Patho Exam 1

12. 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.

A,B,C,D

13. 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.

A,B,C,D

5. Which statements are true concerning cellular metabolism? (Select all that apply.) A. ATP is produced by ATP synthase, a protein in the mitochondrial membrane. B. Energy-requiring reactions within cells are driven by coupling to ATP hydrolysis C. ATP is not stored and must be continuously synthesized by each cell to meet the cell's energy needs. D. Pyruvate can be converted to lactate when oxygen supply is insufficient for oxidative processes. E. Glycolysis is an anaerobic process that produces one ATP molecule, two NADH molecules, and one pyruvate molecule per glucose molecule.

A,B,C,D

10. Your patient's red blood cell 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.

A,B,C,E

14. Necrosis is the result of cellular injury that does not allow for cellular adaptation because it is which of the following? (Select all that apply.) A. Too severe B. Too prolonged C. Acute in nature D. Programmed into the cell itself E. A result of a disrupted blood supply

A,B,E

11. 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.

A,C,D

12. Which type of cellular adaptation would create the greatest concern if found on a biopsy report? A. Dysplasia B. Metaplasia C. Hyperplasia D. Hypertrophy

A. Dysplasia

3. Which form of intercellular chemical signaling is used in chemical neurotransmission by neurons? A. Synaptic B. Paracrine C. Autocrine D. Endocrine

A. Synaptic

12. When the cause is unknown, a condition is said to be idiopathic A. True B. False

A. True

6. All the following stress-induced hormones increase blood glucose except A. aldosterone. B. cortisol. C. norepinephrine. D. epinephrine.

A. aldosterone

3. Selye's three phases of the stress response include all the following except A. allostasis. B. resistance. C. alarm. D. exhaustion.

A. allostasis

6. A client develops weakness in both lower extremities following a prolonged period of bed rest. This condition is most likely caused by A. atrophy. B. dysplasia. C. hypertrophy. D. hyperplasia.

A. atrophy

8. 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.

A. energy and repair

5. The effects of excessive cortisol production include A. immune suppression. B. hypoglycemia. C. anorexia. D. inflammatory reactions.

A. immune suppression

4. 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.

A. norepinephrine

2. 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.

A. primary prevention.

11. In muscle hypertrophy, the hypertrophied cells increase in A. size. B. number. C. calcium. D. accumulations.

A. size

11. Nonketotic hyperglycemic hyperosmolar coma in type 2 diabetes is characterized by which of the following? (Select all that apply.) A. Mild hyperglycemia B. Striking dehydration C. Mortality rate of 11% D. With no or slight ketosis E. Adolescents being most often affected

B,C,D

11. Socioeconomic factors influence disease development because of (Select all that apply.) A. genetics. B. environmental toxins. C. overcrowding. D. nutrition. E. hygiene.

B,C,D,E

10. For the individual with type 2 diabetes, the immediate problems brought about by hyperglycemia can lead to which of the following? (Select all that apply.) A. Ketoacidosis B. Insulin resistance C. Suppressed lipogenesis D. Polydipsia and polyuria E. Further diminished insulin secretion

B,D,E

13. Which is a theory of aging? (Select all that apply.) A. Apoptosis B. Free radical C. Immunologic D. Nutritional injury E. Programmed senescence

B,E

10. What is the mechanism of cellular injury that occurs when deep sea divers get "the bends"? A. Intracellular calcium accumulation creates muscle tetany. B. Gas bubbles form in the blood, blocking circulation and resulting in ischemia. C. Free radicals form abnormal chemical bonds, which destroy the cellular membranes. D. Carbon monoxide binds tightly to hemoglobin, preventing the red blood cells from carrying oxygen.

B. Gas bubbles form in the blood, blocking circulation and resulting in ischemia.

8. In general, with aging, organ size and function A. increase. B. decrease. C. remain the same. D. are unknown.

B. decrease.

7. A disease that is native to a particular region is called A. epidemic. B. endemic. C. pandemic. D. ethnographic.

B. endemic.

6. 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

B. latent

10. The effect of stress on the immune system

B. permanent damage and death A. is unknown. B. has been demonstrated to be non-existent in studies. C. most often involves enhancement of the immune system. D. may involve enhancement or impairment the immune system. $D

4. 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.

B. secondary prevention

3. 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.

B. secondary prevention.

1. Which condition occurs in the presence of cellular damage? A. Cells shrink. B. ATP production increases. C. Osmotic pressure decreases. D. Sodium and water move into the cell.

D

2. Which characteristic uniquely belongs to type 2 diabetes mellitus? A. A strong genetic component B. An absolute absence of insulin production C. A lower than normal basal insulin secretion D. An absent first-phase insulin response and diminished second-phase response

D

3. Cellular hypoxia results in A. increased pH. B. enhanced ATP activity. C. loss of intracellular calcium. D. failure of the sodium-potassium pump.

D

4. Which cellular response is maladaptive? A. Shrinkage of cell size B. Increase in cell size C. Increase in the number of cells D. Change in the shape or arrangement of cells

D

7. Allostasis is best defined as 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.

D

8. Which type of cellular adaptation is most likely to occur as the result of chronic ischemia to a region? A. Hypertrophy B. Hyperplasia C. Metaplasia D. Atrophy

D. Atrophy

2. Which is not normally secreted in response to stress? A. Norepinephrine B. Cortisol C. Epinephrine D. Insulin

D. Insulin

2. Lipid molecules cross cell membranes by A. transporting across the plasma membrane by endocytosis. B. using channel proteins as a membrane transport system. C. using voltage-gated ion channels. D. diffusion.

D. diffusion

1. Indicators that an individual is experiencing high stress include all the following except A. tachycardia. B. diaphoresis. C. increased peripheral resistance. D. pupil constriction.

D. pupil constriction

5. A critical event in the death of a cell is caused by A. disruption of the plasma membrane's permeability barrier. B. an increase in cellular protein content. C. an accumulation of lipofuscin. D. chronic nutrient insufficiency.

A

6. Elevated glucose levels in individuals with diabetes mellitus greatly influence fluid balance and hydration because A. fluids are lost as the kidneys clear excessive glucose during hyperglycemia. B. osmotic pressure rises within the cells during hyperglycemia. C. fluids are accumulated in tissues as blood glucose rises. D. older individuals have impaired thirst perception.

A

7. Macrovascular complications of diabetes mellitus include A. ischemic cerebrovascular accidents. B. retinopathy and nephropathy. C. capillary basement membrane thickening. D. hemorrhagic cerebrovascular accidents.

A

8. Microvascular complications of diabetes mellitus are seen in A. retinopathy and nephropathy. B. ischemic cerebrovascular accidents. C. hemorrhagic cerebrovascular accidents. D. damage to large blood vessels supplying the brain.

A

6. 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.

13. 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.

3. 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, and exhaustion are the three phases of the stress response as described by Selye in the general adaptation syndrome.

1. 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.

5. 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.

6. 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.

6. 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.

4. 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.

3. 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.

4. 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.

11. In type I diabetes, 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.

14. 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. Blood glucose levels in adults with diabetes are recommended to be less than 180 mg/dL after meals. 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.

8. 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 the adaptive purpose of these. 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.

3. 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.

2. 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.

1. Bacteria cause injury to cells by (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.

3. Infectious injury often results from (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.

1. 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.

2. Viruses differ from most bacteria in that they (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.

2. 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.

14. 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.

12. 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.

7. 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.

13. ________ 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.

9. 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.

8. In the United States, nearly ________ people have diabetes mellitus. a. 7 million b. 29.1 million c. 366 million d. 176 billion

ANS: B In the United States, nearly 29.1 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 366 million by 2015. The annual cost of diabetes to the U.S. medical care system was estimated to be $176 billion in 2007.

1. 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.

8. 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.

12. 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. Obesity is a major risk factor for the development of type 2 diabetes. Type 2 diabetes is not caused by an impaired transport of glucose.

15. 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.

5. 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 presence of hypoglycemia. Clinical manifestations of hyperglycemia are not a useful method of evaluating long-term glucose management.

11. 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.

10. 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.

4. 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.

7. 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.

2. 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.

3. 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.

7. Allostasis is best defined as 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 wellbeing.

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

9. 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.

9. 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.

10. 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.

2. 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.

5. 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 sodiumpotassium pump. Lactate production results from anaerobic glycolytic pathway. Metaplasia occurs from persistent cell injury.

10. The effect of stress on the immune system a. is unknown. b. has been demonstrated to be non-existent 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.

1. 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.

3. The pathophysiology of gestational diabetes mellitus most closely resembles that of A. type 1 diabetes. B. type 2 diabetes. C. genetic defects of β-cells. D. chemical-induced diabets.

B

9. Oral antidiabetic agents have been used with success A. as the only required therapy for diabetes. B. with dietary planning for type 2 diabetes. C. equally well for type 1 and type 2 diabetes. D. as a substitute for insulin in type 1 diabetes.

B

9. Viruses injure cells differently than other causes of cellular injury because they A. produce and secrete powerful destructive enzymes that digest cellular membranes and connective tissues. B. are incorporated into the cell, where it uses the cell's RNA or DNA for self- replication. C. cause reperfusion injury as the result of free radical formation. D. injure cells by disrupting chemical bonds through ionization.

B

1. 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.

B. streptococcal infection.

9. 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.

B. subclinical.

2. An increase in which of these characteristics would be present in cells that demonstrate hypertrophy? A. Lipofuscin B. Size of vacuoles C. Size of cells D. Number of cells

C

4. What likelihood is there that gestational diabetes will persist or recur after pregnancy? A. Gestational diabetes markedly increases the development of type 1 diabetes mellitus. B. If glucose tolerance returns after pregnancy, there is low likelihood of recurrence of diabetes mellitus. C. Between 30% to 84%of women with a history of gestational diabetes mellitus will have a recurrence in subsequent pregnancies. D. Women with gestational diabetes have about the same incidence of developing type 2 diabetes as women in the general population.

C

5. Current views about the target group and frequency of screening for diabetes are based on concern for the high prevalence in the adult population of A. unreported HbA1c levels. B. asymptomatic low-risk individuals. C. undiagnosed type 2 diabetes mellitus. D. undiagnosed type 1 diabetes mellitus.

C

7. A heart that has to pump harder in order to effectively circulate blood is likely to undergo which type of cellular adaptation? A. Atrophy B. Metaplasia C. Hypertrophy D. Hyperplasia

C. Hypertrophy

1. Which electrolyte is essential in ensuring a negative resting membrane potential? A. Calcium B. Sodium C. Potassium D. Magnesium

C. Potassium

4. Which electrochemical mechanism is responsible for maintaining cell volume? A. The calcium pump B. Glucose transporters C. The sodium-potassium pump D. ATP-binding cassette (ABC) transporters

C. The sodium-potassium pump

5. 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.

C. tertiary prevention

1. Diabetes mellitus is most accurately defined as a disorder that affects A. the utilization of fats and glucose. B. glucose metabolism and utilization. C. the metabolism of glycogen stores and glucose. D. the utilization of all energy nutrients.

D