berlain 1. Which of the following areas lacks blood vessels and nerves? a. Epidermis b. Dermis c. Subcutaneous tissue d. Fatty tissue 2. What is a raised, thin-walled lesion containing clear fluid called? a. Papule b. Pustule c. Vesicle d. Macule 3. Which of the following is a common effect of a type I hypersensitivity response to ingested substances? a. Contact dermatitis b. Urticaria c. Discoid lupus erythematosus d. Psoriasis 4. What change occurs in the skin with psoriasis? a. Recurrent hypersensitivity reactions b. Autoimmune response c. Increased mitosis and shedding of epithelium d. Basal cell degeneration 5. Which of the following best describes the typical lesion of psoriasis? a. Purplish papules that can erode and become open ulcers b. Firm, raised pruritic nodules that can become cancerous c. Moist, red vesicles, which develop into bleeding ulcers d. Begins as a red papule and develops into silvery plaques 6. Why do secondary infections frequently develop in pruritic lesions? a. Loss of protective sebum b. Entry of resident flora while scratching the lesion c. Blockage of sebaceous glands d. Increased sweat production 7. Which disease is considered an autoimmune disorder? a. Pemphigus b. Erysipelas c. Contact dermatitis d. Scleroderma 8. Which of the following skin lesions are usually caused by Staphylococcus aureus? a. Furuncles b. Verrucae c. Scabies d. Tinea 9. Which of the following statements applies to impetigo? a. Lesions usually appear on the hands and arms. b. The cause is usually a virus. c. The infection is highly contagious. d. Scar tissue is common following infection. 10. What is the common signal that a recurrence of herpes simplex infection is developing? a. Severe pain around the mouth b. Malaise and fatigue c. Fever and severe headaches d. Mild tingling along the nerve or on the lips 11. Herpes virus is usually spread by all of the following EXCEPT: a. saliva during an exacerbation and for a short time thereafter. b. contact with the fluid in the lesion. c. contaminated blood. d. autoinoculation by fingers. 12. How are antiviral drugs effective in treating a viral infection? a. They destroy the virus if administered for at least 2 weeks. b. They limit the acute stage and viral shedding. c. They prevent any systemic effects of viruses. d. They prevent any secondary bacterial infection. 13. Tinea capitis is an infection involving the: a. trunk. b. feet. c. scalp. d. nails. 14. Plantar warts are caused by: a. the fungus aspergillus. b. a parasitic arthropod. c. human papillomavirus. d. the bacterium Streptococcus pyogenes. 15. Which of the following statements regarding acute necrotizing fasciitis is TRUE? a. Infection is localized in a small area of the epidermis. b. It is usually caused by S. aureus. c. Spontaneous recovery usually occurs in 48 hours. d. Infection rapidly causes extensive tissue necrosis and toxic shock. 16. Which type of microbe causes Tinea infections? a. Fungus b. Virus c. Gram-negative bacterium d. Mite 17. What causes the pruritus associated with scabies? a. An allergic reaction to the causative microbe due to endotoxins b. Mites burrowing into the epidermis and reaction to their feces c. Bleeding and injected toxin from bites of the larvae d. Neurotoxins secreted by mites on the skin surface 18. How can pediculosis be diagnosed? a. Pruritus in hairy areas of the body b. Loss of blood due to lice bites c. Finding lice in clothing d. The presence of nits at the base of hair shafts 19. What is the major predisposing factor to squamous cell carcinoma? a. Viral infection b. Presence of nevi (moles) on the skin c. Exposure to ultraviolet light d. Frequent hypersensitivity reactions 20. All of the following statements apply to malignant melanoma EXCEPT: a. The malignant cell is a melanocyte. b. They present as non-pruritic purplish macules. c. The neoplasm grows rapidly and metastasizes early. d. The lesion is usually dark or multicolored with an irregular border. 21. Which of the following factors has contributed to the increased incidence of Kaposi’s sarcoma? a. Excessive sun exposure b. Increased number of nevi c. Increase in immunosuppressed individuals d. Presence of more seborrheic keratoses 22. Which of the following applies to actinic keratoses? a. They predispose to malignant melanoma. b. They arise on skin exposed to ultraviolet radiation. c. They occur primarily on dark-skinned persons. d. They are malignant and invasive. 23. Which lesion distinguishes Tinea corporis? a. Small, brown pruritic lines b. Painful and pruritic fissures c. Erythematous ring of vesicles with a clear center d. Firm, red, painful nodule or pustule 24. Systemic effects of acute necrotizing fasciitis include: a. low-grade fever and malaise. b. toxic shock and disorientation. c. mild nausea and vomiting. d. headache and difficulty breathing. 25. The cause of contact dermatitis can often be identified by: a. using a culture and sensitivity test on the exudate. b. checking the frequency of the exacerbations. c. noting the location and size of the lesion. d. the type of pain associated with the lesion. 26. The pathological change associated with scleroderma is: a. abnormal activation of T lymphocytes and an increase of cytokines. b. an autoimmune reaction damaging the epidermis. c. collagen deposits in the small blood vessels of the skin and sometimes the viscera. d. Type I hypersensitivity and increased serum IgE levels. 27. Choose the best description of the typical lesion of impetigo. a. Large, red, painful nodule filled with purulent exudates b. Small vesicles that rupture to produce a crusty brown pruritic mass c. Red, swollen, painful areas often with projecting red streaks d. Firm, raised papules that may have a rough surface and may be painful 28. Choose the correct match of the skin condition and its usual location. a. Scabies—fingers, wrists, waist b. Impetigo—legs, feet c. Pediculosis humanus corporis—scalp d. Seborrheic keratosis—feet, hands 29. Leprosy (Hansen’s disease) is caused by: a. a fungus. b. a bacterium. c. a virus. d. a helminth. 30. One factor that is responsible for increasing the mortality rate among patients suffering with necrotizing fasciitis is: a. a delay in initial diagnosis. b. lack of proper antibiotics. c. the appearance of additional opportunistic infections. d. secondary fungal infections. 1. Which of the following would result from a reduced number of erythrocytes in the blood? a. Increased hemoglobin in the blood b. Decreased hematocrit c. Increased risk of hemostasis d. Decreased osmotic pressure of the blood 2. What term is used to describe a deficit of all types of blood cells? a. Leucopenia b. Neutropenia c. Pancytopenia d. Erythrocytosis 3. Capillary walls consist of: a. multiple endothelial layers. b. a thick layer of smooth muscle. c. two or three epithelial layers. d. a single endothelial layer. 4. Vitamin K is required by the liver to synthesize: a. heparin. b. prothrombin. c. amino acids. d. bilirubin. 5. Individuals with type O blood are considered to be universal donors because their blood: a. contains A and B antibodies. b. contains A and B antigens. c. lacks A and B antibodies. d. lacks A and B antigens. 6. What are the two circulations that comprise the overall circulatory system? a. Pulmonary and systemic circulations b. Peripheral and central circulations c. Cardiovascular and lymphatic circulations d. Cardiopulmonary and peripheral circulations 7. Chronic blood loss causes anemia because of the: a. shortened life span of the erythrocytes. b. lower metabolic rate. c. loss of protein and electrolytes. d. smaller amount of recycled iron available. 8. What is the cause of sickle cell anemia? a. A defective gene inherited from both parents b. A chronic bacterial infection c. Bone marrow depression d. An autoimmune reaction 9. Which of the following best describes the characteristic erythrocyte associated with pernicious anemia? a. Hypochromic, microcytic b. Normochromic, normocytic c. Elongated, sickle-shaped d. Megaloblastic or macrocytic nucleated cells 10. What causes numbness and tingling in the fingers of individuals with untreated pernicious anemia? a. Persistent hyperbilirubinemia b. Increasing acidosis affecting metabolism c. Vitamin B12 deficit causing peripheral nerve demyelination d. Multiple small vascular occlusions affecting peripheral nerves 11. Jaundice is one typical sign of: a. sickle cell anemia. b. aplastic anemia. c. iron deficiency anemia. d. acute leukemia. 12. What are the typical early general signs and symptoms of anemia? a. Chest pain, palpitations b. Jaundice, stomatitis c. Pallor, dyspnea, and fatigue d. Bradycardia, heat intolerance 13. What is the cause of oral ulcerations and delayed healing occurring with any severe anemia? a. Lack of folic acid for DNA synthesis b. Frequent microinfarcts in the tissues c. Deficit of oxygen for epithelial cell mitosis and metabolism d. Elevated bilirubin levels in blood and body fluids 14. Which of the following is present with pernicious anemia? a. Pancytopenia b. Hypochlorhydria c. Leukocytosis d. Multiple infarcts 15. Why is pernicious anemia treated with injections of vitamin B12? a. An immune reaction in the stomach would destroy the vitamin. b. Digestive enzymes would destroy the vitamin. c. The vitamin irritates the gastric mucosa. d. The ingested vitamin would not be absorbed into the blood. 16. Why do abnormally low hemoglobin values develop with pernicious anemia? a. Decreased production of erythrocytes b. Shorter life span of erythrocytes c. Abnormal structure of hemoglobin chains d. Deficit of folic acid 17. What are the common early signs of aplastic anemia? a. Painful joints and skeletal deformity b. Abdominal discomfort and splenomegaly c. Excessive bleeding and recurrent infections d. Palpitations and chest pain 18. Why do vascular occlusions and infarcts occur frequently with sickle cell anemia? a. The red blood cells are abnormally large. b. Increased hemolysis of erythrocytes occurs. c. Erythrocytes change to sickle shape when hypoxia occurs. d. HbS is unable to transport oxygen. 19. Which of the following applies to sickle cell trait? a. Most hemoglobin is in the form of HgS b. Sickling of erythrocytes occurs with severe hypoxia. c. Painful sickling crises with multiple infarctions occur frequently. d. A child’s skeletal growth is delayed. 20. What is the basic abnormality in thalassemia? a. Several amino acids in the globin chains have been replaced by substitute amino acids. b. More than four globin chains are found in the erythrocytes. c. The iron molecule is displaced in hemoglobin. d. There is failure to synthesize either the alpha or beta chains in the hemoglobin molecule. 21. Which of the following can result from a malabsorption problem? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Pernicious anemia 22. In individuals with pernicious anemia, antibodies form to: a. vitamin B12. b. intrinsic factor or parietal cells. c. mucus-producing glands. d. hydrochloric acid. 23. In cases of polycythemia vera, blood pressure is elevated as a result of: a. increased blood volume. b. frequent infarcts in the coronary circulation. c. congested spleen and bone marrow. d. increased renin and aldosterone secretions. 24. Petechiae and purpura are common signs of: a. excessive hemolysis. b. leucopenia. c. increased bleeding. d. hemoglobin deficit. 25. Which statement applies to the disorder hemophilia A? a. It is transmitted as an X-linked dominant trait. b. There is usually a total lack of factor VIII in the blood. c. Males and females can be carriers. d. Hematomas and hemarthroses are common. 26. Which of the following occurs when disseminated intravascular coagulation develops? a. Increased thrombocytes and blood clotting b. Hemolysis with loss of blood cells c. Massive sepsis and hemorrhage d. Multiple thrombi and deficit of clotting factors 27. Which of the following substances acts as an anticoagulant? a. Prothrombin b. Heparin c. Fibrinogen d. Vitamin K 28. In individuals with acute leukemia, the increased number of malignant leukocytes leads to: 1. decreased hemoglobin. 2. thrombocytopenia. 3. bone pain with increased activity. 4. splenomegaly. a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3, 4 29. Multiple opportunistic infections develop with acute leukemia primarily because: a. the number of white blood cells is decreased. b. many circulating leukocytes are immature. c. severe anemia interferes with the immune response. d. decreased appetite and nutritional intake reduce natural defenses. 30. Why is excessive bleeding a common occurrence with acute leukemia? a. Deficit of calcium ions b. Impaired production of prothrombin and fibrinogen c. Decreased platelets d. Dysfunctional thrombocytes 31. Predisposing factors to leukemia commonly include: a. exposure to radiation. b. certain fungal and protozoal infections. c. familial tendency. d. cigarette smoking. 32. Von Willebrand disease is caused by: a. defective erythrocytes that become deformed in shape, causing occlusions. b. excessive lymphocytes that do not mature. c. absence of a clotting factor that helps platelets clump and stick. d. a lack of hemoglobin due to iron deficiency. 33. Thrombophilia can result in conditions such as: a. severe chronic kidney disease. b. peripheral vascular disease. c. deficient calcium levels in the long bones. d. excessive bleeding of hematomas. 34. Multiple myeloma is a malignant tumor involving: a. plasma cells. b. granulocytes. c. bone cells. d. lymph nodes. 35. What is the primary treatment for the leukemias? a. Radiation b. Chemotherapy c. Surgery d. Immunotherapy 36. Which of the following statements applies to hemochromatosis. It is: a. caused by excessive iron intake in the diet. b. results from excessive hemolysis of RBCs. c. a metabolic error that leads to excess amounts of hemosiderin, causing damage to organs. d. an inherited defect that results in abnormal hemoglobin. 37. Thalassemia is caused by: a. a defect in one or more genes for hemoglobin. b. an abnormal form of heme. c. abnormal liver production of amino acids and iron. d. overproduction of hypochromic, microcytic RBCs. 38. Secondary polycythemia may be associated with: a. frequent angina attacks. b. certain types of anemia. c. severe chronic bronchitis. d. renal disease. 39. All of the following apply to vitamin K EXCEPT: a. it is used as an antidote for warfarin (Coumadin). b. the liver requires it to produce prothrombin. c. it is a fat-soluble vitamin. d. the bone marrow requires it to synthesize hemoglobin. 40. Leukemia is sometimes linked to chromosome abnormalities, as evidenced by: a. the presence of Philadelphia chromosome translocation in cases of acute myelogenous leukemia (AML). b. very low incidence in persons with Down syndrome. c. little evidence of familial incidence. d. transmission as a recessive gene. 41. Iron deficiency anemia frequently results from any of the following EXCEPT: a. certain vegetarian diets. b. excessive menstrual flow. c. malabsorption syndromes. d. diabetes mellitus. 42. Which of the following applies to the leukemias? a. Chronic leukemias are more common in older people. b. AML is the most common childhood leukemia. c. Exposure to chemicals is not considered a predisposing factor. d. Lymphoid tissue produces abnormal leukocytes. 43. A high percentage of blast cells in the leukocyte population indicates a poor prognosis for an individual with: a. thalassemia. b. acute myelogenous leukemia (AML). c. myelodysplastic syndrome. d. multiple myeloma. 44. Which of the following applies to erythropoietin? a. It is produced by the liver. b. It increases iron absorption for heme production. c. It stimulates production of red blood cells. d. Hypoxia stimulates the red bone marrow to produce erythropoietin. 45. Which of the following diagnostic tests would be within the normal range for an individual with hemophilia A? a. Bleeding time b. Coagulation time c. PTT time d. Prothrombin time 46. Which of the following applies to the condition disseminated intravascular coagulation (DIC)? a. It is usually a secondary complication. b. It is always initiated by excessive bleeding. c. It results in an inability of platelets to adhere. d. It is not life threatening. 47. In which blood dyscrasia does pancytopenia develop? a. Pernicious anemia b. Aplastic anemia c. Iron deficiency anemia d. Sickle cell anemia 48. Which of the following applies to the etiology of aplastic anemia? It is: a. idiopathic in many cases. b. a genetic disorder. c. predisposed by exposure to myelotoxins. d. Both A and C. 49. Microcytic and hypochromic erythrocytes are commonly found as a result of: a. iron deficiency anemia. b. polycythemia. c. disseminated intravascular coagulation. d. hemophilia A. 1. Which of the following actions causes the atrioventricular (AV) valves to close? a. Increased intraventricular pressure b. Depolarization at the AV node c. Ventricular relaxation and backflow of blood d. Contraction of the atria 2. When stroke volume decreases, which of the following could maintain cardiac output? a. Decreased peripheral resistance b. Increased heart rate c. Decreased venous return d. General vasodilation 3. Which of the following describes the pericardial cavity? a. It contains sufficient fluid to provide a protective cushion for the heart. b. It is a potential space containing a very small amount of serous fluid. c. It is lined by the endocardium. d. It is located between the double-walled pericardium and the epicardium. 4. Which of the following factors greatly improves venous return to the heart during strenuous exercise? a. Rapid emptying of the right side of the heart b. Forceful action of the valves in the veins c. Contraction and relaxation of skeletal muscle d. Peristalsis in the large veins 5. The function of the baroreceptors is to: a. stimulate the parasympathetic or sympathetic nervous system at the sinoatrial (SA) node as needed. b. adjust blood pressure by changing peripheral resistance. c. sense a change in blood oxygen and carbon dioxide levels. d. signal the cardiovascular control center of changes in systemic blood pressure. 6. The normal delay in conduction through the AV node is essential for: a. preventing an excessively rapid heart rate. b. limiting the time for a myocardial contraction. c. allowing the ventricles to contract before the atria. d. completing ventricular filling. 7. Which of the following is a result of increased secretion of epinephrine? a. Increased heart rate and force of contraction b. Decreased stimulation of the SA node and ventricles c. Vasoconstriction in skeletal muscles and kidneys d. Vasodilation of cutaneous blood vessels 8. Which of the following causes increased heart rate? a. Stimulation of the vagus nerve b. Increased renin secretion c. Administration of beta-blocking drugs d. Stimulation of the sympathetic nervous system 9. The event that causes the QRS wave on an electrocardiogram (ECG) tracing is: a. atrial depolarization. b. atrial repolarization. c. ventricular depolarization. d. ventricular repolarization. 10. The cardiac reserve is: a. afterload. b. the difference between the apical and radial pulses. c. the ability of the heart to increase cardiac output when needed. d. the extra blood remaining in the heart after it contracts. 11. The term preload refers to: a. volume of venous return. b. peripheral resistance. c. stroke volume. d. cardiac output. 12. The first arteries to branch off the aorta are the: a. common carotid arteries. b. pulmonary arteries. c. coronary arteries. d. subclavian arteries. 13. Cardiac output refers to: a. the amount of blood passing through either of the atria. b. the volume of blood ejected by a ventricle in one minute. c. the volume of blood ejected by each ventricle in a single contraction. d. the total number of heartbeats in one minute. 14. Vasodilation in the skin and viscera results directly from: a. decreased blood pressure. b. increased parasympathetic stimulation. c. relaxation of smooth muscle in the arterioles. d. increased stimulation of alpha-adrenergic receptors. 15. Which of the following drugs decrease sodium and fluid retention in the body? a. warfarin (Coumadin) b. digoxin (Lanoxin) c. nitroglycerin (Isordil) d. hydrochlorothiazide (HydroDIURIL) 16. Which of the following are predisposing factors to thrombus formation in the circulation? 1. Decreased viscosity of the blood 2. Damaged blood vessel walls 3. Immobility 4. Prosthetic valves a. 1, 3 b. 2, 4 c. 1, 3, 4 d. 2, 3, 4 17. A drug taken in small doses on a continuing basis to reduce platelet adhesion is: a. acetylsalicylic acid (ASA). b. streptokinase. c. acetaminophen. d. heparin. 18. A partial obstruction in a coronary artery will likely cause: a. pulmonary embolus. b. hypertension. c. angina attacks. d. myocardial infarction. 19. Cigarette smoking is a risk factor in coronary artery disease because smoking: a. reduces vasoconstriction and peripheral resistance. b. decreases serum lipid levels. c. promotes platelet adhesion. d. increases serum HDL levels. 20. The term arteriosclerosis specifically refers to: a. development of atheromas in large arteries. b. intermittent vasospasm in coronary arteries. c. degeneration with loss of elasticity and obstruction in small arteries. d. ischemia and necrosis in the brain, kidneys, and heart. 21. A modifiable factor that increases the risk for atherosclerosis is: a. leading a sedentary lifestyle. b. being female and older than 40 years of age. c. excluding saturated fats from the diet. d. familial hypercholesterolemia. 22. An atheroma develops from: a. a torn arterial wall and blood clots. b. accumulated lipids, cells, and fibrin where endothelial injury has occurred. c. thrombus forming on damaged walls of veins. d. repeated vasospasms. 23. Low-density lipoproteins (LDL): a. promote atheroma development. b. contain only small amounts of cholesterol. c. transport cholesterol from cells to the liver for excretion. d. are associated with low intake of saturated fats. 24. Factors that may precipitate an angina attack include all of the following EXCEPT: a. eating a large meal. b. engaging in an angry argument. c. taking a nap. d. shoveling snow on a cold, windy day. 25. When comparing angina with myocardial infarction (MI), which statement is true? a. Both angina and MI cause tissue necrosis. b. Angina often occurs at rest; MI occurs during a stressful time. c. Pain is more severe and lasts longer with angina than with MI. d. Angina pain is relieved by rest and intake of nitroglycerin; the pain of MI is not. 26. The basic pathophysiology of myocardial infarction is best described as: a. cardiac output that is insufficient to meet the needs of the heart and body. b. temporary vasospasm that occurs in a coronary artery. c. total obstruction of a coronary artery, which causes myocardial necrosis. d. irregular heart rate and force, reducing blood supply to coronary arteries. 27. Typical early signs or symptoms of myocardial infarction include: a. brief, substernal pain radiating to the right arm, with labored breathing. b. persistent chest pain radiating to the left arm, pallor, and rapid, weak pulse. c. bradycardia, increased blood pressure, and severe dyspnea. d. flushed face, rapid respirations, left-side weakness, and numbness. 28. The most common cause of a myocardial infarction is: a. an imbalance in calcium ions. b. an infection of the heart muscle. c. atherosclerosis involving an attached thrombus. d. a disruption of the heart conduction system. 29. Calcium-channel blocking drugs are effective in: a. reducing the risk of blood clotting. b. decreasing the attraction of cholesterol into lipid plaques. c. reducing cardiac and smooth muscle contractions. d. decreasing all types of cardiac arrhythmias. 30. Which of the following confirms the presence of a myocardial infarction? a. A full description of the pain, including the sequence of development b. The presence of elevated serum cholesterol and triglycerides c. Serum isoenzymes released from necrotic cells and an ECG d. Leukocytosis and elevated C-reactive protein 31. The size of the necrotic area resulting from myocardial infarction may be minimized by all of the following EXCEPT: a. previously established collateral circulation. b. immediate administration of thrombolytic drugs. c. maintaining maximum oxygen supply to the myocardium. d. removing the predisposing factors to atheroma development. 32. The most common cause of death immediately following a myocardial infarction is: a. cardiac arrhythmias and fibrillation. b. ruptured ventricle or aorta. c. congestive heart failure. d. cerebrovascular accident. 33. Why does ventricular fibrillation result in cardiac arrest? a. Delayed conduction through the AV node blocks ventricular stimulation. b. Insufficient blood is supplied to the myocardium. c. The ventricles contract before the atria. d. Parasympathetic stimulation depresses the SA node. 34. The term cardiac arrest refers to which of the following? a. Condition where cardiac output is less than the demand b. A decreased circulating blood volume c. Missing a ventricular contraction d. The cessation of all cardiac function 35. Which change results from total heart block? a. A prolonged PR interval b. Periodic omission of a ventricular contraction c. A wide QRS wave d. Spontaneous slow ventricular contractions, not coordinated with atrial contraction 36. The term premature ventricular contraction refers to the condition where: a. atrial muscle cells are stimulating additional cardiac contractions. b. the ventricles contract spontaneously following a period without a stimulus. c. additional contractions arise from ectopic foci in the ventricular muscle. d. increased heart rate causes palpitations. 37. Which of the following is most likely to cause left-sided congestive heart failure? a. Incompetent tricuspid heart valve b. Chronic pulmonary disease c. Infarction in the right atrium d. Uncontrolled essential hypertension 38. The definition of congestive heart failure is: a. cessation of all cardiac activity. b. inability of the heart to pump enough blood to meet the metabolic needs of the body. c. insufficient circulating blood in the body. d. the demand for oxygen by the heart is greater than the supply. 39. Significant signs of right-sided congestive heart failure include: a. severe chest pain and tachycardia. b. edematous feet and legs with hepatomegaly. c. frequent cough with blood-streaked frothy sputum. d. orthopnea, fatigue, increased blood pressure. 40. Paroxysmal nocturnal dyspnea is marked by: a. hemoptysis and rales. b. distended neck veins and flushed face. c. bradycardia and weak pulse. d. cardiomegaly. 41. Compensation mechanisms for decreased cardiac output in cases of congestive heart failure include: a. slow cardiac contractions. b. increased renin and aldosterone secretions. c. decreased erythropoietin secretion. d. fatigue and cold intolerance. 42. In which blood vessels will failure of the left ventricle cause increased hydrostatic pressure? a. Veins of the legs and feet b. Jugular veins c. Pulmonary capillaries d. Blood vessels of the liver and spleen 43. Which of the following drugs improves cardiac efficiency by slowing the heart rate and increasing the force of cardiac contractions? a. Furosemide b. Digoxin c. Epinephrine d. Nifedipine 44. In an infant, the initial indication of congestive heart failure is often: a. distended neck veins. b. feeding problems. c. low-grade fever and lethargy. d. frequent vomiting. 45. Effects that may be expected from a beta-adrenergic blocking drug include: a. increasing systemic vasoconstriction. b. decreased sympathetic stimulation of the heart. c. blockage of an angiotensin receptor site. d. increased release of renin. 46. A sign of aortic stenosis is: a. increased cardiac output. b. congestion in the liver, spleen, and legs. c. flushed face and headache. d. a heart murmur. 47. An incompetent mitral valve would cause: a. increased blood to remain in the right atrium. b. hypertrophy of the right ventricle. c. decreased output from the left ventricle. d. decreased pressure in the left atrium. 48. Which of the following describes the blood flow occurring with a ventricular septal defect? a. From the left ventricle to the right ventricle b. From the right ventricle to the left ventricle c. Increased cardiac output from the left ventricle d. Mixed oxygenated and unoxygenated blood in the systemic circulation 49. Unoxygenated blood enters the systemic circulation in children with tetralogy of Fallot because: a. the aorta and pulmonary artery have exchanged positions. b. pulmonary stenosis changes the ventricular pressures. c. the left ventricular wall has hypertrophied. d. the septal defect allows exchange of blood between the atria. 50. Cyanosis occurs in children with tetralogy of Fallot because: a. more carbon dioxide is present in the circulating blood. b. a large amount of hemoglobin in the general circulation is unoxygenated. c. the pulmonary circulation is overloaded and congested. d. the circulation is sluggish (slow) throughout the system. 51. The initial effect on the heart in cases of rheumatic fever is: a. infection in the heart by hemolytic streptococci. b. highly virulent microbes causing vegetations on the heart valves. c. septic emboli obstructing coronary arteries. d. acute inflammation in all layers of the heart due to abnormal immune response. 52. Common signs of rheumatic fever include all of the following EXCEPT: a. arthritis, causing deformity of the small joints in the hands and feet. b. erythematous skin rash and subcutaneous nodules. c. epistaxis, tachycardia, and fever. d. elevated ASO titer and leukocytosis. 53. Rheumatic heart disease usually manifests in later years as: a. swollen heart valves and fever. b. cardiac arrhythmias and heart murmurs. c. thrombus formation and septic emboli. d. petechial hemorrhages of the skin and mucosa. 54. Septic emboli, a common complication of infective endocarditis, are a result of the fact that: a. vegetations are loosely attached and fragile. b. the valves are no longer competent. c. cardiac output is reduced. d. heart contractions are irregular. 55. Which of the following applies to subacute infective endocarditis? a. A microbe of low virulence attacks abnormal or damaged heart valves. b. Virulent microbes invade normal heart valves. c. No permanent damage occurs to the valves. d. Prophylactic medication does not prevent infection. 56. Pericarditis causes a reduction in cardiac output as a result of which of the following? a. Delays in the conduction system, interfering with cardiac rhythm b. Weak myocardial contractions due to friction rub c. Excess fluid in the pericardial cavity, which decreases ventricular filling d. Incompetent valves, which allow regurgitation of blood 57. Pericarditis may be caused by: 1. infection. 2. abnormal immune responses. 3. injury. 4. malignant neoplasm. a. 1, 2 b. 3, 4 c. 1, 3, 4 d. 1, 2, 3, 4 58. A source of an embolus causing an obstruction in the brain could be the: a. femoral vein. b. pulmonary vein. c. carotid artery. d. coronary artery. 59. The basic pathophysiological change associated with essential hypertension is: a. development of lipid plaques in large arteries. b. recurrent inflammation and fibrosis in peripheral arteries. c. degeneration and loss of elasticity in arteries. d. increased systemic vasoconstriction. 60. Uncontrolled hypertension is most likely to cause ischemia and loss of function in the: a. kidneys, brain, and retinas of the eye. b. peripheral arteries in the legs. c. aorta and coronary arteries. d. liver, spleen, and stomach. 61. When is a diagnosis of essential hypertension likely to be considered in young or middle-aged individuals? a. Blood pressure remains consistently above 140/90 b. Blood pressure fluctuates between 130/85 and 180/105 c. Blood pressure increases rapidly and is unresponsive to medication d. Chronic kidney disease leads to consistently elevated blood pressure 62. Atherosclerosis in the iliac or femoral arteries is likely to cause which of the following? 1. Gangrenous ulcers in the legs 2. Strong rapid pulses in the legs 3. Intermittent claudication 4. Red, swollen legs a. 1, 2 b. 1, 3 c. 2, 3 d. 2, 4 63. The term intermittent claudication refers to: a. sensory deficit in the legs due to damage to nerves. b. chest pain related to ischemia. c. ischemic muscle pain in the legs, particularly with exercise. d. dry, cyanotic skin with superficial ulcers. 64. What is the primary reason for amputation of gangrenous toes or feet in patients with peripheral vascular disease? a. It promotes more rapid healing of ulcerated areas. b. It improves circulation to other areas. c. It prevents spread of infection and reduces pain. d. It reduces swelling in the peripheral areas. 65. An echocardiogram is used to demonstrate any abnormal: a. activity in the conduction system. b. movement of the heart valves. c. change in central venous pressure. d. blood flow in coronary arteries. 66. A friction rub is associated with: a. infectious endocarditis. b. arrhythmias. c. pericarditis. d. an incompetent aortic valve. 67. A dissecting aortic aneurysm develops as: a. a dilation or bulge that develops at one point on the aortic wall. b. a thrombus that accumulates at a point in the aortic wall. c. a section of the aorta that weakens and dilates in all directions. d. a tear in the intimal lining, which allows blood flow between layers of the aortic wall. 68. The outcome for many aortic aneurysms is: a. early diagnosis and repair. b. thrombus formation and pulmonary embolus. c. rupture and hemorrhage. d. pressure on adjacent organs or structures. 69. Which factor predisposes to varicose veins during pregnancy? a. Compressed pelvic veins b. Stenotic valves in leg veins c. Thrombus formation d. Insufficient muscle support for veins 70. Phlebothrombosis is more likely to cause pulmonary emboli than is thrombophlebitis because: a. platelets attach to the inflamed wall. b. thrombus forms in a vein and is less firmly attached. c. leg cramps require massage. d. systemic signs of inflammation require treatment. 71. Shock is defined as: a. failure of the heart to supply sufficient blood to body cells. b. general hypoxia, causing damage to various organs. c. decreased circulating blood and tissue perfusion. d. loss of blood, causing severe hypoxia. 72. Shock follows a myocardial infarction when: a. the stress response causes general vasodilation. b. fluid is lost into ischemic tissues. c. heart valves are damaged. d. a large portion of the myocardium is damaged. 73. What are the early signs of circulatory shock? 1. Pale moist skin 2. Loss of consciousness 3. Anxiety and restlessness 4. Rapid strong pulse a. 1, 2 b. 1, 3 c. 1, 4 d. 3, 4 74. A compensation for shock would include: a. increased heart rate and oliguria. b. lethargy and decreased responsiveness. c. warm, dry, flushed skin. d. weak, thready pulse. 75. Why does anaphylactic shock cause severe hypoxia very quickly? a. Generalized vasoconstriction reduces venous return. b. Bronchoconstriction and bronchial edema reduce airflow. c. Heart rate and contractility are reduced. d. Metabolic rate is greatly increased. 76. Neurogenic (vasogenic) shock results from systemic vasodilation due to: a. increased peripheral resistance and less blood in the microcirculation. b. increased permeability of all the blood vessels, leading to hypovolemia. c. slower, less forceful cardiac contractions. d. increased capacity of the vascular system and reduced venous return. 77. A prolonged period of shock is likely to cause: a. damage to, and increased permeability of, pulmonary capillaries. b. increased permeability of the glomerular capillaries of the kidneys. c. increased pH of blood and body fluids. d. increased systemic vasoconstriction. 78. What would indicate decompensated acidosis related to shock? a. Serum bicarbonate level below normal b. PCO2 above normal c. Serum pH below normal range d. Urine pH of 4.5 79. With shock, anaerobic cell metabolism and decreased renal blood flow cause: a. metabolic alkalosis. b. metabolic acidosis. c. decreased serum potassium. d. increased serum bicarbonate. 80. Shock develops in patients with severe burns as a result of: a. extensive hemorrhage. b. pain and loss of plasma. c. direct damage to the heart. d. extensive hemolysis of erythrocytes. 81. The classic early manifestation(s) of left-sided congestive heart failure is/are ____, whereas the early indicator(s) of right-sided failure is/are _______. a. palpitations and periodic chest pain; shortness of breath on exertion b. swelling of the ankles and abdomen; chest pain c. shortness of breath on exertion or lying down; swelling of the ankles d. coughing up frothy sputum; hepatomegaly and splenomegaly 82. A common adverse effect of many antihypertensive medications is: a. orthostatic hypotension. b. bradycardia. c. altered blood coagulation. d. peripheral edema. 83. The cause of essential hypertension is considered to be: a. chronic renal disease. b. excessive intake of saturated fats and salt. c. sedentary lifestyle. d. idiopathic. 84. A cardiac pacemaker would most likely be inserted in cases of: a. angina pectoris. b. heart block. c. congestive heart failure. d. ventricular fibrillation. 85. Which of the following is considered to be the most dangerous arrhythmia? a. Tachycardia b. Bradycardia c. Ventricular fibrillation d. Second-degree heart block 86. Which of the following is NOT true of the drug nitroglycerin? a. It decreases myocardial workload by causing systemic vasodilation. b. It may be administered sublingually, transdermally, or by oral spray. c. Dizziness or syncope may follow a sublingual dose. d. It strengthens the myocardial contraction. 87. Confirmation of the diagnosis of a myocardial infarction would include: 1. specific changes in the ECG. 2. marked leukocytosis and increased erythrocyte sedimentation rate (ESR). 3. elevation of cardiac isoenzymes in serum. 4. a pattern of pain. a. 1, 2 b. 1, 3 c. 2, 4 d. 3, 4 88. Which of the following statements regarding aneurysms is true? a. Aneurysms are always caused by congenital malformations. b. The greatest danger with aneurysms is thrombus formation. c. Manifestations of aneurysms result from compression of adjacent structures. d. Aneurysms involve a defect in the tunica media of veins. 89. The most common factor predisposing to the development of varicose veins is: a. trauma. b. congenital valve defect in the abdominal veins. c. infection. d. increased venous pressure. 90. In the period immediately following a myocardial infarction, the manifestations of pallor and diaphoresis, rapid pulse, and anxiety result from: a. onset of circulatory shock. b. the inflammatory response. c. release of enzymes from necrotic tissue. d. heart failure. 91. Septic shock differs from hypovolemic shock in that it is frequently manifested by: a. fever and flushed face. b. elevated blood pressure. c. increased urinary output. d. slow bounding pulse. 92. Heart block, in which a conduction delay at the AV node results in intermittent missed ventricular contractions, is called: a. first-degree block. b. second-degree block. c. bundle-branch block. d. total heart block. 93. More extensive permanent damage is likely when a myocardial infarction is caused by: a. a hemorrhage. b. an embolus. c. a thrombus. d. an arrhythmia. 94. A very rapid heart rate reduces cardiac output because: a. venous return is increased. b. ventricular fibrillation develops immediately. c. conduction through the AV node is impaired. d. ventricular filling is reduced. 95. The right side of the heart would fail first in the case of: 1. severe mitral valve stenosis. 2. uncontrolled essential hypertension. 3. large infarction in the right ventricle. 4. advanced chronic obstructive pulmonary disease (COPD). a. 1, 2 b. 2, 3 c. 1, 4 d. 3, 4 96. Which of the following compensations that develop in patients with congestive heart failure eventually increase the workload of the heart? a. Faster heart rate and cardiomegaly b. Peripheral vasoconstriction c. Increased secretion of renin d. A and C e. A, B, and C 97. Which statement applies to paroxysmal nocturnal dyspnea? a. It indicates decreased CO2 diffusion in the lungs. b. It indicates swelling in the bronchioles and bronchi. c. It is caused by increased blood in the lungs when lying in a supine position. d. It results from pleural effusion. 98. In patients with congestive heart failure, ACE inhibitor drugs are useful because they: a. reduce renin and aldosterone secretion. b. slow the heart rate. c. strengthen myocardial contraction. d. block arrhythmias. 99. In a child with ventricular septal defect, altered blood flow: a. leads to increased stroke volume from the left ventricle. b. results in unoxygenated blood in the systemic circulation. c. is called a right-to-left shunt. d. is called a left-to-right shunt. 100. In a child with acute rheumatic fever, arrhythmias may develop due to the presence of: a. endocarditis. b. myocarditis. c. pericarditis. d. congestive heart failure. 101. Prophylactic antibacterial drugs such as amoxicillin are given to patients with certain congenital heart defects or damaged heart valves immediately before invasive procedures to prevent: a. formation of septic thrombi. b. infectious endocarditis. c. abscess formation. d. myocarditis. 102. Varicose ulcers may develop and be slow to heal because: a. leg muscles are painful, restricting movement. b. edema reduces arterial blood supply to the area. c. emboli form in damaged veins, leading to local ischemia. d. valves in veins restrict blood flow. 103. Excessive fluid in the pericardial space causes: a. increased cardiac output. b. myocardial infarction. c. reduced venous return. d. friction rub. 104. Aortic stenosis means the aortic valve: a. allows blood to leak back into the left ventricle during diastole. b. cannot fully open during systole. c. functions to increase stroke volume. d. does not respond to the cardiac cycle. 105. Septic shock is frequently caused by infections involving: a. gram-negative endotoxin-producing bacteria. b. spore-forming saprophytic fungi. c. free-swimming, motile parasitic protozoa. d. parasitic nematodes. 1. What happens in the lungs when the diaphragm and external intercostal muscles relax? a. Air is forced out of the lungs. b. Lung volume increases. c. Intrapulmonic pressure decreases. d. Intrapleural pressure decreases. 2. The respiratory mucosa is continuous through the: 1. upper and lower respiratory tracts. 2. nasal cavities and the sinuses. 3. nasopharynx and oropharynx. 4. middle ear cavity and auditory tube. a. 1 only b. 1, 2 c. 2, 3 d. 1, 3, 4 e. 1, 2, 3, 4 3. Which of the following activities does NOT require muscle contractions and energy? a. Quiet inspiration b. Forced inspiration c. Quiet expiration d. Forced expiration 4. The maximum volume of air a person can exhale after a maximum inspiration is termed the: a. expiratory reserve volume. b. inspiratory reserve volume. c. total lung capacity. d. vital capacity. 5. Which of the following applies to the blood in the pulmonary artery? a. PCO2 is low. b. PO2 is low. c. Hydrostatic pressure is very high. d. It is flowing into the left atrium. 6. Which of the following causes bronchodilation? a. Epinephrine b. Histamine c. Parasympathetic nervous system d. Drugs that block β2-adrenergic receptors 7. The central chemoreceptors in the medulla are normally most sensitive to: a. low oxygen level. b. low concentration of hydrogen ions. c. elevated oxygen level. d. elevated carbon dioxide level. 8. Oxygen diffuses from the alveoli to the blood because: a. PO2 is higher in the blood. b. PO2 is lower in the blood. c. CO2 is diffusing out of the blood. d. more CO2 is diffusing out of cells into the blood. 9. Carbon dioxide is primarily transported in the blood: a. as dissolved gas. b. attached to the iron molecule in hemoglobin. c. as bicarbonate ion. d. as carbonic acid. 10. What would hypercapnia cause? a. Increased serum pH b. Decreased respirations c. Respiratory acidosis d. Decreased carbonic acid in the blood 11. Which of the following would result from hyperventilation? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic alkalosis d. Metabolic acidosis 12. Which of the following values is always decreased with respiratory alkalosis (compensated or decompensated)? a. Serum bicarbonate b. PaCO2 c. Serum pH d. Urine pH 13. What would be the most effective compensation for respiratory acidosis? a. The kidneys eliminating more bicarbonate ions b. The kidneys producing more bicarbonate ions c. The kidneys reabsorbing more hydrogen ions d. An increase in respiratory rate 14. What is the acid-base status of a patient with the following values for arterial blood gases? serum bicarbonate 36.5 mmol/L (normal range: 22-28) PCO2 75 mm Hg (normal range: 35-45) serum pH 7.0 a. Compensated metabolic acidosis b. Decompensated metabolic acidosis c. Compensated respiratory acidosis d. Decompensated respiratory acidosis 15. What does carbaminohemoglobin refer to? a. Replacement of oxygen by carbon monoxide on hemoglobin molecules b. Full saturation of all heme molecules by oxygen c. Carbon dioxide attached to an amino group on the hemoglobin molecule d. Oxygen combined with iron in the hemoglobin molecule 16. Approximately what percentage of bound oxygen is released to the cells for metabolism during an erythrocyte’s journey through the circulatory system? a. 80% b. 25% c. 10% d. 50% 17. The production of yellowish-green, cloudy, thick sputum is often an indication of: a. bacterial infection. b. cancer tumor. c. damage of lung tissue due to smoking. d. emphysema. 18. What does the term hemoptysis refer to? a. Thick, dark red sputum associated with pneumococcal infection b. Reddish-brown granular blood found in vomitus c. Bright red streaks of blood in frothy sputum d. Bloody exudate in the pleural cavity 19. Orthopnea is: a. very deep, rapid respirations. b. difficulty breathing when lying down. c. waking up suddenly, coughing, and struggling for breath. d. noisy breathing with stridor or rhonchi. 20. Light bubbly or crackling breathing sounds associated with serous secretions are called: a. rhonchi. b. stridor. c. rales. d. wheezing. 21. Choose the correct information applying to laryngotracheobronchitis: a. Viral infection in infant under 12 months b. Viral infection in child, 3 months to 3 years c. Bacterial infection in infant under 6 months d. Bacterial infection in child, 3 to 7 years 22. Signs and symptoms of acute sinusitis usually include: a. serous nasal discharge and chronic cough. b. copious frothy sputum and dyspnea. c. severe localized pain in the facial bone and tenderness in the face. d. fetid breath and sore throat. 23. What are early signs and symptoms of infectious rhinitis? a. Purulent nasal discharge and periorbital pain b. Serous nasal discharge, congestion, and sneezing c. Copious purulent sputum, particularly in the morning d. Harsh barking cough and wheezing 24. Why does the influenza virus cause recurrent infection in individuals? a. Elderly patients are predisposed to secondary infections. b. The virus is transmitted by numerous routes. c. The virus is very difficult to destroy. d. Viral mutation reduces immunity from prior infections. 25. What are typical signs and symptoms of epiglottitis? a. Hyperinflation of the chest and stridor b. Hoarse voice and barking cough c. Sudden fever, sore throat, and drooling saliva d. Sneezing, mild cough, and fever 26. What is the most common cause of viral pneumonia? a. Rhinovirus b. Influenza virus c. Haemophilus influenzae d. Pneumococcus 27. Which of the following describes lobar pneumonia? a. Sudden onset of fever and chills, with rales and rusty sputum b. Insidious onset, diffuse interstitial infection c. Viral infection causing nonproductive cough and pleuritic pain d. Opportunistic bacteria causing low-grade fever with cough and thick greenish sputum 28. How does severe hypoxia develop with pneumonia? a. Acidosis depresses respirations. b. Oxygen diffusion is impaired by the congestion. c. Inflammatory exudate absorbs oxygen from the alveolar air. d. Infection reduces effective compensation by the heart. 29. Rust-colored sputum in a patient with pneumonia usually indicates: a. secondary hemorrhage in the lungs. b. Streptococcus pneumoniae is the infecting agent. c. prolonged stasis of mucous secretions in the airways. d. persistent coughing has damaged the mucosa in the bronchi. 30. What is the cause of Legionnaires’ disease? a. Mycoplasma b. A fungus c. A gram-negative bacterium d. Pneumococcus 31. Select the statement related to tuberculosis: a. The microbe is present in the sputum of all patients with a positive TB skin test. b. The infection is transmitted primarily by blood from an infected person. c. TB is usually caused by an acid-fast bacillus, resistant to many disinfectants. d. The microbe is quickly destroyed by the immune response. 32. How is primary tuberculosis identified? a. Cavitation in the lungs and spread of the microbe to other organs b. Persistent productive cough, low-grade fever, and fatigue c. Caseation necrosis and formation of a tubercle in the lungs d. Multiple granulomas in the lungs and rapid spread of the microbe 33. When does active (secondary) infection by Mycobacterium tuberculosis with tissue destruction occur? a. When host resistance is decreased b. When a hypersensitivity reaction is initiated c. When the BCG vaccine is not administered immediately following exposure to the microbe d. When Ghon complexes form in the lungs 34. Which of the following statements does NOT apply to M. tuberculosis? a. Microbes can survive for a long time inside tubercles. b. The bacilli can survive some adverse conditions such as drying and heat. c. Infection is limited to the lungs. d. The bacilli can be destroyed by antibacterial drugs. 35. Which of the following confirms the presence of active (reinfection) tuberculosis? a. A positive skin test for TB b. A calcified tubercle shown on a chest X-ray c. Identification of acid-fast bacilli in a sputum sample d. A history of exposure to individuals being treated for TB 36. Areas in the United States that show higher rates than the national rate of TB are areas that have a high incidence of: a. HIV and homelessness. b. obesity and tobacco use. c. elderly persons and radon. d. steroid use and alcoholism. 37. Histoplasmosis is caused by a: a. fungus. b. virus. c. bacillus. d. protozoa. 38. Cystic fibrosis is transmitted as a/an: a. X-linked recessive gene. b. autosomal recessive gene. c. autosomal dominant gene. d. chromosomal defect. 39. The basic pathophysiology of cystic fibrosis is centered on a/an: a. defect of the exocrine glands. b. impaired function of the endocrine glands. c. chronic inflammatory condition of the lungs. d. abnormal immune response in the lungs and other organs. 40. Growth and development of a child with cystic fibrosis may be delayed because of: a. deficit of gastric enzymes for protein digestion. b. mucus plugs obstructing the flow of pancreatic enzymes. c. lack of available treatment for steatorrhea. d. abnormal salivary secretions. 41. Persistent thick mucus in the bronchioles of a child with cystic fibrosis may cause: 1. air trapping. 2. atelectasis. 3. repeated infections. 4. irreversible damage to lung tissue. a. 1, 2 b. 2, 4 c. 1, 3, 4 d. 1, 2, 3, 4 42. What is a common indicator of cystic fibrosis in the newborn? a. Infant respiratory distress syndrome b. Failure to excrete meconium c. Taste of ammonia on the skin d. Lack of bile secretions 43. What is an early sign of bronchogenic carcinoma? a. Air trapping and overinflation of the lung b. Weight loss c. Bone pain d. Chronic cough 44. Cigarette smoking predisposes to malignant neoplasms because smoking: a. can cause metaplasia and dysplasia in the epithelium. b. promotes malignant changes in all types of benign tumors in the lungs. c. causes paraneoplastic syndrome. d. increases exposure to carbon monoxide in the lungs. 45. Why does hypercalcemia occur with bronchogenic carcinoma? a. Invasion of the parathyroid gland by the tumor b. Secretion of parathyroid or parathyroid like hormones by the tumor c. Destruction of the ribs d. Failure of the kidney to excrete calcium ions 46. What is a sign indicating total obstruction of the airway by aspirated material? a. Hoarse cough b. Rapid loss of consciousness c. Dyspnea d. Inflammation of the mucosa 47. Which of the following predisposes to postoperative aspiration? a. Reduced pressure of the abdominal organs on the diaphragm b. Depression of the vomiting center by anesthetics and analgesics c. Vomiting caused by drugs or anesthesia d. Lack of food intake for the previous 24 hours 48. What is the pathophysiology of an acute attack of extrinsic asthma? a. Gradual degeneration and fibrosis b. Continuous severe attacks unresponsive to medication c. A hypersensitivity reaction involving release of chemical mediators d. Hyperresponsive mucosa 49. During an acute asthma attack, how does respiratory obstruction occur? 1. Relaxation of bronchial smooth muscle 2. Edema of the mucosa 3. Increased secretion of thick, tenacious mucus 4. Contraction of elastic fibers a. 1, 2 b. 1, 3 c. 2, 3 d. 2, 4 50. What cause the expanded anteroposterior (A-P) thoracic diameter (barrel chest) in patients with emphysema? a. Air trapping and hyperinflation b. Persistent coughing to remove mucus c. Recurrent damage to lung tissues d. Dilated bronchi and increased mucous secretions 51. Which of the following is typical of progressive emphysema? a. Vital capacity increases. b. Residual lung volume increases. c. Forced expiratory volume increases. d. Tidal volume increases. 52. Destruction of alveolar walls and septae is a typical change in: a. chronic bronchitis. b. acute asthma. c. emphysema. d. asbestosis. 53. A group of common chronic respiratory disorders characterized by tissue degeneration and respiratory obstruction is called: a. mesothelioma. b. COPD. c. CF. d. MD. 54. Which statement does NOT apply to emphysema? a. The surface area available for gas exchange is greatly reduced. b. A genetic defect may lead to breakdown of elastic fibers. c. The ventilation/perfusion ratio remains constant. d. Expiration is impaired. 55. What is the cause of chronic bronchitis? a. Chronic irritation, inflammation, and recurrent infection of the larger airways b. A genetic defect causing excessive production of mucus c. Hypersensitivity to parasympathetic stimulation in the bronchi d. Deficit of enzymes, preventing tissue degeneration 56. Which of the following is typical of chronic bronchitis? a. Decreased activity of the mucous glands b. Fibrosis of the bronchial wall c. Overinflation of bronchioles and alveoli d. Formation of blebs or bullae on the lung surface 57. What are typical pathological changes with bronchiectasis? a. Bronchospasm and increased mucous secretion b. Adhesions and fibrosis in the pleural membranes c. Airway obstructions and weak, dilated bronchial walls d. Fixation of the ribs in the inspiratory position 58. Which of the following are significant signs of bronchiectasis? a. Persistent nonproductive cough, dyspnea, and fatigue b. Persistent purulent nasal discharge, fever, and cough c. Chronic cough, producing large quantities of purulent sputum d. Wheezing and stridor 59. Why does cor pulmonale develop with chronic pulmonary disease? a. The right ventricle pumps more blood than the left ventricle. b. Pulmonary fibrosis and vasoconstriction increase vascular resistance. c. Demands on the left ventricle are excessive. d. Blood viscosity is increased, adding to cardiac workload. 60. Restrictive lung disorders may be divided into two groups based on: a. patient history of obesity and exposure to other COPD. b. smoking history and congenital defects. c. previous lung disease and cardiovascular disorders. d. anatomical abnormality and lung disease damage, impairing expansion. 61. What is caused by frequent inhalation of irritating particles such as silica? a. Fibrosis and loss of compliance b. Frequent bronchospasm c. Increased number of mucus-producing glands d. Distorted shape of the thorax 62. Pulmonary edema causes severe hypoxia because of: a. decreased diffusion of carbon dioxide from the alveoli. b. interference with expansion of the lungs. c. constant cough and hemoptysis. d. decreased recoil of lungs and ineffective expiration. 63. Which of the following is NOT a cause of pulmonary edema? a. Left-sided congestive heart failure b. Excessive blood volume (overload) c. Inhalation of toxic gases d. Hyperproteinemia and increasing osmotic pressure of the blood 64. Which of the following is a common source of a pulmonary embolus? a. Mural thrombus from the left ventricle b. Thrombus attached to atheromas in the aorta or iliac arteries c. Thrombus forming in the femoral veins d. A blood clot in the pulmonary vein 65. What is a large-sized pulmonary embolus likely to cause? a. Hypertension and left-sided heart failure b. Atelectasis and respiratory failure c. Hypotension and right-sided heart failure d. Pleural effusion and atelectasis 66. Which manifestation(s) of atelectasis is/are associated with airway obstruction? a. Bradycardia and dyspnea b. Tracheal deviation toward the unaffected side c. Decreased breath sounds on the affected side d. Rales and rhonchi 67. How does total obstruction of the airway lead to atelectasis? a. Decreased surfactant production impairs lung expansion. b. The involved lung is compressed. c. Air is absorbed from the alveoli distal to the obstruction. d. Air continues to be inspired but is trapped distal to the obstruction. 68. How does a large pleural effusion lead to atelectasis? a. The cohesion between the pleural membranes is disrupted. b. There is decreased intrapleural pressure. c. The mediastinal contents compress the affected side. d. Pleuritic pain causes very shallow breathing. 69. When does flail chest usually occur? a. An open puncture wound involves the pleural membranes. b. The visceral pleura is torn by a fractured rib. c. Several ribs are fractured at two sites. d. Increasing fluid in the pleural cavity causes atelectasis. 70. With a flail chest injury, events during inspiration include which of the following? a. Air is sucked into the lung through the chest wall. b. The mediastinum shifts toward the unaffected side. c. The floating segment is pushed outward. d. The trachea deviates toward the affected side. 71. How is cardiac output reduced with a flail chest injury? a. Atelectasis compresses the heart. b. Venous return is impaired. c. Intrapleural pressure is decreased. d. Air pressure continues to increase in the pleural space. 72. Which of the following is a manifestation of a simple closed pneumothorax? a. Decreased respiratory rate b. Tracheal deviation toward the unaffected lung c. Asymmetrical chest movements d. Increased breath sounds on the affected side 73. Which of the following is an effect of a large open pneumothorax (sucking wound)? a. Mediastinal flutter, impairing venous return b. Increased venous return c. Progressive atelectasis of both lungs d. Overexpansion of the unaffected lung 74. With a tension pneumothorax, which factors contribute to severe hypoxia? a. Decreasing compression of the inferior vena cava b. More air leaving the pleural cavity on expiration than entering with inspiration c. Shift of the mediastinal contents toward the affected lung d. Continually increasing pressure on the unaffected lung 75. Which of the following statements describe the pathophysiology of adult respiratory distress syndrome? 1. Damage leading to increased permeability of the alveolar capillary membranes 2. Decreased surface tension in the alveoli 3. Excessive fluid and protein interstitially and in the alveoli 4. Multiple diffuse hemorrhages in the lungs a. 1, 2 b. 1, 3 c. 2, 3 d. 3, 4 76. Infant respiratory distress syndrome results from: a. insufficient surfactant production. b. incomplete expiration shortly after birth. c. retention of fluid in the lungs after birth. d. immature neural control of respirations. 77. Obstruction in the upper airway is usually indicated by: a. stridor. b. rales. c. wheezing. d. orthopnea. 78. Which of the following does NOT apply to carbon dioxide? a. It diffuses across membranes much more easily than does oxygen. b. It is carried in blood as carbaminohemoglobin. c. It can be converted into bicarbonate ion. d. It is replaced on hemoglobin by oxygen in the lungs. 79. Whenever PO2 levels decrease below normal, PCO2 levels: a. increase. b. decrease also. c. may or may not change. d. increase slightly. 80. Laryngotracheobronchitis is typically manifested by: a. drooling and difficulty swallowing. b. hoarse voice and barking cough. c. sore and scratchy throat with fever. d. wheezing and dyspnea. 81. Lobar pneumonia is usually caused by: a. Mycoplasma pneumoniae. b. Streptococcus pneumoniae. c. Legionella pneumophila. d. Pneumocystis carinii. 82. Severe acute respiratory syndrome (SARS) is caused by a/an: a. rhinovirus. b. mycoplasma. c. influenza virus. d. coronavirus. 83. SARS typically begins as a flulike syndrome followed, after a few days, by: a. increased exudates in the bronchial tree and pleural cavity. b. productive cough and lobar consolidation. c. interstitial lung congestion, dyspnea, and dry cough. d. hemoptysis and necrosis of mucous membrane. 84. In addition to effects on the lungs and pancreas, cystic fibrosis results in: a. excess bile production. b. high sodium chloride content in saliva and sweat. c. gastric ulcers. d. frequent ear and sinus infections. 85. Which of the following is a significant early sign of bronchogenic carcinoma in a smoker? a. Frequent nonproductive cough b. Fever, dyspnea, generalized aching c. Production of large volumes of purulent sputum d. Hemoptysis and weight loss 86. Which of the following is likely to cause pneumothorax or hemothorax in a patient with bronchogenic carcinoma? a. The tumor obstructs a major bronchus. b. Compression of lung tissue by the tumor causes atelectasis. c. The tumor causes inflammation and erosion of the pleural membranes. d. Inflammation around the tumor causes exudate in the small bronchi. 87. Which of the following would confirm a diagnosis of primary tuberculosis? a. A positive tuberculin skin test b. Occurrence of hemoptysis c. Unproductive cough with absence of sputum d. Small areas of calcification on a chest X-ray 88. Which of the following drugs is usually prescribed for prophylaxis in persons in close contact with a patient with active tuberculosis? a. Streptomycin b. Isoniazid c. Rifampin d. Streptomycin 89. Which of the following statements is FALSE? a. TB bacilli are spread by oral droplet. b. TB bacilli are slow-growing bacteria. c. Active TB must be treated in hospital for many months. d. Active TB can be prevented by good host resistance. 90. Choose the correct reason for severe hypoxia occurring with pulmonary edema: a. Diffusion of oxygen into the alveoli is impaired. b. Fluid in the pleural cavity prevents normal lung expansion. c. Increased concentration of CO2 impairs diffusion of oxygen. d. Increased blood flow through the lungs prevents diffusion of gases. 91. Which of the following drugs in an inhaler would likely be carried by individuals to provide immediate control of acute asthma attacks? a. A glucocorticoid b