2023-2024 NURS231 Pathophysiology Final Exam Module 1-10 With Answers-248 Solved Questions

NURS 231 PATHOPHYSIOLOGY 2023-2024
MODULE 1-10 EXAMS AND 3 VERSIONS OF THE FINAL EXAM
QUESTIONS AND CORRECT ANSWERS
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Path 231 exams reviews
Exam 1
Question 1
Persistent metaplasia can lead to dysplasia.
True
False
Answer: True
Question 2
Barrett esophagus is an example of dysplasia.
True
False
Answer: True
Question 3
Cervical intraepithelial neoplasia is a type of dysplasia.
True
False
Answer: True
Question 4
Endometrial hyperplasia is a normal physiologic occurrence.
True
False

Answer: True
Question 5
1. Proportion of people with a disease who are positive for that disease
a. Validity
2. How likely the same result will occur if repeated
b. Reliability
3. How a tool measures what it is intended to measure
c. Sensitivity
4. People without the disease who are negative on a given test
d. Specificity
Answer:

Question 6
Which are true of the mitochondria? Select all that apply.
a. It is involved in cellular respiration
b. They are found far from the site of energy consumption
c. They play a role in apoptosis
d. They control free radicals
Answer: a. It is involved in cellular respiration

b. They are found far from the site of energy consumption
c. They play a role in apoptosis
Question 7
Which of the following are true regarding cell communication? Select all that apply.
a. Paracrine signaling depends on hormones
b. Neurotransmitters act through synapses
c. Enzyme linked receptors act through an on-off switch
d. Autocrine signaling releases a chemical into the extracellular fluid that affects its own activity
Answer: a. Paracrine signaling depends on hormones
b. Neurotransmitters act through synapses
d. Autocrine signaling releases a chemical into the extracellular fluid that affects its own activity
Question 8
Which of the following are false of the cell?
a. Proteins carry out the functions of the cell membrane.
b. Lysosomes are the digestive system of the cell.
c. The rough ER is the site for lipid synthesis.
d. Microfilaments are thin, threadlike cytoplasmic structures.
Answer: c. The rough ER is the site for lipid synthesis.
Question 9
Which is true of the cytoskeleton? Select all that apply.
a. It controls shape and movement
b. Cilia and flagella are microtubule-filled cellular extensions
c. It includes peroxisomes and proteasomes
Answer: b. Cilia and flagella are microtubule-filled cellular extensions
Question 10
What factors are used by epidemiologic methods? Select all that apply.
a. How disease is spread

b. How to control disease
c. How to prevent disease
d. How to eliminate disease
e. How to treat disease
f. All of the above
g. None of the above
Answer: a. How disease is spread
b. How to control disease
c. How to prevent disease
d. How to eliminate disease
e. How to treat disease
Question 11
A patient complains of a sore throat and headache. What are these examples of?
a. Signs
b. Symptoms
c. Both A & B
Answer: b. Symptoms
Question 12
Which of the following is NOT helpful to the clinician to make a diagnosis?
a. Detailed history
b. Physical exam
c. Evidence based practice
d. Laboratory tests
Answer: a. Detailed history
Question 13
Chemical agents (poison, alcohol) are examples of which of the following?
a. Risk factors
b. Clinical manifestations

c. Pathogenesis
d. Etiologic factors
Answer: a. Risk factors
Question 14
Define primary prevention and give an example
Answer: When the risk factors has to be remove to stop the disease from occurring exampleeathing healthy / exercising to stay in shape or prevent heart disease. Giving vaccination to prevent
disease in children
The goal of primary prevention is to remove risk factors to prevent disease from occurring.
Examples include taking folic acid while pregnant to prevent neural tube defects, vaccinating
children to prevent communicable disease, eating healthy and exercising to prevent heart disease,
and wearing seatbelts or helmets.
Question 15
Explain apoptosis and why it is necessary:
Answer: apoptosis is the programmed of cell death. This process is necessary for cell dividing
because it is removing unwanted cells to make way for new cell.
Apoptosis is programmed cell death. This process eliminates cells that are worn out, have been
produced in excess, have developed improperly, or have genetic damage. Apoptosis is also
responsible for several normal physiologic processes, like replacing cell in the intestinal villi and
removing aging red blood cells.
Question 16
Explain what necrosis is and give an example and description of one type of necrosis.
Answer: necrosis is when cell dies in an organ/tissues that is still alive this process can interferes
with the tissue regeneration and how cell can be replace.
One type of necrosis is gangrenous necrosis which can bowel or the lower extremities that may
causes changes in tissue and it functions

Necrosis refers to cell death in an organ or tissues that is still part of a living person. It often
interferes with cell replacement and tissue regeneration. Coagulative necrosis results most often
from a sudden cutoff of blood supply to an organ (ischemia), particularly the heart and kidney.
Liquefactive necrosis occurs when some of the cells die but their catalytic enzymes are not
destroyed. It is commonly seen with brain infarcts or abscesses. Caseous necrosis occurs as part
of granulomatous inflammation and is most often associated with tuberculosis.
Gangrenous necrosis most often affects the lower extremities or bowel and is secondary to vascular
occlusion. The term gangrene is applied when a considerable mass of tissue undergoes necrosis.
In dry gangrene the affected tissue becomes dry and shrinks, the skin wrinkles, and its color
changes to dark brown or black. The spread of dry gangrene is slow. It results from a cut off in
arterial blood supply and is a form of coagulation necrosis. In wet gangrene, the affected area is
cold, swollen, and pulseless. The skin is moist, black, and under tension. Blebs form on the surface,
liquefaction occurs, and a foul odor is caused by bacterial action. The spread of tissue damage is
rapid.
Question 17
Match the type of cell injury to the cause. Some answers may be used more than once.
1. Sunburn

a. Physical agents

2. Obesity

b. Radiation injury

3. Reactive oxygen species

c. Chemical injury

4. Low oxygen to tissues

d. Biologic agents

5. Fractures

e. Nutritional imbalances

6. OTC drugs

f. Free radical injury

7. Hypothermia

g. Hypoxic cell injury

8. Radiation treatment
9. Lead toxicity
10. Bacteria
Answer:

Question 18
List the 4 types of tissue found in the body. Pick 2 and give a description and example of each.
Answer: nervours tissue-can be find throughout the body and it's used for communication. Muscle
tissue connective tissue epithelial-(covers the outer surface of the body and lines the inner surfaces.
Epithelial tissue covers the body’s outer surface, lines the inner surfaces, and forms glandular
tissue. Epithelial tissue has three distinct surfaces and the basal surface is attached to an underlying
basement membrane. It is avascular, meaning without blood vessels. It receives oxygen and
nutrients from the capillaries of the connective tissue on which it rests.
Connective or supportive tissue is the most abundant tissue in the body. It connects and binds or
supports the various tissues. Its cells produce the extracellular matrix that support and hold tissues
together. Connective tissue is divided into two types: connective tissue proper and specialized
connective tissue (cartilage, bone, and blood cells). The four types of connective tissue proper are
loose (areolar), adipose, reticular, and dense connective tissue.
The function of muscle tissue is to move the skeletal structures, pump blood through the heart, and
contract the blood vessels and visceral organs. Muscle tissue can accomplish this by contraction.
The two types of fibers that contract are called thin and thick filaments. Thin filaments are called
actin, and the thick filaments are myosin. The three types of muscles tissue are skeletal, cardiac,
and smooth.

Nervous tissue is distributed throughout the body for communication. It provides the means for
controlling body function and for sensing and moving about the environment. The two types of
cells are neuron and glial cells. Neurons function is communication. Glial ( meaning glue) cells
support the neurons.
Question 19
What term means “cell eating” and engulfs and then kills microorganisms or other particulate
matter?
Answer: cell eating is referred to phagocytosis
Phagocytosis
Question 20
What term means “cell drinking,” and engulfs small solid or fluid particles, as seen with proteins
and electrolytes?
Answer: cell drinking is referred to pinocytosis
Pinocytosis
Question 21
Give one function of a membrane potential:
Answer: Membrane potential can causes music contractions
Generate nerve impulse, muscle contractions, or cause hormone secretion
Question 22
What is the term that best describes the following process?
A transport protein aiding a lipid insoluble or large molecule across the cell membrane that would
otherwise not be able to pass through on its own.
Answer: Facilitated diffusion

Exam 2

Question 1
Blood tests for tumour markers can make a diagnosis of cancer. Why or why not?
Answer: false, because tumour are usually elevated in benign conditions ,and in the early stages
of malignancy they can't be elevated.
False, only tissue can diagnose. Tumour markers are helpful to assess response to therapy or
reoccurrence.
Question 2
What is the most important procedure in diagnosing the correct cancer and histology?
Answer: tissue biopsy because they play a critical role in dignosing the right cancer and
histology tissue biopsy
Question 3
Explain the TNM system:
Answer: is a staging system that was created by AJCC for the help study cancer. It is also very
effective in classifying cancers tumor componments.
Classification goes as such:
T relates to the local spread of the primary of the tumor and the size
N relates to the involvement of the regional/location of the lymph nodes
M is the extent of the metastatic involvement
T is the size and local spread of the primary tumor.
N is the involvement of the regional lymph nodes.
M is the extent of the metastatic involvement.
Question 4
1. List two signs or symptoms a patient may present with that might indicate a cancer diagnosis:
2. What are two side effects commonly experienced by cancer patients?
Answer: 1) Bleeding and weight loss
2) hair loss and sleep disturbances

1. Bleeding; sore that doesn’t heal; fluid in the pleural, pericardial, or peritoneal spaces; chest
pain, shortness of breath, cough, abdominal discomfort or swelling. Other possible answers can
include a mass or lump, pain (need to be specific), fatigue, fevers, weight loss
2. Weight loss, wasting of body fat and muscle tissue, weakness, anorexia, and anemia, fatigue,
sleep disturbances
Question 5
1. What are the three possible goals of cancer treatment?
2. How does radiation kill cancer cells?
Answer: 1) the three goal is to curative, control and palliative
2) radiation kill cancer cells by using high energy/waves particles to destroy/damage cancer cells.
However this treatment can sometimes interrupt the cells cycle by killing good cells or damaging
DNA cells
1. Curative, control, palliative
2. Radiation therapy uses high-energy particles or waves to destroy or damage cancer cells. This
leads to the creation of free radicals, which damage cell structures. Radiation can interrupt the
cell cycle process, kill cells, or damage DNA in the cells.
Question 6
Cell proliferation is the process in which proliferating cells become more specialized cell types.
True
False
Answer: False, cell differentiation
Question 7
Cell differentiation is the process in which proliferating cells become more specialized cell types.
True
False
Answer: False
Question 8

This type of cell remains incompletely differentiated throughout life:
Answer: stem cell
Question 9
These are cells of the same lineage that have not yet differentiated to the extent that they have
lost their ability to divide:
Answer: they are progenitor
Progenitor or parent cells
Question 10
What is angiogenesis? Why do tumors need it?
Answer: angiogenesis is the devolvement of new blood vessels with a tumor and tumorns need
angiogenesis to grow development of new blood vessels within the tumor. They need it to
continue to grow.
Question 11
What are normal genes called that become cancer-causing if mutated?
Answer: protooncogenes
Question 12
What is a tumor suppressor gene? Give one example.
Answer: they're gene that are associated with gene underactivity because of this it slows down
cell division or may tell cell when to die.
Tumor suppressor genes are associated with gene underactivity. These genes slow down cell
division, repair DNA mistakes, or tell cells when to die. BRCA1 or 2, TP53
Question 13
A 40-year-old woman has experienced heavy menstrual bleeding. She was told she has a uterine
tumor called a leiomyoma. She is worried she has cancer. What do you tell her? Explain at least
2 differences between a benign and malignant tumor.

Answer: I will tell her not to worry because leiomyoma is a non-cancerous tumor and it can be
surgically remove and to always have a regular doctor visit two differences between a benign
and malignant tumor is that has a well-differentiated cells and have slow progressive growth rate.
Malignant tumor is more aggressive because it destroy tissue, grows rapidly and spread to other
body parts and lacks well defined margins Leiomyoma is a benign tumor. (Leiomyosarcoma is
malignant) Student can add any of the following: Benign tumors are well-differentiated cells,
resemble the cells of tissues of origin, and have a slow, progressive rate of growth. They grow
by expansion and remain localized to their site of origin, not capable of metastasizing. They
develop a rim of connective tissue around the tumor called a fibrous capsule, which aids in
surgical removal. Benign tumors are less of a threat unless they interfere with vital functions
Malignant neoplasms invade and destroy tissue. They grow rapidly, spread to other parts of the
body, and lack well-defined margins. They can compress blood vessels and outgrow their blood
supply, causing ischemia and tissue injury. Surgery can be more difficult if it has spread.
Question 14
A 62-year-old man with a 30-pack year smoking history is diagnosed with small cell lung cancer
with metastasis to the bone. (1) Explain the process of how cancer spreads metastatically. (2)
What symptoms might he have presented with? (3) Which screening test would he have benefited
from?
Answer: 1) concern that are spreads by metastatically is loose from the primary tumor that have
extracellular matrix from the surrounding tumor, or has gain access to the blood vessel which it
can grow and establish a blood supply.
2 some symptoms that may be presented are shortness of breath, chest or bone pain and cough
3) how benefited from low dose chest CT that could be done yearly
(1) Metastasis- a cancer cell must break loose from the primary tumor, invade the surrounding
extracellular matrix, gain access to a blood vessel, survive its passage in the bloodstream, emerge
at a favorable location, invade the surrounding tissue, begin to grow, and establish a blood supply.
(2) Chest pain, shortness of breath, cough, bone pain. (3) Yearly low-dose chest CT.
Question 15

Malignant tumors have which of the following characteristics? Select all that apply.
a. Variable rate of growth
b. Spreads by metastasis
c. Well-differentiated cells
d. Fibrous capsule
Answer: a. Variable rate of growth
b. Spreads by metastasis
d. Fibrous capsule
Question 16
What are molecular and cellular mechanisms in genes that increase susceptibility to cancer?
Select all that apply.
a. Lack of cellular senescence
b. Angiogenesis
c. Ability to undergo apoptosis
d. Mutations in growth factor signaling pathways
e. Intact DNA repair genes
Answer: b. Angiogenesis
c. Ability to undergo apoptosis
d. Mutations in growth factor signaling pathways
e. Intact DNA repair genes
Question 17
List 4 of the 7 risk factors linked to cancer as stated in the module.
Answer: 1) obesity
2) hormonal factors
3)environmental agents
4) cancer causing viruses
Heredity, hormonal factors, obesity, immunologic mechanisms, environmental agents such as
chemicals, radiation, and cancer-causing viruses.

Question 18
List three characteristics of cancer cells and briefly explain what it means:
Answer: cancer cells grow in an altered cell differentiation and growth which can also be called
neoplasia they can have a neoplasm growth where normal tissue lacks regulatory controls cancer
cells also have genetic abnormalities that causes uncontrollble proliferation and can cause normal
call or benign tumors into malignant tumors
Any of the following
Anaplasia is the loss of cell differentiation in cancerous tissue.
Genetic instability means they have a high frequency of mutations.
Growth factor independence means cancer cells can proliferate even in the absence of growth
factors.
Cell density-dependent inhibition means cancer cell don’t stop growing when they come into
contact with each other.
Cell cohesiveness and adhesion means they don’t stick together.
Anchorage dependence means cancer cells aren’t anchored to neighboring cells or the underlying
matrix to live and grow.
Cell-to-cell communication in cancer cells is poor, which interferes with intercellular
connections and responsiveness to membrane-derived signals.
Life span is unlimited – cancer cells are immortal.
Antigen expression -cancer cells contain several cell surface molecules or antigens that are
immunologically identified as foreign.
Cancer cells can produce enzymes, hormones, and other substances that the tissues of origin
either does not produce or produces in much smaller amounts.
Cancer cells can show cytoskeletal changes or abnormalities. This includes abnormal
intermediate filament types or changes in actin filaments and microtubules that help with
invasion and metastasis.
Question 19
Which of the following is not a risk factor for developing cancer?
a. Sunscreen
b. Obesity

c. HPV
d. High red meat intake
Answer: a. Sunscreen
Question 20
All of the following viral agents are correctly paired with the associated lesion except:
a. Human papillomavirus (HPV): genital warts
b. Epstein-Barr virus: carcinoma of the cervix
c. Epstein Barr is linked to Burkitt lymphoma and nasopharyngeal cancer. Cervical carcinoma is
linked to HPV.
d. Hepatitis B virus: hepatocellular carcinoma
e. Human herpes virus-8: Kaposi sarcoma
Answer: b. Epstein-Barr virus: carcinoma of the cervix
Question 21
List one example of screening for each method: observation, palpation, and lab test/procedure:
Answer: observation-external
Genitalia palpation-lymph nodes lab test/procedure- pap smear
Observation: skin, mouth, external genitalia
Palpation: breast, thyroid, rectum and anus, prostate, lymph nodes
Laboratory tests and procedures: Pap smear, colonoscopy, mammography

Exam 3
Question 1
Explain the challenges of diagnosing autoimmune disorders.
Answer: since there are too many autoimmune disorder, diagnosing is made by serological
finding, history or physical testing. Blood testing could have been a good way to test but since
some blood are more generic can be elevated to show other diseases therefore it best go by
finding that are listed.

There are over 80 identified, many with overlapping presentations. Many manifestations are
nonspecific and are seen in other non-autoimmune diseases. Blood testing isn’t perfect either, as
some tests are more generic and can be elevated in the presence of other diseases.
Question 2
Which cell is the first responder to phagocytose a foreign invader?
a. Monocyte
b. Basophil
c. Eosinophil
d. Dendritic cell
Answer: a. Monocyte
Question 3
What are the primary cells involved in the adaptive immune response?
a. Antibodies
b. Antigens
c. Neutrophils
d. Lymphocytes
Answer: d. Lymphocytes
Question 4
B lymphocytes produce what type of immunity?
Answer: humoral immunity
Question 5
Which immunoglobulin is responsible in inflammation and allergic responses and combating
parasitic infections?
a. IgM
b. IgE
c. IgA
d. IgD

e. IgG
Answer: b. IgE
Question 6
Which cell type is an early responder and the most abundant in the body?
a. Lymphocytes
b. Eosinophils
c. Basophils
d. Neutrophils
Answer: d. Neutrophils
Question 7
Which is NOT a finding consistent with Graves’ disease?
a. Exophthalmos
b. Hypothyroidism
c. hyperthyroidism
d. Goiter
e. Corneal ulceration
Answer: b. Hypothyroidism
Question 8
A 12-year-old female presents with itchy eyes, nasal congestion and drainage, and sneezing every
spring when the pollen count is high. (1) Explain the immunologic mechanisms that are
responsible for her symptoms. (2) What type(s) of treatment might be used to relieve her
symptoms?
Answer: it can be a cause od Type I hypersensitivety/ IGE as well as allergy, which is
responisible for her symptoms and treatment such as penicillin or some allergy medications
(1) Mast cells, basophils, and eosinophils play an important role in the development of type I
reactions because they contain the chemical mediator histamine. A primary or initial phase
response is vasodilation, vascular leakage, and smooth muscle contraction. A secondary or late-

phase response is characterized by more intense infiltration of tissues with eosinophils and other
acute and chronic inflammatory cells, as well as tissue damage.
(2) Antihistamines and intranasal corticosteroids are the mainstay of treatment.
Question 9
An antibiotic alone will heal an abscess. If false explain why:
Answer: false, because there be some pus in there that need or be drained to make sure that the
area don't infected false, antibiotics can’t penetrate the abscess wall, so incision and drainage are
necessary.
Question 10
An appendectomy is performed on a 16-year-old boy who is hospitalized for right lower quadrant
abdominal pain of 18 hours’ duration. The surgical specimen is edematous and erythematous. An
infiltrate of which of the following cells would be most characteristic of the process occurring
here?
a. Neutrophils
b. Neutrophils are the most characteristic cellular component of the early stages of acute
inflammation.
c. Eosinophils
d. Basophils
e. Lymphocytes
f. Monocytes
Answer: a. Neutrophils
Question 11
During inflammation, blood vessels constrict to minimize tissue damage.
True
False
Answer: True
Question 12

Active immunity provides long lasting protection.
True
False
Answer: False
Question 13
B lymphocytes normally produce antibodies against host tissues.
True
False
Answer: True
Question 14
Antibodies are also known as _____________?
Answer: immunoglobulins
Question 15
Which of the following hypersensitivity reactions can be treated with the administration of
epinephrine?
a. Type I
b. Type II
c. Type III
d. Type IV
Answer: a. Type I
Question 16
Which is NOT a type of type II hypersensitivity reaction?
a. Antigen-mediated cellular inflammation
b. antibody-mediated cellular dysfunction
c. Complement- and antibody-mediated inflammation
d. antibody-dependent cell cytotoxicity
e. complement-activated cell destruction

Answer: c. Complement- and antibody-mediated inflammation
Question 17
A finding of diagnostic significance is the well-known association of HLA-B27 antigen with
which of the following disorders?
a. Rheumatoid arthritis
b. Systemic lupus erythematosus (SLE)
c. Ankylosing spondylitis
d. HLA-B27 antigen is found in almost 90% of patients with ankylosing spondylitis
e. Graves’ disease
Answer: c. Ankylosing spondylitis
Question 18
What are autoantibodies?
Answer: when the immune system don't have the ability to recognize itself and produces
autoantibodies that acts against host tissues
In many autoimmune diseases, the immune system loses its ability to recognize self and produces
what is called autoantibodies, which act against host tissues.
Question 19
1, A 32-year-old woman presents to the clinic for her initial obstetrics visit, about 10 weeks into
her pregnancy. She is in a monogamous relationship. (1) Should an HIV test be part of her initial
blood work? Why?
2. An infant is born, and its initial antibody test is positive for HIV. (2) Does this mean the infant
is infected? What would be the more appropriate test to detect HIV in this infant?
Answer: Although she's in a monogamous relationship and have one partner it is still a good
idea to test for HIV in her initial blood work because if tested positive, it can be transmit directly
to the baby through birth or in the mother milk while breastfeeding.
2) yes, the baby has been infected most likely the virus has been transmission from its mother,
and the most appropriate test to detect HIV in this infants will be to use the DNA/RNA
polymerase cain reaction (PCR) because the infants would still have their mother's antibodies

1. Yes. Transmission from mother to infant is the most common way that children become
infected. The CDC recommends all people between ages 13 and 64 be routinely screened for
HIV. Earlier detection and treatment lead to better outcomes.
2. No. The polymerase chain reaction (PCR) test is a nucleic acid test that can detect HIV DNA.
It tests for the presence of the virus, rather than the antibody, which is helpful in diagnosing HIV
infection in infants born to infected mothers. These infants would have their mother’s antibodies
whether or not they have been infected.
Question 20
Which of the following will promote wound healing?
a. Malnutrition
b. Increased blood flow
c. Infection
d. Foreign bodies
Answer: b. Increased blood flow
Question 21
Which of the following cells is a permanent cell?
a. Epidermal cell
b. Hepatocyte
c. Intestinal mucosal cell
d. Neuron
e. Renal tubular cell
Answer: d. Neuron
Question 22
As the CD4 T cell count decreases, the body becomes susceptible to __________.
Answer: opportunistic infections
Question 23
The time between HIV infection and seroconversion is called what?

Answer: the window period
Question 24
A person with HIV is not infectious when they are asymptomatic.
True
False
Answer: False
Question 25
The T cells that display the host’s MHC antigens and T-cell receptors for a nonself-antigen are
allowed to mature, a process termed negative selection.
True
False
Answer: True
Question 26
What cell mediator is the primary cause of vasodilation seen in acute inflammation?
a. Endothelial cells
b. Platelets
c. Histamine
d. Neutrophils
Answer: b. Platelets
Question 27
Which cell in the blood provides primary hemostasis?
a. Platelets
b. Endothelial cells
c. Histamine
d. Macrophages
Answer: a. Platelets

Exam 4
Question 1
The coagulation cascade involves each of the following except:
a. Make thrombocytes
b. Activate the intrinsic and extrinsic pathways
c. Convert fibrinogen to fibrin
d. Convert prothrombin to thrombin
Answer: a. Make thrombocytes
Question 2
Which of the following are natural anticoagulants? Select all that apply.
a. Factor II
b. Factor VII
c. Factor IX
d. Factor X
e. Protein C
f. Protein S
Answer: b. Factor VII
c. Factor IX
d. Factor X
e. Protein C
f. Protein S
Question 3
Which of the following is NOT a hypercoagulable state? Select all that apply.
a. Oral contraceptive use
b. Mutation of prothrombin gene
c. Hemophilia A
d. Hemophilia B

e. Immobility
Answer: a. Oral contraceptive use
c. Hemophilia A
Question 4
Which of the following are TRUE of hemophilia A? Select all that apply.
a. Spontaneous joint bleeding can occur
b. The platelet count is decreased
c. Aspirin and NSAIDS are the mainstay of treatment
d. The PTT is increased
Answer: a. Spontaneous joint bleeding can occur
b. The platelet count is decreased
d. The PTT is increased
Question 5
Well-known causes of disseminated intravascular coagulation (DIC) include each of the
following conditions except:
a. Retained dead fetus
b. Carcinoma
c. Gram-negative sepsis
d. Heparin administration
Answer: d. Heparin administration
Question 6
Which of the following increases the strength of the muscular contraction?
a. Wall tension
b. Inotropic influence
c. Peripheral vascular resistance
d. Hypoxia
Answer: c. Peripheral vascular resistance

Question 7
Which of the following is true of the renin-angiotensin-aldosterone system?
a. Angiotensin I is converted to angiotensin II in the kidneys
b. Angiotensin II is a potent vasodilator
c. Angiotensin II increases sodium reabsorption in the kidney by stimulating the secretion of
aldosterone
d. The PVR is decreased
Answer: c. Angiotensin II increases sodium reabsorption in the kidney by stimulating the
secretion of aldosterone
Question 8
Which of the following terms refers to the pressure the heart must generate to move blood into
the aorta?
a. Afterload
b. Inotrope
c. Preload
d. Ejection fraction
Answer: a. Afterload
Question 9
What is the most specific test for diagnosing iron deficiency anemia?
a. Ferritin
b. RBC
c. Total iron binding capacity
d. Hematocrit
Answer: a. Ferritin
Question 10
What are the two most common causes of macrocytic anemia?
a. Iron deficiency anemia, Thalassemias
b. Folate deficiency, Sickle cell disease

c. Sickle cell disease, Vitamin B12 deficiency
d. Vitamin B12 deficiency and Folate deficiency
Answer: d. Vitamin B12 deficiency and Folate deficiency
Question 11
Which of the following is FALSE regarding sickle cell disease?
a. Abnormality of HbS gene
b. Blood vessel occlusion is a complication
c. Average red cell lifespan is 60 days
d. Can lead to encapsulated infections
Answer: c. Average red cell lifespan is 60 days
Question 12
A 23-year-old African-American man with a history of severe lifelong anemia requiring many
transfusions has nonhealing leg ulcers and recurrent periods of abdominal and chest pain. These
signs and symptoms are most likely to be associated with which one of the following laboratory
abnormalities?
a. Sickle cells on peripheral blood smear
b. Loss of intrinsic factor
c. Decreased erythropoietin
d. Decreased ferritin
Answer: a. Sickle cells on peripheral blood smear
Question 13
Which of the following is NOT true of vitamin B12 deficiency anemia?
a. Vitamin B12 is bound to intrinsic factor
b. Peripheral neuropathy can be a result of deficiency
c. Dietary deficiencies are common
d. MCV is elevated
Answer: d. MCV is elevated

Question 14
Each of the following are risk factors for secondary hyperlipidemia except?
a. Obesity
b. Diabetes mellitus
c. High cholesterol diet
d. Autosomal dominant disorder of LDL receptor
Answer: d. Autosomal dominant disorder of LDL receptor
Question 15
Lifestyle changes to treat hyperlipidemia include each of the following except:
a. Increase physical activity
b. Increase red meat consumption
c. Smoking cessation
d. Weight reduction
Answer: c. Smoking cessation
Question 16
Which of the following is true of fatty streaks of atherosclerotic lesions?
a. Present in adults only
b. Can be symptomatic
c. Form scar tissue and calcifications
d. Consist of macrophages and smooth muscle cells
Answer: d. Consist of macrophages and smooth muscle cells
Question 17
1. The three major determinants of myocardial oxygen demand (MVO2) include each of the
following except:
a. Diastolic pressure
b. Heart rate
c. Left ventricular contractility
d. Systolic pressure Fill in the Blank:

Answer: a. Diastolic pressure
2. ______ is the most important factor in myocardial oxygen demand. As this increases,
myocardial oxygen consumption or demand also increases.
Answer: Heart rate
3. What is the most common cause of cardiogenic shock?
a. Heart failure
b. Cardiomyopathy
c. Myocardial infarction
d. Hypertension
Answer: c. Myocardial infarction
4. Which does NOT occur during cardiogenic shock?
a. Decreased cardiac output
b. Hypotension
c. Hypoperfusion
d. Decreased systemic vascular resistance
Answer: d. Decreased systemic vascular resistance
Question 18
1. Explain how ventricular hypertrophy is an adaptive mechanism:
2. What happens during exercise in someone with coronary artery disease?
Answer: 1 by increasing the cardica output or physical myocardial changes
2 they might have strength the heart muscle and improve overall hearth or lower chances of heart
attack
1. An increase in wall stress can be caused by an increase in preload or afterload. Ventricular
hypertrophy is an adaptive mechanism by which the ventricle can offset the increase in wall
stress. OR Blood pressure elevation increases the workload of the left ventricle by increasing the
pressure against which the heart must pump as it ejects blood into the systemic circulation. Over
time, the left ventricle hypertrophies to compensate for the increased pressure and work.

2. During exertion, the heart beats harder and faster to supply oxygen to the muscles. The
coronary vessels vasodilate and increase blood flow to the cardiac muscle to meet its increased
demand for oxygen. With atherosclerotic disease, the coronary vessel lumens are narrowed and
blood supply to the heart is diminished. With exertion, the vessels cannot adequately vasodilate.
This can manifest as chest pain or tightness and/or shortness of breath.
Question 19
1. Hypertension is often called “the silent killer.” By the time symptoms of hypertension occur,
the complications can affect the kidneys, heart, eyes, and blood vessels. What is this term called?
2. Left ventricular hypertrophy is a major risk factor for what other diseases? Name at least 2.
Answer: 1 Target organ damage
2 it can cause heart diseases such as heart attack or storke
1. Target-organ damage
2. coronary heart disease, cardiac dysrhythmias, congestive heart failure, and sudden death.
Question 20
With increasing occlusion of the coronary vessel(s), the demands of the resting heart may become
too great. When the patient experiences angina without exertion, or when the level of exertion
necessary to cause anginal symptoms decreases, this is called what?
a. Stable angina
b. Unstable angina
c. Myocardial infarction
Answer: b. Unstable angina
Question 21
Which of the following is NOT a risk factor for hypertension?
a. Increased potassium intake
b. Increased salt intake
c. Increased alcohol intake
d. Increased caloric intake
Answer: a. Increased potassium intake

Question 22
Upon seeing this on your patient, which disease would you screen for?

a. Gout
b. Hypertension
c. Heart failure
d. Hyperlipidemia
Answer: d. Hyperlipidemia
Question 23
Which pharmacologic treatment of hypertension has a mechanism of action characterized by
reducing vascular smooth muscle tone (vasodilation) and reducing cardiac contractility and heart
rate?
a. Diuretics
b. Calcium channel blockers

c. Beta-blockers
d. Ace-inhibitors
Answer: b. Calcium channel blockers
Question 24
Which arrhythmia is the most common chronic arrhythmia and incidence increases with age?
a. Sinus bradycardia
b. Sinus tachycardia
c. Atrial fibrillation
d. Atrial flutter
Answer: c. Atrial fibrillation
Question 25
Which arrhythmias are dangerous because of severely reduced diastolic time and cardiac output?
Select all that apply.
a. Premature atrial contractions
b. Paroxysmal atrial tachycardia
c. Ventricular tachycardia
d. Ventricular fibrillation
e. Premature ventricular contractions
f. Atrial fibrillation
Answer: a. Premature atrial contractions
d. Ventricular fibrillation
e. Premature ventricular contractions
Question 26
_____________ are a group of inherited disorders of hemoglobin synthesis common among
Mediterranean populations.
Answer: Thalassemias
Question 27

Thrombocytes are also known as ____________.
Answer: platelets
Question 28

Patient is found to have the above:
1. What risk factors mostly led to this disease state?
2. What is this person at risk for developing?
3. What lifestyle modifications would you suggest for them?
Answer: 1) obesity, high chilesteral valves, visceral fat and poor die
2) they're at risk od developing Atherosclerosis
3) they can start a healthy diet, stop smoking, reduce alcohol consumption or start taking blood
pressure medication
Picture is of an atherosclerotic plaque
1. Hyperlipidemia, cigarette smoking, obesity and visceral fat, hypertension, diabetes mellitus.
Increasing age, family history of premature CHD, and male sex. May also include C-reactive
protein (CRP) and serum lipoprotein(a).
2. Coronary artery disease, angina, myocardial infarction, aneurysm, stroke (ischemia,
thrombosis, emboli).

3. Stop smoking, lose weight/exercise, healthy diet (low-fat, low-cholesterol), adhere to
medication for blood pressure, hyperlipidemia, and/or diabetes.

Exam 5
Question 1
The rate of perfusion must exceed the rate of ventilation in order to ensure adequate oxygenation
of the blood.
True
False
Answer: False
Question 2
Exercise, allergens, and emotion can all contribute to an asthma attack.
True
False
Answer: True
Question 3
The breathing rate is determined by input from __________ that monitor oxygen, carbon dioxide,
and pH levels in the blood.
Answer: Chemoreceptors
Question 4
Lung ___________ is the term used to describe the ease or difficulty with which the lungs can
be inflated.
Answer: Lung compliance
Compliance
Question 5

During inspiration, air is drawn into the lungs and the chest cavity is decreased.
True
False
Answer: True
Question 6
COPD is reversible airway bronchoconstriction.
True
False
Answer: True
Question 7
The accessory muscles are the main muscles of inspiration.
True
False
Answer: False
Question 8
Excess surface tension makes lung inflation harder.
True
False
Answer: False
Question 9
_______ lowers the surface tension and makes lung inflation easier.
Answer: surfactants Pulmonary surfactant
Question 10
_________ is the flow of blood in the adjacent pulmonary capillaries.
Answer: Perfusion

Question 11
Which of the following cells contribute to airway inflammation in asthma? Select all that apply.
a. Eosinophils
b. Mast cells
c. Neutrophils
d. Leukotrienes
e. Lymphocytes
Answer: a. Eosinophils
b. Mast cells
e. Lymphocytes
Question 12
Alpha-1 antitrypsin deficiency is most likely seen in which disease process?
a. Bronchial asthma
b. Chronic bronchitis
c. Emphysema
d. Bronchiectasis
Answer: c. Emphysema
Question 13
Histologically, chronic bronchitis would exhibit each of the following except:
a. Enlargement of the airspaces
b. Increase in goblet cells
c. Fibrosis of the bronchiolar wall
d. Hypertrophy of the submucosal glands
Answer: a. Enlargement of the airspaces
Question 14
Each of the following are TRUE of ARDS except:
a. Chest x-ray shows a “white-out”
b. Presents with decreased respiratory rate

c. Decreased surfactant function
d. Increased capillary permeability
Answer: b. Presents with decreased respiratory rate
Question 15
A 10-year-old boy who is having an acute asthma attack is brought to the ER. He is observed to
be sitting up and struggling to breathe. His breathing is accompanied by use of accessory
muscles, a weak cough, and audible wheezing sounds. His pulse is rapid and weak, and both
heart and breath sounds are distant on auscultation. His parents relate that his asthma began to
worsen after he developed a “cold,” and now he doesn’t get relief from his albuterol inhaler.
Explain the changes in physiologic function underlying his signs and symptoms.
Answer: In most asthma patients there's an airway inflammation from cold virus that causes
epithelial injury.Also due to severe airway inflammation this patient is most likely experiencing
bronchial hyper-responsiveness which causes airway obstruction or narrowing. However, this
changes can cause fixed obstruction in asthma patients which is not reversible event with the
used of inhalers or bronchodilators
Recruitment of inflammatory cells from the bloodstream into the bronchial wall, where they
directly attack the invading organisms and secrete inflammatory chemicals that are toxic to the
organisms causes airway inflammation. Swelling of the bronchial wall, mucus secretion,
constriction of the airway; bronchial hyper-responsiveness to stimuli causes airway obstruction
or narrowing. They may discuss on a cellular level as well:
Upon a trigger, the cascade of neutrophils, eosinophils, lymphocytes, and mast cells cause
epithelial injury. This causes airway inflammation, which further increases hyperresponsiveness
and decreased airflow. Mast cells release histamine and leukotrienes. These cause major
bronchoconstriction, inflammation, and mucus secretion. Mast cells can trigger multiple
cytokine release, which causes more airway inflammation. The contraction of the airways and
subsequent swelling leads to further airway obstruction.
Question 16

When is the risk for obstructive atelectasis the greatest? What are strategies to decrease the
chance for developing atelectasis?
Answer: the risk is greatest following surgery because anesthesia pain medication and
immobility may help to developed bronchial secretions. strategies such as frequently coughing,
taking deep breath, hydrate adequately and changes positions may decrease the chance for
atelectasis
The risk of obstructive atelectasis is increased following surgery. Anesthesia, pain and pain
medications, and immobility promote retention of bronchial secretions. Patients are encouraged
to frequently cough, deep breath, change positions, hydrate adequately, and ambulate early to
prevent atelectasis.
Question 17
Explain why the oxygen flow rate for people with COPD is normally titrated to maintain the
arterial PO2 between 60 and 65 mm Hg.
Answer: Because their medullary respiratory center is now fuction at a elevated CO2 level and
can't not responds to increase in PCO2.when there is a decrease in PO2 it become a stimulus for
respiration but if there is a higher rate of oxygen, it would suppresses respiratory drive and
stimulus.
Their medullary respiratory center has adapted to the elevated CO levels no longer
Therefore, a decrease in PO2 becomes the stimulus for respiratory drive.
Question 18
What treatment is recommended for a patient with lung damage due to smoking, and what gas
might they retain excessively due to this condition?

Answer: 1) the patient needs to go on a smoking cessation
2) Carbon dioxide
1) smoking cessation
2) Carbon dioxide
Question 19
Some people have the triad of asthma, chronic rhinosinusitis, and nasal polyps. They have asthma
attacks in response to taking what medication(s)?
Answer: Aspirin and Other NSAIDs
Question 20
Each of the following can lead to atelectasis except:

a. Pleural effusion
b. Tumor mass
c. Thrombus
d. Mucous plug
Answer: c. Thrombus
Question 21
Asthma exhibits each of the following characteristics except:
a. Bronchial swelling
b. Mucus secretion
c. Airway remodelling
d. Hypertrophy of the submucosal glands
Answer: d. Hypertrophy of the submucosal glands
Question 22
Each of the following can be daily treatments for asthma except:
a. Bronchodilators
b. Oxygen therapy
c. Inhaled corticosteroids
d. Leukotriene modifiers
Answer: c. Inhaled corticosteroids

Exam 6
Question 1
A patient has experienced a seizure affecting the left temporal lobe. The family reports that the
patient exhibited repetitive lip smacking and hand rubbing followed by a period of great fear and
insecurity. They have experienced which type of seizure?
a. Focal seizure without impairment of consciousness or awareness
b. Focal seizure with impairment of consciousness or awareness

c. Generalized tonic/clonic seizure
Answer: b. Focal seizure with impairment of consciousness or awareness
Question 2
Voluntary tongue movements are controlled by which cranial nerve?
a. CN VII.
b. CN IX.
c. CN XII.
Answer: c. CN XII.
Question 3
You are seeing a patient with Parkinson’s disease in your office. You feel a catch as you passively
take their arm through flexion and extension. This is an example of what physical manifestation
of the disease?
a. Tremor
b. Bradykinesia
c. Cogwheeling
d. Pill-rolling
Answer: d. Pill-rolling
Question 4
Sleep spindles are characteristic of which stage of sleep?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
Answer: b. Stage 2
Question 5

A person reports a generalized depressed mood, changes in appetite, and irritability that gets
worse as the day goes on. They also report that they sleep more than 8 hours which is affecting
their productivity. What type of depression are they experiencing?
a. Melancholic depression
b. Atypical depression
c. Depression with psychotic features
d. Depression with catatonic features
Answer: b. Atypical depression
Question 6
Each of the following statements is true regarding the organization of the nervous system except:
a. The CNS has an afferent and efferent division
b. The autonomic nervous system can be further divided into the sympathetic and
parasympathetic divisions
c. The CNS contains the hindbrain, midbrain, and forebrain
d. The PNS contains the cranial nerves
Answer: b. The autonomic nervous system can be further divided into the sympathetic and
parasympathetic divisions
Question 7
Each of the following statements is true regarding Alzheimer’s disease except:
a. Neurofibrillary tangles are a result of an abnormal accumulation of amyloid in the blood
vessels
b. Neuritic plaques are composed of deteriorating nerve pieces that arrange themselves around a
sticky protein core called amyloid beta (Aβ)
c. Cerebral amyloid angiopathy contributes to the pathogenesis of Alzheimer’s disease
Answer: a. Neurofibrillary tangles are a result of an abnormal accumulation of amyloid in the
blood vessels
Question 8
Non-modifiable factors related to stroke include each of the following except:

a. Male sex
b. Hypertension
c. African American decent
d. Family history
Answer: b. Hypertension
Question 9
Primary insomnia is characterized by each of the following except:
a. Difficulty initiating sleep
b. Difficulty maintaining sleep
c. Waking up too early
d. Can also be called comorbid insomnia
Answer: d. Can also be called comorbid insomnia
Question 10
A “drop attack” is another term for which type of seizure?
a. Myoclonic seizure
b. Clonic seizure
c. Tonic seizure
d. Atonic seizure
Answer: d. Atonic seizure
Question 11
Narcolepsy appears to be linked to an abnormal regulation of which stage of sleep?
a. stage 1
b. stage 2
c. stage 4
d. REM
Answer: d. REM
Question 12

Each of the following statements is true of Parkinson’s disease except:
a. Environmental factors alone lead to disease development
b. It affects the substantia nigra of the brain
c. It is characterized by a loss of dopaminergic neurons
d. Incidence increases with age
Answer: a. Environmental factors alone lead to disease development
Question 13
__________ control the bodily response to sensory input internally and externally.
Answer: stimulus/central nervous system
Interneurons
Question 14
__________ decrease the degradation of serotonin and norepinephrine.
Answer: depression
Monoamine oxidase inhibitors (MAOs)
Question 15
Shallow or abnormally slow breathing is referred to as ________.
Answer: Hyperpnea
Question 16
_________ utilizes electric impulses to inhibit or stop the abnormal nerve activity that causes
tremor and other unwanted movement patterns associated with Parkinson’s disease.
Answer: Deep brain stimulation
Question 17
Specialized ependymal cells that project into the ventricles and produce CSF are called the
__________.
Answer: Choroid plexus

Question 18
Astrocytes help to form the blood-brain barrier which prevents toxins from the blood from
entering the brain.
Answer: True
Question 19
The average age of onset for major depressive disorder is mid-30s; however, the age of onset is
increasing in recent times.
Answer: False
The age of onset is decreasing in recent times.
Question 20
Vital signs increase during stage 1 of NREM sleep.
Answer: False
Vital signs decrease during stage 1 of NREM sleep.
Question 21
Wandering episodes are characteristic of severe Alzheimer’s disease.
Answer: False
Wandering episodes increase in moderate Alzheimer’s disease.
Question 22
Explain the mechanism of electric synapses and how they contribute to the rapid propagation of
an action potential.
Answer: electric synapeses allow the passage of currents through the gap junctions. Gap junction
than penetrate cells junction of neighboring cells which allows current to flow in both direntions
Electrical synapses allow the passage of current-carrying ions through small openings called gap
junctions. These gap junctions penetrate the cell junction of neighboring cells allowing current
to flow in either direction.
Question 23

You witness a seizure in which the person first exhibits a full body muscular contraction followed
by a loss of consciousness and convulsions. Is this a generalized or focal seizure?
Based upon this description, what specific type of seizure did this individual experience?
Answer: this is a case of Generalize seizures and tonic-clonic seizure because in this type of
seizure the person will experience tonic contraction of the muscles and lose consciousness.
Generalized, Tonic-clonic seizure
Question 24
Describe the importance of brain activity that occurs during REM sleep.
Answer: during REM there is a block in the increase sensory input making the brain not to
process it. But there is still a internalized sensory that allows previously memories and the person
is still able to have normal physiologic and psychologic functions.
During this phase of sleep, incoming sensory input is blocked; the brain cannot process it.
However, internalized sensory tracts are stimulated allowing previously formed memories to
replay in one’s mind. Studies have shown that adequate time spent in REM sleep is necessary for
normal physiologic and psychologic functioning during periods of wakefulness.
Question 25
A patient reports to the emergency department where you are working at 7 pm. They report that
earlier that morning they began to experience numbness in their right leg. They had walked more
than usual the day before, so they ignored their symptoms. As the day went on, they noticed that
the numbness got worse, and they began to slur their words. By the time they are evaluated, their
symptoms begin to subside. The numbness disappears, and their speech returns to normal. What
do you suspect this patient has experienced? What is the clinical significance?
Answer: they patent is experiencing TIA when there is a deprivation of oxygen to the brain
However, patient with TIA are most likely to get Strok in their lifetime
This patient has experienced a TIA as their symptoms subsided in less than 24 hours without
intervention. However, this should not be ignored as TIAs serve as a warning sign that a stroke
can occur in the future. Underlying pathology such as atherosclerosis, etc. must be addressed for
prevention.

Question 26
A 72-year-old female is brought to the emergency department via ambulance at 9 am. Her
husband reports that they were eating breakfast and she started to complain of a severe headache
and blurred vision. She then lost consciousness, and he immediately called 911. She has a history
of hypertension, and she is not compliant with her medication because she does not like the way
it makes her feel. Based upon these symptoms and past medical history, what do you suspect this
patient is experiencing? How would you confirm this diagnosis? What treatment should be
administered? Explain why you chose that treatment.
Answer: this patient could be experiencing ishemic stroke, and ACT scan or MRI can be done
to determine if there is clot that may be blocking blood flow to the brain. if ischemic stroke is
confirm, the patient would need a more advance treatment methods because they have passed
the 3-4.5 hours window for a tPA drugs
This patient is more than likely experiencing a hemorrhagic stroke given the sudden onset of her
symptoms and the PMH of uncontrolled hypertension. A CT scan would be needed to determine
if a hemorrhage has occurred. Once this is determined the goal of treatment is to stop bleeding
and decrease intracranial pressure. This can be done through medication that would decrease
blood pressure and intracranial pressure. A craniotomy can be done should medication not work,
or the bleeding is severe. Other surgical methods may be utilized if the bleed is a result of an
aneurysm or AVM.
Question 27
What is the diagnostic criteria for narcolepsy? Describe 2 topics of patient education you would
give to your patient to help them combat symptoms of narcolepsy.
Answer: following a daytime sleep study of 8 mins or more is given to patient in their latency
time. patient education would include covering sleep hygien, and safety during high risk
activities
A diagnosis of narcolepsy is given if the person exhibits a mean sleep latency time of 8 minutes
and two or more episodes of sleep-onset REM during the repeated nap opportunities. You may
educate them on any of the following:
• Sleep hygiene
• Avoidance of sleep deprivation

• Taking several short naps (15 minutes or less) throughout the day

Exam 7
Question 1
The liver is responsible for each of the following EXCEPT:
a. Making clotting factors
b. Storing bile
c. The liver produces bile, but the gallbladder stores it
d. Drug metabolism
e. Stores glucose
Answer: b. Storing bile
Question 2
Risk factors for gallstone formation include each of the following EXCEPT:
a. Obesity
b. Male gender
c. Age (40’s)
d. Pregnancy
Answer: b. Male gender
Question 3
Predisposing factors that may lead to gastroesophageal reflux include each of the following
EXCEPT:
a. Hiatal hernia
b. Pernicious anemia
c. Pregnancy
d. Incompetent esophageal sphincter
Answer: b. Pernicious anemia

Question 4
Clinical presentation of irritable bowel syndrome can include each of the following EXCEPT:
a. Abdominal pain or discomfort for at least 12 weeks duration
b. Pain may be relieved with defecation
c. Constipation or diarrhea may be present
d. Blood in the stool
Answer: d. Blood in the stool
Question 5
Risk factors for the development of peptic ulcer include which of the following? Select all that
apply.
a. Aspirin therapy
b. Eating acidic foods
c. pylori infection
d. Stress
e. NSAID use
Answer: a. Aspirin therapy
c. pylori infection
d. Stress
Question 6
Gastric ulcers are worsened by ______. Duodenal ulcers are worsened by
A. Eating; not eating
B. Not eating; eating
C. Both a & b
D. None of the above
Answer: A. Eating; not eating
Question 7
Each of the following are characteristics of ulcerative colitis EXCEPT:
a. Granulomatous lesions

.

b. Bloody diarrhea
c. Pseudopolyps
d. Risk of toxic megacolon
e. Crypt abscess formation
Answer: a. Granulomatous lesions
Question 8
Each of the following are characteristics of Crohn disease EXCEPT:
a. Affects any part of the GI tract
b. Increased risk of malignancy
c. Skip lesions
d. Cobblestone appearance
e. Granulomatous inflammation
Answer: b. Increased risk of malignancy
Question 9
The controls the rate of stomach contents into the small intestine.
Answer: pyloric sphincter
Question 10
The GI tract produces both enzymes and hormones.
True
False
Answer: True
Question 11
The double layer of peritoneum that holds the organs in place and stores fat is called what?
Answer: mesentery
Question 12
A unique feature of the liver is that is has a dual blood supply.

True
False
Answer: True
Question 13
What are the intermittent contractions that help to mix and move food along?
Answer: Rhythmic movements
Question 14
Activation of the peripheral nervous system decreases or stops the amplitude of the slow waves.
True
False
Answer: True
Question 15
________ lies between the mucosal and muscle layers of the intestinal wall, and is involved with
controlling secretions, absorption, and contraction of each segment of the intestinal tract.
Answer: Submucosal (Meissner) plexus
Question 16
Food is converted in the stomach into a creamy mixture called?
Answer: chyme
Question 17
What are rhythmic movements designed to propel the chyme along the small intestine toward
the large intestine?
Answer: Peristaltic movements
Question 18
What is the purpose of propulsive mass movements?

Answer: it's part of the larger segment of the colon that helps move fecal matter and triggers the
need for bowel movement.
A large segment of the colon contracts as a unit, moving the fecal contents forward. These mass
movements last about 30 seconds, followed by a 2-3-minute period of relaxation, then another
contraction. This is what triggers the need for a bowel movement.
Question 19
Antibiotics should be used to treat all types of diarrhea.
True
False
Answer: False
Question 20
Consistently ignoring the urge to defecate can result in .
Answer: constipation
Question 21
Clinical manifestations of cirrhosis include each of the following EXCEPT:
a. Hemorrhoids
b. Asterixis
c. Esophageal varices
d. Thrombocytosis
e. Ascites
Answer: d. Thrombocytosis
Question 22
What is nonalcoholic fatty liver disease (NAFLD) associated with?
Answer: it's the most common cause of chronic liver disease in the western world that is
associated with obesity and metabolic syndrome
Obesity and metabolic syndrome (type 2 diabetes, hyperlipidemia)

Question 23
A patient presents with right upper quadrant pain, that worsens after eating a fatty meal. What
would be the best imaging modality to evaluate their complaint?
a. Abdominal CT scan
b. HIDA scan
c. Abdominal x-ray
d. Abdominal ultrasound
Answer: d. Abdominal ultrasound
Question 24
Liver damage from cirrhosis, hepatitis, or cancer would cause what type of jaundice?
Answer: Intrahepatic jaundice

Exam 8
Question 1
Each of the following statements are true regarding control over the GFR except:
a. The kidney can maintain a constant GFR despite variations in the arterial blood pressure of the
rest of the body.
b. The sympathetic nervous system cannot supersede the renal autoregulatory system.
c. The sympathetic nervous system can supersede the renal autoregulatory system.
d. The RAA responds when blood pressure drops below normal limits.
Answer: b. The sympathetic nervous system cannot supersede the renal autoregulatory system.
Question 2
Which of the following statements is false regarding ADH?
a. Elevated levels of ADH will lead to a small volume of concentrated urine.
b. Elevated levels of ADH will lead to dilute urine.
c. decreased levels of ADH will lead to dilute urine.
d. Alcohol inhibits ADH.

Answer: b. Elevated levels of ADH will lead to dilute urine.
Question 3
Which of the following statements is true regarding nephrons?
a. It is divided into an outer medulla and an inner cortex
b. It has 1 source of blood supply
c. The glomerulus filters the blood while the tubule reabsorbs needed nutrients
Answer: c. The glomerulus filters the blood while the tubule reabsorbs needed nutrients
Question 4
Low Na+ levels in the plasma and interstitial compartment is characteristic of which of the
following fluid imbalances?
a. Dehydration
b. Water intoxication
c. Edema
Answer: a. Dehydration
Question 5
Tubular reabsorption is characterized by which of the following?
a. The reabsorption of water and ions via passive means only
b. Necessary solutes and fluids are reabsorbed into the tubular fluid
c. Necessary solutes and fluids are reabsorbed into the peritubular capillaries
Answer: a. The reabsorption of water and ions via passive means only
Question 6
Which of the following is/are true regarding acid-base balance? ( mark all that apply )
a. Acid-base balance refers to the balance of the concentration of hydrogen ions (H+) in the blood
b. Acid-base balance refers to the balance of the concentration of bicarbonate ions (OH-) in the
blood
c. Venous blood is characterized by a more acidic pH
d. A higher concentration of OH- ions will increase the pH of the blood

Answer: d. A higher concentration of OH- ions will increase the pH of the blood
Question 7
Acute postinfectious glomerulonephritis is by the following except:
a. Typically caused by a streptococcal infection
b. Associated with a poor prognosis as it often leads to CKD the prognosis is good when
underlying cause is treated
c. Accompanied by glomerular enlargement and hypercellularity
d. Oliguria is often the first symptom
Answer: b. Associated with a poor prognosis as it often leads to CKD the prognosis is good
when underlying cause is treated
Question 8
Which of the following is characteristic of chronic transplant rejection?
a. Involves humoral immunity
b. It responds well to immunosuppressive therapy
c. Involves increased T lymphocytes
Answer: b. It responds well to immunosuppressive therapy
Question 9
Which of the following is true of 1,25-dihydroxycholecalciferol?
a. It is the inactive form of vitamin D taken in through the skin via UV rays
b. It is the inactive form of synthetic vitamin D
c. It is the active form of vitamin D, converted in the liver
d. It is the active form of vitamin D, converted in the kidney
Answer: c. It is the active form of vitamin D, converted in the liver
Question 10
A patient is said to be in stage 3a kidney disease. What would you expect their GFR to be?
A. 97 mL/min/1.73m2
B. 42 mL/min/1.73m2

C. 70 mL/min/1.73m2
D. 14 mL/min/1.73m2
Answer: B. 42 mL/min/1.73m2
Question 11
The following are true regarding tubular secretion except:
a. K+ is secreted in the intercalated cells
b. K+ is secreted in the principal cells
c. H+ along with organic acids and bases are from the proximal tubule
d. Involves the elimination of urea from the filtrate
Answer: a. K+ is secreted in the intercalated cells
Question 12
A decrease in Na+ reabsorption is achieved through the action of which of the following?
a. Cardiovascular baroreceptors
b. Aldosterone
c. Diuretics
Answer: a. Cardiovascular baroreceptors
Question 13
In the nephron, the mass of capillaries surrounded by an epithelial capsule that opens into a tubule
is collectively referred to as the ________.
Answer: renal corpuscle
Question 14
The hormone that is synthesized in the kidneys and regulates the differentiation of red blood cells
is _________.
Answer: erythropoietin
Question 15

The causes CO2 to react reversibly with water to form carbonic acid (H2CO3) to regulate blood
pH.
Answer: red blood cell
Brainstem-respiratory system
Question 16
A person who has a blood Mg2+ concentration of 3.3 mg/dL. Is considered to have

.

Answer: hypermagnesemia
Question 17
A drastic decrease in urine output accompanied by a disproportionate increase of blood urea
nitrogen (BUN) in comparison to serum creatinine levels is characteristic of

failure.

Answer: prerenal
Question 18
When blood pressure rises, the enzyme renin is released by the juxtaglomerular (JG) cells of the
nephron.
Answer: False
Because juxtaglomerular cells usually response when there's a drop in pressure when there is any
kind of stretch or changes in the vascular war
False, when blood pressure drops, the enzyme renin is released by the juxtaglomerular (JG) cells
of the nephron.
Question 19
Hyperkalemia can be caused by movement of K+ from the ECF to the ICF compartment.
Answer: False
It's cause by movement of K+ from the ICF to ECF compartment
False, hyperkalemia can be cause by the movement of K+ from the ICF to the ECF compartment.
Question 20
Explain why renal flow is decreased with sympathetic activity.

Answer: because sympathetic activity deverts blood to the heart, skeletal muscle and brain which
is control by the nervous system. Therefore when there is a narrowing in the afferent arteriole,
there will be a release of epinephrine which will most likely lead decrease of flow in the renal
and GFR
Sympathetic activity diverts blood to the heart, brain, and skeletal muscles. During these times
the renal autoregulatory system may be superseded by nervous system control. In this event, a
narrowing of the afferent arteriole is caused by sympathetic nerve fibers followed by a release of
epinephrine from the adrenal medulla which leads to a subsequent decrease in renal flow and the
GFR.
Question 21
A patient has a diagnosis of acute pancreatitis and a subsequent electrolyte imbalance. Which
electrolyte imbalance may they experience given this condition? Explain why pancreatitis would
lead to this imbalance.
Answer: Dehydration
Pancreatitis would lead to dehadration due to water output that has been exceed by water intake
Hypocalcemia. Acute pancreatitis causes the release of proteolytic and lipolytic enzymes. Free
fatty acids are released during lipolysis in the pancreas. Ca2+ binds to these fatty acids removing
them from the blood.
Question 22
A patient has a diagnosis of glomerular disease. Given what you know about the structural
framework of the glomerular capillaries, what would be detected in this patient’s urine, and
explain why this would happen.
Answer: the urine will have blood and protein due to lock of prevention of red blood cells and
plasma proteins which is provent by the glomerular capillaries from passing through the
glomerular membrane into the filtrate is no longer being block from passing through
Blood and protein may be present in the urine. Spaces within the basement membrane of the
glomerular capillaries, under normal circumstances prevent red blood cells and plasma proteins
from passing through the glomerular membrane into the filtrate. The disease process would
compromise this.

Question 23
A patient with chronic kidney disease must undergo dialysis treatments as they wait for
transplantation. Give 1 reason peritoneal dialysis would be preferable to the patient over
hemodialysis and 1 concern in choosing peritoneal dialysis over hemodialysis.
Answer: Preitoneal dialysis is preferable for the patient because it can be done in the patient's
home which reduces patient going to dialysis clinic. However, there is a high risk for infection
at the catheter site with peritoneal dialysis
Peritoneal dialysis can be done in the patient’s home as opposed to going to a dialysis clinic
multiple times per week. A major concern of the utilization of peritoneal dialysis is the risk for
infection at the catheter site.
Question 24
A patient presents to the emergency department with complaints of sharp pain that comes in
waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been
experiencing nausea and vomiting all day long. They have a past medical history of
hyperparathyroidism. Urinalysis reveals calcium in their urine. A CT scan is ordered, and it
reveals a stone 6 mm in diameter. What type of renal calculi do you suspect? What treatment is
needed? Explain your reasoning for both answers.
Answer: this patient most likely has a calcium stone due to this history and the leave of calcium
in the urine. due to the size of the stone, it may not pass on its own but it can be remove through
ureteroscopy removal and the patient ell be given pain management
The patient has a calcium stone given their past medical history and the findings of calcium in
their urine. The stone will be unable to pass on its own given the diameter greater than 5 mm. It
can be removed through ureteroscopy removal or extracorporeal shockwave lithotripsy. The
patient may also be put on medication for pain management.
Question 25
A patient presents in the emergency department with severe dehydration secondary to vomiting.
The following are the results of their blood work: pH = 8.2, PCO2 = 39 mm, and HCO

3

-

= 33

mEq/L. Based upon these results, what type of acid-base disorder are they experiencing? Is
compensation occurring? Describe a treatment intervention for this disorder.
Normal values are as follows: pH = 7.35-7.45, PCO2 = 35-45 mm, HCO 3- = 22-26 mEq/L.
Answer: the patient has metablic alkalosis and the respiratory compention is occurring as PCO
will fall within the normal limits. also, in this case fluids will be replace with saline solution
The patient is in metabolic alkalosis. The respiratory system is not compensating as PCO2
compensation falls within normal limits. Fluids are replaced with normal saline solution.
Question 26
A patient is in the ICU following open heart surgery. The patient was feeling well earlier in the
day, but suddenly began to demonstrate signs of confusion and disorientation. Blood results
reveal Na+ = 100 mEq/L. Based upon these symptoms and results of blood work, what electrolyte
imbalance is this patient experiencing? What treatment is indicated for this imbalance?
Answer: it's a case of euvolemic hypotonic hyponatremia. treatment can be intravenous saline
solution which would help with sodium deficiency
This patient is experiencing euvolemic hypotonic hyponatremia. The administration of
intravenous saline solution would be indicated to correct the sodium deficiency.

Exam 9
Question 1
Redistribution of body fat with round moon face, dorsal “buffalo hump,” and relatively thin
extremities suggests which of the following:
a. Addison disease
b. Diabetes mellitus
c. Cushing syndrome
d. Hypothyroidism
Answer: c. Cushing syndrome
Question 2

The following are common signs and symptoms of Cushing syndrome EXCEPT:
a. Hypoglycemia
b. Mood changes
c. Muscle weakness
d. Amenorrhea
Answer: a. Hypoglycemia
Question 3
Each of the following are treatments of Addison’s disease EXCEPT?
a. Hormone therapy for life
b. Regular mealtimes
c. ACE inhibitors
d. Higher dose of hormones during stress
Answer: d. Higher dose of hormones during stress
Question 4
Addison’s disease is due to which of the following:
a. Adrenal gland dysfunction
b. Decreased ACTH stimulation from the pituitary
c. Decreased CRH from the hypothalamus
d. All of the above
e. None of the above
Answer: a. Adrenal gland dysfunction
Question 5
An endocrine hormone is released into circulation to act on a target organ.
True
False
Answer: True
Question 6

A paracrine action occurs when a hormone exerts an action on the cells that produced it.
True
False
Answer: False
Question 7
Hormones work through receptors, and the speed of this action varies.
True
False
Answer: True
Question 8
The production and release of hormones by the pituitary gland requires stimulation by the
hypothalamus.
True
False
Answer: True
Question 9
What hormone plays a major role in the maintenance of body metabolism and growth and
development in children?
a. Epinephrine
b. Cortisol
c. Parathyroid
d. Thyroid
Answer: a. Epinephrine
Question 10
The posterior pituitary releases which of the following hormones? Select all that apply.
a. Prolactin
b. Oxytocin

c. ADH
d. ACTH
e. GH
Answer: b. Oxytocin
c. ADH
Question 11
Type 1 diabetes mellitus is associated with each of the following characteristics EXCEPT:
a. Strong family history
b. Precipitated by an autoimmune process
c. Onset in childhood
d. Propensity to ketoacidosis
Answer: d. Propensity to ketoacidosis
Question 12
Type 2 diabetes mellitus is associated with each of the following characteristics EXCEPT:
a. Normal or increased insulin synthesis
b. Autoimmune origin
c. Onset in adults
d. Obesity
e. Rare ketoacidosis
Answer: e. Rare ketoacidosis
Question 13
Glycolysis, in which glucose is broken down for energy, is produced by glucagon.
True
False
Answer: True
Question 14
When the body is in starvation mode, it breaks down fat into ketones.

True
False
Answer: True
Question 15
Most hormones are controlled through negative feedback.
True
False
Answer: True
Question 16
People with type 1 diabetes can start treatment with an oral anti-diabetic agent.
True
False
Answer: False
Question 17
Testing for diabetes should be done on everyone initially at age 60.
True
False
Answer: False
Question 18
A 45-year-old obese, sedentary male has recently been diagnosed with type 2 diabetes. What are
2 strategies to help him normalize his blood sugars? List 2 other macrovascular complications
he is at risk for and how you would screen for them?
Answer: 1) exercise, diet eating healthy which will increase wealth loos may help control his
blood glucose levels.
2) other macrovascular complication are hypertension and hyperlipidemia and always checking
blood pressure, sugar level as well as screening regularly

(1) Diet, exercise, and weight loss may be all that they need to control blood glucose levels. Even
moderate weight loss of 5-10% of total body weight has been shown to improve glucose control.
(2) Hypertension and hyperlipidemia – checking blood pressure and screening with a serum lipid
panel.
Question 19
There are ways to prevent and/or control progression of diabetic kidney disease (nephropathy).
Name 4 of them:
Answer: Ways to prevent/control progression of diabetic nepgropathy is by testing urine
microalbuin, tight glycemic control ,blood pressure control, and hyperlipidemia treatment
Tight glycemic control; blood pressure control (<130/80); hyperlipidemia treatment; smoking
cessation; and limiting proteinuria through ACE inhibitors or ARBs, or protein restriction.
Question 20
Symptoms of diabetic ketoacidosis (DKA) include each of the following EXCEPT:
a. Polydipsia
b. Dehydration
c. Fruity smell on the breath
d. Bradycardia
Answer: d. Bradycardia
Question 21
Which drug therapy for diabetes does not cause hypoglycemia and has a side effect of weight
loss, making it a popular oral antidiabetic treatment?
A. Biguanides (metformin)
B. Insulin secretagogues (sulfonylureas)
C. Thiazolidinediones (glitazones)
D. α-glucosidase inhibitors (acarbose and miglitol)
E. DPP-4 inhibitors (sitagliptin, saxagliptin)
Answer: A. Biguanides (metformin)

Question 22
Your diabetic patient with neuropathy is at risk for developing a foot ulcer. How would you
instruct him to care for his feet? List at least 3.
Answer: Patient should have a proper fitting shoes check feet daily for inspection/blisters or any
signs of infection patient should also avoid smoking and cold temperature
Wear proper fitting shoes, daily feet inspection to look for blisters, sores, or signs of infection.
Avoid smoking, cold temperature, bare feet.
Question 23
__________ is defined as a blood glucose of 500 mg/dL), hyperosmolarity, and
dehydration, without ketoacidosis.
Answer: Hyperosmolar hyperglycemic state (HHS)
Question 26
Which drugs are contraindicated in heart failure patients due to exacerbation of CHF by fluid
accumulation.
Answer: thiazolidinediones (TZDs or glitazones)

Exam 10

Question 1
Each of the following are true of gout except:
a. An acute attack is initiated by an inflammatory response
b. Crystals are more likely to accumulate proximal to the trunk of the body
c. Purine synthesis occurs in 1 of 2 pathways
d. Approximately 90% of patients diagnosed with gout are found to have underexcretion of urate.
Answer: b. Crystals are more likely to accumulate proximal to the trunk of the body
Question 2
Which of the following would a patient likely exhibit on an initial physical exam if you suspect
they have OA? (mark all that apply)
a. A typical gait pattern
b. A capsular pattern
c. Crepitus with movement
d. Bilateral involvement
Answer: b. A capsular pattern
c. Crepitus with movement
Question 3
Which of the following are true regarding synostoses? (mark all that apply)
a. They allow limited movement between them
b. They allow no movement between them
c. They allow a small degree of movement between them
d. They are separated by a fibrous disc
e. They are joined by dense connective tissue
Answer: b. They allow no movement between them
e. They are joined by dense connective tissue
Question 4
Cancellous bone receives its blood supply by what means?
a. Arteries branching from the medullary cavity

b. Arteries branching inward from the periosteal arteries
c. Diffusion through the endosteal surface of the bone and the canaliculi
Answer: c. Diffusion through the endosteal surface of the bone and the canaliculi
Question 5
What is the recommended calcium intake for postmenopausal women?
a. 2000 mg. daily
b. 1500 mg. daily
c. 1000 mg. daily
Answer: b. 1500 mg. daily
Question 6
Which of the following cells when stimulated by bone morphogenic proteins (BMPs)
differentiate to contribute to normal bone growth?
a. Osteocytes
b. Osteoclasts
c. Osteoblasts
d. Osteoprogenitor cells
Answer: d. Osteoprogenitor cells
Question 7
Which of the following is false regarding OA?
a. It is characterized by the gradual deterioration of weight bearing joints
b. Males over the age of 55 have the highest incidence of OA
c. Age, gender, history of trauma, and weight all contribute to the risk of developing OA
d. Males have a higher incidence of developing OA at younger ages
Answer: b. Males over the age of 55 have the highest incidence of OA
Question 8
A patient has low serum calcium levels. Which of the following is true given this scenario?
a. The thyroid gland will secrete PTH to return serum calcium levels to normal

b. The thyroid gland will secrete calcitonin to return serum calcium levels to normal
c. PTH will increase renal reabsorption of calcium while simultaneously increasing renal
excretion of phosphate
d. PTH will increase blood phosphate levels
Answer: c. PTH will increase renal reabsorption of calcium while simultaneously increasing
renal excretion of phosphate
Question 9
A diagnosis of gout is made through which of the following tests? (mark all that apply)
a. Blood work to determine uric acid levels
b. Analysis of synovial fluid
c. 24- hour urine specimen
d. MRI of affected joint
Answer: b. Analysis of synovial fluid
c. 24- hour urine specimen
Question 10
In the early stages of OA, structural changes would include which of the following? (mark all
that apply)
a. Edema in the cartilaginous matrix
b. Thickening of subchondral bone
c. Presence of osteophytes
Answer: a. Edema in the cartilaginous matrix
b. Thickening of subchondral bone
Question 11
Which of the following is false regarding the synovium?
a. The inner membrane of the joint capsule is referred to as the synovium
b. The synovium surrounds the margins of articulation and lines the articulating surfaces of the
joint
c. The synovium secretes fluid that facilitates movement between articulating surfaces

Answer: b. The synovium surrounds the margins of articulation and lines the articulating
surfaces of the joint
Question 12
Senile Osteoporosis is characterized by which of the following? ( mark all that apply )
a. Fractures of the hip joint
b. Fractures of the distal radius
c. A direct relationship between aging and rate of bone loss
Answer: a. Fractures of the hip joint
c. A direct relationship between aging and rate of bone loss
Question 13
Osteoblast replication and activity are increased with age.
Answer: False -activity with osteoblast replication usually increase with age
False, Osteoblast replication and activity are decreased with age.
Question 14
Lamellae house osteocytes.
Answer: True
False, Lacunae house osteocytes.
Question 15
Hyperuricemia may be a result of an underproduction of purines.
Answer: false-end result uric acid
False, Hyperuricemia may be a result of an overproduction of purines.
Question 16
Prolonged immobilization can lead to structural joint changes associated with OA.
Answer: True
Question 17

If someone loses their balance when walking on uneven terrain, explain how tendons and
ligaments work to protect the joint and structures within it.
Answer: the tedons and ligament works by promoteing movment of the body and connect bones
and muscles. When there is increase strech or torsional strain, there will be an reflexive response
cause by nerve fibers which causes tension on the muscles protecting joints and capsule which
has the tension
The tendons and ligaments of joints serve in proprioception (the awareness of ones’ position in
space or movement of the body). When these structures undergo stretch or torsional strain, these
proprioceptive nerve fibers will cause a reflexive response to adjust the tension on the muscles
(to maintain balance and not fall over) that support the joint protecting the capsule and other joint
structures.
Question 18
A patient presents to the ER with severe pain in their right ankle. Blood tests reveal serum uric
acid levels of 7.8 mg/dL. They are kept for observation and their 24-hr urine specimen reveals
underexcretion of urate. Which phase of gout are they in? What is the goal of your treatment
given the phase they are in?
Answer: this patients is most likely in phase 2 of gout/acute gout arthritis
Treatment helps to manage symptoms and reduces the inflammation by used og NSADS drugs
This patient is in phase 2 of gout or acute gout arthritis. The goal of treatment is to manage
symptoms and terminate the acute attack primarily through NSAIDS.
Question 19
Which of the following patients is at greater risk for developing osteoporosis and sustaining a
fracture? Explain how you came to your conclusion. Patient A. is a 75-year-old white Caucasian
male who has a history of a distal radius fractures at age 65. Patient B. is a 60- year- old African
American female who is postmenopausal. She is active and does not have a history of fractures.
Answer: Patient A is at higher risk due to his age over 70,and has a history of bone fractures
Patient A is at higher risk. Even though he is a male, he is advanced in age, white Caucasian, and
sustained a fracture after the age of 50. Patient B is a postmenopausal female; however, she is

active and of African American decent which is associated with high BMD and low rates of
fracture.
Question 20
A 60-year-old, obese female works out of her home and rarely walks due to the sedentary nature
of her job. Give 2 reasons why she is at increased risk for developing OA.
Answer: due to immobilization( the patient can rarely walks) can compromise iubrication of the
joint which will cause more weight on the joint that can lead to joints structural changes
She is a female over the age of 55; she is obese, and she is relatively sedentary which contributes
to the decreased nourishment of the joint that comes with weight bearing and range of motion.
Question 21
Compare and contrast the blood supply of cortical bone and cancellous bone.
Answer: cortical bone has a direct bone supply which perfortating and nutrient the arteries.
Blood passes through the central haversion and volkmann canals.
Cancellous bone does not have a direct blood supply, and receive its blood supply from diffusion
through the endosteal bone surface extending outward through the canaliculi
Cortical bone has a direct blood supply. Nutrient and Perforating arteries form an anastomosis
(collateral circulation) that circulates through the bone through the Haversian and Volkmann
canals. Cancellous bone does not have a direct blood supply. It receives its blood supply through
diffusion from the endosteal bone surface extending outward through the canaliculi.
Question 22
A 22-year-old competitive gymnast has experienced amenorrhea for the past 5 years. Her PCP is
suspecting that she may have premature osteoporosis. Would you expect her OPG levels to be
high, normal, or low? Explain why her levels would be at this level.
Answer: She has a high RANKL levels, because of Estrogen which increase the production of
OPG that has RANKL. However, lower estrogen levels would lead to lower OPG levels which
will increase RANKL and osteoclast activity

Her OPG levels would be low. Amenorrhea results in lower estrogen levels. Estrogen increases
the production of OPG in turn decreasing osteoclast activity. If estrogen levels are low, OPG
levels would also be low resulting in increased osteoclast activity.
Question 23
A 68-year-old, white Caucasian female has a DEXA scan at the recommendation of her PCP. Her
scan yielded a T-score of -2.6. Interpret the results of her DEXA scan. Develop a treatment plan
giving a pharmacologic recommendation if applicable (be specific with name of supplement
and/or class of drug), and a non-pharmacologic recommendation.
Answer: The T-score shows a normal bone density but due to patients background such as age,
race and gender a calcium supplement or vitamin D and activities such as walking and exercise
would be recommend.
This T-score indicates osteoporosis. This patient should take a Calcium and Vitamin D
supplement. In addition, she should be prescribed one of the following: Estrogen, SERMs,
Bisphosphonates, or Calcitonin. She should also participate in regular weight bearing and
resistive exercise being careful to choose activities that would not put her at increased risk for
falling.
Question 24
A 72-year-old male is said to be in phase 3 of gout. He is obese and has a history of alcohol
abuse. Develop a treatment plan including specific pharmacologic intervention and a
nonpharmacologic recommendation to manage his disease.
Answer: Better treatment plan is to maintain normal uric acid leaves, as well as exercise as lower
alcohol intake. diet changes-avoid food that are rich in purine such as bacon, shell fish and fish
can help prevent future attacks.
Phase 3 of gout is called inter-critical gout. The patient is asymptomatic, and no joint
abnormalities are present. The goal of treatment in this phase is to maintain normal uric acid
levels and prevent progression of the disease. Allopurinol is a prescription drug that is used to
reduce uric acid levels. This patient should be encouraged to lose weight and decrease his alcohol
consumption. He should also avoid purine rich foods such as fish, bacon, and liver.

Question 25
A patient has a bilateral presentation of pain in the PIP joints of the hands. You believe this pain
is due to arthritis but are unsure whether it is a result of RA or OA. What are 3 questions you
could ask this patient to help you differentiate between RA and OA?
Answer: 1-is there any daily pain / pain during activity ? if so, is there any period of relief
32 Do you experience of morning stiffness that usually resolves in ess than 30 min or longer?
3- does the pain starts in both hands or start in one hand and deliver to the other hand over time?
1. Do you experience stiffness in the morning? 2. If so, does it last less than or longer than 30
minutes? 3. Does prolonged movement aggravate or alleviate your symptoms? 4. Do you ever
have periods of relief, or do you experience pain daily? 5. Did your pain start in both hands or
did it start with one hand and develop in the other over time? 6. What is your profession?
(occupations requiring repetitive movements often lead to OA)