blue book questions Flashcards
Which are the principle parts of a eukaryotic cell?
organelles
The cell membrane is described as a fluid mosaic. Some proteins have a degree of mobility within the lipid bilayer
The first sentence is true
The second sentence is true
The second sentence is relevant to the first
Which particle can penetrate cell membranes most easily
Lipid soluble, transport protein present
For a cell to engage in active transport process, it requires
All the above (mitochondria, fuel, ATP, Enzymes)
Which is inconsistent with the other?
a. diffusion
b. osmosis
c. filtration
d. phagocytosis
e. facilitated transport
d. phagocytosis
which can transport substance uphill against the concentration gradient?
active transport
carveolae
a. serve as repositories for some receptors
b. provide a route for transport into the cell
c. relay signals into cells
d. all of the above
d. all of the above
which statement is true for cytoplasm?
a. it is located outside the nucleus
b. it provides support for organelles
c. it is mostly water
d. a, b, and c
d. a, b, and c
the retinoblastoma (Rb) protein:
a. is a break on the progress of the cell cycle
b. binds to gene regulatory proteins
c. slows cell proliferation
d. a and c
e. a, b, and c
e.
a major function of connective tissue is
support and binding
which are characteristic of epithelial tissue
protection and secretion
signaling molecules cause all of the following except:
conversion of an intracellular signal into an extracellular response
ligands that bind with membrane receptors include which of the following? (may be more than 1)
a. hormones
b. antigens
c. neurotransmitters
d. drugs
e. infectious agents
b. antigens
e. infectious agents
The products from the metabolism of glucose include which of the following
Kilocalories, CO2, H2O, ATP
Identify the correct sequence of events for initiation and conduction of a nerve impulse
Sodium permeability changes, sodium moves inside, potassium permeability changes, potassium leaves cell, resting potential is reestablished
Increased cytoplasmic calcium
Decreases permeability at the junctional complex
Cell junctions
a. coordinate activités of cell within tissues
b. are an impermeable part of the plasma
c. hold cells together
d. both a and c
e. both b and c
D
Coordinate activities of cells within in tissues and hold cells together
Which genetic disease is caused by abnormal karyotype
Down syndrome
Which is not characteristics of Down syndrome
It is a genetic error of metabolism
Cri-du-chat syndrome in an abnormality of
deletion
An individual’s karyotype lacks a homologous X chromosome and has only a single X chromosome presents. Which statement is not true
The karyotype is 46,XY
If homologous chromosomes fail to separate during meiosis, the disorder is:
nondisjunction
cystic fibrosis has been mapped to chromosome
7
in autosomal dominant inherited disorders
affected persons mating with normal persons have a 50% risk of have an affected offspring
Identify the characteristics of X-linked recessive inherited disorders
Affected males have normal sons
Affected males have affect daughters
Sons of female carriers have a 50% risk of being affected
Which is/are not autosomal dominant disease
Duchenne muscular dystrophy
Pyloric stenosis
When environmental influences cause varied phenotypic expressions of genotypes, the result is
A multifactorial trait
Which likely is not multifactorial inherited disorder
Cystic fibrosis
A cellular adaptation observable in uterine cervical epithelium is:
Dysplasia
What are the consequences when a cell is forced into anaerobic glycolysis?
Increased lactic acid
Inadequate ATP production
What is the probable cause of cellular swelling in the early stages of cell injury
Na+ - K pump fails to remove intracellular Na+
Dystrophic calcification
Occurs in dying or dead tissues
Is observed in chronic lesion
cellular swelling is:
a. irreversible
b. evident early in all types of cellular injury
c. manifested by decreased intracellular sodium
d. none of the above
D
Which is not reversible
Karyolysis
Aging:
Is caused by declining stem cell numbers
In aging, cross-linking implies
cell permeability decreases
Aquaporins is/are:
Water channel proteins that provide cell membrane permeability to water
Of the 60% of the body weight made up of water, about 2/3 is
intracellular water
Sodium is responsible for
Osmotic equilibrium
A milliequivalent is a unit of
Chemical activity
Which statement is true?
a. the number of ions and anions in the body must be equal
b. intravascular molecules of protein are without charge
c. the sodium ions must be united with chloride ions
d. the positive and negative charges in blood plasma must be equal to each other
D
Aldosterone controls ECF volume by
sodium reabsorption
The release of ADH is not stimulated by
hyponatremia
Laboratory studies of an adult reveal the following: Plasma sodium = 110mEq/L Plasma chloride = 85mEq/L Plasma potassium = 4.8mEq/L Plasma calcium = 5.2mEq/L Plasma bicarbonate = 26mEq/L The most likely alteration is :
hyponatremia and calcium deficit
An individual suffers from weakness, dizziness, irritability, and intestinal cramps. Laboratory studies reveal the following: Plasma sodium = 138mEq/L Blood pH= 7.38 Plasma potassium = 6.8mEq/L Plasma bicarbonate = 25mEq/L An EKG with tall, peaked T wave The individual is suffering from:
hyperkalemia
An acid is
A substance/chemical that donates a hydrogen ion or a proton to the solution
Strong acids:
Include phosphoric acid
Contribute many H+ to the solution
Are eliminated by the renal tubules
The pH of saliva is about 7 and the pH of gastric juice is about 2. How many times more concentrated is the hydrogen ion in gastric juice than in saliva
100,00
The blood pH is maintained near 7.4 by buffering systems. The sequence from the fastest-acting to the slowest-acting system is
blood buffers, lungs, kidneys
Which would not shift the blood pH toward alkalosis
Bicarbonate ion secretion into urine
A young female became agitated and apprehensive, and the eventually lost consciousness. At the hospital emergency room, the following laboratory values were obtained : Plasma sodium = 137mEq/L Plasma potassium = 5.0mEq/L Blood pH = 7.53 Serum CO2 = 22mmHg Plasma bicarbonate = 24mEq/L re Her immediate diagnosis is:
respiratory alkalosis
As HCO-3 shifts from the red blood cell to the blood plasma, it is expected that the plasma
Cl- shifts into the red blood cell
An elevated anion gap is associated with an accumulation of
lactate anion
Innate resistance or immunity:
Depends on physical, mechanical, and biochemical barriers
Collectins:
Protect against respiratory infection
Complement is:
A series of proteins in the blood
Diapedesis is a process in which:
Neutrophils migrate from the bloodstream to an injured tissue site
interferon:
Prevents viruses from infecting healthy host cells
The sequence of inflammatory events within the vasculature is:
Arteriolar vasoconstriction, vasodilation, increased capillary permeability, plasma leakage, edema
The inflammatory response
Minimizes injury and promotes healing
The alternative complement pathway is activated by
Gram-negative bacterial and fungal cell wall polysaccharides
The activation of Hageman factor affects all three
Activation of kinin system by a fragment of Hageman factor
The sequence of phagocytosis
Margination, diapedesis, recognition, adherence, ingestion, fusion with lysosomes inside the phagocyte, destruction of the target
Swelling during acute inflammation is caused by
Fluid exudate
Recognition of abnormal environmental components so cells can respond to these substances is by binding to cell surface receptors. Cells involved in the innate resistance have
Pattern recognition receptors (PRR)
Mast cell degranulation release
Histamine, IL-4, and eosinophil chemotactic
Interleukin 6
Stimulates growth of blood cells and fibroblasts
Tumor necrosis factor
Causes tumor cytotoxicity
Characteristic systemic manifestations of acute inflammation include
Fever caused by the release of IL-1 by neutrophils and macrophages
Chronic inflammation is characterized by
Lymphocytic and macrophagic infiltration
Scar tissue is
Nonfunctional collagenous and fibrotic tissue
Neutrophils are
the predominant phagocytes arriving early at inflammatory and infection sites
Macrophages in comparison with neutrophils and basophils,
function for a longer time and later in the inflammatory response and are involved in the activation of the adaptive immune system
Eosinophils
serve as primary defenders against parasites and help regulate vascular mediators released from mast cells by preventing more inflammatory activity than is needed
Natural killer cells r
ecognize and eliminate virus-infected cells and cancerous cells
Granulation tissue is
filled with new capillaries and is surrounded by fibroblasts and macrophages
Immunogenicity depends on
Host foreignness
Which of the following are capable of forming clones
Both T and B cells
Which cells are stimulated by IL-2
T cells and NK cells
Which cells bind with MHC class I molecules
Cytotoxic T cells
HLAs
Are not found on the surfaces of erythrocytes
CD4 markers are associated with
Helper T cells
Antibodies are produced by
Plasma cells
An immunoglobulin contains
Two heavy and two light polypeptide chains
The antibody class that has the highest concentration in the blood
IgG
Which of the following antibodies is matched with its appropriate role
IgM/first to challenge the antigen
The primary immune response involves
A latent period followed by peak antibody production
The B cell receptor complex consists of
Antigen-recognition molecules
Cytokines and their receptors functions
As chemical signals between cells
Clonal selection
Occurs primarily after birth and through life
Immunologic tolerance develops because
Self-reactive lymphocytes are eliminated in the primary lymphoid organs
Antigenic destruction/removal by humoral immunity requires
Phagocytosis
Cytotoxic T cells
Inhibit virus-infected cells
Antibody is effective against
Extracellular viruses
Extracellular viruses
Adhesion molecule pairings involve
Cytotoxic T cell CD8 MHC class I on APC
Transforming growth factor (TGF) functions to
Stimulate wound healing
Helper T Cells
are necessary to include both humoral and cellular immune responses
Regulatory T cells
function to avoid attacking self-antigens or to avoid overactivation of immune response
Super antigens
cause activation of large populations of T lymphocytes irrespective of antigen specificity
The Secretory Immune System
consists of antibodies in bodily secretions that protect the body against antigens yet to penetrate the skin or mucous membranes
Immunologic responses recognized as disease are
Immediate hypersensitivities
Delayed hypersensitivities
Which is not characteristic of hypersensitivity
Prior contact unnecessary to elicit a response
When the body produces antibodies against its own tissue, the condition is called
An autoimmune disease
Which hypersensitivity is cause by poison Ivy
Type IV
The mechanism of hypersensitivity for drugs is
Type I, II, III
Which is not an autoimmune disease
Transfusion reaction
Damage in systemic lupus erythematosus (SLE)
The humoral immune system and complement
The classical complement cascade begins with
Antigen/antibody complexes binding to a component of the complement system
Which of the following is/are an alloimmune disorder
Erythroblastosis fetalis
Immunodeficienceies occur because of impaired function of
B and T cells
Phagocytic cells
Complement
An X-linked recessive disorder of immune deficiency involves a deficit of
IgM
Deficiencies in B cell immune response are suspected when unusual or recurrent severe infections are caused by
encapsulated bacteria
DiGeorge syndrome is a primary immune deficiency caused by
Congenital lack of thymic tissue
Secondary or acquired immunodeficiencies
Develop after birth
May be caused by viral infections
May develop following immunosuppressive therapy
Rejection of a kidney transplant occurred after 2 weeks. The reaction occurred because of:
Immune response against donor HLA antigens
Type IV hypersensitivity
SCID exhibits
B and T cell deficits
A positive HIV antibody test signifies that the
Individual is infected with HIV and likely so for life
Which is incorrect regarding AIDS
The patient will have increased numbers of CD4+ cells or helper Tcells
Which characterizes cancer cells
Poorly differentiated
Metastasis
Infiltrative growth mode
Poor cellular cohesiveness
Tumor cell markers
Can monitor the course of cancer
Telomeres
Block unlimited cell division
Metastasis is
The ability to establish a secondary neoplasm at a new site
Carcinoma in situ is
Pre-invasive
A glandular or epithelial lesion
Known routes of metastasis include
Continuous extension
Lymphatic spread
Continuous extensions
Bloodstream dissemination
Tumor suppressor genes are
Genes that produce proteins that inhibit cellular division
In the current theory of carcinogenesis
Several mutagenic hits are required
Sequential genetic changes occur
Which is not involved in metastasis
Interference
Loss of E-cadherin
Causes cells to detach from their extracellular attachments
The p53 gene
Enables cells to cope with DNA damage
Blocks the proliferation of cells that have suffered carcinogenic mutations
Mutations are the most common genetic lesions in the human race
Mutations disable an emergency brake on cell proliferation
Local invasive factors include all except
Increased cellular adhesion
The sequence of carcinogenesis is
Several mutagenic hits the DNA, reactivation of telomerase, and development of immortal cells
Adjuvant chemotherapy
Follows surgery to eliminate micrometastasis
Neoplasia
Abnormal, proliferating cells possessing a higher degree of autonomy than normal cells
Anaplasia
Lack of cellular differentiation or specialization, primitive cells
Autonomy
Cancer cells’ independence from normal cellular controls
Preventing exposure to ______ can prevent many cancers
carcinogens
The expression of _____ is linked to carcinogenesis because they can act as either oncogenes or tumor-suppressor genes
mRNA
Developmental plasticity
is the ability to develop in a particular way depending on the environment
Xenobiotics
include toxic, mutagenic and carcinogenic chemicals
One function of the somatic nervous system that is not performed by the autonomic nervous system is conduction of impulses
To skeletal muscles
A neuron with a single dendrite at one end of the cell body and a single axon at the other end of the cell body would be classified as
bipolar
Neurons that carry impulses away from the CNS are called
Efferent neurons
Neurons are specialized for the conduction of impulses, whereas neuroglia
Support nerve tissue
There is one-way conduction at a synapse because
Only the presynaptic neuron contains neurotransmitters
Which contains the thalamus and hypothalamus
Diencephalon
The reticular activating system
Maintains wakefulness
Which phases best describe the spinal cord
Conducts motor impulses from the brain
Conducts sensory impulses to the brain
Which is not a protective covering of the CNS
Cauda equine
The composition of cerebrospinal fluid is
A plasma-like liquid with glucose, salts, and proteins
An autonomic ganglion can be described as
The site of synapses between visceral efferent neurons
The sympathetic division of the autonomic nervous system
Mobilizes energy in times of need
Is innervated by cell bodies from T1 through L2
The parasympathetic division of the autonomic nervous system
Conserves and stores energy
Has relatively short postganglionic neurons
Tasting
Facial nerve cranial nerve
Balance maintenance
Vestibulocochlear cranial nerve
Sympathetic Nervous System
More extensive use of norepinephrine as a transmitter
More widespread and generalized effects
Endorphins
Decrease pain sensation
Referred pain from upper abdominal disease involves
T8, L1, and L2
In the gate control theory of pain
Stimulation of large A fibers – closes the gate
Which is not a neuromodulator of pain
Heparin
Interleukin-1
Raises the hypothalamic set point
Is an endogenous pyrogen
Is stimulated by exogenous pyrogens
Increased serum levels of epinephrine increased body temperature by
Increasing heat production
In heatstroke
Core temperature increases as the regulatory center fails
Which is involved in fever
Tumor necrosis factor
Endotoxins
Elevation of the set point in the hypothalamus
In hypothermia
Acidosis can develop
Although non-REM sleep and REM sleep are defined by electrical recordings, they are characterized by physiologic events. Which does not occur
During non-REM sleep, levels of corticosteroids increase
Meniere disease
Disrupts both vestibular and hearing functions
Acute otitis media (AOM)
Displays a tympanic membrane progressing from erythema to opaqueness with bulging
Age-related macular degeneration AMD
Exhibits retinal detachment and loss of photoreceptors
Vestibular nystagmus
Is the constant, involuntary movement of the eyeball caused by ear distribution
Sleep apena
Is lack of breathing during sleep
Can result from airway obstruction during sleep
Individuals affected by sleep apnea may experience
Polycythemia
Cyanosis
Pulmonary hypertension
Supratentorial processes reduce arousal by
Displacement of the brain stem
An individual shows flexion in upper extremities and extension in lower extremities. This is
Decorticate posturing
Cerebral death
Permits normal internal homeostasis
Precipitating causes of seizure include all of the following except
Hyperglycemia
Which epileptic seizure is characterized by temporal lobe spikes in the EEG
complex
Postictal sleeping can be seen in _____ seizures
tonic-clonic
Alzheimer disease
Is most prevalent as a late-onset dementia
Dystonia is
Abnormal posture maintained by muscular contractions
An individual with increased intracranial pressure from a head injury shows small and reactive pupils, widened pulse pressure, and slowed breathing. Which stage of ICP is present
Stage 3
Infratentorial herniation occurs with
Shifting of the cerebellum
In cerebral vasogenic edema
Plasma proteins leak into extracellular spaces
Which statement is not true regarding increasing intracranial pressure
Accumulating CO2 causes vasoconstriction
Intellectual function is impaired in the dementing process. Which intellectual function is not impaired
Anterograde memory
Retrograde memory
Abstraction
Language deficits
In blunt head trauma
The dura remains intact
In an automobile accident, an individual’s forehead struck the windshield. The coup/countercoup injury would be in the
Frontal/occipital region
In moderate diffuse axonal injury
Coma lasts more than 24hrs
Tearing of axons in the cerebral hemisphere occur
Most spinal core injuries occur in the
Cervical and lumbar regions
Injury of the cervical cord may be life threatening because of
Diaphragmatic impairment
Autonomic hyperreflexia is characterized by all of the following except
Hypotension
Intervertebral disk herniation
In the lumbosacral area causes pain over the gluteal region and into the calf or ankle
TIAs are
Focal neurologic deficits that develop suddenly, last more than an hour, and clear without
Which is a risk factor for the development of CVAs
Polycythemia vera
Hypertension
Diabetes mellitus
Hyperhomocysteinemia
Which most typically characterizes the victims of cerebral embolic stroke
Middle-aged individuals with a history of heart disease
Ruptured aneurysms are most likely in which of the following cerebrovascular accidents
Hemorrhagic
Which is not a primary intracerebral neoplasm
Meningioma
In bacterial meningitis, the CSF has
Neutrophilic infiltration
Multiple sclerosis involves
Activation of T cells autoreactive to myelin
Manifestations of subarachnoid hemorrhage include which of the following
A stiff neck
Kernig sign
Which laboratory values would be expected in an individual with SIADH
Serum sodium = 120mEq/L and urine hypoosmolality
Hypopituitarism in an adult male likely includes all of the following except
Dwarfism
Excessive secretion of GH in an adult may cause
Acromegaly
A manifestation shared by both diabetes mellitus and diabetes mellitus and diabetes insipidus is
Polyuria
The manifestation of hyperthyroidism include all of the following except
Constipation
Hypothyroidism crisis is
Myxedema coma
Graves disease is
Hyperthyroidism
Associated with autoimmunity
Manifested by ophthalmopathy
Inadequate levels of THs at birth may cause
Mental retardation
Hyperparathyroidism causes
Increased osteoclastic activity
A manifestation of hypocalcemia is
Tetany
What is the most common cause of acromegaly
Anterior pituitary adenoma
If a 19-year old woman were suffering from shortness of breath, weight loss, excessive sweating, exophthalmos, and irritability, which hormone would you expect to find elevated in her serum
Thyroxine
A 24-year old woman with a history of “juvenileonset” diabetes is found in a stuporous state. She is hypotensive and has cold, clammy skin. What is the likely etiology of her condition
Insulin shock
A 10-year old boy was brought into the emergency room comatose, suffering from metabolic acidosis with a blood glucose level of 800mg/dL. The most probable disease causing his condition is
Type I diabetes mellitus
Your neighbor, not previously diagnosed as a diabetic, has gained 80 pounds in the past year and is able to produce some insulin. Her fasting blood glucose value is always elevated. She is being treated with oral insulin-stimulating drugs. Your neighbor is most likely suffering from
Type 2 diabetes mellitus
Common symptoms and signs of diabetes mellitus include all of the following except
Increased muscle anabolism
Which laboratory finding is inconsistent with a diagnosis of absolute insulin deficiency
FBS (fasting blood sugar) of 90mg/dL
Common complications of diabetes mellitus include all of the following except
Retinopathy
Peripheral neuropathy
Nephropathy
An individual with type 1 diabetes mellitus experiences hunger, lightheadedness, headaches, confusion and tachycardia while performing cross country running. The likely cause of these manifestations is
Hypoglycemia because of running
Which is/are expected during hyperinsulinism
Excess insulin
Epinephrine
Long term corticosteroid therapy may cause which of the following
Delayed wound healing
Osteoporosis
Peptic ulcers
Which electrolyte alteration occurs in Addison disease
Hypoatremia
A benign tumor of adrenal glands that causes hypersecretion of aldosterone is
Conn disease
Hypersecretions of aldosterone causes
hypernatremia
Hypersecretions of glucocorticoids causes
hyperglycemia or osteoporosis
Which is not a plasma component
Platelets
Which is the most abundant protein in blood plasma
Albumins
Eosinophils can
phagocytize
Ingest antigen-antibody complexes
be induced to attach parasites
The precursor of granulocytes is the
Myeloblast
Identify the correct sequence in the differentiation of erythrocytes
Proerythroblast, normoblast, reticulocyte
A differential count of WBCs includes all of the following except
3% reticulocytes
The purpose of erythroprotein is to
Control erythrocyte production
The main regulator of platelet circulating mass is
Thrombopoietin
About how many times more RBCs than WBCs are there in 1mm3 of blood
1000
if the total leukocyte count of an individual was 700/mm3, about how may neutrophils would normally be present in 1mm3 of blood
4200
Which granulocyte function is similar to that of tissue mast cells
Basophils
Erythropoitetin
Is secreted by the kidney
Production is stimulated by tissue hypoxia
Which is not an agranulocyte
Mast cell
Reticulocyte
Which are the most effective phagocytes
Neutrophils and monocytes
Which vitamins are needed for erythropoiesis
C and E
B2 and B12
Kupffer’s cells are found in the
liver
Which test reflects bone marrow activity
Reticulocyte count
As an individual ages
Lymphocytic function decreases
Hemostasis involves all of the following except
Prostacyclin I
When a blood vessel is damaged
Subendothelial collagen is exposed
Platelets are attracted to collagen
Platelets degranulate
The biochemical mediators released by adhering platelets cause
Vasoconstriction of the injured vessel
Which is the correct sequence in coagulation
Damaged tissue – VII – prothrombin
Which is the correct sequence in fibrinolysis
Plasmin, FDP
Anemia refers to a deficiency of
Hemoglobin
Erythrocytes
Morphologic classification of anemia is based on all of the following except
Cause
Hypoxemia causes
Arterioles, capillaries, and venules to dilate
The heart to contract more forcefully
Which symptoms are consistent with aplastic anemia, but not with pernicious anemia
Hemorrhage into the tissues
A cause of macrocytic-normochromic anemia is
Antibodies against parietal cells
An individual with chronic gastritis and tingling in the fingers requires which of the following for treatment
Vitamin B12 by intramuscular injection
Secondary polycythemia may be caused by
Dehydration
Chronic obstructive pulmonary disease
Living in high altitudes
The symptoms of polycythemia are essentially caused by
Increased blood viscosity
Leukocytosis is found in all of the following except
Bone marrow depression
What is the most notable characteristic of infectious mononucleosis
The presence of heterophil antibody is diagnostically helpful
Which likely does not play a role in leukemia
diet
CML is characterized by its
Presence of the Philadelphia chromosome
Clinical manifestations of multiple myeloma
Decreased serum calcium
A thrombocytopenia with a platelet count less than 50,000/mm3 likely will cause
Hemorrhage from minor trauma
Thromboembolic disease can be caused by all of the following except
Deficient dietary intake of vitamin K
DIC is associated with
Endothelial damage
Activation of factor X
Release of TF
Organs that respond to a particular hormone are called
Target organs
A major feature of the “plasma membrane receptor” mechanism of hormonal actions is
Action of cyclic AMP
Requirement of a second messenger
A major feature of the “activation of genes” mechanism of hormonal action is
The hormone enters the cell
A hormone having an antidiuretic effect similar to that of antidiuretic hormone (ADH) is
Oxytocin
The hypothalamus controls the adenohypophysis by direct involvement of
Regulating hormones
Hormones convey regulatory information by
Endocrine signaling
Paracrine signaling
Autocrine signaling
Synaptic signaling
If calcium levels in the blood are too high, thyrocalcitonin concentrations in the blood should
Increase, thereby inhibiting osteoclasts
In the negative feedback mechanism controlling thyroid hormone secretion, which is the nonregulatory hormone
Thyroxine
The control of parathyroid hormone is most accurately described as
Negative feedback not involving the pituitary
The renin-angiotensin-aldosterone system begins to function when renin is secreted by the
None of the above is correct (NOT THE adrenal cortex, medulla, pancreas, kidneys)
The effects of adrenal medullary hormones and the effects of sympathetic stimulation can be described as
Overlapping in most respects
Which best describes the respective effects of insulin and glucagon on blood glucose
Insulin lower blood glucose; glucagon raises it
The releasing hormones produced in the hypothalamus travel to the anterior pituitary via the
Hypophysial portal system
Which anabolic hormone increases muscle protein synthesis
Insulin
Aldosterone maintains electrolyte balance by
None of the above is correct. (NOT the retention of potassium, elimination of sodium, retention of both sodium and potassium)
Mineralcorticoid hormones conserve sodium by
controlling Na+, H+, K+ levels
Glucocorticoid hormones are
anti-inflammatory
Epinephrine causes
fight or flight response
Gonadocorticoids act as
minor sex hormones
Oxygenated blood flows through the
Pulmonary veins
The hepatic vein carries blood from the
Liver to vena cava
The position of the heart in the mediastinum is
Between the lungs and the superior to the diaphragm
The pericardial space is found between the
Visceral pericardium and parietal pericardium
In the normal cardiac cycle, which of the following occurs?
The two atria contract simultaneously, whereas the two ventricles relax
The two ventricles contract simultaneously, whereas the two atria relax
The QRS complex of the ECG represents
Ventricular depolarization
A person having a heart rate of 100 bpm, a systolic blood pressure of 200mmHg, and a stroke volume of 40 mL would have an average cardiac output of
None of these
During atrial systole, the
Atrioventricular valves are open
Which does not significantly affect heart rate
Atrioventricular valves
One cardiac cycle
Has a duration that changes if the heart rate changes
Usually requires less than 1 second to complete
Compared with arteries, veins
Have a larger diameter
Normal systolic pressure within the left ventricle is in the range of
90 to 140 mmHg
Backflow of blood from the arteries into the relaxing ventricles is prevented by the
Semilunar valves
Adrenomedullin (ADM)
Exhibits powerful vasodilatory activity
The Frank-Starling law of the heart concerns the relationship between
The length of the cardiac muscle fiber and the strength of contraction
Cardiac muscle differs from skeletal muscle in the cardiac muscle is
Arranged in branching networks
Singly nucleated
More accessible to sodium and potassium ions
Blood pressure is measured as the
Pressure exerted on arteries by the blood
Identify the correct sequence of the portions of the pulmonary circulation
Right ventricle → pulmonary arteries →lungs → pulmonary veins →left atrium
The normal heartbeat is initiated by the
SA node
If the sympathetic nervous system stimulation of the heart predominates over parasympathetic nervous system stimulation, the heart will
Increase its rate
When blood exhibits a turbulent flow
Resistance increases
Identify the normal sequence of an electrical impulse through the heart’s conduction system
SA node AV node atrioventricular bundle right and left bundle branches purkinje fibers
Which factor might increase resistance to the flow of blood through the blood vessels
Decreased numbers of capillaries
Depolarization of cardiac muscle cells occurs because of
The cell’s interior becoming less negatively charged
Which of the following statements is true
Lymph from the entire body, except for the upper right quadrant, eventually drains into the thoracic duct
Events in the development of atherosclerotic plaque include all of the following except
Complement activation
G.P a 50 year old man, was referred for evaluation of blood pressure. If he has a high diastolic blood pressure, which of the following is G.P’s reading
130/95 mmHg
The complications of uncontrolled hypertension include all of the following except
Anemia
Primary hypertension
Is essentially idiopathic
Orthostatic hypotension is caused by all of the following except
Increased blood volume
Localized out pouching of a vessel wall or heart chamber is
An aneurysm
Which is a possible cause of varicose veins
Gravitational forces on blood
Long periods of standing
Trauma to the saphenous veins
A 76-year old man came to the ER after experiencing chest pain while shoveling snow. Laboratory tests revealed essentially normal blood levels of SGOT, CPK, and LDH enzymes. The chest pain was relieved following rest and nitroglycerin therapy. The most probable diagnosis is
Angina pectoris
Complications of an infarcted myocardium likely could include
Heart failure
Death
Systemic thromboembolism
In pericardial effusion
Tamponade compresses the right heart before affecting other structure
Chamber volume increase is observed in what type of cardiomyopathy
Dilated
Which statement is true regarding rheumatic heart disease
It is caused by hypersensitivity/immunity to streptococci
It usually damages the mitral valve
Transmural myocardial infarction
Is categorized as STEMI
Bacterial infective endocarditis differs from rheumatic heart disease because of which of the following
Bacterial endocarditis is an infection of the heart, endocardium and valves
It may occur following dental or bladder catheterization procedures
Individuals with only left heart failure would exhibit which of the following
Dyspnea
Pulmonary edema
In congestive heart failure, the pump or myocardium itself fails because of which of the following
Loss of contractile force of the heart
Hypertension
Cardiac dysrhythmias
Shock is a complex pathophysiologic process
hypertension
SIRS begins with an infection that progresses to
Bacteremia
Sepsis
Septic shock
MODS
Which statement is incorrect concerning hypertension
Headache is the most reliable symptom
A 53-year old man was admitted to the emergency room after experiencing shortness of breath
An acute myocardial infarct
Considering the sequence of structure through which air enters the pulmonary system, the pharynx is to the trachea as the
Respiratory bronchioles are to the alveolar ducts
The cilia of the bronchial wall
Propel mucus and trapped bacteria toward the oropharynx
As the terminal bronchioles are approached
The epithelium become thinner
The left bronchus
Is more angled than the right
The respiratory unit consists of
Respiratory bronchioles and alveoli
Alveoli are excellent gas exchange units because of
Their large surface area
A very thing epithelial layer
Extensive vascularization
Surfactant
Facilitates alveolar expansion during inspiration
During expiration, which relationship is true
As the lung volume decreases, the pressure increases
When the diaphragm and external intercostal contract
The intrathroacic volume increases
Oxygen diffusion from the alveolus to the alveolar capillary occurs because
The PaO2 is less in the capillary than in the alveolus
A shift to the right in the oxyhemoglobin dissociation cure
Improves oxygen release and increases oxygen movement into the cells
In which sequence does PaO2 progressively decrease
Atmospheric air, aortic blood, body tissue
Alveoli are well-suited for diffusion of respiratory gases because
They contain surfactant, which helps prevent alveolar collapse
Which ordinarily brings about the greatest increase in the rate of respiration
Excess carbon dioxide
The major muscles of inspiration are the
Diaphragm
External intercostals
Stretch receptors
Are sensitive to volume changes in the lung
Are located in airway smooth muscles
Decrease ventilatory rate when stimulated
Prevent lung overinflation when stimulated
Which of the following increases the respiratory rate
Increase PaCO2, decreased pH, decreased PaO2
The dorsal respiratory group (DRG) of neurons
Sets the automatic rhythm of respiration
High altitudes may produce hypoxia by
Decreased oxygen inspiration
In ARDS, increased alveolocapillary membrane
Platelet-activating factor
Oxygen free radicals
Tumor necrosis factor
Type II pneumocyte damage cause
Decreased surfactant production
Pulmonary edema may be caused by abnormal
Capillary hydrostatic pressure
Capillary oncotic pressure
Capillary permeability
In bronchial asthma
Bronchial muscles contract
Asthma is precipitated by which of the following inflammatory mediators
Histamine
Prostaglandins
Leukotrienes
Neutrophilic infiltration
In emphysema
None of the above are correct
NOT area for gas exchange, NO prolonged inspirations, NO increase in diaphragm movement, NO involvement of bronchioles
Chronic bronchitis
Is caused by air pollutants
Exhibits a productive cough
Which is inconsistent with pneumonia
Involves only interstitial lung tissue
Tuberculosis
Is caused by an aerobic bacillus
May affect other organs
Antibodies may be detected by a skin test
Pulmonary emboli usually
Obstruct blood supply to lung parenchyma
Originate from thrombi in the legs
Occlude pulmonary artery branches
Pulmonary hypertension
Occurs when left arterial pressure is elevated
Shows right ventricular hypertrophy on an electrocardiogram
Cor pulmonale
Occurs in response to long-standing pulmonary hypertension
Is right heart failure
Is manifested by altered tricuspid and pulmonic valve sounds
A lung cancer characterized by many anaplastic figures and the production of hormones is most likely
Small cell carcinoma
The metastasis of lung squamous cell carcinoma is
late
Which sequence of structures does urine pass through as it leaves the body
Minor calyx – major calyx – renal pelvis – ureter – urinary bladder – urethra
The functional unit of the human kidney is the
Nephron
One unique feature of the renal blood circulation is that
There are two sets of capillaries
Which has the opposite effect on urine production from the others
Decreased solutes in blood
The glomerular filtration rate is regulated by
the autonomic nervous system
the renin-angiotensin system
atrial natriuretic factor
The capillaries of the glomerulus differ from other capillary networks in the body because they
Branch from and drain into arterioles
Which is not a function of the kidney
Urine storage
Antidiuretic hormone causes water to
Diffuse into the ascending limb of the vasa recta
Return to the systemic circulation
Water reabsorbed from the glomerular filtrate initially enters the
vasa recta
An increase in water permeability of the distal convoluted tubules and collection duct is the result of
an increase in production of ADH
The descending loop of the nephron allows
Water reabsorption
Which most accurately describe the pressures affecting net glomerular filtration
Blood hydrostatic pressure opposes capsular hydrostatic and blood oncotic pressures
Tubular secretion of urea is accomplished in the
Secretion adds material to the filtrate; reabsorption removes materials from the filtrate
The kidneys:
Eliminate H+
Eliminate NH4+
Conserve HCO3-
If a small person excretes about 1 liter of urine during a 24hr period, estimate the total amount of glomerular filtrate formed
100 liters
Which should not appear in the glomerular filtrate just after the process of glomerular filtration has accomplished
protein
The loop of Henle is to vasa recta as convoluted tubules are to
Peritubular capillaries
The two ‘currents’ used in the countercurrent exchange system are the
Ascending and descending limbs
The countercurrent exchange system
Facilitates osmosis
Atrial natriuretic factor
Increases urine output
A waste product of protein metabolism is
Urea
Renal function tests include
Urinalysis
BUN and serum creatinine
Which substance is an abnormal constituent of urine
glucose
The presence of albumin in the urine would indicate probable damage to
Glomeruli
Upper urinary tract obstruction
Can cause hydroureter
Renal calculi may be composed of
Calcium oxalate
Uric acid
Which can be characteristics of ureteral stones
Severe pain in the back
Severe pain in the abdomen
Nausea and vomiting
Which are predisposing factors for acute UTIs
Congenital deformities or the urinary tract
The sex of the patient
Decrease urine flow
A common cause of both pyelonephritis and cystitis is
Invading, ascending microorganisms such as E.coli
Uremia causes
Retention of metabolic acids
Pyelonephritis is
Characterized by fever, chills, and flank pain
Characterized by pyuria, bacteriuria, and hematuria
More common in young women than in young men
Which renal condition usually has a history of recent infection with beta-hemolytic streptococci
Glomerulonephritis
Which statement is not true concerning glomerulonephritis
Approximately 90% of individuals experience chronic disease
Causes of acute renal injury include
Stones and structures in kidneys or ureters
Heart failure leading to poor renal perfusion
Which describes a patient in acute renal injury
Elevated serum creatinine
Oliguria
Which is not a characteristic of chronic renal injury
Anuria
Chronic renal injury
May result from HTN
Is usually the result of chronic inflammation of the kidney
May be treated with dialysis or transplants
An individual has elevated blood concentrations of urea and creatinine because of complete calculi blockage of one ureter. This condition is
Postrenal disease
Nephrotoxins such as antibiotics, may be responsible for
Acute tubular necrosis
Uremia, as seen in chronic renal injury, would include
Metabolic acidosis
Elevated BUN and creatinine
Cardiovascular disturbances
The earliest symptom of chronic renal injury is
Polyuria
In chronic renal failure, tubulointerstitial disease leads to
Sodium wasting
Gonadotropin-releasing hormone (GnRH) reaches the anterior pituitary gland and causes the release of which of the following
FSH and LH
A new menstrual cycle involves a rise in the levels of
FSH
Progesterone
Maintains the thickened endometrium
The ovaries produce
Ova and estrogen
During which days of the menstrual cycle does the endometrium achieve maximum development
20 to 24
Hormones necessary for the growth and development of female breasts are
estrogen and progesterone
The structure that releases a mature ovum is the
Graafian follicle
A major duct of the female reproductive system is the
Uterine tube
Prostate is to the accessory gland as gonad is to the
ovary
Cells that produce testosterone are
Interstitial endocrinocytes
The function of testosterone consists of
Development of male gonads
Bone and muscle growth
Influencing sexual behavior
Growth of testes
Immediately after the sperm cells leave the ductus epididymis, they enter
Ductus deferens
A substance produced in the reproductive system mainly by the bulbourethral gland is
mucus
Which structure produces a secretion that helps maintain the motility of spermatozoa
Prostate
Cowper (bulbourethral) glands
Semen is
The sperm and secretions of the seminal vesicles, prostate, and bulbourethral gland
The vulva consists of the
Labia majora and labia minora
Clitoris
Vaginal orifice
The major difference between female and male hormone production is
Hormonal production is relatively constant in the male
The primary spermatocyte has
46 chromosomes
a diploid number of chromosomes
During the follicular/proliferative phase of the menstrual cycle
Vascularity of breast tissue increases
Most of the lymphatic drainage of the female breast occurs through the
Axillary nodes
What is the likely pathophysiology of PMS
An abnormal nervous, immunologic, vascular, and gastrointestinal response to hormone fluctuations of the menstrual cycle likely occurs
Acute PID
May cause infertility or tubular pregnancy
Anovolatory cycles having prolonged estrogen levels and absence of progesterone production are found in
Endometrial hyperplasia
Depressed T cell function is associated with
Endometriosis
A 42-year old retired prostitute who became sexually active at age 14 is at risk for development of
Cervical carcinoma
Polycystic ovary syndrome is
The most common cause of infertility in the United States
Associated with hyperinsulinemia
Sometimes a precursor of endometrial carcinoma
Endometriosis
Involves the ectopic endometrium responding to hormonal fluctuations of the menstrual cycle
Phimosis is
A condition in which the foreskin cannot be retracted
Caused by poor hygiene and chronic infection
A varicocele is an intrascrotal disorder
That occurs because of independent or congenitally absent valves in the spermatic veins
Cryptorchidism is
Failure of testes to descend into the scrotum
The infectious cause of orchitis is
Mumps virus
In BPH, enlargement of periurethral tissue of the prostate causes
Obstruction of the urethra
Recurrent UTIs in the male causes
Chronic bacterial prostatitis
A symptom or sign of late-stage, metastatic prostatic cancer
Mental confusion associated with brain metastases
Male sexual dysfunction may be caused by
Diabetes mellitus
The muscularis of the gastrointestinal tract is
Composed of circular fibers and longitudinal fibers
The digestive functions performed by the saliva and salivary amylase, respectively are
Lubrication and carbohydrate digestion
The nervous pathway involved in salivary secretion requires stimulation of
Receptors in the mouth, sensory impulses, and parasympathetic impulses to the salivary glands
Food would pass rapidly from the stomach into the duodenum if it were not for the
Pyloric sphincter
The secretion of gastric juice
Occurs in three phases; cephalic, gastric, and intestinal
During nervous control of gastric secretion, the gastric glands secrete before food enters the stomach. This stimulus to the glands comes from
Parasympathetic impulses over the vagus nerve
Pepsinogen
Must be activated by HCl
Is secreted by the chief cells
Is a precursor to pepsin
Beginning at the lumen of the tube, the sequence of layers of gastrointestinal tract is
Mucosa, submucosa, mascularis, serosa
Normally, when chime leaves the stomach
The proteins have been partly digested into polypeptides
Which layer of the small intestine includes microvilli
Mucosa
Which is not an example of mechanical digestion
Conversion of protein molecules into the amino acids
Pancreatic juice is to trypsin as gastric juice is to
Pepsin
Which part of the small intestine is most distal from pylorus
Jejunum
The pancreas
Is a gland with its duct ultimately opening into the duodenum
The chief role played by the pancreas in digestion is to
Secrete enzymes, which digest food in the small intestine
Among the structural feature of the small intestine are villi, microvilli, and circular folds. Their function is to
Increase the surface area for absorption
The fate of carbohydrates in the small intestine is
Digestion to monosaccharides
The absorptive fate of the end products of digestion may be summarized by which of the following
Amino acids and monosaccharides are absorbed into blood capillaries; most fatty acids are absorbed into lymph
A lobule of the liver contains a centrally located
Vein with radiating hepatocytes and sinusoids
An obstruction of the common bile duct would cause blockage of the bile coming from
Both the liver and the gallbladder
The human adult liver does not
Produce erythrocytes
The chime that enters the large intestine is converted to feces by activity of
Bacteria and water reabsorption
During vomiting, there is
Deep inspiration, airway closure, forceful diaphragm and abdominal muscle contractions, and esophageal sphincter relaxation
IBS
Is related to dysregulation of the brain-gut axis
Osmotic diarrhea is caused by
Lactase deficiency
A common manifestation of hiatal hernia is
Gastroesophageal reflux
Postprandial substernal pain
Intestinal obstruction causes
Decreased nutrient absorption
Peptic ulcers may be located in the
Stomach
Esophagus
Duodenum
Colon
Gastric ulcers
May lead to malignancy
Duodenal ulcers
May be complicated by hemorrhage
In malabsorption syndrome, flatulence and abdominal distention are likely caused by
Undigested lactose fermentation by bacteria
The characteristic lesion of Crohn disease is
Found in the ileum
Granulomatous
Low-residue diets and chronic constipation play a roe in the pathogenesis of
Diverticulitis
A 14-year old boy has been admitted to the emergency room with acute-onset abdominal pain in the lower right quadrant. Abdominal rebound tenderness is intense, and he has a fever and leukocytosis. This individual most likely is suffering from
Acute appendicitis
Leptin
Suppresses hunger/appetite at the hypothalamus
Short-term starvation involves
Glycogenolysis
Gluconeogenesis
The most common manifestation of portal hypertension is
Vomiting of blood from esophageal bleeding
Hepatic encephalopathy is manifested by
Cerebral dysfunction
Which would be consistent with a diagnosis of viral hepatitis
Elevated aspartate transaminase serum enzymes
decreased serum albumin levels
prolonged coagulation times
increased serum bilirubin levels
Which viral hepatitis is not associated with a chronic state or a carrier state
Hepatitis A
Which type of jaundice is caused by the increased destruction of erythrocytes
Hemolytic
Which most often causes biliary cirrhosis
Biliary obstruction
Symptoms of cholelithiasis include all of the following except
Decreased serum bilirubin levels
In pancreatitis
The tissue damage likely results from release of pancreatic enzymes
Predisposing factors in the development of colon cancer include all of the following except
High fiber diet
Which stratum of the epidermis contains dead keratinocytes
Corneum
The dermis is composed of all of the following except
Melanocytes
Which does not occur as the skin ages
More melanocytes
Arteriovenous anastomoses in the dermis
Facilitate the regulation of body temperature
The cause of atopic dermatitis is
Mast cell degranulation, T cell and monocyte interaction
The skin lesion of psoriasis is
Thick, scaly, erythematous plaque
A circular, demarcated, salmon-pink scale within in a plaque is characteristic of
Pityriasis rosea
Acantholysis is observed in
Pemphigus
The cause of impetigo in the adult is
Coagulase-positive staphylococci
Beta-hemolytic streptococci
The usually manifestation of HSV is a
Cold sore or fever blister
Of the benign tumors of the skin, keratoacanthomas are characterized by
Origination from hair follicles
A proliferative stage that produces a nodule with a central crust
Which are most likely to undergo malignant transition
Nevi and actinic keratosis
The cause of Kaposi sarcoma likely is
Immunodeficiency
Squamous cell carcinoma of the skin in manifested as
Elevated, firm lesions
An untreated basal cell carcinoma
Ulcerates and involves local tissue
Which malignant skin lesion metastasizes the earliest
Malignant melanoma
In which type of burn does skin function continue
First-degree
A burn that destroys the epidermis and dermis is a
Deep partial thickness burn
Hypovolemic shock in severely burned individuals is the result of
dilation of capillaries
increased capillary permeability
An individuals surviving burn shock, increased wound sepsis is caused by
Released inflammatory cytokines
Fewer opsonins
Inability of phagocytes to migrate to the site of infection
Onychomycosis is
Fungal infection of the nail plate
