NSG5003 Final Exam Study Guidept2.
What is the primary function of amylase in the saliva? Which immunoglobin is
found in saliva? What is the primary function of pepsin in the stomach?
- salivary α-amylase (ptyalin), an enzyme that initiates carbohydrate digestion in the mouth and
stomach. Breaks down starch into maltose and dextrin which are processed in the small intestine.
-Immunoglobulin A is present
-Pepsin is a proteolytic enzyme that breaks down protein-forming polypeptides in the stomach. Once
chyme has entered the duodenum, the alkaline environment of the duodenum inactivates pepsin.
Which organ is primarily impacted by metastasis of malignant tumors in the
intestine?
- The liver is the most common site for metastases from tumors in the gastrointestinal tract that arose
from a colonic neoplasm. In the United States, the incidence of primary hepatocellular carcinoma is
increasing significantly as a result of chronic hepatitis C infection. Liver cancer is common in densely
populated parts of Southeast Asia and sub-Saharan Africa, where hepatitis B virus infection is
endemic. Primary liver cancer is rare before the age of 40 years and most common after 60 years.
Cancer in the liver is usually caused by metastatic spread from a primary site elsewhere in the body.
What roles do glucose transport play in cell and diffusion?
- The sugars are absorbed primarily in the duodenum and upper jejunum by facilitated diffusion
mediated by glucose transporter proteins. The monosaccharides pass through the unstirred layer by
diffusion. At the cell membrane, glucose and galactose are actively transported with a sodium carrier
(SGLT1) and fructose absorption is facilitated by glucose transporter 5 (GLUT5) and GLUT7. Transport
of all three monosaccharides from the cytosol to the bloodstream is facilitated by GLUT2. Insulin
facilitates glucose transport into fat and muscle cells via glucose transporter 4 (GLUT4). Insulin is not
required for the intestinal absorption of glucose. Cellulose is a glucose polysaccharide found in plants.
Humans lack enzymes to digest cellulose, and the undigested fiber contributes to stool volume and
stimulates large intestine motility.
What is the initial treatment for an infant with intussusception (telescoping of
the intestines)?
- Ultrasound of the abdomen and radiographic imaging studies are commonly completed for diagnosis.
For large bowel intussusception, an enema reduction is usually effective and avoids the progression to
ischemia and perforation. Surgical reduction is done on children who fail or, in rare cases, have
perforation. Untreated intussusception in infants is nearly always fatal. Most infants recover if the
intussusception is reduced within 24 hours. Spontaneous reduction of intussusception may occur in
symptomatic or asymptomatic children. replacement of fluid and electrolytes and decompression of
the lumen with gastric or intestinal suction are essential forms of therapy. Laparoscopic procedures can
release adhesions. Immediate surgical intervention is required for strangulation and complete
obstruction or perforation. Colonic stents may be placed for malignant obstruction. Neostigmine, a
parasympathomimetic, is used for colonic pseudo-obstruction, and colonoscopic decompression may
be required. Management of intestinal perforation requires intravenous antibiotics, fluid resuscitation,
and surgery related to the underlying cause of perforation
What are the causes of newborn jaundice? What is the treatment for newborn
,NSG5003 Final Exam Study Guidept2.
jaundice?
,NSG5003 Final Exam Study Guidept2.
Physiologic jaundice (hyperbilirubinemia) of the newborn is usually a transient, benign icterus that
occurs during the first week of life in otherwise healthy full-term infants. It is caused by mild
unconjugated (indirect-reacting) hyperbilirubinemia. Pathologic jaundice appears within 24 hours
after birth with total serum bilirubin level greater than 20 mg/dL or an indirect bilirubin level greater
than 15 mg/dL.
- Pathologic jaundice results from the complex interaction of factors that cause (1) increased bilirubin
production (e.g., hemolysis), (2) impaired hepatic uptake or excretion of unconjugated bilirubin, and (3)
delayed maturation of liver conjugating mechanisms. The most common cause is hemolytic disease of
the newborn, also known as erythroblastosis fetalis, and all pregnant women should be tested for ABO
and Rh incompatibility. Unconjugated bilirubin (indirect bilirubin) is lipid soluble and bound to albumin
in the blood, and in the free form readily crosses the blood-brain barrier in infants. Bilirubin
encephalopathy (kernicterus) is caused by the deposition of toxic, unconjugated bilirubin in brain cells
and usually does not occur in healthy full-term infants.
What can cause delays in puberty for boys?
Boys-Primary hypogonadism: This is when the testes do not respond to the hormones (FSH and LH)
made by the pituitary gland. Secondary hypogonadism: This is when the pituitary gland does not
produce the hormones FSH and LH. This type of delayed puberty might happen very late, but is
otherwise normal. It also tends to run in families.
Review the following conditions (causes, signs and symptoms) and be able to
identify the treatment for each – phimosis, balanitis, benign prostatic
hypertrophy (BPH), prostatitis, testicular cancer, cryptorchidism?
Phimosis- is a condition in which the foreskin cannot be retracted back over the glans. Although
most cases occur in uncircumcised males, stenosis and resultant phimosis can occur in males with
excessive skin remaining after circumcision. It can occur at any age and is caused most commonly by
poor hygiene and chronic infection. Chronic balanoposthitis (inflammation of the glans and prepuce)
predisposes older diabetic men to phimosis. It rarely occurs with normal foreskin. Edema, erythema,
and tenderness of the prepuce and purulent discharge are usually the reasons for seeking treatment;
inability to retract the foreskin is a less common complaint. Circumcision, if needed, is performed after
infection has been eradicated. Complications of phimosis include inflammation of the glans (balanitis) or
prepuce (posthitis) and paraphimosis. may require immediate release if there is urinary obstruction.
Balanitis- is an inflammation of the glans penis and usually occurs in conjunction with posthitis, an
inflammation of the prepuce. It is associated with poor hygiene and phimosis. The accumulation under
the foreskin of glandular secretions (smegma), sloughed epithelial cells, and Mycobacterium smegmatis
can irritate the glans directly or lead to infection. Skin disorders (e.g., psoriasis, lichen planus, eczema)
and candidiasis must be differentiated from inflammation resulting from poor hygienic practices.
Balanitis is seen most commonly in men with poorly controlled diabetes mellitus and candidiasis.
Antimicrobials are used to treat infection. Circumcision can prevent recurrences and can be considered
after the inflammation has subsided.
, NSG5003 Final Exam Study Guidept2.
Review the following conditions (causes, signs and symptoms) and be able to
identify the treatment for each pelvic inflammatory disease (PID), ovarian
cancer?
PID Once the infection is established within the uterus and fallopian/uterine tubes, the infection may
induce changes in the columnar epithelium lining the upper reproductive tract, causing permanent
damage. The resultant inflammatory response causes localized edema and, occasionally, obstruction or
necrosis of the area. PID infection results in permanent changes to the ciliated epithelium of the
fallopian or uterine tubes.
Ovarian cancer in women older than 40 years is associated with conditions associated with increased
ovulation over the lifetime, such as early menarche, late menopause, and nulliparity. A history of
endometriosis also increases risk. Factors that suppress ovulation decrease the risk of ovarian cancer and
include pregnancies, prolonged lactation, and the use of hormonal contraceptives that limit ovulation,
including the birth control pill.
Sexual Transmitted Infections Questions from Week 8 (8 Questions)
Review the following STIs (causes, transmission, signs and symptoms) and be
able to identify the treatment for each –
secondary syphilis is systemic. Cutaneous rashes are generally papulosquamous, but any
variation or combination of macular (flat), papular (raised), and pustular lesions may be seen. Lesions
are often widespread and bilateral, appearing on the palms and soles. Some lesions become
hypertrophied, flat, moist, and wartlike or vegetative. These lesions, called condylomata lata, are highly
contagious and develop on the perineum, vulva, and groin of women, and around the inner thigh and
anal area in men and women. Besides skin sores, oral mucous membrane lesions (known as mucous
patches), lymphadenopathy, pruritus, and alopecia are common. Some individuals develop anemia,
leukocytosis, increased sedimentation rate, hepatitis, transitory proteinuria, arthritis,
electrocardiographic abnormalities, and central nervous system (CNS) symptoms. Regardless of
treatment, cutaneous lesions generally heal in 2 to 10 weeks. Within the CNS, the presence of T.
pallidum in cerebrospinal fluid may cause the manifestations of neurosyphilis, including altered mental
status and meningitis, which can occur within any stage of syphilis infection but are more common in
early stages of infection.
Preferred treatment for all stages of syphilis is parenteral injection of benzathine penicillin G, because
other types of penicillin are not as effective. If the individual has manifested signs of the disease for less
than 1 year, a single intramuscular dose is appropriate. Repeated assessment of VDRL or RPR titers is
used to determine effectiveness of treatment. Titers should decrease fourfold if treatment was
successful. Sexual partners also are tested and treated, and the use of condoms is recommended until
effective treatment is verified.
herpes simplex (HSV-1 & HSV-2) virus Genital herpes can be caused by either of the
two serotypes of HSV: HSV-1 or HSV-2. Historically, HSV-1 lesions were more common around the
mouth while HSV-2 lesions were more frequently found in the genital area. However, HSV-1 is
increasingly found in the anogenital area. HSV-2 outbreaks are more frequent and more severe, so
serologic testing to determine the HSV subtype is warranted at diagnosis to guide suppression efforts.
HSV infection is transmitted through contact with HSV-infected fluids or skin as occurs with genital skin
What is the primary function of amylase in the saliva? Which immunoglobin is
found in saliva? What is the primary function of pepsin in the stomach?
- salivary α-amylase (ptyalin), an enzyme that initiates carbohydrate digestion in the mouth and
stomach. Breaks down starch into maltose and dextrin which are processed in the small intestine.
-Immunoglobulin A is present
-Pepsin is a proteolytic enzyme that breaks down protein-forming polypeptides in the stomach. Once
chyme has entered the duodenum, the alkaline environment of the duodenum inactivates pepsin.
Which organ is primarily impacted by metastasis of malignant tumors in the
intestine?
- The liver is the most common site for metastases from tumors in the gastrointestinal tract that arose
from a colonic neoplasm. In the United States, the incidence of primary hepatocellular carcinoma is
increasing significantly as a result of chronic hepatitis C infection. Liver cancer is common in densely
populated parts of Southeast Asia and sub-Saharan Africa, where hepatitis B virus infection is
endemic. Primary liver cancer is rare before the age of 40 years and most common after 60 years.
Cancer in the liver is usually caused by metastatic spread from a primary site elsewhere in the body.
What roles do glucose transport play in cell and diffusion?
- The sugars are absorbed primarily in the duodenum and upper jejunum by facilitated diffusion
mediated by glucose transporter proteins. The monosaccharides pass through the unstirred layer by
diffusion. At the cell membrane, glucose and galactose are actively transported with a sodium carrier
(SGLT1) and fructose absorption is facilitated by glucose transporter 5 (GLUT5) and GLUT7. Transport
of all three monosaccharides from the cytosol to the bloodstream is facilitated by GLUT2. Insulin
facilitates glucose transport into fat and muscle cells via glucose transporter 4 (GLUT4). Insulin is not
required for the intestinal absorption of glucose. Cellulose is a glucose polysaccharide found in plants.
Humans lack enzymes to digest cellulose, and the undigested fiber contributes to stool volume and
stimulates large intestine motility.
What is the initial treatment for an infant with intussusception (telescoping of
the intestines)?
- Ultrasound of the abdomen and radiographic imaging studies are commonly completed for diagnosis.
For large bowel intussusception, an enema reduction is usually effective and avoids the progression to
ischemia and perforation. Surgical reduction is done on children who fail or, in rare cases, have
perforation. Untreated intussusception in infants is nearly always fatal. Most infants recover if the
intussusception is reduced within 24 hours. Spontaneous reduction of intussusception may occur in
symptomatic or asymptomatic children. replacement of fluid and electrolytes and decompression of
the lumen with gastric or intestinal suction are essential forms of therapy. Laparoscopic procedures can
release adhesions. Immediate surgical intervention is required for strangulation and complete
obstruction or perforation. Colonic stents may be placed for malignant obstruction. Neostigmine, a
parasympathomimetic, is used for colonic pseudo-obstruction, and colonoscopic decompression may
be required. Management of intestinal perforation requires intravenous antibiotics, fluid resuscitation,
and surgery related to the underlying cause of perforation
What are the causes of newborn jaundice? What is the treatment for newborn
,NSG5003 Final Exam Study Guidept2.
jaundice?
,NSG5003 Final Exam Study Guidept2.
Physiologic jaundice (hyperbilirubinemia) of the newborn is usually a transient, benign icterus that
occurs during the first week of life in otherwise healthy full-term infants. It is caused by mild
unconjugated (indirect-reacting) hyperbilirubinemia. Pathologic jaundice appears within 24 hours
after birth with total serum bilirubin level greater than 20 mg/dL or an indirect bilirubin level greater
than 15 mg/dL.
- Pathologic jaundice results from the complex interaction of factors that cause (1) increased bilirubin
production (e.g., hemolysis), (2) impaired hepatic uptake or excretion of unconjugated bilirubin, and (3)
delayed maturation of liver conjugating mechanisms. The most common cause is hemolytic disease of
the newborn, also known as erythroblastosis fetalis, and all pregnant women should be tested for ABO
and Rh incompatibility. Unconjugated bilirubin (indirect bilirubin) is lipid soluble and bound to albumin
in the blood, and in the free form readily crosses the blood-brain barrier in infants. Bilirubin
encephalopathy (kernicterus) is caused by the deposition of toxic, unconjugated bilirubin in brain cells
and usually does not occur in healthy full-term infants.
What can cause delays in puberty for boys?
Boys-Primary hypogonadism: This is when the testes do not respond to the hormones (FSH and LH)
made by the pituitary gland. Secondary hypogonadism: This is when the pituitary gland does not
produce the hormones FSH and LH. This type of delayed puberty might happen very late, but is
otherwise normal. It also tends to run in families.
Review the following conditions (causes, signs and symptoms) and be able to
identify the treatment for each – phimosis, balanitis, benign prostatic
hypertrophy (BPH), prostatitis, testicular cancer, cryptorchidism?
Phimosis- is a condition in which the foreskin cannot be retracted back over the glans. Although
most cases occur in uncircumcised males, stenosis and resultant phimosis can occur in males with
excessive skin remaining after circumcision. It can occur at any age and is caused most commonly by
poor hygiene and chronic infection. Chronic balanoposthitis (inflammation of the glans and prepuce)
predisposes older diabetic men to phimosis. It rarely occurs with normal foreskin. Edema, erythema,
and tenderness of the prepuce and purulent discharge are usually the reasons for seeking treatment;
inability to retract the foreskin is a less common complaint. Circumcision, if needed, is performed after
infection has been eradicated. Complications of phimosis include inflammation of the glans (balanitis) or
prepuce (posthitis) and paraphimosis. may require immediate release if there is urinary obstruction.
Balanitis- is an inflammation of the glans penis and usually occurs in conjunction with posthitis, an
inflammation of the prepuce. It is associated with poor hygiene and phimosis. The accumulation under
the foreskin of glandular secretions (smegma), sloughed epithelial cells, and Mycobacterium smegmatis
can irritate the glans directly or lead to infection. Skin disorders (e.g., psoriasis, lichen planus, eczema)
and candidiasis must be differentiated from inflammation resulting from poor hygienic practices.
Balanitis is seen most commonly in men with poorly controlled diabetes mellitus and candidiasis.
Antimicrobials are used to treat infection. Circumcision can prevent recurrences and can be considered
after the inflammation has subsided.
, NSG5003 Final Exam Study Guidept2.
Review the following conditions (causes, signs and symptoms) and be able to
identify the treatment for each pelvic inflammatory disease (PID), ovarian
cancer?
PID Once the infection is established within the uterus and fallopian/uterine tubes, the infection may
induce changes in the columnar epithelium lining the upper reproductive tract, causing permanent
damage. The resultant inflammatory response causes localized edema and, occasionally, obstruction or
necrosis of the area. PID infection results in permanent changes to the ciliated epithelium of the
fallopian or uterine tubes.
Ovarian cancer in women older than 40 years is associated with conditions associated with increased
ovulation over the lifetime, such as early menarche, late menopause, and nulliparity. A history of
endometriosis also increases risk. Factors that suppress ovulation decrease the risk of ovarian cancer and
include pregnancies, prolonged lactation, and the use of hormonal contraceptives that limit ovulation,
including the birth control pill.
Sexual Transmitted Infections Questions from Week 8 (8 Questions)
Review the following STIs (causes, transmission, signs and symptoms) and be
able to identify the treatment for each –
secondary syphilis is systemic. Cutaneous rashes are generally papulosquamous, but any
variation or combination of macular (flat), papular (raised), and pustular lesions may be seen. Lesions
are often widespread and bilateral, appearing on the palms and soles. Some lesions become
hypertrophied, flat, moist, and wartlike or vegetative. These lesions, called condylomata lata, are highly
contagious and develop on the perineum, vulva, and groin of women, and around the inner thigh and
anal area in men and women. Besides skin sores, oral mucous membrane lesions (known as mucous
patches), lymphadenopathy, pruritus, and alopecia are common. Some individuals develop anemia,
leukocytosis, increased sedimentation rate, hepatitis, transitory proteinuria, arthritis,
electrocardiographic abnormalities, and central nervous system (CNS) symptoms. Regardless of
treatment, cutaneous lesions generally heal in 2 to 10 weeks. Within the CNS, the presence of T.
pallidum in cerebrospinal fluid may cause the manifestations of neurosyphilis, including altered mental
status and meningitis, which can occur within any stage of syphilis infection but are more common in
early stages of infection.
Preferred treatment for all stages of syphilis is parenteral injection of benzathine penicillin G, because
other types of penicillin are not as effective. If the individual has manifested signs of the disease for less
than 1 year, a single intramuscular dose is appropriate. Repeated assessment of VDRL or RPR titers is
used to determine effectiveness of treatment. Titers should decrease fourfold if treatment was
successful. Sexual partners also are tested and treated, and the use of condoms is recommended until
effective treatment is verified.
herpes simplex (HSV-1 & HSV-2) virus Genital herpes can be caused by either of the
two serotypes of HSV: HSV-1 or HSV-2. Historically, HSV-1 lesions were more common around the
mouth while HSV-2 lesions were more frequently found in the genital area. However, HSV-1 is
increasingly found in the anogenital area. HSV-2 outbreaks are more frequent and more severe, so
serologic testing to determine the HSV subtype is warranted at diagnosis to guide suppression efforts.
HSV infection is transmitted through contact with HSV-infected fluids or skin as occurs with genital skin
