Patho Final Review

A 5-year-old patient's parents report loss of appetite and fatigue in their child. The parents also state that the child refuses to walk due to pain. The child's most likely diagnosis is

ALL (acute lymphoid leukemia) ALL is primarily a disorder of children with an abrupt onset of bone pain, bruising, fever, and infection. Children may refuse to walk and experience fatigue, loss of appetite, and abdominal pain. In CML, AML, and CLL, children do not complain of pain with walking. Additionally, chronic leukemia is most commonly found in adults.

Which type of leukemia primarily affects children?

ALL (acute lymphoid leukemia) ALL is primarily a disorder of children. The peak incidence occurs between the ages of 3 and 7 years. The average age of patients with CLL is about 65 to 70 years. The median age of presentation of AML is 64 years. Average onset of CML is between 40 and 50 years.

What assists in the diagnosis of multiple myeloma?

Bence Jones proteins Bence Jones proteins, hypercalcemia (elevated calcium), and bone lesions help in the diagnosis. There are generally renal problems secondary to the elevated plasma proteins. Normal production of erythrocytes, platelets, and leukocytes occurs. Hyperkalemia is not generally observed. Elevated kidney not liver enzymes are common. Erythrocyte production is normal.

Thrombosis in the microcirculation throughout the body is called

Disseminated intravascular coagulation (DIC) Thrombosis may also be initiated by a generalized reduction in flow and release of vasoactive substances that occur in shock states. Systemic derangement in coagulation takes place in disseminated intravascular coagulation (DIC), resulting in thrombosis in the microcirculation throughout the body. A stroke results from the obstruction of blood flow in or to the brain by a clot. Atherosclerosis is a circulatory condition that results in the inability of vessels to regulate blood flow as a result of the stiffening of their walls. An MI is a result of obstructed blood flow in a vessel supplying the heart muscle itself.

Chronic myeloid leukemia (CML) is characterized by which of the following? (Select all that apply.)

Elevated granulocyte count Abdominal discomfort Weight loss Classic signs of CML include elevated granulocyte count, abdominal discomfort, and weight loss. Enlarged painless lymph nodes are seen with chronic lymphoid leukemia (CLL). Symptoms of acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL) are similar and cause bone pain.

What is the marker of choice for detecting a myocardial infarction?

Elevated serum levels of cardiac troponin Two proteins that make up part of the cardiac cell contractile apparatus, troponins I and T, have become the markers of choice for detecting MI. Cardiac troponin levels become elevated in serum at about the same time as CK-MB, but they remain elevated for a longer period. ST-segment elevation is thought to represent acute cell injury and ischemia. An elevated level of serum CK-MB is a highly specific indicator of MI and considered to be diagnostic. However, CK-MB remains elevated for only 48 to 72 hours after MI. Cardiac myoglobin levels are elevated in serum very quickly after MI and may be helpful in early detection; however, cardiac myoglobin is less specific than the other markers.

Anemia of chronic renal failure is caused by the lack of

Erythropoietin Erythropoietin is secreted by the kidney in response to hypoxia caused by a low hemoglobin concentration. Erythropoietin stimulates the bone marrow to produce mature red blood cells. The tissue of the diseased kidney has difficulty producing this hormone. A lack of adrenaline, thyroid hormone, and parathyroid hormone are not factors in anemia of chronic renal failure.

Activation of the renin-angiotensin system in shock causes

Fluid retention Renin triggers stimulates kidney nephrons to conserve sodium and water. Renin triggers the formation of angiotensin II, which is a potent vasoconstrictor. Renin triggers stimulates kidney nephrons to conserve not shift sodium. Activation of the renin-angiotensin system does not cause glucogenesis.

Which disease has the presence of Reed-Sternberg cells on histologic examination?

Hodgkin lymphoma Hodgkin lymphoma has Reed-Sternberg cells. These cells originate from B cells in the germinal centers of lymph nodes. Reed-Sternberg cells are not characteristic of B-cell lymphoma, T-cell lymphoma, or Hodgkin lymphoma.

Which type of hypersensitivity response is mediated by T cells?

Hypersensitivity type IV Type IV hypersensitivity is mediated by T cells. Hypersensitivity types I, II, and III are mediated by antibodies produced by B lymphocytes.

Cardiac output is the product of both

Stroke volume and heart rate The product of stroke volume and heart rate provides the amount of cardiac output. None of the other options (MAP, SVR, or pulse pressure) are factors in cardiac output.

Angiotensin-converting enzyme (ACE) inhibitors block the

conversion of angiotensin I to angiotensin II. Angiotensin I is converted into angiotensin II while it is circulating through the pulmonary vessels, by the angiotensin converting enzyme. ACE inhibitors block the conversion of angiotension I to angiotension II. Renin plays a role in the regulation of arterial blood pressure. ACE inhibitors do not block the conversion of angiotensinogen to angiotensin or the effect of aldosterone on the kidney.

The cellular change that is considered preneoplastic is

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

Cardiogenic shock is characterized by

educed cardiac output.

A disease that is native to a particular region is called

endemic. 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.

Factors released by platelets contribute to hemostasis by enhancing

Platelet aggregation Platelets, when activated, release factors that lead to vasoconstriction, platelet clumping, and vessel repair. Vasodilation is not caused by platelet factors. The intrinsic pathway and fibrinolysis are steps in clot formation.

Which term is used to describe an excess of red blood cells?

Polycythemia Polycythemia is an excess of red blood cells. Anemia is a deficiency of red blood cells. Pancytopenia is a decrease in red blood cells, white blood cells, and platelets. Granulocytopenia is a decrease in platelets.

Which causes of shock are considered to be obstructive? (Select all that apply.)

Pulmonary embolus, Cardiac tamponade, Tension pneumothorax Pulmonary embolism is a mechanical obstruction of blood flow, which results in elevated right-sided heart pressures but left-sided pressures remain normal. Cardiac tamponade results from an accumulation of fluid in the pericardial sac causing elevation of pressures on both sides of the heart. Tension pneumothorax results in shifting and compression of mediastinal structures including the heart, which compromises left ventricular filling. Ventricular rupture is not associated with obstructive shock. Acute hemorrhage is associated with hypovolemic shock.

Which term is used to identify hypertension that has a specific disease as its cause?

Secondary Secondary is the term given to hypertension that is secondary to a specific disease. Idiopathic, primary, and essential hypertension are interchangeable terms for hypertension that cannot be related to a specific disease/cause.

Hypertension with a specific, identifiable cause is known as _____ hypertension

Secondary hypertension has a specific identifiable cause such as a specific pathology or a condition that results in hypertension. Primary hypertension does not have a clearly identifiable etiology and is therefore an idiopathic disorder. Positional changes do not generally result in hypertension. Malignant hypertension is a hypertensive crisis.

Which is a modifiable risk factor for prevention of atherosclerosis?

Smoking Smoking is a behavior that is modifiable although recognized as being difficult to stop. Genetics, gender, and age are not modifiable since they are not under voluntary control of the individual.

Restriction of which electrolytes is recommended in the management of high blood pressure?

Sodium The balance of the intake of water and sodium with their excretion by the kidney remains the central feature of long-term blood pressure maintenance. Sodium is not rapidly eliminated by the kidney like water and adds to the body's fluid volume. It is not necessary to restrict the intake of calcium when managing high blood pressure. Potassium does not need to be restricted in the management of high blood pressure. Magnesium does not play a role in the management of high blood pressure.

The cause of the most common form of anemia is

iron deficiency. Iron deficiency is the most common nutritional deficiency in the world and the most common cause of anemia. Acute blood loss anemia is the result of trauma or disease processes and is highly treatable. Plasma proteins formed in the liver are an essential factor in regulating blood volume. It is important to determine the underlying cause of the anemia so that treatment and control is effective.

After bronchoscopy and histologic examination of a suspected tumor, your patient is diagnosed with primary bronchial carcinoma. Thus, the tumor

is malignant. Bronchial carcinoma is a malignant cancer of the epithelial lining of the bronchi. Carcinoma refers to a malignant tumor. Primary indicates that the cancer began in the lungs and did not metastasize from another site. A staging procedure must be done before knowing if the lung cancer has spread.

The primary source of erythropoietin is provided by the

kidney Erythropoietin is a hormone that is secreted into the bloodstream by the kidney. Bone marrow is not responsible for the production of erythropoietin. Hypoxia from low hemoglobin levels causes a decrease in tissue oxygen tension in the kidney, thereby releasing the hormone erythropoietin. The liver is not associated with erythropoietin production.

After surgery to remove a lung tumor, your patient is scheduled for chemotherapy, which will

kill rapidly dividing cells. Chemotherapy kills rapidly dividing cells. Chemotherapy does not selectively kill tumor cells, but affects all rapidly dividing cells. Chemotherapy has many damaging side effects. Immunotherapy uses the power of the immune system and has the potential for targeting cancer cells.

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.

latent 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.

Necrotic death of brain tissue usually produces _____ necrosis.

liquefactive 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.

Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because

massive histamine release from mast cells leads to vasodilation. Hypotension can occur in type I hypersensitivity due to massive histamine release leading to vasodilation. Toxins are not released during type I hypersensitivity reactions. Sweating occurs as a reaction to shock from severe hypotension; the hypotension occurs first and is due to histamine release. Hypoxia occurs in anaphylaxis due to shock from severe hypotension; the hypotension occurs first and is due to histamine release.

A primary effector cell of the type I hypersensitivity response is

mast cells. Mast cells are a primary effector cell of the type I hypersensitivity response. Monocytes, neutrophils, and cytotoxic cells are not primary effectors of the type I hypersensitivity response.

The role of the circulatory system is to do which of the following?

-Transport O2 and nutrients throughout the body -Remove waste products found within the body The primary functions of the circulatory system include the transportation of O2 and nutrients within the body and the removal of metabolic waste products within the body. Movement of blood through the lungs is via the right side of the heart. Systemic blood flow is supplied by the left side of the heart. Nutrients are absorbed into the blood as it moves through the gastrointestinal tract via splanchnic circulation, and O2 uptake and the release of CO2 occur in the specialized vascular bed of the pulmonary circulation.

How many liters of blood are circulating in the human body at any one time?

4 to 6 There are 4 to 6 liters of blood circulating in the body at any one time. Forty-five percent of the volume is blood cells (red blood cells and white blood cells), and 55% is plasma volume (which contains nutrients and plasma proteins). 1 to 2 and 2 to 3 liters are too low a blood volume. 10 to 20 liters is an exaggerated amount of blood volume.

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria?

128/82 In adults, a normal blood pressure is <120 mm Hg systolic and <80 mm Hg diastolic pressure. Stage 1 hypertension begins with a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg. Between these values, the individual is said to have prehypertension, and interventions related to lifestyle changes should be initiated for primary hypertension. 118/78 is considered normal. An individual with a reading of 140/88 or 138/94 may be considered to have stage 1 hypertension

Left-sided heart failure is characterized by

ANS: pulmonary congestion. Left-sided heart failure is characterized by pulmonary congestion and edema. Rightsided heart failure is characterized by congestion in the systemic venous system that increases systemic vascular resistance. Jugular vein distention is a classic sign of right-sided heart failure. Peripheral edema is seen in right-sided failure.

Risk factors for the development of high blood pressure are which of the following? (Select all that apply.)

Age Race Diet Weight The older a person is, the less elastic the blood vessels are, which results in higher systemic vascular resistance. High blood pressure occurs two to three times more frequently in the African American population than in the Caucasian population. Diets high in fat and sodium have been associated with hypertension. An association with elevated body mass index and high blood pressure has been noted; however, the exact mechanism is unclear. Chronic illness will not necessarily result in hypertension.

Which is a risk factor associated with hypertension? (Select all that apply.)

Age African-American race History of tobacco smoking Normal aging produces a rising systolic pressure over the course of a lifetime, whereas diastolic pressure increases for approximately 50 years, levels off during the sixth decade, and remains stable or declines later on. African Americans are predisposed to hypertension. Also, tobacco use has been shown to increase the risk of hypertension. Being Caucasian is not a known risk factor for hypertension. Diets high in fat and sodium, and low in potassium have been found to increase the risk of developing hypertension.

When a patient receives bone marrow from a closely matched relative, it is referred to as what type of transplant?

Allogenic Allogenic is the term for a transplant from a closely matched relative. Autologous transplants collect stem cells from the patient's own blood to be stored and then re-infused after chemotherapy and irradiation. Graft-versus-host disease is a serious problem that can occur from allogenic transplants. Using peripheral stem cell transplantation (which is a form of autologous transplant) helps eliminate the problem of graft-versus-host disease.

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?

Anaphylactic Exposure to a specific antigen causes receptors on mast cells and basophils to crosslink and activate histamine. The release of histamine along with other vasoactive chemicals produces bronchoconstriction. Cardiogenic shock is not associated with histamine release. Hypovolemic shock is not associated with histamine release. Histamine release does not occur with neurogenic shock.

A severe life-threatening type I hypersensitivity reaction is

Anaphylaxis In some highly allergic people, the type I hypersensitivity reaction can be expressed as a life-threatening allergic reaction known as anaphylaxis. Angioedema, urticaria, and hives are signs that accompany this reaction, but that may also involve other less-threatening reactions.

What is another name for vasopressin?

Antidiuretic hormone Another name for antidiuretic hormone is vasopressin Atrial natriuretic peptide, angiotensin, and aldosterone are not other names for vasopressin.

Which is a lymphoid neoplasm category?

B-cell neoplasm, Hodgkin disease, and Natural Killer cell neoplasm are the three major categories of lymphoid neoplasms. Acute myeloid leukemia and myeloproliferative disease are myeloid neoplasms

The movement of nutrients and O2 as well as the removal of metabolic wastes occurs in

Capillaries The aorta propels blood into the arteries, arterioles, and finally the capillary beds. Here the proximity of the capillary endothelium to the other cells of the body facilitates movement of nutrients and O2 into the cells and removal of cellular metabolic wastes. Capillary blood is then collected by venules in order to be returned to the right side of the heart. Arteries deliver blood to the arterioles. Arterioles deliver blood to the capillary bed.

What is the pathophysiologic phenomenon underlying disseminated intravascular coagulation (DIC)?

Clotting that leads to bleeding DIC is a result of widespread clot formation that consumes platelets and clotting factors, which leaves the patient at risk for serious bleeding. As the result of extensive clotting, platelet and fibrinogen levels are decreased not increased. Inadequate cardiac outcome is the fatal outcome of DIC. Mast cell degranulation is not relevant to DIC.

A common cause of heart failure is which of the following? (Select all that apply.)

Coronary artery disease, Cardiomyopathy, Hypertension The most common cause of HF is myocardial ischemia from coronary artery disease, followed by hypertension and dilated cardiomyopathy. Valvular heart disease and anemia are not common causes of heart failure.

A patient is admitted to the hospital with left-sided heart failure. Which clinical manifestation would the nurse expect the client to exhibit? (Select all that apply.)

Cough Dyspnea Crackles in lungs Common clinical manifestations of left-sided heart failure include cough, dyspnea, and crackles in lungs upon auscultation. Bradypnea describes abnormal slowness of breathing not seen in left-sided heart failure. Peripheral edema is associated with right-sided heart failure.

Uncontrolled massive bleeding causes what type of shock?

Hypovolemic Hypovolemic (low-volume) shock occurs in the presence of massive blood loss when the amount of blood available for circulation decreases. Cardiogenic shock is usually a result of severe ventricular dysfunction associated with myocardial infarction. Other causes include cardiomyopathy, ventricular rupture, and congenital heart defects. Neurogenic shock results from depression of the vasomotor center in the medulla or from interruption of sympathetic nerve fibers in the spinal cord. Causes of neurogenic shock include brain trauma that results in depression of the vasomotor center, spinal cord injury, high spinal anesthesia, and drug overdose. Septic shock commonly is associated with Gram-negative infections.

A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type _____ hypersensitivity reaction.

III Immune complex glomerulonephritis (an inflammatory renal disorder) is an example of a type III hypersensitivity reaction. The circulating immune complex is then deposited in the glomerular capillary wall and mesangium. Glomerulonephritis secondary to strep throat is not a type I, II, or IV sensitivity reaction.

The hypersensitivity reaction that does not involve antibody production is type

IV Type IV hypersensitivity reactions do not involve antibody production. The principal mediators are lymphocytes, including T helper cells (Th) that mediate the reaction by releasing lymphokines (cytokines) and/or antigen-sensitized cytotoxic T cells (Tc) that can directly kill cells. The other types involve antibody production. Type I involves IgE; type II involves IgM or IgG; type III involves IgG.

The principle Ig mediator of type I hypersensitivity reactions is

IgE. Immunoglobulin E (IgE) is the principal antibody mediating type I hypersensitivity reactions. IgA is not the primary Ig mediator of type I hypersensitivity reactions. IgG is involved in type II hypersensitivity reactions. IgM is involved in type II hypersensitivity reactions.

What is the underlying problem common among all types of shock?

Inadequate cellular oxygenation Although each type of shock has specific characteristics, all are associated with a deficiency of cellular oxygen consumption. Inadequate cellular oxygenation may result from decreased cardiac output, maldistribution of blood flow, or reduced blood oxygen content. The impaired oxygen utilization by cells may lead to cell death, organ dysfunction, and stimulation of inflammatory reactions. Cardiac failure can be an outcome, but is not a common cause in all types of shock. Vasodilation occurs in only selective forms of shock. Faulty compensatory mechanisms may contribute to the seriousness of all shocks but that is not the cause of all forms of shock.

The shift to anaerobic metabolism in shock results in

Increased lactate production When the citric acid cycle is inhibited, pyruvate accumulates in the cytoplasm. Pyruvate accumulation would quickly inhibit further glycolysis and shut down ATP production entirely except that it can be converted to a substance called lactate, which diffuses from the cell and into the extracellular fluid. A shift to anaerobic metabolism in shock does not result in metabolic alkalosis, decreased oxygen utilization, or decreased hydrogen ion production.

Which is not normally secreted in response to stress?

Insulin 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.

What is necessary for red blood cell production?

Iron Immature red blood cells produce hemoglobin, which is composed of two pairs of polypeptide chains, the globins. Each globin has an attached heme molecule that contains iron. Dietary iron is transported through the plasma on the RBC membrane. Phosphates are not a necessary component of red blood cell production. Magnesium is not a part of the production of red blood cells. Calcium is not involved in red blood cell production.

Which is a required for red blood cell production?

Iron, folate, and viatmin B12 are required for red blood cell production. Vitamins K and C are not required for red blood cell production.

Your patient is scheduled for a staging procedure. She wants to know what that means. The correct response is which of the following?

It is a procedure for determining the extent of tumor spread. Staging describes the location and pattern of spread of a tumor. Staging does not involve biochemical testing of tumor cells, or the histologic examination of tissues, which is done with cancer grading. CT, MRI, and PET imaging techniques have allowed for noninvasive cancer detection.

Which is true regarding hemophilia A?

It is caused by factor VIII deficiency. Hemophilia A is caused by a deficiency in factor VIII. Hemophilia A is transmitted by an asymptomatic carrier female to an affected son. Hemophilia B is also called Christmas disease. The majority of patients inherit this X-linked recessive disorder.

Which component of the blood is responsible for protecting the body by phagocytosis of micro-organisms and other debris?

Leukocytes Leukocytes protect the body by phagocytosis of micro-organisms and other debris. They also participate in antibody formation. Platelets are essential in clot formation. Erythrocytes are responsible for transporting oxygen. Plasma proteins contribute to blood viscosity and blood pressure.

Dysfunction of which organ would lead to clotting factor deficiency?

Liver The liver is responsible for the synthesis of coagulation factors. A clotting factor deficiency is the result of liver dysfunction. Coagulation does not occur in the kidneys. About 25% of the total number of platelets can be found in the spleen. The pancreas is not a location where coagulation occurs.

Which describes a pathologic manifestation of neurogenic shock?

Loss of sympathetic activation of arteriolar smooth muscle Neurogenic shock results from loss of sympathetic activation of arteriolar smooth muscle. Medullary depression (brain injury, drug overdose) or lesions of sympathetic nerve fibers (spinal cord injury) are the usual causes. Release of vasodilatory mediators such as histamine into the circulation and massive immune system activation are seen in anaphylactic shock. Increased sympathetic nervous stimulation is not a characteristic of neurogenic shock

Regarding iron deficiency anemia, what laboratory features are typically decreased?

MCV, MCH, MCHC. In iron deficiency anemia, the red cells are smaller and paler than normal cells due to the decreased amount of hemoglobin and are described as hypochromic, microcytic red cells. The red cell indices MCV, MCH, and MCHC are decreased. White cell counts in iron deficiency anemia are usually normal. Thrombocyte counts in iron deficiency anemia are usually normal.

Which condition may result in chronic pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure?

Mitral valve stenosis Pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure result from untreated mitral valve stenosis. Syncope, fatigue, low systolic blood pressure, and faint pulses are common signs and symptoms of aortic valve stenosis. Aortic insufficiency is characterized by a high-pitched blowing murmur during ventricular diastole. Patients may complain of palpitations and a throbbing or pounding heart because of the large ventricular stroke volume. Common presenting symptoms of acute myocarditis include fatigue, dyspnea on exertion, and dysrhythmia with associated palpitations.

Renal insufficiency is a common complication of which disease?

Myeloma Renal insufficiency is seen in approximately 50% of patients with plasma cell myeloma, due to hyperproteinemia, Bence Jones protein, hypercalcemia, and hyperuricemia. Chronic myeloid leukemia is manifested by splenomegaly. Chronic lymphoid leukemia is a disease that affects lymphoid tissues and bone marrow. Malignancy along lymphatic pathways is more typical of Hodgkin disease.

A patient is diagnosed with myeloma. The nurse teaches the patient about the multiple tumor sites that can develop with this cancer. The possible tumor sites in myeloma include the (Select all that apply.)

Myeloma may invade bone, lymph nodes, liver, spleen, and kidneys. The stomach and pancreas are not usually tumor sites in myeloma.

Which best defines systolic blood pressure?

Occurs during ventricular contraction Systolic blood pressure occurs during ventricular contraction and is a function of volume ejected and the compliance of the aorta. The diastolic blood pressure occurs during passive elastic recoil of the aorta and is an average of 70 mm Hg. The diastolic blood pressure occurs during passive elastic recoil of the aorta. Systolic blood pressure is a function of volume ejected and the compliance of the aorta, and averages 120 mm Hg.

Which group of clinical findings describes the typical presentation of ALL (acute lymphoid leukemia)?

Pain in long bones, infection, fever, bruising The onset of symptoms of ALL is abrupt and may begin when a child refuses to walk or begins to exhibit loss of appetite, fatigue, or abdominal pain. Bruising, fever, and infection are also common early findings. Vertebral fractures, elevated calcium levels, and bone pain are more frequently associated with plasma cell myeloma. Asymptomatic onset is generally found with CLL and is often found by accident on a routine blood count. Enlarged cervical lymph nodes are seen more commonly in Hodgkin disease.

A patient with heart failure reports awakening intermittently with shortness of breath. Which terms appropriately describes this clinical manifestation?

Paroxysmal nocturnal Paroxysmal nocturnal dyspnea refers to intermittent attacks of severe dyspnea that occur during the night. Dyspnea is a general term referring to difficulty breathing. Cyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. Bradypnea describes abnormal slowness of breathing.

It can be explained to a patient that high blood pressure increases the risk of (Select all that apply.)

Stroke, Renal disease, Ischemic heart disease Hypertension increases morbidity and mortality associated with stroke. Kidney disease or failure is associated with hypertension. Ischemic heart disease has an increase in morbidity and mortality when partnered with hypertension. Diabetes is not directly associated with hypertension. Liver disease is not linked with hypertension

Which disorder is associated with a type III hypersensitivity mechanism of injury?

Systemic lupus erythematosus Systemic lupus erythematosus is a type III hypersensitivity disorder. Type III hypersensitivity is characterized by antigen-antibody complex deposition into tissues, with consequent activation of complement and a subsequent self-sustaining inflammatory reaction. Graves disease and erythroblastosis fetalis are type II hypersensitivity reactions. Seasonal allergic rhinitis is a type I hypersensitivity reaction.

The normal life span of a red blood cell is

The normal life span of a red blood cell is 80 to 120 days

A patient is diagnosed with CML (chronic myeloid leukemia). The patient may experience which of these symptoms? (Select all that apply.)

The usual clinical presentation of CML includes a high granulocyte count on the CBC and splenomegaly. Symptoms of CML include fatigue, weight loss, sweats, bleeding, and abdominal discomfort from the enlarged spleen. Joint pain is not a symptom of CML.

Which term best describes a condition that presents with the symptoms of petechiae, easy bruising, bleeding gums, occult hematuria, or retinal hemorrhages?

Thrombocytopenia Thrombocytopenia produces all of these symptoms and usually occurs with a platelet count below 20,000/mm3. Neutropenia is an absolute neutrophil count of less than 500 cells/mcl resulting in fevers and frequent infections. Leukopenia is a decrease in white blood cells also putting the individual at risk for infections. Anemia is a decrease in hemoglobin and hematocrit affecting the body's ability to transport oxygen causing fatigue and ultimately respiratory issues.

Atherosclerosis predisposes to a number of processes that are factors in myocardial ischemia. These processes include

Thrombus formation Atherosclerotic plaques with large lipid cores are fragile and prone to rupture. Rupture of a plaque exposes subendothelial proteins and initiates platelet aggregation and thrombus formation. Hemorrhage can lead to hemorrhagic shock, but death is not directly related to either atherosclerosis or myocardial ischemia, but rather hypovolemia. Coronary dilation would not hinder blood flow which is a cause of myocardial ischemia. Ventricular dysrhythmia affects cardiac conduction and function, but these dysfunctions are not related to atherosclerosis or myocardial ischemia.

Which is a major determinant of diastolic blood pressure?

Vascular resistance Systemic vascular resistance is the major determinant of diastolic blood pressure. It reflects the arteriolar radius and the degree of constriction, and it is the main variable in determining afterload. Stroke volume is the primary factor impacting systolic pressure. The end-diastolic volume is determined by the amount of blood returned to the heart between contractions, and is typically called the heart s preload. Heart rate is the number of times the heart contracts within a 60-second time frame

A commonly ingested substance associated with prolongation of the bleeding time is

aspirin. Many drugs are associated with prolonged bleeding times. Aspirin is known to alter normal platelet function. Acetaminophen is not associated with prolongation of bleeding time. Tobacco does not interfere with bleeding times. Caffeine does not interfere with bleeding times.

The Philadelphia chromosome is a balanced chromosome translocation that forms a new gene called

bcr-abl. bcr-abl is the translocation of chromosomes 9 and 22, which are known as the Philadelphia chromosome. Rb is a retinoblastoma protein, which is not associated with the Philadelphia chromosome. p53 is a tumor suppressor not associated with the Philadelphia chromosome. ARA-c is a chemotherapeutic agent used to treat leukemia.

Malignant neoplasms of epithelial origin are known as

carcinomas. Carcinoma refers to malignant tumors of epithelial origin. Lymphoma refers to cancer of the lymphatic tissue. Sarcoma refers to malignant tumors of mesenchymal (nerve, bone, muscle) origin. Adenoma is a benign tumor of glandular tissue.

Cancer grading is based on

cell differentiation. Grading refers to the histologic characterization of tumor cells and is basically a determination of the degree of anaplasia (lack of differentiation). The other answer options are associated with tumor staging.

A cause of thrombocytopenia includes

chemotherapy. Bone marrow suppression from chemotherapy, recent immunizations, and alcohol ingestion are common causes of platelet production. Underlying systemic diseases may be present related to bleeding problems. Hypoxemia is not directly associated with thrombocytopenia. A reduction in erythropoietin is not associated with alterations in coagulation. Secondary polycythemia is not a cause of thrombocytopenia.

Your patient eats "lots of fat," leads a "stressful" life, and has smoked "about two packs a day for the last 40 years." Her chronic morning cough recently worsened, and she was diagnosed with a lung mass. The most likely contributing factor for development of lung cancer in this patient is

cigarette smoking The most likely contributing factor for the development of lung cancer is cigarette smoking. Tobacco smoke contains hundreds of compounds, many of which have known genotoxicity and probably serve as initiators. Tobacco smoke also contains promoters, which spur the mutant cells to proliferate. Although a high-fat diet, urban pollutants, and a stressful lifestyle have been implicated in some types of cancer, they are not the likely contributing factor in your patient's lung cancer.

Treatment for hemophilia A includes

factor VIII replacement. Factor VIII administration is a common treatment choice for hemophilia A, particularly with dental procedures requiring local anesthesia. Heparin administration is typically highly contraindicated in an individual with a bleeding disorder although in some cases it is given to patients with DIC. Factor IX may be available as a treatment option for hemophilia B. A platelet transfusion is not of benefit in the hemophilia A patient.

An important mediator of a type I hypersensitivity reaction is

histamine. Histamine mediates type I hypersensitivity reactions. Complement mediates type II hypersensitivity reactions. Antigen-antibody immune complexes mediate type III hypersensitivity reactions. T cells mediate type IV hypersensitivity reactions.

A patient presents to the emergency department with a diastolic blood pressure of 132 mm Hg, retinopathy, and symptoms of an ischemic stroke. This symptomology is likely the result of

hypertensive crisis. Hypertensive crisis is characterized by a diastolic blood pressure of greater than 120 mm Hg, and symptoms of end-organ damage such as retinopathy and ischemic stroke. Blood pressure is not an indication of arthrosclerosis Angina may accompany hypertensive crisis, but the question stem relates directly to hypertensive crisis. The patient may be having a myocardial infarction, but the addition of end-organ damage symptoms points to hypertensive crisis.

An increase in organ size and function due to increased workload is termed

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

A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to

hypotension. Hypotension is low blood pressure characterized by dizziness, blurred vision, syncope, and injury from falls. Hypertension is high blood pressure characterized by headache, confusion, chest pain, and difficulty breathing. Deep vein thrombosis is evidenced by calf pain or tenderness. Angina is characterized by chest, shoulder, or jaw pain.

Coagulative necrosis is caused by

interrupted blood supply. 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.

The cellular response indicative of injury due to faulty metabolism is

intracellular accumulations. 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.

All these cellular responses are potentially reversible except

necrosis. 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 due to 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.

The prevalence of high blood pressure is higher in

non-Hispanic black adults The prevalence of high blood pressure remains higher among non-Hispanic, black adults. Non-Hispanic white adults have a lower prevalence of high blood pressure. Mexican-American adults have a lower prevalence than black adults. Asian children do not display a high prevalence for high blood pressure.

Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by

norepinephrine 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.

Hypotension associated with neurogenic and anaphylactic shock is due to

peripheral pooling of blood. Profound peripheral vasodilation of both arterioles and veins leads to peripheral pooling of blood and hypotension. Decreased venous return to the heart results in decreased cardiac output and hypotension. Hypovolemia is not the source of the hypotension involved in neurogenic and anaphylactic shock. Cardiac output is generally adequate in neurogenic and anaphylactic shock. Hypotension in neurogenic and anaphylactic shock is not related to high afterload.

A 17-year-old college-bound student receives a vaccine against an organism that causes meningitis. This is an example of

primary prevention Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals 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.

A serious complication of deep vein thrombosis is

pulmonary embolus Deep vein thrombosis is treated aggressively, as it is the most frequent source of pulmonary embolus. Deep vein thrombosis is not the cause of a stroke. Hypertensive crisis is unrelated to deep vein thrombosis. Extremity necrosis could result from prolonged arterial occlusion.

The common denominator in all forms of heart failure is

reduced cardiac output. The common manifestation of all forms of heart failure is the failure of the heart to pump blood adequately. The clinical presentation may differ depending on which ventricle fails (left or right, or both). Poor diastolic filling is not seen in all forms of heart failure. Pulmonary edema is seen in left-sided failure. Tissue ischemia is directly related to myocardial infarction, which may induce heart failure.

Cor pulmonale refers to

right ventricular hypertrophy secondary to pulmonary hypertension. Pulmonary disorders that result in increased pulmonary vascular resistance impose a high afterload on the right ventricle. The resultant right ventricular hypertrophy known as cor pulmonale may progress to right ventricular failure as the lung disease worsens. Biventricular failure is most often the result of primary left ventricular failure that progresses to the right. Cor pulmonale is not associated with left ventricular hypertrophy. Only 3% of MIs occur in the right ventricle.

Autologous stem cell transplantation is a procedure in which

stem cells are harvested from the patient and then returned to the same patient. In autologous transplantation, the stem cells are collected from the patient's own blood and then stored and reinfused in the same patient after chemotherapy and radiation. The use of autologous transplants eliminates the problem of graft-versus-host disease. Transplant from a closely matched donor is known as allogenic transplant. In autologous transplant, stem cells are used from the patient's own blood.

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

streptococcal infection. 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.

The activated partial thromboplastin time (aPTT) is a measure of the integrity of

the intrinsic pathway The intrinsic pathway is assessed through the aPTT. The extrinsic pathway is assessed through measurements of the PT and INR. An abnormal factor VIII function results in hemophilia A. The deficiency is verified by factor assay. The aPTT is not utilized to assess the integrity of plasminogen

Allostasis is best defined as

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

Metaplasia is

the replacement of one differentiated cell type with another. 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.

Rheumatic heart disease is most often a consequence of

β-hemolytic streptococcal infection Rheumatic heart disease is an uncommon but serious consequence of rheumatic fever. Rheumatic fever is an acute inflammatory disease that follows infection with group A β-hemolytic streptococci. Rheumatic heart disease is not associated with chronic IV drug abuse. Rheumatic fever is an acute inflammatory infectious disease. Cardiomyopathy does not cause rheumatic heart disease.