Patho Module Five Assignment Infection and Alterations in the Hematologic System   Academic honesty reminder:  It is ok to discuss the assignments with other students as a learning tool, but it is considered a breach of academic honesty to copy answers directly from each other.  Also, when taking a test, do not have this or any other document visible before you.    



1.           Read and study RRD #5 and any other documents that are referred to.

2.           Fill in this worksheet after you finish your readings.

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1.           A patient presents to the ED with fever, chills, myalgia (muscle pain), and a dry cough.  He says he has               recently traveled to China.   He says he got a flu shot a year ago. Which is most likely in this case?  

              a.           This disease is pertussis, probably contracted from an unvaccinated contact when he visited                              China.

              b.           The disease is probably not influenza, since he had a flu shot during last year’s flu season.

              c.           The diagnosis is influenza, probably contracted via fecal/oral route while in China.

              d.           The diagnosis is influenza, possibly contracted because patient did not have this year’s flu shot.

2.           The flu virus has the following characteristics:  

              a.           The causative microbe can also cause a membrane across the pharynx.

              b.           This disease is difficult to treat because of the antigenic drift of its exotoxin.

c.           New mutations of proteins on the viral envelope cause a variety of types each year.

              d.           A later outbreak may include skin lesions in a dermatome pattern.

3.           A commonality of herpetic organisms that cause diseases like chicken pox and shingles is that

              a.           each is caused by a bacterial organism that penetrates the nervous system.

              b.           the causative microbe can remain dormant in the nervous system.

              c.           the causative microbe causes bloody diarrhea.

              d.           each is transmitted via vector. 

4.           An otherwise healthy person whose water supply comes from a well is more at risk for _____.

a.           giardia

              b.           trichinosis

              c.           C. diff

              d.           cysticercosis

5.           A 4-year-old patient presents with bloody diarrhea.  Possible causes include _______ because_______

              a.           shigella: the microbe has caused inflammation in the lining of the intestines.            

              b.           pseudomembranous colitis: C. diff has eradicated normal flora.

              c.           giardia: this protozoa invades the intestinal wall and causes necrosis.

              d.           diphtheria: this bacteria causes parotid enlargement.

6.           After coming home from an overseas assignment, a young army officer begins complaining of extreme               fatigue and arthralgia (joint pain).  He has a very high fever and shaking chills, and he is anemic. The               most likely etiology of his S&S is 

              a.           infection with rabies virus.

              b.           protozoal invasion of his RBCs

              c.           Staph aureus-related cellulitis.

              d.           Guinea worm infestation.

7.           A patient is diagnosed with a staph infection of the skin (cellulitis) and is prescribed a penicillin               antibiotic. A week later, there has been no improvement of the symptoms. A specimen of the draining               wound is collected by the nurse for culture. The nurse suspects MRSA (methicillin-resistant               Staphylococcus aureus).  Which protective personal equipment should the nurse utilize when handling               wound exudate?

              a.           a mask

              b.           a mask and gloves

              c.           gloves

              d.           gloves and a gown

8.           A patient is diagnosed with a staph infection of the skin (cellulitis) and is prescribed a penicillin               antibiotic. A week later, there has been no improvement of the symptoms. The wound culture is               positive for MRSA (methicillin-resistant Staphylococcus aureus).  Which option best describes the               pathology of MRSA?

              a.           A certain Staphylococcus aureus species developed a special bonding affinity with penicillin.

              b.           The patient likely had a compromised immune system, as evidenced by the cellulitis.

  c.           The Staph microbe mutated and developed beta-lactamase; rendering the antibiotic useless.

 d.           Staphylococcus aureus is a microbe that does not respond to any kind of penicillin antibiotic.

9.          After three of weeks of being on strong antibiotics, a patient develops watery diarrhea.  Her stool is cultured. In this question’s context, what organism would you expect the stool culture to grow? 

             a.            MRSA.

             b.            VRE.

             c.             Salmonella.

             d.            C. diff.

10.        A school nurse has identified varicella (chicken pox) in a student at an elementary school. Which information about this illness should the school nurse provide to the child’s parents? 

a.           The child can return to school within two days as long as the child does not have a fever.

              b.           Fluid-filled vesicles will be itchy but pose no threat of transmission.

              c.           Varicella can be spread from a sneeze or cough before the vesicles erupt.

              d.           Chicken pox is a deadly disease but can be prevented with a vaccine.

11.         A young woman presents to her nurse practitioner complaining of SOB and fatigue.  She states that her               menstrual periods have been very heavy.  What is her most likely diagnosis and CBC results? 

              norm RBC count/L = 4-6million

              norm MCV = 80-95

              a.           macrocytic anemia; RBCs = 3 mill & MCV = 102.

              b.           microcytic anemia; RBCs = 3 mill & MCV = 70.

              c.           normocytic anemia; RBCs = 5 mill & MCV = 90.

              d.           polycythemia vera; RBCs = 20 mill & MCV = 90.

12.         A young woman presents to her nurse practitioner complaining of SOB and fatigue.  From the               patient’s history of heavy menstrual periods, identify a likely cause for this patient’s anemia.

              a.           a malfunction in DNA during erythropoiesis causes inadequate ATP formation.

              b.           an underlying chronic disease causes a sudden loss in RBCs. 

              c.           a steady loss of iron results in insufficient hemoglobin production.

              d.           a malformed hemoglobin molecule that decreases oxygen-carrying capacity of each RBC.

13.         A young woman presents to her nurse practitioner because of a history of heavy menstrual periods.               She is complaining of SOB and fatigue and is diagnosed with anemia.  Some form of hypoxemia               (reduced blood O2) is likely present because ________.

              a.           low levels of iron have decreased the O2-carrying capacity of her Hemoglobin (hgb)   

              b.           a secondary polycythemia has resulted from an underlying lung disease

              c.           she is not breathing in enough oxygen, resulting in over-saturated Hgb molecules

              d.           her heavy periods have led to a loss of Von Willebrand factor

14.         A young woman presents to her nurse practitioner complaining of SOB, fatigue and heavy periods and               is diagnosed with anemia. CBC results are: RBCs = 3 mill & MCV = 70. Which treatment, with rationale,               is likely?

              norm RBC count/L = 4-6million

              norm MCV = 80-95

              a.           Iron (Fe) supplements will help the SOB by increasing the capacity of Hgb to carry O2.

              b.           A well-rounded diet will provide nutrients to increase the production of intrinsic factor.

              c.           Blood thinners will be prescribed to reduce the risk of blood clot formation.

              d.           Injections of vitamin B12 to help increase the size of the RBC.

15.         A patient recently diagnosed with a vertebral fracture says, “I can’t understand how I broke it.  I sat

              down a little too hard, but not hard enough to break anything.”  His diagnosis is possibly _____because               _____. 

              a.           Leukemia: excessive, non-functional white blood cells increase risk for infection

              b.           idiopathic thrombocytopenia purpura (ITP): the low platelet count causes increased risk of                  bleeding.

              c.           anemia: suppression of bone marrow stem cell proliferation causes pancytopenia.

              d.           multiple myeloma: increased osteoclastic activity causes osteoporosis.

16.         Which S&S are expected in a patient who is diagnosed with multiple myeloma?

              a.           Multiple petechiae due to thrombosis.

              b.           Leukocytosis due to infection and inflammation.

              c.           Lethargy caused by hypercalcemia.

              d.           Decreased production of clotting factors.

17.         A person notices ecchymosis under her skin in several areas of her body but denies any substantial trauma to those areas. The eccymosis could be related to the presence of the following EXCEPT

              a.           decreased clotting factors.

              b.           compensatory erythrocytosis.

              c.           hypersplenism.

              d.           thrombocytopenia.

18.         A patient, recently diagnosed with leukemia, is admitted to the hospital for chemotherapy. Laboratory values for this patient would most likely reveal a _______________ presenting a risk for ___________.

              a.           hypercalcemia; lethargy and weakness

              b.           leukocytosis; ease of infection

              c.           leukopenia; ease of infection

              d.           thrombocytosis; easy bleeding

19.         Complications that can occur with polycythemia include ______________.

              a.           Sequestration and subsequent destruction of all blood cell types

              b.           Thrombosis and heart failure

              c.           Petechiae, purpura and tarry stools

              d.           RBC over-hemolysis and infection

20.         An elderly man presents to his nurse practitioner with SOB, fatigue and numbness and tingling to both               feet. Upon assessment, the nurse notices a beefy red tongue. What is the likely diagnosis?

              norm RBC count/L = 4-6million

              norm MCV = 80-95

              a.           macrocytic anemia; RBCs = 3 mill & MCV = 102.

              b.           microcytic anemia; RBCs = 3 mill & MCV = 70.

              c.           normocytic anemia; RBCs = 5 mill & MCV = 90.

              d.           polycythemia vera; RBCs = 20 mill & MCV = 90.

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