Pathophysiology 2. Exam 2 - Quiz Questions with Solutions

Pathophysiology 2. Exam 2 - Quiz Questions with Solutions A) HCV Which of the hepatitis viruses most commonly progresses to chronic infection and chronic hepatitis? A) HCV B) HAV C) HBV D) HEV D) Pancreatitis A 35 yo woman is admitted to the ED because of severe upper right quadrant pain and fever. The woman has clay colored stools. Her BMI is 51 kg/m2 (normal range: 18.5-25 kg/m2). PE shows a positive Murphy sign. HR is 105 beats/min, BP is 102/65 mmHg. CT scan shows a mass at the sphincter of Oddi. This woman is at risk for developing which of the following acute problems? A) Peptic ulcer disease B) Esophageal cancer C) Gastritis D) Pancreatitis C) Plasma levels of ammonia will rise A chronic alcoholic is urged to abstain from alcohol, because of which of the following consequences of liver failure? A) Severe hyperglycemia will develop B) Plasma oncotic pressure will rise C) Plasma levels of ammonia will rise D) Absorption of all nutrients will be impaired C) Dry mouth A patient is prescribed an anticholinergic drug, with a potential side effect on salivary production, to treat her chronic obstructive pulmonary disease. Which of the following is the most likely side effect experienced by the patient? A) Spitting B) Weight gain C) Dry mouth D) Bitter taste C) Osmotic diarrhea A 14 wk old baby is admitted to the ED with chronic watery diarrhea. The mother is breast-feeding and reports that the problem has existed since birth. History reveals the daily traveled 600 mi to visit the baby's grandparents one month ago but otherwise have not traveled. THe mother said that her pediatrician did blood tests two days ago, which all came back normal. Current tests show that the baby's stool has a low pH but is otherwise unremarkable. It is decided to switch to IV nutrition and shortly thereafter the diarrhea stops. What is the most likely cause or mechanism for the diarrhea? A) Secretory diarrhea B) Traveler's diarrhea C) Osmotic diarrhea D) Infectious diarrhea A) Colorectal cancer The multistep theory of carcinogenesis can be applied to what form of cancer? A) Colorectal cancer B) Breast cancer C) Head and neck cancer D) Lung cancer B) Ulcerative colitis A 64 yo male presents with complaints of urgent bowel movement. He recalls that he had similar problems several years ago but denies such complications for the past year. He typically voids 2 to 3 times per day. He has noticed several times small amounts of blood in his stool, which he recognized because it was bright red. He sometimes has diarrhea at night, but the stool can also be hard, in which case it is very painful to pass. He has tried over-the-counter hemorrhoid creams w/o relief. For many years he has eaten a high fiber diet. He has not noticed blood in his urine or in his mouth after brushing his teeth. There is no sign of right upper quadrant tenderness or ascites. The whites of his eyes are not tinted. His vital signs, CBC, serum electrolytes, clotting tests, and renal profile are unremarkable. From the following, which is the most likely diagnosis to be considered. A) Diverticulosis B) Ulcerative colitis C) Constipation D) Acute liver disease D) Gastroesophageal reflux disease A 43 yo woman complains about an intermittent radiating pain in the left chest for 3 wks. She also mentions a chronic cough. The pain is more prominent when lying down on her back compared to sitting. At night, she sleeps better with multiple pillows. Sx occur shortly after eating spicy food. PE reveals a white coating on the tongue. Body temp is 37.2 degrees C, BP 118/83 mmHg, HR 80 beats/min, and RR 16 breaths/min. Heart and lung sounds are normal. The following tests were ordered and all came back normal: ECG, exercise stress test, WBC, and CK-MB1 serum levels. Which of the following conditions is the most likely initial working diagnosis? A) Mild MI B) Congestive heart failure C) Gallstones D) Gastroesophageal reflux disease D) Hemodilution A 40 yo man with no significant PMH presents to the ED because of a two-day history of fever, vomiting and diarrhea. His BP is 90/65 mmHg and HR is 110/min. AnIV line is started and he is given 3 L of fluid and then admitted for monitoring. On admission, lab studies are unremarkable except for a serum albumin level of 3 g/dL. Which of the following is the most likely cause of this patient's lab abnormality? A) Nephrotic syndrome B) Liver disease C) Malabsorption D) Hemodilution B) Cholecystokinin Which of the following hormones is produced in the duodenum in response to digestion products and stimulates the pancreas in a true hormonal fashion to produce an enzyme-rich secretion? A) Vasoactive intestinal peptide B) Cholecystokinin C) Secretin D) Gastrin A) Ulcerative colitis A 35 yo woman presented to the ED because of abdominal pain and diarrhea mixed with mucus and blood. She also has ulcerated lesions with violaceous borders on her legs. Gross blood is present on rectal examination. A bx of her colon reveals inflammation confined only to the mucosa and submucosa. Which of the following would be the most likely diagnosis? A) Ulcerative colitis B) Crohn's disease C) Peritonitis D) Irritable bowel syndrome C) Food in the stomach To better understand episodes of uncontrolled hyperphagia in people with bulimia nervosa, the mechanisms for gastric accommodation are studied. Which of the following is normally the primary stimulus for this receptive relaxation pattern of the stomach? A) Elevated serum motilin B) Elevated serum secretin C) Food in the stomach D) Food in the intestine C) Decreasing Ca2+ availability in smooth muscle cells A 29 yo woman presents to her health provider complaining of "trouble eating." She says she has had pain when swallowing both solids and liquids for the past nine months. She states that it has been difficult to maintain an appetite over this time and reports a weight loss of 2.3 jg (5 ib). Sx have remained constant since they appeared nine months ago. The patient does not exhibit tightening of the facial skin, claw-like hands or any other systemic sx. Which of the following drug mechanisms of action is most likely to improve the patient's sx? A) Inhibiting the degeneration of ACh B) Decreasing proton secretion into the stomach lumen C) Decreasing Ca2+ availability in smooth muscle cells D) Enhancing the phosphorylation of myosin light chains C) Gastrin A 25 yo man is severely injured in a motor vehicle collision. After 6 wks of total parenteral nutrition (IV feeding), the stomach and small intestines have atrophied substantially. A lack of which of the following GI hormones is most likely to account for the atrophy in this man? A) Motilin B) Secretin C) Gastrin D) Cholecystokinin B) Cirrhosis The most common cause of portal hypertension is A) Noncirrhotic portal fibrosis B) Cirrhosis C) Hepatic vein thrombosis D) Portal vein obstruction D) Changes in the central control of breathing Which of the variables is not taken into account to explain a change in weight? A) Changes in the secretion of hormones B) Changes in the central control of satiety C) The type of food ingested D) Changes in the central control of breathing D) Obstruction by fecalith In which of the following is the pathogenesis of acute appendicitis and diverticulitis similar? A) Primary bacterial invasion B) Lymphoid hyperplasia C) Increased bulk of stool D) Obstruction by fecalith D) X-linked recessive How do men inherit G6PD deficiency? A) X-linked dominant B) Autosomal recessive C) Autosomal dominant D) X-linked recessive A) Ulcerative colitis A 34 yo man visits his medical provider because he has experienced increasing "itchiness" and fatigue over the past three months. Colonoscopy reveals diffuse, continuous ulcerations of the intestinal mucosa extending proximally from the rectum to the splenic flexure. PE reveals scleral icterus. Given his PMH, ultrasound studies are performed, which reveal obliteration of the intrahepatic bile ducts. What is this man's most likely underlying condition? A) Ulcerative colitis B) Primary biliary cirrhosis C) Hepatitis C infection D) Systemic lupus erythematosus C) Stimulates osteoclasts What is the main action of RANKL in the pathophysiological changes with Paget's disease? A) Stimulates osteoblasts B) Inhibits OPG synthesis C) Stimulates osteoclasts D) Stimulates OPG synthesis A) Decrease of leptin In which of the cases does it lead to weight gain? A) Decrease of leptin B) Increase of leptin receptors C) Increase of lepin D) Drugs that stimulate leptin receptors C) 4-5 times per day What is the frequency of the high-amplitude peristaltic contractions in a constipated patient with IBS? A) 10-12 times per day B) 9-10 times per day C) 4-5 times per day D) 6-8 times per day A) Down modulation of Th1 What is the immune role of IL-10 in cases of Crohn's disease? A) Down modulation of Th1 B) Up modulation of Th17 C) Up modulation of Th2 D) Down modulation of Th2 D) Absence of phenylalanine hydroxylase One of the pathophysiological changes in patients with Phenylketonuria is A) Increase of phenylalanine hydroxylase B) Increase of tyrosine formation C) Hyperpigmentation D) Absence of phenylalanine hydroxylase B) A defect in mismatch repair A 41 yo man comes to the medical provider complaining of crampy, bloating abdominal discomfort. He also reports changes in his bowel habits and recently noticed dark stool. His father, sister, and uncle died of colorectal cancer. At the health clinic, a fecal occult test is positive. Colonoscopy reveals 8-10 small flat polyps in the proximal colon. Which ofthe following is the most likely cause of these findings? A) A defect in nucleotide excision repair B) A defect in mismatch repair C) Exposure to benzo(a)pyrene D) A translocation between chromosomes 15 and 17 B) Calcium A 9 yo boy presents with weight loss and diarrhea. His tongue becomes sore and blistery after eating oatmeal or rye bread, which leads to the diagnosis of celiac disease. The medical provider discusses other possible effects of this disease with the parents and describes that muscle spasms and paresthesia are possible symptoms associated with malabsorption of which of the following nutritional substances? A) Carbohydrates B) Calcium C) Fats D) Iron B) Removal of gluten from the diet Celiac disease commonly presents in infancy as failure to thrive. It is an inappropriate T-cell-mediated immune response, and there is no cure for it. What is the treatment of choice for celiac disease? A) Removal of carbohydrates from the diet B) Removal of gluten from the diet C) Removal of protein from the diet D) Removal of phenylalanine from the diet B) M. Tuberculosis A patient with a HIV (+) test is at high risk of being infected with A) Influenza B) M. Tuberculosis C) Hepatitis C D) N. Meningitides B) Increased sensitivity to injury What would be the effect of a disruption of (Toll-like receptor) TRL signaling in the intestinal microbiota? A) Homeostasis of intestinal surface B) Increased sensitivity to injury C) Enhanced ability to repair cell damage D) Normal repair in response to injury A) Secretory What is the mechanism of action that causes the pathophysiological changes in infection of E.Coli ETEC? A) Secretory B) Hemorrhagic C) Inflammatory D) Aggregative C) Injury to endothelial membrane What is the most common factor that predisposes to the development of endocarditis? A) Increased opsonization B) Protective immunity C) Injury to endothelial membrane D) Increased anaphylatoxins A) Lymphatic capillaries spreading Microbes infect the alveoli through the following mechanisms, with the exception of A) Lymphatic capillaries spreading B) Aspiration of pharyngeal contents C) Hematologic spreading D) Direct inhalation of droplets B) No production of superoxides by neutrophils The pathophysiologic changes of patients with chronic granulomatous disease are due to A) Abnormal neutrophil's chemotaxis effects B) No production of superoxides by neutrophils C) Inability of eosinophil's granules to fuse with phagosomes D) Inability of neutrophil's granules to fuse with phagosomes B) Hepatitis C A patient who came to the ED for a car accident is receiving a blood transfusion. Which of the pathogens would be the one with the highest risk of contagion? A) M. tuberculosis B) Hepatitis C C) N. Meningitides D) Influenza D) Decreased opsonization A patient who has a C3b deficiency disorder is susceptible to H. Influenza due to A) Decreased anaphylatoxins B) Increased anaphylatoxins C) Increased opsonization D) Decreased opsonization B) II-1 and TNF During a pulmonary infection, macrophages are capable of secreting A) Complement B) II-1 and TNF C) IL-10 and IL-2 D) Antibodies A) Innate immunity Monocytes are WBCs that belong to the A) Innate immunity B) Late response C) Adaptive Immunity D) Protective Immunity