COMSAE 2 Questions With Complete Solutions, Exams of Nursing

Download COMSAE 2 Questions With Complete Solutions and more Exams Nursing in PDF only on Docsity! COMSAE 2 Questions With Complete Solutions 3 drugs known to improve Survival in CHF Correct Answers Are ACE inhibitors, spironolactone, and metoprolol. For those with prior CHF with a reduced left ventricular ejection fraction, beta blocker therapy is implicated (carvedilol, metoprolol, or bisoprolol). 5% Sheep Blood added to? Correct Answers Blood agar usually contains 5% sheep blood and is used to determine hemolysis patterns of Streptococcus Abduction of fingers Correct Answers Is accomplished by the dorsal interosseous muscles of the hand. These muscles are innervated by the deep branch of the ulnar nerve, which arises from the medial cord of the brachial plexus Acetazolamide Correct Answers A carbonic anhydrase inhibitor that is useful as a diuretic and for glaucoma. It prevents the reabsorption of bicarbonate, causing excessive loss of bicarbonate and sodium at the proximal tubules. Because of this, there is a compensatory increase in sodium reabsorption in the distal tubule. Chloride follows sodium as a pair in the distal tubule reabsorption, causing hyperchloremia. Therefore a hyperchloremic metabolic acidosis results. The elevated chloride results in a normal anion gap. ACL Injury Correct Answers The ACL is likely injured and often occurs in athletes after a twisting or hyperextension injury. It is common for the patient to report hearing a "pop." The ACL is important in restricting anterior translation of the tibia on the femur. The ACL originates on the posterior aspect of the lateral femoral condyle and inserts on the anterior and medial aspect of the tibial plateau. The examination maneuver described above is a positive anterior drawer test or Lachman test. These tests are considered positive when the tibia translates forward on the femur to a greater degree in the injured knee than the normal knee. An ACL tear can be confirmed by MRI. Adduction of the thumb Correct Answers Is accomplished by the adductor pollicis muscle of the hand. This muscle is innervated by the deep branch of the ulnar nerve, which arises from the medial cord of the brachial plexus. Alkpatonuria Correct Answers An AR disorder that results from deficient activity of the enzyme homogentisic oxidase. It results in elevated levels of homogentisic acid which forms a pigment that is deposited in connective tissue and joints throughout the body. It typically presents in the 3rd decade of life, with initial pigmentation occurring in the ear cartilage and sclera of the eyes. A dark pigment is also deposited in the large joints and the lumbosacral spine. This leads to early onset arthritis and can result in joint replacements at a younger age. The disorder is characterized by urine that is of a normal color initially, but turns a dark black color if left standing due to oxidation of the homogentisic acid. The diagnosis is confirmed by measurement of homogentisic acid in the urine. No effective therapy is available for alkaptonuria. Alpha-1-antitrypsin deficiency Correct Answers A codominant inherited disorder that results in early onset panacinar Iron tablets or Isoniazid Lactic acidosis Ethylene glycol Salicylates. CD14 Correct Answers macrophages CD3 Correct Answers Present on all T cells CD5 Correct Answers T cells and a small subset of B cells Celiac Disease Correct Answers Most often presents between the ages of 10 and 40. It is a gluten-sensitive enteropathy caused by proteins in wheat, barley, and rye. It is associated with a number of autoimmune disorders, including type 1 diabetes mellitus and Hashimoto's thyroiditis. Anti-endomysium IgA- antibodies and anti-tissue transglutaminase are highly sensitive and specific for diagnosis. The classic description of celiac disease includes the symptoms of malabsorption such as steatorrhea, weight loss, and fat-soluble vitamin deficiency. There is a characteristic presence of histologic changes of villous atrophy on small intestinal biopsy. The appropriate treatment is a gluten-free diet for life, and this results in complete resolution of symptoms for most individuals. Choriocarcinoma Correct Answers A malignancy of trophoblastic tissue. These tumors produce hCG, which can manifest as precocious puberty in young girls. Of most concern, choriocarcinoma can spread hematogenously to distant organs, especially to the lungs. Chronic Kidney Disease Correct Answers Diabetes is the most common cause of kidney failure in the United States and affects the kidneys via non-enzymatic glycosylation of the glomerular basement membrane, which produces hyaline arteriolosclerosis of the efferent arterioles causing increased filtration and damage to the endothelial cells ultimately increasing vessel and tubular cell permeability. Hypertension also increases resistance and damages microvessels, which increase permeability to proteins. Patients usually present with signs of microalbuminuria, proteinuria, and polyuria. They can also complain of bone pain due to enhanced osteoclastic activity in the bone. They eventually develop the inability for 1 alpha-hydroxylase that is located in the kidney proximal tubules to convert inactive vitamin D to active vitamin D (calcitriol). This leads to decreased absorption of both calcium as well as phosphorus. Patients will have an increased parathyroid hormone (PTH) level due to the hypocalcemia and hyperphosphatemia. Patients with chronic kidney disease also develop the inability to excrete phosphate through the urine so blood tests will reveal an elevated serum PTH, decreased serum calcium, but increased serum phosphate level. CN IX (Glossopharyngeal N) Correct Answers The gag reflex involves CN IX & X and helps prevent choking. CN IV carries general sensory innervations as well as taste sensation from the posterior 1/3 of the tongue. It also innervates the carotid bodies, carotid sinuses, and the parotid gland. Its only motor output is to the stylopharyngeus muscle. The efferent limb of the reflex is the vagus nerve,which innervates the pharyngeal constrictor muscles as well as some of the palate muscles. Absence of gag reflex could represent damage to the glossopharyngeal nerve, the vagus nerve, or brain death. Complete Molar Mole Correct Answers Vaginal bleeding is a common presentation in those with a hydatidiform mole. Additionally, this patient's uterus is larger than expected according to the dates, no fetal heart tones are audible, and her β-hCG levels are markedly elevated. Complete moles are often associated with hCG levels > 100,000 mIU/mL (normal nonpregnant <5 mlU/mL and peak normal pregnancy level typically <100,000 mlU/mL). Women with a complete hydatidiform moles usually measure larger than dates, whereas women with partial hydatidiform moles measure smaller than dates. The ultrasound findings of a complete molar pregnancy include the absence of an embryo or fetus and no amniotic fluid. A central heterogeneous mass with numerous discrete anechoic spaces is usually present (snowstorm pattern) Corneal Reflex Correct Answers It tests CNs V and VII. The afferent limb of this reflex is carried by the trigeminal nerve, which is responsible for sensation to the face, specifically the ophthalmic branch V1 for the cornea. The efferent limb of the reflex is from CN VII. The facial nerve innervates the muscles of facial expression and is responsible for closure of the eye in this reflex. The facial nerve exits the skull through the stylomastoid foramen, located between the styloid and mastoid processes. Curved rod that grows at 42 degrees celsius Correct Answers Campylobacter jejuni metabolism of neurotransmitters (GABA, serotonin, and glutamate), and buffering potassium concentration. Gardner Syndrome Mneumonic Correct Answers Gaucher Disease Correct Answers An AR lysosomal storage disease that is due to a deficiency in glucocerebrosidase. It leads to an accumulation of glucocerebroside within the lysosomes of cells. It is most prevalent in individuals of Ashkenazi Jewish descent. It can present with diffuse bone pain and avascular necrosis of the femoral heads. Hepatosplenomegaly, anemia, and thrombocytopenia also occur. Histological examination will show the presence of Gaucher cells, which are lipid-laden macrophages that have the appearance of wrinkled tissue paper. Glioblastoma multiforme histology Correct Answers Histology shows central areas of necrosis with "pseudopalisading" pleomorphic tumor cells. Graves Dz is what type of Hypersensitivity? Correct Answers Type 2 HS Heparin Correct Answers Has been documented to decrease and/or inhibit aldosterone levels. This drug potentiates the effect of anti-thrombin III, thereby inhibiting thrombin and Factor Xa working as an anti-coagulant. The patient is most likely suffering from the effects of aldosterone inhibition due to heparin administration HLA-DR2 Correct Answers Multiple sclerosis, hay fever, SLE, Goodpasture's Huntingtons dz is on chromosome? Correct Answers 4 Idioptahic Thrombocytopenia (ITP) Correct Answers The only abnormal finding is a low platelet count with increased bleeding time. It is due to anti-GpIIb/IIIa antibodies, which destroy peripheral platelets. These pts will NOT have anemia, acute kidney injury, or neurological manifestations Inclusion Body Myositis Correct Answers Characterized by inflammation and endomysial infiltrates of CD8+ T cells and macrophages that focally surround and invade myofibrils. The presence of rimmed vacuoles is a characteristic feature. It is more common in males over the age of 50-years-old. It manifests as an insidious onset of proximal muscle weakness, often with associated distal muscle weakness. The distribution of weakness is variable, but unlike polymyositis and dermatomyositis, asymmetry is common. Early involvement of the knee extensors, ankle dorsiflexors, and wrist and finger flexors is characteristic. Weakness of the wrist and finger flexors is often greater than their extensor counterparts. Hence, loss of finger dexterity and grip strength may be a prominent symptom. It also commonly causes greater weakness in knee extension when compared with the hip flexors. Deep tendon reflexes may be impaired or absent if weakness is severe. Laboratory results reveal a normal to slightly elevated level of serum creatine kinase. Muscle biopsy is the gold standard for diagnosis. Insertions of the Scalene mm Correct Answers Iodine 123 Uptake Correct Answers Grave's disease causes increased serum T4, increased free T4, decreased serum TSH (because of negative feedback), and increased I-123 uptake (this is because the thyroid is working vigorously to make new T4, which requires iodine). In contrast, a patient taking excessive thyroid hormones will have a low I-123 uptake because the thyroid is not overactive (as in Grave's disease). Irreversible vs Competitive inhibition Correct Answers Irreversible inhibition decreases Vmax, while competitive inhibition increases Km. Isolated Tricuspid Stenosis MC from? Correct Answers The most common causes are due to carcinoid heart disease and right atrial myxoma. Klumpke's palsy Correct Answers Lower trunk injury involving the nerve roots C8-T1. It may be caused during a difficult breech delivery, by a cervical rib, or by abnormal insertion or spasm of the anterior and middle scalene muscles, which causes elevation of the first or second ribs. The injury causes a claw hand due to the involvement of the C8-T1 nerve roots, which innervate the ulnar nerve. These motor deficits include loss of adduction of the thumb, loss of abduction and adduction of metacarpophalangeal joints, loss of flexion at the metacarpophalangeal and extension of the interphalangeal joints, and weak flexion of proximal interphalangeal joints and distal interphalangeal joints. Krabbe Disease Correct Answers An AR lysosomal storage disease that is due to a deficiency in β-galactocerebrosidase. It Medulloblastoma histology Correct Answers Homer-wright rosettes. Metachromatic Leukodystrophy Correct Answers An AR lysosomal storage disease that causes progressive demyelination of the central and peripheral nervous system. It is due to a deficiency in Arylsulfatase A. Common manifestations include regression of motor skills, gait abnormalities, ataxia, hypotonia, upper motor neuron signs, and peripheral neuropathy. The diagnosis is established by demonstrating deficient arylsulfatase A activity in leukocytes or elevated sulfatides Microglia Correct Answers Phagocytes found in the central nervous system that respond to tissue damage. They arise embryologically from monocytes. These cells enter the nervous system by the third week of development with the blood vessels. Natalizumab Correct Answers A monoclonal antibody that binds to integrin molecules involved in adhesion and migration of leukocytes into inflamed tissues. This drug has utility in inflammatory-mediated diseases such as Crohn's disease and multiple sclerosis. Patients taking this should be tested for the JC-virus prior to and during treatment as it can increase their risk of developing progressive multifocal leukoencephalopathy. Neurofibromatosis type 1 is on chromosome? Correct Answers 17 Nystatin is added to help culture which organism? Correct Answers Nystatin is a part of the VPN or Thayer-Martin agar designed to grow Neisseria gonorrhoeae. Polymyalgia Rheumatica Correct Answers A disease of the elderly that causes proximal myalgias of the hip and shoulder girdles. The symptoms appear first in the shoulder girdle, and patients commonly complain of stiffness after prolonged inactivity. The shoulder and hip girdles can be painful and stiff, causing difficulty in rising from a chair or raising their arms over their shoulder. Patients also have morning stiffness that typically lasts for more than one hour. There is no muscle weakness, as compared to dermatomyositis and polymyositis. It is commonly associated with giant cell arteritis. Laboratory studies reveal an erythrocyte sedimentation rate (ESR) > 40 mm/h. Treatment is with prednisone. Pronation of the forearm Correct Answers Is accomplished by the pronator teres and pronator quadratus muscles. The pronator teres is innervated by the median nerve, and the pronator quadratus is innervated by the anterior interosseus branch of the median nerve. The median nerve arises from both the lateral and medial cords. Pseudohypoparathyroidism (Albrights Hereditary Osteodystrophy) Correct Answers An AD condition involving the kidney's unresponsiveness to parathyroid hormone. Decreased serum levels of calcium, increased serum phosphate, and appropriately elevated PTH levels are seen on blood tests. Individuals with this condition usually have short stature, characteristically shortened fourth and fifth metacarpals, rounded facies, and, often, mild mental retardation. Pupillary Light Reflex Correct Answers It tests cranial nerves II and III. The afferent limb of this reflex is mediated by Optic N CN II. CN III, the oculomotor nerve, is responsible for pupillary constriction (Efferent limb) as it innervates the pupillary sphincter muscle. The optic nerve reaches the brainstem and connects bilaterally with the Edinger-Westphal nucleus, which controls parasympathetic output to the eye. These parasympathetic nerve fibers run along the oculomotor nerve and eventually synapse on the muscles of the iris. Parasympathetic stimulation will cause pupillary constriction. The oculomotor nerve innervates the levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles. Quick Facts About Sarcoidosis Correct Answers Elevated ACE levels is a marker. Bilateral hilar adenopathy, interstitial fibrosis, hypercalcemia, Bell's palsy, and erythema nodosum are the common associations. Raxibacumab Correct Answers A monoclonal antibody that binds and neutralizes the Bacillus anthracis toxin by binding to the free protective antigen component. It can be used as an adjunctive treatment with antibiotics (doxycycline or ciprofloxacin) in cases of inhalational anthrax. It is also used as a second-line treatment for prophylaxis of inhalational anthrax in patients at high risk of exposure. cause a global decrease in the hormones that are produced in the anterior pituitary. The production of ADH and oxytocin is not affected because both hormones are produced in the hypothalamus, and stored in the posterior pituitary gland. Some AD diseases Correct Answers Tuberous Sclerosis achondroplasia Huntington disease Marfan syndrome neurofibromatosis. Some AR diseases Correct Answers cystic fibrosis sickle cell anemia hemochromatosis glycogen storage diseases thalassemias albinism infantile polycystic kidney disease (ARPKD) Steady State Concentration Correct Answers It is an equilibrium that is achieved after a constant rate of infusion. It takes 4-5 half-lives for a drug to reach its steady state concentration, which is approximately 95%. Given the clearance (CL) and the volume of distribution (Vd) of the drug, its half-life can be calculated using the equation: t½= (0.693 x Vd)/CL Using this equation, you find that the t½ of the drug in question is 0.7 x 6.5/2 = 2.275 hours (2.25 when using 0.693 instead of 0.7). Since the steady state is reached after approximately 4 to 5 half-lives, the steady state concentration of this drug should be reached in 9-12 hours. Struma ovari Correct Answers A specialized or monodermal teratoma predominantly composed of mature thyroid tissue. The most common presentation is pelvic pain. Other findings include abdominal pain and symptoms of hyperthyroidism. Histologically, it can be microfollicular, macrofollicular, or oxyphil adenoma with or without papillary hyperplasia. Macrofollicular subtype contains large colloid-filled thyroid follicles. It can be benign or malignant. Superficial Inguinal Nodes Correct Answers Directly drain cutaneous structures inferior to the umbilicus, excluding the external genitalia and anus Sympathetic Vicerosomatics Correct Answers Tacrolimus Correct Answers Tacrolimus ointment is an immunosuppressive agent indicated for atopic dermatitis. The mechanism of action is unknown, but it has been documented to inhibit T-cell activation. Intravenous and intramuscular tacrolimus is often used in transplant operations to prevent rejection of organs Tamoxifen Correct Answers A selective estrogen receptor modulator. It works as a competitive estrogen antagonist in breast tissue and is used to treat estrogen receptor-positive breast cancer. It acts as a partial agonist on the endometrium, resulting in an increased risk of endometrial hyperplasia, polyps, and cancer. Taste sensation to anterior tongue provided by? Correct Answers Facial N The gynecomastia and spider telangiectasia of chronic liver failure are due to? Correct Answers Excess Estrogen The palatoglossus m Correct Answers Is the only muscle of the tongue NOT innervated by the hypoglossal nerve. It is innervated by the vagus nerve. The Stapedius m Correct Answers Located in the middle ear, and is much smaller than the tensor tympani. It is innervated by the facial nerve. Thrombotic Thrombocytopenic Purpura (TTP) Correct Answers A blood disorder characterized by clotting in small blood vessels of the body, resulting in a low platelet count. In severe cases, the disease consists of a pentad of microangiopathic hemolytic anemia, thrombocytopenic purpura, neurologic abnormalities, fever, and renal disease. These pts have unusually large multimers of von Willebrand factor (vWF) in their plasma. They lack a plasma protease that is responsible for the breakdown of these ultra-large vWF multimers. This protease has been isolated and cloned and is designated ADAMTS13. Mostly seen in adults. The classic pentad for TTP is Fever, Anemia, Thrombocytopenia, Renal failure, and Neurological symptoms (mnemonic: FAT RN) result, there is an accumulation of carbon dioxide in the body. Which leads to a respiratory alkolosis which is then followed by a Metabolic acidosis to recompensate (Mixed) What is the most common organism to cause parotitis? Correct Answers The most common organism involved in acute bacterial parotitis is Staphylococcus aureus. Anaerobic bacteria are less frequent causes of parotitis. What nerve innervated the pronator teres? Correct Answers Median N Which hormonal Change can be used to help confirm menopause? Correct Answers Menopause is the result of a decline in the sensitivity of the ovaries to stimulation by gonadotropins. This leads to elevated circulating levels of FSH and LH. Clinically, elevated FSH levels are used to indicate that menopause has occurred. Although both FSH and LH levels are elevated above pre-menopausal levels, FSH rises more significantly because it has a lower renal clearance compared to LH. Whipples Disease Correct Answers Caused by the gram- positive bacillus Tropheryma whipplei. It is another cause of malabsorption syndrome. Intestinal biopsy reveals clumps of Periodic Acid-Schiff macrophages in the lamina propria. Patients often present with migratory arthralgias of the large joints, along with weight loss, diarrhea, and abdominal pain. Treatment is with tetracycline. XLD diseases Correct Answers Rett Syndrome XLR diseases Correct Answers Bruton's agammaglobulinemia Wiskott-Aldrich G6PD deficiency Lesch-Nyhan syndrome Duchenne muscular dystrophy Hemophilia A and B.