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Pathophysiology The Biologic Basis for Disease in Adults and Children,7th Edition by Kathryn L. – Test Bank

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Pathophysiology The Biologic Basis for Disease in Adults and Children,7th Edition by Kathryn L. – Test Bank

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Pathophysiology The Biologic Basis for Disease in Adults and Children,7th Edition by Kathryn L. – Test Bank

Chapter 2: Altered Cellular and Tissue Biology

 

MULTIPLE CHOICE

 

  1. Which type of cell adaptation occurs when normal columnar ciliated epithelial cells of the bronchial lining have been replaced by stratified squamous epithelial cells?
a. Hyperplasia c. Dysplasia
b. Metaplasia d. Anaplasia

 

 

ANS:  B

Metaplasia is the reversible replacement of one mature cell by another, sometimes a less differentiated cell type. The best example of metaplasia is the replacement of normal columnar ciliated epithelial cells of the bronchial (airway) lining by stratified squamous epithelial cells. The other options do not accurately describe the event in the question.

 

PTS:   1                    REF:   Page 54

 

  1. The loss of the adenosine triphosphate (ATP) during ischemia causes cells to:
a. Shrink because of the influx of calcium (Ca).
b. Shrink because of the influx of potassium chloride (KCl).
c. Swell because of the influx of sodium chloride (NaCl).
d. Swell because of the influx of nitric oxide (NO).

 

 

ANS:  C

A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+–K+) pump and sodium-calcium exchange to fail, which leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. (The Na+–K+ pump is discussed in Chapter 1.) Sodium and water can then freely enter the cell, and cellular swelling results. The other options do not accurately describe the result of ATP at the cellular level.

 

PTS:   1                    REF:   Page 57

 

  1. The mammary glands enlarge during pregnancy primarily as a consequence of hormonal:
a. Atrophy c. Anaplasia
b. Hyperplasia d. Dysplasia

 

 

ANS:  B

Hormonal hyperplasia occurs chiefly in estrogen-dependent organs, such as the uterus and breast. The remaining options do not adequately describe the consequence of hormones on breast tissue during pregnancy.

 

PTS:   1                    REF:   Page 53

 

  1. Free radicals play a major role in the initiation and progression of which diseases?
a. Cardiovascular diseases such as hypertension and ischemic heart disease
b. Renal diseases such as acute tubular necrosis and glomerulonephritis
c. Gastrointestinal diseases such as peptic ulcer disease and Crohn disease
d. Muscular disease such as muscular dystrophy and fibromyalgia

 

 

ANS:  A

Emerging data indicate that reactive oxygen species play major roles in the initiation and progression of cardiovascular alterations associated with hyperlipidemia, diabetes mellitus, hypertension, ischemic heart disease, and chronic heart failure. No current research connects the disorders mentioned in the other options to the effects of free radicals.

 

PTS:   1                    REF:   Pages 59-60

 

  1. Free radicals cause cell damage by:
a. Stealing the cell’s oxygen to stabilize the electron, thus causing hypoxia
b. Stimulating the release of lysosomal enzymes that digest the cell membranes
c. Transferring one of its charged, stabilized atoms to the cell membrane, which causes lysis
d. Giving up an electron, which causes injury to the chemical bonds of the cell membrane

 

 

ANS:  D

A free radical is an electrically uncharged atom or group of atoms having an unpaired electron. Having one unpaired electron makes the molecule unstable; thus to stabilize, the molecule gives up an electron to another molecule or steals one. Therefore it is capable of forming injurious chemical bonds with proteins, lipids, or carbohydrates—key molecules in membranes and nucleic acids. The remaining options do not accurately describe the role played by free radicals in cell damage.

 

PTS:   1                    REF:   Page 60

 

  1. What is a consequence of plasma membrane damage to the mitochondria?
a. Enzymatic digestion halts DNA synthesis.
b. Influx of calcium ions halts ATP production.
c. Edema from an influx in sodium causes a reduction in ATP production.
d. Potassium shifts out of the mitochondria, which destroys the infrastructure.

 

 

ANS:  B

The most serious consequence of plasma membrane damage is, as in hypoxic injury, to the mitochondria. An influx of calcium ions from the extracellular compartment activates multiple enzyme systems, resulting in cytoskeleton disruption, membrane damage, activation of inflammation, and eventually DNA degradation. Calcium ion accumulation in the mitochondria causes the mitochondria to swell, which is an occurrence that is associated with irreversible cellular injury. The injured mitochondria can no longer generate ATP, but they do continue to accumulate calcium ions. The remaining options do not accurately describe the consequence of plasma membrane damage to the mitochondria.

 

PTS:   1                    REF:   Page 63

 

  1. What is a consequence of leakage of lysosomal enzymes during chemical injury?
a. Enzymatic digestion of the nucleus and nucleolus occurs, halting DNA synthesis.
b. Influx of potassium ions into the mitochondria occurs, halting the ATP production.
c. Edema of the Golgi body occurs, preventing the transport of proteins out of the cell.
d. Shift of calcium out of the plasma membrane occurs, destroying the cytoskeleton.

 

 

ANS:  A

Enzymatic digestion of cellular organelles, including the nucleus and nucleolus, ensues, halting the synthesis of DNA and ribonucleic acid (RNA). The remaining options do not accurately describe the consequence of lysosomal enzyme leakage during chemical injury.

 

PTS:   1                    REF:   Page 63

 

  1. Lead causes damage within the cell by interfering with the action of:
a. Sodium and chloride c. Calcium
b. Potassium d. ATP

 

 

ANS:  C

Lead affects many different biologic activities at the cellular and molecular levels, many of which may be related to its ability to interfere with the functions of calcium. Lead does not appear to cause damage by interfering with the action of the other options.

 

PTS:   1                    REF:   Page 66

 

  1. Which statement is a description of the characteristics of apoptosis?
a. Programmed cell death of scattered, single cells
b. Characterized by swelling of the nucleus and cytoplasm
c. Unpredictable patterns of cell death
d. Results in benign malignancies

 

 

ANS:  A

Apoptosis is an active process of cellular self-destruction, also known as programmed cell death, which is implicated in normal and pathologic tissue changes. The remaining options do not accurately describe the characteristics of apoptosis.

 

PTS:   1                    REF:   Page 91

 

  1. Lead poisoning affects the nervous system by:
a. Interfering with the function of neurotransmitters
b. Inhibiting the production of myelin around nerves
c. Increasing the resting membrane potential
d. Altering the transport of potassium into the nerves

 

 

ANS:  A

Alterations in calcium may play a crucial role in the interference with neurotransmitters, which may cause hyperactive behavior and the proliferation of capillaries of the white matter and intercerebral arteries. The remaining options do not accurately describe the effects of lead poisoning of the nervous system.

 

PTS:   1                    REF:   Page 66

 

  1. Carbon monoxide causes tissue damage by:
a. Competing with carbon dioxide so that it cannot be excreted
b. Binding to hemoglobin so that it cannot carry oxygen
c. Destroying the chemical bonds of hemoglobin so it cannot carry oxygen
d. Removing iron from hemoglobin so it cannot carry oxygen

 

 

ANS:  B

Because carbon monoxide’s affinity for hemoglobin is 200 times greater than that of oxygen, it quickly binds with the hemoglobin, preventing oxygen molecules from doing so. The remaining options do not accurately describe the means by which carbon monoxide damages tissue.

 

PTS:   1                    REF:   Page 67

 

  1. Acute alcoholism mainly affects which body system?
a. Hepatic c. Renal
b. Gastrointestinal d. Central nervous

 

 

ANS:  D

Acute alcoholism mainly affects the central nervous system but may induce reversible hepatic and gastric changes. Other systems may evidentially be affected by chronic alcoholism.

 

PTS:   1                    REF:   Page 68

 

  1. During cell injury caused by hypoxia, an increase in the osmotic pressure occurs within the cell because:
a. Plasma proteins enter the cell.
b. The adenosine triphosphatase (ATPase)–driven pump is stronger during hypoxia.
c. Sodium chloride enters the cell.
d. An influx of glucose occurs through the injured cell membranes.

 

 

ANS:  C

In hypoxic injury, movement of fluid and ions into the cell is associated with acute failure of metabolism and a loss of ATP production. Normally, the pump that transports sodium ions out of the cell is maintained by the presence of ATP and ATPase, the active-transport enzyme. In metabolic failure caused by hypoxia, reduced ATP and ATPase levels permit sodium to accumulate in the cell, whereas potassium diffuses outward. The increase of intracellular sodium increases osmotic pressure, which draws more water into the cell. (Transport mechanisms are described in Chapter 1.) The remaining options do not accurately describe the cell injury that results in increased osmotic pressure caused by hypoxia.

 

PTS:   1                    REF:   Page 84

 

  1. Which statement is true regarding the difference between subdural hematoma and epidural hematoma?
a. No difference exists, and these terms may be correctly used interchangeably.
b. A subdural hematoma occurs above the dura, whereas an epidural hematoma occurs under the dura.
c. A subdural hematoma is often the result of shaken baby syndrome, whereas an epidural hematoma rapidly forms as a result of a skull fracture.
d. A subdural hematoma usually forms from bleeding within the skull, such as an aneurysm eruption, whereas an epidural hematoma occurs from trauma outside the skull, such as a blunt force trauma.

 

 

ANS:  C

A subdural hematoma is a collection of blood between the inner surface of the dura mater and the surface of the brain, resulting from the shearing of small veins that bridge the subdural space. Subdural hematomas can be the result of blows, falls, or sudden acceleration-deceleration of the head, which occurs in the shaken baby syndrome. An epidural hematoma is a collection of blood between the inner surface of the skull and the dura and is almost always associated with a skull fracture. The other options do not accurately describe the differences between the two hematomas.

 

PTS:   1                    REF:   Page 72 | Table 2-6

 

  1. What physiologic change occurs during heat exhaustion?
a. Hemoconcentration occurs because of the loss of salt and water.
b. Cramping of voluntary muscles occurs as a result of salt loss.
c. Thermoregulation fails because of high core temperatures.
d. Subcutaneous layers are damaged because of high core temperatures.

 

 

ANS:  A

Heat exhaustion occurs when sufficient salt and water loss results in hemoconcentration. The other options do not accurately describe the physiologic changes that occur during heat exhaustion.

 

PTS:   1                    REF:   Page 77

 

  1. In hypoxic injury, sodium enters the cell and causes swelling because:
a. The cell membrane permeability increases for sodium during periods of hypoxia.
b. ATP is insufficient to maintain the pump that keeps sodium out of the cell.
c. The lactic acid produced by the hypoxia binds with sodium in the cell.
d. Sodium cannot be transported to the cell membrane during hypoxia.

 

 

ANS:  B

In hypoxic injury, movement of fluid and ions into the cell is associated with acute failure of metabolism and a loss of ATP production. Normally, the presence of ATP and ATPase, the active-transport enzyme, maintains the pump that transports sodium ions out of the cell. In metabolic failure caused by hypoxia, reduced ATP and ATPase levels permit sodium to accumulate in the cell, whereas potassium diffuses outward. The other options do not accurately describe the cause of the swelling caused by hypoxia.

 

PTS:   1                    REF:   Page 84

 

  1. What is the most common site of lipid accumulation?
a. Coronary arteries c. Liver
b. Kidneys d. Subcutaneous tissue

 

 

ANS:  C

Although lipids sometimes accumulate in heart and kidney cells, the most common site of intracellular lipid accumulation, or fatty changeis liver cells. Subcutaneous tissue is not a common site of lipid accumulation.

 

PTS:   1                    REF:   Pages 84-85

 

  1. What mechanisms occur in the liver cells as a result of lipid accumulation?
a. Accumulation of lipids that obstruct the common bile duct, preventing flow of bile from the liver to the gallbladder
b. Increased synthesis of triglycerides from fatty acids and decreased synthesis of apoproteins
c. Increased binding of lipids with apoproteins to form lipoproteins
d. Increased conversion of fatty acids to phospholipids

 

 

ANS:  B

Lipid accumulation in liver cells occurs after cellular injury sets the following mechanisms in motion: increased synthesis of triglycerides from fatty acids (increases in the enzyme, a-glycerophosphatase, which can accelerate triglyceride synthesis) and decreased synthesis of apoproteins (lipid-acceptor proteins). The other options do not accurately describe this event.

 

PTS:   1                    REF:   Pages 84-85

 

  1. Hemoprotein accumulations are a result of the excessive storage of:
a. Iron, which is transferred from the cells to the bloodstream
b. Hemoglobin, which is transferred from the bloodstream to the cells
c. Albumin, which is transferred from the cells to the bloodstream
d. Amino acids, which are transferred from the cells to the bloodstream

 

 

ANS:  A

Excessive storage of iron, which is transferred to the cells from the bloodstream, causes hemoprotein accumulations in cells. Hemoglobin, albumin, or amino acids will not cause hemoprotein accumulations.

 

PTS:   1                    REF:   Page 86

 

  1. Hemosiderosis is a condition that results in the excess of what substance being stored as hemosiderin in cells of many organs and tissues?
a. Hemoglobin c. Iron
b. Ferritin d. Transferrin

 

 

ANS:  C

Hemosiderosis is a condition that occurs only when excess iron is stored as hemosiderin in the cells of many organs and tissues.

 

PTS:   1                    REF:   Page 86

 

  1. What is the cause of free calcium in the cytosol that damages cell membranes by uncontrolled enzyme activation?
a. Activation of endonuclease interferes with the binding of calcium to protein.
b. Activation of phospholipases, to which calcium normally binds, degrades the proteins.
c. An influx of phosphate ions competes with calcium for binding to proteins.
d. Depletion of ATP normally pumps calcium from the cell.

 

 

ANS:  D

If abnormal direct damage occurs to membranes or ATP is depleted, then calcium increases in the cytosol. The other options do not accurately describe the cause of free calcium in cytosol to damage cell membranes.

 

PTS:   1                    REF:   Pages 57-58 | Page 87 | Figure 2-24

 

  1. What two types of hearing loss are associated with noise?
a. Acoustic trauma and noise-induced c. High frequency and acoustic trauma
b. High frequency and low frequency d. Noise-induced and low frequency

 

 

ANS:  A

Two types of hearing loss are associated with noise: (1) acoustic trauma or instantaneous damage caused by a single sharply rising wave of sound (e.g., gunfire), and (2) noise-induced hearing loss, the more common type, which is the result of prolonged exposure to intense sound (e.g., noise associated with the workplace and leisure-time activities). The remaining options are not related to noise but rather to the amplitude of the sound.

 

PTS:   1                    REF:   Page 83

 

  1. What type of necrosis results from ischemia of neurons and glial cells?
a. Coagulative c. Caseous
b. Liquefactive d. Gangrene

 

 

ANS:  B

Liquefactive necrosis commonly results from ischemic injury to neurons and glial cells in the brain. The other types of necrosis are not related to ischemic injuries in the brain.

 

PTS:   1                    REF:   Page 90

 

  1. What type of necrosis is often associated with pulmonary tuberculosis?
a. Bacteriologic c. Liquefactive
b. Caseous d. Gangrenous

 

 

ANS:  B

Caseous necrosiswhich commonly results from tuberculous pulmonary infection, particularly Mycobacterium tuberculosis, is a combination of coagulative and liquefactive necrosis. The other types of necrosis are not observed in pulmonary tuberculosis.

 

PTS:   1                    REF:   Page 90

 

  1. What type of necrosis is associated with wet gangrene?
a. Coagulative c. Caseous
b. Liquefactive d. Gangrene

 

 

ANS:  B

Wet gangrene develops only when neutrophils invade the site, causing liquefactive necrosis.

 

PTS:   1                    REF:   Page 91

 

  1. Current research supports the believe that, after heart muscle injury, the damage:
a. Remains indefinitely because cardiac cells do not reproduce.
b. Is repaired by newly matured cardiomyocytes.
c. Gradually decreases in size as mitotic cell division occurs.
d. Is replaced by hypertrophy of remaining cells.

 

 

ANS:  B

The recent discovery that cardiac stem cells exist in the heart and differentiate into various cardiac cell lineages has profoundly changed the understanding of myocardial biology; it is now believed that bone marrow–derived cardiac stem cells or progenitor cells that have the ability to mature into cardiomyocytes may populate the heart after injury. The other options do not accurately describe the process that is believed to occur to address cardiac muscle damage.

 

PTS:   1                    REF:   Page 52 | What’s New box

 

  1. After ovulation, the uterine endometrial cells divide under the influence of estrogen. This process is an example of hormonal:
a. Hyperplasia c. Hypertrophy
b. Dysplasia d. Anaplasia

 

 

ANS:  A

Hormonal hyperplasia chiefly occurs in estrogen-dependent organs, such as the uterus and breast. After ovulation, for example, estrogen stimulates the endometrium to grow and thicken for reception of the fertilized ovum. The other options do not accurately describe the process identified in the question.

 

PTS:   1                    REF:   Pages 51-53

 

  1. The abnormal proliferation of cells in response to excessive hormonal stimulation is called:
a. Dysplasia c. Hyperplasia
b. Pathologic dysplasia d. Pathologic hyperplasia

 

 

ANS:  D

Pathologic hyperplasia is the abnormal proliferation of normal cells and can occur as a response to excessive hormonal stimulation or the effects of growth factors on target cells (see Figure 2-4). The other options do not accurately identify the term for the results of excessive hormonal stimulation on cells.

 

PTS:   1                    REF:   Page 53

 

  1. Removal of part of the liver leads to the remaining liver cells undergoing compensatory:
a. Atrophy c. Hyperplasia
b. Metaplasia d. Dysplasia

 

 

ANS:  C

Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate. For example, the removal of part of the liver leads to hyperplasia of the remaining liver cells (hepatocytes) to compensate for the loss. The other options do not accurately identify the compensatory process described in the question.

 

PTS:   1                    REF:   Pages 52-53

 

  1. What is the single most common cause of cellular injury?
a. Hypoxic injury c. Infectious injury
b. Chemical injury d. Genetic injury

 

 

ANS:  A

Hypoxia, or lack of sufficient oxygen, is the single most common cause of cellular injury (see Figure 2-8). The other options are not a commonly observed as is the correct option.

 

PTS:   1                    REF:   Page 56

 

  1. During cell injury caused by hypoxia, sodium and water move into the cell because:
a. Potassium moves out of the cell, and potassium and sodium are inversely related.
b. The pump that transports sodium out of the cell cannot function because of a decrease in ATP levels.
c. The osmotic pressure is increased, which pulls additional sodium across the cell membrane.
d. Oxygen is not available to bind with sodium to maintain it outside of the cell.

 

 

ANS:  B

A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+–K+) pump and sodium-calcium exchange to fail, which leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. (The Na+–K+ pump is discussed in Chapter 1.)

 

PTS:   1                    REF:   Page 57

 

  1. In decompression sickness, emboli are formed by bubbles of:
a. Oxygen c. Carbon monoxide
b. Nitrogen d. Hydrogen

 

 

ANS:  B

If water pressure is too rapidly reduced, the gases dissolved in blood bubble out of the solution, forming emboli. Oxygen is quickly redissolved, but nitrogen bubbles may persist and obstruct blood vessels. Ischemia, resulting from gas emboli, causes cellular hypoxia, particularly in the muscles, joints, and tendons, which are especially susceptible to changes in oxygen supply. The remaining options are not involved in the formation of decompression sickness emboli.

 

PTS:   1                    REF:   Page 77

 

  1. Which is an effect of ionizing radiation exposure?
a. Respiratory distress c. DNA aberrations
b. Sun intolerance d. Death

 

 

ANS:  C

The effects of ionizing radiation may be acute or delayed. Acute effects of high doses, such as skin redness, skin damage, or chromosomal aberrations, occur within hours, days, or months. The delayed effects of low doses may not be evident for years. The other options are not commonly considered effects of radiation exposure.

 

PTS:   1                    REF:   Pages 78-79

 

  1. What is an example of compensatory hyperplasia?
a. Hepatic cells increase cell division after part of the liver is excised.
b. Skeletal muscle cells atrophy as a result of paralysis.
c. The heart muscle enlarges as a result of hypertension.
d. The size of the uterus increases during pregnancy.

 

 

ANS:  A

Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate. For example, the removal of part of the liver leads to hyperplasia of the remaining liver cells (hepatocytes) to compensate for the loss. The other options do not accurately describe the term compensatory hyperplasia.

 

PTS:   1                    REF:   Pages 52-53

 

  1. It is true that nondividing cells are:
a. Found in gastrointestinal lining c. Incapable of synthesizing DNA
b. Affected by hyperplasia d. Affected by only hypertrophy

 

 

ANS:  A

Gastrointestinal lining is made up of rapidly dividing cells. Hyperplasia and hypertrophy take place if the cells are capable of synthesizing DNA; however, only hypertrophy occurs in nondividing cells.

 

PTS:   1                    REF:   Pages 51-53

 

  1. Dysplasia refers to a(n):
a. Abnormal increase in the number of a specific cell type
b. True adaptive process at the cellular level
c. Modification in the shape of a specific cell type
d. Lack of oxygen at the cellular level

 

 

ANS:  C

Dysplasia refers only to abnormal changes in the size, shape, and organization of mature cells.

 

PTS:   1                    REF:   Pages 53-54

 

  1. Current research has determined that chemical-induced cellular injury:
a. Affects the permeability of the plasma membrane.
b. Is often the result of the damage caused by reactive free radicals.
c. Is rarely influenced by lipid peroxidation.
d. Seldom involves the cell’s organelles.

 

 

ANS:  B

Not all the mechanisms causing chemical-induced membrane destruction are known; however, the only two general mechanisms currently accepted include: (1) direct toxicity by combining with a molecular component of the cell membrane or organelles, and (2) reactive free radicals and lipid peroxidation.

 

PTS:   1                    REF:   Pages 62-63

 

MULTIPLE RESPONSE

 

  1. Which organs are affected by lead consumption? (Select all that apply.)
a. Bones
b. Muscles
c. Pancreas
d. Nerves
e. Eyes

 

 

ANS:  A, D

The only organ systems provided as options that are primarily affected by lead include the nervous system, bones, kidneys, teeth, cardiovascular, and reproductive and immune systems.

 

PTS:   1                    REF:   Page 66

 

  1. What effect does fetal alcohol syndrome have on newborns? (Select all that apply.)
a. Failure of alveoli to open
b. Cognitive impairment
c. Incompetent semilunar values
d. Esophageal stricture
e. Facial anomalies

 

 

ANS:  B, E

Fetal alcohol syndrome (FAS) can lead to growth restriction, cognitive impairment, facial anomalies, and ocular disturbances. The other options do not accurately describe the effects of FAS.

 

PTS:   1                    REF:   Page 69

 

  1. What organs are affected by the type of necrosis that results from either severe ischemia or chemical injury? (Select all that apply.)
a. Lungs
b. Brain
c. Kidneys
d. Muscles
e. Heart

 

 

ANS:  C, E

Coagulative necrosis, which occurs primarily in the kidneys, heart, and adrenal glands, is a common result of hypoxia from severe ischemia or hypoxia caused by chemical injury, especially the ingestion of mercuric chloride. The other options do not accurately identify organs affected by necrosis resulting from ischemia or chemical injury.

 

PTS:   1                    REF:   Page 90

 

  1. It is true that melanin is: (Select all that apply.)
a. Rarely found in epithelial cells
b. Found in cells called keratinocytes, which are present in the retina
c. A factor in the prevention of certain types of cancer
d. Most influential in managing the effects of short-term sunlight exposure
e. Accumulated in specific cells found in the skin

 

 

ANS:  B, C, E

Melanin accumulates in epithelial cells (keratinocytes) of the skin and retina and is an extremely important pigment because it protects the skin against long exposure to sunlight and is considered an essential factor in the prevention of skin cancer.

 

PTS:   1                    REF:   Pages 85-86

 

  1. Examples of adaptive cellular responses include: (Select all that apply.)
a. Atrophy
b. Dysplasia
c. Hypertrophy
d. Hyperplasia
e. Metaplasia

 

 

ANS:  A, C, D, E

Atrophy, hypertrophy, hyperplasia, and metaplasia are considered to be adaptive cellular responses.

 

PTS:   1                    REF:   Page 50

 

  1. Blunt force injuries would include a: (Select all that apply.)
a. Bruise to the upper arm, resulting from a fall
b. Simple tibia fracture sustained in a skiing accident
c. Cut on the finger while slicing vegetables for a salad
d. Spleen laceration caused by a punch during a physical fight
e. Small caliber gunshot wound to the foot while target shooting

 

 

ANS:  A, B, D

Blunt force injuries are the result of tearing, shearing, or crushing types of injuries, resulting in bruises, fractures, and lacerations caused by blows or impacts. Sharp force injuries include cuts. Gunshot wounds require the penetration of the skin and muscle by a bullet.

 

PTS:   1                    REF:   Page 72 | Table 2-6

 

  1. Which statements are true regarding the effects of marijuana use? (Select all that apply.)
a. Smoking the drug results in greater absorption that eating it.
b. Heavy use can result in psychomotor impairments.
c. Smoking four “joints” a day equals smoking approximately 20 cigarettes.
d. Research does not support marijuana use as a factor in developing lung cancer.
e. Fetal development appears to be unharmed by marijuana use.

 

 

ANS:  A, B, C

With marijuana smoking, approximately 50% of the potent agents are absorbed through the lungs; when marijuana is ingested, however, only 10% is absorbed. With heavy marijuana use, the following adverse effects have been reported: (1) alterations of sensory perceptions, cognitive and psychomotor impairment (e.g., inability to judge time, speed, distance); (2) smoking three or four joints per day is similar to smoking 20 cigarettes per day, in relation to the frequency of chronic bronchitis and may contribute to lung cancer; (3) data from animal studies only, indicate reproductive changes that include reduced fertility, decreased sperm motility, and decreased circulatory testosterone; (4) fetal abnormalities including low birth weight and increased frequency of childhood leukemia; (5) increased frequency of infectious illness, which is thought to be the result of depressed cell-mediated and humoral immunity.

 

PTS:   1                    REF:   Page 70 | Table 2-5

 

Chapter 12: Cancer Biology

 

MULTIPLE CHOICE

 

  1. Which cancer originates from connective tissue?
a. Osteogenic sarcoma c. Multiple myeloma
b. Basal cell carcinoma d. Adenocarcinoma

 

 

ANS:  A

Cancers arising from connective tissue usually have the suffix -sarcoma. The remaining options are not cancers that originate in the connective tissue and, in addition, are lacking the common suffix.

 

PTS:   1                    REF:   Page 364

 

  1. Carcinoma refers to abnormal cell proliferation originating from which tissue origin?
a. Blood vessels c. Connective tissue
b. Epithelial cells d. Glandular tissue

 

 

ANS:  B

Only cancers arising from epithelial cells are called carcinomas.

 

PTS:   1                    REF:   Page 364

 

  1. Carcinoma in situ is characterized by which changes?
a. Cells have broken through the local basement membrane.
b. Cells have invaded immediate surrounding tissue.
c. Cells remain localized in the glandular or squamous cells.
d. Cellular and tissue alterations indicate dysplasia.

 

 

ANS:  C

Carcinoma in situ (CIS) refers to preinvasive epithelial malignant tumors of glandular or squamous cell origin. These early stage cancers are localized to the epithelium and have not broken through the local basement membrane or invaded the surrounding tissue. Dysplasia refers to changes in mature cell structure.

 

PTS:   1                    REF:   Page 364

 

  1. Which term is used to describe a muscle cell showing a reduced ability to form new muscle while appearing highly disorganized?
a. Dysplasia c. Myoplasia
b. Hyperplasia d. Anaplasia

 

 

ANS:  D

Anaplasia is defined as the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and the loss of normal tissue structure. In clinical specimens, anaplasia is recognized by a loss of organization and a significant increase in nuclear size with evidence of ongoing proliferation. The remaining options refer to specific changes in the cell.

 

PTS:   1                    REF:   Pages 368-369

 

  1. What are tumor cell markers?
a. Hormones, enzymes, antigens, and antibodies that are produced by cancer cells
b. Receptor sites on tumor cells that can be identified and marked
c. Cytokines that are produced against cancer cells
d. Identification marks that are used in administering radiation therapy

 

 

ANS:  A

Tumor (biologic) markers are substances produced by both benign and malignant cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine. Tumor markers may include hormones, enzymes, genes, antigens, and antibodies. The other options do not accurately describe examples of tumor markers and their function.

 

PTS:   1                    REF:   Pages 365-366

 

  1. The function of the tumor cell marker is to:
a. Provide a definitive diagnosis of cancer.
b. Treat certain types of cancer.
c. Predict where cancers will develop.
d. Screen individuals at high risk for cancer.

 

 

ANS:  D

Screening and identifying individuals at high risk for cancer are ways tumor markers can be used. These markers are not used to definitively diagnosis or treat cancer and are not useful in predicting specific sites of cancer development.

 

PTS:   1                    REF:   Page 366

 

  1. Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer?
a. Cancer cells accumulate slower than noncancer cells.
b. An accumulation of mutations in specific genes is required for the development of cancer.
c. Tumor invasion and metastasis progress more slowly in the gastrointestinal tract.
d. Apoptosis is triggered by diverse stimuli, including excessive growth.

 

 

ANS:  B

Multiple genetic mutations are required for the evolution of full-blown cancer. The remaining options do not address the progression of benign to metastatic tumors.

 

PTS:   1                    REF:   Pages 372-373

 

  1. Autocrine stimulation is the ability of cancer cells to:
a. Stimulate angiogenesis to create their own blood supply.
b. Encourage secretions that turn off normal growth inhibitors.
c. Secrete growth factors that stimulate their own growth.
d. Divert nutrients away from normal tissue for their own use.

 

 

ANS:  C

Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. The remaining options do not describe autocrine stimulation.

 

PTS:   1                    REF:   Page 380

 

  1. Apoptosis is a(an):
a. Normal mechanism for cells to self-destruct when growth is excessive
b. Antigrowth signal activated by the tumor-suppressor gene Rb
c. Mutation of cell growth stimulated by the TP53 gene
d. Transformation of cells from dysplasia to anaplasia

 

 

ANS:  A

Normal cells have a mechanism that causes them to self-destruct when growth is excessive and cell cycle checkpoints have been ignored. Diverse stimuli, including normal development and excessive growth, trigger this self-destruct mechanism, called apoptosis. The remaining options do not describe apoptosis.

 

PTS:   1                    REF:   Page 381

 

  1. Many cancers create a mutation of rasras is a(an):
a. Tumor-suppressor gene
b. Growth-promoting gene
c. Intracellular-signaling protein that regulates cell growth
d. Cell surface receptor that allows signaling to the nucleus concerning cell growth

 

 

ANS:  C

Up to one-third of all cancers have an activating mutation in the gene for an intracellular signaling protein called ras. This mutant ras stimulates cell growth even when growth factors are missing. The remaining options do not describe ras.

 

PTS:   1                    REF:   Page 380

 

  1. Oncogenes are genes that are capable of:
a. Undergoing mutation that directs the synthesis of proteins to accelerate the rate of tissue proliferation
b. Directing synthesis of proteins to regulate growth and to provide necessary replacement of tissue
c. Encoding proteins that negatively regulate the synthesis of proteins to slow or halt the replacement of tissue
d. Undergoing mutation that directs malignant tissue toward blood vessels and lymph nodes for metastasis

 

 

ANS:  A

Oncogenes are mutant genes that, before mutation, direct synthesis of proteins that positively regulate (accelerate) proliferation. The remaining options do not describe oncogenes.

 

PTS:   1                    REF:   Page 374

 

  1. Burkitt lymphomas designate a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. This is an example of which mutation of normal genes to oncogenes?
a. Point mutation c. Gene amplification
b. Chromosome translocation d. Chromosome fusion

 

 

ANS:  B

Chromosome translocations, in which a piece of one chromosome is translocated to another chromosome, can activate oncogenes. One of the best examples is the t(8;14) translocation found in many Burkitt lymphomas; t(8;14) designates a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. The remaining options are not best depicted by a Burkitt lymphoma.

 

PTS:   1                    REF:   Pages 375-376

 

  1. In childhood neuroblastoma, the N-myc oncogene undergoes which type of mutation of normal gene to oncogene?
a. Point mutation c. Gene amplification
b. Chromosome fusion d. Chromosome translocation

 

 

ANS:  C

Amplifications are the result of the duplication of a small piece of a chromosome over and over again; consequently, instead of the normal two copies of a gene, tens or even hundreds of copies are present (see Chapter 4). The N-myc oncogene is amplified in 25% of childhood neuroblastoma.

 

PTS:   1                    REF:   Page 376

 

  1. What aberrant change causes the abnormal growth in retinoblastoma?
a. Proto-oncogenes are changed to oncogenes.
b. The tumor-suppressor gene is turned off.
c. Genetic amplification causes the growth.
d. Chromosomes 9 and 21 are fused.

 

 

ANS:  B

One of the first discovered tumor-suppressor genes, the retinoblastoma (Rb) gene, normally strongly inhibits the cell division cycle. When it is inactivated, the cell division cycle can proceed unchecked. The Rb gene is mutated in childhood retinoblastoma. The remaining options do not describe the abnormal growth in retinoblastoma.

 

PTS:   1                    REF:   Page 376

 

  1. Two “hits” are required to inactivate tumor-suppressor genes because:
a. Each allele must be altered, and each person has two copies, or alleles, of each gene, one from each parent.
b. The first hit stops tissue growth, and the second hit is needed to cause abnormal tissue growth.
c. Tumor-suppressor genes are larger than proto-oncogenes, requiring two hits to effect carcinogenesis.
d. The first hit is insufficient to cause enough damage to cause a mutation.

 

 

ANS:  A

A single genetic event can activate an oncogene, acting in a dominant manner in the cell. However, each person has two copies, or alleles, of each gene, one from each parent. Therefore two hits are required to inactivate the two alleles of a tumor-suppressor gene, allowing the process to become active. The remaining options do not describe the reason two hits are required.

 

PTS:   1                    REF:   Page 376 | Page 378

 

  1. The ras gene converts from a proto-oncogene to an oncogene by:
a. Designating a chromosome that has a piece of one chromosome fused to a piece of another chromosome
b. Duplicating a small piece of a chromosome, repeatedly making numerous copies
c. Altering one or more nucleotide base pairs
d. Promoting proliferation of growth signals by impairing tumor-suppressor genes

 

 

ANS:  C

A point mutation is the alteration of one or a few nucleotide base pairs. This type of mutation can have profound effects on the activity of proteins. A point mutation in the ras gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation. The remaining options do not describe point mutation as it affects the conversion of a ras gene.

 

PTS:   1                    REF:   Page 375

 

  1. How do cancer cells use the enzyme telomerase?
a. To repair the telomeres to restore somatic cell growth
b. As an intracellular signaling chemical to stimulate cell division
c. To switch off the telomerase to enable cells to divide indefinitely
d. To switch on the telomerase to enable cells to divide indefinitely

 

 

ANS:  D

Cancer cells, when they reach a critical age, somehow activate telomerase to restore and maintain their telomeres and thereby make it possible for cells to divide over and over again. The remaining options do not describe how cancer cells use telomerase.

 

PTS:   1                    REF:   Page 382

 

  1. What are characteristics of benign tumors?
a. Benign tumors invade local tissues.
b. Benign tumors spread through the lymph nodes.
c. Benign tumors cause systemic symptoms.
d. Benign tumors include the suffix -oma.

 

 

ANS:  D

Benign tumors are usually encapsulated and well-differentiated. They retain some normal tissue structure and do not invade the capsules surrounding them or spread to regional lymph nodes or distant locations. Benign tumors are generally named according to the tissues from which they arise and include the suffix -oma. Benign tumors do not cause systemic symptoms.

 

PTS:   1                    REF:   Page 364

 

  1. Which terms represent the correct nomenclature for benign and malignant tumors of adipose tissue, respectively?
a. Liposarcoma, lipoma c. Adisarcoma, adipoma
b. Lipoma, liposarcoma d. Adipoma, adisarcoma

 

 

ANS:  B

In general, cancers are named according to the cell type from which they originate (e.g., lip for cancers that originate in adipose or fat tissue), whereas benign tumors use the suffix -oma. Cancers arising from connective tissue usually have the suffix sarcoma.

 

PTS:   1                    REF:   Page 364 | Page 367 | Table 12-2

 

  1. What is the major virus involved in the development of cervical cancer?
a. Herpes simplex virus type 6 c. Human papillomavirus
b. Herpes simplex virus type 2 d. Human immunodeficiency virus

 

 

ANS:  C

Infection with specific subtypes of human papillomavirus (HPV) cause virtually all cervical cancers. The remaining options are not known to be associated with cervical cancer.

 

PTS:   1                    REF:   Pages 382-383

 

  1. The Papanicolaou (Pap) test is used to screen for which cancer?
a. Ovarian c. Cervical
b. Uterine d. Vaginal

 

 

ANS:  C

The Pap test, an examination of cervical epithelial scrapings, readily detects early oncogenic human papillomavirus (HPV)infection. The Pap test is not used for screening the other cancer sites listed.

 

PTS:   1                    REF:   Page 382

 

  1. What is the skin-related health risk induced by some types of chemotherapy?
a. Infection c. Pain
b. Ultraviolet damage d. Erythema

 

 

ANS:  A

Decreased renewal rates of the epidermal layers in the skin may lead to skin breakdown and dryness, altering the normal barrier protection against infection. Radiation therapy may cause skin erythema (redness). Pain and ultraviolet damage is not related to chemotherapies.

 

PTS:   1                    REF:   Page 396 | Box 12-2

 

  1. Which cancers are all associated with chronic inflammation?
a. Brain, muscle, and endocrine
b. Colon, thyroid gland, and urinary bladder
c. Bone, blood cells, and liver
d. Eye, tracheal, and kidney

 

 

ANS:  B

Some organs appear to be more susceptible to the oncogenic effects of chronic inflammation; for example, the GI tract, prostate, thyroid gland, pancreas, urinary bladder, pleura, and skin. One large study found a 66% increase in the risk of lung cancer among women with chronic asthma, an inflammatory disease of the airways. At present, no research supports a link between the remaining options and chronic inflammation.

 

PTS:   1                    REF:   Pages 383-384

 

  1. Chronic inflammation causes cancer by:
a. Increasing vasodilation and permeability that alter cellular response to DNA damage
b. Liberating lysosomal enzymes when cells are damaged that initiates mutations
c. Releasing compounds such as reactive oxygen species that promote mutations
d. Increasing the abundance of leukotrienes that are associated with some cancers

 

 

ANS:  C

Inflammatory cells release compounds, such as reactive oxygen species (ROS) and other reactive molecules, that can promote mutations and block the cellular response to DNA damage. At present, no research supports the other options as factors related to inflammation causing cancer.

 

PTS:   1                    REF:   Page 384

 

  1. Inherited mutations that predispose to cancer are almost invariably what kind of gene?
a. Proto-oncogenes c. Tumor-suppressor genes
b. Oncogenes d. Growth-promoting genes

 

 

ANS:  C

Inherited mutations that predispose to cancer are almost invariably in tumor-suppressor genes. At present, no research supports the other options as factors related to how inherited mutations cause cancer.

 

PTS:   1                    REF:   Page 379

 

  1. What is the consequence for cells when the functioning TP53 gene is lost as a result of mutation?
a. Cells undergo apoptosis. c. Cells receive less oxygen.
b. Cells escape apoptosis. d. Cells adhere more readily.

 

 

ANS:  B

The most common mutations conferring resistance to apoptosis occur in the TP53 gene. The remaining options do not accurately describe the effect when the functioning TP53 gene is lost as a result of mutation.

 

PTS:   1                    REF:   Page 381

 

  1. Which gastrointestinal tract condition can be an outcome of both chemotherapy and radiation therapy?
a. Increased cell turnover c. Stomatitis
b. Constipation d. Bloody stool

 

 

ANS:  C

Chemotherapy and radiation therapy may cause a decreased cell turnover, thereby leading to oral ulcers (stomatitis), malabsorption, and diarrhea. None of the other options accurately describe related conditions resulting from chemotherapy and/or radiation therapies.

 

PTS:   1                    REF:   Page 396 | Box 12-2

 

  1. What is the role of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in cell metastasis?
a. To stimulate growth of nearby tumor cells
b. To develop new blood vessels to feed cancer cells
c. To prevent cancer cells from escaping apoptosis
d. To act as a chemical gradient to guide cells to blood vessels

 

 

ANS:  B

By recruiting new vascular endothelial cells and initiating the proliferation of existing blood vessel cells, the angiogenic factors, such as VEGF and growth factor bFGF, allow small cancers to become large cancers. None of the other options accurately describe the role of the various stated factors on cell metastasis.

 

PTS:   1                    REF:   Page 381

 

  1. It has been determined that a tumor is in stage 2. What is the meaning of this finding?
a. Cancer is confined to the organ of origin.
b. Cancer has spread to regional structures.
c. Cancer is locally invasive.
d. Cancer has spread to distant sites

 

 

ANS:  C

Cancer confined to the organ of origin is stage 1; cancer that is locally invasive is stage 2; cancer that has spread to regional structures, such as the lymph nodes, is stage 3; and cancer that has spread to distant sites, such as a liver cancer spreading to the lung or a prostate cancer spreading to bone, is stage 4.

 

PTS:   1                    REF:   Pages 393-394 | Figure 12-25

 

  1. Which statement is true regarding pain and cancer?
a. Pain is primarily a result of pressure caused by the tumor.
b. Pain indicates the metastasis of a cancer.
c. Pain is usually the initial symptom of cancer.
d. Pain is generally associated with late-stage cancer.

 

 

ANS:  D

Pain is generally associated with the late stages of cancer. Pressure, obstruction, invasion of a structure sensitive to pain, stretching, tissue destruction, and inflammation can cause pain. Pain is not the initial symptom of cancer nor does it indication that the cancer has metastasized.

 

PTS:   1                    REF:   Page 399

 

  1. Which cancer may be treated with radiation delivered by brachytherapy?
a. Lung c. Cervical
b. Colon d. Brain

 

 

ANS:  C

Radiation sources, such as small 125I-labeled capsules (also called seeds), can also be temporarily placed into body cavities, a delivery method termed brachytherapy. Brachytherapy is useful in the treatment of cervical, prostate, and head and neck cancers. Brachytherapy is not used in the treatment of the other cancers.

 

PTS:   1                    REF:   Pages 397-398

 

  1. The survival rate for stage IV Hodgkin disease can be as high as:
a. 99% c. 40%
b. 70% d. 20%

 

 

ANS:  B

Survival rates for Hodgkin disease is 99% for stage I and 70% for stage IV.

 

PTS:   1                    REF:   Page 394 | Table 12-10

 

  1. What is the cause of anemia in a patient diagnosed with pancreatic cancer?
a. Impaired pancreatic function c. Chronic bleeding
b. Malnutrition d. Malabsorption of iron

 

 

ANS:  D

Iron is malabsorbed in individuals with gastric, pancreatic, or upper intestinal cancer. Commonly associated with malignancy, mechanisms of anemia include chronic bleeding (resulting in iron deficiency), severe malnutrition, cytotoxic chemotherapy, and malignancy in blood-forming organs. The pancreas is not involved in the formation of blood components. Chronic bleeding and iron deficiency can accompany colorectal or genitourinary malignancies.

 

PTS:   1                    REF:   Page 396 | Box 12-2

 

  1. By what process do cancer cells multiply in the absence of external growth signals?
a. Proto-oncogene c. Reliance on caretaker genes
b. Autocrine stimulation d. Pleomorphology

 

 

ANS:  B

Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. The other options are not involved in the proliferation of cancer cells in the absence of external growth signals.

 

PTS:   1                    REF:   Page 380

 

  1. What is the role of caretaker genes?
a. Maintenance of genomic integrity c. Secretion of growth factors
b. Proliferation of cancer cells d. Restoration of normal tissue structure

 

 

ANS:  A

Caretaker genes are responsible for the maintenance of genomic integrity. The other options are not roles assumed by caretaker genes.

 

PTS:   1                    REF:   Page 379

 

  1. In a normal, nonmutant state, an oncogene is referred to as a:
a. Basal cell c. Caretaker gene
b. Target cell d. Proto-oncogene

 

 

ANS:  D

In its normal nonmutant state, an oncogene is referred to as a proto-oncogene. The other options are not terms used to identify a nonmutant oncogene.

 

PTS:   1                    REF:   Page 374

 

  1. Which statement is true regarding pleomorphic cells?
a. Pleomorphic cells are similar in size.
b. They share a common shape.
c. They are a result of anaplasia.
d. Pleomorphic cells differentiate uniformly.

 

 

ANS:  C

In contrast to normal cells, which are uniform in size and shape, anaplastic cells are of variable size and shape and abnormally differentiate, making them pleomorphic.

 

PTS:   1                    REF:   Pages 368-369

 

  1. What is the most commonly reported symptom of cancer treatment?
a. Nausea c. Hair loss
b. Fatigue d. Weight loss

 

 

ANS:  B

Fatigue is the most frequently reported symptom of cancer and cancer treatment. Although patients report the other options, they are not as frequently experienced as fatigue.

 

PTS:   1                    REF:   Page 396 | Box 12-2

 

  1. The most common site of metastasis for a patient diagnosed with prostate cancer is which location?
a. Bones c. Bladder
b. Brain d. Kidney

 

 

ANS:  A

The bone, especially the lumbar spine area, is the most common metastasis site for prostate cancer.

 

PTS:   1                    REF:   Page 391 | Table 12-8

 

  1. Which statement concerning benign tumors is true?
a. The resulting pain is severe. c. Benign tumors are fast growing.
b. Benign tumors are not encapsulated. d. The cells are well-differentiated.

 

 

ANS:  D

A benign tumor is well-differentiated with its tissue appearing similar to the tissue from which it arose. The other options are characteristic of a malignant tumor.

 

PTS:   1                    REF:   Page 364 | Table 12-1

 

MULTIPLE RESPONSE

 

  1. Normally, which cells are considered immortal (never die)? (Select all that apply.)
a. Germ
b. Stem
c. Blood
d. Epithelial
e. Muscle

 

 

ANS:  A, B

Usually, germ cells (those that generate sperm and eggs) and stem cells are the only cells in the body that are immortal. Other cells in the body are not immortal and can divide only a limited number of times. The remaining options do not identify the appropriate cells.

 

PTS:   1                    REF:   Page 382

 

  1. What is the most common route for distant metastasis? (Select all that apply.)
a. Seeding
b. Blood
c. Lymphatic vessels
d. Invasion
e. Proliferation

 

 

ANS:  B, C

To transition from local to distant metastasis, the cancer cells must also be able to invade local blood and lymphatic vessels. The remaining options are not directly related to distant metastasis.

 

PTS:   1                    REF:   Page 387

 

  1. What cellular characteristics are affected by anaplasia? (Select all that apply.)
a. Size
b. Ability to differentiate
c. Life expectancy
d. Tissue structure
e. Shape

 

 

ANS:  A, B, D, E

Anaplasia is defined as the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and loss of normal tissue structure. Life expectancy is not generally included in this term.

 

PTS:   1                    REF:   Page 364

 

  1. What are the most common causes of nosocomial infections among patients with cancer? (Select all that apply.)
a. Indwelling medical devices
b. Suppressed immune system
c. Visitor-introduced microorganisms
d. Poor appetite
e. Inadequate wound care

 

 

ANS:  A, C, E

Hospital-acquired (nosocomial) infections increase because of indwelling medical devices, inadequate wound care, and the introduction of microorganisms from visitors and other individuals. A suppressed immune system and a poor appetite are possible causes of infections but they are not nosocomial in nature.

 

PTS:   1                    REF:   Page 396 | Box 12-2

 

  1. Which statements concerning aging and the occurrence of cancer are true(Select all that apply.)
a. Decline in immunologic functions
b. Predisposition to nutritional inadequacies
c. Unwillingness to access health care services
d. Reluctance to engage in cancer screenings
e. Effects of immobility on the immune system

 

 

ANS:  A, B, E

Many common malignancies occur mostly in older age as a result of immunologic functions declining with age. Older persons are predisposed to nutritional inadequacies, and malnutrition impairs immunocompetence. Far-advanced cancer often results in immobility and general debility that worsens with age. No research supports a correlation between aging and a reluctance to seek health care, in general, or cancer screenings, in particular.

 

PTS:   1                    REF:   Page 397 | Table 12-12

 

MATCHING

 

Match the phrases with the corresponding terms.

______ A. Is the process of cancer cell growth.

______ B. Is used to kill cancer cells while minimizing damage to normal structures.

______ C. Is guided by molecular analysis in specific diseases.

______ D. Takes advantage of specific vulnerabilities in specific cancer cells.

______ E. Provides a framework to determine treatment.

 

  1. Chemotherapy

 

  1. Radiation

 

  1. Staging

 

  1. Angiogenesis

 

  1. Target agent

 

  1. ANS:  D                    PTS:   1                    REF:   Page 396

MSC:  All chemotherapeutic agents take advantage of specific vulnerabilities in target cancer cells.

 

  1. ANS:  B                    PTS:   1                    REF:   Pages 397-398

MSC:  Radiation therapy is used to kill cancer cells while minimizing damage to normal structures.

 

  1. ANS:  E                    PTS:   1                    REF:   Pages 393-394

MSC:  Staging may alter the choice of therapy, with more aggressive therapy being delivered to more invasive disease (advanced staging).

 

  1. ANS:  A                    PTS:   1                    REF:   Page 381

MSC:  Angiogenesis is the process of growth and proliferation of cancer cells.

 

  1. ANS:  C                    PTS:   1                    REF:   Pages 397-398

MSC:  The newest highly targeted agents that are used to treat cancer exploit specific vulnerabilities uncovered by molecular analysis in specific diseases.

 

MICS: The newest highly targeted agents that are used to treat cancer exploit specific vulnerabilities uncovered by molecular analysis in specific diseases.

Match the organism factor with the cancer it causes.

______ A. HPV

______ B. Human herpesvirus (HHV) 8

______ C. Hepatis B virus (HBV)

______ D. Helicobacter pylori

 

  1. Cervical cancer

 

  1. Kaposi sarcoma

 

  1. Liver cancer

 

  1. Stomach cancer

 

  1. ANS:  A                    PTS:   1                    REF:   Pages 382-383

MSC:  HPV infection causes human cervical cancer.

 

  1. ANS:  B                    PTS:   1                    REF:   Page 383

MSC:  HHV-8 infection causes Kaposi sarcoma.

 

  1. ANS:  C                    PTS:   1                    REF:   Page 383

MSC:  Chronic hepatitis infection with HBV or hepatis C virus (HCV) is the leading cause of liver cancer.

 

  1. ANS:  D                    PTS:   1                    REF:   Page 384

MSC:  Chronic H. pylori-associated inflammation causes stomach cancer.

 

Chapter 24: Alterations of the Female Reproductive System

 

MULTIPLE CHOICE

 

  1. In 95% of children of delayed puberty, the problem is caused by:
a. Disruption in the hypothalamus c. Deficit in estrogen or testosterone
b. Disruption of the pituitary d. Physiologic hormonal delays

 

 

ANS:  D

In 95% of children with delayed puberty, the delay is physiologic; that is, hormonal levels are normal and the hypothalamic-pituitary-gonadal (HPG) axis is intact, but maturation is slowly happening. This option is the only answer that accurately describes the most common cause of delayed puberty.

 

PTS:   1                    REF:   Page 802

 

  1. What is the first sign of puberty in girls?
a. Breast enlargement c. Menstruation
b. Growth of pubic hair d. Vaginal discharge

 

 

ANS:  A

Of the options available, the first sign of puberty in girls is usually thelarche or breast development.

 

PTS:   1                    REF:   Page 802

 

  1. Which type of precocious puberty causes the child to develop some secondary sex characteristics of the opposite sex?
a. Mixed c. Isosexual
b. Incomplete d. Homosexual

 

 

ANS:  A

Mixed precocious puberty, which is virilization of a girl or feminization of a boy, causes the child to develop some secondary sex characteristics of the opposite sex. This option is the only answer that accurately identifies the type of precocious puberty described.

 

PTS:   1                    REF:   Page 804

 

  1. The release of which chemical mediator causes primary dysmenorrhea?
a. Leukotrienes c. Bradykinin
b. Prostaglandins d. C-reactive protein

 

 

ANS:  B

Primary dysmenorrhea is painful menstruation associated with the release of prostaglandins in ovulatory cycles. This option is the only answer that accurately identifies the chemical mediator associated with dysmenorrhea.

 

PTS:   1                    REF:   Page 804

 

  1. Considering the pathophysiologic characteristics of primary amenorrhea, what anatomic structure is involved in compartment II?
a. Ovary c. Hypothalamus
b. Anterior pituitary d. Vagina

 

 

ANS:  A

Compartment II disorders involve only the ovary.

 

PTS:   1                    REF:   Page 805

 

  1. Considering the pathophysiologic characteristics of primary amenorrhea, what anatomic structure is involved in compartment IV?
a. Vagina c. Ovary
b. Hypothalamus d. Anterior pituitary

 

 

ANS:  B

Of the options available, only compartment IV disorders include central nervous system (CNS) conditions, in particular hypothalamic disorders.

 

PTS:   1                    REF:   Page 805

 

  1. Which condition is considered a clinical cause of amenorrhea?
a. Disorder in the endometrium c. Lack of physical exercise
b. Obstruction of the fallopian tubes d. Failure to ovulate

 

 

ANS:  D

Depressed ovarian hormone levels, which are associated with a variety of clinical disorders, also cause amenorrhea by preventing ovulation. This option is the only answer that accurately identifies a clinical cause of cycle irregularities.

 

PTS:   1                    REF:   Page 807

 

  1. Clinical manifestations that include irregular or heavy bleeding, the passage of large clots, and the depletion of iron stores support which diagnosis?
a. Premenstrual syndrome c. Polycystic ovary syndrome
b. Dysfunctional uterine bleeding d. Primary dysmenorrhea

 

 

ANS:  B

Unpredictable and variable bleeding, in terms of amount and duration, characterize dysfunctional uterine bleeding. Especially during perimenopause, dysfunctional bleeding also may involve flooding and the passage of large clots, which often indicate excessive blood loss. Excessive bleeding can lead to iron-deficiency anemia. This option is the only answer that demonstrates the clinical manifestations described.

 

PTS:   1                    REF:   Page 809

 

  1. What statement concerning the pathogenetic mechanisms of polycystic ovarian syndrome (POS) is true?
a. POS causes a decrease in leptin levels; this decrease reduces the hypothalamic pulsatility of gonadotropin-releasing hormone, which reduces the number of follicles that mature.
b. POS is a result of a disorder in the anterior pituitary that increases the follicle-stimulating hormone, which reduces the luteinizing hormone released.
c. POS is a result of a combination of conditions that include oligo-ovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries.
d. POS inhibits testosterone, which stimulates androgen secretion by the ovarian stroma and indirectly reduces sex hormone–binding globulin.

 

 

ANS:  C

POS has at least two of the following conditions: oligo-ovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. Of the options available, only this answer accurately defines the pathogenetic mechanisms of POS.

 

PTS:   1                    REF:   Page 810

 

  1. What is the leading cause of infertility in women?
a. Pelvic inflammatory disease c. Salpingitis
b. Endometriosis d. Polycystic ovary syndrome

 

 

ANS:  D

Polycystic ovary syndrome remains one of the most common endocrine disturbances affecting women, especially young women, and is a leading cause of infertility in the United States.

 

PTS:   1                    REF:   Page 810

 

  1. Considering the mediating factors of premenstrual syndrome (PMS), which medication may be used either continually or only during the menstrual period as a treatment for the condition?
a. NSAIDs c. SSRIs
b. Estrogen d. Progesterone

 

 

ANS:  C

A selective serotonin reuptake inhibitors (SSRI) (an antidepressant) relieves symptoms in approximately 60% to 90% of women and may be continually administered or only prescribed during the premenstrual period. Oral contraceptive pills that contain estrogen and progesterone also can be continuously used for up to 3 months to decrease the frequency of menstrual periods, PMS, and premenstrual dysphoric disorder (PMDD). Nonsteriodal antiinflammatory drugs (NSAIDs) would not be continually administered.

 

PTS:   1                    REF:   Page 813

 

  1. Which statement regarding pelvic inflammatory disease (PID) is true?
a. An episode of mild PID can decrease the possibility of a successful pregnancy by 80%.
b. Such an inflammation results in temporary changes to the ciliated epithelium of the fallopian tubes.
c. PID has not been associated with an increased risk of an ectopic pregnancy.
d. Contracting this infection increases the risk of uterine cancer.

 

 

ANS:  D

PID infection results in permanent changes to the ciliated epithelium of the fallopian or uterine tubes. A recent study has found that one episode of mild, subclinical PID resulted in a 40% decrease in later pregnancy rates, and multiple episodes of PID further increase the risk of infertility. Scarring caused by PID greatly increases the risk of a later ectopic pregnancy by up to tenfold. Scarring and adhesions also can result in chronic pelvic pain and, potentially, an increased risk of later uterine cancer.

 

PTS:   1                    REF:   Pages 813-814

 

  1. When a woman’s uterus is assessed as protruding through the entrance of the vagina to the hymen, which grade of prolapse does this indicate?
a. 0 c. 2
b. 1 d. 3

 

 

ANS:  C

A grade 2 prolapse reaches the hymen (see Figure 24-10).

 

PTS:   1                    REF:   Page 818 | Box 24-10

 

  1. Which term is used to identify the descent of the posterior bladder and trigone into the vaginal canal?
a. Rectocele c. Cystocele
b. Vaginocele d. Enterocele

 

 

ANS:  C

Cystocele is the only term used to identify the descent of a portion of the posterior bladder wall and trigone into the vaginal canal; the trauma of childbirth is usually the cause.

 

PTS:   1                    REF:   Page 819

 

  1. What type of cyst develops when an ovarian follicle is stimulated but no dominant follicle develops and completes the maturity process?
a. Follicular c. Corpus albicans
b. Corpus luteal d. Benign ovarian

 

 

ANS:  D

Only benign cysts of the ovary are produced when a follicle or a number of follicles are stimulated but no dominant follicle develops and completes the maturity process.

 

PTS:   1                    REF:   Page 820

 

  1. Which term is used to identify benign uterine tumors that develop from smooth muscle cells in the myometrium and are commonly called uterine fibroids?
a. Endometrial polyps c. Leiomyomas
b. Myometrial polyps d. Myometriomas

 

 

ANS:  C

Leiomyomas, commonly called myomas or uterine fibroidsare benign smooth muscle tumors in the myometrium (see Figure 24-14). The other terms do not accurately identify the tumors described.

 

PTS:   1                    REF:   Page 821

 

  1. What theory is used to describe the cause of endometriosis?
a. Obstruction within the fallopian tubes prevents the endometrial tissue from adhering to the lining of the uterus.
b. Endometrial tissue passes through the fallopian tubes and into the peritoneal cavity and remains responsive to hormones.
c. Inflammation of the endometrial tissue develops after recurrent sexually transmitted diseases.
d. Endometrial tissue lies dormant in the uterus until the ovaries produce sufficient hormone to stimulate its growth.

 

 

ANS:  B

It has been proposed that endometriosis is caused by the implantation of endometrial cells during retrograde menstruation, during which menstrual fluids move through the fallopian tubes and empty into the pelvic cavity (see Figure 24-16). Similar to normal endometrial tissue, the ectopic (out of place) endometrium responds to the hormonal fluctuations of the menstrual cycle. Of the available options, this answer is the only accepted theory for the cause of endometriosis.

 

PTS:   1                    REF:   Page 823

 

  1. Which virus is a precursor for developing cervical intraepithelial neoplasia (CIN) and cervical cancer?
a. Human papillomavirus (HPV) c. Herpes simplex II virus (HSV)
b. Epstein-Barr virus (EBV) d. Cytomegalovirus (CMV)

 

 

ANS:  A

Infection with high-risk (oncogenic) types of HPV (predominantly 16 and 18) is a necessary precursor to the development of precancerous dysplasia of the cervix that leads to invasive cancer. The other options are not precursors to CIN and cervical cancer.

 

PTS:   1                    REF:   Page 825

 

  1. Which description is used when a progressive neoplastic change involves the full epithelial thickness of the cervix?
a. Cervical intraepithelial neoplasia c. Cervical carcinoma in situ
b. Cervical dysplasia d. Invasive carcinoma of the cervix

 

 

ANS:  C

The progressive neoplastic changes of cervical cells are classified on a continuum from cervical intraepithelial neoplasia (dysplasia) to cervical carcinoma in situ (full epithelial thickness of the cervix is involved), which is generally a precursor of invasive carcinoma of the cervix to invasive carcinoma of the cervical tissue.

 

PTS:   1                    REF:   Page 827

 

  1. Which factor increases the risk for ovarian cancer after the age of 40 years?
a. Use of fertility drugs c. Multiple pregnancies
b. Oral contraceptive use d. Prolonged lactation

 

 

ANS:  A

Ovarian cancer in women older than 40 years of age is associated with early menarche, late menopause, nulliparity, and the use of fertility drugs. The other options are not necessarily related to women older than the age of 40 years.

 

PTS:   1                    REF:   Page 831

 

  1. Infertility is defined as the inability to conceive after how many months of unprotected intercourse with the same partner?
a. 6 c. 18
b. 12 d. 24

 

 

ANS:  B

Infertility is defined as the inability to conceive after 1 year of unprotected intercourse with the same partner.

 

PTS:   1                    REF:   Page 835

 

  1. Which of the following is not considered a cause of galactorrhea?
a. Proliferation of the lactiferous ducts of the breast
b. Hypothyroidism, resulting from a decrease in thyroid-releasing hormone
c. Excess prolactin secretion from the pituitary
d. Drugs such as high-dose oral contraceptives and phenothiazines

 

 

ANS:  A

The most common cause of galactorrhea is nonpuerperal hyperprolactinemia, or excessive amounts of prolactin. A variety of exogenous agents (such as drugs) and disorders can trigger one of these three mechanisms, thereby causing hyperprolactinemia. Hypothyroidism causes increased secretion of hypothalamic thyroid-releasing hormone, which stimulates the release of prolactin from the pituitary. The proliferation of lactiferous breast ducts is not associated with galactorrhea.

 

PTS:   1                    REF:   Pages 836-837

 

  1. Fluid-filled squishy sacs characterize which breast disorder?
a. Paget disease c. Nonproliferative breast lesions
b. Cysts d. Lobular carcinoma in situ

 

 

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. The other options do not accurately identify the disorder associated with these symptoms.

 

PTS:   1                    REF:   Pages 838-839

 

  1. What are typical findings on breast palpation of a woman diagnosed with simple fibroadenoma?
a. Painful, round, movable, and fluid-filled mass
b. Painless, movable, hard, and irregular mass
c. Smooth, solid, mobile, and well-circumscribed mass
d. Smooth, nonmovable, irregular, and soft mass

 

 

ANS:  C

Only this option accurately identifies the typical palpation results of a simple fibroadenoma.

 

PTS:   1                    REF:   Pages 840-841

 

  1. Which benign breast tumor affects postmenopausal women and is characterized by the principal lactiferous ducts becoming dilated and filled with cellular debris?
a. Mammary duct ectasia c. Phyllodes tumor
b. Intraductal papilloma d. Fibroadenoma

 

 

ANS:  A

Of the options available, only mammary duct ectasia is associated with the age and the identified pathologic characteristics (see Table 24-9).

 

PTS:   1                    REF:   Page 838 | Table 24-9

 

  1. The majority of the small percentage of ovarian cancers that are associated with a known pattern of inheritance are associated with:
a. Susceptibility of the BRCA1 gene
b. 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                    REF:   Page 831

 

  1. What is usually the first clinical manifestation of breast cancer?
a. Nipple dimpling c. Enlargement of one breast
b. Nipple discharge d. Painless lump

 

 

ANS:  D

Invasive carcinoma of the breast generally exhibits a nontender palpable mass or thickened area. This option is the only answer that accurately describes the first clinical manifestation of breast cancer.

 

PTS:   1                    REF:   Page 873

 

MULTIPLE RESPONSE

 

  1. What is a recognized treatment for the symptoms often associated with pelvic organ prolapse? (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                    REF:   Page 818

 

  1. Dysfunctional uterine bleeding (DUB), secondary to ovarian dysfunction, is abnormal uterine bleeding resulting from: (Select all that apply.)
a. Endometriosis
b. Progesterone deficiency
c. Sexually transmitted infections
d. Congenital abnormalities in the uterine structure
e. Estrogen excess

 

 

ANS:  B, E

Of the options available, DUB, secondary to ovarian dysfunction, is a result of either progesterone deficiency or unopposed estrogen excess.

 

PTS:   1                    REF:   Pages 808-809

 

  1. The size of benign uterine tumors, such as leiomyomas, is thought to be caused by the influence of which hormone? (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 only estrogen, progesterone, growth factors, angiogenesis, and apoptosis.

 

PTS:   1                    REF:   Page 822

 

  1. What are the common clinical manifestations of endometriosis? (Select all that apply.)
a. Back and flank pain
b. 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                    REF:   Page 824

 

Chapter 48: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Adults

 

MULTIPLE CHOICE

 

  1. What is the final outcome of impaired cellular metabolism?
a. Cellular alterations in the heart and brain
b. Buildup of cellular waste products
c. Cellular alterations in the vasculature structures and kidneys
d. Impairment of urine excretion

 

 

ANS:  B

The common pathway in all types of shock is impairment of cellular metabolism as a result of decreased delivery of oxygen and nutrients, which are frequently coupled with an increased demand, the consumption of oxygen and nutrients, and a decreased removal of cellular waste products. Of the options available, this selection is the only accurate outcome.

 

PTS:   1                    REF:   Page 1669

 

  1. Which clinical manifestation of septic shock confirms an elevation in immune system response?
a. Tachycardia c. Low respiratory rate
b. Increased white blood cell count d. Hypothermia

 

 

ANS:  B

Clinical manifestations common in septic shock are fever, high heart rate, high respiratory rate, or elevations in immune responses, such as increased white blood cells and circulating blood glucose.

 

PTS:   1                    REF:   Page 1671

 

  1. The release of catecholamine by the adrenal glands compensate for which initial effects of hypovolemic shock?
a. Interstitial fluid moves out of the vascular compartment.
b. Systemic vascular resistance is decreased.
c. Heart rate is increased.
d. Water excretion is increased.

 

 

ANS:  C

Compensatory mechanisms (see Figure 48-3) initially offset hypovolemia. Heart rate and systemic vascular resistance increase as a result of catecholamine release by the adrenal glands, which boosts cardiac output and tissue perfusion pressures. Compelled by a decrease in capillary hydrostatic pressures, interstitial fluid moves into the vascular compartment. The liver and spleen add to blood volume by disgorging stored red blood cells and plasma. In the kidneys, renin (through several intermediaries) stimulates aldosterone release and the retention of sodium and therefore water, whereas antidiuretic hormone (ADH), or vasopressin, from the posterior pituitary gland increases water retention. Data on the compensation of ADH, however, show that as shock worsens, ADH in plasma decreases.

 

PTS:   1                    REF:   Page 1672

 

  1. Hypovolemic shock begins to develop when intravascular volume has decreased by what percentage?
a. 5 c. 15
b. 10 d. 20

 

 

ANS:  C

Hypovolemic shock begins to develop when intravascular volume has decreased by approximately 15%.

 

PTS:   1                    REF:   Page 1672

 

  1. What type of shock develops as a result of the overstimulation of the parasympathetic nervous system or the understimulation of the sympathetic nervous system?
a. Septic c. Anaphylactic
b. Cardiogenic d. Vasogenic

 

 

ANS:  D

Only vasogenic shock refers to a widespread and massive vasodilation resulting from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle.

 

PTS:   1                    REF:   Pages 1673-1674

 

  1. What is the clinical hallmark of neurogenic shock as a result of the overstimulation of the parasympathetic nervous system?
a. Vasoconstriction c. Increased metabolism
b. Vasodilation d. Respiratory distress

 

 

ANS:  B

Neurogenic shock refers to a widespread and massive vasodilation that results from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. None of the other options are related to this condition.

 

PTS:   1                    REF:   Page 1673

 

  1. Which form of shock is often more severe than other forms because of its sudden, rapid systemic vasodilation?
a. Septic c. Anaphylactic
b. Hypovolemic d. Neurogenic

 

 

ANS:  C

Anaphylactic shock is often more severe than other types of shock because the hypersensitivity reaction, which triggers vasodilation, has other pathophysiologic effects that rapidly involve the entire body. This action is not associated with the other options.

 

PTS:   1                    REF:   Pages 1674-1675

 

  1. What type of shock is related to a decrease in systemic vascular resistance?
a. Septic c. Hypovolemic
b. Cardiogenic d. Heart failure

 

 

ANS:  A

Clinical manifestations of only septic shock are persistent low arterial pressure, low systemic vascular resistance from vasodilation, and an alteration in oxygen extraction by all cells.

 

PTS:   1                    REF:   Page 1675

 

  1. For which type of shock would antihistamines and corticosteroids be prescribed?
a. Septic c. Hypovolemic
b. Anaphylactic d. Cardiogenic

 

 

ANS:  B

Only anaphylactic shock responds to the administration of epinephrine to decrease mast cell and basophil degranulation. Antihistamines and steroids are administered to stop the inflammatory reaction.

 

PTS:   1                    REF:   Page 1675

 

  1. Which condition is best defined as a clinical syndrome involving a systemic response to infection, which is manifested by two or more of the systemic inflammatory response syndrome criteria?
a. Bacteremia c. Septicemia
b. Sepsis d. Septic shock

 

 

ANS:  B

Of the options available, only sepsis is best defined as a systemic response to infection that is manifested by two or more criteria of the systemic inflammatory response syndrome.

 

PTS:   1                    REF:   Page 1676 | Table 48-1

 

  1. In septic shock, which mediators are antiinflammatory?
a. Interleukin (IL)–4 (IL-4), IL-10, and IL-13
b. Tumor necrosis factor–alpha (TNF-a) and granulocyte cell-stimulating factor
c. IL-1, IL-2, and IL-6
d. Prostaglandin, leukotrienes, and bradykinin

 

 

ANS:  A

In septic shock, the only antiinflammatory mediators released include lipopolysaccharide-binding protein; IL-1 receptor antagonist; soluble cluster of differentiation 14 (CD-14); type 2 IL-1 receptor; leukotriene b4-receptor antagonist; IL-4, IL-10, and IL-13; and soluble TNF.

 

PTS:   1                    REF:   Page 1675

 

  1. What mechanism causes organ injury in primary multiple organ dysfunction syndrome (MODS)?
a. Impaired immune response c. Impaired perfusion
b. Impaired glucose use d. Impaired ventilation

 

 

ANS:  C

In primary MODS, the organ injury is directly associated with a specific insult, most often ischemia or impaired perfusion from an episode of shock or trauma, thermal injury, soft-tissue necrosis, or invasive infection. None of the other options accurately identifies the cause of MODS.

 

PTS:   1                    REF:   Page 1680

 

  1. In secondary multiple organ dysfunction syndrome (MODS), what stimulates the normal endothelial cells to change to a proinflammatory state?
a. Interleukin (IL)–4 (IL-4) and IL-13
b. IL-1, IL-6, and tumor necrosis factor (TNF)
c. Interferon gamma (IFN-g) and granulocyte cell-stimulating factor
d. Prostaglandin, leukotrienes, histamine, and bradykinin

 

 

ANS:  B

Normal endothelial cells have little interaction with leukocytes except when stimulated by TNF, IL-1, and IL-6. This selection is the only option that accurately describes what stimulates the normal endothelial cells to change to a proinflammatory state.

 

PTS:   1                    REF:   Page 1680

 

  1. What stimulates the respiratory burst and production of highly toxic free radicals in the multiple organ dysfunction syndrome (MODS)?
a. Neutrophils adhering to the endothelium
b. Activation of the complement cascade
c. Release of prostaglandins, thromboxanes, and leukotrienes
d. Activation of the fibrinolytic system

 

 

ANS:  A

The accumulation of activated neutrophils in organs is thought to play a key role in the pathogenetic development of MODS. When neutrophils adhere to the endothelium, they undergo a respiratory burst (oxidative burst) and release oxygen radicals. The respiratory burst occurs as the activated neutrophil experiences a sudden increase in oxidative metabolism, producing large quantities of highly toxic oxygen free radicals. This selection is the only option that accurately identifies the stimulant of the respiratory burst that results in the production of toxic free radicals.

 

PTS:   1                    REF:   Page 1682

 

  1. In multiple organ dysfunction syndrome (MODS), the gut hypothesis attempts to explain which phenomena?
a. Paralytic ileus
b. Translocation of bacteria
c. Maldistribution of blood flow
d. Massive diarrhea accompanying septic shock

 

 

ANS:  B

The loss of intestinal barrier function leads to the systemic spread of bacteria and/or endotoxin from the gut (systemic endotoxemia). This phenomenon is called translocation of bacteria. The gut hypothesis provides a possible explanation for the fact that an infectious focus is not always found in individuals with MODS. The gut hypothesis is not related to any other option.

 

PTS:   1                    REF:   Page 1682

 

  1. Blistering of the skin within minutes occurs in which type of burn injury?
a. First degree c. Deep second degree
b. Superficial second degree d. Third degree

 

 

ANS:  B

The hallmark of superficial partial-thickness injury is the appearance of thin-walled, fluid-filled blisters that develop within only a few minutes after injury. Blistering that occurs within minutes of the burn injury is not a defining characteristic of the other options.

 

PTS:   1                    REF:   Page 1686

 

  1. Which form of shock occurs from an acute burn injury?
a. Hypovolemic c. Cardiogenic
b. Septic d. Vasogenic

 

 

ANS:  A

Burn shock consists of a hypovolemic cardiovascular component and a cellular component. Hypovolemia associated with burn shock results from massive fluid losses from the circulating blood volume. The other forms of shock are not directly related to an acute burn injury.

 

PTS:   1                    REF:   Page 1689

 

  1. Which fluid is most often used in fluid resuscitation after a major burn injury?
a. Saline c. Lactated Ringer solution
b. Albumin d. Dextrose in water

 

 

ANS:  C

Lactated Ringer solution is used most often because it closely approximates extracellular fluid, the repository of fluid leaving the circulatory system during this phase of extensive edema formation (see Table 48-4). The other options are not most often used in fluid resuscitation after major burns.

 

PTS:   1                    REF:   Page 1689

 

  1. What is the most reliable criterion of adequate fluid resuscitation after a major burn injury?
a. Blood pressure c. Respiratory rate
b. Pulse rate d. Urine output

 

 

ANS:  D

The most reliable criterion for adequate resuscitation of burn shock is urine output. None of the remaining options are considered reliable.

 

PTS:   1                    REF:   Page 1690

 

  1. The endpoint of burn shock is defined as the time when the individual is able to do which of the following?
a. Maintain adequate blood pressure for 4 hours.
b. Maintain adequate urine output for 2 hours.
c. Manage pain without narcotics.
d. Manage pain during dressing changes.

 

 

ANS:  B

The endpoint of burn shock is defined as the state in which the individual is able to maintain adequate urine output for 2 hours with the intravenous fluid administration rate equal to the individual’s calculated maintenance rate (see Box 48-4). None of the remaining options are defined as the endpoint of burn shock.

 

PTS:   1                    REF:   Page 1690

 

  1. Which condition does a burn injury create for an extended period?
a. Hypervolemia c. Hyponatremia
b. Hypermetabolism d. Hypotension

 

 

ANS:  B

Of the options available, a burn injury induces a hypermetabolic state that persists until wound closure.

 

PTS:   1                    REF:   Page 1691

 

  1. What effect does a fatal burn injury have on interleukins (ILs)?
a. Decreases levels of IL-2, which may decrease T helper 1 (Th1) lymphocytes.
b. Decreases levels of IL-4, which causes a shift in production from Th1 to Th2 lymphocytes.
c. Decreases levels of IL-6, which produces cytokines.
d. Decreases levels of IL-12, which stimulates the production of immunoglobulins.

 

 

ANS:  A

A fatal burn injury has often shown decreased levels of IL-2, which may result in decreased Th1 lymphocytes. This option is the only accurate description of the effect a fatal burn injury has on ILs.

 

PTS:   1                    REF:   Page 1692

 

  1. Daily evaporative water loss after a burn injury is approximately how many times the normal?
a. 5 c. 15
b. 10 d. 20

 

 

ANS:  D

Moncrief and Mason attempted to determine the magnitude of such a loss and determined that daily evaporative water loss was in the range of 20 times normal in the early phase of injury, with gradual decreases as wound closure is achieved.

 

PTS:   1                    REF:   Page 1693

 

  1. What is the significance of a high level of interleukin 1 (IL-1) in a patient who has experienced severe burns?
a. Prognosis is poor. c. Urinary function is improved.
b. Antibiotic therapy is required. d. They are less at risk for death.

 

 

ANS:  D

The level of IL-1 inversely correlates with burn survival; low levels may be associated with a higher mortality. This selection is the only option that accurately identifies the significance of a high level of IL-1.

 

PTS:   1                    REF:   Page 1692

 

  1. What is the purpose of monitoring procalcitonin (PCT) levels in a patient after a burn?
a. To help evaluate the potential risk for respiratory complications
b. To justify the initiation of antibiotic therapy
c. To determine when discontinuing antibiotic use is feasible
d. To help in the selection of appropriate antibiotic therapy agents

 

 

ANS:  C

Seeking to decrease the use of antibiotics in the patient who is critically ill and thus prevent resistance to antibiotics is an important strategy in treating infection. Recent research suggests that monitoring serial PCT levels, a precursor hormone to calcitonin, may be used to shorten antibiotic use in the treatment of respiratory infections. PCT, normally not discernible on assay, when elevated may indicate specific proinflammatory response during a bacterial infection. PCT levels should not be used as an indicator to start antibiotics; however, if monitored sequentially at the start of empiric antibiotics and then dropped to low levels, then discontinuation may be clinically indicated.

 

PTS:   1                    REF:   Page 1679 | What’s New box

 

  1. How many milliliters of fluid replacement per hour does a 70-kg adult with a 50% total body surface area burn and a body surface area of 2 m require?
a. 150 c. 350
b. 275 d. 500

 

 

ANS:  B

A 70-kg adult with a 50% total body surface area burn and a body surface area of 2 m requires the following:

Basal = (1500 ml/day) (2 m2 body surface area) = 3000 ml/24 hr or 125 ml/hr

Evaporative = (25 + 50% total body surface burn)

(2m2 total body surface area) = (75) (2) = 150 ml/hr

Total maintenance fluids = 125 ml + 150 ml = 275 ml/hr

 

PTS:   1                    REF:   Page 1690 | Box 48-4

 

MULTIPLE RESPONSE

 

  1. A patient will be referred to the burn unit when which criteria are met? (Select all that apply.)
a. Patient is older than 5 years of age.
b. The burn involves the face or a major joint.
c. The source of the burn is electrical.
d. Partial thickness burns are on more than 10% of the total body surface area (TBSA).
e. Patient has a life-threatening trauma injury.

 

 

ANS:  B, C, D

A burn unit may treat adults or children or both. Burn injuries that should be referred to a burn unit include the following: partial-thickness burns on more than 10% TBSA, burns that involve the face, hands, feet, genitalia, perineum, or major joints, and electrical burns, including lightning injury. If the trauma poses the greater immediate risk, then the patient’s condition may be initially stabilized in a trauma center before being transferred to a burn center.

 

PTS:   1                    REF:   Page 1689 | Box 48-3

 

  1. Which feedback loop will further impair oxygen in all types of shock? (Select all that apply.)
a. Activation of the fibrinolytic cascade
b. Increased circulating volume
c. Hypermetabolic state
d. Lysosomal enzyme release
e. Activation of the clotting cascade

 

 

ANS:  D, E

Both positive and negative compensatory mechanisms, such as anaerobic metabolism, lysosomal enzyme release, decreased intravascular volume, and activation of the clotting cascade, may further impair oxygen delivery and use. The remaining options are not related to impaired oxygen delivery.

 

PTS:   1                    REF:   Page 1669

 

MATCHING

 

Match the types of shock with the corresponding descriptions. Terms can be used more than once.

______ A. Cardiogenic

______ B. Hypovolemic

______ C. Neurogenic

______ D. Anaphylactic

______ E. Septic

 

  1. Follows a systemic inflammatory response.

 

  1. Follows widespread hypersensitivity reaction.

 

  1. Follows myocardial infarction.

 

  1. Follows major burns.

 

  1. Follows parasympathetic stimulation.

 

  1. ANS:  E                    PTS:   1                    REF:   Page 1675

MSC:  Septic shock begins with systemic inflammatory response syndrome. It then evolves into sepsis, into severe sepsis, and finally into septic shock.

 

  1. ANS:  D                    PTS:   1                    REF:   Page 1674

MSC:  Anaphylactic shock is the outcome of a widespread hypersensitivity reaction known as anaphylaxis.

 

  1. ANS:  A                    PTS:   1                    REF:   Page 1671

MSC:  Cardiogenic shock results from the inability of the heart to pump adequate blood to tissues and end organs. This type of shock occurs from any cause, the most common being within hours of an acute myocardial infarction or severe episode of myocardial ischemia.

 

  1. ANS:  B                    PTS:   1                    REF:   Page 1689

MSC:  Hypovolemia associated with burn shock results from massive fluid losses from the circulating blood volume.

 

  1. ANS:  C                    PTS:   1                    REF:   Pages 1673-1674

MSC:  Any factor that stimulates parasympathetic activity or inhibits sympathetic activity of vascular smooth muscle can cause neurogenic shock.