Maryville Patho NURS 611-PATHO EXAM 2 INTENSE Q&A (ANSWERS)

1. Review: the parasympathetic system is all about what? Conserving energy / rest and digest The sympathetic nervous system primarily serves to protect an individual by doing which of the following? (select all that apply) A. Decreasing mucous production B. Increasing blood sugar levels C. Increasing body temperature D. Decreasing sweat excretion E. Increasing blood pressure 2. Review: the sympathetic system is all about what? Mobilizing energy stores / fight or flight a. Name three examples of this: i. Increase BG levels ii. Decrease insulin stores iii. Redirect blood to major organs 3. Which characteristic is the most critical index of nervous system dysfunction? LOC a. Why? Indicates improvement or deterioration 4. Thought and goal-oriented behaviors are functions of which area of the brain? Pre-frontal lobe a. What four things is it responsible for? i. concentration ii. Short term memory iii. Thought iv. Limbic areas/emotional areas 5. Where is the region responsible for the motor aspects? Brco area i. Why is it special? Only region that affects speech 6. Parkinson's and Huntington's diseases are associated with defects in which area of the brain? Basal ganglia 7. Maintenance of a constant internal environment and the implementation of behavioral patterns are the main functions of which area of the brain? Hypothalamus 2 8. What two parts of the brain mediate the expression of affect, both emotional and behavioral states? a. Limbic system b. Prefrontal cortex 9. Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain? Medulla oblongata a. What does it make up and where is it located? Myelencephalon / brain stem 10. Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture? Cerebellum 11. The brain receives approximately what percentage of the cardiac output? 20% a. How many mL per minute is that? 800-1000 mL 12. What evidence does the nurse expect to see when a patient experiences trauma to the hypothalamus? (select all that apply) A. Uneven expression of mood B. Unstable blood glucose levels C. Poor regulation of body temperature D. Visual disturbances such as blurred vision E. N/V and symptoms of gastroesophageal reflux disease a. Where does the hypothalamus form? Base of diencephalon b. What four things does it control? i. ANS ii. Temperature iii. Endocrine/glucose iv. Emotional expression 13. What is the first defense of our bodies? a. Skin b. Mucous membranes 14. Which action is the purpose of the inflammatory process? Prevent infection of injured tissue 15. What happens if the epithelial barrier is damaged? Local and systemic inflammatory response mobilized a. What does this do? i. Limit extent of damage ii. Protect against infection 3 iii. Initiate repair of damaged tissue 16. What are the 4 major cardinal signs of infection? a. Warmth b. Edema c. Redness d. Pain e. What is the fifth sign known as? Loss of function 17. Which type of white blood cell is first to arrive at the site of infection? Leukocytes 18. What causes the edema that occurs during the inflammatory process? Increased capillary permeability a. What does edema cause? i. Swelling in surrounding tissue ii. Leakage of plasma b. What is this solely responsible for? i. Inflammation-induced edema 19. What process causes heat and redness to occur during the inflammatory process? Vasodilation of blood vessels a. What does this cause, resulting in warmth and redness? i. Increased blood flow ii. Increased concentration of RBCs at inflammation site 20. The chemotactic factor affects the inflammatory process by? Directing leukocytes to the inflamed area 21. Which 2 chemotactic factors are released during mast cell degranulation? What do they do? a. Neutrophil chemotactic factor (NCF) - attracts neutrophils b. Eosinophil chemotactic factor (ECF-A) - attracts eosinophils 22. What four things is pain mediated by? a. Histamines b. Bradykinins c. Leukotrienes d. Prostaglandins 23. The function of opsonization related to the complement cascade is to for destruction by and . Tag pathogenic microorganisms / neutrophils and macrophages 24. Give an example of an efficient opsonin and what is does. a. C3B b. Adheres to the surface of pathogenic microorganism 4 25. Define opsonins. Molecules that tag microorganisms for destruction by cells i. What are they primarily? 1. Neutrophils 2. Macrophages 26. During phagocytosis what is occurring during the step referred to as opsonization? a. Recognition/adherence to bacteria a. During phagocytosis, opsonization involves only what 2 things? i. Recognition ii. Adherence 27. What is the correct sequence of phagocytosis? a. Opsonization (recognition) b. Adherence c. Engulfment d. Fusion (with lysosomal granules) e. Destruction 28. Which manifestations of inflammation is systemic? a. Fever b. Leukocytosis c. What do you see increased levels of? Circulating plasma proteins 29. The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by? a. Endogenous pyrogens i. What are they also known as? 1. Fever-causing cytokines 30. When considering white blood cell differentials, acute inflammatory reactions are related to elevations of which leukocyte? A. Monocytes B. Eosinophils C. Neutrophils D. Basophils a. What are they known for being? Predominant phagocytes in early inflammation b. How quickly do they arrive after initial injury? Within 6-12 hrs after initial injury c. What three things do they ingest? 1. Bacteria 2. Dead Cells 3. Cellular Debris 5 31. What occurs during the process of repair after tissue damage? a. Nonfunctioning scar tissue replaces destroyed tissue b. What is repair defined as? Replacement of destroyed tissue with scar tissue c. What is scar tissue primarily made of? i. Collagen 1. Name 2 ways it helps. a. Fills in lesion b. Restores tensile strength 2. Name the one thing it cannot do? a. Restore function 32. When cellular damage occurs and regeneration is minor with no significant complications, the process of returning the cells to pre-injury function is referred to as: a. Resolution b. What does this mean? i. Tissues return to pre-injury state ii. Physiologic function is possible 33. The role of fibroblasts during the reconstructive phase of wound healing is to? a. Synthesize/secrete collagen b. Secrete connective tissue proteins c. Why are they most important cells during this phase? i. Provide connectivity d. What stimulates fibroblasts? i. TGF-Beta (growth factor from macrophage) 34. Some older adults have impaired inflammation and wound healing because of which problems? a. Chronic illnesses b. Name two examples i. Diabetes ii. CVD 35. Which cell is the body’s primary defense against parasite invasion? a. Eosinophils 36. Normal bacterial flora found in the intestines produce vitamin K to assist in the absorption of which of the following? (select all that apply) ● Calcium ● Fatty acids ● Large polysaccharides ● Iron ● Magnesium 6 37. The flora’s production of vitamin K is needed to absorb various ions such as these 3 things: a. Calcium b. Iron c. Mag 38. An individual’s acquired-immunity is dependent on the function of which cells? (select all that apply) ● T lymphocytes ● B lymphocytes ● Macrophages ● Opsonins ● Neutrophils a. These cells are involved in what process? What other cells do they work along with? i. Acquired-immunity ii. Dendritic cells 39. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? a. Active-acquired immunity 40. Which kind of immunity does not involve the host’s immune response at all? What is it also known as? a. Passive-acquired immunity b. Passive immunity 41. What is the innate immune system also known as? What is it? what is it composed of? a. Nonspecific immune system b. First line of defense c. cells/mechanisms that defend the host from infection in nonspecific manner i. What does that mean? 1. Cells of the innate system recognize and respond in generic way 42. What is the role of a natural killer (NK) cells? a. Eliminate malignant cells i. What do they target? 1. Cells with viruses/infection ii. What else are the good at eliminating? 1. Abnormal host cells 2. Cancer cells 43. What type of immunity is produced when an immunoglobulin crosses the placenta? a. Passive-acquired immunity 44. How does passive immunity occur? 7 a. Preformed antibodies/T-lymphocytes transferred from donor i. Give 2 examples. 1. From mom via placenta 2. In the Clinic/immunotherapy 45. When antigens are administered to produce immunity, why are different routes of administration considered? a. Each route stimulates a different lymphocyte-containing tissue i. What does this result in? 1. Different types of cellular/humoral immunity 46. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? a. IgA i. Name its 2 subclasses and differences. 1. IgA1 (blood) 2. IgA2 (Secretions) 47. Which antibody initially indicates a typical primary immune response? a. IgM i. Which is it follow by? Against what? 1. IgG 2. Same antigen 48. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? a. IgA i. Where and how is this molecule normally found? 1. Bodily sections 2. Dimers anchored together through j-chain and secretory piece ii. How does this decrease the risk of infections in the mucous membrane? 1. Attaches inside mucosal epithelial cells and protects against degradation of enzymes found in secretions 49. Which is an example of an endogenous antigen? a. Cancer cells 50. When a person is exposed to most antigens, antibodies can usually be detected in his or her circulation within how many days? a. 6 days 51. Vaccinations are able to provide protection against certain microorganisms because of the? a. Level of protection by IgG i. What is it the predominant antibody class of? 1. Secondary response ii. How does it present? 1. Concentrations several times larger than IgM 2. Levels remain elevated for a long time 52. How does the aging process of the T-cell activity affect older adults? a. Tendy to develop various infections 8 i. Why does this occur? 1. T-cell activity is deficient 2. Shift in balance of T-cells 53. A hypersensitivity reaction that produces an allergic response is called? a. Anaphylaxis 54. The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins? a. IgE 55. Type I reactions are mediated by and the products of a. Antigen-specific IgE b. Tissue mast cells i. What are the most type 1 reactions? Against what? 1. Common allergies 2. Environmental antigens 56. Which type of antibody is involved in type I hypersensitivity reaction? a. IgE 57. Blood transfusion reactions are an example of? a. Alloimmunity i. What is it also known as? When does it occur? 1. Isoimmunity 2. Immune system of one person produces an immune reaction in another 58. What is the mechanism that results in type II hypersensitivity reactions? a. Antibodies bind to antigens on the cell surface i. What does this reaction begin with? 1. Antibody binding to tissue-specific antigens a. What happens to the cell? i. Destroyed 59. When mismatched blood is administered causing an ABO incompatibility the erythrocytes are destroyed by? a. Complement-mediated cell lysis i. What happens? 1. Erythrocytes are destroyed 60. When antibodies are formed against red blood cell antigens of the Rh system, the blood cells are destroyed by? Where? a. Phagocytosis b. Spleen 61. What are target cells destroyed by in a type II hypersensitivity reaction? a. Natural Killer Cells (NKCs) i. What AREN’T they? 1. Not antigen specific ii. How are target cells recognized? Then what happens? 1. Using FC receptors on NK cells 9 2. Toxic substances released 62. Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction? a. Modulation 63. Graves disease is a result of? a. Autoantibodies binding to TSH receptor sites 64. Type III hypersensitivity reactions are a result of which action? a. Antibodies binding to soluble antigens released into body fluids b. Immune complexes deposited in tissues 65. Raynaud phenomenon is an example of which type of hypersensitivity? a. Type III i. What is this condition caused by? 1. Temperature-dependent disposition of immune complexes in the capillary beds of the peripheral circulation 66. A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? ● No antigens ● Both A and B antigens ● No antibodies ● Both A and B antibodies a. What do type O patient lack? i. Both types of antigens 1. What are they considered? a. Universal donors 67. Immunoglobulin E (IgE) is associated with which type of hypersensitivity? a. Type I 68. Hypersensitivity reactions have been divided into four distinct types: a. Type I - (IgE Mediated; environmental) b. Type II - (Tissue-specific; blood transfusions and Graves) c. Type III - (immune complex-mediated and Raynauld) d. Type IV - (cell-mediated, graft rejection; TB test) 69. Some clinical examples of type IV hypersensitivity reactions include (select all that apply): ● Graft rejection ● Allergic reactions ● Autoimmune reactions ● Delayed 70. Which disorders are considered autoimmune? (select all that apply): ● Crohn disease ● Addison disease 10 ● Systemic lupus erythematosus ● Non-insulin dependent diabetes ● Rheumatoid arthritis 71. Patients with Lupus can suffer from? a. Butterfly facial rash b. Photosensitivity c. Neuro disorder d. Renal disorder e. Hematological disorder 72. Immunodeficiency disorders are differentiated into vs . a. Primary b. Secondary c. What is the difference? i. Primary is rare 73. What factors can contribute to immunodeficiency disorders? a. Aging b. Psych issues c. Poor diet d. Metabolic problems/diseases e. Genetic syndromes f. Radiation g. Medical treatments (anesthesia;splenectomy) h. Chemo 74. What is the first stage in the infectious process? a. Colonization 75. What are the four stages of infectious process/progression? a. Colonization b. Invasion c. Multiplication d. Spread 76. Which two types of microorganisms reproduces on the skin? a. Fungi b. Bacteria 77. Which statement is true concerning exotoxins? ● Exotoxins are contained in cell walls of gram-negative bacteria ● Exotoxins are released during the lysis of bacteria ● Exotoxins are released during bacterial growth ● Exotoxins are able to initiate the complement and coagulation cascades 78. Which statement is true about vaccines? ● Most bacterial vaccines contain attenuated organisms 11 ● Vaccines require booster injections to maintain life-long protection ● Most viral vaccines are made by using dead organisms ● Vaccines provide effective protection against most infections 79. In general, not persist as long as . Thus what may be necessary to maintain protection throughout life? a. Vaccine-induced protection b. Infection-induced immunity c. boosters 80. Define toxigenicity. a. The ability of a pathogen to produce soluble toxins/endotoxins/disease i. What does this affect? 1. Degree of virulence 81. The infectious process is made up of invasion versus evasion. Define evasion. When does this happen. Give an example. a. Evasion - when body defenses result in microorganisms being transported through the blood b. When the body’s defenses are exhausted c. Septicemia 82. Cytokines are thought to cause fevers by stimulating the synthesis of which chemical mediator? a. Prostaglandins i. What do cytokines do? How? Where do they turnover? 1. Raise thermoregulatory set 2. Stimulation of prostaglandin synthesis 3. a. Brain tissues b. Peripheral tissues 83. When exotoxins are released during bacterial growth, they are . What will this do? a. Immunogenic b. Illicit a response 84. Which statements are true regarding endotoxins? (select all that apply): ● Endotoxins are lipopolysaccharides ● Endotoxins are located in the walls of bacteria ● Endotoxins are created during the process of lysis ● Endotoxins are found in gram-negative microorganisms ● Endotoxins are released during the destruction of its host 85. If endotoxins are left unchecked, what can occur? a. Disseminated intravascular coagulation (DIC) 86. Endotoxins work by? a. Causing incredible vasodilation 87. How does the CDC define AIDS? a. Less than 200 CD4 count 88. Which secretion transmits HIV? (select all that apply): ● Semen ● Urine ● Saliva ● Breast milk 12 ● Sweat 89. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? a. Adaption i. What is this a lack of? What does this cause? 1. Adaption 2. a. Impaired immune response b. HF/KF c. Death 90. What three things does norepinephrine promote during a stress response? a. Anxiety b. Arousal c. Vigilance 91. What is the effect that low-serum albumin has on the central stress response? a. Impaired circulation of _epinephrine_ and norepinephrine . i. Why? 1. Both bind to plasma protein albumin 92. Stress-age syndrome directly results in depressed function of which system? a. Immune 93. Stress-induced norepinephrine results in? a. Peripheral vasoconstriction i. What does this cause? 1. Increase BP a. How does this happen? i. Constricting peripheral vessels 1. Physical manifestations of this: a. Dilated pupils b. Piloerection c. Increased sweat 94. The most influential factor in whether a person will experience a stress reaction is his or her? a. Ability to cope 95. What causes constriction of peripheral vessels in order to increase blood pressure? a. Norepinephrine 96. What increases gastric secretions? a. Cortisol i. What might this cause? 1. Ulcers 97. What increases cardiac output by increasing heart rate and myocardial contractility? a. Epinephrine 98. Cortisol is an important player in the stress response. Cortisol that initial inflammatory effect and it acts to the activity of those helper T cells. a. Inhibits b. Suppress 99. What does Cortisol promote? 13 a. Resolution of healing 100. What does Corisol suppress? a. Cytotoxic T-Cells 101. A reduction is an individual’s number of natural killer (NK) cells appears to correlate with an increased risk for the development of? a. Depression 102. The increased production of proinflammatory cytokines is associated with which considerations? a. High anxiety b. Age/gender c. Stress d. Immune Function 103. Which part of the brain and what system is activated during the alarm phase of the general adaptation syndrome (GAS)? a. Hypothalamus b. SNS 104. What is the difference between benign and malignant? a. Benign: cell appears well differentiated and slow growing; avascular; expansive b. Malignant: messy; rapid spread; vascular, and metastasizing 105. High levels of which cytokines initiate the production of corticotropin-releasing hormone (CRH)? a. IL-1 b. IL-6 106. Which are the most common routes for distant metastasis? a. Blood vessels b. Lymph vessels 107. Staging of cancer provides a to determine treatment. a. Framework 108. Staging system of cancer is as follows (use breast cancer as an example): a. T1 → within breast tissue b. T2 → within breast tissue but getting larger c. T3 → invasion of skin/breast wall d. T4 → metastasis to other organs 109. Node involvement means: a. N2 fixed nodes involved 110. Define tumor (biologic) markers? a. Substances produced by benign/malignant cells i. Name four examples produced by either benign or malignant cancer cells. 1. Hormones