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Exam 3 > Patho ?s > Flashcards

Patho ?s Flashcards

1
Q

Which of the following is not a major role of hormones?

a. growth stimulation
b. erythrocyte synthesis
c. fluid balance and regulation
d. metabolic rate regulation

A

b. erythrocyte synthesis

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2
Q

The release of hormones from glands is most often controlled by:

a. negative feedback mechanisms
b. nephrogenic mechanisms
c. ectopic hormone production
d. active transport

A

a. negative feedback mechanisms

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3
Q

The most common cause of endocrine disorders is:

a. surgical removal of endocrine glands
b. infection
c. adenomas
d. immunodeficiency

A

c. adenomas

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4
Q

Excess cortisol is represented by which condition?

a. addison disease
b. cushing syndrome
c. diabetes insipidus
d. hyperthyroidism

A

b. Cushing syndrome

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5
Q

Diabetes insipidus, if left untreated, will rapidly develop into:

a. malignant HTN
b. diabetic coma
c. dehydration
d. metabolic alkalosis

A

c. dehydration

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6
Q

A patient is asked to collect a 24hr urine test to check a hormone level. Why is the 24hr urine needed?

a. this is done to measure female reproductive hormone levels
b. this is done to obtain a measurement of hormone secretion over time
c. it is easier than obtaining a blood sample
d. urine is not an effective method of measuring hormone levels

A

b. this is done to obtain a measurement of hormone secretion over time

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7
Q

You are experiencing constipation, dry skin, weight gain, and cold intolerance. Which condition are you most likely experiencing?

a. hyperthyroidism
b. Addison disease
c. Cushing syndrome
d. hypothyroidism

A

d. hypothyroidism

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8
Q

Which of the following occurs with elevated levels of cortisol?

a. fatty acids are mobilized
b. glucose levels are suppressed
c. plasma protein levels ↑
d. inflammation ↑

A

a. fatty acids are mobilized

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9
Q

Which type of hormone is not produced in the adrenal cortex?

a. mineralocorticoids
b. glucocorticoids
c. adrenal sex hormones
d. neurotransmitters

A

d. neurotransmitters

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10
Q

Diagnosis of SIADH is based on which of the following?

a. hyponatremia
b. hypertonicity
c. ↑ urine volume
d. dilute urine with a low sodium content

A

a. hyponatremia

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11
Q

Release of hormones from the anterior pituitary differs from those released by the posterior pituitary. What is the major way in which these are different?

a. the posterior pituitary is much less complicated
b. the anterior pituitary releases only two hormones
c. the posterior pituitary follows the positive feedback loop
d. the anterior pituitary is controlled by the hypothalamus

A

a. the posterior pituitary is much less complicated

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12
Q

Which of the following major pathways occurs when a hormone is produced in a cell and can have an impact on neighboring cells and on its own cell?

a. paracrine pathway
b. autocrine pathway
c. synaptic pathway
d. neuroendocrine pathway

A

b. autocrine pathway

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13
Q

A patient presents with SIADH and a serum sodium level of 100 mEq/L. What would you expect for clinical manifestations for this patient?

a. polyuria, polydipsia, polyphagia
b. nausea, vomiting, headache
c. muscle cramps, weakness, irritability
d. seizures, psychosis, gait disturbances

A

c. muscle cramps, weakness, irritability

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14
Q

A patent presents with exophthalmos. What condition are they likely experiencing?

a. Addison disease
b. Cushing syndrome
c. graves disease
d. diabetes insipidus

A

c. graves disease

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15
Q

This controls the regulation of many hormones.

a. endocrine system
b. neurotransmitters
c. limbic system
d. hypothalamic-pituitary axis

A

d. hypothalamic-pituitary axis

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16
Q

Which is true about the action of they hypothalamus on the posterior pituitary gland?

a. hormones travel within blood vessels to this part of the pituitary
b. hypothalamus produces antidiuretic hormone released from this part of the pituitary
c. hypothalamus stimulates releasing hormones from this part of the pituitary
d. hypothalamus bypasses the posterior pituitary

A

b. hypothalamus produces antidiuretic hormone related from this part of the pituitary

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17
Q

Hormones travel from the hypothalamus to the anterior pituitary through:

a. hypophyseal portal system
b. nerve axons
c. lymphatic system
d. systemic circulation

A

a. hypophyseal portal system

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18
Q

What household tool functions in a similar way to that of the negative feedback loop?

a. thermostat
b. dishwasher
c. microwave
d. toaster

A

a. thermostat

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19
Q

Which of the following does not prevent the accumulation of hormones in the body?

a. degradation by enzymes
b. inactivation by the liver
c. inhibition of hormone release by somatostatin
d. elimination through the urine or feces

A

c. inhibition of hormone release by somatostatin

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20
Q

Which best explains why hormone only act on certain parts of the body?

a. receptor binding
b. negative feedback mechanisms
c. regulation by the hypothalamic-pituitary axis
d. tissue affinity

A

a. receptor binding

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21
Q

Which hormone pathway is represented by cells in the body that are able to both receive hormone stimulation and secrete the hormone to receptive neighboring cells?

a. paracrine pathway
b. endocrine pathway
c. autocrine pathway
d. synaptic pathway

A

c. autocrine pathway

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22
Q

You are stressed about your pathophysiology final exam. What hormone, released from the hypothalamus, initiates the stress response?

a. antidiuretic hormone
b. adrenocorticotropic hormone
c. corticotropin-releasing hormone
d. cortisol

A

c. corticotropin-releasing hormone

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23
Q

Catecholamines, stimulated and released by the sympathetic nervous system and adrenal glands, are also active in the stress response. Which of the following is not a catecholamine released during stress?

a. serotonin
b. dopamine
c. epinephrine
d. norepinephrine

A

a. serotonin

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24
Q

Which of the following is not a beneficial action of cortisol in the alarm stage of the stress response?

a. releases lipids
b. ↑ circulating blood glucose
c. suppression of the immune response
d. inhibition of metabolism

A

d. inhibition of metabolism

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25
Q

Cortisol elevations are needed in the early stress response but persistent hypercortisolism is problematic because it includes:

a. glucose intolerance
b. protein anabolism
c. autoimmunity
d. an excessive inflammatory response

A

a. glucose intolerance

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26
Q

Your mother is told that she has a hormone receptor problem and her cells are not receptive to hormone stimulation. Why might her receptors not be functioning appropriately?

a. she has too many receptors
b. she has a high sensitivity to the hormone
c. she has a tumor that is secreting ectopic hormone
d. she has antibodies that are blocking the receptors

A

d. she has antibodies that are blocking the receptors

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27
Q

Your grandmother is diagnosed with renal failure. How would this impact her hormone levels?

a. there would be no effect on her hormone levels
b. she would have much higher levels of circulating hormones
c. she would have much lower levels of circulating hormones
d. this is dependent upon whether or not her body adapts by eliminating all hormones through feces

A

b. she would have much higher levels of circulating hormones

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28
Q

What action does excessive ADH secretion have on cellular fluid balance in SIADH?

a. intracellular fluid retention
b. excessive water losses
c. excessive circulating blood volume
d. extracellular fluid retention

A

a. intracellular fluid retention

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29
Q

Which lab indicator is found in diabetes insipidus?

a. excessive ADH levels
b. urine spec gravity less than 1.005
c. serum hypoosmolality
d. serum hyponatremia

A

b. urine spec grav less than 1.005

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30
Q

What is the reason for excessive thyroid gland stimulation in graves disease?

a. excessive TSH release from pituitary
b. excessive thyrotropin-releasing hormone from hypothalamus
c. suppression of TSH release from pituitary
d. antibodies binding to gland receptors

A

d. antibodies binding to gland receptors

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31
Q

Your grandmother, who has a long history of hypothyroidism, has boggy, non pitting edema around her eyes. This condition is referred to as:

a. myxedema
b. goiter
c. exophthalmos
d. mucositis

A

a. myxedema

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32
Q

Which of the following is not a process that leads to Cushing syndrome?

a. long-term use of prednisone
b. excess ACTH secretion
c. tumors of adrenal gland
d. ectopic production of ADH

A

d. ectopic production of ADH

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33
Q

You have inflammation of the lg intestine, a condition called ulcerative colitis. What is the most probably reason that you would develop iron-deficiency anemia?

a. you are experiencing chronic blood loss in your stools
b. you have inadequate hydrochloric acid for absorption of iron
c. you have lost usable surface area in the lg intestine for absorption of iron
d. you do not have adequate iron intake in your diet

A

a. you are experiencing chronic blood loss in your stools

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34
Q

You are part of the healthcare team at a clinic for adolescents with anorexia nervosa. Which of the assessments that you perform is focused on recognizing the most common cause for mortality in those with anorexia nervosa?

a. lung assessment
b. cardiovascular assessment
c. skin assessment
d. neurologic assessment

A

b. cardiovascular assessment

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35
Q

Which dietary change would be recommended for the individual with celiac disease?

a. avoid milk/milk products
b. avoid wheat, barley, rye, oats
c. avoid rice, soy, nuts
d. avoid long-chain fatty acids

A

b. avoid wheat, barley, rye, oats

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36
Q

Which of the following affects the sensations of hunger and satiety and, therefore, plays a major role in the development of obesity?

a. hypothalamus
b. pituitary gland
c. thyroid gland
d. pancreas

A

a. hypothalamus

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37
Q

Which of the following does not contribute as an energy source in the diet?

a. carbs
b. fats
c. proteins
d. vitamins

A

d. vitamins

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38
Q

You are caring for an individual with liver disease. What are you most concerned about in terms of nutrition?

a. patient may be unable to adequately store nutrients
b. patient may be unable to synthesize nutrients
c. patient may be unable to metabolize nutrients
d. all the above

A

d. all the above

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39
Q

Your patient has gallbladder disease and is unable to store and release adequate bile to the small intestine. What dietary modifications do you suggest?

a. ↑ protein intake
b. ↓ fat intake
c. ↑ complex carbs
d. no dietary changes are needed

A

b. ↓ fat intake

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40
Q

You are working in the newborn nursery and are an advocate for breast-feeding. It is the winter in northern Minnesota and you are concerned about low sunlight exposure in infants who are breast-feeding as they may develop vitamin D deficiency. What is the major manifestation of vitamin D deficiency?

a. impaired mineralization in growing bones
b. impaired retinal development
c. impaired osteoclast activity
d. keratinization of mucous membranes

A

a. impaired mineralization in growing bones

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41
Q

You are planning a nutritional in-srvice to your clinic’s service area in California. What concept of altered nutrition should you focus your talk to address the largest nutritional problems in your area?

a. altered metabolism
b. undernutrition
c. overnutrition
d. all of these are equally prevalent

A

c. over nutrition

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42
Q

What is known about glucose transport into the small intestine?

a. it requires cotransport with sodium
b. it occurs through active transport
c. it must first be reduced s it is rarely consumed in the typical diet
d. all of these are true about glucose transport

A

d. all if these are true about glucose transport

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43
Q

Which of the following vitamins is supplemented in pregnancy because of its important role in embryogenesis and the prevention of neural tube defects in the fetus?

a. vitamin A
b. critic acid
c. folate
d. vitamin B12

A

c. vitamin B12

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44
Q

What is the first plan of action for the formula-feed newborn who is just diagnosed with PKU?

a. switch to a special formula with phenylalanine
b. prepare for a blood transfusion
c. switch to a phenylalanine-free formula
d. require the mother to breast-feed

A

c. switch to a phenylalanine-free formula

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45
Q

What are typical manifestations for malabsorption syndromes?

a. constipation, dry mouth, weakness
b. diarrhea, bloating, stomach pain
c. bloody stools, fissures, rectal bleeding
d. nausea, vomiting, stomach cramping

A

b. diarrhea, bloating, stomach pain

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46
Q

Your neighbor, as she put is, is a “lactose intolerant health nut” and she is always experimenting with various supplements. Recently, she went into the clinic for evaluation of pain in her leg and was found to have multiple bone fractures. Which of the following supplements, in toxic levels, causes multiple skeletal fractures?

a. phosphorus
b. iron
c. zinc
d. calcium

A

a. phosphorus

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47
Q

Which of the following is not considered an essential nutrient?

a. water
b. iron
c. vitamin c
d. glucose

A

d. glucose

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48
Q

Which vitamin deficiency is most likely if you are unable to absorb fats?

a. C
b. A
c. B12
d. all of these

A

b. vitamin A

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49
Q

How would you modify the diet of a patient who has a healing wound?

a. add OJ with breakfast
b. remove all simple sugars from diet
c. add butter to morning toast
d. diet does not impact wound healing

A

a. add OJ with breakfast

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50
Q

Which of the following has the greatest impact or caloric needs?

a. lactation
b. pregnancy
c. older age
d. gender

A

a. lactation

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51
Q

What substances must be secreted in order to neutralized stomach acid in the small intestine?

a. pancreatic enzymes
b. hydrochloride
c. bicarbonate
d. bile salts

A

c. bicarbonate

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52
Q

Which nutrient is not the simplest form needed for absorption?

a. fiber
b. monosaccharides
c. amino acids
d. water

A

a. fiber

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53
Q

Loss of which part of the GI tract would have the greatest impact on nutrient absorption?

a. stomach
b. small intestine
c. lg intestine
d. liver

A

c. lg intestine

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54
Q

Which mineral deficiency would inhibit glucose absorption in the small intestine?

a. calcium
b. magnesium
c. sodium
d. potassium

A

c. sodium

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55
Q

Deprivation of this will inhibit fat emulsification.

a. bile salts
b. pancreatic enzymes
c. glycerol
d. cotransport molecules

A

a. bile salts

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56
Q

Which of the following terms relates to a state where a mineral is unbound and must remain unbound (also called an ionic state), in order to be absorbed, such as with calcium?

a. active transport
b. passive diffusion
c. bioavailability
d. ionicity

A

c. bioavailability

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57
Q

Which of the following is least likely to be under consumed and lead to a state of undernutrition?

a. carbs
b. protein
c. iron
d. vitamins

A

a. carbs

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58
Q

Effective adaption to a state or starvation (marasmus) is dependent upon suppression of this hormone?

a. growth hormone
b. glucagon
c. cortisol
d. insulin

A

d. insulin

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59
Q

Which is the replacement source of energy in an effective adaptation to starvation?

a. glucose
b. ketones
c. amino acids
d. monosaccharides

A

b. ketones

60
Q

You are stranded on a deserted island. How long could you survive if you were able to remain hydrated?

a. 1 mo
b. 10 days
c. 1 yr
d. 3 mo

A

a. 1 mo

61
Q

An individual who is deficient in this nutrient is likely to present with severe edema?

a. water
b. proteins
c. carbs
d. fats

A

b. proteins

62
Q

Which of the following patients is most likely to be diagnosed with a malabsorption syndrome?

a. Jane, a 24yo with lactose intolerance
b. Bill, a 36yo with acute pancreatitis
c. Steve, a 40yo with severe IBS
d. Rachelle, a 5yo on pancreatic enzymes for cystic fibrosis

A

c. Steve, a 40yo with severe IBS

63
Q

Why does carbohydrate malabsorption lead to abdominal distention, bloating, pain, diarrhea, and flatulence?

a. chronic bowel inflammation
b. fermentation
c. fibrosis
d. bacterial flora overgrowth in the intestine

A

b. fermentation

64
Q

Which population of those listed is at the lowest risk for iron deficiency anemia?

a. infants
b. adolescents
c. pregnant women
d. elderly men/women

A

d. elderly men/women

65
Q

Those with clinical manifestations for iron deficiency anemia often present with pallor of the skin and mucous membranes, fatigue, weakness, lightheadedness, breathlessness, palpitations, headache, tachycardia, and syncope. What is the cause of these manifestations?

a. electrolyte imbalance
b. hypoxia
c. pagophagia
d. excessive blood loss

A

b. hypoxia

66
Q

Which of the following is not a characteristic of those with anorexia nervosa?

a. weight loss
b. body image distortions
c. ignoring hunger
d. dysmenorrhea

A

d. dysmenorrhea

67
Q

In anorexia nervosa, severe caloric restriction leads to all the the following except:

a. micronutrient deficiencies
b. mobilization of lipid stores
c. protein catabolism
d. reduced metabolic rate

A

a. micronutrient deficiencies

68
Q

What causes gluten malabsorption in celiac disease?

a. T-cell-mediated hypersensitivity
b. excessive intake of glutens
c. pancreatic enzyme deficiency
d. chronic inflammation

A

a. T-cell-mediated hypersensitivity

69
Q

Which of the following provides the most objective measurement of renal dysfunction?

a. WBC count
b. GFR
c. altered urinary electrolytes
d. presence of nitrites in urine

A

b. GFR

70
Q

A characteristic change in stool that may indicate the presence of blood includes which of the following?

a. melena
b. hematuria
c. floating
d. graylike color

A

a. melena

71
Q

Which of the following diagnostic procedures analyzes the entire lg colon?

a. barium enema
b. flexible sigmoidoscopy
c. flexible gastroscopy
d. colonoscopy

A

d. colonoscopy

72
Q

Which of the following foods should be avoided in people with renal calculi?

a. grape juice
b. ground beef
c. strawberries
d. cinnamon

A

c. strawberries

73
Q

Which of the following foods should be avoided in people with diverticular disease?

a. grape juice
b. ground beef
c. strawberries
d. cinnamon

A

c. stawberries

74
Q

Which type of urinary incontinence can be attributed to muscle overactivity?

a. stress
b. urge
c. overflow
d. functional

A

b. urge

75
Q

Identify the enteric nervous system component located between the circular and longitudinal muscle layer of the lg intestine?

a. myenteric plexus
b. submucosal plexus
c. meissner plexus
d. solar plexus

A

a. myenteric plexus

76
Q

The area of the lg intestine that absorbs the majority of water is the:

a. ileum
b. ascending colon
c. descending colon
d. rectum

A

a. ileum

77
Q

The process by which fecal contents enters the rectum is known as:

a. peristalsis
b. segmental contractions
c. mass movement
d. tetany

A

c. mass movement

78
Q

The average volume of urine eliminated each day totals:

a. 200mL
b. 800mL
c. 1500mL
d. 3000mL

A

c. 1500mL

79
Q

The _____ urethral sphincter is made of skeletal muscle and is under voluntary control.

a. internal
b. external
c. anterior
d. posterior

A

b. external

80
Q

Urine spec gravity of 1.030 indicates:

a. concentrated urine
b. dilute urine
c. urine high in bacteria
d. casts in urine

A

a. concentrated urine

81
Q

Which of the following diagnostic criteria is consistently with the diagnosis of functional fecal incontinence?

a. 1yo
b. 3yo
c. 5yo
d. all the above

A

c. 5yo

82
Q

A GFR of 95 mL per minute indicates:

a. normal renal function
b. mild renal disease
c. moderate renal disease
d. several renal disease

A

a. normal renal function

83
Q

Which of the following increases the risk for renal calculi?

a. running 5 miles
b. drinking 32oz of milk/day
c. sedentary lifestyle
d. dehydration

A

d. dehydration

84
Q

Which of the following is a characteristic of urine that indicated adequate hydration?

a. oliguria
b. strong smelling
c. dark color
d. pale color

A

d. pale color

85
Q

The functional unit of the kidney is known as the:

a. bladder
b. trigone
c. nephron
d. cecum

A

c. nephron

86
Q

Vasa recta are most likely to be found around:

a. proximal tubules
b. loops of henle
c. distal convoluted tubules
d. collecting ducts

A

b. loops of Henle

87
Q

Detrusor contraction is stimulated by?

a. sympathetic cholinergic fibers
b. sympathetic adrenergic fibers
c. parasympathetic cholinergic fibers
d. parasympathetic adrenergic fibers

A

c. parasympathetic cholinergic fibers

88
Q

Micturition is stimulated by:

a. bladder filling
b. rectal filling
c. mass movements
d. segmental movement

A

a. bladder filling

89
Q

Stool color is due to?

a. urochrome
b. stercobilin
c. urea
d. hydrogen sulfide

A

b. stercobilin

90
Q

The inartistic enteric nervous system component that transmits sensory impulses through stretch receptors in the colon is:

a. myenteric plexus
b. Auerbach plexus
c. Meissner plexus
d. celiac plexus

A

c. Meissner plexus

91
Q

The presence of epithelial cells in urinary casts indicates which of the following pathophysiologic conditions?

a. glomerulonephritis
b. pyelonephritis
c. UTI
d. acute tubular necrosis

A

d. acute tubular necrosis

92
Q

Altered neuromuscular function may result in:

a. impaired absorption processes
b. obstruction
c. impaired secretion processes
d. all the above

A

d. all the above

93
Q

Obstruction in the renal tubules or colon leads to:

a. dilation of structure proximal to the obstruction
b. dilation of structures distal to the obstruction
c. constriction of structures proximal to the obstruction
d. contrition of structures distal to the obstruction

A

a. dilation of structures proximal to the obstruction

94
Q

Costovertebral angle (CVA) tenderness is a sign of:

a. bladder infection
b. kidney infection
c. appendicitis
d. bowel obstruction

A

b. kidney infection

95
Q

Partial obstructions with manifestations of hard, solidly formed stool are most likely located in which colon segment?

a. cecum
b. ascending
b. traverse
d. sigmoid

A

d. sigmoid

96
Q

Steatorrhea is most commonly associated with:

a. bowel obstruction
b. urolithiasis
c. malabsorption syndromes
d. encopresis

A

c. malabsorption syndromes

97
Q

Blood in stool that cannot be seen with naked eye is known as:

a. hematemesis
b. melena
c. hematochezia
d. occult

A

d. occult

98
Q

Medications for diarrhea that work by absorbing excess fluid in fecal matter in the colon without affecting transport processes across the membrane as known as?

a. anti motility agents
b. adsorbents
c. bulk-forming agents
d. laxatives

A

c. bulk-forming agents

99
Q

The most common components of renal calculi is:

a. calcium oxalate
b. uric acid
c. struvite
d. cystine

A

b. uric acid

100
Q

Which of the following receptor types requires bright light for generation of nerve impulses?

a. free nerve endings
b. hair cells
c. rods
d. cones

A

d. cones

101
Q

Which of the following is not a characteristic of colic pain?

a. dull
b. intermittent
c. radiating
d. excruciating

A

a. dull

102
Q

Surgical stone removal is indicated for:

a. stone too small to pass
b. obstruction of urine flow
c. mild, intermittent pain for 1day
d. small stone without evidence of size increase

A

b. obstruction of urine flow

103
Q

Inability to voluntarily prevent the discharge of urine is known as:

a. encopresis
b. enuresis
c. endocsopic
d. anuria

A

b. enuresis

104
Q

Incontinence cause by exertion stimulus is known as:

a. urge
b. overactive bladder
c. functional
d. stress

A

d. stress

105
Q

The form of PKD that first manifests in the early infant period is most commonly characterized as:

a. autosomal dominant
b. autosomal recessive
c. acquired
d. all the above

A

b. autosomal recessive

106
Q

Manifestations of PKD include which of the following?

a. ↓ in kidney size bilaterally
b. ↑ in kidney size bilaterally
c. ↓ in kidney size unilaterally
d. ↑ in kidney size unilaterally

A

b. ↑ in kidney size bilaterally

107
Q

A single out pouching of the colon wall is called:

a. diverticula
b. diverticulum
c. diverticulosis
d. diverticulitis

A

b. diverticulum

108
Q

In comparing dietary strategies suggested for prevention of both diverticulitis and renal calculi, which one is common to both conditions?

a. avoidance of tea and cola
b. avoidance of high fat
c. avoidance of nuts and strawberries
d. avoidance of rice

A

c. avoidance of nuts and strawberries

109
Q

Retentive incontinence may be caused by:

a. fear of defecation
b. organic bowel impairment
c. ineffective toilet-training management
d. resistant behavior

A

a. fear of defecation

110
Q

Vitamin D inactivation in renal disease is associated with:

a. anemia
b. osteoporosis
c. altered water balance
d. hyperkalemia

A

b. osteoporosis

111
Q

Which of the following is caused by the release of insulin?

a. ↓ blood glucose level
b. ↑ blood glucose level
c. ↑ lipid breakdown
d. ↑ protein breakdown

A

a. ↓ blood glucose level

112
Q

Which of the following is not true of type 1 diabetes?

a. can be treated with oral glycemic agents
b. pancreas is completely unable to produce insulin
c. acute onset
d. definite genetic link

A

a. can be treated with oral glycemic agents

113
Q

Which of the following is not true about type 2 diabetes?

a. accounts for up to 95% of diabetics
b. gradual onset
c. significant weight loss occurs as a sign
d. risk factors are HTN, family hx, and obesity

A

c. significant weight loss occurs as a sign

114
Q

Which of the following is not a sign of DKA?

a. kussmaul respirations
b. dehydration
c. ketonuria
d. low blood glucose level

A

d. low blood glucose level

115
Q

Which lab test is the best predictor of blood glucose control over the previous few months?

a. HbA1c
b. fasting blood glucose
c. urinalysis
d. feasting (postprandial) blood glucose

A

a. HbA1c

116
Q

Neuropathies are a potential complication of diabetes. Why do these occur?

a. infection in the nerves
b. thickening and ischemia of the vessels that supply the nerve fibers
c. inability to provide continuous glucose to the brain and spinal cord
d. excessive glucose exposure to the brain and spinal cord

A

b. thickening and ischemia of the vessels that supply the nerve fibers

117
Q

What is the major difference between the somogyi effect and the dawn of phenomenon?

a. one is caused by the release of certain hormones
b. one occurs between 4am and 9am
c. one triggers insulin resistance and the release of glucose from the liver
d. one is characterized by hyperglycemia that is not triggered by overnight hypoglycemia

A

d. one is characterized by hyperglycemia that is not triggered by overnight hypoglycemia

118
Q

What would happen if your patient did not have alpha cells of the pancreas?

a. they would not be able to secrete insulin
b. they would not be able to secrete somatostatin and gastrin
c. they would not be able to secrete glucagon
d. they would not be able to secrete pancreatic enzymes

A

c. they would not be able to secrete glucagon

119
Q

What would be an unusual sign in a child that may alert the parent to the presence of diabetes?

a. bedwetting in a child that was previously dry through the night
b. irritability
c. asking for water to drink in the middle of the night
d. all of these are signs

A

d. all of these are signs

120
Q

What is your explanation to the parents who do not want to give their child insulin injections to treat type 1 diabetes because they have heard that pills can be used to treat this condition?

a. insulin is destroyed in the GI tract if taken orally, so it must be injected SubQ
b. the child can go ahead and take the oral medication because he does have type 1
c. the child cannot take the pills because we can’t be sure that he would take the entire dose
d. the pills are reserved for those over the age of 12

A

a. insulin is destroyed in the GI tract if taken orally, so it must be injected SubQ

121
Q

When increased blood glucose levels stimulate increased secretion of insulin, this is an example of control by:

a. releasing hormones
b. ectopic hormones
c. negative feedback
d. positive feedback

A

c. negative feedback

122
Q

A major difference between Bobby (type 1) and his father (type 2) is:

a. how the two conditions are diagnosed
b. how the conditions are treated
c. the potential long-term complications
d. the overall goal of treatment for each type

A

b. how the conditions are treated

123
Q

Bobby’s father (with type 2) has been encouraged to ↑ his exercise level. Exercise is encouraged in type 2 because:

a. exercise ↓ stress
b. skeletal muscles can use glucose without a proportionate insulin amount
c. exercise ↓ cardiovascular effects of excessive glucose
d. all of these are correct

A

d. all of these are correct

124
Q

Bobby’s father (with type 2) has been prescribed an oral hypoglycemic drug. Such drugs act:

a. as an insulin replacement
b. to ↓ the body’s need for glucose in body cells
c. to prevent the formation of glucose
d. to ↓ insulin resistance

A

d. to ↓ insulin resistance

125
Q

Bobby (type 1) comes into the clinic after 6mo for a follow-up visit. He indicates that his blood sugars have been around 100-120mg/dL, and he has been fully participating in the other aspects of his diabetes management plan. Which would lead you to believe that he has not been in tight control of his diabetes?

a. a ↓ glycosylated hemoglobin level
b. an ↑ glycosylated hemoglobin level
c. a random blood sugar of 150mg/dL performed in the clinic
d. there is no method to determine whether or not he is in control

A

a. a ↓ glycosyloated hemaglobin level

126
Q

Bobby, a 12yo M, is admitted with type 1 diabetes mellitus. In order for this diagnosis to have been made, Bobby has all of the following pathophysiologic characteristics except:

a. enlarged pancreas
b. peak occurrence between ages 7-15yrs
c. a combination of environmental and genetic factors as the cause
d. hyperglycemia and hyperketonuria

A

a. enlarged pancreas

127
Q

The pathophysiology of type 1 diabetes can best be described as:

a. destruction of the pancreatic islet cells, which produce insulin
b. resistance of insulin-sensitive tissues to insulin
c. ↓ production of releasing hormones by the hypothalamus
d. stimulation by food intake of glucose production resulting in ↑ insulin production

A

a. destruction of the pancreatic islet cells, which produce insulin

128
Q

The origin of the pathophysiology in type 1 diabetes is related to:

a. IgE-mediated hypersensitivity, which destroys the endocrine pancreas and impairs release of insulin
b. IgA-mediated hypersensitivity, which affects the sensitivity of tissues to insulin
c. B-lymphocyte autoimmunity against the endocrine pancreas beta cells
d. T-lymphocyte autoimmunity against the endocrine pancreas beta cells

A

d. T-lymphocyte autoimmunity against the endocrine pancreatic cells

129
Q

Early signs and symptoms you would expect a person with type 1 diabetes to exhibit include:

a. recurrent infections, visual changes, paresthesias
b. polydipsia, polyuria, polyphagia, weight loss, fatigue
c. vomiting, abdominal pain, sweet fruity breath, dehydration, Kussmaul breathing
d. weakness, vomiting, hypotension, mental confusion

A

b. polydipsia, polyuria, polyphasic, weight loss, fatigue

130
Q

What would you expect to find in the individual with type 1 diabetes?

a. elevated blood glucose level
b. elevated insulin level
c. elevated WBC count
d. all the above

A

a. elevated blood glucose level

131
Q

A child asks you if he will outgrow his diabetes and eventually be cured. You tell him:

a. “There is no cure at this time; you will need to take medication everyday to manage the diabetes.”
b. “There is no cure at this time but if you lose some weight it may correct itself.”
c. “As you get older, the disease will decrease in severity; you will be able to control it by diet only.”
d. “By the time you have completed puberty, it will be gone.”

A

a. “There is no cure at this time; you will need to take medication everyday to manage the diabetes.”

132
Q

After Bobby, age 12, was diagnosed with type 1 diabetes, his father, John went for a physical and was diagnosed with type 2 diabetes. What led the practitioner to believe that John had type 2 diabetes.

a. John’s blood glucose was high
b. John was producing no insulin
c. John was overweight
d. all of the above are signs for type 2

A

a. John’s blood glucose was high

133
Q

Obesity is a major risk factor for the development of type 2 diabetes. What is the mechanism for this?

a. obesity is a result of high sugar intake, which leads to hyperglycemia
b. obesity releases fatty acids and cytokines, which interfere with insulin receptors
c. obesity is associated with hypercholesterolemia, which impairs the circulation of insulin
d. obesity is associated with a mutation of the MiR-21 gene, which is the same gene implicated in the development of insulin resistance

A

b. obesity releases fatty acids and cytokines, which interfere with insulin receptor

134
Q

Bobby (type 1), now age 14, is admitted with the following lab values: arterial pH 7.2, serum glucose 500 mg/dL, urine glucose and ketones 4+/strong. His parents state that he has been sick with the “flu” for a week. What relationship do these values have to his insulin deficiency?

a. ↑ glucose utilization causes the shift of fluid from the intravascular to intracellular space
b. ↓ insulin causes fatty acid use, ketone formation, metabolic acidosis, and solute diuresis
c. ↑ glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis
d. ↑ insulin use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss

A

b. ↓ insulin causes fatty acid use, ketone formation, metabolic acidosis, and solute diuresis

135
Q

From the choice provided, the reason that Bobby (type 1) developed diabetic ketoacidosis was most likely related to:

a. skipping a meal
b. strenuous exercise
c. illness
d. insulin overdose

A

c. illness

136
Q

If Bobby (type 1) presented in an unconscious state, how would you know that he was experiencing diabetic ketoacidosis?

a. pale moist skin
b. thirst and poor skin turgor
c. deep rapid respirations and fruity breath odor
d. tremors and strong rapid pulse

A

c. deep rapid respirations and fruity breath odor

137
Q

Loss of consciousness with diabetic ketoacidosis is due directly to:

a. toxic effects of excessive insulin
b. glucose deficit in blood
c. acidosis effects on CNS
d. lack of glucose to CNS

A

c. acidosis effects on CNS

138
Q

Which lab values would you expect to see when Bobby (type 1) presents in ketoacidosis?

a. ↑ serum bicarb
b. serum pH of 7.5 (norm 7.35 - 7.45)
c. ↓ serum potassium
d. urine pH 4.0 (norm 4.5 - 8)

A

d. urine pH 4.0 (norm 4.5 - 8)

139
Q

Bobby (type 1) is sent home on insulin. During his gym class, he experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion for the first time. The most probable cause of these symptoms is:

a. hyperglycemia due to incorrect insulin admin
b. hypoglycemia due to ↑ exercise
c. hyperglycemia due to not eating breakfast
d. hypoglycemia due to administering too little insulin that morning

A

b. hypoglycemia due to ↑ exercise

140
Q

Bobby’s dad (type 2) asks you why insulin injections have no been prescribed for his type 2 diabetes. You tell him:

a. type 2 diabetes is a disease of reduced insulin production and cellular insulin resistance; there is not a lack of insulin production
b. he would be unable to metabolize insulin so it would not help for him to take insulin injections
c. the extra glucose he has has in his body is helpful so he would not want to decrease it with insulin
d. older adults do not benefit from insulin injections as much as children

A

a. type 2 diabetes is a disease of reduced insulin production and cellular insulin resistance; there is not a lack of insulin production

141
Q

Bobby (type 1) has been instructed to maintain “tight” control of his diabetes in order to prevent all of the following chronic complications except:

a. hypoglycemia
b. nephropathy
c. retinopathy
d. PVD

A

a. hypoglycemia

142
Q

John (Bobby’s dad) with type 2 diabetes is more likely than Bobby to develop which of the following complications?

a. hypoglycemia
b. DKA
c. somogyi effect
d. hyperglycemic hyperosmolar nonketotic syndrome

A

d. hyperglycemic hyperosmolar nonketotic syndrome

143
Q

The somogyi effect is a problem of:

a. overnight hypoglycemia with rebound hyperglycemia in the morning
b. ↑ insulin resistance as weight ↑
c. hyperglycemia in the absence of ketosis
d. massive osmotic diuresis and dehydration

A

a. overnight hypoglycemia with rebound hyperglycemia in the morning

144
Q

The mechanism for the development of the dawn phenomenon is related to the release of:

a. inflammatory mediators
b. hormones
c. insulin
d. enzymes

A

b. hormones

145
Q

Visual impairment may develop in people with diabetes, primarily because of:

a. abnormal metabolism in the lens
b. microvascular changes in the eye
c. cataract development
d. development of exophthalmos

A

b. microvascular changes in the eye

Exam 3 (3 decks)

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