Advanced Pathophysiology Week

Advanced Pathophysiology Week 3 Quiz- Version 3 Question 1 0 / 2 pts Clinical manifestations of mild to moderate splenomegaly and hepatomegaly, bronze-colored skin, and cardiac dysrhythmias are indicative of which anemia? Correct Answer Sideroblastic Pernicious You Answered Iron deficiency Aplastic Mild to moderate enlargement of the spleen (splenomegaly) and liver (hepatomegaly) occurs. Occasionally, abnormal skin pigmentation (bronze colored) is seen. Heart rhythm disturbances, along with congestive heart failure, are major life-threatening complications related to cardiac iron overload. Question 2 2 / 2 pts What is the pathophysiologic process of aplastic anemia? Inherited genetic disorder with recessive X-linked transmission Autoimmune disease against hematopoiesis by activated immunoglobulins Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells Correct! Autoimmune disease against hematopoiesis by activated cytotoxic T cells Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Cytotoxic T cells (Tc cells) appear to be the main culprits. Question 3 2 / 2 pts Which anemia produces small, pale erythrocytes? Hemolytic Folic acid Pernicious Correct! Iron deficiency The microcytic-hypochromic anemias, which include iron deficiency anemia (IDA), are characterized by erythrocytes that are abnormally small and contain abnormally reduced amounts of hemoglobin. Question 4 2 / 2 pts Symptoms of polycythemia vera are mainly the result of destruction of erythrocytes. a decreased erythrocyte count. neurologic involvement. Correct! increased blood viscosity. As the disease progresses many of the symptoms are related to the increased blood cellularity and viscosity. Question 5 2 / 2 pts A woman complains of chronic gastritis, fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit levels, and a high mean corpuscular volume. These findings are consistent with _____ anemia. folate deficiency iron deficiency aplastic Correct! pernicious Gastric atrophy commonly occurs in the presence of type A chronic gastritis and may be autoimmune. Autoantibodies against gastric parietal cells are frequently observed. When the hemoglobin level in the blood has decreased significantly (7 to 8 g/dl), the individual experiences the classic symptoms of anemia—weakness, fatigue, paresthesias of the feet and fingers, difficulty in walking, loss of appetite, abdominal pains, and weight loss. Question 6 0 / 2 pts The body compensates for anemia by capillary vasoconstriction. hemoglobin holds on to oxygen more firmly. Correct Answer increasing rate and depth of breathing. You Answered kidneys release more erythropoietin. Tissue hypoxia creates additional demands and compensatory actions on the pulmonary and hematologic systems. The rate and depth of breathing increase in an attempt to increase the availability of oxygen. Question 7 0 / 2 pts Which of the following is a description consistent with acute lymphocytic leukemia (ALL)? The bone marrow and peripheral blood are characterized by leukocytosis and a predominance of blast cells. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. You Answered There is failure of B cells to mature into plasma cells that synthesize immunoglobulins. Correct Answer It is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. The translocation of genetic material from genes 9 and 22 create an abnormal, fused gene identified as BCR-ABL. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. Question 8 2 / 2 pts Heparin-induced thrombocytopenia (HIT) is described as a(n) hematologic reaction to heparin in which the bone marrow is unable to produce sufficient platelets to meet the body’s needs. cell-mediated drug reaction in which macrophages process the heparin and platelet complexes that are then destroyed by activated cytotoxic T cells. IgE-mediated allergic drug reaction that reduces circulating platelets. Correct! IgG immune-mediated adverse drug reaction that reduces circulating platelets. Heparin is a common cause of drug-induced thrombocytopenia. HIT is an immune-mediated, adverse drug reaction caused by IgG antibodies that leads to increased platelet consumption and a decrease in platelet counts. Question 9 0 / 2 pts What is the most common cause of vitamin K deficiency? Administration of warfarin (Coumadin) Correct Answer Total parenteral nutrition (TPN) with antibiotic therapy You Answered Liver failure An IgG-mediated autoimmune disorder The most common cause of vitamin K deficiency is parenteral nutrition in combination with broad-spectrum antibiotics that destroy normal gut flora. Question 10 2 / 2 pts Which of the following is a description consistent with chronic lymphocytic leukemia (CLL)? The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL. The bone marrow and peripheral blood are characterized by leukocytosis and a predominance of blast cells. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. There are defects in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. Correct! There is failure of B cells to mature into plasma cells that synthesize immunoglobulins. Thus CLL is derived from transformation of a partially mature B cell that has not yet encountered antigen. Question 11 2 / 2 pts The sickle cell trait differs from sickle cell disease in that the child with sickle cell trait has a milder form of the disease that is characterized by vaso-occlusive crises and is believed to result from higher hemoglobin values and viscosity. has a mild form of sickle cell disease that causes sickling during fever and infection, but not during acidosis or hypoxia, whereas the child with sickle cells disease develops sickling during each of these conditions. has the mildest form of the disease with normal hemoglobin and hemoglobin F, which prevents sickling. Correct! inherited normal hemoglobin A from one parent and Hb S from the other parent, whereas the child with sickle cell disease has Hb S from both parents. Sickle cell–thalassemia disease and sickle cell–Hb C disease are heterozygous forms in which the child simultaneously inherits another type of abnormal hemoglobin from one parent. Sickle cell trait, in which the child inherits Hb S from one parent and normal Hb A from the other, is a heterozygous carrier state that rarely has clinical manifestations (Table 28-3). Question 12 2 / 2 pts What is the name of the disorder in which levels of bilirubin remain excessively high in the newborn and are deposited in the brain? Icterus neonatorum Jaundice Icterus gravis neonatorum Correct! Kernicterus Without replacement transfusions, in which the child receives Rh-negative erythrocytes, the bilirubin is deposited in the brain, which is a condition called kernicterus. Question 13 0 / 2 pts Polycythemia occurs in a fetus because You Answered the lungs of the fetus are undeveloped and unable to adequately diffuse oxygen to the pulmonary capillaries. Correct Answer there is increased erythropoiesis in response to the hypoxic intrauterine environment. fetal hemoglobin has a greater affinity for oxygen due to DPG. the fetus has a different hemoglobin structure of two α- and two γ-chains rather than two α-and two β-chains. The hypoxic intrauterine environment stimulates erythropoietin production in the fetus. Question 14 2 / 2 pts Idiopathic thrombocytopenic purpura (ITP) is an autoimmune process involving antibodies against Correct! platelets. eosinophils. basophils. neutrophils. ITP is a disorder of platelet consumption. Question 15 0 / 2 pts G6PD and sickle cell disease are diagnosed equally in men and women. Correct Answer disorders initiated by hypoxemia and acidosis. You Answered inherited X-linked recessive disorders. inherited autosomal recessive disorders. Sickling is an occasional, intermittent phenomenon that can be triggered or sustained by one or more of the following stressors: decreased oxygen tension (PO2) of the blood (i.e., hypoxemia), increased hydrogen ion concentration in the blood (decreased pH), increased plasma osmolality, decreased plasma volume, and low temperature (Figure 28-7). Question 16 2 / 2 pts Hemophilia B is caused by clotting factor _____ deficiency. Correct! IX V VIII X Hemophilia B (Christmas disease) is caused by factor IX deficiency. Question 17 2 / 2 pts Which of the following is manufactured by the liver and primarily contains cholesterol and protein? Triglycerides (TGs) High-density lipoproteins (HDLs) Correct! Low-density lipoproteins (LDLs) Very-low-density lipoproteins (VLDLs) A series of chemical reactions in the liver results in the production of several lipoproteins that vary in density and function. These include VLDLs, primarily TG and protein; LDLs, mostly cholesterol and protein; and HDLs, mainly phospholipids and protein. Question 18 0 / 2 pts What is the most common cardiac disorder associated with acquired immunodeficiency syndrome (AIDS) resulting from myocarditis and infective endocarditis? Hypertrophic cardiomyopathy Correct Answer Dilated cardiomyopathy Inflammatory cardiomyopathy You Answered Restrictive cardiomyopathy Individuals infected with HIV and resultant acquired immunodeficiency syndrome (AIDS) are at risk for numerous cardiac complications. Pericardial effusion and left heart failure are the most common complications of HIV infection. Other conditions include cardiomyopathy, myocarditis, tuberculous pericarditis, infective and nonbacterial endocarditis, heart block, pulmonary hypertension, and non-antiretroviral drug-related cardiotoxicity. Question 19 2 / 2 pts In systolic heart failure, what effect does angiotensin II have on stroke volume? Decreases preload and decreases afterload Increases preload and decreases afterload Decreases preload and increases afterload Correct! Increases preload and increases afterload Activation of the renin-angiotensin-aldosterone system (RAAS) causes not only increases in preload and afterload but also direct toxicity to the myocardium. Question 20 2 / 2 pts What changes in veins occur to create varicose veins? An increase in hydrostatic pressure Damage to the venous endothelium An increase in osmotic pressure Correct! Damage to the valves within veins If a valve is damaged, permitting backflow, a section of the vein is subjected to the pressure exerted by a larger volume of blood under the influence of gravity. The vein swells as it becomes engorged and surrounding tissue becomes edematous because increased hydrostatic pressure pushes plasma through the stretched vessel wall. Question 21 2 / 2 pts What is the most important clinical manifestation of aortic coarctation in the neonate? Cor pulmonale Cerebral hypertension Pulmonary hypertension Correct! Congestive heart failure (CHF) The newborn usually presents with CHF symptoms. Once the ductus closes, these infants deteriorate rapidly from the development of hypotension, acidosis, and shock. Question 22 2 / 2 pts The foramen ovale is covered by a flap that creates a check valve allowing blood to flow unidirectionally from the _____ to the _____. left atrium; left ventricle right atrium; right ventricle Correct! right atrium; left atrium right ventricle; left ventricle The nonfused septum secundum and ostium secundum result in the formation of a flapped orifice known as the foramen ovale, which allows the right (atrium)-to-left (atrium) shunting necessary for fetal circulation. Question 23 0 / 2 pts When does most cardiovascular development occur? You Answered By the 28th day of gestation Correct Answer Between the fourth and seventh weeks of gestation Between the eighth and 10th weeks of gestation Between the 12th and 14th weeks of gestation Cardiogenesis begins at approximately 3 weeks of gestation; however, most cardiovascular development occurs between the fourth and seventh weeks. Question 24 0 / 2 pts When does systemic vascular resistance in infants begin to rise? You Answered One hour after birth One month before birth Correct Answer Once the placenta is removed from circulation During the beginning stage of labor Removal of the low-resistance placenta from circulation causes an immediate increase in systemic vascular resistance to about twice that before birth. Question 25 2 / 2 pts An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect? Atrioventricular canal (AVC) defect Atrial septal defect (ASD) Correct! Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) On physical examination a loud, harsh, holosystolic murmur and systolic thrill can be detected at the left lower sternal border. The intensity of the murmur reflects the pressure gradient across the VSD. An apical diastolic rumble may be present with a moderate to large defect, reflecting increased flow across the mitral valve.