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What is a hereditary condition characterized by excessive accumulation of fat in the brain?

1) Wilson disease involves abnormal accumulation of copper in tissues leading to neurological and liver disease.

2) Hemochromatosis is the result of unchecked absorption and deposition of iron and body tissues.

3) Hepatosteatosis is abnormal retention of fat in the liver.

*4) Tay-Sachs involves abnormal accumulation of ganglioside lipids in the brain cells.

Which process is dependent on high levels of intracellular p53?

The protein, p53, arrests the growth of a cell with damaged DNA so the cell can repair itself. If the cell has elevated amounts of p53, the cell undergoes apoptosis (programmed cell death).

Which is an accurate statement about benign tumors?

*1) A benign tumor's resemblance to the tissue from which it grew is a predictor of its potential to be malignant.

2) Benign tumors are encapsulated and do not spread effects to other parts of the body.

3) Malignant tumors cause extensive cell damage.

4) Malignant tumors suppress genetic cell replication programming.

What is the best explanation of how free radicals cause cell damage?

react readily with key molecules in cell membranes and cause membrane damage.

What is characteristic of the tumor marker carcinoembryonic antigen (CEA)?

1) CEA is a tumor marker and tumor markers are not particularly specific for cancer because non-cancerous tumors also contain substances that identify tumor tissue of origin.

2) Angiogenesis is unrelated to tumor markers and may be initiated by production of angiogenic factors related to hypoxia.

*3) Because CEA is a tumor marker, it contains, by definition, some tissue of the involved organ that can be used to identify the origin of a tumor.

4) Although CEA is a tumor marker, it is α-fetoprotein that is associated with hepatic carcinoma and gonadal tumors.

Desquamation of the stratum corneum leads to which type of skin lesion?

1) A bulla is a fluid-filled palpable lesion that is larger than 5 mm.

2) An excoriation lesion is caused by rubbing or scratching, leading to loss of the outer skin layers.

*3) Scales are thin dry layers of the stratum corneum of varying size, consistency, and thickness.

4) Lichenification is hardening of the epidermis, usually through chronic irritation, creating a roughened appearance.

An individual who develops an acute severe reaction to a medication is experiencing which type of reaction?

*1) Anaphylaxis is a type I immediate hypersensitivity reaction to an allergen such as a medication.

2) A cytotoxic reaction is a type II hypersensitivity reaction that is tissue specific and results from antibody attack on cellular antigens.

3) Type IV hypersensitivity represents a delayed cellular hypersensitivity reaction not involving primary antibodies.

4) An immune complex (Arthus) reaction is a type III hypersensitivity reaction to deposition of antigen-antibody complexes in tissue.

What impairs normal wound healing?

*1) One of the side effects of corticosteroid therapy is the slowing of wound healing.

2) Fibroblasts are part of the wound infiltrate and participate in collagen stimulation for wound healing.

3) Leukocytosis occurs during inflammation when phagocytes enter the wound to cleanse it and aid healing.

4) Vasodilation results from mast cell histamine release leading to increased permeability so edematous fluid containing fibrinogen can contribute to staunching blood flow.

How is passive immunity to disease conferred?

introduction of preformed antibodies to confer immunity without B cell involvement

Which factor is responsible for slow surgical wound healing in a debilitated client?

1) Acellular scarring occurs in the final stages of wound healing.

*2) Because a debilitated patient is particularly sedentary, blood circulation is slow, and endogenous growth factors and other components of wound healing are slow to reach the wound site.

3) Reepithelialization aids wound healing by inhibiting entry of infectious agents into the wound.

4) Immunocompetence aids wound healing by initiating antibody production to protect against invasion of infectious agents.

Which degree of burn will show flat, dry skin blisters resembling tissue paper?

1) First-degree burns do not produce blisters.

2) Superficial partial-thickness (second-degree) burns produce fluid-filled blisters.

*3) Deep partial-thickness (second-degree) burns produce flat, dry blisters.

4) Third-degree burns produce blisters in the subcutaneous layer.

Why are granulocyte colony-stimulating factors administered to patients who are undergoing chemotherapy?

Granulocyte colony-stimulating factors

1) Granulocyte colony-stimulating factors are similar to natural growth factors but are not like stem cells.

2) Macrophages are agranulocytes and do not affect the number of T cells.

*3) Neutrophil production is increased by granulocyte colony-stimulating factor, which helps to protect the patient against infection during chemotherapy.

4) Granulocyte colony-stimulating factor increases production of immune cells, such as neutrophils, and does not suppress the immune system.

What is the origin of hemophilia A?

1) Hemophilia is not an autoimmune disease, but a genetic disease.

*2) Hemophilia A is the result of a deficiency of coagulation factor VIII.

3) Nutritional deficiencies can affect coagulation, but this is not hemophilia.

4) Hemophilia is unrelated to platelets.

The development of cold numb hands following exposure to stress or cold is characteristic of which disorder?

1) Buerger disease affects small and medium-sized arteries of the extremities, producing obstruction leading to pain during activity.

*2) Raynaud syndrome is an extreme vasoconstrictive response of the arteries in the hands and fingers, producing the characteristic signs of numb and cold hands after exposure to stress or cold temperatures. As the ischemia progresses, the hands become cyanotic and the pain diminishes. As the vasoconstriction diminishes and reactive hyperemia occurs, the subject complains of throbbing, burning pain, and the hands become erythematous.

3) Valvular incompetence is an alteration of venous flow.

4) The classic signs and symptoms of acute arterial occlusion include pallor, paresthesia, paralysis, pain, and pulselessness.

How does the ECG depict premature atrial complexes (PACs)?

1) PACs do not occur before a normal P wave.

*2) PACs generally occur after a normal P wave and before the QRS complex.

3) PACs do not occur after a normal QRS complex.

4) PACs are not atrial repolarizations.

What best characterizes an aortic dissection?

An aortic dissection is

a tear in the aortic wall that allows blood flow into the adjacent layers and separates the vessel walls.

Which condition is associated with the sensation of unrelenting indigestion, diaphoresis, and elevated serum troponins?

1) Atrophic gastritis is not associated with serum levels of the muscle proteins, troponins.

2) Esophageal reflux is not associated with serum levels of the muscle proteins, troponins.

*3) Troponins I and T are specific to heart muscle contraction and are released during a myocardial infarction.

4) Tricuspid regurgitation is not associated with serum levels of the muscle proteins, troponins.

What best describes the consequences of the accessory pathways in the cardiac conduction system associated with Wolff-Parkinson-White syndrome?

Accessory conducting tracts

link the atria and the ventricles, causing early ventricular depolarization, a pathway for re-entrant arrhythmias, and supraventricular tachycardia.
-----


*4) In Wolff-Parkinson-White Syndrome, the atria and ventricles are linked by accessory conducting tracts, which does cause early ventricular depolarization, re-entrant paths and a potential for supraventricular tachycardia.

Which information indicates a predisposition for an increased risk of developing coronary artery disease (CAD)?

1) Vegetarianism promotes healthy cardiac function.

2) Males and females have the same rate of developing CAD, although men usually develop it earlier because premenopausal women are protected by estrogen.

*3) Consistent hypertension leads to CAD.

4) A sedentary occupation balanced by exercise does not predispose an individual to CAD.

An individual with long standing hypertension is at risk for developing heart failure due to the effects of which condition?

*1) Long standing hypertension increases afterload, thus requiring increased work of the ventricle to eject blood into the aorta. This leads to left ventricular hypertrophy (LVH).

2) The renin - angiotensin - aldosterone system controls blood pressure.

3) Aortic distension decreases afterload, avoiding hypertension.

4) Mitral regurgitation decreases blood pressure by allowing blood into the atrium as well as the aorta.

Which condition is a consequence of hyperventilation?

hypocapnia
----------------------


1) Hypoxemia would result from hypoventilation.

*2) With increased oxygen received through hyperventilation, the amount of carbon dioxide decreases.

3) Because carbon dioxide is transported in the form of bicarbonate, both will decrease during hyperventilation.

If a person is immunosuppressed, which agent would be responsible for the development of Pneumocystis carinii pneumonia (PCP)?

*2) P. carinii, once believed to be a protozoan, is now considered the fungal agent responsible for the rapid development of PCP, the most common initial opportunistic infection occurring in an immunocompromised individual.

Which statement about tuberculosis is most accurate?

1) Because early symptoms of tuberculosis (TB) are nonspecific, early-stage diagnosis of TB is difficult.

*2) The Ghon (Ranke) complex is a pulmonary calcified lesion containing the Mycobacterium tuberculosis bacteria and is the hallmark for diagnosis of TB.

3) The usual therapy for TB is a 9 to 12-month regimen of the antibacterials isoniazid or rifampin.

4) Drug therapy for TB is begun when a person shows a positive skin test for TB.

Which term best describes an adult-onset hyperreactivity of the airways that leads to obstructive symptoms without an identifiable environmental allergen?

1) The most common causes of chronic bronchitis are smoking and swelling of respiratory mucosal leading to obstructive inflammation that is not limited to adult onset.

*2) Intrinsic asthma is due to respiratory infection, psychological stress, exercise, and pulmonary irritants. It is characterized as being of adult onset.

3) Atelectasis is the collapse lung or part of a lung that is unrelated to airway hyperactivity.

4) Pulmonary edema is caused by accumulation of fluid in the lungs and unrelated to airway hyperactivity.

Which arterial blood gas measurement indicates hypoxemia in a 30-year-old person?

1. pH 7.3, PaO2 80 mm Hg, PaCO2 50 mm Hg, HCO3- 24 mEq/L
2. pH 7.5, PaO2 85 mm Hg, PaCO2 30 mm Hg, HCO3- 25 mEq/L 0%
3. pH 7.4, PaO2 90 mm Hg, PaCO2 40 mm Hg, HCO3- 26 mEq/L
*4. pH 7.2, PaO2 70 mm Hg, PaCO2 45 mm Hg, HCO3- 22 mEq/L

Which set of clinical symptoms is most indicative of cystic fibrosis?

*2) Tenacious thick sputum is the hallmark of cystic fibrosis.

In hemodialysis, what is the fundamental principle responsible for fluid exchange?

1) Diffusion is responsible for the movement of electrolytes during peritoneal dialysis and hemodialysis.

2) Osmosis is responsible for the movement of fluids during peritoneal dialysis.

3) Peristalsis is a method of movement, not exchange.

*4) Ultrafiltration is through a semipermeable membrane which allows ions to pass but not larger components, such as proteins.

Which is considered a prerenal cause of acute renal failure?

1) Urethral obstruction would be classified as a postrenal cause of acute renal failure -- a cause that occurs at a point between the kidney and the exit.

2) Prostatic hypertrophy is a potential cause of obstruction, so it is postrenal.

3) Acute tubular necrosis would be classified as an intrarenal cause of acute renal failure -- a cause that occurs within the kidney itself.

*4) Prerenal causes of acute renal failure include hypovolemia (acute fluid volume depletion), decreased cardiac output, and septic shock -- causes that occur before fluid reaches the kidney.

Which statement best describes metabolic acidosis?

Metabolic acidosis

1) Metabolic acidosis can result from a prolonged bout of diarrhea. It is not associated with constipation.

2) An increase in bicarbonate occurs in metabolic alkalosis. Bicarbonate is a base.

*3) Central nervous system depression is a key clinical manifestation of metabolic acidosis.

4) Decreases in non-carbonic acids occur in metabolic alkalosis.

An individual with a history of chronic obstructive pulmonary disease (COPD) is breathing at a rate of 6 breaths per minute. Which acid-base imbalance is most likely to result from this condition?

1) Metabolic acidosis can be caused by fluid imbalances related to burns, severe infection, shock, or diarrhea.

2) Metabolic alkalosis can be caused by fluid loss related to overuse of antacids, emesis, or gastric suction.

*3) Respiratory acidosis can be caused by impaired gas exchange (a general problem for patients with COPD) or other reasons for decreased respirations such as chest injury or use of morphine.

4) Respiratory alkalosis is usually caused by hyperventilation.

Which urinary disorder is associated with frequency, suprapubic pain, and low back pain?

acute cystitis
------------------

*1) This bacterial infection of the bladder urothelium causes frequency, urgency, pain on urination, and flank and/or back pain, and is the most likely diagnosis.

2) Symptoms of a bladder tumor may be similar to those for cystitis, but a tumor is most likely to cause gross or intermittent, painless hematuria accompanying these symptoms.

3) Spastic bladder refers to a failure to store urine because of a reflex spasm and decrease in volume.

4) Vesicoureteral reflux results from incompetence of the valve between the ureter and the bladder. The condition does not cause the listed symptoms, but the reflux itself can predispose the patient to infections.

Which diagnostic study is most often used to detect renal tumors?

1) Urine specific gravity is included in standard urinalysis, and measures the amount of solids in the urine, or the urine concentration. It is not diagnostic for renal tumors.

*2) The intravenous pyelogram is the test of choice to diagnose a renal tumor. It is also used more generally to assess the condition of urinary tract structures or evaluate excretory function.

3) Serum blood urea nitrogen (BUN) and creatinine assays are used to assess renal function, but they do not differentiate. They show a renal malfunction.

4) Urine culture and sensitivity are used to detect the presence of infectious microorganisms. They are not diagnostic for renal tumors.

Which disorder is a chronic demyelinating disorder of the central nervous system (CNS)?

*1) Multiple sclerosis is a chronic demyelinating disease of the central nervous system.

2) Amyotrophic lateral sclerosis is a progressive, degenerative, muscle-wasting disease causing premature neuronal apoptosis.

3) Parkinson disease is a degenerative mobility disorder.

4) Cerebral palsy is a result of brain damage, not demyelination.

Which is a critical factor in the failure to cure brain abscesses?

1. lack of early diagnosis
*2. inadequate course of antibiotic therapy Student Response
3. failure of the patient to have follow-up evaluations
Student Response 4. inability to access the location for draining

The loss of bone density in individuals with osteoporosis is caused by the imbalance between which conditions?

1) This imbalance is not specific for osteoporosis, but could be a factor in a number of metabolic disorders.

2) Age and activity level are generally factors in injury and the development of osteoarthritis.

*3) In osteoporosis, the bone resorption rate is faster than the bone formation rate, resulting in decreased bone mass.

4) An imbalance between calcium intake and absorption into bone can lead to osteomalacia (inadequate mineralization of bone).

When is the oculocephalic response test contraindicated?

when ruling out spinal injury in an unconscious individual
---------------------------------------
1) Decorticate posturing is not a contraindication for testing whether the patient responds to movements of the head.

*2) The oculocephalic (doll's eyes) response test requires rotating the head while holding the patient's eyelids open. This motion is contraindicated until after spinal injury has been ruled out.

3) Absence of spontaneous eye opening in response to stimulus indicates a deterioration in alertness. The oculocephalic response test will still elicit response if the brainstem is intact.

4) A variety of eye reflex tests may be performed to detect the pattern of supratentorial herniation in an unconscious individual, as long as spinal injury has been ruled out.

Patients with major depression are considered to have insufficient levels of which substance?

1) Acetylcholinesterase is an enzyme that hydrolyzes acetylcholine. It is associated with Alzheimer's disease.

2) Dopamine is most associated with Parkinson's disease.

3) Galantamine is associated with Alzheimer's disease.

*4) Serotonin reduction via dysfunction of the hypothalamic-pituitary-adrenal axis is significantly linked to major depression.

What is a primary cause of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

1) Hyponatremia is a result, not a cause, of SIADH.

2) Dehydration is a result, not a cause, of SIADH.

*3) Primary lung malignancies are responsible for ectopic production of antidiuretic hormone (ADH) leading to SIADH. This production is most commonly seen in small cell (oat cell) carcinoma, a common type of lung malignancy.

4) Diabetes insipidus demonstrates deficient antidiuretic hormone (ADH) activity, not secretion.

Chronic strenuous coughing can lead to which disorder?

hiatal hernia
------------------------


*1) Chronic strenuous coughing can force part of the stomach through the diaphragm's esophageal hiatus.

2) Mallory-Weiss syndrome results from a tear of the cardia, leading to bleeding of the mucosa or submucosa.

3) Esophagitis is an inflammation of the esophagus from a variety of causes, but not from coughing.

4) GERD is a type of reflux esophagitis related to a dysfunctional lower esophageal sphincter that allows acidic stomach contents to flow backward into the esophagus.

Which statement best characterizes infectious hepatitis?

1) Hepatitis C is transmitted primarily through blood or blood products. In the US this is associated with intravenous drug use and with a history of blood transfusions before 1990.

*2) Hepatitis A spreads mainly through the fecal-oral route, and is often associated with contaminated food.

3) There is no specific vaccine for hepatitis D, although susceptible persons should receive the hepatitis B vaccine.

4) Hepatitis B is transmitted through blood or blood products and through sexual contact. It can become chronic. It is usually a primary infection, but there is a risk of secondary hepatitis A infection in those wit fulminant hepatitis.

Which statement best characterizes dumping syndrome?

rapid emptying of hyperosmolar chyme into the small intestine
-------------------------------------------------------


1) It is hyperosmolar chyme that is emptied.

2) Dysfunctional intestinal mucosa is found in celiac disease (celiac sprue) and is unrelated to the rapidity of emptying the stomach.

3) Removal of portions of the intestine can lead to malabsorption of nutrients but does not affect gastric emptying.

*4) This is the description of dumping syndrome, which leads to influx of water and stimulation of bowel motility, producing diarrhea, pain, and rebound hypoglycemia.

Which type of cirrhosis exhibits steatosis?

1) Alcoholic hepatitis does not exhibit accumulation of fat in liver cells.

*2) Alcoholic fatty liver exhibits accumulation of fat in liver cells.

3) Acute bile duct obstruction is unrelated to fat deposition.

4) Chronic biliary obstruction is unrelated to fat deposition.

What is the hallmark of endometriosis?

*1) Endometrial implants, also known as endometriomas, are areas of endometrial tissue located outside the uterus.

2) Leiomyomas, also known as fibroids, are common benign growths within the uterus.

3) Bartholinitis is an inflammation of the Bartholin glands located on the wall of the lower vagina.

4) Inflammation is a local response to cell injury.

Hyperpigmentation, dehydration, and orthostatic hypotension are symptoms most often associated with which condition?

*1) Hyperpigmentation is the classic sign of Addison disease in patients with adrenocortical insufficiency. Dehydration and orthostatic hypotension develop as the insufficiency grows.

2) The signs of Cushing disease include truncal obesity, moon face, buffalo hump, and hirsutism, as well as hypertension.

3) The classic sign of Graves disease is protruding eyes (exophthalmia).

4) The classic sign of Hashimoto disease or autommune thyroiditis is enlarged thyroid.

Which condition contributes to the development of encephalopathy in liver disease?

increased plasma ammonium
------------------------------------------


1) Fluid overload is more likely, contributing to cerebral edema. The causes of hepatic encephalopathy are too complex to be attributed to a single fluid/electrolyte state.

2) Increased serum calcium is not a factor in the development of hepatic encephalopathy.

3) Excess (not deficient) bilirubin causes the jaundice seen in many patients with liver disease.

*4) Hepatic encephalopathy is most clearly linked to a high concentration of arterial amonnia, a neurotoxin.

Which medication manages heart failure by reducing afterload?

1) Angiotensin-converting enzyme inhibitors are neurohormonal modulators used to treat heart failure by reducing intravascular volume and preload.

2) B-type natriuretic peptide is a potent diuretic and antagonist of the renin-angiotensin-aldosterone system and is used to reduce intravascular volume and preload.

*3) Calcium channel-blocking drugs cause arteriolar dilation by inhibiting vasoconstrictive neurotransmitters and peptides, thus decreasing left ventricular afterload.

4) Phosphodiesterase inhibitors are positive inotropes that enhance heart muscle contractility by increasing the availability of intracellular calcium ions during systole.

What is the treatment of choice for Legionnaires' disease?

1) Amantadine is an antiviral agent that reduces the symptoms of viral pneumonia.

2) Aminoglycosides treat gram-negative bacterial pneumonia.

3) Amphotericin B is used to treat Aspergillus fungal pneumonia.

*4) Macrolide is the current treatment of choice for Legionella pneumonia.

Persistent low back pain that is worse during rest, poor balance, and a stiffening of the spine are symptoms associated with which disorder?

1) The symptoms of osteoporosis include muscle spasms in the back, difficulty bending over, a dowager's hump, and shortened stature.

2) The symptoms of rheumatoid arthritis include morning stiffness, swelling of joints, and, during acute flare-ups, malaise and fatigue.

3) The symptoms of psoriatic arthiritis include skin or nail changes along with inflammation of joints and surrounding soft tissue.

*4) The cited symptoms are typical for ankylosing spondylitis.

Which symptom is unrelated to autonomic dysreflexia (hyperreflexia)?

upper body flushing
---------------------------------


*1) Autonomic dysreflexia (hyperreflexia) is usually precipitated by a full (distended) bladder in a patient with a spinal injury. Other characteristics of the condition are high blood pressure, headache, slow heart rate, flushing of the upper body, constriction of veins in the lower body, goose bumps, and sweating.

When an individual undergoing a massive blood transfusion experiences severe citrate intoxication, the transfusion is stopped and which action is initiated?

administration of intravenous calcium
------------------------------------------------
1) Diuretics induce micturition during a hypervolemic transfusion reaction and do not affect citrate intoxication.

2) Antipyretics are administered to decrease fever and do not affect citrate intoxication.

*3) Blood drawn for transfusion is preserved and anticoagulated with sodium citrate. This chelates the calcium in the blood, preventing coagulation. When clients are transfused they receive this citrate. With multiple transfusions, the citrate also chelates the client's own calcium, leading to hypocalcemia.

4) Kayexalate (sodium polystyrene sulfonate) is used to remove excess blood potassium that can occur with electrolyte disturbances created by a blood transfusion.

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