NR 605/ NR605 Final Exam (NEW 2026–2027 Updated) Psychiatric Mental Health I | Diagnosis & Management | Exam Questions and Answers | 100% Correct- Chamberlain

…..DLDD NR 605/ NR605 Final Exam (NEW 2026–2027 Updated) Psychiatric Mental Health I | Diagnosis & Management | Exam Questions and Answers | 100% Correct- Chamberlain Q. Which elevated lab value may be protective of the development of atherosclerosis? ANSWERS High-density lipoproteins HDL's Q. Provides one-way flow of blood from the left ventricle into the aorta ANSWERS Aortic valve Q. Transports deoxygenated blood from the right ventricle to the right lung. ANSWERS Right pulmonary artery Q. Transports oxygenated blood from the left ventricle to the systemic circulation. ANSWERS Aorta (aortic arch) Q. Conveys deoxygenated blood from the head and upper extremities to the right atrium? ANSWERS Superior vena cava Q. Provides one-way flow of blood from the right ventricle to the left lung? ANSWERS Pulmonary valve Q. Transports deoxygenated blood from the right ventricle to the left lung? ANSWERS left pulmonary artery Q. Conveys deoxygenated blood from the trunk and lower extremities to the right atrium? ANSWERS Inferior vena cava Q. Transports oxygenated blood from the left lung to the left atrium? ANSWERS Left pulmonary veins Q. Provides one-way flow of blood from the right atrium into the right ventricle ANSWERS tricuspid valve Q. Right ventricle enlargement caused by chronic pulmonary hypertension? ANSWERS Corpulmonale Q. Which chamber of the heart endures the highest pressures? ANSWERS Left Ventricle Q. Occlusion of the left anterior descending artery during a myocardial infarction would interrupt blood supply to which structures? ANSWERS Left and right ventricles and much of the interventricular septum Q. What is the initiating event that leads to the development of atherosclerosis? ANSWERS Injury to the endothelial cells that line the artery walls Q. Name 4 Age-related changes associated with the cardiovascular system include? ANSWERS 1. decreased cardiac output 2. increased blood pressure 3. decreased compliance of the heart muscle 4. thickening of the heart valves. Q. An individual who is demonstrating elevated levels of troponin, creatine kinase-isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators associated with which condition? ANSWERS Myocardial infarction (MI) Q. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance? ANSWERS Right-sided Heart Failure Q. Orthopnea, crackles and coughing pink frothy sputum result from back up into the lungs from which heart failure? ANSWERS Left-sided Heart Failure Q. Jugular venous distention, hepatomegaly and ankle edema are more from backup from which heart failure? ANSWERS Right-sided Heart failure Q. Dilated cardiomyopathy means that ANSWERS the cardiac chambers are enlarged (increased diastolic volume) and the myocardium has decreased contractility. Q. In restrictive cardiomyopathy, the cardiac chambers ANSWERS have decreased volume and the myocardium is rigid and noncompliant Q. Cardiac valve damage in rheumatic fever is caused by ANSWERS an abnormal immune response Q. Acute rheumatic fever is characterized by carditis, acute migratory ANSWERS polyarthritis, chorea, and erythema marginatum, which occurs 1 to 5 weeks after streptococcal infection of the pharynx Q. A condition characterized by thickening and hardening of the vessel wall. ANSWERS Arteriosclerosis Q. Gastroesophageal reflux disease (GERD) is a result of: ANSWERS a zone of low pressure of the lower esophageal sphincter (LES). Q. Define GERD ANSWERS Regurgitation of stomach contents (reflux of chyme) across incompetent Gastroesophageal junction into the esophagus producing irritation and a number of symptoms heartburn being the cardinal symptom often relieved by antacids and aggravated by lying flat. Q. At 3 weeks of age, an infant who has been feeding well and gained weight begins to vomit for no apparent reason. The vomiting has gradually become more forceful. These symptoms may be indicative of which disorder? ANSWERS Pyloric stenosis ‘ Projectile vomiting which is a spontaneous forceful vomiting not usually preceded by nausea or retching. Pyloric stenosis. Epigastric pain, beginning 30 minutes to 2 hours after eating when the stomach is empty or in the middle of the night, is consistent with which diagnosis? Duodenal ulcer Which type of hepatitis is transferred via the fecal-oral route? Hepatitis A Why does a person with cystic fibrosis have an exocrine pancreatic insufficiency? Because the pancreatic ducts are obstructed with mucus What is the primary cause of duodenal ulcers. Helicobacter pylori If a person lacks the enzyme lactase and ingests lactose, the lactose will not be hydrolyzed and absorbed into the intestinal wall; the type of diarrhea that results is _____ diarrhea. Osmotic Increased gastrin secretion by the mother in the last trimester of pregnancy may cause which condition in the infant? Pyloric stenosis Cystic fibrosis is characterized by which symptom? Excessive mucus production characterizes cystic fibrosis. Why is prolonged diarrhea more severe in children than it is in adults? Fluid reserves are smaller in children. Which statement is FALSE regarding the pathophysiologic process of acute pancreatitis? 1) Bile duct or pancreatic duct obstruction blocks the outflow of pancreatic digestive enzymes. 2) Acute pancreatitis can also result from direct cellular injury from drugs or viral infection. 3) Acute pancreatitis is an autoimmune disease in which immunoglobulin G (IgG) coats the pancreatic acinar cells; consequently, the pancreatic enzymes destroy the cells. 4) Acute pancreatitis digests pancreatic tissue and is usually very painful. 3) Acute pancreatitis is an autoimmune disease in which immunoglobulin G (IgG) coats the pancreatic acinar cells; consequently, the pancreatic enzymes destroy the cells. Prolonged diarrhea may cause Dehydration and metabolic acidosis Mr. Smith a 45 y. o. man report fatigue for about four weeks with worsening nausea although he denies vomiting. He also had a cough, and a headache for the last 3 weks and assumed he had a "cold." Today he presents with dark urine, clay colored stools and "yellow eyes." You review his hepatitis seriology and find a surface antigen present. You know this means There is an acute infection IBS is diagnosed by symptoms and exclusion of structural/biochemical causes. Which of the following is an "alarm symptom" that would require more extensive diagnostic testing? Weight loss T/F Signs and symptoms of chronic gastritis correlate with the severity of the disease. Gastric emptying is slowed, causing greater exposure of the mucosa to acid. Irritable bowel syndrome is characterized by all except: a. Pain b. Diarrhea c. Constipation d. Bloody Stool d. Bloody stool Which statement is false concerning how abdominal pain is produced? a.Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain. b.Edema and vascular congestion produce abdominal pain by stretching. c.Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain. d.Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain d.Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain How can abdominal pain that is visceral in nature best be described? a.Abdominal pain that is visceral in nature is diffused, vague, poorly localized, and dull. b.It travels from a specific organ to the spinal cord. c.The pain lateralizes from only one side of the nervous system. d.Abdominal pain is associated with the peristalsis of the gastrointestinal tract. a. Abdominal pain that is visceral in nature is diffused, vague, poorly localized, and dull. Graves disease develops from a(n): a. viral infection of the thyroid gland that causes overproduction of thyroid hormone (TH). b. autoimmune process in which thyroid tissue is replaced by lymphocytes and fibrous tissue. c. thyroid-stimulating immunoglobulins that causes overproduction of thyroid hormones. d. ingestion of goitrogens that inhibits synthesis of the thyroid hormones, causing a goiter. c. thyroid-stimulating immunoglobulins that causes overproduction of thyroid hormones. The pathophysiology of type 1 DM involves: autoimmune destruction of pancreatic beta cells A nurse knows that Graves disease is caused by a(n): 1. Multiple hyperfunctioning nodules 2. Reduced production of the thyroid hormone 3. Autoimmune response 4. Increased myxedema 3. Autoimmune response A person has Cushing syndrome. Which pathophysiologic effect is occurring? 1. Overproduction of pituitary ACTH 2. Excessive aldosterone secretion 3. Reduction of serum glucose 4. Chronic exposure to excess cortisol 4. Chronic exposure to excess cortisol Which information is most correct regarding hyperparathyroidism? Hyperparathyroidism is associated with: 1. Pathologic fractures 2. Increased osteoblast activity 3. Hyperphosphatemia 4. Acidic urine 1. Pathological fractures ___________ is low blood sugar during the night that may lead to morning hypoglycemia Somoygi effect An individual with type 1 diabetes who has the dawn phenomenon has a _______ blood glucose in the early morning that in the middle of the night Higher Metabolic syndrome increases the risk of developing Type I Diabetes In diabetes, microvascular disease refers to damage to Capillaries In diabetes, macrovascular disease refers to damage to large and medium-sized arteries A person has acne, easy bruising, thin extremities, and truncal obesity. These clinical manifestations are indicative of which endocrine disorder? Cushing's Disease Type 2 diabetes mellitus is best described as: a resistance to insulin by insulin-sensitive tissues. What are clinical manifestations of hypothyroidism? Constipation, decreased heat rate, and lethargy Which of the following is a symptom of syndrome of inappropriate antidiuretic hormone (SIADH)? a. Hyponatremia b. Hypernatremia c. Hyperosmolality (serum) d. Hypo-osmolality (urine) a. Hyponatremia A person develops severe dehydration and hyperglycemia. An absence of ketosis has occurred. What condition does this person have? Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) TSH is released to stimulate thyroid hormones and is inhibited when plasma levels of thyroid hormone are adequate negative feedback Hypersecretion of adrenocorticotropic hormone (ACTH) relates to what endocrine disease? Cushing disease The adrenal cortex secretes mineralocorticoids. Which one is the most potent of the naturally occurring mineralocorticoids and acts to conserve sodium by increasing the activity of the sodium pump of the epithelial cells? Aldosterone What effect does aldosterone have on fluid and electrolyte imbalances? It directly increases sodium retention. The level of thyroid-stimulating hormone (TSH) in Graves disease is usually: Low Palpation of the neck of a person with Graves disease would detect a thyroid that is: Enlarged diffusely Graves disease develops from a(n): thyroid-stimulating immunoglobulins that causes overproduction of thyroid hormones. The signs of thyroid crisis resulting from Graves disease include: Hyperthermia and Tachycardia What are clinical manifestations of hypothyroidism? Constipation, decreased heart rate, and lethargy Obesity is present in 60-80% of patients with Type 2 Diabetes Mellitus and is a major contributor to insulin resistance by many mechanisms including: Maintenance of oxidative phosphorylation in cellular mitochondria Hyperkalemia develops in the presence of diabetic ketoacidosis because: hydrogen ions shift into the cell in exchange for potassium to compensate for metabolic acidosis. What pathophysiologic effect is occuring in a person with Cushing Syndrome? Chronic exposure to excess cortisol Neuropathic pain is may be the result of the nerve fibers themselves being damaged, dysfunctional, or injured. These damaged nerve fibers send incorrect signals to other pain centers that cause shooting and burning pain, tingling and numbness Seizures are initiated by: Hypersynchronization and bursts of action potentials All of the following might be useful in assessing cause and type of seizures EXCEPT 1. basic metabolic panel 2. EEG 3. Spinal tap for evaluation of CSF (cerebrospinal fluid) 4. Vagus nerve stimulation test 5. CT 6. health history 4. Vagus nerve stimulation test Lead absorption in children may cause a microcytic anemia by impairing the: Absorption or iron Dementia differs from delirium in that delirium is usually 1. a progressive failure of cerebral functions 2. the result of nerve cell degeneration and brain atrophy 3. language, executive attentional functions, and alterations in behavior 4. An acute, abrupt onset of an overactive ANS common in CCU, high fevers, or with withdrawal from CNS depressants 4. An acute, abrupt onset of an overactive ANS common in CCU, high fevers, or with withdrawal from CNS depressants It is a central nervous system (CNS) demyelination, possibly from an genetic predisposition and a viral infections. multiple sclerosis (MS) the result of an auto-immune reaction to abnormal antibodies Rheumatoid Arthritis Nodular formation in soft tissue Rheumatoid Arthritis abnormality is usually osteophyte formation Osteoarthritis Characterized by skeletal muscle pain, weakness, dark urine, and increased serum creatine kinase. Rhabdomyolosis A pathology that causes loss of articular cartilage and increased osteophyte formations Osteoarthritis Autoimmune disease that can cause severe joint deformities Rheumatoid Arthritis Clinical manifestations of a urinary tract infection that are unique to the elderly population may include confusion and poorly localized abdominal discomfort clinical manifestation of pyelonephritis Flank pain and fever In glomerulonephritis, the glomerular cell walls are damaged by: lysosomal enzymes and or lysis from complement and macrophages The kidney disorder characterized by hypoalbuminemia, edema, hyperlipidemia and lipiduria is nephrotic syndrome. The first indication of nephrotic syndrome in children is: severe periorbital edema and around the ankles and feet. What is a macrocytic anemia (from lack of B12)? Pernicious Which anemia produces small, pale erythrocytes? iron deficiency Beta-thalassemia major also called Cooley anemia has erythrocytes that are unstable and prone to hemolysis because they have too many free hemoglobin alpha chains. Which substance is used to correct the chronic anemia associated with chronic renal failure? Erythropoietin Occlusion of the left anterior descending artery during a myocardial infarction would interrupt blood supply to which structures? Left and right ventricles and much of the interventricular septum Name 4 Age-related changes in the cardiovascular system 1. Decreased cardiac output, 2. Increased blood pressure 3. Decreased compliance of the heart muscle 4. Thickening of the heart valves. The most common cause of dementia in the elderly is Alzheimer's disease. The nurse is assessing an older adult client and observes that the client is having several cognitive problems, including memory and attention deficits and fluctuating levels of orientation. The nurse confirms with the family that the client's symptoms developed over a several-year period. The client's symptoms are commonly observed with which condition? Dementia Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom? Thirst A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; positive urine glucose and ketones; serum potassium (K+) 2 mEq/L; serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the flu for 1 week. What relationship do these values have to his insulin deficiency? Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis Polyuria occurs with diabetes mellitus because of the Elevation of serum glucose Type 2 diabetes mellitus is best described as a Resistance to insulin by insulin-sensitive tissues When comparing the clinical manifestations of both diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome which condition is associated with only DKA Kussmaul respirations Hypoglycemia, followed by rebound hyperglycemia, is observed in those with The somogyi effect What causes the microvascular complications in patients with diabetes mellitus? The capillary basement membranes thicken, and cell hyperplasia develops A chronic complication of diabetes mellitus is likely to result in microvascular complications in which areas? Eyes, renal system, nerves Removing the stomach with its parietal cells would prevent the absorption of an essential nutrient necessary to prevent which type of anemia? Pernicious anemia what is the pathophysiology of acute pancreatitis? Acute pancreatitis is an autoimmune disease in which IgG coats the pancreatic acinar cells so they are destroyed by the pancreatic enzymes. The major physiologic manifestation of anemia is: Hypoxia A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler? Enlargement of the liver The pathogenesis of PCOS is described as excessive androgens that affect follicular decline by suppressing apoptosis, enabling follicles, which normally disintegrate to survive Pyleonephritis is usually caused by antibody-coated Bacteria Which clinical manifestation of pyelonephritis is different from those of cystitis? flank pain The major underlying factor leading to the edema associated with glomerulonephritis and nephrotic syndrome is proteinuria Acute right lower quadrant pain associated with rebound tenderness and systemic signs of inflammation are indicative of appenidcitis What is the underlying pathology experienced by people with irritable bowel syndrome? Increased response to stretching and discomfort resulting in intestinal motility Which joint disease is characterized by joint stiffness on movement and joint pain of weight-bearing joints that usually is relieved by rest? osteoarthritis a chronic inflammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints ankylosing spondylitis Which hormone is linked to obesity and early puberty? Leptin At puberty the vaginal pH: Decreases What causes the vasomotor flushes (hot flashes) that are associated with declining ovarian function with age? Rapid changes in estrogen levels Which infection has clinical manifestations of sudden onset of malaise, low back pain, and perineal pain with high fever and chills, dysuria, nocturia, and urinary retention? Bacterial prostatitis Which clinical diagnosis is associated with hirsutism, amenorrhea, and infertility? Polycystic ovary syndrome (PCOS) What is the correct sequence in the hormonal stimulation of the reproductive systems leading to puberty in the female? 1. Anterior pituitary 2. FSH 3. LH The leading cause of infertility is: polycystic ovary syndrome (PCOS). Type of diet helps relieve symptoms of premenstrual syndrome A low-fat, vegetarian The first sign of puberty in girls is: Breast development or thelarche is the first sign of puberty Premature closure of the epiphysis is due to precocious puberty. The clinical diagnosis of delayed puberty is referred to as delayed puberty. 5 facts about Polycystic ovary syndrome 1. Oligo-ovulation or anovulation 2. Elevated levels of androgens or clinical signs of hyperandrogenism and polycystic ovaries 3. Leading cause of infertility in United States 4. Multifactorial-Hyperinsulinism- prevents follicular decline 5. Dysfunction of follicle development The first sign of puberty in boys is: enlargement of the testes. Which disorder causes a transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center, making them appear as a ringworm? Rheumatic fever Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance? Right Heart failure Which substance is manufactured by the liver and primarily contains cholesterol and protein? Low-density lipoproteins (LDLs) What description is given when all or most of the cervical epithelium shows cellular features of carcinoma, but underlying tissue is not affected? Cervical intraepithelial neoplasia (CIN) What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis? LDLs cause smooth muscle proliferation. In ankylosing spondylitis, the CD8+ T cells are presented with which of the following antigens? Cartilage Considering the pathophysiologic process of osteoporosis, which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts? Estrogen Considering the pathophysiologic process of osteoporosis, what are the effects of extracellular signal-regulated kinases (ERKs) and receptor activator of nuclear factor B ligand (RANKL) on osteoblasts and osteoclasts? ERKs and RANKL increase the life span of osteoclasts and decrease the life span of osteoblasts. What is the primary pathologic alteration resulting from ankylosing spondylitis (AS)? Inflammation of fibrocartilaginous joints of the vertebrae What is the underlying pathology experienced by people with irritable bowel syndrome? Increased response to stretching and discomfort resulting in intestinal motility The nurse is re-enforcing information given to the client who is asking about screening for prostrate cancer. Which of these will be nurse teach the client about the PSA test? An elevated score on a PSA test does not necessarily indicate the presence of cancer. The nurse is caring for a baby with phimosis. Which of these does the nurse explain to the mother is the key feature of this disorder? Tightening of the foreskin preventing full retraction over the penis Acute pyelonephritis primarily affects the Renal Tubules Accumulation of nitrogenous wastes in the blood manifested as elevated BUN and creatinine is known as Azotemia Syndrome that includes azotemia and numerous other clinical manifestations such as fatigue, anemia, and pruritus Uremia The first indication of nephrotic syndrome in children is: severe periorbital edema and around the ankles and feet. When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice? Heme (from dead RBCs) destruction exceeds the liver's ability to conjugate and excrete bilirubin. Beta-thalassemia major also called Cooley anemia has erythrocytes that are unstable and prone to hemolysis because they have too many free hemoglobin alpha chains. T/F: Single gene mutations are rare but highly penetrant True! Are also Mendelian disorders T/F: Chromosomal abnormalities are uncommon and highly penetrant True! T/F: Complex multigenic disorders are uncommon False! They are common! T/F: Diabetes, HT, and autoimmune diseases are complex multigenic disorders True! The sickle cell mutation affecting the beta-globin chain of hemoglobin is an example of what type of mutation? point mutation (amino acid subsitution) T/F: Mutations in non-coding sequences can cause defective transcription and regulation True! T/F: A frameshift mutation occurs when a deletion or insertion is a multiple of three False! Occurs when the deletion or insertion is NOT a multiple of 3 What type of mutation is the incorporation of a variable number of incorrect amino acids followed by truncation resulting from a premature stop codon? A frameshift mutation T/F: Autosomal dominant disorders often have a delayed onset True! Autosomal dominant disorders usually result in... reduced production or inactive protein (could be a structural protein like collagen or a regulatory/transport protein like a receptor) T/F: Autosomal dominant disorders are only manifested in the homozygous state False! They are seen in heterozygous and homozygous duhh Autosomal dominant disorders have ____ penetrance and ____ expressivity reduced penetrance and variable expressivity If both parents are carriers for an autosomal recessive disorder, each sibling has a ___% chance of being affected 25% Autosomal recessive disorders have ____ penetrance and ____ expressivity complete penetrance and uniform expressivity ______ means the gene or genes for a trait are expressed in all the population who have the genes Complete penetrance _____ refers to the degree that a particular genotype is expressed as a phenotype within an individual Expressivity T/F: The onset for autosomal recessive disorders is often delayed False! Onset is usually early in life Autosomal recessive disorders often affect... enzymes X-linked disorders only affect... Males T/F: Most X-linked disorders are recessive True! Example = hemophilia or G6PD deficiency T/F: If a father has an X-linked disorder, all of his daughters will be carriers True! Single gene mutations can cause enzyme defects which can lead to... accumulation of substrate, lack of product, or failure to inactivate a protein which causes damage Marfan syndrome is the result of a ____ defect Fibrillin-1 Autosomal dominant disorder 70-80% of cases are familial What are some key features of Marfan syndrome? - long, tall extremities, elongated digits (arachnodactyly) - bilateral dislocation of the lens of the eye - aorta aneurysm/dissection - floppy mitral valve sydrome T/F: Floppy mitral valve syndrome is associated with Marfan syndrome and can lead to cardiac failure True! What is the most typical cause of death for an individual with Marfan syndrome? aortic aneurysm/dissection What is the molecular basis of Ehler's-Danlos syndrome? deficient collagen synthesis 90% of cases involve deficient synthesis of type V collagen Hyperextensible skin and hyperflexible joints are characteristics of what disorder? Ehler's Danlos Syndrome T/F: Ehler's-Danlos can cause blindness and diaphragmatic hernia True! Familial hypercholesterolemia can result in early-onset... atherosclerosis What disorder involves a mutation in the gene that encodes the receptor for low-density lipoprotein (LDL)? Familial hypercholesterolemia Familial hypercholesterolemia can result in cholesterol-rich deposits in soft tissues called ____ xanthomas T/F: Heterozygotes for familial hypercholesterolemia are typically symptomatic in childhood False! Usually asymptomatic until adult life T/F: Homozygotes for familial hypercholesterolemia are more severely affected than heterozygotes True! With lysosomal storage diseases, there is a deficiency or malfunction in one of the enzymes needed for degradation, resulting in the accumulation of intermediates. This results in a... primary storage defect secondary storage issues result from defective autophagy What is a common feature of lysosomal storage diseases? hepatosplenomegaly (due to the accumulation of partially digested metabolites in phagocytes) another common feature is CNS involvement with neuronal damage Tay-Sachs disease is most common among... Ashkenazi Jews T/F: Infants with Tay-Sachs disease appear normal at birth but die within 2-3 years True! Tay-Sachs is a CNS disease where the patient is deficient in... hexosaminidase which plays a critical role in brain and spinal cord Niemann-Pick Disease Type A presents in infancy with... organomegaly and severe neurologic deterioration (death usually occurs within first 3 years of life) Niemann-Pick Disease Type B presents in infancy with... organomegaly but NO neurologic manifestations (may have late onset CNS disease) T/F: heterozygous carriers of Gaucher disease are at increased risk for Parkinson's True! Gaucher disease type 1 involves... while Types 2 and 3 involve... Type 1 = bone lesions, hepatosplenomegaly, no CNS involvement Types 2 and 3 = mostly neurologic signs and symptoms Complex multigenic disorders are caused by... interactions between multiple gene variants (polymorphisms that are co-inherited) and environmental factors Any exact multiple of the haploid number is called what? What is it called when the number is NOT an exact multiple? Euploid (3n, 4n, etc) Aneuploid (could be monosomy or trisomy) What condition is characterized by an oblique palpebral fissure and prominent epicanthal fold? Trisomy 21 (down syndrome) What cardiovascular and hematologic conditions are commonly seen with Trisomy 21? cardiovascular = congenital heart disease or CHD (~40%) hematologic = acute lymphoblastic leukemia Short broad hands with a single palmar crease and umbilical hernia are often seen with what condition? Trisomy 21 T/F: Males with Trisomy 21 are often sterile True! T/F: Patients with Trisomy 21 are more likely to have Alzheimer's True! Having a webbed neck and a broad chest with widely shaped nipples is characteristic of what condition? Turner Syndrome (Monosomy) Individuals with Turner Syndrome who reach adulthood may have ____ cell lines Mosaic (45, X/46,XX) T/F: Turner syndrome can affect males False! Only females because it is a condition where the individual only has one sex chromosome (one X) so they can only be female XXY describes the sex chromosomes for individuals with what condition? Klinefelter syndrome Hypogonadism, testicular atrophy, and infertility are associated with what condition? Klinefelter sydrome T/F: Individuals with Klinefelter syndrome have a tall stature with an increase in length between the soles and pubic bone True! What condition is marked by reduced facial, body, and pubic hair and bilateral gynecomastia? Klinefelter syndrome T/F: The reduction in intelligence in individuals with Klinefelter syndrome correlates with the number of extra X chromosomes True! What chemical in cigarettes is responsible for tumor promotion? What about reduced oxygen transport? Tumor promotion = phenols Reduced O2 transport = carbon monoxide Tar, polycyclic aromatic hydrocarbons, and nitrosamines are chemicals in cigarettes that are responsible for... carcinogenesis What chemicals in cigarettes are toxic to respiratory mucosa? formaldehyde and nitrogen oxide T/F: smoking multiplies the risk of other carcinogens, such as alcohol, asbestos, and radiation True! T/F: Maternal smoking increases incidence of spontaneous abortion True! Agents in cigarette smoke have a direct irritant effect on ____ mucosa, causing inflammation and increased mucus production tracheobronchial mucosa Increased ____ recruitment to the lung, caused by smoking, can increased elastase production and cause ____ leukocyte can cause emphysema T/F: The risk of developing lung cancer is unrelated to the intensity of exposure False! It is related T/F: Recreational drug use is more hazardous and responsible for more deaths than alcohol abuse False! Alcohol abuse is more widespread and hazardous than recreational drug use; also responsible for more deaths Alcohol abuse can lead to what condition of the liver? acute alcoholic hepatitis multiple fat droplets accumulate in the cytoplasm of hepatocytes Alcohol abuse can lead to what condition of the stomach? acute gastritis or ulceration What organ is the main site of injury for chronic alcoholism? Liver Chronic alcoholism can lead to a ____ deficiency Thiamine can cause Wernicke-Korsakoff syndrome T/F: Lead can cause hematologic, skeletal, neurologic, GI, and renal toxicities True! Who is at the highest risk for lead poisoning? children living in older houses with flaking lead paints can cause brain damage in children T/F: Lead can compete with Ca2+ for binding for PO4 True! Lead can cause microcytic and hypochromic anemias by interfering with ___ synthesis Heme What are the major targets for lead toxicity? bone marrow, nervous system, and kidneys What two things are commonly seen with lead poisoning? lead lines and basophilic stippling ____ poisoning can eventually lead to death due to interference with mitochondria arsenic Chronic low levels of arsenic can lead to... hyperpigmentation and hyperkeratosis which may be followed by nonmelanoma skin cancers What food should pregnant women avoid to avoid mercury poisoning? fish T/F: Renal disease is a common hazard in those with chronic heroin addiction True! ____ is a drug known to cause intense euphoria and stimulation. but overdose can lead to cardiovascular effects like myocardial infarction Cocaine Radiation injury could be caused by... ultraviolet light or ionizing radiation Biological effects due to radiation injury depend heavily on what variables? 1) sensitivity of proliferating tissues 2) vascular damage 3) rate of delivery 4) hypoxia 5) field size T/F: large doses to small fields are more damaging to the body than smaller doses delivered to larger fields (in terms of radiation injury) False! large doses to small fields are safer on the body than smaller doses delivered to larger fields Acute radiation exposure has the greatest effect on what organs/tissues? organs and tissues composed of rapidly dividing cells! gonads, hematopoietic and lymphoid systems, and lining of GI Very high levels of radiation may kill marrow stem cells and induce... permanent aplastic anemia (lower levels cause neutropenia and thrombocytopenia or anemia) Chronic radiation exposure is associated with... vascular damage, fibrosis (can involve fibrointimal thickening and arteriolar sclerosis), and carcinogenesis T/F: Primary malnutrition is when there are issues with absorption or storage of nutrients False! This describes secondary malnutrition Primary vs secondary malnutrition? primary = dietary components are missing from the diet secondary = dietary components are present but there is malabsorption, impaired use or storage, excess loss, or increased requirements T/F: Acute and chronic illnesses lower the basal metabolic rate False! They raise it! Protein-energy malnutrition can be ___ or ____ somatic (proteins in skeletal muscle) or visceral (proteins in visceral organs) Somatic protein-energy malnutrition is affected in what condition? marasmus patients with this condition have a diet which is severely lacking in calories the reduction in muscle mass is reflected by the reduced circumference in the midarm Visceral protein-energy malnutrition is affected when what condition? Kwashiorkor measurement of levels of serum proteins like albumin will be low (hypoalbuminemia) T/F: With Kwashiorkor, protein deprivation is relatively greater than reduction in total calories True! Kwashiorkor is most prevalent in what area? Countries of Southeast Asia Less severe forms of Kwashiorkor may occur in individuals with... chronic diarrheal states (protein is not absorbed) or in individuals with chronic protein loss due to other conditions could also be in individuals suffering from nephrotic syndrome or with extensive burns T/F: Cases of Kwashiorkor in the US have been linked to fad diets and rice-based beverages True! Alternating zones of hyperpigmentation, desquamation, and hypopigmentation on the skin (also called "flaky paint" skin) is characteristic of what condition? Kwashiorkor Loss of hair color or alternating bands of pale and darker color may occur with what condition? Kwashiorkor What abnormalities distinguish Kwashiorkor from Marasmus? 1) fatty liver 2) severe edema (due to protein deficiency and decreased oncotic pressure) 3) anemia 4) malabsorption due to atrophy of the small intestinal villi 5) depigmented bands with pale streaking in hair or skin Protein-energy malnutrition in patients with AIDS or advanced cancers is known as... cachexia aka cachexia is PEM in individuals with severe chronic illness Mortality from cachexia is due to... atrophy of the diaphragm and other respiratory muscles What are the fat soluble vitamins? A, D, E, K In fat malabsorption disorders, fat-soluble vitamins are ____ stored but ____ absorbed readily stored but poorly absorbed this is caused by digestive function disorders T/F: Vitamins D and K can be synthesized endogenously True! Vitamin D from precursor steroids and Vitamin K by intestinal microflora T/F: Vitamin deficiencies can be primary (dietary in origin) or secondary (problems with absorption/use) True! T/F: Single vitamin deficiencies are more common than multiple deficiencies at once False! Deficiency of a single vitamin is uncommon All water soluble vitamins require regular intake, except which one? B12 - the liver stores it in quantities sufficiently large so that deprivation for months or years would be necessary for someone to be deficient T/F: Toxicity from water soluble vitamins is common False! Uncommon because excess is easily excreted in urine Water-soluble vitamin deficiencies have the greatest impact in tissue with... active metabolism because these vitamins are involved in release and storage of energy B complex vitamin deficiencies are often marked by... glossitis, dermatitis, and diarrhea A vitamin B (thiamine) deficiency can lead to what condition? Wernicke-Korsakoff syndrome can also cause wet or dry beriberi (wet = cardiovascular, dry = CNS) A vitamin B (niacin/nicotinic) deficiency can lead to what condition? Pellagra (the 3 D's = dementia, dermatitis, diarrhea) Vitamin C deficiency can cause... impaired wound healing and fragile capillaries (which leads to abnormal bleeding) Scurvy can be caused by a deficiency in what vitamin? Vitamin C scurvy can cause muscle, joint, and bone pain... bleeding gums, hemorrhage, etc What vitamin is involved in the synthesis of clotting factors II, VII, IX, and X? Vitamin K What is the earliest manifestation of Vitamin A deficiency? impaired vision or night blindness (carrots are high in vitamin A that's why people say they are good for your eyes!) T/F: Epithelial metaplasia and keratinization due to a Vitamin A deficiency can produce blindness True! Eating too much liver can lead to ____ toxicity which results in what symptoms? Vitamin A toxicity headache, dizziness, vomiting symptoms may be confused with those of a brain tumor (pseudotumor cerebri) Metastatic calcification of soft tissues like the kidney occurs in adults experiencing what? Vitamin D toxicity Will also have bone pain (Benign/malignant) tumors are associated with local invasion and metastasis Malignant A malignant neoplasia in hematopoietic tissue is known as? Leukemia A malignant neoplasia in melanocytes is known as ____ while a benign neoplasia in melanocytes is known as ___ malignant = melanoma benign = nevus What are the exceptions to the naming rule? (ones that are malignant but not named as one) hepatoma, lymphoma, mesothelioma, melanoma, glioma, seminoma (HLMMGS) What are the two exceptions to the naming rule that are non-neoplastic swellings? granuloma and hematoma What neoplasias contain recognizable mature or immature tissue belonging to more than one germ cell layer? Teratomas Teratomas arise from what? totipotent stem cells What is the term to describe any mass or tissue that bulges or projects above the surface level of skin or mucosa? Polyp can be neoplasm, foci of inflammation, degenerative lesions, or malformations What is a non-neoplastic, disorganized, tumor-like overgrowth of cell types that are regularly found in the affected site? Hamartoma Odontoma = tooth-like structures What is a mass formed by the maldevelopment of tissue of a type not normally found in the affected site? Choristoma ex) Osseous choristoma in tongue What is the unequivocal feature of malignancy? Metastasis!!! ____ is the spread of a tumor to sites that are physically discontinuous with the primary tumor Metastasis The "seeding of body cavities" (where neoplasms penetrate into a natural "open field" lacking physical barriers) is a characteristic feature of ____ carcinomas ovarian Lymphatic spread is more typical of _____ while hematogenous spread is more typical of ____ lymphatic spread = carcinomas hematogenous spread = sarcomas What are the most common sites for hematogenous spread? lungs and liver hematogenous spread is typical of sarcomas What two carcinomas have a tendency to invade veins? renal cell carcinoma and hepatocellular carinoma Translocations are notably seen in what 3 cancers? Burkitt lymphoma, Follicular lymphoma, and chronic myeloid leukemia (which involves the philadelphia chromosome) The tumor suppressor gene Rb is known as the ____ and its loss of function can be due to... "governor of the cell cycle" can be due to mutations in Rb as well as binding by oncogenic viral protein (HPV E7 protein) What type of factors appear to be the dominant risk factor for most cancers? environmental factors (more dominant than host factors) Patients with what autosomal recessive syndrome are prone to developing skin cancer/melanoma? Xeroderma pigmentosum causes mutations in genes responsible for DNA repair due to UV light damage Risk of breast cancer is 3x higher in females who have inherited a mutation in what gene? BRCA1 or BRCA2 What was the first bacterium classified as a carcinogen? helicobacter pylori High risk HPV includes what 4 types? what symptoms is it associated with? 16, 18, 31, 33 squamous cell carcinoma of cervix, anogenital region, and oropharynx What virus infects B lymphocytes and epithelial cells in the nasopharynx? Epstein-Barr Virus Epstein-Barr Virus (EBV) is associated with _____ which is the most common childhood tumor in central Africa Burkitt Lymphoma T/F: "Paraneoplastic syndrome" describes signs and symptoms that cannot be explained by the anatomic distribution of a tumor True! T/F: Cushing syndrome is a small cell type cancer of the lung True! Polycythemia would likely be due to an issue with... erythropoietin (since it is a condition where the concentration of RBC is too high) T/F: Most autoimmune diseases are more common in men than women False! other way around Autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura, myasthenia gravis, and graves disease (hyperthyroidism) are all examples of what type of hypersensitivity reaction? Type II - antibody mediated Systemic lupus erythematosus is an example of what type of hypersensitivity reaction? Type III - immune complex Type 1 diabetes mellitus, rheumatoid arthritis, and multiple sclerosis are all an example of what type of hypersensitivity reaction? Type IV - T cell mediated Genetic susceptibility for autoimmune disorders is often linked to what locus? the HLA locus T/F: MHC I is found on RBC False! only found on nucleated cells SLE is associated with an enormous array of autoantibodies, classically including... antinuclear antibodies or ANAs often against DNA or RNA proteins (smith antigens) What is the most important clinical feature of SLE? Kidney involvement think of our girl selena Cardiac involvement in SLE can cause lesions on heart valves termed... Libman-Sacks endocarditis What syndrome is characterized by dry eyes and dry mouth? Sjogren Syndrome lacrimal and salivary glands are the major targets for this disease (both of these glands contain dense infiltrates of CD4+ T cells) Sjogren syndrome is associated with various autoantibodies, two of which are directed towards... ribonucleoprotein antigens SS-A and SS-B this is specific for this disease! What condition is characterized by fibrosis of the skin and walls of the GI tract and vascular abnormalities? What is the hallmark of this condition? Systemic sclerosis (scleroderma) Hallmark = fibroblast activation with excessive fibrosis What are the components of CREST as it is related to systemic sclerosis? C = calcinosis R = Raynaud's E = esophageal dysfunction S = sclerodactyly (thickening and tightening of hands/fingers) T = telangiectasias (dilation of capillaries under skin) Systemic sclerosis involves an ____ antibody anticentromere antibody (against centromeric proteins) also contains an anti-DNA topoisomerase I protein Allografts describe grafts exchanged between... nonidentical individuals of the same species Rejection of allografts is mediated by ___ and ___ T cells and antibodies Hyperacute graft rejection occurs rapidly after connection of the graft vasculature and is mediated by... What is an example of this? antibodies ABO group incompatibility What is likely to be a prominent finding on a biopsy from acute cellular rejection? an infiltrate with lymphocytes T/F: Acute graft rejection occurs days to weeks after transplantation while hyperacute graft rejection occurs almost immediately after transplantation True! T/F: Immunosuppressive therapy has been more successful in treating acute rejection than any other form True! What has become the major cause of graft failure? chronic rejection Graft-versus-host disease is the major problem seen with what type of transplantation? Hematopoietic stem cell transplantation (bone marrow transplant) In graft-versus-host-disease, grafts contain ____ cells that attack host tissues mature CD8+ T cells (Acute/chronic) GVHD is associated with jaundice, bloody diarrhea, and maculopapular rashes Acute (Acute/chronic) GVHD is associated with vacuolar changes, necrotic epidermal cells, and a lymphocytic infiltrate Acute (Acute/chronic) GVHD is associated with fibrosis of the skin and other tissues Chronic considered a more indolent condition (Acute/chronic) GVHD may resemble systemic sclerosis Chronic causes fibrosis of the skin! T/F: Thymic hypoplasia (DiGeorge syndrome) is an exmaple of a secondary immune deficiency False! It is a primary or congenital immune deficiency What is the most common secondary immunodeficiency? AIDS What condition presents in infancy with defects in humoral and cell-mediated immunity and susceptibility to a diverse range of infections? Severe combined immunodeficiency (SCID) Severe combined immunodeficiency (SCID) is ___ linked and ____ is the mainstay of treatment X linked (mutation in gene that encodes the common gamma chain) HSC transplantation (aka bone marrow transplant) is the mainstay of treatment (based on the maturation of donor lymphoid progenitor cells) What condition results in reduced immunoglobulin levels due to absent germinal centers in the lymph nodes? X-linked agammaglobulinemia can cause repeated bacterial/viral infections early in life Individuals with X-linked hyper-IgM syndrome have high or normal levels of ____ and low levels of ____ High = IgM Low = IgG, IgA, IgE these individuals have a profound deficiency in CMI With common variable immunodeficiency, the number of ___ is normal, the issue is a deficiency in... normal number of B cells have deficiency in plasma cells and antibodies What condition causes deficient T cell maturation and developmental defects in the 3rd and 4th pharyngeal pouches? DiGeorge syndrome (thymic hypoplasia) What condition can result in the microdeletion of chromosome 22? DiGeorge syndrome (thymic hypoplasia) Mother to infant spread of AIDs is termed... vertical transmission can be in utero, during delivery, or by ingestion of breast milk HIV-1 is primarily found in ____ while HIV-2 is dominant in ____ HIV-1 = US and Europe (most common cause of AIDS) HIV-2 = West Africa What protein is used for blood screening for aids? p24 Patients with a CD4 count less than 200 have... AIDS (AIDS causes CD4 destruction) T/F: AIDS is associated with progressive encephalopathy True! AIDS-dementia complex ____ is a vascular neoplasm associated with HIV as it is caused by HHV-8 Kaposi sarcoma blueish-purple macules on skin or oral mucosa ____ is a disease that is EBV+ and associated with HIV that is often found in the oral cavity Hairy leukoplakia ___ is a fungal infection of the mouth that can be associated with HIV Candidiasis ___ is caused by the aggregation of various proteins that are produced in excess or not adequately cleared Amyloidosis Amyloid stains ___ with congo red Pink used for diagnosis of amyloidosis. when stained with congo red, it reveals pink-red deposits of amyloid in the cell walls of blood vessels ____ is generated by proteolysis of serum amyloid A (SAA) and its aggregation is what causes reactive secondary amyloidosis Amyloid A (AA) Primary amyloidosis is caused by an accumulation of... amyloid light chain (AL) What stain is used for amyloidosis in the kidney? PAS stain reveals glycogen-rich deposits ____ are released when a gram - bacteria dies and can cause fever, shock, or disturbances in blood coagulation Endotoxins T/F: Endotoxins are in gram + bacteria while exotoxins are in gram - bacteria False! Endotoxins = gram - Exotoxins = gram + T. pallidum is known for causing... Syphilis B. burgdoferi is known for causing... Lyme disease justin bieber! Staph aureus is a gram + cocci found in the URT that causes various skin lesions such as.. impetigo, scalded skin syndrome, abscesses (including dental) T/F: staph aureus can cause osteomyelitis and endocarditis True! What kind of microbe can cause scarlet fever, rheumatic fever, UTIs, and dental caries? streptococci What microbe is responsible for being the majro cause of dental caries? Streptococcus mutans Primary syphilis is marked by a... chancre (round, firm, painless lesion found at the site of T. pallidum entering the body) Secondary syphilis involves... painless mucocutaneous lesions and a characteristic rash (reddish brown spots on hands and soles of feet) Condylomata lata is caused by ____ NOT HPV secondary Syphilis these are grey/white plaques T/F: The latent period for syphilis is relatively short False! Very long... could be 30 years Latent period is period of time where there are no signs or symptoms of syphilis but bacteria remains in the body Tertiary syphilis develops in about ___% of cases and can result in ___ 33% gumma (soft, tumor-like growth of the tissues) What are the two major symptoms of congenital syphilis? 1) Mulberry molars 2) Hutchinson's incisors Frontal bossing, saddle nose, and a short maxilla are all indicative of... congential syphilis In a radiograph done on someone with mycobacterium tuberculosis, there will be a ___ at the site of infection fibro-calcified pulmonary nodule What is the most common oral presentation of tuberculosis? a non-healing ulcer Bartonella henselae is a gram - rod associated with what disease? Cat scratch disease T/F: Viruses are obligate intracellular parasites so they require host cells to replicate True! Koplik spots (clustered white lesions on buccal mucosa) associated with what disease? Measles (rubeola) Unilateral parotid swelling is associated with what disease? mumps The MMR vaccines protects us from what 3 things? measles, mumps, rubella The latent stage of alpha-group herpes is in ____ while the latent stage of gamma group herpes is in ____ nerve ganglia lymphoid cells Thumb sucking and nail biting by individuals with herpes virus can cause... herpetic whitlow (transmission of virus to fingers, causing infection) What are the two clinical forms of recurrent herpes infection? herpetic labialis (cold sores) and intra-oral recurrent herpes infection (affects gingiva or hard palate) Genital herpes are usually associated with which type of herpes? HSV-2 Primary infection with Varicella Zoster Virus (HHV-3 human herpes virus 3) leads to what condition? acute varicella or chicken pox Herpes virus EBV (HHV-4) can lead to... hairy leukoplakia in HIV (infection of the epithelial cells) T/F: Herpes virus EBV has been thought to be the cause of some human cancers True! including nasopharyngeal carcinoma and lymphomas like Hodgkin and Burkitt What is the most common congenital infection causing serious disease in infants? Cytomegalovirus (HHV-5) is the leading cause of infectious hearing loss and brain development defects in developed countries Hand-foot-mouth disease, herpangina, and hemorrhagic conjunctivitis are all caused by what? Coxsackievirus "SARS" stands for what? severe acute respiratory distress syndrome What species of candida (a fungus) is most likely to cause infection? C. albicans T/F: Candida is not a part of the normal human flora False! 100% of humans have candida as part of their oral flora (but it is opportunistic so it can cause infection!) Pseudomembranous candidiasis plaques have a cottage cheese appearance and (can/cannot) be wiped off Can!! ___ is a very common presentation of Candida but is often overlooked Erythematous candidiasis aka acute atrophic candidiasis or "antibiotic sore mouth" ____ is candidiasis involving the corners of the mouth Angular cheilitis What is a deep fungal infection that can affect the sinonasal tract and has a poor prognosis? Mucormycosis What is an example of a virus/fungus mixed infection? Candidiasis (HIV and C. albican) What is an example of a bacteria/fungus mixed infection? angular cheilitis (C. albicans and S. aureus) What is an example of a virus/virus mixed infection? hairy leukoplakia (HIV and EBV/HHV-4)