PATHO HESI Flashcards [2nd set]

(179 cards)

Research has shown that an elderly adult's mortality is affected when a spouse or partner is hospitalized in the areas of: Select all that apply.

A. emotional stress.

B. financial stress.

C. physical support.

D. psychological support.

E. self-esteem.

A. emotional stress.

B. financial stress.

C. physical support.

D. psychological support.

For elderly people whose spouse had been hospitalized, the short-term risk of dying approaches that of an elderly person after his or her spouse's death. The researchers commented that a spouse's illness or death can increase a partner's mortality by causing severe stress and removing a primary source of emotional, psychological, practical, and financial support. Self-esteem is not generally seen as affecting mortality.

It is correct to assume that Cheyne-Stokes respirations (CSR):

A. involve a pathologically increased ventilatory response.

B. result in hypocapnia and increased ventilatory stimulus.

C. cause changes in PaO2 that produce irregular breathing.

D. increase PaCO2 level when overbreathing occurs.

A. involve a pathologically increased ventilatory response.

The pathophysiology of CSR includes an increased ventilatory response to carbon dioxide stimulation. This causes hypercapnia and diminished ventilatory stimulus. Changes in PaCO2 produce irregular breathing, not changes in PaO2. The PaCO2 level decreases to below normal when overbreathing occurs.

A patient experiences no nausea but significant vomiting with a CNS injury when the trauma:

A. impinges directly on the floor of the third ventricle.

B. causes a decrease in intracranial pressure.

C. involves the vestibular nuclei.

D. also involves the abdominal area.

C. involves the vestibular nuclei.

Vomiting associated with CNS injuries involves the vestibular nuclei. It can also be caused by impingement on the fourth ventricle or an increase in intracranial pressure. Vomiting with no associated nausea indicates direct involvement of the central neural mechanisms regardless of abdominal trauma.

Pinhole-sized pupils can be a result of an overdose of:

A. atropine.

B. scopolamine.

C. opiates.

D. amphetamines.

C. opiates.

Opiates (heroin and morphine) cause pinhole or constricted pupils. The other choices cause large dilated pupils.

A patient has sustained a traumatic brain injury but is able to follow simple commands and can manipulate objects. The term used to describe this state is:

A. coma

B. vegetative

C. minimally conscious

D. locked-in syndrome

C. minimally conscious

The term minimally conscious refers to severely altered consciousness in which the person demonstrates minimal but defined behavioral evidence of self or environmental awareness. The clinical features include following simple commands, manipulation of objects, gestural or verbal yes/no responses, intelligible verbalization, and stereotypical movements. Locked-in syndrome describes an individual who has both the content of thought and the level of arousal intact. The efferent pathways are disrupted, which means the individual cannot communicate through speech or body movement. Coma is a state of neurobehavioral unresponsiveness. Vegetative state is a wakeful unconscious state.

A patient who is experiencing difficulty in recognizing a pattern's form and the nature of objects is exhibiting characteristics of:

A. agnosia.

B. aphasia.

C. dysphasia.

D. Alzheimer disease.

A. agnosia.

Agnosia is a defect of pattern recognition. Aphasia is the complete absence of speech. Dysphasia is impairment of comprehension or production of language. Alzheimer disease is a disease of dementia.

A patient who is experiencing a loss of comprehension or the production of language is described as having:

A. dysphasia.

B. aphasia.

C. expressive dysphasia.

D. transcortical dysphasia.

A. dysphasia.

Aphasia is complete inability to speak. Dysphasia is impairment in comprehension or production of language. Expressive dysphasia is characterized primarily by deficits in expression, but comprehension may be present. Transcortical dysphasia involves the ability to repeat and to recite.

A patient who fell and hit his head 2 days ago is now restless and irritable. This scenario is characteristic of:

A. Alzheimer disease.

B. dementia.

C. delirium.

D. coma.

C. delirium.

Delirium is an acute state of confusion. It is abrupt in its onset. The patient may have difficulty in concentration, restlessness, irritability, tremulousness, insomnia, and poor appetite. Dementia is a more chronic problem in which there is progressive failure of many cerebral functions. Alzheimer disease is a type of dementia. A coma is a loss of consciousness.

It is TRUE that Alzheimer disease is:

A. an uncommon neurologic disorder.

B. not believed to have a genetic relationship.

C. a result of neuronal proteins becoming distorted and tangled.

D. the cause of plaques increasing nerve impulse transmission.

C. a result of neuronal proteins becoming distorted and tangled.

Neurofibrillary tangles occur when the proteins in neurons become tangled and distorted. There is a genetic relationship in late-onset familial Alzheimer dementia. It is a common neurologic disorder; nearly 6 million Americans had the disease in 2000. With the formation of plaques, there is decreased nerve impulse transmission.

The term used to describe a patient who sustains a cerebrovascular accident and is paralyzed on the left side is:

A. hemiplegia.

B. paraplegia.

C. diplegia.

D. quadriplegia.

A. hemiplegia.

Hemiplegia means loss of motor function on one side of the body. Paraplegia refers to loss of motor function of the lower extremities. Diplegia is the paralysis of both upper or both lower extremities as a result of cerebral hemisphere injuries. Quadriplegia refers to paralysis of all four extremities.

A patient who exhibits involuntary twisting movements caused by slow muscle contraction on the right side of the body is experiencing:

A. hypertonia.

B. spasticity.

C. hemidystonia.

D. paratonia.

C. hemidystonia.

Injury to the putamen or its outflow tracts would result in hemidystonia. Hypertonia is increased muscle tone. Spasticity results from hyperexcitability of the stretch reflexes. Paratonia is resistance to passive movement that is proportional to the force applied.

A basic neural system to cognitive function would include: Select all that apply.

A. attentional systems.

B. memory systems.

C. affective or emotive systems.

D. sensory systems.

E. language systems.

A. attentional systems.

B. memory systems.

C. affective or emotive systems.

E. language systems.

In this case, sensory systems are not related to cognitive function.

Abnormal findings in which of the following evaluations would indicate possible neurological dysfunction? Select all that apply.

A. Level of consciousness

B. Pattern of breathing

C. Heart rate

D. Eye position

E. Skeletal muscle motor responses

A. Level of consciousness

B. Pattern of breathing

D. Eye position

E. Skeletal muscle motor responses

The five categories that are critical for the evaluation process for neurologic function include: (1) level of consciousness (LOC), (2) pattern of breathing, (3) size and reactivity of pupils, (4) eye position and reflexive response, and (5) skeletal muscle motor responses. Although heart rate is a vital sign, it is not always indicative of neurologic status.

A characteristic of Alzheimer disease includes: Select all that apply.

A. rapid onset of symptomology.

B. short-term memory loss.

C. increased irritability and agitation.

D. anxiety and depression.

E. remissions resulting in cognitive clarity.

B. short-term memory loss.

C. increased irritability and agitation.

D. anxiety and depression.

Alzheimer disease is characterized with short-term memory loss, increased irritability and agitation, as well as anxiety and depression. Its onset of symptoms is gradual, and there are no remissions that allow for cognitive clarity.

The person at highest risk for traumatic brain injury (TBI) is:

A. African American and economically disadvantaged.

B. male and disabled.

C. female and 20 years of age.

D. an economically advantaged young adult.

A. African American and economically disadvantaged.

Those at highest risk for TBI are children 0 to 4 years of age, older adolescents aged 15 to 19 years, and adults aged 65 years and older. Males have the highest incidence in every age group. TBI is highest among African Americans and in lower- and median-income families.

The most common cause of TBI is:

A. motor vehicle accidents.

B. falls.

C. sports-related events.

D. violence.

A. motor vehicle accidents.

Motor vehicle accidents account for 50%. Falls account for 21%. Sports-related events and violence account for 10% and 12%, respectively.

A trauma patient diagnosed with a brain contusion experiences changes in attention, memory, affect, and emotion. In which region of the brain is the contusion most likely located?

A. Cerebral

B. Frontal

C. Cerebellum

D. Midbrain

B. Frontal

Contusions are most commonly found in the frontal lobes, particularly at the poles and along the inferior orbital surfaces. They result in changes in attention, memory, and executive attentional functioning.

An elderly alcoholic man falls and experiences a hematoma that is on the top of his brain. The hematoma is most likely a:

A. subdural.

B. epidural.

C. extradural.

D. intracerebral.

A. subdural.

Subdural hematomas are commonly found in the elderly and persons who abuse alcohol. The remaining options are injuries not generally observed in this population after experiencing an alcohol-induced fall.

A 23-year-old patient is hit in the temporal portion of his skull during an altercation. Although he initially loses consciousness, he soon awakens and is conversant. Three hours later he is experiencing vomiting, drowsiness, and confusion. These symptoms are most likely related to which type of brain injury?

A. Diffuse axonal

B. Intracerebral

C. Subdural

D. Epidural

D. Epidural

The classic presentation of an epidural hematoma is a person hit in the temporal area with damage to the middle meningeal artery. The patient will lose consciousness at the time of injury, but there may be a period where consciousness is regained. The patient will then become more confused and drowsy. This scenario is not typical with the other types of brain injury.

A patient experiences a vertebral fracture in which the C1 vertebra is fractured into several fragments. This type of fracture can be described as:

A. simple.

B. compressed.

C. comminuted.

D. dislocation.

C. comminuted.

A comminuted fracture is also called a burst fracture, in which the vertebral body is shattered into several fragments. A simple fracture is a single break usually affecting the transverse or spinous process. A compressed fracture is also called a wedge. This occurs when there is a crush type of injury and the vertebrae loses height. A dislocation is when two bones at a joint are no longer in alignment.

It is TRUE that spinal shock:

A. is characterized by an incomplete loss of reflex function.

B. involves all skeletal muscles.

C. causes increased muscle tone below the lesion.

D. results in no disruption of thermal control.

B. involves all skeletal muscles.

Spinal shock does involve function of skeletal muscles resulting in paralysis and flaccidity. Such an injury is characterized by a complete loss of reflex function below the level of the lesion, and impairment of control of thermal regulation is observed.

A patient is experiencing pain that courses over the buttocks and into the calf and ankle. This is suggestive of a herniated disc at which vertebral level?

A. Cervical

B. Thoracic

C. Lumbar

D. Coccyx

C. Lumbar

A herniated disc in the lumbosacral area is associated with pain that radiates along the sciatic nerve and courses over the buttock and into the calf and ankle. Both a cervical and thoracic injury would indicate pain that originated higher on the body. A herniated coccyx vertebrate would result in pain beginning a point lower than that described.

It is true that an acute cerebrovascular accident (CVA) is:

A. the leading cause of disability in the United States.

B. the fifth most common cause of death in the United States.

C. likely to be followed by a second stroke within 1 year.

D. experienced by 2 million individuals each year.

A. the leading cause of disability in the United States.

CVAs are the leading cause of disability and the third leading cause of death. There are 500,000 stroke victims a year, and 5% to 14% have a second stroke within 1 year.

It is TRUE that a hemorrhagic stroke:

A. is the most common cause of CVA.

B. accounts for 50% of all CVA.

C. is commonly caused by hypertension.

D. is often caused by a microinfarct.

C. is commonly caused by hypertension.

Chronic, untreated hypertension is generally the cause of hemorrhagic stroke. Hemorrhagic stroke is the third most common cause of CVA. It accounts for 10% to 15% of strokes in whites and 30% in blacks and Asians. An infarct is a type of occlusive stroke.

It is correct to assume that a subarachnoid hemorrhage is:

A. a risk for individuals with an intracranial aneurysm.

B. seldom experienced in individuals with hypertension.

C. not caused by trauma to the head.

D. rarely fatal.

A. a risk for individuals with an intracranial aneurysm.

Individuals with intracranial aneurysms are at risk for subarachnoid hemorrhage. Hypertension and trauma are also risk factors. The mortality is over 50%.

A patient experiences demyelination of the peripheral nerves with sparing of the axons. This is characteristic of:

A. Alzheimer disease.

B. Guillain-Barré.

C. myasthenia gravis.

D. amyotrophic lateral sclerosis (ALS).

B. Guillain-Barré.

Guillain-Barré is an idiopathic polyneuritis with acute inflammatory demyelinating characteristics. There is demyelination of the peripheral nerves with relative sparing of the axons. Alzheimer disease is a form of dementia caused by tangles. Myasthenia gravis is due to anti-acetylcholine-receptor antibodies. ALS is a degenerative disorder diffusely involving lower and upper motor neurons, resulting in progressive muscle weakness.

A patient is brought to the emergency room following a motor vehicle accident in which he sustained diffuse brain injury. Which of the following symptoms would be expected to accompany his injury? Select all that apply.

A. Memory deficits

B. Swallowing disorders

C. Agitation

D. Fatigue

E. Short attention span

A. Memory deficits

B. Swallowing disorders

C. Agitation

E. Short attention span

Diffuse brain injury can produce, memory deficits, dysphagia, agitation, and short attention span. Fatigue is not part of diffuse brain injury.

Risk factors for a CVA includes: Select all that apply.

A. obesity.

B. smoking.

C. diabetes.

D. arterial hypertension.

E. atrial fibrillation.

B. smoking.

C. diabetes.

D. arterial hypertension.

E. atrial fibrillation.

Obesity may indirectly cause other risk factors but is not a direct risk factor for CVA. The other risk factors for CVAs include arterial hypertension, smoking, diabetes, insulin resistance, polycythemia, increased lipoprotein A, impaired cardiac function, hyperhomocysteinemia, and atrial fibrillation.

A cause of a cerebral aneurysm includes: Select all that apply

A. arteriosclerosis.

B. heroin abuse.

C. congenital anomaly.

D. trauma.

E. cocaine abuse.

A. arteriosclerosis.

B. heroin abuse.

C. congenital anomaly.

D. trauma.

E. cocaine abuse.

Meningiomas are located most commonly in the olfactory grooves, on the wings of the sphenoid bone (at the base of the skull), in the tuberculum sellae (a structure next to the sella turcica), on the superior surface of the cerebellum, and in the cerebellopontine angle and spinal cord

The term that describes "obvious changes in cell function that result from stimulation by a particular hormone" is:

A. upregulation.

B. downregulation.

C. direct effects.

D. permissive effects.

C. direct effects.

Direct effects are obvious changes in cell function that specifically result from stimulation by a particular hormone. Permissive effects are less obvious and facilitate the maximal response or functioning of a cell. Upregulation is when low concentrations of hormone increase the number of receptors per cell. Downregulation occurs when high concentrations of hormone decrease the number of receptors.

It is TRUE that the hypothalamus is:

A. divided into two nuclei.

B. connected to the anterior pituitary by a single membrane.

C. connected to the posterior pituitary by blood vessels.

D. made up of neurosecretory neurons that secrete releasing hormones.

D. made up of neurosecretory neurons that secrete releasing hormones.

It is true that the hypothalamus comprises neurosecretory neurons that secrete releasing hormones. The hypothalamus is divided into numerous nuclei, while being connected to the anterior pituitary by blood vessels and to the posterior pituitary by a nerve tract.

Which hormone is secreted by the posterior pituitary?

A. Oxytocin

B. Calcitonin

C. Thyroid-stimulating (TSH)

D. Parathyroid (PTH)

A. Oxytocin

Oxytocin is secreted by the posterior pituitary. Calcitonin is secreted by the thyroid gland. TSH is secreted by the anterior pituitary. PTH is secreted by the parathyroid glands.

Which hormone is secreted by the anterior pituitary?

A. Androgen

B. Prolactin

C. Thyroid

D. Oxytocin

B. Prolactin

Prolactin is secreted by the anterior pituitary. Androgen is secreted by the adrenal glands and gonads. Thyroid hormone is secreted by the thyroid gland. Oxytocin is secreted by the posterior pituitary.

It is TRUE that the parathyroid gland:

A. is made up of at least 6 to 10 pairs of glands.

B. is large and makes up the majority of the thyroid gland.

C. influences the production of thyroid hormone.

D. secretes the most important factor in Ca++ regulation.

D. secretes the most important factor in Ca++ regulation.

PTH is the most important regulator of Ca++. While there are two pairs of parathyroid glands normally present, there may be two to six. They are small and located behind the thyroid gland. Thyroid hormone is produced by the thyroid gland and is unaffected by the parathyroid gland.

A patient is diagnosed with type 1 diabetes and is unable to produce insulin. The pancreatic cells that are most likely damaged are the:

A. beta.

B. alpha.

C. C-peptide.

D. delta.

A. beta.

The beta cells synthesize insulin. The alpha cells secrete glucagon. The delta cells secrete somatostatin and gastrin. C-peptide is the bond that connects the two peptides of proinsulin.

If the outer two layers of the adrenal cortex are removed, the patient will experience:

A. hypernatremia.

B. hyperkalemia.

C. hyperglycemia.

D. decreased epinephrine.

B. hyperkalemia.

The outer two layers of the adrenal cortex produce aldosterone and glucocorticoids. Aldosterone deficiency would cause hyponatremia and hyperkalemia. A deficiency in glucocorticoids would result in hypoglycemia. Epinephrine would only decrease if the adrenal medulla was damaged or removed.

The posterior pituitary gland secretes:

A. antidiuretic hormone (ADH).

B. prolactin-releasing factor (PRF).

C. thyrotropin-releasing hormone (TRH).

D. gonadotropin-releasing hormone (GnRH).

A. antidiuretic hormone (ADH).

ADH is secreted by the posterior pituitary gland. The hypothalamus secretes the remaining substances.

A characteristic of a hormone includes: Select all that apply.

A. having specific rates and rhythms of secretion.

B. operating independently of feedback systems.

C. affecting only cells with appropriate receptors.

D. being excreted by the kidneys.

E. having little integration with the nervous system.

A. having specific rates and rhythms of secretion.

C. affecting only cells with appropriate receptors.

D. being excreted by the kidneys.

Hormones do operate within feedback systems that may be positive or negative in nature. Hormones convey specific regulatory information between cells and organs and are integrated with the nervous system to maintain communication and control.

The posterior pituitary is composed of the: Select all that apply.

A. median eminence.

B. isthmus.

C. stalk.

D. pars distallis.

E. infundibular process.

A. median eminence.

C. stalk.

E. infundibular process.

The median eminence, stalk, and infundibular process are parts of the posterior pituitary. The pars distallis is part of the anterior pituitary, while the isthmus is found in the thyroid gland.

The thyroid gland contains: Select all that apply.

A. C-cells.

B. follicles.

C. isthmus.

D. somatostatin.

E. chromophils.

A. C-cells.

B. follicles.

C. isthmus.

E. chromophils.

C-cells secrete calcitonin and somatostatin. Follicles secrete thyroid hormone. The isthmus joins the two lobes of the thyroid. Chromophils are found in the anterior pituitary.

The effects of glucocorticoids includes: Select all that apply.

A. metabolic

B. hypertensive.

C. anti-inflammatory.

D. growth suppression.

E. tumor growth.

A. metabolic

C. anti-inflammatory.

D. growth suppression.

The hypertensive response and tumor growth are not a result of glucocorticoids. The other three answers are all effects of glucocorticoids.

Abnormalities in endocrine function may be caused by a(n):

A. decrease in hormone levels.

B. altered metabolism of the hormones.

C. absence of antibodies against specific receptors.

D. faulty feedback systems.

E. hormone production by nonendocrine tissue.

C. absence of antibodies against specific receptors.

Elevated or depressed hormone levels result from: (a) faulty feedback systems, (b) dysfunction of the gland, (c) altered metabolism of hormones, or (d) production of hormones from nonendocrine tissues. There is actually a presence of antibodies against specific receptors that either reduce available binding sites or mimic hormone action.

A symptom of SIADH is:

A. hyponatremia.

B. hypernatremia.

C. hyperosmolality (serum).

D. hypoosmolality (urine).

A. hyponatremia.

The cardinal features of SIADH are symptoms of water intoxication. These include hyponatremia (low serum sodium), serum hypoosmolality, and urine that is inappropriately concentrated (hyperosmolar) with respect to serum osmolality.

It is true that DI:

A. results from low levels of ADH.

B. occurs with organic lesion of the hypothalamus or pituitary.

C. may be demonstrated by excessively concentrated urine.

D. is caused by low levels of ADH.

B. occurs with organic lesion of the hypothalamus or pituitary.

The neurogenic form of DI occurs when a lesion of the hypothalamus, pituitary stalk, or posterior pituitary interferes with ADH synthesis, transport, or release. While the neurogenic form is caused by low levels of ADH, the nephrogenic form is caused by inadequate response of the renal tubules to available ADH. Urine is usually very diluted.

A patient experiences nausea, vomiting, loss of body hair, fatigue, weakness, and hypoglycemia. The hormone deficiency the patient is most likely experiencing is that of:

A. TSH.

B. ACTH.

C. FSH.

D. LH.

B. ACTH.

Within 2 weeks of complete absence of ACTH, symptoms of nausea, vomiting, anorexia, fatigue, and weakness develop. With absence of TSH, there is cold intolerance, dry skin, mild myxedema, lethargy, and decreased metabolic rate. FSH and LH deficiencies are associated with amenorrhea, atrophic vagina, uterus, breasts, decrease in body hair, and diminished libido.

It is correct to assume that pituitary adenomas:

A. will experience rapid growth.

B. are generally metastatic.

C. arise from the anterior pituitary.

D. have a pathogenesis due to infarction.

C. arise from the anterior pituitary.

They arise from the anterior pituitary, are benign, and are usually slow growing in nature. The pathogenesis is not a result of infarction.

A patient with visual changes that begin in one eye then progress to the second eye is likely experiencing:

A. pituitary infarct.

B. ACTH insufficiency.

C. Growth hormone (GH) insufficiency.

D. pituitary adenoma.

D. pituitary adenoma.

With a pituitary adenoma, there can be increased pressure on the optic chiasm, and growth of the tumor can cause visual changes in both eyes. The other conditions do not present with optic nerve involvement.

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It is correct to assume that acromegaly:

A. occurs due to excessive levels of ACTH.

B. is the result of a GH-secreting pituitary adenoma.

C. occurs more frequently in men.

D. is a relatively common condition.

B. is the result of a GH-secreting pituitary adenoma.

Acromegaly is a condition caused by excess of GH, not ACTH, as a result of GH-secreting pituitary adenoma. It occurs more commonly in women and is a relatively uncommon condition occurring in about 40 per 1 million.

A symptom of a prolactinoma would include:

A. galactorrhea.

B. alopecia.

C. excessive menses.

D. pregnancy.

A. galactorrhea.

Galactorrhea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Amenorrhea (absence of menses), hirsutism (excessive body hair), and osteopenia can all be caused by a prolactinoma. Pregnancy is a normal cause of galactorrhea.

Symptoms of Graves disease includes:

A. hypothyroid.

B. goiter.

C. sunken eyeballs.

D. atrial fibrillation.

B. goiter.

Graves disease is an autoimmune disease that can cause hyperthyroidism, goiter (diffuse thyroid enlargement), and ophthalmopathy (protruding eyeballs). Atrial fibrillation is not generally viewed as a symptom of Graves disease.

Two siblings are diagnosed with a thyroid disorder due to destruction of thyroid tissue by lymphocytes and circulating thyroid autoantibodies. This pathology is likely the result of:

A. subacute thyroiditis.

B. Hashimoto disease.

C. painless thyroiditis.

D. postpartum thyroiditis.

B. Hashimoto disease.

Hashimoto disease is also called autoimmune thyroiditis. It results in the gradual destruction of thyroid tissue by infiltration or lymphocytes and circulating thyroid autoantibodies. Painless thyroiditis has a similar course to subacute thyroiditis, but is pathologically identical to Hashimoto disease. Subacute thyroiditis is a nonbacterial inflammation of thyroid often preceded by a viral infection. Postpartum thyroiditis generally occurs within 6 months of delivery and occurs in up to 7% of all women.

Myxedema coma is generally associated with:

A. hyperthyroidism.

B. hyperthermia.

C. lactic acidosis.

D. hyperglycemia.

C. lactic acidosis.

Myxedema coma is a medical emergency involving lactic acidosis. It is associated with a diminished level of consciousness due to severe hypothyroidism. Signs and symptoms include hypothermia, hypoventilation, hypotension, hypoglycemia, and lactic acidosis.

It is correct to assume that primary hypothyroidism:

A. is commonly observed.

B. occurs in children aged 5 to 10 years.

C. is the result of absent thyroid tissue.

D. occurs more frequently in male infants.

C. is the result of absent thyroid tissue.

Primary hypothyroidism is a rare form of hypothyroidism caused by the absence of thyroid tissue. It occurs in infants, and more commonly in female infants.

Diabetic ketoacidosis (DKA) is a result of:

A. an increase in insulin production.

B. a decrease in catecholamine secretion.

C. impaired metabolism seen in the elderly.

D. increased fat mobilization.

D. increased fat mobilization.

DKA develops when there is an absolute or relative deficiency of insulin or increase in insulin counterregulatory hormones and fat is burned for fuel. This includes an increase in catecholamines, cortisol, glucagon, and GH. Emotional factors and stress, especially in children, can contribute to the development of DKA, and there is increased glucose production, decreased peripheral glucose usage, and increased fat mobilization.

A patient develops severe dehydration and hyperglycemia in the absence of ketosis. Which of the following conditions does this patient have?

A. Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)

B. DKA

C. Hypoglycemia

D. Somogyi effect

A. Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)

HHNKS is different from DKA in the degree of insulin deficiency and fluid deficiency. It is also characterized by a lack of ketosis. Somogyi effect occurs when hypoglycemia stimulates glucose counterregulation of hormones, causing a rebound hyperglycemia.

A newly diagnosed diabetic patient will exhibit symptoms of: Select all that apply.

A. polydipsia.

B. anuria.

C. polyphagia.

D. weight loss.

E. loss of muscle mass.

A. polydipsia.

C. polyphagia.

D. weight loss.

Excessive thirst and hunger as well as weight loss will likely be seen in a diabetic patient. Polyuria, not anuria, is seen. Loss of muscle mass is not a symptom of diabetes mellitus.

Risk factors for insulin resistance include: Select all that apply.

A. obesity.

B. inactivity.

C. low-fat diet.

D. age.

E. medications.

A. obesity.

B. inactivity.

D. age.

E. medications.

Resistance of the receptors to insulin is heightened by obesity, inactivity, illnesses, medications, and age. A carbohydrate-rich diet, not low-fat, puts an obese person at risk for insulin resistance.

Complications experienced by patients with chronic uncontrolled type 2 diabetes are: Select all that apply.

A. peripheral vascular disease.

B. orthostatic hypotension.

C. thickened capillary membranes.

D. increased glomerular filtration rate (GFR).

E. visual difficulties.

A. peripheral vascular disease.

B. orthostatic hypotension.

C. thickened capillary membranes.

E. visual difficulties.

GFR decreases due to destruction of the nephrons and thickening of the filtration barrier. All other options occur with uncontrolled hyperglycemia.

Which form of anemia is caused by altered heme synthesis in erythroid cells?

A. Iron deficiency

B. Microcytic-hypochromic

C. Sideroblastic

D. Megaloblastic

C. Sideroblastic

Sideroblastic anemias are a heterogeneous group of disorders characterized by anemia of varying severity due to a dysfunction in the erythroid cells that results in a faulty production of heme. Iron deficiency anemia is usually a result of pregnancy or caused by a continuous loss of blood. Microcytic-hypochromic anemia is caused by small erythrocytes that contain reduced amounts of hemoglobin. Megaloblastic anemia is caused by unusually large erythrocytes.

Which term refers to an abnormally high production of red blood cells?

A. Anemia

B. Hemolytic crisis

C. Polycythemia

D. Apoferritin

C. Polycythemia

Polycythemia is the medical term for abnormally high production of red blood cells. Anemia is a decrease in the number of red blood cells. Hemolytic crisis is fulminate hemolytic anemia and can present with shock. Apoferritin is a protein implicated in altered iron metabolism.

Which statement regarding lymphoma is true?

A. The malignancy occurs in the bone marrow.

B. It is the result of injury to the RNA of a lymphocyte.

C. Palpable, tender lymph nodes are present.

D. Lymphomas are the second most common cause of cancer death.

C. Palpable, tender lymph nodes are present.

Lymphomas are initially identified by the presence of tender, lymph nodes that are enlarged enough to be palpated. They are the sixth most common cause of cancer death and are the result of injury to the DNA of the lymphoid tissue. Malignancy within the lymphatic tissue in the bone marrow is termed lymphocytic leukemia.

Spontaneous bleeding without trauma is possible when the platelet count is:

A. greater than 100,000.

B. between 60,000 and 75,000.

C. between 20,000 and 50,000.

D. less than 10,000.

D. less than 10,000.

With a platelet count of less than 10,000, severe bleeding without trauma may result. It is unlikely that such a bleeding will occur at the other levels.

Which statement regarding iron deficiency anemia is true?

A. Caucasians are more commonly affected.

B. Incidence is most common in those children older than 2 years.

C. It is common in children due to their extremely high need for iron for normal growth.

D. There is decreased risk in children of homeless women.

C. It is common in children due to their extremely high need for iron for normal growth.

It is common in children due to their extremely high need for iron for growth. Incidence is not related to race but is increased in the children of homeless women most likely due to poor nutrition. It is most commonly found between the ages of 6 months and 2 years.

Which statement regarding iron deficiency is true?

A. Splenomegaly is present in 90% of those affected.

B. Hemoglobin of 7 g/dl to 8 g/dl may be accompanied by pallor.

C. Hemoglobin of 10 g/dl is generally accompanied by tachycardia.

D. Widening of sutures is an early sign of iron deficiency.

B. Hemoglobin of 7 g/dl to 8 g/dl may be accompanied by pallor.

Splenomegaly is evident in only 10% to 15% of children with iron deficiency anemia. If the condition is longstanding, the sutures may widen. Mild to moderate iron deficiency (hemoglobin 6 g/dl to 10 g/dl) may show some cellular changes. Hemoglobin less than 8 g/dl can demonstrate pallor, tachycardia, and a systolic murmur.

Microcytic-hypochromic anemia is known to be a result of disorders involving: Select all that apply.

A. iron metabolism.

B. porphyrin synthesis.

C. globin synthesis.

D. vitamin B12 absorption.

E. heme production.

A. iron metabolism.

B. porphyrin synthesis.

C. globin synthesis.

E. heme production.

Research supports that microcytic-hypochromic anemia is a result of disorders involving iron metabolism, porphyrin synthesis, heme production, and globin synthesis. The inability to absorb vitamin B12 results in pernicious anemia, which is a microcytic-normochromic anemia.

Which factors involved in blood clotting are regulated by vitamin K? Select all that apply.

A. II

B. VII

C. VIII

D. IX

E. X

A. II

B. VII

D. IX

E. X

Which situation is a characteristic of the triad of Virchow? Select all that apply.

A. Injury to endothelium

B. Abnormalities of blood flow

C. Hypercoagulability of the blood

D. Decreased clotting factors

E. Impaired vitamin A absorption

A. Injury to endothelium

B. Abnormalities of blood flow

C. Hypercoagulability of the blood

Which statement regarding anemia in children is TRUE?

A. The most common cause of sickle cell disease is anemia.

B. Anemia is the most common blood disorder in children.

C. There is only one cause of hemolytic anemia.

D. Children rarely present with iron deficiency anemia.

B. Anemia is the most common blood disorder in children.

Anemia, not sickle cell disease, is the most common blood disorder in children. The most common cause of anemia is iron deficiency. There are two large categories for hemolytic anemia, including increased destruction and disorders related to damaging extraerythrocytic factors.

Which statement regarding maternal antibodies is TRUE?

A. Placental detachment does not result in fetal erythrocytes crossing the placenta.

B. The first Rh-incompatible pregnancy usually presents with severe complications.

C. Anti-Rh antibodies are formed only in the response to transfusion.

D. ABO incompatibility can cause hemolytic disease without erythrocytes escaping maternal circulation.

D. ABO incompatibility can cause hemolytic disease without erythrocytes escaping maternal circulation.

Anti-Rh antibodies are formed only in response to the presence of incompatible (Rh-positive) erythrocytes in the blood of an Rh-negative mother. Sources of exposure include fetal blood that is mixed with the mother's blood at the time of delivery, transfused blood, and, rarely, previous sensitization of the mother by her own mother's incompatible blood. ABO incompatibility can cause hemolytic disease of the newborn without erythrocytes escaping maternal circulation. Placental detachment results in a large number of fetal erythrocytes entering the mother's bloodstream. The first Rh-incompatible pregnancy usually presents with no difficulties. Anti-Rh antibodies are formed in response to the presence of incompatible (Rh-positive) erythrocytes in the blood of an Rh-negative mother.

Which statement regarding a Coombs test is accurate?

A. Indirect Coombs confirms the diagnosis of antibody-mediated hemolytic disease.

B. Indirect Coombs measures antibodies to the mother's circulation.

C. Direct Coombs indicates if the fetus is at risk for hemolytic disease.

D. Direct Coombs measures free antibodies.

B. Indirect Coombs measures antibodies to the mother's circulation.

The indirect Coombs measures antibody in the mother's circulation and indicates if the fetus is at risk for hemolytic disease. The direct Coombs test measures antibodies already bound to the surfaces of fetal erythrocytes and is used primarily to confirm the diagnosis of antibody-mediated hemolytic disease.

Which condition is defined as the "profound anemia caused by decreased erythropoiesis"?

A. Vaso-occlusive crisis

B. Aplastic crisis

C. Sequestration crisis

D. Hyperhemolytic crisis

B. Aplastic crisis

Aplastic crisis is a profound anemia caused by diminished erythropoiesis despite an increased need for new erythrocytes. Vaso-occlusive crisis may develop spontaneously or be precipitated by infection, cold temperatures, dehydration, or low pH. This is when the cells clump and occlude vessels. Sequestration crisis is when large amounts of the blood become pooled in the liver and spleen. Hyperhemolytic crisis is unusual and often occurs with G6PD.

Congenital deficiency in which plasma clotting factors is most likely to cause hemophilia?

A. V

B. VI

C. IX

D. X

C. IX

About 90% to 95% of hemorrhagic bleeding disorders are caused by clotting factors VIII, IX, and XI. There is no current research to support the role of the other options in the development of hemophilia.

Which statements regarding hemophilia are accurate? Select all that apply.

A. There is a dangerous tendency to bleed.

B. Transmission of the disorder to sons occurs via the father.

C. It is considered a hereditary disorder.

D. Blood coagulation is chronically impaired.

E. Women are carriers of the disorder.

A. There is a dangerous tendency to bleed.

C. It is considered a hereditary disorder.

D. Blood coagulation is chronically impaired.

E. Women are carriers of the disorder.

Hemophilia is a condition characterized by impairment of the coagulation of blood and a subsequent tendency to bleed. The classic disease is hereditary and limited to males, being transmitted through the female to the second generation.

Which clinical manifestation is suggestive of leukemia? Select all that apply.

A. Sudden onset

B. Fever present

C. Fatigue

D. Hemoglobin less than 7 g/dl

E. Unaffected white blood counts

B. Fever present

C. Fatigue

D. Hemoglobin less than 7 g/dl

Which artery travels in the coronary sulcus between the left atrium and the left ventricle?

A. Left anterior descending

B. Circumflex

C. Right coronary

D. Left coronary

B. Circumflex

The circumflex travels in the coronary sulcus. The left anterior descending travels down the anterior surface of the interventricular septum. The right coronary artery originates from an ostium behind the right aortic cusp and travels behind the pulmonary artery. The left coronary artery passes between the left atrial appendage and the pulmonary artery and generally divides into two branches.

Which part of the heart is responsible for electrical impulse stimulation?

A. Atrioventricular (AV) node

B. Sinoatrial (SA) node

C. Bundle of His

D. Right bundle branch

B. Sinoatrial (SA) node

The SA node contains P cells and is the site of impulse formation. The atrioventricular node is the junction of the electrical transmission between the atria and the ventricles. The bundle of His is the next stop, and then the transmission branches to the right and left bundle branches. The terminal branches are the Purkinje fibers.

Which of the following represents the measure of time from the onset of atrial activation to the onset of ventricular activation?

A. PR interval

B. QRS complex

C. ST interval

D. QT interval

A. PR interval

The PR interval measures the time of onset of atrial activation to the onset of ventricular activation. The QRS complex represents the sum of all ventricular muscle cell depolarizations. The ST interval is the time when the entire ventricular myocardium is depolarized. The QT interval is often called the electrical systole.

Which drugs have a major effect in decreasing the strength of cardiac contraction?

A. Calcium channel blockers

B. Narcotics (morphine)

C. Adenosine

D. Aspirin

A. Calcium channel blockers

Calcium channel blockers block the calcium channel, prohibiting the movement of calcium into the myocardial cell. Calcium is necessary for the activation of excitation-contraction coupling; blocking this will decrease the strength of contraction. The other drugs are not known to have that relationship to calcium blocking.

Which items are related in the Frank-Starling law of the heart?

A. Resting sarcomere length to tension generation

B. Resting sarcomere length to end-diastolic volume

C. Tension generation and left ventricular pressure

D. Tension generation and diastolic filling pressures

A. Resting sarcomere length to tension generation

The Frank-Starling law of the heart relates to resting sarcomere length (expressed as the volume of blood in the heart at the end of diastole or end-diastolic volume) to tension generation (development of left ventricular pressure). In summary, this means the volume of blood in the heart at the end of diastole is directly related to the force of contraction of the next systole. The other options do not relate to this law.

states that, to a point, the more myocardial fibers are stretched, the greater their force of contraction

Which phrase is the definition of cardiac preload?

A. Impedance to ejection of blood from the left ventricle

B. Wall tension related to internal blood vessel radius

C. A lower than normal tension curve

D. Pressure generated by the end-diastolic volume

D. Pressure generated by the end-diastolic volume

Preload is the pressure generated in the left ventricle at the end of diastole. Afterload is the resistance or impedance to ejection of blood from the left ventricle. A tension curve lower than normal is characteristic of congestive heart failure. Wall tension is directly related to the product of the intraventricular pressure and internal radius and inversely to the wall thickness (Laplace Law).

Which describes the cardio-inhibitory center?

A. Sympathetic excitatory neurons

B. Parasympathetic excitatory neurons

C. Bainbridge reflex

D. Baroreceptor reflex

B. Parasympathetic excitatory neurons

Parasympathetic excitation slows heart rate and is often referred to as the cardioinhibitory center. Sympathetic stimulation is often called the cardioexcitation center because the heart rate increases. The Bainbridge reflex causes the heart rate to increase after intravenous infusions of blood or fluid. The baroreceptor reflex facilitates blood pressure changes and heart rate changes.

Which hormone is released from heart tissue in response to increases in blood volume?

A. Epinephrine

B. Norepinephrine

C. Thyroid hormone

D. Natriuretic peptide

D. Natriuretic peptide

Atrial natriuretic peptide is released from atrial tissue in response to increases in blood volume. Epinephrine and norepinephrine are catecholamines and part of the sympathetic system. Thyroid hormone enhances sympathetic activity.

What two factors determine cardiac output?

A. Parasympathetic and sympathetic activity

B. Preload and afterload

C. Heart rate and stroke volume

D. Right and left atrial pressure

C. Heart rate and stroke volume

Cardiac output is directly related to heart rate and stroke volume. Changes in either variable affect the cardiac output. The remaining options are not involved in determining cardiac output.

The only action that would not cause a release on renin is the:

A. increase in blood pressure at the renal artery.

B. decrease in the amount of sodium delivered to the kidney.

C. beta-adrenergic stimuli.

D. low potassium concentration.

A. increase in blood pressure at the renal artery.

A decrease in blood pressure at the renal artery causes increased renin release. The remaining options are not related to this action.

What is the effect of angiotensin II?

A. Vasodilation

B. Vasoconstriction

C. Inhibition of aldosterone

D. Excretion of sodium at the kidney

B. Vasoconstriction

Angiotensin II is a potent vasoconstrictor, not a dilator, and causes the stimulation of aldosterone. Aldosterone causes reabsorption of the sodium from the kidneys.

Which peptide has the function of regulating sodium and water balance?

A. Atrial natriuretic peptide (ANP)

B. Brain natriuretic peptide (BNP)

C. C-type natriuretic peptide

D. Urodilantin peptide

D. Urodilantin peptide

Urodilantin is a natriuretic peptide isolated from urine. It acts as a paracrine intrarenal regulator for sodium and water balance. BNP is a proposed marker for left ventricular dysfunction. ANP is an indicator of blood pressure elevation. C-type natriuretic peptide is expressed throughout the vasculature.

Which statement regarding autoregulation is TRUE? Select all that apply.

A. Blood vessels regulate their own blood flow.

B. In coronary circulation, pressure is between 60 mmHg and 180 mmHg.

C. Mechanism is well documented and is related to the sympathetic system.

D. Autoregulation ensures constant coronary blood flow.

E. It is proposed that this process originates in vascular smooth muscles of the arterioles.

A. Blood vessels regulate their own blood flow.

B. In coronary circulation, pressure is between 60 mmHg and 180 mmHg.

D. Autoregulation ensures constant coronary blood flow.

E. It is proposed that this process originates in vascular smooth muscles of the arterioles.

The mechanism is not well understood. Autoregulation ensures adequate coronary blood flow between 60 mmHg and 180 mmHg. The blood vessels regulate their own flow through arteriolar resistance, resulting from the smooth muscle constriction of those vessels.

Awarded 0.0 points out of 4.0 possible points.

Which statement regarding arteriosclerosis is TRUE? Arteriosclerosis is:

A. an acute process of heart muscle degeneration.

B. thickening and hardening of the vessel wall.

C. plaque caused by neutrophils.

D. fatty streaks and foam cells that are identical

B. thickening and hardening of the vessel wall.

Arteriosclerosis is a chronic degeneration of blood vessel walls. A plaque is caused by collagen over a fatty streak that is composed of a large number of lipid-laden foam cells that deposit on the vessel wall.

A patient experiences an elevated systolic pressure accompanied by normal diastolic pressure (below 90 mmHg). Which is the correct term for this condition?

A. Primary hypertension

B. Secondary hypertension

C. Tertiary hypertension

D. Isolated systolic hypertension

D. Isolated systolic hypertension

Isolated systolic hypertension is an elevated systolic pressure with a normal diastolic pressure. Primary hypertension has no known cause. Secondary hypertension is caused by altered hemodynamics. There is no tertiary hypertension.

A condition in which blood has pooled, producing distended and palpable vessels, is referred to as a:

A. thrombus.

B. venous stasis ulcers.

C. varicose veins.

D. deep vein thrombosis.

C. varicose veins.

Varicose veins are distended and palpable vessels. Thrombus is a blood clot that remains attached to a vessel wall. Venous stasis ulcers are caused by cell death and necrosis secondary to trauma or pressure-induced oxygen deficiency. Deep vein thrombosis is a thrombus formation occurring mainly in the lower extremities.

Which complication occurs secondary to hypertension?

A. Cardiovascular muscle atrophy

B. Hypoglycemia

C. Congestive heart failure

D. Decreased demand for coronary perfusion

C. Congestive heart failure

Complications of hypertension include ventricular hypertrophy, angina pectoris, congestive heart failure, coronary artery disease, myocardial infarction, and sudden death. There is no research to support the remaining options as occurring as a result of hypertension.

Which term describes the occlusion of a blood vessel from a bolus of circulating matter in the bloodstream?

A. Thrombus

B. Embolus

C. Thrombophlebitis

D. Foam cell

B. Embolus

An embolus detaches from the wall of a vessel and circulates within the vascular system until it reaches a vessel small enough for it to occlude. A thrombus is a blood clot that remains attached to the vessel wall. Thrombophlebitis is the inflammation caused by a thrombus. Foam cells are lipid-laden cells that contribute to fatty streaks.

Which conditions are associated with dyslipidemia?

A. High-density lipoprotein (HDL) - triglycerides and fat packages

B. Very low-density lipoproteins (VLDL) - triglycerides and proteins

C. Low-density lipoproteins (LDL) - phospholipids and proteins

D. Chylomicrons - triglycerides and phospholipids

B. Very low-density lipoproteins (VLDL) - triglycerides and proteins

VLDL is associated with triglycerides and protein. LDL is associated with cholesterol and protein. HDL is associated with phospholipids and protein. Chylomicrons are dietary fat packages.

Which statement regarding cigarette smoke is correct? Cigarette smoking produces:

A. decreased LDL .

B. increased HDL .

C. increased thrombotic state.

D. decreased inflammatory state.

C. increased thrombotic state.

There is an increased LDL level and thrombotic and inflammatory state and decreased HDL.

A patient presents with chest pain that occurs at rest. Abnormal vasospasm of the coronary arteries is detected. Which is the most likely cause of the chest pain?

A. Stable angina

B. Prinzmetal angina

C. Silent ischemia

D. Angina pectoris

B. Prinzmetal angina

Prinzmetal angina is an abnormal vasospasm of the coronary vessels. It typically produces pain at rest and is common in women. Stable angina occurs with activity and is often limited and resolves with rest. Silent ischemia is occlusion of the coronary arteries without pain. Angina pectoris is chest pain, usually substernal chest discomfort.

Which statement regarding cellular injury of the myocardium is correct?

A. Cardiac cells can withstand ischemic conditions for about 40 minutes.

B. ECG changes are visible after approximately 120 seconds.

C. Myocardial cells remain viable if blood flow returns within 20 minutes.

D. After 20 seconds of decreased blood flow, myocardial cells become cooler.

C. Myocardial cells remain viable if blood flow returns within 20 minutes.

Cardiac cells can withstand ischemic conditions for about 20 minutes. ECG changes are visible after 30 to 60 seconds of hypoxia. After 8 to 10 seconds of blood flow, the myocardial cells are already cooler.

Which is the MOST common complication of an AMI?

A. Dressler syndrome

B. Arrhythmia

C. Pericarditis

D. Heart failure

B. Arrhythmia

All of these answer choices are true complications of AMI; however, the most common is arrhythmia.

A patient experiences spinal cord damage following a motorcycle accident. Which type of shock would most likely result?

A. Hypovolemic

B. Vasogenic

C. Anaphylactic

D. Septic

B. Vasogenic

Vasogenic shock results from an increase in parasympathetic nervous stimulation and a decrease in sympathetic nervous stimulation. Hypovolemic shock results from a decrease in blood volume due to hemorrhage. Anaphylactic shock is a hypersensitivity usually due to penicillin, latex, and food allergies. Septic shock is due to infection.

Which characteristic is associated with hypertension? Select all that apply.

A. Family history positive for hypertension

B. Asian race

C. High dietary sodium

D. Glucose intolerance

E. Obesity

A. Family history positive for hypertension

C. High dietary sodium

D. Glucose intolerance

E. Obesity

Hypertension is associated with positive family history, gender (men younger than 55 and women after menopause), black race (not Asian), high dietary sodium, glucose intolerance, cigarette smoking, obesity, heavy alcohol consumption, and low dietary intake of minerals.

A patient is being transferred from another medical facility with a diagnosis of acute myocardial infarction (AMI). Which symptom is typically observed with the presences of an AMI? Select all that apply.

A. Cough

B. Fever

C. Diaphoresis

D. Substernal pain

E. Cool, clammy skin

B. Fever

C. Diaphoresis

D. Substernal pain

E. Cool, clammy skin

A patient may experience substernal chest pressure or pain, nausea, vomiting, abdominal pain, or indigestion. Fever, sweating, and cool and clammy skin are also typical. A cough is not considered a sign of an MI.