NURS 5315 Pathophysiology | The Biologic Basis for Disease in Adults and Children 8th Edition | Test Bank

NURS 5315 Pathophysiology_The_Biologic_Basis_for_Disease_in_Adults_and_Children_8th_Edition - University of Texas | Test Bank Chapter 1 - Cellular Biology 3 Chapter 2 - Altered Cellular and Tissue Biology Environmental Agents 16 Chapter 3 - The Cellular Environment Fluids and Electrolytes Acids and Bases 28 Chapter 4 - Genes and Genetic Diseases 41 Chapter 5 - Genes Environment-Lifestyle and Common Diseases 51 Chapter 6 - Epigenetics and Disease 59 Chapter 7 - Innate Immunity Inflammation 64 Chapter 8 - Adaptive Immunity 78 Chapter 9 - Alterations in Immunity and Inflammation 89 Chapter 10 - Infection 102 Chapter 11 - Stress and Disease 110 Chapter 12 - Cancer Biology 117 Chapter 13 - Cancer Epidemiology 129 Chapter 14 - Cancer in Children 135 Chapter 15 - Structure and Function of the Neurologic System 140 Chapter 16 - Pain Temperature Regulation Sleep and Sensory Function 151 Chapter 17 - Alterations in Cognitive Systems Cerebral Hemodynamics and Motor Function 165 Chapter 18 - Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction 179 Chapter 19 - Neurobiology of Schizophrenia Mood Disorders and Anxiety Disorders 189 Chapter 20 - Alterations of Neurologic Function in Children 195 Chapter 21 - Mechanisms of Hormonal Regulation 202 Chapter 22 - Alterations of Hormonal Regulation 211 Chapter 23 - Obesity and Disorders of Nutrition NEW 223 Chapter 24 - Structure and Function of the Reproductive Systems 228 Chapter 25 - Alterations of the Female Reproductive System 237 Chapter 26 - Alterations of the Male Reproductive System 246 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34Chapter 27 - Sexually Transmitted Infections 252 Chapter 28 - Structure and Function of the Hematologic System 260 Chapter 29 - Alterations of Erythrocyte Platelet and Hemostatic Function 270 Chapter 30 - Alterations of Leukocyte and Lymphoid Function 280 Chapter 31 - Alterations of Hematologic Function in Children 287 Chapter 32 - Structure and Function of the Cardiovascular and Lymphatic Systems 297 Chapter 33 - Alterations of Cardiovascular Function 309 Chapter 34 - Alterations of Cardiovascular Function in Children 323 Chapter 35 - Structure and Function of the Pulmonary System 331 Chapter 36 - Alterations of Pulmonary Function 341 Chapter 37 - Alterations of Pulmonary Function in Children 357 Chapter 38 - Structure and Function of the Renal and Urologic Systems 365 Chapter 39 - Alterations of Renal and Urinary Function 375 Chapter 40 - Alterations of Renal and Urinary Tract Function in Children 385 Chapter 41 - Structure and Function of the Digestive System 393 Chapter 42 - Alterations of Digestive Function 404 Chapter 43 - Alterations of Digestive Function in Children 415 Chapter 44 - Structure and Function of the Musculoskeletal System 424 Chapter 45 - Alterations of Musculoskeletal Function 436 Chapter 46 - Alterations of Musculoskeletal Function in Children 448 Chapter 47 - Structure Function and Disorders of the Integument 457 Chapter 48 - Alterations of the Integument in Children 468 Chapter 49 - Shock Multiple Organ Dysfunction Syndrome and Burns in Adults 476 Chapter 50 - Shock Multiple Organ Dysfunction Syndrome and Burns in Children 483 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34Chapter 01: Cellular Biology McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE - - - - - - - - - - - - - 1. Which statement best describes the cellular function of metabolic absorption? a. Cells can produce proteins. b. Cells can secrete digestive enzymes. c. Cells can take in and use nutrients. d. Cells can synthesize fats. ANS: C In metabolic absorption, all cells take in and use nutrients and other substances from their surroundings. The remaining options are not inclusive in their descriptions of cellular metabolic absorption. PTS: 1 DIF: Cognitive Level: Remembering 2. Where is most of a cell’s genetic information, including RNA and DNA, contained? a. Mitochondria b. Ribosome c. Nucleolus d. Lysosome ANS: C The nucleus contains the nucleolus, a small dense structure composed largely of RNA, most of the cellular DNA, and the DNA-binding proteins, such as the histones, which regulate its activity. The mitochondria are responsible for cellular respiration and energy production. Ribosomes’ chief function is to provide sites for cellular protein synthesis. Lysosomes function as the intracellular digestive system. PTS: 1 DIF: Cognitive Level: Remembering 3. Which component of the cell produces hydrogen peroxide (H2O2) by using oxygen to remove hydrogen atoms from specific substrates in an oxidative reaction? a. Lysosomes b. Peroxisomes c. Ribosomes d. Endosome ANS: B Chapter 1 - Cellular Biology 3 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34Peroxisomes are so named because they usually contain enzymes that use oxygen to remove hydrogen atoms from specific substrates in an oxidative reaction that produces H2O2, which is a powerful oxidant and potentially destructive if it accumulates or escapes from peroxisomes. Ribosomes are RNA-protein complexes (nucleoproteins) that are synthesized in the nucleolus and secreted into the cytoplasm through pores in the nuclear envelope called nuclear pore complexes. Lysosomes are saclike structures that originate from the Golgi complex and contain more than 40 digestive enzymes called hydrolases, which catalyze bonds in proteins, lipids, nucleic acids, and carbohydrates. An endosome is a vesical that has been pinched off from the cellular membrane. PTS: 1 DIF: Cognitive Level: Remembering 4. Which cell component is capable of cellular autodigestion when it is released during cell injury? a. Ribosome b. Golgi complex c. Smooth endoplasmic reticulum d. Lysosomes ANS: D The lysosomal membrane acts as a protective shield between the powerful digestive enzymes within the lysosome and the cytoplasm, preventing their leakage into the cytoplasmic matrix. Disruption of the membrane by various treatments or cellular injury leads to a release of the lysosomal enzymes, which can then react with their specific substrates, causing cellular self-digestion. The chief function of a ribosome is to provide sites for cellular protein synthesis. The Golgi complex is a network of flattened, smooth vesicles and membranes often located near the cell nucleus. The smooth endoplasmic reticulum is involved in steroid hormone production and removing toxic substances from the cell. PTS: 1 DIF: Cognitive Level: Remembering 5. Which cAMP-mediated response is related to antidiuretic hormone? a. Increased heart rate and force of contraction b. Secretion of cortisol c. Increased retention of water d. Breakdown of fat ANS: C Antidiuretic hormone leads to increased retention of water in the body. Epinephrine causes increases in heart rate and force of contraction. Increased cortisol secretion is due to ACTH. Breakdown of fat is due to glucagon. PTS: 1 DIF: Cognitive Level: Remembering 6. During which phase of the cell cycle is DNA synthesized? a. G1 b. S c. G2 d. M ANS: B Chapter 1 - Cellular Biology 4 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34The four designated phases of the cell cycle are: (1) the G1 phase (G = gap), which is the period between the M phase (M = mitosis) and the start of DNA synthesis; (2) the S phase (S = synthesis), during which DNA is synthesized in the cell nucleus; (3) the G2 phase, during which RNA and protein synthesis occurs, the period between the completion of DNA synthesis and the next phase (M); and (4) the M phase, which includes nuclear and cytoplasmic division. PTS: 1 DIF: Cognitive Level: Remembering 7. What organic compound facilitates transportation across cell membranes by acting as receptors, transport channels for electrolytes, and enzymes to drive active pumps? a. Lipids b. Proteases c. Proteins d. Carbohydrates ANS: C Proteins have several functions, including acting as receptors, transport channels for electrolytes, and enzymes to drive active pumps Lipids help act as the “glue” holding cell membranes together. Proteases cause the breakdown of protein. Carbohydrates are involved in cellular protection and lubrication and help produce energy via oxidative phosphorylation. PTS: 1 DIF: Cognitive Level: Remembering 8. Understanding the various steps of proteolytic cascades may be useful in designing drug therapy for which human diseases? a. Cardiac and vascular disorders b. Autoimmune and malignant disorders c. Gastrointestinal and renal disorders d. Endocrine and gastrointestinal disorders ANS: B Understanding the various steps involved in this process is crucial for designing drug interventions. Dysregulation of proteases features prominently in many human diseases, including cancer, autoimmunity, and neurodegenerative disorders. Cardiac, vascular, gastrointestinal, renal, and endocrine disorders do not involve this process. PTS: 1 DIF: Cognitive Level: Remembering 9. Which structure prevents water-soluble molecules from entering cells across the plasma membrane? a. Carbohydrate chains b. Glycoprotein channels c. Membrane channel proteins d. Lipid bilayer ANS: D Chapter 1 - Cellular Biology 5 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34The bilayer’s structure accounts for one of the essential functions of the plasma membrane. It is impermeable to most water-soluble molecules (molecules that dissolve in water) because the water-soluble molecules are insoluble in the oily core region. The bilayer serves as a barrier to the diffusion of water and hydrophilic substances while allowing lipid-soluble molecules, such as oxygen (O2) and carbon dioxide (CO2), to diffuse through it readily. Carbohydrate chains, glycoprotein channels, and membrane channel proteins do not prevent water-soluble molecules from entering cells across the cell membrane. PTS: 1 DIF: Cognitive Level: Remembering 10. A student asks for an explanation of the absolute refractory period of the action potential. What response by the professor is best? a. A stronger than normal impulse will evoke another response. b. No stimulus is able to evoke another response at this time. c. Multiple stimuli can produce more rapid action potentials. d. The hyperpolarized state means a weaker stimulus produces a response. ANS: B During the absolute refractory state of the action potential, no stimulus is able to evoke another response from the cell. A stronger than normal impulse may generate a response in the relative refractory period. This period of time is not related to the number of stimuli. A hyperpolarized state means a stronger than normal stimulus would be needed to generate a response. PTS: 1 DIF: Cognitive Level: Remembering 11. Which form of cell communication is used to communicate within the cell itself and with other cells in direct physical contact? a. Protein channel (gap junction) b. Plasma membrane-bound signaling molecules c. Hormone secretion such as neurotransmitters d. Extracellular chemical messengers such as ligands ANS: B Cells communicate in three main ways; they display plasma membrane-bound signaling molecules that affect the cell itself and other cells in direct physical contact with it, they affect receptor proteins inside the target cell, and they form protein channels (gap junctions) that directly coordinate the activities of adjacent cells. Neurotransmitters are released by neurons and cross the synaptic cleft to communicate with the cells they innervate. Ligands are involved in binding processes. PTS: 1 DIF: Cognitive Level: Remembering 12. Which mode of chemical signaling uses blood to transport communication to cells some distance away? a. Paracrine b. Autocrine c. Neurotransmitter d. Hormonal ANS: D Chapter 1 - Cellular Biology 6 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34Chemical signaling can be classified into three categories: (1) local-chemical mediator, (2) hormone, and (3) neurotransmitter. Hormones are released by one set of cells and travel through tissues or the bloodstream to another set of cells where they produce a response by those cells. In paracrine signaling, cells secrete local chemical mediators that are quickly absorbed, destroyed, or immobilized. Paracrine signaling requires close membrane-to-membrane contact. Paracrine signaling usually involves different cell types; however, cells also may produce signals that they, themselves, respond to, which is called autocrine signaling. Neurotransmitters are released by neurons and cross the synaptic cleft to communicate with the cells they innervate. PTS: 1 DIF: Cognitive Level: Remembering 13. Which mode of chemical signaling uses local chemical mediators that are quickly taken up, destroyed, or immobilized? a. Paracrine b. Autocrine c. Neurotransmitter d. Hormone ANS: A In paracrine signaling, cells secrete local chemical mediators that are quickly taken up, destroyed, or immobilized. Autocrine signaling occurs when the target cells produce signals that they themselves respond to. Neurotransmitters are released by neurons and cross the synaptic cleft to communicate with the cells they innervate. Hormones are released by one set of cells and travel through tissues or the bloodstream to another set of cells where they produce a response by those cells. PTS: 1 DIF: Cognitive Level: Remembering 14. Neurotransmitters affect the postsynaptic membrane by binding to which structure? a. Lipids b. Ribosomes c. Amphipathic lipids d. Receptors ANS: D In each type of chemical signaling, the target cell receives the signal by first attaching to its receptors. The other options do not correctly describe this process. PTS: 1 DIF: Cognitive Level: Remembering 15. How do cells receive communication from the extracellular fluid surrounding them? a. Protein channel (gap junction) b. Plasma membrane-bound signaling molecules (involving receptors) c. Hormone secretion such as neurotransmitters d. Chemical messengers such as ligands ANS: D Chapter 1 - Cellular Biology 7 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34Signal transduction involves incoming signals or instructions from extracellular chemical messengers (ligands) that are conveyed to the cell’s interior for execution. The other options do not correctly describe how cells receive communication from the surrounding extracellular fluid. PTS: 1 DIF: Cognitive Level: Remembering 16. Which molecule provides the second messenger necessary for extracellular communication to be activated? a. Guanosine triphosphate (GTP) b. Adenosine monophosphate (AMP) c. Adenosine triphosphate (ATP) d. Guanosine diphosphate (GDP) -- - - - - - - -- - - - - - - - - - - - - - - - - - - - If a woman has one affected first-degree relative, her risk of developing breast cancer doubles. Chapter 5 - Genes Environment-Lifestyle and Common Diseases 52 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34PTS: 1 DIF: Cognitive Level: Remembering 8. Adoption studies have shown that the offspring of an alcoholic parent have what amount of an increased risk of developing alcoholism when raised by a nonalcoholic parent? a. Twofold b. Threefold c. Fourfold d. Tenfold ANS: C Adoption studies have shown that the offspring of an alcoholic parent, even when raised by nonalcoholic parents, have a fourfold increased risk of developing the disorder. PTS: 1 DIF: Cognitive Level: Remembering 9. Studies have identified several genes that play a role in the prevention of obesity by affecting what? a. Regulation of appetite b. Metabolizing of fat c. Absorption of fat d. Altering the sense of satiety ANS: A Clinical trials using recombinant leptin have demonstrated moderate weight loss in a subset of obese individuals. In addition, leptin participates in important interactions with other components of appetite control, such as neuropeptide Y and α-melanocyte-stimulating hormone and its receptor, the melanocortin-4 receptor (MC4R). Currently, no research supports the other options as being genetically regulated. PTS: 1 DIF: Cognitive Level: Remembering 10. The BRCA1 and BRCA2 mutations increase the risk of which cancer in women? a. Ovarian b. Lung c. Uterine d. Pancreatic ANS: A BRCA1 mutations increase the risk of ovarian cancer among women (20% to 50% lifetime risk), and BRCA2 mutations also confer an increased risk of ovarian cancer (10% to 20% lifetime prevalence). BRCA1 and BRCA2 mutations are not currently believed to be linked with risks of lung, uterine, or pancreatic cancers. PTS: 1 DIF: Cognitive Level: Remembering 11. What are blood pressure variations associated with? a. β1-Adrenergic receptors to increase heart rate b. The release of an antidiuretic hormone (ADH) c. The renin-angiotensin system’s effect on vasoconstriction d. Serum bradykinin, causing vasodilation Chapter 5 - Genes Environment-Lifestyle and Common Diseases 53 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34ANS: C Studies of blood pressure correlations within families indicate that about 20% to 40% of the variation in both systolic and diastolic blood pressure is caused by genetic factors. Significant research is now focused on specific components that may influence blood pressure variation, such as the renin-angiotensin system (involved in sodium reabsorption and vasoconstriction). β1-Adrenergic receptors, ADH, and bradykinin are not the subjects of such research. PTS: 1 DIF: Cognitive Level: Remembering 12. What are the two most important risk factors for type 2 diabetes? a. Autoantibodies and human leukocyte antigen associations b. Autoantibodies and obesity c. Obesity and positive family history d. HLA associations and positive family history ANS: C The two most important risk factors for type 2 diabetes are positive family history and obesity. Autoantibodies and human leukocyte antigen associations are not believed to be important risk factors for this form of diabetes. PTS: 1 DIF: Cognitive Level: Remembering 13. A parent wants to know how to prevent type 1 diabetes in the newborn. The healthcare professional explains that prevention is not possible, because which of these is a major characteristic of type 1 diabetes mellitus? a. Partial insulin secretion b. An autoimmune cause factor c. Insulin resistance d. Obesity as a common risk factor ANS: B A strong association between type 1 diabetes and the presence of several human leukocyte antigen (HLA) class II alleles indicate that type 1 diabetes mellitus is an autoimmune disease. The remaining options are associated with type 2 diabetes. PTS: 1 DIF: Cognitive Level: Comprehension 14. A patient with several risk factors is concerned about developing type 2 diabetes. The healthcare professional advises the patient to lose weight, explaining that obesity is an important risk factor for type 2 diabetes mellitus because it causes what? a. Reduced insulin production by the pancreas b. Increased resistance to insulin in the cells c. Obstructed outflow of insulin from the pancreas d. Stimulation of glucose production by the liver ANS: B People with type 2 diabetes mellitus suffer from insulin resistance. Obesity causes this resistance so their cells have difficulty using insulin. Obesity does not lead to reduced insulin production, obstructed insulin outflow, or stimulation of glucose production. PTS: 1 DIF: Cognitive Level: Remembering Chapter 5 - Genes Environment-Lifestyle and Common Diseases 54 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 3415. Traits caused by the combined effects of multiple genes are referred to by which term? a. Polygenic b. Multifocal c. Modifiable d. Involuntary ANS: A Traits in which variation is thought to be caused by the combined effects of multiple genes are polygenic, meaning many genes. Multifocal means relating to or arising from many points. Modifiable refers to the changeability of something. Involuntary suggests being out of the control of someone or something. PTS: 1 DIF: Cognitive Level: Remembering 16. Regarding type 2 diabetes, obesity is considered to be what type of risk? a. Genetic b. Empirical c. Relative d. Modifiable ANS: D A modifiable risk is one a person can change in order to reduce risk. Obesity is a modifiable risk factor for many diseases including heart disease, stroke, hypertension, and type 2 diabetes. Genetic, empirical, and relative risks are not changeable by individuals in order to reduce their chance of developing diseases. PTS: 1 DIF: Cognitive Level: Remembering 17. Which disease form is associated with identified empirical risks? a. Polygenic b. Multifactorial c. Monozygotic d. Genetic ANS: B For most multifactorial diseases, empirical risks (i.e., risks based on direct observation of data) have been derived. Traits in which variation is thought to be caused by the combined effects of multiple genes are polygenic. Monozygotic is a term that refers to identical twins. Genetic refers to issues related to genes and their influence on the body. PTS: 1 DIF: Cognitive Level: Remembering 18. The number of persons living with a specific disease at a specific point in time is referred to by which term? a. Relativity b. Survivability c. Prevalence d. Incidence ANS: C Chapter 5 - Genes Environment-Lifestyle and Common Diseases 55 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34The prevalence rate is the proportion of the population affected by a disease at a specific point in time. Thus both the incidence rate and the length of the survival period in affected individuals determine prevalence. The term “relativity” is not related to disease statistics. Survivability would refer to the chances of a person being able to survive a specific disease and is also not related to the question. The incidence rate is the number of new cases of a disease reported during a specific period (typically 1 year) divided by the number of individuals in the population. PTS: 1 DIF: Cognitive Level: Remembering 19. Which type of cancer is said to aggregate among families? a. Breast b. Lung c. Skin d. Brain ANS: A Breast cancer appears to aggregate strongly in families. The other cancers are not believed to be familial in nature. PTS: 1 DIF: Cognitive Level: Remembering 20. Which dietary lifestyle choice has been associated with a decreased risk for developing colon cancer? a. Increased consumption of dairy products b. Increased consumption of foods containing vitamin C c. Decreased consumption of foods high in fat d. Decreased consumption of artificial food coloring ANS: C A low-fat, high-fiber diet is thought to decrease the risk of colon cancer. Consumption of dairy products, vitamin C, and artificial food coloring are not thought to be related to colon cancer. PTS: 1 DIF: Cognitive Level: Remembering 21. What is currently believed about the risk for developing Alzheimer disease? a. It is not directly related to genetic predisposition. b. It is higher among men than it is among women. c. It occurs less among Hispanics than in Asians. d. It doubles among those with an affected first-degree relative. ANS: D The risk of developing Alzheimer disease doubles in individuals who have an affected first-degree relative. There is a genetic link to the disease. It is not true that the risk is higher among men than it is among women. Hispanics have relatively low risk of developing this disease. PTS: 1 DIF: Cognitive Level: Remembering 22. The number of new cases of a disease reported during a specific period divided by the number of individuals in the population is defined as which characteristic of a disease? Chapter 5 - Genes Environment-Lifestyle and Common Diseases 56 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34a. Prevalence rate b. Incidence rate c. Relative risk d. Frequency ANS: B The incidence rate is the number of new cases of a disease reported during a specific period (typically 1 year) divided by the number of individuals in the population. The prevalence rate is the proportion of the population affected by a disease at a specific point in time. The relative risk is a ratio of the increased rate of disease among a population exposed to a risk factor compared with the increased rate of the disease in an unexposed population. Frequency is a simple measure of how often something occurs. PTS: 1 DIF: Cognitive Level: Remembering MULTIPLE RESPONSE 1. Which are cancers that cluster strongly in families? (Select all that apply.) a. Breast b. Colon c. Ovarian d. Lung e. Brain ANS: A, B, C Although breast, ovarian, and colon cancers have shown a strong familial tendency, lung and brain cancers have not. PTS: 1 DIF: Cognitive Level: Remembering 2. Which genes are responsible for an autosomal dominant form of breast cancer? (Select all that apply.) a. LCAT b. CHK1 c. CHK2 d. BRCA1 e. BRCA2 ANS: D, E Women who inherit a mutation in BRCA1 or BRCA2 experience a 50% to 80% lifetime risk of developing breast cancer. The other options do not carry this risk. PTS: 1 DIF: Cognitive Level: Remembering 3. Which lifestyle modifications affect health-related risk factors? (Select all that apply.) a. Diet b. Exercise c. Education d. Finances e. Stress reduction Chapter 5 - Genes Environment-Lifestyle and Common Diseases 57 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34ANS: A, B, E Lifestyle modification (e.g., diet, exercise, stress reduction) can often reduce health risks significantly. Education and finances have not been shown to have an effect on health in a way that involves lifestyle modifications. PTS: 1 DIF: Cognitive Level: Remembering 4. What factors are typically considered when assessing an individual’s risk for developing such common diseases as hypertension? (Select all that apply.) a. Age b. Diet c. Exercise habits d. Family history e. Spiritual beliefs ANS: A, B, C, D Many factors influence the risk of acquiring a common disease, such as cancer, diabetes, or hypertension. These factors can include age, gender, diet, exercise, and family history of the disease. Current research does not support a connection between spiritual beliefs and the development of hypertension. PTS: 1 DIF: Cognitive Level: Remembering 5. Which are examples of multifactorial diseases associated with adults? (Select all that apply.) a. Breast cancer b. Coronary heart disease c. Emphysema d. Diabetes mellitus e. Schizophrenia ANS: A, B, D, E Multifactorial diseases in adults include coronary heart disease, hypertension, breast cancer, colon cancer, diabetes mellitus, obesity, Alzheimer disease, alcoholism, schizophrenia, and bipolar affective disorder. Emphysema is not considered multifactorial. PTS: 1 DIF: Cognitive Level: Remembering Chapter 5 - Genes Environment-Lifestyle and Common Diseases 58 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34Chapter 06: Epigenetics and Disease McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE 1. What genetic process is likely responsible for the occurrence of asthma in only one of a pair of identical twins? a. Epigenetic modifications b. Genomic imprinting c. Transgenerational inheritance d. Methylation ANS: A Epigenetic modifications can cause individuals with the same deoxyribonucleic acid (DNA) sequences (such as identical twins) to have different disease profiles. Imprinting means that either the copy of a gene inherited through the sperm or the copy inherited through the egg is inactivated and remains in this inactive state in all of the somatic cells of the individual. The heritable transmission to future generations of epigenetic modifications is called transgenerational inheritance. DNA methylation occurs through the attachment of a methyl group to the carbon-5 position of a cytosine. PTS: 1 DIF: Cognitive Level: Remembering 2. Prader-Willi syndrome causes a chromosomal defect that is what? a. Initiated by postnatal exposure to a virus b. Inherited from the father c. Related to maternal alcohol abuse d. Transferred from mother to child ANS: B Prader-Willi syndrome can be caused by a 4 Mb deletion of chromosome 15q when inherited from the father. This disorder is not caused by a virus, or related to maternal alcohol abuse. The same gene deletion causes Angelman syndrome when inherited from the mother. PTS: 1 DIF: Cognitive Level: Remembering 3. What can a malfunction in DNA methylation lead to? a. Hypothyroidism b. Blindness c. Cancer d. Diabetes mellitus ANS: C Aberrant methylation can lead to silencing of tumor-suppressor genes in the development of cancer. No research supports a connection between hypothyroidism, blindness, or diabetes mellitus to a malfunctioning of DNA methylation. PTS: 1 DIF: Cognitive Level: Remembering Chapter 6 - Epigenetics and Disease 59 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 344. Which statement is true regarding the embryonic development of stem cells? a. They are already differentiated. b. They are referred to as housekeeping genes. c. They already demonstrate DNA sequencing. d. They are said to be totipotent. ANS: D Early in embryonic development, all cells of the embryo have the potential to become any type of cell in the fetus or adult. These embryonic stem cells are said to be totipotent. They are not yet differentiated. Housekeeping genes are necessary for the function and maintenance of all cells. DNA sequencing is not limited to embryonic stem cells. PTS: 1 DIF: Cognitive Level: Remembering 5. When microRNA (miRNA) are methylated their messenger RNA (mRNA) targets are over-expressed. What would be the resulting effect on existing cancer? a. Cell death b. Metastasis c. Remission d. Relapse ANS: B When miRNA genes are methylated, their mRNA targets are over-expressed, and this over-expression has been associated with aberrant function of tumor-suppression genes. This process does not cause cell death, remission, or relapse. PTS: 1 DIF: Cognitive Level: Remembering 6. What is the difference between DNA sequence mutations and epigenetic modifications? a. DNA sequence mutations can be directly altered. b. Leukemia is a result of only DNA sequence mutation. c. Epigenetic modifications potentially can be reversed. d. No known drug therapies are available for epigenetic modifications. ANS: C Unlike DNA sequence mutations, which cannot be directly altered, epigenetic modifications can be reversed. The remaining options are not true statements regarding the difference between DNA sequence mutations and epigenetic modifications. PTS: 1 DIF: Cognitive Level: Remembering 7. Which term refers to the silenced gene of a gene pair? a. Activated b. Altered c. Mutated d. Imprinted ANS: D Gene silencing, a process during which genes are predictably silenced, depending on which parent transmits them, is known as imprinting; the transcriptionally silenced genes are then said to be imprinted. The remaining options do not accurately identify this process. Chapter 6 - Epigenetics and Disease 60 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34PTS: 1 DIF: Cognitive Level: Remembering 8. What is most likely the shape of the face of a child diagnosed with Russell-Silver syndrome? a. Round b. Square c. Triangular d. Elongated ANS: C Growth retardation, proportionate short stature, leg-length discrepancy, and a small, triangular-shaped face characterizes Russell-Silver syndrome. The other face shapes are not characteristic of Russell-Silver syndrome. PTS: 1 DIF: Cognitive Level: Remembering 9. What are genes responsible for the maintenance of all cells referred to as? a. Universal b. Managerial c. Housekeeping d. Executive ANS: C A small percentage of genes, termed housekeeping genes, are necessary for the function and maintenance of all cells. The remaining options do not accurately refer to these cells. PTS: 1 DIF: Cognitive Level: Remembering 10. What is the belief regarding twins who adopt dramatically different lifestyles? a. They may experience very different aging processes. b. They will retain very similar methylation patterns. c. They will experience identical phenotypes throughout their lifespans. d. They may never demonstrate similar DNA sequences of their somatic cells. ANS: A Twins with significant lifestyle differences (e.g., smoking versus nonsmoking) accumulate large numbers of differences in their methylation patterns. The twins, despite having identical DNA sequences, become more and more different as a result of epigenetic changes, which in turn affect the expression of genes. These results, along with findings generated in animal studies, suggest that changes in epigenetic patterns may be an important part of the aging process. They will not experience identical phenotypes throughout their life spans. PTS: 1 DIF: Cognitive Level: Remembering 11. What do hypomethylation and the resulting effect on oncogenes result in? a. A decrease in the activity of the oncogene, thus suppressing cancer development. b. A deactivation of MLH1 to halt DNA repair. c. An increase in tumor progression from benign to malignant. d. An over-expression of microRNA, resulting in tumorigenesis. - - - - - - - - - - - - - - - - - - - - -- - - - - - - - Hypothyroidism causes increased secretion of hypothalamic thyroid-releasing hormone, which stimulates the release of prolactin from the pituitary. Other causes include some drugs such as phenothiazines and some physical causes. The proliferation of lactiferous breast ducts is not associated with galactorrhea. PTS: 1 DIF: Cognitive Level: Understanding 21. A woman’s chart reveals she has superficial breast cysts. What assessment finding does the healthcare professional correlate with this condition? a. Hard, painful lump b. Reddened skin surrounding the lump c. Squishy feeling and easily palpated d. Dimpling on the surface of the breast ANS: C Cysts (fluid-filled sacs) are a specific type of lump that commonly occurs in women in their 30s, 40s, and early 50s. Cysts feel squishy when they occur close to the surface of the breast; however, when deeply embedded, cysts can feel hard. A reddened area surrounding a lump might signify an infection. Dimpling on the surface of the breast may indicate cancer. PTS: 1 DIF: Cognitive Level: Remembering 22. A woman has been diagnosed with a simple fibroadenoma. What treatment does the healthcare provider educate the woman about? a. A repeat biopsy in 6 months b. More frequent mammograms c. Nothing; no treatment is needed. d. Rapid surgical excision and chemotherapy ANS: C Simple fibroadenomas are benign, and if asymptomatic, do not require treatment. A complex fibroadenoma with surrounding proliferative changes needs further treatment. If the woman has a family history of breast cancer, she may wish to have it removed to decrease worry. PTS: 1 DIF: Cognitive Level: Understanding 23. What are the majority of the small percentage of ovarian cancers that are associated with a known pattern of inheritance associated with? a. Mutation of the BRCA1 gene Chapter 25 - Alterations of the Female Reproductive System 243 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34b. Mutations of the BRCA2 gene c. Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome d. Low progesterone levels ANS: A The majority (approximately 90%) of ovarian cancers are sporadic and not associated with a known pattern of inheritance. Of the 5% to 10% that have a familial component, the majority are associated with the breast cancer susceptibility gene 1 (BRCA1) and a smaller number with mutations of the BRCA2 or mismatched repair genes (HNPCC syndrome). Low progesterone levels are not associated with ovarian cancers. PTS: 1 DIF: Cognitive Level: Remembering MULTIPLE RESPONSE 1. A woman has a pelvic organ prolapse. What treatments does the healthcare professional teach the woman about? (Select all that apply.) a. Pessary b. Kegel exercises c. Estrogen therapy d. Surgical repair e. Bearing down exercises ANS: A, B, C, D A common first-line treatment is a pessary, which is a removable mechanical device that holds the uterus in position. The pelvic fascia may be strengthened through Kegel exercises (repetitive isometric tightening and relaxing of the pubococcygeal muscles) or by estrogen therapy in menopausal women. Maintaining a healthy body mass index, preventing constipation, and treating chronic cough may help as well. Surgical repair with or without a hysterectomy is the treatment of last resort. Bearing down would likely exacerbate the problem. PTS: 1 DIF: Cognitive Level: Remembering 2. The size of benign uterine tumors, such as leiomyomas, is thought to be caused by the influence of which hormones? (Select all that apply.) a. Progesterone b. Estrogen c. Luteinizing hormone d. Gonadotropin-stimulating hormone e. Growth factors ANS: A, B, E The cause of uterine leiomyomas is unknown, although their size appears to be related to estrogen, progesterone, growth factors, angiogenesis, and apoptosis. Luteinizing hormone and gonadotropin-stimulating hormone have no suspected role in leiomyomas. PTS: 1 DIF: Cognitive Level: Remembering 3. What are the common clinical manifestations of endometriosis? (Select all that apply.) a. Back and flank pain Chapter 25 - Alterations of the Female Reproductive System 244 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34b. Infertility c. Dysuria d. Amenorrhea e. Dysmenorrhea ANS: B, E Common clinical manifestations primarily include infertility, dysmenorrhea, dyschezia (pain on defecation), and dyspareunia (pain on intercourse). PTS: 1 DIF: Cognitive Level: Remembering 4. A woman has been diagnosed with compartment IV primary amenorrhea. What assessments would the healthcare professional perform as priorities? (Select all that apply.) a. Weight and body mass index b. Signs of systemic infection c. Stress self-assessment questionnaire d. Genetic family history e. Presence of secondary sex characteristics ANS: A, B, C, E Compartment IV primary amenorrhea is due to CNS dysfunction, specifically of the hypothalamus. The hypothalamus is unable to synthesize GnRH, so the pituitary fails to secrete LH and FSH. Therefore, the ovary does not receive the hormonal signals required to stimulate estrogen production, and ovulation and menstruation do not occur. Because the ovarian hormones are absent, estrogen-dependent sex characteristics do not develop. Other possible causes of this condition include starvation or malnutrition, infections, and stress. The healthcare professional would assess for these contributing factors. Genetic testing/screening would be more appropriate for compartment II primary amenorrhea, which involves the ovaries and is often linked to genetic disorders. PTS: 1 DIF: Cognitive Level: Applying Chapter 25 - Alterations of the Female Reproductive System 245 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 34Chapter 26: Alterations of the Male Reproductive System McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE 1. In the 95% of boys with delayed puberty, the problem is caused by which condition? a. Disruption in the hypothalamus b. Disruption of the pituitary c. Deficit in estrogen or testosterone d. Physiologic hormonal delays ANS: D In 95% of cases, delayed puberty is a physiologic delay; that is, hormonal levels are normal and the hypothalamic-pituitary-gonadal (HPG) axis is intact, but maturation is happening slowly. Hypothalamic and pituitary problems and hormone deficits account for the other 5% of cases. PTS: 1 DIF: Cognitive Level: Remembering 2. What is the first sign of puberty in boys? a. Thickening of the scrotal skin b. Growth of pubic hair c. Enlargement of the testes d. Change in voice ANS: C The first sign of puberty in boys is an enlargement of the testes and a thinning of the scrotal skin. Growth of pubic hair and voice changes come later. PTS: 1 DIF: Cognitive Level: Remembering 3. A student reads in a chart that a child has been diagnosed with mixed precocious puberty and asks for an explanation. What explanation by the healthcare professional is most accurate? a. When a child develops some secondary sex characteristics of the opposite sex b. When a child does not develop any identifiable external sex organs c. When early puberty occurs due to multiple, integrated causative effects d. When early puberty has signs of physical and hormonal abnormalities ANS: A Mixed precocious puberty (i.e., virilization of a girl or feminization of a boy) causes the child to develop some secondary sex characteristics of the opposite sex. It is not the lack of identifiable external sex organs, the effect of many causative factors mixed together, or a combination of physical and hormonal abnormalities specifically. The latter statement is accurate to a point but is too vague to be the best answer. PTS: 1 DIF: Cognitive Level: Understanding Chapter 26 - Alterations of the Male Reproductive System 246 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 344. A healthcare professional sees a patient in the clinic who reports that his foreskin cannot be retracted back over the glans penis. What term does the professional use to document this condition? a. Paraphimosis b. Priapism c. Prephimosis d. Phimosis ANS: D Phimosis is the term used to identify the condition in which the foreskin cannot be retracted back over the glans. Paraphimosis is the opposite condition where the foreskin is retracted and cannot be pulled back over the glans. Prephimosis is not a term used in the text. The healthcare professional would document this patient’s condition as phimosis. PTS: 1 DIF: Cognitive Level: Remembering 5. A student in the medical clinic is reviewing a patient’s medical record and sees the diagnosis of Peyronie’s disease and asks the healthcare professional for an explanation of this disorder. What statement by the professional is most accurate? a. When the man’s foreskin is retracted and cannot go back over the glans b. When the man’s foreskin cannot be retracted over the glans penis c. A very painful condition of prolonged erection seen in some diseases d. A fibrotic condition that leads to curvature of the penis and sexual dysfunction ANS: D Peyronie’s disease (bent nail syndrome) is a fibrotic condition of the tunica albuginea of the penis, resulting in varying degrees of curvature and sexual dysfunction. Although the exact cause is unknown, a local vasculitis-like inflammatory reaction occurs and decreased tissue oxygenation results in fibrosis and calcification. A retracted foreskin that will not reduce back over the glans is known as phimosis. Paraphimosis is the opposite condition where the foreskin is retracted and cannot be pulled back over the glans. Priapism is the term for the painful, prolonged erection. PTS: 1 DIF: Cognitive Level: Understanding 6. A man has balanitis. What action by the healthcare professional is most appropriate? a. Educate the man on the side effects of chemotherapy. b. Perform a finger stick for a blood glucose reading. c. Administer pain medication before retracting the foreskin. d. Prepare the man for a needle aspiration of the corpus. ANS: B Balanitis is an inflammation of the glans penis that is usually associated with poor hygiene and most often in men with poorly controlled diabetes mellitus. The health care professional should test the man’s blood glucose. Chemotherapy is not used to treat this condition. There is no difficulty retracting the foreskin so pain medication is not needed. Needle aspiration is one treatment for priapism. PTS: 1 DIF: Cognitive Level: Understanding Chapter 26 - Alterations of the Male Reproductive System 247 Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition 347. A 7-year-old child has cryptorchidism. What action by the healthcare professional is most appropriate? a. Educate the child and parents on orchiectomy. b. Instruct the parents to give the child all the antibiotics. c. Describe skin precautions used during radiation therapy. d. Describe the correct administration of GnRH. ANS: D Cryptorchidism is a condition of testicular maldescent. Treatment often begins with administration of GnRH or human chorionic gonadotropin (hCG), hormones that may initiate descent. If medical treatment does not work the child may need to have the testis moved surgically (orchiopexy). In children over 10 years of age and adults, the testis is removed in an orchiectomy. Neither Antibiotics nor radiation therapy is needed. PTS: 1 DIF: Cognitive Level: Applying 8. What is the most common infectious cause of orchitis in postpubertal boys? a. Herpes b. Escherichia coli c. Mumps d. Cytomegalovirus ANS: C Of the options available, mumps is the most common infectious cause of orchitis and usually affects postpubertal boys. PTS: 1 DIF: Cognitive Level: Remembering 9. The risk of which cancer is greater if the man has a history of cryptorchidism? a. Penile b. Testicular c. Prostate d. Epididymal ANS: B The risk of testicular cancer is 35 to 50 times greater in men with cryptorchidism or in those with a history of cryptorchidism than it is for the general male population. Cryptorchidism does not increase the risk of penile, prostate, or epididymal cancer. PTS: 1 DIF: Cognitive Level: Remembering 10. What are the clinical manifestations of testicular cancer? a. Firm, nontender testicular mass b. Painful, mobile, firm testicular mass c. Painful fluid-filled testicular mass d. Soft, nontender testicular mass ANS: A A firm, painless testicular enlargement is commonly identified as the first sign of testicular ca