NURS 611-PATHO EXAM 2 INTENSE. 100% CORRECT Question & Answers (GRADED A+)

611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 1 1. Review: the parasympathetic system is all about what? Conserving energy / rest and digest The sympathetic nervous system primarily serves to protect an individual by doing which of the following? (select all that apply) A. Decreasing mucous production B. Increasing blood sugar levels C. Increasing body temperature D. Decreasing sweat excretion E. Increasing blood pressure 2. Review: the sympathetic system is all about what? Mobilizing energy stores / fight or flight a. Name three examples of this: i. Increase BG levels ii. Decrease insulin stores iii. Redirect blood to major organs 3. Which characteristic is the most critical index of nervous system dysfunction? LOC a. Why? Indicates improvement or deterioration 4. Thought and goal-oriented behaviors are functions of which area of the brain? Pre-frontal lobe a. What four things is it responsible for? i. concentration ii. Short term memory iii. Thought iv. Limbic areas/emotional areas 5. Where is the region responsible for the motor aspects? Brco area i. Why is it special? Only region that affects speech 6. Parkinson's and Huntington's diseases are associated with defects in which area of the brain? Basal ganglia 7. Maintenance of a constant internal environment and the implementation of behavioral patterns are the main functions of which area of the brain? Hypothalamus611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 2 8. What two parts of the brain mediate the expression of affect, both emotional and behavioral states? a. Limbic system b. Prefrontal cortex 9. Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain? Medulla oblongata a. What does it make up and where is it located? Myelencephalon / brain stem 10. Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture? Cerebellum 11. The brain receives approximately what percentage of the cardiac output? 20% a. How many mL per minute is that? 800-1000 mL 12. What evidence does the nurse expect to see when a patient experiences trauma to the hypothalamus? (select all that apply) A. Uneven expression of mood B. Unstable blood glucose levels C. Poor regulation of body temperature D. Visual disturbances such as blurred vision E. N/V and symptoms of gastroesophageal reflux disease a. Where does the hypothalamus form? Base of diencephalon b. What four things does it control? i. ANS ii. Temperature iii. Endocrine/glucose iv. Emotional expression 13. What is the first defense of our bodies? a. Skin b. Mucous membranes 14. Which action is the purpose of the inflammatory process? Prevent infection of injured tissue 15. What happens if the epithelial barrier is damaged? Local and systemic inflammatory response mobilized a. What does this do? i. Limit extent of damage ii. Protect against infection611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 3 iii. Initiate repair of damaged tissue 16. What are the 4 major cardinal signs of infection? a. Warmth b. Edema c. Redness d. Pain e. What is the fifth sign known as? Loss of function 17. Which type of white blood cell is first to arrive at the site of infection? Leukocytes 18. What causes the edema that occurs during the inflammatory process? Increased capillary permeability a. What does edema cause? i. Swelling in surrounding tissue ii. Leakage of plasma b. What is this solely responsible for? i. Inflammation-induced edema 19. What process causes heat and redness to occur during the inflammatory process? Vasodilation of blood vessels a. What does this cause, resulting in warmth and redness? i. Increased blood flow ii. Increased concentration of RBCs at inflammation site 20. The chemotactic factor affects the inflammatory process by? Directing leukocytes to the inflamed area 21. Which 2 chemotactic factors are released during mast cell degranulation? What do they do? a. Neutrophil chemotactic factor (NCF) - attracts neutrophils b. Eosinophil chemotactic factor (ECF-A) - attracts eosinophils 22. What four things is pain mediated by? a. Histamines b. Bradykinins c. Leukotrienes d. Prostaglandins 23. The function of opsonization related to the complement cascade is to ___ ___ ___ for destruction by ___ and ___. Tag pathogenic microorganisms / neutrophils and macrophages 24. Give an example of an efficient opsonin and what is does. a. C3B b. Adheres to the surface of pathogenic microorganism611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 4 25. Define opsonins. Molecules that tag microorganisms for destruction by cells i. What are they primarily? 1. Neutrophils 2. Macrophages 26. During phagocytosis what is occurring during the step referred to as opsonization? a. Recognition/adherence to bacteria a. During phagocytosis, opsonization involves only what 2 things? i. Recognition ii. Adherence 27. What is the correct sequence of phagocytosis? a. Opsonization (recognition) b. Adherence c. Engulfment d. Fusion (with lysosomal granules) e. Destruction 28. Which manifestations of inflammation is systemic? a. Fever b. Leukocytosis c. What do you see increased levels of? Circulating plasma proteins 29. The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by? a. Endogenous pyrogens i. What are they also known as? 1. Fever-causing cytokines 30. When considering white blood cell differentials, acute inflammatory reactions are related to elevations of which leukocyte? A. Monocytes B. Eosinophils C. Neutrophils D. Basophils a. What are they known for being? Predominant phagocytes in early inflammation b. How quickly do they arrive after initial injury? Within 6-12 hrs after initial injury c. What three things do they ingest? 1. Bacteria 2. Dead Cells 3. Cellular Debris611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 5 31. What occurs during the process of repair after tissue damage? a. Nonfunctioning scar tissue replaces destroyed tissue b. What is repair defined as? Replacement of destroyed tissue with scar tissue c. What is scar tissue primarily made of? i. Collagen 1. Name 2 ways it helps. a. Fills in lesion b. Restores tensile strength 2. Name the one thing it cannot do? a. Restore function 32. When cellular damage occurs and regeneration is minor with no significant complications, the process of returning the cells to pre-injury function is referred to as: a. Resolution b. What does this mean? i. Tissues return to pre-injury state ii. Physiologic function is possible 33. The role of fibroblasts during the reconstructive phase of wound healing is to? a. Synthesize/secrete collagen b. Secrete connective tissue proteins c. Why are they most important cells during this phase? i. Provide connectivity d. What stimulates fibroblasts? i. TGF-Beta (growth factor from macrophage) 34. Some older adults have impaired inflammation and wound healing because of which problems? a. Chronic illnesses b. Name two examples i. Diabetes ii. CVD 35. Which cell is the body’s primary defense against parasite invasion? a. Eosinophils 36. Normal bacterial flora found in the intestines produce vitamin K to assist in the absorption of which of the following? (select all that apply) ● Calcium ● Fatty acids ● Large polysaccharides ● Iron ● Magnesium611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 6 37. The flora’s production of vitamin K is needed to absorb various ions such as these 3 things: a. Calcium b. Iron c. Mag 38. An individual’s acquired-immunity is dependent on the function of which cells? (select all that apply) ● T lymphocytes ● B lymphocytes ● Macrophages ● Opsonins ● Neutrophils a. These cells are involved in what process? What other cells do they work along with? i. Acquired-immunity ii. Dendritic cells 39. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? a. Active-acquired immunity 40. Which kind of immunity does not involve the host’s immune response at all? What is it also known as? a. Passive-acquired immunity b. Passive immunity 41. What is the innate immune system also known as? What is it? what is it composed of? a. Nonspecific immune system b. First line of defense c. cells/mechanisms that defend the host from infection in nonspecific manner i. What does that mean? 1. Cells of the innate system recognize and respond in generic way 42. What is the role of a natural killer (NK) cells? a. Eliminate malignant cells i. What do they target? 1. Cells with viruses/infection ii. What else are the good at eliminating? 1. Abnormal host cells 2. Cancer cells 43. What type of immunity is produced when an immunoglobulin crosses the placenta? a. Passive-acquired immunity 44. How does passive immunity occur?611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 7 a. Preformed antibodies/T-lymphocytes transferred from donor i. Give 2 examples. 1. From mom via placenta 2. In the Clinic/immunotherapy 45. When antigens are administered to produce immunity, why are different routes of administration considered? a. Each route stimulates a different lymphocyte-containing tissue i. What does this result in? 1. Different types of cellular/humoral immunity 46. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? a. IgA i. Name its 2 subclasses and differences. 1. IgA1 (blood) 2. IgA2 (Secretions) 47. Which antibody initially indicates a typical primary immune response? a. IgM i. Which is it follow by? Against what? 1. IgG 2. Same antigen 48. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? a. IgA i. Where and how is this molecule normally found? 1. Bodily sections 2. Dimers anchored together through j-chain and secretory piece ii. How does this decrease the risk of infections in the mucous membrane? 1. Attaches inside mucosal epithelial cells and protects against degradation of enzymes found in secretions 49. Which is an example of an endogenous antigen? a. Cancer cells 50. When a person is exposed to most antigens, antibodies can usually be detected in his or her circulation within how many days? a. 6 days 51. Vaccinations are able to provide protection against certain microorganisms because of the? a. Level of protection by IgG i. What is it the predominant antibody class of? 1. Secondary response ii. How does it present? 1. Concentrations several times larger than IgM 2. Levels remain elevated for a long time 52. How does the aging process of the T-cell activity affect older adults? a. Tendy to develop various infections611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 8 i. Why does this occur? 1. T-cell activity is deficient 2. Shift in balance of T-cells 53. A hypersensitivity reaction that produces an allergic response is called? a. Anaphylaxis 54. The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins? a. IgE 55. Type I reactions are mediated by _______ ____ and the products of ___ ____ ___ a. Antigen-specific IgE b. Tissue mast cells i. What are the most type 1 reactions? Against what? 1. Common allergies 2. Environmental antigens 56. Which type of antibody is involved in type I hypersensitivity reaction? a. IgE 57. Blood transfusion reactions are an example of? a. Alloimmunity i. What is it also known as? When does it occur? 1. Isoimmunity 2. Immune system of one person produces an immune reaction in another 58. What is the mechanism that results in type II hypersensitivity reactions? a. Antibodies bind to antigens on the cell surface i. What does this reaction begin with? 1. Antibody binding to tissue-specific antigens a. What happens to the cell? i. Destroyed 59. When mismatched blood is administered causing an ABO incompatibility the erythrocytes are destroyed by? a. Complement-mediated cell lysis i. What happens? 1. Erythrocytes are destroyed 60. When antibodies are formed against red blood cell antigens of the Rh system, the blood cells are destroyed by? Where? a. Phagocytosis b. Spleen 61. What are target cells destroyed by in a type II hypersensitivity reaction? a. Natural Killer Cells (NKCs) i. What AREN’T they? 1. Not antigen specific ii. How are target cells recognized? Then what happens? 1. Using FC receptors on NK cells611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 9 2. Toxic substances released 62. Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction? a. Modulation 63. Graves disease is a result of? a. Autoantibodies binding to TSH receptor sites 64. Type III hypersensitivity reactions are a result of which action? a. Antibodies binding to soluble antigens released into body fluids b. Immune complexes deposited in tissues 65. Raynaud phenomenon is an example of which type of hypersensitivity? a. Type III i. What is this condition caused by? 1. Temperature-dependent disposition of immune complexes in the capillary beds of the peripheral circulation 66. A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? ● No antigens ● Both A and B antigens ● No antibodies ● Both A and B antibodies a. What do type O patient lack? i. Both types of antigens 1. What are they considered? a. Universal donors 67. Immunoglobulin E (IgE) is associated with which type of hypersensitivity? a. Type I 68. Hypersensitivity reactions have been divided into four distinct types: a. Type I - (IgE Mediated; environmental) b. Type II - (Tissue-specific; blood transfusions and Graves) c. Type III - (immune complex-mediated and Raynauld) d. Type IV - (cell-mediated, graft rejection; TB test) 69. Some clinical examples of type IV hypersensitivity reactions include (select all that apply): ● Graft rejection ● Allergic reactions ● Autoimmune reactions ● Delayed 70. Which disorders are considered autoimmune? (select all that apply): ● Crohn disease ● Addison disease611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 10 ● Systemic lupus erythematosus ● Non-insulin dependent diabetes ● Rheumatoid arthritis 71. Patients with Lupus can suffer from? a. Butterfly facial rash b. Photosensitivity c. Neuro disorder d. Renal disorder e. Hematological disorder 72. Immunodeficiency disorders are differentiated into ____ vs ______. a. Primary b. Secondary c. What is the difference? i. Primary is rare 73. What factors can contribute to immunodeficiency disorders? a. Aging b. Psych issues c. Poor diet d. Metabolic problems/diseases e. Genetic syndromes f. Radiation g. Medical treatments (anesthesia;splenectomy) h. Chemo 74. What is the first stage in the infectious process? a. Colonization 75. What are the four stages of infectious process/progression? a. Colonization b. Invasion c. Multiplication d. Spread 76. Which two types of microorganisms reproduces on the skin? a. Fungi b. Bacteria 77. Which statement is true concerning exotoxins? ● Exotoxins are contained in cell walls of gram-negative bacteria ● Exotoxins are released during the lysis of bacteria ● Exotoxins are released during bacterial growth ● Exotoxins are able to initiate the complement and coagulation cascades 78. Which statement is true about vaccines? ● Most bacterial vaccines contain attenuated organisms611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 11 ● Vaccines require booster injections to maintain life-long protection ● Most viral vaccines are made by using dead organisms ● Vaccines provide effective protection against most infections 79. In general,_____ ____ ____ not persist as long as ______ _____ _____. Thus what may be necessary to maintain protection throughout life? a. Vaccine-induced protection b. Infection-induced immunity c. boosters 80. Define toxigenicity. a. The ability of a pathogen to produce soluble toxins/endotoxins/disease i. What does this affect? 1. Degree of virulence 81. The infectious process is made up of invasion versus evasion. Define evasion. When does this happen. Give an example. a. Evasion - when body defenses result in microorganisms being transported through the blood b. When the body’s defenses are exhausted c. Septicemia 82. Cytokines are thought to cause fevers by stimulating the synthesis of which chemical mediator? a. Prostaglandins i. What do cytokines do? How? Where do they turnover? 1. Raise thermoregulatory set 2. Stimulation of prostaglandin synthesis 3. a. Brain tissues b. Peripheral tissues 83. When exotoxins are released during bacterial growth, they are _______. What will this do? a. Immunogenic b. Illicit a response 84. Which statements are true regarding endotoxins? (select all that apply): ● Endotoxins are lipopolysaccharides ● Endotoxins are located in the walls of bacteria ● Endotoxins are created during the process of lysis ● Endotoxins are found in gram-negative microorganisms ● Endotoxins are released during the destruction of its host 85. If endotoxins are left unchecked, what can occur? a. Disseminated intravascular coagulation (DIC) 86. Endotoxins work by? a. Causing incredible vasodilation 87. How does the CDC define AIDS? a. Less than 200 CD4 count 88. Which secretion transmits HIV? (select all that apply): ● Semen ● Urine ● Saliva ● Breast milk611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 12 ● Sweat 89. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? a. Adaption i. What is this a lack of? What does this cause? 1. Adaption 2. a. Impaired immune response b. HF/KF c. Death 90. What three things does norepinephrine promote during a stress response? a. Anxiety b. Arousal c. Vigilance 91. What is the effect that low-serum albumin has on the central stress response? a. Impaired circulation of _epinephrine_ and __norepinephrine___. i. Why? 1. Both bind to plasma protein albumin 92. Stress-age syndrome directly results in depressed function of which system? a. Immune 93. Stress-induced norepinephrine results in? a. Peripheral vasoconstriction i. What does this cause? 1. Increase BP a. How does this happen? i. Constricting peripheral vessels 1. Physical manifestations of this: a. Dilated pupils b. Piloerection c. Increased sweat 94. The most influential factor in whether a person will experience a stress reaction is his or her? a. Ability to cope 95. What causes constriction of peripheral vessels in order to increase blood pressure? a. Norepinephrine 96. What increases gastric secretions? a. Cortisol i. What might this cause? 1. Ulcers 97. What increases cardiac output by increasing heart rate and myocardial contractility? a. Epinephrine 98. Cortisol is an important player in the stress response. Cortisol______that initial inflammatory effect and it acts to_____the activity of those helper T cells. a. Inhibits b. Suppress 99. What does Cortisol promote?611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 13 a. Resolution of healing 100. What does Corisol suppress? a. Cytotoxic T-Cells 101. A reduction is an individual’s number of natural killer (NK) cells appears to correlate with an increased risk for the development of? a. Depression 102. The increased production of proinflammatory cytokines is associated with which considerations? a. High anxiety b. Age/gender c. Stress d. Immune Function 103. Which part of the brain and what system is activated during the alarm phase of the general adaptation syndrome (GAS)? a. Hypothalamus b. SNS 104. What is the difference between benign and malignant? a. Benign: cell appears well differentiated and slow growing; avascular; expansive b. Malignant: messy; rapid spread; vascular, and metastasizing 105. High levels of which cytokines initiate the production of corticotropin-releasing hormone (CRH)? a. IL-1 b. IL-6 106. Which are the most common routes for distant metastasis? a. Blood vessels b. Lymph vessels 107. Staging of cancer provides a_______to determine treatment. a. Framework 108. Staging system of cancer is as follows (use breast cancer as an example): a. T1 → within breast tissue b. T2 → within breast tissue but getting larger c. T3 → invasion of skin/breast wall d. T4 → metastasis to other organs 109. Node involvement means: a. N2 fixed nodes involved 110. Define tumor (biologic) markers? a. Substances produced by benign/malignant cells i. Name four examples produced by either benign or malignant cancer cells. 1. Hormones611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 14 2. Enzymes 3. Genes 4. antigens/antibodies ii. Where can they be found? 1. On tumor cell 2. blood 3. Spinal fluid 4. Urine 111. The function of the tumor cell marker is to? a. Screen people with high risk of cancer 112. What are tumor markers NOT useful for? a. Predicting sites of cancer development 113. Autocrine stimulation is the ability of cancer cells to? What is this an example of? a. Secrete growth factors that stimulate own grown b. Mutation 114. What 3 cancers associated with chronic inflammation? a. Colon b. Thyroid c. Urinary bladder i. Name five others associated with inflammation: 1. GI tract 2. prostate 3. Pancreas 4. pleura 5. Skin 115. Chronic inflammation causes cancer by? a. Releasing compounds such as reactive oxygen species that promote mutation i. What do they block? 1. Cellular response to DNA damage 116. Review your Workbook pg. 55. I need you to determine the extent of this cancer. It has been determined that a tumor is in stage 2. a. What is the meaning of this finding? i. Cancer is locally invasive b. Explain the different kind of cancer staging? i. Stage 1 → confined to organ of origin ii. Stage 2 → locally invasive iii. Stage 3 → spread to regional structures/lymph nodes iv. Stage 4 → spread to distant sites 117. Many cancers create a mutation of Ras. What is Ras? a. Intracellular-signaling protein that regulates cell growth 118. The ras gene converts from a proto-oncogene to an oncogene by? a. Via point mutation611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 15 119. What is point mutation? a. Altering one or more nucleotide base pairs i. What does it affect? 1. Mutation can affect the activity of proteins ii. Use Ras as an example. 1. Makes regulated proto-oncogene into unregulated oncogene 120. How do cancer cells use the enzyme telomerase? What does this make possible? a. To enable cells to divide indefinitely b. Reach critical age and activates it 121. What two growth factors work together to develop new blood vessels to feed cancer cells? a. VEGF b. bFGF i. How do they do this? What does this cause? 1. Recruiting new vascular endothelial cells 2. Initiating proliferation of existing blood vessel cells a. Small cancers to become large cancers 122. What is a true statement regarding pain and cancer? a. Pain is generally associated with late-stage cancer i. What six things contribute to this pain? 1. Pressure 2. Obstruction 3. Invaded structure 4. Stretching 5. Tissue dest. 6. Inflamm. ii. Cancer pain does NOT indicate: 1. Metastasis 123. Name three true statements concerning aging and the occurrence of cancer. a. Decline in immunologic functions b. Predisposition to nutritional inadequacies c. Effects of immobility on immune system 124. Paraneoplastic syndromes may be the first or most prominent manifestation of ______. a. Cancer i. How can Cushing Syndrome be used as an example? 1. It’s mediated by humoral factors such as hormones/cytokines secreted by tumor cells/immune response 125. What is the most commonly reported symptom of cancer treatment? a. Fatigue 126. The difference between focal and diffuse brain injury. Give an example. a. Focal → one area i. Name two examples: 1. Epidural hemorrhage 2. Subdural hemorrhage b. Diffuse → entire brain What does it damage? Blood vessels i. Name three examples:611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 16 1. Hypoxia 2. Meningitis 3. Encephalitis 127. In diabetes insipidus we watch for _____ ICP? a. Increased 128. Pressure on the pituitary gland from ICP prevents what from being excreted? What does this lead to? a. ADH b. high urine output 129. What causes autonomic hyperreflexia? a. Complication from injury to T6 and above i. What eight symptoms does this produce? 1. Parox. HTN 2. Headache 3. Blurred 4. Sweating 5. congestion 6. nausea 7. piloerection 8. bradycardia 130. Autonomic hyperreflexia can be triggered by? a. Full bladder b. Fecal impaction c. Restrictive clothing 131. Autonomic hyperreflexia-induced bradycardia is a result of stimulation of the what? a. Carotid sinus to the vagus nerve to the sinoatrial node i. How does the intact ANS respond? 1. Arteriolar spasms to increase BP ii. Then what is stimulated? Why? 1. PNS - baroreceptors sense HTN iii. What is suppressed? Why? 1. Efferent impulses 2. visceral/peripheral vessels don’t dilate 132. Bradycardia in autonomic hyperreflexia is due to? a. Reflexive mechanism i. What does this cause? 1. Stimulation of carotid sinus → Vagus Nerve → SA Node to slow HR down 133. Which person is at the greatest risk for developing delirium? ● An individual with diabetes celebrating his 70th birthday ● A man diagnosed with schizophrenia ● An individual on the second day after hip replacement ● A depressed Hispanic woman 134. What is Delirium is associated with?611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 17 a. ANS over activity i. How long does it take to typically develop? 1. 2-3 days ii. When is it most commonly seen? 1. ICU 2. Post surgery 3. Withdrawal from CNS depressants 135. What is the normal range intracranial pressure (in mmg)? a. 5-15 136. Dementia is commonly characterized by the deterioration in which abilities? ● Decision making ● Memory ● Balance ● Speech ● Sociability 137. Define dementia. a. Progressive failure of many cerebral functions i. What impairments of intellectual function does it include? (decrease in:) 1. Orienting 2. Memory 3. Language 4. Executive attentional functions 5. Behavior 138. Delirium is _____. a. Acute i. It comes on_____ with the onset of: 1. Suddenly a. Disorientation b. incoherence c. Delusions ii. What is it usually caused by? 1. UTI 139. Dementia is ______. a. Insidious i. It usually affects ______ populations. 1. Older 140. What is the only way Alzheimer’s Disease can definitively be diagnosed? It is the leading cause of? What are the two greatest risk factors? Do we know the cause a. Post mortem b. dementia c. Age and family hx d. No 141. Neurofibrillary tangles characterize which neurologic disorder? a. Alzheimer’s Disease i. What 3 things are seen on physical examination of the brain?611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 18 1. Amyloid plaques 2. Neurofibrillary tangles 3. Synaptic losses 142. What is the most common kind of stroke? a. Ischemic 143. What are 5 contributing factors to a stroke? a. DM b. HTN c. Ethnicity d. HL e. AFIB 144. Where is the most common location of a stroke? a. Middle cerebral 145. Which artery is involved with most dysphasias? a. Middle cerebral 146. What symptoms will you see if the MCA is affected by a stroke? a. Contralateral Homonymous agnosia b. Hemi-agnosia i. Give an example of a right-sided stroke. 1. Left sided weakness 147. Contralateral hemiparesis or hemiplegia is on the _______ side of the brain that is going to be affected. a. Opposite 148. A right embolic CVA has resulted in left-sided paralysis and reduced sensation of the left foot and leg. Which cerebral artery is most likely affected by the emboli? a. Anterior cerebral 149. Name the symptoms of an embolic stroke in only the right anterior cerebral artery. a. Left-sided contralateral paralysis/paresis b. Mild upper extremity sensory deficiency i. What may be lost? 1. two-point descrimination 2. vibrarotry/position sense 150. What 3 major diagnoses put a patient at risk for embolic stroke? a. AFIB b. Rheumatic heart disease c. Valvular prosthesis i. Name 7 more: 1. LVA/thromb 2. LAT 3. MI 4. Valve 5. endocard 6. Patent foramen ov. 7. Intracard tu.611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 19 151. Since his cerebrovascular accident, a man has been denying his left hemiplegia. What term is used to describe this finding? Define it. a. Anosognosia - ignorance/denial of existence of disease 152. What term describes the loss of the comprehension or production of language? a. Aphasia 153. With receptive dysphasia (fluent), the individual is able to? What can’t they do? a. Comprehend speech b. Verbally respond 154. After a cerebrovascular accident, a man is unable to either feel or identify a comb with his eyes closed. What is this an example of? a. Tactile agnosia 155. Tactile agnosia is related to injury of which area of the brain? a. Parietal 156. Guillain-Barre Syndrome is an _______ disease that is triggered by? a. Autoimmune i. bacterial/viral infection 157. What does GB typically start from? a. Upper respiratory tract infection 158. What may GB be linked to now? a. Zika 159. Multiple sclerosis is an __________ disease marked by what two things? a. Autoimmune i. Exacerbations ii. Remissions 160. What is the central component of the pathogenic model of multiple sclerosis? a. Demyelination of nerve fibers in CNS 161. What does MS diffusely involve the degeneration of? a. CNS myelination b. Loss of axons 162. How can MS best be described? a. Occurs when previous infections insult CNS has occurred to genetically susceptible individual 163. Multiple sclerosis and Guillain-Barre syndrome are similar in that they both? a. Result from demyelination by an immune reaction 164. What does AIDP stand for? a. Acute inflammatory demyelinating polyneuropathy 165. What is the big difference in GB and MS? a. GB → an autoimmune disease triggered by a preceding bacterial or viral infection b. MS → an autoimmune response to self-antigens in genetically susceptible individuals. 166. Myasthenia gravis is an ________ disease characterized by antibodies attacking _____ receptors. a. Autoimmune611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 20 b. Acetylcholine 167. What is the neuromuscular enzyme/hormone that helps muscles contract? a. Acetylcholine 168. What can MG be? What is it marked by? a. Insidious b. Exertional fatigue 169. What do individual with MG start with? What can it lead to? a. Microaspirations b. Chronic respiratory infections 170. As MG progresses, individuals will display what five things? a. Bouts of pneumonia b. Ptosis/Facial drooping c. Difficulty chewing/swallowing d. Weight loss 171. Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain’s neurotransmitters? a. Dopamine 172. What is Parkinson’s disease? a. Degenerative disorder involving deficits of dopamine 173. Name the four hallmark signs of Parkinson’s disease? a. Fragmented sleep b. Depression c. Bradykinesia d. Muscle stiffness 174. Parkinson’s disease is a degenerative disorder of the brain’s ____ _____. a. Substantia nigra i. What is the cause? 1. Atrophy of neurons 175. The clinical manifestations of Parkinson disease include: (select all that apply) A. Fragmented sleep B. Drooping eyelids C. Depression D. Muscle stiffness E. Bradykinesia 176. In Parkinson disease the basal ganglia influence the hypothalamic function to produce which clinical manifestations? (select all that apply) A. Inappropriate diaphoresis B. Gastric retention C. Vomiting D. Diarrhea E. Urinary retention 177. The basal ganglia influence what two parts of the hypothalamic function? a. Hypothalamic function611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 21 b. Autonomic and neuroendocrine i. These connect which two brain structures? a. Basal ganglia b. Cerebral cortex 178. Migraines are typically seen in _______. a. Women 179. What 3 kinds of onset do Migraines have? a. Rapid b. Slow c. Episodic i. What is the quality of a migraine? a. Throbbing ii. What two things may the migraine include? 1. Aura 2. Prodromal 180. When do Cluster Headaches tend to happen? a. Same time 181. What hormone peaks in the morning when we wake up? a. Cortisol 182. Sleep deprivation causes what to be disrupted? a. Circadian-rhythm i. What then gets messed up? What happens? 1. Cortisol influx/release 2. Releases at wrong time a. What does this cause systemically? i. BP to increase 183. What is another molecule that gets released during sleep deprivation? a. Glucose i. What does this lead to? 1. Pro-inflammatory cytokines 2. Reduced NKC activity 184. What is the leading cause of vision impairment and blindness? a. Glaucoma 185. Which angle of glaucoma is the most common? a. Open i. What does this cause and how fast? 1. Extremely high pressure and within hours/days a. What is the main cause of loss of visual acuity? i. Pressure on optic nerve 186. What are the two major types of hearing loss? a. Conductive hearing loss b. Sensorineural hearing loss 187. What causes conductive hearing loss? What structure is usually affected? a. blockage/interference b. Cerumen i. How will the affected patient usually speak? Why?611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 22 1. Softly 2. They hear their own vocal vibrations loudly 188. What structure does sensorineural hearing loss affect? a. Organ of Corti i. How do these affected individuals usually speak? 1. Loudly 189. Which factors contribute to sensorineural hearing loss? (select all that apply) ● Meniere disease ● Aging ● Outer ear trauma ● Noise exposure ● Diabetes mellitus 190. How quickly does sensorineural hearing loss occur? a. Gradual or sudden i. What conditions normally cause sensorineural hearing loss? 1. congenital/hereditary factors 2. Noise exposure 3. Aging 4. Meniere disease 5. Ototoxicity 6. Systemic diseases (syphilis, Paget, DM) 191. What is the age-related hearing loss called? a. Presbycusis i. What is lost? 1. Hearing high frequencies ii. What is it the most common form of? 1. Sensorineural hearing loss iii. Who does it affect the most? 1. Older people 192. Name the 3 most severe outcomes of a stroke? a. Hemiplegia b. Coma c. Death 193. Name 3 ways strokes are classified. a. Ischemic (thrombotic/embolic) - most common b. Global hypoperfusion (shock) c. Intracerebral hemorrhage 194. What is the single greatest risk for stroke? a. Uncontrolled hypertension 195. In GB, what is usually seen with weakness in the patient? a. Usually plateaus or improves by the fourth week i. What is seen over a few months?611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 23 1. Reaching activity levels similar to pre-disease state 196. What three symptoms of GB show cranial nerve involvement? a. Facial weakness/Bulbar weakness i. Chewing ii. Swallowing iii. Coughing 197. The systemic inflammation in MS causes what 3 things happen? a. Degeneration of CNS myelin b. scarring/formation of plaque c. Loss of axons 198. Which problem related to MS means that progression will soon become rapid? a. Walking 199. What is a clinically isolated syndrome (CIS)? What can it be? a. Single episode of neurologic dysfunction that lasts greater than 24 hours b. A prelude to MS 200. Explain the differences between acute and chronic pain? CHARACTERISTIC ACUTE PAIN CHRONIC PAIN Experience An event A situation; state of existence Source External agent or internal disease usually known Unknown; if known, treatment is prolonged or ineffective Onset Usually sudden May be sudden or develop insidiously Duration Transient (up to 6 months) Prolonged and persistent (months to years) Clinical signs Increased pulse rate, elevated blood pressure, increased respiratory rate, diaphoresis, dilated pupils Response patterns vary; fewer overt signs (adaptation)611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 24 Course Suffering usually decreases over time Suffering usually increases over time Prognosis Likelihood of eventual complete relief Complete relief usually not possible 201. What is neuropathic pain described as? a. Burning b. Shooting c. Shock-like d. Tingling i. What is it characterized by? 1. Hyperalgesia (increased sensitivity to normal pain stimulus) 2. Allodynia (induction of pain by normally non-painful stimuli) 202. What is obstructive sleep apnea (OSA)? a. Disorder of breathing during sleep r/t repetitive upper airway collapse i. What is it associated with? 1. Reduced SpO2 2. Hypercapnia ii. Why is it important? Most commonly diagnosed sleep disorder 203. Explain the differences between Delirium and Dementia. FEATURE DELIRIUM Dementia Age Usually older Usually older Onset Acute—common during hospitalization Usually insidious; acute in some cases of strokes/trauma Associated conditions Urinary tract infection, thyroid disorders, hypoxia, hypoglycemia, toxicity, fluid-electrolyte imbalance, renal insufficiency, trauma, multiple medications May have no other conditions Brain trauma Course Fluctuating; remits with treatment Chronic slow decline611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 25 Duration Hours to weeks Months to years Attention Impaired Intact early; often impaired late Sleep-wake cycle Disrupted Usually normal or fragmented Alertness Impaired Normal Orientation Impaired Intact early; impaired late Behavior Agitated, withdrawn/depressed Intact early Speech Incoherent, rapid/slowed Word-finding problems Thoughts Disorganized, delusions Impoverished Perceptions Hallucinations/illusions Usually intact early 204. What kind of disease is Alzheimer’s Disease (AD)? a. Autosomal dominant i. What three gene deficits is it linked to? 1. PSEN1 2. PSEN2 3. APP gene of chromosome 21 205. When diagnosing AD, what must be done first? a. Rule out all other causes of dementia611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 26 i. How is this done? 1. Brain imaging 2. Labs 3. Course of illness 4. Cognitive testing 5. Thorough clinical history 206. Stroke with no identifiable cause are classified as? a. Undetermined or Cryptogenic 207. What are other major risk factors to a stroke? a. IRDM b. HL c. HHC d. CHD/PVD e. Stenosis f. Polycythemia g. AFIB h. Postmeno. Hormones i. High sodium/Low K+ j. Smoking k. Inactivity l. Obesity m. Chronic sleep deprivation 208. GB is considered an? a. Autoimmune disease i. What is it triggered by? 1. viral/bacterial infection a. What are the first manifestations? i. Numbness ii. Pain iii. Paraseias iv. Weakness in limbs b. What happens to motor signs? i. acute/subacute progressive paralysis c. What kind of pattern will paresis occur in? i. Ascending (limbs, resp, bulbar) 209. When can Myasthenia Gravis first appear? a. Pregnancy b. Post administration of anesthetic agents i. What are the hallmark symptoms of MG? 1. Exertional fatigue/weakness worsens with activity 2. Improves with rest 3. Recurs with resumption of activity ii. What are later signs of disease progression? 1. Respiratory distress 2. Difficulty breathing 210. In PD, what is the primary pathology? a. Degeneration of basal ganglia i. What is the hallmark pathology? 1. Loss of dopaminergic pigmented neurons ii. Where else is dopamine lost? 1. brainstem611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 27 2. Thalamus 3. Cortex 211. Who may be protected from sleep-disordered breathing? Why? a. Premenstrual women b. Progesterone is a respiratory stimulant 212. What four detrimental things occur due to intraocular pressure? a. Myopia b. Loss of peripheral vision c. Central vision impairment d. Blindness 213. How is schizophrenia diagnosed? a. By eliminating other mental disorders/symptoms not caused by substance abuse, meds, or other medical condition 214. What have neuroimaging techniques revealed in schizophrenia? a. Structural brain abnormalities 215. What is the most commonly diagnosed mood disorder in the US? a. Unipolar depressive disorder i. Also known as? 1. Major depressive disorder ii. What are the major symptoms of this disorder? 1. Depression 2. Lost interest 3. Activity change 4. guilt 5. SI 6. Fatigue 7. Concentration 8. sleep/ appetite/weight change 216. What is an early systemic inflammatory response? a. Fever i. What is it induced by? Released from (2)? 1. Exogenous pyrogens 2. neutrophils/macrophages 217. Which immunity involved the antibody circulating in the blood and binding to antigens on infectious agents? a. Humoral immunity 218. What is the primary difference between type II and type III mechanisms? a. Type II i. Hypersensitivity antibody binds to antigen on cell surface b. Type III i. Antibody binds to soluble antigen that was released into blood/body fluids ii. Complex deposited into tissues 219. What are the most characteristic autoantibodies produced in systemic lupus erythematosus (SLE) against?611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 28 a. Nucleic acids 220. Primary immune deficiencies are very _____. a. Rare i. What do they normally involve? 1. immunodeficiency /immunoglobulins 221. Which kind of immune deficiency is more common? a. Secondary i. What are they related to? 1. Environmental factors 222. What can lead to fatal endotoxic shock/septic shock? a. Release of sufficient amount of endotoxin i. What 3 things are released when endotoxin is released in the blood? 1. Vasoactive peptide 2. TNF-a 3. Cytokines a. What does this lead to? i. Decrease O2 delivery ii. Production of subsequent cardiovascular shock 223. What are the 3 stages of stress? a. Alarm/reaction - fight or flight mobilized b. Resistance/adaptation - fight or flight c. Exhaustion - onset of certain diseases/unable to adapt 224. what does TNM stand for? a. T - tumor spread b. N - node involvement c. M - Metastasis i. What is this used for? 1. Staging / choice of therapy 225. Explain paraneoplastic syndrome. a. If the tumor marker has biologic activity, then it causes symptoms 226. Benign vs. Malignant cancer Characteristic Benign Malignant Appearance of Well Poorly differentiated611-PATHO EXAM 2 INTENSE Q&A (ANSWERS) 29 cells differentiated Usual rate of growth Slow Rapid Mitotic Index Low High Presence of capsule Yes No Vascularization Slight Neovascularization through angiogenesis Mode of Growth Expansile Invasive Ability to metastasize No Yes