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PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
lOMoARcPSD| 611-Patho Exam 4 “WE ARE OUT THE DOOR” Q&A Summer 2017
- Exposure to which substance protects the mucosal barrier of the stomach? a. Prostaglandins b. Helicobacter pylori c. Aspirin d. Regurgitated bile Prostaglandins. Prostaglandins and enterogastrones, such as gastric inhibitory peptide, somatostatin, and secretin, inhibit acid secretion.
- Glucose transport enhances the absorption of which electrolyte? a. Sodium b. Potassium c. Phosphate d. Chloride Sodium. Sodium passes through the tight junctions and is actively transported across cell membranes. Sodium and glucose share a common active transport carrier (sodium-glucose ligand transporter 1 [SGLT1]).
- What is the cause of gastroesophageal reflux disease? a. Excessive production of hydrochloric acid b. Zone of low pressure of the lower esophageal sphincter c. Presence of Helicobacter pylori in the esophagus d. Reverse muscular peristalsis of the esophagus Zone of low pressure of the lower esophageal sphincter. Normally, the resting tone of the lower esophageal sphincter maintains a zone of high pressure that prevents gastroesophageal reflux. In individuals who develop reflux esophagitis, this pressure tends to be lower than normal from either transient relaxation or a weakness of the sphincter.
- By what mechanism does intussusception cause an intestinal obstruction? a. Telescoping of part of the intestine into another section of intestine, usually causing strangulation of the blood supply b. Twisting the intestine on its mesenteric pedicle, causing occlusion of the blood supply c. Loss of peristaltic motor activity in the intestine, causing an adynamic ileus d. Forming fibrin and scar tissue that attach to the intestinal omentum, causing obstruction A. Intussusception is the telescoping of part of the intestine into another section of intestine, usually causing strangulation of the blood supply.
- What is the most immediate result of a small intestinal obstruction? a. Vomiting b. Electrolyte imbalances
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
c. Dehydration d. Distention Distention begins almost immediately, as gases and fluids accumulate proximal to the obstruction. Within 24 hours, up to 8 L of fluid and electrolytes enters the lumen in the form of saliva, gastric juice, bile, pancreatic juice, and intestinal secretions. Copious vomiting or sequestration of fluids in the intestinal lumen prevents their reabsorption and produces severe fluid and electrolyte disturbances.
- An intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis by causing which outcome? a. Gain of bicarbonate from pancreatic secretions that cannot be absorbed b. Excessive loss of hydrogen ions normally absorbed from gastric juices c. Excessive loss of potassium, promoting atony of the intestinal wall d. Loss of bile acid secretions that cannot be absorbed Excessive loss of hydrogen ions. If the obstruction is at the pylorus or high in the small intestine, then metabolic alkalosis initially develops as a result of excessive loss of hydrogen ions that normally would be reabsorbed from the gastric juices.
- What are the cardinal symptoms of small intestinal obstruction? a. Constant, dull pain in the lower abdomen relieved by defecation b. Acute, intermittent pain 30 minutes to 2 hours after eating c. Colicky pain caused by distention, followed by vomiting d. Excruciating pain in the hypogastric area caused by ischemia Colicky pain caused by distention followed by vomiting.
- What is the primary cause of peptic ulcers? a. Hypersecretion of gastric acid b. Helicobacter pylori c. Hyposecretion of pepsin d. Escherichia coli Helicobacter pylori.
- A peptic ulcer may occur in all of the following areas except the: a. Stomach b. Jejunum c. Duodenum d. Esophagus Jejunum
- After a partial gastrectomy or pyloroplasty, clinical manifestations that include
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
a. Anaphylactic reaction in which chemical mediators, such as histamine, prostaglandins, and leukotrienes, relax vascular smooth muscles, causing shock. b. Postoperative hemorrhage during which a large volume of blood is lost, causing hypotension with compensatory tachycardia. c. Concentrated bolus that moves from the stomach into the small intestine, causing hyperglycemia and resulting in polyuria and eventually hypovolemic shock. d. Rapid gastric emptying and the creation of a high osmotic gradient in the small intestine, causing a sudden shift of fluid from the blood vessels to the intestinal lumen. D. Dumping syndrome occurs with varying severity in 5% to 10% of individuals who have undergone partial gastrectomy or pyloroplasty. Rapid gastric emptying and the creation of a high osmotic gradient in the small intestine cause a sudden shift of fluid from the vascular compartment to the intestinal lumen. Plasma volume decreases, causing vasomotor responses, such as increased pulse rate, hypotension, weakness, pallor, sweating, and dizziness. Rapid distention of the intestine produces a feeling of epigastric fullness, cramping, nausea, vomiting, and diarrhea
- Which statement is consistent with dumping syndrome? a. Dumping syndrome usually responds well to dietary management. b. It occurs 1 to 2 hours after eating. c. Constipation is often a result of the dumping syndrome. d. It can result in alkaline reflux gastritis. Usually responds well to dietary management.
- Which statement is false regarding the sources of increased ammonia that contribute to hepatic encephalopathy? a. End products of intestinal protein digestion are sources of increased ammonia. b. Digested blood leaking from ruptured varices is a source of increased ammonia. c. Accumulation of short-chain fatty acids that is attached to ammonia is a source of increased ammonia. d. Ammonia-forming bacteria in the colon are sources of increased ammonia. The accumulation of short-chain fatty acids, serotonin, tryptophan, and false neurotransmitters probably contributes to neural derangement and is not associated with ammonia levels. The other options provide accurate information regarding how the sources of ammonia contribute to hepatic encephalopathy.
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
- Which statement is false regarding the pathophysiologic process of acute pancreatitis? a. Bile duct or pancreatic duct obstruction blocks the outflow of pancreatic digestive enzymes. b. Acute pancreatitis can also result from direct cellular injury from drugs or viral infection. c. Acute pancreatitis is an autoimmune disease in which immunoglobulin G (IgG) coats the pancreatic acinar cells; consequently, the pancreatic enzymes destroy the cells. d. Acute pancreatitis is usually mild and spontaneously resolves. The false answer is C. The backup of pancreatic secretions and the activation and release of enzymes (activated trypsin activates chymotrypsin, lipase, and elastase) within the pancreatic acinar cells cause acute pancreatitis, an obstructive disease. The activated enzymes cause autodigestion (e.g., proteolysis, lipolysis) of the pancreatic cells and tissues, resulting in inflammation. Acute pancreatitis is usually a mild disease and spontaneously resolves; however, approximately 20% of those with the disease develop a severe acute pancreatitis that requires hospitalization. Pancreatitis develops because of a blockage to the outflow of pancreatic digestive enzymes caused by bile duct or pancreatic duct obstruction (e.g., gallstones). Acute pancreatitis can also result from direct cellular injury from drugs or viral infection.
- Obesity is defined as a body mass index (BMI) greater than what measurement? a. 22 b. 28 c. 25 d. 30 Obesity is an energy imbalance, with caloric intake exceeding energy expenditure, and is defined as a BMI greater than 30. 15. Which are the early (prodromal) clinical manifestations of hepatitis? (Select all that apply.) a. Fatigue b. Vomiting c. Itching d. Splenomegaly e. Hyperalgia A, B, E. The prodromal (preicteric) phase of hepatitis begins approximately 2 weeks after exposure and ends with the appearance of jaundice. Fatigue, anorexia, malaise, nausea, vomiting, headache, hyperalgia, cough, and low-grade fever are prodromal symptoms that precede the onset of jaundice.
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
cytokines from neutrophils, lymphocytes, plasma cells, macrophages, eosinophils, and mast cells.
- Crohn disease: In Crohn disease, elevations in IgG are associated with the severity of the disease.
- Kidney stones in the upper part of the ureter would produce pain referred to which anatomical area? a. Vulva or penis b. Thighs c. Umbilicus d. Lower abdomen Kidney stones in the upper part of the ureter would produce pain in the umbilicus. Sensory innervation for the upper part of the ureter arises from the tenth thoracic nerve roots with referred pain to the umbilicus.
- The glomerular filtration rate is directly related to which factor? a. Perfusion pressure in the glomerular capillaries b. Diffusion rate in the renal cortex c. Diffusion rate in the renal medulla d. Glomerular active transport Perfusion pressure. The filtration of the plasma per unit of time is known as the glomerular filtration rate (GFR), which is directly related to only the perfusion pressure in the glomerular capillaries.
- When renin is released, it is capable of which action? a. Inactivation of autoregulation b. Direct activation of angiotensin II c. Direct release of antidiuretic hormone (ADH) d. Formation of angiotensin I Formation of angiotensin I.
- How high does the plasma glucose have to be before the threshold for glucose is achieved? a. 126 mg/dl b. 180 mg/dl c. 150 mg/dl d. 200 mg/dl When the plasma glucose reaches 180 mg/dl, as occurs in the individual with uncontrolled diabetes mellitus, the threshold for glucose is achieved.
- What is the end-product of protein metabolism that is excreted in urine? a. Glucose b. Bile c. Ketones
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
d. Urea Urea
- What provides the best estimate of the functioning of renal tissue? a. Glomerular filtration rate b. Hourly urine output c. Serum blood urea nitrogen and creatinine d. The specific gravity of the solute concentration of the urine GFR
- Which renal change is found in older adults? a. Sharp decline in glomerular filtration rate b. Sharp decline in renal blood flow c. Decrease in the number of nephrons d. Decrease in urine output Decrease in the number of nephrons.
- Compared with a younger individual, how is the specific gravity of urine in older adults affected? a. Specific gravity of urine in older adults is increased. b. Specific gravity of urine in older adults is considered high normal. c. Specific gravity of urine in older adults is considered low normal. d. Specific gravity of urine in older adults is decreased. SG in older adults is considered low normal.
- How does progressive nephrons injury affect angiotensin II activity? a. Angiotensin II activity is decreased. b. It is elevated. c. Angiotensin II activity is totally suppressed. d. It is not affected. It’s elevated. Angiotensin II activity is elevated with progressive nephron injury.
- Which mineral accounts for the most common type of renal stone? a. Magnesium-ammonium-phosphate b. Calcium oxalate c. Uric acid d. Magnesium phosphate Calcium stones (calcium phosphate or calcium oxalate) account for 70% to 80% of all stones requiring treatment.
- Regarding the formation of renal calculi, what function does pyrophosphate, potassium citrate, and magnesium perform? a. They inhibit crystal growth. b. Pyrophosphate, potassium citrate, and magnesium stimulate the supersaturation of salt.
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
c. Low blood urea nitrogen (BUN) d. Low serum complement Elevated creatinine concentration is an abnormal laboratory value found in glomerular disorders. Reduced glomerular filtration rate during glomerular disease is evidenced by elevated plasma urea, creatinine concentration, or reduced renal creatinine clearance.
- A patient exhibits symptoms including hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin as the major protein. These data suggest the presence of which disorder? a. Cystitis b. Glomerulonephritis c. Chronic pyelonephritis d. Nephrotic syndrome The data suggest the patient has the disorder known as glomerulonephritis. Two major changes distinctive of more severe glomerulonephritis are (1) hematuria with red blood cell casts and (2) proteinuria exceeding 3 to 5 g/day with albumin as the major protein.
- Hypothyroidism, edema, hyperlipidemia, and lipiduria characterize which kidney disorder? a. Nephrotic syndrome b. Chronic glomerulonephritis c. Acute glomerulonephritis d. Pyelonephritis Symptoms of nephrotic syndrome include edema, hyperlipidemia, lipiduria, vitamin D deficiency, and hypothyroidism.
- How are glucose and insulin used to treat hyperkalemia associated with acute renal failure? a. Glucose has an osmotic effect, which attracts water and sodium, resulting in more dilute blood and a lower potassium concentration. b. When insulin transports glucose into the cell, it also carries potassium with it. c. Potassium attaches to receptors on the cell membrane of glucose and is carried into the cell. d. Increasing insulin causes ketoacidosis, which causes potassium to move into the cell in exchange for hydrogen. B- This selection is the only option that accurately describes glucose metabolism, causing potassium to move to the intracellular fluid; insulin infusions therefore can be effective in shifting potassium from the extracellular to intracellular space, along with the transport of glucose.
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
- Creatinine is primarily excreted by glomerular filtration after being constantly released from what type of tissue? a. Nervous system b. Muscle c. Kidneys d. Liver Creatinine is constantly released from only muscle tissue to be excreted by glomerular filtration. 38. What are considered risk factors for developing bladder and kidney cancers? (Select all that apply.) a. Cigarette smoking b. Hypertension c. Exposure to aniline dyes d. Below normal body weight e. Male gender A, B, C. Risk factors for renal cancer include cigarette smoking, obesity, and hypertension. The risk of primary bladder cancer is greater among people who smoke or those who are exposed to metabolites of aniline dyes or other aromatic amines or chemicals and with heavy consumption of phenacetin. 39. Prerenal injury from poor perfusion can result from which condition? (Select all that apply.) a. Bilateral ureteral obstruction b. Renal vasoconstriction c. Renal artery thrombosis d. Hemorrhage e. Hypotension B, C, D, E. Poor perfusion can result from renal artery thrombosis, hypotension related to hypovolemia (dehydration, diarrhea, fluid shifts) or hemorrhage, renal vasoconstriction and alterations in renal regional blood flow, microthrombi, or kidney edema that restricts arterial blood flow. 40. Which statements about the human papillolmavirus (HPV) and vaccine are true? (Select all that apply.) a. Currently, two HPV vaccines have been approved for use in the United States. b. HPV is believed to be responsible for the majority of the diagnosed cases of cervical cancer. c. A form of the vaccine has been approved for use in males to prevent genital warts. d. The administration of the vaccine is a one-dose intramuscular injection.
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
POS has at least two of the following conditions: oligo-ovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries.
- What is the leading cause of infertility in women? a. Pelvic inflammatory disease b. Salpingitis c. Endometriosis d. Polycystic ovary syndrome Polycystic ovary syndrome remains one of the most common endocrine disturbances affecting women, especially young women, and is a leading cause of infertility in the United States.
- Which statement regarding pelvic inflammatory disease (PID) is true? a. An episode of mild PID can decrease the possibility of a successful pregnancy by 80%. b. Such an inflammation results in temporary changes to the ciliated epithelium of the fallopian tubes. c. PID has not been associated with an increased risk of an ectopic pregnancy. d. Contracting this infection increases the risk of uterine cancer. D. PID infection results in permanent changes to the ciliated epithelium of the fallopian or uterine tubes. A recent study has found that one episode of mild, subclinical PID resulted in a 40% decrease in later pregnancy rates, and multiple episodes of PID further increase the risk of infertility. Scarring caused by PID greatly increases the risk of a later ectopic pregnancy by up to tenfold. Scarring and adhesions also can result in chronic pelvic pain and, potentially, an increased risk of later uterine cancer.
- Which term is used to identify the descent of the posterior bladder and trigone into the vaginal canal? a. Rectocele b. Cystocele c. Vaginocele d. Enterocele Cystocele
- What type of cyst develops when an ovarian follicle is stimulated but no dominant follicle develops and completes the maturity process? a. Follicular b. Corpus albicans c. Corpus luteal d. Benign ovarian
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
Only benign cysts of the ovary are produced when a follicle or a number of follicles are stimulated but no dominant follicle develops and completes the maturity process.
- Which term is used to identify benign uterine tumors that develop from smooth muscle cells in the myometrium and are commonly called uterine fibroids? a. Endometrial polyps b. Leiomyomas c. Myometrial polyps d. Myometriomas Leiomyomas, commonly called myomas or uterine fibroids , are benign smooth muscle tumors in the myometrium. 49. The size of benign uterine tumors, such as leiomyomas, is thought to be caused by the influence of which hormone? (Select all that apply.) a. Progesterone b. Estrogen c. Luteinizing hormone d. Gonadotropin-stimulating hormone e. Growth factors A, B, E. The cause of uterine leiomyomas is unknown, although their size appears to be related to only estrogen, progesterone, growth factors, angiogenesis, and apoptosis. 50. What are the common clinical manifestations of endometriosis? (Select all that apply.) a. Back and flank pain b. Infertility c. Dysuria d. Amenorrhea e. Dysmenorrhea B, E. Common clinical manifestations primarily include infertility, dysmenorrhea, dyschezia (pain on defecation), and dyspareunia (pain on intercourse).
- How does the epididymis become infected? a. he pathogenic microorganisms ascend the vasa deferentia from an already infected urethra or bladder. b. The pathogenic microorganisms are attached to sperm that travel through the genital tract. c. The pathogenic microorganisms from the tunica vaginalis are transported to the epididymis. d. The pathogenic microorganisms from the prostate fluid ascend to the epididymis. A. The pathogenic microorganisms usually reach the epididymis by ascending the vasa deferentia from an already infected urethra or bladder.
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
B, C, D, E. Prostate cancer is the most commonly diagnosed non–skin cancer in American men, and the incidence varies greatly worldwide. Possible causes include a genetic predisposition, environmental and dietary factors, inflammation, and alterations in levels of hormones (e.g., testosterone, dihydrotestosterone, estradiol) and growth factors. Incidence is greatest among northwestern European and North American men (particularly African Americans) older than 65 years of age.
- What unique factor causes adolescent girls to have a high risk for sexually transmitted infections (STIs)? a. They are in an experimental phase with sexual intercourse and believe they are resistant to developing STIs. b. The adolescent cervix is immature and lacks immunity. c. The length of the vaginal canal is short in adolescents, allowing a greater concentration of microorganisms within the internal genitalia. d. In adolescent girls, the anus to the vaginal introitus are in close proximity. B- Partly, perhaps, because of risk-taking behavior (unprotected intercourse or selection of high-risk partners), many adolescents have an increased risk for STI exposure and infection. The unique factor for adolescent women is that they have a physiologically increased susceptibility to infection because of increased cervical immaturity and lack of immunity.
- Which sexually transmitted infection frequently coexists with gonorrhea? a. Syphilis b. Chlamydia c. Herpes simplex virus d. Chancroid The coexistence of chlamydial infection with gonorrhea frequently occurs.
- Aspiration is most likely to occur in the right mainstem bronchus because it: a. Extends vertically from the trachea. b. Is narrower than the left mainstem bronchus. c. Comes into contact with food and drink first. d. Is located at the site where the bronchi bifurcate. A-The right mainstem bronchus extends from the trachea more vertically than the left mainstem bronchus; therefore, aspirated fluids or foreign particles tend to enter the right lung rather than the left. The size of both mainstems is equal. The trachea comes into contact with food and drink first, and the carina is the site where the bronchi bifurcate.
- Where in the lung does gas exchange occur? a. Trachea b. Alveolocapillary membrane c. Segmental bronchi
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
d. Main bronchus
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
d. Show dramatic fluctuation, allowing the O 2 concentration to increase A shift to the right depicts hemoglobin’s decreased affinity for O 2 or an increase in the ease with which oxyhemoglobin dissociates and O 2 moves into the cells. The oxyhemoglobin dissociation curve is shifted to the right by acidosis (low pH) and hypercapnia (increased partial pressure of arterial carbon dioxide [PaCO 2 ]).
- Decreased lung compliance means that the lungs are demonstrating which characteristic? a. Difficult deflation b. Stiffness c. Easy inflation d. Inability to diffuse oxygen A decrease in compliance indicates that the lungs or chest wall is abnormally stiff or difficult to inflate.
- Hypoventilation that results in the retention of carbon dioxide will stimulate which receptors in an attempt to maintain a normal homeostatic state? a. Irritant receptors b. Peripheral chemoreceptors c. Central chemoreceptors d. Stretch receptors Central chemoreceptors indirectly monitor arterial blood by sensing changes in the pH of cerebrospinal fluid (CSF). The central chemoreceptors are sensitive to very small changes in the pH of CSF (equivalent to a 1 to 2 mm Hg change in partial pressure of carbon dioxide [PCO 2 ]) and are able to maintain a normal partial pressure of arterial carbon dioxide (PaCO 2 ) under many different conditions, including strenuous exercise. This selection is the only option that accurately identifies the receptors that are associated with the retention of carbon dioxide.
- How low must the partial pressure of arterial oxygen (PaO 2 ) drop before the peripheral chemoreceptors influence ventilation? a. Below 100 mm Hg b. Below 70 mm Hg c. Below 80 mm Hg d. Below 60 mm Hg The PaO 2 must drop well below normal (to approximately 60 mm Hg) before the peripheral chemoreceptors have much influence on ventilation.
- What is the most important cause of pulmonary artery constriction? a. Low alveolar partial pressure of arterial oxygen (PaO 2 ) b. Hyperventilation
PATHO EXAM 4 WE ARE OUT THE DOOR Q&A
c. Respiratory alkalosis
