Last Leg

Question 1

Which statement is true regarding the development of the reproductive structures?
o The vascular connection between the hypothalamus and the pituitary is established by the second week of life.
o The genital tubercle is developed at week 17.
o Anterior pituitary development starts between the fourth and fifth weeks of fetal life.
o Gonadotropin-releasing hormone (GnRH) is produced at week 20.

Answer 1

o Anterior pituitary development starts between the fourth and fifth weeks of fetal life.

Anterior pituitary gland development starts between the fourth and fifth weeks of fetal life, and the vascular connection between the hypothalamus and the pituitary is established by the twelfth week. GnRH is produced by the hypothalamus by 10 weeks’ gestation. The genital tubercle is developed during the first 7–8 weeks’ gestation.

Question 2

Which factor has been linked with early pubertal development in girls?
o Decreased growth hormone
o Intense exercise
o Thin body habitus
o Presence of leptin

Answer 2

Presence of leptin

Although leptin is not the trigger for the onset of puberty, it plays an important permissive role. Girls who are obese may mature earlier, perhaps from higher estrogen levels related to leptin and gonadotropin secretion. Girls who have low body fat, reduced body weight, and who intensely exercise may experience delayed maturation. Decreased growth hormone has not been linked with early pubertal development.

Question 3

Which is the appropriate term for sexual maturation?
o Adrenarche
o Gonadarche
o Adolescence
o Puberty

Answer 3

Puberty

Puberty is the onset of sexual maturation and differs from adolescence. Adolescence is the stage of development between childhood and adulthood. Adrenarche is the increased production of adrenal androgens, which occurs before puberty. Gonadarche refers to the maturation of the gonads.

Question 4

Which is the appropriate term for sexual maturation?
o Adrenarche
o Gonadarche
o Adolescence
o Puberty

Answer 4

Puberty

Puberty is the onset of sexual maturation and differs from adolescence. Adolescence is the stage of development between childhood and adulthood. Adrenarche is the increased production of adrenal androgens, which occurs before puberty. Gonadarche refers to the maturation of the gonads.

Question 5

In the female reproductive system, what is the appropriate term for the thin perforate membrane that generally covers the vaginal introitus?
o Labia majora
o Vulva
o Hymen
o Mons pubis

Answer 5

Hymen

The hymen is the thin perforate membrane that may cover the vaginal introitus. The mons pubis is a fatty layer of tissue over the pubic symphysis. The labia majora are the twofold of skin that arise at the mons pubis and extend back to the fourchette. The external female genitalia are collectively known as the vulva.

Question 6

Which structure is susceptible to the oncogenic human papillomavirus (HPV)?
o Parietal peritoneum
o Squamous-columnar junction
o Squamous epithelium
o Uterine myometrium

Answer 6

Squamous-columnar junction

The squamous-columnar junction, also known as the transitional zone between the cervix and the vagina, is the structure that is susceptible to the HPV virus (especially HPV, types 16 and 18) and where cervical dysplasia occurs. The parietal peritoneum or perimetrium is the outer serous membrane that covers the uterus. The myometrium is the uterine muscle that facilitates childbirth. Squamous epithelium lines the vagina.

Question 7

Ovulation marks the beginning of which phase of menstruation?
o Menstruation
o Follicular or proliferative
o Luteal or secretory
o Ovulation

Answer 7

Luteal or secretory

The menstrual or ovarian cycle has a follicular or proliferative phase that lasts approximately 14 days and a luteal or secretory phase that lasts approximately 14 days. Ovulation occurs between the follicular and luteal phases, marking the beginning of the luteal or secretory phase. If implantation of the blastocyst does not occur in the late luteal phase, then menstruation (menses) occurs, also known as the ischemic or menstrual phase. The secretory phase is when the glands begin to secrete a thin glycogen-containing fluid.

Question 7

Ovulation marks the beginning of which phase of menstruation?
o Menstruation
o Follicular or proliferative
o Luteal or secretory
o Ovulation

Answer 7

Luteal or secretory

The menstrual or ovarian cycle has a follicular or proliferative phase that lasts approximately 14 days and a luteal or secretory phase that lasts approximately 14 days. Ovulation occurs between the follicular and luteal phases, marking the beginning of the luteal or secretory phase. If implantation of the blastocyst does not occur in the late luteal phase, then menstruation (menses) occurs, also known as the ischemic or menstrual phase. The secretory phase is when the glands begin to secrete a thin glycogen-containing fluid.

Question 8

Which hormone inhibits follicle-stimulating hormone (FSH) secretion?
o Inhibin
o Luteinizing hormone (LH)
o Activin
o GnRH

Answer 8

Inhibin

Activin stimulates the secretion of FSH, whereas inhibin inhibits the secretion of FSH. GnRH is produced in the hypothalamus by 10 weeks’ gestation and controls the production of two gonadotropins (FSH, LH). LH stimulates the ovary to release the ova and secrete progesterone.

Question 9

Which structure is a firm, elastic fibromuscular tube found in the male reproductive system?
o Tunica dartos
o Epididymis
o Corpora cavernosa
o Vas deferens

Answer 9

Vas deferens

The vas deferens is a firm, elastic fibromuscular tube that begins at the tail of the epididymis, enters the pelvic cavity within the spermatic cord, loops up and over the bladder, and ends in the prostate gland. This structure has muscular layers that are capable of powerful peristalsis that transports sperm toward the urethra. The tunica dartos forms a septum that separates the two testes. The smooth muscle of the epididymis helps sperm move through the vasa deferentia. The corpora cavernosa is one of the compartments of the penis.

Question 10

Which structure secretes a thin milky substance with an alkaline pH that helps sperm survive the acidic environment of the female reproductive tract?
o Cowper gland
o Seminal vesicles
o Prostate gland
o Seminiferous tubules

Answer 10

Prostate gland

The prostate gland secrets prostatic fluid, which is a thin, milky substance with an alkaline pH that helps sperm survive in the acidic environment of the female reproductive tract. The Cowper glands secrete mucus into the urethra near the base of the penis. Seminal vesicles provide fructose as a source of energy for ejaculated sperm and secrete prostaglandins that promote smooth muscle contraction assisting with sperm transport. Seminiferous tubules are where spermatids develop into sperm.

Question 11

Which is the appropriate term for breast development?
o Gonadarche
o Puberty
o Thelarche
o Adrenarche

Answer 11

Thelarche

In girls, puberty begins at approximately ages 8–9 years with thelarche or breast development. Adrenarche is the increased production of adrenal androgens. Gonadarche is maturation of the gonads. Puberty is the process of change leading to reproductive maturation.

Question 12

Which factors help maintain the self-cleansing action of the vagina? (Select all that apply.)
Low estrogen level
o Basic pH levels
o Acid-base balance that discourages the proliferation of most pathogenic bacteria
o Thickness of the vaginal epithelium
o Excess of Lactobacillus acidophilus

Answer 12

Acid-base balance that discourages the proliferation of most pathogenic bacteria
Thickness of the vaginal epithelium

Two factors help maintain the self-cleansing action of the vagina and defend it from infection: (1) an acid-base balance that discourages the proliferation of most pathogenic bacteria, and (2) the thickness of the vaginal epithelium. Both defenses are greatest when estrogen levels are high and the vagina contains a normal population of Lactobacillus acidophilus, a harmless resident bacterium that helps maintain pH at acidic levels.

Question 13

Testosterone binds to which of the following? (select all that apply)
o Prolactin
o dihydrotestosterone
o sex-hormone-binding globulin (SHBG)
o albumin

Answer 13

sex-hormone-binding globulin (SHBG)
albumin

Ninety-eight percent of testosterone, the major steroid hormone produced by the testis, binds to either SHBG (40%) or albumin (48%). The remaining 2% remains unbound in the plasma and is free to enter cells and wield its metabolic effects. Prolactin helps maintain biosynthesis of testosterone. Peripheral conversion of testosterone produces DHT, another potent androgen. DHT is necessary for external virilization during embryogenesis and androgen activity beginning at puberty and continuing throughout adulthood.

Question 14

Which clinical diagnosis is consistent with symptoms of painful menstruation in the absence of pelvic disease?
o Secondary dysmenorrhea
o Primary dysmenorrhea
o Secondary amenorrhea
o Primary amenorrhea

Answer 14

Primary dysmenorrhea

Dysmenorrhea is painful menstruation; primary dysmenorrhea is due to the release of prostaglandins in ovulatory cycles. Secondary dysmenorrhea is related to pelvic pathologic conditions (e.g., ovarian cysts, endometriosis), which are expressed in later reproductive years and may occur any time in the menstrual cycle. Primary amenorrhea is failure of menarche by 14 years of age. Secondary amenorrhea is the absence of menarche for the equivalent of three cycles.

Question 15

Which clinical diagnosis is associated with hirsutism, amenorrhea, and infertility?
o Pelvic inflammatory disease (PID)
o Premenstrual syndrome (PMS)
o Primary amenorrhea
o Polycystic ovary syndrome (PCOS)

Answer 15

Polycystic ovary syndrome (PCOS)

Clinical manifestations of PCOS usually appear within 2 years of puberty and include dysfunctional bleeding or amenorrhea, hirsutism, acne, and infertility. PMS is the cyclic recurrence of distressing physical, psychologic, or behavioral changes that impair interpersonal relationships or interfere with usual activities. The clinical manifestations of PID vary from sudden, severe abdominal pain with fever to no symptoms at all. Primary amenorrhea is the continued absence of menarche and menstrual function by 14 years of age without the development of secondary sex characteristics or by 16 years of age if these changes have occurred.

Question 16

Which is the correct term for a prolapse of a portion of the bladder into the vaginal canal?
o Uterine prolapse
o Rectocele
o Cystocele
o Urethrocele

Answer 16

Cystocele

Cystocele is descent of a portion of the posterior bladder wall and trigone into the vaginal canal and is usually caused by the trauma of childbirth. Uterine prolapse is the descent of the cervix or entire uterus into the vaginal canal. Urethrocele is a sagging urethra. A rectocele is the bulging of the rectum and posterior vaginal wall into the vaginal canal.

Question 17

Which condition must be ruled out when identifying the cause of secondary amenorrhea?
o Abnormal thyroid function
o Irregular prolactin production
o Unknown pregnancy
o Pituitary gland dysfunction

Answer 17

Unknown pregnancy

The most common cause of amenorrhea is pregnancy and should be ruled out as the cause of amenorrhea before any other evaluation or treatment is considered.

Question 18

A patient presents with an inflammation of one of the ducts that lead from the introitus. What is the appropriate term for this condition?
o Vulvovestibulitis
o Cervicitis
o Vaginitis
o Bartholinitis

Answer 18

Bartholinitis

Bartholin glands are the ducts that lead from the vaginal opening. Vaginitis is the inflammation of the vagina itself. Inflammation of the cervix is generally termed cervicitis, while pathology in the vulval area is called vulvovestibulitis.

Question 19

A patient presents with an inflammation of one of the ducts that lead from the introitus. What is the appropriate term for this condition?
o Vulvovestibulitis
o Cervicitis
o Vaginitis
o Bartholinitis

Answer 19

Bartholinitis

Bartholin glands are the ducts that lead from the vaginal opening. Vaginitis is the inflammation of the vagina itself. Inflammation of the cervix is generally termed cervicitis, while pathology in the vulval area is called vulvovestibulitis.

Question 20

Which female is at greatest risk for developing a benign ovarian cyst?
o A 70-year-old diagnosed with a cystocele
o A 26-year-old with regular menstrual cycle
o A 48-year-old diagnosed as premenopausal
o A 13-year-old experiencing delayed puberty

Answer 20

A 48-year-old diagnosed as premenopausal

Benign cysts of the ovary may occur at any time during the life span, but an increase in benign ovarian cysts occurs when hormonal imbalances are more common, around puberty and menopause.

Question 21

Which is the most important difference between proliferative and nonproliferative breast tissue changes?
o Nonproliferative breast lesions do not increase the risk of breast cancer.
o Genetic aberrations are more common in nonproliferative lesions.
o Cancer prognosis is better for nonproliferative breast tissue changes.
o Cancer resulting from nonproliferative breast lesions has a higher cure rate.

Answer 21

Nonproliferative breast lesions do not increase the risk of breast cancer.

Nonproliferative breast lesions do not increase the risk of breast cancer. The remaining statements are not true of this type of breast tissue change.

Question 22

Regarding uterine fibroids (leiomyomas), which statements are true? (Select all that apply.)
o Fibroids develop from cartilage.
o Fibroid complications can require hospitalization.
o Fibroid incidence decreases with menopause.
o Fibroids are most prevalent before the age 20 years.
o Fibroids are more common in white women.

Answer 22

Fibroid complications can require hospitalization.
Fibroid incidence decreases with menopause.

Leiomyomas, commonly called myomas or uterine fibroids, are benign smooth muscle tumors in the myometrium. They are the most common benign tumors of the uterus, affecting as many as 70% to 80% of all women; prevalence increases in women 30–50 years of age but decreases with menopause. Leiomyomas are more common in black and Asian women, and complications related to leiomyomas are the number one reason for gynecologic hospitalizations.

Question 23

Which conditions represent nonproliferative changes in breast tissue? (Select all that apply.)
o Florid hyperplasia
o Interductal papillomas
o Mammary dysplasia
o Fibrocystic changes (FCCs)
o Cysts

Answer 23

Mammary dysplasia
Fibrocystic changes (FCCs)
Cysts

Nonproliferative breast lesions are generally not associated with an increased risk in breast cancer. FCCs or physiologic nodularity and cysts, fibrocystic disease, chronic cystic mastitis, and mammary dysplasia are nonproliferative lesions. Florid hyperplasia and intraductal papillomas (solitary papillomas that grow from the wall of a cyst into the lumen of the duct) are considered proliferative breast lesions.

Question 24

Which factors are believed to increase the risk for developing cervical cancer? (Select all that apply.) o Human immunodeficiency viral (HIV) infection o Smoking o Breast cancer o Chlamydia trachomatis infection o Human papillomavirus (HPV) infection

Answer 24

Human immunodeficiency viral (HIV) infection Smoking Chlamydia trachomatis infection Human papillomavirus (HPV) infection Cervical cancer is now established as almost exclusively caused by the cervical HPV infection. Smoking, immunosuppression (HIV infection), and poor nutrition are cofactors. In addition, infection with Chlamydia trachomatis has been correlated with the risk for developing cervical cancer.

Question 25

Regarding infertility, which statements are true? (Select all that apply.) o Ovulatory factors account for 40% of female infertility. o Infertility rates are declining. o Age is a major factor in female fertility. o Infertility affects 15% of couples trying to conceive. o The man is the sole cause of the infertility in 50% of cases.

Answer 25

Ovulatory factors account for 40% of female infertility. Age is a major factor in female fertility. Infertility affects 15% of couples trying to conceive. Infertility affects approximately 15% of all couples and is defined as the inability to conceive after 1 year of unprotected intercourse with the same, opposite-sex partner. Age is a major factor in female fertility, as the regularity of ovulation and the quality of ova decrease with age. Ovulatory factors account for 40% of female infertility. The rate of infertility may be increasing because of an increase in sexually transmitted diseases. The man is the sole cause of the infertility in 40% of cases.

Question 26

What is the most common cause of a urethral stricture in a man? o Indwelling catheter use o Congenital defect o Prostatitis o Carcinoma

Answer 26

Indwelling catheter use A urethral stricture is a fibrotic narrowing of the urethra caused by scarring. The scars may be congenital but are more likely to result from trauma or from untreated or severe urethral infections, most often from long-term use of indwelling urinary catheters. Prostatitis and infection are common complications of urethral stricture. Urethral carcinoma is a less common cause of urethral stricture.

Question 27

What is the medical term for the inflammation of the glans penis? o Paraphimosis o Phimosis o Priapism o Balanitis

Answer 27

Balanitis Inflammation of the glans penis is called balanitis. Phimosis is a condition in which the foreskin cannot be retracted. Paraphimosis is the condition when the foreskin is retracted and cannot be reduced. Priapism is a prolonged erection.

Question 28

What is the medical term for abnormal dilation of the veins in the spermatic cord? o Varicocele o Hydrocele o Spermatocele o Cryptorchidism

Answer 28

Varicocele Abnormal dilation of a vein within the spermatic cord is called varicocele and is classically described as a “bag of worms.” A hydrocele is a collection of fluid within the tunica vaginalis. Spermatoceles (epididymal cysts) are benign cystic collections of fluid of the epididymis located between the head of the epididymis and the testis. Cryptorchidism is a condition of testicular maldescent.

Question 29

Which statement is true regarding benign prostatic hyperplasia (BPH)? o BPH is an uncommon condition. o The prostate is largest at birth and continues to shrink. o Ten percent of men will have BPH by the 80 years of age. o BPH may be problematic if urethral compression occurs.

Answer 29

BPH may be problematic if urethral compression occurs. BPH is a common condition and may become a problem if compression of the urethra occurs. The prevalence among US men who are 60 years of age and older is approximately 50%; among men 70 years of age and older, the prevalence is 90%. The prostate increases in size throughout life and is the smallest at birth.

Question 30

A man reports an abnormal curvature of his penis. He states it has been getting worse since puberty and that intercourse is painful. These symptoms support which diagnosis? o Orchitis o Paraphimosis o Phimosis o Peyronie disease

Answer 30

Peyronie disease Peyronie disease is a fibrotic condition that causes lateral curvature of the penis during erection and is associated with painful erection, painful intercourse (for both partners), and poor erection distal to the involved area. It develops slowly and usually affects middle-aged men. Orchitis is inflammation of the testes. Phimosis and paraphimosis are problems with the foreskin.

Question 31

A man reports unilateral pain in his scrotum. He has a red and swollen area on his scrotum. Which is the most likely cause of his pain? o Epididymitis o Balanitis o Paraphimosis o Testicular cancer

Answer 31

Epididymitis Pain is the main symptom of epididymitis. Pyuria or bacteriuria and urinary symptoms may be present. Balanitis is an inflammation of the glans penis, and paraphimosis is the inability to move the foreskin forward (reduce) to cover the glans. Signs of testicular cancer include abnormal consistency, induration, nodularity, or an irregularity of a testis. A firm, nontender testicular mass or diffuse enlargement is found in the majority of cases.

Question 32

Which statements are true regarding torsion of a testis? (Select all that apply.) o Torsion of a testis is most common in middle-aged men. o Thickened spermatic cord is evident. o High-riding testis may be noted. o Relief is not obtained with the elevation of the scrotum. o Torsion of a testis is a benign condition.

Answer 32

Thickened spermatic cord is evident. High-riding testis may be noted. Relief is not obtained with the elevation of the scrotum. Torsion of a testis is the rotation of a testis, which twists blood vessels in the spermatic cord. This condition causes vascular engorgement and ischemia, resulting in scrotal pain not relieved by scrotal elevation (Prehn sign). On physical examination, men have a tender, high-riding testis, a thickened spermatic cord, and an absent cremasteric reflex. Torsion of a testis is a surgical emergency, and surgery must be performed within 6 hours if it cannot be untwisted with manual manipulation. This event is most common among neonates and pubertal adolescents, but it can occur at any age.

Question 33

What conditions are associated with orchitis? (Select all that apply.) o Systemic infection o Prepubertal boys o Epididymitis o Mumps o Testicular torsion

Answer 33

Systemic infection Epididymitis Mumps Orchitis is an acute infection of the testes and is uncommon except as a complication of a systemic infection or as an extension of an associated epididymitis. Mumps is the most common infectious cause of orchitis and usually affects postpubertal males. Testicular torsion is the rotation of a testis, which twists blood vessels in the spermatic cord.

Question 34

Sexual dysfunction involves impairment of which functions in males? (Select all that apply.) o Ejaculation o Emission o Erection o Spermatogenesis

Answer 34

Ejaculation Emission Erection In men, the normal sexual response involves three processes: erection, emission, and ejaculation. Sexual dysfunction is the impairment of any or all of these processes. Impairment can be caused by a number of physiologic and psychologic factors. Spermatogenesis is the development of sperm by the testes.

Question 35

Which statements are true regarding gynecomastia? (Select all that apply.) o Gynecomastia affects less than 3% of the male population. o Incidence of gynecomastia is greatest among adolescents and older men. o Gynecomastia usually involves an imbalance of the estrogen/testosterone ratio. o Gynecomastia may begin as a palpable mass anywhere on the chest.

Answer 35

Incidence of gynecomastia is greatest among adolescents and older men. Gynecomastia usually involves an imbalance of the estrogen/testosterone ratio. Gynecomastia is breast enlargement that results in a firm, palpable mass, at least 2 cm in diameter located beneath the areola. It has an incidence of 32% to 40% and is most common in adolescents or men older than 50 years of age. Gynecomastia is caused by hormonal or breast tissue alterations that cause estrogen to dominate. These alterations can result from systemic disorders, drugs, neoplasms, or idiopathic causes. Gynecomastia usually involves an imbalance of the estrogen/testosterone ratio.

Question 36

Which condition is considered a complicated gonococcal infection in women? o Urinary tract infection o Ectopic pregnancy o Arthritis o Pelvic inflammatory disease

Answer 36

Pelvic inflammatory disease Complicated gonococcal infections include pelvic inflammatory disease, salpingitis, and bartholinitis in women. Ectopic pregnancy may be the result of the long-term sequelae of salpingitis. Arthritis has been linked with secondary syphilis.

Question 37

Microscopically, which bacterium resembles a corkscrew? o Neisseria gonorrhoeae o Treponema pallidum o Chlamydia trachomatis o Herpes simplex

Answer 37

Treponema pallidum Syphilis is caused by T. pallidum, which is a corkscrew-shaped anaerobe that cannot be cultured. Chlamydia is an obligate gram- negative intracellular bacterium. Gonorrhea is caused by N. gonorrhoeae, a gram-negative diplococcus. Herpes simplex virus is a deoxyribonucleic acid (DNA) virus, not a bacterium.

Question 38

A systemic illness and skin lesions characterize which stage of syphilis? o Tertiary o Primary o Secondary o Latent

Answer 38

Secondary Secondary syphilis is systemic, and blood-borne bacteria spread to all major organ systems. Primary syphilis starts with a chancre and moves to regional lymph nodes. Tertiary is the most severe and affects skin, bone, the central nervous system (CNS), and the cardiovascular system. In latent syphilis, the infected individual has no clinical manifestations.

Question 39

Which disease is associated with the bacterium Haemophilus ducreyi? o Chancre o Chancroid o Pseudobuboes o Donovan bodies

Answer 39

Chancroid Chancroid is caused by the bacterium H. ducreyi. A chancre is an open wound associated with syphilis. Donovan bodies are bacteria-filled vacuoles and occur with granuloma inguinale. Pseudobuboes occur when infection spreads to the inguinal area in granuloma inguinale.

Question 40

A thin, gray malodorous discharge that adheres to the vaginal walls characterizes which medical condition? o HSV infection o Chlamydia o Gonorrhea o Bacterial vaginosis

Answer 40

Bacterial vaginosis Bacterial vaginosis causes a thin, gray, malodorous discharge. Gonorrhea has a purulent-to-mucopurulent discharge from the cervical os. Chlamydial infections may be asymptomatic. HSV infections have painful vesicles.

Question 41

Which sexually transmitted infection (STI) is likely to cause small punctate marks on the cervix? o Entamoeba histolytica o Trichomoniasis o Molluscum contagiosum o Human papillomavirus

Answer 41

Trichomoniasis Trichomoniasis is a sexually transmitted disease that may exhibit small red spots on the cervix, making it appear similar to a strawberry. Human papillomavirus (HPV) exhibits genital warts that are often soft, skin-colored discrete growths. Molluscum contagiosum is a benign viral infection with lesions that are often white or flesh colored. Entamoeba histolytica infection is associated with amoebic dysentery.

Question 42

Which statement is true regarding hepatitis? o Hepatitis D is known to be sexually transmitted. o There are five types of hepatitis viruses. o Three of the viruses have possible cures. o Each type of hepatitis virus causes icteric liver inflammation.

Answer 42

Each type of hepatitis virus causes icteric liver inflammation. All of the hepatitis viruses cause acute, icteric (jaundice-producing) liver inflammation. Six types of viruses cause hepatitis. Hepatitis B is known to be sexually transmitted. Each of the viruses causes liver inflammation with jaundice (icterus). No known cures exist, although the infections are usually self-limiting. Vaccines are available for hepatitis A and B.

Question 43

Which conditions are complications of sexually transmitted infections (STIs)? (Select all that apply.) o Ectopic pregnancy o Infertility o Genital cancers o Pelvic inflammatory disease o Colon cancer

Answer 43

Ectopic pregnancy Infertility Genital cancers Pelvic inflammatory disease

Question 44

Which statements are true regarding gonorrhea? (Select all that apply.) o Gonorrhea affects the genitalia, as well as eyes, mouth, and rectum. o Of those who have intercourse with an infected man, 30% will develop gonorrhea. o Dysuria is a common symptom. o Infection rates of gonorrhea are highest in the northeast region.

Answer 44

Gonorrhea affects the genitalia, as well as eyes, mouth, and rectum. Dysuria is a common symptom. Dysuria, discharge, abnormal menses, and dyspareunia are common complaints with a gonorrhea infection. The risk of developing gonorrhea from intercourse with an infected male partner is 50% to 80%. Gonorrhea can affect the eyes, mouth, and rectum, as well as the genitalia. Infection rates are highest in the southern regions of the country.

Question 45

Antibiotics eradicate which infection? (Select all that apply.) o Chlamydia o Gonorrhea o Molluscum contagiosum o Bacterial vaginosis o Herpes simplex virus (HSV)

Answer 45

Chlamydia Gonorrhea Bacterial vaginosis Gonorrhea, Chlamydia, and bacterial vaginosis may be treated with antibiotics. Currently, HSV has no cure. Antivirals are used to limit the course of outbreaks; however, once an individual contracts HSV, he or she has the condition for life. Molluscum contagiosum is also a virus but is not treated with antibiotics.

Question 46

What is the final outcome of impaired cellular metabolism? o Cellular alterations in the heart and brain o Impairment of urine excretion o Cellular alterations in the vasculature structures and kidneys o Buildup of cellular waste products

Answer 46

Buildup of cellular waste products The common pathway in all types of shock is impairment of cellular metabolism as a result of decreased delivery of oxygen and nutrients, which are frequently coupled with an increased demand, the consumption of oxygen and nutrients, and a decreased removal of cellular waste products. Eventually organ dysfunction and failure do occur. Urine excretion diminishes as the kidneys fail from lack of perfusion or due to hypovolemic shock and volume loss.

Question 47

Which clinical manifestation of septic shock confirms an elevation in immune system response? o Tachycardia o Hypothermia o Increased white blood cell count o Low respiratory rate

Answer 47

Increased white blood cell count The increased WBCs indicate the immune response. Tachycardia occurs as a compensatory mechanism. The respiratory rate will be increased. Temperature will most likely be increased in most patients.

Question 48

The release of catecholamine by the adrenal glands provides which compensatory mechanism in hypovolemic shock? o Systemic vascular resistance is decreased. o Water excretion is increased. o Heart rate is increased. o Interstitial fluid moves out of the vascular compartment.

Answer 48

Heart rate is increased. The heart rate will increase in shock due to the effects of circulating catecholamines. Fluid moving out of the vascular compartment is deleterious, leading to a relative hypovolemia. Systemic vascular resistance is increased to improve blood pressure. Water excretion is not increased as a result of catecholamine release.

Question 49

Hypovolemic shock begins to develop when intravascular volume has decreased by what percentage? o 5 o 10 o 20 o 15

Answer 49

15

Question 50

A student asks the professor to explain the basics of vasogenic shock. What statement by the professor is best? o Vasodilation from an imbalance between the two nervous systems o The outcome of widespread hypersensitivity to an allergen o Inability to get adequate blood to tissues and end organs o Bacteremia combined with systemic inflammatory response

Answer 50

Vasodilation from an imbalance between the two nervous systems Vasogenic shock refers to a widespread and massive vasodilation resulting from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. Widespread hypersensitivity is characteristic of anaphylactic shock. Bacteremia and systemic inflammation are seen in septic shock. The inability to pump adequate blood to tissues and end organs describes cardiogenic shock.

Question 51

What is the clinical hallmark of neurogenic shock as a result of the overstimulation of the parasympathetic nervous system? o Increased metabolism o Vasoconstriction o Respiratory distress o Vasodilation

Answer 51

Vasodilation Neurogenic shock refers to a widespread and massive vasodilation that results from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. Increased metabolism is seen in all forms of shock. Respiratory distress may occur in any form of shock.

Question 52

Four patients are in the intensive care unit with different types of shock. Which patient would the healthcare professional assess as the priority? o Neurogenic o Hypovolemic o Anaphylactic o Septic

Answer 52

Anaphylactic Anaphylactic shock is characterized by massive vasodilation and widespread inflammation that can lead to death in minutes if treatment is not instituted immediately. If all else is equal, the healthcare professional should assess the patient with anaphylactic shock first.

Question 53

Four patients are in the intensive care unit with different types of shock. Which patient would the healthcare professional assess as the priority? o Neurogenic o Hypovolemic o Anaphylactic o Septic

Answer 53

Anaphylactic Anaphylactic shock is characterized by massive vasodilation and widespread inflammation that can lead to death in minutes if treatment is not instituted immediately. If all else is equal, the healthcare professional should assess the patient with anaphylactic shock first.

Question 54

A patient is diagnosed with septic shock. What action by the healthcare professional will address the main underlying pathophysiologic mechanism of this disorder? o Give the patient antihistamines and steroids. o Place patient on an intra-aortic balloon pump. o Administer antibiotics as soon as possible. o Provide high volumes of isotonic fluid.

Answer 54

Administer antibiotics as soon as possible. Septic shock begins when bacteria enter the bloodstream, so the effective treatment for this specific problem is antibiotics. High volumes of fluid may been needed in all types of shock other than cardiogenic. A balloon pump would be beneficial in cardiogenic shock. Antihistamines and steroids would be used in anaphylactic shock.

Question 55

For which type of shock would antihistamines and corticosteroids be prescribed? o Cardiogenic o Anaphylactic o Septic o Hypovolemic

Answer 55

Anaphylactic Only anaphylactic shock responds to the administration of epinephrine to decrease mast cell and basophil degranulation. Antihistamines and steroids are administered to stop the inflammatory reaction. Septic shock specifically requires antibiotics. Hypovolemic shock is treated with large amounts of fluid. Cardiogenic shock requires the use of drugs or devices to improve the pumping ability of the heart.

Question 56

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? o Septicemia o Septic shock o Sepsis o Bacteremia

Answer 56

Sepsis Of the options available, only sepsis is best defined as a systemic response to infection that is manifested by two or more criteria of the systemic inflammatory response syndrome.

Question 57

The student learns that which mechanism causes organ injury in primary multiple organ dysfunction syndrome (MODS)? o Impaired perfusion o Impaired ventilation o Impaired glucose use o Impaired immune response

Answer 57

Impaired perfusion In primary MODS, the organ injury is directly associated with a specific insult, most often ischemia or impaired perfusion from an episode of shock or trauma, thermal injury, soft tissue necrosis, or invasive infection. Although MODS can be associated with impaired immune response, glucose use, and ventilation, the commonality in all cases of primary MODS is impaired perfusion.

Question 58

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? o Tumor necrosis factor o IL-4 o Interleukin (IL)-1 o IL 6

Answer 58

IL-4 Normal endothelial cells have little interaction with leukocytes except when stimulated by TNF, IL-1, and IL-6. The student would recognize that IL4 is not involved in this process.

Question 59

What stimulates the respiratory burst and production of highly toxic free radicals in the multiple organ dysfunction syndrome (MODS)? o Activation of the complement cascade o Activation of the fibrinolytic system o Neutrophils adhering to the endothelium o Release of prostaglandins, thromboxanes, and leukotrienes

Answer 59

Neutrophils adhering to the endothelium The accumulation of activated neutrophils in organs is thought to play a key role in the pathogenetic development of MODS. When neutrophils adhere to the endothelium, they undergo a respiratory burst (oxidative burst) and release oxygen radicals. The respiratory burst occurs as the activated neutrophil experiences a sudden increase in oxidative metabolism, producing large quantities of highly toxic oxygen free radicals. Activation of the complement cascade; release of prostaglandins, thromboxanes, and leukotrienes; and activation of the fibrinolytic system do not provide this stimulus.

Question 60

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? o Maldistribution of blood flow o Death of organs o Translocation of bacteria o Massive inflammatory response

Answer 60

Translocation of bacteria The loss of intestinal barrier function leads to the systemic spread of bacteria and/or endotoxin from the gut (systemic endotoxemia). This phenomenon is called translocation of bacteria. This “gut hypothesis” provides a possible explanation for the fact that an infectious focus is not always found in individuals with MODS. The gut hypothesis is not related to death of organs, maldistribution of blood flow, or massive inflammation.

Question 61

Blistering of the skin within minutes occurs in which type of burn injury? o First degree o Superficial partial thickness o Deep partial thickness o Full thickness

Answer 61

Superficial partial thickness The hallmark of superficial partial-thickness injury is the appearance of thin-walled, fluid-filled blisters that develop within only a few minutes after injury. First degree burns only involve the epidermis and can be compared to a sunburn. A deep partial thickness burn looks waxy white and may initially be indistinguishable from a full thickness burn until new skin buds and hair appear within 7 to 10 days.

Question 62

A patient has an acute burn injury. What type of treatment for shock will the healthcare professional anticipate for this patient? o Antihistamines and steroids o Intravenous fluids o Intra-aortic balloon pump o Antibiotics

Answer 62

Intravenous fluids Acute burn injuries can lead to hypovolemic shock from massive fluid losses from the circulating blood volume. The professional anticipates treating hypovolemic shock with fluid resuscitation. Antibiotics would be used in septic shock. A balloon pump would be used in cardiogenic shock. Antihistamines and steroids are used in anaphylactic shock.

Question 63

What assessment finding would indicate to the healthcare professional that the patient is no longer in burn shock? o Respiratory rate 24 breaths/min o Blood pressure 100/58 mmHg o Urine output 35 mL/hour for 4 hours o Pulse rate 98 beats/min

Answer 63

Urine output 35 mL/hour for 4 hours The most reliable criterion for adequate resuscitation of burn shock is urine output. Normal urine output is minimally 30 mL/hour. The patient having a normal urine output for 4 hours has shown recovery from burn shock. None of the remaining options are considered as reliable as urine output.

Question 64

Which condition does a burn injury create for an extended period? o Hypervolemia o Hyponatremia o Hypotension o Hypermetabolism

Answer 64

Hypermetabolism A burn injury induces a hypermetabolic state that persists until wound closure. Fluid and electrolyte imbalances and hypotension can be resolved with rapid treatment, but the hypermetabolic state lasts for an extended period of time.

Question 65

A student learns that a fatal burn injury has what effect on interleukins (ILs)? o Increases levels of IL-6 o Decreases levels of IL-4 lymphocytes o Decreases levels of IL-2 o Increases levels of IL-12

Answer 65

Decreases levels of IL-2 A fatal burn injury has often shown decreased levels of IL-2, which may result in decreased Th1 lymphocytes. This results in a major disruption in cellular immunity and IgG production.

Question 66

Daily evaporative water loss after a burn injury is approximately how many times the normal? o 5 o 15 o 10 o 20

Answer 66

20 Moncrief and Mason determined that daily evaporative water loss after burn injury was in the range of 20 times normal in the early phase, with gradual decreases as wound closure is achieved.

Question 67

What is the significance of a high level of interleukin 1 (IL-1) in a patient who has experienced severe burns? o Urinary function is improved. o Antibiotic therapy is required. o Prognosis is poor. o They are less at risk for death.

Answer 67

They are less at risk for death. The level of IL-1 inversely correlates with burn survival; low levels may be associated with a higher mortality. This selection is the only option that accurately identifies the significance of a high level of IL-1.

Question 68

What is the most common type of shock in children? o Septic o Hypovolemic o Cardiogenic o Neurogenic

Answer 68

Hypovolemic Hypovolemic shock, the most common type of shock in children, is associated with a reduction in the intravascular volume relative to the vascular space. It is most frequently caused by dehydration and trauma.

Question 69

Hypotension is likely to occur when an infant or child is greater than % dehydrated. o 10 o 2 o 5 o 7

Answer 69

10 Hypotension typically develops when dehydration is greater than 10% in the infant or child or greater than 6% in the adolescent

Question 70

A healthcare professional assesses that a child’s capillary refill time is 4 sec. What does the healthcare professional evaluate that finding to mean? o This finding is normal. o The child is in shock. o The child has compensated shock. o The child must have septic shock.

Answer 70

The child is in shock. Normal capillary refill time is <2 sec (brisk). A refill time of 4 sec in prolonged and indicates a perfusion deficit possibly from shock. In septic shock, the capillary refill time may be normal or faster than normal due to vasodilation.

Question 71

A 2-year-old is in shock. The healthcare professional assesses the child’s heart rate as 52 beats/min. What action by the healthcare professional is most appropriate? o Sedate the child o Begin cpr o Get an ECG o Increase intravenous rate

Answer 71

Begin cpr Bradycardia often indicates impending cardiovascular collapse or cardiac arrest and is the most common terminal cardiac rhythm observed in children. The normal resting heart rate in a toddler is 80 to 120 beats/min, so a heart rate of 52 beats/min is too slow. The provider would assess perfusion and if the heart rate does not rise, begin CPR. The provider would not take the time to order an ECG. There is no reason to increase the fluid rate, or sedate the child at this moment.

Question 72

A child is in cardiogenic shock and the parents ask why the child has hepatomegaly and periorbital edema. What explanation by the healthcare professional is best? o Low cardiac output and systemic venous congestion o Mass vasodilation as a result of chemical mediators released from the myocardium o Reduced renal perfusion, stimulating the RAAS system o Tissue damage to the myocardium, causing increased capillary permeability

Answer 72

Low cardiac output and systemic venous congestion Cardiogenic shock is generally associated with low cardiac output and systemic venous congestion, leading to signs of fluid backup into organs and tissues. The professional would explain that this is the cause of the hepatomegaly and edema. It is not the result of mass vasodilation, tissue damage, or the RAAS system activation.

Question 73

Approximately 80% of all hospital-acquired infections in children are a result of which type of organism? o Viruses o Bacteria o Rickettsia o Fungi

Answer 73

Bacteria In adults and children, approximately 40% of all hospital-acquired infections are linked to gram-negative infections, 40% to gram- positive infections, and 21% each to viruses and fungi.

Question 74

A student asks the healthcare professional to explain reperfusion injuries. What explanation is best? o Damage from restored blood flow and exposure to oxygen o Tissue damage that can occur with blood transfusions o Tissue destruction during rewarming in frostbite o Fluid overload from intravenous therapy that is too rapid

Answer 74

Damage from restored blood flow and exposure to oxygen Reperfusion (reoxygenation) injury is associated with cell damage caused by the restoration of blood flow and physiologic concentrations of oxygen to cells that have been exposed to injurious but nonlethal hypoxic conditions. It is not related to blood transfusions, rewarming specifically, or fluid overload.

Question 75

The healthcare professional plans care for a child in shock. What are the PRIMARY goals for the treatment of shock? o Maintaining all vital signs within normal functioning ranges o Maintaining hydration and adequate urinary output o Maximizing oxygen delivery and minimizing oxygen demand o Supporting all facets of the cardiovascular system

Answer 75

Maximizing oxygen delivery and minimizing oxygen demand The primary goals of the treatment of shock are maximizing oxygen delivery and minimizing oxygen demand. The other goals are desirable, but do not take priority over maximizing oxygen delivery and minimizing demand. If those goals are met, the others will be as a result.

Question 76

To determine a child’s response to fluid therapy for shock, the healthcare professional should monitor which measurements as the priority? o Blood pressure and pulse o Urine output and specific gravity o Hematocrit and hemoglobin levels o Arterial blood gases and heart rate

Answer 76

Urine output and specific gravity Monitoring of the volume of urine output and specific gravity is most useful in determining the child’s response to fluid therapy.

Question 77

A 33-pound child is in shock. Which fluid bolus should the healthcare professional prepare to administer to this child? o Isotonic fluid, 300 mL o Isotonic fluid, 150 mL o Hypotonic fluid, 150 mL o Hypotonic fluid, 300 mL

Answer 77

Isotonic fluid, 300 mL In general, isotonic crystalloids (salt-containing solutions, such as normal saline or lactated Ringer solution) or colloids (protein- containing fluids, such as albumin or blood) are administered in boluses of 20 mL/kg. This child weighs 33 pounds, or 15 kg. 15 × 20 = 300. Hypotonic fluids are not used.

Question 78

What causes renal failure after electrical burns in children? o Myoglobin released from damaged muscles o Cytokines released after the damaged tissue o Immature kidneys are unable to compensate for the electrical burns o Cardiac output is reduced

Answer 78

Myoglobin released from damaged muscles The release of myoglobin may occlude the kidney tubules and result in renal failure. Renal failure after electrical burns is not related to cytokine release or immature kidneys. While severely decreased cardiac output as in cardiogenic shock can affect the kidneys due to poor perfusion, this is not related directly to electrical burns.

Question 79

A 4-year-old child with a burn injury has entered the catabolic flow phase. What assessment would the healthcare provider correlate with this situation? o Cap refill < 2sec o Oxygen saturation normal on room air o Blood pressure 89/56 mmHg o 7-pound weight loss in 1 week

Answer 79

7-pound weight loss in 1 week After the resolution of the shock and the restoration of circulating volume, the metabolic response shifts to a catabolic (flow) phase. A state of hypermetabolism ensues characterized by elevation of catecholamines which are insulin antagonists. Glycogen stores in the child are limited leading to a state of prolonged metabolic dysfunction, the end result of which is loss of lean body mass. The professional would assess the child as being in this phase with a documented weight loss. Oxygen saturation would not give information about oxygen consumption which is elevated in the phase. A capillary refill of <2 sec is normal as is the blood pressure for a 4-year-old.

Question 80

The healthcare professional explains to a student that the most serious outcome resulting from limited glycogen stores in children who have been seriously burned is which of these? o Poor wound healing o Increased morbidity o Decreased immunity o Loss of adipose tissue stores

Answer 80

Increased morbidity Glycogen stores are limited in children, making it hard for them to meet the increased energy demands of the burn. This prolonged metabolic dysfunction may lead to the loss of lean body mass. The most serious effect of weight loss is increased morbidity. Limited glycogen stores do not directly affect wound healing, immunity, or adipose tissue stores.

Question 81

A healthcare professional gets an update on 4 children. Which one should the professional assess as the priority? o School-aged child, respiratory rate of 38 breaths/min o 6-month-old, respiratory rate of 42 breaths/min o 2-year-old, respiratory rate of 39 breaths/min o Preschooler, respiratory rate of 26 breaths/min

Answer 81

School-aged child, respiratory rate of 38 breaths/min The normal respiratory rate for a school-aged child is 18 to 25 breaths/min, so a respiratory rate of 38 is excessive. The professional should assess this child first. The 6-month-old and the preschooler have normal respiratory rates. The 2-year-old’s respiratory rate is slightly above the normal of 27-37 breaths/min, but this is not as large a deviation from normal as seen in the school-aged child.

Question 82

Which information does the student learn regarding multiple organ dysfunction syndrome (MODS)? o Secondary MODS occurs within 3 to 7 days of the initial insult. o Chronic illness increases a child’s risk for MODS. o Risk factors for MODS include severe or prolonged shock, sepsis, and trauma. o Primary MODS occurs immediately after the attributing cause. o Diagnosis requires simultaneous failure of at least two organs.

Answer 82

o Chronic illness increases a child’s risk for MODS. o Risk factors for MODS include severe or prolonged shock, sepsis, and trauma. o Diagnosis requires simultaneous failure of at least two organs. MODS is the simultaneous failure of at least two organs resulting from a single cause and may be either primary or secondary. Primary MODS is directly attributable to the insult and typically occurs 3 to 7 days after an insult. Secondary MODS typically occurs later and may be associated with the more sequential development of organ dysfunction. Risk factors for MODS include severe or prolonged shock, sepsis, trauma, cardiopulmonary arrest, congenital heart disease, and liver and bone marrow transplantation. Children with chronic diseases have an increased risk for MODS and increased mortality.

Question 83

A child has septic shock with significant hypovolemia. What interventions should the healthcare professional prepare to complete? (Select all that apply.) o Titration of inotropes o Aggressive fluid administration o Antibiotic therapy o Permissive hyperglycemia o Vasopressors

Answer 83

o Titration of inotropes o Aggressive fluid administration o Antibiotic therapy o Vasopressors The child with septic shock has significant hypovolemia that typically responds to aggressive fluid administration, antibiotic therapy, titration of inotropes, vasopressors, and vasodilators. Tight glycemic control has shown to be associated with better outcomes in shock.

Question 84

Which behaviors in newborns would support the possibility of shock? o Hyper alertness o Decreased heart rate variability o Hypoglycemia o Increased muscular tone o Temperature instability

Answer 84

o Decreased heart rate variability o Hypoglycemia o Temperature instability Nonspecific signs of distress in newborns include jitteriness or lethargy with decreased muscle tone, bradycardia or decreased heart rate variability, temperature instability, and hypoglycemia.

Question 85

Which assessment findings would be recognized as late signs of shock in a child? o Cool skin o Bradycardia o Hypotension o Prolonged capillary refill o Metabolic (lactic) acidosis

Answer 85

Bradycardia Hypotension Although all of the options are observable, hypotension and bradycardia are recognized as late signs of shock in children.

Question 86

Which information does the professor teach the class regarding how a child’s body compensates for cardiogenic shock? (Select all that apply.) o Compensation prevents the child from developing hepatic or mesenteric failure. o Adrenergic responses produce tachycardia to increase cardiac output. o The renin-angiotensin-aldosterone system is stimulated when renal function decreases. o Splanchnic arteries are constricted to divert blood from the skin, kidneys, and gut to the heart and brain. o Peripheral blood vessels are constricted to raise blood pressure.

Answer 86

All but A In the early stages of cardiogenic shock, adrenergic compensatory mechanisms produce tachycardia, peripheral vasoconstriction, and constriction of the splanchnic arteries to divert blood flow from the skin, gut, and kidneys to maintain flow to the heart and brain. These compensatory mechanisms may be sufficient to maintain the child’s systolic blood pressure and effective coronary artery and cerebral blood flow. However, tachycardia and systemic arterial constriction increase myocardial oxygen consumption. In addition, reduction in gut and kidney blood flow may produce hepatic, mesenteric, or renal ischemia or failure. Decreased renal perfusion stimulates the renin-angiotensin-aldosterone system, as described for hypovolemic shock.

Question 87

A healthcare professional is assessing the severity of a burn injury. What factors does the professional include in this assessment? (Select all that apply.) o Amount of fluid lost over a 24-hour period o Severity of the injury caused to other body systems o Percentage of total body surface area involved o Circumference of the burn injury o Depth of the burn injury

Answer 87

Percentage of total body surface area involved Depth of the burn injury The severity of a burn injury is assessed on the basis of the percentage of the total body surface area involved. Because burn trauma represents a three-dimensional wound, the severity of injury is also assessed in relation to the depth of the injury. Although the other options are considered when planning treatment, the severity of the burn injury, itself, is not based on any of these.

Question 88

Which cytokines are anti-inflammatory mediators? o Nitric oxide o Arachidonic acid metabolites o IL-11 o Colony-stimulating factor o IL-4

Answer 88

IL-11 Colony-stimulating factor IL-4 Antiinflammatory mediators include only IL-4, IL-10, IL-11, and IL- 13; transforming growth factor-beta; colony-stimulating factors; soluble TNF receptor; IL-1 receptor antagonist; and activated protein C.

Question 89

A healthcare professional explains that children under 2 years of age have a higher risk for dehydration because of which factors? (Select all that apply) o Limited glycogen stores o Immature kidneys o Inability to concentrate urine o Larger TBSA compared to weight than adults o Underdeveloped anti-inflammatory mediators

Answer 89

o Immature kidneys o Inability to concentrate urine o Larger TBSA compared to weight than adults Children younger than 2 years lack the ability to concentrate urine because of the immaturity of the renal system (including the kidneys) and are therefore at increased risk for dehydration. They also have a larger TBSA in relationship to weight than do adults. Young children do have limited glycogen stores, but this is not related to becoming dehydrated. A child’s antiinflammatory mediators also do not have a direct impact of hydration status.