Test 2 Flashcards
Match the term to the definition:
A. orderly cell death without inflammation
B. leaky fluid from blood vessels
C. fragmentation of the nucleus of a dying cell causing irregular chromatin distribution
D. death of a body part (finger, foot, ear, etc)
E. cell death occurring in a granuloma
F. too much fluid in a body cavity
terms: caseous necrosis effusion apoptosis gangrenous necrosis karyorrhexis hyperremia
APOPTOSIS - A. orderly cell death without inflammation
HYPEREMIA - B. leaky fluid from blood vessels
KARYORRHEXIS - C. fragmentation of the nucleus of a dying cell causing irregular chromatin distribution
GANGRENOUS NECROSIS - D. death of a body part (finger, foot, ear, etc)
CASEOUS NECROSIS - E. cell death occurring in a granuloma
EFFUSION - F. too much fluid in a body cavity
Which of the following 3 symptoms are most likely experience by a patient with left-sided heart failure with the right side still functioning normally? A. ischemic heart disease B. pulmonary edema C. difficulty breathing when lying down D. brain hemorrhages E. pitted edema in the ankles F. hepatomegaly G. severe headaches
Answer:
A. ischemic heart disease (usually one of the causes of left-sided heart failure)
B. pulmonary edema
C. difficulty breathing when lying down
incorrect answers: D. brain hemorrhages -microhemorrhages in the lungs, not the brain E. pitted edema in the ankles - more of a right-sided heart failure symptom F. hepatomegaly - symptoms of right-sided heart failure G. severe headaches - not mentioned in study guide
Select the correct statement concerning myocardial infarction:
A. universally associated with extreme pain
B. most related deaths are associated with ventricular arrythmias
C. aortic thrombus is usually associated
D. blood levels of troponin T and creatinine phosphate are reduced
Answer: B. most related deaths are associated with ventricular arrhythmias
A. universally associated with extreme pain
- sometimes an MI can be asymptomatic
C. aortic thrombus is usually associated
- its a MURAL thrombus that forms 40% of the time
D. blood levels of troponin T and creatinine phosphate are reduced
- these cardiac enzymes are ELEVATED due to MI
Select the 2 correct statements:
A. Libman-Sacks is endocarditis not associated with autoimmune disease
B. splinter hemorrhages are cardiac miniature blood clots that can migrate to under the finger nails
C. cardiac tamponade is associated with fluid accumulation around the heart which causes excessive cardiac compression
D. bradycardia typically associated with ventricular fibrillations
E. a 1st degree heart block is associated with a lack of heart conduction
F. Atrial fibrillation is very rare, even in the elderly
Answers:
B. splinter hemorrhages are cardiac miniature blood clots that can migrate to under the finger nails
C. cardiac tamponade is associated with fluid accumulation around the heart which causes excessive cardiac compression
incorrect:
A. Libman-Sacks is endocarditis not associated with autoimmune disease
- this endocarditis is associated with autoimmune disease, such as Lupus Erythematosus
D. bradycardia typically associated with ventricular fibrillations
- tachycardia is associated with ventricular arrhythmias
E. a 1st degree heart block is associated with a lack of heart conduction
- a 1st degree heart block refers to a slowed impulse propagation and is usually asymptomatic; a 3rd degree heart block is the one associated with a lack of heart conduction
F. Atrial fibrillation is very rare, even in the elderly
- atrial fibrillation is the most common form of ectopic beats/arrhythmias and is common in elderly people
Which of the following are associated with primary hypertension (1) and which are associated with secondary hypertension (2)?
preeclampsia increased Na+ retention consequence of congestive heart failure 95% of all cases of hypertension associated with diabetes
2 - preeclampsia 1 - increased Na+ retention 2 - consequence of congestive heart failure 1 - 95% of all cases of hypertension 2 - associated with diabetes
Which of the following is least likely to be a compensation for congestive heart failure?
A. cardiomegaly
B. a reduction in cardiac stroke volume
C. increased catecholamine (sympathetic activity)
D. tachycardia
Answer: B. a reduction in cardiac stroke volume (an increase is cardiac stroke volume is a compensation for congestive heart failure)
the other answers are all ways the body will compensate for congestive heart failure.
An elderly, hypertensive man with type II diabetes has suddenly started to experience severe retrosternal chest pain every time he stands up but also often during periods when he is just sitting and there is no exertion. Select which of the following statements is most likely to apply to this condition:
A. this condition is easy to manage and is known as stable angina.
B. this type of pain is often associated with esophageal reflux
C. the use of sublingual nitroglycerin should be effective in rapidly relieving this discomfort
D. this condition could easily become associated with dyspnea and arrhythmias
Answer: D. this condition could easily become associated with dyspnea and arrhythmias
incorrect answers:
A. this condition is easy to manage and is known as stable angina.
- false. this condition is called unstable angina and is difficult to manage. Stable angina is caused by exertion, is the most common type, and the easiest to manage.
B. this type of pain is often associated with esophageal reflux
- reflux pain may be associated with MI, but probably not angina that occurs often and at rest.
C. the use of sublingual nitroglycerin should be effective in rapidly relieving this discomfort
- unstable angina is the most difficult to treat/manage
Select the incorrect statement:
A. endocarditis can cause fatal thromboemboli
B. bradycardia is defined as fewer than 60 bpm and can be caused by cardiac conduction blocks
C. a risk of atrial fibrillation is a stroke-causing embolus
D. lidocaine is an effective treatment for ventricular arrhythmias because of its Ca++ channel blocking action
Answer: D. lidocaine is an effective treatment for ventricular arrhythmias because of its Ca++ channel blocking action
- lidocaine blocks Na+ channels, not Ca++ channels.
Which of the following drugs is used to treat hypertension because of its ability to hyperpolarize vascular smooth muscles by opening K+ channels? A. metoprolol B. dobutamine C. captopril D. minoxidil E. digitalis
Answer: D. minoxidil
incorrect answers:
A. metoprolol
- selective beta 1 blocker that can reduce peripheral vascular resistance and reduce cardiac function
B. dobutamine
- selective beta 1 agonist used for treatment of heart failure; can cause arrhythmias
C. captopril
- ACE inhibitor that reduces peripheral resistance by reducing salt and water
E. digitalis
- positive ionotropic drug that increases intracellular Ca++ and cardiac contractility which increases blood ejection; used to treat heart failure; can cause arrhythmias
Select the two incorrect statements concerning the following antihypertensive drugs:
A. hydrochlorthiazide is a K+ sparing diuretic
B. phenoxybenzamine is an alpha 1 and alpha 2 blocker
C. clonidine is an alpha 2 antagonist
D. captopril is an ACE inhibitor
E. verapamil is a calcium channel blocker
Answers:
A. hydrochlorthiazide is a K+ sparing diuretic
- this is a diuretic that works in the distal convoluted tubule; its main side effect is an electrolyte imbalance, especially with K+, thus it is not K+ sparing.
C. clonidine is an alpha 2 antagonist
- this drug is a centrally-acting alpha 2 agonist, NOT antagonist.
A women in her 22nd week of pregnancy presents positive for diabetes. Abruptly, her normal blood pressure jumps up to a persistent reading of 144/95. Which of the following complications would most likely explain this clinical presentation? A. cardiac tamponade B. left heart failure C. preeclampsia D. cor pulmonale
Answer: C. preeclampsia
incorrect answers:
A. cardiac tamponade
- includes compression of the heart from fluid accumulation which can reduce cardiac output and cause death.
B. left heart failure
- symptoms include increased peripheral edema, reduced blood perfusion to organs, microhemorrhages in the lungs, pulmonary edema and breathing problems, and dyspnea when lying down.
D. cor pulmonale
- abnormal enlargement of the right side of the heart usually because of a heart valve problem; associated with right sided heart failure
What type of thrombus usually forms after a myocardial infarct or from atrial fibrillation? A. mural B. agonal C. red D. white E. fibrin
Answer:
A. mural
incorrect answers: B. agonal C. red D. white E. fibrin - not sure we even learned about these other types of thrombi...
Which of the following is the most likely drug to treat a patient's cholesterol and lipid condition (cholesterol is 270 mg/dL and triglycerides are 200 mg/dL; patient has family history of MI and stroke) A. niacin B. cholesteramine C. fenobrate D. simvastatin
Answer: D. simvastatin
- inhibitor of HMG-CoA reductase (an enzyme necessary for cholesterol synthesis; it is the most common cholesterol medication prescribed; it has been shown to reduce coronary events like stroke and MI)
incorrect answers:
A. niacin
- nicotinic acid; decreases triglycerides and LDLs
B. cholesteramine
- bile-acid binding agent that reduces the reabsorption of bile acids and metabolites
C. fenobrate
- increases lipolysis in the liver and muscles which reduces VLDLs and has a modest effect on LDLs; also increases HDLs and reduces triglycerides.
A 10-year-old female patient has dry mouth and inflamed gingiva and you witness a sneezing/coughing episode with chest tightening and difficulty breathing. What's the most likely diagnosis? A. "blue bloater" B. bronchiectasis C. acute respiratory distress syndrome D. asthma E. sarcoidosis
Answer: D. asthma
incorrect answers:
A. “blue bloater”
- chronic bronchitis (persistent cough for more than 3 months in 2 consecutive years); usually caused by smoking and air pollution
B. bronchiectasis
- obstruction of the bronchi and persistent necrotizing infections (Tb or staph); hypersecretion mucous in the airways.
C. acute respiratory distress syndrome
- progression of acute injury and damage from activated neutrophils and fluid accumulation
E. sarcoidosis
- type of restrictive lung disease (difficult to inhale); abnormal connective tissue and reduced elastic properties; immune-related disease
Select the incorrect statement about bronchitis:
A. you would expect to see a decreased PO2
B. there is a decreased Reid index
C. it is caused by mucous hypersecretion in the smaller airways and bronchi
D. they are referred to as “blue bloaters”
Answer:
B. there is a decreased Reid index
- the Reid index is actually increased in bronchitis. The Reid index is the ratio of mucus glands to bronchial wall. In bronchitis there is excessive mucus production.
Select the incorrect statement concerning pulmonary tumors:
A. the vast majority of lung cancers are carcinomas
B. the most aggressive carcinomas are the small cell (oat cell) type
C. these cancers rarely metastasize to the brain
D. pulmonary carcinomas are the leading cause of cancer deaths worldwide
Answer:
C. these cancers rarely metastasize to the brain
- they frequently spread to the brain
Which of the following is not typically used as an anti-smoking medication? A. bupropion (Zyban) B. varenicline (chantix) C. nicotine-containing gum D. chlorpheniramine
Answer:
D. chlorpheniramine
- this drug is an antihistamine (H1 blocker) and has anticholinergic side effects
incorrect answers:
A. bupropion (Zyban)
- antidepressant
B. varenicline (chantix)
-stimulates nicotine receptors to decrease cravings.
C. nicotine-containing gum
Which of the following is least likely to cause thrombocytopenia?
A. decreased bone marrow production
B. caisson disease
C. multiple transfusions
D. immune reaction to platelet antibodies
Answer:
B. caisson disease
- caused by an air embolism that blocks blood flow (has nothing to due with decreased platelets)
- multiple transfusions can cause thrombocytopenia due to hemodilution.
- immune reaction to platelets can destroy the platelets and cause thrombocytopenia
- platelets are made in the bone marrow
Select the incorrect statement:
A. CBC determination includes red and white blood cells and platelets
B. normal WBC determinations are 3500 - 10,000 cells/uL
C. leukocytosis can be caused by heavy exercising
D. Non-Hodgkin lymphomas are slow growing and likely curable
Answer:
D. Non-Hodgkin lymphomas are slow growing and likely curable
- this is true of Hodgkin lymphomas
Which of the following A/B blood types can be safely transfused into a patient with an A type? A. AB and A B. A and O C. B and A D. O only
Answer: B. A and O
- O blood is the universal donor and can be given to any blood type. O blood can only receive O blood.
- AB is the universal acceptor and can receive any type of blood.
Which of the following "out-patient" anticlotting drugs is popular because it has fewer side effects than warfarin and heparin and has antiplatelet action by blocking the PTT-sensitive pathway? A. dabigatran (Pradaxa) B. cilastazol (Pletal) C. Abciximab (Reopro) D. streptokinase E. Clopidogrel (Plavix)
Answer:
A. dabigatran (Pradaxa)
incorrect answers:
B. cilastazol (Pletal)
- not in the study guide…
C. Abciximab (Reopro)
- glycoprotein inhibito that is injected and used to prevent clot formation such as in unstable angina.
D. streptokinase
- this drug is a thrombolytic inhibitor that can dissolve clots
E. Clopidogrel (Plavix)
- not in the study guide…
Protamine is used as an antidote for which anticlotting medication? A. Warfarin B. Heparin C. Aspirin D. rivaroxaban (Xarelto) E. streptokinase
Answer:
B. Heparin
Select the incorrect statement concerning “chronic renal diseases”
A. diabetes is a common cause
B. often these patients have periodontal disease
C. can cause premature bone loss in the jaws
D. typically causes cysteine-type kidney stones
Answer:
D. typically causes cysteine-type kidney stones
- this is not mentioned in the study guide.
- Other symptoms of chronic renal diseases include: heavy proteinuria, hematuria, inflammatory injury to the kidneys (immune deposits in the glomeruli that block proper filtration and reabsorption), and glomeruli scarring
Select the incorrect statement concerning pyelonephritis:
A. the most common cause is left sided heart failure
B. often associated with flank pain
C. 10-20% result in kidney failure
D. often causes kidney scarring
Answer:
A. the most common cause is left sided heart failure
- pyelonephritis is an upper urinary tract infection and is caused by the retrograde spread of cystitis (lower UTI). It is commonly associated with urinary obstruction, stenosis, and diabetes.
A 40-year-old woman is complaining of feeling chronically lethargic, with tremors. She previously appeared healthy with no other known relevant medical diseases. She has experience a modest weight gain. She feels cold when others feel comfortable and her heart beats are normal. Her TSH levels are elevated. The most likely diagnosis is: A. Plummer's disease B. Grave's disease C. Hashimoto's disease D. nodular goiter E. Toxic nodule
Answer:
C. Hashimoto’s disease
- autoimmune disease that ultimately causes hypothyroidism with high levels of TSH and very low levels of T4; most common thyroid deficiency in US; most common in females.
incorrect answers:
A. Plummer’s disease
- multinodular goiter that occurs in 5-10% of HYPERthyroidism cases
B. Grave’s disease
- autoimmune hyperthyroidism; most common cause of hyperthyroidism where antibodies will activate TSH receptors in the thyroid to stimulate production of TH
D. nodular goiter
- goiter is the most common lesion of the thyroid and is thyroid enlargement; rarely associated with hypothyroidism.
E. Toxic nodule
- idk what this is
The most appropriate treatment for hashimoto's disease is A. removal of the posterior pituitary B. synthyroid C. antiserum for TSH D. beta blocker and radioactive iodine
Answer:
B. synthyroid
- synthetic thyroid hormone replacement
- don’t remove the posterior pituitary because the hormones from the post pit don’t affect the thyroid (TSH is from the ant. pituitary)
- antiserum for TSH may block TSH but it won’t restore function of the thryroid
- a beta blocker and radioactive iodine would further diminish thyroid function.
Hyperparathyroidism can elevate the parathyroid hormone (PTH) and increase the levels of free calcium in the blood by all of the following mechanisms except:
A. blocking the GI absorption of Vit. D
B. stimulating osteoclast activity
C. increasing tubular resorption of calcium in the kidneys
D. stimulating bone resorption
Answer:
A. blocking the GI absorption of Vit. D
- Vitamin D is important for calcium transport in the gut
A 27-year-old woman has recently developed throbbing pain in the head and was found to have episodic severe hypertension. The episodes of hypertension are accompanied by the headaches, along with flushing, nervousness, and excessive sweating. Her 24-hr urine catecholamines are substantially increased. There is a 4 cm diameter right adrenal mass. This patient most likely has: A. adrenal cortical adenoma B. adrenal cortical carcinoma C. neuroblastoma D. paraganglioma E. pheochromocytoma
Answer: E. pheochromocytoma
- tumor of the adrenal medulla (where the catecholamines…NE and Epi….are made)
incorrect answers:
A. adrenal cortical adenoma
- 1% prevelance and are usually non-functional (meaning they don’t secrete a lot of extra hormones…?)
B. adrenal cortical carcinoma
- these are very rare and unlikely
C. neuroblastoma
-idk what this is
D. paraganglioma
- idk
Which of the following are associated with “metabolic syndrome”
A. complex metabolic interaction between insulin resistance and anorexia
B. anticlotting actions
C. damage to renal and neuronal cells
D. elevated HDL levels
E. excessive visceral fat
F. increased tendency toward inflammatory processes
G. Sensitized insulin receptors
Answers:
A. complex metabolic interaction between insulin resistance and anorexia
C. damage to renal and neuronal cells
E. excessive visceral fat
F. increased tendency toward inflammatory processes
incorrect answers:
B. anticlotting actions
- actually a prothrombic state is associated
D. elevated HDL levels
- decreased HDL levels
G. Sensitized insulin receptors
- insensitive insulin receptors
For each of the following statement, say whether it refers to type 1 diabtes, type 2 diabetes, gestaional diabetes, or diabetes insipidus:
__insulin receptors are resistant to activation by insulin
__diuresis
__severe abnormal lipid metabolism
__no insulin
__increased thirst
__increased risk of atherosclerosis and hypertension
__increased risk of periodontal disease
__HbA1c of 8-9%
type 2 - insulin receptors are resistant to activation by insulin
all types of diabetes - diuresis
types 1 and 2 - severe abnormal lipid metabolism
type 1 diabetes - no insulin
all types of diabetes - increased thirst
types 1 and 2 - increased risk of atherosclerosis and hypertension
types 1 and 2 - increased risk of periodontal disease
types 1 and 2, and gestational diabetes - HbA1c of 8-9%
Which of the following drugs is thought to suppress appetite by stimulating the 5HT2c receptor in the hypothalamus? A. glucagon B. phentermine C. Qsymia (topiramate) D. Lorcaserin (Belviq)
Answer:
D. Lorcaserin (Belviq)
incorrect answers:
A. glucagon
- cause increase in blood sugar; opposes the action of insulin
B. phentermine
- inhibits norepinephrine and dopamine uptake (kind of like an anti-depressant)
C. Qsymia (topiramate)
- lipase inhibitor that diminishes fat absorption in the intestines
you have a patient that receives regular hemodialysis for kidney failure. You have extracted an abscessed tooth for this patient. Which of the following should you not recommend for the management of this patient? A. prophylactic antibioitcs B. aspirin for the post-op pain C. acetaminophen for post-op pain D. meticulous oral hygeine
Answer:
B. aspirin for post-op pain
- if the patient receives regular hemodialysis it is very likely they are already on anticoagulant therapy which would be worsened by aspirin.
Which of the following is not an element of hemostasis?
A. injury to a blood vessel causes platelet adherence to the subendothelium by interation with von Willebrand factor
B. aggregation with other platelets initiates a coagulation cascade
C. fibrin interacts with other primary hemostasis elements to form a stable clot
D. the lifespan of a functional platelet is ~100 days
Answer:
D. the lifespan of a functional platelet is ~100 days
- the life span of a platelet is actually ~10 days
All of the following would result in leukocytosis except: A. chronic infection B. some leukemias C. exercise D. Gaisbock Syndrome polycythemia
Answer:
D. Gaisbock Syndrome polycythemia
- this disease is a relative polcythemia (increased RBC count…not increased WBC count) due to decreased plasma volume.
Select the incorrect statement:
A. macrocytic anemias are often caused by internal hemorrhaging
B. vitamin B12 deficiency can cause macrocytic anemias
C. acute myeloid leukemias have diminished maturation of blood cells and elevated blast cells
D. Hodgkin lymphomas typically have a high cure rate
Answer:
A. macrocytic anemias are often caused by internal hemorrhaging
- MICROcyctic anemias are often caused by internal hemorrhaging; these are the iron-deficiency anemias
A newborn has just been delivered and diagnosed with cretinism. What serious complication is this newborn at risk to have?
A. cardiac defects
B. mental retardation
C. narro-set eyes
D. hyperthryroidism associated with neoplasms
Answers:
B. mental retardation
- cretinism is congenital hyPOthyroidism in children
A 30-year-old female tells you she has been diagnosied with Grave's disease. Which of the following findings is least likely to be related? A. weight loss B. tremor C. bradycardia D. exopthalamos
Answer:
C. Bradycardia
- Grave’s disease is hyPERthyroidism. Bradycardia is decreased heart rate, which is inconsistent with hyperthryoidism.
Your patient has been diagnosed with primary hyperparathyroidism due to an adenoma. Which of the following is least likely to be associated with this condition?
A. increase osteoblastic activity causing osteoporosis
B. atrial tachycardia
C. elevated serum calcium
D. constipation
Answer:
A. increase osteoblastic activity causing osteopetrosis
- PTH actually increases osteoclasts and would lead to osteoporosis.
A 30-year-old, non-smoking female patient has recently gained weight with truncal obesity, hypertension, and a puffy face (moon faces). She tells you there is unusual pigmentation on her abdomen. She complains that cold sores and canker sores are very slow to heal. What is the most likely treatment for your patient? A. dexamethasone B. metyrpone C. synthroid D. alendronate (Fosamax)
Answer:
B. metyrapone
- this is a selective inhibitor of cortisol/corticosterone synthesis. The symptoms of this patient are indicative of Cushing’s syndrome which is hypercortisolism.
incorrect answers:
A. dexamethasone
- this is a long-acting corticosteroid/glucocorticoid which would make things worse for this patient.
C. synthroid
- this is synthetic thyroid hormone. this patient doesn’t have a thyroid issue.
D. alendronate (Fosamax)
- this is a bisphosphate used to treat osteoporosis
A 30-year-old man with type 1 diabetes wants to obtain tight control of his diabetes so as to improve his long-term prognosis. His physician has discussed options that included the practice of either administering single injections at various times during the day, or mixing two different insulins and administering these simultaneously. Which of the following regimens did the physician most likely recommend?
A. morning injections of insulin determir, supplemented by small amounts of insulin lispro at mealtimes
B. morning injections of a mixture of NPH insulin and insulin determir
C. evening injections of a mixture of NPH insulin and insulin determir
D. morning and evening injections of insulin lispro, supplemented by small amounts of NPH insulin at mealtimes.
Answer:
A. morning injections of insulin determir, supplemented by small amounts of insulin lispro at mealtimes,
- insulin determir is long-acting background insulin
- NPH insulin is intermediate acting insulin that is often combined with shorter acting varieties.
- insuling lispro (humalog) and humulin R are fast acting insulins for use at mealtimes.
