Please see attached

Please see attached
Exam 2 ? The following 8 questions refer to the scenario for Michelle Owens? Michelle Owens?is a 56 year old woman?with a new diagnosis of poorly differentiated adenocarcinoma of the colon, The cancer is stage 4 and T2, N2, M1.?She is very weak and placed on bedrest.?Ms. Owens also has Mitral Valva Prolapse Syndrome (MVPS).?Vital signs are:?37.9 C, 82, 20, 128/68, 98% on room air. ? Question 1 1? 1?ts MVPS results in increased risk of developing which of the following? ? Pneumonia ? ? Myocarditis ? ? Endocarditis ? ? Rheumatic fever ?? Question 2 1? 1?ts Ms. Owens’ malignant cells are likely to exhibit which of the following? ? Increased cellular communication ? ? Low levels of fibronectin ? ? Decreased metabolic demand ? ? Low levels of cachectin ?? Question 3 1? 1?ts Ms. Owens may benefit from antibiotics in which of the following situations? ? Never because of resistance ? ? Only after lower gastronintestinal infections develop ? ? Only after upper gastrointestinal infections have resolved ? ? Before surgical procedures ?? Question 4 1? 1?ts Ms. Owens’ malignancy development may be promoted by which of the following? ? Increased apoptosis ? ? Inactivation of?p53 tumor suppressor genes ? ? Decreased angiogenesis ? ? Decreased growth factor receptors ?? Question 5 1? 1?ts MVPS results in which of the following? ? Mitral valve not opening properly during ventricular systole ? ? Mitral valve not closing properly during ventricular systole ? ? Mitral valve not opening properly during ventricular diastole ? ? Mitral valve not closing properly during ventricular diastole ?? Question 6 1? 1?ts Ms. Owens’ malignancy involves which of the following? ? Preinvasive epithelial tumor of glandular origin ? ? Cells that do not closely resemble normal colon cells ? ? No lymph node involvement ? ? Cancer that is only locally invasive ?? Question 7 1? 1?ts MVPS may result in the development of which of the following? ? Decreased cardiac output ? ? Acute Pericarditis ? ? Increased cardiac output ? ? Pericardial tamponade ?? IncorrectQuestion 8 0? 1?ts Ms. Owens’ malignancy development may be promoted by which of the following? ? Telomerase genes in the ?switched on? position ? ? Contact inhibition between cells ? ? Density dependent inhibition of?cellular growth ? ? Cellular anchorage dependence ?? The next 4 questions refer to the scenario for Yoobin Chung Ms. Chung is a 25 year old college student with complaints of fatigue and weight loss these past few months.?Today she comes to the student health center with swelling in her left groin and a fever.?Ms. Chung has a chest x-ray which reveals hilar lymphadenopathy.?Ms. Chung?s legs are pink, warm, and dry, with notable edema of the left leg.?Ms. Chung is quite anxious about her health problems and is sobbing uncontrollably, declaring ?I don?t want to die?.?A needle biopsy of the left groin lymphatic mass reveals lymphoid hyperplasia with Reed-Sternberg Cells. Vital signs?re:?38.2 C, 106, 26, 96/48.?96% sat, Pain 0/10 ? Question 9 1? 1?ts If Ms. Chung’s weight loss continues coupled with anorexia & asthenia, this could be related to increased production of which of the following? ? Uric acid ? ? Fibronectin ? ? Telomerase ? ? Cachectin ?? IncorrectQuestion 10 0? 1?ts Ms. Chung?s lymphoma would be staged at which of the following? ? 2a ? ? 2b ? ? 3a ? ? 3b ?? IncorrectQuestion 11 0? 1?ts Which of the following is the likely cause of the left leg swelling? ? Decreased hydrostatic pressure ? ? Decreased plasma oncotic pressure ? ? Increased capillary permeability ? ? Obstructed lymphatic drainage ?? Question 12 1? 1?ts Ms. Chung?s malignancy would be classified as which of the following? ? Non-Hodgkin?s lymphoma ? ? Multiple Myeloma ? ? Chronic lymphocytic lymphoma ? ? Hodgkin?s lymphoma ?? The following 5 questions?refer to the following scenario for Martin Englewood. Marion Englewood is a 60year old female with a history of coronary artery disease and primary hypertension.?Her medical conditions have been well controlled by medications.?She is admitted to the emergency room with acute onset of confusion, pulmonary crackles, nausea and vomiting, and a BP of 212/154.?? IncorrectQuestion 13 0? 1?ts Which of the following interventions would help to reduce the blood pressure? ? Administer fluid ? ? Administer a vasoconstrictor ? ? Block Beta receptors ? ? Administer anticholinergic medications ?? IncorrectQuestion 14 0? 1?ts Ms. Englewood?s hypertension status in the emergency room would be classified as which of the following? ? Primary ? ? Secondary ? ? Malignant ? ? Complicated ?? IncorrectQuestion 15 0? 1?ts Select a characteristic of malignant cells that may explain the metastasis of Ms. Englewood?s breast cancer. ? Increased Cachectin ? ? Decreased Fibronectin ? ? Decreased angiogenesis factor ? ? Increased Uric Acid ?? Question 16 1? 1?ts Diagnostic tests confirm a diagnosis of metastatic infiltrating ductal carcinoma of the breast.?Metastasis to her bones is noted.? Ms. Englewood?s malignancy involves malignant transformation of which of the following? ? connective tissue ? ? glandular tissue ? ? myeloid tissue ? ? epithelial tissue ?? Question 17 1? 1?ts During physical exam, findings suggestive of breast cancer are discovered.?Select the clinical manifestation(s) associated with breast cancer. ? Multiple lumps in both breasts ? ? Painful lumps ? ? Dimpling and retraction ? ? Fluctuation in lesion size ?? The following 7 questions?refer to the following scenario for Chris Martin. Chris Martin is a 29 year old man with cystic fibrosis (CF) admitted to the hospital for a pulmonary infection.?He has a barrel chest, dry skin and mucous membranes, clubbing of the nailbeds,?dyspnea on exertion, difficulty gaining weight,?pedal edema, & steatorrhea.? Mr. Martin is awaiting a lung transplant and hopes donor lungs become available soon. Vital signs?re?38.8C, 108, 26, 98/64. The following laboratory values are obtained: ? IncorrectQuestion 18 0? 1?ts Mr. Martin has pulmonary hypertension, which places him at high risk for which of the following? ? Developing asthma ? ? Developing pulmonary embolism ? ? Developing atelectasis ? ? Developing cor pulmonale ?? Question 19 1? 1?ts Chris?s difficulty gaining weight & steatorrhea are related to which of the following? ? Hyperhomocysteinemia and folate deficiency ? ? Obesity- hypoventilation syndrome ? ? Anorexia-cachexia syndrome ? ? Malabsorption ?? IncorrectQuestion 20 0? 1?ts Mr. Martin develops hemoptysis, therefore a sputum for AFB is ordered to rule out which of the following? ? Tuberculosis ? ? Pneumocystis carnii pneumonia ? ? Pleurisy ? ? Adenocarcinoma ?? Question 21 1? 1?ts Considering the admission ABG, Mr. Martin should have which of the following? ? Not have oxygen administered ? ? Have oxygen administered to increase the SaO2 to >95% ? Have oxygen administered to increase the SaO2 to the 88-92% range ? ? Be removed from the lung transplant list because of his physical condition. ?? IncorrectQuestion 22 0? 1?ts A chest x-ray is done revealing a left pneumothorax, therefore a chest tube is placed into the pleural space, which resolves the problem.?Mr Martin breathes shallowly however because it hurts.?You assess diminished breath sounds and crackles, indicating the likely development of which of the following? ? Atelectasis ? ? Dead space units ? ? Congestive heart failure ? ? Alpha 1 antitrypsin deficiency ?? Question 23 1? 1?ts Mr. Martin develops acute hypoxemia, tracheal shift, and hypotension associated with a severe coughing episode, indicating the likely development of which of the following? ? Pleurisy ? ? Empyema ? ? Tension pneumothorax ? ? Obstructive pulmonary disease ?? IncorrectQuestion 24 0? 1?ts Mr. Martin?s barrel chest has developed secondary to which of the following? ? Acute hypoxemia ? ? Chronic air trapping ? ? Thoracic muscle atrophy ? ? Restrictive pulmonary disease ?? The following 3 questions?refer to the following scenario for Bernie Irving. Bernie Irving is a 66 year old man who developed an abdominal aortic aneurysm which ruptured in the operating room but was surgically repaired.??Mr. Irving?s postoperative course has been complicated with blood?pressure issues and respiratory insufficiency.?Breath sounds are decreased in the bases with bilateral fine crackles.?Mr. Berlin has been smoking for 50 years.? Vital signs?re 38.2, 108, 28, 154/96.?The following laboratory?values are obtained: ? IncorrectQuestion 25 0? 1?ts Considering the above ABG, Mr. Irving should have which of the following? ? Not have oxygen administered ? ? Have oxygen administered to increase the SaO2 to >95% ? Have oxygen administered to increase the SaO2 to the 88-92% range ? ? Be admitted to the intensive care unit for acute respiratory failure ?? IncorrectQuestion 26 0? 1?ts Mr. Irving’s blood pressure?would benefit from which of the following? ? Abundant fluid administration ? ? Inotropic medication administration ? ? Anticholinergic medication administration ? ? Alpha blocker medication administration ?? Question 27 1? 1?ts Mr. Irving develops edema, warmth, and pain in his right calf, with strong pedal pulses and a positive Homan?s sign, suggesting that he has developed which of the following? ? Acute arterial insufficiency ? ? Deep vein thrombophlebitis ? ? Chronic arterial insufficiency ? ? Varicose veins ?? The following 6 questions refer to the scenario for Angela?ucaro Angela Bucaro is a 75 year old retired librarian.?Ms. Bucaro smokes two packs of cigarettes a day and says she has tried to quit smoking, but has poor will power.?Ms. Bucaro has a long history of coronary artery disease (CAD).?She had an anterior wall myocardial infarction (AWMI) several years ago and had a 4 vessel coronary artery bypass graft (CABG).?She takes numerous medications, including anti-hypertensives, anti-anginals, diuretics, and anticoagulants.?She continues to have periodic episodes of chest pain when she exerts herself too much, but she always gets relief from either rest alone or sometimes requires nitroglycerine.?She has a productive cough of green mucous, barrel chest, and bilateral pedal edema.? Vital Signs?re 37.8C, 112, 28, and 148/94. ? IncorrectQuestion 28 0? 1?ts Considering the above data base, Ms. Bucaro?s angina would be classified as which of the following? ? Classic angina ? ? Crescendo angina ? ? Unstable angina ? ? Prinzmetal angina ?? IncorrectQuestion 29 0? 1?ts Ms. Bucaro takes several cardiac medications.?Which of the following types of medications would benefit her myocardial oxygen and supply balance? ? Epinephrine ? ? An anticholinergic ? ? A beta blocker ? ? An alpha adrenergic medication ?? IncorrectQuestion 30 0? 1?ts Ms. Bucaro exhibits which of the following factors that can imbalance her myocardial oxygen supply and demand? ? green mucous ? ? bilateral Pedal Edema ? ? barrel Chest ? ? tachycardia ?? Ms. Bucaro has chest pain that does not respond to rest and nitroglycerine.?A 12 lead ECG is ordered and cardiac enzymes are drawn. ? IncorrectQuestion 31 0? 1?ts Which of the following is true regarding healing of the myocardium after an MI? ? A tough inelastic scar develops in 6-12 hours after the MI onset ? ? A weak fibrotic scar forms 2-4 days after the MI onset ? ? Inflammation has its onset approximately 6 days after MI onset ? ? 10-14 days after MI onset cardiovascular function improves and she may start feeling better ? Question 32 1? 1?ts Ms. Bucaro is diagnosed with atrial fibrillation, therefore which of the following is true? ? Tachycardia is beneficial ? ? There is an increased risk of stroke ? ? Anticoagulants are contraindicated ? ? Cardiac output is likely to be increased ?? IncorrectQuestion 33 0? 1?ts Which of the following changes would be indicative of myocardial injury? ? ST segment depression ? ? T wave inversion ? ? ST segment elevation ? ? P wave depression ?? The following 5 questions?refer to the scenario for Adelaide Hunting Adelaide Hunting is a 79 year old housewife.?Ms. Hunting smokes two packs of cigarettes a day and says she has tried to quit smoking, but has poor will power.?She has a productive cough of green mucous, barrel chest, and bilateral pedal edema.? Vital Signs?re 37.8C, 112, 28, and 148/94. ?? Question 34 1? 1?ts Which of the following medications may help resolve her blood pressure issues? ? A sympathomimetic ? ? A diuretic ? ? An anticholinergic ? ? A vasoconstrictor ?? IncorrectQuestion 35 0? 1?ts A pleural effusion is noted on a chest x-ray, which may result in which of the following? ? Compression atelectasis ? ? Pulmonary embolism ? ? Open pneumothorax ? ? Acute obstructive pulmonary disease ?? Question 36 1? 1?ts Ms. Hunting develops acute onset of wheezing, dyspnea, and coughing related to a staff members strong perfume.?The wheezing is likely related to which of the following? ? Bronchodilation ? ? Elastase production ? ? Bronchospasm ? ? Alpha 1 antitrypsin deficiency ?? Question 37 1? 1?ts Ms. Hunting’s breathing difficulty with wheezing and dyspnea may benefit from administration of which of the following? ? Bronchodilating medications ? ? Parasympathetic medications ? ? Cholinergic medications ? ? Beta blocking medications ?? IncorrectQuestion 38 0? 1?ts The wheezing subsides.?Ms. Hunting declares she has had asthma all her life and that her mother and son have asthma too.?She has had positive skin tests and says cats, dust, and perfumes are her triggers.?Ms. Hunting?s asthma would be classified which of the following? ? Intrinsic ? ? Status asthmaticus ? ? Extrinisic ? ? Non-allergic ?? The following 7 questions?refer to the following scenario for John Fletcher John Fletcher is a young man with a history of HIV infection who is admitted for fatigue, night sweats, a 20 lb weight loss over the last few months, swollen lymph nodes, and pedal edema. He has a productive cough with yellow/brown mucous & complains of orthopnea. Kaposi Sarcoma was diagnosed last month. Vital signs?re?38.9C 112 30 118/76. Labs are assessed & a physical examination is performed. CBC Reveals: RBC, 2.0 mill/mm3, Hgb – 6 gm/dl, HCT -18% MCV – 108fl (80-97)?MCH 29 (27-31), MCHC 34% (32-36) Platelets – 30,000 WBC – 14,900 Polys – 70%, Bands – 2%, Eos – 2%, Basos – 1%, Blasts 20%, Monos 5% ?? IncorrectQuestion 39 0? 1?ts Mr. Fletcher’s pedal edema is related to which of the following? ? increased hydrostatic pressure ? ? decreased plasma oncotic pressure ? ? increased capillary permeability ? ? obstructed lymphatic drainage ?? Question 40 1? 1?ts Mr. Fletcher?s CBC?indicates?which of the following? ? pancytopenia ? ? viral infection ? ? iron deficiency ? ? acute leukemia ?? IncorrectQuestion 41 0? 1?ts Mr. Fletcher complains of infectious symptoms related to which of the following? ? anemia ? ? thrombocytopenia ? ? Macrocytosis ? ? functional leukopenia ?? Question 42 1? 1?ts Mr. Fletcher’s Kaposi Sarcoma?involves malignant transformation of which of the following? ? connective tissue ? ? glandular tissue ? ? myeloid tissue ? ? epithelial tissue ?? A CT Scan of the chest reveals a lung mass.?The sputum cytology reveals atypical hyperplasia with cells compatible with a diagnosis of Oat cell carcinoma. ? Question 43 1? 1?ts Oat cell carcinoma of the lung involves malignant transformation of which of the following? ? Connective tissue ? ? Epithelial tissue ? ? Pleural tissue ? ? Alveolar macrophages ?? IncorrectQuestion 44 0? 1?ts Considering the organ tropism of lung cancer, which of the following would be closely monitored for? ? Increased liver enzymes ? ? Tachycardia ? ? Mental status changes ? ? Pathological fractures ?? Question 45 1? 1?ts Mr Fletcher’s electroytes are assessed, including a serum sodium of 128 mg/dl.?Mr. Fletcher?s sodium level may be caused by ectopic production of which of the following? ? Aldosterone ? ? Calcitonin ? ? ACTH ? ? ADH ?? The following questions 15 questions refer to the following scenario for Ernestine Lipton Ernestine Lipton is a 56 year old woman with Systemic Lupus Erythematosus (SLE).?She complains of swelling of her hands, face, and feet.? Vital signs?re:?37.5C, 78, 26, 164/98 ? IncorrectQuestion 46 0? 1?ts Determination of the cause of the above acid-base imbalance cause can be clarified by evaluation of which of the following? ? Albumin ? ? Anion Gap ? ? Glucose ? ? Blood pressure ?? Question 47 1? 1?ts Ms. Lipton has a kidney transplant and is prescribed medications to prevent transplant rejection.?Transplant rejection is an example of which of the following? ? Type II hypersensitivity reaction ? ? Allergic reaction ? ? Type III hypersensitivity reaction ? ? Alloimmune reaction ?? Question 48 1? 1?ts Ms. Lipton?s electrolyte profile reveals which of the following? ? Renal dysfunction and respiratory acidosis ? ? Renal dysfunction and respiratory alkalosis ? ? Renal dysfunction and metabolic acidosis ? ? Renal dysfunction and metabolic alkalosis ?? Question 49 1? 1?ts Ms. Lipton?s ABG reveals which of the following? ? MIxed metabolic and respiratory acidosis ? ? Totally compensated respiratory acidosis ? ? Partially compensated respiratory acidosis ? ? Totally compensated metabolic acidosis ?? IncorrectQuestion 50 0? 1?ts Considering the pathophysiology of SLE, Ms. Lipton?s hypertension has likely developed secondary to vasculitis from which of the following? ? Cytotoxic T lymphocytes initiating blood vessel damage ? ? Antibodies directed toward the intimal layers of arteries initiating blood vessel damage ? Immune complexes becoming deposited in blood vessel walls, initiating inflammatory mediated damage ? A normal immune response against beneficial vascular tissue ?? Question 51 1? 1?ts If Ms. Lipton develops Immune Thrombocytopenia Purpura (ITP), the mechanism is which of the following? ? Type I hypersensitivity ? ? Type II hypersensitivity ? ? Type III hypersensitivity ? ? Type IV hypersensitivity ?? IncorrectQuestion 52 0? 1?ts Diagnostic criteria for SLE include which of the following? ? Stress response ? ? Opportunistic infection ? ? Alloimmunity ? ? Photosensitivity ?? The following Complete Blood Count is assessed: ? IncorrectQuestion 53 0? 1?ts The above CBC indicates which of the following? ? Bacterial infection ? ? Fungal infection ? ? Viral infection ? ? No infection ?? Question 54 1? 1?ts The above CBC indicates which of the following? ? Iron deficiency ? ? Folate deficiency ? ? Chronic disease ? ? Hemolysis ?? Question 55 1? 1?ts Ms. Lipton is treated with her prescribed anti-rejection medications.?Subsequently her blood counts decrease placing her at risk for developing which of the following? ? Acquired Immune Deficiency Syndrome ? ? Opportunistic Infections ? ? Autoimmune diseases ? ? Allergic reactions to medications ?? Updated CBC for Ms. Lipton: ? Question 56 1? 1?ts Ms. Lipton?s CBC indicates which of the following? ? a viral infection ? ? immunocompetence ? ? aplastic anemia ? ? tissue hypoxia ?? IncorrectQuestion 57 0? 1?ts Ms. Lipton?s current CBC indicates which of the following? ? Iron deficiency ? ? Spontaneous bleeding risk ? ? Chronic infection ? ? Hemolysis ?? Medications are changed and week later another Complete Blood Count reveals: ? IncorrectQuestion 58 0? 1?ts Ms. Lipton develops ecchymosis and epistaxis due to which of the following? ? Anemia ? ? Thrombocytopenia ? ? Neutropenia ? ? Shift to the right ?? IncorrectQuestion 59 0? 1?ts Ms.?Lipton develops fevers related to which of the following? ? Anemia ? ? Thrombocytopenia ? ? Neutropenia ? ? Shift to the right ?? Question 60 1? 1?ts Ms. Lipton complains of?weakness and dyspnea on exertion associated with which of the following? ? Anemia ? ? Thrombocytopenia ? ? Neutropenia ? ? Shift to the right ?? The following 15 questions refer to the scenario for Gordon Cort? Gordon Cort?is a 62 year old man with a new diagnosis of multiple myeloma. Mr.Cort complains of worsening back and leg pain that is intolerable.?He has a history of chronic lung disease and complains of developing a cold and a runny nose.? He is coughing up thick green mucous with streaks of blood, therefore a specimen is sent to the lab for culture and sensitivity.?He is somewhat confused and can?t remember his home address.?He is?pale, weak, dizzy while walking, with instructions not to get out of bed unless he has assistance.? Vital signs?re:?38.9 C, 102, 24, 148/98, 90% sat, pain 8/10.? ? IncorrectQuestion 61 0? 1?ts Mr. Cort?s back and leg pain are likely caused by which of the following? ? Thick green mucous with streaks of blood ? ? History of?weakness while walking, immobility and now bedrest ? ? Cortical bone destruction and nociceptor stimulation ? ? Chronic anemia, hypoxia, and ischemia ?? IncorrectQuestion 62 0? 1?ts Mr. Cort’s mental status most likely been caused by which the following? ? his Potassium level ? ? his Magnesium level ? ? his CO2 level ? ? his Calcium level ?? Question 63 1? 1?ts Mr. Cort?s calcium level has most likely been caused by which of the following? ? His kidney status and consequent phosphate levels in the blood ? ? Destruction of the cortical bone by mutant cells depositing?abnormal IgG ? ? Increased calcitonin production which facilitates calcium absorption ? ? Increased vitamin D production related to his kidney status ?? Question 64 1? 1?ts Mr. Cort?s kidney status has been caused by which of the following? ? M Protein deposition ? ? Gram positive cocci ? ? Increased amounts of Immunoglobulin A ( IgA) ? ? Sternberg Reed Cells ?? Question 65 1? 1?ts The above sodium level may be caused by which of the following? ? Increased renin ? ? Increased ADH ? ? Increased aldosterone ? ? Increased PTH ?? Question 66 1? 1?ts Mr. Cort’s culture and gram stain indicate which of the following? ? viruses are present ? ? bacteria are present ? ? fungi are present ? ? no micro-organisms are present ?? Question 67 1? 1?ts Mr. Cort?s activity level places him at risk for developing which of the following? ? Increased HDLs ? ? Apnea ? ? Hemoptysis ? ? Thromboemboli ?? Question 68 1? 1?ts Mr. Cort ?as an increased risk of infection because of which of the following? ? Decreased reticulocyte counts ? ? Increased iron levels ? ? Decreased antibody production ? ? Increased calcium levels ?? Chemotherapy is administered to Mr. Cort & one week later another CBC reveals: ? Question 69 1? 1?ts Mr. Cort?s above CBC indicates which of the following? ? Immunodeficiency ? ? Bacterial infection ? ? Viral infection ? ? Immunocompetence ?? Question 70 1? 1?ts Mr. Cort develops an elevated uric acid level in his blood, indicating the development of which of the following? ? Tumor lysis syndrome ? ? Disseminated intravascular coagulation ? ? alpha 1 antitrypsin deficiency ? ? Pickwickian syndrome ?? Mr. Cort develops heart failure, with pulmonary edema, hypotension, tachycardia, dyspnea, water retention, and a heart murmur after receiving fluids for his chemotherapy protocol. ? Question 71 1? 1?ts Which physiologic principle helps explain why receiving fluids can result in heart failure, when a person receives more fluid than their heart can handle? ? Pouisseille?s Law ? ? Law of Laplace ? ? Frank-Starling law of the heart ? ? Virchow?s Triad ?? IncorrectQuestion 72 0? 1?ts Mr. Cort?has developed jugular venous distension, hepatomegaly and peripheral edema, because of which of the following? ? Forward Systolic failure ? ? ACE inhibition ? ? RAA stimulation ? ? Backward Diastolic failure ?? IncorrectQuestion 73 0? 1?ts Mr. Cort?s hypotension and tachycardia are a direct consequence of which of the following? ? Backward Diastolic Failure ? ? Increased contractility ? ? Forward Systolic Failure ? ? Right Ventricular Failure ?? IncorrectQuestion 74 0? 1?ts Mr. Cort?s water retention is a consequence of which of the following? ? Adrenergic stimulation ? ? RAA stimulation ? ? ACE inhibition ? ? Cholinergic stimulation ?? Question 75 1? 1?ts Mr. Cort?s pulmonary edema is a consequence of which of the following? ? Backward Diastolic Failure ? ? Increased contractility ? ? Forward Systolic Failure ? ? Right Ventricular Failure ?

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