1. A 14-year-old male has been admitted to the emergencyroom suffering with acute-onset abdominal pain in thelower right quadrant. Abdominal rebound tenderness isintense, and he has a fever and leukocytosis. Thisindividual most likely is suffering from:a. acute appendicitisb. diverticulitisc. ulcerative colitisd. cholelithiasise. cholecystitis: a

2. A 20-year-old man presents with periumbilical pain,fever, and loss of appetite. Which of the following is themost likely cause of his abdominal discomfort?a. Diverticulosisb. Diverticulitisc. Appendicitisd. Mesenteric venous thrombosis: cAppendicitis is an inflammation of the vermiform appendix andcommonly occurs between the ages of 20 and 30. There is oftenperiumbilical pain that can be vague. Diverticulosis isasymptomatic diverticular disease, which is herniation or saclikeoutpouching of mucosa through the muscle layers of the colonwall. Diverticulitis is inflammation of the diverticula in thecolon. Patients are usually older and have a crampy pain, oftenin the left lower quadrant. Mesenteric venous thrombosis usuallyoccurs in older individuals with malignancies, right-sided heartfailure, and deep vein thrombosis.

3. A 23-year-old patient is hit in the temporal portion of hisskull during an altercation. Although he initially losesconsciousness, he soon awakens and is conversant.Three hours later he is experiencing vomiting,drowsiness, and confusion. These symptoms are mostlikely related to which type of brain injury?a. Diffuse axonalb. Intracerebralc. Subdurald. Epidural: dThe classic presentation of an epidural hematoma is a person hitin the temporal area with damage to the middle meningealartery. The patient will lose consciousness at the time of injury,but there may be a period where consciousness is regained. Thepatient will then become more confused and drowsy. Thisscenario is not typical with the other types of brain injury.

4. A 55-year-old obese male presents to a sleep cliniccomplaining of difficulty sleeping. He reports that hewakes gasping for air and his wife is ready to divorcehim because his snoring keeps her up at night. Which isthe most likely diagnosis for this patient?a. Primary hypersomniab. Parasomniac. Somnambulismd. Obstructive sleep apnea: dObstructive sleep apnea is due to upper airway obstruction and isaccompanied by excessive snoring and episodic apnea. Primaryhypersomnia is excessive daytime sleepiness. Parasomnia isunusual behavior during sleep. Somnambulism is sleepwalking.

5. Abnormal findings in which of the following evaluationswould indicate possible neurological dysfunction?Select all that apply.a. Level of consciousnessb. Pattern of breathingc. Heart rated. Eye positione. Skeletal muscle motor responses: all except c

6. Acute otitis media (AOM):a. has no genetic determinantsb. displays a tympanic membrane progressing fromerythema to opaqueness with bulgingc. has breast-feeding as a risk factord. is commonly caused by Staphylococcus aureus: b

7. Age-related macular degeneration (AMD):a. has a higher incidence in hypotensive individualsb. occurs in individuals before the age of 60 yearsc. exhibits retinal detachment and loss ofphotoreceptorsd. exhibits loss of accommodation: c

8. Although non-REM and REM sleep are defined byelectrical recordings, they are characterized byphysiologic events. Which does NOT occur?a. during non-REM sleep, muscle tone decreasesb. Non-REM sleep is initiated by withdrawal ofneurotransmitters from the reticular formationc. during non-REM, cerebral blood flow to the cortexdecreasesd. during non-REM, levels of corticosteroids increase: d

9. Alzheimer disease:a. can be caused by increased cerebral levels ofacetylcholineb. is most prevalent as a late-onset dementiac. manifests as nerve cell tanglesd. manifests as neuron senile plaquese. all above: b

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10. The appropriate definition of perceptual dominance is:a. the duration of time or intensity of pain before overtpain responses are initiated.b. pain at one location that may cause an increase inthreshold at another location.c. repeated exposure to a pain stimulus.d. the point at which pain is perceived.: bPerceptual dominance is pain at one location that may cause anincrease in threshold at another location. For example, when apatient has severe pain in his leg, he may not feel neck pain.Pain tolerance is the duration of time or intensity of pain beforeovert pain responses are initiated. Repeated exposure to painusually decreases pain tolerance. The pain threshold is the pointat which pain is perceived.

11. The appropriate term for pain that is present in an areadistant from its point of origin is:a. acute pain.b. chronic pain.c. referred pain.d. somatic pain.: cReferred pain is pain that is present in an area removed ordistant from its point of origin. Chronic pain is usuallyprolonged, lasting at least 3 months. Somatic pain arises fromconnective tissue, muscle, bone, and skin. It is may be sharp andwell organized or dull, aching, and poorly localized. Acute painarises from cutaneous, deep somatic, or visceral structures and isa protective mechanism.

12. Autonomic hyperreflexia is characterized by all of thefollowing except:a. hypotensionb. slower heart ratec. stimulation of sensory receptors below the level of thecord lesiond. precipitation because of a distended bladder orrectum: a

13. A basic neural system to cognitive function wouldinclude: Select all that apply.a. attentional systems.b. memory systems.c. affective or emotive systems.d. sensory systems.e. language systems.: all except d

14. A benefit of fever to human blood includes:a. decreased lymphocytic transformation.b. diminished phagocytosis.c. increased iron concentration.d. a switch to lipolysis and proteolysis.: dFever has benefits. The higher body temperature decreases serumlevels of iron, zinc, and copper, all of which are need for bacterialreplication. It switches from burning glucose to lipolysis andproteolysis, thus depriving bacteria of a food source. There isincreased lymphocytic transformation, increasing the immuneresponse. Increased phagocytosis also occurs.

15. A cause of a cerebral aneurysm includes: Select all thatapplya. arteriosclerosis.b. heroin abuse.c. congenital anomaly.d. trauma.e. cocaine abuse.: all except b

16. Causes of acute renal failure include:a. cholecystitisb. stones and strictures in kidneys or uretersc. heart failure leading to poor renal perfusiond. b and ce. a, b, and c: d

17. Cerebral death:a. is death of the cerebellumb. permits normal internal homeostasisc. no longer maintains respiratory and cardiovascularfunctionsd. is death of the brainstem: b

18. The characteristic lesion of Crohn disease is:a. found in the ileumb. precancerousc. granulomatousd. malignante. a and c: e

19. A characteristic of Alzheimer disease includes: Select allthat apply.a. rapid onset of symptomology.b. short-term memory loss.c. increased irritability and agitation.d. anxiety and depression.e. remissions resulting in cognitive clarity.: b, c, and d

20. Chronic constipation may be a result of: Select all thatapply.a. low-residue dietb. sedentary lifestylec. hyperthyroidismd. opiates usee. aging: all except c

21. Chronic renal failure:a. may result from hypertensionb. is usually the result of chronic inflammation of thekidneyc. may be treated with dialysis or transplantsd. all abovee. a and c: d

22. The classification of acute pain includes: Select all thatapply.a. acute visceral.b. pleuritic.c. referred.d. acute somatic.e. cutaneous.: all except b

23. A client is diagnosed with a Cushing ulcer. Whatassessment information related to this client's currentmedical condition supports this diagnosis?a. Third-degree burns over 20% of the bodyb. Profound septicemia with high feverc. Severe head trauma resulting from auto accidentd. Massive internal trauma as a result of a fall: cCushing ulcer is a stress ulcer related to severe head trauma orbrain surgery and is caused by overstimulation of the vagus nerveand decreased mucosal blood flow. Ischemic ulcers developwithin hours of an event such as septicemia, hemorrhage,multisystem trauma, severe burns, or CHF.

24. A client is diagnosed with hematochezia. Whichassessment finding confirms this diagnosis?a. Bloody vomitusb. Bright red rectal bleedingc. Presence of tarry stoolsd. Positive testing for occult blood: bHematemesis is blood in the vomitus. Hematochezia is bright redor burgundy-colored blood from the rectum. Melena is thedescription for dark or tarry stools. Occult bleeding is usuallycaused by slow, chronic bleeding, and it is not obvious.

25. A client presents with epigastric pain and vomiting. Heis hyperglycemic and tachycardic. Client reports he is"a heavy drinker but never had problems like thisbefore." Which disease process is supported by thisclient's symptoms?a. Cholelithiasisb. Cholecystitisc. Acute pancreatitisd. Appendicitis: cThe classic presenting symptom of pancreatitis is midepigastricpain and vomiting. This patient admits to heavy alcoholconsumption, which can lead to pancreatitis. The history andassessment do not support the other options.

26. A common cause of both pyelonephritis and cystitis is:a. urinary calculib. invading, ascending microorganisms, such as E. colic. allergy reactionsd. heavy metals: b

27. Common manifestation of hiatal hernia is:a. gastroesophageal refluxb. diarrheac. belchingd. postprandial substernal pain: e

28. Criteria for determining brain death include: Select allthat apply.a. unresponsive coma.b. no spontaneous respiration.c. isoelectric EEG.d. pupils are reactive but unequal.e. ocular response to head turning.: a, b, and c

29. Depressed T cell function is associated with:a. follicular cystsb. endometrial polypsc. leiomyomasd. adenomyosise. endometriosis: e

30. A diabetic child with 4.0 grams of protein in her urineeach day is experiencing edema and vitamin Ddeficiency. Which is the most likely diagnosis?a. Nephritic syndromeb. Nephrotic syndromec. Acute renal failured. Rapidly progressive glomerulonephritis: bNephrotic syndrome is characterized by excretion of 3.5 grams ormore of protein in the urine per day due to glomerular injury.Nephritic syndrome is characterized by blood in the urine withred and white cell casts and varying degrees of protein. Acuterenal failure presents with oliguria and a reduction in GFR andBUN. Rapidly progressive glomerulonephritis usually affectsadults in their 50s and 60s and presents with hematuria.

31. Duodenal ulcers:a. occur 4 times more often in females than in malesb. may be complicated by hemorrhagec. are associated with sepsisd. may cause inflammation and scar tissue formationaround the sphincter of Oddi: b

32. During vomiting, there is:a. forceful diaphragm and abdominal musclecontractions, airway closure, esophageal sphincterrelaxation, and deep inspirationb. deep inspiration, airway closure, forceful diaphragmand abdominal muscle contractions, and esophagealsphincter relaxationc. airway closure, forceful diaphragm and abdominalmuscle contractions, deep inspiration, and esophagealsphincter relaxationd. esophageal sphincter relaxation, forceful diaphragmand abdominal muscle contractions, deep inspiration,and airway closure.: b

33. Dystonia is:a. abnormal posture maintained by muscularcontractionsb. flexed posturec. stooped, hyperflexed postured. a spastic gait: a

34. The earliest symptom of chronic renal failure is:a. pruritusb. oliguriac. polyuriad. decreased BUN: c

35. An elderly alcoholic man falls and experiences ahematoma that is on the top of his brain. The hematomais most likely a:a. subdural.b. epidural.c. extradural.d. intracerebral.: aSubdural hematomas are commonly found in the elderly andpersons who abuse alcohol. The remaining options are injuriesnot generally observed in this population after experiencing analcohol-induced fall.

36. Endogenous opioids include: Select all that apply.a. enkephalins.b. endorphins.c. dynorphins.d. endomorphins.e. denkephalins.: all except e

37. Endometriosis:a. has the ectopic endometrium responding tohormonal fluctuations of the menstrual cycleb. occurs primarily in the pleural cavityc. causes infertility in most women having the disorderd. does not reoccur after treatment: a

38. Endorphins:a. increase pain sensationsb. decrease pain sensationsc. may increase or decrease pain sensationsd. have no effect on pain sensations: b

39. Gastric ulcers:a. may lead to malignancyb. occur at a younger age than duodenal ulcersc. always have increased acid productiond. exhibit nocturnal paine. both a and c: a

40. Gastroesophageal reflux is:a. caused by rapid gastric emptyingb. excessive lower esophageal sphincter functioningc. associated with abdominal surgeryd. caused by spontaneously relaxing lower esophagealsphincter: d

41. H. pylori is discovered in the GI tract of a clientexperiencing an inflammation of the gastric mucosa.These findings support which diagnosis?a. Chronic diarrheab. Paralytic ileusc. Chronic gastritisd. Pyloric obstruction: cHelicobacter pylori infection is associated with gastritis. Theother options are not related to this organism.

42. Hepatic encephalopathy is manifested by:a. ascitesb. splenomegalyc. dark urined. oliguriae. cerebral dysfunction: e

43. In an automobile accident, an individual's foreheadstruck the windshield. The coup/contrecoup injurywould be in the:a. frontal/parietal regionb. frontal/occipital regionc. parietal/occipital regiond. occipital/frontal region: b

44. In bacterial meningitis, the CSF has:a. normal glucose levelsb. an elevated number of lymphocytesc. neutrophilic infiltrationd. none abovee. a, b, and c: c

45. In benign prostatic hyperplasia, enlargement ofperiurethral tissue of the prostate causes:a. obstruction of the urethrab. inflammation of the testisc. decreased urinary outflow from the bladderd. abnormal dilation of a vein within the spermatic corde. tension of the spermatic cord and testis: a

46. In blunt head trauma:a. brain tissues are exposedb. only focal injury occursc. the dura is severedd. the dura remains intact: d

47. In cerebral vasogenic edema:a. active transport failsb. there is autodigestionc. plasma proteins leak into extracellular spacesd. cerebrospinal fluid leaves the ventricles: c

48. In chronic renal failure, tubulointerstitial disease leadsto:a. sodium retentionb. sodium wastingc. no significant changes in sodium levelsd. increased phosphate excretion: d

49. In heatstroke:a. core temperature usually doesn't exceed 101Fb. sodium loss follows sweatingc. core temperature increases as the regulatory centerfailsd. both b and c: c

50. In hypothermia:a. the viscosity of blood is decreasedb. acidosis can developc. hypothalamic center prevents shiveringd. all above: b

51. In malabsorption syndrome, flatulence and abdominaldistension are likely caused by:a. protein deficiency and electrolyte imbalanceb. undigested lactose fermentation by bacteriac. fat irritating the boweld. impaired absorption of amino acids andaccompanying edema: b

52. In moderate diffuse axonal injury:a. coma lasts more than 24 hoursb. coma lasts less than 24 hoursc. disruption of axons occurs in cerebral spheres andthose extending into the diencephalon and brain stemd. tearing of axons in the cerebral hemispheree. a and d: e

53. In pancreatitis:a. the tissue damage likely results from release ofpancreatic enzymesb. high cholesterol intake is causativec. diabetes is uncommon in chronic pancreatitisd. bacterial infection is the etiologic cause: a

54. In the gate control theory of pain:a. a "closed gate" increases pain perceptionb. stimulation of large A fibers "closes the gate."c. Both a and bd. Neither a nor b: b

55. Increased serum levels of epinephrine increase bodytemperature by:a. increasing shiveringb. increasing muscle tonec. increasing heat productiond. decreasing basal metabolic rate: c

56. An individual has an elevated blood level of urea andcreatinine because of complete calculi blockage of oneureter. This is referred to as:a. prerenal diseaseb. intrarenal diseasec. postrenal diseased. preeclampsiae. hypercalcemia: c

57. An individual shows flexion in upper extremities andextension in lower extremities. This is:a. decorticate posturingb. decerebrate posturingc. excitation posturingd. caloric posturing: a

58. An individual with increased intracranial pressurefrom a head injury shows small and reactive pupils,widened pulse pressure, and slowed breathing. Whichstage of ICP exists?a. Stage 1b. Stage 2c. Stage 3d. Stage 4: c

59. Individuals affected by sleep apnea may experience:a. polycythemiab. cyanosisc. pulmonary hypertensiond. all above: d

60. Injury of the cervical cord may be life threateningbecause of:a. increased intracranial pressureb. disrupted reflexesc. spinal shockd. loss of bladder and rectal controle. diaphragmatic impairment: e

61. Intellectual function is impaired in the dementingprocess. Which intellectual function is NOT impaired?a. anterograde memoryb. retrograde memoryc. abstractiond. language deficitse. all above impaired: e

62. Interleukin-1:a. raises hypothalmic set pointb. endogenous pyrogenc. stimulated by exogenous pyrogensd. none abovee. a, b, and c: e

63. Intervertebral disk herniation:a. usually occurs at the thoracic levelb. in the lumbosacral area causes pain over the glutealregion and into the calf or anklec. is infrequent in the lumbosacral disksd. both b and c are correcte. a, b, and c: b

64. Intestinal obstruction causes:a. decreased intraluminal tensionb. hyperkalemiac. decreased nutrient absorptiond. a and be. a, b, and c: c

65. Involuntary unilateral or bilateral rhythmic movementof the eyes is referred to as:a. nystagmus.b. amblyopia.c. glaucoma.d. strabismus.: aNystagmus may be present when at rest or when the eyes move.Amblyopia is reduced vision in an eye secondary to uncorrectedstrabismus. Strabismus is when one eye deviates from the otherwhen a person is looking at an object. Glaucoma is increasedintraocular pressure.

66. It is correct to assume that a saccular aneurysm:a. occurs commonly in childhood.b. grows rapidly.c. can be due to a combination of congenital anddegenerative changes.d. occurs in about 10% of the general population.: cSaccular (berry) aneurysms can be due to a combination ofcongenital and degenerative changes. They affect approximately2% of the general population. They grow slowly over time and arerare in childhood.

67. It is correct to assume that a subarachnoid hemorrhageis:a. a risk for individuals with an intracranial aneurysm.b. seldom experienced in individuals withhypertension.c. not caused by trauma to the head.d. rarely fatal.: aIndividuals with intracranial aneurysms are at risk forsubarachnoid hemorrhage. Hypertension and trauma are alsorisk factors. The mortality is over 50%.

68. It is correct to assume that Cheyne-Stokes respirations(CSR):a. involve a pathologically increased ventilatoryresponse.b. result in hypocapnia and increased ventilatorystimulus.c. cause changes in PaO2 that produce irregularbreathing.d. increase PaCO2 level when overbreathing occurs.: a The pathophysiology of CSR includes an increased ventilatoryresponse to carbon dioxide stimulation. This causes hypercapniaand diminished ventilatory stimulus. Changes in PaCO2 produceirregular breathing, not changes in PaO2. The PaCO2 leveldecreases to below normal when overbreathing occurs.

69. It is correct to assume that Grade III and Grade IVastrocytomas are:a. commonly found in the frontal lobe and cerebralhemisphere.b. generally seen more in women than in men.c. usually neurotic as a result of an absence ofvascularity.d. bluish gray in color with a hard purplish center.: aThey are commonly found in the frontal lobe and cerebralhemisphere and are found twice as often in men as in women.They are often large and well circumscribed with a variegatedpattern. The rim is pinkish gray and solid with a soft, yellow,necrotic center. There is vascular proliferation.

70. It is TRUE that a hemorrhagic stroke:a. is the most common cause of CVA.b. accounts for 50% of all CVA.c. is commonly caused by hypertension.d. is often caused by a microinfarct.: cChronic, untreated hypertension is generally the cause ofhemorrhagic stroke. Hemorrhagic stroke is the third mostcommon cause of CVA. It accounts for 10% to 15% of strokes inwhites and 30% in blacks and Asians. An infarct is a type ofocclusive stroke.

71. It is TRUE that Alzheimer disease is:a. an uncommon neurologic disorder.b. not believed to have a genetic relationship.c. a result of neuronal proteins becoming distorted andtangled.d. the cause of plaques increasing nerve impulsetransmission.: cNeurofibrillary tangles occur when the proteins in neuronsbecome tangled and distorted. There is a genetic relationship inlate-onset familial Alzheimer dementia. It is a commonneurologic disorder; nearly 6 million Americans had the diseasein 2000. With the formation of plaques, there is decreased nerveimpulse transmission.

72. It is true that an acute cerebrovascular accident (CVA)is:a. the leading cause of disability in the United States.b. the fifth most common cause of death in the UnitedStates.c. likely to be followed by a second stroke within 1 year.d. experienced by 2 million individuals each year.: aCVAs are the leading cause of disability and the third leadingcause of death. There are 500,000 stroke victims a year, and 5%to 14% have a second stroke within 1 year.

73. It is TRUE that an oligodendroglioma:a. accounts for 20% of all brain tumors.b. is fast growing.c. usually is undifferentiated.d. rarely includes cysts or calcifications.: dThey often have cysts and calcifications but are slow growing,well-differentiated tumors that comprise 2% of all brain tumors.

74. It is TRUE that encephalitis is:a. an afebrile illness.b. caused by bacteria.c. a result of arthropod borne viruses.d. caused exclusively by herpes simplex II.: cIt is caused by a virus, often arthropod borne (tick/mosquitoborne). Herpes simplex I can also cause the illness; type I ismore common than type II. Encephalitis is an acute febrileillness.

75. It is TRUE that spinal shock:a. is characterized by an incomplete loss of reflexfunction.b. involves all skeletal muscles.c. causes increased muscle tone below the lesion.d. results in no disruption of thermal control.: bSpinal shock does involve function of skeletal muscles resultingin paralysis and flaccidity. Such an injury is characterized by acomplete loss of reflex function below the level of the lesion, andimpairment of control of thermal regulation is observed.

76. It is TRUE that the specificity theory of pain:a. focuses on the attention of pain.b. focuses on previous experience of pain.c. relates the amount of pain to the amount of soft tissueinjury.d. relates to the emotions exhibited toward pain.: cThe specificity theory of pain postulates that the intensity of painis directly related to the amount of associated tissue injury. Itdoes not take into account previous experience, emotions, orattention to pain.

77. Kussmaul respirations can be a result of: Select all thatapply.a. Pulmonary edemab. Metabolic alkalosisc. Metabolic acidosisd. Dehydratione. Impaired protein metabolism: a and c

78. Leptin:a. promotes insulin resistanceb. binds to insulin receptorsc. suppresses hunger/appetite at the hypothalamusd. a, b, and ce. none above: c

79. Low-residue diets and chronic constipation play a rolein the pathogenesis of:a. appendicitisb. diverticulitisc. ulcerative colitisd. Crohn diseasee. cholecystitis: b

80. Manifestations of subarachnoid hemorrhage include(more than 1 answer may be correct):a. an explosive headacheb. muscle flaccidityc. neurologic deficitsd. a delayed age of onset: a, c

81. A means of classifying a seizure includes: Select all thatapply.a. clinical manifestations.b. site of origin.c. response to therapy.d. length of activity.e. EEG correlates.: all except d

82. A mechanism that does not result in heat loss is:a. increased respiration.b. conduction.c. convection.d. vasoconstriction.: dVasoconstriction is a mechanism of heat conservation.Increased respiration, conduction, and convection are allmechanisms of heat loss.

83. Melena is:a. bloody vomitusb. gaseous bowel distentionc. blood in the stoold. loss of appetitee. black, tarry stools: e

84. The most common cause of TBI is:a. motor vehicle accidents.b. falls.c. sports-related events.d. violence.: aMotor vehicle accidents account for 50%. Falls account for 21%.Sports-related events and violence account for 10% and 12%,respectively.

85. The most common manifestation of portal hypertensionis:a. rectal bleedingb. cirrhosisc. intestinal bleedingd. duodenal bleedinge. vomiting of blood from esophageal bleeding: e

86. Most spinal cord injuries occur in the:a. cervical and thoracic regionsb. cervical and lumbar regionsc. thoracic and lumbar regionsd. lumbar and sacral regions: b

87. Multiple sclerosis involves:a. degeneration of dopaminergic receptorsb. activation of the syncytin genec. depletion of GABAd. lower motor neuron muscle wasting: b

88. Nephrotic syndrome is associated with ___ to plasma___ .a. increased glomerular permeability; ureab. decreased glomerular permeability; proteinsc. decreased glomerular permeability; tubular filtrated. increased glomerular permeability; proteins: d

89. Nephrotoxins, such as antibiotics, may be responsiblefor:a. acute tubular necrosisb. acute glomerulonephritisc. pyelonephritisd. cystitis: a

90. Osmotic diarrhea is caused by:a. lactase deficiencyb. bacterial enterotoxinsc. ulcerative colitisd. crohn diseasee. c and d: a

91. A patient diagnosed with Parkinson disease initiallyexperiences:a. difficulty walking.b. fine tremors.c. postural instability.d. rigidity of leg muscles.: bTremor is often the first symptom to appear. The symptoms areoften unilateral and then become bilateral, progressing to affectgait and include postural instability and the inability to walk.

92. A patient experiences a large hematoma from a motorvehicle accident. The patient develops jaundice due toincreased breakdown (hemolysis) of red blood cells.Which statement the pathophysiology of hemolysisregarding this patient's condition is true?a. There is a decrease in conjugated bilirubin.b. Increased amounts of unconjugated bilirubin occur.c. Bilirubin is excreted in the urine.d. Hemolysis is identical to obstructive jaundice.: bHemolysis increases the unconjugated bilirubin, which is notwater soluble so it cannot be excreted in the urine. This does notaffect the conjugated bilirubin, which is increased in obstructivejaundice.

93. A patient experiences a vertebral fracture in which theC1 vertebra is fractured into several fragments. Thistype of fracture can be described as:a. simple.b. compressed.c. comminuted.d. dislocation.: cA comminuted fracture is also called a burst fracture, in whichthe vertebral body is shattered into several fragments. A simplefracture is a single break usually affecting the transverse orspinous process. A compressed fracture is also called a wedge.This occurs when there is a crush type of injury and the vertebraeloses height. A dislocation is when two bones at a joint are nolonger in alignment.

94. A patient experiences abdominal pain that is verylocalized and intense. Which type of pain does thisdescribe?a. Parietalb. Visceralc. Referredd. Phantom: aParietal pain arises from the parietal peritoneum and is morelocalized and intense than visceral pain. Visceral pain is oftenpoorly localized and dull and arises from the organs themselves.Referred pain is well-localized visceral pain felt at some distancefrom a diseased or an affected organ. Phantom pain does notrefer to abdominal pain. It is felt after the loss of a limb.

95. A patient experiences chronic intermittent pain in theepigastric area when the stomach is empty and in themiddle of the night. This history supports a diagnosisof:a. acute gastritis.b. chronic gastritis.c. gastric ulcer.d. duodenal ulcer.: dThese symptoms support a diagnosis of a duodenal ulcer. Acutegastritis often has vague abdominal discomfort, epigastrictenderness, and bleeding. Chronic gastritis has symptoms thatinclude anorexia, fullness, nausea, vomiting, and pain. Gastriculcers have symptoms of epigastric pain and may occurimmediately after eating.

96. A patient experiences demyelination of the peripheralnerves with sparing of the axons. This is characteristicof:a. Alzheimer disease.b. Guillain-Barré.c. myasthenia gravis.d. amyotrophic lateral sclerosis (ALS).: bGuillain-Barré is an idiopathic polyneuritis with acuteinflammatory demyelinating characteristics. There isdemyelination of the peripheral nerves with relative sparing ofthe axons. Alzheimer disease is a form of dementia caused bytangles. Myasthenia gravis is due to anti-acetylcholine-receptorantibodies. ALS is a degenerative disorder diffusely involvinglower and upper motor neurons, resulting in progressive muscleweakness.

97. A patient experiences diarrhea, which her physiciancontributes to increased mucosal discharge of chloride-or bicarbonate-rich fluid. Which of the following typesof diarrhea is this?a. Osmoticb. Secretoryc. Motilityd. Parasitic: bSecretory diarrhea is a form of large-volume diarrhea caused byexcessive mucosal secretion of chloride- or bicarbonate-rich fluidor inhibition of net sodium absorption. Osmotic diarrhea is dueto a nonabsorbable substance in the intestine that draws waterinto the lumen by osmosis; an example is lactase deficiency.Motility diarrhea is caused by resection of the small intestine.This is often found after bypass surgery (bariatric). Parasiticdiarrhea is caused by parasites in the gastrointenstinal (GI)tract.

98. A patient experiences no nausea but significantvomiting with a CNS injury when the trauma:a. impinges directly on the floor of the third ventricle.b. causes a decrease in intracranial pressure.c. involves the vestibular nuclei.d. also involves the abdominal area.: cVomiting associated with CNS injuries involves the vestibularnuclei. It can also be caused by impingement on the fourthventricle or an increase in intracranial pressure. Vomiting withno associated nausea indicates direct involvement of the centralneural mechanisms regardless of abdominal trauma.

99. A patient experiencing the tonic phase of a seizureexhibits:a. muscle contraction with increased muscle tone.b. alternating contraction and relaxation of muscle.c. muscle contraction alternating with placidity.d. complete paralysis.: aThe phase of muscle contraction with increased muscle tone isthe tonic phase. Alternating contraction and muscle relaxationrepresents the clonic phase. The postictal phase immediatelyfollows the seizure. There is no phase that is characterized withmuscle contraction alternating with placidity.

100. A patient has a brain abscess with a decreased necroticcenter and mature collagen. This is most consistentwith which stage?a. Early cerebritisb. Late cerebritisc. Early capsule formationd. Late capsule formation: cEarly capsule formation occurs on days 10 to 13. The necroticcenter decreases in size and inflammatory infiltrate changes incharacter. Mature collagen evolves, forming a capsule. Earlycerebritis occurs on days 1 to 3 and is a localized inflammatoryprocess. There are marked cerebral edema and a central core ofnecrosis. Late cerebritis occurs on days 4 to 9, and there is anecrotic center surrounded by inflammatory infiltrate ofmacrophages and fibroblasts. There is rapid new blood vesselformation. Late capsule formation occurs on day 14 and later.There is a well-formed necrotic center surrounded by a densecollagenous capsule.

101. A patient has sustained a traumatic brain injury but isable to follow simple commands and can manipulateobjects. The term used to describe this state is:a. comab. vegetativec. minimally consciousd. locked-in syndrome: cThe term minimally conscious refers to severely alteredconsciousness in which the person demonstrates minimal butdefined behavioral evidence of self or environmental awareness.The clinical features include following simple commands,manipulation of objects, gestural or verbal yes/no responses,intelligible verbalization, and stereotypical movements. Locked-in syndrome describes an individual who has both the content ofthought and the level of arousal intact. The efferent pathways aredisrupted, which means the individual cannot communicatethrough speech or body movement. Coma is a state ofneurobehavioral unresponsiveness. Vegetative state is a wakefulunconscious state.

102. A patient has uncontrolled or premature contractionsof the detrusor muscle. Which condition is associatedwith this medical problem?a. Spinal cord injuryb. Immune system dysfunctionc. Congestive heart failured. Renal carcinoma: aThis patient's condition is neurogenic detrusor overactivity.Spinal cord injury contributes to uncontrolled or prematurecontractions of the detrusor muscle associated with aneurological disorder. This can also be from Guillain-Barré ortransverse myelitis.

103. A patient is brought to the emergency room following amotor vehicle accident in which he sustained diffusebrain injury. Which of the following symptoms would beexpected to accompany his injury? Select all that apply.a. Memory deficitsb. Swallowing disordersc. Agitationd. Fatiguee. Short attention span: all except d

104. A patient is diagnosed with a kidney stone that iscomposed of magnesium, ammonium, and phosphate.What type of urinary calculus is this?a. Calciumb. Struvitec. Uric acidd. Indinavir: bCalcium oxalate or calcium phosphate stones account for 70% to80% of stones. Struvite stones account for about 15% and arecomposed of magnesium, ammonium, and phosphate. Uric acidstones account for about 7% of stones. Less common stoneelements include cystine, 2,8-dihydroxyadeninuria,triameterene, indinavir, and ammonium acid urate.

105. A patient is diagnosed with a meningioma. The mostlikely site of the tumor is the: Select all that apply.a. sella turcica.b. olfactory groove.c. tuberculum sellae.d. sphenoidal wing.e. cerebellopontine angle.: all

106. A patient is diagnosed with a peptic ulcer. Whichassessment data confirms this diagnosis? Select all thatapply.a. Presence of H. pylori in the duodenumb. Advanced agec. Follows a strict vegetarian dietd. History of alcohol abusee. Diagnosis of rheumatoid arthritis: all except c

107. A patient is diagnosed with colorectal cancer and istold that it is limited to the bowel wall. This ischaracteristic of which stage of cancer?a. Stage Ab. Stage Bc. Stage Cd. Stage D: aStage A is cancer limited to the bowel wall. Stage B is cancerextending through the bowel wall. Stage C is nodal metastasisregardless of extension into the bowel wall. Stage D is distantmetastasis.

108. A patient is diagnosed with hepatitis A. Transmissionof this form of hepatitis occurs via:a. fecal-oral route.b. infected blood or body fluids.c. sexual contact.d. intravenous drug use.: aHepatitis A is transmitted most commonly by the fecal-oral route.

109. A patient is diagnosed with Huntington disease. Whichof the following is a TRUE statement? Huntington'sdisease is:a. a commonly diagnosed neurological disorder.b. a nonhereditary disease.c. also known as chorea.d. asymptomatic until the 2nd decade of life.: cHuntington disease is also called chorea. It is relatively rare andis a hereditary degenerative disorder. It most commonly affectsthose between the ages of 30 and 50.

110. A patient is diagnosed with portal hypertension due toliver disease. Which assessment observation supportsthis diagnosis?a. Hematemesisb. Abdominal pain from splenomegalyc. Ascitesd. Altered mental status: aThe most common clinical manifestation of portal hypertensionis vomiting of blood (hematemesis) from bleeding esophagealvarices. The other options are not associated with this disorder.

111. A patient is experiencing pain that courses over thebuttocks and into the calf and ankle. This is suggestiveof a herniated disc at which vertebral level?a. Cervicalb. Thoracicc. Lumbard. Coccyx: cA herniated disc in the lumbosacral area is associated with painthat radiates along the sciatic nerve and courses over the buttockand into the calf and ankle. Both a cervical and thoracic injurywould indicate pain that originated higher on the body. Aherniated coccyx vertebrate would result in pain beginning apoint lower than that described.

112. A patient presents with a wide-based gait in which thefeet were turned outward. She staggers when walkingand holds her pelvis stiff. These characteristics arerepresentative of:a. cerebellar gait.b. basal ganglion gait.c. decorticate posture.d. apraxia.: aCerebellar dysfunction results in a wide-based gait in which thefeet are turned inward or outward. Basal ganglion gait is a wide-based gait in which the person walks with small steps anddecreased arm swing. Decorticate posture occurs when the upperextremities are flexed at the elbows and held close to the bodywhile the lower extremities are externally rotated and extended.Apraxia is the inability to perform purposeful or skilled motoracts in the absence of paralysis, sensory loss, abnormal posture,or tone.

113. A patient who exhibits involuntary twisting movementscaused by slow muscle contraction on the right side ofthe body is experiencing:a. hypertonia.b. spasticity.c. hemidystonia.d. paratonia.: cInjury to the putamen or its outflow tracts would result inhemidystonia. Hypertonia is increased muscle tone. Spasticityresults from hyperexcitability of the stretch reflexes. Paratonia isresistance to passive movement that is proportional to the forceapplied.

114. A patient who fell and hit his head 2 days ago is nowrestless and irritable. This scenario is characteristic of:a. Alzheimer disease.b. dementia.c. delirium.d. coma.: cDelirium is an acute state of confusion. It is abrupt in its onset.The patient may have difficulty in concentration, restlessness,irritability, tremulousness, insomnia, and poor appetite.Dementia is a more chronic problem in which there isprogressive failure of many cerebral functions. Alzheimer diseaseis a type of dementia. A coma is a loss of consciousness.

115. A patient who is experiencing a loss of comprehensionor the production of language is described as having:a. dysphasia.b. aphasia.c. expressive dysphasia.d. transcortical dysphasia.: aAphasia is complete inability to speak. Dysphasia is impairmentin comprehension or production of language. Expressivedysphasia is characterized primarily by deficits in expression, butcomprehension may be present. Transcortical dysphasia involvesthe ability to repeat and to recite.

116. A patient who is experiencing difficulty in recognizinga pattern's form and the nature of objects is exhibitingcharacteristics of:a. agnosia.b. aphasia.c. dysphasia.d. Alzheimer disease.: aAgnosia is a defect of pattern recognition. Aphasia is thecomplete absence of speech. Dysphasia is impairment ofcomprehension or production of language. Alzheimer disease isa disease of dementia.

117. A patient who reports a loss of childhood memories isdescribing a characteristic of:a. selective attention deficit.b. retrograde amnesia.c. anterograde amnesia.d. executive attention deficits.: bRetrograde amnesia is the loss of past memories, whereasanterograde amnesia is the inability to form new memories.Selective attention deficit is the ability to select specificinformation to be processed from environmental and internalstimuli. Executive attention deficit is the inability to maintainsustained attention, inability to set goals and recognize when anobject meets a goal, and a deficit in working memory.

118. A patient who reports abdominal and back pain hasbeen diagnosed with bacteria in the urine. What is theappropriate term for involvement of the upper urinarytract that is likely to cause such symptoms?a. Cystitisb. Pyelonephritisc. Urinary tract infectiond. Asymptomatic bacteriuria: bCystitis is inflammation of the bladder. A urinary tract infectionis inflammation of the urinary epithelium, followed by invasionand colonization by some pathogen. Pyelonephritis indicatesinvolvement of the upper tracts. Asymptomatic bacteriuria isurine with bacteria that do not provoke infection.

119. A patient who reports that 'everything tastesunpleasant' is exhibiting symptoms of:a. hyposmia.b. anosmia.c. hypogeusia.d. dysgeusia.: dDysgeusia is a perversion of taste in which everything has anunpleasant flavor. Hyposmia is an impaired sense of smell.Anosmia is a complete loss of smell. Hypogeusia is a decrease intaste sensation.

120. A patient who was outside on a summer day and is nowexperiencing increased sweating and thirst, weakness,and dizziness is exhibiting signs of:a. heat cramps.b. heat exhaustion.c. hyperthermic stroke.d. malignant hyperthermia.: bHeat exhaustion is the result of prolonged high coretemperatures. There is often dehydration, feelings of weakness,dizziness, nausea, and fainting. Heat cramps are severe,spasmodic cramps in the abdomen and the extremities thatfollow prolonged sweating and associated sodium loss. Heatstroke may be lethal and is caused by exposure to excessive heatand loss of the body's protective mechanisms for cooling.Malignant hyperthermia is a lethal complication of a rareinherited muscle disorder.

121. Peptic ulcers may be located in the:a. stomachb. esophagusc. duodenumd. colone. a, b, and c: e

122. The person at highest risk for traumatic brain injury(TBI) is:a. African American and economically disadvantaged.b. male and disabled.c. female and 20 years of age.d. an economically advantaged young adult.: aThose at highest risk for TBI are children 0 to 4 years of age,older adolescents aged 15 to 19 years, and adults aged 65 yearsand older. Males have the highest incidence in every age group.TBI is highest among African Americans and in lower- andmedian-income families.

123. Pinhole-sized pupils can be a result of an overdose of:a. atropine.b. scopolamine.c. opiates.d. amphetamines.: cOpiates (heroin and morphine) cause pinhole or constrictedpupils. The other choices cause large dilated pupils.

124. The poor absorption of vitamin A will result in:a. osteoporosis.b. neurological deficiencies.c. night blindness.d. petechiae.: cA deficiency in vitamin A can result in night blindness. VitaminD is involved in osteoporosis, vitamin E in neurologicaldevelopment, and vitamin K in petechiae formation.

125. Postical sleeping can be seen in ____ seizures.a. partialb. unilateralc. grand mald. psychomotor: d

126. Precipitating causes of seizure include all of thefollowing except:a. meningitisb. strokec. hyperglycemiad. hyperthermiae. all above: c

127. Predisposing factors in the development of coloncancer include all of the following EXCEPT:a. familial polyposisb. ulcerative colitisc. low-fiber/high-fat dietd. high-fiber diete. high refined CHO diet: d

128. The presence of albumin in the urine would indicateprobable damage to:a. glomerulib. renal columnsc. collecting tubulesd. pyramidse. none above: a

129. Pyelonephritis is: (More than 1 answer may be correct.)a. an inflammation and infection of the urinary bladderb. characterized by fever, chills, and flank painc. characterized by pyuria, bacteriuria, and hematuriad. more common in young women than in young men:b,c,d

130. Referred pain from upper abdominal diseasesinvolves:a. sacral regionb. L2 to L4c. T8, L1, and L2d. gluteal regions, posterior thighs, calves: c

131. Renal calculi may be composed of:a. calcium oxalateb. uric acidc. cholesterold. all abovee. a and b: e

132. Renal function tests include:a. the urinalysisb. BUN and serum creatininec. SGOT/SGPTd. a and be. a, b, and c: d

133. Risk factors for a CVA includes: Select all that apply.a. obesity.b. smoking.c. diabetes.d. arterial hypertension.e. atrial fibrillation.: all except a

134. Risk factors for esophageal carcinoma would include:Select all that apply.a. alcohol abuse.b. tobacco use.c. thin body habitus.d. zinc deficiency.e. sliding hiatal hernia.: all except c

135. Ruptured aneurysms are most likely in ___cerebrovascular accidents.a. TIAb. thromboticc. embolicd. hemorrhagic: d

136. Short-term starvation involves:a. glycogenolysisb. gluconeogenesisc. proteolysisd. a and be. a, b, and c: d

137. Sleep apnea:a. is lack of breathing during sleepb. can result from airway obstruction during sleepc. is associated with jet-lag syndromed. all abovee. both a and b: e

138. Supratentorial processes reduce arousal by:a. destroying the reticular activating systemb. displacement of the brainstemc. destroying the brainstemd. both a and ce. none of the above: b

139. Symptoms of cholelithiasis include all of the followingEXCEPT:a. nausea and vomitingb. right upper quadrant tendernessc. jaundiced. decreased serum bilirubin levelse. abdominal distress: d

140. The term used to describe a patient who sustains acerebrovascular accident and is paralyzed on the leftside is:a. hemiplegia.b. paraplegia.c. diplegia.d. quadriplegia.: aHemiplegia means loss of motor function on one side of thebody. Paraplegia refers to loss of motor function of the lowerextremities. Diplegia is the paralysis of both upper or both lowerextremities as a result of cerebral hemisphere injuries.Quadriplegia refers to paralysis of all four extremities.

141. Transient ischemic attacks (TIAs) are:a. unilateral neurologic deficits that slowly resolveb. generalized neurologic deficits that occur a fewseconds every hourc. focal neurologic deficits that develop suddenly, lastfor several minutes, and clear in 24 hoursd. neurologic deficits that slowly evolve or develop: c

142. A trauma patient diagnosed with a brain contusionexperiences changes in attention, memory, affect, andemotion. In which region of the brain is the contusionmost likely located?a. Cerebralb. Frontalc. Cerebellumd. Midbrain: bContusions are most commonly found in the frontal lobes,particularly at the poles and along the inferior orbital surfaces.They result in changes in attention, memory, and executiveattentional functioning.

143. Uremia exhibits:a. polycythemiab. retention of metabolic acidsc. low plasma calcium levelsd. increased erythropoiesise. a and d: b

144. Uremia, as seen in chronic renal failure, wouldinclude:a. metabolic acidosisb. elevated BUN and creatininec. cardiovascular disturbancesd. all above: d

145. Vestibular nystagmus:a. is the constant, involuntary movement of the eyeballcaused by ear disturbancesb. is the sensation of spinningc. may be caused by alterations in nervous system fromreceptor to the cerebral cortexd. causes a diminished sense of the position of bodyparts: a

146. When a client reports jaundice, fatigue, anorexia,nausea and vomiting, a diagnosis of hepatitis is made.Which stage of the disease process is supported bythese symptoms?a. Prodromal phaseb. Icteric phasec. Recovery phased. Chronic active hepatitis: aThe prodromal phase begins about 2 weeks after exposure andincludes the symptoms described. The icteric phase begins 1 to 2weeks after the prodromal phase and includes jaundice, darkurine, clay-colored stools, and hepatomegaly. The recovery phasebegins with resolution of jaundice and other symptoms. Chronicactive hepatitis is persistence of clinical manifestations and liverinflammation after acute infection.

147. Which activity has been documented to increase thelevels of circulating endogenous endorphins?a. Coughb. Stressc. Sleepd. Pain: bStress, sexual intercourse, acupuncture, and excessive physicalexertion have all been linked to increased levels of circulatingendorphins. Drinking behavior and cough are actuallymoderated by endorphins. Sleep and pain are not linked withexcessive amounts of endorphins.

148. Which are characteristics of anorexia nervosa? Selectall that apply.a. Fear of becoming obeseb. Distorted body imagec. Body weight 25% less than normald. Absence of three consecutive menstrual periodse. Diagnosed chronic depression: a, b, d

149. Which are frequent sites for distant metastasis forprostate cancer? Select all that apply.a. Brainb. Lymph nodesc. Liverd. Bonese. Lungs: all except a

150. Which are possible causes of prostate cancer? Select allthat apply.a. Elevated androgen levelsb. Reduced levels of 5α-dihydrotestosteronec. High exposure to ultraviolet light raysd. Chronic prostatic inflammatione. Genetic predisposition: all except c

151. Which are predisposing factors for acute urinary tractinfections? (More than 1 answer may be correct.)a. congenital deformities of urinary tractb. the sex of the patientc. decreased urine flowd. increased urine flowe. increased fluid intake: a,b,c

152. Which assessment question demonstrates anunderstanding of a possible cause of achalasia?a. "Are you chronically constipated?"b. "What types of high fiber foods do you eat?"c. "Do you become 'gassy' after meals?"d. "Have you been under a lot of stress lately?": dPsychosocial achalasia has been documented and may be theresult of life stressors. The other options are not associated withthis disorder.

153. Which can be characteristic of urethral stones?a. severe pain in the backb. severe pain in abdomenc. nausea and vomitingd. all abovee. a and c: d

154. Which condition may cause obstructed urine flow?Select all that apply.a. Prostate enlargementb. Pelvic organ prolapsec. Low bladder wall complianced. Detrusor areflexiae. Detrusor hyperflexia: all except d

155. Which describe a patient in acute renal failure? (Morethan 1 answer may be correct)a. elevated serum creatinineb. leukocystitisc. low BUNd. fevere. oliguria: a,e

156. Which does NOT cause constipation?a. opiatesb. megacolonc. sedentary lifestyled. hyperthyroidisme. emotional depression: d

157. Which extraintestinal manifestations are found inulcerative colitis? Select all that apply.a. Gallstonesb. Uveitisc. Polyarthritisd. Cutaneous lesionse. Liver disorders: c, d, e

158. Which is a determinant of severity for obstructiveuropathy? Select all that apply.a. Location of the blockageb. Degree of completeness of the blockagec. Type of blockaged. Duration of the blockagee. Cause of the lesion: all except c

159. Which is a factor that is required before a stone isformed? Select all that apply.a. Supersaturation of one of the saltsb. Precipitation from a liquid to a solidc. Aggregationd. Low concentration of salte. Presence or absence of Tamm-Horsfall protein: allexcept d

160. Which is a risk factor for the development of CVAs?a. polycythemic verab. hypertensionc. diabetes mellitusd. hyperhomocysteinemiae. all above: e

161. Which is involved in fever?a. tumor necrosis factorb. endotoxinsc. elevation of the set point in the hypothalamusd. both a and be. a, b, and c: e

162. Which is NOT a characteristic of chronic renal failure?a. hyperkalemiab. anuriac. anemiad. prurituse. acidosis: b

163. Which is not a neuromodulator of pain?a. prostaglandinsb. 5-hydroxytryptaminec. norepinephrined. lymphokinese. heparin: e

164. Which is NOT a primary intracerebral neoplasm?a. astrocytomab. meningiomac. oligodendrogliomad. ependymoma: b

165. Which is the most important difference betweenproliferative and non-proliferative breast tissuechanges?a. Genetic aberrations are more common in non-proliferative lesions.b. Cancer prognosis is better for non-proliferativebreast tissue changes.c. Non-proliferative breast lesions do not increase therisk of breast cancer.d. Cancer resulting from non-proliferative breastlesions has a higher cure rate.: cNon-proliferative breast lesions do not increase the risk of breastcancer. The remaining statements are not true of this type ofbreast tissue change.

166. Which is TRUE regarding meningitis?a. Bacterial meningitis is a primary infection of the graymatter.b. Aseptic meningitis is most commonly caused by afungus.c. Fungal meningitis is very common.d. Tubercular meningitis has a 90% recovery rate, ifdiagnosed early.: dTubercular meningitis has a 90% recovery rate with earlydiagnosis and treatment. Fungal meningitis is uncommon.Aseptic meningitis is most commonly caused by a virus. Bacterialmeningitis is caused by primary infection of the pia mater andarachnoid.

167. Which is TRUE regarding metastatic tumors that arelocated in the brain?a. Carcinomas are disseminated to the brain from thecirculation.b. One-third of metastatic tumors are located within thebrain.c. Two-thirds of metastatic tumors are located in theextradural spaces.d. Tumors of the pelvis tend to involve the frontal lobe.: aCarcinomas disseminate to the brain from the circulation. Two-thirds of metastatic tumors are located within the brain, and one-third are located in the extradural spaces. Tumors of the pelvistend to metastasize to the cerebellum and pons.

168. Which most often causes biliary cirrhosis?a. malnutritionb. alcoholismc. Hep A or Cd. autoimmunitye. biliary obstruction: e

169. Which most typically characterizes the victims of acerebral embolic stroke?a. individuals older than 65 years of age with a historyof hypertensionb. individuals with a long history of TIAsc. middle-aged individuals with a history of heartdiseased. individuals with gradually occuring symptoms thatthen rapidly disappear: c

170. Which of the following genes have been linked with thedevelopment of breast cancer? Select all that apply.a. BRCA1b. BRCA2c. p53d. PSAe. Her-2/neu: all except d

171. Which of the following is a TRUE statement regardingCrohn disease?a. It involves the mucosa only.b. Skip lesions are common.c. It affects only the rectum.d. The most common site is the rectum.: bCrohn disease affects the entire GI tract and can affect all layersof the mucosa and serosa. Skip lesions are common, meaningthe disease is not continuous; it skips parts of the colon. Themost common area for the disease is the ileocolon

172. Which of the following is a TRUE statement regardingulcerative colitis?a. It extends throughout the entire GI tract.b. It generally appears in childhood.c. African-Americans are more commonly affected.d. Bloody, purulent diarrhea is a common symptom.: dFrequent diarrhea, with passage of small amounts of blood andpurulent mucus, is common. Ulcerative colitis is a chronicinflammatory condition that is common in those of Jewish orEuropean descent. The lesions usually begin appearing between20 and 40 years of age and are located from the rectum to thecolon proximally.

173. Which of the following is considered a risk factor forvaginal cancer?a. Human papillomavirus (HPV)b. Endometriosisc. Concurrent breast cancerd. Birth control pills: aHPV infection and prior carcinoma of the cervix place a womanat higher risk for developing vaginal cancer. Research has notlinked the other options to this form of cancer

174. Which of the following regarding chronic gastritis istrue?a. There are four types.b. Type A, or fundal gastritis, is the most severe.c. Type B, or antral gastritis, is the most rare.d. It tends to occur in young individuals.: bChronic gastritis is classified as type A (fundal) or type B(antral). Fundal is the more rare and severe of the two types. Itoccurs most frequently in the elderly.

175. Which of the following statements is TRUE regardinggrading of the astrocytoma?a. Grade I is not treated.b. Grade II is treated with radiation only.c. Grades III and IV are treated with surgery.d. Grade III is not well circumscribed.: cGrade I is treated with surgery and then follow-up CT scans forrecurrence. Grade II is treated surgically if accessible and thenwith radiation. Grade III and IV are treated with surgery. GradeIII is well circumscribed.

176. Which pair of structures regulates the complexemotional responses to pain?a. Frontal and cerebellar lobesb. Limbic and reticular systemc. Thalamus and brainstemd. Midbrain and nuclei of thalamus: bThe reticular and limbic systems regulate what we feel aboutpain. The remaining structures are not involved.

177. Which renal condition usually has a history of recentinfection with beta-hemolytic streptococci?a. pyelonephritisb. chronic renal failurec. nephrosisd. glomerulonephritise. calculi: d

178. Which statement is NOT true concerningglomerulonephritis?a. Significant damage to kidneys occurs during thebody's response to an infectionb. Fever and flank pain occurc. Complement activation attracts neutrophilsd. It is characterized by hematuria, proteinuria, andthe presence of castse. Approximately 90% of individuals develop chronicdisease: e

179. Which statement is NOT true concerning urinary tractinfections?a. Once cystitis develops, pyelonephritis will certainlyoccurb. They are usually caused by coliforms, especially E.colic. Organisms probably enter the bladder by way of theurethrad. The patient may be asymptomatic: a

180. Which statement is NOT true regarding increasingintracranial pressure?a. accumulating CO2 causes vasoconstrictionb. the brain volume increasesc. the blood volume in the vessels increasesd. brain tissue shifts from the compartment of greaterpressure to one of lesser pressuree. both b and c: a

181. Which statement is TRUE regarding breast cancer?a. The older the age at a woman's first childbirth, thelower the risk.b. It is the second most common cause of cancer inwomen.c. The incidence has been declining since 1955.d. African-American women have the highest mortalityrate.: dAfrican-American women in all age groups experience thehighest mortality rate. It has been on the rise since 1955. It is themost common cause of cancer in women. Early childbirth lowersthe risk of having cancer.

182. Which statement is TRUE regarding cancer of thecolon?a. It is the most frequent cause of cancer death.b. It accounts for 25% of all cancer deaths.c. It tends to occur in young individuals less than 40years of age.d. Treatment will include surgical resection of thecolon.: dTreatment for cancer of the colon is always surgical. Colorectalcancer is the second most frequent cause of cancer death in theUnited States; it accounts for 10% to 15% of all cancer deaths. Italso occurs in individuals older than 50 years.

183. Which statement is true regarding hiatal hernia?a. There are three common types of such a hernia.b. The most common type is paraesophageal.c. Paraesophageal is herniation of the greater curvatureof the stomach.d. Sliding hernia is triggered by standing.: cThere are two types of hiatal hernia: sliding and paraesophageal.Sliding is the most common and reverses with standing. It movesinto the thoracic cavity with sitting, bending, tight clothing,ascites, and obesity. Paraesophageal is caused by herniation ofthe greater curvature of the stomach through a second opening inthe diaphragm.

184. Which statement is TRUE regarding the act of retching?a. It begins with a shallow respiration.b. Hypersalivation and tachycardia are common.c. The esophagus becomes distended.d. Reverse peristalsis seldom occurs.: cRetching begins with a deep inspiration, followed by distentionof the esophagus, contraction and spasm of abdominal muscles,lower esophageal relaxation, and reverse peristalsis.Hypersalivation and tachycardia are common during nausea.

185. Which statement regarding benign prostatichyperplasia (BPH) is TRUE?a. Ten percent of men will have it by age 80 years.b. It is an uncommon condition.c. The prostate is largest at birth and continues toshrink.d. It may be problematic if urethral compressionoccurs.: dBPH is a common condition. It may be a problem if there iscompression of the urethra. Eighty percent of men will have itbefore age 80. The prostate increases in size throughout life andis the smallest at birth.

186. Which statement regarding cirrhosis is true? Select allthat apply.a. Cirrhosis develops rapidly.b. The causes are not clearly understood.c. Portal hypertension is a complication.d. Severity is determined by amount of the toxin.e. Prognosis is poor even when contaminant isremoved.: b, c, d

187. Which statement regarding renal cell carcinoma iscorrect?a. It is associated with p53.b. Symptoms include hematuria.c. Early stages produce a large abdominal mass.d. Granular cell tumors have better prognosis.: bSymptoms include hematuria, flank pan, and flank/abdominalmass. Early stages are often silent, and clear cell tumors have abetter prognosis. Overexpression of p53 is demonstrated inbladder tumors.

188. Which substance is an abnormal constituent of urine?a. ureab. glucosec. sodium chlorided. creatinine: b

189. Which type of hearing loss is a result of foreign bodyobstruction of the inner ear?a. Conductiveb. Sensorineuralc. Functionald. Presbycusis: aConductive hearing loss occurs when a change in the outer ormiddle ear, such as a foreign body lodged in the ear canal,impairs conduction of the sound from the outer to inner ear.Sensorineural hearing loss is caused by impairment of the organof Corti or its central connections. Presbycusis is a form ofsensorineural hearing loss usually seen in elderly people.Functional hearing loss is believed to be caused by emotional orpsychologic factors.

190. Which type of jaundice is caused by the increaseddestruction of erythrocytes?a. obstructiveb. hemolyticc. hepatocellulard. b and c: b

191. Which viral hepatitis is NOT associated with a chronicstate or carrier state?a. Hep Ab. Hep Bc. Hep Cd. serum hepatitise. Hep D: a

192. Which would be consistent with a diagnosis of viralhepatitis? (More than 1 answer may be correct)a. elevated aspartate transaminase (AST) serumenzymesb. decreased serum albumin levelsc. prolonged coagulation timesd. increased serum bilirubin levelse. decreased alanine transaminase (ALT) serumenzymes: a, b,c, d

193. With which bacteria is acute glomerulonephritisassociated?a. E. colib. Staphylococcusc. Group A streptococcusd. Klebsiella: cGlomerulonephritis is an inflammation of the glomeruli and isoften caused by a streptococcal infection. It usually occurs 7 to 10days after the infection.

194. A young child presents with redness of the eyes. Theparents indicate that this condition seems to be 'goingaround' the daycare. Which is the most likelydiagnosis?a. Blepharitisb. Keratitisc. Trachomad. Conjunctivitis: dAcute bacterial conjunctivitis, or pinkeye, is a highly contagiousbacterial infection. Blepharitis is inflammation of the eyelids.Keratitis is an infection of the cornea. Trachoma is a bacterialinfection caused by poor hygiene and is the leading cause ofpreventable blindness.