Chapter 1 Health and Disease

Oh No! Not Another Learning Experience

Learning Objective 1
Exercise 1-1
1. injury
2. acute
Exercise 1-2
1. rapid
2. distinct
3. persistent
4. often treatable
Exercise 1-3
1. acute disease
2. chronic disease
Learning Objective 2
Exercise 1-4
1. functional disorder
2. structural
3. functional
4. functional
5. structural
Exercise 1-5
1. True
2. True
Learning Objective 3
Exercise 1-6
1. onset

2. predisposing factors
3. latent period
4. incubation period
5. prodromal period
6. complications
7. sequelae
8. remission
9. recurrence
10. recovery
Exercise 1-7
See Exercise 1-6 for key terms covered in this section.
Learning Objective 4
Exercise 1-8
1. Pathology
2. lesion
3. pathophysiology
4. etiology
5. pathogenesis
6. idiopathic
7. iatrogenic
8. Nosocomial
Exercise 1-9
See Exercise 1-8 for key terms covered in this section.
Learning Objective 5
Exercise 1-10
1. Epidemiology
2. incidence
3. prevalence
Exercise 1-11

1. False, morbidity
2. True
3. True
Learning Objective 6
Exercise 1-12
1. Environmental factors
2. Genetic factors
3. monogenic
4. polygenic
5. multifactorial
6. determinants of health
Exercise 1-13
See Exercise 1-12 for key terms covered in this section.
Learning Objective 7
Exercise 1-14
1. Symptoms
2. Signs
3. detectible
4. latent
5. diagnosis
Exercise 1-15
See Exercise 1-14 for key terms covered in this section.
Learning Objective 8
Exercise 1-16
1. Anatomic pathology
2. biopsy
3. Clinical pathology

Exercise 1-17
1. Gross Pathology
2. Microscopic Pathology
3. Autopsy
4. Syndrome
5. Biopsy
Learning Objective 9
Exercise 1-18
1. normal range
2. mean
3. mean
4. standard deviation
5. abnormal
6. significant
Exercise 1-19
1. True Positive
2. True Negative
3. Sensitivity: TP/(TP+FN)
4. False Positive
5. False Negative
6. Specificity: TN/(TN+FP)
7. Predictive value
Learning Objective 10
Exercise 1-20
1. sensitive
2. specific
3. sensitivity
4. specificity
5. negative

6. positive
7. prevalence
8. sensitive test
9. specific test
Exercise 1-21
See Exercises 1-20 and 1-21 for key terms covered in this section.
Test Yourself
Multiple Choice
1. The answer is D. Exacerbation, in other words, a period of increased intensity of her
disease likely brought on by overexertion when she was feeling better. Onset would have
occurred prior to her first visit to your office, while no symptoms would be evident in a
latent period. Finally, during recovery, her symptoms would be lessening, not getting
worse.
2. The answer is B. Blood pressure taken by a nurse is an example of a sign. Signs are
objective, and are revealed during the physical, lab, X-ray, or other examinationsand
directly observed by a member of the medical staff. As the nurse took the patients blood
pressure, this is a sign. All other choices are symptoms, as they are patient reported.
3. The answer is A. Symptoms are subjective complaints described by the patient or
someone else on the patients behalf (such as the sore throat reported above). The other
choices are signs.
4. The answer is A. Iatrogenic, as the bleeding was directly related to the prescription of
Motrin (ibuprofen) to the patient for treatment of her rheumatoid arthritis.
5. The answer is D. All of the statements are true.
6. The answer is A. A functional disorder is one in which there is a defect in ability to
perform, as happens in congestive heart failure. Admittedly, it might be tempting to select B
or C because these examples can cause a functional component, but, as described here,
these are first and foremost structural disorders, as is ulceration of the stomach.
7. The answer is A. The patient has undergone a biopsy, or an examination of a living tissue
specimen, which will likely be observed via gross and microscopic examination. Autopsies
are performed on deceased patients to determine cause of death. Clinical pathology is the

study of functional aspects of disease, carried out by labs, while epidemiology is the study
of the broad behavior of disease in large populations.
8. The answer is C. The correct (true) answer is that standard deviation is a measure of the
degree of variability of results. The others choices above are incorrect.
True or False
9. False. Some diseases are not characterized by objective abnormalities.
10. True.
11. False. Lab values outside two standard deviations are considered abnormal, but it does
not necessarily mean that the patient has a disease. Five percent of patients tested have an
abnormal result, but no disease.
Matching
12. A. <ii> Morbidity is the number of people with an illness or complication of an illness; in
this case, the 35% with complication Y.
B. <ii, iii> Incidence is the number of people diagnosed with a disease in a given year; in
this case 12,000. The mortality is also given as an incidence.
C. <iv> Prevalence is the total number of people with a disease; in this case one million
people.
D. <i> Mortality is the number of people dying from a particular disease in a particular time
frame; in this case, the 50% of patients who die.
Short Answer
13. Disease is multifactorial, influenced by genetic and environmental factors, including
risk or predisposing factors. It is also determined by the determinants of health, personal,
social, economic, and environmental factors that may not directly cause disease but can
play a role: for instance, access to healthcare, social support, and a safe environment that
provides opportunities for exercise.
14. Reassurance is key, telling your patient I cant find anything wrong might lead him or
her to think that you do not believe himneither his symptoms nor his pain. In cases like
this, where no physical explanation can be found, it is key to tell the patient that some

diseases have no objective findings; for example, neither irritable bowel syndrome nor
fibromyalgia have abnormal labs, imaging studies, or physical findings.
15. In the face of a positive sensitive test, but a negative specific test, it all depends on the
clinical picture and your confidence. If you feel certain that the patient is displaying signs
and symptoms consistent with your diagnosis, it may be that your specific test is a false
negative (either the test is negative when it should not be, or your patient is the rare find
who lacks presence of the marker). However, if you are uncertain, it pays to review your
patients history and the data at hand to be sure that the etiology is the best explanation of
the clinical picture. In instances where the sensitive test has been used as a screening test,
the result could be a false positive. It is therefore the better decision to again review the
patients presentation to decide if treatment is warranted.
In the face of a negative sensitive test, despite a clinical picture consistent with your
diagnosis, the answer remains the same. Everything depends on your confidence in the
diagnosis. If you believe the patient has the disease (even in the face of a negative test) and
treatment is necessary, by all means treat the disease. However, if the clinical picture
remains incomplete, again review the history and data at hand, and determine whether
another diagnosis might best fit the picture.