WorksheetsGPM Exam 2 Review (part 1)
Total questions: 100
Worksheet time: 5hrs 0mins
What is the large airway that leads from the larynx (voice box) to the bronchi (large airways that lead to the lungs)?
alveoli
trachea
diaphragm
bronchi
intercostal muscles
Ventilation is the __________ of air __________ and __________ of the lungs.
(a)
(a) results from active muscle contraction. It requires energy in order to draw air into the lungs.
(a) results from elastic recoil. The lungs are collapsing because they are under tension and this is also the last breath you will take. It requires no energy.
What does spirometry measure?
the maximum amount of air that is exhaled by a patient after complete inhalation
airflow pressure
air volume
airflow direction
airflow rate
What is the sensor that actually measures airflow rate, called?
respirometer
pneumotachometer
spirometer
peak-flow meter
bronchodilator
Spirometry requires a voluntary maneuver in which a seated patient exhales maximally from tidal breathing to total lung capacity and then exhales to the fullest extent possible. A forceful maneuver generates which of the following?
peak expiratory flow rate (PEFR)
slow vital capacity (SVC)
forced vital capacity (FVC)
forced expiratory volume in one second (FEV1)
forced expiratory flow (FVF)
Spirometry requires a voluntary maneuver in which a seated patient exhales maximally from tidal breathing to total lung capacity and then exhales to the fullest extent possible. A relaxed maneuver generates which of the following?
peak expiratory flow rate (PEFR)
slow vital capacity (SVC)
forced vital capacity (FVC)
forced expiratory volume in one second (FEV1)
forced expiratory flow (FVF)
When a patient has inhaled as much air as possible and their lungs are completely full, what is happening with the spirometer?
the spirometer is broken
no air flow within the spirometer
air is entering the spirometer mouthpiece
air is leaving the spirometer mouthpiece
When a patient has exhaled as much as possible, what is happening with the spirometer?
the spirometer is broken
no air flow within the spirometer
air is entering the spirometer mouthpiece
air is leaving the spirometer mouthpiece
When a patient is exhaling, what is happening with the spirometer?
the spirometer is broken
no air flow within the spirometer
air is entering the spirometer mouthpiece
air is leaving the spirometer mouthpiece
When a patient is inhaling, what is happening with the spirometer?
the spirometer is broken
no air flow within the spirometer
air is entering the spirometer mouthpiece
air is leaving the spirometer mouthpiece
How do you calculate forced vital capacity (FVC)?
slow vital capacity + residual volume
total lung capacity + residual volume
total lung capacity - residual volume
slow vital capacity - residual volume
FVC cannot be determined
What value of FEV1/FVC defines chronic obstruction in airways?
less than 80%
less than 70%
less than 60%
less than 50%
less than 40%
When the post-brochodilator FEV1/FVC is less than 70%, which value defines COPD severity?
FEV1
FVC
FEV1/FVC
FVC/FEV1
COPD severity cannot be determined by this information
In post-brochodilator spirometry, a FEV1 value of 60% predicted is defined as what severity of COPD?
(a)
In post-brochodilator spirometry, a FEV1 value of 25% predicted is defined as what severity of COPD?
mild
moderate
severe
very severe
life-threatening
In post-brochodilator spirometry, a FEV1 value of 85% predicted is defined as what severity of COPD?
(a)
In post-brochodilator spirometry, a FEV1 value of 45% predicted is defined as what severity of COPD?
mild
moderate
severe
very severe
life threatening
Which type of inhalation device is the most demanding?
nebulizer
pressured metered dose inhaler
metered dose inhaler
dry powder inhaler
peak flow meter
Which of the following must occur in order for validity to be assumed on a volume time curve?
a plateau is achieved
inhalation time exceeds 6 seconds
exhalation time exceeds 6 seconds
exhalation time exceeds 10 seconds
result is repeatable
What type of lung disease is shown by the following graphs?
(a)
What type of lung disease is shown by the following graphs?
(a)
What are some benefits of peak flow meters?
portable and easy to use
used for monitoring
used for diagnosis
requires minimal effort each time
Which of the following are functions of blood?
metabolism (O2, CO2, nutrients, wastes)
defense against toxins and pathogens
restriction of fluid losses at injury sites (clotting)
regulation (pH, body temperature, water content)
transport (O2, CO2, nutrients, wastes)
Which of the following are included in a CBC with differential?
WBC
RBC
platelet count
phagocytes
band neutrophils
How is absolute neutrophil count (ANC) calculated?
(total RBC) X (% neutrophils + % bands)
(total WBC) X (% neutrophils + % bands)
(total WBC) X (% lymphocytes + % bands)
(total RBC) X (% lymphocytes + % bands)
(total WBC) X (% neutrophils + % lymphocytes)
An ANC value of 1400 cells/µL is considered what level risk of infection?
(a)
An ANC value of 150 cells/µL is considered what level risk of infection?
(a)
What is bandemia?
What is demargination?
An elevation in ANC is called:
neutrophilia
neutropenia
lymphocytosis
leukopenia
leukemia
An elevation in lymphocytes is called:
(a)
Which of the following provides a direct indication of oxygen-transport capacity of blood?
Hgb
Hct
MCV
MCH
RDW
When someone has decreased hemoglobin, which of the following do we look at next to diagnose anemia?
reticulocyte count
Hct
MCV
MCH
RDW
Macrocytic anemia is considered as:
low Hgb, low MCV
low Hgb, high MCV
high Hgb, low MCV
high Hgb, high MCV
normal Hgb, normal MCV
Microcytic anemia is considered as:
low Hgb, low MCV
low Hgb, high MCV
high Hgb, low MCV
high Hgb, high MCV
normal Hgb, normal MCV
Which of the following are components of an iron study, also known as an iron panel?
serum iron level
total iron binding capacity (TIBC)
serum transferrin
transferrin (iron) saturation
serum ferritin
Which of the following is the best indicator of iron deficiency or iron overload?
serum iron level
serum ferritin
serum transferrin
total iron binding capacity (TIBC)
transferrin (iron) saturation
Serum iron level is usually (a) in iron deficiency anemia (IDA).
Total iron binding capacity (TIBC) is usually (a) in iron deficiency anemia (IDA).
TIBC is a calculated value. How is TIBC calculated?
(transferritin saturation X 100) / serum ferritin
(serum ferritin X 100) / serum iron
(serum iron X 100) / transferrin saturation
(serum ferritin X 100) / transferrin saturation
(serum iron X 100) / serum ferritin
Transferrin saturation is usually __________ in iron deficiency anemia (IDA).
elevated
decreased
normal
Define hemostasis.
Describe the role of platelets.
An elevated platelet count is known as (a) .
Platelets have a lifespan of:
30-60 minutes
12-24 hours
5-10 days
2-4 weeks
3-5 months
What is the name of the proteolytic enzyme that breaks down fibrin?
(a)
Virchow's triad consists of which of the following?
clot degradation
hyper coagulable state
vascular wall injury
circulatory stasis
clot inhibition
Which of the following clot degradation tests is used to assess acute thrombosis and can be used as a rule out test for venous thromboembolism?
fibrinogen
fibrin degrdation
D dimer
protein C and S
PT and INR values
Protein C and protein S inhibit which of the following factors?
IIa
IXa
Va
VIIIa
Xa
Which coagulation tests are affected by heparin?
prothrombin time (PT)
activated partial thromboplastin time (aPTT)
international normalized ratio (INR)
anti-factor Xa
Which coagulation tests are affected by low molecular weight heparins (LMWH)?
prothrombin time (PT)
activated partial thromboplastin time (aPTT)
international normalized ratio (INR)
anti-factor Xa
Which coagulation tests are affected by fondaparinux?
prothrombin time (PT)
activated partial thromboplastin time (aPTT)
international normalized ratio (INR)
anti-factor Xa
Which quadrant of the abdomen is the liver located in?
upper left
upper right
lower left
lower right
middle center
Which two pathways does blood come into the liver from?
hepatic artery
hepatic vein
inferior vena cava
portal artery
portal vein
Blood comes into the liver from 2 different pathways. What fraction of blood is brought into the liver from the hepatic artery?
1/3
2/3
1/4
3/4
1/2
Blood comes into the liver from 2 different pathways. What fraction of blood is brought into the liver from the portal vein?
1/3
2/3
1/4
3/4
1/2
What is the name of the vasculature that goes throughout the GI organs and flows into the portal vein?
(a)
After blood goes through the liver and is cleaned/metabolized/etc., what is the correct pathway that it follows next?
hepatic artery → inferior vena cava → heart → rest of body
hepatic vein → inferior vena cava → heart → rest of body
portal artery → inferior vena cava → rest of body → heart
portal vein → inferior vena cava → heart → rest of body
portal vein → inferior vena cava → rest of body → heart
What is the basic functional unit of the liver?
(a)
Which of the following lack a basement membrane that allows solutes to pass out of the bloodstream?
hepatocytes
hepatic cellular plates
hepatic sinusoids
kuppfer cells
endothelial cells
What are kuppfer cells?
the basic functional unit of the liver
plates within lobules that maintain patency
cells that produce substances like nitric oxide and endothelian
phagocytic cells that engulf pathogens, cell debris, and damaged blood cells
smooth muscle cells that ensure liver structure and function
The liver also secretes bile. This bile is secreted into bile canalculi. After the bile flows out of the canalculi, into the common hepatic duct which leaves the liver, it goes into one of two pathways. What are these 2 pathways?
common bile duct → duodenum to aid in digestion
common bile duct → gallbladder for storage
common bile duct → cystic duct
cystic duct → common bile duct
cystic duct → gallbladder for storage
Some cells within lobules and hepatic cellular plates can produce substances like nitric oxide and endothelian. What is the purpose of endothelians?
Which of the following are liver tests?
aspartate aminotransferase (AST)
alanine aminotransferase (ALT)
albumin and clotting factors (PT/INR)
albumin phosphatase
ammonium levels
The liver has over 200 functions. What are the three main physiologic functions of the liver?
metabolic regulation
hemostasis
hematologic regulation
bile secretion
bile production
Which of the following is the best way to tell about how well the liver is functioning?
hepatocellular injury
hepatocellular synthetic function
excretion
drainage
detoxification
When the liver is not producing clotting proteins, there will be an elevation in which of the following?
AST
ALT
PT
INR
albumin
Clotting proteins are manufactured using what vitamin?
(a)
An increase in bilirubin causing people to turn yellow is known as:
hepatocellular damage
jaundice
scleral icterus
pruritus
xanthoma
An itchy feeling due to accumulation of bile salts is known as:
hepatocellular damage
jaundice
scleral icterus
pruritus
xanthoma
When you order a comprehensive metabolic panel, total bilirubin is part of that panel. Indirect bilirubin comes from the breakdown of erythrocytes. Indirect bilirubin needs to be greater than what percent of the total to be the cause of bilirubinemia?
(a)
Bilirubin is bound to albumin and brought into the liver as indirect bilirubin. Glucuronyl transferase links indirect bilirubin with glucuronic acid to convert it into direct bilirubin. You need bile to eliminate bilirubin, so when you have an excretion/drainage problem, bilirubin can't be excreted in bile so people turn yellow (jaundice). Direct bilirubin has to be greater than what percent of the total to be the cause of bilirubinemia?
10
25
30
50
70
Alkaline phosphatase is an enzyme part of the comprehensive metabolic panel. 80% of it comes from the bone and liver. Cholestasis is a deficiency in the excretory function of the liver/gallbladder. When alkaline phosphatase levels are __________ times __________ than normal, this is suggestive of cholestatic disorder.
2; more
2; less
4; more
4; less
3; more
Hepatic encephalopathy can be caused by which of the following?
elevations in AST and ALT
elevations in PT/INR
decreased albumin
elevations in ammonia
elevations in ammonium
In hepatocellular injury, we are primarily looking for which of the following?
elevations in AST and ALT
decreased AST and ALT
increased PT/INR
elevations in bilirubin
elevations in ammonia
In an excretion/drainage problem, we are primarily looking for which of the following?
elevations in AST and ALT
increased PT/INR
decreased alkaline phosphatase
elevations in bilirubin
elevations in ammonia
In cholestatic disease, we are primarily looking for which of the following?
elevations in alkaline phosphatase
increased PT/INR
decreased alkaline phosphatase
elevations in bilirubin
elevations in ammonia
In hepatocellular synthetic dysfunction, we are primarily looking for which of the following?
elevations in AST and ALT
elevations in albumin
decreased albumin
elevations in bilirubin
decreased PT/INR
Based on the Bristol Stool Chart, mild constipation is described as:
separate hard lumps
soft blobs with clear-cut edges
lumpy and sausage like
sausage shape with cracks in the surface
hard lumps with ragged edges
Based on the Adult's Rome III Criteria for constipation, a patient has to have 2 or more of the following for at least 12 weeks with symptom onset at least 6 months prior to diagnosis. Which of the following are part of this criteria?
straining in lumpy or hard stools at least 15 percent of defecations
straining in lumpy or hard stools at least 25 percent of defecations
more than 3 bowel movements per week
loose stools are present
loose stools are not present
When kids have chronic constipation, they have 2 or more of these: less than 3 stools per week, fecal leakage 1 or more times a week, large diameter stools cause outlet obstruction, demonstrate withholding posture and behavior, and painful bowel movements (poop dance). These are present for more than how long to be defined as chronic constipation in kids?
2 weeks
4 weeks
6 weeks
8 weeks
none of the above
What is the main etiology of constipation, accounting for 90-95% of cases?
metabolic
medications
organic
functional
other reasoning
Which of the following is/are included in the subjective history of constipation?
diameter of stools
weight at onset
signs of hypothyroidism
deep tendon reflexes
changes in stool pattern
Which of the following is/are included in the objective history of constipation?
family history of thyroid or celiac
abdominal exam
signs of hypothyroidism
deep tendon reflexes
previous treatments
When triaging situations concerning constipation, which of the following would you send the patient to their MD for?
present more than 2 weeks
greater than 3 years of age
early passage of meconium
ribbon stools
onset in infants less than 1 month old
Which of the follow is/are alarm symptom(s) of constipation?
abdominal distention
abdominal pain
ribbon stools
nausea and vomiting
failure to thrive
What is the most common complication in adults experiencing constipation?
anal fissures
perianal fistula
cardiac dysrhythmias
hemorrhoids
ribbon stools
In non-drug therapy, when recommending fiber, it is important that the patient drinks enough water so the constipation does not worsen. Patients should drink 2 ounces of water/nondairy per gram of fiber. In patients age 5 and older, up to how many grams of fiber per day should they take?
(a)
Which non-drug therapy/therapies have data that support them treating constipation?
increasing intake of apricots
fiber recommendations
increased physical activity
drinking more water
drinking more apple juice
Which agent(s) have a longer timing of onset (3 days to 1 week)?
linzess
senna
methylnaltrexone
enema
lubiprostone
Which of the following is/are known as a/an "overnight" stimulant?
enema
bulk forming agent
docusate
bisacodyl
senna
What is the mechanism of action (MOA) of saline cathartics?
inhibits absorption of water in colon
creates an osmotic gradient pulling water into intestines/stool
lowers surface tension of stool
osmotically retain water in the GI tract
stimulates bowel motility
Which of the following are evacuation drug therapies?
magnesium citrate
milk of magnesium
polyethylene glycol
dulcolax
fleet
Bisacodyl and Senna are both overnight agents that start to work within 6-12 hours. They have similar MOA and abdominal cramping as a side effect. Senna is more gentle than Bisacodyl and may turn the urine red. What is their MOA?
they are prodrugs converted by colonic bacteria to stimulate bowel and peristaltic motility
they create an osmotic agent by pulling water into the intestines/stool
they inhibit absorption of water in the colon therefore increasing weight of the stool
they absorb water to increase bulk and decrease colonic transit time
they lower surface tension of the stool allowing water and lipids to penetrate
Bulk forming laxatives are polysaccharide derivatives that absorb water to increase bulk and decrease colonic transit time. They must be given with 8oz of water. Some side effects are bloating and flatulence. Which of the following patients should avoid use of a bulk forming laxative?
a patient who is pregnant
a patient with Crohn's
a patient who just had surgery
a patient with obstructive bowel disease
a patient between the ages of 6-17
Which of the following should never be used at the same time as Docusate?
bisacodyl
Miralax
glycerin suppository
mineral oil lubricant
polycarbophil
Mineral oil lubricant may cause oily, leaky stools (orange stools that can stain). It may also decrease absorption of fat soluble vitamins such as:
A
B
D
E
K
What is the first line/first choice for adult patients with constipation?
saline cathartic
electrolyte lavage
bulk forming laxative
osmotic agent
fiber
