FULL TEST BANK
PORTH'S PATHOPHYSIOLOGY CONCEPTS OF ALTERED
HEALTH 10TH EDITION
BY TOMMIE(COMPLETE CHAPTERS 1-52)
,TABLE OF CONTENTS
CHAPTER 1- CONCEPTS OF HEALTH AND DISEASE ................................................................................ 4
CHAPTER 2- CELL AND TISSUE CHARACTERISTICS ............................................................................. 15
CHAPTER 3- CELLULAR ADAPTATION, INJURY, AND DEATH......................................................... 25
CHAPTER 4- GENETIC CONTROL OF CELL FUNCTION AND INHERITANCE ........................... 35
CHAPTER 5- GENETIC AND CONGENITAL DISORDERS ...................................................................... 44
CHAPTER 6- NEOPLASIA ........................................................................................................................................ 55
CHAPTER 7- STRESS AND ADAPTATION ...................................................................................................... 64
CHAPTER 8-A- DISORDERS OF FLUID AND ELECTROLYTE BALANCE ....................................... 74
CHAPTER 8-B- DISORDERS OF ACID-BASE BALANCE ............................................................................ 84
CHAPTER 9- INFLAMMATION, TISSUE REPAIR, AND WOUND HEALING.................................. 93
CHAPTER 10- ALTERATIONS IN TEMPERATURE REGULATION................................................. 103
CHAPTER 10- MECHANISMS OF INFECTIOUS DISEASE .................................................................... 113
CHAPTER 11- INNATE AND ADAPTIVE IMMUNITY............................................................................ 123
CHAPTER 12-A- DISORDERS OF THE IMMUNE RESPONSE ............................................................. 133
CHAPTER 12-B- HIV_ ACQUIRED IMMUNODEFICIENCY SYNDROME ...................................... 144
CHAPTER 13- ORGANIZATION AND CONTROL OF NEURAL FUNCTION ................................ 154
CHAPTER 14- SOMATOSENSORY FUNCTION, PAIN, AND HEADACHE ..................................... 165
CHAPTER 15- DISORDERS OF MOTOR FUNCTION ............................................................................... 176
CHAPTER 16- DISORDERS OF BRAIN FUNCTION .................................................................................. 186
CHAPTER 17- SLEEP AND SLEEP DISORDERS......................................................................................... 197
CHAPTER 18- DISORDERS OF THOUGHT, EMOTION, AND MEMORY ....................................... 207
CHAPTER 19- DISORDERS OF VISUAL FUNCTION ............................................................................... 217
CHAPTER 20- DISORDERS OF HEARING AND VESTIBULAR FUNCTION ................................. 227
CHAPTER 21- BLOOD CELLS AND THE HEMATOPOIETIC SYSTEM ........................................... 237
CHAPTER 22- DISORDERS OF HEMOSTASIS ............................................................................................ 246
CHAPTER 23- DISORDERS OF RED BLOOD CELLS ................................................................................ 257
CHAPTER 24- DISORDERS OF WHITE BLOOD CELLS AND LYMPHOID TISSUES ................ 267
CHAPTER 25- STRUCTURE AND FUNCTION OF THE CARDIOVASCULAR SYSTEM .......... 278
CHAPTER 26-A- DISORDERS OF BLOOD FLOW ...................................................................................... 288
CHAPTER 26-B-DISORDERS OF BLOOD PRESSURE REGULATION .............................................. 298
CHAPTER 27-A- DISORDERS OF CARDIAC FUNCTION ....................................................................... 308
CHAPTER 27-B- HEART FAILURE AND CIRCULATORY SHOCK..................................................... 320
CHAPTER 28- DISORDERS OF CARDIAC CONDUCTION AND RHYTHM ................................... 330
CHAPTER 29- STRUCTURE AND FUNCTION OF THE RESPIRATORY SYSTEM .................... 341
,CHAPTER 30- A-RESPIRATORY TRACT INFECTIONS, NEOPLASMS ........................................... 351
CHAPTER 30-B- CHILDHOOD DISORDERS................................................................................................. 361
CHAPTER 31- DISORDERS OF VENTILATION AND GAS EXCHANGE ......................................... 370
CHAPTER 32- STRUCTURE AND FUNCTION OF THE KIDNEY ...................................................... 380
CHAPTER 33- DISORDERS OF RENAL FUNCTION................................................................................. 390
CHAPTER 34- ACUTE RENAL INJURY AND CHRONIC KIDNEY DISEASE ................................. 400
CHAPTER 35- DISORDERS OF THE BLADDER AND LOWER URINARY TRACT .................... 410
CHAPTER 36- STRUCTURE AND FUNCTION OF THE GASTROINTESTINAL SYSTEM ..... 421
CHAPTER 37- DISORDERS OF GASTROINTESTINAL FUNCTION ................................................. 432
CHAPTER 38- DISORDERS OF HEPATOBILIARY AND EXOCRINE PANCREAS FUNCTION
........................................................................................................................................................................................... 443
CHAPTER 39- ALTERATIONS IN NUTRITIONAL STATUS ................................................................ 454
CHAPTER 40- MECHANISMS OF ENDOCRINE CONTROL .................................................................. 465
CHAPTER 41- DISORDERS OF ENDOCRINE CONTROL OF GROWTH AND METABOLISM
........................................................................................................................................................................................... 474
CHAPTER 42 - STRUCTURE AND FUNCTION OF THE MALE GENITOURINARY SYSTEM
........................................................................................................................................................................................... 485
CHAPTER 43- DISORDERS OF THE MALE RPRODUCTIVE SYSTEM ........................................... 495
CHAPTER 44- STRUCTURE AND FUNCTION OF THE FEMALE REPRODUCTIVE SYSTEM
........................................................................................................................................................................................... 505
CHAPTER 45- DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM .................................. 516
CHAPTER 46- SEXUALLY TRANSMITTED INFECTIONS ................................................................... 526
CHAPTER 47- STRUCTURE AND FUNCTION OF THE MUSCULOSKELETAL SYSTEM ...... 536
CHAPTER 48- DISORDERS OF MUSCULOSKELETAL FUNCTION .................................................. 545
CHAPTER 49 - DISORDERS OF MUSCULOSKELETAL FUNCTION................................................. 556
CHAPTER 50- DISORDERS OF MUSCULOSKELETAL FUNCTION .................................................. 566
CHAPTER 51- STRUCTURE AND FUNCTION OF THE SKIN ............................................................. 577
CHAPTER 52- DISORDERS OF SKIN INTEGRITY AND FUNCTION ............................................... 586
,PORTH'S PATHOPHYSIOLOGY CONCEPTS OF ALTERED HEALTH 10TH EDITION
CHAPTER 1- CONCEPTS OF HEALTH AND DISEASE
1. AT AN INTERNATIONAL NURSING CONFERENCE, MANY DISCUSSIONS AND
BREAKOUT SESSIONS FOCUSED ON THE WORLD HEALTH ORGANIZATION (WHO)
VIEWS ON HEALTH. OF THE FOLLOWING COMMENTS MADE BY NURSES DURING A
DISCUSSION SESSION, WHICH STATEMENTS WOULD BE CONSIDERED A GOOD
REPRESENTATION OF THE WHO DEFINITION? SELECT ALL THAT APPLY.
A) INTERESTS IN KEEPING THE ELDERLY POPULATION ENGAGED IN SUCH
ACTIVITIES AS BOOK REVIEWS AND WORD GAMES DURING SOCIAL TIME
B) INCREASE IN THE NUMBER OF CHAIR AEROBICS CLASSES PROVIDED IN THE
SKILLED CARE FACILITIES
C) INTERVENTIONS GEARED TOWARD KEEPING THE ELDERLY POPULATION
DIAGNOSED WITH DIABETES MELLITUS UNDER TIGHT BLOOD GLUCOSE CONTROL
BY PROVIDING IN-HOME COOKING CLASSES
D) PROVIDING TRANSPORTATION FOR RENAL DIALYSIS PATIENTS TO AND FROM
THEIR HEMODIALYSIS SESSIONS
E) PROVIDING HANDWASHING TEACHING SESSIONS TO A GROUP OF YOUNG
CHILDREN
ANSWER: A, B, C, E
FEEDBACK:
THE WHO DEFINITION OF HEALTH IS DEFINED AS “A STATE OF COMPLETE
PHYSICAL, MENTAL, AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF
DISEASE AND INFIRMITY.” ENGAGING IN BOOK REVIEWS FACILITATES MENTAL
AND SOCIAL WELL-BEING; CHAIR AEROBICS HELPS FACILITATE PHYSICAL WELL-
BEING; AND ASSISTING WITH TIGHT CONTROL OF DIABETES HELPS WITH
FACILITATING PHYSICAL WELL-BEING EVEN THOUGH THE PERSON HAS A
CHRONIC DISEASE. HANDWASHING IS VITAL IN THE PREVENTION OF DISEASE AND
SPREAD OF GERMS.
2. A COMMUNITY HEALTH NURSE IS TEACHING A GROUP OF RECENT GRADUATES
ABOUT THE LARGE VARIETY OF FACTORS THAT INFLUENCE AN INDIVIDUAL'S
HEALTH OR LACK THEREOF. THE NURSE IS REFERRING TO THE HEALTHY PEOPLE
2020 REPORT FROM THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES AS A
TEACHING EXAMPLE. OF THE FOLLOWING ASPECTS DISCUSSED, WHICH WOULD BE
CONSIDERED A DETERMINANT OF HEALTH THAT IS OUTSIDE THE FOCUS OF THIS
REPORT?
,A) THE CLIENT HAS A DIVERSE BACKGROUND BY BEING OF ASIAN AND NATIVE
AMERICAN DESCENT AND PRACTICES VARIOUS ALTERNATIVE THERAPIES TO
MINIMIZE EFFECTS OF STRESS.
B) THE CLIENT HAS A FAMILY HISTORY OF CARDIOVASCULAR DISEASE RELATED
TO HYPERCHOLESTEROLEMIA AND REMAINS NONCOMPLIANT WITH THE
TREATMENT REGIME.
C) THE CLIENT HAS A GOOD CAREER WITH EXCEPTIONAL PREVENTATIVE
HEALTH CARE BENEFITS.
D) THE CLIENT LIVES IN AN AFFLUENT, CLEAN, SUBURBAN COMMUNITY WITH
ACCESS TO MANY HEALTH CARE FACILITIES.
ANSWER: B
FEEDBACK:
IN HEALTHY PEOPLE 2020, THE FOCUS IS TO PROMOTE GOOD HEALTH TO ALL
(SUCH AS USING ALTERNATIVE THERAPIES TO MINIMIZE EFFECTS OF STRESS);
ACHIEVING HEALTH EQUITY AND PROMOTING HEALTH FOR ALL (WHICH
INCLUDES HAVING GOOD HEALTH CARE BENEFITS); AND PROMOTING GOOD
HEALTH (WHICH INCLUDES LIVING IN A CLEAN COMMUNITY WITH GOOD ACCESS
TO HEALTH CARE). A CLIENT'S NONCOMPLIANCE WITH TREATMENTS TO
CONTROL HIGH CHOLESTEROL LEVELS WITHIN THE PRESENCE OF A FAMILY
HISTORY OF CV DISEASE DOES NOT MEET THE “ATTAINING LIVES FREE OF
PREVENTABLE DISEASE AND PREMATURE DEATH” DETERMINANT.
3. A PHYSICIAN IS PROVIDING CARE FOR A NUMBER OF PATIENTS ON A MEDICAL
UNIT OF A LARGE, UNIVERSITY HOSPITAL. THE PHYSICIAN IS DISCUSSING WITH A
COLLEAGUE THE DIFFERENTIATION BETWEEN DISEASES THAT ARE CAUSED BY
ABNORMAL MOLECULES AND DISEASES THAT CAUSE DISEASE. WHICH OF THE
FOLLOWING PATIENTS MOST CLEARLY DEMONSTRATES THE CONSEQUENCES OF
MOLECULES THAT CAUSE DISEASE?
A) A 31-YEAR-OLD WOMAN WITH SICKLE CELL ANEMIA WHO IS RECEIVING A
TRANSFUSION OF PACKED RED BLOOD CELLS
B) A 91-YEAR-OLD WOMAN WHO HAS EXPERIENCED AN ISCHEMIC STROKE
RESULTING FROM FAMILIAL HYPERCHOLESTEROLEMIA
C) A 19-YEAR-OLD MAN WITH EXACERBATION OF HIS CYSTIC FIBROSIS
REQUIRING OXYGEN THERAPY AND CHEST PHYSIOTHERAPY
D) A 30-YEAR-OLD HOMELESS MAN WHO HAS PNEUMOCYSTIS CARINII
PNEUMONIA (PCP) AND IS HIV POSITIVE.
ANSWER: D
FEEDBACK:
,PCP IS AN EXAMPLE OF THE EFFECT OF A MOLECULE THAT DIRECTLY CONTRIBUTES
TO DISEASE. SICKLE CELL ANEMIA, FAMILIAL HYPERCHOLESTEROLEMIA, AND CYSTIC
FIBROSIS ARE ALL EXAMPLES OF THE EFFECTS OF ABNORMAL MOLECULES.
4. A MEMBER OF THE HEALTH CARE TEAM IS RESEARCHING THE ETIOLOGY AND
PATHOGENESIS OF A NUMBER OF CLIENTS WHO ARE UNDER HIS CARE IN A HOSPITAL
CONTEXT. WHICH OF THE FOLLOWING ASPECTS OF CLIENTS' SITUATIONS BEST
CHARACTERIZES PATHOGENESIS RATHER THAN ETIOLOGY?
A) A CLIENT WHO HAS BEEN EXPOSED TO THE MYCOBACTERIUM TUBERCULOSIS
BACTERIUM
B) A CLIENT WHO HAS INCREASING SERUM AMMONIA LEVELS DUE TO LIVER
CIRRHOSIS
C) A CLIENT WHO WAS ADMITTED WITH THE EFFECTS OF METHYL ALCOHOL
POISONING
D) A CLIENT WITH MULTIPLE SKELETAL INJURIES SECONDARY TO A MOTOR
VEHICLE ACCIDENT
ANSWER: B
FEEDBACK:
PATHOGENESIS REFERS TO THE PROGRESSIVE AND EVOLUTIONARY COURSE OF
DISEASE, SUCH AS THE INCREASING AMMONIA LEVELS THAT ACCOMPANY LIVER
DISEASE. BACTERIA, POISONS, AND TRAUMATIC INJURIES ARE EXAMPLES OF
ETIOLOGIC FACTORS.
5. A NEW MYOCARDIAL INFARCTION PATIENT REQUIRING ANGIOPLASTY AND STENT
PLACEMENT HAS ARRIVED TO HIS FIRST CARDIAC REHABILITATION APPOINTMENT.
IN THIS FIRST SESSION, A REVIEW OF THE PATHOGENESIS OF CORONARY ARTERY
DISEASE IS ADDRESSED. WHICH STATEMENT BY THE PATIENT VERIFIES TO THE
NURSE THAT HE HAS UNDERSTOOD THE NURSE'S TEACHINGS ABOUT CORONARY
ARTERY DISEASE?
A) “ALL I HAVE TO DO IS STOP SMOKING, AND THEN I WON'T HAVE ANY MORE
HEART ATTACKS.”
B) “MY ARTERY WAS CLOGGED BY FAT, SO I WILL NEED TO STOP EATING FATTY
FOODS LIKE FRENCH FRIES EVERY DAY.”
C) “SOUNDS LIKE THIS BEGAN BECAUSE OF INFLAMMATION INSIDE MY ARTERY
THAT MADE IT EASY TO FORM FATTY STREAKS, WHICH LEAD TO MY CLOGGED
ARTERY.”
,D) “IF I DO NOT EXERCISE REGULARLY TO GET MY HEART RATE UP, BLOOD
POOLS IN THE VEINS CAUSING A CLOT THAT STOPS BLOOD FLOW TO THE MUSCLE,
AND I WILL HAVE A HEART ATTACK.”
ANSWER: C
FEEDBACK:
THE TRUE ETIOLOGY/CAUSE OF CORONARY ARTERY DISEASE (CAD) IS UNKNOWN;
HOWEVER, THE PATHOGENESIS OF THE DISORDER RELATES TO THE
PROGRESSION OF THE INFLAMMATORY PROCESS FROM A FATTY STREAK TO THE
OCCLUSIVE VESSEL LESION SEEN IN PEOPLE WITH CORONARY ARTERY DISEASE.
RISK FACTORS FOR CAD REVOLVE AROUND CIGARETTE SMOKING, DIET HIGH IN
FAT, AND LACK OF EXERCISE.
6. A 77-YEAR-OLD MAN IS A HOSPITAL INPATIENT ADMITTED FOR EXACERBATION OF
HIS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), AND A RESPIRATORY
THERAPIST (RT) IS ASSESSING THE CLIENT FOR THE FIRST TIME. WHICH OF THE
FOLLOWING ASPECTS OF THE PATIENT'S CURRENT STATE OF HEALTH WOULD BE
BEST CHARACTERIZED AS A SYMPTOM RATHER THAN A SIGN?
A) THE PATIENT'S OXYGEN SATURATION IS 83% BY PULSE OXYMETRY.
B) THE PATIENT NOTES THAT HE HAS INCREASED WORK OF BREATHING WHEN
LYING SUPINE.
C) THE RT HEARS DIMINISHED BREATH SOUNDS TO THE PATIENT'S LOWER LUNG
FIELDS BILATERALLY.
D) THE PATIENT'S RESPIRATORY RATE IS 31 BREATHS/MINUTE.
ANSWER: B
FEEDBACK:
SYMPTOMS ARE SUBJECTIVE COMPLAINTS BY THE PERSON EXPERIENCING THE
HEALTH PROBLEM, SUCH AS COMPLAINTS OF BREATHING DIFFICULTY. OXYGEN
LEVELS, LISTENING TO BREATH SOUNDS, AND RESPIRATORY RATE ARE ALL
OBJECTIVE, OBSERVABLE SIGNS OF DISEASE.
7. WHICH OF THE FOLLOWING SITUATIONS WOULD BE CLASSIFIED AS A
COMPLICATION OF A DISEASE OR OUTCOME FROM THE TREATMENT REGIMEN?
SELECT ALL THAT APPLY.
A) MASSIVE PULMONARY EMBOLI FOLLOWING DIAGNOSIS OF NEW-ONSET
ATRIAL FIBRILLATION
B) BURNING, INTENSE INCISION PAIN FOLLOWING SURGERY TO REMOVE A
PORTION OF COLON DUE TO INTESTINAL AGANGLIONOSIS
,C) DEVELOPMENT OF PULMONARY FIBROSIS FOLLOWING TREATMENT WITH
BLEOMYCIN, AN ANTIBIOTIC CHEMOTHERAPY AGENT USED IN TREATMENT OF
LYMPHOMA
D) GRADUAL DETERIORATION IN ABILITY TO WALK UNASSISTED FOR A PATIENT
DIAGNOSED WITH PARKINSON DISEASE
E) LOSS OF SHORT-TERM MEMORY IN A PATIENT DIAGNOSED WITH ALZHEIMER
DISEASE
ANSWER: A, C
FEEDBACK:
DEVELOPMENT OF PULMONARY EMBOLI AND PULMONARY FIBROSIS FOLLOWING
CHEMOTHERAPY ARE BOTH EXAMPLES OF A COMPLICATION (ADVERSE
EXTENSIONS OF A DISEASE OR OUTCOME FROM TREATMENT). IT IS NORMAL TO
EXPECT INCISIONAL PAIN FOLLOWING SURGERY. AS PARKINSON DISEASE
PROGRESSES, THE INABILITY TO WALK INDEPENDENTLY IS EXPECTED. THIS IS A
NORMAL PROGRESSION FOR PEOPLE DIAGNOSED WITH PARKINSON'S. LOSS OF
SHORT-TERM MEMORY IN A PATIENT DIAGNOSED WITH ALZHEIMER DISEASE IS
AN EXPECTED FINDING.
8. LABORATORY TESTING IS ORDERED FOR A MALE PATIENT DURING A CLINIC VISIT
FOR A ROUTINE FOLLOW-UP ASSESSMENT OF HYPERTENSION. WHEN INTERPRETING
LAB VALUES, THE NURSE KNOWS THAT
A) A NORMAL VALUE REPRESENTS THE TEST RESULTS THAT FALL WITHIN THE
BELL CURVE.
B) IF THE LAB RESULT IS ABOVE THE 50% DISTRIBUTION, THE RESULT IS
CONSIDERED ELEVATED.
C) ALL LAB VALUES ARE ADJUSTED FOR GENDER AND WEIGHT.
D) IF THE RESULT OF A VERY SENSITIVE TEST IS NEGATIVE, THAT DOES NOT
MEAN THE PERSON IS DISEASE FREE.
ANSWER: A
FEEDBACK:
WHAT IS TERMED A NORMAL VALUE FOR A LABORATORY TEST IS ESTABLISHED
STATISTICALLY FROM RESULTS OBTAINED FROM A SELECTED SAMPLE OF PEOPLE.
A NORMAL VALUE REPRESENTS THE TEST RESULTS THAT FALL WITHIN THE BELL
CURVE OR THE 95% DISTRIBUTION. SOME LAB VALUES (LIKE HEMOGLOBIN) ARE
ADJUSTED FOR GENDER, OTHER COMORBIDITIES, OR AGE. IF THE RESULT OF A
VERY SENSITIVE TEST IS NEGATIVE, IT TELLS US THE PERSON DOES NOT HAVE
THE DISEASE, AND THE DISEASE HAS BEEN RULED OUT OR EXCLUDED.
,9. THE LABORATORY TECHNOLOGISTS ARE DISCUSSING A NEW BLOOD TEST THAT
HELPS ESTABLISH A DIFFERENTIAL DIAGNOSIS BETWEEN SHORTNESS OF BREATH
WITH A CARDIAC ETIOLOGY AND SHORTNESS OF BREATH WITH A
RESPIRATORY/PULMONARY ETIOLOGY. A POSITIVE RESULT IS PURPORTED TO
INDICATE A CARDIAC ETIOLOGY. THE MARKETERS OF THE TEST REPORT THAT 99.8%
OF PATIENTS WHO HAVE CONFIRMED CARDIAC ETIOLOGIES TEST POSITIVE IN THE
TEST. HOWEVER, 1.3% OF PATIENTS WHO DO NOT HAVE CARDIAC ETIOLOGIES FOR
THEIR SHORTNESS OF BREATH ALSO TEST POSITIVE. WHICH OF THE FOLLOWING
STATEMENTS BEST CHARACTERIZES THIS BLOOD TEST?
A) LOW VALIDITY; HIGH RELIABILITY
B) HIGH SENSITIVITY; LOW SPECIFICITY
C) HIGH SPECIFICITY; LOW RELIABILITY
D) HIGH SENSITIVITY; LOW RELIABILITY
ANSWER: B
FEEDBACK:
A LARGE NUMBER OF PATIENTS WOULD RECEIVE THE CORRECT POSITIVE
DIAGNOSIS (HIGH SENSITIVITY), WHILE A SIGNIFICANT NUMBER WOULD RECEIVE
A FALSE-POSITIVE DIAGNOSIS (LOW SPECIFICITY). THE INFORMATION GIVEN DOES
NOT INDICATE LOW RELIABILITY OR LOW VALIDITY.
10. AS PART OF A SCREENING PROGRAM FOR PROSTATE CANCER, MEN AT A SENIOR
CITIZENS' CENTER ARE HAVING THEIR BLOOD LEVELS OF PROSTATE-SPECIFIC
ANTIGEN (PSA) MEASURED. WHICH OF THE FOLLOWING STATEMENTS WOULD BEST
CHARACTERIZE A HIGH POSITIVE PREDICTIVE VALUE BUT A LOW NEGATIVE
PREDICTIVE VALUE FOR THIS SCREENING TEST?
A) ALL OF THE MEN WHO HAD HIGH PSA LEVELS DEVELOPED PROSTATE CANCER;
SEVERAL MEN WHO HAD LOW PSA LEVELS ALSO DEVELOPED PROSTATE CANCER.
B) ALL OF THE MEN WHO HAD LOW PSA LEVELS WERE CANCER-FREE; SEVERAL
MEN WHO HAD HIGH LEVELS ALSO REMAINED FREE OF PROSTATE CANCER.
C) MEN WHO HAD LOW PSA LEVELS ALSO DISPLAYED FALSE-POSITIVE RESULTS
FOR PROSTATE CANCER; MEN WITH HIGH LEVELS WERE OFTEN FALSELY
DIAGNOSED WITH PROSTATE CANCER.
D) THE TEST DISPLAYED LOW SENSITIVITY BUT HIGH SPECIFICITY.
ANSWER: A
FEEDBACK:
, THE TEST'S INABILITY TO RULE OUT CANCER WITH A LOW PSA LEVEL INDICATES
A LOW NEGATIVE PREDICTIVE VALUE. ANSWER B SUGGESTS A HIGH NEGATIVE
PREDICTIVE VALUE, WHILE ANSWER C INDICATES A LOW POSITIVE PREDICTIVE
VALUE. HIGH POSITIVE PREDICTIVE VALUE IS ASSOCIATED WITH HIGH
SENSITIVITY.
11. A MALE INTERNATIONAL BUSINESS TRAVELER HAS RETURNED FROM A TRIP
TO INDONESIA. WHILE THERE, HE HIRED A PROSTITUTE FOR COMPANIONSHIP AND
ENGAGED IN UNPROTECTED SEX ON MORE THAN ONE OCCASION. UNBEKNOWNST TO
HIM, THIS PROSTITUTE HARBORED THE HEPATITIS C VIRUS. UPON RETURN TO THE
UNITED STATES, HE EXHIBITED NO SYMPTOMS AND RETURNED TO HIS USUAL
ACTIVITIES. DURING THIS PERIOD OF NO OUTWARD SYMPTOMS, THE MAN WOULD
BE CLASSIFIED AS BEING IN
A) THE PRECLINICAL STAGE OF DISEASE.
B) REMISSION AND UNLIKELY TO DEVELOP HEPATITIS C.
C) THE CLINICAL DISEASE STAGE OF HEPATITIS C.
D) THE CHRONIC PHASE OF HEPATITIS C.
ANSWER: A
FEEDBACK:
DURING THE PRECLINICAL STAGE, THE DISEASE IS NOT CLINICALLY EVIDENT BUT
IS DESTINED TO PROGRESS TO CLINICAL DISEASE.
12. AS OF NOVEMBER 1, 2012, THERE WERE A TOTAL OF 10 CONFIRMED CASES OF
HANTAVIRUS INFECTION IN PEOPLE WHO WERE RECENT VISITORS (MID-JUNE TO
END OF AUGUST, 2012) TO YOSEMITE NATIONAL PARK. THREE VISITORS WITH
CONFIRMED CASES DIED. HEALTH OFFICIALS BELIEVE THAT 9 OUT OF THE 10
PEOPLE WITH HANTAVIRUS WERE EXPOSED WHILE STAYING IN CURRY VILLAGE IN
THE SIGNATURE TENT CABINS. THIS IS AN EXAMPLE OF
A) WHAT THE ANTICIPATED MORTALITY RATE WOULD BE IF A FAMILY OF FIVE
WERE PLANNING TO VACATION IN YOSEMITE NATIONAL PARK.
B) THE PREVALENCE OF HANTAVIRUS ONE CAN ANTICIPATE IF HE OR SHE IS
GOING TO VACATION IN YOSEMITE NATIONAL PARK.
C) THE LOW RATE OF MORBIDITY ONE CAN EXPECT WHILE TRAVELING TO
YOSEMITE NATIONAL PARK.
D) THE INCIDENCE OF PEOPLE WHO ARE AT RISK FOR DEVELOPING HANTAVIRUS
WHILE STAYING IN YOSEMITE NATIONAL PARK.
ANSWER: D
PORTH'S PATHOPHYSIOLOGY CONCEPTS OF ALTERED
HEALTH 10TH EDITION
BY TOMMIE(COMPLETE CHAPTERS 1-52)
,TABLE OF CONTENTS
CHAPTER 1- CONCEPTS OF HEALTH AND DISEASE ................................................................................ 4
CHAPTER 2- CELL AND TISSUE CHARACTERISTICS ............................................................................. 15
CHAPTER 3- CELLULAR ADAPTATION, INJURY, AND DEATH......................................................... 25
CHAPTER 4- GENETIC CONTROL OF CELL FUNCTION AND INHERITANCE ........................... 35
CHAPTER 5- GENETIC AND CONGENITAL DISORDERS ...................................................................... 44
CHAPTER 6- NEOPLASIA ........................................................................................................................................ 55
CHAPTER 7- STRESS AND ADAPTATION ...................................................................................................... 64
CHAPTER 8-A- DISORDERS OF FLUID AND ELECTROLYTE BALANCE ....................................... 74
CHAPTER 8-B- DISORDERS OF ACID-BASE BALANCE ............................................................................ 84
CHAPTER 9- INFLAMMATION, TISSUE REPAIR, AND WOUND HEALING.................................. 93
CHAPTER 10- ALTERATIONS IN TEMPERATURE REGULATION................................................. 103
CHAPTER 10- MECHANISMS OF INFECTIOUS DISEASE .................................................................... 113
CHAPTER 11- INNATE AND ADAPTIVE IMMUNITY............................................................................ 123
CHAPTER 12-A- DISORDERS OF THE IMMUNE RESPONSE ............................................................. 133
CHAPTER 12-B- HIV_ ACQUIRED IMMUNODEFICIENCY SYNDROME ...................................... 144
CHAPTER 13- ORGANIZATION AND CONTROL OF NEURAL FUNCTION ................................ 154
CHAPTER 14- SOMATOSENSORY FUNCTION, PAIN, AND HEADACHE ..................................... 165
CHAPTER 15- DISORDERS OF MOTOR FUNCTION ............................................................................... 176
CHAPTER 16- DISORDERS OF BRAIN FUNCTION .................................................................................. 186
CHAPTER 17- SLEEP AND SLEEP DISORDERS......................................................................................... 197
CHAPTER 18- DISORDERS OF THOUGHT, EMOTION, AND MEMORY ....................................... 207
CHAPTER 19- DISORDERS OF VISUAL FUNCTION ............................................................................... 217
CHAPTER 20- DISORDERS OF HEARING AND VESTIBULAR FUNCTION ................................. 227
CHAPTER 21- BLOOD CELLS AND THE HEMATOPOIETIC SYSTEM ........................................... 237
CHAPTER 22- DISORDERS OF HEMOSTASIS ............................................................................................ 246
CHAPTER 23- DISORDERS OF RED BLOOD CELLS ................................................................................ 257
CHAPTER 24- DISORDERS OF WHITE BLOOD CELLS AND LYMPHOID TISSUES ................ 267
CHAPTER 25- STRUCTURE AND FUNCTION OF THE CARDIOVASCULAR SYSTEM .......... 278
CHAPTER 26-A- DISORDERS OF BLOOD FLOW ...................................................................................... 288
CHAPTER 26-B-DISORDERS OF BLOOD PRESSURE REGULATION .............................................. 298
CHAPTER 27-A- DISORDERS OF CARDIAC FUNCTION ....................................................................... 308
CHAPTER 27-B- HEART FAILURE AND CIRCULATORY SHOCK..................................................... 320
CHAPTER 28- DISORDERS OF CARDIAC CONDUCTION AND RHYTHM ................................... 330
CHAPTER 29- STRUCTURE AND FUNCTION OF THE RESPIRATORY SYSTEM .................... 341
,CHAPTER 30- A-RESPIRATORY TRACT INFECTIONS, NEOPLASMS ........................................... 351
CHAPTER 30-B- CHILDHOOD DISORDERS................................................................................................. 361
CHAPTER 31- DISORDERS OF VENTILATION AND GAS EXCHANGE ......................................... 370
CHAPTER 32- STRUCTURE AND FUNCTION OF THE KIDNEY ...................................................... 380
CHAPTER 33- DISORDERS OF RENAL FUNCTION................................................................................. 390
CHAPTER 34- ACUTE RENAL INJURY AND CHRONIC KIDNEY DISEASE ................................. 400
CHAPTER 35- DISORDERS OF THE BLADDER AND LOWER URINARY TRACT .................... 410
CHAPTER 36- STRUCTURE AND FUNCTION OF THE GASTROINTESTINAL SYSTEM ..... 421
CHAPTER 37- DISORDERS OF GASTROINTESTINAL FUNCTION ................................................. 432
CHAPTER 38- DISORDERS OF HEPATOBILIARY AND EXOCRINE PANCREAS FUNCTION
........................................................................................................................................................................................... 443
CHAPTER 39- ALTERATIONS IN NUTRITIONAL STATUS ................................................................ 454
CHAPTER 40- MECHANISMS OF ENDOCRINE CONTROL .................................................................. 465
CHAPTER 41- DISORDERS OF ENDOCRINE CONTROL OF GROWTH AND METABOLISM
........................................................................................................................................................................................... 474
CHAPTER 42 - STRUCTURE AND FUNCTION OF THE MALE GENITOURINARY SYSTEM
........................................................................................................................................................................................... 485
CHAPTER 43- DISORDERS OF THE MALE RPRODUCTIVE SYSTEM ........................................... 495
CHAPTER 44- STRUCTURE AND FUNCTION OF THE FEMALE REPRODUCTIVE SYSTEM
........................................................................................................................................................................................... 505
CHAPTER 45- DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM .................................. 516
CHAPTER 46- SEXUALLY TRANSMITTED INFECTIONS ................................................................... 526
CHAPTER 47- STRUCTURE AND FUNCTION OF THE MUSCULOSKELETAL SYSTEM ...... 536
CHAPTER 48- DISORDERS OF MUSCULOSKELETAL FUNCTION .................................................. 545
CHAPTER 49 - DISORDERS OF MUSCULOSKELETAL FUNCTION................................................. 556
CHAPTER 50- DISORDERS OF MUSCULOSKELETAL FUNCTION .................................................. 566
CHAPTER 51- STRUCTURE AND FUNCTION OF THE SKIN ............................................................. 577
CHAPTER 52- DISORDERS OF SKIN INTEGRITY AND FUNCTION ............................................... 586
,PORTH'S PATHOPHYSIOLOGY CONCEPTS OF ALTERED HEALTH 10TH EDITION
CHAPTER 1- CONCEPTS OF HEALTH AND DISEASE
1. AT AN INTERNATIONAL NURSING CONFERENCE, MANY DISCUSSIONS AND
BREAKOUT SESSIONS FOCUSED ON THE WORLD HEALTH ORGANIZATION (WHO)
VIEWS ON HEALTH. OF THE FOLLOWING COMMENTS MADE BY NURSES DURING A
DISCUSSION SESSION, WHICH STATEMENTS WOULD BE CONSIDERED A GOOD
REPRESENTATION OF THE WHO DEFINITION? SELECT ALL THAT APPLY.
A) INTERESTS IN KEEPING THE ELDERLY POPULATION ENGAGED IN SUCH
ACTIVITIES AS BOOK REVIEWS AND WORD GAMES DURING SOCIAL TIME
B) INCREASE IN THE NUMBER OF CHAIR AEROBICS CLASSES PROVIDED IN THE
SKILLED CARE FACILITIES
C) INTERVENTIONS GEARED TOWARD KEEPING THE ELDERLY POPULATION
DIAGNOSED WITH DIABETES MELLITUS UNDER TIGHT BLOOD GLUCOSE CONTROL
BY PROVIDING IN-HOME COOKING CLASSES
D) PROVIDING TRANSPORTATION FOR RENAL DIALYSIS PATIENTS TO AND FROM
THEIR HEMODIALYSIS SESSIONS
E) PROVIDING HANDWASHING TEACHING SESSIONS TO A GROUP OF YOUNG
CHILDREN
ANSWER: A, B, C, E
FEEDBACK:
THE WHO DEFINITION OF HEALTH IS DEFINED AS “A STATE OF COMPLETE
PHYSICAL, MENTAL, AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF
DISEASE AND INFIRMITY.” ENGAGING IN BOOK REVIEWS FACILITATES MENTAL
AND SOCIAL WELL-BEING; CHAIR AEROBICS HELPS FACILITATE PHYSICAL WELL-
BEING; AND ASSISTING WITH TIGHT CONTROL OF DIABETES HELPS WITH
FACILITATING PHYSICAL WELL-BEING EVEN THOUGH THE PERSON HAS A
CHRONIC DISEASE. HANDWASHING IS VITAL IN THE PREVENTION OF DISEASE AND
SPREAD OF GERMS.
2. A COMMUNITY HEALTH NURSE IS TEACHING A GROUP OF RECENT GRADUATES
ABOUT THE LARGE VARIETY OF FACTORS THAT INFLUENCE AN INDIVIDUAL'S
HEALTH OR LACK THEREOF. THE NURSE IS REFERRING TO THE HEALTHY PEOPLE
2020 REPORT FROM THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES AS A
TEACHING EXAMPLE. OF THE FOLLOWING ASPECTS DISCUSSED, WHICH WOULD BE
CONSIDERED A DETERMINANT OF HEALTH THAT IS OUTSIDE THE FOCUS OF THIS
REPORT?
,A) THE CLIENT HAS A DIVERSE BACKGROUND BY BEING OF ASIAN AND NATIVE
AMERICAN DESCENT AND PRACTICES VARIOUS ALTERNATIVE THERAPIES TO
MINIMIZE EFFECTS OF STRESS.
B) THE CLIENT HAS A FAMILY HISTORY OF CARDIOVASCULAR DISEASE RELATED
TO HYPERCHOLESTEROLEMIA AND REMAINS NONCOMPLIANT WITH THE
TREATMENT REGIME.
C) THE CLIENT HAS A GOOD CAREER WITH EXCEPTIONAL PREVENTATIVE
HEALTH CARE BENEFITS.
D) THE CLIENT LIVES IN AN AFFLUENT, CLEAN, SUBURBAN COMMUNITY WITH
ACCESS TO MANY HEALTH CARE FACILITIES.
ANSWER: B
FEEDBACK:
IN HEALTHY PEOPLE 2020, THE FOCUS IS TO PROMOTE GOOD HEALTH TO ALL
(SUCH AS USING ALTERNATIVE THERAPIES TO MINIMIZE EFFECTS OF STRESS);
ACHIEVING HEALTH EQUITY AND PROMOTING HEALTH FOR ALL (WHICH
INCLUDES HAVING GOOD HEALTH CARE BENEFITS); AND PROMOTING GOOD
HEALTH (WHICH INCLUDES LIVING IN A CLEAN COMMUNITY WITH GOOD ACCESS
TO HEALTH CARE). A CLIENT'S NONCOMPLIANCE WITH TREATMENTS TO
CONTROL HIGH CHOLESTEROL LEVELS WITHIN THE PRESENCE OF A FAMILY
HISTORY OF CV DISEASE DOES NOT MEET THE “ATTAINING LIVES FREE OF
PREVENTABLE DISEASE AND PREMATURE DEATH” DETERMINANT.
3. A PHYSICIAN IS PROVIDING CARE FOR A NUMBER OF PATIENTS ON A MEDICAL
UNIT OF A LARGE, UNIVERSITY HOSPITAL. THE PHYSICIAN IS DISCUSSING WITH A
COLLEAGUE THE DIFFERENTIATION BETWEEN DISEASES THAT ARE CAUSED BY
ABNORMAL MOLECULES AND DISEASES THAT CAUSE DISEASE. WHICH OF THE
FOLLOWING PATIENTS MOST CLEARLY DEMONSTRATES THE CONSEQUENCES OF
MOLECULES THAT CAUSE DISEASE?
A) A 31-YEAR-OLD WOMAN WITH SICKLE CELL ANEMIA WHO IS RECEIVING A
TRANSFUSION OF PACKED RED BLOOD CELLS
B) A 91-YEAR-OLD WOMAN WHO HAS EXPERIENCED AN ISCHEMIC STROKE
RESULTING FROM FAMILIAL HYPERCHOLESTEROLEMIA
C) A 19-YEAR-OLD MAN WITH EXACERBATION OF HIS CYSTIC FIBROSIS
REQUIRING OXYGEN THERAPY AND CHEST PHYSIOTHERAPY
D) A 30-YEAR-OLD HOMELESS MAN WHO HAS PNEUMOCYSTIS CARINII
PNEUMONIA (PCP) AND IS HIV POSITIVE.
ANSWER: D
FEEDBACK:
,PCP IS AN EXAMPLE OF THE EFFECT OF A MOLECULE THAT DIRECTLY CONTRIBUTES
TO DISEASE. SICKLE CELL ANEMIA, FAMILIAL HYPERCHOLESTEROLEMIA, AND CYSTIC
FIBROSIS ARE ALL EXAMPLES OF THE EFFECTS OF ABNORMAL MOLECULES.
4. A MEMBER OF THE HEALTH CARE TEAM IS RESEARCHING THE ETIOLOGY AND
PATHOGENESIS OF A NUMBER OF CLIENTS WHO ARE UNDER HIS CARE IN A HOSPITAL
CONTEXT. WHICH OF THE FOLLOWING ASPECTS OF CLIENTS' SITUATIONS BEST
CHARACTERIZES PATHOGENESIS RATHER THAN ETIOLOGY?
A) A CLIENT WHO HAS BEEN EXPOSED TO THE MYCOBACTERIUM TUBERCULOSIS
BACTERIUM
B) A CLIENT WHO HAS INCREASING SERUM AMMONIA LEVELS DUE TO LIVER
CIRRHOSIS
C) A CLIENT WHO WAS ADMITTED WITH THE EFFECTS OF METHYL ALCOHOL
POISONING
D) A CLIENT WITH MULTIPLE SKELETAL INJURIES SECONDARY TO A MOTOR
VEHICLE ACCIDENT
ANSWER: B
FEEDBACK:
PATHOGENESIS REFERS TO THE PROGRESSIVE AND EVOLUTIONARY COURSE OF
DISEASE, SUCH AS THE INCREASING AMMONIA LEVELS THAT ACCOMPANY LIVER
DISEASE. BACTERIA, POISONS, AND TRAUMATIC INJURIES ARE EXAMPLES OF
ETIOLOGIC FACTORS.
5. A NEW MYOCARDIAL INFARCTION PATIENT REQUIRING ANGIOPLASTY AND STENT
PLACEMENT HAS ARRIVED TO HIS FIRST CARDIAC REHABILITATION APPOINTMENT.
IN THIS FIRST SESSION, A REVIEW OF THE PATHOGENESIS OF CORONARY ARTERY
DISEASE IS ADDRESSED. WHICH STATEMENT BY THE PATIENT VERIFIES TO THE
NURSE THAT HE HAS UNDERSTOOD THE NURSE'S TEACHINGS ABOUT CORONARY
ARTERY DISEASE?
A) “ALL I HAVE TO DO IS STOP SMOKING, AND THEN I WON'T HAVE ANY MORE
HEART ATTACKS.”
B) “MY ARTERY WAS CLOGGED BY FAT, SO I WILL NEED TO STOP EATING FATTY
FOODS LIKE FRENCH FRIES EVERY DAY.”
C) “SOUNDS LIKE THIS BEGAN BECAUSE OF INFLAMMATION INSIDE MY ARTERY
THAT MADE IT EASY TO FORM FATTY STREAKS, WHICH LEAD TO MY CLOGGED
ARTERY.”
,D) “IF I DO NOT EXERCISE REGULARLY TO GET MY HEART RATE UP, BLOOD
POOLS IN THE VEINS CAUSING A CLOT THAT STOPS BLOOD FLOW TO THE MUSCLE,
AND I WILL HAVE A HEART ATTACK.”
ANSWER: C
FEEDBACK:
THE TRUE ETIOLOGY/CAUSE OF CORONARY ARTERY DISEASE (CAD) IS UNKNOWN;
HOWEVER, THE PATHOGENESIS OF THE DISORDER RELATES TO THE
PROGRESSION OF THE INFLAMMATORY PROCESS FROM A FATTY STREAK TO THE
OCCLUSIVE VESSEL LESION SEEN IN PEOPLE WITH CORONARY ARTERY DISEASE.
RISK FACTORS FOR CAD REVOLVE AROUND CIGARETTE SMOKING, DIET HIGH IN
FAT, AND LACK OF EXERCISE.
6. A 77-YEAR-OLD MAN IS A HOSPITAL INPATIENT ADMITTED FOR EXACERBATION OF
HIS CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), AND A RESPIRATORY
THERAPIST (RT) IS ASSESSING THE CLIENT FOR THE FIRST TIME. WHICH OF THE
FOLLOWING ASPECTS OF THE PATIENT'S CURRENT STATE OF HEALTH WOULD BE
BEST CHARACTERIZED AS A SYMPTOM RATHER THAN A SIGN?
A) THE PATIENT'S OXYGEN SATURATION IS 83% BY PULSE OXYMETRY.
B) THE PATIENT NOTES THAT HE HAS INCREASED WORK OF BREATHING WHEN
LYING SUPINE.
C) THE RT HEARS DIMINISHED BREATH SOUNDS TO THE PATIENT'S LOWER LUNG
FIELDS BILATERALLY.
D) THE PATIENT'S RESPIRATORY RATE IS 31 BREATHS/MINUTE.
ANSWER: B
FEEDBACK:
SYMPTOMS ARE SUBJECTIVE COMPLAINTS BY THE PERSON EXPERIENCING THE
HEALTH PROBLEM, SUCH AS COMPLAINTS OF BREATHING DIFFICULTY. OXYGEN
LEVELS, LISTENING TO BREATH SOUNDS, AND RESPIRATORY RATE ARE ALL
OBJECTIVE, OBSERVABLE SIGNS OF DISEASE.
7. WHICH OF THE FOLLOWING SITUATIONS WOULD BE CLASSIFIED AS A
COMPLICATION OF A DISEASE OR OUTCOME FROM THE TREATMENT REGIMEN?
SELECT ALL THAT APPLY.
A) MASSIVE PULMONARY EMBOLI FOLLOWING DIAGNOSIS OF NEW-ONSET
ATRIAL FIBRILLATION
B) BURNING, INTENSE INCISION PAIN FOLLOWING SURGERY TO REMOVE A
PORTION OF COLON DUE TO INTESTINAL AGANGLIONOSIS
,C) DEVELOPMENT OF PULMONARY FIBROSIS FOLLOWING TREATMENT WITH
BLEOMYCIN, AN ANTIBIOTIC CHEMOTHERAPY AGENT USED IN TREATMENT OF
LYMPHOMA
D) GRADUAL DETERIORATION IN ABILITY TO WALK UNASSISTED FOR A PATIENT
DIAGNOSED WITH PARKINSON DISEASE
E) LOSS OF SHORT-TERM MEMORY IN A PATIENT DIAGNOSED WITH ALZHEIMER
DISEASE
ANSWER: A, C
FEEDBACK:
DEVELOPMENT OF PULMONARY EMBOLI AND PULMONARY FIBROSIS FOLLOWING
CHEMOTHERAPY ARE BOTH EXAMPLES OF A COMPLICATION (ADVERSE
EXTENSIONS OF A DISEASE OR OUTCOME FROM TREATMENT). IT IS NORMAL TO
EXPECT INCISIONAL PAIN FOLLOWING SURGERY. AS PARKINSON DISEASE
PROGRESSES, THE INABILITY TO WALK INDEPENDENTLY IS EXPECTED. THIS IS A
NORMAL PROGRESSION FOR PEOPLE DIAGNOSED WITH PARKINSON'S. LOSS OF
SHORT-TERM MEMORY IN A PATIENT DIAGNOSED WITH ALZHEIMER DISEASE IS
AN EXPECTED FINDING.
8. LABORATORY TESTING IS ORDERED FOR A MALE PATIENT DURING A CLINIC VISIT
FOR A ROUTINE FOLLOW-UP ASSESSMENT OF HYPERTENSION. WHEN INTERPRETING
LAB VALUES, THE NURSE KNOWS THAT
A) A NORMAL VALUE REPRESENTS THE TEST RESULTS THAT FALL WITHIN THE
BELL CURVE.
B) IF THE LAB RESULT IS ABOVE THE 50% DISTRIBUTION, THE RESULT IS
CONSIDERED ELEVATED.
C) ALL LAB VALUES ARE ADJUSTED FOR GENDER AND WEIGHT.
D) IF THE RESULT OF A VERY SENSITIVE TEST IS NEGATIVE, THAT DOES NOT
MEAN THE PERSON IS DISEASE FREE.
ANSWER: A
FEEDBACK:
WHAT IS TERMED A NORMAL VALUE FOR A LABORATORY TEST IS ESTABLISHED
STATISTICALLY FROM RESULTS OBTAINED FROM A SELECTED SAMPLE OF PEOPLE.
A NORMAL VALUE REPRESENTS THE TEST RESULTS THAT FALL WITHIN THE BELL
CURVE OR THE 95% DISTRIBUTION. SOME LAB VALUES (LIKE HEMOGLOBIN) ARE
ADJUSTED FOR GENDER, OTHER COMORBIDITIES, OR AGE. IF THE RESULT OF A
VERY SENSITIVE TEST IS NEGATIVE, IT TELLS US THE PERSON DOES NOT HAVE
THE DISEASE, AND THE DISEASE HAS BEEN RULED OUT OR EXCLUDED.
,9. THE LABORATORY TECHNOLOGISTS ARE DISCUSSING A NEW BLOOD TEST THAT
HELPS ESTABLISH A DIFFERENTIAL DIAGNOSIS BETWEEN SHORTNESS OF BREATH
WITH A CARDIAC ETIOLOGY AND SHORTNESS OF BREATH WITH A
RESPIRATORY/PULMONARY ETIOLOGY. A POSITIVE RESULT IS PURPORTED TO
INDICATE A CARDIAC ETIOLOGY. THE MARKETERS OF THE TEST REPORT THAT 99.8%
OF PATIENTS WHO HAVE CONFIRMED CARDIAC ETIOLOGIES TEST POSITIVE IN THE
TEST. HOWEVER, 1.3% OF PATIENTS WHO DO NOT HAVE CARDIAC ETIOLOGIES FOR
THEIR SHORTNESS OF BREATH ALSO TEST POSITIVE. WHICH OF THE FOLLOWING
STATEMENTS BEST CHARACTERIZES THIS BLOOD TEST?
A) LOW VALIDITY; HIGH RELIABILITY
B) HIGH SENSITIVITY; LOW SPECIFICITY
C) HIGH SPECIFICITY; LOW RELIABILITY
D) HIGH SENSITIVITY; LOW RELIABILITY
ANSWER: B
FEEDBACK:
A LARGE NUMBER OF PATIENTS WOULD RECEIVE THE CORRECT POSITIVE
DIAGNOSIS (HIGH SENSITIVITY), WHILE A SIGNIFICANT NUMBER WOULD RECEIVE
A FALSE-POSITIVE DIAGNOSIS (LOW SPECIFICITY). THE INFORMATION GIVEN DOES
NOT INDICATE LOW RELIABILITY OR LOW VALIDITY.
10. AS PART OF A SCREENING PROGRAM FOR PROSTATE CANCER, MEN AT A SENIOR
CITIZENS' CENTER ARE HAVING THEIR BLOOD LEVELS OF PROSTATE-SPECIFIC
ANTIGEN (PSA) MEASURED. WHICH OF THE FOLLOWING STATEMENTS WOULD BEST
CHARACTERIZE A HIGH POSITIVE PREDICTIVE VALUE BUT A LOW NEGATIVE
PREDICTIVE VALUE FOR THIS SCREENING TEST?
A) ALL OF THE MEN WHO HAD HIGH PSA LEVELS DEVELOPED PROSTATE CANCER;
SEVERAL MEN WHO HAD LOW PSA LEVELS ALSO DEVELOPED PROSTATE CANCER.
B) ALL OF THE MEN WHO HAD LOW PSA LEVELS WERE CANCER-FREE; SEVERAL
MEN WHO HAD HIGH LEVELS ALSO REMAINED FREE OF PROSTATE CANCER.
C) MEN WHO HAD LOW PSA LEVELS ALSO DISPLAYED FALSE-POSITIVE RESULTS
FOR PROSTATE CANCER; MEN WITH HIGH LEVELS WERE OFTEN FALSELY
DIAGNOSED WITH PROSTATE CANCER.
D) THE TEST DISPLAYED LOW SENSITIVITY BUT HIGH SPECIFICITY.
ANSWER: A
FEEDBACK:
, THE TEST'S INABILITY TO RULE OUT CANCER WITH A LOW PSA LEVEL INDICATES
A LOW NEGATIVE PREDICTIVE VALUE. ANSWER B SUGGESTS A HIGH NEGATIVE
PREDICTIVE VALUE, WHILE ANSWER C INDICATES A LOW POSITIVE PREDICTIVE
VALUE. HIGH POSITIVE PREDICTIVE VALUE IS ASSOCIATED WITH HIGH
SENSITIVITY.
11. A MALE INTERNATIONAL BUSINESS TRAVELER HAS RETURNED FROM A TRIP
TO INDONESIA. WHILE THERE, HE HIRED A PROSTITUTE FOR COMPANIONSHIP AND
ENGAGED IN UNPROTECTED SEX ON MORE THAN ONE OCCASION. UNBEKNOWNST TO
HIM, THIS PROSTITUTE HARBORED THE HEPATITIS C VIRUS. UPON RETURN TO THE
UNITED STATES, HE EXHIBITED NO SYMPTOMS AND RETURNED TO HIS USUAL
ACTIVITIES. DURING THIS PERIOD OF NO OUTWARD SYMPTOMS, THE MAN WOULD
BE CLASSIFIED AS BEING IN
A) THE PRECLINICAL STAGE OF DISEASE.
B) REMISSION AND UNLIKELY TO DEVELOP HEPATITIS C.
C) THE CLINICAL DISEASE STAGE OF HEPATITIS C.
D) THE CHRONIC PHASE OF HEPATITIS C.
ANSWER: A
FEEDBACK:
DURING THE PRECLINICAL STAGE, THE DISEASE IS NOT CLINICALLY EVIDENT BUT
IS DESTINED TO PROGRESS TO CLINICAL DISEASE.
12. AS OF NOVEMBER 1, 2012, THERE WERE A TOTAL OF 10 CONFIRMED CASES OF
HANTAVIRUS INFECTION IN PEOPLE WHO WERE RECENT VISITORS (MID-JUNE TO
END OF AUGUST, 2012) TO YOSEMITE NATIONAL PARK. THREE VISITORS WITH
CONFIRMED CASES DIED. HEALTH OFFICIALS BELIEVE THAT 9 OUT OF THE 10
PEOPLE WITH HANTAVIRUS WERE EXPOSED WHILE STAYING IN CURRY VILLAGE IN
THE SIGNATURE TENT CABINS. THIS IS AN EXAMPLE OF
A) WHAT THE ANTICIPATED MORTALITY RATE WOULD BE IF A FAMILY OF FIVE
WERE PLANNING TO VACATION IN YOSEMITE NATIONAL PARK.
B) THE PREVALENCE OF HANTAVIRUS ONE CAN ANTICIPATE IF HE OR SHE IS
GOING TO VACATION IN YOSEMITE NATIONAL PARK.
C) THE LOW RATE OF MORBIDITY ONE CAN EXPECT WHILE TRAVELING TO
YOSEMITE NATIONAL PARK.
D) THE INCIDENCE OF PEOPLE WHO ARE AT RISK FOR DEVELOPING HANTAVIRUS
WHILE STAYING IN YOSEMITE NATIONAL PARK.
ANSWER: D
