Cellular and Molecular Biology Study Notes, Exams of Nursing

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NURS 231 PATHOPHYS FINAL EXAM

and answers 2024

A bodybuilder's muscles will display hyperplasia. \ CORRECT ANSWER IS False Barrett esophagus is an example of dysplasia \ CORRECT ANSWER IS false hypertrophy is an increase in the size of an organ or tissue caused by an increase in the number of cells \ CORRECT ANSWER IS True Lack of nerve stimulation can cause cells to atrophy \ CORRECT ANSWER IS True proportion of people with a disease who are positive for the disease \ CORRECT ANSWER IS sensitivity how likely the same result will occur if repeated \ CORRECT ANSWER IS reliability how a tool measures what it is intended to measure \ CORRECT ANSWER IS validity people without the disease who are negative on a given test \ CORRECT ANSWER IS specificity Which is NOT true of the cytoskeleton? \ CORRECT ANSWER IS it includes peroxisomes and proteasomes Which of the following are true of the cell? Select all that apply. \ CORRECT ANSWER IS 1: Proteins carry out the functions of the cell membrane 2:Lysosomes are the digestive system of the cell 3:Microfilaments are thin, threadlike cytoplasmic structures Which are true of the cell membrane? Select all that apply. \ CORRECT ANSWER IS 1: Controls the transport of materials from the outside fluids to within 2:Helps with the conduction of electrical currents in nerve and muscle cells 3: Aids in the regulation of cell growth and proliferation Which are false of the mitochondria? Select all that apply. \ CORRECT ANSWER IS 1: They are found far from the site of energy consumption. 2:They control free radicals. High blood pressure is an example of which of the following? \ CORRECT ANSWER IS pathophysiology

A patient complains of chest pain and an elevated blood pressure. What are these examples of? \ CORRECT ANSWER IS signs and symptoms Which of the following is true of a test's sensitivity? \ CORRECT ANSWER IS If negative, it can safely be assumed that the person does not have a disease Chemical agents (poison, alcohol) are examples of which of the following? \ CORRECT ANSWER IS Etiologic factors Define tertiary prevention and give an example: \ CORRECT ANSWER IS Tertiary prevention occurs after a disease has been diagnosed and clinical intervention is needed to reduce complications or deterioration. One example is the use of certain medications one must take after a heart attack to help reduce the risk of a future event or death. Compare and contrast the two types of gangrenous necrosis. \ CORRECT ANSWER IS 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. Explain what necrosis is and give an example and description of one type of necrosis.
CORRECT ANSWER IS necrosis is cell death to an organ or tissue with still being apart of a living person. An example of this would be luiquefactive necrosis. this is when the cells die and the catalytic enzymes do not get destroyed after the cells death. This could cause necrosis sunburn \ CORRECT ANSWER IS radiation injury obesity \ CORRECT ANSWER IS nutritional imbalances reactive oxygen species \ CORRECT ANSWER IS free radical injury low oxygen to tissues \ CORRECT ANSWER IS hypoxic cell injury fractures \ CORRECT ANSWER IS physical agents OTC drugs \ CORRECT ANSWER IS Chemical injury hypothermia \ CORRECT ANSWER IS physical agents radiation treatment \ CORRECT ANSWER IS radiation injury lead toxicity \ CORRECT ANSWER IS chemical injury

bacteria \ CORRECT ANSWER IS biologic agents List the 4 types of tissue found in the body. Pick 2 and give a description and example of each. \ CORRECT ANSWER IS Epithelial tissue- covers the body's outer surface, it is avascular and gets its o2 from the capillaries found in the neighboring connective tissues, and example of this is simple squamous tissue which means one layer of thin cells. Muscular tissue Nervous tissue- is found all throughout the body, helps with communication between tissues and the central nervous system. it aids in the functions of the body due to internal and external stimuli, helps with movement, and electrical signaling. neurons are an example of this, they aid in communicating to other cells in the body, they are held and supported by glial cells. Connective tissue What term means "cell eating" and engulfs and then kills microorganisms or other particulate matter? \ CORRECT ANSWER IS Phagocytosis What is the term to describe when cells use energy to move ions against an electrical or chemical gradient? \ CORRECT ANSWER IS Active transport Give one function of a membrane potential: \ CORRECT ANSWER IS Generate nerve impulse, muscle contractions, or cause hormone secretion What is the term that best describes the following process? A transport protein aiding a lipid insoluble or large molecule across the cell membrane that would otherwise not be able to pass through on its own. \ CORRECT ANSWER IS facilitated diffusion Blood tests for tumor markers can make a diagnosis of cancer. Why or why not?
CORRECT ANSWER IS False, only tissue can diagnose. Tumor markers are helpful to assess response to therapy or reoccurrence. Tissue biopsy is of critical importance in what role? \ CORRECT ANSWER IS Diagnosing the correct cancer and histology. Explain the TNM system: \ CORRECT ANSWER IS T is the size and local spread of the primary tumor. N is the involvement of the regional lymph nodes. M is the extent of the metastatic involvement. List two signs or symptoms a patient may present with that might indicate a cancer diagnosis: \ CORRECT ANSWER IS fatigue, anemia

What are two systemic manifestations of cancer exhibited by cancer patients?
CORRECT ANSWER IS Weight loss, wasting of body fat and muscle tissue, weakness, anorexia, and anemia, fatigue, sleep disturbances When would surgery be appropriate in the treatment of cancer? \ CORRECT ANSWER IS if it is a solid tumor and has clear margins Most chemotherapeutic drugs cause pancytopenia due to bone marrow suppression. What are the 3 possible adverse outcomes of this? \ CORRECT ANSWER IS loss of RBCs, WBCs, and platelets, anemia, and hemolysis Cell proliferation is the process in which proliferating cells become more specialized cell types. \ CORRECT ANSWER IS false Cell differentiation is the process in which proliferating cells become more specialized cell types. Correct! \ CORRECT ANSWER IS True What are two important properties that stem cells possess? \ CORRECT ANSWER IS Potency and self-renewal Which of the following are most likely to have arisen from an adult stem cell?
CORRECT ANSWER IS Epithelial Define polyp. Are they benign or malignant? \ CORRECT ANSWER IS A polyp is a growth that projects from a mucosal surface, such as the intestine. A polyp can be benign or malignant What are normal genes called that become cancer-causing if mutated? \ CORRECT ANSWER IS protooncogenes What type of gene is involved in repairing damaged DNA? \ CORRECT ANSWER IS Tumor suppressor gene A 40-year-old woman has experienced heavy menstrual bleeding. She was told she has a uterine tumor called a leiomyoma. She is worried she has cancer. What do you tell her? Explain at least 2 differences between a benign and malignant tumor \ CORRECT ANSWER IS i would explain to her that it is a benign tumor, and that there is nothing to worry about 1 benign tumors grow by expansion and are usually encapsulated; while malignant tumors grow by invading and taking over tissue 2: benign tissue is well differentiated and looks like the tissue of origin, while malignant cells are undifferentiated and are atypical and do not look like the tissues of origin. A 50-year-old woman was diagnosed with breast cancer from tissue biopsy following her diagnostic mammography. They are determining if it has spread to the lymph nodes.

(1) Explain what the sentinel node is. (2) How will they determine if it has spread to the lymph system? (3) Would a detailed family history of disease be important to obtain?
CORRECT ANSWER IS The sentinel node is the first lymph node to which the primary tumor drains. The extent of disease may be determined through lymphatic mapping and sentinel lymph node biopsy. A radioactive tracer and/or blue dye is injected into the tumor to determine the first lymph node. This lymph node is examined for the presence of cancer cells. Yes, heredity can be a strong risk factor for cancer in some families. Malignant tumors have which of the following characteristics? Select all that apply
CORRECT ANSWER IS Variable rate of growth & Spreads by metastasis What are molecular and cellular mechanisms in genes that increase susceptibility to cancer? Select all that apply. \ CORRECT ANSWER IS 1:Lack of cellular senescence 2:Angiogenesis 3:Mutations in growth factor signaling pathways List 4 of the 7 risk factors linked to cancer as stated in the module. \ CORRECT ANSWER IS hereditary, obesity, environmental agents, immunological mechanisms

1. ______ is a systemic treatment that enables drugs to reach the site of the tumor as well as other distant sites. \ CORRECT ANSWER IS chemotherapy The profound weight loss and wasting of fat and tissue that accompany cancer is known as _______. \ CORRECT ANSWER IS wasting or Cancer anorexia cachexia syndrome Which of the following is not a risk factor for developing cancer? \ CORRECT ANSWER IS Sunscreen All of the following viral agents are correctly paired with the associated lesion except:
   CORRECT ANSWER IS Epstein-Barr virus: carcinoma of the cervix List one example of screening for each method: observation, palpation, and lab test/procedure: \ CORRECT ANSWER IS observation: looking at the skin palpation: palpating breast for abnormal masses Lab: pap smear swabbing for cervical cancer Explain the challenges of diagnosing autoimmune disorders. \ CORRECT ANSWER IS 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. Which cell is the first responder to phagocytose a foreign invader? \ CORRECT ANSWER IS monocyte

What allows the lymphocyte to differentiate between self and foreign molecules?
CORRECT ANSWER IS Major histocompatibility complex (MHC) molecule T lymphocytes produce what type of immunity? \ CORRECT ANSWER IS Cell-mediated Which immunoglobulin passes immune factors from the mother to the fetus?
CORRECT ANSWER IS IgG Which cell type is an early responder and the most abundant in the body? \ CORRECT ANSWER IS Neutrophils Which feature is NOT of adaptive immunity? \ CORRECT ANSWER IS Epithelium is a defense mechanism 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? \ CORRECT ANSWER IS 1) 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. A narrow, surgical-type wound is likely to heal by secondary intention. \ CORRECT ANSWER IS false Which of the following is an incorrect pairing of a classic manifestation of acute inflammation with its corresponding cause? \ CORRECT ANSWER IS Dolor - inflammatory cells infiltrating sensory nerves B cells are primarily associated with humoral immunity. \ CORRECT ANSWER IS true T cells mature in the thymus and are active in cellular immunity. \ CORRECT ANSWER IS true B lymphocytes normally produce antibodies against host tissues. \ CORRECT ANSWER IS false Antibodies are also known as ______? \ CORRECT ANSWER IS immunoglobulin Which of the following hypersensitivity reactions can be treated with the administration of epinephrine \ CORRECT ANSWER IS type 1

Which cell is NOT part of the adaptive immune response? \ CORRECT ANSWER IS monocytes Features of systemic lupus erythematosus include all of the following except
CORRECT ANSWER IS Exophthalmos What are the 2 factors that play a role in the development of autoimmune diseases?
CORRECT ANSWER IS genetics and environmental factors A 40-year-old man presents with cough and shortness of breath. After an H&P and chest films, it is determined he has pneumocystis carinii pneumonia (PCP). The provider does an HIV test, which is positive. Upon further testing, the man's CD4+ cell count is 100 cells/μL and his viral load is 250,000 copies/mL. (1) Why did the provider do an HIV test after the man was diagnosed with PCP? (2) What classification does this man fall into based on his CD4+ count and symptomatology, and why \ CORRECT ANSWER IS (1) Opportunistic infections are those common organisms that do not produce infection without impaired immune function. (2) The last phase, or AIDS illness, occurs when the CD4+ cell count falls to less than 200 cells/μL or exhibits an AIDS- defining illness. The risk of opportunistic infections and death increases significantly when the CD4+ cell count falls below 200 cells/μL. Which process is NOT included in wound healing? \ CORRECT ANSWER IS Acute- phase response While labile and stable cells can regenerate themselves, _______ cells are unable to undergo mitotic division. \ CORRECT ANSWER IS Permanent cells ____ disorders occur when the immune system fails to differentiate self from non-self.
CORRECT ANSWER IS autoimmune The time between HIV infection and seroconversion is called what? \ CORRECT ANSWER IS the window period A person with HIV is not infectious when they are asymptomatic. \ CORRECT ANSWER IS False The T cells that display the host's MHC antigens and T-cell receptors for a nonself- antigen are allowed to mature, a process termed negative selection. \ CORRECT ANSWER IS False What cell mediator is the primary cause of vasodilation seen in acute inflammation?
CORRECT ANSWER IS Histamine The three stages of hemostasis include each of the following except: \ CORRECT ANSWER IS Vascular dilation

Which cell in the blood provides primary hemostasis \ CORRECT ANSWER IS Platelets Which of the following medications would decrease a person's risk for clotting? Select all that apply. \ CORRECT ANSWER IS 1: Heparin 2: warfarin 3: lovenox Which of the following is a hypercoagulable state? Select all that apply. \ CORRECT ANSWER IS congestive heart failure, smoking, and post-surgical state Which of the following are TRUE of hemophilia A? Select all that apply. \ CORRECT ANSWER IS Spontaneous joint bleeding can occur, The PTT is increased Which is NOT included in the three principles of blood flow? \ CORRECT ANSWER IS Compliance Which of the following does NOT affect the heart's ability to increase its output?
CORRECT ANSWER IS Cardiac reserve Which of the following is true of the renin-angiotensin-aldosterone system? \ CORRECT ANSWER IS Angiotensin II increases sodium reabsorption in the kidney by stimulating the secretion of aldosterone Which of the following does NOT lead to an increased risk for DVT? Select all that apply. \ CORRECT ANSWER IS Non-smoker Which of the following is NOT associated with iron deficiency anemia? \ CORRECT ANSWER IS Normocytic What are the two major causes of microcytic anemias? \ CORRECT ANSWER IS Iron deficiency anemia, Thalassemias Which of the following are potential causes of a sickle crisis in sickle cell anemia? Select all that apply. \ CORRECT ANSWER IS 1: dehydration 2: cold exposure 3: physical exertion The patient is found to be a severely malnourished alcoholic. The most likely cause of his anemia is: \ CORRECT ANSWER IS Folate deficiency Which of the following is NOT true of vitamin B12 deficiency anemia? \ CORRECT ANSWER IS Dietary deficiencies are common Each of the following are risk factors for secondary hyperlipidemia except? \ CORRECT ANSWER IS Autosomal dominant disorder of LDL receptor

Lifestyle changes to treat hyperlipidemia include each of the following except:
CORRECT ANSWER IS Increase red meat consumption Risk factors for atherosclerosis include each of the following except: \ CORRECT ANSWER IS Female gender (pre-menopause)

1. The three major determinants of myocardial oxygen demand (MVO2) include each of the following except: \ CORRECT ANSWER IS a. Diastolic pressure
2. ______ is the most important factor in myocardial oxygen demand. As this increases, myocardial oxygen consumption or demand also increases. \ CORRECT ANSWER IS heart rate
3. What is the most common cause of cardiogenic shock? \ CORRECT ANSWER IS myocardial infarction
4. Which does NOT occur during cardiogenic shock? \ CORRECT ANSWER IS decreased systemic vascular resistance Explain the differences in the pathophysiology, symptoms, and whether nitroglycerin and/or rest will relieve symptoms in stable angina, unstable angina, and myocardial infarction. \ CORRECT ANSWER IS stable angina is when you have angina with exertion, usually will go away with nitro or rest unstable angia is wen you have angina without exetion and it will not go away with rest, its not very constant and very unstable, may ease woth nitro Myocardial infarction is a heart attack, may include SOB, nausea, chest pain, numbness, or an abnormal EKG. this can easy with nitro but most likely the pt will be sent to the cath lab for catherization. Hypertension is often called "the silent killer." By the time symptoms of hypertension occur, the complications can affect the kidneys, heart, eyes, and blood vessels. What is this term called? \ CORRECT ANSWER IS target organ damage . Left ventricular hypertrophy is a major risk factor for what other diseases? Name at least 2. \ CORRECT ANSWER IS coronary heart disease, cardiac dysrhythmias, congestive heart failure, and sudden death. With increasing occlusion of the coronary vessel(s), the demands of the resting heart may become too great. When the patient experiences angina without exertion, or when the level of exertion necessary to cause anginal symptoms decreases, this is called what? \ CORRECT ANSWER IS Unstable angina A 40-year-old woman is hospitalized with a chronic illness characterized by hepatomegaly, distended neck veins, and peripheral edema. Which of the following

disorders is the most likely cause of these findings? \ CORRECT ANSWER IS Right heart failure Right ventricular failure is commonly characterized by each of the following changes except: \ CORRECT ANSWER IS Pulmonary edema Left ventricular failure is commonly characterized by each of the following except:
CORRECT ANSWER IS Liver congestion Which pharmacologic treatment of heart failure has a mechanism of action characterized by excretion of fluid, reducing preload: \ CORRECT ANSWER IS diuretic The laboratory test that measures the volume of red cells in 100 mL of blood is _____.
CORRECT ANSWER IS hematocrit are a group of inherited disorders of hemoglobin synthesis common among Mediterranean populations. \ CORRECT ANSWER IS Thalassemias The drug most commonly associated with inhibition of platelet aggregation is ______.
CORRECT ANSWER IS aspirin According to JNC 8 guidelines, what category does this patient's blood pressure fall into? What is hypertension a risk factor for? What lifestyle modifications would you suggest for them? Name one medication therapy for hypertension and its mechanism of action.
CORRECT ANSWER IS Hypertension stage 2 Atherosclerosis, CAD (MI), heart failure, stroke, peripheral artery disease Lose weight, exercise, decrease salt intake, decrease alcohol intake Diuretics, like thiazides, lower blood pressure by decreasing vascular volume; Even after forced expiration, a significant amount of air remains in the lungs.
CORRECT ANSWER IS TRUE Nearly all pulmonary emboli are thrombi arising from deep vein thrombosis in the upper and lower extremities. \ CORRECT ANSWER IS true ______ measures expiratory volume in a given time. \ CORRECT ANSWER IS Forced expiratory volume (FEV) The _____ are the actual sites of gas exchange between the air and blood. \ CORRECT ANSWER IS alveoli Intrapleural pressure is always negative in relation to alveolar pressure in a normal inflated lung. \ CORRECT ANSWER IS true

During inspiration, air is drawn into the lungs and the chest cavity is decreased.
CORRECT ANSWER IS false The diaphragm is the primary muscle of inspiration \ CORRECT ANSWER IS true Excess surface tension makes lung inflation harder. \ CORRECT ANSWER IS True Lung volumes can be measured using a ______. \ CORRECT ANSWER IS spirometer _____ is the flow of gases into and out of the alveoli of the lungs. \ CORRECT ANSWER IS Ventilation Which of the following cells contribute to airway inflammation in asthma? Select all that apply. \ CORRECT ANSWER IS Eosinophils, mast cells, neutrophils, Leukotrienes, and lymphocytes Alpha-1 antitrypsin deficiency is most likely seen in which disease process?
CORRECT ANSWER IS Emphysema Histologically, chronic bronchitis would exhibit each of the following except: \ CORRECT ANSWER IS Enlargement of the airspaces Each of the following are TRUE of ARDS except: \ CORRECT ANSWER IS Presents with decreased respiratory rate A 30-year-old man is brought to the ER with a knife wound to the chest. On visual inspection, asymmetry of chest movement during inspiration, displacement of the trachea, and absence of breath sounds on the side of the wound are noted. His neck veins are distended, and his pulse is rapid and thready. What is your initial diagnosis? What type of emergent treatment is necessary? \ CORRECT ANSWER IS 1) tension pneumothorax

2. chest tube When is the risk for obstructive atelectasis the greatest? What are strategies to decrease the chance for developing atelectasis? \ CORRECT ANSWER IS The risk of obstructive atelectasis is increased following surgery. Anesthesia, pain and pain medications, and immobility promote retention of bronchial secretions. Patients are encouraged to frequently cough, deep breath, change positions, hydrate adequately, and ambulate early to prevent atelectasis. Explain why the oxygen flow rate for people with COPD is normally titrated to maintain the arterial PO2 between 60 and 65 mm Hg. \ CORRECT ANSWER IS Their medullary respiratory center has adapted to the elevated CO2 levels and no longer responds to increases in PCO2. Therefore, a decrease in PO2 becomes the stimulus for respiration.

If oxygen is given at too high of a rate, it suppresses the stimulus and the respiratory drive. Each of the following can lead to atelectasis except: \ CORRECT ANSWER IS Thrombus Someone with COPD would exhibit each of the following characteristics except:
CORRECT ANSWER IS Increased D-dimer levels Ventilation \ CORRECT ANSWER IS The flow of gases into and out of the alveoli of the lungs Perfusion \ CORRECT ANSWER IS The flow of blood in the adjacent pulmonary capillaries Diffusion \ CORRECT ANSWER IS The transfer of gases between the alveoli and the pulmonary capillaries Each of the following disorders are correctly paired with related characteristics except:
CORRECT ANSWER IS Atelectasis - decreased respiratory rate 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? \ CORRECT ANSWER IS Focal seizure with impairment of consciousness or awareness Voluntary tongue movements are controlled by which cranial nerve? \ CORRECT ANSWER IS CN XII. You are seeing a patient with Parkinson's disease in your office. You feel a catch as you passively take their arm through flexion and extension. This is an example of what physical manifestation of the disease? \ CORRECT ANSWER IS Cogwheeling Sleep spindles are characteristic of which stage of sleep? \ CORRECT ANSWER IS Stage 2 A person reports a generalized depressed mood, changes in appetite, and irritability that gets worse as the day goes on. They also report that they sleep more than 8 hours which is affecting their productivity. What type of depression are they experiencing?
CORRECT ANSWER IS Atypical depression Each of the following statements is true regarding the organization of the nervous system except: \ CORRECT ANSWER IS The CNS has an afferent and efferent division

Each of the following statements is true regarding Alzheimer's disease except:
CORRECT ANSWER IS Neurofibrillary tangles are composed of deteriorating nerve pieces that arrange themselves around a sticky protein core called amyloid beta (Aβ) Each of the following are modifiable behaviors related to stroke except: \ CORRECT ANSWER IS Hypercholesteremia Primary insomnia is characterized by each of the following except: \ CORRECT ANSWER IS Can also be called comorbid insomnia What type of seizure occurs in 2 phases, involves a loss of consciousness, and lasts approximately 60-90 seconds? \ CORRECT ANSWER IS Tonic-clonic seizure Sleep disturbances associated with narcolepsy include each of the following except:
CORRECT ANSWER IS sleep apnea Each of the following statements is true of Parkinson's disease except: \ CORRECT ANSWER IS It is characterized by an increase of dopaminergic neurons Efferent neurons deliver _______ input from the CNS to the periphery. \ CORRECT ANSWER IS Motor SRIs ________ the reuptake of serotonin at the presynaptic space. \ CORRECT ANSWER IS inhibit _______ is sleep disordered breathing due to the brain not properly signaling the respiratory muscles. \ CORRECT ANSWER IS Central sleep apnea ________ utilizes electric impulses to inhibit or stop the abnormal nerve activity that causes tremor and other unwanted movement patterns associated with Parkinson's disease. \ CORRECT ANSWER IS Deep brain stimulation Specialized ependymal cells that project into the ventricles and produce CSF are called the ______. \ CORRECT ANSWER IS Choroid plexus Schwann cells produce myelin in the CNS. \ CORRECT ANSWER IS False, Schwann cells produce myelin in the PNS. Alterations in the HPA axis have been linked to PTSD. \ CORRECT ANSWER IS True Vital signs increase during stage 1 of NREM sleep. \ CORRECT ANSWER IS False, vital signs decrease during stage 1 of NREM sleep. Someone in the early stages of Alzheimer's disease requires assistance for their activities of daily living. \ CORRECT ANSWER IS False, in the early stages of Alzheimer's disease, individuals are still independent with their ADLs.

Explain how a chemical synapse produces an excitatory or inhibitory signal.
CORRECT ANSWER IS The presynaptic neuron will secrete neurotransmitters which diffuse into the synaptic cleft and bind to excitatory or inhibitory receptors on the postsynaptic membrane eliciting an excitatory or inhibitory signal in one direction. You are babysitting a 7-year-old child with a known history of seizure activity. You notice they appear flushed and seem unresponsive. You ask if they are feeling alright and they stare at you blankly. After a few seconds they act as if nothing happened and return to play. Is this a generalized or focal seizure? Based upon this description, what specific type of seizure did this individual experience? \ CORRECT ANSWER IS Generalized, Absence seizure Compare and Contrast breathing patterns between NREM and REM sleep (include a discussion on the specific stages of NREM sleep.) \ CORRECT ANSWER IS In stages 1 and 2 NREM sleep as well as in REM sleep, breathing is irregular, and brief periods of apnea are often observed (approximately 5-15 seconds.) During stages 3 and 4 of deep sleep, breathing becomes regular. A patient reports to the emergency department where you are working at 10 pm. They report that earlier in the day beginning at approximately 9 am they began to experience tingling in their right arm. They decided to ignore it thinking it was probably a result of all the gardening they did the day before. As the day went on, the tingling sensation got worse, and they started to have difficulty speaking. The patient's spouse reported that they were slurring their words. Past medical history includes a diagnosis of diabetes and hypercholesteremia. By the time they are evaluated, their symptoms start to subside. The tingling disappears and their speech returns to normal. What do you suspect this patient has experienced? What evidence is there to support that diagnosis?
CORRECT ANSWER IS This patient has experienced a TIA. They have experienced symptoms consistent with oxygen deprivation to the brain, however their symptoms subsided within 24 hours of their onset. A 75-year-old male is brought to the emergency department by their 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. 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. \ CORRECT ANSWER IS 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 should receive tPA drugs as they are within the 3-4.5 hour treatment window.

You are seeing a patient in your office with a primary complaint of excessive daytime sleepiness. Their spouse reports that they snore loudly and often wake up gasping for air. What type of sleep disorder do you suspect they are experiencing (be specific)? What type of diagnostic work up needs to be done? Name one treatment option to address this patient's symptoms. \ CORRECT ANSWER IS This pt is experiencing Moderate/ borderline severe Obstructive Sleep apnea, we need to see if he has any of the potential risk factors like large neck girth, obseity, male, etc. the pt needs to go under extensive sleep studies to confirm their OSA diagnosis. depending on the severity, life style changes can help with this apnea but a NCPAP machine or a mouth peice can be given to open the airways and help them not to collapse during the pts sleep. The liver is responsible for each of the following EXCEPT: \ CORRECT ANSWER IS Helps with digestion of lipids Complications of gallstones include each of the following EXCEPT: \ CORRECT ANSWER IS Cirrhosis Treatments for gastroesophageal reflux include each of the following EXCEPT:
CORRECT ANSWER IS Caffeinated beverages Treatment of irritable bowel syndrome includes each of the following EXCEPT:
CORRECT ANSWER IS Anti-diarrheal medication Each of the following factors are associated with increased incidence of peptic ulcer EXCEPT: \ CORRECT ANSWER IS Dietary history The most common complication of peptic ulcers is _____. \ CORRECT ANSWER IS Gastrointestinal bleeding Each of the following are characteristics of ulcerative colitis EXCEPT: \ CORRECT ANSWER IS Granulomatous lesions Each of the following are characteristics of Crohn disease EXCEPT: \ CORRECT ANSWER IS Bloody diarrhea The process of digestion begins in the stomach and finishes in the large intestine.
CORRECT ANSWER IS False is the process of moving nutrients and other materials from the external environment of the GI tract into the internal environment. \ CORRECT ANSWER IS absorption The double layer of peritoneum that holds the organs in place and stores fat is called what? \ CORRECT ANSWER IS mesentery What type of cell secretes gastrin? \ CORRECT ANSWER IS G cells

The amplitude and frequency of the slow waves is regulated by ______? \ CORRECT ANSWER IS Enteric nervous system Activation of the parasympathetic nervous system increases the amplitude of the slow waves. \ CORRECT ANSWER IS True is a linear chain of interconnecting neurons located between the circular and longitudinal muscle layers, involved with GI motility? \ CORRECT ANSWER IS Myenteric (Auerbach) plexus Food is converted in the stomach into a creamy mixture called? \ CORRECT ANSWER IS chyme Which GI hormone has strong growth hormone-releasing activity and stimulates food intake and digestive function? \ CORRECT ANSWER IS Ghrelin Which GI hormone inhibits gastric acid secretion? \ CORRECT ANSWER IS Secretin Anti-diarrheal medication can be used with all types of diarrhea. \ CORRECT ANSWER IS False Constipation and a low fiber diet are a major risk factor for developing what disease?
CORRECT ANSWER IS diverticulosis Clinical manifestations of cirrhosis include each of the following EXCEPT: \ CORRECT ANSWER IS Pancreatitis What is now the most common cause of chronic liver disease in the Western world?
CORRECT ANSWER IS Nonalcoholic fatty liver disease (NAFLD) A patient presents with right upper quadrant pain, that worsens after eating a fatty meal. What would be the best imaging modality to evaluate their complaint? \ CORRECT ANSWER IS Abdominal ultrasound Excessive red blood cell destruction would cause what type of jaundice? \ CORRECT ANSWER IS Prehepatic jaundice Each of the following statements are true regarding control over the GFR except:
CORRECT ANSWER IS The RAA responds when blood pressure rises above normal limits. Which of the following statements is false regarding ADH? \ CORRECT ANSWER IS Elevated levels of ADH will lead to dilute urine.

Cortical nephrons are characterized by the following except: \ CORRECT ANSWER IS They originate deep in the cortex Excess accumulation of fluid within the interstitial compartment is characteristic of which of the following fluid imbalances? \ CORRECT ANSWER IS Edema Reabsorption in the loop of Henle is characterized by the following except: \ CORRECT ANSWER IS Na+ and water are reabsorbed in equal proportions Which of the following is/are true regarding acid-base balance? (mark all that apply)
CORRECT ANSWER IS Acid-base balance refers to the balance of the concentration of hydrogen ions (H+) in the blood, Venous blood is characterized by a more acidic pH, A higher concentration of OH- ions will increase the pH of the blood Acute postinfectious glomerulonephritis is characterized by the following except:
CORRECT ANSWER IS Associated with a poor prognosis as it often leads to CKD Which of the following is characteristic of chronic transplant rejection? \ CORRECT ANSWER IS Involves humoral immunity Which of the following is true of 1,25-dihydroxycholecalciferol? \ CORRECT ANSWER IS It is the active form of vitamin D, converted in the kidney A patient is said to be in stage 4 kidney disease. What would you expect their GFR to be? \ CORRECT ANSWER IS A. 25 mL/min/1.73m The following are true regarding tubular secretion except: \ CORRECT ANSWER IS K+ is secreted in the intercalated cells A decrease in Na+ reabsorption is achieved through the action of which of the following? \ CORRECT ANSWER IS Diuretics In the nephron, the mass of capillaries surrounded by an epithelial capsule that opens into a tubule is collectively referred to as the _______. \ CORRECT ANSWER IS renal corpuscle The hormone that is synthesized in the kidneys and regulates the differentiation of red blood cells is _______. \ CORRECT ANSWER IS erythropoietin The enzyme ___________ causes CO2 to react reversibly with water to form carbonic acid (H2CO3) to regulate blood pH. \ CORRECT ANSWER IS carbonic anhydrase A person who has a blood Mg2+ concentration of 1.2 mg/dL. Is considered to have _______. \ CORRECT ANSWER IS hypomagnesemia

_______ failure is caused by conditions that damage the structures within the kidney.
CORRECT ANSWER IS Intrarenal Angiotensin I is converted to angiotensin II in the kidneys. \ CORRECT ANSWER IS False, angiotensin I is converted to angiotensin II in the lungs. One should take in at least 40-50 mEq/day of potassium through the diet or by supplement. \ CORRECT ANSWER IS true Explain why renal flow is decreased with sympathetic activity. \ CORRECT ANSWER IS Sympathetic activity is referring to the sympathetic nervous system, Fight or flight method. The arterioles in the renal fow respond to this and constrict to decrease renal flow to maintain homeostasis. Whether that would be; making sure enough minerals or water is being absorbed or released. A patient's plasma Ca2+ levels are 11.0 mg/dL. Given these levels, list a symptom affecting the GI tract they may experience and explain why it would be occurring.
CORRECT ANSWER IS The patient has hypercalcemia. Constipation, nausea, and/or vomiting may result secondary to a decrease in smooth muscle activity. A patient has a diagnosis of glomerular disease. Given what you know about the structural framework of the glomerular capillaries, what would be detected in this patient's urine, and explain why this would happen. \ CORRECT ANSWER IS Blood and protein may be present in the urine. Spaces within the basement membrane of the glomerular capillaries, under normal circumstances prevent red blood cells and plasma proteins from passing through the glomerular membrane into the filtrate. The disease process would compromise this. A patient with chronic kidney disease must undergo dialysis treatments as they wait for transplantation. Give 1 reason peritoneal dialysis would be preferable to the patient over hemodialysis and 1 concern in choosing peritoneal dialysis over hemodialysis.
CORRECT ANSWER IS Peritoneal dialysis can be done in the patient's home as opposed to going to a dialysis clinic multiple times per week. A major concern of the utilization of peritoneal dialysis is the risk for infection at the catheter site. 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 is ordered, and it reveals a stone 4 mm in diameter. What type of renal calculi do you suspect? What treatment is needed? Explain your reasoning for both answers. \ CORRECT ANSWER IS since the urine is alkalidic, i suspect a magnesium ammonium phosphate renal calculi. The stone is not large enough to have any surgical intervention, it can pass on it own. pain management would be given as well as antibiotics to treat any current or future UTIs. I chose this answer because If the stone is between 1-5 mm then it can pass on its own, the urine is alkilidic which points to the MAP renal calculi, as well as

you have to treat and even pretreat the UTI so the pt is not at risk for an even worst infection due to the renal calculi. 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, PCO2 = 39 mm, and HCO3- = 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, PCO2 = 35-45 mm, HCO3- = 22-26 mEq/L. \ CORRECT ANSWER IS The patient is in metabolic alkalosis. The respiratory system is not compensating as PCO2 compensation falls within normal limits. Fluids are replaced with normal saline solution. A patient is in the ICU following open heart surgery. The patient was feeling well earlier in the day, but suddenly began to demonstrate signs of confusion and disorientation. Blood results reveal Na+ = 100 mEq/L. Based upon these symptoms and results of blood work, what electrolyte imbalance is this patient experiencing? What treatment is indicated for this imbalance? \ CORRECT ANSWER IS This patient is experiencing euvolemic hypotonic hyponatremia. The administration of intravenous saline solution would be indicated to correct the sodium deficiency. Redistribution of body fat with round moon face, dorsal "buffalo hump," and relatively thin extremities suggests which of the following: \ CORRECT ANSWER IS Cushing syndrome The following are common signs and symptoms of Cushing syndrome EXCEPT:
CORRECT ANSWER IS Weight loss Signs and symptoms of Addison's disease include each of the following EXCEPT:
CORRECT ANSWER IS Hyperglycemia Addison's disease is due to which of the following: \ CORRECT ANSWER IS Adrenal gland dysfunction An autocrine action occurs when a hormone exerts an action on the cells that released them. \ CORRECT ANSWER IS True A paracrine hormone is a hormone that produces a biologic action on the cell that released them. \ CORRECT ANSWER IS False Target cells must have receptors to recognize a hormone and translate the signal into a cellular response. \ CORRECT ANSWER IS True Hormones travel through the bloodstream attached to transport carriers only.
CORRECT ANSWER IS False

What is the source of the hormone that plays a major role in the maintenance of body metabolism and growth and development in children? \ CORRECT ANSWER IS Thyroid The posterior pituitary releases which of the following hormones? Select all that apply.
CORRECT ANSWER IS Oxytocin, ADH Type 2 diabetes mellitus is associated with each of the following characteristics EXCEPT: \ CORRECT ANSWER IS Beta cell mass markedly reduced Each of the following are characteristics of diabetes mellitus EXCEPT: \ CORRECT ANSWER IS Myxedema Of all the people with diabetes, approximately 70% have type 2 diabetes. \ CORRECT ANSWER IS False Gluconeogenesis, or glucose formation, is promoted by the alpha cells. \ CORRECT ANSWER IS True Most hormones are controlled through positive feedback. \ CORRECT ANSWER IS False Those with prediabetes have an increased risk of atherosclerotic heart disease.
CORRECT ANSWER IS True Testing for diabetes should be done on everyone initially at age 60. \ CORRECT ANSWER IS False A 45-year-old obese, sedentary male has recently been diagnosed with type 2 diabetes. What are 2 strategies to help him normalize his blood sugars? List 2 other macrovascular complications he is at risk for and how you would screen for them?
CORRECT ANSWER IS (1) Diet, exercise, and weight loss may be all that they need to control blood glucose levels. Even moderate weight loss of 5-10% of total body weight has been shown to improve glucose control. (2) Hypertension and hyperlipidemia - checking blood pressure and screening with a serum lipid panel. A diabetic's risk of macrovascular diseases is 2-4 times higher and the leading cause of death among diabetics (50-75%) is from a macrovascular disease. Name 3 of the 4 complications listed: \ CORRECT ANSWER IS Peripheral vascular disease, coronary artery disease, heart attack, and stroke Hypothyroidism is caused by each of the following EXCEPT: \ CORRECT ANSWER IS Thyroid adenoma A 40-year-old woman presents with amenorrhea and weight loss despite increased appetite. The history and physical exam show exophthalmos, tachycardia, and warm,

moist skin. Each of the following lab abnormalities are expected EXCEPT: \ CORRECT ANSWER IS Increased TSH Your diabetic patient with neuropathy is at risk for developing a foot ulcer. How would you instruct him to care for his feet? List at least 3. \ CORRECT ANSWER IS Wear proper fitting shoes, daily feet inspection to look for blisters, sores, or signs of infection. Avoid smoking, cold temperature, bare feet. ______ is defined as a blood glucose of <60 mg/dL, with associated cognitive impairment. \ CORRECT ANSWER IS Hypoglycemia The risk factors for _____ _____ include hyperglycemia, hypertension, hyperlipidemia, obesity, altered platelet function, endothelial dysfunction, elevated fibrinogen levels, and systemic inflammation. \ CORRECT ANSWER IS Macrovascular complications / disease ___ ____ is diagnosed by hyperglycemia, low serum bicarbonate, and low pH, with ketonemia and moderate ketonuria. \ CORRECT ANSWER IS Diabetic ketoacidosis (DKA) Which oral antidiabetic drugs increase GLP-1 and GIP, which increase insulin release and decrease glucagon levels. \ CORRECT ANSWER IS DPP-4 inhibitors Each of the following are true of gout except: \ CORRECT ANSWER IS A serum uric acid level greater than 6.8 mg/dL without symptoms leads to a diagnosis of gout Which of the following would a patient likely report if you suspect they have OA?
CORRECT ANSWER IS Stiffness in the morning that resolves in less than 30 minutes Which of the following are true regarding syndesmoses? (mark all that apply)
CORRECT ANSWER IS They allow a small degree of movement between them, They are separated by a fibrous disc Cortical bone receives its blood supply through the following means except?
CORRECT ANSWER IS Diffusion through the endosteal surface of the bone and the canaliculi What is the recommended calcium intake for premenopausal women? \ CORRECT ANSWER IS 1000 mg. daily Which of the following cells regulate bone growth through the secretion of growth factors and tumor necrosis factor? \ CORRECT ANSWER IS Osteoblasts Which of the following contribute to joint destruction associated with OA? (mark all that apply) \ CORRECT ANSWER IS Damaged chondrocytes, Interleukin -1beta,

Tumor Necrosis Factor-Alpha, An imbalance of protease and protease inhibitors A patient has low serum calcium levels. Which of the following is true given this scenario? \ CORRECT ANSWER IS PTH will increase renal reabsorption of calcium while simultaneously increasing renal excretion of phosphate A diagnosis of gout is made through which of the following tests? (mark all that apply)
CORRECT ANSWER IS Blood work to determine uric acid levels, Analysis of synovial fluid, 24-hour urine specimen In the early stages of OA, structural changes would include which of the following? (mark all that apply) \ CORRECT ANSWER IS Edema in the cartilaginous matrix Which of the following is false regarding the synovium? \ CORRECT ANSWER IS The synovium surrounds the margins of articulation and lines the articulating surfaces of the joint Senile Osteoporosis is characterized by which of the following? (mark all that apply)
CORRECT ANSWER IS Fractures of the hip joint, A direct relationship between aging and rate of bone loss A T-score compares the bone of the patient to that of a healthy 20-year-old adult.
CORRECT ANSWER IS false; healthy 30 yr old Haversian canals contain the nerve and blood supply for the osteon. \ CORRECT ANSWER IS true Hyperuricemia may be a result of an underproduction of purines. \ CORRECT ANSWER IS false; it is an overproduction of purines Prolonged immobilization can lead to structural joint changes associated with OA.
CORRECT ANSWER IS true If someone loses their balance when walking on uneven terrain, explain how tendons and ligaments work to protect the joint and structures within it. \ CORRECT ANSWER IS 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. A patient presents to the ER with severe pain in their right ankle. Blood tests reveal serum uric acid levels of 7.8 mg/dL. They are kept for observation and their 24-hr urine specimen reveals underexcretion of urate. Which phase of gout are they in? What is the

goal of your treatment given the phase they are in? \ CORRECT ANSWER IS This patient is in phase 2 of gout or acute gout arthritis. The goal of treatment is to manage symptoms and terminate the acute attack primarily through NSAIDS. Which of the following patients is at greater risk for developing osteoporosis and sustaining a fracture? Explain how you came to your conclusion. Patient A. is a 75-year- old white Caucasian male who has a history of a distal radius fractures at age 65. Patient B. is a 60- year-old African American female who is postmenopausal. She is active and does not have a history of fractures. \ CORRECT ANSWER IS Patient A is at higher risk. Even though he is a male, he is advanced in age, white Caucasian, and sustained a fracture after the age of 50. Patient B is a postmenopausal female; however, she is active and of African American decent which is associated with high BMD and low rates of fracture. A 60-year-old, obese female works out of her home and rarely walks due to the sedentary nature of her job. Give 2 reasons why she is at increased risk for developing OA. \ CORRECT ANSWER IS She is a female over the age of 55; she is obese, and she is relatively sedentary which contributes to the decreased nourishment of the joint that comes with weight bearing and range of motion. (*Note - student only needs to provide 2 reasons.) Compare and contrast the blood supply of cortical bone and cancellous bone.
CORRECT ANSWER IS Cortical bone has a direct blood supply. Nutrient and Perforating arteries form an anastomosis (collateral circulation) that circulates through the bone through the Haversian and Volkmann canals. Cancellous bone does not have a direct blood supply. It receives its blood supply through diffusion from the endosteal bone surface extending outward through the canaliculi. A 22-year-old competitive gymnast has experienced amenorrhea for the past 5 years. Her PCP is suspecting that she may have premature osteoporosis. Would you expect her RANKL levels to be high, normal, or low? Explain why her levels would be at this level. \ CORRECT ANSWER IS Her RANKL levels would be higher than normal. Amenorrhea results in lower estrogen levels. Estrogen increases the production of OPG which inhibits RANKL. Lower estrogen levels would lead to lower OPG levels in turn increasing RANKL and osteoclast activity. A 68-year-old, white Caucasian female has a DEXA scan at the recommendation of her PCP. Her scan yielded a T-score of -2.6. Interpret the results of her DEXA scan. Develop a treatment plan giving a pharmacologic recommendation if applicable (be specific with name of supplement and/or class of drug), and a non-pharmacologic recommendation. \ CORRECT ANSWER IS This T-score indicates osteoporosis. This patient should take a Calcium and Vitamin D supplement. In addition, she should be prescribed one of the following: Estrogen, SERMs, Bisphosphonates, or Calcitonin. She should also participate in regular weight bearing and resistive exercise being careful to choose activities that would not put her at increased risk for falling.

A 72-year-old male is said to be in phase 2 of gout. He is obese and has a history of alcohol abuse. Develop a treatment plan including specific pharmacologic intervention and a non-pharmacologic recommendation to manage his disease. \ CORRECT ANSWER IS Phase 2 of gout is acute gout arthritis. The goal of treatment in this phase is to control inflammation and pain. Colchicine is a prescription drug that could be used to treat his acute inflammation. NSAIDS can also be used to treat inflammation and manage pain. 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. (*Note - the student has to provide 1 pharmacologic intervention and 1 non- pharmacologic recommendation.) A patient has a bilateral presentation of pain in the PIP joints of the hands. You believe this pain is due to arthritis but are unsure whether it is a result of RA or OA. What are 3 questions you could ask this patient to help you differentiate between RA and OA?
CORRECT ANSWER IS 1. Do you experience stiffness in the morning? 2. If so, does it last less than or longer than 30 minutes? 3. Does prolonged movement aggravate or alleviate your symptoms? 4. Do you ever have periods of relief, or do you experience pain daily? 5. Did your pain start in both hands or did it start with one hand and develop in the other over time? 6. What is your profession? (occupations requiring repetitive movements often lead to OA) *Note - student only has to provide 3 questions.