Following a biopsy, a 54 year old man has been diagnosed as having a benigh neoplascit tumor. Which of the following characteristics most likely applies to his tumor?

A. The turmo is poorly approximated and has the potential to break loose.

B. The tumor may secrete hormones or cytokines.

C. The well-differentiated neoplastic cells are clustered together in a single mass.

D. It has a rapid rate of growth and can induce ischemia

C. The well-differentiated neoplastic cells are clustered together in a single mass.

Which of the following characteristics could apply to healthy somatic cells rather than cancerous cells?

 A. A high rate of mutation exists in the cells.

 B. The cells have a reduced tendency to cluster together.

C. They remain viable and multiply without attachments to other cells and the extracellular matrix.

D. The cells are unable to proliferate except by mitotic division.

A 77-year-old male patient with a diagnosis of stomach cancer has been found to have metastases in his liver. The patient and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides?

A. The parenchymal tissue of the liver is particularly susceptible to secondary malignancies.

B. The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.

C. Hepatic stromal tissue shares characteristics with cancerous cells, including lack of anchorage dependence.

D. The proximity of the liver to the stomach allows for direct spread of cancerous cells due to a lack of contact inhibition.

B. The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.

Unbeknownst to her or her care team, a 51-year-old woman's breast cancer has an etiology rooted in the fact that tumor suppressor genes are present but have been silenced. Consequently, she has not synthesized normal cancer-suppressing proteins and neoplasia has resulted. What process has accounted for the woman's cancer?

A. Chromosomal translocation

B. The “two-hit” hypothesis of carcinogenesi

C. Epigenetic mechanisms

D. A DNA repair defect

Which of the following patients of a primary care physician would not require extra screening for cancer?

A. A 51-year-old woman whose grandmother died of breast cancer

B. A 48-year-old man who takes immunosuppressant drugs following a kidney transplant

C. A 50-year-old male who is obese and has a low-fiber, high-fat diet

D. A 38-year-old female with Down syndrome and congenital scoliosis

A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her family physician during an office visit. How can the physician best respond to the woman's query?

A. “Though it's not particularly common, it's true that certain bacteria and viruses can lead to cancer.”

B. “Most cancers that cannot be attributed to family history or lifestyle are in fact associated with viruses.”

C. “There are many viruses, but only a very few of them have been shown to cause cancer in humans.”

“This is true; for example, HIV has been shown to cause cancer in some patients.

The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient's anorexia and cachexia?

A. Inadequate cellular metabolism of glucose results from tumor factors

B. High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting

C. Products of the tumor itself as well as a hypermetabolic state cause cachexia

D. Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat

A 60-year-old man has presented to a clinic and is requesting screening for tumor markers after reading about them in a magazine. What can the clinician most accurately tell the man about the clinical use of tumor markers?

A. “Tumor markers are a very useful screening tool, but they only exist for a very few types of cancer.”

B. “Tests for the presence of tumor markers are limited by the fact that they are only accurate in the very early stages of cancer.”

C. “Tumor markers are an excellent screening tool, but it's only practical to test for those cancers that you're at risk for.”

D. “Tumor markers alone aren't enough to confirm whether you have cancer or not, so they're not a very useful screening tool.”

A 51-year-old female has been found to have a metastatic lesion in her lung, and her oncologist is unsure of the site of the primary tumor. Which of the following procedures is most likely to aid in this determination?

A. Immunohistochemistry

B. Tumor markers

C. Microarray technology

D. Tissue biopsy

A 61-year-old male patient is scheduled to begin chemotherapy for the treatment of his bone cancer. Staff at the cancer center have educated the man and his wife about the goals, course, and expectations for his treatment. Which of the following medications and treatments might the man anticipate needing during and after his course of treatment?

A. Analgesia and corticosteroids

B. Antiemetics and packed red blood cell (PRBC) transfusion

C. Whole blood transfusions and antiplatelet aggregators

D. Diuretics and selective serotonin reuptake inhibitors (SSRIs)

An oncology nurse who has worked for many years caring for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job?

A. There will be a greater number of cancers that are epithelial in origin.

B. A greater proportion of the patients will have cancer that involves the hematopoietic system.

C. The nurse will be working with more patients who have blastomas

D. More patients will be receiving treatment for leukemia

A 26-year-old man who survived childhood acute lymphocytic leukemia (ALL) now complains of weakness, fatigue, and shortness of breath. His treatment for ALL likely included anthracyclines. What is the most likely cause of his symptoms?

A. Recurrence of ALL

B. CNS problems resulting from childhood chemotherapy

C. Congestive heart failure resulting from childhood chemotherapy

D. Hormonal dysfunction resulting from childhood chemotherapy

Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects?

A. Cell-surface receptors

B. Circulating hormone levels

C. Blood vessels

D. Rapidly proliferating cells

After several months of persistent heartburn, a 57-year-old female patient has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem?

A. Surgical correction of the incompetent pylorus

B. Antacids; avoiding positions that exacerbate reflux; a soft-textured diet

C. Weight loss and administration of calcium channel blocking medications

D. Proton pump inhibitors; avoiding large meals; remaining upright after meals

A nurse practitioner is providing care for a male patient with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias?

A. Paraesophageal hiatal hernias are common and are normally not treated if the patient is asymptomatic.

B. The root causes of hiatal hernias are normally treatable with medication.

C. If esophageal acid clearance is impaired, esophagitis can result.

D. An incompetent pyloric sphincter and high fat diet are commonly implicated in the development of hiatal hernias.

A 43-year-old male patient has presented to the emergency department with vomiting that he claims is of sudden onset. The patient also states that the emesis has often contained frank blood in the hours prior to admission. Which of the following potential contributing factors would the care team first suspect?

A. Overuse of aspirin

B. Alcohol consumption

C. Staphylococcal enterotoxins

D. Effects of Helicobacter pylori

Following a history of gastric pain and an endoscopy, a patient has been diagnosed with a duodenal peptic ulcer. Which of the following teaching points should his caregiver provide?

A. “While your diet most certainly contributed to this problem, the good news is that changing your diet can help solve it.”

B. “Ulcers like yours are usually found in the stomach rather than the upper part of the small intestine.”

C. “Your family history, your smoking, and the painkillers you've taken in the past may all have contributed to this problem.”

D. “While there aren't really any effective medications for these ulcers, changes in lifestyle can keep them well controlled.”

Which of the following patients is most clearly displaying the signs and symptoms of IBD?

A. A 32-year-old mother who complains of intermittent abdominal pain that persists even after defecation.

B. A 51-year-old male who states that his stomach pain is in his lower abdomen, “comes and goes,” and “feels more like a cramp than a dull ache.”

C. A 44-year-old man who is under great financial stress and who states that his lower abdominal pain is much worse at night than during the day. 

D. A 24-year-old man who has a stressful job but whose diarrhea and cramping do not worsen during periods of high stress.

A 20-year-old woman has visited her family physician due to occasional bouts of bloody diarrhea over the past several weeks, a phenomenon that she experienced 2 years prior as well. Her physician has diagnosed her with ulcerative colitis based on her history and visualization of the affected region by colonoscopy and sigmoidoscopy. Which of the following pathophysiologic phenomena is most likely to underlie the patient's health problem?

A. Fissures and crevices developing in the mucosa that are seen as a characteristic “cobblestone” appearance.

B. Erosion of the endothelial lining of the distal small intestine by a combination of genetic, autoimmune, and environmental factors

C. Compromise of the mucosal layer of the large intestinal surface by the effects of H. pylori

D. Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated

A 22-year-old male student has developed a fever and bloody diarrhea while on a backpacking trip in Southeast Asia. Though his diarrhea is small in volume, his symptoms are sufficiently distressing that he has visited a local medical clinic. Which of the following diagnoses best characterizes his health problem?

 A. Noninflammatory diarrhea

B. Inflammatory diarrhea

C. Factitious diarrhea

D. Secretory diarrhea

The mother of a 19-week-old infant has brought her baby to a pediatrician for assessment because of the baby's persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child's mother is anxious to know what caused the disease. Which of the following aspects of the etiology of celiac disease would underlie the explanation that the physician provides?

A. Bacterial or chemical invasion of the peritoneum leads to decreased nutrient absorption and transport.

B. An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response.

C. Neurogenic or muscular inhibition of peristalsis results in inappropriate motility of ingested food in the lower small intestine and the colon.

D. Inability to process or absorb the fat content of breast milk results in malnutrition and deficiency of fat-soluble vitamins.

A 71-year-old male has been recently diagnosed with a stage III tumor of colorectal cancer and is attempting to increase his knowledge about his diagnosis. Which of the following statements about colorectal cancer demonstrates a sound understanding of the disease?

A. “If accurate screening tests for this type of cancer existed, it could likely have been caught earlier.”

B. “The NSAIDs and aspirin that I've been taking for many years probably contributed to my getting cancer.”

C. “While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown.”

D. “A large majority of patients who have my type of colon cancer survive to live many more years.”

Parents of a 20-month-old infant report that he refuses food or eats poorly and that he grimaces when he swallows. He also is irritable and cries a lot. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which of the following health problems would the care team first suspect?

A. Rotavirus infection

B. Irritable bowel syndrome

C. Esophagitis from gastrointestinal reflux

D. Ulcerative colitis

A 68-year-old African American man who has smoked for at least 50 years reports that lately he feels as though food is getting stuck in his throat. At first this was a problem just with dry food, but now his morning oatmeal is getting "stuck." On questioning, he reports drinking at least three alcoholic beverages nearly every day. His problem is most likely:

A. Barrett esophagus

B. Squamous cell carcinoma of the esophagus

C. Dysphagia secondary to scleroderma

D. Gastrointestinal reflux disease

A 28-year-old man presents with complaints of diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and complains of pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which of the following diagnoses would his care team first suspect?

A. Crohn disease

B. Ulcerative colitis

C. Diverticulitis

D. Colon cancer

A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse providing for his care, “I know what the lungs do, and I know what the heart does, but honestly I have no idea what the liver does in the body.” Which of the following statements would best underlie the explanation that the nurse provides?

A. The liver is responsible for the absorption of most dietary nutrients as well as the production of growth hormones.

B. The liver contributes to the metabolism of ingested food and provides the fluids that the GI tract requires.

C. The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.

D. The liver maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals, and vitamins.

A 48-year-old woman has been diagnosed with extrahepatic cholestasis following a thorough history, ultrasound, and blood work. Which of the following symptoms most likely caused her to seek medical treatment, and what consequences of her health problem would the medical team anticipate?

A. Complaints of lower flank pain with consequences of impaired fat metabolism

B. Anorexia with consequences of impaired drug metabolism and blood filtration

C. Skin xanthomas (focal accumulations of cholesterol) with consequences of increased risk of bleeding due to deficient clotting factors

D. Pruritus with consequences of deficient levels of fat-soluble vitamins

A 29-year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What changes in the patient's liver and diagnostic results would the care team most likely anticipate?

A. Centrilobular necrosis evidenced by increased ALT and AST levels

B. Allergic inflammation accompanied by an increase in serum IgE and basophils

C. Cholestatic reaction with increased bilirubin count

D. Rapid onset of hepatitis and increased GGT, ALT, and bilirubin levels

A. Centrilobular necrosis evidenced by increased ALT and AST levels

Four weeks after returning from a tropical vacation, a 40-year-old man has presented to the emergency department with malaise, nausea, and “yellow eyes.” Serology has confirmed a diagnosis of hepatitis A (HAV), to the shock of the patient. What teaching is most appropriate for this patient?

A. “You can expect these symptoms to disappear after about 2 months, but you'll be a carrier of the disease indefinitely.”

B. “A vaccine before your trip would have prevented this, but be assured your body will rid itself of the virus over time.”

C. “You likely came in contact with blood or body fluids at some point, and you'll have to ensure no one is subsequently exposed to your own blood or body fluids.”

D. “You likely got this by way of what we call the 'fecal-oral' route; you will have chronic hepatitis now, but the symptoms can be controlled with medication.”

A 40-year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) 1 year ago and is now considered to have chronic viral hepatitis. Which of the following statements by the patient to his care provider would warrant correction?

A. “I know the medications to treat this aren't fantastic, but at least there are some options for controlling the virus.”

 B. “It's at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms.”

C. “Even though I'm sick, at least I won't feel sick most of the time.”

D. “I'm not looking forward to all the side effects of the drug treatments for my HCV, but I hope I don't end up needing a liver transplant.”

A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the patient's statement?

A. “You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking.”

B. “That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer.”

C. “In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes.”

D. “When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts.”

Which of the following patients on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure?

A. A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas

B. A 50-year-old woman with blood pressure of 189/103, jaundice, and multiple thromboses

C. A 68-year-old female patient with sudden onset of confusion, a history of alcohol abuse, and low levels of serum AST and ALT

D. A 55-year-old man with ascites, fever, and recent onset of atrial fibrillation

Following several days of intermittent upper right quadrant pain, a 29-year-old, obese Native American woman has been diagnosed with cholelithiasis. The nurse at the clinic where she presented has taught the patient about the pathophysiology of and contributing factors to her health problem, as well as some of the likely treatment options. Which of the following statements by the patient demonstrates a sound understanding of her diagnosis?

A. “All in all, I guess this is a result of the fact that I've been eating a diet too high in cholesterol for too long.”

B. “Several factors like my genetics and gender may have contributed to this, but I'm glad that medications can cure it.”

C. “This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder.”

D. “I suppose the fever and vomiting I had this week was probably a sign of my gallstones too.”

While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include a temperature of 38.8°C (101.8°F), blood pressure of 89/48 mm Hg, and heart rate of 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which of the following diagnoses would the care team first suspect?

A. Hepatitis C

B. Cholecystitis

C. Liver cirrhosis

D. Acute pancreatitis

A 70-year-old male with a 40-pack-year history of smoking and long-standing non-insulin-dependent diabetes has been diagnosed with pancreatic cancer. Which of the following teaching points should the man's physician provide?

A. “While this is indeed serious, you should know that you have a good chance of beating this disease with appropriate treatment.”

B. “Most likely your pattern of high alcohol intake over the years contributed to your cancer.”

C. “You will likely be facing surgery in the near future, but know that this is very unlikely to eliminate your cancer.”

D. “I know it may seem trivial at this point, but the levels of pain that accompany cancer of the pancreas are normally quite low.”

A 53-year-old woman with a history of chronic alcohol abuse but without visible jaundice comes to the clinic complaining of nausea and weakness. She admits to taking acetaminophen for persistent headaches, but denies exceeding the recommended daily dose; she has not taken any other medications. She is suspected of having acetaminophen toxicity. Which of the following diagnostic test findings would implicate a different cause of her symptoms?

A. Normal serum acetaminophen level

B. Elevated serum HBsAG level

C. Evidence of steatosis on liver biopsy tissue sample 

D. Hypoglycemia

A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her?

A. Lamivudine

B. Peginterferon and ribavirin

C. Interferon-alfa-2b

D. Corticosteroids and immunosuppressant drugs

Question 1 (1 point)

Which of the following physiological processes would be considered a positive feedback mechanism?

a. The release of antidiuretic hormone (ADH) from the posterior pituitary gland

b. Shivering in response to low environmental temperature

c. Secretion of the hormone oxytocin during childbirth

d. Increased production of white blood cells (WBCs) in response to a microorganism

c. Secretion of the hormone oxytocin during childbirth

Question 2 (1 point)

An 81-year-old male patient who has a diagnosis of orthostatic hypotension is experiencing an episode of particularly low blood pressure. The man's body has responded by increasing blood levels of angiotensin II, a hormone that decreases the glomerular filtration rate in the kidneys and contributes to an increase in blood pressure. Which of the following phenomena best describes what has occurred?

a. Positive feedback

b. Adaptation

c. Negative feedback

d. Homeostasis

Question 3 (1 point)

A 61-year-old woman with a 40-pack-year history of cigarette smoking and a diagnosis of chronic obstructive pulmonary disease (COPD) is experiencing an increase in arterial levels of carbon dioxide. This change has been detected in the patient's medulla, aortic bodies, and carotid bodies, stimulating the inspiratory center in the medulla oblongata, which has in turn caused the diaphragm to contract more forcefully and increase the respiratory rate. Which of the following terms best describes the role of the inspiratory center?

a. Integrator/comparator

b. Sensor

c. Effector

d. Feedback system

A 45-year-old woman with a diagnosis of shingles is experiencing an acute onset of severe neuropathic pain. Which stage of Selye's characterization of the stress response is the woman most likely experiencing at the moment?

a. General adaptation syndrome (GAS)

b. Exhaustion

c. Alarm

d. Resistance

An occupational health officer who works for a large police force is attempting to understand the role that stress may play in the health of his patients. According to Selye, which of the following statements best captures an aspect of the phenomenon of stress?

a. The alarm stage involves the release of cortisol and catecholamines.

b. The nature of a stress response is determined by the objective severity of the stressor.

c. Systemic illnesses can sometimes result from the resistance stage of the stress response.

d. Periods of stress can be developmentally positive or negative.

An 80-year-old woman slated for total hip replacement the following day is experiencing a large amount of stress concerning her potential surgical outcomes. Which of the following is most likely to be uninvolved in the physiological response to her stress?

a. Hypothalamus

b. Parathyroid

c. Adrenal cortex

d. Pituitary gland

A medical student is scheduled to undergo a clinical exam of his assessment skills under the supervision of the attending physician. As a result of this stressor, the student has high serum levels of glucocorticoid hormones such as cortisol. Which of the following statements best captures an aspect of the role of glucocorticoid hormones such as cortisol in the physiological response to stress?

a. Blood glucose levels are increased in anticipation of energy expenditure.

b. The immune system is bolstered in response to an impending threat.

c. Osteoblast activity and protein synthesis are suppressed in order to refocus energy.

d. Attention, arousal, and respiratory rate are increased in order to prepare for a response.

A patient who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which of the following results?

a. Increased respiratory rate; increased levels of testosterone

b. Increased blood pressure and heart rate; increased antidiuretic hormone (ADH)

c. Pupil dilation; increased somatomedin C

d. Increased gastrointestinal motility; decreased thyroid-stimulating hormone

An electrician who has been working 14- to 16-hour days for several weeks in order to ensure the financial survival of his business presents to his family physician with complaints of persistent headaches and insomnia. His family physician attributes the physical complaints to the ongoing stress that the man has been undergoing. Which of the following factors has most likely contributed the most to the man's response to this stressful period of his life?

a. The fact that he has previously had difficulty coping with stress

b. The fact that he is not physically active on a regular basis

c. The fact that his company is heavily in debt

d. The fact that he takes a diuretic medication for his hypertension

Based on assessment results, which of the following hospital patients is most likely to be experiencing the effects of chronic stress?

a. A 32-year-old intravenous drug user with a diagnosis of endocarditis

b. A 45-year-old paraplegic who is experiencing delayed wound healing of an ischial ulcer

c. A 79-year-old woman who has diagnoses of acute and chronic renal failure

d. A 63-year-old man with a diagnosis of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF)

A counseling psychologist is working with a 30-year-old female patient who is experiencing the symptoms of post-traumatic stress disorder (PTSD) following a house fire several months prior. Which of the patient's following diagnostic results could most likely be interpreted as a manifestation of PTSD?

a. The patient has decreased levels of cortisol.

b. The patient has decreased levels of norepinephrine.

c. The patient has decreased levels of angiotensin II.

d. The patient has increased levels of growth hormones.

A health care professional has recommended biofeedback to a patient as a method of dealing with the high levels of stress in her life. Which of the following explanations best characterizes an aspect of biofeedback treatment?

a. “You might be asked to use an electrocardiogram as part of the therapy.”

b. “The goal is to make you aware of your physiological processes.”

c. “You'll hopefully be able to gain control over skeletal muscle contractions.”

d. “You'll become aware of the increased skin temperature that accompanies anxiety.”

A student is attempting to trace the feedback cycle involved in the stress response. Which of the following neural structures is thought to be the central integrating site for the stress response?

a. Hypothalamus

b. Cerebral cortex

c. Locus ceruleus (LC)

d. Reticular formation