Final exam 31-45 for podcast

Question 31 Which definition applies to the term karyotype?

✅ Answer: All the chromosomal pairs in an individual – A karyotype is the complete set of chromosomes in an individual, used to identify chromosomal abnormalities.

Question 32 A client presents to the hospital with difficulty in speaking, excessive salivation, and ataxia. Physical exam shows jaundice, ascites and Kayser-Fleisher rings in the eyes. Which of the following is the most common initial or early presentation of adults with Wilson disease?

✅ Answer: Hepatic dysfunction and/or cirrhosis – Wilson's disease is a copper metabolism disorder. In adults, liver disease is the most common initial presentation. Kayser-Fleischer rings are pathognomonic for Wilson's disease.

Question 33 Which of the following cells is able to proliferate or undergo mitosis?

✅ Answer: Hepatocytes – Liver cells (hepatocytes) are labile cells that can regenerate and undergo mitosis. Neurons and cardiac myocytes are permanent cells that cannot regenerate significantly.

Question 34 A patient develops an infection after dental implant surgery. Which condition is the client likely to develop if the infection is left untreated?

✅ Answer: Septicemia – An untreated local infection can spread into the bloodstream, causing septicemia (bloodstream infection), which can become life-threatening sepsis.

Question 35 Lyme disease presents with a bullseye rash after being bitten by an infected tick. What type of pathogen is transmitted?

✅ Answer: Bacteria – Lyme disease is caused by Borrelia burgdorferi, a spirochete bacterium transmitted through the bite of an infected Ixodes tick.

Question 36 A nurse practitioner works in a college infirmary. Which reason does the NP identify for the incidences of Neisseria meningitides within the college population?

✅ Answer: College living exists in close, crowded quarters – Neisseria meningitidis (bacterial meningitis) spreads through respiratory droplets and is facilitated by close, crowded living conditions such as dormitories.

Question 37 Which of the following is TRUE about CD4 cells?

✅ Answer: "The CD4 cells take part in cell-mediated immunity." – CD4+ T helper cells coordinate the immune response by activating other immune cells. They do not directly kill antigens or produce immunoglobulins (that is the role of B cells/plasma cells).

Question 38 Which of the following would be a lab finding in a patient with systemic lupus erythematous or SLE?

✅ Answer: Elevated ESR or erythrocyte sedimentation rate – SLE is an inflammatory autoimmune disease. ESR is elevated due to systemic inflammation. ANA would be positive (not negative) in SLE.

Question 39 An older adult male patient receives chemotherapy for treating cancer. A complete blood count report after chemotherapy shows red blood cells 3.02 million cells/microliter, white blood cells 3,200 cells/microliter, and platelets 100,000/microliter. What disorder does this patient have?

✅ Answer: Myelodysplastic syndrome – All three cell lines are low (pancytopenia), which is characteristic of myelodysplastic syndrome, commonly seen after chemotherapy when bone marrow is suppressed.

Question 40 A 75 year old man with bone pain in the lower back presented to the ER and was found to have multiple myeloma from biopsy of lesions in his lumbar spine and high levels of m-proteins in his urine. Which of the following treatments would NOT be a possible therapy for multiple myeloma?

✅ Answer: Cadaver liver transplant – Liver transplant is not a treatment for multiple myeloma. Bisphosphonates (for bone protection), chemotherapy, and radiation to bone lesions are all used in MM treatment.

Question 41 A mature erythrocyte lacks:

✅ Answer: A nucleus – Mature red blood cells (erythrocytes) eject their nucleus during development to maximize space for hemoglobin. They retain cytoplasm, hemoglobin, and a plasma membrane.

Question 42 Which anemia is caused by a lack of intrinsic factor leading to a vitamin B12 deficiency?

✅ Answer: Pernicious anemia – Intrinsic factor is produced by gastric parietal cells and is required for B12 absorption in the terminal ileum. Without it, B12 deficiency causes megaloblastic (pernicious) anemia.

Question 43 A female patient presents for pre-surgical screening and admits to heavy menses each month. She also admits to easy bruising. Her labs show a remarkably low von Willebrand factor level. What should the surgeon be aware of for this patient?

✅ Answer: Increased bleeding tendency during surgery – Von Willebrand factor is essential for platelet adhesion and carrying factor VIII. Low levels impair primary hemostasis, increasing bleeding risk during surgery.

Question 44 All of the following are steps of the coagulation cascade EXCEPT:

✅ Answer: Initial common pathway – The coagulation cascade consists of the intrinsic pathway, extrinsic pathway, and final common pathway. There is no "initial common pathway."

Question 45 A child admitted to the hospital with fever and presumed pneumonia has persistent fever despite two days of antibiotics. The child has conjunctivitis, uveitis and a "strawberry tongue" on examination. The fevers have been as high as 104 degrees Fahrenheit. Symptoms of joint pain, nausea and abdominal pain are also present. What is the diagnosis?

✅ Answer: Kawasaki's disease – Kawasaki disease is a vasculitis in children presenting with prolonged fever, conjunctivitis, strawberry tongue, rash, and lymphadenopathy. It is resistant to antibiotics and treated with IVIG and aspirin.

Good luck on your exam! 🎓

Question 31 Which definition applies to the term karyotype?

Answer: All the chromosomal pairs in an individual. A karyotype is the complete set of chromosomes in an individual, used to identify chromosomal abnormalities. Each human cell typically contains 46 chromosomes arranged into 23 pairs, with one chromosome of each pair inherited from each parent. Karyotyping can reveal structural changes, numerical abnormalities, such as aneuploidy, and help in diagnosing genetic disorders and conditions such as Down syndrome, Turner syndrome, and Klinefelter syndrome.

Question 32 A client presents to the hospital with difficulty in speaking, excessive salivation, and ataxia. Physical exam shows jaundice, ascites, and Kayser-Fleisher rings in the eyes. Which of the following is the most common initial or early presentation of adults with Wilson disease?

Answer: Hepatic dysfunction and/or cirrhosis. Wilson's disease is a genetic disorder affecting copper metabolism due to defective copper transport that leads to copper accumulation in the body, primarily in the liver and brain. In adults, liver disease is the most common initial presentation. Early signs include hepatomegaly, jaundice, appetite loss, and ascites. The presence of Kayser-Fleischer rings, which are greenish-brown deposits of copper in the cornea, is pathognomonic for the disease but typically appears later.

Question 33 Which of the following cells is able to proliferate or undergo mitosis?

Answer: Hepatocytes. Liver cells (hepatocytes) are labile cells that can regenerate and undergo mitosis, which is essential for liver function and recovery from injury. Hepatocyte proliferation is significant in liver repair following damage from toxins, diseases, or surgical interventions. Neurons and cardiac myocytes, on the contrary, are classified as permanent cells due to their limited regenerative capacity, which presents challenges in recovery from injuries in the brain and heart.

Question 34 A patient develops an infection after dental implant surgery. Which condition is the client likely to develop if the infection is left untreated?

Answer: Septicemia. An untreated local infection can spread into the bloodstream, causing septicemia, which is a serious bloodstream infection that can lead to sepsis—a life-threatening condition characterized by organ dysfunction caused by dysregulated body responses to infection. Signs include fever, chills, increased heart rate, and potentially profound hypotension as septic shock develops.

Question 35 Lyme disease presents with a bullseye rash after being bitten by an infected tick. What type of pathogen is transmitted?

Answer: Bacteria. Lyme disease is caused by Borrelia burgdorferi, a spirochete bacterium transmitted through the bite of an infected Ixodes tick. This condition is characterized by early localized manifestations, such as erythema migrans (bullseye rash), flu-like symptoms, and may progress to systemic complications affecting the joints, heart, and nervous system if not treated promptly.

Question 36 A nurse practitioner works in a college infirmary. Which reason does the NP identify for the incidences of Neisseria meningitides within the college population?

Answer: College living exists in close, crowded quarters. Neisseria meningitidis, responsible for bacterial meningitis, spreads through respiratory droplets and is facilitated by close, crowded living conditions such as dormitories and communal living spaces. Factors like the ages of college students and high social interactions further contribute to increased infection risks within this population.

Question 37 Which of the following is TRUE about CD4 cells?

Answer: "The CD4 cells take part in cell-mediated immunity." CD4+ T helper cells play a crucial role in the immune system by coordinating the immune response, activating other immune cells such as B cells, cytotoxic T cells, and macrophages. They do not directly kill antigens or produce antibodies; that role primarily belongs to B cells and plasma cells. CD4+ T cells are vital for orchestrating responses to infections and for memory immune responses.

Question 38 Which of the following would be a lab finding in a patient with systemic lupus erythematous or SLE?

Answer: Elevated ESR or erythrocyte sedimentation rate. SLE is an inflammatory autoimmune disease characterized by a wide range of clinical manifestations affecting multiple organ systems. ESR is commonly elevated due to systemic inflammation, which is a hallmark of conditions like SLE. Additionally, antinuclear antibodies (ANA) would be positive, serving as a marker for autoimmune activity, but the specificity may vary among individuals.

Answer: Myelodysplastic syndrome. The laboratory results reflect pancytopenia, characterized by low counts across all three blood cell lines, which is indicative of myelodysplastic syndromes commonly resulting from previous chemotherapy or radiation therapy. This disorder arises from ineffective hematopoiesis and can lead to an increased risk of progression to acute myeloid leukemia.

Question 40 A 75-year-old man with bone pain in the lower back presented to the ER and was found to have multiple myeloma from biopsy of lesions in his lumbar spine and high levels of m-proteins in his urine. Which of the following treatments would NOT be a possible therapy for multiple myeloma?

Answer: Cadaver liver transplant. Liver transplant is not a recognized treatment for multiple myeloma, as this hematologic malignancy primarily affects plasma cells in the bone marrow. Standard treatment includes a combination of bisphosphonates to protect bone integrity, chemotherapy regimens, immunomodulatory drugs, and radiation therapy aimed at painful bone lesions. The goal is to control disease progression and manage symptomatology effectively.

Question 41 A mature erythrocyte lacks:

Answer: A nucleus. Mature red blood cells (erythrocytes) eject their nuclei during development to maximize the space available for hemoglobin, the oxygen-carrying component. This unique adaptation enhances oxygen transport capacity. Despite lacking a nucleus, erythrocytes retain cytoplasm, hemoglobin itself, and a flexible plasma membrane, which allows them to navigate through small capillaries.

Question 42 Which anemia is caused by a lack of intrinsic factor leading to a vitamin B12 deficiency?

Answer: Pernicious anemia. Intrinsic factor, produced by gastric parietal cells, is critical for vitamin B12 absorption in the terminal ileum. A deficiency in intrinsic factor leads to pernicious anemia, characterized by megaloblastic changes, where erythrocytes are larger than normal, and may present with neurological symptoms due to the effects of vitamin B12 deficiency on the nervous system, highlighted by numbness and tingling in extremities.

Answer: Increased bleeding tendency during surgery. Von Willebrand factor is essential for platelet adhesion and also carries factor VIII, vital in clotting. Low levels impair primary hemostasis, suggesting this patient is at heightened risk for excessive bleeding during surgical procedures. Preoperative evaluation should integrate detailed counseling and consideration for using hemostatic agents or factor replacement.

Question 44 All of the following are steps of the coagulation cascade EXCEPT:

Answer: Initial common pathway. The coagulation cascade consists of the intrinsic pathway, extrinsic pathway, and final common pathway. Each pathway initiates at different stimuli, but there is no distinct "initial common pathway" as this suggests a phase prior to established mechanisms of coagulation. Understanding these pathways is crucial for managing coagulopathies and guiding appropriate therapeutic interventions.

Question 45 A child admitted to the hospital with fever and presumed pneumonia has persistent fever despite two days of antibiotics. The child has conjunctivitis, uveitis, and a "strawberry tongue" on examination. The fevers have been as high as 104 degrees Fahrenheit. Symptoms of joint pain, nausea, and abdominal pain are also present. What is the diagnosis?

Answer: Kawasaki's disease. Kawasaki disease is an acute vasculitis affecting children characterized by prolonged fever, conjunctivitis, a distinctive strawberry tongue presentation, rash, and lymphadenopathy. This disease is resistant to antibiotics and necessitates immediate treatment with intravenous immunoglobulin (IVIG) and aspirin to mitigate the risk of coronary artery aneurysms.