Copyright 2007, Lippincott Williams & Wilkins. All rights reserved. The glycolic pathway of metabolism facilitates the process of glycolysis in order to liberate energy when oxygenation is impaired. convert lactic acid back to pyruvate for energy. add a phosphate high-energy bond to ADP. activate glucose energy in the citric acid cycle. Glycolysis is the process by which energy is liberated from glucose during periods of impaired oxygenation (anaerobic metabolism). The reversal of lactic acid back to pyruvate form is used to synthesize glucose instead of releasing it. The process of high-energy bonds being added to ADP to form ATP is called oxidative phosphorylation during aerobic metabolism (the citric acid cycle). Unlike simple diffusion, facilitated diffusion requires input of metabolic energy across a concentration gradient. a transport protein to carry the substance into the cell. active movement from lower to higher concentrations. dispersion of particles in a membrane-coated vesicle. Facilitated diffusion requires a large or nonlipid soluble substance to bind to a protein transporter for passage through the cell membrane pores. Like simple diffusion, this process does not require an input of metabolic energy. In facilitated diffusion, a substance can move only from higher to lower concentration. Moving particles in a membrane-coated vesicle is endocytosis (pinocytosis), which is unrelated to facilitated diffusion. Secondary active transport uses the _______ of primary active transport to _________. highly charged ions; activate surface receptors. movement; open non-gated ion channels. pathways; equalize substance distribution. energy; co-transport another substance. Active transport is the use of energy to move ions against a strong chemical or electrical gradient, for an uneven substance distribution. Primary active transport uses the energy source (ATP) for transportation; secondary active transport takes the already available energy to transport the original substance with another in the same direction (co-transport). Active transport does not involve the use of surface receptors and may use gated voltage or ligand ion channels. Instead of entering cells, chemical messengers assist cell-to-cell communication by passing rapidly through extracellular fluid. changing the electrical membrane potential. binding to receptors on or near the cell surface. converting membrane protein into signals in the cell. Cells utilize chemical messengers for communication by binding the chemical receptors on the surface or moving through gap junctions without ever entering the extracellular fluid. Electrical membrane potentials conduct impulses instead of communication. Signal transduction (conversion of cell membrane proteins into signals within the cell) is not a function of chemical messengers. Which of the following types of body tissue is correctly matched with its characteristics? epithelial; avascular and a basement membrane. connective; communication system of impulses. muscle; extracellular matrix with reticular fibers. nervous; multinucleated fibers form sarcomeres. Epithelial tissue is avascular and has a basement membrane. Nervous tissue is a communication system of impulses. Muscle tissue has sarcomeres formed from multinucleated fibers. Connective tissue has an extracellular matrix with reticular fibers. When the heart's workload increases, the myocardial tissue will adapt by enlarging existing cells. accumulating free radicals. increasing the number of cells. differentiating immature cells. Increased workload causes the existing cells to enlarge (hypertrophy) in order to meet the demand. Accumulation of free radicals will damage, rather than assist, cell function. Cardiac cells are incapable of dividing to increase the cell number (hyperplasia). Immature cells are not fully functional and would hinder, rather than help, myocardial function. A patient who had a stroke has been confined to bed for 6 months, unable to move anything on his right side. The resulting muscle atrophy is caused by the lack of muscle cell use. chronic muscle cell irritation. calcium loss from his bones. compression by interstitial edema. Atrophy of normal cells is often due to a lack of use or stimulation. Muscle irritation that is ongoing and chronic causes abnormal cell changes. Calcium loss weakens bones, and accumulation in the muscle is damaging. Compression of muscle tissue would result in hypoxic damage to cells. Intracellular accumulations are significant but reversible when dystrophic calcification enters the cell. they are caused by an inborn error of metabolism. they reflect a correctible systemic disorder. a mutation causes misfolding of proteins. Accumulations are reversible if the underlying systemic disorder resolves, with resulting elimination of the excesses. Dystrophic calcification occurs in dead tissue. Inborn errors of metabolism are genetic and cause irreversible cell dysfunction. Misfolded proteins cause permanent toxic accumulations and deposits in the cell. Apoptotic cell death is induced by impaired cell membrane permeability and loss of ATP. rapid bacterial invasion and accumulation in necrotic tissue. inflammation with spontaneous unregulated enzymatic digestion. activation of intracellular controls to degrade DNA and proteins. Apoptosis is a systematic and controlled cell death, unrelated to cell injuries. Impaired permeability and loss of ATP cause cell damage and inappropriate accumulations within the cell. Necrotic tissue (already dead tissue) with bacterial growth is gangrene. Inflammation causes unregulated cell injury. The patient has a history of cigarette smoking for 10 years, works in an insecticide chemical factory, and has been taking large amounts of acetaminophen daily for her chronic headaches. The smoking, drug overuse, and chemical exposures have caused cell injury by interruption of impulses in the excitable tissues. continued replication of the toxic enzymes. disrupting the osmotic and ionic balance. a deficiency of free radical formation. Chemical agents and drugs damage cells in many ways, including the cell membrane permeability. The damaged cell membrane allows an inappropriate influx/outflow of fluids and electrolytes. Interruption of impulses in excitable tissues occurs with electrical damage of cells. Continued replication of toxins is a characteristic of bacterial or viral invasion of cells. Free radicals are in abundance near the oxygen-deprived cells, causing more cell damage. Although DNA determines what protein the cell will synthesize, transmission and decoding of information needed is carried out by intracellular chromatin. nucleotides. mitochondria. ribonucleic acid. RNA, ribonucleic acid, carries out the synthesis of proteins. Chromatin is a complex of DNA, several types of protein, and some RNA. DNA is composed of nucleotides, which consist of phosphoric acid, a sugar, and a nitrogenous base. Mitochondria contain some DNA that is inherited from the mother. DNA changes that occur in germ cell mutations are uniquely different from somatic cell mutations because they can be _____ base pair errors. inherited. duplication. spontaneous. polymorphic. Germ cell mutations can be inherited. Somatic cell mutations that do not impact the health or function of the person are called polymorphic. Both somatic and germ cell mutations can be spontaneous or the result of duplication of DNA. Polygenic inheritance of genetic traits involves multiple genes at different loci. genotype matching the phenotype unpredictable karyotype placement. environmental effects on the genes. Polygenic inheritance involves multiple genes at different loci, with each gene exerting a predictable additive effect in determining the trait. The genotype will produce a variable phenotype, depending on the loci of the multiple genes. Multifactorial inheritance differs from polygenic in that it includes environmental effects on the genes. A recessive trait is expressed when there is/are homozygous pairing. multifactorial mutations. heterozygote with a carrier. carrier paired with a noncarrier. Recessive traits are ones expressed only in homozygous pairing. A dominant trait can result from heterozygous pairing. A carrier who is heterozygous for a recessive trait will not express the trait. Multifactorial mutations involve multiple genes and do not follow the single-gene rules of inheritance. Genetic engineering methods have resulted in the ability to identify a person based on his DNA. assign genes to specific chromosomes. identify when two traits will occur together. reproduce certain proteins in large quantities. Genetic engineering methods can be used to reproduce proteins (some only found in small amounts) in large quantities. DNA fingerprinting is the use of DNA strands to identify a person, now commonly used in forensics. Genomic mapping is the assignment of genes to specific chromosomes. Linkage studies are use to estimate distances between gene markers and identify pairs or blocks of genes that consistently cause two traits to occur together. Which of the following genetic disorders results in a person with less than the normal 23 pairs of chromosomes in all somatic cells? X aneuploidy disorder-Turner syndrome. single-gene disorder-neurofibromatosis. multifactorial inheritance-congenital heart disease. inborn error of metabolism-phenylketonuria (PKU). Aneuploidy means there is a change in chromosome number in each cell. Turner syndrome is monosomy of the X chromosome (45, X/O). PKU (autosomal recessive), congenital disorders, and single-gene disorders all have the normal number of 23 pairs (46 chromosomes), but there is an abnormality located on one of the chromosomes in each cell. Sally's father has Marfan syndrome. Sally will transmit the defective gene to only 50% of her offspring because both parents must be affected for 100% transmission. autosomal dominant disorders require only one affected parent. X-linked disorders require two carriers for transmission. nondisjunction occurs 50% of the time during meiosis. Marfan syndrome is an autosomal dominant disorder, which requires only one affected parent to transmit the defective gene to 50% of all offspring. Autosomal recessive inheritance requires the abnormal gene to be present on both parents' chromosomes. X-linked disorders require at least one affected parent. Aneuploidy is an alteration of chromosome separation, not genetic coding. Joe has an X-linked recessive chromosomal disorder but his twin Jane is only a carrier. X-linked recessive diseases are less common in female offspring because the fragile gene is translocated from the Y. female has fewer normal Barr bodies. defective gene must be present on both Xs. male is more likely to have trisomy X aneuploidy. Males are more likely to have X-linked disorders because the abnormal gene does not have a normal one on another X to offset the defect. X-linked recessive disorders only occur in females in the unlikely event that both parents have matching defects on both X chromosomes. Very little genetic information is derived from the Y chromosome; the Y is unrelated to X chromosome disorders. Barr bodies identify females because they are only present when there is more than one X in the cell. The more X chromosomes present, the less likely that an X-linked disorder will occur. The infant has the characteristic facial features of Down syndrome, trisomy 21 aneuploidy. This genetic disorder is usually caused by chromosomal translocation. breakage. mitosis error. nondisjunction. Trisomy 21 (three of chromosome 21 in each cell) is usually the result of maternal nondisjunction during the first or second phase of meiosis. Trisomy 21 is not the outcome of chromosome structure disorders such as translocation or breakage. Chronic alcohol (a teratogen) intake by a pregnant female has variable effects on fetal development, including poor muscle control. early-onset puberty. advanced development. intellectual impairment. Fetal alcohol syndrome (FAS) causes characteristic facial features and varying degrees of neurologic problems that include intellectual impairment and developmental delays. Muscle control difficulties and hormonal disorders with variations in the onset of puberty are not characteristic of FAS. Neoplasms are identified as benign when the tumor cells are clustered together and replicate rapidly. invade area tissue. well differentiated. vary in size and shape. Benign neoplasms have well-differentiated tumor cells that are similar in size and shape, and remain clustered together. Benign tumors have uncontrolled slow cell replication. Because the tumor expands slowly, it develops a fibrous capsule, without invading area tissue. Unlike benign tumors, malignant tumors grow by ______ the surrounding tissues. infiltrating. resembling. compressing. encapsulating. Malignant tumors grow by invading, infiltrating, and destroying area tissue, then metastasizing to distant sites. Malignancies bear little or no resemblance to the healthy cells that surround it. Although any tumor can compress area tissues and vessels, malignant cells have crab-like projections that penetrate and destroy tissue. Benign neoplasms are encapsulated and do not invade other tissues. The spread of solid tumors occurs through three pathways that include lymphatic and vascular systems, direct extension, and ____ in body cavities. seeding. apoptosis. anaplasia. shedding. The three pathways of metastasis include lymphatic and vascular travel, direct extension and invasion of area tissue, and seeding in body cavities. Malignant cells have endless lives; apoptosis does not occur as it should. Anaplasia is a loss of all differentiation, which indicates a highly malignant cell without providing a pathway for spread. Malignant tumors often shed surface cells that are incapable of replication or growth, and are diagnostic when found in body fluids. In contrast to activated tumor suppressor genes, activated oncogenes promote autonomous cell growth. mutations of the p53 gene. cell-to-cell communication. repair of damaged DNA. Activated oncogenes promote autonomous uncontrolled cell growth; activated tumor suppressor cells inhibit cell proliferation. The p53 gene functions as a tumor suppressor; mutation of p53 is a component of cancer development. Cell-to-cell communication is totally absent from active or inhibited cancer cells. DNA repair genes affect uncontrolled cell growth by fixing nonlethal damage to genes (such as proto-oncogene) that control cell growth and replication. The transformation of healthy lung cells to malignant cells is a three-stage process. Although the first stage of initiation is irreversible, the second stage of promotion is reversible if the promoter substance is removed. tumor suppressor genes are inhibited. immune cells kill the transformed cells. initiating exposure occurred only once. Promotion stage is reversible if the promoter substance is totally removed. The permanently initiated cells become dormant. Inhibited tumor suppressor cells allow uncontrolled proliferation of transformed cells. Although the immune system attacks cancer cells, the surviving mutated cells will enter the progression stage and metastasize. The ______ of nondiffusible particles determines the osmotic activity of the extracellular fluid. rate. size. number. pressure. It is the number (not the size or rate) of nondiffusible particles that determines the osmotic activity of a solution. Osmotic pressure opposes the osmosis of water. Third spacing (obstruction of lymph flow in serous cavities) causes fluid_____ in the transcellular compartment. edema. diffusion. exchange. accumulation. Fluid accumulation in the transcellular compartment is referred to as third spacing because it is usually not exchanged with the rest of the ECF. Edema represents an increase in interstitial fluid volume. Diffusion is the movement of particles along a concentration gradient. Since diabetes insipidus (DI) is caused by a decreased response to ADH, persons with this disorder are unable to _________ urine during periods of water restriction. excrete. acidify. produce. concentrate. Decreased ADH response causes the renal system to be unable to concentrate urine when there is dehydration and a need to retain water. DI is characterized by polyuria of dilute alkalotic urine. The signs and symptoms of potassium excess are mainly due to alterations in acid-base balance. renal tubule function. gastrointestinal absorption. neuromuscular excitability. Signs and symptoms of hyperkalemia are closely related to the alterations in neuromuscular excitability (muscle tone and function, especially the heart muscle). Acidosis is associated with hyperkalemia, often as a result of altered neuromuscular activity. The gastrointestinal system is not a regulator of potassium absorption or balance. Although impaired renal tubule function can cause hyperkalemia, it is not the major cause of signs and symptoms. In metabolic acidosis, the body compensates for the decreased pH by urinary bicarbonate excretion. rapid deep respirations. serum chloride increase. sodium lactate production. To compensate for metabolic acidosis, the respiratory system will decrease the carbon dioxide level by increasing the respiratory rate. Metabolic acidosis renal compensation is the retention of bicarbonate. Hyperchloremia and increased sodium lactate are causes of metabolic acidosis. The general adaptation syndrome (GAS), a response to stress, is considered to be a syndrome because the physical manifestations are coordinated and dependent on each other. deplete energy stores. activate conditioning factors. stabilize protective functions. The general adaptation syndrome (GAS), as perceived by Hans Selye, is considered a syndrome because the manifestations are coordinated and dependent on each other. The outcome of GAS reactions may result in general systemic stabilization. Body systems, such as the cardiovascular system, use their ________ to increase function as an adaptive response to increased need. feedback system. anatomic surplus. physiologic reserve. coping mechanisms. The physiologic reserve is used for a body system to stay functional in response to increased need. Acute stress situations are controlled by a negative feedback system, and psychological coping mechanisms are an attempt to adapt to emotional stressors. Chronic activation of the stress response, such as with posttraumatic stress disorder (PSTD), is characterized by three types of symptoms that include avoidance. memory loss. hallucinations. hypoarousal. Chronic stress response, for example with PSTD, is characterized by intrusion (flashbacks, nightmares) based on fact, avoidance (emotional numbing), and hyperarousal. Homeostasis is maintained by ___________ that consist of sensors (detect changes in function), an integrator (compares sensed changes with a set point), and the effector system (returns the sensed function to within set-point range). feedback systems. integrated responses. neuroendocrine responses. physiologic control systems. Homeostasis is maintained by physiologic control systems. Stress initiates integrated (including neuroendocrine) responses that are controlled by a negative feedback system. Stress reducers, such as relaxation techniques and guided imagery, are techniques used to increase coping behaviors. achieve muscle relaxation. decrease feelings of loneliness. control physiologic functioning. Relaxation techniques and guided imagery are techniques to reduce stress by achieving muscle relaxation. Biofeedback is a technique to learn to control physiologic functioning and reduce stress responses. Music therapy is effective in decreasing feelings of loneliness and isolation. Stress-reducing techniques help to reduce coping behaviors that impose a risk to health. Adipose tissue not only serves as a storage site for body fuels, it also synthesizes lipids. releases vitamin E. stimulates glucagon. transports antibodies. Adipose tissue is composed of fat cells that synthesize lipids. Fat-soluble vitamin E is released by the liver. Antibodies are transported in the lymphatic system. The presence of food in the stomach (not adipose tissue) stimulates increased release of glucagon. When calorie intake is restricted for any reason, fat cells are broken down and _______ is one substance released as an energy source. leptin. glycerol. amino acid. cholesterol. When calories are restricted, fat cell triglycerides are broken down and glycerol and fatty acids are released to provide a source of energy. Cholesterol is elevated by saturated fats and is not stored in fat cells. Leptin is released from adipose cells as a result of increased fat storage, for purposes other than energy. The two types of obesity, upper body and lower body, are determined by measuring the waist-hip ratio. body mass index. height and weight. skin fold thickness. The waist-hip ratio differentiates upper body from lower body obesity. When the ratio is greater than 1.0 in men and 0.8 in women, it indicates upper body obesity. The body mass index (BMI), skin fold thickness, and height and weight measurements identify nutritional status and obesity, but not the type of obesity. Childhood obesity is associated with having parents that are obese and hypertensive. highly educated. smoke cigarettes. have type 1 diabetes. Parents of obese children are often obese themselves and highly educated. The parents and child frequently have type 2 diabetes. Hypertension is one complication of obesity, without any correlation to obese children of obese parents. Smoking cigarettes is a contributing factor in many disorders, but is not associated with obesity. The effects of malnutrition and starvation on body function include hypokalemia. osteoporosis. hypertension. type 1 diabetes. Malnutrition and starvation affect calcium stores and estrogen hormone levels, resulting in osteoporosis. Hyperkalemia occurs due to the extensive cell injuries associated with protein deficiency. Malnutrition and starvation are associated with hypovolemia, hypotension, and depletion of energy stores with hypoglycemia. Type 1 diabetes is a primary disorder unrelated to protein-calorie intake. The patient has a serious chronic infection, and his lab results show an elevated lymphocyte count. Which of the following is a subtype of lymphocytes? B cells. phagocytes. mast cells. PMN cells. B-cell lymphocytes proliferate in response to bacterial infections. Lymphocytes are not phagocytic cells. Mast cells, a form of basophils, are active in the immune response to allergens and parasites. PMN cells are an immature form of neutrophils. The cancer patient has neutropenia following chemotherapy. Other causes of neutropenia include thrombocytopenia. autoimmune disorders. iron deficiency anemia. T-cell mediated reactions. Neutropenia, a very low neutrophil count, is usually drug related like the response to chemotherapeutic drugs. Autoimmune responses can cause premature destruction of neutrophils. Thrombocytopenia is low platelet count and does not involve white blood cells. Iron deficiency (iron deficit on hemoglobin) anemia is unrelated to granulocyte loss. T-cell mediated reactions are a function of lymphocytes that can elevate or lower in response to viral, fungal, and bacterial infections. A teenage boy has developed infectious mononucleosis after kissing and drinking from the same cup as his girlfriend. This infectious disease causes lymph nodes to enlarge because monocytes replicate rapidly. blood accumulates in tissues. B lymphocytes are infected. phagocytes collect in them. Infectious mononucleosis is a viral disease (thought to be caused by Epstein-Barr virus) that infects B-cell lymphocytes. T-cell lymphocytes respond and slow the process. High monocyte count and blood accumulation do not affect lymph node size and are not characteristic of the disease. The nodes enlarge because of the inflammatory response to infection and the increased numbers of lymph cells. Lymphocytes are not phagocytic cells. Lymphocytic leukemia differs from lymphomas in that the leukemia malignancy originates in the bone marrow. lymphoid tissue. differentiated cells. thymus histiocytes. Lymphocytic leukemia originates in immature, undifferentiated stem cells in the bone marrow. Lymphomas can originate in lymphoid tissue, which includes the thymus and histiocytes. Patients with multiple myeloma develop pathologic bone fractures as a direct result of B-cell destruction of plasma cells. abnormal osteoclast activation. infection and hypocalcemia. excessive calcium deposits. Multiple myeloma causes proliferation and activation of osteoclasts that lead to bone resorption and destruction. B cells stimulate plasma cells to form immunoglobulins. Multiple myeloma affects the plasma cells directly, without involving the B cells. The bone destruction results in a high level of serum calcium and a lack of calcium within the damaged bone. Hemostasis consists of five stages. The second stage, formation of the platelet plug, involves platelet ______ followed quickly by platelet aggregation. adhesion. activation. retraction. coagulation. The second stage of hemostasis involves platelet adhesion and aggregation. The third stage is coagulation resulting from activation of the clotting cascade. The fourth stage is clot retraction. What factor is required for all but the first two steps of the clotting process? calcium. fibrinogen. prothrombin. von Willebrand factor. Calcium (factor IV) is required for all but the first two steps of the coagulation cascade. Von Willebrand factor is a carrier protein for factor VIII. Fibrinogen is converted to fibrin to form the meshwork that cements the platelets and other blood cells together. Hypercoagulation caused by increased platelet function is associated with clotting factor inactivation. antiphospholipid syndrome. decreased platelet sensitivity. vascular endothelium damage. Vascular endothelium damage and increased sensitivity can cause an increase in platelet function in the area, thus hypercoagulation. Clotting factor activation increases clotting activity. Antiphospholipid syndrome consists of antibody destruction of anticoagulant proteins. The anticoagulant deficiency allows excessive coagulation to occur. Disseminated intravascular coagulation (DIC) begins with massive uncontrolled activation of the clotting cascade that consumes all available coagulation proteins and platelets. The result is life-threatening infection. necrosis. thrombosis. hemorrhage. DIC begins with excessive thrombus formation. The result of the uncontrolled coagulation with depletion of clotting factors is severe hemorrhage. Causes of DIC include severe infection and tissue necrosis. One of the several causes of thrombocytopenia is decreased platelet production due to bone marrow diseases. antiplatelet antibodies. autoimmune complexes. vitamin K deficiency. Thrombocytopenia can result from decreased platelet production caused by bone marrow disease. Reduced platelet survival is caused by antiplatelet antibodies. ITP, an autoimmune disease, causes platelet antibody complex formation and platelet destruction. Vitamin K deficiency impairs the synthesis of coagulation factors in the liver. The most important anatomic feature that enables the red blood cell to transport oxygen is the nucleus size. mitochondria. transferrin protein. hemoglobin content. Hemoglobin transports oxygen using the red blood cell. The red blood cell does not have a nucleus or mitochondria. Transferrin is a transport protein that carries iron in circulation to tissues, where it is stored as ferrin. At the end of the red blood cell's 120-day life span, the iron content is excreted in urine. converted to bilirubin. bound to surface receptors. returned to the bone marrow. Iron is salvaged, returned to the bone marrow, and reused as new red blood cells form. Bilirubin contains the remnants of red cell destruction, and the conjugated form is excreted in feces as bile. When early, excessive RBC destruction occurs, hemoglobin may be excreted in urine or remain in plasma, bound to haptoglobin. Since the hematocrit measures the red cell mass percentage in 100 mL of plasma, the lab result will increase when the patient has excessive hemolysis. water intake. hypertension. dehydration. When plasma volume is lowered, the hematocrit is increased due to hemoconcentration. Hemolysis is early destruction of red cells, and will decrease the RBC count and hematocrit. Increased water intake would increase volume and lower the hematocrit. Hypertension is associated with volume overload (over hydration) or narrowed vessels, unrelated to red cell mass. Sickle cell disease is characterized by an abnormal hemoglobin S (HbS) that changes the erythrocyte shape in response to hypoxemia. iron deficiency. volume overload. hyperventilation. In hypoxic conditions, the abnormal hemoglobin S causes the red blood cell to become stiffened and change shape (sickled). Dehydration, not over-hydration, decreases blood flow, lowers blood pressure, and leads to blood stasis and hypoxic conditions. Hyperventilation lowers CO2 content, causes alkalosis, and decreases the possibility of hypoxia-related shape change. Vasodilation is unrelated to erythrocyte shape. Secondary polycythemia is caused by hypoxic conditions that initiate compensatory increased vascular flow. blood pressure. iron production. erythropoiesis. Secondary polycythemia is due to increased erythropoiesis caused by hypoxic conditions. The polycythemia will slow vascular flow and increase blood pressure as a result of the increased RBC volume. Since the body does not produce iron, the recycled and stored iron is used for the increased RBC numbers. The severity of a bacterial infectious disease depends on many variables, including ______ of the microorganism. origin. motility. microflora. virulence. The severity of an infectious disease (viral or bacterial) depends on the virulence (disease- producing potential) of the microorganism and the health of the host at the time of infection. Some individual bacteria have flagella for enhanced motility, a feature that is independent of disease severity. Normal microflora are harmless bacteria that inhabit the interior and exterior surfaces of the body, functioning to aid and protect the host. Knowing the origin of the bacteria helps with identification and prevention of transmission to other external hosts. Some bacteria are called anaerobes because they can replicate in open wounds. spread in droplet form. survive without oxygen. grow hyphae colonies. Anaerobic bacteria can survive only in an oxygen-free environment. The organisms die when exposed to oxygen. Droplets coughed out of the lungs can spread aerobic organism diseases only, because of the presence of oxygen. Molds are aerobic and grow long hollow hyphae filaments. The convalescent stage of a disease is distinguished by resolution of symptoms. predictable short duration. dissemination of pathogens. progressive tissue damage. The convalescent stage of a disease is characterized by resolution of associated symptoms, progressive containment, and elimination of pathogens. Dissemination of pathogens is heightened during the acute stage rather than the convalescent stage. The duration of complete convalescence is unpredictable and depends on the type of pathogen and the host's immune response. Invasive factors, produced by pathogens to facilitate penetration of host tissue, are usually proteins. enzymes. adhesives. endotoxins. Most invasive factors are enzymes capable of destroying protein complexes, membranes, and tissue. Before invasion, adhesion factors attach the microorganism to host receptors anchored on the cell membrane. Endotoxins are lipid and polysaccharide molecules found in the cell wall of gram-negative bacteria that are already causing infection or disease. Serology testing is useful for identifying infectious organisms by measuring pathogen-specific serum ________, because levels will rise during the acute phase of the disease. antibody titers. blood cell types. Gram's stain reaction. inflammatory proteins. Serologic tests are useful for identifying the specific antibodies that are released in large numbers in response to certain pathogens. A high-antibody titer indicates acute disease.The nonspecific inflammatory and immune response to antigens will alter blood cell levels and increase inflammatory proteins, without identifying the specific organism. Gram's stain reaction is used to identify colonies of pathogens growing in a culture. As part of the innate immune response, the body's epithelial surfaces keep pathogens out by activating toll-like receptors. secreting antimicrobial enzymes. blocking surface cell messengers. adhering microbes to dead skin cells. The epithelial surfaces keep pathogens out and protect against colonization by secreting antimicrobial enzymes and peptides and by preventing pathogen adherence. Toll-like receptors are present internally on phagocytic cells. As part of the innate response, cytokines (cell messengers) are activated to regulate and coordinate cell activities. The key trigger for the activation of B and T lymphocytes is the recognition of the antigen by effector cells. surface receptors. natural killer cells. hapten complexes. The key trigger for activation is the recognition of the antigen by unique surface receptors on B and T cells. Effector cells are activated during the final stages of the immune response to destroy the antigen. Haptens combine with larger protein molecules to be recognized as an antigen, not by an antigen. NK (natural killer) cells are part of the direct innate immune response without activation of lymphocytes. T-helper cells, with clusters of differentiation (CD) 4+ on the cell surface, are essential for ________ functions of the immune system. class I MHC. regulatory. phagocytic. antigen-presenting. CD4+ T-helper cells function to regulate most cell functions of the immune system response. Class I MHC molecules are present on cells other than those of the immune system. Phagocytic cells such as tissue macrophages engulf and destroy pathogens, initially without activating an immune response. Antigen-presenting cells (APCs) process antigens into the epitopes required to activate T-helper and B cells for a immune response. Recovery from many infectious diseases occurs during the slow primary humoral immune response, when the ______ reaches its peak. bacterial colonization. antibody concentration. booster immunization. memory T-cell differentiation. During a primary humoral immune response, the antigen elicits a slow B-cell response to proliferate and differentiate into antibody-secreting plasma cells, and recovery can occur when the antibody concentration is reaching its peak, destroying bacteria cells rapidly. Memory T-cell mediated response is not a part of a humoral (B cell) primary response. Booster immunization causes a secondary (memory) response, a quick and rapid rise of antibody levels in response to the repeated exposure. In organ or tissue transplantation, the closer the match of _______, the lower the chance of rejection. human leukocyte antigens. activated immunoglobulins. clusters of differentiation. natural killer lymphocytes. Human major histocompatibility complex (MHC) proteins are called human leukocyte antigens (HLA) and are inherited as a pair of haplotypes. The closer the match of HLA, the more likely the organ or tissue transplant will be successful. Clusters of differentiation (CD) molecules are found on the surface of immune cells and are not unique to each individual human. Immunoglobulins are the antibodies that proliferate in response to the foreign tissue antigens and cause a transplant rejection response. Natural killer cells are programmed to automatically kill foreign cells (antigens). Fluid exudation into tissue spaces at the site of an acute inflammatory response is beneficial because it produces edema. dilutes the antigen. compresses area nerves. lowers capillary pressure. The fluid movement into local area interstitial spaces is beneficial because it dilutes the foreign antigen. Edema (swelling) due to increased interstitial osmotic pressure is one of the cardinal signs of acute inflammation and is not beneficial because it removes plasma proteins from circulation and compresses area nerves (causing pain). Vasodilation of arterioles and venules, rather than exudation, causes area vascular congestion, hyperemia, and increased capillary osmotic pressure. During an acute inflammatory response, the ____ blood cell count is very high and bone marrow releases the immature form, called ____, to meet the excessive demand. neutrophil; bands. monocyte; PMNs. lymphocyte; segs. basophil; blasts. Neutrophil white blood cells respond quickly and in great numbers to acute inflammation. The neutrophil cell count goes even higher as bone marrow releases the immature form (band cells) early in an attempt to meet the high demand. Neutrophils are granulocytes that are also called PMNs (polymorphonuclear neutrophils) or segmented neutrophils (segs). Monocytes, immature macrophages, and lymphocytes are present in greater numbers during chronic inflammation. Basophil cell count is more likely to be high during chronic inflammation. Blast cells are very immature blood cells in the bone marrow and should not ever be present in circulation. Systemic inflammation indicators during the acute-phase response include monocytosis. low-level CRP. fibrous exudates. accelerated ESR. Systemic indicators of acute-phase inflammatory response include an accelerated erythrocyte sedimentation rate (ESR) in response to the increased plasma levels of acute phase proteins such as C-reactive protein (CRP). Exudate is a localized indicator, rather than systemic. Increased monocyte white blood cells, immature macrophages, are an indicator of chronic inflammation rather than acute phase. Chronic inflammation can be classified as either the granulomatous type, which results in granuloma lesions, or the nonspecific type, which results in giant cells. scar tissue. serous exudates. granulocytosis. Nonspecific chronic inflammation results in replacement of area tissue by connective tissue, with permanent scar tissue formation. Chronic inflammation is characterized by lymphocytosis, monocytosis, and fibroblast proliferation, rather than exudation and neutrophilia/ granulocytosis of acute inflammation. Giant cells are associated with granuloma formation. In uncomplicated wound healing by secondary intention, the injury undergoes wound ____ during the proliferative and remodeling phases and results in a ______ scar. contraction; smaller. separation; wide. tissue overgrowth; keloid. hemostasis; reddened. After the inflammatory phase, a wound healing by secondary intention will contract and result in a smaller scar than the original wound size. Hemostasis occurs during the inflammatory phase of healing and is unrelated to the scar formation. Impaired healing, possibly by wound infection, can cause wound edge separation in primary or secondary intention. A keloid is a mass caused by excess production of scar tissue and does not occur during uncomplicated wound healing. Allergic contact dermatitis is characteristic of T-cell delayed-type hypersensitivity (DTH) response because the manifestations are present almost immediately. in systemic inflammation. after at least 12 hours. with first-time contact. Type IV delayed-type hypersensitivity allergic contact dermatitis responses are confined to the skin and are initiated by reexposure to an allergen. The delayed allergic contact dermatitis manifests after at least 12 hours following the reexposure to the allergen. The main cause of a person being able to inactivate an immune response directed against self-antigens is autoimmunity. self-tolerance. sensitization. immunodeficiency. When a person does not develop an immune response against self-antigens, it is self-tolerance. Autoimmunity is caused by the inability of the immune system to differentiate between self- and nonself antigens, resulting in the destruction of both. Immunodeficiency is an impaired immune response with deficient types of certain immune cells, allowing the development of autoimmunity and other immune disorders. Sensitized cells activate memory cells and an immune response when a person has previously been exposed to the same nonself antigen. In addition to the CD4+ T lymphocytes (T-helper cells), human immunodeficiency virus (HIV) also directly infects granulocytes. plasma cells. macrophages. reticulocytes. In addition to CD4+ T cells, HIV directly infects macrophages and dendritic cells. The impaired T-helper cells indirectly affect B cells and proliferation of plasma cells. The virus cannot penetrate or replicate in granulocytes or red cells such as the immature reticulocyte cells. During the primary phase of HIV infection, manifestations include opportunistic infections. lymphadenopathy. encephalopathy. wasting syndrome. During the primary infection phase, an infected person will have seroconversion illness or an acute mononucleosis-like syndrome that includes lymphadenopathy. The second phase is the chronic asymptomatic or latent period. The third is the overt AIDS phase, manifested by opportunistic infections, dramatic weight loss (wasting syndrome), and AIDS encephalopathy/dementia. Type I hypersensitivity reactions such as bronchial asthma have an immediate phase with manifestations partially caused by the release of histamine. leukotrienes. lipid mediators. prostaglandins. The immediate phase manifestations of type I hypersensitivity reactions are caused by the release of histamine and acetylcholine (vasodilation, smooth muscle contraction). The late-phase response starts a few hours later, as lipid mediators are broken down and synthesis of leukotrienes and prostaglandins begins. The Law of Laplace states the relationship among wall tension, transmural pressure, and radius. When the vessel radius decreases, the pressure becomes ____ in order to overcome vessel wall tension. greater. equalized. turbulent. decreased. The Law of Laplace states that the pressure needed to overcome wall tension becomes greater as the radius decreases. Turbulence is a characteristic of blood flow, unrelated to the Law of Laplace. If the pressure decreases as the radius decreases, the blood vessel could collapse. During diastole, the AV valves open and the ventricles relax. empty. contract. narrow. During diastole, the AV valves open to fill the resting ventricles, which are in a relaxed state. The ventricles expand to accommodate the load. Ventricular contraction occurs as systole begins and blood is ejected into the aorta. The heart's ability to increase output in response to increased need for oxygenated blood depends on preload, afterload, heart rate, and pressure. contractility. stroke volume. action potential. The ability of the heart to increase cardiac output in response to greater need is dependent on preload (filling), afterload (resistance to ejection of blood from the heart), heart rate (frequency of ejection), and myocardial contractility (interaction of the actin and myosin filaments of cardiac muscle fibers). Stroke volume reflects a difference is diastolic/systolic end volumes, rather than increased output. Action potential is the conductivity of the heart, which creates the electrical conduction rather than the mechanical contractility. Pulse pressure, generated by the intermittent ejection of blood into the aorta, is directly affected by stroke volume and ejection fraction. refractory periods. venous pressure. arterial compliance. Pulse pressure is directly affected by stroke volume and arterial distensibility (compliance). Aortic and large artery compliance allows those vessels to accommodate the pulsatile cardiac output. The venous system is a low-pressure system capable of distending, storing, and returning blood to the right atrium. Refractory periods occur during the electrical conduction cycle, unrelated to pressure changes. The ejection fraction is the percentage of diastolic volume ejected during systole, rather than the pressure of ejection. Since venous flow is a low-pressure system, the return of blood to the right atrium is dependent on _______ and muscle pumps to offset the effects of gravity. venous valves. thick vessel walls. body position. oxygenated blood. Veins are thin walled and collapsible vessels that rely on valves and muscle pumps to prevent back flow and to return de-oxygenated blood back to the heart. The venous system contains a large volume of blood that moves against gravity. Although blood volume will redistribute with body position changes, the venous system is not dependent on this mechanism for the return of blood to the right atrium. Causes of secondary hyperlipoproteinemia include diabetes mellitus and high calorie intake. sedentary lifestyle. cigarette smoking. cardiovascular disease. High calorie intake contains excess VLDL that converts to LDL and triglycerides and lowers HDL level. Cardiovascular disease is an outcome of chronic hyperlipoproteinemia that damages and occludes blood vessels. Although sedentary lifestyle and cigarette smoking can predispose a person to atherosclerosis, they do not cause hyperlipoproteinemia. Atherosclerotic lesions produce severe coronary and cerebral artery dysfunction when _______ causes ischemia and infarction. arterial vasculitis. vessel occlusion. foam cell necrosis. aneurysm formation. Atherosclerotic lesions occlude vessels, blocking blood flow and causing ischemia and infarctions in the coronary and cerebral arteries. Arterial vasculitis is characterized by inflammatory changes in the vessel and vessel necrosis. Aneurysms are formed by weakened vessel walls that stretch and dilate, increasing the blood flow with possible rupture and hemorrhage. Foam cell necrosis releases lipids that may accumulate to form plaque. The primary symptom of chronic arterial obstruction in the legs is _______ with walking. intermittent pain. foot numbness. lower leg edema. loss of balance. Peripheral artery disease of the legs causes the early primary symptom of intermittent claudication (pain) with ambulation, related to distal arterial ischemia. Lower leg edema is often caused by venous vascular congestion instead of arterial obstruction. Loss of balance is unrelated to vascular blood flow, since balance is a neurologic function. Foot numbness can be an indicator of progressive peripheral nerve damage or long-term impaired tissue oxygenation. Cardiac output is the product of the stroke volume and the heart rate. contractility. blood pressure. peripheral resistance. Cardiac output is the product of the stroke volume (amount of blood ejected from the heart with each beat) and the heart rate. Peripheral vascular resistance and cardiac output determine the systolic and diastolic blood pressure. Myocardial contractility is essential for the pumping action of the heart, but it does not determine cardiac output. Venous thrombus can develop in any vein as a result of vessel injury and stasis of venous flow with _______, often resulting in venous insufficiency and emboli formation. vasodilation. hypertension. atherosclerosis. hypercoagulation. Venous thrombus will develop in the presence of hypercoagulation (hemoconcentration, polycythemia, or thrombocytosis), venous stasis (hypotension, obstructed venous return), and vessel injury (pressure damage). Atherosclerosis is an arterial disorder. Hypertension can cause vessel injury. Vasodilation can cause venous pooling and stasis due to low pressure. The most frequent cause of myocardial infarction is disruption of heart rhythm. cardiac output. collateral circulation. atherosclerotic plaque. Atherosclerosis is by far the most common cause of coronary artery disease, and coronary atherosclerotic plaque disruption is the most frequent cause of myocardial infarction. Disruption of heart rhythm often occurs during the severe pain of myocardial infarction. Ventricular function and cardiac output are disrupted as a result of the myocardial damage. Collateral coronary circulation is a compensatory response to decrease the risk of ischemic damage in myocardial areas distal to vessel stenosis or obstruction. Unlike stable angina, variant angina is caused by ______ and usually occurs during minimal exercise. vasospasms. silent ischemia. emotional stress. thrombosis. Variant angina is caused by vasospasms of the coronary arteries during sleep, rest, or mild exercise. Silent myocardial ischemia occurs without angina. Stable angina is provoked by situations that increase the heart's oxygen needs, such as emotional stress and physical exertion. Chronic stable angina is associated with fixed coronary obstruction such as thrombosis, which disrupts coronary blood flow. Symptomatic inflammatory myocarditis of the heart muscle and conduction system, without myocardial infarction, typically manifests as severe chest pain. flu-like symptoms. shortness of breath. new onset murmur. Symptomatic inflammatory myocarditis typically manifests as a flu-like syndrome, following a viral respiratory or gastrointestinal infection. Viral myocarditis is often asymptomatic. Although often noted with many other cardiac and pulmonary disorders, shortness of breath is not characteristic of myocarditis. Severe chest pain is an indicator of ischemic coronary disease or myocardial infarction. A new onset murmur is characteristic of valvular disease such as infective endocarditis or rheumatic carditis. Incomplete opening of a stiffened mitral valve causes left atrial hypotension. atrial enlargement. ventricular fibrillation. ventricular hypertrophy. Mitral valve stenosis causes increased left atrial volume, pressure, and compensatory enlargement. Atrial fibrillation and thrombus formation are complications of mitral stenosis, which can result in a stroke. The reduced emptying of the atrium, and loss of atrial kick, decreases left ventricular pressure and eliminates the need for hypertrophic cell changes. Congenital heart defects with right-to-left shunting cause systemic cyanosis when predominantly unoxygenated blood mixes with oxygenated blood in the right atrium. left ventricle. pulmonary vein. pulmonary artery. The congenital defect allows direct passage of low oxygen blood from the right to the left side of the heart. Right-to-left shunting results in unoxygenated blood moving from the right side (bypassing the pulmonary circulation) into the left side of the heart and cardiac output with low oxygen saturation. Systemic cyanosis is evident. The right atrium receives low oxygen venous blood. The pulmonary artery carries some of the blood from the right side into the pulmonary vascular bed for gas exchange. High oxygen content blood is carried by the pulmonary vein into the left heart. Unoxygenated blood mixes with the oxygenated blood in the left ventricle; low oxygen saturated blood enters the aorta and cyanosis continues. Brain natriuretic peptide (BNP) levels become markedly elevated in patients with severe heart failure because BNP correlates with the extent of ventricular dysfunction. norepinephrine release. pulmonary hypertension. atrial stretch and pressure. BNP is stored in ventricular cells and responds to increased ventricular filling pressures. Elevated BNP is diagnostic for heart failure and the extent of ventricular dysfunction. Endothelial peptide ET-1 plays a role in mediating pulmonary hypertension in persons with heart failure. Atrial natriuretic peptide (ANP) is released from atrial cells in response to increased atrial stretch and pressure, resulting in several hormone changes that cause diuresis and inhibition of norepinephrine release. A major effect of right-sided heart failure is arterial insufficiency. peripheral edema. pulmonary congestion. left ventricle hypertrophy. Right-sided heart failure impairs the ability to move deoxygenated blood from the systemic circulation into the pulmonary circulation and the left side of the heart. The right-sided failure causes systemic venous hypertension and peripheral accumulation of edema fluid. Left-sided heart failure impairs left ventricle emptying, causing left ventricular hypertrophy, accumulation of pulmonary edema fluid, decreased cardiac output, and arterial insufficiency. Early manifestations of heart failure include _______ resulting from the edema fluid returning to circulation while in the supine position. nocturia. cachexia. bronchospasms. exertional dyspnea. Nocturia results from edema fluid returning to circulation while a person is sleeping in the supine position. The fluid shift increases intravascular volume, cardiac output, renal blood flow, glomerular filtration, and urine output during the night (nocturia). Cardiac cachexia with malnutrition, tissue wasting, and muscle loss occurs in end-stage heart failure when all energy stores are depleted and high energy needs of the body continue to exceed the supply. Other manifestations of heart failure, bronchospasms and exertional dyspnea, result from bronchial congestion and increased demand for oxygen during activity. Unlike other types of distributive shock, septic shock is commonly associated with right heart failure. systemic infection. peripheral hypotension. decreased urine output. Septic shock is associated with severe systemic blood infection and the systemic inflammatory response (SIR) to infection. Obstructive shock, often due to pulmonary embolism, results in elevated right heart pressure and impaired venous return to the heart. All types of shock are characterized by decreased cardiac output and peripheral hypotension with blood vessel tone loss, vascular compartment enlargement, and vascular volume displacement. Decreased urine output is a compensatory response to all types of shock, an attempt to increase intravascular fluid volume and thus maintain adequate blood pressure. Infants and children commonly display signs of ______ as the first and most noticeable indication of heart failure. weight loss. dry, warm skin. dependent edema. respiratory distress. Children develop interstitial edema that reduces lung compliance and increases the work of breathing, resulting in signs of respiratory distress with tachypnea, accessory muscle use, and grunting. A frequent manifestation of heart failure in infants is excessive sweating (due to increased sympathetic tone) and cool extremities. Weight gain is slow due to high energy requirements, increased respiratory effort/ distress with feeding, and low calorie intake. Dependent edema is rarely seen with childhood heart failure unless the central venous pressure is extremely high. As oxygenated air enters the respiratory tract thought the nasal passages, it is _____ before reaching the larynx and bronchial airways. cooled. filtered. absorbed. exchanged. As inhaled air flows through the nasal passages, it is filtered, warmed, and humidified. Oxygen is absorbed through the capillary membrane in the terminal air sacs of the lungs (alveoli) during oxygen-carbon dioxide gas exchange. Intrapleural pressure of the inflated lung is _____ in relation to alveolar pressure. zero. equal. negative. increased. Elastic recoil of the lungs increases and intrapleural pressure is always negative (decreased) in relation to alveolar pressure during lung inflation. When the glottis is open and air is not moving in or out of the lungs, the intrapulmonary pressure is zero or equal to atmospheric pressure. Intrathoracic pressure is essentially equal to intrapleural pressure. Lung compliance is impaired by conditions that increase lung elasticity. obstruct smaller airways. decrease surface tension. increase thoracic flexibility. Lung compliance is diminished by conditions that reduce lung elasticity, block the bronchi or smaller airways, increase alveolar surface tension, or decrease the flexibility of the thoracic cage. The inner surface of the alveoli is lined with surfactant molecules that prevent alveoli collapse by lowering lung compliance. keeping the alveoli dry. increasing surface tension. thickening the membrane wall. The presence of adequate amounts of surfactant molecules in alveoli increases lung compliance, decreases surface tension, and helps to prevent fluid from entering the alveoli through the capillary membrane. All of these actions are necessary to prevent alveoli collapse. Although surfactant lines the inner alveoli membrane surface, its function is independent from the membrane wall. The distribution of alveolar ventilation and pulmonary capillary blood flow varies with lung volume and body position. gas diffusion. heart rate. coughing. Distribution of alveolar gas ventilation and pulmonary capillary blood flow varies with the volume of gas in the lungs and the body position. Diffusion is transfer of gases at the capillary level, rather than distribution of blood flow and gases. Heart rate affects the rate of gas exchange at the capillary level, without disrupting distribution within the lungs. The cough reflex keeps the airways clear of secretions and debris that might impede ventilation. One distinguishing feature of viral influenza is the very rapid onset of profound malaise. thick nasal discharge. nausea and vomiting. productive coughing. One distinguishing feature of influenza is the rapid onset, sometimes within minutes, of profound malaise. There is also a rapid onset of profuse watery nasal discharge, nonproductive coughing, fever, and sore throat. Gastrointestinal distress, nausea, and vomiting are not features of typical viral influenza. The most common cause of community-acquired bacterial pneumonia is _____. Chlamydia pneumoniae. Parainfluenza virus. Staphylococcus pneumoniae. Escherichia coli. The most common cause of community-acquired bacterial pneumonia is Staphylococcus pneumoniae. An atypical, and much less common, agent is Chlamydia pneumoniae. Parainfluenza virus is a common cause of community-acquired viral pneumonia. E. coli is often the bacterial cause of hospital-acquired pneumonia. Tuberculosis respiratory infection is spread by inhalation of droplet nuclei. air-borne spores. H. capsulatum fungi. polysaccharide capsules. Tuberculosis is spread by inhalation of air that contains minute, invisible droplet nuclei particles of tubercle bacillus. H. capsulatum fungi lung infection is acquired by inhaling the fungal spores that are released when bird excretion-enriched soil is disturbed. S. pneumoniae bacteria, gram-positive diplococci with capsular polysaccharides inhaled in air-borne droplets, is a common cause of bacterial pneumonia. Small-cell lung cancer (SCLC) is the highly malignant type of bronchogenic carcinoma that originates in alveolar tissues. spreads slowly into major bronchi. localizes in peripheral lung tissue. infiltrates and disseminates early. The SCLCs are highly malignant and tend to infiltrate widely and disseminate early in their course. About 70% of SCLCs have detectable metastasis at the time of diagnosis. Adenocarcinomas originate in either the bronchiolar or alveolar tissues of the lung. Squamous cell carcinoma tends to spread centrally into major bronchi and nodes and disseminates later than other types of bronchogenic cancers. Large-cell carcinomas tend to occur in the periphery of the lung, invading subsegmental bronchi. Compensatory manifestations of childhood restrictive lung disorders include rib cage retractions. expiratory grunting. slow, deep respirations. audible stridor sounds. Children with restrictive lung disorders, such as pulmonary edema, have a fast and shallow respiratory pattern and display expiratory grunting, an audible noise emitted during expiration, as compensatory efforts to raise end-expiratory pressure and prolong alveolar capillary gas exchange. When an airway obstruction is in the intrathoracic airways, as occurs with obstructed airways (such as bronchial asthma), the child uses accessory expiratory muscles (abdominals), and rib cage retractions may be present. Increased turbulence of air moving through the obstructed airways produces an audible crowing sound called a stridor during inspiration. The common denominator underlying all forms of asthma is loss of lung fiber elasticity. deficiency of a1-antitrypsin. hypertrophy of submucosa. bronchial hypersensitivity. The common denominator underlying all forms of asthma is exaggerated hypersensitivity response to stimuli, resulting in airway inflammation, bronchospasms, and airway obstruction. COPD characteristics include submucosal gland hypertrophy and loss of elastic lung fibers. The earliest manifestations of chronic bronchitis are hypersecretion of mucus and submucosal gland hypertrophy in the trachea and bronchi. One cause of emphysema is an inherited deficiency of a1-antitrypsin, an antiprotease enzyme that protects the lung from injury. Tension pneumothorax occurs when a chest injury allows air to enter but not leave the pleural space, causing lung compression and opposite-sided chest pain. bleb rupture. mediastinal shift. absent breath sounds. With tension pneumothorax, trapped air compresses the affected lung, and structures in the mediastinal space shift toward the opposite side of the chest. Spontaneous pneumothorax occurs when an air-filled bleb, or blister, on the lung surface ruptures; manifestations include development of ipsilateral (same side) chest pain. Breath sounds are decreased or absent directly over the area of the tension pneumothorax. In contrast to persons with chronic obstructive bronchitis, those with emphysema are able to maintain ______ by increasing their breathing efforts. normal blood gases. pulmonary circulation. alveolar oxygenation. exercise tolerance. Persons with emphysema overventilate and thus maintain relatively normal blood gas levels until late in the disease. Persons with chronic bronchitis are unable to compensate by increasing their ventilation; instead, hypoxemia and cyanosis develop. Chronic bronchitis is characterized by shortness of breath with a progressive decrease in exercise tolerance. Pulmonary embolus creates a mechanical obstruction of the pulmonary circulation, resulting in reflex vasoconstriction. left-sided heart failure. arterial hypertension. local bronchodilation. The effects of emboli on the pulmonary circulation are related to mechanical obstruction of the pulmonary circulation by the blood clot and associated reflex vasoconstriction. Pulmonary hypertension and right heart failure may develop when a venous blood-borne substance lodges in a branch of the pulmonary artery, causing massive vasoconstriction. Obstruction of pulmonary blood flow also causes reflex bronchoconstriction in the affected area of the lung. Acute respiratory failure causes hypercapnia, which manifests as hypoventilation. central cyanosis. metabolic alkalosis. carbon dioxide narcosis. Hypercapnia has nervous system effects similar to those of an anesthetic-hence the term carbon dioxide narcosis. Air hunger and rapid breathing occur when alveolar PCO2 levels rise. Central cyanosis is evident in the tongue and lips. It is caused by an increased amount of deoxygenated hemoglobin or an abnormal hemoglobin derivative in the arterial blood. Elevated levels of PCO2 produce a decrease in pH and respiratory acidosis. Serum creatinine reflects the _____ and can be used to estimate renal function. urine concentration. tubular reabsorption. blood urea nitrogen. glomerular filtration rate. RATIONALE: Serum creatinine reflects the glomerular filtration rate because creatinine is freely filtered in the glomeruli and not reabsorbed in the tubules. Urine concentration is measured by the specific gravity of urine, which does not estimate renal function. Blood urea nitrogen (BUN) is a measure of protein by-product entirely eliminated by the kidneys. BUN level is influenced by hydration status and protein intake, in addition to renal elimination rate. The loop of Henle plays an important role in controlling urine _____ since it reabsorbs more sodium and chloride than water. alkalinity. proteins. potassium. concentration. The loop of Henle controls urine concentration by means of a countercurrent system that keeps water out of the area surrounding the tubule, and solutes are retained. Protein remains in the blood rather than passing through the basement membrane into the tubules. The loop of Henle controls osmolality without affecting the urine pH. Potassium reabsorption is controlled by the cortical collecting tubule. Potassium elimination is directly regulated by the GFR and angiotensin II. aldosterone secretion. atrial natriuretic peptide (ANP). anti-diuretic hormone (ADH). Aldosterone secretion is the regulator of potassium reabsorption and secretion of excess in the distal tubule. In order to control volume, osmolality, and pressure, sodium (separate from potassium) concentration is regulated by multiple mechanisms that include angiotensin II, ANP, ADH, and aldosterone. The stimulus for synthesis of erythropoietin by the kidney is alkalosis. hypoxia. dehydration. hypertension. The kidney regulates red blood cell production by increasing the synthesis of erythropoietin in response to tissue hypoxia. Urine buffers and elimination of hydrogen ions regulate the body pH within a narrow range. Dehydration may decrease plasma volume without lowering the oxyhemoglobin on red cells-so tissue oxygenation is maintained. Hypertension is increased pressure in the vessels, unrelated to the oxygenation of the tissues. The juxtaglomerular complex releases ______ to keep arterial blood pressure within normal range and to maintain a constant GFR (glomerular filtration rate). nitric oxide. vasopressin. renin enzyme. sodium chloride. The juxtaglomerular complex monitors arterial blood pressure and sodium chloride concentration in the filtrate and releases renin as an autoregulatory mechanism to maintain arterial pressure and GFR within normal range. Nitric oxide is a potent vasodilator produced by the vascular endothelium. Sodium elimination is regulated by aldosterone in the distal tubule. Vasopressin (also known as ADH) is released by the pituitary gland in response to hyperosmotic extracellular fluid. Excessive bone resorption caused by immobility or hyperparathyroidism can result in the formation of _____ renal calculi. cystine struvite. calcium. uric acid. Excessive bone resorption caused by immobility, bone disease, hyperparathyroidism, and renal tubular acidosis increases the serum/urine calcium levels, resulting in calcium phosphate or calcium oxalate stone formation. Struvite stones form only in alkaline urine and urine containing bacteria with urease enzyme, which splits urea into ammonia and carbon dioxide. Uric acid stones develop when there is a high concentration of uric acid in the urine. Cystine stones are seen in cystinuria, which results from a genetic defect in renal transport of cystine. Nephritic syndromes are caused by diseases that produce ____ in the glomeruli. thrombosis. inflammation. lipid deposits. sclerotic changes. Nephritic syndromes are caused by diseases that provoke a proliferative inflammatory response of the endothelial, mesangial, or epithelial cells of the glomeruli. Nephrotic syndrome is characterized by lipiduria (e.g., free fat, oval bodies, and fatty casts). Thrombotic complications reflect a loss of coagulation and anticoagulation factors. Glomerulosclerosis, a nephrotic syndrome, is characterized by sclerosis (i.e., increased collagen deposition) and glomerular membrane damage. Generalized edema, a hallmark of nephrosis, occurs when compensatory responses to _______ cause salt and water retention. hypolipidemia. hypoalbuminemia. bacterial infection. immune complexes. Generalized edema, a hallmark of nephrosis, results from salt and water retention and decreased plasma colloid osmotic pressure due to massive proteinuria and hypoalbuminemia. The hyperlipidemia that occurs in persons with nephrosis is characterized by elevated levels of triglycerides and low-density lipoproteins (LDLs). Diffuse proliferative glomerulonephritis follows infections caused by strains of group A B-hemolytic streptococci; the inflammatory response is caused by an immune reaction that occurs when circulating immune complexes become entrapped in the glomerular membrane. Patients with urinary reflux and obstructive disorders have increased risk for _______ because of the associated urine stasis in the bladder. infections. thrombosis. neoplasms. cyst formation. Depending on the location, degree, and duration, urinary obstructive disorders produce stasis of urine. Urine remains in the bladder and acts as a medium for microbial growth, predisposing to infection and calculi formation and development of intrarenal hypertension. Intrarenal hypertension interferes with renal blood flow, destroys kidney tissue, and predisposes to hydronephrosis. Renal artery thrombosis causes ischemic damage to nephrons and decreases GFR. Renal tumors may result from chronic irritation associated with kidney stones. The risk of renal cell carcinoma also is increased in persons with cystic kidney disease, which decreases GFR. Hematuria with proteinuria is characteristic of glomerulonephritis. nephrotic syndrome. acute pyelonephritis. polycystic disease. Glomerulonephritis is characterized by early oliguria, followed by proteinuria and hematuria because of increased glomerular capillary wall permeability. Nephrotic syndrome affects the integrity of the glomerular capillary membrane and is characterized by massive proteinuria, hypoalbuminemia, generalized edema, lipiduria, and hyperlipidemia. Acute pyelonephritis represents a patchy interstitial, infectious, and inflammatory process with pyuria, chills, fever, headache, and back pain. The manifestations of polycystic kidney disease include pain from the enlarging cysts, episodes of gross hematuria from bleeding into cysts, infected cysts, and hypertension. The most common indicator of acute renal failure is uremia. azotemia. dehydration. hypercalcemia. Azotemia, accumulation of nitrogenous wastes in the blood, is the most common indicator of acute renal failure. Uremia is azotemia plus fluid/electrolyte imbalances, anemia, and encephalopathy characteristic only of chronic renal failure. Chronic (rather than acute) renal failure is associated with phosphate retention and hypocalcemia (the two electrolytes are inversely related). Dehydration is a symptom of several disorders; it may temporarily cause BUN to increase, without the presence of abnormal serum creatinine or renal damage. The maintenance phase of acute tubular necrosis (ATN) is characterized by edema. diuresis. hypokalemia. discolored urine. The maintenance phase of ATN is indicated by a decreased GFR, oliguria, and fluid retention that causes edema. Metabolites, such as potassium, are retained and serum levels increase. Discolored urine is associated with the obstructive presence of hemoglobin or myoglobin in the initiating phase of ATN. Some drugs administered as treatment for severe bacterial infection, systemic toxin damage, or as a radiological contrast agent can cause ________ tubular damage. ischemic. nephrotoxic. hypoperfusion. myoglobinuria. Some antibiotic drugs and contrast agents cause nephrotoxic tubule damage as a result of renal vasoconstriction, direct damage, or intratubular obstruction. Myoglobinuria obstructs the tubules when it is release into circulation by extensively damaged muscle tissue. Hypoperfusion and ischemia are direct causes of acute tubular necrosis unrelated to nephrotoxicity. In advanced chronic renal failure, impaired tubular reabsorption of sodium causes the common problem of salt wasting. dehydration. hypochloremia. metabolic alkalosis. Impaired tubular reabsorption of sodium causes salt wasting (hyponatremia with hypernaturia) as the kidneys lose the ability to regulate sodium excretion. The hyponatremia due to excess loss or restricted intake can cause volume depletion and further decrease in GFR as water accompanies the sodium loss. Chloride and sodium are inversely related. Cell death and retention of metabolic wastes cause potassium retention and acidotic pH, which is unrelated to sodium imbalances. The stage of renal failure characterized by compensatory hypertrophy by the healthy nephrons and increased dilute urine loss is postrenal failure. azotemic uremia. renal insufficiency. diminished renal reserve. The renal insufficiency stage of chronic renal failure is manifested by increased output as the tubules lose the ability to concentrate urine. As insufficiency persists, the remaining healthy nephrons hypertrophy in an attempt to maintain glomerular filtration. Postrenal failure is a type of acute failure due to outlet obstruction. Diminished renal reserve is asymptomatic. Azotemia is a characteristic of the renal insufficiency stage; uremia is only present in complete renal failure. The micturation center in the brain stem coordinates the action of the detrusor muscle and external sphincter. conscious control. bladder pressure. neuromediators. The micturation center, in the pons, coordinates the detrusor muscles and external sphincter to produce inhibition or relaxation. The cortical center permits conscious control of micturation. When the muscles and sphincter are stimulated by the increased pressure of a full bladder, conscious control permits the neuromuscular coordination of micturation in an appropriate location. The autonomic nervous system directly supplies neuromediators: parasympathetic innervation for detrusor and internal sphincter contraction, and sympathetic innervation for detrusor relaxation and increasing bladder volume. As pressure in the bladder increases, backflow into the ureters is prevented by sphincters. compression. valve closure. ureter pressure. Compression of the end of the ureter against the full bladder wall prevents backflow and, as a result, increases ureter pressure. Ureters do not have valves or sphincters at the bladder end to prevent backflow. When urine outlet obstruction continues and worsens, compensatory changes to allow urination include increased bladder residual. diverticula. hypertrophy. backpressure. In order to generate the pressure needed to overcome the obstruction, the bladder muscle hypertrophies to increase contractile strength. Diverticula, small pockets of mucosal tissue, form between bladder muscle fibers, a noncompensatory change because diverticula lack muscle cells and decrease detrusor muscle contractility. Increased residual, post-void urine retention, is noncompensatory and increases the risk for infection. Hypertrophy of the bladder trigone area causes noncompensatory ureter backpressure, with urine backflow into the kidneys. Involuntary loss of urine during activities that increase intra-abdominal pressure is usually the result of pelvic floor weakness. loss of bladder elasticity. bladder outlet obstruction. detrusor muscle hyperactivity. Pelvic floor weakness causes uncontrolled loss of urine (stress incontinence) when the person coughs, sneezes, or laughs and the intra-abdominal pressure pushes the urine into the urethra. Bladder outlet obstruction and hyperactive, excitable detrusor muscle are both myogenic causes of overactive bladder syndrome. Loss of bladder elasticity and lack of detrusor activity cause overdistention of the bladder with uncontrolled loss of small amounts of urine (overflow incontinence). Manifestations of neurogenic spastic bladder dysfunction include failure of the bladder to relax. empty. distend. store. Neurogenic spastic bladder dysfunction results from lesions above the level of the sacral micturation reflexes and manifests as reflexive bladder spasms and decreased bladder volume, with an inability to fill/store urine. Neurogenic flaccid bladder dysfunction manifests as diminished detrusor muscle and external sphincter tone, with an inability to voluntarily empty the bladder. Neurogenic nonrelaxing external sphincter manifests as urine retention, bladder distention, and impaired ability to empty the bladder. Because of its regenerative capabilities, injury to the digestive tract _______ layer heals rapidly without leaving scar tissue. mucosal. peritoneal. submucosal. circular muscle. The inner luminal, or mucosal, layer produces mucus that protects the inner surface, and has full regenerative capabilities. The peritoneum, the outer digestive tract layer, is a serous membrane incapable of healing without scarring. The submucosal layer is connective tissue with blood vessels and nerves that are incapable of regeneration. The circular muscle layer facilitates movement of contents; muscle layer injuries take longer to heal and scar tissue forms. When the voluntary pharyngeal phase of swallowing oral contents is initiated, the _______ moves to inhibit respiration and prevent aspiration of food into the lungs. larynx. epiglottis. soft palate. nasopharynx. The epiglottis moves to cover the larynx and protect the airway while the bolus of food is moved backward into the esophagus. Upward soft palate and palatopharyngeal movement prevents food from entering the nasopharynx. Sympathetic stimulation of the gastrointestinal tract smooth muscle inhibits the colonic motility. vagal responses. sphincter function. swallowing center. Sympathetic stimulation reduces the contractions and motility of the gastrointestinal tract, in addition to enhancing sphincter function. Vagus (vagal) nerve responses are controlled by parasympathetic innervation. The swallowing center in the medulla and lower pons carries motor impulses in several cranial nerves, including the vagus nerve (parasympathetic response). The entry of acid chyme into the intestine stimulates secretin release, which stimulates the pancreas to secrete insulin. ghrelin. enzymes. bicarbonate. Secretin stimulates the pancreas to secrete bicarbonate-rich fluid and inhibits gastric acid secretion. Other pancreatic functions, insulin production and digestive enzyme release, are unrelated to secretin functions. Ghrelin is a gastric hormone that stimulates food intake. Nausea and vomiting are both caused by stimulation of the medullary vomiting center, but only vomiting involves the dopamine antagonists. autonomic nervous system. secretion of cholecystokinin. chemoreceptor trigger zone. Only vomiting involves stimulation of both the medullary vomiting center and the chemoreceptor trigger zone. The autonomic nervous system response is characteristic of both vomiting and nausea. Secretion of cholecystokinin helps to regulate gastric emptying into the duodenum, rather than stimulate regurgitation or vomiting of gastric contents. Dopamine antagonists depress vomiting caused by stimulation of the chemoreceptor trigger zone. The most frequent symptom of gastroesophageal reflux is nausea. laryngitis. heartburn. dysphagia. Gastrointestinal reflux refers to the backward movement of gastric contents into the esophagus. The most frequent symptom is severe heartburn, occurring 30 to 60 minutes after eating. Dysphagia, difficulty swallowing, can result from disorders that produce narrowing of the esophagus. Regurgitation of stomach contents into the esophagus occurs without nausea. Persistent reflux produces a cycle of mucosal damage that causes hyperemia, edema, and erosion of the esophageal surface, and does not affect the larynx. In addition to chronic gastritis, _______ plays a critical role in peptic ulcer disease and gastric cancer. C. difficile bacillus. psychologic stress. H. pylori bacteria. chronic NSAID use. H. pylori gastritis, the most common type of chronic nonerosive gastritis, is a chronic inflammatory disease of the stomach and plays a critical role in peptic ulcer disease, gastric adenocarcinoma, and low-grade B-cell gastric lymphoma. Broad-spectrum antibiotic treatment disrupts the normal protective bacterial flora of the colon, leading to C. difficile infection and colon mucosa damage. Peptic ulcers are no longer considered a result of psychologic stress. Stress ulcers develop in persons with major physiologic stress such as burns or trauma. Chronic NSAID intake has a critical role in peptic ulceration without increasing the risk for gastric cancer. Although both Crohn disease and ulcerative colitis produce inflammation of the bowel, only Crohn disease is characterized by multiple crypt abscesses. causative agents. granulomatous lesions. mucosal pseudopolyps. Characteristic features of Crohn disease include multiple sharply demarcated, granulomatous lesions surrounded by normal-appearing mucosal tissue. Both diseases produce inflammation of the bowel and both lack confirming evidence of proven causative agents. The ulcerative colitis inflammatory process results in mucosal layer tongue-like projections resembling polyps (pseudopolyps), pinpoint mucosal hemorrhages that suppurate, form crypt abscesses, become necrotic, and ulcerate. In day-care centers, a common cause of severe diarrhea outbreaks in young children is ______ infection that is spread by a fecal-oral route. rotavirus. bacterial. celiac sprue. Escherichia coli 0157:H7. Rotavirus, spread by the fecal-oral route, is a common cause of diarrhea outbreaks in children under 5 years old in day-care centers, where children play closely together, sharing toys and secretions. E. coli 0157:H7 infection is spread by ingestion of food such as undercooked hamburger or on fruits and vegetables; it is also spread person-to-person in nursing homes, day-care settings, and hospitals. Diarrhea caused by bacterial infection (some forms of food poisoning) is caused by ingestion of preformed bacterial toxins that invade/destroy epithelial cells in the intestine. Celiac disease, also known as celiac sprue and gluten-sensitive enteropathy, is an immune-mediated disorder triggered by ingestion of gluten-containing grains. A highly significant early symptom of colon cancer is rectal bleeding. painful defecation. abdominal distention. persistent constipation. Almost all cancers of the colon and rectum bleed intermittently, although the amount of blood is small and usually not apparent in the stools. Bleeding is a highly significant early symptom, commonly causing persons to seek medical care. Other symptoms include a change in bowel habits, diarrhea or constipation, and sometimes a sense of urgency or incomplete emptying of the bowel. Pain usually is a late symptom. Abdominal distention is characteristic of ileus, bowel obstruction, peritoneal inflammation, or ascites. The most common presenting symptom in persons with cholestasis is pruritis. jaundice. indigestion. fatty lesions. Pruritis is the most common presenting symptom in persons with cholestasis, probably related to an increase of bile acids in the blood. Jaundice (icterus) results from the high accumulation of bilirubin in the blood, causing a yellowish discoloration to the skin and deep tissues. Jaundice becomes evident when the serum bilirubin levels rise above 2.0 to 2.5 mg/dL. A history of pruritis preceding jaundice is common in obstructive (cholestatic) jaundice. Skin xanthoma lesions (focal accumulations of cholesterol) may occur as a result of hyperlipidemia and impaired excretion of cholesterol. Other manifestations of reduced bile flow relate to intestinal absorption, including digestive disorders and fat-soluble vitamin deficiencies. Hepatitis D infection occurs as a coinfection or superinfection with ____ and increases the tendency to develop chronic hepatitis. hepatitis B. HIV infection. alcoholic cirrhosis. autoimmune hepatitis. Hepatitis D infection depends on concomitant infection with hepatitis B, specifically the presence of HBsAg. Acute hepatitis D occurs in two forms: coinfection with acute hepatitis B and as a super-infection of hepatitis D with chronic hepatitis B or the hepatitis B carrier state. The immune deficiencies of HIV patients predispose them to develop a viral hepatitis infection of any type. Chronic autoimmune hepatitis is a chronic inflammatory liver disease with circulating autoantibodies and high serum gamma globulin levels; differential diagnosis includes measures to exclude other causes of liver disease, including hepatitis B and C. Alcoholic liver disease, directly caused by alcohol ingestion, includes fatty liver disease, alcoholic hepatitis, and cirrhosis. Many cholelithiasis, also called gallstones, are primarily composed of excessive _____ excreted by the liver in response to chronic cholecystitis. albumin. bile salts. ammonia. cholesterol. Gallstones form in bile that is supersaturated with cholesterol or bilirubinate, and most gallstones are composed primarily of cholesterol. Bile contains the bile salts essential for fat digestion and absorption of fat-soluble vitamins. Bile salts produce secretory proteins, such as albumin, that are released into the circulation. Albumin contributes significantly to the plasma colloidal osmotic pressure and to the binding and transport of numerous substances, including some hormones, fatty acids, bilirubin, and other anions. Because ammonia is very toxic to body tissues, particularly neurons, it is converted to urea in the liver and excreted by the kidneys without combining with bile. The encephalopathy that appears late in the course of cirrhosis is caused by an accumulation of _____ that directly damages neurons. cortisol. glucose. ammonia. aldosterone. Ammonia is very toxic to body tissues, particularly neurons. With liver failure, the conversion of ammonia, a by-product of protein and amino acid metabolism, to urea is impaired. When the blood from the intestine bypasses the liver or the liver is unable to convert ammonia to urea, ammonia moves directly into the general circulation and from there to the cerebral circulation. The diseased liver is unable to metabolize the steroid hormones (such as cortisol); therefore, these hormones are often elevated in persons with liver failure. A decrease in aldosterone metabolism may contribute to salt and water retention. Liver failure disrupts synthesis and storage of glucose, causing hypoglycemic episodes. Which one of the following enzymes becomes elevated during the first 24 hours following the onset of acute pancreatitis? serum amylase. cholecystokinin. alpha-fetoprotein. alkaline phosphatase. Total serum amylase is the test used most frequently in the diagnosis of acute pancreatitis. Serum amylase levels rise within the first 24 hours after onset of symptoms and remain elevated for 48 to 72 hours. Products of food digestion, particularly lipids, stimulate the release of the gastrointestinal hormone cholecystokinin, which provides a strong stimulus for gallbladder contraction. Total serum bilirubin, aminotransferase, and alkaline phosphatase levels usually are elevated with acute cholecystitis. Serum a-fetoprotein, a serum protein present during fetal life, normally is barely detectable in the serum after the age of 2 years, but it is present in 90% of cases of hepatocellular carcinoma. Hormones are highly specialized organic molecules produced by endocrine glands, with numerous functions that include the ability to initiate systemic reactions. transport protein molecules. modulate cellular responses. produce enzymes within cells. Hormones have the ability to modulate cellular responses, but are incapable of initiating systemic or cellular reactions. Hormones are chemical messengers that are transported by proteins in body fluids, rather than being the transporters of protein. Some intracellular hormone receptors modulate enzyme synthesis, rather than produce enzymes. In turn, enzymes can convert, inactivate, and degrade hormones on or inside cells. The response of a target cell to a hormone varies with the number of receptors and the _____ of the receptors for binding. rate. affinity. actions. location. Hormones exert their actions by binding to high-affinity receptors located on the surface or inside target cells. The rate at which hormones react depends on their mechanism of action. The numbers of receptors for binding, regardless of their location, directly affect target cell responses. Some hormones have localized ______ actions on cells other than those that produced the hormone, such as sex steroid action on the ovary. autocrine. peptide. eicosanoid. paracrine. Paracrine actions are localized on cells other than those that produced the hormone. Autocrine actions are localized on the cells from which they were produced, such as insulin and pancreatic beta cells. Peptide hormones produce precursor hormone, which is called prohormone when extra amino acids are present (e.g., insulin). Eicosanoids (e.g., leukotrienes) are systemically active fatty-acid derivatives and serve as mediators. Hormones are often divided into four categories according to their diverse structures. Category three, steroid hormones, is derived from tyrosine. retinoids. cholesterol. glycoprotein. Category three, steroid hormones, is derived from cholesterol. The first category, amines, is derived from single amino acids such as tyrosine. The second category, peptides and glycoprotein hormones, is derived from three or more amino acids. The fourth category, fatty acid derivatives, includes retinoids. With the exception of growth hormone and prolactin, most pituitary hormones are regulated by hypothalamic cytokines. inhibition. stimulation. metabolites. Most pituitary hormones are regulated by hypothalamic hormone stimulation. Hormone metabolites are measured in urine to monitor circulating hormone levels. Cytokines, in addition to involvement in immune system activity, help regulate hypothalamic gland function, rather than pituitary hormones. Growth hormone and prolactin are regulated by hypothalamic hormone inhibition, rather than stimulation. The most common cause of hypothyroidism is Graves disease. thyroid adenoma. iodine deficiency. Hashimoto thyroiditis The most common cause of hypothyroidism is Hashimoto thyroiditis, an autoimmune disorder in which the thyroid gland may be totally destroyed by an immunologic process. Iodine deficiency, which can cause goiter and hypothyroidism, is rare in the United States because of the widespread use of iodized salt and other iodide sources. The most common cause of hyperthyroidism is Graves disease; other causes of hyperthyroidism are multinodular goiter and adenoma of the thyroid. Graves disease is characterized by the triad of goiter, ophthalmopathy, and elevated TSH. myxedema. hypothermia. hyperthyroidism. Graves disease is characterized by the triad of hyperthyroidism, goiter, and ophthalmopathy (or dermopathy). A low serum T4 and elevated TSH levels are characteristic of primary hypothyroidism. Myxedematous coma is a life-threatening end-stage expression of hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, and hypoventilation. Myxedema is a mucous type of edema. Primary adrenal insufficiency is characterized by adrenal cortical hormone deficiency and high ____ levels. ACTH. cortisol. androgen. aldosterone. Addison disease is primary adrenal insufficiency in which adrenal cortical hormones are deficient and ACTH levels are elevated because of lack of feedback inhibition. Manifestations are related primarily to mineralocorticoid deficiency (aldosterone), glucocorticoid deficiency (cortisol), and hyperpigmentation resulting from elevated ACTH levels. Adrenal androgens are physiologically important in women with Addison disease, and replacement therapy should be considered. GH secretion is stimulated by free fatty acids. severe stress. high cortisol. morbid obesity. GH secretion is stimulated by hypoglycemia, fasting, starvation, increased blood levels of amino acids (particularly arginine), and stress conditions such as trauma, excitement, emotional stress, and heavy exercise. GH is inhibited by increased glucose levels, free fatty acid release, cortisol, and obesity. Impairment of secretion, leading to growth retardation, is not uncommon in children with severe emotional deprivation. The major manifestations of Cushing syndrome represent an exaggeration of the many actions of cortisol that include hyperkalemia. hypotension. osteoporosis. weight loss. Osteoporosis may develop because of destruction of bone proteins and alterations in calcium metabolism. The glucocorticoids possess mineralocorticoid properties; this causes hypokalemia as a result of excessive potassium excretion and hypertension resulting from sodium retention. Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen; subclavicular fat pads or "buffalo hump" on the back; and a round, plethoric "moon face." Counterregulatory hormones that increase blood glucose concentrations include epinephrine. thyroid hormone. mineralcorticoids. proinsulin. The hormones glucagon, epinephrine, growth hormone, and the glucocorticoids maintain or increase blood glucose concentrations and are referred to as counterregulatory hormones. Active insulin is formed in the beta cells from a larger molecule called proinsulin. Insulin's blood glucose:lowering action results from its ability to increase the transport of glucose into body cells and to decrease the production and release of glucose into the bloodstream by the liver. Type 1A diabetes, formerly called juvenile diabetes, is characterized by total beta cell destruction. insulin receptor resistance. autoimmune beta cell damage. idiopathic beta cell damage. Type 1A diabetes is thought to be an autoimmune disorder resulting from a genetic predisposition (i.e., diabetogenic genes); an environmental triggering event, such as an infection; or a T lymphocyte:mediated hypersensitivity reaction against some beta cell antigen. The term idiopathic type 1B diabetes is used to describe those cases of beta cell destruction in which no evidence of autoimmunity is present. Type 1 diabetes mellitus is characterized by destruction of the pancreatic beta cells. The metabolic abnormalities that lead to type 2 diabetes include (1) peripheral insulin resistance, (2) deranged secretion of insulin by the pancreatic beta cells, and (3) increased glucose production by the liver. Which test provides a good measure of blood glucose levels over the previous 2 to 3 months? glucose tolerance test. fasting blood glucose test. capillary blood-monitoring tests. glycosylated hemoglobin test. Glycosylation involves the irreversible attachment of glucose to the hemoglobin molecule; the measurement of A1C provides an index of blood glucose levels during a period of several months. The diagnosis of diabetes mellitus is based on clinical signs of the disease, fasting plasma glucose levels, random plasma glucose measurements, and results of the glucose tolerance test. Self-monitoring provides a means of maintaining near-normal blood glucose levels through frequent testing of blood glucose and adjustment of insulin dosage. Persons with uncontrolled type 1 diabetes develop metabolic acidosis caused by excess _____ accumulation in the blood. ketone. lactic acid. bicarbonate. carbon dioxide. Diabetic ketoacidosis (DKA) occurs when ketone production by the liver exceeds cellular use and renal excretion. DKA most commonly occurs in a person with type 1 diabetes, in whom the lack of insulin leads to mobilization of fatty acids from adipose tissue. The increase in fatty acid levels leads to ketone production by the liver. Metabolic acidosis is caused by the excess ketoacids that require buffering by bicarbonate ions; this leads to a marked decrease in serum bicarbonate levels. Lactic acidosis occurs as cells turn to anaerobic metabolic processes for energy. Excess carbon dioxide is associated with respiratory acidosis. Suboptimal response to infection in a person with diabetes is caused by the presence of chronic vascular and neurologic complications and electrolyte imbalances. chronic low hemoglobin. altered neutrophil function. fat-soluble vitamin deficiency. Suboptimal response to infection in a person with diabetes is caused by the presence of chronic complications, such as vascular disease and neuropathies, and by the presence of hyperglycemia and altered neutrophil function. Red blood cells and hemoglobin levels are unaffected by infection that causes chronically high white cell counts and inflammation response. Diabetics usually do not usually have vitamin deficiencies, unless dietary intake is altered. Uncontrolled diabetics may develop dehydration and electrolyte imbalances related to polydipsia and polyuria-unrelated to infections. The region of the brain involved in emotional experience and the control of emotion-related behavior is the precentral gyrus. parietal lobe. limbic system. temporal cortex. The limbic lobe is involved in emotional experience and control of emotion-related behavior. Stimulation can lead to feelings of dread, high anxiety, exquisite pleasure, and violent behaviors. The temporal cortex functions include sound pattern recognition and long-term memory recall of complex sensory patterns. In the parietal lobe, the somatosensory cortex perceives where a stimulus is in space, in relation to body parts. The precentral gyrus is the primary motor cortex which provides precise movement control for distal flexor muscles of the hands and feet and of the phonation apparatus required for speech. In contrast to the conduction of electrical synapses, each successive event at chemical excitatory and inhibitory synapses consumes time. energy. glucose. oxygen. Chemical synapses are the slowest component in progressive communication through a sequence of neurons. In contrast to the conduction of electrical synapses, each successive event at the chemical synapse-transmitter secretion, diffusion across the synaptic cleft, interaction with postsynaptic receptors, and generation of a subsequent action potential in the postsynaptic neuron-consumes time. The nervous system has a high level of metabolic activity, requiring a continuous supply of oxygen and glucose. For most autonomic-mediated functions, the ______ serves as the major control center. forebrain. medulla. brain stem. hypothalamus. For most autonomic-mediated functions, the hypothalamus serves as the major control center. The hypothalamus, which has connections with the cerebral cortex, the limbic system, and the pituitary gland, is in a prime position to receive, integrate, and transmit information to other areas of the nervous system. The organization of many life-support reflexes occurs in the reticular formation of the medulla and pons. At the hypothalamic level, reflexes are integrated into more general response patterns, such as rage, defensive behavior, eating and drinking, voiding, and sexual function. Forebrain and especially limbic system control of behaviors involve inhibiting or facilitating release of the response patterns according to social pressures during learned emotion-provoking situations. While the blood-brain barrier excludes most highly water-soluble compounds, most ______ molecules cross the layers of the barrier with ease. lipid. protein. peptide. high charged. Most highly water-soluble compounds are excluded from the brain, especially molecules with high ionic charge, such as many of the catecholamines. Large molecules such as proteins and peptides are largely excluded from crossing the blood-brain barrier. In contrast, many lipid-soluble molecules cross the lipid layers of the blood-brain barrier with ease. Muscarinic and nicotinic are the two types of supporting cells. catecholamines. neurotransmitters. cholinergic receptors. Receptors that respond to acetylcholine are called cholinergic receptors. There are two types of cholinergic receptors: muscarinic and nicotinic. Adrenergic receptors are divided into a and B receptors. The catecholamines, which include norepinephrine, epinephrine, and dopamine, are synthesized in the sympathetic nervous system. The main neurotransmitters of the autonomic nervous system are acetylcholine and the catecholamines, epinephrine and norepinephrine. Supporting cells of the CNS consist of the oligodendrocytes, astrocytes, microglial cells, and ependymal cells. Free nerve endings are specialized tactile receptors in the skin and other tissues, including the cornea, that detect touch and pressure. light object movement. heavy continuous pressure. low-frequency vibration. Free nerve endings detect touch and pressure. Meissner corpuscles are present in nonhairy parts of the skin and are particularly sensitive to movement of very light objects over the surface of the skin and to low-frequency vibration. Ruffini end-organs signal continuous states of deformation, such as heavy and continuous touch and pressure. The specificity theory of pain explains physiologic basis for the pain experience as separate sensory modality. neural gating mechanisms. pain receptors share pathways. a widely distributed neural network. Specificity theory regards pain as a separate sensory modality evoked by the specific receptor activity, with information transmitted to pain centers or regions in the forebrain where pain is experienced. The pattern theory proposes that pain receptors share endings or pathways with other sensory modalities but that different patterns of activity of the same neurons can signal painful and nonpainful stimuli. Gate control theory, a modification of specificity theory, postulates the presence of neural gating mechanisms at the segmental spinal cord level to account for interactions between pain and other sensory modalities. The neuromatrix theory proposes that the brain contains a widely distributed neural network called the body-self neuromatrix. If a person is stung on the index finger by a bee and the association cortex is functional, the person can identify the general area of pain. localize the pain to a precise area. interpret the bee as related to the pain. hit the bee with the other hand. If a person is stung on the index finger by a bee and only the thalamus is functional, the person reports pain somewhere on the hand. With the primary sensory cortex functional, the person can localize the pain to the precise area on the index finger. With the association cortex functional, the person can interpret the buzzing and sight of the bee that preceded the pain as being related to the bee sting. A diffuse pain that results from stretching, distention, or ischemia of tissues originates in ______ tissues. visceral. muscle. cutaneous. dermatome. Cutaneous pain arises from superficial structures, such as the skin and subcutaneous tissue; it can be localized accurately and may be distributed along the dermatomes. Visceral pain is induced by strong contractions, distention, or ischemia affecting the walls of the viscera. It is diffuse and poorly localized and tends to be referred to other locations. Deep somatic pain originates in deep body structures, such as the periosteum, muscles, tendons, joints, and blood vessels. This pain is more diffuse than cutaneous pain. The primary or chronic headache pain that is pulsatile, unilateral, and accompanied by visual disturbances, nausea, vomiting, and sensitivity to light and sound is classified as cluster. migraine. tension type. chronic daily. Migraine is a pulsatile, throbbing, unilateral headache that is accompanied by nausea and vomiting, sensitivity to light and sound, and visual disturbances or visual hallucinations such as stars, sparks, and flashes. Cluster headache includes severe, unrelenting, unilateral pain located behind the eye associated with agitation, conjunctival redness, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. A tension-type headache frequently is described as a dull, aching, diffuse, nondescript headache, occurring in a hatband distribution around the head, and not associated with nausea or vomiting or worsened by activity. A chronic daily headache is a tension-type or migraine headache that occurs on a frequent basis. One of the most outstanding features of lower motor neuron (LMN) lesions is spastic paralysis. muscle atrophy. muscle hypertonicity. increased resistance. Upper motor neuron (UMN) lesions produce spastic paralysis and hypertonicity, and lower motor neuron (LMN) lesions produce flaccid paralysis. One of the outstanding features of LMN lesions is the profound development of muscle atrophy. With complete LMN lesions, the muscles of the affected limbs, bowel, bladder, and genital areas become atonic, and it is impossible to elicit contraction by stretching the tendons. After several weeks of weakness, UMN problems convert to hypertonicity or spasicity, which is manifested by an initial increased resistance (stiffness) to the passive movement of a joint at the extremes of range of motion followed by a sudden or gradual release of resistance. Spinal cord shock is described as ______ below the level of injury. hypertension. hyperreflexia. flaccid paralysis. painful spasms. Immediate response to spinal cord injury is often referred to as spinal cord shock. It is characterized by flaccid paralysis with loss of tendon reflexes below the level of injury, absence of somatic and visceral sensations below the level of injury, and loss of bowel and bladder function. Loss of systemic sympathetic vasomotor tone may result in vasodilation, increased venous capacity, and hypotension. When autoantibodies bind to acetylcholine receptor sites at the neuromuscular junctions, the resulting disorder is Parkinson disease. myasthenia gravis. amyotrophic lateral sclerosis. multiple sclerosis. Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated destruction of acetylcholine receptors in the neuromuscular junction. The pathophysiology of multiple sclerosis involves the demyelination of nerve fibers and subsequent degeneration of nerve fibers in the CNS. Amyotrophic lateral sclerosis is a progressive and devastating neurologic disorder that affects motor function of UMNs in the brain stem and cerebral cortex and LMNs in the spinal cord. Parkinson disease is a degenerative disorder of the basal ganglia characterized by progressive destruction of the nigrostriatal pathway with a subsequent reduction in striatal concentrations of dopamine. In the recovery phase of spinal cord injury, the severe complication of autonomic hyperreflexia is manifested as lethargy. polyuria. tachycardia. hypertension. Autonomic hyperreflexia/dysreflexia is characterized by vasospasm, hypertension, skin pallor, and gooseflesh. Continued hypertension produces a baroreflex-mediated vagal slowing of the heart rate to bradycardic levels, flushed skin and profuse sweating above the level of injury, severe pounding headache, nasal stuffiness, and feelings of anxiety. In many cases, the dysreflexic response results from a full bladder due to urine retention. Guillain-Barre syndrome is an acute immune-mediated polyneuropathy characterized by permanent leg atrophy. descending muscle weakness. paresthesia and numbness. concurrent strep infection. Guillain-Barre syndrome is characterized by rapidly progressive limb weakness and loss of tendon reflexes. Approximately two thirds of affected persons report having had an acute, influenza-like illness prior to (rather than during) the onset of symptoms. The disorder is characterized by progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. Symptoms of paresthesia and numbness often accompany the loss of motor function. Approximately 80% to 90% of persons with the disease achieve a full and spontaneous recovery within 6 to 12 months. When the pressure of brain edema is unevenly distributed, the result is hydrocephalus. epidural hematoma. tentorial herniation. cerebral hemorrhage. Brain herniation is displacement of brain tissue under the falx cerebri or through the incisura of the tentorium cerebelli. It occurs when the pressure exerted by brain edema or a mass lesion is not evenly distributed, resulting in shifting or herniation of brain tissue from a compartment of higher pressure to one of lower pressure. Enlargement of the CSF compartment occurs with hydrocephalus, which is defined as an abnormal increase in CSF volume in any part or all of the ventricular system. An epidural hematoma results from an arterial tear that develops between the inner table of the bones of the skull and the dura. A cerebral hemorrhage occurs suddenly, resulting in cerebral edema and high pressure (a cause instead of a result of herniation). In mild head injury, a concussion is manifested as subarachnoid hemorrhage. transient ischemic attacks. bruising to the cortical surface. momentary loss of consciousness. In mild head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. A contusion is a bruise to the cortical surface of the brain caused by blunt head trauma. Cerebral contusions, particularly those accompanied by tearing of the superficial layers of the brain, are an important cause of traumatic subarachnoid hemorrhage. The causes of transient ischemic attacks (TIAs) are the same as those of ischemic stroke, and include atherosclerotic disease of cerebral vessels and emboli. TIA or "ministroke" is equivalent to "brain angina" and reflects a temporary disturbance in focal cerebral blood flow, which reverses before infarction occurs. Which type of stroke causes pure motor or sensory deficits? lacunar. embolic. thrombotic. hemorrhagic. Because of their size and location, lacunar infarcts usually do not cause cortical deficits. Instead, they produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with the clumsy hand syndrome. An embolic stroke is caused by a moving blood clot that travels from its origin to the brain, with a sudden onset and immediate maximum deficit. Thrombi, a common cause of ischemic strokes, usually occur in atherosclerotic blood vessels. These infarcts often affect the cortex, causing aphasia or visual field defects. With rupture of a blood vessel, hemorrhage into the brain tissue occurs; the clinical course progresses rapidly to coma and frequently to death. In addition to the manifestations it shares with viral meningitis, patients with viral encephalitis display fever. seizures. headaches. nuchal rigidity. Like meningitis, encephalitis is characterized by fever, headache, and nuchal rigidity; but more often patients also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma. Manifestations of the first stage of Alzheimer-type dementia include wandering "sundown syndrome." confusion and disorientation. inability to communicate. short-term memory loss. The first stage of Alzheimer disease is characterized by short-term memory loss that often is difficult to differentiate from the normal forgetfulness that occurs in the elderly. As the disease progresses, the person with Alzheimer disease enters the second or confusional stage of dementia. There is extreme confusion, disorientation, lack of insight, and inability to carry out the activities of daily living; personal hygiene is neglected; and language becomes impaired. Wandering, also referred to as "sundown syndrome," is characterized by confusion, restlessness, agitation, and wandering, and may become a daily occurrence late in the afternoon. The third stage of the disease is the terminal stage. Early hearing loss in persons with otosclerosis is characterized by an inability to hear a whisper. vowel sounds. their own voice. in noisy locations. The symptoms of otosclerosis involve an insidious hearing loss. Initially, the affected person is unable to hear a whisper or someone speaking at a distance. In the earliest stages, the bone conduction by which the person's own voice is heard remains relatively unaffected. At this point, the person's own voice sounds unusually loud. Because of bone conduction, most of these persons can hear fairly well on the telephone, which provides an amplified signal. Many are able to hear better in a noisy environment. A reddened eye caused by glaucoma is distinguished from conjunctivitis by the presence of a cloudy cornea. constricted pupil. watery discharge. itching sensation. Attacks of increased intraocular pressure are manifested by ocular pain and blurred or iridescent vision caused by corneal edema. With repeated or prolonged attacks, the eye becomes reddened, and edema of the cornea may develop, giving the eye a hazy appearance. Drugs used in the long-term management of glaucoma include ones that increase aqueous outflow through contraction of the ciliary muscle and pupillary constriction (miosis). A usually watery discharge, or exudate, may be present with all types of conjunctivitis and may cause transient blurring of vision. Important symptoms of conjunctivitis are a foreign body sensation, a scratching or burning sensation, severe itching, and photophobia. Diabetic retinopathy causes vision loss as ________ develops and damages the retina. papilledema. retinal detachment. neovascularization. macular degeneration. Neovascularization, the formation of new blood vessels, occurs in conditions that impair retinal circulation, including vascular occlusion, sickle cell disease, and diabetes mellitus. With papilledema, the optic cup is distorted by protrusion into the interior of the eye; this sign occurs when intracranial pressure is significantly elevated. Retinal detachment involves the separation of the sensory retina from the pigment epithelium. Factors that predispose to retinal detachment include myopia, cataract extraction, and conditions with preretinal fibrosis or exudate between the two layers of the retina. Macular degeneration is age-related loss of central vision due to destructive changes of the macular or yellow-pigmented area surrounding the central fovea. It is the leading cause of blindness among persons over 75 years of age. The degenerative changes of aging are the primary cause of some visual and hearing problems that include glaucoma. amblyopia. otosclerosis. presbycusis. Presbycusis is degenerative hearing loss that occurs with advancing age. Approximately 23% of persons between 65 and 75 years of age and 40% of the population older than 75 years of age have presbycusis. Amblyopia is the result of inadequately developed CNS circuitry, caused by visual deprivation or abnormal binocular interactions during the period of visual immaturity (childhood). Otosclerosis is a familial disorder of the otic capsule that results in hearing loss due to immobilization of the stapes and conduction deafness. Glaucoma usually results from congenital or acquired lesions of the anterior segment of the eye that mechanically obstruct aqueous outflow. Persons with glaucoma may develop impaired vision and intraocular degenerative changes unrelated to the aging process. Disorders of peripheral vestibular function include Meniere disease, which is caused by tympanosclerosis. repeated otitis media. excessive endolymph. medication ototoxicity. Disorders of peripheral vestibular function, which involve the inner ear sensory organs, include Meniere disease. The disease is caused by an over accumulation of endolymph, and characterized by severe, disabling episodes of tinnitus, feelings of ear fullness, and violent rotary vertigo. Acute otitis media (OM) is characterized by the presence of fluid in the middle ear in combination with signs and symptoms of an acute or systemic infection. Recurrent OM is defined as three new acute otitis media episodes within 6 months or four episodes in 1 year. Tympanosclerosis involves the formation of whitish plaques and nodular deposits on the submucosal surface of the tympanic membrane, with adherence of the ossicles and conductive hearing loss. Drugs and medications that damage inner ear structures are labeled ototoxic. Vestibular symptoms of ototoxicity include light-headedness, giddiness, and dizziness; if toxicity is severe, tinnitus or hearing loss occurs. The function of the male reproductive system is under the negative feedback control of the hypothalamus and FSH and LH. Leydig's cells. testosterone. Sertoli inhibin. The function of the male reproductive system is under the negative feedback control of the hypothalamus and the anterior pituitary gonadotropic hormones FSH and LH. FSH is thought to be inhibited by a substance called inhibin, produced by Sertoli's cells. Inhibin suppresses FSH release from the pituitary gland. The production of testosterone by the interstitial cells of Leydig is regulated by LH. FSH binds selectively to Sertoli's cells surrounding the seminiferous tubules, where it functions in the initiation of spermatogenesis. Peyronie disease is initially characterized by _______ that results in fibrosis and upward bowing of the penis. priapism. ulcerations. inflammation. Kaposi sarcoma. Peyronie disease is characterized initially by pain and inflammation that results in dense fibrous plaque formation, usually on the dorsal midline of the shaft, causing upward bowing of the shaft during erection. Priapism is an involuntary, prolonged painful erection, not associated with sexual excitement, due to impaired blood flow in the corpora cavernosa. Approximately 18% of men with AIDS-related Kaposi sarcoma have lesions of the penis or genitalia. Invasive carcinoma of the penis begins as a small lump or ulceration. A testicular hydrocele forms when ________ accumulates between the layers of the tunica vaginalis and forms a cystic mass. fluid. sperm. blood. mucus. The tunica vaginalis has an outer parietal layer and a deeper visceral layer. A space exists between these two layers and typically contains a few milliliters of serous fluid. A hydrocele forms when excess fluid collects between the layers of the tunica vaginalis. A hematocele is an accumulation of blood in the tunica vaginalis. A spermatocele is a painless, sperm-containing cyst that forms at the end of the epididymis. There are no mucus-secreting cells in the tunica. Males with _______ are at great risk for developing testicular cancer. high PSA levels. testicular torsion. chronic prostatitis. undescended testis. Testicular cancer is strongly associated with cryptorchidism or undescended testes. Higher locations of undescended testis greatly increase the risk for cancer. High PSA levels are associated with increased risk for prostate cancer. Testicular torsion is a twisting of the spermatic cord that suspends the testis. Chronic bacterial prostatitis is recurrent urinary tract infections of the same strain of pathogenic bacteria in prostatic fluid and urine. Manifestations of benign prostatic hypertrophy are mainly caused by urethra compression. decreased perfusion. recurrent prostatitis. low testosterone level. Because the prostate encircles the urethra, benign prostatic hypertrophy (BPH) exerts its effect through urethra compression and obstruction of urinary outflow from the bladder. Common risk factors for generalized penile arterial insufficiency and hypoperfusion include systemic hypertension, hyperlipidemia, cigarette smoking, and diabetes mellitus. Chronic recurrent prostatitis is a common cause of relapsing urinary tract infections in men. Testosterone is produced and secreted by the interstitial Leydig's cells in the testes; adequate levels are maintained if the testes are intact and healthy. Cervical cancer is often considered a sexually transmitted disease because a preexisting or concurrent _______ infection is usually present. Neisseria gonorrhoeae. human papillomavirus. herpes simplex virus. Chlamydia trachomatis. Carcinoma of the cervix is often considered a sexually transmitted disease because evidence suggests a causal link between human papillomavirus (HPV) infection, spread by sexual contact, sexual practices, and cervical cancer. Acute cervicitis may be caused by a variety of infective agents, including Neisseria gonorrhoeae, Chlamydia trachomatis, and herpes simplex virus. Untreated cervicitis may extend to include the development of pelvic cellulitis, low back pain, painful intercourse, cervical stenosis, dysmenorrhea, and further infection of the uterus or fallopian tubes. Factors that predispose women to the development of pelvic inflammatory disease (PID) include a history of multiple sexual partners and unmarried status. drug abuse. pregnancies. age over 30. PID is a polymicrobial infection. Factors that predispose women to the development of PID include age between16 and 24 years, unmarried status, nulliparity, history of multiple sexual partners, and previous history of PID. Women over age 35 frequently develop benign smooth muscle tumors of the uterus that may cause endometriosis. recurrent cystitis. excess bleeding. atypical cervicitis. Smooth muscle tumors of the uterus, also known as myomas or fibroids, are benign neoplasms. They are asymptomatic or they may cause excessive menstrual bleeding, anemia, urinary frequency, rectal pressure/constipation, abdominal distention, and infrequently pain. Endometriosis is a primary condition in which functional endometrial tissue is found in ectopic sites outside the uterus. Some fibroid types may displace genitourinary structures, causing noninflammatory conditions such as hydroureter or urine retention. Acute cervicitis is an inflammatory condition, a direct result of cervical infection or secondary to a vaginal or uterine infection. Chronic anovulation, an underlying cause of polycystic ovary syndrome, is characterized by abnormal hormone levels that include low levels of LH. FSH. prolactin. androgens. Most women with polycystic ovary syndrome have elevated luteinizing hormone (LH) levels with normal estrogen and follicle-stimulating hormone (FSH) production. Elevated levels of testosterone, androstenedione, and hyperprolactinemia or hypothyroidism are common. The elevated LH level results in increased androgen production, which in turn prevents normal follicular development and contributes to the vicious cycle of anovulation. The overall goal of treatment is to suppress insulin-facilitated, LH-driven androgen production. Ovarian cancer is often diagnosed in the late stage because symptoms, when present, are gastrointestinal. urinary disorders. premenstrual. neuromuscular. Most cancers of the ovary produce no symptoms, or the symptoms are so vague that the woman seldom seeks medical care until the disease is advanced. Preceding other symptoms by months, vague discomforts include gastrointestinal manifestations of abdominal distress, flatulence, and bloating, especially after ingesting food. Stimulation of the ovarian epithelium, which occurs with nulliparity and uninterrupted ovulation, may predispose to ovarian cancer. Condylomata acuminata, or genital warts, are caused by herpes simplex virus. Treponema pallidum. human papillomavirus. Trichomoniasis vaginalis. Condylomata acuminata, or genital warts, are caused by the human papillomavirus (HPV). Herpes simplex virus type 1 (HSV-1) is usually associated with cold sores, and HSV-2 is usually associated with genital herpes lesions. Syphilis, a genital and systemic disease, is caused by a spirochete, Treponema pallidum. Trichomoniasis vaginalis is a large anaerobic, pear-shaped, flagellated protozoan that commonly causes vaginitis when some imbalance allows the protozoan to proliferate. Infection of the urethra and lower genital tract and severe reproductive complications are often caused by the intracellular parasites characteristic of Chlamydia trachomatis. Condylomata acuminata. herpes simplex virus. Neisseria gonorrhoeae Genital warts typically present as soft, raised, fleshy lesions on the external genitalia. Both of HSV-1 and HSV-2 viruses replicate in the skin and mucous membranes at the site of infection (oropharynx or genitalia), where they cause vesicular lesions of the epidermis. Chlamydiae are intracellular parasites that are smaller than most bacteria. They lack the enzymes necessary to generate ATP and must parasitize the machinery of the host cell to reproduce. The N. gonorrhoeae gonococcus is a pus-forming, gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates. A significant difference between chlamydial and gonococcal salpingitis is that as many as 85% to 95% of chlamydial infections in men and women are secondary to HIV. penicillin resistant. causes of infertility. totally asymptomatic. The most significant difference between chlamydial and gonococcal salpingitis is that as many as 85% to 95% of C. trachomatis infections in men and women are asymptomatic; therefore, most cases are undiagnosed, unreported, and untreated. Penicillin-resistant strains of N. gonorrhoeae are prevalent worldwide; penicillin is ineffective in the treatment of chlamydial infection. Up to two thirds of cases of tubal infertility are secondary to C. trachomatis infection. Gonorrhea causes uterine infections and acute or chronic fallopian tube infection, resulting in scarring and infertility. Infection with C. trachomatis is believed to be a cofactor in transmission of HIV infection in both men and women. Most STDs predispose to human immunodeficiency virus (HIV) transmission. Gonorrheal transmission usually is by unprotected heterosexual or homosexual intercourse. Causes of yeast infections, overgrowth of Candida albicans, include antibiotic therapy. low hormone levels. anaerobic bacteria. alkaline vaginal pH. Causes for the overgrowth of C. albicans include antibiotic therapy, which suppresses the normal protective bacterial flora; high hormone levels of pregnancy or use of oral contraceptives, which cause an increase in vaginal glycogen stores; and diabetes mellitus or HIV infection, because they compromise the immune system. Bacterial vaginosis appears to result from imbalance of the normal vaginal flora, overgrowth of anaerobic bacteria, and a reduction in the lactobacillus species in the vagina. The pH of the candidiasis discharge, which is checked with litmus paper, typically is less than 4.5 (acidic). The most common presentation of secondary syphilis is _____, especially noted on the palms of the hands and soles of the feet. vesicle clusters. chancre papules. syphilitic gummas. maculopapular rashes. The most common presentation of secondary syphilis is erythematous and maculopapular rash, involving the trunk and extremities, especially the palms of the hands and soles of the feet. Primary syphilis is characterized by the appearance of a chancre at the site of exposure. Tertiary stage syphilitic gummas are peculiar, rubbery, necrotic lesions caused by noninflammatory tissue necrosis, most commonly found in the liver, testes, and bone. Herpes simplex replicates in the skin and mucous membranes at the site of infection, where it causes vesicular lesions of the epidermis. Ligaments and structures that must undergo repeated stretching contain a high proportion of osteoblasts. elastic fibers. fibrocartilage. collagen protein. Ligaments and structures that must undergo repeated stretching contain a high proportion of elastic fibers. Elastin is the major component of elastic fibers that allows them to stretch several times their length and rapidly return to their original shape when the tension is released. The osteoblasts, or bone-building cells, form the bone matrix rather than elastic fibers in connective tissue. Fibrocartilage is nonelastic and is found in the intervertebral disks, in areas where tendons are connected to bone, and in the symphysis pubis. Collagen is an inelastic and insoluble fibrous protein found in skeletal tissue. In diarthrodial joints, the articulating ends of the bones are indirectly linked by a ________ that supports the joint and helps to hold the bones in place. menisci. ligament. bursae sac. joint capsule. In a diarthrodial joint, the articulating ends of the bones are not connected directly but are indirectly linked by a strong fibrous capsule (joint capsule) that surrounds the joint and is continuous with the periosteum. Ligaments that extend between the bones of the joint may provide additional support. In some diarthrotic joints, the synovial membrane forms closed bursae sacs of synovial fluid that are not part of the joint. Bursae sacs occur in areas where pressure is exerted. Intraarticular menisci are fibrocartilage structures that extend part way through the joint and have a free inner border, or they may extend through the joint, separating it into two separate cavities. Cartilage cells, called chondrocytes, are surrounded by a gel-like intercellular matrix of collagen fibers. blood vessels. nerve endings. calcium salts. Cartilage cells, called chondrocytes, are located in lacunae which are surrounded by an uncalcified, gel-like intercellular matrix of collagen fibers and ground substance. Cartilage is devoid of blood vessels and nerves. Because cartilage has no blood vessels, this tissue fluid allows the diffusion of gases, nutrients, and wastes between the chondrocytes and blood vessels outside the cartilage. Diffusion cannot take place if the cartilage matrix becomes impregnated with calcium salts, and cartilage dies if it becomes calcified. Bone is connective tissue that has great tensile and compressible strength because the intercellular matrix is composed of two thirds inorganic bone cells. trabeculae. calcium salts. yellow marrow. Inorganic matter (salts) constitutes approximately two thirds of the dry weight of bone. The inorganic matter consists of hydroxyapatite--an insoluble macrocrystalline structure of calcium phosphate salts and small amounts of calcium carbonate and calcium fluoride. The organic matter of bone cells, blood vessels, and nerves makes up the other one third. Interior cancellous (spongy) bone is composed of trabeculae of bone that form a lattice like structures lined with osteogenic cells and filled with red or yellow bone marrow. The _____ cells are active during growth, healing fractures and continually replacing worn-out bone tissue. osteocytes. osteoclast. osteoblast. osteogenic. The undifferentiated osteogenic cells are found in the periosteum, endosteum, and epiphyseal plate of growing bone. These cells differentiate into osteoblasts and are active during normal growth, in adult life during healing of fractures, and also participate in the continual replacement of worn-out bone tissue. The osteoblasts, or bone-building cells, are responsible for the formation of the bone matrix. The osteocytes are mature bone cells that are actively involved in maintaining the bony matrix. Osteoclasts are "bone-chewing" cells that function in the resorption of bone, removing the mineral content and the organic matrix. Small, loose pieces of bone or cartilage within a joint space can irritate underlying healthy cartilage and cause dislocation. subluxation. osteoarthritis. chondromalacia. Loose bodies, commonly referred to a "joint mice," are small pieces of bone or cartilage within a joint space that repeatedly get caught in the crevice of a joint, pinching the underlying healthy cartilage. Unless the loose body is removed, it may cause osteoarthritis and restricted movement. Dislocation of a joint is the loss of articulation of the bone ends in the joint capsule, usually following a severe trauma that disrupts the holding ligaments. A subluxation is a partial dislocation in which the bone ends in the joint are still in partial contact with each other. Chondromalacia, or softening of the articular cartilage, is seen most commonly on the undersurface of the patella, the result of recurrent subluxation of the patella or overuse in strenuous athletic activities. A fatigue, or stress, fracture is caused by excessive direct force. repetitive bone overuse. underlying osteoporosis. squeezing bones together. A fatigue fracture results from repeated wear on a bone. A pathologic fracture occurs in bones that already are weakened by disease or tumors and may occur spontaneously with little or no stress. A compression fracture, as occurs in the vertebral body, involves two bones that are crushed or squeezed together. The most common fractures are those resulting from sudden injury. The force causing the fracture may be direct, such as a fall or blow, or indirect, such as a massive muscle contraction or trauma transmitted along the bone. Factors that impair bone healing include hematoma formation. mineral salt deposits. fracture misalignment. granular callus formation. There are essentially four stages of bone healing: hematoma formation, fibrocartilaginous callus development, ossification, and remodeling. The next event in fracture healing is formation of granulation tissue or soft tissue callus. Ossification represents the deposition of mineral salts into the callus. Malunion is healing with deformity, angulation, or rotation that is visible on x-ray films. Malunion is caused by inadequate reduction or alignment of the fracture. The early hallmark of an acute compartment syndrome is extreme pain. paresthesia. profuse bleeding. muscle necrosis. The hallmark symptom of an acute compartment syndrome is severe pain that is out of proportion to the original injury or physical findings. Associated nerve compression will cause changes in sensation (paresthesia such as burning or tingling), diminished reflexes, and eventually the loss of motor function. Because muscle necrosis can occur in as little as 4 to 8 hours, it is important that persons at risk for compartment syndrome be identified and proper treatment methods instituted. Bleeding and edema caused by fractures and bone surgery are high-risk factors for development of compartment syndrome. Chronic osteomyelitis is characterized by low-grade fever. infected dead bone. direct contamination. purulent exudates. Chronic osteomyelitis is identified by acute osteomyelitis that persists over a long period of time and the presence of sequestrum or piece of dead bone that has separated from the surrounding living bone. The most common cause of acute osteomyelitis is the direct contamination of bone from an open wound. With advancement of the acute bone infection, purulent exudate collects and finds its way beneath the periosteum. General inflammation can cause low-grade fever, nonspecific to osteomyelitis. Osteoarthritis is a joint disease that directly damages articular cartilage. bone osteoclasts. symmetrical joints. synovial membranes. The joint changes associated with osteoarthritis include progressive damage and loss of articular cartilage and subchondral bone, resulting from inflammatory changes that occur when cartilage tries to repair itself. Rheumatoid arthritis is a chronic systemic inflammatory disorder affecting multiple, symmetrical joints with inflammatory changes of the synovium. In rheumatoid arthritis, bone remodeling takes place in the osteons, beginning with osteoclast resorption of existing bone. Systemic lupus erythematosus is a chronic inflammatory disease characterized by the formation of _______that causes musculoskeletal system and systemic damage. T-cell hyperreactivity. immune complexes. collagen deposits. crystallized tophi. Persons with systemic lupus erythematosus (SLE) appear to have B-cell hyperreactivity and increased production of autoantibodies that directly damage tissues or combine with corresponding antigens to form tissue-damaging immune complexes. Systemic sclerosis is an autoimmune disease of connective tissue characterized by excessive collagen deposition in the skin and internal organs. Acute gouty arthritis is characterized by recurrent attacks of auricular and periauricular inflammation and formation of tophi, or accumulation of crystalline deposits in articular surfaces, bones, and soft tissue surrounding joints. In contrast to osteoporosis, which causes a loss of total bone mass, the bone weakening disorders of osteomalacia and rickets result in chaotic bone deposits. fibrous bone marrow. rapid bone formation. defective mineralization. In contrast to osteoporosis, which causes a loss of total bone mass, osteomalacia and rickets result in defective mineralization. Chaotic, rapid bone formation predominates in advanced stages of Paget disease, with sclerotic lesions and bone marrow that becomes replaced by vascular and fibrous tissue. A feature of rheumatoid arthritis that differentiates it from other forms of inflammatory arthritis is the formation of cartilaginous osteophytes. multiple skeletal deformities. vascular granulation tissue. autoantibody immune deposits. Characteristic of rheumatoid arthritis is the development of an extensive network of new blood vessels (angiogenesis) of destructive vascular granulation tissue called pannus, in the synovial membrane. Pannus is a feature of rheumatoid arthritis that differentiates it from other forms of inflammatory arthritis. Inflammatory arthritis conditions all result in some skeletal abnormalities or deformities. Systemic lupus is characterized by autoantibodies that directly damage tissues or combine with corresponding antigens to form tissue-damaging immune complexes. In osteoarthritis, formation of new bone and cysts usually occurs at the joint margins, forming abnormal bony outgrowths called osteophytes, or spurs. People at greatest risk for developing osteoporosis include those with hypocalcemia. severe obesity. active lifestyles. vitamin D deficit. Postmenopausal women of small stature or lean body mass, who have a sedentary lifestyle, poor calcium intake, and who have diseases that demineralize bone, are at greatest risk for developing osteoporosis. Other risk factors found to be associated with osteoporosis are a diet high in protein, consumption of caffeine-containing beverages, cigarette smoking, and alcohol ingestion. Regular exercise and adequate calcium intake are important factors in preventing osteoporosis. A main cause of osteomalacia is deficiency or resistance to the action of vitamin D, due to biliary tract or intestinal diseases that impair fat and fat-soluble vitamin absorption. The basal lamina (basement membrane) serves as a filter, interfaces between the dermis and epidermis, and is involved in skin disorders that cause _____ formation. blister. macule. callus. nodule. Blisters are vesicles or fluid-filled papules formed when degeneration of epidermal cells and disruption of intercellular junctions cause layers of the skin to separate, resulting in fluid accumulation. A callus is a hyperkeratotic plaque of skin caused by hyperplasia of dead keratinized cells that make up the cornified or horny layer of the skin. A macule is a circumscribed flat, nonpalpable change in skin color. A nodule is a palpable elevated solid mass. In the basal layer of the skin, melanocytes produce melanin pigment that helps protect the skin from harmful tyrosinase. keratinocytes. telangiectases. ultraviolet rays. The primary function of melanin is to protect the skin from harmful ultraviolet sun rays. The ability to synthesize melanin depends on the ability of the melanocytes to produce tyrosinase enzyme, which converts the amino acid tyrosine to a precursor of melanin. Keratinocytes of the epidermis produce the fibrous protein keratin, which is essential to the protective function of skin. Telangiectases are dilated superficial blood vessels, capillaries, or terminal arteries that appear either red or bluish. Langerhans cells are found in the epidermis and function as immune cells. energy storage. sensory receptors. support structures. Langerhans cells link the epidermis to the immune system. They are the only immune cells in the skin known to be capable of antigen presentation and therefore may be responsible for allergic reactions affecting the skin. The subcutaneous tissue layer serves as a major energy storage site. The dermis provides the epidermis with support. Sensory receptors for touch, pressure, heat, cold, and pain are widely distributed in the dermis. The nearly transparent nail plate provides a view of the color of blood in the dermal vessels, which is useful for assessing blood oxygen. growth cycles. pigmentation. temperature. The nearly transparent nail plate provides a useful window for viewing the amount of oxygen in the visible dermal blood vessels. Unlike hair, nails grow continuously rather than cyclically. The thin papillary layer of the dermis is supplied with free nerve endings that serve as thermoreceptors. Direct contact with the skin surface serves as a means of assessing temperature. Skin pigmentation is easily assessed by observing skin rather than fingernails. Gray hair is the result of _______ melanosomes in the hair bulb. fewer. enlarged. spherical. encapsulated. Melanocytes in the bulb transfer melanosomes to the cells of the bulb matrix much in the same way as in the skin and are therefore responsible for the color of the hair. Similar to the skin, large melanosomes are found in the hair of darker skinned persons; aggregated and encapsulated melanosomes are found in persons with light skin. Red hair has spherical melanosomes, whereas gray hair is the result of a decreased number of melanosome-producing melanocytes. The second-stage lesions of the highly contagious varicella (chickenpox) virus are described as macules. vesicles. granular. scabs. The characteristic skin lesion of varicella occurs in three stages: macule, vesicle, and granular scab. The macular stage is characterized by development within hours of macules over the trunk of the body, spreading to the limbs, buccal mucosa, scalp, axillae, upper respiratory tract, and conjunctiva. During the second stage, the macules form vesicles with depressed centers. The vesicles break open and a scab forms during the third stage. Atopic eczema (atopic dermatitis) is caused by type I hypersensitivity reaction. superficial fungus invasion. excessive histamine release. communicable bacterial infection. Atopic eczema (atopic dermatitis) is a common skin disorder that is associated with a type I hypersensitivity reaction. Histamine is the most common mediator of urticaria. The superficial fungal infections, more commonly known as tinea or ringworm, invade only the superficial keratinized tissue. Impetigo, which is caused by staphylococci or B-hemolytic streptococci, is the most common superficial bacterial infection, spread by contact with the lesion exudate. Psoriasis is an inflammatory primary skin disorder characterized by macules with edema. pustules with erythema. plaques with silvery scale. clusters of painful vesicles. Psoriasis is a common inflammatory skin disease characterized by circumscribed red, thickened plaques with an overlying silvery-white scale. The characteristic Pityriasis rosea lesion is an oval macule or papule with surrounding erythema that spreads with central clearing, much like tinea corporis. Herpes zoster (shingles) is acute, localized vesicular clusters distributed over a dermatome segment of the skin. Rosacea has a variety of clinical manifestations that include eruptions of inflammatory papules and pustules primarily on the central areas of the face, with a permanent dark red erythema. Which one of the following skin disorders seen in elderly persons is considered a premalignant lesion? telangiectases. senile angiomas. actinic keratosis. seborrheic keratosis. Actinic keratoses, the most common premalignant skin lesions that develop on sun-exposed areas, usually are less than 1 cm in diameter and appear as dry, brown scaly areas, often with a reddish tinge. A seborrheic keratosis (i.e., seborrheic wart) is a benign, sharply circumscribed, wart-like lesion that has a stuck-on appearance. Senile angiomas (cherry angiomas) are smooth, cherry-red or purple, dome-shaped papules usually found on the trunk. Telangiectases are single dilated blood vessels, capillaries, or terminal arteries that appear on areas exposed to sun or harsh weather, such as the cheeks and the nose. Second-degree full-thickness burns are described as painful with _____ areas. reddened. moist red. waxy white. dry, leathery. Second-degree full-thickness burns appear as mottled pink, red, or waxy white areas with blisters and edema. The blisters resemble flat, dry tissue paper, rather than the bullous blisters seen with superficial partial-thickness injury. Second-degree partial-thickness burns are painful, moist, red, and blistered. First-degree burns are red or pink, dry, and painful. Third-degree burns vary in color from waxy white or yellow to tan, brown, deep red, or black. These burns are hard, dry, and leathery.