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NARAYAN CHANGDER
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Contents
1 Respiratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1 Respiratory Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.2 Bronchiectasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3 Pulmonology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.4 Chronic Obstructive Pulmonary Disease . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.5 Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
1.6 Fibrotic Lung Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
1.7 Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
1.8 Old Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
1.9 Pleural Effusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
1.10 Patient with Previous Lung Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
2 Abdominal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
2.1 Abdominal Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
2.2 Chronic Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
2.3 Generalised Lymphadenopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
2.4 Thalassemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
2.5 Hemoglobinopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
2.6 Gastrointestinal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
2.7 Renal Replacement Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
3 Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
3.1 Cerebellar Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
3.2 Hemiparesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
3.3 Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
1
3.4 Myotonic Dystrophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299

3.5 Ocular Palsies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302

3.6 Parkinson’ s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
3.7 Peripheral Neuropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
3.8 Mononeuropathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
3.9 Motor Neurone Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
3.10 Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
3.11 lateral Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
3.12 Spastic Paraparesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
3.13 Visual Field Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
4 Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
4.1 Aortic Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
4.2 Aortic Regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
4.3 Eisenmenger’ s Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
4.4 Hypertrophic Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
4.5 Mitral Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
4.6 Heart Auscultation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
4.7 Mitral Regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
4.8 Mixed Aortic Valve Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
4.9 Prosthetic Heart Valves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
4.10 Tricuspid Regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
4.11 Ventricular Septal Defect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
5 Clinical Encounters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

5.1 Ankylosing Spondylitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
5.2 Anticoagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
5.3 Diabetic Retinopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
5.4 Facial Nerve Palsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
5.5 Bell’s Palsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
5.6 Hyperthyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
5.7 Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
5.8 Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
5.9 Rheumatoid Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
5.10 Carpal Tunnel Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
5.11 Systemic Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
5.12 Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
1. Respiratory
NARAYAN CHANGDER
1.1 Respiratory Station
1. The dome-shaped muscle that plays an im- 4. Blood is composed of
portant role in breathing is the A. red blood cells
A. diaphragm B. white blood cells
B. alveoli C. platelets and plasma
C. larynx D. all of the above
D. bronchus 5. One organ listed is part of the digestive
system. Which organ below is incorrectly
2. These two body systems bring oxygen paired with a respiratory function?
into your body and then move to all your
body parts. What are these two sys- A. nose-filters and warms air
tems? B. bronchi-moves air into the lungs
A. respiratory and muscular C. diaphragm-muscle that powers
breathing
B. digestive and circulatory
D. esophagus-moves air from the nose
C. respiratory and digestive into the lungs
D. circulatory and respiratory
6. carry oxygen throughout the human
3. Which type of cell is like a delivery truck body.
because it delivers oxygen and nutrients A. veins
to all the cells of the body?
B. blood plasma
A. red blood cell C. red blood cells
B. white blood cell D. white blood cells
C. bone cell
7. Air is filtered, cleaned and warmed in
D. plant cell what part of the respiratory system?
1. A 2. D 3. A 4. D 5. D 6. C 7. A
1.1 Respiratory Station 3
A. nose A. work together

B. mouth B. work independently

C. bronchi C. all have the same function
D. alveoli D. have no connection one another
8. the smallest blood vessels in your body 13. The major organ of the circulatory system,
the heart
A. arteries
A. removes bodily waste
B. veins
B. pumps blood throughout the body
C. capillaries C. carries oxygen throughout the body
D. aorta D. transmits impulses throughout the
9. These are very small vessels where oxy- body
gen and nutrients leave the blood to go 14. Blood vessels that carry blood containing
into the cells and carbon dioxide and other oxygen away from the heart to all parts
waste products enter the blood from the of the body are called
cells.
A. veins
A. veins B. arteries
B. arteries C. capillaries
C. capillaries D. lymphatic vessels
D. pacemaker
15. The systems are most responsible for
10. When you breathe in oxygen it is carried providing cells with oxygen and removing
to this organ. Here the red blood cells pick the carbon dioxide.
up the oxygen and carry the oxygen to all A. excretory and muscular
parts of the body. What is this organ? B. digestive and excretory
A. diaphragm C. skeletal and respiratory
B. heart D. circulatory and respiratory
C. lungs 16. blood vessels that direct blood away from
D. trachea the heart
A. arteries
11. Your circulatory system helps to move the
oxygen to all of your cells. What carries B. capillaries
the oxygen to every cell in your body? C. veins
A. blood D. none of above
B. food 17. Which is a type of muscle found in your
C. heart heart:
D. veins A. bicep
B. smooth
12. While running you breathe faster and
harder and your heart rate increases. This C. skeletal
illustrates that body systems D. cardiac
8. C 9. C 10. C 11. A 12. A 13. B 14. B 15. D 16. A 17. D

1.2 Bronchiectasis 4
18. which colorless part of your blood fights 23. Which parts of the respiratory system di-
off germs to keep you from getting sick? vide into smaller and smaller tubes in a
pattern that resembles the branches of a
A. red blood cells
tree?
B. plasma
A. pharynx
C. white blood cells
B. trachea
D. platelets C. bronchi
NARAYAN CHANGDER
19. How is carbon dioxide released from the D. epiglottis
body?
24. Which organ (of the excretory system) fil-
A. When we exhale ters waste from the blood?
B. When we urinate A. Skin
C. When we sweat B. Kidney
D. When we inhale C. Liver
D. Heart
20. blood vessels that direct blood back to the
heart 25. all other parts of the blood float in which
A. veins watery substance? (Hint:it is yellow and
makes up 90% of blood)
B. arteries
A. plasma
C. capillaries
B. platelets
D. none of above
C. puss
21. The organ that moves air from the nose to D. cytoplasm
the lungs and is often called the windpipe
is 26. Where is oxygen absorbed into the blood
and carbon dioxide released into the air?
A. larynx
A. larynx
B. pharynx
B. bronchioles
C. esophagus
C. alveoli
D. trachea
D. none of above
22. In which part of the respiratory system 27. The lungs and respiratory system work
is the air first cleaned, moistened, and closely with the system to make sure
warmed? oxygen reaches all the cells of our body.
A. nose A. circulatory
B. lungs B. digestive
C. pharynx C. integumentary
D. bronchi D. nervous
1.2 Bronchiectasis
18. C 19. A 20. A 21. D 22. A 23. C 24. B 25. A 26. C 27. A
1. Hypoxia is a condition of 7. Large tubes (one for each lung) that serve
A. cilia as a passageway for air..

B. blood in the lungs A. bronchi
C. insufficient carbon dioxide B. larynx

C. trachea
D. insufficient oxygen
D. alveoli
2. The pharynx can also be called the
8. Luftsichel sign is seen in
A. nasopharynx
A. left upper lobe collapse
B. oropharynx
B. Broncho alveolar cell carcinoma
C. laryngopharynx
C. Adenoid cystic carcinoma
D. throat
D. Invasive Pulmonary Aspergillosis
3. Air is warmed and moistened in the
9. If someone experiences a loss of intrapleu-
A. trachea. ral pressure due to a puncture, what will
B. bronchi. occur?
C. larynx. A. Breathing will stop.
D. nasal cavity. B. Sudden exhalation will occur.
C. Sudden inhalation will occur.
4. Where gas exchange takes place..
D. The lung will collapse.
A. bronchi
B. bronchioles 10. If you have your tonsils removed
C. alveoli A. tonsilitis
D. trachea B. tonsillplasty
C. tonsillectomy
5. Which is FALSE stamenet Regarding Be-
daquiline D. tonsillotomy
A. Belongs to the diarylquinoline class 11. Large tube supported by C-shaped rings of
B. Targets the rpoB gene encoding the cartilage; often called the “windpipe”..
subunit c of the ATP synthase of Mycobac- A. trachea
terium tuberculosis B. bronchi
C. Binds to the oligomeric and proteolipic C. larynx
subunit c of mycobacterial ATP synthase
D. throat
D. Bedaquiline is rapidly absorbed orally
12. Even with extensive investigation no spe-
6. What is the main muscle responsible for cific cause identified in % of pt with
pulmonary ventilation? bronchiectasis
A. Internal intercostal muscles A. 50
B. External intercostal muscles B. 60
C. Scalenes C. 40
D. Diaphragm D. 20
1. D 2. D 3. D 4. C 5. B 6. D 7. A 8. A 9. D 10. C 11. A 12. C 13. A

13. A surgical puncture to remove fluid from 18. Which term means the study of the ear,
the pleural cavity nose, and voice box?
A. thoracentesis A. otonasalaryngology
B. tracheostomy B. otorhinolaryngology
C. tonsillectomy C. otonasopharyngology
D. thoracotomy D. otorhinopharyngology
14. bronchiectasis is 19. Discharge from my nose
NARAYAN CHANGDER
A. sudden, involuntary contractions of A. rhinitis
the bronchus B. rhinoplasty
B. inflammation of the bronchus C. rhinorrhea
C. dilation of the bronchus D. pansinusitis
D. none of above 20. Which of the following is a chronic con-
15. Which of the following conditions may re- dition that causes constriction of the
sult in a collapsed lung? bronchial airways due excessive mucus
and bronchospasms?
A. pulmonary embolism
A. bronchiectasis
B. tuberculosis
B. asthma
C. pleurisy
C. anthracosis
D. pneumothorax
D. adult respiratory distress syndrome
16. What is the respiratory membrane and
21. Small airways that lack supportive carti-
what is its role?
lage..
A. It lines the nasal cavity, where it
A. bronchioles
serves to warm and moisten inspired air.
B. trachea
B. It lines the bronchial tree, where it se-
cretes a layer of protective mucus, which C. larynx
serves to purify air entering the respira- D. bronchi
tory tract.
22. Optimal suction in persistent airleak,
C. It consists of the alveolar epithelium, should entail pressures of cm h20
the capillary endothelium and their joined
basement membranes; it provides the sur- A. -10 to-20
face through which gas exchange occurs. B. <-5
D. It lines the thoracic cavity, where it C. -20 to-30
aids in lung expansion. D. -30 to-40
17. Who completed the first successfull lung 23. The root word PNEUMON/O or PUL-
transplantation in the world? MON/O
A. Joel D Cooper A. chest
B. James hardy B. lungs
C. Peter John Barnes C. ribs
D. Chevaliar Jackson D. head
14. C 15. D 16. C 17. B 18. B 19. C 20. B 21. A 22. A 23. B
24. Loss of voice 29. Which of the following feature is not a

part of the Well’s Score for predicting the
A. dysphonia
probability of Pulmonary Embolism?

B. hypophonia
A. HR>100 B
C. aphonia B. Age>50
D. none of above C. Haemoptysis
25. Brensocatib showed promising reults in D. Malignancy

bronchiectasis pt with history of two or 30. The inspiratory and expiratory centers are
more exb in a year, in phase 3 trial is located in the
A. antagonist of CXC chemokine receptor A. medulla.
2
B. pons.
B. oral rev inh of dipeptidyl peptidase inh C. cerebellum.
1
D. diaphragm.
C. IL4 inh
31. External respiration refers to the ex-
D. neutrophil elastase inh
change of oxygen and carbon dioxide be-
tween:
26. Which of the following terms means lack
of breathing? A. outside air and cells of the body.
A. apnea B. bloodstream and cells
B. eupnea C. lungs and heart

D. alveoli and pulmonary capillaries.
C. orthopnea
D. dyspnea 32. Muscular tube commonly called the
throat..
27. Which condition is characterized by the de- A. alveoli
struction of the walls of the alveoli result-
B. trachea
ing in overexpanded air sacs?
C. larynx
A. emphysema
D. pharynx
B. histoplasmosis
33. Acts as a passageway between the phar-
C. pneumoconiosis
ynx and trachea; also produces sound..
D. empyema A. trachea
28. This respiratory disease is an inherited B. bronchi
condition characterized by very thick mu- C. larynx
cus
D. throat
A. emphysema
34. Which among the following is a third gen-
B. atelectasis eration EGFR?
C. histoplasmosis A. Geftinib
D. cystic fibrosis B. Erlotinib
24. C 25. B 26. A 27. A 28. D 29. B 30. A 31. D 32. D 33. C 34. D 35. B
1.3 Pulmonology 8
C. afatinib B. The space between the visceral and

D. Rosiletinib parietal pleurae is called the pleural cav-
ity.
35. Hypercalcemia is a Paraneoplastic syn-
drome in which Lung cancer? C. The fluid in the pleural cavity lubri-
cates the pleural surfaces, allowing the
A. Small Cell Ca
two surfaces to glide painlessly against
B. Squamous Cell Ca each other as the lungs expand and con-
C. Acleno Ca tract.
NARAYAN CHANGDER
D. Large Call Ca D. The visceral pleura covers the surface
36. Which of these statements about the of the lungs.
pleura is NOT correct? E. The pleural cavity is a space between
A. The parietal pleura lines the entire tho- the two membranes that are normally sep-
racic cavity. arated only by a small amount of air.
1.3 Pulmonology
1. FEV1=60% FVC=58% FEV1/FVC=0.91 C. prevents aspiration
DLCO=43% Respiratory function mainly D. is site of airway exchange
raises suspicion of:
A. asthma 4. What is the treatment for advanced silico-
sis?
B. COPD
A. Steroids
C. Interstitial lung disease
B. High-dose chemotherapy
D. Skeletal/muscular disease of the
chest C. whole lung lavage
D. Lung transplant
2. A 55 year old man came to the PKM be-
cause of a cough for the last 3 months. 5. When auscultating the lungs it is important
1 year ago I was diagnosed with TB and to
had been undergoing TB treatment for 2
months and stopped because I felt cured. A. listen only anteriorly
The current examination results are BTA B. listen over the scapula to auscultate
(+). What is the right treatment?
C. only listen to the left side
A. Category 1
D. listen anteriorly and posteriorly with
B. Category 2 comparing the left and right side
C. Category 2 without streptomycin
6. ? CF Which of the following bacteria is a
D. Insert phase poor prognostic marker b
E. Category 2 intermittent phase A. Moraxella cat.
3. The epiglottis B. E Coli
A. vibrates producing sound C. H. Inf
B. is the voice box D. Pseudomonas aer.
36. E 1. C 2. B 3. C 4. D 5. D 6. D 7. A
1.3 Pulmonology 9
7. What is the most prominent symptom of 12. Bluish discoloration of the skin caused by
bronchitis lack of oxygen to the tissues.

A. productive cough A. Asthma
B. asthma attack B. Emphysema
C. tachypnea C. Cyanosis
D. chills D. Chronic Bronchitis
13. Stridor breath sounds are

8. The main component of the respiratory
system is/are the A. shrill, harsh inspiratory sound; indi-
cates laryngeal obstruction
A. heart
B. dry, rubbing, or grating sound
B. lungs
C. low pitched, continuous sound
C. capillaries
D. high pitched, musical sound
D. diaphragm
14. The small tubes within the lungs that
9. Brief or prolonged absence of spontaneous transport air to the alveoli are called
respiration due to respiratory failure or
A. bronchioles
respiratory arrest
B. trachea
A. Bradypnea
C. capillaries
B. Apnea
D. bronchial tubes
C. Tachypnea
15. What is an infection in the aveloli that can
D. Eupnea
be caused by bacteria or virus?
10. What will we not do in the initial investi- A. asthma
gation of bronchiectatic lung disease? B. COPD
A. Lung biopsy C. pneumonia
B. You will notice sweat D. allergic rhinitis
C. Electron microscope test for CILIA to
16. The is often called the “wind pipe.”
determine PCD
A. trachea
D. IGG IGA IGM levels and IGG sub-
groups B. esophagus
C. bronchiole
11. FEV1=60% FVC=98% FEV1/FVC=0.56
DLCO=96% Respiratory function mainly D. alveoli
raises suspicion of: 17. Infection of some or all of the lobes of the
A. asthma lungs.
B. COPD A. Asthma
C. Interstitial lung disease B. Pneumonia
D. Skeletal/muscular disease of the C. Influenza

chest D. Rhinorrhea
8. B 9. B 10. A 11. A 12. C 13. A 14. A 15. C 16. A 17. B 18. D

1.3 Pulmonology 10
18. What is the most correct about COPD? D. Renal failure

A. A preventable disease 22. The is a large breathing muscle that
B. In emphysema low diffusion is ob- contracts to create a vacuum, drawing air
served into the nose and mouth.
C. Patients with chronic bronchitis are A. intercoastal muscle
prone to flare-ups and CO2 retention
B. skeletal muscle
D. All the answers are correct
C. trachea
NARAYAN CHANGDER
19. A male patient came to the ER with short- D. diaphragm
ness of breath, history of asthma (+). af-
ter being nebulized 2x the patient still 23. Small blood vessels where oxygen is ex-
feels shortness of breath and wheezing is changed for carbon dioxide are called
still heard. Next course of action? A. veins
A. Aminophylline IV B. capillaries
B. Dexamethasone IV
C. alveoli
C. Followed nebul 1x again
D. bronchioles
D. Adrenalin IV
24. Chronic Obstructive Pulmonary Disease
E. Observation 1 day, treat MRS
(COPD) includes which of the following
20. A 40-year-old male patient came with two conditions?
complaints of coughing up blood for 2 days, A. Pneumothorax and Hemothorax
previously the patient had had a cough
for 1 month and it was getting worse, B. Emphysema and Chronic Bronchitis
the patient complained of a decrease in C. Hematochezia and Hemoptosis
appetite, from the physical examination, D. Atelectasis and Auscultation
crackles were found on the right and left
apex. GeneXpert examination obtained + 25. Arterial Blood Gases (ABG) determines
M.tb, Rifampicin sensitive. What is the ap-
propriate therapy given?
A. if a patient has mild, moderate or se-
A. OAT 2RHZE+4RH vere restrictive disease
B. OAT 2RHZS + 4R3H3 B. if the patient has a foreign body in the
C. OAT 2RHZES + RHZE + 5RHE airway
D. OAT 2RHZES + 4RHS C. the blood pH and pressures of O2 and
CO2 in the arterial blood
E. OAT 2RH + 4RHE
D. if the patient has a tumor
21. In pleural fluid:protein in fluid 2, protein in
serum 4.4 LDH in fluid = 160 LDH in 26. A 39-year-old man came for treatment
serum 430 Which of the following is least with complaints of vomiting, weakness
suitable for the differential diagnosis? and yellow-looking eyes since the past
A. Heart failure 1 week. The patient previously had a
long cough and had undergone routine OAT
B. lupus erythematosus SLE. treatment for 3 weeks. Which OAT drug
C. Cirrhosis of the liver can cause symptoms in this patient?
19. C 20. A 21. B 22. D 23. B 24. B 25. C 26. B

1.3 Pulmonology 11
A. Rifampicin, INH, ethambutol 31. The medical term for fast breathing.
B. Pyrazinamide, rifampicin, INH A. Tachypnea

C. Streptomycin and ethambutol B. Dyspnea
D. Streptomycin, ethambutol and INH C. Orthopnea
E. Pyrazinamide, streptomycin and D. Bradypnea
ethambutol
32. A few years after exposure to as-
27. The four parts of a traditional examination bestos, lung disease-asbestosis or pleural
of the chest consist of malignancy-mesothelioma will appear
A. CXR, bronchoscopy, auscultation, in- A. About 5 years
spection
B. about 10 years
B. sputum culture, palpation, visualize,
tinne test C. about 15 years
C. look, feel, auscultate, x-ray D. about 30 years
D. inspection, palpation, percussion, aus- 33. The respiratory system removes a harmful
cultation waste product called
28. The human body contains two which A. oxygen
carry air into the lungs. B. bile
A. trachea
C. carbon dioxide
B. bronchial tubes
D. carbon monoxide
C. bronchioles
D. capillaries 34. The need to be propped in an upright or
semi-upright position in order to breath
29. are tiny air sacs in the lungs which are and sleep comfortably
surrounded by capillaries. A. Dyspnea
A. Bronchioles B. Orthopnea
B. Arteries C. Eupnea
C. Axons
D. Orthopedics
D. Alveoli
35. A typical symptom of tuberculosis is
30. Which of the following combinations is cor-
rect? A. night sweats
A. IPF:the image in the city and homoge- B. wheezing

neous pathology C. tightness in chest
B. NSIP:the homogeneous filtration of D. non-productive cough
only collagen fibers in septa
36. Leukotriene Receptor Blockers
C. IPF:a normal lung should also be seen
in addition to fibrosis for diagnosis A. Treat tuberculosis
D. NSIP:the image in the city and hetero- B. Blocks leukotriene, which causes in-
geneous pathology flammation and edema
27. D 28. B 29. D 30. C 31. A 32. D 33. C 34. B 35. A 36. B 36. D
1.3 Pulmonology 12
C. Dilate constricted airways by relaxing 42. What are the diagnostic test that may be
the smooth muscles surrounding the bron- used to diagnose lung cancer?
chioles A. Colonoscopy and CT
D. Treats asthma B. Chest x-ray, thoracentesis, sputum cy-
37. By listening, tapping and checking Permi- tology
tos we cannot differentiate between: C. pulmonary function test, chest x-ray
A. Pneumonia and complete collapse of a D. endoscopy and hemoptysis
NARAYAN CHANGDER
lung
43. An example of a bronchodilator used as a
B. Air chest and pleural effusion
“rescue inhaler” is
C. Pleural effusion and whole lung effu-
A. Prednisone
sion
B. Albuterol inhaler
D. Air chest and emptying of a whole lung
C. cough syrup
38. Hemoptysis is
D. Tessalon capsules
A. lung infection
B. an abnormal breath sound 44. The function of the respiratory system is
to supply the body with
C. a test to determine lung capacity
A. carbon dioxide
D. spitting up blood
B. nutrients
39. A positive TB screening test (PPD) result C. oxygen
indicates the patient
D. blood
A. Should receive a vaccine to prevent the
spread of TB 45. The medical term for collapsed lung.
B. had active TB A. Epistaxis
C. needs to be quarantined B. Atelectasis
D. Does not necessarily have active C. Pneumothorax
disease-a chest x-ray needs to be done
D. Hemothorax
to determine
46. Tidal volume is
40. Expectoration
A. amount of air inhaled and exhaled dur-
A. Coughing up blood
ing a normal respiration
B. Coughing up cheezits
B. the reserve of expiratory volume in
C. Coughing up gummy bears your lungs
D. Coughing up sputum C. peak volume
41. The medical term for nosebleed. D. total lung capacity
A. Atelectasis 47. What are symptoms of laryngeal cancer
B. Pertusissis A. hoarseness lasting longer than 3
C. Epistaxis weeks
D. Auscultation B. feeling of lump in the throat
CHECK GOOGLE PLAY BOOKS FOR ANSWERS KEYS

1.4 Chronic Obstructive Pulmonary Disease 13
C. burning in the throat when drinking cit- D. progressive irreversible disease with
rus juice diminished respiratory capacity

D. all the above
52. The tube that leads from the nose and
48. Which of the following is used to measure mouth to the lungs.
the amount of air moving into and out of A. Esophagus
the lungs of asthma patients
B. Duodenum
A. peak flow meter
C. Ilium
B. nebulizer
D. Trachea
C. bronchodilator
D. patient’s personal best diary 53. The medical term for difficulty breathing.
A. Tachypnea
49. The respiratory system removes a harmful
waste product called B. Dyspnea
A. oxygen C. Orthopnea
B. bile D. Bradypnea
C. carbon dioxide 54. What is an infectious disease spread by
D. carbon monoxide droplets with symptoms of productive
cough, night sweats, malaise
50. The diaphragm separates the heart and
lungs from the A. tuberculosis
A. skeletal muscles B. laryngeal cancer
B. brain C. bronchitis
C. abdominal cavity D. asthma
D. mouth and nose 55. Hyperactivity of the bronchi that causes
bronchospasm.
51. Thoracentesis is a
A. Asthma
A. a chronic condition
B. Emphysema
B. surgical puncture into the pleural cav-
ity for aspiration of serous fluid C. Bronchiectasis
C. permanent stoma in the neck D. Rhinorrhea
1.4 Chronic Obstructive Pulmonary Disease

1. FEV1 index after bronchodilator test of D. GOLD 4
1 COPD patient is 60% of the predicted
value, the level of obstruction of GOLD pa- 2. COPD is a collective name for:
tient? A. chronic bronchitis and emphysema
A. GOLD 1 B. asthma and emphysema
B. GOLD 2 C. emphysema and pneumonia
C. GOLD 3 D. chronic bronchitis and pneumothorax

3. COPD stands for: 8. Select the correct answers

A. chronic obese pulmonary disease A. Influenza vaccine is recommended for
B. chronic obstructive pulmonary disor- patients with COPD and booster shot ev-
der ery 5 years
C. chronic obstructive pulmonary distur- B. Pneumococcal conjugate vaccines

bance (PCV13 and PPSV23) are recommended
for COPD patients over 60 years of age
D. chronic obstructive pulmonary disease
NARAYAN CHANGDER
C. The pneumococcal conjugate vaccine
4. Wat is ‘long emfyseem’? PPSV23 is recommended for patients
A. Slappe en verwijde longblaasjes bij younger than 65 years of age with a pre-
COPD dicted FEV1 of <40% and particularly
with concomitant cardiac or chronic lung
B. Schade aan het strottenhoofd bij COPD disease.
C. Schade aan de keelholte
D. According to GOLD 2021, COPD pa-
D. none of above tients are recommended to be vaccinated
against covid 19 (Pfizer vaccine, Moderna
5. How many people in Scotland are diag- vaccine).
nosed with COPD
A. 79, 000 9. What is an example of an anti-
inflammatory drug used in COPD.
B. 129, 000
A. NSAID
C. 179, 000
D. 329, 00 B. Ibuprofen
C. Corticosteroid.
6. Common symptoms of COPD patients,
which of the following is incorrect? D. Paracetamol
A. difficulty breathing intermittently for a 10. Treatment with and in separate
long time inhalers has bigger impact on FEV1 than
B. There may be a lot of phlegm in the either component alone (as mentioned in
cough, or a dry cough GOLD guidelines).
C. Sometimes wheezing is heard on aus- A. Budesonide and Formoterol
cultation
B. Tiotropium and Formoterol
D. Chronic bronchitis presents as a “pink
C. Glycopyrronium and Formoterol
puffer”
D. Beclomethasone and Formoterol
7. what vaccinations should be recommended
for someone diagnosed with COPD 11. Indicate which type of COPD is the most
A. Annual Flu serious:
B. Annual Covid A. COPD-GOLD 1
C. Pneumoccocal B. COPD-GOLD 2
D. TB C. COPD-GOLD 3
E. Diptheria D. COPD-GOLD 4

12. Which of the following are asthma trig- 17. The following are characteristics of COPD
gers? (Select all that apply) A. COPD is based on a history of concomi-

A. Smoke tant allergic/rhinitis
B. Caffeine B. COPD generally appears during young
adulthood
C. Beta agonists
C. COPD is slowly progressive
D. GERD
D. COPD symptoms vary from time to
E. Pests time
13. The cause of bronchopneumonia can be: 18. For the acute exacerbation of COPD, which
of the following can avoid prescribing an-
A. By lying on the bed, the elderly care re-
tibiotics?
cipients do not breathe in and out properly
A. Dyspnea + increased sputum volume
B. By choking on a piece of bread.
+ increased purulent sputum
C. Lots of coughing B. Dyspnea + increased sputum produc-
D. A virus infection tion
C. Increased sputum volume + in-
14. What is the medical term for shortness of
creased purulent sputum
breath?
D. Dyspnea + increased purulent spu-
A. apnea tum
B. betray
19. What does COPD stand for?
C. orthopnea
A. Chronic Obstructive Pulmonary Dis-
D. dyspnoea ease
B. Chronic Obesity Pulmonary Disease
15. A nurse determines the interventions to
promote airway clearance in a client C. Cool Obstructive Pulmonary Disease
with chronic obstructive pulmonary dis- D. Chronic Obstructive Pain Disease
ease (COPD) are successful based on which
of the following findings? 20. In patients who experience an exacerba-
tion of asthma, the presence of the follow-
A. Improved mental status
ing factors will increase the risk of death
B. Effective productive cough due to asthma except
C. ABG’s within normal range A. High use of SABA (more than 1 canis-
ter of salbutamol/month)
D. Absence of dyspnea
B. Low use of SABA
16. What advice do you give the patient after C. Do not use inhaled corticosteroids
using an anti-inflammatory?
D. Have been treated for asthma in the
A. to drink water. last 12 months
B. rinse mouth with water
21. What are the signs and symptoms of
C. toothbrushing COPD?
D. rinse mouth and throat with water A. Wheezing, snoring & sneezing

B. Weight muscle, mucus & wheezing D. Chronic obstruction of lung airflow

C. Wheezing, mucus & weight loss that interferes with normal breathing.
D. Shortness of breath, sneezing & mu- 26. Based on GOLD 2019, COPD patients with
cus FEV1 after administration of a 60% pre-
dicted bronchodilator, CAT (COPD Assess-
22. Smokers wrinkle? times more than non- ment Test) score of 8, history of exacerba-
smokers: tions 2x in the last 1 year, including group
A. 3 times patients:
NARAYAN CHANGDER
B. 4 times A. GOLD 2, Group C
C. 5 times B. GOLD 2, Group D
D. 6 times C. GOLD 3, Group C
D. GOLD 3, Group D
23. A 65-year-old male patient with a his-
tory of COPD was admitted to the emer- 27. Mrs. Frijns, known with COPD, has a
gency department because of shortness SaO2 of 75% after the operation. What
of breath, cloudy sputum production, and can you do?
low-grade fever. The patient had difficulty A. max. 2 l. administer oxygen
breathing, had to sit, and could not speak
in full sentences. Chest X-ray:2 lung fields B. Administer a high concentration of O2,
are bright, diaphragm is flattened, medi- because she has an oxygen deficiency
astinum is narrow. Drug of choice to re- C. Administer a high concentration of O2,
lieve dyspnea in this patient only under continuous monitoring
A. Ventolin and Ipratropium bromide D. Just leave it that way
B. Hydrocortison TTM 28. A COPD patient was once hospitalized for
C. N-acetylcystein an acute attack within a year, and usu-
ally suffers from shortness of breath when
D. Theophylline
walking fast on flat ground, FEV1/FVC
24. mMRC scale grade 2 indicates = 0.65, FEV1 = 61%. According to the
GOLD guidelines, what kind of control
A. SOB going up 2 flights of stairs
drug should be given at the beginning?
B. SOB after 100m
A. Long-acting β 2 (beta2) sympathetic
C. SOB walking on the flat stimulants (LABAs)
D. SOB when hurrying on flat or going up B. Long-acting cholinergic receptor block-
gentle slope ers (LAMAs)
E. SOB getting dressed C. LABA + LAMA
25. What is the definition of COPD? D. LABA + LAMA + Inhaled Steroids
(ICS)
A. Chronic obstruction of blood flow that
interferes with normal breathing. 29. COPD is a term to describe a group of
B. Chronic obstruction of lung airflow breathing condition such as
that interferes with normal breathing. A. Chronic bronchitis, emphysema &
C. Chronic obstruction of mucus airflow asthma
that interferes with normal breathing. B. Bronchi, epimysium & asthma

C. Chronic bronchitis, emphysema & ah- 34. What usually causes COPD?
mar A. use of too much alcohol

D. Chronic, emphysema & asthma B. coronavirus
30. How many people are there in the Nether- C. smoking

lands with COPD? D. drug use
A. 50.000 35. Based on the 2019 GINA guidelines, giv-
B. 500.000 ing ICS/formoterol as a reliever drug to
asthma patients can be given at the fol-
C. 60.000 lowing levels:
D. 600.000 A. Level 1-2
31. A 66-year-old man presents with progres- B. Levels 2-5
sive dyspnoea due to COPD. He is cur- C. Levels 1-5
rently able to perform daily activities but
D. Level 3-5
has difficulty walking if the distance is
longer than 1 block. Examination revealed 36. According to the new version of the
that he had shortness of breath on exha- COPD guidelines (GOLD guideline) in 2017,
lation, wheezing and resonant percussion. which of the following is mainly distin-
He is being treated appropriately for his guished as group ABCD?
COPD condition. Which of the following is
A. Mainly determined by the severity of
also indicated in the management of this
airflow restriction and FEV1
condition?
B. Patients are grouped by their current
A. Meningococcal vaccine
dose of medication
B. Annual flu shot C. Add the comprehensive patient’s
C. Haemophilus influenza B vaccine symptoms and attack frequency to deter-
mine
D. Annual pneumococcal vaccination
D. Patients are grouped by their current
32. The inflammation is in the small bronchi dose of medication
and then goes to the alveoli. This is the?
37. Choose the wrong statement about COPD
A. Lobaire pneumonia exacerbations?
B. Aspiration pneumonia A. An acute event characterized by wors-
ening of respiratory symptoms, which is
C. Broncho pneumonia
different from the daily manifestations
D. none of above and leads to the need for a change in med-
ication or treatment.
33. You call a respiratory rate of 8/min?
B. During an exacerbation, there is usu-
A. orthopnoe ally an increase in dyspnea, cough, wheez-
ing, and sputum volume, but the nature of
B. dyspnoea
the sputum remains unchanged
C. tachypnoe
C. With or without symptoms such as
D. bradypnoe fever, muscle aches, sore throat

D. These are episodes that are prominent 42. An exacerbation in COPD is:
in the natural history of COPD
A. A period of increase/worsening of dis-
38. What are the drugs commonly used in ease symptoms.
COPD?
B. A period of stability of symptoms
A. bronchodilator
C. A period of improvement in symptoms
B. Steroid
C. vaccine D. A period of deterioration of the lung tis-
NARAYAN CHANGDER
sue but the symptoms do not change
D. Fei Kean dredging agent
39. You can recognize pneumonia in a patient 43. What can be the consequences of an oxy-
by: gen deficiency
A. confusion A. Blue lips
B. fever B. Confusion
C. cough C. Drowsiness
D. low temperature
D. Answer 1 to 3 is correct
E. all answers are correct
40. What is the best way of treatment for peo- 44. year-old male, long-term smoker 1 pack
ple with COPD? a day since the age of 18, chronic
cough with sputum for about 5 years,
A. Know how to manage time & get med-
lung function FEV1:56% predicted value,
ication
FEV1/FVC:65%, mMRC 2, hospitalized
B. Know how to handle self without ad- for acute deterioration in the past year 1
vice from anyone time, which of the following is correct?
C. Know how to change lifestyle but did A. According to the 2017 GOLD treatment
not eat medicine guidelines, the patient belongs to GOLD 2
D. Know how to manage self & get the Group D
right medication
B. May encourage patients to do pul-
41. Which of the following is incorrect in the monary exercise rehabilitation
pre-treatment assessment of COPD?
C. Incentive spirometry can be used for
A. First, the diagnosis should be deter- lung rehabilitation
mined based on clinical, medical history,
lung function, imaging, laboratory data, D. Can help cough up sputum through flut-
etc. ter and posture drainage
B. According to FEV1 to assess the sever-
45. Initiation drug for patients with COPD
ity of airway obstruction, FEV1 = 79% is
group A is
mild obstruction
C. Assess severity of symptoms and A. SABA
risk of acute exacerbation based on:CAT, B. TWO
mMRC, and history of exacerbations
C. SAME
D. If wheezing during strenuous exercise,
mMRC = 0 D. All ideas are correct

46. What causes COPD 50. Regarding the drug treatment of COPD,
which of the following is NOT?
A. Pneumonia
A. Short-acting inhaled β -2 sympathetic

B. Smoking
stimulants (SABA) duration of action
C. Virus infection about 4-6 hrs, mainly used as a reliever
D. Genetically determined by the mother. drug when needed
B. LAMA (tiotropium) is more effective
47. According to GINA asthma symptoms in than LABA in reducing the rate of exacer-
the last 4 weeks below are used to deter- bations
mine the level of asthma control, except:
C. Aminophylline is recommended for
A. Asthma symptoms in the morn- routine use to improve lung function and
ing/afternoon more than 4 times/week exercise tolerance
B. Waking up at night due to asthma D. Eosinophil > 300, may be better with
C. The need for reliever drugs more than ICS
2 times / week
51. A 70-year-old patient with chronic ob-
D. Limited physical activity due to asthma structive pulmonary disease came to the
emergency department with an acute ex-
48. Which of the following statements about acerbation. Arterial blood gas analysis
non-invasive positive pressure mechani- was pH:7.3, PaCO2:55 mmHg, PaO2:75
cal ventilation for acute exacerbations mmHg, HCO3-:30 mEq/L. Respiratory
of chronic obstructive pulmonary disease rate:30 times/min, conscious, blood pres-
(COPD) is correct? sure and other vital signs are stable.
A. ineffective treatment Which of the following treatments is not
suitable?
B. lack of evidence-based medicine
A. Endotracheal intubation and ventilator
C. Can reduce the chance of intubation support
and mortality
B. Look for evidence of infection and give
D. It is effective in relieving symptoms antibiotics if found
of some patients, but cannot shorten the
length of hospital stay C. Administer non-invasive positive pres-
sure ventilation (NPPV)
49. Which statement is wrong about patient- D. Administration of inhaled bronchodila-
ventilator asynchrony when using a non- tors
invasive positive pressure ventilator for
chronic obstructive pulmonary disease? 52. Wat is COPD?
A. auto-PEEP is an important cause of A. longziekte
B. Higher inspiratory flow reduces this B. hartaandoening
problem
C. een virus
C. Turning up the pressure support set-
ting can reduce this problem D. leverziekte
D. This problem often occurs with pres- 53. Which of the following statements about
sure support ventilation modes COPD is false?

A. Chronic inflammation of the lungs and the description of pulmonary complica-

respiratory tract tions occurred, which of the following is
B. chronic diseases that are preventable wrong?
and treatable A. more likely than non-COPD patients
C. Proper treatment is a curable airway B. Patients with stable asthma have a
obstructive disease higher incidence of postoperative pul-
monary complications than patients with
D. The prevalence is directly related to
COPD
NARAYAN CHANGDER
the prevalence of smoking
C. Before surgery, it is best to control no
54. Bij COPD en astma is er wheeze and no active infection
A. Bronchoconstrictie-inflammatie- D. If the preoperative forced expiratory
hyposecretie volume in the first second (FEV1) is less
than 800 mL, pulmonary resection is not
B. Bronchodilatatie-inflammatie-hypersecretie
recommended
C. Bronchoconstrictie-inflammatie- 58. What inhaler type would you recommend

hypersecretie for a patient with one exacerbation in last
year and daily activity is no limited in any
D. none of above way but a history of asthma as a child
55. What Are Symptoms of COPD? Multiple A. Salbutamol
answers possible. B. Formoterol
A. Cough C. LAMA
B. To sneeze D. LABA/LAMA
C. Stomach ache E. LABA/LAMA/ICS
D. chest tightness 59. For the diagnosis of COPD, which of the
E. Fatigue following is true?
A. Spirometry FEV1/FVC < 0.7, indicat-
56. If in the last 4 weeks, the average patient
ing persistent expiratory airflow obstruc-
has experienced asthma symptoms during
tion
the day 4 days a week, sometimes wakes
up at night due to asthma, requires re- B. Pulmonary function tests showing ex-
liever therapy to treat asthma symptoms piratory airflow obstruction are necessary
more than 4x/week, there are no activity for the diagnosis of COPD
limitations due to asthma, then based on C. Chest computed tomography is recom-
GINA 2019 includes: mended to improve diagnostic accuracy
A. Well controlled (terkontrol) D. Clinical manifestations, disease his-
B. Partly controlled tory is highly suspicious of COPD, even
without lung function, it can be diagnosed
C. Uncontrolled (not controlled) as COPD
D. Unclassifiable
60. What can you do yourself against COPD?
57. For patients with chronic obstructive pul- Multiple answers possible.
monary disease, after undergoing surgery, A. Better clean your house

B. Quit smoking D. The emphysema phenotype is the fre-

C. Reduce exposure to polluted air quent abnormal dilation of the terminal air
space of the terminal bronchioles due to

D. Move more alveolar destruction.
E. Eating unhealthy
65. Exercise can help COPD patients improve
61. In pulmonary emphysema symptoms, and the intensity should start
A. there is progressive damage to the tra- from? % of the maximum oxygen con-
chea. sumption?
B. the lungs lose their elasticity. A. 40%
C. there is no CO2 retention. B. 50%
D. none of above C. 60%
D. 70%
62. Which of the following spirometry results
is consistent with COPD: 66. Non-drug treatments for the treatment of
A. FEV1/FVC < 0, 7 stable COPD are which of the following?
B. FEV1 increase > 12% and > 200 ml A. quit smoking
after bronchodilator test B. pulmonary rehabilitation
C. FEV1/FVC <0.8 after bronchodilator C. Vaccine
test
D. All of the above
D. Gaensler index < 0.7 after bron-
chodilator test 67. The inflammation of all or a large part of
the lung lobe. You call this the?
63. Which of the following is least associated
A. Broncho pneumonia
with the development of cardiac arrhyth-
mias in patients with acute respiratory B. Lobaire pneumonia
failure in chronic obstructive pulmonary C. Aspiration pneumonia
disease (COPD)?
D. none of above
A. inhaled bronchodilators
68. Smokers live about? years less than non-
B. Theophylline (theophylline) overdose
smokers:
C. inhaled steroids
A. 5-10 years
D. electrolyte imbalance
B. 10-15 years
64. Which of the following statements about C. 15-20 years
COPD is FALSE?
D. 20-25 years
A. There is airflow obstruction and air
trapping 69. Which of the following statements is true
B. Pulmonary hypertension and can lead about factors affecting the pathogenesis
to bronchiectasis and progression of COPD, EXCEPT?
C. The “blue bloater” phenotype is usu- A. Genetics, age, sex, economic status
ally “green fat” patients with chronic B. Exposure to particles from:tobacco,
bronchitis and pan-lobular alveolar dilata- marijuana including passive smoking, oc-
tion. cupational exposure

C. Asthma and other non-airway related B. A blue bloater makes heavy use of the
exaggerated responses, infections breathing muscles
D. Chronic bronchitis is not associated C. A pinky puffer is overweight.
with rate of decline in respiratory function D. none of above
70. Which of the following statements about 75. which of the following are clinical indica-
chronic obstructive pulmonary disease is tors for a COPD diagnosis
correct?
A. SOB that is worsening
NARAYAN CHANGDER
A. Chronic bronchitis and emphysema
B. Recurrent Wheeze
are separate subtypes with no overlap
C. Chronic Cough
B. The typical pulmonary function of
COPD is FEV1/FVC > 0.7 D. History of LRT infections
C. Long-term poorly controlled asthma is E. History of risk factors
one of the possible causes of COPD 76. Based on GOLD 2019, COPD diagnosis
D. Emphysema is mainly caused by the should involve the following assessments,
destruction of the alveoli, and the bronchi- except:
oles are still normal, so there is no prob- A. History of allergies
lem of bronchial stenosis
B. Symptoms of prolonged cough with
71. What is NOT an abnormal breath sound? phlegm (sputum)
A. stridor C. Tobacco smoking risk factors
B. pleural leaflets D. Pulmonary function assessment
through spirometry
C. rhonchi
D. you will crackle 77. Smoking seriously affects health, with an
average of about? seconds, one person
72. The medical term for collapse of part of the dies from smoking-related diseases:
lungs is? A. 5.5 seconds
A. atelectase B. 6.5 seconds
B. pneumonia C. 8.5 seconds
C. surfactant D. 12.5 seconds
D. stridor
78. years old male patient because of short-
73. How many stages are there in COPD? ness of breath and coughing a lot. 3 days
ago, the patient had a low fever, the cough
A. 9 gradually increased, the next day the pa-
B. 3 tient found it more difficult to breathe,
coughed more sputum, yellow sputum was
C. 7
difficult to spit out, and using ventolin
D. 4 spray only felt a little better. History
of COPD for 5 years, NV 4 times in the
74. Which statement is correct? past 1 year, being treated with Salbuta-
A. A pinky puffer has predominantly em- mol 100mcg spray 2 times when breath-
physema. ing difficulty, theophyllin 0.3mg orally to

1 tablet. 9 years hypertension on enalapril 82. What is a normal resting respiratory

treatment. Examination:Patient is awake, rate?
pulse 90l/min, SpO2 89% in air, lung

A. 6-10 AH/Mn
rale and snoring scattered in 2 lung
fields. CTM:Hb 13g/dl, Hct 35%, WBC B. 12-16 AH/Mn
16.5k/mm3, NEU 87%, PLT 300k/mm3. C. 60-70 ah/min
Blood pressure PaO2:52mmHg, PaCO2 D. 20-24 AH/Mn
60mmHg, blood pH 7.35. The most appro-
priate diagnosis in this patient 83. Regarding pulmonary function tests for
asthma and COPD, which of the following
A. Moderate COPD exacerbation
statements is correct?
B. Severe COPD exacerbations A. Patients with chronic obstructive pul-
C. no respiratory failure monary disease often have decreased
forced expiratory volume in one second
D. life-threatening acute respiratory fail-
(FEV1)
ure
B. Asthmatic patients often have de-
E. non-life threatening acute respiratory
creased forced expiratory volume (FVC)
failure
C. FEV1/FVC in patients with chronic ob-
79. The primary purpose of pursed-lip breath- structive pulmonary disease is mostly nor-
ing is to: mal
A. Promote oxygen intake. D. Diffusion capacity for carbon monox-
ide (DLco) decreases in asthmatic pa-
B. Strengthen the diaphragm tients
C. Strengthen the intercostal muscles
84. A nurse is caring for a patient with an
D. Promote carbon dioxide elimination asthma exacerbation. For which of the fol-
lowing reasons should the nurse carefully
80. In which condition can respiratory asym- inspect the chest wall of the client?
metry be observed?
A. Monitor chest expansion
A. COPD
B. Observe for intercostal muscle use
B. pneumonia
C. Observe for signs of diaphoresis
C. pneumothorax D. Monitor for hyperventilation
D. asthma
85. What is the name of the substance in a
81. Management of patients with moderate cigarette that has an addictive effect?
COPD exacerbations A. Nicotine
A. Consider hospitalization B. Carbon dioxide
B. Using a combination of SABA and C. Oxygen
SAMA . bronchodilators D. Teer
C. Use of LAMA/LABA in combination
86. An 80-year-old male was hospitalized for
with antibiotics and/or corticosteroids
multiple acute exacerbations of chronic ob-
D. Give mechanical ventilation, maintain structive pulmonary disease. The arte-
SpO2 >88% rial blood gas analysis showed pH:7.28,

PaCO2:65 mm Hg, PaO2:61 mm Hg, 90. What test diagnoses COPD?

HCO3-:24.1 mEq/L, which of the follow- A. Lung function test
ing is wrong?
B. Breathalyzer
A. The blood oxygen content should not
be too high to avoid the Haldane effect C. Blood test
causing the partial pressure of CO2 in the D. Saliva test
plasma to rise
91. Respiratory failure caused by which of the
B. Consider non-invasive positive pres-
NARAYAN CHANGDER
following diseases should shorten the in-
sure respirators spiratory time when adjusting the param-
C. The inspiratory pressure of the non- eters of the respirator?
invasive positive pressure respirator is A. Diffuse pulmonary infiltrates
adjusted to tidal volume (tidal volume) 4 6
B. obstructive lung disease
mL/kg
C. interstitial lung disease
D. If the arterial blood gas analysis
PaCO2 is 62 mm Hg after using a non- D. Pulmonary Fibrosis
invasive positive pressure respirator for
92. What is the most common bacterial infec-
1 to 2 hours, the EPAP can be increased
tion in COPD exacerbations?
to improve the PaCO2 cut-off.
A. Streptococcus pneumoniae
87. Smokers also age? years older than non- B. Pseudomonas aeruginosa
smokers:
C. Klebsiella pneumoniae
A. 5 years old
D. Acinetobacter baumannii
B. 10 years old
93. An example of a bronchodilator is .
C. 15 years old
A. Pulmicort
D. 20 years old
B. Becotide
88. Where in the lungs does gas exchange C. Ventolin
take place?
D. Flixotide
A. alveoli
94. Why is exercise good for COPD?
B. trachea
A. Exercise is not good for COPD at all.
C. longhilus
B. It is healthy.
D. pleuraholte
C. Your condition gets better.
89. Management of patients with COPD ex- D. You get stronger.
acerbations requiring hospitalization, EX-
CEPT 95. A 68-year-old client with chronic obstruc-
tive pulmonary disease (COPD) is admit-
A. SAMA + SABA ted to a rehabilitation unit. Pneumococcal
B. Mask Venturi Target SpO2 88-92% and flu vaccines are administered. The pa-
tient wants to know if they have to get
C. Prophylactic antibiotics
the vaccine every year? How should the
D. Prednisone 40mg for 5 days nurse respond?

A. “It is unnecessary to have any follow- C. Lung function report FEV1:40% pre-
up injections of the pneumococcal vaccine dicted value, FEV1/FVC:55%, belongs to
after this dose.” GOLD stage II

B. “You should get the flu and pneumo- D. In acute attacks, systemic steroids
coccal vaccines at your annual physical ex- should be avoided to avoid side effects
amination.” such as infection and gastric ulcers
C. “The pneumococcal vaccine should be 99. Smoking is the most dangerous killer in the
received in early autumn every year.” world, so it has been likened to:
D. “You need to receive the pneumococ-
A. Three inch nail
cal vaccine every other year.”
B. grenades
96. Purpose of changes to GINA 2019, except:
C. Barrels of gasoline
A. To reduce the risk of exacerbation and
D. sandstorm
death from asthma at all levels, including
in patients with mild asthma 100. what FEV1 and FEV1/FVC results will
B. To provide consistent messaging re- confirm a COPD diagnosis
garding the goals of asthma treatment, A. <0.7 best and <0.7 predicted
including prevention of exacerbations,
across all levels of asthma B. <0.8 best and <0.8 predicted
C. To prevent patients from becoming C. <0.7 best and <0.8 predicted

SABA dependent from an early stage D. <0.8 best and <0.7 predicted
D. To increase the use of SABA E. none of these
97. Which statement about COPD is correct? 101. Smoking is a serious problem. It is esti-
A. COPD is curable mated that there are 1.25 billion smokers
in the world, and they are even more af-
B. COPD mainly occurs in young people fected by air pollution. What is PM2.5?
C. the cause of COPD is 90% smoking A. Air Pollution Indicators Version 2.5
D. the cause of COPD is childhood asthma Specifications
98. A 79-year-old male smokes one pack a B. Air pollution index reached 2.5 units
day. He has a long-term chronic cough. He C. Fine Suspended Particles 2.5 microns
has to stop and rest when he walks less
D. AQI index PM2.5 exceeded the stan-
than 100 meters. He needs to be hospi-
dard
talized twice due to acute attacks of cold
symptoms within a year. Which of the fol- 102. The amount of nicotine residue detected
lowing is correct? in lanugo is half that of the mother, and
A. In acute exacerbations, consider an- the probability of giving birth to a cleft lip
tibiotics only if pneumonia is suspected on baby is also higher? %:
chest x-ray A. 30-40%
B. Inhaled steroids may be added in com- B. 40-50%
bination with long-acting inhaled bron-
chodilators to reduce the chance of C. 50-70%
seizures D. 70-80%

103. If asthma patients are still not controlled D. Smoking substances also stimulate fi-
with Level 2 therapy, then based on GINA broblasts, leading to fibrosis of the air-
2019 for controller drugs: ways
A. Need to add tiotropium
107. Among the deaths from smoking-related
B. Need to add LABA (to low dose diseases, deaths in the prime of life
ICS/LABA) account for about the total number of
C. A medium dose of ICS/LABA should be deaths:
NARAYAN CHANGDER
given A. 1/2
D. Need to be given medium / high doses B. 1/3
of corticosteroids and LABA
C. 1/4
104. A nurse reviews the arterial blood gas D. 1/5
values:pH of 7.50, a Pco2 of 30 mm Hg,
and an HCO3 of 25 mEq/L. The nurse in- 108. A client is admitted to the hospital with
terprets these values as indicating: a diagnosis of an exacerbation of asthma.
A. Metabolic acidosis, uncompensated What should the nurse plan to do to best
help this client?
B. Respiratory alkalosis, uncompensated
A. Encourage the client to use an incen-
C. Respiratory acidosis, uncompensated tive spirometer routinely.
D. Metabolic acidosis, partially compen- B. Review the client’s asthma action plan
sated
C. Determine the client’s emotional
105. Which of the following is incorrect for state.
the initial setting of mechanical ventilation D. Administer the ordered bronchodila-
for patients with chronic obstructive pul- tors.
monary disease?
A. Tidal volume:6-8 ml/kg body weight 109. What does COPD mean
B. PEEP is set at 80% of auto-PEEP A. Chronisch obstructive pulmonary dis-
ease
C. Inhalation time:0.6-1.2 seconds
B. Chronisch obstructa pulmonus disease
D. Breathing frequency:8-16 breaths/minute
C. Chronic obstructive pulmonary dis-
106. Regarding the mechanism of COPD, ease
which of the following is incorrect?
D. none of above
A. Smoking substances stimulate
macrophages to further secrete a variety 110. A 10-year-old severely short of breath
of cytokines patient is very likely to have this condi-
B. Cytokines activate neutrophils and se- tion:
crete proteases to destroy alveolar struc- A. COPD
tures
B. emphysema
C. Cytokines also activate helper T cells
C. asthma
(CD4 T cells, helper T cells), causing dam-
age to the alveolar structure D. pseudo croup

1.5 Cystic Fibrosis 27
111. Oxygen therapy:Long-term oxygen ther- A. Majority of smokers (>90%) are

apy greater than 15 hours per day in pa- prone to develop COPD in adults
tients with chronic respiratory failure has

B. Smokers have developed adult COPD,
been shown to increase survival in pa-
and their lung function declines faster af-
tients with severe resting hypoxia, choose
ter quitting smoking
FALSE
A. Indicated when PaO2 <50 mmHg or C. Smoking will not cause tracheal epi-
SaO2 <88% dermal cells to fall off, and it is not easy
to cause tracheal constriction
B. Indicated when PaO2 > 55 mmHg but
< 60 mmHg associated with left heart fail- D. Cigarette ignition includes particulate
ure or polycythemia and volatile substances, and volatile harm-
C. The goal is to keep SaO2 ≥ 90% ful substances can easily lead to emphy-
sema
D. After 60-90 days, the effectiveness of
oxygen should be re-evaluated or contin- 114. A 79-year-old COPD male patient
ued oxygen therapy was admitted to the hospital due to
112. If a patient chokes, he may develop a asthma. The room air blood gas is
as follows:pH:7.52, PaCO2:45 mm Hg,
A. Lobaire pneumonia
PaO2:50 mm Hg, HCO3-:36 mEq/L. Which
B. Broncho pneumonia of the following is the most appropriate
C. Aspiration pneumonia treatment?
D. none of above A. CPAP FiO2:24%
113. The incidence of chronic obstructive pul- B. Nasal cannula 5L/min
monary disease in adults is closely related
C. 28% air entrainment mask
to smoking. Which of the following state-
ments is correct? D. Simple mask 8L/min
1.5 Cystic Fibrosis

1. What does Cystic Fibrosis affect? D. 16, 000
A. The brain 3. Is there a cure for CF?
B. The heart A. No
C. The lungs and pancreas B. Yes
D. Nerves and arteries C. Maybe
2. people in the U.S. have Cystic Fibrosis. If D. Not at all
there are 1, 000 new cases of Cystic fibro-
4. is a hereditary disease that affects the
sis each year, how many cases were there
lungs and digestive system. The body pro-
in 2005
duces thick and sticky mucus that can clog
A. 14, 000 the lungs and obstruct the pancreas.
B. 2, 000 A. cistic fibrosis
C. 8, 000 B. fibrocratic cysts

C. cystic fibrosis C. A disorder that causes major climate

D. cystic fibrois issues
D. A disease that causes back problems
5. What is the cure for cystic fibrosis?
A. Airway clearance 10. What are some symptoms of CF?
B. Mucus thinners A. Salty-Tasting Sweat
C. Chest physical therapy B. Cold Feet
NARAYAN CHANGDER
D. There isn’t one C. Yellow Eyes
6. If 50% of the people with cystic fibro- D. Digestive System Problems
sis are 18 years or older, given that 70, E. Chest Problems
000 people currently have CF (cystic fibro-
sis) world wide and there are 1, 000 new 11. what percentage of men are infertile with
cases each year, how many people that CF?
have CF will be 18 years or older in 2045?
(pretend that all of them are still living at A. 34%
that time) B. 12%
A. 46, 375 C. 98%
B. 48, 000 D. 100%
C. 47, 500
12. what disease are they prone to?
D. 35, 000
A. lung cancer & diabetes
7. what ethnic group is cystic fibrosis found
most in? B. stoke & heart attack
A. Asian C. Flu & strep
B. African American D. bronchitis & pneumonia
C. Hispanics
13. the symptoms of cystic fibrosis?
D. Caucasian
A. headache
8. Which of the following are diagnostic tech- B. diarrhea
niques for cystic fibrosis?
C. muscle or body aches
A. Genetic test
D. repeated coughing, shortness of
B. Angiogram
breath
C. Spirometry
D. Sweat test 14. Who came up with the first modern de-
scription for cystic fibrosis?
9. What is a genetic disease? A. Theodore Jankins
A. A disorder or disease that can be
B. Hippocrates
passed down genetically
C. Dorothy Anderson
B. A disorder or disease that can
spreaded physically D. John Lenny

15. Select all 21. How much did the life expectancy increase
in 50 years (1960-2010)?
A. Sickled red blood cells

A. From 24 to 58
B. Sticky mucus buildup on the lungs
B. From 30 to 80
C. Salty skin
C. From 17 to 35
D. Tremors
D. From 6 to 37
16. What is the nucleotide mutation?
22. What is the mucus like that is in the lungs
A. exon 3 when a person has Cystic fibrosis.
B. exon 19 A. thin and sticky
C. exon 4 B. thick and slimey
D. exon 13 C. thin and slimey
D. thick and sticky
17. When you have CF what is your stools
like? 23. What do people do to try to get you health-
ier?
A. soft / diarrhea
A. Bone transplant from sibling
B. soft / constipated
B. Bone marrow transplant from sibling
C. Hard / constipated
C. DNA transplant from sibling
D. none of above
D. Cell takeout
18. Which ion is unable to move across the 24. What is the inheritance pattern of cystic
membrane in CF? fibrosis?
A. Chloride A. Autosomal dominant
B. Hydrogen B. Autosomal recessive
C. Fluoride C. X-linked dominant
D. Sodium D. X-linked recessive
19. Location where it is 25. what causes cystic fibrosis

A. Chromosome 9 A. mutation in the brain
B. Chromosome 7 B. mutation in the gene
C. Chromosome 1 C. both A and B

D. None
D. Chromosome 4
26. Knowing that it effects the lungs, what
20. What type of disorder is CF? does Cystic fibrosis make it hard to do?
A. genes A. Breathe
B. autosomal dominant B. Talk
C. autosomal recessive C. Sleep
D. genetics D. Eat

27. what is a symptom 33. What does this cause?

A. wheezing A. Nothing
B. coughing B. Mr. Potato in your lungs
C. weight gain C. Organ failure
D. all of the above D. Mucus on the cells
28. What are one of the tests the doctor does 34. What organ is affected from waste of en-
zymes
NARAYAN CHANGDER
to see if you have it?
A. biopsy test A. Kidney
B. Liver
B. Sweat test
C. Pancreas
C. neurological exam
D. Stomach
D. gastroscopy test
35. what are 2 major places that it is found?
29. CF affects which of the following? Select
all that apply. A. Lung & Liver
B. Pancreas & spleen
A. Pancreas
C. Liver & Colon
B. Lungs
D. Heart & Brain
C. Heart
D. Gall bladder 36. Which of the following is not a symptom
of cystic fibrosis?
30. What part of your body does Cf affects? A. salty sweat
A. heart B. shortness of breath
B. lower abdomen C. persisted coughing
C. Lungs & pancreas D. rashes
D. liver 37. CF-Related Diabetes (CFRD). Primary de-
31. Tick all the issues with CF fect is insulin insufficiency. Mucus leads to
scarring in pancreas but still able to make
A. Can waste enzymes some insulin. What is the primary treat-
B. Can cause blocked lungs ment for CFRD?
C. Can cause blocked liver A. Metformin
D. Can cause blocked windpipe B. Non-Insulin Therapy
C. Insulin
32. How many copies of the mutated CFTR
gene are required for a person to develop D. none of above
cystic fibrosis? 38. How can you get diagnosed?
A. 1 A. Screening when you are a newborn
B. 2 B. Spit in a cup and get test results
C. 3 C. Go to a certain doctor and get tested
D. 4 D. none of above

39. Mark all the respiratory symptoms. B. older medicine that is way too strong
A. Heartburn and wipes out the illness completely

B. Coughing mucus and/or blood C. older medicine that doesn’t work
C. Lung infections D. older medicine that is unreliable
D. High blood pressure 45. people have CF world wide and 30, 000
E. Excessive sweating have it in the U.S. What is the percent of
people in the U.S. that have it AND the per-
40. The mutated gene associated with CF is lo- cent of those who have it that are not in
cated on chromosome the U.S.? SELECT TWO ANSWERS!!!
A. 7 A. 43%
B. X B. 60%
C. 21 C. 42%
D. 13 D. 57%
41. How many defective genes do you need? E. 40%
A. 2 46. What are the effects of Cystic Fibrosis
B. 3 A. brain
C. 1 B. feet
D. 4 C. your mucus is thick and sticky
42. What’s the long term effect? D. legs
A. Lungs 47. What part of the gene is affected?
B. brain A. CFTR
C. skin
B. Chromosome 7
D. none of above
C. Chromosome 9
43. Did/Are you enjoy(ing) this Quizizz? D. Nothing
There is no wrong answer
48. CF is passed on
A. Yes
A. If both parents carry the dominant
B. No
gene
C. I’d rather not say
B. When one parent has the dominant
D. DON’T CLICK THIS GIVE YOUR gene
OPINION
C. If both parents carry the recessive
44. Most people with cystic fibrosis have the gene
F508del version and that is also the type D. When one parent carries the recessive
that medicine is mostly tested for. People gene
without that type of cystic fibrosis get
A. older medicine that their bodies get 49. What does CFTR mean?
used to at some point which makes it A. cystic fibrosis transmembrane conduc-
harder to fight their illness. tance regulator

B. Constipation fatigue tough regulator 55. Which of the following is NOT a symptom
of CF
C. cystic fibrosis translator regulator
A. sore and dry throat
D. cystic fibrosis um i don’t know
B. repeated lun infections
50. The mutated gene C. severe constipation
A. CFST D. greasy stools
B. CTFR
NARAYAN CHANGDER
56. Another name for Red Blood Cells
C. CPPR (RBCs)?
D. CQRS A. Thrombocytes
B. Leukocytes
51. Select the antibiotic that is NOT commonly
C. Erythrocytes
used in treatment of CF bacterial infec-
tions. D. Eosinophils
A. Azithromycin 57. The deletion of 3 base pairs at position
B. Amoxicillin 508 causes about what percentage of cys-
tic fibrosis cases.
C. Tobramycin
A. 30%
D. Aztreonam B. 100%
52. What is Cystic Fibrosis? C. 10%
A. A rock band D. 70%
B. Cancer 58. How’s cystic treated?

C. Disease A. with therapies
D. Disease that builds mucus on cells B. medicine to thick secretion in lungs
C. surgery
53. Mutations in which gene causes cystic fi-
D. clap chest several times
brosis?
A. HTT 59. what does CF stand for?
A. Chick-fil-A
B. PINK1
B. Cystic Fibrosis
C. CFTR
C. Crummy Feet
D. HBB
D. none of above
54. which one of these symptoms are true for
60. If both parents are hybrid for CF then what
cystic fibrosis
are the possible genotypes? ? ?
A. skin tastes like salt A. Cc
B. skin turns yellow B. CC
C. memory loss C. cc
D. weight gain D. Ca

61. Cystic fibrosis was first discovered in 66. CF is associated with which process?
1938 by Dorothy Andersen, but the A. DNA duplication
CFTR (cystic fibrosis transmembrane con-

ductance regulator) gene wasn’t discov- B. Chromosomal synthesis
ered until 1989. Assuming that 3, 286 C. Mitosis
people had CF in 1938 and there were 937 D. Meiosis
new cases per year, how many people had
cystic fibrosis when the CTFR gene was 67. The cystic fibrosis transmembrane conduc-
discovered? tance regulator protein controls what in
A. 50, 832 the body?
B. 47, 787 A. Amount of surfactant produced to keep

a structure hydrated and stable.
C. 48, 000
B. The chloride (salt) levels of surfac-
D. 51, 073 tants.
62. is there a cure to CF? C. Regulates the conductivity of proteins.
A. No D. It controls you.
B. Yes 68. There were 30, 000 people in the U.S.
C. Maybe have Cystic Fibrosis in 2019. If there
are 1, 000 new cases of Cystic fibrosis
D. none of above each year, how many cases were there in
2005?
63. How many people are currently living in
the U.S with CF A. 14, 000
A. 45, 000 B. 2, 000
B. 29, 500 C. 8, 000
C. 30, 000 D. 16, 000
D. 10, 000 69. What is cystic fibrosis
64. Which of the following is mutated in CF? A. Too much salt in the body
A. DNA B. Too much mucus produced
B. RNA C. Too much iron produced
C. Lipids D. Too much blood produced
D. Carbohydrates 70. If 70, 000 people have Cystic fibrosis

world wide and 75% of people are diag-
65. people have CF world wide and 30, 000 nosed by the age of 2, how many people
have it in the U.S. What is the percent of who have this disease were diagnosed by
people in the U.S. that have it? the age of 2?
A. 43% A. 53, 200
B. 60% B. 51, 800
C. 42% C. 52, 500
D. 40% D. 49, 000

1.6 Fibrotic Lung Disease 34
1.6 Fibrotic Lung Disease

1. Which of these is not a characteristic of ex- 6. How common is Cystic Fibrosis?
acerbations in patients with Cystic Fibro- A. Common
sis?
B. Rare
A. Bradypnea
C. Extremely rare
B. Asthenia D. none of above
NARAYAN CHANGDER
C. Dyspnoea
7. The average mortality life expectancy in
D. Tos Peru due to Cystic Fibrosis exceeds:
2. The nasal transmembrane potential differ- A. 30 years
ence is usually pathological, it is character- B. 35 years
istic of: C. 50 years
A. nodular cystic fibrosis D. 40 years
B. Classic Cystic Fibrosis 8. Corrects the functional defect of the CFTR
C. CFTR-related disease anion channel altered by mutations:
D. Atypical Cystic Fibrosis A. Ivermectin
B. ivacaftor
3. Which of these are pulmonary complica-
tions from CF? C. Salbutamol
A. hemoptysis D. Azithromycin
B. Hidrotorax 9. A highly contagious viral infection of the

upper respiratory system
C. Pneumothorax
A. Influenza
D. Pulmonary hypertension
B. Pleurisy
4. Around 1 in Asain Americans are di- C. Rhinitis
agnosed with Cystic fibrosis in the United D. none of above
States.
A. 1000 10. Inflammation of the Larynx or vocal cords
A. Vocalitis
B. 5000
B. Laryngitis
C. 17000
C. TB
D. 31000
D. none of above
5. What is the main function of the respira- 11. On which chromosome is the cftr gene lo-
tory system? cated?
A. To help you breathe. A. chromosome 6
B. To help you not get colds. B. chromosome 7
C. To convert cemicals. C. chromosome 8
D. To help get rid of wastes. D. chromosome 5

12. The CFTR protein that acts as an anion 17. Respiratory disorder usually caused by a
transporter channel. Especially what ions sensitivity to an allergen such as dust,
does it transport? pollen, and animal, medications, or a food

A. Cl- A. Bronchitis
B. hustle- B. Asthma
C. H + C. Epistaxis
D. HCl- D. none of above
13. Most important early symptom of F. Cys- 18. What does cystic fibrosis affect?
tica A. The Heart
A. respiratory distress B. The Mind
B. Pulmonary Wheezing C. The Lungs
C. Headache D. The entire body
D. Tos 19. what is pneumonoultramicroscopicsilico-
volcanoconiosis
14. What epidemiological characteristics are
related to CF A. lung disease
A. Incidence of 1 in 2500 B. lung cancer
B. More common in African Americans C. a laughing matter

D. none of above
C. Same in men and women
D. increases every year 20. What therapy helps ease the effects of cys-
tic fibrosis?
E. Occurs only in a certain region
A. Retail Therapy
15. what is the correct spelling B. Nutritional Therapy
A. pnumonoultraicroscopicsilicovol- C. Talking Therapy
canoconiosis
D. Pulmonary Therapy
B. pneumonoultramicroscopisilicovol-
canoconiosis 21. Main pathogen that can be detected by
sputum culture:
C. pneumonoultramicroscopicsilicovol-
canoconiosis A. Staphylococcus aureus
D. pneumonoultramicroscopicsilicovolco- B. Burkholderia
coniosis C. Pseudomonas aeruginosa
16. Treatment for CF may include which of D. Haemophilus influenzae

the following? Bronchopulmonary hygiene 22. TB is an infectious lung disease caused by
Lung expansion therapy Aerosolized med- Mycobacterium tuberculosis. What kind of
ications Oxygen therapy isolation should this patient be on?
A. 1, 2 and 3 A. Contact
B. 2, 3, and 4 B. Standard
C. 2 and 3 C. Airborne
D. 1, 2, 3 and 4 D. none of above

23. of patients with classic CF present: 29. Cystic Fibrosis is caused by mutations in a
A. ACUTE PANCREATITIS gene called
B. DIABETES A. CRTF
C. EXOCRINE PANCREATIC INSUFFI- B. CTRF
CIENCY C. CFTR
D. OBSTRUCTION AT THE LEVEL OF THE D. CFRT
TERMINAL ILEUM
NARAYAN CHANGDER
30. What are symptoms to this disorder?
24. Inflammation of the Bronchi
A. Constipation
A. Bronchitis
B. Whining about homework
B. Asthma
C. A very high temperature
C. Empysema
D. none of above
D. none of above
31. Nose bleed
25. Condition in which an individual stops
breathing while sleeping A. Emphysema
A. Lung Cancer B. Epistaxis
B. Sleep Apnea C. Bronchitis
C. COPD D. none of above
D. none of above 32. Where does gaseous exchange take
place?
26. Which of these pathogens can cause sepsis
resulting in death? A. Red blood cells
A. Haemophilus influenzae B. Alveoli
B. Burkholderia C. lungs
C. Staphylococcus aureus D. Bronchus
D. Pseudomonas aeruginosa 33. What does CFTR stand for?
27. Any chronic lung disease that results in ob- A. CF transmembrane conductance regu-
struction of the airways lator
A. Emphysema B. CF transmembrane regulator
B. Lung Cancer C. CF Transmembrane Behavior Re-
C. COPD viewer
D. none of above D. Ma FQ transmembrane reviewer
28. Inflammation of the nasal mucous mem- 34. Inflammation or infection of the lungs char-
brane acterized by exudate in the alveoli
A. Sinusitis A. TB
B. Rhinitis B. Sleep Apnea
C. Sleep Apnea C. Pneumonia
D. none of above D. none of above

1.7 Lung Cancer 37
35. Cystic fibrosis affects the cells that pro- B. White blood cells
duce mucus, sweat and C. Insulin

A. Digestive Juices D. Red blood cells
1.7 Lung Cancer

1. where is lung cancer located? 4. SATA what would you expect to find in a
lung cancer patient
A. heart
A. increased sputum
B. lung
B. abnormal lung sounds
C. eyes
C. nothing
D. ears
D. head injury
2. The nurse writes a problem of ‘impaired
gas exchange’ for a client diagnosed with 5. The nurse is taking the social history of a
cancer of the lung. Which interventions client diagnosed with SCLC. Which informa-
should be included for the plan of care? tion is significant for this disease?
A. Apply oxygen via nasal cannula. A. Worked in a factory for a short time
many years ago.
B. Place the client in respiratory isola-
B. Has a family Hx of this type of lung can-
tion.
cer.
C. Have the dietitian plan for 6 small
C. Has numerous tattoos on upper and
meals per day.
lower arms.
D. Assess vital signs for fever.
D. Has smoked 2 packs of cigarettes/day
E. Listen to lung sounds q shift. for 20 years.
E. Stopped smoking for a 9 months after
3. A patient who recently stopped smoking
a Hx of smoking.
asks a healthcare provider about the risks
of developing lung cancer. The healthcare 6. How many Fridays does Wellness Friday
provider’s best response is: take place every Friday?
A. “If lung cancer hasn’t developed yet, A. The 1st
the ongoing risk is equivalent to a non-
smoker.” B. The 2nd
C. The 3rd
B. “In 8 months, the risk of developing
lung cancer is twice as high as a non- D. The 4th
smoker.”
7. Power of Prevention is one of the HPE
C. “In 15 years, the risk of developing Wellness Programs related to disease pre-
lung cancer will be equivalent to a non- vention
smoker.”
A. Diabetes
D. “An elevated risk of developing lung
cancer compared to a non-smoker will re- B. Hypertension
main constant life-long.” C. Cancer

1.7 Lung Cancer 38
D. Covid-19 13. How much money were smoking-related

E. Leather deaths costing the NHS per year by
1985?
8. Which of the following contains anti- A. £95 million
carcinogenic:
B. £135 million
A. cabbage, tempeh, garlic
C. £165 million
B. garlic, carrots, broccoli
D. £195million
NARAYAN CHANGDER
C. tomato
D. all true 14. Why is there an ethical question involved
in giving a lung cancer patient donor
9. The healthcare provider is assessing a pa- lungs?
tient with a diagnosis of lung cancer after
A. The cancer might already ahve spread
a left lobectomy. Which of the following
so then it is a waste of lungs.
assessments is an early indication the pa-
tient has developed atelectasis? B. You cannot be sure that they won’t
carry on smoking and ruin their new lungs
A. Central cyanosis
too.
B. Inspiratory wheezing bilaterally
C. Some people do not like the idea of or-
C. Intercostal retractions gan donation.
D. Decreased breath sounds in the right D. becasue is it fair to give someone new
lung lungs when they have ruined their own?
E. Low grade fever
15. In which decade did lung cancer deaths
10. symptoms of Lung cancer.? peak amongst men?
A. Coughing up blood A. 1950s
B. Gaining weight B. 1960s
C. Sleeping C. 1970s
D. leg pain D. 1980s
11. How can lung cancer be treated? . 16. What does a broncoscope do?
A. Stop smoking A. It is passed into the patient’s lungs
B. Not going to chemotherapy where it can be used to excise (remove)
the tumour.
C. Smoking
B. It is passed down into the patient’s
D. Chemotherapy
lungs where it collects a sample of cells
12. Which is a genuine public health campaign. for further testing.
A. Stop Smoking Now C. It is like a CT scan, but focused on the

lungs and uses radioactive dye to be able
B. Change4Life to see better inside the lungs.
C. Stoptember D. It involves key hole suregery with tiny
D. Don’t let good times go drunk cameras on the lungs.

1.7 Lung Cancer 39
17. What is lung cancer? . C. All wrong

A. Main types called small cells D. none of above

B. Eating a lot 22. Which of the following factors increase the
C. Sleeping risk of cancer?
D. Laughing A. Fatty food
18. The healthcare provider is caring for a B. Fibrous vegetables
postoperative patient who has undergone C. Iron and Zinc Deficiencies
a lobectomy. The plan of care will include
D. a and b are true
positioning the patient:
E. a and c are true
A. Laying on the non-operative side.
B. Supine in a high Fowler’s position. 23. A patient with a diagnosis of lung can-
cer is receiving chemotherapy and reports
C. Supine with the head of the bed flat.
nausea and loss of appetite resulting in
D. Laying in Sims position. decreased food intake. What should the
healthcare provider recommend to pro-
19. Apa saja cakupan Employee Assistance
mote adequate nutrition? Advise the pa-
Program?
tient to:
A. Face-to-face consultation
A. Eat only favourite foods to increase ap-
B. Telephone consultation petite.
C. Email Consultation B. Eat small meals throughout the day.
D. 24-Hour emergency hotline support C. Eat large meals but less frequently
E. Semua pilihan benar throughout the day.
D. Eat only when feeling hungry.
20. A patient recovering from a lobectomy
has a chest tube attached to a water-seal 24. The client is 4 hours post-lobectomy for
drainage system. The healthcare provider lung cancer. Which assessment data
notices the fluid in the water-seal column warrant immediate intervention by the
has stopped fluctuating. Which of the fol- nurse?
lowing would explain why the fluctuations
A. Intake of 1500 mL IV and output of
have stopped?
1000 mL.
A. The lung has collapsed.
B. 550 mL of bright red drainage in the
B. Positive intrapleural pressure has in- chest tube.
creased.
C. Complaining of pain at a 5 on a 1-10
C. There may be fibrin clots in the tubing. scale.
D. There is leak in the drainage system. D. Absent lung sound on the side of
E. The lung had fully expanded. surgery.
21. Which of the following are probiotic 25. How many times will the Global Wellness
foods? Challenge (GWC) be held in 2021?
A. Fiber from vegetables and fruit A. 1
B. Yogurt & Nato B. 2

1.7 Lung Cancer 40
C. 3 B. Increasing taxation on tobacco prod-

D. 4 ucts.
E. 5 C. Producing campaigns to advertise the

dangers of smoking.
26. What is usually the first step in diagnosing D. Banning smoking in cars with children.
lung cancer?
A. A PET-CT scan 31. Which food processing technique is prefer-
able:
NARAYAN CHANGDER
B. An X Ray
A. burnt
C. A CT scan
B. boiled
D. A bronchoscopy
C. high temperature baked
27. A patient with a diagnosis of small cell car-
D. fried
cinoma in the right lung exhibits shortness
of breath, facial and periorbital edema, E. heated repeatedly
and jugular vein distension. Which action
32. What is the most severe effect
should the healthcare provider do first?
A. Unexplained headaches
A. Obtain an electrocardiogram (ECG).
B. Shortness of breath
B. Take a full set of vital signs.
C. weakness
C. Administer oxygen.
D. lingering cough
D. Increase the IV flow rate.
33. What is the survival rate? .
28. Finish the sentence:Lung cancer is the
A. 18%for men
A. most common form of cancer in the
UK. B. 55%for men
B. second most common form of cancer C. 67%for men
in the UK. D. 25% for women
C. most prolific form of cancer in the UK.
34. In 1950 who published a study that con-
D. least common form of cancer in the clusively linked smoking to lung cancer?
UK.
A. The Royal Society
29. In what year was the smoking ban first B. The British Medical Association
introduced? (What year did it come into
force) C. The British Medical research council
A. 2005 D. Cancer Research UK
B. 2006 35. While undergoing radiation therapy for

C. 2007 lung cancer, the patient develops dry,
itchy, and flakey skin. The healthcare
D. 2008 provider will recommend the patient to:
30. Find an accurate example of how the gov- A. Increase time between treatments to
ernment has tried to PREVENT people from reduce exposure to radiation.
becoming smokers. B. Cleanse area with lukewarm water to
A. Banning smoking in workplaces. avoid tissue damage.

1.8 Old Tuberculosis 41
C. Use an exfoliator to remove dead cells A. well steps

to decrease irritation to the area.
B. StartOrganic

D. Apply ice to reduce inflammation to ir-
ritated area. C. Global Wellness Challenge
D. Power of Prevention
36. The following are not included in the HPE
Wellness Program E. Headspace
1.8 Old Tuberculosis

1. What does TB XDR mean? 5. How many percent of ocular tuberculosis
A. Sensitivity to isoniazid, rifampicin, two patients report a history of systemic symp-
fluoroquinolones, and a second-line in- toms (cough, night sweats, etc.)
jectable A. 10-20%
B. Resistance to isoniazid and rifampicin B. 21-30%
C. Resistance to isoniazid, rifampicin, a
C. 31-40%
fluoroquinolone, and a second-line in-
jectable D. 41-50%
D. none of above
6. How many deaths each year are caused by
2. Tuberculosis is a contagious disease. How tuberculosis?
can someone catch tuberculosis?
A. 8, 000, 000
A. through someone who sneezed near
them B. 2, 000, 000
B. through someone who spoke near C. 40, 000, 000
them
D. 100, 000, 000
C. through someone who sang near them
D. through saliva 7. which symptom was not named in the ex-
amples? ? ? ?
3. Who discovered the causative agent of tu-
berculosis? A. weightloss
A. Luis Pasteur B. shaking chills
B. Anthony van Leeuwenhoek C. coughing up blood
C. Robert Koch D. dry cough
D. Marcello Malpighi
8. Which of these are not symptoms of tuber-
4. What is the disease most frequently asso- culosis?
ciated with tuberculosis in Mexico?
A. back pain
A. VIH/SIDA
B. Diabetes Mellitus B. Weightloss
C. Alcoholism C. increased appetite

D. Malnutrition D. night sweats

9. To which drugs is resistance generated in C. It is an infectious disease caused by a

Multidrug-resistant Tuberculosis? bacterium
A. rifampicin D. N.A
B. Ethambutol
15. The abbreviation for tuberculosis is
C. Rifampicin and isoniazid
A. TB
D. Isoniazid of pyrazinamide
B. TBD
NARAYAN CHANGDER
10. The factors that favor the transmission of C. TU
TUBERCULOSIS are
D. TS
A. Concentration of bacilli in the environ-
ment. 16. are symptoms of TB except
B. Poor room ventilation A. weightloss
C. Contact degree B. dry cough
D. absence of sunlight
C. loss of appetite
E. All
D. hemoptysis
11. Phase 2 treatment in cases of sensitive
Meningeal TB corresponds to 17. who dicovered tuberclosis
A. 112 doses A. Robert koach
B. 168 doses B. Filippo Pacini

C. 224 doses C. John snow
D. 280 doses D. none of above
12. The Ghon complex is characteristic of 18. What is the most common presentation
of choroidal involvement among patients
A. Actinomicosis
with ocular tuberculosis?
B. Nocardiosis
A. Choroidal vasculitis
C. primary tuberculosis
B. Ampiginous choroiditis
D. Secondary tuberculosis
C. Serpiginous-like choroiditis
13. TB often attacks the
D. Choroidal granuloma
A. lungs
19. According to the COTS consensus, which
B. stomach
of the following diagnostic examinations
C. hands should be positive in multifocal choroiditis
D. mouth to suggest ATT initiation?
A. Positive skin test alone
14. What is Tuberculosis?
B. Positive skin test and IGRA (QGold)
A. It is a viral disease
C. Positive IGRA and Chest xray
B. It is a disease that is transmitted by
blood D. Positive chest xray alone

20. How is Tuberculosis spread? POSITIVE prior to starting ATT in the fol-
A. Air lowing phenotypes:

B. Spit A. Recurrent anterior granulomatous
uveitis
C. Contact
B. First episode anterior granulomatous
D. Water
uveitis
21. What is an essential antituberculosis drug C. Panuveitis
A. Penicillin D. Intermediate uveitis
B. Isoniacida
26. The first line of defense against pulmonary
C. Viadil
TB is:
D. All
A. airway mucus
22. Do people who are affected by tubercu- B. nose hair follicles
losis always experience symptoms right
away? C. mask in the infected patient
A. Yes D. upper respiratory tract
B. No 27. It is not a preventive measure for tubercu-
C. Sometimes losis
D. none of above A. handwashing
23. Diagnosis of latent tuberculosis infection? B. ventilated environments
A. Positive sputum culture C. use of masks
B. X-ray suggestive of tuberculosis D. overcrowding
C. Positive PPD or IGRA test
28. the tuberculin test is also called
D. Ghon complex
A. mantoux method
24. Which of the following statements are B. method minutox
true about what happened to the over
2000 people injected with Tuberculin? Se- C. Mantoux method
lect all that apply. D. none of the above because jairo writes
A. All of the people were cured very badly
B. All of the people died
29. What disease did Robert Koch study
C. None of the people died first?
D. Only two dozen (twenty-four) people A. Tetanus
were cured
B. Anthrax
E. Thirty people died
C. Pneumonia
25. According to the COTS consensus, both ra-
D. Cholera
diologic (chest CT / xray) and immunologic
tests (TST or IGRA) are suggested to be E. Botulism

30. According to the COTS, what is the most C. prescribe isoniazid for prophylaxis and
common anatomic presentation of ocular send patient home.
tuberculosis?
D. treat the patient with isoniazid plus ri-
A. Anterior uveitis fampin
B. Intermediate uveitis
35. How many types of tuberculosis are
C. Posterior uveitis
there?
D. Panuveitis
A. 1
NARAYAN CHANGDER
31. What parts of the tree does tuberculosis B. 2
attack?
C. 3
A. Estate
B. trunk and branches D. none of above
C. Leaves 36. How does tuberculosis manifest itself?

D. fruits A. like tumors
32. Pick the correct answer B. like brown spots
A. blue C. As yellowing (chlorosis)
B. teal
D. As blackening (necrosis)
C. yellow
D. red 37. TB affects
A. Lungs
33. what is the best youtuber
A. DEVOUN! B. Nose
B. flamingo C. Eyes
C. denis daily D. Corazon
D. rb batt le e
38. What is the method to give resistance to
34. (OBA; from Pharma faculty)4.A 21-year- people who are exposed to infections?
old woman from Southeast Asia has been A. PCR tests
staying with family members in the United
States for the last 3 months. She has B. Vaccination-BCG
been feeling very tired for the last month, C. pharmacotherapy
poor appetite, and lost weight.An acid-
fast stain revealed many thin rods of pink- D. Host resistance
ish hue. A preliminary diagnosis was made
of pulmonary tuberculosis. Sputum is sent 39. It represents 20% of tuberculosis cases in
to the laboratory for culture.The most ap- all its forms
propriate course of action is to: A. pulmonary tuberculosis
A. hospitalize and start treatment with 4 B. tuberculosis meningea
anti-tubercular drugs.
C. bone tuberculosis
B. hospitalize and start treatment with ri-
fampin. D. tuberculosis extrapulmonar

40. Does TB have a cure? B. Ciprofloxacin, cycloserine, isoniazid,

A. and paraamino salicylic acid (PAS).

B. no C. Ethambutol, isoniazid, pyrazinamide,
rifampin.
C. perhaps
D. nose D. Isoniazid, pyrazinamide, rifampin,
streptomycin.
41. HOW OFTEN IS TB TREATED
A. MONDAY TO SATURDAY 45. Tuberculosis is caused by a virus called:
B. MARTES A. Mycobacterium meningea

C. WEDNESDAY B. Mycobacterium tuberculosis
D. none of above C. Mycobacterium Pylori
42. Passive detection is important for: D. Balasa Mycobacterium
A. prevent disease
46. Select the risk factors for tuberculosis
B. look for positives in schools
A. Traveling or living in areas where tu-
C. look for positives in nursing homes
berculosis is higher
D. reduce late diagnosis.
B. weakened immune system
43. According to NOM-006-SSA-2013, how
long should chemoprophylaxis be given to C. Lack of medical care
a 10-year-old child without vaccination, D. Use of substances such as tobacco
with BCG and PPD (-), who was exposed
to a patient with tuberculosis. 47. How is pulmonary tuberculosis transmit-
A. 3 months ted?
B. 6 months A. Cutaneous route
C. 9 months B. digestive track
D. 12 months C. Respiratory pathway
44. (OBA; from Pharma faculty)5.A 21-year- D. none of above
old woman from Southeast Asia has been
staying with family members in the United 48. Pregnancy. Although isoniazid and ri-
States for the last 3 months. She has fampicin cross the placental barrier, they
been feeling very tired for the last month, have not been associated with teratogenic
poor appetite, and lost weight.An acid- effects; only the use of should
fast stain revealed many thin rods of pink- be avoided because it is ototoxic to the fe-
ish hue. A preliminary diagnosis was made tus.
of pulmonary tuberculosis. Sputum is sent
to the laboratory for culture.Which treat- A. ethambutol
ment regimen should be started in this pa- B. Streptomycin
tient?
C. rifampicin
A. Amikacin, isoniazid, pyrazinamide,
streptomycin. D. piraji tears

49. Patient with a history of more than C. Acid fast staining is a diagnostic
two previous treatments, regardless of method.
whether or not they have completed the D. Full Blood Picture is diagnostic.
treatment scheme.
E. Mantoux test negative exclude diagno-
A. therapeutic failure sis
B. abandonment
54. One of the main measures to prevent the
C. chronic spread of pulmonary TB
NARAYAN CHANGDER
D. relapse A. respiratory isolation
50. From the point of view of its location, Tu- B. Exposure to fresh air
berculosis is classified into .. C. Diet rich in easily absorbed carbohy-
A. Pulmonary Tuberculosis drates
B. Tuberculosis Meningea D. immediate hospitalization
C. Tuberculosis Extrapulmonar 55. How many representative sputum bacil-
D. Tuberculosis osteoarticular loscopy samples should be taken?
A. 1 sample
51. Regions prioritized for having a high num-
ber of TB cases in Peru B. 2 samples
A. Metropolitan Lima, Ica, Callao, Loreto C. 3 samples
and La Libertad D. Solo Genexpert
B. East Lima, Ica, Tacna, Tumbes and La
Libertad 56. How is polyresistance defined?
C. Metropolitan Lima, La Libertad, Loreto A. Resistant to a first-line anti-TB drug

and Tumbes B. Resistant to more than one first-line
D. Loreto, Callao, Metropolitan Lima, Ica, anti-TB drug
Lambayeque C. Rifampicin resistant
52. What is the short acronym for tuberculo- D. none of above

sis? 57. What are the symptoms?
A. TB A. Cough with phlegm for more than 15
B. TC days
C. TS B. night sweats, weight loss
D. TU C. Fever, tiredness and lack of appetite
D. All of the above
53. (TRUE/FALSE:from Microbiology faculty)2
. Regarding laboratory diagnosis of tuber- 58. What is the maximum dose of isoniazid?
culosis:
A. 100 mg
A. The most appropriate specimen is spu-
tum. B. 500 mg
B. The causative organism grows well on C. 300 mg

blood agar. D. 1000 mg

59. Patient who has been receiving treatment 64. A 7-year-old boy arrives at your office, ap-
for more than 30 days and who interrupts parently healthy and vaccinated with BCG,
it for more than 30 days whose readmis- who was exposed to a family member

sion smear is positive. with recently diagnosed tuberculosis. The
A. new case child is without symptoms and with a PPD
of 4 cm. What would be the next to do?
B. rekeda
A. Start prophylactic treatment with ri-
C. abandonment fampicin for 3 months.
D. therapeutic case B. Keep under observation and perform
PPD at 3 months
60. The severity and permanence of the dis-
ease will only depend on C. Start prophylactic treatment with iso-
niazid and repeat PPD at 3 months
A. The consistency of the medication
D. Start prophylactic treatment with ri-
B. Permanent direct contact with a sick fampicin and repeat the PPD at 3 months
person
C. compromised immune system 65. TB vaccine shortly after birth:
A. Come on
D. Opportunistic exogenous infections
B. Get on your fours
61. What is the best way to prevent drug re-
C. Antiseptic
sistance in tuberculosis?
D. BCG
A. Timely detection and cure of all new
cases (with supervised schemes) E. Against the flu
B. Encourage the use of face masks 66. Which organ/organs in the human body
is/are mostly affected by tuberculosis.
C. Isoniazid preventive therapy
A. lungs
D. none of above
B. kidneys
62. Bacteriologically confirmed case of tuber- C. brain
culosis is one that is configured by the pos-
itive result of D. liver
A. test at ADA E. heart
B. Bacilloscopy (direct staining of the 67. The place where the tuberculosis bacilli
sample), culture in liquid medium or first go
molecular test A. bronchi
C. tuberculin B. Trachea
D. All are correct C. middle lobe bronchi
63. Does tuberculosis bacteria spread to many D. lung alveoli
different parts of the body? 68. The following are first-line OAT, except:
A. Always A. Isoniazid
B. Never B. Kanamycin
C. Sometimes C. Rifampicin
D. none of above D. Streptomycin

69. Some of the clinical samples in which this 74. who is most likely to get TB
bacterium is found are A. Women
A. urine and feces
B. Children
B. sputum and urine
C. Men
C. stool and sputum
D. Elderly
D. All are correct
75. WHAT IS TUBERCULOSIS?
NARAYAN CHANGDER
70. After how many days of coughing up
phlegm can I suspect that it is tuberculo- A. Infectious disease caused by the
sis? KOCH bacillus
A. 7 days B. Disease that can affect the lungs
B. 4 days C. Chronic circulatory infection
C. 15 days D. Only a and b are correct
D. 20 days 76. (True/False; From Microbiology Fac-
71. According to the COTS consensus, which ulty):Regarding the pathogenesis of tu-
choroidal manifestation/s require only a berculosis:
positive immunologic test (IGRA or TST) to A. Mode of transmission is by inhalation.
suggest starting anti-TB therapy?
B. The vast majority of M. tuberculosis in-
A. Tuberculoma fected individuals will not develop active
B. Focal choroiditis tuberculosis.
C. Multifocal choroiditis C. Reactivation of tuberculosis can be
triggered by immunosuppression.
D. Serpiginous-like choroiditis
D. Co-infection with HIV reduces the risk
72. Sign of severity that depends on the stage of developing active tuberculosis
of the disease, characterized by bloody ex-
pectoration. E. M. tuberculosis encounter the den-
dritic cells in the trachea.
A. haematemesis
B. hemorrhage 77. The routine method for dx of Tb is:
C. hemoptysis A. lung auscultation
D. none of above B. chest x-ray
C. blood test
73. What are the drugs for sensitive TB?
A. Isoniazid, ethambutol, streptomycin, D. breathing capacity
rifampicin
78. The mode of transmission of pulmonary TB
B. Isoniazid, rifampicin, streptomycin, is:
pyrazinamide
A. through blood transfusion
C. Rifampicina, pyrazinamide, ethambu-
B. direct sexual contact
tol, levofloxacino
D. Isoniazid, rifampicin, pyrazinamide, C. Por the middle of the fomites
ethambutol D. through the air

79. How long is the treatment time for sensi- C. Koch’s coconut
tive tuberculosis? D. Mycobacterium de Koch

A. 6 months
85. What were two other names for tubercu-
B. 8 meses
losis during the 19th century?
C. 9 months
A. Sniffles
D. 12 months
B. The Deadly Cough
80. what is the worst thing to ever happen in C. Consumption
roblox
D. Sneeze & Die
A. end of egg hunts
E. The White Death
B. suing condo owners and people who
post inappropriate stuff on roblox 86. In the pathophysiology and infection by M.
C. end of events Tuberculosis, what is the average duration
of the preallergic phase of tuberculosis?
D. ugc becoming ew
A. 4 to 8 weeks
81. What is the most common onset of ocular B. 6 to 10 weeks
tuberculosis?
C. 2 to 4 weeks
A. Acute (<6 weeks)
D. 4 to 6 weeks
B. Subacute (6-12 weeks)
C. Chronic (>12 weeks) 87. What is the bacteria called that causes
TB?
D. Both subacute and chronic
A. Tuberculosis bacteria
82. The treatment of ASSOCIATED tuberculosis
B. Mycobacteria tuberculosis
refers to:
A. Using a minimum of four anti-TB drugs C. tuberculosis
B. guarantee taking and compliance with D. none of above

the treatment until completion and its 88. who is the best teacher
cured condition.
A. Arsenic
C. Strictly supervised medication intake
B. Talia
D. none of above
C. Jocasta
83. What time is it
D. none of above
A. 1
89. The objective of tx against pulmonary TB
B. w
is:
C. R
A. Check the effectiveness of medica-
D. none of above tions
84. By what other name is the bacterium My- B. Completely eliminate the strain from
cobacterium Tuberculosis called? the organism
A. Koch’s bacilococcus C. Protect healthcare personnel
B. Bacillus de Koch D. interrupt the chain of transmission

90. Do they have a flagellum? C. Floroquinola

A. And D. Azithromycin
B. No 96. How many people died in the age group
C. This option is not 75-79
D. neither is this A. 200
B. 1000
91. Until what month of life can the PPD test
C. 500
NARAYAN CHANGDER
give a false positive result?
D. 700
A. 1 mes
B. 12 months 97. What is the bacteria called that attacks?
A. Bacterium
C. 6 months
B. Streptococcus
D. 8 months
C. TB
92. ASSOCIATED, using a minimum of four anti- D. Mycobacterium tuberculosis
tuberculosis drugs to:
98. What are the routes of transmission of Tu-
A. manage to kill all the bacilli in their dif-
berculosis?
ferent phases of metabolic growth.
A. When talking
B. to guarantee the taking and compli-
ance of the treatment until its completion B. Cough
and its cured condition. C. Sneeze
C. avoid resistor selection D. All are correct
D. to avoid over-or under-dosing of anti- 99. How can tuberculosis be controlled?
TB drugs. A. Quickly removed affected parts
93. What is the abbreviation for tuberculo- B. With fungicidal treatments
sis? C. Disinfecting pruning tools
A. TB D. With insecticidal treatments
B. TBC 100. TB can be diagnosed by
C. CCZ A. medical history
D. SLB B. lab test
94. La tuberculosis C. chest x-ray
A. It is contagious D. physical examination

E. all of the above
B. It is transported by airborne droplets
C. Causes cough, fatigue 101. A person is said to be exposed to MDR-
TB if they are resistant to it
D. All of the above
A. Pyrazinamide
95. It is a medicine used for its treatment B. Rifampicin
A. piraji tears C. Ethambutol
B. ceftriaxone D. Isoniazid

102. Which part(s) of the body can the tuber- A. hemoptysis

culosis infection spread to? B. respiratory insufficiency

A. all organs of the body C. pulmonary fibrosis
B. only the bones D. bronchiectasis
C. only the intestines
107. Presumptive tuberculosis was formerly
D. only the skin known as:
103. According to NOM-006-SSA-2013, how A. tuberculosis case
long should chemoprophylaxis be given to B. Diagnosis of tuberculosis
children < 6 years of age with or without
BCG and PPD (-) vaccination, who were C. Suspected of Tuberculosis
exposed to a patient with tuberculosis. D. Tuberculosis
A. 3 months 108. Main physical assessment to diagnose
B. 6 months pulmonary tuberculosis
C. 9 months A. bronchi
D. 12 months B. lung alveoli
104. It is the most frequent location, repre- C. middle lobe bronchi

senting more than 80% of the cases of Tu- D. Trachea
berculosis in all its forms, being able to be
BAAR (+) and BAAR (-). 109. What is the most common clinical presen-
tation of ocular tuberculosis?
A. tuberculosis meningea
A. Occlusive retinal vasculitis
B. tuberculosis miliar
B. Retinal vasculitis without occlusive
C. pulmonary tuberculosis features
D. tuberculosis genitourinaria C. Disc hyperemia or edema
105. Patients who received anti-TB therapy D. Choroidal involvement
had a greater proportion of successful out-
comes compared to those who did not 110. Tuberculosis is caused by:
receive ATT. What is the percentage of A. Virus
treatment failure among patients receiving B. bacteria
ATT?
C. Fungus
A. 5-15%
D. none of above
B. 15-30%
C. 30-45% 111. The drugs administered in the intensive
phase are:
D. <5%
A. Rifampin, isoniazid, and ethambutol
106. Permanent and irreversible dilatation of B. Rifampicin and isoniazid
the bronchial walls. It manifests with
cough, abundant purulent expectoration C. Ethambutol pyrazinamide
and dyspnea, after the cure of tuberculo- D. Rifampicin, isoniazid, ethambutol and
sis. pyrazinamide

112. What day is today Complex. What is the possible cause and
A. mars interpretation of the results obtained?
B. Wednesday A. Culture sensitivity exceeds molecular

test and smear microscopy
C. Friday
B. Presence of PCR inhibitory substances
D. none of above
C. Presence of Nontuberculous Mycobac-
113. Which of the antituberculous drugs is con- teria
sidered second line?
NARAYAN CHANGDER
D. All of the above
A. isoniacida
118. What did Conan Doyle say Tuberculin
B. ethambutol might be used for?
C. piraji tears A. As a medicine to cure Anthrax
D. etionacid B. As a medicine to cure Tuberculosis
E. rifampicin C. As a test to diagnose Tuberculosis
114. What are the symptoms of active tuber- D. As a medicine to ease the symptoms of
culosis? Tuberculosis
A. weightloss E. As a test to diagnose Pneumonia
B. night sweats 119. We talk about

. when it develops at the
C. fever
expense of the reactivation of a latent
D. loss of appetite focus formed years ago
E. FACING A. tb internal
115. How many Respiratory Symptomatics B. endogenous tb
have to be identified to find a SR BK +? C. exogenous tb
A. 100 D. inactive tb
B. 60 120. The WHO recommends application of BCG
C. 51 vaccine in the pediatric age in countries
D. 39 with a high burden of morbidity due to tu-
berculosis, based on this, what is the inci-
116. The following P.EP are needed to work dence of cases to consider vaccination?
with a person who has TB. (select all that A. 20 per 100, 000 inhab.
apply)
B. 50 per 100, 000 inhab.
A. Gloves
C. 10 per 100, 000 inhab.
B. Masks
D. 2 per 100, 000 inhab.
C. child
121. Who discovered the bacillus?
D. Protective glasses
A. koch
117. Patient suspected of tuberculosis in the B. juanito
general population with Negative Bacil-
loscopy, positive liquid culture and neg- C. little stoner
ative molecular test for M. tuberculosis D. none of above

122. What type of morphology does the B. It is a disease that can contaminate
bacterium Mycobacterium tuberculosis the community
present?

C. It is a contagious infectious disease
A. Coco caused by Koch’s bacillus.
B. breather D. None
C. Vibrio
128. They should receive preventive treat-
D. Bacillus ment with isoniazid (IPT)
123. THE NAME OF THE TB BACTERIA IS A. Over 5 years of positive contact
A. mycobacterium tuberculosis B. Silicosis
B. mycobacterium tuberculosis C. Prior to administering anti-TNF bio-
logic therapy with active TB
C. mycobacterium tuberculosis
D. Under 5 years of positive contact
D. none
129. How many sputum samples should be col-
124. A child under 14 years of age who is
lected for smear microscopy
in close contact with a patient with pul-
monary TB who is asymptomatic arrives at A. One
the general medicine consultation. Medical B. Of the
conduct must be
C. Three
A. Remit the assessment by pediatrics
D. Four
B. Order molecular test, liquid culture, rx.
C. Order molecular test, culture, rx and 130. Which of the above is an adverse effect
ppd. of ethambutol?
D. bk liquid culture, ppd, chest rx A. Peripheral neuritis

B. Neuritis retrobulbar
125. How many drugs approved to treat tu-
berculosis are there? C. Hyperuricemia
A. 5 D. Altered color vision
B. 10 131. What is tuberculosis?
C. 6 A. A bacterium
D. 15 B. A disease caused by a bacterium
126. Where was TB first found C. A fungus
A. Russia D. A disease caused by a fungus
B. China 132. What is the population vulnerable to con-
C. Atlit Yam tracting tuberculosis?
D. India A. seniors
127. TB is: B. people with HIV
A. It is a non-contagious and curable dis- C. health personnel

ease. D. all

133. What is the treatment regimen for sensi- 139. The natural habitat of the bacterium My-
tive TB? cobacterium tuberculosis is
A. A) Erhaz / 4 (Ir) (4 AH) A. Agua
B. B) 4RHZE/2(3H)(3H) B. Floor
C. Q) Erhaz / 4 (Ar) (PBUH) C. Gastrointestinal tract of animals
D. d) Erhaz / 4 (Ar) (pbuh) D. All are correct
NARAYAN CHANGDER
134. The bacteria that cause tuberculosis are: 140. What breed is considered more available
A. Bacillus de Koch for tuberculosis?
B. Helicobacter Pylori A. holstein
C. Enterobacteriaceae B. Cebu
D. none of above C. jersey
135. what do i love about D. none of above
A. i dont know 141. Are There Several Types of Tuberculosis?
B. click me
A. And
C. this is the correct answer click it now
B. No
before’nt it’s a wrong answer!
C. Perhaps
D. this is the correct button
D. none of above
136. What does MDR-TB mean?
A. Sensitivity to all first-line drugs 142. WHAT DO YOU THINK ARE THE SYMP-
TOMS OF TUBERCULOSIS?
B. Resistance to isoniazid and rifampicin
A. FEVER
C. Resistance to isoniazid, rifampicin, a
fluoroquinolone, and a second-line in- B. TOS
jectable C. RASH
D. none of above D. COUGH, FEVER, WEIGHT LOSS
137. Which is the first-line anti-TB drug is 143. Tuberculosis is known as:
A. Amikacin
A. IRA
B. Fluoroquinolones
B. TBV
C. Pyrazinamides
C. TB o TBC
D. Ethamthol
D. none of above
138. What is the cut-off point to consider PPD
positive in latent TB? 144. What can Tuberculosis attack?
A. < 5 mm A. lungs, kidneys, heart
B. > 15 mm B. lungs and heart
C. > 5 mm C. lungs, brain, spine and kidneys
D. 3-4 mm D. heart, brain, and spine

145. What is the treatment scheme for active 149. How long is the treatment time for tuber-
tuberculosis in adults and children weigh- culosis with HIV/AIDS infection?
ing between 25 and 39 kg?

A. 6 months
A. 2 tab RHRifampicina 150 mg + Isoni- B. 8 meses
azida 75 mg
C. 9 months
B. First phase:2 tablets-Combination of
RHZE*Rifampicin 150 mg + Isoniazid 75 D. 12 months
mg+ Pyrazinamide 400 mg+ Ethambutol 150. are types of tuberculosis except
275 mg-Second phase:2 tablets Combina-
A. endogenous tb
tion of RHRifampicin 150 mg + Isoniazid
75 mg B. primary tb
C. First phase:3 tablets-Combination of C. exogenous tb
RHZE*Rifampicin 150 mg + Isoniazid 75 D. tb post prima
mg+ Pyrazinamide 400 mg+ Ethambutol
275 mg-Second phase:3 tablets Combina- 151. The organ that attacks tuberculosis is:
tion of RHRifampicin 150 mg + Isoniazid A. Stomach
75 mg
B. The liver
D. First phase:3 tablets-Combination of
C. Lungs
RHZE*Rifampicin 150 mg +Isoniazid 75
mg+ Pyrazinamide 400 mg+ Ethambutol D. none of above
275 mg
152. About how many people have latent tu-
146. What is the test that checks for hypersen- berculosis?
sitivity to Mycobacterium tuberculosis? A. 2 billion people
A. chest x-rays B. 2 million people
B. Culture methods with Ziehl-Neelsen C. 2 thousand people
staining D. none of above
C. tuberculin test
153. the tuberculin test indicates that the user
D. Bacilloscopy has
147. Diagnosis of pulmonary tuberculosis? A. tuberculosis activa
A. Bacteriological B. tuberculosis infection
B. Clinical diagnosis C. tuberculosis disease
C. Radiological D. inactive tuberculosis disease
D. all 154. The prognosis for patients with pul-
monary TB is:
148. what are the possibilities that tb has
when entering the orgaism. A. There is no prognosis, since they in-
variably die
A. scarring and proliferation
B. No drugs are administered, the im-
B. progression and evolution mune system takes care of it
C. progression and proliferation C. Administration of antibiotics for 6
D. healing and progression months

D. Administration of retrovirals for one 160. What was considered healthy to do in

year public in the 19th century, that will be con-
sidered inappropriate today?
155. According to tuberculosis infection, which
of the following mycobacteria is NOT A. laughing
pathogenic in humans? B. eating
A. M. tuberculosis C. littering
B. M. Bovis D. spitting
NARAYAN CHANGDER
C. M. affricatum E. running
D. M. microti
161. Is Tuberculosis Contagious?
156. what is my cool awesome little name
A. And
A. erikc
B. No
B. erik
C. Perhaps
C. eric
D. none of above
D. erick
162. Select the CORRECT morphological as-
157. What is the tuberculosis treatment pe-
pects of tuberculosis
riod?
A. No capsulados
A. 6-9 months
B. 6-9 years B. fast growing
C. 6 months C. Mobile
D. 9 months D. slightly curved

E. do not form spores
158. How long is the treatment time for extra-
pulmonary tuberculosis with CNS, miliary 163. If TB is treated early and with treatment,
and osteoarticular involvement? can it be cured?
A. 6 months A. TRUE
B. 8 meses
B. False
C. 9 months
C. I don’t understand
D. 12 months
D. All of the above
159. For operational purposes, the tuberculo-
sis case definition is based on 164. Which of the following tests confirms the
dx of pulmonary tuberculosis with effu-
A. Location of the disease (pulmonary sion?
and extrapulmonary).
A. test at ADA
B. Sputum bacteriology of pulmonary TB
cases. B. PPD
C. History(s) of treatment(s). C. sputum smear microscopy
D. all are correct D. chest x-ray

165. Which of the 4 1-line antibiotics in the 170. According to treatment history:Patient
management of sensitive TB is considered who received anti-tuberculosis treatment
the most hepatotoxic? for less than one month.

A. rifampicin A. new case
B. Ethambutol B. relapse
C. Isoniazid C. abandonment
D. piraji tears D. therapeutic failure
166. What is the reservoir for Tuberculosis? 171. What are symptoms of Tuberculosis?
A. Humans A. Most people who have Tuberculosis
B. Animals don’t suffer from symptoms
C. Plants B. Cough
D. All living organisms C. Fever
167. What foods should not be consumed if D. Fatigue

you have tuberculosis
172. Primary infection by Mycobacterium tu-
A. Candies berculosis is characterized
B. fruits A. skin lesions and spread
C. vegetables B. lung lesions without spread
D. scrap C. asymptomatic spreading lung lesions
168. Why, among all the TB Symptoms, are D. pulmonary lesions with intracranial le-
the SRs selected as the basis? sions
A. Because they are the most frequent
173. It is not a symptom of tuberculosis
symptoms (cough and/or prolonged ex-
pectoration) of the most frequent form of A. cough with phlegm for more than 15
TB (pulmonary TB) days
B. Because they are the most contagious B. diarrhea
symptoms (cough) of the TB form
C. night sweats
C. All of the above
D. fever
D. none of above
174. The Diagnosis of TB Disease is through:
169. What factors are involved in the patho-
genesis of man-man contagion of TB? A. Clinical Assessment
A. Number of viable bacilli in sputum and B. Microbiology
concentration in air C. Radiology and Tuberculin Test
B. FACING D. Pathology and Unconventional Meth-
C. host susceptibility ods
D. aerosolization of droplets with cough E. All of the above

175. WHERE IT IS APPLIED IN THE TUBER- 181. How is tuberculosis transmitted?

CULIN TEST
A. Through the blood
A. in the hand
B. Through the air
B. in the gluteal area
C. through touch
C. on the thigh
D. on the forearm D. none of above
NARAYAN CHANGDER
176. In pulmonary tuberculosis, the ghon com- 182. They are self-care measures
plex is characterized by
A. Handwashing
A. be located at the apex of one or both
lungs B. Use of masks
B. be subpleural parenchymal lesion C. Ventilation and lighting of rooms or of-
C. affects other organs fices
D. THAT D. All are correct
177. In which case is Gene xpert used? 183. According to the histopathology of tuber-
A. people with DM culosis, what are the types of lesions in
tuberculosis?
B. HIV
C. MDR contacts A. Exudative and productive type
D. all B. Number of mycobacteria and accord-

ing to the host
178. DIAGRAM I (2 RHZE / 4 RH) Indications:
C. Tuberculin and PCR
A. new cases
D. Pale epitheloids and peripheral fibrous
B. pediatric
tissue
C. dropouts
D. therapeutic failures 184. How do you cure Tuberculosis?
179. One of the diagnoses of tuberculosis is A. It goes away in time (6 to 9 months)

made by taking B. Take antibiotics
A. 1 Bacilloscopy
C. Eat healthy
B. 3 bacilloscopies
D. Exercise frequently
C. 2 smears
D. none of above 185. The incidence of TB among intimate con-
tacts is:
180. there once was a ship that put to sea
A. 50%
A. i ran out of questions
B. hi B. 100%
C. bye C. 20%
D. yellow D. 5%

186. The Mantoux test is a screening tech- B. Alexander Fleming

nique which consists of intradermally plac- C. James Simpson
ing a derivative of purified protein killed

D. Louis Pasteur
by heat from Mycobacterium tuberculosis.
Regarding the above, what measure is con- E. Thomas Edison
sidered positive for students in the health
191. Causative organism for TB
area, injection drug users?
A. Mycobacterium tuberculosis
A. 4 mm
B. Mycobacterium leprae
B. 5 mm
C. MAC
C. 10 mm
D. Mycobacterium intracellulare
D. 15 mm
192. First-line drugs are the basis of treat-
187. What did Robert Koch reveal the ingredi- ment for tuberculosis cases:
ents of Tuberculin to be? A. Chemoprophylactic
A. Anthrax bacteria in glycerin extract B. Sensible
B. Active tuberculosis microbes in glyc- C. Resistant
erin extract D. none of above
C. Tuberculosis bacteria only
193. Respiratory symptoms is:
D. Dead tuberculosis microbes in glycerin A. person who has a respiratory infection
extract
B. Any person who has a cough for more
E. Dead cholera microbes in glycerin ex- than 15 days with or without expectora-
tract tion
188. Which of the following definitions is con- C. The presence of Koch’s bacillus
sidered a NEW CASE (tuberculosis) D. None
A. Patient who has never received treat- 194. It is an unintended noxious response
ment or has received less than one month to an antituberculous drug and occurs at
B. Patient who received treatment for doses normally used in humans.
more than a month A. ALLERGY
C. Patient receiving treatment B. ANAPHYLAXIS
D. Patient with positive bacilloscopy at C. RAFA (Adverse Reactions to Antituber-
the end of the first phase of treatment culosis Drugs)
189. What does tb attack first D. None of the above
A. Heart 195. The most common adverse effect of tu-

berculosis treatment is:
B. lungs
A. Allergy
C. liver
B. liver disorders
D. none of above
C. Anemia
190. Who found a cure for anthrax? D. Kidney damage
A. Robert Koch E. Visual disturbances

1.9 Pleural Effusion 60
196. Cultivation indications: A. 6 months

A. Patient with smear results of 1 to 9 B. 9 months
AFB in a single slide of the three samples
C. 12 months
examined.
D. 15 months
B. Symptomatic Respiratory with two
negative serial bacilloscopies, treated 199. What nationality was Robert Koch?
with antibiotics (not quinolones) and with-
A. French
out clinical improvement.
NARAYAN CHANGDER
C. Patient contact of MDR TB case B. Dutch
D. All C. American
D. Italian
197. What test is done to check for TB infec-
tion? E. German
A. chest diagnosis 200. Which of the following parts of the body
B. tuberculin test is not affected by tuberculosis?
C. respiratory test A. Brain
D. blood test B. kidneys
198. The treatment time for cases of Multi- C. spine

bacillary Leprosy corresponds to D. heart
1.9 Pleural Effusion

1. What procedure is most commonly used in B. Congestive heart failure
pleural effusions
C. Hepatic hydrothorax
A. paracentesis
D. Nephrotic syndrome
B. thoracentesis
4. Before Robin was Batman’s apprentice, he
C. effusioncentesis
used to work in a
D. none of above
A. Circus doing acrobatics
2. Which of the following is(are) associated B. an ice cream show
with pleural effusion?
C. worked in a pet store with birds
A. Increased RV
D. police station
B. Decreased RV/TLC ratio
C. Increased VT 5. nephrotic syndrome usually causes what
type of pleural effusion
D. Decreased VC
A. transudative
3. Which of the following is probably the
B. exudative
most common cause of a transudative pleu-
ral effusion? C. executive
A. Pulmonary embolus D. none of above

1.10 Patient with Previous Lung Surgery 61
6. pleural protein/serum protein ration >0.5 10. malignancy usually causes what type of
is likely pleural effusion

A. exudate A. transudative
B. transudate B. exudative
C. executive C. executive
7. What would you expect to see on a chest
11. Which of the following is(are) associated
x-ray if a patient has a pleural effusion?
with exudative effusion? 1. Few blood
A. Mediastinal shift toward affected side cells 2. Inflammation 3. Thin and watery
B. Hyperinflation fluid 4. Infection
C. Blunted costophrenic angles A. 2 only
D. Pneumothorax B. 4 only
8. Where would a chest tube be placed to C. 1 and 3 only
drain a pleural effusion? D. 2 and 4 only
A. 1-2 intercostal space at the midaxillary
line 12. superior vena cava obstruction usually
causes what type of pleural effusion
B. 3-4 intercostal space at the midaxillary
line A. transudative
C. 4-5 intercostal space at the midaxillary B. exudative
line C. executive
D. 5-6 intercostal space at the midaxillary
D. none of above
line
9. which medication is not associated with 13. PE usually causes what type of pleural ef-
pleural effusions? fusion
A. beta blockers A. transudative

B. amiodarone B. exudative
C. phenytoin C. executive
D. lovastatin D. none of above
1.10 Patient with Previous Lung Surgery

1. Signs and symptoms of dyspnea include wheezing.
A. Wheezing and fever 2. The current treatment of choice for small
B. Productive cough and fever cell lung cancer is:-
C. Tachypnea, nostril flaring and digital A. Radiation alone.

clubbing. B. Alpha interferon alone
D. Productive cough, digital clubbing and C. .Combination of chemotherapy.

D. Surgical resection and interleukin 3. 7. The classification by histologic types for

non small cell lung cancer
3. The bronchoscopic intervention in other
thoracic malignancy A. .Large cell includes undifferentiated
and neuroendocrine.
A. Chemotherapy.
B. Small cell carcinoma
B. Brachytherapy.
C. Squamous carcinoma includes well or
C. Cryotherapy. poorly differentiated.
NARAYAN CHANGDER
D. Electrocauterization. D. Adenocarcinoma is the most common
type and its increasing and includes aci-
4. In thoracic surgery, the following state- nar, papilary and bronchoalveolar.
ments is TRUE
A. Localization of the tumor must be 8. In management of chest tube, the nursing
achieved before surgery. management of care are
B. Pulmonary toilet is indicated to maxi- A. No need to do pain scoring and wound

mize ventilatory function. dressing.
C. Anatomic location and extent tumor is B. Assure the underwater seal in a flat
not important in selection of surgical ap- surface area.
proach. C. Put the 2 artery forceps next to patient
D. There is a few options which are for emergency use.
wedge resection, segmentectomy, lobec- D. Record whether the underwater seal
tomy and pneumonectomy. is fluctuating or bubbling.
5. In preventing lung cancer, there are impor- 9. Leng has the chest tube in the left lung. On
tant things which able to help in lowering making rounds, note an absence of fluctu-
the risk ation in the water-seal chamber and a lack
A. Encourage people to quit smoking of fluid drainage in the collection chamber.
The signs indicate
B. Advice community to avoid contact
with second-hand smoke whenever possi- A. Obstruction
ble. B. Air leak
C. Encourage them to practice a healthy C. Positive occlusive seal at the insertion
diet and increase intake of fruits and veg- site
etables.
D. Accumulation of some debris in the col-
D. Never limit the community to involve lection chamber
with people that smoke in the open area.
10. Which of the following pulmonary tests
6. The uses of tumor marker in small cell lung are done to localize and perform a biopsy
cancer on a lesion in the lung?
A. Screening. A. Bronchoscopy.
B. Confirmation of diagnosis. B. Thoracentesis.
C. Monitoring of cancer survivors. C. Mediastinoscopy.
D. Diagnosis of specific tumor types. D. Computed tomography (CT) scan.

11. The mechanism of hemoptysis are C. CD56

A. Tumour necrosis. D. EGFR

B. Trauma from a cough
16. The nurse evaluating discharge education
C. Pleural fluid accumulates when its pro- for a patient with dyspnea. The nurse
duction overwhelms removal-formation knows the patient has an understanding
MPE. of discharge instructions when the patient
D. Growth of new blood vessels (neovas- states:
cularization) in and around neoplasm. A. “ I will contact my doctor if I sudden
pain.”
12. Lung cancer metastasizes to the brain,
bone or liver. The signs or symptoms B. “ Oxygen therapy has no side effects
would indicate possible liver metastasis and it will always help mybreathing.”
A. Changes in personality C. “ I won’t worry if I have skin changes,
since this does not haveanything to do
B. Bone pain
with my breathing.”
C. Jaundice.
D. “ I will make sure to continue my
D. Kussmaul breathing pattern. schedule at home, sinceactivity is good for
my breathing.”
13. A removal of entire lung is the thoracic
surgery called as 17. The followings are the analgesic that given
A. Lobectomy. post-thoracotomy
B. Wedge resection A. SC Heparin
C. Pneumonectomy. B. Morphine infusion.
D. Rigid bronchoscopy C. Patient control analgesia (PCA) with
morphine
14. On preparation patient for bronchoscopy,
the followings are the responsibility of the D. Thoracic epidural for large thoraco-
respiratory oncology nurse tomy wound.
A. Consent was taken at least 8 hours be- 18. Indications of procedure bronchoscopy
fore the procedure.
A. Haemoptysis
B. No need to NBM patient by midnight be-
fore the procedure to be done. B. Unexplained cough.
C. Do a skin test 1 day before procedure C. Excessive bronchiol secretions.
by using intradermal injection lignocaine D. Abnormal chest X-ray
2 % (0.1 ml).
D. All investigation such as FBC, PT/APTT, 19. The common problems that occur in Lym-
LFT and renal profile and chest x-ray took phoma cases
before bronchoscopy. A. Cough.
15. Tumor marker for small cell lung cancer B. Neutropenia
A. CEA C. Hemoptysis.
B. TIF-1 D. Superior vena cava obstruction.

20. The extensive stage for small cell lung can- 25. Nursing assessment that needs to be per-
cer formed after thoracic surgery with the
A. It describe cancers that spread widely chest drain.
throughout the lung. A. Vital signs 4 hourly.
B. It also consider into the fluid around. B. Post operative pain score
C. It spread also to the lymph node on the C. Monitor the signs of respiratory dis-
other side of the chest. tress.
NARAYAN CHANGDER
D. It localized at the organ D. Monitor the nature and amount of
drainage
21. An important nursing intervention for the
patient with SIADH 26. Arisa with lung adenocarcinoma cancer
with pleural effusion having a dyspnea,
A. Bed rest. what the nursing management that need
B. Restrict of fluids. to be implement to the patient
C. A low sodium diet. A. Assess patient’s whether cyanosed.
D. Safety and seizure precautions. B. Positioning patient in fowler’s posi-
tion.
22. The management on hemoptysis
C. Put patient with appropriate oxygen
A. Monitor for respiratory distress. support.
B. Put patient complete rest in bed with D. Check patient’s breathing pattern, res-
supine position piratory rate and oxygen saturation.
C. .Positioning so that the bleeding lung
27. The pulmonary sign and symptom that
independent.
might be seen in patients who have small
D. Monitored for increased blood loss cell lung cancer
changes in blood pressure and pulse. A. Fever
23. An important nursing intervention to pre- B. Cough
vent laryngeal edema immediately after a C. Dyspnea
bronchoscopy is to
D. Shoulder pain
A. Administer lidocaine spray
B. Provide ice chips to suck on. 28. Raju is plan for a left pneumonectomy .The
preoperativeteaching should include that
C. Apply a cool mist oxygen face tent after surgery, the client may not lie in
D. Provide adequate pain control. what position
A. On the left side.
24. Treatment for patient with Mesothelioma
B. Flat on the back.
A. Radiation
C. On the right side.
B. Concurrent chemotherapy and radia-
tion. D. There is no restriction on how to lie.
C. Pleurectomy. 29. Lung cancer that most commonly associ-

D. Chemotherapy with combination Cis- ated with smoking.
platin/ Gemzar or Carboplatin. A. Large cell carcinoma

B. Adenocarcinoma D. Quit attempt involve support and med-

C. Small cell carcinoma ications.

D. Squamous cell carcinoma 35. Which of the following statements is
true?
30. Video-assisted thoracic surgery (VATS)
A. More man than female is active smok-
A. It used to perform a lobectomy.
ers.
B. Removal entire lung
B. Regular use of cigarettes causes be-
C. This procedure involved inserted long, havioral and pharmacologic dependence
thin tube with the camera. on TAR a powerfully psychoactive drug.
D. It used to get a biopsy of the lung tis- C. 30% of smokers who quit are still
sues and to confirm a lung cancer diagno- not smoking one year after quitting, al-
sis. though an individual’s success increases
31. Appropriate treatment for non small cell with each attempt.
lung cancer associated with stage of the D. Legislative approaches to preventing
disease. lung cancer have included taxation on
A. Stage IIab-surgery and radiation cigaretes, warning labels and eliminating
smoking in the public areas.
B. Stage Ia-surgery
C. Stage IV-chemotherapy and palliative 36. Ahmad has been diagnosed with lung can-
D. Stage IIIb-combination of chemother- cer and requires a wedge resection. How
apy and radiation much of the lung is removed?
A. One entire lung.
32. In minimizing the sensation of dyspnea, a
patient should be advised to B. A lobe of the lung.
A. Maintain bedrest. C. A segment of the lung including a bron-
chiole and its alveoli
B. Practise relaxation techniques
D. A small localized area near the surface
C. Perform low impact exercises.
of the lung.
D. Breath using a rapid and shallow pat-
tern. 37. Muthu developed fatigue post chemother-
apy. The management of fatigue that need
33. Immediately after thoracentesis is com- to be implemented to him
pleted, it is important for the nurse to as-
sess the patient for: A. Exercise.
A. Expectoration of blood B. Sleep Aids.
B. Increased breath sound C. Activity planning.
C. Decreased respiratory rate D. Anaemia management with the iron
supplement
D. Increased blood pressure
38. The common cause of lung cancer
34. The correct smoker’s pathway
A. Nonsmoker A. Smoking pipe.
B. Brief advice on smoking. B. Smoking cigars.

C. Smoker attends the clinic for any prob- C. Second smoker.
lem. D. Smoking Cigarettes.

2. Abdominal
NARAYAN CHANGDER
2.1 Abdominal Station
1. The abbreviation “Tx” stands for: 4. Body parts that are located below the
transverse plane are called?
A. Texas
A. Superior
B. Treatment
B. Medial
C. Time is up
C. Distal
D. Transverse
D. Inferior
2. Clinically, which of the following state-
ments regarding indirect inguinal hernia is 5. Distal
false? A. Below
A. It could be a congenital hernia. B. Above
B. It penetrates the deep inguinal ring. C. Toward the Trunk/Joint
C. If the hernia is lateral to the inferior D. Away from the Trunk/Joint
epigastric vessels.
6. The portion covering the deep surface of
D. It lies within the deep spermatic fas- the transverse abdominis muscle and its
cia. aponeurosis is
E. It passes through the inguinal triangle. A. Camper band
B. Shoe band
3. What position should the patient be in to
perform the abdominal assessment? C. Fascia endoabdominal
A. Supine/ventral decubitus D. Fascia transversal
B. Supine/dorsal decubitus 7. CPR is used for people:
C. Prone/lateral decubitus A. who are severely bleeding
D. Prone/ventral decubitus B. whose heart has stopped beating

2.1 Abdominal Station 67
C. who have asthma C. clutching at the stomach

D. who have chronic obstructive lung dis- D. coughing forcefully

ease
13. Which history taking is considered a char-
8. Which quadrant is the left hypochondriac
acteristic of pain?
region located in?
A. RUQ A. persistent pain
B. RLQ B. smart
C. LLQ C. intense pain
D. LUQ D. none of above
9. How is inflammation of the parietal peri-
14. What structure forms the floor of the in-
toneum characterized?
guinal canal?
A. Constant, uncomfortable and without
exact reference. A. iliococcygeal scintillation
B. Constant, uncomfortable and with ex- B. Lig. Inguinal

act reference. C. Lig. de Hasselbach
C. Intermittent, uncomfortable and with-
D. none of above
out exact reference.
D. Intermittent, uncomfortable and with 15. Which quadrant is the right hypochondriac
exact reference. region located in?
10. The SPLEEN is located in which of the fol- A. RUQ
lowing quadrants?
B. RLQ
A. RUQ
C. LLQ
B. LUQ
C. RLQ D. LUQ
D. LLQ 16. The term that means toward the head is

11. A fractured pelvis may lead to the inabil- A. caudal
ity to move or feel the legs. What else can
cause the same condition? B. superficial (external)
A. Injury to the lower spine C. cranial (cephalic)

B. Rupture of the spleen D. deep (internal)
C. Fracture of the femur
17. Virchow’s node suggests metastasis of
D. Heart attack
A. Chest
12. Signs of choking that indicate a need to
provide care include: B. Abdomen
A. severe headache C. Cerebral

B. weak, ineffective cough D. none of above

18. A construction worker has fallen onto a 23. What sounds should you hear upon percus-
sharp wooden stake, which has punctured sion when you percuss over the liver?
his chest. When you arrive he is lying on A. Resonant sounds
his back, and there is blood coming through
his jacket. He is responsive and gasp- B. Hollow sounds
ing for air. You hear air entering his rib C. Dull sounds
cage with each respiration.You suspect the D. No sounds
stake has caused a:
NARAYAN CHANGDER
A. Fractured rib 24. What are two names for the “back of the
body”?
B. Sucking chest wound
A. Dorsal and Distal
C. Flail chest
B. Ventral and Frontal
D. Kidney perforation
C. Posterior and Dorsal
19. What is the topographic location of the
D. Anterior and Posterior
liver?
A. Right hypochondrium => Epigas- 25. If an AED arrives during CPR:
trium => Left hypochondrium A. Complete the chest compressions
B. Right flank => Epigastrium => Left B. Complete the rescue breaths
hypochondrium
C. Open the airway
C. Right hypochondrium => Mesogas-
trium => Left hypochondrium D. Use the AED immediately
D. none of above 26. What is the point that goes from the right
iliac spine to the navel called?
20. What is the most common finding on ab-
dominal CT in patients w/ covid-19? A. Mc Bourney Point
A. Intestinal wall thickening B. Murphy’s Point
B. mesenteric artery thrombosis C. cystic point
C. Pancreatitis D. none of above
D. Solid organ infarction 27. The incubation period in typhoid fever is
21. What is the membrane that separates the within:
bladder from the rectum called? A. 6-25 days
A. Pouch of Douglas B. 6-26 days
B. gastric fundus C. 7-25 days
C. Hartmann’s fornix D. Hatzel
D. none of above
28. In burpee exercise after push up move-
22. Superior ment you will do
A. Above A. squat
B. Below B. jump
C. Toward Surface C. lying
D. Toward Core D. mount climb

29. Which body cavity contains organs includ- 34. Mark the alternative that has all the
ing the stomach, spleen, liver, gallbladder, painful points
and pancreas?

A. Gastric points, cystic point, ureteral
A. abdominal point, appendicular point, splenic point.
B. pelvic B. Cystic point, gastric points, ureteral
point, appendicular point.
C. thoracic
C. Xiphoid point, cystic point, ureteral
D. none of above
point, appendicular point, splenic point.
30. When treating someone with a closed ab- D. Epigastric point, ureteral point, cys-
dominal injury, the patient’s legs should tic point, appendicular point and xiphoid
be: point.
A. Bent with knees pulled towards the 35. A location closer to the trunk of the body.
chest
A. Proximal
B. Lower than the patient’s head
B. Superficial
C. Raised approximately 15 cm (6 in)
C. Medial
D. Slightly bent with a rolled-up blanket
or pillowunder the knees D. Lateral
36. Closer to midline in relation to another

31. While do the plank exercise, you must
part
bend your elbow degree
A. Deep
A. 90
B. Distal
B. 120
C. Medial
C. 40
D. Proximal
D. 45
37. What is the point that goes from the navel
32. Standing up straight with palms turned to the right armpit called?
forward
A. cystic point
A. Anterior Position
B. Murphy’s Point
B. Anatomy Position
C. Mc Bourney Point
C. Palmer Position
D. none of above
D. Anatomical Position
38. a large sac-like cavity located posterior to
33. A body part is below another body part, is the stomach, lesser omentum, and adja-
toward the feet cent structures
A. Distal A. omental pouch
B. Inferior B. pyramid bag
C. Proximal C. mind bag
D. Sagittal D. peritoneal sac

39. An unresponsive person should be placed C. Inspection. Auscultation. Percussion.

in what position when CPR is needed? Palpation
A. On the right side D. Inspection. Auscultation. Palpation.
B. Facedown Percussion
C. On a soft surface, such as a bed 45. Which of these is NOT a abdominal re-
D. Face up on a firm, flat surface gion?
40. HEMATEMESIS is BEST described as which A. Left Upper
NARAYAN CHANGDER
of the following? B. Right Illiac
A. Blood in the stool C. Epigastric
B. Vomiting blood D. Left Lumbar
C. Coughing up blood
46. Continue CPR until:
D. Nosebleed
A. The person begins breathing, cries, or
41. Which layer causes you to flex your trunk moves
(bend forward)?
B. An AED arrives and is used
A. transverse abdominis
C. You are replaced by a trained individ-
B. rectus abdiminis ual
C. external oblique D. You are too tired to continue
D. internal oblique
47. Non-draining organ into the portal system
42. What receptors are the targets of the
A. Liver
Covid-19 virus?
A. ACE-I B. Colon
B. ACE-II C. Small intestine

C. Aldosterone D. Kidney
D. Angiotensin 48. The term that means nearer to the point of
attachment or a given reference point is
43. What body plane divides the body into
front and back halves. A. distal
A. Front B. proximal
B. Frontal C. superior
C. Medial D. inferior
D. Transverse
49. What organ does the cranial cavity con-
44. I gave the abdominal evaluation maneuver tain?
in order
A. Skull
A. Auscultation. Inspection. Percussion.
B. Brain
Palpation
B. Percussion. Inspection. Appeal. Aus- C. Cranium
cultation D. Spinal Cord

50. Medial 56. Weight gain is a consequence of

A. Toward Middle A. improper diet

B. Toward Side B. Sedentary lifestyle
C. Toward Front C. bad lifestyle
D. Toward Back D. All
51. What is the largest organ? 57. What is the action to follow in the pres-
ence of penetrating objects in the ab-
A. Heart
domen?
B. Brain
A. Cover with damp cloths
C. Skin B. Withdraw and apply pressure
D. Lungs C. Immobilize and do not remove
52. If Bernard was cooking BBQ and acciden- D. none of above
tally cut himself in the stomach, what re-
gion of the body is his injury in? 58. Select the correct region term with the as-
sociated pain
A. cranial
A. cardiac pain:::abdominopelvic region
B. patellar
B. lumbar pain:::cranial region
C. abdominal
C. femoral pain:::dorsal region
D. caudal
D. gastric pain:::abdominal region
53. The lower limit of the abdominal wall is
59. Posterior
made up of
A. Toward Middle
A. Pelvis
B. Toward Side
B. Superior border of the iliac bone
C. Toward Front
C. Diaphragm
D. Toward Back
D. none of above
60. Clinical presentation of cholecystitis is pain
54. What is the topographic location of the in which of the following quadrants?
bladder?
A. RUQ
A. Mesogastrio
B. RLQ
B. hypogastrium
C. LUQ
C. Right lower quadrant
D. LLQ
D. none of above
61. This structure absorbs water back in the
55. The knee is to the ankle. body.
A. proximal A. stomach
B. lateral B. small intestine
C. distal C. esophagus
D. medial D. large intestine

62. The term that means farther from the point 68. The phalanges are to the elbow
of attachment or a given reference point is
A. proximal
A. distal
B. inferior
B. proximal
C. medial
C. superior
D. inferior D. distal
63. My nose is to my shoulders 69. What is the sequence suggested in the
NARAYAN CHANGDER
A. inferior physical examination?
B. superior A. Palpation, auscultation, percussion
C. proximal and inspection.
D. distal B. Auscultation, palpation, percussion

and inspection.
64. When performing abdominal thrusts, your
should make fist with one hand and put C. Inspection, palpation, auscultation,
the thumb side and percussion
A. above the navel D. Inspection, percussion, auscultation

and palpation
B. below the navel
C. across the chest 70. To examine the abdomen, the patient must
D. on their breastbone initially be placed in the following position:
65. Where are the Abdominal muscles lo- A. Dorsal decubitus

cated? B. prone position
A. Muscles of the front of the upper chest C. Semifowler
B. Muscles of the middle and lower back
D. Lateral decubitus
C. Muscles of the upper and middle shoul-
der 71. one function of abs muscle to hold in a
D. Muscles of the stomach/core place
66. At what point in the assessment is the A. organs

stethoscope used? B. weight
A. Auscultation C. food
B. Inspection
D. liquid
C. Percussion
D. deep palpation 72. The pathogen of typhoid fever has the fol-
lowing characteristics
67. which is NOT a parietal branch of the aorta
A. sensitive to high temperatures
A. Sacra media
B. Lower diaphragms B. sensitive to low temperatures
C. Capsular Media C. sensitive to penicillin

D. lumbar D. none of above

73. The Kussmaul sign is when the jugular ve- 79. How many layers does the anterolateral
nous pressure increases in wall of the abdomen have?

A. Inspiration A. 4
B. Expiration B. 8
C. Both C. 7
D. none of above D. 3
74. The term that means within the body is 80. A body part is above another part, or is
closer to the head
A. caudal
A. Superficial
B. superficial (external)
B. Lateral
C. cranial (cephalic)
C. Superior
D. deep (internal) D. Deep
75. In what structure do direct hernias form? 81. The lumbar vertebra are to the cranium
A. Canal inguinal A. lateral
B. Hasselbach’s triangle B. proximal
C. Lig. de Hasselbach C. medial
D. none of above D. inferior
76. How many abdominal thrust should you 82. There are two groups of anterolateral ab-
perform? dominal muscles, which are:
A. 3 A. external and internal
B. 4 B. irregular and smooth
C. 5 C. Flat and vertical
D. 6 D. none of above
77. produces insulin and enzymes for digestion 83. LLQ stands for what in abdominal quad-
rants?
A. gallbladder
A. Left Lumbar Quadrant
B. pancreas
B. Left Lower Quadrant
C. liver C. Left Left Quadrant
D. kidney D. Right Lower Quadrant
78. What is the last part of the large intestine 84. WHERE DOES THE APPENDICULAR
called? ARTERY COME FROM?
A. pancreas A. ILEOCOLIC
B. esophagus B. RIGHT COLIC
C. appendix C. MEDIUM COLIC
D. rectum D. LEFT COLIC

85. What is the topographic location of the 90. The patella is to the ankle
stomach?
A. distal
A. Epigastrium => Left hypochondrium
B. medial
B. Epigastrium => Right hypochon-
drium C. inferior
C. Epigastrium => Right hypochon- D. proximal
drium
91. Which of these branches originates from a
NARAYAN CHANGDER
D. none of above parietal branch of the abdominal aorta?
86. SELECT ALL the areas/organs that are A. Capsular superior
specifically palpated for abnormal sizes
and masses. B. Capsular inferior
A. Liver C. Capsular media

B. Stomach D. none of above
C. Kidneys
92. How fast should you give chest compres-
D. Aorta sions?
E. Bladder A. 60 per minute
87. What are the possible types of sounds B. As fast as you can
present during percussion?
C. To the beat of the Bee Gees song
A. Timpanismo, subtimpanismo, macicez “Stayin’ Alive”
e submacicez
D. 1 compression every 2 seconds
B. Tympanism, hypertympanism, dull-
ness and subduedness 93. What is the function of the rectus abdomi-
C. Tympanism, hypertympanism, hyper- nis?
dullness and dullness A. It provides structural support to the
D. Only the tympanism and the dullness trunk and surrounds and protects the
spinal cord.
88. What is the best position for this patient
who has suffered a stab wound in the ab- B. They make the internal organs stay in-
domen? (a) side the abdominal cavity.
A. Supine with knees slightly bent C. Produces flexion of the vertebral col-
umn through the ribs.
B. Sitting position
C. Recovery position D. Withstands load and motion cycles
throughout a lifetime.
D. Prone position
94. SELECT ALL the correctly defined terms.
89. Who do you call if a person is choking?
A. 411 A. Dysphagia = difficulty swallowing
B. 211 B. Dysphagia = painful swallowing

C. *HP C. Odynophagia = difficulty swallowing
D. 911 D. Odynophagia = painful swallowing

95. In the topographic division by regions, the 100. Bone is to muscle

abdomen is divided into:
A. superficial

A. 4 regions B. superior
B. 9 regions C. distal
C. 5 regions D. deep
D. 8 regions
101. Conduct with reference to the patient
96. The APPENDIX is located in which of the with typhoid fever
following quadrants? A. compulsory admission
A. RUQ B. hospitalization of serious forms
B. LUQ C. treatment in the day hospital
C. RLQ D. internment of decreed persons
D. LLQ
102. Which of the following BEST describes dif-
97. What is the topographic location of the ficulty urinating?
Spleen? A. Dysuria
A. Left flank B. Hematuria
B. Epigastrium C. Nocturia
C. left hypochondrium D. Polyuria
D. none of above
103. stores bile which assists in digesting fats
98. Which abbreviation stands for:“Left A. pancreas
Lower Quadrant”?
B. gallbladder
A. LIQ
C. liver
B. LLQ
D. spleen
C. LIQ
104. What artery supplies the spleen?
D. LWQ
A. SPLENIC ARTERY
99. Functions of the anterolateral muscles of B. HEPATIC ARTERY
the abdomen
C. PANCREATIC ARTERY
A. They form a firm and dilatable support
for the anterolateral wall of the abdomen. D. RIGHT GASTRIC ARTERY
B. Compress abdominal contents to main- 105. QUIEN IRRIGA AL COLON ASCENDENTE?

tain or increase intra-abdominal pressure,
opposing the diaphragm A. ARTERIA COLICA DERECHA
C. They move the trunk and help maintain B. ARTERIA COLICA IZQUIERDA
posture. C. ARTERIA GASTRICA DERECHA
D. support the pubic bones D. ARTERIA ESPLENICA

106. Inferior 112. What are the main regions of the spine
A. Above called?
B. Below A. Anterior, lateral y posterior.

B. Trunk and flow.
C. Toward Surface
C. Epigastric and lumbar.
D. Toward Core
D. Zygomatic and mental.
107. The liver is mostly located within the
113. materials here are considered waste and
NARAYAN CHANGDER
A. RUQ prepared for excretion
B. RLQ A. small intestine
C. LLQ B. large intestine
D. LUQ C. obliques
108. Which of the following best describes D. stomach
presence of bruits?
114. The GALLBLADDER is located in which of
A. Gurgling sound the following quadrants?
B. Strong pulsing sound A. RUQ
C. Whooshing sound B. LUQ
D. Crackling sound C. RLQ
109. Secondary muscle that you train while do D. LLQ

the squat exercise is 115. Corresponds to a spleen palpation maneu-
A. bicep ver
B. abs A. Israeli maneuver
C. triceps B. Adams maneuver
D. calf C. Merlo maneuver
D. Mathieu’s maneuver
110. WHO IRRIGATES THE RECTUM?
A. RECTAL ARTERY 116. Excessive gurgling bowel sounds may be
most likely indicative of which of the fol-
B. RIGHT COLIC ARTERY lowing?
C. LEFT COLIC ARTERY A. Normal bowel sounds
D. SUPERIOR MESENTERIC ARTERY B. Constipation
111. If the abdomen is struck with a blunt ob- C. Diarrhea
ject, there may be damage to the spleen, D. Ascites
which may result in:
117. Before approaching an unresponsive per-
A. Infection
son:
B. Gastroenteritis A. Check for bleeding from ears and nose
C. Severe blood loss B. Look for items to splint possible frac-
D. Difficulty breathing (dyspnea) tures

C. Check the scene for hazards C. liver

D. Begin rescue breaths immediately D. pancreas

118. When lines are drawn for the quadrants, 124. Leg exercises by lifting heels are called
at what point on the body do they inter-
A. step up
sect?
A. Sternum B. squat
B. Belly button/umbilicus C. calf raise
C. Liver D. jumping jack
D. Ribs 125. I a person cannot cough, speak or breath,

you should?
119. How many abdominal regions are there?
A. Cheer them on
A. 4
B. Provide care if they give you consent
B. 6
C. Leave the scene
C. 8
D. 9 D. Give chest compressions
120. What is the initial measurement in as- 126. To care for an ALERT choking adult or
cites? child:
A. restrict salt intake A. Wait until the person becomes unre-

sponsive to provide care
B. Restrict fluid intake
B. Open the airway and begin rescue
C. Diuretics
breathing
D. none of above
C. Give abdominal thrusts until the object
121. Lateral is removed
A. Toward Middle D. Begin chest compressions
B. Toward Side 127. Which is more medial, stomach or el-
C. Toward Front bow?
D. Toward Back A. Spleen
122. What is the topographic location of the B. Stomach

Appendix? C. Elbow
A. Right lower quadrant D. Shoulder
B. hypogastrium
128. The term that means close to the surface
C. left iliac fossa of the body is
D. none of above A. caudal
123. holding tank for liquid waste B. superficial (external)
A. bladder C. cranial (cephalic)
B. kidney D. deep (internal)

129. Pneumothorax is caused by which of C. BOF

the following entering the pleural space
D. MRI
around the lung?
A. Digestive enzymes 135. The stomach is mostly located in the
B. Blood A. RUQ
C. Air
B. RLQ
D. Tissue
NARAYAN CHANGDER
C. LLQ
130. How would you classify the pain pre-
D. LUQ
sented by the patient?
A. Parietal 136. One reason you would stop giving care
B. Visceral A. Victim cannot breath
C. Referido
B. Object is lodged
D. Urente
C. Victim goes unconscious
131. A patient is describing having lumbar
pain. As a physician you will want to check D. Victim cannot speak
what region of their body?
137. Deep
A. Cranial
A. Above
B. Medial
C. Caudal B. Below
D. Dorsal C. Toward Surface
132. Tratamentul patogenetic include: D. Toward Core (internal)
A. antibiotice 138. A middle-aged man has been stabbed in

B. dezintoxicare the abdomen. He is responsive and is
C. vitamine breathing adequately. His skin is pale and
sweaty, and he is complaining of thirst.
D. antipiretice You see blood running down his side onto
133. How do you open up someone’s airway? the ground beneath him. As you get close
you see a large wound just above his
A. Push their chin down towards the navel, and there is part of an organ pro-
ground truding from the wound.Which of the fol-
B. Lift the chin up lowing should you do?
C. Push back gently on the forehead A. Cover the protruding organs with a
D. Pinch the nose moist sterile dressing
134. Which of the following images is not B. Cover the patient with a dry dressing
included for gastrointestinal imaging in or towel to maintain warmth
Covid-19 patients? C. Remove clothing from around the
A. CT scan wound
B. USG D. All of the above

139. Abdominal pain associated with any coming from anywhere else. You should
symptoms Need to refer to a doctor imme- cover the hole with your gloved hand until
diately. you are able to cover the wound with:

A. lose weight A. Sterile gauze
B. no burp, no fart B. An adhesive bandage
C. yellow eyes C. A non-occlusive dressing
D. none of above D. A triangular bandage
140. Which of the following organs should be 145. What divides into front and back
specifically percussed? halves?
A. Bladder A. Dorsal/Posterior Plane
B. Kidneys B. Frontal/Coronal Plane
C. Spleen C. Midsagittal/Median Plane
D. Liver D. Anterior/Ventral Plane
E. Aorta 146. Select the correct name of the indicated
structure
141. What is consent?
A. Fibras of Nicaise
A. Choking
B. Douglas angle
B. Permission
C. Louis angle
C. Breathing
D. none of above
D. Lodged
147. If air enters the pleural space, what con-
142. RUQ stands for what in abdominal quad-
dition may occur? (a)
rants
A. Pneumothorax
A. Right Upper Quaprant
B. Flail chest
B. Left Upper Quadrant
C. Hemothorax
C. Right Under Quadrant
D. Abdominal aortic aneurysm
D. Right Upper Quadrant
148. Which plane divides the body into equal
143. It is the largest and most superficial of right and left sides?
the three anterolateral flat abdominal mus-
cles. A. transverse plan
A. External oblique B. midsagittal plane
B. internal oblique C. frontal or coronal plane
C. Rector D. sagittal plane
D. Transversal 149. The internal face of the abdominal wall
is covered by membranous and areolar
144. You expose the chest of a sucking chest sheets of variable thickness.
wound and see a hole in the man’s left side.
You do not see any other wounds on the A. Camper band
chest or abdomen, nor do you see blood B. Shoe band

C. Fascia endoabdominal 155. Another word for back side is

D. Fascia transversal A. ventral
B. anterior
150. abducts arm, flexes arm at shoulder, ex-
C. dorsal
tends arm at shoulder
D. sagital
A. brachialis
156. The pancreas would be found in which ab-
B. deltoid
dominal region?
NARAYAN CHANGDER
C. trapezius A. Right Iliac
D. brachioradialis B. Epigastric
C. Left Lumbar
151. The forehead is my side
D. Hypogastric
A. inferior
157. On abdominal CT of patients with Covid-
B. superior
19, infiltrates are often found in the infe-
C. dorsal rior lobes of the lungs bilaterally, what is
D. ventral their distribution
A. central dominance
152. To treat flail chest, you should: B. peripheral dominance
A. Apply bulky dressings to the flail seg- C. involving 1 lobe
ment
D. none of above
B. Tightly bind the patient’s arm to the
chest toform an anatomical splint 158. What tests help confirm a diagnosis of
cholecystitis?
C. Place the patient in the recovery posi-
A. Cullen sign
tion
B. Rovsing’s sign
D. Bind the entire chest, ensuring you do
notrestrict the patient’s breathing C. Murphy’s sign
D. none of above
153. It represents 84% of ascites
159. It is not within a SAAG less than 1.1gr/el
A. Cirrhosis
A. Escape from bile
B. Carcinomatosis B. Cirrhosis
C. Tuberculosis C. Pancreatitis
D. Chlamydia D. Tuberculosis
154. What is the function of the gall bladder 160. The separates the two major cavities
on the ventral side of the body
A. store bile
A. heart
B. make bile B. lungs
C. store digestive enzymes C. spleen
D. make salivary amylase D. diaphragm

161. How many abdominal quadrants should 166. Superficial

you auscultate to listen to the bowel A. Above
sounds?

B. Below
A. 2
C. Toward Surface
B. 4
D. Toward Core
C. 9
167. What is the smallest structural unit of the
D. 12
human body?
162. How do you know a person needs assis- A. Cell
tance if they are choking? B. Tissue
A. They can cough C. Organ
B. They cannot speak D. Body System
C. They can breath
168. What organ is the largest and helps clean
D. They are holding their throat your blood by destroying worn out blood
cells?
163. In the management of hypovolemic shock,
in class 1 and 2, what is the treatment to A. pancreas
follow? B. small intestines
A. 1-3 liters of crystalloid solution in 15 C. esophagus
min D. liver
B. Isotonic crystalloid solutions in the 3
169. My lungs are to my small intestine.
to 1 rule
A. Posterior
C. Isotonic crystalloid solutions in the 3
to 1 rule B. Anterior
D. none of above C. inferior
D. superior
164. How many movements does the cox-
ofemoral joint have? 170. What are the organs of the quadrant of
the Right Lumbar Region.
A. 6
A. Ureters, descending colon and lower
B. 5
kidney.
C. 7 B. Ascending colon and lower kidney.
D. 4 C. Sigmoid colon, ovary (in women), sper-
matic cord (in men).
165. Your appendix is located right about your
right hip. Which quadrant would your ap- D. There are no organs.
pendix be located?
171. Proximal
A. RUQ
A. Toward the Back
B. RLQ
B. Toward the Front
C. LLQ C. Toward the Joint or Point of Attach-
D. LUQ ment

D. Away from the Joint or Point of Attach- 177. The thoracic cavity and the ab-
ment dominopelvic cavity are both contained
within the cavity.
172. According to the chronology, this pain
A. dorsal
was of establishment.
B. ventral
A. Sudden
C. cranial
B. Fast
D. spinal
NARAYAN CHANGDER
C. Gradual
178. Which artery accompanies the Lig. from
D. This
Hesselbach?
173. Before providing care to a victim who is A. Femoral
choking, you should first ask them ? B. inferior epigastric
A. Are you choking? C. shutter
B. What happened? D. none of above
C. How did you choke? 179. SELECT ALL THAT APPLY. Which of the fol-
D. You need something to drink? lowing physical assessment techniques are
utilized in the Abdominal Exam?
174. Which plane passes through the body
A. Inspection
from side to side, dividing the body into
anterior and posterior portions? B. Palpation
A. vertical plane C. Percussion

D. Auscultation
B. frontal plane
C. horizontal plane 180. What are the body parts above the trans-
verse plane called?
D. sagittal plane
A. Inferior
175. It is the intermediate abdominal flat mus- B. Cranial
cle and consists of a thin sheet of muscle
C. Superior
that fans out anteromedially.
D. Caudal
A. External oblique
B. internal oblique 181. WHO DOES NOT BELONG TO THE
BRANCHES OF THE CELIAC TRUNK?
C. Recto
A. LEFT GASTRIC ARTERY
D. Transversal
B. COMMON HEPATIC ARTERY
176. The abdominal wall is divided into how C. SPLENIC ARTERY
many quadrants? D. CYSTIC ARTERY
A. 6
182. Which quadrants would contain most of
B. 8 your intestines?
C. 11 A. RUQ & RLQ
D. 4 B. LUQ & LLQ

C. RLQ & LLQ 188. In which muscle do we find the semilunar

D. RUQ & LLQ line?

A. Transverse
183. In non-penetrating abdominal trauma
(Closed) which organs are frequently in- B. External oblique
jured:
C. rectus abdominis
A. Spleen, Liver
D. none of above
B. Liver
C. Spleen, liver and small intestine 189. Which is not seen in a patient with acute
pancreatitis?
D. none of above
A. Dilated pancreatic duct
184. How many back blows do you give a con-
scious choking victim? B. Peripancreatic free fluid
A. 3 C. The size of the pancreas decreases
B. 4 D. none of above
C. 5
190. One of the aspects to specify in the exam
D. 6 and in the written record is:
185. Secondary muscle that you train while do A. If the patient was drowsy and stu-
a leg raise exercise is porous
A. biceps B. Hydroacoustic heart sounds and liver
B. quardiceps sounds
C. hamstring C. Hydroacoustic sounds and sensitivity
D. lower back to light
D. Air-fluid bowel sounds and tone
186. This term is used only on the limbs (arms
and legs)
191. Abdominal pain around the navel in early
A. Proximal appendicitis What kind of pain mechanism
B. Deep is it?
C. Anterior A. visceral
D. Posterior B. parietal
187. What are the organs of the Right C. referral
Hypochondrium quadrant.
D. none of above
A. Ureters, descending colon and lower
kidney. 192. Corresponds to a flat muscle:
B. Ascending colon and lower kidney. A. External oblique
C. Kidney upper part, adrenal gland, liver B. rectus abdominis
right lobe, gallbladder, hepatic flexure of
the colon. C. Pyramidal
D. What Sara doesn’t have. D. none of above

193. How many regions of the abdomen A. pancreas

should be lightly and deeply palpated dur- B. gallbladder
ing the abdominal exam?
C. stomach
A. 2
D. none of above
B. 4
199. The LIVER is located in which of the fol-
C. 9
lowing quadrants?
D. 12
A. RUQ
NARAYAN CHANGDER
194. plays large role in the immune system B. LUQ
and produces and destroys red blood cells C. RLQ
A. kidney D. LLQ
B. liver
200. SELECT ALL THAT APPLY. Which of the fol-
C. gallbladder lowing is/are used to assess for acute ap-
D. spleen pendicitis?
A. McBurney point
195. Which of the following is made of a group
of cells working together to do a common B. Murphy sign
job? C. Rovsing sign
A. Cell D. Psoas sign
B. Tissue E. Obturator sign
C. Organ 201. RAB stands for:
D. Body System A. Recognize, Action, Breathing
196. How many regions is the abdomen di- B. Responsiveness, Activate, Breathing
vided into? C. Repair, Accelerate, Bend
A. 2 D. Recognize, Analyze, Bring
B. 8
202. The back is my side
C. 9 A. super
D. 11 B. inferior
197. Where should you place your hands when C. ventral
giving chest compressions? D. dorsal
A. 2 inches below the sternum
203. These abdominal muscles are located on
B. On the stomach above the navel the anterior side of the abdominal wall,
C. On the sternum in the center of the and are commonly refereed to as the “six
chest pack.”
D. On the left side of the ribcage A. External Oblique
B. Internal Oblique
198. Abdominal pain radiating to the right
shoulder Think of the cause of the abnor- C. Rectus Abdominis
mality from which organ? D. Transverse Abdominis

204. Clinical presentation of appendicitis is C. gray turner sign

pain in which of the following quadrants?
D. cullen sign

A. RUQ
B. RLQ 210. While do the step up movement, you
raise your right leg and swing your
C. LUQ from the back.
D. LLQ
A. left hand
205. To check responsiveness B. left leg
A. Tap the person and shout, “Are you C. right hand
okay? ”
D. head
B. Pull the person’s hair
C. Pinch the person’s finger 211. The following are signs that can be found
D. Squeeze the person’s hand on gastrointestinal imaging in Covid-19
patients, except
206. What are the body parts located above A. Intestinal wall thickening
the transverse plane called?
B. Liver fat
A. superior
C. Hollow organ infarction
B. inferior
C. proximal D. Intestinal dilatation
D. distal 212. Away from midline

207. What is the purpose of the muscle vault? A. Lateral
Apa tujuan dari loncatan otot?
B. Distal
A. Help digestion? Membantu pencer-
naan? C. Superior
B. Support an restrain vicera? Men- D. Transverse

dukung vicera penahan?
213. My heart is to my spinal cord.
C. Look beautiful? Terlihat cantik?
A. Posterior
D. none of above
B. Anterior
208. The term that means toward the lower
end of the spine is C. inferior
A. caudal D. superior
B. superficial (external) 214. What is the function of the Abdominal
C. cranial (cephalic) muscles?
D. deep (internal) A. Bends the body at the waist
209. Periumbilical ecchymosis corresponds to: B. Pushes the arms forward

A. Aaron’s sign C. Straightens the arm at the elbow
B. Signo de Chvostek D. Pulls the arms downward

215. Small muscular pouch responsible for B. Supine

storing bile C. Lateral
A. pancreas D. Medial
B. mechanical
221. Body spaces within the body that contain
C. amylase
vital organs are called?
D. gallbladder
A. Organs
216. What is the column made of?
NARAYAN CHANGDER
B. Body cavities
A. All of the above. C. Planes
B. Three different joints. D. Vital cavities
C. A single long bone:the femur.
222. Anterior
D. Bones, muscles, tendons, nerves and
A. Toward Middle
other tissues.
B. Toward Side
217. Which set of abdominal muscles are the
deepest? C. Toward Front
A. External Oblique D. Toward Back
B. Internal Oblique 223. SELECT ALL THAT APPLY. Which of the

C. Rectus Abdominis following is/are used to assess for acute
cholecystitis?
D. Transverse Abdominis
A. McBurney point
218. Toward the back; opposite of Anterior B. Murphy sign
A. Superior C. Rovsing sign
B. Posterior D. Psoas sign
C. Inferior
E. Obturator sign
D. Lateral
224. Which of the following is the center re-
219. Choose the specific clinical signs for ty- gion of the 9 abdominal regions? (like the
phoid fever middle of a tic-tac-toe board)
A. hepatosplenomegaly A. epigastric
B. it is patent B. umbilical
C. Filipovic sign C. hyopgastric
D. headache, chills D. pelvic
E. roseola rash
225. Pain in the hypogastric area is thought of
220. This term is used to describe a patient with any organ dysfunction.
lying on their back with the face up. A. Duodenum
(hint:how do you carry a bowl of soup?
)(hint2:A patient lying on their spine, is a B. Sigmoid colon
patient lying ) C. Ileum
A. Prone D. none of above

226. The term that means toward the midline C. pectoralis major
of the body is D. teres major

A. anterior (ventral)
232. SELECT ALL THAT APPLY. Which of the fol-
B. posterior (dorsal) lowing is/are TRUE regarding bruits?
C. medial A. Bruits are NORMAL findings
D. lateral B. Bruits are assessed via auscultation
227. The primary muscles that you train while C. Bruits may be indicative of blockages
do the step up movement is in the blood vessels
A. biceps D. Bruits are ABNORMAL findings
B. triceps 233. A long, broad strap-shaped muscle is the
C. quardiceps main vertical muscle of the anterolateral
wall of the abdomen.
D. abs
A. External oblique
228. The thumbs are to the fingers B. internal oblique
A. medial C. Recto
B. proximal D. Transverse
C. distal
234. What is the topographic location of the
D. lateral Pancreas?
229. Transparent, continuous, slippery and A. Left flank
shiny serous membrane. Lines the ab- B. Epigastrium
dominopelvic cavity and surrounds the vis-
cera C. Mesogastrio
A. Peritoneum D. none of above
B. Fur 235. Abdominal pain comes on suddenly,

quickly, severely. Can you think of the
C. Stomach
cause of the abnormality from which or-
D. Esophagus gan?
230. What cells are the targets of the covid- A. hepatitis
19 virus? B. intestinal contractions
A. Alveolar tipe I C. gastritis
B. Alveolar type II D. none of above
C. Alveolar type III
236. The thoracic cavity includes which or-
D. none of above gans?
231. flexes arm at shoulder, adducts & medi- A. Heart, stomach, and lung
ally rotates arm B. Stomach, heart, and lung
A. latissimus dorsi C. Stomach, intestines, liver
B. deltoid D. Heart, lung, large blood vessels

2.2 Chronic Liver Disease 88
237. Matte:Muffled noise generated by strik- 241. What is the topographic location of the
ing solid organs such as: Duodenum?
A. Stomach A. Mesogastrio
B. Bladder B. hypogastrium
C. Liver C. Epigastrium
D. Large intestine D. none of above
NARAYAN CHANGDER
238. Towards the Front. [The eyes are to 242. If someone receives a penetrating trauma
the brain]. about 5 cm (2 in.) below the navel, which
A. Inferior organ is most likely to be injured?
B. Deep A. Pancreas
C. Lateral B. Gallbladder
D. Anterior C. Smallintestine
D. Liver
239. Mention the name of the following mus-
cles 243. Away from the origin or trunk
A. External oblique A. Deep
B. Transverse B. Distal
C. internal shutter C. Proximal
D. none of above D. Posterior
240. Why can the small intestine and large in- 244. What are the indirect signs of
testine be targets of SARS-CoV 2? Gastrointestinal-covid?
A. because it has ACE-I receptors A. Mesenteric lymphadenitis
B. because it has an ACE-II receptor B. Intestinal wall thickening
C. because it has goblet cells C. Fat stranding
2.2 Chronic Liver Disease

1. Which is not a job of the liver? 2. Which type of senescent cell do Kupffer
cells break down?
A. Filters blood coming through the diges-
tive tract A. pathogens
B. hepatocytes
B. Produces proteins that helps your
blood to clot C. erythrocytes
D. macrophages
C. Produces enzymes such as pepsin
3. Which are types of cirrhosis?
D. Works together with the pancreas, the
small intestine, the large intestine, and A. postnecrotic
the gallbladder to digest food B. Laennec’s

C. biliary C. “Do not take any more of the medica-

D. cancerous tion until your stools firm up.”

D. “We will need to send a stool specimen
4. Which is the correct term for the formation
to the laboratory as soon as possible.”
of glycogen?
A. gluconeogenesis 9. Select the home care management for cir-
B. glycogenesis rhosis.
C. glycogenolysis A. Laxatives
D. hyperglycaemia B. Antibiotics
C. Diuretics
5. Ways to promote nutrition for a hepatitis
patient? D. Acsites drain
A. high carb/ high calorie diet E. NSAIDs *No more than 2000 mL from
B. small frequent meals abdomen at one time to prevent hypov-
olemic shock *Avoid NSAIDS hepatic toxic
C. supplemental vitamins
herbs, vitamins, and minerals. *Constipa-
D. moderate fats and protein tion bleeding and infection can increase
E. low sodium diet encephalopathy.
6. What is the name of the cycle that con- 10. Recommended protein intake for cirrhosis
verts ammonia into urea for excretion? A. low
A. arginine
B. high
B. ornithine
C. 1 cup
C. citrulline
D. moderate
D. uric acid
11. What is the name for the liver disease
7. part of the body becomes reddened,
where healthy tissue is replaced by fibrous
swollen, hot, and often painful, especially
scar tissue?
as a reaction to injury or infection.
A. cirrhosis
A. sad
B. inflammation B. hepatitis
C. spot C. fatty liver disease

D. none of above D. diabetes
8. The nurse is caring for a client who is pre- 12. What is Hepatitis?
scribed lactulose. The client states, “I do A. Fat accumulation in the liver without
not want to take this medication because excessive consumption of alcohol
itcauses diarrhea.” How would the nurse
respond? B. Chronic liver damage from a variety of
causes leading to scarring and liver fail-
A. “Diarrhea is expected; that’s how your
ure
body gets rid of ammonia.”
B. “You may take antidiarrheal medica- C. Inflammation of the pancreas
tion to prevent loose stools.” D. Inflammation of the liver

13. How is Hepatitis E contracted? 18. What does GGT stand for
A. fecal-oral route A. the Galaxy goes tipsy
B. sexual contact B. Gummy gummybeartreasure
C. blood to blood transmission C. Gogo turbotax
D. needle sticks D. Gamma glutamyltransferase
14. The nurse is preparing to teach a client 19. What are globulins?
NARAYAN CHANGDER
with chronic hepatitis B about lamivudine
A. a group of proteins in the blood
therapy. What health teaching would the
nurseinclude? B. a group of proteins in the urine
A. “Follow up on all appointments to mon- C. a group of lipids in the blood
itor your lab values.” D. a group of RBCs in the blood
B. “Do not take amiodorone at any time
while on this drug.” 20. Select signs and symptoms that may be
seen in a patient with cirrhosis.
C. “Monitor for jaundice, rash, and itchy
skin while on this drug.” A. fatigue
D. “Report any changes in urinary elimi- B. weight change

nation while on this drug.” C. GI symptoms
15. Which form of hepatitis is transmitted via D. alcohol withdrawl

blood-to-blood tranmission? E. dilated pupils
A. C
21. The nurse is assessing a client with hep-
B. B atitis C. The client asks the nurse how it
C. A was possible to have this disease. What
questionsmight the nurse ask to help the
D. D client determine how the disease was con-
tracted? (Select all that apply.)
16. Which is not a symptom of Cirrhosis?
A. “How old are you? ”
A. Liver enlargement
B. “Do you work in health care?
B. Edema in legs and feet
C. “Are you receiving hemodialysis? ”
C. Jaundice
D. “Do you use IV drugs? ”
D. Hypotension
E. “Did you receive blood before 1992? ”
17. Which vessel brings nutrient-rich, oxygen-
poor blood from the small intestines to the 22. circulation takes blood from heart to
liver? lungs and back.
A. hepatic vein A. Systemic
B. hepatic portal vein B. Body
C. hepatic artery C. Pulmonary
D. inferior vena cava D. Blood

23. what is the normal albumin to globulin ra- 29. Which food item will the nurse remove
tio? from the dietary tray of a client with hep-
atic encephalopathy?

A. 1:2
B. 6:10 A. salad
C. 1:4 B. apple
D. 2:1 C. bread
D. legumes A high-protein diet can
24. is a term used to describe elevated worsen hepatic encephalopathy; there-
pressure in the portal vein fore, the nurse will remove the food item
A. Portal hypertention (legumes) that is high in protein.
B. Portal hypotension 30. yellowish discoloration of the skin
C. Vein hypertension A. spray paint
D. Portal hypertension B. bananas
25. What type of reaction releases urea from C. jaundice
arginine? D. none of above
A. dehydration
31. How is alcohol detoxified by the liver?
B. reduction
A. using ethanol dehydrogenase
C. condensation
B. converted to hydrophobic substances
D. hydrolysis
C. converted to hydrophilic substances
26. Biliary cirrhosis is caused by which? D. converted to urea
A. chronic biliary obstruction
32. What is the prescribed diet for liver cirrho-
B. autoimmune disease sis?
C. HTN A. Low sodium low fat diet
D. alcohol B. Low fat low protein diet
27. Symptoms of compensated liver cirrhosis. C. Low sodium ow protein diet
(Select all that apply) D. none of above
A. Ankle edema
33. The nurse is caring for a client who is
B. Intermittent mild fever scheduled for a paracentesis. Which action
C. Abdominal pain is appropriate for the nurse to take?
D. Asymptomatic A. Have the client sign the informed con-
sent form.
28. Which is the correct term for the removal
of an amine group from a molecule? B. Get the patient into a chair before the
procedure.
A. detoxification
C. Help the client lie flat in bed on the
B. dehydrogenation right side.
C. ornithine cycle D. Assist the client to void before the pro-
D. denamination cedure.

34. Complications of cirrhosis? toxins from the blood as well as a healthy

A. portal hypertension liver can. These toxins can then build up
in the brain and cause mental confusion
B. swelling in legs and abdomen and difficulty concentrating. With time,
C. enlargement in spleen hepatic encephalopathy can progress to
D. biliary obstruction unresponsiveness or coma. * Jaundice.
Jaundice occurs when the diseased liver
E. renal encephalopathy * High blood doesn’t remove enough bilirubin, a blood
pressure in the veins that supply the liver
NARAYAN CHANGDER
waste product, from your blood. Jaundice
(portal hypertension). Cirrhosis slows the causes yellowing of the skin and whites of
normal flow of blood through the liver, the eyes and darkening of urine . ICTERUS
thus increasing pressure in the vein that * Bone disease. Some people with cirrho-
brings blood to the liver from the in- sis lose bone strength and are at greater
testines and spleen. * Swelling in the risk of fractures. * Increased risk of
legs and abdomen. The increased pres- liver cancer. A large proportion of peo-
sure in the portal vein can cause fluid ple who develop liver cancer have pre-
to accumulate in the legs (edema) and in existing cirrhosis. * Acute-on-chronic cir-
the abdomen (ascites). Edema and as- rhosis. Some people end up experiencing
cites also may result from the inability of multiorgan failure. Researchers now be-
the liver to make enough of certain blood lieve this is a distinct complication in some
proteins, such as albumin. * Enlarge- people who have cirrhosis, but they don’t
ment of the spleen (splenomegaly). Por- fully understand its causes.
tal hypertension can also cause changes
to and swelling of the spleen, and trap- 35. What disease(s) is jaundice associated
ping of white blood cells and platelets. De- with?
creased white blood cells and platelets
in your blood can be the first sign of A. Pancreatitis
cirrhosis. * Bleeding. Portal hyperten- B. Cirrhosis
sion can cause blood to be redirected to
smaller veins. Strained by the extra pres- C. Hepatitis, Cirrhosis, Pancreatitis
sure, these smaller veins can burst, caus- D. Hepatitis C
ing serious bleeding. Portal hyperten-
sion may cause enlarged veins (varices) 36. Esophageal varices are a potentially
in the esophagus (esophageal varices) or life-threatening complication of cirrhosis.
the stomach (gastric varices) and lead to Without treatment, what can occur?
life-threatening bleeding. If the liver can’t
A. hemorrhage
make enough clotting factors, this also
can contribute to continued bleeding. * In- B. portal vein blockage
fections. If you have cirrhosis, your body
C. esophageal obstruction
may have difficulty fighting infections. As-
cites can lead to bacterial peritonitis, a se- D. death Esophageal varices are a po-
rious infection. * Malnutrition. Cirrhosis tentially serious complication of cirrhosis.
may make it more difficult for your body Without treatment, between 25 and 40
to process nutrients, leading to weakness percent of people with varices will experi-
and weight loss. * Buildup of toxins in the ence an episode of severe bleeding (hem-
brain (hepatic encephalopathy). A liver orrhage) resulting in significant illness or
damaged by cirrhosis isn’t able to clear even death.

37. The nurse is caring for a client with hep- 40. The nurse is assessing a client who has
atic portal-systemic encephalopathy (PSE). hepatitis C. What extrahepatic complica-
The client is thin and cachectic, and the fam- tions would the nurse anticipate? (Select

ilyexpresses distress that the patient is re- all thatapply.)
ceiving little dietary protein. How would A. Pancreatitis
the nurse respond?
B. Polyarthritis
A. “A low-protein diet will help the liver
rest and will restore liver function.” C. Heart disease
D. Myalgia
B. “Less protein in the diet will help pre-
vent confusion associated with liver fail- E. Peptic ulcer disease
ure.”
41. Other than urea, what is produced when
C. “Increasing dietary protein will help arginine is hydrolysed?
the patient gain weight and muscle mass.”
A. citrulline
D. “Low dietary protein is needed to pre- B. ornithine
vent fluid from leaking into the abdomen.”
C. ammonia
38. The nurse plans care for a patient who has D. urea
hepatopulmonary syndrome. Which inter-
ventions would the nurse include in this 42. Alcohol mainly effects the
client’splan of care? (Select all that ap- A. brain and nervous system
ply.)
B. digestive system
A. Oxygen therapy
C. circulatory system
B. Feet elevated on pillows D. respiratory system
C. Daily weights
43. Which are problems of the liver? (Click all
D. Respiratory therapy that apply)
E. Physical therapy A. Cirrhosis
B. Anemia
39. The nurse is caring for a client with hep-
atitis C. The client’s brother states, “I do C. Cancer
not want to get this infection, so I’m not D. Celiac Disease
goinginto his hospital room.” How would
E. Hepatitis
the nurse respond?
A. “Hepatitis C is not spread through ca- 44. What is ALP’s ‘job’?
sual contact.” A. facilitates the transfer of metabolites
B. “If you wear a gown and gloves, you across cell membranes and is associated
will not get this virus.” with glucose transport and the calcifica-
tion process in bone degeneration
C. “This virus is only transmitted through
B. facilitates the transfer of metabolites
a fecal specimen.”
across cell membranes and is associated
D. “I can give you an update on your with protein transport and the calcifica-
brother’s status from here.” tion process in bone synthesis

C. facilitates the transfer of metabolites 50. Which polysaccharide is stored in liver

across cell membranes and is associated cells?
with enzyme transport and the calcifica- A. glucose
tion process in bone degeneration
B. lactose
D. facilitates the transfer of metabolites
across cell membranes and is associated C. cellulose
with lipid transport and the calcification D. glycogen
process in bone synthesis
NARAYAN CHANGDER
51. Treatment for ascites?
45. Portal circulation ends in
A. low-sodium diet
A. Liver
B. diuretics
B. Heart
C. abdominal paracentesis
C. Stomach
D. arteriography The basic treatment for
D. Lungs ascites is a low-sodium diet with a goal of
2, 000 mg or less of sodium per day . If
46. Is this quizlet hard?
diet is ineffective, people are usually also
A. Kinda given diuretics (such as spironolactone or
B. No furosemide). Paracentesis is used for di-
agnosis.
C. it’s not a quizlet, it’s a quizizz
D. Yes 52. Jaundice is caused by:
A. intrahepatic obstruction
47. What foods should you not eat with liver
failure B. leukopenia
A. Alcohol C. testicular atrophy
B. More carbs than protein D. acites
C. Sugar 53. The nurse is caring for a client who has cir-
D. Salt rhosis of the liver. What nursing action is
appropriate to help control ascites?
48. What type of reaction is the addition of
A. monitor I & O
ammonia to an intermediate?
B. provide a low-sodium diet
A. dehydration
C. increase oral fluid intake
B. reduction
C. condensation D. weight the patient daily
D. hydrolysis 54. Which is NOT a way to take care of your

liver?
49. Interventions for a patient with cirrhosis?
A. Eat a healthy diet
A. manage fluid volume
B. Do not drink too much alcohol and
B. prevent or manage hemorrhage avoid drug use
C. prevent or manage confusion C. Only visit a doctor when you know
D. manage pruritis something is wrong
E. manage weight loss D. Exercise regularly

55. Which organelles are largest/in the assessment finding would require immedi-
largest numbers in the hepatocytes to fa- ateaction by the nurse?
cilitate enzyme synthesis?

A. Urine output via indwelling urinary
A. golgi, rough endoplasmic reticulum catheter is 20 mL/hr
B. golgi, mitochondria, free ribosomes B. Blood pressure increases from 110/58
to 120/62 mm Hg
C. golgi, mitochondria, rough endoplas-
mic reticulum C. Respiratory rate decreases from 22 to
16 breaths/min
D. golgi, smooth endoplasmic reticulum
D. A decrease in the client’s weight by 3
56. The yellow skin caused by jaundice is from lb (1.4 kg)
an overproduction of bilirubin (bile pig-
ment) resulting from 61. what can cause hypoproteinemia?
A. The breakdown of red blood cells A. severe burns
B. The production of reactive metabolites B. loss of blood
in the detoxification process C. leakage into the GI tract
C. The ultrafiltration of the blood D. loss of urine
D. Overproduction of antioxidants
62. A telehealth nurse speaks with a client
57. What enzyme that catalyzes the break- who is recovering from a liver transplant 2
down of starch and glycogen? weeks ago. The client states, “I’m having
rightbelly pain and have a temperature of
A. Amylase 101◦ F (38.3◦ C).” How would the nurse
B. Lipase respond?
C. Ramylase A. “The anti-rejection drugs you are tak-
D. Ripase ing make you susceptible to infection.”
B. “You should go to the hospital immedi-
58. What foods should you eat for liver failure ately to get checked out.”
A. Grains C. “You should take an additional dose of
B. Fruits and Veggies cyclosporine today.”
C. Meat or Protein D. “Take acetaminophen every 4 hours
until you feel better soon.”
D. Dairy
63. What organ does Cirrhosis affect?
59. Portal triads are composed of what three
major tubes? (Select all that apply.) A. Pancreas
A. portal vein B. Liver
B. hepatic artery C. Kidney
C. bile duct D. Heart
D. hepatic vein 64. Globulins play an important role in
60. The nurse assesses a client who is recover- A. blood clotting

ing from a paracentesis 1 hour ago. Which B. uric acid formation

C. liver function B. assimilation

D. fight infections C. digestion
65. What is one of the precipitating factor of D. deamination

liver cirrhosis?
71. Laennec’s cirrhosis is caused by what?
A. Age
A. alcohol
B. Obesity
B. drugs
NARAYAN CHANGDER
C. Race
C. autoimmune disease
D. Environment
D. liver failure
66. a fluid created by infection.
72. What is the name of the enzyme that
A. pus breaks down alcohol?
B. water A. ethanal dehydrogenase
C. blood B. ethanoate dehydrogenase
D. none of above C. ethanol
67. How many molecules of ammonia does it D. ethanol dehydrogenase
take to make one molecule of urea via the
ornithine cycle? 73. Who is susceptible to contracting Hepatitis
D?
A. one
A. only people infected with Hep B al-
B. two
ready
C. three
B. only people infected with Hep A al-
D. four ready
68. Where is ALT found primarily? C. only people infected with Hep C al-
ready
A. heart
D. none of above
B. liver
C. kidney 74. What is the name of the enzyme that catal-
yses the breakdown of hydrogen perox-
D. muscle tissue
ide?
69. Which is not a cause of Cirrhosis? A. lysolase
A. Cystic fibrosis B. hydrolase
B. Low triglyceride levels C. catalase
C. Accumulation of cooper in the liver D. dehydrogenase
D. Chronic alcohol abuse
75. A nurse assesses a client who has cirrho-
70. What is the name of the process in which sis of the liver. Which laboratory findings
excess amino acids undergo a conversion would the nurse expect in clients with this-
in the liver to form urea with the removal disorder? (Select all that apply.)
of the amino group? A. Elevated international normalized ra-
A. absorption tio (INR)

B. Elevated serum ammonia D. Elevating the head of bed >30 de-

C. Elevated prothrombin time (PT) grees Decompensated Cirrhosis-oblivious
signs of liver failure (Portal HTN, Ascites,

D. Elevated aspartate transaminase Biliary Obstruction, Hepatic Encephalopa-
E. Decreased serum globulin levels thy) Decompensated cirrhosis has mul-
tiple complications, of which bleeding
76. Diabetic patients feel faint when there is esophageal varices is one. This condi-
a lack of sugar in their blood.Which of the tion can present a life-threatening emer-
following foods would be the most appro- gency. Preventing nausea and vomiting is
priate for a diabetic patient when they are an important intervention in the manage-
feeling faint? ment of esophageal varices. Monitoring
A. bread protein, fluid balance, and client position-
ing are also important interventions in the
B. potato chips care of the client with end-stage liver dis-
C. sweets ease.
D. water
80. How is ammonia detoxified by the liver?
77. What do Kupffer cells produce? A. using ethanol dehydrogenase
A. bile B. converted into hydrophobic sub-
B. bile pigments stances
C. amino acids C. converted into hydrophilic substances
D. urea D. converted into urea
78. After teaching a client who has been diag- 81. Which of the following is fatty liver dis-
nosed with hepatitis A, the nurse assesses ease associated with?
the client’s understanding. Which state- A. Stroke
ment bythe client indicates correct under-
B. Diabetes
standing of the teaching?
C. All of the above
A. “Some medications have been known
to cause hepatitis A.” D. none of above
B. “I may have been exposed when we 82. What type of BioMol are the intermediates
ate shrimp last weekend.” in the ornithine cycle?
C. “I was infected with hepatitis A A. carbohydrates
through a recent blood transfusion.”
B. fatty acids
D. “My infection with Epstein-Barr virus
can co-infect me with hepatitis A.” C. triglycerides
D. amino acids
79. What is the priority nursing intervention
in the management of a client with decom- 83. The nurse is caring for a client with
pensated cirrhosis? early encephalopathy due to cirrhosis of
A. Limiting protein intake the liver. Which factors may contribute
to increasedencephalopathy for which the
B. Managing nausea and vomiting nurse would assess? (Select all that ap-
C. Monitoring fluid intake and output ply.)

A. Infection 88. Which of the following is not broken down

B. GI bleeding in the liver?
C. Irritable bowel syndrome A. nicotine
D. Constipation B. alcohol
E. Hypovolemia C. paracetamol
84. Postnecrotic cirrhosis is caused by which D. hydrogen peroxide
of the following?
NARAYAN CHANGDER
89. What is one cause of Hepatitis C?
A. vital hepatitis
A. Sharing of needles
B. drugs
B. Excessive alcohol consumption
C. toxins
D. alcohol C. Smoking cigarettes
D. Low blood sugar
85. What is the correct name for the liver
cells? 90. What is the clinical significance of in-
A. hepacytes creased levels of ammonia?
B. hippocytes A. indicates kidney failure
C. hepatocytes B. indicates pancreatic failure
D. hypercytes C. indicates liver failure
86. The liver controls the storage and break- D. indicates pituitary gland failure
down of which substance that helps regu-
late blood sugar 91. After teaching a client who has alcohol-
A. Glycogen induced cirrhosis, a nurse assesses the
client’s understanding. Which statement
B. Insulin made by theclient indicates a need for fur-
C. Bile Salts ther teaching?
D. Cholesterol A. “I cannot drink any alcohol at all any-
more.”
87. Which assessment finding requires imme-
diate nursing intervention in a client with B. “I should not take over-the-counter
severe ascites? medications.”
A. confusion C. “I need to avoid protein in my diet.”
B. temperature 38.2C D. “I should eat small, frequent, bal-
C. tachycardia, 110bpm anced meals.”
D. shallow respirations, rate 32 bpm As- 92. Who is more at risk of having liver cirrho-
cites can increase abdominal distention, sis?
which interferes with lung expansion and
compromises ventilation and oxygenation. A. 35 years old male
Risk for infection, fluid displacement, and B. 68 years female
confusion are also assessment variables
C. 68 years old male
requiring monitoring in a client with as-
cites. D. 35 years old female

93. when are increased blood levels present? 98. Portal system includes vein which drains
(ALP) blood from

A. when cholestasis or bone degenera- A. Head and neck
tion is present
B. lungs
B. when myleostasis or enzyme synthesis
C. abdomen
is present
D. kidney
C. when lipostasis or bone synthesis is
present 99. characteristics of an illness
D. when cholestasis or protein degenera-
A. cause
tion is present
B. symptoms
94. The nurse is teaching a client a client about
C. treatment
taking elbasvir for hepatitis C. What in-
formation in the client’s history would the D. none of above
nurseneed prior to drug administration?
100. taking steps to keep something from hap-
A. History of hepatitis B pening or getting worse
B. History of kidney disease
A. cure
C. History of cardiac disease
B. prevention
D. History of rectal bleeding
C. treatment
95. Which form of hepatitis is transmitted by D. none of above
sexual contact, needles, infect tears and
saliva? 101. before a baby has been born
A. A A. pre-natal
B. B B. post-natal
C. C C. conception
D. E D. none of above
96. What is the nitrogenous end product of
102. What type of cell are kuppfer cells?
deamination?
A. hepatocytes
A. urea
B. lymphocyte
B. ammonia
C. urine C. macrophage
D. uric acid D. erythrocyte
97. Which form of hepatitis is transmitted by 103. new, usually of rapid onset and of con-
fecal-oral route? cern
A. A A. chronic
B. B B. acute
C. C C. sprint
D. D D. none of above

104. What is found in blood when there is ob- C. enzymes

struction to bile flow or cholestasis?
D. reduced coenzymes
A. GTT
B. GGT 110. What is the opposite of glycogenesis?
C. TTG A. gluconeogenesis
D. TGG B. glycogenolysis
105. What hormones involved in carbohydrate C. hyperglycaemia
NARAYAN CHANGDER
metabolism? D. glucagon
A. insulin
B. glycogen 111. injection of a weakened or mild form of a
pathogen to produce immunity
C. imuline
A. vaccination
D. glucagon
B. disease
106. Where is Alkaline Phosphatase (ALP)
generally found? C. chronic
A. liver, spine, kidney, and placenta cells D. none of above

B. liver, bone, intestine, spleen
112. The nurse is caring for a client who has a
C. pancreas, bone, intestine, kidney risk gene for developing cirrhosis. Which
D. liver, bone, intestine, kidney, and pla- racial/ethnic group has this gene most of-
centa cells ten?
A. black
107. What is one of the signs of Pancreatitis?
A. Edema B. asian
B. Fatigue C. latinos
C. Severe abdominal pain that radiates to D. french
the back
D. Myalgia 113. The reason why something happens
A. cause
108. What is the main cause of cirrhosis in the
UK? B. symptom
A. Hepatitis C C. treatment
B. excessive alcohol consumption D. none of above
C. smoking
114. Which hormones promotes the formation
D. cancer
of glycogen?
109. The liver is the main organ of detoxifi- A. insulin
cation. What does it produce in order to
achieve this? B. glucagon
A. toxins C. adrenaline
B. anti-toxins D. testosterone

115. A blood test that is used to evaluate the B. cirrhosis

overall health of the client and detect a C. pus
wide range of diseases such as anemia, in-

fection or leukemia. D. none of above
A. Leukocyte 120. What is albumin?

B. Red blood cells A. enzyme
C. Hemoglobin B. glucose
D. Complete Blood Count C. fat
D. protein
116. The nurse is teaching assistive personnel
(AP) about care of a client who has ad- 121. When is the albumin to globulin ratio re-
vanced cirrhosis. Which statements would versed?
the nurseinclude in the staff teaching? (Se-
lect all that apply.) A. Achoo syndrome
A. “Apply lotion to the client’s dry skin ar- B. disease of the kidney
eas.” C. disease of the liver
B. “Use a basin with warm water to bathe D. chronic infections
the patient.”
122. continuing for a long time
C. “For the patient’s oral care, use a soft
toothbrush.” A. acute
D. “Provide clippers so the patient can B. long weekend

trim the fingernails.” C. chronic
E. “Bathe with antibacterial and water- D. none of above
based soaps.”
123. What pancreatic hormone increase blood
117. disease states that cause most cases of glucose levels?
pancreatic disease A. glucagon
A. CF B. insulin
B. Bile obstruction C. glucocorticoid
C. Pancreatitis D. epinephrine
D. Pancreatic carcinoma
124. something to fix an illness
118. Pulmonary vein carries A. cause
A. Oxygenated blood B. symptoms
B. Deoxygenated blood C. treatment
C. Mixed Blood D. none of above
D. Toxic blood 125. What is ALT generally located in the mem-
119. a potentially serious liver disease that branes of?
may lead to liver cancer A. liver
A. kidney stones B. bone

C. intestine consumption or another cause-it tries to

D. kidney repair itself. In the process, scar tissue
forms. As cirrhosis progresses, more and
E. placenta cells more scar tissue forms, making it diffi-
126. The nurse is caring for a client who has cult for the liver to function (decompen-
late-stage (advanced) cirrhosis. What as- sated cirrhosis). Advanced cirrhosis is
sessment findings would the nurse ex- life-threatening.
pect? (Selectall that apply.) 130. circulation takes place from the heart
NARAYAN CHANGDER
A. Jaundice to rest of the body.
B. Clay-colored stools A. Systemic
C. Icterus B. Full body
D. Acites C. Pulmonary
E. Dark Urine D. Heart to lung
127. best oil to cook with for bile disease 131. General s/s of Hepatitis?
A. Avocado A. abdominal pain
B. Coconut B. icterus
C. Olive C. jaundice
D. none of above D. myalgia
128. when will blood levels of albumin be E. fibrosis

low? 132. Do all liver diseases require the same
A. chronic UTIs diet?
B. chronic liver damage A. Yes
C. CF B. Diets are based off of the nutritional
D. Achoo disease needs of each individual client
C. there are two diet options to choose
129. Select what characterizes cirrhosis of the from
liver.
D. none of above
A. Widespread fibrotic (scarred) bands of
connective tissue 133. cannot be treated by antibiotics
B. Tissue becomes nodular A. cause
C. Nodules block blood and lymph flow B. viral infections
D. Liver shrinks in size and softens C. liver
E. Reversible if treated in early stages D. none of above
hardens Cirrhosis is a late stage of scar-
ring (fibrosis) of the liver caused by 134. How does alcohol affect how a person
many forms of liver diseases and condi- acts and feels?
tions, such as hepatitis and chronic alco- A. It makes people less inhibited it
holism. Each time your liver is injured- makes people say or do things they nor-
whether by disease, excessive alcohol mally don’t do.

2.3 Generalised Lymphadenopathy 103
B. All of your senses become impaired. drained from the abdominal cavity. A sub-
C. Your coordination or balance are stantial decrease in blood pressure can in-
dicate shock. Residual should be obtained

thrown off, too.
during the procedure. The client should
D. All of the above. not feel a sensation or need to urinate, be-
135. give a sample of blood to test for disease cause a primary safety measure is to have
the client void right before the procedure
A. x-ray
to avoid injury to the bladder during the
B. blood test procedure.
C. blood pressure check
138. organ that produces bile
D. none of above
A. heart
136. What is hypoproteinemia?
B. lung
A. the condition involving a total fat level
C. liver
more than the reference interval
B. the condition involving a total enzyme D. none of above
level more than the reference interval
139. Which type of BioMol do amine groups
C. the condition involving a total protein need to be removed from?
level less than the reference interval
A. lipids
D. the condition involving a total glucose
level less than the reference interval B. polysaccharides
C. amino acids
137. A 63-year-old client with cirrhosis under-
went paracentesis today. Which assess- D. nucleotides
ment finding alerts the nurse that the pro-
cedure was successful? 140. The nurse is caring for a client who has
cirrhosis of the liver. Which risk factor is
A. Decrease in post-procedure weight the leading cause of cirrhosis?
B. No residual obtained during procedure
A. metabolic syndrome
C. Substantial decrease in blood pres-
B. liver cancer
sure
D. Immediate sensation of a need to uri- C. nonalcoholic fatty liver disease
nate Weight should decrease as fluid is D. hepatitis c
2.3 Generalised Lymphadenopathy

1. A macroscopic investigation of the ap- verified. What is the most likely diag-
pendix, 9 cm in length and 0.9 cm in thick- nose?
ness, revealed dull and hyperemic serous A. Superficial appendicitis
membrane. Microscopic study determined
edema, stases in capillaries and venules, B. Simple appendicitis
fine hemorrhages throughout the mucosa. C. Suppurative appendicitis
Besides these, the necrotic foci with leuko- D. Flegmonous-ulcerative appendicitis
cyte infiltration around them were also
2. Which lymphatic structure drains lymph

from the right side of the head and right C. Chronic milliary tuberculosis
upper limbs? D. Disseminated tuberculosis
A. Coronary veins
6. A 20-year old woman presented with en-
B. Lumbar Trunk
larged, not painful, condensed inguinal
C. Thoracic Duct lymph nodes. In her genital mucosa there
D. Right lymphatic duct was a small ulcer with firm edges and the
“varnished” grayish color floor. What is
3. The combining form that means lymph is:
NARAYAN CHANGDER
the most likely diagnosis?
A. lymphangi/o A. Syphilis
B. lymphaden/o B. Leprosy.
C. leuk/o
C. Tuberculosis.
D. lymph/o
D. Gonorrhea.
4. A patient died of a diffuse peritonitis. An
autopsy revealed in the distal part of 7. A 7-year-old girl developed an acute dis-
a small bowel multiple oval ulcers with ease. She presented to the hospital with
rounded edges, which were parallel to the a sore throat, and a fever, accompa-
longitudinal axis of the intestine. A bot- nied with a widespread rash. A phys-
tom of ulcers was clean, smooth and glit- ical examination revealed severe hyper-
ter. Base of the ulcers presented either by emia of a pharynx, a ‘raspberry’ tongue,
muscular layer of ileum or its serosa. Two and enlarged bright red tonsils with some
ulcers had perforation apertures 0, 5cm in grayish and yellowish dim areas. These
diameter each. What disease resulted on zones also extended on peritonsillar tis-
a death of a patient? sues. Submandibular lymph nodes were
enlarged. For what disease the given
A. Dysentery changes are characteristic?
B. Cholera A. Scarlet fever
C. Typhoid
B. Measles
D. Tuberculosis
C. Fauces diphtheria
5. A 52-year-old man with a long history of D. Larynx diphtheria
a tubercular prostatitis died of a meningo-
cephalitis. An autopsy revealed in arach- 8. Histological investigation of the mitral
noids of the basis and lateral surfaces of a valves of the heart revealed the focal
brain, in a spleen, kidneys and liver a con- desquamation of endothelial cells replaced
siderable quantity of dense grey color nod- by thrombi. The connective tissue had
ules 0, 5-lmm in diameter. Histological in- mucoid swelling areas and also zones of
vestigation of nodules showed epithelioid, sclerosis and revascularization. Name the
lymphoid and some giant cells with nuclei type of valve’s endocarditis?
located on a cell periphery in the form of
A. Relapsing warty endocarditis
a horseshoe. What is the most likely diag-
nosis? B. Diffuse endocarditis
A. Acute milliary tuberculosis C. Acute warty endocarditis
B. Acute tuberculous sepsis D. Fibroplastic endocarditis

9. A 1, 5-year-old child presented with focal the hospital. A post-mortem revealed

thickenings of ribs, wrists, and a curva- the right lung enlarged, firm, hypoventi-
ture of legs. A stomatologist pointed to lated, with a liver-like consistency and fib-

retarded dentition, the teething order dis- rin fibers on the pleura. On a cut sec-
turbance, the irregular mineralization of tion pulmonary tissue had a gray color-
the enamel and dentine, a reconfiguration ing and looked granular. A turbid liquid
of the upper jaw in a horizontal direction flowed down the surface. Histological in-
(dolichouranic). What is the most likely vestigation showed an acute inflammation
disease presented in that case? with the exudate within alveoli consisted
A. Rachitis mainly of neutrophil polymorphs. What is
B. Osteomalacia
A. Croupous pneumonia
C. A metabolic calcification
B. Staphylococcal pneumonia
D. A metastatic calcification
C. Focal pneumonia
10. A post-mortem of a 25-year old woman D. Intestinal interalveolar pneumonia
who died from chronic kidney failure re-
vealed a reddish malar rash (’butterfly 13. Microscopic study of appendix determined
rash’) and small (up to 0, 2 cm) pale intensive leukocyte infiltration hyperemia,
tan spreading vegetations over the mi- stases throughout all its layers. What is
tral valve surface. Histological investi- the most likely type of appendicitis?
gation of kidneys showed foci of fibri- A. Suppurative appendicitis
noid necrosis, eosinophilic deposits (hema-
B. Gangrenous appendicitis
toxylin bodies), “wire loop” lesions in
the basement membrane of the glomerular C. Superficial appendicitis
tuft and karyorrhexis. What is the most D. Simple appendicitis
likely diagnosis?
14. The thymus is most active during
A. Lupus erythematosus.
A. fetal development
B. Nodular periarteritis.
B. childhood
C. Rheumatism.
C. middle age
D. Rheumatic arthritis.
D. old age
11. HIV and AIDS
15. A 48-year-old female after exposure to
A. caused by a virus that hinders the cold presents to her physician with painful
body’s ability to fight off infection deformed fingers joints, which bones were
B. inflammation of the lymph vessels restricted in their movements. Physical
examination revealed small firm nodules
C. resembling or pertaining to lymph tis-
near the joints. Histological investigation
sue
of the nodules biopsy showed the centrally
D. none of above located core of fibrinoid necrosis with sur-
rounding rim of macrophages and hystio-
12. A 48-year old male, with a history of com- cytes. What is the most likely diagnosis?
mon cold after acute cooling, presented
to his physician with symptoms of lung A. Rheumatoid arthritis.
a heart insufficiency. He died soon at B. Dermatomyositis.

C. Rheumatism. 19. A 66-year-old male suddenly died on his

D. Gout way to operation room. An autopsy re-
vealed a hemorrhage into retroperitoneal
16. A 42-year-old man, with a history fat, a saccular dilatation of the abdom-
of an acute respiratory disease, died inal aorta wall with rupture in arterial
of pulmonary insufficiency. A post- wall. The aorta’s defect had uneven edges
mortem investigation revealed fibrinous- and stony hardening of surrounding tis-
hemorrhagic inflammation in a larynx and sues. Name the most likely disease, re-
trachea mucosa, destructive panbronchitis sulted in described complication?
NARAYAN CHANGDER
and enlarged lungs. Multiple abscesses,
A. Atherosclerosis
hemorrhages and necroses created a mot-
ley appearance of a pulmonal tissue. What B. Hypertension
of the listed diagnoses the most likely? C. Systemic vasculitis
A. Influenza D. Visceral Syphilis E.
B. Parainfluenza
20. How is the thymus effected by age?
C. Respiratory syncytial infection
D. Measles A. The older you get the bigger it gets.
B. The older you get the smaller it gets.
17. A macroscopic investigation of the re-
moved kidney reveled renal swallowing, C. It gets larger during your early years,
congestion and a capsule easily taken then starts getting smaller as you get
out. Renal pelvis and calyxes were di- older.
lated, filled by turbid urine. Their mucosa D. Age has no effects on age
was dim, with the areas of hemorrhages.
The cut surface of a kidney had a mot- 21. An autopsy of a 48-year-old man revealed
ley pattern; yellow-grey zones were sur- the infarct of the left hemisphere of a brain.
rounded by plethora and hemorrhages ar- A macroscopic study also showed a big
eas. To what disease there corresponds septic spleen, immunocomplex glomeru-
such macroscopic picture of kidneys? lonephritis, ulcers in aortal valve leaflets,
A. Acute pyelonephritis covered with polypous thrombi. The lat-
ter ones had colonies of staphilococcuses,
B. Acute glomerulonephritis determined by microscopic study. What
C. Amyloidosis of kidneys disease resulted in cerebral thromboem-
D. Nephrolitiasis bolism?
A. Septic bacterial endocarditis
18. A 42-year-old woman presented with
acyclic, plentiful, uterine bleedings. A his- B. Septicemia
tological investigation of a curettage mate- C. Acute rheumatic valvulitis
rial revealed increased quantity of glands
and their cystic dilation. What is the most D. Septicopyemia
likely diagnosis?
22. cytokines
A. Hyperplasia of endometrium
A. proteins that signal cells to start the
B. Atrophy of endometrium immune response
C. Hypertrophy of endometrium B. resembling or pertaining to lymph tis-
D. Metaplasia sue

C. an agent that kills cells C. Salmonellosis

D. none of above D. Typhoid

23. A 33-year old female died from chronic 26. A histological investigation of a skin
kidney failure. A post-mortem revealed biopsy showed serous-hemorrhagic in-
multiple scars and infarcts in kidneys and flammation and a focus of necrosis. His
spleen. Histological investigation showed medical records revealed the beginning
alteration of small and medium sized ar- of the disease from a small red maculae
teries presented with sclerosis and mild formation with the bubble in the centre,
endothelial proliferation. A severe lym- filled by serous-hemorrhagic liquid. Sub-
phocytes and histiocytes infiltrates were sequently the central part became black.
also recognized at the perivascular tissues. What disease is the most probable?
What is the most likely disease caused A. Carbuncle at a malignant anthrax
these alterations?
B. Actinomycosis of skin
A. Nodular periarteritis
C. Allergic dermatitis
B. Atherosclerosis
D. Streptococcal carbuncle
C. Hypertonic disease
D. Morphine’s Disease 27. -edema
A. swelling; accumulation of fluid in body
24. A 50-year-old man with a history of tu- tissues
berculosis died of a chronic pulmonary
and heart failure. A post-mortem re- B. spark
vealed a lobar lesion of the right lung. C. spleen
The upper lobe of the right lung was en- D. none of above
larged, dense, with fibrinous membranes
on pleura. A gross investigation of a cut 28. A 42 years old female was hospitalized on
surface showed the yellow brittle tissue. the twelfth day of illness. The disease be-
What is the most likely form of secondary gan acutely with chills replaced by feeling
tuberculosis described in that case? of heat, the temperature of 39, 5◦ C, intox-
A. Caseous pneumonia ication. The fever attack lasted 6 hours,
after that the temperature decreased to
B. Fibrous-focal tuberculosis 36, 5◦ C with considerable sweating. At-
C. Infiltrative tuberculosis. tacks of fever repeated every third day.
D. Tuberculoma Objectively:there are herpes rash on the
lips, mild jaundice of scleras and hepa-
25. An autopsy of a 65-year-old man, who tolienal syndrome. Blood test:anemia, leu-
died in week from the beginning of a copenia, lymphocytosis, ESR-19 mm/ h.
profuse diarrhea, revealed severe exico- Which is the most informative method of
sis, dry all tissues and thick, concentrated the diagnosis?
blood. A bacteriological study of contents A. Clinical analysis of blood
of a small bowel, which reminded the rice
broth, determined vibrioes. What disease B. Bacteriologic analysis of urine
resulted in the patient’s death? C. Serological Vidal’s test
A. Cholera D. Smear and thick film of blood
B. Dysentery E. Determination of blood sterility

29. A 48-year-old woman died of renal insuffi- was taken. A histological investigation
ciency. A post-mortem revealed enlarged revealed the aggregates of large, oblong
flaccid kidneys with wide, swallowed, dim form cells with light nuclei, rich with a cy-
cortical layer. A yellow-grey with red toplasm. The nuclei were located on pe-
specks cortex was delimited from dark riphery in the form of a horseshoe. The
red cerebral substance. Microscopic inves- described histological changes are charac-
tigation showed a proliferation of Bow- teristic for:
man’s capsule epithelial cells, podocytes A. Tuberculosis
and macrophages, resulted in crescents
NARAYAN CHANGDER
formation. For what disease described B. Leprosy
changes are characteristic? C. Syphilis
A. Subacute glomerulonephritis. D. Rhinoscleroma
B. Acute glomerulonephritis. 33. A 42-year-old woman presented with the
C. Chronic glomerulonephritis obesity, chiefly of the trunk and face,
D. Acute pyelonephritis steroid diabetes, an arterial hypertension
and secondary dysfunction of ovaries. An
30. The combination of weight loss, sweat- autopsy. revealed a hypertrichosis, a hir-
ing, recurrent aphthous stomatitis, herpes sutism, strias on a skin of hips and a ab-
zoster and lymphadenopathy allowed doc- domen. In the anterior lobe of the pitu-
tors to suppose HIV infection in patient. itary gland a tumour was found. Histo-
What can be found at extensive survey: logical investigation showed the basophilic
A. Shift of neutrophils to the left adenoma of the pituitary and hyperplasia
of a fascicular layer in adrenals. What of
B. Decreased ratio of T4-T8 lymphocytes the listed diagnoses is the most likely?
C. Increased ratio of T4-T8 lymphocytes A. Itsenko-Cushing disease
D. Hypereosinophilia B. Itsenko-Cushing syndrome
E. Lymphomonocytosis C. Simtnonds’ disease
31. An autopsy of a 63-year-old man revealed D. Adiposogenital dystrophy
in the second segment of the right lung a
tubercular panbronchitis, with the focus of 34. If you were looking for the Peyer’s patch,
a caseous bronchopneumonia. The focus you’d probably find it the
was surrounded by a wall of epithelioid A. Colon
cells with some lymphocytes and few gi- B. Garden
ant Pirogov-Langhans cells. What form of
a pulmonary tuberculosis presented in this C. Small intestine
case? D. Large intestine
A. Acute pulmonary tuberculosis E. Liver
B. Primary tuberculous complex 35. A 9-month-old child presented with re-
C. Growth of primary affect tarded dentition, the teething order distur-
D. Acute miliary tuberculosis bance, a reconfiguration of the upper jaw
in a horizontal direction (dolichouranic).
32. A 42-year-old patient complained of a Microscopical investigation of his teeth
voice timbre change. The larynx biopsy revealed the irregular mineralization of

the enamel and crumpled enamel prisms. neck soft tissues determined. Histologi-
Some of them were rich with vacuoles. cal investigation showed the necrosis of
There were also expansion of a predentin an epithelium of tonsils and the palatine

zone and a presence of solitary denticles. arch. Tissues underneath were infiltrated
What is the most likely disease in that by a fibrinous exudate, which formed mas-
case? sive stratifications on a surface. What is
A. Rachitis, early stage the most likely diagnosis?
B. Rachitis, late stage A. Diphtheria

C. Osteomalacia B. Scarlet fever
D. A gout C. Adenoviral infection
36. Something that works to prevent is called D. Infectious mononucleosis
39. A post-mortem of a 40-year-old patient

A. prophylactic revealed a pneumocystosis carinii pneu-
B. placebo monia, Kaposi’s sarcoma and B-cell lym-
phoma. Medical records suggested that
C. medication
he actively practiced unsafe sexual inter-
D. corticosteroids course with multiple partners at his life.
What is the most likely diagnosis?
37. The worker of a stockbreeding farm pre-
sented to the hospital with acute dis- A. A human immunodeficiency virus infec-
ease and died soon of intoxication. An tion, AIDS’Stage
autopsy revealed the enlarged, flaccid B. A human immunodeficiency virus infec-
spleen, which had a dark-cherry colour- tion, pre-AIDS stage
ing of its cut surface. The scrape of the
spleen’s pulp was plentiful. Arachnoids of C. A secondary immunodeficiency as a re-
the brain’s fornix and base were edema- sult of primary B-cell lymphoma
tous, impregnated by blood, had a dark D. A secondary immunodeficiency as a re-
red colouring (”cardinal’s hat”). Micro- sult of Kaposi’s sarcoma
scopical investigation found the serous-
hemerrhagic inflammation of brain’s mem- 40. An autopsy of a female, with a history of
branes and tissues with destruction of fine a rheumatic disease with a mitral steno-
vessels walls. Diagnose a disease. sis, resulted in decompensation stage, re-
A. Anthrax vealed a general venous plethora, small,
firm and micronodular liver. Gross inves-
B. Brucellosis
tigation of a cut surface showed a lobu-
C. Plague lar structure and yellowish-brown color of
D. Cholera hepatic tissue. Define the most probable
pathology diagnosed in a liver
38. A young 19-year-old man, with an acute
A. Portal cirrhosis
onset of disease, died of an infectious-
toxic shock. An autopsy revealed the en- B. Fatty dystrophy
larged tonsils, covered with grey-white
C. Billiary cirrhosis
membranes, which extended on the pala-
tine arch. In addition, an edema of the D. Atrophy

41. A post-mortem of a patient, who died of 44. A 63-years-old patient, with a history
diffuse fibropurulent peritonitis, revealed of hypertensive disease, died from car-
in the wall of a small bowel multiple oval diac insufficiency. At autopsy, the heart
ulcers with rounded edges, which were enlargement and dilated ventricular cavi-
parallel to the longitudinal axis of the in- ties were revealed. Microscopical inves-
testine. A base of the ulcers presented tigation showed marked hypertrophy of
either by muscular layer of ileum or its cardiomyocytes, with their fatty dystro-
serosa. Two ulcers had perforation aper- phy and hyperchrotnic barrel-like nucle-
tures 0, 3cm in diameter each. Define a uses. What pathological process is the
NARAYAN CHANGDER
typhoid stage. most likely in a heart?
A. Stage of pure ulcers A. Eccentric hypertrophy
B. Stage of “dirty ulcers” formation B. Myocarditis
C. Necrotic stage C. Concentric hypertrophy
D. Stage of a medullar swelling D. Angiogenic cardiosclerosis

45. The tiny oval shaped lymph structure lo-
42. A post-mortem of a 58-year-old patient cated throughout the body are known as?
revealed plural pathological cavities in
both lungs. Microscopical study showed A. Lymph nodes
the inner layer of one cavity presented B. Spleen
with necrotic masses and diffuse neu- C. Lymph fluid
trophil infiltration; the middle one con-
tained an infiltrate of epithelioid cells, lym- D. none of above
phocytes and multinuclear giant cells. The 46. A child presented with acute a catarrhal
external layer consisted of a mature con- nasopharyngitis. In 2 days he died. An au-
nective tissue. Diagnose the form of sec- topsy revealed arachnoids were markedly
ondary tuberculosis. hyperemic, edematous, infiltrated with
A. Fibrocavernous tuberculosis turbid, thick, yellowish-greenish liquid.
A brain was swelled, cerebellum tonsils
B. Acute inflammatory
were enlarged in volume, and sulcus of the
C. Fibre-inflammatory cerebrum impaction was well defined. The
D. Acute cavernous described changes are the most typical for:
A. Meningococcal infection
43. A histological investigation of a thyroid B. Influenza
gland, presented to pathology, revealed a
mild atrophy of a parenchyma, sclerosis, C. Whooping cough
diffusive infiltration of a stroma by lym- D. Diphtheria
phocytes and plasmocytes with formation
of lymphoid follicles. What is the most 47. An autopsy of a 74-year-old man revealed
likely diagnose? the enlargement and deformation of the
right knee joint. A histological investi-
A. Autoimmune thyroiditis gation determined the massive foci of a
B. Parenchymatous goiter caseous necrosis, surrounded by periph-
eral mantle of epithelioid, lymphoid cells
C. Toxic goiter
and some multinucleated giant cells.What
D. Thyroiditis is the most likely disease?

A. Tuberculous arthritis 51. The girl within last 3 months ate the crude
B. Syphilitic arthritis cow milk. She arrived in the hospital
with the “acute abdomen” symptoms. An

C. Rheumatic arthritis operation revealed in a caecum a circu-
D. Gonorrheal arthritis lar ulcer with perforation. A histologi-
cal study of the ulcer edges’ determined
48. A 48-year-old male, with a long history necrotic masses, lymphocytes, epithelioid
of living in the mountain district of Cen- cells, and few multinucleated giant cells
tral Asia, presented with a thyroid gland What is your diagnosis?
enlargement, resulted in complicated swal-
lowing. A physical investigation revealed A. Primary intestinal affect at tuberculo-
an increasing of a body mass, slowness, sis
drowsiness, and puffy face. A microscopic B. Nonspecific ulcerous colitis
study of a thyroid gland showed irregular
C. Amebiasis
follicles with a hypochromic colloid. What
of diagnoses is the most probable? D. Carcinoma of blind gut (cecum)
A. Endemic goiter.
52. Which blood cells does human immunodefi-
B. Basedow’s goiter. ciency virus have the most tropism to?
C. Hashimoto’s thyreoiditis. A. Erythrocytes
D. Sporadic goiter. B. T-suppressor
49. A 24 years old female visited a doctor C. T-killer
in connection with long-term fever, night D. Platelets
sweating. She has lost 7 kg for the
past three months. There was indiscrim- E. T-helper
inate sex. Objectively:all groups of lymph
53. An autopsy of a 44-year-old female re-
nodes are enlarged, hepatolienal syn-
vealed a substantial enlargement of a right
drome is presented. In blood:leucocytes-
kidney reminding grape clusters. The cut
2, 2*109/L. What disease should be sus-
surface showed cavities varying in size
pected?
from 0, 5 to 3 cm in diameter, which were
A. Lymphogranulomatosis filled by serous liquid and colloid masses.
B. HIV Kidney parenchyma between cavities was
thinned to 0, 1 cm. What is the most likely
C. Tuberculosis
diagnosis?
D. Infectious mononucleosis
A. Renal cystic disease
E. Chronic sepsis
B. Chronic pyelonephritis
50. What generates “memory” lympho-
C. Acute pyelonephritis
cytes?
D. Nephrolithiasis
A. Thymus
B. Heart 54. Histological investigation of a kidney
C. Spleen biopsy showed sclerosis, lymphocyte-
plasmocyte infiltration of the renal pelvis
D. Liver walls and calyces; tubules dystrophy and
E. Peyer’s patch atrophy. The intact tubules were dilated,

stretched by colloid-like masses. The ep- a dead body revealed her fingers reminded
ithelium was flattened. In whole, the mi- drum sticks. A dissection of lugs showed a
croscopic picture of tissue sample had ‘a bronchial alteration with a saccular defor-
thyroid kidney’ pattern. What diagnosis mity and purulent inflammation. What is
is most probable? the most likely diagnosis?
A. Chronic pyelonephritis A. Bronchiectatic disease
B. Sharp pyelonephritis B. Tuberculosis
NARAYAN CHANGDER
C. Glomerulonephritis C. Chronic bronchitis
D. Nephrosclerosis D. Abscess
55. An autopsy of a 53-year-old man revealed
59. The test for HIV-AIDS Is:
few 4-5cm ulcers. The margins were
elevated above the mucosa. The walls A. ELISA
of ulcers were covered by the yellowish- B. PCP
grayish crumble masses. The Widal test
was positive. Diagnose a disease? C. KS
A. Typhoid D. SMAC
B. Paratyphoid 60. A post-mortem of a patient, with a his-
C. Recurrent typhus tory of a drug abuse, revealed red-purple
D. Dysentery papular nodules and blotches on the skin
of his lower extremities (Kaposi’s sar-
56. Cervical nodes are located ? coma). In addition, acute pneumocysto-
sis carinii pneumonia was also determined.
A. Near the neck
For what disease the given symptoms are
B. In the throat area characteristic?
C. In the groin A. AIDS
D. In the Arm pits B. Influenza
57. A histological investigation of the removed C. Measles
stomach ulcer revealed in its floor the fib-
D. Diphtheria
rinopurulent exudate, a zone of the fib-
rinoid necrosis, a granulation tissue with 61. A 64-year-old patient died of a cachexia.
a fibrous tissue underneath. What is the A post-mortem revealed an adenoma of
most likely diagnosis? parathyroid glands, bones deformation of
A. Chronic ulcer extremities, a vertebral column, and ribs.
B. Acute ulcer Bones were soft, with slight porousness
and easily deformed or cat. What of the
C. Acute erosion listed diagnoses is the most likely?
D. Phlegmon of stomach A. Parathyroid osteodystrophy
58. A female patient, with 10 years history B. Osteoporosis
of cough with a purulent sputum and dys-
C. Chondrodysplasia
pnea, died from respiratory and heart fail-
ure. A post-mortem gross investigation of D. Osteomyelitis

62. A 44-year-old woman presents to her 65. At autopsy of 63-year-old male revealed
physician ulnar deviation of the hands an atherosclerosis of the brain’s arter-
and flexion-hypertension (’swan neck” or ies and a thrombosis of the internal

“walrus flipper”) deformities of the fin- carotid artery’s branch. Gross investiga-
gers. Her metacarpal phalangeal joints are tion showed a focus of moist softening in
easily exposed to a dislocation and a sub- his brain’s tissue. Define the pathological
luxation. Microscopical examination re- process in the brain.
vealed nodular proliferations of synovium,
A. Ischemic infarction
cartilage destruction and “pannus” forma-
tion. What is the most likely diagnosis? B. Hemorrhagic infiltration
A. Rheumatoid arthritis C. Hematoma
B. Rheumatic arthritis
D. Encephalitis
C. Osteoarthritis.
D. Lupus erythematosus 66. A young woman presented to the hospi-
tal with an acute pain. Her uterine tube
63. A child presented to a hospital with an
was removed at gynecology department.
acute fever, sore throat and swelling
Macroscopic investigation of a tube re-
of submaxillary (submandibular) lymph
vealed its local dilation at the middle third
nodes. A gross investigation of fauces
and blood clots accumulations within the
revealed the edematous and slightly hy-
lumen. A histological research showed
peremic mucous membrane, enlarged ton-
chorion villi, surrounded by areas of ery-
sils, covered by the grayish-whitish mem-
throcytes with some leucocytes. What is
branes. They left a raw surface, when
forcibly removed. What is the most likely
diagnosis? A. Tubal pregnancy
A. Diphtheria B. Acute purulent salpingitis
B. Catarrhal angina
C. Hemorrhage in tube of the uteri
C. Scarlet fever
D. Hemorrhagic salpingitis
D. Meningococcal infection
64. A 55-year-old woman died from uraemia. 67. A lungs roentgenograrn investigation re-
A post-mortem revealed a parathyroid vealed a dark patch. During a diagnos-
gland adenoma, bones deformation of ex- tic express biopsy of a lymph node of
tremities, a vertebral column, and ribs. a bronchus was removed. A histological
Bones were soft, with slight porousness. study showed a caseous tissue necrosis,
On a cut they had a motley pattern with round which lied epithelioid and lymphoid
multiple cysts. Histological investigation layers with few multinuclear large cells
revealed marked bone remodelling and la- (Langhans’ cells). Specify the cause of the
cunar resorption of osteoid and fibrous tis- lymphadenitis.
sues. What is the most likely diagnosis?
A. Tuberculosis
A. Parathyroid osteodystrophy.
B. Syphilis
B. Chronic osteomyelitis
C. Osteoporosis C. Pneumonia
D. Fibrous dysplasia D. Metastases of cancer

68. The capillaries, vessels and ducts that re- C. Secondary-restricted kidney
turn lymph from tissues to venous tissues. D. Chronic pyelonephritis
A. lymphangi/o
72. A 53-year old male, with a history of
B. lymph/o the chronic diffusive bronchitis, presented
C. lymphaden/o to the hospital symptoms of cardiopul-
monary insufficiency, then resulted in the
D. splen/o
lethal outcome of the disease. An au-
69. Microscopic study determined edema, dif- topsy revealed increased volume and hy-
NARAYAN CHANGDER
fusive leukocyte infiltration of appendix perinflation of lungs, which covered a me-
wall and also a mucosa! lesion with alter- diastinum with their edges and keep their
ation of its muscular layer. What is the form when removed from the body and
most likely diagnose? put at autopsy table. Gross investigation
showed a pale grey colour of lungs and a
A. Flegmonous-ulcerative appendicitis
crunch sound while making an incision of
B. Suppurative appendicitis a pulmonal tissue. A pressing a finger on
C. Gangrenous appendicitis a lungs tissue creates a fossa. A mucop-
urulent exudate was determined within
D. Superficial appendicitis
bronchi’s lumen. What is the most likely
70. At autopsy of 52-year-old male revealed diagnosis?
yellowish areas at his aorta’s intima, this A. Chronic diffuse obstructive emphy-
did not bulge above its surface. Histologi- sema
cal investigation showed the accumulation
B. Chronic focal emphysema
of cells with foamy cytoplasm, stained by
Sudan III in yellow color. Name the most C. Intestinal emphysema
likely stage of atherosclerosis in aorta? D. Primary idiopathic. emphysema
A. Lipidosis 73. A 9-year-old boy presented with painless,
B. Atheromatosis firm 1-2 mm nodules at the skin around ul-
C. Pre-lipoidosis nar and knee joints (at extensor’s area).
Biopsy investigation revealed a central
D. Liposclerosis area of fibrinoid necrosis of the connec-
71. A 65-year-old male long time was ill by hy- tive tissue surrounded by lymphocytes and
pertensive disease and died from chronic macrophages. What disease these nodules
kidney insufficiency. The autopsy showed, are characteristic for?
that both kidneys are considerably de- A. Rheumatism.
crease in sizes, their surfaces are gran- B. Rheumatoid arthritis.
ulated; histologically-most glomeruluses
C. Systemic scleroderma.
are containing hyaline, part of them in
sclerotic condition, other in hyperplasia; D. Lupus erythematosus.
in stroma-the fields of sclerosis, arteriolo-
74. Which disease is infectious?
and arteriosclerosis, elastofibrosis of
large kidney arteries branches. What is A. Lymphoma
the name of the exposed changes? B. Lymphadenopathy
A. Arteriolosclerotic nephrosclerosis C. Both
B. Atherosclerotic nephrosclerosis D. Neither

75. Which of the following is a thin watery 79. Histological investigations of the bronchus
fluid, composed of intercellular fluid? wall biopsy material, from the patient
with a history of chronic bronchitis, re-

A. Lymph
vealed granulation tissue and diffuse in-
B. Lymph capillaries flammatory infiltrate. What kind of a
C. Lymph vessels bronchitis was diagnosed?
A. Chronic polypous bronchitis
D. Lymph nodes
B. Chronic mucopurulent bronchitis
76. An autopsy of the man revealed a bronze C. Chronic mucous bronchitis
coloring of a skin and mucosa of an oral
cavity. In addition, caseous masses were D. Chronic purulent bronchitis
defined in adrenals. What is the most 80. immunity is the main defense against
likely disease in that case? bacterial antigens where by antibodies are
A. Addison’s disease produced.
B. Itsenko-Cushing syndrome A. humoral
B. cell-mediated
C. Basedow’s disease
C. acquired
D. Acromegaly
D. active
77. A 68-year old patient, with a history of
81. A post-mortem of a patient, who died of a
the chronic inflammatory disease of lungs
HIV-infection, revealed alterations of his
since his childhood, presented to the hospi-
brain. A histological investigation deter-
tal with coughing accompanied by scanty
mined in subcortical white matter, mid-
sputum (expectoration). The complica-
brain and a brain stem fine, perivascular
tions of pulmonary and a heart failure re-
necroses, microglial nodules with multinu-
sulted in his death. What changes in heart
clear giant cells, focal gliosis and fibrosis.
have been found at post-mortem?
Name the most likely lesion of the central
A. Right ventricular hypertrophy and di- nervous system?
latation A. Subacute meningocephalitis
B. Left ventricular hypertrophy and dilata- B. Metabolic encephalopathy
tion
C. Cytomegaloviral encephalitis
C. Ventricular hypertrophy
D. Primary lymphoma of CNS
D. Ventricular dilatation
82. A man died of liver cirrhosis. An autopsy
78. lymphoid tissue revealed in the 1-2 segment of the right
lung three grey-yellow, dense foci, 1-1,
A. resembling or pertaining to lymph tis- 5? ? in diameter with a dim surface. A
sue histological research showed the tubercu-
B. proteins that signal cells to start the lar endobronchitis, foci of a caseous bron-
immune response chopneumonia, surrounded with a wall of
epithelioid, lymphoid and giant Pirogov-
C. fluid placed between the tissue spaces
Langhans cells. For what form of a tuber-
culosis the described changes are charac-
D. none of above teristic?

A. Acute focal tuberculosis was diagnosed in his heart. What is the

B. Infiltrative tuberculosis most likely disease?
C. Fibrous-focal tuberculosis A. Epidemic typhus

B. Q fever
D. Caseous pneumonia
C. Typhoid fever
83. A child presented with diphtheria and died
D. Periarteritis nodosa
on the 2nd week of the disease from an
acute heart failure. A post-mortem re- 86. . An autopsy of a 44-year-old man re-
NARAYAN CHANGDER
vealed numerous fine centres of a myoly- vealed tuberculosis. A macroscopical in-
sis, accompanied with some perifocal lym- vestigation showed in the apex of the
phoid infiltration. What became a cause of right lung the foci of caseous pneumo-
death? nia. There were caseous lymphadenitis
A. Myocarditis, caused by bacterial ecto- of enlarged lymph nodes of mediastinum
toxin and plural milium nodules in many organs.
Name the described form of tuberculosis
B. Bacterial myocarditis
A. Primary with mixed form of progress-
C. Septic myocarditis ing
D. Myocardial infarction B. Primary with gematogenic spreading
84. A patient developed substemal pains in the C. Primary with lymphogenic spreading
7 o’clock in the morning. He presented at D. Primary with growth of a primary af-
the Emergency Department in 8 o’clock in fect
the morning, where electrocardiograph in-
vestigation revealed a myocardial infarc- 87. A 45-years-old male presented to the hos-
tion. Ten minutes later he died. What most pital with gradual enlargement of feet,
reliable morphological sign of myocardium right hand, nose and lips. The adenoma
infarction would be found at histological of a pituitary body was diagnosed. What
investigation after the autopsy? is the most likely disease?
A. Disappearance of glycogen in myocar- A. Acromegaly
dial cells B. Nanism
B. Vacuolar dystrophy of myocardial cells C. Basedow’s disease
C. Fatty infiltration of myocardial cells D. Addison’s disease
D. Necrosis of myocardial cells 88. The thumus is located ?
85. patient died as a result of a heart A. Near the neck
failure. Macroscopically traces of a B. In the throat area
preexisted rash in the form of mac- C. In the groin
ulae and spots were recognized. A
D. In the Arm pits
gross investigation revealed decubituses
at the areas of breeches and spinous pro- E. None of the above
cesses of vertebra. Microscopical study
89. Which of the following is/are mucosa-
showed a destructive-proliferative endo-
associated lymphatic tissue?
trombovasculitis and Popov’s granulomas
in the central nervous system, in a skin, A. Appendix
and adrenals. An interstitial myocarditis B. Peyer’s Patch

C. Tonsil A. definition of lymphoma

D. Thymus B. definition of lymphedema

E. Liver C. definition of lymphadenitis
90. A 24-year-old man presented with en- D. none of above

larged cervical lymphatic node. A 94. In which condition does the body turn
histological investigation revealed the against itself and mistakenly attack nor-
growth of epithelioid, lymphoid cells and mal cells?
macrophages with nuclei in the form of
a horseshoe. In some centers the ag- A. autoimmune disease
gregates of unstructured light pink color B. allergy
masses with nuclei fragments were deter-
C. Hodgkin’s disease
mined. For what disease the described
changes are characteristic? D. cardiovascular disease
A. Tuberculosis 95. Which organ stores blood platelets?
B. Lymphogranulomatosis (Hodgkin’s dis- A. Stomach
ease)
B. Spleen
C. Actinomycosis
C. Lymph Node
D. Metastasis of tumor
D. Thoracic Duct
91. A man died of renal insufficiency. A post-
mortem revealed enlarged flaccid kidneys 96. A child died of a diffuse peritonitis. An
with wide, yellow-grey with red specks autopsy revealed the primary intestinal
cortex. Microscopic investigation showed tubercular complex with primary affect,
a proliferation of Bowman’s capsule ep- a lymphangitis and regional caseous lym-
ithelial cells, resulted in crescents forma- phadenitis. In addition, an ulcer of
tion. Capillary loops exhibited necrotic al- an empty intestine with perforation was
terations and fibrin thrombi within their lu- found within the primary affect focus.
mens. What is the most likely diagnosis? What is the most likely way of tubercu-
losis infection in presented case?
A. Subacute glomerulonephritis
A. Alimentary (nutritional)
B. Acute glomerulonephritis
B. Transplacental
C. Lipoid nephrosis
C. Aero genie
D. Chronic glomerulonephritis
D. Mixed
92. What is the purpose of antibodies?
97. A 32-year-old female with a long history
A. To pump lymph through the vessels of rheumatic valve’s defect presented at
B. To create lymph the hospital with tachypnea and dyspnea,
C. To fight infection leg’s edema, ascites and hepatomegaly.
She died from the chronic heart insuffi-
D. To remove old red blood cells ciency. An autopsy revealed a mitral
93. abnormal collection of lymph fluid in ex- stenosis. What was the most likely factor
tremities, swelling can also extend to the of the mitral stenosis morphogenesis?
fingers and toes A. Leaves union between itself

B. Sclerosis and bulge of leaves A. Cytomegalovirus

C. Sclerosis and shortening of leaves B. Pneumocystis carinii
D. Shortening of tendon filaments C. Atypical mycobacterium
D. Herpes-virus
98. The lymph glands in the armpits are:
A. inguinal 102. At the patient with suspicion on a sys-
temic disease a biopsy from a site of the
B. axillary skin tightening and restricted motility was
NARAYAN CHANGDER
C. cervical taken. A histology investigation revealed
D. thoracic all kinds of disorganization of connective
tissue fibers with mild cellular reaction and
99. Of the two collecting ducts in your lym- also transition in excessive sclerosis and a
phatic system, which one drains more hyalinosis. What is the most likely diag-
lymph? nosis?
A. left lymphatic duct A. Scieroderma
B. right cervical duct B. Nodular periarteritis
C. thoracic duct C. Lupus erythematosus
D. right lymphatic duct D. Psoriasis
100. The man had sexual contact 2 days ago 103. A post-mortem of a 43-year-old man re-
with turned out later HIV infected partner vealed in the 3 segment of the right lung
appealed with a request to eliminate prob- under the pleura an area of consolidation,
ability of infection. When the first inves- 1, 5 cm in diameter, with the accurate bor-
tigation on antibodies against HIV should ders, surrounded with a whitish fibrous
be done? tissue. A gross investigation of a cut sec-
tion showed the white-yellow crumbling
A. In 3 months foci. Presence of the described focus is
B. In the day of appeal characteristic for:
C. In 1 month after sexual contact A. Encapsulation of primary affect
D. In 6 months B. Peripheral carcinoma
E. In 1, 5 years C. Chondroma
D. Fibroma
101. A 35-year-old narcomaniac (drug abuser)
with a history of HTV-infection died at 104. The patient treated for a cold by the
the hospital. A post-mortem revealed big doses of paracetamol, presented symp-
that both lungs were dense, dark-red-grey toms of an oliguria and a/otemia. In
color, with little air. Histological study 5 days he died of an acute renal in-
showed that interalveolar septs were infil- sufficiency. Histological investigation of
trated by lymphocytes. Some alveolocytes kidneys revealed the diffusive edema of
were transformed to the big cells, with a an interstitial tissue of a kidneys cor-
centrally located round nucleus with a light tex, its infiltration by lymphocytes, the
rim of cytoplasm (”an owl’s eye”). What eosinophils, some neutrophils. Almost in-
opportunistic infection caused pneumonia tact glomerules were found along with a
in that case? destruction of a tubular epithelium. Name

the most probable type of a kidneys le- large, up to 2 cm in diameter, thrombuses

sion? attached to tissues underneath. What is

A. Tubulointerstitial nephritis
B. Acute glomerulonephritis A. Polypous-ulcerative endocarditis
C. Nephrotic syndrome B. Acute warty endocarditis
D. Pyelonephritis C. Recurrent warty endocarditis

D. Diffuse endocarditis
105. A 48-year-old butcher died of a sepsis.
A gross investigation of his right cheek 108. An autopsy of a 49-year-old patient,
revealed a dense, dark red, 6 cm in di- who died from lungs edema, revealed in
ameter, corn-shape infiltrate with a black myocardium a yellow-grey, large focus
crust in its centre. The right half of his and a fresh blood clot in a coronal artery.
face and neck were edematous and solid. What is the most likely diagnosis?
A microscopical investigation of a lesion
showed the peracute serous-hemorrhagic A. Myocardium infarction
inflammation with epidermal and adjacent B. Myocarditis
tissue necrosis within the central zone of C. Amyloidosis
an infiltrate. What is the most likely diag-
nosis? D. Cardiomyopathy
A. Anthrax 109. A 56 years old patient has moderate
B. Plague icterus of skin and scleras, enlargement
of liver and spleen. 3 years ago he was
C. Tularemia
treated for hepatitis B. The examination
D. Phlegmon of a neck detected:HBsAg, HBeAg (+), the high con-
centration of HBV DNA. Which drug is the
106. A 52-year old female, with a history of most suitable for basic treatment of the ill-
the chronic glomerulonephritis and chronic ness?
renal failure, presented to the hospital
with coughing spells accompanied by thick A. Vitogepat
phlegm and breathlessness. Bronchoscopy B. Essentiale forte
revealed congested, edematous, bronchial
mucus membrane wim small hemorrhages. C. Alpha-interferon
A bronchial lumen was narrowed by thick D. Carsil
mucus. Name the process in bronchi?
E. Prednisolone
A. Secondary acute catarrhal bronchitis
110. A 10-year-old girl arrived in traumato-
B. Primary acute catarrhal bronchitis
logical unit with symptoms of pathological
C. Chronic catarrhal bronchitis fracture of the right femur. A histologi-
D. Destructive-ulcerous bronchitis cal investigation of an operational mate-
rial revealed in a bone marrow of a femur
107. A 48-year-old patient with a history of fragment, a plural foci of a caseous necro-
croupous pneumonia died of the pulmonary sis with peripheral mantle of epithelioid
and heart failure. A post-mortem revealed cells, lymphocytes and solitary Pirogov-
a hyperplasia of a spleen, a thickening and Langhans’ giant cells. Zones of a caseous
defects of the aortal valve leaflet with necrosis extended on adjoining sites of a

bone tissue, resulting in osseous destruc- 114. A post-mortem of 40-year old female
tion. What is the most likely disease? who died from uremia revealed enlarged
A. Tuberculous osteomyelitis kidneys, which had a patchy pattern of
their surface. Histological investigation
B. Tuberculous spondylitis of kidneys showed eosinophilic deposits
C. Tuberculous koxitis (hematoxylin bodies), “wire loop” lesions
D. General(common) macrofocal tubercu- in the basement membrane of the glomeru-
losis lar tuft, hyaline thrombi and foci of fib-
rinoid necrosis. Besides these, Libman-
NARAYAN CHANGDER
111. An autopsy of the patient who died of a Sacks endorcarditis was also determined.
plague revealed a hemorrhagic syndrome, What is the most likely pathology in kid-
accompanied with the hemorrhagic necro- neys?
sis of a hip skin, a lymphangitis and an in-
A. Lupus erythematosus nephritis.
guinal hemorrhagic lymphadenitis. Name
the plague form. B. Rheumatoid glomerulonephritis.
A. Dermo-bubonic C. Choleric glomerulonephritis.
B. Bubonic D. Sclerotic kidney
C. Primary septic 115. A 21 years old patient without per-
D. Primary pulmonic manent residence complains on diarrhea
for 2 months, 13 kg weight loss, weak-
112. What “happens” in the lymph nodes?
ness, constant subfebrile temperature, re-
A. Excess glucose in the lymph is stored current herpes. There is herpes rash
in the liver on the lips, generalized lymphadenopa-
B. Carbon dioxide is removed from the thy, enlargement of the liver to 2
lymph and passed to the lungs for exha- cm. In blood:erythrocytes-4, 4, Hb-
lation 115, ESR-15 mm/hour, leucocytes-10, 0,
eosinophiles-2 %, bands-6 %, segm.-n.-
C. Lymph is oxgenated and pumped
61 %, lymphocytes-17 %, monocytes-3
through the body
%, atypical mononuclear cells-6 %. What
D. Lymph is cleaned of foreign antigens is the most probable diagnosis?
and debris
A. Protracted dysentery
113. An autopsy of 11-year-old child revealed B. AIDS
plural hemorrhages, mainly in skin of
breeches and lower extremities, serous C. Infectious mononucleosis
and mucosas, and also in a brain. Gross D. Lymphogranulomatosis
investigation determined a focal necro-
E. Amoebiasis
sis and massive hemorrhages in adrenals,
a necrotic nephrosis in kidneys, a puru- 116. The functions of the lymphatic and im-
lent arthritis, an iridocyclitis and vasculitis. mune system are:
Choose the correct diagnosis.
A. collect excess fluid and brings it back
A. Meningococcemia to the heart
B. Epidemic typhus B. defense against pathogens
C. Periarteritis nodosa C. transports fats absorbed by the small
D. Systemic lupus erythematosus intestine

D. all of these are functions 120. A histological investigation of curettage

of the cervical canal of the uteri revealed
117. A medical record of a dead child reveled a prismatic epithelium and a significant

meningeal symptoms in his medical history. amount of gland-like structures. They de-
His X-ray showed a dark patch in the III veloped from the prismatic epithelium cam-
segment of the right lung and enlarged rad- bial elements, originated from the neck of
ical lymph nodes. At autopsy, in cerebral a uterus. What is the most likely diag-
arachnoids, the millet grains-like nodules nose?
were found. Microscopical study of a nod-
ule determined a focus of a caseous necro- A. Proliferative endocervicosis
sis with wall of epithelioid, lymphoid cells B. Simple endocervicosis
with giant cells between them. These gi-
ant cells had big nuclei, situated on periph- C. Endocervicosis, stage of healing
ery in the form of a half moon. What is D. Cervical adenomatosis
the most likely kind of meningitis?
121. If you were looking for the Lymph capil-
A. Tuberculous
laries, you’d most likely find them in the
B. Syphilitic
C. Brucellous A. Digestive system
D. Influenza
B. CNS
118. An autopsy of an 8-year-old child re- C. Bones and teeth
vealed in his colon multiple irregular form
and various depth defects with uneven D. bone marrow
edges. In addition, there were grey-white
122. Which type of cells make antibodies?
membranes intimately connected with tis-
sues underneath. What is the most likely A. A cells
diagnosis? B. B cells
A. Dysentery
C. M cells
B. Salmonellosis
D. T cells
C. Typhoid
D. Amebiasis 123. The thymus is a lymphoid organ that di-
rectly fights antigens.
119. An 8-year-old child presented with raised
A. True
body temperature up to 39◦ C, rhinitis,
conjunctivitis, and cough. A physical in- B. False
vestigation revealed blotchy skin rash and C. Neither above
whitish rashes on a buccal mucosa. Sud-
denly appeared pant resulted in asphyxia, D. none of above
followed by patient death. What is the
most likely diagnosis? 124. Two main organs of the lymph system:
A. Measles A. Thymus & Pancreas

B. Scarlet fever B. Pancreas & Thyroid
C. Diphtheria C. Spleen & Thymus
D. Meningococcal nasopharyngitis D. Tonsils & Thyroid

125. Removal of old or defective blood cells A. Amyloid-contracted kidneys

from the blood is done by the B. Contracted kidney
A. Stomach C. Arteriolosclerotic kidney
B. Liver D. Pielonephritic contracted kidneys
C. Spleen
129. A histological investigation of a my-
D. Lymph Nodes ocardium revealed fatty dystrophy and
126. immunodeficiency plural necroses of cardiomyocytes, few fo-
NARAYAN CHANGDER
cal cellular interstitial infiltrates. A med-
A. inadequate immune response
ical record showed that a child had diph-
B. proteins that can attach to foreign theria, resulted in the heart failure. What
cells, labeling them for destruction kind of myocarditis is the most likely?
C. accumulation of fluid in body tissues A. Alterative myocarditis
due to obstruction of lymphatic structures
B. Diffusive exudative myocarditis
C. Focal exudative myocarditis
D. none of above
D. Intersticial myocarditis
127. A child presented to the clinic with paral-
ysis of a phrenic nerve and dysphagia, re- 130. A removed appendix delivered to pathol-
sulted in his death soon. An autopsy re- ogy department. Macroscopic investiga-
vealed ulcers of tonsils with a cuticulariza- tion revealed its thickening, enlargement,
tion, a hemorrhage in adrenals, and flac- dull and hyperemic serous membrane. A
cidity of a myocardium. Specify disease yellowish-green liquid lumen was visible
for which the described changes and com- on a cut section within its lumen. What is
plications are characteristic the most likely type of the appendicitis?
A. Diphtheria A. Suppurative appendicitis
B. Scarlet fever B. Catarrhal appendicitis
C. Agranulocytosis C. Superficial appendicitis.
D. Measles D. Gangrenous appendicitis
128. A patient with a history of fibrous- 131. A gastroscopy of a 44-year old patient,
cavernous tuberculosis died of a renal fail- with a history of a pain in epigastrium
ure. A post-mortem revealed a urine smell, after meal, revealed a hyperemia of the
left ventricle hypertrophy, fibrinous peri- stomach mucosa with the stomach folds
carditis, and fibrinous-hemorrhagic entero- reduction. Histological study showed a
colitis. Kidneys were small, reduced in thinning of the mucosa, a reduction of
sizes, dense, with plural foci of shrink- the glands quantity accompanied with the
age. Histological investigation of the growth of a connecting tissue, lympho-
slides with Congo-Red staining showed cytes and plasmocytes infiltration. Spec-
pink masses within glomuleruli and ves- ify, what of the listed diagnoses is the
sels walls. In addition, destruction and an most probable?
atrophy of the majority of nephrons, ac- A. Chronic atrophic gastritis.
companied with a nephrosclerosis were de-
termined. What is the most likely pathol- B. Acute catarrhal gastritis.
ogy of kidneys? C. Acute suppurative gastritis.

D. Chronic superficial gastritis 137. A child died of a spontaneous pheumoth-

orax. A post-mortem revealed a collapse
132. The combining form that means lymph and interstitial emphysema of the right

node is: lung, focal atelectases of lungs, a punctual
A. lymph/o hemorrhage in a brain and a conjunctiva of
eyes. What is the most likely diagnosis?
B. aden/o
A. Whooping cough
C. lymphaden/o
D. lymphangi/o B. Bronchopneumonia
C. Measles
133. Which of the following carry lymph from
tissues? D. Diphtheria of respiratory tracts
A. Lymph 138. General state of 40 years old patient
B. Lymphocytes with acute viral hepatitis B worsened sud-
denly on the 10th day after hospitaliza-
C. Lymph vessels
tion. Nausea, permanent vomiting ap-
D. Lymph nodes peared, the pain under a right rib and skin
and sclera jaundice increased. There is
134. The combining form that means protec- leucocytosis, high level of bilirubin with
tion is: prevalence of indirect part in blood. What
A. path/o complication occurred?
B. meg/o A. Renal failure
C. immun/o B. Intensifying of cholecystitis
D. lymph/o C. Hepatic encephalopathy
135. The largest lymphatic structure is? D. Obstruction jaundice
A. Lymph E. Intrahepatic cholestasis
B. tonsils
139. The state when the immune response is
C. Spleen too intense or hypersensitive to an envi-
D. none of above ronmental substance is called
A. anaphylaxis
136. A 52-year-old male, after repeated in-
tramural heart infarction of myocardium, B. allergen
gradually returned to health and further C. allergy
supervision of a district internist. In 2
years he died in a motor-car accident. De- D. antigen
fine a pathological process in myocardium,
which wound be revealed at the autopsy? 140. neoplasm affecting lymphoid tissue
A. Focal cardiosclerosis A. definition of lymphoma

B. Diffuse cardiosclerosis. B. definition of lymphedema
C. Atrophy C. definition of lymphadenitis
D. Necrosis D. none of above

141. A 7-year-old child presented to the hos- resulted in crescents formation, necrosis of
pital with a punctuated bright-pink rash capillary loops and fibrin thrombi within
on hyperemic skin of a forehead, a neck, their lumens. In addition, the histological
in the bottom of abdomen and popliteal study showed sclerosis and hyalinosis of
fossa. A nasolabial triangle remained glomeruli, tubular atrophy and stromal fi-
pale. Physical investigation of a stomato- brosis of kidneys. What of the listed diag-
pharynx revealed circumscribed bright red noses the most likely?
hyperemia of mucosa, ‘raspberry’ tongue. A. Subacute glomerulonephritis
His tonsils were friable and edematous;
NARAYAN CHANGDER
lacunas filled with pus. Lymph nodes of B. Acute glomerulonephritis
a neck were enlarged, dense and painful. C. Chronic glomerulonephritis
What is the most likely diagnosis? D. Focal segmental sclerosis
A. Diphtheria
145. immunology
B. Scarlet fever
A. study of the immune system
C. Whooping cough
B. study of the nervous system
D. Infectious mononucleosis C. study of the cardiovascular system
142. A 32-year-old man with a long history D. none of above
of a drug abuse, presented with a fever,
the intoxication and a pyuria. An echocar- 146. The kidney biopsy is taken from the man
dioscopy revealed massive superimposi- who is in clinic with symptoms of a mer-
tions (vegetations) on the heart valves. cury poisoning. Histological investigation
Microbiological blood test showed a pres- revealed focal tubular necrosis, an edema,
ence of a staphylococcus. The patient hyperemia, hemorrhages and leukocytic in-
died of a thromboembolism of a pulmonary filtration in a stroma. What condition has
artery. Specify the changes of heart, re- developed at the patient?
vealed at post-mortem? A. Acute necrotic nephrosis
A. Polypous-ulcerative endocarditis B. Acute glomerulonephritis
B. Libman-Sacks endocarditis C. Chronic renal insufficiency
C. Diffuse valvulitis D. Acute pyelonephritis
D. Acute warty endocarditis 147. Axillary nodes are located ?
143. The lymphatic structure that closely par- A. Near the neck
allell veins are called? B. In the throat area
A. Capillaries C. In the groin
B. Lymph D. In the Arm pits
C. Lymph Vessels 148. A patient presented to the hospital an
D. none of above ascites, twice enlarged spleen, a varicose
esophagogastric veins and veins around
144. A 42-year-old man died of renal insuffi- and within the rectum. A histological in-
ciency. Microscopic investigation revealed vestigation of liver biopsy revealed mi-
a proliferation of Bowman’s capsule ep- cronodular cirrhosis. What process has
ithelial cells, podocytes and macrophages, complicated cirrhosis?

A. Portal hypertension C. Acute hepatic failure

B. Cardiac insufficiency D. Hypoglycemic shock

C. Hepatotenal syndrome E. Meningoencephalitis
D. Hepatic-cellular insufficiency 152. An 8-year-old child, with no disease in
his medical history, presented to the hos-
149. A macroscopical investigation of a re-
pital with a dyspnea. An x-ray inspection
moved kidney revealed in proximal area of
showed the air and a liquid in a pleural
an ureter the concrement which obturated
cavity. During operation in the right lung
its lumen. The kidney was markedly en-
the subpleural cavity, 2, 4 cm in diameter
larged; a parenchyma was atrophic with
was found. It had an irregular form with
considerably dilated pelvis and calyces.
the residual caseous masses inside. The le-
Microscopical study of kidney’s sample
sion was connected with the pleural cavity.
showed the diffusive sclerosis, an atrophy
The similar caseous masses were found at
of glomeruli and tubules. Survived tubules
a cut of the enlarged radical lymph nodes.
were cystically dilated. What complication
A histological research of a cavity’s wall
of a nephrolithiasis developed at the pa-
determined lymphocytes, epithelioid cells
tient?
and multinuclear giant cells. How correctly
A. Hydronephrosis to name a cavity?
B. Pyonephrosis A. Primary pulmonary cavity (cavern) at
C. Pyelonephritis tuberculosis
D. Glomerulonephritis B. Abscess of lungs
C. Empyema of pleura
150. The patient was concerned about the at-
tacks of fever that repeated periodically D. Cavity (cavern) at acute cavernous tu-
every third day. There is jaundice of scle- berculosis
ras and skin, hepatosplenomegaly. What 153. The combining form that means to eat or
is the most probable diagnosis? swallow is:
A. Yersiniosis A. phag/o
B. Sepsis B. pin/o
C. Hepatitis C. leuk/o
D. Malaria D. path/o
E. Leptospirosis 154. A 57-year-old man, with a long history
151. In a female, who was hospitalized with of an alcohol abuse, died at the increasing
viral hepatitis B, headache, nausea, re- phenomena of chronic heart failure. An au-
peated vomiting, “failures” in memory, topsy revealed the weight of a heart 580
“flapping” tremor of the hands, rapid grams; a languid, clay color myocardium,
pulse, sweet smell from the mouth ap- with intensive diffuse interstitial fibrosis.
peared. The body temperature is 37, 6◦ C, Coronal arteries were intact. A microscop-
heart rate is 89 beats per min. What com- ical study of myocardium showed a com-
plication developed in a famale? bination of hydropic and fatty dystrophy
of cells; atrophy and hypertrophy of car-
A. Gastrointestinal bleeding diomyocites. There were also some foci
B. Ischemic stroke of a cells lysis, accompanied with sclerosis.

What kind of cardiomyopathy described in B. Intracellular regeneration

that case?
C. Myocarditis
A. Alcoholic
D. Atrophy of myocardium
B. Hypertrophic
C. Dilatative 158. . A 35-year-old woman had an opera-
tion of uterine tube removal at gynecology
D. Restrictive
department. A histological research of a
tube’s wall reveled chorion villi and decid-
NARAYAN CHANGDER
155. A 45-year-old male died in a traffic ac-
cident. A histological investigation of his ual cells. What is the most likely diagno-
aorta revealed a lipid infiltration of its in- sis?
tima with fats accumulation in myocytes A. Tubal pregnancy
and macrophages of aortal medial layer.
Name the stage of atherosclerosis? B. Placental polyp
A. Lipoidosis C. Choriocarcinoma
B. Liposclerosis D. Paper-doll fetus
C. Atheromatosis
159. A 59-year-old man with a long history
D. Pre-lipoidosis of bronchiectasis disease, a pneumorrha-
gia, presented with facial and back edema,
156. A 42-year old man presented to the hos-
and proteinuria of 33mg/l. A pulmonary
pital with symptoms of malaise, compli-
bleeding soon resulted in his death. A post-
cated with a collapse one hour later. He
mortem revealed the enlarged firm kid-
died soon, not coming to consciousness. A
neys with a sebaceous (waxy) cut surface.
post-mortem revealed the lungs enlarged,
Histological investigation showed the ac-
congested, cut with a sound of crunch.
cumulation at glomeruli and under tubu-
Whole of a right inferior lobe had a liver-
lar epithelium homogeneous eosinophilic,
like texture with some fibrin fibers super-
Congo-Red positive masses, which gave
posed on the pleura. On a cut section pul-
a metachromasia reaction with the methyl
monary tissue exhibited a gray-brown col-
violet. Name process which has developed
oring. What is the most likely diagnosis?
in kidneys?
A. Amyloidosis
B. Bronchopneumonia
B. Hyalinosis
C. Acute venous hyperemia in lungs
D. Acute myocardial infarction C. Fatty dystrophy
D. Mucoid swelling
157. A patient, with a history of myocardial in-
farction, develops symptoms of blood cir- 160. An ultrasound investigation of the young
culation insufficiency after physical exer- 17-year-old man’s right kidney revealed
cises. There is marked cyanosis and edema pyeloectasis, accompanied with distur-
of subcutaneous tissue of his lower ex- bance of outflow of urine by urethra.
tremities. What changes have developed Microscopical investigation of the renal
on a place of a myocardial infarction at the biopsy showed a diffusive infiltration of
recovered person? the interstitium by lymphocytes and hys-
A. Cardiosclerosis tiocytes. In the cortical and medullar

zones there were the foci of a destruc- 164. Which of the following are small open
tion with formation of the cavities, sur- ended vessels that act like drain pipes?
rounded by peripheral mantle of epithe-

A. Lymph
lioid, lymphoid cells and some multinucle-
ated Pirogov-Langhans’ giant cells. What B. Lymphatic capillaries
disease is the most probable? C. Lymph vessels
A. Tuberculosis of kidney D. Lymph nodes
B. Suppurative (apostematous) nephritis
165. A 46-year old male, with a history of
C. Nonspecific tubular-interstitial nephri- the chronic bronchiectasis, died from ure-
tis mia. An autopsy revealed enlarged, firm
D. Polycystic kidney kidneys, with sebaceous (waxy) cut sur-
face. To what disease there correspond
161. A 68-year-old woman, with a 20 years
such changes?
history of fibrous-cavernous pulmonary
tuberculosis, presented to the Department A. Amyloidosis of kidney
of Nephrology with symptoms of uremia, B. Glomerulonephritis
Intravital test on amyloid in kidneys ap-
peared positive. What is the most likely C. Acute tubular necrosis
form of an amyloidosis presented in this D. Pyelonephritis
case?
166. A 30-year-old woman, with a history of
A. Secondary systemic
a chronic endocervicitis, passed routine in-
B. Primary systemic spection at the gynecologist with no com-
C. Limited (local) plaints. A histological investigation of a
biopsy, taken from the pars vaginalis neck
D. Familial congenital
of the uteri, revealed the high cylindrical
162. A 48-year old female presents to her epithelium, secreting mucus and branched
physician enlarged supraclavicular lymph out glands underneath. What is the most
nodes. Microscopic investigation of a likely diagnose?
biopsy from a lymph node revealed A. Endocervicosis
the metastasis of the signet-ring cancer.
Choose the most probable localization of B. Squamons metaplasia
a primary tumor. C. Glandular metaplasia
A. Cancer of stomach D. LeukopJakia
B. Cancer of oesophagus.
167. A 68-year-old man presented with diffi-
C. Cancer of thyroid. culty of a miction. The prostate was op-
D. Cancer of lung. eratively removed. A microscopical inves-
tigation revealed an increase of glandular
163. history and physical exam, CT and MRI
and muscular elements numbers. A lobu-
scans for confirmation
lar structure of prostate was also altered.
A. Diagnosis of lymphoma What process in a prostate is the most
B. diagnosis of lymphedema probable?
C. diagnosis of lymphadenitis A. Mixed nodular hyperplasia
D. none of above B. Glandular hyperplasia

C. Fibromuscular hyperplasia C. Toxoplasmosis

D. Prostatitis D. Meningococcal infection
168. A young man died of intoxication on 171. A 48-year-old woman died of pulmonary
4th day after eating the crude eggs. An insufficiency. A post-mortem revealed
autopsy revealed the stomach and small the enlarged lung with the dark red and
bowel mucosa inflamed, covered by a mu- pinkish-yellow colour areas (”the big mot-
cous exudate. In addition, abscesses were ley lung”) and necrotic tracheobronchitis.
found in lungs, brain and liver. What diag-
NARAYAN CHANGDER
What is the preliminary diagnosis in that
nosis is the most likely? case?
A. Salmonellosis (septic form) A. Influenzal pneumonia
B. Dysentery
B. Croupous pneumonia
C. Salmonellosis (typhoid form)
C. Caseous pneumonia
D. Salmonellosis (intestinal form)
D. Fibrosing alveolitis
169. The liver biopsy is taken from the pa-
tient with symptoms of a parenchymatous 172. These cells become active due to illness?
icterus and a portal hypertension. Histo- A. Lympocytes
logical investigation revealed a fatty dys-
trophy of hepatocytes, a destruction of B. Macrophages
a hepatic beam and a lobular structure, C. Red blood cells
a formation of false lobes and regenera-
tive nodes. These were accompanied with D. White blood cells
a porto-portal fibrous septae formation E. None of the above
and periportal lympho-macrophageal infil-
trates. What is the most likely diagnosis? 173. A histological investigation of the en-
A. Cirrhosis of liver larged supraclavicular lymph nodes, re-
moved from a 40-year-old woman, re-
B. Alcoholic hepatitis vealed an alteration of their structure with
C. Chronic hepatosis aggregates of slightly extended cells with
D. Viral hepatitis a light nucleus. The multinuclear, large,
oval-round form cells were also deter-
170. A 4-year-old child died of respiratory in- mined. These cells were rich with a cy-
sufficiency as a result of a respiratory mus- toplasm and their nuclei were located on
culation paralysis. Histological investiga- periphery in the form of a paling. The lym-
tion revealed a hyperemia of the mora- phoid cells created the next layer. The
cal part of a spinal cord, the unclear pat- unstructured pinkish masses were seen
tern of the grey substance, punctual hem- within the centers of lesions. What the
orrhages and fine sinking down sites of an described changes are characteristic for?
encephalomalacia. In addition, there was A. Tuberculous lymphadenitis
an inflammation with a neuroglia prolifer-
ation around and by the necrotic neurons. B. Metastasis of tumor
What is the most likely diagnosis? C. Lymphogranulomatosis (Hodgkin’s dis-
A. Poliomyelitis ease)
B. Cytomegaly D. Hyperplasic lymphadenitis

174. The elderly man, with 15 years history 177. A 4-year-old child presented to the hospi-
of a membranous-proliferative glomeru- tal with a fever and a sore throat. An oral
lonephritis, constantly received hemodialy- cavity examination revealed an edema of

sis therapy. The last half a year he did not a soft palate and grey membranes on ton-
receive a treatment. He presented to the sils. These membranes left a raw hem-
hospital with extremely severe condition, orrhagic surface when forcibly removed.
without consciousness, with a smell of What the most likely diagnosis is among
urea from his body and edemas. A marked listed below?
pleuritis, pericarditis and peritonitis were
A. Diphtheria fauces
also diagnosed. In a whole, all symptoms
were regarded as a uremia. What kind of B. Simonovsky-Vensans’ angina
an inflammation is the most probable?
C. Lacunar angina
A. Fibrinous inflammation
D. Infectious mononucleosis
B. Purulent inflammation
C. Catarrhal inflammation 178. A 9-year-old child developed a sharp pain
at swallowing and a neck edema. His body
D. Hemorrhagic inflammation
temperature had risen to 39◦ C. A motley-
175. Histological study of a renal biopsy re- red, punctulated, widespread rash ap-
vealed a necrosis and a marked dystrophy peared. A physical examination revealed
of the convoluted tubules epithelium, tubu- severe hyperemia of a pharynx (’fiery
lorrhexis, stromal edema and hyperemic pharynx’) and a ‘raspberry’ tongue. The
medulla. Name the pathological process? enlarged bright red tonsils presented with
some grayish necrotic zones. What is the
A. Necrotic nephrosis most likely diagnosis?
B. Pyelonephritis
A. Scarlet fever
C. Glomerulonephritis
B. Meningococcal nasopharyngitis
D. Kidney stone disease
C. Diphtheria
176. A 56-year-old patient presented to the
D. Influenza
hospital with symptoms of acute myocar-
dial infarction. A diagnosis was confirmed
179. A post-mortem of a male with a his-
by the EKG and laboratory tests. For 5th
tory of anemia accompanied by vomiting
days the condition acutely worsened. A
by dark gastric contents reveled in a stom-
progressive cardiac insufficiency resulted
ach about 1 liter of liquid blood and bloody
in patient’s death. A dissection con-
clots. A gross investigation showed an on
firmed the diagnosis of myocardial infarc-
small curvature of a stomach an oval soli-
tion, complicated by the heart’s wall rup-
tary ulcer with the elevated firm edgesand
ture and tamponade of pericardium. What
a smooth floor. What is the most likely di-
process developed in the area of myocar-
agnosis?
dial infarction?
A. Aseptic autolysis A. Chronic gastric ulcer
B. Organization B. Chronic atrophic gastritis

C. Encapsulation C. Acute gastritis
D. Septic disintegration D. Acute gastric ulcer

180. An autopsy of a child, who died of a C. Nephrolithiasis

heart failure, revealed the dilated heart
D. Nephrotic syndrome
chambers. Microscopic investigations
showed the hyperemia of the myocardial
183. A histological investigation of a gastric
stroma, edema, and diffuse interstitial-
biopsy of a 50-year old woman revealed
infiltrates consists of hystiocytes, lym-
a thinning of a stomach mucosa with reduc-
phocytes, some scattered neutrophils and
tion of a glands quantity, foci of an intesti-
eosinophils. What is the most likely diag-
nal metaplasia; a plethora, an edema and
nosis?
NARAYAN CHANGDER
a stromal sclerosis. These were accom-
A. Diffuse interstitial exudative myocardi- panied with a diffuse leucocytes, lympho-
tis cytes and plasmocytes infiltration of the
B. Focal interstitial exudative myocarditis mucosa. What is the most likely diagno-
sis?
C. Nodular productive myocarditis
D. Interstitial productive myocarditis A. Chronic atrophic gastritis in an active
phase
181. An autopsy of the 69-year-old man with
B. Chronic atrophic gastritis in a nonac-
a long history of chronic bronchitis re-
tive phase
vealed increased pulmonary volume and
hyperinflation, pale grey color, soft tex- C. Chronic superficial gastritis
ture lungs that kept their form when re-
moved from the body and put at au- D. Acute catarrhal gastritis
topsy table. Histological investigation
showed markedly dilated proximal acini, 184. A 47-year-old man died of an acute ane-
thinned and somewhere ruptured inter- mia, resulted from the pulmonary bleed-
alveolar septas. For what disease of lungs ing. An autopsy revealed in the 2 seg-
such morphological picture is characteris- ment of the right lung the cavity, 5-6 cm
tic? in the size, which had connection with the
bronchus lumen. The cavity had irregular
A. Emphysema of lungs roundish form and filled with blood. The
B. Chronic intestinal pneumonia internal surface of a cavity was rough and
C. Atelectasis of lungs covered by a flabby unstructured yellow-
ish tissue. A wall was thin, presented
D. Bronchiectatic disease by the condensed, inflammatorily changed
182. A patient died from uremia. A post- pulmonary tissue A histological investiga-
mortem revealed enlarged flaccid kidneys tion showed that the cavity inside layer
with wide, swallowed with red specks consisted of the fused caseous masses
cortex. Medulla had a dark red coloring. with a considerable quantity of segmented
Microscopic investigation showed epithe- leucocytes. What is the most likely pathol-
lial crescents which compressed capillaries. ogy presented in that case?
Nephrocytes exhibited a dystrophy; a stro- A. Acute cavernous tuberculosis
mal edema and infiltration were also rec-
ognized. What is the most likely diagno- B. Abscess of lung
sis? C. Disintegrating carcinoma of lung
A. Glomerulonephritis D. Infarction of lung with septic disinte-
B. Pyelonephritis gration

185. The lymph glands in the groin region are: temperature to 40◦ C, feeling of heat that
A. axillary changes by considerable sweating. The
patient had suffered three such attacks,

B. thoracic which appeared in a day and lasted for 12
C. inguinal hours. For the last three months she lived
in Africa. Liver and spleen are enlarged. In
D. cervical
blood:erythrocytes-2, 5*1012/L. What is
186. A 7-year-old child, on the 3ld week of the most probable diagnoses?
disease, presented with hectic fever, skin A. Sepsis
and sclera icterus. He died soon of the
B. Hemolytic anemia
hepatorenal failure. An autopsy reveled
in a rectum many irregular form defects C. Leptospirosis
with uneven edges. These defects were D. Malaria
covered by grey-white membranes, inti-
mately soldered to a tissue underneath. E. Typhus
In addition, there was a purulent throm-
bophlebitis of the intestinal vessels. Plu- 189. A 52-year old male presented to hospi-
ral pylephlebitic abscesses and fatty dys- tal with symptoms of acute pneumonia,
trophy of hepatocytes were diagnosed in complicated on the 6th day by pulmonary
a liver. An acute necrotic nephrosis was edema. The latter one resulted in the pa-
found in kidneys. What disease caused a tient’s death. A post-mortem revealed the
lethal outcome? upper part of the right lung enlarged, firm,
with fibrin fibers on the pleura. On a cut
A. Dysentery section pulmonary tissue had a gray col-
B. Cholera oring and looked granular. A turbid liq-
uid flowed down the surface. Histological
C. Salmonellosis
investigation showed the exudate within
D. Typhoid alveoli consisted of fibrin, neutrophil poly-
morphs, macrophages, and disintegrated
187. An autopsy of a 61-year-old female re- red cells. What is the most likely diagno-
vealed the thickening of her heart’s left sis?
ventricle up to 2.5 cm. Her kidneys were
small, contracted and firm. The surface A. Croupous pneumonia
of the kidneys had a granular appearance. B. Staphylococcal bronchopneumonia
On a cut, there was a thinning of a corti-
cal substance. Microscopical investigation C. Virus pneumonia
showed arteriolosclerosis, glomeruloscle- D. Hypostatic pneumonia
rosis and interstitial sclerosis. What is the
most likely disease 190. A 23-year-old woman presents with her
menstrual cycle disorder went trough a
A. Hypertension
transvaginal puncture of Douglas’ cul-de-
B. Atherosclerosis sac resulted in aspiration of blood and
C. Ischemic heart disease some other material. A microscopic in-
vestigation of the puncture fluid revealed
D. Rheumatism blood, some decidual cells and chorion villi.
188. A 23 years old female complains on pe- What is the most likely diagnosis?
riodic fever with increasing of the body A. Ectopic tubal pregnancy

B. Salpingitis 194. A 45-year-old man presented in the infec-

C. Rupture of Fallopian tube tious diseases hospital with a profuse di-
arrhea, exicosis, acute decline of his body
D. Hydatidiform mole temperature. He died soon of an uremia.
An autopsy revealed in his small bowel lu-
191. A child with a history of an acute catarrh
men a colorless liquid in the form of rice
of the upper respiratory tract, conjuncti-
broth and edematous mucosa. Microscopi-
vas and blotchy, papular skin rash, died
cal investigation of a small bowel showed
of pulmonary insufficiency. A histological
a hyperemia of vessels, a focal hemor-
NARAYAN CHANGDER
investigation revealed an interstitial pneu-
rhage, a desquamation ofenterocytes, a
monia with focal serous macrophageal in-
hypersecretion of a beaker (goblet) cells
flammation and set of giant cells within
and lympho-leucocytes infiltration of a mu-
alveoli walls. What is the most likely di-
cosal stroma. What is the most likely di-
agnosis?
agnosis?
A. Adenoviral infection
A. Cholera
B. Parainfluenza
B. Salmonellosis
C. Influenza
C. Dysentery
D. Measles
D. Typhoid
192. Macroscopic investigation of a removed
195. A patient died in 3 weeks of the pneu-
appendix revealed its thickening, enlarge-
monia onset. Macroscopic investigation
ment, dull and hyperemic serous mem-
of lungs revealed the whole of a left in-
brane with whitish membranaceous incrus-
ferior lobe became enlarged, consolidated
tation. A whitish-yellow, opaque, viscous
and airless. Grossly lungs got the ap-
liquid detected on a cut section within its
pearance of a grayish brown, dry surface
lumen. What is the most likely type of the
with fibrin fibers on the pleura. Histo-
appendicitis?
logical investigation showed the collapsed
A. Suppurative appendicitis. and bloodless alveolar capillaries, the ex-
B. Gangrenous appendicitis udate within alveoli consisted mainly of
neutrophil polymorphs. What is the most
C. Simple appendicitis likely diagnosis?
D. Superficial appendicitis A. Croupous pneumonia
193. A post-mortem of a 65-year-old male re- B. Focal bronchopneumonia
vealed yellowish streaks and spots in the C. Fibrinous pleuritis
abdominal aorta’s intima, which did not
rise above endothelial surface. These ar- D. Intestinal pneumonia
eas were stained by Sudan III in orange
196. A 49-years-old-patient with a 10 days
color. What stage of atherosclerosis such
history of dysentery presented with
changes are characteristic for?
raised body temperature, a pain in lum-
A. Lipidosis bar area, a fever and a considerable quan-
B. Liposclerosis tity of leucocytes in urine. Histological
investigation of a puncture renal biopsy
C. Atheromatosis revealed hyperemia, interstitial leukocytic
D. Ulceration infiltration and numerous inflammatory

cells (mainly neutrophiles) with a desqua- B. Postinfectious glomerulonephritis

mated epithelium, filling renal tubules. C. Rapidly progressive glomerulonephri-
What complication has developed at the

tis
patient?
D. Focal segmental glomerulosclerosis
A. Acute pyelonephritis
B. Chronic pyelonephritis 200. A post-mortem revealed the left lung
enlarged, firm, with fibrin fibers on the
C. Pyelitis pleura. On a cut section pulmonary tissue
D. Glomerulonephritis had a gray coloring. A turbid liquid flowed
down the surface. What is the most likely
197. Which lymphatic organ is mass of lym- diagnosis?
phatic tissue located in the center of the
upper chest? A. Croupous pneumonia
A. Tonsil B. Focal pneumonia
B. Thymus C. Intestinal pneumonia
C. Spleen D. Cancer of lungs
D. Peyer’s patch 201. What medical term means lymph gland in-
flammation?
198. A patient presented with a sustained
fever, enlarged and painful spleen. On A. lymphaginitis
the 10th day of a disease a rash of B. lymphadenitis
flat, rose-colored spots appeared. On the
C. lymphadenopathy
21st hospital day he died after develop-
ing peritonitis. An autopsy revealed in the D. lymphadgioma
ileum deep ulcers within the area of necro-
202. What is the protein containing fluid
tized group of lymphoid follicles (Peyer’s
within the lymphatic vessels?
patches). One of ulcers was perforated;
there was a flbrinopurulent diffuse peri- A. Platelets
tonitis. What is the most likely disease? B. blood
A. Dysentery C. lymph
B. Cholera D. Peyer’s Patch
C. Typhoid
203. An autopsy of a child, who died of
D. Salmonellosis meningocephalitis revealed under pleura
199. A 5-year-old girl with a history of and in pulmonal tissue plural, punctual,
an acute respiratory virus infection pre- yellow-white lesions which reminded mil-
sented with widespread swelling, a mas- let grains. Histological investigation
sive proteinuria, a hypoalbummemia, a showed granulomas with a necrosis zone
lipidemia. A microscopic investigation of in the centre and a wall of epithelioid cells,
the renal biopsy revealed an absence of lymphocytes, macrophages and some gi-
small podocytes processes within vascular ant Pirogov-Langhans cells. What is the
glomerulus. What is the most probable di- most likely disease?
agnosis? A. Primary milliary tuberculosis
A. Lipoid nephrosis B. Secondary tuberculosis

C. Focal pneumonia B. Tumour of kidney

D. Croupous pneumonia C. Postinfectious glomerulonephritis
204. years-old plumber became ill acutely. D. Primary amyloidosis

Chills, t-39, 8◦ C, severe headache, vomit-
207. A 64-year-old patient, with long history
ing and muscle pain appeared. He didn’t
of atherosclerosis and myocardial infarc-
visit the doctors. The state worsened.
tion, developed the attack of substernal
Hyperemia of face, injecting of the sclera
pain. A patient was hospitalized in 3 days
NARAYAN CHANGDER
vessels, herpes with hemorrhagic mainte-
and died soon from progressive cardiovas-
nance on the lips and nose bleeding ap-
cular insufficiency. An autopsy revealed in
peared. Skin and scleras became yellow-
the back wall of the left ventricle and inter-
ish, urine color was of strong tea, diuresis
ventricular septum of heart a white color
was 200 ml. Acholia was not presented.
focus, about 3 cm in a diameter. It was
What is a probable source of infection?
fibred, falling back, with a clear boundary.
A. Person-carrier Give the name for these changes:
B. Cat A. Focal cardipsclerosis
C. Person-convalescent B. Myocardial ischemia
D. Rat C. Myocardial infarction
E. Ticks, which are characterized by D. Myocarditis
transovarial transmission
208. A worker of the agricultural enterprise
205. What is the medical term for watery fluid presented with an acute disease and died
inside the lympathic vessels? soon of intoxication. An autopsy re-
A. Plasma vealed the enlarged and flaccid spleen with
a dark-cherry coloring of a cut surface.
B. Lymph
There were a superfluous pulp’s scrape
C. Blood from the lien cut surface. Arachnoids of
D. none of above the brain’s fornix and base were edema-
tous, impregnated by blood (’red cap’ or
206. An autopsy of a 59-year-old man re- ‘cardinal’s hat’). Microscopical investiga-
vealed the coral-like stone filled all re- tion found the serous-hemorrhagic inflam-
nal pelvis of a right kidney. The kid- mation of brain’s membranes and cerebral
ney was enlarged, hyperemic with the cap- tissues. What is the most likely diagno-
sule, taken out hardly. The pelvis and sis?
calyxes cavities were dilated, filled by a A. Anthrax
turbid, greenish-yellowish viscous liquid.
The mucosal layer was dim with some B. Tularemia
hemorrhages. A cut surface investigation C. Plague
showed motley pattern of the kidney’s tis-
D. Cholera
sue, with yellow spots in up to 1cm in di-
ameter. What complication to nephrolithi- 209. A morphological investigation of a thy-
asis has developed? roid removed due to thyrotoxicosis struma
A. Chronic pyelonephritis with exacerba- revealed a diffuse infiltration of a gland
tion by lymphocytes with a destruction of

parenchyma and an area of connective tis- B. disease of the lymph nodes, especially
sue. What is the most likely diagnose? enlargement of the lymph nodes

A. * Hashimoto’s thyreoiditis C. tumors of lymph tissue
B. Anaphylactic reaction D. none of above
C. Thyrotoxicosis 214. The abbreviation for laboratory is
D. Cancer of thyroid A. lab
B. labo
210. An immediate allergic reaction that leads
to severe respiratory distress or failure is C. lbrtry
A. hypersensitivity D. none of above
B. prohylactic 215. A male patient presented with obesity of

the trunk and face. He also had a long
C. inflammatory response
medical history of an arterial hypertension.
D. anaphylaxis The death resulted from a hemorrhage in
a brain. A morphological investigation re-
211. Which of the following is NOT a function vealed a basophilic adenoma of a pituitary
of the lymphatic system? body and hyperplasia of adrenals cortex.
A. removes excess fluid from around or- What is the most likely preliminary diag-
gans nosis?
B. absorbs/transports fats A. Itsenko-Cushing disease
C. circulates blood B. Diabetes mellitus A. Acromegaly
D. produces white blood cells C. Pituitary nanism
D. Adiposogenital dystrophy
212. A 60-year-old woman died of a chronic
renal failure. An autopsy revealed the 216. -Chinese
irregularly contracted and markedly lob- A. movement
ulated kidneys with a fibrous tissue al- B. poison
ternated with an intact parenchyma. Re-
nal pelvises were dilated, their walls- C. thymus gland
thickened. Histological investigation D. none of above
showed sclerosis, lymphocyte-plasmocyte
217. A 67-year-old man died of pulmonary in-
infiltration of the renal pelvis walls, and
sufficiency. A post-mortem investigation
interstitium. What diagnosis is most prob-
of a lungs cut surface revealed multiple,
able?
bright, red, deaerated 2, 5 cm foci with ir-
A. Chronic pyelonephritis regular form and inaccurate borders. A mi-
B. Acute pyelonephritis croscopic study showed erythrocytes and
some lymphocytes within alveoli. The de-
C. Acute glomerulonephritis scribed changes are characteristic for:
D. Tubulointerstitial nephritis A. Influenzal pneumonia
213. anaphylactic shock B. Croupous pneumonia
A. a severe allergic reaction to an aller- C. Hemorrhagic infarction of the lung
gen that can result in death D. Measles virus pneumonia

218. An autopsy of the 58-year-old patient re- mucosa opposite the first molar. In addi-
vealed an enlarged kidneys, which had a tion, a blotchy and papular rash appeared
well defined yellow-grey with red specs on the patient’s face, trunk and extremi-
cortical layer. Kidney’s medulla colored ties later. What is the most likely diagno-
in a dark red. Histological investigation sis?
revealed proliferation of capsular epithe- A. Measles
lial cells and podocytes with crescents
formation, sclerosis and hyalinosis-of the B. Scarlet fever
glomerular tufts, stromal fibrosis. What
NARAYAN CHANGDER
C. Meningococcal infection
is the most likely kidneys disease?
D. Epidemic typhus
A. Extracapillary productive glomer-
alonephritis 222. A 39-year-old patient died on the 4th day
after operation concerning perforation of
B. Intracapillary productive glomeru-
a colon wall, resulted in diffuse purulent
lonephritis
peritonitis. An autopsy revealed the mu-
C. Extracapillary exudative glomeru- cosa of a colon wall thickened, covered
lonephritis by fibrinous membrane. Some single ul-
D. Intracapillary exudative glomeru- cers got on different depth. Histological
lonephritis study of a colon wall showed a necrosis of
mucous, a fibrinous inflammation, infiltra-
219. Which tissue produces lymphocytes and tion by leucocytes with focuses of hemor-
filters out impurities and harmful sub- rhages. What complication of disease be-
stances from the lymph? came a cause of patient’s death?
A. spleen A. Dysentery
B. tonsils B. Typhoid
C. thymus C. Nonspecific ulcerative colitis.
D. lymph nodes D. Crohn’s disease
220. A histology investigation of a mitral 223. A physical examination of a fauces of a

valve sample of a patient who died from 12-year-old child with tonsillitis revealed
complications of rheumatism revealed a the reddening and slight edema of mu-
mucoid swelling, a damage of the endothe- cosa, with reactive enlargement of tonsils,
lial cells and also thrombi at the valve clo- dotted by pinpoints of exudates emanat-
sure line. Name the type of the rheumatic ing from the tonsillar crypts.What clinical-
endocarditis? morphological variant of tonsillitis is the
A. Acute warty endocarditis most probable in this case?
B. Diffuse endocarditis A. Lacunar tonsillitis
C. Fibroplastic endocarditis B. Catarrhal tonsillitis
D. Relapsing warty endocarditis C. Purulant tonsillitis

D. Fibrinous tonsillitis
221. A child presented with catarrhal conjunc-
tivitis, pharyngitis, a laryngotracheobron- 224. A renal puncture biopsy was taken
chitis. A gross investigation of the oral from a patient with elevated blood sugar
cavity revealed white spot on the buccal levels and high amounts of glucose in

his urine. Histological investigation re- A. Alcoholic cirrhosis.

vealed extension of mesangium with fo- B. Chronic active alcoholic hepatitis
cal accumulation of membranous sub-

stances and periglomerular sclerosis of C. Chronic persistent alcoholic hepatitis.
some glomerules. In addition, there were D. Toxic dystrophy of liver
found a hyalinosis and plasmatic infiltra-
227. An autopsy of a patient, who had been
tion of arterioles; lymphocytes, histio-
working within 20 years the coal worker,
cytes and some leucocytes infiltration of a
revealed enlarged, slightly firm and hy-
stroma; glycogen deposits within nephro-
poinflated lungs. At the gross investi-
cytes of narrow segment. What is the
gation of the lungs sectional view mul-
most likely diagnosis?
tiple, round, grayish-black, diffuse nod-
A. Diabetic glomerulonephritis ules were discovered. Histological study
B. Arteriolosclerotic nephrocirrosis showed nodules composed of concentric
C. Pyelonephritis whorls of dense collagen fibers, some of
them-with hyaline degeneration. What is
D. Acute glomerulonephritis the most likely disease?
225. A 7-year-old boy presented to the hospi- A. Nodular form of silicosis
tal with an acute catarrh in pharynx and B. Miliary tuberculosis of lung
tonsils which had extended on a mouth
mucosa, tongue and fauces. A tongue C. Bronchiectatic disease
was fiery red (crimson red) with promi- D. Croupous pneumonia
nent papillae (’raspberry’ or ‘strawberry’
tongue). A gross investigation of tonsils 228. A histological study of the enlarged cer-
showed superficial necroses. A casting-off vical lymph nodes revealed nodules with
necrotic tissue resulted in ulcers formation. giant, spherical-oval form cells. These
Cervical lymphatic nodules were enlarged. cells had a light pink cytoplasm and nu-
A punctuate erythematous rash was deter- clei located on a periphery. The found out
mined over the trunk, arms and legs. Face changes are characteristic for:
was also involved but a small area about A. Tuberculosis
the mouth remained unaffected to produce B. Lymphogranulomatosis (Hodgkin’s dis-
circumoral pallor. What is the most likely ease)
diagnosis?
C. Sarcoidosis (Boeck’s disease)
A. Scarlet fever
D. Brucellosis
B. Diphtheria
C. Angina 229. A post-mortem of a 58-year-old patient,
with a history of tuberculosis, revealed in
D. Measles the upper lobe of the right lung a cavity,
226. An autopsy of a male, with a history of 3x2cm in sizes, which connected with a
a chronic alcohol abuse, revealed a small, bronchus. A cavity had dense walls and
firm, micronodular liver. Histological in- three layers. The internal layer was pyo-
vestigation showed a fatty dystrophy of genic; the middle one was presented with
hepatocytes, a formation of small regen- tubercular granulation tissue and the ex-
erative (false) nodes separated by fibrous ternal coating of connective tissue. What
septae with lympho-macrophageal infiltra- of the listed diagnoses the most likely?
tion. What is the most likely diagnosis? A. Fibrocavernous tuberculosis

B. Fibrous focal tuberculosis were pale, dense, and sebaceous. Micro-

scopic investigation showed the unstruc-
C. Tuberculoma.
tured, amorphous, eosinophilic, Congo red
D. Acute focal tuberculosis positive deposits by reticular stroma and
within vessels walls. These changes indi-
230. A 64-year-old man, with a medical his- cate a development of:
tory of a diabetes mellitus, presented aug-
mented symptoms of renal failure. What A. Amyloidosis
disease caused such changes in a pan- B. Mucoid swelling
NARAYAN CHANGDER
creas? C. Fibrinoid swelling
A. GIomerulosclerosis. D. Lipidosis
B. . Necrosis of renal tubular epithelium
234. A 48-year-old patient with severe ty-
C. Amyloidosis. phoid developed an acute renal failure, re-
D. Proliferative glomerulonephritis sulted in a lethal outcome of a disease.
An autopsy revealed enlarged and swollen
231. Phagocyte-The white blood cells that kidneys. On a cut section, the cortex was
the body by eating dirt, bacteria and dead pale grey, while pyramids were dark red.
or dying cells. A histological investigation showed that
in the majority of tubules the lumen was
A. Protect narrowed, epithelial Cells were enlarged
B. Destroy and lost their nuclei; glomeruli were col-
lapsed. A renal stroma was edematous
C. Break Down with a small leukocytic infiltration and fine
D. Consume hemorrhage. What pathology of kidneys
presented in that case?
232. An autopsy of a 62-year-old male, with a
A. Necronephrosis
history of ischemic heart disease, revealed
an atherosclerosis of coronal arteries and B. Acute pyelonephritis
signs of hypertensive disease. On a cut C. Acute glomerulonephritis
of the heart, in the area of the apex and
D. Pyonephrosis
left ventricle’s frontal and lateral walls,
there was a well defined yellowish focus, 235. An autopsy of a 36-year-old man re-
surrounded by hemorrhages. What is the vealed in his liver s roundish formation,
most likely pathological process in the car- 0, 5 cm in diameter. Microscopical inves-
diac muscle? tigation showed in the centre of lesion
A. Myocardium Infarction necrotic masses, surrounded by the granu-
lation tissue with some plasmatic and lym-
B. Postinfarction Cardiosclerosis phoid cells. There were also signs of the
C. Diffuse Cardiosclerosis vasculitis in the blood vessels. What is the
most likely diagnosis in that case?
D. Myocarditis
A. Solitary gumma of liver
233. An autopsy of the middle age man with B. Solitary adenoma of liver
a long history of bronchiectasis revealed
markedly enlarged adrenals volume at the C. Solitary leproma of liver
expense of a cortical layer. Adrenals D. Chronic abscess of liver.

236. A 6-year-old boy developed pain at swal- of a foamy sputum discharge and facial
lowing and raised body temperature. On cyanosis developed. A patient died from
a second day of the disease, a physical progressive cardiac insufficiency. An au-

investigation revealed the appearance of topsy revealed enlarged grey-pink color
the fine, densely set, widespread skin rash lungs. A foamy liquid flowed down from
with a small unaffected circumoral area. the cut surface. What pathological process
An oral cavity examination showed the in lungs caused a death?
bright reddening of a pharynx, enlarged
A. Edema of the lungs
tonsils and raspberry-red tongue. What
is the most likely diagnose? B. Lungs infarction
A. Scarlet fever C. Hydro thorax
B. Adenoviral infection. D. Pneumonia
C. Fauces diphtheria.
240. Isolated clusters of lymph follicles found
D. Measles in the wall of the small intestine.
237. Microscopic investigation of the heart au- A. Peyer’s patches
ricle from a patient with a history of mitral
stenosis revealed the Achoff-Talalayev’s B. Thoracic duct
bodies (granulomas). What was the most C. Lymph nodes
likely cause of the heart insufficiency sup-
D. Spleen
ported by the histology results?
A. Rheumatic 241. A 3-month-old child died of pneumonia.
B. Atherosclerotic A macroscopical investigation revealed up-
ward slant of palpebral fissures of the
C. Syphilitic
eyes, a sinking down dorsum of nose,
D. Innate dolichouranic, a low locating of small au-
ricles. An autopsy revealed a defect of a
238. A microscopical investigation of a liver
heart and the main vessels’ development.
biopsy revealed a dystrophy, necroses
A genetic study showed a chromosome 21
of hepatocytes, a sclerosis, accompanied
trisomy. What of the listed diagnoses is
with destruction of a hepatic beam and
the most likely?
a lobular structure, a formation of false
lobes and regenerative nodes. What is the A. Down’s syndrome
most likely diagnosis? B. Patau’s syndrome
A. Cirrhosis of liver
C. Shereshevsky-Turner’s syndrome (go-
B. Chronic gepatoz nadal dysgenesis)
C. Chronic hepatitis D. Edwards’ syndrome
D. Massive diffuse necrosis of liver
242. red-
239. A 66-year-old patient presented in the
hospital with the acute recurrent myocar- A. Cell
dial infarction of front-lateral wall of the B. Red
left ventricle. On the 4th day of dis-
C. Blue
ease, an acute, marked difficulty in breath-
ing, a cough with considerable quantity D. White

243. A 63-year-old man, with a long history and solitary small hemorrhage of the stom-
of hypertensive disease, died from a hem- ach mucosa. These were accompanied
orrhage in the brain. An autopsy revealed with considerable quantity of a muddy, vis-
reduced in sixes, firm kidneys with fine- cous grey exudate on a gastric surface.
grained surface and thinned cortex matter. What gastritis has developed at the pa-
These changes in kidneys are characteristic tient?
for A. Catarrhal gastritis
A. Primary-scarring kidneys B. Hemorrhagic gastritis
NARAYAN CHANGDER
B. Secondary-scarring kidneys C. Flegmonous gastritis
C. Amyloidal-scarring kidneys D. Corrosive gastritis
D. Pyelonephritic-scarring of kidneys
248. A 58-year-old male, with a history of hy-
244. Storage of Iron is done by the pertensive disease, developed a long at-
tack of substernal pain. The infarction
A. Stomach
of myocardium was diagnosed. A patient
B. Liver died soon. An autopsy revealed flabby my-
C. Spleen ocardium with uneven blood filling. His-
tological and histochemical examinations
D. Lymph Nodes
showed disappearance of glycogen gran-
245. A post-mortem revealed on the external ules and decreased activity of oxidizing en-
surface of the aortal valve the large, 1-2 zymes. What stage of myocardial infarc-
cm, brownish-red, easily crumbling super- tion presented in that case?
impositions (vegetations). They covered A. Ischemic stage
ulcerative defects in the valves. What is
B. Necrotic stage
C. Organization
A. Polypous-ulcerative endocarditis
D. Recurrent myocardial infarction
B. Recurrent warty endocarditis
C. Acute warty endocarditis 249. A 52-year-old man with a long history
of tuberculosis died of a bleeding from
D. Fibroplastic endocarditis
lungs. An autopsy revealed in lungs some
246. A histological investigation of the cervi- oval and round cavities. The walls of cavi-
cal lymph node revealed the aggregation ties were presented with necrotic masses
of epithelioid cells, lymphocytes and giant and a pulmonal tissue. What is the most
Pirogov-Langhans cells. In the centre of likely form of tuberculosis presented in
a lesion a caseous necrosis was present. that case?
Specify the most likely pathology. A. Acute cavernous
A. Tuberculosis B. Fibrocavernous
B. Rhinoscleroma. C. Tuberculoma
C. Sarcoidosis (Boeck’s disease) D. Caseous pneumonia
D. Syphilis 250. Dimer; combines with harmful ingested
247. A gastroscopy of a 55-year old patient or inhaled antigens
revealed a diffusive swelling, hyperemia A. IgG

B. IgM of Langerhans islets. What disease caused

C. IgA such changes in a pancreas?

D. IgE A. Diabetes mellitus.
251. A histological investigation of a thyroid B. Acute pancreatitis.

gland biopsy, presented to pathology, re- C. Mucoviscidosis
vealed lymphoid structures with the ger-
minal (growth) centers among the follicles D. Cancer of pancreas
filled with a colloid. What is the most
likely disease presented in that case? 256. The main collecting duct of the lymphatic
system is the left lymphatic duct, also
A. Hashimoto’s goiter.
known as the
B. Endemic goiter
A. jugular trunk
C. Sporadic goiter
B. thoracic duct
D. Basedow’s goiter
C. subclavian artery
252. red blood cell
D. trabeculae
A. plasma
B. erythrocyte 257. A 44-year old patient, with a history of
C. leukocyte the chronic duodenum peptic ulcer, died of
peritonitis. An autopsy revealed multiple
D. thrombocyte
steatonecroses of a retroperitoneal tissue
253. An immune response that does not in- and a pancreas. A gross investigation of a
volve antibodies but rather involves the duodenum demonstrated an ulcerative de-
activation of macrophages and natural fect, which was 5 mm in diameter and 10
killer cells: mm deep. The edges presented necrotic
masses. Diagnose the complication of a
A. Acquired Passive Immunity
duodenal peptic ulcer?
B. Natural Immunity
A. Penetration
C. Acquired Active Immunity
B. Hemorrhage
D. Cell-Mediated Immunity
C. Stenosis
254. biopsy of lymph tissue with Reed Stern-
berg cells present D. Perforation
A. Diagnosis of lymphoma
258. An autopsy of a child revealed a necrotic
B. diagnosis of lymphedema tonsillitis, neck phlegmon, purulent otitis
C. diagnosis of lymphadenitis and purulent meningitis. These alterations
are the most typical for:
D. none of above
A. Septic scarlet fever
255. A 64-year-old man died with symptoms
of a hypoglycemic coma. A postmortem re- B. Meningococcal infection
vealed reduced, dense pancreas. Histolog-
C. Toxic scarlet fever
ical investigation of pancreas showed the
growth of a connecting tissue, an atrophy D. Fauces diphtherias

259. allergic reaction 262. A 42-year old woman, with a history

of common cold after acute cooling, pre-
A. when the body is exposed to a foreign
sented to his physician with symptoms of
substance and the immune system overre-
cough, chest pain, fever, and difficulty in
acts and harms the body
breathing. She died on the 5th day staying
B. proteins that can attach to foreign at the hospital. A post-mortem revealed
cells, labeling them for destruction the inferior lobe the right lung enlarged,
C. hemorrhage from the spleen firm, with membranous fibrin fibers on the
pleura. On a cut section pulmonary tissue
NARAYAN CHANGDER
D. none of above had a gray coloring and looked granular.
260. A 26-year-old patient arrived in a hospi-
tal with complaints to a fever and weak- A. Croupous pneumonia
ness. One of the enlarged cervical lymph B. Influenzal pneumonia
nodes was taken for histological study.
Microscopical investigation showed in lym- C. Bronchopneumonia
phoid tissue the centers of necrosis, sur- D. Caseous pneumonia
rounded with epithelioid cells, giant mult-
inuclear Pirogov-Langhans cells and lym- 263. An elderly male, with 15 years history
phocytes. What is the most likely dis- of essential hypertension, died from renal
ease? failure. What would be the most likely
gross picture of his kidneys at autopsy?
A. Tuberculosis
A. Small, dense, a surface is fine-grained.
B. Lymphogranulomatosis (Hodgkin’s dis-
ease) B. Large pied and soft.
C. Lymphatic leukemia C. Large red
D. Sarcoidosis (Boeck’s disease) D. Large white and smooth
261. An autopsy of 61-year-old male with 264. The fluid that removes cellular waste
a history of rheumatoid arthritis re- products, pathogens and dead blood cells.
vealed enlarged dense kidneys, which had A. lymphangi/o
yellowish-whitish color and waxy appear- B. lymph/o
ance. Grossly, foci of scars were recog-
nized at kidneys surface. Microscopically, C. splen/o
at the slides stained by Congo red, ho- D. myel/o
mogeneous pink masses at capillaries of
glomeruli tufts, arterioles walls and ar- 265. An autopsy of a 48-year-old woman with
teries, basal membranes of tubuli and in a history of the stomach neoplasm re-
stroma were found. Name the described vealed the markedly enlarged, firm, white
complication of rheumatoid arthritis? color ovary. Microscopic investigation
showed markedly atypical epithelial cells
A. Secondary amyloidosis of kidneys.
placed among the layers and fibers of a
B. Postinfective glomemlonephritis. connecting tissue. What is the most likely
C. Quickly progressive glomerulonephri- diagnosis?
tis. A. Krukenberg tumor of ovary.
D. Acute necrotic nephrosis. B. Serous cystadenocarcinoma

C. Pseudomucinous cystadenocarcinoma 269. The young man presented in hospital with

D. Malignant thecoma a headache and giddiness. Within last
year he often had high arterial pressure.

266. At autopsy of an elderly female an aorta Medical drugs almost did not help. Kid-
tissue sample collected for histology. Mi- neys biopsy investigation revealed the ex-
croscopic investigation revealed in aorta’s tra capillary epithelial proliferation with a
intima the accumulation of xanthoma’s crescent formation. For what disease de-
cells. At what disease such morphological scribed pathology is characteristic?
picture is possible? A. Rapidly progressive glomerulonephri-
A. Atherosclerosis tis
B. Hypertension
C. Lupus glomerulonephritis
C. Syphilitic mesaortitis
D. Wegener’s granulomatosis
D. Nonspecific aortoarteritis
270. A 43-year-old woman presents to her
267. A thyroid gland of a 48-year-old male physician with pain and immobility of the
was removed at surgery department. His- bones in metacarpal phalangeal and feet
tological investigation revealed various joints. Similar complains in symmetric pat-
size follicles which were lined by tall tern were about ulnar and knee joints,
columnar epithelium. The latter one was though not so severe. Physical exam-
pilled up at places forming papillary in- ination revealed pastous skin over the
foldings. Colloid appeared lightly stain- joints, a partial ankylosis of metacarpal
ing, watery and finely vacuolated. The phalangeal and feet joints, and also ul-
stroma showed increased accumulation of nar deviation of the hands and flexion-
lymphoid cells. hypertension (’swan neck”or”walrus flip-
A. Basedow’s goiter per”) deformities of the fingers. In ad-
dition, movable firm, rubbery and tender
B. Hashimoto’s thyreoiditis 1cm hypodermic nodules were found in the
C. De Quervain’s thyroiditis phalangeal joints area. An aspirate of joint
fluid showed increased turbidity and pres-
D. Nodular goiter
ence of white “grains” (”rice bodies”).
268. A 42-year-old man presented with a thy- Immunofluorescence also revealed the rhe-
roid gland enlargement in two times. A matoid factor. What is the most likely di-
physical investigation revealed firm, ir- agnosis?
regular lobulated gland. Histological in- A. Rheumatic poliartritis
vestigation showed a diffusive infiltration B. Systemic disease of connective tissue
of thyroid gland by lymphocytes, plas-
C. Gout
mocytes with follicles formation and the
enhanced growth of a connective tissue. D. Osteoartrosis
271. A blockage of lymph flow is called:
A. Hashimoto’s goiter. A. lymphangioma
B. Endemic goiter B. lymphedema
C. Sporadic goiter. C. lymphadenitis
D. Diffuse toxic goiter. D. lymphoplexy

272. A 64-years-old patient died from the edema. What histological changes will be
brain’s hemorrhage. An autopsy revealed characteristic for a liver?
markedly decreased kidneys (6x3x2cm in A. Necrosis of hepatocytes in the center
sizes and 60, 0 grams weight). They were of lobule, fatty dystrophy on periphery
dense, anemic with an even, fine-grained
surface. On a cut, there was a constant B. Necrosis of hepatocytes in the center
thinning of the kidneys’ cortex. Changes of lobule, hyalin dystrophy on periphery
in kidneys are the implication of: C. Necrosis of hepatocytes in the center
NARAYAN CHANGDER
A. Arteriolosclerotic nephrosclerosis of lobule, hydropic dystrophy on periphery
B. Atherosclerotic nephrosclerosis D. Fatty dystrophy of hepatocytes in the

center of lobule, necrosis on periphery
C. Secondary-scarring kidney
277. An autopsy of a male, with a history of
D. Amyloidal-scarring kidney.
a drug abuse, revealed vacuolar dystro-
273. The combining form that means spleen is: phy of hepatocytes, a Councilman’s bodies,
periportal inflammation consisted mainly
A. spleenomega/o
of chronic inflammatory cells, lympho-
B. splen/o cytes, plasma cells and histiocytes. What
C. lymph/o is the most likely etiology of the disease?
D. spleen/o A. Viral
B. Bacterial
274. white blood cell
C. Toxic
A. plasma
D. Parasite
B. erythrocyte
278. An autopsy of 3-year-old child revealed
C. leukocyte
hyperemic, turbid arachnoids, which had
D. thrombocyte a form of yellowish-greenish ‘cap’. At
microscopic investigation a characteristic
findings of arachnoids thickening, hyper-
hyperemic, yellowish-greenish arachnoids,
emia, purulent with fibrin exudate infiltra-
infiltrated by purulent and fibrinous exu-
tion was present. What is the most likely
date resembled a ‘cap’. What is the most
diagnosis?
likely diagnosis?
A. Meningococcal infection
A. Meningococcal meningitis
B. Tuberculosis
B. Tubercular meningitis
C. Anthrax
C. Influenzal meningitis
D. Influenza
D. Anthrax meningitis
279. An autopsy of a 56-year-old male, with
276. A 42-year-old male, with a history of a history of ischemic heart disease, re-
rheumatic stenosis of the left atrioventric- vealed the edema of lungs. What patho-
ular orifice resulted in chronic heart insuffi- logical changes could cause a pulmonary
ciency, presented at the hospital with dys- disorder?
pnea at small physical exercises, tachycar-
dia, a cyanosis of his lips, bubbling rales A. Acute insufficiency of left ventricle
in the inferior segments of lungs, leg’s B. Acute general anemia

C. Acute insufficiency of right ventricle both lungs. In addition, disseminated foci

D. Ischemia of small circle of a caseous necrosis, 5mm-2 cm in diame-
ter, were found in the lower lobes of lungs.

280. A 39-year-old milkmaid died of cardio- Diagnose the tuberculosis form.
vascular insufficiency. A post-mortem A. Secondary fibrocavernous
reveled in the aortal valve a polypous-
B. Secondary fibre-inflammatory
ulcerative endocarditis. A microscopical
study of the valve showed the polymorph C. Gematogenic inflammatory with lesion
cellular inflammatory infiltration, zones of of lungs
destruction and thrombuses with the or- D. Primary, growth of primary affect
ganization. In addition, a sclerosis with
granulomas, consisted of randomly located 283. A-post-mortem of a pregnant woman
epithelioid, giant, plasmatic, eosinophyie revealed a brain edema, hemorrhagic
cells were diagnosed within a stroma of pneumonia, motley liver with a hemor-
a myocardium. A vasculitis was also de- rhage. Microscopic study showed dissemi-
termined in the heart vessels. For what nated blood clotting of vessels, plural fine
disease the described changes in heart are necroses, and hemorrhages in internal or-
characteristic? gans. In addition, in kidneys there were
A. Brucellosis found cortical necroses and a fibrinoid
necrosis of a tubules epithelium within a
B. Chronic sepsis nephron. What is the most likely diagno-
C. Rheumatic disease sis?
D. Systemic lupus erythematosus A. Eclampsia
B. Pre-eclampsia
281. A 45-year-old woman with a medical
history of a menstrual cycle disturbance C. Septicopyemia
had curettage of the uterine cavity to D. Septicemia
obtain endometrial tissue for histopatho-
logic analysis. Microscopic investigation 284. year-old male, with a history of kidney
revealed the increased quantity of the en- transplantation, followed by immunosup-
dometrial glands, their form irregularity. pressive therapy, died of intoxication. A
Some of glands were dilated or had a saw- histological investigation of his lungs, kid-
like pattern. What is the most likely diag- neys and pancreas revealed strikingly en-
nosis? larged (giant) cells with basophilic cyto-
plasm and large nucleus. The violet in-
A. Cystic glandular hyperplasia of en-
tranuclear inclusions surround by a small
dometrium
clear halo, reminded an eye of an owl.
B. Placental polyp What is the most likely diagnosis?
C. Atypical hyperplasia of endometrium A. Cytomegaly
D. Glandular polyp of endometrium B. Tuberculosis
282. A 40-year-old prisoner died in peniten- C. Syphilis

tiary of tuberculosis. An autopsy revealed D. Lepra
a deformation and reduction of the both
lungs apexes, plural cavities with dense, 285. interstitial fluid
2-3 mm thick walls in the upper lobes of A. fluid placed between the tissue spaces

B. process of recording the lymphatic was a minimal inflammatory reaction and

vessels or lymph nodes to detect prob- also noticeable amount of a brownish dust.
lems What is the most likely type of pneumoco-
C. proteins that signal cells to start the niosis in this case?
immune response A. Silicosis
D. none of above B. Talcosis
286. A 3-year-old girl presented with a sharp C. Asbestosis
NARAYAN CHANGDER
pain at the swallowing, a marked neck D. Siderosis
edema, and the body temperature raised
to 40◦ C. A gross investigation of ton- 289. A 12-year-old boy with a history of acute
sils revealed the grayish-yellowish mem- tonsillitis two weeks ago presented with
branes, which left a raw surface with edematous face in the mornings, increas-
bleeding ulceration, when forcibly re- ing of arterial pressure, urine in a kind
moved. What is the most likely diagno- of “meat slops”(’coca-cola’ colour). Im-
sis? munohistochemistry of kidneys biopsy re-
A. Diphtheria vealed immune complexes on basal mem-
branes of capillaries and within glomerular
B. Scarlet fever
mesangium. What disease has developed
C. Measles at the patient?
D. Meningococcal nasopharyngitis A. Acute glomerulonephritis
287. A young man presented with rash in the B. Acute interstitial nephrite
form of roseolas and small hemorrhages C. Necrotic nephrosis
(petechias) on a skin of a stomach, tho-
rax and petechial rash on eyes conjunc- D. Acute pyelonephritis
tiva. Lesion of his brain soon resulted
in his death. A microscopical investiga- 290. Where do T cells mature?
tion revealed in destructive-proliferative A. blood
endo-trombovasculitis in medullar oblon-
gata and pons of a brain, also in a skin, kid- B. bone marrow
neys and myocardium. What is the most C. thymus
likely disease?
D. tonsils
A. Epidemic typhus
B. Sepsis 291. A 54-year old male, with a history of de-
structive purulent bronchitis died of mul-
C. Periarteritis nodosa tiple organ failure. An autopsy revealed
D. Systemic Lupus Erythematosus cardiomegaly, a sebaceous (waxy) kidney
and a sago spleen. What process has com-
288. An autopsy of the miner, who had plicated bronchitis?
worked in coal mine more of 10 years, re-
vealed in a lung whitish fibrous fibers and A. Secondary amyloidosis
nodules 0, 2-0, 3 cm in diameter. His- B. Senile amyloidosis
tological investigation of nodules showed
C. Primary amyloidosis
bundles of interacting concentric pink col-
lagen with apparent hyalinosis. There D. Generalized hyalinosis

292. An autopsy of the 68-year-old man re- 296. autoimmune disease

vealed a sallow-grey colour of his skin A. an immune response to one own’s
with petechial hemorrhages. His face and

body tissue; destruction of one’s own
tongue had a powdery ‘uremic frost’. Fib- cells by the immune system
rinous hemorrhagic laryngitis, a tracheitis,
a shaggy pericardium and a catarrhal gas- B. proteins that can attach to foreign
troenterocolitis were also diagnosed. For cells, labeling them for destruction
what syndrome the given complex of mor- C. accumulation of fluid in body tissues
phological changes is characteristic? due to obstruction of lymphatic structures
A. Chronic renal insufficiency D. none of above
B. Acute hepatic insufficiency 297. spleen
C. Acute renal insufficiency A. an organ that stores and produces red
D. Chronic heart insufficiency blood cells and gets rid of bacteria
B. an organ important in immunity
293. The biopsy is taken from a suspicious site
at the mucous the right bronchus of a 58- C. an organ that filters bacteria
year old male, with a history of the chronic D. none of above
bronchitis, pneumosclerosis and cardiopul-
rnonary insufficiency. Flistological investi- 298. Swelling of the body caused by an abnor-
gation revealed cellular and tissue atypia, mal grouping of lymph.
presence of a “cancer pearls” structures. A. Lymphedema
What pathological process associated with
B. Lymphedemine
histological changes listed below?
C. Lymphoma
A. Squamous cell keratinous carcinoma
D. Non Hodgkin’s Lymphoma
B. Chronic polypous bronchitis
C. Bronchiectasis 299. radiation and chemotherapy
D. Squamous metaplasia of the bronchial A. treatment of lymphoma
epithelium B. treatment of lymphedema
294. Two main organs of the lymphatic system C. treatment of lymphadenitis
are: D. none of above
A. Thymus & Pancreas
300. An autopsy of a 45-year-old man, who
B. Spleen & Thymus died on the 5th day of typhoid fever, re-
C. Pancreas & Thyroid vealed groups of enlarged, hyperemic lym-
phoid follicles in small bowel. The folli-
D. Tonsils & Thyroid
cles protruded above the mucosal surface;
295. pentameter; very efficient in combining their surface reminded brain’s gyri and
with fungi sulci. Microscopical investigation showed
hyperemia, edema and granulomas forma-
A. IgG tion. Specify, what period of local changes
B. IgM of typhoid is the most likely?
C. IgA A. Stage of medullar swelling
D. IgE B. Necrotic stage

C. Stage of healing E. Leptospirosis

D. Stage of pure ulcers 304. A histological study of a biopsy from
an oral cavity ulcer revealed the foci
301. An autopsy of a 58-year-old female re-
of caseous necrosis surrounded with
vealed in myocardium a large, dense, grey
plasmocytes, epithelioid, lymphoid cells
focus, which histologically consisted of the
and solitary giant multinucleated Pirogov-
rough connective tissue fibers. It was
Langhans’ cells. There were also signs of
surrounded by the hypertrophied muscular
endo-and a perivasculitis in fine vessels.
NARAYAN CHANGDER
fibers. What changes arose up in a heart?
Specify the disease.
A. Postinfarction Cardiosclerosis
A. Syphilis
B. Ischemic stage of myocardial infarc-
B. Tuberculosis
tion
C. Leprosy
C. Necrotic stage of myocardial infarc-
tion D. Rhinoscleroma
D. Diffuse Cardiosclerosis 305. An autopsy of a 48-year-old man, with a
history of typhoid fever, revealed groups
302. An autopsy of a 48-year-old man re- of enlarged lymphoid follicles in small
vealed in the first segment of the right bowel. The follicles protruded above the
lung the round formation, 5 cm in diame- mucosal surface; they had a grey-red color-
ter, surrounded with a thin connective tis- ing, juicy appearance and a surface, which
sue layer. The centre was presented by reminded gyri and sulci. Microscopical in-
write, brittle masses. Diagnose the form vestigation showed granulomas formation.
of secondary tuberculosis. Specify, what of the listed stages of ty-
A. Tuberculoma. phoid is the most likely?
B. Caseous pneumonia A. Medullar swelling
C. Acute cavernous tuberculosis B. Necrotic
D. Acute inflammatory tuberculosis C. Formation of ulcers
D. Pure ulcers.
303. A 25 years old patient was admitted
to the infectious department on the third 306. A lung lobe was removed at Surgery De-
day of illness with complains on headache, partment due to preliminary diagnosed pu-
backache, pain in calf muscles, high fever, rulent inflammation of a cyst. A gross in-
chills. The state is moderate. Scleras are vestigation of the operative material re-
icterus. The tongue is dry, coated with dry vealed within the 8 segment a dense focus
brown cover. Abdomen is floated. Liver with irregular roundish form, 1, 8 cm in di-
is + 2 cm. Spleen is not enlarged. Palpa- ameter. On a cut, it had white-yellow col-
tion of muscles, especially calf, is painful. oring with a dim surface and fine sites of
Urine is dark. Feces are of normal color. osteal density. The described macroscopi-
What is the most probable diagnosis cal picture characteristic for:
A. Yersiniosis A. Tuberculous affect with healing
B. Viral Hepatitis A B. Peripheral carcinoma of lung
C. Malaria C. Chondromas
D. Infectious mononucleosis D. Carnification

307. A 33 years old patient was hospitalized D. none of above

to the infectious hospital on the 7th day
of the illness with complaints on severe 310. A 19 years old citizen of Nigeria became

weakness, high fever, pain in the leg mus- ill acutely. There were strong chills, which
cles and lower back, jaundice, dark urine, lasted for an hour and changed by feeling
headache. He became ill acutely with of heat. Headache, aching and aching pain
fever, increasing of the body temperature in muscles are observed. In a day an at-
to 40◦ C, headache, pain in the calf muscles tack repeated. Objectively:t-39, 6◦ C. Scle-
and lower back. On the 4th day of the ill- ras are icterus. There is herpes on the lips.
ness jaundice appeared, on the fifth day The spleen and liver are enlarged. What in-
nosebleeds and bleeding in the scleras are vestigation should be done to confirm the
noticed. Duration of the fever is 6 days. diagnosis?
Diuresis is 200 ml. What is the most prob- A. Ultrasonography of the abdomen or-
able diagnosis? gans
A. Viral hepatitis B. Microscopy of urine centrifugate
B. Typhoid C. Determination of activity of ALT, AST
C. Leptospirosis D. Bacteriologic analysis of blood
D. Sepsis E. Microscopy of peripheral blood
E. Yersiniosis
311. A 28-year-old woman died in the postna-
308. The woman of 45 years within sev- tal period. A post-mortem revealed a puru-
eral years has difficulties at swallowing. lent endometritis and thrombophlebitis of
She also notes the limitation of fingers a uterus veins, plural abscesses of lungs,
movements at printing on the computer kidneys and a spleen. In addition, there
keyboard, though joints are not painful. were an apostematous myocarditis and pu-
Physical investigation revealed her “stony rulent meningitis. What is the most likely
face” (no wrinkles) owing to tightening kind of a sepsis?
of the facial skin and restricted motion
A. Septicopyemia
of the mouth. The skin biopsy showed a
widespread fibrosis of a derma without B. Septicemia
inflammatory infiltration. Diagnose dis- C. Chroniosepsis
ease on the listed clinical and morpholog-
ical data. D. The prolonged septic endocarditis
A. Scleroderma 312. A died woman had a chronic pulmonal ab-

B. Lupus erythematosus scess in her medical records. An autopsy
revealed in 2nd segment of the right lung
C. Dermatomyositis a roundish cavity, 5cm in the size. The
D. Amyloidosis internal surface of a cavity was created
by caseous masses; the external one-by
309. swelling, pain, tenderness in the lymph a dense pulmonal tissue. A pyogenic mem-
gland, node, or both brane was absent. What is the most likely
A. signs and symptoms of lymphoma pathology?
B. signs and symptoms of lymphedema A. Acute cavernous tuberculosis
C. signs and symptoms of lymphadenitis B. Fibrocavernous tuberculosis

C. Acute abscess. 316. A 53-year-old female died from acute

D. Chronic abscess. myocardial infarction. An autopsy re-
vealed multiple whitish dense plaques
313. A 5-year-old child presented with raised in her coronal arteries’ intimae, which
body temperature, punctulated rash, and bulged in and narrowed the vessel’s lumen.
conjunctivitis. He died of the super- Name the most likely stage of a coronary
imposed pneumonia. A histological re- atherosclerosis?
search of lungs revealed endo-mezo- A. Liposclerosis
NARAYAN CHANGDER
panbronchitis and giant-cell pneumonia.
B. Lipoidosis
For what disease the presented changes
are characteristic? C. Atheromatosis
A. Measles D. Ulceration
B. Scarlet fever 317. What part of the lymphatic system filters
C. Diphtheria foreign material from blood and destroys
old RBCs?
D. Croupous pneumonia
A. spleen
314. An autopsy of 48-year-old patient,
B. lymph nodes
who died from the complications of
hypertensive disease, revealed small, C. thymus
dense kidneys with fine-grained surface. D. lymphatic vessels
Parenchyma and cortex matter were atro-
phied. Give the name for such kidneys 318. Which of the following are small masses
of lymphatic tissue found through the ilium
A. Primary-scarring kidneys
region of the small intestine?
B. Amyloidal-scarring kidneys
A. Tonsils
C. Secondary-scarring kidneys
B. Thymus
D. Pyelonephritic-scarrmg of kidneys
C. Spleen
315. A histological investigation of the en- D. Peyer’s patch
larged cervical lymph nodes revealed the
nodules consisted mainly of flat, slightly 319. antibiotics compression therapy, surgical
extended cells with pale nucleus. There intervention depending on cause
were also giant cells with spherical-oval A. treatment of lymphoma
form, light pink cytoplasm and with nuclei
B. treatment of lymphedema
located on a cell periphery. The centre of
some nodules was presented with the un- C. treatment of lymphadenitis
structured, light pink colored masses. The D. none of above
described changes are characteristic For:
A. Tuberculosis 320. Severe itching due to hives is called:
B. Lymphogranulomatosis (Hodgkin’s dis- A. urticaria

ease) B. anaphylactic shock
C. Sarcoidosis (Boeck’s disease) C. dyscaria
D. Brucellosis D. sarcoidosis

321. All of the following are functions of B. Purulent hepatitis

lymph nodes EXCEPT
C. Cirrhosis of the liver

A. produce red blood cells
D. Toxic dystrophy of the liver
B. produce lymphocytes
C. protect the body by developing immu- 325. The abbreviation for injection is
nity A. in
D. filter lymph
B. inject
322. The Lymphatic System is part of the C. inj
and systems.
D. none of above
A. Nervous, Digestive
B. Circulatory, Skeletal 326. A 52-year-old man with a history of
C. Circulatory, Immune hematogenic tuberculosis presented to the
hospital with hyperpigmentation skins
D. Muscular, Cardiovascular (melanosis) and mucosas, a cachexia, car-
323. A post-mortem of a 40-year-old patient, diovascular insufficiency. What disease
with a 10 years history of tuberculosis, re- caused such changes?
vealed a cavity in the 1 and? segments of A. Addison’s disease
his right lung. It had dense walls. The in-
ner layer was rough, with beams formed B. Pheochromocytoma
by the obliterated bronchi and the throm- C. Simmonds’ disease
bosed vessels. The middle and lower lobes
D. Itsenko-Cushing disease
were firm, with the yellow foci on a cut
surface. What form of tuberculosis is the
327. A 56-year-old woman with a long his-
most likely in that case?
tory of parathyroid glands disease, died
A. Fibrocavernous from increased renal insufficiency. A post-
B. Acute cavernous mortem revealed a bones deformation of
extremities, a vertebral column, and ribs.
C. Fibrous inflammatory
Bones were fragile, soft and easily de-
D. Tuberculoma formed or cat. They had some mot-
ley tumorous formations. Kidneys were
324. A patient presented with vomiting, loss
contracted. Histological investigation re-
of appetite and jaundice. A histological
vealed lacunar bone resorption. In ad-
investigation of his liver biopsy revealed
dition, a microscopic study demonstrated
vacuolar and ballooning dystrophies of
giant cell granulomas within the centres
hepatocytes and necrosis of some cells.
of tumorous formations, accumulations of
The Councilman’s bodies were also deter-
erythrocytes and a hemosiderin. Name the
mined. Besides, a destruction of the liver’s
described disease.
beam architecture within lobes and inflam-
mation consisted mainly of chronic inflam- A. Parathyroid osteodystrophy
matory cells, lymphocytes, plasma cells B. Metastases of cancer in a bone
and histiocytes were registered. What
form of virus hepatitis is most likely? C. Chronic renal insufficiency
A. Viral hepatitis D. Paget’s disease

328. A histological investigation of a gastric A. Septicopyemia

biopsy revealed a thinning of a stomach B. Septicemia
mucosa with reduction of a glands quan-
tity. This was accompanied with a con- C. Chroniosepsis
siderable growth of a connecting tissue, D. Lung sepsis
dilation of a glands lumen, lymphocytes
and plasmocytes infiltration of the mucosa. 332. A post-mortem of the patient who died
What is the most likely diagnosis? from uremia revealed deformation of a
spine column with severe restriction of
NARAYAN CHANGDER
A. Chronic atrophic gastritis
its mobility. Articular cartilages of spine
B. Chronic superficial gastritis joints were destructed with persistent
C. Chronic atrophic gastritis with an in- chronic inflammation in tissues of joints.
testinal metaplasia The joints cavities filled with connective
tissue, in some places leading to ossifica-
D. Phlegmon of stomach
tion and ankylosis formation. In an aorta,
329. Lymphoid tissue that appears as swelling heart, lungs a chronic inflammation and a
of the mucosa in the oral cavity is call a(an) focal sclerosis were discovered. In kidneys
an amyloidosis was recognized. What di-
A. Sore throat
agnosis in this case is most probable?
B. Fractured lymph node
A. Ankiloid spondiloartritis (the Be-
C. Swollen tongue hterev’s disease)
D. Tonsils B. The Pedget’s disease (deforming osto-
330. A postmortem of a 58-year-old male resis)
vealed in kidneys asymmetrical, coarse, C. Rheumatoid arthritis.
corticomedullary scars. Histological inves- D. Parathyroid osteodystrophy.
tigation of a kidney showed atrophy of
cyst-like dilated tubules, filled with col- 333. year-old child presented with a body tem-
loid eosinophilic masses. Interstitium was perature up to 40◦ C, an acute headache,
characterized by pronounced periglomeru- vomiting, anxiety and a fever. In four
lar sclerosis. What diagnosis is most prob- days appeared a hemorrhagic skin rash, an
able oliguria and adrenal insufficiency, resulted
A. Chronic pyelonephritis with scarring in patient’s death. A bacteriological study
of smear preparation from a pharynx re-
B. Chronic glomerulonephritis with scar-
vealed a meningococcus. What form of dis-
ring of kidneys
ease is found out?
C. Amyloidosis of kidneys
A. Meningococcemia
D. Tuberculosis of kidneys
B. Meningococcal meningitis
331. A young woman with a history of the out- C. Meningocephalitis
of-hospital abortion presented with ad-
vanced purulent endomyometritis resulted D. Meningococcal nasopharyngitis
in a lethal outcome. A post-mortem re- 334. physical examination, blood culture,
vealed numerous abscesses of lungs, pus- biopsy to confirm diagnosis
tules under kidneys’ capsule and spleen hy-
perplasia. What form of a sepsis has de- A. Diagnosis of lymphoma
veloped? B. diagnosis of lymphedema

C. diagnosis of lymphadenitis 338. An autopsy of a man with a history of tu-

D. none of above berculosis revealed in the second segment
of the right lung the white-grey focus, 3

335. A 62-year-old woman presents to her cm in diameter, surrounded with a capsule.
physician with considerable deformation Microscopic study showed a focus of necro-
of metacarpal phalangeal and feet joints. sis with a capsule and lack of a perifocal in-
Histological examination of the soft tis- flammation. Name the tuberculosis form.
sues adjacent to the joints revealed a A. Tuberculoma
mucoid swelling of the connective tissue,
areas of a fibrinoid necrosis surrounded B. Acute cavernous tuberculosis
by palisading epithelioid macrophages and C. Fibrocavernous tuberculosis
sclerosis. Few ‘rice bodies’ were found
D. Cirrhotic tuberculosis
within a synovia! cavity. What is the most
likely diagnosis? 339. The medical term that means to cut into
A. Rheumatic arthritis the spleen is:
B. Rheumatism A. splenectomy
C. Behterev’s Disease B. splenotomy
D. Hematogenic tuberculosis C. splenoplexy
336. Storage of blood platelets is done by the D. splenoplasia
340. Which of the following is true about the

A. Stomach lymphatic system?
B. Liver
A. Lymph flows towards the heart
C. Spleen
B. Lymph flows away from the heart
D. Lymph Nodes
C. Lymph is mostly made of plasma
337. In 42 years old patient attacks of fever D. Lymph is only found in lymph nodes
appear every 48 hours for a week and
then change to heating. The body temper- 341. An autopsy of a 54-year-old man reveled
ature rises to 40◦ C. Reduction of temper- above valvular rupture of an aorta with
ature accompanied by excessive sweating resulted in a cardiac tamponade. Histolog-
in 3-4 hours. Appetite worsened, general ical investigation of ascending part of an
weakness appeared. Skin is pale with sal- aorta showed in its external and middle
low shade. Liver and spleen are enlarged layers inflammatory infiltrates. They con-
and dense by palpation. Which is the most sisted of lymphoid, plasmatic and epithe-
effective method of confirming of the diag- lioid cells. There were also recognized the
nosis? necrosis centers and proliferation of a ves-
A. Microscopy of blood smear and thick sels’ wall. Changes in an aorta are charac-
film teristic for:
B. Complete blood A. Syphilitic aortitis
C. Bacteriological method B. Septic aortitis
D. ELISA C. Rheumatic aortitis
E. Microscopy of hanging blood drop D. Atherosclerosis

342. inflammation of lymph glands, nodes, or clumped together and had intraglandular
both papillary protrusions. Some glandular
A. definition of lymphoma cells exhibited the signs of nuclear and cy-
toplasm polymorphism. What is the most
B. definition of lymphedema likely diagnosis?
C. definition of lymphadenitis A. Atypical hyperplasia of endometrium
D. none of above
B. Cystic glandular hyperplasia of en-
343. A 32-year-old man suddenly died during dometrium
NARAYAN CHANGDER
the emotionally strained work. An au- C. Glandular hyperplasia of endometrium
topsy revealed uneven myocardium blood
D. Glandular polyp of endometrium
supply. Histochemical investigation de-
tected a decrease of the amount of glyco- 347. The combining form that means lymph
gen. Electron-microscopical study showed vessel is:
a destruction of mitochondria, the contrac-
A. lymphaden/o
tures of myofibrils. What is the most
likely disorder of a blood circulation? B. lymphangi/o
A. Acute ischemia C. lymph/o
B. Chronic ischemia D. splen/o
C. Vacating arterial hyperemia 348. A gross investigation of a brain at a post-
D. Acute vein hyperemia mortem revealed the edema, a plethora,
and fine hemorrhage in medulla oblongata.
344. The enlargement of 1 or several lymph A microscopical investigation showed a
nodes is called: chromatolysis, hydropy and a necrosis of
A. Lymphoma nervous cells. In addition, the eosinophilic
B. Autism intracytoplasmic formations (little bodies
the Babesh-Negri bodies) were defined
C. Lymphadenopathy in pyramidal neurons of the hippocam-
D. Cancer pus. What diagnosis answers the de-
scribed morphological implications?
345. immunoglobulin
A. Rabies
A. proteins that can attach to foreign
cells, labeling them for destruction B. Meningococcal meningitis
B. inflammation of the lymph nodes C. Encephalitis
C. resembling or pertaining to lymph tis- D. Encephalomyelitis
sue
349. Microscopic study of appendix deter-
D. none of above mined intensive leukocyte infiltration
346. A 52-year-old woman, with a medical throughout all its layers. What is the
history of the menstrual cycle disturbances most likely type of inflammation?
and hemorrhages, had curettage of the A. Suppurative appendicitis
uterine cavity. Histological investigation B. Apostematous appendicitis
revealed the increased quantity of the en-
dometrial glands. Many glands had a mor- C. Gangrenous appendicitis
phological pattern of a proliferation phase, D. Superficial appendicitis

350. A 20 years old patient entered the in- disease the described changes in lungs are
fectious hospital on the 7th day of ill- characteristic?
ness with complains on jaundice of skin

A. Caseous pneumonia
and scleras, dark color of urine, non-
permanent vomiting, decreased appetite, B. Infiltrative tuberculosis
the increase of temperature to 38, 0◦ C C. Croupous pneumonia
during 2 days. He went fishing with his D. Lymphogranulomatosis of lungs
friends 3 weeks ago and used one crock- (Hodgkin’s disease)
ery. Objectively:The patient is sick . T is
38, 0◦ C. Skin and scleras are icterus. The 354. A histological investigation of a thy-
liver comes forward from under the costal roid revealed a considerable infiltration
arc on 3cm, sensitive by palpation. Spleen of a gland by lymphocytes with forma-
is not palpated. Urine is dark. Stool is tion of lymphoid follicles, a destruction of
partly acholic. What is previous diagno- parenchyma, growth of connective tissue
sis? fibers. What is the most likely disease pre-
A. Infectious mononucleosis sented in that case?
B. Viral hepatitis A A. Hashimoto’s goiter
C. Leptospirosis B. Colloid goiter

C. Endemic goiter
D. Hemolytic anemia
D. Diffuse toxic goiter
E. Intestinal yersineosis
355. A child complains of the general weak-
351. -immune ness, a pharyngalgia at swallowing and
A. immunity; safe nausea. Objectively, a bright redden-
ing revealed in fauces; tonsils were en-
B. lymph node
larged. Later, the fine, densely located
C. spleen maculae, size about papaverous grain, ap-
D. none of above peared on a neck, in the top of a back
and a breast. Microscopical investigation
352. Macrophages showed in a mucosa and tonsils tissue an
acute plethora and grayish, dim areas of
A. Keep bacteria from replicating
necroses. On the periphery of the necrotic
B. Bind to viruses zones, within the edema and fibrinous in-
C. “Eat” foreign cells flammation areas, the chains of strepto-
coccuses were defined. What is the most
D. Alert killer T cells likely diagnosis?
353. An autopsy of a 40-year-old man with a A. Diphtheria
history of AIDS revealed both lung lobes B. Scarlet fever
enlarged, dense, air free, with fibrinous
membranes on pleura. A gross investiga- C. Meningococcal nasopharyngitis
tion of a cut surface showed the yellow D. Measles
dim pulmonal tissue. A histological investi-
gation determined in alveoli the seroftbri- 356. Which of the following are popularly
nous and fibrinous exudate with large foci called lymph glands?
of a pulmonal tissue necrosis. For what A. Lymphatic capillaries

B. Lymphatic vessels 360. A 72-year old female died of severe

grippe. A post-mortem revealed “the
C. Lymph nodes
big motley lungs”. Histological investi-
D. Lymph gation showed acute hyperemia, hemor-
rhages, an edema of a pulmonary tissue,
357. A 42-year-old patient, with a history of erythrocyte-rich exudate that, filled the
dysentery, presented with symptoms of bronchi and alveoli. What is the most
paraproctitis. What is the most probable likely kind of pneumonia?
stage of local changes presented in that
NARAYAN CHANGDER
case? A. Hemorrhagic bronchopneumonia
B. Catarrhal bronchopneumonia
A. Formation of ulcers
C. Purulent bronchopneumonia
B. Fibrinous colitis
D. Desquamative bronchopneumonia
C. Follicular colitis
D. Catarrhal colitis 361. A 38-year-old man died of diffuse fib-
rinopurulent peritonitis. A post-mortem
358. A 42-year-old woman presented with revealed an ulcer in a small bowel, which
dysfunctional uterine bleeding. A histo- replicated a form of a Peyer’s patch and
logical investigation of a curettage mate- perforated the intestine’s wall. Micro-
rial revealed increased quantity of coiled scopical investigation showed an alter-
glands and their cystic dilation. What is ation of lymphoid tissue pattern with re-
the most likely diagnosis? placement of lymphocytes by proliferating
monocytes, followed by granulomas for-
A. Cystic glandular hyperplasia
mation. The complication of what disease
B. Atrophy resulted in patient’s death?
C. Metaplasia A. Typhoid
D. Displasia B. Dysenteries
C. Cholera
359. A histological research of an autopsy ma-
terial revealed in a brain tissue a wide D. Brucellosis
zone of proliferating microglia cells round
362. A post-mortem revealed the enlarged kid-
small vessels. In addition, the marked pro-
neys with a lobulated surface due to plural
liferation of an endothelium, an adventitia
cavities, with the smooth wall, filled with
and pericytes were determined in the skin
a transparent liquid. What is the most
vessels. Perivascular moderate lympho-
likely disease?
cytes infiltration with single neutrophiles
added was also found. The vessels walls A. Renal cystic disease
underwent various signs of destruction. B. Necrotic nephrosis
Name the causative organism of described
infection disease? C. Pyelonephritis
D. Glomerulonephritis
A. Rickettsia
B. Spirochete 363. A 52-year-old male had a long history
of hypertension. He presented to emer-
C. Meningococcus
gency care physician with complains of an
D. Streptococcus acute, persisted for few hours rise of a

blood pressure. What is the most likely A. Tuberculosis

alteration of the arterioles’ walls due to B. Sarcoidosis (Boeck’s disease)
hypertonic crisis?

C. Rhinoscleroma.
A. Fibrinous necrosis
D. Glanders
B. Hyalinosis
C. Sclerosis 367. Antibody concentration is increased in al-
lergic individuals
D. Amyloidosis
A. IgG
364. An autopsy of a 52-year-old man re-
B. IgM
vealed in sigmoid and rectum plural brown-
green membranes, hemorrhages, some C. IgA
blood in the lumen of intestine. Histolog- D. IgE
ical study showed a fibrinous colitis. Bac-
teriological investigation found S. Sonne. 368. An autopsy of 48-year-old female re-
What is the most likely diagnosis? vealed a mitral stenosis with valve’s in-
competence. Histological investigation
A. Dysentery
showed the post-inflammatory cardioscle-
B. Cholera rosis and Aschoff-Talalayev nodes (granu-
C. Salmonellosis lomas). What is the most likely diagno-
sis?
D. Yersiniosis
A. Rheumatism
365. A patient died from progressive cardiac
B. Systemic scleroderma
insufficiency. An autopsy revealed a flac-
cid, dilated in diameter heart. A cut sur- C. Dermatomyositis
face investigation showed the irregular D. Nodular periarteritis
blood filling of a myocardium, resulted in
the patchy pattern of its tissue. A histo- 369. A 38-year-old man died of intoxication.
logical study determined a hyperemia of A post-mortem revealed in a small bowel
myocardium and stromal accumulations of an edema of lymphoid follicles groups. The
small mononuclear cells. The described follicles protruded above the mucosal sur-
morphological changes present: face like a soft plaques with irregular sur-
face pattern, which reminded brain’s gyri
A. Nonpurulent interstitial myocarditis
and sulci. What diagnosis is most proba-
B. Vein plethora ble?
C. Fatty dystrophy of myocardium A. Cholera
D. Cardiosclerosis B. Dysentery
366. A 7-year-old boy with a history of ton- C. Salmonellosis
sillitis presented with markedly enlarged D. Typhoid
paratracheal, bifurcate and cervical lymph
nodes. A microscopical investigation of 370. An autopsy of a 53-year old patient, with
the removed cervical lymph node revealed a history of a chronic alcoholism and re-
the centers of a necrosis surrounded with peated attacks of an alcoholic hepatitis,
lymphocytes, epithelioid cells and Pirogov- revealed a firm, yellow color liver with
Langhans cells. Specify the most likely pointed edge. A liver surface was coarsely
pathology. scarred with multiple fine knots on a cut

surface. What is the most likely diagno- revealed fibrinous-hemorrhagic inflamma-

sis? tion in a larynx and trachea mucosa, en-
A. Cirrhosis of liver larged lungs. On a cut section lungs had
a motley pattern due to areas of pneu-
B. Cancer of liver monia, hemorrhages in lung parenchyma,
C. Fatty dystrophy of liver acute abscesses and atelectases. In addi-
tion, circulative disturbances and dystro-
D. Chronic hepatitis.
phies were determined in internal organs.
NARAYAN CHANGDER
371. A 64-years-old male died from uremia.
At autopsy revealed reduced in sizes kid- A. Influenza, severe form
neys, with 50.Og weight. Their surfaces
B. Influenza, moderately severe form
were regularly granulated; the cortexes
were thin. A microscopic study showed C. Parainfluenza
considerably thickened walls of glomeralar D. Respiratory syncytial infection
arterioles due to deposition of homoge-
neous unstructured pink masses. The lu- 374. Which is the simplest lymphatic organ?
mens of these vessels were markedly nar- A. Spleen
rowed; nephrons were diminished with
B. Tonsils
sclerotic changes, tubules were atrophic.
For what disease the described changes C. Thymus
are characteristic? D. Peyer’s patch
A. Hypertension E. Cervical node
B. Chronic glomerulonephritis
375. An autopsy of a child, with a history
C. Amyloidosis of kidneys of diarrhea, revealed an exicosis and
D. Pyelonephritis with scarring of kidneys a widespread fibrinous colitis. A mu-
cosal smear imprint study showed gram-
372. A patient, the inhabitant of a seaside negative rod bacteria. What is your diag-
city in the south of the country, presented nosis?
to the hospital with severe diarrheas and A. Dysentery
vomiting, resulted in his death from dehy-
dration. An autopsy revealed an acute gas- B. Cholera
troenteritis with serous-desquamative in- C. Typhoid
flammation in a small bowel. Choose the
D. Salmonellosis
most likely diagnosis.
A. Cholera 376. What insect carries the worm larvae that
causes Filiariasis?
B. Bacterial dysentery
A. Mosquitos
C. Typhoid
B. Flies
D. Amebiasis
C. Humming birds
373. . A 66-year-old man presented with D. Ticks
acute tracheitis and bronchitis, soon re-
sulted in bronchopneumonia. He died 377. Histological investigation of a rectum
on the 12th day at the hospital from revealed large areas of necrosis in mu-
the pulmonal-heart failure. An autopsy cosa. Necrotic masses were impregnated

by fibrin, resulting in membrane forma- 380. A 54-year-old male died after develop-
tion. Mucous and submucous on periphery ing a heart failure. An autopsy revealed
of necrotic zones were hyperemic, edema- a chronic venous hyperemia of the internal

tous, with hemorrhages and leukocytic in- organs, hypertrophy of the left ventricle of
filtration. What is the most likely diagno- a heart and focal cardiosclerosis. Gross in-
sis? vestigation of aorta showed yellow-white
A. Dysentery plaques in the intima with fine-grained
masses in their centers, which infiltrated
B. Cholera
the aortal wall. Give the name of this
C. Typhoid pathological process.
D. Salmonellosis A. Atheromatosis
378. A post-mortem of a patient with a his- B. Lipoidosis
tory of chronic renal insufficiency revealed
C. Liposclerosis
the enlarged, firm, sebaceous (waxy) kid-
neys with multiple retractions on their sur- D. Arteriolosclerosis
face. Histological investigation showed
many glomeruli were replaced by the 381. A post-mortem of the 17-year-old girl,
Congo-Red positive masses. The same who died of a pulmonary insufficiency, re-
substance was found on the basal mem- vealed confluent zones of a caseous necro-
branes of capillaries, in mesangium and sis in the lower lobe of the right lung. The
also within arterial walls and kidneys caseous necrosis was also determined in
stroina. What of the listed diagnoses the broncho-pulmonal, bronchial and bifurca-
most likely? tional lymph nodes. What of the listed di-
agnoses the most likely?
A. Amyloidosis of kidneys
A. Growth primary affect at primary tu-
berculosis
C. Chronic glomerulonephritis
B. Gematogenic form of progress of pri-
D. Subacute glomerulonephritis mary tuberculosis
379. An elderly male, with 20 years history C. Tuberculoma
of hypertension, died from uremia. An au-
D. Gematogenic tuberculosis with lesion
topsy revealed a heart hypertrophy and
of lungs
diffuse cardiosclerosis. There were also
small, dense kidneys with granularity of 382. A 33-year-old woman gave birth to a
their surface. Histological investigation dead fetus with gestational age more
of kidneys tissue showed the collapse than 43 weeks. The fetal skin was dry
of glomerular’s arterioles and sclerosis. and chap. An autopsy revealed a gen-
Some glomeruli were replaced with pink- eral hypotrophy and nuclei of ossification
ish homogenous masses, negative to the (Beclard’s nuclei) in a proximal epiphysis
Kongo-red staining. Tubules were atrophic. of tibial and humeral bones. Amniotic fluid,
Name the kidney pathology? an umbilical cord and placental membranes
A. Primary-scarring kidneys were dyed by meconium. Name the period
B. Secondary-scarring kidneys of the described perinatal Pathology
C. Amyloidosis A. The antenatal period
D. Chronic glomerulonephritis B. The prenatal period

C. The intranatal period from dark red pyramids. Histological in-

D. The postnatal period vestigation showed the absence of nuclei
in epithelium of convoluted tubules, tubu-
383. immune lorrhexis, venous hyperemia. Nuclei of
the cells of vascular glomeruli and straight
A. immunity; safe
tubules were unchanged. What pathology
B. poison of kidneys has developed at the patient?
C. lymph vessels A. Necronephrosis
NARAYAN CHANGDER
D. none of above B. Infarct
384. The environmental substance that causes C. Glomerulonephritis
a reaction is a/an D. Pyelonephritis
A. allergy
387. A 44-year-old man presented to a
B. pathogen
surgery department with diffuse flbrinop-
C. allergen urulent peritonitis. An operation revealed
D. antigen an ulcer of ileum with a perforation. An
ulcer closure, followed by abdomen cavity
385. A patient presented to his physician with drainage was performed. Four days later
expressed immunodeficiency, lymphope- patient died. At post-mortem iliac ulcers
nia with change of parity T-helpers to T- of Peyer’s patches, parallel to the longi-
suppressors, the lesion of a skin of the tudinal axis of the intestine, were found.
lower extremities. The cutaneous pathol- A base of the ulcers was presented by
ogy was characterized by plural tumorous serosa. For what disease such changes are
nodules, dome-shaped purple plaques, in- characteristic?
volved in skin breakdown with resulting
A. Typhoid
fungating lesions. A histological investi-
gation of the skin’s biopsy showed the B. Dysentery
neoplasm of blood vessels, a dilatation C. An intestine tuberculosis
of capillaries, slit-like blood-filled vascular
spaces. What is the most likely diagno- D. Intestinal tumours
sis?
A. Kaposi’s sarcoma hemorrhagic enanthesis (skin rash), mild
B. Basalioma hyperemia and edema of nasopharynx mu-
cous, fine hemorrhages in mucosas and in-
C. Derraatomycosis
ternal organs, severe dystrophy in a liver
D. Phoma of skin and myocardium, an acute necrotic nephro-
sis, ‘massive hemorrhages in adrenals.
386. At the patient operated concerning a What disease is the most likely to present
widespread tumour of an abdominal cav- such symptoms?
ity, the considerable bleeding and declin-
ing of arterial pressure took place. After A. Meningococcal infection
operation the acute renal insufficiency, re- B. Scarlet fever
sulted in the patient’s death, developed.
C. Diphtheria
An autopsy revealed the wide light pink
cortical layer, which was clearly delimited D. Measles

389. The worker of a cattle-breeding farm 392. A physical examination of a young

died in 4, 5 months of the disease begin- woman revealed marked edemas and high
ning. A post-mortem revealed in his in- proteinuria. A histological investigation

ternal organs the granulomas consisted of of kidneys biopsy determined a disappear-
epithelioid, giant Pirogov-Langhans cells, ance of podocytes, a declining of heparan-
plasmocytes and eosinophyles. There sulfate in a basal membrane of glomeru-
were many vessels within a granuloma. lar capillaries. What is the most likely dis-
A histological investigation showed a ease?
productive-destructive vasculitis in the
A. Idiopathic nephrotic syndrome
vessels of internal organs. What is the
most likely disease? B. Postinfectious glomerulonephritis
A. Brucellosis C. Rapidly progressive glomerulonephri-
B. Anthrax tis
C. Tuberculosis D. Chronic glomerulonephritis
D. Epidemic typhus
393. man, with a history of frequent drink-
390. An autopsy of 47-year-old man revealed ing non-boiled water from the river, has
in sigmoid and rectum plural red ulcers developed vomiting and explosive ‘rice-
with irregular form, A mucous between ul- water’ diarrhea. The abdominal pains
cers was covered by dirty grey membrane. were absent; the body temperature did
What is the most likely etiology of the dis- not rise. The intestine biopsy revealed a
ease? plethora, a marked swallowing, an edema
of enterocytes, and some infiltration of
A. Shigella villi by lymphocytes, plasmocytes, and
B. Ameba few leucocytes. What is the most likely
C. Mycobacterium tuberculosis disease?
D. Staphilococcus A. Cholera
B. Salmonellosis
391. A 40-year-old man died of a pulmonary
bleeding. An autopsy revealed in the up- C. Typhoid fever
per lobe of the right lung a cavity, 4cm in
D. Dysentery
diameter, with dense walls and a rough
internal surface, filled with blood clots. A
394. A 52-year-old patient presented with fa-
microscopical study of the wall showed the
tigue, loss of appetite, muscle and joint
inner layer, presented with fell to pieces
aches, an increase in body temperature to
leucocytes; the middle layer formed by ep-
38◦ C. On the 7th day a patient exhibited a
ithelioid, lymphoid and giant multinuclear
yellow color in the skin, urine and around
cells with nuclei located like a horseshoe.
the whites of the eyes and also an acute
The changes found out in a lung are char-
pain in right hypochondrium. A histological
acteristic for:
investigation of his liver biopsy revealed
A. Tuberculous cavern (cavity) a destruction of the liver’s beam architec-
B. Bronchiectatic cavern (cavity) ture, -vacuolar and ballooning dystrophies
of hepatocytes, some cells were necrotic.
C. Abscess of lungs The Councilman’s bodies were also deter-
D. Congenital cyst mined. On the periphery of lobes were

registered the enlarged quantity of mult- C. Rising of blood pressure in the small
inuclear hepatocytes. What form of virus circulatory circle
hepatitis is most likely? D. Scar formation with thinning of wall of
A. Icteric hepatitis the left ventricle
B. Malignant hepatitis 398. At operation of excision of a diffusive
C. Chronic hepatitis thyroid gland struma a patient died from
D. Cholestatic hepatitis acute adrenals insufficiency. An autopsy,
NARAYAN CHANGDER
besides the atrophy of adrenals, revealed
395. A male patient, with 5 days history of a left ventricle hypertrophy in a heart, a
diarrhea, had a colonoscopy. The inves- hypertrophy and an intracellular edema of
tigation revealed a colon mucosa inflam- cardiomyocytes, a serous edema and lym-
mation with grey-green membranes, inti- phoid infiltration of a myocardial stroma.
mately connected with tissue underneath. What is the figurative name of a heart
What is the most likely diagnosis? pathology presented at post-mortem?
A. Dysentery A. Thyrotoxyc heart
B. Typhoid B. Tabby cat heart
C. Nonspecific ulcerative colitis C. Cor bovinum
D. Salmonellosis D. Cor pulmonary
396. A biopsy of cervix uteri was taken from 399. An autopsy revealed substantial enlarge-
the 34-year-old woman. Histological in- ment of a right kidney. A gross investiga-
vestigation revealed the inflammatory in- tion of a renal cut section showed a stone
filtration with involving of fine arteries in it with marked dilation of the pelvis
and veins walls. The infiltrate composed and calyces by urine and thinning of the
of plasmocytes, lymphocytes, and epithe- renal parenchyma. What of diagnoses is
lioid cells. There were also zones of scle- the most likely?
rosis and a tissue hyalinosis. What is the
A. Hydronephrosis
most likely disease?
B. Pyelectasia
A. Syphilis
C. Pyelonephritis
B. Cervical erosion
C. Tuberculosis. D. Cyst of kidney
D. Leukoplakia 400. A 38-year-old patient was on mountain

pastures and then presented to the hos-
397. A 36-year-old man, with acute transmu- pital in severe condition, with high body
ral infarction of the left ventricle’s my- temperature. A physical investigation re-
ocardium, died from the rupture of the vealed the lymph nodes were markedly en-
heart and tamponade. What process could larged, soldered to surrounding tissue, mo-
be a reason of the heart rupture in the tionless, a skin over them was red and
zone of infarction? very painful. A microscopical study of a
A. Autolysis with melting of myocardium lymph node showed the peracute serous-
fabric (myomalacia) hemorrhagic inflammation. For what dis-
B. Substitution of connective fabric in ease it is characteristic?
area of infarction (organization) A. Plague

B. Brucellosis Which drug is the most indicated for etio-

C. Anthrax logic treatment of this patient?

D. Tularemia A. Prednisolone
B. Essentiale-forte
401. An autopsy of the 60-year-old man with
C. Alpha-interferon
a long history of over consumption of alco-
hol revealed the right lung enlarged, firm, D. Carsil
with fibrin fibers on the pleura. On a cut E. Levamisole
section pulmonary tissue had a gray color-
ing. Histological investigation showed the 404. An autopsy of a patient, who had been
exudate within alveoli consisted of fibrin working within 20 years the coal worker,
and disintegrated erythrocytes. What is revealed grayish-black dense, sclerotic
the most likely diagnosis? lungs. The vast areas of collagen tissue
new growth and multiple macrophages,
carrying black pigment within cytoplasm,
B. Focal pneumonia were recognized under microscope. What
C. Intestinal pneumonia is the most likely disease?
D. Primary tuberculosis of lung A. Anthracosis
B. Anthracosilicos Anthracosilicosis is
402. A 24-year-old woman, on a 3rd day af-
ter childbirth, presented with a diffusive C. Silicoanthracosis
edema and painful palpation of the right D. Talcosis
breast. Physical examination revealed hy-
peremia of the breast and a fervescence. 405. An elderly woman, with a long history of
Histological research of a gland’s tissue bronchial asthma, ischetnic heart disease
showed diffusive leucocytes infiltration of and hypertension, presented with hyper-
stroma, an interstitial edema and hypertrophy of her heart’s left ventricle. Name
emia of vessels. What is the most likely the cause of the heart alteration?
diagnose? A. Arterial hypertension
A. Acute phlegmonous mastitis B. Pulmonary insufficiency
B. Acute apostematous mastitis C. Chronic ischemia of cardiac muscle
C. Acute serous mastitis D. Bronchial asthma
D. Chronic purulent mastitis 406. In female P., pig farm worker, amaz-
403. A 36 years old female complains on ing chills, fever to 39, 9◦ C, intensive
general weakness, irritability, feeling of headache and nausea appeared on the
weight under a right rib, subfebrile fever. background of good health. On the next
She had viral hepatitis 4 years ago. These day she noticed pain in the muscles of the
complaints increased gradually for the last lower extremities, nasal bleeding. Objec-
3 months. Objectively:Liver is +3. Labora- tively:on the third day of the illness the
tory:total bilirubin-64.5 mcmol/L:direct- state is severe. The face is hyperemic.
22, 7 mcmol/L, gamma-globulins-31%, There are scleritis and subicterus of scle-
AST-1, 42 mmol / H*L, ALT-1, 96 mmol/ ras. Liver is + 3 cm. Daily diuresis is 700
H*L. The signs of active viral replication ml. What diagnosis do you suppose
(HBe Ag-positive reaction) are presented. A. Leptospirosis

B. Viral hepatitis 411. years-old patient complains on enlarge-

C. Yersiniosis ment of the lymph nodes for the last six
months, progressive weakness, sweating,
D. Influenza periodic rises of the body temperature to
E. Hemorrhagic fever with renal syn- 38, 0◦ C. He has been intravenous injection
drome drug user for several years. The patient is
bad-fed. There is widespread seborrheic
407. A lymphatic structure located in the upper dermatitis. Enlarged, painless cervical, ax-
left quadrant of the abdomen is called? illary and inguinal lymph nodes of the size
NARAYAN CHANGDER
A. Lymph to 2-2, 5cm are palpated. What research
should be appointed in the first place?
B. Lymph fluid
C. Spleen A. Examination of blood for antibodies to
HIV
D. none of above
B. Bacteriologic analysis of blood
408. An autopsy of a 54-year-old man re-
vealed a fibrinous inflammation at colon. C. Biopsy of lymph nodes
What is your diagnosis? D. Examination of blood for antibodies to
A. Dysentery Epstein-Barr virus
B. Amebiasis
412. The goal of the lymphatic system is to
C. Typhoid fever prevent from entering the general cir-
D. Cholera culation.
409. A 53-year-old patient with a history of a A. waste products

chronic glomerulonephritis died of chronic B. nutrients
renal insufficiency. A post-mortem re-
vealed smaller than normal, firm kidneys. C. oxygen
Their capsule was taken out hardly, baring D. hemoglobin
a granular renal surface. On a cut section
a cortical and cerebral layers were thin
413. A 7-year-old child presented with raised
with dry, anemic, grey color kidneys tis-
body temperature up to 38, 5◦ , rhinitis,
sue. How is called such kidneys?
conjunctivitis, and cough. A physical inves-
A. Secondary-scarring kidneys tigation revealed blotchy and papular skin
B. Primary-scarring kidneys rash and whitish bran-like rashes in a buc-
cal mucosa. On the fourth day appeared
C. Atherosclerotic-scarring kidneys a dyspnea and wet pulmonary rhonchuses.
D. Amyloidal-scarring kidneys Soon, difficulty of breath resulted in pa-
tient death from asphyxia. What is the
410. A clear liquid similar to plasma containing most likely diagnosis?
many white cells is called
A. Measles
A. lymphocytes
B. platelets B. Meningococcemia
C. lymph C. Influenza
D. none of above D. Pneumonia

414. The prepuce was removed from a young abundant foul sputum. A gross investiga-
man. A microscopical investigation re- tion of a cut surface showed a honey-comb
vealed the polymorphic infiltrate consist- pattern of a lungs tissue. A microscopic

ing from randomly located plasmatic, lym- study demonstrated the chronic inflamma-
phoid and epithelioid cells. There was tion within bronchial wall and also a re-
marked vessels’ vasculitis. For what displacement of elastic and muscular fibers
ease the described changes are character- by a connecting tissue. These changes in
istic? a lung are regarded as:
A. Syphilis A. Bronchiectasis
B. Tuberculosis B. Bronchopneumonia
C. Actinomycosis C. Chronic bronchitis
D. Periarteritis nodosa D. Chronic pneumonia
415. they know 418. How is lymph moved through lymphatic
A. spark vessels?
B. poison A. Contractions of the small intestine
C. cell B. Blood cells carry lymph through the
D. none of above vessels
C. Contractions of the heart
416. A 56-year-old man died of a progress-
ing heart failure. A post-mortem revealed D. Contractions of skeletal muscle
small, dense lungs; the upper lobes were around the vessels
deformed, penetrated by a cicatrical tissue,
with the encapsulated foci of a caseous 419. A 28-year old female died from uremia.
necrosis, 0, 2-0, 5cm in diameter. In the A post-mortem revealed an enlarged kid-
upper and middle lobes there were cavi- neys, which had a patchy pattern with
ties, 3-4 and 4-5cm in the size, with dense hemorrhages on there surface. Histolog-
walls and fiber internal surface, filled with ical investigation showed eosinophilic de-
the opaque yellow-green liquid. The sur- posits (hematoxilin bodies), “wire loop”
rounding pulmonary tissue was sclerotic. lesions in the basement membrane of the
The heart was enlarged at the expense of glomerular tuft, hyaline thrombi and foci
the hypertrophied right ventricle. Define of fibrinoid necrosis and also ‘onion skin’
the form of secondary pulmonary tubercu- sclerosis at the spleen’s vessels. What is
losis the most likely diagnosis?
A. Cirrhotic tuberculosis A. Lupus erythematosus.

B. Fibrous-focal tuberculosis. B. Rheumatism.
C. Infiltrative tuberculosis C. Systemic scteroderma.
D. Acute cavernous tuberculosis D. Rheumatoid arthritis.
417. A 42-year old male, with a history of the 420. A 48-year-old male presented with a sus-
amyloidosis, died of chronic renal failure. tained high fever, severe headache, a dys-
A post-mortem revealed in the lower lung pnea, palpitation. A physical investigation
lobe multiple dilated bronchi filled with revealed a pediculosis, a rash in the form

of roseolas and small hemorrhages (pe- C. Septic endocarditis.

techias) on his thorax skin. In addition, de- D. Ischemic heart disease.
cubituses of legs and foot gangrene were
also determined. He died of a heart fail- 423. Lymphoma-Cancer of the Lymph
ure. A histological study showed in the A. Vessels
medullar oblongata a hyperemia, stasis,
B. Tissues
perivascular plasmocytes infiltrates and a
proliferation of a microglia (Popov’s granu- C. Nodes
loma). What is the most likely diagnosis?
NARAYAN CHANGDER
D. Pods
A. Epidemic typhus 424. tonsillectomy
B. Antrax meningocephalitis A. excision (removal) of the tonsils
C. Meningococcal meningitis B. inflammation of the lymph vessels
D. Typhoid fever C. an immune response to one own’s
body tissue; destruction of one’s own
421. A 42-year-old woman, who worked at cells by the immune system
a fur atelier, suddenly died. An autopsy D. none of above
revealed dark red, impregnated by blood
arachnoids of the brain’s fornix and base, 425. A condition that results in thick blood due
which reminded a red cap. Microscopical in- to to many red blood cells is called:
vestigation found the serous-hemorrhagic A. hemophilia
inflammation of brain’s membranes and B. hyperlipidemia
tissues with necrosis of fine vessels walls
and numerous hemorrhages. What is the C. thalassemia
most likely diagnosis? D. polycythemia vera
A. Anthrax 426. An autopsy of a 34year-old patient with
B. Cerebral hemorrhage in case of hyper- a long history of rheumatism, revealed
tension disease the epicardial surface of the heart with
shaggy exudate formed by grey strands
C. Cerebral hemorrhage due to trauma which easily separate from underlying tis-
D. Meningococcal infection sues and described as ‘bread-and-butter’
pericarditis (’hairy heart’). What is the
422. A post-mortem of a 19-year old female most likely diagnosis?
revealed multiple furuncles on her skin, A. Fibrinous pericarditis
a warty endocarditis of the heart valves
(Libman-Sacks endocarditis), a focal hem- B. Purulent pericarditis
orrhage under the endocardium, ulcerative C. Hemorrhagic pericarditis
stomatitis, esophagus ulcers, pneumonia, D. Proliferated pericarditis
nephritis, and a spleen hyperplasia with
a perivascular sclerosis. Morphological in- 427. A 48-year-old woman with a grease
vestigation of her brain showed areas of bloody flux from her genital tracts had a
necrosis and signs of vasculitis within tha- diagnostic curettage of her uterus cavity.
lamus. What is the most likely diagnosis? Microscopical research of the uterus curet-
tage material revealed a thinning of a mu-
A. Lupus erythematosus cosal layer, reduction of the endometrial
B. Rheumatism. glands number, a fibrosis of a stroma and

some lymphoid cells infiltration. What is 431. A nonspecific immune response is

the most likely diagnosis? A. inflammatory response

A. Chronic atrophic endometritis B. infection
B. Acute purulent endometritis C. anaphylaxis
C. Chronic cystic endometritis D. hypersensitivity
D. Chronic hypertrophic endometritis
432. A 62-year old patient, with a history of
428. The nurse practitioner gives out immu- chronic virus hepatitis, died of an acute
nization shots for measles, mumps and posthemorrhagic anaemia resulted from
rubella. What type of immunity to these an esophageal varicose veins bleeding. An
diseases would someone get? autopsy revealed the reduced, dense liver
A. Artificial acquired immunity with coarsely scarred surface. A micro-
scopical investigation shpwed regenera-
B. Natural acquired immunity
tive false nodules separated by fibrous
C. Natural immunity tissue, contained the remnants of portal
D. Passive acquired immunity tracts. What morphogenetic type of cirrho-
sis took place in this case?
429. A 38-year-old man presented with an
acute fever, elevated temperature to A. Portal cirrhosis
40◦ C, a headache, a cough and dyspnea. B. Postnekrotic cirrhosis
He died on the 5th day of a disease. An au- C. Mixed cirrhosis
topsy revealed enlarged lungs with a mot-
D. Viral cirrhosis
ley pattern of a pulmonary tissue-“the big
motley lung”. For what disease the de- 433. The lymphatic system has pump(s).
scribed signs are characteristic?
A. One
A. Influenza
B. Two
B. Adenoviral infection
C. Three
C. Croupous pneumonia
D. Zero
D. Respiratory syncytial infection
434. The is a small organ intimately asso-
430. A physical examination of a 68-year-old ciated with the lymphatic vessels.
man, with complains to an acute ischuria
(retention or suppression of the urine), A. Lymph Nodes
revealed the nodular enlargement of a B. Spleen
prostate. A microscopical investigation C. Peyer’s Patch
showed that the majority of knots were
D. Brain
constructed of polymorphic glandular struc-
tures, with some retention cysts. The lat- 435. A 30-year-old woman with a history
ter ones had thick secreta. What is the of abortion presented with purulent en-
most likely diagnose? dometritis resulted in a death from sepsis.
A. Glandular hyperplasia of prostate A post-mortem revealed a purulent lym-
B. Fibromuscular hyperplasia of prostate phadenitis, abscesses in lungs, kidneys,
a myocardium, a spleen hyperplasia, and
C. Hyperplasia of prostate mixed form dystrophy of parenchymatous organs. De-
D. Adenoma of prostate fine the clinico-anatomic form of a sepsis.

A. Septicopyemia gyri and sulci. Microscopical investiga-

B. Septicemia tion showed monocytes, histiocytes and
reticular cells proliferation. Macrophages
C. Septic endocarditis formed aggregates (typhoid granulomas),
D. Granulomatous sepsis which replaced lymphocytes. For what dis-
ease the described changes are character-
436. A 28 year old patient is drug user. He istic?
has been ill for a year, when he observed
A. Typhoid
general weakness, increased sweating,
NARAYAN CHANGDER
weight loss. He has been often ill from B. Salmonellosis
respiratory diseases. The past 2 days C. Dysentery
he had an intermittent fever with a pro- D. Cholera
fuse night sweating, general weakness in-
creased, diarrhea with mucus and blood 439. A patient presented to surgery with
added. By inspection:there are polylym- symptoms of hypothyrosis. Macroscopic
phadenopaty, herpetic rash in oral cavity, investigation of the. removed thyroid
liver and spleen are enlarged by palpation. gland revealed its considerable enlarge-
What is the most probable diagnosis? ment, dense-elastic texture and lobu-
lated surface. Histological investiga-
A. Chronic lymphocytic leukemia
tion showed the diffuse infiltration of
B. Colon cancer lymphocytes and plasmocytes of gland’s
C. AIDS parenchyma with formation of lymphoid
follicles. The latter ones had hyperplas-
D. Tuberculosis
tic germinal centers with atypia and a
E. Chronic sepsis metaplasia of a follicular epithelium. In
addition, the sclerotic alterations of a
437. An autopsy at the Forensic Pathology De- parenchyma were also determined. What
partment of an unknown man, with a his- is the most likely diagnose?
tory of alcohol intoxication, revealed in his
small bowel the enlarged Peyer’s patches, A. Autoimmune thyroiditis
which protruded above the mucosal sur- B. Diffuse toxic goiter
face. They were soft, with irregular sur- C. Colloid goiter
face, which reminded brain’s gyri and sulci.
D. Nodular goiter
The cut surface had a gray-red coloring.
For what disease the described changes 440. An autopsy of a 42-year-old man re-
are characteristic? vealed in the second segment of the right
A. Typhoid lung the focus of consolidation, 5 cm in
diameter, surrounded with a thin capsule.
B. Dysentery The centre was presented by a dense dry
C. Lamb lias is crumbling tissue with a dim surface. Mor-
phological changes in a lung are character-
D. Amehiasis
istic for:
438. An autopsy of a 45-year-old man re- A. Tuberculoma
vealed in his small bowel the enlarged, hy-
B. Carcinoma of lung
peremic groups of lymphoid follicles. The
follicles protruded above the mucosal sur- C. Chondromas
face; their surface reminded child’s brain D. The tumorous formof a silicosis

441. Lymph nodes are located in 446. A 46-year-old man died of an odon-
A. armpits togenic sepsis. An autopsy revealed
the marked thickening of semilunar aortic

B. shoulder valves. They were whitish, opaque and
C. neck stiff, with thrombotic masses, 1x1.5 cm
D. back in the size on the external surface. What
is the most likely form of an endocarditis?
E. groin
A. Polypous-ulcerative endocarditis
442. Which tonsils are located at the base of B. Diffuse endocarditis
the tongue?
C. Acute warty endocarditis
A. Biggest tonsils
B. Palatine tonsils
C. Lingual tonsils 447. An autopsy of an elderly man revealed
enlarged, soft, elastic, slightly nodular
D. Pharyngeal tonsils prostate. A gross investigation of a cut
443. Which of the following statements resection showed separate nodes parted by
garding lymphatic vessels is NOT true? layers of a connective tissue. The com-
pressed surrounding prostatic tissue cre-
A. Lymphatic vessels have valves to en- ated a plane of cleavage about them. A
sure forward movement of lymph. microscopic study found the increase of
B. There are only two large lymphatic glands quantity. There were variable num-
ducts, the right lymphatic duct and the tho- ber of prostatic nodes and glands in them.
racic duct. A. Glandular nodular hyperplasia
C. The smallest lymphatic vessels are B. Fibrpmuscular (stromal) hyperplasia
called lymphatic capillaries.
C. Mixed nodular hyperplasia
D. The thoracic duct drains the right arm
and right side of the neck and chest. D. Adenocarcinoma
444. The lymph nodes are in your groin 448. Which of the following serves as a stor-
age for purified lymph before it returns to
A. axillary the bloodstream?
B. femoral A. Cisterna chyli
C. lumbar B. Tonsils
D. inguinal C. Lymph nodes
445. A 62-year old patient, with a history of a D. Lymphatic vessels
cholelithiasis accompanied with cholangitis
and cholangiolitis, presented to the hospi- 449. The DIGESTIVE SYSTEM has millions of
tal liver cirrhosis. What is the most likely lymphatic vessels (lacteals) that absorb
type of cirrhosis presented? the fats and fatty acids that we ingest and
transports them directly to the where
A. Biliary they enter the circulatory system to use as
B. Infection fuel.
C. Toxins A. Lungs
D. Nutritional deficiency B. Brain

C. Heart 454. A post-mortem of a patient with a long

history of cystitis and a dyskinesia of
D. Arteries
ureters revealed morphological signs of
450. lymphoma uremia. Kidneys were contracted, with
irregularly scarred surface. In the renal
A. tumors of lymph tissue pelvis fine urate stones and sand were reg-
B. inflammation of the lymph vessels istered. Histological investigation showed
‘the thyroid kidney’ and areas of an in-
C. hemorrhage from the spleen
terstitial inflammation. What is the most
NARAYAN CHANGDER
D. none of above likely diagnosis?
451. A 58-year-old patient with a history of A. Chronic pyelonephritis

purulent osteomyelitis died of chronic re- B. Acute pyelonephritis
nal insufficiency. A post-mortem revealed
the enlarged firm kidneys of white-yellow C. Atherosclerotic-contracted kidney
color with a sebaceous (waxy) cut surface. D. Primary-contracted kidney
A. Amyloidosis of kidneys 455. A 56-year old male with a long history of
a rheumatic heart insufficiency died with
B. Chronic glomerulonephritis
symptoms of hemiplegia shortly before
C. Subacute glomerulonephritis death. Histological examination of his mi-
D. Septic nephrite2 tral; valve revealed severe sclerosis, nodu-
lar collection of inflammatory cells and
452. smallest but most common antibody vegetations composed mainly of platelets
and fibrin. Name the most likely type of
A. IgG
endocarditis
B. IgM
A. Relapsing warty endocarditis
C. IgA
B. Acute warty endocarditis
D. IgE
C. Diffuse endocarditis
453. A 48-year-old man, with a history of
transmural heart infarction of the left ven-
tricle’s myocardium, died from the verita-
456. An autopsy of an elderly woman, with a
ble rupture of. heart (the heart tampon-
long history of hypertensive disease, re-
ade). What process in an infarct zone
vealed small size and weight (80 grams),
could promote a heart’s wall rupture?
firm kidneys. They had grey color and
A. Autolysis with melting of myocardium granular surface. On a cut, there was uni-
tissue (myomalacia) form thinning of a cortex. How it is possi-
B. Substitution of connective tissue in ble to name the changes in kidneys?
area of infarction (organization) A. Primary-scarring kidneys
C. Rising of blood pressure in the small B. Pyelonephritic scarring of kidneys
circulatory circle
C. Secondary-scarring kidneys
D. Scar formation with thinning of wall of
the left ventricle D. Amyloidal-scarring kidneys

457. Histological investigation revealed pro- 460. A 48-year-old man died of a pulmonary-
liferation of Bowman’s capsule epithe- heart failure. An autopsy revealed pneu-
lial cells, podocytes and macrophages, re- mosclerosis, emphysema of lungs, and hy-

sulted in crescents formation, which com- pertrophy of a right ventricle of heart.
pressed glomeruli. Necrotic capillary loops In both lungs, mainly under pleura, there
had fibrinous thrombi within their lu- were plural foci, 1 cm in diameter. Histo-
mens. A sclerosis and hyalinosis of some logical investigation of the foci showed a
glomeruli were detected. In addition, necrosis zone in the centre and a wall of
the expressed nephrocytes dystrophy, an epithelioid cells, lymphocytes with some
edema and stromal infiltration of kidneys macrophages and plasmocytes on periph-
was observed. What is the most likely kid- ery. Giant Pirogov-Langhans cells were
neys pathology? also defined. The small numbers of vas-
A. Rapidly progressive glomerulonephri- cular capillaries were present on a periph-
tis ery of the foci. What is the most likely
disease?
B. Postinfectious glomerulonephritis
A. Gematogenic tuberculosis.
C. Chronic pyelonephritis
B. Actinomycosis of lungs.
D. Amyloidosis of kidneys
C. Sarcoidosis (Boeck’s disease)
458. tonsils D. Syphilis.
A. an organ that filters bacteria
461. Which of the following is the biggest lym-
B. an organ important in immunity phatic organ?
C. an organ that stores and produces red A. Tonsils
blood cells and gets rid of bacteria
B. Spleen
D. none of above
C. Thymus
459. A post-mortem of a 72-year-old D. Peyers patch
vagabond, with marked kypho-scoliosis,
revealed the partially destructed thoracal 462. Histological investigation of pulmonary
vertebral bodies due to formation of cavi- segment, removed from a coal worker’s
ties (sequesters), filled with white-yellow lung, revealed multiple roundish, nodules
brittle masses. A histological investiga- composed of concentric whorls of dense,
tion determined within altered vertebras hyaline fibers of collagen. What is the
big foci of a caseous necrosis, surrounded most likely disease?
with solitary giant multinucleated Pirogov- A. Silicosis
Langhans’ cells, epithelioid cells and lym-
B. Tuberculosis
phocytes. Similar changes were diagnosed
at mediastinum lymph nodes and dissem- C. Bronchitis
inated in lungs and kidneys. What is the D. Fibrosing alveolitis
most likely diagnosis?
463. A condition of localized fluid retention
A. Tuberculous osteomyelitis and tissue swelling in the lymphatic ves-
B. Purulent osteomyelitis sels is known as
C. Syphilitic osteomyelitis A. lymphadenitis
D. Osteoporosis B. lymphadenopathy

C. lymphangioma 467. A young man died of a burn dis-

ease. A post-mortem revealed the brain
D. lymphedema
edema, liver and kidneys enlargement.
464. Any disease of the lymph glands Gross investigation showed the thickened
pale-grey cortical layer and hyperemic
A. lymphangiopathy medulla. Histological study demonstrated
B. lymphangiography focal tubular necrosis at different points
along the nephron with a disruption of
C. lymphadenopathy tubular basement membrane interstitial
NARAYAN CHANGDER
D. lymphadenography edema with leukocytic infiltration and a
hemorrhage. What of the listed diagnoses
465. A 25-year-old woman with a medical the most authentic?
history of recent childbirth presented to A. Necrotic nephrosis.
gynecology department with metrorrha-
gia. The histological investigation of a B. Tubulointerstitial nephritis
curettage material revealed a pathologic C. Pyelonephritis
growth, consisted of fibrin clots, chorion D. Gouty kidney.
villi and decidual tissue, undergoing orga-
nization. What is the most likely diagno- 468. A man’s oral cavity investigation re-
sis? vealed an oval, cartilaginous density,
A. Placental polyp slightly elevated ulcer at his buccal mucosa.
A meaty, reddened floor was covered with
B. Glandular hyperplasia of the en- grayish sebaceous deposits. A microscopi-
dometrium cal investigation showed lymphocyte infil-
C. Hydatidiform mole tration, situated mainly round fine vessels.
There was also an endothelium prolifera-
D. Choriocarcinoma tion within the vessel’s walls..What dis-
ease has developed in that case?
466. An autopsy of a 7-year-old child re-
vealed in the apex of the right lung, un- A. Syphilis
der the pleura, a focus of caseous necro- B. Traumatic ulcer
sis, 15 mm in diameter. There were also
C. Erosive-ulcerated leukoplakia
enlarged bifurcational lymph nodes with
small necrotic foci. A microscopical investi- D. Ulcer-Carcinoma
gation of the pulmonal focus and the lymph
node’s lesion showed necrotic masses sur- 469. thymus
rounded by epithelioid cells, lymphocytes A. an organ important in immunity
and solitary giant multinuclear Pirogov- B. an organ that stores and produces red
Langhans’ cells. What is the most likely blood cells and gets rid of bacteria
disease?
C. an organ that filters bacteria
A. Primary tuberculosis
D. none of above
B. Gematogenic tuberculosis with the le-
sions of lungs 470. An autopsy of a 40-year-old woman re-
vealed the obesity, chiefly of the trunk and
C. Gematogenic generalized tuberculosis
face (”moonface” and “buffalo hump”),
D. Secondary inflammatory tuberculosis strias on a skin of hips and abdomen. She

had in her medical records an osteoporo- A. Dysentery

sis with spontaneous fractures of bones, B. Anthrax
an amenorrhea, an arterial hypertension,

C. Crohn’s disease
a hyperglycemia. What of the listed diag-
noses is the most likely? D. Paratyphoid
A. Itsenko-Cushing syndrome 474. A post-mortem investigation of a
B. Addison’s disease 42-year-old man revealed serous-
hemorrhagic inflammation in a larynx and
C. Friderichsen-Waterhouse syndrome
trachea mucosa, a focal pneumonia, areas
D. Conn’s syndrome of atelectases and acute lungs emphysema.
Histological research showed a vacuolar
471. A post-mortem of an elderly male re-
dystrophy and loss of cilia within the ep-
vealed microscopic alteration of his coro-
ithelium layer, an exfoliating of cells with
nary artery. There was narrowing of ves-
oxyphile inclusions. Such changes in lungs
sel’s lumen due to a fibrous plaque with
are caused:
some admixture of lipids. Name the stage
of atherosclerosis: A. Influenza viruses
A. Liposclerosis B. Parainfluenza viruses
B. Lipoidosis C. Measles virus
C. Pre-lipoidosis D. Adenoviruses
D. Atheromatosis 475. the abbreviation for level of conscious-
ness is
472. A histological investigation of the re-
moved enlarged thyroid gland revealed ir- A. LCO
regular form and sizes follicles. The follic- B. LOC
ular epithelium proliferated both into folli- C. OCL
cles lumen and outside. Layers of the con-
D. none of above
nective tissue separated various sites of
the thyroid. What is the most likely diag- 476. What is the body’s hypersensitive re-
nosis? sponse to an outside substance that is oth-
A. Macro-microfollicular goiter erwise harmless?
B. Diffuse goiter A. autoimmune disease
C. Autoimmune thyroiditis B. allergy
D. Follicular carcinoma C. Hodgkin’s disease
D. cardiovascular disease
473. A 65-year-old patient addressed to a doc-
tor his complains to frequent urge and 477. A 35-year-old female presented her
painful passage of stool, with mucous and physician intermittent episodes of is-
some blood in feces. Proctosigmoidoscopy chemia of her fingers, marked by pallor,
revealed marked narrowing of a colon’s lu- paresthesias and pain, accompanied by
men, especially in its distal part. A mucosa tightening and thickening of the skin and
was edematous, hyperemic, with areas of poliarthralgia. Histological investigation
necrosis and hemorrhages. A bacteriologi- of the skin biopsy from affected areas re-
cal study of feces determined the Shigella vealed mild epidermal atrophy, hyalinosis
flexneri. Define the disease? of collagen fibers within derma, scattered

perivascular lymphocytes’ infiltrates. Un- A. Acquired immunodeficiency syndrome

derlying skeletal muscles expressed inter- (AIDS)
stitial edema, loss of cross-section stria-
B. Persisten generalised lymphadenopa-
tion, nidal necroses followed with petrifi-
thy
cation. What is the most likely diagnosis?
C. Incubation period
A. Dermatomyositis
D. Pre-AIDS (AIDS-related complex)
B. Systemic scleroderma
NARAYAN CHANGDER
C. Lupus erythematosus 481. A 32 years old patient is suffering from
chronic hepatitis, has complaints of a dull,
D. Nodular periarteritis
aching pain in right hypochondrium, nau-
sea, dryness in the mouth. Objectively:the
478. A man, with 4 weeks history of the ty-
size of the liver by Kurlov is 13-12-11 cm,
phoid, presented with symptoms of ‘acute
spleen is +2. AST-3, 2 mmoll/L per hour,
abdomen’. He died soon of intoxication.
ALT-4, 8 mmoll/L per hour. At serologi-
At post-mortem a pathologist found a per-
cal studies HBeAg, high HBV DNA concen-
foration of iliac wall and diffuse purulent
tration is revealed. What following drugs
peritonitis. For what stage of disease the
are drugs of choice in the treatment of pa-
described complication is characteristic?
tient?
A. Stage of pure ulcers
A. Acyclovir
B. Stage of a medullar swelling
B. Alpha-interferon
C. Necrotic stage
C. Remantadine
D. Stage of healing of ulcers
D. Arabinozid monophosphate
479. A 62-year-old man with a 14 years medi- E. Essentiale forte
cal history of a diabetes mellitus presented
with significantly worsened eye vision for 482. Histological investigation of a biopsy of
the last two years. What characteristic a bronchus revealed a tumor which is con-
processes resulted in worsening of the eye structed from clusters of atypical cells of
vision? a laminated (stratified) squamous epithe-
lium, some areas with typical “pearls”.
A. Microangiopathy
B. Macroangiopathy
A. Squamous cell keratinous carcinoma
C. Calcinosis of hyaloid body
B. Squamous cell nonkeratinous carci-
D. Dimness of cornea noma
480. A post-mortem of a woman revealed a C. Solid carcinoma

septicopyemia with metastatic abscesses D. Mucinous carcinoma
of lungs and kidneys; pyosalpinx, a pu-
rulent peritonitis, a cachexia and lym- 483. A man with a history of a lower extrem-
phadenopathy. Medical records indicated ity wound, presented with persistent pye-
HIV-positive blood test results within Jast sis of a lesion, resulted in death of intox-
5 years. What clinical period of AIDS cor- ication. An autopsy revealed a cachexia,
responds with the given pathomorphologic dehydration; a brown atrophy of a liver,
signs? a myocardium, a spleen and cross-striated

muscles. In addition, there was amyloido- muscular layer. What is the most likely
sis of kidneys. What of the listed diag- diagnosis?
noses is most probable?

A. Chronic ulcer in exacerbation
A. Chroniosepsis B. Chronic ulcer in remission
B. Septicopyemia C. Acute ulcer
C. Septicemia D. Erosion
D. Chernogubov’s disease
488. A 52-year-old woman died in surgery de-
484. hypersensitivity reaction partment of a diffuse purulent peritoni-
tis. A post-mortem revealed in a distal
A. when the body is exposed to a foreign part of a small intestine enlarged Peyer’s
substance and the immune system overre- patches, which projected into the intes-
acts and harms the body tine’s lumen. There surface was covered
B. inflammation of the lymph nodes by brownish-greenish scab. In the centre
of some patches were found deep defects,
C. enlargement of the spleen
extended to a serous layer. For what dis-
D. none of above ease described intestinal changes are char-
acteristic?
485. immunity develops under contact
with a pathogenic microorganism A. Typhoid
B. Staphylococcal enteritis
A. passive
C. Dysentery
B. humoral
D. An intestine tuberculosis
C. acquired
D. none of above 489. The removed appendix thickened and cov-
ered by fibrinopuralent incrustation. A pu-
486. . A 23-years-old male presented to his rulent exudate infiltrated all appendix lay-
physician with excess of the somatotropic ers; the destruction of mucosa membrane
hormone, the enlarged nose, lips, ears, a was evident. What is the most likely diag-
mandible, hands and feet. What is the nosis?
most likely diagnosis? A. Flegmonous-ulcerative appendicitis
A. Acromegaly B. Simple appendicitis
B. Pituitary nanism C. Suppurative appendicitis
C. Itsenko-Cushing disease D. Gangrenous appendicitis
D. Addison’s disease
490. A 56-year-old man with a long history
487. . A gross investigation of a stomach re- of fibrous-cavernous pulmonary tuberculo-
vealed a deep defect of a gastric wall with sis died of a chronic pulmonary and heart
a lesion of a muscular layer. The proximal failure. Within last months the expressed
edge was undermined and distal one was proteinuria was observed. A post-mortem
flat. A histological study of the removed revealed enlarged, firm kidneys, with a
stomach showed in its floor the zone of waxy surface. What changes developed
the fibrinoid necrosis, a granulation tissue in kidneys at this form of tuberculosis?
and massive fibrosis, which replaced the A. Amyloidosis of kidney

B. Tuberculosis of kidney the rectus abdominis and a hip muscles.

C. Glomerulonephritis They reminded a stearin candle. The de-
scribed changes are the result of
D. Nephrolithiasis
A. Zenker’s necrosis
491. An oral cavity examination of a 4- B. Fibrinoid necrosis
year-old child, revealed a hyperemia of
the fauces and tonsils mucus membranes. C. Caseous necrosis
Gross investigation showed enlarged ton- D. Colliqative necrosis
NARAYAN CHANGDER
sils, covered by dense, whitish-yellowish
membranes. They left a raw surface, with 495. A 10-year-old boy presented with
deep defect, when forcibly removed. Soft Hutchinson’s triad:parenchymatous kerati-
tissues of a neck were edematous, re- tis, sensorineural deathess and deformed
gional lymph nodes were enlarged and Hutchinson’s teeth (the barrel form), along
painful. What the most likely diagnosis is with saddle-nose deformity.For what ill-
among listed below? ness the presented changes are character-
istic?
A. Diphtheria
B. Scarlet fever A. Syphilis.
C. Measles B. Toxoplasmosis
D. Parotitis C. Leprosy
D. Tuberculosis.
492. Lymph nodes are about the size and
shape of a pea, and there are through- 496. A 44-year-old man died of pulmonary
out the body! insufficiency and severe intoxication. A
A. Hundreds post-mortem investigation of a lungs cut
surface revealed a motley pattern with
B. Ten
plural focal hemorrhages and the zones of
C. Millions emphysema. Histological study showed
D. Thousands a hemorrhagic bronchopneumonia with
abscesses formation. A cytoplasm of
493. An autopsy of the 47-year-old man re- bronchial epithelium cells had eosinophilic
vealed the right lung firm with dry hypoin- and basophilic inclusions. What is the most
flated granular pulmonary tissue. Visceral likely diagnosis?
pleura presented with membranous gray- A. Influenza
brown fibrin fibers on the pleura. What
is the most likely diagnosis? What is the B. Parainfluenza
most likely diagnosis? C. Adenoviral infection
A. Croupous pneumonia D. Respiratory syncytial infection
B. Tuberculosis
497. A 45-years-old male presented to the
C. Bronchopneumonia hospital with enlarged nose, ears, a
D. Intestinal pneumonia mandible and feet. What is the most likely
diagnosis?
494. A post-mortem of a 57-year-old male,
with a history of typhoid, revealed a A. Acromegaly
dense, fragile whitish-yellowish color of B. Nanism

C. Cerebro-hypophyseal cachexia glands with ‘saw-’ and a ‘spin-like’ pat-

D. Adiposogenital dystrophy tern. A stromal proliferation with hyper-
plasia of its cells was also determined.

498. A 48-years-old woman presented with What is the most likely diagnosis?
insomnia (inability to get enough sleep, a A. Glandular hyperplasia of endometrium
bad dream), a fatigue, irritability, exoph-
thalmos (protuberance of eyes) and tachy- B. Acute endometritis
cardia. The thyroid gland was enlarged. C. Leiomyoma
She died soon due to cardiovascular insuf- D. Hydatidiform mole
ficiency. Histological investigation of the
thyroid tissue revealed a proliferation of 502. A gynecologic investigation of the 36-
an epithelium with formation of papillas, year-old woman revealed bright red bril-
a colloid colliquation, lymphocyte and plas- liant maculae on a uterus neck. They bleed
mocyte infiltration and formation of lym- easily at a touch. Biopsy investigation
phatic follicles with the germinal centres. showed that a tissue sample was covered
What is the most likely diagnosis? by a cylindrical epithelium with papillary
A. Diffuse toxic goiter. (Basedow’s dis- growths. There was also a growth of
ease) glands within the thickness of a uterus
neck tissue. What pathology of a uterus
B. Endemic goiter neck was diagnosed?
C. Sporadic goiter A. Pseudoerosion
D. Hashimoto’s thyreoiditis B. Cervical erosion
499. An autopsy 54-year-old man revealed C. Endocervicitis
markedly dilated lumen of a small bowel D. Glandular hyperplasia
filled with a liquid, which reminded “rice
broth”. The intestine wall was edematous 503. antibiotic treatment for bacterial infec-
with multiple petechial hemorrhages. For tion
what infectious disease the described en- A. treatment of lymphoma
teritis is characteristic?
B. treatment of lymphedema
A. Cholera
C. treatment of lymphadenitis
B. Dysentery
D. none of above
C. Salmonellosis
504. An autopsy of a patient, who died from
D. Amebiasis
poisoning of ethylene glycol, revealed en-
500. The suffix that means removal or carry larged edematous kidneys. Their capsule
away is: was taken out very easily. Gross investi-
gation showed the wide pale-grey cortical
A. apheresis
layer and dark red medulla. What disease
B. phonpheresis has developed at the patient?
C. emia A. Necrotic nephrosis
D. pareasis B. Acute pyelonephritis
501. A microscopic investigation of an en- C. Acute glomerulonephritis

dometrium revealed coiled extended D. Acute tubulointerstitial nephritis

2.4 Thalassemia 178
505. A post-mortem of a 52-year-old man, C. Hydatidiform mole

with a long history of chronic glomeru- D. Invasive hydatidiform mole
lonephritis, resulted in his death, revealed
markedly reduced, firm, finegrained kid- 507. Which is nit a part of the digestive tract
neys. Microscopical investigation showed associated with the lymphatic tissue.
fibrinous inflammation of serous and mu- A. Palatine tonsils
cosas, dystrophic changes of parenchyma-
tous organs and a brain edema. What com- B. Lingual tonsils
plication has led to the serous and mucosas
NARAYAN CHANGDER
C. Peyer’s Patch
lesions?
D. Stomach
A. Uremia
508. An autopsy revealed groups of en-
B. Anaemia larged, hyperemic lymphoid follicles in
C. Sepsis small bowel. The follicles protruded above
the mucosal surface; their surface re-
D. DIC-syndrome minded brain’s gyri and sulci. The cut sur-
face of follicles was succulent; with gray-
506. A 29-year-old woman presented to ma-
red coloring. Microscopical investigation
ternity department with termination of
showed monocytes and histiocytes prolif-
pregnancy at 20 weeks of gestation. The
eration. Macrophages formed aggregates
fetus and fetal membranes were delivered
(typhoid granulomas). Name a morpholog-
with some blood clots. Histological investi-
ical stage of typhoid.
gation revealed fetal membranes, chorion
villi and decidual tissue. Name the de- A. Medullar swelling
scribed pathology of pregnancy. B. Necrotic
A. Spontaneous complete abortion C. Formation of ulcers
B. Premature birth D. Pure ulcers
2.4 Thalassemia
1. History of Sickle Cell continued All four pa- A. Glutamic Acid
tients were of African descent-led to com- B. →
mon 1949 named SCD as the first
“molecular disease” First proof of disease C. 6th
caused by an protein First disease under- D. β
stood on the 1957-amino acid change in
E. 9th
beta globin chains identified
F. α
A. misconception
B. Linus Pauling 3. The hemolytic anemia associated with the
thalassemias is due to:
C. abnormal
A. Imbalance of globin chain synthesis
D. molecular level
B. Microcytic, hypochromic cells
E. single
C. Ineffective erythropoiesis caused by
2. (a) (Glu) Valine (Val):position of chain immune factors

2.4 Thalassemia 179
D. Structurally abnormal hemoglobin 9. Hemoglobin E migrates with which of the

following on alkaline electrophoresis?
4. Label each part of the Sickled RBC. A. HbF

A. Deoxy-HbS polymer B. HbS & C
B. HbSS RBC C. HbA2 & C
C. Oxy-SS RBC D. HbA & F
D. Vaso-occlusion 10. (a) seemed to offer protection from, mech-
E. Oxy-HbS Monomer anism still not completely
A. SCT
5. Reversible pathophysiology of SCD is in B. malaria
the presence of oxygen bond only for a cer-
tain amount of time. C. understood
D. recognized
A. True
E. hemoglobin
B. False, it stays for a long time
F. anemia
C. False G. phagocytosis
D. none of above H. of parasitised AS red cells
6. What percent of African Americans carry I. Schizogonic cycle
the Alpha Thalassemia trait? J. AA
A. 68% K. Invasion
B. 13% L. AS
M. trait
C. 87%
N. Disease
D. 30%
O. Sickle Cell Trait
7. Clinical signs of disease vary, depending P. No Trait or Disease
on the class of involved, as well as
11. In which part of the world is the a gene
gene zygosity.
mutation causing Hb Bart hydrops fetalis (
A. Altered stability / ) most common?
B. globin chain A. Northern Africa
C. Solubility B. Mediterranean
D. Altered function C. Middle East
D. Southeast Asia
8. What is the amino acid substitution in pa-
tients with sickle cell anemia? 12. b-Thalassemia minor (heterozygous) usu-
ally exhibits:
A. adenine for thymine
A. Increased Hb Constant Spring
B. lysine for valine B. 50% Hb F
C. valine for glutamic acid C. No Hb A
D. glutamic acid for valine D. Increased Hb A2

2.4 Thalassemia 180
13. Which statement about Thalassemia 17. In the 1940s was the breakthrough be-
tween Sickle Cell and Malaria.
A. This disease is caused by a sick person.
Being sneezed by a thalassemia patient A. True
B. This disease can happen. When the B. False, it was the 1950s
country is in volatile weather conditions a C. False, it was the 1920s
breeding ground for pathogens
D. none of above
C. This disease can occur when It de-
NARAYAN CHANGDER
pends on the parents because it is a hered- 18. HbH inclusions are seen when stained with
itary disease. which of the following?
D. right on all counts A. Wright-Giemsa
B. Prussian Blue
14. Which of these is not a pathophysiology of
C. Brilliant Cresyl Blue
SCD?
D. Romanowsky
A. Reversible vs. irreversible sickled
cells 19. Place each word correctly on the HGB pro-
B. extravascular hemolysis of sickled duction.
cells A. Globin gene mutations
C. Increased solubility of Hgb S in oxy- B. Thalassemia
genated state, molecules depolymerize C. Heme enzymes
into flexible aggregates
D. SA porphyrias
D. microvasculature blockages lead to tis-
sue necrosis E. Cytokines
F. iron
15. What are the long-term effects of blood
G. IDA ACD
transfusions?
H. ACD
A. Excess calcium in the body
I. EPO
B. Excess iron in the body
20. What disease does the following code
C. Excess red cells in the body
for:αα /
D. Excess blood in the body
A. Aphal thal trait
16. Thalassemia carrier screening for or pri- B. Alpha thal minor
mary screening To find out if there is a C. Hgb H
chance to be a carrier or thalassemia But
still can not be identified as a carrier. or D. Hgb Bart’s
thalassemia or not What inspections are 21. Which of the following hemoglobins con-
there? tains β 4 tetramers?
A. Red Blood Cell Indices (CBC) A. Hgb Bart’s
B. One Tube Fragility (OF) B. Hgb Gower
C. Dichlorophenol Indole Phenol (IP) C. Hgb H
D. right on all counts D. Hgb Portland

2.4 Thalassemia 181
22. A 25-year-old man is getting married in 25. Which of the following alpha thalassemia
the next 2 months. come to consult about is inconsistent with life?
thalassemia anemia Blood concentration

A. Alpha thal trait
test results are as follows:Hb 13 g/dl, Hct
41%, MCV 82 fl, RDW 15%OF-ve, DCIP- B. Alpha thal minor
ve What advice would you give? C. Hgb H
A. normal blood results without tha- D. Hgb Bart’s
lassemia There is no need to bring the
26. A hemoglobin electrophoresis showed
wife to come for the examination.
49% Hb S, 42% Hb C, Hb F 6%, and Hb
B. Further testing should be performed A2-3%. These results are consistent with
as it may be a carrier of alpha tha- a diagnosis of:
lassemia. A. sickle cell anemia
C. Further testing should be performed B. sickle cell trait
as it may be a beta thalassemia carrier.
C. Hgb SC disease
D. should be examined further because it
D. Hgb C trait
may be a carrier of both alpha and beta
thalassemia 27. Inherited disorders of Globin synthesis The
most genetic diseases worldwide, affect-
23. Hb H inclusions in a supravital stain prepa- ing of the global population children born
ration appear as: each year worldwide of births occur in-
A. A few large, blue, round bodies in the income countries
RBCs with aggregated reticulum A. common
B. Uniformly stained blue cytoplasm in B. 7%
the RBC C. >300, 000
C. Small, evenly distributed, greenish- D. 80%
blue granules that pit the surface of RBCs E. low-to mid
D. Uniform round bodies that adhere to
28. What are the possible signs and symptoms
the RBC membrane
of Thalassemia? Alin sa mga sumusunod
ang posibleng sintomas ng Thalassemia?
24. Which of the following statements is not
true about HbA2? A. Pale skin (Pamumutla ng balat)
A. The insured has a condition Tha- B. Yellowish skin (Paninilaw ng balat)
lassemia therefore HbA2 occurs and C. Weakness (Panghihina ng katawan)
when found can be identified as Tha-
D. All of the above (Lahat ng nabanggit)
lassemia.
B. This is because beta globin is not 29. Which of these is the most common world-
enough for alpha globin. wide symptomatic hemoglobinopathy?
A. Stan Writes Anemia
C. Formed by alpha globin binding to
delta. B. Pulmonary Anemia
D. There is a normal occurrence of the C. Sickle Cell Anemia

body. D. Hemolytic Anemia

2.4 Thalassemia 182
30. Which of these is not a qualitative Disor- D. are carriers of both alpha and beta tha-
der of hemobloniopathies? lassemia types
A. Result of inherited genetic mutations 34. Hb Bart is composed of:
in which amino acid substitutions or dele-
tions cause structural changes in globin A. Two a and two b chains
chains of the Hgb molecule B. Two e and two g chains
B. Altered amino acid sequence causes C. Four b chains
globin chains to behave differently-
NARAYAN CHANGDER
D. Four g chains
structurally, electrochemically, and func-
tionally 35. Hgb = beta 2; of normal Hgb
C. Causes an imbalance between “part- A. A
ner” chains
B. alpha2
D. Structurally abnormal Hgb may cause
a wide range of clinical features, from C. 97%
none at all to life-threatening symptoms. D. adult
31. The predominant hemoglobin present in E. child

b0-thalassemia major is: F. delta2
A. Hb A G. C
B. Hb A2
36. How is the thalassemia test/screening
C. Hb F done?
D. Hb C A. Urine test
32. RBC morphologic features in b- B. Cell uptake test
thalassemia would most likely include C. Health check
A. Microcytes, hypochromia, target cells, D. Blood test
elliptocytes, stippled cells
37. Hemoglobin (Hemoglobin) is an important
B. Macrocytes, acanthocytes, target
part of red blood cells formed from which
cells, stippled cells
protein chain, known as globin (globin)
C. Microcytes, sickle cells
A. Alpha, Heem
D. Macrocytes, hypochromia, target cells,
B. beta, beta
stippled cells
C. beta, alpha
33. Thai woman, 22 years old. Pre-marital
blood test. Hb 11.3 g/dl, Hct 33.9%, D. beta, alpha
MCV 62 fl, RDW 15.8%OF +ve, DCIP- 38. The insured’s ability to be thalassemia
veHb typing:HbA 89.9%, HbA2 5.6%, must have any component
HbF 3.3%, α -gene result. study:αα ,
αα Which of the following is correct? A. The insured must be female. Because
Thalassemia disease is mainly caused by
A. Not a thalassemia carrier the sex chromosomes.
B. Being an alpha thalassemia carrier B. must depend mainly on father and
C. Being a beta thalassemia carrier mother because it is a hereditary disease

2.4 Thalassemia 183
C. depending on the environment and C. You do not have to do anything be-

diet of the insured cause it is the treatment of the insured.

D. must be the insured having low birth D. none of them are correct
weight and being born prematurely
43. Which of these is NOT a Quantitative dis-
39. Researchers noticed that areas where was order of Thalassemias?
also had prevalence of than other regions. A. Named according to decreased
A. gene for Hgb S chainAlpha ThalassemiaBeta Thalassemia
B. prevalent B. Causes an imbalance between “part-
C. higher ner” chains
D. malaria C. Result of various genetic defects that
cause decreased synthesis of normal
E. lower
globin chains
F. not prevalent
D. Altered amino acid sequence causes
G. sickle-cell globin chains to behave differently-
structurally, electrochemically, and func-
40. The following are signs and symptoms of
tionally
thalassemia MAJOR EXCEPT
. what was the allocation ratio in the RCT
44.
A. Always weak and restless (Luspatercept Vs Placebo)?
B. Jaundice A. 1:1
C. There are no changes in the formation B. 2:1
of the face as children grow C. 3:1
D. Stunted growth D. 2:3
E. Abdominal distension due to swelling
45. Which of the following is NOT a way
of the liver and spleen
to avoid infection for a child with Tha-
41. Sickle Cell affects how many Americans lassemia? Which of the following is the
yearly? WRONG way to avoid infection in a child
with Thalassemia?
A. 100, 000
B. 114, 000 A. Proper hand washing
C. 16, 300 B. Visit crowded areas
D. 25, 000 C. Get all recommended vaccinations

D. none of above
42. The patient Thalassemia (confirmed by a
doctor). There is a TDT (Transfusion de- 46. Match the correct label to the Hemoglobin
pendent thalassemia) treatment. What ad- Molecule.
ditional components should be considered A. Heme
for consideration?
B. β chain
A. Biography of parents to see the risk of
the insured C. α chain
B. Examination of the iron value in the in- D. α chain

sured’s body E. β chain

2.4 Thalassemia 184
47. Which of the following is NOT a symptom 51. All but one of the following may be seen in
of B-thalassemia? the PB smear when a sickle cell crisis has
occurred
A. Chipmunk face
A. Target cells
B. Hair-on-End Skull Xray
B. NRBCs
C. Hepatosplenomegaly
C. Polychromasia
D. Moon face
D. Moderate elliptocytes
NARAYAN CHANGDER
48. Complete the diagram. 52. The thalassemias are caused by:
A. or deletions A. Structurally abnormal hemoglobins
B. Globin B. Absent or defective synthesis of a
C. Heme polypeptide chain in hemoglobin
D. disturbed C. Excessive absorption of iron

D. Abnormal or defective protoporphyrin
E. Hemoglobin
synthesis
F. Hemoglobinopathies
53. Normal RBC
G. abnormal
A. Oxy-RBC
49. Which of the following lab results would B. O2
be expected in a patient with alpha tha-
C. RBC
lassemia?
D. Blood
A. MCH = 32 pg
54. Correctly place each label with its HGB ab-
B. MCV = 70 fl
normality.
C. stomatocytes
A. thousands
D. Increased Hgb A B. Arab
50. A 4-month-old infant of Asian heritage C. Lepore
is seen for a well-baby check. Because D. G
of pallor, the physician suspects anemia
E. D
and orders a CBC. The RBC count is 4.5 3
109/L, Hb concentration is 10 g/dL, and F. C
MCV is 77 fL, with microcytosis, hypochro- G. Harlem
mia, poikilocytosis, and mild polychroma-
H. S
sia noted on the peripheral blood film.
These findings should lead the physician to I. E
suspect:
55. What disease does the following code
A. b-Thalassemia major for:β + β
B. a-Thalassemia silent carrier state A. beta thal minor
C. Iron deficiency anemia B. beta thal intermedia
D. Homozygous a-thalassemia ( / C. beta thal major
) D. Cooley’s anemia

2.4 Thalassemia 185
56. SICKLE CELL ANEMIA Greatest prevalence 59. The principle for hemoglobin electrophore-
in (but also seen in other areas where is sis is based on which of the following?
endemic) babies born/year in Africa 2,

A. Net charge of the hemoglobin
600/year in and /year in Europe Relation-
molecule
ship to Plasmodium falciparum and other
forms of malaria B. Amount of hemoglobin present
A. sub-Saharan Africa C. Structure of heme portion
B. malaria D. Temperature
C. 250, 000
D. U.S. 60. The single best lab test to distinguish β -
Thalassemia minor from α -Thalassemia,
E. 1, 300 IDA, HPFH, and hemoglobinopathies is?
F. ∼ 500, 000
A. HbA2 levels
G. sub-terrania Africa
B. Serum iron
H. Middle East
C. Hemoglobin solubility
57. couple come to consult about thalassemia
D. Heinz body stain
disease The wife was 20 weeks preg-
nant and the results were as fol-
61. α -Thalassemia most commonly results
lows:Husband:Hb 13.5 g/dl, Hct 45%,
from which of the following genetic le-
MCV 80 fl, RDW 15% OF-ve, DCIP +ve Hb
sions?
typing:HbA 68.7%, HbE 26%, HbF 0.6%
α -. gene study: α 3.7, αα Wife:Hb A. Promoter mutation
10.5 g/dl, Hct 32 %, MCV 76.1 fl, RDW
B. Gene deletion
17.1% OF +ve, DCIP +ve Hb typing:HbA
59.8%, HbE 32.1%, HbF 0.9% α -gene C. Termination codon mutation
study:αα , αα from the above results
D. Splice site mutation
What is the chance of having a child with-
out thalassemia? How many %?
62. List two sets of lab data that can distin-
A. 12.5 guish IDA from beta thalassemia trait.
B. 25 A. Serum iron and RBC
C. 75
B. Hgb and Hct
D. 100
C. WBC and RDW
58. When one a gene is deleted (a-/aa), a pa- D. RBC indices and Platelets
tient has:
A. Normal hemoglobin levels 63. Which genotype is correct for β -
B. Mild anemia (hemoglobin range 9 to 11 Thalassemia major?
g/dL) A. β /β , β 0/β +, β -/β -
C. Moderate anemia (hemoglobin range 7 B. β sc/β , β +/β , β 0/β 0
to 9 gm/dL)
C. β +/β -, β -/β -, β -/β 0
D. Marked anemia requiring regular
transfusions D. β 0/β 0, β 0/β +, β +/β +

2.4 Thalassemia 186
64. Which of these is NOT Defective globin A. Because the body cannot produce
synthesis in HGB production? Choose all alpha-line globin at all.
that apply. B. Because the body cannot produce beta
A. Thalassemias globin at all.
B. Hemoglobinopathies C. Because the body cannot produce
C. Iron deficiency anemia (IDA) globin, gamma line at all.
D. Siderblastic anemia (SA) D. Because the body is unable to produce
NARAYAN CHANGDER
delta globin at all.
65. What is the name of the disorder when
there is one Thalassemia gene and one 70. couple come to consult about tha-
Sickle gene? lassemia anemia Wife was pregnant
at 8 weeks, husband:Hb 11.7%, Hct
A. Sickle Cell Thalassemia 35.6%, MCV 67.7 fl, RDW 15.3%OF
B. Thalassemia Sickle +ve, DCIP-veHb typing:HbA 87.8%,
HbA2 2.9%, HbF 0.3%Inclusion body-
C. Sickle Cell Disease
negativeResult α -gene study: SEA,
D. Sickle Minor αα Wife:Hb 10.5%, Hct 31.0%, MCV
62 fl, RDW15.5%OF +ve, DCIP-veHb
66. Which of the following factors contributes typing:HbA 87.8%, HbA2 2.9%., HbF
to the pathophysiology of sickling? 0.3%Inclusion body-positiveResults α -
A. increased iron concentration gene study: , α csα Which is most
B. hypochromia accurate about the couple’s sons?
C. fava beans A. All children will be thalassemia carri-

ers.
D. dehydration
B. 75% of children are asymptomatic.
67. The condition Hb S-b0-thalassemia has a C. 50% of children have mild thalassemia.
clinical course that resembles:
D. It is advisable to screen for the risk of
A. Sickle cell trait thalassemia in children.
B. Sickle cell anemia
71. Which answer(s) are types of Tha-
C. b-Thalassemia minor lassemia?
D. b-Thalassemia major A. All of the Choices
68. What are the episodes of pain in Sickle Cell B. Minor
Anemia called?
C. Beta
A. Attacks
D. Alpha
B. Crises
72. The cells in Sickle Cell are shaped like a
C. Disturbances
A. football
D. Fits
B. strawberry
69. Hb Bart’s hydrops Fails Why does the child
die in the womb or is born within a few C. crescent moon
minutes? D. ball

2.4 Thalassemia 187
73. Luspatercept mechanism of action (class): 78. Hgb = rings + chains + 4 atoms 1
hemoglobin molecules
A. Erythroid maturation agent:restores

RBC production A. 4 porphyrin
B. Epoetin alfa analogue B. 4 globin
C. Multivitamin with iron C. iron

D. carries 4 O2
D. Heavy metal antagonists:Iron-binding
agent 79. What is the percentage for Thalassemia
patients to get a donor sibling match?
74. Which of these is not a diagnosis of Sickle
A. 15%
Cell?
B. 20%
A. first described in 1910 in Chicago, joint
pain C. 25%
B. heart palpitations, “acute chest syn- D. 50%

drome” 80. Which of these is NOT a defective heme
C. shortness of breath, jaundice synthesis in HGB production?
D. loss of hair A. Thalassemias
E. crescent-shaped RBCs in peripheral B. Iron Deficiency anemia (IDA)

blood; 4th case reported in 1922 C. Anemia of chronic disease
(ACD)/Anemia of inflammation (AOI)
75. What is the cure to Sickle Cell Anemia? D. Sideroblastic anemia (SA)
A. Blood Transfusion
81. Sickle Cell and Thalassemia are which type
B. Gene Therapy of disorder?
C. Stem Cell Transplant A. Bone Disorder
D. Bone Marrow Transplant B. Blood Disorder
C. Mental Disorder
76. What is thalassemia disease?
D. Hemoglobin Disorder
A. Genetic disease of red blood cells
82. Where is the specialized treatment center
B. Genetic disease of white blood cells for Thalassemia?
C. Blood plasma genetic diseases A. Sungai Buloh Hospital
D. Non-genetic red blood disease B. Tengku Ampuan Rahimah Hospital
C. Ampang Hospital
77. Where is the thalassemia treatment cen-
ter? D. Shah Alam Hospital
A. All hospitals 83. (a) American babies born with SCT every
B. All government hospitals year 1 in 14-American births 1 in 143-
American births Caucasian births 1 in 500-
C. All private hospitals American births
D. Patient’s home A. 60, 000+

2.4 Thalassemia 188
B. African C. Normal Hemoglobin (top view)

C. Hispanic D. Function
D. 1 in 333 E. Normal hemoglobin
E. Asian F. Primary Structure
84. Medications and blood transfusions are G. Secondary and tertiary
treatments for H. Quaternary
NARAYAN CHANGDER
A. Thalassemia I. β
B. Sickle Cell J. Sickle-cell hemoglobin
C. Neither K. β subunit
D. Both L. α
85. The insured is female, aged 2 months, and M. Molecules
has a father and mother with thalassemia.
Is the insured person likely to have tha- 88. Which nationality is MOST likely to be af-
lassemia? fected by thalassemia?
A. No chance because both parents are A. Chinese

not thalassemia. B. South American Indians
B. No chance because the insured is still C. Southeast Asians
young
D. Europeans
C. There is a chance because the mother
is a thalassemia carrier. 89. In the consideration of guaranteeing HC, if
the mother, the Hb-typing result is Hb E
D. There is a chance because both par-
trait (born from the Beta line) and the fa-
ents have thalassemia.
ther, the Hb-typing result is the Hb H trait
86. Pathophysiology of SCD Hgb S has oxygen (born from the Alpha line), there will be a
affinity Decreased solubility of Hgb S in, tendency for how to consider
molecules into rigid aggregates Hgb S poly- A. Not accepting HC, receiving life STD
mers can in length beyond the of the RBC, because parents are only carriers of tha-
causing sickling. lassemia, but they are different types.
A. decreased B. Receiving HC Receiving Life STD as
B. deoxygenated state both parents are thalassemia carriers
C. polymerize C. Patients with HC cannot consider Life
as both parents are thalassemia carriers.
D. grow
D. Not receiving HC and still unable to
E. diameter
consider life because both parents are
F. increased thalassemia carriers. CBC and Hb-typing
G. shrinks blood tests must be informed first.
87. Label each part of the picture shown. 90. How is thalassemia treated? (3 answers)
A. α A. Blood transfusion treatment
B. β subunit B. Heart replacement treatment

2.4 Thalassemia 189
C. Bone marrow transfer C. Three

D. Surgery to remove the spleen D. Four

91. Which of the following is true about red 96. What methods can cure thalassemia pa-
blood cells? tients?
A. It carries oxygen to the organs of the A. Bone marrow transplant from parents
body. B. Bone marrow transplant from friends
B. as a carrier of carbon dioxide to get rid C. Bone marrow transplant from siblings
of waste from the lungs who also have thalassemia
C. Adults Red blood cells are produced in D. Bone marrow transplantation from
the spinal cord. healthy and HLA-matched siblings
D. right on all counts (matched sibling donor)
97. Thalassemia major patients typically live
92. that the bridegroom rubs for a blood test
till the age of
Hb 12.8 g/dl, Hct 35.6%, MCV 76.1
fl, RDW 17.1%OF +ve, DCIP +veHb typ- A. 21
ing:HbA 59.8%, HbE 32.1%, HbF 0.9% B. 3
α -gene study:αα , αα Any conclusion is C. 5
correct
D. 16
A. Not a thalassemia carrier
98. Sickle Cell patients live up to their and
B. Being an alpha thalassemia carrier
above.
C. Being a beta thalassemia carrier
A. late-twenties
D. are carriers of both alpha and beta tha-
B. mid-thirties
lassemia types
C. mid-fourties
93. Hb H is composed of D. early-fifties
A. Two a and two b chains
99. Bride to be screened for Thalassemia
B. Two e and two g chains Blood concentration test results are as fol-
C. Four b chains lows:Hb 11.7%, Hct 35.6%, MCV 67.7fl,
RDW 15.3%, platelet 350, 000 which is
D. Four g chains
correct?
94. Which of these is how many genes a per- A. Probably a carrier of thalassemia.
son inherited for a disorder?
B. Anemia due to iron deficiency
A. zygosity C. Correct on both points
B. Solubility D. unsure
C. affinity
100. A red protein responsible for transport-
D. hemolytic anemia ing oxygen within the blood is
95. What is the classification of thalassemia A. Hemoglobin
disease? B. Anemia
A. One C. Protein
B. Two D. Cell

2.4 Thalassemia 190
101. Hemoglobin present on electrophoresis 106. Which gender will be more likely to get
for homozygous sickle cell disease? Thalassemia disease?
A. HbA, S, F, A2 A. Men
B. HbS, F, A2 B. Woman
C. The same
C. HbA, E, F, A2
D. none of above
D. HbA, C, F
107. Why is hydrops fetalis incompatible with
NARAYAN CHANGDER
102. What is the treatment for α -Thalassemia life?
minor?
A. Life cannot exist without HbA
A. Splenectomy B. Lack of embryoinc hemoglobins pre-
B. Transfusion therapy cludes fetal development
C. Bone marrow transplant C. All three normal adult hemoglobins
contain alpha chains
D. Usually asymptomatic, no treatment
D. Fetal hgb is essential to sustain life af-
103. Cells containing large amounts of Hb S ter birth
sickle when which of the following condi- 108. In Thalassemia, iron-rich food should be
tions occur? avoided. Which among the following are
A. high oxygen tension, and acidosis iron-rich foods? In patients with Tha-
lassemia, iron-rich foods must be avoided.
B. hypoxia and alkalosis Which of the following foods is rich in
C. temperatures <37 C and alkalosis iron?
D. temperatures>37 C and hypoxia A. meet (to)
B. Fish
104. Which thalassemiapresents with an ab-
C. Nuts (Mani)
normal hgb that precipitates in red cells
and will have a golf ball appearance after D. All of the above
incubation with brilliant cresyl blue
109. What is the majority hemoglobin in beta
A. Hgb F thalassemia major
B. Hgb H A. Hgb A
C. Hgb Bart’s B. Hgb A2
C. Hgb F
D. Beta thal major
D. Hgb H
105. the most common SE of grade 3 or higher
110. How many times should Thalassemia ma-
in the luspatercept are:
jor patients undergo blood transfusion
A. Anemia Increased Iron liver concen- treatment per month?
tration Hyperuricemia
A. 1-2 kali
B. Bone pain arthralgia vomiting B. 3-4 kali
C. dizziness anemia hypertension C. 5-6 kali
D. Back pain bone pain dizziness D. 7-8 kali

2.5 Hemoglobinopathy 191
111. Which of the following laboratory find- B. Target cells and basophilic stippling on
ings is inconsistent with b-thalassemia mi- the peripheral blood film
nor?

C. Hemoglobin level of 10 to 13 g/dL
A. A slightly elevated RBC count and
marked microcytosis D. Elevated MCHC and spherocytic RBCs
2.5 Hemoglobinopathy
1. Adult Hb (HbA) consists of medical attention between 6 months S2
A. two alpha-globin subunits and two years of age.
gamma-globin subunits A. Thalassemia major
B. two alpha-globin subunits and two B. Thalassemia intermedia
beta-globin subunits C. Thalassemia minor
C. two alpha-globin subunits and two D. Sickle cell disease
delta-globin subunits
4. In some areas of South Africa many peo-
D. two alpha-globin subunits and one
ple have sickle cell disease characterized
beta-globin subunit
by red blood cells that assume an abnor-
2. Substitution of the glutamic acid on va- mal sickle shape due to the substitution of
line was revealed while examining initial glutamic acid for valine in the hemoglobin
molecular structure. For what inherited molecule. What is the cause of this dis-
pathology is this symptom typical? ease?
A. Thalassemia A. Transduction
B. Sickle-cell anemia B. Chromosomal aberration
C. Tay-Sachs disease C. Gene mutation
D. MacArdle disease D. Crossing-over
3. microcytic hypochromatic hemolytic ane- 5. Which of the following hereditary diseases

mia, abnormal peripheralblood smear refers to hemoglobinopathies?
with nucleated red blood cells, reduced A. Thalassemia
amounts of HbA, severe anemia, hep- B. mucopolysaccharidosis
atosplenomegaly, fail to thrive, become
progressively pale, regular bloodtransfu- C. Marfan syndrome
sion are necessary, and usually come to D. Tay-Sachs disease
2.6 Gastrointestinal
1. How is your appetite? D. none of above
A. Ada hilang berat badan?
2. It is characterized by the accumulation of
B. Ada selera makan? serous fluids in the peritoneal cavity.
C. Ada selera minum? A. Paracentesis

2.6 Gastrointestinal 192
B. dehydration 8. Do you have diarrhoea?

C. ascites A. Anda ada sembelit?
D. dyspepsia B. Anda ada sakit perut?
C. Anda ada cirit-birit?
3. Point out the incorrect relationship, with
respect to the final product of food diges- D. none of above
tion
9. Time it takes for a material to move from
NARAYAN CHANGDER
A. carbohydrates-monosaccharides one place to the next in the digestive tract:
B. fats-3-monoglycerol A. interdigestive time
C. proteins-amino acids B. Transit time
D. all are correct C. intradigestive time
4. Salivary amylase disappears with a pH D. none of above
less than:
10. The makes bile and the stores it.
A. 3
A. Gallbladder; liver
B. 4
B. Liver; gallbladder
C. 5
C. Gallbladder; pancreas
D. 6
D. Liver; pancreas
5. What is the name of disease in which in- 11. Protein digestion is catalyzed by the en-
testine is chronically inflamed? zyme:
A. peptic ulcer A. lactase.
B. celiac disease B. It feels like it.
C. hemorrhoids C. Pepsin.
D. Crohn’s disease D. Lipase.
6. Which of the following serves as a storage 12. During primary peristalsis, how long does
channel in the digestive system? it take for the wave to travel from the
A. upper part pharynx to the stomach?
B. middle portion A. 8 a 10 s
C. lower segment B. 15 a 20 s
D. accessory organs C. 1 minute
D. 5s
7. What separates the esophagus from the
stomach? 13. How long?
A. villi A. How much poop when pooping?
B. pyloric sphincter B. How long is there blood in stool?
C. rugae C. What color is poop?
D. cardiac sphincter D. none of above

14. which one is conserved amino acid in gas- 19. What does the activation of gastric
trin and CCK? pepsinogens depend on?
A. pH

A. Pentagastrin
B. Octagastrin B. From the amount of gastric mucosa
C. presence of water
C. Heptagastrin
D. none of above
D. trigastrin
20. Large mucosal folds formed when the
15. In the gastrointestinal system, the pres- stomach is empty are called
ence of bile favors the A. the rugae
A. Distribution B. the fundus
B. Elimination C. the muscularis layer
C. Release D. the pyloric sphincter
D. Absorption 21. The inflammation of the lining of the stom-

ach is called
16. The neurotransmitter that participates in A. gastritis
the parasympathetic fibers is:
B. Crohn’s disease
A. dopamine C. celiac disease
B. norepinephrine D. mucositis
C. serotonin 22. Within the stomach lining, cells secrete
D. acetylcholine pepsinogen.
A. chief
17. chemical process
B. goblet
A. It starts in the mouth with the action of C. principal
enzymes followed by the salivary glands
D. argentaffin
B. It starts in the mouth with the action
of the salivary glands 23. Can I listen to your stomach?
C. It starts in the mouth with the action A. Boleh saya dengar perut anda?
of the salivary glands followed by the en- B. Boleh saya tepuk perut anda?
zymes of the stomach. C. Boleh saya dengar paru-paru anda?
D. none is correct D. none of above
18. Numerous fingerlike projections in the 24. Which of the following would you recom-
folds of the wall of the ileum is classified mend when discussingconservative man-
as agement of a hernia? Select all that apply.
A. Address constipation
A. Bolus
B. Aim for BMI 19-25
B. Chyme
C. Aim to achieve a gym bench-press
C. Bile record
D. Villi D. Stop smoking

25. The sphincter that connects the esophagus A. Cholecystokinin (CCK)

to the stomach is the B. Gastrin
A. the cards C. Motilin
B. Fundus D. Secretin
C. Body
31. Name given to food when mixed with gas-
D. Pyloric tric secretions
E. Gaster A. qui membrane
NARAYAN CHANGDER
26. Regarding the rectus sheath, what is ante- B. kilo
rior to the rectus muscle above the arcuate C. Gastric juice
line? Select all the apply.
D. none of above
A. External oblique aponeurosis
32. What is GERD?
B. internal oblique aponeurosis
A. stomach acid flows back into esopha-
C. Transversalis aponeurosis
gus
D. Transversalis fascia
B. hard stool
27. Longest part of the digestive tract: C. chronic inflammation of digestive tract
A. Esophagus D. group of symptoms that affect the
B. Small intestine large intestine
C. Large intestine 33. bowel frequency

D. none of above A. berapa kali buang air besar?
28. Color of the stool B. berapa kali kencing?

C. bila sakit mula?
A. Warna tahi
D. none of above
B. Jenis tahi
C. Berak berair 34. HCl secreting cells
D. none of above A. epithelial
B. parenting
29. Colorectal cancer is currently the most
common cause of cancer-related death in C. Parietals
the world. D. Argentafines
A. Second
35. When chyme penetrates a portion of the
B. Third small intestine, distension of the intestinal
C. Fourth wall induces localized concentric contrac-
tions spaced at intervals along the length
D. Fifth of the intestine, how long does it take?
30. Biopsies are taken from the antra and duo- A. less than 1 minute
denal mucosa of a 65-year-old woman. B. 1 minute
which of the following hormones can be
found in tissue homogenates from both lo- C. from 1 to 5 mountainous
cations? D. 15 to 30 minutes

36. The inguinal ligament is formed from the B. Gastrin secretion is Stimulated by the
A. external oblique aponeurosis digestive products of fat

B. internal oblique aponeurosis C. Somatostatin is a powerful stimulator
to both gastric secretion and motility
C. Scarpa’s fascia
D. Vasoactive Intestinal Peptide (VIP) in-
D. transversalis abdominis fascia hibit gastric Secretion
37. Which of the following is NOT a direct 42. Where are the α and β cells in the pan-
cause of jaundice? creas located?
A. Gallstones A. Islets of Langerhans
B. Hepatitis B. Acini
C. Cirrhosis C. Ducts
D. Bladder infections D. Hepatic cords
38. What are types of receptors available in 43. The migratory motor complexes are initi-
GIT ated by:
A. Mechanoreceptor A. digestion periods.
B. Osmoreceptor B. To motilin.
C. Chemoreceptor C. gastric secretion.
D. All of the above D. The bile juice.
39. food poisoning 44. Can I tap on your stomach?

A. perut berkeroncong A. Boleh saya rasa perut anda?
B. makanan tersangkut B. Boleh saya tepuk perut anda?
C. keracunan makanan C. Boleh saya dengar dada anda?
40. Which of the following hormones is re- 45. What type of medicine is Antacid?
leased by the presence of fat and protein A. Weak base
in the small intestine and has major effect
to decrease gastric emptying? B. Weak acid
A. Cholecystokinin (CCK) C. Strong acid
B. Gastrin D. Strong base
C. Glucose Dependent Insulinotorphic 46. Cellular metabolism:Set of reactions of

Peptide (GIP) an organism that aims to produce for
D. Secretin the functioning of cells.
A. chemicals molecules
41. Which of the following gastrointestinal
hormone functions is correct? B. physical energy
A. Cholecystokinin and Secretin Increase C. mechanics energy

both gastric secretion and motility D. chemicals energy

47. Which enzymes does the pancreas pump 52. When?

out? (3 answers) A. Why stomach ache?
A. Amylase B. When did the pain start?
B. Protease C. Where is the colic?
C. Lipase D. none of above
D. Bile 53. What is esophagus?
NARAYAN CHANGDER
48. Which diarrhea medication is a C-V con- A. none
trolled substance? B. It is a muscular sciphil tube that con-
A. Loperamide (Imodium) nects the pharynx to the stomach.
B. Bismuth subsalicylate (Pepto-Bismol) C. It is a cylindrical, muscular tube lined
with mucosa that connects the pharynx
C. Atropine/diphenoxylate (Lomotil) with the stomach.
D. None of the above D. all
49. Mr. A had a third stroke, this stroke 54. Time it takes for chyme to travel from the
caused Mr. A experienced a decrease in pylorus to the ileocecal valve
consciousness, the affected organ was on A. 3 a 5 hrs
the right, based on the case above to pro-
vide suitable nutrition for Mr. A is B. 5 a 7 hrs
A. Oral C. 1 a 2 hrs
D. 30 minutes
B. Parenteral
C. Enteral 55. What effect would cause some reflexes to
block the arrival of new acid content from
D. Rectal the stomach until the pancreatic game neu-
E. axilla tralizes the duodenal chyme.
A. A PH of less than 3.5 to 4
50. What are the stimulus for gastrin secre-
tion? B. A PH of 7
A. peptide and amino acid C. A Ph of 7.35 to 7.85
B. distension D. None of the above
C. both of the above 56. What is the organ that produces bile?
D. none of the above A. Pancreas
B. Gallbladder
51. Drugs when they are in solution form will
be absorbed mainly by C. Liver
A. passive diffusion D. none of above
B. Active transport 57. It is passedthrough the ingestion of food

and waterthat has been contaminated and-
C. All of the above
transmitted by individual who handlefood
D. none of the above with unwashed hands.

A. Cholera 63. What are the effectors after getting stim-

B. Dysentery ulates by hormones?

C. Diarrhea A. Muscle in the GIt walls
D. Mental Block B. secretion of the exocrine glands
58. Gastrin family of hormones are (select C. Both of the above

more than one question) D. None of the above
A. Gastrin
64. Do you have blood in the stool?
B. CCK
A. Anda ada darah dalam kencing?
C. Secretin
B. Anda ada darah dalam tahi?
D. glucagon
C. Anda ada selera makan?
59. stomach storage capacity
D. none of above
A. 0, 8 a 1, 5 l
B. 2 L 65. Organ like a muscular tube with a length of
C. 0, 5 a 1 L + 25 cm and a diameter of 2 cm and func-
tions to distribute food into the stomach is
D. 800 ml
the
60. Among the diseases of domestic carni- A. Faring
vores, parvovirus in dogs and feline pan-
leukopenia are two important diseases in B. Larynx
the small animal clinic, obtaining the fol- C. Gaster
lowing characteristics, except:
D. Esophagus
A. Cerebellar hypoplasia in newborn cats
E. Intestine
B. Dehydration, depression and vomiting
C. They are associated with important 66. What is the main stimulant for HCl secre-
bacteria of the Parvoviridae family tion and what is the main inhibitor?
D. Immunosuppression and lymphoid A. gastrin and somatostatin
necrosis B. acetylcholine and leptins
61. Portions of the Digestive system are the C. Histamine and somatostatin
following, except
D. none of above
A. Oral Cavity
B. Stomach 67. point out the wrong
C. Pharynx A. Between 25-35 g of sodium is ab-
sorbed
D. Septum
B. Chlorine absorption occurs by diffu-
62. HCl destroys: sion
A. Toxins, fat and nutrients
C. Bicarbonate is absorbed in the duode-
B. Fat, bacteria and protein num and jejunum.
C. Bacteria, toxins and degrades food D. Calcium is mainly absorbed in the je-
D. Proteins, breaks down food and fat junum.

68. What is the main function of the digestive B. Glucose-dependent insulinotropic pep-
tract? tide (GIP)
A. Absorption C. Gastrin
B. Secretion D. Secretin
C. Excretion E. Motilin
D. Protection
73. because of
NARAYAN CHANGDER
69. Which of the following is a “stool soft-
ener”? A. jika
A. Senna B. kalau
B. Docusate C. pasal / kerana
C. Omeprazole D. none of above
D. Psyllium
74. What initiates distension of the rectum by
70. It is called a food bolus stool?
A. Food that is broken down in the stom- A. Reflected contractions of his muscles
ach and the desire to defecate.
B. The food that is unfolded in the mouth B. The desire to defecate.
C. Food that is broken down in the duode- C. parasympathetic innervation
num
D. none of above
D. none of above
71. Regarding gastric torsion/volvulus, judge 75. Which of the following statement about
the items and mark the correct one:I- Gastrointestinal hormone is true? (you
Occurs in large and giant breed dogs; II- can choose more than one answers)
Meals several times a day in large quan- A. Gastrin is released as a result of stom-
tities; III-Intense movement after meals; ach distension and vagal stimulation.
IV-Chronic gastric dilation
B. Secretin stimulates the pancreatic aci-
A. I and II. nar cells to secrete enzymes.
B. I, II and III.
C. Secretin causes excessive gastric se-
C. I and III. cretion and accelerates gastric emptying.
D. All are correct. D. Vasoactive Intestinal Peptide induces
gastric acid secretion
72. A 10-year old boy consumes a cheese-
burger, fries, and chocolate shake. The
76. Maximum frequency of concentration of
meal stimulates the release of several gas-
the terminal ileum
trointestinal hormones. The presence of
fat, carbohydrate, or protein in the duo- A. 8 to 9 contractions per minute
denum stimulates the release of which of B. 5 per minute
the following hormones from the duodenal
mucosa? C. 12 per minute
A. Cholecytokinin (CCK) D. 3 to 5 per minute

77. Choose CORRECT statement regarding 83. Gastrin function

small intestine. A. Facilitates gastric emptying

A. About 6 meters long B. Inhibits gastric emptying
B. Extend from pylorus to illeoceacal junc- C. protein breakdown in the stomach
tion
D. lipid breakdown in the stomach
C. Attached to posterior abdominal wall
by a mesentry 84. Stimulates gastric acid secretion and mu-
D. Its lower part is fixed cous growth
A. Secretina
78. “Friendly” Bacteria are known as:
B. gastrin
A. Fibras
C. motilin
B. prebiotics
D. cholecystokinin
C. only bacteria
D. probiotics 85. One of the following is NOT part of the
digestive system
79. Major tunics of the Digestive system, ex- A. Pharynx
cept
B. Larynx
A. Radialis
C. Esophagus
B. Muscularis
D. None of the above
C. Mucosa
D. Submucosa 86. Feces are formed due to:
A. Excess feeding.
80. stomach rumbling
B. Malfunction of prebiotics.
A. sakit perut
C. The part of fibers that were not fer-
B. perut berkeroncong mented.
C. kenyangkan perut D. water absorption
D. none of above
87. What does the vomit start with?
81. Do you have constipation? A. With the feeling of nausea.
A. Anda ada sembelit? B. With the sialorrhea and the feeling of
B. Anda ada masalah makan? nausea.
C. Anda ada cirit-birit? C. By withholding food.
82. Parts of the small intestine after the duo- 88. In this area of the stomach adaptive relax-
denum is known as ation occurs:
A. Jejunum A. medial portion
B. Lipase duodenum B. proximal portion
C. Amylase duodenum C. distal portion
D. Lipase ileum D. none of above

89. Most of the digestion takes place in: C. breathing and ear function
A. Mouth. D. Breathing and ventilation of the middle
B. Stomach. ear
C. Small intestine. 95. What digestive enzyme that is found in the

stomach and begins the digestion of pro-
D. The large intestine.
teins?
90. Regarding pepsin, mark the CORRECT A. Amylase
NARAYAN CHANGDER
A. It reaches its highest activity at a pH B. Pepsin
of 5.
C. Lipase
B. Pepsin has the ability to digest colla-
D. Rennin
gen
C. Contributes with 30-40% of protein di- 96. Peak frequency of small bowel segmenta-
gestion tion concentrations
D. Deactivates with a pH between 2-3 A. 12 per minute
B. 1 per minute
91. The movement of the esophagus so that
food enters the stomach is called C. from 3 to 5 per world
A. spontaneous D. 8 to 9 per minute
B. relaxation 97. Helicobacter pylori is commonly present in
C. peristaltic
D. contraction A. Peptic ulcer disease
B. Crohn disease
92. which statement is/are correct?
C. Ulcerative colitis
A. Acetylcholine act by cAMP pathway
D. GERD
B. Gastrin act by cAMP pathway
98. What is the sphincter of the common bile
C. Hitamine act by PIP2 pathway
duct called?
D. Histamine act by cAMP pathway
A. Off
93. The type of good bacteria that helps the B. bile ducts
process of decomposing food scraps in the
C. cystic duct
large intestine is
D. none
A. Escherichia coli
B. Entamoeba coli 99. Where is secretin released?
C. Streptococcus infantarius coli A. In the duodenal mucosa in response to
the arrival of gastric acid
D. Campylobacter coli
B. In the esophageal mucosa in response
94. What is the breathing function of the na- to the arrival of a food bolus
sopharynx? C. In the gastric mucosa in response to
A. The breathing the arrival of the bolus and the mixture
B. Middle ear ventilation function D. none of above

100. stages of nutrition A. primary peristalsis

A. Swallowing, Digestion, Ingestion, Ab- B. Secondary peristaltism

sorption and Excretion C. voluntary swallowing phase
B. Ingestion, Digestion, Swallowing, Ab- D. Pharyngeal phase
sorption and Excretion
C. Ingestion, Swallowing, Digestion, Ab- 106. wear belt
sorption and Excretion A. wear a belt
D. Ingestion, Swallowing, Absorption, Di- B. wear a bra
gestion and Excretion C. wear shoes
101. Digestion begins at: D. none of above
A. Stomach 107. Where does peristalsis take place?
B. Mouth A. Esophagus
C. Small intestine B. Stomach
D. Esophagus C. Pharynx
102. In which disease the body’s immune sys- D. none of above
tem attacks the gastrointestinal tract, pos-
108. Which cells produce insulin and what is
sibly targeting microbial antigens?
its function?
A. peptic ulcer
A. alpha cells/raise blood glucose
B. celiac disease
B. beta cells/lower blood glucose
C. hemorrhoids
C. delta cells/inhibit alpha and beta cells
D. Crohn’s disease
D. F cells/inhibit somatostatin secretions
103. Where is the pharynx located?
109. A medical term referring to the Inflamma-
A. behind the nostrils tion of the GI tract, usually the stomach
B. ahead of the spine and the intestines
C. All A. Gastroenteritis
D. None B. Colic
C. Foreign Body
104. Do you have change in bowel habit?
D. Intussusception
A. Berapa kali anda buang air besar?
B. Anda ada tabiat buang air besar tak 110. Which one of the following parts of
sama? the GI tract has the following character-
istics:simple columnar epithelium, muscu-
C. Berapa kali anda buang air kecil? laris mucosa, Meissner’s plexus, two lay-
D. none of above ers of smooth muscle in the tunica mus-
cularis and Peyer’s patches of lymph nod-
105. It is a simple continuation of the peri- ules?
staltic wave that begins in the pharynx
and continues towards the esophagus dur- A. duodenum
ing the pharyngeal phase of swallowing. B. jejunum

C. ileum 115. Enzyme responsible for formation of acid

D. colon by combining water and carbon di oxide
A. Amylase
111. What happens to the large intestine dur-
ing the process of digesting food is B. galactosidase
A. kill germs that come in with food C. carbonic anhydrase
B. absorption of water and decomposi- D. peptidyl transferase
tion of food remains
NARAYAN CHANGDER
C. carbohydrate and fat digestion 116. Upper/ lower part of the abdomen
D. dissolving water-soluble vitamins A. lelangit atas/ bawah
112. You are tracing a drop of blood from the B. Abdomen atas/ bawah
blood capillary network in the small intes-
tine to the inferior vena cava. The path- C. sakit perut
way is D. none of above
A. hepatic vein → sinusoid → central
vein → hepatic portal vein → inferior 117. Absorption:
vena cava. A. Passage of nutrients to the internal
B. hepatic portal vein → sinusoid → in- medium
ferior vena cava.
B. act of swallowing food
C. hepatic portal vein → sinusoid → cen-
tral vein → hepatic vein → inferior vena C. Process in which food is transformed
cava into simpler nutrients
D. hepatic portal vein → hepatic vein → D. act of putting food in the mouth
sinusoid → central vein → inferior vena
cava 118. Nausea
113. definition of nutrition A. diarrhea

A. Process in which food is transformed B. loya
into nutrients
C. Appetite
B. Food digestion process for mainte-
nance of vital functions D. none of above
C. Process of absorbing food to maintain 119. phase, when the food bolus penetrates
vital functions the back of the mouth and pharyngeal
D. Science that studies nutrients area, it stimulates the epithelial areas of
swallowing
114. Which of the following is a feedback path-
way of the gastrointestinal system? A. involuntary pharyngeal phase of swal-
lowing
A. Arrival of chyme in the intestine
B. CCK secretion B. voluntary swallowing phase
C. Motility inhibition C. gastric phase of swallowing

D. Decreased insulin secretion D. epithelial phase of swallowing

120. The anatomical division of the large intes- B. mysteric reflex

tine C. gastrocolic reflex

A. right hemicolon and left hemicolon
D. reflex of parasympathetic fibers
B. colon and rectum
125. Mobility layer of the stomach wall
C. ascending colon, transverse colon, de-
scending colon, pelvic ileus colon, and rec- A. Mucosa
tum B. Submucos
D. all C. fluffy
E. none D. Muscular
121. An atrophy of the gastric mucosa causes
126. Do you have problem swallowing?
a decrease in the production of the intrinsic
factor of vit B12, which can produce: A. Anda ada masalah sembelit?
A. iron deficiency anemia B. Anda ada masalah cirit-birit?
B. Sickle cell anaemia. C. Anda ada masalah telan?
C. Anemia megaloblastica. D. none of above
D. Thalassemia.
127. When the primary peristaltic wave fails
122. The process of absorption of water in the to move all the food that has entered
digestive tract of food occurs in the esophagus towards the stomach, is it
caused?
A. colon
A. primary swallowing phase
B. rectum
B. Gastric mobilization phase
C. that one
D. fasting C. secondary peristalsis
D. feedback phase of the esophagus
123. It has a stratified keratinized epithelium
and in some parakeratinized regions it cor- 128. Which of the followings can cause gastri-
responds to: tis?
A. oral cavity lining A. alcohol
B. esophageal cavity lining B. cocaine
C. none C. smoking
D. none of above D. long stay in toilet
124. This defecation reflex is strong; The sig- E. stress
nals come from the bone marrow and the
entire autonomic nervous system and the 129. The teeth that work to tear food are
sum of other organs such as:The descent .
of the diaphragm through deep inspiration A. seri
Closing the epiglottis Contraction of ab-
B. tight
dominal muscles The descent of the pelvic
floor C. premolars
A. Reflejo vagovagal D. back molars

130. Which part of the small intestine joins the 136. hungry
large intestine?
A. full
A. Ileum
B. pain
B. Duodenum
C. hungry
C. Jejunum
131. Only is a proton pump inhibitor. 137. The myenteric plexus is also called:
NARAYAN CHANGDER
A. Ranitidine A. Meissner’s plexus
B. Omeprazole B. Auerbach’s plexus
C. Sucralfate
C. Plexus of Ranvier
D. Aluminum hydroxide
D. none of above
132. This enzyme digests fats (lipids)
A. Protease 138. This defecation reflex is the softest;
Nerve impulses are sent from the descend-
B. Carbohydrase
ing colon to begin peristalsis movements
C. Lipase and displace fecal matter.
D. Bile A. mysteric reflex
133. Lipase hydrolyzes in fat, this begins B. Reflejo vagovagal
with:
C. Reflex parasympathetic fibers
A. bile and pancreatic juice
D. gastrocolic reflex
B. The pancreas
C. The bile 139. Regarding the digestion of fats, point out
D. saliva the wrong thing
134. Contains amylase (degrades starch) and A. Approximately 30% is digested by lin-
lingual lipase (degrades fat), water, salts, gual lipase.
lysozyme (bactericide) and mucin (lubri- B. The emulsion of fats is given by the ac-
cant). tion of bile
A. Saliva C. The most important enzyme for diges-
B. substance P tion is pancreatic lipase.
C. gastric acids D. The final product is free fatty acids.
D. none of above
140. Which of the following treats flatu-
135. Name secretions released by parietal lence?
cells when food bolus reach your stomach.
A. Bismuth subsalicylate
A. Pepsinogen
B. Intrinsic factor B. Simethicone
C. Acid hydrochloric C. Loperamide

D. Secretin D. Famotidine

141. (1) Doudem (2) Jejunum (3) Illium (4) Ap- 147. The greatest motility presented in the
pendix Which is part of the small intestine gastrointestinal tract is found in:
is A. Jejunum.

A. 1, 2 and 3 B. Duodenum.
B. 2 and 4 C. Ileum.
C. 1 and 3 D. Descending colon.
D. 4
148. The pancreatic juice, produced by acinar
E. 1, 2, 3 and 4 cells, is secreted into the
142. Gastrin is secreted at A. stomach
A. Buccal cavity B. duodenum
B. Esophagus C. jejunum
C. Intestine D. ileum
D. Stomach 149. Juice that helps digest fats and some vi-
tamins
143. The large intestine stores or absorbs:
A. Gastric juice
A. electrolytes and water
B. Tangerine juice
B. Just water
C. Pancreatic juice
C. electrolytes only
D. Speed
D. stool
150. Storage of large amounts of food Mixing
144. Metabolism is divided into: of food Slow emptying of chyme. They are
A. anabolism and catabolism motor functions of:
B. Mechanical and physical process A. Small intestine
C. chemical and mechanical process B. Large intestine
D. physical chemical process C. Esophagus
145. pants are loose D. Stomach
A. seluar longgar 151. Which one inhibit the acid secretion

B. tali pinggang A. Gastrin
C. baju longgar B. Histamine
D. none of above C. Acetylcholine
D. Somatostatin
146. In order for nutrients to be absorbed,
they must necessarily participate in diges- 152. A condition in which waste is remaining
tion: in the colon causing the colon to become
A. Bile and pancreatic juice. abnormally enlarged
B. Gastric juice, bile and pancreatic juice. A. Resection and Anastomosis
C. gastric juice and pancreatic juice B. Megacolon
D. Saliva, gastric juice, bile and pancre- C. Foreign Body
atic juice. D. Intussusception

153. Examples of diseases of the gastroin- 158. Occurs in the distal stomach:
testinal system that affect cattle, horses A. motilin
and carnivores respectively are:
B. gastrin
A. Paratuberculosis, Brucellosis and FIP;
C. cholecystokinin
B. Rodococose, DVB e Parvovirose
D. Gastric inhibitory polypeptide
C. DVB, Paratuberculosis and PIF
159. Movements carried out in the ascending
D. DVB, Rodococose e PIF
portion and consists of the contraction of
NARAYAN CHANGDER
154. Where is the swallowing center located? the longitudinal muscle and with it gives
you the result of the haustras
A. Bulb and lower pons areas
A. Mov. mix
B. median eminence
B. mov. massa
C. Hypothalamo-pituitary
C. Mov. of propulsion
D. spinal bulb and hypothalamus
D. Mov. gastric emptying
155. What does the ileocecal valve do?
160. Swollen veins in lower rectum is symp-
A. Generates segmentation contractions.
tom of which disease?
B. It restricts the reflux of colonic con- A. peptic ulcer
tents and especially the large number
of commensal bacteria into the relatively B. celiac disease
sterile ileum. C. hemorrhoids
C. Segmentation contractions, which D. Crohn’s disease
shift chyme from one side to the other
and increase its contact with the mucosal 161. What is the acid in the stomach?
surface. A. HCl
D. none of above B. H2SO4
156. The media used to count the number of all C. H+

growing bacterial colonies is D. H2O
A. PCA agar 162. The primitive intestine is divided into
B. endo agar A. primitive intestine
C. In order to Mac Conkey B. posterior primitive gut
D. EMB agar C. mid primitive intestine
157. Gastrointestinal diseases refer to dis- D. all are correct
eases involving which of the following or- 163. slow waves of smooth muscle cells of the
gans? small intestine are:
A. esophagus A. tonic contractions
B. intestine B. physical contractions
C. liver C. resting membrane potential oscilla-
D. mouth tions
E. muscles D. none

164. Can you show me where it hurts? 170. Surgical removal of the appendix
A. Boleh saya rasa perut anda? A. hernioplasty

B. Di mana sakit perut? B. appendicitis
C. Boleh tunjuk mana sakit? C. appendectomy
D. none of above D. hysterectomy
165. The last section of the large intestine 171. Severe, often fluctuating pain in the ab-
domen caused by intestinal gas or obstruc-
A. cecum tion in the intestines
B. rectum A. Gastroenteritis
C. sigmoid B. Colic
D. ileum C. Foreign Body
D. Intussusception
166. What color is your stool?
A. Berapa lama tahi ada darah? 172. Regarding absorption, mark the COR-
RECT
B. Apa warna tahi?
A. Only water-soluble substances are ab-
C. Bahagian mana perut sakit? sorbed in the stomach.
D. none of above B. Connivent valves and villi increase the
absorptive surface
167. Which digestive organ functions to pro-
duce acid to kill germs that enter with C. The small intestine can absorb up to 10
food? liters of water a day.
A. mouth D. none of above
B. stomach 173. Salivary secretion is:

C. small intestine A. 800-1500 ml
D. colon B. 500-700 ml
C. 1000-2000 ml
168. no need
D. None of the above
A. can not
174. Which is not a function of the pancreas?
B. do not like
A. Production of the hormone insulin
C. no need
B. Production of pancreatic juice to neu-
D. none of above tralize food
169. The primary gastrointestinal system func- C. Production of enzymes to digest food
tions include all of the following except: D. Produces bilirubin for stool staining
A. Digestion
175. Stool that has been formed will be col-
B. Absorption lected temporarily at
C. Secretion A. rectum
D. All are GI functions B. sigmoid colon

C. anus 181. How big is big gastrin (hint:Big-big, big,

D. the blind gastrin, gastrin-IV)
A. 95
176. The process of expelling feces is also
B. 34
called
C. 17
A. defecation
D. 14
B. absorption
NARAYAN CHANGDER
C. secretion 182. In which section of the pharynx are the
palatine tonsils located?
D. urinal
A. Nasopharynx
177. About chewing, how do digestive en- B. Mesopharynx
zymes work?
C. oropharynx
A. They act on the surfaces of food parti-
cles D. Hipofaringe
B. They act on the surfaces of the stom- 183. Watery stool

ach walls. A. darah dalam tahi
C. They act on the gastric juice B. warna tahi
D. none of above C. Tahi berair
178. The secretions that lubricate the food so D. none of above
it moves easily through the digestive tract
184. The gastrointestinal hormones have
and also protects the epithelium are called
physiological effects that can be elicited
at normal concentrations as well as phar-
A. mucus macological effect that require higher than
B. water normal concentrations. Which of the fol-
lowing hormone will have the direct phys-
C. digestive enzymes
iological affect to stimulate gastric acid
D. hormones secretion?
179. What are the main enzymes involved in A. Gastrin

the digestion of lipids? B. Secretin
A. Peptidases and lipases C. Cholecystokinin (CCK)
B. Disaccharidases and exopeptidases D. Motilin
C. Lipases and colipases 185. What is the phase called, when the food
D. ferroportin and hepcidin is ready to be swallowed, the upward and
backward pressure of the tongue against
180. Types of stool the palate drags or moves it posteriorly?
A. berat badan A. voluntary swallowing phase
B. bila berak B. pharyngeal phase of swallowing
C. Jenis tahi C. gastric phase of swallowing
D. none of above D. voluntary phase of propulsion

186. Mrs. A received IVFD Nacl 0.9% therapy. B. The secretin.

1000/ml in 8 hours. What is the drip rate
C. Pancreozymine.
of Mrs. A?

D. The gastrin.
A. 41
B. 43 192. largest part of the stomach
C. 45 A. Second
D. 47 B. Pylorus
E. 30 C. Body
187. An important treatment target for is D. none of above
the chemoreceptor trigger zone.
193. The process of digesting food in the
A. Nausea and vomiting mouth using the teeth and tongue is called
B. Inflammatory bowel disease digestion.
C. PUD A. Mechanical
D. IBS B. Country
188. Where does the absorption of nutritive C. Chemical
substances mainly take place? D. Smooth
A. Small intestine
194. What is an immune disease in which peo-
B. Large intestine ple can’t eat gluten because it will damage
C. Pancreas their small intestine?
D. Liver A. peptic ulcer
189. What are the end products of carbohy- B. celiac disease

drate digestion? C. hemorrhoids
A. Glucose D. Crohn’s disease
B. Saccharose
195. It is a condition of unusualfrequent and
C. Fructose liquid bowel movement.
D. Galactose
A. Diarrhea
190. vomiting B. Cholera
A. throws up C. Dysentery
B. diarrhea D. Brain Damage
C. constipation
196. Not a factor affecting drug absorption
D. none of above
A. Foods
191. The gastrointestinal hormone that stimu-
B. Physical activity
lates the secretion of hydrochloric acid by
parietal cells is: C. blood pH
A. cholecystokinin. D. gastrointestinal transit

197. Which of the following is OTC? 203. If you have upper abdominal pain you
A. Protonix could have
A. gastritis
B. AcipHex
B. Crohn’s disease
C. Prevacid 24HR
C. hemorrhoids
D. Asacol
D. Celiac disease
198. It helps to keep the food longer for better
204. Bile is made up of:
NARAYAN CHANGDER
absorption of nutrients and can receive a
reverse pressure of 50 to 60 cm of water. A. bile salts
A. Valvula ileocecal B. bilirubin
C. Cholesterol
B. Esfinter pillory
D. LECITHIN
C. Esfinter duodenal
D. The reflection of the mass 205. What are the stimuli for GIT hormones
secretion (select more than one answer)
199. It is an infection of thesmall intestine that A. Distension
mayresult to severe diarrhea?
B. Chyme Osmolarity
A. Diarrhea
C. Chyme acidity
B. Dysentery D. Chyme concentration
C. Cholera
206. Gastrin stimulates the secretion of
D. none of above
A. Acid
200. hard stool B. carboxypeptidase
A. color together C. trypsin
B. some keras D. chymotrypsin
C. type of stool 207. The sequence of organs that food passes
D. none of above through in human digestion is .
A. Mouth-Throat-Stomach-Liver-Intestine
201. Where is gastric inhibitory peptide (GIP)
released?
B. Mouth-Throat-Intestine-Stomach-
A. Upper part of the small intestine Anus
B. oral portion of stomach C. Mouth-Esophagus-Liver-Stomach-
C. caudal portion of stomach Intestines
D. Mouth-Esophagus-Stomach-Intestine-
D. distal portion of the esophagus
Anus
202. What is/are the phase of GI control? 208. food stuck on the throat
A. Cephalic A. makanan tersangkut
B. Gastric B. makanan tersangkut di tekak
C. Intestinal C. tercekik makanan
D. All of the above D. none of above

209. what will happen when glucose concen- B. Boleh saya tepuk perut anda?
tration in your blood getting high? C. Beritahu kalau sakit?

A. Beta cell secrete glucagon and make D. none of above
you high
B. Beta cell secrete insulin and promotes 214. what are the overall functions of gastrin?
movement of glucose into certain cells (select more than one option)
C. alpha cell secrete glucagon and help A. Stimulate Gastric Acid and pepsin se-
your blood circulation cretion
D. alpha cell secrete insulin and give you B. Growth of gastric mucosa and intesti-
energy nal mucosa
C. Stimulate Gastric Motility
210. to make stomach full
D. Contraction of muscle at gastro
A. lapar esophageal junction cardiac sphincter pre-
B. perut berkeroncong vents reflux
C. kenyangkan perut 215. Which of the following is not a symp-
D. none of above tom?
A. Diarrhea
211. Occurs when strange objects are unsuc-
cessful in getting out of the intestinal B. Emesis
tract. C. Auscultation
A. Resection and Anastomosis D. seborrheic
B. Colic
216. In the laboratory examination of the food
C. Foreign Body sample, the results were obtained:Gram
D. Intussusception negative staining of rods, culture on Mac
Conkey media obtained pink colonies, bio-
212. Regarding intussusception, an intestinal chemical test of lactose fermentation (-)
obstruction where the intestinal segment glucose (+), Citrate (+), SIM motility (+)
penetrates the immediately distal portion sulfur ( +), TSIA H2S (+). The most appro-
of the organ, we can say that: priate conclusion from the identification re-
A. It is associated with hypomotility, due sults is
to enteritis or parasites A. Salmonella typhi
B. Among the possible etiologies is the B. Escherichia coli
presence of the Strongylus vulgaris para- C. Shigella dysentery
site, common in horses.
D. Staphylococcus aureus
C. Among the lesions observed, there is
a white coloration and absence of hemor- 217. Region where chyme enters the small in-
rhage. testine is known as
D. In intussusception, the thinner intesti- A. colon
nal walls are observed B. ileum
213. Let me know if it hurts? C. jejunum
A. Beritahu jika tekak sakit? D. duodenum

218. Fat-filled peritoneal processes through- 223. Ingestion:

out the large intestine are called A. waste disposal
A. vermiform appendages B. Food processing process
B. haustras C. all are right
C. lieberkuhn valves D. none is correct
D. omental appendages 224. Chief cells secrete
NARAYAN CHANGDER
E. none A. Booger
219. A patient with gastroesophageal reflux B. HCl
disease may receive which of the follow- C. Intrinsic factor
ing medications?
D. Pepsinogen
A. Calcium carbonate E. gastric lipase
B. Ranitidine
225. Which of the following is not part of the
C. Omeprazole small intestine is
D. All of the abouve A. rectum
220. What are the pacemaker cells of the gas- B. duodenum

trointestinal tract? C. fasting
A. Enteric plexus neurons D. ileum
B. Neurons of the myenteric plexus (Auer- 226. Plexus that initiates peristaltic waves
bach) from the descending colon, sigmoid colon,
C. Submucosal plexus neurons (Meiss- and rectum and propels feces toward the
ner) anus
D. interstitial cells of Cajal A. Auerbach’s myenteric plexus

B. gastrointestinal plexus
221. The movements that occur in the diges-
C. sacral plexus
tive tract are known as:
D. none of above
A. Of mix.
B. Of segmentation. 227. Gastric juice is mainly composed of:
A. Hydrochloric acid, Pepsin and mucin
C. Of transport.
B. Pepsin, Water and Mucin
D. All of the above.
C. Pepsin and hydrochloric acid
222. The oral route does not require unusual D. Hydrochloric Acid, Pepsin, Water and
aseptic processes Mucin
A. False
228. All of these are functions of the liver EX-
B. TRUE CEPT:
C. Who knows A. Biotransformation of molecules
D. I don’t think B. Production of digestive enzymes

C. Storage of glycogen, fat, vitamins, and 234. This reflex occurs 15 to 30 minutes after
iron breakfast and is carried out by the myen-
teric plexus. Ignoring this reflex is a cause

D. Synthesis of bile
of constipation.
229. The swallowing reflex activates afferent A. gastrocolic reflex
pathways that run through the glossopha-
ryngeal nerve to reach the swallowing cen- B. ileocolic reflex
ter, which is located in: C. Reflejo vagovagal
A. hypothalamus D. mass reflex
B. premotor cortex 235. WHEN DOES THE DIGESTIVE SYSTEM BE-
C. medulla oblongata GIN TO FORM?
D. Hard body A. THIRD WEEK
230. heartburn B. FOURTH WEEK
A. stomach ache C. FIFTH WEEK
B. belly clap D. 14 DIAS
C. heartburn 236. lately

D. none of above A. Today
231. The main cells of the stomach secrete: B. tomorrow
A. pessinogeno C. lately
B. HCL D. none of above
C. gastrin 237. What kind of food reaches the large in-

D. factor extrinsic testine the most?
A. Proteins
232. This reflex starts from the stomach to-
wards the brainstem and returns to the B. electrolytes and water
stomach to reduce the tone of the muscle C. Fiber
wall, which is distended to accumulate pro- D. sodium and water
gressive amounts of food.
A. gastrocolic reflex 238. Why?
B. ileocolic reflex A. Where is the stomach ache?
C. mass reflex B. When stomach ache?
D. Reflejo vagovagal C. Why stomach ache?

D. none of above
233. What are the different parts of the small
intestine? 239. Rectal bleeding
A. duodenum, hilum and jejunum A. Darah dalam kencing
B. jejunum, duodenum and cecum B. berak berair
C. duodenum, jejunum C. Darah dalam berak
D. jejunum, duodenum and ileum D. none of above

240. Slow waves originate from: B. Lansoprazole 30 mg. orally 30 minutes

A. enterocytes before breakfast, amoxicillin 1 gr 2 times
a day and metronidazole 500 mg. 2 times
B. postganglionic cells a day for 10 to 14 days.
C. interstitial cells of Cajal
C. Lansoprazole 30 mg. orally 30 minutes
D. none of above before breakfast, amoxicillin 1 gr 2 times
241. How much? a day and clarithromycin 500 mg. 2 times
a day for 10 to 14 days.
NARAYAN CHANGDER
A. How long is there blood in stool?
B. How can you get a stomach ache? D. Omeprazole 40 mg. orally a day, amox-
icillin 1 gr. 2 times a day, metronidazole
C. How much poop when pooping? 500 mg. 2 times a day orally for 10 to 14
D. none of above days.
242. Very common in horses, intestinal torsion
and volvulus result from vascular obstruc- 246. Which of the following statements is true
tion and severe ischemia, which can lead about Vasoactive Intestinal Peptide hor-
the animal to death. Among these etiolo- mones functions? (you can choose more
gies, which one is not associated? than one answers)
A. Cramps A. It stimulates intestinal secretion of

electrolytes and water
B. mesenteric lipomas
C. Linear foreign bodies B. Stimulate gastric acid and pepsin se-
cretion
D. dystocia deliveries
C. Relaxation of intestinal smooth muscle
243. Do you have pain in tummy?
including sphincters.
A. Anda ada sakit tekak?
D. It inhibit intestinal secretion of elec-
B. Anda ada sakit perut?
trolytes and water.
C. Anda ada sakit kaki?
D. none of above 247. The large intestine is capable of:
244. Occurring in all animal species, intestinal A. Transport 1 liter of fluid every two days
obstructions can have different etiologies,
B. Transport 1 liters of fluid daily
except:
A. Pythiosis in puppies C. Transports 1/2 liter of daily fluid
B. foreign bodies D. Transports 2 liters of fluid daily
C. Dogs that are fed once a day
D. Enteroliths in horses 248. The first place where protein breaks
down is:
245. Indicate the triple therapy used to man-
A. Mouth
age Helicobacter pylori.
A. Lansoprazole 30 mg. twice a day, B. Stomach
amoxicillin 1 g twice a day and clar-
C. Large intestine
ithromycin 500 mg. 2 times a day orally
for 10 to 14 days. D. Small intestine

249. Muscular organ that churns and mashes D. Myenteric plexus stimulates villi move-
food into chyme ment

A. Saliva 254. The gland whose function is to protect the
B. Tonuge duodenal mucosa from Hcl and pepsin irri-
C. Esophagus tation is the
D. Stomach A. Pancreatic gland

B. Spleen gland
250. Clinical experiment is conducted in which
C. Bruner’s gland
one group of subjects is given 50g of glu-
cose intravenously and another group is D. Pituitary gland
given 50 g of glucose orally. Which of the E. Adrenal glands
following factors can explain why the oral
glucose load is cleared from the blood at 255. What does mucus do?
a faster rate compared to the intravenous A. Digests food in the mouth.
glucose load?
B. Digests food in the stomach
A. CCK-induced insulin release
C. Protects the stomach from digesting
B. CCK-induced VIP release iteself
C. GIP-induced glucagon release D. Absorbs nutrients from food so the
D. GIP-induced insulin release body has energy.
251. The first-pass effect involves the 256. What happens in the small intestine?
A. Heart A. The food is stored; mixed with acid,
mucus, and pepsin, and released at a con-
B. Liver
stant and balanced rate into the duode-
C. Kidney num.
D. Large intestine B. The fundus and upper portion of the
gastric body relax to accommodate food.
252. Which of the following make up the up-
per part of the digestive system? Select C. The intestinal contents are mixed with
all that apply. the secretions of the mucosal cells and
with the pancreatic juice and bile.
A. mouth
D. none of above
B. small intestine
C. esophagus 257. From which embryonic layer does the
primitive intestine derive?
D. stomach
A. ectoderm
253. Which statements are correct? B. mesoderm
A. Submucosal plexus stimulates circular C. neural crests
and longitudinal muscle
D. endoderm
B. Myenteric plexus stimulates circular
and longitudinal muscle 258. Removing a part of the intestines and re-
C. Submucosal plexus stimulates villi connecting the remaining ends
movement A. Resection and Anastomosis

B. Megacolon 264. What parts is the pharynx divided into?

C. Foreign Body A. Nanopharynx, mesopharynx and
D. Intussusception amenopharynx
B. Nasopharynx, oropharynx, and laryn-
259. Describes a condition in which one seg- gopharynx
ment of the intestine telescopes into an ad-
jacent part of the intestines C. Hypopharynx, mesopharynx and mu-
cosopharynx
A. Resection and Anastomosis
NARAYAN CHANGDER
D. Orthopharynx, nasopharynx and hy-
B. Colic popharynx
C. Foreign Body
265. The vomiting control center is located:
D. Intussusception
A. hypothalamic
260. In the chemical digestion of the small in- B. Brainstem
testine:
C. Pituitary
A. Gastrin (a hormone that stimulates
D. spinal cord
the secretion of hydrochloric acid) is pro-
duced. 266. Abdominal pain
B. Intestinal glands secrete intestinal A. color together
juice B. swallowing problems
C. Pepsin is produced C. stomach ache
261. Movement of annular contraction that oc- 267. What is peristalsis?
curs in the walls of a tubular organ:
A. When a food is present in the intestine,
A. Antiperistalsis the intestinal nervous system promotes a
B. Motility type of motility.
C. peristalsis B. It is a reflex response triggered by af-
ferent impulses from the trigeminal, glos-
D. Bags
sopharyngeal, and vagus nerves.
262. Dicyclomine (Bentyl) helps patients with C. It is a reflex response that begins
when the intestinal wall is stretched by
A. Constipation the luminal contents, and it occurs in all
segments of the digestive tract from the
B. Ulcerative colitis
esophagus to the rectum.
C. Irritable bowel syndrome
D. none of above
D. None are correct
268. What percentage of fluids does the colon
263. Gastrointestinal Agents are absorb?
A. Inorganic agents A. 90%
B. Organic Agents B. 45%
C. Both C. 60%
D. none of above D. 25%

269. Can I feel your tummy? 274. Regulates intestinal motility in periods of
A. Boleh saya rasa perut anda? fasting between meals:
A. motilin

B. Boleh saya tepuk perut anda?
C. Boleh saya rasa muka anda? B. gastrin
D. none of above C. cholecystokinin
D. Gastric inhibitory polypeptide
270. What is the function of carboxypepti-
dase? 275. This reflex helps to intensify the peristal-
A. Separate small molecules into sis of the ileum and forces the chyme to
polypeptides cross the ileocecal valve to reach the ce-
cum.
B. attack the carboxy terminus of
polypeptides A. gastrocolic reflex
B. gastroileal reflex
C. digests elastin fibers
C. mass reflex
D. All are correct
D. Reflejo vagovagal
271. Constipation
276. What is the lingual papilla that is present
A. cirit-belit
in a specific place on the tongue?
B. selera makan
A. caliciformes
C. sembelit
B. larynx
D. none of above
C. none
272. What are the contraction patterns? D. none of above
A. Phase
277. Have you lost weight?
B. tonic
A. Boleh saya rasa perut?
C. Major migratory complex B. Ada hilang berat badan?
D. peristalsis C. Ada masalah telan?
E. segmental contractions D. none of above
273. What are the segment-specific types of 278. The small intestine does not include the
motility?
A. Mouth and esophagus, chewing, swal- A. Duodenum
lowing and lower esophageal sphincter.
B. Jejunum
B. Mouth and esophagus, chewing, swal-
lowing, lower esophageal sphincter, C. Colon
aerophagia and intestinal gas, gastric D. Ileum
emptying.
279. HCL acid from gastric juice is produced in
C. Chewing, swallowing, lower cells
esophageal sphincter, aerophagia and in-
A. D cells
testinal gas.
B. main
D. Mouth and esophagus, chewing, swal-
lowing, lower esophageal sphincter, C. none
aerophagia and intestinal gas. D. parietal

280. Choose which is the movement that char- 285. It acts as an inhibitor and blocks the po-
acterizes the large intestine: tentiation of gastric motility produced by
A. Segmentation movements. gastrin.
B. Antral systolic contractions. A. cholecystokinin
C. Mild, short-range peristalsis. B. HCL
D. Haustral contractions.
C. Pepsinogen
281. What is the phase called, when the food
NARAYAN CHANGDER
D. saliva
is ready for swallowing, the upward and
backward pressure of the tongue against
286. Two autoimmune disorders are:
the palate, drags or moves it <voluntarily>
posteriorly? A. Diarrhea and constipation
A. voluntary swallowing phase B. Ulcerative colitis and irritable bowel
B. pharyngeal phase of swallowing syndrome
C. gastric phase of swallowing C. Irritable bowel syndrome and diarrhea
D. voluntary phase of propulsion
D. Ulcerative colitis and Crohn’s disease
282. Regarding esophagitis:
A. There is only one type and it is called 287. diarrhea
reflux esophagitis. A. liquid stool
B. Among the etiologies, it can occur in a
B. some keras
traumatic way, due to Spirocerca lupi.
C. In chemical esophagitis, necrosis and C. constipation
marked edema are observed only in the D. none of above
esophageal mucosa.
D. As consequences of traumatic/obstructive 288. Choose (more than one) what growth me-
esophagitis, there is rumen tympanism dia can be used for Enterobacteriacea bac-
and phytobezoars. teria culture?
283. How many segment-specific types of A. Mac Conkey
motility are there?
B. endo agar
A. 7
C. Agar Eosin Methylene Blue (EMB)
B. 6
C. 5 D. Blood agar
D. 4
289. Which of the following manages vertigo
284. How many parts is the esophagus divided or dizziness?
into?
A. Pepto-Bismol
A. 2
B. Meclizine
B. 4
C. 3 C. Docusate sodium
D. 5 D. Esomeprazole

2.7 Renal Replacement Therapy 219
290. With regard to the formation of feces, in- D. All absorption occurs in the second
dicate the correct half of the colon.

A. It can absorb up to 3 liters of liquid per 291. The ingestion process is carried out in:
day A. Mouth
B. Feces are made up of 1/4 water B. Stomach
C. Solid matter is made up of 30% dead C. Small intestine

bacteria D. Large intestine.
2.7 Renal Replacement Therapy

1. What is A correct order of the steps of 5. What are the two main types of dialysis?
function within the nephron? A. Continuous renal replacement therapy
A. Secretion, Reabsorption, Filtration and peritoneal dialysis
B. Reabsorption, Secretion, Filtration B. Hemodialysis and peritoneal dialysis
C. Filtration, Reabsorption, Secretion C. Hemofiltration and peritioneal dialysis
D. Secretion, Filtration, Reabsorption D. Hemodialysis and continuous renal re-
placement therapy
2. Which of the following are dialysis clinics
required to work with? 6. What Does “Pay for Performance”
mean?
A. Centers for Medicare and Medicaid
Services (CMS) A. Medicare pays the clinic for each dial-
ysis treatment
B. National Kidney Foundation
B. Clinics that dont meet certain quality
C. Renal Physicians Association
standards will have their payments cut.
D. ESRD Networks
C. Billing cannot be done until after treat-
3. Which of these is a step of the CQI pro- ments are given.
cess? D. Patient track the clinics performance
A. Implement the PDCA cycle. and decide if the clinic should be paid.
B. Write a long article about the problem 7. The name for the cause of initial homeosta-
C. Develop a hypothesis sis imbalance is the
D. Consult and expert. A. response
B. effect
4. Which of the following enters into the
Bowman’s capsule, while the rest are left C. stimulus
behind in the capillaries? D. homeostasis
A. White blood cells 8. Which of the following is NOT a type of
B. Red blood cells renal replacement therapy
C. Platelets A. Hemodialysis
D. Plasma B. Peritoneal dialysis

C. Osmotic Diuretics 14. What is a hallmark concept of Chronic Kid-

D. Kidney Transplant ney Disease?
A. It can be reversed
9. Drugs or substances that cause a person
to urinate more frequently B. It always requires dialysis
A. catheterization C. Two or more contributing factors are a

bad sign
B. incontinence
D. Kidney transplant is the only treatment
NARAYAN CHANGDER
C. calculus
15. Which of the following is a responsibility
D. diuretics
of the ESRD Networks?
10. The movement of water from an area of A. Collect and report data about dialysis
high concentration to an area of lower con-
B. Handle patient grievances
centration is called
C. Help clinics seal with conflict
A. facilitated diffusion
D. Promote rehabilitation
B. active transport
E. All the above
C. osmosis
D. dialysis 16. Type of dialysis in which a machine re-
ceives waste-filled blood from the pa-
11. How are dialysis clinics paid by Medicare tient’s bloodstream, filters the blood, and
for dialysis treatment? then returns the cleansed blood to the pa-
A. Separate billing tients body; sometimes called an artificial
kidney.
B. Contract pricing
A. peritoneal dialysis
C. Prospective payment system bundles
B. dialysis
D. Composite rate
C. hemodialysis
12. Homeostasis in the human body is often D. nephro sclerosis
maintained by a:
A. neutral feedback loop 17. In the collecting duct, what is reab-
sorbed?
B. solar feedback loop
A. Ions like Na+ and Cl-
C. positive feedback loop
B. Nutrients like glucose and amino acids
D. negative feedback loop
C. Substances like drug metabolites and
13. Which of the following actions shows that waste
you are behaving as a professional? D. Water
A. Shouting across the dialysis clinic
18. The renal artery carries oxygen blood
B. Getting to work on time
A. rich
C. Talking about patients in front of other
patients. B. powerful
D. Sharing your personal problems with C. poor

your patients D. like

19. What are “clinical practive guidelines”? C. post-renal injury

A. Efforts to improve patient outcomes by D. Occlusive-renal injury

finding best practices
24. What is the hallmark manifestation of
B. ESRD Network quality improvement ef- nephrotic syndrome?
forts.
A. Loss of 3.5 grams of protein per day
C. Medicare rules for what dialysis clinics
must do. B. Massive edema
C. Pulmonary edema
D. The Measure Assessment Tool.
D. Hyperlipidemia
20. Positive feedback is when the change
caused by the stimulus is 25. How do you become a certified dialysis
technician?
A. decreased
A. Act in a unprofessional way on the job
B. non existant
B. Take a test given by an approved Pro-
C. increased
gram
D. changes constantly C. work as a technician for five years
21. What type of dialysis requires an abdomi- D. Write to your US Senator
nal catheter?
26. In the collecting duct, what is reabsorbed
A. Continuous Renal Replacement Ther- in the presence of ADH?
apy (CRRT)
A. Ions like Na+ and Cl-
B. Hemodialysis
B. Nutrients like glucose and amino acids
C. Sustained Low-Efficiency Dialysis
(SLED) C. Substances like drug metabolites and
waste
D. Peritoneal Dialysis
D. Water
22. Which of the following is an example of
27. How does the glomerulus filter blood into
a boundary that should be kept between
the Bowman’s capsule?
you and your patients?
A. High pressure
A. You should not ask patients about their
symptoms or medical history B. Concentration Gradient
B. You may accept gifts, money, or tips C. Active transport
from patients. D. Passive transport
C. You can borrow money from patients
28. After the process of filtration, the filtrate
D. You should not invite patients to your enters into the proximal convoluted tubule
home where most of the water, amino acids, and
glucose are
23. The nurse should recognize that the pro-
duction of lactic acid would place the client A. stored in the bladder
at risk for which of the following? B. excreted through the ureters
A. Pre-renal injury C. reabsorbed
B. Intra-renal injury D. concentrated in the urine

29. NaCl is isotonic to red blood cells. Which of burst.

these describes what will happen if a tech- B. The cells exposed to the solution will
nician misplaces a decimal point and makes shrink.
9.0% NaCl solution instead and adminis-
ters it to a patient? C. The cells will remain the same size.
D. The cells exposed to the solution will
A. The cells exposed to the solution will expand but not burst.
NARAYAN CHANGDER

3. Neurology
3.1 Cerebellar Syndrome

1. The following nucleus is related to 5. What is the outermost layer of the
Archicerebellum Meninges?
A. dentate A. Dura Mater
B. emboliformis B. Arachnoid Mater
C. globosus C. Cerebellar Cortex
D. Fastagius D. Pia Mater
2. Climbing fibers originate from what struc- 6. The meninges are a common site for
ture
A. Lesions
A. Ipsilateral Pontine Nuclei
B. Cranial Bleeds
B. Contralateral Pontine Nuclei
C. Ipsilateral Inferior Olive C. Intracranial Bleeds
D. Contralateral Inferior Olive D. Meningitis
3. Zones of cerebellum 7. Interposed nuclei

A. vermis A. dentate
B. intermediate zone B. fastigial
C. lateral hemispheres C. emboliform
D. flocculonodular D. globose
4. Cerebellum in Latin means: 8. A friend has taken a job in a neuroscience
A. movement research lab, and is studying neurons in
B. big brain a freshwater snail. He has been told to
calculate the equilibrium potential of K+.
C. seperate Which equation will he use and what other
D. little brain information will he need?

3.1 Cerebellar Syndrome 224
A. Nernst equation; concentration of K+ C. To fill up space.

inside and outside of the cell D. To heal hurt parts of the body.
B. Nernst equation; concentration of K+
inside and outside of the cell and perme- 13. The innermost part of the cerebellum con-
ability of K+ taining nerve cells that communicate infor-
mation from the cerebellum
C. Goldman equation; concentration of
K+ inside and outside of the cell A. Cerebellar Cortex
B. Cerebellar Nuclei
NARAYAN CHANGDER
D. Goldman equation; concentration of
K+ inside and outside of the cell and per- C. Cerebral Nuclei
meability of K+ D. Cerebral Cortex
E. Nernst equation; concentration of K+,
14. Which of these subcortical structures is not
Na+, and Cl-inside and outside of the cell
structurally attached to the basal ganglia
9. Largest part of the brain that is associated but is important for its functioning
with higher level thinking A. amygdala
A. cerebrum B. putamen
B. cerebellum C. substantia nigra
C. brain stem D. thalamus
D. none of above E. sub-thalamic nuclei
10. What is the brain part of? 15. The whole hemisphere of the cerebellum:
A. Muscular System A. related to the ipsilateral side of the
body and the contralateral side of the cor-
B. Nervous System
tex
C. Skeletal System
B. related to the contralateral side of the
D. Cardiovascular System body and the ipsilateral side of the cortex
11. The cerebellum functions as a comparator. C. is related to the ipsilateral side of the
This means that the cerebellum compares brainstem and has no connection with the
cortex
A. intended movements with actual move-
ments. D. Connected to both sides of the body
and the cortex (bilaterally) equally
B. spinal cord activity with the activity of
the cerebrum. 16. What does your Brain Stem do?
C. the incoming sensory stimuli with the A. Make your muscles work TOGETHER.
outgoing sensory stimuli. B. Used to communicate with or-
D. the right cerebellar hemisphere with gans/involuntary muscles.
the left cerebellar hemisphere. C. Control Voluntary muscles.
12. What are nerves for? D. Be the control center of the body.
A. Controlling muscles. 17. is a deep groove in the midline on the
B. Letting you know what happens all inferior surface of cerebellum.
over your body. A. Vallecula

B. Flocculonodular lobe 23. Lateral medullary syndrome is due to the

C. Vermis occlusion of

D. none of above A. Anterior spinal artery
18. A nurse is caring for a patient who exhibits B. Anterior inferior cerebellar artery
the following symptoms:
C. Posterior inferior cerebellar artery
A. midbrain.
D. Posterior spinal artery
B. brainstem.
C. cerebellum. 24. The following statements refer to the ac-
D. basal ganglia. tion of the cerebellum. Mark the correct
answers
19. What helps you communicate with the rest
of your body? Also known as the “High- A. The cortex of the cerebellum has two
way”. main types of input:climbing fibers coming
from the inferior olive to Purkinje cells and
A. Brain Stem
Mossy fibers forming synapses on gran-
B. Cerebrum ular cells and from there to the parallel
C. Spinal Cord fibers of Purkinje cells.
D. Cerebellum B. The cerebellum modulates the inten-
sity of the vestibular signal reaching the
20. Inferior cerebellar peduncle brain. An example of this was found by re-
A. White matter of cerebellum searchers when they measured the effect
B. Ridges of the cerebellar cortex of using glasses with a magnifying lens
C. Connect the cerebellum to the mid C. The cerebellum is involved in main-
brain taining balance, maintaining muscle tone.
D. Connect cerebellum to medulla oblon- Related to the coordination of voluntary
gata movements and motor learning
21. The following peduncle does not have Ef- D. The lateral lobes of the cerebellum
ferent fibres are associated with the correction of limb
movements
A. superior cerebellar peduncle
E. The vestibular nuclei mediate the activ-
B. Middle cerebellar peduncle
ity of the Flocculonodular Lobe
C. Inferior cerebellar peduncle
D. none of above 25. Select all that apply. What are the three
major regions of the cerebellum?
22. What is the disease called when your Cere-
bellum is pushed farther into the hole A. Vermis
where your vertebrates meet the brain?
B. Infundibulum
A. Chiari Malformation
C. Substantia nigra
B. Cerebellum Brain Disease
C. Shrinking Brainstem Disease D. Right hemisphere
D. Purple Hair disease E. Flocculonodular lobe

26. The following are nuclei of the cerebellum 31. Superior cerebellar peduncle
EXCEPT A. Ridges of cerebellar cortex
A. Dentate nucleus B. White matter of the cerebellum
B. Solitary nucleus C. Connect the cerebellum to the pons
C. Emboliform nucleus D. Connect the cerebellum to the mid-
D. Globose nucleus brain
32. Which lobe allows us to process what we
NARAYAN CHANGDER
E. Fastigial nucleus
are hearing?
27. Controls smooth muscles that control one’s
A. Frontal
ability to vomit, gag, swallow, cough, and
sneeze. B. Parietal
A. Cerebellum C. Temporal
B. Cerebrum D. Occipital
C. Pons 33. The tree of Life

D. Medulla Oblongata A. White matter of cerebellum
E. Brain Stem B. Ridges of the cerebellar cortex
C. Connect the cerebellum to the mid
28. What is your Nervous System for? brain
A. Controlling movements and communi- D. Connect the cerebellum to the medulla
cating with your body. oblongata
B. Providing structure and making blood.
34. How can you damage your brainstem
C. Having muscles work together. A. Listening to
D. Pumping blood. B. Smashing you brain off walls
29. If the patient has nystagmus, what func- C. You can get a stroke
tional classification of cerebellum is af- D. none of above
fected?
35. Contains a Respiratory Center that con-
A. Paleocerebellum
trols skeletal muscles associated with
B. Archicerebellum breathing.
C. Spinocerebellum A. Cerebellum
D. Cerebrocerebellum B. Cerebrum
E. None of the above C. Pons
D. Medulla Oblongata
30. protects the brain
E. Brain Stem
A. skull
36. Contains a Vasomotor Center that controls
B. meninges
smooth muscles in blood vessel walls to
C. cerebrum regulate blood pressure.
D. cerebrospinal fluid A. Cerebellum

B. Cerebrum C. stellate
C. Pons D. none of above

42. Pendular knee jerk is due to the lesion of
E. Brain Stem
A. Archicerebellum
37. For the flocculonodular lobe of cerebellum,
all are true EXCEPT: B. Paleocerebellum
A. It includes both folocculi and their pe- C. Neocerebellum

duncles D. none of above
B. It includes the nodules
C. It has vestibular connection 43. What is your Brain?
D. It has spinal connection. A. The Control Center of your body.

B. The Cerebrum, Cerebellum, and Brain
38. Contains a Respiratory Center that con-
Stem
trols smooth muscles that control one’s
respiratory rate. C. THE Nervous System.
A. Cerebellum D. Nerves all over your body.
B. Cerebrum
44. Functions of Basal Ganglia?
C. Pons
D. Medulla Oblongata A. Maintain circadian rhythm
E. Brain Stem B. Helps relay messages from the cortex

and cerebellum
39. Dysmetria is due to the lesion of
C. Control of voluntary motor movements
A. Archicerebellum
D. A messenger of neurological info
B. Paleocerebellum
C. Neocerebellum 45. which of the following would depolarize a
D. none of above neuron?
A. K+ diffusing out of a neuron
40. Which of the following is not a common
feature of the cerebrum and cerebellum? B. Na+ diffusing into a neuron
A. A superficial layer of gray matter C. Cl-diffusing into a neuron
B. Nuclei located within the white matter D. Ca2+ diffusing out of a neuron
C. Presence of one or more ventricles
46. unconscious proprioception from upper
D. The presence of white matter deep to
limb is carried by
the cortex
A. Lateral spinocerebellar tract
41. In superior view, the shape of cerebellum
is B. cuneocerebellar tract
A. ovoid C. Posterior column
B. butterfly D. olivocerebellar tract

47. What is the main purpose of your Nervous 52. Which lobe allows us to judge the conse-
System? quences of our behaviors?
A. To “Communicate” with your body us- A. Frontal
ing electrical signals and messages and to B. Occipital
receive information from neurons.
C. Temporal
B. To Send Information to your body. D. Insula
C. To Receive Information from your
53. Most of the output from the cerebellum
NARAYAN CHANGDER
body.
comes from
D. To Control Voluntary muscles. A. Purkinje cell axons
48. Structures called connect the cerebel- B. Axons of cells in the deep nuclei
lum to the brainstem and allow communi- C. Mossy fibers
cation between the cerebellum and other D. Climbing fibers
parts of the CNS.
54. What is your Cerebellum’s job?
A. Vermis
A. Keeping your organs functioning
B. Funiculi
B. Maintain Balance
C. Peduncles C. Connects nerves to your toes
D. Commissure D. Tells heart to pump
49. Abnormally increased muscle activity or 55. Where is your Brainstem Located
movement A. Front of Brain
A. Hyperkinesia B. Back of Brain
B. Choreoathetosis C. Left side of Brain
C. Tremor D. Right side of Brain
E. In the cold medicine bottle
D. Dystonia
56. The following tract is responsible for crude
50. The largest division according to functional movement of limbs
division of cerebellum is
A. vestibulocerebellar
A. cerebrocerebellum B. spinocerebellar
B. spinocerebellum C. corticopontocerebellar
C. vestibulocerebellum D. none of above
D. none of above 57. The nuclei that make up the basal ganglia
include (select all that apply)
51. Lobes of cerebellum
A. caudate nucleus
A. anterior lobe
B. red nucleus
B. posterior lobe C. putamen
C. flocculonodular lobe D. globus pallidus
D. folia lobe E. globus nigra

58. The largest intracerebellar nuclei is 64. Middle cerebellar peduncle

A. dentate A. White matter of cerebellum

B. emboliform B. Ridges of cerebellar cortex
C. globose C. Connect the cerebellum to the pons
D. fastigial D. Connect cerebellum to medulla oblon-
gata
59. The Cerebellum is responsible for:
A. Balance 65. List the layers of the Meninges from inner-
most to outermost:
B. Movement
A. Dura, Arachnoid, Pia
C. Coordination
B. Dura, Pia, Arachnoid
D. Memory
C. Pia, Arachnoid, Dura
E. Vision
D. none of above
60. Cerebellum covered superiorly by the
66. Intermediate zone is located at
A. falx cerebri
A. vermis
B. falx cerebeli
B. side of vermis
C. tentorium notch
C. midline
D. tentorium cerebeli
D. lateral hemisphere
61. Stores memories about previous learned
movements 67. Vermis is classified as
A. Cerebellum A. Cerebrocerebellum
B. Cerebrum B. Neocerebellum
C. Pons C. Archicerebellum
D. Medulla Oblongata D. Paleocerebellum
E. Brain Stem 68. Contains a Cardiac Center that controls car-
62. Cerebellum lies to the pons & the diac muscles in the heart to control heart
medulla oblongata hate and the strength of cardiac contrac-
tions.
A. posterior
A. Cerebellum
B. superior
B. Cerebrum
C. anterior
C. Pons
D. none of above
63. What is the largest part of the brain? E. Brain Stem
A. Cerebrum
69. fibers carry motor impulses from the
B. Cerebellum central nervous system to effectors such
C. Brainstem as muscles and glands
D. Diencephalon A. intrinsic

3.2 Hemiparesis 230
B. afferent 73. What Does Your Cerebrum do?

C. efferent A. It Communicates with with your body.
D. none of above B. It helps you use your senses, like smell
and feel.
70. Which of the following is NOT a function
of the cerebellum? C. It moves VOLUNTARY muscles.
A. Integrating sensory information relat- D. It moves and controls INVOLUNTARY
ing to position of body parts muscles.
NARAYAN CHANGDER
B. Coordinating skeletal muscle activity E. It lets you communicate with the en-
C. Maintaining posture tirety of your body.
D. Controlling breathing 74. Receives sensory information to adjusts
71. What is the Brainstem’s function skeletal muscles to maintain posture
and/or balance.
A. To attach the spinal cord to the brain
A. Cerebellum
B. Sends nerve signals throughout the
body B. Cerebrum
C. To help you think C. Pons
D. To help the Bills win a superbowl for D. Medulla Oblongata
the first time in forever
E. Brain Stem
72. Coordinates and fine-tunes skeletal muscle
75. What is good for the brain?
movements to ensure that muscle contrac-
tions lead to smooth movements A. Antifreeze
A. Cerebellum B. Healthy Food
B. Cerebrum C. Dairy Queen
C. Pons D. Exercise
D. Medulla Oblongata E. Laying down on the couch like a lazy
E. Brain Stem slob.
3.2 Hemiparesis
1. Stages of Motor Recovery for Hemipare- A. least responsive.
sis: synergy influence begins to decline B. most responsive.
A. Stage 1
C. minimally responsive.
B. Stage 2
D. coma.
C. Stage 3
3. Which of the following, if left untreated,
D. Stage 4
can lead to an ischemic stroke?
2. The nurse has documented a client diag- A. Atrial fibrillation
nosed with a head injury as having a Glas-
gow Coma Scale (GCS) score of 7. This B. Arteriovenous malformation (AVM)
score is generally interpreted as C. Ruptured cerebral arteries

3.2 Hemiparesis 231
D. Cerebral aneurysm has developed cerebral vasculitis and in-

creased ICP. What neurologic sequelae
4. The nurse is assessing the throat of a client might this client develop?

with throat pain. In asking the client to
A. Damage to the facial nerve
stick out the tongue, the nurse is also as-
sessing which cranial nerve? B. Damage to the optic nerve
A. Cranial nerve V C. Damage to the olfactory nerve
B. Cranial nerve I D. Damage to the vagal nerve
C. Cranial nerve XII 9. A client has been diagnosed with a concus-
D. Cranial nerve XI sion and is to be released from the emer-
gency department. The nurse teaches the
5. A patient had a small pituitary ade- family or friends who will be caring for the
noma removed by the transsphenoidal ap- client to contact the physician or return to
proach and has developed diabetes in- the ED if the client
sipidus. What pharmacologic therapy will A. reports generalized weakness.
the nurse be administering to this patient
to control symptoms? B. sleeps for short periods of time.
C. Vomits
A. Furosemide (Lasix)
D. reports a headache.
B. Mannitol
C. Vasopressin 10. Common Loss of energy, fatigue, inabil-
ity to concentrate Decreased interest in
D. Phenobarbital daily life Time frame:6 months to 2 years
6. The nurse is caring for a client admitted post-CVA Medication important
with a stroke. Imaging studies indicate A. Depression
an embolus partially obstructing the right B. Apathy
carotid artery. What type of stroke does
the nurse know this client has? C. Sadness
A. Ischemic D. Pursuit of Happyness
B. Hemorrhagic 11. A client with a traumatic brain injury is

showing early signs of increasing intracra-
C. Right-sided
nial pressure (ICP). While planning care for
D. Left-sided this client, what would be the priority ex-
pected outcome?
7. Stages of Motor Recovery for Hemipare-
sis: full synergy patterns / spasticity A. Displays no signs or symptoms of in-
fection
A. Stage 1
B. Attains desired fluid balance
B. Stage 2
C. Maintains a patent airway
C. Stage 3
D. Demonstrates optimal cerebral tissue
D. Stage 4 perfusion
8. The critical care nurse is caring for a 12. Which method is used to help reduce in-
client with bacterial meningitis. The client tracranial pressure?

3.2 Hemiparesis 232
A. Rotating the neck to the far right with know that this client may need what to
neck support accomplish self-care?
B. Keeping the head of bed flat A. Appropriate assistive devices
C. Extreme hip flexion, with the hip sup- B. Advice from his family
ported by pillows C. A personal health care aide
D. Using a cervical collar D. An assisted-living environment
13. The community health nurse is conducting 16. Which of the following is the most common
NARAYAN CHANGDER
a home visit with a client who was dis- side effect of tissue plasminogen activator
charged from hospital 3 days ago after sur- (tPA)?
gical resection of a brain tumor and radia-
tion therapy. The client is accompanied by A. Bleeding
his partner during the nurse’s visit. Dur- B. Headache
ing the visit, the client’s partner becomes C. Hypertension
tearful. How should the nurse respond?
D. Increased intracranial pressure (ICP)
A. “Going through this experience with
your partner has been very difficult for 17. Pt uses stronger UE / LE to get to weaker
you, I’m sure. Can you tell me about your side
experience so far? ” A. Pusher Syndrome
B. “Many caregivers experience burnout. B. Ahh, push it
Are you experiencing symptoms depres-
sion and anxiety? ” C. Push it real good
C. “Sometimes people are unhappy about D. Puller Syndrome

the way they were treated in the hospital. 18. When the nurse observes that the patient
Were you happy with the care your partner has extension and external rotation of
received in the hospital? ” the arms and wrists, and extension, plan-
D. “It is okay to say you give up. Are you tar flexion, and internal rotation of the
worried you will not be able to continue to feet, she records the patient’s posturing
provide care for your partner? ” as which of the following?
14. Imaging: X-ray-dye injected into carotid A. Flaccid

arteries Risk of causing stroke Pts on bed B. Decerebrate
rest-24 hrs C. Normal
A. Angiographies / Arteriographies D. Decorticate
B. MRI
19. * Most common * Contralateral hemipare-
C. MRA (angiography) sis * Sensory loss of face * Homonymous
D. Doppler Ultrasound hemianopsia * Aphasia in (L) hemisphere *
Perceptual deficits in (R) hemisphere* (R)
15. The nurse is admitting a client into the side of this lacks insight into deficits * Sup-
rehabilitation unit after an industrial ac- plies lateral aspect of cerebral hemisphere
cident. The client’s nursing diagnoses in- (frontal, temporal, and parietal lobes)
clude disturbed sensory perception and
the nurse identifies that he has decreased A. Anterior Cerebral Artery (ACA)
strength and dexterity. The nurse should B. Middle Cerebral Artery (MCA)

3.2 Hemiparesis 233
C. Posterior Cerebral Artery (PCA) 24. Synergy Pattern: Hip extension / adduc-
D. none of above tion / IR Knee extension Ankle PF, inver-
sion Toe PF

20. Imaging: Vascular abnormalities (steno- A. UE Flexion
sis) Image of arteries in brain
B. UE Extension
A. CT Scan
C. LE Flexion
B. MRI
D. LE Extension
C. MRA (angiography)
D. Doppler Ultrasound 25. The nurse is taking care of a client with
a history of headaches. The nurse takes
21. A client comes to the clinic for evaluation measures to reduce headaches and admin-
because of complaints of dizziness and dif- ister medications. Which appropriate nurs-
ficulty walking. Further assessment re- ing interventions may be provided by the
veals a staggering gait, marked muscle in- nurse to such a client?
coordination, and nystagmus. A brain tu- A. Use pressure-relieving pads or a simi-
mor is suspected. Based on the client’s lar type of mattress
assessment findings, the nurse would sus-
pect that the tumor is located in which area B. Perform the Heimlich maneuver
of the brain? Frontal lobe C. Maintain hydration by drinking eight
A. Frontal lobe glasses of fluid a day
B. Occipital lobe D. Apply warm or cool cloths to the fore-

head or back of the neck
C. Motor cortex
D. Cerebellum 26. Bell palsy is a disorder of which cranial
nerve?
22. A 64-year-old client reports symptoms A. Trigeminal (V)
consistent with a transient ischemic attack
(TIA) to the health care provider in the B. Vagus (X)
emergency department. Which is the ori- C. Vestibulocochlear (VIII)
gin of the client’s symptoms? D. Facial (VII)
A. hypertension
27. The nurse is preparing the client for a diag-
B. impaired cerebral circulation nostic test to evaluate blood flow within
C. diabetes insipidus intracranial blood vessels. For which test
D. cardiac disease is the nurse preparing the client?
A. Cerebral angiography
23. The nurse is caring for a patient in the
emergency department with a diagnosed B. Computed tomography
epidural hematoma. What procedure will C. Magnetic resonance imaging
the nurse prepare the patient for? D. Transcranial Doppler
A. Hypophysectomy
28. T/F:Stroke is the 4th leading cause of
B. Insertion of Crutchfield tongs death, and leading cause of long term dis-
C. Burr holes ability.
D. Application of Halo traction A. True

3.2 Hemiparesis 234
B. False, 3rd A. Cardiogenic shock

C. False, 2nd B. Tetraplegia
D. False, 5th C. Paraplegia
29. The nurse is caring for a patient with Hunt- D. Spinal shock
ington’s disease in the long-term care facil- 33. Which is the most common cause of acute
ity. What does the nurse recognize as the encephalitis in the United States?
most prominent symptom of the disease
NARAYAN CHANGDER
that the patient exhibits? A. St. Louis virus
A. Rapid, jerky, involuntary movements B. West Nile virus
B. Slow, shuffling gait C. Western equine virus
C. Dysphagia and dysphonia D. Herpes simplex virus
D. Dementia 34. A patient learning to ambulate with

crutches advances both crutches and then
30. The nurse is caring for a client who was di- lifts both feet, moving them forward and
agnosed with a glioma 5 months ago. To- landing them in front of the crutches. The
day, the client was brought to the emer- patient then repeats this motion. The
gency department by his caregiver because nurse identifies this as which type of
he collapsed at home. The nurse suspects crutch gait?
late signs of rising intracranial pressure
(ICP) when which blood pressure and pulse A. 3-point
readings are noted? B. Swing-through
A. BP = 150/90 mm Hg; HR = 90 bpm C. 4-point
B. BP = 90/50 mm Hg; HR = 75 bpm D. Swing-to
C. BP =130/80 mm Hg; HR = 55 bpm 35. The nurse learns a client was reported to
D. BP = 175/45 mm Hg; HR = 42 bpm have a history of basilar skull fracture
with otorrhea. What assessment finding
31. A client admitted with a cerebral contu- does the nurse anticipate?
sion is confused, disoriented, and restless.
Which nursing diagnosis takes the highest A. The client has ecchymosis in the peri-
priority? orbital region.
A. Feeding self-care deficit related to B. The client has an elevated tempera-

neurologic trauma ture.
B. Risk for injury related to neurologic C. The client has cerebral spinal fluid
deficit (CSF) leaking from the ear.
C. Disturbed sensory perception (visual) D. The client has serous drainage from
related to neurologic trauma the nose.
D. Impaired verbal communication re- 36. Imaging: Noninvasive-sends soundwaves

lated to confusion into body Transcranial version of this ex-
amines posterior circulation of brain
32. The nurse is caring for a client immediately
following a spinal cord injury (SCI). Which A. CT Scan
is an acute complication of SCI? B. MRI

3.2 Hemiparesis 235
C. MRA (angiography) 40. Imaging: 1st ordered to rule out hemor-

rhage Identifies LARGE arteries / veins
D. Doppler Ultrasound
only Cerebral edema Cerebral infarction

37. The nurse is called to attend to a patient A. CT Scan
having a seizure in the waiting area. What B. MRI
nursing care is provided for a patient who
is experiencing a convulsive seizure? Se- C. MRA (angiography)
lect all that apply. D. Doppler Ultrasound
A. Positioning the patient on his or her 41. The pre-nursing class is learning about the
side with head flexed forward nervous system in their anatomy class.
B. Loosening constrictive clothing What part of the nervous system would
the students learn is responsible for di-
C. Restraining the patient to avoid self ingesting food and eliminating body waste?
jury
A. Sympathetic
D. Opening the patient’s jaw and insert-
ing a mouth gag B. Peripheral
C. Central
E. Providing for privacy
D. Parasympathetic
38. Pts are commonly treated w/ anticonvul-
sant medications Postictal state-pt may 42. Cognitive Dysfunction: Memory gaps
present w/ stroke like deficits w/ hemi- filled in w/ inappropriate words or fabri-
paresis following this; PT commonly con- cated stories
sulted Altered state of consciousness Usu- A. Common
ally lasts b/w 5 and 30 minutes, some- B. Confabulation
times longer Drowsiness, confusion, nau-
sea, hypertension, headache or migraine, C. Perservation
other disorienting symptoms D. none of above
A. Seizures 43. The nurse is caring for a client with apha-
B. Bladder and Bowel Dysfunction sia. Which strategy will the nurse use to
facilitate communication with the client?
C. Cardiopulmonary Dysfunction
A. Avoiding the use of hand gestures
D. DVT and PE
B. Speaking loudly
39. A client who recently experienced a stroke C. Speaking in complete sentences
tells the nurse that he has double vision.
D. Establishing eye contact
Which nursing intervention is most appro-
priate? 44. Emotional liability Lesions of frontal lobe,
A. Alternatively patch one eye every 2 hypothalamus Uncontrolled emotions-
hours. uncontrolled outbursts of crying, laughing
that is inconsistent w/ the pt’s current
B. Instill artificial tears. mood Current medication controls this
C. Turn out the lights in the room. A. Delirium
D. Encourage the client to close his eyes. B. Sudowoodo

3.2 Hemiparesis 236
C. Dysphagia B. “I was putting my shoes on.”

D. Pseudobulbar effect C. “I was brushing my teeth.”
45. Synergy Pattern: Hip flexion / abduction D. “I was sitting at home watching televi-
/ ER Knee flexion Ankle DF, inversion Toe sion.”
DF 49. A healthcare provider orders several drugs
A. UE Flexion for a client with hemorrhagic stroke.
Which drug order should the nurse ques-
B. UE Extension
NARAYAN CHANGDER
tion?
C. LE Flexion
A. Methyldopa
D. LE Extension
B. Phenytoin
46. The nurse is developing a bowel training C. Dexamethasone
program for a patient. What education can
D. Heparin sodium
the nurse provide for the patient that will
increase the chance of success of the bowel 50. A patient presents to the emergency room
program? (Select all that apply.) with complaints of having an “exploding
A. Take a retention enema daily. headache” for the last 2 hours. The pa-
tient is immediately seen by a triage nurse
B. Have a fluid intake between 2 and 4
who suspects the patient is experiencing a
L/day.
stroke. Which of the following is a possi-
C. Take a laxative daily. ble cause based on the characteristic symp-
D. Set a daily defecation time that is tom?
within 15 minutes of the same time every A. Cerebral aneurysm
day.
B. Small artery thrombosis
E. Have an adequate intake of fiber con-
C. Cardiogenic emboli
taining foods.
D. Large artery thrombosis
47. The nurse is discussing spinal cord injury
(SCI) at a health fair at a local high school. 51. Which term refers to the inability to per-
The nurse relays that the most common form previously learned purposeful motor
cause of SCI is acts on a voluntary basis?
A. Falls A. Perseveration
B. Acts of violence B. Agnosia
C. Sports-related injuries C. Apraxia
D. Motor vehicle crashes D. Agraphia
48. The nurse is caring for a patient in the 52. The nurse is completing an assessment on
emergency department with an onset of a client with myasthenia gravis. Which
pain related to trigeminal neuralgia. What of the following historical recounting pro-
subjective data stated by the patient does vides the most significant evidence regard-
the nurse determine triggered the parox- ing when the disorder began?
ysms of pain? A. Sensitivity to bright light
A. “I was taking a bath.” B. Drooping eyelids

3.2 Hemiparesis 237
C. Shortness of breath B. The client has weakness on the right

D. Muscle spasms side of the body.

C. The client has complete bilateral paral-
53. A client with a traumatic brain injury has ysis of the arms and legs.
developed increased intracranial pressure
resulting in diabetes insipidus. While as- D. The client has weakness on the right
sessing the client, the nurse expects which side of the face and tongue.
of the following findings? E. The client has lost the ability to move
A. Oliguria and serum hyperosmolarity the right arm but is able to walk indepen-
dently.
B. Excessive urine output and decreased
urine osmolality 57. Impaired balance and uncontrolled tremors
C. Oliguria and decreased urine osmolal- of Parkinson’s disease is correlated with
ity which neurotransmitter?
D. Excessive urine output and serum A. Serotonin
hypo-osmolarity B. Acetylcholine
54. When developing a plan of care for a pa- C. Glutamate
tient with impaired physical mobility who D. Dopamine
must remain on complete bedrest, which of
the following would the nurse most likely 58. A nurse is assessing a client who will be
include to prevent external rotation of the discharged home after rehabilitation for
hip? a stroke. The nurse is questioning the
A. Protective boots client about his instrumental activities of
daily living (IADLs). Which of the follow-
B. Range-of-motion exercises
ing would the nurse address?
C. Trochanter roll
A. Grooming
D. Pillow between the legs
B. Bathing
55. Medical management of arthropod-borne C. Dressing
virus (arboviral) encephalitis is aimed at
D. Cooking
A. preventing muscular atrophy.
B. controlling seizures and increased in- 59. A client is diagnosed with a brain tumor
tracranial pressure. of the parietal lobe. Based on the tumor’s
location, which assessment finding would
C. preventing renal insufficiency. the nurse most likely note? Select all that
D. maintaining hemodynamic stability apply.
and adequate cardiac output.
A. difficulty with reading
56. The nurse is assigned to care for a B. problems with mathematical calcula-
client with complete right-sided hemipare- tions
sis from a stroke. Which characteristics
C. impaired reasoning
are associated with this condition? Select
all that apply. D. memory changes
A. The client is aphasic. E. changing moods

3.2 Hemiparesis 238
60. Who did Shelby suggest Mark dress up as 65. A client with Guillain-Barre syndrome can-
for Halloween? not swallow and has a paralytic ileus; the
A. Chris Tucker in 5th Element nurse is administering parenteral nutrition
intravenously. The nurse is careful to as-
B. Chris Tucker in Rush Hour 1 sess which of the following related to in-
C. Chris Tucker in Rush Hour 2 take of nutrients?
D. Chris Tucker in Rush Hour 3 A. Urinary output and capillary refill
B. Condition of skin
NARAYAN CHANGDER
61. Which lobe of the brain is responsible for
spatial relationships? C. Respiratory status
A. Frontal D. Gag reflex and bowel sounds
B. Occipital 66. * Typically linked to a thrombus * Tem-
C. Temporal porary interruption in blood supply to an
D. Parietal area * Pt may present w/ symptoms of
CVA, but resolves quickly (<24 hrs) * No
62. Which statement indicates appropriate evidence of brain damage or permanent
nursing intervention for a client with post- neuro dysfunction * 15% of strokes are
polio syndrome? preceded by this
A. Avoid the use of heat applications in A. Transient Ischemic Attack (TIA)
the treatment of muscle and joint pain B. Ischemic Stroke
B. Administer antiretroviral agents C. Hemorrhagic Stroke
C. Provide care aimed at slowing the loss D. none of above
of strength and maintaining overall well-
being. 67. A client is scheduled for a laminectomy
D. Plan activities for evening hours rather to repair a herniated intervertebral disk.
than morning hours When developing the postoperative care
plan, the nurse should include which ac-
63. A patient with a brain tumor is complaining tion?
of headaches that are worse in the morn- A. Maintaining bed rest for 72 hours after
ing. What does the nurse know could be the laminectomy
the reason for the morning headaches?
B. Keeping a pillow under the client’s
A. Migraines knees at all times
B. Dehydration C. Turning the client from side to side, us-
C. The tumor is shrinking. ing the logroll technique
D. Increased intracranial pressure D. Placing the client in semi-Fowler’s po-
sition
sis: near normal movement patterns 68. A client with a spinal cord injury says he
A. Stage 5 has difficulty recognizing the symptoms of
urinary tract infection (UTI). Which symp-
B. Stage 6 tom is an early sign of UTI in a client with
C. Stage 3 a spinal cord injury?
D. Stage 4 A. Lower back pain

3.2 Hemiparesis 239
B. Fever and change in urine clarity A. They can affect vital functioning.
C. Frequency of urination B. They are all metastatic.

D. Burning sensation on urination C. The prognosis is very poor.
69. Decreased physical activity leads to D. They do not require surgical removal.
higher risk of this Fall risk of the
74. The nurse is evaluating the serum albumin
stroke population-impaired balance, pro-
of a client newly admitted on the reha-
prioception, vision, behavioral impulsivity,
bilitation unit. The nurse determines that
etc. Vertebral and hip of this are com-
the client’s serum albumin concentration is
mon More involved side
low, indicating that the client has which
A. Osteoporosis and Fracture Risk deficiency?
B. Bladder and Bowel Dysfunction A. Calcium
C. Cardiopulmonary Dysfunction B. Phosphorous
D. DVT and PE C. Protein
70. Urinary incontinence common UTIs treat- D. Potassium
able Constipation due to limited activity /
diarrhea 75. A client is diagnosed with an ischemic
stroke. For which reason(s) would the
A. Seizures nurse question the use of tissue plasmino-
B. Bladder and Bowel Dysfunction gen activator (tPA) for this client? Select
C. Cardiopulmonary Dysfunction all that apply.
D. DVT and PE A. Prothrombin time 10 seconds

B. Platelet count 95, 000/mm3
71. Aphasia: Both expressive and receptive;
seen w/ severe brain damage C. Received low-molecular weight hep-
arin injections twice a day
A. Expressive / non-fluent
D. Diastolic blood pressure 120 mm Hg
B. Receptive
E. Systolic blood pressure 198 mm Hg
C. Global
D. none of above 76. What is of great importance when it comes
to providing tx for a pt who tragically sus-
72. Who spent 13 hours at school preparing tained a CVA?
this quiz?
A. Function
A. Jacky
B. Function
B. Jacky
C. Function
C. Jacky
D. Function
D. Tanner
77. A nurse is monitoring a client for increas-
73. The nurse is seeing the mother of a client ing intracranial pressure (ICP). Early signs
who states, “I’m so relieved because my of increased ICP include:
son’s doctor told me his brain tumor is
benign.” The nurse knows what is true A. diminished responsiveness.
about benign brain tumors? B. decreasing blood pressure.

3.2 Hemiparesis 240
C. pupillary changes. C. Hyperreflexia along with spastic ex-

D. elevated temperature tremities
D. Spasticity of all four extremities
78. The nurse is caring for a client with a head
injury. The client is experiencing CSF rhin- 82. A patient is admitted to the emergency
orrhea. Which order should the nurse ques- room with a fractured skull sustained in a
tion? motorcycle accident. The nurse notes fluid
A. Out of bed to the chair three times a leaking from the patient’s ears. The nurse
NARAYAN CHANGDER
day knows this is a probable sign of which type
of skull fracture?
B. Urine testing for acetone
C. Serum sodium concentration testing A. Depressed
D. Insertion of a nasogastric (NG) tube B. Comminuted

C. Basilar
79. A client with possible bacterial meningitis
is admitted to the ICU. What assessment D. Simple
finding would the nurse expect for a client
with this diagnosis? 83. High risk of this during acute phase Why?
* Immobilized pt* Cognitive impairments*
A. Numbness and tingling in the lower ex-
Limb paralysis* Hemineglect Calf pain /
tremities
tenderness, tight feeling in calf, swelling
B. Pain upon ankle dorsiflexion of the foot of foot / ankle 47% of pts get this
C. Neck flexion produces flexion of knees chest pain, tachypnea, tachycardia, anxi-
and hips ety, restlessness, apprehension together
w/ persistent cough tx:supplemental O2,
D. Inability to stand with eyes closed and
intubation, anticoagulants, thrombolytic
arms extended without swaying
drugs, surgery
80. A nurse is caring for a client who under- A. Seizures
went a lumbar laminectomy 2 days ago.
Which finding requires immediate interven- B. Bladder and Bowel Dysfunction
tion? C. Cardiopulmonary Dysfunction
A. Temperature of 99.2◦ F (37.3◦ C) D. DVT and PE
B. More back pain than the first postoper-
ative day 84. A nurse caring for a patient with head
trauma will be monitoring the patient for
C. Urine retention or incontinence
Cushing’s triad. What will the nurse rec-
D. Paresthesia in the dermatomes near ognize as the symptoms associated with
the wounds Cushing’s triad? Select all that apply.
81. A client with quadriplegia is in spinal shock. A. Tachycardia

What finding should the nurse expect? B. Bradycardia
A. Absence of reflexes along with flaccid C. Hypertension
extremities
D. Bradypnea
B. Positive Babinski’s reflex along with
spastic extremities E. Pupillary constriction

3.2 Hemiparesis 241
85. Which condition occurs when blood collects B. Ischemic Stroke

between the dura mater and arachnoid C. Hemorrhagic Stroke
membrane?

D. Vertebrobasilar Stroke
A. Subdural hematoma
89. Which is a modifiable risk factor for
B. Intracerebral hemorrhage
transient ischemic attacks and ischemic
C. Epidural hematoma strokes?
D. Extradural hematoma A. Smoking
86. A client arrives at the emergency de- B. Thyroid disease
partment complaining of extreme muscle C. Social drinking
weakness after minimal effort. The physi- D. Advanced age
cian suspects myasthenia gravis. Which
drug will be used to test for this disease? 90. Stroke cause = vascular disease CAD-
A. Edrophonium (Tensilon) impaired CO, rhythm disorders, cardiac
decomposition (CHF) Deconditioning →
B. Carbachol (Carboptic) side-effect post-stroke Decreased muscle
C. Pyridostigmine (Mestinon) strength, flexibility, bone-mass, depres-
sion, increased fatigue, limited endurance
D. Ambenonium (Mytelase)
A. Seizures
87. Acute confusional state* Hallucinations
B. Bladder and Bowel Dysfunction
and agitation may be common* Significant
confusion* Too much stimulation is worse C. Cardiopulmonary Dysfunction
for the pt D. DVT and PE
A. Delirium 91. Which of the following types of hematoma
B. Crazy results from venous bleeding with blood
C. Psychopathic gradually accumulating in the space below
the dura?
D. Yew cray cray
A. Intracerebral
88. * Small vessel disease deep in cere- B. Subdural
bral white matter* Branches off of
C. Epidural
MCA* Symptoms are not as severe*
Cause:hypertensive hemorrhage or di- D. Cerebral
abetic microvascular disease* Can be
92. Lower motor neuron lesions cause
pure motor or pure sensory* Ataxia /
dysarthria are possible symptoms* dia- A. increased muscle tone.
betic nephropathy-chronic loss of kidney B. no muscle atrophy.
function, neuropathy, and retinopathy*
C. flaccid muscles.
Early symptoms include floaters, blurri-
ness, dark areas of vision, and diffi- D. hyperactive and abnormal reflexes.
culty perceiving colors. Blindness can oc- 93. A nurse is preparing an in-service presen-
cur*Deficits in consciousness, language or tation that focuses on promoting pressure
visual not seen bc higher cortical centers ulcer healing. The nurse is planning to in-
are preserved clude information about appropriate nutri-
A. Lacunar Stroke tion. Which of the following would the

3.2 Hemiparesis 242
nurse include as important for overall tis- 98. A nurse is instructing the spouse of a client
sue repair? who suffered a stroke about the use of eat-
ing devices the client will be using. Dur-
A. Zinc sulfate
ing the teaching, the spouse starts to cry
B. Vitamin C and states, “One minute he is laughing,
C. Protein and the next he’s crying; I just don’t un-
derstand what’s wrong with him.” Which
D. Water statement is the best response by the
nurse?
NARAYAN CHANGDER
94. Which of the following early warning signs
does NOT belong? A. “Emotional lability is common after a
stroke, and it usually improves with time.”
A. Headache
B. “This behavior is common in clients
B. Vision changes with stroke. Which does your spouse do
C. Sudden numbness, weakness more often? Laugh or cry? ”
D. All of the above are early warning C. “You seem upset, and it may be hard
signs for you to focus on the teaching, I’ll come
back later.”
95. Cerebral edema peaks at which time point D. “You sound stressed; maybe using
after intracranial surgery? some stress management techniques will
A. 12 hours help.”
B. 24 hours 99. A client with tetraplegia cannot do his own
C. 48 hours skin care. The nurse is teaching the care-
giver about the importance of maintaining
D. 72 hours skin integrity. Which of the following will
the nurse most encourage the caregiver to
96. Myasthenia gravis occurs when antibodies
do?
attack which receptor sites?
A. Watch closely for signs of urinary tract
A. GABA
infection.
B. Acetylcholine B. Avoid range of motion exercises for
C. Serotonin the client because of spasms.
D. Dopamine C. Keep accurate intake and output.
D. Maintain a diet for the client that is
97. A client presents to the emergency depart- high in protein, vitamins, and calories.
ment stating numbness and tingling occur-
ring down the left leg into the left foot. 100. A female client reports to a nurse that
When documenting the experience, which she experiences a loss of urine when she
medical terminology would the nurse be jogs. The nurse’s assessment reveals no
most correct to report? nocturia, burning, discomfort when void-
ing, or urine leakage before reaching the
A. Paresthesia
bathroom. The nurse explains to the client
B. Sciatic nerve pain that this type of problem is called:
C. Paralysis A. reflex incontinence.
D. Herniation B. functional incontinence.

3.2 Hemiparesis 243
C. stress incontinence. B. Place food on the affected side of the

D. total incontinence. mouth.

C. Allow ample time to eat.
101. A nurse is reviewing a CT scan of the
brain, which states that the client has D. Test the gag reflex before offering
arterial bleeding with blood accumulation food or fluids.
above the dura. Which of the following 105. Imaging: Greater resolution than CT De-
facts of the disease progression is essen- tects smaller lesions Contraindicated for
tial to guide the nursing management of pts w/ pacemakers
client care?
A. CT Scan
A. The crash cart with defibrillator is kept
nearby. B. MRI
B. Bleeding continues into the intracere- C. MRA (angiography)

bral area. D. Doppler Ultrasound
C. Monitoring is needed as rapid neuro- 106. Which is a late sign of increased intracra-
logic deterioration may occur. nial pressure (ICP)?
D. Symptoms will evolve over a period of A. Altered respiratory patterns
1 week.
B. Headache
102. The nursing instructor gives their stu- C. Slow speech
dents an assignment of making a plan of
D. Irritability
care for a client with Huntington’s disease.
What would be important for the students 107. Aphasia: Inability to speak, speech is
to include in the teaching portion of the slow and hesitant, vocabulary is limited
care plan?
A. Expressive / Non-fluent
A. How to exercise
B. Receptive
B. How to take a bath
C. Global
C. How to facilitate tasks such as using
D. none of above
both hands to hold a drinking glass
D. How to perform household tasks 108. Cognitive Dysfunction: Inattention,
alertness, memory, easily distracted
103. A client is having a tonic-clonic seizure.
A. Common
What should the nurse do first?
B. Confabulation
A. Elevate the head of the bed.
C. Perservation
B. Restrain the client’s arms and legs.
D. none of above
C. Take measures to prevent injury.
D. Place a tongue blade in the client’s 109. A client with a cerebellar brain tumor is
mouth. admitted to an acute care facility. The
nurse formulates a nursing diagnosis of
104. Which interventions would be recom- Risk for injury. Which “related-to” phrase
mended for a client with dysphagia? Se- should the nurse add to complete the nurs-
lect all that apply. ing diagnosis statement?
A. Assist the client with meals. A. Related to visual field deficits

3.2 Hemiparesis 244
B. Related to psychomotor seizures 114. When caring for a client who is post-
C. Related to impaired balance intracranial surgery what is the most im-
portant parameter to monitor?
D. Related to difficulty swallowing
A. Extreme thirst
110. The nurse cares for a client with Hunting-
B. Intake and output
ton disease. What intervention is a prior-
ity for safe care? C. Nutritional status
A. Measuring electrolytes D. Body temperature
NARAYAN CHANGDER
B. Protecting the client from falls 115. Which of the following stroke risk factors
C. Assessing serum cholesterol does NOT belong?
D. Range-of-motion exercises A. HTN
111. The nurse explains to the client with pro- B. Smoking
jectile vomiting and severe headache that C. Race
a medication is being prescribed to reduced
D. All of the above are stroke risk factors
edema surrounding the brain and lessen
these symptoms. What medication is the 116. Which of the following common observa-
nurse preparing to administer? tions you would see in a pt w/ dysphagia
A. Everolimus does NOT belong?
B. Bevacizumab A. Drooling
C. Mannitol B. Ingesting food
D. Temozolomide C. Compromised nutritional status
112. Stages of Motor Recovery for Hemipare- D. Hydration
sis: relative I of synergy? Spasticity
117. Frontal and parietal lobes Contralat-
decreases Isolated jiont movements are
eral hemiparesis and sensory loss Greater
more apparent
LE involvement than UE Possible neglect,
A. Stage 5 aphasia, apraxia, and agraphia Perserva-
B. Stage 6 tion Loss of behavioral inhibition o Mental
C. Stage 3 changes
D. Stage 4 A. Anterior Cerebral Artery (ACA)

B. Middle Cerebral Artery (MCA)
113. A 30-year-old was diagnosed with amy-
otrophic lateral sclerosis (ALS). Which C. Posterior Cerebral Artery (PCA)
statement by the client would indicate a D. none of above
need for more teaching from the nurse?
118. Which of the following is the initial diag-
A. “I will have progressive muscle weak-
nostic in suspected stroke?
ness.”
A. Cerebral angiography
B. “I need to remain active for as long as
possible.” B. Magnetic resonance imaging (MRI)
C. “I will lose strength in my arms.” C. Noncontrast computed tomography
D. “My children are at greater risk to de- (CT)
velop this disease.” D. CT with contrast

3.2 Hemiparesis 245
119. The nurse is caring for a client imme- B. Regulation of BP, dietary, smoke ces-
diately after supratentorial intracranial sation
surgery. The nurse performs the appropri-

C. Regular exercise
ate action by placing the patient in the
D. All of the above
A. Trendelenburg position.
B. prone position with the head turned to 124. The nurse reviews the physician’s emer-
the unaffected side. gency department progress notes for the
client who sustained a head injury and
C. dorsal recumbent position.
sees that the physician observed the Bat-
D. supine position with the head slightly tle sign. The nurse knows that the physi-
elevated. cian observed which clinical manifesta-
tion?
120. A nurse is working on a surgical floor.
The nurse must logroll a client following A. Escape of cerebrospinal fluid from the
a: client’s ear
A. hemorrhoidectomy B. Escape of cerebrospinal fluid from the
client’s nose
B. laminectomy
C. thoracotomy C. An area of bruising over the mastoid
bone
D. cystectomy.
D. A bloodstain surrounded by a yellow-
121. Stages of Motor Recovery for Hemipare- ish stain on the head dressing
sis: early synergy patterns, early spastic-
ity 125. When performing a postoperative as-
sessment on a client who has undergone
A. Stage 1
surgery to manage increased intracranial
B. Stage 2 pressure (ICP), a nurse notes an ICP read-
C. Stage 3 ing of 0 mm Hg. Which action should the
nurse perform first?
D. Stage 4
A. Document the reading because it re-
122. A client is receiving an IV infusion of man- flects that the treatment has been effec-
nitol (Osmitrol) after undergoing intracra- tive.
nial surgery to remove a brain tumor. To
B. Continue the assessment because no
confirm that this drug is producing its ther-
actions are indicated at this time.
apeutic effect, the nurse should consider
which finding most significant? C. Check the equipment.
A. Increased urine output D. Contact the physician to review the
care plan.
B. Decreased heart rate
C. Elevated blood pressure 126. While caring for clients who have suf-
D. Decreased level of consciousness fered neurologic deficits from causes such
(LOC) as cerebrovascular accident and closed
head injury, an important nursing goal that
123. Which of the following do NOT belong un- motivates nurses to offer the best care
der stroke prevention? possible is preventing:
A. Education A. infection.

3.2 Hemiparesis 246
B. complications. C. “My headache and nausea should be

C. choking. lessened somewhat.”
D. falls. D. “Any tissue that was dead will be re-

moved.”
127. Bone density testing in clients with post-
polio syndrome has demonstrated 131. The provider diagnoses the patient as
A. calcification of long bones. having had an ischemic stroke. The eti-
ology of an ischemic stroke would include
NARAYAN CHANGDER
B. low bone mass and osteoporosis. which of the following?
C. osteoarthritis A. Cerebral aneurysm
D. no significant findings.
B. Intracerebral hemorrhage
128. While riding a bicycle in a race, a patient C. Arteriovenous malformation
fell into a ditch and sustained a head in-
jury. Another cyclist found the patient ly- D. Cardiogenic emboli
ing unconscious in the ditch and called 911.
What type of concussion does the patient 132. Bone density testing will be completed
most likely have? for the client with post-polio syndrome.
The nurse teaches the client bone density
A. Grade 2 concussion testing is used to identify what potential
B. Grade 1 concussion complication?
C. Grade 3 concussion A. Pathologic fractures
D. Grade 4 concussion B. Osteoarthritis
129. A client with suspected Parkinson dis- C. Calcification of long bones
ease is initially being assessed by the D. Low bone mass and osteoporosis
nurse. When is the best time to assess
for the presence of a tremor? 133. Lesions in the temporal lobe may result
A. When the client is ambulating in which type of agnosia?
B. When the client is preparing his or her A. Auditory
meal tray to eat
B. Visual
C. When the client is resting
C. Tactile
D. When the client is participating in oc-
cupational therapy D. v
130. A client with a malignant glioma is sched- 134. Synergy Pattern: Scapular protrac-
uled for surgery. The client demonstrates tion Shoulder adduction / IR Elbow ex-
a need for additional teaching about the tension Forearm pronation Wrist / finger
surgery when he states which of the fol- flexion
lowing? A. UE Flexion
A. “There will be less cancer left that
B. UE Extension
might be resistant to chemotherapy.”
C. LE Flexion
B. “The surgeon will be able to remove all
of the tumor.” D. LE Extension

3.2 Hemiparesis 247
135. Aphasia: Inability to undersatnd, audi- 139. Blunted emotional response, can be per-
tory comprehension is impaired, speech is ceived as poor motivation
smooth; following commands impaired

A. Depression
A. Expressive / Non-fluent B. Apathy
B. Receptive C. Sadness
C. Global D. Pursuit of Happyness
D. none of above
140. A patient sustained a head trauma in a
136. Possible occipital infarcts * Vision diving accident and has a cerebral hemor-
affected can produce homonymous hemi- rhage located within the brain. What type
anopsia and visual agnosias, prosopag- of hematoma is this classified as?
nosia * Thalamic branches can produce tha- A. An intracerebral hematoma
lamic pain syndrome and contralateral sen-
sory loss Thalamus transits sensory B. An epidural hematoma
info (numbness / tingling / loss of sensa- C. A subdural hematoma
tion) * Contralateral hemiplegia * Possible
D. An extradural hematoma
ataxia
A. Anterior Cerebral Artery (ACA) 141. Which of the following neurotransmitters
are deficient in myasthenia gravis?
B. Middle Cerebral Artery (MCA)
A. Dopamine
C. Posterior Cerebral Artery (PCA)
B. Serotonin
D. none of above
C. Acetylcholine
137. A 53-year-old man presents to the emer- D. GABA
gency department with a chief complaint
of inability to form words, and numbness 142. Which disease is a chronic, progressive,
and weakness of the right arm and leg. hereditary disease of the nervous system
Where would you locate the site of in- that results in progressive, involuntary
jury? dancelike movements and dementia?
A. Left basal ganglia A. Multiple sclerosis
B. Left frontoparietal region B. Creutzfeldt-Jakob disease
C. Left temporal region C. Parkinson disease
D. Right frontoparietal region D. Huntington disease
138. The nurse teaches the client that corticos- 143. The nurse is caring for an 82-year-
teroids will be used to treat his brain tu- old client diagnosed with cranial arteritis.
mor to What is the priority nursing intervention?
A. reduce cerebral edema. A. Administer corticosteroids as ordered.
B. identify the precise location of the tu- B. Document signs and symptoms of in-
mor. flammation.
C. facilitate regeneration of neurons. C. Give acetaminophen per orders.
D. prevent extension of the tumor. D. Assess for weight loss.

3.2 Hemiparesis 248
144. An acoustic neuroma is a benign tumor of 148. The nurse is assessing a client with
which cranial nerve? meningitis. Which of the following signs
would the nurse expect to observe?
A. Fifth
A. Ptosis and diplopia
B. Eighth
B. Hyporeflexia in the lower extremities
C. Ninth
C. Headache and nuchal rigidity
D. Seventh
D. Numbness and vomiting
NARAYAN CHANGDER
145. While providing information to a commu- 149. A nurse is assisting during a lumbar punc-
nity group, the nurse tells them the pri- ture. How should the nurse position the
mary initial symptoms of a hemorrhagic client for this procedure?
stroke are:
A. Prone, with the head turned to the
A. Foot drop and external hip rotation right
B. Severe headache and early change in B. Lateral, with right leg flexed
level of consciousness C. Supine, with the knees raised toward
C. Weakness on one side of the body and the chest
difficulty with speech D. Lateral recumbent, with thighs flexed
D. Confusion or change in mental status 150. A client who is disoriented and restless
after sustaining a concussion during a car
146. Synergy Pattern: Scapular retraction / accident is admitted to the hospital. Which
elevation Elbow flexion Forearm supina- nursing diagnosis takes the highest prior-
tion Wrist / finger flexion ity in this client’s care plan?
A. UE Flexion A. Risk for injury
B. UE Extension B. Disturbed sensory perception (visual)
C. LE Flexion C. Dressing or grooming self-care deficit
D. LE Extension D. Impaired verbal communication
151. The nurse is caring for a client diagnosed

147. An emergency department nurse is inter-
with a hemorrhagic stroke. The nurse rec-
viewing a client who is presenting with
ognizes which intervention is most impor-
signs of an ischemic stroke that began 2
tant?
hours ago. The client reports a history
of a cholecystectomy 6 weeks ago and A. Monitoring for seizure activity
is taking digoxin, warfarin, and labetalol. B. Administering a stool softener
What factor poses a threat to the client for
C. Elevating the head of the bed to 30 de-
thrombolytic therapy?
grees
A. Surgery 6 weeks ago
D. Maintaining a patent airway
B. Taking digoxin
C. Two hour time period of the stroke sis: synergies begin to develop isolated
D. International normalized ratio greater movement impossible
than 2 A. Stage 1

3.3 Surgery 249
B. Stage 2 to current context

C. Stage 3 A. Common

D. Stage 4 B. Confabulation
153. The nurse is assessing a client newly diag- C. Perseveration

nosed with myasthenia gravis. Which of D. none of above
the following signs would the nurse most
likely observe? 155. Which well-recognized sign of meningi-
tis is exhibited when the client’s neck is
A. Numbness flexed and flexion of the knees and hips is
B. Loss of proprioception produced?
C. Patchy blindness A. Photophobia
D. Diplopia and ptosis B. Positive Brudzinski sign
154. Cognitive Dysfunction: Continued repeti- C. Positive Kerning sign

tion of words, thoughts or acts not related D. Nuchal rigidity
3.3 Surgery
1. Pneumonia tends to occur in patients with 3. A patient is to have an angiography
one or more of these five underlying disor- done using fluorescein as a contrast agent
ders: , , , and to determine if the patient has macular
A. hypotension, shock, respiratory failure edema.Which laboratory studies will the
nurse u monitor prior to the angiography?
B. alcoholism, chronic obstructive pul-
monary disease (COPD), acquired im- A. BUN and creatinine
mune deficiency syndrome (AIDS), dia- B. AST and ALT
betes, heart failure
C. Hemoglobin and hematocrit
C. hypotension, shock, respiratory fail-
ure D. Platelet count
D. Tachypnea, dyspnea, mild to moderate 4. The nurse is assisting with an endotracheal
hypoxemia insertion for a patient in respiratory fail-
2. , , and are hallmarks of the ure.Which nursing action will ensure that
severity of atelectasis. the endotracheal tube is placed in the ap-
propriate position?
A. alcoholism, chronic obstructive pul-
monary disease (COPD), acquired im- A. Obtain a chest x-ray for confirmation
mune deficiency syndrome (AIDS), dia- of tube placement.
betes, heart failure B. Observe condensation in the endotra-
B. Tachypnea, dyspnea, mild to moderate cheal tube.
hypoxemia C. Listen to breath sounds on the anterior
C. Streptococcus pneumonia, Haemophilus chest wall.
influenza, Staphylococcus aureus D. Observe the patient’s oxygen satura-
D. hypotension, shock, respiratory failure tion level

3.3 Surgery 250
5. The most common color vision test is per- and a red, swollen tongue, the nurse sus-
formed using pects chronic, severe iron deficiency ane-
A. iridotomy mia based on which finding?
B. trabeculoplasty A. Low ferritin level concentration

B. Elevated hematocrit concentration
C. Ishihara polychromatic plates
C. Enlarged mean corpuscular volume
D. polarimetry
(MCV)
NARAYAN CHANGDER
6. Integral component of the immune system D. Elevated red blood cell (RBC) count
A. T cells
11. Name five factors that influence the devel-
B. Hemostasis opment of anemia-associated symptoms.
C. Erythrocyte A. Factors include the rapidity with which
D. Lymphocytes the anemia has developed, the duration of
the anemia, the metabolic requirements
7. , , and are the three layers of a of the patient, other concurrent disorders
healthy tear. or disabilities, and complications or con-
comitant features of the condition that
A. Lipoid, aqueous, sucoid
produced the anemia.
B. Lipoid, mucoid
B. Correcting or controlling the cause of
C. Lipoid, aqueous, mucoid the anemia.
D. Sipoid, aqueous, mucoid C. The heart rate and cardiac output do
not increase as quickly; thus fatigue, dys-
8. Acute lymphocytic leukemia pnea, and confusion may be seen more
A. Results from a defect in the hematopoi- readily in the anemic olderadult.
etic stem cell that differentiates into all D. Dietary teaching sessions should be in-
myeloid cells dividual. ized, involve family members,
B. Arises from a mutation in the myeloid and include cultural aspects related to
stem cell food preferences and food prepa-ration.
Additional amounts of iron, up to 2 mg
C. Results from an uncontrolled prolifer-
daily, must be absorbed by women of
ation of immature cells derived from the
childbearing age to replace that lost dur-
lymphoid stem cell
ing menstruation.
D. Derived from a malignant clone of B
lymphocytes 12. The overall prevalence of anemia increases
with age, from % in people aged 65
9. The pigmented, vascular coating of the eye to 69, to % in people over age 85.
A. Uvea A. 4-6
B. Limbus B. 5-8
C. Corneas C. 13-14
D. Retina D. 12-13
10. During the review of morning laboratory 13. Describe the two main types of emphy-
values for a client reporting severe fatigue sema.

3.3 Surgery 251
A. panlobular (panacinar) type of emphy- cells on the smear. The diagnosis is con-
sema, there is destruction of the respira- firmed by hemoglobin electrophoresis.
tory bronchiole, alveolar duct, and alveo-

B. Chemical agents potentially respon-
lus. sible for bone marrow aplasia include
B. centrilobular (centroacinar) form, benzene and benzene derivatives such
pathologic changes take place mainly in as airplane glue, paint remover, and
the center of the secondary lobule, pre- dry-cleaning solutions. Certain toxic
serving the peripheral portions of the ac- materials-such as inorganic arsenic, gly-
inus (i.e., the terminal airway unit where col ethers, plutonium, and radon-have
gas exchange occurs). also been implicated as potential causes.
C. enlarged submucosal glands (proximal C. Bleeding from ulcers, gastritis, inflam-
airways matory bowel disease (IBD), or gastroin-
testinal (GI) tumors
D. inflammation and air way narrowing
(peripheral airways), and narrowing of D. Dietary teaching sessions should be in-
the airway lumen. dividual. ized, involve family members,
and include cultural aspects related to
14. Three common pathogens that cause aspi- food preferences and food prepa-ration.
ration pneumonia are , , and Additional amounts of iron, up to 2 mg
A. Streptococcus pneumonia, Haemophilus daily, must be absorbed by women of
influenza, Staphylococcus aureus childbearing age to replace that lost dur-
ing menstruation.
B. Streptococcus pneumonia, Haemophilus
influenza 17. Beta-2 adrenergic agonist agentsodium
C. Tachypnea, dyspnea, mild to moderate A. Combivent
hypoxemia B. Albuterol
D. hypotension, shock, respiratory failure C. Ipratropium bromide
15. A characteristic sign of viral conjunctivitis D. none of above
is
18. Upon assessment, the nurse suspects that
A. Mucoid a patient with COPD may have bron-
B. Lipoid chospasm.Which manifestations validate
the nurse’s concern? (Select all that ap-
C. “pink eye, “ or dilation of the conjunc-
ply.)
tival bloodvessels
A. Compromised gas exchange
D. dilation
B. Decreased airflow
16. What diagnostic findings are present in C. Wheezes
patients who have sickle cell trait versus
those present in patients who have sickle D. Jugular vein distention
cell disease? 19. The strongest predisposing factor for
A. The patient with sickle cell trait usually asthma is
has a normal hemoglobin level, a normal A. ARDS
hematocrit, and a normal blood smear. In
contrast, the patient with sickle cell dis- B. COPD
ease has a low hematocrit and sickled C. Wheezes

3.3 Surgery 252
D. Allergy B. A client admitted with suspected co-

caine overdose
20. The brain center responsible for balancing
C. A client with heart failure and renal
and coordination is the
failure
A. thalamus
D. A client with a stage IV pressure ulcer
B. hypothalamus
25. The site of blood cell formation
C. temporal
A. Monocytes
NARAYAN CHANGDER
D. cerebellum
B. Phagocytosis
21. Transparent part of the fibrous coat of the C. Hemoglobin
eyeball D. Bone marrow
A. Corneas
26. A patient with sickle cell disease comes
B. Sclera to the emergency department reporting se-
C. Iris vere pain in the back, right hip, and right
arm. Which action is important for the
D. Retina
nurse to perform?
22. The nurse is assessing the auricles of a pa- A. Administer aspirin.
tient. When the left auricle is manipulated, B. Administer ibuprofen.
the patient reports pain. Which is the sig-
nificance of this finding? C. Start an intravenous line with dextrose
5% in 0.24 normal saline.
A. The patient may have seborrheic der-
D. Begin oxygen at 2 L/min.
matitis.
B. The patient may have an inner ear in- 27. A assessment should be performed for
fection. patients with known megaloblastic ane-
mia.
C. The patient may have acute external
otitis. A. delirium
B. paresthesias
D. The patient may have acute otitis me-
dia. C. neurologic
D. Aplastic
23. The most common laser surgeries for glau-
coma are and 28. Name five substances that the bone mar-
A. Streptococcus, pneumonia row requires for normal erythrocyte pro-
duction, and describe what can result if
B. laser trabeculoplasty, laser iridotomy any of these factors are deficient.
C. Ishihara polychromatic, plates A. Iron, vitamin B12, folic acid, pyridox-
D. polarimetry, trabeculoplasty ine, protein, and other factors are re-
quired. A deficiency of these factors dur-
24. The nurse is reviewing plans of care for ing erythropoiesis can result in decreased
several clients. The nurse recognies that red cell production.
which client is most at risk for develop- B. The stroma is important in an in-
ing disseminated intravascular coagulation direct manner, in that it produces the
(DIC)? colony-stimulating factors needed for
A. A client admitted with sepsis hematopoiesis.

3.3 Surgery 253
C. An intricate clotting mechanism is ac- B. Lithotomy position

tivated when necessary to seal any leak C. Supine with head of the bed elevated
in the blood vessels. Excessive clotting

30 degrees
is equally dangerous, because it can ob-
struct blood flow to vital tissues. To pre- D. Jackknife position
vent this, the body has a thrombolytic (fib- 33. While caring for a client, the nurse notes
rinolytic) mechanism that eventually dis- petechiae on the client’s trunk and lower
solves clots formed within blood vessels. extremities. What precaution will the
D. An increased number of band cells is nurse take when caring for this client?
sometimes called a left shift or shift to the A. Use an electric razor when assisting
left. A shift to the left indicates that more client with shaving.
immature cells are present in the blood
B. Apply supplemental oxygen to main-
than normal.
tain the client’s oxygenation.
29. A nurse on a hematology/oncology floor C. Elevate the client’s head of the bed.
is caring for a client with aplastic anemia. D. Where a mask when entering the
Which would not be included in the client’s client’s room.
discharge instructions?
34. A nurse notes that the FEV /FVC ratio is
A. Encourage frequent handwashing.
less than 70% for a patient with COPD.
B. Avoid contact with family/friends who Which stage should the nurse document
are sick. the patient is in?
C. Plan for frequent periods of rest. A. 0
D. Use a disposable razor when shaving. B. I
30. A term used to describe an inflammatory C. II
condition of the uveal tract D. III
A. Keratitis 35. A patient has expressive speaking aphasia
B. Iritis after having a stroke. Which portion of
the brain does the nurse identify has been
C. Myopia
affected?
D. Uveitis
A. a. Temporal lobe
31. Abnormal sensitivity to light B. b) Inferior posterior frontal areas
A. Astigmatism C. c. Posterior frontal area
B. Aphakia D. d. Parietal-occipital area
C. Oculus sinister 36. A patient is scheduled for an electroen-
D. Photophobia cephalogram (EEG) in the morning. Which
food on the patient’s tray should the nurse
32. The nurse is preparing a patient for a bone remove prior to the test?
marrow aspiration and biopsy from the
A. Orange juice
site of the posterior superior iliac crest.
Which position will the nurse place the pa- B. Toast
tient in? C. Coffee
A. Lateral position with one leg flexed D. Eggs

3.3 Surgery 254
37. Small, hard, bony protrusions in the lower 42. The two most common areas used for bone
posterior bony portion of the ear canal marrow aspirations in an adult are the
A. Dizziness and the
A. femur
B. Vertigo
B. sternum
C. Exostoses
C. ribs
D. Nystagmus
D. iliac crest
NARAYAN CHANGDER
38. One of the most serious ocular conse-
43. The organ of hearing is known as the
quences of diabetes is
A. external acoustic meatus
A. diabetic retinopathy
B. iris
B. mucoid
C. cochlea
C. cytomegalovirus
D. sclera
D. Lipoid
44. , one of the complicationsof emphy-
39. Drainage from the nose sema, is right-sided heart failure brought
A. Presbycusis on by long-term high blood pressure in the
pulmonary arteries.
B. Otorrhea
A. Cor pulmonale
C. Rhinorrhea
B. spirometry
D. Exostoses
C. bullectomy
40. A patient is taking hydroxyurea for D. none of above
the treatment of primary myelofibrosis.
While the patient is taking this medication, 45. The nurse assesses a patient for a possi-
which laboratory studies will the nurse ble pulmonary embolism. Which frequent
monitor to determine effectiveness? sign of pulmonary embolus does the nurse
identify on assessment?
A. Leukocyte and platelet count
A. Cough
B. BUN and creatinine levels
B. Hemoptysis
C. Aspartate aminotransferase (AST) and
C. Syncope
alanine transaminase (ALT) levels
D. Tachypnea
D. Hemoglobin and hematocrit
46. Describe how sound is conducted and
41. The health care provider prescribes a beta- transmitted.
2 adrenergic agonist agent that is short-
A. Hearing is conducted over two path-
acting and administered only by inhaler.
ways:air and bone. Sounds transmitted
Which medication does the nurse adminis-
by air conduction travel over the air-filled
ter as prescribed?
external and middle ear through vibra-
A. Metaproterenol tion of the tympanic membrane and ossi-
B. Terbutaline cles.Sounds transmitted by bone conduc-
tion travel directly through bone to the
C. Formoterol inner ear, bypassing the tympanic mem-
D. Isoproterenol brane and ossicles.

3.3 Surgery 255
B. A tympanogram, or impedance au- 51. Makes up 95% of the mass of the red
diometry, measures middle ear muscle re- blood cell (RBC)
flex to sound stimulation and compliance

A. Hemoglobin
of the tympanic membrane by changing
the air pressure in a sealed ear canal. B. Phagocytosis
C. This barrier is formed by the endothe- C. Monocytes
lial cells of the brain’s capillaries, which
form continuous tight junctions, creating a D. Fibrinogen
barrier to macromolecules and many com-
pounds. 52. A patient comes to the emergency depart-
ment with severe pain in the face that
D. none of above
was stimulated by brushing the teeth. The
47. potential collaborative problems for a pa- nurse identifies which cranial nerve dys-
tient with an altered LOC. function is causing this pain?
A. respiratory distress A. III

B. pneumonia, aspiration B. IV
C. pressure injury, deep vein thrombosis C. V
D. contractures. D. VI
48. The process of continually replacing blood
cells 53. A patient is scheduled to have an audi-
tory brain stem response in 2 days. What
A. Phagocytosis does the nurse instruct the patient to do in
B. Hemoglobin preparation for the test?
C. Hematopoiesis A. Shave several areas on the scalp
D. Bone marrow where the electrodes will be placed.
B. Do not eat or drink 8 hours prior to
49. primary symptoms associated with the
testing.
progressive stage of COPD.
A. Chronic cough C. Wash and rinse hair before test but do
not apply any other hair products.
B. sputum production
D. Omit daily medications prior to testing.
C. dyspnea on exertion.
D. wheezes 54. The nurse is caring for a patient in the
neurologic ICU who sustained head trauma
50. A(n) is an accumulation of thick, puru- in a physical altercation. Which optimal
lent fluid within the pleural space, often range does the nurse identify for this pa-
with fibrin development and a loculated tient?
area where infection is located.
A. 8 to 15 mm Hg
A. hypoxemia
B. dyspnea B. ) O to 10 mm Hg
C. Tachypnea C. 20 to 30 mm Hg
D. empyema D. 25 to 40 mm Hg

3.3 Surgery 256
55. The nurse is assigned to care for a patient A. Sepsis, trauma, cancer, shock, abrup-
with COPD experiencing hypoxemia and tion placentae, toxins, and allergic reac-
hypercapnia. When planning care for this tions
patient, which outcome of treatment will
B. Answer may include the following:in
the nurse evaluate?
an acute exacerbation of anemia, in the
A. The patient will demonstrate adequate prevention of severe complications from
oxygenation. anesthesia and surgery, in improving the
B. The patient will avoid the use of supple- response to infection, in the case of acute
NARAYAN CHANGDER
mentary oxygen to decrease hypoxicdrive. chest syndrome and multiorgan failure, in
thwarting the evolution of a stroke or an
C. Monitor pulse oximetry every 8 hours acute neurologic defect, and in diminish-
while awake. ing episodes of sickle cell crisis in preg-
D. Educate the patient about the use of di- nant women.
aphragmatic breathing techniques.
C. Chemical agents potentially respon-
56. The ingestion and digestion of bacteria by sible for bone marrow aplasia include
neutrophils benzene and benzene derivatives such
as airplane glue, paint remover, and
A. Monocytes dry-cleaning solutions. Certain toxic
B. Phagocytosis materials-such as inorganic arsenic, gly-
col ethers, plutonium, and radon-have
C. Fibrinogen
also been implicated as potential causes.
D. Albumin
D. Chemical agents potentially respon-
57. Which patient assessed by the nurse is sible for bone marrow aplasia include
identified as most likely to be affected by benzene and benzene derivatives such
sickle cell disease? as airplane glue, paint remover, and
dry-cleaning solutions. Certain toxic
A. A 14-year-old African American boy materials-such as inorganic arsenic, gly-
B. A 26-year-old Eastern European Jew- col ethers, plutonium, and radon-have
ishwoman also been implicated as potential causes.
C. An 18-year-old Chinese woman
60. What is the function of the blood-brain bar-
D. A 28-year-old Israeli man rier?
58. A patient has been diagnosed with a fun- A. This barrier is formed by the endothe-
gal infection causing external otitis. Which lial cells of the brain’s capillaries, which
is the most common fungal infection in the form continuous tight junctions, creating a
ear? barrier to macromolecules and many com-
pounds.
A. Staphylococcus aureus
B. Aspergillus B. The autonomic nervous system regu-
lates the activities of internal organs such
C. Pseudomonas as the heart, lungs, blood vessels, diges-
D. Streptococcus tive organs, and glands. Maintenance
and restoration of internal homeostasis is
59. What chemical agents may be responsible largely the responsibility of the autonomic
for producing bone marrow aplasia? nervous system

3.3 Surgery 257
C. Flaccid paralysis and atrophy of the af- 65. A client with anemia is prescribed an oral
fected muscles. iron supplement. Which statement indi-
cates that teaching about this supplement

D. Destruction or dysfunction of the basal
ganglia leads not to paralysis but to mus- has been effective?
cle rigidity, disturbances of posture, and A. “I will stop taking it if my stool turns
difficulty initiating or changing movement. black.”
61. The nurse is caring for a patient with acute B. “I will be sure to take this medication
myeloid leukemia (AML) with high uric acid with food.”
levels. Which medication administered by C. “I will take it in the morning with or-
the nurse will prevent crystallization of ange juice.”
uric acid and stone formation? D. “I will limit my intake of raw fruit and
A. Allopurinol vegetables.”
B. Filgrastim 66. Accommodates to the intensity of light by
C. Hydroxyurea dilating or contracting
D. Asparaginase A. Pupil
62. Which patient assessed by the nurse is B. Vitreous humor

at greatest risk for the development of C. Corneas
myelo-dysplastic syndromes (MDSs)? D. Retina
A. A 24-year-old female taking oral con-
traceptives 67. Thalassemia major
B. A 40-year-old patient with a history of A. Megaloblastic anemias

hypertension B. Hemolytic anemias
C. A 52-year-old patient with acute kidney C. Hypoproliferative anemias
injury D. none of above
D. A 72-year-old patient with a history of
cancer 68. Complications of asthma may include ,
, , and
63. A tear in the eye tissue A. status asthmaticus
A. Ptosis B. respiratory failure
B. Astigmatism C. pneumoniae
C. Strabismus D. atelectasis
D. Laceration E. fever
64. Red bone marrow. activity is confined in 69. The minimum noise level known to cause
adults to the , , , and noise-induced hearing loss, regardless of
A. ribs duration, is to dB.
B. vertebrae A. 85, 95
C. pelvis B. 85, 90
D. sternum C. 80, 90
E. clavicle D. 75, 90

3.3 Surgery 258
70. The preganglionic fibers of the sympa- or disabilities, and complications or con-
thetic neurons are located in the segments comitant features of the condition that
of the spinal cord identified as to produced the anemia.
A. C1, L5 B. Correcting or controlling the cause of
B. C8, L3 the anemia.
C. C4, L2 C. Bleeding from ulcers, gastritis, inflam-
matory bowel disease (IBD), or gastroin-
D. C3, L8
NARAYAN CHANGDER
71. The single most cost-effective intervention D. Dietary teaching sessions should be in-
to reduce the risk of developing COPD or dividual. ized, involve family members,
slow its progression is and include cultural aspects related to
A. smoking food preferences and food prepa-ration.
B. cessation of alcohol
daily, must be absorbed by women of
C. cessation of smoking childbearing age to replace that lost dur-
D. bullectomy ing menstruation.
72. A patient describes numbness in the arms 75. A child is having an asthma attack and the
and hands with a tingling sensation. The parent cannot remember which inhaler to
patient also frequently stumbles when use for quick relief. The nurse accesses the
walking. What vitamin deficiency does the child’s medication information and tells the
nurse determine may cause some of these parent to use which inhalant?
symptoms? A. Cromolyn sodium
A. Iron B. Theophylline
B. B12
C. Salmeterol
C. Thiamine
D. Albuterol
D. Folate
76. The most common cause of retinal inflam-
73. Which type of lymphocyte is responsible mation in patients with acquired immune
for cellular immunity? deficiency syndrome (AIDS) is
A. Plasma cell A. polarimetry
B. T lymphocyte
B. cytomegalovirus (CMV)
C. B lymphocyte
C. ptosis
D. Basophil
D. pink eye
74. When the nurse is educating the patient
and family about a healthy diet for the 77. Plasma proteins consist primarily of
treatment of iron deficiency anemia, what and
should be included? A. hemoglobin
A. Factors include the rapidity with which B. plasma
the anemia has developed, the duration of
the anemia, the metabolic requirements C. albumin
of the patient, other concurrent disorders D. globulins

3.3 Surgery 259
78. Muscle and nerve inhibitory transmissions A. Crackles auscultated bilaterally

A. Dopamine B. Respiratory rate of 10 breaths/minute

B. Norepinephrine C. Oral temperature of 97◦ F
C. encephalin D. Pain and tenderness in calf area
D. Gamma-aminobutyric acid
83. The nurse is performing an assessment of
79. Each 100 mL of blood should normally con- a patient’s ears. Which appearance of the
tain g of hemoglobin. tympanic membrane does the nurse docu-
ment as normal?
A. 12
A. Pearly gray and translucent Is thing
B. 13
B. White and cloudy
C. 14
C. Pink with white exudate
D. 15
D. Dark yellow with cerumen
80. Hematopoietic malignancies are often clas-
sified by the involved. 84. If a bone marrow analysis is performed
A. cells on a patient with AML, what results are
seen?
B. T cells
A. The results will show an excess of im-
C. white blood cells mature blast cells, which is the hallmark
D. red blood cells of the diagnosis.
81. A patient has been treated for external oti- B. The signs and symptoms result from
tis for the second time during the summer insufficient production of normal blood
months. Which education will be provided cells.
for the patient to reduce the risk of devel- C. The goal of treatment is to obtain re-
oping this problem? (Select all that apply.) mission without excess toxicity and with
A. Do not clean the external canal with a rapid hematologic recovery so that ad-
cotton-tipped applicators. ditional therapy can be administered if
needed.
B. Irrigate the ears daily with a warm
saline solution. D. Because the illness is unpredictable.
C. Avoid getting the ear wet when swim- 85. The normal adult produces about mI of
ming or showering. cerebrospinal fluid daily from the ventri-
D. Use an antiseptic preparation after cles.
swimming, unless there is a history of tym- A. 125
panic membrane perforation.
B. 140
E. Ensure that cerumen is absent from
C. 150
the external canal by irrigating once a
week after instilling mineral oil. D. 160
82. The nurse should be alert to which ad- 86. During a routine eye examination, a pa-
verse assessment finding when transfus- tient reports being unable to read road
ing a unit of packed red blood cells (PRBCs) signs at a distance when driving the car.
too rapidly? Which will the patient be assessed for?

3.3 Surgery 260
A. Astigmatism B. b. Blurred vision results after applica-

B. Anisometropia tion.
C. Myopia C. It has a lower concentration than eye-

drops.
D. Presbyopia
D. d. It has more side effects than eye
87. A patient with chronic anemia has had drops.
many blood transfusions over the last 3
years.Which type of transfusion reaction 91. A patient develops a hemolytic reaction to
NARAYAN CHANGDER
will the nurse monitor for that is commonly a blood transfusion. Which priority actions
found in patients who frequently receive will the nurse perform? (Select all that ap-
blood transfusions? ply.)
A. Allergic reactions A. Administer diphenhydramine.
B. Acute hemolytic reaction B. Begin iron chelation therapy.
C. Circulatory overload C. Obtain appropriate blood specimens.
D. Febrile nonhemolytic reactions D. Collect a urine sample to detect
hemoglobin.
88. Multiple myeloma
E. Document the reaction according to
A. Proliferative disorder of the myeloid policy.
stem cells
B. Stem cell disease within the bone mar- 92. Which medication is the antidote to war-
row farin?
C. Malignant disease of the most mature A. Aspirin

form of B lymphocyte, the plasma cell B. Clopidogrel
D. Unicentric in origin and is initiated in a C. Vitamin K
single node
D. Protamine sulfate
89. A patient is prescribed a mast cell stabi-
93. Term for the right eye
lizer for the treatment of asthma. Which
commonly used medication will the nurse A. Oculus dexter
educate the patient about? B. Uveitis
A. Albuterol C. Myopia
B. Budesonide
D. Iritis
C. Cromolyn sodium
94. A nurse assesses the patient’s LOC using
D. Theophylline
the Glasgow Coma Scale. Which score in-
90. The nurse is administering an ophthalmic dicates severe impairment of neurologic
ointment to a patient with conjunctivi- function?
tis.Which disadvantage of the application A. 3
of an ointment does the nurse explain to
B. 6
the patient?
A. a. It does not work as rapidly as eye C. 9
drops do. D. 12

3.3 Surgery 261
95. The nurse is caring for a patient postoper- 99. Another term for platelets
atively after intracranial surgery for the
treatment of a subdural hematoma. The A. Lymphocytes

nurse observes an increase in the patient’s B. Thrombocytes
blood pressure from the baseline and a de-
crease in the heart rate from 86 to 54, and C. Plasma
crackles in the bases of the lungs. Which
D. Bone marrow
situation does the nurse suspect is occur-
ring?
100. . A nurse is assessing a patient’s urinary
A. Increased ICP
output no as an indicator of diabetes in-
B. Exacerbation of uncontrolled hyperten- sipidus related to a traumatic brain injury.
sion The nurse identifies that an hourly output
C. Infection of which volume over 2 hours may be a
positive indicator?
D. Increase in cerebral perfusion pres-
sure A. 50 to 100 mL/hr
96. What are the potential long-term com- B. 100 to 150 mL/hr
plications of therapy for a patient with
Hodgkin lymphoma? C. 150 to 200 mL/hr
A. Second cancers. D. More than 200 mL/hr
B. Fertility issues
C. Infections 101. A sensorineural (perceptive hearing loss
results from impairment of the cranial
D. Thyroid problems
nerve.
E. Heart disease and stroke
A. eighth
97. The major receiving and communication
center for afferent sensory nerves is the B. sixth
C. tenth
A. thalamus
B. hypothalamus D. seventh
C. pituitary
102. Three severe complications of pneumonia
D. temporal , , and
98. Essential thrombocythemia A. impaired central nervous system (CNS)
A. Proliferative disorder of the myeloid function, neuromuscular, musculoskele-
stem cells tal, pulmonary dysfunction
B. Stem cell disease within the bone mar- B. hypotension, shock, respiratory failure
row
C. Unicentric in origin and is initiated in a C. alcoholism, chronic obstructive pul-
single node monary disease (COPD), acquired immune
deficiency syndrome (AIDS), diabetes,
D. Heterogeneous group of cancers that
originate from the neoplastic growth of D. Tachypnea, dyspnea, mild to moderate
lymphoid tissue hypoxemia

3.3 Surgery 262
103. A hearing loss that is a manifestation of A. Iron deficiency anemia

an emotional disturbance is known as B. Megaloblastic anemia
hearing loss.
C. Sickle cell disease
A. slight
D. Aplastic anemia
B. diminished
107. A patient with end-stage kidney dis-
C. severe
ease(ESKD) develops anemia. When re-
D. functional viewing the laboratory studies, which find-
NARAYAN CHANGDER
ing is significant in this stage of anemia?
104. A patient with end-stage COPD and heart
failure asks the nurse about lung reduction A. Potassium level of 5.2 mEq/L
surgery. Which is the best response by the B. Magnesium level of 2.5 mg/dL
nurse? C. Calcium level of 9.4 mg/dL
A. “You are not a candidate because you D. Creatinine level of 6 mg/100 mL
have heart failure.”
108. Area where most of the blood vessels for
B. “You would have a difficult time recov- the eye are located
ering from the procedure.”
A. Retina
C. “At this point, do you really want to go
through something like that? ” B. Pupil
D. “You and your primary provider should C. Lens

discuss the options that are available for D. Choroid
treatment.”
109. A nurse is caring for a patient having
105. When is the Amsler grid test used? a bone marrow aspiration with biopsy.
Which complication will the nurse monitor
A. The Amsler grid is a test often used for for?
patients with macular problems, such as
macular degeneration. A. Hemorrhage
B. The Acuity grid is a test often used for B. Infection

patients with macular problems, such as C. Shock
macular degeneration. D. Splintering of bone fragments
C. The Anglar grid is a test often used for
110. Name the principal signs of lower motor
oculomotor neuron disease.
macular degeneration.
A. The autonomic nervous system regu-
D. The Omsler grid is a test often used for
as the heart, lungs, blood vessels, diges-
macular degeneration.
tive organs, and glands. Maintenance
106. The nurse is assessing a patient who re- and restoration of internal homeostasis is
ports feeling “constantly tired and very largely the responsibility of the autonomic
weak.” The patient reports a very sore nervous system
tongue, and upon observing the patient’s B. Destruction or dysfunction of the basal
oral cavity, the nurse notices the tongue is ganglia leads not to paralysis but to mus-
beefy red. Which type of anemia do these cle rigidity, disturbances of posture, and
findings correlate with? difficulty initiating or changing movement.

3.3 Surgery 263
C. This barrier is formed by the endothe- these may result in abnormally increased
lial cells of the brain’s capillaries, which IOP.
form continuous tight junctions, creating a

D. Visual acuity is tested for both near (14
barrier to macromolecules and many com- inchesaway) and distance (20 feet away)
pounds. vision and performed on each eye sepa-
D. Flaccid paralysis and atrophy of the af- rately with a standardized Snellen chart
fected muscles. for distance and a Rosenbaum pocket
screener for near vision.
111. A patient has a Mantoux skin test prior
to being placed on a biologic medication for 115. A is a surgical option for select pa-
the treatment of Crohn’s disease. Which tients with bullous emphysema.
results would determine that the medica- A. Bullectomy
tion may be administered as prescribed by
B. spirometry
the nurse?
C. cessation of smoking
A. 0 to 4 mm
D. cigarette smoking
B. 5 to 6 mm
C. 7 to 8 mm 116. Complications of severe anemia include
, , and,
D. 9 mm
A. heart failure
112. Anticholinergic agent B. paresthesia
A. Albuterol C. delirium
B. Ipratropium bromide D. lung failure
C. Combivent
117. When the health care provider informs
D. Theophylline the nurse that the patient has a “shift to
the left, “ what does this mean?
113. Sensation of fullness or pain in the ear
A. Knowledge of correct administration
A. Exostoses techniques and possible complications is
B. Otorrhea required. It is very important to be famil-
iar with the facility’s policies and proce-
C. Otalgia dures for transfusion therapy.
D. Otosclerosis B. The stroma is important in an in-
direct manner, in that it produces the
114. Describe how the nurse would assess a
colony-stimulating factors needed for
patient’s visual acuity.
hematopoiesis.
A. Patients are cautioned to avoid squeez-
C. Iron, vitamin B12, folic acid, pyridox-
ing the eye-lids, holding the breath.
ine, protein, and other factors are re-
B. The Amsler grid is a test often used for quired. A deficiency of these factors dur-
patients with macular problems, such as ing erythropoiesis can result in decreased
macular degeneration. red cell production.
C. Patients are cautioned to avoid D. An increased number of band cells is
squeezing the eye-lids, holding the breath, sometimes called a left shift or shift to the
or performing a Valsalva maneuver, as left. A shift to the left indicates that more

3.3 Surgery 264
immature cells are present in the blood 121. The nurse is administering a blood trans-
than normal. fusion to a client over 4 hours. After 2
hours, the client reports chills and has a
118. Name seven possible clinical manifesta- fever of 101◦ F, an increase from a pre-
tions of atelectasis. vious temperature of 99.2◦ F. What does
A. Frequent turning, early mobilization, the nurse recognize is occurring with this
deep breathing maneuvers, assistance client?
with the use of spirome-try, suctioning, A. The client is having decrease in tissue
NARAYAN CHANGDER
postural drainage, aerosol nebulizer treat- perfusion from a shock state.
ments, and chest percussion
B. The client is having an allergic reaction
B. Dyspnea, cough, sputum production, to the blood.
tachycardia, tachypnea
C. The client is experiencing vascular col-
C. impaired central nervous system lapse.
(CNS) function, neuromuscular, muscu-
D. The client is having a febrile non-
loskeletal, pulmonary dysfunction
hemolytic reaction.
D. Dyspnea, cough, sputum production,
tachycardia, tachypnea, pleural pain, and 122. Chronic use of to reduce gastric acid
central cyanosis production can inhibit B12 absorption, as
can the use of in managing diabetes.
119. Which type of leukocyte contains his-
A. Proton pump inhibitors (PPIs), met-
tamine and is an important part of hyper-
formin
sensitivity reactions?
B. Proton pump inhibitors (PPIs), Tresiba
A. B lymphocyte
C. Proton pump inhibitors (PPIs), huma-
B. Neutrophil
log
C. Plasma cell
D. Proton pump inhibitors (PPIs), antacid
D. Basophils
123. A patient is having a lumbar puncture
120. The nurse is administering a blood trans- and the health care provider has removed
fusion to a patient over 4 hours. After 2 20 ml of cerebrospinal fluid (CSF). Which
hours, the patient reports chills and has nursing action is a priority after the proce-
a fever of 101◦ F, an increase from a pre- dure?
vious temperature of 99.2◦ F. Which does
A. Encourage the patient to ambulate im-
the nurse identify the patient is experienc-
mediately.
ing?
B. Have the patient lie flat for 6 hours.
A. The patient is having an allergic reac-
tion to the blood. C. Have the patient lie flat for 1 hour and
then sit for 1 hour before ambulating.
B. The patient is experiencing vascular
collapse. D. Have the patient lie in a semi-Fowler
position with the head of the bed at30 de-
C. The patient is having a decrease in tis-
grees
sue perfusion from a shock state.
D. The patient is having a febrile non- 124. Describe the results of chronic airway in-
hemolytic reaction. flammation in COPD.

3.3 Surgery 265
A. Chronic inflammation results in the 129. Drooping of the upper eyelid

following increased goblet cells and en-
A. Astigmatism
larged submucosal glands (proximal air-

ways) B. Strabismus
B. inflammation and air way narrowing C. Ptosis
(peripheral airways), and narrowing of
the airway lumen. D. Laceration
C. postural drainage 130. A patient arrives in the emergency de-

D. chest percussion partment after being involved in a motor
vehicle crash. The nurse observes para-
125. Antibodies formed by lymphocytes and doxical chest movement when removing
plasma cells in response to an immuno- the patient’s shirt. What does the nurse
genic stimulus are called know that this finding indicates?
A. epinephrine
A. Pneumothorax
B. antigens
B. Flail chest
C. immunoglobulins
C. ARDS
D. IgE
D. Tension pneumothorax
126. is a controversial treatment strategy
that treats DIC by interrupting thethrom- 131. he nurse is caring for a patient with an al-
bosis process. tered level of consciousness (LOC). Which
A. Heparin infusion is the first priority of treatment for this
B. paresthesias patient?
C. delirium A. a. Assessment of pupillary light re-

flexes o
D. anemia
B. b. Determination of the cause
127. A patient is admitted to the hospital with
an ICP reading of 20 mm Hg and a mean ar- C. c. Positioning to prevent complica-
terial pressure of 90 mm Hg. Which is the tions
calculated cerebral perfusion pressure? D. d) Maintenance of a patent airway
A. a. 50 mm Hg
B. b. 60 mm Hg 132. Four respiratory system mechanisms that
can lead to acute respiratory failure (ARF)
C. (C 70 mm Hg are , , , and
D. d. 80 mm Hg
A. impaired central nervous system (CNS)
128. The most serious complication and most function, neuromuscular, musculoskeletal
frequent cause of death among patients B. hypotension, shock, respiratory failure
withCOVID-19 is
C. impaired central nervous system
A. ARDS
(CNS) function, neuromuscular, muscu-
B. RADS loskeletal, pulmonary dysfunction
C. ARSD D. Dyspnea, cough, sputum production,
D. SARD tachycardia

3.3 Surgery 266
133. The nurse is educating a patient with 136. An inflammatory condition affecting the
asthma about preventative measures to iris
avoid having an asthma attack. Which
A. Photophobia
preventative intervention will the nurse
educate the patient about to prevent an B. Ulcer
asthma attack?
C. Keratitis
A. Use a long-acting steroid inhaler when
an attack is coming. D. Iritis
NARAYAN CHANGDER
B. Avoid exercise and any strenuous ac- 137. Primarily excitatory; can produce vagal
tivity. stimulation of heart
C. Prepare a written action plan. A. Enkephalin
D. Stay in the house if it is too cold or too
B. Norepinephrine
hot.
C. Dopamine
134. Acute myeloid leukemia
D. Acetylcholine
A. Results from a defect in the hematopoi-
etic stem cell that differentiates into all 138. The nurse is instructing the client with
myeloid cells polycythemia vera how to perform isomet-
B. Arises from a mutation in the myeloid ric exercises such as contracting and relax-
stem cell ing the quadriceps and gluteal muscle dur-
C. Results from an uncontrolled prolifer- ing periods of inactivity. What does the
ation of immature cells derived from the nurse understand is the rationale for this
lymphoid stem cell type of exercise?
D. Derived from a malignant clone of B A. Isometric exercise decreases the

lymphocytes workload of the heart and restores oxy-
genated blood flow.
135. A patient will need a blood transfusion
B. This type of exercise increases arterial
for the replacement of blood loss from the
circulation as it returns to the heart.
gastrointestinal tract. The patient states,
“That stuff isn’t safe!” Which response by C. Isometric exercise programs are inclu-
the nurse will be the best? sive of all muscle groups and have an aer-
A. “I agree that you should be concerned obic effect to increase the heart rate.
with the safety of the blood, but it is im- D. Contraction of skeletal muscle com-
portant that you have this transfusion.” presses the walls of veins and increases
B. “The blood is carefully screened, so the circulation of venous blood as it re-
there is no possibility of you contracting turns to the heart.
any illness or disease from the blood.”
139. Leukotriene modifier
C. “I understand your concern. The blood
is carefully screened but is not completely A. Albuterol
risk free.” B. Montelukast
D. “You will have to decide if refusing the
C. Cromolyn
blood transfusion is worth the risk to your
health.” D. Ipratropium bromide

3.3 Surgery 267
140. A patient with end-stage kidney dis- 145. Describe the characteristic and diagnostic
ease(ESKD) is taking recombinant ery- feature of ARDS.
thropoietin for the treatment of anemia.

A. Tachypnea, dyspnea, mild to moderate
Which laboratory study will be obtained at hypoxemia
least monthly related to this medication?
A. Potassium level influenza, Staphylococcus aureus
B. Creatinine level
C. Frequent turning, early mobilization,
C. Hemoglobin level deep breathing maneuvers
D. Folate levels D. Hypoxemia that does not respond to
supplemental oxygen
141. Place the patient in a lateral position
A. Footdrop 146. The nurse is caring for a patient with a
traumatic brain injury (TBI). Which does
B. Paralyzed diaphragm the nurse identify as the earliest sign of
C. Impaired cough reflex serious impairment of brain circulation re-
lated to increasing ICP?
D. none of above
A. A bounding pulse
142. Suspected disease; diagnosis pending
B. Bradycardia
A. Class 4
C. Hypertension
B. Class 2
D. Lethargy and stupor
C. Class 3
D. Class 5 147. The nurse observes a coworker eating
ice frequently. The nurse encourages the
143. depresses the activity of scavenger coworker to have an examination and
cells and affects the respiratory tract’s diagnostic workup with the health care
ciliary cleansing mechanism, which keeps provider because frequently eating ice may
breathing passages free of inhaled irri- indicate which type of anemia?
tants, bacteria, and other foreign matter. A. Iron deficiency anemia
A. spirometry B. Megaloblastic anemia
B. smoking C. Sickle cell disease
C. bullectomy D. Aplastic anemia
D. none of above
148. The nurse is conducting a community pro-
144. A patient is being treated for status asth- gram about prevention of respiratory ill-
maticus. Which arterial blood gas analysis ness.Which illness does the nurse recog-
does the nurse evaluate that can indicate nize is the most common cause of death
impending respiratory failure? in the United States?
A. Respiratory acidosis A. Atelectasis
B. Respiratory alkalosis B. Pulmonary embolus
C. Metabolic acidosis C. Pneumonia
D. Metabolic alkalosis D. Tracheobronchitis

3.3 Surgery 268
149. Decrease fat intake. C. Hemoglobin

A. The patient is at risk for tooth decay. D. Phagocytosis
B. The patient will develop gingival hyper-
154. c. Degree of convexity modified by con-
plasia.
traction and relaxation of the ciliary mus-
C. The patient can develop osteonecrosis cles
of the jaw.
A. Pupil
D. The patient can develop loosening of
B. Lens
NARAYAN CHANGDER
the teeth.
C. Retina
150. The edge of the cornea where it joins the
D. Corneas
sclera
A. Sclera 155. The nurse advises a patient who is iron
B. Iris deficient to take extra vitamin , which
is known for increasing iron absorption.
C. Uvea
A. D3
D. Limbus
B. C
151. Prostaglandins are primary chemical me- C. K
diators that respond to a stimulus by con-
tracting smooth muscle and increasing cap- D. B12
illary permeability. This response causes
156. The term for red blood cell
A. T cells
A. the pain and fever seen with inflamma-
tory responses B. Hemostasis
B. arthritis C. Erythrocyte
C. dermatitis D. RES
D. allergy 157. The nurse is monitoring a patient with
152. Hodgkin lymphoma bronchiectasis. Which complication should
the nurse be alert for?
A. Proliferative disorder of the myeloid
stem cells A. Atelectasis
B. Stem cell disease within the bone mar- B. Emphysema
row C. Pleurisy
C. Unicentric in origin and is initiated in a D. Pneumonia
single node
D. Heterogeneous group of cancers that 158. The nurse is developing a plan of care for
originate from the neoplastic growth of a patient with severe vertigo. Which ex-
lymphoid tissue pected outcome statement would be a pri-
ority for this patient?
153. The mature form of white blood cells A. Patient will experience no falls due to
(WBCs) balance disorder.
A. Lymphocytes B. Patient will take medications as pre-
B. Hematopoiesis scribed.

3.3 Surgery 269
C. Patient will perform exercises as pre- A. Pneumocystis pneumonia

scribed. B. Acute chest syndrome

D. Patient will have decreased fear and
C. An exacerbation of asthma
anxiety.
D. Pulmonary edema
159. A patient is admitted to the hospi-
tal with pulmonary arterial hypertension. 164. The balance between clot formation and
Which significant assessment finding by clot dissolution
the nurse will be reported to the health
A. Hemostasis
care provider?
A. Ascites B. Erythrocyte
B. Dyspnea C. RES
C. Hypertension D. T cells
D. Syncope 165. The nurse is educating a patient tak-
160. Which is the optimal way to determine ing imatinib mesylate for treatment of
the level of a patient’s alertness? Insti- leukemia.Which will the nurse be sure to
tute a bowel-training program include when educating the patient about
the best way to take the medication that
A. Footdrop will optimize absorption?
B. Impaired cough reflex
A. Take the medication with a source of
C. Paralyzed diaphragm vitamin C to enhance absorption.
D. Incontinence B. Take antacids if needed for gastroin-
testinal (GI) upset 2 hours after taking the
161. Excitatory response, mostly affecting
medication.
moods
A. Norepinephrine C. Take the medication with food to en-
hance absorption.
B. Serotonin
D. Take the medication with ac-
C. Acetylcholine etaminophen to prevent decreased ab-
D. Dopamine sorption and GI upset.
162. The letters used for the term reticuloen- 166. A patient comes to the clinic report-
dothelial system ing fever, cough, and chest discomfort.
A. Erythrocyte The nurse aus-cultates crackles in the
B. T cells left lower base of the lung and suspects
that the patient may have pneumonia.
C. Hemostasis Which does the nurse identify is the most
D. RES common organism that causes community-
acquired pneumonia?
163. A patient with sickle cell disease, brought
to the emergency department by a par- A. Staphylococcus aureus
ent, has a fever of 101.6◦ F, heart rate of B. Mycobacterium tuberculosis
116, a respiratory rate of 32, and bilat-
eral wheezes. Which do these findings in- C. Pseudomonas aeruginosa
dicate to the nurse? D. Streptococcus pneumonia

3.3 Surgery 270
167. The nurse is performing an assessment C. c. Positioning the patient on their side
of cranial nerve function and asks the pa- with head flexed forward
tient to cover one nostril at a time to see
D. d. Providing for privacy
if the patient can smell coffee, alcohol, and
mint.The patient is unable to smell any E. e. Restraining the patient to avoid self-
of the odors. Which cranial nerve does injury
the nurse identify is not functioning as it
should? 171. he nurse is caring for a patient who was
involved in a motor vehicle injury and sus-
NARAYAN CHANGDER
A. CNI
tained a head injury. When assessing deep
B. CN II tendon reflexes (DTR), the nurse observes
C. CN III diminished or hypoactive reflexes. How
will the nurse document this finding?
D. CN IV
A. 0
168. A patient is being seen in the ophthal-
mology clinic for a suspected detached B. 1+
retina. Which clinical manifestations does C. 2+
the nurse identify as significant for a reti-
nal detachment? (Select all that apply.) D. 3+
A. A visual field of floating particles 172. The lobe of the cerebral cortex that is
B. A definite area of blank vision responsible for the understanding of lan-
guage and music is the lobe.
C. Momentary flashes of light
D. Pain A. temporal
E. Halos around the eyes B. dopamine

C. frontal
169. In current tuberculosis (TB) treatment,
four first-line medications are used: , D. hypothalamus
, , and
A. rifampin, pyrazinamide, ethambutol, 173. Voluntary muscle control is governed by
isoniazid a vertical band of “motor cortex” located
in the lobe.
B. rifampin, pyrazinamide, ethambutol
A. thalamus
C. Tachypnea, dyspnea, mild to moderate
hypoxemia B. pituitary
D. Tachypnea, dyspnea, hypoxemia C. hypothalamus
170. The nurse is called to attend to a patient D. frontal

having a tonic clonic seizure in the wait-
ing area. Which nursing interventions are 174. Term for the left eye
provided for this patient? (Select all that A. Photophobia
apply.)
B. Astigmatism
A. (a) Loosening constrictive clothing
C. Oculus sinister
B. b. Opening the patient’s jaw and in-
serting a mouth gag D. Aphakia

3.3 Surgery 271
175. Describe why the stroma of the bone mar- C. Remove the intravenous line.
row is important. D. Administer prescribed PRN anti-

A. The stroma is important in an indirect anxiety agent.
manner,
178. and Should not be taken with iron
B. The stroma is important in an in- preparations, because they greatly dimin-
direct manner, in that it produces the ish the absorption of iron.
colony-stimulating factors needed for
hematopoiesis. A. Antacids, dairy products
C. Iron, vitamin B12, folic acid, pyridox- B. Antacids, food products

ine, protein, and other factors are re- C. Pepto-Bismol dairy products
D. anxiety medication, dairy product
ing erythropoiesis can result in decreased
red cell production. 179. A patient with cystic fibrosis is admitted
D. An increased number of band cells is to the hospital with pneumonia. When
sometimes called a left shift or shift to the will the nurse administer the pancreatic
left. A shift to the left indicates that more enzymes that the patient has been pre-
immature cells are present in the blood scribed?
than normal. A. After meals and at bedtime
176. The nurse is preparing the patient for B. One hour prior to mealtime in the
a test to determine the cause of vitamin morning
B12 defi-ciency. The patient will receive a C. With meals
small oral dose of radioactive vitamin B12
D. Three times a day regardless of meal
followed by a large parenteral dose of non-
time
radioactive B12.Which test is the patient
being prepared for? 180. The nurse is educating a patient with iron
A. Bone marrow aspiration deficiency anemia about food sources high
in iron and how to enhance the absorption
B. Schilling test
of iron when eating these foods. Which
C. Bone marrow biopsy can the nurse inform the patient will en-
D. Magnetic resonance imaging (MRI) hance the absorption?
study A. Eating calf’s liver with a glass of or-
ange juice
177. A client receiving a blood transfusion re-
B. Eating leafy green vegetables with a
ports shortness of breath, appears anx-
glass of water
ious, and has a pulse of 125 beats/minute.
What is the best action for the nurse C. Eating apple slices with carrots
to take after stopping the transfusion D. Eating a steak with mushrooms
and awaiting further instruction from the
health care provider? 181. The sleep-wake cycle regulator and the
A. Ensure there is an oxygen delivery de- site of the hunger center is known as the
vice at the bedside.
B. Place the client in a recumbent posi- A. thalamus
tion with legs elevated. B. hypothalamus

3.3 Surgery 272
C. pituitary 186. A patient who had gastric bypass

D. temporal surgery3 years ago is experiencing fa-
tigue. The patient takes pantoprazole
182. Subjective perception of sound with inter- for the treatment of frequent heartburn.
nal Origin; unwanted noises in the head or Which type of anemia is this patient at risk
ear for?
A. Otosclerosis A. Aplastic anemia
B. Tinnitus
NARAYAN CHANGDER
B. Iron deficiency anemia
C. Rhinorrhea C. Sickle cell disease
D. Presbycusis D. Pernicious anemia
183. A nurse is reviewing a client’s most re-
cent platelet count and identifies the need 187. Two significant changes in the optic nerve
to institute bleeding precautions. Which that occur in patients with glaucoma are
result would the nurse most likely have and
noted? A. Lipoid, aqueous
A. 90, 000/mm3 B. Streptococcus pneumonia, Haemophilus
B. 110, 000/mm3 influenza
C. 200, 000 /mm3 C. pallor (lack of blood supply), cupping
D. 45, 000/mm3 of the optic nerve disc
D. laser trabeculoplasty, laser iridotomy
184. The nurse is assessing a patient who is a
strict vegetarian. Which type of anemia is
188. The nurse is educating a patient with
this patient at greatest risk for?
a seizure disorder. Which nutritional ap-
A. Iron deficiency anemia proach for seizure management would be
B. Aplastic anemia beneficial for this patient?
C. Megaloblastic anemia A. Low in fat
D. Sickle cell disease B. Restricts protein to 10% of dailv
caloric intake
185. A client with megaloblastic anemia re-
ports mouth and tongue soreness. What C. High in protein and low in carbohy-
instruction will the nurse give the client re- drate & . At least 50% carbohydrate
garding eating while managing the client’s D. none of above
symptoms?
A. “Eat small amounts of bland, soft 189. A protein that forms the basis of blood
foods frequently.” clotting
B. “Eat cold, bland foods with a large A. Plasminogen
amount of water.”
B. Lymphocytes
C. “Eat larger amounts of bland, soft
foods less frequently.” C. Erythrocyte
D. “Eat low-fiber blended foods only.” D. Hemostasis

3.3 Surgery 273
190. Three primary complications of increased 194. The site of activity for most macrophages
ICP are , , and A. Hemostasis

A. cerebral edema, pain, seizures, in- B. Spleen
creased ICP, neurologic status
C. Plasminogen
B. brain stem herniation, diabetes in- D. Lymphocytes
sipidus, syndrome of inappropriate antidi-
uretic hormone (SIADH) 195. Parkinson’s disease is caused by an im-
balance in the neurotransmitter known as
C. brain herniation resulting in death
D. none of above A. frontal
191. The nurse is administering packed RBC B. Serotonin
transfusions for a patient with MDS. The C. dopamine
patient has had several transfusions and is
D. hypothalamus
likely to receive several more. Which is a
pri. ority for the nurse to monitor related 196. The nurse is performing a neurologic as-
to the transfusions? sessment and requests that the patient
A. Creatinine and blood urea nitrogen stand with eyes open and then closed for
(BUN)levels 20 seconds to assess balance. Which type
of test is the nurse performing?
B. Iron levels
A. Weber test
C. Magnesium levels B. Rinne test
D. Potassium levels C. ) Romberg test
192. A patient with end-stage kidney disease D. Watch-tick test
(ESKD) has developed anemia. What lab- 197. Latent infection; no disease (e.g., posi-
oratory finding does the nurse understand tive PPD)
to be significant in this stage of anemia?
A. Class 3
A. Calcium level of 9.4 mg/dL
B. Class 0
B. Potassium level of 5.2 mEq/L C. Class 2
C. Creatinine level of 6 mg/100 mL D. Class 1
D. Magnesium level of 2.5 mg/dL 198. B12 deficiency
193. It is determined that a patient is legally A. Megaloblastic anemias
blind and will be unable to drive any B. Hemolytic anemias
longer. Legal blindness refers to a best
C. Hypoproliferative anemias
corrected visual acuity (BCVA) that does
not exceed what reading in the better D. none of above
eye? 199. The nurse is administering anticoagulant
A. 20/50 therapy with heparin. Which international
normalized ratio (IN) does the nurse iden-
B. 20/100
tify as within therapeutic range and will
C. 20/150 continue administration of the heparin?
D. 20/200 A. 0.5 to 1.0

3.3 Surgery 274
B. 1.5 to 2.5 C. “It is all right if I have a grilled cheese

C. 2.0 to 2.5 sandwich with American cheese.”
D. “It is fine if I eat sushi with a little bit
D. 3.0 to 3.5
of soy sauce.
200. Which is a symptom of severe thrombo-
204. The nurse is instructing the patient with
cytopenia?
asthma in the use of a newly prescribed
A. Inflammation of the mouth leu-kotriene receptor antagonist. Which
NARAYAN CHANGDER
B. Dyspnea education will the nurse include?
C. Inflammation of the tongue A. Take the medication with meals be-

cause it may cause nausea,
D. Petechiae
B. Take the medication separately with-
201. A patient describes numbness in the arms outother medications.
and hands with a tingling sensation and C. Take the medication an hour before
frequent stumbling when walking. Which meals or 2 hours after a meal.
vitamin deficiency does the nurse identify
D. Take the medication with a small
may contribute to some of these symp-
amountof liquid.
toms?
A. Thiamine 205. Combination short-acting beta-2 adrener-
gic agonist agent
B. Folate
A. Combivent
C. B12
B. Cromolyn
D. Iron
C. Theophylline
202. The patient has a deficiency in the leuko- D. none of above
cyte responsible for cell-mediated immu-
nity. Which findings in the white blood cell 206. Another term for nearsightedness
count will the nurse identify that correlate A. Ulcer
with this deficiency?
B. Iritis
A. Basophils
C. Myopia
B. Monocytes
D. Keratitis
C. Plasma cells
207. A person’s personality and judgment are
D. T lymphocytes
controlled by the area of the brain known
203. A patient is being educated by the nurse as the lobe.
about the administration of isoniazid (INH) A. hypothalamus
therapy for tuberculosis. Which statement B. temporal
made by the patient indicates that the ed-
ucation is understood? C. frontal
A. “I am going to have a tuna fish sand- D. dopamine

wich for lunch.” 208. List the four most common causes of iron
B. “It is all right if I drink a glass of red deficiency anemia in men and postmeno-
wine with my dinner.” pausal women.

3.3 Surgery 275
A. decreased mobility, increased depres- A. Cor pulmonale

sion, increased risk for falling, and delir-
B. Smoking
ium.

C. Cessation of smoking
B. Bleeding from ulcers, gastritis, inflam-
matory bowel disease (IBD), or gastroin- D. Spirometry
212. A client with myelodysplastic syndromes
C. Dietary teaching sessions should be
(MDS) receives routine blood transfusions.
individual. ized, involve family members,
Which treatment will the nurse expect to
and include cultural aspects related to
be prescribed to prevent the development
food preferences and food prepa-ration.
of iron overload?
daily, must be absorbed by women of A. Eltrombopag
childbearing age to replace that lost dur- B. Chelation therapy
ing menstruation.
C. Epoetin alpha
D. Chemical agents potentially responsi-
ble for bone marrow aplasia include ben- D. Romiplostim
zene and benzene deriv. atives such
as airplane glue, paint remover, and 213. The common feature of the is an un-
dry-cleaning solutions. Certain toxic regulated proliferation of leukocytes in the
materials-such as inorganic arsenic, gly- bone marrow
col ethers, plutonium, and radon-have A. cells
also been implicated as potential causes.
B. myeloid
209. A patient with polycythemia vera reports
C. leukemias
severe itching. Which triggers does the
nurse know can cause this symptom? (Se- D. lymphoid
lect all that apply.)
214. The nurse is caring for a client who has
A. Temperature change
a unit of whole blood removed every 6
B. Allergic reaction to the RBC increase weeks as treatment for polycythemia vera.
C. Alcohol consumption Which laboratory test will the nurse mon-
itor to determine if the procedure is ad-
D. Exposure to water of any temperature
versely affecting the client?
E. Aspirin
A. Potassium
210. A condition in which one eye deviates
B. Iron
from the object at which the person is look-
ing C. Calcium
A. Astigmatism D. White blood cell count
B. Strabismus
215. Excessive production of tears
C. Laceration
A. Uveitis
D. Ptosis
B. Oculus dexter
211. is used to evaluate airflowobstruc-
C. Sty
tion, which is determined by the ratio of
FEV, to forced vital capacity (FVC). D. Epiphora

3.3 Surgery 276
216. The parasympathetic division of the auto- 220. Chronic myeloid leukemia
nomic nervous system yields impulses that
A. Results from a defect in the hematopoi-
are mediated by the secretion of , the
etic stem cell that differentiates into all
dominant neurotransmitter in parasympa-
myeloid cells
thetic nervous system functions.
B. Arises from a mutation in the myeloid
A. Serotonin
stem cell
B. acetylcholine
C. Results from an uncontrolled prolifer-
NARAYAN CHANGDER
C. cerebellum ation of immature cells derived from the
D. dopamine lymphoid stem cell
217. Chronic myeloid leukemia (CML) arises D. Derived from a malignant clone of B
from a mutation in the myeloid lymphocytes
A. infection 221. A patient is being tested for a gag re-
B. myeloid flex.When the nurse places the tongue
C. lymphoid blade to the back of the throat, there is no
response elicited. Which dysfunction does
D. stem cell the nurse identify the patient is experienc-
218. A patient who has suffered a stroke is ing?
unable to maintain respiration and is in- A. Dysfunction of the spinal accessory
tubated and placed on mechanical ventila- nerve
tor support.Which portion of the brain is
B. Dysfunction of the acoustic nerve
most likely responsible for the inability to
breathe? C. Dysfunction of the facial nerve
A. Frontal lobe D. Dysfunction of the vagus nerve
B. Occipital lobe
222. A patient comes to the clinic for the third
C. Parietal lobe time in 2 months with chronic bronchi-
D. Brain stem tis.Which clinical symptoms does the nurse
assess in this patient?
219. A patient had a lumbar puncture 3 days
ago in the outpatient clinic and calls A. Chest pain during respiration
the nurse reporting a throbbing headache. B. Sputum and a productive cough
Which education will the nurse provide to
C. Fever, chills, and diaphoresis
the patient regarding relief of the discom-
fort? (Select all that apply.) D. Tachypnea and tachycardia
A. Limit the amount of fluid to decrease
223. The nurse is planning the care for a pa-
cerebral edema.hrs 1
tient at risk for the development of a pul-
B. b. Force fluids (unless contraindi- monary embolism. Which nursing actions
cated). will be included in the care plan? (Select
C. c. Get plenty of bed rest. all that apply.)
D. d. Take some over-the-counter anal- A. Encourage a liberal fluid intake.
gesics. B. Assist the patient to do leg elevations
E. e. Walk around. above the level of the heart.

3.3 Surgery 277
C. Instruct the patient to dangle the legs C. Ask the patient to cough to observe the
over the side of the bed for 30 minutes, sputum color and consistency.
four times a day.

D. Notify the health care provider of a
D. Use elastic stockings, especially when possible cerebrospinal fluid leak.
decreased mobility would promote ve-
nousstasis. 228. The nurse is performing an assessment
for a patient with anemia admitted to the
E. Apply a sequential compression de-
hospital for the administration of blood
vice.
transfusions.Why would the nurse need to
224. An initial treatment for a splash injury to include a nutritional assessment for this
the eye would be patient?
A. irrigation with normal saline A. It is part of the required assessmentin-
formation.
B. irrigation
B. It is important for the nurse to deter-
C. saline
mine what type of foods the patient will
D. irrigation with water eat.
225. Maintain dorsiflexion to affected C. It may indicate deficiencies in essen-
areaWhich is the optimal way to deter- tial nutrients.
mine the level of a patient’s alertness? D. It will determine what type of anemia
A. Footdrop the patient has.
B. Impaired cough reflex 229. A patient with chronic kidney disease
C. Paralyzed diaphragm has Chronic anemia. Which pharmacologic
D. none of above alternative to blood transfusion may be
used for this patient?
226. A nurse, caring for a client with human A. GM-CSF
immunodeficiency virus (HIV), reviews the
client’s differential WBC count. What type B. Erythropoietin
of WBC will the nurse check the level of? C. Eltrombopag
A. T lymphocytes D. Thrombopoietin
B. Monocytes
230. A nurse cares for a client with mega-
C. B lymphocytes loblastic anemia who had a total gastrec-
D. Leukocytes tomy three years ago. What statement
will the nurse include in the client’s teach-
227. A patient 3 days postoperative from ing regarding the condition?
a craniotomy informs the nurse, “I feel
A. “The condition is likely caused by a vi-
something trickling down the back of
tamin B12 deficiency.”
my throat and I taste something salty.”
Which priority action does the nurse initi- B. “The condition causes abnormally
ate? rigid red blood cells.”
A. Give the patient some mouthwash to C. “The condition causes abnormally
gargle with. small red blood cells.”
B. Request an antihistamine for the post- D. “The condition is likely caused by a fo-
nasal drip. late deficiency.”

3.3 Surgery 278
231. A plasma protein primarily responsible 235. Severe hearing loss is associated with a
for the maintenance of fluid balance decibel loss in the range of to dB.
A. Plasminogen A. 70, 80
B. Hemostasis B. 70, 90
C. Spleen C. 70, 95
D. Albumin D. 70, 85
232. To help prevent infections in patients 236. White part of the eye
NARAYAN CHANGDER
with COPD, the nurse should recommend
vaccination against two bacterial organ- A. Limbus
isms , , and, B. Uvea
A. streptococcus C. Iris
B. pneumoniae D. Sclera
C. Haemophilus influenza 237. A patient who wears contact lenses is to
D. bacillus be placed on rifampin for tuberculosis ther-
apy.Which information will the nurse pro-
233. The nurse is administering two units of
vide to the patient?
packed RBCs to an older adult patient with
a bleeding duodenal ulcer. The patient be- A. “Only wear your contact lenses during
gins to experience difficulty breathing and the day and take them out in the evening
the nurse assesses crackles in the lung before bed.”
bases, jugular vein distention, and an in- B. “You should switch to wearing your
crease in blood pressure. Which action by glasses while taking this medication.”
the nurse is a priority? (Select all that ap-
C. “The health care provider can give you
ply.)
eye drops to prevent any problems.”
A. Continue the infusion but slow the rate
D. “There are no significant problems
down.
with wearing contact lenses.”
B. Place the patient in an upright position
with the feet dependent. 238. Mechanical vibrations are transformed
C. Administer diuretics as prescribed. into neural activity so that sounds can be
differentiated by the
D. Discontinue the transfusion.
A. external acoustic meatus
E. Administer oxygen.
B. organ of Corti
234. A patient who has long-term packed RBC
C. cochlea
transfusions develops symptoms of iron
toxicity that affect liver function. Which D. internal acoustic meatus
immediate treatment will the nurse pre-
239. The nurse is caring for a patient with sta-
pare the patient for that may help prevent
tus asthmaticus in the intensive care unit
organ damage?
(ICU).Which blood gas analysis related to
A. Iron chelation therapy hyperventilation does the nurse observe
B. Oxygen therapy with this patient?
C. Therapeutic phlebotomy A. Metabolic acidosis
D. Anticoagulation therapy B. Metabolic alkalosis

3.3 Surgery 279
C. Respiratory acidosis 245. The nurse obtains a Snellen eye chart

D. Respiratory alkalosis when assessing cranial nerve function.
Which cranial nerve is the nurse testing

240. A patient with chronic renal failure is ex- when using the chart?
amined by the health care provider for ane- A. CNI
mia. Which laboratory results will the
B. CN II
nurse monitor?
C. CN III
A. Increased reticulocyte count
D. CN IV
B. Decreased level of erythropoietin
C. Decreased total iron-binding capacity 246. A patient with polycythemia vera has a
highRBC count and is at risk for the devel-
D. Increased mean corpuscular volume opment of thrombosis. Which treatment is
important to reduce blood viscosity and to
241. Folic acid deficiency deplete the patient’s iron stores?
A. Megaloblastic anemias A. Blood transfusions
B. Hemolytic anemias B. Radiation
C. Hypoproliferative anemias C. Chelation therapy
D. none of above D. Phlebotomy
242. The leading cause of seizures in the older 247. Which is the optimal way to determine
adult is the level of a patient’s alertness? Elevate
A. cerebral edema the head of the bed to 30 degrees
A. Footdrop
B. status epilepticus
B. Impaired cough reflex
C. cerebrovascular disease
C. Paralyzed diaphragm
D. none of above
D. none of above
243. A client with a diagnosis of pernicious
anemia comes to the clinic reporting of 248. It is projected that by 2050, % of
numbness and tingling in his arms and legs. people over age 55 will have some form
What do these symptoms indicate? of hearing loss
A. 50
A. Insufficient intake of dietary nutrients
B. 55
B. Neurologic involvement
C. 60
C. Severity of the disease
D. 65
D. Loss of vibratory and position senses
249. The process of stopping bleeding from a
244. A clotting factor present in plasma severed blood vessel
A. Fibrinogen A. Erythrocyte
B. Albumin B. Lymphocytes
C. Spleen C. Hemostasis
D. Hemostasis D. Plasminogen

3.3 Surgery 280
250. Absence of the lens 255. An older adult patient has noticed a sig-
nificant amount of vision loss in the last
A. Ulcer
few years.Which does the nurse recognize
B. Aphakia as the most common cause of visual loss
C. Astigmatism in older adults?
D. Photophobia A. Macular degeneration

B. Ocular trauma
251. A nurse is caring for a client admitted
NARAYAN CHANGDER
with pernicious anemia. Which set of find- C. Retinal vascular disease
ings should the nurse expect when assess- D. Uveitis
ing the client?
A. Pallor, tachycardia, and a sore tongue 256. is used to measure nerve fiber layer
thickness and is an important indicator of
B. Pallor, bradycardia, and reduced pulse glaucoma progression.
pressure
A. Polarimetry
C. Angina pectoris, double vision, and
anorexia B. Laser scanning
D. Sore tongue, dyspnea, and weight gain C. Light scanning polarimetry
D. Laser scanning polarimetry
252. Inflammation of the cornea
A. Keratitis 257. A client receiving a unit of packed red
blood cells (PRBCs) has been prescribed
B. Oculus sinister
morphine 1 mg intravenously now for pain.
C. Photophobia What is the best method for the nurse to
D. Ulcer administer the morphine?
A. Disconnect the blood tubing, flush with
253. Cranial nerve I name/function normal saline, and administer morphine.
A. TrochlearEye movement B. Administer the morphine into the clos-
B. OculomotorEye movement est tubing port to the client for fast deliv-
ery.
C. OlfactorySmell
C. Add the morphine to the blood to be
D. OpticVision
slowly administered.
254. Three major potential complications in D. Inject the morphine into a distal port
a patient with a depressed level of con- on the blood tubing.
sciousness(LOC) , , and
258. Complications of AML include and
A. pneumonia, aspiration, respiratory
the major causes of death from this condi-
failure, fever
tion.
B. pneumonia, aspiration, respiratory
A. illness
failure
B. bleeding
C. brain stem herniation, cerebral edema
C. infection
D. none of above D. dysplasia

3.3 Surgery 281
259. Aplastic anemia B. Iron, vitamin B12, folic acid, pyridox-

A. Hemolytic anemias ine, protein, and other factors are re-

B. Hypo proliferative anemias ing erythropoiesis can result in decreased
C. Megaloblastic anemias red cell production.
D. Hypo proliferative anemias C. An increased number of band cells is
sometimes called a left shift or shift to the
260. Which is the optimal way to determine left. A shift to the left indicates that more
the level of a patient’s alertness? Assist immature cells are present in the blood
with daily active or passive range of mo- than normal.
tion
D. Knowledge of correct administration
A. a. Footdrop techniques and possible complications is
B. f. Paralyzed extremity required. It is very important to be famil-
C. c. Impaired cough reflex iar with the facility’s policies and proce-
dures for transfusion therapy.
D. e. Paralyzed diaphragm
263. A patient with pulmonary hypertension
261. When the patient has anemia, what med- has a positive vasoreactivity test. Which
ical management goal will the nurse assist medication will the nurse administer to the
the patient and health care team in achiev- patient as prescribed?
ing?
A. Calcium channel blockers
A. Bleeding from ulcers, gastritis, inflam-
matory bowel disease (IBD), or gastroin- B. Angiotensin-converting enzyme in-
testinal (GI) tumors hibitor
B. Correcting or controlling the cause of C. Beta-blockers
the anemia. D. Angiotensin receptor blockers
C. The heart rate and cardiac output do
264. A term used to describe T lymphocytes
pnea, and confusion may be seen more A. Erythrocyte
readily in the anemic olderadult. B. RES
D. The patient with sickle cell trait usually C. T cells
has a normal hemoglobin level, a normal
hematocrit, and a normal blood smear. In D. Hemostasis
contrast, the patient with sickle cell dis-
265. The nurse provides care for an older adult
ease has a low hematocrit and sickled
client, diagnosed with anemia, who has a
cells on the smear. The diagnosis is con-
hemoglobin of 9.6 g/dL and a hematocrit
firmed by hemoglobin electrophoresis.
of 34%. To determine the cause of the
262. When the nurse must administer blood or client’s blood loss, which is the priority
blood components, what knowledge is re- nursing action?
quired? A. Evaluate the client’s dietary intake.
A. The stroma is important in an indi- B. Monitor the client’s blood pressure.
rect manner, in that it produces the
colony-stimulating factors needed for C. Monitor the client’s body temperature.
hematopoiesis. D. Observe the client’s stools for blood.

3.3 Surgery 282
266. A patient is taking prednisone 60 B. Hypoxemia that does not respond to

mg/day for the treatment of an acute ex- supplemental oxygen
acerbation of Crohn’s disease. The pa- C. Superinfection is suspected when a
tient has developed lymphopenia with a subsequent infection occurs.
lymphocyte count of less than 1500 mm’.
Which will the nurse monitor the patient D. none of above
for? 270. the three most common Asthma symp-
A. The onset of a bacterial infection toms are , and
NARAYAN CHANGDER
B. Bleeding A. Cough
C. Abdominal pain B. fever
D. Diarrhea C. wheezing
D. dyspnea
267. The nurse is caring for a patient with
chronic myeloid leukemia (CML) taking 271. Which iron-rich foods should a nurse en-
imatinib mesylate. In which phase of the courage an anemic client requiring iron
leukemia is this medication most useful to therapy to eat?
induce remission? A. Shrimp and tomatoes
A. Chronic B. Cheese and bananas
B. Transformation C. Lamb and peaches
C. Accelerated D. Lamb and peaches
D. Blast crisis
272. A loss of cornea substance or tissue as a
268. What is the goal of treatment in acute result of inflammation
lymphocytic leukemia (ALL)? A. Aphakia
A. The goal of treatment is to obtain re- B. Oculus sinister
mission without excess toxicity and with C. Ulcer
a rapid hematologic recovery so that ad-
ditional therapy can be administered if D. Photophobia
needed. 273. The nurse is assessing a patient who has
B. The results will show an excess of im- been admitted with possible acute respi-
mature blast cells, which is the hallmark ratory distress syndrome (ARDS). Which
of the diagnosis. findings would distinguish ARDS from car-
diogenic pulmonary edema?
C. The signs and symptoms result from
insufficient production of normal blood A. Elevated white blood count
cells. B. Elevated troponin levels
D. Because the illness is unpredictable. C. Elevated myoglobin levels
269. Explain the meaning of the term superin- D. Elevated B-type natriuretic peptide
fection. (BNP) levels
A. Superinfection is suspected when a 274. In acute myeloid leukemia (AML), any

subsequent infection occurs with another age group can be affected, although it in-
bacterium during antibiotic therapy. frequently occurs before the age of and

3.3 Surgery 283
the incidence rises with age, with a peak C. Aplastic anemia

incidence at the age of years.
D. Sickle cell disease

A. 50, 72
279. Describe how natural killer (NK) cells
B. 55, 67
serve as an important part of the body’s
C. 45, 65 immune defense system.
D. 60, 73 A. The stroma is important in an indi-
275. Multiple myeloma is a malignancy of the rect manner, in that it produces the
most mature form of , the plasma cell. colony-stimulating factors needed for
hematopoiesis.
A. A lymphocyte
B. NK cells accumulate in the lymphoid
B. B lymphocyte
tissues (especially spleen, lymph nodes,
C. C lymphocyte and tonsils), where they mature. When
D. D lymphocyte activated, they serve as potent killers
of virus-infected and cancer cells. They
276. The nurse is assessing the pupils of a pa- also secrete chemical messenger pro-
tient who has had a head injury. Which teins, called cytokines, to mobilize the T
parasympathetic effect does the nurse and B cells into action.
identify the patient is experiencing?
C. An increased number of band cells is
A. Dilated pupils sometimes called a left shift or shift to the
B. Constricted pupils left. A shift to the left indicates that more
immature cells are present in the blood
C. Roth spots
than normal.
D. Roth spots
D. Iron, vitamin B12, folic acid, pyridox-
277. is a condition in which the hemoglobin ine, protein, and other factors are re-
concentration is lower than normal, reflect- quired. A deficiency of these factors dur-
ing the presence of fewer than the normal ing erythropoiesis can result in decreased
number of erythrocytes within the circula- red cell production.
tory system.
280. A patient reports ringing in the left ear
A. Anemia
and hearing loss in the same ear, but does
B. delirium not have any associated dizziness or ver-
C. paresthesia tigo. Which condition will the patient be
assessed for?
D. heart failure
A. Otitis media
278. A nursing instructor in a BSN program is
B. Acoustic neuroma
preparing for a lecture on disorders of the
hematopoietic system. Included in the lec- C. Labyrinthitis
ture are conditions caused by reduced lev-
D. Tinnitus
els or absence of blood-clotting proteins.
Which of the following is the instructor 281. Antibodies, the most effective defense
most likely referring to? mechanisms in the body, react with anti-
A. Pancytopenia gens in three ways: , , and
B. Coagulopathy A. neutralizing toxic antigens

3.3 Surgery 284
B. precipitating the antigens out of solu- 286. Mast cell stabilizer

tion A. albuterol
C. coating the surface of the antigens B. combivent
D. immunoglobulins
C. cromolyn
282. A client at the clinic has just been diag- D. none of above
nosed with iron deficiency anemia. What
would you recommend the client consume 287. Normal intraocular pressure is
NARAYAN CHANGDER
to promote the absorption of iron? A. 10 to 21 mm Hg
A. Sources of vitamin B12 B. 12 to 21 mm Hg
B. Meat, egg yolks, oysters, and shellfish C. 10 to 14 mm Hg
C. Vitamin E D. 10 to 31 mm Hg
D. Rich sources of vitamin C
288. When educating a patient about the use
283. The nurse is caring for a patient with of anticonvulsant medication, what will
pleurisy.Which symptoms does the nurse the nurse inform the patient is a result
identify correlate with the patient’s ill- of long-term use of the medication in
ness? women?
A. Dullness or flatness on percussion A. a. Anemia
over areas of collected fluid
B. b. Osteoarthritis
B. Dyspnea and coughing
C. (C. Osteoporosis
C. Fever and chills
D. d. Obesity
D. Stabbing pain during respiratorymove-
ment 289. The nurse is developing a plan of care
for a patient with acute tracheobronchi-
284. A patient has serous otitis media with
tis. Which nursing interventions will be in-
significant hearing loss in the right ear.
cluded in the plan of care? (Select all that
The patient states, “I have not been able
apply.)
to hear for 2 months.” Which procedure
does the nurse prepare the patient for? A. Encouraging the patient to remain in
bed
A. Irrigation of the ear
B. Myringotomy B. Using cool-vapor therapy to relieve la-
ryngeal and tracheal irritation
C. Removal of cerumen with a cerumen
curette C. Increasing fluid intake to removese-
cretions
D. Instillation of otic solution
D. Administering a narcotic analgesic for
285. Type IlI hypersensitivity reactions in- pain
volve the binding of antibodies to antigens.
List two possible results: and 290. A client is treated for anemia. What
is the nurse’s best understanding about
A. arthritis
the correlation between anemia and the
B. serum sickness client’s iron stores?
C. certain types of nephritis A. There is a strong correlation between
D. some types of bacterial endocarditis. iron stores and hemoglobin levels.

3.3 Surgery 285
B. There is a weak correlation between B. The results will show an excess of im-
iron stores and hemoglobin levels. mature blast cells, which is the hallmark
of the diagnosis.

C. There is a strong correlation between
iron stores and hemoglobin characteris- C. he goal of treatment is to obtain re-
tics. mission without excess toxicity and with
D. There is an inverse relationship be- a rapid hematologic recovery so that ad-
tween iron stores and hemoglobin levels. ditional therapy can be administered if
needed.
291. A healthy person can often tolerate
D. Because the illness is unpredictable.
as much as % gradual reduction
in hemoglobin without pronounced symp- 296. A client with severe anemia reports
toms or significant incapacity. symptoms of tachycardia, palpitations, ex-
A. 40 ertional dyspnea, cool extremities, and
dizziness with ambulation. Laboratory
B. 50
test results reveal low hemoglobin and
C. 60 hematocrit levels. Based on the assess-
D. 30 ment data, which nursing diagnoses is
most appropriate for this client?
292. Contains nerve endings that transmit vi-
A. Imbalanced nutrition, less than body
sual impulses to the brain
requirements, related to inadequate in-
A. Corneas take of essential nutrients
B. Pupil B. Ineffective tissue perfusion related to
C. Retina inadequate hemoglobin and hematocrit
D. Vitreous humor C. Fatigue related to decreased
hemoglobin and hematocrit
293. Altered sensation of orientation in space
D. Risk for falls related to complaints of
A. Nystagmus dizziness
B. Exostoses
297. A patient with sickle cell disease is to be-
C. Vertigo
gin treatment with hydroxyurea. Which
D. Dizziness education does the nurse provide about
the benefits of treatment with this medi-
294. The most important environmental risk
cation? (Select all that apply.)
factor for COPD worldwide is
A. Fewer painful episodes of sickle cell
A. bullectomy
crisis
B. cessation of smoking
B. Lower incidence of acute chest syn-
C. cigarette smoking drome
D. cor pulmonal C. Decreased need for blood transfu-
sions
295. What do the signs and symptoms of AML
result from? D. Decreased need for other analgesic
A. The signs and symptoms result from medications
insufficient production of normal blood E. Ability to reverse the damage done
cells. from sickling of cells

3.3 Surgery 286
298. An older adult patient informs the nurse, B. Constricted pupil

“I don’t see as well as I used to.” What C. Marked blurring of vision
will the nurse educate the patient about re-
garding why vision becomes less efficient D. Watery ocular discharge
with age? (Select all that apply.) 302. A patient with acute myeloid leukemia
A. There is a decrease in pupil size. (AML) has a neutrophil count that persists
B. There is slowing of accommodation. at less than 100/mm? . Which will the
nurse cautiously monitor this patient for?
NARAYAN CHANGDER
C. There is an increase in lens opaque-
ness. A. Abdominal cramps
D. Most older patients develop glaucoma. B. Hypotension

C. Seizure activity
E. The optic nerve begins to degenerate.
D. Infection
299. A patient is undergoing platelet pheresis
at the outpatient clinic. What does the 303. A nurse caring for a patient with head
nurse know is the most likely clinical dis- trauma will be monitoring the patient for
order the patient is being treated for? Cushing triad. Which are the identified
symptoms associated with Cushing triad
A. Extreme leukocytosis
that the nurse documents? (Select all that
B. Sickle cell anemia apply.)
C. Renal transplantation A. a. Bradycardia
D. Essential thrombocythemia B. b. Bradypnea
300. A female patient has a hemoglobin of 6.4 C. c Hypertension
g/dL and is preparing to have a blood D. d. Tachycardia
transfusion. Why would it be important
E. e. Pupillary constriction
for the nurse to obtain information about
the patient’s history of pregnancy prior to 304. Another term for an external hordeolum
the transfusion?
A. Uveitis
A. A high number of pregnancies can in-
B. Sty
crease the risk of reaction.
C. Oculus
B. If the patient has never been pregnant,
it increases the risk of reaction. D. dexter
C. Obtaining information about gravidity 305. Chronic lymphocytic leukemia
and parity is routine information for all fe- A. Results from a defect in the hematopoi-
male patients etic stem cell that differentiates into all
D. If the patient has been pregnant, she myeloid cells
may have developed allergies. B. Arises from a mutation in the myeloid
301. The nurse is performing an assessment of stem cell
the visual fields for a patient with glau- C. Results from an uncontrolled prolifer-
coma.When assessing the visual fields in ation of immature cells derived from the
acute glaucoma, which will the nurse ex- lymphoid stem cell
pect to find? D. Derived from a malignant clone of B
A. Clear cornea lymphocytes

3.3 Surgery 287
306. What three tests are used to evaluate A. Destruction or dysfunction of the basal
gross auditory acuity? ganglia leads not to paralysis but to mus-
cle rigidity, disturbances of posture, and

A. Chime, Weber, and Whisper tests
difficulty initiating or changing movement.
B. Whine, Weber, and Whisper tests
B. Flaccid paralysis and atrophy of the af-
C. Rhine, Weber, and Whisper tests fected muscles.
D. Rhine, Weber, and Yelling tests C. The autonomic nervous system regu-
307. A patient with chronic kidney disease is as the heart, lungs, blood vessels, diges-
identified as having anemia. Which labo- tive organs, and glands. Maintenance
ratory test results will the nurse likely ob- and restoration of internal homeostasis is
serve? largely the responsibility of the autonomic
A. Decreased level of erythropoietin nervous system
D. This barrier is formed by the endothe-
B. Decreased total iron-binding capacity
C. Increased mean corpuscular volume form continuous tight junctions, creating a
D. Increased reticulocyte count barrier to macromolecules and many com-
pounds.
308. An older adult patient presents to the
311. Myelodysplastic syndromes (MDSs) are
clinic reporting feeling “exhausted all the
a group of clonal disorders of the myeloid
time. “The nurse will assess which labora-
stem cell that cause in one or more
tory values that commonly associate with
types of cell lines.
this patient’s symptoms?
A. myeloid
A. WBC count
B. infection
B. RBC count
C. dysplasia
C. Thrombocyte count
D. bleeding
D. Levels of plasma proteins
312. The nurse cares for a client with a co-
309. If a patient with an altered LOC read re- agulation factor deficiency who is actively
quites suctioning, which intervention is a bleeding. Which blood component replace-
priority for the nurse to provide? ment does the nurse anticipate administer-
A. Before and after suctioning, the pa- ing?
tient is adequately ventilated to prevent A. PRBCs
hypoxia. B. IV gamma-globulin
B. after suctioning, the patient is ade- C. FFP
quately ventilated to prevent hypoxia.
D. Antithrombin III
C. Before suctioning, the patient is ade-
quately ventilated to prevent hypoxia. 313. Hospital-acquired pneumonia develops
hours or more afteradmission and does
D. none of above
not appear to be incubating at the time of
310. Describe the role and functions of the au- admission.
tonomic nervous system. A. 24

3.3 Surgery 288
B. 48 318. Non-Hodgkin lymphoma

C. 36 A. Proliferative disorder of the myeloid
D. 72 8 stem cells
314. A patient with End Stage Kidney Disease B. Stem cell disease within the bone mar-
is taking recombinant erythropoietin for row
the treatment of anemia. What laboratory C. Unicentric in origin and is initiated in a
study does the nurse understand will have single node
NARAYAN CHANGDER
to be assessed at least monthly related to
this medication? D. Heterogeneous group of cancers that
A. Folate levels originate from the neoplastic growth of
lymphoid tissue
B. Creatinine level
C. Hemoglobin level 319. Primary causes for an acute exacerbation
D. Potassium level ofCOPD are and
315. A nurse cares for a client with myelodys- A. cessation of smoking

plastic syndrome who requires frequent B. smoking
PRBC transfusions. What blood compo-
nent does the nurse recognize as being C. tracheobronchial infection
most harmful if accumulated in the tissues D. air pollution
due to chronic blood transfusions?
A. Iron 320. Excitatory; inhibits pain transmission
B. Potassium A. Gamma-aminobutyric acid
C. Hemoglobin
B. Dopamine
D. Calcium
C. Enkephalin
316. The classification of immunoglobulin (g)
that occupies certain receptors on mast D. Norepinephrine
cells and produces an inflammatory re-
sponse is 321. The nurse is educating a patient who will
be started on an antituberculosis medica-
A. epinephrine
tion regimen. The patient asks the nurse,
B. IgE “How long will I have to be on these med-
C. immunoglobulins ications? ” Which statement by the nurse
D. penicillin is most informative?
317. The nurse is assessing a patient with A. “You will need to take the medication
polycythemia vera. Which skin assess- for 3 months.
ment data will the nurse identity as a nor- B. “Depending on your symptoms, 3 to 5
mal finding for this patient? months is the most you will take them.”
A. Pale skin and mucous membranes C. It is important that you take the medi-
B. Bronze skin tone cation as prescribed for 6 to 12 months.”
C. Ruddy complexion D. “Most patients have to take the medi-
D. Jaundice skin and sclera cation for at least 13 to 18 months “

3.3 Surgery 289
322. The nurse is assisting with a lumbar punc- A. A tympanogram, or impedance au-
ture and observes that when the health diometry, measures middle ear muscle re-
care provider obtains cerebrospinal fluid flex to sound stimulation and compliance

(CSF), it is clear and colorless. What is the of the tympanic membrane by changing
significance of this finding? the air pressure in a sealed ear canal.
A. A subarachnoid hemorrhage B. A tympanogram, or impedance au-
diometry.
B. Severe sepsis
C. stimulation and compliance of the tym-
C. A normal finding; the fluid will be sent
panic membrane by changing the air pres-
for testing to determine other factors
sure in a sealed ear canal.
D. Local trauma from the insertion of the D. none of above
needle
326. No exposure; no infection
323. Uneven curvature of the cornea
A. Class 3
A. Astigmatism
B. Class 0
B. Keratitis
C. Class 5
C. Aphakia D. Class 2
D. Ulcer
327. An acoustic neuroma is a benign tumor of
324. What clinical manifestations occur when the nerve.
there is destruction or dysfunction in the A. fourth
basal ganglia?
B. fifth
A. Destruction or dysfunction of the basal
C. seventh
ganglia leads not to paralysis but to mus-
cle rigidity, disturbances of posture, and D. eighth
difficulty initiating or changing movement.
328. Illusion of movement in which the person
B. The autonomic nervous system regu- or the surroundings are sensed as moving
A. Otalgia
as the heart, lungs, blood vessels, diges-
tive organs, and glands. Maintenance B. Nystagmus
and restoration of internal homeostasis is C. Vertigo
largely the responsibility of the autonomic
D. Exostoses
nervous system
C. Flaccid paralysis and atrophy of the af- 329. The nurse is having an information ses-
fected muscles. sion with a women’s group at the YMCA
about lung cancer. Which frequent and
D. This barrier is formed by the endothe-
commonly experienced symptom will the
nurse include in the session?
form continuous tight junctions, creating a
barrier to macromolecules and many com- A. Copious sputum production
pounds. B. Coughing
325. A patient is having a tympanogram. C. Dyspnea

What is the significance of this test? D. Severe pain

3.3 Surgery 290
330. Contractile membrane between the C. seventh

cornea and lens
D. ninth
A. Limbus
B. Iris 335. The nurse is caring for a patient with
C. Uvea suspected acute respiratory distress syn-
drome(ARDS) with a POz of 53. The pa-
D. Sclera tient is placed on oxygen via facemask and
331. The nurse is examining the area behind the POz remains the same. Which key
NARAYAN CHANGDER
the patient’s auricle and sees a flaky sca- characteristic of ARDS does the nurse iden-
liness.Which disorder does the nurse sus- tify is occurring?
pect the patient has? A. Unresponsive arterial hypoxemia
A. Sebaceous cysts
B. Diminished alveolar dilation
B. Seborrheic dermatitis
C. Tachypnea
C. Tophi
D. Acute external otitis D. Increased Pa02
332. , , , and are the three or- 336. What should the nurse educate the pa-
ganisms that most commonly cause bacte- tient about when performing tonometry?
rial conjunctivitis.
A. Visual acuity is tested for both near
A. Haemophilus influenza, Staphylococ- and far.
cus aureus
B. Visual acuity is tested for both near (14
inchesaway) and distance (20 feet away)
influenza, Staphylococcus aureus
vision and performed on each eye sepa-
C. Streptococcus pneumonia, Haemophilus rately with a standardized Snellen chart
influenza for distance and a Rosenbaum pocket
D. cupping of the optic nerve disc screener for near vision.
333. The nurse is obtaining the health his- C. Patients are cautioned to avoid
tory of a client suspected of having a squeezing the eye-lids, holding the breath,
hematological condition. The nurse notes or performing a Valsalva maneuver, as
the client has a history of alcohol abuse. these may result in abnormally increased
Which clinical presentation is related to al- IOP.
cohol consumption? D. The Amsler grid is a test often used for
A. Myelodysplastic syndrome patients with macular problems, such as
B. Neutropenia macular degeneration.
C. Thrombocytopenia
337. Disease; clinically active
D. Anemia
A. Class 0
334. A facial nerve neuroma is a tumor on the
B. Class 3
nerve.
A. fifth C. Class 4
B. sixth D. Class 2

3.3 Surgery 291
338. The nurse is talking to a family mem- 342. Describe how anemia impacts the older
ber of a hearing-impaired patient and the adult patient.
patient states, “I know you are talking

A. Bleeding from ulcers, gastritis, inflam-
about me.You are just whispering so that I
matory bowel disease (IBD), or gastroin-
will not hear what you are saying.” Which
is the significance of the statement made
by the patient? B. Bleeding from ulcers, gastritis, in-
flammatory bowel disease (IBD), or gas-
A. False pride
trointestinal (GI) tumorsBleeding from ul-
B. Indecision cers, gastritis, inflammatory bowel dis-
C. Insecurity ease (IBD), or gastrointestinal (GI) tu-
D. Suspiciousness mors
C. decreased mobility, increased depres-
339. When a nonfunctioning nasogastric tube
sion, increased risk for falling, and delir-
allows the gastric contents to accumulate
ium.The heart rate and cardiac output do
in the stomach, a condition known as
may result.
pnea, and confusion may be seen more
A. aspiration readily in the anemic olderadult.
B. Tachypnea D. Dietary teaching sessions should be in-
C. silent aspiration dividual. ized, involve family members,
D. dyspnea and include cultural aspects related to
food preferences and food prepa-ration.
340. is a neurotransmitter that helps con- Additional amounts of iron, up to 2 mg
trol mood and sleep. daily, must be absorbed by women of
A. Serotonin childbearing age to replace that lost dur-
B. frontal ing menstruation.
C. dopamine 343. List etiologic factors and nursing assess-

D. temporal ments for patients with ARDS.
341. The nurse is caring for a patient with A. head of bed 30-40 degrees
Hodgkin lymphoma in the hospital and B. avoid bolus feeding
preparing discharge planning education.
C. swallow evaluation
Because this patient is at risk for the de-
velopment of a second malignancy, which D. use sedatives
education is beneficial for the nurse to dis-
cuss to reduce the risk factors? (Select all 344. The nurse at the eye clinic is caring for a
that apply.) patient with suspected glaucoma. Which
report by the patient would be significant
A. Reduce exposure to excessive sun-
for a diagnosis of glaucoma?
light.
B. Smoking cessation. A. A significant loss of central vision
C. Decrease alcohol intake. B. Diminished acuity

D. Decrease intake of antipyreticmedica- C. Pain associated with a purulent dis-
tions such as acetaminophen charge
E. Decrease fat intake. D. The presence of halos around lights

3.3 Surgery 292
345. The nurse is educating a patient with 349. The fluid portion of blood
glaucoma about medications. Which medi-
A. Lymphocytes
cations will the nurse educate the patient
about that decrease aqueous production? B. Hematopoiesis
(Select all that apply.)
C. Plasma
A. Alpha-adrenergic agonists
D. Thrombocytes
B. Carbonic anhydrase inhibitors
350. A patient sustained a head injury during
NARAYAN CHANGDER
C. Beta-blockers
a fall and has changes in personality and
D. Miotics affect. Which part of the brain does the
E. Calcium channel blockers nurse identify has been affected in this in-
jury?
346. Iron deficiency
A. Frontal lobe
A. Megaloblastic anemias
B. Parietal lobe
B. Hemolytic anemias
C. Hypoproliferative anemias C. Occipital lobe
D. none of above D. Temporal lobe
347. Which triggers may lead to the develop- 351. Women of childbearing years need an ad-
ment of disseminated intravascular coagu- ditional mg daily of iron to replace that
lation (DIC)? loss during menstruation.
A. Sepsis, trauma, cancer, shock, abrup- A. 2
tion placentae, toxins, and allergic reac-
B. 4
tions
B. Bleeding from ulcers, gastritis, inflam- C. 5
matory bowel disease (IBD), or gastroin- D. 6
C. The patient with sickle cell trait usually 352. Why is caring for a patient with
has a normal hemoglobin level, a normal myelodysplastic syndromes (MDSs) such a
hematocrit, and a normal blood smear. In challenge?
contrast, the patient with sickle cell dis- A. Because the illness is unpredictable.
ease has a low hematocrit and sickled
cells on the smear. The diagnosis is con- B. The goal of treatment is to obtain re-
firmed by hemoglobin electrophoresis. mission without excess toxicity and with
a rapid hematologic recovery so that ad-
D. Correcting or controlling the cause of ditional therapy can be administered if
the anemia. needed.
348. Involuntary rhythmic eye movement C. The results will show an excess of im-
A. Nystagmus mature blast cells, which is the hallmark
of the diagnosis.
B. Exostoses
D. The signs and symptoms result from
C. Vertigo insufficient production of normal blood
D. Otalgia cells.

3.3 Surgery 293
353. The “master gland” is also known as the is equally dangerous, because it can ob-
gland. struct blood flow to vital tissues. To pre-
vent this, the body has a thrombolytic (fib-

A. frontal
rinolytic) mechanism that eventually dis-
B. temporal solves clots formed within blood vessels.
C. thalamus D. An intricate clotting mechanism is acti-
vated when necessary to seal any leak in
D. pituitary
the blood vessels.
354. The nurse is assigned to care for a patient
357. cranial nerve V name/function
in the intensive care unit (ICU) with status
asthmaticus. Why does the nurse include A. AbducensEye movement
fluid intake as being an important aspect B. OculomotorEye movement
of the plan of care? (Select all that apply.)
C. TrochlearEye movement
A. To combat dehydration
D. TrigeminalFacial sensation
B. To assist with the effectiveness of the
corticosteroids 358. Identify eight nursing interventions that
C. To loosen secretions are used to prevent atelectasis.
D. To facilitate expectoration A. Atelectasis
E. To relieve bronchospasm B. Frequent turning, early mobilization,

deep breathing maneuvers, assistance
355. The largest classification of leukocytes with the use of spirome-try, suctioning,
postural drainage, aerosol nebulizer treat-
A. Spleen ments, and chest percussion
B. Albumin C. ARDS
C. Monocytes D. Dyspnea, cough, sputum production,
D. Fibrinogen tachycardia, tachypnea, pleural pain, and
central cyanosis
356. A patient sustaining a trauma is at risk
for excess blood loss. Which protective 359. A client is hospitalized 3 days prior to a
mechanism is activated to prevent excess total hip arthroplasty and reports a high
blood loss? level of pain with ambulation. The client
has been taking warfarin at home, which
A. To prevent this, the body has a throm- is now discontinued. To prevent the forma-
bolytic (fibrinolytic) mechanism that even- tion of blood clots, which action should the
tually dissolves clots formed within blood nurse take?
vessels.
A. Have the client limit physical activity.
B. Excessive clotting is equally danger-
B. Monitor partial thromboplastin (PTT)
ous, because it can obstruct blood flow to
time.
vital tissues.
C. Administer the prescribed enoxaparin
C. An intricate clotting mechanism is ac-
(Lovenox).
tivated when necessary to seal any leak
in the blood vessels. Excessive clotting D. Encourage a diet high in vitamin K.

3.3 Surgery 294
360. Define the etiology of cor pulmonale. C. The nurse can instill a small amount of
mineral oil into the canal and have the pa-
A. hypotension, shock, respiratory failure
tient return for removal of the wax.
B. Enlargement of the right ventricle of
D. The nurse can instill mineral oil into
the heart because of diseases affecting
the canal and immediately irrigate to re-
the structure or functions of the lung
move the adherent wax.
C. ARDS
364. A patient is brought into the emergency
D. Frequent turning, early mobilization, department with chemical burns to both
NARAYAN CHANGDER
deep breathing maneuvers, assistance eyes. Which is the priority action of the
with the use of spirome-try, suctioning, nurse for this patient’s care?
postural drainage, aerosol nebulizer treat-
A. a. Administering local anesthetics and
ments, and chest percussion
antibacterial drops for 24 to 36 hours
361. A patient is undergoing plateletpheresis B. Applying hot compresses at 15-
at the outpatient clinic. Which does the minuteintervals
nurse identify as the most likely clinical C. c. Flushing the lids, conjunctiva, and
disorder the patient is being treated for? cornea with tap water or normal saline
A. Essential thrombocythemia D. d. Cleansing the conjunctiva with a
B. Extreme leukocytosis small cotton-tipped applicator
C. Sickle cell disease 365. The nurse is caring for a patient with in-
creased ICP. As the pressure rises, what
D. Renal transplantation
osmotic diuretic does the nurse prepare to
362. The nurse is auscultating the patient’s administer as prescribed?
lung sounds to determine if there is the A. Glycerin
presence of fluid overload. Which adven- B. Isosorbide
titious lung sounds are significant for pul-
C. Mannitol
monary edema?
D. Urea
A. Crackles in the lung bases
B. Low-pitched rhonchi during expiration 366. A nursing student is learning how to ad-
equately use an otoscope to examine the
C. Pleural friction rub ear.Which method should the instructor ed-
D. Sibilant wheezes ucate the student to use when examining
with an otoscope?
363. A patient comes to the clinic with some A. Otoscope should be held in the exam-
hearing loss. The health care provider is iner’s left hand, in a pencil-hold position,
unable to observe the tympanic membrane with the examiner’s hand braced against
due to the accumulation of cerumen. Which the patient’s face.
intervention will the nurse provide so that
B. Otoscope should be held in the exam-
observation can be made?
iner’s left hand, with a full hand grasp to
A. The nurse can remove the wax with a be able to guide the scope into the internal
cerumen curette. ear.
B. The ear can be irrigated with cool wa- C. Otoscope should be held in the exam-
ter until all of the wax is removed. iner’s right hand, with a full hand grasp to

3.3 Surgery 295
be able to guide the scope into the internal 371. Progressive hearing loss associated with
ear. aging

D. Otoscope should be held in the exam- A. Presbycusis
iner’s right or left hand, with a full hand
grasp to be able to guide the scope into B. Otosclerosis
the internal ear.
C. Rhinorrhea
367. cranial nerve II name/function D. Otorrhea
A. AbducensEye movement
B. OpticVision 372. Blood cell formation (hematopoiesis) oc-
C. OculomotorEye movement curs in the
D. TrochlearEye movement A. yellow marrow
368. A young client is diagnosed with a mild B. bone marrow

form of hemophilia and is experiencing
C. red marrow
bleeding in the joints with pain. In prepar-
ing the client for discharge, what instruc- D. spongey bone
tions should the nurse provide?
A. Undergo genetic testing and counsel- 373. When assessing hearing and balance,
ing if the client is male. what will be included?
B. Wear a medical identification bracelet. A. Inspection of the external, outer, and
C. Take ibuprofen for joint pain. inner ear
D. Take warm baths to lessen pain. B. Inspection of the internal, middle, and
inner ear
369. A patient comes to the clinic with a sus-
pected eye infection. The nurse identifies C. Inspection of the external, middle, and
that the patient most likely has conjunctivi- inner ear
tis, as evidenced by which symptom?
D. none of above
A. Blurred vision
B. Elevated IOP 374. A patient arrives to have an MRI done
C. A mucopurulent ocular discharge in the outpatient department. Which infor-
mation provided by the patient warrants
D. Severe pain
further assessment to prevent complica-
370. The nurse is performing an assessment tions related to the MRI?
for a patient with acute myeloid leukemia
A. “I am trying to quit smoking and have
(AML) and observes multiple areas of ec-
a patch on.”
chymosis and petechiae. Which laboratory
study will the nurse be most concerned B. “I have been trying to get an appoint-
about? ment for so long.”
A. WBC count of 4200 cells/mcL C. “I have not had anything to eat or drink
B. Hematocrit of 38% for 3 hours.”
C. Platelet count of 9000/mm3 D. “My legs go numb sometimes when I
D. Creatinine level of 1.0 mg/dL sit too long.

3.3 Surgery 296
375. is a severe hemolytic anemia that C. bones, mucous membranes, tongue

results from inheritance of the sickle
D. skin, mucous membranes, tongue
hemoglobin gene, which causes the
hemoglobin molecule to be defective.
380. A patient is suspected of having glau-
A. delirium coma.Which reading of IOP would demon-
B. heart failure strate an increase resulting from optic
nerve damage?
C. Sickle cell disease
A. 0 to 5 mm Hg
NARAYAN CHANGDER
D. Aplastic anemia
B. 6 to 10 mm Hg
376. Sickle cell disease
A. Hemolytic anemias C. 11 to 20 mm Hg
B. Hypoproliferative anemias D. 21 mm Hg or higher

C. Megaloblastic anemias 381. Inhibits pain pathways and can control
D. Hemolytic anemias sleep
377. A patient has a lesion affecting the pons, A. Dopamine
resulting in paralysis and the inability to B. Norepinephrine
speak, but has vertical eve movements
and lid elevation. This patient is suffering C. Serotonin
from D. Acetylcholine
A. locked-in syndrome
B. respiratory failure 382. The leukemias are commonly classified ac-
cording to the stem cell line involved, ei-
C. aspiration ther or
D. pneumonia
A. myeloid
378. A patient with acute myeloid leukemia B. lymphocyte
(AML) is having hematopoietic stem cell
transplantation (HSCT) with radiation C. leukemias
ther-apy. Which complication will recog- D. lymphoid
nize the donor’s lymphocytes as foreign
and set up reactions to attack the foreign 383. The development of hematologic neo-
host? plasms is complex. Understanding the pro-
A. Acute respiratory distress syndrome cesses and the rationale for treatments
is important so that nurses may appropri-
B. Graft-versus-host disease
ately , , , and , with patients
C. Remission who have hematologic neoplasms.
D. Bone marrow depression A. assess
379. Assessment of patients who have or are B. monitor
at risk for megaloblastic anemia includes
inspection of the , , and C. educate
A. heart failure, paresthesias, delirium D. intervene
B. Aplastic anemia E. explain

3.3 Surgery 297
384. The critical level of loudness that most materials-such as inorganic arsenic, gly-
people (without a hearing loss) are com- col ethers, plutonium, and radon-have
fortable with is a decibel (dB) reading of also been implicated as potential causes.

dB. B. in an acute exacerbation of anemia,
A. 50 in the prevention of severe complications
from anesthesia and surgery, in improving
B. 20
the response to infection, in the case of
C. 40 acute chest syndrome and multiorgan fail-
D. 30 ure, in thwarting the evolution of a stroke
or an acute neurologic defect, and in di-
385. The nurse is assessing a patient with a minishing episodes of sickle cell crisis in
drooping eyelid and documents this as pregnant women.
A. ptosis C. Sepsis, trauma, cancer, shock, abrup-
tion placentae, toxins, and allergic reac-
B. mucoid
tions
C. lipoid
D. The patient with sickle cell trait usually
D. aqueous has a normal hemoglobin level, a normal
hematocrit, and a normal blood smear. In
386. A patient has a severe neurologic impair- contrast, the patient with sickle cell dis-
ment from a head trauma. Which does the ease has a low hematocrit and sickled
nurse recognize is the type of posturing cells on the smear. The diagnosis is con-
that occurs with the most severe neuro- firmed by hemoglobin electrophoresis.
logic impairment?
389. A client has a history of sickle cell anemia
A. a. Decerebrate
with several sickle cell crises over the past
B. b. Decorticate 10 years. What blood component results
C. (c. Flaccid in sickle cell anemia?
D. d. Rigid A. hemoglobin S
B. hemoglobin F
387. Affects behavior, attention, and
C. hemoglobin M
finemovement
D. hemoglobin A
A. Gamma-aminobutyric acid
B. Enkephalin 390. Maintains the form of the eyeball
C. Acetylcholine A. Iris
B. Vitreous humor
D. Dopamine
C. Corneas
388. Describe at least five types of situations
D. Sclera
in which the transfusion of red blood cells
(RBCs)is highly effective. 391. Nursing postoperative management in-
A. Chemical agents potentially respon- cludes detecting and reducing reliev-
sible for bone marrow aplasia include ing , preventing and monitoring
benzene and benzene derivatives such and
as airplane glue, paint remover, and A. cerebral edema, pain, seizures, in-
dry-cleaning solutions. Certain toxic creased ICP, neurologic status

3.3 Surgery 298
B. brain stem herniation, diabetes in- 396. Drainage from the ear
sipidus, syndrome of inappropriate antidi- A. Otosclerosis
uretic hormone (SIADH)
B. Otorrhea
C. pneumonia, aspiration, respiratory
failure C. Presbycusis
D. none of above D. Nystagmus
392. Exposure; no evidence of infection 397. is a rare disease caused by a decrease
NARAYAN CHANGDER
A. Class 1 in or damage to marrow stem cells, dam-
age to the microenvironment within the
B. Class 2 marrow, or replacement of the marrow
C. Class 3 with fat.(PPIs>
D. Class 4 A. delirium
393. Which type of medication will the nurse B. Aplastic anemia
use in combination with mydriatics to di- C. Sickle cell
late the patient’s pupil?
D. paresthesias
A. Anti-infectives
B. Corticosteroids 398. The leukemias are also classified as
Or
C. Cycloplegics
A. acute, chronic
D. NSAIDs
B. acute, severe
394. major factors that determine the clini-
C. acute
cal course and survival of patients with
COPD. D. acute, urgent
A. history of cigarette smoking, passive 399. The principal function of the erythrocyte,
smoking exposure which is composed primarily of , is to
B. age, rate of decline of FEV
C. hypoxemia, weight loss, reversibility A. myofibril; transport oxygen between
of airflow obstruction, the lungs and the tissues
D. pulmonary artery pressure, and rest- B. T cells; transport oxygen between the
ing heart rate. lungs and the tissues
395. A patient with acute myeloid leukemia C. hemoglobin; transport oxygen be-
(AML) is having aggressive chemotherapy tween the lungs and the tissues
to attempt to achieve remission and is D. white blood cells; transport oxygen be-
aware that hospitalization will be neces- tween the lungs and the tissues
sary for several weeks. Which type of
therapy will the nurse educate the patient 400. Name the three characteristics that are
about? essential when evaluating hearing.
A. Induction therapy A. Frequency, range, and intensity.
B. Supportive therapy B. Frequency, pitch, and intensity.
C. Antimicrobial therapy C. Treble, pitch, and intensity.
D. Standard therapy D. Frequency, pitch, and transpose.

3.4 Myotonic Dystrophy 299
401. A patient has had cataract extractions 405. Atelectasis, which refers to closure or col-
and the nurse is providing discharge in- lapse of alveoli, may be chronic or acute
structions.Which will the nurse encourage in nature.What are some of the possible

the patient to do at home after discharge? causes of atelectasis in the postoperative
A. Maintain bed rest for 1 week. patient?
B. Lie on the stomach while sleeping. A. Streptococcus pneumonia
C. Avoid bending the head below the B. Streptococcus aureus
waist. C. H influenza
D. Lift weights to increase muscle D. Gram Neg. Bacilli
strength.
406. A patient with vertigo is scheduled
402. The nurse is collecting a sputum culture to to have an electronystagmography in 2
identify the causative organism for a pa- weeks.Which instructions will the nurse
tient with acute tracheobronchitis. Which provide to the patient prior to the test?
causative fungal organism does the nurse
suspect? A. Withhold caffeine and alcohol 48 hours
before the test.
A. Aspergillus
B. Withhold blood pressure medication
B. Haemophilus
24 hours before the test.
C. Mycoplasma pneumoniae
C. Withhold vestibular suppressants 48
D. Streptococcus pneumonia hours before the test. Do not eat or drink
anything 12 hours before testing
403. Disease; not clinically active
A. Class 5 D. none of above
B. Class 3 407. A patient had a small pituitary ade-

C. Class 2 noma removed by the transsphenoidal ap-
proach and has developed diabetes in-
D. Class 0 sipidus. Which pharmacologic therapy will
404. A condition characterized by abnormal the nurse be administering to this patient
spongy bone formation around the stapes as prescribed to control symptoms?
A. Presbycusis A. a. Mannitol
B. Otorrhea B. b. Furosemide (Lasix)
C. Otalgia C. c Vasopressin
D. Otosclerosis D. d. Phenobarbital
3.4 Myotonic Dystrophy

1. What is Muscular Dystrophy? D. bigger than normal muscles
A. Weaker muscles 2. What muscle extends the head?

B. Stronger muscles A. Latissimus dorsi
C. collapsing muscles B. Trapezius

C. Triceps brachii 8. Protrusion of an organ through the wall of

the cavity that normally contains it
D. Semitendinosus
A. Hernia
3. Someone with myotonic dystrophy will
B. Tendinitis
have trouble
C. Scoliosis
A. Relaxing muscles
D. fracture
B. Standing up
NARAYAN CHANGDER
C. walking 9. What type of muscle tissue has numerous
nuclei within each cell?
D. running
A. Visceral smooth muscle
4. Schwann cells have the ability to B. Cardiac Muscle
A. repair nerve cells C. Skeletal muscle
B. damage nerve cells D. Multiunit smooth muscle
C. repair the spinal cord 10. What disease is associated with the ani-
D. send messages mal not being able to pick up a toy?
A. Myasthenia gravis
5. What muscle has its origin in the femur and
its insertion in the tibia? B. Polymyositis
C. Muscular dystrophy
A. Biceps femoris
D. Masticatory myositis
B. Deltoid
C. Quadriceps 11. Abnormal softening of bones in adults
D. Triceps brachii A. osteoperosis

B. osteomalacia
6. What is tendonitis?
C. osteotendinitis
A. Inflammation or irritation of tendon
D. osteotendinosis
B. A stretched or torn muscle or tendon
12. When a bone breaks through the skin, this
C. Genetic disorder causing loss of ten- is called a
don function
A. stress fracture
D. Strong, painful contraction of the ten-
don B. compound fracture
C. transverse fracture
7. What disease is defined as “persistent
D. hairline fracture
contraction of muscle fibers when begin-
ning to move”? 13. When do you get muscular dystrophy?
A. Non-inflammatory myotonia A. When your born
B. Polymyositis B. In your 20’s
C. Myasthenia gravis C. In your 50’s
D. Non-inflammatory myopathy D. In your childhood

14. Disease characterized by the inability to 20. What muscular disease can be caused from
relax muscles at will following contrac- trauma?
tions

A. Polymyositis
A. Fibromylasia B. Myasthenia gravis
B. Duchenne’s muscular dystrophy C. Masticatory myositis
C. Fibrodysplasia ossificans progressiva
D. Muscular rupture
D. Myotonic muscular dystrophy
21. All the muscle within the body has a re-
15. What muscle flexes the jaw? lationship with the system to produce
A. Brachiocephalicus movement and contraction.
B. Deltoid A. Cardiovascular
C. Masseter B. Skeletal
D. Trapezius C. Nervous
16. Widespread musculoskeletal pain along D. Respiration

with sleep/memory/mood issues, and fa- 22. What type of muscle is small and delicate
tigue. and found within the iris of the eye?
A. Duchenne’s muscular dystrophy A. Visceral smooth muscle
B. Myasthenia gravis B. Cardiac muscle
C. Fibromylasia
C. Skeletal muscle
D. Tendonitis
D. Multiunit smooth muscle
17. A condition in which the body’s bones be-
23. Which of the following is not deadly?
come weak and break easily.
A. Leukemia
A. osteomalacia
B. osteoperosis B. Huntington’s
C. osteobones C. Sprain
D. all of the above D. Alzheimer’s
18. In what range of motion does the limb 24. Mental decline and deterioration
move away from the median plane? A. Dementia
A. Abduction B. Multiple Sclerosis
B. Adduction C. Scoliosis
C. Extension D. Alzheimer’s
D. Flexion
25. What type of disease is myasthenia
19. What term means “loss of muscle mass”? gravis?
A. Atrophy A. Autoimmune disorder
B. Dystrophy B. Viral infection
C. Myopathy C. Genetic disorder
D. Myositis D. Bacterial infection

3.5 Ocular Palsies 302
26. Someone with muscular dystrophy will C. Adduction

A. have strong muscles D. Extension
B. have weak muscles 32. The two parts of the nervous system in-
C. have strong bones clude &
D. have weak bones A. peripheral and central
B. peripheral and autonomic
27. Which is not a symptom of a sprain?
NARAYAN CHANGDER
C. peripheral and middle
A. Pain
D. peripheral and parasympathetic
B. Swelling
C. Bruising 33. Inflammation of a tendon
D. Muscle spasms A. tendinosis
B. tendinitis
28. What muscle is not part of the thoracic
limb? C. muscle strain
A. Brachiocephalicus D. torn ligament
B. Deltoid 34. What is muscle atrophy?
C. Pectoral A. Strong, painful muscle contraction
D. Triceps brachii B. Muscle loses tone and wastes away
29. Striation refers to what? C. Stretching or tearing of ligament
A. Branching D. Inflammation or irritation of tendon
B. Multi nuclei 35. Alexis has been in a cast for 4 weeks due
to a fracture. Her Dr. ordered physical
C. Spindling
therapy after the cast was removed. Why
D. Banding would the Dr. order therapy? Physical
therapy will treat
30. An injury in which the ligaments holding
bones together are stretched too far and A. Muscle atrophy
tear. B. Muscle hypertrophy
A. sprain C. Poor posture
B. strain D. Sarcoplasm
C. dislocation
36. What disease is not immune-mediated?
D. none of above
A. Myasthenia gravis
31. What type of movement is involuntary? B. Polymyositis
A. Mastication C. Non-inflammatory myotonia
B. Digestion D. Masticatory myositis
3.5 Ocular Palsies

1. How is farsightedness corrected? 7. The anteroposterior diameter of the eye-

A. with sunglasses ball measures 25 mm; if this diameter
were considerably reduced, the patient

B. Use of converging lenses, which help would present:
light rays to project onto the retina
A. GLAUCOMA
C. With a herb cleanse from Tlaxcala
B. MYOPIA
D. divergent contact lenses
C. PRESBYOPIA
2. How many layers does the cornea have? D. FARSIGHTEDNESS
A. 2 8. How heavy is the eyeball
B. 1 A. 1-4gr
C. 5 B. stone
D. 6 C. 12gr
3. When is vitrectomy usually indicated D. 9-12gr
A. Floaters 9. The retina is the internal tunic or a very
B. Peripheral posterior vitreous detach- thin and transparent layer that covers the
ment inside of the eye, up to the ora serrata.
Its function is to take charge of the pho-
C. Vitreous-proliferative retinopathy totransduction process, providing the phe-
without macula rugosa nomenon of visual perception. In other
D. Vitreous inflammation that does not words, the function of the retina is
show resorption A. photosensitive membrane, whose mis-
4. what is mydriasis sion is to transform light into nerve stimu-
lation
A. the pupil becomes small
B. membrane that contains blood vessels
B. the pupil gets bigger important for vision
C. the pupil closes C. 10-layer membrane whose function is
D. does not exist to support the eye
D. nourish the choroid and sclera
5. is the first refractive medium
A. crystalline 10. the inferior wall of the orbit is formed by,
except
B. cornea
A. zygomatic
C. iris
B. jaw
D. pet
C. palatine
6. They are usually caused by corrooretinitis. D. sphenoid
A. posterior vitreous detachment
11. Between the sclera and choroid there is a
B. Sinerese sheet called:
C. vitreous inflammation A. beetle
D. Proliferative vitreoretinopathy B. Luschka

C. lucid C. optic nerve

D. None D. nervous system
12. Wall of the orbital vault most exposed to 18. Regarding the RETINA; The photoreceptor
trauma: layer, or the rod-cone layer, is supplied by:
A. PARED LATERAL A. CENTRAL ARTERY OF THE RETINA
B. PARED MEDIAL B. CAPILLARIES OF THE CHORIOCAPI-
LAR LAYER (CHOROID)
NARAYAN CHANGDER
C. TOP WALL OR CEILING
C. WHIRLPOOL VASA
D. PARED INFERIOR O BASE
D. IT IS COMPLETELY AVASCULAR
13. how many layers does the retina have
19. What is the medium of suspension of the
A. 2 lens?
B. 7 A. Zinn’s zonule
C. 8 B. ciliary processes
D. 10 C. ciliary muscles
14. To which patient profile would you offer a D. None
few drops for eye hydration?
20. Optical Grade Polycarbonate:
A. diabetic patients
A. Filters UV radiation.
B. Patients using diuretics
B. Filters UV and IR radiation.
C. contact lens wearers
C. Filters IR radiation.
D. All of them
D. none of above
15. Capsule that surrounds the eyeball 21. The parts of the eyeball are:
A. Tenon’s Capsule A. Iris, retina and pupil
B. Zinn capsule B. pupil and eyebrows
C. Beetle capsule C. Eyebrows, eyelashes and eyelids
D. None D. Iris, pupil and eyebrow
16. What is the point of convergence of the 22. Pathology that occurs when the vitreous
optic nerve called? loses its support function
A. Optical disc A. Sinerese
B. Fovea B. posterior vitreous detachment
C. Macula C. Asteroid Hyaloid
D. None D. floaters
17. It is in charge of sending the signals that 23. It is correct to say:
the eye perceives to our brain. A. Vitreous support function may change
A. choroid B. The vitreous transparency function
B. sclera may change

C. The vitreous is prone to adhesions. 29. What primary difference is there between
a goggle and a spectacle?
D. All alternatives are correct.

A. The visual amplitude or field of vision.
24. what is the function of the lens B. The HC and AF treatment.
A. give color to objects C. The protective seal around the eyes.
B. focus at different distances D. none of above
C. transmit images to the brain 30. It is caused by retinal pigment epithelium
D. see objects in low light and glial cells.
A. Hemorrhage
25. It is in charge of nourishing the cornea
B. posterior vitreous detachment
A. vitreous humor
C. Sinerese
B. aqueous humor
D. Proliferative Vitreoretinopathy
C. agua
31. The cornea is an extremely sensitive struc-
D. ciliary body ture; this innervation is provided by:
26. What are the shades (colors) of the A. TRIGEMINAL NERVE:OPHTHALMIC
glasses for? BRANCH (V1)
A. To let some areas of the light spectrum B. TRIGEMINAL NERVE:MAXILLARY

pass through and reflect others. BRANCH (V2)
C. OPTIC NERVE (II)
B. To block the incidence of sunlight.
D. OCULOMOTOR NERVE (III)
C. To provide comfort to the operator in
each task. 32. Wraparound tunics of the eye:
D. To filter direct rays of pulsed light. A. fibrous tunic, vascular, nervous
B. Fibrous, spongy, nervous tunic
27. -it is a colorless and transparent gel, -
avascular occupies 4/5 of the eyeball, -it C. Fibrous, vascular, membranous tunic
does not regenerate D. none of above
A. aqueous humor 33. What is the problem that you can suffer
B. choroid thanks to the excessive use of the cell
phone?
C. vitreous humor
A. Astigmatism
D. tear
B. Myopia
28. Enophthalmos, elevation restriction and in- C. COVID
fraorbital anaesthesia is seen in
D. Sarna
A. BLOW IN FRACTURE
34. The posterior wall of the anterior chamber
B. BLOW OUT FRACTURE of the eye corresponds to:
C. NONE A. Iris
D. none of above B. Cornea

C. Crystalline 40. How often does the Aqueous H regener-

ate?
D. None
A. 30-40min
35. what is the function of the ciliary body B. 1-2 dias
A. give elasticity C. 90-100min
B. produces aqueous humor D. 60min
C. protect the choroid 41. IT IS PART OF THE MEDIAL WALL OF THE
NARAYAN CHANGDER
D. produces the vitreous humor ORBIT
A. ORBITARY LAMINA OF ETMOID
36. Extraocular muscles originate from: B. CYGOMATIC
A. neural crests C. PALATINE
B. Surface ectoderm D. GREATER WING OF THE SPHENOID
C. Neuroectodermo 42. Do screens affect our Eye Health?
D. none of above A. Exposure to screens is positive for our
eye health.
37. An AF treatment is used to: B. Doesn’t affect at all
A. To reflect the incident light. C. Exposure to screens negatively affects
B. To increase the ability of anti-fogging. our eye health.
C. For jobs interspersed between indoor D. none of above

and outdoor environments. 43. what is miosis
D. none of above A. the pupil gets bigger
B. the pupil becomes small
38. is the colored part of the eye
C. the pupil closes
A. pet
D. does not exist
B. crystalline
44. is the innermost membrane
C. iris
A. iris
D. zonule B. pet
39. Case 1 A child undergone tooth extraction. C. cornea
After a day, the child notice swelling of D. retina
the face at the side where tooth has been
extracted.1. Possible sinus affected mani- 45. Vitreous change common in myopic people
fested by swelling of the face as complica- A. Hyalose Asteroid and synerese
tion after tooth extraction: B. Vitreous hemorrhage and posterior vit-
A. Maxillary sinusitis reous detachment
B. Ethmoditis C. Syneresis and posterior vitreous de-

tachment
C. Frontal sinusitis
D. Vitreous inflammation and vitreous
D. Mastoditis hemorrhage

46. What parts is the eye divided into? C. the outside of the underworld
A. Retina, iris, eyebrows D. SUPEROEXTERNAL

B. Eyeball and protective organs of the
52. Where does the aqueous humor drain?
eye
C. retina, iris, pupil A. ciliary processes
D. Eyebrows, eyelids, eyelashes B. Duct de Schlemm

C. tear ducts
47. The superior oblique muscle receives inner-
vation from the D. None
A. VI cranial pair 53. The term retinal detachment is used to
B. IV cranial nerve describe the separation between the neu-
rosensory retina and the retinal pigment
C. V cranial pair
epithelium. The three categories that de-
D. lll Par craneal scribe the cause of the most common rock-
falls are:
48. Symptom reported by the patient referring
to floaters A. Rhegmatogenous detachment, trac-
tional detachment, exudative detachment
A. arc shaped light
B. Dark shapes in your field of vision B. Detachment due to fluid accumulation,
detachment due to pressure, and detach-
C. light stimulus ment due to trauma
D. Clear shapes in your visual field C. Detachment due to disease, detach-
ment due to rupture, detachment due to
49. All these can occur in trauma to eye except
traction
A. Hyphema
D. Serous detachment, traction detach-
B. Commotio retinae ment, detachment due to systemic dis-
C. Hypopyon eases
D. Choroidal tear 54. Most common symptom of vitreous abnor-
50. Lateral rectus muscle receives innervation malities
from the following cranial nerve: A. sparkling migraine
A. VI B. sparkling flies
B. V C. floaters
C. III D. light flickers
D. VII
55. what is the ciliary body
51. The posterior opening of the eyeball cor-
A. circle of tissue surrounding the lens
responds to the entrance of the OPTIC
NERVE (II N.C), which is located in the B. avascular circle surrounding the
quadrant: cornea
A. INNER HELL C. vascular circle surrounding the cornea
B. SUPEROINTERNO D. circle within the vitreous humor

56. Produces aqueous humor 61. In dry eye syndrome

A. ciliary processes A. Usually ONLY one layer of the tear film
is affected.
B. lacrimal gland
B. The integrity of the aqueous humor is
C. yellow spot
affected.
D. None
C. In most cases the deficiency is in sev-
57. The choroid is basically made up of blood eral layers of the tear film.
NARAYAN CHANGDER
vessels that are organized into lobes and D. none of above
decrease in caliber as they become more
internal. For this reason one of the main 62. Its finding on funduscopy consists of a ring-
functions of the choroid is: shaped opacity
A. Responsible for blood supply to sur- A. vitreous hemorrhage

rounding structures B. Asteroid hyalosis
B. Provide nutrition at the level of the cil- C. posterior vitreous detachment
iary body and the iris D. vitreous inflammation
C. Being the diaphragm, between the
63. A facial protector is designed to protect us
retina and the sclera
primarily from:
D. Avoid the accumulation of vitreous hu-
A. Inhalation of pollutants.
mor and irrigate the cornea
B. Impact protection from forehead to
58. The retina originates from the: chin.
A. Endoderm C. From flashes of IR radiation.
B. Mesodermo D. none of above
C. Neuroectodermo 64. Which requires early surgical interven-
D. none of above tion(multiple choices)
A. Anterior dislocation of lens
59. cataract that mostly affects near vision
and has a rapid growth rate B. Posterior dislocation of lens
A. posterior subcapsular cataract C. Penetrating injury
B. nuclear cataract D. Hyphema
C. catarata cortical 65. what is the function of the pupil

D. congenital cataract A. give better near vision
B. control view focus
60. You state that the patient has glau-
coma when his intraocular pressure is . C. control the amount of light that enters
mmHg. D. shape the eye
A. 12-15
66. Suspect intraocular foreign body when
B. 22 there is
C. 23 A. Dislocation of lens
D. 25 B. Hyphema

C. Iris hole 72. What main risks do we protect ourselves

D. Subconjunctival hemorrhage from when using eye protection?

A. Splashes and Sparks
67. An Outdoor/Indoor treatment is used to:
B. Particles and Vapors
A. Improve visual range
C. Impact and Radiation
B. Work at very low temperatures
D. Liquids and Radiation
C. Switch between artificially lit environ-
ments and bright natural light 73. What material are the lenses of LIBUS
D. none of above glasses made of?
68. The anterior wall of the anterior chamber A. Simplified polycarbonate.

corresponds to: B. Optical grade polycarbonate.
A. Cornea C. Translucent polyethylene.
B. Iris D. Cristal Mineral.
C. Crystalline
74. Where are the photoreceptors located?
D. None
A. Retina
69. To a patient who comes to pick up B. choroid
a prescribed product for a stye, I can
recommend C. Crystalline
A. A teaspoon of Agua del Carmen on an D. Cornea
empty stomach
75. aqueous humor is produced by
B. Oral hydration capsules
A. ciliary processes
C. Of choice we will offer a product for
eyelid cleaning B. now closed
D. none of above C. choroid
70. All are features of traumatic optic neuropa- D. sclera

thy except
76. the sclera is
A. Loss of vision
A. transparent
B. Hemorrhage over optic disc
B. blanca
C. Relative afferent pupillary defect
C. multiple colors
D. Defective colour vision
D. the vascular layer
71. Failure to close the choroidal fissure is the
cause of: 77. Who keeps the eyes clean and moist?
A. a) Atypical coloboma A. eyebrows and eyelashes
B. (b) Typical coloboma B. The eyelids
C. c) Aniridia C. The protective organs of the eye
D. none of above D. lacrimal gland

3.6 Parkinson’ s Disease 310
78. Degenerative condition involving small C. optic nerve

white opacities in the vitreous
D. pet
A. Asteroid hyalosis
B. Myodesopsias 80. Part of the eye that converges rays to
reach the retina
C. floaters
D. Sinerese A. Pet
79. What is the white part of the eye called? B. lacrimal glands
NARAYAN CHANGDER
A. retina C. Eyebrows
B. sclera D. Crystalline
3.6 Parkinson’ s Disease

1. Which of the following symptoms would C. Michael J. Fox
lead to a diagnosis of Parkinson disease?
D. Muhammad Ali
A. Tremor
B. Rigidity 5. The leading treatment for PD is
C. Postural instability A. Carbidopa-levodopa
D. All of the above B. Cardipoda-levopoda
2. Approximately how many people have C. Carbinova-levopada
Parkinson’s Disease in Australia and who
D. Carbonipa-levadopa
is more likely to get it?
A. 40, 000 People (Men = Women) 6. Why is it important to use clocks and cal-
B. 50, 000 People (Men < Women) endars in a dementia patient’s room?
C. 60, 000 People (Men = Women) A. To keep the patient oriented with real-
D. 40, 000 People (Men > Women) ity
3. Who is the actor who funded a well- B. To make sure the patient is not late for
known foundation to find a cure for parkin- appointments
son’s disease C. To keep the patient in a good mood
A. Elvis presley D. none of above
B. Michael jordan
C. Michael J.Fox 7. A seizure is a set of clinical symptoms as-
sociated with abnormal activity in neu-
D. Muhammad Ali rons in the cortex of the brain.
4. Who is the famous actor who funded a a A. oxygen
well-known foundation to find a cure for
Parkinson’s disease? B. physical
A. Elvis Presley C. mechanical

B. Michael Jordan D. electrical

8. A commonly used and effective medication B. A concert name.

for Parkinson’s Disease is which is con- C. A progressive disease that destroys
verted to by neurons.

memory and other important mental func-
A. dopamine; L-dopa tions.
B. botox, acetylcholine D. A disease that effects your brain and
C. acetylcholine; L-dopa can be cured by surgery and certain heavy
medications given only in the hospital.
D. L-dopa, dopamine
14. How many stages of parkinson’s is there
9. Dopamine is produced by neurons in the
A. 5
B. 10
A. Peripheral nervous system
C. 2
B. Basal ganglia
D. 0
C. Substantria nigra
D. Frontal lobe 15. Alzheimer’s Disease is the result of dam-
age to the brain that affects the activity
10. Epilepsy is of the neurotransmitter
A. Having two or more seizures A. dopamine
B. Caused by trauma to the peripheral B. serotonin
nervous system. C. adrenaline
C. A tendency to having recurrent seizure D. acetylcholine
D. All of the above
16. What is the name of the main chemi-
11. When a patient is having a seizure you cal messenger of the sympathetic nervous
should system that people with Parkinson’s Dis-
A. put a tongue depressor in their mouth ease lose the ability to produce?
to keep them from swallowing their A. Histamine
tongue B. Epinephrine
B. turn them on their side C. Serotonin
C. hold them down D. Norepinephrine
D. leave them alone to call for help
17. Which of the following are true about neu-
12. Which one of these are NOT treatments for rodegenerative diseases?
Parkinson’s Disease? A. Most begin and progress slowly
A. Pramipexole B. Some depend on genetic factors, but
B. Levodopa mostly begin randomly
C. Adatonin C. Overtime, there is a gradual loss of
neurons
D. Apomorphine
D. Several cures have been discovered in
13. Define Alzheimer’s: the past 20 years
A. A progressive disease that destroys E. Symptoms are usually symmetrical (af-
your lungs and makes it hard to breath. fecting both sides of body)

18. What is the age range for onset of Parkin- B. Tremor

son’s disease? C. A rash on the upper torso
A. 0-12 D. Muscle rigidity
B. 13-28
24. Average age for parkinson’s is
C. 29-45
A. 50
D. 55-69
B. 60
NARAYAN CHANGDER
19. Hi, I’m a touch neuron and my friend is a vi-
C. 80
bration neuron. I can detect touch but not
vibration. He can detect vibration but not D. 70
touch. What explains this phenomena?
25. What type of surgery is used to regulate
A. Transduction specificity abnormal nerve signals in the brain for
B. Leading lines Parkinson’s?
C. Specific pathway A. Neuroendoscopy
D. Labeled lines B. Deep Brain Stimulation
C. Craniotomy
20. What effects does Parkinson’s disease
have? D. Biospy
A. stiffness 26. Aphsia is
B. fatigue A. difficulty swallowing
C. difficulty speaking B. a language disability
D. All of the above C. a neurological disease
21. Which of the following best characteristic D. recurrent seizure
of parkinson’s disease
27. Which of the following is NOT a motor
A. Deterioration in the myelin sheath
symptom of Parkinson’s Disease
B. Memory loss
A. Postural instability
C. Deterioration of dopamine-releasing
B. loss of sense of smell
neuron
C. muscle rigidity
D. Immune system breakdown
D. resting tremors
22. Is it possible to still have an amazing life
with Parkinson’s disease 28. Can Parkinson’s disease be cured?
A. Yes A. yes
B. Yes B. no
C. no C. can be controlled (reduced )
D. no D. none of above
23. Which of the following is not a symptom 29. People with schizophrenia have reduced
of Parkinson’s Disease? activity in the
A. Loss of Balance A. parietal lobe

B. occipital lobe 35. What stage of Parkinson’s disease is the

C. amygdala worst?
A. Last stage

D. prefrontal cortex
B. new born
30. What’s the closest thing to a “solution” C. I have no idea
for Parkinson’s disease?
D. butterfly?
A. Lead
36. Below is/ are the symptom(s) of
B. Levodopa Alzheimer’s Disease EXCEPT:
C. water A. Short-term memory loss
D. Ibuprofen B. Change in mood & personality
31. Non-motor symptoms of Parkinson’s Dis- C. Lethargy (lack of energy)
ease D. none of above
A. speech problems 37. If one identical twin has schizophrenia, the
B. gait disturbances other twin has % chance of developing
the disorder.
C. restless legs
A. 25
D. loss of smell
B. 50
32. A brain disorder marked by repeated C. 70
seizures over time. D. 100
A. Epilepsy
38. The most dramatic type of seizure is
B. Extrapyramidal symptoms
A. Absence
C. Bradykinesia B. Tonic-clonic
D. none of above C. Clonic
33. Which of the following are the symptoms D. Atonic
of parkinson’s disease? 39. The loss of nerve cells in the causes a
A. Shaking loss of dopamine which results in Parkin-
B. Paralysis son’s Disease
A. Cerebrum
C. Seizures
B. Brain Stem
D. Hypotension
C. Cerebellum
E. Mental Disorders
D. Substantia Nigra
34. Schizophrenia is linked with which neuro- 40. The cause of Parkinson’s disease
transmitter?
A. degeneration of dopamine-producing
A. Cortisol neurons
B. GABBA B. Idopathic
C. Serotonin C. Low GABA levels
D. Dopamine D. Damage to the Substantia Nigra

41. What causes Parkinson’s disease D. a disease that makes you sad
A. low calcium level
46. Parkinsons affects the of the brain
B. low dopamine level
A. Brain
C. high level of dopamine
D. high level of calcium B. mind
C. substantia nigra
42. As a result of a brain injury, a patient can-
not speak or understand language. What D. Sutstabia nigra
NARAYAN CHANGDER
is the term for this impairment?
A. Ambulation 47. Who is credited with discovering “Parkin-
sonism”?
B. Narcolepsy
A. Linton Heathcliff
C. Aphasia
D. Communicable B. Elizabeth Bennet
C. James Parkinson
43. In what stage does Parkinsons start to af-
fect the whole body movement D. James Joyce
A. stage 3
48. Who discovered Parkinson’s disease in
B. stage 6 1817?
C. stage 2
A. Jean Martin
D. stage 8
B. James Parkinson
44. is a clinical condition in which there are
C. Willam Gowers
multiple seizures that are unprovoked.
A. Stroke D. Galen Parkinson
B. Epilepsy 49. What is Alzheimer’s
C. Cardiac arrest
A. Remembring everything
D. Transient ischaemic attack
B. forget your personal things only
45. What is Parkinson’s disease?
C. Keep on forgetting things you used to
A. a neurodegenerative disorder that af- know
fects predominantly dopamine-producing
neurons in a specific area of the brain D. none of above
B. a hereditary disease marked by de- 50. What are some types of self care activ-
generation of the brain cells and causing ities for patients diagnosed with Parkin-
chorea and progressive dementia. son’s disease?
C. chromosomal condition that is associ-
A. Exercise
ated with intellectual disability, a charac-
teristic facial appearance, and weak mus- B. Healthy diet
cle tone (hypotonia) in infancy. All af-
C. Joining support groups for fun activi-
fected individuals experience cognitive de-
ties
lays, but the intellectual disability is usu-
ally mild to moderate. D. All of the above

51. Changes to levels of and have key B. Hippocampus & Brocas area
roles in parkinson’s disease
C. Werenickes area & Amygdala

A. Dopamine, acetylcholine
D. Werenickes area & Brocas area
B. Serotonin, acetylcholine
C. Dopamine, melatonin 57. Neurons that are often impaired, reduced
or non-functional in Parkinson’s Disease
D. Dopamin, serotonin
are called?
52. All of these are symptoms of a seizure EX- A. Sensory neurons
CEPT
B. Motor neurons
A. Muscle stiffness
C. Inhibitory neurons
B. Uncontrollable jerking
D. Dopamine neurons
C. Cold sweats
D. Loss of consciousness 58. Which of the following best characterises
Parkinson’s disease?
53. What can increase your chances of getting
parkinson’s disease? A. deterioration in the myelin sheath
A. Playing in the snow B. memory loss
B. Watering planets C. deterioration of dopamine-releasing
C. Stress neurons
D. Running D. immune system breakdown
54. Changes to levels of and have key 59. How do medications designed to treat
roles in Parkinson’s disease. Alzheimer’s disease work?
A. dopamine; acetylcholine A. They replace levels of serotonin in the
B. serotonin; acetylcholine brain
C. dopamine; melatonin B. They prevent acetylcholine from being
broken down in the brain.
D. dopamine; serotonin
C. They cure Alzheimer’s disease by
55. Which of the following best characterises restoring memory functioning.
Alzheimer’s disease?
D. They prevent levels of acetylcholine
A. slowed movement, rigidity and involun- from breaking down and replace depleted
tary movement of the hands, arms, feet, levels of acetylcholine.
legs, jaws or head
B. amyloid plaques, memory loss and im- 60. If I poke you with a toothpick in receptor
paired acetylcholine functioning field 1 AND receptor field 2, what do you
feel?
C. deterioration of Wernicke’s area
D. immune system impairment A. Nothing
B. One toothpick
56. Schizophrenia has been linked with a de-
crease in size of which brain areas? C. Two toothpicks
A. Hippocampus & Amygdala D. Lots of pocking

61. what stage includes hallucinations and 67. Which of the following is an early symp-
may require a wheelchair tom of Parkinson’s disease?
A. Stage 1 A. Speech changes
B. Stage 4 B. Tiredness
C. Stage 3 C. Mood Swings
D. Stage 5 D. All of the above
NARAYAN CHANGDER
62. Which is not (usually) a symptom of 68. What stage do you have to stop living by
Parkinson’s Disease? yourself
A. Muscle tremor A. Stage 6

B. Stage 4
B. Muscle rigidity
C. Stage 3
C. Slow muscle movement
D. Stage 7
D. Pain
69. What body system does Parkinson’s dis-
63. Can parkinson’s disease be cured ease effect?
A. Yes A. Skeletal System
B. No B. Digestive system
C. Can be controlled(reduced) C. Respiratory system
D. none of above D. Nervous system
64. Our interpretation of a stimulus is 70. Which of the following is a symptom of

Parkinson’s disease
A. sensation
A. Fast speaking
B. transduction
B. Hyper-activity
C. perception
C. Bradykinesia (slow movement)
D. belief
D. Good sense of odour
65. What causes Parkinson’s?
71. What body system does the Parkinson’s
A. Sensory neuron death Disease directly affect?
B. Motor neurons apathy A. Circulatory System
C. Decreased acetylcholine B. Nervous System
D. Loss of dopamine producing cells C. Respiratory System
D. Digestive System
66. Which one of these are NOT symptoms of
Parkinson’s Disease? 72. There is a cure for parkinson’s today
A. Tremors A. True
B. Loss of Coordination B. False
C. Blurry Vision C. Maybe
D. Changes in writing D. none of above

3.7 Peripheral Neuropathy 317
73. Parkinson’s disease is a , , dis- D. “resting tumor”

ease that affects body movements.
76. What does initially Parkinson’s affect

A. continuous, deadly, incurable
A. vision
B. progressive, degenerative, neurologi-
cal B. Dopamine amount
C. progressive, degenerative, psycholog- C. it cripples you

ical D. none of above
D. continuous, curable, weary 77. What causes parkinson’s
74. When not enough dopamine is produced in A. Sensory neuron death
the brain a resulting condition is called B. Motor neurones apathy
A. Alzheimer’s Disease C. Decreased acetylcholine
B. Parkinson’s Disease D. Loss of dopamine producing cells
C. Stroke
78. Why can’t we inject PD patients with
D. Multiple Sclerosis dopamine?
75. A symptom of Parkinson’s is A. It’s expensive
A. “resting tremor” B. It doesn’t cross the blood brain barrier
B. “woken tremor” C. We can’t artificially make dopamine
C. the “hand shake” D. We can
3.7 Peripheral Neuropathy

1. Choose the correct clinical manifestation of 3. Henderson considered the person to be of
Injury to the MEDIAN NERVE primary importance and that is the reason
A. Carpal tunnel syndrome why we categorize her theory as client-
centered. How many activities did Virginia
B. Hand of benediction Henderson have in her “nursing activities
C. Pronator syndrome for client assistance”?
D. Anterior Interosseous Nerve(AIN) A. 12 activities
compressive neuropathy
B. 14 activities
2. Nurse Bonita is caring for a diabetic client. C. 11 activities
Her patient suffering from peripheral neu-
ropathy and could not feed herself. Accord- D. 10 activities
ing to Henderson, which of the following
role of nursing is NOT included? 4. Nocireceptors detect
A. A substitute for the nurse A. pain
B. A helper to the patient B. temp

C. A partner with the patient C. pressure
D. A substitute for the patient D. the position of joints

5. the tenth cranial nerve that innervates di- 11. Below are test to check the Instability of
gestive organs, heart and other areas shoulder EXCEPT
A. Sciatic A. Anterior drawer
B. Tibial B. Posterior drawer
C. Vagus C. Telescope test
D. Femoral D. Neer test
6. what is the correct order of the first 3 CN?
NARAYAN CHANGDER
12. Nerve of the anterior upper arm
A. Optic, Olfactory, Oculomotor
A. Cranial
B. Oculomotor, Optic, Olfactory
B. Sural
C. Olfactory, Optic, Oculomotor
D. Optic, Olfactory, Oculomotor C. Musculocutaneous
D. Radial
7. As per study, 600 mg/day of ALA
for 5 weeks helps to improve neuropathic 13. ADA 2020 recommenadtions says that
symptoms and deficit. screening and periodic check up for Dia-
A. SYDNEY 2 betic peripheral neuropathy for Type 2DM
B. TANG Et Al should be done
C. DECLARE TIMI 58 A. At Dignosis and Annually

D. none of above B. At Dignosis and after 2 years
8. Nerve that runs down the back of the leg C. At Dignisisis only
and branches out to the muscles of the D. none of above
foot.
14. The nervous system controls uncon-
A. Sural
scious activities.
B. Peroneal
A. somatic
C. Sciatic
B. sympathetic
D. Femoral
C. parasympathetic
9. move eyeball
D. autonomic
A. optic
B. oculomotor 15. Henderson states that individuals have ba-
sic needs that are component of health and
C. vagus
require assistance to achieve health and
D. olfactory independence or a peaceful death. Hen-
10. What is the central nervous system (CNS) derson believed that the nursing theory
made up of? should be centered around ?
A. brain & spinal cord A. The family

B. sensory neurons B. Patient/ Patient needs
C. motor neurons C. The health care team
D. sensory receptors D. The nurse

16. A network of spinal nerves 22. sensory nerve of the face

A. roots A. olfactory

B. plexus B. optic
C. cauda equina C. trigeminal
D. CNS D. accessory
17. The plexus that supplies nerves to the neck 23. Tactile receptors detect
A. lumbar A. Pain
B. brachial B. Pressure
C. cervical C. Temperature
D. cranial D. Touch
18. The plexus that supplies nerves to the 24. What is Maslow’s highest level of need in
arms is known as hierarchy pyramid?
A. cervical A. Safety needs
B. lumbar B. Love and belonging
C. sacral
C. Self-Actualization
D. brachial
D. Esteem and Value
19. neurons carry messages away from
25. test that measures the speed at which im-
the central nervous system.
pulses travel through a nerve
A. Motor
A. NCV
B. Inter
B. EMG
C. Sensory
C. Diagnostic Imaging
D. Flower
D. CSF
20. The part of the autonomic nervous sys-
tem is active during resting. 26. SOFT GELATIN CAPSULE of Nervup OD en-
sures ease of and Improves
A. sympathetic
A. handling and protein binding
B. parasympathetic
B. Swallowing, bioavailability
C. somatic
C. Storage, Outcome
D. peripheral
D. none of above
21. Goes numb when the dentist gives you
novocaine 27. controls lateral rectus eye muscles
A. Trigmemial A. optic
B. abducens B. oculomotor
C. vagus C. abducens
D. glossopharyngeal D. vagus

28. Chewing 34. Moves the tongue

A. optic A. Trigeminal
B. accessory B. Facial
C. abducting C. Hypoglossal
D. trigeminal D. Accessory
29. Alpha-lipoic acid in diabetic peripheral Im-
35. The part of the nervous system that con-
proves nerve conduction velocity of motor
NARAYAN CHANGDER
sists of nerves that branch out from the
fibres by
CNS (central nervous system) and connect
A. 18 % to other body parts
B. 12 % A. Sympathetic
C. 14 % B. Parasympathetic
D. none of above
C. Autonomic
30. Salivary glands, taste D. Peripheral
A. facial
36. Part of the peripheral nervous system that
B. optic controls conscious activities
C. olfactory
A. autonomic
D. accessory
B. somatic
31. Swallowing C. sympathetic
A. glossopharyngeal D. parasympathetic
B. hypoglossal
37. laboratory test in which CSF obtained from
C. trigeminal
a lumbar puncture is evaluated macroscop-
D. optic ically for clarity and color, microscopically
for cells, and chemically for proteins and
32. Choose the muscles of the Rotator cuff
other substances
A. Teres minor
A. CSF
B. Teres major
B. EMG
C. Supraspinatus
C. Neurological Exam
D. Infraspinatus
D. Diagnostic Imaging
E. Subscapularis
33. Myelinated fibers (tracts) form matter 38. Controls automatic functions like breath-
while unmyelinated fibers form mat- ing, heart rate, body temperature, wake
ter. and sleep cycles, etc.
A. sensory, motor A. cerebrum

B. gray, white B. cerebellum
C. motor, sensory C. basal ganglia
D. white, gray D. brainstem

39. Sensory-motor nerve that, with its 44. Axons of some neurons arecovered by mul-
branches, supplies the thumb side of the tilayered lipid and protein covering called-
arm and back of the hand.

A. Dendried
A. Cranial B. Myelin Sheath
B. Radial C. Axons
C. Musculocutaneous D. none of above
D. Sural 45. Which of the following is the primary con-
cern of Abdellah’s theory?
40. How come C fibers tend to get damaged
A. Disease orientation
first in diabetic neuropathy?
B. Client orientation
A. Long preganglionic
C. Medical interventions
B. Short preganglionic
D. Nursing-centered orientation
C. No myelin
46. According to Abdellah, the most appro-
D. none of above priate evaluation would be the nurse
progress or lack of progress toward the
41. The nurse’s goal is to make the patient achievement of the stated goals.
complete, whole, or independent. In turn,
the nurse collaborates with the physi- A. True
cian’s therapeutic plan. The third level of B. False
Maslow’s hierarchy of needs is what? C. Neither
A. Safety needs D. none of above
B. Love and belonging 47. neurons carry messages to the central
C. Self-Actualization nervous system
D. Esteem and Value A. Motor

B. Inter
42. nerve of the posterior lower leg C. Sensory
A. Tibial D. Fun
B. Ulnar 48. The Twenty-one Nursing PRoblems Theory
C. Sural was developed by Faye Glenn Abdellah.
The twenty One nursing problems identi-
D. Radial
fied in the nursing theory are composed
of steps used to identify the patient’s
43. Below are the special tests for carpal tun-
problems and eleven skills used in develop-
nel syndrome. Which is the most sensitive
ing a treatment typology or nursing care
test?
plan.
A. Phalen test
A. 11
B. Durkan test B. 12
C. Tinnel test C. 10
D. Flick sign D. 9

49. Nerve of the leg that supplies impulses to 54. person is asked to protrude and retract
the skin of the inner side of the leg and tongue.
foot. A. olfactory
A. Sural B. auditory
B. Peroneal C. facial
C. Brachial D. hypoglossal
D. Cranial
NARAYAN CHANGDER
55. swallowing (IX)
50. gag reflex A. hypoglossal
B. vagus
A. glossopharyngeal
C. trigeminal
B. vagus
D. glossopharyngeal
C. trigeminal
D. optic 56. anterior thigh nerve
A. Peroneal
51. Loss of vision B. Vagus
A. optic nerve C. Femoral
B. olfactory nerve D. Sciatic
C. abducting 57. trapezius and sternocleindomastoid move-
D. oculomotor ments
A. abducens
52. The “fight or flight” response during
threatening situations in the role of the: B. accessory
A. sympathetic nervous system C. glossopharyngeal

D. hypoglossal
B. parasympathetic system
C. somatic nervous system 58. Nervup OD is powered by FFS Technology,
which stands for,
D. cerebellum
A. Form fill and Secure technology.
53. The major role of the interneuron (associa- B. Form fill and seal technology.
tion neuron) is to
C. Form fix and seal technology.
A. carry information from the central ner- D. none of above
vous system to muscles and/or the vis-
cera 59. Virginia Henderson also believed that it
was important that nursing be based on
B. form a lipid-protein (lipoprotein) cell
evidence, and that research was a critical
membrane on the outside of axons
component of improving nursing practice.
C. transmit nerve impulses from the skin Using Maslow’s Hierarchy of Needs, which
and organs to the central nervous system of the following is an example of physio-
D. connect motor and sensory neurons in logical needs?
their pathways A. Worship according to one’s faith

B. Work at something providing a sense 63. Sensory-motor nerve that, with its
of accomplishment branches, affects the little-finger side of
the arm and palm of the hand.

C. Move and maintain desirable posture
A. Sciatic
D. Avoid environmental dangers
B. Sular
60. As per Study, 11.9% morepatients C. Ulnar
achieved pain reduction with Methylcobal-
amin, Pregabalin Pregabalin & ALA. D. Femoral
A. VISUAL 64. In Henderson’s definition of health, she

stated that “individuals will achieve or
B. DAPA 58 maintain health if they have the necessary
C. MAINTAIN strength, will or knowledge”. Based on
the overview of Henderson’s philosophy
D. none of above
presented in the chapter, it would be most
accurate to consider her theory as a
61. Which of the following is/are NOT in-
cluded in Abdellah’s 21 Nursing Problem A. Needs theory
Theory? B. Practice theory
A. Spirituality C. Outcome theory
B. Sensory Functions D. Middle-range theory
C. Sub-optimal activity and rest 65. The part of the nervous system that con-
D. Interrelatedness of emotions and ill- sists of nerves that branch out from the
ness CNS and connect to other body parts
A. Sympathetic
62. Henderson stressed that individual person
or client is a whole, complete and inde- B. Parasympathetic
pendent being with biological, sociological, C. Autonomic
and spiritual components. These compo- D. Peripheral
nents are operationalized in the 14 fun-
damental or basic human needs. Based 66. Part of the autonomic nervous system that
on Henderson’s theory, the following are activates in high stress emergencies
examples of psychological components ex-
A. sympathetic
cept?
B. reflexal
A. A. Learn, discover, or satisfy the cu-
riosity that leads to normal development C. parasympathetic
and health and use the available health fa- D. somatic
cilities
67. Most common neuropathy
B. B. Select suitable clothes-dress and
undress. A. Small-fibre-predominant neuropathy
C. C. Avoid dangers in the environment B. Mononeuropathy

and avoid injuring others. C. Rediculoplexopathy
D. Both B and C D. none of above

68. Nervup OD offers and Dosing B. accessory

A. Uniform and Precise C. trigeminal
B. Time controlled andsafer dosing D. oculomotor
C. Economical and Uniform
74. In diabetic neuropathy, what fibers tend
D. none of above to be damaged?
69. X-Vagus A. Delta
NARAYAN CHANGDER
A. Speech and swallowing B. Alpha
B. cranial and spinal branches C. C
C. moves eye D. none of above
D. none of above
75. Technologies that doctors use to look in-
70. Smell side your body for clues about a medical
condition; includes X-rays, CT scans, nu-
A. Olfactory
clear medicine scans, MRI scans and ultra-
B. optic sound.
C. oculomotor A. NCV
D. none of above B. Diagnostic Imaging
71. nerve extending from the base of the spine C. EMG
down the thigh, lower leg, and foot D. Neurological Exam
A. Tibial
76. The plexus that supplies nerves to the
B. Vagus pelvis and legs
C. Sciatic A. brachial
D. Radial
B. cervical
72. An 85 year old female client experienced C. lumbar
severe chest pain. In addition, she experi-
D. femoral
enced shortness of breath, tachycardia and
profuse diaphoresis. Which of the follow- 77. autonomic control of the heart, lungs, di-
ing statements pertain to the basic nursing gestion, taste, communication between
care should this client receive? brain and organs
A. Teach early signs and symptoms of car- A. vagus
diac distress
B. hypoglossal
B. Teach the appropriate course of action
in resolving the problem C. vestibulocochlear
C. Explore his work-related goals D. trigeminal
D. Elevate the head of bed 78. What are the causes for Diabetic neuropa-
thy?
73. You can test this nerve by asking the pa-
tient to crease their forehead A. exposure to high glucose
A. facial B. Long duration of diabetes.

C. Autoimmune factors, Lifestyle factors, 83. Choose the correct test to assess impinge-
damage to the blood vessels ment syndrome

D. All of Above A. Painful arch
79. Chemicals in the neuron that help send B. Telescope test

messages C. Neer test
A. dendrites D. Hawkin kennedy
B. neurotransmitters E. Drop arm
C. axon terminals
84. Which of the following is the identified lim-
D. vesicles itation of Abdellah’s 21 nursing problem
theory?
80. Which of the following is the correct order
of the nursing process? A. It’s problem solving approach
A. Assessing, Planning, Diagnosing, Eval- B. The language used by Abdellah in cre-
uating, Implementing ating the theory’s framework
B. Planning, Assessing, Implementing, C. The emphasis in providing medical at-
Diagnosing, Evaluating tention to client’s needs
C. Diagnosing, Planning, Assessing, Im- D. The very strong nurse-centered orien-
plementing, Evaluating tation
D. Assessing, Diagnosing, Planning, Im- 85. Where the message transfers from one
plementing, Evaluating neuron to another
81. Nurse Faye is done performing assessment A. myelin sheath
and is identifying a nursing diagnosis of B. Central nervous system
acute shoulder pain. which of the follow-
ing is an appropriate client-centered goal: C. Synapse
A. Encourage client to focus on positive D. Somatic Nervous Axon

thoughts when pain begins.
86. Which cranial nerve carries visual informa-
B. Assess the effect of pain intensity on tion from the eye to the brain?
client function using the pain rating scale
A. olfactory
C. Obtain an order for a PRN analgesic
B. optic
30 minutes before physical therapy treat-
ment C. oculomotor
D. Client reports a decrease of pain inten- D. accessory
sity of 4 or less during hospital stay
87. trapezius muscles are checked for strength
82. oculomotor is a test for:Cranial Nerve
A. eye and eyelid movement A. abducens
B. smell B. accessory
C. balance C. vagus
D. hearing D. auditory

88. Virginia Henderson is a nurse, theorist, 94. Shrugs the shoulders

and author known for her Need Theory. A. Accessory
She is still fondly referred to as the
B. Vestibulocochlear
A. Girl Next Door
C. Abducens
B. Lady with the Lamp
D. Trigeminal
C. Nursing Pioneer
95. A loss of hearing could be associated with
D. First Lady of Nursing
which cranial nerve?
NARAYAN CHANGDER
89. pairs of nerves that carry messages to and A. Olfactory
from the brain
B. Trigeminal
A. Sural C. Vestibulocochlear
B. Saphenous D. Accessory
C. Musculocutaneous
96. Accessory
D. Cranial
A. lifts shoulders
90. facial expression B. abducts eye
A. olfactory C. rotates eye
B. optic D. tongue control
C. facial
97. Which of the following is Virginia Hender-
D. abducting son’s definition of nursing?
91. systematic examination of the nervous A. Nursing is an art and science that is hu-
system manistic and humanitarian.
A. Diagnostic Imaging B. Nursing is a participation in care, core

and cure aspects of patient care, where
B. Neurological Exam CARE is the sole function of nurses
C. CSF C. The unique function of the nurse is to
D. EMG assist the individual, sick or well, in the
performance of those activities contribut-
92. Thermoreceptors detect ing to health or its recovery (or to peaceful
A. Pain death).
B. Pressure D. Nursing is an interpersonal, therapeu-

tic process that takes place when pro-
C. Temperature fessionals, specifically educated to be
D. Chemicals nurses, engage in therapeutic relation-
ships with people who are in need of
93. Moves eyes laterally away from the nose health services.
A. abducens
98. Part of the peripheral that controls con-
B. facial scious activities
C. trigeminal A. autonomic
D. accessory B. somatic

C. sympathetic 105. The response is known as fight or

D. parasympathetic flight.

A. parasympathetic
99. Baroreceptors detect
B. sympathetic
A. Pain
C. somatic
B. Temperature
D. peripheral
C. Pressure
106. The most important impact of Abdellah’s
D. Position of joints theory to the nursing practice is that it
helped transform the focus of the profes-
100. eye muscle and controls superior oblique
sion from being to
A. trochlear
A. disease-centered; client-centered
B. optic
B. client-centered; disease-centered
C. oculomotor
C. disease-centered; nursing-centered
D. trigeminal D. nursing-centered; client-centered
101. sensation in teeth 107. What is NOT part of the peripheral ner-
A. trigeminal vous system (PNS)?
B. hypoglossal A. axons
C. vagus B. sensory receptors
D. glossopharyngeal C. spinal cord
D. motor neurons
102. Olfactory nerve function to what
A. Sense of taste 108. abducting
B. Sense of Touch A. abducts arm
C. Sense of smell B. elevates shoulders

C. moves eye away from nose
D. Sense of pain
D. constricts the pupil
103. Balance
109. hearing and balance
A. vestibulocochlear
A. read through
B. olfactory
B. vestibulocochlear
C. vagus
C. trigeminal
D. cranial nerve III
D. accessory
104. organs
110. The nursing process is an evidence-based,
A. accessory five-step scientific method used to ensure
B. hypoglossal that the patient is assessed, diagnosed
and receives continuity of care across ap-
C. vagus propriate healthcare providers and depart-
D. olfactory ments. Once a nurse assesses a client’s

3.8 Mononeuropathies 328
condition and identifies appropriate nurs- assessmen

ing diagnoses, a
111. Slows the heart rate
A. Nurses develop a plan of care
A. Glossopharyngeal
B. Nurses begin physical assessments B. Vagus
C. Determining list of priorities. C. Accessory
D. Team members conducts a review of D. Hypoglossal
NARAYAN CHANGDER
3.8 Mononeuropathies
1. About ALS A. Burning sensation
A. it affects only the striated muscles B. Cold feeling on the soles of the feet
B. it comes in 2 forms:bulbar and spinal C. Feeling like electric shock / electrocu-
tion
C. there is amyotrophy, fasciculations
and motor deficit D. The lower limbs cannot be moved
D. ROTs are abolished 5. Lateral curvature of the spine with an in-
E. riluzole is the only ET having proven its crease in convexity on the side that is
effectiveness on survival curved is called
A. Kyphosis
2. Why is Methycobal different from other vi-
tamins B12: B. Lordosis
A. Methycobal is vitamin B12 that con- C. Scoliosis

tains CH3 D. Spondylitis
B. Methycobal is a new and very effective 6. axonopathy is NOT
vitamin B12
A. irreversible in CNS
C. Methycobal is vitamin B12 which can
B. degeneration of axon
be used anytime
C. resulted in mental deterioration
D. Methycobal is a fast-acting vitamin
B12 D. none of above
3. The substance / group needed to convert 7. which is TRUE regarding meylinopathy?

Homocysteine into Methionine (this group A. degeneration of schwann cells
is provided by Methycobal) is B. may develop sensory disturbance
A. Gugus Methyl C. can lead to cell death
B. Gugus Hidroxyl D. able to interrupt impulse transmission
C. Phenol group
8. About multiple mononeuropathies
D. Carbonyl Glucose
A. they correspond to truncal damage to
4. The following sensations are felt from the peripheral nerves
Painful Diabetic Neuropathy (PDN), B. can be caused by diseases of the sys-
except tem

C. can be caused by leprosy 13. What are small sacs filled with synovial
fluid that serve to cushion the joint?
D. can be caused by the plague

A. Ganglion
E. motor neuropathy with persistent con-
duction blocks (NMMBC) is a differential B. Bursae
diagnosis of ALS C. Boutonniere
D. Corn
9. Les polyneuropathies axonales
A. they are length-dependent 14. Why is lecithin important?
A. Lecithin is the raw material for the
B. nerve root damage
myelin sheath
C. rather symmetrical, distal, “sock-like”
B. Lecithin is a substance to repair nerve
involvement
cells
D. diabetes, alcohol and toxic are the C. Lecithin is a substance that produces
main etiologies nucleic acids
E. they are complicated by ataxia D. Lecithin is a substance as a raw mate-
rial for protein
10. Methycobal increases conductivity velocity
in diabetic patients with peripheral neu- 15. This test is commonly used to diagnose
ropathy. This is the result of research sleep disorders
from? A. Electroencephalogram
A. Lee Gee, 1999 B. Evoked potential test
B. Carasco, 2011 C. Electromyogram
C. Winblad, 2006 D. Nerve Conduction test
D. D Love-And, 2005 16. These tests do not require sensors on the
scalp, they requre sensors on other parts
11. Myopathies and mostly diagnosed via .. of the skin, e.g. limbs
A. Electroencephalogram (EEG) A. Electroencephalogram and Elec-
B. Electromyogram (EMG) tromyogram (EEG and EMG)
B. Nerve conduction velocity and Elec-
C. Nerve conduction velocity (NCV)
tromyogram (NCS and EMG)
D. none of above
C. Evoked potentials and Nerve conduc-
tion studies (EP and NCS)
12. Methycobal is effective in reducing symp-
toms of diabetic neuropathy such as numb- D. none of above
ness, heat, chills, spontaneous pain, and
17. A nontender, round, enlarged, swollen,
hypoesthesia. This is the result of re-
fluid-filled cyst seen on the wrist is known
search from?
as a(n)
A. Lee-Gee 1999 A. ganglion
B. Carasco 2011 B. bursae
C. Winland, 2006 C. osteoblast
D. D Love-And, 2005 D. callus

18. Best describes neuropathy. D. lengthening of latencies

A. reversible process E. motor conduction blocks
B. necrosis to the cells 23. Why Methycobal can repair nerve cells:
C. cells still can transmit information A. Methycobal provides its methyl group
D. did not induce Parkinson to convert lecithin to cepalin
B. Methycobal provides its methyl group
19. This test is used mainly to diagnose to convert homocysteine into cepalin
NARAYAN CHANGDER
epilepsy
C. Methycobal donates its methyl group
A. Electroencephalogram to convert methionine to lecithin
B. Evoked potential D. Mthycobal provides its methyl group to
C. Electromyogram convert cephalin to lecithin
D. Nerve conduction 24. These tests can be used together to diag-
nose peripheral neuropathy
20. A risk factor of CVA includes:
A. Electroencephalogram and Elec-
A. Low body mass tromyogram (EEG and EMG)
B. poor nutrition intake of low protein B. Nerve conduction velocity and Elec-
C. eating disorder tromyogram (NCV and EMG)
D. hypertension C. Evoked potentials and Nerve conduc-

tion velocity (EP and NCV)
21. If the nurse finds that the client’s thought D. none of above
processes are distorted and memory is
impaired, then the nurse should consider 25. A risk factor of osteoporosis includes
which of the following? A. elevated blood pressure
A. proceed with the gathering of subjec- B. low calcium intake
tive data and compare findings to the last C. depression
assessment.
D. bleeding disorders
B. skip the assessment for that day and
wait until the client’s condition has im- 26. The nurse finds that the client is unable to
proved. correctly identify familiar objects placed in
their hand with eyes closed. The condition
C. use another means of obtaing neces- indicated is:
sary objective data because the validityof
the information provided by the cliet is in A. Graphesthesia
question. B. Localization
D. do not complete the physical assess- C. Asterognosis
ment at this time. The data will not be D. Neuropathy
valid.
27. Normal levels in the blood are:
22. Demyelinating damage to ENMG A. 5-15 µ mol/L
A. normal speeds B. > 5 µ mol/L
B. decreased speeds C. 5-10 µ mol/L
C. dispersion of action potentials D. < 5 µ mol/L

3.9 Motor Neurone Disease 331
28. Which is FALSE on neurotransmission C. Electromyogram and Nerve conduc-

anomality? tion studies (EMG and NCS)

A. interruption of transmission D. none of above
B. inhibit neurotransmitter uptake
31. Mecobalamin is a substance that can’t
C. block the communication stand exposure to light. What solution did
D. caused by OP Eisai give to overcome it?
29. Characteristics of Peripheral Diabetic Neu- A. By using blister packs

ropathy (PDN), except: B. By using LPE (Light-Protect-Easy
A. Pain increases during the day Open)
B. numbness, tingling, pain increasing to C. By using a brown vial
the touch (hyperesthesia), burning, elec- D. By using chocolate capsules
tric shock, stabbing with paraesthesia,
deep pain 32. A “neuro check” includes all but the fol-
C. Pain occurs in the feet and lower legs lowing:
D. Pain is chronic and progressive A. Level of consciousness

B. pupillary checks
30. These tests require sensors on the scalp
C. movemement and strength of extremi-
A. Electroencephalogram and Evoked Po-
ties
tentials test (EEG and EP)
B. Electromyogram and Evoked poten- D. patellar reflex
tials test (EMG and EP) E. vital signs
3.9 Motor Neurone Disease

1. The chemoreceptors that detect the need A. There is an increase in concentration
to increase the heart rate are found in of sodium ions inside the neurone.
which artery?
B. The neurone membranes become po-
A. Renal larised.
B. Pulmonary
C. The Pacinian corpuscle membrane be-
C. Coronary comes more permeable to sodium ions.
D. Carotid D. The stretch-mediated sodium channels
2. What treatments are available? narrow.
A. Therapy
4. Who does Motor Neuron Disease effect
B. Palliative Care the most?
C. There is no cure A. Female
D. Physiotherapy
B. Male
3. If pressure is applied to the skin, what re-
C. Adults
sponse is generated in thePacinian corpus-
cles? D. Children

3.10 Multiple Sclerosis 332
5. The sympathetic nerve of an athlete be- A. They will not be able to feel pain.
comes damaged. What would be a result B. They may have difficulty gripping a pen-
of this during strenuous exercise? cil.
A. An increase in carbon dioxide concen- C. Speed of impulse along the sensory
tration of the blood. neurone is reduced.
B. An increase in pH of the blood. D. Fewer impulses are received by their
C. An increase in impulses received by central nervous system (CNS).
NARAYAN CHANGDER
the sinoatrial node.
7. If a patient has a heart rate of 120bpm
D. An increase in heart rate. and a cardiac output of 6.6dm3min1, cal-
6. Motor neurone disease is characterised culate their stroke volume.
by progressive damage to the motor neu- A. 0.055 dm3
rones. Using your knowledge of the re- B. 18
flex arc, which statement is likely to be
true about people suffering from motor C. 0.055 cm3
neurone disease? D. 18 dm3
3.10 Multiple Sclerosis

1. Which is a risk factor for MS? D. Vision problems
A. elderly age
5. Which of the following is the most helpful
B. lack of vitamin D study in the clinical investigation of MS?
C. seasonal allergies A. MRI
D. cancer
B. Radiography
2. What is the most common type of MS? C. Visual evoked potentials
A. Secondary progressive MS D. Lumbar puncture
B. Relapsing remitting MS
6. What kind of disease is multiple sclero-
C. Primary progressive MS
sis?
D. Benign
A. Infectious
3. What helps the body to weaken? B. Viral
A. lack of defenses
C. Autoimmune
B. lack of vitamins
D. Blood
C. the lack of proteins
D. lack of antibodies 7. what are the consequences of multiple scle-
rosis?
4. Which is NOT a s/s of MS?
A. Headache, Memory Loss, Loss of
A. Walking difficulties Strength, Immobility
B. Numbness B. affects mobility, coordination, vision
C. Nausea and communication of the body

3.10 Multiple Sclerosis 333
C. Memory Loss, Stomach Pain, Nervous 13. The clear cause of MS remains unknown,
System Damage though may be important factors.

D. Deterioration of the Lungs, Lack of Oxy- A. Ethnicity, diet, and antibiotic resis-
gen, Memory Loss tance
B. Height, blood pressure, and birth or-
8. Multiple sclerosis is a disease of the der
system and develops in the system.
C. Sleep hygiene, emotional health, child-
A. Nervous, Respiratory hood habits
B. Respiratory, Immune D. Environment, viruses, and genetics
C. Nervous, immune 14. Some people with multiple sclerosis
D. Immune, Respiratory may lose the ability to without help,
others may experience long periods of re-
9. What cures MS? mission without new symptoms appear-
ing.
A. Radiation treatment
A. Severe, Walk
B. Ibuprofen B. Mild, Talk
C. Anti-inflammatory medicine C. Severe, Talk
D. There is no cure D. Mild, Walk
10. What type of sickness is MS? 15. Select the TRUE statements about the
pathophysiology of multiple sclerosis
A. virus
A. Plaques of demyelination, dissemi-
B. autoimmune disease nated in time and space, interfere with
C. bacterial infection neuronal transmission
B. The dendrites on the neuron are over-
D. spinal injury
stimulated leading to the destruction of
the axon.
11. MS affects central nervous system (CNS).
Which part of the CNS is affected C. The dopaminergic neurons in the part
of the brain called substantia nigra have
A. Nerve cell(neurons) started to die.
B. Myelin D. none of above
C. Plaques 16. You’re developing a plan of care for a pa-
D. Vertebrae tient with multiple sclerosis who presents
with Uhthoff’s Sign. What interventions
12. This disease commonly affects people will you include in the patient’s plan of
with: care?
A. <17 A. Avoid movements of the head and neck
downward
B. 18-34
B. Keep room temperature cool
C. 45-54
C. Encourage patient to use warm packs
D. 60> and heating pads for symptoms

3.11 lateral Sclerosis 334
D. none of above C. Body attacks axon
17. Can you die from MS? D. Body attacks myelin sheath
A. Everyone who has MS dies from it 20. Multiple Sclerosis is

B. Yes, but only from complications of MS A. A progressive autoimmune condition
C. No in which the neurons of the central ner-
vous system demyelinate
D. none of above
B. Immune system attacks the joints
NARAYAN CHANGDER
18. Criteria used in the diagnosis of MS C. When the immune system attacks
A. Jones blood vessels
B. Duke D. none of above
C. McDonald 21. Which is NOT a Dx of MS?
D. none of above A. CT scan
19. What is the etiology? B. Spinal fluid analysis
A. CSF doesn’t protect spinal cord C. CBC
B. Dendrites are attacked by the body D. MRI
3.11 lateral Sclerosis

1. What is a common name for ALS 4. How many World Series did Lou Gehing
win
A. Lou Gehings disease
A. 0
B. multiple sclerosis
B. 6
C. william Johnson
C. 4
D. none of above
D. 5
2. What type of disease is ALS
5. What medication can help ALS
A. A motor neuron disease
A. Penicillin
B. A sensory neuron disease
B. Advil
C. A muscle disease
C. Riluzole
D. A affront neuron disease D. none of above
3. How many people are diagnosed with ALS 6. What is one test to help rule out other neu-
daily rological diseases
A. 55 A. MRI
B. 18 B. EEG
C. 15 C. PET
D. 7 D. VEP

3.12 Spastic Paraparesis 335
7. How much money has the ALS association B. 100, 000, 000
Donated toward the disease? C. 56 millian

A. 100, 000 D. 67 million
3.12 Spastic Paraparesis

1. CSF is secreted by the choroid plexus. It 5. Occlusion of the MCA results in which man-
flows from the lateral ventricles into the ifestation(s)?
3rd ventricle through what opening? A. Spastic paresis of the contralateral
A. Cerebral aqueduct lower face and upper limb
B. Foramen of Monro B. Anesthesia of the ipsilateral face and
upper limb [contralateral]
C. Foramen of Luschka
C. Paresis of the contralateral lower limb
D. Foramen of Magendie [occlusion of ACA]
D. All of the above
2. Which among these is a protein that be-
longs to a class of motor proteins which 6. Which of the secondary vesicles and its
supports several cellular functions includ- adult derivatives are correctly paired?
ing mitosis, meiosis, anterograde axonal
A. Diencephalon-Pons
transport?
B. Metencephalon-Midbrain
A. Dynein
C. Myelencephalon-Medulla
B. Dystrophin
D. Telencephalon-Spinal Cord
C. Kinesin
7. This area is involved in organizing and
D. Tubulin planning the intellectual and emotional as-
pects of behavior
3. In the choroid plexus, water from capillar-
ies is transported directly into the CSF by A. Prefrontal cortex
what structure? B. Primary somatosensory cortex
A. Astrocytes C. Premotor cortex
B. Ependyma D. Somatosensory cortex
C. Microglial cells 8. Which Brodmann areas are affected in pa-

tients with expressive aphasia?
D. Lining of the central canal
A. BA 39, 40
4. In what lobe is the primary auditory cor- B. BA 21, 24
tex located?
C. BA 1, 3
A. Frontal lobe D. BA 44, 45
B. Parietal lobe
9. From which of these primary brain vesicles
C. Temporal lobe will the adult cerebrum form?
D. Occipital lobe A. Diencephalon

3.13 Visual Field Defects 336
B. Mesencephalon A. Agraphiaxia
C. Metencephalon B. Alexia w/o Agraphia
D. Telencephalon C. Conduction Aphasia
10. The caudal end closes on what day? D. Visual agnosia
A. Day 25
13. Lesions to the corpus callosum caused by
B. Day 26
an infarct of the anterior cerebral artery
C. Day 27
NARAYAN CHANGDER
may result in another type of disconnect
D. Day 28 syndrome known as:
11. A type of spina bifida wherein both the A. Conduction Aphasia
meninges and spinal cord protrude through B. Asomatognosia
vertebral defect and is seen with Arnold-
Chiari Type II. C. Transcortical Aphasia
A. Spina bifida occulta D. Receptive Aphasia
B. b. Spina bifida with meningocele 14. Which sulcus in the lateral surface of the
C. Spina bifida with myeloschisis cerebral cortex separates the frontal and
D. Spina bifida with meningomyelocele temporal lobe rostrally?
12. A principal “higher-order” deficit associ- A. Lateral fissure of Sylvius

ated with occipital lobe damage. The pa- B. Central sulcus of Rolando
tients are unable to read at all and, curi-
C. Lateral cingulate sulcus
ously, often have a color anomia, but able
to write. D. Fronto-Temporal sulcus
3.13 Visual Field Defects

1. How eyes adjust in order to focus the im- C. 0.66 m
age of near or distant objects on retina? D. 1 m
A. The lens moves in or out according to
the position of the object 3. The disability of the eye to form distinct
images of nearby objects on its retina at a
B. The retina moves in or out according
young age is known as
to the position of the object
A. nearsightedness
C. The lens becomes thicker or thinner
according to the position of the object B. farsightedness
D. The pupil gets larger or smaller accord- C. presbyopia
ing to the position of the object D. stress
2. A person uses a lens of power + 3 D to 4. A got his eye tested. The optician’s pre-
normalize vision. Near point of hyperme- scription for the spectacles was:Left eye:-
tropic eye is 3 DRight eye:-3.50 DThe person is having
A. 1.66 m a defect of vision called:
B. 0.33 m A. Presbyopia

3.13 Visual Field Defects 337
B. Myopia B. The near point of his eyes has come

closer to him.
C. Astigmatism

C. The far point of his eyes has receded
D. Hypermetropia
away.
5. A near sighted person wears eye glass of D. The far point of his eyes has come
power 5.5 D for distant vision. His doc- closer to him.
tor prescribes a correction of +1D in near
vision part of his bi-focals, which is mea- 7. With both eyes open, a person’s field of
sured relative to the main part of the lens. view is about:
Then, the focal length of his near vision A. 90o
part of the lens is B. 150o
A. -18.18 cm C. 180o
B. -20 cm D. 360o
C. +20.22 cm 8. Having two eyes facilitates in:A:Increasing
D. -22.22 cm the field of viewB:Bringing three dimen-
sional viewC:Developing the concept of
6. A man finds it difficult to read the odome- distance/size.Then the correct option
ter on the dashboard of the car but is able is/are:
to clearly read a distant road sign. Which A. A only
of the following statement is correct about
this man? B. A and B only
A. The near point of his eyes has receded C. B only

away. D. A, B and C

4. Cardiology
NARAYAN CHANGDER
4.1 Aortic Stenosis
1. What is medication will require life-long B. mammals and reptiles
of aortic dissection to manage blood pres- C. amphibians and reptiles
sure?
D. birds and amphibians
A. ACEI
B. Beta blockers 5. In Labeo there are pairs of aortic
arches.
C. ARB
A. 3
D. Calcium channel blocker
B. 4
2. In Aves systemic arch forms median C. 5
dorsal aorta.
D. 6
A. right
6. from the separation of the aortic wall may
B. left
cause
C. both right and left
A. Aortic stenosis
D. none of these
B. Aortic Regurgitation
3. What conditions can aortic aneurysms C. Tricuspid Regurgitation
cause?
D. Mitral Regurgitation
A. Stridor
7. In Scoliodon the first pair of aortic arch
B. Hoarseness
(the mandibular) disappears, hence there
C. Dysphagia are only pairs of aortic arches.
D. All of the above A. 3
4. Two systemic arches join together and B. 4
form dorsal aorta in C. 6
A. birds and mammals D. 5

4.2 Aortic Regurgitation 339
8. The role of nurses in caring for aortic dis- 11. The Vertebrate animal has a maximum
section patients pairs of aortic arches.

A. Control Blood pressure A. 4
B. Control Pain B. 5
C. Obs. Sign of shock C. 6
D. All of the above D. 7
9. In reptiles, birds and mammals the aor- 12. The connection between third and fourth
tic arch becomes the carotid artery. aortic arches is known as
A. first A. ductus caroticus
B. second B. ductus arteriosus
C. third C. ductus botalli
D. fourth D. pulmonary
10. In mammals systemic arch forms me- 13. Connection between sixth aortic and dor-
dian dorsal aorta. sal aorta is called
A. right A. ductus caroticus
B. left B. ductus arteriosus
C. both right and left C. ductus botalli
D. none of these D. pulmonary
4.2 Aortic Regurgitation

1. Stridor is indicative of what? C. Bronchial breath sounds plus crackles,
A. Smaller airway narrowing increased percussion resonance.
B. High extra thoracic obstruction D. Vesicular breath sounds, normal per-
C. Infection cussion resonance.
D. Inflamed and roughened pleura
3. Power is graded on what scale?
2. What would you hear listening to a chest
if there was consolidation present? A. 0-5
A. Bronchial breath sounds plus crackles, B. 1-5
reduced/dull percussion resonance.
C. 0 to ++++
B. Vesicular breath sounds, reduced/dull
percussion resonance. D. Weak to strong
4.3 Eisenmenger’ s Syndrome

4.3 Eisenmenger’ s Syndrome 340
1. A 2yo boy is transported to the ER after he E. If aneurysms are small, aspirin ther-
was found unresponsive and “choking on apy can be stopped at 8 weeks
his vomit” in his father’s workshop. On
PE he is difficult to arouse and appears 4. day old newborn boy. Grade 2/6 medium-
confused and disoriented. During evalua- pitched systolic ejection murmur, best
tion for presumed accidental toxic inges- heard at L upper sternal border. Mur-
tion, calcium oxalate crystals are identi- mur radiates to the back and axillae.Most
fied in his urine.Which of the following sub- likely etiology?
stances did he most likely ingest?
NARAYAN CHANGDER
A. Venous hum
A. Salicylate B. Peripheral pulmonary stenosis
B. Ethylene glycol C. Vibratory (Still’s) murmur
C. Digoxin
D. Pulmonary flow murmur
D. Imipramine
E. VSD
2. week-old FT newborn. SOB with feeds.
5. hour old M. Cyanotic. RR 88
Mom had no prenatal care. Physical ex-
breaths/minute . Parasternal heave on
amination is remarkable for a blood pres-
cardiac physical exam. Single loud S2.
sure of 100/60 mmHg in the right arm,
Soft systolic ejection murmur at the mid-
redundant skin overlying the posterior
left sternal border. Echo:pulmonary artery
neck, and edema of the lower extremi-
arises posteriorly from the left ventricle.
ties. MURMUR:Gallop rhythm and a re-
Aorta arises anteriorly from the right ven-
gurgitant murmur at the mid-precordium.
tricle. Which of the following best de-
Femoral pulses are diminished. Subcostal
scribes expected findings on a radiograph
retractions. Rales on auscultation of the
of the chest in patients with this disor-
lungs. MOST appropriate next step in the
der?
evaluation of this infant is:
A. Decreased vascular markings with a
A. Blood Chromosomal analysis
boot-shaped heart
B. Chest Radiograph
B. Narrow mediastinum associated with
C. Complete metabolic profile mild cardiomegaly
D. 12 lead EKG C. Normal heart size with decreased vas-
cular markings
3. Which of the following is correct regarding
coronary artery pathology in a child with D. none of above
KAWASAKI?
6. A 12-year-old boy presents to the clinic
A. Child less than 1 yo have decreased for a preparticipation sports exam. He is
risk of coronary aneurysm currently asymptomatic and his past his-
B. Majority of small coronary aneurysms tory and family history are both unremark-
regress back to normal coronary vessels able. His review of systems evaluation is
noncontributory. Which of the following
C. Immunoglobulins must be given within
findings on physical examination would be
first 20 days of fever
of greatest concern for a potential car-
D. Approx. 20% of untreated kids will de- diac complications during athletic participa-
velop coronary aneurysms tion?

A. A resting heart rate of 56 beats per D. A harsh holosystolic murmur heard

minute best at the left lower sternal border,
which decreases during assumption of the

B. Sinus arrhythmia noted on ausculta-
tion erect position
C. A prominent laterally displaced PMI E. A harsh crescendo-decrescendo sys-
tolic murmur heart best at the apex and
D. A vibratory murmur intensified with ex- lower left sternal border, increases in in-
ercise tensity with the Valsalva maneuver
E. A lower right arm BP than that ob-
tained in the leg 9. Hi Dr. Zonana, this is Mrs. Girgis. My
son Stephen had his ASD closed 10 months
7. week old F. Murmur noted at 48 hours of ago. His echo said “residual L→R shunt-
age. Which of the following describes the ing across device.” He has cavities and his
MOST COMMON CONGENITAL HEART LE- dentist is asking if he’ll need antibiotics be-
SION? fore he fills them.
A. Harsh holosystolic murmur best heard A. Does not require prophylaxis to pre-
at the L lower sternal border vent subacute bacterial endocarditis
B. Loud systolic ejection murmur in the L (SBE)
upper sternal border, a/w RVH on EKG B. Requires prophylaxis because of the
C. Machine-like continuous murmur residual shunt
heard throughout systole and diastole C. Requires SBE prophylaxis because of
D. none of above the type of dental procedure being per-
formed
8. Following the sudden death of his twin
brother during high school football prac- D. Requires SBE prophylaxis because she
tice, a 16-year-old boys is evaluated with underwent device closure of the atrial sep-
an echocardiogram. Results include evi- tal defect
dence of asymmetric left ventricular and E. Requires SBE prophylaxis only during
septal hypertrophy associated with ante- the 12 months after closure of the defect
rior motion of the anterior leaflet of the
mitral valve. Which of the following best 10. month-old male. History of moderate-size
describes findings on cardiac auscultation ventricular septal defect. Feeding poorly
in this patient for the last few days. During feedings
the infant coughs and SOB. Mild subcostal
A. A harsh early systolic murmur asso- retractions. Fine bilateral crackles. Pre-
ciated with a prominent systolic ejection cordium active. Grade 3/6 holosystolic
click, which is most evident while the pa- murmur, maximal at lower left sternal
tient is squatting border. Liver palpable 3 cm below right
B. A harsh holosystolic murmur heard costal margin.The medication MOST likely
best at the apex and lower left sternal bor- to provide significant clinical improvement
der associated with a prominent ejection is oral:
click A. Captopril
C. A harsh holosystolic murmur associ- B. Carvedilol
ated with an early decrescendo diastolic
murmur heard best along the mid-lower C. Digoxin
right sternal border D. Furosemide

E. Spironolactone B. Systolic ejection murmur in the region

of the R ventricular outflow tract and a
11. Infant in the newborn nursery 3 days after fixed split S2
birth. Failed the congenital heart disease
screening testing performed 3 days after C. Apical systolic murmur a/w a midsys-
birth. Examination reveals a soft 1/6 systolic click
tolic murmur at the left lower sternal bor- D. Low-pitched harsh systolic murmur
der, clear lungs, and weak femoral pulses best heard at the mid-to-lower Left ster-
bilaterally, and a capillary refill of 4 to 5 nal border
NARAYAN CHANGDER
seconds in the lower extremities. Arterial
blood gas includes a pH of 7.25, Pco2 of 14. A 14 year old boy presents to the emer-
39 mm Hg, Po2 of 45 mm Hg, bicarbon- gency department after injuring his right
ate of 17 mEq/L (17 mmol/L), and base arm during football practice. A plain ra-
deficit of-9.Next step: diogram of the right forearm is consistent
A. Infuse Sodium Bicarbonate with a type IV Salter Harris fracture of
the distal radius. Which of the following
B. Initiate prostaglandin E1 best describes a Salter-Harris type IV frac-
C. Place and endotracheal tube ture?
D. Provide 40% hood oxygen A. A fracture through the physis and adja-
E. Start Dopamine cent epiphysis
B. A fracture through the physis and ad-
12. year-old girl is brought to the hospital jacent metaphysis
after falling backwards into a campfire
pit. She has been intubated and se- C. A crush injury
dated in anticipation of painful dressing D. A fracture through the physis, adjacent
changes. Her weight is 20 kg. Her vi- metaphysis and epiphysis
tal signs include a temperature of 37◦ C,
pulse of 120 beats/min, respiratory rate 15. You walk into a mother’s room to perform
of 20 breaths/min, and blood pressure of a newborn discharge examination at 72
90/50 mm Hg. The girl has second degree hours after birth to find a mottled infant
burns involving her neck, posterior trunk, with cool extremities. The term newborn
and buttocks. There are no other exter- is appropriate for gestational age and was
nal signs of trauma.Calculate approximate born by scheduled repeat cesarean section
BSA % affected following an unremarkable pregnancy. Vi-
A. 9% tals signs include a temperature of 36.6◦ C,
heart rate of 180 beats/min, respiratory
B. 20% rate of 74 breaths/min, blood pressure of
C. 35% 50/35 mm Hg (mean blood pressure, 38
D. 50% mm Hg), and oxygen saturation of 90%
on room air. The examination is notable
13. yo girl with anorexia nervosa. HR 52 for diffuse mottling, a capillary refill of 5
bpm. BP 95/60.Which of the following to 6 seconds, tachycardia with a single S2
is most likely to be identified during addi- and no murmur, liver down 2 centimeters
tional evaluation? below the right costal margin, and weak
pulses.
A. Continuous murmur heard in the L
infra-clavicular area A. Cardiac Tamponade

B. Cardiomyopathy 18. A 4 year old boy is transported to the

ED after a preschool field trip to the farm.
C. Hypoplastic left heart syndrome
Emergency services personnel report that

D. Myocardial infarction the patient has respiratory distress, BP is
E. Supraventricular tachycardia 88/40, HR 48 bpm. He is drooling, tear-
ing and appears confused and frightened.
16. A 3-year-old boy is brought to the emer- Which of the following is expected to be
gency department 30 minutes after ingest- the most effective in his treatment?
ing one of his grandmother’s medications. A. Activated charcoal
The boy’s mother reports that the grand-
B. Atropine
mother takes medications for depression
and hypertension. During the first hour C. Lidocaine
of being monitored in the ED, the boy be- D. Epinephrine
comes increasingly lethargic and develops
mydriasis and a dry mouth. You notice E. Gastric lavage
on the cardiopulmonary monitor that his
19. yo F, lacrosse player. 2 months of chest
heart rate is 130 beats/min and he now
pain during activity. Episodes of pain
appears to have a prolonged QRS duration.
last 3-5 minutes and have been associated
An electrocardiogram demonstrates a QRS
with palpitations and pre-syncope. MUR-
duration of 110 milliseconds, right axis de-
MUR:Soft 2/6 systolic ejection murmur at
viation, and prolonged PR and QT intervals
lower left sternal border. Normal EKG. Of
MOST likely medication ingested by the pa-
the following, the MOST appropriate next
tient is
step in evaluation of this teenager is to:
A. amitriptyline
A. Order magnetic resonance imaging of
B. clonidine the brain with contrast
C. fluoxetine B. Order serum C-reactive protein and
white blood cell count with differential
D. labetalol
C. Order tilt-table testing
E. nicardipine
D. Reassure her and her family that are
17. Following evaluation of a 6 year old girl no further testing is needed
with multiple systemic complaints, a di- E. Restrict her from exercise pending
agnosis of acute rheumatic fever is made evaluation by a cardiologist
based upon both clinical findings and doc-
umentation of an elevated streptococcal 20. Irritable and febrile 3 yo M. Morbilliform
antibody titer. Which of the following is rash. Bulbar conjunctival injection. Found
considered a major manifestation of acute to have a L coronary aneurysm. Which of
rheumatic fever? the following is most likely to be identified
A. Fever during additional evaluation:
A. Multiple dilated loops of large bowel
B. Chorea
with bubbly linear gas collections in the
C. Elevated ESR bowel wall
D. Arthralgia B. Dilation of the aortic root
E. Prolonged PR interval on ECG C. Renal artery thrombosis

D. Intramural duodenal hematoma son home. BEST next step in managing this
patient is:
E. Acute distension of the gallbladder
A. administration of activated charcoal at
21. You are taking weekend telephone calls 1 g/kg
for your practice when the father of a B. perform gastric lavage to remove in-
12-year-old boy calls to let you know gested pill fragments from the stomach
he is driving his son to the local hospi-
tal. The boy was working in the family C. discharge the boy after educating his
NARAYAN CHANGDER
garage when he drank an unknown sub- mother about signs and symptoms to ob-
stance out of a plastic bottle that he mis- serve for at home
takenly thought contained water. Since D. observe the boy in the emergency de-
swallowing some of the substance, the partment for development of symptoms
boy has complained of severe throat pain, over the next 6 hours
burning pain in his chest, difficulty swal-
lowing, and nausea. The father tells you 23. A 10-year-old boy comes to your office
that his son is drooling and that he can see for an initial visit. He has been in fos-
a few white “sores” on his tongue and ter care for several years, but is reunited
the roof of his mouth.Of the following, the with his mother. He had heart surgery
MOST likely substance to cause the boy’s at 2 years of age, but the patient does
symptoms and physical findings is: not have any records from that procedure.
As far as his mother knows, he has never
A. antifreeze (ethylene glycol)
been hospitalized for respiratory illnesses
B. furniture polish (hydrocarbon) such as asthma or pneumonia. He does not
take any medications. He has decreased
C. insecticide (organophosphate)
exercise tolerance. On PE, he is a slen-
D. toilet bowl cleaner (sodium hydroxide) der boy is no acute distress. His weight
is at the 10th percentile for his age, and
E. weed killer (glycophosphate)
height is at the 50th percentile. His heart
22. year-old boy is brought to ED. 30 minutes rate is 100 bpm and respiratory rate is
ago, his mother discovered him eating pills 28 breaths/min. Oxygen saturation on
from a pillbox at his grandparents’ house room air is 89%. His blood pressure is
and called 911. The boy’s mother states 96/65 mmHg in the right arm, and his
that the pillbox contained a 1-week sup- blood pressure is 115/90 mmHg in the
ply of his grandparents’ daily medications. right leg. His neck veins are not distended.
She did not count how many tablets re- His chest shows clear and equal breath
mained in the box before the ambulance ar- sounds. There is a well-healed sternotomy
rived, but she states, “I think only a couple scar. His heart examination shows a nor-
were missing.” Both grandparents take mal S1 with a very loud P2 component to
“blood pressure medicine” and that the S2. There is a 2/6 soft systolic murmur
grandfather takes “a pill for his nerves.” at the right midsternal border that does
The boy is well-appearing and playful. His not radiate to either axilla. There is no
vital signs are normal for his age, and you organomegaly on abdominal examination.
note no abnormalities on physical exami- The femoral pulses are 2+. His Hg level is
nation. The mother states that she now 17 g/dL. Diagnosis:
feels “silly for panicking over nothing.” A. Coarctation of the aorta with poor sys-
She asks you how soon she can take her temic circulation

4.4 Hypertrophic Cardiomyopathy 345
B. Large residual ventricular septal de- due to a suspected drug overdose. Upon
fect with pulmonary over circulation arrival, he is disoriented with a temper-
C. Moderate-sized patent duct arteriosus ature of 104.8 F.Which of the following

with left to right shunt is most often associated with hyperther-
mia?
D. Pulmonary hypertension with Eisen-
menger syndrome A. Cocaine
E. Pulmonic stenosis with decreased pul- B. Marijuana
monary blood flow C. Amphetamines
24. A 17 year old boy is transported to the ED D. MDMA
4.4 Hypertrophic Cardiomyopathy

1. What is the main difference between “bro- C. Ballooning of right atrium
ken heart syndrome” and a heart attack? D. Ballooning of left atrium
A. A heart attack can be fatal
5. What percentage of people die from Takot-
B. There is no major blockage of the coro- subo cardiomyopathy?
nary arteries
A. 0%
C. Cardiac biomarkers elevate then re-
B. 5%
turn to normal in broken heart syndrome
C. 10%
D. Broken heart syndrome occur due to
stress D. 20%
2. All of the following assist in the diagnosis 6. What is Takotsubo cardiomyopathy named
of Takotsubo cardiomyopathy, EXCEPT: after?
A. CT scan A. A frightful event
B. Cardiac angiography B. A rise in emotions
C. EKG C. An octopus trap
D. MRI D. A vase
3. Who is most at risk for Takotsubo car- 7. Which is NOT a treatment for cardiomy-
diomyopathy? opathy
A. Digoxin
A. 35-year-old male who smokes
B. Blood-thinning medication
B. 42-year-old female with diabetes
C. Surgery for the heart muscle
C. 66-year-old post-menopausal female
D. Beta Blockers
D. 72-year-old male who lives a happy life
8. Which is NOT a type of cardiomyopathy?
4. What is the important feature in an
echocardiogram of Takotsubo cardiomy- A. Hypertrophic Cardiomyopathy
opathy? B. Restrictive Cardiomyopathy
A. Ballooning of right ventricle C. Ventricular Cardiomyopathy
B. Ballooning of left ventricle D. Dilated Cardiomyopathy

4.5 Mitral Stenosis 346
9. Which part of the heart is affected by car- B. Chest discomfort, rapid heartbeats,
diomyopathy? and fatigue
A. The Myocardium C. Bloating, dizziness, and nausea
B. The Arteries D. Rapid heart beats, fever, and nausea
C. The Ventricles 11. What are the signs and symptoms of

Takotsubo cardiomyopathy?
D. The Auricles
A. Chest pain
NARAYAN CHANGDER
10. What are the common symptoms for car- B. Shortness of breath
diomyopathy? C. Fainting
A. swelling, fatigue, and fever D. All of the above
4.5 Mitral Stenosis

1. What is the function of aortic Valve? 4. Valves use to regulate blood flow.
A. flows the oxygen-rich blood to get A. Flappy Bois
pumped to the body
B. Cusps
B. opens to allow blood to leave from the
C. Pressure
right ventricle to aorta
D. Lids
C. holds the oxygen-rich blood before get-
ting pumped into the body 5. The tricuspid valve is on which side of the
D. closes to hold the blood before getting heart?
pumped into the aorta A. Left
2. Blood flows from the right atrium into the B. Right
right ventricle through which valve? C. Neither
A. closed tricuspid valve
D. Center
B. open mitral valve
6. What are the two heart tissues called?
C. open tricuspid valve
D. closed mitral valve A. periwinkle & myocardial
B. peri the platypus and myocardium
3. Blood is pumped out of what? Through
what? C. pericardium and myocardium
A. Left ventricle through the pulmonary D. pericardium and myocarditis
valve
7. Which valve closes off the lower right
B. Right ventricle through the pulmonary chamber?
arteries
A. Bicuspid valve
C. Right ventricle through the pulmonary
B. Tricuspid valve
valve
D. Left ventricle through the pulmonary C. Pulmonary valve
arteries D. Aortic valve

8. Which valve closes off the upper left cham- 14. what are the valves tissue called?
ber? A. leaflets

A. Tricuspid valve B. cuspid
B. Pulmonary valve C. none of the above
C. Bicuspid valve D. Both
D. Aortic valve
15. What the function of Tricuspid Valve?
9. Two of the layers of the heart are the A. blood flows into the left atrium
and the
B. to prevent backflow of blood into the
A. Epicardium right atrium
B. Myocardium C. blood flows into the right atrium
C. Typocardium D. prevents back flows of blood into the
D. Endocardium left atrium
10. what are some types of heart valves dis- 16. Which way does the role of pulmonic valve
ease go?
A. Open right ventricle, closed to allow
A. Atresia
blood to pump to heart & lungs to receive
B. stebobis is a narrowed valve oxygen.
C. all the above B. Open right atrium, closed to allow
D. regurgitation is a leaky valve blood to pump to heart & lungs to receive
oxygen.
11. What are the four heart valves?
C. Closed right ventricle, open to allow
A. tricuspid, cuspid, aortic, & pulmonary blood to pump to heart & lungs to receive
B. tricuspid, bicuspid, aortic, & pul- oxygen.
monary D. Closed right atrium, open to allow
C. tricuspid, bicuspid, aorta, & pulmonary blood to pump to heart & lungs to receive
oxygen.
D. tricuspid, cuspid, aorta, or pulmonary
17. A heart is comprised of muscle, this muscle
12. How many chambers are there in the is called
heart?
A. Smooth Muscle.
A. 5
B. Cardiac Muscle.
B. 1
C. Skeletal Muscle.
C. 4
D. Red Muscle.
D. 2
18. What keeps the blood from flowing back
13. What protects the Chambers of Hearts? into the right ventricle?
A. Myocardium A. When the tricuspid valve snaps shut.
B. Pericardium B. When the pulmonary valve snaps shut.
C. Epicardium C. When the bicuspid valve snaps shut.
D. None of the Above D. When the pulmonic valve snaps shut.

19. The pulmonary valve lies between the B. right

A. Left Ventricle and the Septum C. left & right
B. Aortic Valve and the Right Atrium D. none of above
C. Right Ventricle and Pulmonary Artery
25. How many pulmonary veins are in our
D. Aorta and Superior Vena Cava hearts?
20. When the Bicuspid Valve closes, it keeps A. 1
NARAYAN CHANGDER
the blood from flowing back into the B. 2
artium.
C. 3
A. right
D. 4
B. right & left
C. Left 26. What is another name for the bicuspid
valve?
D. none of above
A. mitro valve
21. Which two valves are located between the
atria and the ventricles? B. two cuspid
A. Bicuspid Valve and Aortic Valve C. double cuspid
B. Aortic Valve and Tricuspid Valve D. mitral valve

C. Pulmonic Valve and Aortic Valve 27. Which Valve is located between the right
D. Bicuspid Valve and Tricuspid Valve ventricle and the Pulmonary Artery
A. Pulmonary Valve
22. What are Papillary Muscles
A. None B. Aortic Valve
B. Tough, Fibrous strings C. Tricuspid Valve
C. Part of the inside walls of the ventri- D. Mitral Valve

cles
28. Which one is not a Properly Working valve
D. none of above
A. Formed and flexible
23. How many leaflets are in each valve? B. opens all the way so that the right
A. Mitral/Tricuspid valve-4, Aor- amount of blood can pass through
tic/pulmonary valve-2 C. Closes tightly so that no blood leaks
B. Mitral/Tricuspid valve-3, Aor- back into the chamber
tic/pulmonary valve-2 D. leaves an open so that blood comes
C. Mitral/Tricuspid valve-2, Aor- out into any chamber
tic/pulmonary valve-3
29. Which is NOT one of the 4 heart valves?
D. Mitral/Tricuspid valve-1, Aor-
tic/pulmonary valve-2 A. Aortic Valve
B. Pulmonary Valve
24. The Aortic Valve force opens to pump
blood through the ventricle. C. Biprotic Valve
A. left D. Mitral Valve

30. What valve closes and keeps the blood D. Mitral/Tricuspid located between right
from not flowing backward ventricle, Aortic/Pulmonic located be-
tween left ventricle

A. tricuspid valve
B. bicuspid valve 35. Which valve opens to allow blood to pass
C. pulmonary valve from the upper left atrium to the left ven-
tricle?
D. aortic valve
A. Aortic Valve
31. Which valve closes off the left ventricle B. Mitral(Bicuspid) valve
that holds the oxygen rich blood before it
is pumped out of the body? C. Pulmonary valve
A. mitral(bicuspid) valve D. Tricuspid valve

B. aortic valve 36. Blood flows from the right atrium into the
C. pulmonary valve right ventricle through the open what?
D. tricuspid valve A. Pulmonary Valve
B. Chordae Tendineae
32. When the right ventricle is full, the tricus-
pid valve closes and keeps blood flow from C. Tricuspid Valve
going ? D. Bicuspid Valve
A. going sideways into right atrium
37. The Pulmonary Valve snaps shut to stop
B. going backward into right atrium blood from flowing back to which ventri-
C. going forward into right atrium cle?
D. going backward into left atrium A. The left
33. The keep blood moving through the B. The right

heart in the right direction. C. The left and right
A. Valves D. The Pulmonary Valve does not do this.
B. Blood
38. What is a heart valve disease?
C. Oxygen
A. Atresia
D. Person
B. Cardiovascular
34. Where are the heart valves located? C. Coronary Artery
A. Mitral/Tricuspid located between ven- D. None of them
tricles, Aortic/Pulmonic located between
Atria 39. The bicuspid valve is on what side of the
B. Mitral/Tricuspid located between heart?
Atria, Aortic/Pulmonic located between A. Left
Ventricles
B. Right
C. Mitral/Tricuspid located between
C. Neither
lungs, Aortic/Pulmonic located between
heart D. Center

40. The pattern is then repeated and blood 46. Which way does Mitral valve role goes?
flows continously to where? A. Closed left atrium, open to allow blood
A. The heart, lungs, & body to pass from left atrium to left ventricle
B. just the lungs B. Closed left ventricle, open to allow
C. just the heart blood to pass from left ventricle to left
atrium
D. none of above
C. Open left atrium, closed to allow blood
41. How many valves are in the heart
NARAYAN CHANGDER
to pass from left atrium to left ventricle
A. 1 D. Open left ventricle, closed to allow
B. 2 blood to pass from left ventricle to left
atrium
C. 4
D. 5 47. How does the heart pump blood?
42. The Venae Cavae are the veins that A. The heart has four separate chambers
that the pump the blood, two on the right
A. Carry oxygen rich blood to the body. and lefts side.
B. Extract nutrients from food. B. 1 and 3
C. Bring oxygen depleted blood to the C. the heart is divided into two seperate
right ventricle. pump system, the right and left side
D. Regulate Breathing.
D. The pump through one side only
43. What are 4 valves of the heart?
48. What body part is the heart roughly
A. tricuspid, pulmonary, mitral (bicuspid), shaped like?
and aortic
A. a closed fist
B. right and left ventricle
B. a closed mouth
C. pulmonary, aortic, tricuspid
C. bridge of nose
D. tricuspid, aortic, pulmonary, atrium
D. earlobe
44. When the left ventricle is full, what
closes? 49. Where is the aortic valve and pulmonic
valve located?
A. Mitral Valve
A. Between the ventricles and major
B. Aortic Valve blood vessels
C. Tricuspid
B. Between atria and ventricles
D. none of above
C. Between blood vessels and arteries
45. Which valve is located between the left D. Between pulmonary artery
atrium and the left ventricle (It only has
two leaflets) 50. What is the upper left chamber called
A. Pulmonary Valve A. Left ventricle
B. Mitral Valve B. Right ventricle
C. Tricuspid Valve C. Left Atria
D. Aortic Valve D. Right Atria

51. What valves are located between the ven- C. Bicuspid Valve
tricles and the major blood vessels leaving D. None of the above
the heart?

A. Pulmonic(Pulmonary) and Aortic valve 56. Blood enters through what veins?
B. Aortic and Mitral(Bicuspid) valve A. Inferior Vena Cava
C. Pulmonic(Pulmonary) and Tricuspid B. Superior Vena Cava
valve C. Pulmonary
D. Mitral(Bicuspid) and Tricuspid valve D. A & B
52. How many valve(s) does a heart have?
57. The Chordae Tendineae are attached to the
A. 8 valves and are used to
B. 2 A. Open and close valves.
C. 4 B. Strengthen valves.
D. 1 C. Work valves out.
53. What’s the role of Tricuspid valve? D. Open valves only.
A. Closed right ventricle, open top right 58. How does the blood get pumped into the
ventricle to prevent blood from flowing lungs from the Pulmonary artery?
back into atrium
A. Blood is pumped out the right ventri-
B. Closed right atrium, open top right cles through the Pulmonary Valve into the
atrium to prevent blood from flowing back Pulmonary artery, then into the lungs.
into atrium
B. Blood is pumped out the left ventricles
C. Open right ventricle, closed top right through the Pulmonary artery into the Pul-
ventricle to prevent blood from flowing monary valve, then into the lungs.
back into atrium
C. None of the above
D. Open right atrium, closed top right
atrium to prevent blood from flowing back D. none of above
into atrium
59. How many heart tissues are there?
54. Which valve closes off the lower left cham- A. 1
ber
B. 3
A. Aortic valve
C. 4
B. Pulmonary valve
D. 2
C. Bicuspid valve
D. Tricuspid valve 60. Which two valves need to open to make
the blood flow in the heart?
55. Which valve closes off the lower left cham-
A. Tricuspid and Bicuspid
ber that holds the oxygen-rich blood be-
fore it is pumped out to the body? B. Pulmonary and Aortic
A. Tricuspid Valve C. Tricuspid and Pulmonary
B. Aortic Valve D. Bicuspid and Aortic

61. Which valve closes off the upper right 66. Where is the Tricuspid valve located?
chamber? A. In front of the left atrium and the left
A. Tricuspid valve ventricle
B. Bicuspid valve B. Between the right atrium and the right
ventricle
C. Pulmonary valve
C. On top of the left atrium and the left
D. Aortic valve ventricle
NARAYAN CHANGDER
62. How do the heart valves let blood flow D. Behind the right atrium and the right
through the heart? ventricle
A. they close 67. What valves are located between the atria
B. they open and the ventricle?
A. Mitral(Bicuspid) and Aortic valve
C. they open and close
B. Aortic and Pulmonic(Pulmonary) valve
D. none of the above
C. Mitral(Bicuspid) and Tricuspid valve
63. Where is the Bicuspid Valve located? D. Pulmonic(Pulmonary) and Tricuspid
A. Between major blood vessels valve
B. Below the ventricles 68. How does the tricuspid valve function?
C. Between the atria & ventricles A. closes off the lower left chamber that
D. none of above holds the oxygen-rich blood before it is
pumped out to the body
64. Blood flows from the atrium into the B. opens to allow blood to the left ven-
ventricles to open the the Tricuspid tricle, then closes to prevent blood from
Valve flowing back into left atrium
A. left, left C. closes when the ventricle squeezes
B. right, right blood out to the lungs and then opens to
let more blood into the ventricle.
C. right, left
D. valve acts as a doorway that lets blood
D. left, right into and out of the heart
65. How does the aortic valve function? 69. What also supports the leaflets of the tri-
cuspid and mitral valves
A. opens in ventricular systole, when the
pressure in the right ventricle rises above A. chordae tendineae
B. closes off the lower left chamber that B. papillary muscles
holds the oxygen-rich blood before it is C. Both
pumped out to the body.
D. pulmonary valve
C. closes the artery in the lower right
chamber in order to send oxygen to other 70. Which valve is located between the right
parts of the body atrium and right ventricle?
D. opens the artery in order to prevent A. Mitral(bicuspid) Valve

blood from entering the lungs B. Aortic Valve

C. Pulmonary Valve 75. Which valves have three leaflets(cusps)?

D. Tricuspid Valve A. Aortic & Pulmonary Valves

B. Mitral(bicuspid) & Tricuspid Valves
71. Where is the pulmonary valve located?
C. all of the Valves
A. between right atrium and right ventri-
cle D. Aortic & Tricuspid Valves
B. between right ventricle and pulmonary 76. The pulmonic and aortic valves are closed
artery when?
C. between left atrium and left ventricle A. The right ventricle finishes contract-
ing.
D. between pulmonary artery and left
atrium B. The left atrium is finished contracting.
C. The left ventricle finishes contracting.
72. Which valve makes sure the blood flows in
a forward direction from the right atrium D. The right atrium is finished contract-
to the ventricle? ing.
A. Tricuspid Valve 77. WHat are the essentials for working

valve?
B. Mitral Valve
A. closed tight and not flexible
C. Pulmonic Valve
B. flexible and open all the way for blood
D. Bicuspid Valve to pass
73. How does the pulmonic valve function? C. flexible and open a little for blood to
pass
A. opens to allow blood to the left ven-
tricle, then closes to prevent blood from D. None of them
flowing back into left atrium 78. What the function of Bicuspid (mitral)
B. closes and keeps blood from flowing Valve?
backward into right atrium when ventricle A. prevent backflow from blood into the
contracts right ventricle
C. closes to prevent regurgitation of B. prevents backflow from blood into the
blood from the right ventricle back into left atrium
right atrium
C. permits blood to flow one way only
D. blood flows from right ventricle from left atrium into the left ventricle
through pulmonary valve to pulmonary
D. permits the blood to flow through two
artery then into the lungs, where it picks
flaps
up oxygen and deliver to your body
79. As the left ventricle begins to contract, the
74. What is another name for mitral valve? acrtic valve if forced to what?
A. pulmonic valve A. Tightened
B. gate valve B. Losened
C. tricuspid valve C. Open
D. bicuspid valve D. Closed

80. What important function do healthy heart 86. What do the valves do?
valves perform? A. keep the blood moving through the
A. creates electricity in heart heart in the right diffraction
B. put oxygen in blood B. keep the blood moving through the
C. open and close to keep blood flowing heart in the opposite direction
correctly C. keep the blood moving through the
D. squeezes heart so it pumps heart in the left diffraction
NARAYAN CHANGDER
D. keep the blood moving through the
81. The Aortic Valve is snapped shut to stop heart in the up and down diffraction
blood from flowing back into which ventri-
cle? 87. What are the valves that are made of
A. right strong, thin flaps of tissue called
B. left A. Chordae tendineae
C. both B. Leaflets
D. none of above C. bicuspid valve

D. Tricuspid valve
82. Which two valves are on the left side?
A. Tricuspid and Bicuspid 88. Which Valve is located between the right
atrium and the right ventricle
B. Pulmonary and Aortic
A. Mitral Valve
C. Tricuspid and Pulmonary
B. Tricuspid valve
D. Bicuspid and Aortic
C. Aortic Valve
83. Which Valve is located between the left D. Pulmonary Valve
ventricle and the Aorta
A. Tricuspid Valve 89. what is the function of pulmonic valve?
B. Aortic Valve A. closes to hold the blood before getting
pumped
C. Pulmonary Valve
B. opens to allow blood to be pumped
D. Mitral Valve from the heart to the lungs where it will
84. Which way does blood flow from? receive oxygen
A. right ventricle to right atrium C. closes off the lower left chamber or
right ventricle
B. left ventricle to left atrium
D. opens the lower right chamber and left
C. left atrium to right ventricle ventricle
D. right atrium to right ventricle
90. What is another name for the Mitral
85. Where is the heart located? Valve?
A. in the chest under your lungs A. Bicuspid Valve
B. under the big toe B. Aortic Valve
C. on top of the pinky toe C. Pulmonic Valve
D. in the chest between your lungs D. Tricuspid Valve

91. Where is the mitral valve and tricuspid 97. Which valve opens to allow blood to be
valve located? pumped from the heart to the lungs?

A. Between ventricles A. mitral(bicuspid) valve
B. Between pulmonary artery B. aortic valve
C. Between atria and ventricles C. pulmonary valve
D. Between aorta and ventricles D. tricuspid valve
92. How many valve(s) are in each chamber of 98. What is the shape of a heart?
the heart?
A. rectangular
A. 2
B. triangular
B. 6
C. oval
C. 1
D. diamond
D. 3
99. How does the mitral valve function?
93. Which two relax at the same time
A. opens to allow blood to the left ven-
A. Left, Right ventricles tricle, then closes to prevent blood from
B. Left, Right Atrias flowing back into left atrium
C. Pulmonary, Aortic Valves B. closes to prevent regurgitation of
D. Tricuspid, Mitral Valves blood from the right ventricle back into
right atrium
94. Which is the correct way open pul-
C. closes off the lower left chamber that
monic/aortic valve works?
holds the oxygen-rich blood before it is
A. Right ventricle → pulmonic valve → pumped out to the body.
pulmonary artery
D. blood flows from right ventricle
B. Left ventricle → pulmonary artery → through pulmonary valve to pulmonary
pulmonic valve artery and then into the lungs, where it
C. Aorta → pulmonic valve → pulmonary picks up oxygen to deliver to your body
artery
100. Where is the aortic valve located?
D. none of above
A. between right ventricle and pulmonary
95. The heart is a artery
A. muscle B. between right atrium and aorta
B. ligament C. between aorta and left atrium
C. tendon D. between the left ventricle and aorta
D. none of the above
101. When the heart valves open and close the
96. What are the valves? heart
A. Tricuspid Valve A. becomes tired
B. Bicuspid(mitral) valve B. relaxes & contracts
C. Aortic Valve and Pulmonic Valve C. beats rapidly
D. All the above D. all of the above

4.6 Heart Auscultation 356
102. The mitral valve closes and keeps blood A. left ventricle
from what? B. right ventricle
A. Flowing backward into the aorta. C. left atrium
B. Flowing backward into the left atrium D. right atrium
when the ventricle contracts.
C. Flowing backward into the pulmonary 105. The Aortic Valve is in the
arteries. A. Superior Left Ventricle
NARAYAN CHANGDER
D. Flowing backward into the right atrium B. Superior Right Ventricle
when the ventricle contracts. C. Aorta
103. What is a Chordae Tendineae D. Left Pulmonary Artery
A. tough, Fibrous strings 106. Which is the correct way the role of Aor-
B. Part of the inside walls of the ventri- tic valve goes?
cles A. Left ventricle → Aorta → Body
C. Muscle B. Left atrium → Superior vena cava →
D. None Aorta
104. Blood is pumped out of the through C. Right ventricle → Body → Aorta
the aortic valve D. Right atrium → Aorta → Body
4.6 Heart Auscultation

1. How many valves are auscultated in the B. 4
heart? C. 5
A. 3 D. none of above
4.7 Mitral Regurgitation

1. A patient comes in with mitral valve steno- A. Make sure they are never detached
sis. You expect the following manifesta- from the cardiac monitor
tions:
B. Teach their family members on CPR
A. Loud S2
C. Assist the patient to and from the bath-
B. Crackles in the lungs room and apply a falls risk identification
band
C. Paresthesia
D. Make sure they get coffee in the morn-
D. Dyspnea
ing and a sleeping pill at night
2. A patient with dysrhythmias is admitted
3. Which of the following valvular disorders
to your unit. In addition to monitor-
would you expect to hear a diastolic mur-
ing ABCs (Airway, Breathing, Circulation),
mur?
what is an important nursing intervention
for this patient? A. Mitral Stenosis

4.8 Mixed Aortic Valve Disease 357
B. Mitral Regurgitation 6. A patient asks how to manage pain for a

C. Aortic Stenosis DVT. What would be the most appropriate
response?

D. Mitral Valve Prolapse
A. Warm, moist compress
4. Which is not a physical exam finding of pe-
ripheral artery disease? B. Ibuprofen prn
A. Clubbing of fingernails C. Cool compresses
B. Shiny, hairless legs D. Bedrest
C. Intermittent claudication
D. Thin, brittle fingernails 7. Which is the most life-threatening valvu-
lar disorder because it can cause sudden
5. What is the main intervention for a patient cardiovascular collapse?
with a small aortic aneurysm?
A. Mitral Valve Stenosis
A. Increase sodium in diet
B. Mitral Valve Prolapse
B. Decrease blood pressure
C. Decrease calcium in their diet C. Aortic Regurgitation
D. Start them on a blood thinner D. Aortic Stenosis
4.8 Mixed Aortic Valve Disease

1. Upon physical assessment of a patient di- D. “People who have heart transplants
agnosed with pericarditis, the nurse antic- are at risk for multiple complications after
ipates what type of heart sound? surgery. “
A. Pericardial friction rub 3. A nurse is caring for a patient diagnosed
B. Diastolic murmur with bacterial endocarditis and assess-
ment reveals nontender hemorrhagic mac-
C. S3 or S4
ules found on the palms and soles. What
D. Pleural friction rub are these abnormalities known as?
2. A 53-year-old patient with heart fail- A. Osler nodes
ure and type 2 diabetes asks the nurse B. Roth spots
whether heart transplant is a possible
C. Splinter hemorrhages
therapy. He is currently on maximum med-
ical therapy. Which response by the nurse D. Janeway lesions
is most appropriate? 4. How many leaflets can be seen in the aor-
A. “Because you have diabetes, you tic valve?
would not be a candidate for a heart trans- A. 1
plant.”
B. 2
B. “Deciding transplant eligibility de-
C. 3
pends on many different factors.”
D. 4
C. “Your heart failure has not reached
the stage in which heart transplants are 5. A patient with carotid artery disease is at
needed.” high risk for what complication?

4.8 Mixed Aortic Valve Disease 358
A. Bradycardia B. Heart failure

B. Stroke C. Diabetes
C. Hypertension D. Myocardial infarction
D. Neck pain
10. A 19-year-old man has had a low-grade
6. Which one of the following is not included fever for 3 weeks. A tender spleen tip is
as major criteria in Jones criteria? palpable. There are splinter hemorrhages
under the fingernails and tender hemor-
NARAYAN CHANGDER
A. Pancarditis rhagic nodules on the palms and soles.
B. Elevated ESR A heart murmur is heard on auscultation.
C. Subcutaneous nodule Which of the following infectious agents
is most likely to be cultured from this pa-
D. Polyarthritis tient’s blood?
7. A patient with a history of coronary artery A. Streptococcus viridans
disease is being treated for a myocardial B. Trypanosoma cruzi
infarction (MI). During treatment, acute
mitral valve regurgitation occurs. What is C. Coxsackievirus B
the most likely cause of the acute mitral D. Mycobacterium tuberculosis
valve dysfunction?
11. Which of the following is NOT a cause of
A. Infective endocarditis
regurgitation in VHD?
B. Rupture of chordae tendinae
A. Primary cuspal abnormality originat-
C. Atherosclerosis ing from a chronic process
D. Increased preload B. Intrinsic disease of the valve cusps
8. A 82 year old client presents to the emer- C. Disruption of the supporting struc-
gency room with dizziness, weakness, and tures
palpitations. His heart rate is 152. The D. Appear suddenly
nurse demonstrates an understanding of
EKG changes that occur in the elderly when 12. Which term is known as the primary le-
she makes what correct statement about sions of IE, consisting of fibrin, leukocytes,
the client’s condition? platelets, and microbes that stick to the
valve surface or endocardium?
A. Ventricular fibrillation is a common ar-
rhythmia in older patients. A. Petechiae
B. It is normal for an aging heart to go B. Embolism
into complete heart block. C. Vegetations
C. Atrial fibrillation is a common dys- D. none of above
rhythmia in older patients.
D. Sinus bradycardia can occur due to de- 13. In degenerative valvular heart diseases
creased baroreceptor reactivity. (VHD), the extra cellular matrix (ECM) of
the valve is affected. Among the men-
9. Which of the following conditions occurs tioned answers, which does not affect the
most commonly with cardiomyopathies? integrity of degenerative VHD?
A. Pericardial effusion A. Calcification

4.9 Prosthetic Heart Valves 359
B. Alteration in ECM C. MV regurgitation causes a narrowing

in the valve opening
C. Changes in production of matrix metal-

loproteinases or their inhibitors D. MV regurgitation causes blood to back
up into the left atrium
D. Bacterial infection
15. What type of murmur is associated with
14. Which statement from the nurse demon- mitral stenosis?
strates understanding about mitral valve A. Diastolic murmur
regurgitation?
B. Mid-systolic murmur which has
A. MV regurgitation causes blood to back crescendo-decrescendo character
up into the right atrium C. Decrescendo blowing diastolic mur-
B. MV regurgitation causes an increased mur
cardiac output D. Systolic murmur
4.9 Prosthetic Heart Valves

1. is a dense, mobile mass, rarely > 1 cm, A. the PS is usually valvular
with a consistency that closely resembles B. consists of five defects
the chordae tendineae
C. usually a right-to-left VSD
A. fibroma
D. all of the above
B. myxoma
C. papillary fibroelastoma 5. Papillary fibroelastoma is the most com-
mon valvular tumor; in adults, the are
D. rhabdomyoma
usually involved
2. If the patient has a porcine valve in the A. AOV, LVOT and AMVL
mitral position, should be ruled out
B. AV valves
A. abnormal degree of stenosis and/or
regurgitation C. SL valves
B. calcification D. TV, RVOT and PV
C. dehiscence 6. Rhabdomyoma is typically associated with

D. all of the above
A. arrhythmias
3. can occur when a mechanical prosthetic
valve damages the red blood cells. B. LVOTO
A. dehiscence C. tuberous sclerosis
B. hemolysis D. all of the above
C. mechanical breakdown 7. Bioprosthetic valves are and mechani-
D. mechanical failure cal valves are
4. Which of the following is true regarding A. biological tissue/synthetic

TOF? B. for young patients/for elderly patients

C. made for long term use/for those at compared to last year’s echo results; what
an increased risk of thromboembolism is most likely the diagnosis
D. synthetic/biological tissue A. hemolysis
B. perivalvular leak
8. All prosthetic valves are inherently
stenotic; the degree of physiologic steno- C. physiologic stenosis
sis depends on D. thrombus
A. prosthesis site
NARAYAN CHANGDER
13. With , if the anatomic ventricles are
B. prosthesis size switched and there are no other defects
C. prosthesis type present, the heart can usually function nor-
mally for several years
D. all of the above
A. d-TGA
9. The severity of symptoms depends on B. l-TGA
the size of the VSD, the degree of PS and
C. simple TGA
the position of the aorta.
D. TOF
A. cor triatriatum
B. infundibular PS 14. The BP is usually in the upper extremi-
ties than in the lower extremities with AO
C. levo-transposition of the great arter- coarctation.
ies
A. equal to
D. tetralogy of fallot
B. greater
10. Echo findings include fixed, rigid TV C. lower than
leaflets, sever TR and an elevated RVSP;
what is most likely the diagnosis? D. not affected by
A. carcinoid heart disease 15. Which of the following is true of angiosar-

coma
B. infiltrative cardiomyopathy
A. most are located in the RA or on the
C. rheumatic heart disease
pericardium
D. tricuspid endocarditis B. most common primary malignant tu-
11. The patient is rushed to the ER after ac- mor
cidentally shooting a nail from a nail gun C. often associated with pericardial effu-
into his chest; echo is ordered to rule out sion
D. all of the above
A. myocardial rupture
16. may aquire surgical excision depend-
B. pericardial effusion ing on size, mobility, and associated symp-
C. valvular disruption toms
D. all of the above A. fibroma
B. lipoma
12. The patient presents with a St. Jude
bileaflet tilting disc in the mitral position C. papillary fibroelastoma
and the MVA has decreased significantly D. rhabdomyoma

17. HLHS is diagnosed when the 22. Survival of the HLHS patient has improved
due to surgical procedures, such as
A. aortic annulus is dilated

A. Bi-directional Glenn shunt procedure
B. large over-riding aorta
B. Fontan procedure
C. left ventricle is less than 10 mm
C. Norwood procedure
D. TV is distorted or absent
D. all of the above
18. A fibroma is associated with other compli-
cations such as 23. A 6 year old with congenital PS returns for
her annual echo; the sonographer needs to
A. LVOTO acquire the
B. metastasizing carcinoid tumor A. previous echo report for comparison
C. tuberous sclerosis B. PVA
D. valvular disease C. PV peak velocity and PG
D. all of the above
19. At the end of the third week, the common
trunk divides into the pulmonary artery 24. If the peak PG across the stenotic pulmonic
and the aorta through a spiral growth pro- valve is 50 mmHg, what is the degree of
cess; if there is a disruption in any of these PS?
mechanisms, can result.
A. mild
A. coarctation of the aorta
B. moderate
B. endocardial cushion defect
C. severe
C. TGA
D. not enough data
D. truncus venosus
25. The most common cause of valvular PS is
20. HLHS results when the left heart is re-
duced in size due to a restriction of the left A. bicuspid
ventricular inflow and/or outflow, such as
B. congenital
C. degenerative
A. hypoplasia of the pulmonary artery
D. rheumatic
B. mitral atresia
C. pulmonic atresia 26. Rhabdomyoma is a yellowish-gray tumor
found anywhere in the heart, but is fre-
D. all of the above quently in the
21. With Ebstein anomaly, a portion of the A. interatrial septum
becomes atrialized resulting in a large RA, B. pericardium
small RV and TR.
C. valves
A. right atrium
D. ventricular walls or cavity
B. right ventricle
27. While interrogating the apex for throm-
C. tricuspid valve
bus, the sonographer should utilize differ-
D. all of the above ent techniques such as

A. CWD of the apex C. rotatoin of the papillary muscles

B. lower frequency transducer D. all of the above
C. varying depths
33. is an encapsulated tumor composed of
D. all of the above mature fat cells that is usually soft and
28. The patient presents with new diastolic large
murmur, weight loss, chest pain, hemop- A. fibroma
tysis and clubbing of the fingertips:what
NARAYAN CHANGDER
is most likely the diagnosis B. lipoma
A. LA myxoma with secondary stenosis C. myxoma

B. LA thrombus with embolization D. rhabdomyoma
C. MV endocarditis
34. Secondary metastatic tumors frequently
D. RA myxoma with TV complications travel
29. TEE is indicated primarily to rule out in A. from the IVC to the right heart
the Afib patient prior to cardioversion B. from the pulmonary veins to the LA
A. LA/LAA thrombus
C. to the pericardium, then into the my-
B. LV myxoma ocardium and endocardium
C. LV thrombus D. all of the above
D. lipomatous hypertrophy of the IAS
35. An elderly woman is admitted to the ER
30. is the most common primary cardiac tu- with fever, chills, and dizziness. She is cer-
mor found in children; many arediagnosed tain that she ahd a valve replaced but does
within the first year of life and greater not have a scar on her chest, and there
than 90% by the age of 15 is no previous echo report available. Echo
A. fibroma findings include a very bright AOV annu-
lus with an unusual cusp and moderate AR;
B. lipoma
what is most likely the diagnosis?
C. myxoma
A. mechanical AOV with pannus
D. rhabdomyoma
B. native AOV with IE
31. Coarctation of the AO is
C. porcine AOV with PVE
A. a narrowing in the aorta
D. TAVR with PVE
B. located between the innominate artery
and the left common carotid artery 36. is developed from a human aortic
C. often associated with cleft mitral valve valve or dura mater and appears very sim-
ilar to a native valve
D. all of the above
A. autograft
32. Cleft MV frequently has associated le-
sions, such as B. heterograft
A. accessory papillary muscle or leaflet C. homograft
B. MVP D. TAVR

4.10 Tricuspid Regurgitation 363
37. PS involves a 41. If the patient has a stentless autograft,

RVOTO what type of valve do they most likely
have?

A. fibrotic
A. bileaflet valve
B. funnel
B. valve from another human
C. supravalvular
C. valve from the patient’s own fascia
D. valvular lata
38. A fibroma is a bulky tumor that is fre- D. valve from a pig
quently embedded in the
42. is a known complication of the biopros-
A. atrial walls thetic heart valve
B. interatrial septum A. thrombus
C. myocardial wall of the ventricles B. hemolysis
D. all of the above C. mechanical failure
D. all of the above
39. is present if the systemic flow travels
from the RA to the RV to the Aorta to the 43. At birth, the infant with HLHS may appear
Body to the RA normal; soon after birth, the infant expe-
riences a sudden worsening of symptoms
A. d-TGA
because the
B. l-TGA A. ductus arteriosus and foramen ovale
C. normal flow close
D. TGA B. first breath is taken
C. flow changes direction
40. If the patient’s pulmonic valve annulus and
trunk are excised and relocated to the aor- D. right heart takes over
tic position, they have a(n) 44. A mechanical prosthesis is selected for
A. allograft A. children and young adults
B. autograft B. patients with a large valve annulus
C. heterograft C. patients with mild AR
D. homograft D. all of the above
4.10 Tricuspid Regurgitation

1. What etiologies are considered secondary E. Fibro-elastic deficiency (FED)
mitral diseases. Check all that apply
2. Considering the pathophysiological triad of
A. Ischemic cardiomyopathy mitral disease, stenosis and regurgitation
B. Mitral Annular Calcification (MAC) are considered:
C. Hypertrophic cardiomyopathy A. Etiology
D. Dilated cardiomyopathy B. Lesions

4.11 Ventricular Septal Defect 364
C. Dysfunction D. none of above
4.11 Ventricular Septal Defect

1. How would a normal pedal pulse be docu- blood flow in the heart due to this congen-
mented? ital heart defect.
A. 3+ A. “The blood in the heart is shunting
from the right ventricle to the left ventri-
NARAYAN CHANGDER
B. 1+
cle, which is increasing pulmonary blood
C. 0 flow.”
D. 2+ B. “The blood in the heart is shunting
2. Which medication when given by G-tube from the left ventricle to the right ventri-
should be given 1 hour before feeds or 2 cle, which is decreasing pulmonary blood
hours after feeds? flow.”
C. “The blood in the heart is shunting
A. Phenobarbital
from the left ventricle to the right ventri-
B. Acetaminophen cle, which is increasing pulmonary blood
C. Phenytoin flow.”
D. Ibuprofen D. “The blood in the heart is bypassing
the left ventricle and is being shunted to
3. Type of sound heard for pleural effusion the right ventricle, which is decreasing
during percussion note? lung blood flow.”
A. Hyper resonant
6. A patient who received spinal anesthesia
B. Resonant four hours ago during surgery is trans-
C. Dull ferred to the surgical unit and, after one
and a half hours, now reports severe inci-
D. none of above
sional pain. The patient’s blood pressure is
4. A 4-month-old is scheduled to take 170/90 mm Hg, pulse is 108 beats/min,
Digoxin for treatment of a VSD. The pa- temperature is 99 o F (37.2 o C), and respi-
tient’s apical pulse is 89 beats per minute. rations are 30 breaths/min. The patient’s
As the nurse what will you do:(select all skin is pale, and the surgical dressing is
that apply): dry and intact. The most appropriate nurs-
ing intervention is to:
A. Hold the dose
A. Medicate the patient for pain.
B. Recheck the pulse via the brachial
artery B. place the patient in a high Fowler posi-
tion and administer oxygen.
C. Administer the dose as scheduled
C. Place the patient in a reverse Trende-
D. Notify the physician
lenburg position and open the IV line.
5. A two-month-old is showing signs and D. Report the findings to the provider.
symptoms of heart failure. An echocar-
diogram is ordered. The test shows the 7. Which physiological response is often as-
infant has ventricular septal defect (VSD). sociated with surgery-related stress?
Which statement below best describes the A. Bronchial constriction

B. Decreased cortisol levels primarily concerned with physiologic pa-

C. Peripheral Vasodilation rameters.

D. Sodium and water retention 11. Which statement by a patient with di-
abetes mellitus indicates an understand-
8. The nursing diagnosis for a patient with ing of the medication insulin glargine (Lan-
a myocardial infarction is activity intoler- tus)?
ance. The plan of care includes the patient
outcome criterion of: A. Lantus causes weight loss
A. Agreeing to discontinue smoking B. Lantus is only used at night
B. Ambulating 50 feet without experience C. The duration of Lantus is six hours

dyspnea D. There is no peak time for Lantus
C. Experiencing no dyspnea on exertion 12. The nurse is caring for a patient with a
D. Tolerating activity well postoperative wound evisceration. Which
action should the nurse perform first?
9. The medical-surgical nurse, who is caring
for a patient with a new diagnosis of can- A. Explain to the patient what is happen-
cer, observes the patient becoming angry ing and provide support
with the physicians and nursing staff. The B. Cover the protruding organs with ster-
best approach to diffuse the emotionally ile gauze moistened with sterile saline so-
charged discussion is to: lution
A. Allow the patient and family members C. Push the protruding organ back into
time to be alone the abdominal cavity
B. Arrange time for the patient to speak D. Ask the patient to drink as much fluid
with another patient with cancer as possible
C. Direct the discussion and validation of
13. When assessing for adequate breathing in
emotion, without false reassurance
a patient it is standard practice to look for
D. Request a consultation from a social
A. pneumonia, agonal respirations,
worker on the oncology unit
wheezing, retractions
10. Nursing diagnoses mostly differ from med- B. cyanosis, nausea, numbness, angina
ical diagnoses, in that they are:
C. rate, rhythm, quality
A. Dependent upon medical diagnoses
D. rate, auscultation, stridor, pneumotho-
for the direction of appropriate interven-
rax
tions.
B. Primarily concerned with caring, while 14. What are the earliest signs of digoxin tox-
medical diagnoses are primarily con- icity in children are (select all):
cerned with curing. A. Vomiting
C. primarily concerned with human re- B. Changes in heart rate and rhythm
sponse, while medical diagnoses are pri-
marily concerned with pathology. C. Dysrhythmias
D. primarily concerned with psychosocial D. Blurred Vision

parameters, while medical diagnoses are E. Lethargy

15. An 80-year-old patient is placed in iso- 19. When evaluating an EKG strip of a pa-
lation when infected with methicillin- tient on a telemetry unit, the nurse notices
resistant Staphylococcus aureus . The pa- that patient is having premature ventricu-
tient was alert and oriented on admission, lar contractions (PVCs). What criterion on
but is now having visual hallucinations and the EKG strip does the nurse use to evalu-
can follow only simple directions. The ate the presence of PVCs?
medical-surgical nurse recognizes that the A. An indiscernible PR interval
changes in the patient’s mental status are
B. P waves at appear erratic
related to:
NARAYAN CHANGDER
C. P waves that have a sawtooth configu-
A. A fluid and electrolyte imbalance
ration
B. A stimulating environment
D. A QRS complex followed by a compen-
C. Sensory Deprivation satory pause
D. Sundowning 20. Capillary refill time is normally:
16. During an assessment of a patient who A. 15 seconds
sustained a head injury 24 hours ago, the B. 7-10 seconds
medical-surgical nurse notes the develop-
C. 4 to 6 seconds
ment of slurred speech and disorientation
to time and place. The nurse’s initial action D. 1 to 3 seconds
is to: 21. A patient, age 41, undergoes a right up-
A. Continue hourly neurological assess- per lobectomy. Postoperatively, he has
ments a chest tube connected to an underwater
B. Inform the neurosurgeon of the pa- seal with suction. One day after surgery,
tient’s status the nurse detects no bubbling in the suction
compartment. What would be the best
C. Prepare the patient for emergency nursing action at this time?
surgery
A. Milk the chest tube using slow even
D. Recheck the patient’s neurological sta- strokes
tus in 15 minutes
B. Add more sterile water to the suction
17. The most common, preventable complica- department
tion of abdominal surgery is: C. Check the practitioner’s order for
A. Atelectasis amount of suction, and increase pressure
until gentle bubbling occurs
B. Fluid and Electrolyte Imbalance
D. Check the practitioner’s order for
C. Thrombophlebitis amount of suction and increase the water
D. Urinary Retention seal by 10 cm.
18. What is the normal lung breath sound dur- 22. The healthcare provider is auscultating
ing auscultation? the heart of patient with valve disease.
A quiet but immediately audible murmur
A. Bronchial
is heard. How would this murmur be
B. Vesicular graded?
C. Tracheal A. Grade I
D. none of above B. Grade II

C. Grade III C. Grunting increases end expiratory

pressure and promotes gas exchange
D. Grade IV

D. During grunting the diameter of the
E. Grade V
bronchi and bronchioles is increased
23. Which of the following is the most common
26. The main goal of treatment for acute
diagnosis of murmur in children?
glomerulonephritis is to:
A. Innocent murmur
A. Encourage Activity
B. Rheumatic heart disease
B. Encourage high protein intake
C. Patent ductus arteriosus
C. Maintain fluid balance
D. Ventricular septal defect
D. Teach intermittent urinary catheteriza-
24. A 78-year-old patient is scheduled for tion
transition to home after treatment for
27. For the evaluation feedback process to be
heart disease. The patient’s spouse, who
effective, the medical-surgical nurse who
has chronic obstructive pulmonary disease,
is a manager:
plans to care for the patient at home.
The spouse says that their grown children, A. Conducts weekly meetings with staff
who live nearby, will help. The best ap- members
proach to discharge planning is to
B. Considers staff member’s interests
A. Arrange nursing home placement for and abilities when delegating tasks
the couple
C. Informs staff members regularly of
B. Consult the spouse’s healthcare how well they are performing their jobs
provider about the spouse’s ability to care
D. Provides goals for staff members to
for the patient
meet
C. Contact the children to ascertain their
commitment to help 28. What are the name of the two most com-
monly used gastrostomy tubes with chil-
D. Discuss community resources with the
dren?
spouse and offer to make referrals
A. Argyle and Salem
25. While caring for an infant with a diagno-
B. Bard and Mickey
sis of bronchiolitis, the healthcare provider
notices audible grunting sounds during the C. Foley and Bard
infant’s respirations. How should the D. Mickey and Peg
healthcare provider interpret the grunting
in relation to the infant’s respiratory sta- 29. Which of the following pathophysiology of
tus? heart failure in children is the most com-
A. Oxygen consumption is decreased mon?
with grunting which helps to resolve hy- A. Low cardiac output
poxemia
B. Myocardial dysfunction
B. During grunting lung volume increases
C. Pulmonary congestion
as more air moves through the conducting
airways D. Systemic venous congestion

30. Which of the following conditions can 34. What action best describes a sentinel
cause right-sided heart failure? event alert?
A. A Ventricular septal defect A. Documenting the breakdown in com-
munication during shift report
B. An anterior MI
B. Indicating that a community or institu-
C. An atrial septal defect tion is unsafe
D. Constrictive pericarditis C. Recording harm done when a medica-
NARAYAN CHANGDER
tion error occurs
31. For people older than middle age or with a
history of CVD, aucultation of the carotid D. Signaling the need for immediate in-
artery may demonstrate the presence of vestigation and response
a swishing sound, indicating blood flow
35. A concerned mother brings her 3-month-
tubulence. What is this called?
old to the clinic. The mother states the in-
A. murmur fant seems to be small for its age. While
B. bruit collecting a through health history, what
other signs and symptoms described by
C. thrill the mother may indicate the child has a
D. heave congential heart defect, such as a VSD. Se-
lect all that apply:
32. Which factor is the reason why murmur of A. Diarrhea
a VSD is not heard in the first few days of
B. Frequent treatment of lung infections
life of a newborn baby?
C. Excessive wet diapers
A. The defect is small
D. Diaphoresis when nursing
B. The pulmonary artery pressure is nor-
mal E. Swelling in hands and feet
C. The pulmonary vascular resistance is 36. A baby, exhibiting no obvious symptoms

high of congestive heart failure has been diag-
nosed with a small ventricular septal de-
D. The LV pressure is low
fect. Which of the following information
33. After completing a thorough neurological should the nurse explain to the baby’s par-
and physical assessment of a patient who ents.
is admitted for a suspected stroke, the A. The baby will most likely need open
medical-surgical nurse anticipates the next heart surgery with a week
step in the immediate care of this patient B. The defect will likely close without
to include: therapy
A. Administering tissue plasminogen acti- C. The defect likely developed early in the
vator (TPA) second trimester
B. Obtaining a computed tomography D. The baby will likely be placed on a high-
scan of the head without contrast calorie formula
C. obtaining a neurosurgical consultation
37. The first step in applying the quality im-
D. preparing for carotid doppler ultra- provement process to an activity in a clin-
sonography ical setting is to:

A. Assemble a Team to review and revise B. Auscultating the lungs

the activity C. Examining the neck

B. Collect data to measure the status of D. Inspecting and palpating the pre-
the activity cordium
C. Select an activity for improvement E. Inspecting the hand and lower legs
D. Set a measurable standard for the ac- 42. A patient’s family does not know the pa-
tivity tient’s end-of-life care preferences, but as-
38. Which are not considered adventitious sumes that they know what is best for the
breath sounds patient under the circumstances. This as-
sumption reflects:
A. Clear bilaterally
A. Justice
B. rhonchi
B. Paternalism
C. wheezing C. Pragmatism
D. crackles D. Veracity
39. For a patient with Crohn’s disease, the 43. Which action occurs primarily during the
medical-surgical nurse recommends a diet evaluation phase of the nursing process?
that is:
A. Data Collection
A. high in fiber, low in protein and calo- B. Decision making and judgement
ries
C. Priority setting and expected out-
B. high in potassium comes
C. low in fiber, high in protein and calo- D. Reassessment and audit
ries
44. It is hospital policy to assess and record
D. low in potassium a patient’s pulse before administering
40. Which statement by a patient demon- digoxin (Lanoxin). By auditing the nurs-
strates an accurate understanding about ing records to determine the frequency of
herbal supplements? compliance with this policy, the quality as-
sessment and improvement committee is
A. “Herbs may interact with prescribed conducting:
mediations but not other herbs”
A. A process analysis
B. “Most herbs have been tested and
B. A quality analysis
found to be safe and therapeutic”
C. A system analysis
C. “The Food and Drug Administration
regulates herbs and allows advertising” D. An outcome analysis
D. “There is no standardization among 45. When listening to heart sounds, you can
the manufacturers of herbs in this coun- best hear S1 at the:
try” A. base of the heart
41. The nurse prepares to perform a cardiac B. apex of the heart
examination. The nurse understands the C. aortic area
components of this examination include: D. second intercostal space to the right of
A. Examining the face the sternum

46. A high pitched crowing sound from the up- 51. You’re auscultating for heart sounds in a 3-
per airway results from tracheal or laryn- year-old girl and hear an s3. You assess
geal spasm and is called? the sound to be a:
A. Stridor A. normal finding
B. Crackles B. probable signs of heart failure
C. Rales C. possible signs of atrial septal defect
D. Wheezes D. probable sign of mitral stenosis
NARAYAN CHANGDER
47. What are the most common skin problems 52. To prepare a patient on the unit for a bron-
associated with Mickey G-tubes? choscopic procedure, the medical-surgical
A. Granulation, Drainage, and Redness nurse administers the IV sedative. The
B. Drainage, Granulation, and Itchiness nurse then instructs the licensed practi-
cal/vocational nurse to:
C. Redness, Itchiness, and Infection
A. Educate the patient about the pending
D. Redness, Drainage, and Infection
procedure
48. In a pediatric patient with right-sided B. Give the patient of small sips of water
heart failure, which of the following signs only
would you expect:
C. Measure the patient’s blood pressure
A. Dependent edema and pulse readings
B. Ascites
D. Take the patient to the bathroom one
C. Hypertension more time
D. Hypotension
53. What is the purpose of tactile fremitus?
E. Adventitious breath sounds
A. Used as an indirect measure of the
49. A nursing department in an acute care set- amount of air and density of tissue
ting decides to redesign its nursing prac- present within the lungs.
tice based on a theoretical framework.
B. Suggests the vibration in the chest
The feedback from patients, families, and
produced by the passage of air through
staff reflects that caring is a key ele-
bronchial tubes that are partially ob-
ment. Which theorist best supports this
structed by mucous secretions.
concept?
C. Suggests the presence of fluid or air
A. Erikson
outside of the lung
B. Maslow
D. none of above
C. Rogers
D. Watson 54. When examining a patient who is par-
alyzed below the T4 level, the medical-
50. The nurse auscultates the base of the lungs surgical nurse expects to find:
to assess for what reason?
A. flaccidity of the upper extremities
A. It best reflects the health of the lungs
B. hyperreflexia and spasticity of the up-
B. It is where fluid begins to accumulate per extremities
C. It indicates early infection C. impaired diaphragmatic function re-
D. It is the first sign of COPD quiring ventilator support

D. independent use of upper extremities D. Pleurtic chest pain

and efficient cough
58. How much flush should be given after ad-

55. A patient suddenly has difficulty breath- ministering a liquid medication through a
ing and has audible inspirations that sound pediatric g-tube?
like wheezes. She is suffering from: A. 3 ml
A. Chronic bronchitis B. 5 ml
B. Emphysema C. 8 ml
C. Asthma D. 10 ml
D. Left-sided heart failure
59. To prevent a common, adverse effect of
56. What is primarily a developmental task of prolonged use of phenytoin sodium (Di-
middle age? lantin), patients taking the drug are in-
structed to:
A. Learning and acquiring new skills and
information A. Avoid crowds and obtain an annual in-
fluenza vaccination.
B. Rediscovering or developing satisfac-
tion in one’s relationship with a significant B. Drink at least 2 L of fluids daily, includ-
other ing 8 to 10 glasses of water.
C. Relying strongly upon spiritual beliefs C. Eat a potassium-rich, low sodium diet.
D. Risk taking and its perceived conse- D. Practice good dental hygiene and re-
quences port gum swelling or bleeding
57. A 10-month-old infant was seen in the 60. The nurse prepares to administer an ACE
Emergency Department for respiratory dis- inhibitor to a patient with an acute MI for
tress is admitted to the pediatric unit with which reason?
a diagnosis of bronchiolitis. Which of A. To minimize platelet aggregation
these if assessed, alerts the healthcare B. To reduce preload and afterload
provider the bronchiolitis is worsening?
C. To reduce myocardial oxygen con-
A. Head bobbing sumption
B. Inspiratory stridor D. To decrease myocardial oxygen de-
C. Drooling mand

5. Clinical Encounters
NARAYAN CHANGDER
5.1 Ankylosing Spondylitis
1. Inflammation at the insertion of a liga- B. Limitation of lumbar spine motion in
ment or tendon to the bone. Can be sagittal and frontal planes
identified by pressing certain places, for C. Decreased chest expansion
example:ischial tuberosity, trochanter ma-
jor, spinous process, costochondral and D. Radiologic criteria
manubriosternal junctions and plantar iliac E. Bilateral sacroiliitis grade 2 or higher,
fasciitis. This is an examination? or unilateral sacroiliitis grade 3 or higher
A. Physical examination, Enthesitis
4. Sacroiliitis Grading has 5 Grades
B. Physical examination Chest expansion
A. Grade 1-Grade 5
C. Physical examination, spinal mobility
B. Grade 0-Grade 4
D. Posture/body posture
C. Grade 1, Grade 2, Grade 4, Grade 5
2. What is the preferred NSAID for the treat- D. none of above
ment of Ankylosing Spondylitis?
5. Which therapy is the best option to treat
A. Ibuprofen
those with Ankylosing Spondylitis?
B. Naproxen
A. Ultrasound
C. Dicoflenac
B. Heat
D. Indomethcladone
C. Exercise Therapy
E. There is no preferred NSAID
D. TENS / IFC
3. Modified New York Criteria (1984)Ini 6. Physical examination Limited range of mo-
merupakan clinical criteria untuk Diagnosis tion in the vertebrae, especially the lum-
AS, clinical criterianya adalah? bar vert, forward flexion, rear side and
A. LBP & stiffness > 3 mnth, improves extension. Schober’s test or modification
with exercise, not relieved by rest thereof. Which physical exam?

5.1 Ankylosing Spondylitis 373
A. Posture posture 11. Clinical features in Ankylosing spondylitis

B. Spine mobility A. <16 t-18 years:oligoarthritis. Aver-

age:26 years
C. Enthesitis
B. Low back pain:1. Insidius2. Pain per-
D. Chest expansion
sists for at least 3 months 3. Stiffness
7. The biological agents are Anti Il- in the waist in the morning 4. Pain is re-
17:Secukimumab TNF-α :Etanarcept, In- duced/improved by exercise
fliximab, Golimumab, Adalimumab Is this C. Sleepy, hungry
statement correct?
D. Angry
A. Salah
12. This is a surgical step-Very effective in
B. Can be both patients with severe manifestations (se-
C. Correct vere pain), which usually involves the hip
joint-Total hip arthroplasty-Osteotomy-
D. none of above
Fixation Is this statement correct?
8. Definite AS if radiologic criteria is associ- A. Salah
ated with at least 1 clinical criteriaProba- B. Can be both
ble AS if:3 clinical criteria present or radi-
ologic criteria are present without clinical C. Correct
criteria Pernyataan ini benar atau salah? D. none of above
A. Benar
13. For physical examination (body pos-
B. Salah ture/posture). Loss of normal posture
C. Bisa keduanya Lumbar lordosis disappears (early symp-
toms). If the cervical vertebrae are
D. none of above affected:
9. Sacroiliitis, Enthesitis, Synovitis, Oth- A. Wifian
ers:uveitis, myocardial changes, intestinal B. The patient’s neck shifts forward, re-
mucosal lesions, skin lesions sulting in the occiput not being able to
A. fracture stick to the wall
B. Ankylosing spondylitis C. Lying around
C. trauma D. Limited neck movement
D. injury 14. Which of the following are Red Flags for

Ankylosing Spondylitis? Select all those
10. What percentage of those with Ankylos- that apply
ing Spondylitis suffer from inflammation
A. Difficulty Bending Anteriorly/Posteriorly/Laterally
of the eye
A. 60%
B. Pain that worsens with sleep
B. 20%
C. Chronic pain / stiffness of lower back
C. 40% / pelvic region
D. 50% D. Rib cage pain while exhaling

5.2 Anticoagulation 374
15. A 26-year-old man came to the health cen- D. Genetic Testing

ter with complaints of pain and stiffness E. None of the above
in the waist in the morning. Pain per-
sists for at least 3 months. Pain is re- 19. Which allele predisposes patients to Anky-
duced/improved by exercise. Is the clin- losing Spondylitis?
ical symptom of ankylosing spondylitis a
manifestation? A. QRS-T22
A. Skeletal manifestations B. HLA-B27
NARAYAN CHANGDER
B. Non-skeletal manifestations C. H1N1-99
C. Physical manifestation D. BRU-H47
D. Local manifestation E. None of the Above
16. Which of the following is not a general 20. A 27-year-old woman came with com-
characteristic of a patient with Ankylosing plaints of chest wall expansion. Existing
Spondylitis? inspection
A. Age 20-30 A. Measurement begins and maximal in-
B. Male spiration after maximal expiration.
C. Lack of Spinal Mobility B. Varies depending on age and gender
D. Hypermobile Hips C. Guidelines for chest expansion < 5cm
E. Chronic Low Back Pain D. Men-IV intercostal space; woman-
under mamae
17. A 19-year-old man came to the health cen-
ter with complaints of fatigue, weight loss, 21. Formation of HLA-B27 homodimers due
subfibrils since 2.5 months ago. These to misfolding in the endoplasmic reticu-
three complaints are called symptoms? lum Accumulation of misfolded proteins in
A. Symptoms appear cells causes a proinflammatory intracellu-
B. Tropical symptoms lar stress response Expression of HLA-B27
homodimers recognized as foreign anti-
C. Constitutional symptoms gens What is the pathogenesis theory
D. none of above A. Arthritogenic peptides
18. What is the Gold Standard for diagnosis of B. Self-association of the HLA-B27
Ankylosing Spondylitis molecule
A. MRI C. Alteration of intracellular handling of
B. Radiograph microbes due to HLA-B27
C. Blood Serum Sample D. none of above
5.2 Anticoagulation
1. Mr Tumbleweed returns an international ward registrar orders Vitamin K for war-
normalised ratio (INR) of 9 and there is farin reversal. The intern rings you in a
evidence of minor bleeding. The medical flap asking for a stat dose to use, what

would you recommend? A. 2500 IU

A. 1 mg orally B. 2000 IU

B. 3 mg orally C. 1500 IU
C. 1.5 mg IV D. 1000 IU
D. 3 mg IV
6. INNs of HNFs
2. Which of the following is the mechanism A. heparin sodium
of Sodium citrate?
B. calcium heparin
A. It will remove Ca2+ through chela-
tion. C. nadroparin calcium
B. It will forms a complex with antithrom- D. dalteparin sodium
bin III, catalyzing the inhibition of throm-
bin. 7. Write down the advantage of EDTA
C. It will removes calcium from coagula- A. Coagulation study
tion system by precipitating it into unus- B. Blood smear
able form.
C. OFT
D. It will add calcium ion in blood prevent-
ing clotting. D. none of above
3. About VKAs: 8. Besides aspirin, the preferred antiplatelet

agent is:
A. It is better to take them in the morning
B. There is a hemorrhagic risk linked to A. ticlopidine
an under-dosage B. abciximab
C. There is a risk of thrombosis linked to C. acetaminophen
an underdose
D. clopidogrel
D. They are introduced after the start of
heparin therapy 9. Which of the following is the function of
E. It is better to take them in the evening platelet?
A. Oxygen and carbon dioxide transporta-
4. Excessive hemorrhaging is protected tion
against by normal:
B. Blood cells’ production
A. hemostasis
C. Body immunity
B. metabolism
D. Hemostasis
C. blood clotting
D. use of aspirin 10. What will be the conandection for antico-
agulant or antiplatelet
5. Miss Littlewood has been in a car accident
and needs urgent surgery, one of her reg- A. Hemoglobin below 7PLT below 50, 000
ular medications is Apixaban, the surgeon B. Stomach ulcer
wants to use Prothrombinex, her weight
C. 9 Hemoglobin below PTT below 30
is 50 kgs, what dose would you recom-
mend? D. Headache

11. Blood clotting occurs in a series of steps 17. For preventive treatment for arterial
known as a(n): blockage, what medicine would be suit-
A. thrombi able?
B. cascade A. Claxan
C. clotting factor B. Coumadin
D. waterfall C. aspirin
D. none of above
12. aspirin
NARAYAN CHANGDER
A. is an antiplatelet agent 18. Which of the following is calcium chelaters
B. is an oral anticoagulant A. oxalates
C. causes allergic reactions B. EDTA
D. causes digestive problems C. Citrate
D. Both A and C
13. acetylsalicylic acid is taken:
E. Both B and c
A. without food
B. during meals 19. What is the INR of an untreated patient
C. never mind A. 2
D. none of above B. 3
14. About heparin-induced thrombocytopenia C. 1

(HIT): D. greater than 2
A. Type 1 HIT is benign 20. The oral anticoagulant of choice is:
B. Type 2 HIT is benign A. ticlopidine
C. Type 1 HIT can cause thrombosis
B. ow-molecular-weight heparin
D. Type 2 HIT can cause thrombosis
C. warfarin
E. HIT type 2 requires treatment discon-
D. standard heparin
tinuation
21. Its all happening on the medical ward, Mrs
15. What is the vxzexq
Green returns an international normalised
A. bleu ratio (INR) of 11 but theres no evidence
B. leon of bleeding, what stat dose of Vitamin K
would you recommend?
C. delighted
A. 5 mg
D. will love
B. 10 mg
16. Heparin is not measured in milligrams but
C. 15 mg
in:
D. 20 mg
A. international untis
B. micrograms 22. What is D-Dimer?
C. grains A. product of vasoconstriction
D. cubic centimeters B. product of degradation

C. product of fibrinolysis C. Heparin sodium has a duration of ac-

D. product of primary and secondary tion of 3 hours

hemostasis D. Heparin sodium has an onset of action
of a few minutes
23. Mr Popple is being initiated on warfarin, it
is day 3 and his international normalised E. The goal of treatment is to have a TCA
ratio (INR) is 2.7, what dose of warfain between 50 and 70 seconds
would you recommend?
28. Name the colour of sodium heparin tube
A. 3 mg
A. Green
B. 2 mg
B. Light blue
C. 4 mg
C. Lavender
D. 5 mg
D. none of above
24. Contraindications of LMWHs
29. Antiplatelet agents may prevent arterial
A. known allergy thrombosis, myocardial infarction, or:
B. ATCD of heparin-induced thrombocy- A. stroke
topenia HIT
B. kidney failure
C. Disorders of haemostasis, situation at
risk of haemorrhage C. hemorrhage
D. Severe kidney failure D. perfusion
E. Elderly subjects 30. When the platelets become sticky and ad-
here to the inner lining of an injured vessel,
25. Which of the following disease can be they are called a:
treated by anticoagulant?
A. cascade
A. Myocardial infarction
B. seal
B. Diabetes Mellitus
C. platelet plug
C. Pancreatitis
D. net
D. Liver dysfunction
31. Before you anticoagulants who are consid-
26. Which of these specialties are anticoagu-
ered safe
lants?
A. enoxaparin
A. Lovenox®
B. heparin
B. Kardegic®
C. warfarin
C. Previscan®
D. none of above
D. Calciparine®
E. Plavix® 32. INR definition
27. About standard heparins: A. measurement of adaptation time
A. Calcium heparin has a delay of action B. measurement of vasoconstriction time

of a few minutes C. clotting time measurement
B. Calcium heparin is injected SC D. measurement of repair time

33. Mrs Orange has been diagnosed with a ve- C. 5 mg once daily
nous thromboembolism (VTE), the doctor D. 5 mg twice daily
wants to treat with rivaroxaban. Mrs Or-
ange has an eGFR of 35 mls/min, what 37. About INR:
dose would you recommend?
A. INR is monitored when taking stan-
A. 15 mg twice daily dard heparin
B. 15 mg once daily B. The INR is monitored when taking AVK
NARAYAN CHANGDER
C. 20 mg once daily C. It is measured by comparing the clot-
D. 20 mg twice a day ting time of a patient to that of a control
subject.
34. Which of the following is the mechanism
D. The target INR depends on the pathol-
of heparin?
ogy
A. It will remove Ca2+ through chela-
E. Target INR is always 1
tion.
B. It will forms a complex with antithrom- 38. Which of the following is the mechanism
bin III, catalyzing the inhibition of throm- of EDTA?
bin. A. It will remove Ca2+ through chela-
C. It will removes calcium from coagulation.
tion system by precipitating it into unus- B. It will forms a complex with antithrom-
able form. bin III, catalyzing the inhibition of throm-
D. It will add calcium ion in blood prevent- bin.
ing clotting. C. It will removes calcium from coagula-
tion system by precipitating it into unus-
35. definition of hemostasis
able form.
A. set of physiological mechanisms that
D. It will add calcium ion in blood prevent-
will contribute to the increase in bleeding
ing clotting.
leading to the formation of a clot
B. set of psychological mechanisms that 39. What are the side effects of heparins?
will contribute to stopping the bleeding by A. Hyperleukocytosis
leading to the formation of a clot
B. Bleeding risk
C. set of physiological mechanisms that
will contribute to stopping the bleeding by C. Constipation
leading to the formation of a clot D. Injection site hematoma
D. it prevents thrombosis E. Thrombocytopenia
36. Mrs Rankin had a venous thromboemolism 40. Which of the following agents is classified
6 months ago and the doctor wants to as an anticoagulant?
continue her apixaban to prevent further
A. Heparin
occurences, what dose would you recom-
mend? B. Premarin
A. 10 mg twice daily C. Haloperidol
B. 10 mg once daily D. Hydroquinone

41. LMWH administration methods 47. If any factor are present in insufficient
A. Sous cut quantity the coagulation process is
A. Fast

B. IM
B. Slow
C. IV
C. Very good
D. per us
D. none of above
42. The trade name for clopidogrel is:
48. The allows rapid healing and preven-
A. Ticlid tion from. Spontaneous bleeding
B. Plavix A. Platelet
C. Xarelto B. Fibrin
D. ReoPro C. Coagulation pathway
43. Which clotting factors are vitamin K depen- D. none of above

dent? 49. Which of the following is the CORRECT
A. II:Prothrombin colour coded tube tops with its function?
B. VII:Proconvertin A. Green-EDTA
C. IX:Antihemophilic B B. Purple-Heparin
D. XII:Hageman factor C. Red-Plain tube
D. Grey-Sodium chloride
E. X:Stuart Factor
50. What is the full form of EDTA
44. What is heparin monitoring?
A. Ethylene di-amine tetra acidic acid
A. stool monitoring
B. Ethylene di-amine tetra acetate
B. platelet count monitoring
C. Electrolytes di-amine tetra acidic acid
C. white blood cell count monitoring
D. none of above
D. serum potassium monitoring
51. Which of the following anticoagulant can
45. Warfarin is an antagonist of vitamin: be used in vivo?
A. B A. Sodium fluoride
B. C B. Sodium citrate
C. K C. Thrombin
D. A D. Heparin
46. Which of these specialties are platelet ag- 52. Mr Izka is going to run a test that will de-
gregation inhibitors? termine the rate of blood cell precipitate in
one hour. What type of anticoagulant that
A. Aspegic® used in this test?
B. Kardegic® A. sodium citrate
C. Plavix® B. heparin
D. Lovenox® C. plain tube
E. Calciparine® D. oxalate

53. What element of blood is involved in pri- 59. the aod are indicated in case of:
mary hemostasis? A. stroke prevention and systemic em-
A. Leukocytes bolism in adults
B. Platelets B. prevention of venous thromboem-
C. Lymphocytes bolic disease after scheduled orthopedic
surgery
D. Erythrocytes
C. TTT of non-serious DVT and PE
E. Enzymes
NARAYAN CHANGDER
D. Atherosclerosis TTT
54. what are oral anticoagulants?
E. DTT of acute myocardial infarction
A. Aspirin
60. concerning the heparin/AVK relay:
B. Plavix
A. we administer them one by one
C. Pradasha
B. they are administered simultaneously
D. Eliquis
C. up to INR sup or = 2 for 2 consecutive
55. what are the risks of VKAs? days
A. hemorrhage due to underdosage D. up to INR greater than or equal to 1 for
B. bleeding due to overdose 3 consecutive days
C. underdose-related thrombosis 61. AAPO are indicated in case of:
D. overdose-related thrombosis A. myocardial infarction
56. Which of the following are the pathway of B. anchor
blood coagulation C. arteritis obliterans of the lower limbs
A. Extrinsic and intrinsic D. ischemic stroke
B. Primary and secondary E. DTT atheroslerosis
C. Extinsic or intinsic
62. What are the contraindications for hep-
D. none of above arins?
57. Medications that prolong bleeding time A. History of HIT
and help to prevent harmful clots are B. Severe renal failure in curative treat-
known as: ment
A. thrombolytics C. Uncontrolled high blood pressure
B. anticoagulants D. Severe renal failure in preventive
C. coagulants treatment
D. antiplatelets E. recent hemorrhagic stroke
58. Examples of ATCOD drug names? 63. clinical signs of AVK overdose
A. acyclovir A. nosebleed
B. Pradasha B. vomiting
C. Harelto C. headaches
D. insulin D. hematuria
E. eliquis E. hematoma

64. Which of the following test used heparin 70. What formation that leads to stop bleed-
tube? ing from damaged area by coagulation?
A. Complete blood count

A. Clot formation
B. Fasting glucose level B. Wound formation
C. Osmotic fragility test C. Fibrin formation
D. Blood smear D. none of above
65. Warfarin is popularly marketed as: 71. What is the correct order of the stages of
A. Ticlid hemostasis?
B. Plavix A. Fibrinolysis, Vasoconstriction, Primary
Hemostasis, Coagulation
C. Coumadin
B. Vasoconstriction, Coagulation, Pri-
D. Streptase
mary Hemostasis, Fibrinolysis
66. While the major adverse effect of heparin C. Coagulation, Vasoconstriction, Pri-
therapy is hemorrhage, another adverse mary Hemostasis, Fibrinolysis
effect involves blood pooling in the skin,
D. Vasoconstriction, Primary Hemostasis,
which is called:
Coagulation, Fibrinolysis
A. hematopoiesis
E. Fibrinolysis, Primary Hemostasis, Co-
B. hemarthrosis agulation, Vasoconstriction
C. subdural hematoma
72. What is the standard for NFS platelets?
D. ecchymosis
A. 200-450 g/L
67. Fibrinolysis is the: B. 150-450 g/L
A. building up of fibrin C. 450-750 g/L
B. building up of fibrinogen D. 450-900 g/L
C. breakdown of fibrin
73. About antiplatelet drugs:
D. breakdown of fibrinogen
A. Acetylsalicylic acid is an antiplatelet
68. Which of the following dissolve blood agent
clots?
B. They have a role in primary hemostasis
A. Hemolytics
C. They have a role in secondary
B. Antiperfusion agents hemostasis
C. Platelet aggregation inhibitors D. They are contraindicated during preg-
D. Thrombolytics nancy and lactation
69. what are the different types of heparin? E. They are contraindicated in cases of
severe renal insufficiency
A. unfractionated heparins (UFH)
B. low molecular weight heparins 74. heparin antidote
(LMWH) A. vitamin K
C. Plasma heparin B. Naloxone
D. Heparin sodium C. Sulfate de protamine
E. Heparin calcium D. Fluimucil

5.3 Diabetic Retinopathy 382
5.3 Diabetic Retinopathy

1. What OCT biomarker is closely related as a 5. Which includes the Inclusion Criteria in this
long-term predictor of visual acuity in this journal?
study? A. Centre Involve DME
A. Intaknya ILM and EZ coating B. History of macular laser treatment
B. Intaknya RPE and ELM layers C. Vitreoretinal surgery history
NARAYAN CHANGDER
C. Intact the ELM and EZ layers D. History of Amblyopia
D. Intanya intraretinal lining
6. Rearrange the sequence of loss of
2. Which of the following best explain hard glycosaminoglycans (GAGs) in diabetic
exudates which is one of the observation retinopathy? i. Vascular leakage from
in diabetic retinopathy? the retinal capillaries followed by microa-
neurysmsii. Collagen progressively re-
A. Growth of new vessels to bypass the places the GAGs of the basal membraneiii.
damaged blood vessel The substitution of GAGs by collagen leads
B. Fluid which collected under the macula to a basal membrane thickeningiv. Vas-
cular permeability due to altered anionic
C. Bleeding in the retina charge
D. Accumulation of serum proteins and A. i, ii, iii, iv
lipids deposit in the retina from vascular
leakage B. ii, iii, i, iv
C. iii, ii, iv, i
3. What statistical analysis was used to as-
D. ii, iii, iv, i
sess the relationship between Visual Acu-
ity and other variables in this journal? 7. What retinal structures were observed
A. Stepwise multiple regression and assessed both qualitatively and quan-
titatively with OCT in the research in this
B. Qualitative analysis
Journal?
C. Cross sectional A. Internal Limiting membrane, Ellipsoid
D. Quantitative analysis Zone, Retinal Pigment Epithelium
B. External Limiting membrane, Retinal
4. Which of the following regarding to Non
Pigment Epithelium, Bruch’s membrane
Proliferative DR (NPDR) are TRUE? (mul-
tiple selection) C. Inner Nuclear Layer, Retinal Pigment
Epithelium, Membrane Bruch
A. It is a diabetic retinopathy with no new
blood vessel formation D. External Limiting membrane, Ellipsoid
Zone, Retinal Pigment Epithelium
B. Less severe form of diabetic retinopa-
thy 8. Which is not a benefit of DRIL in the jour-
C. Micro-aneurysm and haemorrhage are nal below is
common symptoms A. Predict visual outcome
D. There are presence of new vessel for- B. Patient education in terms of therapy
mation in the retina performed

5.4 Facial Nerve Palsy 383
C. Become an imaging biomarker that B. Lucentis, Triamcinolone acetonide,

can be used to classify patients for treat- atau Bevacizumab
ment

C. Bevacizumab, Ranibizumab, or Afliber-
D. Can be used as a benchmark for the cept
prognosis of patients D. Lucentis, Triamcinolone acetonide,
9. One of the limitations of research in this atau Eylia
journal is? 12. Which of the following are the findings
A. In the data collection process, the from DRESS study? (multiple selection)
information provided by respondents A. There is a significant statistical differ-
through a questionnaire ence in the improvement of hard exudates
B. Trial uses large funds B. Oral sulodexide therapy over 12
C. The trial was not conducted in a large months improved macular hard exudates
multicenter in patients with mild-to-moderate NPDR
D. The number of respondents is limited C. There are no statistical difference in
the adverse effects among sulodexide and
10. What is the thickness of CMT which is cate- placebo
gorized as Resolved DME in this journal?
D. Placebo has more side effect com-
A. CMT 250 um pared to sulodexide group
B. CMT < 315 um
13. Which includes the exclusion criteria in this
C. CMT 275 um journal?
D. CMT 315 um A. patient with amblyopia
11. What are the anti-VEGF regimens used in B. patient with CI-DME in at least 1 eye
the research in this journal? C. Patients with a history of DME on anti-
A. Triamcinolone acetonide, Beva- VEGF therapy
cizumab, or Ranibizumab D. patients with age equal to 18 years
5.4 Facial Nerve Palsy

1. What is Tardy Ulnar Palsy? 2. Damage or compression to which nerve
causes Claw Hand Deformity.
A. The result of diagnostic and therapeu-
tic procedures undertaken on a patient. A. Radia Nerve
B. An assessment designed to measure B. Musculocutaneous Nerve
physical function and symptoms in people
C. Median Nerve
with musculoskeletal disorder of the up-
per limb. D. Ulnar Nerve
C. Compression or damage to the ulnar
3. What did you learn today?
nerve presenting delayed symptoms.
A. Causes of Tardy Ulnar Nerve Palsy
D. Delayed neurological symptoms of the
1st, 2nd, and 3rd digit. B. Surgical Interventions for treatment

5.5 Bell’s Palsy 384
C. Common Mechanisms of Injury and 7. What are the outcomes with surgical inter-
Risk Factors vention?
D. Nothing A. 85% of patients saw improvement
4. What is a common deformity of Tardy Ul- B. 70% of patients saw improvement
nar Nerve Palsy? C. 50% of patients saw improvement
A. Claw Hand Deformity
D. 15% of patients saw improvement
B. Swan Neck Deformity
NARAYAN CHANGDER
C. Benediction Hand Deformity 8. Which of the following is NOT a surgical
intervention for Tardy Ulnar Palsy?
D. Ape Hand Deformity
A. Cubital Tunnel Release
5. What is common Mechanism of Injury?
B. Ulnar Nerve Anterior Transpotation
A. Degenerative or Inflammatory Dis-
eases C. Medial Epicondylectomy
B. Ulnar Nerve Compression/Injury D. Lateral Posterior Release
C. Iatrogenic or Occupational Diseases
9. Which assessment would be appropriate
D. All of the Above for assessing Tardy Ulnar Nerve Palsy?
6. Which of the following is not a symptom A. Fatigue Severity Scale
of Tardy Ulnar Palsy? B. Disabilities of the Arm, Shoulder, and
A. Weakness Hand
B. Muscular loss C. Detailed Assessment of Speed of
C. increase in strength Handwriting
D. Sensory Deficit D. Assessment of Driving-Related Skills
5.5 Bell’s Palsy

1. A patient with Bell’s palsy is known to D. none of above
have a disorder of which cranial nerve?
3. Temporary paralysis of the seventh cranial
A. facial (VII)
nerve that causes paralysis only of the af-
B. trigeminal (V) fected side of the face is-
C. abducens (VI) A. Bell’s palsy
D. glossopharyngeal (IX) B. Myelitis
2. When are all functions affected? C. Sciatica
A. If the lesion is after the geniculate gan- D. Stupor
glion
4. Cranial nerve that affects the ability to
B. If the lesion is just after the stylomas-
smile
toid foremen
C. If the lesion is before the geniculate A. vagus
ganglion B. coccygeal

C. abducens 10. Facial nerve paralysis is a sign of

D. facial A. Cancer

5. Among the clinical manifestations that can B. Stroke
be seen in Bell’s Palsy patients are as fol- C. Bell’s Palsy
lows:i. facial muscles deviate to the side
D. All of the above
involved. ii. saliva secretion. iii. failure
to open the eyes iv. hypersensitivity of 11. Which of the following medical treatments
the involved part. is least likely prescribed for Bell’s Palsy?
A. (ii) and (iii) A. Corticosteroids
B. (i) day (iv)
B. Eye patch/eye drops
C. (i) and (ii)
C. Surgery
D. (iii) and (iv)
D. Pain relievers
6. How many branches of the facial nerve are
there? 12. Which is correct if your client is having a
stroke vs Bell’s Palsy?
A. 2
A. The lower face is always affected
B. 3
B. Symptom onset is seconds
C. 4
D. 5 C. Upper face is always affected
D. Age of client is typically 20-35 years
7. Which cranial nerve is the facial nerve?
A. CN VI 13. Which region of the brain does the facial
nerve originate?
B. CN VII
C. CN IX A. Thalamus
D. CN VIII B. Midbrain
C. Pons
8. Which of the following is not a branch of
the facial nerve? D. Medulla
A. Buccal 14. A man (40 years) came to the hospital
B. Cervical with complaints of headaches which in-
C. Temporal creased when he coughed or bent over,
if he had pain, nausea, vomiting and
D. Maxillary convulsions a week ago. Complaints of
E. Zygomatic seizures preceded by visual disturbances.
The results of the doctor’s examination
9. Bell’s Palsy has the following characteris-
stated that there was a high probability
tics except:
that there was a tumor in the brain and
A. signs and symptoms are subacute further examination was needed immedi-
B. saliva secretion ately. Based on the patient’s complaints,
where is the location of the tumor?
C. uncontrollable tear secretion
D. the condition of the mouth is deviated A. Frontal Lobe
to the abnormal side B. Temporal Lobe

C. Parietal Lobe From the examination he was diagnosed

D. Occipital Lobe with bell’s palsy and did not need to be
treated. Is nursing education a priority in
E. Before cases?
15. What is Bell’s Palsy? A. Use artificial tears four times a day to
A. Unilateral facial paralysis lubricate the eyes
B. Irreversible axonal damage and scar- B. Massage is combined with warm and
moist heat
NARAYAN CHANGDER
ring of the myelin sheath
C. Occluded blood flow to CN VII C. Providing a gentle diet that does not
require chewing
D. Loud ringing in the ears
D. face ROMs
16. Which of the following muscles is not in- E. Collaborative use of nerve damage
nervated by the 7th cranial nerve? drugs
A. Orbicularis occuli
20. Numbed by the dentist when you’re get-
B. Orbicularis oris ting a cavity filled in the lower jaw
C. Buccinator A. Occulomotor
D. Temporalis B. Trigeminal
17. Massage therapy for Bell’s Palsy: C. Facial
A. Provides a sense of relaxation D. Glossopharyngeal
B. Improves the neural pathways so that 21. When performing testing, a client with
the client will recover faster Bell’s Palsy will exhibit all of the following
C. Improves active range of motion of the except:
facial muscles A. Inability to close the affected eye
D. Prevents damage to the affected eye B. Inability to open the affected eye
18. Parkinsonism is a disorder of brain func- C. Inability to fully smile showing the
tion that is responsible for abnormal mus- teeth
cle movements. The main characteristics D. Inability to fully smile without showing
presented by the patient are as follows ex- the teeth
cept:
A. Rigidity (stiffness) in the neck 22. A woman (53 years) was admitted to
the ICU with a sudden loss of conscious-
B. ‘Tremor’ (shaking) of the fingers dur- ness when the patient was cooking in
ing rest the kitchen. The patient has paralysis
C. Hypokinesia of the facial muscles, unable to frown
D. I was in a hurry and the right corner of the mouth cannot
be lifted. The patient’s food always col-
19. A man (42 years) was brought to the hos- lects between the cheek and gum on the
pital by his family because of paralysis of right. The patient was diagnosed with
the upper left eyelid. The patient said that Bell’s palsy for 1 year. Where is the lo-
initially he felt pain then numbness in the cation of the neurological damage experi-
left face and the patient could not frown. enced in this case?

5.6 Hyperthyroidism 387
A. The damage is as high as between the 24. Taste sensation on the anterior 2/3 of the
chorda tympani and the stapedius nerve tongue

B. Damage level between the stapedius A. facial
nerve and the geniculate ganglion B. trigeminal
C. Damage to the level of the stylomas- C. glossopharngeal
toid foramen
D. hypoglossal
D. Damage to the level of the geniculate
ganglion 25. Regarding Bell’s Palsy prognosis:Which of
E. Damage to the internal acoustic the following is incorrect?
porous A. A complete lesion has a poorer progno-
sis
23. What functions does the facial nerve inner-
vate? B. If there is pain with the onset, a poorer
prognosis is likely
A. Muscles of facial expression
C. Medical treatment improves the recov-
B. Muscles of mastication ery by 70%
C. Taste on the anterior 2/3 of the tongue D. Many recover within 3 months without
D. Tear & saliva production treatment
5.6 Hyperthyroidism
1. The nurse is caring for a postoperative D. Change in apical HR from 72 bpm to 94
patient 24 hours following a partial thy- bpm
roidectomy for persistent hyperthyroidism.
What assessment data should the nurse 2. A patient reports they consume too much
immediately report to the HCP? of foods that contain iodine. What condi-
tion are they most susceptible to?
A. Change in temperature from 99 F to
100.4 F A. Type I Diabetes Mellitus
B. Change in RR from 30 to 22 B. Pheochromocytoma
C. Change in pulse oximeter from 93% to C. Hypothyroidism

91% D. Hyperthyroidism
5.7 Osteoporosis
1. what food can you eat to cure osteoporo- Turmeric/Curcumin?
sis
A. Doctor’s Best Curcumin C3 Com-
A. kale plex®is a potent antioxidant that protects
B. eggs cells and tissues by fighting free radicals
and proven to support healthy joint func-
C. asparagus
tion.
D. cucumber
B. Curcumin blocks certain enzymes and
2. Which statement is/are true about cytokines that lead to inflammation. This

5.7 Osteoporosis 388
sheds light on the possibility of curcumin 7. Pregnancy and lactation is known to:
as a complementary treatment for RA.
A. Decrease calcium requirements
C. BioPerine®, an extract of Black Pep-
per fruit that contains 95-98% piperine, as B. Result in bone mineral loss from the
a natural bioenhancer to help in absorp- skeleton
tion of curcumin.
C. Decrease the rate of dietary calcium
D. Curcumin is the main active ingredi- absorption
ent in turmeric. It has powerful anti-
NARAYAN CHANGDER
inflammatory effects and is a very strong D. Affect bone mineral content later in
antioxidant. life
E. All of the above.
8. A client who is at risk for developing os-
3. Risk factor’s teoporosis asks what can be done to de-
A. Women crease the risk of actually developing the
disease. Which intervention would be the
B. Age most beneficial for this client?
C. Athlete
A. Decreasing the amount of calcium in
D. Vegan the client’s diet
E. High dairy intake
B. Providing the client with assisted
4. There are lifestyle habits that can help im- range of motion exercising twice daily
prove bone quality, such as:
C. Increasing regular weight-bearing ac-
A. adequate calcium intake tivities
B. fruit consumption
D. Protecting the client’s bones with
C. physical exercise strict bedrest
D. drink a lot of water
E. No Smoking 9. What is osteoporosis?
5. Sally has a blood vessel that is blocked A. Softening of the bones due to lack of
in her brain due to atherosclerosis. She vitamin D
is having difficulty speaking and left sided B. decreased bone density
weakness. She is experiencing a
A. myocardial infarction C. Bones become brittle and more likely
to break
B. stroke
C. hypoglycemic attack D. All are correct
D. hypotensive attack
10. Which of these is a doctor you could see
6. What cells help in the process of bone for- for Osteoporosis?
mation?
A. Cardiologist
A. Osteoclasts
B. Endocrynologist
B. Osteoblasts
C. Estrogen C. Nurse
D. Insulin D. Surgeons

11. What is the main mineral that is added to 16. Osteoporosis caused by reduced produc-
bone tissue in ossification? tion of the hormone estrogen is called?

A. Calcium A. Osteoporosis type 1
B. Magnesium B. Osteoporosis seconds
C. Sodium C. Idiopathic Osteoporosis
D. Potassium D. Osteoporosis Type 2 (Senile)
12. They are NON-MODIFIABLE factors of car- 17. The following statements describe the
diovascular pathologies functions of SAM-e EXCEPT for one:
A. age, gender, smoking A. It is a naturally occurring amino acid
B. Diabetes Mellitus, overweight that supplies energy to all cells in the
body.
C. age, gender, family history
B. It helps to enhance mood and promote
D. Arterial hypertension
cognitive health.
13. An assessment finding that alerts the C. It promotes joint comfort and mobility
nurse to the presence of osteoporosis in and supports liver health and detoxifica-
a middle-aged patient is tion.
A. the presence of bowed legs D. It is required for the biosynthesis of
B. measurable loss of height critical neurotransmitters and hormones.
C. an aversion to dairy products 18. contains antioxidant, have pain-
D. statements about frequent falls relieving and anti-inflammatory proper-
ties. It also supports healthy prostate
14. he nurse is providing teaching to a young function.
adult who is at risk for early-onset os-
teoporosis. Which intervention should the A. Boswellin
nurse suggest? B. Chinese skullcap
A. The client should stop all physical ac- C. Stinging nettle
tivity. D. Ginger
B. The client should reduce the intake of
dairy in the diet. 19. What is the definition of osteoporosis?
C. The client should increase intake of A. Damage to bone mass
calcium and vitamin D. B. Hollow bones
D. The client should start estrogen re- C. Reduced bone mass so that bones
placement therapy. break easily
15. What is the age range that osteoporosis D. Bone mass is slightly lower than nor-
affects? mal people
A. 14-18 20. Factor associated with a low risk of osteo-
B. 41-60 porosis
C. 41-60+ A. White race
D. 19-40 B. Physical inactivity

C. Obesity 26. A postmenopausal adult client is concerned

D. high calcium intake about the development of osteoporosis
and wants to begin preventative activities.
21. for short-term treatment of fracture; Which statement by the nurse is appropri-
ate?
A. short exposures to the sun
A. “You should first determine if you are
B. it is good to leave the affected area in at risk for the development of osteoporo-
the air sis.”
NARAYAN CHANGDER
C. it is good to immobilize the affected B. “After menopause, the decline is
area too rapid to begin preventative interven-
D. it is advisable not to take calcium tions.”
C. “Weight-bearing exercise and calcium
22. Which of the following test is considered supplements are helpful in the prevention
as gold standard to assess osteoporosisa) of osteoporosis.”
A. CT Scan. D. “Hormone replacement therapy
B. X-ray. should be initiated as soon as possible.
“
C. Gallium study.
D. Bone density test. 27. Which of the following statements about
Osteoarthritis is/are true?
23. Which are modifiable risk factors for os- A. It occurs when the protective cartilage
teoporosis? that cushions the ends of the bones wears
A. Age down over time.
B. History of osteoporosis B. Osteoarthritis symptoms can usually
be managed, although the damage to
C. Intake of vitamins and minerals
joints can’t be reversed.
D. Chronic disease C. Staying active and maintaining a
healthy weight might slow progression
24. What is one thing that does not prevent
of the disease.
osteoporosis?
D. All of the above.
A. drinking soda
B. exercise regularly 28. which of these options is correct?
C. being a nonsmoker A. osteoporosis is a symptom of fi-
bromyalgia
D. eating a calcium rich diet
B. Vitamin C is a fundamental substance
25. Select the correct option. Is it a medium- for bone
term objective? C. the fracture causes severe pain and
A. Ease the pain may require surgery
B. prevent deformities D. osteoporosis is excess calcium
C. Improve and potentiate respiratory ca- 29. Select the correct option. Is it a primary
pacities prevention intervention in osteoporosis?
D. health education A. prevent fractures

B. Avoid loss of bone mass 35. Biocell®and UC-II®are collagen derived

from which source?
C. Avoid sedentary lifestyle
A. Beef

D. avoid falls
B. Shellfish
30. What is the main preventive measure for C. Chicken
osteoporosis? D. Shark
A. Diet rich in calcium. 36. Is osteoporosis characterized by?
B. Anti-inflammatories. A. bad bone formation
C. Antibiotics. B. bone hardness
D. ointments. C. Low bone mass density and by deteri-
oration of the microarchitecture of bone
31. prevention of a fracture: tissue
A. extreme sports D. cell loss
B. plenty of exercise, consume calcium 37. Symptoms of CHD

and vitamin D A. Shortness of breath
C. sedentary life and consumption of B. Fatigue
meat foods C. Nausea
D. all are correct D. All of the Above
32. At what age do we begin to lose Bone? 38. Osteoporosis Classification

A. Osteoporosis Primaria
A. Mid 30’s
B. Osteopenia
B. 70’s
C. Secondary osteoporosis
C. Mid 20’s D. Osteoporosis
D. Mid 40’s E. Osteoporosis Grave
33. What cells cause the process of bone re- 39. A mother checked her bone mineral den-
sorption? sity (BMD) with a T-Score of-2.8. The
mother’s BMD results can be catego-
A. Osteoclasts rized?
B. Osteoblasts A. Normal
C. Estrogen B. Osteopenia
D. Insulin C. Osteoporosis
D. Abnormal
34. What causes bones to become less dense?
40. What are LDLs?
A. osteoporosis
A. Liver Deadly Levels
B. athritis B. HDLs
C. fracture C. Good Cholesterol
D. sprain D. Low-Density Lipo Proteins

41. A nurse is conducting a health history on 45. Indicates What is a T-score value for se-
an older adult client. Which assessment vere osteoporosis?
finding indicates the client is at risk for os-
A. -2.5
teoporosis?
B. -2.5 w/ fragility fracture
A. Having a body mass index (BMI) that
indicates obesity C. -2.1 w/ fragility fracture
B. Using glucocorticoids for 10 years be- D. -3 s/ fragility fracture
cause of a chronic lung disorder
NARAYAN CHANGDER
46. If you don’t drink enough milk (aka eat
C. Eating three to five servings of shrimp
enough calcium), where will your body get
and liver per week
the calcium it needs for cardiac and neural
D. Drinking three glasses of skim milk function?
daily
A. it doesn’t and you get sick.
42. The loss of bone mass occurs in 2 stages. B. from your bones
A. senescence C. it makes its own from other minerals
B. YOUTH D. none of above
C. THE MENOPAUSE
47. What is a fracture?
D. ADULTHOOD
A. muscle loss
43. The so-called strain is B. infectious wound
A. Ligament lacerations in joints C. a break usually in the bone
B. Muscle lacerations in joints D. skin lesions
C. Tendon lacerations in joints
48. What bone cells decrease their activity in
D. Capsule laceration of the joint
elderly people?
44. Which statement below best describe for A. Osteoblast.
Doctor’s Best, Best MSM?
B. Osteocito.
A. Helps to maintain joint health through
C. Osteoclasto.
its ability in the formation of proteogly-
cans. D. Osteoprogenitoras.
B. Attracts water to the tissue, which
49. Which of the following are risk factors for
helps the joint stay elastic and function as
osteoporosis? (check all that apply)
a shock absorber for joint.
A. white/asian
C. Methylation is an essential process in
ensuring healthy joint function. B. havina a small body frame
D. A sulfur compound which may C. eating prednisolone like candy for
help mitigate* joint tissue break- more than 3 months
down and promotes healthy joint func-
D. poor diet
tion.*Mitigate=make something bad less
serious E. Having had a hysterectomies’

50. What are the health risks of Osteoporo- 56. what is osteoporosis?
sis? A. bone disease

A. Not being able to stand up. B. blood disease
B. Fainting. C. skin disease
C. Increasing risk of fractures. D. hair loss
D. Death.
57. A condition where bones become brittle
51. bone mass decreases after how many and fragile from loss of tissue
years of age? A. Lifestyle Disease
A. 60+ B. Disease
B. 41 C. Bones
C. 35 D. Osteoporosis
D. 50
58. What is NOT a contributing factor to the
52. What is Osteoporosis? development of Osteoporosis?
A. Minor bone loss A. Being Physical Active
B. something you only have to worry B. Family History
about after your 50+ yrs old C. A diet low in Calcium and Vitamin D
C. Age-related bone loss D. Excess Sodium and Caffeine intake
D. Only affects women E. decline in estrogen
53. Who is most at risk of osteoporosis? 59. Which cells cause bone resorption?
A. children A. Osteoclasts
B. teenagers B. Osteoblasts
C. the men C. Estrogen
D. women D. Insulin
54. What is an advantage of the T score? 60. How can you prevent Osteoporosis
A. simplicity A. Go to the chiropractor more often.
B. Depends on the reference population B. Eat lots of fish and broccoli.
C. Does not provide information on other C. Donate more blood.
risk factors D. When you are young drink lots of milk
D. does not have criteria so you have more dense bones.
55. What body systems are affected 61. What supporting tissue is lost in the great-
A. Your circulatory system. est amount in osteoporosis?
B. Your bones because you lose bone den- A. Spongy bone.
sity. B. Cortical bone.
C. Your digestive system. C. hyaline cartilage.
D. Your muscular system. D. Fibrous cartilage.

62. Why is high blood pressure or hyperten- C. Humerus

sion a ‘silent’ killer? D. Lumbar and arm bones
A. It has no sound
67. A community health nurse is providing
B. It has no symptoms a teaching session on osteoporosis to
C. It kills people women living in the community, the nurse
informs these community residents that
D. It is a leading cause of death in the
which of the following is a risk factor for
world
this disorder
NARAYAN CHANGDER
63. What is the classification of primary osteo- A. A larger skeletal frame
porosis? B. Low thyroid hormone levels.
A. Postmenopausal (type I)-Senile (II) C. A diet low in Vitamin D
B. Posmenopausica-Senil (III) D. A high dietary intake of calcium.
C. A and B are correct.
68. Systemic skeletal disease, characterized
D. None by low bone mass.
64. Doing active physical activity is one way A. Osteopenia

to prevent osteoporosis, why? B. Esclerosis Multiple
A. Physical activity increases the process C. Osteoporosis
of absorption by osteoclasts D. none of above
B. Physical activity reduces the process
69. First aid for 2nd degree strains/sprains
of absorption by osteoclasts
A. Metode RICE
C. Physical activity increases the process
of bone formation by osteoblasts B. rest
D. Physical activity decreases the pro- C. Immobilization
cess of bone formation by osteoblasts D. Reposition
65. What is cardiovascular disease? 70. The immobile client is at risk for disuse
osteoporosis, the nurse understands that
A. Cancers that involve the heart and
which of following substances plays an im-
blood vessels
portant role in the bone remodeling pro-
B. Group of disorders that involve the cess
heart and blood vessels
A. Vitamin C.
C. Group of disorders that involve the B. Vitamin A.
liver and spleen
C. Calcitonin.
D. Group of disorders that involve the
heart and the arms D. Thyroid hormone.
71. Osteoporosis only affects women?
66. Osteoporosis type 1 usually occurs where
bone demineralization occurs in the bone A. And
where? B. No
A. Tibia C. affects both
B. Pelvis D. none of above

72. The goal of osteoporosis treatment C. candy

A. increase calcium D. all of these are correct

B. It is the reduction in the number of 78. BONE CELL THAT DESTROYS BONE
fragility fractures.
A. OSTEON
C. reduce pain
B. OSTEOCYTE
D. timely operation C. OSTEOCLAST
73. Which bones are more complicated when D. OSTEOBLAST
recovering from an osteoporotic fracture?
79. The American Heart Association has en-
A. femur and ribs dorsed a diet program to stop hyperten-
B. radius and ulna sion. What is the name of this diet pro-
gram?
C. clavicle and shoulder blade
A. Low fat diet
D. spine and hip
B. DASH diet
74. What are the causes of Osteoporosis? C. Low sodium diet
A. An imbalance between new bone for- D. Keto diet
mation and old bone resorption.
80. What is this condition that is characterized
B. When the red blood cell’s have too
by a chronic inflammatory disease in which
much oxygen to keep the Bone alive.
the immune system attacks the joints and
C. When you eat too much meat. sometimes other parts of the body?
D. When your bone hit’s something too A. Patellar Tendon Tear
hard.
B. Rheumatoid Arthritis
75. at what age do symptoms start to appear. C. Osteoarthritis
A. 30 D. Gout
B. 35 81. KNOW WHAT IS OSTEOPOROSIS?
C. 44 A. It is a skeletal disease in which there
D. 45 is a decrease in bone mass density.
B. It is a skeletal condition in which it pro-
76. If you have osteoporosis it means you
duces an increase in bone mass density.
have a lack of what in your bones?
C. It is a skeletal benefit that produces
A. calcium none of the bone mass density.
B. vitamin D D. none of above
C. chloride
82. what percentage of men are affected by
D. both A and B are right osteoporosis?
77. what do your bones look like if you have A. 50%
osteoporosis? B. 25%
A. sponges C. 20%
B. a tooth with cavities D. 80%

83. Roy has a strong family history of heart B. feeding

disease, what can Roy do to decrease his C. Vitamin D
risk of developing heart disease?
D. Soccer
A. weight control
B. diet low in fat 89. PTH indirectly stimulates osteoclasts to re-
lease calcium from bones into the blood.
C. exercise This results in
D. all of the choices A. lower blood calcium levels and higher
NARAYAN CHANGDER
84. Proteolytic enzymes are used to support bone calcium levels
for muscle, joint and overall tissue health. B. lower levels of both blood and bone cal-
Which enzyme IS NOT in Doctor’s Best Pro- cium
teolytic Enzyme? C. higher levels of both blood and bone
A. Pancreatine calcium
B. Bromelain D. higher blood calcium levels and lower
bone calcium
C. Serratiopeptidase
D. Papain 90. Braden has atherosclerosis. He is at risk
for developing
85. Vitamin D helps your body
A. myocardial infarction
A. absorb protein
B. stroke
B. get rid of calcium
C. diabetes
C. absorb calcium
D. myocardial infarction and stroke but
D. break down protein not diabetes
86. Osteoporosis is a skeletal disease charac- 91. Active physical activity is one way to pre-
terized by decreased vent osteoporosis, why?
A. bone architecture A. Physical activity increases the resorp-
B. muscular time tion process by osteoclasts
C. bone mass B. Physical activity decreases the resorp-
tion process by osteoclasts
D. the fragility
C. Physical activity increases the process
87. Why is osteoporosis called the “silent epi- of bone formation by osteoblasts
demic”? D. Physical activity decreases the pro-
A. Does not produce symptoms cess of bone formation by osteoblasts
B. no fractures 92. The management of joint dislocations be-
C. there is no diagnosis low is for dislocations accompanied by
D. none of above fractures, except
A. Closed Repositioning
88. What does the strength of the bone de-
pend on? B. Open Repositioning
A. Osteoclasts, osteoblasts and osteo- C. Retaining

cytes D. Rehabilitation

93. What are the chances of getting Osteo- C. It presents many symptoms
porosis? D. All are correct

A. 1 in 6 Women, 4 in 10 Men
99. common symptoms of osteoporosis
B. Its totally random
A. bone tone change
C. 1 in 4 Women, 2 in 5 Men
B. height loss and pain
D. 1 in 3 Women, 1 in 5 Men C. redness
94. The etiology of Osteophorosis, except D. Headaches
A. Genetic 100. Pharmacological Treatment of Osteoporo-
B. DM sis
C. Women A. bisolfren
D. Age B. MATERIAL
C. Bisphosphonates
95. What helps prevent High Blood Pressure?
D. Soccer
A. Physical Excersise
101. What are the symtoms of Osteoporosis?
B. Stress Management
A. Loss of weight, wanting junk food.
C. All of the Above
B. Never wanting to eat.
D. Low Sodium Diets
C. A hunched over posture, easy to brake
96. A nurse is conducting health screening bones, when you even bend over you could
for osteoporosis, which of the following fracture your bone, back pain, loss of
clients is at greatest risk of developing this height.
disorder D. Get tired more easily and spend more
A. A 25-year old woman who jogs time in your house.
B. A 36-year old man who as asthma 102. Which is NOT a way to prevent the de-
C. A 70-year old man who consumes ex- velopment of Osteoporosis
cess alcohol A. Maximizing peak bone density
D. A sedentary 65-year old woman who B. Engaging in regular physical activity
smokes cigarettes
C. Eating a healthy diet rich in Vitamin D
97. A disease linked with the way people live and Calcium
their lives. D. Nothing-you don’t need to worry about
A. Lifestyle Disease it until your over 50
B. Osteoporosis 103. What is osteomalacia?

C. Endocrynologist A. Softening of the bones due to lack of
vitamin D
D. Disease
B. decreased bone density
98. Select osteoporosis overview
C. Bones become brittle and more likely
A. silent disease to break
B. Presents at an early age D. All are correct

104. Select the INCORRECT answer. What is B. Osteoarthritis is the most common
the short-term treatment for osteoporo- form of arthritis, it is an autoimmune con-
sis? dition.
A. electrotherapy C. OA doesn’t have a cure.
B. magnetotherapy D. Losing as little as 5 pounds can help
decrease the symptoms of OA.
C. hydrotherapy
110. At what age does senile osteoporosis (II)
D. weight transfers
NARAYAN CHANGDER
affect?
105. Primary osteoporosis usually occurs bone A. Over 30 years.
demineralization in the bone where? B. Over 70 years.
A. Tibia C. Under 50 years.
B. Pelvis D. None
C. Humerus 111. Fractures of the neck of the femur appear
D. Lumbar and arm bones in a:
A. 15% of osteoporotic women and 5% of
106. It is a major risk factor for osteoporosis.
men
A. height increase B. 20% of osteoporotic women and 15%
B. chronic back pain of men
C. Be under 65 years of age C. 10% of osteoporotic women and 5% of
men
D. Active life
D. None
107. What is bone mineral density?
112. Signs and symptoms of Osteoporosis
A. amount of fat A. Headache
B. Amount of bone material in the skele- B. spontaneous fractures
ton
C. height increase
C. amount of minerals
D. infrequent fractures
D. none of above
113. Select possible treatment methods?
108. Which of these is the biggest option to A. Healthy Diet
treat Osteoporosis?
B. doing nothing and hoping for the best
A. Be Prescribed Medications C. Resistant Training
B. Eat Food D. Weight-bearing exercises
C. Run
114. Preventive measure for osteoporosis
D. Diet without Calcium A. Educate on good nutrition and physical
activation
109. What statement below does not describe
Osteoarthritis (OA)? B. smoking
A. Weight, family history and occupation C. Balance diet
are some of the risk factors of OA. D. none of above

115. Physical agents that can be used in pac. C. greater than-2.5 with fracture
with OP D. greater than-

A. hot wet compress
121. When blood calcium levels drop, what
B. Kotz current happens to PTH?
C. aerobic exercise A. it increases to increase blood calcium
D. Ultrasound levels
E. Laser B. it decreases to increase blood calcium
levels
116. How do you prevent Osteoporosis?
C. it increases to decrease blood calcium
A. Have Iron rich products. levels
B. Have Calcium rich products. D. it is unchanged
C. Don’t do sports.
122. Select the clinical manifestations of osteo-
D. Eat Fruits. porosis
117. An older female client is diagnosed with A. Arthralgia
osteoporosis, the nurse teaches the client B. low back pain
about self-care measures because the
client is most at risk for which of the fol- C. Rigidity
lowing as a result of this disorder of the D. None
bones
123. What is osteopenia?
A. Nutritional deficiencies.
A. Softening of the bones due to lack of
B. Loss of appetite. vitamin D
C. Fractures. B. decreased bone density
D. Diarrhea. C. Bones become brittle and more likely
118. Risk factors for osteoporosis to break
A. Age greater than 40 years. D. All are correct
B. Environmental factors 124. Select the treatments that can be applied

C. Medicines in a Pac. with OP
D. All are correct A. weight downloads

B. Short lever exercises without distal
119. main cause of weakening of the bones loading
A. they are all false C. postural correction
B. bone loss and osteoporosis D. hydrotherapy
C. loss of red blood cells and melanin E. high frequency electrotherapy
D. none of above
125. What percentage of fractures are caused
120. T-score for severe osteoporosis by Osteoporosis?
A. less than-1.0 A. 75%
B. -1.0 2.5 B. 80%

C. 20% 131. how many days a week should you exer-

cise if you have this disease?
D. 60%
A. 0 days
126. What consequences does osteoporosis B. 4 days
have?
C. 5 days
A. Pain D. 7 days
B. Fatigue
132. Which statement below is NOT true
NARAYAN CHANGDER
C. fractures about Doctor’s Best Celadrin®?
D. none of above A. Able to penetrate cell membranes, en-
hancing membrane permeability and cell-
127. what is the main cause of osteoporosis to-cell signaling.
A. not eating enough fruits B. Support the disulfide bonds that rein-
force collagen fibers.
B. a lack of calcuim
C. Lubricated cell membranes, restoring
C. a lack of protien fluids that cushion bones and joints to pro-
D. none of above mote flexibility and mobility.
D. Comprises of a proprietary blend of es-
128. What are the main fractures caused by terified fatty acids.
osteoporosis?
133. What is not a bisphosphonate used in os-
A. Hip, Spine and Wrist teoporosis?
B. Hip, Tibia and Wrist A. alendronate
C. Spine, Hip and Ankle B. Pamidronato
D. none of above C. Denosumab

D. Zoledronic acid
129. Which treatment for osteoporosis is con-
sidered as mainstay of therapy for peri- 134. what are the symptoms of osteoporo-
menopausal women sis?
A. A stooped posture and a loss of height
A. Weight bearing exercises.
over time.
B. Smoking cessation. B. Back pain
C. High phosphate diet. C. A bone that breaks more easily than ex-
D. Hormone replacement therapy. pected.
D. the bones in your body moves easily
130. Which of the following is NOT a risk fac-
tor for osteoporosis? 135. Which of the following endocrine dis-
eases increases the risk of osteoporosis?
A. Ageing
A. DM1
B. Early menopause B. Acromegaly
C. smoking C. hypoparathyroidism
D. regular exercise D. Cushing’s Syndrome

136. The following are risk factors of os- 142. Most serious complication of osteoporo-
teoarthritis, EXCEPT: sis

A. Obesity A. Pain
B. Balance and healthy diet B. osteoporotic fracture
C. Family history C. decreased height
D. Age D. None
137. what should you drink to help 143. The nurse is assessing a postmenopausal
client. Which question should the nurse
A. coffee
ask to assess for signs of osteoporosis?
B. juice
A. “Have you experienced any palpita-
C. tea tions? ”
D. milk B. “Are you having any low back pain? ”
138. What does osteoporosis affect? C. “Are you having problems with
swelling in your feet? ”
A. decreased muscle density
D. “Is constipation a problem for you? ”
B. decreased vision
C. overall decline 144. Which of these options can help prevent
Osteoporosis?
D. decreased bone density
A. Fracturing Bones
139. Which of the following puts you more at B. Eat More Meat
risk for developing Osteoporosis?
C. Back Pain
A. being hispanic
D. Try Not to fracture bones
B. exercising
C. smoking 145. Features of densitometry
A. It is used to determine the bone den-
D. good balanced diet
sity
140. Total cholesterol should be B. Applies too high radiation
A. below 200 C. They are unreliable measurements.
B. over 200 D. All are correct
C. below 100
146. Calcium, Sodium, and Fluoride are exam-
D. above 60 ples of ?
141. What are the MODIFIABLE risk factors A. Minerals
for cardiovascular pathologies? B. Vitamins
A. smoking C. Fruits
B. Diabetes Mellitus D. Fiber
C. Age 147. Which of these is a symptom of Osteo-
D. Gender porosis?
E. Sedentary lifestyle A. Deafness

B. Heart Attacks so the client can see to use the restroom.6

C. Back Pain / 14
D. Gaining Height A. Using furniture as obstacles to keep

the client in the bed
148. When should calcium supplements be
B. Keeping the bed in the lowest position
given?
C. Keeping a nightlight on in the hallway
A. There is no contribution of sufficient
amounts D. The use of wrist restraints
NARAYAN CHANGDER
B. Excess vitamin D 152. How many Canadians are affected by Os-
C. Excess calcium intake teoporosis?
D. none of above A. 2 million Americans.
149. Process by which bone is formed, re- B. 2 million Canadians.
newed or repaired? C. 1 million Canadians.
A. Osteoporosis D. 500 Canadians
B. Edification
153. What is the main risk group for a frac-
C. Ossification
ture?
D. Euphoria
A. all are true
150. Which product contain Boswellia, a po- B. menopausal women
tent anti-inflammatory compound that
aids in reducing joint pain? C. the elderly
A. Doctor’s Best Joint Support NEM with D. children

Curcumin
154. What is the best tool for diagnosing os-
B. Nordic Naturals Omega Joint Xtra teoporosis?
C. Futurebiotics FlexMend A. QUESTION
D. Natures Plus Glucosamine Chondroitin B. DEXA
MSM Ultra Rx-Joint Liquid
C. Serum Calcium
151. An adult client who resides in a long-term
D. Vitamin D serum
care facility is diagnosed with osteoporo-
sis. The client has a history of falls and 155. Which of the following Doctor’s Best
dementia. Which nursing intervention will Products is/are suitable for supporting
best aid in meeting an outcome goal of in- your joint health?
jury prevention for this client? Answer:B
Explanation:A) Keeping the bed in the low- A. Doctor’s Best Celadrin 500 mg, 90
est position will reduce the incidence of in- caps
jury should the client attempt to get up. B. Doctor’s Best Vitamin C featuring
The use of restraints could increase the in- Quali-C 1000mg, 120 vcaps
cidence of injury. Using the furniture as an
C. Doctor’s Best SAM-e, Double-Strength
obstacle could cause injury if the client is
400mg, 30 tabs
able to get up. In a long-term care facility,
a nightlight should be provided in the room D. All of the above

5.8 Psoriasis 403
156. What is a cause for osteoporosis? aminations, the adolescent BMD is catego-
A. Increase of the organic matrix of colla- rized?

gen A. Normal
B. Increased tensile strength of bone B. Osteopenia
C. Decrease and deconfiguration of the C. Osteoporosis
organic matrix
D. Abnormal
D. none of above
159. What cells are responsible for bone re-
157. Regenasure®is a patented 100% veg-
sorption?
etarian glucosamine which delivers glu-
cosamine hydrochloride, a significantly A. Osteocytes.
heavier and more concentrated form than B. Osteoblast.
the glucosamine sulfate, this can be found
from which product? C. Chondrocytes.
A. Doctor’s Best Vegan Glucosamine D. osteoclasts.
B. Natures Plus Glucosamine Chondroitin 160. In the Tx Ft, you have to avoid
MSM Ultra Rx-Joint-Triple Strength
A. carry heavy objects
C. Futurebiotics FlexMend
B. Traction
D. Natrol Vegetarian Hyaluronic Acid,
MSM & Glucosamine C. high impact exercises
158. A teenage girl has her BMD checked with D. Aerobic exercises
a T-Score of-2.00. Based on these ex- E. trunk flexion
5.8 Psoriasis
1. Atopic dermatitis is distinguished by der- 3. Atopic dermatitis is characterized by a
matitis in flexion areas, especially in the family history of?
antecubital and popliteal areas. These
A. Asma
manifestations occur in?
B. Allergic rhinitis
A. infants
B. Childhood and adolescence C. Eccema
C. Seniors D. Respiratory infections of the upper air-

way
D. Adults
2. Well-demarcated erythematous plaques 4. It is the only oral drug approved against

predominantly affecting elbows, knees, dermatophytosis that affects the skin,
and scalp. hair, or nails.
A. Psoriasis A. Geiseofulvina
B. lichen planus B. fluconazole
C. Pityriasis rosada C. Glucocorticoids
D. Dermatophytosis D. Imidazol

5.8 Psoriasis 404
5. How can psoriasis be prevented? 11. We always use DMARS with Biotech
A. have moist and clean skin A. TRUE
B. put on sunscreen and repellent B. False
C. keep hydrated and neat C. It depends on the organic
6. Psoriasis is a disease: 12. The treatment of psoriasis depends on
the?
NARAYAN CHANGDER
A. acute
B. Chronicle A. Type
C. Autoimmune therefore it is acute B. location
D. Autoimmune therefore it is chronic C. Extension
D. chronicity
7. How many weeks was the total duration
of the TRANSFIGURE study? 13. It is characterized by the appearance of
A. 132 weeks small red scaly dots and can develop into
plaque psoriasis.
B. 16 weeks
A. psoriasis droplets
C. 52 weeks
B. inverted psoriasis
D. 104 weeks
C. plaque psoriasis
E. 156 weeks
D. scalp psoriasis
8. Individuals with AD may present various
immunoregulation alterations such as in- 14. Total What is the maximum number of
creased synthesis of? NAPSI scores?
A. IgE A. 24
B. IgA B. 36
C. IgG C. 80
D. IgD D. 160
9. It is not a papulosquamous disorder. 15. The typical site of involvement of stasis

A. Psoriasis dermatitis is the?
B. Pityriasis rosada A. inner ankle
C. Papules B. palms of hands
D. lichen planus C. Cara

D. anterior trunk
10. In all individuals with hand eczema, a der-
matophyte infection must be ruled out us- 16. the It is a characteristic and impor-
ing a? tant sign of atopic dermatitis.
A. potassium hydroxide A. Itching
B. Calcium chloride B. Pain
C. aluminum dioxide C. redness
D. sodium hypochlorite D. All

5.8 Psoriasis 405
17. When both parents are affected with AD, B. Gutate psoriasis
the . % of their children develop the C. psoriasis on the scalp
disease

D. Psoriasis pustulosa
A. >80 %
B. >50 % 23. It is better not to apply glucocorticoids to
ulcers because they can?
C. 100%
A. delay healing
D. none of above
B. increase itching
18. The treatment of atopic dermatitis consist-
C. Both
ing of?
D. none of above
A. Avoid skin irritants
B. Maintain skin hydration 24. When I choose a Biotechnologist to treat
patients with psoriasis
C. Apply topical anti-inflammatories
A. DMARD therapy fails does not improve
D. Recommend that they bathe with hot
the COUNTRY
water
B. Failure to treat with NSAIDs does not
19. It causes punched-out ulcerative lesions improve the COUNTRY
most often caused by primary and sec-
C. Ruling to Steroids does not improve in
ondary infection by.
the COUNTRY
A. staphylococcus aureus
D. After no improvement of at least 3
B. Streptococcus pyogenes months with DMARS and no improvement
C. Both in the PASI
D. none of above 25. Where on the body is it most common for
psoriasis to develop?
20. Which biologic has a dedicated study for
nail psoriasis? A. in the gums and in the eyes
A. secukinumab B. on the scalp and knees
B. Ixekizumab C. on the elbow and on the nose
C. Guselcumab D. in the ear and in the armpits
D. Risankizumab 26. Is there a cure for psoriasis?
21. Psoriasis for its diagnosis is needed A. and
A. Biopsy B. no
B. clinic is enough C. treatment only
C. HLA B51 D. none of above
D. Come on 27. It is a manifestation of delayed-type hy-
22. It is characterized by the appearance of persensitivity mediated by memory T lym-
raised red plaques covered with white phocytes in the skin. is?
scales and, on some occasions, itching. A. allergic contact dermatitis
A. plaque psoriasis B. irritant contact dermatitis

5.8 Psoriasis 406
C. lichen simplex chronicus 33. The main clinical characteristic of acne vul-
D. none of above garis is the comedon, what could it be?
A. Open
28. Characterized by circular or oval “coin-
B. Closing
like” lesions
C. Both
A. nummular eczema
D. None
B. hand eczema
34. Exudative and crusting skin lesions can be-
NARAYAN CHANGDER
C. asteatotic eczema
come infected with?
D. All
A. S. Aureus
29. The rash appears in skin folds, often af- B. S.Pyogenes
fects the trunk, almost never affects the
C. S.Numoniae
palms of the hands or the soles of the feet.
D. none of above
A. Pityriasis rosada
B. Psoriasis 35. Is it important to choose for atopic der-
matitis treatment?
C. Dermatophytosis
A. Low-potency topical glucocorticoids
D. lichen planus
B. high potency glucocorticoids
30. Baseline total (Baseline total) Which study C. Non-steroidal anti-inflammatory drugs
had the highest NAPSI score?
D. Steroidal anti-inflammatories
A. TRANSFIGURED
36. Start of treatment in Psoriasis is:
B. IXORA-S
A. steroids
C. UNCOVER 3
B. Immunomodulators
D. ULTIMATE 2
C. biotechnological
31. A characteristic defect of atopic dermatitis D. UV
that contributes to the pathophysiology is
the alteration of the barrier? 37. What are the treatments for spoken dis-
ease?
A. Epidermal
A. I quote:3
B. cutis
B. ibuprofen and serum
C. Both
C. creams, and phototherapy
D. none of above
D. sleep and eat well
32. Which studies included Unapproved doses
38. In pityriasis rosea its first manifestation
in the extension period?
is the appearance of an annular lesion
A. TRANSFIGURED (heraldic plaque) of?
B. IXORA-S A. 2 a 6 cm
C. UNCOVER 3 B. 4 a 8 mm
D. VOYAGE 2 C. > 1 m
E. ULTIMATE 1 D. none of above

5.9 Rheumatoid Arthritis 407
39. In hand eczema are important factors in- B. MATERIAL

volved? C. Anti allergic

A. Endogenously D. anti hypertensive
B. exogenous
44. Which of the following is not a histological
C. Both feature of plaque psoriasis?
D. None A. elongated rete ridges
40. Which biotechnologist can I indicate if I B. shortening of dermal papillae
have a palmoplantar condition with psori-
C. dilated blood vessels
asis
D. absence of granular layer
A. You are blown away
B. antiIL4 45. Is a common superficial bacterial skin infec-
tion most often caused by S. Aureus?
C. You are Alaa/23
A. Impetigo
D. antiIL17a
B. Ectima
41. This disease is common and chronic and is
C. Forunculosis
characterized by greasy scales on plaques
or erythematous areas. D. All
A. Seborrheic dermatitis 46. Psoriasis affects:
B. contact dermatitis A. 125 million people
C. atopic dermatitis B. It is predominantly in men than in
D. none of above women
C. Not related to race
42. If the patient fails DMARS, what do I have
to take into account to prepare the patient D. It affects men and women equally 1:1
for biotechnological:
47. Psoriasis is a skin disease where the cells
A. Nationality involved in its pathophysiology are:
B. Tuberculosis A. dendritic cells
C. Vaccinations in adults B. T lymphocytes
D. Age C. Neutrofilos
43. Which drug mentioned below is related to D. All of the above are cells involved in the
activating psoriasis physiopathogenesis of psoriasis.
A. Hydroxychloroquine E. Only T lymphocytes are involved
5.9 Rheumatoid Arthritis

1. Which of the following is not a goal of uric acid
treating physiotherapy in cases of both
Rheumatoid Arthritis and Gout Arthritis? B. Reduces pain and inflammation
A. Reducing levels of rheumatism and C. Improve joint range of motion

D. Increases functional mobility 7. subluxation of the first MCP joint with hy-
E. Improves joint stability and integrity perextension of the first interphalangeal
(IP) joint causes this kind of deformity
2. What happens in the first stage of RA? that may result from damage to the ten-
dons, joint capsule, and other soft tissues
A. Destruction of the joints
in these small joints.
B. Inflammation
A. Swan Neck Deformity
C. Affects the tissues
B. Z-line deformity
NARAYAN CHANGDER
D. Spreads in other organs
C. Boutonniere
3. Which antibody targets the fc domain of D. Trigger fingers
the altered IgG?
A. Anti-CCP 8. Vaughn-Jackson syndrome in rheumatoid
arthritis is best described as?
B. RF
A. Cranial migration of the dens from soft
C. CD28
tissue erosion and bone loss between oc-
D. DKK-1 ciput and C1 & C2
4. The purpose of examining joint play move- B. Rupture of flexor pollicis longus due to
ment (JAPAN) in cases of Gout Arthritis attrition with spur in scaphoid
is? C. Synovitis in the DRUJ leading to
A. To determine muscle endurance supination of the carpal bones away from
the head of the ulna
B. To determine grip strength
D. Rupture of the extensor digiti minimi
C. To know the Range of Motion in joints
due to caput ulna syndrome.
D. To determine the movement of acces-
sories and endfeel in joints E. Synovitis of the MTP joints with even-
tual hyperextension deformity of the MTP
E. To determine the level of pain in the
joints 9. What is a treatment for Rheumatoid
Arthritis?
5. Who is mostly affected?
A. Surgery
A. Women
B. Medication
B. Men
C. Therapy
C. Children
D. All of the Above
D. none of above
6. COX-2 inhibitors NSAIDs: 10. The following are appropriate interven-

tions in cases of Rheumatoid Arthritis, EX-
A. Block prostaglandin synthesis by the CEPT?
COX-2 isozyme
A. Administration of High Intensity Short-
B. Does not affect action of COX-1 wave Diathermy to increase tissue elastic-
isozyme ity
C. Anti-inflammatory B. Giving Pulsed Ultrasound to improve
D. Affects action of COX-1 isozyme the healing process

C. Provision of passive ROM exercises to 15. which of the following bones are com-
maintain or increase the range of motion monly unaffected in a patient with RA
of the joints

A. DIP
D. Joint protection aims to prevent defor- B. MCP
mity
C. MTP
E. Functional exercises to improve func-
tion and adaptation in carrying out daily D. PIP
activities 16. A RA patient presented with inability to
11. Non-selective NSAIDs: extend fingers at MCPJ for 6 months and
is affecting her daily activities. She was
A. Anti-inflammatory
then diagnosed with extensor tendon rup-
B. Reversible inhibition of COX-2 isozyme ture of LF, RF and MF. Which is the best
C. Reversible inhibition of both COX-1 treatment option for her
and COX-2 isozyme A. Direct tendon repair
D. Reduction in prostaglandin synthesis B. End to side of all ruptured tendon to IF
12. Immunological testing of anti-citrullinated C. FDS tendon from MF to power LF, RF
peptide antibodies (ACPA) is most com- and MF
monly used for the diagnosis and progno- D. EIP to power RF and LF + MF end to
sis of which immunological condition? side to IF
A. Ankylosis spondylitis E. EIP to power LF, RF and MF
B. Rheumatoid arthritis
17. Flexion of the PIP joint with hyperexten-
C. Psoriatic arthritis sion of the DIP joint
D. Systemic lupus erythematosus A. Z-Line deformity
E. Reiter’s syndrome B. Swan-Neck Deformity
13. Which statement about Rheumatoid Arthri- C. Trigger fingers
tis is correct? D. Boutonniere
A. Caused by metabolic disorders
18. Characteristic of Sjogren’s syndrome EX-
B. There is erosion of the joint cartilage
CEPT:
due to loading
A. Xerstomia
C. Increased levels of uric acid in the
blood B. Keratoconjuctivitis Sicca
D. There is inflammation of the synovial C. Dry Skin
membrane D. 10% of RA patients
E. Marked by the appearance of Tophi
19. What is the genetic component associated
14. Who discovered “Rheumatic Gout”? with RA?
A. Augustin Jacob Landre’-Beauvais. A. HLA-DRB3
B. Antonie van Leeuwenhoek B. HLA-A
C. Carl Wilhelm Scheele C. HLA-DP1
D. Alfred Garrod D. HLA-DRB1

20. Which gender is more likely to be diag- 25. Type of anemia that often develops in pa-
nosed with RA? tients with RA
A. Men A. Normochromic Normocytic
B. Women B. Hypochromic Normocytic
C. Both equally C. Iron deficiency anemia
D. none of above D. Megaloblastic
21. Which of the following is not part of the
NARAYAN CHANGDER
26. Which of the following is the correct state-
Clinical triad of Felty’s Syndrome
ment to describe the functional status in
A. Neutropenia cases of Rheumatoid Arthritis Class 3?
B. Lymphadenopathies A. Able to carry out daily activities includ-
C. Splenomegaly ing self-care, vocational and avocational
D. Nodular RA B. Able to do self-care and vocational, but
limited in avocational
22. The following are TRUE regarding rheuma-
toid arthritis of the hand C. Able to do self-care, but limited in vo-
cational and avocational
A. Marginal osteophytes
D. Has limitations in carrying out self-
B. Marginal erosion
care activities, vocational and avocational
C. Periarticular osteopenia
E. Able to carry out all functional activ-
D. Subchondral sclerosis ities without interruption including self-
E. Joint ankylosis care, vocational, avocational
23. Which of the following is a true statement 27. Pathologic hallmark of RA except?
regarding Gout Arthritis?
A. Synovial Erosion
A. Caused by a disorder of the Autoim-
mune System B. Thinning of articular cartilage
B. There is erosion of the joint cartilage C. Focal bone erosion

due to loading D. Synovial inflammation
C. Increased levels of uric acid in the
28. The following is the right choice regarding
blood
the difference between Rheumatoid Arthri-
D. There is inflammation of the synovial tis and Osteorthritis?
membrane
A. In RA, morning stiffness lasts less than
E. Marked by the emergence of Nodule 30 minutes
24. In patient with rheumatoid arthritis of the B. In OA, affecting 3 or more joints
wrist, which of the following extensor ten-
C. In RA, the distribution of arthritis is
dons is most at risk of rupture
symmetrical
A. Extensor digiti minimi
D. In OA, showing a positive result in
B. Abductor policis longus Rheumatoid Serum
C. Extensor policis longus E. In RA, it affects the weight bearing
D. Extensor carpi ulnaris joints

5.10 Carpal Tunnel Syndrome 411
29. The following data obtained at INSPEC- 32. What Does Rheumatoid Arthritis Effect?
TION in cases of gout arthritis are? A. All Connective Tissue in Body and All

A. Decreased muscle strength Joints
B. It feels hot B. The Pancreas
C. There is a tophi lump C. The Bones
D. There is crepitation D. All joints and The Nervous System
E. Increase in segment diameter
33. Does RA have a cure?
30. Regarding rheumatoid arthritis (RA), the
incidence A. Yes
A. is higher in men B. No
B. decreases with age C. Maybe
C. is equal in men and women D. none of above
D. is approximately 53 per 100, 000 for
34. What are joints?
women annually, and about half that for
men A. Is a fibrous connective tissue which at-
taches muscle to bone
31. Which are s/s of Rheumatoid Arthritis?
B. Is the main type of connective tissue
A. Edema seen throughout the body
B. Erythema
C. A point of connection between two
C. Heat bones that allows motion
D. Pain D. A rigid tissue that constitutes part of
E. Tenderness the vertebrate skeleton
5.10 Carpal Tunnel Syndrome

1. Each of these is a possible cause for Carpal 3. Where is the tunnel located?
Tunnel Syndrome EXCEPT? A. Shoulders
A. Repeatedly speaking in front of a large B. Wrists
audience, like the governor.
C. Fingertips
B. Playing video games
D. between New York and New Jersey
C. Typing
4. Your feet should be when you are sit-
D. Playing an instrument ting at the computer
2. The pain and tingling felt in your hands is A. Crossed Indian style
caused by the tunnel squeezing on a B. Flat on the floor
A. bone C. Crossed lady like
B. nerve D. Wrapped around the legs of the chair
C. cartilage 5. The nerve that passes through the carpal
D. joint tunnel to reach the hand is the nerve.

5.11 Systemic Sclerosis 412
A. Median by excessive repetitive or abnormal mo-

tion of the wrist
B. Average
A. Carpal Tunnel Syndrome
C. Wrist
B. Back Pain
D. Hand
C. Waist pain
6. What is inflammation of a tendon caused D. Persistent fatigue
NARAYAN CHANGDER
5.11 Systemic Sclerosis
1. What are the principles of TC treatment? 4. Treatment of systemic sclerosis is different
A. make a thorough diagnosis and initial for each organ involved, and immunosup-
assessment pressive therapy is used for severe organ
inflammation.
B. determine the stage of the disease
A. right right right
C. determine the risk of serological, ge-
netic and organ system clinical complica- B. right right wrong
tions C. right wrong wrong
D. organ system-based treatment D. wrong wrong right
E. early detection of complications and E. wrong wrong wrong
treatment of organ systems
5. The effects of TC on the digestive sys-
2. Mention the factors that influence the for- tem?
mation of hardening of the system?
A. asymptomatic
A. Genetic factors
B. loss of esophageal motility
B. In autoimmune conditions
C. The lower end of the esophagus will
C. Changes in vascular function not be fully closed
D. External environmental factors D. heartburn
E. Socio-economic factors E. the vessels of the stomach are dilated,
3. What are the minimum criteria for the di- and symptoms of “stomach like a stom-
agnosis of systemic sclerosis? ach” appear
A. hardening of the skin on the toes or fin- 6. What is the treatment for TC stomach dis-
gers ease?
B. shapeless ulcers on the tips of the fin- A. PPI
gers
B. antibiotics and antidiarrheals
C. Fingers become shorter due to harden-
C. supplemental intravenous feeding
ing of the skin
D. activate the spinal nerves
D. 2-sided lower lobe hardening of the
lungs 7. Which of the following is an anti-
E. hardening of the skin involving the toes inflammatory treatment for systemic scle-
or fingers and a larger area roderma?

5.12 Dysphagia 413
A. Calcium channel blockers A. non-selective

B. Corticosteroids B. Affect T cells

C. Immunosuppressive drugs C. Affect B cells
D. Vitality D. biological
E. Spa treatment
E. intravenous immunoglobulin
8. What is the treatment for interstitial lung
disease in TC? 10. What is the treatment for TC heart dis-
ease?
A. O2
A. O2
B. cyclophosphamide, prednisolone
C. warfarin, spironolactone B. cyclophosphamide, prednisolone
D. bozentan, C. paraffin
9. What is the immunosuppressive treatment D. put on a pacemaker

for TC? E. heparin ointment
5.12 Dysphagia
1. Symptoms below suggests suprae- C. Gurgly-behind
sophageal cause of dysphagia EXCEPT D. none of above
A. Regurgitation
4. Choose the most likely cause of acute dys-
B. Aspiration phagia from the list given below
C. Dysphonia A. Esophageal cancer
D. Rapid weight loss B. Foreign body ingestion
C. Laryngopharyngeal reflux
2. Choose the best translation for these
phrases D. Laryngeal cancer
A. GERD-Food Regurgitation-Peristalsis 5. A stroke in this artery can often lead to
B. Acid Reflux-Nasal Regurgitation- dysphagia because it supplies to Nucleus
Muscular Dystrophy ambiguus
C. GERD-Nasal Regurgitation-Neuromuscular A. What is posterior cerebellar (PCA)?
Problem B. What is anterior inferior cerebellar
D. GERD-Food Regurgitation-Muscular (AICA)?
Dystrophy C. What is posterior-inferior cerebellar
artery (PICA)?
3. What are the appropriate synonyms for
D. Can we please just be done already?
the underlined words? General signs of
dysphagia are coughing and a wet voice 6. The fourth stage of the swallow is called
during or right after eating or drinking. the
A. Gurgly-at the time of A. Pharyngeal phase
B. Harsh-after that B. Oesophageal phase

5.12 Dysphagia 414
C. Pre-oral phase 12. is the diversion of emotions such as

angers from original source to substitute
D. Oral phase
target.
7. Abnormal enlargement to which part of A. Dissociation
the heart can sometimes cause dyspha- B. Displacement
gia?
C. Regression
A. Right atrium
D. none of above
NARAYAN CHANGDER
B. Left atrium
13. What are the appropriate synonyms for
C. Right ventricle the underlined words? A persistent sore
D. Left ventricle throat is a symptom of dysphagia.
A. Consistent-painful-thorax
8. Which one has a different meaning?
B. Alternative-aching-pharynx
A. Dysphagia C. Continues-aching-pharynx
B. Swallowing problems D. none of above
C. Swelling problems
14. Select a statement that best describes dys-
D. none of above phagia
A. Dysphagia is a symptom characterised
9. Symptoms below are red flag symptoms in by difficult swallowing
dysphagia EXCEPT
B. Dysphagia is a symptom characterised
A. Complete dysphagia by painful swallowing
B. Rapid weight loss C. Dysphagia is a sign characterised by
C. Aspiration pooling of saliva
D. Dysphagia is a sign characterised by
D. Dysarthria
tenderness at the throat upon swallowing
10. What are the antonyms for the underlined 15. is developing false though acceptable
words? Aging leads to impaired coordina- excuses to justify irrational and/or unac-
tion of the process of swallowing. ceptable behavior.
A. Weakened-relationship A. Rationalization
B. Damaged-proportion B. Disassociation
C. Healthy-imbalance C. Displacement
16. Which cause of dysphasia is NOT progres-
11. Relevant examination in patients with
sive but IS associated with a “stacked
dysphagia is described below EXCEPT
ring” appearance?
A. Hydration status A. Eosinophilic esophagitis
B. Examination of the cranial nerve B. Achalasia
C. Ear examination C. Scleroderma
D. Nutritional status D. Esophageal cancer

5.12 Dysphagia 415
17. What is the most common cause by far of B. Esophago-gastro-duodenoscopy

esophageal dysphasia? C. Chest x-ray

A. Esophageal stricture secondary to D. Video fluoroscopy for swallowing
GERD
B. Esophageal cancer 22. of parents agree that speech, language,
and hearing are some of the most impor-
C. Achalasia tant developmental
D. Food impaction A. Red flags
18. Which type of dysphagia is more com- B. Milestones
mon/commands more attention from the C. Structures
medical literature?
D. none of above
A. Oropharyngeal/transfer
B. Esophageal/transport 23. How many stages are there to the swal-
low?
C. Both are the same
A. One
D. Neither really matters
B. Two
19. A 3 year-old boy complains of high grade
C. Three
fever associated with severe odynophagia
and drooling of saliva. The mother is wor- D. Four
ried that the child is having trouble breath-
24. Which one isn’t related to “defense mech-
ing. What is the most likely diagnosis?
anisms”? The brain’s ways
A. Acute epiglottis
A. To keep us safe and fully aware of un-
B. Laryngopharyngeal reflux pleasant thoughts
C. Laryngeal cancer B. To keep us safe and fully aware of feel-
D. Esophageal cancer ings.
C. To protect ourselves from physical
20. What important things happen at the pha-
damages
ryngeal phase?
D. none of above
A. The swallow sequence is rapid, for
breathing to resume 25. For which of the following etiologies does
B. Food and drink enter the oesophagus dysphagia occur in 90% of patients?
C. The bolus is mixed with saliva A. Esophageal stricture secondary to
GERD
D. The airway is protected so food and
drink does not enter the lungs B. Esophageal cancer
C. Scleroderma/Systemic Sclerosis
21. A 58-year-old diabetic suffered from
a massive cerebrovascular accident 2 D. Achalasia
months ago, following which he developed
swallowing incoordination. Choose the 26. What happens in the oral phase (tick all
best investigation to investigate his prob- that apply)
lem. A. See the food
A. Barium swallow B. Smell the food

5.12 Dysphagia 416
C. Teeth grind together associated with severe odynophagia and

D. Saliva produced drooling of saliva. The mother is worried
that the child is having trouble breathing.
27. Select as many oesophageal causes of dys- What is the next step in management of
phagia from the list below this boy?
A. Achalasia A. Examination of the oral cavity
B. Distal Esophageal Spasm B. Flexible nasopharyngeal laryngoscope
C. Gastro-esophageal Reflux Disease
NARAYAN CHANGDER
C. Urgent CT scan
D. Pharyngeal pouch
D. Urgent referral to the casualty
28. Clinical features of tongue cancer include
below EXCEPT 30. is detachment from reality and from
A. Dysarthria oneself and the finding of another repre-
sentation of self.
B. Neck swelling
A. Dissociation
C. Dysphagia
D. Tinnitus B. Displacement
C. Regression
29. A 3 year-old boy presented to the maxillo-
facial clinic complaining of high grade fever D. none of above

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