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D115 ADVANCED PATHOPHYSIOLOGY OA EXAM
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Which term describes recurrent, intrusive thoughts or impulses? A) Hallucinations B) Compulsions C) Obsessions D) Delusions - Correct Answer - C) Obsessions Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. During an intake interview with a 26-year-old man diagnosed with generalized anxiety disorder, the FNP might observe what type of behavior? A) An inflated sense of self B) Constant relation to future events C) Inability to concentrate and irritability when questioned D) Nervousness and fear of the FNP during the interview - Correct Answer - C) Inability to concentrate and irritability when questioned Impaired concentration and irritability are major characteristics of GAD.
The FNP would expect which symptoms in a patient with a diagnosis of schizophrenia? A) High energy with varying sleep patterns and non stop conversation. B) Extreme and frequent mood swings with hyperactivity and difficulty concentrating. C) Paranoia, delusions, hallucinations, and diminished self-care. D) Anti-social behavior, manipulative behavior, charisma, and ability to lie convincingly. - Correct Answer - C) Paranoia, delusions, hallucinations, and diminished self-care. The characteristics of schizophrenia are paranoia, delusions, tangential thoughts, suspiciousness, disorganized behavior, and hallucinations. The FNP is seeing a 10 year old child with complaints of otalgia and muffled hearing. The mother states the child recently recovered from an upper respiratory infection. The FNP suspects that this child has: A) Acute otitis media B) Acute otitis externa C) Cholesteatoma D) Chronic otitis media - Correct Answer - A) Acute otitis media The classic presentation of otitis media is otalgia, muffled hearing, popping sensation, and a recent history of a cold or flare up of allergic rhinitis. During an evaluation of a patient with prediabetes, the FNP identifies which finding in the patient's objective data that is associated with the increasing insulin resistance?
Risk factors of type 2 DM include increasing age, obesity, race, and genetics. Which of the following is NOT a risk factor for endometrial cancer? A) Obesity B) Oral contraceptive use C) Unopposed estrogen use D) Advancing age, greater than 50 years - Correct Answer - B) Oral contraceptive use Oral contraceptives have been shown to reduce the incidence of endometrial cancer. Priapism has been associated with the abuse of which substance? A) Marijuana B) Alcohol C) Cocaine D) Heroin - Correct Answer - C) Cocaine Priapism is an uncommon condition of prolonged penile erection. In 60% of cases the cause is idiopathic. The remaining 40% are associated with spinal cord trauma, sickle cell disease, leukemia, pelvic tumors, or infections. It has also been associated with cocaine use. The FNP understands the most accurate explanation for the diagnosis of mixed precocious puberty is:
A) When a child develops some secondary sex characteristics of the opposite sex. B) When a child does not develop any identifiable external sex organs. C) When early puberty occurs due to multiple, integrated causative effects. D) When early puberty has signs of physical and hormonal abnormalities. - Correct Answer - A) When a child develops some secondary sex characteristics of the opposite sex. Mixed precocious puberty cases the child to develop some secondary characteristics of the opposite sex, such as the feminization of a boy. Which of the following characteristics applies to type 1 diabetes mellitus? A) Significant hyperglycemia and ketoacidosis result from a lack of insulin. B) This condition is commonly diagnoses on routine examination or work-up for other health problems. C) Initial response to oral sulfonylureas is usually favorable. D) Insulin resistance is a significant part of the diease. - Correct Answer
- A) Significant hyperglycemia and ketoacidosis result from a lack of insulin. Type 1 DM is associated with beta cell destruction leading to absolute insulin deficiency resulting in significant hyperglycemia and potential for ketoacidosis. In the majority of children experiencing delayed puberty, the problem is caused by:
Benign ovarian, or functional cysts, are variations of normal physiologic events. Benign cysts of the ovary are produced when a follicle is stimulated but does not complete the maturity process. When assessing for the signs and symptoms of acute respiratory distress syndrome, the absence of which condition is considered characteristic? A) Progressive respiratory distress B) Bilateral infiltrates C) Decreased pulmonary compliance D) Heart failure - Correct Answer - D) Heart failure ARDS is the most severe form of acute lung inflammation and is defined by acute onset of bilateral infiltrates not explained by cardiac failure or fluid overload, and a low ratio of the partial pressure of arterial oxygen to the fraction of inhaled oxygen. Pulmonary edema in ARDS is the result of an increase in what? A) Levels of serum sodium and water B) Capillary permeability C) Capillary hydrostatic pressure D) Oncotic pressure - Correct Answer - C) Capillary hydrostatic pressure The most common cause of pulmonary edema is left-sided heart disease which leads to increasing pressure on the left side of the heart which can cause a concomitant increase in pulmonary capillary hydrostatic pressure.
Capillary hydrostatic pressure (CHP) versus capillary permeability - Correct Answer - accumulation of excess interstitial fluid, which results from elevated capillary hydrostatic pressure while permeability edema results from disruption of the physical structure of the pores in the microvascular membrane such that the barrier is less able to restrict the movement Which immunoglobulin may contribute to the pathophysiologic characteristics of asthma? A) IgA B) IgE C) IgG D) IgM - Correct Answer - B) IgE Immunoglobulin E-mediated airway inflammation is active in most patients with asthma. When providing patient education regarding asthma. The FNP states that control of symptoms is necessary due to which pathophysiologic process? A) Norepinephrine causes bronchial smooth muscle contraction and mucus secretion but it also causes high blood pressure. B) Uncontrolled inflammation leads to increased bronchial hyperresponsiveness and eventual scarring. C) The release of epinephrine leads to development of cardiac dysrhythmias. D) Immunoglobulin G causes smooth muscle contraction which will eventually weaken the respiratory muscles. - Correct Answer - B)
Graves' disease, an autoimmune condition also known as "diffuse toxic goiter" is the most common cause of hyperthyroidism in this age group. Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? A) Increased norepinephrine B) Adducin C) Angiotensin II D) Insulin resistance - Correct Answer - C) Angiotensin II Hypertension causes an increased cardiovascular mechanical load that can deleteriously affect heart function. An early myocardial response is an increase in cardiac Angiotensin II (Ang II) protein levels, which is intimately associated with the pathogenesis of cardiac hypertrophy and heart failure. The FNP is seeing a patient for a routine health maintenance visit. The patient's initial blood pressure, taken by the RN is 156/102 mm Hg. A repeat BP by the FNP is 148/92. The remainder of the patient's physical exam in unremarkable. The FNP understands that the plan of care for this patient should include all of the following except: A) Assessment of lifestyle and risk factors B) CBC, BMP, and UA C) Initiation of anti-hypertensive medications D) Follow up visit to re-assess blood pressure. - Correct Answer - C) Initiation of anti-hypertensive medications Evaluation and management of blood pressure should by highly individualized. The diagnosis of hypertension is based upon the
measurement of blood pressure on AT LEAST two separate occasions averaging at least 2 mins apart. Evaluation should also include a comprehensive assessment of lifestyle and risk factors, CBC, BMP, and UA. Initiation of anti-hypertensive medication would not occur until the diagnosis of hypertension is confirmed, and is dependent upon the stage of hypertension. An older adult patient has a diagnosis of left-sided heart failure. The FNP would identify what common condition associated with heart failure? A) Peripheral vascular disease B) Untreated hypertension C) Ventricular dysrhythmias D) COPD - Correct Answer - B) Untreated hypertension Untreated HTN causes significant increased work of the the LV, eventually causing left-sided HF. When cardiac output falls in heart failure, the body attempts to compensate. What electrolyte imbalances result from this response? A) Hypernatremia and hyperkalemia B) Hyponatremia and hypokalemia C) Hypophosphatemia and hypercalcemia D) Hyperphosphatemia and hypocalcemia - Correct Answer - B) Hyponatremia and hypokalemia The compensatory mechanism causes excess secretion of aldosterone that predisposes to potassium excretion. total body sodium content will be greater than normal, but the excessive secretion of ADH causes
lymphadenopathy and abnormal lab analysis with lymphocytosis, although neutropenia, anemia, and thrombocytopenia can be observed. Which of the following changes occurs in the RBC indices for pernicious anemia? A) microcytic, normochromic B) microcytic, hypochromic C) normocytic, normochromic D) macrocytic, normochromic A macrocytic, normochromic anemia resulting from atrophic gastric mucosa not secreting intrinsic factor is the definition of pernicious anemia. These indices could also include folic-acid deficiency. - Correct Answer - D) macrocytic, normochromic A macrocytic, normochromic anemia resulting from atrophic gastric mucosa not secreting intrinsic factor is the definition of pernicious anemia. These indices could also include folic-acid deficiency. An older adult who has acute myelogenous leukemia is undergoing cytotoxic chemotherapy treatment and has the following laboratory reports: elevated serum uric acid, serum potassium, and serum phosphate and a low serum calcium level. The WBC count is extremely elevated, and on physical exam, there is noted lymphadenopathy and splenomegaly. What is the most likely cause? A) DIC B) Leukostasis C) Pancytopenia D) Tumor lysis syndrome - Correct Answer - D) Tumor lysis syndrome
Tumor lysis syndrome occurs when a patient has a high WBC count and is undergoing cytotoxic chemotherapy for the treatment of AML. It is characterized by the development of acute hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. pancytopenia - Correct Answer - deficiency of all types of blood cells ___ occurs when the blood vessels become overcrowded with immature blast cells in patients with AML who have high WBC counts, which can lead to ischemia and infarcts in the pulmonary and cranial blood vessels.
- Correct Answer - Leukostasis An adult patient with pernicious anemia may present with which signs and symptoms? A) Peripheral neuropathy, ataxia, lethargy, and fatigue B) Hepatomegaly, jaundice, and RUQ pain C) Hypertension, angina, and peripheral edema D) Blurred vision, diplopia, and decreased vibratory sensation - Correct Answer - A) Peripheral neuropathy, ataxia, lethargy, and fatigue Vitamin B12 deficiency may result in neurologic signs and symptoms including peripheral neuropathy, paresthesias, unsteady gait, loss of proprioception, decreased vibratory sensation, lethargy and fatigue. In later stage, spasticity, hyperactive reflexes and the presence of Romberg's sign are noted because of the formation of a demyelinating lesion of the neurons of the spinal cord and cerebral cortex and the presence of a beefy red tongue. These findings are specific to pernicious anemia and must be assessed in all patient who present with anemia.
F) Sickle cell trait is a heterozygous carrier state and not a disease. Sickle cell trait is the most common genetic mutation of the hemoglobin. An individual with sickle cell trait inherits one mutated gene from the mother or the father, with a non-mutated gene from the other parent. Sickle cell trait is a heterozygous carrier state and not a disease. Individuals with sickle cell trait are often from W. Africa, the Middle East, and the Mediterranean region, and India. These are areas in which malaria occurs frequently, and sickle cell trait offers some protection against malaria. Carrier states increases the risk of having an offspring with sickle cell trait, and if the partner also has sickle cell trait, then sickle cell disease is possible. The life expectancy of persons with sickle cell trait is similar to that of the general population. An older adult woman has an area of vesicles in clusters with an erythematous base that extend from her spine, around and under her arm and breast, to the sternum on her left side. She states that the area was very tender last week and that the vesicles started erupting yesterday. She is complaining of severe pain in the area. What is the probable diagnosis? A) Psoriasis B) Herpes Zoster C) Contact dermatitis D) Cellulitis - Correct Answer - B) Herpes Zoster Herpes zoster typically presents with a history of tenderness followed by eruptions and vesicles that follow a dermatome on one side of the body. The condition is very painful. Other symptoms may include fever, headaches, and malaise.
The FNP is assessing an older patient diagnosed with shingles in the prodromal stage. What would the practitioner expect to find on the assessment of this patient? A) Erythematous lesions present over four different parts of the body. .B) Red, pin point, painless rash. C) Burning pain in a line on only half the patient's chest that does not cross the midline. D) Painless purulent lesions for 2 days followed by complaints of itching, burning, and nausea. - Correct Answer - C) Burning pain in a line on only half the patient's chest that does not cross the midline. Shingles is a vesicular dermatomal eruption related to a reactivation of latent varicella virus. It increases with advanced age and is characterized by burning pain and paresthesia along one or two dermatomes, not crossing the midline, and may be accompanied by fever, malaise, or headache prodromal stage - Correct Answer - the period between the appearance of initial symptoms and the full development of a rash or fever. Which are common sites for atopic dermatitis in adults? A) Cheeks, forehead, and scalp. B) Wrists, ankles, and antecubital fossae. C) Antecubital fossae, face, neck, and back. D) Hands and face - Correct Answer - D) Hands and face Atopic dermatitis is a chronic, pruritic inflammatory skin disease that occurs most frequently in children, but can also affect adults. Atopic dermatitis in adults may be generalized, however it frequently appears in
E) Hematuria F) Elevated A1c - Correct Answer - C) Presence of proteinuria D) Decrease in GFR The earliest indication of renal damage from diabetes is the presence of microalbuminuria; because of this all patients with diabetes should have this tested annually. A decrease in GFR is also noted. Diabetic nephropathy is characterized by proteinuria, hypertension, edema, and renal insufficiency. proteinuria - Correct Answer - protein in the urine; results form increased blood sugar in people with diabetes, as well as high blood pressure, which is a common co-occurring condition in people with diabetes. Typically, the earliest sign of lower-extremity venous insufficiency is: A) edema The earliest signs of venous insufficiency are lower extremity edema, especially after extended periods of standing. B) altered pigmentation C) skin atrophy D) shiny skin - Correct Answer - A) edema The earliest signs of venous insufficiency are lower extremity edema, especially after extended periods of standing. A 24-year-old man presents with a 3-month history of upper abdominal pain. He describes it as an intermittent, centrally located burning feeling
in his upper abdomen, most often occuring 2-3 hours after meals. His presentation is most consistent with the clinical presentation of: A) acute gastritis B) gastric ulcer C) duodenal ulcer D) cholecystitis - Correct Answer - C) duodenal ulcer The pain associated with duodenal ulcers typically improves immediately following meals and returns several hours after a meal. Which of the following is most likely to be found in a 50-year-old woman with new-onset reflux esophagitis? A) recent initiation of estrogen-progestin hormonal therapy B) recent weight loss C) report of melena D) evidence of h. pylori infection - Correct Answer - A) recent initiation of estrogen-progestin hormonal therapy The use of certain medications including estrogen, progestin, theophylline, calcium channel blockers, and nicotine can results in a decrease in lower esophageal sphincter pressure and worsen GERD. The clinical presentation of acute gouty arthritis affecting the base of the great toe includes: A) slow onset of discomfort over many days B) greatest swelling and pain along the median aspect of the joint C) improvement of symptoms with joint rest
