exam 7 Flashcards
Which problem is a pathophysiologic consequence common to all shock states?
Hypoperfusion
Vasoconstriction
Pulmonary edema
Hypertension
Hypoperfusion
What term is used to identify the consequence of switching from aerobic to anaerobic cellular metabolism during shock states?
Increased ATP production
Cellular dehydration
Lactic acidosis
Free radical formation
Lactic acidosis
In shock, how does the body maintain blood glucose levels once available glucose and glycogen stores are used up?
By stimulating the release of glucose stores from the spleen
By breaking down protein to fuel gluconeogenesis
By converting urea and ammonia to glucose
By inhibiting the release of cortisol and thyroid hormone
By breaking down protein to fuel gluconeogenesis
Which of the following conditions is NOT a potential cause of cardiogenic shock?
Tension pneumothorax
Spinal cord injury
Cardiac tamponade
Cardiac dysrhythmias
B. Spinal cord injury
Which of the following shock states manifests with tachycardia, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment?
Anaphylactic
Hypovolemic
Neurogenic
Septic
Hypovolemic
Which of the following shock states is (are) characterized by vasodilation of the systemic arteries?
Hypovolemic
Cardiogenic
Distributive
All of the above
Distributive
Which of the following shock states is (are) characterized by acute, severe bronchoconstriction?
Cardiogenic
Anaphylactic
Hypovolemic
Neurogenic
Anaphylactic
What are some of the causes of hypovolemic shock? Select all that apply.
Dehydration Blood loss Brainstem injury Diuresis Electrolyte imbalance
Dehydration
Blood loss
Diuresis
Which clinical manifestations would not support a diagnosis of hypovolemic shock?
Pulmonary edema
Tachycardia
Hypotension
Oliguria
Pulmonary edema
During hemorrhagic shock, the clinical manifestations of pale skin and cool extremities are most directly caused by what process?
Hypothermia
Accumulation of toxic metabolites
Vasoconstriction of peripheral arterioles
Increased tissue oxygen demand
Vasoconstriction of peripheral arterioles
Neurogenic shock is caused by what event?
Spinal cord injuries below T6
Inhibition of the parasympathetic nervous system
Injury to the cerebral cortex
A lack of sympathetic activity
A lack of sympathetic activity
Which of the following pathophysiologic events causes the severe hypotension observed in neurogenic shock?
Increased capillary permeability
Diuresis
Decreased peripheral vascular resistance
Release of massive amounts of histamine
Decreased peripheral vascular resistance
Anaphylactic shock is a severe response to what trigger?
Viral infections
Allergic reactions
Brain trauma
Burn injuries
Allergic reactions
Anaphylactic shock manifests with the rapid onset of which set of symptoms?
Bradycardia, decreased arterial pressure, and oliguria
Dyspnea, hypotension, and urticaria
Hypertension, anxiety, and tachycardia
Fever, hypotension, and erythematous rash
Dyspnea, hypotension, and urticaria
Which of the following conditions presents the most significant risk factor for developing septic shock?
Use of immunosuppressant medications
History of severe allergies
Diagnosis of chronic congestive heart failure
Genetic predisposition to disorders of hemostasis
Use of immunosuppressant medications
What is the primary cause of hypotension in early stages of septic shock?
Blood loss
Arterial vasodilation
Activation of the parasympathetic nervous system
Heart failure
Arterial vasodilation
Which set of clinical manifestations is highly characteristic of a septic shock state?
Tachycardia, hypotension, and warm skin
Confusion, bradycardia, and truncal rash
Severe respiratory distress, jugular venous distention, and chest pain
Decreased cardiac output, hypertension, and poor skin turgor
Tachycardia, hypotension, and warm skin
Which of the following features is highly characteristic of a septic shock state?
High peripheral vascular resistance
Inhibition of the sympathetic nervous system
Metabolic alkalosis
Hypermetabolism
Hypermetabolism
Low levels of which molecule contribute to the pathophysiology of septic shock?
Nitric oxide
Interleukin 1
Activated protein C
Epinephrine
Activated protein C
What is the most common cause of multiple organ dysfunction syndrome (MODS)?
Myocardial infarction
Septic shock
Chronic pulmonary disease
Autoimmune disease
Septic shock
Secondary MODS is defined as the progressive dysfunction of two or more organ systems resulting from:
a drug overdose.
severe hemorrhaging.
an uncontrolled inflammatory response.
myocardial depression.
an uncontrolled inflammatory response.
In MODS, which of the following events contribute to organ failure? Select all that apply.
Microvascular clotting Interstitial edema Exhaustion of fuel supply Anarobic state Soft tissue necrosis
A. Microvascular clotting
B. Interstitial edema
C. Exhaustion of fuel supply
E. Soft tissue necrosis
Which of the following laboratory alterations would indicate that a patient is developing renal failure associated with MODS?
Increased serum creatinine
Decreased lactate dehydrogenase (LDH) levels
Decreased blood urea nitrogen (BUN)
Hypokalemia
Increased serum creatinine
Which alteration would fail to confirm that a patient is developing liver failure associated with MODS?
Increased serum ammonia levels
Jaundice
Increased liver enzymes
Decreased serum urea levels
Decreased serum urea levels
Which burn injury involves most of the dermis and leaves only a few epidermal appendages intact?
First degree
Superficial partial thickness (second degree)
Deep partial thickness (second degree)
Third degree
Deep partial thickness (second degree)
Which burn injury is characterized by the immediate appearance of large water-filled blisters and a red wound bed?
First degree
Superficial partial thickness (second degree)
Deep partial thickness (second degree)
Third degree
Superficial partial thickness (second degree)
Which burn injury is essentially painless in the wound bed?
First degree
Superficial partial thickness (second degree)
Deep partial thickness (second degree)
Third degree
Third degree
During the first 24 hours after a severe burn injury, which of the following physiologic responses typically occurs?
Increased capillary permeability
Inhibition of stress hormone release
Increased cardiac contractility and cardiac output
Increased peripheral vascular resistance
Increased capillary permeability
Which of the following physiologic alterations would you expect to see in the delayed response to a severe burn injury?
Hypoglycemia
Hypovolemia
Hypometabolism
Bleeding from wound beds
Hypovolemia
Individuals with severe burns are often at risk for becoming hypothermic. Which of the following descriptions best characterizes the underlying cause of this problem?
Burn patients experience hypothermia as a rebound reaction from the heat damage.
Burn patients tend to be hypothermic as a result of hypotension and ischemia.
Evaporative heat loss from major burn wounds can lead to hypothermia.
Blood coagulation limits the blood circulating to the body core, thereby causing hypothermia.
Evaporative heat loss from major burn wounds can lead to hypothermia.
Why do individuals with severe burns have difficulty breathing and often require intubation, even if there was no smoke inhalation causing acute lung injury?
Severe pulmonary edema develops immediately after all severe burn injuries.
Pulmonary emboli typically form after severe burn injuries.
Airway edema is a common occurrence with severe burn injuries.
Pneumothorax and pleural effusions occur with severe burn injuries.
Airway edema is a common occurrence with severe burn injuries
Why would a third-degree, circumferential burn of the thigh require prompt medical attention?
Wound contraction and edema can severely impair limb circulation.
It is difficult to perform skin grafts of the limbs.
Burn shock is inevitable.
Third-degree burns are very painful.
Wound contraction and edema can severely impair limb circulation.
bone forming cells
osteoblast
bone resorbing cells
liberate the stores of bone
osteoclasts
bone maintaining cells
osteoblasts that get caught in the matrix
osteocytes
Which bone cells produce osteocalcin when stimulated by 1,25-dihydroxyvitamin D and synthesize osteoid?
a. Osteoclasts
b. Osteocytes
c. Fibrocytes
d. Osteoblasts
d. Osteoblasts
What happens to the original bone during the second phase of bone remodeling?
a. The original bone is replaced.
b. It hardens.
c. The original bone is resorbed.
d. It is synthesized.
c. The original bone is resorbed.
Which cells function to maintain bone matrix?
a. Osteoclasts
b. Osteocytes
c. Osteoblasts
d. Osteophytes
b. Osteocytes
Which bone cells are large and multinucleated and contain lysosomes filled with hydrolytic enzymes?
a. Osteoblasts
b. Osteoclasts
c. Osteocytes
d. Fibrocytes
b. Osteoclasts
Which bone cell secretes hydrochloric acid to help dissolve bone minerals and collagenase, thus aiding in the digestion of collagen?
a. Osteocytes
b. Osteoblasts
c. Osteoclasts
d. Osteophytes
c. Osteoclasts
Which glucoprotein is believed to inhibit calcium phosphate precipitation and play a part in bone
resorption by recruiting osteoclasts?
a. Osteocalcin
b. Osteonectin
c. Laminin
d. Osteopontin
a. Osteocalcin
Which glucoprotein is thought to transport essential elements such as hormones, ions, and other metabolites to and from the bone cells?
a. Osteocalcin
b. Osteonectin
c. Laminin
d. Bone albumin
d. Bone albumin
Which part of an injured joint becomes insensitive to pain and regenerates slowly and minimally?
a. Synovium
b. Articular cartilage
c. Bursa
d. Tendon
b. Articular cartilage
The outer layer of the periosteum contains blood vessels and nerves that penetrate the inner
structures of the bone by way of which structure?
a. Volkmann canals
b. Canaliculi
c. Sharpey canals
d. Trabeculae
a. Volkmann canals
The student learns that after puberty, the epiphyseal plate calcifies and the epiphysis merges with which structure?
a. Epiphyseal line
b. Epiphyseal plate
c. Metaphysis
d. Articular cartilage
c. Metaphysis
The stage of healing in the bone that involves procallus formation entails which process?
a. Formation of a hematoma that allows the development of a fibrin network
b. Production of granulation tissue by fibroblasts, capillary buds, and osteoblasts
c. Development of a primitive bone matrix termed woven bone
d. Remodeling of the periosteal and endosteal bone surfaces
b. Production of granulation tissue by fibroblasts, capillary buds, and osteoblasts
The professor asks a student to describe the movement of a diarthrosis joint. What answer by the
student is best?
a. Immovable joint
b. Slightly moveable
c. Variable movement
d. Freely moveable
d. Freely moveable
What anchors articular cartilage to the underlying bone?
a. Sharpey fibers
b. Collagen fibers
c. Glycoproteins
d. Elastin fibers
b. Collagen fibers
Which statement indicates that a student needs more information about muscles?
a. Muscle comprises 50% of an adult’s body weight and 40% of a child’s body weight.
b. Muscle is 75% water, 20% protein, and 5% organic and inorganic compounds
c. Muscle contains 32% of all protein stores for energy and metabolism.
d. Muscles are encased in fascia
a. Muscle comprises 50% of an adult’s body weight and 40% of a child’s body weight.
Which characteristic of type II (white fast-motor) muscle fibers does the student learn?
a. Slow contraction speed
b. Fast conduction velocities
c. Profuse capillary supply
d. Oxidative metabolism
b. Fast conduction velocities
Which four-step process correctly describes muscle contraction?
a. Coupling, contraction, relaxation, excitation
b. Contraction, relaxation, excitation, coupling
c. Relaxation, excitation, coupling, contraction
d. Excitation, coupling, contraction, relaxation
d. Excitation, coupling, contraction, relaxation
Which type of ion directly controls the contraction of muscles?
a. Sodium
b. Potassium
c. Calcium
d. Magnesium
c. Calcium
In which type of contraction does the muscle maintain a constant tension as it moves?
a. Isotonic
b. Isometric
c. Hypertonic
d. Hypotonic
a. Isotonic
Which term is used to identify a functional muscle contraction in which the muscle contracts but
the limb does not move?
a. Isotonic
b. Isometric
c. Eccentric
d. Concentric
b. Isometric
In adults, hematopoiesis typically takes place in which bone marrow cavities? (Select all that apply.)
a. Skull
b. Shoulders
c. Sternum
d. Long bones
e. Pelvis
a. Skull
b. Shoulders
c. Sternum
e. Pelvis
What information does the student learn about osteocytes? (Select all that apply.)
a. An osteocyte is a transformed osteoblast.
b. An osteocyte obtains nutrients from capillaries in the canaliculi.
c. Osteocytes are the prime target of thyroid hormone action.
d. Osteocytes signal osteoclasts and osteoblasts to form new bone.
e. An osteocyte helps maintain levels of calcium and phosphorus in blood plasma.
a. An osteocyte is a transformed osteoblast.
b. An osteocyte obtains nutrients from capillaries in the canaliculi.
d. Osteocytes signal osteoclasts and osteoblasts to form new bone.
e. An osteocyte helps maintain levels of calcium and phosphorus in blood plasma.
Which factors influence the rate of protein synthesis of skeletal muscles? (Select all that apply.)
a. Insulin
b. Cortisol
c. Parathyroid hormone
d. Growth hormone
e. Amino acid substrates
a. Insulin
e. Amino acid substrates
Which structure attaches skeletal muscle to bone?
a. Tendon
b. Ligament
c. Bursa
d. Mesentery
a. Tendon
Which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts?
a. Parathyroid hormone
b. Glucocorticoid
c. Growth hormone
d. Estrogen
d. Estrogen
hat is a primary defect in osteoarthritis?
a. Stromelysin and acid metalloproteinase breakdown articular cartilage.
b. Immunoglobulin G (IgG) destroys the synovial membrane.
c. Synovial membranes become inflamed.
d. Cartilage-coated osteophytes create bone spurs.
a. Stromelysin and acid metalloproteinase breakdown articular cartilage.
Which clinical manifestations are characteristic of rheumatoid arthritis? (Select all that apply.)
a. Subcutaneous tissue crystals
b. Anorexia
c. Painful, stiffening of joints
d. Edema of the wrists
e. Fever
b. Anorexia
c. Painful, stiffening of joints
d. Edema of the wrists
The student wants to know how the clinical manifestations and onset of juvenile idiopathic
arthritis (JIA) differ from those of rheumatoid arthritis (RA) in adults. What answer by the healthcare professional is best?
a. JIA begins insidiously with systemic signs of inflammation.
b. JIA predominantly affects large joints.
c. JIA has more severe joint pain than adult RA.
d. JIA has a rapid onset of generalized aches as the first symptom.
b. JIA predominantly affects large joints.
What is the final outcome of impaired cellular metabolism?
a. Cellular alterations in the heart and brain
b. Buildup of cellular waste products
c. Cellular alterations in the vasculature structures and kidneys
d. Impairment of urine excretion
b. Buildup of cellular waste products
Which clinical manifestation of septic shock confirms an elevation in immune system response?
a. Tachycardia
b. Increased white blood cell count
c. Low respiratory rate
d. Hypothermia
b. Increased white blood cell count
The release of catecholamine by the adrenal glands provides which compensatory mechanism in
hypovolemic shock?
a. Interstitial fluid moves out of the vascular compartment.
b. Systemic vascular resistance is decreased.
c. Heart rate is increased.
d. Water excretion is increased.
c. Heart rate is increased.
Hypovolemic shock begins to develop when intravascular volume has decreased by what
percentage?
a. 5
b. 10
c. 15
d. 20
c. 15
A student asks the professor to explain the basics of vasogenic shock. What statement by the professor is best?
a. The outcome of widespread hypersensitivity to an allergen
b. Bacteremia combined with systemic inflammatory response
c. Inability to get adequate blood to tissues and end organs
d. Vasodilation from an imbalance between the two nervous systems
d. Vasodilation from an imbalance between the two nervous systems
What is the clinical hallmark of neurogenic shock as a result of the overstimulation of the parasympathetic nervous system?
a. Vasoconstriction
b. Vasodilation
c. Increased metabolism
d. Respiratory distress
b. Vasodilation
Four patients are in the intensive care unit with different types of shock. Which patient would the
healthcare professional assess as the priority?
a. Septic
b. Hypovolemic
c. Anaphylactic
d. Neurogenic
c. Anaphylactic
A patient is diagnosed with septic shock. What action by the healthcare professional will address the main underlying pathophysiologic mechanism of this disorder?
a. Administer antibiotics as soon as possible.
b. Provide high volumes of isotonic fluid.
c. Place patient on an intra-aortic balloon pump.
d. Give the patient antihistamines and steroids.
a. Administer antibiotics as soon as possible.
For which type of shock would antihistamines and corticosteroids be prescribed?
a. Septic
b. Anaphylactic
c. Hypovolemic
d. Cardiogenic
b. Anaphylactic
Which condition is best defined as a clinical syndrome involving a systemic response to infection, which is manifested by two or more of the systemic inflammatory response syndrome criteria?
a. Bacteremia
b. Sepsis
c. Septicemia
d. Septic shock
b. Sepsis
The student learns that which mechanism causes organ injury in primary multiple organ dysfunction syndrome (MODS)?
a. Impaired immune response
b. Impaired glucose use
c. Impaired perfusion
d. Impaired ventilation
c. Impaired perfusion
A student has studied secondary multiple organ dysfunction syndrome (MODS). What substance
does the student learn is least likely to stimulate the normal endothelial cells to change to a proinflammatory state?
a. Interleukin (IL)-1
b. IL-4
c. IL 6
d. Tumor necrosis factor
b. IL-4
What stimulates the respiratory burst and production of highly toxic free radicals in the multiple organ dysfunction syndrome (MODS)?
a. Neutrophils adhering to the endothelium
b. Activation of the complement cascade
c. Release of prostaglandins, thromboxanes, and leukotrienes
d. Activation of the fibrinolytic system
a. Neutrophils adhering to the endothelium
A student is perplexed that in a patient with multiple organ dysfunction syndrome (MODS), no infectious source has been found. What statement by the healthcare professional best describes this phenomenon?
a. Death of organs
b. Translocation of bacteria
c. Maldistribution of blood flow
d. Massive inflammatory response
b. Translocation of bacteria
Blistering of the skin within minutes occurs in which type of burn injury?
a. First degree
b. Superficial partial thickness
c. Deep partial thickness
d. Full thickness
b. Superficial partial thickness
A patient has an acute burn injury. What type of treatment for shock will the healthcare professional anticipate for this patient?
a. Intravenous fluids
b. Antibiotics
c. Intra-aortic balloon pump
d. Antihistamines and steroids
a. Intravenous fluids
What assessment finding would indicate to the healthcare professional that the patient is no
longer in burn shock?
a. Blood pressure 100/58 mmHg
b. Pulse rate 98 beats/min
c. Respiratory rate 24 breaths/min
d. Urine output 35 mL/hour for 4 hours
d. Urine output 35 mL/hour for 4 hours
Which condition does a burn injury create for an extended period?
a. Hypervolemia
b. Hypermetabolism
c. Hyponatremia
d. Hypotension
b. Hypermetabolism
A student learns that a fatal burn injury has what effect on interleukins (ILs)?
a. Decreases levels of IL-2
b. Decreases levels of IL-4 lymphocytes
c. Increases levels of IL-6
d. Increases levels of IL-12
a. Decreases levels of IL-2
Daily evaporative water loss after a burn injury is approximately how many times the normal?
a. 5
b. 10
c. 15
d. 20
d. 20
What is the significance of a high level of interleukin 1 (IL-1) in a patient who has experienced severe burns?
a. Prognosis is poor.
b. Antibiotic therapy is required.
c. Urinary function is improved.
d. They are less at risk for death.
d. They are less at risk for death.
A healthcare professional is determining the disposition of four burn patients in the Emergency
department. Which patients will the professional refer to the burn center? (Select all that apply.)
a. Partial thickness burn 20% TBSA
b. Burn of the genitals
c. Lightening injury
d. Both arms burned
e. Concomitant trauma
a. Partial thickness burn 20% TBSA
b. Burn of the genitals
c. Lightening injury
e. Concomitant trauma
In septic shock, which mediators are antiinflammatory? (Select all that apply.)
a. Interleukin (IL)-4 (IL-4)
b. IL-10
c. IL-13
d. Tumor necrosis factor–alpha (TNF-)
e. Prostaglandin
a. Interleukin (IL)-4 (IL-4)
b. IL-10
c. IL-13
Lesions that usually have depressed centers with rolled borders and are frequently located on the
face and neck characterize which malignancy?
a. Squamous cell carcinoma
b. Kaposi sarcoma
c. Malignant melanoma
d. Basal cell carcinoma
d. Basal cell carcinoma
The student learns that alteration of which gene is associated with basal cell carcinoma?
a. myc
b. TP53
c. src
d. Ras
b. TP53
Bowen disease is a form of which type of cancer?
a. Kaposi sarcoma
b. Malignant melanoma
c. Basal cell carcinoma
d. Squamous cell carcinoma
d. Squamous cell carcinoma
What is NOT considered a risk factors for osteoarthritis?
Low calcium intake
Older age
Obesity
Orthopedic injury
Low calcium intake
What is the primary manifestation of osteoarthritis?
Joint fusion
Joint pain
Hypermobility of joints
Contractures
Joint pain
Rheumatoid arthritis results from joint inflammation triggered by what?
Bacterial infection
Trauma
Autoimmune injury
Congenital hypermobility
Autoimmune injury
Surface epithelial tumor
Basal Cell Carcinoma
Pearly or ivory in appearance
slightly elevated
has depressed centers
rolled borders as it grows
Basal Cell Carcinoma
Mutation in the TP53 and PTCH1 genes
Basal Cell Carcinoma
Tumor of the epidermis
Squamous Cell Carcinoma
In situ (Bowen disease) and invasive
Squamous Cell Carcinoma
Mutation of the TP53 gene and other oncogenic signals
Squamous Cell Carcinoma
