NURS231 Pathophysiology Module 1 Exam With Answers-253 Solved Questions

Module I Exam

True/False:
A bodybuilder’s muscles will display hyperplasia.
A. True
B. False
Answer: A. True

During pregnancy, uterine enlargement is caused by hypoplasia.
A. True
B. False
Answer: B. False

Persistent dysplasia eventually results in cancer.
A. True
B. False
Answer: A. True

Endometrial hyperplasia is a normal physiologic occurrence.
A. True
B. False
Answer: A. True

Match the following:
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
Answer:

d. Specificity

Multiple Choice

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
C. They play a role in apoptosis

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: B. Neurotransmitters act through synapses
D. Autocrine signaling releases a chemical into the extracellular fluid that affects its own activity

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.

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: A. It controls shape and movement
B. Cilia and flagella are microtubule-filled cellular extensions

High blood pressure is an example of which of the following?
A. Pathology
B. Pathophysiology
C. Physiology
D. No answer text provided.
Answer: A. Pathology

A patient complains of chest pain and an elevated blood pressure. What are these examples of?
A. Signs
B. Symptoms
C. Both A & B
Answer: C. Both A & B

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: C. Evidence based practice
Which of the following is the effect of an illness on one’s life?
A. Incidence
B. Morbidity
C. Prevalence

D. Mortality
Answer: B. Morbidity

Define secondary prevention and give an example:
Answer: Secondary prevention aims to detect and treat disease early, usually when they are
asymptomatic and curable. An example is going for an annual pap smear.
Secondary prevention aims to detect and treat disease early, usually while the disease is
asymptomatic and curable. Some examples include annual Pap smears to detect early cervical
cancer, encouraging smoking cessation, checking blood pressure and cholesterol, and colonoscopy
screening.

Explain apoptosis and why it is necessary:
Answer: Apoptosis, referred to as programmed cell death, eliminates excess cells, damaged cells,
improperly formed cells and genetically damaged cells.
Apoptosis is important to ensure the cell gets rid of unwanted cells and tissue that may impair or
disrupt its normal functioning.
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.

Explain what necrosis is and give an example and description of one type of necrosis.
Answer: Necrosis refers to the death of a tissue or organ which is part of a living person.
An example of necrosis is coagulative necrosis, which is the sudden cut-off of blood flow to an
organ, usually the heart or kidney.
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.

Match the type of cell injury to the cause. Some answers may be used more than once. (1 point
each)
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
8. Radiation treatment
9. Lead toxicity
10. Bacteria

g. Hypoxic cell injury

Answer:

List the 4 types of tissue found in the body. Pick 2 and give a description and example of each.
Answer: The 4 types of tissues found in the body are
1. epithelial tissue
2. connective tissue
3. muscle tissue
4. nerve tissue
Muscle tissue function to provide movement to skeletal structures, pump blood through the heart,
and contract blood vessels and visceral organs. An example of a muscle tissue is skeletal muscle.
Nerve tissue is found throughout the body, and is used in communication between peripheral
tissues and the central nervous system. An example of a nervous tissue cell is neuron
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.
What term means “cell eating” and engulfs and then kills microorganisms or other particulate
matter?
Answer: Phagocytosis
Phagocytosis

What term means “cell drinking,” and engulfs small solid or fluid particles, as seen with proteins
and electrolytes?
Answer: Pinocytosis
Pinocytosis

Give one function of a membrane potential:
Answer: Membrane potential in muscle tissue leads to muscle contraction
Generate nerve impulse, muscle contractions, or cause hormone secretion

What is the diffusion of water called?
Answer: Osmosis
osmosis

Module 2 Exam

True/False:

Blood tests for tumor markers can make a diagnosis of cancer. Why or why not?
Answer: False. Because they are elevated in benign conditions, and most are not elevated during
early part of malignant conditions.
False, only tissue can diagnose. Tumor markers are helpful to assess response to therapy or
reoccurrence.

Tissue biopsy is of critical importance in what role?
Answer: Diagnosis of the correct cancer and histology.
Diagnosing the correct cancer and histology.

1. List two signs or symptoms a patient may present with that might indicate a cancer diagnosis:
2. What are two systemic manifestations of cancer exhibited by cancer patients?
Answer: 1. Bleeding, chest pain
2. Wasting of body fats and muscle tissues, Anorexia
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

Explain the TNM system:
Answer: The TNM system is a detailed staging system used in cancer facilities. It classifies cancer
using 3 tumor components, namely tumor, nodes and metastasis.
T is the size and local spread of the primary tumor
N is the involvement of the regional lymph node
M is the extent of the matastatic 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.

1. What are the three possible goals of cancer treatment?
2. How does radiation kill cancer cells?
Answer: 1. Curative, control and palliative
2. Radiation uses high energy waves that damage or destroy cancer cells. They produce free
radicals that can damage cell structure. Radiation can damage, kill cells or impair the DNA of the
cell.
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.

Cell proliferation is the process in which proliferating cells become more specialized cell types.
A. True
B. False
Answer: B. False
cell differentiation

Cell differentiation is the process in which proliferating cells become more specialized cell types.
A. True
B. False
Answer: A. True

What are two important properties that stem cells possess?
Answer: 1. Self renewal
2. Potency
Potency and self-renewal

Which of the following are most likely to have arisen from an adult stem cell?
A. Muscle
B. Bone
C. Epithelial
D. Neural
Answer: B. Bone

Define polyp. Are they benign or malignant?
Answer: Polyp is a growth that projects from a mucosal surface like the intestine. They can be
benign or malignant.
A polyp is a growth that projects from a mucosal surface, such as the intestine. A polyp can be
benign or malignant

How do cancer cells achieve immortality?
Answer: Cancer cells achieve immortality through unregulated and uncontrolled growth. The
ability of cancer cells to invade and metastasize, establishing its own blood supply contributes to
its achieving immortality.
Cancer cells keep high levels of telomerase, an enzyme that prevents telomere shortening. This
gives the ability of the chromosomes to continue to replicate forever.
looking for the specific mechanism

What is a tumor suppressor gene? Give one example.
Answer: A tumor suppressor gene is a gene that encodes proteins that inhibits cell growth and
signals apoptosis. They reduce cell division and repair DNA mistakes.
An example is TP53
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

Determine if the tumor is benign or malignant based on the nomenclature:
1. Papilloma
2. Lipoma
3. Leiomyosarcoma
4. Hemangioma
5. Adenocarcinoma
6. Neuroblastoma
7. Adenoma
8. Melanoma
9. Lymphoma
10. Glioma
Answer:

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. Metastasis is a multi-step process. Cancer cells shed from a tumor invade the
extracellular matrix and gain access to the blood vessel. If passage through the blood vessel is
successful, it finds a favorable environment and invade the surrounding tissue and grow, and
importantly establishes a blood supply.
2. Chest pain, cough, shortness of breath
3. Chest CT
(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.

Benign tumors have which of the following characteristics? Select all that apply.
A. Undifferentiated cells

B. Grows by expansion
C. Gains access to blood and lymph channels
D. Growth may stop or regress
Answer: B. Grows by expansion
D. Growth may stop or regress

What are the genetic events that can lead to cancer? Select all that apply.
A. Gene amplification
B. Pleomorphism
C. Point mutation
D. Seeding
E. Chromosomal translocation
Answer: A. Gene amplification
C. Point mutation
E. Chromosomal translocation

List 4 of the 7 risk factors linked to cancer as stated in the module.
Answer: 1. Heredity
2. Obesity
3. Immunologic mechanism
4. Cancer-causing viruses
Heredity, hormonal factors, obesity, immunologic mechanisms, environmental agents such as
chemicals, radiation, and cancer-causing viruses.

List three characteristics of cancer cells and briefly explain what it means:
Answer: 1. Cell anchorage: Normal cells require contact and anchorage to extracellular matrix and
other cells and tissue to survive. Cancer cells do not need to be anchored to other cells and tissues
for survival
2. Cell Growth: The growth of cancer cells are uncontrolled, and not regulated, expanding and
invading surrounding tissues and other parts of the body
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.
Need specific terms and cell growth would not be one. You would need to more specifically list
characteristics that give them uncontrolled growth. The 3rd is not listed in answer.

Which of the following are risk factors for developing cancer? Select all that apply.
A. HBV
B. Alcohol
C. High intake of smoked meats
D. Deodorant
Answer: A. HBV
B. Alcohol
C. High intake of smoked meats

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

List one example of screening for each method: observation, palpation, and lab test/procedure:
Answer: Observation: Mouth
Palpation: Breast
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

Module 3

Short answer
Explain how the skin’s physical barrier makes it inhospitable to microorganisms.
Answer: Keratin, covers the skin and provide salty and acidic environment which is inhospitable
to microrganisms. They also contain antimicrobial proteins and lysosomes which inhibits and help
destroy microrganisms.
It has closely packed cells in multiple layers that are continuously being shed. Keratin covers the
skin, which creates a salty, acidic environment inhospitable to microbes. It also contains
antimicrobial proteins and lysozymes that inhibit microorganisms and help to destroy them.

Which cell is the first responder to phagocytose a foreign invader?
A. Monocyte
B. Basophil
C. Eosinophil
D. Dendritic cell
Answer: A. Monocyte

What are the primary cells involved in the adaptive immune response?
A. Antibodies
B. Antigens
C. Neutrophils

D. Lymphocytes
Answer: D. Lymphocytes

T lymphocytes produce what type of immunity?
Answer: Cell-mediated immunity
Cell-mediated

Multiple Choice

Which immunoglobulin provides local immunity on mucosal surfaces?
A. IgA
B. IgM
C. IgG
D. IgD
E. IgE
Answer: A. IgA

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

Which feature is NOT of adaptive immunity?
A. Response to repeated infection is immediate
B. Antibodies are involved
C. Epithelium is a defense mechanism
D. Microbe recognition is specific
Answer: C. Epithelium is a defense mechanism

A 9-year-old boy with a peanut allergy was exposed to peanuts. He presents to the emergency
room with an anaphylactic reaction. (1) What symptoms might he present with? (2) Does the
quantity of exposure mean he will have a more severe reaction? (3) What is the initial immediate

treatment? (4) What are 2 things people with anaphylaxis should always carry?
Answer: 1. Bronchospasm, cardiac dysrythmias, cardiac collapse
2. No
3. Epinephrine
4. Identification about the allergy, Epi pen
(1) Any of the following reactions are accepted.
Grade I: erythema and urticaria, with or without angioedema.
Grade II: hypotension, tachycardia, dyspnea, and GI manifestations, like nausea, vomiting,
diarrhea, and abdominal cramping from mucosal edema.
Grade III: bronchospasm, cardiac dysrhythmias, and cardiac collapse.
Grade IV: cardiac arrest
(2) No
(3) Epinephrine
(4) identification about allergy, EpiPen

True/False:

An antibiotic alone will heal an abscess. If false explain why:
A. True
B. False
Answer: A. True.
False, antibiotics can’t penetrate the abscess wall, so incision and drainage are necessary.

__________ are low molecular weight molecules that can elicit production of antibodies when
combined with a larger protein?
Answer: Antigens
haptens

True/False:

B cells are primarily associated with humoral immunity.
A. True
B. False
Answer: A. True

Passive immunity is achieved through immunization.
A. True
B. False
Answer: B. False
False, active immunity

Passive immunity provides long lasting protection.
A. True
B. False
Answer: B. False

14. Type II hypersensitivity reactions are ______ mediated reactions.
Answer: Antibody(IgG or IgM)
antibody

Multiple Choice:

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

Which cell is NOT part of the adaptive immune response?
A. Monocytes
B. Lymphocytes
C. Antigen presenting cells
D. Effector cells
Answer: A. Monocytes

Features of systemic lupus erythematosus include all of the following except:

A. Arthralgias and arthritis
B. Skin manifestations
C. Pericarditis
D. Renal disease
E. Exophthalmos
Answer: E. Exophthalmos

Short Answer:

What are the 2 factors that play a role in the development of autoimmune diseases?
Answer: 1. Genetic factors
2. Environmental factors
Genetics and environmental factors

A 40-year-old man presents with cough and shortness of breath. After an H&P and chest films, it is
determined he has pneumocystis carinii pneumonia (PCP). The provider does an HIV test, which is
positive. Upon further testing, the man’s CD4+ cell count is 100 cells/µL and his viral load is
250,000 copies/mL. (1) Why did the provider do an HIV test after the man was diagnosed with
PCP? (2) What classification does this man fall into based on his CD4+ count and
symptomatology, and why?
Answer: 1. Opportunistic infections are infections that occur frequently and more severe in
patients with HIV because of the damaged immune system. PCP is an opportunistic infection
2. The last stage or overt AIDS. This is because his CD4+ cell count is below 200 cells/uL, and he
has AIDS-defining symptoms.
(1) Opportunistic infections are those common organisms that do not produce infection without
impaired immune function. (2) The last phase, or AIDS illness, occurs when the CD4+ cell count
falls to less than 200 cells/µL or exhibits an AIDS-defining illness. The risk of opportunistic
infections and death increases significantly when the CD4+ cell count falls below 200 cells/µL.

Multiple Choice

Which process is NOT included in wound healing?
A. Inflammatory
B. Proliferative

C. Acute-phase response
D. Remodeling
Answer: C. Acute-phase response

Which of the following cells are NOT classified as either labile or stable cells?
A. Epidermal cell
B. Hepatocyte
C. Intestinal mucosal cell
D. Skeletal muscle cell
E. Renal tubular cell
Answer: D. Skeletal muscle cell
HIV is a _________ virus that destroys the body’s immune system by taking over and destroying
_______ cells.
Answer: HIV is a retrovirus that destroys the body's immune system by taking over and destroying
CD4+T cells
retrovirus, CD4 T cells
The term to describe the time when an infected person’s blood converts from being negative for
HIV antibodies to being positive is called what?
Answer: Seroconversion
seroconversion

A person with HIV is not infectious when they are asymptomatic.
A. True
B. False
Answer: B. False
The T cells that display the host’s MHC antigens and T-cell receptors for a non-self-antigen are
allowed to mature, a process termed negative selection.
A. True
B. False
Answer: B. False

What cell mediator is the primary cause of vasodilation seen in acute inflammation?
A. Endothelial cells
B. Platelets
C. Histamine
D. Neutrophils
Answer: C. Histamine

Which lab value will typically be increased in a viral infection?
A. Neutrophils
B. Eosinophils
C. Basophils
D. Lymphocytes
Answer: D. Lymphocytes

Module 4 Exam

The three stages of hemostasis include each of the following except:
A. Vascular constriction
B. Vascular dilation
C. Formation of platelet plug
D. Blood coagulation
Answer: B. Vascular dilation

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: E. Protein C
F. Protein S

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: C. Hemophilia A
D. Hemophilia B

Which of the following defects is associated with hemophilia A?
A. Deficiency of hemoglobin S
B. Deficiency of hemoglobin A
C. Defective gene in the X chromosome
D. Defective gene in the Y chromosome
Answer: C. Defective gene in the X chromosome

In which of the following ways is blood flow NOT negatively affected?
A. Blood viscosity
B. Diameter of the vessel
C. Low hematocrit
D. Compliance
Answer: C. Low hematocrit
Which of the following does NOT affect the heart’s ability to increase its output?
A. Preload
B. Afterload
C. Cardiac contractility
D. Cardiac reserve
E. Heart rate
Answer: D. Cardiac reserve

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

Which of the following does NOT lead to an increased risk for DVT? Select all that apply.
A. Factor V Leiden mutation
B. Obesity
C. Non-smoker
D. Sepsis
Answer: C. Non-smoker

Which of the following symptoms is NOT associated with iron deficiency anemia?
A. Pica
B. Fatigue
C. Neurologic changes
D. Brittle hair and nails
Answer: C. Neurologic changes

What are the two major causes of microcytic anemias?
A. Iron deficiency anemia, Vitamin B12 deficiency
B. Vitamin B12, Folate deficiency
C. Iron deficiency anemia, Thalassemias
D. Thalassemias, Folate deficiency
Answer: C. Iron deficiency anemia, Thalassemias

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

The spleen of a patient with sickle cell anemia would be expected to be:

A. Enlarged
B. Shrunken
C. Normal sized
Answer: B. Shrunken

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: C. Dietary deficiencies are common

Which of the following descriptions best applies to atherosclerotic plaques?
A. Cholesterol infiltration of thickened vascular intima and media
B. Cystic degeneration and necrosis of vascular media
C. Intimal lesion consisting of fibrous cap overlying necrotic lipid-laden core
D. Organized old thrombotic residues overlying atrophic vascular intima
Answer: A. Cholesterol infiltration of thickened vascular intima and media

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: B. Increase red meat consumption

Risk factors for atherosclerosis include each of the following except:
A. Increasing age
B. Female gender (pre-menopause)
C. Elevated CRP levels
D. Cigarette smoking
Answer: B. Female gender (pre-menopause)

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
Answer: C. Left ventricular contractility

________ is the most important factor in myocardial oxygen demand. As this increases,
myocardial oxygen consumption or demand also increases.
Answer: Heart Rate

What is the most common cause of cardiogenic shock?
A. Heart failure
B. Cardiomyopathy
C. Myocardial infarction
D. Hypertension
Answer: A. Heart failure

Which does NOT occur during cardiogenic shock?
A. Decreased cardiac output
B. Hypotension
C. Hypoperfusion
D. Decreased systemic vascular resistance
Answer: C. Hypoperfusion

Explain the differences in the pathophysiology, symptoms, and whether nitroglycerin and/or rest
will relieve symptoms in stable angina, unstable angina, and myocardial infarction.
Answer: Stable angina occurs when a person experiences brief episode of chest pain, tightness
and/or shortness of breath with exertion. It is resolved by rest or nitroglycerine.
Unstable angina occurs when a person experiences brief episode of chest pain, tightness and/or
shortness of breath without exertion. Rest does not resolve it. It is resolved by nitroglycerine.
If a plaque ruptures, thrombosis can lead to total occlusion. Tissue ischemia occurs, causing the
death of some of the muscles. Myocrdial infarction presents as chest pain which is not resolved by
rest, radiating to the left arm or neck, nausea, vomiting, dyspnea. Nitroglycerine does not relieve

symptoms of myocardial infarction.
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.
Stable angina- The heart is stable at rest but cannot keep up with the demand of exertion. Stable
angina typically has a >70% stenosis of the coronary arteries. It is relieved by rest or nitroglycerin
(vasodilator).
Unstable angina- 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 unstable angina. It
can be relieved by nitroglycerin, but not rest. Unstable angina means one or more coronary vessels
is nearly totally occluded.
Myocardial infarction- If a plaque ruptures, coronary thrombosis can cause complete occlusion. If
collateral flow is inadequate, the tissue supplied becomes ischemic. Without oxygen, a portion of
the muscle can die. MI can present as chest pain unrelieved by rest, sometimes radiating down the
left ram or into the jaw or neck, dyspnea, nausea/vomiting, sweating, and/or other signs of distress.
Other symptoms include a crushing pain or like “something is sitting on my chest.” Women may
present with weakness, fatigue, shortness of breath, or GI complaints. Symptoms are not relieved
by nitroglycerin.
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: Myocardial infarction, Hypertension, Artherosclerosis
1. Target-organ damage
2. coronary heart disease, cardiac dysrhythmias, congestive heart failure, and sudden death.

The most common cause of death immediately after the onset of acute myocardial infarction is:
A. Arrhythmia
B. Left ventricular rupture
C. Congestive heart failure
D. Shock
E. Pulmonary edema
Answer: C. Congestive heart failure

A 40-year-old woman is hospitalized with a chronic illness characterized by hepatomegaly,
distended neck veins, and peripheral edema. Which of the following disorders is the most likely
cause of these findings?
A. Hypertrophic cardiomyopathy
B. Dilated cardiomyopathy
C. Right heart failure
D. Left heart failure
Answer: C. Right heart failure

Right ventricular failure is commonly characterized by each of the following changes except:
A. Distended neck veins
B. Hepatomegaly
C. Ankle edema
D. Sodium and water retention
E. Pulmonary edema
Answer: E. Pulmonary edema

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: C. Beta-blockers

The ______ is the organ most closely associated with platelet storage and destruction.
Answer: Liver
Spleen

The laboratory test that measures the volume of red cells in 100 mL of blood is _________.
Answer: Hematocrit
hematocrit

Approximately 55% of blood volume consists of _______
Answer: Plasma
Plasma

Thrombocytes are also known as _____________.
Answer: Agranulocytes
Platelets

Short Answer:

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. Hyperlipidema, obesity, smoking, C-reative proteins
2. Coronary artery disease, angina, myocardial infarction, stroke.
3. Stop smoking, Increased physical activity, weigth loss, exrecise
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.

Module 5 Exam

Both carbon dioxide and oxygen are able to bind with hemoglobin.
A. True
B. False
Answer: A. True

Exercise, allergens, and emotion can all contribute to an asthma attack.
A. True
B. False
Answer: A. True

_________ measures expiratory volume in a given time.
Answer: Forced expiratory volume
Forced expiratory volume (FEV)

Lung _______ is the term used to describe the ease or difficulty with which the lungs can be
inflated.
Answer: compliance
compliance

During inspiration, air is drawn into the lungs and the chest cavity is decreased.
A. True
B. False
Answer: A. True

COPD is reversible airway bronchoconstriction.
A. True
B. False

Answer: B. False

The accessory muscles are the main muscles of inspiration.
A. True
B. False
Answer: B. False
diaphragm

The FEV1/ FVC ratio is decreased in restrictive lung disorders.
A. True
B. False
Answer: A. True

Lung volumes can be measured using a _____________
Answer: spirometer
spirometer

__________ is the flow of gases into and out of the alveoli of the lungs.
Answer: Ventilation
Ventilation

Risk factors for asthma include each of the following except:
A. IgE hypersensitivity
B. Drug overdose
C. Tobacco smoke
D. Gastroesophageal reflux disease
Answer: B. Drug overdose

People with emphysema would exhibit each of the following except:
A. Use of accessory muscles
B. Pursed-lip breathing
C. Barrel-chest
D. Cyanosis and fluid retention
Answer: D. Cyanosis and fluid retention

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

ARDS is caused by each of the following conditions except:
A. Shock
B. Sepsis
C. Inhalation of toxic irritants
D. Bronchial obstruction by foreign body
E. Head injury
Answer: D. Bronchial obstruction by foreign body

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: Constriction of the airways, secretion of mucous and swelling of the bronchial wall.
There is also recruitment of inflammatory cells from the blood stream that invade the foreign
substance, releasing chemicals that are toxic to them.
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.

When is the risk for obstructive atelectasis the greatest? What are strategies to decrease the chance
for developing atelectasis?
Answer: The risk of obstructive atelectasis is greatest after surgery. Anastesia, pain medicine and
immobility promotes the retension of bronchial secretions.
Ambulation, taking deep breaths, frequent change of posture.
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.

1. Upon autopsy, what was this patient’s cause of death?
2. What risk factors predispose this patient to this outcome?
3. What would have been an effective treatment for this patient?
Answer: 1. Pulmonary embolism
2. Immobility, surgery, fracture of the hips femur, child birth.

3. Anticoagulant therapy and thrombolytic therapy
1. Pulmonary embolism,
2. Venous stasis, venous endothelial injury, and hypercoagulability states: inherited
hypercoagulability disorders that increase risk of thrombosis (e.g. antithrombin III deficiency,
protein C and S deficiencies, factor V Leiden mutation). Venous stasis and venous endothelial
injury can result from prolonged bed rest or immobility, trauma, surgery, childbirth, fractures of
the hip and femur, MI and CHF, cancer, and spinal cord injury.
3. thrombolytics, anticoagulant therapy, compression stockings or intermittent pneumatic
compression boots can prevent venous stasis.

1. _________ are the preferred method of determining the partial pressure of oxygen (PO 2) and
carbon dioxide (PCO2) levels in the blood.
2. Hemoglobin’s affinity for oxygen is increased by ______ Name one factor:
Answer: 1. Arterial blood gases
2. Increased pH
1. Arterial blood gases (ABGs)
2. Any of the following - hemoglobin saturation, increased pH (alkalosis), decreased CO2,
decreased body temperature

________ are alveoli that are ventilated but not perfused.
Answer: Alveoli dead space
Alveolar dead space

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 some NSAIDS.
Aspirin and other NSAIDs

Each of the following can be daily treatments for asthma except:
A. Bronchodilators
B. Oxygen therapy
C. Inhaled corticosteroids
D. Leukotriene modifiers
Answer: B. Oxygen therapy

Asthma exhibits each of the following characteristics except:
A. Bronchial swelling
B. Mucus secretion
C. Airway remodeling
D. Hypertrophy of the submucosal glands
Answer: A. Bronchial swelling

Module 6 Exam

A patient experiences a seizure that manifests with motor weakness on the right side, a tingling
sensation on the right side, and flushing. 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: A. Focal seizure without impairment of consciousness or awareness

A patient is having difficulty tracking their eye laterally. Which cranial nerve is affected?
A. CN II.
B. CN III.
C. CN IV.
D. CN VI.
Answer: D. CN VI.
You are seeing a patient with Parkinson’s disease in your office. You notice they are repetitively
rubbing their right thumb and forefinger. This is an example of what physical manifestation of the
disease?
A. Pill-rolling
B. Cogwheeling
C. Bradykinesia
D. Rigidity
Answer: A. Pill-rolling

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

A person reports feelings of anhedonia, guilt, and worthlessness that seem to be worse in the
morning. They also exhibit excessive weight loss and experience insomnia. What type of
depression are they experiencing?
A. Melancholic depression
B. Atypical depression
C. Depression with psychotic features
D. Depression with catatonic features
Answer: A. Melancholic depression

Each of the following statements is true regarding the organization of the nervous system except:
A. The PNS has an afferent and efferent division
B. The somatic 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 somatic nervous system can be further divided into the sympathetic and
parasympathetic divisions
Each of the following statements is true regarding Alzheimer’s disease except:
A. Tau protein is resistant to breakdown even after the neuron that produced it dies
B. Neurofibrillary tangles 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: B. Neurofibrillary tangles are composed of deteriorating nerve pieces that arrange
themselves around a sticky protein core called amyloid beta (Aβ)

Each of the following are modifiable factors related to stroke except:
A. Hypertension

B. Diabetes
C. Cardiac disease
D. Obesity
Answer: D. Obesity

Adjustment insomnia is characterized by each of the following except:
A. More than 30 days of insomnia symptomology
B. Disrupted sleep is in response to physical or emotional stressor
C. Resolves on its own once an adjustment is made/stressor is removed
Answer: A. More than 30 days of insomnia symptomology

What type of seizure manifests with a blank stare, lasts only for a few seconds, and often goes
unnoticed?
A. Atonic seizure
B. Absence seizure
C. Tonic seizure
D. Clonic seizure
Answer: B. Absence seizure

Sleep disturbances associated with narcolepsy include each of the following except:
A. hypnagogic hallucinations
B. sleep apnea
C. cataplexy
D. sleep paralysis
Answer: B. sleep apnea
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

Efferent neurons deliver ________ input from the CNS to the periphery.

Answer: motor
Motor

_______ work by blocking membrane receptors and the subsequent reuptake of serotonin and
norepinephrine.
Answer: Tricyclic antidepressants
Tricyclic antidepressants (TCAs)

Shallow or abnormally slow breathing is referred to as _____________.
Answer: dysphagia
hypopnea

________ is the precursor for ______ that crosses the blood brain barrier making it the drug of
choice for treatment of Parkinson’s disease.
Answer: Levadopa is the precurser for dopamine that crosses the blood brain barrier making it the
drug of choice for treatment of Parkison's disease.
Levadopa, dopamine

Specialized ependymal cells that project into the ventricles and produce CSF are called the
_________.
Answer: choroid plexus
Choroid plexus

Astrocytes help to form the blood-brain barrier which prevents toxins from the blood from entering
the brain.
A. True
B. False
Answer: A. True

The average age of onset for major depressive disorder is mid-30s; however, the age of onset is
increasing in recent times.
A. True
B. False
Answer: B. False

The age of onset is decreasing in recent times.

Brain activity is decreased during REM sleep.
A. True
B. False
Answer: B. False
Brain activity is increased during REM sleep.
Complete dependence for activities of daily living is characteristic of severe Alzheimer’s disease.
A. True
B. False
Answer: A. True

Explain 3 mechanisms in which neurotransmitters are removed from the synaptic cleft.
Answer: Neurotransmitters can be acted on by enzymes, converting it to inactive substances
Neurotransmitters can diffuse into the intercellular fluid until their concentration is too low to elicit
any post-synaptic response
Neurotransmitters can be drawn back into the pre-synaptic phase by a process called reuptake
• A neurotransmitter can be broken down by enzymatic activity into inactive substances.
• A neurotransmitter can be drawn back into the presynaptic neuron by a process known as
reuptake.
• A neurotransmitter can diffuse into the intercellular fluid until its concentration is too low to elicit
a postsynaptic response.

You witness a seizure in which the person exhibits twitching in their right arm as well as repetitive
lip smacking. Once this subsides, they report hallucinations that coincide with their abnormal
movement patterns. Is this a generalized or focal seizure? Based upon this description, what
specific type of seizure did this individual experience?
Answer: Focal seizure, focal seizure with impairment of consciousness or awareness.
Focal seizure with impairment of consciousness or awareness

Compare and Contrast breathing patterns between NREM and REM sleep (include a discussion on
the specific stages of NREM sleep.)
Answer: NREM sleep is characterized by slow and rolling eyes, moderate motor activity,

decreased vital signs and brain activity. Stage 1 sleep is associated with alpha waves, stage 2 with
theta waves, and stages 3 and 4 associated with delta waves.
REM sleep is characterized by rapid eye movement, diminished muscular tone and motor activity,
and increased vital signs and brain activity. REM sleep is associated with beta waves.
In stages 1 and 2 NREM sleep as well as in REM sleep, breathing is irregular, and brief periods of
apnea are often observed (approximately 5-15 seconds.) During stages 3 and 4 of deep sleep,
breathing becomes regular, prompt is not addressed. this should be targeted towards breathing
patterns

A patient reports to the emergency department where you are working at 10 pm. They report that
earlier in the day beginning at approximately 9 am they began to experience tingling in their right
arm. They decided to ignore it thinking it was probably a result of all the gardening they did the
day before. As the day went on, the tingling sensation got worse, and they started to have difficulty
speaking. The patient’s spouse reported that they were slurring their words. Past medical history
includes a diagnosis of diabetes and hypercholesteremia. By the time they are evaluated, their
symptoms start to subside. The tingling disappears and their speech returns to normal. What do you
suspect this patient has experienced? What evidence is there to support that diagnosis?
Answer: Transient ischemic attack. There was a temporary obstruction of blood flow to the brain
from the main arteries feeding the brain, leading to temporary loss of oxygen in the brain, which
was resolved within 24 hours
This patient has experienced a TIA. They have experienced symptoms consistent with oxygen
deprivation to the brain, however their symptoms subsided within 24 hours of their onset.

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: Ischemic stroke.
An MRI and CT scan should be done to confirm the type of stroke, either ischemic stroke or
hemorrhagic stroke.
The patient can be treated with tissue plasminogen activator, since the patient was taken to the

emergency department within 3-4.5 hours of onset of the symptons. If it had fallen beyond 3-4.5
hours, then a catheter-based method of treatment would have to be used.
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.
Need to narrow the type of event to either hemorrhagic or ischemic based on the symptoms and the
select the proper treatment

A patient is being seen in your office with a primary complaint of daytime fatigue that has lasted
for the past 2 months. They go on to tell you that they are having difficulty with work performance
and are constantly on edge. You suspect they have chronic insomnia. What are the 4 primary
symptoms of insomnia? Describe a nonpharmacologic treatment plan that you can prescribe for
this patient.
Answer: Difficulty initiating sleep
Difficulty maintaining sleep
Poor sleep
Waking up too early.
Establishing a consistent sleep pattern, avoiding stimulants like caffeine several hours before sleep,
ensuring comfortable sleep environment including optimum temperature, and avoid putting on
lights and television just before going to bed.
The 4 primary symptoms of insomnia are:
• Difficulty initiating sleep
• Difficulty maintaining sleep
• Waking up too early
• Chronic nonrestorative or poor sleep
You would educate the patient on proper sleep hygiene and encourage them to evaluate possible
stressors that may need to be removed from their daily routine. Sleep hygiene involves the
establishment of consistent sleep patterns (going to bed at the same time each night and only
sleeping as long as one needs to feel refreshed during the day), creating a comfortable sleeping
environment (optimal room temperature), avoidance of screens and excessive light right before

bed, and finally, avoidance of stimulants (caffeine) several hours prior to normal bedtime.

Module 7 Exam

The liver is responsible for each of the following EXCEPT:
A. Producing bile
B. Stores vitamins and minerals
C. Releases insulin
D. Synthesizes protein
Answer: C. Releases insulin

Risk factors for gallstone formation include each of the following EXCEPT:
A. Female gender
B. Oral contraceptive use
C. Age (60’s)
D. Obesity
Answer: C. Age (60’s)

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

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: C. Constipation or diarrhea may be present

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. H. Pylori infection
D. Stress
E. NSAID use
Answer: C. H. Pylori infection
E. NSAID use

The most common complication of peptic ulcers is _________.
Answer: gastroduodenal bleeding
Gastrointestinal bleeding

Each of the following are characteristics of ulcerative colitis EXCEPT:
A. Extraintestinal manifestations
B. Confluent inflammation
C. Fistulas and perianal abscesses
D. Increased risk of malignancy
E. Affects primarily rectum and left colon
Answer: C. Fistulas and perianal abscesses

Each of the following are characteristics of Crohn disease EXCEPT:
A. Cobblestone appearance
B. Primarily submucosal
C. Continuous extent of involvement
D. Affects primarily ileum
E. Perianal abscesses
Answer: C. Continuous extent of involvement

The process of digestion begins in the stomach and finishes in the large intestine.
A. True
B. False
Answer: B. False

The GI tract is innervated autonomically.
A. True
B. False
Answer: A. True

What is the largest serous membrane in the body?
Answer: Peritonium
peritoneum

What type of cell secretes gastrin?
Answer: G cell
G cells

What type of movements have a constant level of contraction or tone without regular periods of
relaxation?
Answer: Tonic movement
Tonic movements

Activation of the peripheral nervous system increases the amplitude of the slow waves.
A. True
B. False
Answer: A. True

_______ is a linear chain of interconnecting neurons located between the circular and longitudinal
muscle layers, involved with GI motility?
Answer: Myenteric plexus
Myenteric (Auerbach) plexus

What is one cause of gastric retention?
Answer: Slow gastric emptying
obstruction, gastric atony, surgery

What are rhythmic movements designed to propel the chyme along the small intestine toward the
large intestine?

Answer: Peristaltic contractions
Peristaltic movements

Which GI hormone inhibits gastric acid secretion?
Answer: Secretin
Secretin

Anti-diarrheal medication can be used with all types of diarrhea.
A. True
B. False
Answer: B. False

Constipation and a low fiber diet are a major risk factor for developing what disease?
Answer: Diverticular disease
diverticulosis

Clinical manifestations of cirrhosis include each of the following EXCEPT:
A. Hemorrhoids
B. Asterixis
C. Esophageal varices
D. Thrombocytosis
E. Ascites
Answer: C. Esophageal varices

What is the most specific and sensitive test for the diagnosis of cirrhosis?
Answer: liver biopsy
Liver biopsy

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: A. Abdominal CT scan

Liver damage from cirrhosis, hepatitis, or cancer would cause what type of jaundice?
Answer: Intrahepatic jaundice
Intrahepatic jaundice

Module 8 Exam

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: C. The sympathetic nervous system can supersede the renal autoregulatory system.

Which of the following statements is false regarding ADH?
A. Elevated levels of ADH will lead to a small volume of concentrated urine.
B. Decreased levels of ADH will lead to dilute urine.
C. Alcohol increases ADH levels.
D. Alcohol is a diuretic and will inhibit the release of ADH.
Answer: C. Alcohol increases ADH levels.

Juxtamedullary nephrons are characterized by the following except:
A. They make up 85% of all nephrons
B. They make up 15% of all nephrons
C. They originate deep in the cortex
D. Their loops of Henle extend across the entire medulla
Answer: A. They make up 85% of all nephrons
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: B. Water intoxication

Reabsorption in the PCT is characterized by the following except:
A. Na+ and water are reabsorbed in equal proportions
B. Glucose and amino acids are minimally reabsorbed in the PCT
C. Glucose and amino acids are almost completely reabsorbed in the PCT
D. Sodium, chloride, potassium, and bicarbonate are 65%-80% reabsorbed from the filtrate
Answer: B. Glucose and amino acids are minimally reabsorbed in the PCT

Which of the following is/are true regarding acid-base disorders? (mark all that apply)
A. Metabolic disorders are a result of a change in plasma HCO3- levels
B. Respiratory disorders are a result of a change in plasma CO2 levels
C. Normal HCO3- = 35-45 mm
D. Normal blood pH = 7.35-7.45
Answer: A. Metabolic disorders are a result of a change in plasma HCO3- levels
B. Respiratory disorders are a result of a change in plasma CO2 levels
D. Normal blood pH = 7.35-7.45

Acute postinfectious glomerulonephritis is characterized by the following except:
A. Edema of the hands and face can be a sign of this condition
B. Associated with a good prognosis and rarely causes kidney disease
C. Lab results will include an elevated antistreptococcal antibody (ASO) titer
D. Hypocellularity
Answer: B. Associated with a good prognosis and rarely causes kidney disease

Which of the following is characteristic of acute transplant rejection?
A. Occurs months to years after transplant
B. Involves increased T lymphocytes
C. It does not respond well to immunosuppressive therapy
Answer: B. Involves increased T lymphocytes

Which of the following is true of cholecalciferol?
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: A. It is the inactive form of vitamin D taken in through the skin via UV rays

A patient is said to be in stage 4 kidney disease. What would you expect their GFR to be?
A. 25 mL/min/1.73m2
B. 42 mL/min/1.73m2
C. 70 mL/min/1.73m2
D. 14 mL/min/1.73m2
Answer: A. 25 mL/min/1.73m2

The following are true regarding tubular secretion except:
A. H+ is secreted in the intercalated cells
B. K+ is secreted in the principal cells
C. H+ along with organic acids and bases are secreted from the distal tubule
Answer: C. H+ along with organic acids and bases are secreted from the distal tubule
H+ along with organic acids and bases are secreted from the proximal tubule

Dilation of the afferent arterioles is achieved through the action of which of the following?
A. Cardiovascular baroreceptors
B. Aldosterone
C. Diuretics
Answer: A. Cardiovascular baroreceptors

The inner portion of the kidney that houses the loop of Henle and the renal pyramids is called the
____________.
Answer: renal medulla
renal medulla

The hormone that is synthesized in the kidneys and regulates the differentiation of red blood cells
is _____________
Answer: erythropoietin
erythropoietin

The _________ has the largest impact on pH control.
Answer: renal control mechanism
renal control mechanism
A person who has a blood Mg2+ concentration of 3.3 mg/dL. Is considered to have ________.
Answer: hypermagnesemia
hypermagnesemia

____________ failure is caused by conditions that damage the structures within the kidney.
Answer: intrarenal
Intrarenal

When blood pressure rises, the enzyme renin is released by the juxtaglomerular (JG) cells of the
nephron.
A. True
B. False
Answer: B. False. When blood pressure falls, the enzyme renin is released by the juxtaglomerular
(JG) cells of the nephron.
False, when blood pressure drops, the enzyme renin is released by the juxtaglomerular (JG) cells of
the nephron.
The kidneys have compensatory mechanisms needed to conserve K+ during periods of excessive
loss.
A. True
B. False
Answer: B. False. The kidneys do not have compensatory mechanisms needed to conserve K+
during periods of excessive loss.
False, the kidneys do not have compensatory mechanisms needed to conserve K+ during periods of
excessive loss.

Explain why renal flow is decreased with sympathetic activity.
Answer: Sympathetic activity diverts blood to the brain, heart and skeletal muscles. During this
period, the renal autoregulation is superseded by the nervous system. Constriction of the afferent

arterioles are caused by the sympathetic nerves followed by the release of epinephrine, which leads
to decrease in renal flow 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.

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: Hypocalcemia. Pancreatitis causes the release of proteolytic and lipolytic enzymes. Free
fatty acids are released during lipolysis. Calcium binds to these fatty acids removing them from the
blood.
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.

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: Blood and plasma proteins. Spaces within the structural framework of the basement
membrane prevent substances like red blood cells and plasma proteins from passing through the
membrane into the filtrate. A glomerular disease will cause a compromise in the the spaces of the
basement membrane allowing blood and proteins to be filtered through the capillaries.
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.

Explain why a patient with chronic kidney disease may develop anemia.
Answer: Erythropoietin, which is synthesized in the kidney regulates the differentiation of red
blood cells. The formation of erythropoetin is preceded by low oxygen levels in the tissue. A
patient with chronic kidney disease will not be able to synthesize erythropoietin when anemic.

Under normal circumstances, erythropoietin is synthesized in the kidneys and regulates the
differentiation of red blood cells within the bone marrow. The formation of erythropoietin is
hindered in chronic kidney disease.

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: Calcium stones. The patients medical history together with the fact that urinalysis found
calcium in their urine. Since the stone is more than 5mm, it will not pass own its own. Uretescopic
removal can be done to get rid of the stones. The patient can be given medication to help with 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 ureteroscopic removal or extracorporeal shockwave lithotripsy. The patient may
also be put on medication for pain management.

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 HCO3- = 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, HCO3- = 22-26 mEq/L.
Answer: Metabolic alkalosis. Respitaory compensation is not occuring as the the pressure of CO 2
is within normal range. The treatment will be the administration of normal saline solution.
The patient is in metabolic alkalosis. The respiratory system is not compensating as PCO 2
compensation falls within normal limits. Fluids are replaced with normal saline solution.

A 5-year-old is brought to the emergency department after spending the day at an amusement park.
The child is agitated, and their skin is flushed. No tears are produced when they cry. Blood Na + =
152 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: Hypernatremia. Treatment for this condition will be to administer fluid intravenously.

This patient is experiencing hypernatremia. Treatment for hypernatremia includes treating the
underlying cause and replenishing fluids orally or intravenously.

Module 9 Exam

If a patient is taking exogenous forms of corticosteroid hormones, what would their labs show?
A. High levels of ACTH
B. Low levels of ACTH
C. Hyperkalemia
D. None of the above
Answer: B. Low levels of ACTH

The following clinical measurements or lab values are commonly seen with Cushing syndrome
EXCEPT:
A. Hypokalemia
B. Hypertension
C. Elevated cortisol
D. Hyponatremia
Answer: D. Hyponatremia
Signs and symptoms of Addison’s disease include each of the following EXCEPT:
A. Hyperpigmentation
B. Weight loss
C. Muscle weakness
D. Hyperglycemia
Answer: D. Hyperglycemia
Signs and symptoms of Addison’s disease include each of the following EXCEPT:
A. Lethargy
B. Retention of sodium
C. Nausea and vomiting
D. Hypotension

Hormones must be shut off in order to prevent accumulation.

A. True
B. False
Answer: A. True

A paracrine action occurs when a hormone exerts an action on the cells that produced it.
A. True
B. False
Answer: B. False

The number of hormone receptors on a cell stays the same.
A. True
B. False
Answer: B. False

The production and release of hormones by the pituitary gland requires stimulation by the
hypothalamus.
A. True
B. False
Answer: A. True

What hormone affects nutrient metabolism, regulates blood glucose levels, and has antiinflammatory actions?
A. Insulin
B. Cortisol
C. Glucagon
D. T3, T4

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

Type 1 diabetes mellitus is associated with each of the following characteristics EXCEPT:
A. Markedly reduced beta cell mass
B. Markedly reduced circulating insulin level
C. Gradual, subtle onset
D. Usually normal body weight

Each of the following are true about metabolic syndrome EXCEPT:
A. Pear-shaped obesity
B. Hypertension
C. Hyperlipidemia
D. Elevated blood sugar
Answer: A. Pear-shaped obesity

Of all the people with diabetes, approximately 70% have type 2 diabetes.
A. True
B. False
Answer: B. False

Gluconeogenesis, or glucose formation, is promoted by the alpha cells.
A. True
B. False
Answer: A. True

Most hormones are controlled through negative feedback.
A. True
B. False
Answer: A. True

Those with prediabetes have an increased risk of atherosclerotic heart disease.
A. True
B. False
Answer: A. True

Testing for diabetes should be done on everyone initially at age 60.
A. True
B. False
Answer: B. False

A 45- year-old female presents with increased appetite, weight loss, and nervousness. Lab findings
show a high serum T4 and low TSH.
1. What diagnosis would her history and lab findings indicate?
2. What is one treatment (not symptom treatment) you would suggest?
Answer: 1. Primary hyperthyroidism
2. Beta blockers can be used for the treatment of anxiety
(1) Hyperthyroidism; (2) methimazole or propylthiouricil, radioactive iodine, or surgical removal.

There are ways to prevent and/or control progression of diabetic kidney disease (nephropathy).
Name 4 of them:
Answer: 1. Control blood pressure
2. Control blood sugar level
3. Control chosterol
4. Weight control
Tight glycemic control; blood pressure control (500 mg/dL), hyperosmolarity, and
dehydration, without ketoacidosis.
Answer: Hyperosmolar hyperglycemic state (HHS)
Hyperosmolar hyperglycemic state (HHS)

Which drugs are contraindicated in heart failure patients due to exacerbation of CHF by fluid
accumulation.
Answer: TZDs
thiazolidinediones (TZDs or glitazones)

Module 10 Exam

Each of the following are true of gout except:
A. Uric acid dissolves readily in synovial fluid
B. Typically occurs at the first metatarsophalangeal joint
C. Anyone can get gout
D. Uric acid is a byproduct of purine metabolism
Answer: A. Uric acid dissolves readily in synovial fluid

Which of the following would a patient likely report if you suspect they have OA?
A. Pain in their MCP joint
B. Stiffness in the morning that resolves in less than 30 minutes
C. Pain that would be described as “acute”
D. They feel “looser” after they move around
Answer: B. Stiffness in the morning that resolves in less than 30 minutes

Which of the following are true regarding syndesmoses? (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: C. They allow a small degree of movement between them
D. They are separated by a fibrous disc

Blood circulates through bone by what means? (mark all that apply)
A. Via the central Haversian and Volkmann canals
B. An anastomosis between perforating and nutrient arteries
C. Diffusion through the endosteal surface of the bone and the canaliculi
Answer: A. Via the central Haversian and Volkmann canals
B. An anastomosis between perforating and nutrient arteries
C. Diffusion through the endosteal surface of the bone and the canaliculi

Which of the following drugs is most commonly prescribed to treat osteoporosis?
A. Raloxifene
B. Alendronate
C. Calcitonin
Answer: B. Alendronate

Which of the following cells are stimulated by PTH?
A. Osteocytes
B. Osteoclasts
C. Osteoblasts
D. Osteoprogenitor cells
Answer: B. Osteoclasts

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

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

Which of following medication is used to treat an acute gout attack? (mark all that apply).
A. Colchicine
B. NSAIDS
C. Allopurinol
Answer: A. Colchicine

B. NSAIDS

Which of the following is false regarding structural changes in OA?
A. Articular cartilage will erode over time leaving the subchondral bone exposed
B. Chondrocytes enlarge and reorganize
C. Microfractures extend through the articular surface but not into the subchondral bone
D. Small fragments of cartilage will break off and become free-floating in the joint cavity
Answer: C. Microfractures extend through the articular surface but not into the subchondral bone

Which of the following is true regarding the synovium?
A. The outer 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: C. The synovium secretes fluid that facilitates movement between articulating surfaces

Postmenopausal Osteoporosis is characterized by which of the following? (mark all that apply)
A loss of cortical bone
B. Low levels of OPG
C. Fractures are mostly seen in the vertebrae and distal radius
Answer: B. Low levels of OPG
C. Fractures are mostly seen in the vertebrae and distal radius

A T-score compares the bone of the patient to that of a healthy 20-year-old adult.
Answer: False- A T-score compares the bone of the patient to that of a healthy 30-year old adult
False, A T-score compares the bone of the patient to that of a healthy 30-year-old adult.

Haversian canals contain the nerve and blood supply for the osteon.
A. True
B. False
Answer: A. True

Secondary gout is characterized by the overproduction or the underexcretion of uric acid.
A. True

B. False
Answer: B. False
Primary gout is characterized by the overproduction or the underexcretion of uric acid
Primary gout is characterized by the overproduction or the underexcretion of uric acid.

Corticosteroids can be used as needed for the management of pain associated with OA.
A. True
B. False
Answer: B. False
Corticosteroids are to be used sparingly in the management of pain associated with OA as they
contribute to the destruction of the joint.

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: Tendons and ligaments serve in proprioception. When these structures undergo stress or
strain, the proprioceptive nerve fibers cause a reflexive response to adjust tension in the muscle,
which maintains the balance and stability of the body and prevent the body from falling over.
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.

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: Acute gout athritis or phase 2. The goal of the treatment is to manage the symptoms using
NSAIDs.
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.

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 has a greater risk of developing osteoporosis and sustaining a fracture. This is
because his age and history of distal radius fracture at age 65 makes him more susceptible to
developing osteoporosis, regardless of the fact that he is male. Also his race, being white
Caucasian makes him susceptible. Though patient B is postmenopausal, she is African American
woman and active, which is associated with high BMD, and she has no history of 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.

A 40-year-old patient sustains an incomplete spinal cord injury affecting their ability to walk. They
primarily use a wheel chair to complete daily activities. Explain why this patient is at increased
risk for developing OA in their lower extremities.
Answer: Immobility compromises lubrication of joints which come with range of motion and
weight bearing. This increases the risk for developing OA
Immobilization can compromise lubrication of the joint which comes with range of motion and
weight bearing. The decreased nourishment of the articular cartilage will eventually lead to the
structural joint changes associated with OA.

Compare and contrast the blood supply of cortical bone and cancellous bone.
Answer: Cortical bone have direct blood supply. Nutrient and perforating arteries form an
anastamoses that circulates through the bone through the central harvesian and Volkmann canals.
Cancellous bones do not have a direct blood supply. They get their blood supply through the
diffusion from the endosteal surface to the bone surface through the canaluculi.
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.

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 RANKL levels to be
high, normal, or low? Explain why her levels would be at this level.

Answer: Her RANKL level would be high. Estrogen levels increase the production of OPG which
inhibits RANKL. With a condition such as amenorrhea for 5 years, the estrogen levels will be low,
resulting in low production of OPG hence high levels of RANKL and osteoclast activity.
Her RANKL levels would be higher than normal. Amenorrhea results in lower estrogen levels.
Estrogen increases the production of OPG which inhibits RANKL. Lower estrogen levels would
lead to lower OPG levels in turn increasing RANKL and osteoclast activity.

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: A T-score of -2.6 is lower than -2.5, hence he is considered to have osteoporosis. For
non-pharmologic treatment, she should be engaged in regular exercise including weight bearing
exercise.
For pharmalogic treatment, she should be given estrogen, which is effective at reducing
progression of osteoporosis.
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.

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 non-pharmacologic
recommendation to manage his disease.
Answer: For phase 3 of gout, the patient should be administered allopurinol to reduce his serum
uric acid level.
For non-pharmologic treatment, he should reduce alcohol consumption, reduce her weight and
avoid foods rich in purine like fish, liver and bacon.
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. (*Note – the student has to provide 1
pharmacologic intervention and 1 non-pharmacologic recommendation.)

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. Does the patient's profession involve repetitive movements?
2. Does movement alleviate or worsens the pain?
3. Does the patient experiences stiffness in the morning, and does it last less or more than 30
minutes?
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) *Note – student only has to provide 3 questions.