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3rd exam

chap. 20,21,23,24
In some anemias, the erythrocytes are present in various sizes; this is referred to as:
A newborn is diagnosed with congenital intrinsic factor deficiency. From which of the following types of anemia does he suffer?
Pernicious anemia
Erythrocytes that are _____ contain an abnormally low concentration of hemoglobin.
A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias falls into this category?
Hemolytic anemia
What hemodynamic change occurs after initial compensation for a reduction in the number of circulating erythrocytes?
Hyperdynamic blood flow
A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations could be expected?
Blood vessel dilation
A 60-year-old female emphysema patient experiences a rapid and pounding heart, dizziness, and fatigue with exertion. How would the respiratory system compensate for the increased oxygen demand?
Increased rate and depth of breathing
A 2-year-old malnourished child has vitamin B12 and folate deficiencies. A blood smear would reveal _____ amounts of hemoglobin.
A 45-year-old male is diagnosed with pernicious anemia. The most likely cause of this condition is:
defective DNA synthesis
Which of the following statements explains why vitamin B12 and folate deficiencies cause anemia?
Red blood cells have a shorter life span.
A 20-year-old female undergoes lab testing for anemia. Results show high iron, bilirubin, and transferrin and low hemoglobin and hematocrit. Which of the following is the most likely diagnosis?
Sideroblastic anemia
A 35-year-old female is diagnosed with vitamin B12 deficiency anemia. A decrease in which of the following is the most likely cause?
Intrinsic Factor
Which of the following individuals is at highest risk for developing a vitamin B12 deficiency anemia?
47-year-old male who had a gastrectomy procedure (removal of the stomach)
A 50-year-old male experienced loss of appetite, weight loss, and beefy red tongue shortly before his death. Autopsy would most likely reveal:
A 40-year-old male vegetarian is diagnosed with folate deficiency anemia. He reports that he is an alcoholic. Which of the following factors put him at greatest risk for developing his disease?
Being alcoholic
The Schilling test for pernicious anemia involves:
the administration of radioactive cobalamin and the measurement of its excretion in the urine.
A 67-year-old female has chronic gastrointestinal bleeding. The primary cause of her anemia is:
iron deficiency.
A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These findings are consistent with which type of anemia?
Hemolytic anemia
A 58-year-old female presents in the clinic with complaints of fatigue, weight loss, and tingling in her fingers. Laboratory findings show a low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These findings are consistent with which type of anemia?
Pernicious Anemia
Which of the following tests directly measures iron stores?
Bone marrow bx
A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit?
Red, sore tongue
A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is 32%. Which of the following treatments would you expect to be prescribed for her?
Iron replacement and change of diet
A 45-year-old male is diagnosed with sideroblastic anemia. Which of the following is the most likely cause of this disease?
Ineffective iron uptake and hemoglobin production
A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following would most likely occur?
Pale skin
Aplastic anemia is caused by:
stem cell deficiency
All of the following pathogenic mechanisms cause anemia in chronic inflammation except:
increased basal metabolic rate
Posthemorrhagic anemia can result in death when blood loss is in excess of
40% to 50%
A 57-year-old male presents to his physician for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating:
polycythemia vera
A 67-year-old female is admitted to the emergency room with a diagnosis of polycythemia vera. She will most likely complain of:
chest pain
A 68-year-old female is admitted to the emergency room with a diagnosis of polycythemia vera. Her symptoms are mainly the result of:
increased blood viscosity
A 67-year-old female is admitted to the emergency room with a diagnosis of polycythemia vera. Treatment for her condition might involve:
therapeutic phlebotomy
A 70-year-old male is brought to the emergency room, where he dies shortly thereafter. Autopsy reveals polycythemia vera. His death was most likely the result of:
cerebral thrombosis
A 67-year-old male was diagnosed with polycythemia vera but refused treatment. His condition is at risk for converting to:
acute myeloid leukemia
Leukocytosis can be defined as:
A high leukocyte count
A 35-year-old male was diagnosed with hepatitis B. Further tests revealed neutropenia characterized by a neutrophil count less than _____ per milliliter.
A 20-year-old female has an increase in eosinophils. Which of the following is the most likely cause?
Parasitic invasion and allergic reactions
A 15-year-old female presents with splenomegaly, hepatomegaly, and lymph node enlargement. She is diagnosed with infectious mononucleosis. Further testing would indicate an acute infection of:
A 35-year-old male with hyperthyroidism begins treatment to decrease thyroid activity. Which of the following could result secondary to the treatment?
A 15-year-old male is diagnosed with infectious mononucleosis. The most likely cause is:
Epstein-Barr virus (EBV).
A 15-year-old male with infectious mononucleosis is being given instructions on how to prevent the spread of this infection to others. Which statement represents a correct instruction?
Do not share drinking glasses or eating utensils
A 15-year-old male is diagnosed with infectious mononucleosis. He most likely presented with the classic triad of symptoms: fever, sore throat, and:
lymph node enlargement
Known causes of acute leukemia include:
chemotherapy treatment for other cancers
A 10-year-old male is diagnosed with leukemia. Which of the following could be associated with his disease?
Down syndrome
A 5-year-old female is diagnosed with acute leukemia. She will most likely be treated with:
Multiple myeloma can be defined as a neoplasm of:
B cells
A 65-year-old male is diagnosed with multiple myeloma. He complains of severe pain. This pain can be attributed to:
destruction of bone tissue
A 35-year-old female is diagnosed with lymphadenopathy. The most likely finding leading to this diagnosis is:
enlarged lymph nodes
A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would be expected with this disease?
Reed-Sternberg cell
The country with the lowest rate of Hodgkin lymphoma is:
A 62-year-old female tells her health care provider she has been experiencing regular night sweats that cause her to wake up drenched. She also remarks that she has been unintentionally losing weight. Physical exam reveals enlarged lymph nodes on her neck that do not appear to be painful. She should be screened for which of the following cancers?
Hodgkin lymphoma
A 10-year-old male presents with abdominal swelling, night sweats, fever, and weight loss. He is diagnosed with Burkitt lymphoma. Which of the following is the most likely cause?
Epstein-Barr virus (EBV)
Under the conditions of hypersplenism, erythrocytes are:
Thrombocytopenia may be:
congenital or acquired
Thrombocytopenia is described as a platelet count below _____ platelets per cubic millimeter.
A 30-year-old female presents with hematuria, menorrhagia, and bleeding gums. She is diagnosed with immune thrombocytic purpura (ITP). The most likely cause is:
antibody destruction of platelets
A 50-year-old female is diagnosed with primary thrombocythemia. A blood smear reveals _____ platelets
A 52-year-old male IV drug user was diagnosed with hepatitis C 5 years ago. He is now experiencing impaired blood clotting. A decrease in which of the following could be the cause?
Individuals with liver disease often suffer from coagulation disorders because:
clotting factors are produced in the liver
A 40-year-old female develops disseminated intravascular coagulation (DIC). The most likely cause of this condition is:
The sequence of events in disseminated intravascular coagulation (DIC) is initiated by the release of:
tissue factor
In DIC, active bleeding occurs after intravascular clotting because:
clotting factors are depleted
A 22-year-old female just delivered a healthy baby girl. She suffered from eclampsia during her pregnancy, and on the second postpartum day she complained of bleeding gums and bruising on her arms and legs. Hematology lab tests indicate that she had DIC. Further testing revealed an increase in:
fibrin degradation products (FDPs).
A common, life-threatening complication of a thrombus in a deep vein is:
pulmonary embolus
A 1-year-old female is diagnosed with anemia secondary to insufficient erythropoiesis. The most likely cause is:
an iron deficiency
Iron deficiency anemia:
may be related to socioeconomic factors
A 12-month-old toddler weighing 18 pounds is brought to the clinic because of weakness, slow physical growth, and developmental delays. His mother reports that the only food he will consume is cow's milk. Considering this information, the nurse decides that the child probably has:
iron deficiency anemia
A 16-month-old female presents with tachycardia, pallor, anorexia, and systolic murmur. Hemoglobin determination indicates a content below _____ g/dl.
Maternal-fetal blood incompatibility may exist in which of the following conditions?
Mother is Rh-negative, and fetus is Rh-positive
A 22-year-old female gives birth at 20 weeks' gestation to a stillborn fetus. Physical exam reveals gross edema of the entire body and anemia. This condition is referred to as:
hydrops fetalis
Sickle cell disease is characterized by the presence of Hb S. Which of the following amino acids is present in Hb S and not present in normal Hb?
A 10-year-old male is diagnosed with sickle cell anemia. He most likely inherited it from:
Both his mother and father
In the United States, sickle cell disease most commonly occurs in:
African Americans
A 25-year-old female has a child that is diagnosed with sickle cell anemia. She does not have the disease. Which of the following characterizes the genetic makeup of the parents with regard to this trait?
HbS and HbA
The erythrocytes of a person with sickle cell anemia may become sickled if:
oxygen tension is low
A 12-year-old male is diagnosed with sickle cell anemia. A blood smear reveals severely sickled cells. The sickled cells will be removed from circulation mostly by the:
A major symptom of vaso-occlusive crisis in sickle cell anemia is:
peripheral edema
The type of sickle cell crisis seen only in young children is
A 6-year-old male presents with fatigue, jaundice, and irritability. A blood smear shows the presence of sickled cells. Erythropoiesis is compromised in this child, resulting in a(n):
aplastic crisis
A 5-year-old female dies from sickle cell disease. The most likely cause of death is:
The alpha and beta thalassemias are inherited in an _____ fashion.
autosomal recessive
A 2-year-old male presented with growth and maturation retardation and splenomegaly. He died shortly after arriving at the ER. Autopsy revealed thalassemia secondary to defective:
HgB synthesis
A 38-year-old female gives birth to a stillborn fetus. Autopsy reveals cardiomegaly, hepatomegaly, edema, and ascites. The most likely cause is:
alpha-thalassemia major.
Hydrops fetalis may result from which type of thalassemia?
Alpha Major
The mother of a 3-year-old child speaks to the pediatrician because the child took several hours to stop bleeding following a minor scrape. Testing reveals that the child has hemophilia A resulting from a deficiency in:
Factor VIII
Hemophilia B is also known as:
Christmas Dz
A 3-year-old child presents with bruising on the legs and trunk and a petechial rash. The mother also reports frequent nosebleeds. Lab tests reveal a decreased platelet count. The most likely diagnosis is:
idiopathic thrombocytopenic purpura
A 5-year-old male is diagnosed with idiopathic thrombocytic purpura (ITP). This condition is caused by:
virally induced antibody destruction of platelets.
Which of the following clusters of symptoms would lead you to suspect a child has idiopathic thrombocytopenic purpura (ITP)?
Spontaneous nosebleeds; bruising; petechiae
A 1-year-old is diagnosed with idiopathic thrombocytopenic purpura (ITP). The most serious concern is development of:
intracranial bleeding
The most common childhood cancer is:
acute lymphoblastic leukemia
A 5-year-old male is diagnosed with leukemia. Which of the following symptoms would be expected?
A 10-year-old male with Down syndrome undergoes chemotherapy for cancer. Following treatment, he is most susceptible to:
acute myelogenous leukemia
A 10-year-old female is diagnosed with a malignancy in the brain and lung. DNA analysis reveals translocation at chromosome 7 and 14. The most likely diagnosis is:
lymphoblastic non-Hodgkin lymphoma
Which condition increases the risk of developing malignant lymphoma?
A 60 year old male presents to his physician complaining of chest pain. He is dx with atherosclerosis. The dz is cx by?
abnormal thickening and hardening of vessel walls
In general, atherosclerosis is cxed by?
endothelial injury and inflammation
Foam cells in a fatty steak are?
macrophages that engulf LDL
Normal blood pressure of adults age 18 or older is:
systolic pressure less than 120mm Hg and diastolic pressure less than 80 mm Hg
Most cases of combined systolic and diastolic HTN have no known cx and are dx as ____________HTN
A 30 year old Caucasian female was recently dx with primary HTN. She reports that she eats fairly well, usually having red meats and potatoes daily. She also reports that her father has HTN as well. Which of the following risk factors is most likely associated with this dx?
A 65 year old male presents for a routine checkup. A BP check reveals a systolic pressure of 160mm Hg and a diastolic pressure of 70 mm Hg. Which of the following is the most likely cx of this type of pressure elevation?
Rigidity of the aorta
A 55 year old has undiagnosed HTN. She presents to her physician complaining of impaired vision and chronic edema. Lab tests reveal that she also has renal insufficiency. The most likely cx for these findings?
end organ damage
The rapid onset of malignant HTN resullts in:
Orthostatic hypotension refers to a drop in BP when with:
Standing up
A 50 year old male is dx with orthostatic hypotension. Which of the following would he most likely experience?
Syncope and fainting
A 65 y/o female presents to ther ER c/o difficulty swallowing and SOB. A CT scan would most likely show an aneurysm in the:
A 60 y/o male is dx with cerebral aneurysm. The most likely area for it to occur is the:
circle of willis
A detached blood clot is called a:
A 32 y/o female presents with lower leg pain and redness. An ultrasound reveals venous thrombus. Which of the following could have cx her condition?
Vascular injury and inflammation
A 28 y/o female presents with severe chest pain and SOB. She is dx with a PE, which most likely originated from the:
deep veins of the legs
Individuals with Raynauds dz have severe sx under which of the following conditions?
Cold exposure
A 75 y/o obese female presents to her physician c/o edema in the lower extremities Physical exam reveals that she has varicose veins. Which of the following is a possible cx?
Long periods of standing
A 52 y/o males presents with pooling of blood in the veins of the lower extremities and edema. The most likely manifestation of this disorder is?
skin depigmentation
Superior vena cava syndrome is a progressive ______ of the superior vena cava that leads
to venous distention of the upper extremities and head.
A 50 y/o male with a 30 yr hx of smoking was dx with bronchogenic ca. He developed edema and venous distension in the upper extremities and face. Which of the following is the most likely dx?
Superior vena cava syndrome
A 52 y/o female is dx with coronary artery dz. She would be expected suffer from myocardial:
A 50 y/o obese male with HTN and CAD visits a nutrionalist for food conseling. He is told that ___ fats raise LDL and lower HDL levels and should be avoided.
The most common cx of myocardial ischemia?
A 53 y/o male presents with recurrent chest pain on exertion. He is dx with angina pectoris. The pain he experiences occurs when:
the myocardial oxygen supply has fallen below demand
A 51 y/o male is at his health clinic for an annual physical exam. After walking from the car to the clinic, he developed a substernal pain. He also reported discomfort in his left shoulder and jaw, lasting 2 to 3 mins and then subsiding with rest. He indicates that this has occurred frequently over the past few months with similar exertion. He is most likely experiencing:
stable angina
A 49 y/o male presents to his physician c/o chest pain. EKG reveals ST elevation. He is dx with myocardial ischemia. Which of the following interventions would be most beneficial?
Increase myocardial oxygen supply
A 68 y/o male presents to the ER c/o chest pain. He has a hx of stable angina that now appears to be unstable. He most likely has:
impending myocardial infarction
A 55 y/o male died of myocardial infarction. Autopsy would most likely reveal:
platelet aggregation within the atherosclerotic coronary artery
Cardiac cells can withstand ischemic conditions for ____before irreversible cell injury occurs
20 mins
A 60 y/o female had a myocardial infarction. She was brought to the hospital 30 mins later. She survived but now has impaied ventricular function because:
the resulting ischemia leads to hypoxic injury and myocardial cell death
A 75 y/o male has severe chest pain and dials 911. Lab tests at the hospital reveal elevated levels of creatinine phosphate and lactic dehydrogenase. These elevated levels indicate :
A 28 y/o female presents to the ER complaining of severe chest pain that worsens with
respiration or lying down. She has a fever, tachycardia, and a friction rub. The most likely cx of these sx is:
acute pericarditis
A 56 y/o male presents to his physician for a checkup. Physical exam reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is a concern?
A 42 y/o female is dx with constrictive pericarditis. She would also have a decreased cardiac output because of:
fibrosis and calcification of the pericardial layers
Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following can result in both types of what valvular dz?
Rheumatic fever or heart dz.
In valvular _____, the valve opening is constricted and narrow because the valve leaflets, or cusps, fail to open completely.
A 67 y/o female was previously dx with rheumatic heart dz. Tests reveal lipoprotein deposition with chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which of the following is the most likely dx?
Aortic stenosis
A 60 y/o female was dx with mitral stenosis. As a result, she has incomplete emptying of the:
left atrium
A 72 y/o female has a hx of HTN and atherosclerosis. An echo reveals backflow of blood into the left ventricle. Which of the following is most likely the dx?
Aortic regurgitation
A 35 y/o male presents with pulmonary HTN. Testing reveals he is in heart failure. Which of the following is the most likely dx?
Tricuspid regurgitation
The most common cardiac valve dz in the united states, which tends to be the most prevalent in young women is:
Mitral valve prolapse
A 10 y/o male presents with fever, lymphadenopathy, arthalgia, and nose bleeds. He is dx rheumatic heart dz. The most likely cx of this dz is:
Group B-hemolytic streptococcus infections
A 10 y/o male presents with fever, lymphadenopathy, arthalgia, and nose bleeds. He is dx with rheumatic heart dz. This dz is usually characterized by:
antigens that bind to the valvular lining, triggering an autoimmune response.
A 30 y/o female presents to her physician with fever, cardiac murmur, and petechial skin lesions. She is dx with infective endocarditis. The most likely cx of her dz is:
Inflammatory cells have difficultly limiting the colonization of microorganisms in infective endocarditis because:
the microorganisms are sequestered in a fibrin clot
A 50 y/o male visits the cardiologist for an EKG. Results indicate he has no PR interval and a variable rate QRS with rhythm irregularity. Which of the following is the most likely dx?
A fib
A 65 y/o male with a hx of untreated HTN is now experiencing left heart failure. The mist likely reason is:
Myocardial hypertrophy and ventricular remodeling
A 59 y/o female is dx with left ventricular failure. The decrease in kidney perfusion would ultimately cx:
Increased systemic vascular resistance
A 68 y/o female is experiencing left heart failure. Physical exam reveals elevated blood pressure most likely cx by:
sympathetic nervous system compensated for decreased cardiac output
A 65 y/o male is dx with chronic pulmonary dz and elevated pumonary vascular resistance. Which of the following heart failures generally results from this condition?
A 72 y/o female has a hx of right HF cx by right ventricular myocardial infarction. Which of the following sx are specifically r/t her Right HF:
Significant edema to both lower legs and feet
High output failure occurs with:
When a person is in shock, impairment in cellular metabolism is cx by:
inadequate tissue perfusion
One consequence of switching from aerobic to anaerobic cellular metabolism during shock state is:
Decreased ATP production
During shock status, glucose uptake is usually:
A 50 y/o male was admitted to the intesnive care unit with a dx of acute myocardial infarction. He is being tx for shock. His cardiopulmonary sx include low BP, tachycardia and tachypnea. His skin is pale and cool. The primary cx of his shock is most likely:
decreased cardiac contractility
An 82 y/o female was admitted to the hospital with confusion and severe hypotension. Her body's compensatory mechanisms are increased heart rate, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment. What kind of shock do you suspect?
A 27 y/o male is admitted to a neurologic unit with a complete C-5 spinal cord transection. On inital assessment, he is bradycardic, hypotensive, and hyperventilating. He appears to be going into shock. The most likely mechanism of his shock is:
vasodilation cx by decrease in sympathetic stimulation
Neurogenic shock can be cx by any factor that inhibits the:
sympathetic nervous system
A 15 y/o male who is allergic to peanuts eats a peanut butter cup. He then goes into anaphylatic shock and develops:
bronchoconstriction, hives or edema, and hypotension
For an infection to progress to septic shock, which of the following must occur?
bacteria must enter the bloodstream
A 20 y/o female is being admitted to the hospital with fever and septic shock. Which set of clinical manifestations would you expect her to exhibit?
Low BP, Tachycardia, generalized edema
The hypotensive state seen in septic shock can cx:
gut lining disruption and the translocation of bacteria into the bloodstream
The most common cx of multiple organ dysfucntion syndrome (MODS) is:
septic shock
A 75 y/o female has been critically ill with MODS for longer than a week and has developed a severe oxygen supply and demand imbalance. The statement that best describes this imbalance is:
The reserve has been exhausted, and the amount of oxygen consumed depends on the amount the circulation is able to deliver
An 8-week old infant presents to his pediatrician for a well-baby check up. Physical exam reveals a murmur and an ECG confirms a ventricular septum defect. Which of the following genetic factors would most likely accompany this dx?
Down syndrome
A newborn child experiences hypoxia and cyanosis. The most likely dx is congenital heart defect cx a ____ stunt
A newborn is dx with pulmonary stenosis. Which of the following intrauterine factors could have
cx this defect?
A 40 y/o pregnant women is concerned about the health of her unborn child. She has phenylketonuria (PKU) and recently had a viral infection. The child is born with a congenital heart defect, which of the following is the most likely based on the mother's hx?
Patent ductus arteriosus
Coarctation of the aorta is the local narrowing of the aorta near the:
ductus arteriosus
A newborn is suspected of having coarctation of the aorta. Which of the following assessments would aid in dx?
weak or absent femerol pulses
A newborn child s dx with trisomy 18. Which og the following congenital heart defects will she most likely have?
Ventricular deptal defect
A 1-month old infant visits her physician for a well baby check. Physical exam reveals decreased cardiac output, hypotension, tachycardia, and loud murmur suggestive of aortic stenosis. Which of the following would be expected with this dx?
ventricular hypertrophy
A newborn develops a murmur and cyanosis shortly after birth. She is dx with pulmonary stenosis after an ECG revealed narrowing of the:
pulmonary valve orifice
The patent opening between the aorta and pulmonary artery in a fetus is called the:
ductus arteriosus
A 2 wk old infant presents with poor feeding, fatigue, dyspnea, and a murmur. She is dx with a patent ductus arteriosus. This condition results in a:
left to right shunt
An infant under goes an Echo for a suspected heart defect. Tests reveal an opening in the middle of the atrial septum. This defect is referred to as:
ostium secundum atrial septal defect
The most common type of congenital heart defect is:
ventricular septal defect
A newborn experiences frequent periods of cyanosis. An echo reveals that the tricuspid valve failed to develop and no blood flows between the right atrium and right ventricle. This condition is referred to as triscuspid:
Which of the following statements best describes total anomalous pulmonary venous connection?
Pulmonary venous return into the right atrium
A newborn baby is severely cyanotic. An echo reveals transportation of the great arteries. Which of the following occurs with this defect?
The aorta leaves the right ventricle
A 1 month old infant was dx with trucus arteriosus with a ventricular septal defect. Which of the following would also be expected?
Blood from both ventricles mixing in a common vessel
A 22 y/o pregnant female presents for a fetal echo. Tests reveal small left atrium and mitral valve and ab absent left ventricle and aortic valve. This defect is:
an indication for neonatal heart transplant
A 1 y/o female with a ventricular septal defect is experiencing CHF. Which of the following will most likely occur?
Failure to thrive and periorbital edema
A 3 y/o Japanese male is dx with Kawasaki dz. Which of the followig is most likely the cx:
Systemic vasculitis of unknown etiology
A 5 y/o female is found to have HTN during three seperate visits to her physician. Lab tests reveal
that the HTN is secondary to :
Renal dz