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Board Review Week 1 Test. Good luck!!. Question 1 of 40. E Opioids
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Board Review Week 1 Test Good luck!!
E Opioids The patient is experiencing the classic symptoms of withdrawal from opioids which are anxiety, insomnia, anorexia, sweating, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea, yawning. Symptoms usually appear within 8 to 10 hours after abstinence. The onset is longer if methadone has been withdrawn. These symptoms peak within 48 to 72 hours and then disappear in 7 to 10 days. Methadone lessens the effects of withdrawal. It should be given no more than 20-50mg/day. Alcohol withdrawal appears within a few hours of stopping or decreasing alcohol consumption. It lasts for three to four days and sometimes as long as a week. The patient experiences tachycardia, tremulousness, diaphoresis, nausea, orthostatic hypotension, malaise, anxiety, and irritability. Benzodiazepine should be administered in a tapering dose over three days. Cocaine withdrawal is classified by psychological symptoms such as increased sleep, REM rebound causing nightmares, lassitude, increased appetite, depression, and suicide attempts. Treatment would consist of an antidepressant such as bupropion. Amphetamine withdrawal would include a post use crash, including anxiety, lethargy, headache, stomach cramps, hunger, severe depression, dysphoria mood, fatigue, and insomnia or hypersomnia. Barbiturate withdrawal is characterized by anxiety, seizures, delirium, and life threatening cardiovascular collapse.
D Increase in oxygen tension within the blood To state that increase in pulmonary arterial pressure associated with increase blood flow to the lungs is the major component in closure of the ductus arteriosus is to state the opposite of actual events. Pulmonary pressure and pulmonary blood pressure decreases, resulting in a decrease flow from the pulmonary circuit to the systemic circuit. To state that reduction of aortic arterial pressure due to reduction in systemic resistance is a major component in closure of the ductus arteriosus is to state the opposite of actual events. After birth, systemic blood pressure rises as a result of increased effective blood volume and decreased pulmonary resistance. The ductus no longer serves as a shunt from pulmonary to systemic circulation. As gas exchange increases, the amount of carbon dioxide in the neonate will decrease. However, this does not initiate vasoconstriction and closure of the ductus arteriosus. Increase in oxygen tension is thought to be the primary initiator of closure of the ductus arteriosus. The pO2 increases from 15 to 20 mm Hg to around 100 mm Hg in a few hours. Prostaglandins are thought to be responsible for maintaining patency of the ductus arteriosus.
E Monocyte This cell represents a mononuclear leukocyte and is regarded as agranular, even though small, faintly staining granules may be seen in the cytoplasm. The monocyte is a large cell with a diameter of 10-15mm. The nucleus is never segmented, but it usually stains less dense than a lymphocyte and appears rounded, kidney or horseshoe-shaped. Several nucleoli may be visualized. The "agranular" appearance of the cytoplasm is due to the presence of fine, abundant azurophil granules. These cells differentiate in the tissue into macrophages.
D 400 per One hundred thousand population The incidence rate is the number of new cases of a disease during a specific period per population at risk. Twenty thousand divided by 5 million women gives a rate of 1 case per 250 women, or 400 cases per One hundred thousand populations.
C Third branchial arch The fifth arch is often absent, and when present, it is rudimentary.
D Basophil The basophil as found in the peripheral blood contains large, darkly staining, membrane-bound granules that contain a variety of substances, including SRS, heparin sulfate and histamine. Upon stimulation, the release of histamine and SRS will induce the dilation of small blood vessels. The basophil, as found in the peripheral blood, may be related, at least functionally, to the tissue mast cell.
C Neutrophils In females, the inactive X chromosome appears as a drumstick-like appendage on one of the lobes of the nucleus. This is not obvious in all neutrophils, however. Acidophils, basophils, monocytes, and lymphocytes do not show such structures.
B Reliability The mode is the most commonly occurring value in a series of data. Reliability is a measure of the reproducibility of a test over different conditions. The four most common types are inter-observer reliability, intra-observer reliability, split-sample reliability, and repeat testing reliability. Accuracy is a measure of the extent to which a test approximates the real value of that which is measured. New tests are measured against the gold standard, if one exists. Validity is the assessment of the degree to which a test measures that for which it was designed. In other words, you need to determine whether it reflect the outcome of interest or other outcomes. Precision is the degree to which a measurement is not subject to random variation.
D The ductus arteriosus becomes the ligamentum arteriosum The umbilical vein becomes the ligamentum teres and the ductus venosus becomes the ligamentum venosum. The foramen ovale closes at birth in 75% of the population. The patent ductus arteriosus is the most common congenital malformation associated with maternal rubella infection during pregnancy.
B Approximately 68% of the students had pulses between 60 and 80 When a test is conducted on a normally distributed population, 68% of the population will have values within one standard deviation of the mean, 95% of the population will have values within two standard deviations of the mean, and 99.7% of the population will have values within three standard deviations of the mean. Therefore, in this population, 68% of the pulses will be between 60 and 80, 95% between 50 and 90, and 99.7% between 40 and 100.
B Conduct Disorder Conduct Disorder, which may develop as early as 5-6, is seen more frequently in physically strong males and the symptoms frequently include lying, truancy, running away from home, theft, fighting and intimidation, cruelty, and destruction of property. One symptom of the disorder must be present for at least six months and in this instance it is shoplifting. The disorder may continue to increase in seriousness until the adult years, when crimes of burglary and sexual misconduct are seen and the diagnosis may be that of Antisocial Personality Disorder. The behavioral symptoms provided in this illustration are classic Conduct Disorder. Antisocial Personality Disorder is not diagnosed before age 18. Disruptive Behavior Disorder NOS would not be appropriate since the criteria for Conduct Disorder are fully met. Attention-Deficit/Hyperactivity Disorder NOS is not adequate because the illustration fails to provide evidence of inattention or hyperactivity-impulsivity. Oppositional Defiant Disorder would not be given because it fails to meet the criteria for frequent loss of temper, arguing with adults, refusing to comply with requests, blaming, vindictiveness, and hostility. Simon may engage in some of these, but his prominent symptoms are clearly in the area of how he conducts himself.
A First The first pharyngeal (branchial) arch gives rise to the endochondral and dermal bones of the upper and lower jaw. As it develops, the maxillary and mandibular swellings form. They will give rise to the upper and lower jaws, respectively. In short, the first arch gives rise to the bottom half of the face, including the mastication muscles (temporalis, masseter, and pterygoids).
C Results of a study on the relationship between gender and lung cancer Parametric techniques can be used to analyze data where at least one of the variables is quantitative (interval or ratio) and where the data is distributed normally. If the data is not distributed normally or both variables are qualitative (nominal or ordinal), non-parametric techniques must be used. Gender and lung cancer are both qualitative variables, so non-parametric techniques, such as chi-square, are used to determine the relationship between them. LDL cholesterol, forced vital capacity, hemoglobin, and reticulocyte count are quantitative ratio variables, so studies involving them can be analyzed using parametric techniques, assuming they are normally distributed. The use of a new lipid-lowering drug and the presence or absence of asbestos exposure is qualitative nominal variables. Weight is a quantitative ratio variable, and various parametric techniques can be used to compare the means, ranges, and variances of distributions between populations.
A Dependent personality disorder Passive individuals characterize Dependent personality disorder. They let others guide their lives because they feel they are unable to guide their own lives. Spouses or parents make all the major decisions of their lives, including where they should live and what type of employment they should obtain. Their needs are secondary to the people on whom they depend. They see themselves as helpless or stupid and they avoid having to be self-reliant. They have an extreme need to be taken care of, which is shown through their clinging behavior and fear of separation. Their personality is shown through their inability to make everyday decisions without advice from others. They need others to take responsibility for their lives, they do not initiate projects because of a lack of self-confidence, and they go to the extreme to get nurturing. In addition, they have exaggerated fears of being helpless, they seek close relationships quickly when the one before has ended, and they have an extreme fear of having to take care of oneself. In the medical setting, their fear of abandonment increases and they become needier and therefore complain and demand a lot. The physician in this case must plan, along with the nurses and staff, what kind of care should be given. They should advise the patient how often, and when, they will check on them so that the patient has set limits. If limits are not set, the patient can become extremely demanding and then the caretakers will react in a very punitive way. An individual who is shy and timid, but wants to have friends characterizes Avoidant personality. They fear rejection and therefore avoid social contact. If given strong guarantees that they are truly accepted, they will make friends. They have low self-esteem, are hypersensitive to criticism and feel inadequate (these feelings usually begin by early adulthood). In addition, they avoid activities in which they may be ridiculed or rejected, do not want to get close to anyone unless they are certain they will be liked, and keep away from close relationships so they will not be shamed. They are preoccupied with worrying about being criticized, or rejected in social situations. They are also withdrawn in new social situations due to feelings of inadequacy, and believe that they are inferior to others. They are unwilling to take risks because they do not want to get embarrassed. In the medical setting, these patients are good patients because they are undemanding and cooperative. They allow others to take care of them but they are very sensitive to criticism and they can interpret remarks as being hurtful and then withdraw emotionally. A person who thinks of himself or herself highly, but is at the same time sensitive to criticism characterizes narcissistic personality disorder. They cannot empathize with others and they are more interested in the superficial. They see themselves as superior and therefore exaggerate their achievements. They have fantasies of unlimited power, success, beauty, or ideal love. In addition, they believe they should only associate with certain people of high status or from certain institutions, and they require admiration. They believe people should go with their expectations and they take advantage of others to achieve something for themselves. They do not consider the needs of others or their feelings. They are usually jealous of others or think others are jealous of them and they are arrogant. In the medical setting, the patient sees illness as destroying their perfection. They demand special attention. They see the physician as all good or all bad. They have a tendency to show anger or boredom in a hospital setting. This disorder is more characteristic of physicians rather than their patients. A person who is on the border between neurosis and psychosis characterizes borderline personality disorder. This person has unstable personal relationships and unstable moods. They have an identity crisis; they are confused about their sexual orientation, goals, self-image, and friends. These symptoms begin in early adulthood. They try to avoid abandonment and have intense relationships, which go from idealization to devaluation. They have a distorted sense of self and are reckless in 2 areas that are self-damaging such as sex, substance abuse, reckless driving, and binge eating. They have recurrent suicidal threats or self-mutilating behavior. In addition, they have intense feelings such as euphoria, irritability, or anxiety lasting only a few hours or a few days. They feel very empty and can display intense anger or lack of control of anger. They can display paranoia under stress or severe dissociative symptoms. This disorder is seen twice as much in females then in males. Ninety percent of those diagnosed with this disorder also have a psychiatric disorder. It can be caused by severe physical, verbal, or sexual abuse in childhood. They also have decreased levels of serotonin. In the medical setting, the patient has extreme amounts of stress, which can lead to paranoia, and other symptoms this disorder entails. They become even more emotionally unstable. They will cause the physicians and nurses to take sides and see things as either all good or all bad. This is called splitting because they cannot see a person as having both, they have to label people into categories, and certain people are all good and certain others are all bad. An individual who continually violates the rights of others characterizes the antisocial personality disorder. They are unable to control their impulses or to postpone immediate gratification. They are insensitive, usually selfish and demanding, and are free of fear and guilt. They start showing symptoms before the age of 15. They fail to conform to social norms and they are irritable and aggressive. They are irresponsible in finances or in work behavior because they do not plan. In addition, they deceive others by lying for pleasure or personal gain, do not care about their safety or others around them, and are indifferent to having hurt someone. This disorder is more common in males. Family problems with alcoholism increase the risk of antisocial personality coming out in their sons and daughters. It can be caused by head trauma or encephalitis and inconsistent and impulsive parenting is also a factor. In the medical setting, it is possible to see fights, suicides, or other injuries done by these types of people. They usually are charming when under stress, but then they become manipulative if given a chance. They usually have difficulty with authority figures and therefore may be noncompliant in taking their medicine and following the doctor's orders. They usually leave the hospital when they feel like it.
B the therapies being compared in the study The independent variable is defined as the variable that is to be manipulated or controlled, or that has been selected by the researcher. In the study, as the researcher you are controlling the type of therapy to be utilized in the study. You are also controlling whether or not the participants are receiving any therapy at all. The subjects that are participating in the different therapy groups and that have been assigned to serve as the control group are the sample being used in this study. The sample simply means the participants chosen to represent the larger population. The level of depression in the participants at the end of the study is considered to be the dependent variable. The dependent variable is defined as the response to the independent variable (or therapy), the observed or measured behavior, or the outcome of the study.
A Appearance of the sulci Appearance of the sulci occurs on day 21. Secretion by the developing myocardium of cardiac jelly starts on day 22. Cardiac folding starts on day 23. The septum primum is formed on day 26. The foramen ovale is formed on day 43.
C Eosinophil The eosinophil is one of the granulated leukocytes having a lobulated nucleus. The nucleus of the eosinophil is frequently bi-lobed, as seen in this image, but may have three or four nuclear lobules. The distinctive feature of this cell is the presence of large brilliant, red-staining cytoplasmic granules that are so closely packed they tend to obscure the nucleus.
B Peroxidase This cell depicted in this photomicroscopic image is an eosinophil demonstrating the characteristic bi-lobed nucleus and the distinctive closely packed brilliant red granules. These granules are lysosomes, and contain a high content of peroxidase. They differ from the azurophil granules of the neutrophil in that they do NOT contain phagocytin. Eosinophil granules also contain histaminase and other hydrolytic enzymes. Lactase, lipase and nucleases are located within lysosomes of cells, but do not constitute a high content in eosinophils.
C "One to eight days after first breath" As oxygen tension in the blood increases, the ductus arteriosus begins to close. However, this The ductus may begin to show signs of closure, but it is still shunting blood away from pulmonary circulation and toward systemic circulation. process is relatively slow and the ductus is still open at this stage. The ductus arteriosus constricts and is functionally closed within the first eight days of life. The ductus becomes occluded and structurally closed within the first four months of life. If a ductus is still shunting blood at this stage, it is considered to be patent.
A Nicotine withdrawal Dysphoric mood, insomnia, irritation, frustration, anger, anxiety, difficulty concentrating, restlessness, increased appetite, weight gain and decreased heart rate are all symptoms which represent diagnostic criteria for a DSM-IV diagnosis of nicotine withdrawal. Symptoms must cause clinically significant distress or impairment in social, occupational, or other essential areas of functioning. Furthermore, symptoms cannot be due to a general medical disorder and cannot be better accounted for by another mental disorder. At least four of the above mentioned symptoms or complaints must be present for this diagnosis.
C interval In statistical measurements, IQ is considered an interval scale because the difference between an IQ of 90 and 100 is indistinguishable from the difference in an IQ of 100 and 110. In interval scales, the difference between intervals is relative. The difference between 1 and 2 is relative to the difference between 3 and 4. Nominal measurements are used for variables in which there are no numerical values that can be compared, such as gender or ethnic background. Ordinal scales are used for rank ordering. Ordinal scales can be used for such variables as attractiveness, or grades in school. In each case one can state that s/he is more attractive then, or an A or B is better than a C or D. Ratio scales are based in measurements where there is an absolute 0. In IQ's there are no absolute zeros, and one cannot state that an IQ of 50 is half as good as an IQ of 100. Ratio scales can be used for variables such as the number of hours a student spends studying, 2 hours of studying would be half as many hours as 4 hours of study. Correlations are not used as a method of statistical measurements, but are used in research and statistics to define a relationship between two variables.
E Ventricular septal defect • A small to moderate ventricular septal defect produces a loud 'tearing' pan systolic murmur and a systolic thrill over the lower left sternal edge. There is usually no cyanosis. There may be a prominent apex beat and cardiac enlargement. • Atrial septal defect: This is often diagnosed only in adulthood and is more common in females. Patients are usually asymptomatic, though occasionally they may experience palpitations. The murmur is usually an ejection systolic, pulmonary flow murmur. • Coarctation of aorta: Increased incidence in patients of Turner's syndrome. It is often asymptomatic. Examination reveals a radio femoral delay and hypertension in the upper limbs. • Patent ductus arteriosus: Often seen in pre mature babies. The continuous murmur is classically described as a 'machinery' murmur, and is best heard in the first intercostal space on the left. • Tetralogy of Fallot: Consists of • 1. ventricular septal defect2. overriding of the aorta3. right ventricular outflow obstruction4. right ventricular hypertrophy • Children present with dyspnea and a history of Fallot's spells and squatting. Central cyanosis is usually present since birth. There is a systolic ejection murmur with a thrill, in the second left intercostal space close to the sternum.
B Left umbilical vein The umbilical veins are transformed as follows: (1) the right umbilical vein and the part of the left umbilical vein between the liver and the sinus venosus degenerate; and (2) the persistent part of the left umbilical vein carries all the blood from the placenta to the fetus. Concurrently, a large shunt called the ductus venosus develops within the liver and connects the umbilical vein with the inferior vena cava. The ductus venosus forms a bypass through the liver, enabling some blood from the placenta to pass directly to the heart. After birth the umbilical vein and ductus venosus become the ligamentum teres and ligamentum venosum, respectively. The right cardinal vein and the right common cardinal vein become the superior vena cava.
D There is no significant difference between populations tested The null hypothesis states that there is no significant difference between the populations being tested, and that any difference that is found is attributable to chance. It is tested against the alternative hypothesis, which is that there is a significant difference between the populations tested.
