adv pathophys exam 1 practice

Compute the anion gap from these lab values: Na 136 K 4.0 Cl 106 Albumin 3.0 BUN 20 HCO3 22

8

The anion gap is Na less Chloride less Bicarb Na - (Cl + HCO3), so it is 136 - (106+22) 136 - 128 AG = 8

A diabetic is seen in the ER. His capillary blood glucose is 350 and his labs are as follows. Na 140 K 2.8 Cl 95 BUN 35 HCO3 20 Using these lab values, what can you conclude about his acid base balance?

A.) Nothing, there are no blood gas values

B.) He is in ketoacidosis, because his anion gap is elevated.

C.) He is in compensated ketoacidosis, because his anion gap is normal

B.) He is in ketoacidosis, because his anion gap is elevated.

The anion gap can be used without ABGs to support the idea of types of metabolic acidosis. We seldom draw ABGs, yet we can compute the anion gap quickly with a standard set of lab values. In this case, his anion gap was 15 indicating an acidosis due to his diabetes.

Match the blood gases to the acid-base problem portrayed.

1. pH 7.31 PCO2 40 HCO3 18

2. pH 7.47 pCO2 28 HCO3 26

3. pH 7.52 PCO2 36 HCO3 32

4. pH 7.30 PCO2 70 HCO3 24

1. Metabolic acidosis

2. Respiratory alkalosis

3. Metabolic alkalosis

4. Respiratory acidosis

CO2 changes in respiratory disease and bicarbonate changes with metabolic disease.

Match the acid-base imbalances to the initial method of compensation for it.

1. Respiratory acidosis

2. Respiratory alkalosis

3. Metabolic acidosis

4. Metabolic alkalosis

1. Increased excretion of acid in the urine

2. Excretion of bicarbonate in the urine

3. Rapid deep breathing

4. Decreased rate and depth of breathing

The lungs compensate for metabolic problems and do so quickly. The kidneys compensate for respiratory problems and take a day or two.

Match the acid-base disorder to a common etiology. Answers can be used once, more than once or not at all.

1. Diabetic ketoacidosis

2. Hyperventilation

3. Emphysema with air trapping

4. Prolonged NG suction

5. Narcotic overdose

6. Renal failure

1. Metabolic acidosis

2. Respiratory alkalosis

3. Respiratory acidosis

4. Metabolic alkalosis

5. Respiratory acidosis

6. Metabolic acidosis

CO2 is an acid and when it is retained, the patient becomes acidotic. When it is "blown off" the patient loses acid and becomes alkalotic. When stomach acid (HCl) is lost through GI drainage or vomiting, the loss of acid makes the patient alkalotic. Since the loss is not pulmonary, it becomes a metabolic alkalosis. Metabolic acidosis develops when the amount of acid in the body is increased through ingestion of a substance that is, or can be broken down (metabolized) to, an acid—such as wood alcohol (methanol), antifreeze (ethylene glycol), or large doses of aspirin . Metabolic acidosis can also occur as a result of abnormal metabolism. The body produces excess acid in the advanced stages of shock and in poorly controlled type 1 diabetes mellitus. Even the production of normal amounts of acid may lead to acidosis when the kidneys are not functioning normally and are therefore not able to excrete sufficient amounts of acid in the urine.

What is the metabolic byproduct specific to fat metabolism?

A.) Carbon dioxide

B.) Ketones

C.) Sulfuric acid

D.) Alcohol

B.) Ketones

The byproduct of fat metabolism are ketones. Carbon dioxide is the byproduct of carbohydrate metabolism. Sulfuric acid is the byproduct of protein metabolism. Alcohol is not a byproduct of our metabolism, it is derived from yeast.

What is the metabolic byproduct of protein metabolism?

A.) Carbon dioxide

B.) Lactic acid

C.) Sulfuric acid

D.) Carbonic anhydrase

C.) Sulfuric acid

Sulfuric acid is the byproduct of protein metabolism. Carbon dioxide is the byproduct of carbohydrate metabolism. Lactic acid is the byproduct of anaerobic metabolism. And carbonic anhydrase is the enzyme that breaks down carbonic acid into water and CO2.

Which metabolic product accumulates from carbohydrate metabolism?

A.) Carbon dioxide

B.) Lactic acid

C.) Sulfuric acid

D.) Carbonic anhydrase

A.) Carbon dioxide

Carbon dioxide is the byproduct of carbohydrate metabolism. Lactic acid is the byproduct of anaerobic metabolism. Sulfuric acid is the byproduct of protein metabolism. And carbonic anhydrase is the enzyme that breaks down carbonic acid into water and CO2.

Which of these diseases is most often transmitted vertically?

A.) MRSA

B.) Hepatitis B

C.) Tetanus

D.) Pseudomonas

B.) Hepatitis B

Vertical transmission is from mother to baby through the placenta, at the time of birth or in breast milk. The most likely organism on this list is hepatitis B transmitted at the time of birth.

Which of these diseases is most often transmitted horizontally?

A.) MRSA

B.) Hepatitis B

C.) HIV

D.) Syphilis

A.) MRSA

Horizontal transmission is between two species, not mother and child. Most of the sexually transmitted diseases are transmittable between mother and baby.

Match the aspect of virulence to an example of when it would be an important aspect of its pathogenesis.

1. Mode of transmission

2. Adherence

3. Invasion of the host

4. Toxin production

5. Production of granuloma

1. Lack of HCl in the stomach

2. Presence of artifical valves

3. Production of collagenase, hyaluronadase or coagulase

4. Produces substances that can be used as toxoids

5. Intracellular survival

The mode of transmission is made easier when one of the primary barriers (eg. intact skin, loss of stomach HCl) does not prevent entrance. Adherence is easier on foreign objects because there is no blood flow to combat the organism. Invasion of the tissues of the host is aided by all of the "ases" or enzymes that digest tissue. Toxin production can be fatal (exotoxin) or make the patient very ill (endotoxin) and the exotoxins are used to make toxoids (tetanus toxoid). Intracellular survival is aided by the presence of a "wall", often called granuloma.

Which of these are characteristics of an exotoxin? (one or more answers may be correct)

A.) Produced by the cell wall of gram-negative bacteria

B.) Often fatal

C.) Vaccines can be made from the toxoids

D.) Leads to fever and shock

E.) Secreted from the cell

F.) Examples would be tetanus and pseudomembranous colitis

B.) Often fatal

C.) Vaccines can be made from the toxoids

E.) Secreted from the cell

F.) Examples would be tetanus and pseudomembranous colitis

Exotoxins are the very toxin, often fatal substances produced by cells. They include tetanus, botulism, gas grangrene, anthrax and pseudomembranous colitis. Fortunately, many have toxoids that can be used as vaccines.

What characteristics of endotoxin can be seen in patients with septic shock?

A.) Death may not be due to the bacteria, but rather the cytokines (tumor necrosis factor, interleukins)

B.) Fever from release of interleukin-1 by macrophages

C.) Hypotension from vasodilation from bradykinin

D.) DIC from activation of the coagulation system

E.) All of the above

E.) All of the above

All of these are true. Septic shock is due to the combination of vasodilation by the kinins (bradykinin in particular) leading to hypotension, fever, and DIC. It is often fatal due to all of these effects rather than the bacteria alone. In fact, the blood cultures may be negative due to antibiotics.

What is the difference between Systemic Inflammatory Response Syndrome (SIRS) and sepsis?

A.) Sepsis is SIRS plus a documented infection site.

B.) SIRS is the same thing as sepsis.

C.) Blood cultures are positive in both.

D.) Only sepsis can be fatal.

A.) Sepsis is SIRS plus a documented infection site.

SIRS is an inflammatory reaction to bacteria or virus, but there is not bacteria in the blood (i.e., positive blood culture) nor a known site of infection. It is not often fatal, but can be in high risk patients.

Which of these functions is typically seen in all nucleated cells?

A.) Cell division

B.) Unregulated cell growth

C.) Cell movement

D.) Energy conservation

A.) Cell division

When there is a nucleus, the cell can reproduce itself by dividing (multiplying by dividing!!). Unregulated cell growth is cancer. Not all cells move, only those with flagella. Cells don't conserve energy, they make it.

Match the organelle to its function. Answers may be used more than once or not at all.

1. Location of DNA used for protein synthesis templates

2. Destroys incorrectly made proteins or the cell if needed

3. Distributes and ships the protein for use inside or outside of the cell

4. Assembles amino acids into protein strands

5. Regulates cellular metabolism by production of ATP

6. Ribosomes on it make proteins and then it folds proteins

1.) Nucleus

2.) Lysosome

3.) Golgi apparatus

4.) Ribosome

5.) Mitochondria

6.) Endoplasmic reticulum

Insulin is synthesized in the Beta cells in the pancreas' islets of Langerhans. Insulin is a protein (peptide) hormone composed of 51 amino acids. What is the order of steps that occur for insulin to be produced?

1.) Pancreas cells membranes sense elevated blood glucose or are stimulated by hormones and enzymes from the GI tract

2.) Pancreatic alpha/delta cells suspend production of glucose

3.) Chains of 51 amino acids are assembled in the ribosome

4.) Nucleus DNA for insulin divides in half to to be copied

5.) RNA leaves the nucleus carrying the template

6.) Insulin DNA template is copied in nucleus for RNA

7.) Insulin is folded in the endoplasmic reticulum (as "proinsulin")

8.) Proinsulin is sent to the Golgi complex where it is packaged into granules and the "pro" is cleaved off leaving just insulin

9.) Insulin is moved to the cell membrane of the Islet cell

10.) Insulin is released into the blood stream

Based on the fact that gastric acid stays in the stomach and does not normally digest other tissues, what type of cell junction must the stomach have?

A.) Tight junctions

B.) Gap junctions

C.) Anchoring junctions

D.) Adhesive junctions

A.) Tight junctions

The stomach lining is composed of tight junctions with prohibit gastric acid from leaving.

What method of fluid and solute movement is shown in the diagram?

A.) Active transport

B.) Diffusion

C.) Osmosis

D.) Passive transport

B.) Diffusion

This is diffusion. The greater amount of a sustance moved until the concentration was equal.

The blood brain barrier is normally a tight cellular junction that does not allow the movement of substances across it. However, ethanol easily passes through the barrier to affect thinking, reaction times, emotions and so on. Why is ethanol able to cross the barrier?

A.) There is a receptor for ethanol on the surface of the brain.

B.) The tight junctions are impaired and allow ethanol to pass.

C.) Ethanol is a small water-soluble molecule and diffuses across the barrier.

D.) Ethanol is engulfed by the cell through pinocytosis

C.) Ethanol is a small water-soluble molecule and diffuses across the barrier.

Because of the complete miscibility with water, ethyl alcohol is readily distributed throughout the body in the blood stream after consumption. Because of this water solubility, it is readily crosses important biological membranes, such as the blood brain barrier, to affect a large number of organs and biological processes in the body. The passage of ethyl alcohol across biological membranes occurs by a process of simple passive diffusion along concentration gradients, in accordance with Fick's law.

Which of these statements is the best description of the terms "antigen" and "antigenic determinant"? (One or more statement can be chosen.)

A.) An antigen is a foreign protein that interacts with the immune system, initiating an immune response.

B.) An antigen is a foreign protein to which the immune system has developed a tolerance to, and does not initiate an immune response.

C.) The antigenic determinant is the portion of the antigen that is most virulent, and causes the disease.

D.) The antigenic determinant is the portion of the antigen that is recognized by the T cell or antibody.

A.) An antigen is a foreign protein that interacts with the immune system, initiating an immune response.

D.) The antigenic determinant is the portion of the antigen that is recognized by the T cell or antibody.

The antigen is a foreign protein, usually a bacteria or virus. The antigenic determinant is the portion of the antigen that is determined to be foreign.

Match an example of the types of immunity to the correct label.

1. Humans do not develop canine distemper

2. Immunizations to tetanus as a child

3. Having measles as a child

4. Using serum from a pediatrician

5. Getting breastmilk

1. Innate (species based) immunity

2. Active acquired immunity

3. Active acquired immunity

4. Passive acquired immunity

5. Passive acquired immunity

Any time you make the antibodies for yourself it is an active process. It does not matter whether you had the disease or just had the immunization. The antibodies are made, stored, remembered and ready when the disease comes again. Passive forms of immunity are when you borrow someone else's antibodies to hold you over until you can make your own. The borrowed antibodies are not capable of being replaced, since the memory does not exist to manufacture them.

Match the attributes of T and B cells to their descriptors.

1. Mature in the thymus

2. Mature is bursal equivalent tissues

3. Produce antibodies

4. Produce cytotoxic cells, helper cells and suppressor cells

5. Stored cells are found in plasma and memory cells

6. Are also named immunoglobulins, like IgM, IgG

1. T cells

2. B cells

3. B cells

4. T cells

5. B cells

6. B cells

The T cells mature in the thymus and produce all the named cells, such as the T helper cell, cytotoxic T cell, suppressor T cell. The B cells mature in the bursal equivalent tissues, which is likely the bone marrow in humans. These cells produce antibodies, which are called immunglobulins and named by the letters G, M, A, E and D. Antibodies have memory and are manufactured in the plasma cell and stored in the memory cells.

Autoimmune diseases are ones in which the T cells did not have the proper "education" or failed in quality control. How does this error lead to disease? (One or more than one answer may be correct.)

A.) The T cell recognizes the body's own tissues as "self"

B.) The T cell sees the body's own tissues as foreign and destroys them.

C.) The T cell does not recognize antigens as "non-self" and does not destroy them

D.) The T cell does recognize antigens as "non-self" but develops a tolerance to them

B.) The T cell sees the body's own tissues as foreign and destroys them.

C.) The T cell does not recognize antigens as "non-self" and does not destroy them

Part of T cell education is sorting out the T cells that do not recognize the body as self and keeping those that do. It is also getting rid of the T cells that do not recognize antigens.

Match the 5 categories of immunoglobulins to their common purpose.

1. Seen in allergic responses.

2. Major fetal antibody

3. Used in parasitic infections

4. First antibody to be produced after birth

5. Function really unknown

6. Protects from upper respiratory infections

7. Responsible for most of the usual antibody functions

8. First antibody to be produced when an antigen is present

9. Transmitted in breast milk

1. IgE

2. IgG

3. IgE

4. IgM

5. IgD

6. IgA

7. IgG

8. IgM

9. IgA

IgA is the antibody found in breast milk and protects us from upper respiratory infections. IgD is not well understood. IgE is the allergy and parasitic antibody. IgG is the major antibody used in immune responses. IgM is the first antibody produced after birth and the most common one to be used in response to an antigen.

Which of these statements is true about the Helper T cell?

A.) It is the centerpiece of the cellular immune response.

B.) It is able to kill antigens if it recognizes them as antigens.

C.) It remembers previous antigens and develops antibodies to them.

D.) It stimulates the suppressor T cells to slow down the immune response.

E.) It is presented the antigen by the macrophage.

F.) It is the cell that is diseased in HIV.

G.) It is also known as the CD-4 cell.

H.) It is also known as the CD-8 cell.

A.) It is the centerpiece of the cellular immune response.

D.) It stimulates the suppressor T cells to slow down the immune response.

E.) It is presented the antigen by the macrophage.

F.) It is the cell that is diseased in HIV.

G.) It is also known as the CD-4 cell.

The helper T cell coordinates the responses of the cytotoxic T cell and the suppressor cells, once presented the antigen by the macrophage. It is also known as the CD-4 cell.

Match the events in the diagram, labeled A-D, with the activity that is occurring.

Step A:

Step B:

Step C:

Step D:

A. Recognition

B. Mobilization

C. Disposal

D. Immunity

The first thing to happen is the white cell recognizes and engulfs the pathogen. It then signals other cells to the area, where unique antibodies are manufactured to combat it. Finally, the patient has immunity.

What is happening in Step "C" of the immune response as shown in the diagram above?

A.) Antigens are being made

B.) Pathogens are destroying antibodies

C.) Antibodies are destroying pathogens

D.) Pathogens are destroying antigens.

C.) Antibodies are destroying pathogens

The antibodies are destroying the pathogens. Antiboides are depicted here as the small Y shaped molecule (that is what they look like)

Match the likely electrolyte imbalance to the patient's risk profile. Answers may be used once, many times or not at all.

1. A patient with renal failure and EKG changes showing a wide QRS wave

2. A patient who begins chemotherapy for a large lymphoma

3. A patient after a thyroidectomy who reports facial twitching

4. An alcoholic patient hallucinating in active withdrawal

5. A patient with an insulin-secreting tumor

6. A patient with indigestion who has consumed 4 rolls of Tums daily for the past several days

7. A patient who sustained a crush injury to his legs

8. An NPO patient with a history of prolonged vomiting

9. A patient in renal failure with dark necrotic ulcers on his legs

10. A patient with small cell lung cancer with bony metastasis

11. A patient with renal failure who has taken Milk of Magnesia

1. High K

2. High Phosphorus

3. Low Ca

4. Low Magnesium

5. Low K

6. High Ca

7. High K

8. Low K

9. High Phosphorus

10. High Ca

11. High Magnesium

Cellular destruction (crush injury, tumor lysis from chemotherapy) releases the electrolytes found in the cell, which are potassium, phosphorus and magnesium. So if you chose potassium or phosphorus for the chemotherapy one, you are also correct. Potassium must be ingested daily, so patients who are NPO and/or vomiting can deplete their supply quickly. Insulin also drives potassium into the cell, so when excess insulin is present, serum K will fall.

Calcium is regulated by the parathyroid gland and inadvertent removal of it during thyroidectomy can occur. An unusual response occurs with many forms of cancer, they secrete a parathyoid like hormone and calcium rises (more on this later). Oral ingestion of Tums, which is calcium, can cause serum levels to rise. Phosphorus problems are rare; they tend to occur in patients in renal failure. In renal failure, the kidney wastes calcium and retains phosphorus. Phosphorus binds in the skin and creates very nasty black, necrotic skin lesions. Magnesium levels rarely fall, but low levels can be seen in alcoholics, especially those who are delirious.

Match the pattern of fever to the name of the febrile response.

1. Diurnal variation in body temperature

2. Sustained fever

3. Intermittent fever

4. Remittent fever

5. Relapsing fever

1. Temp rises and falls every 24 hours, never rising over 99.5 (F)

2. Fever is steadily over 101 (F) without ever falling to normal levels

3. Fever rises each day to above normal (101 F) and falls to normal each day

4. Fever rises (101 F) and falls but never falls to normal each day

5. Fever occurs every 2-3 days

The lymphatic system is important because it: (one or more than one answer may

A.) removes excess interstitial fluid from tissues

B.) removes antigenic material from tissues

C.) provides a location for antibody-producing B-lymphocytes to destroy antigens

D.) provides a location for T-lymphocytes to mature

A.) removes excess interstitial fluid from tissues

B.) removes antigenic material from tissues

C.) provides a location for antibody-producing B-lymphocytes to destroy antigens

The lymphatic system removes excess instititial fluid from tissues; removes antigenic material from tissues; and provides a location for antibody-producing B-lymphocytes to destroy antigens

Clumps of lymphoid tissue are found in many parts of the body, especially in: (one or more than one answer may be correct)

A.) the linings of the digestive tract

B.) the airways and lungs

C.) the tonsils

D.) the adenoids

A.) the linings of the digestive tract

B.) the airways and lungs

C.) the tonsils

D.) the adenoids

Lymphatic vessels can be described by the following characteristics:

A.) their walls are composed of several tightly-connected layers of endothelial cells

B.) they are connecting channels between tissue arterioles and venules

C.) they empty into lymph nodes where the lymph fluid is filtered

D.) they help drain particulate matter and antigenic material from the interstitial tissue space

C.) they empty into lymph nodes where the lymph fluid is filtered

D.) they help drain particulate matter and antigenic material from the interstitial tissue space

A fever that is present for 2-3 weeks and no one can determine what is causing the fever is called:

fever of unknown origin

Fever of unknown origin (FUO) is a unique problem in which the source of the fever is not easily identified.

A patient has an abdominal incision. Match the possible outcomes of his wound healing to the name of the intention of wound healing.

1. Incision is open, with exposed fat, and it is being packed with gauze now.

2. The incision is still sutured closed, slightly red along the suture marks and has a firm raised ridge along the incision line.

3. The incision was cleaned up with dressings, and sutured closed again.

4. The incision is not going to stay closed and it will be left to heal with scar tissues.

1. Delayed primary healing

2. Primary healing intention

3. Tertiary healing, or delayed primary closure

4. Secondary intention healing

Delayed primary healing is small areas of open incisions that will granulate closed in time. Primary intention healing is letting an incision just heal using the suture to hold it in place while it heals. Secondary healing is letting a large wound heal by granulation and scar. Tertiary healing, or delayed primary closure, is suturing a wound closed again, once it it clean.

Match the cell or enzyme to the period of wound healing for which it is most important.

1. Fibroblast

2. Platelet

3. Collagen

4. Matrix metalloprotease (MMP)

1. Reconstructive phase

2. Inflammatory phase

3. Maturation/remodeling phase

4. Reconstructive phase

The process of wound healing begins with the platelet initiating inflammation. After the wound is cleaned up, fibroblasts lay down the matrix for healing. MMPs can interfere with this phase becasue they eat the newly formed tissues. In the last phase collagen in laid into the matrix and the wound closes.

There are several aspects of wound healing that can be altered. Match the problems with wound healing to the factor that is impaired.

1. Protein malnutrition

2. Lack of vitamin C

3. Use of hydrogen perioxide

4. Too much pressure on the wound

5. Invasive numbers of bacteria in the wound

6. Use of corticosteroids

7. Cigarette smoking

8. Tissue hypoxia

1. Impaired collagen synthesis

2. Impaired collagen synthesis

3. Impaired epitheliazation

4. Impaired epitheliazation

5. Impaired inflammatory responses

6. Impaired inflammatory responses

7. Impaired epitheliazation

8. Impaired epitheliazation

The inflammatory response is suppressed by steroids and aggravated by bacteria. Collagen deposition is impaired by a lack of the materials needed to make it (protein and vitamin C). Epitheliazation is slowed by toxic topical agents (H202...remember that white blood cells kill by producing it and H2O2 is part of oxygen free radical tissue injury?), and too little oxygen from too much pressure, smoking and general hypoxia.

Match the components of nonspecific immunity to their purpose or function. Answers can be used once, more than once or not at all.

1. Mast cell

2. Histamine

3. Prostaglandin

4. Complement

5. Monocyte

6. Macrophage

7. Interleukin

8. Interferon

1. Degranulates and releases histamine

2. Causes vasodilation

3. Irritate nerve endings, causing pain

4. Participates in many aspects of inflammation, even destroying cells

5. The WBC that becomes a macrophage

6. The "big eater", a cell that recognizes foreign protein and digests it

7. Enhance many aspects of inflammation, and produce fever

8. Prevents viruses from infecting healthy cells

Mast cells are the most important cell in the nonspecific aspects of inflammation, inthat they start the process by releasing histamine. Histamine causes vasodilation, allowing the monocyte to escape into the tissues and become a phagocyte. Leukocytes also move into tissue. The mast cell also stimulates the production of prostaglandin which causes pain (we give a lot of prostaglandin inhibitors as pain meds, such as ibuprofen). Complement is released in a cascade response andstimulates many aspects of inflammation; it can even kill cells directly. Interleukins are proteins and communicate with other white blood cells (interleukin means between white [cells]) and produce fever. Interferon is used in viral infections, it prevents viruses from infecting healthy cells.

Which of the following features are true for Candida Albicans? (multiple select)

A.) It is part of the normal flora of the vagina, mouth and GI tract.

B.) It is opportunistic, growing when host defenses are impaired.

C.) It is only seen in women.

D.) Candidal infections can create pseudomembranes such as seen in thrush.

E.) It is spread by air-droplet method.

F.) Skin infection is common in warm, moist areas and the skin becomes red and weeps.

A.) It is part of the normal flora of the vagina, mouth and GI tract.

B.) It is opportunistic, growing when host defenses are impaired.

D.) Candidal infections can create pseudomembranes such as seen in thrush.

F.) Skin infection is common in warm, moist areas and the skin becomes red and weeps.

Candida is an opportunistic infection, developing in patients who are immunocompromised or on a lot of antibiotics which has altered their normal flora. It is seen in both men and women and because it already exists on the skin, it is not transmitted. Skin infected with Candida is red and weeping, it may also produce a creamy white or "cheesy discharge".

Which of these signs and symptoms or history occur with amebic dysentary? (multiple select)

A.) Bloody diarrhea

B.) Lower abdominal pain

C.) Travel to areas of the world where water sanitation is not protected

D.) No risk of progression to the liver

E.) Foul smelling stool

F.) Low grade fever

A.) Bloody diarrhea

B.) Lower abdominal pain

C.) Travel to areas of the world where water sanitation is not protected

F.) Low grade fever

Amebic dysentary is due to drinking water that is contaminated, however travel may not have been outside the US. It presents with bloody, mucus containing diarrhea along with lower abdominal pain, flatulence, low grade fever and pain with defecation. There is a risk that the organism can move to the liver.

Match the risk profile of the patient to the most likely organism to cause infection in that patient. Answers can be used once or more than once or not at all.

1. A diabetic patient with dialysis-dependent renal failure who needs coronary bypass grafting.

2. A diabetic with a chronic open wound on the foot.

3. A prolonged hospitalized patient who has been on many antibiotics and now has diarrhea

4. A ventilator dependent patient with cystic fibrosis

5. An obese, female patient who has been on antibiotics.

1. Staphylococcus Aureus

2. Methicillin Resistant Staphylococcus Aureus

3. Vancomycin Resistant Enterococcus

4. Pseudomonas

5. Candida Albicans

Diabetics are at especially high risk for staph infections and the longer the wound is open, the greater their chances of the infection being from MRSA. Any time a patient is on antibiotics, especially if the drugs are from many categories, opportunistic organisms can grow such as Candida and VRE, Pseudomonas

Darwin's theory of evolution and survival of the fittest can be applied to:

A.) Viral replication

B.) Bacterial resistance

C.) Budding reproduction in yeasts

D.) Viral prion diseases

B.) Bacterial resistance

The best example of evolution is the mutation of bacteria into organisms that are resistant to antibiotics. Those bacteria that were killed by the bacteria no longer reproduce do they?

A patient presents with a small open wound in the groin on Monday afternoon. By early Tuesday morning, he is septic and the wound is enormous. What is the likely organism causing the problem and why?

A.) Beta Hemolytic Streptococcus A (pyogenes) because it secretes an exotoxin (hyaluronidase) protease) that dissects tissue.

B.) Group B streptococci because it secretes hyaluronidase (an enzyme) which allows it to reach deep tissues

C.) Enterococci because they are common urinary tract infectious organisms

D.) Staphylococcus aureus because it forms walls to protect itself from attack

A.) Beta Hemolytic Streptococcus A (pyogenes) because it secretes an exotoxin (hyaluronidase) protease) that dissects tissue.

Strep A is the one associated with necrotizing fasciitis, a disease of very rapid loss of tissue (commonly called flesh eating bacteria). Staph does cause "walling off" but those infections are usually abscesses. Group B is passed from mother to child during delivery.

Why is pseudomonas called the "epitome" of bacteria?

A.) It can live in many types of environments.

B.) It produces exotoxin that damages cells.

C.) It is resistant to many antibiotics.

D.) All of the above

D.) All of the above

They are all true. Pseudomonas is a tough, tough organism. Having its home in soil it is especially resistant to environmental changes and now resistant to many antibiotics.

Match the hormone to its predominant effect in the stress response.

1. Aldosterone

2. Cortisol

3. Epinephrine

4. Norepinephrine

1. Increased salt reabsorption and then water retention

2. Immune suppression

3. Increased heart rate and cardiac output

4. Increased blood pressure

The sympathetic nervous system, or fight or flight response, allows us to be ready to move during times of stress. So blood pressure, heart rate, and blood glucose are elevated. The immune system is suppressed probably so that we don't feel pain and can keep going. Blood glucose also rises from epinephrine and cortisol.

Why is the development of viral infections and cancers seen in patients who have severely stressful life situations?

A.) Their blood glucose is elevated, which slows their immune response

B.) Their production of B and T lymphocytes is reduced

C.) Their gastric production of mucus is reduced

D.) Their ability to synthesize protein is reduced

B.) Their production of B and T lymphocytes is reduced

While all the items listed happen, the research has shown that the lost of cellular immune response is linked to the development of viral infections and cancers after a stressful response.

For years and years, a patient has lived in an unsafe neighborhood, with almost nightly crime. Her job is temporary and she expects she could be "let go" fairly soon due to cuts in employees. She has 2 dependent children and is a single parent. How does the stress response fit in this story?

A.) If she perceives her life as stressful, her body will respond as if it was a physical stressor.

B.) If she perceives her life as stressful, her body will only respond for a few days with a stress response.

C.) No matter how she perceives her life, her body will respond as if she is in a stressful situation.

D.) No matter how she perceives her life, the stress response only occurs in physical trauma.

A.) If she perceives her life as stressful, her body will respond as if it was a physical stressor.

The body does not know the difference between physical and psychological or sociological stress. It responds the same way each time, and although the response may be limited in time, the diseases prolonged stress cause is not limited.

Match the intracellular organelle to the change seen in it when it is deprived of oxygen.

1. Mitochondria

2. Lysosome

3. Endoplasmic reticulum

1. Failure to convert glucose to ATP

2. Destruction of the cell

3. Failure to manufacture protein

These organelles will remain important to our upcoming disucssions, be certain you know what the mitochondria (powerhouse of the cell, create energy), endoplasmic reticulum and its ribosomes(manufacturing protein) and lysosome (destruction) do.

Which of these cells dies first from the lack of oxygen?

A.) Cells with high amounts of Na-K pumps

B.) Cells with moderate amounts of Na-K pumps

C.) Cells with low amounts of Na-K pumps

A.) Cells with high amounts of Na-K pumps

Cells that need and use a lot of energy to run, have a lot of Na-K pumps, therefore would die first without oxygen. The brain and heart are two of those organs.

Match the type of tissue response to the condition:

1. Stenosis of supplying arteries

2. Lack of innervation

3. Hypertension

4. Exposure to high altitude

5. Exposure to cigarette smoke

1. Atrophy

2. Atrophy

3. Hypertrophy

4. Hyperplasia

5. Dysplasia

Exposure to high altitudes would stimulate the production of more RBCs, or hyperplasia. These cells are normal, there are just more of them.

Match the organ to its type of tissue death

1. Brain, nerves

2. Heart

3. Lung

4. Skin, muscle

1. Liquifactive necrosis

2. Coagulative

3. Caseating

4. Gangrene

Neurological tissues seemingly liquify when their self destruction goes on. Tissues amply supplied with blood have coagulation of the blood and hence the name coagulative necrosis. Caeseating means cheeselike and is seen in TB. Gangrene, of course, is the end product of lack of blood supply. It is seen in the skin, but can occur in all tissues supplied with blood, so it initially is an ischemic process, followed by liquification.

Which of the following viruses becomes dormant or latent?

A.) Poiloviruses

B.) Herpes viruses

C.) Rhinoviruses

D.) Influenza viruses

B.) Herpes viruses

Herpes virus displays latency or the ability to lie dormant in the cell and then reappear with the production of more viruses. We call this a fever blister when it appears on the lips, but Herpes can also be reactivated by sunlight or heat.

Viruses are obligate intracellular parasites. Which of these statements about viruses is NOT correct?

A.) Viruses cannot generate energy outside the cell.

B.) Viruses cannot synthesize proteins outside the cell.

C.) Viruses can only reproduce inside the cell.

D.) Viruses must degrade host DNA to obtain the genetic nucleic acids.

D.) Viruses must degrade host DNA to obtain the genetic nucleic acids.

Viruses cannot reproduce unless inside a cell that makes proteins and generates energy. They can use DNA or RNA in the cell for replication.

How does a retrovirus differ from other viruses?

A.) Use reverse transcriptase present in the host cell

B.) Copy the cell's RNA using the viruses DNA

C.) Viral RNA is made into cellular DNA

D.) Difficult to kill due to a protein capsid

C.) Viral RNA is made into cellular DNA

The RNA virus takes over the usual machinery in the cell to make protein which is DNA (a stable molecule) creating RNA (a molecule often marked with errors) to signal the endoplasmic reticulum to make proteins. It uses enzymes that it has to put their RNA into the cells DNA and take over the entire cell function. Fortunately, they are covered with a lipid envelope which makes them easy to destroy, even with simple soap.

What can be the end result of a viral infection?

A.) The host's immune system will combat it

B.) The virus will lie dormant in the host cells

C.) The virus will change the host cells into its own manufacturing plant and make more viruses

D.) The virus will permanently change the host cell into a cancer.

E.) The virus will leave the host cell covered by a piece of cell membrane so it cannot be seen (like the cloaking device used by the Klingons in Star Trek!)

F.) All of the above

F.) All of the above

All of these are characteristics of viruses. (A hint: when there is a long list and you know at least 2 on the list are right and "All of the above" is an option...look at it carefully. It is likely that all of the answers are correct.)

Which of these statements is true about RNA viruses?

A.) RNA viruses include Herpes virus and cox virus.

B.) Reproduction of RNA viruses is prone to errors and mutations.

C.) RNA viruses have been and will be easily to make immunizations for.

D.) None of the above are true

B.) Reproduction of RNA viruses is prone to errors and mutations.

RNA viruses are a unique and dangerous type of virus due to the error in replication that can lead to mutations. The mutation rate makes it difficult to develop vaccinations for them. Examples include Rubella, Influenza, common cold, Ebola, West Nile, Herpes and Cox virus are DNA viruses.