Medical Terminology and Pathophysiology, Exams of Nursing

Download Medical Terminology and Pathophysiology and more Exams Nursing in PDF only on Docsity! NR 507 Final Exam Advanced Pathophysiology - Chamberlain College of Nursing Questions with Verified Correct Answers (Graded A+) What term is used to describe a hernial protrusion of a saclike cyst that contains meninges, spinal fluid, and a portion of the spinal cord through a defect in a posterior arch of a vertebra?--- correct answer --- Myelomeningocele What provides the best estimate of the functioning of renal tissue?--- correct answer --- Glomerular filtration rate Where are langerhans cells found?--- correct answer --- Skin Where in the lung does gas exchange occur?--- correct answer --- Alveolocapillary membrane The tonic neck reflex observed in a newborn should no longer be obtainable by: 5 months When renin is released, it is capable of which action?--- correct answer --- Formation of angiotensin 1 The portion of the antigen that is configured for recognition and binding is referred to as what type of determinant?--- correct answer --- epitope Which sexually transmitted infection frequently coexists with gonorrhea?--- correct answer --- Chlamydia How is the effectiveness of vitamin B12 therapy measured?--- correct answer --- Reticulocyte count Carcinoma refers to abnormal cell proliferation originating from which tissue origin?--- correct answer --- Epithelial cells Which type of microorganism reproduces on the skin?--- correct answer --- Bacteria and fungi An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. A wide fixed splitting of the second heart sound is also found. These clinical findings are consistent with which congenital heart defect?--- correct answer --- Atrial Septal Defect An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom?--- correct answer --- Lack of symptoms The number of persons living with a specific disease at a specific point in time is referred to by which term?--- correct answer --- Prevalence Which risk factor for hypertension is influenced by genetic factors and lifestyle?--- correct answer --- Obesity Having ejected a mature ovum, the ovarian follicle then develops into: corpus luteum The failure of bones to ossify resulting in soft bones and skeletal deformity characterizes which disorder rickets what is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding?--- correct answer --- tolerance Aldosterone directly increases the reabsorption of: sodium atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke?--- correct answer --- embolic which clinical manifestations are associated with fibromyalgia?--- correct answer -- - sensitivity at the ender points and profound fatigue Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation?--- correct answer --- heat exhaustion what is the leading cause of infertility in women?--- correct answer --- polycystic ovary syndrome which substance is a water soluble protein hormone?--- correct answer --- insulin what is the target tissue for prolactin releasing factor?--- correct answer --- anterior pituitary what is the cause of familial hypercholesterolemia?--- correct answer --- reduction in the number of low density lipoprotein receptors on the cell surfaces Regarding type 2 diabetes, obesity is considered to be what type of risk?--- correct answer --- modifiable which 4 step process correctly describes muscle contration excitation, coupling, contraction, relaxation Adoption studies have shown that the offspring of an alcoholic parent when raised by nonalcoholic parents have what amount of an increased risk of developing alcoholism?--- correct answer --- fourfold which hormone stimulates gonads to produce both male and female hormones?--- correct answer --- LH A person with 47 XXY karyotype has the genetic disorder resulting in which syndrome klinefelter which would be considered a positive symptom of schizophrenia?--- correct answer --- auditory hallucinations what term describes the loss of the comprehension or production of language?--- correct answer --- aphasia Consanguinity refers to the mating of: persons having common family relation Haversian system parkinson disease is a degenerative disorder of the brains basal ganglia Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain?--- correct answer --- GCT saliva contain which immunoglobulin?--- correct answer --- IgA what type of fracture occurs at a site of preexisting bone abnormality and is a result of a force that would not normally cause a fracture pathologic An infant suddenly develops abdominal pain, becomes irritable (colicky), and draws up the knees. Vomiting occurs soon afterward. The mother reports that the infant passed a normal stool, followed by one that looked like currant jelly. Based on these data, which disorder does the nurse suspect?--- correct answer --- intussception in 95% of children of delayed puberty, the problem is caused by physiologic hormonal delays which characteristic is true of type 2 muscle fibers fast conduction velocities neurofibrillary tangles characterize which neurologic disorder?--- correct answer -- - alzheimers disease which hormone triggers uterine contractions?--- correct answer --- oxytocin how does the release (increase) of epinephrine raise body temperature it raises the metabolic rate which hormone is linked to an increase in appetite during puberty?--- correct answer --- leptin chvostek and trousseau signs indicate which electrolyte imbalance hypocalcemia How does chest wall compliance in an infant differ from that of an adult?--- correct answer --- an adults chest wall compliance is lower than an infants What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated?--- correct answer --- refractory what is the suggested mean blood pressire for an 8 to 9 year old child 106/58 which is an example of endogenous antigen cancer cells what is the most commonly reported symptom of cancer treatment fatigue at birth, which statement is true?--- correct answer --- gas exchange shifts from the placenta to the lung what is the treatment of choice for pernicious anemia vitamin b12 injection which disease is an example of rickettsial infection rocky mountain spotted fever which statement is true regarding pain and cancer Pain is generally associated with late-stage cancer during an infection why do lymph nodes enlarge and become tender?--- correct answer --- B lymphocytes proliferate what is a significant cause of morbidity and mortality worldwide infectious disease After sexual transmission of HIV, a person can be infected yet seronegative for how many months?--- correct answer --- 6-14 months which organism is responsible for development of syphilis treponema pallidum it is true that myesthenia gravis causes muscle weakness what effect does hyperphosphatemia have on other electrolytes decreases serum calcium which pancreatic enzyme is responsible for the breakdown of carbohydrates amylase what part of the brain provides the emotional response to pain limbic the secretion of acth will result in the increased level of which hormone cortisol which clinical manifestations would be expected for a child who has complete trisomy of the twenty first chromosome an IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears which assessment finding characterizes osgood-schlatter disease tendinitis of the anterior patellar tendon Dilation of the ipsilateral pupil following uncal herniation is the result of pressure on which of the following cranial nerves?--- correct answer --- oculomotor CN III what directly causes ovulation during the mentrsual cycle sudden increase of LH what anchors cartilage to underlying bone collagen fibers At 2 or 3 weeks of age, an infant who has been well fed and has gained weight begins to vomit for no apparent reason. The vomiting gradually becomes more forceful. These symptoms may be indicative of which disorder?--- correct answer -- - pyloric stenosis the common property among the three types of medications used to treat depression is that they increase neurotransmitter levels within the synapse The presence of a zygote having one chromosome with the normal complement of genes and one with a missing gene is characteristic of which genetic disorder?--- correct answer --- cri du chat alterations in which part of the brain are linked to hallucinations, delusions, and thought disorders associated with schizophrenia?--- correct answer --- temporal lobe which person is at the greatest risk for developing delerium an individual on the second day after a hip replacement what term is used to identify the condition that exists when the urethral meatus is located on the undersurface of the penis hypospadius A primary care NP prescribes a nonselective NSAID for a patient who has osteoarthritis. The patient expresses concerns about possible side effects of this medication. When counseling the patient about the medication, the NP should tell this patient: to take each dose of the NSAID with a fll glass of water A patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four times each month. The NP should: prescribe an anticonvulsant such as topiramate A patient who has osteoarthritis is scheduled to have knee surgery. Pt takes Aspirin and Naproxen for pain and inflammation. Which statement indicates a need for further teaching?--- correct answer --- I will need to stop both meds 1 week before I have surgery Who is a candidate for dialysis? --- correct answer ---End-stage renal disease (ESRD) is the final stage of CKD with the number one cause being diabetes mellitus combined with hypertension. At this point, the patient is completely dependent on dialysis to survive. CKD is classified into five stages and is based on the patient's GFR rather than symptoms. Patients will need dialysis when the following symptoms are present: --Metabolic acidosis. --Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an indication for dialysis. --Hyperkalemia by itself is not an indication for dialysis. --Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol). --Fluid volume overload that is not responsive to diuretics. --Uremic symptoms due to nitrogenous wastes in the blood stream. Stage I CKD --- correct answer ---There is kidney damage with normal or elevated GFR 90-120 Stage II CKD --- correct answer ---There is kidney damage with mild decrease in GFR 60-89 Stage III CKD --- correct answer ---There is a moderate decrease in GFR 30-59 Stage IV CKD --- correct answer ---There is a severe decrease in GFR 15-29 Stage V CKD --- correct answer ---Kidney failure- End-stage renal disease <15 (dialysis) Once Stage IV is reached, progression to Stage V is inevitable as well as dialysis or kidney transplant Complications of Decreased GFR --- correct answer ---Anemia Hypertension Decreased calcium absorption Hyperlipidemia Heart failure Left ventricular hypertrophy Fluid volume overload Hyperkalemia Hyperparathyroidism Hyperphosphatemia Metabolic acidosis Malnutrition (late complication) GERD --- correct answer ---Warning signs include: Symptoms over age of 50: -Dysphagia (difficulty swallowing) -Odynophagia (pain on swallowing) -Nausea and vomiting -Weight loss -Melena -Early satiety (feeling full after eating very little food Hiatal Hernia --- correct answer ---Often asymptomatic Generally, a wide variety of symptoms develop later in life and are associated with other GI disorders, primarily GERD --Sliding hiatal hernia: treatment usually conservative. Individuals can diminish reflux by eating small, frequent meals and avoiding the recumbent position after eating. Abdominal supports and tight clothing are avoided and weight control recommended for obese individuals. Duodenal Ulcer --- correct answer ---Characteristic manifestation = chronic intermittent pain in epigastric area Pain begins 30 minutes to 2 hours after eating when stomach is empty Hormone replacement therapy with the hormone levothyroxine is the treatment of choice Thyroid-Stimulating Hormone (TSH) --- correct answer ---TSH released by anterior pituitary Review hypothalamic-pituitary axis (Picture) Thyroid-releasing hormone (hypothalamus) Hyperthyroidism/ Grave's Disease --- correct answer ---Two most distinguishing factors of Grave's disease = pretibial myxedema and exophthalmos Treatment directed at controlling excessive TH production, secretion or action and includes antithyroid drug therapy (methimazole or propylthiouracil), radioactive iodine therapy (absorbed only by thyroid tissue, causing death of cells), and surgery Goal of radioactive iodine ablation for the treatment of Grave's disease is to destroy overactive thyroid tissue Two categories of ophthalmopathy associated with Grave's Disease: --- correct answer ---Functional Abnormalities: resulting from hyperactivity of the sympathetic division of the autonomic nervous system (lag of the globe on upward gaze or a lag of the upper lid on downward gaze) Infiltrative Changes: involving the orbital contents with enlargement of the ocular muscles. These changes affect more than half of individuals with Grave's Disease. Increased secretion of hyaluronic acid, adipogenesis, inflammation and edema of the orbital contents results in exophthalmos (protrusion of the eyeball), periorbital edema and extraocular muscle weakness leading to strabismus and diplopia (double vision) Hyperparathyroidism --- correct answer ---Characterized by stimulation of parathyroid gland in response to hypocalcemia Hypercalcemia --- correct answer ---Hypercalcemia & Hypophosphatemia may be asymptomatic or affected individuals may present with symptoms related to the neuromuscular changes that include paresthesias and muscle cramps Patients with hypercalcemia can have low bone density that is most noted in the distal one-third of the radius Hypoparathyroidism --- correct answer ---Hypomagnesemia inhibits PTH secretion Hypomagnesemia may be related to chronic alcoholism, malnutrition, malabsorption, increased renal clearance of magnesium caused by the use of aminoglycoside antibiotics or certain chemotherapeutic agents, or prolonged magnesium-deficient parenteral nutritional therapy Hypocalcemia --- correct answer ---Symptoms: Dry skin Loss of body and scalp hair Hypoplasia of developing teeth Horizontal ridges on nails Cataracts Basal ganglia calcifications Bone deformities Bowing of the long bones Hypercortisolism --- correct answer ---Glucose intolerance associated with hypercortisolism --Occurs because of cortisol-induced insulin resistance and increased gluconeogenesis and glycogen storage by the liver Cushing's syndrome characterized by patterns of fat deposition have been described as "truncal obesity", "moon face" and "buffalo hump" Adrenal Crisis- Hypocortisolism --- correct answer ---Onset of adrenal crisis is signified by hypotension Hypotension can progress to complete vascular collapse and shock. This is known as adrenal crisis or addisonian crisis and develops with undiagnosed disease, acute withdrawal of glucocorticoid therapy or the occurrence of infection or other comorbid stressful events Primary Hypocortisolism- Adrenal Insufficiency --- correct answer ---Lab work that indicates primary hypocortisolism: Multiple Sclerosis (MS) --- correct answer ---Risk factors that may be involved in the development of MS include: --Smoking --Vitamin D deficiency --Epstein-Barr Virus Infection Febrile Seizures --- correct answer ---One possibility for the development of a febrile seizure is that neurons are excited by decreased CO2 levels caused by hyperventilation during a febrile state Cluster Headache --- correct answer ---Unilateral trigeminal distribution of severe pain with ipsilateral autonomic manifestations, including tearing on the affected side, ptosis of the ipsilateral eye and congestion of the nasal mucosa Occurs in one side of the head primarily in men between 20 to 50 years of age Pain may alternate sides with each headache episode Severe, stabbing and throbbing Pain often referred to the midface and teeth Migraine Headache --- correct answer ---Episodic neurologic disorder whose marker is headache lasting 4 to 72 hours Diagnosed when any two of the following occur: --Unilateral head pain --Throbbing pain --Pain worsens with activity --Moderate or severe pain intensity And at least one of the following: --Nausea and/or vomiting --Photophobia and phonophobia Migraine with aura with visual, sensory or motor symptoms Migraine without aura (most common) Chronic migraine Tension Headache (Tension Type Headache/TTH) --- correct answer ---Most prevalent type of recurrent headache Not vascular or migrainous Average age of onset is during the second decade of life Usually mild to moderate bilateral headache with sensation of a tight band or pressure around head Bell's Palsy --- correct answer ---Associated with Cranial Nerve VII paralysis and results in facial asymmetry and inability to close eye, smile or frown on the affected side Bacterial Meningitis --- correct answer ---Associated with compression of Cranial nerve V and results in severe and sharp stabbing pain that can worsen with chewing Trigeminal neuralgia --- correct answer ---Characterized by clinical manifestations of systemic infection including Characterized by clinical manifestations of systemic infection including --Fever --Tachycardia --Chills Symptoms of Upper UTI (6) --- correct answer ---pyleonephritis fever flank pain CVA tenderness N/V malaise Is acute renal failure reversible? --- correct answer ---yes How do you determine the prognosis of acute renal failure? --- correct answer ---If we give a diuretic and we get output, this means we have functioning kidneys Examples of Pre-renal failure with diagnostic examples(2) --- correct answer --- Dehydration (diabetics) and inability to perfuse (heart failure) Examples of intrarenal failure (4) --- correct answer ---Contrast dye, glomerulonephritis, ischemia, diabetes Examples of post-renal failure (3) --- correct answer ---renal stones, tumors, swollen prostate Key diagnostic test result for acute pyelonephritis --- correct answer ---WBC casts What type of renal failure are renal calculi? --- correct answer ---Post renal Gold standard of diagnosing renal calculi? --- correct answer ---CT scan Treatment goals for renal calculi (4) --- correct answer ---pain management, pass stone, reduce size of stone, prevent new stones Who is a candidate for dialysis? (5) --- correct answer ---Unresolvable hyperkalemia, acidosis, uremic symptoms, fluid overload resistant to therapy, stage 5 CKD What co-morbidities are associated with CKD? (3) --- correct answer --- Hypertension, diabetes, lupus is CKD reversible? --- correct answer ---No, it is progressive and irreversible Stage 1 of CKD --- correct answer ---Kidney damage but normal GFR >90 Stage 2 of CKD --- correct answer ---Mild decrease in GFR (60-89) Stage 3 of CKD --- correct answer ---Moderate decrease in GFR (30-59) Still a chance for improvement of kidney function Stage 4 of CKD --- correct answer ---Severe decrease in GFR 15-29 Stage 5 of CKD --- correct answer ---Kidney failure GFR <15 or dialysis Warning signs of GERD (5) --- correct answer ---heartburn while eating & worse when laying down, dysphagia, sensation of lump in your throat, abdominal/chest pain, regurgitation GERD symptoms over the age of 50 (6) --- correct answer ---dysphagia, odynophagia, N/V, weight loss, melena, early satiety Symptoms of hiatal hernia --- correct answer ---Typically asymptomatic Treatment of sliding hiatal hernia (4) --- correct answer ---Small, frequent meals, avoid lying flat after eating, avoid tight clothes, weight control Key symptom of duodenal ulcers --- correct answer ---chronic, intermittent pain in the epigastric region When do patients with duodenal ulcers typically have the most pain (2) --- correct answer ---30min-2hrs after eating or in the middle of the night (d/t stomach being empty) Where do we typically see peptic ulcer disease? (3) --- correct answer ---lower esophagus, stomach and duodenum What is the first line medication for treatment of major depression --- correct answer ---SSRI's What factors affect antidepressant prescription? (5) --- correct answer --- symptoms, age, side effects, safety and cost What is social anxiety disorder? --- correct answer ---Fear and avoidance of social situations Positive schizophrenia symptoms (3) --- correct answer ---hallucinations, thought disorder and bizarre behaviors Negative schizophrenia symptoms (5) --- correct answer ---flattened affect, alogia, anhedonia, attention deficit and apathy Cognitive schizophrenia symptoms --- correct answer ---inability to perform daily tasks that require attention and planning What would imaging show for patients with schizophrenia (2) --- correct answer --- Enlarged lateral & third ventricle and widened frontocortical fissures and sulci What people are more at risk for developing hypothyroidism? (2) --- correct answer ---Women and elderly Treatment for hypothyroidism --- correct answer ---Levothyroxine What can cause adrenal crisis? --- correct answer ---Improper weaning off glucocorticoid meds key symptoms associated with parkinson's disease (5) --- correct answer --- shuffling gait, dysphagia, resting tremor, postural disturbance and dysarthia Risk factors for MS (3) --- correct answer ---smoking, vit D deficiency and epstein- barr virus what kind of disease is MS --- correct answer ---demyelinating characteristics of cluster headache --- correct answer ---unilateral trigeminal distribution of severe pain with ipsilateral manefistations symptoms of cluster headache (3) --- correct answer ---tearing on affected side, ptosis of ipsilateral eye and congestion of nasal mucosa Where does pain refer to in cluster headaches (2) --- correct answer ---midface and teeth characteristics of a migraine --- correct answer ---unilateral, throbbing pain that worsens with activity Symptoms of migraine headache (3) --- correct answer ---N/V, photophobia and phonophobia What type of migraine is most common --- correct answer ---migraine without an aura Characteristics of tension headache --- correct answer ---bilateral headache that feels like a tight band around the head what type of headache is the most common --- correct answer ---tension What cranial nerve is associated with bells palsy --- correct answer ---cranial nerve VII What cranial nerve is associated with trigeminal neuralgia --- correct answer --- cranial nerve V Symptoms of bells palsy --- correct answer ---asymmetry and inability to close eye, smile or frown on affected side Symptoms of trigeminal neuralgia --- correct answer ---severe sharp stabbing pain that worsens with chewing symptoms of bacterial meningitis or meningial irritation --- correct answer --- severe throbbing headache, severe photophobia, nuchual rigidity and positive kernig/brudinski Result of infarct in the ACA --- correct answer ---motor contralateral paralysis or paresis that is greater in the foot and thigh result of basal artery infarct --- correct answer ---loss of vibratory sense, sense of position with dysmetria, loss of two-point discrimination, impaired rapid alternating movement causes of rosacea (5) --- correct answer ---chronic sun exposure/damage, alcohol/hot beverage consumption, hormones, mites (demodex folliculorum) and mental stress/anxiety Most aggressive skin cancer --- correct answer ---melanoma typical presentation of plaque psoriasis --- correct answer ---well-demarcated, thick, silvery, scaly, erythamatous plaque surrounded by normal skin NR 507 Final Exam Advanced Pathophysiology 3 Cystitis (UTI) --- correct answer ---Uncomplicated, responds well to antibiotic. Caused mostly by e coli. No casts present in ua c& s pyelonephritis --- correct answer ---kidney infection Complicated Iv atb to treat Classic triad: vomiting, flank pain, fever Casts are present in ua c& s calcium oxalate --- correct answer ---most common type of kidney stone Most common site of renal calculus --- correct answer ---Ureterovesicular junction Gold standard diagnosis for renal calculus --- correct answer ---Ct scan True or false: all types of renal stones can be seen on ct scan --- correct answer --- True Kidney stones that pass on their own --- correct answer ---< 0.5 cm Kidney stones that cause obstruction --- correct answer --->1.0cm goals of treatment for renal stones --- correct answer ---manage acute pain promote passage of stone reduce stone size prevent new stone formation GFR <15 indicates what stage CKD --- correct answer ---stage 5 GFR 15-29 indicates what stage CKD --- correct answer ---stage 4 GFR 30-59 indicates what stage CKD --- correct answer ---stage 3 GFR 60-89 indicates what stage of chronic kidney disease --- correct answer --- stage 2 GFR 90-120 indicates what stage of CKD --- correct answer ---stage 1 Warning signs of GERD --- correct answer --->50 yrs old, odynophagia, N&V, weight loss, melena, early satiety Associated with GERD diagnosis, often asymptomatic --- correct answer ---hiatal hernia conservative treatment, suggestion is to eat small frequent meals and stay upright after eating --- correct answer ---sliding hiatial hernia Characterized by chronic intermittent epigastric pain, decreases after meals. Pain can occur in the middle of the night and disappears by the morning , no risk of cancer, Caused by NSAID use --- correct answer ---Duodenal ulcer Characterized by increased pain after meals. Increased risk of cancer --- correct answer ---Gastric ulcer depression theory that states the cause of depression is decreased levels of serotonin, norepinephrine and dopamine ( monamines) --- correct answer --- monoamine deficiency theory breaks in the integrity of the mucosa of the esophagus, stomach or duodenum, least likely to occur in the large intestine --- correct answer ---Peptic Ulcer disease social anxiety disorder --- correct answer ---an anxiety disorder involving the extreme and irrational fear of being embarrassed, judged, or scrutinized by others in social situations consistent finding , enlargement of lateral and third ventricles and the widening of the frontocortical fissures and sulci are characteristics of .... --- correct answer --- Schizophrenia the most common thyroid disorder --- correct answer ---hypothyroidism Released by the anterior pituitaty --- correct answer ---TSH Stage of schizophrenia that presents as withdrawn, seclusion, mimics depression -- - correct answer ---prodromal phase Stage of Schizophrenia that presents as more severe symptoms of delusions, hallucinations, disorganized speech --- correct answer ---active phase High TSH, low T4/TH, fatigue, diminished deep tendon reflexes= --- correct answer ---primary hypothyroidism cause of secondary hypothyroidism --- correct answer ---pituitary malfunction, hypothalamic malfunction Hypothyroidism symptoms --- correct answer ---low metabolism, cold intolerance, weight gain, fatigue, weak pulse, decreased alertness Thyroid Releasing Hormone (TRH) --- correct answer ---promotes the release of thyroid-stimulating hormone (TSH) in the hypothalamus hypothalamic-pituitary axis --- correct answer ---hypothalamus and pituitary action to regulate the levels of certain endocrine hormones through a negative feedback system hypothalamus--> TRH--> Pituitary--> TSH--> Thyroid--> TH (T3&T4) two categories of ophthalmopathy in graves disease --- correct answer --- functional: lag, upward gaze infiltrative: enlargement of ocular muscles two most distinguishing factors of graves disease --- correct answer ---pretibial myxedema exophthalmos hyperthyroidism/ grave's disease --- correct answer ---abnormally high secretion of thyroid hormones High TH and Low TSH, enlarged liver, hand tremors --- correct answer --- hyperthyroidism primary hyperthyroidism causes --- correct answer ---Grave's Disease (most common cause) Toxic Multinodular goiter Thyroid Carcinoma Toxic adenoma Thyroiditis Type of diabetes Caused by environmental factors viral infections H.Pylori exposure to cows milk lack of vitamin D --- correct answer ---type 1 DM Cause of hypoparathyroidism --- correct answer ---Thyroid or parathyroid surgery, autoimmune, congenital ___________ inhibits PTH secretion --- correct answer ---hypomagnesemia Hypercortisolism (Cushing's syndrome) --- correct answer ---hypersecretion of cortisol by the adrenal glands S/S of Cushing's --- correct answer ---truncal obesity, hypertension, diabetes mellitus, purple striae, moon face, buffalo hump , glucose intolerance preferred treatment for hypercorticolism --- correct answer ---transsphenoidal hypophysectomy Hypercortisolism (Addisonian crisis) onset --- correct answer ---hypotension N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP Cause of Addisonian crisis --- correct answer ---acute withdrawal of glucocorticoid therapy, ACTH increased, serum and urine cortisol levels are decreased in.... --- correct answer ---primary hypercortisolism smoking vitamin d deficiency and Epstein barr virus are risk factors of.... --- correct answer ---Multiple sclerosis cluster headache --- correct answer ---Unilateral, severe periorbital headache with tearing and conjunctival erythema. migraine headache --- correct answer ---a headache characterized by throbbing pain on one side of the head, pain worsens with activity, and is followed by nausea , vomiting or photophobia tension headache --- correct answer ---pain is like a band squeezing the head. Most prevalent type of headache. Bilateral pain Bell's Palsy --- correct answer ---temporary paralysis of the seventh cranial nerve that causes paralysis only on the affected side of the face Clinical manifestations of bacterial meningitis --- correct answer ---fever, nuchal rigidity, photophobia, headache, positive brudzinski and kernig's sign, confusion, skin rash, and changes in LOC Kernig's sign --- correct answer ---inability to extend the leg completely when the thigh is flexed Brudzinski's sign --- correct answer ---pain with resistance and involuntary flex of hip/knee when neck is flexed to chest when lying supine Aca infarct results in --- correct answer ---Motor deficits contra lateral paralysis Basilar artery infarct deficits --- correct answer ---Contra lateral loss of sense of position and movement sensations Rosacea --- correct answer ---Familial , increased by sun, heat, alcohol, hot beverages, hormones, derm mites,stress Melanoma --- correct answer ---The most serious form of skin cancer, thickness impacts diagnosis Plaque Psoriasis --- correct answer ---the most common type of psoriasis, characterized by plaques of thick, scaly red NR 507 Final Exam Advanced Pathophysiology 4 Dermatomes --- correct answer ---area of the skin that is mainly supplied by branches of a single spinal sensory nerve root. These spinal sensory nerves enter the nerve root at the spinal cord, and their branches reach to the periphery of the body. Substance release at the synapse --- correct answer ---Acetylcholine- Excitatory or inhibitory- alzheimers Norepi- Excitatory or inhibitory- sleep/wake cycle, SYNS transmission Dopa- Excitatory (h1 and h2 receptors) and inhibitory (H3 receptors). parkinson disease Spondylolysis --- correct answer ---structural defect (degeneration, fracture, or developmental defect) in the pars interarticularis of the vertebral arch (the joining of the vertebral body to the posterior structures). The lumbar spine at L5 is affected most often. -Heredity -Other congenital spinal defects motor and sensory areas of the brain --- correct answer ---Parietal lobe- major area for somatic sensory input, located along the postcentral gyrus. which is adjacent to the primary motor area in the precentral gyrus. Cause of respiratory Alkalosis --- correct answer ---- fever -anemia, -anxiety, panic -thyrotoxicosis -hyperventilation buffer molecules --- correct answer ----Plasma- Bicarbonate-carbonic acid and HGB. -Intracellular- Phosphate and protein Renal- Ammonia and Phosphate Cushing's disease --- correct answer ---- Excess endogenous secretion of ACTH (Corticotropin). -from a pituitary adenoma or by an ectopic secreting non pituitary tumor such as small cell carcinoma of the lung.or adrenal tumor (rare) - HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia, weight gain, thin hair, moon face, easy bruising, buffalo hump, protein wasting Cause of hypoparathyroidism --- correct answer ----decreased PTH -Damage to or removal of the parathyroid gland during thyroid surgery. - genetic syndromes, familial hypoparathyroidism, diGeorge syndrome, and idiopathic, or autoimmune Primary hypothyroidism labs --- correct answer ---*Increased levels of TSH and decreased levels of TH (Total T3 and total and free T4* Autoimmune- Presence of thyroperoxidase and thyroglobulin antibodies Thyroid Storm --- correct answer ----occurs in people who have severe hyperthyroidism and are subject to extreme stress (infection, trauma, burns, surgery, emotional). -Sudden release and increased action of thyroxine (T4) and triiodothyronine (T3) exceeding metabolic demands. -Hyperthermia, tachycardia, atrial tachydysrhythmias, high-output heart failure, agitation, n/v, diarrhea -Tx- beta blockers, block TH synthesis, corticosteroids, iodine, plasma exchange Thyrotoxicosis (hyperthyroidism) --- correct answer ---Increased metabolic rate, heat intolerance, thin hair, bulgy eyes, enlarged thyroid, heart failure, tachycardia, weight loss, diarrhea, warm skin, sweaty palms, pretibial myxedema. Muscle contraction ions --- correct answer ---Calcium is combined with troponin Long bone growth --- correct answer ---cartilage cells at the epiphyseal side of the physeal plate multiply and enlarge. Cartilage cells at the metaphyseal side of the plate are destroyed and replaced by bone. appendicular skeleton --- correct answer ---126 bones that make up upper and lower extremities, shoulder girdle, pelvic girdle valve problem in women --- correct answer ----Mitral valve prolapse -genetic or environmental disruption of valvular development during the fifth or sixth week of gestation Reversible myocardial ischemia --- correct answer ---Chronic coronary obstruction results in recurrent predictable chest pain called stable angina. Abnormal vasospasm of coronary vessels results in unpredictable chest pain called Prinzmetal angina OR unstable angina (impending infarction) Stable angina --- correct answer ---transient substernal chest discomfort, ranging from a sensation of heaviness or pressure to moderately severe pain -Feels like indigestion -May radiate to neck, lower jaw, left arm and left shoulder or back or down right arm -Pallor diaphoresis and dyspnea -relieved by rest and nitrates -Women (atypical chest pain, palpitations, sense of unease and severe fatigue) orthostatic hypotension --- correct answer ---decrease in SBP of at least 20, or decrease in DBP of at least 10 within 3 minutes of standing. -neurogenic, caused by ANS dysfunction -dizziness, blurring of vision, syncope, fainting -Tx: inc. salt intake, raise HOB, thigh-high stockings, erythropoietin, vomune, vasoconstrictors (midodrine) Isolated systolic hypertension --- correct answer ---High SBP, normal DBP -Associated with cardiovascular and cerebrovascular events, all age groups Insulin resistance in HTN --- correct answer ----associated with endothelial injury and affects renal function, causing renal salt and water retention L vs R heart failure --- correct answer ---L: Blood backs up into pulmonary (inadequate systemic circulation) Sx:pulmonary edema, waking in the middle of the night, SOB, fatigue R: Blood backs up in the body (inadequate pulmonary circulation) Sx:Peripheral edema, HTN, JVD, Dep. edema, hepatosplenomegaly infective endocarditis --- correct answer ----Infection and inflammation of the endocardium (esp valves). - Most common cause: Staphylococcus aureus. - Risk fx: prosthetic valve, congenital lesions associated with highly turbulent flow, IV drug use, long-term IV catheter, Pacemaker, heart transplant with defective valve, dental procedures with manipulation of gingiva, - Endocardial damage, Bacterial adherence, and formation of vegetations - Sx: fever, cardiac murmur, petechial lesions of the skin conjunctiva and oral mucosa, night sweats, weight loss, back pain, heart failure, Osler nodes (erythematous nodules on the pads of fingers or toes) Patho of DVT --- correct answer ---Accumulation of clotting factors leads to thrombus formation (often near a valve). Inflammation leads to further platelet aggregation. Thrombus grows proximally Virchow's Triad --- correct answer ---1) Venous stasis (associated with immobility, obesity, age, CHF) 2) Venous intimal damage (related to trauma, venipuncture, IV meds) 3) Hypercoagulable state ( from inherited disorders, smoking, liver disease, pregnancy, oral contraceptives, hormone replacement, malignancy) Physiologic response to anemia --- correct answer ---- Compensation for reduced blood volume causes interstitial fluid to move intravascularly (inc. plasma volume, dec. viscosity) causing hyperdynamic circulatory state (inc SV/HR/cardiac dilation and heart valve insufficiency). -Inc rate and depth of breathing, dizziness, fatigue, heart failure, Folate Deficiency Anemia --- correct answer ---People at risk: Pregnant/ lactating, alcoholics, chronic malnourishment, Labs for Iron def. anemia --- correct answer ---- Low- HGB/Hct/ mcv/plasma iron/ferritin, transferrin - High- Total iron binding capacity/free erythrocyte protoporphyrin -Normal- reticulocyte count/B12, Folate, Bili sickle cell anemia --- correct answer ---a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape -Chronic hemolysis, microvascular occlusions, and tissue damage, vaso occlusive crisis -abnormal or absent splenic function Cause of aplastic anemia --- correct answer ---Failure of bone marrow to produce mature cells causing pancytopenia (reduction of all 3 blood cell types) - Idiopathic, acquired stem cell defects, immune mediated - whole-body irradiation, viral infections, hepatitis, CMV, epstein-barr virus, herpes zoster, inherited -Chemica: alkylating agents, antimetabolites, benzene, chloramphenicol, arsenicals, carbamazepine, gold salts Autoimmune Hemolytic Anemia --- correct answer ---1) Warm reactive antibody type- IgG binds optimally to erythrocytes at a normal body temperature. 2) Cold agglutinin type- IgM antibodies optimally bind to erythrocytes at colder temps (lower than 31 deg. Celsius). Recognized by phagocytes in the liver and spleen. Fingers, toes, ears, may have obstructed blood flow 3) Cold hemolysin type- Hemoglobinuria Acquired disorders caused by autoantibodies or complement or both, on RBCs against antigens normally on the surface of erythrocytes. Secondary Polycythemia --- correct answer ----physiologic response from increased erythropoietin secretion in response to chronic hypoxia. -Noted in people living in high altitudes, smokers, COPD, CHF -Abnormal hgb Anemia of chronic renal failure --- correct answer ---- Kidney damage affects secretion of erythropoietin, diminishes bone marrow erythropoiesis. - Uremic toxins that increase in the blood d/t renal failure may suppress bone marrow function and damage erythrocytes - Platelet dysfunction (bleeding) - loss of erythrocytes Hypovolemic shock --- correct answer ---Loss of whole blood (hemorrhage), plasma (burns), or interstitial fluid (sweat, DM, DI, emesis, diuresis) in large amounts. Deep tissue pressure ulcer healing --- correct answer ---Bacteria colonize the dead tissue, and infection is usually localized and self-limiting. Proteolytic enzymes from bacteria and macrophages dissolve necrotic tissues and cause a foul-smelling discharge that resembles, but is not, pus. The necrotic tissue initiates an inflammatory response with potential pain, fever, and leukocytosis. Contractures and wound healing --- correct answer ---- Burn wounds are susceptible to contractures. -Internal contractures= Common in liver cirrhosis - Scar tissue that is contracted constricts blood flow and may contribute to portal hypertension and esophageal varices. -Control myofibroblast contraction by giving colchicine and prevent collagen cross- linking or MMP activity. -Myofibroblast binding to collagen can "lock" contracted cells in position. tactile fremitus --- correct answer ---palpable vibration- Usually indicative of pneumonia Pneumothorax --- correct answer ---Primary (Spontaneous)- Occurs unexpectedly in healthy people. Rupture of bleb on visceral pleura.Apex of lung. rx: smoking Secondary (Traumatic)- chest trauma (Stab, rib fx, bullet) Iatrogenic- caused by transthoracic needle aspiration Open (communicating)- Air pressure in pleural space equals barometric pressure b/c air that is drawn into pleural space during inspiration is forced back out during expiration. Tension- One-way valve- air enters during inspiration and cannot exit during expiration. Air pressure exceeds barometric pressure. displaces heart, trachea, and great vessels. Life threatening Alpha-1-antitrypsin deficiency --- correct answer ---- Primary emphysema - Autosomal recessive inherited - Proteolysis in lung tissues is not inhibited Surfactant in ARDS --- correct answer ---Becomes inactivated, and production by type 2 alveolar cells is impaired as alveoli and bronchioles fill with fluid and collapse. -Atelectasis and decreased lung compliance Cheyne-Stokes respiration --- correct answer ---alternating periods of slow, irregular respirations and rapid, shallow respirations, possibly along with periods of apnea - High PaCO2 needed to stimulate ventilation, but leads to tachypnea. When PaCO2 decreases, apnea occurs. How vaccines are formed --- correct answer ---1) Characterizing the desired protective immune response (Antibody, t-cell) 2) Identify the antigen to induce that response (immune responses against some agents on an infectious agent are ineffective to increase risk for infection) 3) determine the most effective route (oral, inhaled) 4) Optimize the #/timing of vaccine doses 5) Decide on the most effective form for administration (live, inactivated) Antibiotic resistance --- correct answer ----Enzymatic inactivation of antibiotics -Multi-drug-resistance transporters (MDRs) -Resistance genes- Spread by horizontal gene transfer -Decreased uptake of the ATB by the bacteria (ex. thickened cell walls) Normal flora --- correct answer ----Compete with pathogens for nutrients and block attachment to the endothelium -Produce chemicals (ammonia, phenols, indoles) and toxic proteins (bacteriocins) that inhibit colonization of pathogenic microorganisms. -Helps develop local and systemic adaptive immune systems. Desensitization therapy --- correct answer ---Repeated exposure to stimulus which gradually reduces intense reaction. -Works best for routine respiratory tract allergens and biting insect allergies. -Not good for food allergies -Blocks circulating IgG. Allergen is unable to bind with IgE on mast cells "left-shift" in WBC differential --- correct answer ----When demand for mature neutrophils exceeds the supply -Premature release of immature WBCs (leukocytes) Immunity --- correct answer ----Innate/Natural/Native- Natural barriers (physical, mechanical, and biochemical-in place at birth) and inflammation (2nd line of defense, prevent infection, promote healing) -Passive-preformed antibodies or T lymphocytes are transferred from a donor to the recipient (only temporary) (placenta to fetus) - Tx: surgery Duchenne Muscular dystrophy --- correct answer ---- Most common and most severe X-linked recessive disorder -Progressive muscle degeneration (unable to walk by 10-12yo) - Affects heart and resp muscles and death usually before 20yo - dystrophin is absent Multifactorial traits --- correct answer ---traits that result from the interaction of one or more environmental factors and two or more genes -BP, Height, quantitative traits, , cancers, DM, CAD, Stroke -Follow a normal or bell-shaped distribution in populations -Diseases do not have bell-shaped distribution Transcription --- correct answer ---The process by which RNA is synthesized from a DNA template. - results in messenger RNA -RNA polymerase binds to a promoter site on DNA -transcription factors bind to transcription factor binding sites (regulate timing of transcription and tissues) -Each transcribed segment corresponds to one gene that makes up our chromosomes Genetic mutations occur when: --- correct answer ---1) an existing error in coding is transcribed to the new DNA 2) a transcription error occurs that results in an error in coding 3) mutation in the coding occurs after transcription. Chromosomes --- correct answer ---Somatic cells -46 chromosomes (23 pairs)- muscles, liver, epithelial, etc-Diploid (2N) Gamete cells- 23 chromosomes (one from each of the 23 pairs)- Egg or sperm- Haploid (1N) Translation --- correct answer ---involves the actual synthesis of protein DNA and genetics --- correct answer ---Genotype- individual's chromosomes- the blueprint Phenotype- the physical end results (eye color, hair color, blood type) -Human genome= 20,000 genes -97% of genes are noncoding DNA -3% codes for synthesis of 60,000-80,000 different proteins, enzymes, hormones, ion channels, cell membrane receptors -99.9% of DNA in humans is the same genetic mutations --- correct answer ---spontaneously or as the result of exposure to external mutagens such as radiation, chemicals, viruses -like typos in our DNA -Base pair substitution- simple typo- may cause problems, may not -Frame shift mutation- gibberish, complex typo, nothing makes sense- very complex NR 507 Final Exam Advanced Pathophysiology 5 Which of the following is true regarding a complicated urinary tract infection? --- correct answer ---Can be caused by a structural urinary tract disorder Which of the following is a risk factor for the development of a urinary tract infection (UTI)? --- correct answer ---Pregnancy A symptom of a lower urinary tract infection includes: --- correct answer ---urgency Women are at a higher risk for the development of a UTI because of having a shorter urethra. --- correct answer ---true Which of the following can help to prevent a UTI? --- correct answer ---Increase water consumption Uncomplicated UTI --- correct answer ---Occurs in the normal urinary tract Responds well to short course of antibiotic therapy Simple cystitis in non-pregnant women without any urologic abnormalities Complicated UTI --- correct answer ---UTI extends beyond the bladder Caused by structural or functional urinary tract abnormalities or untreated UTI Infants and older adults affected Associated with: indwelling catheters, renal calculi, diabetes, pregnancy A 25 year- old female presents to the primary care office with urinary burning and frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological history is negative and reports no vaginal discharge. The only new Men who have BPH are prone to developing a UTI because: --- correct answer --- Stagnated urine in the bladder promotes bacterial growth. The prostate specific antigen (PSA) helps to liquefy semen post-ejaculation. --- correct answer ---true The underlying cause of BPH is that normal prostate cells respond to increases in dihydrotestosterone that causes them to live longer and multiply. --- correct answer ---true The location of the characteristic hyperplastic nodules of BPH is: --- correct answer ---In the periurethral zone. The type of stone that forms due to a urinary tract infection is: --- correct answer -- -Struvite stone. Renal stones are formed when calcium and oxalate in the urine combine. --- correct answer ---true Renal calculi are typically confined to the bladder. --- correct answer ---false The most common type of stone is: --- correct answer ---calcium stone The gold standard for diagnosing a renal stone is a urinalysis. --- correct answer --- false (ct scan) A 45-year-old male presents to the primary care office with right flank pain that he describes as unremitting; he also reports nausea and vomiting. The NP performs an exam and observes him writhing in pain on the exam table with the inability to find a comfortable position. He is afebrile, BP 156/88 mmHg and HR 106/min. Right flank is mildly tender on palpation. Abdominal exam is negative for any abnormality. A urinalysis was performed and revealed 1+ blood. Urine microscopy also revealed 10-20 RBCs per high-power field (hpf). A kidney stone is suspected. The patient reports no prior history of a kidney stone. After providing the patient an analgesic, where the patient reported mild relief, the NP had the patient transferred to the emergency room for intravenous fluids, pain management and further work-up for the kidney stone. Upon follow-up in the office a week later, the patient reported that he was diagnosed with --- correct answer ---adequate hydration balanced diet Lithotripsy is an invasive procedure used to break up the stone --- correct answer -- -false The most common stone found in the patient with gout is: --- correct answer ---uric acid stone Hematuria can be seen with kidney stones because: --- correct answer ---The stone injures the urinary structures as it passes through them. Renal colic is caused by the passing of the stone through the ureter. --- correct answer ---true At least half of individuals with renal stones will have a reoccurrence within 10 years of the prior stone. --- correct answer ---true Which of the following actions will relax the detrusor muscle of the bladder? --- correct answer ---Activation of Beta-2 receptors by the sympathetic nervous system. The relay station in the brain that plays a major role in regulating micturition is: -- - correct answer ---Pontine micturition center. The location of the internal sphincter is under the urogenital diaphragm. --- correct answer ---false (located in the bladder) When the bladder is empty, the detrusor muscle relaxes, and the internal and external sphincters constrict. --- correct answer ---true The levator ani muscle plays a major role in constriction of the external sphincter. --- correct answer ---true stress incontinence --- correct answer ---leakage of urine with activity Increased intra-abdominal pressure causes leaking because there is no resistance to counteract the intra-abdominal pressure urge incontinence --- correct answer ---leakage of urine with sensation of need to urinate Detrusor muscle hyperactivity leads to urine leakage neurogenic incontinence --- correct answer ---unimpeded urine leakage Neurological lesions alter nervous system impulses that innervate the detrusor muscle. The result is decreased bladder compliance and decreased sphincter tone overflow incontinence --- correct answer ---leakage of urine is associated with urgency, frequency, dribbling, and hesitancy Leakage is due to retained urine in the bladder that leads to over-distention A 54-year-old female reports to the primary care office with complaints of frequent urination. She reports that she is "leaking" urine several times a day, especially when she coughs, sneezes, or lifts a heavy object. She indicates that she has not experienced any dysuria or any urgency. The NP looked at the patient's previous urine culture obtained approximately 1 month ago and determined that it was negative. Other than her urinary complaints, she is in otherwise good health. BP 128/76; HR 78 bpm; T 98.6; Ht. 5'4"; Wt: 180lbs.; BMI 30.9. The NP performs a One of the issues that requires management of a patient with acute renal failure is hypokalemia --- correct answer ---false (Hyperkalemia) The result of vitamin D deficiency results in: --- correct answer ---hypocalcemia The number one cause of end-stage renal disease is diabetes mellitus and hypertension combined. --- correct answer ---true Stage III kidney disease is signified when the GFR drops below 60. --- correct answer ---true Which of the following is a complication of decreased GFR? --- correct answer --- anemia The anemia seen in renal failure is due to the lack or iron. --- correct answer --- false (Anemia occurs because there is a reduced production of erythropoietin which is responsible for triggering the production of RBCs rather than the lack of iron or a decrease in the RBCs) stage 1 --- correct answer ---There is kidney damage with normal or elevated GFR (90-120) Stage 2 --- correct answer ---There is kidney damage with mild decrease in GFR (60-89) stage 3 --- correct answer ---There is a moderate decrease in GFR (30-59) stage 4 --- correct answer ---There is a severe decrease in GFR (15-29) stage 5 --- correct answer ---Kidney failure- End-stage renal disease (<15 dialysis) Need dialysis with these symptoms --- correct answer ---Metabolic acidosis. Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an indication for dialysis. Hyperkalemia by itself is not an indication for dialysis. Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol). Fluid volume overload that is not responsive to diuretics. Uremic symptoms due to nitrogenous wastes in the blood stream. The decision to begin dialysis is guided by the patient's symptoms rather than GFR. --- correct answer ---true Diuretic therapy is used in Stage IV kidney failures to stimulate kidney function. --- correct answer ---false (diuretics used for stages 1-111 and dialysis for 4 and 5) The major acid/base disturbance in renal failure is: --- correct answer ---metabolic acidosis Dietary management of a patient with CKD includes: --- correct answer ---low potassium, low sodium, and low phosphate The Monoamine Deficiency Theory states that the underlying basis of depression is low levels of serotonin, norepinephrine and dopamine. --- correct answer ---true Dysthymia is a persistent depressive disorder used to describe milder symptoms of depression that happen over longer periods of time. --- correct answer ---true Despite the different classifications, all antidepressant medications are equally effective in reducing the major symptoms of major depressive disorder. --- correct answer ---true Selective Serotonin Reuptake Inhibitors are the most common antidepressants prescribed. --- correct answer ---true Electroconvulsive Therapy (ECT) is no longer used as a treatment of major depressive disorder (MDD). --- correct answer ---false (Still used) Post-partum depression --- correct answer ---after childbirth, a mother's depressed mood (hormonal change accompanies) atypical depression --- correct answer ---improved mood when exposed to pleasurable or positive events A 42-year-old female presents to the primary care clinic with a three- month history of "feeling low", poor energy, inability to concentrate and irritability. She is concerned about her loss of interest in her usual social activities of walking with her friends and participating in her sewing group. She is especially concerned about her recent 15-pound weight gain. Other reported symptoms are frequent headaches, difficulty getting out of bed in the morning, and feeling worthless. She denies suicide ideation. She reports a family history of depression (mother and sister) and denies any consumption of drugs and alcohol. She is divorced and has a grown son who lives approximately one hour away but rarely sees because of his work schedule. The patient is interested in knowing if her symptoms are related to depression. Upon initial evaluation, the NP considers if the patient meets the criteria for MDD by consulting the DS --- correct answer ---Depressed mood Fatigue/loss of energy Loss of interest/Anhedonia Feeling worthless or having excessive guilt Insomnia or hypersomnia Poor concentration Recurrent thoughts of death, suicide, a suicide plan or attempt Psychomotor agitation or retardation indicates that one of the casinos there needs her help decorating for the upcoming 4th of July. Her spouse tells the primary care provider that she has become obsessed with going to Las Vegas since seeing a commercial about the 4th of July events advertised. What is the best diagnosis for his wife? --- correct answer ---Bipolar 1 In a mixed episode, the individual experiences symptoms of depression and mania simultaneously. --- correct answer ---true In rapid cycling, the individual has 4 or more episodes of depression and mania within one year. --- correct answer ---true Lithium is best at treating both manic and depressive episodes. --- correct answer -- -false (only manic) Talk therapy and cognitive behavioral therapy are not helpful in treating the manic episodes of bipolar disorder. --- correct answer ---true Major depression is required to be present in order to diagnose Bipolar 1 and Bipolar 2 disorder. --- correct answer ---false (Major depression may be present in both but not required for diagnosis) Benzodiazepines are drugs that reduce depression associated with the individual's anxiety. --- correct answer ---false (psychoactive drugs that reduce anxiety by providing calming effect on individual) Generalized Anxiety Disorder (GAD) is episodic in nature that is brought on by stressful situation --- correct answer ---false (GAD is characterized by excessive, persistent, unreasonable anxiety about everyday situations) Psychotherapy helps the individual to think and act in different ways to deal with stressful situation --- correct answer ---true Cognitive behavioral therapy has major advantages over medications in the long- term treatment of anxiety --- correct answer ---true Physical manifestations can also be associated with Generalized Anxiety Disorder -- - correct answer ---true B. R. is a 20-year-old college student who reports feeling anxious "about everything", restlessness and irritability. She reports no significant past medical or mental health history. She states that her anxiety started about 6 months ago when she decided to change her major to pre-med and complete an application to participate in a summer pre-med preparation program. During an open house meeting with the medical school academic advisors attended by all students applying for the summer program, she learned that only 50 students would be selected out of 450 applications to participate in the summer program. Despite wanting to enter the summer program, she felt that she would be unable to cope with the pressure associated with a short summer program or the rejection if she was not selected. She told the NP that she did not feel "good enough" to be selected as she compared herself to the other applicants. She said that --- correct answer --- Generalized anxiety disorder J.J. is a 44-year-old male who works as a department head for a Fortune-500 company that is down-sizing due to economic reasons. Top level management has announced that there will be restructuring of the company where many of the management roles will be consolidated. Some department head positions will be eliminated altogether. Each department head has been given the task of developing a presentation to provide an overview of their department specifically sharing data to demonstrate productivity and the meeting of company initiatives. From the moment J.J. read the email outlining the presentation requirements, he started to feel fearful of the possibility of losing his job. On the day of delivering the presentation, all department heads were present with top-level management. As he listened to the other department heads deliver their presentations, he began to feel nausea. He even noticed his heart pounding. When it --- correct answer ---Panic attack R.D. is a 34-year-old female who is engaged to be married in one month. This will be her second marriage. She has been divorced for three years. Her fiancé, who has never been married, has invited his parents to town to meet their soon- to - be daughter-in-law. R.D. learns that her future in-laws have very traditional thoughts on marriage, specifically, unfavorable thoughts about divorce. On the day of the parent's arrival, R.D.'s fiancé asks her to pick them up from the airport. R.D. agrees, but starts to feel uneasy about it. She is concerned that they will not accept her because of her previous divorce, although she has spoken to them on the phone and they were very gracious and accepting of their son's relationship with her. The closer she got to the airport, the more uneasy she felt to the point of disorientation. Just before entering the airport terminal, she turned around and called her fiancé to inform him th --- correct answer ---social anxiety A panic attack involves a very stressful situation where the individual develops an intense fear that something bad will happen. --- correct answer ---true Serotonin Selective Reuptake Inhibitors (SSRIs) are commonly prescribed to create a relaxing effect in the anxious individual. --- correct answer ---true Which of the following is a situation where the individual may experience social anxiety? --- correct answer ---Making small talk (think of adult interaction) Antiseizure medication can be used in severe panic attacks. --- correct answer --- true Monitoring the panic attacks using a diary can be an effective component of psychotherapy. --- correct answer ---true More men than women seem to be affected by schizophrenia with onset in the mid- twenties. --- correct answer ---true 4. thinks someone in his rival frat is trying to murder him 5. cell phone is wire-tapped 6. sits and stares 7. refuses to answer any questions In the active phase of schizophrenia, the individual experiences more severe delusions, hallucinations and disorganized behavior. --- correct answer ---true Which of the following symptoms together would be used in the diagnosis of schizophrenia? --- correct answer ---Delusions and hallucinations In the residual phase of schizophrenia, the individual may exhibit cognitive symptoms of not being able to concentrate or becoming withdrawn. --- correct answer ---true Which of the following cognitive symptoms are seen in schizophrenia? --- correct answer ---Memory. Ability to learn new things. Understanding. Avolition is the lack of content in speech. --- correct answer ---false (decrease in motivation to complete certain goals) NR 507 Final Exam Advanced Pathophysiology 6 Fat Soluble Hormones --- correct answer ---Steroids Water Soluble Hormones --- correct answer ---Need 2nd Messenger to transport across phospholipid membranes Pituitary Hormones --- correct answer ---TSH, GH, ACTH, FSH, LH, Oxytocin, ADH, Melanocyte Stimulating Hormone Anterior Pituitary --- correct answer ---Acct for 75% of total weight of pituitary gland. Three regions, pars distalis, parts tuberalis, and pars intermedia. Pars distalis is major component of Anterior Pituitary and source of Anterior Pituitary Hormones. Posterior Pituitary (neurohypophysis) --- correct answer ---Arises from 3rd ventricle of brain, consists of three parts, median eminence, pituitary stalk, and infundibular process (pars nervosa or neural tube). Median eminence is composed mainly of nerve endings of axons that arise primarily from ventral hypothalamus. Hypothalamic releasing Hormones in Posterior pituitary's median eminence. --- correct answer ---Includes 10 hypothalamic releasing hormones and neurotransmitters such as dopamine, norepinephrine, serotonin, acetylcholine, and histamine. Pituitary stalk --- correct answer ---contains axons of neurons that originate in the supraoptic and paraventricular nuclei of the hypothalamus. Hormones of posterior pituitary --- correct answer ---ADH, and Oxytocin (Peptide Hormones) ADH (antidiuretic Hormone) --- correct answer ---Major homeostatic function of posterior pituitary is control of plasma osmolality, as regulated by ADH Hypothalamic hormones and target tissues (Hypophysiotropic hormones) --- correct answer ---HORMONES: Thyrotropin Releasing Hormone (TRH), Gonadotropoin-releasing hormone (GnRH), Somatostatin, Growth hormone- releasing hormone (GHRH), corticotropin-releasing hormone (CRH), Substance P, Dopamine, Prolactin-releasing factor. TARGET Tissue: Anterior Pituitary Somatostatin --- correct answer ---Inhibits release of growth hormone and TSH Gonadotropoin-releasing hormone --- correct answer ---Stimulates release of FSH and LH Dopamine --- correct answer ---Inhibits synthesis and secretion of prolactin Prolactin-releasing factor (PRF) --- correct answer ---Stimulate secretion of prolactin Tropic Hormones of Anterior Pituitary and their function --- correct answer --- ACTH, Melanocyte-stimulating Hormone (MSH, Somatotropic hormones, GH, prolactin, LH, TSH, FSH, glycoprotein hormones Adrenocorticotropic hormone (ACTH) --- correct answer ---SECRETORY CELL TYPE: Corticotropic TARGET ORGANS: Adrenal Gland (cortex) FUNCTIONS: Increased steroidogenesis (cortisol, and androgenic hormones Prolactin, --- correct answer ---Milk production TSH --- correct answer ---Increased production and secretion of thyroid hormone Luteinizing Hormone (LH) --- correct answer ---Ovulation, progesterone production (in glanulosa cells) Follicle Stimulating Hormone (FSH) --- correct answer ---Follicle maturation, estrogen production (In Women: Granulosa Cells, In Men: Sertoli Cells) IGF (insulin-like growth factors) --- correct answer ---IGF-1, and IGF-2, IGF-1 most biologically active. IGF-2 causes a negative effect on tissue thus balancing IGF-1 Pineal Gland --- correct answer ---Located in the brain and composed of photoreceptive cells that secrete melatonin. Melatonin --- correct answer ---In Pineal Gland. Its' release is stimulated by darkness, and inhibited by light exposure. It is synthesized from tryptophan which is first converted to serotonin than to melatonin. Thyroid hormone (TH) is regulated by: --- correct answer ---through a negative feedback loop involving hypothalamus Thyrotropin-releasing hormone (TRH) --- correct answer ---synthesized and stored within the hypothalamus initiates negative feedback loop TRH levels increase with exposure to what? --- correct answer ---Cold or stress and decreased levels of T4. TSH is a glycoprotein synthesized and stored where? --- correct answer ---Anterior pituitary When TSH is secreted by the anterior pituitary it circulates to bind with what? --- correct answer ---TSH receptor sites located on plasma membrane of thyroid follicular cells What are the effects of TSH on the thyroid? --- correct answer ---increase in release of stored thyroid hormone, increase in iodide uptake and oxidation, and increase in thyroid hormone synthesis, increase in the synthesis and secretion of prostaglandins by the thyroid. Thyroid hormones have a ____________feedback effect. --- correct answer --- Negative Thyroid hormone inhibit what hormones? --- correct answer ---TRH and TSH which decreased TH synthesis and secretion. T3 and T4 thyroid hormones regulate many functions in body. --- correct answer --- Calcitonin --- correct answer ---Elevated serum calcium (major stimulant for calcitonin), regulates gastrin, pregnancy, lowered serum calcium, (suppresses calcitonin release). Calcitonin lowers serum calcium by opposing bone resorbing effects of PTH, prostaglandins, and calciferols by inhibiting osteoclastic activity. Thyroid hormones affect many body tissues and influence the genetic expression of specific proteins. They affect cell metabolism by altering what? --- correct answer - --protein, fat and glucose metabolism, and as a result heat production and oxygen consumption are increased. Calcitonin are used to treat what? --- correct answer ---Osteoporosis, osteoarthritis, Paget bone disease, hypercalcemia, osteogensesis imperfecta, and metastatic cancer of bone. Precursor molecule to calcitonin is what? --- correct answer ---procalcitonin (stress hormone) which is elevated in infection and inflammation and can aid in diagnosing disease. Parathyroid glands. --- correct answer ---2 pairs but may range from 2-6. Located behind the upper pole and lower pole of the thryoid gland. Parathyroid gland produce what? --- correct answer ---PTH PTH works with Vitamin ? --- correct answer ---Vitamin D to increase serum calcium concentration and decrease serum phosphate level. What other 2 things affect PTH levels? --- correct answer ---Magnesium and phosphate What is the function of PTH? --- correct answer ---The overall effect of PTH secretion is to increase serum calcium concentration and decrease serum phosphate level. What acts as a stimulant to secrete PTH in people with normal calcium levels? --- correct answer ---Hypomagnesemia What happens with PTH when a person with hypocalcemia have hypomagnesium? - -- correct answer ---PTH secretion is decreased. Hyperphosphatemia leads to what? --- correct answer ---hypocalcemia because of calcium phosphate precipitation in soft tissue and bone. Alterations in serum phosphate levels may indirectly influence PTH secretion by affecting what? --- correct answer ---serum calcium levels PTH hormone effects are mediated by what? --- correct answer ---Adenylyl cyclase system To achieve regulation of serum calcium concentration, PTH acts directly on what? - -- correct answer ---Bone and Kidneys PTH secretion stimulates what? In acute hypocalcemia to release receptor activator for nuclear factor-kappa beta ligan (RANKL) and macrophage colony stimulating factor which results in osteoclasts proliferation, maturation and release of acidic enzymes, such as cathepsin. --- correct answer ---osteoblasts Cathepsin --- correct answer ---This enzyme mobilize calcium release from bone which increases the serum calcium level. Chronic stimulation of PTH results in what? --- correct answer ---Bone remodeling.