccines, this patient needs the hepatitis B vaccine, human papillomavirus (HPV) vaccine, and varicella vaccine (if no history of chickenpox).
Which of the following physical exam findings is most specific for systemic lupus erythematosus (SLE)? a) Swollen and painful joint involvement b) Fatigue and myalgia c) Stiffness and swelling of multiple joints d) Malar rash
D- A malar rash is the butterfly-shaped rash on the middle of the face that is caused by a type of photosensitivity reaction. It is associated with systemic lupus erythematosus (SLE). The other answer options are found with diseases such as rheumatoid arthritis, polymyalgia rheumatica, and others.
A 20-year-old college student reports to the student health clinic with a laceration of her left hand. She tells the nurse practitioner that she cut her hand while working in her garden. Her last Td booster was 5½ years ago. Which of the following is correct? a) Administer a booster dose of the Tdap vaccine b) Administer the Td vaccine and the Td immunoglobulin (HyperTET) c) Administer Td immunoglobulin (HyperTET) only d) She does not need any Td immunoglobulin (HyperTET) or a Td booster
a- The Centers for Disease Control and Prevention (CDC) recommends a Td booster every 10 years or more recent if an injury occurs and the vaccine was more than 5 years ago. The Td vaccine has tetanus and diphtheria. One Td booster can be replaced with a Tdap (tetanus, diphtheria, and pertussis) if not already given. The Tdap vaccine should only be administered once for adults and teens.
