NURS 231 Pathophysiology All Module Exams VERSION 3 ALL MODULES KNOWLEDGE CHECK UP COMPLETE PRACTICE EXAM QUESTIONS AND ANSWERS SOLUTION

NURS 231 Pathophysiology All Module Exams VERSION 3 ALL MODULES KNOWLEDGE CHECK UP COMPLETE PRACTICE EXAM QUESTIONS AND ANSWERS SOLUTION Module 1 Exam Question 1 0 / 2.5 pts True/False: A bodybuilder’s muscles will display hyperplasia. You Answered True Correct Answer False Question 2 2.5 / 2.5 pts True/False: During pregnancy, uterine enlargement is caused by hypoplasia. True Correct! False It’s hypertrophy and hyperplasia. Question 3 2.5 / 2.5 pts True/False: Persistent dysplasia eventually results in cancer. Correct! True False Question 4 0 / 2.5 pts True/False: Endometrial hyperplasia is a normal physiologic occurrence. You Answered True Correct Answer False Question 5 10 / 10 pts Match the following: 1. Proportion of people with a disease who are positive for that disease a. Validity 2. How likely the same result will occur if repeated b. Reliability 3. How a tool measures what it is intended to measure c. Sensitivity 4. People without the disease who are negative on a given test d. Specificity Correct! Proportion of people with a disease who are positive for that disease Correct! How likely the same result will occur if repeated Correct! How a tool measures what it is intended to measure Correct! People without the disease who are negative on a given test Question 6 2.5 / 2.5 pts Multiple Choice Which are true of the mitochondria? Select all that apply. Correct! It is involved in cellular respiration They are found far from the site of energy consumption c. Sensitivity b. Reliability a. Validity d. Specificity Correct! They play a role in apoptosis They control free radicals Question 7 2.5 / 2.5 pts Which of the following are true regarding cell communication? Select all that apply. Paracrine signaling depends on hormones Correct! Neurotransmitters act through synapses Enzyme linked receptors act through an on-off switch Correct! Autocrine signaling releases a chemical into the extracellular fluid that affects its own activity Question 8 2.5 / 2.5 pts Multiple Choice Which of the following are false of the cell? Proteins carry out the functions of the cell membrane. Lysosomes are the digestive system of the cell. Correct! The rough ER is the site for lipid synthesis. Microfilaments are thin, threadlike cytoplasmic structures. Question 9 2.5 / 2.5 pts Which is true of the cytoskeleton? Select all that apply. Correct! It controls shape and movement Correct! Cilia and flagella are microtubule-filled cellular extensions It includes peroxisomes and proteasomes Question 10 0 / 2.5 pts Multiple Choice High blood pressure is an example of which of the following? You Answered Pathology Correct Answer Pathophysiology Physiology No answer text provided. Question 11 2.5 / 2.5 pts Multiple Choice A patient complains of chest pain and an elevated blood pressure. What are these examples of? Signs Symptoms Correct! Both A & B Question 12 2.5 / 2.5 pts Multiple Choice Which of the following is NOT helpful to the clinician to make a diagnosis? Detailed history Physical exam Correct! Evidence based practice Laboratory tests Question 13 2.5 / 2.5 pts Multiple Choice Which of the following is the effect of an illness on one’s life? Incidence Correct! Morbidity Prevalence Mortality Question 14 10 / 10 pts Define secondary prevention and give an example: Your Answer: Secondary prevention aims to detect and treat disease early, usually when they are asymptomatic and curable. An example is going for an annual pap smear. Secondary prevention aims to detect and treat disease early, usually while the disease is asymptomatic and curable. Some examples include annual Pap smears to detect early cervical cancer, encouraging smoking cessation, checking blood pressure and cholesterol, and colonoscopy screening. Question 15 10 / 10 pts Explain apoptosis and why it is necessary: Your Answer: Apoptosis, referred to as programmed cell death, eliminates excess cells, damaged cells, improperly formed cells and gentically damaged cells. Apoptosis is important to ensure the cell gets rid of unwanted cells and tissue that may impair or disrupt its normal functioning. Apoptosis is programmed cell death. This process eliminates cells that are worn out, have been produced in excess, have developed improperly, or have genetic damage. Apoptosis is also responsible for several normal physiologic processes, like replacing cell in the intestinal villi and removing aging red blood cells. Question 16 10 / 10 pts Explain what necrosis is and give an example and description of one type of necrosis. Your Answer: Necrosis refers to the death of a tissue or organ which is part of a living person. An example of necrosis is coagulative necrosis, which is the sudden cut-off of blood flow to an organ, usually the heart or kidney. Necrosis refers to cell death in an organ or tissues that is still part of a living person. It often interferes with cell replacement and tissue regeneration. Coagulative necrosis results most often from a sudden cutoff of blood supply to an organ (ischemia), particularly the heart and kidney. Liquefactive necrosis occurs when some of the cells die but their catalytic enzymes are not destroyed. It is commonly seen with brain infarcts or abscesses. Caseous necrosis occurs as part of granulomatous inflammation and is most often associated with tuberculosis. Gangrenous necrosis most often affects the lower extremities or bowel and is secondary to vascular occlusion. The term gangrene is applied when a considerable mass of tissue undergoes necrosis. In dry gangrene the affected tissue becomes dry and shrinks, the skin wrinkles, and its color changes to dark brown or black. The spread of dry gangrene is slow. It results from a cut off in arterial blood supply and is a form of coagulation necrosis. In wet gangrene, the affected area is cold, swollen, and pulseless. The skin is moist, black, and under tension. Blebs form on the surface, liquefaction occurs, and a foul odor is caused by bacterial action. The spread of tissue damage is rapid. Question 17 9 / 10 pts Match the type of cell injury to the cause. Some answers may be used more than once. (1 point each) 1. Sunburn a. Physical agents 2. Obesity b. Radiation injury 3. Reactive oxygen species c. Chemical injury 4. Low oxygen to tissues d. Biologic agents 5. Fractures e. Nutritional imbalances 6. OTC drugs f. Free radical injury 7. Hypothermia g. Hypoxic cell injury 8. Radiation treatment 9. Lead toxicity 10. Bacteria Correct! Sunburn Correct! Obesity Correct! Reactive oxygen species Correct! Low oxygen to tissues Correct! Fractures Correct! OTC drugs You Answered Hypothermia Correct Answer a. Physical agents Correct! Radiation treatment Correct! Lead toxicity Correct! Bacteria Question 18 10 / 10 pts List the 4 types of tissue found in the body. Pick 2 and give a description and example of each. b. Radiation injury e. Nutritional imbalances f. Free radical injury g. Hypoxic cell injury a. Physical agents c. Chemical injury b. Radiation injury b. Radiation injury c. Chemical injury d. Biologic agents Your Answer: The 4 types of tissues found in the body are 1. epithelial tissue 2. connective tissue 3. muscle tissue 4. nerve tissue Muscle tissue function to provide movement to skeletal structures, pump blood through the heart, and contract blood vessels and visceral organs. An example of a muscle tissue is skeletal muscle. Nerve tissue is found throughout the body, and is used in communication between peripheral tissues and the central nervous system. An example of a nervous tissue cell is neuron Epithelial tissue covers the body’s outer surface, lines the inner surfaces, and forms glandular tissue. Epithelial tissue has three distinct surfaces and the basal surface is attached to an underlying basement membrane. It is avascular, meaning without blood vessels. It receives oxygen and nutrients from the capillaries of the connective tissue on which it rests. Connective or supportive tissue is the most abundant tissue in the body. It connects and binds or supports the various tissues. Its cells produce the extracellular matrix that support and hold tissues together. Connective tissue is divided into two types: connective tissue proper and specialized connective tissue (cartilage, bone, and blood cells). The four types of connective tissue proper are loose (areolar), adipose, reticular, and dense connective tissue. The function of muscle tissue is to move the skeletal structures, pump blood through the heart, and contract the blood vessels and visceral organs. Muscle tissue can accomplish this by contraction. The two types of fibers that contract are called thin and thick filaments. Thin filaments are called actin, and the thick filaments are myosin. The three types of muscles tissue are skeletal, cardiac, and smooth. Nervous tissue is distributed throughout the body for communication. It provides the means for controlling body function and for sensing and moving about the environment. The two types of cells are neuron and glial cells. Neurons function is communication. Glial (meaning glue) cells support the neurons. Question 19 2.5 / 2.5 pts What term means “cell eating” and engulfs and then kills microorganisms or other particulate matter? Your Answer: Phagocytosis Phagocytosis Question 20 2.5 / 2.5 pts What term means “cell drinking,” and engulfs small solid or fluid particles, as seen with proteins and electrolytes? Your Answer: Pinocytosis Pinocytosis Question 21 2.5 / 2.5 pts Give one function of a membrane potential: Your Answer: Membrane potential in muscle tissue leads to muscle contraction Generate nerve impulse, muscle contractions, or cause hormone secretion Question 22 2.5 / 2.5 pts What is the diffusion of water called? Your Answer: Osmosis osmosis Module 2 Exam Question 1 3 / 3 pts True/False: Blood tests for tumor markers can make a diagnosis of cancer. Why or why not? Your Answer: False. Because they are elevated in benign conditions, and most are not elevated during early part of malignant conditions. False, only tissue can diagnose. Tumor markers are helpful to assess response to therapy or reoccurrence. Question 2 3 / 3 pts Tissue biopsy is of critical importance in what role? Your Answer: Diagnosis of the correct cancer and histology. Diagnosing the correct cancer and histology. Question 3 4 / 4 pts 1. List two signs or symptoms a patient may present with that might indicate a cancer diagnosis: 2. What are two systemic manifestations of cancer exhibited by cancer patients? Your Answer: 1. Bleeding, chest pain 2. Wasting of body fats and muscle tissues, Anorexia 1. Bleeding; sore that doesn’t heal; fluid in the pleural, pericardial, or peritoneal spaces; chest pain, shortness of breath, cough, abdominal discomfort or swelling. Other possible answers can include a mass or lump, pain (need to be specific), fatigue, fevers, weight loss 2. Weight loss, wasting of body fat and muscle tissue, weakness, anorexia, and anemia, fatigue, sleep disturbances Question 4 10 / 10 pts Explain the TNM system: Your Answer: The TNM system is a detailed staging system used in cancer facilities. It classifies cancer using 3 tumor components, namely tumor, nodes and metastasis. T is the size and local spread of the primary tumor N is the involvement of the regional lymph node M is the extent of the matastatic involvement T is the size and local spread of the primary tumor. N is the involvement of the regional lymph nodes. M is the extent of the metastatic involvement. Question 5 10 / 10 pts 1. What are the three possible goals of cancer treatment? 2. How does radiation kill cancer cells? Your Answer: 1. Curative, control and palliative 2. Radiation uses high energy waves that damage or destroy cancer cells. They produce free radicals that can damage cell structure. Radiation can damage, kill cells or impair the DNA of the cell. 1. Curative, control, palliative 2. Radiation therapy uses high-energy particles or waves to destroy or damage cancer cells. This leads to the creation of free radicals, which damage cell structures. Radiation can interrupt the cell cycle process, kill cells, or damage DNA in the cells. Question 6 2.5 / 2.5 pts True/False: Cell proliferation is the process in which proliferating cells become more specialized cell types. True Correct! False False, cell differentiation Question 7 0 / 2.5 pts True/False: Cell differentiation is the process in which proliferating cells become more specialized cell types. Correct Answer True You Answered False Question 8 2.5 / 2.5 pts What are two important properties that stem cells possess? Your Answer: 1. Self renewal 2. Potency Potency and self-renewal Question 9 0 / 2.5 pts Which of the following are most likely to have arisen from an adult stem cell? Muscle You Answered Bone Correct Answer Epithelial Neural Question 10 4 / 4 pts Define polyp. Are they benign or malignant? Your Answer: Polyp is a growth that projects from a mucosal surface like the intenstine. They can be benign or malignant. A polyp is a growth that projects from a mucosal surface, such as the intestine. A polyp can be benign or malignant Question 11 0 / 3 pts How do cancer cells achieve immortality? Your Answer: Cancer cells achieve immortality through unregulated and uncontrolled growth. The ability of cancer cells to invade and metastasize, establishing its own blood supply contributes to its achieving immortality. Cancer cells keep high levels of telomerase, an enzyme that prevents telomere shortening. This gives the ability of the chromosomes to continue to replicate forever. looking for the specific mechanism Question 12 3 / 3 pts What is a tumor suppressor gene? Give one example. Your Answer: A tumor suppressor gene is a gene that encodes proteins that inhibits cell growth and signals apoptosis. They reduce cell division and repair DNA mistakes. An example is TP53 Tumor suppressor genes are associated with gene underactivity. These genes slow down cell division, repair DNA mistakes, or tell cells when to die. BRCA1 or 2, TP53 Question 13 10 / 10 pts Determine if the tumor is benign or malignant based on the nomenclature: 1. Papilloma 2. Lipoma 3. Leiomyosarcoma 4. Hemangioma 5. Adenocarcinoma 6. Neuroblastoma 7. Adenoma 8. Melanoma 9. Lymphoma 10. Glioma Correct! Papilloma Correct! Lipoma Correct! Leiomyosarcoma Correct! Hemangioma Correct! benign benign malignant benign Adenocarcinoma Correct! Neuroblastoma Correct! Adenoma Correct! Melanoma Correct! Lymphoma Correct! Glioma Question 14 10 / 10 pts A 62-year-old man with a 30-pack year smoking history is diagnosed with small cell lung cancer with metastasis to the bone. (1) Explain the process of how cancer spreads metastatically. (2) What symptoms might he have presented with? (3) Which screening test would he have benefited from? Your Answer: 1. Metastasis is a multi-step process. Cancer cells shed from a tumor invade the extracellular matrix and gain access to the blood vessel. If passage through the blood vessel is successful, it finds a favorable environment and invade the surrounding tissue and grow, and importantly establishes a blood supply. 2. Chest pain, cough, shortness of breath 3. Chest CT (1) Metastasis- a cancer cell must break loose from the primary tumor, invade the surrounding extracellular matrix, gain access to a blood vessel, survive its passage in the bloodstream, emerge at a favorable location, invade the surrounding tissue, begin to grow, and establish a blood supply. (2) Chest pain, shortness of breath, cough, bone pain. (3) Yearly lowdose chest CT. Question 15 3 / 3 pts Benign tumors have which of the following characteristics? Select all that apply. Undifferentiated cells malignant malignant benign malignant malignant benign Correct! Grows by expansion Gains access to blood and lymph channels Correct! Growth may stop or regress Question 16 3 / 3 pts What are the genetic events that can lead to cancer? Select all that apply. Correct! Gene amplification Pleomorphism Correct! Point mutation Seeding Correct! Chromosomal translocation Question 17 4 / 4 pts List 4 of the 7 risk factors linked to cancer as stated in the module. Your Answer: 1. Heredity 2. Obesity 3. Immunologic mechanism 4. Cancer-causing viruses Heredity, hormonal factors, obesity, immunologic mechanisms, environmental agents such as chemicals, radiation, and cancer-causing viruses. Question 18 3 / 10 pts List three characteristics of cancer cells and briefly explain what it means: Your Answer: 1. Cell anchorage: Normal cells require contact and anchorage to extracellular matrix and other cells and tissue to survive. Cancer cells do not need to be anchored to other cells and tissues for survival 2. Cell Growth: The growth of cancer cells are uncontrolled, and not regulated, expanding and invading surrounding tissues and other parts of the body Answer: Any of the following Anaplasia is the loss of cell differentiation in cancerous tissue. Genetic instability means they have a high frequency of mutations. Growth factor independence means cancer cells can proliferate even in the absence of growth factors. Cell density-dependent inhibition means cancer cell don’t stop growing when they come into contact with each other. Cell cohesiveness and adhesion means they don’t stick together. Anchorage dependence means cancer cells aren’t anchored to neighboring cells or the underlying matrix to live and grow. Cell-to-cell communication in cancer cells is poor, which interferes with intercellular connections and responsiveness to membrane-derived signals. Life span is unlimited – cancer cells are immortal. Antigen expression -cancer cells contain several cell surface molecules or antigens that are immunologically identified as foreign. Cancer cells can produce enzymes, hormones, and other substances that the tissues of origin either does not produce or produces in much smaller amounts. Cancer cells can show cytoskeletal changes or abnormalities. This includes abnormal intermediate filament types or changes in actin filaments and microtubules that help with invasion and metastasis. Need specific terms and cell growth would not be one. You would need to more specifically list characteristics that give them uncontrolled growth. The 3rd is not listed in answer. Question 19 3.5 / 3.5 pts Which of the following are risk factors for developing cancer? Select all that apply. Correct! HBV Correct! Alcohol Correct! High intake of smoked meats Deodorant Question 20 3.5 / 3.5 pts All of the following viral agents are correctly paired with the associated lesion except: Human papillomavirus (HPV): genital warts Correct! Epstein-Barr virus: carcinoma of the cervix Epstein Barr is linked to Burkitt lymphoma and nasopharyngeal cancer. Cervical carcinoma is linked to HPV. Hepatitis B virus: hepatocellular carcinoma Human herpes virus-8: Kaposi sarcoma Question 21 3 / 3 pts List one example of screening for each method: observation, palpation, and lab test/procedure: Your Answer: Observation: Mouth Palpation: Breast Lab/test procedure: pap smear Observation: skin, mouth, external genitalia Palpation: breast, thyroid, rectum and anus, prostate, lymph nodes Laboratory tests and procedures: Pap smear, colonoscopy, mammography Module 3 Question 1 5 / 5 pts Short answer Explain how the skin’s physical barrier makes it inhospitable to microorganisms. Your Answer: Keratin, covers the skin and provide salty and acidic environment which is inhospitable to microrganisms. They also contain antimicrobial proteins and lysosomes which inhibits and help destroy microrganisms. It has closely packed cells in multiple layers that are continuously being shed. Keratin covers the skin, which creates a salty, acidic environment inhospitable to microbes. It also contains antimicrobial proteins and lysozymes that inhibit microorganisms and help to destroy them. Question 2 2.5 / 2.5 pts Multiple choice: Which cell is the first responder to phagocytose a foreign invader? Correct! Monocyte Basophil Eosinophil Dendritic cell Question 3 2.5 / 2.5 pts Multiple Choice: What are the primary cells involved in the adaptive immune response? Antibodies Antigens Neutrophils Correct! Lymphocytes Question 4 3 / 3 pts T lymphocytes produce what type of immunity? Your Answer: Cell-mediated immunity Cell-mediated Question 5 2 / 2 pts Multiple Choice: Which immunoglobulin provides local immunity on mucosal surfaces? Correct! IgA IgM IgG IgD IgE Question 6 2 / 2 pts Multiple Choice: Which cell type is an early responder and the most abundant in the body? Lymphocytes Eosinophils Basophils Correct! Neutrophils Question 7 3.5 / 3.5 pts Multiple Choice: Which feature is NOT of adaptive immunity? Response to repeated infection is immediate Antibodies are involved Correct! Epithelium is a defense mechanism Microbe recognition is specific Question 8 10 / 10 pts A 9-year-old boy with a peanut allergy was exposed to peanuts. He presents to the emergency room with an anaphylactic reaction. (1) What symptoms might he present with? (2) Does the quantity of exposure mean he will have a more severe reaction? (3) What is the initial immediate treatment? (4) What are 2 things people with anaphylaxis should always carry? Your Answer: 1. Bronchospasm, cardiac dysrythmias, cardiac collapse 2. No 3. Epinephrine 4. Identification about the allergy, Epi pen (1) Any of the following reactions are accepted. Grade I: erythema and urticaria, with or without angioedema. Grade II: hypotension, tachycardia, dyspnea, and GI manifestations, like nausea, vomiting, diarrhea, and abdominal cramping from mucosal edema. Grade III: bronchospasm, cardiac dysrhythmias, and cardiac collapse. Grade IV: cardiac arrest (2) No (3) Epinephrine (4) identification about allergy, EpiPen Question 9 0 / 3.5 pts True/False: An antibiotic alone will heal an abscess. If false explain why: Your Answer: True. false, antibiotics can’t penetrate the abscess wall, so incision and drainage are necessary. Question 10 0 / 3 pts _______ are low molecular weight molecules that can elicit production of antibodies when combined with a larger protein? Your Answer: Antigens haptens Question 11 3.5 / 3.5 pts True/False: B cells are primarily associated with humoral immunity. Correct! True False Question 12 3 / 3 pts True/False: Passive immunity is achieved through immunization. True Correct! False false, active immunity Question 13 2.5 / 2.5 pts True/False: Passive immunity provides long lasting protection. True Correct! False Question 14 3.5 / 3.5 pts Type II hypersensitivity reactions are _____ mediated reactions. Your Answer: Antibody(IgG or IgM) antibody Question 15 3.5 / 3.5 pts Multiple Choice: Which of the following hypersensitivity reactions can be treated with the administration of epinephrine? Correct! Type I Type II Type III Type IV Question 16 3.5 / 3.5 pts Multiple Choice: Which cell is NOT part of the adaptive immune response? Correct! Monocytes Lymphocytes Antigen presenting cells Effector cells Question 17 0 / 3.5 pts Multiple Choice: Features of systemic lupus erythematosus include all of the following except: Arthralgias and arthritis Skin manifestations You Answered Pericarditis Renal disease Correct Answer Exophthalmos Question 18 5 / 5 pts Short answer: What are the 2 factors that play a role in the development of autoimmune diseases? Your Answer: 1.Genetic factors 2. Environmental factors Answer: genetics and environmental factors Question 19 10 / 10 pts Short answer A 40-year-old man presents with cough and shortness of breath. After an H&P and chest films, it is determined he has pneumocystis carinii pneumonia (PCP). The provider does an HIV test, which is positive. Upon further testing, the man’s CD4+ cell count is 100 cells/µL and his viral load is 250,000 copies/mL. (1) Why did the provider do an HIV test after the man was diagnosed with PCP? (2) What classification does this man fall into based on his CD4+ count and symptomatology, and why? Your Answer: 1. Opportunistic infections are infections that occur frequently and more severe in patients with HIV because of the damaged immune system. PCP is an opportunistic infection 2. The last stage or overt AIDS. This is because his CD4+ cell count is below 200 cells/uL, and he has AIDS-defining symptoms. (1) Opportunistic infections are those common organisms that do not produce infection without impaired immune function. (2) The last phase, or AIDS illness, occurs when the CD4+ cell count falls to less than 200 cells/µL or exhibits an AIDS-defining illness. The risk of opportunistic infections and death increases significantly when the CD4+ cell count falls below 200 cells/µL. Question 20 3.5 / 3.5 pts Multiple Choice: Which process is NOT included in wound healing? Inflammatory Proliferative Correct! Acute-phase response Remodeling Question 21 3.5 / 3.5 pts Multiple Choice: Which of the following cells are NOT classified as either labile or stable cells? Epidermal cell Hepatocyte Intestinal mucosal cell Correct! Skeletal muscle cell Renal tubular cell Question 22 3.5 / 3.5 pts Fill in the blank HIV is a ____virus that destroys the body’s immune system by taking over and destroying ____ cells. Your Answer: HIV is a retrovirus that destroys the body's immune system by taking over and destroying CD4+T cells Answer: retrovirus, CD4 T cells Question 23 3.5 / 3.5 pts The term to describe the time when an infected person’s blood converts from being negative for HIV antibodies to being positive is called what? Your Answer: Seroconversion Answer: seroconversion Question 24 3.5 / 3.5 pts True/False: A person with HIV is not infectious when they are asymptomatic. True Correct! False Question 25 2.5 / 2.5 pts True/False: The T cells that display the host’s MHC antigens and T-cell receptors for a nonself-antigen are allowed to mature, a process termed negative selection. True Correct! False Question 26 2.5 / 2.5 pts Multiple Choice: What cell mediator is the primary cause of vasodilation seen in acute inflammation? Endothelial cells Platelets Correct! Histamine Neutrophils Question 27 2.5 / 2.5 pts Multiple Choice: Which lab value will typically be increased in a viral infection? Neutrophils Eosinophils Basophils Correct! Lymphocytes Module 4 Exam Question 1 2.5 / 2.5 pts The three stages of hemostasis include each of the following except: Vascular constriction Correct! Vascular dilation Formation of platelet plug Blood coagulation Question 2 2.5 / 2.5 pts Which of the following are natural anticoagulants? Select all that apply. Factor II Factor VII Factor IX Factor X Correct! Protein C Correct! Protein S Question 3 2.5 / 2.5 pts Which of the following is NOT a hypercoagulable state? Select all that apply. Oral contraceptive use Mutation of prothrombin gene Correct! Hemophilia A Correct! Hemophilia B Immobility Question 4 2.5 / 2.5 pts Which of the following defects is associated with hemophilia A? Deficiency of hemoglobin S Deficiency of hemoglobin A Correct! Defective gene in the X chromosome Defective gene in the Y chromosome Question 5 2.5 / 2.5 pts In which of the following ways is blood flow NOT negatively affected? Blood viscosity Diameter of the vessel Correct! Low hematocrit Compliance Question 6 2.5 / 2.5 pts Which of the following does NOT affect the heart’s ability to increase its output? Preload Afterload Cardiac contractility Correct! Cardiac reserve Heart rate Question 7 2.5 / 2.5 pts Which of the following is true of the renin-angiotensin-aldosterone system? Angiotensin I is converted to angiotensin II in the kidneys Angiotensin II is a potent vasodilator Correct! Angiotensin II increases sodium reabsorption in the kidney by stimulating the secretion of aldosterone The PVR is decreased Question 8 2.5 / 2.5 pts Which of the following does NOT lead to an increased risk for DVT? Select all that apply. Factor V Leiden mutation Obesity Correct! Non-smoker Sepsis Question 9 2.5 / 2.5 pts Multiple Choice Which of the following symptoms is NOT associated with iron deficiency anemia? Pica Fatigue Correct! Neurologic changes Brittle hair and nails Question 10 2.5 / 2.5 pts Multiple Choice What are the two major causes of microcytic anemias? Iron deficiency anemia, Vitamin B12 deficiency Vitamin B12, Folate deficiency Correct! Iron deficiency anemia, Thalassemias Thalassemias, Folate deficiency Question 11 2.5 / 2.5 pts Multiple Choice Which of the following is FALSE regarding sickle cell disease? Abnormality of HbS gene Blood vessel occlusion is a complication Correct! Average red cell lifespan is 60 days Can lead to encapsulated infections Question 12 2.5 / 2.5 pts Multiple Choice: The spleen of a patient with sickle cell anemia would be expected to be: Enlarged Correct! Shrunken Normal sized Question 13 2.5 / 2.5 pts Multiple Choice: Which of the following is NOT true of vitamin B12 deficiency anemia? Vitamin B12 is bound to intrinsic factor Peripheral neuropathy can be a result of deficiency Correct! Dietary deficiencies are common MCV is elevated Question 14 0 / 2.5 pts Multiple Choice: Which of the following descriptions best applies to atherosclerotic plaques? You Answered Cholesterol infiltration of thickened vascular intima and media Cystic degeneration and necrosis of vascular media Correct Answer Intimal lesion consisting of fibrous cap overlying necrotic lipid-laden core Organized old thrombotic residues overlying atrophic vascular intima Question 15 2.5 / 2.5 pts Multiple Choice: Lifestyle changes to treat hyperlipidemia include each of the following except: Increase physical activity Correct! Increase red meat consumption Smoking cessation Weight reduction Question 16 2.5 / 2.5 pts Multiple Choice: Risk factors for atherosclerosis include each of the following except: Increasing age Correct! Female gender (pre-menopause) Elevated CRP levels Cigarette smoking Question 17 2.5 / 10 pts Multiple Choice: 1. The three major determinants of myocardial oxygen demand (MVO2) include each of the following except: a. Diastolic pressure b. Heart rate c. Left ventricular contractility d. Systolic pressure Fill in the Blank: 2. ______ is the most important factor in myocardial oxygen demand. As this increases, myocardial oxygen consumption or demand also increases. Multiple Choice: 3. What is the most common cause of cardiogenic shock? a. Heart failure b. Cardiomyopathy c. Myocardial infarction d. Hypertension Multiple Choice: 4. Which does NOT occur during cardiogenic shock? a. Decreased cardiac output b. Hypotension c. Hypoperfusion d. Decreased systemic vascular resistance Your Answer: 1. c 2. Heart rate 3. a 4. c 1. A 2. Heart rate 3. C 4. D Question 18 10 / 10 pts Explain the differences in the pathophysiology, symptoms, and whether nitroglycerin and/or rest will relieve symptoms in stable angina, unstable angina, and myocardial infarction. Your Answer: Stable angina occurs when a person experiences brief episode of chest pain, tightness and/or shortness of breath with exertion. It is resolved by rest or nitroglycerine. Unstable angina occurs when a person expereinces brief episode of chest pain, tightness and/or shortness of breath without exertion. Rest does not resolve it. It is resolved by nitroglycerine. If a plaque ruptures, thrombosis can lead to total occlusion. Tissue ischemia occurs, causing the death of some of the muscles. Myocrdial infarction presents as chest pain which is not resolved by rest, radiating to the left arm or neck, nausea, vomiting, dyspnea. Nitroglycerine does not relieve symptoms of myocardial infarction. With atherosclerotic disease, the coronary vessel lumens are narrowed and blood supply to the heart is diminished. With exertion, the vessels cannot adequately vasodilate. This can manifest as chest pain or tightness and/or shortness of breath. Stable angina- The heart is stable at rest but cannot keep up with the demand of exertion. Stable angina typically has a >70% stenosis of the coronary arteries. It is relieved by rest or nitroglycerin (vasodilator). Unstable angina- With increasing occlusion of the coronary vessel(s), the demands of the resting heart may become too great. When the patient experiences angina without exertion, or when the level of exertion necessary to cause anginal symptoms decreases, this is called unstable angina. It can be relieved by nitroglycerin, but not rest. Unstable angina means one or more coronary vessels is nearly totally occluded. Myocardial infarction- If a plaque ruptures, coronary thrombosis can cause complete occlusion. If collateral flow is inadequate, the tissue supplied becomes ischemic. Without oxygen, a portion of the muscle can die. MI can present as chest pain unrelieved by rest, sometimes radiating down the left ram or into the jaw or neck, dyspnea, nausea/vomiting, sweating, and/or other signs of distress. Other symptoms include a crushing pain or like “something is sitting on my chest.” Women may present with weakness, fatigue, shortness of breath, or GI complaints. Symptoms are not relieved by nitroglycerin. Question 19 5 / 10 pts 1. Hypertension is often called “the silent killer.” By the time symptoms of hypertension occur, the complications can affect the kidneys, heart, eyes, and blood vessels. What is this term called? 2. Left ventricular hypertrophy is a major risk factor for what other diseases? Name at least 2. Your Answer: 1. 2. Myocardial infarction, Hypertension, Artherosclerosis 1. Target-organ damage 2. coronary heart disease, cardiac dysrhythmias, congestive heart failure, and sudden death. Question 20 0 / 2.5 pts Multiple Choice: The most common cause of death immediately after the onset of acute myocardial infarction is: Correct Answer Arrhythmia Left ventricular rupture You Answered Congestive heart failure Shock Pulmonary edema Question 21 2.5 / 2.5 pts Multiple Choice: A 40-year-old woman is hospitalized with a chronic illness characterized by hepatomegaly, distended neck veins, and peripheral edema. Which of the following disorders is the most likely cause of these findings? Hypertrophic cardiomyopathy Dilated cardiomyopathy Correct! Right heart failure Left heart failure Question 22 2.5 / 2.5 pts Multiple Choice: Right ventricular failure is commonly characterized by each of the following changes except: Distended neck veins Hepatomegaly Ankle edema Sodium and water retention Correct! Pulmonary edema Question 23 0 / 2.5 pts Multiple Choice: Which pharmacologic treatment of hypertension has a mechanism of action characterized by reducing vascular smooth muscle tone (vasodilation) and reducing cardiac contractility and heart rate? Diuretics Correct Answer Calcium channel blockers You Answered Beta-blockers Ace-inhibitors Question 24 0 / 2.5 pts Fill in the blank: The _____ is the organ most closely associated with platelet storage and destruction. Your Answer: Liver Spleen Question 25 2.5 / 2.5 pts Fill in the blank: The laboratory test that measures the volume of red cells in 100 mL of blood is _____. Your Answer: Hematocrit hematocrit Question 26 2.5 / 2.5 pts Fill in the blank: Approximately 55% of blood volume consists of _____. Your Answer: Plasma Plasma Question 27 0 / 2.5 pts Fill in the blank: Thrombocytes are also known as _______. Your Answer: Agranulocytes Platelets Question 28 10 / 10 pts Patient is found to have the above: 1. What risk factors mostly led to this disease state? 2. What is this person at risk for developing? 3. What lifestyle modifications would you suggest for them? Your Answer: 1. Hyperlipidema, obesity, smoking, C-reative proteins 2. Coronary artery disease, angina, myocardial infarction, stroke. 3. Stop smoking, Increased physical activity, weigth loss, exrecise Answer: Picture is of an atherosclerotic plaque 1. Hyperlipidemia, cigarette smoking, obesity and visceral fat, hypertension, diabetes mellitus. Increasing age, family history of premature CHD, and male sex. May also include C-reactive protein (CRP) and serum lipoprotein(a). 2. Coronary artery disease, angina, myocardial infarction, aneurysm, stroke (ischemia, thrombosis, emboli). 3. Stop smoking, lose weight/exercise, healthy diet (low-fat, low-cholesterol), adhere to medication for blood pressure, hyperlipidemia, and/or diabetes. Module 5 Exam Question 1 2.5 / 2.5 pts True/False: Both carbon dioxide and oxygen are able to bind with hemoglobin. Correct! True False Question 2 2.5 / 2.5 pts True/False: Exercise, allergens, and emotion can all contribute to an asthma attack. Correct! True False Question 3 2.5 / 2.5 pts ______ measures expiratory volume in a given time. Your Answer: Forced expiratory volume Forced expiratory volume (FEV) Question 4 2.5 / 2.5 pts Lung _____ is the term used to describe the ease or difficulty with which the lungs can be inflated. Your Answer: compliance compliance Question 5 0 / 2.5 pts True/False: During inspiration, air is drawn into the lungs and the chest cavity is decreased. You Answered True Correct Answer False Question 6 2.5 / 2.5 pts True/False: COPD is reversible airway bronchoconstriction. True Correct! False Question 7 2.5 / 2.5 pts True/False: The accessory muscles are the main muscles of inspiration. True Correct! False diaphragm Question 8 0 / 2.5 pts True/False: The FEV1/ FVC ratio is decreased in restrictive lung disorders. You Answered True Correct Answer False Question 9 5 / 5 pts Fill in the blank: Lung volumes can be measured using a ______. Your Answer: spirometer spirometer Question 10 5 / 5 pts _____ is the flow of gases into and out of the alveoli of the lungs. Your Answer: Ventilation Ventilation Question 11 2.5 / 2.5 pts Multiple Choice: Risk factors for asthma include each of the following except: IgE hypersensitivity Correct! Drug overdose Tobacco smoke Gastroesophageal reflux disease Question 12 2.5 / 2.5 pts Multiple Choice: People with emphysema would exhibit each of the following except: Use of accessory muscles Pursed-lip breathing Barrel-chest Correct! Cyanosis and fluid retention Question 13 2.5 / 2.5 pts Multiple Choice: Histologically, chronic bronchitis would exhibit each of the following except: Correct! Enlargement of the airspaces Increase in goblet cells Fibrosis of the bronchiolar wall Hypertrophy of the submucosal glands Question 14 2.5 / 2.5 pts Multiple Choice: ARDS is caused by each of the following conditions except: Shock Sepsis Inhalation of toxic irritants Correct! Bronchial obstruction by foreign body Head injury Question 15 10 / 10 pts Short answer: A 10-year-old boy who is having an acute asthma attack is brought to the ER. He is observed to be sitting up and struggling to breathe. His breathing is accompanied by use of accessory muscles, a weak cough, and audible wheezing sounds. His pulse is rapid and weak, and both heart and breath sounds are distant on auscultation. His parents relate that his asthma began to worsen after he developed a “cold,” and now he doesn’t get relief from his albuterol inhaler. Explain the changes in physiologic function underlying his signs and symptoms. Your Answer: Constriction of the airways, secretion of mucous and swelling of the bronchial wall. There is also recruitment of inflammatory cells from the blood stream that invade the foreign substance, releasing chemicals that are toxic to them. Recruitment of inflammatory cells from the bloodstream into the bronchial wall, where they directly attack the invading organisms and secrete inflammatory chemicals that are toxic to the organisms causes airway inflammation. Swelling of the bronchial wall, mucus secretion, constriction of the airway; bronchial hyper-responsiveness to stimuli causes airway obstruction or narrowing. They may discuss on a cellular level as well: Upon a trigger, the cascade of neutrophils, eosinophils, lymphocytes, and mast cells cause epithelial injury. This causes airway inflammation, which further increases hyperresponsiveness and decreased airflow. Mast cells release histamine and leukotrienes. These cause major bronchoconstriction, inflammation, and mucus secretion. Mast cells can trigger multiple cytokine release, which causes more airway inflammation. The contraction of the airways and subsequent swelling leads to further airway obstruction. Question 16 10 / 10 pts Short answer: When is the risk for obstructive atelectasis the greatest? What are strategies to decrease the chance for developing atelectasis? Your Answer: The risk of obstructive atelectasis is greatest after surgery. Anastesia, pain medicine and immobility promotes the retension of bronchial secretions. Ambulation, taking deep breaths, frequent change of posture. The risk of obstructive atelectasis is increased following surgery. Anesthesia, pain and pain medications, and immobility promote retention of bronchial secretions. Patients are encouraged to frequently cough, deep breath, change positions, hydrate adequately, and ambulate early to prevent atelectasis. Question 17 10 / 10 pts Short answer: 1.) Upon autopsy, what was this patient’s cause of death? 2.) What risk factors predispose this patient to this outcome? 3.) What would have been an effective treatment for this patient? Your Answer: 1. Pulmonary embolism 2. Immobility, surgery, fracture of the hips femur, child birth. 3. Anticoagulant therapy and thrombolytic therapy 1) Pulmonary embolism, 2) Venous stasis, venous endothelial injury, and hypercoagulability states: inherited hypercoagulability disorders that increase risk of thrombosis (e.g. antithrombin III deficiency, protein C and S deficiencies, factor V Leiden mutation). Venous stasis and venous endothelial injury can result from prolonged bed rest or immobility, trauma, surgery, childbirth, fractures of the hip and femur, MI and CHF, cancer, and spinal cord injury. 3) thrombolytics, anticoagulant therapy, compression stockings or intermittent pneumatic compression boots can prevent venous stasis. Question 18 10 / 10 pts Short answer: 1.) ________ are the preferred method of determining the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) levels in the blood. 2.) Hemoglobin’s affinity for oxygen is increased by _____. Name one factor: Your Answer: 1. Arterial blood gases 2. Increased pH 1.) Arterial blood gases (ABGs) 2.) Any of the following - hemoglobin saturation, increased pH (alkalosis), decreased CO2, decreased body temperature Question 19 10 / 5 pts Fill in the blank _____ are alveoli that are ventilated but not perfused. Your Answer: Alveoli dead space Alveolar dead space Question 20 5 / 5 pts Short answer Some people have the triad of asthma, chronic rhinosinusitis, and nasal polyps. They have asthma attacks in response to taking what medication(s)? Your Answer: Aspirin and some NSAIDS. Aspirin and other NSAIDs Question 21 5 / 5 pts Multiple Choice: Each of the following can be daily treatments for asthma except: Bronchodilators Correct! Oxygen therapy Inhaled corticosteroids Leukotriene modifiers Question 22 0 / 5 pts Multiple Choice: Asthma exhibits each of the following characteristics except: You Answered Bronchial swelling Mucus secretion Airway remodeling Correct Answer Hypertrophy of the submucosal glands Module 6 Exam Question 1 2.5 / 2.5 pts Multiple Choice: A patient experiences a seizure that manifests with motor weakness on the right side, a tingling sensation on the right side, and flushing. They have experienced which type of seizure? Correct! Focal seizure without impairment of consciousness or awareness Focal seizure with impairment of consciousness or awareness Generalized tonic/clonic seizure Question 2 2.5 / 2.5 pts Multiple Choice: A patient is having difficulty tracking their eye laterally. Which cranial nerve is affected? CN II. CN III. CN IV. Correct! CN VI. Question 3 2.5 / 2.5 pts Multiple Choice: You are seeing a patient with Parkinson’s disease in your office. You notice they are repetitively rubbing their right thumb and forefinger. This is an example of what physical manifestation of the disease? Correct! Pill-rolling Cogwheeling Bradykinesia Rigidity Question 4 2.5 / 2.5 pts Multiple Choice: Sleep spindles are characteristic of which stage of sleep? Stage 1 Correct! Stage 2 Stage 3 Stage 4 Question 5 2.5 / 2.5 pts Multiple Choice: A person reports feelings of anhedonia, guilt, and worthlessness that seem to be worse in the morning. They also exhibit excessive weight loss and experience insomnia. What type of depression are they experiencing? Correct! Melancholic depression Atypical depression Depression with psychotic features Depression with catatonic features Question 6 2.5 / 2.5 pts Multiple Choice: Each of the following statements is true regarding the organization of the nervous system except: The PNS has an afferent and efferent division Correct! The somatic nervous system can be further divided into the sympathetic and parasympathetic divisions The CNS contains the hindbrain, midbrain, and forebrain The PNS contains the cranial nerves Question 7 2.5 / 2.5 pts Multiple Choice: Each of the following statements is true regarding Alzheimer’s disease except: Tau protein is resistant to breakdown even after the neuron that produced it dies Correct! Neurofibrillary tangles are composed of deteriorating nerve pieces that arrange themselves around a sticky protein core called amyloid beta (Aβ) Cerebral amyloid angiopathy contributes to the pathogenesis of Alzheimer’s disease Question 8 2.5 / 2.5 pts Multiple Choice: Each of the following are modifiable factors related to stroke except: Hypertension Diabetes Cardiac disease Correct! Obesity Question 9 2.5 / 2.5 pts Multiple Choice: Adjustment insomnia is characterized by each of the following except: Correct! More than 30 days of insomnia symptomology Disrupted sleep is in response to physical or emotional stressor Resolves on its own once an adjustment is made/stressor is removed Question 10 2.5 / 2.5 pts Multiple Choice: What type of seizure manifests with a blank stare, lasts only for a few seconds, and often goes unnoticed? Atonic seizure Correct! Absence seizure Tonic seizure Clonic seizure Question 11 2.5 / 2.5 pts Multiple Choice: Sleep disturbances associated with narcolepsy include each of the following except: hypnagogic hallucinations Correct! sleep apnea cataplexy sleep paralysis Question 12 2.5 / 2.5 pts Multiple Choice: Each of the following statements is true of Parkinson’s disease except: Correct! Environmental factors alone lead to disease development It affects the substantia nigra of the brain It is characterized by a loss of dopaminergic neurons Incidence increases with age Question 13 2 / 2 pts Fill in the blank: Efferent neurons deliver _______ input from the CNS to the periphery. Your Answer: motor Answer: Motor Question 14 2 / 2 pts Fill in the blank: _______ work by blocking membrane receptors and the subsequent reuptake of serotonin and norepinephrine. Your Answer: Tricyclic antidepressants Answer: Tricyclic antidepressants (TCAs) Question 15 0 / 2 pts Fill in the blank: Shallow or abnormally slow breathing is referred to as _______. Your Answer: dysphagia Answer: hypopnea Question 16 2 / 2 pts Fill in the blanks: _______ is the precursor for ______ that crosses the blood brain barrier making it the drug of choice for treatment of Parkinson’s disease. Your Answer: Levadopa is the precurser for dopamine that crosses the blood brain barrier making it the drug of choice for treatment of Parkison's disease. Answer: Levadopa, dopamine Question 17 2 / 2 pts Fill in the blank: Specialized ependymal cells that project into the ventricles and produce CSF are called the ______. Your Answer: choroid plexus Answer: Choroid plexus Question 18 5 / 5 pts T/F – Make true if False Astrocytes help to form the blood-brain barrier which prevents toxins from the blood from entering the brain. Your Answer: True Answer: True Question 19 2.5 / 5 pts T/F – Make true if False The average age of onset for major depressive disorder is mid-30s; however, the age of onset is increasing in recent times. Your Answer: False Answer: False, the age of onset is decreasing in recent times. Make true if False Question 20 2.5 / 5 pts T/F – Make true if False Brain activity is decreased during REM sleep. Your Answer: False Answer: False, brain activity is increased during REM sleep. Make true if False Question 21 5 / 5 pts T/F – Make true if False Complete dependence for activities of daily living is characteristic of severe Alzheimer’s disease. Your Answer: True Answer: True Question 22 5 / 5 pts Short Answer Essay Explain 3 mechanisms in which neurotransmitters are removed from the synaptic cleft. Your Answer: Neurotransmitters can be acted on by enzymes, converting it to inactive substances Neurotransmitters can diffuse into the intercellular fluid until their concentration is too low to elicit any post-synaptic response Neurotransmitters can be drawn back into the pre-synaptic phase by a process called reuptake  A neurotransmitter can be broken down by enzymatic activity into inactive substances.  A neurotransmitter can be drawn back into the presynaptic neuron by a process known as reuptake.  A neurotransmitter can diffuse into the intercellular fluid until its concentration is too low to elicit a postsynaptic response. Question 23 5 / 5 pts Short Answer Essay You witness a seizure in which the person exhibits twitching in their right arm as well as repetitive lip smacking. Once this subsides, they report hallucinations that coincide with their abnormal movement patterns. Is this a generalized or focal seizure? Based upon this description, what specific type of seizure did this individual experience? Your Answer: Focal seizure, focal seizure with impairement of consciousness or awareness. Answer: Focal seizure with impairment of consciousness or awareness Question 24 1.5 / 5 pts Short Answer Essay Compare and Contrast breathing patterns between NREM and REM sleep (include a discussion on the specific stages of NREM sleep.) Your Answer: NREM sleep is characterized by slow and rolling eyes, moderate motor activity, decreased vital signs and brain activity. Stage 1 sleep is associated with alpha waves, stage 2 with theta waves, and stages 3 and 4 associated with delta waves. REM sleep is characterized by rapid eye movement, diminished muscular tone and motor activitity, and increased vital signs and brain activity. REM sleep is associated with beta waves. Answer: In stages 1 and 2 NREM sleep as well as in REM sleep, breathing is irregular, and brief periods of apnea are often observed (approximately 5-15 seconds.) During stages 3 and 4 of deep sleep, breathing becomes regular. prompt is not addressed. this should be targeted towards breathing patterns Question 25 5 / 5 pts Short Answer Essay A patient reports to the emergency department where you are working at 10 pm. They report that earlier in the day beginning at approximately 9 am they began to experience tingling in their right arm. They decided to ignore it thinking it was probably a result of all the gardening they did the day before. As the day went on, the tingling sensation got worse, and they started to have difficulty speaking. The patient’s spouse reported that they were slurring their words. Past medical history includes a diagnosis of diabetes and hypercholesteremia. By the time they are evaluated, their symptoms start to subside. The tingling disappears and their speech returns to normal. What do you suspect this patient has experienced? What evidence is there to support that diagnosis? Your Answer: Transient ischemic attack. There was a temporary obstruction of blood flow to the brain from the main arteries feeding the brain, leading to temporary loss of oxygen in the brain, which was resolved within 24 hours Answer: This patient has experienced a TIA. They have experienced symptoms consistent with oxygen deprivation to the brain, however their symptoms subsided within 24 hours of their onset. Question 26 3.3 / 10 pts Long Answer Essay A 72-year-old female is brought to the emergency department via ambulance at 9 am. Her husband reports that they were eating breakfast and she started to complain of a severe headache and blurred vision. She then lost consciousness, and he immediately called 911. She has a history of hypertension, and she is not compliant with her medication because she does not like the way it makes her feel. Based upon these symptoms and past medical history, what do you suspect this patient is experiencing? How would you confirm this diagnosis? What treatment should be administered? Explain why you chose that treatment. Your Answer: Ischemic stroke. An MRI and CT scan should be done to confirm the type of stroke, either ischemic stroke or hemorrhagic stroke. The patient can be treated with tissue plasminogen activator, since the patient was taken to the emergency department within 3-4.5 hours of onset of the symptons. If it had fallen beyond 3-4.5 hours, then a catheter-based method of treatment would have to be used. Answer: This patient is more than likely experiencing a hemorrhagic stroke given the sudden onset of her symptoms and the PMH of uncontrolled hypertension. A CT scan would be needed to determine if a hemorrhage has occurred. Once this is determined the goal of treatment is to stop bleeding and decrease intracranial pressure. This can be done through medication that would decrease blood pressure and intracranial pressure. A craniotomy can be done should medication not work, or the bleeding is severe. Other surgical methods may be utilized if the bleed is a result of an aneurysm or AVM. Need to narrow the type of event to either hemorrhagic or ischemic based on the symptoms and the select the proper treatment Question 27 10 / 10 pts Long Answer Essay A patient is being seen in your office with a primary complaint of daytime fatigue that has lasted for the past 2 months. They go on to tell you that they are having difficulty with work performance and are constantly on edge. You suspect they have chronic insomnia. What are the 4 primary symptoms of insomnia? Describe a nonpharmacologic treatment plan that you can prescribe for this patient. Your Answer: Difficulty initiating sleep Difficulty maintaining sleep Poor sleep Waking up too early. Establishing a consistent sleep pattern, avoiding stimulants like caffeine several hours before sleep, ensuring comfortable sleep environment including optimum temperature, and avoid putting on lights and television just before going to bed. Answer: The 4 primary symptoms of insomnia are:  Difficulty initiating sleep  Difficulty maintaining sleep  Waking up too early  Chronic nonrestorative or poor sleep You would educate the patient on proper sleep hygiene and encourage them to evaluate possible stressors that may need to be removed from their daily routine. Sleep hygiene involves the establishment of consistent sleep patterns (going to bed at the same time each night and only sleeping as long as one needs to feel refreshed during the day), creating a comfortable sleeping environment (optimal room temperature), avoidance of screens and excessive light right before bed, and finally, avoidance of stimulants (caffeine) several hours prior to normal bedtime. Module 7 Exam Question 1 5 / 5 pts Multiple choice The liver is responsible for each of the following EXCEPT: Producing bile Stores vitamins and minerals Correct! Releases insulin Synthesizes protein Question 2 5 / 5 pts Multiple Choice: Risk factors for gallstone formation include each of the following EXCEPT: Female gender Oral contraceptive use Correct! Age (60’s) Obesity Question 3 5 / 5 pts Multiple choice: Predisposing factors that may lead to gastroesophageal reflux include each of the following EXCEPT: Hiatal hernia Correct! Pernicious anemia Pregnancy Incompetent esophageal sphincter Question 4 0 / 5 pts Multiple choice Clinical presentation of irritable bowel syndrome can include each of the following EXCEPT: Abdominal pain or discomfort for at least 12 weeks duration Pain may be relieved with defecation You Answered Constipation or diarrhea may be present Correct Answer Blood in the stool Question 5 3.75 / 5 pts Risk factors for the development of peptic ulcer include which of the following? Select all that apply. Correct! Aspirin therapy Eating acidic foods Correct! H. Pylori infection Correct Answer Stress Correct! NSAID use Question 6 5 / 5 pts Fill in the blank: The most common complication of peptic ulcers is _____. Your Answer: gastroduodenal bleeding Answer: Gastrointestinal bleeding Question 7 5 / 5 pts Multiple choice Each of the following are characteristics of ulcerative colitis EXCEPT: Extraintestinal manifestations Confluent inflammation Correct! Fistulas and perianal abscesses Increased risk of malignancy Affects primarily rectum and left colon Question 8 5 / 5 pts Multiple Choice Each of the following are characteristics of Crohn disease EXCEPT: Cobblestone appearance Primarily submucosal Correct! Continuous extent of involvement Affects primarily ileum Perianal abscesses Question 9 2.5 / 2.5 pts True/False The process of digestion begins in the stomach and finishes in the large intestine. True Correct! False Question 10 2.5 / 2.5 pts True/False: The GI tract is innervated autonomically. Correct! True False Question 11 2.5 / 2.5 pts Fill in the blank: What is the largest serous membrane in the body? Your Answer: Peritonium Answer: peritoneum Question 12 2.5 / 2.5 pts Fill in the blank: What type of cell secretes gastrin? Your Answer: G cell Answer: G cells Question 13 2.5 / 2.5 pts Short answer: What type of movements have a constant level of contraction or tone without regular periods of relaxation? Your Answer: Tonic movement Answer: Tonic movements Question 14 2.5 / 2.5 pts True/False Activation of the peripheral nervous system increases the amplitude of the slow waves. Correct! True False Question 15 2.5 / 2.5 pts Short Answer: ____ is a linear chain of interconnecting neurons located between the circular and longitudinal muscle layers, involved with GI motility? Your Answer: Myenteric plexus Answer: Myenteric (Auerbach) plexus Question 16 2.5 / 2.5 pts Short answer: What is one cause of gastric retention? Your Answer: Slow gastric emptying Answer: obstruction, gastric atony, surgery Question 17 5 / 5 pts Short answer What are rhythmic movements designed to propel the chyme along the small intestine toward the large intestine? Your Answer: Persistaltic contractions Answer: Peristaltic movements Question 18 5 / 5 pts Short answer: Which GI hormone inhibits gastric acid secretion? Your Answer: Secretin Answer: Secretin Question 19 5 / 5 pts True/False: Anti-diarrheal medication can be used with all types of diarrhea. True Correct! False Question 20 5 / 5 pts Short Answer: Constipation and a low fiber diet are a major risk factor for developing what disease? Your Answer: Diverticular disease Answer: diverticulosis Question 21 0 / 5 pts Multiple Choice: Clinical manifestations of cirrhosis include each of the following EXCEPT: Hemorrhoids Asterixis You Answered Esophageal varices Correct Answer Thrombocytosis Ascites Question 22 5 / 5 pts Short Answer: What is the most specific and sensitive test for the diagnosis of cirrhosis? Your Answer: liver biopsy Answer: Liver biopsy Question 23 0 / 5 pts Multiple Choice: A patient presents with right upper quadrant pain, that worsens after eating a fatty meal. What would be the best imaging modality to evaluate their complaint? You Answered Abdominal CT scan HIDA scan Abdominal x-ray Correct Answer Abdominal ultrasound Question 24 5 / 5 pts Short Answer: Liver damage from cirrhosis, hepatitis, or cancer would cause what type of jaundice? Your Answer: Intrahepatic jaundice Answer: Intrahepatic jaundice Module 8 Exam Question 1 2.5 / 2.5 pts Each of the following statements are true regarding control over the GFR except: The kidney can maintain a constant GFR despite variations in the arterial blood pressure of the rest of the body. Correct! The sympathetic nervous system cannot supersede the renal autoregulatory system. The sympathetic nervous system can supersede the renal autoregulatory system. The RAA responds when blood pressure drops below normal limits. Question 2 2.5 / 2.5 pts Which of the following statements is false regarding ADH? Elevated levels of ADH will lead to a small volume of concentrated urine. Decreased levels of ADH will lead to dilute urine. Correct! Alcohol increases ADH levels. alcohol is a diuretic and will inhibit the release of ADH. Question 3 2.5 / 2.5 pts Juxtamedullary nephrons are characterized by the following except: Correct! They make up 85% of all nephrons they make up 15% of all nephrons They originate deep in the cortex Their loops of Henle extend across the entire medulla Question 4 2.5 / 2.5 pts Low Na+ levels in the plasma and interstitial compartment is characteristic of which of the following fluid imbalances? Dehydration Correct! Water intoxication Edema Question 5 2.5 / 2.5 pts Reabsorption in the PCT is characterized by the following except: Na+ and water are reabsorbed in equal proportions Correct! Glucose and amino acids are minimally reabsorbed in the PCT glucose and amino acids are almost completely reabsorbed in the PCT Sodium, chloride, potassium, and bicarbonate are 65%-80% reabsorbed from the filtrate Question 6 2.5 / 2.5 pts Which of the following is/are true regarding acid-base disorders? (mark all that apply) A. Metabolic disorders are a result of a change in plasma HCO3 - levels B. Respiratory disorders are a result of a change in plasma CO2 levels C. Normal HCO3- = 35-45 mm D. Normal blood pH = 7.35-7.45 Correct! A. Correct! B. C. Correct! D. Question 7 0 / 2.5 pts Acute postinfectious glomerulonephritis is characterized by the following except: Edema of the hands and face can be a sign of this condition You Answered Associated with a good prognosis and rarely causes kidney disease Lab results will include an elevated antistreptococcal antibody (ASO) titer Correct Answer Hypocellularity Question 8 2.5 / 2.5 pts Which of the following is characteristic of acute transplant rejection? Occurs months to years after transplant Correct! Involves increased T lymphocytes It does not respond well to immunosuppressive therapy Question 9 2.5 / 2.5 pts Which of the following is true of cholecalciferol? Correct! It is the inactive form of vitamin D taken in through the skin via UV rays It is the inactive form of synthetic vitamin D It is the active form of vitamin D, converted in the liver It is the active form of vitamin D, converted in the kidney Question 10 2.5 / 2.5 pts A patient is said to be in stage 4 kidney disease. What would you expect their GFR to be? A. 25 mL/min/1.73m2 B. 42 mL/min/1.73m2 C. 70 mL/min/1.73m2 D. 14 mL/min/1.73m2 Correct! A. B. C. D. Question 11 2.5 / 2.5 pts The following are true regarding tubular secretion except: A. H+ is secreted in the intercalated cells B. K+ is secreted in the principal cells C. H+ along with organic acids and bases are secreted from the distal tubule A. B. Correct! C. H + along with organic acids and bases are secreted from the proximal tubule Question 12 2.5 / 2.5 pts Dilation of the afferent arterioles is achieved through the action of which of the following? Correct! Cardiovascular baroreceptors Aldosterone Diuretics Question 13 2 / 2 pts Fill in the blank: The inner portion of the kidney that houses the loop of Hen