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247 Cards in this Set

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1. Which secretion provides antibacterial and antifungal fatty acids as well as lactic acid to provide a first line of defense:
a. Tears
b. Saliva
c. Perspiration
d. Sebaceous glands
Sebacious Glands
a. Skin cells – dead skin cells shed thus removing adherent ______________
bacteria
a. Mucus membranes – normal turnover of cells ____________ the surface my mechanically removing many microorganisms.
washing
a. GU – vomiting ___________ eliminates ingested pathogens
mechanically
b. GI – Urination mechanically ______________
cleansing
b. Hairlike cilia in the respiratory tract move mucus that _____________ microorganisms to be expelled by coughing or sneezing.
traps
2. Body fluids defend the body from pathogens by the _________ (acid or basic) pH that makes an inhospitable environment.
acidic (3-5)
2. True or False. Many of the normal bacterial flora in the intestines produce vitamin K (for clotting) and assist in the absorption of calcium, iron and magnesium.
True
2. When normal intestinal flora is altered by prolonged antibiotic treatment, ______________ (yeast) and ___________ (bacterium) are two microorganisms that can have overgrowth
Candida Albicans
Clostridium Difficile
3. True or False. Normal flora in the GI tract produce chemicals that inhibit colonization of pathogenic microorganisms.
True
3. Inflammation is nonspecific meaning that it takes place in approximately the same way regardless of the type of injury. Injury that results in the inflammatory response includes ______________ from various types of microorganisms, mechanical damage, _____________ deprivation, nutritional deprivation, _______________ or immune defects, chemical agents, __________________ extremes, or radiation exposure.
Infection
Oxygen
Genetic
Tempurature
3. The cardinal signs of inflammation are ________________, _________________, swelling/edema and __________________.
Redness
Heat
Pain
3. What causes the edema that occurs during the inflammatory process?
a. Vasoconstriction
b. Increased capillary permeability
c. Endothelial cell contraction
d. Emigration of neutrophils
Increase capillary permeability
What is pus made of? _________________ _______________
Cellular Infiltrates (WBC's)
4. All of the following are essential plasma protein systems EXCEPT:
a. Complement system
b. Mast cell system
c. Clotting system
d. Kinin system
Mast Cell System
4. Activation of the complement system can occur in all of the listed pathways EXCEPT:
a. Activated by proteins of the acquired immune system (antibodies) bound to their specific targets (antigens)
b. Activated by certain bacterial carbohydrates
c. Activate by gram negative bacterial and fungal cell wall polysaccharides
d. Activated by macrophage destruction
Activated by macrophage destruction
4. What is the outcome of the complement cascade?
a. Activates the clotting cascade
b. Prevents the spread of infection to adjacent tissues
c. Inactivates chemical mediators such as histamine
d. Attacks bacterial cell membranes (causing cell lysis)
Attacks bacterial cell membranes (causing cell lysis)
4. The outcome of the clotting cascade includes all EXCEPT:
a. Prevents the spread of infection to adjacent tissues
b. Traps microorganisms and foreign bodies for removal by infiltrating cells (neutrophils & macrophages)
c. Tags microorganisms for destruction
d. Forms a clot that stops bleeding
e. Provides a framework for future healing
Tags microorgnaism for destruction
4. Which component of the plasma protein system tags pathogenic microorganisms for destruction by neutrophils and macrophages?
a. Complement cascade
b. Clotting system
c. Kinin system
d. Immune system
Complement Cascade
"opsonins"
4. Which chemical mediators induce pain during an inflammatory response?
a. Prostaglandins and bradykinin
b. Leukotienes and serotonin
c. Tryptase and histamine
d. Phospholipase and prostacyclin
Prostaglandins and Bradykinin
True or False. Mast cells play a very large role in tissue response to injury and in the proliferation of tissue after injury.
True
5. True or False Chemotactic factor released from the mast cell attract neutrophils or eosinophils to the site of inflammation.
True
5. Essential fatty acids and inflammation: Which fatty acid chain may improve health and reduce the risk of cardio vascular disease and cancer?
a. Omega 3 fatty acid
b. Omega 6 fatty acid
Omega 3 Fatty Acid
5. Place the steps of phagocytosis in the correct order
a. Destruction of the target
b. Adherence of the phagocyte to the target
c. Isolation of target within membrane bound vesicles (to protect the phagocyte from self digestion)
d. Engulfment (ingestion)
e. Opsonization (recognition of the target cell)
f. Fusion with lysosomal granules with in the phagocyte
1. Opsonization (recognition of the target cell)
2. Adherence of the phagocyte to the target
3. Engulfment (ingestion)
4. Fusion with lysosomal granules with in the phagocyte
5. Isolation of target within membrane bound vesicles (to protect the phagocyte from self digestion)
6. Destruction of the target
The predominant phagocyte
Neutrophils
Is a phagocyte that arrives to site of injury within 6-12 hours of injury
Neutrophils
Is a phagocyte that may arrive to site of injury as early as 24 hours after injury but usually arrive 3-7 days after injury.
Monocytes
body’s primary defense against parasite
Eosinophils
regulate vascular mediators released from mast cells
Eosiniphils
least prevalent granulocyte
Basophils
associated with allergies and asthma but primary role is unknown
Basophils
functions to recognize and eliminate cells infected with viruses and abnormal host cells (cancer cells)
Natural Killer Cells
6. When looking at white blood cell differentials, nurses know that individuals have early, acute inflammatory reactions when they notice elevations of which leukocyte?
a. Monocytes
b. Eosinophils
c. Neutrophils
d. Basophils
Neutrophils
6. Which of the following about cytokines is not true?
a. There are three categories of cytokines: interleukins, interferons and other (ex. Tumor necrosis factor)
b. Interferons protect against viral infection
c. Interleukins & other cytokines are endogenous pyrogens and react with the hypothalamus and affect the body’s thermostat.
d. Interleukins only have effects on pathogenic microoganisms.
Interleukins only have effects on pathogenic microoganisms.
6. Which manifestation of inflammation is systemic?
a. Formation of exudates
b. Fever and leukocytosis
c. Redness and heat
d. Pain and edema
Fever and Leukocytosis
True or False A “left shift” in the WBC differential refers to increase in immature WBC in relation to the number of mature WBCs. The production of immature WBC (granulocytes and monocyte precursors) occurs in the bone marrow in response to inflammation (from disease)
False
7. True or False Several bacteria, such as Mycobacterium tuberculosis, are resistant to killing by granulocytes and can survive inside macrophages.
True
wound edge separation which is caused by infection 50% of the time.
Dehiscence
the body’s attempt to wall off and isolate an infected area forms a ________
Granuloma
Healthy connective tissue that grows inward at the beginning of the healing process
Granlulation Tissue
the most abundant protein in the body that forms crosslinks by intermolecular bonds to add strength along the lines of mechanical stress.
Collagen
the inward movement of the wound edge occurring as the final process of the reconstructive phase of healing
Contraction
phagocytosis of particulate matter found at the site of injury including dissolution of the scab
Debridement
accumulation of fibrin after hemorrhage that forms fibrous bands that shrink with time and cause problems
to organs.
Adhesions
a raised scar caused by overproduction of collagen
Keloid
excessive wound contraction results in ________________ and can best prevented through ROM exercises (prevention is more effective than treatment after development)
Contracture
that synthesize and secrete collagen and other connective tissue proteins cells
fibroblasts
Healing condition of minimal tissue loss
Primary Intention
1. True or False Antibodies cannot protect a host against viral infection.
False
1. True or False Another name for antibody is immunoglobulin
True
1. The primary characteristic that differentiates the immune response from other protective mechanisms is that the immune response is :
a. Similar each time it is activated
b. Specific to the antigen that initiates it.
c. A short term response to a specific pathogen
d. An innate response, rather than acquired
Specific to the antigen that initiates it
1. Figure 7-2 Lymphoid stem cell produced in the bone marrow migrate to the central lymphoid organs and undergo a series of cellular divisions and differentiation stages resulting in either immunocompetent T cells from the ____________________ or immunocompetent B cells from the ________________.
Thymus
Bone Marrow
1. B lymphocytes mature and undergo changes that commit them ot becoming B cell s in the:
a. Thymus gland
b. Regional lymph nodes
c. Bone marrow
d. spleen
Bone Marrow
1. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen?
a. Passive acquired
b. Active acquired
c. Passive innate
d. Active innate
Active Acquired
1. What type of immunity is produce when an immunoglobulin crosses the placenta?
a. Passive acquired
b. Active acquired
c. Passive innate
d. Active innate
Passive Acquired
1. The most important determinant of immunogenicity is the antigen’s:
a. Size
b. Foreignness
c. Complexity
d. Quantity
Fireignness
1. When antigens are administered to individuals to produce immunity, why are different routes of administration used (eg. Some are given intravenously, whereas others are given subcutaneously or nasally.)
a. Different routes allow the speed of onset of the antigen to be varied, with the intravenous route being the fastest.
b. Some individuals appear to be unable to respond to an antigen by a specific route, thus requiring the availability of different routes for the same antigen
c. Antigen-presenting cells are highly specialized and thus require stimulation by different routes.
d. Each route stimulates a different lymphocyte-containing tissue resulting in different types of cellular and humoral immunity.
Each route stimulates a different lymphocyte-containing tissue resulting in different types of cellular and humoral immunity.
1. Antibodies are produced in
a. Helper T lyphocytes
b. The thymus gland
c. Plasma cells
d. The bone marrow
Plasma Cells
1. Which immunoglobulin is present in blood, saliva, breast milk and respiratory secretions?
a. IgA
b. IgE
c. IgG
d. IgM
IgA
1. Which antibody idicates a typical primary immune response?
a. IgG
b. IgM
c. IgA
d. IgE
IgM
1. If a person had very low levels of Ig____, that individual is more susceptible to infections of the mucous membranes.
a. G
b. M
c. A
d. E
A
1. Table 7-6 The difference between clonal diversity and clonal selection is:
a. Clonal diversity occurs primarily in the fetus
b. Diversity is the production of large number of T and B lymphocytes that are capable of the maximum diversity of antigen receptors and selection is the antigen specific T and B lymphocytes
c. Foreign antibodies are involved in diversity but not selection
d. Clonal selection arises from clonal selection
Diversity is the production of large number of T and B lymphocytes that are capable of the maximum diversity of antigen receptors and selection is the antigen specific T and B lymphocytes
1. Table 7-5 All of the following about Cytokines (Interleukins, Interferons, tumor necrosis factor)are true EXCEPT
a. Stimulate differentiation of T cell
b. Stimulate differentiation n of B cell
c. Attract neutrophils by chemotactic factor
d. Play a minor, non-essential role in immune response
Play a minor, non-essential role in immune response
1. When a person is exposed to most antigens, how long does it take before an antibody can be detected in the blood?
a. 12 hours
b. 24 hours
c. 3 days
d. 6 days
6 Days
1. Vaccinations are able to provide protection against certain microorganisms because of the
a. Strong response from IgM
b. Level of protection provided by IgG
c. Memory cells for IgE
d. Rapid response from IgA
Level of Protection provided by IgG
1. Some viruses, such as measles and herpes, are inaccessible to antibodies after the initial infection because they:
a. Do not circulate in the blood
b. Do not have antibody receptors
c. Resist agglutination
d. Are soluble antigens
Do not circulate in the blood (In the Cells)
1. Which is an example of a bacterial toxin that has been inactivated, but still retains its immunogenicity to protect the person?
a. Poliomyelitis
b. Measles
c. Tetanus
d. Gonorrhea
Tetanus
1. Antibodies protect the host from bacterial toxins by:
a. Lysing the cell membrane of the toxins
b. Binding to the toxins to neutralize their biologic effects
c. Inhibiting the synthesis of DNA proteins needed for growth
d. Interfering with the DNA enzyme needed for replication
Binding to the toxins to neutralize their biologic effects
1. Which T cell controls or limits the immune response to protect the host’s own tissues against an autoimmune response?
a. Cytotoxic T cells
b. TH1 cells
c. Th2 cells
d. Regulatory t (treg) cells
Regulatory T Cells (treg)
1. At birth, samples of cord blood from the umbilical cord (fetal blood) indicate which immunoglobulin levels, if any are near adult levels?
a. Non of the immunoglobulins
b. IgG
c. IgM
d. IgG
IgG
1. Increased age may cause all of the following changes in lymphocyte function EXCEPT?
a. Decrease in T cell activity
b. Decreased number of circulating T cells
c. Decreased B cell function in response to specific antigen
d. Increased circulating autoantibodies
Decreased number of circulating T cells
Crosses the placenta (antibody)
IgG
Is the first antibody produced during initial or primary response to an antigen
IgM
Mediates many common allergic responses (Antibody)
IgE
1. True or False Atopic individuals tend to produce higher levels of IgM.
False
1. True or False Immunodeficiencies can be congenital or acquired.
True
1. True or False Persons with blood type O are considered universal recipients.
False
2. Hypersensitivity is best defined as a(n):
a. disturbance in the immunologic tolerance of self-antigens.
b. immunologic reaction of one person to the tissue of another person.
c. altered immunologic response to an antigen that results in disease.
d. undetectable immune response in the presence of antigens.
altered immunologic response to an antigen that results in disease
2. The systemic hypersensitivity reaction that occurs after a person who is allergic to bee stings is stung by a bee is called:
a. hemolytic shock.
b. anaphylaxis.
c. necrotizing vasculitis.
d. systemic erythematosus.
Anaphylaxis
2. Common hay fever allergy is expressed through a reaction that is mediated by:
a. IgE
b. IgM
c. IgG
d. T cells
IgE
2. The class of antibody involved in type I hypersensitivity reactions is:
a. IgA
b. IgE
c. IgG
d. IgM
IgE
2. During an IgE-mediated hypersensitivity reaction, which leukocyte is activated?
a. Neutrophils
b. Monocytes
c. Eosinophils
d. T lymphocytes
Eosiniphils
2. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm?
a. Bronchial edema caused by chemotactic factor of anaphylaxis
b. Bronchial edema caused by binding of the cytotropic antibody
c. Smooth muscle contraction caused by histamine bound to H1 receptors
d. Smooth muscle contraction caused by histamine bound to H2 receptors
Smooth muscle contraction caused by histamine bound to H1 receptors
2. During an IgE-mediated hypersensitivity reaction, the degranulation of mast cells is a result of the action of _____ receptors.
a. histamine bound to H2
b. chemotactic factor of anaphylaxis bound to
c. epinephrine bound to mast cell
d. acetylcholine bound to mast cell
Histamine bound to H2
2. What is a characteristic of atopic individuals who are genetically predisposed to develop allergies?
a. They produce greater quantities of histamine than other individuals.
b. They have more histamine receptors than other individuals.
c. They produce greater quantities of IgE than other individuals.
d. They have a deficiency in epinephrine compared with other individuals
They produce greater quantities of IgE than other individuals.
2. What is the mechanism in type II hypersensitivity reactions?
a. Antibodies coat mast cells by binding to receptors that signal its degranulation followed by discharge of preformed mediators.
b. Antibodies bind to soluble antigens that were released into body fluids and the immune complexes are deposited in the tissues.
c. Cytotoxic T lymphocytes or lymphokines-producing Th1 cells attack and destroy cellular targets directly.
d. Antibodies bind to the antigens on the cell surface.
Antibodies bind to the antigens on the cell surface.
2. In a type II hypersensitivity reaction, when soluble antigens from infectious agents enter circulation, tissue damage is a result of:
a. complement-mediated cell lysis.
b. phagocytosis by macrophages.
c. phagocytosis in the spleen.
d. neutrophil granules and toxic oxygen products.
neutrophil granules and toxic oxygen products.
2. In a type II hypersensitivity reaction, that is an antibody-dependent cell-mediated cytotoxicity (ADCC), target cells are destroyed by:
a. complement-mediated cell lysis.
b. phagocytosis by macrophages.
c. neutrophil granules and toxic oxygen products.
d. natural killer cells.
natural killer cells.
2. What is the mechanism in type III hypersensitivity reactions?
a. Antibodies coat mast cells by binding to receptors that signal its degranulation followed by discharge of preformed mediators.
b. Antibodies bind to soluble antigens that were released into body fluids and the immune complexes are deposited in the tissues.
c. Cytotoxic T lymphocytes or lymphokine-producing Th1 cells attack and destroy cellular targets directly.
d. Antibodies bind to the antigen on the cell surface.
Antibodies bind to soluble antigens that were released into body fluids and the immune complexes are deposited in the tissues.
2. What is the mechanism in type IV hypersensitivity reactions?
a. Antibodies coat mast cells by binding to receptors that signal its degranulation followed by discharge of preformed mediators.
b. Antibodies bind to soluble antigens that were released into body fluids and the immune complexes are deposited in the tissues.
c. Cytotoxic T lymphocytes or lymphokine-producing Th1 cells attack and destroy cellular targets directly.
d. Antibodies bind to the antigen on the cell surface.
Cytotoxic T lymphocytes or lymphokine-producing Th1 cells attack and destroy cellular targets directly.
2. In a type III hypersensitivity reaction, the harmful effects after the immune complexes are deposited in tissues are a result of:
a. cytotoxic T cells.
b. natural killer cells.
c. complement activation.
d. degranulation of mast cells.
complement activation.
2. What mechanism occurs in Raynaud phenomenon that classifies it as a type III hypersensitivity reaction?
a. Immune complexes are deposited in capillary beds, blocking circulation.
b. Mast cells bind to specific endothelial receptors that cause them to degranulate, creating a localized inflammatory reaction that occludes capillary circulation.
c. Cytotoxic T lymphocytes attack and destroy the capillaries so that they are unable to perfuse local tissues.
d. Antibodies detect the capillaries as foreign protein and destroy them using lysosomal enzymes and toxic oxygen species.
Immune complexes are deposited in capillary beds, blocking circulation.
2. When a tuberculin skin test is positive, the hard center and erythema surrounding the induration are a result of:
a. histamine.
b. T lymphocytes and macrophages.
c. immune complexes.
d. products of complement.
T lymphocytes and macrophages.
2. Pg 265 In families in which one parent has an allergy, allergies develop in about _______% of offspring. If both parents have allergies, the incidence in the offspring may be as high as _____%.
40%
80%
2. Although not directly answered in the text – page 265 provides information for you to make an educated guess. For a patient with a history of anaphylactic reaction, which of the following treatments demonstrates the fact that for a current reaction the primary mechanism for control is autonomic nervous system (prevention vs treatment approach).
a. Oral Benadryl administration (antihistamine)
b. Epinephrine given SQ
c. Singulair (leukotreine inhibitor)
d. Intal (Mast cell stabilizer)
Epi given SubQ
1. What disease involves the deposition of circulating immune complexes containing an antibody against host DNA, resulting in tissue damage?
a. Hemolytic anemia
b. Pernicious anemia
c. Systemic lupus erythematosus (SLE)
d. Myasthenia gravis
Systemic Lupus Erythematosus (SLE)
3. Which blood cell carries the carbohydrate antigens for blood type?
a. Platelets
b. Neutrophils
c. Lymphocytes
d. Erythrocytes
Erythrocytes
3. Figure 8-8 A person with type O blood is likely to have high titers of anti-___ antibodies.
a. A
b. B
c. A and B
d. O
A and B
3. Which component of the immune system is deficient in people with infections caused by viruses, fungi, or yeast?
a. NK cells
b. Macrophages
c. B cells
d. T cells
T-Cells
2. By _____ months, the newborn is sufficiently protected by antibodies produced by its own B cells.
a. 1 to 2
b. 4 to 5
c. 6 to 8
d. 10 to 12
6 to 8
2. Considering the effects of nutritional deficiencies on the immune system, severe deficits in calories and protein lead to deficiencies in the formation of which immune cells?
a. B cells
b. T cells
c. NK cells
d. Neutrophils
T-Cells
2. Deficiencies in which element can produce depression of both B- and T-cell function?
a. Iron
b. Zinc
c. Iodine
d. Magnesium
Zinc
Congenital immune deficiency
Agammaglobulinemia
Type IV hypersensitivity
Poison ivy
Type III hypersensitivity
Raynaud phenomenon
Type II hypersensitivity
Graves disease
Type I hypersensitivity
Urticaria
1. True or False Viruses have no metabolism and are incapable of independent reproduction.
True
1. True or False All viruses have a protein receptor binding site on their surface that adheres to specific binding site on the host cell.
True
1. True or False One person with HIV cannot transmit the virus to others until HIV antibodies are detected.
False
1. True or False Antibodies to HIV appear within weeks of transmission through blood products, but within months after sexual transmission.
True
1. What of the following remains a significant cause of morbidity and mortality worldwide?
a. Starvation
b. Traumatic injury
c. Cardiovascular disease
d. Infectious disease
Infectious Disease
1. For which microorganisms is the skin the site of reproduction?
a. Viruses
b. Bacteria and fungi
c. Protozoa and rickettsiae
d. Mycoplasma
Bacteria and Fungi
1. Once they have penetrated the first line of defense, which microorganisms do neutrophils actively attack, engulf, and destroy by phagocytosis?
a. Bacteria
b. Fungi
c. Viruses
d. Mycoplasma
Bacteria
1. Once they have penetrated the first line of defense, which microorganisms do natural killer (NK) cells actively attack?
a. Bacteria
b. Fungi
c. Viruses
d. Mycoplasma
Viruses
1. Which are characteristics of exotoxins?
a. They are contained in cell walls of gram-negative bacteria.
b. They are released during the lysis of bacteria.
c. They can initiate the complement and coagulation cascades.
d. They are released during bacterial growth.
They are released during bacterial growth
1. Which statement is true about fungal infections?
a. They occur only on skin, hair, and nails.
b. They are controlled by phagocytes and T lymphocytes.
c. They result in release of endotoxins.
d. They are be prevented by vaccines.
They are controlled by phagocytes and T-lymphocytes
1. Cytokines are thought to raise the thermoregulatory set point to cause fever by stimulating the synthesis of which chemical mediator?
a. Leukotriene
b. Histamine
c. Prostaglandin
d. Bradykinin
Prostaglandin
1. One systemic manifestation of an acute inflammatory response is fever that is produced by:
a. endogenous pyrogens acting directly on the hypothalamus.
b. exogenous pyrogens acting directly on the hypothalamus.
c. immune complexes acting indirectly on the hypothalamus.
d. cytokines acting indirectly on the hypothalamus.
endogenous pyrogens acting directly on the hypothalamus.
1. Which statement about vaccines is true?
a. Most bacterial vaccines contain attenuated organisms.
b. Most viral vaccines are made by using dead organisms.
c. Vaccines require booster injections to maintain lifelong protection.
d. Vaccines provide effective protection for all people against viruses, bacteria, and fungal infections.
Vaccines require booster injections to maintain lifelong protection.
1. What is the role of reverse transcriptase in HIV infection?
a. It converts single DNA into double-stranded DNA.
b. It is needed to produce integrase.
c. It transports the RNA into the cell nucleus.
d. It converts RNA into double-stranded DNA.
It converts RNA into double-stranded DNA.
1. Which secretion transmits human immunodeficiency syndrome?
a. Sweat
b. Urine
c. Saliva
d. Breast milk
Breast Milk
1. A major immunologic finding in AIDS is the striking decrease in the number of which cells?
a. Macrophages
b. CD8+ T cells
c. CD4+ Th cells
d. Memory T cells
CD4+ Th cells
1. HIV antibodies appear within ______ weeks after infection through blood products.
a. 1 to 2
b. 4 to 7
c. 10 to 12
d. 20 to 24
4 to 7
1. After sexual transmission of HIV, a person can be infected yet seronegative for _____ months.
a. 1 to 2
b. 6 to 14
c. 18 to 20
d. 24 to 36
6 to 14
2. Pg 294 What percent of strep pneumo, a common cause of otitis media, pneumonia and bactermia is resistant to penicillin?
a. 10%
b. 25%
c. 55%
d. 75%
25%
3. Pg 309 Vaginal candida is normal flora in 20% of healthy women. Although the text does not list all of the contributing factors to vaginal yeast infections – make a guess keeping in mind what can contribute to pH changes in the vagina. All of the following can lead to vaginal overgrowth of candida EXCEPT?
a. Absence of normal bacterial flora that produce antifungal agents (often secondary to antibiotic use)
b. Vaginal douching
c. Elevations in blood sugar
d. Frequent intercourse
e. Intake of lactobaclillus
Intake of Lactobacillus
Ability of the pathogen to invade and multiply in the host
Virulence
Potency of a pathogen measured in terms of the number of microorganisms or micrograms of toxin required to kill the host
Infectivity
An important factor in determining a pathogen's ability to produce disease by production of a soluble toxin
Toxigenicity
The ability of an agent to produce disease
Pathogenicity
the period when the body has successfully removed the infectious agent and symptoms decline
Convalescence
the occurrence of initial symptoms – often mild and include a feeling of discomfort and tiredness.
Prodromal stage
the period from initial exposure to an infectious agent when the pathogen numbers are not yet high enough to cause the onset of symptoms
Incubation period
the pathogen is multiplying rapidly, immune & inflammatory responses are being triggered, symptomatic period
Invasion period
1. True or False Flight or fight occurs in the exhaustion stage in the general adaptation syndrome (GAS)
False
1. True or False A person does not have a stress reaction unless the stress exceeds his or her coping abilities.
True
1. True or False The decrease in insulin during a stress response prevents glucose from being taken up by peripheral tissue so that more glucose will be available for the CNS.
True
1. True or False For catecholamines to be immunosuppressive, their levels must be chronically elevated
True
1. True or False Stress and negative emotions have not been associated with the production of increased levels of proinflammatory cytokines.
False
1. True or False Lymphocytes secrete growth hormone (GH), prolactin, adrenocorticotropic hormone (ACTH), and endorphins.
True
1. True or False Studies have shown a relationship between depression and reduction in lymphocyte proliferation and natural killer (NK) cell activity.
True
1. True or False Stress has no effect on the development of cancer.
False
1. Exhaustion occurs if stress continues and _____ is not successful.
a. flight or fight
b. alarm
c. adaptation
d. arousal
Adaption
1. The _____ is stimulated during the alarm phase of the GAS?
a. adrenal cortex
b. hypothalamus
c. anterior pituitary
d. limbic system
Hypothalamus
1. During a stress response, increased anxiety, vigilance, and arousal is prompted by:
a. norepinephrine.
b. epinephrine.
c. cortisol.
d. ACTH.
Norepinephrine
1. Perceived stress elicits an emotional, anticipatory response that begins in the:
a. prefrontal cortex.
b. anterior pituitary.
c. limbic system.
d. hypothalamus.
Limbic System
1. During a stress response, which hormone decreases lymphocytes, eosinophils, and macrophages and prostaglandin?
a. ACTH
b. Cortisol
c. Prolactin
d. Growth hormone
Cortisol
1. The effect that low serum albumin has on the central stress response is to:
a. impair circulation of epinephrine and norepinephrine.
b. impair wound healing.
c. lessen circulation of cortisol.
d. diminish oncotic pressure.
impair circulation of epinephrine and norepinephrine.
1. The effect epinephrine has on the immune system during stress response is to increase:
a. NK cells.
b. immunoglobulins.
c. cytokines.
d. helper T cells.
NK Cells
1. Stress-induced norepinephrine results in:
a. decreased blood flow to the brain and skin
b. peripheral vasoconstriction.
c. increased glycogen synthesis in the liver.
d. decreased muscle contraction as a result of an energy depletion.
Peripheral Vasoconstriction
1. What is the effect of increased secretions of epinephrine, glucagon, and growth hormone?
a. Hyperglycemia
b. Hypertension
c. Bronchodilation
d. Pupil dilation
Hyperglycemia
1. Which hormone increases the formation of glucose from amino acids and free fatty acids?
a. Epinephrine
b. Norepinephrine
c. Cortisol
d. Growth hormone
Cortisol
1. The _____ (gland) regulates the immune response and mediates the apparent effects of circadian rhythms on immunity.
a. anterior pituitary
b. adrenal
c. basal ganglia
d. pineal
Pineal (Melatonin)
1. The action of which hormone helps explain increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory diseases in women as a result of stimulation of the CRH gene promoter and central norepinephrine system?
a. Progesterone
b. Cortisol
c. Estrogen
d. Prolactin
Estrogen
1. Which statement is true about the differences between stress-induced hormonal alterations of men and women?
a. After injury, women produce more proinflammatory cytokines than men, a profile that is associated with poor outcomes.
b. Androgens appear to reduce a greater degree of immune cell apoptosis following injury, creating greater immunosuppression in injured men than women.
c. Psychologic stress associated with some types of competition decreases both testosterone and cortisol especially in athletes older than 45 years of age.
d. After stressful stimuli, estrogen is increased in women, but testosterone is decreased in men.
Androgens appear to reduce a greater degree of immune cell apoptosis following injury, creating greater immunosuppression in injured men than women.
1. Stress-age syndrome results in decreased:
a. catecholamines.
b. ACTH.
c. cortisol.
d. immune system.
Immune System
Constricts peripheral vessels to increase blood pressure
Norepinephrine
Increases cardiac output by increasing heart rate and myocardial contractility
Epinephrine
Increases gastric secretions
Cortisol
2. True or False Androgens and estrogen have NO effect on the immune system
False
1. True or False Anaplasia is recognized by loss of organization and a marked increase in nuclear size.
True
1. True or False Some tumors initially described as benign can progress to malignant tumors.
True
1. True or False Cancer is predominantly a disease of aging.
True
1. True or False For the function of tumor suppressor genes to be lost, only one chromosome (allele) of the gene must be inactivated.
False
1. True or False Most cancers must acquire mutation in six distinct areas: growth signals, antigrowth signals, evading apoptosis, replicating ability, angiogenesis, and invasion and metastasis.
True
1. True or False Invasion is a prerequisite for metastasis.
True
1. True or False As a tumor increases in size, some cells undergo apoptosis. The only cells to survive and multiply are those with mutations to one copy of the TP53 gene.
False
1. True or False The term neoplasm can refer to a benign tumor.
True
1. True or False Cells with mutant TP53 genes escape apoptosis.
True
1. True or False All tumor cells that are released into the blood eventually find a compatible tissue to multiply in and create a tumor.
False
1. True or False Breast cancer cells metastasize to the bone because the chemokines released by the bone attract breast cells to it.
True
1. True or False Terminal cancers eventually produce pain.
True
1. True or False Infection is the most significant cause of complications and death in individuals with cancer.
True
1. Which of the following cancers originate from connective tissue?
a. Osteogenic sarcoma
b. Basal cell carcinoma
c. Multiple myeloma
d. Adenocarcinoma
Osteogenic sarcoma
1. Carcinoma refers to abnormal cell proliferation originating from which tissue origin?
a. Blood vessels
b. Epithelial cells
c. Connective tissue
d. Glandular tissue
Epithelial Cells
1. What are characteristics of cancer in situ?
a. Cells have broken through the local basement membrane.
b. Cells have invaded immediate surrounding tissue.
c. Cells remain localized in the glandular or squamous cells.
d. Cellular and tissue changes indicate dysplasia.
Cells remain localized in the glandular or squamous cells.
1. Cells from a muscle tumor show a reduced ability to form new muscle and appear highly disorganized. This is an example of:
a. dysplasia.
b. hyperplasia.
c. myoplasia.
d. anaplasia.
Anaplasia
1. What are tumor cell markers?
a. Hormones, enzymes, antigens, and antibodies produced by cancer cells
b. Receptor sites on tumor cells that can be identified and marked
c. Cytokines produced against cancer cells
d. Identification marks used in administering radiation therapy
Hormones, enzymes, antigens, and antibodies produced by cancer cells
1. Tumor cell markers are used to:
a. provide a definitive diagnosis of cancer.
b. treat certain types of cancer.
c. predict where cancers will develop.
d. screen individuals at high risk for cancer.
screen individuals at high risk for cancer.
1. Intestinal polyps are benign neoplasms and the first stage in development of colon cancer. These findings support the notion that:
a. cancers of the colon are more easily diagnosed in the benign form because they can be visualized during colonoscopy.
b. an accumulation of mutations in specific genes is required for the development of cancer.
c. tumor invasion and metastasis progress more slowly in the gastrointestinal tract.
d. apoptosis is triggered by diverse stimuli including excessive growth.
an accumulation of mutations in specific genes is required for the development of cancer.
1. Autocrine stimulation is the ability of cancer cells to:
a. stimulate angiogenesis to create their own blood supply.
b. stimulate secretions that turn off normal growth inhibitors.
c. secrete growth factors that stimulate their own growth.
d. divert nutrients away from normal tissue for their own use.
secrete growth factors that stimulate their own growth.
1. What is apoptosis?
a. A normal mechanism for cells to self-destruct when growth is excessive
b. An antigrowth signal activated by tumor-suppressor gene Rb
c. A mutation of cell growth stimulated by the TP53 gene
d. The transformation of cells from dysplasia to anaplasia
A normal mechanism for cells to self-destruct when growth is excessive
1. Many cancers create a mutation of ras. What is ras?
a. A tumor-suppressor gene
b. A growth-promoting gene
c. An intracellular signaling protein that regulates cell growth
d. A cell surface receptor that allows signaling to the nucleus about cell growth
An intracellular signaling protein that regulates cell growth
1. Oncogenes are genes that:
a. have undergone mutation that direct the synthesis of protein to accelerate the rate of tissue proliferation.
b. direct synthesis of proteins to regulate growth and provide necessary replacement of tissue.
c. encode proteins that negatively regulate the synthesis of proteins to slow or halt replacement of tissue.
d. have undergone mutation to direct malignant tissue toward blood vessels and lymph nodes for metastasis.
have undergone mutation that direct the synthesis of protein to accelerate the rate of tissue proliferation.
1. Burkitt lymphomas designate a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. This is an example of which mutation of normal genes to oncogenes?
a. Point mutation
b. Chromosome translocation
c. Gene amplification
d. Chromosome fusion
Chromosome translocation
1. What aberrant change causes the abnormal growth in retinoblastoma?
a. Proto-oncogenes are changed to oncogenes.
b. The tumor-suppressor gene is turned off.
c. Genetic amplification causes the growth.
d. Chromosomes 9 and 21 are fused.
The tumor-suppressor gene is turned off.
1. Why are two hits required to inactivate tumor-suppressor genes?
a. Because each allele must be altered and each person has two copies, or alleles, of each gene, one from each parent
b. Because the first hit stops tissue growth and the second hit is needed to cause abnormal tissue growth
c. Because they are larger than proto-oncogenes requiring two hits to effect carcinogenesis
d. Because the first hit is insufficient to cause enough damage to cause a mutation
Because each allele must be altered and each person has two copies, or alleles, of each gene, one from each parent
1. By what process does the ras gene convert from a proto-oncogene to an oncogene?
a. By designating a chromosome that has a piece of one chromosome fused to a piece of another chromosome
b. By duplicating a small piece of a chromosome, repeatedly making numerous copies
c. By alternating one or more nucleotide base pairs
d. By promoting proliferation of growth signals by impairing tumor-suppressor genes
By alternating one or more nucleotide base pairs
1. How do cancer cells use the enzyme telomerase?
a. They use it to repair the telomeres to restore somatic cell growth.
b. They use it as an intracellular signaling chemical to stimulate cell division.
c. They switch off the telomerase so that cells can divide indefinitely.
d. They switch on the telomerase so that cells can divide indefinitely.
They switch on the telomerase so that cells can divide indefinitely.
1. What are characteristics of benign tumors?
a. They invade local tissues.
b. They spread through lymph.
c. They cause systemic symptoms.
d. They include the suffix -oma.
They include the suffix -oma.
1. Which of the following represents the correct nomenclature for benign and malignant tumors of adipose tissue, respectively?
a. Liposarcoma, lipoma
b. Lipoma, liposarcoma
c. Adisarcoma, adipoma
d. Adipoma, adisarcoma
Lipoma, liposarcoma
1. The major virus involved in cervical cancer is:
a. herpes simplex virus type 6.
b. herpes simplex virus type 2.
c. human papillomavirus.
d. human immunodeficiency virus.
human papillomavirus.
1. The Papanicolaou (Pap) test is used to screen for which cancer?
a. Ovarian
b. Uterine
c. Cervical
d. Vaginal
Cervical
1. Which of the viruses below are oncogenic DNA viruses?
a. Papovaviruses, adenoviruses, and herpesviruses
b. Retroviruses, papovaviruses, and adenoviruses
c. Adenoviruses, herpesviruses, and retroviruses
d. Herpesviruses, retroviruses, and papovaviruses
Papovaviruses, adenoviruses, and herpesviruses
1. Which cancers are associated with chronic inflammation?
a. Skin, lung, and pancreatic
b. Colon, liver, and lung
c. Bone, blood cells, and pancreatic
d. Bladder, skin, and kidney
Colon, liver, and lung
1. How does chronic inflammation cause cancer?
a. By vasodilation and increased permeability that alter cellular response to DNA damage
b. By liberating lysosomal enzymes when cells are damaged, which initiates mutations
c. By releasing compounds such as reactive oxygen species that promote mutations
d. By increasing the abundance of leukotrienes that are associated with some cancers
By releasing compounds such as reactive oxygen species that promote mutations
1. Inherited mutations that predispose to cancer are almost invariably what kind of gene?
a. Proto-oncogenes
b. Oncogenes
c. Tumor-suppressor genes
d. Growth-promoting genes
Tumor-suppressor
1. What is the consequence for cells when the functioning TP53 gene is lost due to mutation?
a. Cells undergo apoptosis.
b. Cells escape apoptosis.
c. Cells receive less oxygen.
d. Cells adhere more readily.
Cells escape apoptosis.
1. During angiogenesis, what is the role of platelet factor-4, angiostatin, endostatin, thrombospondin, and interferon-alpha and interferon-beta?
a. They stimulate the development of new blood vessels.
b. They facilitate the attachment of the tumor implants to new blood vessels.
c. They inhibit the formation of new blood vessels.
d. They prevent the formation of emboli that protect for tumor cells from host defenses.
They inhibit the formation of new blood vessels.
1. What is the role of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-alpha (TGF) in cell metastasis?
a. To stimulate growth of nearby tumor cells
b. To develop new blood vessels to feed cancer cells
c. To prevent cancer cells from escaping apoptosis
d. To act as a chemical gradient to guide cells to blood vessels
To develop new blood vessels to feed cancer cells
1. A pathology report stages a tumor as T2, N1, M0. What is the meaning of this finding?
a. There is a tumor with no spread to surrounding lymph nodes and no metastasis.
b. There are two malignant tumors and one involved lymph node with metastasis.
c. There is a tumor with spread to surrounding lymph nodes and no metastasis.
d. There is no tumor after two biopsies and one lymph node biopsy and no metastasis.
There is a tumor with spread to surrounding lymph nodes and no metastasis.
1. Why do nausea and vomiting occur after cancer therapy to the abdomen?
a. Because the person is receiving chemotherapy at the same time as the radiation therapy
b. Because the radiation is metabolized by the liver, which alters the intestinal mucosa
c. Because the cancer in the gastrointestinal tract causes these clinical manifestations
d. Because of the agents direct action on the body’s vomiting centers
Because of the agents direct action on the body’s vomiting centers
1. Which cytokine is involved in producing cachexia syndrome?
a. Interleukin-1 (IL-1)
b. Colony-stimulating factor (CSF)
c. Tumor necrosis factor (TNF)
d. Interleukin-15 (IL-15)
Tumor necrosis factor (TNF)
1. Interleukin is used as adjuvant therapy for a person with metastatic renal cell carcinoma. The goal of this type of therapy is to:
a. improve the cellular response to chemotherapy.
b. enhance the immune response to tumor cells.
c. reduce the metastasis of malignant cells.
d. prevent bone marrow depression.
enhance the immune response to tumor cells.
1. Which biologic therapy produced by B lymphocytes is capable of binding to target cells?
a. Interferon
b. Interleukin
c. Erythropoietin
d. Monoclonal antibodies
Monoclonal antibodies
4. Normally, which cells, are considered immortal (never die)? (Select all that apply.)
a. Germ cells
b. Stems cells
c. Blood cells
d. Epithelial cells
e. Muscle cells
Germ cells
Stems cells
4. What is the most common route for distant metastasis? (Select all that apply.)
a. Seeding
b. Blood
c. Lymphatics
d. Invasion
e. Proliferation
Blood
Lymphatics
a. Loss of differentiation
Anaplasia
a. Cancer cells secrete growth factor for their own growth
Autocrine stimulation
a. Cells that vary in size and shape
Pleomorphic
a. Unaltered normal allele
Proto-oncogene
a. Responsible for maintenance of genomic integrity
Caretaker gene
a. Cancer cell growth
Angiogenesis
a. Used to kill cancer cells while minimizing damage to normal structures
Radiation
a. Forms antibodies specific for tumor antigen
Monoclonal antibodies
a. Agents that take advantage of specific vulnerabilities in target cancer cells
Chemotherapy
a. Provides a framework to determine treatment
Staging
3. Match the mechanisms causing pain from tumor invasion with the organ commonly involved.
a. Pressure
Breast
3. Match the mechanisms causing pain from tumor invasion with the organ commonly involved.
a. Stretching
Liver
3. Match the mechanisms causing pain from tumor invasion with the organ commonly involved.
a. Obstruction
Abdomen
3. Match the mechanisms causing pain from tumor invasion with the organ commonly involved.
a. Tissue destruction
Buccal Area
1. True or False There is no current evidence that associates adult obesity with cancer formation.
False
1. True or False An increased number of sexual partners have been shown to be related to the incidence of cervical cancer.
True
1. Which characteristic among women correlates with a high morbidity of cancer of the colon, liver, gallbladder, pancreas, breast, uterus, and kidney?
a. Women older than 45 years of age
b. Women who never had children
c. Women who had a high body mass index
d. Woman who smoked for more than 10 years
Women who had a high body mass index
1. Which of the following has been shown to increase the risk of cancer when used in combination with tobacco smoking?
a. Alcohol
b. Steroids
c. Antihistamines
d. Antidepressants
Alcohol
1. Which of the following diagnostic tests provides the greatest exposure to ionizing radiation?
a. A four-view mammogram
b. A whole body DEXA scan
c. A CT scan of the abdomen
d. A PET scan of the brain
A CT scan of the abdomen
1. Tobacco smoking is associated with cancers of all of the following except
a. lung.
b. Skin
c. Bladder
d. Kidney
e. Pancreas
Skin
1. The most important risk factors associated with the development of skin melanoma include: (Select all that apply.)
a. light-colored hair.
b. blue eyes.
c. fair skin.
d. freckles.
e. history of acne.
History of Acne
1. Which of the following environmental factors has been shown to have the greatest effect on the frequency of genetic mutations in humans?
a. Tobacco use
b. Radiation exposure
c. Obesity
d. Alcohol abuse
e. Stressful occupation
Tobacco use
Radiation exposure
Obesity
1. Research data support the relationship between ultraviolet sunlight exposure and the development of: (Select all that apply.)
a. basal cell carcinoma.
b. squamous cell carcinoma.
c. melanoma.
d. non-Hodgkin lymphoma.
e. soft tissue sarcoma.
basal cell carcinoma.
squamous cell carcinoma.
1. Alcohol consumption has been proven to be a consistent risk factor in the development of which of the following major cancers? (Select all that apply.)
a. Colorectal
b. Kidney
c. Breast
d. Esophageal
e. Pancreatic
Colorectal
Breast
Esophageal
1. True or False Most childhood cancers originate from the mesodermal germ layer that gives rise to connective tissue, bone, blood, blood vessels, kidney, and lymph.
True
1. True or False Cancers in children are slow growing and usually have not metastasized at time of diagnosis.
False
1. True or False Leukemia is the most common malignancy in children.
True
1. True or False Embryonic tumors are usually diagnosed after 5 years of age.
False
1. True or False Secondary cancers are a late effect faced by children cured of cancer.
True
1. True or False Cancer is the leading cause of death in children.
False
1. True or False Mutations of proto-oncogenes into oncogenes have been identified with pediatric lymphoma and leukemia.
True
1. True or False Children with acquired immunodeficiency syndrome (AIDS) have an increased risk of developing certain cancers such as Kaposi sarcoma.
True
1. What congenital malformation is commonly linked to acute leukemia in children?
a. Down syndrome
b. Wilms tumor
c. Retinoblastoma
d. Neuroblastoma
Down Syndrome
1. When are childhood cancers most often diagnosed?
a. During infancy
b. At peak times of physical growth
c. After diagnosis of chronic illness
d. After an acute illness
At peak times of physical growth
1. What percentage of children with cancer can be cured?
a. 40%
b. 50%
c. 60%
d. 70%
70%
1. Most childhood cancers arise from the:
a. epithelium.
b. mesodermal germ layer.
c. embryologic ectodermal layer.
d. viscera.
Mesodermal Germ Layer
1. Chronic myelogenous leukemia, retinoblastoma, and osteosarcoma are associated with which genetic factors in childhood cancers?
a. Chromosome aberrations or single gene defect
b. Mutation of proto-oncogenes to oncogenes
c. Tumor-suppressor genes that have lost their suppressor function
d. Congenital malformations
Chromosome aberrations or single gene defect
1. Childhood exposure to all of the following risk factors increases susceptibility to cancer EXCEPT
a. drugs.
b. ionizing radiation.
c. cigarette smoke.
d. viruses.
Cigarette Smoke
1. There are research data to support a carcinogenic relationship in children resulting from exposure to the _____ virus.
a. herpes simplex
b. influenza
c. varicella
d. Epstein-Barr
Epstein-Barr Virus