Pathopharmacology Test 2 - Chapters 10, 14, 16 & 17

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Again, Dr. Nmezi gets full credit for creating the quiz. My only intent is to offer others a user-friendly, high-tech medium with which to utilize the Study Guide he created. This quiz is from chapters 10, 14, 16 & 17 in the McCance Pathophisiology E-text.


Questions and Answers
  • 1. 

    Stress-induced norepinephrine results in:

    • A.

      Decreased blood flow to the brain and skin

    • B.

      Peripheral vasoconstriction

    • C.

      Increased glycogen synthesis in the liver

    • D.

      Decreased muscle contraction as a result of an energy depletion

    Correct Answer
    B. Peripheral vasoconstriction
    Explanation
    Norepinephrine regulates blood pressure by constricting smooth muscle in all blood vessels. During stress, norepinephrine raises blood pressure by constricting peripheral vessels.

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  • 2. 

    Stress-induced cortisol released from the adrenal cortex results in:

    • A.

      Stimulation of gluconeogenesis

    • B.

      Increased lipolysis

    • C.

      Stimulation of glycogenolysis

    • D.

      Increased peripheral uptake and use of glucose

    Correct Answer
    A. Stimulation of gluconeogenesis
    Explanation
    One of the primary effects of cortisol is the stimulation of gluconeogenesis, or the formation of glucose from noncarbohydrate sources, such as amino acids or free fatty acids in the liver.

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  • 3. 

    What is the effect of increased secretions of epinephrine, glucagon, and growth hormone?

    • A.

      Hyperglycemia

    • B.

      HTN

    • C.

      Bronchodilation

    • D.

      Pupil dilation

    Correct Answer
    A. Hyperglycemia
    Explanation
    Cortisol also enhances the elevation of blood glucose promoted by other hormones, such as epinephrine, glucagon, and growth hormone.

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  • 4. 

    Which hormone increases the formation of glucose from amino acids and free fatty acids?

    • A.

      Epinephrine

    • B.

      Norepinephrine

    • C.

      Cortisol

    • D.

      Growth hormone

    Correct Answer
    C. Cortisol
    Explanation
    One of the primary effects of cortisol is the stimulation of gluconeogenesis, or the formation of glucose from noncarbohydrate sources, such as amino or free fatty acids in the liver.

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  • 5. 

    Which immune cells are suppressed by corticotropin-releasing hormone (CRH)?

    • A.

      B cells and eosinophils

    • B.

      Cytokines and neutrophils

    • C.

      Cytotoxic T cells and NK cells

    • D.

      Helper T cells and monocyte-macrophage cells

    Correct Answer
    D. Helper T cells and monocyte-macrophage cells
    Explanation
    Direct suppressive effects of CRH (corticotropin-releasing hormone) have been reported also on two immune cell types possessing CRH receptors - the monocyte/macrophage and CD4 (T helper) lymphocytes.

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  • 6. 

    The ___ gland regulates the immune response and mediates the apparent effects of circadian rhythms on immunity

    • A.

      Anterior pituitary

    • B.

      Adrenal

    • C.

      Basal ganglia

    • D.

      Pineal

    Correct Answer
    D. Pineal
    Explanation
    The pineal gland regulates the immune response and mediates the apparent effects of circadian rhythm on immunity.

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  • 7. 

    Which cytokines initiate the production of corticotropin-releasing hormone (CRH)?

    • A.

      IL-1 and IL-6

    • B.

      IL-2 and TNF-

    • C.

      IFN and IL-12

    • D.

      TNF-B and IL-4

    Correct Answer
    A. IL-1 and IL-6
    Explanation
    A number of stress factors initiate CRH production, including high levels of IL-1 and IL-6.

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  • 8. 

    The release of which cytokines is triggered by bacterial or viral infections, cancer, and tissue injury that in turn initiate a stress response?

    • A.

      IL-1 and IL-2

    • B.

      IL-12, TNF-, and colony-stimulating factor

    • C.

      IFN, TNF-B, and IL-6

    • D.

      IL-4 and IL-24

    Correct Answer
    C. IFN, TNF-B, and IL-6
    Explanation
    The release of immune inflammatory mediators IL-6, TNF-B, and interferon is triggered by bacterial or viral infections, cancer and tissue injury that in turn initiates a stress response through the (hypothalamic-pituitary-adrenal) HPA pathway.

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  • 9. 

    The ___ is a large network of neurons within the brainstem that is essential in maintaining wakefulness

    • A.

      Midbrain

    • B.

      Reticular Activating System

    • C.

      Medulla oblongata

    • D.

      Pons

    Correct Answer
    B. Reticular Activating System
    Explanation
    The reticular formation is essential for maintaining wakefulness. The remaining options are not essential to this function.

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  • 10. 

    Elaboration of thought and goal oriented behavior are functions of the ___ area of the brain

    • A.

      Thalamic

    • B.

      Limbic System

    • C.

      Prefrontal

    • D.

      Occipital lobe

    Correct Answer
    C. Prefrontal
    Explanation
    The prefrontal area is responsible for the goal-oriented behavior (i.e. ability to concentrate), short-term memory recall, and the elaboration of thought and inhibition on the limbic (emotional) areas of the CNS. The remaining options are not involved in these functions.

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  • 11. 

    Where is the region responsible for motor aspects of speech?

    • A.

      Wernicke area in the temporal area

    • B.

      Broca area in the frontal lobe

    • C.

      Wronka area in the parietal lobe

    • D.

      Barlow area in the occipital lobe

    Correct Answer
    B. Broca area in the frontal lobe
    Explanation
    Broca speech area is responsible for the motor aspects of speech.

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  • 12. 

    Parkinson and Huntington diseases are associated with defects in the:

    • A.

      Thalamus

    • B.

      Medulla oblongata

    • C.

      Cerebellum

    • D.

      Basal ganglia

    Correct Answer
    D. Basal ganglia
    Explanation
    Parkinson and Huntington diseases are conditions associated with defects of the basal ganglia. There is no current data to support any role of the other options in these diseases.

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  • 13. 

    The ___ has 2 main functions: maintenance of constant internal environment and implementation of behavioral patterns.

    • A.

      Thalamus

    • B.

      Epithalamus

    • C.

      Subthalamus

    • D.

      Hypothalamus

    Correct Answer
    D. Hypothalamus
    Explanation
    Hypothalamic function falls into 2 major areas: 1- maintenance of a constant internal environment and 2- implementation of behavioral patterns. These functions are not addressed by the remaining options.

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  • 14. 

    The ability of the eyes to track moving objects through a visual field is primarily a function of the ___ colliculi.

    • A.

      Inferior

    • B.

      Superior

    • C.

      Mid

    • D.

      Posterior

    Correct Answer
    B. Superior
    Explanation
    The superior colliculi are involved with voluntary and involuntary visual motor movements (e.g. the ability of the eyes to track moving objects in the visual field). This is not the primary function of the remaining options.

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  • 15. 

    What parts of the brain mediate the expression of affect, both emotional and behavioral states?

    • A.

      Hypothalamus and subthalamus

    • B.

      Parietal and frontal lobes

    • C.

      Limbic system and prefrontal cortex

    • D.

      Basal ganglia

    Correct Answer
    C. Limbic system and prefrontal cortex
    Explanation
    Expression of affect (emotional and behavioral states) is mediated by extensive connections with the limbic system and prefrontal cortex.

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  • 16. 

    The ___ controls reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing.

    • A.

      Pons

    • B.

      Midbrain

    • C.

      Cerebellum

    • D.

      Medulla oblongata

    Correct Answer
    D. Medulla oblongata
    Explanation
    The medulla oblongata makes up the myelencephalon and is the lowest portion of the brainstem. Reflex activities are controlled in this area.

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  • 17. 

    From which part of the midbrain do cranial nerves V to VIII emerge?

    • A.

      Midbrain

    • B.

      Pons

    • C.

      Medulla oblongata

    • D.

      Lateral colliculi

    Correct Answer
    B. Pons
    Explanation
    The nuclei of the cranial nerves V through VIII are located in the pons.

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  • 18. 

    From which part of the midbrain do cranial nerves IX through XII emerge?

    • A.

      Midbrain

    • B.

      Pons

    • C.

      Medulla oblongata

    • D.

      Lateral colliculi

    Correct Answer
    C. Medulla oblongata
    Explanation
    The nuclei of cranial nerves IX through XII are located in the medulla oblongata.

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  • 19. 

    The ___ is responsible for conscious and unconscious synergy and maintaining balance and posture.

    • A.

      Cerebrum

    • B.

      Cerebellum

    • C.

      Diencephalon

    • D.

      Brainstem

    Correct Answer
    B. Cerebellum
    Explanation
    The cerebellum is responsible for the conscious and unconscious muscle synergy and for maintaining balance and posture.

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  • 20. 

    Which are clinical manifestations caused by damage to the lower pons?

    • A.

      Abnormal flexion with or without extensor response of the lower extremities

    • B.

      Abnormal extension response of the upper and lower extremities

    • C.

      Abnormal extension to the upper extremities and flexion of the lower extremities

    • D.

      Abnormal flaccid response of the upper and lower extremities

    Correct Answer
    D. Abnormal flaccid response of the upper and lower extremities
    Explanation
    A flaccid state with little or no motor response to stimuli is characteristic of damage to the pons.

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  • 21. 

    What is the best prognostic indicator of recovery of consciousness or functional outcome?

    • A.

      GCS

    • B.

      Glasgow Outcome Score

    • C.

      Etiology of injury and time since onset of coma

    • D.

      Pupillary reaction and reflective eye movements

    Correct Answer
    C. Etiology of injury and time since onset of coma
    Explanation
    To date there are no specific indicators. Eitiology of the injury and time since onset of injury are the currently used prognostic indicators.

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  • 22. 

    A sudden, explosive, disorderly discharge of cerebral neurons is termed:

    • A.

      Reflex

    • B.

      Seizure

    • C.

      Epilepsy

    • D.

      Convulsion

    Correct Answer
    B. Seizure
    Explanation
    A sudden, explosive, disorderly discharge of cerebral neurons describes a seizure.

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  • 23. 

    Which description is consistent with a complex partial seizure?

    • A.

      Alternative tonic and clonic movements

    • B.

      Consciousness is impaired as well as the ability to respond to exogenous stimuli

    • C.

      Focal motor movement without loss of consciousness

    • D.

      One seizure followed by another in less than 1 minute

    Correct Answer
    B. Consciousness is impaired as well as the ability to respond to exogenous stimuli
    Explanation
    A complex partial seizure results in impaired consciousness as well as the inability to respond to exogenous stimuli.

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  • 24. 

    Status epilepticus is considered a medical emergency because of the:

    • A.

      Loss of consciousness

    • B.

      Development of cerebral hypoxia

    • C.

      Possibility of a head injury during the seizures

    • D.

      Decrease in brain metabolism

    Correct Answer
    B. Development of cerebral hypoxia
    Explanation
    The situation is a true medical emergency because a single seizure can last more than 30 minutes, resulting in hypoxia of the brain.

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  • 25. 

    The most critical aspect in diagnosing a seizure disorder and establishing cause is:

    • A.

      CT scan

    • B.

      CSF fluid analysis

    • C.

      Skull x-ray films

    • D.

      Health Hx

    Correct Answer
    D. Health Hx
    Explanation
    Although Hx may be supplemented with the remaining options, it remains the pivotal tool for establishing cause.

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  • 26. 

    A seizure that starts with the fingers and progressively spreads up the arm and extends to the leg is known as a(n) ___ seizure.

    • A.

      Simple partial

    • B.

      Focal

    • C.

      Psychomotor

    • D.

      Aversive

    Correct Answer
    A. Simple partial
    Explanation
    This type of seizure most often begins in the face and fingers and progressively spreads to other body parts.

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  • 27. 

    What area of the brain mediates several cognitive functions, including vigilance, reasoning, and executive functions?

    • A.

      Limbic

    • B.

      Prefrontal

    • C.

      Parietal

    • D.

      Occipital

    Correct Answer
    B. Prefrontal
    Explanation
    It is the prefrontal lobe that mediates several cognitive functions, including vigilance, reasoning and executive functions.

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  • 28. 

    ___ is the loss of speech or the loss of comprehension of spoken or written language.

    • A.

      Agnosia

    • B.

      Aphasia

    • C.

      Akinesia

    • D.

      Dysphasia

    Correct Answer
    B. Aphasia
    Explanation
    Aphasia is the loss of speech and comprehension of the written language.

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  • 29. 

    With receptive dysphasia (fluent), the individual is able to:

    • A.

      Respond in writing but not in speech

    • B.

      Speak back, but not comprehend speech

    • C.

      Comprehend speech, but not respond verbally

    • D.

      Respond verbally, but not comprehend speech

    Correct Answer
    C. Comprehend speech, but not respond verbally
    Explanation
    Receptive dysphasia may result in expressive deficits.

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  • 30. 

    Normal intracranial pressure is ___mmHg.

    • A.

      5 to 15

    • B.

      7 to 20

    • C.

      12 to 14

    • D.

      80 to 120

    Correct Answer
    A. 5 to 15
    Explanation
    Normal ICP is 5 to 15mmHg.

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  • 31. 

    Cerebral edema is an increase in the fluid content of the:

    • A.

      Ventricles

    • B.

      Brain tissue

    • C.

      Neurons

    • D.

      Meninges

    Correct Answer
    B. Brain tissue
    Explanation
    Cerebral edema is an increase in the fluid content of the brain tissue; a net accumulation of water within the brain.

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  • 32. 

    A herniation of which disk would likely result in motor and sensory changes of the lateral lower legs and soles of the feet?

    • A.

      L2-L3

    • B.

      L3-L5

    • C.

      L5-S1

    • D.

      S2-S3

    Correct Answer
    C. L5-S1
    Explanation
    Clinical manifestations of posterolateral protrusions include radicular pain exacerbated by movement and straining (medial calf suggests L5, lateral calf suggests S1 root compression).

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  • 33. 

    Of the following people, who is at highest risk for a CVA?

    • A.

      White females >65

    • B.

      Black females >70

    • C.

      Black males >65

    • D.

      White males >70

    Correct Answer
    B. Black females >70
    Explanation
    50% of CVAs occur in persons >70. Strokes, however, do occur in a 3:10 ratio (28%) in individuals

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  • 34. 

    A right hemisphere embolic CVA has resulted in left-sided paralysis and reduced sensation of the left foot and leg. The vessel most likely affected by the emboli is the right ___ artery.

    • A.

      Middle cerebral

    • B.

      Vertebral

    • C.

      Posterior cerebral

    • D.

      Anterior cerebral

    Correct Answer
    D. Anterior cerebral
    Explanation
    Symptomatology of an embolic stroke in the right anterior cerebral artery would include left-sided contralateral paralysis or paresis (greater in foot and thigh) and mild upper extremity weakness with mild contralateral lower extremity sensory deficiency with loss of vibratory and/or position sense and loss of 2 point discrimination.

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  • 35. 

    Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke?

    • A.

      Hemorrhagic

    • B.

      Thrombotic

    • C.

      Embolic

    • D.

      Lacunar

    Correct Answer
    C. Embolic
    Explanation
    High risk sources for the onset of embolic stroke are Afib (15%-20% of strokes), LV aneurysm or thrombus, left atrial thrombus, MI, rheumatic valvular disease, mechanical prosthetic valve, nonbacterial thrombotic endocarditis, bacterial endocarditis, PFO, and primary intracrdiac tumors.

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  • 36. 

    Microinfarcts resulting in pure motor or pure sensory deficits are the result of which type of stroke?

    • A.

      Embolic

    • B.

      Hemorrhagic

    • C.

      Lacunar

    • D.

      Thrombotic

    Correct Answer
    C. Lacunar
    Explanation
    A lacunar stroke (lacunar infarct) is a microinfarct smaller than 1cm in diameter. Because of the subcortical location and small area of infarction, these strokes may have pure motor and sensory deficits.

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  • 37. 

    Which vascular malformation of characterized by arteries that feed directly into veins through vascular tangles of abnormal vessels?

    • A.

      Cavernous angioma

    • B.

      Capillary telangiectasia

    • C.

      Arteriovenous angioma

    • D.

      Arteriovenous malformation

    Correct Answer
    D. Arteriovenous malformation
    Explanation
    In an AV malformation, arteries feed directly into veins through a vascular tangled of malformed vessels.

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  • 38. 

    Which clinical finding is considered a diagnostic indicator for an AVM?

    • A.

      Systolic bruit over the carotid artery

    • B.

      Decreased LOC

    • C.

      HTN with bradycardia

    • D.

      Diastolic bruit over the temporal artery

    Correct Answer
    A. Systolic bruit over the carotid artery
    Explanation
    A systolic bruit over the carotid artery in the neck, the mastoid process, or (in a young person) the eyeball is almost always the diagnostic of an AVM.

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  • 39. 

    Which cerebral vascular disorder causes meningeal irritation, photophobia, and positive Kernig and Brudzinski signs?

    • A.

      Intracranial hemorrhage

    • B.

      Subarachnoid hemorrhage

    • C.

      Epidural hemorrhage

    • D.

      Subdural hemorrhage

    Correct Answer
    B. Subarachnoid hemorrhage
    Explanation
    Assessment findings related to a subarachnoid hemorrhage include meningeal irritation and inflammation causing neck stiffness (nuchal rigidity), photophobia, blurred vision, irritability restlessness, and low grade fever. A (+) Kernig sign (in which straightening the knee with the hip and knee in a flexed position produces pain in the back and neck regions) and Brudzinski sign (in which passive flexion of the neck produces neck pain and increased rigidity) may appear.

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  • 40. 

    Which clinical manifestation is characteristic of cluster headache?

    • A.

      Aura before the HA with photophobia and N/V

    • B.

      Severe unilateral tearing, burning, or temporal pain

    • C.

      Gradual onset of bilateral pain with sensation of a tight band around the head

    • D.

      Throbbing HA with intermittent burning sensation

    Correct Answer
    B. Severe unilateral tearing, burning, or temporal pain
    Explanation
    The HA attack usually begins without warning and is characterized by severe, unilateral tearing, burning, periorbital and retrobullar or temporal pain lasting 30 minutes to 2 hours.

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  • 41. 

    In adults most intracranial tumors are located:

    • A.

      Above the tentorium cerebelli (supratentorially)

    • B.

      Below the tentorium cerebelli (infratentorially)

    • C.

      Laterally

    • D.

      Posterolaterally

    Correct Answer
    A. Above the tentorium cerebelli (supratentorially)
    Explanation
    Approximately 70% to 75% of all intracranial tumors diagnosed in adults are located supratentorially.

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  • 42. 

    In children most intracranial tumors are located:

    • A.

      Above the tentorium cerebelli (supratentorially)

    • B.

      Below the tentorium cerebelli (infratentorially)

    • C.

      Laterally

    • D.

      Posterolaterally

    Correct Answer
    B. Below the tentorium cerebelli (infratentorially)
    Explanation
    Approximately 70% of all tumors diagnosed in children are located infratentorially.

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