Chapter 19 - Medical Physiology: Integration Using Clinical Cases

Chapter 19
Medical Physiology: Integration Using Clinical Cases
 

Multiple Choice Questions

 

1. An alteration in either the structure or function of the human body leading away from a
state of normal healthy function is called disease. More specifically the study of the changes
in function associated with disease is known as 
A. Homeopathy
B. Protoptosis
C. Pathophysiology
D. Necropsy
E. Autopsy

Bloom's Level: 1. Remember

Section 19 Introduction
Topic: General
 

2. An important point to remember in using and applying factual physiological information is
that 
A. Most diagnostic normal parameters or values fall within a range of values
B. While specific physiological values are collected through specific tests, it is necessary to
know how all are related to one another in normal and abnormal physiological states
C. Rather than memorizing what specific values represent specific disease states, it is more
important to understand the processes at work that may be producing these values
D. Recognition of the processes that maintain homeostasis is required to recognize the
physiological indicators used in the diagnosis and treatment of disease
E. All of the above are correct.

Bloom's Level: 2. Understand

Section 19 Introduction
Topic: General
 

19-1
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

3. Each of the following physiological processes could be associated with a person's feelings
of excessive warmth, EXCEPT 
A. Ingestion of food
B. Increased blood thyroid hormone level
C. Decreased epinephrine release from adrenal glands
D. Movements exhibited normally by active smooth muscle
E. Increased activities regulated and sustained through the activity of the sympathetic nervous
system

Bloom's Level: 2. Understand

Section 19.01
Topic: Nutrition and Metabolism
 

4. Which of the following would not be a physical manifestation seen in an individual with a
hyperactive thyroid gland? 
A. Enlarged thyroid gland in neck; goiter
B. Decreased levels of total and free T4 hormone in blood serum
C. Increased TSH in blood serum
D. Proptosis and diplopia
E. Abnormally low blood glucose level

Bloom's Level: 3. Apply

Section 19.01
Topic: Endocrine System
 

5. The effects of hyperthyroidism on the cardiovascular system: increased heart rate, increased
blood pressure, and increased respiratory rate, are due to 
A. Compensatory increased activity by the parasympathetic nervous system
B. Compensatory decreased activity by the sympathetic nervous system
C. The up-regulation of beta-adrenergic receptors by thyroid hormone
D. Decreased utilization of iodine consequently leaving largely unused amounts in the
bloodstream
E. All of the choices are correct.

Bloom's Level: 4. Analyze

Section 19.01
Topic: Endocrine System
 

19-2
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

6. Diseases, other than Graves' disease, which can produce symptoms of hyperthyroidism,
could provide an error in diagnosis. Which physiological parameters should be examined also
to rule out Graves' disease? 
A. Fasting plasma glucose (diabetes mellitus)
B. Serum calcium (hyperparathyroidism)
C. Blood pH (diabetes mellitus)
D. Serum prolactin levels (hyperprolactinemia)
E. Serum protein levels (proteinuria)

Bloom's Level: 4. Analyze

Section 19.01
Topic: Endocrine System
 

7. The increased metabolic rate exhibited in individuals who are suffering from increased
secretion of thyroid hormone would include all of the following symptoms or signs, except 
A. Weight gain
B. Increased body temperature
C. Elevated perspiration and sweating
D. Irritability and anxiety
E. Hyperactive reflex reactions

Bloom's Level: 2. Understand

Section 19.01
Topic: Endocrine System
 

8.  Bruits are audible sounds heard in a stethoscope when  

A.  Listening to the breath sounds of a patient
B.  Monitoring the flow of blood through an occluded carotid artery
C.  The enlarged thyroid gland rises and falls during deglutition
D.  Listening to the opening and closing of the mitral valve
E.  Blood passes through the radial artery during pulse counts

Bloom's Level: 1. Remember

Section 19.01
Topic: Endocrine System
 

19-3
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

9.  Treatments for hyperthyroidism all involve reduction of the thyroid hormone levels. Which
of those listed below is the most likely to do so by interfering with the synthesis of TH
without destroying viable thyroid gland tissue cells.  
A.  Radioactive nucleotide
B.  Thyroidectomy
C.  Propylthiouracil and methimazole
D.  Beta-adrenergic receptor blockers
E.  Anti-inflammatory glucocorticoids

Bloom's Level: 4. Analyze

Section 19.01
Topic: Endocrine System
 

10. An individual experiencing chest pain, and shortness of breath, fearing that she may be
having a heart attack could be expected to exhibit elevated blood pressure and increased heart
rate as a consequence of 
A. Decreased parasympathetic nervous system activity
B. Increased sympathetic nervous system activity
C. Increased parasympathetic nervous system activity
D. Increased levels of epinephrine in the bloodstream
E. All except increased parasympathetic nervous system activity

Bloom's Level: 3. Apply

Section 19.02
Topic: Cardiovascular System
 

11. Arterial blood pH increasing to values greater than 7.5 (acute respiratory alkalosis) can be
caused by 
A. Atelectasis and decreased ventilation
B. Hyperventilation
C. Increased urine volume
D. Decreased hemoglobin production
E. Hyperemia

Bloom's Level: 3. Apply

Section 19.02
Topic: Water, Electrolyte, and Acid-Base Balance
 

19-4
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

12. Hypoxemia is the condition in which 

A. Circulating arterial oxygen level is increased
B. Circulating venous oxygen level is reduced
C. Circulating venous carbon dioxide level is increased
D. Circulating arterial oxygen level is decreased
E. Respiratory alakalosis is observed

Bloom's Level: 1. Remember

Section 19.02
Topic: Respiratory System
 

13. Which of the following conditions is most likely to be the physiological cause of

hypoxemia? 
A. Increased depth and rate of ventilation
B. Chronic obstructive lung diseases causing ventilation-perfusion imbalances
C. Anatomical anomalies permitting mixed venous blood to bypass alveolar circulation and
passage from the right side of heart to left
D. Interference with gas exchange between alveolar capillaries and alveoli due to thickened
alveolar epithelial membranes
E. Failure of the kidney to produce adequate amounts of renal erythropoietic factor

Bloom's Level: 4. Analyze

Section 19.02
Topic: Respiratory System
 

14. Long periods of inactivity or lack of exercise can lead to formation of _____, which block
blood flow and impede gas exchange in small blood vessels due to long-term pooling of blood
in ____. 
A. Thrombuses, deep leg veins
B. Emboli, superficial abdominal arteries
C. Thrombuses, superficial cutaneous arteries
D. Emboli, deep leg veins
E. Thrombuses, renal and hepatic veins

Bloom's Level: 1. Remember

Section 19.02
Topic: Cardiovascular System
 

19-5
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

15. The distribution and flow of blood through lung vasculature is assessed by using a
procedure called a ventilation-perfusion scan. Decreased distribution of blood through the
lungs is highly suggestive of a respiratory disorder known as _________, supported by the
results of a(n) _______ procedure performed on the patient's legs, and then will require
treatment referred to as ________ to remove the blood clots. 
A. Systemic venous thrombosis, ultrasound, streptokinase
B. Pulmonary embolism, ultrasound, tissue plasminogen activator
C. Chronic obstructive pulmonary disorder, ultrasound, tissue plasminogen activator
D. Pulmonary embolism, CT scan, coumadin
E. Systemic venous thrombosis, MRI, heparin

Bloom's Level: 1. Remember

Section 19.02
Topic: Respiratory System
 

16. In a fever response, an individual feels "chills" despite elevated temperature that ensues
because 
A. Vasodilation occurs to improve blood flow, subsequently increasing conductive heat loss
from the skin to the external environment
B. Systemic vasoconstriction throughout the body promotes reduced blood flow and minimal
heat distribution
C. The hypothalamic temperature set-point is lowered by exposure to toxins, stress, and
certain kinds of trauma
D. Shivering thermogenesis creates an immediate heat loss before proceeding long enough to
produce a perceptible increase in heat
E. Of increased heat loss due to decreased perspiration

Bloom's Level: 2. Understand

Section 19.03
Topic: Nutrition and Metabolism
 

19-6
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

17. The presence of pain and tenderness to touch in the lower right anterior abdominal
quadrant is commonly associated with 
A. Gastric ulcer
B. Hemorrhoids
C. Urinary tract infection
D. Ovarian cyst
E. Appendicitis

Bloom's Level: 1. Remember

Section 19.03
Topic: Digestive System
 

18. Elevated white blood cell counts can be indicative of 

A. Bacterial infection
B. Viral infection
C. Parasitic infection
D. Immune hypersensitivities / allergic reactions
E. All of the choices are correct.

Bloom's Level: 2. Understand

Section 19.03
Topic: Lymphatic System and Immunity
 

19.  Sepsis, associated with bacterial infections, is defined by which of the following signs /
symptoms?  
A.  Decreased respiratory rate and depth
B.  Elevated / high neutrophil count
C.  Decreased arterial pCO2
D.  Increased arterial pO2
E.  Hypothermia

Bloom's Level: 2. Understand

Section 19.02
Topic: Lymphatic System and Immunity
 

19-7
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

20.  In the condition known as peritonitis  

A.  There is an inflammation of the membranes and fluid filled space surrounding abdominal
organs
B.  Perforations of the pleural membranes lead to accumulation of pus and interstitial fluids in
the thoracic cavity
C.  The covering connective tissues surrounding the abdominal muscles develop a paralyzing
type of infection and may become necrotic
D.  A procedure known as dialysis is done to cleanse the blood of bacterial toxins
E.  An infection of the GI tract is producing referred pain in the abdominal and pubic regions
leading to cramping and diarrhea

Bloom's Level: 2. Understand

Section 19.03
Topic: Lymphatic System and Immunity
 

21. Septic shock is the most common type of vasodilatory shock, very frequently associated
with multiple organ dysfunction syndrome. The primary cause for concern in cases such as
this is 
A. That septic shock is always accompanied by major hemorrhage
B. Chemical mediators involved in promoting the immune response, increase peripheral blood
pressure
C. Immune inflammatory mediators trigger decreased peripheral circulation and potential
edema
D. Reduced peripheral blood pressure impairs venous return and impedes arterial flow to
organs
E. Both immune inflammatory mediators trigger decreased peripheral circulation and
potential edema and reduced peripheral blood pressure impairs venous return and impedes
arterial flow to organs are correct

Bloom's Level: 3. Apply

Section 19.03
Topic: Cardiovascular System
 

19-8
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

22. A reliable sign of infection is pus, which is also a sign that a defensive immune reaction is
taking place. An analysis of pus would show it to be composed of which of these infection
fighting agents? 
A. Necrotic cells
B. Tissue macrophages
C. Histamine
D. Red blood cells
E. Interstitial fluids

Bloom's Level: 3. Apply

Section 19.03
Topic: Lymphatic System and Immunity
 

23. In the scenario of the patient with peritonitis caused by appendicitis, the appendix is
surgically removed and the abdominal organs are given a thorough washing with saline and
antibiotics. Why was this done? 
A. To reduce the number of bacterial cells and toxins present through flushing
B. To create a hypertonic environment to kill the E. coli bacteria
C. To create a hypotonic environment to inhibit growth of the E. coli bacteria
D. To rehydrate the local tissues and replace fluids lost through vomiting and diarrhea
E. To act as a supplement to fluids being replaced by intravenous therapy and to maintain an
osmotic balance in the area affected by the surgery

Bloom's Level: 2. Understand

Section 19.03
Topic: Lymphatic System and Immunity
 

24.  Norepinephrine and vasopressin are used therapeutically to  

A.  Decrease glomerular filtration rates
B.  Decrease blood pressure
C.  Increase blood pressure
D.  Stabilize respiration rates
E.  Enhance CO2 and O2 exchange between alveoli and alveolar capillaries

Bloom's Level: 1. Remember

Section 19.03
Topic: Cardiovascular System
 

19-9
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

25.  Increased levels of lactate in the blood indicate  

A.  Cells are creating ATP so rapidly that acidosis is a result
B.  Rapid excretion of hydrogen ions in the urine
C.  Cells are relying more on anaerobic ATP synthesis
D.  The arterial pO2 and oxygen delivery to tissue cells is more than adequate for the
metabolic needs
E.  Respiratory alkalosis

Bloom's Level: 3. Apply

Section 19.03
Topic: Nutrition and Metabolism
 

26.  In the inflammatory immune response one hallmark of action is increased permeability of
tissue capillaries leading to infiltration of plasma and plasma proteins into the interstitial
fluids around the lungs. Consequently fluid accumulates within the lung and  
A.  Blood pressure increases
B.  Gas exchange at the alveoli and alveolar capillaries is improved
C.  Arterial pCO2 increases
D.  Arterial pO2 increases
E.  An immediate response by the kidney excretes more H+ ions into urine

Bloom's Level: 3. Apply

Section 19.03
Topic: Lymphatic System and Immunity
 

27.  The high mortality rates in patients with septic shock (40%-60%) demand that vital
physiological parameters be monitored. Which of those listed below are most likely to offer
the first signs that an individual is experiencing septic shock?  
A.  Fever / increase in body temperature
B.  Decreased heart rate
C.  Increased blood pressure
D.  Increased urine output
E.  Increased arterial O2 saturation level

Bloom's Level: 4. Analyze

Section 19.03
Topic: Cardiovascular System
 

19-10
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

28. Immediate therapeutic interventions in the treatment of septic shock as a consequence of

infection are aimed at the priority of relieving _____, which could lead to multisystem organ
failure throughout the body, by improving _____. 
A. Vascular hypertension, vasomotor tone
B. Thromboembolism, levels of prostacycline
C. Fever, blood plasma viscosity
D. Tissue hypoxia, mean arterial blood pressure
E. Respiratory alkalosis, ventilation rate and depth

Bloom's Level: 1. Remember

Section 19.03
Topic: Cardiovascular System
 

29. When treating the initial stages of an infection 

A. A narrow spectrum antibiotic is administered immediately upon determination that an
infection is present
B. Antibiotic treatment is withheld for no less than 48 hrs. to allow the growth and
identification of the infectious agent in consideration for selection of the antibiotic
C. Drugs other than antibiotics will be used initially to relieve the symptoms of the infection
in order to reduce the possibility of antibiotic resistance by the infectious agent
D. A broad spectrum antibiotic will be administered and replaced with one known to be more
effective once the precise infectious agent has been identified
E. Both antibiotic treatment is withheld for no less than 48 hrs. to allow the growth and
identification of the infectious agent in consideration for selection of the antibiotic and drugs
other than antibiotics will be used initially to relieve the symptoms of the infection in order to
reduce the possibility of antibiotic resistance by the infectious agent are correct

Bloom's Level: 2. Understand

Section 19.03
Topic: Lymphatic System and Immunity
 

19-11
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

30. With mortality rates for septic shock patients at or near 50% in the United States, every
year important alternative supportive therapy is used. Which of the methods listed below is
mismatched to the physiological variable it is intended to target in the patient's health? 
A. Paralysis of respiratory muscles - reduced oxygen demand and improved delivery to vital
organs
B. Glucocorticoid injections - overall reduced responses to the physiological stresses
associated with the infection
C. Cortisol blocking agents - vasodilation to promote increased blood pressure and flow
throughout the body
D. Cortisol - minimizes and inhibits the inflammatory response
E. Norepinephrine - counteracts the typical toxic effects of infectious agents by inducing
vasoconstriction and increasing blood pressure

Bloom's Level: 4. Analyze

Section 19.03
Topic: Cardiovascular System
 
 

True / False Questions

 

31. Seldom does a disease state related to human physiology have associated effects on more
than one of the major organ systems at the same time. 
FALSE

Bloom's Level: 1. Remember

Section 19 Introduction
Topic: General
 

32. Coming to terms with the cause(s) of disease must often begin with recognition of the
physiological process(es) associated with a particular symptom or sign and working through
the cause and effect relationships integrated through interactions between multiple organ
systems. 
TRUE

Bloom's Level: 1. Remember

Section 19 Introduction
Topic: General
 

19-12
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

33. The practice of medicine can best be described as a skill which requires one to memorize
the specific treatment called for in every conceivable disease state. 
FALSE

Bloom's Level: 1. Remember

Section 19 Introduction
Topic: General
 

34. Recent, short-term, respiratory alkalosis is characterized by failure to eliminate carbon

dioxide as quickly as it is produced by compensatory reflexive responses in rate and depth of
ventilation. 
TRUE

Bloom's Level: 1. Remember

Section 19.02
Topic: Respiratory System
 

35. Chest pain and shortness of breath is rarely, if ever, indicative of any other physiological
disorder other than myocardial infarction. 
FALSE

Bloom's Level: 1. Remember

Section 19.02
Topic: Cardiovascular System
 

36. While occurring in less than 3% of the population, some individuals can inherit a
condition known as hypercoagulability, directly related to a resistance in an activated blood
protein. 
TRUE

Bloom's Level: 1. Remember

Section 19.02
Topic: Cardiovascular System
 

19-13
Chapter 19 - Medical Physiology: Integration Using Clinical Cases

37. To experience the effects of septic shock due to a bacterial infection, one must have viable
reproducing microorganisms present in the bloodstream. 
FALSE

Bloom's Level: 1. Remember

Section 19.02
Topic: Lymphatic System and Immunity
 

19-14