Final Exam |Pathophysiology |Questions With Answers 2024, Exams of Nursing

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Final Exam |Pathophysiology |Questions With Answers 2024

Question 1 Which are true of the cell membrane? Select all that apply. Controls the transport of materials from the outside fluids to within Helps with the conduction of electrical currents in nerve and muscle cells Aids in the regulation of cell growth and proliferation Which of the following is an active form of Vitamin D? 25-hydroxycholecalciferol Question 2 Hypertrophy can occur under normal and pathological conditions. True Fill in the blank propels chyme along the small intestine toward the large intestine in one direction. Peristaltic movements True or False: Peristaltic movements occur in two directions. Peristaltic movements occur in one direction. Question 3 Metaplastic cells are not better prepared to survive under stressful circumstances. False Persistent metaplasia can lead to dysplasia True Barrett esophagus is an example of dysplasia. False Cervical intraepithelial neoplasia is a type of dysplasia. True Endometrial hyperplasia is a normal physiologic occurrence. False Taking your child to the pediatrician for their annual well check-up and keeping up with the recommended vaccination schedule would be an example of

Primary prevention James is being seen for his first colonoscopy. He turned 50 this year, and his father recently passed away from colon cancer at age 85. This would be an example of: Primary prevention Question 4 Which are true of the mitochondria? Select all that apply. It is involved in cellular respiration They play a role in apoptosis Which is Not true of the cytoskeleton? It includes peroxisomes and proteasomes You are reading results from a recent blood panel for Fred, a 76-year-old male. His hemoglobin levels are 15. g/dL. Would this be considered a normal or abnormal value? Normal You are reading results from a recent blood panel for Jane, a 37-year-old female. Her hemoglobin levels are 13 g/dL. Would this be considered a normal or abnormal value? Normal Question 5 Compare and contrast the two types of gangrenous necrosis. In dry gangrene the affected tissue becomes dry and shrinks, the skin wrinkles, and its color changes to dark brown or black. The spread of dry gangrene is slow. It results from a cut off in arterial blood supply and is a form of coagulation necrosis. In wet gangrene, the affected area is cold, swollen, and pulseless. The skin is moist, black, and under tension. Blebs form on the surface, liquefaction occurs, and a foul odor is caused by bacterial action. The spread of tissue damage is rapid 3 True or False. If false, explain why the statement is false: A benign neoplasm invades and destroys tissue and possesses a rapid rate of growth. False. A malignant neoplasm invades and destroys tissues and possesses a rapid rate of growth OR a benign neoplasm resembles the cells of the tissues of origin and possesses a slow rate of growth

Question 6 Cell proliferation is the process in which proliferating cells become more specialized cell types. False, cell differentiation You are talking to your patient who has been recently diagnosed with Osteoporosis. They mention that they joined a Silver Sneakers program at their local gym because they read that weight-bearing exercise promotes bone density. What word of caution would you give to them as they participate in this program? While weight-bearing exercises have been shown to increase bone density, they should be done in a safe way minimizing the risk for falls as they are at increased risk for fracture with a diagnosis of osteoporosis Question 7 Cell differentiation is the process of increasing cell numbers by mitotic cell division. False, cell proliferation You are working in the Emergency Department, and a 17-year-old male who is 6’2” is brought in via ambulance with complaints of chest pain on the left side and difficulty breathing. His parents reported that the was playing basketball in their driveway and suddenly collapsed with complaints of the above symptoms. You order a CT scan of his chest and determine that he has experienced a large, spontaneous pneumothorax in his left lung. Describe the treatment required for this condition. In a large pneumothorax, the air must be removed by needle aspiration or a closed drainage system with or without suction. Question 8 What are two important properties that stem cells possess? Potency and self-renewal 4 True or False. If false, explain why it is false. Humoral immunity is a form of innate immunity False, humoral immunity is a form of adaptive immunity. An initial immune response that is generalized (non-specific) and unable to distinguish between various foreign agents is characteristic of adaptive immunity. False. An initial immune response that is generalized (non-specific) and unable to distinguish between

various foreign agents is characteristic of innate immunity. OR Adaptive immunity serves not only to distinguish self from non-self but to recognize and destroy specific foreign agents based on their different antigenic properties Question 9 These are cells of the same lineage that have not yet differentiated to the extent that they have lost their ability to divide: progenitor or parent cells Which of the following are most likely to have arisen from an adult stem cell? Epithelial Each of the following is characteristic of Addison’s Disease except? Emotional disturbances Which of the following would you expect to find if someone has Cushing’s Disease? Select all that apply. Increased cortisol levels A buffalo hump Question 10 is a systemic treatment that enables drugs to reach the site of the tumor as well as other distant sites. Chemotherapy 5 The profound weight loss and wasting of fat and tissue that accompany cancer is known as. Cancer anorexia-cachexia syndrome What type of signaling occurs in the nervous system as neurotransmitters act on adjacent nerve cells? Synaptic Question 11 Explain the challenges of diagnosing autoimmune disorders. There are over 80 identified, many with overlapping presentations. Many manifestations are

nonspecific and are seen in other non-autoimmune diseases. Blood testing isn’t perfect either, as some tests are more generic and can be elevated in the presence of other diseases. Explain how the skin’s physical barrier makes it inhospitable to microorganisms. It has closely packed cells in multiple layers that are continuously being shed. Keratin covers the skin, which creates a salty, acidic environment inhospitable to microbes. It also contains antimicrobial proteins and lysozymes that inhibit microorganisms and help to destroy them You recently diagnosed your patient with Narcolepsy. You prescribed a low dose of Adderall to treat this daytime sleepiness. What are TWO behavior modifications he should make to control/prevent his symptoms? He should practice proper sleep hygiene, avoid sleep deprivation, and practice safety during high-risk activities, e.g., driving. He should take several short naps per day (approximately 15 minutes in length) to help ease the symptom of daytime sleepiness. Your friend is suffering from adjustment insomnia. She just started a new job and is anxious about her new responsibilities. What are TWO behavior modifications she can make to prevent sleep disturbances? Treatment and prevention for any type of insomnia must begin with patient education to promote good sleep hygiene (sleep habits.) This involves the establishment of consistent sleep patterns (going to bed at the same time each night and only sleeping as long as one needs to feel refreshed during the day), creating a comfortable sleeping environment (optimal room temperature), avoidance of screens and excessive light right before bed, and finally, avoidance of stimulants (caffeine) several hours prior to normal bedtime 6 Question 12 The T cells that display the host’s MHC antigens and T-cell receptors for a non-self-antigen are allowed to mature, a process termed negative selection. False (positive selection) You are seeing Tom, a 65-year-old male in your office whose chief complaint is severe pain in his right knee. Tom reports that he experiences some stiffness when he first wakes up, but if he walks around for a little bit, the stiffness goes away. Tom likes to be active and is on his feet a lot throughout the day. He reports that by the end of the day he has to take a Tylenol because he cannot tolerate the pain. Would you suspect that Tom has OA or RA? List TWO pieces of evidence that support your diagnosis. Tom more than likely has OA. His age of onset is higher. He has unilateral presentation. His stiffness in

the morning is relieved quickly by moving around. His pain worsens the longer he is on his feet. Question 13 Which lab value will typically be increased in a viral infection? Bacterial infections cause the neutrophil counts to increase. Parasitic infections and allergic responses cause an increase in eosinophils. Viral infections tend to decrease the neutrophils and increase the lymphocytes. You are seeing Jenny, a 25-year-old female in your office whose chief complaint is debilitating pain in the MCP joints of both hands. Jenny reports general feelings of fatigue, and you notice nodules over her MCP joints. She states that she experiences stiffness in her hands in the morning that lasts well over an hour. However, as she gets moving, this seems to subside. Would you suspect that Jenny has OA or RA? List TWO pieces of evidence that support your diagnosis. Jenny more than likely has RA. As She is young. She has a bilateral presentation. Her MCP joints are affected, which is most common with RA. She is exhibiting systemic symptoms of fatigue. She has prolonged morning stiffness in her joints, but this is alleviated with movement. (If the correct diagnosis is identified, 3 points should be awarded. Full credit should begiven if the correct diagnosis is made with two pieces of supporting evidence.) Which cell in the blood provides primary hemostasis? 7 Platelet Your patient has serum uric acid levels of 7.5 mg/dL. They are not complaining of pain, and there are no signs of inflammation. What phase of gout would you place them? Asymptomatic hyperuricemia Question 14 A 9-year-old boy with a peanut allergy was exposed to peanuts. He presents to the emergency room with an anaphylactic reaction. (1) What symptoms might he present with? (2) Does the quantity of exposure mean he will have a more severe reaction? (3) What is the initial immediate treatment? (4) What are 2 things people with anaphylaxis should always carry? Grade I: erythema and urticaria, with or without angioedema. Grade II: hypotension, tachycardia, dyspnea, and GI manifestations, like nausea, vomiting, diarrhea, and abdominal cramping from mucosal edema. Grade III: bronchospasm, cardiac dysrhythmias, and cardiac collapse.

Grade IV: cardiac arrest (2) No (3) Epinephrine (4) identification about allergy, EpiPen Which of the following is/are characteristic of normal tissue function, renewal and repair? Select all that apply. Hypertrophy & Apoptosis A 12-year-old female presents with itchy eyes, nasal congestion and drainage, and sneezing every spring when the pollen count is high. (1) Explain the immunologic mechanisms that are responsible for her symptoms. (2) What type(s) of treatment might be used to relieve her symptoms? Mast cells, basophils, and eosinophils play an important role in the development of type I reactions because they contain the chemical mediator histamine. A primary or initial-phase response is vasodilation, vascular leakage, and smooth muscle contraction. A secondary or late-phase response is characterized by more intense infiltration of tissues with eosinophils and other acute and chronic inflammatory cells, as well as tissue damage. (2) Antihistamines and intranasal corticosteroids are the mainstay of treatment 8 Question 15 A 23-year-old African American man with a history of severe lifelong anemia requiring many transfusions has nonhealing leg ulcers and recurrent periods of abdominal and chest pain. These signs and symptoms are most likely to be associated with which one of the following laboratory abnormalities? Sickle cells on peripheral blood smear The patient is found to be a severely malnourished alcoholic. The most likely cause of his anemia is: Folate deficiency An LDL cholesterol reading of 90 would be considered: Optimal A total cholesterol reading of 300 would be considered: High Question 16 Which of the following is NOT true of vitamin B12 deficiency anemia?

MCV is decreased Which of the following is NOT true of vitamin B12 deficiency anemia? Dietary deficiencies are common Your patient has recently been diagnosed with GERD. They have been prescribed a PPI for treatment. List Two behavioral modification they could adopt and one food or drink they could eliminate from their diet to prevent worsening of symptoms. Foods - coffee/caffeine, chocolate, mints, citrus fruits, acidic/spicy foods, or fats. Behavior modifications - Avoid positions that increase reflux, like lying down immediately after eating or bending. Avoiding large meals close to bedtime and sleeping with the head elevated may help to prevent reflux at night. Weight loss is recommended if needed Each of the following are risk factors for secondary hyperlipidemia except? 9 Autosomal dominant disorder of LDL receptor Explain the diagnostic criteria required for an autoimmune disease to be concluded. In order for an autoimmune disorder to be concluded, the following criteria must be met: evidence of an autoimmune reaction, the immunologic findings are not secondary to another condition, and no other identifiable causes are found. Your patient has recently been diagnosed with GERD. They have been prescribed a PPI for treatment. List TWO behavioral modifications they could adopt to prevent worsening of symptoms. Any of the following are correct answers: Avoid positions that increase reflux, like lying down immediately after eating or bending. Avoiding large meals close to bedtime and sleeping with the head elevated may help to prevent reflux at night. Weight loss is recommended if needed. Question 17 Explain the diagnostic criteria required for an autoimmune disease to be concluded. In order for an autoimmune disorder to be concluded, the following criteria must be met: evidence of an autoimmune reaction, the immunologic findings are not secondary to another condition, and no other identifiable causes are found. Question 18 Risk factors for coronary heart disease include each of the following except:

HDL > 60

A patient has experienced a seizure affecting the left temporal lobe. The family reports that the patient exhibited repetitive lip smacking and hand rubbing followed by a period of great fear and insecurity. They have experienced which type of seizure? Focal seizure with impairment of consciousness or awareness/ occurs in lobes Question 19 Patient is found to have the above:

1. What risk factors mostly led to this disease state?
3. What is this person at risk for developing?
4. What lifestyle modifications would you suggest for them? **Atherosclerotic plaque
5. Hyperlipidemia, cigarette smoking, obesity and visceral fat, hypertension, diabetes mellitus. Increasing age, family history of premature CHD, and male sex. May also include C-reactive protein (CRP) and serum lipoprotein(a).
6. Coronary artery disease, angina, myocardial infarction, aneurysm, stroke (ischemia, thrombosis, emboli).
7. Stop smoking, lose weight/exercise, healthy diet (low-fat, low-cholesterol), adhere to medication for blood pressure, hyperlipidemia, and/or diabetes.** An increase in the size of an organ or tissue due to the increase in size of the cells that comprise it is called: Hypertrophy An abnormal cellular growth, resulting in cells that vary in size, shape, and organization is called: Dysplasia Question 20 is the transfer of gases between the alveoli and the pulmonary capillaries. Diffusion is the flow of gases into and out of the alveoli of the lungs. Ventilation

Stages of Kidney Disease A patient is experiencing kidney damage with a mild decrease in GFR, and their GFR is 60-89 mL/min/1.73m2. What stage of kidney disease are they in? 2 A patient is experiencing a severe reduction in GFR, and their GFR is 15-29 mL/min/1.73m. What stage of kidney disease are they in? Stage 4

Stage Description Glomerular Filtration Rate (GFR) 1 Kidney damage with normal GFR 90 mL/min/1.73m^2 or above 2 Kidney damage with mild decreased in GFR 60-89 mL/min/1.73m^2 3a Moderate decrease in GFR 45-39 mL/min/1.73m^2 3b Moderate decrease in GFR 30-44 mL/min/1.73m^2 4 Severe reduction in GFR 15-29 mL/min/1.73m^2 5 Kidney Failure Less than 15 mL/min/1.73m^2 Question 21 Each of the following can lead to atelectasis Except: Thrombus Someone with COPD would exhibit each of the following characteristics Except: Increased D-dimer levels Steve is a 55-year-old male who has atherosclerosis. Steve smokes 2 packs of cigarettes per day, and his lipid panel reveals that he has elevated LDL and low HDL levels. List one thing Steve can do to slow the progression of atherosclerosis or mitigate its effects. He could stop smoking and change his diet to decrease his LDL and increase his HDL levels Question 22 A 10-year-old boy who is having an acute asthma attack is brought to the ER. He is observed to be sitting up and struggling to breathe. His breathing is accompanied by use of accessory muscles, a weak cough, and audible wheezing sounds. His pulse is rapid and weak, and both heart and breath sounds are distant on auscultation. His parents relate that his asthma began to worsen after he developed a “cold,” and now he doesn’t get relief from his albuterol inhaler. Explain the changes in physiologic function underlying his signs and symptoms.

With asthma patients upon a trigger, recruitment of inflammatory cells occurs from the bloodstream into the bronchial wall, where they directly attack the invading organisms and secrete inflammatory chemicals causing epithelial injury, resulting in the swelling of the bronchial wall, mucus secretion, and the additional bronchial hyper-responsiveness to stimuli causing airway obstruction or narrowing. And via his severe airway inflammation airway remodeling appears to have occurred as he does not receive relief via steroids, bronchodilators, or both.

Give a specific example of how our diet can increase our risk for cancer. Any of the following are acceptable answers: While some dietary carcinogens occur naturally in plants (aflatoxins), others are used in the preparation or preservation of food. For instance, when foods are fried in fat that has been reused multiple times, due to the extreme heat, benzo[a] pyrene (and other polycyclic hydrocarbons) are converted to carcinogens. The polycyclic aromatic hydrocarbons are among the most potent and can be found in many common places. They are produced from animal fat when charcoal- broiling meats, are present in smoked meats and fish, and are also present in tobacco smoke. Nitrosamines are formed in foods that are smoked, salted, cured, or pickled using nitrites or nitrates as preservatives. The effects of nitrosamines, however, may be reduced by antioxidants such as vitamin C found in fruits and vegetables. Colon cancer is associated with high dietary fat and red meat intake and low dietary fiber intake, as well as obesity and low physical activity. Explain one reason why obesity puts someone at increased risk for cancer. Obesity is associated with insulin resistance and increased production of pancreatic insulin, both of which can have a carcinogenic effect. It is associated with increased levels of sex hormones, androgens, and estrogens. These stimulate cell proliferation, inhibit apoptosis, and increase the chance of malignant cell transformation, especially of the endometrial and breast tissue. Lastly, obesity has been related to chronic inflammation, which can lead to the development of malignancies Question 23 Oligodendrocytes produce myelin in the PNS. False, oligodendrocytes produce myelin in the CNS. Astrocytes help to form the blood-brain barrier which prevents toxins from the blood from entering the brain. True The flow of gases into and out of the alveoli of the lungs is called Ventilation

The flow of blood in the adjacent pulmonary capillaries is called: Perfusion

Question 24 Someone in the early stages of Alzheimer’s disease requires assistance for their activities of daily living. False, in the early stages of Alzheimer’s disease, individuals are still independent with their ADLs. True or False. If false, explain why it is false. Apoptosis sets off an inflammatory immune response. False, Necrosis sets off an inflammatory immune response Each of following is true of apoptosis except: It sets off an inflammatory immune response Question 25 A 75-year-old male is brought to the emergency department via ambulance at 5 pm. The patient’s spouse reports that when they woke up (approximately at 6 am) he reported to her that he was having some blurred vision but decided to go about his day. As the day progressed, he started experiencing tingling and feelings of weakness on the entire left side of his body. He has a past medical history of diabetes. Based upon these symptoms and past medical history, what do you suspect this patient is experiencing? How would you confirm this diagnosis? What treatment should be administered? Explain why you chose that treatment. Answer: This patient is more than likely experiencing an ischemic stroke. A CT scan and MRI would be needed to determine if a clot was blocking blood flow to the brain tissue and to rule out a hemorrhagic stroke. If a clot is found, this patient would need to be re-perfused through catheter-base methods as they are outside of the 3-4.5 treatment window for the use of tPA drugs. True or False. If false, explain why it is false. There are no specific tests for diagnosing Parkinson’s Disease. True - There are no specific tests for diagnosing Parkinson’s Disease. Question 26 Risk factors for gallstone formation include each of the following EXCEPT: Male gender Complications of gallstones include each of the following EXCEPT: Cirrhosis (liver)

Jake is a 12 y/o male, who is brought in by his mom. He complains of coughing fits when he plays sports and has to catch his breath a lot. He also feels “tight” with breathing when he’s around cats and dogs. His mom is also allergic to certain animals. Given the patient’s presentation, what is your initial diagnosis? Asthma Leah is a 25 y/o female who complains of a stuffy nose and sneezing every Spring and Fall. Benadryl makes her sleepy, and it doesn’t really help her nasal congestion. Given the patient’s past medical history and presentation, what is your initial diagnosis? What about her current presentation leads you to this conclusion? Allergic rhinitis. Sneezing and congestion that present when pollen counts are high leads us to this conclusion. Question 27 Risk factors for the development of peptic ulcer include each of the following EXCEPT: Stress Each of the following factors are associated with increased incidence of peptic ulcer EXCEPT: Dietary history Jeffrey, a 62 y/o patient, presents with progressing shortness of breath, profound iron deficiency, and is hemoccult positive (blood in stool). What specialist would you send him to and why? An oncologist because you want to rule out cancer If constipation occurs as a change from a person’s normal bowel habits, and no new meds have been started, what should you suspect? Colorectal cancer Question 28 What are rhythmic movements designed to propel the chyme along the small intestine toward the large intestine? Answer: Peristaltic movements Which GI hormone has strong growth hormone-releasing activity and stimulates food intake and digestive function? Ghrelin

A 75-year-old male is brought to the emergency department by his spouse at 8 pm. The spouse reports that they

were cleaning up after dinner at approximately 6:30 pm, and she noticed that her husband’s speech was very unclear. When she asked him what was going on, he said that he didn’t know and that the entire right side of his face felt numb. She reports that he is very active, but he has a past medical history of atrial fibrillation. Given the patient’s past medical history and presentation, what is your initial diagnosis? Stroke or CVA Question 29 Anti-diarrheal medication can be used with all types of diarrhea. False Antibiotics should be used to treat all types of diarrhea. False Sydney, an 18 y/o female, presents with constipation, fatigue, and dry skin. Her menstrual periods have gotten heavier, and she has gained 15 lbs since her last visit. Given the patient’s past medical history and presentation, what disease is on your differential diagnosis list? Hypothyroidism You are seeing Pam, a 52-year-old female in your office today. She is coming to you after 4 months of struggling with difficulty sleeping and just feeling “down”. When you ask her to describe her symptoms specifically, she states that she feels a sense of guilt over everything, and nothing seems to make her happy. She feels worse in the morning. Given the patient’s presentation, what is your initial diagnosis? Depression Question 30 Which of the following is characteristic of chronic transplant rejection? Involves humoral immunity

Which of the following is characteristic of acute transplant rejection? Involves increased T lymphocytes A patient presents to the emergency department with complaints of sharp pain that comes in waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been experiencing nausea and vomiting all day long. They have a history of UTIs. Urinalysis reveals that the pH of their urine is 7.8. Given the patient’s past medical history and presentation, what is your initial diagnosis?

Kidney stones or renal calculi Chad, a 20 y/o male, presents with episodes of diarrhea with mucus and rectal bleeding. A colonoscopy and biopsy are done to confirm ulcerative colitis. How does this disease differ from Crohn disease? Crohn - granulomatous, skip lesions, affects ileum, rectal bleeding rare, fistulas /strictures /perianal abscesses are common, cancer development uncommon. UC - ulcerative inflammation, continuous involvement, cancer development common Question 31 A patient is said to be in stage 2 kidney disease. What would you expect their GFR to be? 70 mL/min/1.73m A patient is said to be in stage 4 kidney disease. What would you expect their GFR to be? 25 mL/min/1.73m Anne is a 48 y/o female who presents with excessive vaginal bleeding x 6 months. Her skin is pale, she reports feeling fatigued, and often craves a large cup of Sonic crushed ice. A quick in-office H&H shows a hemoglobin of 9 and hematocrit of 30%. Given the patient’s past medical history and presentation, what is your initial diagnosis? Anemia Question 32 Explain how the kidney can maintain a constant GFR despite variations in the arterial blood pressure of the rest of the body. Answer: The renal autoregulatory system causes the efferent arteriole to constrict leading to an increased resistance to outflow from the glomeruli with a subsequent increase in glomerular pressure and the GFR.

When the afferent arteriole constricts there is a reduction in renal blood flow, glomerular pressure, and the GFR. Bill and Angela have brought their mom into your office today. They tell you that their mom has experienced dementia for some time now, but they have not been too concerned because, for the most part, she has been able to care for herself, only needing assistance here and there for her daily activities. However, recently things have changed. Her ability to recall recent events has drastically decreased; she is having trouble with sleep; they’ve noticed some mood changes, and the most alarming thing is that she has started to wander outside of her home. They are concerned for her safety. You suspect the patient has Alzheimer’s. How would you stage the disease process this patient is experiencing? What about her current presentation leads you to this conclusion?

Moderate Alzheimer’s Disease. Changes in sleep, changes in mood, and wandering episodes are all characteristic of moderate Alzheimer’s.(If the categorization is correct (Moderate Alzheimer’s) A 75-year-old male is brought to the emergency department by his spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30 pm, and she noticed that her husband’s speech was very unclear. When she asked him what was going on, he said that he didn’t know and that the entire right side of his face felt numb. She reports that he is very active, but he has a past medical history of atrial fibrillation. What do you suspect this patient is experiencing? Specifically, categorize the disease process based upon his past medical history and his current presentation and explain how you arrived at this specific diagnosis. He is more than likely experiencing an ischemic stroke. A past medical history of atrial fibrillation puts him at an increased risk for clots. Question 33 A patient presents in the emergency department with severe dehydration secondary to vomiting. The following are the results of their blood work: pH = 8.2 , PCO 2 = 39 mm , and HCO 3 - = 33 mEq/L. Based upon these results, what type of acid-base disorder are they experiencing? Is compensation occurring? Describe a treatment intervention for this disorder. Normal values are as follows: pH = 7.35-7.45 , PCO 2 = 35-45 mm, HCO3- = 22- 26 mEq/L. Answer: The patient is in metabolic alkalosis. The respiratory system is not compensating as PCO 2 compensation falls within normal limits. Fluids are replaced with normal saline solution.

A patient is admitted to the hospital with pneumonia. The following are the results of their blood work : pH = 6.9, PCO2= 52 mm , and HCO 3 -= 30 mEq/L. Based upon these results, what type of acid-base disorder are they experiencing? Is compensation occurring? Describe a treatment intervention for this disorder. Normal values are as follows: pH = 7.35-7.45, PCO 2 = 35-45 mm, HCO 3 -= 22-26 mEq/L Answer: The patient is in respiratory acidosis. The renal system is attempting to compensate as HCO3- concentration is elevated above normal limits. The goal of treatment for respiratory acidosis is improving ventilation. Supplemental O2can be administered; in severe cases mechanical ventilation may be indicated. Anne is a 48 y/o female who presents with excessive vaginal bleeding x 6 months. Her skin is pale, she reports feeling fatigued, and often craves a large cup of Sonic crushed ice. A quick in-office H&H shows a hemoglobin of 9 and hematocrit of 30%. You suspect Anne may be anemic. What type of anemia do you think she has, and what about her current presentation leads you to this conclusion? Blood loss anemia or iron deficiency anemia. Vaginal bleeding, pale skin, fatigue, and low H&H (If the categorization is correct (blood loss anemia or iron deficiency anemia)

Question 34 Signs and symptoms of Addison’s disease include each of the following EXCEPT: Hyperglycemia Bob is a 55 y/o male here for his annual physical exam. He has no current complaints. His BMI is 31, BP 150/90, HR 72, RR 16. He does not smoke, drinks alcohol occasionally, and has a family history of cardiovascular disease. His BP was retaken in the opposite arm and was 155/86. How would you stage Bob’s hypertension? Stage 2, >140/ Jake is a 12 y/o male, who is brought in by his mom. He complains of coughing fits when he plays sports and has to catch his breath a lot. He also feels “tight” with breathing when he’s around cats and dogs. His mom is also allergic to certain animals. You suspect Jake is asthmatic. What about his current presentation leads you to this conclusion? Exercise-induced and/or allergic asthma; coughing and chest tightness Question 35 An endocrine hormone is released into circulation to act on a target organ. True

6 y/o Tommy is brought in by his mom today for complaints of vomiting and diarrhea. He does not have a fever. His stool is hemoccult negative (no blood). His younger sibling has similar symptoms. You diagnose Tommy with viral gastroenteritis. Would you categorize this condition as inflammatory or non-inflammatory? Non-inflammatory Question 36 Hormones work through receptors, and the speed of this action varies. True Sydney, an 18 y/o female, presents with constipation, fatigue, and dry skin. Her menstrual periods have gotten heavier, and she has gained 15 lbs since her last visit. What lab test would you order to confirm your diagnosis? TSH and free T3 and T Question 37 A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Lab findings show a low serum T4 and elevated TSH.

1. What diagnosis would her history and lab findings indicate? 2. What type of treatment should be given?

Answer: (1) Hypothyroidism; (2) synthetic T4 thyroid hormone, thyroxine A 75-year-old male is brought to the emergency department by his spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30 pm, and she noticed that her husband’s speech was very unclear. When she asked him what was going on, he said that he didn’t know and that the entire right side of his face felt numb. She reports that he is very active, but he has a past medical history of atrial fibrillation. You suspect this patient has suffered an ischemic CVA. What diagnostic test would you run to confirm your diagnosis? A CT scan and MRI would be needed to determine if a clot is blocking blood flow to the brain tissue and to rule out a hemorrhagic stroke. Bill and Angela have brought their mom into your office today. They tell you that their mom has experienced dementia for some time now, but they have not been too concerned because, for the most part, she has been able to care for herself, only needing assistance here and there for her daily activities. However, recently things have changed. Her ability to recall recent events has drastically decreased; she is experiencing difficulty with sleep;

they’ve noticed some mood changes, and the most alarming thing is that she has started to wander outside of her home. They are concerned for her safety. You suspect the patient has Alzheimer’s. What are the diagnostic criteria or processes for your suspected diagnosis? A neurologic exam will determine if there are other disease processes that may be causing symptoms such as Parkinson’s disease, hydrocephalus, small or large vessel strokes, or the presence of a tumor. The Mini Mental State Exam (MMSE) or the Mini-Cog test are standardized tests used to determine whether someone has dementia and the severity of it. MRI and CT scans are primarily used to eliminate other disease processes as a diagnosis but can be used to measure levels of Aβ. As previously discussed, higher levels of Aβ would indicate Alzheimer’s disease as a diagnosis while normal levels would suggest it is not the cause of the presenting dementia. Question 38 Symptoms of diabetic ketoacidosis (DKA) include each of the following EXCEPT: Bradycardia Hypothyroidism is caused by each of the following EXCEPT: Thyroid adenoma Jake is a 12 y/o male, who is brought in by his mom. He complains of coughing fits when he plays sports and has to catch his breath a lot. He also feels “tight” with breathing when he’s around cats and dogs. His mom is also allergic to certain animals. You suspect that Jake is asthmatic. What diagnostic test would you run to confirm your diagnosis? Pulmonary function test or peak flows Question 39

Which of the following would a patient likely report if you suspect they have OA? Stiffness in the morning that resolves in less than 30 minutes/ A “grinding feel” with movement You are seeing Pam, a 52-year-old female in your office today. She is coming to you after 4 months of struggling with difficulty sleeping and just feeling “down”. When you ask her to describe her symptoms specifically, she states that she feels a sense of guilt over everything, and nothing seems to make her happy. She feels worse in the morning. You suspect that Pam is suffering from depression. What are the diagnostic criteria for your suspected diagnosis? The patient must have consistent symptoms for longer than 2 months. This patient would be considered to have chronic depression, as her symptoms have gone on for 4months

Anne is a 48 y/o female who presents with excessive vaginal bleeding x 6 months. Her skin is pale, she reports feeling fatigued, and often craves a large cup of Sonic crushed ice. A quick in-office H&H shows a hemoglobin of 9 and hematocrit of 30%. You suspect Anne is anemic. What diagnostic test would you run to confirm your diagnosis? What would her red blood cells look like on the slide? (size and color) CBC with peripheral smear and ferritin level. RBCs would appear microcytic and hypochromic. Question 40 Blood circulates through bone by what means? (mark all that apply) Via the central Haversian and Volkmann canals/ An anastomosis between perforating and nutrient arteries/Diffusion through the endosteal surface of the bone and the canaliculi Cancellous bone receives its blood supply by what means? Diffusion through the endosteal surface of the bone and the canaliculi A patient presents to the emergency department with complaints of sharp pain that comes in waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been experiencing nausea and vomiting all day long. They have a history of UTIs. Urinalysis reveals that the pH of their urine is 7.8. A CT scan reveals a renal calculi that is 7 mm in diameter. What is the best treatment plan for this patient? Explain your reasoning for this treatment plan. It must be removed through ureteroscopic removal or extracorporeal shockwave lithotripsy, as it is greater than 5 mm in diameter. The patient should be placed on antibiotics to treat the UTI, as well as medication for pain management. Question 41

If someone loses their balance when walking on uneven terrain, explain how tendons and ligaments work to protect the joint and structures within it. The tendons and ligaments of joints serve in proprioception (the awareness of ones’ position in space or movement of the body). When these structures undergo stretch or torsional strain, these proprioceptive nerve fibers will cause a reflexive response to adjust the tension on the muscles (to maintain balance and not fall over) that support the joint protecting the capsule and other joint structures.

Jake is a 12 y/o male who is brought in by his mom. He complains of coughing fits when he plays sports and has to catch his breath a lot. He also feels “tight” with breathing when he’s around cats and dogs. His mom is also allergic to certain animals. Jake is diagnosed with exercise-induced and/or allergic asthma. What is the best treatment plan for him? Short-acting beta agonist / Albuterol before exercise or when around pets Question 42 A 72-year-old male is said to be in phase 3 of gout. He is obese and has a history of alcohol abuse. Develop a treatment plan including specific pharmacologic intervention and a nonpharmacologic recommendation to manage his disease. ( metatarsophalangeal joint or the great toe) Phase 3 of gout is called inter-critical gout. The patient is asymptomatic, and no joint abnormalities are present. The goal of treatment in this phase is to maintain normal uric acid levels and prevent progression of the disease. Allopurinol is a prescription drug that is used to reduce uric acid levels. This patient should be encouraged to lose weight and decrease his alcohol consumption. He should also avoid purine rich foods such as fish, bacon, and liver. A 75-year-old male is brought to the emergency department by his spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30 pm, and she noticed that her husband’s speech was very unclear. When she asked him what was going on, he said that he didn’t know and that the entire right side of his face felt numb. She reports that he is very active, but he has a past medical history of atrial fibrillation. A CT scan confirms that this patient has suffered from an ischemic CVA. What is the best treatment plan for this patient? Explain your reasoning. This patient should receive tPA drugs, as they are within the 3-4.5 hour treatment window Question 43 Sydney, an 18 y/o female, presents with constipation, fatigue, and dry skin. Her menstrual periods have gotten heavier, and she has gained 15lbs since her last visit. Sydney’s lab results confirm a diagnosis of hypothyroidism. What treatment would you prescribe? Explain your reasoning for choosing this treatment plan.

Synthetic T4 thyroid hormone, thyroxine. Sydney’s thyroid isn’t producing enough thyroid hormone, so you need to replace it.

Question 44 Jeffrey, a 62 y/o patient, presents with progressing shortness of breath, profound iron deficiency, and is hemoccult positive (blood in stool). What screening tests for cancer should a 62 y/o male undergo annually? colonoscopy, PSA, skin check Jeffrey, a 62 y/o patient, is asking how he can decrease his chance of developing cancer. List TWO recommendations you can give to lower his chances of developing cancer. Healthy weight, exercise, diet low in fat, high fiber, increased fruits and vegetables, decreased smoked or red meats, avoid smoking and alcohol Question 45 Your type 2 diabetic patient comes in today for a checkup. What screening tests could you perform in the office today to prevent secondary complications? ( not bloodwork) Monofilament foot check for sensation and skin integrity, weight check, blood pressure Joe, a 65 y/o male, presents with generalized lymphadenopathy. He has come in for frequent infections. He has a past history of IV drug use and multiple sexual partners. Bloodwork was taken, and the HIV test was positive. The patient is wondering if he should get a flu shot this year. What is your response? It is important for HIV+ individuals to be vaccinated against common (and preventable) infections as soon as possible, as well as to avoid, recognize, and treat opportunistic infections early.