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Test Bank For Gould’s Pathophysiology For The Health Professions, 5e 5th Edition 01: Introduction to Pathophysiology Chapter 01: Introduction to Pathophysiology Test Bank MULTIPLE CHOICE 1. W... hich of the following would be the most likely cause of an iatrogenic disease? a. An inherited disorder b. A combination of specific etiological factors c. An unwanted effect of a prescribed drug d. Prolonged exposure to toxic chemicals in the environment 6 2. The manifestations of a disease are best defined as the: a. subjective feelings of discomfort during a chronic illness. b. signs and symptoms of a disease. c. factors that precipitate an acute episode of a chronic illness. d. early indicators of the prodromal stage of infection. 6 3. The best definition of the term prognosis is the: a. precipitating factors causing an acute episode. b. number of remissions to be expected during the course of a chronic illness. c. predicted outcome or likelihood of recovery from a specific disease. d. exacerbations occurring during chronic illness. 7 4. Which of the following is considered a systemic sign of disease? a. Swelling of the knee b. Fever c. Pain in the neck d. Red rash on the face 6 5. Etiology is defined as the study of the: a. causes of a disease. b. course of a disease. c. expected complications of a disease. d. manifestations of a disease. 5 6. A type of cellular adaptation in which there is a decrease in cell size is referred to as: a. hypertrophy. b. metaplasia. c. anaplasia. d. atrophy. 8 7. A change in a tissue marked by cells that vary in size and shape and show increased mitotic figures would be called: 8 8. A deficit of oxygen in the cells usually due to respiratory or circulatory problems is called: a. apoptosis. b. ischemia. c. hypertrophy. d. necrosis. 9 9. When a group of cells in the body dies, the change is called: a. ischemia. b. gangrene. a. metaplasia. b. atrophy. c. dysplasia. d. hypertrophy. c. hypoxia. d. necrosis. 10 10. Rigorous weight lifting/body building regimens may result in the skeletal muscle cells undergoing: 8 11. The term cancer refers to: a. dysplasia. b. hyperplasia. c. metaplasia. d. malignant neoplasm. 9 12. To which of the following does the term apoptosis refer? a. Increased rate of mitosis by certain cells b. Ischemic damage to cells a. hypertrophy. b. dysplasia. c. atrophy. d. regeneration. c. Liquefaction of necrotic tissue d. Preprogrammed cell self-destruction 9 13. Which of the following statements is TRUE? a. Alteration of DNA does not change cell function. b. Damaged cells may be able to repair themselves. c. All types of cells die at the same rate. d. Mild ischemia causes immediate cell death. 10 14. Caseation necrosis refers to an area where: a. cell proteins have been denatured. b. cell are liquefied by enzymes. c. dead cells form a thick cheesy substance. d. bacterial invasion has occurred. 10 15. Routine application of sun block to skin would be an example of: a. an iatrogenic cause of cancer. b. a preventive measure. c. a precipitating factor. d. a predisposing condition. 6 16. A circumstance that causes a sudden acute episode of a chronic disease to occur is termed: a. latent stage. b. predisposing factor. c. incidence. d. precipitating factor. 7 17. The term homeostasis refers to: a. the causative factors in a particular disease. b. maintenance of a stable internal environment. c. a condition that triggers an acute episode. d. a collection of signs and symptoms. 2 18. Which term is used to describe a new and secondary or additional problem that arises after the original disease has been established? a. Symptoms b. Occurrence c. Manifestations d. Complication 7 19. Pathophysiology involves the study of: a. the structure of the human body. b. the functions of various organs in the body. c. functional or structural changes resulting from disease processes. d. various cell structures and related functions. 2 20. Which of the following is the best definition of epidemiology? a. The science of tracking the occurrence and distribution of diseases b. The relative number of deaths resulting from a particular disease c. Identification of a specific disease through evaluation of signs and symptoms d. The global search for emerging diseases 7 21. Which of the following can cause cell injury or death? 1. Hypoxia 2. Exposure to excessive cold 3. Excessive pressure on a tissue 4. Chemical toxins a. 1, 2 b. 2, 4 c. 1, 3, 4 d. 1, 2, 3, 4 9 22. All of the following are part of the Seven Steps to Health EXCEPT: a. follow cancer screening guidelines. b. use sun block agents whenever exposed. c. participate in strenuous exercise on a regular daily basis. d. choose high fiber, lower fat foods. 2 23. The term disease refers to: a. the period of recovery and return to a normal healthy state. b. a deviation from the normal state of health and function. c. the treatment measures used to promote recovery. d. a basic collection of signs and symptoms. 2 24. A collection of signs and symptoms, often affecting more than one organ or system, that usually occur together in response to a certain condition is referred to as a (an): 7 25. All of the following statements are correct about cell damage EXCEPT: a. The initial stage of cell damage often causes an alteration in metabolic reactions. b. If the factor causing the damage is removed quickly, the cell may be able to recover and return to its nor c. If the noxious factor remains for an extended period of time, the damage becomes irreversible and the ce d. Initially, cell damage does not change cell metabolism, structure, or function. 9 26. Which of the following conditions distinguishes double blind studies used in health research? a. Neither the members of the control group or the experimental group nor the person administering the trea receiving the experimental therapy. b. Both groups of research subjects and the person administering the treatment know who is receiving the ex c. The research subjects do not know, but the person administering the treatment knows who is receiving pla therapy. d. Only members of the control group know they are receiving standard therapy. a. acute disease. b. multiorgan disorder. c. syndrome. d. manifestation. 3 | 4 27. If the data collected from the research process confirm that the new treatment has increased effectiveness and is safe, this is called: 4 28. A short-term illness that develops very quickly with perhaps a high fever or severe pain is called: a. acute. b. latent. c. chronic. d. manifestation. 6 29. The term prognosis refers to the: a. period of recovery and return to a normal state. b. expected outcome of the disease. c. mortality and morbidity rates for a given population. d. typical collection of signs and symptoms. a. the placebo effect. b. evidence-based research. c. blind research studies. d. approval for immediate distribution. 7 30. When prolonged ischemia occurs to an area of the heart, the resulting damage is referred to as: a. atrophy. b. liquefactive necrosis. c. apoptosis. d. infarction. 10 31. During the evaluation process for a new therapy’s effectiveness and safety, a double blind study may be conducted during: 3 32. Why are the predisposing factors for a specific disease important to health professionals? a. To predict the prognosis b. To determine treatments c. To develop preventive measures d. To develop morbidity statistics a. the first stage. b. the second stage. c. the third stage. d. any of these stages. 3 33. Cell damage may be caused by exogenous sources such as: a. abnormal metabolic processes. b. certain food additives. c. genetic defects. d. localized hypoxia. 9 | 10 34. Which of the following is usually included in a medical history? 1. Past illnesses or surgeries 2. Current illnesses, acute and chronic 3. Prescribed medication or other treatments 4. Nonprescription drugs and herbal remedies 5. Current allergies a. 1, 3 b. 2, 4, 5 c. 1, 3, 4 d. 1, 2, 3, 4, 5 4 | 5 35. A situation when there is a higher than expected number of cases of an infectious disease within a given area is called a/an: a. epidemic. b. exacerbation. c. morbidity. d. pandemic. 7 36. The term pathogenesis refers to: a. the development of a disease or sequence of events related to tissue changes involved in the disease proc b. the determination of the cause(s) involved in the development of a malignant neoplasm. c. the specific signs and symptoms involved in the change from an acute disease to a chronic disease. d. the changes in cells of affected tissue that result in necrosis. 6 02: Fluid, Electrolyte, and AcidBase Imbalances Chapter 02: Fluid, Electrolyte, and Acid-Base Imbalances Test Bank MULTIPLE CHOICE 1. Choose the correct proportion of water to body weight to be expected in a healthy male adult’s body: a. 30% b. 45% c. 60% d. 70% 15 2. Choose the correct proportion of blood (to body weight) in an adult male’s body: a. 30% b. 20% c. 10% d. 4% 15 3. Insensible fluid loss refers to water lost through: a. perspiration only. b. feces only. c. perspiration and expiration. d. urine and feces. 15 4. When the osmotic pressure of the blood is elevated above normal, water would shift from the: a. blood into the cells. b. interstitial compartment into the cells. c. interstitial compartment into the blood. d. cells into the interstitial compartment. 16 5. Which of the following would result from a deficit of plasma proteins? a. Increased osmotic pressure b. Decreased osmotic pressure c. Increased hydrostatic pressure d. Decreased hydrostatic pressure 16 6. Which of the following would cause edema? a. Decreased capillary hydrostatic pressure b. Increased capillary osmotic pressure c. Decreased capillary permeability d. Increased capillary permeability 16-19 7. Which of the following would likely be related to an elevated hematocrit reading? a. Fluid excess b. Fluid deficit c. Increased sodium level d. Decreased erythrocytes 23-24 8. Which of the following is a typical sign of dehydration? a. Rapid, strong pulse b. Low hematocrit c. Increased urine output d. Rough oral mucosa 21 9. Which of the following terms refers to a combination of decreased circulating blood volume combined with excess fluid in a body cavity? 21 10. Which of the following is the primary cation in the extracellular fluid? a. Sodium b. Potassium a. Dehydration b. Third-spacing c. Hypovolemia d. Water retention c. Calcium d. Iron 21 11. Which of the following is a common cause of hyponatremia? a. Loss of the thirst mechanism b. Excessive sweating c. Excessive aldosterone secretion d. Prolonged period of rapid, deep respirations 22-23 12. Which of the following is a common effect of both hypokalemia and hyperkalemia? a. Skeletal muscle twitch and cramps b. Oliguria c. Elevated serum pH d. Cardiac arrhythmias 26 13. Choose the correct effect of increased parathyroid hormone. a. Increased movement of calcium ions into the bones b. Increased activation of vitamin D c. Increased absorption of calcium from the digestive tract d. Decreased reabsorption of calcium in the kidneys 26 14. Which of the following results from hypocalcemia? 1. Low serum phosphate levels 2. Nausea and constipation 3. Skeletal muscle twitch and spasms 4. Weak cardiac contractions a. 1, 2 b. 1, 4 c. 2, 3 d. 3, 4 27 15. Which of the following causes tetany? a. Increased permeability of nerve membranes due to low serum calcium b. Excess calcium ions in skeletal muscle due to excess parathyroid hormone (PTH) c. Excess calcium ions inside somatic nerves as a result of neoplasms d. Increased stimulation of the nerves in the cerebral cortex 27 16. In which of the following processes is phosphate ion NOT a major component? a. Bone metabolism b. Metabolic processes involving adenosine triphosphate (ATP) c. Blood clotting d. Acid-base balance 28 17. Which of the following would be considered normal serum pH? a. 4.5-8 b. 7.0 c. 7.4 d. 8 28 18. When many excess hydrogen ions accumulate in the blood, what happens to serum pH? The pH: a. decreases. b. increases. c. remains constant. d. varies based on metabolism. 28 19. What is the slowest but most effective control for acid-base balance? a. Respiratory system b. Buffer systems in the blood c. Kidneys d. Brain 29 20. Which of the following is essential in order to maintain serum pH within normal range? a. Carbonic acid and bicarbonate ion must be present in equal quantities. b. All excess carbonic acid must be excreted by the kidneys. c. The concentration of bicarbonate ion must remain constant. d. The ratio of carbonic acid to bicarbonate ion must be 1:20. 30 21. Which is the correct effect on the body of abnormally slow respirations? a. Increased carbonic acid b. Decreased carbonic acid c. Increased bicarbonate ion d. Decreased bicarbonate ion 31 22. Which condition is likely to cause metabolic acidosis? a. Slow, shallow respirations b. Prolonged diarrhea c. Mild vomiting d. Excessive fluid in the body 32 23. What would a serum pH of 7.33 in a patient with kidney disease indicate? a. Metabolic alkalosis b. Metabolic acidosis c. Respiratory alkalosis d. Respiratory acidosis 32 24. Which serum value indicates decompensated metabolic acidosis? a. pH is below normal range b. pH is above normal range c. Bicarbonate level decreases d. Bicarbonate level increases 32 25. What is the effect on blood serum when excessive lactic acid accumulates in the body? a. Bicarbonate ion levels decrease b. Bicarbonate ion levels increase c. Carbonic acid levels increase d. pH increases 32 26. The direct effects of acidosis are manifested primarily in the functioning of the: a. Digestive system b. Urinary system c. Nervous system d. Respiratory system 32 27. Compensation mechanisms in the body for dehydration would include: a. increased antidiuretic hormone (ADH). b. decreased aldosterone. c. slow, strong heart contraction. d. peripheral vasodilation. 21 28. Which acid-base imbalance results from impaired expiration due to emphysema? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis 32 29. In patients with impaired expiration associated with emphysema, effective compensation for the acid-base imbalance would be: 32 30. An anxiety attack often causes hyperventilation leading to: a. increased PCO2. b. decreased PCO2. c. respiratory acidosis. d. metabolic acidosis. 32 31. One of the factors involved in the increased need for water in infants is: a. increased rate and depth of respiration. b. decreased rate and depth of respiration. c. increased urine pH and decreased serum bicarbonate. d. decreased urine pH and increased serum bicarbonate. a. proportionally smaller body surface area. b. higher metabolic rate. c. smaller respiratory capacity. d. greater surface area of exposed mucous membranes. 20 32. Compensation for respiratory system depression due to anesthesia and sedation would be: a. decreased reabsorption of bicarbonate ions in the kidneys. b. increased secretion of hydrogen ions into the filtrate. c. increased respiratory rate and depth. d. increased renin secretion. 32 33. A prolonged state of metabolic acidosis often leads to: a. hypokalemia. b. hyperkalemia. c. hyponatremia. d. hypercalcemia. 25 34. Strenuous physical exercise on a hot day is likely to result in: a. hypokalemia. b. hypernatremia. c. hyperchloremia. d. hypovolemia. 19 | 23 35. Place the following events in the correct sequence of events when ketoacids increase in the blood of a diabetic patient. Not all options are used in the answers. 1. Serum pH decreases 2. Serum bicarbonate decreases 3. PCO2 decreases 4. Respiration decreases 5. Respiration increases 6. Serum pH increases 7. Urine pH decreases a. 1, 3, 7, 4, 2, 6 b. 5, 2, 7, 3, 4, 1 c. 2, 1, 5, 3, 7, 6 d. 3, 1, 2, 5, 7, 6 34-37 36. Which of the following is a manifestation of respiratory alkalosis? a. Bradycardia and deep rapid breathing b. Drowsiness and general lethargy c. Increased nervous system irritability d. Decreased urine pH 33 37. Prolonged diarrhea results in: a. loss of fluid and bicarbonate ions, leading to metabolic acidosis. b. increased fluid and serum bicarbonate ions, leading to metabolic acidosis. c. loss of chloride ions only, leading to metabolic alkalosis. d. surplus bicarbonate ions, leading to respiratory alkalosis. 32 38. In the initial stage, vomiting results in: a. metabolic acidosis. b. metabolic alkalosis. c. respiratory alkalosis. d. None of the above 32 39. Which two ions are most important for acid-base balance in the body? a. K+, Na+ b. Cl– and HCO – 3 c. Ca++, Na+ d. Na+, Cl– 28 40. The bicarbonate-carbonic acid buffer system helps maintain serum pH. The balance of the carbonic acid and bicarbonate ion levels are controlled by the: 30 41. Alkalosis increases irritability and spontaneous stimulation of nerves by: a. blocking normal nerve conduction. b. increasing the permeability of nerve membranes. c. blocking movement of calcium ions. d. decreasing phosphate ion levels. 26 | 33 42. Hypocalcemia causes weak cardiac contractions because: a. liver and pancreas. b. lungs and kidneys. c. lungs and plasma proteins. d. kidneys and bone marrow. a. permeability of nerve membranes increases. b. insufficient calcium ions are available for muscle contraction. c. low phosphate ion levels prevent muscle contraction. d. excessive amounts of calcium are stored in cardiac muscle. 27 43. Serum potassium levels are affected by: 1. ADH. 2. aldosterone. 3. serum H+ levels. 4. insulin levels. a. 2 only b. 1, 2 c. 1, 3 d. 2, 3, 4 e. 1, 2, 3 24 | 25 44. Which of the following is the primary control of serum Na+ levels? a. ADH b. Aldosterone c. Serum H+ levels d. serum K+ levels 21 45. The control center for thirst is located in the: a. kidneys. b. thalamus. c. medulla. d. hypothalamus. 15 46. Which statements apply to atrial natriuretic peptide? 1. It is secreted by heart muscle cells. 2. It is a hormone secreted by the kidneys. 3. It helps to control water and sodium balance. 4. It is released in response to low blood pressure. a. 1, 3 b. 1, 4 c. 2, 3 d. 2, 4 15 47. What are the three mechanisms that control or compensate for serum pH? a. Hypothalamus, metabolic changes by digestive system, lymphatic system filtration b. Buffer pairs in blood, change in kidney excretion rate, change in respiration rate c. Neural feedback, increase in heart rate, decrease in calcium intake d. Modification of water intake, increased capillary permeability, decrease in blood volume 29-31 48. Hypokalemia refers to a condition in which the serum has a very low level of which ion? a. Sodium b. Phosphate c. Calcium d. Potassium 24 49. In the blood and extracellular fluids, hypernatremia refers to: a. a deficient sodium level. b. an excess phosphate level. c. an excess sodium level. d. an excessively low phosphate level. 23 50. Increased milk and/or antacid intake can contribute to development of “milk-alkali syndrome,” which can cause which of the following? 27 03: Introduction to Basic Pharmacology and Other Common Therapies Chapter 03: Introduction to Basic Pharmacology and Other Common Therapies Test Bank MULTIPLE CHOICE 1. Which of the following are considered to be the toxic effects of a drug? a. Additional, mild, unwanted effects b. Unusual, unexpected mild effects c. Serious, possibly life-threatening effects d. Reduction of the allergic response 41 2. What is the unique, simple, and official name assigned to a specific drug for worldwide use? a. Hyponatremia b. Hyperkalemia c. Hypercalcemia d. Hypovolemia a. Trade name b. Chemical name c. Proprietary name d. Generic name 46 3. Which is the route of administration by which the largest proportion of the drug dose is likely lost before reaching the site of action? 44 4. Ingesting a drug with a large meal may be likely to: a. immediately increase the blood level of the drug. b. prevent gastric irritation. c. ensure that the total dose is absorbed into the blood. d. cause more rapid excretion of the drug. 42 a. Oral b. Intramuscular c. Sublingual d. Intravenous 5. What is the reaction called when two drugs interact to produce a result much greater than the sum of individual effects? 42 6. At which site are most drugs metabolized and prepared for excretion? a. Liver b. Kidneys c. Circulating blood d. Lymphoid tissue 45 7. In traditional Asian medicine, acupoints are usually located: a. over pain or other sensory receptors. b. where blood vessels branch. c. over joints. d. on designated meridians. 49 a. Antagonism b. Beneficial c. Synergism d. Potentiation 8. Traditional drug or surgical therapy is incorporated with nontraditional methods by: a. chiropractors. b. naturopaths. c. homeopaths. d. osteopaths. 48 9. Contraindications printed on the label of a drug identify: a. those circumstances under which the drug should probably not be used. b. those typical side effects associated with this drug. c. the dosage limits associated with the use of the drug. d. the maximum shelf life of the medication. 41 10. After they are metabolized, most drugs are excreted through the: a. lungs. b. pancreas. c. kidneys. d. large intestine. 42 11. A drug that binds with selected specific cell receptors may: 1. stimulate activity in those cells. 2. inhibit activity in those cells. 3. change specificity and attach to other cells. 4. be disabled by macrophages. a. 1, 2 b. 2, 3 c. 3, 4 d. 1, 3, 4 45-46 12. A placebo may be described as a tablet or capsule: a. that does not contain an active drug. b. that contains a small amount of active drug for use in clinical trials. c. that contains a different drug to be used for its psychological effect. d. that contains high amounts of a drug to determine the maximum dose allowed. 47 13. The form of therapy that involves assessment of physical function and works to restore any problems and prevent any further dysfunction using methods such as appropriate exercises and ultrasound is referred to as: a. registered massage therapy. b. naturopathy. c. physiotherapy. d. reflexology. 47 14. A medical history should include all: 1. legally prescribed drugs. 2. vitamin or mineral supplements. 3. any medication not requiring a prescription (over-the-counter items). 4. herbal treatments. a. 1 only b. 1, 3 c. 1, 2, 4 d. 1, 2, 3, 4 47 15. Antagonistic drugs may be used to: a. increase the effectiveness of selected drugs. b. prolong the action of a drug. c. act as an antidote when necessary. d. speed up the excretion of a drug. 42 16. The full course of a prescribed antimicrobial drug should be completed so as to prevent: a. undesirable side effects. b. development of resistant microbes. c. an allergic response. d. proper metabolism and excretion of drug. 42 Chapter 04: Pain Chapter 04: Pain Test Bank MULTIPLE CHOICE 1. The impulses related to acute pain are usually transmitted by: a. nociceptors. b. myelinated A delta fibers. c. unmyelinated C fibers. d. any sensory fiber with a low pain threshold. 55 2. In which structure do pain impulses ascend the spinal cord? a. Reticular formation b. Corticospinal tract c. Spinothalamic tract d. Relevant dermatome 55 3. According to the gate-control theory, passage of pain impulses may be naturally blocked: a. at the synapse by entry of other sensory impulses. b. by the stress response. c. by administration of morphine directly into the spinal cord. d. by referring the pain to other parts of the body. 55 4. What is the term used to describe the degree of pain that is endured before an individual takes action? 55 5. What is the definition of endorphins? a. Neurotransmitters at the nociceptors b. Transmitters for sensory impulses c. Opiate-like blocking agents in the central nervous system a. Pain threshold b. Referred pain c. Phantom pain d. Pain tolerance d. Pain-causing chemical mediators 57 6. Pain perceived in the left arm during the course of a heart attack is an example of: a. referred pain. b. phantom pain. c. chronic pain. d. subjective pain response. 57 7. A headache that is related to changes in cerebral blood flow is classified as a/an headache. 60 8. What is a common analgesic administered to control a moderate level of pain? a. Meperidine b. Acetaminophen c. Codeine a. tension b. sinus c. migraine d. intracranial d. Ibuprofen 62 9. Which of the following applies to spinal anesthesia? a. It causes analgesia with loss of consciousness. b. The drug is injected into cerebrospinal fluid (CSF) or the epidural space of the spinal cord. c. The drug stimulates release of endorphins in the spinal cord. d. The transmission of pain impulses is blocked in a small area of the body. 62 10. Which of the following is a characteristic of acute pain but not of chronic pain? a. Depression and debilitation b. A perception of increased generalized pain and discomfort c. Fatigue and lower pain tolerance d. Severe but short term 55-57 11. What is the role of nociceptors? They are: a. pain receptors that are stimulated by thermal, chemical, or physical means. b. spinal nerves that conduct impulses from specific areas of the skin. c. responsible for the state of arousal with pain. d. useful in localizing pain to a specific area of the body. 54 12. Intractable pain is best defined as: a. pain that is perceived as occurring in an amputated limb. b. severe pain that cannot be controlled by medication. c. pain perceived as coming from a source other than the actual source. d. pain coming from a specific dermatome. 62 13. Which of the following statements is TRUE? a. The brain is more aware of pain impulses when the reticular activating system is depressed. b. Acute pain does not cause a reflex response at the spinal cord synapses. c. Young infants typically respond to pain with tachycardia and increased blood pressure. d. Chronic pain is easier to tolerate without negative effects. 57 14. Ibuprofen is classified as an NSAID and is particularly useful in treating: a. severe pain. b. pain caused by inflammation. c. intracranial pain. d. pain in young infants. 61 15. Which of the following analgesics acts to reduce pain at the peripheral site? a. Acetaminophen b. Morphine c. Codeine d. Intravenous general anesthesia 61 16. Cancer-related pain has been broken down into three basic categories: pain caused by the advance of the disease and resultant damage to the body, pain that is the result of a coexisting disease unrelated to the cancer, and: 61 17. Pain that is caused by trauma or disease involving the peripheral nerves is referred to as: a. neuropathic pain. b. central pain. a. phantom pain as a result of amputation. b. pain associated with the treatment of the disease. c. pain caused by emotional stress and metabolic changes. d. pain associated with damage to the peripheral nerves. c. neurogenic pain. d. referred pain. 61 18. Pain resulting from a profound, sudden loss of blood flow to an organ or tissues in a specific area of the body is referred to as: 61 19. Which of the following is a characteristic of chronic pain? a. It usually initiates a physiological stress response. b. It always involves a strong emotional response such as high anxiety. c. It is more difficult to diagnose and treat than is acute pain. d. It involves tissue damage to a specific organ. 59 | 60 20. A headache that results from pressure on the meninges surrounding the brain is referred to as a/an: a. chronic pain. b. central pain. c. cardiovascular pain. d. ischemic pain. a. intracranial headache. b. intrameningeal headache. c. migraine headache. d. cerebral headache. 60 Chapter 05: Inflammation and Healing Chapter 05: Inflammation and Healing Test Bank MULTIPLE CHOICE 1. Tears are considered to be part of the: 1. first line of defense. 2. second line of defense. 3. third line of defense. 4. specific defenses. 5. nonspecific defenses. a. 1, 4 b. 1, 5 c. 3, 4 d. 2, 5 66 2. A specific defense for the body is: a. phagocytosis. b. sensitized T lymphocytes. c. the inflammatory response. d. intact skin and mucous membranes. 66 3. The inflammatory response is a nonspecific response to: a. phagocytosis of foreign material. b. local vasodilation. c. any tissue injury. d. formation of purulent exudates. 66 4. Chemical mediators released during the inflammatory response include: a. albumin and fibrinogen. b. growth factors and cell enzymes. c. macrophages and neutrophils. d. histamine and prostaglandins. 69 5. Which of the following result directly from the release of chemical mediators following a moderate burn injury? 1. Pain 2. Local vasoconstriction 3. Increased capillary permeability 4. Pallor a. 1, 2 b. 1, 3 c. 2, 3 d. 2, 4 69 6. Granulation tissue is best described as: a. highly vascular, very fragile, and very susceptible to infection. b. an erosion through the wall of viscera, leading to complications. c. a type of adhesion with no vascularization. d. a form of stenosis, in a duct, that is extremely tough and resists attack by microbes. 76 7. Edema associated with inflammation results directly from: a. increased fluid and protein in the interstitial compartment. b. increased phagocytes in the affected area. c. decreased capillary permeability. d. general vasoconstriction. 70 8. The warmth and redness related to the inflammatory response results from: a. increased interstitial fluid. b. production of complement. c. a large number of white blood cells (WBCs) entering the area. d. increased blood flow into the area. 70 9. What is the correct order of the following events in the inflammatory response immediately after tissue injury? 1. Increased permeability of blood vessels 2. Dilation of blood vessels 3. Transient vasoconstriction 4. Migration of leukocytes to the area 5. Hyperemia a. 5, 3, 2, 1, 4 b. 1, 2, 4, 5, 3 c. 2, 3, 5, 4, 1 d. 3, 2, 5, 1, 4 69 10. The process of phagocytosis involves the: a. ingestion of foreign material and cell debris by leukocytes. b. shift of fluid and protein out of capillaries. c. formation of a fibrin mesh around the infected area. d. movement of erythrocytes through the capillary wall. 70 11. Systemic effects of severe inflammation include: a. erythema and warmth. b. loss of movement at the affected joint. c. fatigue, anorexia, and mild fever. d. abscess formation. 71 12. The term leukocytosis means: a. increased white blood cells (WBCs) in the blood. b. decreased WBCs in the blood. c. increased number of immature circulating leukocytes. d. significant change in the proportions of WBCs. 72 13. Which of the following statements applies to fever? a. Viral infection is usually present. b. Heat-loss mechanisms have been stimulated. c. It is caused by a signal to the thalamus. d. It results from release of pyrogens into the circulation. 71 14. Mechanisms to bring an elevated body temperature down to the normal level include: a. general cutaneous vasodilation. b. generalized shivering. c. increased heart rate. d. increased metabolic rate. 71 15. Replacement of damaged tissue by similar functional cells is termed: a. fibrosis. b. regeneration. c. resolution. d. repair by scar tissue. 73 16. Scar tissue consists primarily of: a. granulation tissue. b. epithelial cells. c. collagen fibers. d. new capillaries and smooth muscle fibers. 76 17. Which of the following promotes rapid healing? a. Closely approximated edges of a wound b. Presence of foreign material c. Exposure to radiation d. Vasoconstriction in the involved area 76 18. Glucocorticoids are used to treat inflammation because they directly: a. promote the release of prostaglandins at the site. b. decrease capillary permeability. c. mobilize lymphocytes and neutrophils. d. prevent infection. 74 19. Patients taking glucocorticoids for long periods of time are likely to develop all of the following EXCEPT: 75 20. Which of the following drugs relieves fever and some types of pain but is NOT an antiinflammatory agent? 74 21. A burn area in which the epidermis and part of the dermis is destroyed is classified as: a. full-thickness. b. deep partial-thickness. a. decreased bone density. b. wasting of skeletal muscle. c. opportunistic infections. d. increased leukocyte production. a. Acetaminophen b. Prednisone c. Aspirin d. Ibuprofen c. superficial partial-thickness. d. first-degree. 79 22. A woman has burns on the anterior surfaces of her right arm, chest, and right leg. The percentage of body surface area burned is approximately: 80 | 82 23. The characteristic appearance of a full-thickness burn is: a. painful with multiple blisters. b. heavy bleeding. c. red with some swelling. d. dry, firm, charred, or hard white surface. 79 24. A typical source of infection in burn areas is: a. the skin grafts. b. microbes surviving in the hair follicles in the burn area. a. 13.5%. b. 18%. c. 22.5%. d. 31.5%. c. circulating blood bringing microbes to the burn wound. d. opportunistic virus in digestive tract. 83 25. A large burn area predisposes to decreased blood pressure because: a. bleeding occurs under the burn surface. b. the heart is damaged by toxic materials from the burn. c. fluid and protein shift out of the blood. d. vasoconstriction occurs in the burn area. 82 26. During an inflammatory response, hyperemia is caused by: a. increased blood flow in the area. b. increased capillary permeability. c. irritation of sensory nerve endings by histamine. d. increased leukocytes in the area. 69 27. The advantages of applying a biosynthetic skin substitute to a large area of full-thickness burns include: 1. reduced risk of infection. 2. decreased loss of plasma protein and fluid. 3. developing stronger fibrous scar tissue. 4. more rapid healing. 5. regeneration of all glands, nerves, and hair follicles. a. 1, 3 b. 4, 5 c. 1, 2, 4 d. 2, 3, 5 84 28. Purulent exudates usually contain: a. small amounts of plasma protein & histamine in water. b. red blood cells & all types of white blood cells. c. numerous leukocytes, bacteria, and cell debris. d. large amounts of water containing a few cells. 71 29. Isoenzymes in the circulating blood: a. are a type of plasma protein normally present in the circulating blood. b. often indicate the precise location of an inflammatory response. c. are normally released from leukocytes during the inflammatory response. d. are pyrogens, causing low-grade fever. 72 30. A serous exudate is best described as a: a. thin, watery, colorless exudate. b. thick, sticky, cloudy secretion. c. thick, greenish material containing microbes. d. brownish, clotted material. 70 31. Systemic manifestations of an inflammatory response include: a. edema and erythema. b. area of necrosis and loss of function. c. pain and tenderness. d. fever and malaise. 71 32. Some local effects of a general inflammatory response would include: a. high, spiking fever and chills. b. redness, warmth, and swelling. c. leukopenia and reduced erythrocyte sedimentation rate (ESR). d. anorexia and headaches. 67 33. Prolonged administration of glucocorticoids such as prednisone may cause: 1. atrophy of lymphoid tissue. 2. increased resistance to infection. 3. thrombocytopenia. 4. decreased protein synthesis. a. 1, 2 b. 1, 3 c. 1, 4 d. 2, 4 75 34. Application of ice to an injured knee reduces edema by: a. promoting return of lymph fluid. b. causing local vasoconstriction. c. increasing the rate of tissue repair. d. causing systemic vasodilation. 75 35. Healing of large areas of skin loss (including dermis and epidermis) would be most successful through: a. rapid mitosis and regeneration of skin layers. b. resolution of damaged cells in the area. c. covering the area with biosynthetic skin substitute. d. graft of fibrous tissue to the area. 84 36. Prostaglandins are produced from and cause . a. activated plasma protein; increased capillary permeability b. mast cells; vasodilation and pain c. platelets; attraction of neutrophils, chemotaxis d. mast cell granules; activation of histamines and kinins 69 37. The number of neutrophils in the blood is increased significantly: a. during allergic reactions. b. during chronic inflammation. c. to produce antibodies. d. in order to promote phagocytosis. 69-70 38. An abscess contains: a. serous exudate. b. purulent exudate. c. fibrinous exudate. d. hemorrhagic exudate. 71 39. Nonspecific agents that protect uninfected cells against viruses are called: a. neutrophils. b. macrophages. c. interferons. d. pyrogens. 66 40. Causes of inflammation include: a. direct physical damage such as cuts and sprains. b. allergic reactions. c. infection. d. All the above 67 41. In normal capillary exchange, what is net hydrostatic pressure based on? a. The difference between the hydrostatic pressure within the capillary, as compared with the hydrostatic pre interstitial fluid b. The relative osmotic pressures in the blood and the interstitial fluid c. The difference between the hydrostatic pressure and osmotic pressure within the capillary d. The difference between the concentrations of blood cells, plasma proteins, and dissolved substances in th interstitial fluid 66 42. The cardinal signs of inflammation include all of the following EXCEPT: a. redness. b. loss of function. c. nausea. d. swelling. 67 43. Drugs that have anti-inflammatory, analgesic, and antipyretic activities include: 1. COX-2 inhibitors (NSAIDs). 2. glucocorticoids (e.g., prednisone). 3. ibuprofen (NSAID). 4. acetaminophen. 5. aspirin (ASA). a. 1, 2 b. 2, 4 c. 1, 3, 5 d. 1, 4, 5 74 44. Aspirin (ASA) is discouraged for treatment of viral infection in children because of: a. decreased bone growth after puberty. b. frequent production of blood clots. c. formation of a granuloma filled with virus. d. the risk of developing Reye’s syndrome. 74 45. Systemic manifestations of inflammation include all EXCEPT: a. pyrexia. b. malaise. c. local swelling. d. anorexia. 71 46. Which of the following cellular elements found in the inflammatory response are responsible for phagocytosis? a. Macrophages b. Basophils c. B lymphocytes d. T lymphocytes e. Eosinophils 66 47. Which chemical mediator is involved in prolonging the inflammatory response? a. Bradykinin b. Histamine c. Leukotrienes d. Chemotactic factors 69 48. Potential complications after healing by scar formation include all the following EXCEPT: a. lack of sensory function in the area. b. contractures and adhesions. c. increased hair growth. d. keloid formation. 77-78 49. All of the following are correct statements regarding wound healing EXCEPT: a. Resolution occurs where there is minimal tissue damage and the cells can recover. b. Granulation tissue forms a permanent replacement for damaged tissue. c. Regeneration occurs where the cells are capable of mitosis. d. Scar tissue forms where the surrounding cells are incapable of mitosis. 73 | 75-76 50. Which of the following statements regarding inflammation is incorrect? a. Inflammation caused by an allergen or a burn will typically produce a serous exudate. b. Infection is one cause of inflammation. c. Inflammation is the body’s nonspecific response to tissue injury. d. Disorders are named using the ending -sarcoma to indicate inflammation. 66 | 67 | 70 51. Which of the following helps to localize and “wall off” the foreign material during an inflammatory response? 69 52. Why is an application of cold recommended as part of the RICE first aid measures immediately following an inflammatory response due to injury? a. Lymphocytes b. Increased fluid c. Fibrinogen d. Antibodies a. It improves circulation in the area removing chemical mediators. b. It causes local vasoconstriction to reduce local edema. c. It draws more phagocytic cells to the area to remove debris. d. It promotes immediate healing. 75 53. One goal for current research in tissue engineering is to: a. create a functional replacement tissue when regeneration is not possible. b. adapt cells from the injured organ to produce replacement tissue. c. design a nonliving synthetic replacement tissue. d. use stem cells as a temporary covering for damaged tissue. 76 54. Identify the proper sequence in the healing process. a. A blood clot forms; granulation tissue grows into the gap; new blood vessels develop; phagocytosis of for cell debris occurs; and collagen fibers form a tight, strong scar. b. A blood clot forms; phagocytes remove foreign material and cell debris; granulation tissue grows into the vessels form; and collagen fibers promote formation of a tight, strong scar. c. Collagen fibers form in the damaged area; a blood clot forms; granulation tissue grows into the gap; angio and foreign material and cell debris are removed by phagocytes. d. Foreign material and cell debris are removed by phagocytes; a blood clot forms; granulation tissue grows blood vessels form; and collagen fibers grow and cross-link. 76 55. All of the following are factors that promote healing EXCEPT: a. good nutrition: protein, vitamins A and C. b. a clean, undisturbed wound. c. effective circulation. d. advanced age. 77 56. Identify the correct statement about burns: a. The severity of the burn depends on the temperature, duration, and extent of the burn. b. Young children are less likely to suffer severe burns from immersion in excessively hot water. c. Burns to the palms of the hands are more damaging than burns on the face. d. With a major burn, excessive bleeding usually causes shock. 78 57. Which statement applies to the recommended emergency care for burns? a. Drop and lie completely still on your back. b. Call a neighbor for help if the burn appears to be extensive. c. Apply lotion and cover burn tightly with a sheet or towel. d. Cover the burn area with clean, cool, or tepid water and remove nonsticking clothing. 82 58. Inhalation of carbon monoxide is a threat for many burn patients because this gas: a. causes swelling in the trachea. b. quickly reduces the available oxygen in the blood. c. prevents full expansion of the lungs. d. is toxic to the nervous system. 82 59. Hypermetabolism is common with major burns because of: a. increased heat loss from the burn wound. b. demand for tissue repair. c. recurrent stress response. d. All of the above 83 60. How does scar tissue usually cause obstructions to develop in tube-like structures? a. Scar tissue continues to grow and spread, causing a blockage. b. Scar tissue does not stretch, but rather shrinks in time, causing narrowing. c. Scar tissue twists and forms knots as it develops. d. Scar tissue attaches to nearby normal tissue, causing obstruction. 78 61. Which of the following is a serious potential complication found only with the anti-inflammatory COX-2 inhibitor drugs? a. Increased risk of infection at the site of inflammation b. Reye’s syndrome developing in children and young adults c. Increased incidence of heart attacks d. Greatly delayed blood clotting 74 Chapter 06: Infection Chapter 06: Infection Test Bank MULTIPLE CHOICE 1. Bacteria that form an irregular cluster of spheres are called: a. bacilli. b. diplococci. c. staphylococci. d. streptococci. 89 2. A strict anaerobe requires which specific environment? a. A dry environment b. An acidic medium c. Air at a temperature less than 61° F/16° C d. The absence of oxygen 89 3. The presence of the bacterial capsule: a. aids in the release of endotoxins. b. protects the microbe from phagocytosis. c. increases the release of toxins and enzymes. d. prevents replication of the bacterium. 90 4. Microbial mutation means that: a. genetic information has changed. b. pathogens become nonpathogens. c. the microbe survives adverse conditions but can no longer replicate. d. the immune response to that microbe is strengthened. 101 5. A bacterial endospore can: a. also be classified as an acid-fast bacterium. b. exist in latent form inside a host cell. c. reproduce very rapidly. d. survive high temperatures and a dry environment. 96 6. The structure of a virus includes: a. a cell wall and membrane. b. metabolic enzymes for replication. c. a protein coat and either DNA or RNA. d. a slime capsule and cilia. 92 7. What method do viruses use to replicate? a. Binary fission b. Budding of a daughter cell from the parent viral cell c. Producing reproductive spores d. Using a host cell to produce and assemble components 92 8. A retrovirus such as HIV contains: a. RNA and enzymes for its conversion. b. a double strand of DNA. c. many enzymes to limit budding of new virions. d. numerous mitochondria. 92 9. How do antiviral drugs act? a. They interfere with cell wall development. b. They decrease cell membrane permeability. c. They destroy new, immature viral particles. d. They reduce the rate of viral replication. 107 10. Which statement applies to yeasts? a. They are usually considered to be pathogenic. b. They seldom contain a distinct nucleus. c. They may cause opportunistic infection in the body. d. They are normally not found in large numbers in resident flora. 96 11. Fungi reproduce by: 1. budding. 2. extension of hyphae. 3. binary fission. 4. production of spores. a. 1, 2 b. 2, 4 c. 1, 2, 4 d. 2, 3, 4 96 12. Which of the following is NOT classified as a protozoan agent of disease? a. Plasmodium vivax b. Trichomonas vaginalis c. Tinea pedis d. Entamoeba histolytica 96-97 13. Which of the following is a characteristic of rickettsia? a. It is a very small gram-negative intracellular microbe. b. It exists in three forms. c. It causes sexually transmitted disease. d. It reproduces by budding. 93 14. Entamoeba histolytica is transmitted by which of the following? a. Mosquitoes (bites) b. Inhaling contaminated particles c. Sexual intercourse d. Cysts in feces 97 15. Which of the following is a characteristic of resident or normal flora (microflora)? a. It exists in all areas of the body. b. Different species inhabit various areas of the body. c. It is of no benefit to the human host. d. It consists only of bacteria. 98 16. Which of the following is normally considered sterile? a. Urine b. Pharynx c. Distal urethra d. Vagina 99 17. The term nosocomial infection means: a. transmission involves an insect or animal host. b. acquired in a hospital or medical facility. c. transmitted by a fomite. d. spread by direct contact with secretions from an open lesion. 99 18. Transmission of microbes by direct contact includes: a. touching a contaminated countertop. b. sexual intercourse. c. drinking contaminated water. d. inhaling dust-borne microbes. 99 19. What does the term carrier mean? a. A person with active infection who acts as a reservoir for microbes b. Animals, insects, objects, or surfaces contaminated by pathogens c. An individual who is contagious through infected secretions on the hands d. An asymptomatic person whose body harbors pathogens and can transmit them to others 99 20. Opportunistic infection may develop when: a. pathogens enter the body but cannot colonize the site of entry. b. an imbalance occurs in the normal resident flora. c. host resistance increases, and the balance of resident flora is restored. d. contaminated food or water is unknowingly ingested. 99 21. Host resistance is promoted by all of the following EXCEPT: a. prescribed immunizations. b. chronic respiratory disease. c. vitamin and mineral supplements. d. appropriate inflammatory or immune response. 100-101 22. Which of the following factors would NOT increase the virulence of a specific microbe? a. Secretion of endotoxin b. Presence of a bacterial capsule c. Production of interferons d. Secretion of invasive enzymes 101 23. That time in the course of an infection when the infected person may experience a headache or fatigue and senses he or she is “coming down with something” is referred to as which of the following? 104 24. The principle of Universal Precautions is based on: a. using disinfectants at all times to eliminate cross-infections. b. not touching any open or bleeding lesions. c. sterilizing all instruments and equipment after each use. d. assuming that all body fluids from all individuals are possible sources of infection. 102 25. The “incubation period” refers to the time period between: a. entry of the pathogen into the body and the first signs of infectious disease. b. the onset of the prodromal period and the peak of the acute infection. c. the onset of clinical signs and signs of recovery from infection. d. the acute period and establishment of chronic infection. 104 a. Subclinical period b. Eclipse period c. Prodromal period d. Presymptomatic period 26. What does “bacteremia” refer to? a. Numerous pathogens circulating and reproducing in the blood b. Uncontrolled sepsis throughout the body c. Multiple infections, primary and secondary, established in the body d. Microbes present in the blood 105 27. Which of the following is a local sign of infection? a. Fever and leukocytosis b. Headache and anorexia c. Pain, erythema, and swelling d. Nausea, weight loss, and fatigue 105 28. What are culture and sensitivity tests used for? a. To determine the type of microbe present in an exudate b. To provide a specific medium that supports maximum microbial growth c. To identify the causative microbe and the effective antimicrobial agent for it d. To provide living host cells for microbes requiring such for replication 106 29. A broad-spectrum bactericidal agent would be expected to: a. destroy many gram-positive and gram-negative bacteria. b. destroy all pathogenic microbes in contact with the agent. c. reduce the replication of many bacteria. d. inhibit the growth of most spores and acid-fast bacteria. 107 30. How does penicillin act as a bactericidal agent? a. It interferes with cell-wall synthesis. b. It blocks protein synthesis. c. It increases cell membrane permeability. d. It prevents DNA replication. 107 31. Secondary infection may occur with administration of antibacterial drugs because the: a. patient is allergic to the drug. b. balance of species in the resident flora is upset. c. mucosa of the stomach is irritated. d. infecting microbes spread to adjacent areas. 107-108 32. All of the following are mechanisms of antiviral drug action EXCEPT: a. interference with attachment to host cell. b. block assembly of viral particles. c. interference with mitosis. d. shedding of protein coat. 108 33. Secondary bacterial infections occur frequently during influenza epidemics primarily because: a. antiviral drugs lower host resistance. b. the virus causes extensive tissue inflammation and necrosis. c. respiratory droplets transmit infections. d. the viral infection is usually self-limiting. 110 34. The primary pathological effect of influenza virus is: a. destruction of the mucosa in the lower respiratory tract. b. replication of the virus in respiratory secretions. c. destruction of leukocytes and macrophages in the lungs. d. inflammation and necrosis of the upper respiratory epithelium. 110 35. What does leukocytosis frequently indicate? a. Immunosuppression b. Bone marrow damage c. Presence of bacterial infection d. An allergic or autoimmune reaction 105 36. When an infection or inflammation is suspected, what does leucopenia often indicate? a. Bacterial infection b. Viral infection c. Allergic reaction d. Septicemia 106 37. Which of the following statements applies to Chlamydia? a. The microbe exists as a chain of cells. b. It causes a common STD. c. It possesses many flagella. d. It is excreted in feces. 93 38. Which of the following microbes is classified as an obligate intracellular parasite? a. Fungus b. Bacterium c. Virus d. Protozoa 93 39. Which of the following are characteristics of influenza virus? 1. It is an obligate intracellular parasite. 2. It contains RNA. 3. It usually causes nausea and vomiting. 4. There are three subtypes: A, B, C. a. 1, 4 b. 1, 3 c. 2, 3, 4 d. 1, 2, 4 93 40. The widespread necrosis of respiratory mucosa caused by an influenza infection often gives rise to: a. severe anemia. b. secondary infections. c. asthma. d. emphysema. 110 41. Prions cannot be cultured in a PETRI plate of media because: a. they take so long to grow. b. they require extensive amounts of specialized nutrients. c. they are proteinaceous particles, not living organisms. d. they are viruses that don’t grow on conventional media. 98 42. Which of the following statements applies to Influenza A H1N1? a. It alters human chromosomes to cause manifestations. b. It usually causes severe respiratory distress and high fever. c. Infection is common in the elderly. d. It contains genetic material from avian, swine, and human viruses. 93 43. Which of the following does NOT directly determine the virulence of a microbe? a. Capacity for opportunism b. Production of toxins c. Ability to mutate d. Invasive qualities 101 44. Which of the following is a function of interferons? a. They block the invasion of pathogenic bacteria. b. They reduce the inflammatory response to local infection. c. They increase host cell resistance to viral invasion. d. They may facilitate the spread of some cancer cells. 100 45. Inflamed tissue is likely to become infected because: a. the immune system is not effective in inflamed tissue. b. the increased fluid and protein in the inflamed area supports microbial growth. c. phagocytes cannot penetrate the inflamed areas. d. capillaries are less permeable in the affected area. 105 46. When an infectious disease is occurring globally at a higher rate than usual, it may be designated as a/an: a. sporadic occurrence. b. epidemic. c. pandemic. d. emerging disease. 99 47. Which of the following is the primary difference between an antiseptic and a disinfectant? a. Antiseptic is used on living tissue, whereas disinfectant is designed for nonliving surfaces. b. Antiseptic is much stronger than the potency of a disinfectant. c. Antiseptic often causes allergic skin reactions, whereas disinfectant is always hypoallergenic. d. Antiseptic is effective against endospores; disinfectants are not effective against endospores. 103-104 48. Drugs that are designed to inhibit or slow down growth of microbes but not necessarily kill them are considered: 107 Chapter 07: Immunity Chapter 07: Immunity Test Bank MULTIPLE CHOICE a. ineffective. b. bacteriostatic. c. narrow-spectrum. d. bactericidal. 115 1. Neutrophils: a. are phagocytic cells. b. produce histamine. c. produce antibodies. d. are elevated during an allergic response. 115 2. Which cells are required to process and present antigens from foreign material as the initial step in the immune response? 115 3. Humoral immunity is mediated by: a. natural killer cells. b. T lymphocytes (T cells). c. B lymphocytes (B cells). d. neutrophils. a. T–helper cells b. Macrophages c. Eosinophils d. Monocytes 122 4. A secondary immune response differs from the primary immune response in that: a. it is more rapid than the primary response and results in higher antibody levels. b. it is slower than the primary response and doesn’t change the antibody levels. c. it occurs at the same time as the primary response but results in a decrease in antibodies. d. it only occurs in hyperallergic reactions and results in a decrease of antibodies. 118 5. Which type of immunity is provided by a vaccination? a. Active natural b. Active artificial c. Passive natural d. Passive artificial 119 6. When an allergen binds with IgE antibodies on mast cells, resulting in release of chemical mediators, this reaction is called: a. cytotoxic hypersensitivity. b. immune complex hypersensitivity. c. type I hypersensitivity. d. type IV hypersensitivity. 124 7. The role of memory cells is to: a. change into an antibody-secreting cell following activation. b. immediately secrete antibodies following the first exposure to antigen. c. recognize the antigen and stimulate the immune response. d. bind complement to the antibody. 115 8. Which statement applies to contact dermatitis? a. It occurs when IgE antibodies on the skin react with the causative substance. b. It may result from ingested foods. c. Urticaria (hives) gradually spread over the body. d. A type IV reaction occurs in affected areas. 126 9. Which of the following causes anaphylaxis? a. A severe, systemic allergic reaction b. Type III hypersensitivity c. Cell-mediated hypersensitivity d. Immune complex deposits in many tissues 127 10. Following a positive HIV antibodies blood test and ELISA test, what is the test commonly used for confirmation? 135 11. Incompatible blood transfusions result in: a. hemolysis of erythrocytes. b. a type I immune response. c. deposits in multiple organs. d. immune deficiency. 124 12. An autoimmune disease is: a. excessive formation of antibodies following exposure to foreign material. b. an extreme response to normally harmless material in the environment. c. an abnormal response to ingested food and drugs. d. failure of the immune system to distinguish self from nonself. a. Agglutination b. Double immunodiffusion test c. Western blot test d. Sedimentation rate test 13. Systemic lupus erythematosus is caused by: a. a chronic allergic condition. b. development of an immune-deficient state. c. a deficiency of T lymphocytes. d. immune complex deposits of antinuclear antibodies. 127-128 14. Distinguishing clinical features of systemic lupus erythematosus include: a. inflammation in multiple organs. b. lack of a specific diagnostic blood test. c. acute onset and nonprogressive course. d. typical skin rash on the chest and back. 128 15. Which of the following are the target cells for HIV? a. Helper T lymphocytes (CD4 lymphocytes) b. B lymphocytes c. Natural killer cells d. Macrophages 130 | 131 16. A diagnosis of HIV positive means that: a. the number of T lymphocytes in the circulating blood is decreased. b. significant opportunistic infection is present in the body. c. the individual has AIDS. d. the virus and its antibodies are present in the blood. 131 17. HIV infection impairs: a. humoral immunity. b. cell-mediated immunity. c. both humoral and cell-mediated immunity. d. neither type of immunity. 133 18. Immunodeficiencies may result in an increased risk of infections by normally harmless microorganisms. These infections are referred to as: 134 19. Serious infections frequently occurring in patients with AIDS include: a. opportunistic. b. prophylactic. c. abnormal. d. transient. 1. tuberculosis. 2. Pneumocystis carinii pneumonia. 3. influenza. 4. tetanus. a. 1, 2 b. 1, 4 c. 2, 3 d. 3, 4 135 20. Which of the following statements does NOT apply to major histocompatibility complex (MHC) proteins or molecules? 114 21. CD4-positive helper T cells function by: a. direct cytotoxic action. b. facilitating all immune system activity. a. They are genes on chromosome 6. b. All members of a family have identical MHCs. c. They alert the immune system to virus-infected cells. d. A close match is essential for successful tissue transplants. c. producing immunoglobulins. d. inactivating allergens. 117 22. Host-versus-graft disease refers to: a. hyperacute rejection of tissue. b. T cells in grafted tissue attacking host cells. c. infection resulting from immunosuppression therapy. d. transplant rejection by the recipient’s immune system. 121 23. Which of the following complications does NOT occur frequently in AIDS patients? a. Kaposi’s sarcoma b. Wasting syndrome c. Lymphoma d. Polyarthritis 135-136 24. Which of the following characteristics apply to HIV? 1. It contains two strands of DNA. 2. It tends to mutate frequently to form new strains. 3. The incubation period is extremely short. 4. It is inactivated by heat and many disinfectants. a. 1, 2 b. 1, 3 c. 2, 4 d. 3, 4 135 | 137 25. In cases of HIV infection, the “window period” refers to the time between: a. entry of the virus into the blood and the initial manifestations. b. entry of the virus into the body and the appearance of antibodies in the blood. c. entry of the virus into the body and a significant drop in CD4 T-helper lymphocyte count. d. diagnosis of “HIV positive” and diagnosis of “AIDS.” 133 26. Which of the following is an effect of cytokines? They: a. activate and stimulate proliferation of B and T lymphocytes. b. destroy antigens quickly. c. increase the rate of mitosis in tumors. d. cause immediate pain. 115 27. What does seroconversion mean in relation to HIV and AIDS? a. The virus has been identified in the blood and body fluids. b. Antibodies for HIV have been identified in the blood. c. HIV was found in lymphocytes. d. Active infection has developed in the patient. 119 | 132 28. Which of the following statements is TRUE regarding a patient who is HIV positive? a. No medication is required until the CD4 cell count drops below normal range. b. Antibodies are present, destroying the virus and preventing transmission to others. c. Antibodies in the blood indicate presence of virus and possible transmission to others. d. Enzymes have not yet converted RNA to DNA for replication. 134 29. The term tolerance refers to: a. surveillance and destruction of new cancer cells by the immune system. b. the ability of the immune system to ignore “self” cells. c. the ability of T and B lymphocytes to work together. d. the role of lymphoid tissue in the body defenses. 118 30. Which of the following statements applies to the complement system? a. It is activated by IgE. b. It blocks the inflammatory response. c. It consists of proteins in the blood that must be activated. d. It may destroy antibodies in the circulation. 118 31. Which of the following statements regarding immunoglobulins is TRUE? a. They consist of a unique sequence of amino acids. b. They are produced in the red bone marrow. c. They are attached to mucosal membranes at entry points into the body. d. IgA binds to allergens. 117 32. Which of the following is NOT a cause of immunodeficiency? a. Hypoplasia of the thymus b. Delayed hypersensitivity c. Immunosuppressive drugs d. Atrophy of the lymph nodes 130 33. Which statement is TRUE regarding infants born to HIV-infected mothers? a. Infants usually test negative for HIV after birth. b. There is little risk of infected mothers passing the virus to their infants during delivery. c. Breast milk does not contain HIV or antibodies. d. Infants test positive for HIV because of the presence of maternal antibodies. 134 34. The most common cause of death in patients who have AIDS is: a. HIV encephalopathy. b. tuberculosis. c. Pneumocystis carinii pneumonia. d. Candida infection. 135 35. Tissue transferred between two genetically identical twins is referred to as a/an: a. allograft. b. syngraft. c. isograft. d. autograft. 121 Chapter 08: Skin Disorders Chapter 08: Skin Disorders Test Bank MULTIPLE CHOICE 1. Which of the following areas lacks blood vessels and nerves? a. Epidermis b. Dermis c. Subcutaneous tissue d. Fatty tissue 142 2. What is a raised, thin-walled lesion containing clear fluid called? a. Papule b. Pustule c. Vesicle d. Macule 143 3. Which of the following is a common effect of a type I hypersensitivity response to ingested substances? a. Contact dermatitis b. Urticaria c. Discoid lupus erythematosus d. Psoriasis 145 4. What change occurs in the skin with psoriasis? a. Recurrent hypersensitivity reactions b. Autoimmune response c. Increased mitosis and shedding of epithelium d. Basal cell degeneration 147 5. Which of the following best describes the typical lesion of psoriasis? a. Purplish papules that can erode and become open ulcers b. Firm, raised pruritic nodules that can become cancerous c. Moist, red vesicles, which develop into bleeding ulcers d. Begins as a red papule and develops into silvery plaques 147 6. Why do secondary infections frequently develop in pruritic lesions? a. Loss of protective sebum b. Entry of resident flora while scratching the lesion c. Blockage of sebaceous glands d. Increased sweat production 148 7. Which disease is considered an autoimmune disorder? a. Pemphigus b. Erysipelas c. Contact dermatitis d. Scleroderma 147 8. Which of the following skin lesions are usually caused by Staphylococcus aureus? a. Furuncles b. Verrucae c. Scabies d. Tinea 148 9. Which of the following statements applies to impetigo? a. Lesions usually appear on the hands and arms. b. The cause is usually a virus. c. The infection is highly contagious. d. Scar tissue is common following infection. 148 10. What is the common signal that a recurrence of herpes simplex infection is developing? a. Severe pain around the mouth b. Malaise and fatigue c. Fever and severe headaches d. Mild tingling along the nerve or on the lips 150 11. Herpes virus is usually spread by all of the following EXCEPT: a. saliva during an exacerbation and for a short time thereafter. b. contact with the fluid in the lesion. c. contaminated blood. d. autoinoculation by fingers. 150 12. How are antiviral drugs effective in treating a viral infection? a. They destroy the virus if administered for at least 2 weeks. b. They limit the acute stage and viral shedding. c. They prevent any systemic effects of viruses. d. They prevent any secondary bacterial infection. 150 13. Tinea capitis is an infection involving the: a. trunk. b. feet. c. scalp. d. nails. 150 14. Plantar warts are caused by: a. the fungus aspergillus. b. a parasitic arthropod. c. human papillomavirus. d. the bacterium Streptococcus pyogenes. 150 15. Which of the following statements regarding acute necrotizing fasciitis is TRUE? a. Infection is localized in a small area of the epidermis. b. It is usually caused by S. aureus. c. Spontaneous recovery usually occurs in 48 hours. d. Infection rapidly causes extensive tissue necrosis and toxic shock. 149 16. Which type of microbe causes Tinea infections? a. Fungus b. Virus c. Gram-negative bacterium d. Mite 150 17. What causes the pruritus associated with scabies? a. An allergic reaction to the causative microbe due to endotoxins b. Mites burrowing into the epidermis and reaction to their feces c. Bleeding and injected toxin from bites of the larvae d. Neurotoxins secreted by mites on the skin surface 152-153 18. How can pediculosis be diagnosed? a. Pruritus in hairy areas of the body b. Loss of blood due to lice bites c. Finding lice in clothing d. The presence of nits at the base of hair shafts 153 19. What is the major predisposing factor to squamous cell carcinoma? a. Viral infection b. Presence of nevi (moles) on the skin c. Exposure to ultraviolet light d. Frequent hypersensitivity reactions 154 20. All of the following statements apply to malignant melanoma EXCEPT: a. The malignant cell is a melanocyte. b. They present as non-pruritic purplish macules. c. The neoplasm grows rapidly and metastasizes early. d. The lesion is usually dark or multicolored with an irregular border. 155 21. Which of the following factors has contributed to the increased incidence of Kaposi’s sarcoma? a. Excessive sun exposure b. Increased number of nevi c. Increase in immunosuppressed individuals d. Presence of more seborrheic keratoses 155 22. Which of the following applies to actinic keratoses? a. They predispose to malignant melanoma. b. They arise on skin exposed to ultraviolet radiation. c. They occur primarily on dark-skinned persons. d. They are malignant and invasive. 154-155 23. Which lesion distinguishes Tinea corporis? a. Small, brown pruritic lines b. Painful and pruritic fissures c. Erythematous ring of vesicles with a clear center d. Firm, red, painful nodule or pustule 150 24. Systemic effects of acute necrotizing fasciitis include: a. low-grade fever and malaise. b. toxic shock and disorientation. c. mild nausea and vomiting. d. headache and difficulty breathing. 149 25. The cause of contact dermatitis can often be identified by: a. using a culture and sensitivity test on the exudate. b. checking the frequency of the exacerbations. c. noting the location and size of the lesion. d. the type of pain associated with the lesion. 145 26. The pathological change associated with scleroderma is: a. abnormal activation of T lymphocytes and an increase of cytokines. b. an autoimmune reaction damaging the epidermis. c. collagen deposits in the small blood vessels of the skin and sometimes the viscera. d. Type I hypersensitivity and increased serum IgE levels. 147 27. Choose the best description of the typical lesion of impetigo. a. Large, red, painful nodule filled with purulent exudates b. Small vesicles that rupture to produce a crusty brown pruritic mass c. Red, swollen, painful areas often with projecting red streaks d. Firm, raised papules that may have a rough surface and may be painful 149 28. Choose the correct match of the skin condition and its usual location. a. Scabies—fingers, wrists, waist b. Impetigo—legs, feet c. Pediculosis humanus corporis—scalp d. Seborrheic keratosis—feet, hands 153 29. Leprosy (Hansen’s disease) is caused by: a. a fungus. b. a bacterium. c. a virus. d. a helminth. 149 30. One factor that is responsible for increasing the mortality rate among patients suffering with necrotizing fasciitis is: a. a delay in initial diagnosis. b. lack of proper antibiotics. c. the appearance of additional opportunistic infections. d. secondary fungal infections. 149 Chapter 09: Musculoskeletal Disorders Chapter 09: Musculoskeletal Disorders Test Bank MULTIPLE CHOICE 1. Which of the following cells produce new bone? a. Osteocytes b. Osteoblasts c. Osteoclasts d. Stem cells from the bone marrow 159 2. What is the chemical transmitter released at the neuromuscular junction? a. Norepinephrine b. GABA c. Serotonin d. Acetylcholine 161 3. What are the two types of bone tissue? a. Vascular and nonvascular b. Spongy and calcified c. Compact and cancellous d. Dense and pliable 159 4. Which of the following would identify an open or compound fracture? a. The skin and soft tissue are exposed at the fracture site. b. A bone is crushed into many small pieces. c. The bone appears bent with a partial fracture line. d. One end of a bone is forced into an adjacent bone. 164 5. Which of the following describes a Colles’ fracture? a. The distal radius is broken. b. The distal fibula is broken. c. A vertebra appears crushed. d. A spontaneous fracture occurs in weakened bone. 165 6. During the fracture healing process, the hematoma: a. is broken down and absorbed immediately. b. provides the base for bone cells to produce new bone. c. is the structure into which granulation tissue grows. d. produces fibroblasts to lay down new cartilage. 166 7. When a fracture is healing, the procallus or fibrocartilaginous callus: a. can bear weight. b. serves as a splint across the fracture site. c. is the tissue that lays down new cartilage. d. is made up of new bone. 166 8. The inflammation surrounding a fracture site during the first few days may complicate healing by causing: 166-167 9. What is a sign of a dislocation? a. excessive bone movement. b. severe ischemia and tissue necrosis. c. malunion or nonunion. d. fat emboli to form. a. Crepitus b. Pain and tenderness c. Increased range of motion at a joint d. Deformity at a joint 168 10. All of the following predispose to osteoporosis EXCEPT: a. weight-bearing activity. b. a sedentary lifestyle. c. long-term intake of glucocorticoids. d. calcium deficit. 169 11. Which of the following statements does NOT apply to osteoporosis? a. Bone resorption is greater than bone formation. b. It causes compression fractures of the vertebrae. c. Osteoporosis is always a primary disorder. d. It often leads to kyphosis and loss of height. 169 12. Which of the following best describes the typical bone pain caused by osteogenic sarcoma? a. Intermittent, increasing with activity b. Sharp, increased with joint movement c. Mild, aching when weight-bearing d. Steady, severe, and persisting with rest 171 13. How is Duchenne’s muscular dystrophy inherited? a. Autosomal recessive gene b. X-linked recessive gene c. Autosomal dominant gene d. Codominant gene 172 14. Which of the following is true about Duchenne’s muscular dystrophy? a. There is difficulty climbing stairs or standing up at 2 to 3 years of age. b. It involves only the legs and pelvis. c. Skeletal muscle atrophy can be seen in the legs of a toddler. d. It cannot be detected in any carriers. 172 15. The most common type of joint, which are freely movable, are called: a. Synarthroses b. Amphiarthroses c. Anarthroses d. Diarthroses 163 16. Which of the following is characteristic of osteoarthritis? a. Inflammation and fibrosis develop at the joints. b. Degeneration of articulating cartilage occurs in the large joints. c. It progresses bilaterally through the small joints. d. There are no changes in the bone at the affected joints. 173-174 17. What is a typical characteristic of the pain caused by osteoarthritis? a. Decreases over time b. Quite severe in the early stages c. Aggravated by general muscle aching d. Increased with weight-bearing and activity 174 18. What limits joint movement in osteoarthritis? a. The osteophytes and irregular cartilage surface b. The wider joint space c. Decreased amount of synovial fluid in the cavity d. Fibrosis involving the joint capsule and ligaments 174 19. Joints affected by osteoarthritis can sometimes affect healthy joints by: a. causing enzymes to be released that travel to other joints. b. bacteria traveling from the affected join to a healthy one through the bloodstream. c. inflammation and edema affecting the entire limb. d. the affected individual’s exerting stress on the normal joint to protect the damaged one. 174 20. What is the typical joint involvement with rheumatoid arthritis? a. Random single joints, progressing to involve other joints b. Bilateral small joints, symmetrical progression to other joints c. Abused or damaged joints first, then joints damaged by compensatory movement d. Progressive degeneration in selected joints 177 21. What is the basic pathology of rheumatoid arthritis? a. Degenerative disorder involving the small joints b. Chronic inflammatory disorder affecting all joints c. Systemic inflammatory disorder due to an autoimmune reaction d. Inflammatory disorder causing damage to many organs 175-177 22. How is the articular cartilage damaged in rheumatoid arthritis? a. Enzymatic destruction by the pannus b. Inflamed synovial membrane covers the cartilage c. Fibrous tissue connects the ends of the bones d. Blood supply to the cartilage is lost 175 23. How does the joint appear during an exacerbation of rheumatoid arthritis? a. Relatively normal b. Enlarged, firm, crepitus with movement c. Deformed, pale, and nodular d. Red, warm, swollen, and tender to touch 177 24. Ankylosis and deformity develop in rheumatoid arthritis because: a. skeletal muscle hypertrophies. b. fibrosis occurs in the joint. c. replacement cartilage changes alignment. d. ligaments and tendons shorten. 176 25. Systemic effects of rheumatoid arthritis are manifested as: a. nodules in various tissues, severe fatigue, and anorexia. b. headache, leukopenia, and high fever. c. swelling and dysfunction in many organs. d. progressive damage to a joint. 176 26. What is a common effect of long-term use of glucocorticoids to treat rheumatoid arthritis? a. Leukocytosis b. Osteoporosis c. Severe anemia d. Orthostatic hypotension 177 27. Juvenile rheumatoid arthritis (JRA) differs from the adult form in that: a. only small joints are affected. b. rheumatoid factor is not present in JRA, but systemic effects are more severe. c. onset is more insidious in JRA. d. deformity and loss of function occur in most children with JRA. 177 28. Which of the following distinguishes septic arthritis? a. Multiple joints that are swollen, red, and painful at one time b. Presence of mild fever, fatigue, and leukocytosis c. Purulent synovial fluid present in a single, swollen joint d. Presence of many antibodies in the blood 178 29. Which of the following may precipitate an attack of gout? a. A sudden increase in serum uric acid levels b. Severe hypercalcemia c. Mild trauma to the toes d. Development of a tophus 178 30. Where does inflammation usually begin in an individual with ankylosing spondylitis? a. Costovertebral joints with progression down the spine b. Cervical and thoracic vertebrae, causing kyphosis c. Sacroiliac joints with progression up the spine d. Peripheral joints and then proceeds to the vertebrae 178 31. What is a common outcome of fibrosis, calcification, and fusion of the spine in ankylosing spondylitis? 178-179 32. Which statement applies to menisci? a. They are found in the hip joints. b. They are secretory membranes in joints. c. They prevent excessive movement of joints. d. They are found in the shoulder joint. 163 33. Which factors delay healing of bone fractures? a. Damage to the spinal nerves and loss of function b. Frequent fractures of long bones c. Impaired heart function d. Rigidity, postural changes, and osteoporosis 1. Lack of movement of the bone 2. Prolonged inflammation and ischemia 3. Presence of osteomyelitis 4. Close approximation of bone ends a. 1, 2 b. 1, 3 c. 2, 3 d. 3, 4 166-167 34. What is the likely immediate result of fat emboli from a broken femur? a. Additional ischemia in the broken bone b. Nonunion or malunion of the fracture c. Pulmonary inflammation and obstruction d. Abscess and infection at a distant site 167 35. A sprain is a tear in a: a. ligament. b. tendon. c. skeletal muscle. d. meniscus. 168 36. Therapeutic measures for osteoporosis include: a. non–weight-bearing exercises. b. dietary supplements of calcium and vitamin D. c. transplants of osteoblasts. d. avoidance of all hormones. 170 37. What is the distinguishing feature of primary fibromyalgia syndrome? a. Joint pain and stiffness throughout the body b. Degeneration and atrophy of skeletal muscles in back and lower limbs c. Localized areas of constant pain d. Specific trigger points for pain and tenderness 173 38. Ewing’s sarcoma metastasizes at an early stage to the: a. brain. b. liver. c. lungs. d. other bones. 171 39. Immovable joints are called: a. amphiarthroses. b. synarthroses. c. diarthroses. d. synovial joints. 163 40. Rickets results from: a. excessive bone resorption by osteoclasts. b. a deficit of vitamin D and phosphates. c. replacement of bone by fibrous tissue. d. hyperparathyroidism. 170 41. Paget’s disease often leads to which of the following? a. A reduction in bone fractures b. Decreased intracranial pressure c. Cardiovascular disease d. Disintegration of joint cartilage 170 42. Bones classified as “irregular” would include: a. skull bones. b. the mandible. c. wrist bones. d. the femur. 159 43. A dislocation is: a. the tearing of a tendon in the joint. b. the separation of bones in the joint with a loss of contact. c. the twisting of a joint, causing excessive inflammation of the surrounding tissue. d. the overstressing of ligaments, causing loss of elasticity. 167 44. A diagnostic test that measures the electrical charge of muscle contraction and can help differentiate muscle disorders from neurological disease is a/an: a. electromyogram. b. arthroscopy. c. radiograph. d. electroencephalograph. 164 45. The type of compound fracture in which there are multiple fracture lines and bone fragments is referred to as a/an: 164 46. Fluid-filled sacs composed of synovial membrane located between structures such as tendons and ligaments and act as additional cushions are called: 179 Chapter 10: Blood and Circulatory System Disorders Chapter 10: Blood and Circulatory System Disorders Test Bank a. compression fracture. b. greenstick fracture. c. simple fracture. d. comminuted fracture. a. articular capsules. b. bursae. c. synovial sacs. d. hyaline chambers. MULTIPLE CHOICE 1. Which of the following would result from a reduced number of erythrocytes in the blood? a. Increased hemoglobin in the blood b. Decreased hematocrit c. Increased risk of hemostasis d. Decreased osmotic pressure of the blood 185 2. What term is used to describe a deficit of all types of blood cells? a. Leucopenia b. Neutropenia c. Pancytopenia d. Erythrocytosis 205 3. Capillary walls consist of: a. multiple endothelial layers. b. a thick layer of smooth muscle. c. two or three epithelial layers. d. a single endothelial layer. 183 4. Vitamin K is required by the liver to synthesize: a. heparin. b. prothrombin. c. amino acids. d. bilirubin. 190 | 202 5. Individuals with type O blood are considered to be universal donors because their blood: a. contains A and B antibodies. b. contains A and B antigens. c. lacks A and B antibodies. d. lacks A and B antigens. 192 6. What are the two circulations that comprise the overall circulatory system? a. Pulmonary and systemic circulations b. Peripheral and central circulations c. Cardiovascular and lymphatic circulations d. Cardiopulmonary and peripheral circulations 183 7. Chronic blood loss causes anemia because of the: a. shortened life span of the erythrocytes. b. lower metabolic rate. c. loss of protein and electrolytes. d. smaller amount of recycled iron available. 193 8. What is the cause of sickle cell anemia? a. A defective gene inherited from both parents b. A chronic bacterial infection c. Bone marrow depression d. An autoimmune reaction 198 9. Which of the following best describes the characteristic erythrocyte associated with pernicious anemia? 201 a. Hypochromic, microcytic b. Normochromic, normocytic c. Elongated, sickle-shaped d. Megaloblastic or macrocytic nucleated cells 10. What causes numbness and tingling in the fingers of individuals with untreated pernicious anemia? 195 11. Jaundice is one typical sign of: a. sickle cell anemia. b. aplastic anemia. c. iron deficiency anemia. d. acute leukemia. 198 12. What are the typical early general signs and symptoms of anemia? a. Chest pain, palpitations b. Jaundice, stomatitis c. Pallor, dyspnea, and fatigue d. Bradycardia, heat intolerance 193 a. Persistent hyperbilirubinemia b. Increasing acidosis affecting metabolism c. Vitamin B12 deficit causing peripheral nerve demyelination d. Multiple small vascular occlusions affecting peripheral nerves 13. What is the cause of oral ulcerations and delayed healing occurring with any severe anemia? a. Lack of folic acid for DNA synthesis b. Frequent microinfarcts in the tissues c. Deficit of oxygen for epithelial cell mitosis and metabolism d. Elevated bilirubin levels in blood and body fluids 193 14. Which of the following is present with pernicious anemia? a. Pancytopenia b. Hypochlorhydria c. Leukocytosis d. Multiple infarcts 195 15. Why is pernicious anemia treated with injections of vitamin B12? a. An immune reaction in the stomach would destroy the vitamin. b. Digestive enzymes would destroy the vitamin. c. The vitamin irritates the gastric mucosa. d. The ingested vitamin would not be absorbed into the blood. 195 16. Why do abnormally low hemoglobin values develop with pernicious anemia? a. Decreased production of erythrocytes b. Shorter life span of erythrocytes c. Abnormal structure of hemoglobin chains d. Deficit of folic acid 195 17. What are the common early signs of aplastic anemia? a. Painful joints and skeletal deformity b. Abdominal discomfort and splenomegaly c. Excessive bleeding and recurrent infections d. Palpitations and chest pain 197 18. Why do vascular occlusions and infarcts occur frequently with sickle cell anemia? a. The red blood cells are abnormally large. b. Increased hemolysis of erythrocytes occurs. c. Erythrocytes change to sickle shape when hypoxia occurs. d. HbS is unable to transport oxygen. 199 19. Which of the following applies to sickle cell trait? a. Most hemoglobin is in the form of HgS b. Sickling of erythrocytes occurs with severe hypoxia. c. Painful sickling crises with multiple infarctions occur frequently. d. A child’s skeletal growth is delayed. 198 20. What is the basic abnormality in thalassemia? a. Several amino acids in the globin chains have been replaced by substitute amino acids. b. More than four globin chains are found in the erythrocytes. c. The iron molecule is displaced in hemoglobin. d. There is failure to synthesize either the alpha or beta chains in the hemoglobin molecule. 200 21. Which of the following can result from a malabsorption problem? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Pernicious anemia 195 22. In individuals with pernicious anemia, antibodies form to: a. vitamin B12. b. intrinsic factor or parietal cells. c. mucus-producing glands. d. hydrochloric acid. 195 23. In cases of polycythemia vera, blood pressure is elevated as a result of: a. increased blood volume. b. frequent infarcts in the coronary circulation. c. congested spleen and bone marrow. d. increased renin and aldosterone secretions. 205 24. Petechiae and purpura are common signs of: a. excessive hemolysis. b. leucopenia. c. increased bleeding. d. hemoglobin deficit. 201 25. Which statement applies to the disorder hemophilia A? a. It is transmitted as an X-linked dominant trait. b. There is usually a total lack of factor VIII in the blood. c. Males and females can be carriers. d. Hematomas and hemarthroses are common. 203 26. Which of the following occurs when disseminated intravascular coagulation develops? a. Increased thrombocytes and blood clotting b. Hemolysis with loss of blood cells c. Massive sepsis and hemorrhage d. Multiple thrombi and deficit of clotting factors 203-204 27. Which of the following substances acts as an anticoagulant? a. Prothrombin b. Heparin c. Fibrinogen d. Vitamin K 190 28. In individuals with acute leukemia, the increased number of malignant leukocytes leads to: 1. decreased hemoglobin. 2. thrombocytopenia. 3. bone pain with increased activity. 4. splenomegaly. a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3, 4 206-208 29. Multiple opportunistic infections develop with acute leukemia primarily because: a. the number of white blood cells is decreased. b. many circulating leukocytes are immature. c. severe anemia interferes with the immune response. d. decreased appetite and nutritional intake reduce natural defenses. 206-207 30. Why is excessive bleeding a common occurrence with acute leukemia? a. Deficit of calcium ions b. Impaired production of prothrombin and fibrinogen c. Decreased platelets d. Dysfunctional thrombocytes 206-207 31. Predisposing factors to leukemia commonly include: a. exposure to radiation. b. certain fungal and protozoal infections. c. familial tendency. d. cigarette smoking. 207 32. Von Willebrand disease is caused by: a. defective erythrocytes that become deformed in shape, causing occlusions. b. excessive lymphocytes that do not mature. c. absence of a clotting factor that helps platelets clump and stick. d. a lack of hemoglobin due to iron deficiency. 203 33. Thrombophilia can result in conditions such as: a. severe chronic kidney disease. b. peripheral vascular disease. c. deficient calcium levels in the long bones. d. excessive bleeding of hematomas. 204 34. Multiple myeloma is a malignant tumor involving: a. plasma cells. b. granulocytes. c. bone cells. d. lymph nodes. 209 35. What is the primary treatment for the leukemias? a. Radiation b. Chemotherapy c. Surgery d. Immunotherapy 207 36. Which of the following statements applies to hemochromatosis. It is: a. caused by excessive iron intake in the diet. b. results from excessive hemolysis of RBCs. c. a metabolic error that leads to excess amounts of hemosiderin, causing damage to organs. d. an inherited defect that results in abnormal hemoglobin. 188 37. Thalassemia is caused by: a. a defect in one or more genes for hemoglobin. b. an abnormal form of heme. c. abnormal liver production of amino acids and iron. d. overproduction of hypochromic, microcytic RBCs. 200 38. Secondary polycythemia may be associated with: a. frequent angina attacks. b. certain types of anemia. c. severe chronic bronchitis. d. renal disease. 205 39. All of the following apply to vitamin K EXCEPT: a. it is used as an antidote for warfarin (Coumadin). b. the liver requires it to produce prothrombin. c. it is a fat-soluble vitamin. d. the bone marrow requires it to synthesize hemoglobin. ANS REF:189 | 190 | 202 40. Leukemia is sometimes linked to chromosome abnormalities, as evidenced by: a. the presence of Philadelphia chromosome translocation in cases of acute myelogenous leukemia (AML). b. very low incidence in persons with Down syndrome. c. little evidence of familial incidence. d. transmission as a recessive gene. 206-207 41. Iron deficiency anemia frequently results from any of the following EXCEPT: a. certain vegetarian diets. b. excessive menstrual flow. c. malabsorption syndromes. d. diabetes mellitus. 193 42. Which of the following applies to the leukemias? a. Chronic leukemias are more common in older people. b. AML is the most common childhood leukemia. c. Exposure to chemicals is not considered a predisposing factor. d. Lymphoid tissue produces abnormal leukocytes. 207 43. A high percentage of blast cells in the leukocyte population indicates a poor prognosis for an individual with: a. thalassemia. b. acute myelogenous leukemia (AML). c. myelodysplastic syndrome. d. multiple myeloma. 208 44. Which of the following applies to erythropoietin? a. It is produced by the liver. b. It increases iron absorption for heme production. c. It stimulates production of red blood cells. d. Hypoxia stimulates the red bone marrow to produce erythropoietin. 187 | 192 45. Which of the following diagnostic tests would be within the normal range for an individual with hemophilia A? 192 46. Which of the following applies to the condition disseminated intravascular coagulation (DIC)? a. Bleeding time b. Coagulation time c. PTT time d. Prothrombin time a. It is usually a secondary complication. b. It is always initiated by excessive bleeding. c. It results in an inability of platelets to adhere. d. It is not life threatening. 203-204 47. In which blood dyscrasia does pancytopenia develop? a. Pernicious anemia b. Aplastic anemia c. Iron deficiency anemia d. Sickle cell anemia 205 48. Which of the following applies to the etiology of aplastic anemia? It is: a. idiopathic in many cases. b. a genetic disorder. c. predisposed by exposure to myelotoxins. d. Both A and C. 197 49. Microcytic and hypochromic erythrocytes are commonly found as a result of: a. iron deficiency anemia. b. polycythemia. c. disseminated intravascular coagulation. d. hemophilia A. 201 Chapter 11: Lymphatic System Disorders Chapter 11: Lymphatic System Disorders Test Bank MULTIPLE CHOICE 1. The spleen has a number of important functions, which include: a. lymph production, hematopoiesis, platelet production. b. hematopoiesis, destruction of old erythrocytes, blood reservoir. c. defense from infection, metabolism of vitamins, platelet production. d. lipid metabolism, production of hemoglobin, water absorption. 213 2. The function of the hormones secreted by the thymus gland is to: a. break down old erythrocytes and recycle the hemoglobin. b. concentrate the lymph and filter out toxins. c. stimulate lymph production. d. enable lymphocytes to develop into mature T cells. 214 3. Malignant neoplasms involving lymphocyte proliferation in the lymph nodes are called: a. lymphomas b. myelomas c. lymphocytomas d. lymphedemas 216 4. The atypical cell that serves as a marker for diagnosing Hodgkin’s lymphoma is the: a. monocyte. b. Ann Arbor cell c. Hodgkin’s lymphocyte d. Reed-Sternberg cell 216 5. The staging system typically used in determining the stage of the Hodgkin’s lymphoma is the: a. Reed-Sternberg system. b. sequential staging system. c. Ann Arbor system. d. differential landmark system. 216 6. One of the reasons non-Hodgkin’s lymphomas are harder to treat than Hodgkin’s lymphomas is that they: 216 7. Multiple myeloma is a neoplastic disease of unknown etiology occurring in older adults and involving: 219 8. Elephantiasis, caused by the obstruction of lymphatic vessels by parasitic worms, is an example of the condition known as: a. tend to be much larger than Hodgkin’s lymphomas. b. involve multiple nodes and widespread metastases. c. are not affected by the newer drug treatments. d. are asymptomatic until they reach stage IV. a. plasma cells. b. T cells. c. NK cells. d. monocytes. a. plasma cell myeloma. b. diverticulitis. c. lymphedema. d. obstructive vessel disorder. 219-220 9. A rare illness that involves the overgrowth of lymphoid tissue, although not itself considered a cancer is: 220 10. Non-Hodgkin’s lymphomas are increasing in incidence, partly due to the numbers associated with: 216 a. Castleman disease. b. hyperlymphatic disease. c. hypolymphatic disease. d. Ann Arbor disease. a. an increase in resistant microorganisms. b. an increase in adult obesity. c. an increase in high cholesterol levels. d. an increase in HIV infections. Chapter 12: Cardiovascular System Disorders Chapter 12: Cardiovascular System Disorders Test Bank MULTIPLE CHOICE 1. Which of the following actions causes the atrioventricular (AV) valves to close? a. Increased intraventricular pressure b. Depolarization at the AV node c. Ventricular relaxation and backflow of blood d. Contraction of the atria 227 2. When stroke volume decreases, which of the following could maintain cardiac output? a. Decreased peripheral resistance b. Increased heart rate c. Decreased venous return d. General vasodilation 228 3. Which of the following describes the pericardial cavity? a. It contains sufficient fluid to provide a protective cushion for the heart. b. It is a potential space containing a very small amount of serous fluid. c. It is lined by the endocardium. d. It is located between the double-walled pericardium and the epicardium. 224 4. Which of the following factors greatly improves venous return to the heart during strenuous exercise? 224 5. The function of the baroreceptors is to: a. stimulate the parasympathetic or sympathetic nervous system at the sinoatrial (SA) node as needed. b. adjust blood pressure by changing peripheral resistance. c. sense a change in blood oxygen and carbon dioxide levels. d. signal the cardiovascular control center of changes in systemic blood pressure. 225 6. The normal delay in conduction through the AV node is essential for: a. preventing an excessively rapid heart rate. b. limiting the time for a myocardial contraction. a. Rapid emptying of the right side of the heart b. Forceful action of the valves in the veins c. Contraction and relaxation of skeletal muscle d. Peristalsis in the large veins c. allowing the ventricles to contract before the atria. d. completing ventricular filling. 225 7. Which of the following is a result of increased secretion of epinephrine? a. Increased heart rate and force of contraction b. Decreased stimulation of the SA node and ventricles c. Vasoconstriction in skeletal muscles and kidneys d. Vasodilation of cutaneous blood vessels 225 8. Which of the following causes increased heart rate? a. Stimulation of the vagus nerve b. Increased renin secretion c. Administration of beta-blocking drugs d. Stimulation of the sympathetic nervous system 230 9. The event that causes the QRS wave on an electrocardiogram (ECG) tracing is: a. atrial depolarization. b. atrial repolarization. c. ventricular depolarization. d. ventricular repolarization. 225 10. The cardiac reserve is: a. afterload. b. the difference between the apical and radial pulses. c. the ability of the heart to increase cardiac output when needed. d. the extra blood remaining in the heart after it contracts. 228 11. The term preload refers to: a. volume of venous return. b. peripheral resistance. c. stroke volume. d. cardiac output. 228 12. The first arteries to branch off the aorta are the: a. common carotid arteries. b. pulmonary arteries. c. coronary arteries. d. subclavian arteries. 226 13. Cardiac output refers to: a. the amount of blood passing through either of the atria. b. the volume of blood ejected by a ventricle in one minute. c. the volume of blood ejected by each ventricle in a single contraction. d. the total number of heartbeats in one minute. 228 14. Vasodilation in the skin and viscera results directly from: a. decreased blood pressure. b. increased parasympathetic stimulation. c. relaxation of smooth muscle in the arterioles. d. increased stimulation of alpha-adrenergic receptors. 229-230 15. Which of the following drugs decrease sodium and fluid retention in the body? a. warfarin (Coumadin) b. digoxin (Lanoxin) c. nitroglycerin (Isordil) d. hydrochlorothiazide (HydroDIURIL) 233 16. Which of the following are predisposing factors to thrombus formation in the circulation? 1. Decreased viscosity of the blood 2. Damaged blood vessel walls 3. Immobility 4. Prosthetic valves a. 1, 3 b. 2, 4 c. 1, 3, 4 d. 2, 3, 4 263 17. A drug taken in small doses on a continuing basis to reduce platelet adhesion is: a. acetylsalicylic acid (ASA). b. streptokinase. c. acetaminophen. d. heparin. 233 18. A partial obstruction in a coronary artery will likely cause: a. pulmonary embolus. b. hypertension. c. angina attacks. d. myocardial infarction. 237 19. Cigarette smoking is a risk factor in coronary artery disease because smoking: a. reduces vasoconstriction and peripheral resistance. b. decreases serum lipid levels. c. promotes platelet adhesion. d. increases serum HDL levels. 237-238 20. The term arteriosclerosis specifically refers to: a. development of atheromas in large arteries. b. intermittent vasospasm in coronary arteries. c. degeneration with loss of elasticity and obstruction in small arteries. d. ischemia and necrosis in the brain, kidneys, and heart. 234 21. A modifiable factor that increases the risk for atherosclerosis is: a. leading a sedentary lifestyle. b. being female and older than 40 years of age. c. excluding saturated fats from the diet. d. familial hypercholesterolemia. 238 22. An atheroma develops from: a. a torn arterial wall and blood clots. b. accumulated lipids, cells, and fibrin where endothelial injury has occurred. c. thrombus forming on damaged walls of veins. d. repeated vasospasms. 234 23. Low-density lipoproteins (LDL): a. promote atheroma development. b. contain only small amounts of cholesterol. c. transport cholesterol from cells to the liver for excretion. d. are associated with low intake of saturated fats. 235 24. Factors that may precipitate an angina attack include all of the following EXCEPT: a. eating a large meal. b. engaging in an angry argument. c. taking a nap. d. shoveling snow on a cold, windy day. 240 25. When comparing angina with myocardial infarction (MI), which statement is true? a. Both angina and MI cause tissue necrosis. b. Angina often occurs at rest; MI occurs during a stressful time. c. Pain is more severe and lasts longer with angina than with MI. d. Angina pain is relieved by rest and intake of nitroglycerin; the pain of MI is not. 234 26. The basic pathophysiology of myocardial infarction is best described as: a. cardiac output that is insufficient to meet the needs of the heart and body. b. temporary vasospasm that occurs in a coronary artery. c. total obstruction of a coronary artery, which causes myocardial necrosis. d. irregular heart rate and force, reducing blood supply to coronary arteries. 240 27. Typical early signs or symptoms of myocardial infarction include: a. brief, substernal pain radiating to the right arm, with labored breathing. b. persistent chest pain radiating to the left arm, pallor, and rapid, weak pulse. c. bradycardia, increased blood pressure, and severe dyspnea. d. flushed face, rapid respirations, left-side weakness, and numbness. 241 28. The most common cause of a myocardial infarction is: a. an imbalance in calcium ions. b. an infection of the heart muscle. c. atherosclerosis involving an attached thrombus. d. a disruption of the heart conduction system. 240 29. Calcium-channel blocking drugs are effective in: a. reducing the risk of blood clotting. b. decreasing the attraction of cholesterol into lipid plaques. c. reducing cardiac and smooth muscle contractions. d. decreasing all types of cardiac arrhythmias. 261 30. Which of the following confirms the presence of a myocardial infarction? a. A full description of the pain, including the sequence of development b. The presence of elevated serum cholesterol and triglycerides c. Serum isoenzymes released from necrotic cells and an ECG d. Leukocytosis and elevated C-reactive protein 242 31. The size of the necrotic area resulting from myocardial infarction may be minimized by all of the following EXCEPT: 243 32. The most common cause of death immediately following a myocardial infarction is: a. cardiac arrhythmias and fibrillation. b. ruptured ventricle or aorta. c. congestive heart failure. d. cerebrovascular accident. 241-242 33. Why does ventricular fibrillation result in cardiac arrest? a. previously established collateral circulation. b. immediate administration of thrombolytic drugs. c. maintaining maximum oxygen supply to the myocardium. d. removing the predisposing factors to atheroma development. a. Delayed conduction through the AV node blocks ventricular stimulation. b. Insufficient blood is supplied to the myocardium. c. The ventricles contract before the atria. d. Parasympathetic stimulation depresses the SA node. 245 34. The term cardiac arrest refers to which of the following? a. Condition where cardiac output is less than the demand b. A decreased circulating blood volume c. Missing a ventricular contraction d. The cessation of all cardiac function 246 35. Which change results from total heart block? a. A prolonged PR interval b. Periodic omission of a ventricular contraction c. A wide QRS wave d. Spontaneous slow ventricular contractions, not coordinated with atrial contraction 244 36. The term premature ventricular contraction refers to the condition where: a. atrial muscle cells are stimulating additional cardiac contractions. b. the ventricles contract spontaneously following a period without a stimulus. c. additional contractions arise from ectopic foci in the ventricular muscle. d. increased heart rate causes palpitations. 245 37. Which of the following is most likely to cause left-sided congestive heart failure? a. Incompetent tricuspid heart valve b. Chronic pulmonary disease c. Infarction in the right atrium d. Uncontrolled essential hypertension 246 38. The definition of congestive heart failure is: a. cessation of all cardiac activity. b. inability of the heart to pump enough blood to meet the metabolic needs of the body. c. insufficient circulating blood in the body. d. the demand for oxygen by the heart is greater than the supply. 246 39. Significant signs of right-sided congestive heart failure include: a. severe chest pain and tachycardia. b. edematous feet and legs with hepatomegaly. c. frequent cough with blood-streaked frothy sputum. d. orthopnea, fatigue, increased blood pressure. 247 40. Paroxysmal nocturnal dyspnea is marked by: a. hemoptysis and rales. b. distended neck veins and flushed face. c. bradycardia and weak pulse. d. cardiomegaly. 250 41. Compensation mechanisms for decreased cardiac output in cases of congestive heart failure include: 246 42. In which blood vessels will failure of the left ventricle cause increased hydrostatic pressure? a. slow cardiac contractions. b. increased renin and aldosterone secretions. c. decreased erythropoietin secretion. d. fatigue and cold intolerance. a. Veins of the legs and feet b. Jugular veins c. Pulmonary capillaries d. Blood vessels of the liver and spleen 247 43. Which of the following drugs improves cardiac efficiency by slowing the heart rate and increasing the force of cardiac contractions? 250 44. In an infant, the initial indication of congestive heart failure is often: a. distended neck veins. b. feeding problems. c. low-grade fever and lethargy. d. frequent vomiting. 250 45. Effects that may be expected from a beta-adrenergic blocking drug include: a. Furosemide b. Digoxin c. Epinephrine d. Nifedipine a. increasing systemic vasoconstriction. b. decreased sympathetic stimulation of the heart. c. blockage of an angiotensin receptor site. d. increased release of renin. 232 46. A sign of aortic stenosis is: a. increased cardiac output. b. congestion in the liver, spleen, and legs. c. flushed face and headache. d. a heart murmur. 250-251 47. An incompetent mitral valve would cause: a. increased blood to remain in the right atrium. b. hypertrophy of the right ventricle. c. decreased output from the left ventricle. d. decreased pressure in the left atrium. 253 48. Which of the following describes the blood flow occurring with a ventricular septal defect? a. From the left ventricle to the right ventricle b. From the right ventricle to the left ventricle c. Increased cardiac output from the left ventricle d. Mixed oxygenated and unoxygenated blood in the systemic circulation 252 49. Unoxygenated blood enters the systemic circulation in children with tetralogy of Fallot because: a. the aorta and pulmonary artery have exchanged positions. b. pulmonary stenosis changes the ventricular pressures. c. the left ventricular wall has hypertrophied. d. the septal defect allows exchange of blood between the atria. 254-255 50. Cyanosis occurs in children with tetralogy of Fallot because: a. more carbon dioxide is present in the circulating blood. b. a large amount of hemoglobin in the general circulation is unoxygenated. c. the pulmonary circulation is overloaded and congested. d. the circulation is sluggish (slow) throughout the system. 255 51. The initial effect on the heart in cases of rheumatic fever is: a. infection in the heart by hemolytic streptococci. b. highly virulent microbes causing vegetations on the heart valves. c. septic emboli obstructing coronary arteries. d. acute inflammation in all layers of the heart due to abnormal immune response. 255 52. Common signs of rheumatic fever include all of the following EXCEPT: a. arthritis, causing deformity of the small joints in the hands and feet. b. erythematous skin rash and subcutaneous nodules. c. epistaxis, tachycardia, and fever. d. elevated ASO titer and leukocytosis. 255-256 53. Rheumatic heart disease usually manifests in later years as: a. swollen heart valves and fever. b. cardiac arrhythmias and heart murmurs. c. thrombus formation and septic emboli. d. petechial hemorrhages of the skin and mucosa. 256 54. Septic emboli, a common complication of infective endocarditis, are a result of the fact that: a. vegetations are loosely attached and fragile. b. the valves are no longer competent. c. cardiac output is reduced. d. heart contractions are irregular. 257 55. Which of the following applies to subacute infective endocarditis? a. A microbe of low virulence attacks abnormal or damaged heart valves. b. Virulent microbes invade normal heart valves. c. No permanent damage occurs to the valves. d. Prophylactic medication does not prevent infection. 257 56. Pericarditis causes a reduction in cardiac output as a result of which of the following? a. Delays in the conduction system, interfering with cardiac rhythm b. Weak myocardial contractions due to friction rub c. Excess fluid in the pericardial cavity, which decreases ventricular filling d. Incompetent valves, which allow regurgitation of blood 258 57. Pericarditis may be caused by: 1. infection. 2. abnormal immune responses. 3. injury. 4. malignant neoplasm. a. 1, 2 b. 3, 4 c. 1, 3, 4 d. 1, 2, 3, 4 258 58. A source of an embolus causing an obstruction in the brain could be the: a. femoral vein. b. pulmonary vein. c. carotid artery. d. coronary artery. 242 59. The basic pathophysiological change associated with essential hypertension is: a. development of lipid plaques in large arteries. b. recurrent inflammation and fibrosis in peripheral arteries. c. degeneration and loss of elasticity in arteries. d. increased systemic vasoconstriction. 259 60. Uncontrolled hypertension is most likely to cause ischemia and loss of function in the: a. kidneys, brain, and retinas of the eye. b. peripheral arteries in the legs. c. aorta and coronary arteries. d. liver, spleen, and stomach. 260 61. When is a diagnosis of essential hypertension likely to be considered in young or middle-aged individuals? 259 62. Atherosclerosis in the iliac or femoral arteries is likely to cause which of the following? 1. Gangrenous ulcers in the legs 2. Strong rapid pulses in the legs 3. Intermittent claudication 4. Red, swollen legs a. 1, 2 a. Blood pressure remains consistently above 140/90 b. Blood pressure fluctuates between 130/85 and 180/105 c. Blood pressure increases rapidly and is unresponsive to medication d. Chronic kidney disease leads to consistently elevated blood pressure b. 1, 3 c. 2, 3 d. 2, 4 261 63. The term intermittent claudication refers to: a. sensory deficit in the legs due to damage to nerves. b. chest pain related to ischemia. c. ischemic muscle pain in the legs, particularly with exercise. d. dry, cyanotic skin with superficial ulcers. 261 64. What is the primary reason for amputation of gangrenous toes or feet in patients with peripheral vascular disease? 262 65. An echocardiogram is used to demonstrate any abnormal: a. activity in the conduction system. a. It promotes more rapid healing of ulcerated areas. b. It improves circulation to other areas. c. It prevents spread of infection and reduces pain. d. It reduces swelling in the peripheral areas. b. movement of the heart valves. c. change in central venous pressure. d. blood flow in coronary arteries. 225 66. A friction rub is associated with: a. infectious endocarditis. b. arrhythmias. c. pericarditis. d. an incompetent aortic valve. 258 67. A dissecting aortic aneurysm develops as: a. a dilation or bulge that develops at one point on the aortic wall. b. a thrombus that accumulates at a point in the aortic wall. c. a section of the aorta that weakens and dilates in all directions. d. a tear in the intimal lining, which allows blood flow between layers of the aortic wall. 262 68. The outcome for many aortic aneurysms is: b. thrombus formation and pulmonary embolus. c. rupture and hemorrhage. d. pressure on adjacent organs or structures. 262 69. Which factor predisposes to varicose veins during pregnancy? a. Compressed pelvic veins b. Stenotic valves in leg veins c. Thrombus formation d. Insufficient muscle support for veins 263 70. Phlebothrombosis is more likely to cause pulmonary emboli than is thrombophlebitis because: a. platelets attach to the inflamed wall. b. thrombus forms in a vein and is less firmly attached. c. leg cramps require massage. d. systemic signs of inflammation require treatment. 264 71. Shock is defined as: b. general hypoxia, causing damage to various organs. c. decreased circulating blood and tissue perfusion. d. loss of blood, causing severe hypoxia. 264 72. Shock follows a myocardial infarction when: a. the stress response causes general vasodilation. b. fluid is lost into ischemic tissues. c. heart valves are damaged. d. a large portion of the myocardium is damaged. 242 73. What are the early signs of circulatory shock? 1. Pale moist skin 2. Loss of consciousness 3. Anxiety and restlessness 4. Rapid strong pulse a. 1, 2 b. 1, 3 c. 1, 4 d. 3, 4 267 74. A compensation for shock would include: a. increased heart rate and oliguria. b. lethargy and decreased responsiveness. c. warm, dry, flushed skin. d. weak, thready pulse. 267 75. Why does anaphylactic shock cause severe hypoxia very quickly? a. Generalized vasoconstriction reduces venous return. b. Bronchoconstriction and bronchial edema reduce airflow. c. Heart rate and contractility are reduced. d. Metabolic rate is greatly increased. 267 76. Neurogenic (vasogenic) shock results from systemic vasodilation due to: a. increased peripheral resistance and less blood in the microcirculation. b. increased permeability of all the blood vessels, leading to hypovolemia. c. slower, less forceful cardiac contractions. d. increased capacity of the vascular system and reduced venous return. 265 | 266 77. A prolonged period of shock is likely to cause: a. damage to, and increased permeability of, pulmonary capillaries. b. increased permeability of the glomerular capillaries of the kidneys. c. increased pH of blood and body fluids. d. increased systemic vasoconstriction. 265 78. What would indicate decompensated acidosis related to shock? a. Serum bicarbonate level below normal b. PCO2 above normal c. Serum pH below normal range d. Urine pH of 4.5 267 79. With shock, anaerobic cell metabolism and decreased renal blood flow cause: a. metabolic alkalosis. b. metabolic acidosis. c. decreased serum potassium. d. increased serum bicarbonate. 267-268 80. Shock develops in patients with severe burns as a result of: a. extensive hemorrhage. b. pain and loss of plasma. c. direct damage to the heart. d. extensive hemolysis of erythrocytes. 265-266 81. The classic early manifestation(s) of left-sided congestive heart failure is/are , whereas the early indicator(s) of right-sided failure is/are . a. palpitations and periodic chest pain; shortness of breath on exertion b. swelling of the ankles and abdomen; chest pain c. shortness of breath on exertion or lying down; swelling of the ankles d. coughing up frothy sputum; hepatomegaly and splenomegaly 249-250 82. A common adverse effect of many antihypertensive medications is: a. orthostatic hypotension. b. bradycardia. c. altered blood coagulation. d. peripheral edema. 261 83. The cause of essential hypertension is considered to be: a. chronic renal disease. b. excessive intake of saturated fats and salt. c. sedentary lifestyle. d. idiopathic. 259 84. A cardiac pacemaker would most likely be inserted in cases of: a. angina pectoris. b. heart block. c. congestive heart failure. d. ventricular fibrillation. 245 85. Which of the following is considered to be the most dangerous arrhythmia? a. Tachycardia b. Bradycardia c. Ventricular fibrillation d. Second-degree heart block 245 86. Which of the following is NOT true of the drug nitroglycerin? a. It decreases myocardial workload by causing systemic vasodilation. b. It may be administered sublingually, transdermally, or by oral spray. c. Dizziness or syncope may follow a sublingual dose. d. It strengthens the myocardial contraction. 232 87. Confirmation of the diagnosis of a myocardial infarction would include: 1. specific changes in the ECG. 2. marked leukocytosis and increased erythrocyte sedimentation rate (ESR). 3. elevation of cardiac isoenzymes in serum. 4. a pattern of pain. a. 1, 2 b. 1, 3 c. 2, 4 d. 3, 4 242 88. Which of the following statements regarding aneurysms is true? a. Aneurysms are always caused by congenital malformations. b. The greatest danger with aneurysms is thrombus formation. c. Manifestations of aneurysms result from compression of adjacent structures. d. Aneurysms involve a defect in the tunica media of veins. 263 89. The most common factor predisposing to the development of varicose veins is: a. trauma. b. congenital valve defect in the abdominal veins. c. infection. d. increased venous pressure. 263 90. In the period immediately following a myocardial infarction, the manifestations of pallor and diaphoresis, rapid pulse, and anxiety result from: 267-269 91. Septic shock differs from hypovolemic shock in that it is frequently manifested by: a. fever and flushed face. b. elevated blood pressure. c. increased urinary output. a. onset of circulatory shock. b. the inflammatory response. c. release of enzymes from necrotic tissue. d. heart failure. d. slow bounding pulse. 267 92. Heart block, in which a conduction delay at the AV node results in intermittent missed ventricular contractions, is called: 244 93. More extensive permanent damage is likely when a myocardial infarction is caused by: a. a hemorrhage. b. an embolus. c. a thrombus. d. an arrhythmia. 242 94. A very rapid heart rate reduces cardiac output because: a. venous return is increased. b. ventricular fibrillation develops immediately. c. conduction through the AV node is impaired. a. first-degree block. b. second-degree block. c. bundle-branch block. d. total heart block. d. ventricular filling is reduced. 243 95. The right side of the heart would fail first in the case of: 1. severe mitral valve stenosis. 2. uncontrolled essential hypertension. 3. large infarction in the right ventricle. 4. advanced chronic obstructive pulmonary disease (COPD). a. 1, 2 b. 2, 3 c. 1, 4 d. 3, 4 246 96. Which of the following compensations that develop in patients with congestive heart failure eventually increase the workload of the heart? a. Faster heart rate and cardiomegaly b. Peripheral vasoconstriction c. Increased secretion of renin d. A and C e. A, B, and C 246 97. Which statement applies to paroxysmal nocturnal dyspnea? a. It indicates decreased CO2 diffusion in the lungs. b. It indicates swelling in the bronchioles and bronchi. c. It is caused by increased blood in the lungs when lying in a supine position. d. It results from pleural effusion. 249-250 98. In patients with congestive heart failure, ACE inhibitor drugs are useful because they: a. reduce renin and aldosterone secretion. b. slow the heart rate. c. strengthen myocardial contraction. d. block arrhythmias. 250 99. In a child with ventricular septal defect, altered blood flow: a. leads to increased stroke volume from the left ventricle. b. results in unoxygenated blood in the systemic circulation. c. is called a right-to-left shunt. d. is called a left-to-right shunt. 252-253 100. In a child with acute rheumatic fever, arrhythmias may develop due to the presence of: a. endocarditis. b. myocarditis. c. pericarditis. d. congestive heart failure. 256 101. Prophylactic antibacterial drugs such as amoxicillin are given to patients with certain congenital heart defects or damaged heart valves immediately before invasive procedures to prevent: 257 102. Varicose ulcers may develop and be slow to heal because: a. leg muscles are painful, restricting movement. b. edema reduces arterial blood supply to the area. c. emboli form in damaged veins, leading to local ischemia. d. valves in veins restrict blood flow. 264 a. formation of septic thrombi. b. infectious endocarditis. c. abscess formation. d. myocarditis. 103. Excessive fluid in the pericardial space causes: a. increased cardiac output. b. myocardial infarction. c. reduced venous return. d. friction rub. 258 104. Aortic stenosis means the aortic valve: a. allows blood to leak back into the left ventricle during diastole. b. cannot fully open during systole. c. functions to increase stroke volume. d. does not respond to the cardiac cycle. 251 105. Septic shock is frequently caused by infections involving: a. gram-negative endotoxin-producing bacteria. b. spore-forming saprophytic fungi. c. free-swimming, motile parasitic protozoa. d. parasitic nematodes. 265 Chapter 13: Respiratory System Disorders Chapter 13: Respiratory System Disorders Test Bank MULTIPLE CHOICE 1. What happens in the lungs when the diaphragm and external intercostal muscles relax? a. Air is forced out of the lungs. b. Lung volume increases. c. Intrapulmonic pressure decreases. d. Intrapleural pressure decreases. 275 2. The respiratory mucosa is continuous through the: 1. upper and lower respiratory tracts. 2. nasal cavities and the sinuses. 3. nasopharynx and oropharynx. 4. middle ear cavity and auditory tube. a. 1 only b. 1, 2 c. 2, 3 d. 1, 3, 4 e. 1, 2, 3, 4 273-274 3. Which of the following activities does NOT require muscle contractions and energy? a. Quiet inspiration b. Forced inspiration c. Quiet expiration d. Forced expiration 275 4. The maximum volume of air a person can exhale after a maximum inspiration is termed the: a. expiratory reserve volume. b. inspiratory reserve volume. c. total lung capacity. d. vital capacity. 276-277 5. Which of the following applies to the blood in the pulmonary artery? a. PCO2 is low. b. PO2 is low. c. Hydrostatic pressure is very high. d. It is flowing into the left atrium. 279 6. Which of the following causes bronchodilation? a. Epinephrine b. Histamine c. Parasympathetic nervous system d. Drugs that block β2-adrenergic receptors 302 7. The central chemoreceptors in the medulla are normally most sensitive to: a. low oxygen level. b. low concentration of hydrogen ions. c. elevated oxygen level. d. elevated carbon dioxide level. 277 8. Oxygen diffuses from the alveoli to the blood because: a. PO2 is higher in the blood. b. PO2 is lower in the blood. c. CO2 is diffusing out of the blood. d. more CO2 is diffusing out of cells into the blood. 278 9. Carbon dioxide is primarily transported in the blood: a. as dissolved gas. b. attached to the iron molecule in hemoglobin. c. as bicarbonate ion. d. as carbonic acid. 280 10. What would hypercapnia cause? a. Increased serum pH b. Decreased respirations c. Respiratory acidosis d. Decreased carbonic acid in the blood 278 11. Which of the following would result from hyperventilation? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic alkalosis d. Metabolic acidosis 278 12. Which of the following values is always decreased with respiratory alkalosis (compensated or decompensated)? 282-283 13. What would be the most effective compensation for respiratory acidosis? a. The kidneys eliminating more bicarbonate ions b. The kidneys producing more bicarbonate ions c. The kidneys reabsorbing more hydrogen ions d. An increase in respiratory rate 279-280 14. What is the acid-base status of a patient with the following values for arterial blood gases? serum bicarbonate 36.5 mmol/L (normal range: 22-28) PCO275 mm Hg (normal range: 35-45) serum pH 7.0 a. Serum bicarbonate b. PaCO2 c. Serum pH d. Urine pH a. Compensated metabolic acidosis b. Decompensated metabolic acidosis c. Compensated respiratory acidosis d. Decompensated respiratory acidosis 320 15. What does carbaminohemoglobin refer to? a. Replacement of oxygen by carbon monoxide on hemoglobin molecules b. Full saturation of all heme molecules by oxygen c. Carbon dioxide attached to an amino group on the hemoglobin molecule d. Oxygen combined with iron in the hemoglobin molecule 280 16. Approximately what percentage of bound oxygen is released to the cells for metabolism during an erythrocyte’s journey through the circulatory system? 279 17. The production of yellowish-green, cloudy, thick sputum is often an indication of: a. 80% b. 25% c. 10% d. 50% a. bacterial infection. b. cancer tumor. c. damage of lung tissue due to smoking. d. emphysema. 281 18. What does the term hemoptysis refer to? a. Thick, dark red sputum associated with pneumococcal infection b. Reddish-brown granular blood found in vomitus c. Bright red streaks of blood in frothy sputum d. Bloody exudate in the pleural cavity 281 19. Orthopnea is: a. very deep, rapid respirations. b. difficulty breathing when lying down. c. waking up suddenly, coughing, and struggling for breath. d. noisy breathing with stridor or rhonchi. 282 20. Light bubbly or crackling breathing sounds associated with serous secretions are called: a. rhonchi. b. stridor. c. rales. d. wheezing. 282 21. Choose the correct information applying to laryngotracheobronchitis: a. Viral infection in infant under 12 months b. Viral infection in child, 3 months to 3 years c. Bacterial infection in infant under 6 months d. Bacterial infection in child, 3 to 7 years 283 22. Signs and symptoms of acute sinusitis usually include: a. serous nasal discharge and chronic cough. b. copious frothy sputum and dyspnea. c. severe localized pain in the facial bone and tenderness in the face. d. fetid breath and sore throat. 283 23. What are early signs and symptoms of infectious rhinitis? a. Purulent nasal discharge and periorbital pain b. Serous nasal discharge, congestion, and sneezing c. Copious purulent sputum, particularly in the morning d. Harsh barking cough and wheezing 285 24. Why does the influenza virus cause recurrent infection in individuals? a. Elderly patients are predisposed to secondary infections. b. The virus is transmitted by numerous routes. c. The virus is very difficult to destroy. d. Viral mutation reduces immunity from prior infections. 285 25. What are typical signs and symptoms of epiglottitis? a. Hyperinflation of the chest and stridor b. Hoarse voice and barking cough c. Sudden fever, sore throat, and drooling saliva d. Sneezing, mild cough, and fever 289 26. What is the most common cause of viral pneumonia? a. Rhinovirus b. Influenza virus c. Haemophilus influenzae d. Pneumococcus 288 27. Which of the following describes lobar pneumonia? a. Sudden onset of fever and chills, with rales and rusty sputum b. Insidious onset, diffuse interstitial infection c. Viral infection causing nonproductive cough and pleuritic pain d. Opportunistic bacteria causing low-grade fever with cough and thick greenish sputum 288 28. How does severe hypoxia develop with pneumonia? a. Acidosis depresses respirations. b. Oxygen diffusion is impaired by the congestion. c. Inflammatory exudate absorbs oxygen from the alveolar air. d. Infection reduces effective compensation by the heart. 288 29. Rust-colored sputum in a patient with pneumonia usually indicates: a. secondary hemorrhage in the lungs. b. Streptococcus pneumoniae is the infecting agent. c. prolonged stasis of mucous secretions in the airways. d. persistent coughing has damaged the mucosa in the bronchi. 289 30. What is the cause of Legionnaires’ disease? a. Mycoplasma b. A fungus c. A gram-negative bacterium d. Pneumococcus 290 31. Select the statement related to tuberculosis: a. The microbe is present in the sputum of all patients with a positive TB skin test. b. The infection is transmitted primarily by blood from an infected person. c. TB is usually caused by an acid-fast bacillus, resistant to many disinfectants. d. The microbe is quickly destroyed by the immune response. 290-291 32. How is primary tuberculosis identified? a. Cavitation in the lungs and spread of the microbe to other organs b. Persistent productive cough, low-grade fever, and fatigue c. Caseation necrosis and formation of a tubercle in the lungs d. Multiple granulomas in the lungs and rapid spread of the microbe 291 33. When does active (secondary) infection by Mycobacterium tuberculosis with tissue destruction occur? 290 34. Which of the following statements does NOT apply to M. tuberculosis? a. Microbes can survive for a long time inside tubercles. b. The bacilli can survive some adverse conditions such as drying and heat. c. Infection is limited to the lungs. d. The bacilli can be destroyed by antibacterial drugs. 291 35. Which of the following confirms the presence of active (reinfection) tuberculosis? a. When host resistance is decreased b. When a hypersensitivity reaction is initiated c. When the BCG vaccine is not administered immediately following exposure to the microbe d. When Ghon complexes form in the lungs a. A positive skin test for TB b. A calcified tubercle shown on a chest X-ray c. Identification of acid-fast bacilli in a sputum sample d. A history of exposure to individuals being treated for TB 290 36. Areas in the United States that show higher rates than the national rate of TB are areas that have a high incidence of: 293 37. Histoplasmosis is caused by a: a. fungus. b. virus. c. bacillus. d. protozoa. 294 38. Cystic fibrosis is transmitted as a/an: a. HIV and homelessness. b. obesity and tobacco use. c. elderly persons and radon. d. steroid use and alcoholism. a. X-linked recessive gene. b. autosomal recessive gene. c. autosomal dominant gene. d. chromosomal defect. 294 39. The basic pathophysiology of cystic fibrosis is centered on a/an: a. defect of the exocrine glands. b. impaired function of the endocrine glands. c. chronic inflammatory condition of the lungs. d. abnormal immune response in the lungs and other organs. 294 40. Growth and development of a child with cystic fibrosis may be delayed because of: a. deficit of gastric enzymes for protein digestion. b. mucus plugs obstructing the flow of pancreatic enzymes. c. lack of available treatment for steatorrhea. d. abnormal salivary secretions. 294 41. Persistent thick mucus in the bronchioles of a child with cystic fibrosis may cause: 1. air trapping. 2. atelectasis. 3. repeated infections. 4. irreversible damage to lung tissue. a. 1, 2 b. 2, 4 c. 1, 3, 4 d. 1, 2, 3, 4 294 42. What is a common indicator of cystic fibrosis in the newborn? a. Infant respiratory distress syndrome b. Failure to excrete meconium c. Taste of ammonia on the skin d. Lack of bile secretions 297 43. What is an early sign of bronchogenic carcinoma? a. Air trapping and overinflation of the lung b. Weight loss c. Bone pain d. Chronic cough 296-297 44. Cigarette smoking predisposes to malignant neoplasms because smoking: a. can cause metaplasia and dysplasia in the epithelium. b. promotes malignant changes in all types of benign tumors in the lungs. c. causes paraneoplastic syndrome. d. increases exposure to carbon monoxide in the lungs. 297 45. Why does hypercalcemia occur with bronchogenic carcinoma? a. Invasion of the parathyroid gland by the tumor b. Secretion of parathyroid or parathyroid like hormones by the tumor c. Destruction of the ribs d. Failure of the kidney to excrete calcium ions 299 46. What is a sign indicating total obstruction of the airway by aspirated material? a. Hoarse cough b. Rapid loss of consciousness c. Dyspnea d. Inflammation of the mucosa 299 47. Which of the following predisposes to postoperative aspiration? a. Reduced pressure of the abdominal organs on the diaphragm b. Depression of the vomiting center by anesthetics and analgesics c. Vomiting caused by drugs or anesthesia d. Lack of food intake for the previous 24 hours 300 48. What is the pathophysiology of an acute attack of extrinsic asthma? a. Gradual degeneration and fibrosis b. Continuous severe attacks unresponsive to medication c. A hypersensitivity reaction involving release of chemical mediators d. Hyperresponsive mucosa 300 49. During an acute asthma attack, how does respiratory obstruction occur? 1. Relaxation of bronchial smooth muscle 2. Edema of the mucosa 3. Increased secretion of thick, tenacious mucus 4. Contraction of elastic fibers a. 1, 2 b. 1, 3 c. 2, 3 d. 2, 4 303 | 322 50. What cause the expanded anteroposterior (A-P) thoracic diameter (barrel chest) in patients with emphysema? 303 51. Which of the following is typical of progressive emphysema? a. Vital capacity increases. b. Residual lung volume increases. c. Forced expiratory volume increases. d. Tidal volume increases. 303 52. Destruction of alveolar walls and septae is a typical change in: a. chronic bronchitis. b. acute asthma. a. Air trapping and hyperinflation b. Persistent coughing to remove mucus c. Recurrent damage to lung tissues d. Dilated bronchi and increased mucous secretions c. emphysema. d. asbestosis. 302 53. A group of common chronic respiratory disorders characterized by tissue degeneration and respiratory obstruction is called: 303 54. Which statement does NOT apply to emphysema? a. The surface area available for gas exchange is greatly reduced. b. A genetic defect may lead to breakdown of elastic fibers. c. The ventilation/perfusion ratio remains constant. d. Expiration is impaired. 307 55. What is the cause of chronic bronchitis? a. Chronic irritation, inflammation, and recurrent infection of the larger airways b. A genetic defect causing excessive production of mucus a. mesothelioma. b. COPD. c. CF. d. MD. c. Hypersensitivity to parasympathetic stimulation in the bronchi d. Deficit of enzymes, preventing tissue degeneration 307 56. Which of the following is typical of chronic bronchitis? a. Decreased activity of the mucous glands b. Fibrosis of the bronchial wall c. Overinflation of bronchioles and alveoli d. Formation of blebs or bullae on the lung surface 307 57. What are typical pathological changes with bronchiectasis? a. Bronchospasm and increased mucous secretion b. Adhesions and fibrosis in the pleural membranes c. Airway obstructions and weak, dilated bronchial walls d. Fixation of the ribs in the inspiratory position 308 58. Which of the following are significant signs of bronchiectasis? a. Persistent nonproductive cough, dyspnea, and fatigue b. Persistent purulent nasal discharge, fever, and cough c. Chronic cough, producing large quantities of purulent sputum d. Wheezing and stridor 302 | 304 59. Why does cor pulmonale develop with chronic pulmonary disease? a. The right ventricle pumps more blood than the left ventricle. b. Pulmonary fibrosis and vasoconstriction increase vascular resistance. c. Demands on the left ventricle are excessive. d. Blood viscosity is increased, adding to cardiac workload. 308 60. Restrictive lung disorders may be divided into two groups based on: a. patient history of obesity and exposure to other COPD. b. smoking history and congenital defects. c. previous lung disease and cardiovascular disorders. d. anatomical abnormality and lung disease damage, impairing expansion. 303 61. What is caused by frequent inhalation of irritating particles such as silica? a. Fibrosis and loss of compliance b. Frequent bronchospasm c. Increased number of mucus-producing glands d. Distorted shape of the thorax 309 62. Pulmonary edema causes severe hypoxia because of: a. decreased diffusion of carbon dioxide from the alveoli. b. interference with expansion of the lungs. c. constant cough and hemoptysis. d. decreased recoil of lungs and ineffective expiration. 309 63. Which of the following is NOT a cause of pulmonary edema? a. Left-sided congestive heart failure b. Excessive blood volume (overload) c. Inhalation of toxic gases d. Hyperproteinemia and increasing osmotic pressure of the blood 309 64. Which of the following is a common source of a pulmonary embolus? a. Mural thrombus from the left ventricle b. Thrombus attached to atheromas in the aorta or iliac arteries c. Thrombus forming in the femoral veins d. A blood clot in the pulmonary vein 309-310 65. What is a large-sized pulmonary embolus likely to cause? a. Hypertension and left-sided heart failure b. Atelectasis and respiratory failure c. Hypotension and right-sided heart failure d. Pleural effusion and atelectasis 312 66. Which manifestation(s) of atelectasis is/are associated with airway obstruction? a. Bradycardia and dyspnea b. Tracheal deviation toward the unaffected side c. Decreased breath sounds on the affected side d. Rales and rhonchi 312 67. How does total obstruction of the airway lead to atelectasis? a. Decreased surfactant production impairs lung expansion. b. The involved lung is compressed. c. Air is absorbed from the alveoli distal to the obstruction. d. Air continues to be inspired but is trapped distal to the obstruction. 312 68. How does a large pleural effusion lead to atelectasis? a. The cohesion between the pleural membranes is disrupted. b. There is decreased intrapleural pressure. c. The mediastinal contents compress the affected side. d. Pleuritic pain causes very shallow breathing. 316 69. When does flail chest usually occur? a. An open puncture wound involves the pleural membranes. b. The visceral pleura is torn by a fractured rib. c. Several ribs are fractured at two sites. d. Increasing fluid in the pleural cavity causes atelectasis. 316 70. With a flail chest injury, events during inspiration include which of the following? a. Air is sucked into the lung through the chest wall. b. The mediastinum shifts toward the unaffected side. c. The floating segment is pushed outward. d. The trachea deviates toward the affected side. 316 71. How is cardiac output reduced with a flail chest injury? a. Atelectasis compresses the heart. b. Venous return is impaired. c. Intrapleural pressure is decreased. d. Air pressure continues to increase in the pleural space. 314 72. Which of the following is a manifestation of a simple closed pneumothorax? a. Decreased respiratory rate b. Tracheal deviation toward the unaffected lung c. Asymmetrical chest movements d. Increased breath sounds on the affected side 314 73. Which of the following is an effect of a large open pneumothorax (sucking wound)? a. Mediastinal flutter, impairing venous return b. Increased venous return c. Progressive atelectasis of both lungs d. Overexpansion of the unaffected lung 316 74. With a tension pneumothorax, which factors contribute to severe hypoxia? a. Decreasing compression of the inferior vena cava b. More air leaving the pleural cavity on expiration than entering with inspiration c. Shift of the mediastinal contents toward the affected lung d. Continually increasing pressure on the unaffected lung 319 75. Which of the following statements describe the pathophysiology of adult respiratory distress syndrome? 1. Damage leading to increased permeability of the alveolar capillary membranes 2. Decreased surface tension in the alveoli 3. Excessive fluid and protein interstitially and in the alveoli 4. Multiple diffuse hemorrhages in the lungs a. 1, 2 b. 1, 3 c. 2, 3 d. 3, 4 317 76. Infant respiratory distress syndrome results from: a. insufficient surfactant production. b. incomplete expiration shortly after birth. c. retention of fluid in the lungs after birth. d. immature neural control of respirations. 282 77. Obstruction in the upper airway is usually indicated by: a. stridor. b. rales. c. wheezing. d. orthopnea. 280 78. Which of the following does NOT apply to carbon dioxide? a. It diffuses across membranes much more easily than does oxygen. b. It is carried in blood as carbaminohemoglobin. c. It can be converted into bicarbonate ion. d. It is replaced on hemoglobin by oxygen in the lungs. 278 79. Whenever PO2 levels decrease below normal, PCO2 levels: a. increase. b. decrease also. c. may or may not change. d. increase slightly. 283 80. Laryngotracheobronchitis is typically manifested by: a. drooling and difficulty swallowing. b. hoarse voice and barking cough. c. sore and scratchy throat with fever. d. wheezing and dyspnea. 286 81. Lobar pneumonia is usually caused by: a. Mycoplasma pneumoniae. b. Streptococcus pneumoniae. c. Legionella pneumophila. d. Pneumocystis carinii. 290 82. Severe acute respiratory syndrome (SARS) is caused by a/an: a. rhinovirus. b. mycoplasma. c. influenza virus. d. coronavirus. 290 83. SARS typically begins as a flulike syndrome followed, after a few days, by: a. increased exudates in the bronchial tree and pleural cavity. b. productive cough and lobar consolidation. c. interstitial lung congestion, dyspnea, and dry cough. d. hemoptysis and necrosis of mucous membrane. 294 84. In addition to effects on the lungs and pancreas, cystic fibrosis results in: a. excess bile production. b. high sodium chloride content in saliva and sweat. c. gastric ulcers. d. frequent ear and sinus infections. 297 85. Which of the following is a significant early sign of bronchogenic carcinoma in a smoker? a. Frequent nonproductive cough b. Fever, dyspnea, generalized aching c. Production of large volumes of purulent sputum d. Hemoptysis and weight loss 297 86. Which of the following is likely to cause pneumothorax or hemothorax in a patient with bronchogenic carcinoma? 292 87. Which of the following would confirm a diagnosis of primary tuberculosis? a. A positive tuberculin skin test b. Occurrence of hemoptysis c. Unproductive cough with absence of sputum d. Small areas of calcification on a chest X-ray 293 a. The tumor obstructs a major bronchus. b. Compression of lung tissue by the tumor causes atelectasis. c. The tumor causes inflammation and erosion of the pleural membranes. d. Inflammation around the tumor causes exudate in the small bronchi. 88. Which of the following drugs is usually prescribed for prophylaxis in persons in close contact with a patient with active tuberculosis? 293 89. Which of the following statements is FALSE? a. TB bacilli are spread by oral droplet. b. TB bacilli are slow-growing bacteria. c. Active TB must be treated in hospital for many months. d. Active TB can be prevented by good host resistance. 309 90. Choose the correct reason for severe hypoxia occurring with pulmonary edema: a. Diffusion of oxygen into the alveoli is impaired. b. Fluid in the pleural cavity prevents normal lung expansion. c. Increased concentration of CO2 impairs diffusion of oxygen. d. Increased blood flow through the lungs prevents diffusion of gases. 302 a. Streptomycin b. Isoniazid c. Rifampin d. Streptomycin 91. Which of the following drugs in an inhaler would likely be carried by individuals to provide immediate control of acute asthma attacks? 304 92. Development of emphysema in a nonsmoker may be the result of: a. a genetic factor. b. obesity. c. vitamin deficiencies. d. a developmental defect. 312 93. Which factors contribute to postoperative atelectasis? 1. Decreased secretions in the airways 2. Drug-related respiratory depression 3. Abdominal distention and pain 4. Excessive deep-breathing and coughing a. 1, 2 b. 2, 3 a. A glucocorticoid b. Epinephrine c. Cromolyn d. A β2-adrenergic agent c. 3, 4 d. 1, 4 289 94. Primary atypical pneumonia (PAP) is caused by: a. Klebsiella oxytoca. b. Candida albicans. c. Mycoplasma pneumoniae. d. Streptococcus pneumoniae. 317 95. All of the following are expected with infant respiratory distress syndrome EXCEPT: a. severe hypoxia. b. respiratory alkalosis. c. pulmonary vasoconstriction. d. fluid and protein in the alveoli. 282 96. Which factor usually causes metabolic acidosis to develop in association with hypoxia? a. Anaerobic metabolism b. Failure to excrete CO2 c. Liver dysfunction d. Increased blood volume 316 97. Mediastinal flutter associated with chest injury is likely to: a. cause pulmonary edema. b. cause hypocapnia. c. increase lung expansion. d. decrease venous return to the heart. 292 98. Which of the following individuals is NOT considered to be at high risk for developing active tuberculosis? 285 99. Which of the following distinguishes influenza from infectious rhinitis? a. Influenza is a viral infection. b. Treatment is symptomatic a. Homeless individuals b. Individuals with AIDS c. Persons who experience acute asthma attacks d. Those living in institutions c. Influenza has a sudden onset with fever, marked muscle aching, and severe malaise. d. Complications can occur with influenza. 300 100. The use of a continuous positive airway pump in the treatment of sleep apnea will: a. reduce bronchospasm. b. force expansion of pleural membranes. c. maintain an open airway. d. awaken the person and increase respirations. 309 101. Hemoptysis is a significant sign of: a. pleural effusion. b. pulmonary embolus. c. pulmonary edema. d. atelectasis. 293 102. Which of the following applies to anthrax infection? a. It is caused by a virus that mutates frequently. b. When inhaled, it causes flulike symptoms followed by acute respiratory distress. c. There is a long incubation period, often months, following exposure. d. It is a common infection in North America. 294 103. The mutated gene for cystic fibrosis is located on the: a. seventh chromosome. b. tenth chromosome. c. fifteenth chromosome. d. X chromosome. 298 Chapter 14: Neurological Disorders Chapter 14: Neurological Disorders Test Bank MULTIPLE CHOICE 1. Through what area does the cerebrospinal fluid circulate around the brain and spinal cord? a. Between the double layers of the dura mater b. In the subdural space c. In the subarachnoid space d. Through the arachnoid villi 327 2. Which of the following is the usual location of language centers? a. Left hemisphere b. Right hemisphere c. Brainstem d. Hypothalamus 329 3. What would be the effect of damage to the auditory association area in the left hemisphere? a. Loss of hearing in both ears b. Inability to understand what is heard c. Loss of hearing in the left ear d. Inability to determine the source of the sound 329 4. Which of the following applies to the corticospinal tract? a. It is an ascending tract. b. The nerve fibers conduct sensory impulses. c. It is an extrapyramidal tract. d. It is a pyramidal tract for efferent impulses. ANS: D REF REF: 332 5. What is a major function of the limbic system? a. Overall control of fluid balance b. Required for logical thinking, reason, and decision making c. Determines emotional responses d. Responsible for artistic and musical talents 330 6. Where are β1-adrenergic receptors located? a. Bronchiolar walls b. Arteriolar walls c. Cardiac muscle d. Glands of the intestinal tract 337 7. What does a vegetative state refer to? a. Depression of the reticular activating system (RAS) and inability to initiate action b. Loss of awareness and intellectual function but continued brainstem function c. Continuing intellectual function but inability to communicate or move d. Disorientation and confusion with decreased responsiveness 338-339 8. Which of the following conditions is NOT part of the criteria for a declaration of “brain death”? a. No activity on EEG b. Absence of all reflexes c. No spontaneous respirations d. Presence of any head injury 339 9. What is the best definition of aphasia? a. The inability to comprehend or express language appropriately b. Difficulty swallowing c. Loss of the visual field contralateral to the area of damage d. The inability to articulate words clearly 340 10. What is an early indicator of increased intracranial pressure? a. Papilledema b. Bilateral fixed dilated pupils c. Decreasing responsiveness d. Rapid heart rate 342 11. What is the rationale for vomiting in a patient who has increased intracranial pressure? a. Chemoreceptors responding to changes in the blood b. Pressure extending to spinal nerves c. Pressure on the emetic center in the medulla d. Stimuli to the hypothalamic center for hunger and thirst 342 12. What is the typical change in blood pressure in a patient who has increased intracranial pressure? a. Erratic diastolic pressure b. Decreasing systolic pressure c. Systolic and diastolic pressures decreasing proportionately d. Increasing pulse pressure 342 13. The largest category of primary malignant brain tumors that arise from cells in the central nervous system (CNS) are called: 345 14. Which of the following causes papilledema? a. gliomas. b. sarcomas. c. lymphomas. d. myelomas. a. Increased pressure of cerebrospinal fluid (CSF) at the optic disc b. Increased intraocular pressure c. Pressure on the oculomotor nerve d. Pressure on the optic chiasm 342 15. What is the effect of an enlarging brain abscess on cardiovascular activity? a. Increased heart rate and systemic vasodilation b. Low blood pressure and irregular heart and respiratory rates c. Systemic vasoconstriction and slower heart rate d. Immediate depression of the cardiac control centers 342 16. As intracranial pressure rises, the pupil of the eye, ipsilateral to the lesion, becomes dilated and unresponsive to light because of pressure on the: 342 17. Which of the following characteristics indicates that the CSF is normal? a. optic nerve. b. peripheral nervous system (PNS) fibers in cranial nerve III. c. sympathetic nervous system (SNS) nerve to the eye. d. occipital lobe. a. Cloudy and pale yellow color b. Presence of erythrocytes c. Presence of numerous leukocytes d. Clear and colorless fluid 327 18. Which of the following statements is TRUE about malignant brain tumors? a. Most brain tumors arise from malignant neurons. b. Primary brain tumors rarely metastasize outside the CNS. c. The blood-brain barrier prevents secondary brain tumors. d. Brainstem tumors do not manifest signs until they are quite large. 345 19. Secondary brain tumors usually arise from: a. severe head trauma. b. metastasized breast or lung tumors. c. exposure to carcinogenic agents. d. exposure to radiation. 345 20. Why are focal or generalized seizures sometimes an early indication of a brain tumor? a. Surrounding inflammation stimulates neurons to discharge spontaneously. b. Malignant tumors cause alkalosis, exciting the CNS. c. Systemic effects of the brain tumor may cause seizures. d. Metabolic effects of cancer change blood chemistry to trigger seizures. 345 21. Which of the following is a TRUE statement about transient ischemic attacks (TIAs)? a. They usually cause necrosis and permanent brain damage. b. They may be caused by rupture of an aneurysm or a damaged artery. c. They usually indicate systemic hypertension. d. They can warn of potential cerebrovascular accidents. 346 22. What is the probable source of an embolus causing a cerebrovascular accident (CVA)? a. Right ventricle of the heart b. Femoral vein c. Common carotid artery d. Pulmonary artery 347 23. Collateral circulation is most likely to be present when a CVA results from: a. rupture of a cerebral artery. b. an embolus. c. atherosclerosis. d. vasospasm in the cerebral circulation. 347 24. All of the following apply to CVA EXCEPT: a. the common cause is an atheroma with thrombus. b. maximum necrosis and infarction develop within several hours of onset. c. warning signs may appear with partial obstruction of the artery. d. increasing neurological deficits usually develop during the first few days. 346-347 25. Signs and symptoms of a stroke depend upon: a. location of obstruction, size of artery, and area affected. b. duration of the blockage, distance from the heart, and type of obstruction. c. health of the victim, area affected, and collateral circulation. d. size of the obstruction, condition of the heart, and duration of blockage. 348 26. In the weeks following CVA, why might some neurological function return? 1. Presence of collateral circulation 2. Immediate therapy to dissolve thrombi and maintain perfusion 3. Reduced inflammation in the area 4. Development of alternative neuronal pathways a. 1 only b. 2 only c. 1, 3 d. 2, 3, 4 e. 1, 2, 3, 4 347 27. Which of the following statements about berry aneurysms in the brain is NOT true? a. They usually develop at points of bifurcation in the circle of Willis. b. They are usually asymptomatic for many years. c. CSF remains free of blood. d. Following rupture, blood appears in the subarachnoid space. 349-350 28. In a case of bacterial meningitis, where does swelling and purulent exudate form? a. In the pia mater, arachnoid, and surface of the entire brain b. In the dura mater and epidural space c. At the site of the injury or entry point of the microbes d. Primarily around the spinal cord 350 29. What are significant signs of acute bacterial meningitis? a. Severe headache, nuchal rigidity, and photophobia b. Fatigue and lethargy, fever, and anorexia c. Focal signs, such as progressive paralysis in a limb d. Ascending paralysis beginning in the legs 351 30. In many types of encephalitis, such as St. Louis encephalitis, how are the viruses transmitted? a. Carriers b. Mosquito and tick bites c. Respiratory droplet d. Septic emboli in the circulation 352 31. All of the following apply to tetanus infection EXCEPT: a. it is caused by an anaerobic, spore-forming bacillus. b. the exotoxin causes strong skeletal muscle spasms. c. death usually results from respiratory failure. d. signs of fever, vomiting, stiff neck, and paralysis. 353 32. In cases of Guillain-Barré syndrome, what does the pathophysiology include? a. Damage and loss of function in the motor neurons of the spinal cord and medulla b. Encephalopathy, with disorientation, headache, and coma c. Infection and inflammation of the motor cortex d. Inflammation and demyelination of peripheral nerves, leading to ascending paralysis 354 33. How does a depressed skull fracture cause brain damage? a. A bone fragment penetrates and tears brain tissue. b. A section of the skull is missing, leaving the brain unprotected. c. A section of skull bone is displaced below the level of the skull, causing pressure on the brain. d. Many fracture lines are present, causing instability. e. The contrecoup injury is the cause of brain damage. 355 34. Following a head injury, what is the most likely cause of secondary damage to the brain? a. Hematoma or infection b. Laceration by foreign objects c. Hypoxia or acidosis d. Tearing of blood vessels as the brain rotates across the inside of the skull 357 35. An epidural hematoma is located between the: a. dura mater and the arachnoid mater. b. dura mater and the skull. c. arachnoid mater and the pia mater. d. pia mater and the brain. 358 36. What does the term otorrhea mean? a. Bleeding from the nose. b. CSF leaking from the ear. c. Torn meninges but no skull fracture. d. Hemorrhage from the ear. 358 37. Vertebral fractures are classified as: a. simple, compression, wedge, dislocation. b. compound, open, closed, shattered. c. complex, torsion, open, multiple. d. pressure, complex, simple, variable. 359 38. Following a spinal injury at C5, what is the expected effect during the period of spinal shock? a. Spastic paralysis below the level of the injury b. Urinary incontinence c. Possible periods of apnea d. Normal blood pressure 360 39. Following an injury at L2 to L3, what would indicate recovery from spinal shock? a. Spastic paraplegia b. Urinary retention c. Labile body temperature d. Increased sensation in the legs 361 40. What are the signs of autonomic dysreflexia in a person with cervical spinal injury? a. Unexpected drop in blood pressure and apnea b. Sudden marked increase in blood pressure with bradycardia c. Hyperreflexia in the arms and legs d. Urinary and bowel incontinence 362 41. Expressive aphasia is most likely to result from damage to: a. the left frontal lobe. b. the left temporal lobe. c. the right motor cortex. d. Wernicke’s area. 340 42. What is the usual result of damage to the right occipital lobe? a. Left eye is blind b. Loss of left visual field c. Rig