Clinical Sciences in Nursing 2: Sample Quiz Answers

Quiz 1: NeoplasiaQuestion Response

1A All the components of the immune system have the potential

for eradicating cancer cells including the natural killer cells. The natural killer cell does the actual killing of the cancer cell.

B All the components of the immune system have the potential for eradicating cancer cells including the antibodies. Antibodies can destroy cancer cells through complement-mediated mechanisms or through antibody-dependent cellular toxicity. However, it has been suggested that cancer development might be associated with escape in the surveillance capacity of the immune system.

C All the components of the immune system have the potential for eradicating cancer cells including T and B lymphocytes. The T-cell response controls the growth of antigenic tumor cells and responsible for direct killing of tumor cells and for activation of other components of the immune system. Macrophages are important as antigen-presenting cells to initiate the immune response and as effector cells in tumor cell breakdown.

D Best answer: All the above answers pertain to cancer cells, hence, this answer is the best response.

2A Cancer of the colon is usually present for a long time before it

produces symptoms. Bleeding is an early symptoms as well as a change in bowel habits such as diarrhea, constipation, urgency, and incomplete emptying.

B Moles or nevi are usually benign. They may undergo cancerous transformation by becoming dysplastic. Hence, any mole that undergoes a change warrants medical examination.

C As cancers grow, they compress and erode blood vessels, causing ulceration and necrosis along with frank bleeding and sometimes hemorrhage.

D Best answer: Blurring of vision has been reported to indicate tumor of the eye but the opacity of lens indicates cataract. This answer is the best response as clouding of lens does not indicate a malignant process.

3A Oncogenesis refers to the genetic mechanism whereby normal

cells are transformed into cancer cells. The genes that promote autonomous cell growth in cancer cells are called oncogenes. They are derived from mutations in proto-oncogenes and are characterized by the ability to promote cell growth in the absence of normal growth-promoting signals. This answer describes cancer cells.

B Contact inhibition is the cessation of growth of growth after a cell comes in contact with another cell. This usually switches

off cell growth by blocking the synthesis of DNA, RNA and protein. Cancer cells lack this inhibition and tend to grow rampantly without regard for adjacent tissue. This answer describes correctly cancer cells.

C Malignant cells are undifferentiated, with anaplasia and atypical structure that often bears little resemblance to cells in the tissue of origin. They display marked variations in size and shape. This answer describes correctly cancer cells.

D Best answer: Cancer cells, unlike normal cells, fail to undergo normal cell proliferation and differentiation. Anaplasia is the term used to describe the lack of cell differentiation in cancerous tissue. Anaplastic cells resemble each other more than they do their tissue of origin and because they lack differentiation, they do not function properly. This answer does not describe accurately cancer cells.

4A Benign neoplasms are slow, progressive rate of growth that

may come to a standstill or regress and localised. Benign tumors are unable to metastasise to distant sites. These characteristics do not refer to malignant tumors.

B Best answer: Malignant tumors tend to grow rapidly and spread widely. They grow by invasion, sending out processes that infiltrate the surrounding tissues. This answer describes malignant tumors best.

C Malignant cells consist of cells which bears little resemblance to the tissue of origin. This answer is incorrect as it refers to benign cancers which are well-differentiated cells that resemble cells in the tissue of origin.

D Benign tumors are encapsulated, cohesive and with well-defined borders, not malignant tumors. The capsule is responsible for a sharp demarcation line between the benign tumor and adjacent tissue. Benign tumors stick together unlike malignant tumors that are not cohesive and adhesive thereby permitting the shedding of the tumor’s surface cells.

5A This is an incorrect answer because a malignant tumor of

epithelial tissue origin is called carcinoma and not sarcoma. B This is an incorrect answer because a malignant tumor of

glandular epithelial tissue is called adenocarcinoma and not sarcoma.

C Best answer: This is the correct answer. Malignant tumor of mesenchymal origin which gives rise to connective tissue is called sarcoma.

D This is an incorrect answer because papillomas are benign finger-like projections that grow on surfaces.

6A Best answer: Telomerase is an enzyme that governs

chromosomal aging through its action on telomeres (special DNA sequences at the end of each chromosome). With each cell division, a small segment of telomeric DNA is lost. In the absence of telomerase, the telomeres shorten resulting in the inhibition of cell replication. It is thought that in cancer cells, telomerase maintains telomere length, thereby enhancing cell

replication. This is the correct answer. B In the process of tumor development, tumor cells secrete

tumor-associated angiogenic factors, which enables the development of new blood vessels in the tumor. This answer refers to angiogenesis and not to immortality of cancer cells.

C The development of secondary tumor in a location distant from the primary tumor is called metastasis. Metastasis occurs by way of the lymph channels and blood vessels. The answer does not explain why cancer cells are immortal.

D All of the above is an incorrect answer as explained in B and C.

7A Hormones and other enzymes may be normally produced by

affected tissue but be overexpressed as a result of cancer. The phrase tumor markers is appropriate.

B Most cancers synthesise and secrete enzymes that break down proteins and contribute to the infiltration, invasion and penetration of the surrounding tissues. These are referred to as lytic enzymes which destroy normal tissue. This answer is incorrect.

C The extracellular matrix is made up of extracellular macromolecules. The fibrous proteins (collagen and elastin) and the fibrous adhesive proteins (fibronectin) are found in the basement membrane. The ‘slipperiness’ trait of cancer cells is related to this fibronectin which regulates cell attachment. This answer is incorrect.

D Best answer: Tumor markers are antigens that are expressed on the surface of tumor cells or substances released from normal cells in response to the presence of tumor. This is the best answer.

8A Local invasion of tissue near the tumor occurs is possible

through increase rate of multiplication, pressure, lytic enzymes, and tissue damage. This answer explains local invasion.

B Tumor cells secrete proteolytic enzymes that degrade the basement membranes and other proteins contributing to invasion of tissue. This answer explains local invasion.

C Best answer: This is the correct answer because cancer cells do not adhere to one another as well as normal cells. Cell ‘slipperiness’ and movement is the key for tumor cells to invade.

D With increase in number of cells, there is an increase in mechanical pressure from the growing mass, blocking local blood vessels leading to tissue death and reduced mechanical resistance that further aids the spread of cancer. This answer explains local invasion.

9A One of the treatment modalities to treat primary cancers and to

eliminate metastases is chemotherapy utilizing cytotoxic drugs. While hyperpigmentation and hair loss (alopecia) are some adverse effects of cytotoxic drugs, these are not as serious as bone marrow suppression. This answer is incorrect.

B Best answer: The major toxicity of anticancer drugs is bone marrow suppression which leads to loss of neutrophils (infection), loss of thrombocytes (bleeding), and loss of erythrocytes (anemia). This is the best answer for this question.

C As in B. Severe and prolonged pain from local injury may occur during extravasation because of leakage producing high concentrations, resulting in pain, infection and loss of mobility. This is not the correct answer.

D As in B. The epithelial lining of the GIT has a very high growth fraction and so are very sensitive to cytotoxic drugs. Stomatitis and diarrhea are common with these drugs. GIT injuries can be life-threatening but these need to be severe. This is not the best answer.

10A Killing target cells (cancer cells) is the goal of cytotoxic drugs.

In fact, the goal is to achieve 100% cancer cell kill. This is an incorrect answer.

B Anemia is the reduction in the number of circulating erythrocytes and anticancer drugs cause anemia. Cachexia is weight loss and wasting away of body fat and muscle tissue and this is associated with many cancers, not anticancer drugs. Several cytokines have been proposed as mediators of the cachexic response. This is an incorrect response.

C Best answer: The major limitation to the use of chemotherapy is toxicity to normal cells (lack of selective toxicity). Chemotherapeutic drugs are highly toxic to tissues whose growth fraction is high. This is the best answer.

D As in C. Anticancer agents act directly on cancer cells to cause their. Most disrupt processes related to the synthesis of DNA or its precursors while others block mitosis or protein synthesis. These drugs are most toxic to tissues with high proportion of proliferating cells. This answer does not explain increased harm in anticancer agents.

Quiz 2: Altered body defenses and immune function

Question Response

1A It is not a primary cause of impaired humoral immunity

because the impairment is secondary to nephrotic syndromeB Best answer: Antibody production represents humoral

immunity and it has been impaired secondary to another disease process that is nephrotic syndrome.

C Antibody production is associated with humoral immunity not cellular immunity

D As for C

2A A type IV response is mediated through T lymphocytes and

not antibody production.B As for AC Best answer: A type IV response is mediated through T

lymphocytes which require time to increase in number following sensitization. When sufficient numbers of sensitized T lymphocytes are available tissue damage becomes apparent, in this case dermatitis occurs.

D This is not the case.

3A Immune complex formation is associated with Type III

reactions.B Best answer: A Type I response involves histamine release

from IgE coated mast cells.C IgE is the mast cell related antibody not IgGD Type II hypersensitivity involves antibodies attaching to

antigens on tissues and not the formation of immune complexes.

4A HIV is a secondary cause of impaired cellular immunity.B Best answer: The thymus gland plays an essential role in the

production of functional T lymphocytes. Therefore the congenital absence of the Thymus gland (Di George syndrome) is a primary cause of impaired cellular immunity.

C Immunoglobulin or antibody production is associated with B lymphocyte function and humoral immunity not cellular immunity.

D Chemotherapy would be a secondary cause of impaired cellular immunity.

5A Best answer: The liver produces complement proteins and

therefore damage to the liver by alcohol would be a secondary cause of decreased complement.

B The development of AIDS following HIV infection in children is generally shorter than for adults. This is the case because the immune system of children is less well developed than adults and hence is more rapidly damaged by HIV.

C Corticosteroids do influence phagocyte functionD Absence of the thymus gland causes a deficiency of T

lymphocytes not phagocytes.

6A This is a type I reactionB This is a type IV reactionC This is a type III reaction

D Best answer: This is a type II reaction because it involves auto antibodies being produced which attach to the thyroid gland and stimulate it to release thyroxine.

7A As for question 6B As for question 6C Best answer: Rheumatoid arthritis involves rheumatoid factor

(modified or damaged IgG antibodies) being treated as foreign material and attacked by other antibodies. The antibody antigen complexes deposit out in the tissues (joints) and activate complement and hence the inflammatory process (Type III reaction).

D As for question 6

8A Best answer: HIV attacks T helper cells that are central to

maintaining a functional immune system. When the T helper cell numbers decrease the immune system becomes less effective and AIDS develops. If T helper cell numbers remain sufficient AIDS will not develop.

B Individuals are infective throughout the disease process.C Helper T cells generally decrease with a HIV infection.D The ELISA test has some false positive results and therefore a

Western Blot test is needed following an ELISA test.

9A B Lymphocytes are not attacked by HIV.B Individuals are infective throughout the disease process.C Best answer: As per A in question 8D HIV is transmitted through breast milk and therefore places a

neonate at risk.

10A Best answer: Cyclosporine blocks interleukin 2 from T helper

cells which is required to activate B lymphocytes and cytotoxic T lymphocytes.

B It does not kill lymphocytes.C Inhibits the activity of both cytotoxic T lymphocytes and B

lymphocytes which are responsible for antibody production.D Cyclosporine does not effect phagocytes directly.

Quiz 3: CNS disorders

Question Response

1A Parkinson disease is a degenerative disorder of the basal

ganglia that results in tremor, rigidity and bradykinesia. This is an incorrect answer because Parkinson disease is not a disorder of the hypothalamus

B This is an incorrect answer because Parkinson disease is not a disorder of the adrenals.

C This is an incorrect answer because Parkinson disease is not a disorder of the pituitary glands.

D Best answer: Parkinson disease is a degenerative disorder of the basal ganglia that results in tremor, rigidity and bradykinesia. The basal ganglia are a group of deep interrelated subcortical nuclei that play an important role in the control of movement.

2A The disorder is characterized by progressive destruction of the

nigrostriatal pathway with subsequent reduction of dopamine. The answer is incorrect.

B Best answer: This is the correct answer. In Parkinson disease, dopamine depletion results from degeneration of the dopamine nigrostriatal system.

C This answer is incorrect as explained in B.D This answer is incorrect as explained in B.

3A The cardinal manifestations of Parkinson disease are tremor,

rigidity and bradykinesia. Other manifestations include falls, fluctuations in motor function, neuropsychiatric disorders, and sleep problems. This answer is incorrect.

B This answer is incorrect as explained in A. C This answer is incorrect as explained in A.D Best answer: This is the best answer. Tremor is the most

visible manifestation, along with rigidity or resistance to movement and bradykinesia which means slowed movement.

4A Best answer: Dementia is a syndrome of intellectual

deterioration that interferes with occupational or social performance. It may involve disturbances in memory, language, perception, motor skills and may interrupt the ability to problem solve, think abstractly, and make judgments.

B This is not the correct answer as explained in A.C This is not the correct answer as explained in A.D Depression is the most common treatable illness that may

masquerade as dementia and must be excluded when a diagnosis of dementia is considered. Cognitive function returns after depression is treated. This is an incorrect answer.

5A Disorientation to time and date characterises stage 1 of

Alzheimer’s disease. This is an incorrect answer.B Best answer: Stage 2 is characterised by impaired cognition

and abstract thinking, restlessness and agitation, impaired judgment. It includes also wandering and ‘sundown’ syndrome. This answer is correct.

C Stage 3 is characterised by emaciation, incontinence, seizures

and inability to communicate. This is a wrong response.D This is an incorrect answer because some of the alternatives

refer to stages 1 and 3.

6A Trachoma is benign suppurative conjunctivitis caused by

Chlamydia trachomatis. This pairing is incorrect.B Cataract is a lens opacity that interferes with the transmission

of light to the retina. This pairing is incorrect.C Glaucoma usually results from an increase in intraocular

pressure that results from abnormalities in the balance between aqueous production and outflow. Long-term exposure to sunlight has been associated with cataract and not glaucoma. This matching is incorrect.

D Best answer: Conjunctivitis is the inflammation of the conjunctiva which may result from bacterial or viral infection, allergens, chemical agents, physical irritants, or radiant energy. This is a correct pairing.

7A The most frequently fatal stroke is a spontaneous hemorrhage

into the brain substance. This answer is incorrect.B This answer is incorrect as explained in A.C Best answer: The most frequently fatal stroke is a spontaneous

hemorrhage into the brain substance. With rupture of blood vessel, hemorrhage into the brain tissue occurs resulting in edema, compression of brain contents, or spasm of adjacent blood vessels. Advancing age and hypertension are predisposing factors.

D This is an incorrect answer. Lacunar infarct is small to very small infarct located in the deeper noncortical parts of the brain and does not cause cortical deficits like aphasia or apraxia.

8A Best answer: Tonic-clonic seizures (formerly called grand mal

seizures) are the most common major motor seizure. The person experiences contraction of muscles with extension of extremities followed by rhythmic bilateral contraction and relaxation of extremities. The answer best describes tonic-clonic seizure activity.

B While there is immediate loss of consciousness in tonic-clonic seizures, this answer does not distinguish this type of seizure.

C This answer is incorrect as explained in A. The sudden, split-second loss of muscle tone leading to slackening of the jaw, drooping of the limbs or falling on the ground is called atonic seizures and not tonic-clonic seizures.

D This answer refers to tonic seizures only and not tonic-clonic seizure activity. Clonic seizures consist of repeated contractions and relaxations of the major muscle groups.

9A This answer is associated with multiple sclerosis. There is

evidence that antibody-mediated damage involving myelin oligodendroglial protein. Thus MS is generally believed to be an immune-mediated disorder.

B This answer is also associated with multiple sclerosis. In fact,

this explains its pathophysiology.C Best answer: This answer is the correct answer because

multiple sclerosis is not associated with corticosteroid antagonist drugs. The pharmacological agents to treat MS include corticosteroids as mainstay of treatment for acute relapses of MS. These agents reduce inflammation, improve nerve conduction, and have immunologic effects.

D This answer is also related to multiple sclerosis. The lesions of MS consist of hard, sharp-edges demyelinated or sclerotic patches called plaques.

10A This is an incorrect answer as it does not describe stroke.

Hematomas result from vascular injury and bleeding.B Best answer: Stroke is a syndrome of acute focal neurologic

deficit from a vascular disorder that injures the brain tissue. There are two main types: ischemic and hemorrhagic.

C The direct contusion of the brain at the site of external is referred to as a coup injury whereas the opposite side of the brain receives the contre-coup injury from rebound against the inner skull surfaces. This answer is incorrect as it does not describe stroke.

D This answer is incorrect because it describes transient ischemic attacks and not stroke. TIAs provide warning of impending stroke.

Quiz 4: CNS drugs

Question Response

1A Antiepileptics suppress the discharge of neurons within a

seizure focus and suppress the propagation of seizure from the focus to other areas of the brain by suppressing sodium influx. The drugs bind to sodium channels while they are in an inactivated state prolonging channel inactivation. By delaying the return of active state, these drugs decrease the firing ability of neurons suppressing seizures. While this mechanism is true for many of the antiepileptics, some of these drugs use different mechanisms.

B Other antiepileptics act by inhibiting influx of calcium ions through calcium channels. These drugs block inflow of calcium through T-type channels suppressing the generation of the action potentials involved in absence seizures. While this is also true for some antiepileptics, other drugs use different mechanisms.

C Some antiepileptics potentiate the actions of an inhibitory neurotransmitter GABA and in doing so decrease neuronal excitability and suppress seizure activity. This mechanism is also only true for some antiepileptics.

D Best answer: Antiepileptics suppress the discharge of neurons within a seizure focus and suppress the propagation of seizure from the focus to other areas of the brain by acting through any one or more of the three mechanisms mentioned.

2A Best answer: Phenytoin is active against partial seizures and

primary generalized tonic-clonic seizures. It can be used to treat all major forms of epilepsy except absence seizures. Therefore, it is not indicated for all types of seizures.

B The mechanism of action of phenytoin is selective inhibition of sodium channels. This statement is associated with the drug.

C Adverse effects include cardiovascular effects such as dysrhythmias and hypotension, especially when administered quickly by IV. 20% of patients may develop gingival hyperplasia which is an overgrowth of gum tissue. The statement is associated with phenytoin.

D The therapeutic range of phenytoin is narrow. As stated previously, infusions must be given slowly to prevent cardiovascular collapse. The statement is associated with the drug phenytoin.

3A Valproic acid acts through three mechanisms, namely blockade

of sodium channels, blockade of calcium channels and enhanced inhibitory effects of GABA. Enhancing the effects of acetylcholine is not an effect exhibited by valproic acid.

B Valproic acid suppresses neuronal firing through blockade of sodium channels.

C Valproic acid suppresses influx through T-type calcium channels.

D Best answer: Valproic acid acts through three mechanisms, namely blockade of sodium channels (B), blockade of calcium channels (C) and enhanced inhibitory effects of GABA.

4A The approach to the treatment of Parkinson’s disease is to give

drugs that restore or replace dopamine as a neurotransmitter in the basal nuclei. For this purpose dopaminergic agents (drugs that activate dopamine receptors are used. Monoamine oxidase inhibitors (MAOI) is incorrect. MAOIs are antidepressants.

B Anticholinergic drugs are avoided in the current treatment of Parkinsons disease due to significant adverse effects on the parasympathetic nervous system and because they enhance mental confusion.

C Best answer: The approach to the treatment of Parkinson’s disease is to give drugs that restore the balance between dopamine and acetylcholine. While in the past two types of drugs were used such as dopaminergic agents (drugs that activate dopamine receptors) and anticholinergic agents (drugs that block receptors for acetylcholine). Currently dopaminergic agents are predominantly used by far in an attempt to minimize side effects.

D Anticonvulsants are drugs used for epilepsy and not Parkinson’s disease

5A Carbidopa is used to enhance the effects of levodopa. It has no

therapeutic effect of its own but it inhibits decarboxylation of levodopa in the intestine and peripheral tissues making more levodopa available to the CNS. Moreover, carbidopa reduces cardiovascular responses to levodopa administration and also reduces nausea and vomiting. This answer is correct.

B Carbidopa is used to enhance the effects of levodopa. It has no therapeutic effect of its own but it inhibits decarboxylation of levodopa in the intestine and peripheral tissues making more levodopa available to the CNS. This answer is correct as well.

C Carbidopa is used to enhance the effects of levodopa. It has no therapeutic effect of its own but it inhibits decarboxylation of levodopa in the intestine and peripheral tissues making more levodopa available to the CNS. Moreover, carbidopa reduces cardiovascular responses to levodopa and thus decrease the adverse effects of levodopa. This answer is correct as well.

D Best answer: This answer is the best answer as explained above.

6A Best answer: High-potency antipsychotics differ from low-

potency anti-psychotics in that high-potency agents cause early extrapyramidal reactions such as dystonia, parkinsonism, akathisia, but less sedation, hypotension and anticholinergic effects. Because of the lesser side effects, high-potency agents such as haloperidol, are generally preferred for initial therapy. This is the best answer.

B High-potency antipsychotics such as haloperidol cause less anticholinergic effects such as dry mouth, blurred vision, urinary retention, constipation and tachycardia. The answer is wrong.

C This is not true as initial dosage is 0.5 to 2 mg taken 3-3 times a day up to 100 mg for severe illness. Once symptoms have

been controlled, the dosage may be reduced.D High-potency antipsychotics differ from low-potency anti-

psychotics in that high-potency agents cause early extrapyramidal reactions, but less sedation and hypotension, not equal sedation and hypotension effects. This answer is wrong.

7A The effects of benzodiazepines result from the depressant

actions in the CNS. Benzodiazepines depress neuronal function at multiple sites in the CNS.

B Benzodiazepines reduce anxiety through effects on the limbic system, which is associated with emotions.

C Benzodiazepines promote sleep through effects on cortical areas and on sleep-wakefulness rhythm.

D Best answer: While benzodiazepines undergo extensive metabolic alterations, they do not stimulate the production of hepatic enzymes. This is not a property of benzodiazepines.

8A Best answer: CNS stimulants increase the activity of the CNS.

The amphetamines act primarily by by promoting the release of norepinephrine or noradrenaline (NE or NA), and dopamine (DA), and also by inhibiting the reuptake of these neurotransmitters.

B CNS stimulants like amphetamines do not potentiate the actions of GABA, which is an inhibitory neurotransmitter. This answer is wrong.

C This is not the mechanism of action of amphetamines. This answer is wrong.

D This is not the mechanism of action of amphetamines. This is a wrong answer.

9A Prozac is fluoxetin, a selective serotonin reuptake inhibitor.

As such, it intensifies the transmission at serotonergic synapses. It does not block reuptake of dopamine making this answer wrong.

B Best answer: Prozac or fluoxetin produces selective inhibition of serotonin reuptake intensifying transmission at the serotonergic synapses.

C Prozac or fluoxetin does not block cholinergic, histaminergic, or alpha-adrenergic receptors. This answer is wrong.

D Prozac or fluoxetin does not prevent activation of NE and serotonin neurotransmitters. This is a wrong answer.

10A Prozac or fluoxetine is used primarily to treat major

depression. Antidepressant effects begin in 1-3 weeks, equivalent to those produced by tricyclics. This answer is incorrect.

B Therapeutic effects develop slowly. This delay suggests that the effects are due to adaptive cellular changes that occur in response to prolonged uptake blockade. Therapeutic effects will not occur almost immediately, hence this answer is incorrect.

C Best answer: Antidepressant effects begin in 1-3 weeks,

equivalent to those produced by tricyclics. This answer is correct.

D While there is delay in the onset of effects, 3-6 months is too long. This is an incorrect answer.