ADVANCED PATHOPHYSIOLOGY EXAM 3 350 QUESTIONS AND WELL ELABORATED ANSWERS ALREADY A GRAD, Exams of Pathophysiology

Download ADVANCED PATHOPHYSIOLOGY EXAM 3 350 QUESTIONS AND WELL ELABORATED ANSWERS ALREADY A GRAD and more Exams Pathophysiology in PDF only on Docsity! ADVANCED PATHOPHYSIOLOGY EXAM 3 350 QUESTIONS AND WELL ELABORATED ANSWERS ALREADY A GRADED WITH EXPERT FEEDBACK TOP RATED VERSION FOR |BRAND NEW!!{REVISED} 1. What are clinical manifestations of hypothyroidism? a. Intolerance to heat, tachycardia, and weight loss b. Oligomenorrhea, fatigue, and warm skin c. Restlessness, increased appetite, and metrorrhagia d. Constipation, decreased heart rate, and lethargy - CORRECT ANSWER - The lower levels of thyroid hormone result in decreased energy metabolism, resulting in constipation, bradycardia, and lethargy, thus eliminating the remaining options. 1. Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. This is an example of: a. Positive feedback b. Neural regulation c. Negative feedback d. Physiologic regulation - CORRECT ANSWER - Negative feedback. Feedback systems provide precise monitoring and control of the cellular environment. Negative feedback occurs because the changing chemical, neural, or endocrine response to a stimulus negates the initiating change that triggered the release of the hormone. Thyrotropin-releasing hormone (TRH) from the hypothalamus stimulates TSH secretion from the anterior pituitary. Secretion of TSH stimulates the synthesis and secretion of THs. Increasing levels of T4 and triiodothyronine (T3) then generate negative feedback on the pituitary and hypothalamus to inhibit TRH and TSH synthesis. 1. Lipid-soluble hormone receptors are located: a. Inside the plasma membrane in the cytoplasm b. On the outer surface of the plasma membrane c. Inside the mitochondria d. On the inner surface of the plasma membrane - CORRECT ANSWER - Inside the plasma membrane in the cytoplasm. Lipid-soluble hormone receptors are located inside the plasma membrane and easily diffuse across the plasma membrane to bind to either cytosolic or nuclear receptors. 1. The releasing hormones that are made in the hypothalamus travel to the anterior pituitary via the: a. Vessels of the zona fasciculata b. Hypophyseal stalk c. Infundibular stem d. Portal hypophyseal blood vessels Portal hypophyseal blood vessels. - CORRECT ANSWER - Releasing and inhibitory hormones are synthesized in the hypothalamus and are secreted into the portal blood vessels through which they travel to the anterior pituitary hormones. 1. Which mineral is needed for thyroid-stimulating hormone (TSH) to stimulate the secretion of thyroid hormone (TH)? a. Iron b. Iodide c. Zinc d. Copper - CORRECT ANSWER - Iodide. TSH, which is synthesized and stored in the anterior pituitary, stimulates secretion of TH by activating intracellular processes, including the uptake of iodine necessary for the synthesis of TH. 1. What effect does hyperphosphatemia have on other electrolytes? a. Increases serum calcium b. Decreases serum magnesium c. Decreases serum calcium d. Increases serum magnesium Decreases serum calcium. - CORRECT ANSWER - Hyperphosphatemia leads to hypocalcemia. Remember that phos and calcium are inversely related. 1. Insulin transports which electrolyte in the cell? a. Potassium b. Sodium c. Calcium d. Phosphorus - CORRECT ANSWER - Potassium. Insulin facilitates the intracellular transport of potassium, phosphate, and magnesium. 1. Which second messenger is stimulated by epinephrine binding to a β-adrenergic receptor? a. Calcium b. Inositol triphosphate (IP3) c. Diacylglycerol (DAG) d. Cyclic adenosine monophosphate (cAMP) - CORRECT ANSWER - Cyclic adenosine monophosphate (cAMP). Second-messenger molecules are the initial link between the first signal (hormone) and the inside of the cell. For example, the binding of epinephrine to a β adrenergic-receptor subtype activates (through a stimulatory G protein) the enzyme, adenylyl cyclase. Adenylyl cyclase catalyzes the conversion of adenosine triphosphate (ATP) to the second messenger, 3', and 5'- cAMP. 1. Regulation of the release of catecholamines from the adrenal medulla is an example of which type of regulation? a. Negative feedback b. Neural c. Positive feedback d. Physiologic - CORRECT ANSWER - Neural. The release of hormones occurs either in response to an alteration in the cellular environment or in the process of maintaining a regulated level of certain hormones or certain substances. Several different mechanisms, one of which is neural control (e.g., stress-induced release of catecholamines from the adrenal medulla), regulate the release of hormones. b. Autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue. c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones. d. Ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter. - CORRECT ANSWER - Thyroid-stimulating immunoglobulin that causes the overproduction of thyroid hormones. The pathologic features of Graves disease indicates that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms that result in the stimulation of excessive TH. 1. Pathologic changes associated with Graves disease include: a. High levels of circulating thyroid-stimulating immunoglobulins b. Diminished levels of thyrotropin-releasing hormone c. High levels of thyroid-stimulating hormone d. Diminished levels of thyroid-binding globulin - CORRECT ANSWER - High levels of circulating thyroid-stimulating immunoglobulins. The only option that correctly describes the changes associated with Graves disease identifies high levels of circulating thyroid-stimulating immunoglobulins that are found in more than 95% of individuals diagnosed with the disease. 1. The signs of thyrotoxic crisis include: a. Constipation with gastric distention b. Hyperthermia and tachycardia c. Bradycardia and bradypnea d. Constipation and lethargy - CORRECT ANSWER - Hyperthermia and tachycardia 1. The level of thyroid-stimulating hormone (TSH) in individuals with Graves disease is usually: a. High b. Normal c. Low d. In constant flux Low. - CORRECT ANSWER - The hyperfunction of the thyroid gland leads to suppression of TSH because of the normal negative feedback mechanism. 1. Palpation of the neck of a person diagnosed with Graves disease would detect a thyroid that is: a. Left of midline b. Normal in size c. Small with discrete nodules d. Diffusely enlarged - CORRECT ANSWER - Diffusely enlarged. 1. The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include solute: a. Retention and water retention b. Dilution and water retention c. Retention and water loss d. Dilution and water loss - CORRECT ANSWER - Dilution & water retention 1. The common cause of elevated levels of antidiuretic hormone (ADH) secretion is: a. Ectopically produced ADH b. Posterior pituitary tumor c. Inflammation of the hypothalamus d. Inflammation of the nephrons - CORRECT ANSWER - Ectopically produced ADH 1. Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? a. Hypernatremia and urine hypo-osmolality b. Serum potassium (K+) level of 5 mEq/L and urine hyper-osmolality c. Serum sodium (Na+) level of 120 mEq/L and serum hypo-osmolality d. Hypokalemia and serum hyper-osmolality - CORRECT ANSWER - Serum Na level of 120 and serum hypo-osmolatlity. A diagnosis of SIADH requires a serum sodium level of less than 135 mEq/L, serum hypo-osmolality less than 280 mOsm/kg, and urine hyper-osmolarity. Potassium levels are not considered a factor. 1. A patient who is diagnosed with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, no change in his polyuria level has occurred. These symptoms support a diagnosis of: a. Neurogenic diabetes insipidus b. Syndrome of inappropriate antidiuretic hormone c. Psychogenic polydipsia d. Osmotically induced diuresis - CORRECT ANSWER - Neurogenic diabetes insipidus. Remember, sodium has to be below 135 to meet the requirement for SIADH. 1. Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom? a. Polyuria b. Vomiting c. Edema d. Thirst - CORRECT ANSWER - Thirst, is the only symptom in common. 1. The cause of neurogenic diabetes insipidus (DI) is related to an organic a. Anterior pituitary b. Posterior pituitary c. Thalamus d. Renal tubules - CORRECT ANSWER - Posterior pituitary. Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk. 1. Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity? a. Neurogenic b. Nephrogenic c. Psychogenic d. Ischemic - CORRECT ANSWER - Nephrogenic. Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH. 1. Which laboratory value is consistently low in a patient with diabetes insipidus (DI)? a. Urine-specific gravity b. Urine protein c. Serum sodium d. Serum total protein - CORRECT ANSWER - Urine-specific gravity. The basic criteria for diagnosing DI include a low urine-specific gravity while sodium levels are high. Protein levels are not considered. 1. Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)? a. Neurogenic b. Nephrogenic c. Psychogenic d. Ischemic - CORRECT ANSWER - Neurogenic DI is treated with ADH replacement therapy. 1. The term used to describe a person who experiences a lack of all hormones associated with the anterior pituitary is: a. Panhypopituitarism b. Hypopituitarism c. Adrenocorticotropic hormone deficiency - CORRECT ANSWER - Panhypopituitarism is the only available term that is correctly associated with the lack of all anterior pituitary hormones. 1. Diabetes insipidus is a result of: a. Antidiuretic hormone hyposecretion b. Insulin hyposecretion c. Antidiuretic hormone hypersecretion d. Insulin hypersecretion - CORRECT ANSWER - ADH hyposecretion 1. Visual disturbances are a result of a pituitary adenoma because of the: a. Liberation of anterior pituitary hormones into the optic chiasm b. Pituitary hormones clouding the lens of the eyes c. Pressure of the tumor on the optic chiasm d. Pressure of the tumor on the optic and oculomotor cranial nerves - CORRECT ANSWER - Pressure on the optic chiasm is the only cause for visual disturbances resulting from a pituitary adenoma. 1. Which hormone is involved in the regulation of serum calcium levels? a. Parathyroid hormone (PTH) b. Thyroxine (T4) c. Adrenocorticotropic hormone (ACTH) d. Triiodothyronine (T3) - CORRECT ANSWER - The parathyroid glands produce PTH, a regulator of serum calcium. 1. Target cells for parathyroid hormone are located in the: a. Tubules of nephrons b. Glomeruli of nephrons c. Thyroid gland 1. Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake? a. Biguanide (metformin) b. Meglitinides (glinides) c. Sulfonylureas (glyburide) d. α-Glycosidase inhibitor (miglitol) - CORRECT ANSWER - Biguanides (metformin). Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake. 1. What causes the microvascular complications in patients with diabetes mellitus? a. The capillaries contain plaques of lipids that obstruct blood flow. b. Pressure in capillaries increase as a result of the elevated glucose attracting water. c. The capillary basement membranes thicken, and cell hyperplasia develops. d. Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries. - CORRECT ANSWER - Capillary basement membranes thicken and cell hyperplasia develops. Microvascular complications are a result of capillary basement membranes thickening and endothelial cell hyperplasia. 1. Retinopathy develops in patients with diabetes mellitus because: a. Plaques of lipids develop in the retinal vessels. b. Pressure in the retinal vessels increase as a result of increased osmotic pressure. c. Ketones cause microaneurysms in the retinal vessels. d. Retinal ischemia and red blood cell aggregation occur. - CORRECT ANSWER - Retinal ischemia and RBC aggregation occur. Retinopathy appears to be a response to retinal ischemia and red blood cell aggregation. 1. Which disorder is caused by hypersecretion of the growth hormone (GH) a. Cushing syndrome b. Giantism c. Acromegaly d. Myxedema - CORRECT ANSWER - Acromegaly is a term for adults who have been exposed to continuously high levels of GH, whereas the term giantism is reserved for children and adolescents. 1. Which disorder is considered a co-morbid condition of acromegaly? a. Hypotension b. Brain cancer c. Diabetes d. Thyroid cancer - CORRECT ANSWER - Diabetes. Symptoms of type 2 diabetes mellitus, such as polyuria and polydipsia, may occur. Acromegaly-associated hypertension is usually asymptomatic until symptoms of heart failure develop. Neither thyroid nor brain cancer has been associated with acromegaly. 1. Giantism occurs only in children and adolescents because their: a. Growth hormones are still diminished. b. Epiphyseal plates have not yet closed. c. Skeletal muscles are not yet fully developed. d. Metabolic rates are higher than in adulthood. - CORRECT ANSWER - Giantism is related to the effects of growth hormones on the growth of long bones at their epiphyseal plates. This information makes the other options incorrect. 1. Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by: a. Posterior pituitary adenoma b. Prolactinoma c. Thymoma d. Growth hormone adenoma - CORRECT ANSWER - Of the options available, the hallmark of a prolactinoma is the sustained elevation of serum prolactin that is responsible for the symptoms listed. 1. The signs of thyrotoxic crisis include: a. Constipation with gastric distention b. Hyperthermia and tachycardia c. Bradycardia and bradypnea d. Constipation and lethargy - CORRECT ANSWER - The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia. 1. A person has acne, easy bruising, thin extremities, and truncal obesity. These clinical manifestations are indicative of which endocrine disorder? a. Hyperthyroidism b. Diabetes insipidus c. Hypoaldosteronism d. Cushing disease - CORRECT ANSWER - These symptoms are characteristic of Cushing disease and are caused by excessive cortisol secretion. 1. A person may experience which complications as a result of a reduction in parathyroid hormone (PTH)? (Select all that apply.) a. Muscle spasms x b. Tonic-clonic seizures x c. Laryngeal spasms x d. Hyporeflexia e. Asphyxiation x - CORRECT ANSWER - Symptoms associated with hypoparathyroidism are related to hypocalcemia. Hypocalcemia causes a lowering of the threshold for nerve and muscle excitation so that a slight stimulus anywhere along the length of a nerve or muscle fiber may initiate a nerve impulse. This creates tetany manifested as muscle spasms, hyperreflexia, tonic- clonic convulsions, laryngeal spasms, and, in severe cases, death from asphyxiation. 1. A chronic complication of diabetes mellitus is likely to result in microvascular complications in which areas? (Select all that apply.) a. Eyes x b. Coronary arteries c. Renal system x d. Peripheral vascular system e. Nerves x - CORRECT ANSWER - The areas most often affected are the retina, kidneys, and nerves. 1. Which compound or hormone is secreted by the adrenal medulla? a. Cortisol b. Androgens c. Epinephrine d. Aldosterone - CORRECT ANSWER - Epinephrine 1. The secretion of adrenocorticotropic-stimulating hormone (ACTH) will result in the increased level of which hormone? a. Thyroxine b. Cortisol c. Insulin d. Antidiuretic hormone - CORRECT ANSWER - Cortisol. Psychologic and physiologic stress (e.g., hypoxia, hypoglycemia, hyperthermia, exercise) increases ACTH secretion, leading to increased cortisol levels. Only cortisol describes the appropriate feedback loop. 1. Aldosterone directly increases the reabsorption of: a. Magnesium b. Sodium c. Calcium d. Water - CORRECT ANSWER - Sodium. In the kidney, aldosterone primarily acts on the epithelial cells of the nephron- collecting duct to increase sodium ion reabsorption. 1. Which is an expected hormonal change in an older patient? a. Thyroid-stimulating hormone secretion below normal b. Triiodothyronine level below normal c. Cortisol level below normal d. Adrenocorticotropic hormone level above normal - CORRECT ANSWER - Thyroid-stimulating hormone secretion below normal. Aging causes overall thyroid- stimulating hormone secretion to diminish but does not bring about the other changes. 1. What are actions of glucocorticoids? (Select all that apply.) a. Decreasing muscle cell reuptake of glucose b. Fat storage c. Decreased blood glucose d. Carbohydrate metabolism Liver gluconeogenesis - CORRECT ANSWER - Decreasing muscle cell reuptake of glucose, carbohydrate metabolism, and liver gluconeogenesis. The term glucocorticoid refers to those steroidal hormones that have direct effects on carbohydrate metabolism. These hormones increase blood glucose concentration by promoting gluconeogenesis in the liver and by decreasing uptake of glucose into muscle cells, adipose cells, and lymphatic cells. Glucocorticoids are not capable of fat storage. 1. What is the most abundant class of plasma protein? a. Globulin b. Clotting factors c. Albumin c. Liver hypoxia d. Renal failure - CORRECT ANSWER - Heart failure 1. Considering sideroblastic anemia, what would be the expected effect on the plasma iron levels? a. Plasma iron levels would be high. b. Levels would be low. c. Levels would be normal. d. Levels would be only minimally affected. - CORRECT ANSWER - Plasmin iron levels would be high. 1. In aplastic anemia (AA), pancytopenia develops as a result of which of the following? a. Suppression of erythropoietin to produce adequate amounts of erythrocytes b. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes c. Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes d. Lack of stem cells to form sufficient quantities of leukocytes - CORRECT ANSWER - Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes. AA is a critical condition characterized by pancytopenia, which is a reduction or absence of all three blood cell types, resulting from the failure or suppression of bone marrow to produce adequate amounts of blood cells. 1. What is the most common pathophysiologic process that triggers aplastic anemia (AA)? a. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells. b. Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells. c. Autoimmune disease against hematopoiesis by activated immunoglobulins. d. Inherited genetic disorder with recessive X-linked transmission. - CORRECT ANSWER - Answer is A. Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Tc cells appear to be the main culprits. 1. When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice? a. Erythrocytes are destroyed in the spleen. b. Heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. c. The patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT). d. The erythrocytes are coated with an immunoglobulin. - CORRECT ANSWER - Heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. Jaundice (icterus) is present when heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. This selection is the only option that accurately describes the process that affects the occurrence of hemolytic anemia-related jaundice. 1. Which statement is true regarding the physical manifestations of vitamin B12 deficiency anemia? a. Vitamin B12 deficiency anemia seldom results in neurologic symptoms. b. The chances of a cure are good with appropriate treatment. c. The condition is reversible in 75% of the cases. d. Symptoms are a result of demyelination. - CORRECT ANSWER - Symptoms are a result of demyelination. The neurologic manifestations characteristic of vitamin B12 deficiency anemia result from nerve demyelination that may produce neuronal death. These complications pose a serious threat because they are not reversible, even with appropriate treatment. 1. A 2000 ml blood loss will produce which assessment finding? (Select all that apply.) a. Air hunger b. Normal blood pressure in the supine position c. Rapid thready pulse d. Cold clammy skin e. lactic acidosis - CORRECT ANSWER - A, C, D. With a 2000 ml loss of blood, central venous pressure, cardiac output, and arterial blood pressure are below normal, even when at rest and in the supine position. The person commonly has air hunger; a rapid, thready pulse; and cold, clammy skin. With a 1500 ml loss of blood, supine blood pressure and pulse can still be normal. Lactic acidosis is observed with a blood loss of 2500 ml or more. 1. Which conditions are generally included in the symptoms of pernicious anemia (PA)? (Select all that apply.) a. Weakness b. Weight gain c. Low hemoglobin d. Paresthesias e. Low hematocrit - CORRECT ANSWER - A, C, D, E. When the hemoglobin and hematocrit levels in the blood have significantly decreased, the individual experiences the classic symptoms of PA—weakness, fatigue, paresthesias of the feet and fingers, difficulty in walking, loss of appetite, abdominal pains, and weight loss. 1. What are the clinical manifestations of folate deficiency anemia? (Select all that apply.) a. Constipation b. Flatulence c. Dysphagia d. Stomatitis e. Cheilosis - CORRECT ANSWER - B, C, D, E. Specific symptoms of folate deficiency anemia include severe cheilosis (scales and fissures of the lips and corners of the mouth), stomatitis (inflammation of the mouth), and painful ulcerations of the buccal mucosa and tongue. Gastrointestinal symptoms may be present and include dysphagia (difficulty swallowing), flatulence, and watery diarrhea. 1. Which diseases are commonly associated with anemia of chronic disease? (Select all that apply.) a. Rheumatoid arthritis b. Acquired immunodeficiency syndrome (AIDS) c. Polycythemia vera d. Systemic lupus erythematosus e. Chronic hepatitis - CORRECT ANSWER - A, B, D, E. AIDS, rheumatoid arthritis, systemic lupus erythematosus, malaria, acute and chronic hepatitis, and chronic renal failure are commonly associated with anemias of chronic disease. 1. Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails? a. Pernicious b. Aplastic c. Iron deficiency d. Hemolytic - CORRECT ANSWER - Iron deficiency. Early symptoms of iron deficiency anemia (IDA) include fatigue, weakness, and shortness of breath. Pale earlobes, palms, and conjunctivae (see Figure 28-4) are also common signs. Progressive IDA causes more severe alterations, with structural and functional changes apparent in epithelial tissue (see Figure 28-4). The nails become brittle, thin, coarsely ridged, and spoon-shaped or concave (koilonychia) as a result of impaired capillary circulation. The tongue becomes red, sore, and painful. 1. Which statement concerning erythrocytes is true? a. Erythrocytes contain a nucleus, mitochondria, and ribosomes. b. Erythrocytes synthesize proteins. c. Erythrocytes have the ability to change shape to squeeze through microcirculation. d. Erythrocyte colony-stimulating factor (E-CSF) stimulates erythrocytes. - CORRECT ANSWER - C. Reversible deformity enables the erythrocyte to assume a more compact torpedo-like shape, squeeze through the microcirculation, and return to normal. 1. Which of the following are formed elements of the blood that are not cells but are disk-shaped cytoplasmic fragments essential for blood clotting? a. Monocytes b. Macrophages c. Platelets d. Erythrocytes - CORRECT ANSWER - Platelets (thrombocytes) are not true cells but are disk-shaped cytoplasmic fragments that are essential for blood coagulation and control of bleeding. 1. What is the life span of platelets (in days)? a. 10 b. 90 c. 30 d. 120 - CORRECT ANSWER - A platelet circulates for approximately 10 days and ages. Macrophages of the mononuclear phagocyte system, mostly in the spleen, remove platelets. 1. Which blood cells are the chief phagocytes involved in the early inflammation process? a. Neutrophils b. Eosinophils c. Monocytes 1. What is the most reliable and specific test for diagnosing disseminated intravascular coagulation (DIC)? a. Prothrombin time (PT) b. Activated partial thromboplastin time (aPTT) c. Fibrin degradation products (FDP) d. D-dimer - CORRECT ANSWER - D-dimer testing measures a specific DIC-related product. 1. When the demand for mature neutrophils exceeds the supply, immature neutrophils are released indicating: a. A shift to the right b. Leukocytosis c. A shift to the left d. Leukemia - CORRECT ANSWER - A shift to the left. When the demand for circulating mature neutrophils exceeds the supply, the marrow begins to release immature neutrophils (and other leukocytes) into the blood. Premature release of the immature white cells is responsible for the phenomenon known as a shift to the left or leukemoid reaction. 1. Hodgkin disease is characterized by the presence of which of the following? a. Philadelphia chromosome b. Microvascular thrombi c. Virchow triad d. Reed-Sternberg (RS) cells - CORRECT ANSWER - Reed-Sternberg cells. Hodgkin disease is characterized by its progression from one group of lymph nodes to another, the development of systemic symptoms, and the presence of RS cells, but not the involvement of the Philadelphia chromosome. Virchow triad is a symptom related to thrombus formation. Disseminated intravascular coagulation is associated with microvascular thrombi. 1. Reed-Sternberg (RS) cells represent malignant transformation and proliferation of which of the following? a. Interleukin (IL)-1, IL-2, IL-5, and IL-6 b. Tumor necrosis factor-beta c. B cells d. T cells - CORRECT ANSWER - B cells. Although the molecular events that cause malignant transformation remain controversial, RS cells are apparently from B-cell lineage. 1. Which description is consistent with acute lymphocytic leukemia (ALL)? a. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. b. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c. B cells fail to mature into plasma cells that synthesize immunoglobulins. d. The translocation of genetic material from genes 9 and 22 create an abnormal, fused gene identified as BCR-ABL. - CORRECT ANSWER - The answer is A. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. 1. Which description is consistent with chronic myelogenous leukemia (CML)? a. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. b. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c. B cells fail to mature into plasma cells that synthesize immunoglobulins. d. The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1. - CORRECT ANSWER - The answer is D. The Philadelphia chromosome is present in more than 95% of those with CML, and the presence of the BCR-ABL1 protein is responsible for the initiation of CML. 1. Which description is consistent with chronic lymphocytic leukemia (CLL)? a. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. b. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c. B cells fail to mature into plasma cells that synthesize immunoglobulins. d. The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL. - CORRECT ANSWER - Answer is C. CLL is derived from transformation of a partially mature B cell that has not yet encountered antigen. 1. Which electrolyte imbalance accompanies multiple myeloma (MM)? a. Hyperkalemia b. Hyperphosphatemia c. Hypercalcemia d. Hypernatremia - CORRECT ANSWER - Hypercalcemia. Elevated levels of calcium in the blood (hypercalcemia) characterize the common presentation of MM. 1. Which statements are true regarding leukemias? (Select all that apply.) a. A single progenitor cell undergoes a malignant change. b. Leukemia is a result of uncontrolled cellular proliferation. c. Bone marrow becomes overcrowded. d. Leukocytes are under produced. e. Hematopoietic cell production is decreased. - CORRECT ANSWER - A, B, C, D. In the leukemias, a single progenitor cell undergoes malignant transformation. The common feature of all forms of leukemia is an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and decreased production and function of normal hematopoietic cells. 1. The two major forms of leukemia, acute and chronic, are classified by which criteria? (Select all that apply.) a. Predominant cell type b. Rate of progression c. Age of individual when cells differentiation occurs d. Stage of cell development when malignancy first occurs e. Serum level of leukocytes - CORRECT ANSWER - A & B. The current classification of leukemia is based on (1) the predominant cell of origin (either myeloid or lymphoid) and (2) the rate of progression, which usually reflects the degree at which cell differentiation was arrested when the cell became malignant (acute or chronic). 1. Which chamber of the heart endures the highest pressures? a. Right atrium b. Left ventricle c. Left atrium d. Right ventricle - CORRECT ANSWER - Pressure is greatest in the systemic circulation, driven by the left ventricle. 1. Oxygenated blood flows through which vessel? a. Superior vena cava b. Pulmonary artery c. Pulmonary veins d. Coronary veins - CORRECT ANSWER - Pulmonary veins. Only the four pulmonary veins, two from the right lung and two from the left lung, carry oxygenated blood from the lungs to the left side of the heart. 1. The significance of the atrial kick is that it affects the contraction of the: a. Right atria, which is necessary to open the tricuspid valve. b. Right atria, which is necessary to increase the blood volume from the vena cava. c. Left atria, which increases the blood volume into the ventricle. d. Left atria, that is necessary to open the mitral valve. - CORRECT ANSWER - C, Left atrial contraction, the atrial kick, provides a significant increase of blood to the left ventricle. 1. The coronary sinus empties into which cardiac structure? a. Right atrium b. Superior vena cava c. Left atrium d. Aorta - CORRECT ANSWER - Right atrium. The cardiac veins empty only into the right atrium through another ostium, the opening of a large vein called the coronary sinus. 1. During the cardiac cycle, which structure directly delivers action potential to the ventricular myocardium? a. Sinoatrial (SA) node b. Purkinje fibers c. Atrioventricular (AV) node d. Bundle branches - CORRECT ANSWER - Purkinje fibers. Each cardiac action potential travels from the SA node to the AV node to the bundle of His (AV bundle), through the bundle branches, and finally to the Purkinje fibers and the ventricular myocardium, where the impulse is stopped. The refractory period of cells that have just been polarized prevents the impulse from reversing its path. The refractory period ensures that diastole (relaxation) will occur, thereby completing the cardiac cycle. This selection is the only option that accurately describes the structure that delivers the action potential directly to the myocardium. b. Cells are unable to make the normal amount of vasodilating cytokines. c. Cells produce an increased amount of antithrombotic cytokines. d. Cells develop a hypersensitivity to homocysteine and lipids. - CORRECT ANSWER - Cells are unable to make the normal amount of vasodilating cytokines. Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines. 1. Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? a. Increased norepinephrine b. Angiotensin II c. Adducin d. Insulin resistance - CORRECT ANSWER - Angiotensin II. Of the available options, only angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension. 1. What pathologic change occurs to the kidney's glomeruli as a result of hypertension? a. Compression of the renal tubules b. Ischemia of the tubule c. Increased pressure from within the tubule d. Obstruction of the renal tubule - CORRECT ANSWER - Ischemia of the tubule. n the kidney, vasoconstriction and resultant decreased renal perfusion cause tubular ischemia and pre-glomerular arteriopathy. This selection is the only option that accurately identifies the pathologic change to the kidney that occurs as a result of hypertension. 1. What effect does atherosclerosis have on the development of an aneurysm? a. Atherosclerosis causes ischemia of the intima. b. It increases nitric oxide. c. Atherosclerosis erodes the vessel wall. d. It obstructs the vessel. - CORRECT ANSWER - Atherosclerosis erodes the vessel wall. Atherosclerosis is a common cause of aneurysms because plaque formation erodes the vessel wall. 1. What change in a vein supports the development of varicose veins? a. Increase in osmotic pressure b. Damage to the venous endothelium c. Damage to the valves in veins d. Increase in hydrostatic pressure - CORRECT ANSWER - Damage to the valves in veins. If a valve is damaged, permitting backflow, then a section of the vein is subjected to the pressure exerted by a larger volume of blood under the influence of gravity. The vein swells as it becomes engorged, and the surrounding tissue becomes edematous because increased hydrostatic pressure pushes plasma through the stretched vessel wall. 1. What term is used to identify when a cell is temporarily deprived of blood supply? a. Infarction b. Necrosis c. Ischemia d. Inflammation - CORRECT ANSWER - Ischemia. Coronary artery disease (CAD) can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause ischemia, a local state in which the cells are temporarily deprived of blood supply. 1. The risk of developing coronary artery disease is increased up to threefold by which factor? a. Diabetes mellitus b. Obesity c. Hypertension d. High alcohol consumption - CORRECT ANSWER - Hypertension. Hypertension is the only factor responsible for a twofold-to-threefold increased risk of atherosclerotic cardiovascular disease. 1. Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic lipoprotein? a. Diabetes mellitus b. Obesity c. Hypertension High alcohol consumption - CORRECT ANSWER - Diabetes mellitus. Of the available options, only diabetes mellitus is associated with CAD because of the resulting alteration of hepatic lipoprotein synthesis; it increases triglyceride levels and is involved in low-density lipoprotein oxidation. 1. Nicotine increases atherosclerosis by the release of which neurotransmitter? a. Histamine b. Angiotensin II c. Nitric oxide d. Epinephrine - CORRECT ANSWER - Epinephrine. Nicotine stimulates the release of catecholamines (e.g., epinephrine, norepinephrine), which increases the heart rate and causes peripheral vascular constriction. As a result, blood pressure increases, as do both cardiac workload and oxygen demand. 1. Which substance is manufactured by the liver and primarily contains cholesterol and protein? a. Very low-density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs) d. Triglycerides - CORRECT ANSWER - Low-density lipoproteins. A series of chemical reactions in the liver results in the production of several lipoproteins that vary in density and function. These include VLDLs, primarily triglycerides and protein; LDLs, mostly cholesterol and protein; and HDLs, mainly phospholipids and protein. LDLs are the only lipoproteins that are manufactured by the liver and primarily contain cholesterol and protein. 1. Which elevated value may be protective of the development of atherosclerosis? a. Very low-density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDL) Triglycerides - CORRECT ANSWER - High-density lipoproteins. Low levels of HDL cholesterol are also a strong indicator of coronary risk, whereas high levels of HDLs may be more protective for the development of atherosclerosis than low levels of LDLs. 1. Which laboratory test is an indirect measure of atherosclerotic plaque? a. Homocysteine b. Low-density lipoprotein (LDL) c. Erythrocyte sedimentation rate (ESR) d. C-reactive protein (CRP) - CORRECT ANSWER - C-reactive protein. Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and, of the available options, is an indirect measure of atherosclerotic plaque-related inflammation. 1. An individual who is demonstrating elevated levels of troponin, creatine kinase- isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators associated with which condition? a. Myocardial ischemia b. Myocardial infarction (MI) c. Hypertension d. Coronary artery disease (CAD) - CORRECT ANSWER - MI. Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. Other biomarkers released by myocardial cells include CK-MB and LDH. 1. How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)? a. By increasing the peripheral vasoconstriction b. By causing dysrhythmias as a result of hyperkalemia c. By reducing the contractility of the myocardium d. By stimulating the sympathetic nervous system - CORRECT ANSWER - By increasing the peripheral vasoconstriction. Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways. First, it results in the systemic effects of peripheral vasoconstriction and fluid retention. These homeostatic responses are counterproductive in that they increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II is also locally released, where it is a growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts; promotes catecholamine release; and causes coronary artery spasm 1. The pulsus paradoxus that occurs as a result of pericardial effusion is caused by a dysfunction in which mechanism? a. Diastolic filling pressures of the right ventricle and reduction of blood volume in both ventricles b. Blood ejected from the right atrium and reduction of blood volume in the right ventricle c. Blood ejected from the left atrium and reduction of blood volume in the left ventricle d. Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers. - CORRECT ANSWER - D. Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration