Questions for Nle Auto Saved)

RESPIRATORY QUESTIONS.

1. Which of the following conditions correlate with the following information: High pH High HCO3

High BE Neutral pCO2

A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Metabolic alkalosis

2. Which of the following conditions correlate with the following information: High pH Neutral HCO3

Neutral BE Low pCO2


3. Which of the following conditions correlate with the following information: Low pH Low HCO3

Low BE Neutral pCO2


4. Which of the following information corresponds with a negative TB test?

A. 0-4 mm induration at 48 hours B. 0-5 mm induration at 48 hours C. 0-6 mm induration at 48 hours D. 0-7 mm induration at 48 hours

5. Which of the following is the most common type of lung cancer?

A. Large cell B. Adenocarcinoma C. Oat cell D. Squamous cell

6. What cell type secrets surfactant?

A. Plasma cell B. Type I alveolar cell C. Type II alveolar cell D. Type III alveolar cell

7. Which of the following pulmonary term correlates with the definition: noted obstruction of the trachea or larynx.

A. Rhonchi B. Stridor C. Wheezes D. Vesicular

8. Normal values for pCO2 are considered:

A. 20-40 mm Hg B. 25-30 mm Hg C. 30-40 mm Hg D. 35-45 mm Hg

9. Normal values for HCO3 are considered:

A. 15-30 mEq/L B. 20-35 mEq/L C. 22-26 mEq/L D. 24-29 mEq/L

10. Pneumoncystis carinii infections are commonly treated with which of the following medications?

A. Pentamidine B. Allopurinol C. Iorazepam D. Chlorpropamide

11. Which of the following is not generally caused by COPD?

A. Pneumonia B. Right sided heart failure C. Headaches D. Cor pulmonale

12. Which of the following is not considered a COPD related disease?

A. Bronchiectasis B. Bronchial asthma C. Bronchitis D. Bronchial hypotension

13. Which of the following pulmonary term correlates with the definition: bronchospasm of the bronchial walls?

A. Wheezes B. Rhonchi C. Stridor D. Pleural Rub

14. Which of the following is considered an expectorant?

A. Acetylcysteine B. Guaifenesin C. Theophylline D. Epinephrine HCL

15. Which of the following is considered a bronchodilator?


16. Which of the following is considered a xanthine?


17. Which of the following is considered a mucolytic?


18. Which of the following matches the definition: The volume of air that can be inhaled following exhalation of tidal volume?

A. Expiratory reserve volume B. Inspiratory capacity C. Inspiratory reserve volume D. Vital capacity

19. Which of the following matches the definition: The maximum volume of air that can be exhaled after taking the deepest breath possible?

A. Expiratory reserve volume B. Inspiratory capacity C. Inspiratory reserve volume D. Vital capacity

20. The respiratory center is located in the ____ and ______.

A. Midbrain and pons B. Pons and Medulla oblongata C. Midbrain and Medulla oblongata D. Pons and Hypothalamus

Answer Key 1. D 2. A 3. C 4. A 5. D 6. C 7. B 8. D 9. C 10. A 11. C 12. D 13. A 14. B 15. D 16. C 17. A 18. B 19. D 20. B

Syndrome Practice Questions

60

1. Which of the following syndromes corresponds to: A failure of neutrophils to generate an immune response and lab values indicate elevated IgE levels?

A. Job's syndromeB. Wiskott-Aldrich syndromeC. Carcinoid syndromeD. Mallory-Weiss syndrome

2. Which of the following syndromes corresponds to: right sided valvular disease and diarrhea?


3. Which of the following syndromes corresponds to: lab values indicate elevated IgA levels and presence of thrombocytopenia?


Free Practice Questions

Psychiatric Disorders

Cardiac Disorders

Diabetes

Digestive Disorders

Endocrine Disorders

Neurological Disorders

Nutrition

Respiratory Disorders

4. Which of the following syndromes corresponds to: presence of arthritis and commonly found in males?

A. Reiter's syndromeB. Sjogren's syndromeC. Kartagener's syndromeD. Ehlers-Danlos syndrome

5. Which of the following syndromes corresponds to: immotile sperm and presence of reoccurring sinusitis?


6. Which of the following syndromes corresponds to: presence of arthritis, xerophthalmia and commonly found in females?


7. Which of the following syndromes corresponds to: excessive movement occurring at joints and loose skin?


8. Which of the following syndromes corresponds to: hematuria, glomerulonephritis and pulmonary dysfunction?

A. Brown-Sequard syndromeB. Thoracic outlet syndromeC. Angelman's syndromeD. Goodpasture's syndrome

9. Which of the following syndromes corresponds to: presence of ipsilateral motor loss and contralateral spinothalmic tract damage?


10. Which of the following syndromes corresponds to: C8/T1 nerve involvement and weakness in hand muscles?


11. Which of the following syndromes corresponds to: maternal genetic phenotype syndrome?


12. Which of the following syndromes corresponds to: Abnormal development of the 3rd and 4th (Pharyngeal pouches)?

A. Acute coronary syndromeB. ARDSC. Budd-Chiari syndromeD. DiGeorge's syndrome

13. Which of the following syndromes corresponds to: leads to an increased risk of stroke?


14. Which of the following syndromes corresponds to: abdominal pain, ascites, and hepatic vein occulsions?


15. Which of the following syndromes corresponds to: increased pulmonary permeability and fluid entering the lung space?


16. Which of the following syndromes corresponds to: can be caused by high doses of Tetracyclines?

A. Dubin-Johnson syndromeB. Fanconi's syndromeC. Edward's syndromeD. Cri-du-chat syndrome

17. Which of the following syndromes corresponds to: caused by poor liver excretion?


18. Which of the following syndromes corresponds to: chromosomal deficit of #5?





A. Dubin-Johnson syndromeB. Patau's syndromeC. Edward's syndromeD. Down syndrome

Answer Key

1. A2. C3. B4. A5. C6. B7. D8. D9. A10. B11. C12. D13. A14. C15. B16. B17. A18. D19. C20. B

Psychiatric Disorders Practice Questions

1. Antidepressant medication is an initial primary treatment modality for moderate to severe major depressive disorder unless:

a. ECT is plannedb. Patient is less than 18 years of agec. Patient is admitted to hospitald. Patient is age 65 and older

2. Dysthymia may be treated with all of the following except:

a. Antidepressantsb. Cognitive behavioral therapyc. ECTd. Interpersonal therapy

3. Symptoms of depression in children and adolescents include all of the following except:

a. Persistent depressive or sad mood b. Irritabilityc. Gregariousness d. Anhedonia

4 Prior to initiating bright light therapy for seasonal affective disorder, it is important to:

a. Try a course of antidepressant drugsb. Consider ophthalmological evaluation for persons with a history of eye disordersc. Initiate milieu therapyd. Complete a course of cognitive behavioral therapy

5. All of the following are associated with bipolar disorder except:

a. Functional impairmentb. Manic episodesc. Rapid cyclingd. Frequent spontaneous resolution of all symptoms

6. Which of the following statement about children and adolescents with bipolar disorder is not true?

a. Most require ongoing treatment to prevent relapse and some require lifelong treatmentb. Many have co-occurring disorders such as substance abuse, suicidality, and psychosocial issuesc. Treatment generally involves a combination of medication and behavioral/psychosocial interventionsd. A significant proportion outgrows the disorder and requires no further follow-up

7. The goals of acute treatment for schizophrenia include all except:

a. Encouraging introspection and reflection b. Eliminating or reducing symptoms such as disturbed behaviorc. Reducing the severity of psychosis and associated symptomsd. Preventing harm

8. When may ECT be used to treat adults with schizophrenia or schizoaffective disorder?

a. In both the acute phase and stable phase for psychotic symptoms that have not responded to pharmacological treatment b. Only during the acute phasec. Only during the stable phased. Only in persons who have not been treated with antipsychotic agents

9. The most common behavioral health problem in adults, adolescents and children is:

a. Depressionb. Anxietyc. ADHDd. Thought disorders

10. An effective intervention for many anxiety disorders is:

a. Antipsychotic agents aloneb. Antidepressants alonec. Behavioral health treatment, especially cognitive behavioral therapyd. ECT and pharmacotherapy

11. The percentage of persons with generalized anxiety disorder with a comorbid condition is:

a. 25%b. >50%c. <20%d. 15%

12. Symptoms of panic disorder may include all of the following except:

a. Chest pain and tachycardiab. Feelings of impending doomc. Dizziness and shortness of breathd. Fever and shaking chills

13. All of the following are true about panic disorder except:

a. Panic attacks do not occur during sleepb. It affects an estimated 6 million adults in the United Statesc. Twice as many women are affectedd. The tendency to develop panic attacks appears to be heritable

14. Trichotillomania is an impulse control disorder that involves:

a. Disordered eatingb. An irresistible urge to pull out hairc. Compulsive gamblingd. Harming pets and small animal

15. All of the following statements about oppositional defiant disorder are true except:

a. It involves recurrent patterns of hostility and negative behaviorsb. It arises from a combination of genetic, biological and environmental causesc. It is a developmentally appropriate behavior displayed by children d. Early onset is associated with poorer prognosis

16. Persons with intermittent explosive disorder generally display all of the following except:

a. Aggressive outbursts and violenceb. Destruction of propertyc. Remorse, regret and embarrassment about their actionsd. Bulimia

17. All of the following are impulse disorders or disruptive behaviors except:

a. Pathological gamblingb. Kleptomaniac. Maniad. Pyromania

18. Naltrexone may be used as pharmacotherapy for which of the following disorders:

a. Mood disordersb. Impulse and Disruptive Behaviorsc. Schizoaffective disorderd. Substance use disorders

19. Outpatient detoxification may be contraindicated for all of the following groups except:

a. Persons with a history of delirium tremens or withdrawal seizuresb. Persons with unstable medical conditions such as diabetes, hypertension, or pregnancyc. Persons whose withdrawal signs and symptoms are sufficiently severe to require 24-hour inpatient care d. Adolescents

20. Nearly one-half of patients with schizophrenia have which type of comorbid disorders?

a. Hypertensionb. ADHDc. Trichotillomaniad. Substance use disorders

Answers and Explanations

1. A: Antidepressant medication is an initial primary treatment modality for mild major depressive disorder as well as moderate to severe major depressive disorder. For psychotic depression, a combination of antipsychotic and antidepressant medication or ECT may be prescribed. Psychotherapy alone as an initial treatment modality may be used for patients with mild to moderate depressive disorder.

2. C: Drug treatment for dysthymia is similar to treatment for depression and may include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). Along with the above-mentioned therapies, persons with dysthymia also may respond to cognitive therapy and behavioral therapy.

3. C: Additional symptoms of depression in children and adolescents include the following: irritable mood; loss of interest and pleasure; persistent thoughts of death; suicidal ideation or attempts; changes in appetite, weight or sleep; diminished activity, concentration or energy; and changes in feelings of self-worth and guilt. Depressed children may withdraw socially, present with somatic complaints, exhibit low tolerance for frustration, and throw temper tantrums.

4. B: Because bright light therapy has the potential to cause eyestrain and headaches, an ophthalmologic exam is advised for persons with a history of eye diseases. In is important to bear in mind that in bright light treatment has the potential to trigger episodes of hypomania or mania in vulnerable patients.

5. D: Bipolar disorder is associated with functional impairments even during periods of euthymia. Along with periodic episodes of mania and depression, some patients experience rapid cycling - four or more mood disturbances in a single year that meet the criteria for a major depressive, mixed, manic, or hypomanic episode.

6. D: Children and adolescents with bipolar disorder should be carefully evaluated for all of the above-mentioned co-occurring disorders as well as medical problems. Primary treatment for mania is pharmacotherapy; however, psychotherapy is an important component of comprehensive treatment.

7. A: The goals of treatment during the acute phase of illness are to prevent harm, control disturbed behavior, reduce symptoms such as agitation and aggression, evaluate and address the stressors that triggered the acute episode, and enable rapid return to the best level of functioning. As with other psychiatric disorders it is vitally important to develop an alliance with the patient and family, establish attainable objectives of treatment, and follow-up with appropriate care.

8. A: A combination of ECT and antipsychotic medications may be prescribed for patients with schizophrenia or schizoaffective disorder with severe psychotic symptoms that have not responded to pharmacological treatment. Maintenance ECT may benefit some patients who have responded to acute treatment with ECT but for whom pharmacological prophylaxis alone has not prevented relapse or is not tolerated.

9. B: An estimated 40 million adults in the United States have an anxiety disorder. Anxiety disorders include panic disorders with or without agoraphobia, specific phobias, social anxiety disorder, obsessive-compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD).

10. C: A combination of psychotherapy and medication management is helpful for most anxiety disorders. Of psychotherapeutic interventions, cognitive-behavioral therapy (CBT) has demonstrated efficacy; however, it requires the patient to commit to approximately 12 to 20 sessions of treatment.

11. B: More than half of persons diagnosed with generalized anxiety disorder have a comorbid condition such as panic disorder and major depressive disorder is the most common. Panic disorder is often comorbid with substance abuse. Because the anxiety disorders share many common signs and symptoms, it is imperative to conduct a thorough assessment to establish the primary diagnosis.

12. D: People who have panic disorder are often disabled by the condition; they avoid normal activities of daily living such as shopping and riding buses or trains. About one-third becomes housebound or able to confront a feared situation only when accompanied. Panic disorder is one of the most treatable of all the anxiety disorders; most people respond well to pharmacological and psychosocial interventions.

13. A: Panic attacks occur suddenly, often without warning, and can occur at any time, even during sleep. Panic attacks commonly begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have a single attack and do not develop the persistent pattern that characterizes panic disorder.

14. B: A combination of pharmacological and psychotherapeutic treatment appears to be most effective. Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice and cognitive behavioral therapy is the psychotherapeutic modality of choice.

15. C: Oppositional defiant disorder (ODD) is not the oppositional behavior displayed by children in the course of normal development; ODD is an extreme and significant exaggeration of developmentally normal behaviors. Because ODD is frequently a co-morbid condition, it is vital that other conditions/disorders be identified and treated.

16. D: Intermittent explosive disorder is characterized by repeated outbursts of aggressive, violent behavior People with intermittent explosive disorder may attack and harm others and vandalize and destroy property. Following these outbursts they are often contrite, expressing remorse, regret and embarrassment about their actions.

17. C: Although persons with mania may behave impulsively, mania is a mood disorder characterized by abnormal affect, inflated feelings of self-worth, pressured speech, scattered ideas, increased interest in goal-directed activities and high-risk behaviors, unexplained euphoria, irritable mood, decreased need for sleep, and magical thinking.

18. D: Naltrexone, an opioid receptor antagonist, may be used as a pharmacotherapy for alcohol-dependent and opioid-dependent patients. It has demonstrated efficacy in helping alcohol-dependent patients adhere to treatment by reducing cravings, thereby, reducing the frequency and severity of relapse. Naltrexone has not demonstrated comparable efficacy for opioid dependency, largely because there is lower adherence to treatment in this population.

19. D: Persons with mild to moderate withdrawal symptoms may be effectively managed in intensive outpatient programs or partial hospitalization programs. Because many such programs are on medical center campuses or close to hospitals, immediate transfer to a higher level of care is feasible.

20. D: Many patients with schizophrenia self-medicate with alcohol, prescription drugs, and street drugs. It is vitally important to identify the presence of comorbid substance use and to develop a treatment plan that effectively addresses schizophrenia and substance use.

Cardiac Disorders Practice Questions

2

1. The risk of dying as a result of cardiovascular disease increases with advancing age. Approximately what percent of persons who die of coronary heart disease are older adults - age 65 or older?

a. >80%b. 55%c. 66%d. 75%

2. Modifiable risk factors that increase the risk of acute myocardial infarction (MI) include all of the following except:

a. Hypertensionb. Smokingc. Food allergiesd. Lack of physical activity

3. The overwhelming majority of strokes are ischemic. The percentage of strokes attributable to intracerebral hemorrhage is:

a. 25%b. 18%c. 10%d. <6%

4. More than 60% of stroke deaths occur in:

a. Native Americansb. Womenc. Mexican Americansd. Persons age 45-64

5. Risk of ischemic stroke is reduced among women with all of the following characteristics except:

a. Low BMIb. Regular exercisec. Healthy dietd. Menopause before age 42

6. Transient ischemic attacks (TIA) are associated with all of the following except:

a. Increased risk of stroke in the first 30 days following the TIAb. Increased risk of stroke in the first 90 days following the TIAc. Increased risk of death within one year of the TIAd. Increased risk of congenital heart disease

7. High blood pressure is less common among women who:

a. Are age 45 and youngerb. Are obesec. Use oral contraceptivesd. Are African American

8. By definition, prehypertension is untreated systolic or diastolic pressure ranging from:

a. Systolic pressure of 120-139 mm Hg or diastolic pressure of 80-89 mm Hgb. Systolic pressure of 110-129 mm Hg or diastolic pressure of 70-79 mm Hgc. Systolic pressure of 130-149 mm Hg or diastolic pressure of 90-99 mm Hgd. Systolic pressure of 130-149 mm Hg and diastolic pressure of 90-99 mm Hg

9. The most commonly occurring congenital cardiovascular defect is:

a. Tetralogy of Fallotb. Ventricular septal defectsc. Coarctation of the aortad. Hypoplastic left heart syndrome

10. Among postmenopausal women with coronary heart disease the strongest risk factor for heart failure is:

a. First child after age 30b. No childrenc. Diet low in fruit and vegetablesd. Diabetes

11. Heart disease is the leading cause of death among men and women of all races and ethnic groups, however mortality varies by ethnicity. The group with the lowest mortality is:

a. African Americansb Native Americans or Alaska Nativesc. Hispanics/Latinosd. Asian or Pacific Islanders

12. Reducing cholesterol and blood pressure may reduce all of the following except:

a. Heart disease mortalityb. Incidence of nonfatal myocardial infarctionc. Risk of developing heart diseased. Risk of congenital heart disease

13. The most commonly occurring arrhythmia is:

a. Atrial fibrillation b. Ventricular tachycardia c. Bradycardia d. Ventricular fibrillation

14. Symptoms such as shortness of breath, fatigue, weakness, difficulty breathing when recumbent, weight gain, and swelling in the lower extremities may indicate:

a. Atrial fibrillationb. Heart failurec. Cardiac arrestd. Stroke

15. To reduce the risk of heart disease total cholesterol levels should be less than:

a. 100 mg/dLb. 60 mg/dLc. 200 mg/dLd. 150 mg/dL

16. Which condition has a 95% risk of death?

a. Myocardial infarctionb. Atrial fibrillationc. Heart failured. Sudden cardiac arrest

17. Atrial septal defect is:

a. A congenital heart defect in which there is a hole between the heart's two lower chambersb. A congenital heart defect in which there is a hole between the heart's two upper chambersc. A nonfatal cardiac arrhythmiad. Enlargement of the atria

18. Which of the following groups is not at increased risk of developing endocarditis?

a. Patients with artificial heart valve or implanted medical devices in the heart or blood vesselsb. Patients with congenital heart defectsc. Persons with poor dental hygiene and gum diseased. Persons with elevated cholesterol levels

19. Which of the following statement about mitral valve prolapse is false?

a. It is generally asymptomatic and requires no treatmentb. It affects less than 3% of the populationc. It is more common in persons with connective tissue disorders such as Marfan syndromed. All people with mitral valve prolapse require immediate medical or surgical treatment

20. The risks associated with stents include all of the following except:

a. Blood clot at the stent siteb. Rupture of an aneurysmc. Blocked blood flow to the lower bodyd. Elevated cholesterol or triglyceride levels


1. A: About 81% of people who die of CHD are age 65 or older.

2. C: Modifiable risk factors - cigarette smoking, abnormal blood lipid levels, hypertension, diabetes, abdominal obesity, a lack of physical activity, and alcohol over-consumption account for more than 90% of the risk of an initial acute MI.

3. C: 87% of strokes are ischemic, 3% result from subarachnoid hemorrhage, and 10% are due to intracerebral hemorrhage.

4. B: Because strokes tend to occur in older persons and women live longer than men, more women die of strokes. The AHA reports that more than 60% of stroke deaths in 2006 occurred in women.

5. D: According to the Framingham Heart Study, women with early menopause (before age 42) have twice the stroke risk of other women in different age groups.

6. D: The risk of stroke is highest in the 30 days following TIA, and the 90-day risk ranges from 3-17.3%. In the year following TIA, 25% of patients die.

7. A: More men than women suffer from high blood pressure until age 45. From ages 45-64, the rates are comparable for men and women. After age 65, many more women than men have high blood pressure. Women who are older, obese, or take oral contraceptives are at higher risk for high blood pressure.

8. A: An estimated 25 -37% of persons age 20 and older in the U.S. are prehypertensive.

9. B: Ventricular septal defects are the most common. Many close spontaneously; however, approximately 15% require intervention during the first year of life.

10. D: Among postmenopausal women with CHD, those with diabetes are at greatest risk of heart failure.

11. B: Native Americans or Alaska Natives have the lowest reported death rates from heart disease, followed by Asians or Pacific Islanders, Hispanics/Latinos, African Americans, and whites.

12. D: Lowering elevated cholesterol levels and blood pressure may prevent the development of heart disease and reduce the incidence of nonfatal MI and overall heart disease mortality.

13. A: Atrial fibrillation is the most common problematic cardiac arrhythmia. An estimated 3-5% of Americans, most age 65 or older, suffer from atrial fibrillation. It is an electrical disturbance that causes the atria to quiver rather than pump effectively. As a result, blood may remain in the atrium and it may clot. Blood clots can cause a stroke if they block an artery that supplies blood to the brain.

14. B: Heart failure occurs when the heart is unable to pump sufficient quantities of blood to supply the organs with oxygen. Coronary artery disease, hypertension, and diabetes are common causes of heart failure.

15. C: For persons at risk for heart disease, LDL cholesterol should be <100 mg/dL and triglycerides should be < 150 mg/dL. HDL cholesterol, which is considered protective against heart disease, should be 60 mg/dL or higher.

16. D: Although immediate defibrillation to restore normal rhythm may be lifesaving, 95% of persons with sudden cardiac arrest die within minutes.

17. B: Atrial septal defect is a congenital heart defect; a hole between the atria that allows blood to pass from the left side of the heart to the right side. As a result, oxygen-rich blood may be pumped to the lungs rather than throughout the body. Some atrial septal defects close spontaneously; however, many require surgical repair.

18. D: Endocarditis is an infection of the lining of the heart's chambers and valves. It is more common in men than women, and in addition to the groups identified above, injection drug users are also at increased risk of developing endocarditis.

19. D: Even people with symptoms attributable to mitral valve prolapse such as palpitations, shortness of breath, cough, dizziness and fatigue may not have significant backflow through the mitral valve. Mitral valve backflow may be more significant among persons with high blood pressure and persons with backflow sufficient to provoke serious symptoms such as arrhythmias or endocarditis may require surgery to repair the valve.

20. D: An estimated 1-2% of people who have stents place.

Diabetes Practice Questions

194

1. The risk factors for type 1 diabetes include all of the following except:

a. Dietb. Geneticc. Autoimmuned. Environmental

2. Type 2 diabetes accounts for approximately what percentage of all cases of diabetes in adults?

a. 55%-60%b. 35%-40%c. 90-95%d. 25-30%

3. Risk factors for type 2 diabetes include all of the following except:

a. Advanced ageb. Obesityc. Smokingd. Physical inactivity

4. What percentage of women with gestational diabetes is diagnosed with type 2 diabetes following pregnancy?

a. 25%-30%b. 5%-10%c. <5%d. 20%-25%

5. Untreated diabetes may result in all of the following except:

a. Blindnessb. Cardiovascular diseasec. Kidney diseased. Tinnitus

6. Prediabetes is associated with all of the following except:

a. Increased risk of developing type 2 diabetesb. Impaired glucose tolerancec. Increased risk of heart disease and stroked. Increased risk of developing type 1 diabetes

7. Diabetics are at increased risk of heart disease if they also:

a. Smokeb. Have high HDL cholesterol levelsc. Take aspirind. Consume a high-fiber diet

8. Blood sugar is well controlled when Hemoglobin A1C is:

a. Below 7%b. Between 12%-15%c. Less than 180 mg/dLd. Between 90 and 130 mg/dL

9. Excessive thirst and volume of very dilute urine may be symptoms of:

a. Urinary tract infectionb. Diabetes insipidusc. Viral gastroenteritisd. Hypoglycemia

10. Among female children and adolescents, the first sign of type 1 diabetes may be:

a. Rapid weight gainb. Constipationc. Genital candidiasisd. Insomnia

11. Untreated hyperglycemia may lead to all of the following complications except:

a. Hyperosmolar syndromeb Vitiligoc. Diabetic ketoacidosisd. Coma

12. Hyperinsulinemia may be caused by all of the following except:

a. An insulinomab. Nesidioblastosisc. Insulin resistanced. Type 1 diabetes

13. Which statement about diabetes is false?

a. The U.S. prevalence of diabetes is decreasing b. Diabetes is the seventh leading cause of death in the United Statesc. Diabetes is the leading cause of blindness among persons age 20 to 74d. Diabetes is the leading cause of kidney failure

14. The lifetime risk of developing diabetes for a male born in 2000 is:

a. 1 in 5b. 1 in 3c. 2 in 5d. 1 in 2

15. Which of the following measures does not help to prevent diabetes complications?

a. Controlling blood glucoseb. Controlling blood pressure and blood lipidsc. Eliminating all carbohydrates from the dietd. Prompt detection of diabetic eye and kidney disease

16. Proliferative retinopathy is often treated using:

a. Tonometryb. Fluorescein angiogramc. Antibioticsd. Laser surgery

17. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?

a. Sulfonylureasb. Meglitinidesc. Biguanidesd. Alpha-glucosidase inhibitors

18. The benefits of using an insulin pump include all of the following except:

a. By continuously providing insulin they eliminate the need for injections of insulinb. They simplify management of blood sugar and often improve A1Cc. They enable exercise without compensatory carbohydrate consumptiond. They help with weight loss

19. Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes?

a. A single anti-diabetes drugsb. Once daily insulin injectionsc. A combination of oral anti-diabetic medicationsd. Three or four injections per day of different types of insulin.

20. Diabetic neuropathies are diagnosed using all of the following except:

a. Nerve conduction studies or electromyographyb. Ultrasoundc. Foot examinationsd. Minnesota Mutiphasic Personality inventory (MMPI)


1. A: Type 1 diabetes is a primary failure of pancreatic beta cells to produce insulin. It primarily affects children and young adults and is unrelated to diet.

2. C: Type 2 diabetes accounts for the overwhelming majority of cases diagnosed in adults. It develops gradually, beginning with insulin resistance and as the requirement for insulin increases, the pancreas becomes progressively less able to produce it.

3. C: Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.

4. B: African-American, Hispanic/Latina and Native American women are at greater risk of developing gestational diabetes than are white women. Women who experience gestational diabetes are at increased risk of developing diabetes during the decade following pregnancy.

5. D: Untreated diabetes also may result in loss of lower limbs to amputation and death.

6. D: Persons with elevated glucose levels that do not yet meet the criteria for diabetes are considered to have prediabetes and are at increased risk of developing type 2 diabetes. Weight loss and increasing physical activity can help people with prediabetes prevent or postpone the onset of type 2 diabetes.

7. A: Diabetics who smoke are at greater risk of developing heart disease because both diabetes and smoking act to narrow blood vessels. Smoking also is associated with increased risk of eye problems and may compromise circulation to the legs.

8. A: A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the two to three months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.

9. B: Diabetes insipidus is a condition in which the kidneys are unable to conserve water, often because there is insufficient antidiuretic hormone (ADH) or the kidneys are unable to respond to ADH. Although diabetes mellitus may present with similar symptoms, the disorders are different. Diabetes insipidus does not involve hyperglycemia.

10. C: The signs and symptoms that suggest type 1 diabetes include excessive thirst, hunger, urination, weight loss, fatigue, irritability, blurred vision, and infection with candida albicans (also known as yeast infections).

11. B: Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.

12. D: Hyperinsulinemia indicates a difficulty in blood sugar regulation; the pancreas is working to produce enough insulin to regulate blood sugar. Hyperinsulinemia may be cause by a tumor of insulin-producing cells (an insulinoma), excessive numbers of insulin producing cells (nesidioblastosis), or insulin resistance.

13. A: The prevalence of diabetes is increasing dramatically. The CDC reports an increase of more than three million cases in the two years from 2006 to 2008. By 2008, an estimated 8% of the U.S. population had diabetes.

14. B: The CDC reports that adults in the U.S. are at high risk of developing diabetes. Females are at higher risk than males and Hispanics/Latinos are at the greatest risk.

15. C: There is no evidence that eliminating all sugar from the diet benefits people with diabetes. It is more important for diabetics to manage and control total carbohydrate intake so that their blood glucose levels remain on target. Controlling blood glucose, blood pressure, and blood lipid levels can aid in the prevention of complications associated with diabetes.

16. D: Scatter laser treatment is used to shrink abnormal blood vessels in an effort to preserve vision. When there is significant bleeding in the eye, it is removed in a procedure known as vitrectomy. Tonometry is a diagnostic test that measures pressure inside the eye. A fluorescein angiogram is a diagnostic test that traces the flow of dye through the blood vessels in the retina; it is used to detect macular edema.

17. C: Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels

18. D: Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.

19. D: Because persons with type 1 diabetes do not produce insulin, they require insulin and cannot be treated with oral anti-diabetic drugs. Several injections of insulin per day, calibrated to respond to measured blood glucose levels, offer the best blood glucose control and may prevent or postpone the retinal, renal, and neurological complications of diabetes.

20. D: Nerve conduction studies assess transmission of electrical signals through nerves and electromyography evaluates nerve transmission to muscles. Ultrasound can assess the responsivity and function of internal organs that may be compromised by neurological damage. Foot exams help to assess peripheral neuropathy and to ensure the integrity of skin. The MMPI is a psychological test and is not used to assess diabetic neuropathy.

ed develop a blood clot at the insertion site. The risk of blood clots is greatest in the months following stent placement. Most patients are prescribed aspirin or other anticlotting agents to prevent clot formation.

Digestive Disorders Practice Questions

1. Persons with celiac disease cannot tolerate:

a. Glutenb. Lactosec. Peanutsd. Eggs

2. GERD is a risk factor for the development of:

a. Celiac diseaseb. Biliary Atresiac. Barrett's Esophagusd. Inguinal Hernia

3. Risk factors for hepatitis A include all of the following except:

a. Men who have sex with menb. Illegal drug usersc. Overweight d. Persons who visit developing countries

4. Interferon is prescribed for the treatment of:

a. Hepatitis Ab. Chronic Hepatitis Bc. GERDd. Diverticulitis

5. Persons of Jewish heritage are disproportionately affected by:

a. Barrett's Esophagusb. Diverticulosisc. Appendicitisd. Crohn's disease

6. Which of the following conditions usually is asymptomatic?

a. Diverticulitisb. Crohn's diseasec. Inflammatory bowel diseased. Diverticulosis

7. Bowel diversion surgery may be indicated for all of the following conditions except:

a. Gastroparesisb. Cancerc. Inflammatory bowel diseased. Bowel obstruction

8. The most frequent cause of abdominal adhesions is:

a. Abdominal surgeryb. Gastroenteritisc. Hepatitis Ad. Hepatitis B

9. The most frequent cause of emergency abdominal surgery is:

a. Inflammatory bowel diseaseb. Appendicitisc. Viral gastroenteritisd. Barrett's Esophagus

10. Abdominal pain associated with appendicitis is generally described as:

a. Near the diaphragmb. Relieved by eatingc. Near or around the umbilicus and in the right lower quadrant of the abdomend. Worse in the morning

11. Physical examination of a patient with acute appendicitis may reveal all of the following except:

a. Guardingb Rectal bleedingc. Rebound tendernessd. Rovsing's sign

12. Symptoms of ulcerative colitis may include abdominal pain, rectal bleeding, diarrhea, and all of the following except:

a. Anemiab. Weight lossc. Joint paind. Bradycardia

13. Peptic ulcers may be caused by all of the following except:

a. Emotional stress and eating spicy foods b. Bacterial infection with Helicobacter pyloric. Long-term use of nonsteroidal anti-inflammatory agents (NSAIDS)d. Malignant tumors in the stomach or pancreas

14. All of the following are symptoms of peptic ulcer except:

a. Pain is relieved by eatingb. Pain is unrelenting and quickly worsensc. Pain is relieved by antacidsd. Pain occurs at night when the stomach is empty

15. Which of the following symptoms is not associated with dyspepsia?

a. Feeling overly full after a normal mealb. Mild to severe epigastric painc. Black tarry stoolsd. Epigastric burning sensations

16. In the United States the most common causes of hepatitis C are:

a. Wilson disease, cystic fibrosis, and glycogen storage diseasesb. Alpha-1 antitrypsin deficiency and hemochromatosisc. Chronic hepatitis B and Dd. Excessive alcohol consumption, hepatitis C, and obesity

17. Food borne illness associated with eating raw and undercooked eggs is generally attributable to:

a. Campylobacter jejunib. L. monocytogenesc. Salmonella enteriditisd. C. botulinum

18. About 80% of gallstones are composed of:

a. Calciumb. Bilec. Bilirubind. Hardened cholesterol

19. Persons at risk for gallstones include all of the following except:

a. Adults age 60 and olderb. Pregnant women or women using hormone replacement therapy or oral contraceptivesc. Native Americans and Mexican Americansd. People with rheumatoid or osteoarthritis

20. Disorders that increase risk for chronic pancreatitis include all of the following except:

a. Cystic fibrosisb. Hypercalcemiac. Excessive alcohol consumptiond. Hyperthyroidism


1. A: Celiac disease is a T cell-mediated autoimmune, inflammatory condition of the small intestine, prompted by the consumption of gluten (contained in foods such as wheat, rye, and barley) in genetically susceptible individuals. Between one and two percent of the U.S. population is believed to suffer from celiac disease.

2. C: Gastroesophageal reflux disease (GERD) is persistent acid reflux and is a risk factor for the development of Barrett's Esophagus, the condition in which the lining of the esophagus is replaced by mucosal tissue like that which lines the intestines. A small percentage of persons with Barrett's Esophagus develop a form of esophageal cancer.

3. C: Hepatitis A is viral infection that is preventable. The hepatitis A vaccine consists of two injections administered 6 months to one year apart. Hepatitis A is commonly spread by contact with an infected person's stool.

4. B: Chronic hepatitis B is treated with interferon and peginterferon as well as with orally administered agents, including lamivudine, telbivudine, adefovir and entecavir. When chronic hepatitis B results in liver failure, liver transplantation may be indicated.

5. D: Crohn's disease is an inflammatory bowel disease that frequently presents in young adults ages 20 to 30. Symptoms include pain in the lower right quadrant of the abdomen, diarrhea, weight loss, arthritis, and rectal bleeding. Complications include intestinal blockage, nutritional deficiencies, skin problems, gallstones, and kidney stones.

6. D: The presence of diverticula (pouches in the intestines) is common with advancing age; nearly half of persons age 60 and older have diverticulosis, which is generally asymptomatic. In contrast, persons with diverticulitis experience abdominal pain and other symptoms such as cramping fever and chills.

7. A: Bowel diversion surgeries such as colostomy, ileostomy and ileoanal reservoir surgery remove damaged or diseased portions of the intestines. Gastroparesis, or delayed gastric emptying, may be treated with diet, drugs including metoclopramide, erythromycin, domperidone, parenteral nutrition, or gastric electrical stimulation.

8. A: Abdominal surgery, especially bowel and gynecological procedures are the most frequent cause of abdominal adhesions. Abdominal adhesions may cause intestinal obstruction and female infertility.

9. B: Appendicitis, an acute infection and inflammation of the appendix, results in more emergency abdominal surgeries than any other condition. Medical history and physical examination are often sufficient to establish the diagnosis, however laboratory tests and imaging studies may be performed if the patient presents with atypical symptoms.

10. C: In addition to worsening right abdominal pain the symptoms of appendicitis may include nausea and vomiting, constipation or diarrhea, low-grade fever, and abdominal swelling. 11. B: Guarding, rebound tenderness, and Rovsing's tenderness (pain in the lower right quadrant of the abdomen when the examiner presses and releases pressure on the left side) are indicative of appendicitis as are psoas sign (flexing the psoas produces pain) and obturator sign (flexing the obturator produces abdominal pain).

12. D: Ulcerative colitis symptoms are often chronic and intermittent. They may be mild or severe and also include fatigue, anorexia, malnutrition, skin lesions, and impaired growth in children. The goal of treatment for ulcerative colitis is to reduce symptoms and achieve a remission. The drugs used to induce remission include aminosalicylates, corticosteroids, and immunomodulators.

13. A: H. pylori is responsible for most peptic ulcers. The bacteria weaken the mucosal lining of the stomach, rendering it acid permeable. The combination of the bacteria and acid erode the lining and produce the ulcer. Although stress and a diet of spicy food do not cause peptic ulcers, both may exacerbate symptoms.

14. B: Peptic ulcer pain is described as dull and gnawing and is often intermittent - arising and subsiding over the course of several days. It generally occurs within a couple of hours of eating and may be accompanied by bloating, nausea, and vomiting.

15. C: Mild dyspepsia, or indigestion, may be treated by diet (several small, low-fat meals rather than three large meals, eliminating alcohol, coffee and carbonated beverages from the diet, stopping smoking, and eliminating use of drugs that are known to irritate the gastric mucosa such as aspirin and anti-inflammatory agents) and managing stress. Nonprescription antacids, H2 receptor antagonists, proton pump inhibitors, and prokinetics also may relieve symptoms.

16. D: All of the conditions listed above may cause cirrhosis, the condition in which healthy liver is replaced by scar tissue. Cirrhosis is the 12th leading cause of death and many people have more than one causal factor. Rising rates of obesity have resulted in increasing number of cases of nonalcoholic fatty liver disease, which causes cirrhosis.

17. C: Food borne illnesses that result from consuming raw and undercooked meat and poultry are generally attributable to Campylobacter jejuni, E. coli O157:H7, L. monocytogenes, and Salmonella. Food borne illnesses that result from consuming raw foods and unpasteurized milk and dairy products are generally attributable to L. monocytogenes, Salmonella, Shigella, Staphylococcus aureus, and C. jejuni. Improperly canned goods and smoked or salted fish may harbor C. botulinum.

18. D: An estimated 10% of the population has gallstones but most people are asymptomatic and as such, require no treatment. In instances where gallstones injure or lodge in bile ducts or impede the flow of bile or digestive enzymes, oral dissolution therapy, contact dissolution therapy or surgery - laparoscopic cholecystectomy or in about 5% of cases open procedures - may be indicated.

19. D: Populations at risk for gallstones include the above-mentioned groups as well as persons who are overweight or obese, persons who experience rapid weight loss such as bariatric surgery patients, diabetics, persons with a family history of gallstones, and persons who take statin drugs.

20. D: Chronic pancreatitis is often presents in adults ages 30 to 40 and in addition to chronic, excessive alcohol use, cystic fibrosis, and hypercalcemia may be caused or precipitated by hyperlipidemia, hypertriglyceridemia, or autoimmune disorders. Untreated, chronic pancreatitis results in calcification, which is permanent damage, and may require surgical excision.

Endocrine Disorders Practice Questions

1. Acromegaly is most frequently diagnosed in:

a. Middle-aged adultsb. Newbornsc. Children ages 2 to 5d. Adults age 65 and older

2. Grave's disease is:

a. The most common cause of hypothyroidismb. The most common cause of hyperparathyroidismc. The most common cause of hyperthyroidismd. The most common cause of adrenal insufficiency

3. Symptoms of Grave's ophthalmopathy include all of the following except:

a. Bulging eyeballsb. Dry, irritated eyes and puffy eyelidsc. Cataracts d. Light sensitivity

4. An ACTH stimulation test is commonly used to diagnose:

a. Grave's diseaseb. Adrenal insufficiency and Addison's diseasec. Cystic fibrosisd. Hashimoto's disease

5. All of the following are symptoms of Cushing's syndrome except:

a. Severe fatigue and weaknessb. Hypertension and elevated blood glucosec. A protruding hump between the shouldersd. Hair loss

6. Which of the following conditions is caused by long-term exposure to high levels of cortisol?

a. Addison's diseaseb. Crohn's diseasec. Adrenal insufficiencyd. Cushing's syndrome

7. A "sweat test" or newborn screening may be used to detect:

a. Cystic fibrosisb. Adrenal insufficiencyc. Grave's diseased. Hypothyroidism

8. Hashimoto's disease is:

a. Chronic inflammation of the thyroid glandb. Diagnosed most frequently in Asian-Americans and Pacific Islandersc. A form of hyperthyroidismd. A rare form of hypothyroidism

9. Persons at increased risk of developing Hashimoto's disease include all of the following except:

a. Persons with vitiligob. Asian-Americansc. Persons with rheumatoid arthritisd. Persons with Addison's disease

10. All of the following statements about Hashimoto's disease are true except:

a. Many patients are entirely asymptomaticb. Not all patients become hypothyroidc. Most cases of obesity are attributable to Hashimoto's diseased. Hypothyroidism may be subclinical

11. The most common benign tumor of the pituitary gland is a:

a. Gliomab Prolactinomac. Carcinoid tumord. Islet cell tumor

12. Symptoms of polycystic ovarian syndrome (PCOS) may include all of the following except:

a. Pelvic painb. Acne, oily skin, and dandruffc. Infertilityd. Weight Loss

13. Women with PCOS are at increased risk for all of the following except:

a. Pregnancy b. Diabetesc. Cardiovascular diseased. Metabolic syndrome

14. All of the following organs may be affected by multiple endocrine neoplasia type 1 except:

a. Parathyroid glandsb. Kidneysc. Pancreas and Duodenumd. Pituitary gland

15. What is the treatment for hyperparathyroidism?

a. Synthetic thyroid hormoneb. Desiccated thyroid hormonec. Surgical removal of the glandsd. Calcium and phosphate

16. The most common causes of death in people with cystic fibrosis is:

a. Dehydrationb. Opportunistic infectionc. Lung cancerd. Respiratory failure

17. Untreated hyperthyroidism during pregnancy may result in all of the following except:

a. Premature birth and miscarriageb. Low birthweightc. Autismd. Preeclampsia

18. Short stature and undeveloped ovaries suggest which of the following disorders:

a. Polycystic ovarian syndromeb. Prolactinomac. Grave's diseased. Turner syndrome

19. Endocrine disorders may be triggered by all of the following except:

a. Stressb. Infectionc. Chemicals in the food chain and environmentd. Cell phone use

20. An analysis of data from the Women's Health Initiative questioned the use of which therapy to prevent heart disease?

a. Synthetic thyroid hormoneb. Oral contraceptivesc. Weight-loss drugsd. Postmenopausal hormone replacement therapy


1. A: Acromegaly results from benign tumors on the pituitary gland that produce excessive amounts of growth hormone. Although symptoms may present at any age, the diagnosis generally occurs in middle-aged persons. Untreated, the consequences of acromegaly include type 2 diabetes, hypertension and increased risk of cardiovascular disease, arthritis and colon polyps.

2. C: Grave's disease is an autoimmune disorder characterized by an enlarged thyroid gland and overproduction of thyroid hormones producing symptoms of hyperthyroidism such as rapid heartbeat, heat intolerance, agitation or irritability, weight loss, and trouble sleeping. It usually presents in persons age 20 to 40 and it is much more common in women than in men.

3. C: Grave's ophthalmopathy is an inflammation of tissue behind the eye causing the eyeballs to bulge. In addition to the above-mentioned symptoms, Grave's ophthalmopathy may cause pressure or pain in the eyes, double vision, and trouble moving the eyes. About one-quarter of persons with Grave's disease develop Grave's ophthalmopathy. The condition is frequently self-limiting, resolving without treatment over the course of a year or two.

4. B: The ACTH stimulation test measures blood and urine cortisol before and after injection of ACTH. Persons with chronic adrenal insufficiency or Addison's disease generally do not respond with the expected increase in cortisol levels. An abnormal ACTH stimulation test may be followed with a CRH stimulation test to pinpoint the cause of adrenal insufficiency.

5. D: Cushing's syndrome also may cause fragile, thin skin prone to bruises and stretch marks on the abdomen and thighs as well as excessive thirst and urination and mood changes such as depression and anxiety. Women who suffer from high levels of cortisol often have irregular menstrual cycles or amenorrhea and present with hair on their faces, necks, chests, abdomens, and thighs.

6. D: Cushing's syndrome is a form of hypercortisolism. Risk factors for Cushing's syndrome are obesity, diabetes, and hypertension. Cushing's syndrome is most frequently diagnosed in persons ages 20 to 50 who have characteristic round faces, upper body obesity, large necks, and relatively thin limbs.

7. A: Cystic fibrosis is the most common inherited fatal disease of children and young adults in the United States. Cystic fibrosis is usually diagnosed by the time an affected child is three years old. Often, the only signs are a persistent cough, a large appetite but poor weight gain, an extremely salty taste to the skin, and large, foul-smelling bowel movements. A simple sweat test is currently the standard diagnostic test. The test measures the amount of salt in the sweat; abnormally high levels are the hallmark of the disorder.

8. A: Hashimoto's disease is the most common cause of hypothyroidism. It is an autoimmune disease that produces chronic inflammation of the thyroid gland. More women are affected than men and it is generally diagnosed in persons ages 40 to 60. When treatment is indicated, synthetic T4 is administered.

9. B: Along with the above-mentioned groups, persons with type 1 diabetes and persons suffering from pernicious anemia (insufficient vitamin b12) are at increased risk of developing Hashimoto's disease. Because it tends to run in families, there is likely a genetic susceptibility as well. Environmental factors such as excessive iodine consumption and selected drugs also have been implicated as potential risk factors.

10. C: Although weight gain may be a symptom of Hashimoto's disease, the majority of obese people have normal thyroid function; rarely is thyroid disorder the sole cause of obesity. Other symptoms of Hashimoto's disease include fatigue, cold intolerance, joint pain, myalgias, constipation, dry hair, skin and nails, impaired fertility, slow heart rate, and depression.

11. B: Prolactinomas can cause symptoms by releasing excessive amounts of prolactin into the blood or mechanically by pressing on surrounding tissues. In women, symptoms may include menstrual irregularities and infertility; in men erectile dysfunction and libido may be impaired.

12. D: In addition to the above-mentioned symptoms, PCOS may cause menstrual irregularities, thinning hair or male-pattern baldness, thick skin or dark patches of skin and excessive hair growth on the face, chest, abdomen, thumbs and toes.

13. A: Women with PCOS produce excessive amounts of androgens and do not release ova during ovulation, which seriously compromises their ability to conceive. Although women with PCOS can become pregnant, often by using assistive reproductive technology, they are at increased risk for miscarriage.

14. B: Multiple endocrine neoplasia type 1, also known as Werner's syndrome, is a heritable disorder that causes tumors in endocrine glands and the duodenum. Although the tumors associated with multiple endocrine neoplasia type 1 are generally benign, they can produce symptoms chemically by releasing excessive amounts of hormones or mechanically by pressing on adjacent tissue.

15. C: When hyperparathyroidism requires treatment, surgery is the treatment of choice and is considered curative for 95% of cases. Because untreated hyperparathyroidism may elevate blood and urine levels of calcium and deplete phosphorus, bones and teeth may lose the minerals needed to remain strong.

16. D: Declining pulmonary function is a hallmark of cystic fibrosis. Drugs such as Pulmozyme (dornase alfa) and Zithromax (azithromycin) can slow the progression of lung disease and mechanical physical therapy devices help CF patients to breathe more easily by loosening and dislodging mucus. For some patients with severe lung damage, lung transplantation is a treatment option.

17. C: In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation, confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.

18. D: Turner syndrome results from a chromosomal abnormality and occurs in an estimated 1 in 2,500 female births. It occurs more frequently in preterm pregnancies. Affected women are shorter than average and are infertile because they lack ovarian function. They also may have webbed necks, broad chests, arms that turn out from the elbow, lymphedema of the hands and feet and skeletal, cardiac, and renal problems.

19. D: Endocrine function may be influenced by myriad factors. In addition to the above-mentioned, there is evidence that exposure to naturally occurring and man-made endocrine disruptors such as tributyltin, certain bioaccumulating chlorinated compounds, and phytoestrogens is widespread and in susceptible individuals, may trigger endocrine disorders.

20. D: The results of the Women's Health Initiative study prompted the U.S. Food and Drug Administration (FDA) to advise against using hormone therapy (estrogen-alone or estrogen-plus-progestin) to prevent heart disease. When hormone replacement therapy is used to treat moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy it should used at the lowest doses for the shortest duration needed to achieve treatment objectives.

Neurological Disorders Practice Questions

1. Amyloid plaques and neurofibrillary tangles are the hallmarks of:

a. Alzheimer's diseaseb. Amyotrophic lateral sclerosisc. Ataxia Telengiectasiad. Autism

2. Difficulty speaking and understanding speech is termed:

a. Apneab. Ataxiac. Aphasiad. Dyslexia

3. The most common form of transient facial paralysis is:

a. Alzheimer's diseaseb. Transient ischemic attackc. Bell's palsyd. Erb's palsy

4. Gradually increasing pain and weakness and numbness in the hand or wrist that radiates up the arm suggest:

a. Amyotrophic lateral sclerosisb. Carpal tunnel syndromec. Bloch-Sulzberger Syndromed. Dystonia

5. All of the following may be associated with Guillain-Barré Syndrome except:

a. Weakening or tingling sensation in the legsb. Weakness in the arms and upper bodyc. Nearly complete paralysisd. First symptom is altered mental status

6. Which of the following statement about herpes zoster is not true?

a. It is caused by the varicella-zoster virusb. It causes burning, tingling pain and lesions, generally on one side of the bodyc. Anyone who has had chickenpox is at risk of postherpetic neuralgiad. It is a sexually transmitted disease

7. Diagnostic tests for epilepsy include all of the following except:

a. Simple blood testsb. EEGc. Brain scand. Wada test

8. Treatment for epilepsy to eliminate or sharply reduce the frequency of seizures may involve all of the following except:

a. Cognitive-behavioral therapy b. Narrow-spectrum and broad-spectrum antiepileptic drugs c. Vagus-nerve stimulationd. Surgery

9. The most common inherited neurological disorder is:

a. Bloch-Sulzberger Syndromeb. Charcot-Marie-Tooth diseasec. Alper's diseased. Asperger Syndrome

10. A severe form of epilepsy that appears during the first year of life is called:

a. Dandy-Walker syndromeb. Devic's syndromec. Dravet syndromed. Fabry disease

11. Lack of ceramide trihexosidase, also known as alpha-galactoside-A causes:

a. Fahr's syndromeb Fabry diseasec. Fisher syndromed. Gaucher's disease

12. Symptoms of trigeminal neuralgia may include all of the following except:

a. Extreme, intermittent facial pain in the jaw or cheekb. Tingling or numbness on one side of the facec. Pain triggered by contact with the face or facial movementsd. Inability to swallow

13. All of the following are true about Tourette syndrome except:

a. Drug treatment completely eliminates symptomsb. It is involuntary and may be a chronic conditionc. Symptoms are generally most severe during adolescence d. Symptoms are generally detected in children

14. Huntington's disease is a heritable disorder that involves:

a. Sudden paralysisb. Chorea, loss of cognitive abilities, and emotional disturbancec. Uncontrollable swearing and repetitive actionsd. Inability to recognize faces

15. All of the following statements about amyotrophic lateral sclerosis are true except:

a. It causes degeneration and death of upper and lower motor neuronsb. Patients lose strength and control of voluntary muscles c. It impairs cognition and sensesd. It progresses rapidly and is fatal

16. Children with Angelman syndrome generally display all of the following except:

a. Developmental delays and speech impairmentb. Feeding problemsc. Seizuresd. Loss of hearing and sense of smell

17. All of the following are true about autism except:

a. Affected persons have communication, interpersonal, and behavioral problems b. Affected persons display obsessive or repetitive behaviors and interestsc. It is the direct result of immunization with thimerosal-containing vaccinesd. Early intervention is associated with improved outcomes

18. Brain and spinal tumors may be treated with any or all of the following modalities except:

a. Surgeryb. Radiationc. Chemotherapyd. Positron emission tomography

19. Symptoms of Parkinson's disease include all of the following except:

a. Tremors of the hands, arms, legs, jaw, and faceb. Stiff limbsc. Bradykinesia and impaired balance d. Impaired cognition

20. Narcolepsy is a disorder characterized by:

a. Narcotic abuseb. Grand mal seizuresc. Reliance on soporific drugsd. Inability to regulate sleep-wake cycles


1. A: Alzheimer's disease (AD) is a specific type of dementia and the most common form of dementia in persons age 65 and older. It is a progressive neurological disease that produces a decline in cognitive function and memory and changes in behavior. In addition to the above-mentioned features of AD, there is a loss of connections between the neurons involved with learning and memory.

2. C: Aphasia results from damage to the portion of the brain involved in creating and interpreting language. Aphasia is not a disease. It is a symptom of a neurological disorder or injury, such as stroke, brain tumor, or head injury. Expressive aphasia is the term for problems communicating using spoken or written language. Receptive aphasia refers to problems understanding language.

3. C: Bell's palsy is a temporary paralysis that generally affects one side of the face. It results from damage or trauma to facial nerves. Bell's palsy has sudden onset with symptoms that may include varying degrees of weakness or paralysis, drooping eyelid or corner of the mouth, drooling, dry eye or mouth, impaired sense of taste, excessive tearing, and facial distortion.

4. B: Carpal tunnel syndrome is caused by compression of the median nerve in the wrist. As the disorder progresses, there is a loss of grip strength and manual dexterity may decrease. Resting the affected wrist, immobilization, ice packs, and nonsteroidal anti-inflammatory agents may provide relief by reducing swelling and pressure on the median nerve.

5. D: Guillain-Barré Syndrome is a rare autoimmune disease that often follows a respiratory or gastrointestinal viral illness. It also may occur following surgery or immunization. There is no cure for Guillain-Barré Syndrome; however, treatment, including plasmapheresis and high-dose immunoglobulin therapy administered intravenously, aims to reduce the severity of symptoms.

6. D: Herpes zoster, commonly known as shingles, occurs along a dermatome and produces characteristic itching, burning, blisters, and pain. It is caused by a reactivation of the varicella-zoster virus that causes chickenpox. The severity and duration of an outbreak can be reduced by prompt treatment with antiviral agents. Older adults who have had chickenpox may be given a varicella-zoster virus vaccine to significantly reduce the risk of developing shingles.

7. A: The diagnosis of epilepsy may be established using the above-mentioned tests as well as continuous video EEG monitoring, magnetic resonance imaging (MRI) and functional MRI, and single photon emission computed tomography (SPECT), which traces cerebral blood flow to detect abnormalities during and between seizures.

8. A: Because people with epilepsy, especially children and adolescents, may develop behavioral or emotional difficulties in response to stigmatization, cognitive behavioral therapy may be considered as adjunctive therapy. It is not, however, a treatment for the seizure disorder, which for the majority of affected persons is controllable with the use of antiepileptic drugs.

9. B: Charcot-Marie-Tooth disease affects an estimated 1 in 2,500 persons in the United States. It is a hereditary motor and sensory neuropathy that affects the peripheral nerves. As such, symptoms include weakness of the feet and legs and foot deformities resulting from weak muscles, which in turn may produce foot drop, tripping, and falls.

10. C: Dravet syndrome, also known as severe myoclonic epilepsy of infancy, presents with frequent fever-related seizures during the first year of life. Other types of seizures generally occur over time, and children with Dravet syndrome are often developmentally delayed in language, motor, and interpersonal skills.

11. B: Persons with Fabry disease cannot efficiently metabolize lipids and as a result, excessive lipid deposition occurs in the eyes, kidneys, cardiovascular system, and autonomic nervous system. Symptoms of this heritable disease include burning sensations in the hands, raised skin lesions, and in boys especially, corneal changes. Persons with Fabry disease are at increased risk of heart disease and stroke.

12. D: Trigeminal neuralgia is characterized by sudden onset of severe pain that lasts less than a minute. It presents most commonly in persons age 50 and older and among women. The frequency and severity of attacks recurs and remits, progressively worsening over time. While the disorder may be debilitating, it is not life threatening.

13. A: Tourette Syndrome is characterized by tics - repetitive, involuntary behaviors, vocalizations and movements such as eye blinking, grimacing, and shrugging or jerky muscle movements. Tics also may include self-harm such as repetitively punching oneself as well as coprolalia and echolalia. Persons with Tourette syndrome frequently suffer behavioral problems such as hyperactivity, impulsivity, attention disorders, and repetitive behaviors.

14. B: Huntington's disease is a progressive brain disorder that causes the degeneration of cells in a pair of nerve clusters deep in the brain. The disease affects both the body and the mind. HD is caused by a single dominant gene and affects men and women of all races and ethnic groups. It generally begins during the third and fourth decades of life; however, there is a form of the disease that can affect children and adolescents.

15. C: Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, causes muscle weakness and atrophy. As it progresses ALS patients have difficulty moving, swallowing, speaking, and ultimately, breathing on their own. Many ALS patients require mechanical ventilation and most die from respiratory failure three to five years from the time initial symptoms are detected.

16. D: Angelman syndrome is a genetic disorder that causes developmental delays and multiple neurological problems such as motor difficulties that impair functions. Children with Angelman syndrome are often hyperactive and suffer from movement, balance, and sleep disorders. They have characteristic small, flat heads and protruding tongues. Jerky movements are also characteristic of the disorder.

17. C: Although the etiology of autism remains unknown, it is thought to arise from a combination of genetic predisposition and environmental triggers. A review of the evidence conducted by the Institute of Medicine concluded that there is no causal relationship between thimerosal-containing vaccines and autism.

18. D: Brain and spinal tumors may be benign or malignant and benign tumors may be asymptomatic depending on their location. Symptoms of brain tumors include the following: headache; seizures; nausea and vomiting; vision, hearing, and motor problems; and sensory and cognitive changes. Symptoms of spinal cord tumors include pain, sensory changes, and motor problems.

19. D: Symptoms of Parkinson's disease often begin on one side of the body and over time affect the entire body. The four characteristic symptoms of Parkinson's disease are tremor, rigidity, slowness of movement, and postural instability. Tremor is generally most apparent at rest or when the patient is stressed and improves with deliberate movement.

20. D: Narcolepsy is a neurological disorder that causes affected individuals to experience irresistible bouts of sleep, causing them to fall asleep for periods ranging from seconds to minutes throughout the day. Along with excessive daytime sleepiness, persons with narcolepsy also suffer from cataplexy, hallucinations at the onset of sleep and/or upon awakening, and transient complete paralysis at the onset or end of sleep.

Nutrition Practice Questions

142

1. Fruits, vegetables and cereals are potent sources of:

a. Antioxidantsb. Unsaturated fatc. Saturated fatd. Free radicals

2. The leading source of antioxidants in the U.S. diet is:

a. Citrus fruitsb. Spinachc. Coffeed. Egg yolks

3. The essential fatty acids that must be derived from the diet are:

a. Stearidonic acid and eicosatetraenoic acidb. Eicosapentaenoic acid and docosapentaenoic acidc. Linoleic and alpha-linoleic acidd. Gamma-linoleic acid and arachidonic acid

4. All of the following statements about omega-3 fatty acids are true except:

a. They help to maintain healthy triglyceride and high-density lipoproteinb. They have significantly contributed to the obesity epidemicc. They are necessary for healthy infant growth and developmentd. They play an important role in the production of hormones that govern numerous metabolic and biological processes

5. All of the following may be associated with scurvy except:

a. Loss of appetite and irritabilityb. Diarrhea and feverc. Tenderness and swelling in legsd. First symptom is altered mental status

6. The only fat-soluble antioxidant synthesized in the body is?

a. Vitamin Db. Thiaminec. Ascorbic acidd. CoQ10

7. Good source of vitamin D include all except:

a. blueberriesb. Sunlightc. Salmon, tuna sardines and mackereld. Fortified milk and other dairy products

8. One of the fat-soluble vitamins involved in coagulation is:

a. Vitamin K b. Vitamin Ac. Vitamin Dd. Vitamin E

9. Products that contain live microorganisms in sufficient numbers to alter intestinal microflora and promote intestinal microbial balance are known as:

a. Antibioticsb. Probioticsc. Fruits and vegetablesd. Digestive enzymes

10. Nondigestible food ingredients that stimulate the growth and activity of certain bacteria in the colon are called:

a. Insoluble fiberb. Probioticsc. Prebioticsd. Cellulose

11. A deficiency of thiamine (vitamin B1) in the diet causes:

a. Osteopeniab Beri-beric. Protein malnutritiond. Scurvy

12. Symptoms of trigeminal neuralgia may include all of the following except:

a. Extreme, intermittent facial pain in the jaw or cheekb. Tingling or numbness on one side of the facec. Pain triggered by contact with the face or facial movementsd. Inability to swallow

13. All of the following are true about Tourette syndrome except:

a. Drug treatment completely eliminates symptomsb. It is involuntary and may be a chronic conditionc. Symptoms are generally most severe during adolescence d. Symptoms are generally detected in children

14. The USDA Dietary Guidelines for Americans advise:

a. Limiting carbohydrates to 10 percent of daily caloriesb. Limiting total fat intake to 20 to 35 percent of caloriesc. Limiting protein to 10 percent of daily caloriesd. Limiting intake of fats and oils to 10 percent of daily calories

15. All of the following statements about vitamin B3 (niacin) are true except:

a. It helps to release energy in carbohydrates, fat, and proteinb. It improves blood lipid levels c. Deficiency causes beriberid. It is involved in the synthesis of sex hormones

16. The average American consumes approximately how much sodium per day?

a. 2,300 mgb. 230 mgc. 340 mgd. 3,400 mg

17. All of the following are potentially modifiable risk factors for osteoporosis except:

a. Anorexia nervosa b. Chronically low intake of calcium and vitamin Dc. Chronically low intake of vitamins C and B6d. Excessive alcohol consumption

18. Consuming fewer than 130 grams of carbohydrate per day may lead to:

a. Hypoglycemiab. Kwashiorkorc. Marasmusd. Ketosis

19. Characteristics of successful dieters include all of the following except:

a. Maintaining a daily food journalb. Counting caloriesc. Adhering to a strict eating pland. Eliminating all carbohydrates from their diets

20. Iron supplements are frequently recommended for all of the following except:

a. Women who are pregnantb. Infants and toddlersc. Teenage girlsd. Post-menopausal women


1. A: In addition to the above-mentioned foods, legumes (including broad beans, pinto beans, and soybeans) are good sources of antioxidant vitamins and a variety of phytonutrients that often act as antioxidants, protecting the cells of the body from the damaging effect of free radicals. Some of the best sources of antioxidants are berries, ginger, pomegranate, sunflower seeds, and walnuts.

2. C: Because most Americans do not consume the recommended number of servings of fruits and vegetables each day, coffee is the leading source of antioxidants in Americans' diets. It is not because coffee is especially high in antioxidants, but because Americans drink so much of it. Their morning coffee gives Americans nearly 1,300 mg daily of antioxidants in the form of polyphenols.

3. C: Although essential fatty acids are required for human metabolism, the body does not produce linoleic acid (LA or ?-6 or omega-6) and alpha-linoleic acid (LNA or ?-3 or omega-3), and they must be derived from the diet. Also known as polyunsaturated fatty acids (PUFAs), omega-3 and omega-6 fatty acids play vital roles in brain function as well as normal growth and development.

4. B: In addition to the above-mentioned facts, omega-3 fatty acids are necessary for the structure of cell membranes, especially in the brain and retina. The cardioprotective effects of omega-3 fatty acids relate to improvements in blood pressure, cardiac function, and arterial and vascular function as well as improved lipid metabolism, antiplatelet, and anti-inflammatory effects.

5. D: Scurvy is caused by insufficient consumption of vitamin C. Although it is rare, older adults, persons who abuse alcohol, and those who eat a diet that does not contain fresh fruit and vegetables may be at risk of developing scurvy. Along with the above-mentioned symptoms, persons with scurvy may suffer bleeding gums, petechial hemorrhage of the skin and mucous membranes, bleeding in the eye, hyperkeratosis, and sicca syndrome.

6. D: Coenzyme Q10 (CoQ10) is a fat-soluble quinone, a vitamin-like compound that is vital for activities related to energy metabolism. CoQ10 is the coenzyme for at least three mitochondrial enzymes as well as enzymes in other parts of the cell and is involved in the key biochemical reactions that produce energy in cells. It also is a free radical scavenger and is metabolized to ubiquinol, which prolongs the antioxidant effect of vitamin E. The highest amounts of it are found in the mitochondria of cells of organs with high-energy requirements such as the heart muscle, liver, kidneys, and pancreas.

7. A: Humans obtain vitamin D from two natural sources: sunlight and consumed food. Solar UVB radiation penetrates the skin and converts 7-dehydrocholesterol to previtamin D3, which is rapidly converted to vitamin D3. Along with the above-mentioned foods, cod liver oil is a potent source of vitamin D and some orange juice, soy, and rice beverages are fortified with vitamin D.

8. A: Vitamin K1 is a cofactor needed for the synthesis of some of the substances that help blood to clot. In adults, low dietary intake of vitamin K may be the result of chronic illness, malnutrition, alcoholism, multiple abdominal surgeries, long-term parenteral nutrition, malabsorption, gallbladder disease, liver disease, cystic fibrosis, inflammatory bowel disease, and long-term use of drugs such as antibiotics and cholestyramine, which binds to bile acids, preventing fat-soluble vitamin absorption.

9. B: Probiotics protect against harmful bacteria in the following ways: by penetrating and binding to the surfaces of harmful organisms; by stimulating the lining of the digestive tract to prevent penetration by pathogens; and by modifying immunoregulation. Probiotics have been shown to relieve temporary abdominal bloating and to reduce intestinal gas.

10. C: Prebiotics are primarily oligosaccharides-short chains of sugar molecules that can only partially be digested. Most naturally occurring oligosaccharides are found in plants. Prebiotics are often called bifidogenic factors because they primarily stimulate growth of bifidobacteria. Prebiotics work in concert with probiotics and have been found to produce many of the same health benefits.

11. B: Beri-beri is rarely seen in the United States because many foods are fortified with thiamine. Persons at risk of developing beri-beri include those who abuse alcohol, persons on dialysis, and those taking high doses of diuretics as well as infants breastfed by mothers who lack sufficient thiamine.

12. D: Trigeminal neuralgia is characterized by sudden onset of severe pain that lasts less than a minute. It presents most commonly in persons age 50 and older and among women. The frequency and severity of attacks recurs and remits, progressively worsening over time. While the disorder may be debilitating, it is not life threatening.

13. A: Tourette Syndrome is characterized by tics - repetitive, involuntary behaviors, vocalizations and movements such as eye blinking, grimacing and shrugging, or jerky muscle movements. Tics also may include self-harm such as repetitively punching oneself as well as coprolalia and echolalia. Persons with Tourette syndrome frequently suffer behavioral problems such as hyperactivity, impulsivity, attention disorders, and repetitive behaviors.

14. B: The USDA Dietary Guidelines suggest that most dietary fats should be obtained from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. The Guidelines also advise limiting intake of fats and oils high in saturated and/or trans fatty acids.

15. C: In addition to the above-mentioned actions, vitamin B3, also known as niacin or nicotinic acid, is a water-soluble vitamin that is necessary for cell respiration and supports the circulation, skin, nervous system, and secretion of bile. Insufficient niacin intake is associated with symptoms such as canker sores, depression, fatigue, indigestion, weakness, skin problems, and inflammation. Chronic niacin deficiency is called pellagra.

16. D: The average American consumes about 50% more sodium than the 2,300 mg per day recommended in the Dietary Guidelines for Americans. Excessive sodium consumption is associated with increased risk for hypertension, which is associated with increased risk of developing cardiovascular disease.

17. C: Long-term inadequate intake of calcium is associated with low bone mass, rapid bone loss, and high risk of fracture. In addition to the above-mentioned risk factors, chronic use of glucocorticoids, some anticonvulsants, inactivity, smoking, and changes in sex hormones such as amenorrhea, menopause, and low testosterone may increase the risk for osteoporosis.

18. D: Low carbohydrate diets promote ketosis, the process of breaking down fat as opposed to carbohydrate to generate energy. Ketones are acidic chemicals, which can build up in the blood and urine. Diet-induced ketosis may be intentional as a treatment for some people with epilepsy, however, for some people, long-term adherence to a very low carbohydrate diet may produce damage to the liver and kidneys.

19. D: Along with the above-mentioned characteristics, successful dieters monitor their weight, practice portion control, increase physical activity, and aim for healthy realistic weight loss ranging from 10% to 20% of initial bodyweight in a year. Successful dieters maintain their motivation by celebrating the achievement of weight-loss milestones.

20. D: In addition to the above-mentioned populations, supplemental iron may be given to treat anemia that occurs during pregnancy or as a result of heavy menstrual periods, kidney disease, or chemotherapy. Supplemental iron also may be recommended for vegetarians and women who are lactating. Iron requirements decrease for post-menopausal women.

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