NURS 545/BIOLOGY 4344: Patho Exam 2 Review

____ 1. Anaplasia is recognized by loss or organization and a marked increase in nuclear size. ____ 2. A hallmark of cancer cells is their immortality. ____ 3. For the function of tumor suppressor genes to be lost, only one chromosome (allele) of the gene must be inactivated. ____ 4. Most cancers must acquire mutation in six distinct areas: growth signals, antigrowth signals, evading apoptosis, replicating ability, angiogenesis, and invasion and metastasis. ____ 5. There is no current evidence that associates obesity with cancer formation. ____ 6. The term “neoplasm” can refer to a benign tumor. ____ 7. The brain does not require insulin for glucose uptake. ____ 8. Somatostatin produced by the hypothalamus inhibits the release of growth hormone and thyroid stimulating hormone. ____ 9. Adrenocorticotropic hormone (ACTH) directly affects melanocyte stimulation. ____ 10. Aldosterone secretion is stimulated by angiotensin I. ____ 11. Antidiuretic hormone has no direct effect on electrolyte levels. ____ 12. A person with syndrome of inappropriate antidiuretic hormone (SIADH) usually craves cold drinks. ____ 13. Pituitary adenomas are malignant tumors. ____ 14. Abnormal immunologic mechanisms producing autoantibodies are responsible for both Graves’ disease and hypothyroidism. ____ 15. Thyroid carcinoma, although rare, is the most common endocrine malignancy. ____ 16. The most common cause of hypoparathyroidism is damage to the glands during surgery. ____ 17. Individuals with type 2 diabetes mellitus have a greater degree of pancreatic changes than individuals with type 1 diabetes. ____ 18. Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by increased levels of antidiuretic hormone (ADH). ____ 19. Glucose levels are considerably lower in hyperosmolar hyperglycemic nonketosis syndrome (HHNKS) than in diabetic ketoacidosis (DKA). ____ 20. When the myocardium hypertrophies, the capillaries of the heart become more extensive and numerous. ____ 21. Veins are less compliant than arteries. ____ 22. Autoregulation ensures constant coronary blood flow despite normal shifts in perfusion pressure. ____ 23. Metabolic or hormonal agents produce changes in the heart and circulatory system faster than autonomic neural transmission. ____ 24. While both produce vasoconstriction, the effects of norepinephrine are quantitatively more vasoconstrictive than the effects of epinephrine. ____ 25. Decreasing low-density lipoproteins (LDL) can cause regression of atherosclerotic lesions and improve endothelial function. ____ 26. Once fatty streaks accumulate, they form foam cells that cause immunologic changes that damage the endothelium. ____ 27. Even though air is lighter than blood, it can form an embolism and cause the occlusion of a blood vessel. ____ 28. Raynaud disease is characterized by vasospasms of large peripheral arteries. ____ 29. Many people with diabetes mellitus type 2, who were treated with drugs that increased insulin sensitivity, experienced a decline in their blood pressure without taking antihypertensive drugs. ____ 30. Chronic venous insufficiency can progress to varicose veins and valvular incompetence. ____ 31. Although cholesterol can be easily obtained via dietary intake, most body cells are also capable of synthesizing cholesterol. ____ 32. In high output failure, the heart increases its output, but the body’s metabolic needs are still not met. ____ 33. When fluid collects gradually in a pericardial effusion, the pericardium stretches to accommodate large quantities of fluid without compressing the heart. ____ 34. Acute rheumatic fever can develop only as a sequel to pharyngeal infection by group A -streptococcus. ____ 35. An increase in left ventricular end-diastolic volume in diastolic heart failure may lead to pulmonary edema. ____ 36. Many cases of mitral valve prolapse are completely asymptomatic. ____ 37. Chorea or St. Vitus dance is the most definitive sign of rheumatic fever. ____ 38. Atrial and brain natriuretic peptides are increased in congestive heart failure and may have some protective effect in decreasing preload. Multiple Choice Identify the letter of the choice that best completes the statement or answers the question. ____ 39. Which are cancers arising from connective tissue tissues? a. Osteogenic sarcoma b. Basal cell carcinoma c. Multiple myeloma d. Adenocarcinoma ____ 40. Carcinoma refers to abnormal cell proliferation originating from which tissue origin? a. Blood vessels b. Epithelium cells c. Connective tissue d. Glandular tissue ____ 41. What are characteristics of cancer in situ? a. Cells have broken through the local basement membrane. b. Cells have invaded immediate surrounding tissue. c. Cells remain localized in the glandular or squamous cells. d. Cellular and tissues changes indicate dysplasia. ____ 42. Cells from a muscle tumor show a reduced ability to form new muscle and appear highly disorganized. This is an example of: a. dysplasia. b. hyperplasia. c. myoplasia. d. anaplasia. ____ 43. What are tumor cell markers? a. Hormones, enzymes, antigens, and antibodies produced by cancer cells b. Receptor sites on tumor cells that can be identified and marked c. Cytokines produced against cancer cells d. Identification marks used in administering radiation therapy ____ 44. How are tumor cell markers used? a. To provide a definitive diagnosis of cancer b. To treat certain types of cancer c. To predict where cancers will develop d. To screen individuals at high risk for cancer ____ 45. Intestinal polyps are benign neoplasms and the first stage in development of colon cancer. These findings support the notion that: a. cancers of the colon are more easily diagnosed in the benign form because they can be visualized during colonoscopy. b. an accumulation of mutations in specific genes is required for the development of cancer. c. tumor invasion and metastasis progress more slowly in the gastrointestinal tract. d. apoptosis is triggered by diverse stimuli including excessive growth. ____ 46. What is autocrine stimulation? a. The ability of cancer cells to stimulate angiogenesis to create their own blood supply b. The ability of cancer cells to stimulate secretions that turn off normal growth inhibitors c. The ability of cancer cells to secrete growth factors that stimulate their own growth d. The ability of cancer cells to divert nutrients away from normal tissue for their own use ____ 47. Many cancers create a mutation of ras. What is ras? a. A tumor suppressor gene b. A growth promoting gene c. An intracellular signaling protein that regulates cell growth d. A cell surface receptor that allows signaling to the nucleus about cell growth ____ 48. What are oncogenes? a. Genes that have undergone mutation that direct the synthesis of protein to accelerate the rate of tissue proliferation b. Genes that direct synthesis of proteins to regulate growth and provide necessary replacement of tissue c. Genes that encode proteins that negatively regulate the synthesis of proteins to show or halt replacement of tissue d. Genes that have undergone mutation to direct malignant tissue toward blood vessels and lymph nodes for metastasis ____ 49. Burkitt lymphomas designate a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. This is an example of which mutation of normal genes to oncogenes? a. Point mutation b. Chromosome translocation c. Gene amplification d. Chromosome fusion ____ 50. In chronic myeloid leukemia (CML) a piece of chromosome 9 fuses to a piece of chromosome 22. This is an example of which mutation of normal genes to oncogenes? a. Point mutation b. Chromosome fusion c. Gene amplification d. Chromosome translocation ____ 51. What aberrant change causes the abnormal growth in retinoblastoma? a. Proto-oncogenes are changed to oncogenes. b. The tumor suppressor gene is turned off. c. Genetic amplification causes the growth. d. Chromosomes 9 and 21 are fused. ____ 52. Why are two “hits” required to inactivate tumor suppressor genes? a. Because each allele must be altered and each person has two copies, or alleles, of each gene, one from each parent b. Because the first “hit” stops tissue growth and the second “hit” is needed to cause abnormal tissue growth c. Because they are larger than proto-oncogenes requiring two “hits” to effect carcinogenesis d. Because the first “hit” is insufficient to cause sufficient damage to cause a mutation ____ 53. By what process does the ras gene convert from a proto-oncogene to an oncogene? a. By designating a chromosome that has a piece of one chromosome fused to a piece of another chromosome b. By duplicating a small piece of a chromosome repeatedly making numerous copies c. By alternating one or more nucleotide base pairs d. By promoting proliferation of growth signals by impairing tumor suppressor genes ____ 54. What are characteristics of benign tumors? a. They invade local tissues. b. They spread through lymph. c. They cause systemic symptoms. d. They have a low mitotic index. ____ 55. Which of the following represents the correct nomenclature for benign and malignant tumors of adipose tissue, respectively? a. Liposarcoma, lipoma b. Lipoma, liposarcoma c. Adisarcoma, adipoma d. Adipoma, adisarcoma ____ 56. Most human cancers appear to arise via: a. autosomal recessive gene inheritance. b. spontaneous gene mutations. c. X-linked recessive gene inheritance. d. autosomal dominant gene inheritance. ____ 57. Smoking is associated with cancers of all of the following except: a. lung. b. skin. c. bladder. d. kidney. e. pancreas. ____ 58. The major virus involved in cervical cancer is: a. herpes simplex virus type 6. b. herpes simplex virus type 2. c. human papillomavirus. d. human immunodeficiency virus. ____ 59. The Papanicolaou (Pap) test is used to screen for which cancer? a. Ovarian b. Uterine c. Cervical d. Vaginal ____ 60. Which of the viruses below are oncogenic DNA viruses? a. Papovaviruses, adenoviruses, and herpesviruses b. Retroviruses, papovaviruses, and adenoviruses c. Adenoviruses, herpesviruses, and retroviruses d. Herpesviruses, retroviruses, and papovaviruses ____ 61. Which characteristic among women correlates with a high morbidity of cancer of the colon, liver, gallbladder, pancreas, breast, uterus, and kidney? a. Women over 45 years b. Women who never had children c. Women who had a high body mass index d. Woman who smoked for more than 10 years ____ 62. Which cancers are associated with chronic inflammation? a. Skin, lung, and pancreatic b. Colon, liver, and lung c. Bone, blood cells, and pancreatic d. Bladder, skin, and kidney ____ 63. How does chronic inflammation cause cancer? a. By vasodilation and increased permeability that alter cellular response to DNA damage b. By liberating lysosomal enzymes when cells are damaged, which initiates mutations c. By releasing compounds such as reactive oxygen species that promote mutations d. By increasing the abundance of leukotrienes that are associated with some cancers ____ 64. Inherited mutations that predispose to cancer are almost invariably what kind of gene? a. Proto-oncogenes b. Oncogenes c. Tumor suppressor genes d. Growth promoting genes ____ 65. Regulation of the release of epinephrine from the adrenal medulla is an example of _____ regulation. a. negative-feedback b. positive-feedback c. neural d. physiologic ____ 66. Hormones are effective communicators because they: a. are regularly synthesized in response to cellular and tissue activities. b. increase their secretion in response to rising hormone levels. c. are rapidly degraded once they enter the cell. d. decrease their secretion in response to rising plasma hormone levels. ____ 67. Which of the following is a protein hormone that is water soluble? a. Thyroxine (T4) b. Aldosterone c. Follicle-stimulating hormone (FSH) d. Insulin ____ 68. How are most protein hormones transported in the bloodstream? a. Bound to a lipid-soluble carrier b. Free in an unbound, water-soluble form c. Bound to a water-soluble binding protein d. Free because of their lipid-soluble chemistry ____ 69. Which second messenger is stimulated by epinephrine binding to a ß-adrenergic receptor? a. Calcium b. Inositol triphosphate (IP3) c. Diacylglycerol (DAG) d. Cyclic adenosine monophosphate (cAMP) ____ 70. Which of the following hormones acts on its target cell via a second messenger? a. Angiotensin II b. Thyroxine c. Estrogen d. Testosterone e. Aldosterone ____ 71. Calcium is rigidly controlled within cells. It is highly regulated because it: a. is controlled by the calcium negative-feedback loop. b. is continuously synthesized. c. acts as a second messenger. d. carries lipid-soluble hormones in the bloodstream. ____ 72. Under what circumstances does antidiuretic hormone act to cause vasoconstriction? a. When urine output is less than 20 ml per hour b. When serum osmolality is increased c. When osmotic and oncotic pressures are increased d. When vasopressin is given pharmacologically ____ 73. What is the target tissue for prolactin-releasing factor? a. Hypothalamus b. Anterior pituitary c. Mammary glands d. Posterior pituitary ____ 74. Where is oxytocin synthesized? a. Hypothalamus b. Paraventricular nuclei c. Anterior pituitary d. Posterior pituitary ____ 75. Norepinephrine stimulates the release of which hormone? a. Thyroxine b. Adrenocorticotropic hormone c. Growth hormone d. Insulin ____ 76. What effect does hyperphosphatemia have on other electrolytes? a. It increases serum calcium. b. It decreases serum calcium. c. It decreases serum magnesium. d. It increases serum magnesium. ____ 77. Which electrolyte does insulin transport in the cell? a. Potassium b. Calcium c. Sodium d. Magnesium ____ 78. Which lab value would be expected for the patient with hypothyroidism? a. Increased triiodothyronine (T3) b. Increased thyroxine (T4) c. Increased thyroid stimulating hormone (TSH) d. Increased calcitonin ____ 79. Target cells for parathyroid hormone (PTH) are located in the: a. tubules of nephrons. b. thyroid gland. c. glomeruli of nephrons. d. smooth and skeletal muscles. ____ 80. A surgical patient just arrived on the unit from the post-anesthesia care unit. This patient’s respirations are 4 per minute and shallow. As the nurse calls for assistance, the patient suddenly feels jittery and breathing quickens. Which of the following feedback loops is operating for the nurse in this situation? a. The central nervous system stimulates hypothalamus-releasing factor, which acts on the anterior pituitary gland to secrete thyroid-stimulating hormone (TSH) and stimulates the release of thyroxine (T4) and triiodothyronine (T3). b. The central nervous system directly stimulates the release of insulin, which reduces blood glucose levels. c. The central nervous system directly stimulates the adrenal medulla to secrete epinephrine and stimulates hypothalamus-releasing factor, which acts on the anterior pituitary gland to secrete adrenocorticotropic-stimulating hormone (ACTH), stimulating the release of cortisol. d. The central nervous system stimulates the hypothalamus to synthesize oxytocin and antidiuretic hormone, which are secreted by the posterior pituitary, activating uterine contraction and renal absorption of water. ____ 81. What are actions of glucocorticoids? a. Protein catabolism and liver gluconeogenesis b. Fat storage and glucose use c. Decreased blood glucose and fat mobilization d. Fat, protein, and carbohydrate anabolism ____ 82. What are the effects of high levels of aldosterone? a. Hypokalemia and alkalosis b. Hyperkalemia and alkalosis c. Hyperkalemia and acidosis d. Hypokalemia and acidosis ____ 83. What effect does aldosterone have on fluid and electrolyte imbalances? a. It directly increases magnesium reabsorption. b. It directly increases calcium reabsorption. c. It directly increases sodium reabsorption. d. It directly increases water reabsorption. ____ 84. Which of the following is an expected change in an older patient? a. Thyroid stimulating hormone (TSH) secretion below normal b. Triiodothyronine (T3) level below normal c. Cortisol level above normal d. Adrenocorticotropin hormone (ACTH) level above normal ____ 85. Cell surface receptors include all of the following except: a. G-protein–linked. b. ion channel. c. second messenger. d. tyrosine-kinase linked. ____ 86. What are the effects of syndrome of inappropriate antidiuretic hormone (SIADH)? a. Solute retention and water retention b. Solute retention and water loss c. Solute dilution and water retention d. Solute dilution and water loss ____ 87. The nurse is evaluating a patient with oat cell adenocarcinoma of the lung for syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory values would the nurse expect to find if the patient had SIADH? a. Hypernatremia and urine hypo-osmolality b. Serum K 5 and urine hyperosmolality c. Serum Na 120 and serum hypo-osmolality d. Hypokalemia and serum hyperosmolality ____ 88. A patient with a closed head injury secondary to a motorcycle accident has a urine output of 6 to 8 L/day and electrolytes are within normal limits. The nurse draws a serum ADH level and conducts a water deprivation test. With no intake for 4 hours, there is no change in the patient’s polyuria. The serum ADH level is low. These are an indication of: a. neurogenic diabetes insipidus. b. syndrome of inappropriate antidiuretic hormone (SIADH). c. psychogenic polydipsia. d. osmotically induced diuresis. ____ 89. Which is a cause of diabetes insipidus (DI)? a. Organic lesion of the anterior pituitary b. Organic lesion of the thalamus c. Organic lesion of the posterior pituitary d. Organic lesion of the renal tubules ____ 90. If the target cells for ADH do not have receptors, the result is _____ diabetes insipidus (DI). a. neurogenic b. nephrogenic c. psychogenic d. ischemic ____ 91. Which laboratory value is consistent with diabetes insipidus (DI)? a. Urine specific gravity is low. b. Serum sodium is low. c. Urine protein is low. d. Serum total protein is low. ____ 92. The type of diabetes insipidus that is most likely to be treatable with exogenous ADH is: a. neurogenic. b. psychogenic c. nephrogenic. d. ischemic. ____ 93. Hyperpituitarism is generally caused by: a. a pituitary adenoma. b. hypothalamic hyposecretion. c. autoimmune disorder of the pituitary. d. a neurohypophysial tumor. ____ 94. What is the term used to describe a patient who experiences cortisol deficiency from lack of adrenocorticotropic hormone (ACTH), thyroid deficiency from lack of thyroid stimulating hormone (TSH), and gonadal failure with loss of secondary sex characteristics from the absence of follicle stimulating hormone (FSH) and luteinizing hormone (LH)? a. Panhypopituitarism b. Adrenocorticotropic hormone (ACTH) deficiency c. Hypopituitarism d. Anterior pituitary failure ____ 95. How does a primary adenoma cause thyroid and adrenal hypofunction? a. The tumor metastasizes to the thyroid and adrenal glands through the lymphatic system causing reduce secretion of necessary hormones. b. The tumor has a paradoxical effect on adjacent cells, which results in hyposecretion of other anterior pituitary hormones. c. The tumor invades the hypothalamus adjacent to it and causes a reduction in the amount of hormones produced. d. The tumor releases tumor markers that occupy the hormone receptor sites of other endocrine organs. ____ 96. Which disorder is caused by hypersecretion of the growth hormone in adults? a. Cushing syndrome b. Acromegaly c. Gigantism d. Myxedema ____ 97. What tumor causes amenorrhea, galactorrhea, hirsutism, and osteopenia? a. Posterior pituitary adenoma b. Thymoma c. Prolactinoma d. Growth hormone adenoma ____ 98. How does Graves’ disease develop? a. A viral infection of the thyroid gland that causes overproduction of thyroid hormones b. A chronic autoimmune process in which thyroid tissue is replaced by lymphocytes and fibrous tissue c. A development of thyroid-stimulating immunoglobulins that causes overproduction of thyroid hormones d. An ingestion of goitrogens or foods that inhibits synthesis of the thyroid hormones, causing a goiter ____ 99. What are signs of thyroid crisis from Graves’ disease? a. Weight gain to 155 lb with height of 5'8" b. Heart rate 90 beats/min and respiratory rate 16 breaths/min c. Hot and moist skin with protrusion of eyeballs d. Constipation and amenorrhea ____ 100. What pathologic changes occur in Graves’ disease? a. High levels of circulating thyroid-stimulating immunoglobulins b. Stimulation by thyrotropin-releasing hormone (TRH) c. Stimulation by thyroid-stimulating hormone (TSH) d. Stimulation of thyroid-binding globulin Patho Exam 2 Review Answer Section