PATHO E1

The organelle that contains enzymes necessary for oxidative phosphorylation to produce ATP is the a. mitochondria. b. ribosome. c. lysosome. d. nucleus.

ANS: A The inner membrane of the mitochondria contains many enzymes that promote oxidative phosphorylation which produces ATP. Ribosomes synthesize proteins. Lysosomes and peroxisomes detoxify substances. The nucleus contains genomic DNA that codes for protein synthesis.

Repolarization of a neuron after a depolarizing action potential is because of a. activation of the Na+-K+ pump. b. influx of calcium. c. efflux of potassium. d. influx of sodium.

ANS: C Repolarization is because of efflux of potassium from the cell. The Na+ -K+ pump maintains cellular volume via osmotic pressure and helps to maintain resting membrane potential. Calcium influx prolongs the action potential. Influx of sodium initiates depolarization.

In diabetic ketoacidosis, respiratory compensation may occur through a process of a. respiratory alkalosis. b. respiratory acidosis. c. metabolic acidosis. d. metabolic alkalosis

ANS: A Respiratory compensation for the metabolic acidosis in the form of deep, labored respirations that are ―fruity‖ in odor results in lowered PCO2 values from compensatory respiratory alkalosis. Respiratory acidosis is not the mechanism of respiratory compensation. In hyperglycemia, metabolic acidosis ensues as the bicarbonate concentration decreases, and diabetic ketoacidosis results. Metabolic alkalosis is not the compensatory mechanism for hyperglycemia.

All the following stress-induced hormones increase blood glucose except a. aldosterone. b. cortisol. c. norepinephrine. d. epinephrine.

ANS: A Aldosterone results in water and sodium retention and potassium loss in the urine. It does not affect blood glucose. Cortisol is a glucocorticoid secreted by the adrenal cortex. Cortisol stimulates gluconeogenesis in the liver, thus increasing blood glucose. Norepinephrine inhibits insulin secretion, thus increasing blood sugar. Epinephrine increases glucose release from the liver and inhibits insulin secretion, thus increasing blood glucose.

The primary effect of aging on all body systems is a. decreased functional reserve. b. diseased function. c. programmed senescence. d. senility

ANS: A All body systems show age-related changes that can be generally described as a decrease in functional reserve; aging leads to inability to adapt to (internal and external) environmental changes. Not all effects of aging are considered disease; some are considered a normal part of aging. Programmed senescence is currently only a theory of aging that states cells have a preprogrammed number of cell divisions before they will die. Senility is an outdated term used to describe the cognitive changes associated with dementia; dementia is a disease and is not a normal part of aging.

Selye's three phases of the stress response include all the following except a. allostasis. b. resistance. c. alarm. d. exhaustion.

ANS: A Allostasis is defined as the ability to successfully adapt to challenges. Allostasis may/may not occur in response to stress. Alarm, resistance (or adaptation), and exhaustion are the three phases of the stress response as described by Selye in the general adaptation syndrome.

The underlying pathogenic mechanism for type 1 diabetes is a. pancreatic -cell destruction. b. lack of insulin receptors. c. lack of exercise and chronic overeating. d. impaired glucose transport into cells.

ANS: A By definition, type 1 diabetes is characterized by destruction of the cells of the pancreas. Type 1 diabetes mellitus is characterized by an absolute insulin deficiency, and thus glucose cannot enter muscle and adipose tissue. Type 1 diabetes is unrelated to lack of exercise and chronic overeating. In type 1 diabetes, production of glucose by the liver is no longer opposed by insulin.

The effects of excessive cortisol production include a. immune suppression. b. hypoglycemia. c. anorexia. d. inflammatory reactions.

ANS: A Cortisol suppresses immune function and inflammation and stimulates appetite. Cortisol leads to hyperglycemia by stimulating gluconeogenesis in the liver. Cortisol also leads to increased appetite and food-seeking behaviors and plays a significant role in inflammatory reactions.

The cardiac drug digitalis enhances myocardial contraction because it a. increases intracellular calcium level in cardiac cells. b. inhibits sodium from entering cardiac cells. c. enhances the sodium-potassium pump. d. increases the sodium gradient across the cell membrane.

ANS: A Digitalis inhibits the sodium-potassium pump and allows the accumulation of intracellular sodium, decreasing the sodium gradient across the cell membrane. This leads to less efficient calcium removal by the sodium-dependent calcium pump. Increased calcium inside the cardiac cell leads to more forceful cardiac muscle contraction to treat congestive heart failure caused by cardiac muscle weakness.

Diabetic neuropathy is thought to result from a. decreased myoinositol transport. b. elevated HbA1c. c. deficient neuronal insulin receptors. d. neuronal demyelination.

ANS: A Glucose appears to compete with myoinositol in transport into the cell. Degradation of glucose to sorbitol and fructose (the polyol pathway) occurs in the nerves in the presence of hyperglycemia and insulinopenia. Elevated HbA1c is not associated with diabetic neuropathy. Deficient neuronal insulin receptors are not responsible for neuropathy. Focal ischemic lesions of the nerves may have a role in diabetic neuropathy.

Metaplasia is a. the replacement of one differentiated cell type with another. b. the transformation of a cell type to malignancy. c. an irreversible cellular adaptation. d. the disorganization of cells into various sizes, shapes, and arrangements.

ANS: A Metaplasia is the replacement of one differentiated cell type with another secondary to persistent damage. Dysplasia transforms cells to preneoplastic lesions, which may become malignant. Metaplasia is reversible when the damage is stopped. Disorganization of cells into various sizes, shapes, and arrangements occurs in dysplasia.

Type 2 diabetes mellitus is often associated with a. nonketotic hyperosmolality. b. childhood. c. autoimmune destruction of the pancreas. d. ketoacidosis.

ANS: A More common in type 2 diabetes mellitus, especially in older individuals, is nonketotic hyperglycemic hyperosmolar syndrome characterized by severe hyperglycemia with no or slight ketosis and striking dehydration. Type 1 diabetes is seen more in childhood than type 2. Type 2 diabetes is characterized by a lack of insulin. Ketoacidosis is found in type 1 diabetes.

All these cellular responses are potentially reversible except a. necrosis. b. metaplasia. c. atrophy. d. hyperplasia.

ANS: A Necrosis refers to death of cells/tissue and is not reversible. Metaplasia refers to the replacement of one differentiated cell type with another from persistent injury and is reversible when the injury stops. Atrophy occurs because of lack of use of an organ and is reversible. Hyperplasia is an increase in the number of cells from increased physiologic demands or hormonal stimulation and is reversible.

Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by a. norepinephrine. b. cortisol. c. glucagon. d. ACTH.

ANS: A Norepinephrine is secreted in response to activation of the sympathetic nervous system during stress by the adrenal medulla. Cortisol is secreted by the adrenal cortex. Glucagon is secreted by the pancreas. ACTH is secreted by the pituitary gland.

A 17-year-old college-bound student receives a vaccine against an organism that causes meningitis. This is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention. d. disease treatment.

ANS: A Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals, in this case by providing vaccination. Secondary prevention is the early detection, screening, and management of the disease. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed.

The American Diabetes Association recommends a postprandial blood glucose level of___________ mg/dL for adults with diabetes. a. less than 180 b. more than 180 c. 70 d. 130

ANS: A The American Diabetes Association recommends a postprandial blood glucose level less than 180 mg/dL for adults with diabetes. The American Diabetes Association recommends as goals a preprandial blood glucose level between 70 and 130 mg/dL. A preprandial blood glucose level between 70 and 130 mg/dL is recommended.

The primary adaptive purpose of the substances produced in the alarm stage is a. energy and repair. b. invoke resting state. c. produce exhaustion. d. set a new baseline steady-state.

ANS: A These resources are used for energy and as building blocks, especially the amino acids, for the later growth and repair of the organism. The substances do not produce a resting state. The substances can produce exhaustion if they continue, but that is not their adaptive purpose. Although a new baseline steady state may result from the stress response that is not the adaptive purpose of the substances produced during the alarm stage.

Which are clinical findings usually associated with type 1 diabetes mellitus? (Select all that apply.) a. Polyuria b. Polydipsia c. Polyphagia d. Obesity e. Weight gain

ANS: A, B, C Classic manifestations of type 1 diabetes include polyuria, polydipsia, polyphagia, and weight loss. Obesity and weight gain are not typically associated with type 1 diabetes

Events which occur during the alarm stage of the stress response include secretion of (Select all that apply.) a. catecholamines. b. ACTH. c. glucocorticoids. d. immune cytokines. e. TSH

ANS: A, B, C, D During the alarm stage, catecholamines (epinephrine, norepinephrine), ACTH, glucocorticoids, and immune cytokines are secreted. TSH is not secreted during the stress response

Chronic activation of stress hormones can lead to (Select all that apply.) a. cardiovascular disease. b. depression. c. impaired cognitive function. d. autoimmune disease. e. overactive immune function.

ANS: A, B, C, D Excessive cortisol levels promote hypertension, atherosclerosis, and the development of cardiovascular disease. Chronic overactive stress hormones may result in atrophy and death of brain cells. Elevated levels of stress hormones are found in individuals with depressive disorders. Chronic stress leads to immune function impairment, rather than overactive immune function, and has been implicated in autoimmune disorders.

Bacteria cause injury to cells by which mechanisms? (Select all that apply.) a. Producing exotoxins b. Producing endotoxins c. Producing destructive enzymes d. Reproducing inside of host cells altering cellular function e. Evoking an immune reaction

ANS: A, B, C, E Bacteria function in multiple ways to cause cell injury, including producing exotoxins that interfere with cellular function, producing endotoxins that cause fever and circulatory shock when the bacteria are lysed, producing enzymes that digest cellular membranes, or evoking an immune response with release of chemicals (e.g., histamines, kinins, lymphokines) that can injure cells. Bacteria do not reproduce inside host cells.

Infectious injury often results from which of the following? (Select all that apply.) a. Exotoxins b. Endotoxins c. Self-destruction of cells d. Anti-inflammatory reactions e. Enzymes from white blood cells

ANS: A, B, C, E Exotoxins produced by bacteria interfere with cellular functions. Endotoxins are a component of some bacteria; when the bacteria are lyses, endotoxins are released, causing fever and even circulatory shock. Virally infected cells may trigger their own destruction. Enzymes from white blood cells can harm cells in the area of inflammation. Infectious injury promotes inflammation; inflammation can cause more damage than the infecting agent

Your patient's red blood cell count is slightly elevated today. This might be explained by (Select all that apply.) a. gender difference. b. situational factors. c. normal variation. d. cultural variation. e. illness.

ANS: A, B, C, E Gender, situations (e.g., altitude), normal variations, and illness may all determine red blood cell count. Culture affects how manifestations are perceived (normal versus abnormal)

When determining additional data to gather before making a diagnosis, what factors need to be considered? (Select all that apply.) a. Reliability b. Expense c. Validity d. Generalizability e. Repetition

ANS: A, C Two considerations one must use when choosing additional data to gather include the reliability and validity of the tests being weighed. Reliability, or precision, is the ability of a test to give the same result in repeated measurements. Validity, or accuracy, is the degree to which a measurement reflects the true value of the object it is intended to measure. Expense, generalizability, and repetition are not characteristics that are typically considered

Aldosterone may increase during stress, leading to (Select all that apply.) a. decreased urinary output. b. increased blood potassium. c. increased sodium retention. d. increased blood volume. e. decreased blood pressure.

ANS: A, C, D Aldosterone increases water and sodium reabsorption and potassium excretion by the renal distal tubules and collecting ducts, thus leading to decreased urinary output, sodium retention in the body, and increased extracellular fluid volume. Because it leads to potassium excretion, aldosterone leads to decreased blood potassium.

Which therapies would be appropriate for a patient with type 1 diabetes mellitus? (Select all that apply.) a. Carbohydrate counting b. High-protein diet c. Daily exercise d. Insulin e. Oral hypoglycemic agents

ANS: A, C, D Current recommendations are for an individualized diet that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk. Carbohydrate intake can be monitored by carbohydrate counting, exchanges, or experienced estimation. Exercise can play a role in lowering blood glucose levels and promoting health maintenance. Insulin therapy is required in 100% of persons with type 1 diabetes. Chronic high-protein intake is linked to heightened glomerular flow rates and renal hypertrophy. It is thought that continued renal hyperfunction can lead to nephropathy in diabetic patients. Oral hypoglycemic agents are used with type 2 diabetes.

Which of the following are correct regarding membrane transport of macromolecules? (Select all that apply.) a. Endocytosis refers to the cellular ingestion of extracellular molecules. b. Pinocytosis is the ingestion of large particles such as microorganisms. c. Clatharin-mediated endocytosis starts with a pit formation in the plasma membranes. d. Exocytosis involves packaging substances and secreting them. e. Transporter proteins are an important component of macromolecule transport.

ANS: A, C, D Endocytosis refers to cellular ingestion of extracellular molecules. Clatharin-mediated endocytosis begins at the cell surface by the formation of an indentation, or pit, in the plasma membrane. Exocytosis is the reverse of endocytosis and occurs when substances that are secreted from the cell are packaged in membrane-bound vesicles and travel to the inner surface of the plasma membrane. Pinocytosis is the method of ingesting fluids and small particles. Transporter proteins are used to transport small water-soluble molecules.

Viruses differ from most bacteria in that they act in which of the following ways? (Select all that apply.) a. Enter the host cell b. Directly produce free radicals c. Use the host's metabolic processes to survive and replicate d. Do not induce an immune response e. Do not produce toxins

ANS: A, C, E Viruses are able to enter the host cell and use host metabolic processes to survive and replicate. Viruses do not produce toxins. Viruses do not directly produce free radicals, although these can be produced indirectly by the immune response that follows viral infection. Both viruses and bacteria produce an immune response.

C.Q. was recently exposed to group A hemolytic Streptococcus and subsequently developed a pharyngeal infection. His clinic examination reveals an oral temperature of 102.3°F, skin rash, dysphagia, and reddened throat mucosa with multiple pustules. He complains of sore throat, malaise, and joint stiffness. A throat culture is positive for Streptococcus, and antibiotics have been prescribed. The etiology of C.Q.'s disease is a. a sore throat. b. streptococcal infection. c. genetic susceptibility. d. pharyngitis.

ANS: B Etiology refers to the proposed cause or causes of a particular disease process. A sore throat is the manifestation of the disease process. Genetic susceptibility refers to inherited tendency to develop a disease. Pharyngitis refers to inflammation of the throat and is also a clinical manifestation of the disease process.

What patient is most at risk for severe protein malnutrition? a. A postsurgical patient who has been NPO for 3 days b. A postburn patient who has a deep partial-thickness burn c. A febrile patient who has had a temperature of 102.6°F for 3 days d. An immobile patient who has been in skeletal traction for 1 week

ANS: B A burn is an extreme stressor that results in significant hypermetabolism. The energy needs of a burn patient increase 50% to 100% from the basal metabolic requirement. Burn wounds increase the negative nitrogen balance and burns leak soluble proteins from the wound. The postoperative energy requirement can increase from 10% to 35% above BMR. A combination of increased need with decreased intake can have a major impact on wound healing. The metabolic response to fever is both anabolic and catabolic, which greatly increases nutrient requirements. An effect of immobilization is nitrogen loss as tissue mass is decreased from diffuse atrophy.

A disease that is native to a particular region is called a. epidemic. b. endemic. c. pandemic. d. ethnographic.

ANS: B A disease that is native to a particular region is called endemic. An epidemic is a disease that spreads to many individuals at the same time. Pandemics are epidemics that affect large geographic regions, perhaps spreading worldwide. Ethnographic does not describe a disease distribution pattern

Apoptosis is a process that results in cellular a. atrophy. b. death. c. proliferation. d. mutation.

ANS: B Apoptosis results in death of a cell when it is no longer needed. Atrophy refers to reduction in size of an organ because of cellular shrinkage. Proliferation refers to growth of new cells. Mutation refers to alteration in the genetic structure of cellular DNA.

Carbon monoxide injures cells by a. destruction of cellular membranes. b. reducing oxygen level on hemoglobin. c. promotion of free radicals. d. crystallization of cellular organelles.

ANS: B Carbon monoxide binds tightly to hemoglobin preventing the red blood cell from carrying adequate oxygen, leading to hypoxic injury. Other chemicals such as carbon tetrachloride promote free radicals, which injure cells and destroy cellular membranes. Crystallization of cellular organelles is caused by hypothermia

The cellular component that is most susceptible to radiation injury is the a. membrane. b. DNA. c. RNA. d. ribosomes.

ANS: B Cellular DNA is particularly susceptible to damage from radiation via breakage of the bonds holding the linear DNA together. Cell membranes, RNA, and ribosomes are not the most susceptible to radiation injury.

During times of fasting, the body uses as a source of energy. a. protein b. fat c. carbohydrates d. glucagon

ANS: B During times of fasting, the body reverts to the breakdown and use of fats as its energy source. Protein is not used as a source of energy during fasting. Carbohydrates are not an energy source during fasting. The body does not use glucagon as a source of energy during fasting.

The cellular change that is considered preneoplastic is a. anaplasia. b. dysplasia. c. metaplasia. d. hyperplasia.

ANS: B Dysplastic cells have the potential to become cancerous and are therefore referred to as preneoplastic. Anaplasia, metaplasia, and hyperplasia are not considered preneoplastic.

Which condition is associated with an increase in basal metabolic rate? a. Aging b. Fever c. Obesity d. Starvation

ANS: B Fever is a factor in increasing basal metabolic rate. The aging process decreases the metabolic rate. Calorie-restricted diets and reduced muscle-mass decrease basal metabolic rate. Starvation is associated with a reduction in the basal metabolic rate.

_________is the most powerful predictor of developing type 2 diabetes mellitus. a. Aging b. Obesity c. Sedentary lifestyle d. Cardiovascular disease

ANS: B For type 2 diabetes mellitus, the most powerful predictor is obesity. Excessive abdominal fat introduces a greater threat of diabetes mellitus. Risk factors include aging and a sedentary lifestyle. Leading a sedentary lifestyle carries a greater risk of diabetes. The presence of cardiovascular disease is a risk factor in developing type 2 diabetes, but is not the primary factor.

Gap junctions are connecting channels that allow passage of small molecules from one cell to the next and are especially important for a. distance signaling. b. tissues requiring synchronized function. c. communication within a cell. d. passage of large molecules.

ANS: B Gap junctions are especially important in tissues in which synchronized functions are required such as in cardiac muscle contraction. Gap junctions are channels between adjacent cells, not distant cells. Gap junctions function to promote communication not within a cell, but between adjacent cells. Gap junctions allow passage of small molecules, but not large molecules.

Glycolysis is the metabolic process of breaking down a glucose molecule to form a. CO2 and H2O. b. 2 ATP and 2 pyruvate. c. 30 ATP. d. oxygen.

ANS: B Glycolysis produces a net gain of two ATP molecules and breaks down glucose modules to produce two pyruvate molecules. Oxidative phosphorylation produces CO2 and H2O. Oxidative phosphorylation produces 30 ATP molecules. Oxygen is not produced by glycolysis, but it is necessary for oxidative phosphorylation

Persistence of the alarm stage will ultimately result in a. stress reduction. b. permanent damage and death. c. movement into the resistance stage. d. exhaustion of the sympathetic nervous system.

ANS: B If the alarm stage were to persist, the body would soon suffer undue wear and tear and become subject to permanent damage and even death. Actions taken by the individual during the resistance stage lead to stress reduction. The resistance stage may or may not occur following the alarm stage, based on resource availability. The sympathetic nervous system will continue to function, resulting in continued release of stress hormones.

In general, with aging, organ size and function a. increase. b. decrease. c. remain the same. d. are unknown.

ANS: B In general, with aging, organ size and function decrease.

In the United States, more than people have diabetes mellitus. a. 7 million b. 34.2 million c. 366 million d. 327 billion

ANS: B In the United States, more than 34.2 million people have diabetes. Diabetes affects much more than 7 million people in the United States. It is estimated that worldwide the number of people who have diabetes will rise to 693 million by 2045. The annual cost of diabetes to the U.S. medical care system was estimated to be $327 billion in 2017.

An increase in organ size and function caused by increased workload is termed a. atrophy. b. hypertrophy. c. metaplasia. d. inflammation.

ANS: B Increased function of an organ such as the heart or skeletal muscle results in organ hypertrophy because of cellular enlargement. Atrophy refers to reduction in size of an organ because of cellular shrinkage. Metaplasia refers to replacement of one differentiated cell type with another. Inflammation results from immune response rather than workload.

A patient has been exposed to meningococcal meningitis but is not yet demonstrating signs of this disease. This stage of illness is called the stage. a. prodromal b. latent c. sequela d. convalescence

ANS: B Incubation refers to the interval between exposure of a tissue to an injurious agent and the first appearance of signs and symptoms. In infectious diseases, this period is often called the incubation (latent) period. Prodromal refers to the appearance of the first signs and symptoms indicating the onset of a disease. These are often nonspecific, such as headache, malaise, anorexia, and nausea, which are associated with a number of different diseases. Sequela refers to subsequent pathologic condition resulting from a disease. Convalescence is the stage of recovery after a disease, injury, or surgical operation.

Ribosomes are very important organelles within the cell that have the function of a. detoxifying substances. b. synthesizing proteins. c. converting energy to forms that can be used. d. coding for protein synthesis

ANS: B Ribosome's primary function is the synthesis of proteins. Lysosomes and peroxisomes detoxify substances. Mitochondria convert energy to forms that can be used to drive cell reactions. The nucleus contains genomic DNA that codes for protein synthesis

An obese but otherwise healthy teen is given a prescription for a low-calorie diet and exercise program. This is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention. d. disease treatment.

ANS: B Secondary prevention is the early detection, screening, and management of the disease such as prescribing diet and exercise for an individual who has already developed obesity. Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed.

A patient with high blood pressure who is otherwise healthy is counseled to restrict sodium intake. This is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention. d. disease treatment.

ANS: B Secondary prevention is the early detection, screening, and management of the disease, such as by prescribing sodium restriction for high blood pressure. Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed.

Somatic death refers to death a. of a body organ. b. of the entire organism. c. of nerve cells. d. secondary to brain damage.

ANS: B Somatic death refers to death of an entire organism. Somatic death is not simply death of one body organ. Somatic death involves death of all cells in the body. Brain death refers to death of the brain only, but organ systems can remain living with mechanical assistance.

The benefit of glycolysis is that this second stage of catabolism supplies a. ATP to meet energy needs of the body. b. pyruvate to the citric acid cycle. c. energy for oxidative phosphorylation. d. lactate during anaerobic conditions.

ANS: B The benefit of glycolysis is to supply pyruvate to the citric acid cycle of cellular metabolism, which then produces much ATP. Glycolysis only produces two ATP modules, which is insufficient for energy needs. Glycolysis does not supply energy for oxidative phosphorylation. Lactate produced during prolonged anaerobic conditions builds up and can lead to lactic acidosis, which is an undesirable outcome.

The resting membrane potential in nerve and skeletal muscle is determined primarily by a. extracellular sodium ion concentration. b. the ratio of intracellular to extracellular potassium ions. c. activation of voltage-gated sodium channels. d. activity of energy-dependent membrane pumps.

ANS: B The major determinant of the resting membrane potential is the difference in potassium ion concentration across the membrane. Extracellular sodium helps maintain cell volume and resting membrane potential, but it is not the primary determinant. Activation of voltage-gated sodium channels helps initiate an action potential. Channels are not linked to an energy source; ions flow passively across the cell membrane

The postoperative energy requirement can increase above BMR. a. 7% b. 10% to 35% c. 15% to 30% d. 50%

ANS: B The postoperative energy requirement can increase from 10% to 35% above basal metabolic rate. Fever increases metabolic needs by 7% for each increase of 1 degree. Energy expenditure is increased by 15% to 30% in trauma patients. The energy needs of a burn patient increase 50% to 100% from basal metabolic requirement.

The stage during which the patient functions normally, although the disease processes are well established, is referred to as a. latent. b. subclinical. c. prodromal. d. convalescence.

ANS: B The stage during which the patient functions normally, although the disease processes are well established, is called the subclinical stage. The interval between exposure of a tissue to an injurious agent and the first appearance of signs and symptoms may be called a latent period or, in the case of infectious diseases, an incubation period. The prodromal period, or prodrome, refers to the appearance of the first signs and symptoms indicating the onset of a disease. Convalescence is the stage of recovery after a disease, injury, or surgical operation

The underlying pathogenic mechanism for type 2 diabetes is a. pancreatic -cell destruction. b. insulin resistance and -cell dysfunction. c. lack of exercise and chronic overeating. d. impaired glucose transport into cells.

ANS: B Type 2 diabetes is characterized by a relative lack of insulin. The processes instrumental in producing the relative lack of insulin are insulin resistance and -cell dysfunction. By definition, type 1 diabetes is characterized by destruction of the cells of the pancreas. Lack of exercise and chronic overeating are major risk factors for the development of type 2 diabetes. Type 2 diabetes is not caused by an impaired transport of glucose

Acute physiologic stress is associated with a. preferential use of glycogen. b. catabolism of body proteins. c. decreased basal metabolic rate. d. conservation of body energy stores.

ANS: B With physiologic stress, two phases of catabolism occur. The immediate phase of catabolism is characterized by increased sympathetic nervous system stimulation with release of glucagon, glucocorticoids, and catecholamines. The adaptive phase occurs if the sympathetic nervous system response can selectively keep up with the stressors present. An increased production of insulin occurs with immediate physiologic stress. Acute physiologic stress is associated with an increase in basal metabolic rate. In catabolism, an energy deficit is created and alternative mechanisms of glucose production are required.

Which patients are at highest risk for severe negative nitrogen balance? (Select all that apply.) a. Postsurgical patient b. Postburn patient c. Posttrauma patient d. Postsepsis patient e. Pregnant patient

ANS: B, C Negative nitrogen balance is increased by catabolism and by the use of amino acids to form stress proteins. In addition, burn wounds directly contribute to protein loss, because soluble proteins leak from the wound and proteolysis is activated. Because trauma is a sudden stress, catabolism is much greater than anabolism because the body has not had enough time to replenish the proteins lost. This dominance of catabolism results in excessive negative nitrogen balance and significant loss of skeletal muscle. Nitrogen loss through wounds can be large and create a greater need for increased protein intake. Catabolism is a protective mechanism that provides needed substrates for activation of the immune response to infection, such as in the postsepsis patient. Anabolism is primary in pregnancy.

Which are microvascular complications of diabetes mellitus? (Select all that apply.) a. Cardiovascular disease b. Retinopathy c. Nephropathy d. Neuropathy e. Stroke

ANS: B, C Retinopathy is a microvascular complication of diabetes and is the primary cause of new cases of blindness in adults. Nephropathy is a microvascular complication which accounts for end-stage renal disease in diabetics. Cardiovascular disease is a macrovascular complication. Diabetic neuropathy is a neuropathic complication which accounts for sensory dysfunction. Stroke is considered to be a macrovascular complication

Which of the statements regarding cellular growth and proliferation are true? (Select all that apply.) a. Dormant cells can remain in the G2 phase indefinitely. b. Duplication of DNA occurs in the S phase. ' c. There are six stages of the M phase. d. Proliferation of cells is partly dependent on available space. e. Mitosis involves significant chromosomal rearrangement.

ANS: B, C, D Duplication of DNA occurs in the S phase. The M phase consists of 6 stages. Two strategies of cell cycle control occur, one of which includes cell response to spatial signals from the extracellular matrix and neighboring cells that indicate how much room is available. Dormant cells can remain in the G1 phase indefinitely. Significant chromosomal rearrangement occurs is meiosis

Socioeconomic factors influence disease development because of (Select all that apply.) a. genetics. b. environmental toxins. c. overcrowding. d. nutrition. e. hygiene.

ANS: B, C, D, E Socioeconomic factors influence disease development via exposure to environmental toxins (occupational) and overcrowding, nutrition (over- or undernutrition), and hygiene (e.g., in developing countries). Genetics is not influenced by socioeconomic factors

Which are hormones that increase serum glucose level? (Select all that apply.) a. Vasopressin b. Glucagon c. Growth hormone d. Catecholamine e. Corticosteroid

ANS: B, C, D, E The production of catecholamines, glucagon, corticosteroids, and growth hormone causes an increase in blood glucose levels. Vasopressin does not increase serum glucose levels.

Which of the following statements are accurate when considering diagnostic testing for an individual with a possible medical condition? (Select all that apply.) a. The more often a patient has a test, the more accurate the average result is. b. Sensitivity is the chance the test will be positive if the hypothesized disease is present. c. Testing is generally not accurate during the prodromal stage to make a diagnosis. d. Specificity shows that a test will be negative if the person does not have the disease. e. Reliability demonstrates a test is accurate under a number of different conditions.

ANS: B, D Sensitivity is the probability that the test will be positive when applied to a person with the condition. Specificity is the probability that a test will be negative when applied to a person who does not have a given condition. Test results are usually not aggregated and averaged. A disease process is well established during the prodromal phase of illness, so some diagnostic testing would indicate its presence. Reliability, or precision, is the ability of a test to give the same result in repeated measurements.

Which insulin types are considered rapid-acting? (Select all that apply.) a. NPH b. Aspart c. Glargine d. Lispro e. Regular

ANS: B, D Types of insulin are classified into four groups according to their duration of action: rapid acting, short acting, intermediate acting, and long acting. The most commonly used insulins in the rapid-acting category are aspart, glulisine, and lispro. Intermediate-acting agents include NPH and Lente. Glargine is in the category of long-acting. Regular insulin is considered short-acting.

Which of the following correctly match intracellular organelles to their functions? (Select all that apply.) a. Cytoskeleton: Provides a rigid boundary against cellular invasion. b. Nucleus: Holds the cell's genetic material and directs cell activity. c. Golgi apparatus: Arranges the lipid bilayer according to polarity. d. Lysosomes: Digests organic waste materials. e. Mitochondria: Produce cellular energy in the form of ATP.

ANS: B, D, E The cell's nucleus holds the cell's genetic material and directs daily cellular activity. Lysosomes, along with peroxisomes, perform the task of intracellular digestion of organic waste. Mitochondria produce cellular energy in the form of ATP. The cytoskeleton organizes the intracellular compartment. The Golgi apparatus produces, packages, and transports proteins and lipids to the plasma membrane and lysosomes.

An increase in extracellular potassium ion from 4.0 to 6.0 mEq/L would a. hyperpolarize the resting membrane potential. b. make it more difficult to reach threshold and produce an action potential. c. hypopolarize the resting membrane potential. d. alter the threshold potential

ANS: C An increase in extracellular potassium hypopolarizes the cell (makes it less negative) because more K+ ions stay inside the cell owing to the reduced concentration gradient. Hyperpolarization of the resting membrane potential (makes it more negative) is caused by a decrease in extracellular potassium. Hyperpolarization resulting from a decrease in extracellular potassium makes it more difficult to reach threshold and produce an action potential. The threshold for action potential does not change with a change in extracellular potassium.

The main source of energy for the body comes from a. proteins. b. fats. c. carbohydrates. d. water.

ANS: C Carbohydrates are the main source of energy for the body. Proteins are broken down into amino acids. Fats are the most concentrated form of energy. Water is not the main source of energy for the body

Of the statements below, the accurate statement regarding nutrition and cellular health is a. the body can generally produce elements essential for nutritional balance. b. obese individuals are generally nutritionally healthy. c. deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types. d. a normal BMI indicates nutritional health.

ANS: C Deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types such as in diabetes mellitus. Most of these essential nutrients must be obtained from external sources, because the cell is unable to manufacture them. Obesity involves an excess of caloric intake. The BMI is a measure for obesity, but does not indicate if a nutritional imbalance is present.

Cell-to-cell communication through secretion of chemical signals into the bloodstream to target cells throughout the body is called signaling. a. synaptic b. paracrine c. endocrine d. autocrine

ANS: C Endocrine signaling is accomplished by specialized endocrine cells that secrete hormones that travel via the bloodstream to target cells throughout the body. Synaptic signaling occurs at specialized junctions between the nerve cell and its target cell; the neuron secretes a chemical neurotransmitter into a small space between the nerve and target cell. In paracrine signaling, chemicals are secreted into a localized area, and only those cells in the immediate area are affected. Autocrine signaling occurs when cells respond to signaling molecules that they secrete and provides feedback to that cell rather than other cells.

A patient with a fever of 3°F above normal would be expected to have increased energy expenditure of a. 3%. b. 15%. c. 21%. d. 50%

ANS: C Fever increases metabolic needs by 7% for each 1°F increase (13% for each 1°C increase). Energy expenditure is increased by 15% to 30% in trauma patients. The energy needs of a burn patient increase by 50% to 100%.

GTP-binding proteins (G-proteins) function to a. activate receptors on the extracellular surface. b. degrade second-messenger molecules. c. activate intracellular enzyme systems. d. synthesize ATP.

ANS: C G-proteins activate specific target enzymes within the cell and these enzymes then produce second-messenger molecules that trigger specific intracellular function. Membrane-bound G-protein channels are a component of the cell membrane; they do not activate other receptors on the extracellular surface. G-proteins do not degrade second messengers, but instead produce these. G-proteins do not synthesize ATP

The process of metabolizing proteins to provide energy is called a. glycogenolysis. b. glycolysis. c. gluconeogenesis. d. proteolysis

ANS: C Gluconeogenesis is the process by which glucose is formed from noncarbohydrate sources. Glycogenolysis is the breakdown of glycogen to form glucose. Glycolysis is the metabolic sequence that converts glucose to pyruvate. The process of metabolizing proteins to provide energy is not known as proteolysis.

What indicator is most helpful in evaluating long-term blood glucose management in patients with diabetes mellitus? a. Blood glucose levels b. Urine glucose levels c. Glycosylated hemoglobin levels (HbA1c) d. Clinical manifestations of hyperglycemia

ANS: C HbA1c values are used clinically to estimate long-term control and to set and evaluate therapeutic goals. Monitoring of blood glucose levels is useful for monitoring short-term glycemic control. The blood glucose level at which glucose is measurable in the urine, the glycemic threshold, varies from individual to individual, is usually unacceptably high, and cannot be used to establish the degree of long-term management. Clinical manifestations of hyperglycemia are not a useful method of evaluating long-term glucose management.

Extreme cold injures cells by all the following except a. ischemic injury from vasoconstriction. b. peripheral nerve damage from rebound vasodilation. c. decreased blood viscosity. d. crystallization of cellular components.

ANS: C Hypothermia causes increased blood viscosity, which can result in ischemic injury. Initial vasoconstriction causes ischemic injury. Rebound vasodilation leads to intense swelling which damages peripheral nerves. Crystallization of cellular components leads to rupture of these components

The breakdown of stored glycogen in the liver and muscles is called a. glycolysis. b. glycogenesis. c. glycogenolysis. d. gluconeogenesis.

ANS: C In the fasting state, glucose is produced by glycogenolysis (breakdown of stored glycogen) in the liver and muscles. Glycolysis is the process of oxidization for the energy needs of the cell. Glycogenesis is the production of glycogen in the muscle and liver. Gluconeogenesis is the production of glucose from amino acids and other substrates in the liver.

Necrotic death of brain tissue usually produces necrosis. a. coagulative b. caseous c. liquefactive d. fat

ANS: C Liquefactive necrosis is produced when brain tissue dies, as it is rich in enzymes and has little connective tissue. Coagulative necrosis occurs from ischemic injury in any tissue. Caseous necrosis occurs in lung tissue damaged by tuberculosis. Fat necrosis occurs in adipose (fat) tissue.

A body mass index of 25.5 is considered to be a. morbidly obese. b. normal. c. overweight. d. obese.

ANS: C Overweight is defined with a BMI of 25 to 29.9 kg/m2 . Morbid obesity is a BMI of 40 kg/m2 or more. Normal body weight is BMI less than 25. Obesity is defined as a BMI greater than 30 kg/m2 .

A type of insulin that would be most appropriate for acute management of hyperglycemia is a. NPH. b. Semilente. c. regular. d. Ultralente.

ANS: C Regular insulin is short-acting and would be used for acute hyperglycemia. NPH insulin is an intermediate-acting agent which would not be useful in acute hyperglycemia. Acute management of hyperglycemia is not accomplished with Semilente insulin. Ultralente insulin is not the most appropriate treatment for acute hyperglycemia.

After suffering a heart attack, a middle-aged man is counseled to take a cholesterol-lowering medication. This is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention. d. disease treatment.

ANS: C Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning such as prescribing a cholesterol-lowering medication following a heart attack. Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Secondary prevention is the early detection, screening, and management of the disease. Disease treatment involves management of the disease once it has developed.

The metabolic response to fever is a. anabolic. b. catabolic. c. both anabolic and catabolic. d. related to gluconeogenesis.

ANS: C The metabolic response to fever is both anabolic and catabolic, which greatly increases nutrient requirements. The metabolic response to fever is not catabolic only. Gluconeogenesis is increased in trauma patients.

The nutritional effects of cancer can be severe and result in a. malnutrition. b. anorexia. c. cachexia. d. catabolism.

ANS: C The nutritional effects of cancer can be severe and result in what is commonly termed cancer cachexia. The cause of cachexia is inadequate nutritional intake relative to energy requirements and increased anaerobic glycolysis. The nutritional deficits associated with cancer are not known as malnutrition. A major cause of cachexia is anorexia associated with the malignancy and with the treatment. Catabolism is the degradative phase of metabolism and is not caused by cancer

Insulin binding to its receptor on target cells results in a. increased active transport of glucose into the cell. b. glycogen breakdown within target cells. c. increased facilitated cellular diffusion of glucose. d. gluconeogenesis.

ANS: C The plasma membranes of cells are permeable to glucose, and the diffusion of glucose into some cells is controlled by glucose transporters. Activated glucose transporters translocate to the cell membrane to facilitate diffusion of glucose. Glycogen breakdown does not occur when insulin binds to its receptor on target cells. Gluconeogenesis is not the result of insulin binding to target cells

A clinical finding consistent with a hypoglycemic reaction is a. acetone breath. b. warm, dry skin. c. tremors. d. hyperventilation

ANS: C Tremors are a sign of hypoglycemia. Acetone breath is not a sign of hypoglycemia. Diaphoresis (excessive sweating) is a sign of hypoglycemia. Hyperventilation does not indicate hypoglycemia

Starvation is associated with a. loss of visceral protein. b. low serum albumin levels. c. loss of somatic fat and protein. d. generalized edema.

ANS: C With physiologic stress, conservation of lean body mass does not occur. The metabolic rate increases rather than decreases, and a high sustained rate of catabolism (breakdown of protein to meet energy needs) results. Adipose is not well used for energy. Starvation is associated with protein being used as an energy source. Low serum albumin levels are not associated with starvation. Retention of fluid and sodium occurs in the immediate phase of stress on the body

Phospholipids spontaneously form lipid bilayers because they are a. polar. b. charged. c. insoluble. d. amphipathic.

ANS: D Phospholipids have a hydrophilic (water-loving) polar end and a hydrophobic (water-fearing) polar end. This amphipathic nature causes the lipids to form bilayers. It is the water-loving and water-fearing nature of the end rather than simply being polar, charged, or insoluble that forms the bilayers.

Allostasis is best defined as a. a steady state. b. a state of equilibrium, of balance within the organism. c. the process by which the body heals following disease. d. the overall process of adaptive change necessary to maintain survival and well-being

ANS: D Allostasis refers to the overall process of adaptive change necessary to maintain survival and well-being.

An immobile patient should be treated with an extra g of protein daily. a. 2 to 4 b. 4 to 6 c. 7 to 9 d. 10 to 15

ANS: D An effect of immobilization is nitrogen loss as tissue mass is decreased from disuse atrophy. This loss can total 2 to 3 g/kg per day and require up to 10 to 15 g of protein to replenish the daily loss. Immobility is associated with muscle atrophy and bone demineralization. Patients should be given an extra 10 to 15 g of protein. Patients require up to 10 to 15 g of protein to replenish daily loss. Ten to fifteen grams of protein are required daily in the immobile patient.

Coagulative necrosis is caused by a. dissolving of dead cells and cyst formation. b. trauma or pancreatitis. c. lung tissue damage. d. interrupted blood supply

ANS: D Coagulative necrosis results from interrupted blood supply leading to ischemic cell injury. Liquefactive necrosis results from dissolving of dead cells and cyst formation. Fat necrosis is caused by trauma or pancreatitis. Caseous necrosis is caused by lung tissue damage such as that caused by tuberculosis.

Diabetes mellitus is the leading cause of death and a major cause of disability in the United States. a. first b. second c. fourth d. seventh

ANS: D Diabetes mellitus is the seventh leading cause of death and a major cause of disability in the United States. Diabetes is not the leading cause of death in the United States at this time. The second leading cause of death in the United States is not diabetes. The fourth leading cause of death in the United States is not related to diabetes.

The metabolic response to physiologic stress is characterized by a. loss of somatic protein. b. preservation of visceral protein. c. body weight less than 80% of ideal. d. stress-induced protein catabolism.

ANS: D During times of disease, stress, fever, or starvation or during the release of certain hormones such as thyroid hormone and cortisol, catabolism dominates the body's metabolic processes. Loss of somatic protein does not occur in response to physiologic stress. Tissue wasting associated with catabolism may lead to cellular injury. Body weight less than 80% of ideal is not characteristic of a metabolic response to stress

Reperfusion injury to cells a. results in very little cellular damage. b. results from calcium deficiency in cells. c. occurs following nutritional injury. d. involves formation of free radicals.

ANS: D Free radicals are formed when high-energy electrons partially reduce oxygen in reperfusion injury. Reperfusion injury usually causes more cell damage than the original hypoxia. It results from calcium overload in the cells. Reperfusion injury results from hypoxic injury, rather than from nutritional injury.

Which is not normally secreted in response to stress? a. Norepinephrine b. Cortisol c. Epinephrine d. Insulin

ANS: D Insulin secretion is impaired during stress to promote energy from increased blood glucose. Norepinephrine is secreted during stress as a mediator of stress and adaptation. Cortisol is secreted during stress as a mediator of stress and adaptation and stimulates gluconeogenesis in the liver to supply the body with glucose. Epinephrine is secreted during stress as a mediator of stress and adaptation and increases glycogenolysis and the release of glucose from the liver.

The cellular response indicative of injury because of faulty metabolism is: a. hydropic swelling. b. lactate production. c. metaplasia. d. intracellular accumulations.

ANS: D Intracellular accumulations result from faulty metabolism of lipids, carbohydrates, glycogen, and proteins. Hydropic swelling results from malfunction of the sodium-potassium pump. Lactate production results from anaerobic glycolytic pathway. Metaplasia occurs from persistent cell injury

The effect of stress on the immune system a. is unknown. b. has been demonstrated to be nonexistent in studies. c. most often involves enhancement of the immune system. d. may involve enhancement or impairment the immune system.

ANS: D Many studies demonstrate that long-term stress impairs the immune system, but many researchers identify that short-term stress may enhance the immune system

Ion channels open and close in response to all the following except a. mechanical pressure. b. ligand binding. c. voltage changes. d. temperature changes.

ANS: D No temperature change channels are present on the cell membrane. Mechanically gated channels respond to mechanical deformation. Ligand-gated channels respond to the binding of a signaling molecule (neurotransmitter or hormone). Voltage-gated channels respond to a change in membrane potential.

Indicators that an individual is experiencing high stress include all the following except a. tachycardia. b. diaphoresis. c. increased peripheral resistance. d. pupil constriction

ANS: D Pupils dilate during stress from the effects of catecholamines. Tachycardia, diaphoresis, and increased peripheral resistance are indicators of stress and also occur because of catecholamine release.

Excitable cells are able to conduct action potentials because they have a. receptors for neurotransmitters. b. tight junctions. c. ligand-gated channels. d. voltage-gated channels.

ANS: D Voltage-gated channels respond to changes in membrane potential and are responsible for conducting action potentials. Receptors for neurotransmitters allow neurotransmitters to bind to the cell membrane but are not directly responsible for action potentials in excitable cells. Tight junctions are intercellular connections that help segregate proteins on the cell membrane and are not involved in conducting action potentials. Ligand-gated channels respond to binding of a signaling molecule such as a neurotransmitter, but are not directly responsible for action potentials in excitable cells.