Essentials of Human Diseases and Conditions, 8th Edition by Tracie Fuqua Chapter 1-15 By Tracey Fuqu

TEST BANK

Test Bank For Essentials of Human Diseases and Conditions, 8th Edition 2025 Tracie Fuqua Chapter 1-15 Chapter 01: Mechanisms of Disease, Diagnosis, and Treatment MULTIPLE CHOICE 1. Signs of disease a. always cause symptoms. b. rarely correlate with symptoms. c. include abnormal objective findings. d. are always described by the patient.

ANS: C

Signs, or abnormal objective findings, are the evidence of disease found by physical examination and diagnostic testing. Signs of disease often correlate with the symptoms.

REF: p. 2

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2. Predisposing factors of disease a. precisely predict the occurrence of disease. b. make a person or group more vulnerable to disease. c. never overlap or occur in combination. d. can all be controlled by prevention.

ANS: B

A person may be susceptible to a greater or lesser degree, because of one or more risk factors that overlap or occur in combination. Predisposing factors include age, gender, lifestyle, environment, heredity, and immunodeficiency.

REF: p. 2

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3. Genetic diseases may be a. produced by an abnormality in or mutation of the genetic code in a single gene. b. caused by several abnormal genes. c. caused by the abnormal presence or absence of a chromosome or an alteration of

the structure of chromosomes. d. All of the answer options ANS: D

Genetic predisposition (inheritance) currently is considered a major risk factor. Hereditary factors in disease that appear regularly in successive generations are likely to affect males and females equally. Hereditary or genetic diseases often develop as a result of the combined effects of inheritance and environmental factors.

REF: p. 6

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4. Which statement is true of benign tumors?

a. b. c. d.

Tend to remain encapsulated Infiltrate surrounding tissue Do not compress surrounding tissue or obstruct organs Do not resemble the tissue of origin

ANS: A

Benign tumors usually develop slowly and can arise from any tissue. They tend to remain encapsulated and do not infiltrate surrounding tissue.

REF: p. 7

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5. Which statement is true of malignant tumors? a. Tend to infiltrate other tissue. b. Tend to bleed, ulcerate, and become infected. c. May spread to distant sites in the body. d. All of the answer options ANS: D

Malignant tumors can represent a serious threat to the health and life of a person. Cancer cells are variable in appearance and disorderly (anaplastic) and tend to bleed, ulcerate, and become infected. Malignant tumors have the ability to infiltrate and invade the surrounding tissue.

Often malignant cells enter the bloodstream or the lymphatic vessels and spread to distant sites in the body leading to tumor growth in other areas of the body.

REF: p. 8

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6. Which statement is true regarding the TNM (tumor, nodes, metastasis) cancer staging system? a. Assesses the size and extent of the spread of the primary tumor. b. Is a grading system based on the degree of differentiation of tumor cells. c. Both answer options are true. d. Neither answer options are true.

ANS: A

Although a number of different staging systems exist, the majority of cancers use a TNM system. TNM staging assesses the neoplasm in three different areas: the size or extent of the primary tumor (T), the extent of regional lymph node involvement by the tumor (N), and the number of distant metastases (M).

REF: p. 10

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7. The tumor Gleason grade reflects which information about the tumor? a. Stage b. Degree of abnormal microscopic appearance of the cells c. Location d. None of the answer options ANS: B

The Gleason grade correlates with extent of disease throughout the body and with prognosis.

Analysis of prostate tumor histology is performed, and the two predominant patterns are recorded and scored from 1 to 5 (1 represents a well-differentiated histology; 5 is the most poorly differentiated).

REF: p. 12

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8. Which statement correctly states the sequence of an allergic response within the body? a. Immunoglobulin E (IgE) antibodies enter the body and produce an allergen. b. The release of histamine sensitizes mast cells and produces symptoms. c. Exposure to allergen stimulates production of IgE antibodies that can subsequently

trigger symptoms of allergy. d. Histamine produces mast cells, which stimulate plasma cells.

ANS: C

Initial exposure to an allergen, which acts as an antigen (a substance that causes the allergic response), stimulates the production of IgE antibodies, and the person thus is sensitized.

REF: p. 14

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9. Systemic manifestation(s) of severe allergic responses include which problem? a. Arthralgia b. Status asthmaticus c. Anaphylaxis d. All of the answer options ANS: D

Severe systemic manifestations of allergic responses include anaphylaxis, serum sickness, arthralgia, and status asthmaticus. For example, anaphylaxis (anaphylactic shock), the result of a severe systemic allergic reaction, calls for emergency life-saving intervention.

REF: p. 14

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10. Which order of steps is most accurate when making a diagnosis? a. Medical history, physical examination, diagnostic tests, diagnosis, integration of

results, treatment b. Medical history, diagnostic tests, physical examination, treatment plan c. Physical examination, medical history, radiographs, prognosis, integration of all

information d. Comparison of normals, physical examination, history, treatment plan, prognosis ANS: A

Establishing a diagnosis is a decision-making process in which data collected from the medical history, physical examination, and diagnostic tests are analyzed, integrated, and interpreted. A diagnosis provides a logical basis for determining treatment and prognosis.

REF: p. 16

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11. Mechanical and chemical barriers, the inflammatory response, and the immune response are a. risk factors for disease. b. the combined effects of inheritance and environmental factors. c. included in the body’s natural defense system against infection. d. agents that damage deoxyribonucleic acid.

ANS: C

The body’s natural defense systems against infection include (1) natural mechanical and chemical barriers, such as skin, the cilia, body pH, and normal body flora; (2) the inflammatory response; and (3) the immune response.

REF: p. 3

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12. Immune disorders are the result of a breakdown in the body’s defense system that may

generate which problems? a. Allergies b. Autoimmune diseases c. Immunodeficiency disorders d. All of the answer options ANS: D

The immune system is a complex network of specialized cells and organs that has evolved to defend the body against attacks by foreign organisms.

REF: p. 14

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13. Immunodeficiency disorders result from a. an exudative response. b. physical trauma. c. motor vehicle accidents. d. a depressed or absent immune response.

ANS: D

Causative factors can be primary, manifested by a characteristic decrease in the number of T cells and B cells, leaving the body unable to adequately defend itself against infection and tumors.

REF: p. 15

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14. Which statement(s) is/are correct regarding autoimmune diseases? a. The diseases allow the immune system to become self-destructive. b. Many serious diseases have a strong autoimmune component. c. Both answer options are correct. d. Both answer options are incorrect.

ANS: C

In autoimmune diseases, antibodies are formed against self-antigens mistakenly identified as foreign.

REF: p. 15

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15. Homeostasis refers to a. disease related to age. b. internal stability of the body. c. a chronic disease process. d. genetic predisposition to disease.

ANS: B

Pathologic conditions involve measurable changes in normal structure and function that threaten the internal stability, or homeostasis, of the body.

REF: p. 2

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16. Pathogens cause disease by a. invasion of living tissue. b. destruction of living tissue. c. intoxication. d. All of the answer options ANS: D

Infectious diseases are caused by pathogens. The result is tissue damage that has the potential for producing systemic involvement.

REF: p. 3

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17. The normal protective physiologic response(s) to tissue injury and disease is/are a. infection. b. acute inflammation. c. cachexia. d. All of the answer options ANS: B

Acute inflammation, a normal protective physiologic response to tissue injury and disease, is accompanied by redness, heat, swelling, pain, and loss of function. Widespread inflammation is marked by systemic symptoms, such as fever, malaise, and loss of appetite.

REF: p. 3

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18. MRSA refers to a ―superbug‖ that is a. methicillin-resistant Staphylococcus aureus. b. a common cold virus. c. a noninfectious, noncontagious skin condition. d. All of the answer options ANS: A

In addition to skin infections, MRSA can cause fatal pneumonia, bone infections, and septicemia. Many MRSA strains of bacteria are currently resistant to several different antibiotics.

REF: p. 4

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19. The spread of ―superbugs‖ can be controlled by a. frequent, thorough hand washing. b. stricter infection control in all health care facilities. c. considering everyone a risk for infection, especially in hospitals. d. All of the answer options ANS: D

Participating medical facilities have implemented active surveillance testing such as nasal swab tests on patient admission. Public education stresses thorough and frequent hand washing across the board as an effective practice of infection control in the community as well.

REF: p. 6

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20. Anaphylaxis, serum sickness, arthralgia, and status asthmaticus are a. part of aging. b. systemic manifestations of severe allergic responses. c. immunodeficiency disorders. d. mild allergic conditions.

ANS: B

Severe systemic manifestations of allergic responses include anaphylaxis, serum sickness, arthralgia, and status asthmaticus. For example, anaphylaxis (anaphylactic shock), the result of a severe systemic allergic reaction, calls for emergency life-saving intervention.

REF: p. 14

OBJ: 14

21. Which predisposing factor is related to smoking, excessive drinking, poor nutrition, and lack

of exercise? a. Age b. Environment c. Heredity d. Lifestyle ANS: D

Smoking, excessive drinking, poor nutrition, and lack of exercise are predisposing factors associated with a person’s lifestyle.

REF: pp. 2-3

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22. In preventive health care, the emphasis is on a. accident intervention. b. freedom of lifestyle. c. prophylactic medical services. d. personal rights.

ANS: C

Current statistical evidence indicates that positive personal health behavior, in conjunction with prophylactic medical services, may reduce the mortality rate associated with certain diseases, such as cardiovascular disease.

REF: p. 24

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23. The single greatest avoidable cause of death and disease is a. smoking tobacco and exposure to secondhand smoke. b. insufficient exercise. c. a diet high in sodium. d. poor personal hygiene.

ANS: A

Of particular concern is scientific evidence that smoking tobacco and exposure to secondhand smoke is the single greatest avoidable cause of death and disease. Public education in this regard has led to laws that prohibit smoking in many restaurants and other public arenas.

REF: p. 24

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24. Vaccines that may be given to prevent cancer include a. human papilloma virus (HPV) vaccine to protect against cervical cancer. b. hepatitis B vaccine that helps prevent liver cancer. c. Both answer options d. Neither answer options ANS: C

There are currently some vaccines that may be given to prevent cancer, such as the HPV vaccine that protects against cervical cancer and the hepatitis B vaccine that helps to protect against liver cancer.

REF: p. 12

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25. Which statement(s) is/are true about understanding a patient’s pain? a. Pain is subjective. b. Pain has individualized effects. c. Pain is a necessary entity in life. d. All of the answer options are true.

ANS: D

Pain is subjective, individualized, and perceived only by the individual experiencing it. It can be physiologic or psychologic. A variety of pain rating scales, using numbers and figures, are sometimes used to help measure an individual’s perception of pain intensity and quality.

REF: p. 21

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26. Osteopathy a. is not practiced by trained medical physicians. b. emphasizes the body’s natural process to heal and provide well-being. c. does not use manipulation techniques. d. All of the answer options ANS: B

Osteopathy is probably the most widely accepted form of alternative medicine. In the United States, osteopathic physicians (Doctors of Osteopathy) are trained medical doctors who emphasize stimulation of the body’s natural processes as a means to promote healing and well-being. In addition to traditional medical and surgical concepts, osteopathic physicians use manipulation techniques to realign body structure, thereby restoring balance and promoting healing.

REF: p. 25

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27. Pain may be described as a. dull and aching, burning, or throbbing. b. shooting, dull, stabbing.

c. frightening, intense, tiring. d. All of the answer options ANS: D

The way a patient describes his or her pain is taken seriously. In the clinical setting, assessment of a patient’s pain is noted when vital signs are taken. This information is helpful in tracking the patient’s response to treatment.

REF: p. 21

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28. The holistic concept of medical care focuses on a. the needs of the whole person: spiritual, cognitive, social, physical, and emotional. b. narrowly defining physical pathologic changes. c. discounting the needs of a patient as a whole to expedite healing. d. All of the answer options ANS: A

The physical and psychologic well-beings of the individual are dependent on each other. It is this established mind-and-body interaction that compels the holistic health care provider to consider the patient as a whole person.

REF: p. 19

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29. Which statement(s) is/are correct concerning chemotherapy treatment for cancer? a. Chemotherapy is most effective against the rapidly developing cells of cancer. b. Many of the side effects of chemotherapy are caused by destruction of some

normal cells in the body. c. Both answer options d. Neither answer options ANS: C

Chemotherapy involves the use of medicines to destroy cancer cells. Most of the drugs affect cell replication, so chemotherapy is most effective against rapidly dividing cells such as cancer cells. Normal cells in other parts of the body that are known to divide rapidly also are often destroyed, and this accounts for many of the classic side effects of chemotherapy.

REF: p. 12

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30. Recognizing the aspects of the cultural diversity of patients includes a. language, religious beliefs, views about health issues, and life experiences. b. dietary preferences. c. death rituals and other traditions. d. All of the answer options ANS: D

One important aspect of holistic medicine is recognition of the cultural diversity of patients.

The United States continues to grow more culturally diverse. Health care providers must be aware of the challenges of caring for such a diverse population.

REF: p. 20 31. Patient education

OBJ: 18

a. b. c. d.

helps improve patient and family coping. is interactive. is based on the patient’s plan of care.

All of the answer options

ANS: D

The concept of patient teaching is based on patient-centered care, with the patient being a partner in the process of learning skills, solving problems, and preventing complications.

Patient education should give an individual the confidence needed to take responsibility for his or her health or recovery.

REF: p. 28

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TRUE/FALSE 1. When a product lacks U.S. Food and Drug Administration (FDA) approval, that may mean

that the ingredients listed outside the bottle may not be inside the bottle, or may not be included in the amount listed.

ANS: T

Many such products do not have FDA approval and may damage health if taken unwarily or in conjunction with prescription drugs.

REF: p. 12

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2. The use of hormone therapy and immunotherapy in the treatment of cancer continues to

evolve.

ANS: T

Hormone therapy can be effective in hormone-dependent cancers, such as breast cancer and prostate cancer.

REF: p. 12

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3. The philosophy of hospice affirms life and neither hastens nor postpones death.

ANS: T

Terminally ill persons can be referred to hospice care for compassionate, holistic case management.

REF: p. 13

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4. Among some common concerns about the health issues of older adults are substance abuse

and nutritional problems.

ANS: T

Attention must be paid to the functional status and to the health issues of older adult patients.

Common concerns are substance abuse, overmedication, loss of mental acuity, depression, and nutritional problems.

REF: p. 15

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5. One of the main goals of patient teaching is to encourage the patient to comply with the

treatment plan to assure recovery.

ANS: T

REF: p. 28

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6. In the process of deciding or confirming the identification of a disease, the results of

diagnostic studies are integrated with the medical history and physical examination findings.

ANS: T

Establishing a diagnosis is a decision-making process in which data collected from the medical history, physical examination, and diagnostic tests are analyzed, integrated, and interpreted. A diagnosis provides a logical basis for determining treatment and prognosis.

REF: p. 16

OBJ: 16

Chapter 02: Developmental, Congenital, and Childhood Diseases and Disorders Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Which characteristic is true of congenital diseases? a. Always fatal b. Genetic etiology c. Nongenetic d. Can be either physical or mental.

ANS: D

Congenital anomalies can be mental or physical and can vary widely in severity, from trivial to fatal.

REF: p. 32

OBJ: 1

2. Which action can be used as an attempt to halt premature labor and ensure a fetus is more

ready to live outside the uterus if delivered early? a. Having the mother on complete bed rest b. Using drug therapy to slow or halt contractions c. Giving the mother a short course of steroids to aid fetal lung maturation d. All of the answer options ANS: D

Attempts may be made to halt premature labor by having the mother on complete bed rest or using drug therapy to slow or halt contractions. The mother is often given a short course of steroids to aid fetal lung maturation. Many times the efforts to allow the fetus more time to grow and mature in the mother’s uterus are unsuccessful.

REF: p. 37

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3. The collapse of a seemingly healthy young athlete during a strenuous sporting event or other

period of stressful exercise is often caused by which condition? a. Patent ductus arteriosis (PDA) b. Hypertrophic cardiomyopathy c. Respiratory distress syndrome d. Atrial septal defect (ASD) ANS: B

Tragically the first sign of hypertrophic cardiomyopathy is often the collapse of a seemingly healthy young athlete during a strenuous sporting event or other period of stressful exercise.

This collapse can be followed by cardiac arrest caused by a cardiac arrhythmia. Many have no symptoms until the collapse. It is possible that some individuals experience no symptoms.

Signs may be discovered during a physical examination. Symptoms, often ignored by young people, may include chest pain, syncope, hypertension, palpitations, or shortness of breath.

Some report experiencing fatigue, shortness of breath when lying down, or reduced tolerance of activity.

REF: p. 45

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4. Down syndrome, a genetic syndrome, is the result of the child having ______ pairs of

chromosomes. a. 45 b. 46 c. 47 d. 48 ANS: C

Down syndrome (formerly called mongolism) is a genetic syndrome in which the individual has 47 chromosomes instead of the usual 46, resulting in a congenital form of mild to severe intellectual developmental disorder that is accompanied by characteristic facial features and distinctive physical abnormalities.

REF: pp. 45-46

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5. Which condition is the most common crippler of children? a. Spina bifida b. Muscular dystrophy (MD) c. Down syndrome d. Cerebral palsy (CP) ANS: D

Cerebral palsy is the most common crippler of children, is a condition consisting of a group of disorders possibly involving the brain and nervous system functions that deal with movement, learning, hearing, sight, and thinking. This disorder may be congenital or acquired and bilateral or unilateral in the form of a nonprogressive paralysis that results from damage to the central nervous system (CNS).

REF: p. 47

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6. All females of child-bearing age capable of becoming pregnant are encouraged to take which

supplement? a. Calcium b. Vitamin D c. Folic acid d. Iron ANS: C

Increased intake of folic acid is encouraged in females planning to become pregnant and during early stages of pregnancy. Because many pregnancies are unplanned, all females of child-bearing age capable of becoming pregnant are encouraged to take the recommended amount of folic acid each day.

REF: p. 49

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7. Which statement is true of Duchenne MD? a. Usually the result of trauma b. Progressive and causes crippling and immobility c. Affects males and females equally d. Is not a genetic condition

ANS: B

MD is a progressive degeneration and weakening of the skeletal muscles in which muscle fibers are abnormally vulnerable to injury. There are several types of the disease, but all are rare. The most common and best-known type is Duchenne MD, which is diagnosed soon after birth or during early childhood, usually before the age of 5 years. MD initially affects the muscles of the shoulders, hips, thighs, and calves of the legs, causing the characteristic waddling gait and toe walking. Affected muscles sometimes look larger than normal because fat replaces atrophied muscle. The child also may have lordosis or other spinal deformities. In addition, the child has difficulty climbing stairs and running, tends to fall easily, and has difficulty getting up. As the disease progresses, it involves all the muscles, causing crippling and immobility (see Fig. 2.13). Contractures typically develop, and the child becomes increasingly susceptible to serious pulmonary infections such as pneumonia. Also, children with Duchenne MD often are impaired mentally.

REF: p. 48

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8. Which condition is also referred to as hyaline membrane disease? a. Bronchomalacia b. Infant respiratory distress syndrome (IRDS) c. Retinopathy of prematurity (ROP) d. Necrotizing enterocolitis (NEC) ANS: B

IRDS, or hyaline membrane disease, is similar to adult respiratory distress syndrome in that the patient suffers acute hypoxemia caused by infiltrates within the alveoli.

REF: p. 39

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9. The symptoms and signs of anemia include a. pallor, weakness, fatigability, and listlessness. b. an abnormal reduction of red blood cells (RBCs). c. tachycardia, jaundice, and mental sluggishness. d. All of the answer options ANS: D

Anemia is an abnormal reduction in the concentration of RBCs or in the hemoglobin content of circulating blood. Pallor, weakness, fatigability, and listlessness are noted initially in the anemic child or infant. Palpitations, tachycardia, cardiac enlargement, jaundice, and mental sluggishness are symptoms of severe anemia.

REF: p. 90

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10. Childhood immunizations are important because a. they are needed to obtain a passport. b. they help prevent colds. c. they prevent epidemics of serious contagious diseases. d. All of the answer options ANS: C

Dramatic results have been achieved in pediatric medicine through routine prophylactic immunization with vaccines that build specific and prolonged protection. To prevent epidemics of contagious diseases, all U.S. states require that children have inoculations before entering school.

REF: p. 72

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11. Which warning signs are indicative of lead poisoning? a. Loss of appetite and vomiting b. Irritability and ataxic gait c. Anemia d. All of the answer options ANS: D

Children exposed to toxic levels of lead, a poisonous metallic element, exhibit signs of lead poisoning. Some warning signs are loss of appetite, vomiting, irritability, and ataxic gait.

Chronic symptoms include anemia, weakness, colic, and peripheral neuritis. Evidence of intellectual developmental disorder resulting from brain damage is possible. A child with acute lead intoxication presents as a medical emergency. The child has symptoms of encephalopathy with vomiting, headache, stupor, convulsions, and coma resulting from cerebral edema (see Fig. 2.50).

REF: p. 93

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12. Which statement(s) is/are true about asthma? a. The bronchial tubes are hyperactive and hypersensitive. b. Severe attacks require hospitalization. c. It is a leading cause of absenteeism in school children. d. All of the answer options are true.

ANS: D

Asthma is the result of hyperactive and hypersensitive bronchial tubes. The bronchial spasms of asthma can be triggered by many extrinsic (allergic) or intrinsic (nonallergic) factors, including stress, heavy exercise, infection, and inhalation of allergens or other substances. In a severe attack unresponsive to drug therapy, a condition called status asthmaticus may lead to fatal respiratory failure and thus the need for endotracheal intubation. The patient requires hospitalization for aggressive medical treatment and follow-up. Asthma is a chronic, reversible, obstructive disease caused by increased reactivity of the tracheobronchial tree to various stimuli. There are two major processes at work: constriction of the bronchioles and inflammation of the airway. It is a leading cause of chronic illness and school absenteeism in children.

REF: p. 84

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13. Which statement is true in regard to cerebral palsy (CP)? a. Result of damage to the CNS b. Condition that can be cured with treatment c. Condition that primarily affects intelligence d. All of the answer options ANS: A

CP, the most common crippler of children, is a condition consisting of a group of disorders possibly involving the brain and nervous system functions that deal with movement, learning, hearing, sight, and thinking.

REF: p. 47

OBJ: 8

14. Which statement or statements are true of Down syndrome? a. A congenital form of mild to severe intellectual developmental disorder b. Associated with distinctive physical abnormalities and heart defects c. Caused by a chromosomal abnormality d. All of the answer options ANS: D

Down syndrome, in addition to mild to severe intellectual developmental disorder, is associated with heart defects and other congenital abnormalities. Typically the infant has a small head; a skull with a flat back; a characteristic slant to the eyes; a flat nasal bridge; small, low-set ears; a small mouth with a protruding tongue; and small, weak muscles (see Figs. 2.10 and 2.11). The hands are short with stubby fingers and a deep horizontal crease across the palm (simian line). There is an exaggerated space between the big and little toes. Infants with Down syndrome have an extra chromosome number 21 (trisomy 21). It occurs in 1 in 650 live births and more often in infants born to women more than 35 years of age (see Fig. 2.12).

Infants with severe Down syndrome usually are identified at or before birth; milder forms are diagnosed later. The physical characteristics may be blatantly obvious. Findings on examination of the eyes may include the presence of small white dots on the iris. A karyotype showing the chromosomal abnormality can confirm the diagnosis.

REF: p. 46

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15. Which condition is the most common cyanotic congenital heart defect that is actually a

combination of four defects? a. Ventricular septal defect (VSD) b. PDA c. Tetralogy of Fallot d. Transposition of the great arteries ANS: C

The most common cyanotic cardiac defect is a combination of four congenital heart defects: (1) VSD, an abnormal opening in the ventricular septum; (2) pulmonary stenosis, a tightening of the pulmonary valve or vessel; (3) dextroposition (displacement to the right) of the aorta, which overrides (receiving circulation from both ventricles) the VSD; and (4) right ventricular hypertrophy, caused by increased pressure in the ventricle.

REF: p. 59

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16. Which techniques are used in the diagnostic investigation of a congenital heart defect? a. Physical examination and patient history b. Radiographic studies of the chest and blood tests c. Heart catheterization and electrocardiogram (ECG) d. All of the answer options ANS: D

Physical examination and patient history are essential. The physician palpates the neck vessels and auscultates for blood pressure and murmurs. Diagnostic procedures depend on the initial findings and may include radiographic chest x-ray, blood tests, cardiac catheterization, echocardiogram, and ECG. Many defects can be detected on a prenatal ultrasound. The diagnostic investigation determines the presence and severity of any structural or functional abnormality or defect.

REF: p. 60

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17. Which statement is descriptive of developmental dysplasia of the hip (DDH)? a. Causes cleft palate b. Nontraumatic deformity of the tibia c. More common in male infants d. Abnormal development of the hip joint ANS: D

Developmental dysplasia of the hip is an abnormal development of the hip joint that ranges from an unstable joint to dislocation of the femoral head from the acetabulum.

REF: p. 62

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18. Which diagnosis is a birth defect in which there is a hole in the middle of the roof of the

mouth? a. Cleft palate b. Cri-du-chat syndrome c. Robinow syndrome d. Meningocele ANS: A

Cleft palate is a birth defect in which there is a hole in the middle of the roof of the mouth (palate).

REF: p. 62

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19. A diagnosis of Cryptorchidism indicates a patient has which problem? a. Congenital malignant tumor b. Phimosis c. Failure of the testicle(s) to descend into the scrotum d. Wilms’ tumor ANS: C

Cryptorchidism is failure of one or both of the testicles to descend from the abdominal cavity into the scrotum.

REF: p. 63

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20. Which symptoms are associated with Wilms’ tumor? a. Nasal regurgitation during feeding b. Hematuria, pain, and hypertension c. A shortening of the femur d. Projectile vomiting, loss of weight, and skin rash

ANS: B

The most common presentation of Wilm’s tumor is a mass in the kidney region, which is often discovered by a parent or examining physician. The mass is firm, nontender, and usually confined to one side of the body. The patient may experience other symptoms resulting from compression caused by the tumor mass, metabolic alterations caused by the tumor, or metastasis. These include hematuria, pain in the abdomen or chest, hypertension, anemia, vomiting, intestinal obstruction, constipation, weight loss, and fever.

REF: p. 64

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21. The disease that involves impairment of intestinal motility, which causes obstruction of the

distal colon, is called a. Hirschsprung disease. b. pyloric stenosis. c. cryptorchidism. d. phimosis.

ANS: A

Hirschsprung disease, a congenital condition, is an impairment of intestinal motility that causes obstruction of the distal colon.

REF: p. 66

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22. Cystic fibrosis (CF), a chronic dysfunction of the exocrine glands, primarily attacks which

body system? a. Nervous b. Pulmonary c. Cardiovascular d. Immune ANS: B

Cystic fibrosis primarily attacks the lungs and the digestive system, producing copious thick and sticky mucus that accumulates and blocks glandular ducts. Symptoms may become apparent soon after birth or may develop in childhood.

REF: p. 68

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23. Which treatment is used when a patient is diagnosed with phenylketonuria (PKU) includes a. oxygen therapy. b. a high-sodium chloride diet. c. a protein-restricted diet. d. surgical intervention.

ANS: C

The treatment for PKU is to place the infant on a phenylalanine-free protein-restricted diet that allows the infant to grow with normal brain development. Individuals with PKU must eat a diet low in phenylalanine for the rest of their lives. Because natural proteins contain phenylalanine, the patient must remain on a protein-restricted diet. Restrictions or elimination of the following food is required: meat, chicken, fish, cheese, nuts, and dairy products. The newborn cannot have breast milk with its high levels of phenylalanine. Some starchy foods, including potatoes, corn, pasta, and bread, require close monitoring. The sweetener aspartame used in diet soda and diet food is metabolized into substances including phenylalanine.

REF: p. 69

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24. The production of copious thick and sticky mucus that accumulates and blocks glandular

ducts is characteristic of a. Wilms’ tumor. b. PKU. c. pyloric stenosis. d. CF. ANS: D

The disease primarily attacks the lungs and the digestive system, producing copious thick and sticky mucus that accumulates and blocks glandular ducts. The clinical effects of CF can be immense, including a dry paroxysmal cough, exercise intolerance, pneumonia, bulky diarrhea, vomiting, and bowel obstruction.

REF: p. 68

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25. Klinefelter syndrome and Turner syndrome are examples of a. inherited chromosomal diseases. b. genetic, chromosomal diseases that are not inherited. c. chromosomal diseases that affect females only. d. inherited diseases of no significant consequence.

ANS: B

Klinefelter syndrome and Turner syndrome are examples of genetic, chromosomal diseases that are not inherited. They result from nondisjunction, or the failure of a chromosome pair to separate, during gamete production (see Fig. 2.33).

REF: p. 69

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26. Which statement/s is/are true about erythroblastosis fetalis? a. Antibodies in the mother’s blood destroy the RBCs of the fetus. b. It is characterized in the fetus by anemia, jaundice, and enlargement of the liver

and spleen. c. Neither of the answer options d. Both of the answer options ANS: D

The cause of erythroblastosis fetalis is Rh factor incompatibility. Rh factor is the antigen found on RBCs of the Rh-positive individual. The mother, through a prior pregnancy, has become sensitized to the Rh factor (Rh isoimmunization) of the fetal RBCs. When sensitized maternal blood finds its way into fetal circulation, particularly during delivery, the antibodies in the mother’s blood destroy the RBCs of the fetus (see Figs. 2.48 and 2.49). If an Rh-negative woman has children with an Rh-positive man, some or all of the infants will be Rh positive. During pregnancy, blood from the Rh-positive fetus may move from fetal circulation into the mother’s bloodstream, where it can stimulate the mother’s body to form antibodies against the Rh factor. When sufficient quantities of the antibodies pass back into the infant’s circulation, the antibodies can clump and destroy Rh-positive cells, causing the symptoms of erythroblastosis fetalis. Erythroblastosis fetalis is characterized by anemia, jaundice, kernicterus, and enlargement of the liver and spleen. In the most severe form, called hydrops fetalis, the fetus or infant is in great jeopardy because of extreme hemolysis. If the infant survives, the condition is marked by heart failure, edema, pulmonary congestion, lethargy, seizures, and intellectual developmental disorder.

REF: p. 92

OBJ: 26

27. Sudden infant death syndrome (SIDS) is a. most likely to occur in a sick infant. b. not known to have any risk factors. c. the number one cause of death of infants between ages 1 month and 12 months. d. predictable and preventable.

ANS: C

SIDS, formerly called crib death, is defined officially as the sudden death of an infant under the age of 1 year for which a cause cannot be established. It is the number one cause of death among infants from 1 to 12 months of age; 1 in 2000 infants dies of SIDS. REF: p. 80

OBJ: 19

28. Which statement is true about lead poisoning? a. The child suffering from acute lead intoxication presents a medical emergency. b. It is hard to detect, since lead is normally present in the blood. c. It is a silent disease, because there are no warning signs or chronic symptoms. d. There is no evidence of intellectual developmental disorder resulting from brain

damage.

ANS: A

Children exposed to toxic levels of lead, a poisonous metallic element, exhibit signs of lead poisoning which is an acute medical emergency. Some warning signs are loss of appetite, vomiting, irritability, and ataxic gait. Chronic symptoms include anemia, weakness, colic, and peripheral neuritis. Evidence of intellectual developmental disorder resulting from brain damage is possible. A child with acute lead intoxication presents as a medical emergency. The child has symptoms of encephalopathy with vomiting, headache, stupor, convulsions, and coma resulting from cerebral edema (see Fig. 2.50).

REF: p. 93

OBJ: 27

29. A systemic disease with superficial cutaneous lesions that begin as red macules that progress

to papules then to vesicles that form crusts is known as _____________.

a. b. c. d.

rubeola rubella chickenpox diphtheria

ANS: C

Chickenpox is a systemic disease with superficial cutaneous lesions that begin as red macules that progress to papules and then finally become vesicles that form crusts. The lesions first are seen on the face or the trunk and then spread over the extremities; they can be distributed everywhere on the body and even have been found internally.

REF: p. 72

OBJ: 17

30. Pregnant women should be isolated from individuals infected with _________ to prevent

perinatal infection. a. rubeola b. rubella c. chickenpox d. diphtheria ANS: B

Rubella causes great danger to the unborn children of pregnant women who contract the disease. Women of child-bearing age who have not been immunized against rubella or who have not had the disease can transmit rubella to their infants if they become infected during pregnancy. When the virus is transferred to the fetus during the first trimester of pregnancy, a variety of congenital deformities, known as congenital rubella syndrome, occur in about 25% of births. The risk is lower if infection occurs later in pregnancy. Anomalies caused by congenital rubella syndrome include congenital cardiac disease, blindness, deafness, and intellectual developmental disorder. Pregnant women should be isolated from individuals infected with rubella to prevent perinatal infection; in addition, pregnant women must not be given the rubella vaccine. The best protection against congenital rubella syndrome is universal routine immunization with live rubella vaccine during infancy or as soon as possible in adulthood.

REF: p. 79

OBJ: 18

31. Prompt and complete treatment of acute tonsillitis caused by group A beta-hemolytic

streptococci is necessary to prevent which condition/s? a. Rheumatic fever b. Rheumatic heart disease c. Kidney complications d. All of the answer options ANS: D

When the throat culture is positive for group A beta-hemolytic streptococci (strep throat), a full 10-day course of penicillin is given to prevent rheumatic fever, rheumatic heart disease, and kidney complications. The patient may need a liquid diet or saline throat irrigations if the pain is debilitating. Tonsillectomy may be recommended for chronic tonsillitis.

REF: p. 83

OBJ: 21

32. Serious side effects of uncontrolled diarrhea in the infant or child include a. intestinal obstruction and rhonchi. b. dehydration and electrolyte imbalance. c. diaper rash and Reye’s syndrome. d. All of the answer options ANS: B

Diarrhea may be mild or severe, acute, or chronic. In the infant or child, diarrhea can rapidly cause dehydration and electrolyte imbalance when fluid loss is profuse.

REF: p. 88

OBJ: 13

33. Which statement/s is/are true about leukemia? a. It is the most common childhood malignancy. b. Neither of the answer options are true c. The diagnosis is confirmed by microscopic examination of the bone marrow. d. Both of the answer options are true.

ANS: D

Leukemia, a cancer of blood-forming tissues, is the most common childhood malignancy which is confirmed by positive results of bone marrow aspiration. Chromosome analysis of the leukemic cells is performed for diagnosis because the presence of different characteristic abnormalities has prognostic value.

REF: p. 91

OBJ: 25

34. Causes of prematurity include which factors? a. Incompetent cervix, bicornuate uterus, and premature rupture of membranes b. Maternal physical conditions including infection and hypertension c. Multiple gestation d. All of the answer options ANS: D

There are many reasons that infants enter the world before reaching the traditionally accepted gestational age of 40 weeks and thus have very low birth weights. Causes of premature labor resulting in a premature infant are an incompetent cervix, bicornuate uterus, toxic conditions, maternal infection, trauma, premature rupture of the amniotic membranes, history of previous miscarriages, multiple gestations, intrauterine fetal growth developmental disorder, and other physical conditions of the mother, such as pregnancy-induced or chronic hypertension.

Diabetes, heart disease, kidney disease, poor nutrition, substance abuse, and lack of prenatal care also contribute to the incidence of the mother giving birth to a preterm infant. In some cases, the etiology is never identified. Attempts may be made to halt premature labor by having the mother on complete bed rest or using drug therapy to slow or halt contractions. The mother is often given a short course of steroids to aid fetal lung maturation. Many times the efforts to allow the fetus more time to grow and mature in the mother’s uterus are unsuccessful.

REF: p. 37

OBJ: 4

35. Which conditions often result from premature birth? a. NEC, IRDS, and ROP

b. Spina bifida, hydrocephalus, and anencephaly c. MD, CF, and Down syndrome d. All of the answer options ANS: A

NEC, IRDS, and ROP often result from premature birth, despite advances in technology which result in survival of low-weight and short-gestation infants possible. The prognosis for these children varies depending on gestational age, weight, and the occurrence of anomalies and developmental deficits. There are documented cases of 12-ounce and/or 22-gestational-week babies surviving. They fall into the 1% of premature babies born at that weight and gestational age. Being born before the normal prenatal development is complete, these children often have many problems to overcome (see Fig. 2.5). A primary risk is a cerebral bleed, which may occur during the labor and delivery process or may result from handling after delivery. The cerebral bleed may cause the development of CP, mental functioning deficiencies, or other neurologic conditions. Another major concern is underdevelopment of the pulmonary system, including the lung tissue and the airway. Some pulmonary conditions these infants experience are IRDS, bronchopulmonary dysplasia, laryngomalacia, tracheomalacia, and bronchomalacia. Lack of body fat can affect the maintenance of body temperature. Any stress or increased or high supplemental O2 flow may be responsible for ROP and possible blindness. NEC is a danger in the digestive system because of the reduced tolerance of the alimentary tract. ASD and PDA often are present because the fetal circulatory system has failed to mature.

REF: p. 38

OBJ: 4

36. At which areas of the body may twins be conjoined? a. Head to head (cranial). b. Posteriorly at the sacrum and coccyx c. Chest to chest d. All of the answer options ANS: D

Conjoined twins may be joined at different locations of the body and may share various organs. The attachment to each other may involve a small portion of tissue or may be as extensive as fusion at the head or sharing of an organ or body part. Common types or variations usually are categorized by the location and involvement of the junction through the term pagus, meaning fastened, included in the classification terminology. Twins with a cranial union are considered to be craniopagus. Those with anterior junction at the chest, often sharing the heart and vital portions of the chest wall and internal organs, are called thoracopagus conjoined twins. Thoracopagus is the most common form of conjoined twins.

The term pygopagus describes those twins who are joined posteriorly at the rump. Another posterior junction occurring at the sacrum and coccyx is termed ischiopagus. When the connection proceeds from the breastbone to the waist, the term omphalopagus describes the junction. A very rare form, dicephalus, is the condition in which the individual has one body and two separate heads and necks.

REF: p. 36

OBJ: 1

37. The most common childhood malignancy is a. Wilms’ tumor. b. leukemia.

c. anemia. d. neuroblastoma.

ANS: B

Leukemia, a cancer of blood-forming tissues, is the most common childhood malignancy. It is characterized by an abnormal increase in the number of immature white blood cells (WBCs) or undifferentiated blastocytes.

REF: p. 91

OBJ: 25

38. Causes of infantile colic may include a. sensitivity to cow’s milk. b. sensitivity to iron. c. excessive swallowing of air during feeding process. d. A and C. ANS: D

The etiology of colic is unknown, although several theories have been advanced. One hypothesis suggests that improper feeding techniques may be responsible, and another theory blames overeating or the swallowing of excessive air. Sensitivity to cow’s milk may be the causative factor, even for the nursing infant. In this case, the nursing mother is urged to eliminate cow’s milk from her own diet. Regardless of the cause, the infant is extremely uncomfortable and cries a great deal, with sleep pattern disturbance.

REF: p. 87

OBJ: 13

39. Cardiac cyanotic defects include which conditions? a. VSD and PDA b. Tetralogy of Fallot and transposition of the great arteries c. Coarctation of the aorta d. ASD ANS: B

Central cyanosis is a sign that the atrial blood is not fully oxygenated. The infant will appear cyanotic with a blue tinge to the lips, tongue, and nail beds. The five main cardiac causes of central cyanosis are tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, tricuspid atresia, and total anomalous pulmonary venous return. The two most common defects are discussed here. (See Evolve for discussion of the remaining defects.)

REF: pp. 58-59

OBJ: 10

40. What is the most common fatal genetic disease? a. Hypertrophic cardiomegaly b. CF c. Down syndrome d. Tetralogy of Fallot ANS: B

CF, an autosomal recessive inherited disorder, is a chronic dysfunction of a gene called the CF transmembrane conductance regulator that affects multiple body systems. It is the most common fatal genetic disease.

REF: p. 67

OBJ: 15

41. Chickenpox is spread by virus which is transmitted by which method or route? a. Bacillus entering through damaged skin b. A toxin formed in respiratory mucosa c. Direct or indirect droplet nuclei from the respiratory tract of the infected person d. Group A beta-hemolytic streptococci ANS: C

The causative organism is the varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV-3), a member of the herpes virus group. The virus is transmitted by direct or indirect droplet nuclei spread from the respiratory tract of the infected person or a carrier. Fluid from the cutaneous lesions is also infectious, but dried crusty lesions are not contagious. The patient is considered contagious for 1 to 2 days before the eruptions until about 6 days after the eruptions.

REF: p. 72

OBJ: 17

42. Symptoms and signs of rubeola include a. tenderness in the neck and below the ears. b. Koplik spots on the buccal mucosa. c. a violent cough ending in a high-pitched inspiratory whoop. d. red macules that progress to papules and then vesicles that form crusts.

ANS: B

Early symptoms include cough, coryza, conjunctivitis, and photophobia. The child has a fever, followed in 3 to 7 days by a red blotchy rash. The rash starts behind the ears, hairline, and forehead and then progresses down the body (see Fig. 2.38). Before the eruption of the rash, Koplik spots can be detected on the oral mucosa as tiny white spots on a red background.

REF: p. 77

OBJ: 17

43. Mumps is a childhood disease that is best prevented by which measure? a. The measles-mumps-rubella (MMR) vaccine b. Gardasil vaccine c. Broad-spectrum antibiotics d. Cough medicines ANS: A

Childhood immunization is the best prevention for mumps. Children should receive the first immunization of MMR at the age of 12 to 18 months. The second dose should be given before the child enters school.

REF: p. 76

OBJ: 17

44. When a person is diagnosed with leukemia, which changes will be seen in a blood specimen? a. Increase in WBCs b. Decrease in WBCs c. Normal WBC count d. Decrease in platelets ANS: A

Leukemia, a cancer of blood-forming tissues, is the most common childhood malignancy. It is characterized by an abnormal increase in the number of immature WBCs or undifferentiated blastocytes.

REF: p. 91

OBJ: 25

45. The most common progressive form of MD is a. occulta. b. Duchenne. c. Down. d. myotonic.

ANS: B

Duchenne is the most common progressive form of MD. Weakening of the skeletal muscles occurs and muscle fibers are abnormally vulnerable to injury. There are several types of the disease, but all are rare. The most common and best-known type is Duchenne MD, which is diagnosed soon after birth or during early childhood, usually before the age of 5 years.

REF: p. 48

OBJ: 8

46. One way to prevent epidemics of contagious diseases is a. aspirin. b. immunizations. c. multivitamins. d. cold and cough medications.

ANS: B

Dramatic results have been achieved in pediatric medicine through routine prophylactic immunization with vaccines that build specific and prolonged protection. To prevent epidemics of contagious diseases, all U.S. states require that children have inoculations before entering school (see Fig. 2.35). (See the discussion of immunity in Chapter 3.) Although the infant acquires limited natural immunity from the mother, the growing child is vulnerable to many infectious diseases and the disabilities that they cause. Many of these communicable diseases can be prevented.

REF: p. 72

OBJ: 17

47. The procedure that allows amniotic fluid to be tested and cells to be microscopically

examined for abnormal substances or chromosomal abnormalities is a. fetal monitoring. b. amniocentesis. c. acupuncture. d. ultrasound studies.

ANS: B

One can diagnose congenital anomalies in a fetus by taking a fluid sample from the amniotic sac between the 15th and 18th weeks of pregnancy. This procedure, known as amniocentesis, allows amniotic fluid to be tested and cells to be microscopically examined for abnormal substances or chromosomal abnormalities.

REF: p. 34

OBJ: 2

48. Bronchiolitis, inflammation of the bronchioles, the smallest air passages of the lungs, is

usually caused by a. bacteria. b. viruses. c. fungi. d. protozoa.

ANS: B

Bronchiolitis is most commonly caused by infection with respiratory syncytial virus (RSV).

Many other viruses can cause this disease, including parainfluenza and adenovirus.

REF: p. 41

OBJ: 23

TRUE/FALSE 1. Genetic disorders and syndromes are the result of an abnormal gene taking up residence on

one of the 22 pairs of nonsex chromosomes.

ANS: T

Genetic syndromes are a form of congenital anomalies. Genetic information is contained in microscopic threadlike structures in the nucleus of human body cells. The genetic material contained within the genes is responsible for inheritance traits. Each cell within the human body contains 46 chromosomes arranged in 23 pairs, 22 of which are termed homologous pairs, and the remaining pair is the sex chromosomes.

REF: p. 33

OBJ: 2

2. The lungs of the neonate lack the surfactant needed to allow the alveoli to expand.

ANS: T

The lungs of the neonate lack the surfactant needed to allow the alveoli to expand. The surfactant normally is produced relatively late in fetal life; consequently, premature infants are at risk. The outcome of this inability of the lungs to expand is inadequate surface area for proper gas exchange and a potentially fatal lack of oxygen in the blood.

REF: p. 39

OBJ: 4

3. A congenital spinal defect in which no herniation of spinal cord or meninges exists is called a

myelomeningocele.

ANS: F

Myelomeningocele (also known as spina bifida cystica) is a protrusion of a portion of the spinal cord and the meninges through a defect in the spinal column, usually in the lumbar region. Myelomeningocele is the most severe form of spina bifida. Because spinal nerves or the spinal cord are present in this herniation, the infant exhibits neurologic symptoms. The infant may have musculoskeletal malformation, immobile joints, or paralysis of the lower extremities. Depending on the level of the anomaly, bowel or bladder control may be affected.

REF: p. 51

OBJ: 7

4. In hydrocephalus, a large amount of cerebrospinal fluid (CSF) accumulates in the skull,

causing increased intracranial pressure.

ANS: T

In hydrocephalus, the amount of CSF is increased greatly or its circulation is blocked, resulting in an abnormal enlargement of the head and characteristic pressure changes in the brain.

REF: p. 51

OBJ: 7

5. PKU is an inborn error in metabolism of amino acids causing brain damage and intellectual

developmental disorder when not corrected.

ANS: T

PKU is an inborn error in the metabolism of amino acids that causes brain damage and intellectual developmental disorder when not corrected.

REF: p. 69

OBJ: 14

6. Because anemia is a symptom of various diseases, it is important to determine the cause of the

anemia.

ANS: T

Anemia is a symptom of various problems or diseases and can lead to tissue hypoxia if the cause is not determined and treated.

REF: p. 89

OBJ: 25

7. Reye’s syndrome has been linked with the use of aspirin to treat chickenpox and influenza.

ANS: T

The cause of Reye’s syndrome is unknown. However, it typically follows infection with influenza A or B viruses or chickenpox. It has been linked to the use of aspirin during these infections.

REF: p. 95

OBJ: 17

8. Rh factor incompatibility occurs when the mother, through prior pregnancy, has become

sensitized to the Rh factor of the fetal RBCs. ANS: T

The cause is Rh factor incompatibility. Rh factor is the antigen found on RBCs of the Rh-positive individual. The mother, through a prior pregnancy, has become sensitized to the Rh factor (Rh isoimmunization) of the fetal RBCs. When sensitized maternal blood finds its way into fetal circulation, particularly during delivery, the antibodies in the mother’s blood destroy the RBCs of the fetus (see Figs. 2.48 and 2.49).

REF: p. 92

OBJ: 26

9. Leukemia is characterized by an abnormal decrease in the number of immature WBCs.

ANS: F

Leukemia, a cancer of blood-forming tissues, is the most common childhood malignancy. It is characterized by an abnormal increase in the number of immature WBCs or undifferentiated blastocytes.

REF: p. 91

OBJ: 25

10. The infant born with fetal alcohol syndrome (FAS) may experience alcohol withdrawal

shortly after birth.

ANS: T

Intrauterine exposure to sufficient levels of alcohol has been associated with fetal growth developmental disorder, in which the infants are short and below average in weight. The infant may exhibit signs of alcohol withdrawal shortly after birth. Facial characteristics of FAS include smaller eye openings with eyes spaced widely apart and a thin upper lip. The infant may experience growth deficiencies and CNS problems. Heart defects including ASD and VSD may be present. FAS is also associated with intellectual developmental disorder.

REF: p. 96

OBJ: 28

11. Closure of PDA may be achieved by medication or by surgical closure of the ductus.

ANS: T

PDA results when the ductus fails to functionally close. During normal fetal circulation, the patent ductus short circuits shunting the circulation from the lungs and instead directs blood from the pulmonary trunk to the aorta. If PDA continues after birth, circulation of oxygen is compromised because this abnormal opening is a shunt that allows oxygenated blood to recirculate through the lungs (see Fig. 2.22). PDA is detected during a physical examination when a classic ―machinery‖ murmur is heard on auscultation and palpitation reveals a thrill.

The infant’s growth and development may be slowed, and various signs of heart failure may be present. Closure may be attempted by drug therapy using an antiprostaglandin or ibuprofen. The other option is surgical closure of the ductus.

REF: p. 56

OBJ: 9

12. Tetanus is an acute, potentially deadly systemic infection characterized by painful involuntary

contraction of skeletal muscles.

ANS: T

Tetanus is an acute, potentially deadly systemic infection characterized by painful involuntary contraction of skeletal muscles. The patient is extremely febrile (temperature >101 F), is irritable, and sweats profusely. He or she has a stiff neck, a tight jaw (lockjaw), spasms of the facial muscles, and difficulty swallowing. As the infection progresses, the muscles of the back and abdomen become rigid, with generalized convulsive muscle spasm (opisthotonos). These tonic spasms may cause death from asphyxiation.

REF: p. 79

OBJ: 17

13. NEC is an acute inflammatory process resulting from ischemic necrosis of the lining of the

bronchial tubes.

ANS: F

NEC is a danger in the digestive system because of the reduced tolerance of the alimentary tract.

REF: p. 42

OBJ: 5

14. Epiglottitis typically strikes children between ages 3 and 7 years.

ANS: T

Epiglottitis typically strikes children between ages 3 and 7 years. The symptoms include a sore throat, croupy cough, fever, and respiratory distress caused by laryngeal obstruction.

Visual inspection reveals a red and swollen epiglottis. Rapidly increasing dyspnea and drooling are the most significant signs of this critical respiratory emergency.

REF: p. 82

OBJ: 20

15. Asthma is a leading cause of chronic illness and school absenteeism in children.

ANS: T

Asthma is a chronic reversible obstructive disease caused by increased reactivity of the tracheobronchial tree to various stimuli. There are two major processes at work: constriction of the bronchioles and inflammation of the airway. It is a leading cause of chronic illness and school absenteeism in children.

REF: p. 84

OBJ: 22

16. Neural tube defects include spina bifida occulta, meningocele, and myelomeningocele.

ANS: T

Spina bifida is a group of malformations of the spine in which the posterior portion of the bony canal containing the spinal cord (usually in the lumbar region) is completely or partially absent (see Fig. 2.14A). Also called neural tube defects, the three different levels of the condition originate during early weeks of gestation as the spinal cord and bony canal develop.

During this developmental stage, there is a failure of the posterior spinal processes to close, usually in the lumbar region. This failure of complete closure allows the meninges and, in severe cases, the spinal cord to herniate. Depending on the extent of the herniation and the amount of the neural tube that has herniated, various degrees of neural deficits or impairment occur. The three types of spina bifida are spinal bifida occulta, meningocele, and myelomeningocele.

REF: p. 49

OBJ: 7

17. A child with Down syndrome has a normal appearance of their hands.

ANS: F

The hands are short with stubby fingers and a deep horizontal crease across the palm (simian line).

REF: p. 46

OBJ: 6

18. Young individuals with hypertrophic cardiomyopathy usually exhibit obvious symptoms of

the disorder.

ANS: F

Tragically, the first sign is often the collapse of a seemingly healthy young athlete during a strenuous sporting event or other period of stressful exercise. This collapse can be followed by cardiac arrest caused by a cardiac arrhythmia. Many have no symptoms until the collapse. It is possible that some individuals experience no symptoms. Signs may be discovered during a physical examination. Symptoms, often ignored by young people, may include chest pain, syncope, hypertension, palpitations, or shortness of breath. Some report experiencing fatigue, shortness of breath when lying down, or reduced tolerance of activity.

REF: p. 45

OBJ: 2

19. MD affects only males.

ANS: T

As is the case for hemophilia and color blindness, the disease affects only males and generally is inherited through female carriers.

REF: p. 48

OBJ: 8

20. Hydrocephalus is easily diagnosed prenatally.

ANS: F

Diagnosis is made through the clinical picture, physical examination, and radiographic skull studies. Computed tomography and magnetic resonance imaging scans demonstrate the condition.

REF: p. 52

OBJ: 7

21. Treatment of hydrocephalus consists of placing a ventriculoatrial shunt.

ANS: T

Treatment consists of surgical intervention to place a shunt in the ventricular or subarachnoid spaces to drain off the excessive CSF. Some catheters empty into the peritoneal cavity, and other shunt catheters empty into the right atrium of the heart (see Fig. 2.17). One-way valves help to shunt the excessive CSF away from the cerebrospinal canal and to maintain a normal pressure.

REF: p. 52

OBJ: 7

22. During fetal circulation, blood bypasses the lungs.

ANS: T

Because the fetal lungs are not functioning, this blood mostly bypasses the lungs. Most of the blood entering the right atrium by the inferior vena cava is shunted directly into the left atrium through the foramen ovale. There is a small valve on the left side of the atrial septum called the septum primum. This valve keeps blood from going back into the right atrium. The remaining fetal blood that has entered the right atrium contains a large amount of oxygen-poor blood from the superior vena cava and travels to the right ventricle and into the pulmonary trunk. The pulmonary blood vessels have a high resistance to blood flow because of the collapsed state of the lungs; thus they only allow a small amount of blood to enter the pulmonary circulation. This small amount is enough to nourish the pulmonary tissue.

REF: p. 55

OBJ: 10

23. Cryptorchidism may be treated with hormonal therapy.

ANS: T

If the testicles do not descend by 4 years of age, the treatment is to place the undescended testes into the scrotum by either surgical manipulation (orchiopexy) or hormonal drug therapy (B-HCG or testosterone). Treatment is important because untreated cryptorchidism may lead to sterility in the adult male. There is an increased risk of testicular cancer in untreated cryptorchidism.

REF: p. 63

OBJ: 12

24. Symptoms of pyloric stenosis include episodes of projectile vomiting and failure to gain

weight.

ANS: T

Vomiting can range from a mild regurgitation to projectile expulsion. The infant has a distended abdomen, is irritable, and often has a fever. Aspiration of vomitus into the lungs can result in pneumonia.

REF: p. 90

OBJ: 13

25. Abdominal distension is not a symptom of Hirschsprung disease.

ANS: F

The symptoms and signs differ slightly depending on the age of the child experiencing an exacerbation of the condition. In the neonatal period, the newborn fails to pass meconium within 48 hours after birth. The infant may have bile-stained or fecal vomitus and does not want to feed. The abdomen becomes distended. After the neonatal period, the symptoms and signs include a failure to thrive, with obstinate constipation, vomiting, and abdominal distention. When the condition worsens, the infant may become feverish and may have explosive, watery diarrhea.

REF: p. 66

OBJ: 13

26. Turner syndrome can be cured with proper treatment.

ANS: F

There is no cure for this genetic disorder; however, the prognosis is good if the patient has no other complicating conditions, including cardiac or kidney disorders. Moderate degrees of learning disorders are common. These females will never be able to conceive their own child because they have no ovaries to produce eggs.

REF: p. 72

OBJ: 16

27. Chickenpox is caused by a member of the herpes virus group.

ANS: T

The causative organism is the VZV, also known as HHV-3, a member of the herpes virus group. The virus is transmitted by direct or indirect droplet nuclei spread from the respiratory tract of the infected person or a carrier. Fluid from the cutaneous lesions is also infectious, but dried crusty lesions are not contagious. The patient is considered contagious for 1 to 2 days before the eruptions until about 6 days after the eruptions. The incubation period is 2 to 3 weeks.

REF: p. 72

OBJ: 17

28. It is recommended that all adults receive the Tdap immunization every 10 years to reduce the

incidence of whooping cough.

ANS: T

Adults should have a booster inoculation to ensure that immunity still exists. Therefore when an injection to prevent tetanus is administered to adults, the inoculation Tdap should be administered. This will also be helpful in preventing outbreaks of whooping cough.

REF: p. 75

OBJ: 17

29. Adenoid hyperplasia can contribute to recurrent otitis media and conductive hearing loss.

ANS: T

Adenoid hyperplasia can contribute to recurrent otitis media and conductive hearing loss resulting from obstruction of the eustachian tube.

REF: p. 83

OBJ: 21

30. Status asthmaticus is not considered a medical emergency.

ANS: F

In a severe asthma attack unresponsive to drug therapy, a condition called status asthmaticus may lead to fatal respiratory failure and thus the need for endotracheal intubation. The patient requires hospitalization for aggressive medical treatment and follow-up. Occasionally some children may develop pneumonia concurrent with the asthma attack.

REF: p. 84

OBJ: 22

31. Tetanus can cause death.

ANS: T

Tetanus is an acute, potentially deadly systemic infection characterized by painful involuntary contraction of skeletal muscles. Tetanus carries a 35% mortality rate, so prevention is important.

REF: p. 80

OBJ: 17

32. Helminth infestation may be detected through stool specimens.

ANS: T

The diagnosis is made by detection of eggs or worms in the anal opening by the placing of transparent adhesive tape in the perianal area. A stool specimen examined microscopically may be positive.

REF: pp. 87-88

OBJ: 24

33. It is necessary to monitor urinary output of children with diarrhea.

ANS: T

Teach parents to observe urinary output for volume and color. When the child is in diapers, have parents count the number of soiled or wet diapers within a set time and report this to the office.

REF: p. 89

OBJ: 13

34. Tetanus carries a 35% mortality rate, so prevention is important.

ANS: T

Tetanus carries a 35% mortality rate, so prevention is important.

REF: p. 80

OBJ: 17

35. Congenital anomalies in a fetus can be diagnosed by taking a fluid sample from the amniotic

sac between the 15th and 18th weeks of pregnancy.

ANS: T

One can diagnose congenital anomalies in a fetus by taking a fluid sample from the amniotic sac between the 15th and 18th weeks of pregnancy. This procedure, known as amniocentesis, allows amniotic fluid to be tested and cells to be microscopically examined for abnormal substances or chromosomal abnormalities.

REF: p. 34

OBJ: 1

36. An example of an abnormal substance obtained during an amniocentesis is an elevated

alpha-fetoprotein (AFP) level.

ANS: T

An example of an abnormal substance is an elevated AFP level.

REF: p. 34

OBJ: 3

37. Treatment for bronchiolitis is supportive care.

ANS: T

Treatment is supportive care. Albuterol, racemic epinephrine, or hypertonic saline given via a nebulizer may improve respiratory symptoms. Supplemental oxygen may be required. If the patient is unable to feed, administration of intravenous fluids is necessary. In extreme cases, the patient experiences respiratory failure and must be intubated and mechanically ventilated until the infection runs its course. Even after the acute infection, the airways may be sensitive for several weeks, leading to recurrent wheeze and cough.

REF: p. 86

OBJ: 23

Chapter 03: Immunologic Diseases and Conditions Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Which term is used when the immune system reacts appropriately to specific antigens and

homeostasis is maintained? a. Autoimmunity b. Immunocompetence c. Allergy d. None of the answer options ANS: B

Immunocompetence is the term used when the immune response assists the body in maintaining its functional integrity and assists in maintaining homeostasis. Battling infection by bacteria, viruses, fungi, and parasites takes place to achieve a balanced state of health.

REF: p. 101

OBJ: 2

2. Which type immunity is acquired when a person has a disease? a. Active b. Passive c. Attenuated d. All of the answer options ANS: A

Active immunity results when a person has had previous exposure to a disease or pathogen, or when a person receives immunizations against a disease to stimulate the production of a specific antibody. Active immunity affords the person acquired permanent protection.

A person gains passive immunity by being given immune substances created outside that person’s body for temporary immunity, such as antibodies received through the placenta, breast milk, or when immune globulin, an antibody-containing preparation made from the plasma of healthy donors, is given to help a person combat disease.

REF: pp. 103-104

OBJ: 7

3. Immunoglobulins that provide the ability to recognize foreign organisms stimulating the

antigen-antibody reaction are which type cells? a. T-killer b. T-helper

c. T-suppressor d. B ANS: D

Once activated by exposure to an antigen, B-cells are stimulated to proliferate and form a clone of cells that respond to that specific antigen. Some B-cells become antibody-secreting plasma cells, whereas others become memory B-cells, ready for a quick response if the target antigen presents itself again.

REF: p. 103

OBJ: 4

4. The group of diseases that occur when antibodies develop and begin to destroy the body’s

own cells is a. immunodeficiency. b. autoimmune. c. immunocompetent. d. reticuloendothelial.

ANS: B

It is crucial that the immune system be able to differentiate between self and foreign molecules. When this is not the case, autoimmune disease is the result. In autoimmune disease, the body mistakenly recognizes molecules of its own tissues as foreign and then attacks them.

REF: p. 102

OBJ: 11

5. Decreased gastric production of hydrochloric acid and the resulting shortage of the intrinsic

factor cause which condition? a. Rheumatoid arthritis (RA) b. Systemic lupus erythematosus (SLE) c. Autoimmune hemolytic anemia d. Pernicious anemia ANS: D

Pernicious anemia is caused by chronic atrophic gastritis resulting in decreased gastric production of hydrochloric acid and a shortage of intrinsic factor. Additionally antibodies are produced that are directed against intrinsic factor and parietal cells. These two factors lead to impaired vitamin B12 absorption and B12 deficiency.

REF: p. 116

OBJ: 12

6. A patient with a platelet deficiency and blood clotting inability has a. autoimmune hemolytic anemia. b. pernicious anemia. c. idiopathic thrombocytopenic anemia. d. None of the answer options ANS: C

It is believed that platelet destruction and/or inhibition of platelet production is the result of autoantibodies against platelets. Symptoms are related to an inability of the blood to clot and include spontaneous hemorrhages in skin, mucous membranes, or internal organs.

REF: p. 118

OBJ: 11

7. An autoimmune condition in which erythrocytes (red blood cells, RBCs) are destroyed by

antibodies, causing the patient to experience fatigue, chills, fever, dyspnea, and jaundice, is a. ankylosing spondylitis (AS). b. autoimmune hemolytic anemia. c. multiple sclerosis. d. None of the answer options ANS: B

Autoimmune hemolytic anemia results because of a misguided immune response and B-cell–produced antibodies do not identify RBCs as self, resulting in agglutination of RBCs and an attack on and destruction of the red corpuscles.

REF: p. 115

OBJ: 11

8. Fever, joint pain, malaise, weight loss, and the characteristic butterfly rash are indications of

which condition? a. SLE b. Scleroderma c. RA d. Sjögren’s syndrome ANS: A

SLE, also called lupus, can inflame and damage connective tissue anywhere in the body. SLE most commonly produces inflammation of skin, joints, nervous system, kidneys, lungs, and other organs. The formal diagnosis of SLE can be made if four or more of a list of specific symptoms or positive laboratory tests are present either at the same time or sequentially.

REF: p. 120

OBJ: 13

9. Which systemic disease usually begins with joint inflammation and edema of the synovial

membranes surrounding the joint? a. SLE b. Scleroderma c. RA d. Sjögren’s syndrome ANS: C

RA is one of the most severe forms of arthritis, commonly causing deformity and disability.

RA usually begins with joint inflammation and edema of the synovial membranes surrounding the joint and affects 1.5 million Americans, women three times more often than men. RA may begin at any age, but it most commonly strikes individuals in their 30s and 40s.

REF: p. 124

OBJ: 14

10. Which treatment/s is primary when treating RA? a. Reduction of inflammation and pain b. Preservation of joint function c. Prevention of joint deformity d. All of the answer options

ANS: D

Treatment of RA includes a combination of medication, rest, special exercises, and joint protection in order to reduce inflammation and pain, preserve joint function and prevent joint deformity.

REF: p. 125

OBJ: 15

11. Which condition is an inflammatory disease of the central nervous system that attacks the

myelin sheath? a. Myasthenia gravis b. Muscular dystrophy c. Multiple sclerosis d. None of the answer options ANS: C

Multiple sclerosis attacks the myelin sheath of the nervous tissue and prevents the transmission of stimuli to the brain and spinal cord, which results in many sensory and motor abnormalities. The most common characteristic of multiple sclerosis is relapse, the onset of clinical dysfunction, followed by a remission during which the symptoms resolve for a period of time.

REF: pp. 128-129

OBJ: 17

12. A chronic, progressive neuromuscular disease that is characterized by extreme muscular

weakness (generally appearing first in the face) and progressive fatigue is a. myasthenia gravis. b. muscular dystrophy. c. multiple sclerosis. d. None of the answer options ANS: A

Myasthenia gravis causes muscle weakness and progressive fatigue. A myasthenic crisis (sudden inability to swallow and respiratory distress) may be so severe that mechanical ventilation becomes necessary.

REF: p. 130

OBJ: 17

13. Where are T-cell lymphocytes produced? a. Bone marrow b. Spleen c. Thymus gland d. Blood ANS: C

Some of the stem cells migrate to the thymus gland, where they become T-cells (T lymphocytes), which multiply and develop the capacity to combine with specific foreign antigens derived from viruses, fungi, tumors, or transplanted tissue. Those T-cells coded to recognize self-antigens are destroyed. The remaining T-cells are coded to seek out foreign invaders. Helper T-cells stimulate the B-cells to differentiate into plasma cells and to produce more antibodies.

REF: p. 102

OBJ: 5

14. A history of repeated chronic infections because of an acquired B-cell deficiency and

decreased antibody production and/or function is usually indicative of a. AS. b. polymyositis. c. common variable immunodeficiency disease (CVID). d. DiGeorge’s anomaly.

ANS: C

CVID is an acquired B-cell deficiency that results in decreased antibody production and/or function. The person with CVID has a history of chronic or recurrent infections. The number of circulating B-cells is often normal, but the ability of the B-cells to produce all types of immunoglobulins is reduced. Although the use of immunoglobulin has improved the prognosis, patients often succumb to chronic lung disease or malignancies. Lower levels of immunoglobulin and a lower percentage of B-cells are associated with a poorer prognosis.

REF: p. 109

OBJ: 10

15. The most common form of immunodeficiency is a. X-linked agammaglobulinemia. b. severe combined immunodeficiency disease (SCID). c. selective immunoglobulin A (IgA) deficiency disease. d. CVID. ANS: C

The most common form of immunodeficiency is selective IgA deficiency. A failure to produce the normal levels of IgA. Failure of B-cells to produce adequate levels of IgA is the most common immunologic defect in the general population. The most common risk factor for the disease is a family history of either IgA deficiency or CVID. REF: p. 110

OBJ: 10

16. Which diagnosis is a chronic, progressive, systemic autoimmune disease of skin that is

characterized by hardening and shrinking of skin? a. SLE b. Systemic scleroderma c. RA d. Multiple sclerosis ANS: B

Scleroderma is a chronic, progressive disease characterized mostly by sclerosis (hardening) of skin; scarring of certain internal organs can occur as well. The cause of scleroderma is unknown, but it appears to be an autoimmune disease.

REF: p. 121

OBJ: 13

17. Pyridostigmine bromide [Mestinon] is the drug of choice for treatment of which condition? a. Myasthenia gravis b. Multiple sclerosis c. Small vessel vasculitis d. Systemic necrotizing vasculitis

ANS: A

The treatment of myasthenia gravis is symptomatic and supportive. Treatment choice is largely based on the patient’s age and pregnancy status. Restricted activity, complete bed rest for severe cases, and a soft or liquid diet may be necessary. Anticholinesterase drugs are effective initial treatment for the fatigue and muscle weakness, but they become less effective as the condition worsens. Pyridostigmine bromide [Mestinon] is the drug of choice for treatment.

REF: p. 131

OBJ: 17

18. _____ is a systemic, usually progressive inflammatory disease primarily affecting the spinal

column. a. Scleroderma b. Wiskott-Aldrich syndrome c. Polymyositis d. AS ANS: D

AS commonly affects young men. It is several times more common in men than in women.

Clinical findings include back pain and stiffness, joint pain with limitation of motion, positive family history, and mildly elevated erythrocyte sedimentation rate or C reactive protein. The HLA-B27 antigen is present in blood testing of nearly 90% of Caucasian individuals with AS. Characteristic x-ray findings are noted years after the onset and include bilateral sacroiliitis, ―squaring‖ of the vertebrae, fusion of joints, and generalized osteoporosis. These changes produce the classic appearance of a ―bamboo spine.‖ REF: p. 127

OBJ: 16

19. A child in the emergency room with multiple bruising of unknown cause and

thrombocytopenia may be exhibiting signs of which condition? a. Multiple sclerosis b. Idiopathic thrombocytopenic purpura (ITP) c. Pernicious anemia d. Selective IgA deficiency ANS: B

ITP is an acquired disorder that results from an isolated deficiency of platelets (i.e., other blood counts are normal). It is believed that platelet destruction and/or inhibition of platelet production is the result of autoantibodies against platelets. Symptoms are related to an inability of the blood to clot and include spontaneous hemorrhages in skin, mucous membranes, or internal organs.

REF: p. 118

OBJ: 12

20. With proper therapy which prognosis is most likely for children with juvenile rheumatoid

arthritis? a. Generally good b. Poor c. Very likely to mean a lifetime of dependence on others for care d. Total remission in 10% of cases

ANS: A

With proper therapy, children with all forms of arthritis will usually improve over time and have a generally good prognosis, leading normal lives without significant physical limitations.

REF: p. 126

OBJ: 14

21. Chronic mucocutaneous candidiasis (CMC) refers to a group of disorders characterized by

persistent and recurrent candidal (fungal) infection of which body structures? a. Skin b. Nails c. Mucous membrane d. All of the answer options ANS: D

Frequent, persistent fungal infections of skin, nails and mucous membranes in the young child necessitate a prompt appointment with the physician for medical evaluation and to begin treatment. In the immunocompetent individual, Candida albicans is a nonpathogenic normal flora. Patients with CMC have a T-cell deficit specific to Candida that makes them susceptible to infection.

REF: p. 113

OBJ: 10

22. Which immunodeficiency diseases affect only males? a. X-linked agammaglobulinemia b. Wiskott-Aldrich’s syndrome c. Both of the answer options d. Neither of the answer options ANS: C

Both X-linked agammaglobulinemia and Wiskott-Aldrich’s syndrome affect males. X-linked agammaglobulinemia, a congenital X-linked disorder, is caused by a defect in the Bruton tyrosine kinase gene, which is normally expressed in B-cells during all stages of development.

Wiskott-Aldrich syndrome is a congenital disorder that is characterized by inadequate B- and T-cell function, thrombocytopenia, and eczema. This rare immunodeficiency disorder is inherited as an X-linked trait.

REF: p. 110 | p. 114

OBJ: 10

23. Transmission of human immunodeficiency virus (HIV) is possible a. before it can be detected by laboratory tests. b. neither of the answer options c. during the ―window period.‖ d. both of the answer options ANS: D

Transmission of HIV is possible during all stages of infection, even before it can be detected by laboratory tests, which is called the ―window period.‖ Patients with positive test results for HIV should be encouraged to inform their sexual partners since they may be at high risk for contracting the disease.

REF: p. 108

OBJ: 8

24. Which action is appropriate when an individual reports a known HIV exposure through

unprotected sexual contact or an accidental puncture with a contaminated needle? a. Immediate medical care should be arranged b. Medical care should be sought within six months c. After HIV testing takes place d. None of the answer options ANS: A

When an individual reports a known HIV exposure through unprotected sexual contact or puncture with a contaminated needle, immediate medical care should be arranged.

REF: p. 106

OBJ: 8

25. Some types and functions of T-cells in the body’s immune system include a. cytotoxic T-cells that destroy virus and tumor cells. b. helper T-cells that stimulate B-cells to produce antibodies. c. suppressor T-cells that moderate the immune response. d. All of the answer options ANS: D

Cytotoxic T-cells destroy virus and tumor cells, helper T-cells stimulate B-cells to produce antibodies and suppressor T-cells moderate the immune response.

REF: p. 102

OBJ: 6

26. Testing for which immunodeficiency disease is part of newborn screening in the United

States? a. SCID b. Polymyositis c. CVID d. None of the answer options ANS: A

Testing for SCID is part of the routine newborn screen in the United States. If the clinical picture indicates suspicion of SCID, many laboratory tests are performed. These include measurement of immunoglobulin levels, antibody titers, and numbers of T-cells and B-cells.

REF: p. 111

OBJ: 10

27. Patients with severe IgA deficiency should be encouraged to obtain a medical alert bracelet

owing to risk for a. Kaposi sarcoma. b. DiGeorge anomaly. c. allergic reaction to blood products. d. All of the answer options ANS: C

Encourage patients with severe IgA deficiency to obtain a medical alert bracelet owing to risk for allergic reaction to blood products.

REF: p. 110

OBJ: 10

28. The five immunoglobulins are a. IgM, IgG, IgA, IgD, and IgE. b. variations of the T-cells in the blood. c. measured by home testing. d. the cause of opportunistic infections.

ANS: A

The five immunoglobulins are IgM, IgG, IgA, IgD, and IgE. B-cells are coated with immunoglobulins, giving them the ability to recognize foreign protein and stimulate an antigen-antibody reaction. Complement fixation is the process by which an antibody targets an infected cell for destruction by binding to the cell surface.

REF: p. 103

OBJ: 4

29. Which term or condition is an inflammation of the walls of blood vessels? a. Pernicious anemia b. Multiple sclerosis c. Vasculitis d. Immune neutropenia ANS: C

Vasculitis is an inflammation in the walls of blood vessels. The affected vessel becomes necrotic when it is obstructed by a thrombus, and an infarct of adjacent tissue results.

REF: p. 131

OBJ: 18

TRUE/FALSE 1. Opportunistic infections can emerge as a result of deficiencies of the immune system.

ANS: T

An absent or inadequate response of the immune system results in immunodeficiency conditions and increased susceptibility to other diseases and opportunistic infections.

Immunodeficiency can occur in any of the following major components of the immune system: B-cells, T-cells, complement, or phagocytes.

REF: p. 105

OBJ: 2

2. Tolerance to self-antigens is believed to commence during fetal life.

ANS: T

Tolerance to self-antigens is believed to commence during fetal life. As the body ages and experiences various disease processes or environmental exposures, persons with a variety of genetic risks can have changes in their immune system whereby the system misidentifies body tissues and develops autoantibodies that result in self-destruction.

REF: p. 115

OBJ: 3

3. Autoimmune diseases occur when autoantibodies develop and begin to destroy the body’s

own cells.

ANS: T

Autoimmune diseases can occur in many body systems when lymphocytes and antibodies are sensitized to develop against ―self,‖ that is, against the constituents of the body’s own tissues.

The production of the autoantibodies may occur by means of several mechanisms, including disease, injury, metabolic change, and a mutation of immunologically competent cells.

REF: p. 115

OBJ: 11

4. There are no cures for connective tissue diseases, and treatment is only palliative.

ANS: T

No cures for connective tissue diseases are known; treatment is directed at quieting the overactive immune system and reducing inflammation. In some patients, serious damage to the heart, lungs, or kidneys occurs.

REF: p. 120

OBJ: 13

5. Immunization with live virus vaccines may be contraindicated in children with compromised

immune systems.

ANS: T

Live virus vaccines are often not given to people known to have CVID. Otherwise, appropriate vaccination is recommended although vaccine response may be poor.

REF: p. 109

OBJ: 10

6. Injections of vitamin B12, which must be continued for life, are the primary treatment for

pernicious anemia.

ANS: T

Intrinsic factor must be present in the gastric mucosa for vitamin B12 absorption to occur.

Vitamin B12 is necessary for RBC formation, and a deficiency causes RBCs to be deformed and reduced in number.

REF: p. 116

OBJ: 12

7. All patients with HIV will develop full-blown acquired immunodeficiency syndrome (AIDS).

ANS: F

Although AIDS is ultimately a fatal disease, the number of Americans dying of AIDS each year has dropped. Treatment strategies that result in better prognosis include use of highly active antiretroviral therapy (HAART), use of prophylactic antibiotics, and care by a physician experienced with HIV care.

REF: p. 108

OBJ: 8

8. According to the Centers for Disease Control and Prevention (CDC), most sexually

transmitted cases of HIV in the United States occur through men having sex with men.

ANS: T

According to the CDC, most sexually transmitted cases of HIV infection in the United States occur through men having sex with men. Worldwide primary mode of transmission is heterosexual exposure to someone exposed.

REF: p. 107

OBJ: 8

9. Side effects of nonsteroidal antiinflammatory drugs (NSAIDs) include gastrointestinal

ulceration and bleeding, blood dyscrasias, tinnitus, rash, hypersensitivity reactions, and liver toxicity.

ANS: T

Antiinflammatory medications, including high doses of aspirin, are among the first choices to ease pain and stiffness, to reduce edema, and to control inflammation. NSAIDs are prescribed as an alternative to aspirin.

REF: p. 125

OBJ: 15

10. The use of HAART significantly decreases the risk of HIV transmission to an

HIV-seronegative sexual partner.

ANS: T

The drugs used in HAART can be administered as postexposure prophylaxis after a needlestick injury. Patients with positive test results for HIV should be encouraged to inform their sexual partners since they may be at high risk for contracting the disease.

REF: p. 108

OBJ: 8

11. HIV is primarily transmitted through sexual contact and through contaminated blood and

blood products.

ANS: T

Because HIV is transmitted directly from human to human, prevention measures relate to avoiding risk factors for sexually transmitted diseases and practicing infection control through the use of universal precautions.

REF: p. 108

OBJ: 8

12. Prevention measures for HIV infection relate directly to avoiding risk factors such as hugging,

touching, and handshaking.

ANS: F

HIV is spread most readily by direct contact with the blood or semen of an infected person. It is not transmitted by casual contact, such as touching, handshaking, and hugging. Sexual contact is the primary means of transmission.

REF: p. 107

OBJ: 8

13. The risk of transmission of HIV to and from health care workers and patients is minimized by

strict adherence to the universal precautions for infection control.

ANS: T

Exposure to bloodborne and body fluid illnesses is limited by using universal precautions in the health care workplace.

REF: p. 107

OBJ: 8

Chapter 04: Diseases and Conditions of the Endocrine System Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Which endocrine gland is the master gland? a. Thyroid b. Pituitary c. Adrenal d. Parathyroid ANS: B

The pituitary gland, intricately connected to the hypothalamus, plays a central role in regulating most of the endocrine glands and is called the master gland. It has a cascading effect on the glands it stimulates.

REF: p. 136

OBJ: 2

2. Insulin and glucagon are produced by which organ? a. Pancreas b. Stomach c. Kidney d. Brain ANS: A

The pancreas produces both insulin and glucagon. Glucagon increases concentration of glucose in blood by causing conversion of glycogen to glucose. Insulin regulates metabolism of glucose in the body cells and thereby maintains proper blood glucose level.

REF: p. 138

OBJ: 2

3. Hypersecretion of human growth hormone (hGH) by the pituitary gland before puberty,

resulting in abnormal and accelerated growth, is called a. Addison’s disease. b. Cushing’s syndrome. c. Myxedema. d. Gigantism.

ANS: D

Inflammation or tumor of the pituitary gland can lead to a chronic and progressive disease resulting from the excessive production and secretion of pituitary hormones, for example, hGH. The excessive hGH produces one of two distinct conditions—gigantism or acromegaly—depending on the age at which the dysfunction begins.

REF: p. 139

OBJ: 3

4. A deficiency in the release of vasopressin (antidiuretic hormone [ADH]) by the posterior

pituitary gland causes which condition? a. Hypoglycemia b. Dwarfism c. Diabetes insipidus d. None of the answer options ANS: C

Diabetes insipidus results from a deficiency in the release of vasopressin (ADH) by the posterior pituitary gland, resulting in the excretion of copious amounts of dilute urine.

REF: p. 142

OBJ: 6

5. What causes a simple, or nontoxic, goiter? a. Excessive iodine in the diet b. Inadequate amounts of iodine in the diet c. Excessive circulating cortisol levels d. A deficiency of glucose in the blood ANS: B

Simple, or nontoxic, goiter results from a shortage of iodine in the diet. Iodine is necessary for the synthesis of both triiodothyronine (T3) and thyroxine (T4). Treatment in the early stages is simple: the administration of one drop per week of saturated solution of potassium iodide.

Prevention calls for the addition of iodine to the diet; iodine-deficient areas are no longer seen in the United States because of the introduction of iodized salt.

REF: p. 144

OBJ: 7

6. Rapid heartbeat and palpitations, increased metabolism, weight loss, nervousness, excitability,

profuse perspiration, excessive thirst, muscular weakness, exophthalmos, and the presence of a goiter are symptoms and signs of which problem/s? a. Graves’ disease b. Primary hyperthyroidism c. Overproduction of thyroid hormone d. All of the answer options ANS: D

Graves’ disease, a condition of primary hyperthyroidism, occurs when the entire thyroid gland hypertrophies, resulting in a diffuse goiter and an overproduction of thyroid hormones.

REF: p. 145

OBJ: 9

7. Polyuria, polyphagia, polydipsia, weight loss, and fatigue are the principal signs and

symptoms of which condition? a. Hypoglycemia b. Diabetes insipidus c. Diabetes mellitus d. All of the answer options ANS: C

Diabetes mellitus is a chronic disorder of carbohydrate, fat, and protein metabolism caused by inadequate production of insulin by the pancreas or faulty use of insulin by the cells.

REF: p. 154

OBJ: 14

8. Which treatments and measures are indicated in a diagnosis of diabetes mellitus? a. A calculated diet b. Insulin administration if needed c. Regular exercise d. All of the answer options ANS: D

The goal of treatment is to normalize blood glucose levels and thus prevent complications.

Management of diabetes is multifactorial, including a well-balanced diet closely integrated with insulin administration or oral medication, exercise, blood and urine testing, and hygienic measures.

REF: p. 155

OBJ: 18

9. Which diagnosis is associated with a hypersecretion of hGH that causes overgrowth of the

hands and feet, abnormal thickening of the bones of the face, and excessive overgrowth of soft tissue, occurring after puberty? a. Acromegaly b. Gigantism c. Cretinism d. All of the answer options ANS: A

Acromegaly is a chronic metabolic condition of adults caused by hypersecretion of growth hormone (GH) by the pituitary gland, occurring after puberty.

REF: p. 140

OBJ: 4

10. What is the cause of hypopituitarism? a. Radiation b. Surgical removal c. Ischemia d. All of the answer options ANS: D

Hypopituitarism can result from damage to the pituitary gland caused by radiation or surgical removal or from ischemia of the gland caused by infarct, tumor, or basilar skull fracture.

REF: p. 141

OBJ: 3

11. Which condition is a chronic disease of the immune system that attacks the thyroid gland and

causes a goiter? a. Acromegaly b. Cushing’s syndrome c. Hashimoto’s thyroiditis d. Addison’s disease ANS: C

The outstanding clinical feature of Hashimoto’s thyroiditis is the gradual and painless lumpy enlargement of the thyroid gland, which causes a feeling of pressure in the neck and may result in difficulty with swallowing. Signs and symptoms of hypothyroidism, such as sensitivity to cold, weight gain, fatigue, depression, and mental apathy, appear as the disease progresses.

REF: p. 145

OBJ: 8

12. A congenital hypothyroid condition that causes mental and growth developmental disorder in

the infant or young child is called a. cretinism. b. gigantism. c. acromegaly. d. None of the answer options ANS: A

Cretinism is a congenital hypothyroid condition in which the thyroid gland is absent or the thyroid hormone is not synthesized by the thyroid gland. The child develops as a dwarf, stocky in stature with a protruding abdomen.

REF: pp. 146-147

OBJ: 10

13. Hyperparathyroidism or overproduction of parathyroid hormone (PTH) causes a. increased breakdown of bone. b. hypercalcemia, or increased circulating calcium. c. cardiac arrhythmias and renal calculi. d. All of the answer options ANS: D

The parathyroid glands are found on the back of the thyroid gland. They secrete PTH, the main hormone the body uses to maintain calcium homeostasis. Blood calcium levels are regulated by a feedback loop to maintain a normal calcium level. Disorders of parathyroid secretion result in serious disturbances throughout the body.

REF: p. 149

OBJ: 12

14. Which term describes a condition caused by overactivity of one or more of the four

parathyroid glands and results in the overproduction of PTH? a. Hyperpituitarism b. Hypoparathyroidism c. Hyperparathyroidism d. Hypopituitarism ANS: C

Hyperparathyroidism is a condition caused by overactivity of one or more of the four parathyroid glands and results in the overproduction of PTH? REF: p. 149

OBJ: 12

15. The syndrome caused by hypersecretion of the adrenal cortex, which results in excessive

circulating cortisol levels, fatigue, muscular weakness, and changes in body appearance, is called

a. b. c. d.

Cushing’s syndrome.

Hashimoto’s thyroiditis.

Addison’s disease.

None of the answer options

ANS: A

Cushing’s syndrome is a condition of chronic hypersecretion of the adrenal cortex, which results in excessive circulating cortisol levels. Early manifestations include weight gain, hypertension, and emotional instability. These symptoms warrant a medical evaluation.

REF: p. 152

OBJ: 13

16. Adrenal insufficiency, with progressive destruction of the adrenal gland, is called a. Cushing’s syndrome. b. Hashimoto’s thyroiditis. c. Addison’s disease. d. None of the answer options ANS: C

Addison’s disease is identified as an insufficiency or a sudden decrease in adrenocortical hormone levels, such as from a sudden withdrawal of glucocorticoid therapy. This can result in a life-threatening emergency, called an addisonian crisis.

REF: p. 153

OBJ: 13

17. Which type diabetes has its onset during pregnancy? a. Type 1, insulin-dependent diabetes mellitus b. Gestational diabetes mellitus (GDM) c. Type 2, non–insulin-dependent diabetes mellitus (NIDDM) d. Nonspecific diabetes ANS: B

GDM is a condition of damaged ability to process carbohydrate that has its onset during pregnancy. Increased destruction of insulin by the placenta plays a role in causing GDM. There is reduced effectiveness of maternal insulin during pregnancy.

REF: p. 157

OBJ: 15

18. The presence of a painless lump or nodule on the thyroid gland, along with complaints of

persistent hoarseness and trouble swallowing, should raise the suggestion of which condition? a. Hyperparathyroidism b. Hypoparathyroidism c. Hypoglycemia d. Cancer of the thyroid gland ANS: D

Signs of cancer include palpation of a hard, painless lump or nodule on the thyroid gland; vocal cord paralysis; obstructive symptoms; and cervical lymphadenopathy. Some patients exhibit dysphagia or hoarseness resulting from compression of the upper aerodigestive tract.

The most important prognostic factors are age at diagnosis, size of the primary tumor, and the presence of tissue invasion or metastases.

REF: p. 148

OBJ: 11

19. Insulin reaction can be caused by a. too much insulin. b. delayed meal or insufficient food. c. excessive exercise. d. any of the above.

ANS: D

Known diabetes having warning signs of diabetic coma or insulin reaction needs instructions for immediate medical intervention. Explain the value of wearing a medical alert bracelet.

REF: p. 155

OBJ: 16

20. Symptoms and signs that a person may experience a diabetic coma include a. hypoglycemia, dry skin, hunger, and thirst. b. hyperglycemia, hunger, cold sweat, and trembling. c. hyperglycemia, thirst, nausea and vomiting, and dry skin. d. hypoglycemia, anxiety, fruity breath odor, and thirst.

ANS: C

Symptoms of impending diabetic coma include hyperglycemia, excessive thirst, nausea, vomiting and dry skin. Ketone levels are usually also increased.

REF: p. 155

OBJ: 16

21. What statement(s) is/are true about a simple goiter? a. The patient may notice a swelling of the neck and experience difficulty

swallowing. b. Thyroid ultrasonography can confirm the presence of a thyroid nodule. c. Both of the answer options are true. d. Neither of the answer options are true.

ANS: C

The patient, who is usually female, may be unaware of the condition until the anterior aspect of the neck enlarges with a conspicuous swollen thyroid gland called a goiter. As the hyperplasia increases, it presses on the esophagus, producing difficulty swallowing, and occasionally it can enlarge further, pressing onto the trachea and producing dyspnea.

Treatment in the early stages is simple: the administration of one drop per week of saturated solution of potassium iodide.

REF: p. 144

OBJ: 7

22. Which statement(s) is/are true about insulin? a. Too much insulin, a delayed meal, or not enough food can result in insulin shock. b. A reduction in insulin or insulin resistance results in hyperglycemia. c. The functional pancreas secretes insulin and maintains glucose levels in a precise

range. d. All of the answer options are true.

ANS: D

The functional pancreas secretes insulin and maintains glucose levels in a precise range.

Insulin normally reduces blood glucose levels by transporting glucose into the cells for use as energy and storage as glycogen. A reduction in insulin results in hyperglycemia and deprives cells of fuel.

REF: pp. 154-155

OBJ: 1

23. Type 2 diabetes a. usually requires treatment with insulin injections. b. is seldom seen in adults. c. is the most common form of diabetes. d. is described by none of the answer options.

ANS: C

Type 2 diabetes (formerly known as adult onset diabetes or NIDDM), the most common form, has a gradual onset in adults older than 30, and more often in people over the age of 55. In this form, some pancreatic function remains, permitting control of symptoms by dietary management; in addition, an oral hypoglycemic medication is often prescribed.

REF: p. 154

OBJ: 15

24. Metabolic syndrome is a. defined by five main components. b. a constellation of conditions that includes obesity. c. a collection of signs and/or conditions that may predict a risk for type 2 diabetes. d. All of the answer options ANS: D

Early recognition of this syndrome can help determine suitable interventions to correct individual mechanisms of metabolic syndrome.

REF: p. 158

OBJ: 18

25. When is precocious puberty diagnosed? a. Defined in boys as the onset of puberty before the age of 9 b. Defined in girls as the onset of puberty before the age of 8 c. Both of the answer options d. Neither of the answer options ANS: C

Precocious, or earlier-than-expected, sexual maturity in the male is manifested by early development of secondary sex characteristics, gonadal development, and spermatogenesis.

Precocious sexual maturity in the female is marked by increased growth rate, breast enlargement, and the appearance of pubic hair and underarm hair before 8 years of age; the onset of menstruation (menarche) may occur before 10 years of age. Ovarian function makes pregnancy a possibility.

REF: pp. 159-160

OBJ: 20

26. Established risk factors for thyroid cancer include a. being a relative of a thyroid cancer patient. b. being a male, as males are more susceptible.

c. eating too much dietary salt. d. being a young adult.

ANS: A

Established risk factors for thyroid cancer include: (1) being female (women are nearly three times more likely to develop thyroid cancer), (2) previous head and neck radiation exposure, and (3) a genetic basis.

REF: p. 148

OBJ: 11

TRUE/FALSE 1. Dysfunction of the endocrine system results in decreased or increased secretion of hormones.

ANS: T

The influence of hormones is of vital importance as they regulate body function to promote health.

REF: p. 136

OBJ: 1

2. Dwarfism is the abnormal underdevelopment of the body, or hypopituitarism, occurring in

children.

ANS: T

The deficiency of pituitary GH in children results in short stature. Dwarfism is generally defined as an abnormal underdevelopment of the body in children, attaining an adult height of 4 feet 10 inches or less.

REF: p. 141

OBJ: 5

3. More recent technology offers an alternative to multiple injection regimens for type 1

diabetes, as well as for some type 2 diabetes on insulin.

ANS: T

Methods of insulin delivery include injection, insulin pump therapy, and insulin pens.

REF: p. 155

OBJ: 17

4. Oral hypoglycemic agents such as DiaBeta and Glucophage can cause symptoms similar to

diabetic coma.

ANS: F

A rare but serious side effect of metformin [Glucophage] is lactic acidosis.

REF: p. 156

OBJ: 16

5. Early implementation and use of combination medications seems to be the most effective way

to treat diabetes.

ANS: T

Improved glycemic control and adequate blood pressure and lipids control prevent diabetic complications. Untreated or poorly managed diabetes has many systemic complications: retinopathy, which leads to blindness; neuropathy; renal failure; and atherosclerosis, leading to myocardial infarction and cerebrovascular accidents. Hyperglycemia delays healing and impairs resistance to infection.

REF: p. 154

OBJ: 17

6. Patients who are bedridden or unable to drink enough water to compensate for urinary loss of

water can become dangerously dehydrated.

ANS: T

Patients who are bedridden or unable to drink enough water may become dehydrated.

Symptoms of dehydration include dry mucous membranes, hypotension, dizziness, and poor skin turgor. The onset of symptoms may be abrupt.

REF: p. 143

OBJ: 1

7. Hyperparathyroidism increases breakdown of bone and excessive reabsorption of calcium into

the blood (hypercalcemia).

ANS: T

Hypercalcemia from hyperparathyroidism reduces the irritability of nerve and muscle tissue, and this causes the patient to experience muscle weakness and atrophy, gastrointestinal pain, and nausea. High serum calcium levels can produce conduction defects in the heart.

REF: p. 150

OBJ: 12

8. Patients with hyperparathyroidism may be prone to fractures.

ANS: T

Bone tenderness, arthritis-type pain, and easy fracturing of the bones are the result of demineralization of the bone which happens as a result of hyperparathyroidism.

REF: p. 150

OBJ: 12

9. Severe, prolonged hypoglycemia can cause irreversible brain damage.

ANS: T

In acute hypoglycemia, the priority is to restore a normal blood glucose level through intravenous infusion of glucose.

REF: p. 159

OBJ: 19

10. Addison’s disease is partial or complete failure of adrenocortical function.

ANS: T

The onset of Addison’s disease is usually gradual, with progressive destruction of the adrenal gland and reduction in its important hormones.

REF: p. 153

OBJ: 13

Chapter 05: Diseases and Disorders of the Eye and Ear Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. A defect in the _____ results in difficulty in visual detection of color and fine detail. a. lens b. cones c. rods d. cones and rods ANS: B

The retina is a light-sensitive layer made up of photo-receptive cells called rods and cones.

The rods function best in dim light, thereby enabling night vision, whereas the cones function in bright light and also detect color and fine detail. Within the rods and cones, the image initiates a chemical reaction and sends messages through the nerve fiber layer of the retina to the optic nerve.

REF: p. 164

OBJ: 1

2. Which structure is the sensor receptive cells in the retina that function best in dim light and

enable night vision? a. Iris b. Pupil c. Rods d. Cones ANS: C

The retina is a light-sensitive layer made up of photo-receptive cells called rods and cones.

The rods function best in dim light and enable night vision.

REF: p. 164

OBJ: 1

3. An inflammation of the thin, transparent membrane covering the visible portion of the sclera

and lining the inside of the eyelids results in which condition? a. Conjunctivitis b. Choroiditis c. Corneal abrasion d. Lens distortion ANS: A

Conjunctivitis can be caused by infection, most commonly viral or bacterial, and also by irritation resulting from allergies or chemicals. Infections often are transmitted when contaminated fingers, washcloths, or towels touch the eyes. Conjunctivitis can also be produced through sexual contact with someone who has a sexually transmitted disease.

REF: p. 173

OBJ: 3

4. Hyperopia, myopia, and presbyopia are refractive errors that result when the a. pressure within the anterior chamber of the eye is elevated.

b. eye is unable to focus light effectively. c. tympanic membrane ruptures. d. lens of the eye becomes cloudy.

ANS: B

Hyperopia (farsightedness) occurs when light that enters the eye is focused behind the retina rather than on the retina. Myopia (nearsightedness) is the result of light rays entering the eye being focused in front of the retina, causing blurred vision. Presbyopia is the inability of the internal lens of the eye to focus on near objects caused by loss of elasticity of the lens.

REF: p. 166

OBJ: 1

5. Which statement(s) is/are true about nystagmus? a. Usually treated with warm compresses b. Also known as strabismus c. Necessitates a complete neurologic evaluation when acquired d. All of the answer options are true ANS: C

Any repetitive or involuntary movement of one or both eyes is a sign of nystagmus. Acquired nystagmus always necessitates a complete neurologic evaluation.

REF: pp. 167-168

OBJ: 2

6. Corrective treatment/s of refractive errors of the eye might include which measures? a. Laser surgery b. Contact lenses c. Eyeglasses d. All of the answer options ANS: D

Correcting refractive errors involves fitting the patient with artificial lenses in the form of eyeglasses or contact lenses or performing corrective surgery. Radial keratotomy, a surgical procedure used to reshape the eye, has been replaced by laser surgery, which results in more precise visual correction and has fewer complications. The following refractive surgical procedures can be done to correct myopia, hyperopia, and astigmatism: laser-assisted in-situ keratomileusis (LASIK), astigmatic keratotomy, photorefractive keratotomy, laser thermal keratoplasty, conductive keratoplasty, and intraocular contact lenses (lenses permanently placed in the eyes).

REF: p. 167

OBJ: 1

7. Which is the etiology of an inflammatory infection of the hair follicles of the eyelid called

hordeolum (styes)? a. Staphylococcal bacteria b. Entropion c. Keratitis d. None of the answer options ANS: A

Often styes are the result of a staphylococcal infection and can be associated with and secondary to blepharitis, which is inflammation of the margins of the eyelids involving hair follicles and glands.

REF: p. 169

OBJ: 3

8. Conjunctivitis can be caused by which problem? a. A deterioration of the lens b. Infection, irritation, allergies, or chemicals c. Hemorrhage behind the retina d. A drooping of the upper eyelid ANS: B

Conjunctivitis can be caused by infection, most commonly viral or bacterial, and also by irritation resulting from allergies or chemicals. Infections often are transmitted when contaminated fingers, washcloths, or towels touch the eyes.

REF: p. 173

OBJ: 3

9. Which diagnosis is a cloudy or opaque area in the normally clear lens of the eye? a. Stye b. Blepharitis c. Cataract d. Myopia ANS: C

A cataract is a cloudy or opaque area in the normally clear lens of the eye. The most common cause of cataracts is opacification of the lens caused by the aging process, and the condition is present in about 50% of persons over age 75 in the United States. They also may be congenital or may result from ocular trauma; drug toxicity (prolonged high-dose corticosteroid administration); systemic disease, such as diabetes mellitus; or a complication of other ocular diseases. Long-term, unprotected exposure to sunlight is considered causative as well. Cataracts often have a familial occurrence; however, they also are a common condition in the general population.

REF: pp. 176-177

OBJ: 4

10. Which statement is true about chronic open-angle glaucoma? a. Caused by a decrease in intraocular pressure (IOP) b. Produces symptoms at the onset c. Rarely progresses d. Most treatable cause of blindness ANS: D

Chronic open-angle glaucoma, a silent disease, is the most common form of glaucoma and is the most treatable cause of blindness. Patients can have open-angle glaucoma for a significant period of time before symptoms appear. By the time symptoms do appear, considerable damage usually has occurred. If chronic open-angle glaucoma goes untreated, the patient experiences characteristic loss of vision. The central vision may remain clear for a considerable period of time. However, if the condition progresses, the central vision is also lost, causing complete blindness. The best way to detect glaucoma is by having periodic routine ophthalmic examinations, which include IOP readings and optic nerve evaluations.

REF: p. 178

OBJ: 5

11. Macular degeneration is a. caused by progressive deterioration in the macula of the retina. b. usually related to aging. c. Both of the answer options d. None of the answer options ANS: C

Age-related macular degeneration (AMD) is the most common cause of blindness among white persons in the United States. Macular degeneration is often considered to be age related.

The result is loss of central vision. No cure is known, and the success of treatment has been limited.

REF: p. 179

OBJ: 6

12. A person experiencing early symptoms of retinal detachment will have which symptoms? a. New floaters and light flashes b. Purulent drainage c. Redness of the eye and a gritty feeling d. Ringing in the ears ANS: A

A retinal detachment usually begins with a tear in the retina which causes new floaters and light flashes. Fluid then leaks under the retina and separates it from the choroid. After the retina is separated from the choroid, that portion of the retina no longer functions visually. As the retina continues to detach, more and more vision is lost.

REF: p. 182

OBJ: 8

13. Which vision impairment is a result of old age and the loss of elasticity in the lens is called? a. Astigmatism b. Emmetropia c. Presbyopia d. Diplopia ANS: C

Presbyopia is the inability of the internal lens of the eye to focus on near objects caused by loss of elasticity of the lens. This condition is related to aging and usually starts in people in their mid-40s.

REF: p. 166

OBJ: 1

14. A major cause of blindness in the United States is a. eye trauma. b. retinal detachment. c. strabismus. d. glaucoma.

ANS: D

A major cause of blindness in the United States is glaucoma which causes damage to the optic nerve in the presence of elevated IOP. It is more common in patients older than 60 years of age; however, it can occur at any age. Several different pathologic causes and abnormalities in fluid drainage lead to glaucoma. Early treatment of glaucoma is essential; if not treated promptly, the disease can lead to blindness because any vision lost as a result of the disease generally cannot be regained.

REF: p. 177

OBJ: 5

15. Which statement(s) is/are true regarding adult-onset macular degeneration (AMD)? a. Early evidence of AMD, such as tiny drusen, can be seen during a routine eye

examination by an ophthalmologist. b. Patients with AMD may report seeing wavy lines when looking at lines that are

straight. c. With progression of AMD, reading and activities requiring sharp vision become

impossible. d. All of the answer options are true.

ANS: D

Adult-onset macular degeneration is usually painless, develops slowly, and does not affect the peripheral vision. In most cases, both eyes are affected, either at the same time or one right after the other. As the condition worsens, reading and activities that require sharp vision become impossible. Eventually, the central vision may disappear altogether.

REF: p. 179

OBJ: 6

16. Which factors attribute to the development of macular degeneration? a. Age b. Genetic factors c. Exposure to bright lights d. All of the answer options.

ANS: D

Age, genetic factors, and exposure to bright light are causative factors for macular degeneration. The presence of abnormal fragile and hemorrhage-prone blood vessels can develop behind the macula and convert the disease to its wet form. Hemorrhage may occur when these abnormal vessels break and damage the retina. The result is loss of central vision.

REF: p. 179

OBJ: 6

17. Ototoxicity caused by drugs or chemicals affects the _____ cranial nerve. a. fifth b. sixth c. seventh

d. eighth ANS: D

Ototoxicity occurs when a drug or chemical causes damage to the eighth cranial (acoustic) nerve or to the inner ear, resulting in temporary or permanent hearing loss or disturbances in balance.

REF: p. 187

OBJ: 10

18. Which diagnosis is a chronic disease of the inner ear marked by a recurring syndrome of

vertigo, tinnitus, progressive hearing loss, and a sensation of pressure in the ear? a. Cholesteatoma b. Otosclerosis c. Ménière’s disease d. Mastoiditis ANS: C

Ménière’s disease is marked by a recurring syndrome of vertigo, tinnitus, progressive hearing loss, and a sensation of fullness or pressure in the affected ear. Symptoms have a sudden onset. Nausea, vomiting, tinnitus, sweating, and loss of balance can follow an acute attack of vertigo. Some individuals may be subjected to nystagmus, whereas others may experience an unusual sensitivity to noises (hyperacusis). These attacks can last from a few hours to several days and may become increasingly serious with each recurrence. Ménière’s disease usually affects just one ear, but both ears may become involved eventually. The disease usually manifests in individuals between 40 and 50 years of age.

REF: p. 193

OBJ: 13

19. Placement of sharp objects into the ear canal, an explosion, a severe middle ear infection, or a

blow to the ear could result in which condition? a. Otosclerosis b. Cholesteatoma c. Mastoiditis d. A ruptured tympanic membrane ANS: D

The four most common causes of a ruptured eardrum are insertion of sharp objects into the ear canal, a nearby explosion (including lightning strikes), a severe middle ear infection, and a blow to the ear. A ruptured eardrum also can occur as a result of a fractured skull. The eardrum occasionally ruptures spontaneously.

REF: p. 195

OBJ: 14

20. The cause of sensorineural deafness, also referred to as occupational hearing loss, includes a. loud noise. b. the aging process. c. the side effects of certain medication. d. All of the answer options ANS: D

The cause of sensorineural hearing loss is nerve failure or damage to the cochlea or the auditory nerve (VIII vestibulocochlear cranial nerve). This can be the result of the aging process (see Table 5.3); however, loud music, machinery noise, or sometimes the side effects of medications—including aminoglycosides (tobramycin), loop diuretics, aspirin, or antimetabolites (methotrexate)—can cause such damage at any age (see Fig. 5.35A and B).

Other causes include mumps, measles, syphilis, meningitis, suppurative labyrinthitis, or viral infections. In addition, physical trauma with a fracture of the temporal bone may be a causative factor.

REF: p. 198

OBJ: 10

21. Which procedure is the insertion of a tympanostomy tube into the eardrum as a treatment for

otitis media? a. Electronystagmography b. Myringotomy c. Cryotherapy d. Stapedectomy ANS: B

Myringotomy is the insertion of a tympanostomy tube into the eardrum and is used as a treatment for persistent otitis media. Analgesics and decongestants may be ordered to provide pain relief and to promote drainage in both types of otitis media. Oral or topical antibiotics are ordered for cases of suppurative otitis media.

REF: p. 191

OBJ: 12

22. Ankylosing of the stapes is called a. Ménière’s disease. b. otomycosis. c. otosclerosis. d. exotropia.

ANS: C

Otosclerosis, an abnormal bone growth in the middle ear, primarily affects the stapes, the third bone or ossicle of the middle ear, as the individual ages. Movement of the ossicles is impaired, which causes diminished conduction of sound waves and resulting hearing loss (see Fig. 5.30). With this condition, an abnormal growth of spongy bone forms around the oval window, causing ankylosis of the stapes. Ankylosis produces conductive deafness because the ossicles cannot conduct the sound vibrations as they enter the ear. Symptoms of otosclerosis are tinnitus and a gradual hearing loss of low or soft sounds, which may be unilateral at first, but usually affects both ears at some point. Patients usually report not being able to hear as well with the affected ear when talking on the telephone. Relatives may notice that patients turn their heads to hear well. Otosclerosis is a young person’s disease, with onset usually beginning after puberty and before 35 years of age.

REF: p. 192

OBJ: 12

23. Which symptoms are experienced when the patient has a neoplasm of the ear? a. Progressive hearing loss and discharge from the ear b. A visible mass or lesion c. Facial paralysis

d. All of the answer options ANS: D

Signs and symptoms of these neoplasms commonly include progressive hearing loss, chronic otic discharge, a visible mass or lesion on ear examination, loss of equilibrium, and tinnitus.

Some cancers, such as squamous cell carcinoma of the middle ear, are quite painful.

REF: p. 200

OBJ: 15

24. Infection or inflammation in the semicircular canals is called a. cholesteatoma. b. labyrinthitis. c. otomycosis. d. presbycusis.

ANS: B

The labyrinth is a group of three fluid-filled chambers (the semicircular canals) in the inner ear that control balance (see Fig. 5.31). Inflammation or infection of these chambers is called labyrinthitis.

REF: p. 194

OBJ: 14

25. Diagnostic findings for benign paroxysmal positional vertigo (BPPV) may include a. the sensation of the room spinning and lack of coordination. b. nystagmus. c. decreased hearing. d. All of the answer options ANS: D

Diagnosis is made from the history and examination. In addition to the false sensation of the room spinning or the patient spinning, nystagmus (involuntary eye movements) may be present. An audiogram or other means of hearing testing are used to determine the patient’s level of hearing. Many times the hearing will be decreased.

REF: p. 194

OBJ: 14

26. Blepharitis is defined as a. inflammation of the margins of the eyelids involving hair follicles and glands. b. inflammation or infection of the cornea. c. drooping of the upper eyelid. d. None of the answer options ANS: A

Blepharitis is an inflammation of the margins of the eyelids involving hair follicles and glands. It causes persistent redness and crusting on and around the eyelids.

REF: p. 171

OBJ: 3

27. Drug therapy used in the treatment of mastoiditis includes a. antibiotic. b. hydrogen peroxide. c. latanoprost [Xalatan].

d. prednisone.

ANS: A

Mastoiditis is treated with antibiotic therapy targeted to the causative bacteria.

REF: p. 197

OBJ: 3

28. Treatment and prevention of swimmer’s ear includes a. thoroughly cleaning and drying the ear after swimming. b. antihistamines. c. antifungal cream. d. myringotomy.

ANS: A

It is important for the ear canal to be kept clean and to be dried after swimming. Antibiotic or steroid eardrops and systemic antibiotics may be prescribed, depending on the severity of the condition. Swimmer’s ear tends to recur and can become chronic for those with repeated exposure to water as in swimming.

REF: p. 189

OBJ: 11

29. Causes of ruptured tympanic membrane are a. infection. b. blow to the ear. c. nearby explosion. d. All of the answer options ANS: D

Any type of tear or injury to the eardrum causes a breach in the integrity of the membrane.

This may be the result of pressure, force, or insult from the exterior aspect, or it may be caused by increased pressure within the middle ear.

REF: p. 195

OBJ: 14

30. Labyrinthitis is an inflammation of the a. stapes. b. conjunctiva. c. semicircular canal. d. tympanic membrane.

ANS: C

Labyrinthitis is an inflammation or infection of the labyrinth of the inner ear. The inner ear contains two membrane-lined chambers, each filled with fluid, called the cochlea and the labyrinth. The cochlea contains tiny hairs that change the sound waves in the fluid into nerve impulses, which then are transmitted to the brain via the auditory nerve. The labyrinth is responsible for maintaining balance. It consists of three connected tubes bent into half circles, called the semicircular canals. Their function is to detect movement of the head and relay this information to the brain.

REF: p. 194

OBJ: 14

31. Treatment of BPPV includes

a. b. c. d.

antibiotics. sulfonamides. antihistamines, anticholinergics, and benzodiazepines. bed rest for several days.

ANS: C

Antihistamines [Antivert, Dramamine], anticholinergics [Scopolamine], and benzodiazepines [Compazine] may be prescribed to reduce symptoms of positional vertigo. Exercises in which the individual repeatedly turns the head from side to side may also be helpful.

REF: p. 194

OBJ: 14

TRUE/FALSE 1. The only treatment that cures otosclerosis is a surgical procedure called stapedectomy.

ANS: T

The only treatment that cures otosclerosis is a surgical procedure called a stapedectomy. A stapedectomy involves the removal of the diseased stapes and replacement with a prosthesis.

The composition of the prosthesis may be metal or a ceramic or plastic material. Use of a ceramic or plastic is likely because these materials facilitate visualization by MRI for the purpose of diagnosing and because of the inability to perform an accurate test of the patient’s hearing if the prosthesis is made of metal. If the condition is bilateral, only one ear is operated on at a time so the success of the procedure can be evaluated. Generally hearing improves soon after the surgery. A recent procedure, a stapedotomy, is performed with a laser creating a hole in the stapes permitting placement of a prosthetic device. If surgery is not an option for the patient, a hearing aid can be tried.

REF: p. 192

OBJ: 12

2. The middle ear is normally air-filled.

ANS: T

The middle section of the ear is filled with air and contains the tympanic membrane and three ossicles (tiny bones) called the malleus (hammer), the incus (anvil), and the stapes (stirrup).

Also in the middle ear is a canal, called the eustachian tube, which leads to a cavity (the pharynx) at the back of the nose. At the innermost region of the middle ear is the oval window, the opening to the inner ear. The middle ear receives the sound waves from the vibrating eardrum and relays them along the three bones to the oval window (see Fig. 5.19).

REF: p. 185

OBJ: 9

3. Serous otitis media may be either acute or chronic.

ANS: T

Serous otitis media may be either acute or chronic. With acute serous otitis media (see Fig. 5.24), the cause is usually a virus from an upper respiratory infection that has spread through the eustachian tube into the middle ear. It can occur spontaneously or may result from an allergic reaction. Chronic otitis media (see Fig. 5.25) can develop from an acute attack, hypertrophy of the adenoids, or chronic sinus infections. Suppurative otitis media (see Fig. 5.26) is caused by bacteria, which also can enter the middle ear through the eustachian tube from the nose or throat or from a ruptured tympanic membrane. This condition often follows a bout of influenza or mumps. Variations in the normal structure of the eustachian tube can predispose a person to this disease. Oftentimes an allergic response is responsible for swelling of the eustachian tube and the resulting otitis media.

REF: p. 190

OBJ: 12

4. Sensorineural hearing loss that is caused by damage to the cochlea is irreversible; therefore

prevention is essential.

ANS: T

Sensorineural hearing loss that is caused by damage to the cochlea is irreversible. Prevention is essential.

REF: p. 198

OBJ: 15

5. Chronic open-end glaucoma results from a malfunction of the drainage system, which causes

IOP to be raised.

ANS: T

In chronic open-angle glaucoma, a block at the level of the trabecular meshwork impairs aqueous humor reabsorption. Chronic open-angle glaucoma can occur secondary to trauma, even years later. Overuse of topical steroids also can cause the condition. If the IOP is somewhat elevated or the optic nerve shows signs of enlarging, glaucoma needs to be considered as a possibility.

REF: p. 178

OBJ: 5

6. Symptoms of corneal abrasion or ulcer include pain, redness, tearing, and sometimes visual

impairment.

ANS: T

A corneal abrasion is the painful loss of surface epithelium, or outer layer of the cornea. The patient with corneal abrasion may experience significant persistent pain in the eye. Prompt medical care is indicated.

REF: p. 175

OBJ: 3

7. The internal lens of the eye is elastic and, therefore can focus images both near and far.

ANS: T

Refractive errors are the most common cause for diminished visual acuity. Refractive errors that result in the eye being unable to focus light effectively on the retina are identified as hyperopia, myopia, astigmatism, and presbyopia.

REF: p. 166

OBJ: 1

8. Blepharoptosis can be ectropion or entropion.

ANS: F

Blepharoptosis, also called ptosis, is a permanent drooping of the upper eyelid, such that it partially or completely covers the eye. Blepharoptosis usually affects one eye, but both can be involved. In the case of entropion, the eyelid margins (more often the margin of just the lower lid) turn inward, causing the lashes to rub the conjunctiva. Ectropion is a condition in which the lower eyelid everts from the eyeball, and the exposed surface of the eyeball and the lining of the eyelid become dry and irritated.

REF: pp. 172-173

OBJ: 8

9. Infants and young children should be evaluated for leukokoria (white pupil) and strabismus at

well child exams and referred urgently to an ophthalmologist if noted.

ANS: T

Strabismus should be treated as soon as possible. Early intervention is the key. Corrective glasses, treatment to minimize or prevent amblyopia, or surgery to restore the eye muscle balance may be used in the course of the treatment. Patients reporting visible lesions around or ―in‖ the eye, or those experiencing any unusual appearance or movement of the eye(s) with or without pain, need a timely appointment for a medical evaluation and an ophthalmic examination.

REF: p. 184

OBJ: 8

10. The most common tumor of the eye is cancer that has metastasized to the eye from another

area of the body.

ANS: T

The most common sites of origin are the lung in men and the breast in women, but many other types of cancer also are known to metastasize to the eye.

REF: p. 184

OBJ: 8

11. The major risk with having a ruptured eardrum is infection in the inner ear.

ANS: F

The major risk of a ruptured eardrum is that an infection may develop in the middle ear.

Symptoms of a ruptured tympanic membrane (eardrum) are usually slight pain and partial loss of hearing and may include a slight discharge or bleeding from the ear. Buzzing in the ear and/or facial weakness or dizziness may be experienced. When an infectious process is involved, the drainage is usually purulent in nature. These symptoms may last only a few hours.

REF: p. 195

OBJ: 14

12. A cholesteatoma and mastoiditis can both be the result of a neglected otitis media.

ANS: T

A cholesteatoma and mastoiditis can be caused from neglected otitis media. This condition often begins to develop in infancy or it may be the result of chronic ear infection. The eustachian tube from the middle ear to the pharynx either fails to open properly or becomes blocked with material from recurring middle ear infections (see ―otitis media‖ section). As a result, this normally air-filled chamber develops a weak vacuum, causing the eardrum to become retracted. This forms the pocket in the eardrum that allows the cholesteatoma to develop. Acute mastoiditis is the result of neglected acute otitis media. Streptococcus is the usual causative organism, but certain pneumococci and Staphylococcus aureus may also be involved. Chronic mastoiditis, necessitating radical or modified radical mastoidectomy, is associated with cholesteatoma.

REF: pp. 196-197

OBJ: 12

13. The ear’s only function is hearing.

ANS: F

The ear is the organ of balance and the organ of hearing.

REF: p. 185

OBJ: 9

14. Cochlear implants restore normal hearing.

ANS: F

Individuals who experience severe sensorineural hearing loss that is not helped by hearing aids may have partial hearing restored by means of cochlear implants. Cochlear implants are electronic devices that use minute electrical currents to stimulate the auditory nerve and help the currents travel to the auditory cortex to be perceived as sound.

REF: p. 186

OBJ: 10

15. Certain medications can cause ototoxicity.

ANS: T

Drugs that can cause ototoxicity include salicylates (aspirin and aspirin-containing products); nonsteroidal antiinflammatory drugs; certain antibiotics (aminoglycosides, erythromycin, vancomycin); loop diuretics (furosemide [Lasix], bumetanide [Bumex], ethacrynic acid [Edecrin]); chemotherapeutic agents (cisplatin, vincristine, vinblastine); quinines (quinidine and quinine); and heavy metals, including mercury and lead.

REF: p. 187

OBJ: 12

16. The labyrinth is responsible for maintaining balance.

ANS: T

The inner ear contains two membrane-lined chambers, each filled with fluid, called the cochlea and the labyrinth. The cochlea contains tiny hairs that change the sound waves in the fluid into nerve impulses, which then are transmitted to the brain via the auditory nerve. The labyrinth is responsible for maintaining balance. It consists of three connected tubes bent into half circles, called the semicircular canals. Their function is to detect movement of the head and relay this information to the brain.

REF: p. 186

OBJ: 14

17. Audiograms are used to diagnose otosclerosis.

ANS: T

A diagnosis of otosclerosis is made by the physician using an audiogram, the patient history, and otoscopy. The audiogram will show a moderate to severe hearing loss, especially for loss in the low range.

REF: p. 192

OBJ: 12

18. Sensorineural hearing loss has a noticeable onset.

ANS: F

Sensorineural hearing loss usually has an insidious onset. Many times the hearing loss is detected during a routine medical examination or pre-employment screening. An abrupt onset of hearing loss is possible after sudden exposure to a loud explosive type of noise or nearby lightning strike.

REF: p. 198

OBJ: 15

19. Benign tumors of the ears include acoustic and facial neuromas, and glomus tumors.

ANS: T

Benign tumors of the ear include acoustic neuromas, facial neuromas, and glomus tumors. An acoustic neuroma arises from the eighth cranial nerve, whereas a facial neuroma is a tumor of the facial nerve. These tumors put pressure on the nerve fibers as they expand, causing hearing loss or facial paralysis, respectively, among other symptoms. Glomus tumors are the most common tumors of the middle ear and arise from the glomus bodies (tiny structures that serve as baroreceptors) (see Fig. 5.36).

REF: p. 200

OBJ: 15

20. Lightning strikes may cause a ruptured tympanic membrane.

ANS: T

The four most common causes of a ruptured eardrum are insertion of sharp objects into the ear canal, a nearby explosion (including lightning strikes), a severe middle ear infection, and a blow to the ear. A ruptured eardrum can also occur as a result of a fractured skull. The eardrum occasionally ruptures spontaneously.

REF: p. 195

OBJ: 14

21. Diabetic retinopathy occurs most often in those with diabetes who do not control their blood

glucose levels.

ANS: T

Diabetic retinopathy usually occurs about 8 to 10 years after the onset of diabetes mellitus. It occurs most often in those with diabetes who do not control their blood glucose levels, but all persons with diabetes are susceptible.

REF: p. 181

OBJ: 7

Chapter 06: Diseases and Conditions of the Integumentary System Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Which condition is one of the most common skin disorders marked by an inflammatory

condition of the sebaceous glands? a. Psoriasis b. Atopic dermatitis (eczema) c. Impetigo d. Seborrheic dermatitis ANS: D

Seborrheic dermatitis, one of the most common skin disorders, is an inflammatory condition of the sebaceous, or oil, glands.

REF: p. 207

OBJ: 3

2. The most common dermatitis during infancy, called cradle cap, is a form of which condition? a. Psoriasis b. Atopic dermatitis (eczema) c. Impetigo d. Seborrheic dermatitis ANS: D

Seborrheic dermatitis can occur at any age, but is most common during infancy, when it is called cradle cap. Cradle cap usually clears without treatment by 8 to 12 months of age.

REF: p. 207

OBJ: 3

3. _____ is a chronic skin condition marked by thick, flaky, red patches of various sizes, covered

with characteristic white, silvery scales. a. Psoriasis b. Atopic dermatitis (eczema) c. Impetigo d. Seborrheic dermatitis ANS: A

Psoriasis is a chronic skin condition marked by thick, flaky, red patches of various sizes, covered with characteristic white, silvery scales (see Fig. 6.8).

REF: p. 212

OBJ: 4

4. _____ is a type of inflammation of skin that tends to occur in persons with a family history of

allergic conditions. a. Psoriasis b. Atopic dermatitis (eczema) c. Impetigo d. Seborrheic dermatitis

ANS: B

Atopic dermatitis (eczema) is a chronic inflammation of skin that tends to occur in patients with a family history of allergic conditions.

REF: p. 209

OBJ: 4

5. _____ is a common contagious superficial skin infection caused by either Streptococcus or

Staphylococcus aureus. a. Psoriasis b. Atopic dermatitis (eczema) c. Impetigo d. Seborrheic dermatitis ANS: C

Impetigo is a common, contagious, superficial skin infection. It manifests with early vesicular or pustular lesions that rupture and form thick yellow crusts (see Fig. 6.16).

Impetigo is caused by either Streptococcus or Staphylococcus aureus. The infection is thought to originate from insect bites, scabies infestation, poor hygiene, anemia, and malnutrition and impairment in skin integrity related to eczema. It is also highly contagious and so may be spread from child to child in the school or child care environment. Cases of impetigo are common in temperate climates and occur more often in warm weather.

REF: p. 218

OBJ: 7

6. Contact dermatitis can be induced by a. irritation. b. sensitization. c. photoallergy. d. All of the answer options ANS: A

Contact dermatitis is an acute inflammation response of skin triggered by an exogenous chemical or substance. Contact dermatitis is caused either by the action of irritants on skin’s surface or by contact with a substance that causes an allergic response. Symptoms include erythema, edema, and small vesicles that ooze, itch, burn, or sting (see Fig. 6.4). Many substances can induce contact dermatitis, including plants such as poison ivy, oak, or sumac.

Poison ivy may be spread as an airborne irritant by burning plants. Other irritants are dyes used in soaps and facial and toilet tissue, other dyes, latex, furs, preservatives, drugs, detergents, cleaning compounds, cosmetics, chemicals, acids, and certain metals (e.g., nickel) used to make jewelry. Solar radiation and other forms of radiation, including exposure through a tanning bed, may cause the dermatitis. If an irritant remains in constant contact with skin, the dermatitis spreads.

REF: p. 209

OBJ: 4

7. _____ is an eruption of extremely painful vesicles that occur in a bandlike unilateral pattern

along the course of a peripheral nerve. a. Scabies b. Pediculosis c. Herpes zoster d. Acne vulgaris

ANS: C

Herpes zoster, or shingles, is an acute inflammatory dermatomal eruption of extremely painful vesicles. Shingles occurs in a bandlike unilateral pattern along the course of the peripheral nerves or dermatomes that are affected and do not cross the midline of the body (see Fig. 6.14).

REF: p. 216

OBJ: 6

8. The cause of acne vulgaris is a. unknown. b. thought to be linked to hormonal changes and predisposed by heredity. c. accompanied by plugs that promote the growth of bacteria in the follicles. d. All of the answer options.

ANS: D

The cause of acne vulgaris is unknown; however, research links it to hormonal changes of adolescence that affect the activity of the sebaceous glands. Hereditary tendencies are also known to be predisposing factors. Precipitating factors may include food allergies, endocrine disorders, psychologic factors, fatigue, and the use of steroid drugs. Sebum, an oily substance produced by the sebaceous glands, reaches skin surface through the hair follicle.

Overproduction of the oil seems to stimulate the follicle walls, causing a faster shedding of skin cells. This causes the cells and sebum to stick together and form a plug, which promotes the growth of bacteria in the follicles. This is the process by which pimples and nodules form.

REF: p. 215

OBJ: 5

9. Which treatments are used for cellulitis? a. Incision and drainage b. Immobilization, elevation, compresses, and antibiotics c. Antifungal medications d. All of the answer options ANS: B

Cellulitis is treated by immobilized and elevation of the extremity, compresses, and antibiotics. The warm compresses should be applied to increase circulation to the affected part. Systemic antibiotics, with penicillin being the drug of choice, are prescribed for the infection. Aspirin, nonsteroidal antiinflammatory drugs, or acetaminophen alone or in combination with codeine is given for pain. Hospitalization is indicated when cellulitis is severe.

REF: p. 220

OBJ: 8

10. Which statement(s) is/are true about scabies and pediculosis? a. They are the two most common parasitic infections to infest humans. b. Both are caused by impairment of blood supply to skin. c. They are diagnosed by visualization of the ulcers. d. All of the answer options are true.

ANS: A

Itch mites (scabies) and lice (pediculosis) are the two most common parasitic insects to infest humans.

REF: p. 223

OBJ: 11

11. Tinea capitis, tinea corporis, tinea pedis, and tinea cruris are manifestations of a. pediculosis. b. scabies. c. dermatophytosis. d. erysipelas.

ANS: C

Dermatophyte infections are classified by the body region they inhabit. All dermatophytosis lesions are characterized by an active border and are marked by scaling with central clearing.

Dermatophytosis occurring on the scalp is called tinea capitis; the body, tinea corporis; the nails, tinea unguium; the feet, tinea pedis (athlete’s foot); and the groin region, tinea cruris.

REF: p. 220

OBJ: 9

12. Preventive measures for a decubitus ulcer include a. good skin care. b. position changes every 2 hours. c. early ambulation. d. All of the answer options ANS: D

Preventive measures include frequent inspection of skin for signs of breakdown, alleviation of pressure points over bony prominences, good skin care, early ambulation when possible, position changes every 2 hours, passive range-of-motion exercises, and the use of special pads and mattresses.

REF: p. 223

OBJ: 10

13. The most common premalignant tumors are a. nevi. b. skin tags. c. epidermal cysts. d. Keloids.

ANS: A

Nevi (moles) are the most common premalignant tumors.

REF: p. 225

OBJ: 12

14. A precursor to skin cancer is a. squamous cell carcinoma (SCC). b. basal cell carcinoma (BCC). c. malignant melanoma. d. actinic keratosis.

ANS: D

Actinic keratoses are common premalignant lesions and are seen on sun-exposed areas of the body. They are caused by long-term exposure to the ultraviolet (UV) portion of sunlight, and their numbers increase with age. Light-skinned people have a higher risk.

REF: p. 227

OBJ: 12

15. The most serious type of skin cancer is a. squamous cell carcinoma (SCC). b. basal cell carcinoma (BCC). c. malignant melanoma. d. actinic keratosis.

ANS: C

Malignant melanoma is the most serious of the three types of skin cancer, but it is not as common as squamous cell carcinoma.

REF: p. 229

OBJ: 13

16. _____ is a serious form of skin cancer that often ulcerates, forms a crust, and has a tendency

to metastasize if allowed to reach an advanced stage. a. Squamous cell carcinoma b. Basal cell carcinoma c. Malignant melanoma d. Actinic keratosis ANS: A

SCC lesions often present as a crusted or scaly area with a red, inflamed base; as a growing tumor; as a nonhealing ulcer; or as a raised, firm papule (see Fig. 6.35). Hyperkeratosis is an important feature that distinguishes SCC from BCC. The ulcerated lesions may be painful.

REF: p. 228

OBJ: 13

17. Which characteristic is the most common sign of malignant melanoma? a. A smooth growth that is symmetrical b. Inflammation and bleeding of a skin lesion c. Hard-surfaced nodules with visible scales d. A change in a new or existing pigmented lesion or mole ANS: D

The most common sign of malignant melanoma is change in either a newly pigmented area of skin or a change in a mole that may have been present since birth or childhood. Most melanomas occur as solitary lesions. They can be found anywhere on skin, but are most common on the backs of men and the legs of women (see Fig. 6.36A and B).

REF: p. 229

OBJ: 13

18. The ABCDEs of malignant melanoma include a. family history, sunburn, large moles, bleeding, and previous cancer. b. asymmetry, border, color, diameter, and elevation. c. age, brown, color, diameter, elevation. d. Asymmetry, bleeding, color, diameter, equal sides.

ANS: B

ABCDEs of Malignant Melanoma • A = Asymmetry (lack of equality in the diameter)

• • • •

B = Border (notched, scalloped, or indistinct) C = Color (uneven, variegated—ranging from tan, brown, or black to red and white) D = Diameter (usually larger than 6 mm) E = Evolving (Any change in size, shape, color, elevation, or other trait, or any new symptom such as bleeding, itching, or crusting points to danger.)

REF: p. 230

OBJ: 13

19. Causes of alopecia (baldness) include a. chemotherapy and other medications. b. aging and heredity factors. c. certain systemic diseases. d. All of the answer options ANS: D

In most cases, baldness is a result of the aging process or heredity. It can, however, be a consequence of certain systemic illnesses, such as thyroid diseases, iron deficiency anemia, syphilis, or an autoimmune disease. Chemotherapy and radiation therapy are used to treat cancer, and some other types of medications may lead to thinning and loss of hair.

REF: pp. 234-235

OBJ: 16

20. A _____ is an abscess that involves the entire hair follicle and adjacent subcutaneous tissue. a. furuncle b. skin tag c. hemangioma d. keloid ANS: A

A furuncle, or boil, is a pus-containing abscess that involves the entire hair follicle and adjacent subcutaneous tissue. A carbuncle is either an unusually large furuncle or multiple furuncles that develop in adjoining follicles, connected by many drainage canals.

REF: p. 218

OBJ: 2

21. _____ is associated with severe itching followed by the appearance of redness and an area of

swelling (wheal) in a localized area of skin. a. Scabies b. Erysipelas c. Urticaria (hives) d. Psoriasis ANS: C

Urticaria, or hives, is associated with severe itching followed by the appearance of redness and an area of swelling (wheal) in a localized area of skin (see Fig. 6.7).

REF: p. 211

OBJ: 2

22. Which condition is a chronic inflammatory disorder of the facial skin, which causes redness,

primarily in the areas where individuals blush or flush? a. Impetigo b. Rosacea

c. Psoriasis d. Seborrheic dermatitis ANS: B

Rosacea, a chronic inflammatory disorder of the facial skin, causes redness, primarily in the areas where individuals blush or flush.

REF: p. 213

OBJ: 2

23. Warts, a cutaneous manifestation of human papillomavirus (HPV) infection, are a. localized hyperplastic areas of the stratum corneum layer of the epidermis. b. inflammatory reactions of the hair follicles. c. spread by touch or contact with skin shed from a wart. d. also termed vitiligo.

ANS: A

Warts are a cutaneous manifestation of HPV infection.

REF: p. 236

OBJ: 17

24. Folliculitis is an inflammation of a. hair follicles. b. sebaceous glands. c. fissure. d. comedo.

ANS: A

Folliculitis is an inflammatory reaction of the hair follicles that produces erythemic, pustular lesions (see Fig. 6.43).

REF: p. 237

OBJ: 2

25. Which term refers to dark pigment found in the basal layer of skin? a. Paronychia b. Melanin c. Sebum d. Melasma ANS: B

Skin normally contains special cells called melanocytes that produce melanin, a black pigment that gives color to skin.

REF: p. 231

OBJ: 1

26. Tinea pedis is also called a. ringworm. b. jock itch. c. athlete’s foot. d. barber’s itch.

ANS: C

Tinea pedis, also referred to as athlete’s foot, is characterized by intense burning, stinging pruritus between the toes and on the soles of the feet (see Fig. 6.21). Skin can become inflamed, dry, and peeling, and fissures (see Fig. 6.2J) may develop.

REF: p. 221

OBJ: 9

27. Acrochordon, common benign skin growths, may also be called a. skin tags. b. actinic keratosis. c. epidermal cyst. d. keloids and hypertrophic scars.

ANS: A

Acrochordon are called skin tags. Other common benign and premalignant tumors include seborrheic keratoses, dermatofibromas, keratoacanthomas, keloids and hypertrophic scars, epidermal (sebaceous) cysts, actinic keratoses, and nevi.

REF: p. 225

OBJ: 12

28. Which option/s are functions of skin? a. Protecting the body from trauma, infections, and toxic chemicals b. Synthesizing vitamin D c. Regulating body temperature d. All of the answer options ANS: D

Skin, one of the largest organs, protects the body from trauma, infections, and toxic chemicals. When exposed to sunlight, skin synthesizes vitamin D. Within skin are millions of tiny nerve endings called receptors. These receptors sense touch, pressure, pain, and temperature. In addition to skin’s roles in protection, sensation, and synthesis of vitamin D, skin assists in the regulation of body temperature and in excretion.

REF: p. 205

OBJ: 1

TRUE/FALSE 1. Appearance and location of lesions confirm the diagnosis of each of the three types of skin

carcinoma.

ANS: F

Unusual skin lesions are often identified by the patient or by the physician on examination of skin. A biopsy (usually a punch biopsy) of the lesion is required for definitive diagnosis.

Patients with SCC should have a lymph node examination to assess for nodal metastasis.

Those with high-risk SCC may also require a computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) scan to evaluate for disease spread. SCC is staged according to the TNM (tumor, nodes, metastasis) staging system.

REF: p. 229

OBJ: 2

2. BCC is the most common type of skin cancer.

ANS: T

Collectively, skin cancers, BCC, SCC, and malignant melanoma represent the most common type of malignancy. In fact, BCC is the most prevalent form of cancer worldwide.

REF: p. 227

OBJ: 13

3. A guideline for preventing excessive sun exposure is to avoid sunlight between 10 AM and 3

PM when UV rays are the strongest.

ANS: T

The guidelines for preventing excessive sun exposure are to avoid sunlight between 10 AM and 3 PM, when UV rays are the strongest. Planning outdoor activities for early morning or late afternoon is another measure. Wearing protective clothing, especially a hat when outside, is also beneficial. Applying sunscreen with a sun protection factor of at least 15, applied 15 to 30 minutes before exposure and again after getting wet, especially after swimming.

REF: p. 231

OBJ: 14

4. Itch mites and lice spread easily from one person to another by close physical contact.

ANS: T

Itch mites and lice can infest anyone at any age. Both are spread easily from one person to another by close physical contact. Transmission occurs most often between children playing together, family members, and sexual partners.

REF: p. 224

OBJ: 11

5. Warts are caused by a noninfectious fungal infection.

ANS: F

Warts are a cutaneous manifestation of HPV infection. The three most often seen are common warts, plantar warts, and flat warts. Warts are caused by viruses and are spread by touch or contact with skin shed from a wart. Each of the types of viruses known to cause warts tends to infect a different part of the body.

REF: p. 236

OBJ: 17

6. The function of the subcutaneous layer of skin is to insulate the body against heat loss.

ANS: T

Third is the subcutaneous layer, a thick, fat-containing section that insulates the body against heat loss.

REF: p. 205

OBJ: 1

7. Contact dermatitis is an acute inflammation response of skin triggered by an exogenous

chemical or substance.

ANS: T

Contact dermatitis is an acute inflammation response of skin triggered by an exogenous chemical or substance.

REF: p. 208

OBJ: 4

8. Keloids occur secondary to trauma or surgery.

ANS: T

Keloids and hypertrophic scars occur secondary to trauma or surgery. A keloid first appears normal, but after several months, it becomes noticeably larger and thicker (see Fig. 6.30).

REF: p. 226

OBJ: 2

9. Disorders that can produce nail deformities include psoriasis, lichen planus, and chronic

paronychia causing the end of the nail to separate from the underlying skin. Bacteria can enter this space and make the nail turn a blackish green.

ANS: T

Injury to the nail bed caused by continuous pressure from ill-fitting shoes or poor circulation caused by arteriosclerosis can lead to thickening of the whole nail. Many disorders can produce nail deformities. Psoriasis, lichen planus, and chronic paronychia can cause the end of the nail to separate from the underlying skin. Bacteria can enter this space and make the nail turn a blackish green. Iron deficiency anemia can cause spooning of the nails. Congenital heart disorders and lung cancer can cause clubbing, or knobby ends of the fingers or toes, and then cause the nails to grow around these ends.

REF: p. 238

OBJ: 18

Chapter 07: Diseases and Conditions of the Musculoskeletal System Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Which term is a lateral curvature of the spine? a. Kyphosis b. Lordosis c. Lumbago d. Scoliosis ANS: D

Scoliosis is a lateral (sideways) curvature of the spine. Scoliosis typically is congenital, but some diseases can also cause it.

REF: p. 251

OBJ: 3

2. Which statement(s) about fibromyalgia is/are true? a. It is a painful debilitating syndrome that causes chronic pain in muscles and soft

tissues surrounding joints b. May be aggravated by poor posture, inappropriate exercise, weight, and smoking c. Appears to be linked to changes in how the brain and spinal cord process pain

signals

d. All of the answer options are true.

ANS: D

Fibromyalgia, one of the most common diseases affecting the muscles, causes chronic pain in muscles and soft tissues surrounding joints. Fatigue is extremely common in patients with this condition. It may be aggravated by poor posture, inappropriate exercise, weight, and smoking.

Fibromyalgia appears to be linked to changes in how the brain and spinal cord process pain.

REF: p. 247

OBJ: 3

3. Chronic, progressive, inflammatory disease of bones and joints caused by degenerative

changes in the cartilage is called a. chondromalacia. b. osteochondroma. c. osteoarthritis. d. rheumatoid arthritis (RA).

ANS: C

Osteoarthritis is a chronic, progressive, inflammatory disease of bones and joints caused by degenerative changes in the cartilage. It also known as degenerative joint disease or degenerative arthritis, and is the most common form of arthritis. It develops as a result of normal wear and tear on the joints and is most common in the older adults, being almost universal in those older than 75 years.

REF: p. 252

OBJ: 2

4. A tick-carried bacterium causes _____, which is characterized by symptoms of arthritis,

malaise, myalgia, and neurologic and cardiovascular signs. a. ankylosing spondylitis b. Lyme disease c. systemic lupus erythematosus d. kyphosis ANS: B

Ticks that bite skin spread Lyme disease by injecting the bacterium from their guts into the human body when securing a blood meal.

REF: p. 254

OBJ: 4

5. An infection in a bone, which can lead to an abscess formation and sequestrum if not properly

cared for, is called a. osteomyelitis. b. rickets. c. osteochondroma. d. osteitis.

ANS: A

Inflammation, swelling, localized heat, redness, pain, and local tenderness over and around the affected bone are characteristic signs and symptoms of osteomyelitis. Other signs and symptoms of osteomyelitis include chills, fever, sweating, and malaise. As the infection progresses, a purulent material called a subperiosteal abscess may develop. Osteomyelitis usually requires extensive, long-term antibiotic treatment with follow-up care to prevent recurrent infections.

REF: pp. 256-257

OBJ: 5

6. Which condition is an inflammation of the joints caused by excessive uric acid levels in the

blood and joints? a. Myositis b. Bursitis c. Fibrositis d. Gout ANS: D

Gout results from excessive uric acid levels in the blood and joints.

REF: p. 257

OBJ: 7

7. Which characteristic is true of bursitis? a. Curable b. Involves the joint c. Prognosis for bursitis is guarded with treatment d. Heat applications are recommended ANS: A

Bursitis is curable. With treatment and proper attention to any underlying cause, the outlook is excellent.

REF: p. 256

OBJ: 8

8. Which term is wasting away or deterioration of muscle? a. Hypertrophy b. Ankylosis c. Atrophy d. Myositis ANS: C

Permanent muscle atrophy can result from tendon damage.

REF: p. 273

OBJ: 6

9. A vitamin D deficiency can result in which metabolic bone disease? a. Osteoporosis b. Osteogenesis imperfecta c. Osteomalacia d. Osteoclasis ANS: C

Osteomalacia is a metabolic bone disease resulting from deficiency or ineffective use of vitamin D, which is essential for proper bone formation. Without adequate vitamin D, the body cannot absorb and use the bone-building minerals (calcium and phosphorus).

REF: p. 265

OBJ: 1

10. Which statement is true about osteomalacia? a. Osteomalacia can be caused by too much sunlight. b. Osteomalacia is called rickets in children and can impact the growing skeleton. c. The treatment involves taking vitamin B. d. None of the answer options is true.

ANS: B

Osteomalacia causes the bones to become increasingly soft, flexible, and deformed. When the disorder occurs in children, it impacts the growing skeleton and is called rickets.

REF: p. 265

OBJ: 11

11. _____ is an injury that is the result of overuse, overstretching, or forcible stretching of a

muscle beyond its functional capacity. It sometimes involves a tendon or ligament. a. Avulsion b. Sprain c. Shin splints d. Strain ANS: D

A strain is an injured tendon, muscle, or other tissue resulting from overuse, overstretching, or excessive forcible stretching of the tissue beyond its functional capacity.

REF: p. 270

OBJ: 11

12. A bone that is normally in contact with a joint but becomes separated from that joint causing

loss of joint function describes which condition? a. Fracture b. Separation c. Dislocation d. Dorsiflexion ANS: C

A bone that becomes separated from a joint results in a dislocation. Traumatic dislocations require immediate emergency medical care. Occasionally the injury that causes the dislocation also causes a fracture.

REF: p. 271

OBJ: 12

13. The onset of a stiff and painful shoulder after injury or a period of disuse is typical of which

condition? a. A compression injury of the shoulder b. A shoulder avulsion c. Bursitis d. Adhesive capsulitis (―frozen shoulder‖)

ANS: D

Adhesive capsulitis is a condition in which a shoulder is significantly limited in its range of motion (ROM) as a result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. With time the pain subsides, but the mobility of the shoulder often remains permanently impaired, or frozen.

REF: p. 272

OBJ: 16

14. _____ is/are a tendon injury that produces immediate, severe pain, inflammation, and

immobility of the affected part. a. Tendonitis b. Fracture c. Severed tendon d. All of the answer options ANS: C

Tendons are long, fibrous cords that connect muscles to bones (e.g., the Achilles tendon connects the gastrocnemius muscle to the calcaneus bone at the back of the heel). A severed tendon is torn completely into two sections and thus prevents the muscle from performing its function of moving a body part.

REF: p. 273

OBJ: 17

15. An inflammatory response at the heel bone, which is a common problem in individual’s active

in sports and especially in runners, is a. Neither answer options b. plantar fasciitis. c. spur. d. Both answer options ANS: D

Plantar fasciitis, also known as calcaneal, or heel spur syndrome, is an inflammatory response at the bottom of the heel bone (calcaneus).

REF: p. 274

OBJ: 17

16. Which injury involves the semilunar cartilages in the knee? a. Rotator cuff tear b. Torn meniscus c. Sciatic d. Compression ANS: B

A torn meniscus is a crack or fissure that is usually a result of wear or injury. The injured knee should be immobilized immediately and elevated, with ice applied to slow bleeding and edema. No weight bearing should be allowed, and the physician should be seen as soon as possible. Antiinflammatory or analgesic medications are often needed.

REF: p. 276

OBJ: 19

17. _____ is an injury to the shoulder muscles and is usually the result of acute trauma or

degenerative changes. It leaves the individual unable to abduct his or her arm.

a. b. c. d.

A strain A frozen shoulder A torn rotator cuff Bursitis

ANS: C

A torn rotator cuff is usually the result of acute trauma or degenerative changes.

REF: p. 278

OBJ: 20

18. _____ is a surgical procedure necessary because of peripheral vascular disease and consequent

gangrene. Trauma, malignancy, or congenital defects are additional reasons. a. Amputation b. Arthroscopy c. Fasciectomy d. None of the answer options ANS: A

An amputation can range from removal of a portion of a digit to a complete disarticulation at the hip or shoulder. Amputations are performed because of peripheral vascular disease and consequent gangrene.

REF: p. 270

OBJ: 21

19. An unpleasant sensation or complication that sometimes follows the removal of an appendage

is called a. fibromatosis. b. myositis. c. phantom limb. d. sciatica.

ANS: C

Phantom pain is the feeling that the limb is still attached when it has been removed. Phantom limb pain of the leg can present as a burning sensation of the foot or as a feeling of having the toes stepped on when no limb exists.

REF: p. 270

OBJ: 14

20. A degenerative disorder of the metatarsal-phalangeal joint of the great toe is called a. hammertoe. b. hallux valgus. c. hallux rigidus. d. polymyositis.

ANS: C

Hallux rigidus is a stiff big toe that develops as a result of degeneration of the cartilage of the first metatarsophalangeal joint.

REF: p. 266

OBJ: 14

21. Which structure is a strong, tough strand or cord of dense connective tissue that serves as

attachment for muscle to bone?

a. b. c. d.

Ligament Cartilage Collagen A tendon

ANS: D

Tendons are tough strands, or cords, of dense connective tissue. They serve to attach muscles to bones and other parts.

REF: p. 245

OBJ: 12

22. The major supporting element or ―glue‖ in the connective tissue is a. ligaments. b. cartilage. c. collagen. d. tendons.

ANS: C

Collagen, a fibrous protein, constitutes 30% of the total body protein and is the major supporting element, or glue, in the connective tissues between the cells that holds them together.

REF: p. 247

OBJ: 1

23. Tough, dense, fibrous bands of connective tissue that hold bones together are called a. ligaments. b. cartilage. c. collagen. d. tendons.

ANS: A

Tough, dense, fibrous bands of connective tissue that hold bones together are called ligaments.

REF: p. 245

OBJ: 1

24. Which statement/s is/are true about osteoporosis? a. Osteoporosis rarely causes permanent disability. b. Osteoporosis is a silent disease until a bone breaks to cause pain. c. No specific diagnostic data are available to confirm osteoporosis. d. All of the answer options are true.

ANS: B

Osteoporosis is a silent disease until a bone breaks to cause pain. Collapse of vertebrae from the weakened bone of osteoporosis is often responsible for the hunchback (dowager’s hump) that develops in the older person, particularly the postmenopausal woman.

REF: p. 264

OBJ: 1

25. Which statement is true about Lyme disease? a. Curable with early treatment b. Vaccine is readily available

c. Only exists in the northeast part of the United States d. Diagnosed by throat swab ANS: A

Lyme disease is curable with antibiotics. The outlook for patients with Lyme disease is dependent on how early it is detected.

REF: p. 255

OBJ: 10

26. Which risk factors are included in those for primary bone tumors? a. Prior chemotherapy or radiation therapy (RT) b. A history of Paget’s disease c. History of benign bone tumors d. All of the answer options ANS: C

Risk factors for primary bone tumors include prior chemotherapy, RT, or a history of Paget’s disease or other benign bone lesions. Bone tumors, whether benign or malignant, are treated by surgical excision. The surrounding muscle, bone, and other tissue are often removed also, and bone grafting may be needed. The goal is to perform limb-sparing surgery, but tumor location and extent may necessitate amputation.

REF: p. 262

OBJ: 5

27. A patient reporting bone pain, with or without local swelling, and systemic symptoms a. requires a timely medical evaluation. b. needs the earliest appointment available. c. Neither of the answer options. d. Both of the answer options.

ANS: D

A patient having bone pain with or without local swelling and systemic symptoms must be evaluated for fracture and infection of bone along with blood calcium and alkaline phosphatase levels. The earliest appointment available should be scheduled.

REF: p. 261

OBJ: 9

28. A bone tumor weakens the bone and makes it more susceptible to fracture when subjected to

the slightest strain. This is called a. a simple fracture. b. a pathologic fracture. c. Both of the answer options d. None of the answer options ANS: B

A pathologic fracture occurs because of another problem. Diseases such as neoplasms, tuberculosis of the bone, Paget’s disease, and osteoporosis cause pathologic fractures, which occur without significant external trauma.

REF: p. 261 TRUE/FALSE

OBJ: 9

1. Tumors in muscles are usually malignant.

ANS: F

Neoplasms of muscle include benign tumors or malignant sarcomas that may arise at any site in the body. Malignant tumors are more rare than benign tumors. Surgical resection of the tumor is performed for all tumors, benign or malignant.

REF: p. 263

OBJ: 9

2. Osteoporosis occurs 4:1 more times in men than women.

ANS: F

Osteoporosis occurs more often in women than men, especially in postmenopausal women.

Women who are small boned, who come from northern European or Asian backgrounds, who smoke, and who have a family history of the disease are at the greatest risk for osteoporosis.

REF: p. 264

OBJ: 9

3. A bunion is also called hallux valgus.

ANS: T

A bunion is often the result of a foot disorder known as hallux valgus, in which the great toe is positioned toward the midline of the body. The condition has also been associated with RA. REF: p. 265

OBJ: 10

4. A strained muscle is more serious than a sprained muscle.

ANS: F

Sprains may include damage to blood vessels and nerves, and edema, ecchymosis, and sharp, transient pain may develop.

REF: p. 270

OBJ: 12

5. Muscles are classified as either voluntary or involuntary.

ANS: T

Skeletal muscle is voluntary and is under the control of the conscious mind. Smooth muscle and heart muscle are involuntary and function without conscious control or awareness.

REF: p. 244

OBJ: 15

6. The skeletal system is composed of 306 bones.

ANS: F

The skeletal system is composed of 206 bones. These serve to provide an important support system for the many body parts, enabling a person to assume various body postures.

REF: p. 244

OBJ: 1

7. The complete skeleton is formed by the end of the third month of gestation.

ANS: T

The fetal skeleton is composed of cartilage tissue, which is replaced gradually by bone cells in a process called ossification. The complete skeleton is formed by the end of the third month of fetal age.

REF: p. 245

OBJ: 1

8. The majority of joints are of the slightly movable type.

ANS: F

Slightly movable (amphiarthrodial) joints (e.g., the intervertebral joints and the pubic symphysis) are connected by cartilage. These are not the most abundant type joints in the body.

REF: p. 245

OBJ: 1

9. Inflammation of the bursae is called polymyositis.

ANS: F

Bursitis is inflammation of a bursa. A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.

REF: p. 255

OBJ: 1

10. When it is necessary for a patient with osteoarthritis to use a cane to lessen the strain on a

joint, always examine cane tips to be certain that they are not dangerously worn.

ANS: T

The tips on assistive devices such as canes should be checked periodically. For supportive care, it may be necessary to use a cane, walker, braces, or crutches to lessen the strain on some joints.

REF: p. 253

OBJ: 6

11. Overuse and overpronation are the most common factors that predispose an individual to shin

splints.

ANS: T

Pronation of the foot is an inward rotation of the ankle that causes the inner arch of the foot to sag and the ankle joint to tip upward. Excessive pronation places abnormal stress on the calf muscles. This leads to the development of shin splints and tendon and ligament strain around the ankles and knees.

REF: p. 274

OBJ: 4

12. Fractures, or broken bones, are classified by the nature of the fracture, which is the result of

the mechanism of injury.

ANS: T

Fractures are classified by the nature of the fracture. They can occur in any bone in the body.

REF: p. 268

OBJ: 18

Chapter 08: Diseases and Conditions of the Digestive System Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Gingivitis that is not treated may lead to which condition? a. Plaque b. Periodontitis c. Discoloration of the teeth d. Impacted molars ANS: B

Advanced cases of gingivitis can cause loss of healthy teeth and periodontitis.

REF: pp. 285-286

OBJ: 2

2. Pain and limitation of the movement of the jaw with tinnitus as a result of inflammation of the

temporomandibular joints is characteristic of which condition? a. TMJ syndrome b. Gingivitis c. Periodontitis d. Dental caries ANS: A

TMJ syndrome is a symptom complex related to inflammation, disease, or dysfunction of the temporomandibular joints.

REF: p. 289

OBJ: 3

3. Oral thrush, a fungal infection that produces sore patches in the mouth and throat, may be the

result of a. leukoplakia. b. plaque. c. prolonged antibiotic therapy. d. All of the answer options ANS: C

The fungus Candida albicans causes most cases of thrush. Those who have had treatment with antibiotics should report any signs of thrush.

REF: p. 292

OBJ: 4

4. What is the treatment of oral leukoplakia? a. The application of a brace b. Tooth extraction c. Root canal d. Finding or correcting the source of irritation ANS: D

The treatment of leukoplakia consists of eliminating the source of the irritation. A rough tooth or denture may be smoothed, and giving up smoking may be advised.

REF: p. 294

OBJ: 5

5. The diagnostic evaluation for peptic ulcers might include a. endoscopy and biopsy of the lesion. b. patient history. c. upper gastrointestinal (GI) barium series and the study of gastric contents and stool

for evidence of bleeding. d. All of the answer options ANS: D

Diagnosis of a peptic ulcer can be suspected based on the patient’s history and physical examination; an endoscopy and biopsy of the lesion; and upper GI barium series and the study of gastric contents and stool for evidence of bleeding.

REF: p. 302

OBJ: 9

6. Agents that may damage the gastric lining and cause gastritis include a. medications. b. mechanical injury. c. irritation from foods. d. All of the answer options ANS: D

Many agents damage the gastric lining, including common medications, such as aspirin and other anti-inflammatory drugs. Mechanical injury and irritation from foods are also other causes of damage to the gastric lining.

REF: p. 303

OBJ: 9

7. Which treatments are used when treating gastric cancer? a. Control of symptoms by using Valsalva maneuver b. Antibiotic therapy, bland diet, and anti-inflammatory drugs c. Gastric resection usually followed by chemoradiotherapy d. Anti-inflammatory drugs ANS: C

The treatment regimen for gastric cancer is identified following accurate tumor staging.

Gastric resection, often followed by combined chemoradiotherapy, offers the best chance of long-term survival for patients with localized disease.

REF: p. 305

OBJ: 10

8. Abdominal discomfort with maximum tenderness of the abdomen at McBurney point, nausea,

vomiting, fever, diarrhea, or constipation are clinical signs of which condition? a. Hiatal hernia b. Gastric cancer c. Gastritis d. Appendicitis

ANS: D

Abdominal discomfort with maximum tenderness of the abdomen at McBurney point, nausea, vomiting, fever, diarrhea, or constipation are clinical signs of appendicitis.

REF: p. 306

OBJ: 11

9. Which etiology is associated with hiatal hernia? a. Swallowing a foreign body b. A weakness that develops in the diaphragm c. Lack of dietary bulk d. Too much dietary bulk ANS: B

A hiatal hernia is a weakness or defect in the diaphragm that permits a segment of the stomach to slide into the thoracic cavity.

REF: p. 306

OBJ: 12

10. Which diagnosis is a fairly common chronic inflammatory disease of the alimentary canal

involving all layers of the bowel, which causes chronic diarrhea? a. Acute gastritis b. Hiatal hernia c. Crohn disease d. Diverticulosis ANS: C

Crohn disease is a chronic inflammatory disorder of the alimentary canal in which all layers of the bowel wall are edematous and inflamed. Any portion of the GI tract from mouth to anus can be affected and the condition causes chronic diarrhea.

REF: p. 309

OBJ: 14

11. ―Traveler’s diarrhea,‖ a common syndrome of gastroenteritis, is usually caused by a. ingestion of food or water contaminated with bacteria. b. a virus. c. a drug reaction. d. an allergic reaction.

ANS: A

Ingestion of disease-causing bacteria or parasites from contaminated food or water is the primary cause of traveler’s diarrhea, whereas ―stomach flu‖ is usually the result of a virus.

REF: p. 312

OBJ: 15

12. What causes mechanical obstruction of the bowel? a. Ileus or a paralytic condition of the small bowel b. The use of broad-spectrum antibiotics c. Neoplasm, fecal impaction, volvulus, or intussusception d. None of the answer options ANS: C

Mechanical blockage of the bowel narrows the normal lumen and prevents the flow of intestinal contents. Mechanical causes of intestinal obstruction include neoplasm, fecal impaction, volvulus, or intussusception.

REF: p. 312

OBJ: 17

13. A condition in which out-pouches of the mucosa penetrate weak points in the muscular layer

of the large intestine is called a. hiatal hernia. b. peritonitis. c. diverticulitis. d. diverticulosis.

ANS: D

Diverticulosis is a progressive condition, common with age, characterized by defects in the muscular wall of the large bowel. Diverticulitis is an infection of one or more diverticula.

REF: p. 313

OBJ: 18

14. The earliest signs and symptoms of colorectal cancer are a. often vague and nonspecific. b. obvious and easy to detect in most cases. c. an intestinal obstruction. d. peritonitis.

ANS: A

Signs and symptoms in the early stages are often vague and nonspecific. Most patients with colorectal cancer have one or more of the following signs or symptoms at presentation: abdominal pain, change in bowel habits (diarrhea, constipation), bloody stools, weakness, weight loss, or symptoms related to iron deficiency anemia.

REF: p. 316

OBJ: 19

15. Pseudomembranous enterocolitis is related to a. inflammation of the peritoneum. b. short bowel syndrome. c. use of broad-spectrum antibiotics. d. hemorrhoids.

ANS: C

Pseudomembranous enterocolitis is often related to the use of broad-spectrum antibiotics; the patient is either taking the antibiotics or has been undergoing antibiotic therapy during the previous 6 weeks. Antibiotic therapy reduces the body’s protective natural intestinal flora (along with the target pathogens) and allows a bacterial infection with Clostridium difficile to develop.

REF: p. 317

OBJ: 20

16. Inflammation, infection, or irritation of the large serous membrane that lines the abdominal

cavity and folds over the visceral organs is called a. peritonitis. b. esophagitis.

c. appendicitis. d. diverticulitis.

ANS: A

Peritonitis is inflammation, infection, or irritation of the large serous membrane that lines the abdominal cavity and folds over the visceral organs. The inflammation of the peritoneum can be acute or chronic and local or generalized.

REF: p. 320

OBJ: 22

17. Which statement is true about cirrhosis of the liver? a. It is a chronic but reversible degeneration of the liver. b. The disease is usually idiopathic. c. The symptoms are all related to digestion. d. Causes loss of appetite and weight, nausea, vomiting and abdominal distention.

ANS: D

As the liver is destroyed and cirrhosis occurs, the patient experiences loss of appetite and weight, nausea and vomiting, indigestion, abdominal distention (caused by ascites), and edema. As the cirrhosis advances, memory is impaired, and confusion and drowsiness occur and intensify. If cirrhosis is left untreated, hepatic failure and death eventually follow.

REF: p. 322

OBJ: 23

18. Viral hepatitis A is usually transmitted by which route? a. The fecal-oral b. Contaminated food, water, and stools c. Poor hygiene d. Respiratory ANS: A

The causative virus, hepatitis A virus (HAV), is highly contagious and is transmitted by the fecal-oral route from contaminated food (including shellfish and contaminated raw fruit and vegetables), water, and stools. HAV is present in the stool before symptoms are evident.

Vaccination against hepatitis A is recommended before travel into areas where hepatitis A is prevalent and where sanitation is poor.

REF: p. 323

OBJ: 24

19. Cancer of the liver is a. usually a primary cancer. b. usually a secondary cancer. c. likely to have a good prognosis. d. likely to be discovered early.

ANS: A

Hepatocellular carcinoma (HCC) is a primary tumor of the liver that usually arises in the setting of chronic liver disease. The most important etiologic factor in cancer of the liver worldwide is hepatitis B virus infection. Additional risk factors include hereditary hemochromatosis, cirrhosis resulting from any cause.

REF: p. 326

OBJ: 25

20. Cholelithiasis, which causes obstruction of bile ducts, causes the patient to experience which

symptoms? a. Colicky pain, rectal bleeding, and hobnail liver b. No symptoms at all c. Colicky pain over McBurney point d. Biliary colic, with radiating pain and jaundice ANS: D

Acute onset of biliary colic with nausea, vomiting, chills, fever, and jaundice requires a prompt medical evaluation. Most cholecystitis results from an obstruction of the gallbladder caused by gallstones. Trauma or other insult to the gallbladder, including infection, is occasionally the cause.

REF: p. 329

OBJ: 27

21. Inflammation of the gallbladder commonly associated with gallstones is called ___________. a. pancreatitis. b. cholecystitis. c. cholelithiasis. d. hepatitis.

ANS: B

Most cholecystitis results from an obstruction of the gallbladder caused by gallstones. Trauma or other insult to the gallbladder, including infection, is occasionally the cause. Patients with longstanding gallstone disease can develop chronic cholecystitis.

REF: p. 329

OBJ: 27

22. Signs and symptoms of malnutrition can result from a. eating too much or too little. b. a malabsorption syndrome. c. a case involving severe burns or other severe trauma. d. All of the answer options ANS: D

Signs and symptoms of malnutrition can result from eating too little or too much, malabsorption syndrome, severe burns, or other severe trauma. As the malnutrition continues, the hair and nails become brittle and rashes develop. Nutritional status assessment is a priority.

REF: p. 332

OBJ: 30

23. Which disease of the small intestine is characterized by malabsorption, gluten intolerance, and

damage to the lining of the intestine? a. Short bowel syndrome b. Diverticulitis c. Crohn disease d. Celiac sprue ANS: D

Celiac sprue is characterized by malabsorption, gluten intolerance, and damage to the lining of the intestine. For a positive diagnosis, three criteria are needed: (1) positive serologic testing, (2) a biopsy of the small intestine showing changes or destruction in the mucosal lining, and (3) improvement while on a gluten-free diet.

REF: p. 335

OBJ: 31

24. Which diagnosis is linked to a psychologic disturbance in which hunger is denied by

self-imposed starvation? a. Anorexia nervosa b. Bulimia c. Malabsorption syndrome d. Volvulus ANS: A

Anorexia nervosa is linked to a psychologic disturbance in which hunter is denied by self-imposed starvation. The typical anorectic patient is a female adolescent who is meticulous, is a high achiever, and refuses food intake; she is preoccupied with obesity and obsessed with her weight. Although she experiences continued weight loss, she does not believe that anything is wrong.

REF: p. 337

OBJ: 33

25. The most serious complications of bulimia and anorexia nervosa include a. loss of weight. b. denial and anger. c. electrolyte imbalance and cardiac irregularities. d. a morbid fear of being fat.

ANS: C

The binge-purge eating pattern of bulimia is fueled by a morbid fear of becoming fat.

Vomiting can result in poor dentition, pharyngitis, esophagitis, aspiration, and electrolyte abnormalities. Anorexia can also cause electrolyte imbalance and cardiac irregularities. The prognosis varies with the nature and severity of malnutrition of both diseases.

REF: p. 338

OBJ: 33

26. Which of the following statement(s) is/are true about hepatitis C? a. It is considered a widespread epidemic. b. The source of infection is usually known. c. Most patients do not develop cirrhosis. d. Health care workers are not considered at risk.

ANS: A

Hepatitis C virus (HCV), considered a widespread epidemic, is the most common bloodborne infection in the United States. Many of those infected with HCV, often young adults, are asymptomatic and may unknowingly infect others.

REF: p. 325

OBJ: 26

27. The treatment of gastroesophageal reflux disease (GERD) includes a. a light evening meal 4 hours before bedtime.

b. the use of an H2-receptor antagonist or a proton pump inhibitor. c. elevation of the head of the bed about 6 inches. d. All of the answer options ANS: D

Treatment of GERD includes a light evening meal rather than a large one four hours before bedtime, use of an H2-receptor antagonist or a proton pump inhibitor. Elevation of the head of the bed is also recommended.

REF: p. 296

OBJ: 6

28. The causal factor(s) of peptic ulcers is/are a. H. pylori infection. b. NSAIDs. c. chronic gastritis. d. All of the answer options ANS: D

Although the cause is not always clear, an area of breakdown of mucous membrane precipitates ulceration of the epithelial lining of the stomach or intestine. This can occur because of use of NSAIDs and chronic gastritis. A crucial causal factor of peptic ulcers is H. pylori infection, thought to be the most common worldwide human bacterial infection.

REF: p. 302

OBJ: 9

29. The management of peptic ulcers most frequently involves which measures? a. Rest, changes in diet, adjustments of lifestyle, and drug therapy b. The use of an ulcerogenic drug and surgical intervention c. Increased physical activity d. Surgical intervention in all cases ANS: A

The management of peptic ulcers requires rest, medication, changes in the diet, and adjustments in lifestyle especially for stress reduction. Surgery may be indicated in severe cases. If etiology is confirmed (e.g., the use of an ulcerogenic drug, such as aspirin, NSAIDS, or alcohol), the identified agent must be eliminated.

REF: p. 302

OBJ: 9

30. The causes of pancreatitis include a. alcoholism, trauma, and infection. b. biliary tract disease, structural anomalies, and drugs. c. None of the answer options d. Both of the answer options ANS: D

Acute pancreatitis is thought to result from the ―escape‖ of activated pancreatic enzymes from acinar cells (i.e., cells of the tiny lobules of the gland) into surrounding tissues. Alcoholism, trauma, infection, biliary tract disease, structural anomalies, and drugs can cause pancreatitis.

Gallstones are often the cause of pancreatitis in the nonalcoholic individual. Less often, the cause is a metabolic or endocrine disorder. Some cases are idiopathic. Smoking may increase the risk of alcoholic and idiopathic pancreatitis.

REF: p. 330

OBJ: 22

31. Crohn disease is a chronic, relapsing inflammatory disorder of the alimentary canal a. in which all layers of the bowel are edematous and inflamed. b. whose cause is easily identified. c. that is considered medically curable. d. that usually has no complications.

ANS: A

Crohn disease is a chronic inflammatory disorder of the GI tract that affects up to 480,000 persons in the United States. It is also called regional enteritis.

REF: p. 309

OBJ: 14

32. Intestinal obstruction can be a. mechanical. b. functional. c. partial or complete. d. All of the answer options ANS: D

Intestinal obstruction is mechanical or functional blockage of the intestines. Intestinal obstruction occurs when the contents of the intestine cannot move forward because of a partial or complete blockage of the bowel. The obstruction can be mechanical, functional, partial, or complete.

REF: p. 312

OBJ: 16

33. Patient teaching for patients with colorectal cancer will include which information? a. Avoiding discussion of the side effects of treatment so as not to frighten the patient b. Limiting the patient’s time to ask questions so that he or she does not become

anxious c. Informing the patient that family members have increased risk and should undergo

screening d. All of the answer options ANS: C

High-risk patients should start screening by age 40, or 10 years younger than the earliest colorectal cancer diagnosis in their family, with repeat screening every 5 years. Those with familial cancer syndromes should begin screening in the third decade of life. Patients with a history of colorectal cancer should receive surveillance colonoscopy at 1 year and then every 3 to 5 years to screen for new cancer.

REF: p. 317

OBJ: 19

34. A key feature of irritable bowel syndrome (IBS) is a. that it is a mechanical bowel disorder. b. a change of bowel habits with predominant diarrhea or constipation. c. that it is associated with GERD. d. pain is involved but no changes in normal stool.

ANS: B

IBS is a functional bowel disorder characterized by chronic abdominal pain or discomfort, bloating, and erratic dysfunction of bowel habits.

REF: p. 319

OBJ: 20

35. Celiac disease a. is a disease of the small intestine. b. is characterized by malabsorption, gluten intolerance, and damage to the lining of

the intestine. c. requires a lifelong compliance with a strict gluten-free diet. d. All of the answer options ANS: D

Celiac disease (celiac sprue) is a disease of the small intestine that is characterized by malabsorption, gluten intolerance, and damage to the lining of the intestine. It requires a lifelong compliance with a strict gluten-free diet.

REF: p. 335

OBJ: 31

36. Which disease has the higher morbidity and mortality rate than any other source of GI

bleeding? a. Bleeding esophageal varices b. Diverticulitis c. Hiatal hernia d. Hemorrhoids ANS: A

Bleeding esophageal varices have a higher morbidity and mortality rate than any other source of upper GI bleeding. The long-term prognosis is somewhat guarded because of the tendency to hemorrhage. Forty percent of patients die with the first episode of massive hemorrhage. Of those who survive, recurrent bleeding frequently occurs within 1 year, with a similar mortality rate for each episode.

REF: p. 298

OBJ: 8

37. Which test for esophagitis that is considered a superior method and includes a biopsy? a. Liver function study b. Esophagoscopy c. A chest x-ray d. A barium study ANS: B

Assessment begins with patient history and radiographic film of the upper GI tract (esophagoscopy) to confirm diagnosis and determine the extent of inflammation and tissue damage.

REF: p. 296

OBJ: 8

38. Patients with Barrett esophagus usually undergo endoscopies to screen for progression to a. adenocarcinoma. b. osteosarcoma.

c. Both of the answer options d. None of the answer options ANS: A

Those with Barrett esophagus usually undergo endoscopies to screen for progression to adenocarcinoma. Although no management strategy has been proven to prolong life, there are several options currently in use: treatment of GERD, endoscopic surveillance to detect dysplasia, and treatment of the dysplasia.

REF: p. 301

OBJ: 7

39. Which statement is true about food poisoning? a. Symptoms are not related to the cause. b. Infection control is the first line of defense. c. Food poisoning is always self-limiting. d. None of the answer options is true ANS: B

Food poisoning can be prevented by the fastidious practice of infection-control techniques as primary prevention.

REF: p. 337

OBJ: 32

40. Overweight and obesity are identified objectively by a. gender, race, and weight. b. age, ethnicity and weight. c. use of the body mass index (BMI). d. gender and race.

ANS: C

Overweight and obesity are identified objectively by the use of the BMI. The calculation is weight in pounds, divided by (height in inches)2 times 703. A number greater than 25.0 defines overweight, and a BMI of 30.0 or higher is classified as morbid obesity. A BMI of 40.0 or higher defines extreme obesity.

REF: p. 334

OBJ: 29

TRUE/FALSE 1. Pain is usually the initial symptom of gastric cancer.

ANS: F

The patient with early carcinoma of the stomach is frequently asymptomatic.

REF: p. 304

OBJ: 10

2. The symptoms of food poisoning are owing to the pathogens themselves or to the toxins they

produce.

ANS: T

Some bacteria produce toxins in food that cause food poisoning when ingested (see ―food poisoning‖ section). Ingestion of the poison in certain food (e.g., poisonous mushrooms) or chemicals (e.g., arsenic) causes gastroenteritis.

REF: p. 312

OBJ: 32

3. Hypervitaminosis is toxicity from any vitamin, but especially the fat-soluble vitamins A and

D. ANS: T

Hypervitaminosis is toxicity occurs with excess of any vitamin intake. The four fat (lipid)-soluble vitamins A, D, E, and K are stored in fat tissue.

REF: p. 333

OBJ: 30

4. Vitamin D is considered highly toxic, especially in infants and children.

ANS: T

Vitamin D is considered highly toxic, especially in infants and children. It can cause calcification of soft tissue, poor appetite, weakness, kidney damage, excessive thirst and urination, and mental changes. Note: The tolerable upper level for adults has been set at 2000 IU (50 mcg).

REF: p. 333

OBJ: 1

5. There is no genetic component to fatness and the regional distribution of fat.

ANS: F

Fatness and the regional distribution of fat have a strong genetic component.

REF: p. 344

OBJ: 29

6. The most common bloodborne infection in the United States is hepatitis A. ANS: F

HCV, considered a widespread epidemic, is the most common bloodborne infection in the United States. Hepatitis C is caused by HCV, which is transmitted by blood and body fluids.

REF: p. 325

OBJ: 26

7. Colorectal cancer is the third most common form of cancer and cause of cancer death in men

and women.

ANS: T

Colorectal cancer is the third most common form of cancer and cause of cancer death in men and women. Relatively simple improvements in nutrition and physical activity and the use of available screening procedures could help prevent many cases of colorectal cancer and resulting deaths. Screening for colorectal cancer has two functions: it enables the discovery and removal of adenomas to prevent the incidence of cancer, and it detects cancer in the earlier, more curable stages.

REF: p. 315

OBJ: 19

8. Barrett esophagus is a severe consequence of GERD. ANS: T

One of the most severe consequences of chronic gastroesophageal reflux disease (GERD) is Barrett esophagus, the replacement of the normal stratified squamous epithelium of the distal esophagus with abnormal columnar epithelium. Those with Barrett esophagus have a risk of over 30 times that of the normal population of developing adenocarcinoma. It should be noted that more than 40% of those with Barrett esophagus have no symptoms of heartburn.

REF: p. 300

OBJ: 7

9. Health care workers exposed to body fluids are at risk for hepatitis B. ANS: T

Hepatitis B is common enough to cause concern about unvaccinated health care workers.

Employers are required by the Occupational Safety and Health Administration to make hepatitis B vaccine available to workers in high-risk occupations, such as staff at hemodialysis centers, physicians, dentists, nurses, physical therapists, and personnel working in clinical and pathology laboratories and blood banks.

REF: pp. 324-325

OBJ: 24

10. Cancer of the pancreas is twice as common in men as women and is the fourth leading cause

of cancer-related death in the United States.

ANS: T

The prognosis is poor even after surgical resection; the 5-year survival rate is about 5% to 25%. The median survival is 8 to 12 months for those with locally advanced, unresectable disease and 3 to 6 months for those with metastatic disease.

REF: p. 331

OBJ: 28

11. The signs and symptoms of abdominal hernias vary with the site and the size of the hernia.

ANS: T

A visible hernia can be assessed by palpation for size with the patient standing and supine.

The medical assessment also might include radiographic studies of the abdomen and a white blood cell count.

REF: p. 307

OBJ: 13

12. Those who have had abdominal surgery and those over age 65 are more susceptible to

Clostridium difficile infection.

ANS: T

Severe cases, though rare, can be life threatening. The 30-day mortality attributed to infection with this strain is 7%, increasing to 14% in the older adults. C. difficile bacteria and spores are easily transmitted from infected patients on contaminated hands of health care workers. All health care providers should be educated about the precautions that avoid transmitting C. difficile.

REF: p. 317

OBJ: 21

Chapter 09: Diseases and Conditions of the Respiratory System Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. The primary function(s) of the pulmonary system is/are a. atelectasis and anosmia. b. ventilation and respiration. c. hemoptysis. d. All of the answer options ANS: B

Ventilation and respiration are the primary functions of the pulmonary system. Respiration maintains life by supplying oxygen to organs, tissues, and cells and allowing for the removal of carbon dioxide (a waste product of metabolism). This process is made possible by ventilation (the bellows-like action of the chest) and healthy lung tissue that is adequately perfused with blood.

REF: p. 343

OBJ: 1

2. The maintenance of the acid-base balance of the blood is linked to the function of the lungs

and a. b. c. d.

kidneys. adrenal glands. nervous system. bronchial tubes.

ANS: A

The lungs, along with the kidneys, have a major metabolic function: the maintenance of acid-base (pH) balance of the blood. The kidneys work to adjust bicarbonate in the blood in response to carbon dioxide.

REF: p. 343

OBJ: 1

3. The common cold is a group of minor illnesses caused by which pathogen/s? a. Fungi b. Bacteria c. Almost 200 viruses or from Mycoplasma d. All of the answer options ANS: C

The common cold may result from viruses or Mycoplasma. There are also other atypical organisms that are more like bacteria than viruses. There is no cure for a cold. Resting, drinking plenty of fluids, using a vaporizer, and taking over-the-counter antihistamines, decongestants, cough suppressants, and mild analgesics can give temporary relief of symptoms.

REF: p. 345

OBJ: 2

4. The treatment of sinusitis may include which measure/s? a. Antibiotics, decongestants, and antihistamines b. Allergy testing, immunotherapy, and corticosteroids c. Sinusotomy d. All of the answer options ANS: D

Treatment of sinusitis can include saline nasal spray, corticosteroid nasal sprays, broad-spectrum antibiotics, oral corticosteroids, antihistamines, and decongestants and sinus surgery. Allergy testing and immunotherapy may also be indicated.

Sinusitis can be caused by either viral, fungal, or, more commonly, bacterial infections that travel to the sinuses from the nose, often after the patient has been infected by a common cold.

This occurs easily because the mucous membranes that line the nasal cavity extend into and also line the sinuses.

REF: p. 347

OBJ: 2

5. Which problem/s may result from a crooked nasal septum or deviated septum? a. Compromise of the air passage b. Increased tendency to sinusitis c. Cosmetic concern d. All of the answer options ANS: D

A deviated septum causes narrowing and obstruction of the air passage, making breathing somewhat difficult. An increased tendency for sinusitis and cosmetic concerns are also problems the patient may experience.

REF: p. 350

OBJ: 2

6. Growths that form from distended mucous membranes protruding into the nasal cavity are

called a. adenoid hypertrophy. b. lymphadenopathy. c. nasal polyps. d. All of the answer options ANS: C

Growths that form from distended mucous membranes protruding into the nasal cavity are nasal polyps. Surgical removal is the treatment of choice; however, considerable relief may be obtained through the injection of a steroid directly into the polyps.

REF: p. 350

OBJ: 3

7. What are causes of epistaxis? a. Direct trauma or foreign body b. Hypertension or other systemic disorders c. Hemophilia and leukemia d. All of the answer options ANS: D

Direct trauma to the nose, picking the nose, and the presence of a foreign body are the most common causes of epistaxis. Nasal hemorrhage also has been encountered in relation to many systemic disorders, such as measles, scarlet fever, pertussis, rheumatic fever, hypertension, congestive heart failure, and chronic renal disease. Epistaxis may be the foremost symptom of conditions, such as hemophilia, thrombocytopenia, agranulocytosis, and leukemia.

REF: p. 352

OBJ: 4

8. The common symptom of a tumor of the larynx is a. dysphonia. b. hemoptysis. c. stridor. d. exsanguination.

ANS: A

Dysphonia is usually the only symptom of a tumor on the larynx. Hoarseness caused by a benign tumor is usually intermittent, whereas hoarseness caused by cancer is continuous and gradually becomes worse. Cancer of the larynx almost always can be cured if it is diagnosed early.

REF: p. 352

OBJ: 5

9. Which statements are factual about health hazards attributed to toxic mold? a. Mold exposure always presents a health problem. b. A constant supply of moisture is not necessarily required for mold growth. c. People with decreased immunity, allergies, or underlying lung disease are more

susceptible to fungal infections. d. Moldy items do not need to be discarded.

ANS: C

Individuals who have decreased immunity, such as those with acquired immunodeficiency syndrome (AIDS) or those with underlying lung disease or chronic diseases, are more susceptible to fungal infections and allergic pneumonitis. All molds should be treated the same with respect to potential health risks and removal. Recommendations for preventing mold infestation include ensuring adequate ventilation, using paint with mold inhibitors, cleaning bathrooms with mold-killing products, and promptly removing flooded carpets.

REF: p. 359

OBJ: 8

10. Atelectasis, an airless or collapsed state of pulmonary tissue, may result from a. obstruction in the bronchial tree. b. prolonged inactivity. c. failure to breathe deeply postoperatively. d. All of the answer options

ANS: D

Atelectasis is caused by an obstruction in the bronchial tree; this can be a mucus plug, foreign body, or bronchogenic cancer. Compression atelectasis results when a tumor exerts pressure on the lung and does not allow air to enter that part. Inflammatory pulmonary disease can result in accumulation of fluid in the pleural cavity (pleural effusion) and induce atelectasis.

REF: p. 355

OBJ: 6

11. Stasis of blood flow from immobility, injury to a vessel, or predisposition to clot formation

increases the risk of which diagnosis? a. Pulmonary embolism b. Chronic obstructive pulmonary disease (COPD) c. Emphysema d. All of the answer options ANS: A

Stasis of blood flow from immobility, injury to a vessel, or predisposition to clot formation increases the risk of pulmonary embolism. The most common symptom of acute pulmonary embolism is the sudden onset of dyspnea and chest pain when the embolism enters the pulmonary circulation and interrupts the blood flow.

REF: p. 357

OBJ: 7

12. Which diseases are similar to pneumonia and caused by bacteria that thrive in warm aquatic

environments and are inhaled from moisture droplets in air conditioning units? a. Histoplasmosis b. Pulmonary abscess c. Flail chest d. Legionella infection ANS: D

Legionella can evolve in two different forms. The more severe Legionnaires’ disease and the milder form, Pontiac fever. Legionnaires’ disease, an acute respiratory tract infection, produces severe pneumonia like symptoms or possibly fatal pneumonia.

REF: p. 361

OBJ: 10

13. _____ is a fungal disease originating in the lungs, with the greatest occurrence in the

Midwestern United States. a. Histoplasmosis b. Pulmonary abscess c. Flail chest d. Legionella infection ANS: A

Histoplasmosis may cause pneumonia or may become systemic. Many patients with histoplasmosis are asymptomatic at onset; it is not contagious. Histoplasmosis is caused by the fungus Histoplasma capsulatum, which is carried by dust and is inhaled. It is the most common endemic mycosis in the United States.

REF: p. 362

OBJ: 11

14. An area of contained infectious material in the lung is known as a. histoplasmosis. b. pulmonary abscess. c. flail chest. d. Legionella infection.

ANS: B

Pulmonary abscesses are often a complication of pneumonia caused by bacteria. Aspiration of food, a foreign object, bronchial stenosis, or neoplasms may cause pulmonary abscesses to form. Background factors include periodontal disease, gingivitis, sinus infection, intravenous (IV) drug abuse, and general anesthesia or other causes of reduced levels of consciousness.

REF: p. 360

OBJ: 9

15. A double fracture of three or more adjacent ribs resulting in instability in the chest wall

describes a patient with which condition? a. Histoplasmosis b. Pulmonary abscess c. Flail chest d. Legionella infection ANS: C

Direct trauma to the chest wall that fractures three or more adjacent ribs is the cause of flail chest. This trauma may be from direct compression by a heavy object, a motor vehicle accident (especially injury by the steering wheel), a hard fall onto a solid object, or an industrial accident.

REF: p. 372

OBJ: 19

16. Permanent, irreversible dilation or distortion of the bronchi, resulting from destruction of

muscular bronchial wall, describes which condition? a. Emphysema b. Bronchiectasis c. Pneumoconiosis d. Pneumothorax ANS: B

Bronchiectasis, a condition that takes many years to develop, is usually bilateral and involves the lower lobes of the lungs. A chronic cough producing large quantities of purulent, foul-smelling sputum is the main symptom of bronchiectasis.

REF: p. 366

OBJ: 15

17. A collection of air or gas in the pleural cavity, resulting in a collapsed lung, describes which

condition? a. Emphysema b. Bronchiectasis c. Pneumoconiosis d. Pneumothorax ANS: D

Pneumothorax is collapse of a lung. Pneumothorax causes severe shortness of breath, sudden and sharp chest pain, falling blood pressure, rapid weak pulse, and shallow and weak respirations. The patient may be cyanotic and appear anxious. Hemothorax is the accumulation of blood and fluid in the pleural cavity. Blood enters the pleural space as the result of trauma, erosion of a pulmonary vessel, or hematologic disorders. This causes the lung to collapse. A hemothorax is life threatening and requires emergency medical care.

REF: p. 370

OBJ: 18

18. Occupational diseases that cause progressive, chronic inflammation and infection in the lungs

from inhalation of inorganic dust are termed a. emphysema. b. bronchiectasis. c. pneumoconiosis. d. pneumothorax.

ANS: C

Pneumoconiosis means dust in the lungs resulting in interstitial lung disease. It refers to a number of occupational diseases that cause progressive, chronic inflammation, fibrosis, and infection in the lungs. Asbestos fibers, carbon deposits, or quartz dust inhaled are mineral causes of interstitial lung disease. Other workers who are also susceptible to dust diseases are those who work with aluminum, beryllium, iron, cotton, sugar cane, and a number of synthetic fibers.

REF: pp. 368-369

OBJ: 16

19. _____ is a destructive disease of the alveoli and the adjacent capillary walls resulting in

chronic dyspnea, cough, and the characteristic barrel chest. a. Emphysema b. Bronchiectasis c. Pneumoconiosis d. Pneumothorax ANS: A

Pulmonary emphysema, a destructive disease of the alveolar septa, interferes with both the breathing process and gas exchange in the lungs. Alveoli become enlarged, which precipitates destruction of the alveolar walls and damage to the adjacent capillary walls. As a result of the decreased area for gas exchange and the trapped air, the patient experiences dyspnea.

REF: p. 367

OBJ: 15

20. The Epstein-Barr virus is the cause of which illness? a. Infant respiratory distress syndrome (IRDS) b. COPD c. Infectious mononucleosis d. Adult respiratory distress syndrome (ARDS) ANS: C

Epstein-Barr virus causes infectious mononucleosis. The two main symptoms of this infection are lymphadenopathy and fever that typically peaks in the afternoon. Initially, symptoms are vague. They include general malaise, anorexia, and chills. As the infection progresses, symptoms include sore throat, fever, headache, fatigue, and cervical and generalized lymphadenopathy; the tonsils may appear coated with debris. The syndrome causes a mild transient hepatitis and atypical lymphocytosis.

REF: p. 373

OBJ: 21

21. Severe hypoxemia in a patient who has recently experienced trauma is called shock lung or a. IRDS. b. COPD. c. infectious mononucleosis. d. ARDS. ANS: D

Hypoxemia in a patient who has recently experienced trauma is called shock lung or ARDS. The lungs are hemorrhagic, wet, boggy, congested, and unable to diffuse oxygen; atelectasis results. The onset of symptoms is usually 24 to 48 hours after medical or surgical insult to the body. Primary symptoms include sudden and severe dyspnea with rapid and shallow respirations.

REF: p. 374

OBJ: 22

22. _____ refers to obstructive diseases of the lungs, including chronic bronchitis, bronchiectasis,

asthma, emphysema, and pneumoconiosis. a. IRDS b. COPD c. Infectious mononucleosis d. ARDS ANS: B

COPD, or chronic obstructive lung disease (COLD), describes a condition of slow and irreversible progressive airway obstruction. It encompasses several obstructive diseases of the lungs, including chronic bronchitis, bronchiectasis, asthma, emphysema, cystic fibrosis, and pneumoconiosis. Although the mechanism of the obstruction can vary, the consequence is the same; the patient with COPD is unable to ventilate the lungs freely, which results in an ineffective exchange of respiratory gases.

REF: p. 365

OBJ: 24

23. Which treatment is used for pneumonia? a. Organism-specific antibiotics for bacterial pneumonia b. Penicillin for viral pneumonia c. Thoracentesis d. All of the answer options ANS: A

Pneumonia is an infective inflammation of the lungs caused by viral or bacterial infections.

Treatment is based on the underlying cause of the pneumonia so organism-specific antibiotics are used to treat bacterial pneumonia.

Organisms commonly causing bacterial pneumonia are pneumococci, staphylococci, group A hemolytic streptococci, Haemophilus influenzae type B, Klebsiella pneumoniae types 1 and 2, and other gram-negative organisms.

REF: p. 359

OBJ: 7

24. What is the most common site for head and neck tumors? a. Nasal septum b. Tonsils c. Larynx d. Sinuses ANS: C

Laryngeal cancer describes a neoplasm of the larynx, the part of the respiratory tract between the pharynx and the trachea that houses the vocal cords. It is the most common site for head and neck tumors. Because of the early manifestation of symptoms, laryngeal cancer is often diagnosed at a stage in which a cure is possible.

REF: p. 353

OBJ: 5

25. Which age group is at most risk for RSV pneumonia? a. Infants b. Young children c. Older adults d. All of the answer options ANS: D

RSV pneumonia, an inflammatory and infectious condition of the lungs, is most common in infants, young children, and the older adults.

REF: p. 361

OBJ: 11

26. Sputum removal management is the most important in the treatment of which condition? a. Flail chest b. Bronchiectasis c. Pleurisy d. Pharyngitis ANS: B

When a patient has bronchiectasis, sputum removal management is very important and can be aided with vibratory devices, such as the Acapella vest. Antibiotics and bronchodilators are prescribed, and postural drainage is encouraged. Sputum removal management is very important and can be aided with vibratory devices, such as the Acapella Vest.

REF: p. 366

OBJ: 15

27. Some points to stress in patient teaching regarding cessation of smoking include a. reducing one’s exposure to secondhand smoke is recommended. b. there are no benefits to cessation of smoking to patients who already have lung

cancer. c. there is less danger of relapse in patients who survive lung cancer and continue to

smoke.

d. the prognosis for patients with lung cancer is generally good.

ANS: A

The primary risk factor for development of lung cancer is cigarette smoking so teaching a patient to reduce their exposure to secondhand smoke is recommended. Smoking has been shown to be responsible for 90% of lung cancers, and smokers are between 10 and 30 times more likely to develop lung cancer than are nonsmokers. Lung cancer is the most common cause of cancer death worldwide for both men and women, accounting for almost 30% of all cancer deaths. It is usually caused by repeated carcinogenic irritation to the bronchial epithelium, leading to increased rates of cell division.

REF: p. 378

OBJ: 25

TRUE/FALSE 1. Pontiac fever is a milder form of Legionellosis; neither form is contagious.

ANS: T

Both disorders are caused by L. pneumophila and are not contagious.

REF: p. 361

OBJ: 10

2. Target groups for influenza immunization include persons aged 50 and older, patients with

chronic disease, health care providers, and other high-risk persons.

ANS: T

During a known epidemic, the health care provider may give the telephone screener(s) guidelines to address callers with symptoms typical of influenza. Individuals with severe symptoms or those who are at high risk for complications (i.e., the very young, the older adults, or those chronically ill) are given a prompt appointment for close medical monitoring.

REF: p. 363

OBJ: 12

3. Prophylactic use of vaccines against influenza is effective in reducing the occurrence of the

disease, especially in older adults.

ANS: T

Prophylactic use of vaccines against influenza is effective in reducing the occurrence of the disease, especially in older adults. Because immunity from vaccination lasts only 1 year, annual booster doses are needed for optimal protection. After vaccination, about 2 to 4 weeks is required for immunity to develop.

REF: p. 364

OBJ: 12

4. A history of smoking is listed as an etiologic factor in bronchitis, bronchiectasis, emphysema,

and lung cancer.

ANS: F

A history of smoking is listed as an etiologic factor in bronchitis, emphysema, and lung cancer. Bronchiectasis may be caused by repeated damage to the bronchial wall caused by recurrent airway infections. It also can result from pneumonia, TB, bronchial obstruction, or inhalation of a corrosive gas. Although the etiology of pulmonary emphysema is not completely understood, long-term cigarette smoking appears to be a contributing factor.

Progressive and irreversible changes in the bronchi can result from constant irritation from smoking or exposure to industrial pollution or recurrent infections. There is an increased risk for lung cancer, especially in those with asbestosis.

REF: p. 366

OBJ: 25

5. In most cases the prognosis of lung cancer is good because people seek medical attention

before metastasis occurs.

ANS: F

The prognosis for patients with lung cancer is generally poor. If patients survive their lung cancer, relapse is much more likely in patients who continue to smoke.

REF: p. 378

OBJ: 24

6. Common colds impart immunity and respond to antibiotic therapy.

ANS: F

Antibiotics are of little value in treating viral infections like the common cold. Patients with recurring attacks of bronchitis or frequent middle ear infections may receive some protection against these bacteria-caused complications by taking antibiotics. There are some data to suggest that taking zinc lozenges may shorten (slightly) the course of the common cold.

REF: p. 346

OBJ: 2

7. Allergic sinusitis can lead to inflammation of the mucosa of the sinuses and result in sinusitis.

ANS: T

Allergic sinusitis can lead to inflammation of the mucosa of the sinuses and resulting sinusitis.

No specific preventive measures are known.

REF: p. 346

OBJ: 2

8. Because of improved prevention and treatment measures for tuberculosis (TB), TB is no

longer considered a public health risk.

ANS: F

From 1982 to 1985, increased immigration and travel from Asia and South and Central America and the AIDS epidemic contributed to an upsurge of TB in the United States. Since then improved prevention and treatment measures have resulted in a significant drop in the case rate, and TB is no longer considered an epidemic. TB still remains a public health risk.

Worldwide TB remains a leading cause of adult infectious mortality.

REF: p. 373

OBJ: 25

9. Acute bronchitis is usually caused by a bacterial infection, so no known prevention exists.

ANS: F

Prevention for acute bronchitis includes good patient education. Patients with chronic bronchitis are advised not to smoke or expose themselves to known respiratory irritants. It is important for the patient to avoid the primary causative factors: smoking, chronic exposure to pollutants in the air, and recurrent respiratory infections. If a secondary bacterial infection is suspected, an antibiotic is prescribed.

REF: p. 366

OBJ: 20

10. Sarcoidosis is a multisystem granulomatous disorder most commonly detected in the lungs;

serious disability is rare.

ANS: T

The prognosis varies for people with pulmonary sarcoidosis if the lungs scar and become fibrotic or if other organ damage exists. Serious disability is rare with sarcoidosis, and most people can live normally. Relapses can occur after cessation of immunosuppressive drugs.

REF: pp. 375-376

OBJ: 14

11. The U.S. Prevention Services Task Force now recommends lung cancer screening for

high-risk individuals with an annual low-dose chest CT. ANS: T

CT scanning is recommended for lung cancer screening. If should be discontinued if it has been more than 15 years since quitting smoking or there is a limited life expectancy.

REF: p. 378

OBJ: 23

12. Lung abscesses are often a complication of pneumonia caused by bacteria. Aspiration of food,

a foreign object, bronchial stenosis, or neoplasms may cause pulmonary abscesses to form. A pulmonary abscess also may develop when a septic embolism is carried to the lung via the pulmonary circulation.

ANS: T

Lung abscesses are often a complication of pneumonia caused by bacteria. Aspiration of food, a foreign object, bronchial stenosis, or neoplasms may cause pulmonary abscesses to form. A pulmonary abscess also may develop when a septic embolism is carried to the lung via the pulmonary circulation. Background factors include periodontal disease, gingivitis, sinus infection, IV drug abuse, and general anesthesia or other causes of reduced levels of consciousness.

REF: p. 360

OBJ: 24

13. The patient with pleurisy usually presents with abdominal pain and headache and without any

history of recent infection or injury.

ANS: F

A patient who has pleurisy usually reports general unilateral sharp, needlelike pain, which increases with inspiration and coughing. Additionally, this patient experiences a cough, fever, and chills. Inspirations are shallow, rapid, and restricted. Pain may radiate to the shoulder or abdomen.

REF: p. 369

OBJ: 9

14. The cause of pneumoconiosis is Legionnaires’ disease.

ANS: F

Pneumoconiosis is considered to be an occupational disease caused by inhaling inorganic dust particles over a prolonged period and is not caused form Legionnaire’s disease. Asbestos fibers, carbon deposits, or quartz dust inhaled are mineral causes of the interstitial lung disease. Other workers who are also susceptible to dust diseases are those who work with aluminum, beryllium, iron, cotton, sugar cane, and a number of synthetic fibers.

REF: p. 369

OBJ: 17

Chapter 10: Diseases and Conditions of the Circulatory System Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. The condition where fat-containing substances are deposited on the coronary artery lumens

causing a narrowing is a. congestive heart failure (CHF). b. cerebral artery disease. c. ischemia. d. coronary artery disease (CAD).

ANS: D

CAD is a condition involving the arteries supplying the myocardium (heart muscle) (see Fig. 10.7). The arteries become narrowed by atherosclerotic deposits over time, causing temporary cardiac ischemia and eventually myocardial infarction (MI), or heart attack. Deposits of fat-containing substances called plaque in the lumen (opening) of the coronary arteries result in atherosclerosis and subsequent narrowing of the lumens of the arteries.

REF: p. 386

OBJ: 4

2. The procedure in which a catheter with a balloon is threaded into a coronary artery and

expanded to compress the plaque and widen the lumen is called a. coronary artery bypass. b. angioplasty. c. magnetic resonance imaging. d. coronary stent.

ANS: B

Angioplasty with a balloon or stenting is used to open the coronary arteries of the heart.

First-line drug therapy for the prevention of CAD may include angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), calcium channel blockers, thiazide diuretics, or vasodilators. Beta-blockers and anticoagulants are used to prevent blood clots from breaking off and lodging in cerebral arteries. When the blockage is severe or does not respond to drug therapy or angioplasty, coronary artery bypass surgery may be indicated to restore circulation to the affected myocardium.

REF: p. 387

OBJ: 7

3. Which condition is most likely when the patient experiences chest pain with exertion? a. Angina pectoris b. CAD c. Myocardial infarction d. CHF ANS: A

Angina pectoris, chest pain caused by ischemia during or shortly after exertion, is the result of reduced oxygen supply to the myocardium.

REF: p. 389

OBJ: 5

4. Which disorder is the most prevalent cardiovascular disorder in the United States? a. Angina pectoris b. CAD c. MI d. CHF ANS: B

The most prevalent cardiovascular disorder in the United State is coronary artery disease (CAD). Almost one-third of all deaths in Western countries are attributed to heart disease.

Most of these deaths are caused by CAD and hypertension.

REF: p. 383

OBJ: 3

5. The patient who complains of sudden onset of severe headache, blurred vision, and dyspnea

may be suffering from which condition? a. CHF b. MI c. Malignant hypertension d. Angina pectoris ANS: C

A patient with malignant hypertension experiences headaches, epistaxis, lightheadedness, or syncope, although there are usually no symptoms. The hypertension is generally detected when blood pressure is taken during a physical examination or screening process.

Hypertension is more common with increased age in all groups. If hypertension is accompanied by hyperlipidemia, it may lead to atherosclerosis.

REF: p. 395

OBJ: 8

6. The patient who experiences gradually increasing dyspnea, anxiety, and edema of the feet and

ankles may be suffering from which diagnosis? a. CHF b. MI c. Malignant hypertension d. Angina pectoris ANS: A

CHF usually has an insidious onset with the patient experiencing gradually increasing dyspnea. Cardiac and respiratory rates increase, and the patient becomes anxious. As the condition progresses, the neck veins distend and edema is noted in the ankles. When the right side of the heart fails, the liver and spleen enlarge and the peripheral edema is more prominent. Left-sided CHF causes increased pulmonary congestion and more pronounced respiratory difficulties.

REF: p. 396

OBJ: 9

7. Which medical problem involves a fluid shifting into the extravascular spaces of the lungs

with accompanying dyspnea, coughing, and bloody, frothy sputum? a. MI b. Pulmonary edema c. Angina pectoris d. Malignant hypertension ANS: B

Pulmonary edema is a condition of fluid shift into the extravascular spaces of the lungs.

Pulmonary edema is caused by left-sided heart failure, mitral valve disease, pulmonary embolism, systemic hypertension, arrhythmias, and renal failure. Head trauma, drug overdose, and exposure to high altitudes are other causes. Excessive fluid accumulates in the pulmonary tissue and air spaces of the lungs. The pulmonary circulation is overloaded with an excessive volume of blood.

REF: p. 400

OBJ: 10

8. Acute or chronic inflammation of the sac enclosing the heart is a. endocarditis. b. myocarditis. c. pericarditis. d. rheumatic fever.

ANS: C

Pericarditis is an acute or chronic inflammation of the pericardium (serosa), the sac enclosing and protecting the heart.

REF: p. 402

OBJ: 12

9. Which diagnosis is a systemic inflammatory disease of the joints and cardiac tissue that

follows a sore throat caused by group A beta-hemolytic streptococcus? a. Endocarditis b. Myocarditis c. Pericarditis

d. Rheumatic fever ANS: D

Rheumatic fever follows a sore throat caused by group A beta-hemolytic streptococcus. The patient, usually a child, experiences a fever and polyarthritis, including joint pain, edema, redness, and limited range of motion. Joints frequently involved include finger, knee, and ankle joints, with inflammation transient among these joints. In addition, the patient experiences carditis, cardiac murmurs, cardiomegaly, and even CHF. Other symptoms include weakness, malaise, anorexia, weight loss, a rash on the trunk, abdominal pain, and the development of small nodules on the tendon sheaths in the knees, knuckles, and elbows. The symptoms occur 1 to 5 weeks after the upper respiratory tract infection.

REF: p. 405

OBJ: 13

10. Valvular heart disease can occur in what forms? a. Insufficiency b. Stenosis c. Neither of the answer options d. Both of the answer options ANS: D

Valvular heart disease is an acquired or congenital disorder that can involve any of the four valves of the heart. This condition can occur in the form of either insufficiency or stenosis.

Insufficiency, the failure of the valves to close completely, allows blood to be forced back into the previous chamber as the heart contracts. This exerts added pressure on that chamber and increases the heart’s workload. Stenosis, a hardening of the cusps of the valves that prevents complete opening of the valves, impedes the blood flow into the next chamber.

REF: p. 408

OBJ: 15

11. Which valve is most frequently involved in valvular heart disease? a. Aortic b. Mitral c. Pulmonary d. Tricuspid ANS: B

Valvular heart disease is an acquired or congenital disorder that can involve any of the four valves of the heart, with the mitral valve most often affected. This condition can occur in the form of either insufficiency or stenosis. Insufficiency, the failure of the valves to close completely, allows blood to be forced back into the previous chamber as the heart contracts.

This exerts added pressure on that chamber and increases the heart’s workload. Stenosis, a hardening of the cusps of the valves that prevents complete opening of the valves, impedes the blood flow into the next chamber.

REF: p. 408

OBJ: 15

12. The patient with pale, cold, clammy skin; a rapid and weak pulse; tachypnea; and an altered

level of consciousness is experiencing a. CHF. b. shock.

c. atherosclerosis. d. hypertension.

ANS: B

Shock causes inadequate perfusion of organs and tissues. The patient has pale, cold, and clammy skin; a rapid, weak, and thready pulse; rapid breathing; and an altered level of consciousness. The blood pressure drops, and the patient may be anxious, irritable, or restless and often expresses a feeling of impending doom. The patient may experience dizziness, extreme thirst, and profuse sweating. In late stages, the pupils dilate, the eyes become dull and lusterless, and the patient experiences shaking and trembling.

REF: p. 414

OBJ: 18

13. Cardiac arrhythmias may be caused by a. disturbances in the normal conduction system of the heart. b. ischemia and drugs. c. failure of the sinoatrial (SA) node. d. All of the answer options ANS: D

Arrhythmias can arise from disturbances in the normal conduction system of the heart, including the pacemaker (the SA node), the atrioventricular (AV) node, the bundle branches, and the Purkinje fibers (see Fig. 10.35). Ischemia and drugs cause many arrhythmias. Failure of the SA node may be responsible. Table 10.1 lists the causes of arrhythmias. Heart block occurs when the impulses from the SA node become slow or irregular at or below the AV node.

REF: p. 410

OBJ: 16

14. Which treatment is used for cardiac tamponade? a. Drainage of the blood in the pericardium b. Drug therapy c. Watchful waiting d. Cardiac catheterization ANS: A

Treatment consists of inserting a needle into the pericardial space and withdrawing the offending blood. Surgery is usually indicated to repair the leak.

REF: p. 417

OBJ: 19

15. Possible consequences of emboli include a. cerebral vascular accident (CVA). b. MI. c. pulmonary venous obstruction. d. All of the answer options ANS: D

Emboli are clots of aggregated material (usually blood). They can lodge in blood vessels and inhibit blood flow. Treatment depends on the area of involvement. Treatment of pulmonary embolism MI, and CVA is aggressive and immediate if the patient is to survive. The treatment of a patient with arterial emboli in an extremity is also aggressive and immediate to prevent the death of tissue and eventual gangrene. Blood flow is reestablished to the affected part by lowering the limb, wrapping it to maintain warmth to the area, and treating any constriction of blood vessels. Heparin or enoxaparin [Lovenox] are administered to deter further clot formation, and antispasmodic drugs are given for vascular spasms. If this therapy is not successful, surgical intervention may be indicated to remove the obstruction and to restore circulation. In another option, a thrombolytic drug (such as urokinase, tissue plasminogen activator, tenecteplase, alteplase, reteplase, or streptokinase) can be administered via a central catheter directly into the spot of the coronary embolism to breakdown the emboli. The prognosis varies and depends on the location of the emboli. When the emboli are in an extremity, aggressive treatment and/or surgical intervention usually are successful.

REF: p. 419

OBJ: 20

16. Which condition is present when the patient has a pulsating mass that is noted mid-abdomen? a. An arrhythmia b. Palpitations c. Aortic aneurysm d. Pulmonary embolus ANS: C

The symptoms of an aneurysm may have either an insidious or a sudden, acute onset.

Symptoms depend on the location and size of the aneurysm and the extent of the dilation.

Abdominal aortic aneurysm is the most common form. An asymptomatic aneurysm of the aorta is often discovered during a routine physical examination when the abdomen is being palpated or as the result of an abdominal radiographic study conducted for another reason. As the aortic aneurysm enlarges, the patient may experience abdominal or back pain, and a pulsating mass is observed in the abdomen. A complication of any aneurysm is leakage from the wall of the artery or sudden rupture of the weak area. When this occurs, the patient exhibits symptoms and signs of hemorrhagic shock. Rupture of a cerebral aneurysm mimics signs of a CVA, with unilateral neurologic deficits being noted.

REF: p. 422

OBJ: 22

17. A vasospastic disease of the fingers, hands, or feet resulting in pain, numbness, and

sometimes discoloration is a. Buerger’s disease. b. Raynaud’s disease. c. varicose veins. d. thrombophlebitis.

ANS: B

Raynaud’s disease is a vasospastic condition of the fingers, hands, or feet. It causes pain, numbness, and sometimes discoloration in these areas.

REF: p. 426

OBJ: 24

18. The condition in which a reduction in the quantity of either red blood cells (RBCs) or

hemoglobin (Hgb) exists is a. anemia. b. thrombocytopenia. c. leukemia. d. agranulocytosis.

ANS: A

Anemia is defined as a condition in which there is a reduction in the quantity of either RBCs or Hgb in a measured volume of blood, reducing the blood’s ability to carry oxygen to the cells.

REF: p. 428

OBJ: 25

19. The condition that results in painless gross swelling of an extremity is a. lymphangitis. b. lymphedema. c. Buerger’s disease. d. Raynaud’s disease ANS: B

Lymphedema results in a swelling of the extremity. Most patients experience no pain, though in severe cases lymphedema can cause pain and limit movement. The extremity becomes swollen and grossly distended.

REF: p. 436

OBJ: 29

20. Painless enlargement of the lymph nodes, severe itching, fever, night sweats, weight loss,

fatigue, and malaise are symptoms of a. lymphedema. b. Hodgkin disease. c. anemia. d. Buerger’s disease.

ANS: B

The initial symptoms of Hodgkin lymphoma are painless enlargement of the lymph nodes in the neck or mediastinum, fatigue, and pruritus. As the disease progresses, the patient may experience the systemic B symptoms of fever, night sweats, and weight loss. Hodgkin disease is differentiated from other lymphomas by the presence in the lymphatic tissue of a Reed-Sternberg cell, a large cell with two or more mirror-image nuclei, each with a single nucleolus.

REF: pp. 439-440

OBJ: 30

21. _____ is a hereditary bleeding disease resulting from a deficiency of clotting factors. a. Disseminated intravascular coagulation (DIC) b. Temporal arteritis c. Hemophilia d. Leukemia ANS: C

Classic hemophilia is a hereditary bleeding disorder resulting from deficiency of clotting factors. An X-linked genetic disorder in males, hemophilia is transmitted by the asymptomatic carrier mother to her son. Factor VIII, a clotting factor in the intrinsic clotting cascade, is functionally inactive. Any minor trauma can initiate a bleeding episode.

REF: p. 443

OBJ: 32

22. Which treatment is used for CHF? a. Medication to slow and strengthen the heartbeat b. Administration of diuretics c. Digitalis d. All of the answer options ANS: D

Treatment for CHF is directed at reducing the workload of the heart and increasing its efficiency. ACE inhibitors and ARBs were recently approved for use in the treatment of CHF, mainly to increase blood flow. Diuretics help to reduce the volume of fluid in the body, and vasodilators help to reduce vascular pressure. Aldosterone antagonists (eplerenone or spironolactone) may be used in combination with other drug therapies. Digoxin may also be prescribed in specific cases to strengthen and slow the heartbeat. Intake of fluid and sodium is restricted. Some patients with severe CHF may require special pacemakers, defibrillators, or in extreme cases, a heart transplant.

REF: p. 398

OBJ: 10

23. The patient experiencing crushing chest pain, dyspnea, diaphoresis, and anxiety is usually

suffering from a. angina. b. CHF. c. MI. d. pulmonary edema.

ANS: C

A MI results from an occlusion of a coronary artery resulting in ischemia and infarct (death) of the myocardium. This causes sudden, severe substernal or left-sided chest pain The pain may be crushing, causing a feeling of massive constriction of the chest, burning, or may be just a vague discomfort. This pain may radiate to the left or right arm, back, or jaw and is not relieved by rest or the administration of nitroglycerin. Irregular heartbeat, dyspnea, and diaphoresis often accompany the pain, and the patient usually exhibits denial and experiences severe anxiety, sometimes with the feeling of impending doom (see Fig. 10.15). Some may experience nausea. MI is occasionally clinically silent, especially in diabetes.

REF: p. 390

OBJ: 7

24. Noninflammatory disease of the heart muscle with enlargement of the myocardium and

ventricular dysfunction refers to a. rheumatic fever. b. mitral stenosis. c. cardiomyopathy. d. mitral valve prolapse (MVP).

ANS: C

Cardiomyopathy is a noninflammatory disease of the cardiac muscle resulting in enlargement of the myocardium and ventricular dysfunction.

REF: p. 400

OBJ: 11

25. The chronic hereditary form of anemia found predominately in the black race is called _____

anemia. a. sickle cell b. hemolytic c. pernicious d. aplastic ANS: A

Sickle cell anemia, a chronic hereditary hemolytic form of anemia, is found predominately in those of the black race. The presence of Hgb S along with Hgb A is noted in erythrocytes, causing them to acquire a sickle or elongated shape on deoxygenation. These rigid, misshapen cells obstruct capillary flow and lead to tissue hypoxia and further sickling; this in turn causes further obstruction and eventually infarction. When the sickling causes an obstruction, the individual experiences severe pain. When the sickled cells are reoxygenated, they resume the natural round disk shape of a normal erythrocyte. In addition, Hgb S has reduced oxygen-carrying capacity.

REF: p. 430

OBJ: 26

26. Joint and bone pain, fever, weight loss, fatigue, weakness, hepatomegaly, splenomegaly, and

enlarged lymph glands are typical symptoms of which problem? a. Varicose veins b. Leukemia c. Raynaud’s disease d. Phlebitis ANS: B

The patient with leukemia appears pale and may report joint and bone pain, weight loss, sore throat, fatigue, fever, night sweats, and weakness. There is a tendency toward increased bruising and bleeding. As the leukemic cells infiltrate the spleen, liver, lymph nodes, and nervous system, they interfere with the normal functioning of these organs. Lymphadenopathy and splenomegaly are common at presentation. Symptoms of central nervous system involvement include headache, blurred vision, nausea, vomiting, and cranial nerve palsies. A mediastinal mass can be found in many patients with the T cell acute lymphoid leukemia.

REF: p. 433

OBJ: 28

27. The presence of Reed-Sternberg cells in lymphatic tissue is diagnostic of a. rheumatic fever. b. sickle cell anemia. c. pernicious anemia. d. Hodgkin disease.

ANS: D

The initial symptoms of Hodgkin lymphoma are painless enlargement of the lymph nodes in the neck or mediastinum, fatigue, and pruritus. As the disease progresses, the patient may experience the systemic B symptoms of fever, night sweats, and weight loss. Hodgkin disease is differentiated from other lymphomas by the presence of a Reed-Sternberg cell in the lymphatic tissue, a large cell with two or more mirror-image nuclei, each with a single nucleolus.

REF: p. 440

OBJ: 30

28. Interference with the conduction system of the heart may be the source of a. essential hypertension. b. cardiac arrhythmias. c. atherosclerosis. d. All of the answer options ANS: B

Arrhythmias result when there is interference with the conduction system of the heart, resulting in an abnormality of the heartbeat. Symptoms include palpitations, rapid heartbeat (tachycardia), skipped heartbeats, slow heart rate (bradycardia), syncope, and fatigue.

Arrhythmias can arise from disturbances in the normal conduction system of the heart, including the pacemaker (the SA node), the AV node, the bundle branches, and the Purkinje fibers. Ischemia and drugs cause many arrhythmias.

REF: p. 410

OBJ: 30

29. Medical intervention for varicose veins includes a. rest and elevation of the legs. b. exercise, warm soaks, and support stockings. c. surgical intervention or injection of a sclerosing agent into the vein. d. All of the answer options ANS: D

Medical intervention for varicose veins includes rest periods throughout the day, with the patient lying down and elevating the feet higher than the heart. Engaging in exercise and submerging the legs in warm water increases the flow of blood. The patient may wear support stockings that encourage the return flow of blood. Those who have to stand for long periods are instructed to move the legs at frequent intervals to stimulate the muscular ―milking‖ of the veins. Painful, twisted, and swollen veins that have progressed beyond the treatment of rest and exercise usually require surgical intervention in the form of a vein ligation and stripping or injection of sclerosing solutions that harden and eventually atrophy the affected veins.

Collateral circulation develops to augment the blood return to the heart.

REF: p. 425

OBJ: 23

30. Symptoms of cardiovascular disease include a. chest pain, fatigue, and fainting. b. rapid heartbeat and palpitations. c. cyanosis, edema, and dyspnea. d. All of the answer options ANS: D

Important presenting symptoms that tend to recur in patients with cardiovascular disease and need further investigation include • chest pain • dyspnea (difficulty in breathing) on exertion • tachypnea (rapid breathing) • palpitations (rapid fluttering of the heart) • cyanosis (slight blue color) • edema • fatigue • syncope (fainting) REF: pp. 384-285

OBJ: 2

31. Common symptoms of an MI are a. left-sided, crushing-type chest pain. b. irregular heartbeat, dyspnea, and excessive sweating. c. nausea, anxiety, and denial. d. All of the answer options ANS: D

A MI results from an occlusion of a coronary artery resulting in ischemia and infarct (death) of the myocardium and causes sudden, severe substernal or left-sided chest pain. The pain may be crushing, causing a feeling of massive constriction of the chest, may be burning, or may be just a vague discomfort. This pain may radiate to the left or right arm, back, or jaw and is not relieved by rest or the administration of nitroglycerin. Irregular heartbeat, dyspnea, and diaphoresis often accompany the pain. Some patients may experience nausea. MI is occasionally clinically silent, especially in diabetes. Angina pectoris, chest pain caused by ischemia during or shortly after exertion, is the result of reduced oxygen supply to the myocardium.

REF: p. 390

OBJ: 6

32. The diagnosis of anemia indicates that the patient is experiencing a reduction in a. RBCs or Hgb. b. platelets. c. lymphatic tissue. d. white blood cells (WBCs).

ANS: A

Anemia is defined as a condition in which there is a reduction in the quantity of either RBCs or Hgb in a measured volume of blood, reducing the blood’s ability to carry oxygen to the cells.

REF: p. 428

OBJ: 25

33. Referring to the conduction system of the heart, the pacemaker is located in the a. AV node. b. Purkinje fibers. c. SA node. d. bundle branches.

ANS: C

Arrhythmias can arise from disturbances in the normal conduction system of the heart, including the pacemaker, the AV node, the bundle branches, and the Purkinje fibers (see Fig. 10.35). Ischemia and drugs cause many arrhythmias. Failure of the SA node may be responsible. Table 10.1 lists the causes of arrhythmias. Heart block occurs when the impulses from the SA node become slow or irregular at or below the AV node. Assisting the heart’s natural pacemaker, the SA node, and when necessary the rest of the impulse conduction system, artificial pacemakers can be external (a temporary intervention) or implanted.

REF: p. 410

OBJ: 16

34. Clots of aggregated material (usually blood) are a. emboli. b. necrosis. c. stenosis. d. claudication.

ANS: A

Emboli are clots of aggregated material (usually blood). They can lodge in blood vessels and inhibit blood flow.

REF: p. 418

OBJ: 20

35. The weakening and resulting local dilation of the wall of an artery is a. varicose veins. b. aneurysm. c. thromboangiitis obliterans. d. Raynaud’s syndrome.

ANS: B

An aneurysm is a weakening and resulting local dilation of the wall of an artery.

REF: p. 422

OBJ: 22

36. A condition of simultaneous hemorrhage and thrombosis is a. hemophilia. b. disseminated intravascular coagulation (DIC) c. Hodgkin’s lymphoma. d. Raynaud’s syndrome.

ANS: B

DIC is a condition of simultaneous hemorrhage and thrombosis. It is a syndrome occurring secondary to other diseases or dramatic events.

REF: p. 443

OBJ: 33

37. Hardening of the cusps of the cardiac valves is a. arteriosclerosis. b. stenosis. c. insufficiency. d. thrombus.

ANS: B

Stenosis, a hardening of the cusps of the valves that prevents complete opening of the valves, impedes the blood flow into the next chamber (see Fig. 10.34).

REF: p. 408

OBJ: 15

38. Ischemia causes a. death to tissue. b. swelling of tissue. c. blood disorders. d. hemorrhage.

ANS: A

Ischemia causes death to tissue. An MI is death of myocardial tissue caused by the development of ischemia. An occlusion of a coronary artery resulting in ischemia and infarct (death) of the myocardium causes sudden, severe substernal or left-sided chest pain. The pain is caused by ischemia, and if ischemia is not reversed within about 6 hours, the cardiac muscle dies. Coronary thrombosis is the most common cause of MI. REF: p. 390

OBJ: 7

39. Abnormally slow heart rate is a. asystole. b. tachycardia. c. bradycardia. d. fibrillation.

ANS: C

In some disorders of the heart and circulatory system, the rhythm of the heartbeat becomes irregular. Bradycardia is an abnormally slow heart rate. Disorders of cardiac rhythm are called arrhythmias or dysrhythmias. Arrhythmias result when there is interference with the conduction system of the heart, resulting in an abnormality of the heartbeat. Symptoms include palpitations, rapid heartbeat (tachycardia), skipped heartbeats, slow heart rate (bradycardia), syncope, and fatigue.

REF: p. 383

OBJ: 17

40. The two upper chambers of the heart are the a. atria. b. septa. c. ventricles. d. valves.

ANS: A

The heart consists of two side-by-side pumps, each divided into two chambers: two upper chambers called atria, and two lower chambers called ventricles. As venous blood returns to the heart from the body, it enters the right atrium, passes through the tricuspid valve, and with atrial contraction, enters the right ventricle. Heart valves prevent the blood from flowing backward. From the right ventricle, blood is pumped through the pulmonary valve and, with ventricular contraction, into the pulmonary arteries and on to the lungs. In the lungs, carbon dioxide is removed and oxygen is added to the blood. Freshly oxygenated blood then returns to the heart via the pulmonary veins. It enters the left atrium, moves through the mitral (bicuspid) valve with atrial contraction, and enters the left ventricle. As the left ventricle contracts, the blood is forced through the aortic valve, into the aorta, and on to the rest of the body. This process is called the cardiac cycle.

REF: p. 382

OBJ: 1

41. ―Hardening of the arteries,‖ refers to a. plaque. b. arteriosclerosis. c. atherosclerosis. d. fat.

ANS: B

Arteriosclerosis is a group of diseases characterized by hardening of the arteries.

Arteriosclerosis has three forms: atherosclerosis, Mönckeberg's arteriosclerosis, and arteriolosclerosis. Atherosclerosis occurs when plaques of fatty deposits form within the arterial tunica intima. Mönckeberg's arteriosclerosis, medial calcific sclerosis, involves the arterial tunica media; there is destruction of muscle and elastic fibers along with calcium deposits. Arteriolosclerosis occurs when the walls of the arterioles thicken, resulting in loss of elasticity and contractility.

REF: p. 386

OBJ: 21

TRUE/FALSE 1. Transfusion incompatibility reactions are always fatal.

ANS: F

The prognosis varies depending on the amount of blood infused, the cause of the reaction, and the speed of the intervention.

REF: p. 443

OBJ: 31

2. Patients with coronary heart disease always experience pain.

ANS: F

Patients are asymptomatic initially, with the first symptom being the pain of angina pectoris (see ―angina pectoris‖ section). In advanced disease, the severe pain of MI is described as burning, squeezing, crushing, and radiating to the arm, neck, or jaw (see ―myocardial infarction‖ section) and is caused by diminished blood flow and lower oxygen saturation.

Nausea, vomiting, and weakness can also be experienced. Changes in the electrocardiogram are often but not always recognized. Many patients may be asymptomatic up until an MI or sudden death event; this is why noninvasive screening of high-risk patients is imperative.

REF: p. 385

OBJ: 5

3. The cause of essential hypertension is unknown.

ANS: T

The etiology of essential hypertension is unknown, but many factors are thought to contribute to the condition. Stress is considered a major factor in hypertension. Age, heredity, smoking, obesity, sedentary lifestyle, poor dietary habits, and hyperactive personality or type A personality are possible causative factors in essential hypertension.

REF: p. 396

OBJ: 8

4. Mitral stenosis is usually the result of rheumatic heart disease.

ANS: T

Rheumatic heart disease is the cause of most cases of mitral stenosis. The group A beta-hemolytic streptococcus stimulates antibody production, and the antibodies often attack the body tissue in an autoimmune response.

REF: p. 408

OBJ: 14

5. Patients with mitral valve prolapse (MVP) experience severe crushing chest pain and syncope.

ANS: F

MVP, usually a benign condition, occurs when the valve cusps do not close completely. Most patients are asymptomatic, and the condition is usually discovered during a routine examination.

REF: p. 409

OBJ: 15

6. Sickle cell anemia is asymptomatic.

ANS: F

Sickle cell anemia, a chronic hereditary hemolytic form of anemia, is found predominately in those of the black race and does present with symptoms. The presence of Hgb S, along with Hgb A, is noted in erythrocytes, causing them to acquire a sickle or elongated shape on deoxygenation. Depending on the severity of the anemia, one or many symptoms may occur, including pallor, fatigue, dizziness, shortness of breath, and irregular heartbeat.

REF: p. 430

OBJ: 25

7. MI is the death of myocardial tissue caused by ischemia.

ANS: T

MI is the death of myocardial tissue caused by the development of ischemia. MI results from insufficient oxygen supply, such as occurs when a coronary artery is occluded by atherosclerotic plaque, thrombus, or myocardial muscle spasm. The pain is caused by ischemia, and if ischemia is not reversed within about 6 hours, the cardiac muscle dies.

Coronary thrombosis is the most common cause of MI. REF: p. 390

OBJ: 7

8. Causes of cardiac arrest include respiratory arrest, MI, trauma, electrocution, hemorrhage, and

drug overdose.

ANS: T

Cardiac arrest results from anoxia (absence of oxygen to the tissue) or interruption of the electrical stimuli to the heart. It can be caused by respiratory arrest, arrhythmia, or MI. Electrocution, drowning, severe trauma, massive hemorrhage, or drug overdose can also cause cardiac arrest.

REF: p. 392

OBJ: 7

9. Cardiomyopathy is a noninflammatory disease of the cardiac muscle.

ANS: T

Cardiomyopathy is a noninflammatory disease of the cardiac muscle resulting in enlargement of the myocardium and ventricular dysfunction.

REF: p. 400

OBJ: 11

10. Agranulocytosis (also called neutropenia) is a blood dyscrasia in which leukocyte levels

become extremely low.

ANS: T

Agranulocytosis (also called neutropenia) is a blood dyscrasia in which leukocyte levels become extremely low. Blood studies show leukopenia, with a substantial decrease in the number of polymorphonuclear cells. Bone marrow studies reveal a lack of granulocytes, and the developing WBCs are not mature and are reduced in number.

REF: p. 430

OBJ: 27

11. CAD results from deposits of fat-containing substances called plaque in the lumen (opening)

of the coronary arteries resulting in atherosclerosis and subsequent narrowing of the lumen of the arteries.

ANS: T

Deposits of fat-containing substances called plaque in the lumen (opening) of the coronary arteries result in atherosclerosis and subsequent narrowing of the lumen of the arteries.

REF: p. 386

OBJ: 3

12. Agranulocytosis is usually caused by drug toxicity or hypersensitivity.

ANS: T

Agranulocytosis is usually caused by drug toxicity or hypersensitivity. For example, cancer chemotherapy with chemotoxic agents can be a cause. Benzene is another chemical agent that causes neutropenia. Agranulocytosis, or neutropenia, is an acute insult to the body’s immune system and drastically reduces the body’s response to bacterial infection. The infectious agents usually invade the body through the oral or pharyngeal mucosa and are often already present but are no longer held in check by the now-absent granulocytes. Patients are occasionally sensitive to a particular drug, such as chlorpromazine, propylthiouracil, phenytoin, chloramphenicol, and phenylbutazone.

REF: p. 430

OBJ: 27

13. Immediate intervention for thrombophlebitis is not necessary.

ANS: F

Immediate intervention for thrombophlebitis is necessary. The affected part is immobilized to prevent the thrombus from spreading and dislodging to become an embolus. Heparin is administered to prevent the clot from enlarging, and antibiotics are given to prevent infection.

REF: p. 424

OBJ: 23

Chapter 11: Diseases and Conditions of the Urinary System Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Proper function of the urinary system is frequently evaluated by a. physical examination alone. b. the patient’s history alone. c. urinalysis (UA) and blood tests. d. how much liquid the patient is drinking daily.

ANS: C

The function of the urinary system is often evaluated by UA and blood tests. Normal results demonstrate proper filtration, absorption, and elimination of metabolic waste, as well as precise fluid and electrolyte balance.

REF: p. 450

OBJ: 1

2. The urinary system is responsible for which functions? a. Cleansing the blood of waste products. b. Regulating the normal balance of water and electrolytes. c. Storing and excreting urine. d. All of the answer options above.

ANS: D

The urinary system is responsible for producing, storing, and excreting urine; these processes prevent the body from becoming toxic. The kidneys facilitate reabsorption of necessary nutrients, water, and electrolytes. Cleansing the blood of the waste products of metabolism and regulating the water, salts, and acids in the body fluids ensure the body’s homeostasis.

Regulation of volume of water in the body is an essential function of the urinary system. The urinary system includes the kidneys, which manufacture urine and play a role in the regulation of systemic blood pressure and the accessory structures.

REF: p. 450

OBJ: 2

3. The disease that encompasses a group of symptoms referred to as the protein-losing kidney is a. hydronephrosis. b. acute glomerulonephritis. c. nephrotic syndrome. d. diabetic nephropathy.

ANS: C

Nephrotic syndrome, a disease of the basement membrane of the glomerulus, is secondary to a number of renal diseases and a variety of systemic disorders. Nephrotic syndrome encompasses a group of symptoms sometimes referred to as the protein-losing kidney.

REF: p. 458

OBJ: 7

4. Which symptoms and signs are indicative of acute glomerulonephritis? a. Edema, hematuria, protein in the urine, and decreased urinary output. b. An abnormal UA. c. Hypertension, headaches, and low-grade fever. d. All of the answer options above.

ANS: D

Acute glomerulonephritis is marked by proteinuria (protein in the urine), edema, and decreased urine volume. Hematuria can range from insignificant to a sudden onset of urine that is grossly bloody (gross hematuria). The urine may appear dark or may be described as coffee colored. Occurring most often in children and adolescents, this disease process usually follows a streptococcal infection by 1- to 2 weeks (post -streptococcal glomerulonephritis).

Hypertension related to altered renal function and fluid retention is possible, accompanied by headaches, visual disturbances, malaise, anorexia, and a low-grade fever. Flank or back pain develops as a result of swelling of the kidney tissue.

REF: p. 452

OBJ: 4

5. Acute glomerulonephritis usually follows which pathology? a. infection by group A beta-hemolytic streptococcus. b. Kidney trauma. c. Excessive calcium in the blood. d. All of the answer options above.

ANS: A

Acute glomerulonephritis usually follows an infection caused by group A beta-hemolytic streptococcus.

REF: p. 452

OBJ: 5

6. The condition of the kidney caused by pressure from urine that cannot flow past an

obstruction in the urinary tract is called a. enuresis. b. diabetic nephropathy. c. hematuria. d. hydronephrosis.

ANS: D

Hydronephrosis is an abnormal dilation of the renal pelvis caused by pressure from urine that cannot flow past an obstruction in the urinary tract.

REF: p. 463

OBJ: 12

7. Which treatments are indicated for renal calculi? a. Relief of pain, lithotripsy, surgical intervention, increased fluid intake, and

diuretics. b. Dialysis, kidney transplant, and antibiotic therapy. c. Both of the answer options. d. Neither of the answer options.

ANS: A

Treatments indicated for renal calculi include relief of pain, lithotripsy, surgical intervention, increased fluid intake, and diuretics.

REF: p. 466

OBJ: 13

8. Glomerulosclerosis describes renal changes that are caused by to a systemic endocrine disease

and that are typical of a. urethritis. b. cystitis. c. diabetic neuropathy. d. polycystic kidney disease.

ANS: C

Diabetic nephropathy refers to the renal changes resulting from diabetes mellitus, a systemic endocrine disease caused by failure of the pancreas to release enough insulin into the body.

These changes, called glomerulosclerosis, can be expected eventually in all patients with insulin-dependent (type 1) diabetes, which increases their morbidity and mortality.

Additionally, many patients with non-insulin-dependent (type 2) diabetes can also develop this kidney disorder. Diabetic glomerulosclerosis is a complication of diabetes mellitus; lesions of the glomeruli eventually cause the filtration rate to decrease. Insufficient control of blood glucose levels and blood pressure in the patient with diabetes may hasten the deterioration of renal function.

REF: p. 468

OBJ: 15

9. Weakening of pelvic floor muscles and the urethral structure as a result of trauma, childbirth,

hormonal changes of aging, obesity, or certain medications may precipitate which problem? a. Renal cell carcinoma (RCC).

b. Bladder tumors. c. Polycystic kidney disease. d. Stress incontinence (enuresis).

ANS: D

Stress incontinence results from weakening of the pelvic floor muscles and the urethral structure. Trauma to the area resulting from childbirth is the most common cause. Pressure from an existing pregnancy may also be the cause. The hormonal changes of aging and menopause make the condition more common in older women. Certain medications and obesity can also precipitate the disorder.

REF: p. 471

OBJ: 18

10. Dialysis filters out unwanted elements from the blood, usually removed by healthy kidneys;

thus a. dialysis is considered a cure for kidney failure. b. the body’s proper fluid, electrolyte, and acid-base balance is maintained. c. dialysis is never used until the symptoms of ultimately fatal uremia develop. d. All of the answer options above.

ANS: B

Dialysis filters out unwanted elements from the blood by diffusion across a semipermeable membrane; the healthy kidneys usually remove these wastes. Thus the proper fluid, electrolyte, and acid-base balances are maintained in the body.

REF: p. 456

OBJ: 6

11. Which items are nephrotoxic agents known to cause renal damage? a. Solvents and heavy metals. b. Antibiotics and pesticides. c. Poisonous mushrooms. d. All of the answer options above.

ANS: D

Nephrotoxic agents include solvents and heavy metals, antibiotics, pesticides, and poisonous mushrooms. In addition, controlling exposure to substances known to be nephrotoxic, including drugs, insecticides, organic solvents, and cleaning agents, helps prevent acute renal failure (ARF).

REF: p. 458

OBJ: 8

12. The cause(s) of cystitis and urethritis is/are a. an ascending bacterial invasion of the urinary tract. b. sexually transmitted diseases (STDs). c. inflammation as a result of chemotherapy or radiation. d. All of the answer options above.

ANS: D

The usual cause of cystitis and urethritis is an ascending bacterial invasion of the urinary tract.

The most common causative microorganism is Escherichia coli, followed by Klebsiella, Enterobacter, Proteus, and Pseudomonas species. STDs can cause cystitis and urethritis.

Other sources of the conditions are viruses, fungi, parasites, and inflammation caused by chemotherapy or radiation. Lesions can develop in the bladder secondary to inflammation, thereby intensifying the symptoms.

REF: p. 467

OBJ: 14

13. Which statements is true about renal cell carcinoma (RCC)? a. The prognosis is good in all cases. b. The cause is known to be viral. c. Risk factors may include smoking, obesity, and prolonged exposure to chemicals

such as asbestosis and cadmium. d. The most common primary tumor of the kidney occurs in the renal pelvis.

ANS: C

Risk factors for sporadic RCC are smoking, obesity, hypertension, dialysis patients with acquired cystic kidney disease, and prolonged exposure to chemicals such as asbestos and cadmium. RCC is more common in men, and incidence varies geographically, with the highest rates found in the Czech Republic and North America.

REF: p. 472

OBJ: 19

14. Polycystic kidney disease a. is a reversible condition. b. greatly enlarges the kidneys and leads to kidney failure. c. is not inherited and is an acute condition. d. is not usually seen on x-ray.

ANS: B

Polycystic kidney disease is a slowly progressive and irreversible disorder in which normal renal tissue is replaced with multiple grapelike cysts. The condition is bilateral, with cysts that form from dilated nephrons and collecting ducts. Eventually the kidneys become grossly enlarged, with compression of surrounding tissue leading to impaired renal function and renal failure.

REF: p. 468

OBJ: 16

15. The cause of neurogenic bladder, a bladder-control dysfunction, is a. damage to the brain, spinal cord, or nerves supplying the lower urinary tract. b. hydronephrosis. c. renal calculi. d. ARF. ANS: A

An insult to the brain, spinal cord, or the nerves supplying the lower urinary tract, whether by trauma or disease process, may result in the inability to empty the bladder of urine or to maintain continence as is seen in neurogenic bladder. Damage may be caused by cerebrovascular accident, spinal cord trauma, tumors, neuropathies, herniated lumbar disks, poliomyelitis, spinal cord lesions, or myelomeningocele.

REF: p. 470

OBJ: 18

TRUE/FALSE 1. Lithotripsy is a procedure used to examine the urinary tract.

ANS: F

Lithotripsy is a procedure used to destroy renal calculi which are also called kidney stones.

Treatment for kidney stones begins with analgesic therapy and hydration during the initial evaluation. Location and size of the calculi indicate the course of treatment. Small calculi (<5 mm) may be treated by observation and with fluid hydration in the hope that the stone will pass spontaneously. Large calculi can be removed by any of several surgical procedures.

Attempts are made to crush stones that are (1) too large to pass down the ureter, (2) lodged in the pelvis of the kidney, or (3) trapped in the proximal portion of the ureter. ESWL is a procedure that breaks apart (crushes) the stones, thus allowing the small particles to flush out of the body naturally. A surgical procedure using an ureteroscope to capture the stone in a basket and remove it is attempted for stones trapped in the distal aspect of a ureter. If the attempt to capture the stone is unsuccessful, EHL or laser lithotripsy is used in an attempt to break the stone apart into small particles that can be flushed out of the system.

REF: p. 466

OBJ: 3

2. Catheterization may be indicated before or after surgery (or both before and after), to relieve

urinary retention, to obtain a sterile specimen, to irrigate the bladder, or to treat urinary incontinence.

ANS: T

Urinary catheterization is indicated to empty the bladder before surgery, to obtain a sterile urine specimen, to relieve urinary retention, and to treat incontinence (an indwelling catheter is attached to a drainage bag).

Urinary catheterization involves the insertion of a catheter into the urinary bladder through the urethra for the withdrawal of urine for irrigation of the bladder with a therapeutic solution.

Strict sterile technique is necessary to prevent cystitis.

REF: p. 470

OBJ: 17

3. Chronic glomerulonephritis (CGN) is a slowly progressive, noninfectious disease that can

lead to renal failure.

ANS: T

CGN is a slowly progressive, noninfectious disease that can lead to irreversible renal damage and renal failure. As an advanced stage of many kidney disorders, CGN results in inflammation followed by progressive destruction of the glomeruli. This progressive destruction causes a reduction in glomerular filtration with resulting retention of uremic poisons.

REF: p. 454

OBJ: 5

4. ARF is a clinical emergency.

ANS: T

ARF, a sudden and severe reduction in renal function, is a common clinical emergency because nitrogenous waste products begin to accumulate in the blood quickly, thereby causing an acute uremic episode.

REF: p. 459

OBJ: 9

5. Pyelonephritis is the most common type of kidney disease.

ANS: T

Pyelonephritis, the most common type of renal disease, is an inflammation of the renal pelvis and connective tissues of one or both kidneys.

REF: p. 461

OBJ: 11

6. Symptoms of renal calculi are the same regardless of the size of the stone.

ANS: F

The symptoms of renal calculi vary according to the size of the stone. Kidney stones can be solitary or multiple and vary in size. A larger stone formed in the shape of the renal pelvis is known as a staghorn calculus. Small stones can be passed spontaneously unnoticed. The patient’s symptoms vary with the degree of obstruction. If infection or blockage caused by the calculi are present, the patient experiences sudden severe pain in the flank area, known as renal colic, with urinary urgency and other urinary symptoms. Other symptoms include nausea and vomiting, hematuria, fever, chills, and abdominal distention. Blood in the urine can be the result of trauma caused by the presence of small stones, which may be gravel-like in consistency, or larger stones, such as staghorn calculi. Hydronephrosis can develop if urine is prevented from flowing past the calculi.

REF: p. 465

OBJ: 13

7. Hydronephrosis is caused by decreased blood flow to the kidney.

ANS: F

Hydronephrosis is an abnormal dilation of the renal pelvis caused by pressure from urine that cannot flow past an obstruction in the urinary tract.

REF: p. 463

OBJ: 12

8. Urinary urgency, frequency, and possible incontinence are symptoms of chronic renal failure

(CRF).

ANS: F

The patient with CRF can feel weak, tired, and lethargic. Hypertension and edema result from the retention of fluids in the body as the condition progresses. As the uremic syndrome worsens, many other symptoms and signs are generated: arrhythmias, muscle weakness, dyspnea, metabolic acidosis, ulceration of the gastrointestinal mucosa, and hair and skin changes.

REF: p. 460

OBJ: 10

9. Polycystic disease is inherited.

ANS: T

Polycystic kidney disease is inherited, but may not manifest until adolescence or adulthood. It is not clearly understood why the cysts form.

REF: p. 469

OBJ: 16

10. The most common symptom of a bladder tumor is gross, intermittent, painless hematuria.

ANS: T

The most common symptom of a bladder tumor is gross, intermittent, painless hematuria. Pain in the flank or suprapubic area may occur as the carcinoma becomes locally advanced or metastatic. Voiding symptoms, such as dysuria, urgency, and increased frequency, are sometimes experienced. Symptoms of advanced disease include fatigue, weight loss, and anorexia.

REF: p. 473

OBJ: 19

11. The patient who has CRF is evaluated for dialysis or kidney transplantation to prolong life.

ANS: T

Chronic renal failure requires evaluation for dialysis or kidney transplant to prolong life. The underlying cause, if known, must be treated. Diet and nutritional modifications control protein and sodium intake to reduce the work of the diseased kidneys. Fluid intake and output are monitored and regulated. Drug therapy includes the administration of diuretics, antihypertensives, antiinfective agents, and antiemetics. Many different complications are possible, so the prognosis is uncertain.

REF: p. 461

OBJ: 10

Chapter 12: Diseases and Conditions of the Reproductive System Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Which condition results from an infection of Human papillomavirus virus (HPV) ? a. genital herpes. b. genital warts c. chancroid. d. gonorrhea.

ANS: B

Human papillomavirus virus (HPV) causes genital warts. Risk factors for acquiring persistent infection with HPV are early age for initiation of sexual activity and having multiple sexual partners. Coinfection with human immunodeficiency virus (HIV) causes a further increase in HPV-related cancer risk. .

REF: p. 485

OBJ: 6

2. Cervical cancer is commonly associated with a. genital herpes. b. use of condoms. c. one of many types of HPV viruses identified by scientists. d. trichomoniasis.

ANS: C

There are many types of HPV, some of which are known to cause cancers of the cervix, anus, vagina, vulva, and penis. HPV infection is most often associated with cervical cancer.

REF: p. 485

OBJ: 6

3. The most commonly notifiable sexually transmitted disease (STD) in the United States is a. genital herpes. b. trichomoniasis. c. syphilis. d. chlamydia.

ANS: D

Chlamydia is the most commonly notifiable sexually transmitted disease (STD) in the United States. Newborns can acquire chlamydia from their infected mothers during birth, resulting in conjunctivitis, blindness, arthritis, or overwhelming infection. The organism can be found in the cervix, throat, or rectum, and can be transmitted unknowingly. Recently more cases are prevalent in adolescents and young adults. Chlamydia is sometimes called the ―silent STD‖ because it often has no symptoms and thus it is sexually transmitted unknowingly. Infected patients should inform sexual contacts of their infection.

REF: p. 481

OBJ: 3

4. Failure to seek treatment for a gonorrhea infection can result in which complication/s? a. Pelvic inflammatory disease (PID). b. Septicemia. c. Septic arthritis. d. All of the answer options above.

ANS: D

Neglecting treatment of a gonococcal infection can lead to complications, including PID, septicemia, infertility, and septic arthritis. Salpingitis (inflammation or infection of the fallopian tube) is the most common complication of gonorrhea. Up to 50% of men and women are asymptomatic in the early stages of infection, so they may unknowingly continue to spread the infection, making transmission difficult to control. The disease can also infect the eyes and throat or become systemic.

REF: p. 482

OBJ: 4

5. The treatment of genital herpes is directed at a. curing the disease. b. preventing transmission at all times. c. reducing the duration and frequency of outbreaks. d. All of the answer options above.

ANS: C

There is no cure for genital herpes, but prescription drugs are currently available to reduce the duration and frequency of outbreaks. These drugs include acyclovir [Zovirax], famciclovir [Famvir], and valacyclovir [Valtrex]. In some cases, the body’s own immunity makes the episodes less severe. In addition, women with genital herpes must be watched more carefully for cervical cancer. A Pap (Papanicolaou) smear every 6 months is recommended.

REF: p. 484

OBJ: 5

6. Which statement is true about syphilis? a. The cause and mode of transmission is unclear. b. No known cure for the disease exists. c. When the primary lesion heals, the disease is cured. d. Syphilis can be cured with a course of antibiotic therapy.

ANS: D

Syphilis can be easily cured in its early stages with a course of antibiotic therapy using penicillin G. If the patient is allergic to penicillin, other antibiotics are used, such as doxycycline, azithromycin, and ceftriaxone.

REF: p. 486

OBJ: 7

7. Invasive cervical cancer a. has no identifiable risk factors. b. is often considered a preventable disease. c. is most commonly diagnosed before the age of 35. d. is none of the answer options above.

ANS: B

Invasive cervical cancer is often considered a preventable disease because it has a long premalignant stage (often 10 years or longer) and an effective screening program with effective therapies. Therefore, the biggest risk factor for development of invasive cervical carcinoma is lack of regular cervical Pap smear screening.

REF: p. 510

OBJ: 26

8. The pathologic outcomes of endometriosis includes a. functioning endometrial tissue outside the uterine cavity. b. fluid-filled sacs that form on or near ovaries. c. changes that result from menopause. d. All of the answer options above.

ANS: A

The implants of endometrium are found most commonly in the pelvis but may occur in distant sites, outside of the uterine cavity. Secondary dysmenorrhea is more likely to be caused by an underlying disorder or disease condition, including pelvic infections, fibroids, cervical stenosis, but most commonly by endometriosis.

REF: p. 502

OBJ: 20

9. The diagnosis of PID may include a. a Gram stain and sensitivity studies. b. a laparoscopy.

c. ultrasonography. d. All of the answer options above.

ANS: D

Sometimes the symptoms or signs are not clear in cases of PID. Cervical cultures, ultrasound, and laparoscopy can be helpful to confirm the diagnosis. Fever, elevated white blood cell count, and pelvic examination are usually all that are needed to make the diagnosis and begin treatment.

REF: p. 503

OBJ: 21

10. The cause(s) of toxic shock syndrome (TSS) is/are thought to be a. unprotected sexual intercourse. b. estrogen replacement therapy. c. increase in staphylococcal colonization on superabsorbent tampons. d. All of the answer options above.

ANS: C

The cause of TSS is thought to be an increase in staphylococcal colonization on superabsorbent tampons. The toxins produced by these bacteria create the illness. TSS can also occur in women using contraceptive sponges or even diaphragms. Currently physicians are treating staphylococcal toxic shock with intravenous (IV) vancomycin to cover methicillin-resistant Staphylococcus aureus.

REF: p. 506

OBJ: 22

11. Early diagnosis and prompt treatment of PID helps prevent complications, including a. pelvic adhesions. b. increased risk of ectopic pregnancy. c. peritonitis and septicemia. d. All of the answer options above.

ANS: D

Early diagnosis and prompt treatment lessen the damage to the reproductive system. Recurrent or severe PID can cause pelvic adhesions, increased risk of ectopic pregnancy, peritonitis and septiscemia along with scarring of the fallopian tubes, obstruction, and infertility. Early and aggressive therapy can improve the prognosis.

REF: p. 504

OBJ: 21

12. Which symptoms and signs indicate toxemia in pregnancy, preeclampsia, and eclampsia? a. Hypertension, edema, protein in the urine, and convulsions. b. Hypotension and other indications of shock. c. Symptoms that mimic pregnancy. d. None of the answer options above.

ANS: A

Hypertension, edema, protein in the urine and convulsions are signs of toxemia in pregnancy, preeclampsia, and eclampsia. Preeclampsia can be preceded by increased weight gain.

Elevation of blood pressure to a level >140/90 is a sign. When there is >300 mg of protein in the urine over a 24-hour period, then the conditions for the diagnosis of preeclampsia are present. If the patient has a seizure, it is usually of the grand mal variety, and they can have the usual postictal manifestation of confusion and disorientation. These patients are also at increased risk for stroke, and thus any symptom of a central neurologic nature may need to be evaluated for the presence of stroke.

REF: p. 521

OBJ: 31

13. In pregnancy, when the placenta is implanted in the lower uterine segment and encroaches on

the internal cervical os causing vaginal bleeding, the condition is called a. ectopic pregnancy. b. hyperemesis gravidarum (HG). c. abruptio placentae. d. placenta previa.

ANS: D

The onset of bright red vaginal bleeding during pregnancy requires immediate attention, close observation, and diagnostic evaluation. The attending physician is notified.

For any massive hemorrhage with fetal or maternal compromise, immediate delivery by cesarean section is warranted. At no time is vaginal delivery allowed with a viable fetus when there is a placenta previa present.

REF: p. 523

OBJ: 32

14. Benign prostatic hyperplasia (BPH) causes which symptoms? a. Malaise and pain. b. Swelling and tenderness of one or both testes. c. A weak stream of urine with inability to empty the bladder. d. Acute onset of fever and convulsions.

ANS: C

Enlargement of the prostate gland is a common condition in men older than 50 years, and the frequency increases with age. BPH usually progresses to the point of causing compression of the urethra with urinary obstruction and resulting urinary retention. Urinary frequency, including nocturia, and in severe cases, inflammation and symptoms of renal disease, have been observed.

REF: p. 494

OBJ: 15

15. Which procedures are used in the diagnostic evaluation for prostate cancer? a. A rectal examination. b. Blood testing for prostate-specific antigen (PSA). c. A biopsy to confirm the diagnosis. d. All of the answer options above.

ANS: D

Prostate cancer is often asymptomatic at diagnosis since it is usually detected clinically by abnormalities on routine digital rectal examination (DRE) or by a high concentration of PSA in the serum. Although abnormally high PSA level and abnormal DRE are highly suggestive findings, prostate biopsy is necessary for a cancer diagnosis. The Gleason score and the PSA level are incorporated into the TNM stage determination as well.

REF: p. 495

OBJ: 16

16. _____ accounts for more deaths than any other gynecologic malignancy. a. Breast b. Uterine c. Vaginal d. Ovarian ANS: D

Because of the location of the ovaries deep within the pelvis, ovarian cancer is often asymptomatic until the more advanced stages.

REF: p. 512

OBJ: 24

17. What is the first sign of testicular cancer? a. A painful lump discovered in the testicle. b. a painless lump discovered in the testicle. c. Urinary incontinence. d. Sexual dysfunction.

ANS: B

The most common presentation of testicular cancer is a lump, nodule, or painless swelling of one testicle. Some patients complain of a dull ache or a heavy sensation in the abdomen, perianal area, or scrotum.

REF: p. 497

OBJ: 27

18. Which risk factor/s place women at a higher risk for cancer of the breast? a. Family history. b. Increased age. c. Hormonal, reproductive, and genetic factors. d. All of the answer options above.

ANS: D

Risk factors that place a woman at higher risk for breast cancer include, being female, family history of breast cancer, increased age, hormonal, reproductive, and genetic factors. Breast cancer is 100 times more common in women than men. Prolonged exposure to and higher concentrations of endogenous estrogen increase the risk of breast cancer. Therefore, younger age at menarche, older age at first full-term pregnancy, and older age at menopause are risk factors. Long-term (>5 years) use of combined estrogen/progesterone HRT modestly increases the risk of breast cancer.

REF: p. 529

OBJ: 18

19. Endometrial cancer is a. primarily a disease of postmenopausal women.

b. is often caused by to high cumulative exposure to estrogen. c. may be detected on a routine Pap smear. d. All of the answer options above.

ANS: D

Endometrial cancer (also known as uterine cancer) involves the lining of the uterus, which undergoes cyclic changes as a result of hormonal stimulation such as that which occurs with menopause. It may be caused bydue to high cumulative exposure to estrogen. It can be detected on a routine Pap smear.

REF: p. 513

OBJ: 34

20. Causes usually associated with spontaneous abortion (miscarriage) include a. abnormal chromosomes, infection, and metabolic disturbances. b. travel and exercise. c. drugs and prescribed medications. d. sexual intercourse.

ANS: A

Abnormal chromosomes, infection, and metabolic disturbances are associated with spontaneous abortion. Drugs and most prescribed medications do not normally cause abortions. Travel, exercise, and intercourse are also not associated with miscarriage. Women who work as anesthesiologists have been noted to have a higher spontaneous abortion rate.

REF: p. 518

OBJ: 27

21. One of the major risk factors for ectopic pregnancy is a. contraception. b. poor diet. c. history of PID. d. exercise.

ANS: C

One of the major risk factors for ectopic pregnancy is a history of PID. Preventing this infection can reduce the chances of ectopic pregnancies. Most causes of ectopic pregnancy cannot be altered.

REF: p. 519

OBJ: 29

22. Which condition/s of pregnancy is/are considered a medical emergency? a. Symptoms of abruptio placentae b. Onset of seizures c. Onset of pain and vaginal bleeding d. All of the answer options above ANS: D

When the placenta separates prematurely from the uterine wall (abruptio placentae), it can cause hemorrhage, abdominal pain, fetal distress, or even fetal death. The onset of seizures requires emergency intervention. Excessive bleeding may lead to hypovolemia, which causes a rapid pulse and low blood pressure.

REF: p. 522

OBJ: 30

23. Which statement(s) is/are correct regarding multiple pregnancies? a. They are occurring more often. b. Problems associated with multiple pregnancies are many. c. The fetuses usually must be delivered by cesarean section. d. All of the above answer options are correct.

ANS: D

Multiple pregnancies are occurring more often. Infertility treatment contributes to this increase because fertility drugs such as Follistim are given to stimulate ovulation. The mother is at greater risk for toxemia and all complications that can affect a singleton pregnancy.

REF: p. 524

OBJ: 28

24. Which statement is inaccurate in regard to diseases of the breast? a. Changes in the breast tissue such as lumps or nipple crusting are not concern for

investigation. b. Men do experience diseases of the breast. c. Diseases of the breast range from mild to fatal. d. The vast majority of breast diseases are diagnosed through abnormal mammogram

findings.

ANS: A

Any changes in the breast tissue, such as lumps, indentations, nipple crusting, or leaking, should be the cause for concern and investigation.

REF: p. 526

OBJ: 33

25. The modes of transmission of hepatitis B include a. contact with blood, semen, vaginal secretions. b. sharing contaminated needles, accidental inoculation. c. from an infected mother to her infant during birth. d. All of the answer options above.

ANS: D

Hepatitis B virus is transmitted primarily through percutaneous and perimucosal routes. While the hepatitis B antigen is present in the blood, the disease is highly transmissible with exposure to blood and body fluids of the infected individual. Exposure may occur through needlesticks, sexual relations with an infected person, or from an infected mother to her child during the birth process.

REF: p. 480

OBJ: 34

26. Peritonitis is a. a condition that requires prompt and aggressive medical intervention. b. also referred to as cholecystitis. c. caused by short bowel syndrome. d. None of the answer options above.

ANS: A

Peritonitis requires prompt and aggressive medical intervention because it can spread the infection throughout the abdominal cavity, or if the infection becomes blood-borne, septicemia and even death may result. Recurrent or severe PID can cause scarring of the fallopian tubes, obstruction, and infertility. Early and aggressive therapy can improve the prognosis.

REF: p. 504

OBJ: 8

27. The most common male sexual disorder is a. torsion of the testicle. b. erectile dysfunction (ED) impotence. c. infertility. d. orchitis.

ANS: B

ED is the most common male sexual disorder, affecting most men at some time during their lives. The condition can be temporary or may become chronic.

REF: p. 488

OBJ: 21

28. How does a varicocele contribute to male infertility? a. Causes blockage of the urinary tract. b. Causes enlargement of the prostate gland, which blocks the sperm. c. Is a consequence of the mumps virus. d. Increased presence of venous blood raises the temperature within the scrotum

which may contribute to a lower sperm count.

ANS: D

Because the increased presence of venous blood raises the temperature within the scrotum, varicocele may contribute to a lower sperm count.

REF: p. 493

OBJ: 9

29. In postmenopausal women, which symptom should prompt evaluation for malignancy? a. Cystocele b. Lack of uterine bleeding c. Uterine bleeding d. None of the answer options above ANS: C

Uterine bleeding in postmenopausal women must be investigated as this is an indication for malignancy. A gynecologic examination and a Pap smear for any woman having abnormal uterine bleeding should be scheduled.

REF: p. 513

OBJ: 12

30. Which statement(s) is/are true about prostate cancer? a. It rarely occurs before age 40. b. It occurs much more commonly in black men. c. Annual screening usually begins at age 50. d. All of the above answer options are true.

ANS: D

Schedule a physical examination with screening for prostate cancer annually at age 50 or over or when a patient reports urinary symptoms or new onset ED. Ethnicity is also important, as prostate tumors are much more common in black men than in white or Hispanic men.

REF: pp. 495-496

OBJ: 23

31. The incidence of STDs is increasing among which population of people? a. Senior citizens.Neither of the answer options b. Men having sex with men (MSM). c. Women. d. Both B and C.of the answer options ANS: D

The incidence of STDs is increasing among populations of people who are men having sex with men and also women.

REF: p. 480

OBJ: 17

32. Which STD is the most prevalent in the United States? a. Syphilis b. Gonorrhea c. Chlamydia d. Herpes ANS: C

According to the Centers for Disease Control and Prevention, chlamydia is the most commonly reported STD in the United States.

REF: p. 481

OBJ: 1

33. Which method of birth control is permanent? a. Tubal ligation b. Intrauterine device (IUD) c. Diaphragm d. Progesterone implant ANS: A

Tubal ligation, vasectomy, and hysterectomy are all forms of permanent birth control.

REF: p. 490

OBJ: 1

TRUE/FALSE 1. Both the male and female reproductive systems are vulnerable to many diseases, including

STDs, malignancies, benign growths, and chemical imbalances.

ANS: T

Both the male and female reproductive systems are vulnerable to many diseases, including STDs, malignancies, benign growths, and chemical imbalances.

REF: p. 479

OBJ: 1

2. Alcohol, recreational drugs, antihistamines, diuretics, and drugs used to treat hypertension can

cause impotence.

ANS: T

Medications prescribed to treat hypertension and depression can have a side effect of ED. REF: p. 488

OBJ: 10

3. There are various possible causes of male or female infertility, including the presence of an

STD. ANS: T

In about 40% of cases, the male is the cause of infertility; in another 40% of cases, various female factors are found to be the cause, with <10% of cases unexplained.

REF: p. 489

OBJ: 11

4. The absence of menstrual periods, whether temporary or permanent, is called dysmenorrhea.

ANS: F

The absence of menstrual periods, whether temporary or permanent, is known as amenorrhea.

Primary amenorrhea is no menses by age 16. Secondary amenorrhea is no menses after a woman has been having menstrual cycles.

REF: p. 499

OBJ: 11

5. The best prevention of epididymitis is the early treatment of urinary tract infections.

ANS: T

The best prevention for epididymitis is the early treatment of urinary tract and sexually transmitted infections. Condom use during sexual intercourse is also recommended.

REF: p. 491

OBJ: 20

6. Hyperemesis gravidarum usually self-limiting and transient.

ANS: F

Hyperemesis Gravidarum, excessive vomiting in pregnancy, occurs when the pregnant patient experiences frequent, severe episodes of nausea and vomiting, weight loss, and dehydration, and is unable to keep either food or liquid in the stomach. In severe cases, the patient is hospitalized. There she can reverse the dehydration with IV fluids.

REF: p. 516

OBJ: 13

7. Although the cause is not always clearly understood, the best prevention of premature labor is

good prenatal care.

ANS: T

All elements of good prenatal care are the best prevention of premature labor. Attention to individual needs and the medical history are clearly presented with as many teaching aids as possible.

REF: p. 520

OBJ: 28

8. The patient with hydatidiform mole experiences symptoms that mimic pregnancy.

ANS: T

The patient with hydatidiform mole experiences symptoms that mimic pregnancy.

Occasionally, there may be more nausea and vomiting and more vaginal bleeding than one might usually see in pregnancy. On physical examination, the uterus may feel larger than expected based on the last menstrual period. In cases of complete molar pregnancy, no fetus develops and the ultrasound shows an empty or absent sac and an abnormal appearing placenta.

REF: p. 525

OBJ: 28

9. Fibroadenoma is a nontender malignant tumor of the breast.

ANS: F

Fibroadenoma is a nontender benign tumor of the breast.

REF: p. 527

OBJ: 32

10. The surest way to avoid transmission of STDs is the use of male latex condoms.

ANS: F

The surest way to avoid transmission of STDs is to abstain from sexual intercourse or to be in a long-term mutually monogamous relationship with a partner who has been tested and whom you know is uninfected. No protective method is 100% effective and condom use cannot guarantee absolute protection against any STD. REF: p. 480

OBJ: 34

11. Many physical or medical conditions can play a significant role in erectile dysfunction.

ANS: T

Many physical or medical conditions can play a significant role in erectile dysfunction. Sexual health and proper sexual functioning are important to human beings for the pleasure they provide, for the intimacy they nurture in a relationship, and for reproduction. To fulfill these purposes, the individuals must be free from organic disease and psychosexual disorders.

REF: p. 488

OBJ: 2

12. Torsion of the testicle is a condition in which one testicle is twisted out of its normal position;

emergency treatment is required.

ANS: T

Testicular torsion is an emergent condition. It occurs when the testis rotates on the spermatic cord, causing a sudden, extreme twist or torsion. It can happen spontaneously or as a result of trauma. Immediate consultation with urology is required, followed by surgical intervention of both testes. Surgery should never be delayed, as it may result in permanent damage to the testicle.

REF: pp. 492-493

OBJ: 9

13. There are prenatal diagnostic tests that can identify fetal genetic or chromosomal

abnormalities and detect complications.

ANS: T

Prenatal diagnostic tests are reliable in identifying fetal genetic or chromosomal abnormalities and other complications of pregnancy. These include the following tests: Amniocentesis – —a small amount of amniotic fluid is extracted for laboratory analysis. Chorionic villus sampling – —a biopsy procedure to excise placental tissue for laboratory analysis. Maternal serum fetal-free deoxyribonucleic acid (DNA) analysis. Doppler ultrasonography – —noninvasive real-time, three-dimensional fetal imaging.

REF: p. 514

OBJ: 14

14. The anterior pituitary gland produces hormones that regulate the menstrual cycle.

ANS: T

The anterior pituitary gland produces gonadotropic hormones that cause the ovaries to produce estrogen and progesterone, which regulate the menstrual cycle.

REF: p. 479

OBJ: 28

15. Prolapse of the uterus is a downward displacement of the uterus from the normal location in

the pelvis.

ANS: T

Prolapse of the uterus is a downward displacement of the uterus from the normal location in the pelvis. Surgery is the only way to correct prolapse. In women who no longer need their uterus, a hysterectomy is commonly performed with or without reattaching the vaginal apex to the sacrum or to the sacrospinous ligaments.

REF: p. 507

OBJ: 23

16. Emergency birth control is used when a person has been sexually assaulted.

ANS: F

Emergency birth control is used when no birth control took place prior to or during intercourse.

REF: p. 490

OBJ: 25

MATCHING

Match the following descriptions with the appropriate terms. a. Pain that occurs at ovulation b. Bacterial ulceration of the genitalia c. Displacement of the urinary bladder into the vagina d. Protrusion of the rectum into the vagina e. A more severe stage of morning sickness of pregnancy 1.

2.

3.

4.

5.

Rectocele Cystocele Chancroid Mittelschmerz Hyperemesis gravidarum

1.

2.

3.

4.

5.

ANS: D ANS: C ANS: B ANS: A ANS: E

REF: REF: REF: REF: REF:

p. 509 p. 508 p. 487 p. 501 p. 516

OBJ: OBJ: OBJ: OBJ: OBJ:

30 25 25 7 19

Chapter 13: Neurologic Diseases and Conditions Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Nerves that transmit impulses toward the brain and spinal cord are a. afferent. b. efferent. c. motor. d. receptor.

ANS: A

Sensory (afferent) nerves transmit impulses from parts of the body (e.g., skin, eye, ear, and nose) to the spinal cord and brain.

REF: p. 535

OBJ: 1

2. Nerves that transmit impulses away from the brain and spinal cord to the muscles and glands

are a. b. c. d.

efferent. afferent. sensory. efferent and sensory.

ANS: A

Motor (efferent) nerves transmit impulses away from the CNS and produce responses in muscles and glands.

REF: p. 535

OBJ: 1

3. Possible causes of peripheral neuritis include which factors? a. Chronic alcohol intoxication, toxicity, and infectious diseases b. History of head injury or skull fractures c. Stress, a noisy environment, and edema in the blood vessels d. Are not known ANS: A

Peripheral neuritis is caused from chronic alcohol intoxication, toxicity, and infectious diseases. CNS abscesses may be the result of a local infection or may be secondary to infections Chronic alcohol intoxication; toxicity from arsenic, lead, carbon disulfide, benzene, or phosphorus; infectious diseases, including mumps, pneumonia, and diphtheria; metabolic or inflammatory disorders, including diabetes, rheumatoid arthritis, gout, and systemic lupus erythematosus; and certain nutritional deficiency diseases are all causative factors. The nerve degeneration leads to muscle weakness and sensory loss.

REF: p. 564

OBJ: 18

4. Of the following, which is not associated with a cerebrovascular accident (CVA)? a. Arrhythmias b. Cerebral embolism c. Glioblastoma d. Cerebral thrombosis ANS: C

A glioblastoma is a cancerous brain tumor and causes symptoms of seizures, nausea, vomiting and headache, but not strokes. A stroke is usually the result of one of three types of vascular disorders: occlusion of an artery caused by an atheroma; sudden obstruction by an embolus, including a cerebral thrombosis (clot), embolism (moving clot), or other moving emboli; or a cerebral bleed. They are also associated with heart arrhythmias such as atrial fibrillation.

REF: p. 570

OBJ: 4

5. Temporary episodes of impaired neurologic functioning caused by inadequate blood flow to a

portion of the brain are termed a. Neither of the answer options b. transient ischemic attacks (TIAs). c. ministrokes. d. Both of the answer options ANS: D

Transient cerebral ischemia can occur in various sites. TIAs are often referred to as ―little strokes‖ or ―ministrokes‖ because they resemble a stroke caused by an embolism.

REF: pp. 542-543

OBJ: 5

6. Nuchal rigidity, headache, and photopia are symptomatic of a. trigeminal neuralgia. b. hydrocephalus. c. postpolio syndrome. d. meningeal irritation or meningitis.

ANS: D

Early symptoms of meningitis include vomiting and a headache that increases in intensity with movement or shaking of the head. Attempts of the examiner to move the head reveal nuchal rigidity, a stiffness of the neck that resists any sideways or flexion-extension movements of the head; this is a classic sign. Positive Kernig sign (resistance to leg extension after flexing the thigh on the body) and Brudzinski’s sign (neck flexion causes flexion of the hips from a supine position) indicate meningeal irritation. Deep tendon reflexes increase, and the patient exhibits irritability, photophobia, and a hypersensitivity of skin. Seizures caused by cortical irritation can be late manifestations of the process. Drowsiness may progress to stupor and coma.

REF: p. 566

OBJ: 19

7. A collection or mass of blood that forms between the skull and the dura mater is termed a(n) a. subdural hematoma. b. epidural hematoma. c. meningocele. d. concussion.

ANS: B

An epidural hematoma is a collection or mass of blood that forms between the skull and the dura mater, the outermost of the three meningeal layers covering the brain. With a subdural hematoma, the blood collects or pools between the dura mater and the arachnoid membrane, the second meningeal membrane (see Fig. 13.8).

REF: p. 544

OBJ: 7

8. Bruising of the brain tissues along or just beneath its surface accompanied by symptoms

lasting more than 24 hours describes a a. concussion. b. contusion. c. CVA. d. TIA. ANS: B

A cerebral contusion is more serious than a concussion. This injury to the brain involves bruising of tissue along or just beneath the surface of the brain. It may also be termed a contrecoup insult. The symptoms and signs of a contusion vary according to the site and extent of the injury and persist for longer than 24 hours. They may range from temporary loss of consciousness to coma. When conscious, the person may report a severe headache and hemiparesis. Symptoms may be progressive in nature. The person may appear drowsy and lethargic or hostile and combative.

REF: p. 546

OBJ: 7

9. Loss of motor and sensory control of the trunk of the body and lower extremities as a result of

a spinal cord injury describes a. peripheral neuritis. b. quadriplegia. c. paraplegia. d. a degenerative disk.

ANS: C

When the spinal cord is injured, a part or parts of the body inferior to the point of injury may be affected. The damage to the cord may be only temporary, but it usually leads to some degree of permanent disability because nerve pathways control many bodily functions and actions. Paraplegia results in the loss of motor and sensory control of the trunk of the body and lower extremities. Loss of bowel, bladder, and sexual function is also common.

REF: p. 548

OBJ: 9

10. How do infectious organisms reach the brain in cases such as meningitis? a. The blood b. Penetrating trauma c. An infection in adjoining structures such as the ear or sinuses d. All of the answer options ANS: D

Meningitis can be either bacterial or viral. The infection can originate directly from the brain, spinal cord, or sinuses. Open head injuries are additional portals of entry for the offending bacteria. Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae are the bacteria responsible for most meningeal infections. CNS abscesses may be the result of a local infection or may be secondary to infections elsewhere in the body. Common causative organisms are staphylococci, streptococci, or pneumococci. Any occurrence that breaches the integrity of the CNS, including head trauma and a craniotomy wound, may be the portal of entry for the microorganisms. The abscess may be secondary to another infectious process, including sinusitis, otitis, dental abscess, subdural empyema, and bacterial endocarditis.

REF: p. 568

OBJ: 19

11. Paralysis of all four extremities is known as a. paraplegia. b. quadriplegia. c. hemiplegia. d. hemiparesis.

ANS: B

Quadriplegia is loss of nerve function at the cervical region resulting in paralysis of the arms, hands, trunk, and legs.

REF: p. 548

OBJ: 8

12. Periodic severe headaches that may be completely incapacitating are called a. cephalalgia. b. peripheral neuritis. c. neuralgia. d. migraines.

ANS: D

Periodic severe headaches that may be completely incapacitating and almost always are accompanied by other symptoms, such as nausea and vomiting, anorexia, intense hemicrania or bilateral throbbing pain, and visual signs and symptoms, are known as migraine headaches.

REF: p. 556

OBJ: 12

13. Which diagnosis is a chronic brain disorder characterized by sudden episodes of abnormally

intense electrical activity in the brain? a. Epilepsy b. Bell’s palsy c. Amyotrophic lateral sclerosis (ALS) d. Parkinson disease ANS: A

Epilepsy, a seizure disorder, is a chronic brain disorder, characterized by sudden episodes of abnormal intense electrical activity in the brain, which result in seizure activity.

REF: p. 557

OBJ: 13

14. Which symptoms are characteristic of Parkinson disease? a. ―Pill-rolling‖ tremor of thumb and forefinger, muscular rigidity, masklike facial

expression, and shuffling gait b. Narcolepsy, hemiparesis, muscular atrophy, and seizures c. Tongue smacking; dementia; and ceaseless, involuntary movements d. All of the answer options ANS: A

Parkinson disease is a common, slowly progressive neurologic disorder characterized by the onset of recognizable disturbances: a ―pill-rolling‖ tremor of the thumb and forefinger, muscular rigidity, slowness of movement, and postural instability.

REF: p. 559

OBJ: 14

15. _____ involves degeneration of the nerves outside the CNS and affects the distal muscles of

the extremities. a. Bell’s palsy b. Neuralgia c. Peripheral neuritis d. Parkinson disease ANS: C

Peripheral neuritis, the degeneration of peripheral nerves, affects the distal muscles of the extremities.

REF: p. 563

OBJ: 18

16. The patient with _____ experiences excruciating pain that radiates along the fifth cranial

nerve distribution, affecting any of the branches. a. tic douloureux b. peripheral neuritis c. trigeminal neuralgia d. tic douloureux and trigeminal neuralgia ANS: D

The transient, excruciating pain of trigeminal neuralgia (tic douloureux) radiates along the fifth cranial nerve distribution and can affect any of the three fifth cranial nerve branches, although it usually affects the second and/or third.

REF: p. 564

OBJ: 18

17. Inflammation of the membranes covering the brain and spinal cord is called a. encephalitis. b. meningitis. c. blepharitis. d. polyneuritis.

ANS: B

Meningitis is an inflammation of the meninges, the membranous coverings of the brain and spinal cord.

REF: p. 566

OBJ: 19

18. Which vascular disorders may result in a CVA? a. Cerebral thrombosis and cerebral embolism b. Cerebral hemorrhage c. Both of the answer options d. Neither of the answer options ANS: C

A CVA is usually the result of one of three types of vascular disorders: occlusion of an artery caused by an atheroma; sudden obstruction by an embolus, including a cerebral thrombosis (clot), embolism (moving clot), or other moving emboli; or a cerebral bleed.

REF: p. 541

OBJ: 4

19. Unilateral facial paralysis is called a. quadriplegia. b. hemiparesis. c. Bell’s palsy. d. epilepsy.

ANS: C

Bell’s palsy is a disorder of the facial nerve (seventh cranial nerve) that causes a sudden onset of weakness or paralysis of facial muscles. The severity of paralysis in Bell’s palsy varies widely. The patient may be aware of pain or a drawing sensation behind the ear, followed by an inability to open or close the eye and drooping of the mouth and drooling of saliva. Often the disorder is first noticed in the morning, having developed overnight.

REF: p. 565

OBJ: 18

20. An acute, rapidly progressive disease of the spinal nerves with progressive muscle weakness

and paralysis in a 24- to 72-hour period may be indicative of which medical illness? a. Parkinson disease b. Guillain-Barré syndrome c. Huntington chorea d. ALS ANS: B

The individual with Guillain-Barré syndrome experiences numbness and tingling of the feet and hands at the onset of the disease, followed by increasing muscle pain and tenderness.

Progressive muscle weakness and paralysis usually start in the lower extremities and move up the body in 24 to 72 hours. Although most patients experience an ascending paralysis, occasionally some patients have a descending weakness and paralysis. Respiratory insufficiency is possible, as is difficulty swallowing.

REF: p. 567

OBJ: 21

21. Which condition involves a slight paralysis in either half of the body? a. Paraplegia b. Quadriplegia c. Hemiparesis d. Bell’s palsy ANS: C

Hemiparesis causes a slight paralysis in either half of the body. This typically occurs as a result of a stroke. The symptoms and signs of a stroke reflect the portion of the brain affected.

Common stroke symptoms include the following: Sudden severe headache Sudden aphasia, dysphasia, or difficulty understanding language Sudden weakness, numbness, or paralysis of the face, including one-sided drooping mouth and eyelid (hemiparesis) Sudden confusion or impaired consciousness Sudden loss of vision, blurred vision, unequal pupils, or diplopia Sudden onset of dizziness, loss of balance, or loss of coordination REF: p. 537

OBJ: 3

22. Which condition involves progressive destruction of motor neurons resulting in muscle

atrophy? a. Parkinson disease b. Guillain-Barré syndrome c. Huntington chorea d. ALS ANS: D

ALS, also known as Lou Gehrig’s disease, is a progressive, destructive motor neuron disease that results in muscular atrophy.

REF: p. 561

OBJ: 15

23. _____ is an abnormal condition in which there are sudden, transient disturbances of brain

function causing seizures. a. Parkinson disease b. Guillain-Barré syndrome c. Epilepsy d. Bell’s palsy ANS: C

Epilepsy, a seizure disorder, is a chronic brain disorder, characterized by sudden episodes of abnormal intense electrical activity in the brain, which result in seizure activity.

REF: p. 557

OBJ: 13

24. Paralysis of the lower half of the body as a result of damage in the lower portion of the spinal

cord is called a. paraplegia. b. quadriplegia. c. hemiparesis. d. Bell’s palsy.

ANS: A

Paraplegia is loss of nerve function below the waist and paralysis of the lower trunk and legs.

Injuries to the spinal cord affect the innervation of any spinal nerves distal to the point of insult. The extent of the injury and consequential edema often result in the failure of spinal nerve functioning, with resulting loss of motor and sensory function.

REF: p. 548

OBJ: 8

25. _____ is a highly contagious viral disease that affects the anterior horn cells of the gray matter

in the spinal cord. a. Poliomyelitis b. Meningitis c. Encephalitis d. Brain abscess ANS: A

Poliomyelitis is a viral infection of the anterior horn cells of the gray matter of the spinal cord and causes a selective destruction of the motor neurons.

REF: p. 569

OBJ: 22

26. _____ is the result of the bones of the floor of the cranial vault being broken. a. CVA b. Depressed fracture c. Basilar fracture d. Encephalitis ANS: C

A basilar skull fracture is a fracture of the bones of the floor of the cranial vault. This injury usually results from a massive insult to the cranium during a motor vehicle accident or other violent trauma in which the head is struck anteriorly or laterally in the midportion.

REF: p. 548

OBJ: 7

27. Symptoms and signs of brain tumors include a. headache, seizures, and cognitive dysfunction. b. gait disturbances, lethargy, and nystagmus. c. fever, stiff neck, and unilateral facial paralysis. d. All of the answer options

ANS: A

Common symptoms of brain tumors include, focal or generalized seizures, cognitive dysfunction (including memory problems and personality changes), muscle weakness, sensory loss, aphasia, or visual dysfunction. Regardless of the brain tumor cell type, symptoms and signs result from displacement and compression of normal brain tissue by the tumor, causing progressive neurologic deficits, expansion of the brain (cerebral edema), and increased intracranial pressure (ICP).

REF: p. 570

OBJ: 22

28. Pill-rolling tremor of thumb and forefinger, muscular rigidity, masklike facial expression, and

shuffling gait are all signs of which condition? a. Bell’s palsy b. Parkinson disease c. Epilepsy d. Neuropathy ANS: B

A primary symptom of Parkinson disease is tremor or trembling in hands, arms, jaw, face, and legs. In addition, there is a rigidity or stiffness of limbs and trunk, causing the posture to be stooped. The patient moves slowly with a peculiar shuffling gait: the head is bowed, the body is flexed forward, the knees are slightly bent, and the patient has a tendency to fall because of impaired balance and coordination. The face takes on a masklike or expressionless appearance, speech is muffled, and swallowing is difficult. Gradual changes in behavior and mental activity are noted in some patients as the disease progresses. The mean age of onset is 60 years, but many cases appear in younger persons. Parkinson disease afflicts more men than women, and the usual life span after diagnosis is 10 years.

REF: pp. 558-559

OBJ: 14

29. Blood, penetrating trauma, and infection in adjoining structures such as the ear or sinuses are

all routes in which infectious organisms may reach the brain and cause a. infection. b. a stroke. c. a subdural hematoma. d. restless legs syndrome (RLS).

ANS: A

Blood, penetrating trauma, and infection in adjoining structures such as the ear or sinuses are all routes in which infectious organisms may reach the brain and cause infection.

REF: p. 568

OBJ: 3

30. The prognosis for patients with tumors involving the brain is a. poor. b. always death. c. good. d. difficult to project.

ANS: D

The prognosis for patients with brain tumors is difficult to project. Regardless of the tumor cell type, symptoms and signs result from displacement and compression of normal brain tissue by the tumor, causing progressive neurologic deficits, expansion of the brain, and increased ICP, leading to possible herniation. Although brain tumors can be malignant or benign, the distinction is blurred in the brain. Unlike benign neoplasms in other locations of the body, benign brain tumors may cause the same symptoms as malignant cancers, such that distinguishing between benign and malignant on clinical grounds can be very difficult. Even a benign tumor with little to no metastatic potential can be lethal if it occurs in a region of the brain that precludes full surgical resection.

REF: p. 571

OBJ: 12

31. ALS causes symptoms of a. pill-rolling and shuffling of feet. b. progressive destruction of motor neurons, resulting in muscle atrophy. c. dancelike movements and a decline in mental function. d. paralysis.

ANS: B

ALS causes symptoms of progressive destruction of motor neurons, resulting in muscle atrophy. Fasciculations small local involuntary muscular contractions and accompanying atrophy and weakness are noted in the forearms and hands. Difficulty in speech, chewing, swallowing, and breathing; eventually, a ventilator is required. No sensory neuron involvement is noted, and functioning of the mind is not affected. ALS characteristically affects men slightly more often than women, with onset occurring after the age of 50 to 60 years.

REF: p. 561

OBJ: 15

32. A disorder of the facial nerve (seventh cranial nerve) that causes a sudden onset of weakness

or paralysis of facial muscles is a. trigeminal neuritis. b. Guillain-Barré syndrome. c. epilepsy. d. Bell’s palsy.

ANS: D

Bell’s palsy is a disorder of the facial nerve (seventh cranial nerve) that causes a sudden onset of weakness or paralysis of facial muscles.

REF: p. 565

OBJ: 18

33. Electrical impulses are carried throughout the body by the________________. a. nephrons b. tendons c. hormones d. neurons ANS: D

Electrical impulses are carried throughout the body by the neurons.

REF: p. 534

OBJ: 1

34. The spinal cord is divided into ____ segments, each giving rise to a pair of spinal nerves. a. 7 b. 12 c. 5 d. 31 ANS: D

The spinal cord, a continuation of the medulla oblongata, is divided into 31 segments, each giving rise to a pair of spinal nerves that act like a telephone switchboard, or reflex center, carrying impulses to and from the brain.

REF: p. 535

OBJ: 1

35. Encephalitis frequently results from a. bacteria. b. the bite from an infected mosquito. c. fungus. d. contaminated soil.

ANS: B

Most cases of encephalitis are the result of a bite from an infected mosquito. Eastern equine, western equine, and Venezuelan equine encephalomyelitis and St. Louis encephalitis are forms of encephalitis encountered in the United States.

REF: p. 567

OBJ: 20

TRUE/FALSE 1. Spinal stenosis contributes to sciatic pain caused by a narrowing of the spinal canal that

causes compression of spinal nerve roots.

ANS: T

Spinal stenosis, a narrowing of the spinal canal or nerve root foramen, is often termed sciatica because of the compression on the spinal cord and spinal nerve roots.

REF: p. 554

OBJ: 10

2. Narrowing of intervertebral spaces on imaging studies may indicate degeneration of an

intervertebral disk.

ANS: T

Narrowing of intervertebral spaces on imaging studies may indicate degeneration of an intervertebral disk. The clinical findings and a history of previous back involvement leads to investigation with various types of imaging. This may include radiographic films, most often an MRI scan, myelogram with contrast to show the disk status, and rarely, a CT scan.

REF: p. 551

OBJ: 10

3. With an epidural hematoma, the onset of symptoms is delayed as a result of a slower

accumulation of blood.

ANS: F

Symptoms of an epidural hematoma typically appear within a few hours of head trauma. They include sudden headache, dilated pupils, nausea and often vomiting, increased drowsiness, and perhaps hemiparesis.

REF: p. 544

OBJ: 7

4. All brain tumors originate in the brain tissue.

ANS: F

Brain tumors can be primary tumors, neoplasms that originate in the brain itself, or secondary tumors, cancers that have metastasized from another area of the body such as the lung, liver, kidney, or skin.

REF: p. 570

OBJ: 12

5. Another term for herniated disk is ruptured or slipped disk.

ANS: T

A herniated disk, also known as a ruptured or slipped disk, is the rupture of the nucleus pulposus through the annular wall of the disk and into the spinal canal (see Fig. 13.15A and C).

REF: p. 552

OBJ: 10

6. The amnesia of transient global amnesia is permanent.

ANS: F

Transient global amnesia, although frightening and anxiety provoking, is transient or temporary, having a duration of 1 to 6 (maybe even up to 12) hours.

REF: p. 562

OBJ: 17

7. TIA and transient global amnesia are the same thing.

ANS: F

TIA and transient global amnesia are not the same thing. TIAs (transient ischemic attacks) are temporary episodes with duration of <24 hours of impaired neurologic functioning caused by an inadequate flow of blood to a portion of the brain. Transient global amnesia, is transient or temporary, having a duration of 1 to 6 (maybe even up to 12) hours.

REF: pp. 542, 562

OBJ: 17

8. The CNS’s function is to process and store sensory and motor information and to govern the

state of consciousness.

ANS: T

The CNS includes the brain and spinal cord. Its function is to process and store sensory and motor information and to govern the state of consciousness.

REF: pp. 534-535

OBJ: 1

9. During a neurologic assessment a patient’s mental status may be graded with the Glasgow

coma scale, which is a standardized system for assessing the response to stimuli.

ANS: T

During a neurologic assessment the patient’s mental status may be graded with the Glasgow coma scale, which is a standardized system for assessing the response to stimuli.

REF: p. 536

OBJ: 2

10. The goals of treatment for all spinal cord injuries include restoration of the normal alignment

and stability of the spine; decompression of the spinal cord, nerves, and vertebrae; and early rehabilitation of the patient.

ANS: T

The goals of treatment for all spinal cord injuries include restoration of the normal alignment and stability of the spine; decompression of the spinal cord, nerves, and vertebrae; and early rehabilitation of the patient. These goals may involve surgery or using specialized medications and procedures.

REF: p. 549

OBJ: 9

11. Cephalalgia, or secondary headache, is sometimes a symptom of an underlying disorder or

disease.

ANS: T

Cephalalgia, or secondary headache, is sometimes a symptom of an underlying disorder or disease (e.g., sinus infection or congestion, temporomandibular joint syndrome, hypertension, stroke, brain tumor, and encephalitis). In most cases, however, headaches are caused by nothing more serious than fatigue or tension.

REF: p. 556

OBJ: 11

12. RLS is caused by hypertension.

ANS: F

The exact cause of RLS is unknown. The incidence of developing RLS appears to increase after the ages of 40 or 50. Anemia may play a part in the disorder. Stressful events may precipitate the onset of symptoms.

REF: p. 562

OBJ: 16

13. Ruptured disks in the cervical region of the spine often produce pain and weakness in the

arms and neck.

ANS: T

Ruptured disks in the cervical region of the spine often produce pain and weakness in the arms and neck. Pain from injury to a disk can be either unilateral or bilateral.

The rupture can cause severe back pain and even disability if it presses against or pinches the spinal nerves. Sudden, sharp pain that worsens with movement or in certain positions. It may radiate from the back to the buttocks, thigh, and leg following the course of the impinged nerve, causing pain, paresthesia, and muscle weakness in the leg.

REF: pp. 552-553

OBJ: 10

Chapter 14: Mental Disorders Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. Identifiable causes of intellectual developmental disorder include a. genetic disorders, infection, trauma, or poisoning. b. early alterations in embryonic development and general medical conditions. c. prematurity or hypoxia. d. All of the answer options ANS: D

Intellectual developmental disorder has a variety of causes, many of which are unidentifiable.

The identifiable causes include genetic disorders, infection, trauma, poisoning, early alterations in embryonic development and general medical conditions. Prematurity and hypoxia may also be associated with intellectual developmental disorder.

Any condition that compromises the blood supply to the developing brain, depriving it of oxygen and nutrients, can result in neurologic damage and intellectual developmental disorder. Some examples are placental insufficiency, cord or head compression during the perinatal period, failure to breathe at birth, premature birth, and viral infections in the mother in the prenatal period or in the infant or child after birth. Trauma of any type that causes hypoxia or anoxia may also contribute to the deficit. Fetal alcohol syndrome may also result in intellectual developmental disorder.

REF: p. 577

OBJ: 2

2. Criteria for the diagnosis of intellectual developmental disorder include limitation in at least

which two areas? a. Communication, health, safety, and self-care b. Social or interpersonal skills, self-direction, and home living c. Adaptive functioning d. All of the answer options ANS: D

The diagnosis of intellectual developmental disorder requires limitations in at least two of the following areas: communication, home living, self-care, social or interpersonal skills, self-direction, and health and safety. Onset must be before 18 years of age. Criteria for the diagnosis of intellectual developmental disorder also include subaverage general intellectual functioning accompanied by significant limitations in adaptive functioning as described.

REF: p. 577

OBJ: 2

3. A major factor that creates and maintains stuttering is a. anxiety. b. hypoxia. c. vitamin deficiency. d. heredity.

ANS: A

Anxiety appears to be a major factor that creates and maintains stuttering. Although the etiology is uncertain, genetic factors may be involved. Stuttering appears to have a familial tendency, with the condition occurring more often in males. Parents may also unwittingly cause anxiety in their child by overreacting to mild speech limitation.

REF: p. 579

OBJ: 13

4. _____ involves a progressive, general deterioration of the mental capacities of perceiving,

thinking, and remembering. a. Somatoform disorder b. Mood disorder c. Sleep disorder d. Dementia ANS: D

Dementia brings a progressive, general deterioration of mental faculties, including deterioration of perceiving, thinking, and remembering. Cognitive functioning declines abnormally. Dementia, not a part of normal aging, represents a pathologic development. The irreversible brain damage may be the result of compromised blood flow to the brain resulting from atherosclerosis, thrombi, or trauma. In addition, toxins, metabolic conditions, organic disorders, infections, tumors, or Alzheimer’s disease (AD) may be responsible for the deterioration.

REF: p. 584

OBJ: 8

5. The anxiety disorder that results from an external event of an overwhelming painful nature is

called a. pain disorder. b. posttraumatic stress disorder (PTSD). c. hypochondriasis. d. apnea.

ANS: B

PTSD is a delayed response to an external traumatic event that produces signs and symptoms of extreme distress. PTSD caused by human actions (e.g., rape, acts of war, and continued abuse) tends to precipitate more severe reactions than PTSD caused by natural disasters such as hurricanes, earthquakes, and floods. In the case of natural disasters, the greater the threat of death and the greater the number of people affected, the greater the likelihood of severe PTSD. REF: p. 606

OBJ: 14

6. A child who experiences extreme withdrawal and obsessive behavior along with lack of social

interaction suffers from which condition?

a. b. c. d.

Attention-deficit disorder (ADD) Tourette’s disorder Autism A learning disorder

ANS: C

A child who experiences extreme withdrawal and obsessive behavior along with lack of social interaction suffers from autism. The autistic child will exhibit a notable impairment in socialization, communication, activities, and other interests. The impairment is noted in nonverbal behaviors, such as eye-to-eye gaze, facial expressions, and other forms of nonverbal communication. In addition, the child fails to establish normal peer relationships and to seek shared enjoyment. Communication impairments include delayed or absent verbal communication, inability to initiate a conversation, and repetitive use of inappropriate language. The child does not initiate age-appropriate play activities. Repetitive motions, often self-destructive, may be noted along with inflexibility toward change and a compulsion for sameness. Four symptoms that are nearly always present are social isolation, cognitive (based on knowledge) impairment, language deficits (shortages or missing), and repetitive naturalistic motions. Aversion to physical contact or cuddling can also be a sign. The autistic child resists any change or transition or has difficulty transitioning.

REF: p. 580

OBJ: 3

7. Which disorder includes multiple motor tics coupled with vocal tics? a. Attention-deficit/hyperactivity disorder (ADHD) b. Tourette’s disorder c. Autism d. A learning disorder ANS: B

Tourette’s disorder, also known as Gilles de la Tourette syndrome, is a syndrome of multiple motor tics coupled with one or more vocal tics, which may appear simultaneously or at different times.

REF: p. 583

OBJ: 5

8. Treatment of Tourette’s disorder may include which medications? a. Haldol b. Thorazine c. Dexedrine and Ritalin d. All of the answer options ANS: A

Some patients with Tourette’s disorder have improved with the administration of haloperidol lactate [Haldol]. Other treatment options include clonidine or clonazepam for their calming effects. Additionally, fluoxetine [Prozac] may be helpful in treating repetitive and obsessive behaviors found with Tourette’s disorder.

REF: p. 584

OBJ: 5

9. A major affective disorder which causes abnormally intense mood swings from manic state to

depressive syndrome is

a. b. c. d.

Alzheimer’s disease.

Tourette’s disorder. bipolar disorder. factitious disorder.

ANS: C

Bipolar disorder is a major affective disorder with abnormally intense mood swings from a hyperactive, or manic, state to a depressive syndrome. In some cases, symptoms of hyperactivity and depression may coexist. This is known as a mixed episode. The patient may remain manic for days, weeks, or months before experiencing depression. Assessment findings vary with the type of episode (manic, depressive, or mixed) that the patient is experiencing at the time of medical evaluation.

REF: p. 598

OBJ: 11

10. Which illness is progressive degenerative disease of the brain most common in individuals

over the age of 65 with symptoms that include loss of short-term memory, inability to concentrate, and changes in social skills and personality? a. Alzheimer’s disease b. Conversion disorder c. Bipolar disorder d. Hypochondriasis ANS: A

Alzheimer’s disease is a progressive degenerative disease of the brain most common in individuals over the age of 65 with symptoms that include loss of short-term memory, inability to concentrate, and changes in social skills. It is the most common cause of deterioration in intellectual capacity, or dementia.

REF: p. 584

OBJ: 6

11. Which treatment is appropriate for vascular dementia? a. Carotid endarterectomy and drug therapy b. Vitamin B12 injections c. Organ transplant d. Radiation therapy ANS: A

When the carotid arteries are compromised, surgical intervention in the form of carotid endarterectomy may limit the progress of the condition. Treatment aims to increase the blood supply to the brain. Low-dose aspirin, clopidogrel [Plavix], prasugrel [Effient], and cilostazol [Pletal] are all used for their antiplatelet effect in preventing stroke or its recurrence, especially with patients who are hypertensive or have had a myocardial infarction. Drug therapy may help increase the blood flow.

REF: p. 587

OBJ: 8

12. Excessive use of alcohol is frequently associated with which diagnosis/diagnoses? a. Anxiety b. Impotence c. Amnesia

d. All of the answer options ANS: D

Excessive use of alcohol often is associated with anxiety, depression, insomnia, impotence, and behavioral disorders both before and during intoxication. Amnesia often occurs after intoxication. Alcohol acts on the central nervous system as a depressant.

REF: p. 589

OBJ: 9

13. Prolonged, heavy use of alcohol may result in a. pancreatitis. b. cirrhosis. c. peripheral neuropathy. d. All of the answer options ANS: D

Prolonged heavy use of alcohol may cause cirrhosis of the liver, pancreatitis, and peripheral neuropathy, resulting in muscle weakness and paresthesia. The risk of cancer of the esophagus, stomach, and other parts of the GI system is also increased. The consequences of chronic alcohol abuse include dysfunction within family and social relationships and disruption in occupational responsibilities. Some people are prone to aggressive or violent behavior, accidents, and threatened or attempted suicide. The patient often denies an inability to control or discontinue alcohol abuse.

REF: p. 590

OBJ: 9

14. The psychosis that is characterized by distortions of perception, emotions, and thoughts and

that often includes bizarre behavior is a. bipolar disorder. b. obsessive-compulsive disorder (OCD). c. factitious disorder. d. schizophrenia.

ANS: D

Distortions in perception, emotions, and thoughts are characteristics of schizophrenia.

Hallucinations may be auditory, visual, olfactory, or sensory. The patient with auditory hallucinations acknowledges hearing voices that may be threatening, instructive, or conversational. Delusions, which are erroneous beliefs, represent exaggerations or distortions of perceptions or experiences. In persecutory delusion, for instance, people may believe that they are being mistreated, deceived, or stalked. More bizarre delusions may include belief that one’s thoughts are controlled by an ―alien.‖ REF: p. 596

OBJ: 10

15. The individual experiencing sleep disturbances, fatigue, loss of concentration, appetite

changes, despair, and hopelessness suffers from which disorder? a. Bipolar b. Obsessive-compulsive c. Major depressive d. Gender-identity ANS: C

Major depressive disorder is a serious alteration in mood that may be described as deep and persistent sadness, despair, and hopelessness. Individual experiencing major depressive disorder experience sleep disturbances, fatigue, loss of concentration, appetite changes, despair, and hopelessness.

REF: p. 599

OBJ: 11

16. Personality disorders (PDOs) include a. schizophrenia. b. histrionic disorder. c. paranoia. d. All of the answer options ANS: D

Examples of PDO’s include schizophrenia, histrionic disorder, and paranoia. A PDO is a pattern of behavior that deviates from society’s norms. In addition, a person with a PDO typically has thoughts about the self and the world that cause inappropriate behavior.

REF: p. 616

OBJ: 19

17. Anxiety disorders include a. panic disorders. b. phobic disorders. c. obsessive compulsive disorders. d. All of the answer options ANS: D

Anxiety disorders, previously known as neuroses, include four specific disorders or syndromes that are different in behavioral manifestations but share the fact that the person’s behavior is dominated by anxiety. The four disorders are generalized anxiety disorder, panic disorder, phobic disorder, and obsessive compulsive disorder.

REF: p. 604

OBJ: 13

18. The somatoform disorder previously called hysteria is a. hypochondriasis. b. pain disorder. c. conversion disorder. d. factitious disorder.

ANS: C

Conversion disorders formerly were termed hysteria. Anxiety is changed (converted) to a physical or somatic symptom. The anxiety is too difficult to face, and as a defense mechanism, the physical symptoms allow the person to escape or avoid a stressful situation.

REF: p. 608

OBJ: 15

19. Which treatment/s are used for anxiety disorders? a. Drug therapy b. Hypnosis c. Stress elimination d. All of the answer options

ANS: D

Drug therapy, hypnosis, and stress elimination are all methods of treating anxiety. If the anxiety prevents the person from living a normal life, a psychiatrist or a practitioner trained in treating psychologic problems (e.g., psychologist or psychoanalyst) should be consulted.

Hypnosis is sometimes used to help the patient and the therapist to gain access to the subconscious mind. If the anxiety is caused by a specific stress (e.g., job related), steps should be taken to minimize or eliminate the problem. Various methods of relaxation such as systematic desensitization, progressive relaxation, breathing exercises, and guided imagery can lessen the symptoms. Relaxation exercises (e.g., biofeedback) to relax tense muscles or a physical activity, such as brisk walking, jogging, or swimming, may be beneficial. In addition, or as an alternative, the physician may prescribe an anxiolytic drug. Serotonin-specific reuptake inhibitors (SSRIs) (fluvoxamine [Luvox] is U.S. Food and Drug Administration approved for treatment of OCD) are first-line therapy, but many patients with major depression also may have been prescribed a tricyclic amitriptyline/nortriptyline along with the SSRI and recommended psychotherapy. Benzodiazepines are also frequently prescribed.

Examples are lorazepam [Ativan], clonazepam [Klonopin], and alprazolam [Xanax].

REF: p. 605

OBJ: 13

20. The phases of the grief process are a. denial, anger, bargaining, depression, and acceptance. b. not identifiable. c. depression, bargaining, anger, and denial. d. anger, denial, rejection, and acceptance.

ANS: A

The normal grieving process passes through several phases. The most recognized stages are those identified by Elisabeth Kübler-Ross. The first is denial: ―No, I don’t believe it.‖ Second is anger: ―Why did he or she do this to me?‖ or ―Why is God letting this happen?‖ The third stage is bargaining: ―If only this task can be accomplished or I can achieve this goal (live long enough), I will do this.‖ Fourth is depression, in which people retreat within themselves and have little or no involvement with their environment. Finally, in the fifth stage, acceptance comes. Not everyone is able to move through these steps, and not everyone moves through them at the same pace or in the same order. Some people cannot express anger at the dead person or at God and do not move on. Many of these people never complete the grieving process, so they remain in a depressed state and have reduced coping mechanisms. Medical intervention may help during depression, but most people recover with minimal treatment.

REF: p. 601

OBJ: 12

21. Treatment of major depressive disorder includes a. electroconvulsive therapy (ECT). b. psychotherapy. c. antidepressant drug therapy. d. All of the answer options ANS: D

The most effective treatment for major depressive disorder is a combination of medication and psychotherapy. Most patients have relief of symptoms and a good prognosis if they respond favorably to antidepressant therapy. ECT helps when a patient is severely incapacitated, has psychotic features, or does not respond to other therapeutic measures.

REF: p. 599

OBJ: 11

22. The individual with narcolepsy is treated with a. drug therapy. b. psychotherapy. c. electroconvulsive therapy d. phototherapy.

ANS: A

Drug therapy is useful in treating narcolepsy. Stimulants including methylphenidate and dextroamphetamine are prescribed. Modafinil [Provigil] and armodafinil [Nuvigil] are nonamphetamine stimulants and wakefulness-promoting drugs and may be prescribed for excessive daytime sleepiness.

REF: p. 614

OBJ: 18

23. According to Stanford-Binet testing, individuals with an intelligence quotient (IQ) of 90 to 70

are considered to have a. average intelligence. b. below average intelligence. c. mild intellectual developmental disorder. d. moderate intellectual developmental disorder.

ANS: B

According to Stanford-Binet testing, individuals with an intelligence quotient (IQ) of 90 to 70 are considered to have below average intelligence. Diagnosis requires observation and confirmation of the intellectual capabilities and adaptive behavior of the child.

REF: p. 577

OBJ: 1

24. A major affective disorder with abnormally intense mood swings is _____ disorder. a. bipolar b. obsessive-compulsive c. major depressive d. gender-identity ANS: A

Bipolar disorder is a major affective disorder with abnormally intense mood swings from a hyperactive, or manic, state to a depressive syndrome. In some cases, symptoms of hyperactivity and depression may coexist. This is known as a mixed episode. The patient may remain manic for days, weeks, or months before experiencing depression. Assessment findings vary with the type of episode (manic, depressive, or mixed) that the patient is experiencing at the time of medical evaluation.

REF: p. 598

OBJ: 11

25. Which disorder causes a serious alteration in mood described as deep and persistent sadness,

despair, and hopelessness? a. Bipolar b. Alcoholism c. Major depressive d. Gender-identity ANS: C

Major depressive disorder is a serious alteration in mood that may be described as deep and persistent sadness, despair, and hopelessness. Symptoms develop gradually over several days, during which an anxious or brooding appearance may be noted. The person may experience an empty or heavy feeling inside accompanied by a vague sense of loss. The person also may have an attitude of self-blame, remorse, guilt, or loss of self-esteem. Other symptoms include sleep disturbance (insomnia or hypersomnia), physical sluggishness or fatigue, loss of concentration, and inability to experience pleasure. In addition, a depressed person may have a variety of physical symptoms.

REF: p. 599

OBJ: 11

26. A disorder in which there is a delayed response to an external traumatic event is a. acute stress response. b. phobic disorder. c. PTSD. d. major depressive disorder.

ANS: C

PTSD is a delayed response to an external traumatic event that produces signs and symptoms of extreme distress.

REF: p. 606

OBJ: 14

27. Which disorder involves a person being preoccupied with fear of having a serious disease? a. Hypochondriasis b. Pain disorder c. Conversion disorder d. Factitious disorder ANS: A

The patient with hypochondriasis is preoccupied with fear of having a serious disease. The patient has this excessive fear despite negative medical tests and reassurance that there is no clinical basis for the symptoms. Patients mistake body system symptoms or aches and pains without clinical basis for serious illnesses.

REF: p. 610

OBJ: 16

28. Which disorder is present when the patient simulates symptoms of illness and presents for no

apparent reason other than treatment? a. Hypochondriasis b. Pain c. Conversion d. Factitious

ANS: D

Factitious disorder occurs when the patient simulates symptoms of illness and presents for no apparent reason other than treatment.

REF: p. 610

OBJ: 17

29. Which group of sleep disorders includes sleepwalking, night terrors, and nightmares? a. Insomnia b. Parasomnias c. Narcolepsy d. Sleep apnea ANS: B

Parasomnias are a group of sleep disorders that include sleepwalking, night terrors, and nightmares. Parasomnias may also be termed sleep arousal disorders and oftentimes include dreams.

REF: p. 613

OBJ: 18

30. Which disorder that has a pattern of behavior that deviates from society’s norms? a. Somatoform b. Posttraumatic stress c. Phobic d. Personality ANS: D

A personality disorder is a pattern of behavior that deviates from society’s norms. In addition, a person with a PDO typically has thoughts about the self and the world that cause inappropriate behavior.

REF: p. 610

OBJ: 19

TRUE/FALSE 1. Somatoform disorders include a group of mental disorders in which physical symptoms have

an organic cause.

ANS: F

Somatoform disorders are a group of mental disorders in which the person experiences physical symptoms without an underlying organic cause. These symptoms are not under voluntary control and are real to the affected person.

REF: p. 608

OBJ: 15

2. Major depression can lead to suicidal thoughts and actions that must be taken seriously for

effective intervention.

ANS: T

Major depressive disorder is a serious alteration in mood that may be described as deep and persistent sadness, despair, and hopelessness. The patient withdraws socially and may admit to having suicidal thoughts; suicidal behavior is common in major depression.

REF: p. 599

OBJ: 11

3. Chronic or inappropriate anxiety can become an illness like panic disorder, phobic disorder, or

OCD. ANS: T

Anxiety is a common form of psychologic disorder. Only when anxiety persists and prevents the person from leading a normal life does it become an illness. As a group, anxiety disorders represent the single largest mental health problem in the United States.

REF: p. 603

OBJ: 13

4. Pervasive development disorders (PDDs) include autistic disorder, Rett’s syndrome, and

Asperger’s syndrome.

ANS: T

Children diagnosed with PDD differ widely in abilities, intelligence, and behaviors. Principal characteristics of PDDs are severe impairments in several areas of development, including communication and social interaction skills. The following are the disorders listed as pervasive development-type disorders: autism, pervasive developmental disorder not otherwise specified, Rett’s syndrome, childhood disintegrative disorder, and Asperger’s syndrome.

REF: p. 579

OBJ: 3

5. Each person with attention deficit disorder has problems with hyperactivity.

ANS: F

Many children and adults simply have difficulty maintaining attention and have no hyperactivity problems.

REF: p. 581

OBJ: 4

6. Cluster B of Personality Disorders includes paranoid, schizoid, and schizotypal behaviors.

ANS: F

Cluster B of personality disorders includes Antisocial, Borderline, Histrionic, and Narcissistic behaviors.

REF: p. 616

OBJ: 19

7. Malingering is the feigning of symptoms for financial or personal gain.

ANS: T

Malingering is the feigning of symptoms for financial or personal gain. The action is deliberate and fraudulent, and the symptoms are usually exaggerated. The patient may report these symptoms to avoid or delay various undesirable events. The diagnosis is difficult because the symptoms are often subjective and cannot be disproved.

REF: p. 611

OBJ: 15

8. Bipolar disorder is a major affective disorder.

ANS: T

Bipolar disorder is a major affective disorder with abnormally intense mood swings from a hyperactive, or manic, state to a depressive syndrome. In some cases, symptoms of hyperactivity and depression may coexist. This is known as a mixed episode. The patient may remain manic for days, weeks, or months before experiencing depression. Assessment findings vary with the type of episode (manic, depressive, or mixed) that the patient is experiencing at the time of medical evaluation.

REF: p. 598

OBJ: 11

9. Oppositional defiant disorder (ODD) is the most common referral complaint.

ANS: T

ODD is a behavior disorder in which children demonstrate behaviors that are oppositional toward adults. This is the most common referral complaint to counselors and a major source of family stress, as ODD behaviors occur hundreds of times per week. Comorbid conditions include ADHD (incidence increases with age), conduct disorder, PTSD, learning disabilities, school underperformance, poor social skills, dysthymia, and major depression. ODD is a strong predictor of poor outcomes (e.g., school underachievement, poor peer relations, delinquency, major depression, early substance initiation and abuse, and school expulsion and drop out).

REF: p. 582

OBJ: 4

10. Learning disabilities are no indication of intelligence level.

ANS: T

The person with a learning disorder exhibits difficulty in acquiring a skill in a specific area of learning, such as reading, writing, or mathematics. This lower level of achievement occurs despite the child’s normal (sometimes above normal) intelligence and adequate schooling.

Individuals with learning disabilities may have problems listening or paying attention, reading or writing, speaking, and/or performing arithmetic problems. Individuals with learning disabilities experience difficulties performing specific types of skills or completing tasks. The disability is no indication of intelligence level.

REF: p. 578

OBJ: 2

11. There is a cure for Alzheimer disease.

ANS: F

No cure is known for Alzheimer disease, so the treatment is supportive and is geared toward helping alleviate symptoms.

REF: p. 585

OBJ: 7

12. Dementia may be caused by traumatic insult to the brain.

ANS: T

A traumatic insult causing reduced blood flow to the cerebrum may result in dementia.

Deprivation of oxygen and nutrition (ischemia) results in death of brain cells. Both closed and open head injuries, hematomas, and skull fractures are examples of insults that cause reduced blood flow to the cells.

REF: p. 588

OBJ: 8

13. Amnesia often occurs after intoxication.

ANS: T

Amnesia often occurs after intoxication alcohol acts on the central nervous system as a depressant. Individuals under the influence of alcohol may experience a decrease in activity, tension, and normal inhibitions. Ingestion of a few drinks of alcohol may change behavior, decrease ability to think clearly, slow motor skills, and impair judgment and concentration.

Excessive use of alcohol is often associated with anxiety, depression, insomnia, impotence, and behavioral disorders both before and during intoxication. Amnesia often occurs after intoxication.

REF: p. 589

OBJ: 9

Chapter 15: Disorders and Conditions Resulting from Trauma Frazier and Fuqua: Essentials of Human Diseases and Conditions, 8th Edition MULTIPLE CHOICE 1. The soft-tissue injury that occurs when a body part becomes entangled or entrapped, resulting

in skin, tissue, and bone being pulled from the body is a(n) a. laceration. b. avulsion. c. incision. d. abrasion.

ANS: B

With avulsion injuries, a portion of skin and possibly underlying tissue is torn away, either completely or partially. The mechanism of this kind of injury is usually one in which the affected body part becomes entangled in machinery, clothing, or some other means of entrapment, causing skin, tissue, and possibly bone to be torn and pulled away from the body.

If the limb or appendage is severed completely from the body, it is termed an amputation.

REF: p. 622

OBJ: 3

2. A soft-tissue injury in which the outer layer of skin has been scraped away is an a. abrasion. b. avulsion. c. amputation. d. incision.

ANS: A

Abrasions occur when the outer layers of skin are scraped away or roughed up and deeper layers are exposed. Abrasions are caused by the friction created when a rough, hard surface comes in contact with skin as a consequence of a scraping or sliding type of motion, often the result of a fall or scrape. Such injuries are often referred to as friction burns, floor burns, rug burns, or road rash.

REF: p. 621

OBJ: 3

3. Treatment of a puncture wound includes a. brisk scrubbing of the area with a brush. b. copious irrigation of the wound. c. approximation of the wound edges for suturing. d. All of the answer options ANS: B

Treatment of a puncture wound involves copious irrigation of the wound with sterile fluid and removal of the foreign body (FB). A sterile dressing is applied. Tetanus prophylaxis is confirmed or tetanus, diphtheria, and pertussis vaccination (Tdap) is recommended and/or administered if necessary, and antibiotics may be prescribed as an additional prophylactic measure. Impaled objects are stabilized until they can be removed by the physician.

REF: p. 625

OBJ: 6

4. Which burn involves destruction of skin and underlying tissue? a. Superficial b. Partial thickness c. Full thickness d. Radiation ANS: C

Full-thickness burns involve both skin and the underlying subcutaneous tissue. Resultant destruction of nerve endings often results in minimal pain in that particular area; however, pain may be reported in areas around the periphery of the burn site.

REF: p. 631

OBJ: 8

5. In electrical shock, the current a. follows the path of least resistance. b. always enters the heart. c. destroys the brain tissue. d. always destroys lung tissue.

ANS: A

In electrical shock, the electrical current follows the path of least resistance through the body, usually along nerve routes. The current enters the body at the point of contact with the electrical source and exits at the point of grounding.

REF: pp. 635-636

OBJ: 10

6. The individual who has a body temperature above 105 F; red, hot, and dry skin; headache;

dizziness; and shortness of breath is experiencing which condition? a. Heat exhaustion

b. Heat stroke c. Hypothermia d. All of the answer options ANS: B

Heat stroke occurs when the person has a body temperature of 105 F or greater. Skin is hot, red, and usually dry. The patient may have a dry mouth, headache, nausea or vomiting, dizziness and weakness, and shortness of breath. The pulse is rapid and strong at the onset, gradually becoming weak, and the blood pressure decreases. The pupils are constricted.

Patients exhibit anxiety, mental confusion, irritability, aggression, and even hysterical behavior. In extreme cases, the person collapses and experiences altered levels of consciousness and may have seizure activity.

REF: p. 637

OBJ: 11

7. The person suffering from hypothermia experiences a. shivering. b. disorientation. c. fatigue. d. All of the answer options ANS: D

Hypothermia, a generalized severe cooling of the body, causes the person to shiver and have a feeling of extreme cold or numbness. Fatigue is followed by loss of coordination, thick speech, and disorientation. Skin appears blue and puffy and ash-colored for dark-skinned people, with the pulse being slow and weak. Core body temperature drops below 95 F. Breathing is slow and shallow, and the pupils are dilated. As the body temperature drops, the person experiences confusion, stupor, and unconsciousness.

REF: p. 638

OBJ: 11

8. Tetanus toxoid prophylaxis is important in any person who has sustained open trauma because a. boosters are required throughout life. b. tetanus toxoid is a broad-spectrum antibiotic. c. organisms that cause tetanus enter the body directly into the bloodstream through

wounds. d. All of the answer options ANS: C

Open wounds can be the source of tetanus infection; therefore tetanus prophylaxis must be provided. Those who have completed the initial inoculation series for tetanus require a booster dose every 10 years. Those with no previous inoculation history are given tetanus immune globulin (TIG) (human) and referred to a physician for the complete series of tetanus toxoid inoculations. When the patient has not had a booster injection within the past 10-year period, the booster injection of tetanus, diphtheria, and pertussis (Tdap) is recommended and/or administered.

REF: p. 621

OBJ: 4

9. Which treatment is used for a snakebite? a. Keeping the victim quiet and transporting to an emergency facility

b. Putting a tourniquet around the limb c. Applying ice d. Antibiotics ANS: A

First aid and intervention at the scene of the snakebite consists of removing the person from the injury site to prevent further risk and keeping her or him calm and quiet. The emergency medical service (EMS) system should be activated. Cleanse the bitten area with soap and water. Any jewelry, including rings or other constricting objects, should be removed from the affected limb. The extremity should be immobilized and, if possible, kept below the level of the heart. Transportation to the nearest emergency facility should be initiated as soon as possible so that aggressive treatment can begin immediately. If it is not possible to reach emergency care within 30 minutes, consideration should be given to suctioning the bite with equipment from a snakebite kit.

REF: p. 645

OBJ: 12

10. Cumulative trauma disorders, or repetitive motion injuries include a. carpal tunnel syndrome. b. white finger. c. synovitis. d. All of the answer options ANS: D

Cumulative trauma disorders, include but are not limited to white finger (Raynaud’s phenomenon), trigger finger, carpal tunnel syndrome, tennis elbow, thoracic outlet syndrome, de Quervain disease, synovitis, tenosynovitis, and nonspecific tendinitis.

REF: p. 648

OBJ: 13

11. When is the rule of nines used? a. Cardiac failure b. To calculate the percentage of body surface affected by burns c. According to the type of thermal trauma d. Respiratory failure ANS: B

The rule of nines provides a fast and fairly accurate calculation of the body surface involved in a burn. Percentages used to ascertain the burned tissue area in the adult are as follows: head, 9%; anterior trunk, 18%; posterior trunk, 18%; entire right arm, 9%; entire left arm, 9%; anterior surface right leg, 9%; posterior surface right leg, 9%; anterior surface left leg, 9%; posterior surface left leg, 9%; and perineum, 1%. Percentages in children and infants are slightly different.

REF: p. 631

OBJ: 9

12. Compression of the brachial plexus nerves may also be called a. tendinitis. b. thoracic outlet syndrome. c. tennis elbow. d. trigger finger.

ANS: B

Thoracic outlet syndrome is the compression of the brachial plexus nerves.

REF: p. 650

OBJ: 14

13. _____ is a severe systemic infection, transmitted by a tick, and characterized by a

maculopapular rash, small hemorrhages under skin, and involvement of vital organs. a. Rocky Mountain spotted fever b. Rabies c. Acquired immunodeficiency syndrome (AIDS) d. Malaria ANS: A

Rocky mountain spotted fever is a severe systemic infection, transmitted by a tick, and characterized by a maculopapular rash, small hemorrhages under skin, and involvement of vital organs. The patient may recall being bitten by a tick, typically during outdoor activity, such as camping and hiking. Patients are frequently unaware of the insects because they are flat and small and may be hidden in an area covered in hair.

REF: p. 640

OBJ: 12

14. Physical patterns observed in child abuse include a. bruising and burns. b. observable injuries such as teeth marks. c. welts and fractures. d. All of the answer options ANS: D

Often children who are victims of child abuse are identified as such by teachers, day care providers, or health care providers. The injuries to the child encompass many forms, including bruises, fractures, burns, bites, and welts. The injuries can even be fatal.

Bruising can exhibit many telltale appearances, such as finger marks, which wrap around the child’s limb and may show evidence of rings worn by the perpetrator; imprints of electrical cords or hangers; and horizontal wraparound marks left by belts or straps, and possibly buckle marks. These bruises appear on soft tissue and not over bony prominences where normal falls would have caused them to be. The bruising is often seen in areas normally covered by clothing and the bruises are in various stages of healing.

Burns from cigarettes appear as small circles (the diameter of a cigarette), often on hands, feet, buttocks, or genitals. These are at various stages of healing. Another form of burn is the scald burn with the pattern of ―dipping,‖ straight lines with no splash marks, a result of the child’s being held in scalding water (see Fig. 15.30A and B).

REF: p. 653

OBJ: 16

15. The legal responsibilities of the health care provider in battered spouse syndrome a. are not in the scope of concern. b. vary from facility to facility. c. vary by state but should be known. d. All of the answer options ANS: C

The legal responsibilities of the health care provider in battered spouse syndrome vary by state but should be known. Prevention is difficult because many spouses feel that they deserve the battering and that it is accepted behavior in society as they know it. Raising awareness of the issue in the community and in the educational system and teaching that battering is not acceptable behavior may prevent battering and acceptance of battering in future generations.

The state, not the victim, is the complainant, removing the responsibility of filing a charge from the victim. In addition, batterer’s intervention programs are becoming part of the sentencing protocols in domestic violence cases.

REF: p. 658

OBJ: 17

16. Treatment of a laceration includes a. gentle cleansing and approximation and securing the edges. b. débridement, suturing, and sterile dressing application. c. the use of tissue glue. d. All of the answer options ANS: D

Lacerations should be cleansed gently with germicidal soap and water. If the laceration is not too deep and bleeding is controlled, approximating and securing the edges with tape, a butterfly dressing, or sterile adhesive strips (Steri-Strips) may be the only intervention necessary other than a sterile dressing application. In some cases, a new type of ―glue‖ is used to hold the edges together, thereby eliminating the need for sutures. Lacerations that are deep, have jagged edges, or continue to bleed need to be débrided and have the edges trimmed to facilitate good approximation.

REF: p. 626

OBJ: 6

17. Complications of survivors of lightning strikes include a. cataracts. b. cervical spine injuries. c. ruptured tympanic membranes. d. All of the answer options ANS: D

Complications of survivors of lightning strikes include cataracts, cervical spine injuries and ruptured tympanic membranes. Prognosis varies according to the extent of the insult.

REF: p. 637

OBJ: 10

18. Which foreign bodies may be found in the ears? a. Bugs and insects b. Cereal, peas, beans, grapes, and pebbles c. Cotton d. All of the answer options ANS: D

FBs in the ear typically range from bugs, pebbles, and bits of cotton to anything small enough to fit in the ear canal.

REF: p. 626

OBJ: 7

19. Which method is the best way to remove the ―stinger‖ from the site of an insect sting? a. Pulling it out using tweezers b. Squeezing it out c. Scraping across it with a credit card d. Cutting it out with a pocket knife ANS: C

The first step in treating an insect sting is to determine whether the stinger is still present. If it is present, it must be removed to prevent further damage. The best method of removal is scraping across the site of the sting with a plastic card or a fingernail. (The use of forceps or tweezers squeezes more venom into the site.) The area is then cleansed with soap and water.

The person should be observed for any signs of allergic reaction to the sting or bite.

REF: p. 641

OBJ: 12

20. All incidents of open trauma have a commonality in a. the risk of infection. b. pain. c. risk of tetanus. d. All of the answer options ANS: D

All incidents of open trauma have a commonality, the risk of infection if the wound is not appropriately cleansed and dressed. Pain is also usually involved in most open trauma.

REF: p. 621

OBJ: 5

21. An easy way to remove a live bug from an ear is a. grasp with tweezers. b. turn off light and shine a flash light in the ear. c. pull on ear lobe. d. have patient stand in shower.

ANS: B

The individual with a live bug in the ear should be placed in a dark room and have a flashlight shone in the ear. Bugs that are alive will crawl out of the ear toward the light. Bugs that are not responsive to the light technique may have to be washed out of the ear. The goal of treatment is removal of the offending object without damaging the ear canal or tympanic membrane.

REF: p. 627

OBJ: 7

22. What is an easy way to remove a FB from the nose of a child? a. Grasp it with tweezers. b. Irrigate. c. Have child blow his/her nose. d. Shine a light in nares.

ANS: C

The child is encouraged to blow the nose, hopefully expelling the object. If the offending foreign substance is cereal, squeezing the nose usually will crush the cereal bit and permit it to be expelled by blowing the nose. A physician may need to grasp the object with forceps for removal.

REF: p. 629

OBJ: 7

23. Treatment for altitude sickness includes which step? a. Drinking alcohol b. Moving to a lower altitude c. Climbing until symptoms cease d. Taking salt pills ANS: B

Those who experience symptoms should descend to a lower altitude and drink plentiful amounts of water. Rest and curtailing stressful activities help in relieving symptoms and are necessary interventions for shortness of breath and increased heart rate.

REF: p. 643

OBJ: 12

24. Lateral humeral epicondylitis is a. trigger finger. b. tennis elbow. c. carpal tunnel syndrome. d. thoracic outlet syndrome.

ANS: B

Tennis elbow, technically known as lateral humeral epicondylitis, is the result of repetitive movement involving flexion of the wrist against resistance. The result of this repetitive action is an inflammatory condition of the tissue at the distal portion of the humerus.

REF: p. 649

OBJ: 14

TRUE/FALSE 1. The three main types of exposure to ionizing radiation are slow, cumulative whole body

exposure; sudden whole body exposure; and high-dose localized exposure.

ANS: T

The three main types of exposure to ionizing radiation are slow, cumulative whole body exposure; sudden whole body exposure; and high-dose localized exposure.

REF: p. 634

OBJ: 8

2. Only women are victims of intimate partner violence (IPV).

ANS: F

IPV is the result of threatened or actual physical abuse, a pattern of behavior in which the victim is repeatedly physically assaulted by her or his partner. Other terms for IPV include domestic violence, spouse abuse, and battered spouse syndrome.

REF: p. 657

OBJ: 17

3. Victims of elder abuse are eager to admit to being victims.

ANS: F

It is rare for the older adult abuse victim to complain of the abuse. The evidence of the abuse is usually discovered as the result of examination for another purpose. Signs are similar to those of other forms of abuse, are varied, and often are hidden by clothing.

REF: p. 656

OBJ: 16

4. Carpal tunnel syndrome involves entrapment of the median nerve.

ANS: T

Entrapment and compression of the median nerve in the carpal tunnel causes pain and numbness in the wrist, hands, and fingers, resulting in carpel tunnel syndrome.

Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome.

REF: p. 648

OBJ: 14

5. Deoxyribonucleic acid (DNA)-parentage testing is conclusive in determining genetic profiles

of the mother, child, and father.

ANS: T

DNA-parentage testing is the most reliable and powerful method of providing parentage for legal and medical reasons. It conclusively answers difficult questions, resolves disputes, and helps streamline court proceedings.

Testing is based on a highly accurate analysis of the genetic profiles of the mother, child, and alleged father. DNA, the unique genetic blueprint within each nucleated cell of a person’s body, determines the genetic pattern and individual characteristics. A child inherits half of this DNA pattern from the mother and half from the father. If the mother’s and child’s patterns are known, the father’s can be deduced with virtual certainty.

REF: p. 659

OBJ: 17

6. There are no specific tests or documentation procedures available for the rape victim.

ANS: F

There are specific tests and documentation measures for victims of rape. Diagnosis is made by evaluating the history, clinical findings, and physical examination, including pelvic examination and sex crime evidence gathering. Samples of debris, clothing, saliva, hair, pubic hair, fingernails, and scrapings from under the nails are collected. A urinalysis is obtained, along with blood tests for sexually transmitted diseases, AIDS, and possible pregnancy.

Photographs may be taken for documentation of injury. It is recommended that this type of complete examination take place in a facility with staff professionally trained in treating sexual assault victims.

REF: p. 660

OBJ: 17

7. Rust rings on the cornea may be the result of an FB in the eye.

ANS: T

Metal pieces or rust fragments falling from the undercarriage of a motor vehicle may result in eventual rust rings forming in the eye. These may have to be removed by an ophthalmologist.

REF: p. 628

OBJ: 7

8. Treatment of frostbite includes vigorous massage of the affected area.

ANS: F

When frostbite occurs, the affected skin area should never be rubbed Treatment consists of removing the patient from the cold environment. People suffering from superficial frostbite should be warmed with an external source of even heat. The temperature of the heat source should not be above 105 F. Patients suffering from frostbite should be treated by a physician if possible. Rewarming of deep frostbite (frozen tissue) should not begin until professional medical care can be provided.

REF: p. 639

OBJ: 12

9. In shaken infant syndrome, there is no outward indication of physical trauma most of the time.

ANS: T

Most of the time, there is no outward indication of physical trauma when shaken baby syndrome occurs. The shaken baby may experience altered levels of consciousness to complete loss of consciousness. Irritability, changes in skin color to paleness or cyanosis, vomiting, lethargy, and convulsions are additional symptoms. Most of the time, there is no outward indication of physical trauma. Fractured or dislocated bones and neck or spinal injuries may be found. Examination of the eyes may reveal retinal hemorrhages. Babies shaken into unconsciousness are often put to bed in hopes that the injury will resolve, and thus the opportunity for life-saving treatment is usually lost.

REF: p. 654

OBJ: 15

10. The most common symptom of tendonitis is acute pain.

ANS: T

The most common symptom of tendonitis is acute pain. The patient experiences nonspecific pain anywhere along the route of the tendon or its attachments.

REF: p. 651

OBJ: 14

11. Sun protection factors (SPFs) of at least 6 are recommended by the Skin Cancer Foundation as

a protection against the sun’s harmful rays or ultraviolet B (UVB).

ANS: F

SPFs of at least 15 are recommended by the Skin Cancer Foundation as a protection against the sun’s harmful rays or UVB. SPF is the technical name for measurement of UVB protection provided by sunscreen. The numbers assigned to a product designate the length of time it takes to redden skin as compared with no protection.

REF: p. 633

OBJ: 8

12. Physical trauma is a leading cause of death in the United States for person’s age 1 year old to

approximately age 44.

ANS: T

Physical trauma is a leading cause of death in the United States for persons 1 year old to approximately age 44. Traumatic occurrences do include physical and psychologic injury that is derived from external force or violence; trauma may be self-inflicted, accidental, or the result of an act of violence. Regardless of the cause, trauma can interfere with body functions or the homeostatic status of the body, it can inflict a permanent disability, or it may be life threatening. Major types are open trauma, assault trauma, thermal trauma, and psychologic trauma. Whether physical or emotional, trauma, including abuse and sexual attack, is prevalent in current society.

REF: p. 621

OBJ: 1

13. Another name for ―trigger finger‖ is stenosing tenosynovitis.

ANS: T

―Trigger finger‖ is technically known as stenosing tenosynovitis. The index finger has a lump or knot that appears on the flexor tendon. Flexion or extension of the finger may be interrupted and then begin again in a jerking or snapping type of motion when the hand is opened and closed.

REF: p. 650

OBJ: 14

14. Health care providers are at risk for puncture wounds from contaminated needlesticks.

ANS: T

Health care providers are at risk for puncture wounds from contaminated needlesticks. OSHA guidelines must be followed to lessen the risk of occurrence and to reduce the likelihood of transmitting AIDS or hepatitis B. REF: p. 624

OBJ: 6