Midterm exam

1. What is the initiating event that leads to the development of atherosclerosis? a. Release of the inflammatory cytokines b. Macrophages adhere to vessel walls. c. Injury to the endothelial cells that line the artery walls d. Release of the platelet-deprived growth factor 2. Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? a. Increased norepinephrine c. Angiotensin II b. Adducin d. Insulin resistance 3. What effect does atherosclerosis have on the development of an aneurysm? a. Atherosclerosis causes ischemia of the intima. b. It increases nitric oxide. c. Atherosclerosis erodes the vessel wall. d. It obstructs the vessel. 4. Which statement best describes Raynaud disease? a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands b. Neoplastic disorder of the lining of the arteries and veins of the upper extremities c. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes d. Autoimmune disorder of the large arteries and veins of the upper and lower extremities 5. The risk of developing coronary artery disease is increased up to threefold by which factor? a. Diabetes mellitus c. Obesity b. Hypertension d. High alcohol consumption 6. Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic lipoprotein? a. Diabetes mellitus c. Obesity b. Hypertension d. High alcohol consumption 7. Nicotine increases atherosclerosis by the release of which neurotransmitter? a. Histamine c. Angiotensin II b. Nitric oxide d. Epinephrine 8. Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary arteries? a. Unstable c. Silent b. Stable d. Prinzmetal 9. An individual who is demonstrating elevated levels of troponin, creatine kinase–isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators associated with which condition? a. Myocardial ischemia c. Myocardial infarction (MI) b. Hypertension d. Coronary artery disease (CAD) 10. What imbalance lessens the rate of secretion of parathyroid hormone (PTH)? a. Increased serum calcium levels b. Decreased serum magnesium levels c. Decreased levels of thyroid-stimulating hormone d. Increased levels of thyroid-stimulating hormone 11. Regulation of the release of catecholamines from the adrenal medulla is an example of which type of regulation? a. Negative feedback c. Neural b. Positive feedback d. Physiologic 12. How does a faulty negative-feedback mechanism result in a hormonal imbalance? a. Hormones are not synthesized in response to cellular and tissue activities. b. Decreased hormonal secretion is a response to rising hormone levels. c. Too little hormone production is initiated. d. Excessive hormone production results from a failure to turn off the system. 13. Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. This is an example of: a. Positive feedback c. Neural regulation b. Negative feedback d. Physiologic regulation 14. The control of calcium in cells is important because it: a. Is controlled by the calcium negative-feedback loop. b. Is continuously synthesized. c. Acts as a second messenger. d. Carries lipid-soluble hormones in the bloodstream. 15. The portion of the pituitary that secretes oxytocin is: a. Posterior c. Anterior b. Inferior d. Superior 16. What is the target tissue for prolactin-releasing factor? a. Hypothalamus c. Mammary glands b. Anterior pituitary d. Posterior pituitary 17. Where is antidiuretic hormone (ADH) synthesized, and where does it act? a. Hypothalamus; renal tubular cells c. Anterior pituitary; posterior pituitary b. Renal tubules; renal collecting ducts d. Posterior pituitary; loop of Henle 18 .Which mineral is needed for thyroid-stimulating hormone (TSH) to stimulate the secretion of thyroid hormone (TH)? a. Iron c. Iodide b. Zinc d. Copper 19. Insulin transports which electrolyte in the cell? a. Potassium c. Sodium b. Calcium d. Phosphorus ANS: A Insulin facilitates the intracellular transport of potassium, phosphate, and magnesium. Insulin does not facilitate the transport of the other electrolytes. PTS: 1 REF: Pages 705-706 20. A person who has experienced physiologic stresses will have increased levels of which hormone? a. Adrenocorticotropic hormone c. Somatostatin b. Thyroid hormone d. Alpha endorphin 21. What is the action of calcitonin? a. Increases metabolism. c. Increases serum calcium. b. Decreases metabolism. d. Decreases serum calcium. 22. The secretion of adrenocorticotropic-stimulating hormone (ACTH) will result in the increased level of which hormone? a. Thyroxine c. Cortisol. b. Insulin d. Antidiuretic hormone 23. Aldosterone directly increases the reabsorption of: a. Magnesium c. Sodium b. Calcium d. Water 24. Which is an expected hormonal change in an older patient? a. Thyroid-stimulating hormone secretion below normal b. Triiodothyronine level below normal c. Cortisol level below normal d. Adrenocorticotropic hormone level above normal 25. The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include solute: a. Retention and water retention c. Dilution and water retention b. Retention and water loss d. Dilution and water loss 26. Diabetes insipidus is a result of: a. Antidiuretic hormone hyposecretion c. Insulin hyposecretion b. Antidiuretic hormone hypersecretion d. Insulin hypersecretion 27. Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom? a. Polyuria c. Vomiting b. Edema d. Thirst 30. 28. Which condition may result from pressure exerted by a pituitary tumor? a. Hypothyroidism c. Diabetes insipidus b. Hypercortisolism d. Insulin hyposecretion 29. Which disorder is caused by hypersecretion of the growth hormone (GH) in adults? a. Cushing syndrome c. Giantism b. Acromegaly d. Myxedema 30. Graves disease develops from a(n): a. Viral infection of the thyroid gland that causes overproduction of thyroid hormone b. Autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones d. Ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter 31. The signs of thyrotoxic crisis include: a. Constipation with gastric distention c. Hyperthermia and tachycardia b. Bradycardia and bradypnea d. Constipation and lethargy 32. Pathologic changes associated with Graves disease include: a. High levels of circulating thyroid-stimulating immunoglobulins b. Diminished levels of thyrotropin-releasing hormone c. High levels of thyroid-stimulating hormone d. Diminished levels of thyroid-binding globulin 33. Palpation of the neck of a person diagnosed with Graves disease would detect a thyroid that is: a. Left of midline c. Normal in size b. Small with discrete nodules d. Diffusely enlarged 34. What are clinical manifestations of hypothyroidism? a. Intolerance to heat, tachycardia, and weight loss b. Oligomenorrhea, fatigue, and warm skin c. Restlessness, increased appetite, and metrorrhagia d. Constipation, decreased heat rate, and lethargy 35. Diagnosing a thyroid carcinoma is best performed with: a. Measurement of serum thyroid levels c. Ultrasonography b. Radioisotope scanning d. Fine-needle aspiration biopsy 36. Renal failure is the most common cause of which type of hyperparathyroidism? a. Primary c. Exogenous b. Secondary d. Inflammatory 37. A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; positive urine glucose and ketones; serum potassium (K+) 2 mEq/L; serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the “flu” for 1 week. What relationship do these values have to his insulin deficiency? a. Increased glucose use causes the shift of fluid from the intravascular to the intracellular space. b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. c. Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis. d. Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss. 38. Polyuria occurs with diabetes mellitus because of the: a. Formation of ketones c. Elevation in serum glucose b. Chronic insulin resistance d. Increase in antidiuretic hormone 39. Type 2 diabetes mellitus is best described as a(an): a. Resistance to insulin by insulin-sensitive tissues b. Need for lispro instead of regular insulin c. Increase of glucagon secretion from a cells of the pancreas d. Presence of insulin autoantibodies that destroy b cells in the pancreas 40. A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: a. Hyperglycemia caused by incorrect insulin administration b. Dawn phenomenon from eating a snack before bedtime c. Hypoglycemia caused by increased exercise d. Somogyi effect from insulin sensitivity 41. Hypoglycemia, followed by rebound hyperglycemia, is observed in those with: a. The Somogyi effect b. The dawn phenomenon c. Diabetic ketoacidosis d. Hyperosmolar hyperglycemic nonketotic syndrome 42. The first laboratory test that indicates type 1 diabetes is causing the development of diabetic nephropathy is: a. Dipstick test for urine ketones b. Increase in serum creatinine and blood urea nitrogen c. Protein on urinalysis d. Cloudy urine on the urinalysis 43. What causes the microvascular complications in patients with diabetes mellitus? a. The capillaries contain plaques of lipids that obstruct blood flow. b. Pressure in capillaries increase as a result of the elevated glucose attracting water. c. The capillary basement membranes thicken, and cell hyperplasia develops. d. Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries. 44 Retinopathy develops in patients with diabetes mellitus because: a. Plaques of lipids develop in the retinal vessels. b. Pressure in the retinal vessels increase as a result of increased osmotic pressure. c. Ketones cause microaneurysms in the retinal vessels. d. Retinal ischemia and red blood cell aggregation occur. 45. A person has acne, easy bruising, thin extremities, and truncal obesity. These clinical manifestations are indicative of which endocrine disorder? a. Hyperthyroidism c. Diabetes insipidus b. Hypoaldosteronism d. Cushing disease 46. How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)? a. By increasing the peripheral vasoconstriction b. By causing dysrhythmias as a result of hyperkalemia c. By reducing the contractility of the myocardium d. By stimulating the sympathetic nervous system 47. What is the most common cause of infective endocarditis? a. Virus c. Bacterium b. Fungus d. Rickettsiae 48. In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume? a. Increases preload and decreases afterload. b. Increases preload and increases afterload. c. Decreases preload and increases afterload. d. Decreases preload and decreases afterload. 49. Where can coarctation of the aorta (COA) be located? a. Exclusively on the aortic arch b. Proximal to the brachiocephalic artery c. Between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen d. Between the origin of the aortic arch and the origin of the first intercostal artery 50. What factors contribute to the development of orthostatic hypotension? (Select all that apply.) a. Altered body chemistry b. Drug action of certain antihypertensive agents c. Prolonged immobility d. Effects of aging on postural reflexes e. Any condition that produces volume overload 51. Which condition poses the highest risk for a cerebrovascular accident (CVA)? a. Insulin-resistant diabetes mellitus c. Polycythemia b. Hypertension d. Smoking 52. Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke? a. Hemorrhagic c. Embolic b. Thrombotic d. Lacunar 53. Microinfarcts resulting in pure motor or pure sensory deficits are the result of which type of stroke? a. Embolic c. Lacunar b. Hemorrhagic d. Thrombotic 54. What is the central component of the pathogenic model of multiple sclerosis? a. Myelination of nerve fibers in the peripheral nervous system (PNS) b. Demyelination of nerve fibers in the CNS c. Development of neurofibrillary tangles in the CNS d. Inherited autosomal dominant trait with high penetrance 55. It is true that Guillain-Barré syndrome (GBS): a. Is preceded by a viral illness. c. Results in asymmetric paralysis. b. Involves a deficit in acetylcholine. d. Is an outcome of HIV. 56. It is true that myasthenia gravis: a. Is an acute autoimmune disease. c. May result in adrenergic crisis. b. Affects the nerve roots. d. Causes muscle weakness. 57. In which disorder are acetylcholine receptor antibodies (IgG antibodies) produced against acetylcholine receptors? a. Guillain-Barré syndrome c. Myasthenia gravis b. Multiple sclerosis d. Parkinson disease 58. Antipsychotic drugs block which neurotransmitter receptor? a. Norepinephrine c. Serotonin b. Gamma-aminobutyric acid d. Dopamine 59. Which nutritional deficiency in a pregnant woman is associated with neural tube defect (NTD)? a. Iron c. Zinc b. Vitamin C d. Folate 60. Benign febrile seizures are characterized by: a. A temperature lower than 39° C b. Respiratory or ear infections c. Onset after the fifth year of life d. Episodes lasting 30 minutes or longer 61. The clinical manifestations of dyskinetic cerebral palsy include: a. Increased muscle tone and prolonged primitive reflexes b. Exaggerated deep tendon reflexes, clonus, and rigidity of extremities c. Scoliosis, contractures, and stiffness of trunk muscles d. Jerky uncontrolled and abrupt fine musculoskeletal movements 62. When diagnosed with hemolytic disease of the newborn (HDN), why does the newborn develop hyperbilirubinemia after birth but not in utero? a. Excretion of unconjugated bilirubin through the placenta into the mother’s circulation is no longer possible. b. Hemoglobin does not break down into bilirubin in the intrauterine environment. c. The liver of the fetus is too immature to conjugate bilirubin from a lipid-soluble to water-soluble form. d. The destruction of erythrocytes producing bilirubin is greater after birth. 63. Sickle cell disease is classified as a(an): a. Inherited X-linked recessive disorder b. Inherited autosomal recessive disorder c. Disorder initiated by hypoxemia and acidosis d. Disorder that is diagnosed equally in men and women 64. Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process? a. Deficiency in glucose 6-phosphate dehydrogenase (G6PD) that changes hemoglobin A (HbA) to HbS. b. Genetic mutation in which two amino acids (histidine and leucine) are missing. c. Genetic mutation in which one amino acid (valine) is replaced by another (glutamic acid). d. Autoimmune response in which one amino acid (proline) is detected as an antigen by abnormal immunoglobulin G (IgG). 65. Which type of anemia occurs as a result of thalassemia? a. Microcytic, hypochromic c. Macrocytic, hyperchromic b. Microcytic, normochromic d. Macrocytic, normochromic 66. What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias? a. Poikilocytosis c. Anisocytosis b. Isocytosis d. Microcytosis 67. What is the fundamental physiologic manifestation of anemia? a. Hypotension c. Hypoxia b. Hyperesthesia d. Ischemia 68. Which of the following describes how the body compensates for anemia? a. Increasing rate and depth of breathing b. Decreasing capillary vasoconstriction c. Hemoglobin holding more firmly onto oxygen d. Kidneys releasing more erythropoietin 69. Which of the following is classified as a megaloblastic anemia? a. Iron deficiency c. Sideroblastic b. Pernicious d. Hemolytic 70. After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result? a. Iron deficiency c. Folic acid b. Aplastic d. Pernicious 71. What causes the atrophy of gastric mucosal cells that result in pernicious anemia? a. Erythrocyte destruction c. Vitamin B12 malabsorption b. Folic acid malabsorption d. Poor nutritional intake 72. Which statement about folic acid is false? a. Folic acid absorption is dependent on the enzyme folacin. b. Folic acid is stored in the liver. c. Folic acid is essential for RNA and DNA synthesis within erythrocytes. d. Folic acid is absorbed in the upper small intestine. 73. Which anemia produces small, pale erythrocytes? a. Folic acid c. Iron deficiency b. Hemolytic d. Pernicious 74. Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails? a. Pernicious c. Aplastic b. Iron deficiency d. Hemolytic 75. In aplastic anemia (AA), pancytopenia develops as a result of which of the following? a. Suppression of erythropoietin to produce adequate amounts of erythrocytes b. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes c. Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes d. Lack of stem cells to form sufficient quantities of leukocytes Tamara Abull Perez Midterm Exam Advanced Pathophysiology Facilitator: Alberto Garcia