Pathophysiology Exam 2 Practice Questions

What are malignant neoplasms arising from connective tissue cells called? a. Carcinomas b. Sarcomas c. Melanomas d. Fibromas

b. Sarcomas

What method do viruses use to replicate? a. Binary fission b. Budding of a daughter cell from the parent viral cell c. Producing reproductive spores d. Using a host cell to produce and assemble components

d. Using a host cell to produce and assemble components

An autoimmune disease is: a. excessive formation of antibodies following exposure to foreign material. b. an extreme response to normally harmless material in the environment. c. an abnormal response to ingested food and drugs. d. failure of the immune system to distinguish self from nonself.

d. failure of the immune system to distinguish self from nonself.

A warning sign of possible cancer would be any of the following EXCEPT: a. persistent, unusual bleeding. b. a change in bowel habits. c. sudden development of fever, nausea, and diarrhea. d. a change in shape, color, or surface of a skin lesion.

c. sudden development of fever, nausea, and diarrhea.

Prions cannot be cultured in a PETRI plate of media because: a. they take so long to grow. b. they require extensive amounts of specialized nutrients. c. they are proteinaceous particles, not living organisms. d. they are viruses that dont grow on conventional media.

c. they are proteinaceous particles, not living organisms.

24. Which of the following characteristics apply to HIV (select all)? 1. It contains two strands of DNA. 2. It tends to mutate frequently to form new strains. 3. The incubation period is extremely short. 4. It is inactivated by heat and many disinfectants.

2, 4

The term tolerance refers to: a. surveillance and destruction of new cancer cells by the immune system. b. the ability of the immune system to ignore self cells. c. the ability of T and B lymphocytes to work together. d. the role of lymphoid tissue in the body defenses.

b. the ability of the immune system to ignore self cells.

Which of the following causes anaphylaxis? a. A severe, systemic allergic reaction b. Type III hypersensitivity c. Cell-mediated hypersensitivity d. Immune complex deposits in many tissues

a. A severe, systemic allergic reaction

Which of the following are the target cells for HIV? a. Helper T lymphocytes (CD4 lymphocytes) b. B lymphocytes c. Natural killer cells d. Macrophages

a. Helper T lymphocytes (CD4 lymphocytes)

How do antiviral drugs act? a. They interfere with cell wall development. b. They decrease cell membrane permeability. c. They destroy new, immature viral particles. d. They reduce the rate of viral replication.

d. They reduce the rate of viral replication.

The primary pathological effect of influenza virus is: a. destruction of the mucosa in the lower respiratory tract. b. replication of the virus in respiratory secretions. c. destruction of leukocytes and macrophages in the lungs. d. inflammation and necrosis of the upper respiratory epithelium.

d. inflammation and necrosis of the upper respiratory epithelium.

A diagnosis of HIV positive means that: a. the number of T lymphocytes in the circulating blood is decreased. b. significant opportunistic infection is present in the body. c. the individual has AIDS. d. the virus and its antibodies are present in the blood.

d. the virus and its antibodies are present in the blood.

The role of memory cells is to: a. change into an antibody-secreting cell following activation. b. immediately secrete antibodies following the first exposure to antigen. c. recognize the antigen and stimulate the immune response. d. bind complement to the antibody.

c. recognize the antigen and stimulate the immune response.

Which of the following statements applies to the complement system? a. It is activated by IgE. b. It blocks the inflammatory response. c. It consists of proteins in the blood that must be activated. d. It may destroy antibodies in the circulation.

c. It consists of proteins in the blood that must be activated.

Which of the following is a local sign of infection? a. Fever and leukocytosis b. Headache and anorexia c. Pain, erythema, and swelling d. Nausea, weight loss, and fatigue

c. Pain, erythema, and swelling

All of the following are mechanisms of antiviral drug action EXCEPT: a. interference with attachment to host cell. b. block assembly of viral particles. c. interference with mitosis. d. shedding of protein coat.

c. interference with mitosis.

1. Bacteria that form an irregular cluster of spheres are called: a. bacilli. b. diplococci. c. staphylococci. d. streptococci.

c. staphylococci.

When an allergen binds with IgE antibodies on mast cells, resulting in release of chemical mediators, this reaction is called: a. cytotoxic hypersensitivity. b. immune complex hypersensitivity. c. type I hypersensitivity. d. type IV hypersensitivity.

c. type I hypersensitivity.

Which statement is TRUE regarding infants born to HIV-infected mothers? a. Infants usually test negative for HIV after birth. b. There is little risk of infected mothers passing the virus to their infants during delivery. c. Breast milk does not contain HIV or antibodies. d. Infants test positive for HIV because of the presence of maternal antibodies.

d. Infants test positive for HIV because of the presence of maternal antibodies.

Which statement best describes the etiologic development and transmission of AIDS? a. AIDS is caused by a retrovirus and transmitted through body fluids. b. The mechanism of AIDS transmission is unknown; therefore, AIDS is considered to be highly contagious. c. AIDS is an autoimmune disease triggered by a homosexual lifestyle. d. AIDS is caused by a virus that can be transmitted only by sexual contact.

ANS: A AIDS is caused by an infection of HIV, which is proven to be transmitted through blood and body fluids. The mechanism of HIV transmission is known to be through blood and body fluid exposure, newborn infection from the mother, and unprotected sex with an infected partner. AIDS is not an autoimmune disease of the homosexual. HIV can be transmitted through unprotected intercourse. HIV is a virus that is transmitted through various routes, not sexual contact only.

Antigen-presenting cells function to a. display foreign antigen on their cell surfaces bound to MHC. b. stimulate cytokine production by macrophages. c. phagocytose and degrade foreign antigens. d. initiate the complement cascade by way of the alternative pathway.

ANS: A Antigen-presenting cells function to display foreign antigen on their cell surfaces bound to MHC for T cell recognition. Antigen-presenting cells do not stimulate cytokine production or initiate the complement cascade. They also do not phagocytose and degrade foreign antigens, but instead present these to T cells for these functions.

Functions of antibodies include (Select all that apply.) a. antigen agglutination. b. antigen precipitation. c. opsonization. d. phagocytosis. e. complement activation.

ANS: A, B, C, E Antibody functions include antigen precipitation, agglutination, neutralization, and opsonization. Antibodies also activate complement. Antibodies do not phagocytize.

Deficits in immune system function occur in cancer due to (Select all that apply.) a. chemotherapy. b. cancer cells. c. cancer metastasis to bone marrow. d. immunotherapy. e. malnutrition.

ANS: A, B, C, E Cancer cells secrete substances that suppress the immune system. Bone marrow suppression may be due to invasion of blood-forming cells in the bone marrow, poor nutrition, and chemotherapeutic agents. By contrast, immunotherapy is a method of harnessing the immune system in the treatment of cancer.

After bronchoscopy and histologic examination of a suspected tumor, your patient is diagnosed with primary bronchial carcinoma. Thus, the tumor a. is benign. b. is malignant. c. is secondary to cancer elsewhere in the body. d. has spread.

ANS: B 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.

Drug resistance of microbes occurs secondary to a. patient allergy to a drug. b. mutation of the microbe. c. enhance pathogenicity of the microbe. d. using high doses of drugs.

ANS: B Drug resistance develops secondary to chance mutations of microbes in response to a change in the host's environment. Patient allergy to a drug does not cause drug resistance. Although drug resistance may lead to enhanced pathogenicity of a microbe, pathogenicity does not lead to drug resistance. Using low doses of a drug to treat infection leads to drug resistance.

Leukocytosis with a "shift to the left" refers to a. elevated segmented neutrophils. b. elevated immature neutrophils. c. decreased monocytes. d. decreased immature neutrophils.

ANS: B During acute inflammation, the bone marrow releases stored neutrophils. As they are consumed, the demand exceeds the production resulting in an immature (band) neutrophil. Segmented neutrophils are mature neutrophils. Monocytes are immature macrophages and are only 5% of the total WBC. Leukocytosis with a "shift to the left" refers to increased immature leukocytes.

A patient with metastatic lung cancer wants to know her chances for survival. Which response is correct? a. "Lung cancer is always fatal." b. "Lung cancer has about a 15% survival rate." c. "Lung cancer is highly curable when diagnosed early." d. "Lung cancer death rate has decreased significantly, as with all other cancers."

ANS: B Lung cancer has a 15% survival rate. Lung cancer is not always fatal, but is not highly curable at any stage of diagnosis. The death rate from lung cancer has increased dramatically.

Which of the following statements regarding immunoglobulins is TRUE? a. They consist of a unique sequence of amino acids. b. They are produced in the red bone marrow. c. They are attached to mucosal membranes at entry points into the body. d. IgA binds to allergens.

a. They consist of a unique sequence of amino acids.

Which of the following is a characteristic of a benign tumor? a. It is unencapsulated and invasive. b. It consists of undifferentiated cells. c. It exerts systemic effects. d. Cells appear relatively normal.

d. Cells appear relatively normal.

The structure of a virus includes: a. a cell wall and membrane. b. metabolic enzymes for replication. c. a protein coat and either DNA or RNA. d. a slime capsule and cilia.

c. a protein coat and either DNA or RNA.

HIV infection impairs: a. humoral immunity. b. cell-mediated immunity. c. both humoral and cell-mediated immunity. d. neither type of immunity.

c. both humoral and cell-mediated immunity.

The spleen is an important defense against infection, because it a. activates the complement cascade. b. initiates inflammation. c. controls phagocytosis. d. filters the blood.

ANS: D The spleen filters the blood; macrophages in the spleen filter out foreign substances. Lymphocytes activated in the spleen can be transported to other lymphoid tissue to fight infection. The spleen does not activate the complement cascade, initiate inflammation, or have a role in controlling phagocytosis.

A retrovirus such as HIV contains: a. RNA and enzymes for its conversion. b. a double strand of DNA. c. many enzymes to limit budding of new virions. d. numerous mitochondria.

a. RNA and enzymes for its conversion.

Retroviruses are associated with human cancers, including a. Burkitt lymphoma. b. Hodgkin's lymphoma. c. pancreatic cancer. d. hepatic cancer.

ANS: A At least three retroviruses are thought to be causative factors in some human cancers: HIV Kaposi sarcoma, Epstein-Barr in Burkitt lymphoma, and human T-lymphocyte type I in T-cell leukemia-lymphoma. The other answer options are not associated with a retrovirus.

Functions of B cells include a. synthesizing antibodies. b. secreting cytokines. c. killing antigen-presenting cells. d. stimulating B cells. e. killing virally infected cells.

ANS: A B lymphocytes mature into plasma cells and synthesize antibodies. B cells do not secrete cytokines, kill antigen-presenting cells, or kill virally infected cells; T cells do these.

Familial retinoblastoma involves the transmission of what from parent to offspring? a. Mutant tumor suppressor gene b. Cancer-causing virus c. Oncogene d. Extra chromosome

ANS: A Familial retinoblastoma involves transmission of a mutant tumor-suppressor gene from parent to child. Familial retinoblastoma is not caused by a virus and does not involve an extra chromosome, but rather a single gene. Familial retinoblastoma is caused by a mutant tumor suppressor gene, not an oncogene, which is a mutated proto-oncogene.

Which type of HIV virus causes most infections in the United States and Europe? a. HIV type 1 b. HIV type 2 c. HIV type A d. HIV type B

ANS: A HIV-1 is the organism of most cases in Central Africa, the United States, Europe, and Australia. HIV-2 is found in West Africa or in countries with socioeconomic ties to West Africa. HIV type A is a subtype currently in research. HIV type B is a strain in research phases.

Which clinical finding is most indicative of an acute bacterial infection? a. Increased (band) neutrophils. b. Elevated temperature. c. Elevated erythrocyte sedimentation rate. d. Elevated WBC count.

ANS: A Neutrophils are early responders and most active in bacterial infections, and the number of neutrophil bands indicates the severity of the infection. Elevated temperature can occur in infection caused by any organism. The erythrocyte sedimentation rate is non-specific for the type of organism causing an infection. The total WBC count can increase in any infection. The specific type of WBC that is elevated indicates the type of organism involved.

An HIV-positive patient is hospitalized for evaluation of symptoms of progressive weakness, dyspnea, weight loss, and low-grade fever. A biopsy of lung tissue reveals Pneumocystis carinii pneumonia. This diagnosis means that the patient a. has AIDS. b. has less than 2 years to live. c. cannot be treated. d. was an intravenous drug abuser.

ANS: A Pneumocystis carinii pneumonia (PCP) is a common initial opportunistic infection in HIV and is an AIDS-defining diagnosis. A diagnosis of PCP is not associated with a life-expectancy of 2 years or less. PCP is treated with antibiotic therapy. PCP is a pulmonary manifestation of AIDS, which is not associated with intravenous drug abuse.

The hypermetabolic state leading to cachexia in terminal cancer is thought to be due to a. tumor necrosis factor. b. angiogenesis. c. loss of ATP production. d. pain medications.

ANS: A Production of tumor necrosis factor (TNF) and other immune cytokines is thought to be important in producing the hypermetabolic state leading to cachexia in cancer. Angiogenesis is the development of new blood vessels to feed the tumor; it is not a cause of the hypermetabolic state leading to cachexia in terminal cancer. Loss of ATP production and pain medications are not causes of the hypermetabolic state leading to cachexia in terminal cancer.

Your patient is scheduled for a staging procedure. She wants to know what that means. The correct response is which of the following? a. It is a procedure for determining the extent of tumor spread. b. It is a histologic examination of tissues to determine the degree of tumor differentiation. c. Is based on exploratory surgery. d. It is biochemical testing of tumor cells to determine the genetic basis of the tumor.

ANS: A 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.

Breast cancer in women who have the breast cancer gene a. occurs at an earlier age. b. is more likely to be unilateral. c. is more common than non-inherited breast cancer. d. is more responsive to treatment.

ANS: A The age of onset of inherited breast cancer is earlier than the onset of non-inherited forms and the prevalence of bilateral breast cancer is higher. Breast cancer in women who have the breast cancer gene is less common (only 5% to 10% of all cases) than non-inherited breast cancer and is more likely to be bilateral. Response to treatment is not affected by whether the cancer gene is present.

The primary function of eosinophils is to a. kill parasitic helminths (worms). b. kill bacteria. c. stop viral replication. d. phagocytize fungi.

ANS: A The primary function of eosinophils is to kill parasitic helminths (worms); this is evident by the elevation in eosinophil level in parasitic infections. Neutrophils, not eosinophils, function to kill bacteria. Eosinophils have no role in stopping viral replication. The primary role of eosinophils does not involve phagocytizing fungi.

The mononuclear phagocyte system consists of (Select all that apply.) a. monocytes and tissue macrophages. b. dendritic cells. c. bone marrow stem cells. d. antibody-secreting plasma cells. e. basophils.

ANS: A, B The mononuclear phagocyte system is composed of monocytes and macrophages, and dendritic cells that are widely distributed throughout body tissues. Monocytes from the circulating blood migrate to organs and tissues to become macrophages. The mononuclear phagocyte system does not include the bone marrow stem cells, antibody-secreting plasma cells, or basophils.

Passive immunity is provided by (Select all that apply.) a. transfer of preformed human antibodies. b. injection of human immune globulin. c. injection with preformed animal antibodies. d. vaccines with dead or altered organisms. e. active infections.

ANS: A, B, C Passive immunity is provided by immunization with preformed antibodies from either humans or animals, and by injection of human immune globulin. Vaccination with dead or altered organisms provides active immunity. Active infection induces active immunity.

A nurse who works in an assisted living facility is preparing to teach the residents about safe sex practices. What resident criteria should the nurse take into consideration when creating a teaching plan? (Select all that apply.) a. Age b. Ethnicity c. Culture d. Sexual preference e. Mobility status

ANS: A, B, C, D It is important that education regarding safe sex practices be tailored to appropriate age groups, ethnicity, culture, and sexual preference. Mobility status is not a consideration when teaching about safe sex practices.

In which type of cells is the CD4 found? (Select all that apply.) a. T cells b. Microglial cells c. Retinal cells d. Cervical cells e. Pacemaker cells

ANS: A, B, C, D The CD4 receptor is found on many types of cells, including T cells, microglial cells, monocyte-macrophages, follicular dendritic cells, immortalized B cells, retinal cells, Langerhans cells in the skin, bone marrow stem cells, cervical cells, bone marrow-derived circulating dendritic cells, and enterochromaffin cells in the colon, duodenum, and rectum.

Characteristics of complement include (Select all that apply.) a. stimulating chemotaxis. b. lysing target cells. c. having multiple plasma proteins. d. being synthesized in the bone marrow. e. enhancing phagocytosis.

ANS: A, B, C, E Complement functions to stimulate chemotaxis and thereby enhance phagocytosis. Complement consists of 20 plasma proteins that can lyse target cells. Complement proteins are synthesized in the liver and by macrophages and neutrophils, not in the bone marrow.

Risk of infection is increased in (Select all that apply.) a. use of corticosteroids. b. diabetes mellitus. c. spleen removal. d. stomach removal. e. stress.

ANS: A, B, C, E Use of corticosteroids depresses immune function and increases risk of infection. Diabetes mellitus increases risk of infection due to high blood sugar, decreased resistance to infection, and inability to sense pain secondary to neuropathies. Spleen removal increases susceptibility to infection as one of its functions was phagocytosis of encapsulated bacteria. Stress increases hormones that affect immune responsiveness. The stomach is not an organ that affects immune function; therefore, removal of the stomach does not increase the risk for infection.

Characteristics of telomerase include (Select all that apply.) a. repairs the end caps of chromosomes. b. contributes to cancer cell immortality. c. is deficient in cancer cells. d. activity allows a cell to replicate indefinitely.

ANS: A, B, D Telomerase functions to repair the end caps of chromosomes. It contributes to cancer cell immortality by allowing a cell to replicate indefinitely. Telomerase is present in cancer cells at higher than normal levels.

A patient presents to the clinic with flu-like symptoms and a rash. The nurse knows that the type of rash associated with HIV may include (Select all that apply.) a. maculopapular. b. vesicular. c. impetigo. d. urticarial. e. psoriasis.

ANS: A, B, D The rash in HIV is not the same in every patient and may be maculopapular, vesicular, or urticarial. Impetigo and psoriasis are not rashes linked to HIV.

which modes of transmission occur with HIV infection? (Select all that apply.) a. Sexual transmission b. Parenteral transmission c. Fomite transmission to intact skin d. Perinatal transmission to fetus e. Inhalant transmission

ANS: A, B, D Unprotected sex with infected partners is a proven method of HIV transmission. Needle and syringe sharing between intravenous drug users is a proven HIV transmission method. Transmission from an infected mother to her infant may occur in the intrauterine period or at the time of delivery. The risk of contracting HIV through the skin has only been found with a direct puncture. HIV is not known to be transmitted via aerosol routes.

Side effects of chemotherapy include (Select all that apply.) a. anemia. b. nausea. c. leukocytosis. d. bleeding. e. infections.

ANS: A, B, D, E Chemotherapy leads to anemia, bleeding, and infections from bone marrow suppression and deficient production of RBS, platelets, and WBCs, respectively. Chemotherapy also causes nausea, a frequent and debilitating side effect. Chemotherapy causes leukopenia (reduction of WBCs).

The CDC defines three CD4+ T cell categories of T cell ranges. Which values are correct? (Select all that apply.) a. In category 1, the CD4+ T cell count is greater than or equal to 500/ml. b. In category 1, the CD4+ T cell counts range from 200 to 499/ml. c. In category 2, the CD4+ T cell counts range from 200 to 499/ml. d. In category 3, the CD4+ T cell count is less than 200/ml. e. In category 3, the CD4+ T cell count is less than 300/ml.

ANS: A, C, D In category 1, the CD4+ T cell count is greater than or equal to 500/ml. In category 2, the CD4+ T cell counts range from 200 to 499/ml. In category 3, the CD4+ T cell count is less than 200/ml.

Which drugs are used for the management of HIV? (Select all that apply.) a. Nucleoside reverse transcriptase inhibitors b. DNA polymerase inhibitors c. Protease inhibitors d. Non-nucleoside reverse transcriptase inhibitors e. CD4 analogs

ANS: A, C, D Nucleoside reverse transcriptase inhibitors are used to prevent replication by preventing HIV DNA synthesis. Protease inhibitors attack a phase in the viral life cycle by inhibiting the enzyme protease. Nonnucleoside reverse transcriptase inhibitors are potent antiretrovirals. DNA polymerase inhibitors are not used in the management of HIV. CD4 analogs are nonexistent as a pharmacological agent.

Characteristics of immunization include which of the following? (Select all that apply.) a. Giving injections of preformed antibodies provides immediate immunity b. Immunization provides life-long immunity c. Immunization with killed vaccines may lead to infection from the agent d. Herd immunity controls disease without immunizing everyone in the population e. Lack of immunization may lead to an epidemic

ANS: A, D, E Injections of preformed antibodies to an organism provides immediate immunity to disease caused by that organism. Herd immunity controls disease, because a certain percentage of the population is no longer susceptible to the disease. Lack of immunization may lead to an epidemic. Immunization does not provide lifelong immunity. For example, immunization with preformed antibodies is temporary. The CDC monitors disease outbreaks and recommends additional boosters for some infectious diseases. Immunization with killed vaccines does not lead to infection from the agent, as the organism is no longer living.

Proto-oncogenes a. are the same as oncogenes. b. are normal cellular genes that promote growth. c. lead to abnormal tumor suppressor genes d. result from severe mutational events.

ANS: B Proto-oncogenes are normal cellular genes that promote growth. Proto-oncogenes are not the same as oncogenes, which are mutant proto-oncogenes. They are different from tumor suppressor genes and do not alter tumor suppressor genes. Mutational events lead to oncogenes, a mutated proto-oncogene.

Immunity to a specific organism can be determined by a. active phase protein count. b. antibody titer. c. erythrocyte sedimentation rate. d. WBC count.

ANS: B Specific serum antibody concentration for a particular organism can be measured by a blood antibody titer. Active phase protein count indicates level of inflammation. Erythrocyte sedimentation rate indicates degree of inflammation. WBC count helps determine if infection with any organism is present.

HIV infection causes immunodeficiency because it a. directly inhibits antibody production by B cells. b. causes the destruction of T-helper cells. c. causes excessive production of cytotoxic T cells. d. blocks the ability of macrophages to present antigens.

ANS: B The hallmark of HIV infection is defective cell-mediated immunity, with a decrease in CD4 or T-helper lymphocytes. HIV infection does not directly inhibit the production of antibodies by B cells. There is not an excessive production of cytotoxic T cells with HIV infection. HIV infection does not block the ability of macrophages to produce antigens.

The most common tumor suppressor gene defect identified in cancer cells is a. Rb. b. P53. c. DCC. d. APC.

ANS: B The most common tumor suppressor gene defect identified in cancer cells involves P53. More than half of all types of human tumors lack functional P53, which inhibits cell cycling. Rb, DC, and APC are not the most common tumor suppressor gene defects identified in cancer cells.

The HIV nurse educator teaches a newly diagnosed patient about HIV. The nurse educator tells the patient that in the United States, those at greatest risk of HIV infection include (Select all that apply.) a. infants born to infected fathers. b. heterosexual women. c. homosexual men. d. restaurant workers. e. men over age 50.

ANS: B, C In the United States, those at greatest risk of HIV infection include: men who have sex with other men (MSM), also called homosexual men; intravenous drug users who share needles or syringes; sexual partners of those in high risk groups, particularly heterosexual women; and infants born to infected mothers. Infants born to infected mothers, not infected fathers, are at greatest risk of HIV infection. Restaurant workers are not at greater risk of HIV infection solely due to their working in the restaurant industry. Using public restrooms, swimming in public swimming pools, touching or hugging someone who is HIV-positive, and eating with community utensils or in restaurants are safe practices. Approximately 10% to 11% of all HIV cases involve people over age 50, but this does not comprise the highest-risk group.

Functions of T cells include (Select all that apply.) a. synthesizing antibodies. b. secreting cytokines. c. killing antigen-presenting cells. d. stimulating of B cells. e. killing virally infected cells.

ANS: B, C, D, E Certain types of T cells (T helper 2) secrete cytokines that stimulate B cell proliferation. Other T cells (cytotoxic T cells) kill antigen-presenting cells and recognize and destroy virally infected cells. T cells do not synthesize antibodies.

Paraneoplastic syndromes in cancer involve excessive production of substances by multiple means. A common substance found in excessive amounts due to cancer paraneoplastic syndromes is a. insulin. b. tumor necrosis factor. c. potassium. d. calcium.

ANS: D Common paraneoplastic syndromes include hypercalcemia associated with abnormal production of parathyroid hormone-related protein by tumor cells. Insulin is a general growth factor for a number of tissues and may be implicated in development of some cancers, but it is not a cause of paraneoplastic syndromes. Tumor necrosis factor is associated with cachexia in cancer, but it is not associated with paraneoplastic disorders of cancer. Potassium is not found in excess amounts in cancer.

Opportunistic infections are a hallmark of HIV and AIDS. Which infections are considered opportunistic? (Select all that apply.) a. Acinetobacter b. Cytomegalovirus c. Candida albicans d. Pneumocystis carinii e. Clostridium difficile

ANS: B, C, D, E Cytomegalovirus is an opportunistic infection seen in AIDS. Candida albicans is an oropharyngeal manifestation seen in most patients with HIV. Pneumocystis carinii is a respiratory manifestation and a major source of morbidity and mortality in the AIDS patient. Clostridium difficile is a gastrointestinal manifestation of HIV. The GI tract is the major target organ in HIV infection, and malnutrition is the leading cause of death among AIDS patients worldwide. Acinetobacter is not typically associated with HIV and AIDS.

Tumor markers (Select all that apply.) a. are found only in the blood. b. are produced by normal cells. c. help determine cancer origin. d. help identify progression of cancer. e. include prostatic-specific antigen.

ANS: B, C, D, E Tumor markers are substances associated with tumor cells that may be helpful in identifying their tissue of origin and progression and proliferation of cancer cells. Most tumor markers are not very specific for cancer since normal cells in the tissue of origin also produce them. Tumor markers include prostatic-specific antigen. Some tumor cell markers are released into the circulation, but others must be identified through biopsy of metastatic tissue.

Activation of the complement cascade results in (Select all that apply.) a. antibody production. b. inflammation. c. immunosuppression. d. autoimmunity. e. chemotaxis.

ANS: B, E Activation of the complement cascade result is enhanced inflammation and chemotaxis. The complement cascade does not result in antibody production or autoimmunity. It also does not result in immunosuppression; it enhances immune function.

Which HIV-positive patient should be given a diagnosis of AIDS? a. One who has a CD4 count of 300/µl b. One who has neuropathy c. One who has Mycobacterium tuberculosis d. One who has genital herpes

ANS: C AIDS is a syndrome that is expressed in many ways. If a person has a CD4 count less than 200/ml along with an opportunistic infection such as Mycobacterium tuberculosis, then the person is diagnosed with AIDS. A patient is not diagnosed with AIDS until the CD4 count is less than 200/ml. Neuropathy would possibly be a sign or symptom associated with an opportunistic infection, but is not used to diagnose AIDS. Genital herpes is not used to diagnose AIDS.

Proteins that are increased in the bloodstream during acute inflammation are called a. membrane attack complexes. b. selectin receptors. c. acute phase proteins. d. major histocompatibility complexes.

ANS: C Acute phase proteins are produced in the liver during acute inflammation and circulate in the bloodstream. Two of the most important acute phase proteins are C-reactive protein (CRP) and serum amyloid A. Membrane attack complexes are porelike structures that function within the complement system. Selectin receptors are receptors on neutrophils that help neutrophils stick to capillary endothelium. Major histocompatibility complexes are a cluster of genes on chromosome 6 involved in antigen presentation.

Malignant neoplasms of epithelial origin are known as a. lymphoma. b. sarcomas. c. carcinomas. d. adenomas.

ANS: C 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 a. tumor size. b. local invasion. c. cell differentiation. d. metastasis.

ANS: C 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.

The immune system disorder associated with HIV is a. an overactive B-cell system. b. proliferation of immature WBCs (blasts). c. deficiency of T-helper lymphocytes. d. cancerous growth of lymph tissue.

ANS: C HIV has been identified as a type of retrovirus associated with a disorder of the T-helper lymphocytes. T-cells have an interaction with B-cells, but this relationship is not associated with HIV. Immature blast cells are not the deficiency that contributes to HIV. Cancerous growths of lymphatic tissue have not been found to be the source of HIV.

HIV replicates very quickly from the onset of infection. What is the major site of HIV replication? a. Vaginal mucosa b. Anal mucosa c. GI tract d. Respiratory tract

ANS: C HIV is primarily a mucosal disease that replicates very quickly from the onset of infection. The GI tract is the major site of HIV replication because the infection replicates quickly in the GI tract and overwhelms the body's defenses. The vaginal mucosa, anal mucosa, and respiratory tract may be involved in HIV replication, but these are not the initial sites of infection.

Immune function is likely to be most effective in a a. newborn. b. 7-month-old infant. c. 30-year-old. d. 70-year-old.

ANS: C Immune function is most effective in middle life. Newborns have an immature immune system. In older infants, maternal IgG that crossed the placenta at birth begins to fade over the first 6 months of life, and these babies are at greater risk for serious infection. Immunity tends to decline in the elderly resulting in reduced antibody responses to new antigens. The very young and the very old are more susceptible to infection because of immature or degenerating immune functions.

A patient receiving zidovudine and a protease inhibitor to manage HIV infection is found to have an undetectable viral load. This means that the a. dosage of both agents should be reduced. b. zidovudine can be discontinued. c. therapy is effective. d. HIV virus has been eliminated.

ANS: C Protease inhibitors attack at a phase of the viral cycle and are used in conjunction with zidovudine. The goal of treatment is to suppress the viral load. Dosage of both agents would not be reduced, because the undetectable viral load means that the therapy is effective. Zidovudine would not be discontinued, because it is deemed effective in creating an undetectable viral load in this case. The HIV virus has not been eliminated in the event of an undetectable viral load. Rather, HIV plasma is suppressed and disease progression delayed.

A characteristic of some bacteria is a. intracellular parasite. b. composed of RNA or DNA. c. contains cell wall endotoxin. d. cannot replicate extracellularly.

ANS: C Some bacteria contain endotoxin in the cell wall. Viruses are intracellular parasites using host cell components to replicate; bacteria do not use host cell components to replicate. Viruses are composed of RNA or DNA, as opposed to bacteria. Bacteria can replicate extracellularly.

HIV infection of T-helper cells is facilitated by attachment of the viral envelope protein gp120 to a. CD8 proteins on suppressor cells. b. reverse transcriptase. c. CD4 proteins on helper cells. d. the macrophage lipid bilayer.

ANS: C The HIV envelope protein gp120 specifically binds to the CD4 receptor. The receptor cells of the CD4 cells are attracted to virus changes. Reverse transcriptase is not found to be attracted to the gp120 protein at this time. The macrophage lipid bilayer is not associated with the CD4 receptor.

An effective HIV vaccine is difficult to produce, primarily because a. HIV is not immunogenic. b. B cells are unable to produce antibodies against HIV. c. HIV mutates frequently. d. reverse transcriptase cleaves to the vaccine.

ANS: C The variability between strains of HIV and the frequency of mutations makes it difficult to produce a vaccine. HIV infection does not overwhelm the immune system, because it is an immune deficiency. Research is still being conducted to develop a vaccine. Researchers are testing cloned T-cells for response to new therapies. Reverse transcriptase is not proven to adhere to the vaccine.

A patient is infected with the retrovirus HIV. The patient may have contracted HIV as it was transmitted via (Select all that apply.) a. saliva. b. tears. c. semen. d. cervical secretions. e. cerebrospinal fluid.

ANS: C, D HIV is transmitted three ways: sexual transmission via semen or vaginal and cervical secretions through homosexual or heterosexual intercourse; parenteral transmission via blood, blood products, or blood-contaminated needles or syringes; and perinatal transmission in utero, during delivery, or in breast milk. HIV is known to be present in but has not been shown to be transmitted via urine, saliva, tears, cerebrospinal fluid, amniotic fluid, and feces. HIV is not known to be transmitted via aerosol routes.

Which statement about HIV testing is correct? a. Any patient can be tested for HIV with or without their informed consent. b. A negative HIV test ensures absence of infection. c. The false-positive rate for HIV testing is zero. d. Significant exposure to infected blood or body fluids requires HIV testing.

ANS: D After a significant exposure to HIV-infected blood or body fluids, health care workers should be treated according to post-exposure protocols. These include testing and possible prophylactic medications. Patients that need to be tested for HIV should always be given the opportunity to provide verbal or written consent according to state consent guidelines. Negative HIV tests are not always indicative of negative status. False negative tests can occur during the period before seroconversion. Initial HIV tests are highly sensitive but should always be confirmed with a Western blot test.

As of 2010, _____ individuals worldwide have been infected with HIV infection. a. 100,000 b. 1 million c. slightly less than 16 million d. nearly 35 million

ANS: D An estimated 33.3 million people were living with HIV worldwide as of 2010. Infection rates are calculated per 100,000 population. In the United States, more than 1 million people have been diagnosed with HIV and AIDS. Of the total number of people infected, women comprise 15.9 million.

After surgery to remove a lung tumor, your patient is scheduled for chemotherapy, which will a. selectively kill tumor cells. b. stimulate immune cells to fight the cancer. c. have minimal side effects. d. kill rapidly dividing cells.

ANS: D 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.

The primary function of kinins is a. phagocytosis of antigens. b. production of antibodies. c. to limit immune reactions. d. vasodilation to enhance inflammation.

ANS: D Kinins are especially active in inflammation via powerful vasodilation to bring immune cells to the site of infection. Kinins are not phagocytic, but bring phagocytes to an area of infection via vasodilation. B cells produce antibodies. Kinins do not limit immune reactions.

Interleukin-1, interleukin-6, and tumor necrosis factor-α are inflammatory cytokines secreted by a. plasma cells. b. neutrophils. c. lymphocytes. d. macrophages.

ANS: D Macrophages secrete cytokines, including IL-1, IL-6, IL-12, and tumor necrosis factor-α that promote inflammation. Plasma cells, neutrophils, and lymphocytes do not secrete inflammatory cytokines.

The "classical pathway" for activation of the complement cascade is triggered by a. activation of C3. b. inflammation. c. first recognition of an antigen. d. antigen-antibody complexes.

ANS: D The classical pathway for activation of the complement cascade is triggered by the presence of IgG or IgM antigen-antibody complexes. Activation of C3 initiates the alternative pathway. Inflammation does not initiate the classical pathway, but instead inflammation is enhanced by the complement cascade. First recognition of an antigen initiates the lectin pathway or the alternative pathway.

4. The membrane attack complex formed by complement is similar in function to a. CD4+. b. granzymes. c. gp120. d. perforin.

ANS: D The membrane attack complex functions in a similar manner to perforin. CD4+ do not function similar to the membrane attack complex. Granzymes do not function similar to the membrane attack complex. gp120 does not function similar to the membrane attack complex.

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 a. high-fat diet. b. urban pollutants. c. stressful lifestyle. d. cigarette smoking.

ANS: D 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.

The clinical latency period after HIV infection is a time when no a. viral replication occurs. b. decline in CD4 lymphocytes occurs. c. virus is detectable in the blood. d. significant symptoms of immunodeficiency occur.

ANS: D This latency period is the time when no significant symptoms occur, although mild symptoms of lymphadenopathy, lack of energy, weight loss, frequent fevers, and sweats may occur. Viral reproduction occurs immediately after the latency period, and can last up to 18 months. A decline in the CD4 T-cell count is taking place during the time of rapid virus production. Seroconversion usually occurs between 3 weeks and 6 months after exposure.

Active immunity involves (Select all that apply.) a. injection of preformed human antibodies. b. injection of human immune globulin. c. injection with preformed animal antibodies. d. vaccines with dead or altered organisms. e. active infections.

ANS: D, E Active immunity is provided by vaccination with dead or altered organisms and by active infections. Injection of preformed antibodies from either humans or animals produces passive immunity. Injection of human immune globulin produces passive immunity.

In general, a cancer cell that is more tissue-specific differentiated is ____ (more/less) likely to be aggressive.

ANS: less The degree of tissue-specific differentiation predicts malignant potential. A lack of differentiated features in a cancer cell is called anaplasia, and a greater degree of anaplasia is correlated with a more aggressively malignant tumor.

Which of the following is an effect of cytokines? They: a. activate and stimulate proliferation of B and T lymphocytes. b. destroy antigens quickly. c. increase the rate of mitosis in tumors. d. cause immediate pain.

a. activate and stimulate proliferation of B and T lymphocytes.

A secondary immune response differs from the primary immune response in that: a. it is more rapid than the primary response and results in higher antibody levels. b. it is slower than the primary response and doesnt change the antibody levels. c. it occurs at the same time as the primary response but results in a decrease in antibodies. d. it only occurs in hyperallergic reactions and results in a decrease of antibodies.

a. it is more rapid than the primary response and results in higher antibody levels

Immunodeficiencies may result in an increased risk of infections by normally harmless microorganisms. These infections are referred to as: a. opportunistic. b. prophylactic. c. abnormal. d. transient.

a. opportunistic.

Which of the following statements does NOT apply to major histocompatibility complex (MHC) proteins or molecules? a. They are genes on chromosome 6. b. All members of a family have identical MHCs. c. They alert the immune system to virus-infected cells. d. A close match is essential for successful tissue transplants.

b. All members of a family have identical MHCs.

Which of the following is NOT a cause of immunodeficiency? a. Hypoplasia of the thymus b. Delayed hypersensitivity c. Immunosuppressive drugs d. Atrophy of the lymph nodes

b. Delayed hypersensitivity

Opportunistic infection may develop when: a. pathogens enter the body but cannot colonize the site of entry. b. an imbalance occurs in the normal resident flora. c. host resistance increases, and the balance of resident flora is restored. d. contaminated food or water is unknowingly ingested.

b. an imbalance occurs in the normal resident flora.

CD4-positive helper T cells function by: a. direct cytotoxic action. b. facilitating all immune system activity. c. producing immunoglobulins. d. inactivating allergens.

b. facilitating all immune system activity.

Which of the following statements is TRUE regarding a patient who is HIV positive? a. No medication is required until the CD4 cell count drops below normal range. b. Antibodies are present, destroying the virus and preventing transmission to others. c. Antibodies in the blood indicate presence of virus and possible transmission to others. d. Enzymes have not yet converted RNA to DNA for replication.

c. Antibodies in the blood indicate presence of virus and possible transmission to others.

Which factor provides the basis for the grading of newly diagnosed malignant tumors? a. Size of the tumor b. Number of metastases c. Degree of differentiation of the cells d. Number of lymph nodes involved

c. Degree of differentiation of the cells

Systemic lupus erythematosus is caused by: a. a chronic allergic condition. b. development of an immune-deficient state. c. a deficiency of T lymphocytes. d. immune complex deposits of antinuclear antibodies.

d. immune complex deposits of antinuclear antibodies.

Host-versus-graft disease refers to: a. hyperacute rejection of tissue. b. T cells in grafted tissue attacking host cells. c. infection resulting from immunosuppression therapy. d. transplant rejection by the recipients immune system.

d. transplant rejection by the recipients immune system.