MSN 570-ADVANCED PATHOPHYSIOLOGY FINAL EXAM
300 PRACTICE QUESTIONS AND ANSWERS VERIFIED 100%
CORRECT
A man with low sperm count is found to have low testosterone levels. He is given
GnRH, which does not change testosterone levels. He is given LH, which raises
testosterone levels to normal levels. Based upon this information you can determine
that the problem with this man is most likely that his: --ANSWER-- anterior pituitary is
not releasing LH
The buffalo hump and moon face are most likely associated with which of the following
normal functions of cortisol? --ANSWER-- stimulation of gluconeogenesis type 2
diabetes --ANSWER-- -The cause of microvascular complications in diabetics is that the
capillary basement membranes thicken and there is endothelial cell hyperplasia.
-Hyperosmolar hyperglycemic nonketotic state in type 2 diabetes is characterized by
striking dehydration, severe hyperglycemia, no or slight ketosis, and a mortality rate of
11%. Nonketotic hyperglycemic hyperosmolar coma is morelikely to occur in
institutionalized patients, especially patients unable to recognize or respond
appropriately to thirst.
-Obesity is present in approximately 80% of patients with type 2 DM, and when weight
is lost, insulin responsiveness improves.The relationship between insulin and obesity is
best described by the phrase: Insulin resistance leads to excess blood glucose levels
that are converted into fat by the liver.
endometriosis --ANSWER-- -Pathogenesis of endometriosis is believed to involve some
combination of hereditary factors, exposure to environmental toxins, and compromise to
the immune system
-Endometriosis is the presence of endometrial tissue outside the lining of the uterine
cavity. The only normal location for endometrial tissue is the endometrial lining of the
uterus, but with endometriosis, the tissue is found outside the uterine cavity. Diagnosis
is made by a physician based on symptoms. The most prominent symptom of
endometriosis is dysmenorrheal. diabetes insipidus --ANSWER-- -A patient is not
secreting sufficient antidiuretic hormone (ADH) from the posterior pituitary. Most likely,
the patient is suffering from neurogenic diabetes insipidus.Central diabetes insipidus
may be treated by dDAVP, which is a synthetic replacement for vasopressin (or ADH).
-Atrial Natriuretic Factor is the hormone most likely to cause a decrease in blood volume
and decrease mean arterial pressure.The part of the nephron where antidiuretic
hormone (ADH) primarily acts is the collecting tubule.
Addisons disease --ANSWER-- As you discussed, one of the signs and symptoms of
Addison's disease is low blood pressure; and the primary adrenal insufficiency may be
due to autoimmune destruction of the adrenal gland. Individuals suffering from
Addison's disease may suffer from hyperpigmentation since excess ACTH stimulates
,melanocytes.The most severe clinical manifestations of adrenocortical insufficiency
occur because of inadequate levels of circulating cortisol
Trichomonas Vaginalis --ANSWER-- -Trichomoniasis vaginalis, protozoa, may be
isolated from the vagina, urethra, and Bartholin or Skene glands. After attachment to
the host cells, it ignites an inflammatory response exhibited as a discharge containing
elevated levels of polymorphonuclear leukocytes. The pathogen causes direct damage
to the epithelium, leading to microulcerations.
Diagnosis is usually performed with a wet mount or Papanicolaou smear. In women,
symptoms are characterized by diffuse, malodorous, yellow-green vaginal discharge
with vulvar irritation. Some women may be asymptomatic.
-Metronidazole may be administered PO as a single 2 g dose or 500 mg twice daily for
7 days. Pregnant women should be prescribed the single dose of metronidazole. The
cure rates are greater than 90% when metronidazole is administered as either a single
2 g dose or a 7-day regimen. Possible adverse effects include an unpleasant metallic
taste, reversible neutropenia, urticaria, rash, flushing, dry mouth, darkened urine, and a
disulfiram-like reaction. When using these agents, advise patients to avoid the
consumption of alcohol.
male hypogonadism --ANSWER-- -Hypogonadism may be caused by an inherited
(congenital) trait or something that happens later in life (acquired) such as injury or
infection.Turner's syndrome, a disorder that affects females, causes hypogonadism and
physical characteristics such as a webbed neck, broad chest, and short stature.
-Lack of testosterone production by the testes is associated with primary
hypogonadism.Hypogonadism in children and young adults causes the loss of the
protective effects of estrogen and testosterone, which can result in severe osteoporosis.
cyrptorchidism --ANSWER-- -Primary hypogonadism is the lack of testosterone
production by the testes.
-Several studies have revealed an increased prevalence of testicular tumors in subjects
with a history of cryptorchidism. The incidence of cryptorchidism is about 0.7% to 1.0%
of male infants at 1 year of age. Because of the increased risk of malignancy and
infertility, treatment at an early age to bring the testis into a normal scrotal position is
recommended. The cause of the condition is uncertain but may be related to an intrinsic
testicular defect or a subtle hormonal deficiency.
-A twisting of the spermatic cord with subsequent testicular ischemia and infarction,
testicular torsion, commonly presents with sudden onset of severe testicular pain.
Prostatitis is manifested by a tender, swollen prostate. Testicular cancer has a slower,
less dramatic presentation. Epididymitis can resemble testicular torsion but usually
presents with an enlarged, reddened, and tender scrotum instead of a sudden onset of
severe pain
PCOS --ANSWER-- -Major symptoms of PCOS include excess weight, hirsutism, and
amenorrhea. The most common etiology of ovulatory dysfunction is polycystic ovary
syndrome, a condition in which the ovaries are filled with follicular cysts and the patient
has elevated levels of androgens and estrogen. Hirsutism is commonly observed in
these women due to the excessive androgen levels.
,-During embryonic development, the nervous system is derived from the primary germ
layer, the ectoderm.
-During pregnancy, there are a number of hormones that help maintain the pregnancy
and prepare for delivery and lactation. Human chorionic thyrotropin is responsible for
increasing maternal metabolism during pregnancy.
-Lack of testosterone production by the testes is associated with primary
hypogonadism.
ALL --ANSWER-- Severe combined immunodeficiency is a disorder that results from
the loss of B-cell function and T-cell function.
Acute lymphoblastic leukemia (ALLs) are neoplasms composed of immature B or T cells
referred to as lymphoblasts. About 85% are B-ALLs, which typically manifest as
childhood acute leukemias. This is considered the most common cancer of children.
The less common are T-ALLs these tend to present in adolescent males as thymic
lymphomas. In adolescence, the thymus reaches its maximum size.
Hodgkin's vs Non-Hodgkin's lymphoma --ANSWER-- Hodgkin lymphoma encompasses
a group of lymphoid neoplasms that differ from NHL in several respects. Hodgkin
lymphoma arises in a single node or chain of nodes and spread first to anatomically
contiguous lymphoid tissues. Where as NHLs frequently occur at extranodal sites and
spread in an unpredictable fashion. Hodgkin has distinctive morphologic features that is
characterized by the presence of neoplastic giant cells called Reed-Sternberg cells.
Hodgkin lymphoma (HL) has the presence of Reed- Sternberg cells on histologic
examination. However, non-Hodgkin lymphoma (NHL) occurs more frequently than
Hodgkin's lymphoma and it appears that NHL does not exhibit the malignant Reed-
Sternberg cells. sickle cell --ANSWER-- Appropriate treatment for sickle cell disease is
acetaminophen for fever control.
Sickle cell anemia is a severe, sometimes fatal, hereditary disease characterized by an
abnormal hemoglobin type. A person who inherits only one defective gene develops a
form of the disease called sickle cell trait, in which red blood cells contain a small
proportion of a hemoglobin type that is less soluble than normal. This hemoglobin forms
solid crystals when the blood oxygen level is low, causing distortion and the red blood
cell's fragility. If two defective genes are inherited (one from each parent), more of the
defective hemoglobin is produced, and the distortion of red blood cells becomes severe.
hemophilia --ANSWER-- Hemophilia A (Factor VIII deficiency) is an X-linked recessive
disorder or trait and affects mainly males and homozygous females.Hemophilia A is the
most common hereditary disease associated with life- threatening bleeding caused by
mutations in factor VIII, an essential cofactor for factor IX in the coagulation cascade.
Patients with hemophilia A have a prolonged PTT and normal PT results that point to an
abnormality of the intrinsic coagulation pathway. Factor VIII-specific assays are required
for diagnosis. Hemophilia A is treated with infusions of recombinant factor VIII.
diabetes type 1 --ANSWER-- -Diabetes Mellitus Type 1 is caused by deficient insulin
resulting from T- cell-mediated autoimmune destruction of the pancreas' insulin-
secreting beta cells. -The individual has circulating autoantibodies to islet cells, insulin,
, and enzymes involved in insulin production. This form of the disease has a strong
genetic influence based on multiple genetic variants.
-The beta-cell damage rate is variable among affected individuals, being rapid mainly in
infants and children and slow mostly in adults. The presenting sign of T1DM is often
ketoacidosis, particularly in children. Many affected adults retain some beta-cell function
that prevents ketoacidosis for many years, but they eventually become dependent on
exogenous insulin for survival.
-The gold standard laboratory test used to diagnose diabetes is a fasting plasma
glucose level. A fasting plasma glucose level greater than 126 mg/dL on two separate
days confirms the diagnosis. Random plasma glucose greater than 200 mg/dL repeated
on more than one occasion is also a diagnostic of the disorder.
The pancreas has a number of endocrine responsibilities including the release of insulin
when glucose levels are high to help recruit glucose transporters to the cells. -The
relationship between insulin and obesity is best described by the phase - insulin
resistance leads to excess blood glucose levels that are converted into fat by the
liver.Hormones released from the gastrointestinal (GI) tract play a role in insulin
resistance, beta-cell function, and diabetes. Ghrelin stimulates GH secretion, controls
appetite, and plays a role in obesity and insulin sensitivity regulation. Ghrelin is a
peptide produced in the stomach and pancreatic islets that regulate food intake, energy
balance, and hormonal secretion. Decreased levels of circulating ghrelin have been
associated with insulin resistance and increased fasting insulin levels. The incretins are
a class of peptides released from the GI tract in response to food intake and function to
increase the secretion of insulin and have many other positive effects on metabolism. -
The most studied incretin is called glucagon-like peptide 1 (GLP-1), and studies have
demonstrated that beta-cell responsiveness to GLP-1 is reduced both in prediabetes
and in type 2 diabetes. Incretin therapies include GLP-1 receptor agonists (GLP-1 RAs)
and dipeptidyl peptidase IV (DPP-IV) inhibitors, which can help control postprandial
glucose levels by promoting glucose-dependent insulin secretion.
wound healing --ANSWER-- -Pressure ulcers and severe burns are examples of
wounds that require secondary and tertiary intention healing. These wounds have large
areas of missing skin, dermis, and deeper tissue replaced by scar tissue.Wound healing
consists of four phases: hemostasis, inflammation, proliferation, and remodeling.
-To perpetuate and stimulate healing, debridement of a wound is often necessary.
Debridement is the removal of necrotic tissue to promote and enable re-epithelialization
and new growth of tissue.
Injurious agents may produce sublethal and reversible cellular damage or may lead to
irreversible cell injury and death. Cell death can involve two mechanisms: apoptosis or
necrosis. Apoptosis involves controlled cell destruction and is the means by which the
body removes and replaces cells that have been produced in excess, developed
improperly, have genetic damage, or are worn out. Necrosis refers to cell death
characterized by cell swelling, rupture of the cell membrane, and inflammation. DIC --
ANSWER-- -DIC is sometimes referred to as a consumptive coagulopathy. There is
active stimulation of the coagulation cascade with the formation of fibrin clots.
300 PRACTICE QUESTIONS AND ANSWERS VERIFIED 100%
CORRECT
A man with low sperm count is found to have low testosterone levels. He is given
GnRH, which does not change testosterone levels. He is given LH, which raises
testosterone levels to normal levels. Based upon this information you can determine
that the problem with this man is most likely that his: --ANSWER-- anterior pituitary is
not releasing LH
The buffalo hump and moon face are most likely associated with which of the following
normal functions of cortisol? --ANSWER-- stimulation of gluconeogenesis type 2
diabetes --ANSWER-- -The cause of microvascular complications in diabetics is that the
capillary basement membranes thicken and there is endothelial cell hyperplasia.
-Hyperosmolar hyperglycemic nonketotic state in type 2 diabetes is characterized by
striking dehydration, severe hyperglycemia, no or slight ketosis, and a mortality rate of
11%. Nonketotic hyperglycemic hyperosmolar coma is morelikely to occur in
institutionalized patients, especially patients unable to recognize or respond
appropriately to thirst.
-Obesity is present in approximately 80% of patients with type 2 DM, and when weight
is lost, insulin responsiveness improves.The relationship between insulin and obesity is
best described by the phrase: Insulin resistance leads to excess blood glucose levels
that are converted into fat by the liver.
endometriosis --ANSWER-- -Pathogenesis of endometriosis is believed to involve some
combination of hereditary factors, exposure to environmental toxins, and compromise to
the immune system
-Endometriosis is the presence of endometrial tissue outside the lining of the uterine
cavity. The only normal location for endometrial tissue is the endometrial lining of the
uterus, but with endometriosis, the tissue is found outside the uterine cavity. Diagnosis
is made by a physician based on symptoms. The most prominent symptom of
endometriosis is dysmenorrheal. diabetes insipidus --ANSWER-- -A patient is not
secreting sufficient antidiuretic hormone (ADH) from the posterior pituitary. Most likely,
the patient is suffering from neurogenic diabetes insipidus.Central diabetes insipidus
may be treated by dDAVP, which is a synthetic replacement for vasopressin (or ADH).
-Atrial Natriuretic Factor is the hormone most likely to cause a decrease in blood volume
and decrease mean arterial pressure.The part of the nephron where antidiuretic
hormone (ADH) primarily acts is the collecting tubule.
Addisons disease --ANSWER-- As you discussed, one of the signs and symptoms of
Addison's disease is low blood pressure; and the primary adrenal insufficiency may be
due to autoimmune destruction of the adrenal gland. Individuals suffering from
Addison's disease may suffer from hyperpigmentation since excess ACTH stimulates
,melanocytes.The most severe clinical manifestations of adrenocortical insufficiency
occur because of inadequate levels of circulating cortisol
Trichomonas Vaginalis --ANSWER-- -Trichomoniasis vaginalis, protozoa, may be
isolated from the vagina, urethra, and Bartholin or Skene glands. After attachment to
the host cells, it ignites an inflammatory response exhibited as a discharge containing
elevated levels of polymorphonuclear leukocytes. The pathogen causes direct damage
to the epithelium, leading to microulcerations.
Diagnosis is usually performed with a wet mount or Papanicolaou smear. In women,
symptoms are characterized by diffuse, malodorous, yellow-green vaginal discharge
with vulvar irritation. Some women may be asymptomatic.
-Metronidazole may be administered PO as a single 2 g dose or 500 mg twice daily for
7 days. Pregnant women should be prescribed the single dose of metronidazole. The
cure rates are greater than 90% when metronidazole is administered as either a single
2 g dose or a 7-day regimen. Possible adverse effects include an unpleasant metallic
taste, reversible neutropenia, urticaria, rash, flushing, dry mouth, darkened urine, and a
disulfiram-like reaction. When using these agents, advise patients to avoid the
consumption of alcohol.
male hypogonadism --ANSWER-- -Hypogonadism may be caused by an inherited
(congenital) trait or something that happens later in life (acquired) such as injury or
infection.Turner's syndrome, a disorder that affects females, causes hypogonadism and
physical characteristics such as a webbed neck, broad chest, and short stature.
-Lack of testosterone production by the testes is associated with primary
hypogonadism.Hypogonadism in children and young adults causes the loss of the
protective effects of estrogen and testosterone, which can result in severe osteoporosis.
cyrptorchidism --ANSWER-- -Primary hypogonadism is the lack of testosterone
production by the testes.
-Several studies have revealed an increased prevalence of testicular tumors in subjects
with a history of cryptorchidism. The incidence of cryptorchidism is about 0.7% to 1.0%
of male infants at 1 year of age. Because of the increased risk of malignancy and
infertility, treatment at an early age to bring the testis into a normal scrotal position is
recommended. The cause of the condition is uncertain but may be related to an intrinsic
testicular defect or a subtle hormonal deficiency.
-A twisting of the spermatic cord with subsequent testicular ischemia and infarction,
testicular torsion, commonly presents with sudden onset of severe testicular pain.
Prostatitis is manifested by a tender, swollen prostate. Testicular cancer has a slower,
less dramatic presentation. Epididymitis can resemble testicular torsion but usually
presents with an enlarged, reddened, and tender scrotum instead of a sudden onset of
severe pain
PCOS --ANSWER-- -Major symptoms of PCOS include excess weight, hirsutism, and
amenorrhea. The most common etiology of ovulatory dysfunction is polycystic ovary
syndrome, a condition in which the ovaries are filled with follicular cysts and the patient
has elevated levels of androgens and estrogen. Hirsutism is commonly observed in
these women due to the excessive androgen levels.
,-During embryonic development, the nervous system is derived from the primary germ
layer, the ectoderm.
-During pregnancy, there are a number of hormones that help maintain the pregnancy
and prepare for delivery and lactation. Human chorionic thyrotropin is responsible for
increasing maternal metabolism during pregnancy.
-Lack of testosterone production by the testes is associated with primary
hypogonadism.
ALL --ANSWER-- Severe combined immunodeficiency is a disorder that results from
the loss of B-cell function and T-cell function.
Acute lymphoblastic leukemia (ALLs) are neoplasms composed of immature B or T cells
referred to as lymphoblasts. About 85% are B-ALLs, which typically manifest as
childhood acute leukemias. This is considered the most common cancer of children.
The less common are T-ALLs these tend to present in adolescent males as thymic
lymphomas. In adolescence, the thymus reaches its maximum size.
Hodgkin's vs Non-Hodgkin's lymphoma --ANSWER-- Hodgkin lymphoma encompasses
a group of lymphoid neoplasms that differ from NHL in several respects. Hodgkin
lymphoma arises in a single node or chain of nodes and spread first to anatomically
contiguous lymphoid tissues. Where as NHLs frequently occur at extranodal sites and
spread in an unpredictable fashion. Hodgkin has distinctive morphologic features that is
characterized by the presence of neoplastic giant cells called Reed-Sternberg cells.
Hodgkin lymphoma (HL) has the presence of Reed- Sternberg cells on histologic
examination. However, non-Hodgkin lymphoma (NHL) occurs more frequently than
Hodgkin's lymphoma and it appears that NHL does not exhibit the malignant Reed-
Sternberg cells. sickle cell --ANSWER-- Appropriate treatment for sickle cell disease is
acetaminophen for fever control.
Sickle cell anemia is a severe, sometimes fatal, hereditary disease characterized by an
abnormal hemoglobin type. A person who inherits only one defective gene develops a
form of the disease called sickle cell trait, in which red blood cells contain a small
proportion of a hemoglobin type that is less soluble than normal. This hemoglobin forms
solid crystals when the blood oxygen level is low, causing distortion and the red blood
cell's fragility. If two defective genes are inherited (one from each parent), more of the
defective hemoglobin is produced, and the distortion of red blood cells becomes severe.
hemophilia --ANSWER-- Hemophilia A (Factor VIII deficiency) is an X-linked recessive
disorder or trait and affects mainly males and homozygous females.Hemophilia A is the
most common hereditary disease associated with life- threatening bleeding caused by
mutations in factor VIII, an essential cofactor for factor IX in the coagulation cascade.
Patients with hemophilia A have a prolonged PTT and normal PT results that point to an
abnormality of the intrinsic coagulation pathway. Factor VIII-specific assays are required
for diagnosis. Hemophilia A is treated with infusions of recombinant factor VIII.
diabetes type 1 --ANSWER-- -Diabetes Mellitus Type 1 is caused by deficient insulin
resulting from T- cell-mediated autoimmune destruction of the pancreas' insulin-
secreting beta cells. -The individual has circulating autoantibodies to islet cells, insulin,
, and enzymes involved in insulin production. This form of the disease has a strong
genetic influence based on multiple genetic variants.
-The beta-cell damage rate is variable among affected individuals, being rapid mainly in
infants and children and slow mostly in adults. The presenting sign of T1DM is often
ketoacidosis, particularly in children. Many affected adults retain some beta-cell function
that prevents ketoacidosis for many years, but they eventually become dependent on
exogenous insulin for survival.
-The gold standard laboratory test used to diagnose diabetes is a fasting plasma
glucose level. A fasting plasma glucose level greater than 126 mg/dL on two separate
days confirms the diagnosis. Random plasma glucose greater than 200 mg/dL repeated
on more than one occasion is also a diagnostic of the disorder.
The pancreas has a number of endocrine responsibilities including the release of insulin
when glucose levels are high to help recruit glucose transporters to the cells. -The
relationship between insulin and obesity is best described by the phase - insulin
resistance leads to excess blood glucose levels that are converted into fat by the
liver.Hormones released from the gastrointestinal (GI) tract play a role in insulin
resistance, beta-cell function, and diabetes. Ghrelin stimulates GH secretion, controls
appetite, and plays a role in obesity and insulin sensitivity regulation. Ghrelin is a
peptide produced in the stomach and pancreatic islets that regulate food intake, energy
balance, and hormonal secretion. Decreased levels of circulating ghrelin have been
associated with insulin resistance and increased fasting insulin levels. The incretins are
a class of peptides released from the GI tract in response to food intake and function to
increase the secretion of insulin and have many other positive effects on metabolism. -
The most studied incretin is called glucagon-like peptide 1 (GLP-1), and studies have
demonstrated that beta-cell responsiveness to GLP-1 is reduced both in prediabetes
and in type 2 diabetes. Incretin therapies include GLP-1 receptor agonists (GLP-1 RAs)
and dipeptidyl peptidase IV (DPP-IV) inhibitors, which can help control postprandial
glucose levels by promoting glucose-dependent insulin secretion.
wound healing --ANSWER-- -Pressure ulcers and severe burns are examples of
wounds that require secondary and tertiary intention healing. These wounds have large
areas of missing skin, dermis, and deeper tissue replaced by scar tissue.Wound healing
consists of four phases: hemostasis, inflammation, proliferation, and remodeling.
-To perpetuate and stimulate healing, debridement of a wound is often necessary.
Debridement is the removal of necrotic tissue to promote and enable re-epithelialization
and new growth of tissue.
Injurious agents may produce sublethal and reversible cellular damage or may lead to
irreversible cell injury and death. Cell death can involve two mechanisms: apoptosis or
necrosis. Apoptosis involves controlled cell destruction and is the means by which the
body removes and replaces cells that have been produced in excess, developed
improperly, have genetic damage, or are worn out. Necrosis refers to cell death
characterized by cell swelling, rupture of the cell membrane, and inflammation. DIC --
ANSWER-- -DIC is sometimes referred to as a consumptive coagulopathy. There is
active stimulation of the coagulation cascade with the formation of fibrin clots.
