Portage Learning NURS 231 Pathophysiology All Module Exams ( all answers are 100% correct ) EXCELLENT STUDY GUIDE

PATHOPHYS Module Exams Module 1 Exam Question 1 2.5 / 2.5 pts True/False: A bodybuilder’s muscles will display hyperplasia. True Correct! False It will display hypertrophy. Question 2 2.5 / 2.5 pts True/False ...

PATHOPHYS Module Exams Module 1 Exam Question 1 2.5 / 2.5 pts True/False: A bodybuilder’s muscles will display hyperplasia. True Correct! False It will display hypertrophy. Question 2 2.5 / 2.5 pts True/False: Barrett esophagus is an example of dysplasia. True Correct! False It’s metaplasia. Question 3 0 / 2.5 pts True/False: Hypertrophy is an increase in the size of an organ or tissue caused by an increase in the number of cells You Answered True Correct Answer False Question 4 2.5 / 2.5 pts True/False: Hypertrophy can occur under normal and pathological conditions. Correct! TrueFalse Question 5 10 / 10 pts Match the following: Deals with the cause of death in a population a. Incidence Number of new cases in a population at risk during a specified time b. Prevalence Number of people with the disease in a population in a given time c. Morbidity The effect of an illness on one’s life d. Mortality Question 6 2.5 / 2.5 pts Multiple Choice Which is NOT true of the cytoskeleton? It controls shape and movement Cilia and flagella are microtubule-filled cellular extensions Correct! It includes peroxisomes and proteasomes Peroxisomes and proteasomes are not part of the cytoskeleton. Question 7 1.67 / 2.5 pts Which of the following move across the cell membrane via diffusion? Select all that apply. Correct!Oxygen Glucose Correct Answer Water Correct! Carbon dioxide Question 8 2.5 / 2.5 pts Multiple Choice Which of the following are false regarding cell communication? Endocrine signaling depends on hormones Neurotransmitters act through synapses G-protein linked receptors act through an on-off switch Correct! Paracrine signaling releases a chemical into the extracellular fluid that affects its own activity 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? Pathology Correct AnswerPathophysiology Physiology You Answered No answer text provided. Question 11 2.5 / 2.5 pts Multiple Choice A patient has a fever and rash. What are these examples of? Correct! Signs Symptoms Both A & B Question 12 2.5 / 2.5 pts Multiple Choice Which of the following is true of a test’s sensitivity? It is how likely the same result will occur if repeated Correct! If negative, it can safely be assumed that the person does not have a disease It is considered a true-negative result It can only be calculated from people without the disease 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! MorbidityPrevalence Mortality Question 14 10 / 10 pts Define secondary prevention and give an example: Your Answer: It is one of three categories in disease prevention. It aims to detect and treat disease early, while the disease is asymptomatic and curable. An example is 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 Compare and contrast the two types of gangrenous necrosis. Your Answer: 2 types are dry and moist. In dry gangrenous, the affected tissue is dehydrated, shrinks back and becomes dark brown or black in color. THe spread of dry is slow. In wet, the affected area is cold, swollen, with no pulse. The skin is moist, black, and distended. Small blisters form and as liquefaction occurs, foul ordor emerges. The spread of wet gangrenous is rapid. 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 16 10 / 10 pts Explain what necrosis is and give an example and description of one type of necrosis. Your Answer: Necrosis is cell death in tissue or organ that is still part of a living person. An example of a type of necrosis is coagulative necrosis. This results from a sudden cutoff of the blood supply to an organ, such as the heart. 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 10 / 10 pts Match the type of cell injury to the cause. Some answers may be used more than once. (1 point each) Sunburn a. Physical agents Obesity b. Radiation injury Reactive oxygen species c. Chemical injury Low oxygen to tissues d. Biologic agents Fractures e. Nutritional imbalances OTC drugs f. Free radical injury Hypothermia g. Hypoxic cell injury Radiation treatment Lead toxicity 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. Your Answer: Epithelial, Connective, Muscle, and Nervous Epithelial tissue covers the body's outer surface, lines inner surfaces, forms glandular tissue. It is avascular and can be squamous, cuboidal, and columnar. An example of this type of tissue is our skin. Muscle tissue functions to move our bones, pump blood through the heart, as well as contract blood vessels. Cardiac muscle tissue is an example of muscle tissue. 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 underlyingbasement 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 is the most studied active transport system in the human body? Your Answer: The most studied active transport system is the sodium-potassium-ATPase pump. This pumo moves sodium from inside the cell to outside region, returning potassium to the inside of the cell. If this did not occur, sodium would remain in the cell, water would follow resulting in the cell to swell. Sodium-potassium (Na+/K+)-ATPase pump Question 20 2.5 / 2.5 pts What is the term to describe when cells use energy to move ions against an electrical or chemical gradient? Your Answer: Active transport Active transport Question 21 2.5 / 2.5 pts Give one function of a membrane potential: Your Answer: Generate nerve impulses Generate nerve impulse, muscle contractions, or cause hormone secretion Question 22 2.5 / 2.5 pts What is the term that describes a transport protein to help lipid soluble or large molecules pass through the membrane, that otherwise would not be able to get through? Your Answer: Facilitated diffusion facilitated diffusion Module 2 ExamQuestion 1 3 / 3 pts True/False: Blood tests for tumor markers are the single best screening tool for cancer. Why or why not? Your Answer: False. Tumor markers, which can be used for establishig prognosis, monitoring treatment and detecting recurrent disease, have limitiations. Under benign situations, tumor markers can still be elevated. Whereas in early stages of malignancy, not elevated. They have a lack of specificity and are then limited in their ability to screen or diagnose accuratley. False, they are elevated in benign conditions, most are not elevated in the early stages of malignancy. Question 2 3 / 3 pts Tissue biopsy is of critical importance in what role? Your Answer: Play a critical role in histologic and cytologic studies for diagnosis of cancers. 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 side effects commonly experienced by cancer patients? Your Answer: 1) Bleeding and/or weight loss 2) Anorexia, hair loss 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: TNM system is a detailed staging system, created by AJCC, is used by cancer facilites. It classifies cancers into stages using 3 tumor components; Tumor, Nodes, Metastasis. T is size and spread of the primary tumor. N is how involved the lymph nodes. M is the extent of metastatic involvement. Classification: Tx, T0, Tis, T1-4 Nx, N0, N1-3 Mx, M0, M1 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. When would surgery be appropriate in the treatment of cancer? 2. Most chemotherapeutic drugs cause pancytopenia due to bone marrow suppression. What are the 3 possible adverse outcomes of this? Your Answer: 1. Surgery can be used if the tumor is solid and small with well-defines margins. Also can be used to treat oncologic emergencies and be used as prophylactic measures. 2. 3 possible adverse outcomes are neutropenia, anemia, thrombocytopenia. 1. Surgery is often the first treatment for solid tumors. If the tumor is small with well-defined margins, it can be removed completely. It is also used for oncologic emergencies and prophylactic surgery in high risk patients. 2. Neutropenia- risk for infections Anemia- causing fatigue Thrombocytopenia- risk for bleeding 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 2.5 / 2.5 pts True/False: Cell differentiation is the process of increasing cell numbers by mitotic cell division. True Correct! False False, cell proliferation Question 8 2.5 / 2.5 pts What are two important properties that stem cells possess? Your Answer: Stem cells possess self-renewal and potency. Self renewal means that they can undergo mitotic divisions while maintaining undifferentiated state. Potency is the differentiation potential of stem cells. Potency and self-renewalQuestion 9 0 / 2.5 pts Which of the following are most likely to have arisen from an adult stem cell? You Answered Muscle Bone Correct Answer Epithelial Neural Question 10 4 / 4 pts What is angiogenesis? Why do tumors need it? Your Answer: Angiogenesis is the development of new blood vessels within the tumor. In order to continue growing, it must establish blood vessels and growth factors. development of new blood vessels within the tumor. They need it to continue to grow. Question 11 3 / 3 pts What are normal genes called that become cancer-causing if mutated? Your Answer: Proto-oncogenes and Tumor suppressor genes protooncogenes Question 12 1 / 3 pts What is a tumor suppressor gene? Give one example. Your Answer: It is a gene that codes for a protein that inhibits cell growth and signals apoptosis. An example is p53. 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: Papilloma Lipoma Leiomyosarcoma Hemangioma Adenocarcinoma Neuroblastoma Adenoma MelanomaLymphoma 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 breaks loose from the primary tumor and enters circulation via a blood vessel or lymp system. It finds a new favorable location to invade, grow, and establish blood supply. 2. Patient might have presented with shortness of breath, chest pain, and cough. 3. Patient would have benefited from a chest CT scan. (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 low-dose chest CT. Question 15 3 / 3 pts Benign tumors have which of the following characteristics? Select all that apply. Undifferentiated cells 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. environmental agents 3. radiation 4. cancer-causing viruses Heredity, hormonal factors, obesity, immunologic mechanisms, environmental agents such as chemicals, radiation, and cancer-causing viruses. Question 18 5 / 10 pts 1. ______ is a systemic treatment that enables drugs to reach the site of the tumor as well as other distant sites. 2. The profound weight loss and wasting of fat and tissue that accompany cancer is known as _______. Your Answer: 1. Chemotherapy 2. Wasting 1. chemotherapy 2. cancer anorexia-cachexia syndromeQuestion 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: skin Palpation: breast Lab test: 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 answerExplain the challenges of diagnosing autoimmune disorders. Your Answer: Diagnosing is made by history, physical, and serological findings. Since some blood tests are more generic, results can be imprecise. Markers can be elevated in the presence of other diseases.Criteria for diagnosis: Evidence of an autoimmune reaction, immunological findings are not second to other conditions, and no other causes are found. There are over 80 identified, many with overlapping presentations. Many manifestations are nonspecific and are seen in other non-autoimmune diseases. Blood testing isn’t perfect either, as some tests are more generic and can be elevated in the presence of other diseases. Question 2 2.5 / 2.5 pts Multiple Choice: Which type of immunity is characterized by the development of a specific response to an antigen? Innate immunity Correct! Adaptive immunity Autoimmunity Active immunity Question 3 2.5 / 2.5 pts Multiple Choice: What allows the lymphocyte to differentiate between self and foreign molecules? Antigen presenting cells Regulatory cells Correct! Major histocompatibility complex (MHC) molecule Effector cells Question 4 0 / 3 pts T lymphocytes produce what type of immunity? Your Answer: Adaptive immunity Cell-mediated Question 52 / 2 pts Multiple Choice: Which immunoglobulin passes immune factors from the mother to the fetus? IgM IgA Correct! 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 is NOT a finding consistent with Graves’ disease? Exophthalmos Correct! Hypothyroidism hyperthyroidism GoiterCorneal ulceration 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) shortness of breath, skin redness/hives , abdominal cramping 2) quantity of the exposure does NOT play role on how severe the reaction can be 3) elimination of the food and EpiPen (epiniphereine) 4) carry 2 EpiPens (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 3.5 / 3.5 pts True/False: Following a heart attack, the area of heart muscle that has undergone necrosis because of lack of blood supply will heal by scar tissue replacement. Correct! True False Question 10 3 / 3 pts Multiple Choice: Which of the following is an incorrect pairing of a classic manifestation of acute inflammation with its corresponding cause? Rubor – vasodilation Correct! Dolor – inflammatory cells infiltrating sensory nerves In acute inflammation, dolor (pain) is caused by increased hydrostatic pressure in tissues and by chemical mediators. Calor – increased blood flowTumor – exudation of fluid and cells into extravascular tissues Question 11 3.5 / 3.5 pts True/False: Lymphocytes are categorized as either granulocytes or agranulocytes. True Correct! False false, leukocytes 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: B lymphocytes normally produce antibodies against host tissues. True Correct! False Question 14 3.5 / 3.5 pts Antibodies are also known as ______? Your Answer: immunoglobulins immunoglobulins 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 3.5 / 3.5 pts Multiple Choice: The body’s ability to distinguish self from nonself is termed what? Autoantibodies Positive selection Correct! Self-tolerance Anergy Question 18 5 / 5 pts Short answer: What are autoantibodies? Your Answer:In autoimmune diseases, the immune sustem loses its ability to recognize self and produces autoantibodies, which act against host tissues Answer: In many autoimmune diseases, the immune system loses its ability to recognize self and produces what is called autoantibodies, which act against host tissues. 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) PCP is a lung infection that affects people with weakened immune systems, such as those infected with HIV. It is listed as an opportunistic infection. 2) Overt AIDS. Patient's CD4+ cell count is below 200 cells/uL. Patient also presented with an AIDSdefining illness, such as PCP. (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 is a permanent cell? Epidermal cellHepatocyte Intestinal mucosal cell Correct! Neuron Renal tubular cell Question 22 3.5 / 3.5 pts Fill in the blank As the CD4 T cell count decreases, the body becomes susceptible to ______ ______. Your Answer: opportunistic infections Answer: opportunistic infections 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 positive selection. Correct! True FalseQuestion 26 0 / 2.5 pts Multiple Choice: The process of leukocyte accumulation in the cellular phase of acute inflammation is called what? You Answered Adhesion Transmigration Chemotaxis Correct Answer Margination 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 Question 1 2.5 / 2.5 pts Which of the following increases the chance of clotting? Select all that apply. Vitamin K deficiency Von Willebrand factor deficiency Correct! Protein C deficiency ThrombocytopeniaQuestion 2 2.5 / 2.5 pts A deficiency in which of the following would lead to a hypercoagulable state? Select all that apply. Correct! Protein C Correct! Protein S Factor II Factor VII Factor IX Factor X Correct! Antithrombin III Question 3 2.5 / 2.5 pts Which of the following is a hypercoagulable state? Select all that apply. Hemophilia A Correct! Congestive heart failure Correct! Smoking Thrombocytopenia Correct! Postsurgical state Question 4 0 / 2.5 pts Which of the following is FALSE of disseminated intravascular coagulation (DIC)? Select all that apply. Microthrombi cause vessel occlusion and tissue ischemia You AnsweredIt can cause multiple organ failure Severe hemorrhage results Obstetric disorders are the main cause of DIC Correct! Lab results show a decreased PT, PTT Question 5 2.5 / 2.5 pts Well-known causes of disseminated intravascular coagulation (DIC) include each of the following conditions except: Retained dead fetus Carcinoma Gram-negative sepsis Correct! Heparin administration 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 NOT a regulator of blood pressure? BaroreceptorsRenin-angiotensin-aldosterone system Vasopressin Correct! Parasympathetic nervous system activation Question 8 2.5 / 2.5 pts Antiphospholipid syndrome is NOT associated with which of the following? Select all that apply. Correct! Bleeding risk Thrombus risk Recurrent fetal loss Thrombocytopenia Can be seen with SLE Question 9 2.5 / 2.5 pts Multiple Choice What is the most specific test for diagnosing iron deficiency anemia? Correct! Ferritin RBC Total iron binding capacity Hematocrit Question 10 2.5 / 2.5 pts Multiple Choice Hemolytic anemias are characterized by each of the following except: Premature destruction of red cells Correct!Decrease in erythropoiesis Sickle cell disease and thalassemias are included Bone marrow is hyperactive Question 11 2.5 / 2.5 pts Which of the following are potential causes of a sickle crisis in sickle cell anemia? Select all that apply. Alkalosis Correct! Dehydration Correct! Cold exposure Correct! Physical exertion Question 12 0 / 2.5 pts Multiple Choice: A 23-year-old African-American man with a history of severe lifelong anemia requiring many transfusions has nonhealing leg ulcers and recurrent periods of abdominal and chest pain. These signs and symptoms are most likely to be associated with which one of the following laboratory abnormalities? Correct Answer Sickle cells on peripheral blood smear Loss of intrinsic factor You Answered Decreased erythropoietin Decreased ferritin Question 13 2.5 / 2.5 pts Multiple Choice: Which of the following is NOT true of vitamin B12 deficiency anemia?Dietary deficiencies are not common Peripheral neuropathy can be a result of deficiency Vitamin B12 is bound to intrinsic factor Correct! MCV is decreased Question 14 2.5 / 2.5 pts Multiple Choice: Each of the following are risk factors for secondary hyperlipidemia except? Obesity Diabetes mellitus High cholesterol diet Correct! Autosomal dominant disorder of LDL receptor Question 15 2.5 / 2.5 pts Multiple Choice: Risk factors for coronary heart disease include each of the following except: Correct! HDL > 60 Smoking Hypertension Family history of heart disease Question 16 2.5 / 2.5 pts Multiple Choice: Risk factors for atherosclerosis include each of the following except: Increasing ageCorrect! Female gender (pre-menopause) Elevated CRP levels Cigarette smoking Question 17 8 / 10 pts Matching: Match the cardiac procedures to their description and what they are best used for. 2 answers per question (1 from Set 1, and 1 from Set 2). 1. Cardiac catheterization 2. Exercise stress testing 3. Electrocardiography 4. Echocardiography Set 1: a. Records electrical potential differences during the cardiac cycle b. Observes cardiac function under stress c. Checks for structure and function of the heart d. Catheter is inserted into the great vessels and chambers of the heart Set 2: a. Best to assess ventricular function and heart failure b. Best to assess for arrhythmias and myocardial infarction c. Best to assess need for coronary artery bypass graft and stenting d. Best to assess suspected ischemic heart disease Your Answer: 1. D, C 2. B, D 3. A, A 4. C, B 1. Set 1: d, Set 2: c 2. Set 1: b, Set 2: d 3. Set 1: a, Set 2: b 4 . Set 1: c, Set 2: a 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:In stable angina, with exertion, the vessels cannot properly vasodilate. This can cause chest pain, tightness or shortness of breath. Heart is stable at rest, but cannot keep up with the exertion demand. It is relieved with rest and/or use of nitroglycerin. With increasing occlusion of the coronary vessel, the demands of the resting heart may become too great. Unstable agina is when patient has angina without exertion. Rest is insuffient, but can be releived with nitroglycerin. If the plaque ruptures, complete occulsion can occur. This can lead to lack of oxygen to tissues in the heart and muscle can die. This is myocardial infarction. Chest pain unrelieved by rest, sharp pain down left arm, vomitting are signs of distress. Emergency/hospital interventions are needed. 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 10 / 10 pts 1. Name 2 lifestyle changes to prevent further progression of atherosclerotic diseases: 2. Name 2 medications used to treat someone with coronary artery disease and their mechanisms of action: Your Answer: 1. Stop smoking and frequent exercise 2. ACE inhibitors prevent conversion of angiotensin I to angiotensin II, which decreases vasocontriction, aldosterone production, sodium and water retiention by the kidneys. Diuretics promote the excretion of fluids, reducing preload. 1. Reduction in fat intake, quitting smoking, weight loss, exercise 2. Aspirin or other platelet inhibitors are used to prevent thrombosis formation. Beta-blockers and calcium channel blockers (CCB) – both decrease the heart rate and contractile force – can be initiated to decrease the heart’s demand of oxygen. CCB also increase coronary vasodilatation and decrease coronary vasospasm. Nitrates are used to quickly dilate the coronary vessels. Nitrates also dilate veins, decreasing the heart’s work by decreasing preload and afterload. Question 20 2.5 / 2.5 pts Multiple Choice: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 what? Stable angina Correct! Unstable angina Myocardial infarction Question 21 2.5 / 2.5 pts Multiple Choice: Which of the following is NOT a risk factor for hypertension? Correct! Increased potassium intake Increased salt intake Increased alcohol intake Increased caloric intake Question 22 2.5 / 2.5 pts Multiple Choice: Each of the following lifestyle modifications will help to decrease blood pressure except: Losing weight Increase fruits and vegetables Correct! 3 drinks or more of alcohol Limiting salt intake Question 23 2.5 / 2.5 pts Multiple Choice: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. What is this referred to as? Correct! Stable angina Unstable angina Myocardial infarction Question 24 2.5 / 2.5 pts Multiple Choice: Which arrhythmia is the most common chronic arrhythmia and incidence increases with age? Sinus bradycardia Sinus tachycardia Correct! Atrial fibrillation Atrial flutter 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: _____ are a group of inherited disorders of hemoglobin synthesis common among Mediterranean populations. Your Answer: thalassemias Thalassemias Question 27 2.5 / 2.5 ptsFill in the blank: The drug most commonly associated with inhibition of platelet aggregation is ______. Your Answer: aspirin aspirin Question 28 10 / 10 pts Patient is found to have the above: What risk factors mostly led to this disease state? What is this person at risk for developing? What lifestyle modifications would you suggest for them? Your Answer: 1. Smoking, poor diet, high cholesteral values, obesity, diabetes 2. Atherosclerosis 3. Stop smoking, exercise, dietary changes, reduce alcohol consumption Answer: Picture is of an atherosclerotic plaque 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). Coronary artery disease, angina, myocardial infarction, aneurysm, stroke (ischemia, thrombosis, emboli). Stop smoking, lose weight/exercise, healthy diet (low-fat, low-cholesterol), adhere to medication for blood pressure, hyperlipidemia, and/or diabetes. MODULE 5 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 The breathing rate is determined by input from ______ that monitor oxygen, carbon dioxide, and pH levels in the blood. Your Answer: chemorecpetors chemoreceptors Question 4 2.5 / 2.5 pts The _____ are the actual sites of gas exchange between the air and blood. Your Answer: alveoli alveoli Question 5 2.5 / 2.5 pts True/False: Asthma is considered reversible airway bronchoconstriction. Correct! True False Question 6 2.5 / 2.5 pts True/False: Intrapleural pressure is always negative in relation to alveolar pressure in a normal inflated lung.Correct! True 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: The diaphragm is innervated by _____. Your Answer: the phrenic nerve, cervical nerves C3, C4, C5 C3, C4, C5 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 1.5 / 2.5 ptsWhich of the following cells contribute to airway inflammation in asthma? Select all that apply. Correct! Eosinophils Correct! Mast cells Correct Answer Neutrophils Correct Answer Leukotrienes Correct! Lymphocytes Question 12 2.5 / 2.5 pts Multiple Choice: Alpha-1 antitrypsin deficiency is most likely seen in which disease process? Bronchial asthma Chronic bronchitis Correct! Emphysema Bronchiectasis 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 wallHypertrophy of the submucosal glands Question 14 2.5 / 2.5 pts Multiple Choice: Each of the following are TRUE of ARDS except: Chest x-ray shows a “white-out” Correct! Presents with decreased respiratory rate Decreased surfactant function Increased capillary permeability 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: In asthma patients, the airways begin to narrow. COntact with a trigger, such as a cold virus, starts a cascade of inflammatory cells to cause epithelial injury, resulting in airway inflammation. With the severe airway inflammation, patient is experiencing airway remodeling, development of specific structureal changes in the airway wall. This can cause fixed obstruction in asthma patients and not reversible with inhalers or bronchodilaters. 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:An 18-year-old woman is admitted to the ER with a suspected drug overdose. Her respiratory rate is slow (4-6 breaths/minute) and shallow. Arterial blood gases reveal a PCO2 of 80 mm Hg and a PO2 of 60 mm Hg. What is the cause of this women’s high PCO2 and low PO2? Hypoventilation almost always causes an increase in PCO2. Explain. Your Answer: The patient has decreased ventilation, impaired alveolar ventilation. This causes an increase in plasma PCO2 and decrease in PO2. She cannot expire the air at a normal rate resulting in accumulation of CO2. Hypoventilation is when there is a reduced amount of air entering the lungs and alveoli. This results in decrease of oxygen and increase of CO2 in the blood. Breathing is often too shallow or too slow. Respiratory acidosis; with a decreased respiratory rate, you are not exhaling enough carbon dioxide and it accumulates. Question 17 10 / 10 pts Short answer: Explain why the oxygen flow rate for people with COPD is normally titrated to maintain the arterial PO2 between 60 and 65 mm Hg. Your Answer: Those with oxygen therapy, its vital not to supplement with too much oxygen. The respirator center in the medulla has adapted to elevated CO2 levels, no longer responding to increases in PCO2. A decrease in PO2 becomes the stimulus for respiration. If oxygen is given at too high of rate, the respiratory drive and stimulus is supressed. Their medullary respiratory center has adapted to the elevated CO2 levels and no longer responds to increases in PCO2. Therefore, a decrease in PO2 becomes the stimulus for respiration. If oxygen is given at too high of a rate, it suppresses the stimulus and the respiratory drive. Question 18 10 / 10 pts Short answer:1.) Your patient’s lung showed the following: what is the only treatment that can delay the progression of this disease? 2.) Which is more soluble in plasma: carbon dioxide or oxygen? Your Answer: 1) Smoking cessation only treatment that slows disease progression 2) Carbon Dioxide 1.) smoking cessation 2.) Carbon dioxide Question 19 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 other NSAIDs Aspirin and other NSAIDsQuestion 20 5 / 5 pts Multiple Choice: Each of the following can lead to atelectasis except: Pleural effusion Tumor mass Correct! Thrombus Mucous plug Question 21 5 / 5 pts Multiple Choice: Each of the following are helpful treatments for COPD patients except: Oxygen therapy Bronchodilators Correct! Anticoagulants Pneumococcal vaccination Influenza vaccinationMODULE 6 Question 1 2.5 / 2.5 pts Multiple Choice: A patient has experienced a seizure affecting the left temporal lobe. The family reports that the patient exhibited repetitive lip smacking and hand rubbing followed by a period of great fear and insecurity. They have experienced which type of seizure? Focal seizure without impairment of consciousness or awareness Correct! 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 worthlessness and guilt as well as difficulty sleeping. As they are speaking, you notice a repetitive, accentuated blinking of their eyes. What type of depression are they experiencing? Melancholic depression Atypical depressionDepression with psychotic features Correct! 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: Correct! Neurofibrillary tangles are a result of an abnormal accumulation of amyloid in the blood vessels Neuritic plaques 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 behaviors related to stroke except: Obesity Smoking Correct!Hypercholesteremia Immobility 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: A “drop attack” is another term for which type of seizure? Myoclonic seizure Clonic seizure Tonic seizure Correct! Atonic seizure Question 11 2.5 / 2.5 pts Multiple Choice: Narcolepsy appears to be linked to an abnormal regulation of which stage of sleep? stage 1 stage 2 stage 4 Correct! REMQuestion 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, TCAs Answer: Tricyclic antidepressants (TCAs) Question 15 2 / 2 pts Fill in the blank: _______ is sleep disordered breathing due to the brain not properly signaling the respiratory muscles. Your Answer: Central sleep apnea Answer: Central sleep apnea Question 16 2 / 2 pts Fill in the blanks:The aim of drug therapy used for Parkinson’s disease is to increase _______ neuron activity or decrease _______ neuron activity. Your Answer: dopaminergic, cholinergic Answer: dopaminergic, cholinergic Question 17 2 / 2 pts Fill in the blank: Connective tissue sheaths that surround the brain and spinal cord providing protection are called the _______. Your Answer: meninges Answer: Meninges Question 18 5 / 5 pts T/F – Make true if False Oligodendrocytes produce myelin in the PNS. Your Answer: False Answer: False, oligodendrocytes produce myelin in the CNS. Question 19 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. Question 20 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. 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 the mechanism of electric synapses and how they contribute to the rapid propagation of an action potential. Your Answer: Electric synapses allow the passage of the current through openings called gap junctions. Gap juntions penetrate the junctions of neighboring cells, which allows the current to move in either direction. This results in the ability of the action potential to move rapidly from neuron to neuron. Answer: Electrical synapses allow the passage of current-carrying ions through small openings called gap junctions. These gap junctions penetrate the cell junction of neighboring cells allowing current to flow in either direction. Question 23 5 / 5 pts Short Answer Essay You are babysitting a 7-year-old child with a known history of seizure activity. You notice they appear flushed and seem unresponsive. You ask if they are feeling alright and they stare at you blankly. After a few seconds they act as if nothing happened and return to play. Is this a generalized or focal seizure? Based upon this description, what specific type of seizure did this individual experience? Your Answer: The specific type of seizure described is an absence seizure, which is considered a subcategory of generalized seizures. Answer: Generalized, Absence seizure Question 24 5 / 5 pts Short Answer Essay Describe the importance of brain activity that occurs during REM sleep. Your Answer: During REM sleep, internalized sensory are stimulated which allows formed memories to replay. REM sleep is necessary for normal physiolgic and psychologic functioning during wake times. REM deprivation can lead to anxiety, decreased concentration, and behavioral changed. Answer: During this phase of sleep, incoming sensory input is blocked; the brain cannot process it. However, internalized sensory tracts are stimulated allowing previously formed memories to replay in one’s mind. Studies have shown that adequate time spent in REM sleep is necessary for normal physiologic and psychologic functioning during periods of wakefulness. 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 theday 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: The patient experienced a TIA, transient ischemic attack, or mini stroke. The patient's symptoms, tingling sensation, slurred speech, difficulty speaking, are signs of a stroke. However, with TIA, the symptoms/signs, will resolve within 24 hours. The patient's medical history of diabetes and hypercholesteremia also are risk factors for stroke. 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 10 / 10 pts Long Answer Essay A 75-year-old male is brought to the emergency department via ambulance at 5 pm. The patient’s spouse reports that when they woke up (approximately at 6 am) he reported to her that he was having some blurred vision but decided to go about his day. As the day progressed, he started experiencing tingling and feelings of weakness on the entire left side of his body. He has a past medical history of diabetes. 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: This patient is experiencing a stroke. A CT scan and MRI will be ordered to determine the type of stroke and rule out possible other disorders. A vasular image will be done to determine source of the block. Since its been over 4 hours since symptom onset, the window to safely administer tPA has passed. A catheter based method is necessary. This will mechanically break the clot and deliver drugs directly to the clot itself. A stent might be place as well. Answer: This patient is more than likely experiencing an ischemic stroke. A CT scan and MRI would be needed to determine if a clot was blocking blood flow to the brain tissue and to rule out a hemorrhagic stroke. If a clot is found, this patient would need to be re-perfused through catheterbase methods as they are outside of the 3-4.5 treatment window for the use of tPA drugs. 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: The 4 symptoms are: DIfficulty initiating sleep Difficulty maintaining sleep Waking up too early Chronic nonrestorative (poor)sleepFor a primary insomnia diagnosis, patient must exhibit at least 3 symptoms from the list above and at least one sympton during wake hours, such as poor work performance and irritability. Nonpharmacologic treatment will be patient education and good sleep hygiene, sleep habits. This includes a comfortable sleeping environmnet, going to bed at the same time each night, avoid caffeine or other stimulants several hours prior to bedtime, avoidance of screens before 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 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: Complications of gallstones include each of the following EXCEPT: Correct! Cirrhosis Biliary obstruction Pancreatitis CholecystitisQuestion 3 5 / 5 pts Multiple choice: Treatments for gastroesophageal reflux include each of the following EXCEPT: Losing weight Sleeping with head elevated Correct! Caffeinated beverages Proton pump inhibitors Question 4 5 / 5 pts What symptoms of irritable bowel syndrome would require further investigation? Select all that apply. Correct! Blood in stool Correct! Weight loss Nausea and anorexia Bloating Correct! Anemia Question 5 5 / 5 pts Multiple choice Risk factors for the development of peptic ulcer include each of the following EXCEPT: pylori infection Family history of PUD NSAID useAlcohol use Correct! Stress Question 6 5 / 5 pts Multiple Choice Gastric ulcers are worsened by _____. Duodenal ulcers are worsened by _____. Correct! A. Eating; not eating B. Not eating; eating C. Both a & b D. None of the above Question 7 5 / 5 pts Multiple choice Each of the following are characteristics of ulcerative colitis EXCEPT: Correct! Granulomatous lesions Bloody diarrhea Pseudopolyps Risk of toxic megacolon Crypt abscess formation Question 8 5 / 5 pts Multiple Choice Each of the following are characteristics of Crohn disease EXCEPT: Fistulas and stricturesAbscesses Skip lesions Cancer development is rare Correct! Bloody diarrhea Question 9 2.5 / 2.5 pts Fill in the blank: The _____ prevents feces from going back into the ileum. Your Answer: ileocecal valve Answer: ileocecal valve Question 10 2.5 / 2.5 pts True/False: The GI tract produces both enzymes and hormones. Correct! True False Question 11 2.5 / 2.5 pts Fill in the blank: The double-layered fold of peritoneum that hangs down from the stomach to adjacent organs is called what? Your Answer: omentum Answer: omentum Question 12 2.5 / 2.5 pts Fill in the blank: What type of cell secretes hydrochloric acid in the stomach? Your Answer: parietal cells Answer: Parietal cellsQuestion 13 2.5 / 2.5 pts Short answer: What are the intermittent contractions that help to mix and move food along? Your Answer: Rhythmic movements Answer: Rhythmic movements Question 14 2.5 / 2.5 pts True/False Activation of the sympathetic nervous system increases amplitude of the slow waves. True Correct! False Question 15 2.5 / 2.5 pts Short Answer: _____ lies between the mucosal and muscle layers of the intestinal wall, and is involved with controlling secretions, absorption, and contraction of each segment of the intestinal tract. Your Answer: Submucosal plexus Answer: Submucosal (Meissner) plexus Question 16 2.5 / 2.5 pts Short answer: What is it called when there is abnormally fast emptying of hyperosmotic gastric secretions? Your Answer: Dumping syndrome Answer: Dumping syndrome Question 17 5 / 5 pts Short answer Which GI hormone has strong growth hormone-releasing activity and stimulates food intake and digestive function? Your Answer: Ghrelin Answer: GhrelinQuestion 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 Fill in the blank: Consistently ignoring the urge to defecate can result in _____. Your Answer: constipation Answer: constipation Question 21 0 / 5 pts Multiple Choice: Clinical manifestations of cirrhosis include each of the following EXCEPT: Splenomegaly Correct Answer Choledocholithiasis Portal hypertension You Answered Coagulation factor deficiencies Encephalopathy Question 225 / 5 pts Short Answer: What is now the most common cause of chronic liver disease in the Western world? Your Answer: Nonalcoholic fatty liver disease, NAFLD Answer: Nonalcoholic fatty liver disease (NAFLD) Question 23 5 / 5 pts Short Answer: Cholelithiasis would be an example of what type of jaundice? Your Answer: Posthepatic Answer: Posthepatic jaundice Question 24 5 / 5 pts Short Answer: Excessive red blood cell destruction would cause what type of jaundice? Your Answer: Prehepatic Answer: Prehepatic jaundice MODULE 8 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. The sympathetic nervous system can supersede the renal autoregulatory system. Correct! The RAA responds when blood pressure rises above normal limits. 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. Correct! Elevated levels of ADH will lead to dilute urine.decreased levels of ADH will lead to dilute urine. Alcohol inhibits ADH. Question 3 2.5 / 2.5 pts Which of the following statements is true regarding nephrons? It is divided into an outer medulla and an inner cortex It has 1 source of blood supply Correct! The glomerulus filters the blood while the tubule reabsorbs needed nutrients Question 4 0 / 2.5 pts Low Na+ levels in the plasma and interstitial compartment is characteristic of which of the following fluid imbalances? You Answered Dehydration Correct Answer 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 balance? (mark all that apply) Correct! Acid-base balance refers to the balance of the concentration of hydrogen ions (H+) in the bloodAcid-base balance refers to the balance of the concentration of bicarbonate ions (OH-) in the blood Venous blood is characterized by a more alkaline pH Correct! A higher concentration of H+ ions will decrease the pH of the blood Question 7 2.5 / 2.5 pts Acute postinfectious glomerulonephritis is characterized by the following except: Typically caused by a streptococcal infection Correct! Associated with a poor prognosis as it often leads to CKD the prognosis is good when underlying cause is treated Accompanied by glomerular enlargement and hypercellularity Oliguria is often the first symptom 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 0 / 2.5 pts Which of the following is true of 25-hydroxycholecalciferol? You Answered 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 Correct Answer It is the active form of vitamin D, converted in the liverIt 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: Correct! K+ is secreted in the intercalated cells K+ is secreted in the principal cells H+ along with organic acids and bases are secreted from the proximal tubule Involves the elimination of urea from the filtrate 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 Not yet graded / 2 pts Fill in the blank:The outer portion of the kidney that houses the glomeruli and convoluted tubules is called the _______. Your Answer: outer cortex Answer: renal cortex Question 14 Not yet graded / 2 pts Fill in the blank: The formation of erythropoietin is preceded by low levels of _______. Your Answer: oxygen in the tissues Answer: oxygen Question 15 Not yet graded / 2 pts Fill in the blank: The __________ has the largest impact on pH control. Your Answer: kidney Answer: renal control mechanism Question 16 Not yet graded / 2 pts Fill in the blank: A person who has a blood Mg2+ concentration of 3.3 mg/dL. Is considered to have _______. Your Answer: hypermagnesemia Answer: hypermagnesemia Question 17 Not yet graded / 2 pts Fill in the blank: _______ failure is caused by conditions that damage the structures within the kidney. Your Answer: renal Answer: Intrarenal Question 18 Not yet graded / 5 pts T/F, if False make the statement True Angiotensin I is converted to angiotensin II in the kidneys. Your Answer: False. Angiotensin I is converted to angiotensin II in the lungs Answer: False, angiotensin I is converted to angiotensin II in the lungs. Question 19Not yet graded / 5 pts T/F, if False make the statement True Hyperkalemia can be caused by movement of K+ from the ECF to the ICF compartment. Your Answer: False. Caused by the movement of K+ from the ICF to ECF compartment. Answer: False, hyperkalemia can be cause by the movement of K+ from the ICF to the ECF compartment. Question 20 Not yet graded / 5 pts Short Answer: Explain why renal flow is decreased with sympathetic activity. Your Answer: Renal flow is decreased when there is an increase sympathetic activity. This is due to the afferent vasocontriction. Answer: Sympathetic activity diverts blood to the heart, brain, and skeletal muscles. During these times the renal autoregulatory system may be superseded by nervous system control. In this event, a narrowing of the afferent arteriole is caused by sympathetic nerve fibers followed by a release of epinephrine from the adrenal medulla which leads to a subsequent decrease in renal flow and the GFR. Question 21 Not yet graded / 5 pts Short Answer: A patient’s plasma Ca2+ levels are 11.0 mg/dL. Given these levels, list a symptom affecting the GI tract they may experience and explain why it would be occurring. Your Answer: A GI symptom is constipation. This would occur due to the decrease in neural excitability and decrease in smooth muscle activity. Answer: The patient has hypercalcemia. Constipation, nausea, and/or vomiting may result secondary to a decrease in smooth muscle activity. Question 22 Not yet graded / 5 pts Short Answer: A patient has a diagnosis of glomerular disease. Given what you know about the structural framework of the glomerular capillaries, what would be detected in this patient’s urine, and explain why this would happen. Your Answer: Protein and blood will be detected in the the urine. This happens due to the increased permeability of the glomerular capillary wall. Answer: Blood and protein may be present in the urine. Spaces within the basement membrane of the glomerular capillaries, under normal circumstances prevent red blood cells and plasma proteins from passing through the glomerular membrane into the filtrate. The disease process would compromise this. Question 23Not yet graded / 5 pts Short Answer: A patient with chronic kidney disease must undergo dialysis treatments as they wait for transplantation. Give 1 reason peritoneal dialysis would be preferable to the patient over hemodialysis and 1 concern in choosing peritoneal dialysis over hemodialysis. Your Answer: Peritoneal dialysis can be prefered because it can be done at the patient's home. A concern of choosing peritoneal dialysis is the risk for infection at the catheter exit site. Answer: Peritoneal dialysis can be done in the patient’s home as opposed to going to a dialysis clinic multiple times per week. A major concern of the utilization of peritoneal dialysis is the risk for infection at the catheter site. Question 24 Not yet graded / 10 pts A patient presents to the emergency department with complaints of sharp pain that comes in waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been experiencing nausea and vomiting all day long. They have a past medical history of hyperparathyroidism. Urinalysis reveals calcium in their urine. A CT scan is ordered, and it reveals a stone 6 mm in diameter. What type of renal calculi do you suspect? What treatment is needed? Explain your reasoning for both answers. Your Answer: Calcium stones is suspected because of increased calcium levels in urine and history of hyperparathyroidism. Since the stone is 6mm, it may not pass on its own. Ureteroscopic removal may be required. This allows the ureter to be dilated, giving the physician ability to remove the stone. Answer: The patient has a calcium stone given their past medical history and the findings of calcium in their urine. The stone will be unable to pass on its own given the diameter greater than 5 mm. It can be removed through ureteroscopic removal or extracorporeal shockwave lithotripsy. The patient may also be put on medication for pain management. Question 25 Not yet graded / 10 pts A patient presents in the emergency department with severe dehydration secondary to vomiting. The following are the results of their blood work: pH = 8.2, PCO2 = 39 mm, and HCO3- = 33 mEq/L. Based upon these results, what type of acid-base disorder are they experiencing? Is compensation occurring? Describe a treatment intervention for this disorder. Normal values are as follows: pH = 7.35-7.45, PCO2 = 35-45 mm, HCO3- = 22-26 mEq/L. Your Answer: Metabolic alkalosis. Respiratory compensation is occuring. Treatment is fluid replacement with normal saline solution. Answer: The patient is in metabolic alkalosis. The respiratory system is not compensating as PCO2 compensation falls within normal limits. Fluids are replaced with normal saline solution. Question 26 Not yet graded / 10 pts A patient is in the ICU following open heart surgery. The patient was feeling well earlier in the day, but suddenly began to demonstrate signs of confusion and disorientation. Blood results reveal Na+ = 100 mEq/L. Based upon these symptoms and results of blood work, what electrolyte imbalance is this patient experiencing? What treatment is indicated for this imbalance? Your Answer: Patient is experiencing euvolemic hypotonic hyponatremia. Treatment is administering saline solution.Answer: This patient is experiencing euvolemic hypotonic hyponatremia. The administration of intravenous saline solution would be indicated to correct the sodium deficiency. MODULE 9 Question 1 0 / 5 pts Multiple Choice If a patient is taking exogenous forms of corticosteroid hormones, what would their labs show? You Answered High levels of ACTH Correct Answer Low levels of ACTH Hyperkalemia None of the above Question 2 5 / 5 pts Multiple Choice: The following are common signs and symptoms of Cushing syndrome EXCEPT: Correct! Hypoglycemia Mood changes Muscle weakness Amenorrhea Question 3 5 / 5 pts Multiple Choice: Primary adrenocortical deficiency (Addison’s disease) is most frequently caused by: Correct! Autoimmune mechanisms InfectionMetastatic tumor Trauma Question 4 0 / 5 pts Multiple Choice: Addison’s disease is due to which of the following: Correct Answer Adrenal gland dysfunction Decreased ACTH stimulation from the pituitary Decreased CRH from the hypothalamus You Answered All of the above None of the above Question 5 0 / 2.5 pts An autocrine action occurs when a hormone exerts an action on the cells that produced it. Correct Answer True You Answered False Question 6 2.5 / 2.5 pts A paracrine hormone is a hormone that produces a biologic action on the cell that released them. True Correct! False Question 7 2.5 / 2.5 pts Hormones work through receptors, and the speed of this action varies. Correct!True False Question 8 2.5 / 2.5 pts The production and release of hormones by the hypothalamus requires stimulation by the pituitary gland. True Correct! False Question 9 5 / 5 pts What hormone affects nutrient metabolism, regulates blood glucose levels, and has anti-inflammatory actions? Insulin Correct! Cortisol Glucagon T3, T4 Question 10 5 / 5 pts The anterior pituitary releases which of the following hormones? Select all that apply. Correct! TSH Calcitonin Correct! FSH Correct! LH Somatostatin Question 11 5 / 5 ptsType 1 diabetes mellitus is associated with each of the following characteristics EXCEPT: Markedly reduced beta cell mass Markedly reduced circulating insulin level Correct! Gradual, subtle onset Usually normal body weight Question 12 5 / 5 pts Each of the following are characteristics of diabetes mellitus EXCEPT: Delayed gastric emptying Bladder infections Correct! Myxedema Glaucoma Question 13 2 / 2 pts Of all the people with diabetes, approximately 70% have type 2 diabetes. True Correct! False False (90%) Question 14 2 / 2 pts Insulin promotes glycogenesis and glycolysis. Correct! True False Question 15 2 / 2 pts Most hormones are controlled through positive feedback.True Correct! False Question 16 2 / 2 pts Type 2 diabetics can improve hyperglycemia with weight loss. Correct! True False Question 17 2 / 2 pts Hemoglobin A1C measures glucose control over the previous 6 months. True Correct! False Question 18 Not yet graded / 5 pts A 45-year-old obese, sedentary male has recently been diagnosed with type 2 diabetes. What are 2 strategies to help him normalize his blood sugars? List 2 other macrovascular complications he is at risk for and how you would screen for them? Your Answer: Proper heart healthy diet and exercise, which can lead to weight loss can help blood sugars. Certain medications can help as well. 2 macrovascular complications are coronary artery disease and stroke. Risk factors for macrovascular disease is hyperglycemia and hyperlipidemia. A fasting glucose test and A1C test is used to measure blood glucose and glucose control respectivly. Answer: (1) Diet, exercise, and weight loss may be all that they need to control blood glucose levels. Even moderate weight loss of 5-10% of total body weight has been shown to improve glucose control. (2) Hypertension and hyperlipidemia – checking blood pressure and screening with a serum lipid panel. Question 19 Not yet graded / 5 pts Why are foot ulcers such a big problem with diabetics? Your Answer: Foot ulcers are common in those with neuropathy. Its a big problem because these infections cannot be undetected due to the loss of sensation and pain. Answer: Trauma or infection may be present, but undetected due to the loss of sensation and pain. It is worsened by vascular insufficiency and the decreased ability to heal.Question 20 5 / 5 pts Symptoms of diabetic ketoacidosis (DKA) include each of the following EXCEPT: Polydipsia Dehydration Fruity smell on the breath Correct! Bradycardia Question 21 5 / 5 pts A 40-year-old woman presents with amenorrhea and weight loss despite increased appetite. The history and physical exam show exophthalmos, tachycardia, and warm, moist skin. Each of the following lab abnormalities are expected EXCEPT: Increased T4 Increased T3 Correct! Increased TSH Increased radioactive iodine uptake Question 22 Not yet graded / 10 pts People with diabetes should be followed closely by their health care provider to monitor glycemic control and be screened regularly for complications. List 5 ways they should be screened: Your Answer: Check weight, blood pressure, fasting blood glucose and A1C, lipid profile, foot exam Answer: Checking weight, blood pressure, fasting blood glucose and hemoglobin A1C, lipid profile, serum creatinine, microalbumin, foot exam, dilated eye exams, and dental exam. Question 23 Not yet graded / 2.5 pts ______ is defined as a blood glucose of <60 mg/dL, with associated cognitive impairment. Your Answer: hypoglycemia Answer: Hypoglycemia Question 24 Not yet graded / 2.5 ptsA ______ test to assess sensation, vascular status, and skin integrity, should be administered annually on all diabetic patients. Your Answer: monofilament Answer: monofilament Question 25 Not yet graded / 2.5 pts ____ ____ ____ is diagnosed by hyperglycemia (blood glucose >500 mg/dL), hyperosmolarity, and dehydration, without ketoacidosis. Your Answer: hyperosmolar hyperglycemic state Answer: Hyperosmolar hyperglycemic state (HHS) Question 26 Not yet graded / 2.5 pts ____ is an oral antidiabetic drug that does not cause hypoglycemia and has a side effect of weight loss. Your Answer: metformin Answer: Biguanides or metformin MODULE 10 Question 1 2.5 / 2.5 pts Multiple Choice: Each of the following are true of gout except: Correct! Uric acid dissolves readily in synovial fluid Typically occurs at the first metatarsophalangeal joint Anyone can get gout Uric acid is a byproduct of purine metabolism Question 2 2.5 / 2.5 pts Multiple Choice: Which of the following would a patient likely report if you suspect they have OA? Stiffness in the morning that lasts longer than 30 minutes Pain that is alleviated with activity Correct!A “grinding feel” with movement Pain in their MCP joint Question 3 2.5 / 2.5 pts Which of the following are true regarding synovial joints? (mark all that apply) Ball and socket joints are characterized by limited range of motion Correct! Condyloid joints allow gliding of irregular joint surfaces Correct! They are freely moving The synovium lines articulating surfaces of the joint Correct! The synovium surrounds the joint margins Question 4 2.5 / 2.5 pts Multiple Choice: Cancellous bone receives its blood supply by what means? Arteries branching from the medullary cavity Arteries branching inward from the periosteal arteries Correct! Diffusion through the endosteal surface of the bone and the canaliculi Question 5 0 / 2.5 pts Multiple Choice: Which of the following drugs is most commonly prescribed to treat osteoporosis? Raloxifene Correct Answer Alendronate You AnsweredCalcitonin Question 6 2.5 / 2.5 pts Multiple Choice: Which of the following cells when stimulated by bone morphogenic proteins (BMPs) differentiate to contribute to normal bone growth? Osteocytes Osteoclasts Osteoblasts Correct! Osteoprogenitor cells Question 7 2.5 / 2.5 pts Multiple Choice: Which of the following are true of articular cartilage? Proteoglycans of the extracellular matrix resist compression forces Polypeptide chains give form and tensile strength Interstitial osmotic pressure and available fluid contribute to joint lubrication Correct! a. b. and c. are all true a. b. and c. are all false Question 8 2.5 / 2.5 pts Multiple Choice: A patient has low serum calcium levels. Which of the following is true given this scenario? The thyroid gland will secrete PTH to return serum calcium levels to normal The thyroid gland will secrete calcitonin to return serum calcium levels to normal Correct!PTH will increase renal reabsorption of calcium while simultaneously increasing renal excretion of phosphate PTH will increase blood phosphate levels Question 9 2.5 / 2.5 pts Which of the following medications is used to maintain normal levels of uric acid? (mark all that apply) Colchicine NSAIDS Correct! Allopurinol Question 10 0 / 2.5 pts Multiple Choice: Damage to the synovial membrane resulting in non-specific inflammation occurs in which stage of OA? Early stages You Answered Mid stages Correct Answer Late stages Question 11 2.5 / 2.5 pts Multiple Choice: Which of the following is false regarding the synovium? The inner membrane of the joint capsule is referred to as the synovium Correct! The synovium surrounds the margins of articulation and lines the articulating surfaces of the joint The synovium secretes fluid that facilitates movement between articulating surfaces Question 12 2.5 / 2.5 ptsSenile Osteoporosis is characterized by which of the following? (mark all that apply) Correct! Fractures of the hip joint Fractures of the distal radius Correct! A direct relationship between aging and rate of bone loss Question 13 Not yet graded / 2.5 pts T/F – If False, change the statement to make it True Osteoblast replication and activity are increased with age. Your Answer: False. osteoclast False, Osteoblast replication and activity are decreased with age. Question 14 Not yet graded / 2.5 pts T/F – if False, change the statement to make it True Haversian canals contain the nerve and blood supply for the osteon. Your Answer: True True Question 15 Not yet graded / 2.5 pts T/F – if False, change the statement to make it True Secondary gout is characterized by the overproduction or the underexcretion of uric acid. Your Answer: False. Primary gout False, Primary gout is characterized by the overproduction or the underexcretion of uric acid. Question 16 Not yet graded / 2.5 pts T/F – if False, change the statement to make it True Prolonged immobilization can lead to structural joint changes associated with OA. Your Answer: True True Question 17 Not yet graded / 5 ptsIf someone loses their balance when walking on uneven terrain, explain how tendons and ligaments work to protect the joint and structures within it. Your Answer: Tendons connects bones and muscles. Ligaments connect bone to bone. Tendons and ligaments are made up of collagen, a fibrous protein. Molecualr structure of collagen contributes to high tensile strenth. This allows for joint stability in the body. The tendons and ligaments of joints serve in proprioception (the awareness of ones’ position in space or movement of the body). When these structures undergo stretch or torsional strain, these proprioceptive nerve fibers will cause a reflexive response to adjust the tension on the muscles (to maintain balance and not fall over) that support the joint protecting the capsule and other joint structures. Question 18 Not yet graded / 5 pts A patient presents to the ER with severe pain in their right ankle. Blood tests reveal serum uric acid levels of 7.8 mg/dL. They are kept for observation and their 24-hr urine specimen reveals underexcretion of urate. Which phase of gout are they in? What is the goal of your treatment given the phase they are in? Your Answer: Patient is in phase 2, acute gout arthritis. Goal is to address the attack and reduce the inflammation. This can be done by using NSAIDs, such as colchicine, or corticosteriods. This patient is in phase 2 of gout or acute gout arthritis. The goal of treatment is to manage symptoms and terminate the acute attack primarily through NSAIDS. Question 19 Not yet graded / 5 pts Which of the following patients is at greater risk for developing osteoporosis and sustaining a fracture? Explain how you came to your conclusion. Patient A. is a 75-year-old white Caucasian male who has a history of a distal radius fractures at age 65. Patient B. is a 60- year-old African American female who is postmenopausal. She is active and does not have a history of fractures. Your Answer: Patient A. The patient is a white male over the age of 70. He has a previous history of bone fractures. Patient A is at higher risk. Even though he is a male, he is advanced in age, white Caucasian, and sustained a fracture after the age of 50. Patient B is a postmenopausal female; however, she is active and of African American decent which is associated with high BMD and low rates of fracture. Question 20 Not yet graded / 5 pts A 40-year-old patient sustains an incomplete spinal cord injury affecting their ability to walk. They primarily use a wheel chair to complete daily activities. Explain why this patient is at increased risk for developing OA in their lower extremities. Your Answer: Males have a higher risk of developening OA. Immobility is a risk factor for developing OA. It compromises the lubrication of the joint. This can lead to structural changes. Immobilization can compromise lubrication of the joint which comes with range of motion and weight bearing. The decreased nourishment of the articular cartilage will eventually lead to the structural joint changes associated with OA. Question 21Not yet graded / 5 pts Compare and contrast the blood supply of cortical bone and cancellous bone. Your Answer: Cortical bones receive blood supply from nutrient and perforating arteries. Blood is circulated via the central haversion and volkmann canals. Cancellous bones receives blood differently. Instead of receiving blood by vessels, it receives blood via diffusion. It begins at the endoseal surface of the tissue and extends outward through the cancaliculi. Cortical bone has a direct blood supply. Nutrient and Perforating arteries form an anastomosis (collateral circulation) that circulates through the bone through the Haversian and Volkmann canals. Cancellous bone does not have a direct blood supply. It receives its blood supply through diffusion from the endosteal bone surface extending outward through the canaliculi. Question 22 Not yet graded / 5 pts A 22-year-old competitive gymnast has experienced amenorrhea for the past 5 years. Her PCP is suspecting that she may have premature osteoporosis. Would you expect her RANKL levels to be high, normal, or low? Explain why her levels would be at this level. Your Answer: WIth 5 years of amenorrhea, this can result in a decline in overall estrogen levels. This will result in high RANKL levels. Estrogen increases the production of OPG, which lowers the rate of osteoclasts. Low levels of estrogen will result in low levels of OPG, which will lead to higher rates of osteoclast activity. Her RANKL levels would be higher than normal. Amenorrhea results in lower estrogen levels. Estrogen increases the production of OPG which inhibits RANKL. Lower estrogen levels would lead to lower OPG levels in turn increasing RANKL and osteoclast activity. Question 23 Not yet graded / 10 pts A 68-year-old, white Caucasian female has a DEXA scan at the recommendation of her PCP. Her scan yielded a T-score of -0.9. Interpret the results of her DEXA scan. Develop a treatment plan giving a pharmacologic recommendation if applicable (be specific with name of supplement and/or class of drug), and a non-pharmacologic recommendation. Your Answer: T-score of -1.0 and above are considerd normal bone density. This patient is borderline, so its important that the patient take regular and adequate calcium, as well as incorporate weight bearing excercises. Recommended for postmenapausal women is 1500mg of calcium. This can be consumed via diet or supplements. Vitamin D supplements, between 400 and 800IUs, should be consumed as well. Vitamin D increases calcium absroption. This T-score indicates normal bone density; however, because of this patient’s age, race, and gender, she should take a Calcium supplement as well as a Vitamin D supplement. She should also be participating in regular weight bearing activities such as walking or even resistance exercise. Question 24 Not yet graded / 10 pts A 72-year-old male is said to be in phase 3 of gout. He is obese and has a history of alcohol abuse. Develop a treatment plan including specific pharmacologic intervention and a non-pharmacologic recommendation to manage his disease. Your Answer: During this inter-critical phase, preventing future attacks is key. Its important to get the uric acid levels under control. Allopurinol or a uricosuric drug can be used to reduce the uric acid. Lifestyle changes, such as decreasing alcohol consumption, avoiding foods rich in purines (fish, shellfish, bacon), and maintaning a healthy weight, can help in preventing future attacks.Phase 3 of gout is called inter-critical gout. The patient is asymptomatic, and no joint abnormalities are present. The goal of treatment in this phase is to maintain normal uric acid levels and prevent progression of the disease. Allopurinol is a prescription drug that is used to reduce uric acid levels. This patient should be encouraged to lose weight and decrease his alcohol consumption. He should also avoid purine rich foods such as fish, bacon, and liver. (*Note – the student has to provide 1 pharmacologic intervention and 1 non-pharmacologic recommendation.) Question 25 Not yet graded / 10 pts A patient has a bilateral presentation of pain in the PIP joints of the hands. You believe this pain is due to arthritis but are unsure whether it is a result of RA or OA. What are 3 questions you could ask this patient to help you differentiate between RA and OA? Your Answer: 1) Is this more of an acute pain or has been going on for sometime? 2) Do you experience morning stiffness, which resolves in less than 30min or does the pain linger past 30min? 3) Do you feel more pain during activity or does the pain resolve during activity? 1. Do you experience stiffness in the morning? 2. If so, does it last less than or longer than 30 minutes? 3. Does prolonged movement aggravate or alleviate your symptoms? 4. Do you ever have periods of relief, or do you experience pain daily? 5. Did your pain start in both hands or did it start with one hand and develop in the other over time? 6. What is your profession? (occupations requiring repetitive movements often lead to OA) *Note – student only has to provide 3 questions.