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2024 NR507 MIDTERM CHAMBERLAIN VERIFIED
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Type 3 hypersensitivity reaction - CORRECT ANSWER antigen-antibody response
Where does the antibody bind to the antigen in type 3 response? - CORRECT ANSWER in blood or body fluids and then circulates to tissue
Where does the antibody bind to the antigen in type 1, 2, and 4? - CORRECT ANSWER on cell surface
Primary effector cell in type 3 - CORRECT ANSWER neutrophils
example of type 3 reaction - CORRECT ANSWER serum sickness
type 4 hypersensitivity reaction - CORRECT ANSWER cell-mediated response
primary mediators of type 4 - CORRECT ANSWER lymphocytes and macrophages
type 4 mediated by - CORRECT ANSWER T lymphocytes and do not use antibodies
example of type 4 - CORRECT ANSWER localized contact dermatitis (poison ivy)
Damage occurs with ABO incompatibility because: - CORRECT ANSWER Complement damages RBC membrane causing cell lysis.
Which of the following is the underlying pathology for hay fever? - CORRECT ANSWER mast cell degranulation
The diagnosis for an individual who presents to the office with sudden swollen lips and eyes, shortness of breath and throat tightness after a bee sting is: - CORRECT ANSWER anaphylaxis
Which of the following assessment findings would be expected in a patient who presents with urticaria? - CORRECT ANSWER Eosinophilia.
An example of a primary immunodeficiency is: - CORRECT ANSWER Chronic Granulomatous Disease.
what is a predominant cause of secondary immune deficiencies worldwide. - CORRECT ANSWER Malnutrition
Which of the following is an autoimmune disease? - CORRECT ANSWER Systemic Lupus Erythematosus (SLE).
Which is true about a primary immunodeficiency? - CORRECT ANSWER It is the result of a single gene defect. (genetics)
Examples of secondary immunodeficiency - CORRECT ANSWER HIV, cancer
Secondary immunodeficiency caused by - CORRECT ANSWER external to immune system
examples of primary immunodeficiency - CORRECT ANSWER Chronic granulomatous Disease of Childhood
DiGeorge Syndrome
Familial Mediterranean fever
Job Syndrome
Common Variable Immunodeficiency
Primary effector cells of type 2 - CORRECT ANSWER macrophages
Examples of type 2 reactions - CORRECT ANSWER drug allergies, hemolytic anemia, blood transfusion mismatch, allergies against infectious agents
Type 2 causes - CORRECT ANSWER The cell to be destroyed by the antibody
Cell destruction through phagocytosis by macrophages
Damage to the cell by neutrophils triggering phagocytosis
Natural killer cells to release toxic substances that destroy the target cell
Malfunction of the cell without destruction
Cancer is a secondary immunodeficiency. - CORRECT ANSWER true
Sinusitis is considered a primary immunodeficiency. - CORRECT ANSWER false
A patient with human immunodeficiency virus (HIV) was admitted to the acute care facility with difficulty breathing. He is diagnosed with Pneumocytis carinii. Pneumocystis carinii an example of: - CORRECT ANSWER secondary immune disease
Which of the following findings can be used to diagnose Systemic Lupus Erythematosus (SLE)?
- CORRECT ANSWER Facial rash confined to the cheeks.
A renal disease most often associated with autoimmunity is - CORRECT ANSWER Glomerulonephritis.
The major immune system change associated with Sjogren's Syndrome is: - CORRECT ANSWER Autoantibodies and auto-reactive T-cells against apoptotic cells.
Which of the following can depress a person's normal immune function? - CORRECT ANSWER Psychological Stress
Which of the following assessment findings would support a diagnosis of Rheumatoid Arthritis (RA)? - CORRECT ANSWER Swollen metacarpophalangeal joints.
Which of the following statements best describes the symptoms of Systemic Lupus Erythematosus (SLE). - CORRECT ANSWER Tissue inflammation, vasculitis, rash, tissue inflammation.
The presence of a low number of autoantibodies is an indicator that the individual will develop an autoimmune disease. - CORRECT ANSWER false *does not indicate
The following immune components can be involved in autoimmune diseases: T-Cells, B-cells and autoantibodies. - CORRECT ANSWER true
Which of the following microcytic anemias is characterized by hyperchromic RBCs? - CORRECT ANSWER Hereditary spherocytosis.
Which of the following is NOT a clinical characteristic of anemia? - CORRECT ANSWER bradycardia
Which of the following is considered a microcytic anemia? - CORRECT ANSWER Iron deficiency.
Which of the following indices measures the average size of red blood cells? - CORRECT ANSWER Mean Corpuscular Volume (MCV).
What is anemia? - CORRECT ANSWER reduction in the total number of circulating red blood cells (RBCs) and/or a decrease in hemoglobin (Hb) amount or function
Anemia can be caused by - CORRECT ANSWER 1) impaired RBC production, 2) excessive blood loss, 3) increased RBC destruction OR any combination of the three.
Clinical manifestations of anemia - CORRECT ANSWER Severe fatigue
Pallor
Weakness
Dyspnea
Dizziness
The terms normocytic, microcytic, and macrocytic characterizes red blood cells by their - CORRECT ANSWER size
Which of the following is a type of macrocytic anemia? - CORRECT ANSWER Vitamin B- deficiency.
Identification of the type of anemia involves an examination of size of the RBC only. - CORRECT ANSWER false
Which of the following would normocytic-normochromic indicate? - CORRECT ANSWER The cell is normal in size and normal in hemoglobin level
Which of the following anemias can be categorized as microcytic-hypochromic? - CORRECT ANSWER Sideroblastic anemia.
Iron deficiency anemia.
Anemia of inflammation and chronic disease.
Which of the following conditions could result in iron deficiency anemia? - CORRECT ANSWER excessive bleeding
The most common type of anemia is - CORRECT ANSWER iron deficiency anemia
The treatment of iron deficiency anemia includes: - CORRECT ANSWER iron supplementation
examples of microcytic hypochromic anemia - CORRECT ANSWER iron deficiency
sideroblastic
thalassemia
examples of microcytic normochromic - CORRECT ANSWER anemia of inflammation and chronic disease
examples of microcytic hyperchromic - CORRECT ANSWER hereditary spherocytosis
Causes of iron deficiency anemia - CORRECT ANSWER nadequate dietary intake.
Chronic and or occult bleeding: hemorrhage, colitis, cirrhosis, GI ulcers, esophageal lesions, or menorrhagia; note that it only takes 2-4 mL (about 1 tsp) of blood loss per day to lose 1-2 mg of iron).
Decreased ability to utilize Fe for heme synthesis (e.g. transferrin deficiencies and mitochondrial defects). These are a less common cause of IDA.
When iron stores are depleted, the cell's mitochondria are still able to utilize iron effectively due to compensatory mechanisms. - CORRECT ANSWER false
Which of the following are iron rich foods - CORRECT ANSWER Spinach.
Lima beans.
Meat.
Although less common, transferrin deficiencies and mitochondrial defects can lead to iron deficiency anemia. - CORRECT ANSWER true
A transferrin deficiency will most likely result in: - CORRECT ANSWER iron-deficiency anemia
Folic acid is essential to the body because it: - CORRECT ANSWER Plays a major role in the maturing of RBCs.
Which of the following lab values will be low in a patient with folate deficiency? - CORRECT ANSWER Reticulocyte count.
In a patient with pernicious anemia, what lab values can be normal or low? - CORRECT ANSWER folate
The blank lab values will be normal in a patient with pernicious anemia - CORRECT ANSWER MCHC
Which of the following lab values are normal for the patient with folate deficiency? - CORRECT ANSWER ferritin
Which of the following is a cause of hemolytic anemia? - CORRECT ANSWER Drugs.
Infection.
Transfusion reaction.
autoimmune reactions
hemolytic disease of the newborn
Acute blood loss of anemia is usually associated with acute GI bleeding and labor and delivery complications. - CORRECT ANSWER true
Aplastic anemia can be caused by: - CORRECT ANSWER Antibiotics
congenital defects
chemical or radiation exposure
viral induced
tumors
In hemolytic anemia, the destruction of lysis of RBCs is due to: - CORRECT ANSWER Enzymes or toxins produced by an infectious agent.
Chemical release medication by one's immune system.
Effects of drugs.
chronic blood loss is commonly associated with chronic GI bleeding - CORRECT ANSWER true
The MCHC will be normal in which of the following anemias? - CORRECT ANSWER Aplastic anemia
Post-hemorrhagic anemia
Hemolytic anemia
the blank lab value will be normal in post-hemorrhagic anemia - CORRECT ANSWER MCHC
the blank lab values are low in aplastic anemia. - CORRECT ANSWER reticulocyte count
the blank lab values are normal for hemolytic anemia. - CORRECT ANSWER MCV
The patient with sickle cell anemia is at high risk for stroke. - CORRECT ANSWER true
Which of the following statements are correct regarding thalassemia? - CORRECT ANSWER May have many possible genetic mutations.
Cells that contain abnormal types of hemoglobin are more susceptible to infection by the parasite that causes malaria - CORRECT ANSWER false *RESISTANT
There are four genes involved in encoding synthesis of the alpha protein chains for Hb and are located on chromosome number 16. - CORRECT ANSWER true
The pathophysiology of sickle cell anemia involves a single amino-acid change on the beta- chain. - CORRECT ANSWER true
Which electrolytes play a major role in muscle contraction - CORRECT ANSWER sodium, potassium, calcium
Which of the following is a non-modifiable risk factor for Coronary Artery Disease? - CORRECT ANSWER family history
Which of the following statements correctly describes the flow of blood between the heart and lungs: - CORRECT ANSWER Oxygenated blood is transported from the lungs to the heart via the pulmonary veins.
Coronary artery disease (CAD) is mainly the result of: - CORRECT ANSWER Longstanding atherosclerosis.
In Coronary Artery Disease (CAD), pumping ability of the heart can be impaired due to the deprivation of oxygen. - CORRECT ANSWER true
Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)? - CORRECT ANSWER obesity
Modifiable risk factors for CAD - CORRECT ANSWER dyslipidemia, DM, obesity, smoking, hypertension, sedentary lifestyle
Non-modifiable risk factors for CAD - CORRECT ANSWER age, male, family history, menopause
Cor Pulmonale is: - CORRECT ANSWER Right ventricular failure secondary to pulmonary hypertension.
Which of the following conditions can decrease preload? - CORRECT ANSWER Hemorrhage.
the most common cause of right-sided heart failure is: - CORRECT ANSWER pulmonary hypertension
Hypertension has its most immediate effect on: - CORRECT ANSWER Afterload
In the healthy heart, the response to an increase in preload is for the stroke volume to - CORRECT ANSWER increase
Right sided heart failure - CORRECT ANSWER JVD
peripheral edema
hepatosplenomegaly
cor pulmonale
tricuspid valve damage
left sided heart failure - CORRECT ANSWER increased left ventricle afterload
decreased ejection fraction
increased left ventricular preload
pulmonary edema
dyspnea
The patient with aortic stenosis would most likely present with: - CORRECT ANSWER Mid- systolic crescendo-decrescendo murmur.
A patient with mitral regurgitation would most likely present with - CORRECT ANSWER a blowing, holosystolic murmur
The patient with aortic regurgitation would most likely present with: - CORRECT ANSWER An early, high-pitched diastolic murmur heard at the left lower sternal border
A diastolic rumbling murmur heart at the apex of the heart
A systolic crescendo-decrescendo murmur heart at the left upper sternal border
A 40-year old male reports to the primary care office with a chief complaint of dyspnea, especially with activity, over the last 5 days. He also notices that several times during the last two days that he could feel his heart "pounding and racing". On collecting the medical history, the patient indicates that he had rheumatic heart disease as a young child but remembers little about it. On exam, the NP determines that he is tachycardic with a heart rate of 120 beats/minute that is irregularly irregular. A low-pitched murmur is also auscultated and is heard most prominently at the apex. The NP also notes jugular vein distention (JVD) and bilateral crackles in the lung bases. The NP performs an ECG in the office that reveals atrial fibrillation and left atrial hypertrophy. - CORRECT ANSWER mitral stenosis
The NP notes that a patient's FEV1/FVC ratio is severely reduced. Which of the following conditions is most likely the patient's pulmonary issue? - CORRECT ANSWER chronic asthma
The NP reviews the results of a patient's pulmonary function tests and notes that the FEV1, FVC, and total lung capacity (TLC) are reduced. The FEV1/FVC ratio is normal. Based on interpretation, this reflects: - CORRECT ANSWER restrictive lung disease
Simple spirometry can be used to measure any of the following EXCEPT: - CORRECT ANSWER residual volume
Simple spirometry can be used to measure: - CORRECT ANSWER tidal volume, vital capacity, inspiratory reserve volume
A patient with normal lungs should be able to exhale blank of the forced vital capacity within the first second. - CORRECT ANSWER 80%
The NP is seeing a patient with chronic bronchitis that needs spirometry on today's visit. What pulmonary function test (PFT) findings are anticipated based on the diagnosis of chronic bronchitis? - CORRECT ANSWER Decreased forced expiratory flow (FEV1).
Chronic bronchitis will decrease which of the following parameters? - CORRECT ANSWER decreased forced expiratory flow (FEV1)
Which of the following spirometry results indicate restrictive lung disease? - CORRECT ANSWER FEV1, FVC, and total lung capacity reduced; FEV1/FVC ratio normal.
The NP notes that a patient's FEV1/FVC ratio is normal. Which of the following conditions is most likely the patient's pulmonary issue? - CORRECT ANSWER pulmonary fibrosis
Simple spirometry includes a measure of residual capacity - CORRECT ANSWER false
Which of the following would indicate obstructive lung disease? - CORRECT ANSWER chronic asthma
Which of the following pulmonary function test results are expected in a patient with chronic bronchitis? - CORRECT ANSWER Decreased FEV1/FVC ratio.
The number one cause of chronic bronchitis is - CORRECT ANSWER cigarette smoking
A patient with chronic bronchitis is most likely to experience: - CORRECT ANSWER Respiratory acidosis due to inability to exhale CO2.
The effects of an Alpha-antitrypsin 1 deficiency is: - CORRECT ANSWER inability to block the effects of proteolysis
Which of the following is considered a late effect of emphysema? - CORRECT ANSWER Hypoxemia and Hypercapnia.
Hyperresonance found on lung percussion with a patient with COPD is primarily due to - CORRECT ANSWER air trapping
A lung volume measurement that indicates air trapping in a COPD patient is: - CORRECT ANSWER increased residual volume
Which of the following pulmonary function test results are consistent with asthma? - CORRECT ANSWER decreased peak expiratory flow rate
Interstitial lung disease (ILD) includes infectious and neoplastic lung diseases. - CORRECT ANSWER false
A subjective finding in interstitial lung disease is rhonchi in the upper posterior airways. - CORRECT ANSWER false (fine crackles)
Choose the types of interstitial lung diseases (ILD) that are commonly associated with smoking:
- CORRECT ANSWER Desquamative interstitial pneumonia
Pulmonary langerhans cell histiocytosis
respiratory bronchiolitis interstitial lung disease
Interstitial lung disease refers to any disease affecting the pulmonary interstitium and typically excludes infectious and neoplastic diseases - CORRECT ANSWER true
Choose the drugs that are commonly associated with development of a medication-induced interstitial lung disease (ILD): - CORRECT ANSWER Amiodarone (drugs for heart conditions)
methotrexate (immunosuppressant drugs)
nitrofurantoin (antibiotics)
-not lisinopril, warfarin, omeprazole
The symptoms that are common to all types of interstitial lung disease are shortness of breath and non-productive cough. - CORRECT ANSWER true
The characteristic finding of on a chest x-ray of an individual with ILD is a honey-comb pattern - CORRECT ANSWER true
An objective finding in a patient with ILD include productive cough. - CORRECT ANSWER false- subjective
Choose the interstitial lung diseases that are the most diagnosed: - CORRECT ANSWER 1. radiation pnemonitis
- pneumonconioses
- hypersensitivity -pneumonitis
The four key diagnostic tests for interstitial lung disease are pulmonary function tests, high resolution CT scan, bronchoalveolar lavage and lung biopsy. - CORRECT ANSWER true
PFT's - CORRECT ANSWER non-invasive test that provides information about lung function
When to order PFT's - CORRECT ANSWER When signs and symptoms of a respiratory problem requires evaluation (cough, dyspnea, cyanosis, wheezing, hypoxemia, hypercapnia and lung hyperinflation).
When disease progression needs to be determined.
When monitoring the effectiveness of drug therapy.
When monitoring for potential toxic effects of certain drugs.
Forced vital capacity (FVC) - CORRECT ANSWER measures volume of air in the lungs that can be exhaled
normal: 80-120%
Pt inhales as deep possible and then exhales as long and as forcefully as possible
amount of air patient can inspire and expire
Forced expiratory volume in one second (FEV1) - CORRECT ANSWER Normal: 80-120%
Amount of air forcefully exhaled from the lungs in the first second
The patient inhales and forcefully exhales as fast as possible
