WorksheetsPatho Final (1-100)
Total questions: 100
Worksheet time: 52mins
The four stages of nociception include all EXCEPT: ________
Transduction
Transmission
Perception
Modulation
Termination
Transduction in pain physiology refers to: ________
the process of converting painful stimuli to neuronal action potentials at the sensory receptor.
the transmission of action potentials along the nerve fiber to the spinal cord.
the perception of pain in the brain.
the modulation of pain signals in the spinal cord.
3. Cyclooxygenase inhibitors block the production of: ________
insulin
dopamine
prostaglandin
histamine
4. Aδ fibers transmit pain that is: ________
Dull, aching and slow
Sharp, Stinging, Cutting, Pinching
Diffuse, burning, and persistent
Throbbing, radiating, and chronic
C fibers are characterized by all of the following EXCEPT: ________
They are myelinated
They are unmyelinated 90%
Polymodal stimuli (mechanical,
thermal, chemical)
Slower traveling, 0.6–2 m/sec
Dull, burning, aching
Widening the pain gate via Aβ fiber stimulation is basis of: ________
Pattern Theory
Specificity Theory
Intensity Theory
Gate Control Theory
Wind-up phenomenon is due to: ________
Inhibition of A-delta fibers in the spinal cord
Decreased neurotransmitter release at the synapse
excessive or repeated stimulation of C fibers leading to sensitization of spinal cord neurons through glutamate and NMDA receptor activity, painful
Blockade of NMDA receptors in the brain
8. Pain from C fibers travels mainly in the: ________
Paleospinothalamic tract
Neospinothalamic tract
Dorsal column-medial lemniscal pathway
Corticospinal tract
9. Periaqueductal gray mediates analgesia via: ________ (Select all that apply)
Dopamine release stimulating motor cortex
release of endogenous opioids (endorphins, enkephalins)
serotonin (5-hydroxytryptamine) is the neurotransmitter that conveys analgesic signal from PAG area to the raphe magnus
Acetylcholine release activating pain fibers
α2-adrenergic agonists like clonidine reduce pain by: ________ (select al that apply)
Increasing serotonin release in the periphery
Blocking NMDA receptors in the spinal cord
Mimicking norepinephrine in descending pain pathways → analgesia
Blocking sympathetically mediated pain transmission when given epidurally
11. Endorphins are: ________
endogenous opioids that are produced within the CNS and released in response to stressors, exercise, certain foods (most notably chocolate), laughter, and from massage or acupuncture
A type of neurotransmitter that increases blood pressure
Hormones responsible for regulating blood sugar levels
Enzymes that break down carbohydrates in the digestive system
Ergotamine is contraindicated in patients with: ________
Epilepsy, Parkinson's disease, glaucoma, cataract
Diabetes mellitus, hypothyroidism, anemia, asthma
Migraine without aura, tension headache, cluster headache, sinusitis
Cardiovascular disease and pregnancy
Rebound headache may result from overuse of: ________
Antibiotics; may cause allergic reactions' not associated with headaches
Abuse/addictive potential; may cause sedation; rebound headache with frequent use; withdrawal potential
Antacids; may cause gastrointestinal upset; not linked to headache
Antihypertensives; may cause dizziness; not related to headache
Chronic pain is pain lasting longer than: ________
more than 6 months
more than 1 week
more than 1 month
more than 1 year
Neuropathic pain arises from: (select all that apply) ________
Lesions or disease of the somatosensory nervous system
Peripheral or central nerve injury/dysfunction
Tumor growth / metastasis, Radiation therapy
Elevated blood glucose (diabetes), Viral infection
Surgery, Trauma
Diabetic neuropathy pain often worsens at: ________
Pain is frequently worse at night
Pain is frequently worse after meals
Pain is frequently worse in the early morning
Pain is frequently worse after exercise
Postherpetic neuralgia is defined as pain lasting > ________
for less than a week after shingles
only during the rash phase of shingles
More than 8 weeks after the onset of skin lesions
only when blisters are present
Shingles rash follows a: ________
A rash that spreads randomly across the body with no specific pattern
by a burning pain that follows along a dermatomal pathway and is accompanied by a blistering rash
Itching and redness confined to the palms and soles
Random distributionA flat, non-painful rash that fades within 24 hours
Herpes zoster vaccination reduces the risk of: ________
Developing chickenpox
Developing influenza and pneumonia
Contracting bacterial infections
Preventing or lessening the severity of a varicella zoster outbreak and decreasing the risk of postherpetic neuralgia
Trigeminal neuralgia pain is described as: ________
Sharp, electric shock-like, stabbing facial pain
Dull, aching pain in the jaw
Burning sensation in the tongue
Constant throbbing headache
Spinal cord stimulation alleviates pain by: ________
closing the pain gate through modulation of descending input from the brain to the spinal cord
Increasing the release of excitatory neurotransmitters in the spinal cord
Directly stimulating pain receptors in the brain
Enhancing the transmission of pain signals to the cortex
Which class of drugs is first-line for chemotherapy-induced neuropathy? (select all that apply)
Anticonvulsants
Opioids
tricyclic Antidepressants
NSAIDs
Celecoxib selectively inhibits: ________
phospholipase A2 enzyme
cyclooxygenase-1 (COX-1) enzyme.
lipoxygenase enzyme.
cyclooxygenase-2 (COX-2) enzyme.
Acetaminophen analgesia is mediated primarily in the: ________
Central nervous system (CNS)
Peripheral nervous system (PNS)
Musculoskeletal system
Gastrointestinal tract
The maximal daily dose of acetaminophen in adults is: ________
6 grams (6000 mg) per day
2 grams (2000 mg) per day
4 grams (4000 mg) per day
8 grams (8000 mg) per day
COX-2 inhibitors increase risk of: ________ (select all that apply)
gastrointestinal toxicity
Renal toxicity,
Possible cardiovascular side effects
Asthma exacerbation
The most frequent bacterial cause of septic arthritis in adults is: ________
Staphylococcus aureus
Escherichia coli
Streptococcus pneumoniae
Neisseria gonorrhoeae
The characteristic skin lesion of early Lyme disease is called: ________
Psoriasis
Erythema nodosum
Erythema migrans
Lichen planus
Rheumatoid arthritis predominantly spares which joint?
wrist joints
Proximal interphalangeal (PIP) joints
Metacarpophalangeal (MCP) joints
Distal interphalangeal (DIP) joints
The autoantibody most specific for RA is: ________
the anti-cyclic citrullinated peptide (anti-CCP) antibody
rheumatoid factor (RF)
anti-nuclear antibody (ANA)
anti-double stranded DNA (anti-dsDNA) antibody
Pannus formation in RA leads to: ________ (select all that apply)
Destruction of articular cartilage and bone erosion, bone cyst and fissures
inflammation, shortening, and even rupture of tendons, as well as ligament laxity, joint subluxations, contractures, and deformities
Formation of osteophytes
Ankylosis without cartilage damage
FLACC stands for: (Select all that apply)
Face
Legs
Activity
Cry
Consolability
Classic hand deformity in RA is called: ________
Mallet finger
Dupuytren's contracture
Heberden's nodes
Ulnar deviation with swan-neck and boutonnière deformities
Ethical pain management principle: autonomy means: ________
Respecting the patient’s right to self-determination — including the right to report their own pain and make informed decisions about pain treatment
Ensuring all patients receive the same treatment regardless of their wishes
Allowing only healthcare professionals to make decisions for the patient
Focusing solely on pain relief without considering patient preferences
Glucagon raises glucose by: ________
Inhibiting insulin secretion from the pancreas
Stimulating glycogenolysis and gluconeogenesis in the liver as well as stimulating lipolysis
Increasing glucose uptake by muscle cells
Promoting fatty acid synthesis in adipose tissue
Truvite stones are associated with infections by ________
Anaerobic bacteria
Gram-negative cocci
Urease-producing bacteria
Non-urease producing bacteria
Uric acid stones form in urine pH: ________
Alkaline urine (pH > 7.0)
Acidic urine (pH < 5.5)
Neutral urine (pH ~7.0)
Slightly acidic urine (pH 6.0-6.5)
An early sign of postinfectious glomerulonephritis is: ________
Cloudy urine with a foul odor
Smoky or coffee-colored urine attributable to hematuria and RBC casts (nephritic syndrome)
Clear urine with no sediment
BradycardiaIncreased urine output and dehydration
Crescent formation in Bowman space indicates: ________
crescentic glomerulonephritis (rapidly progressive glomerulonephritis, RPGN)
Minimal change disease
Membranous nephropathy
Diabetic nephropathy
The primary lesion in minimal change disease is damage to: ________
Basement membrane
Mesangial cells
Endothelial cells
Podocytes
Histamine and bradykinin in wounds exudate cause: ________
rapid tissue regeneration without inflammation
increased blood clotting and scab formation
vasodilation, increased vascular permeability, and pain
decreased blood flow and tissue pallor
Direct-invasion bone infection occurs via: ________
Open fractures, penetrating wounds, surgical contamination, or insertion of prostheses/metal plates/screws
Hematogenous spread from distant organs
Congenital transmission from mother to fetus
Inhalation of airborne pathogens
Chronic osteomyelitis sinus tracts drain: ________
To the lymph nodes
Into the bloodstream directly
Into the joint cavity
pus to the skin surface
Bursitis causes pain primarily because of: ________
Degeneration of the joint cartilage
Inflammation of the bursa located at stress points of muscle function
Fracture of the underlying bone
Tearing of the muscle fibers
De Quervain tenosynovitis affects tendons at the:
extensor pollicis brevis and abductor pollicis longus tendons of the thumb
extensor pollicis brevis and abductor pollicis longus tendons of the elbow
extensor pollicis brevis and abductor pollicis longus tendons of the knee
extensor pollicis brevis and abductor pollicis longus tendons of the ankle
Myositis ossificans may result from: _________
Deficiency of vitamin D.
Viral infection of the muscle tissue.
blunt trauma with muscle contusion and hemorrhage that calcifies
Congenital absence of muscle fibers.
Compartment syndrome is dangerous because of it: ___________.
Leads to excessive bleeding due to ruptured blood vessels.
increased pressure reduces capillary blood flow, causing muscle and nerve ischemia, excruciating pain, and tissue damage
Results in immediate bone fracture in the affected limb.
Causes rapid infection spread throughout the body.
Which phase of soft tissue healing involves granulation tissue?
Remodeling Phase
Inflammatory phase
Maturation phase
Proliferative phase
The first stage of fracture healing is: ___________.
Hematoma formation
Callus formation
Remodeling
Fibrous union
The triad of reactive (Reiter) arthritis includes: (select all that apply)
arthritis, dermatitis, and encephalitis
arthritis, nephritis, and hepatitis
arthritis, urethritis, and conjunctivitis
arthritis, gastritis, and bronchitis
The HLA association in ankylosing spondylitis is: ________
HLA-B27
HLA-DR4
HLA-A3
HLA-DQ2
Morning stiffness lasting >1 hour suggests: ________.
Fibromyalgia
Osteoarthritis
Inflammatory arthritis such as rheumatoid arthritis
Mechanical back pain
The Philadelphia chromosome is associated with: ________
Multiple Myeloma
Acute Lymphoblastic Leukemia (ALL)
Hodgkin's Lymphoma
Chronic Myeloid Leukemia (CML)
The Charcot joint (neuropathic osteoarthropathy) commonly occurs in all of the following except: ________.
alcoholism
Diabetes mellitus
Osteoarthritis
Multiple sclerosis
pernicious anemia
Gold-standard diagnosis of gout is the identification of: ________.
monosodium urate crystals in synovial fluid of the involved joint
calcium pyrophosphate crystals in synovial fluid of the involved joint
rheumatoid factor in blood
antinuclear antibodies in serum
First-line acute treatment for gout is: ________.
physical therapy and rest
antibiotics such as penicillin
long-term uric acid lowering therapy
aggressive antiinflammatory medication such as NSAIDs or corticosteroids (oral, parenteral, or intraarticular)
Systemic JIA (Still disease) presents with: ________.
spiking fevers (103°F to 104°F), daily or twice daily and usually in the afternoon, with return to baseline without antipyretics; transient, pale pink rash; lymphadenopathy; hepatosplenomegaly; and pericardial or pleural effusions. Fatigue, muscle atrophy, and weight loss can be severe. Anemia, leukocytosis, and thrombocytosis are common.
persistent low-grade fever, chronic cough, and night sweats; weight gain and increased appetite.
acute onset of joint pain with erythema and warmth, but no systemic symptoms; normal blood counts.
gradual onset of fatigue, mild joint stiffness, and photosensitivity; no organomegaly or effusions.
Psoriatic arthritis often involves (select all that apply)
Peripheral joint involvement, usually asymmetric oligoarthritis
Nail involvement such as pitting and onycholysis
Sacroiliac and spinal involvement, especially in HLA-B27–positive patients
skin lesions typical of psoriasis
Elevated inflammatory markers with negative RF and anti-CCP
Enthesitis and dactylitis (inflammation at tendon insertions and sausage-shaped digits)
The most common benign bone tumor around the joint is: ________
Osteochondroma
Chondrosarcoma
Ewing's sarcoma
Osteosarcoma
The “terrible triad” of the elbow includes: (Select all that apply)
Elbow dislocation
Radial head/neck fracture
Coronoid fracture
Olecranon fracture
Cystography is contraindicated in: ________
Neurogenic bladder
Renal calculi
Benign prostatic hyperplasia
Acute Urinary Tract infection
The _______________ is the most commonly diagnosed type of primary glomerulonephritis worldwide.
Poststreptococcal glomerulonephritis
IgA nephropathy (Berger disease)
Membranous nephropathy
Minimal change disease
When not idiopathic, causes of crescentic glomerulonephritis fall into which of the following categories?
complication of an acute or subacute infection
complication of a multisystem disease
drug exposure
a primary disorder in the absence of other systemic disease
Genetic inheritance pattern
The pain induced by nephrolithiasis is often accompanied by all of the following symptoms
nausea and vomiting
diaphoresis
tachycardia
tachypnea
Constipation
Chronic active hepatitis may progress to ________.
Pancreatitis
Gastritis
Cirrhosis
Nephritis
The ________is a principal neurotransmitter in the adult CNS. It is important for rapid neuron-to-neuron communication. It also plays a role in neuron growth and brain development and maturation.
Dopamine
Glutamate
Serotonin
GABA
This anatomic region of the cord is involved in pain transmission and is characterized by multiple synaptic connections among primary sensory afferent neurons, interneurons, and anterolateral ascending fibers.
The substantia gelatinosa
The dorsal columns
The ventral horn
The central canal
The __________ is a common virus in the developing world that causes an illness similar to HAV infection but has a relatively high mortality in pregnant women.
Hepatitis D virus
Hepatitis B virus
Hepatitis C virus
Hepatitis E virus
The infection of this Virus is also known as enteric hepatitis because it is generally transmitted by ingestion of contaminated substances.
Hepatitis C virus
Hepatitis A virus
Hepatitis B virus
Hepatitis D virus
The Cerebral edema due to hepatic encephalopathy is managed primarily by
Intravenous infusion of hypertonic saline
Administration of mannitol to increase serum osmolarity
Keeping the patient in the semi-Fowler position (head and trunk elevated 30 degrees)
Restricting fluid intake to prevent dehydration
Administering hypotonic IV fluids
The ability to accommodate changes in volume without significant increases in pressure is called ________.
Resistance
Compliance
Elasticity
Contractility
In hepatic encephalopathy grade 3, the patient shows: ________.
Mild Confusion, Normal speech, no flap
Alert and oriented, no neurological deficits
Comatose, unresponsive to painful stimuli
Stuporous but can follow commands, marked confusion, slurred speech, flap present
The major pathway for pain signal transmission up the spinal cord is the ________.
coricospical tract
dorsal column
anterolateral tract
spinocerebellar tract
Renin release is increased by: ________.
when neurotransmitters released by the SNS bind to β1 receptors in the kidney
when blood pressure is high
when sodium levels are elevated
when parasympathetic stimulation increases
This renal disease is characterized by small, atrophied kidneys with diffuse scarring and blunting of the calices secondary to persistent or recurrent infection of the kidney.
Renal cell carcinoma
Acute glomerulonephritis
Chronic pyelonephritis
Nephrotic syndrome
Which percentage of untreated Lyme patients develop neurologic symptoms?
15%
5%
30%
50%
Which of the following is false about the composition of the Bile?
Normal bile is composed mainly of water, electrolytes, and organic solutes.
It has a high protein content, containing bile acids, pigments, cholesterol, and phospholipids.
Primary bile salts include cholic and chenodeoxycholic acids.
Secondary bile salts include deoxycholic, ursodeoxycholic, and lithocholic acids.
Lecithin and bile salts keep cholesterol soluble; imbalance can lead to gallstones.
The Crush injury to the epiphyseal plate in young children commonly leads to _________?
premature growth cessation
increased bone length
osteoporosis
joint dislocation
A wound classification for a fracture Type IIIB means _________?
fracture with only minor skin abrasion
minimal soft tissue damage with no bone exposure
closed fracture with no external wound
extensive injury or loss of soft tissue, as well as periosteal stripping and bone exposure
The most common causes of increased ICP (Increased Intracranial Pressure) include all of the following except:
Increased brain tissue volume (e.g., tumor, hemorrhage, infection, ischemia)
Increased cerebrospinal fluid volume (e.g., hydrocephalus, pseudotumor cerebri)
Increased blood volume (e.g., dural sinus thrombosis, high PaCO₂)
Decreased Blood Volume; etabolic acidosis
Nephralgia occurs when the renal: _________
artery is blocked, leading to a sudden drop in blood pressure.
capsule is innervated by nociceptors and when a disease process causes it to be distended, inflamed, or punctured, a dull to sharp pain is felt.
tubules are unable to reabsorb water, resulting in excessive urination.
pelvis is compressed, causing urine to back up into the kidney.
32. Endometriosis is rare in women _________. (Select all that apply)
during pregnancy
between 20 and 40 years of age.
younger than 20 years
after menopause.
Who have regular menstrual cycles
The __________ is the fifth most frequently occurring pediatric malignancy and accounts for 95% of childhood kidney cancers.
Neuroblastoma
Nephroblastoma (Wilms Tumor)
Rhabdomyosarcoma
Osteosarcoma
The medication Mirabegron, a β3-adrenergic agonist, is helpful in managing what kind of Incontinence?
management of UUI (Urgency urinary incontinence)
management of SUI (Stress urinary incontinence)
management of overflow incontinence
management of functional incontinence
The exercise prescription is as essential in diabetes management as the medication or nutrition prescription. The CDC recommends _________
Moderate-intensity exercise for at least 30 minutes, 5 or more days per week
Vigorous-intensity exercise for 20 minutes, 3 or more days per week
No more than 2 consecutive days without exercise
All of the above
The _______ is an important component of bile that helps keep cholesterol from precipitating into crystals.
Bilirubin
Bile pigment
Lecithin
Cholesterol
The most common predisposing factors for pancreatitis in the United States are ________. (select all that apply)
Biliary tract disease
Hypertriglyceridemia
Ethanol-associated pancreatitis (alcohol use)
Viral infection
High-protein diet
The principal function of the gallbladder is to: _________
the secretion of the insulin
the production of digestive enzymes.
the absorption of nutrients.
the concentration and storage of bile.
Bence Jones proteins are: ________
Proteins found in the urine of patients with multiple myeloma, derived from antibody light chains
Enzymes produced by the liver that help digest proteins
Plasma proteins responsible for oxygen transport
Antibodies that protect against viral infections
Malignant plasma cells have a predilection to invade ________.
the lungs and cause fibroids
the skin and cause rashes.
bone and form multiple tumor sites.
the liver and cause cirrhosis.
The overall 5-year survival rate for treated Hodgkin disease, including all stages, is approximately ________.
60%
85%
40%.
25%.
The majority of cases of non-Hodgkin lymphoma arise from ________.
Bone marrow only
Lymph nodes, but they can originate in any lymphoid tissue
Epithelial tissue of the skin
The thymus gland exclusively
Reed–Sternberg cells are seen in: ________.
lymph nodes of patients with non-Hodgkin lymphoma.
bone marrow of patients with multiple myeloma.
blood smears of patients with chronic lymphocytic leukemia.
affected lymph nodes of patients with Hodgkin disease.
Which buffer is most important in the extracellular fluid?
phosphate buffer system
Bicarbonate buffer system
Hemoglobin buffer system
Protein buffer system
A solution with a low pH has: ________.
Many Hydrogen ions (H+), making it more acidic
Many Hydroxide ions (OH-), making it more basic
Equal numbers of H+ and OH- ions
No ions present at all
The lungs excrete carbonic acid as: ________.
Nitrogen and ammonia
Oxygen (O₂) and glucose.
Carbon dioxide (CO₂) and water (H₂O).
Bicarbonate ions and hydrogen ions.
If PaCO₂ increases, what will likely occur? ________
The blood becomes more alkaline, leading to respiratory alkalosis
The kidneys immediately excrete bicarbonate to raise pH
Carbonic acid accumulates in the blood, causing the pH to drop and resulting in respiratory acidosis
Oxygen levels in the blood increase significantly
What triggers chemoreceptors to increase respiratory rate?
A decrease in arterial carbon dioxide tension (PaCO₂)
An increase in arterial carbon dioxide tension (PaCO₂), which lowers blood pH and stimulates the medullary center
An increase in blood oxygen levels
A decrease in hydrogen ion concentration (increased pH)
49. Kidneys compensate for carbonic acid excess by: _________
increasing the excretion of metabolic acids and reabsorbing more bicarbonate (HCO3−)
decreasing the excretion of metabolic acids and reabsorbing less bicarbonate (HCO3−)
increasing the excretion of bicarbonate (HCO3−) and retaining more metabolic acids
decreasing the excretion of both metabolic acids and bicarbonate (HCO3−)
Which is not a cause of respiratory acidosis?
Impaired gas exchange (e.g., COPD, pneumonia, pulmonary edema)
Impaired neuromuscular function (e.g., Guillain–Barré syndrome, respiratory muscle fatigue)
Impaired respiratory control from brainstem depressant drugs (e.g., opioids, barbiturates)
Hyperventilation due to anxiety
