NR 507 Advanced Pathophysiology Final Exam. Complete solution. - Chamberlain College of Nursing

NR 507 Questions & Answers Question Question 1 2 / 2 pts What is the major virus involved in the development of cervical cancer? a) Herpes simplex virus type 6 b) Herpes simplex virus type 2 c) Human papillomavirus d) Human immunodeficiency virus Question 2 2 / 2 pts Which statement accurately describes childhood asthma? a) An obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation b) A pulmonary disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest x-ray imaging c) A pulmonary disorder involving an abnormal expression of a protein, producing viscous mucus that lines the airways, pancreas, sweat ducts, and vas deferens d) An obstructive airway disease characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency Question 3 0 / 2 pts The ability of the pathogen to invade and multiply in the host is referred to as: a) Infectivity b) Toxigenicity c) Pathogenicity d) Virulence Question 4 2 / 2 pts Obesity creates a greater risk for dehydration in people because: a) Adipose cells contain little water because fat is water repelling. b) The metabolic rate of obese adults is slower than the rate of lean adults. c) The rate of urine output of obese adults is higher than the rate of output of lean adults. d) The thirst receptors of the hypothalamus do not function effectively. Question 5 2 / 2 pts Continued therapy of pernicious anemia (PA) generally lasts how long? a) 6 to 8 weeks b) 8 to 12 months c) Until the iron level is normal d) The rest of one’s life Question 6 2 / 2 pts Which statement best describes cystic fibrosis? a) Obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation b) Respiratory disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest x-ray imaging c) Pulmonary disorder involving an abnormal expression of a protein-producing viscous mucus that obstructs the airways, pancreas, sweat ducts, and vas deferens d) Pulmonary disorder characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency Question 7 2 / 2 pts What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx? a) Nasal turbinates b) Alveolar macrophages c) Cilia d) Irritant receptors on the nares Question 8 2 / 2 pts As stated in the Frank-Starling law, a direct relationship exists between the _____ of the blood in the heart at the end of diastole and the _____ of contraction during the next systole. a) Pressure; force Volume; b) strength Viscosity; c) force Viscosity; strength Question 9 2 / 2 pts The tonic neck reflex observed in a newborn should no longer be obtainable by: a) 2 years b) 1 year c) 10 months d) 5 months Question 10 2 / 2 pts Carcinoma refers to abnormal cell proliferation originating from which tissue origin? a) Blood vessels b) Epithelial cells c) Connective tissue d) Glandular tissue Question 11 2 / 2 pts Which of the following describes how the body compensates for anemia? a) Increasing rate and depth of breathing b) Decreasing capillary vasoconstriction c) Hemoglobin holding more firmly onto oxygen d) Kidneys releasing more erythropoietin Question 12 2 / 2 pts What term is used to describe a hernial protrusion of a saclike cyst that contains meninges, spinal fluid, and a portion of the spinal cord through a defect in a posterior arch of a vertebra? a) Encephalocele b) Meningocele c) Spina bifida occulta d) Myelomeningocele Question 13 2 / 2 pts Chvostek and Trousseau signs indicate which electrolyte imbalance? a) Hypokalemia b) Hyperkalemia c) Hypocalcemia d) Hypercalcemia Question 14 2 / 2 pts After sexual transmission of HIV, a person can be infected yet seronegative for how many months? a) 1 to 2 b) 6 to 14 c) 18 to 20 d) 24 to 36 Question 15 2 / 2 pts Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? a) Norepinephrine b) Epinephrine c) Cortisol d) Adrenocorticotropic hormone (ACTH) Question 16 2 / 2 pts Which blood cells are the chief phagocytes involved in the early inflammation process? a) Neutrophils b) Monocytes c) Eosinophils d) Erythrocytes Question 17 2 / 2 pts Where are alveolar macrophages found? a) Skin b) Breasts c) Gastrointestinal tract d) Lungs Question 18 2 / 2 pts Which normal physiologic change occurs in the aging pulmonary system? a) Decreased flow resistance b) Fewer alveoli c) Stiffening of the chest wall d) Improved elastic recoil Question 19 2 / 2 pts An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom? a) Intermittent murmur b) Lack of symptoms c) Need for surgical repair d) Triad of congenital defects Question 20 2 / 2 pts Hemophilia B is caused by a deficiency of which clotting factor? a) V b) VIII c) IX d) X Question 21 2 / 2 pts A hypersensitivity reaction that produces an allergic response is called: a) Hemolytic shock b) Anaphylaxis c) Necrotizing vasculitis d) Systemic erythematosus Question 22 2 / 2 pts Which statement is true regarding pain and cancer? a) Pain is primarily a result of pressure caused by the tumor. b) Pain indicates the metastasis of a cancer. c) Pain is usually the initial symptom of cancer. d) Pain is generally associated with late-stage cancer. Question 23 2 / 2 pts What is the anomaly in which the soft bony component of the skull and much of the brain is missing? a) Anencephaly b) Myelodysplasia c) Cranial meningocele d) Hydrocephaly Question 24 0 / 2 pts At birth, which statement is true? a) Systemic resistance and pulmonary resistance fall. b) Gas exchange shifts from the placenta to the lung. c) Systemic resistance falls and pulmonary resistance rises. d) Systemic resistance and pulmonary resistance rise. Question 25 2 / 2 pts What is the most commonly reported symptom of cancer treatment? a) Nausea b) Fatigue c) Hair loss d) Weight loss Question 26 2 / 2 pts The common property among the three types of medications used to treat depression is that they: a) Increase neurotransmitter levels within the synapse. b) Increase neurotransmitter levels in the presynapse. c) Decrease neurotransmitter levels in the postsynapse. d) Decrease neurotransmitter levels within the synapse. Question 27 2 / 2 pts Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation? a) Heat cramps b) Heat stroke c) Malignant hyperthermia d) Heat exhaustion Question 28 2 / 2 pts Congenital aganglionic megacolon (Hirschsprung disease) involves inadequate motility of the colon caused by neural malformation of which nervous system? a) Central b) Parasympathetic c) Sympathetic d) Somatic Question 29 2 / 2 pts What type of fracture occurs at a site of a preexisting bone abnormality and is a result of a force that would not normally cause a fracture? a) Idiopathic b) Incomplete c) Pathologic d) Greenstick Question 30 2 / 2 pts What is the leading cause of infertility in women? a) Pelvic inflammatory disease b) Endometriosis c) Salpingitis d) Polycystic ovary syndrome Question 31 2 / 2 pts Alterations in which part of the brain are linked to hallucinations, delusions, and thought disorders associated with schizophrenia? a) Parietal lobe b) Limbic system c) Temporal lobe d) Hypothalamus . Question 32 2 / 2 pts What is the function of the mucus secreted by the Bartholin glands? a) Enhancement of the motility of sperm b) Lubrication of the urinary meatus and vestibule c) Maintenance of an acid-base balance to discourage proliferation of pathogenic bacteria d) Enhancement of the size of the penis during intercourse Question 33 0 / 2 pts People with gout are at high risk for which co-morbid condition? a) Renal calculi b) Joint trauma c) Anemia d) Hearing loss Question 34 2 / 2 pts The tear in a ligament is referred to as a: a) Fracture b) Strain c) Disunion d) Sprain Question 35 2 / 2 pts Regarding type 2 diabetes, obesity is considered to be what type of risk? a) Genetic b) Empirical c) Relative d) Modifiable Question 36 2 / 2 pts Adoption studies have shown that the offspring of an alcoholic parent when raised by nonalcoholic parents have what amount of an increased risk of developing alcoholism? a) Twofold b) Threefold c) Fourfold d) Tenfold Question 37 2 / 2 pts What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis? a) Reduced excretion of purines b) Overproduction of uric acid c) Increase in the glycosaminoglycan levels d) Overproduction of proteoglycans Question 38 0 / 2 pts It is true that Guillain-Barré syndrome (GBS): a) Is preceded by a viral illness. b) Involves a deficit in acetylcholine. c) Results in asymmetric paralysis. d) Is an outcome of HIV. Question 39 2 / 2 pts The failure of bones to ossify, resulting in soft bones and skeletal deformity, characterizes which disorder? a) Osteogenesis imperfecta b) Rickets c) Osteochondrosis d) Legg-Calvé-Perthes disease Question 40 2 / 2 pts Which dietary lifestyle choice has been associated with a decreased risk for developing colon cancer? a) Increased consumption of dairy produces b) Increased consumption of foods containing vitamin C c) Decreased consumption of foods high in fat d) Decreased consumption of artificial food coloring Question 41 2 / 2 pts The sudden apparent arousal in which a child expresses intense fear or another strong emotion while still in a sleep state characterizes which sleep disorder? a) Night terrors b) Insomnia c) Somnambulism d) Enuresis Question 42 2 / 2 pts Which virus is a precursor for developing cervical intraepithelial neoplasia (CIN) and cervical cancer? a) Human papillomavirus (HPV) b) Epstein-Barr virus (EBV) c) Herpes simplex II virus (HSV) d) Cytomegalovirus (CMV) Question 43 2 / 2 pts What anchors articular cartilage to the underlying bone? a) Sharpey fibers b) Collagen fibers c) Glycoproteins d) Elastin fibers Question 44 2/ 2 pts Which gastric cells secrete hydrochloric acid and intrinsic factor? a) Parietal b) Chief c) G d) H Question 45 2 / 2 pts Which water-soluble vitamin is absorbed by passive diffusion? a) Vitamin B6 b) Vitamin B1 c) Vitamin K d) Folic acid Question 46 2 / 2 pts What is the first sign of puberty in girls? a) Breast enlargement b) Growth of pubic hair c) Menstruation d) Vaginal discharge Question 47 2 / 2 pts Pinkeye is characterized by inflammation of which structure? a) Eyelids b) Sebaceous glands c) Meibomian glands d) Conjunctiva Question 48 2 / 2 pts What syndrome, characterized by an absent homologous X chromosome with only a single X chromosome, exhibits features that include a short stature, widely spaced nipples, and webbed neck? a) Down b) Cri du chat c) Turner d) Klinefelter Question 49 2 / 2 pts A criterion for a diagnosis of generalized anxiety disorder (GAD) is a period of excessive worrying that lasts for at least how many months? a) 3 b) 6 c) 9 d) 12 Question 50 0 / 2 pts Obesity acts as an important risk factor for type 2 diabetes mellitus by: a) Reducing the amount of insulin the pancreas produces b) Increasing the resistance to insulin by cells c) Obstructing the outflow of insulin from the pancreas d) Stimulating the liver to increase glucose production Question 51 0 / 2 pts Which clinical manifestations would be expected for a child who has complete trisomy of the twenty-first chromosome? a) Widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair b) An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears c) High-pitched voice, tall stature, gynecomastia, and an IQ of 60 to 90 d) Circumoral cyanosis, edema of the feet, short stature, and mental slowness Question 52 0 / 2 pts Where is the usual site of cervical dysplasia or cancer in situ? a) Squamous epithelium of the cervix meets the cuboidal epithelium of the vagina. b) Columnar epithelium of the cervix meets the squamous epithelium of the uterus. c) Squamous epithelium of the cervix meets the columnar epithelium of the uterus. d) Columnar epithelium of the cervix meets the squamous epithelium of the vagina. Question 53 2 / 2 pts How can glaucoma cause blindness? a) Infection of the cornea b) Pressure on the optic nerve c) Opacity of the lens d) Obstruction of the venous return from the retina Question 54 0 / 2 pts Parkinson disease is a degenerative disorder of the brain’s: a) Hypothalamus b) Anterior pituitary c) Frontal lobe d) Basal ganglia Question 55 0 / 2 pts Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain? a) GCT Pattern theory b) Specificity theory c) Neuromatrix theory Question 56 0 / 2 pts Where is oxytocin synthesized? a) Hypothalamus b) Paraventricular nuclei c) Anterior pituitary d) Posterior pituitary Question 57 0 / 2 pts An insufficient dietary intake of which vitamin can lead to rickets in children? a) C b) B12 c) B6 d) D Question 58 2 / 2 pts What term is used to identify the condition that exists when the urethral meatus is located on the undersurface of the penis? a) Hypospadias b) Epispadias c) Hyperspadias d) Chordee Question 59 2 / 2 pts The most critical aspect in ly diagnosing a seizure disorder and establishing its cause is: a) Computed tomographic (CT) scan b) Cerebrospinal fluid analysis c) Skull x-ray studies d) Health history Question 60 2 / 2 pts Transcription is best defined as a process by which: a) DNA polymerase binds to the promoter site on ribonucleic acid (RNA). b) RNA directs the synthesis of polypeptides for protein synthesis. c) RNA is synthesized from a DNA template. d) A base pair substitution results in a mutation of the amino acid sequence. Question 61 0 / 2 pts Which person is at the greatest risk for developing delirium? a) An individual with diabetes celebrating a 70th birthday b) A depressed Hispanic woman c) An individual on the second day after hip replacement d) A man diagnosed with schizophrenia Question 62 2 / 2 pts Which hormone is linked to an increase in appetite during puberty? a) Inhibin b) Leptin c) Activin d) Follistatin Question 63 2 / 2 pts Which type of diarrhea results from lactose intolerance? a) Secretory b) Motility c) Osmotic d) Small volume Question 64 2 / 2 pts An amniocentesis is recommended for pregnant women who: a) Have a history of chronic illness b) Have a family history of genetic disorders c) Have experienced in vitro fertilization d) Had a late menarche Question 65 2 / 2 pts Which characteristic is true of type II (white fast-motor) muscle fibers? a) Slow contraction speed b) Fast conduction velocities c) Profuse capillary supply d) Oxidative metabolism Question 66 2 / 2 pts The mucosal secretions of the cervix secrete which immunoglobulin? a) IgA b) IgE c) IgG d) IgM Question 67 2 / 2 pts Dilation of the ipsilateral pupil, following uncal herniation, is the result of pressure on which cranial nerve (CN)? a) Optic (CN I) b) Abducens (CN VI) c) Oculomotor (CN III) d) Trochlear (CN IV) Question 68 2 / 2 pts Which of the following is a lipid-soluble hormone? a) Cortisol b) Oxytocin c) Epinephrine d) Growth hormone Question 69 2 / 2 pts What is the first indication of nephrotic syndrome in children? a) Periorbital edema b) Scrotal or labial edema c) Frothy urine d) Ascites Question 70 2 / 2 pts The BRCA1 and BRCA2 mutations increase the risk of which cancer in women? a) Ovarian b) Lung c) Uterine d) Pancreatic Question 71 2 / 2 pts The data reporting that sickle cell disease affects approximately 1 in 600 American blacks is an example of which concept? a) Incidence b) Prevalence c) Ratio d) Risk Question 72 2 / 2 pts When a woman’s uterus is assessed as protruding through the entrance of the vagina to the hymen, which grade of prolapse does this indicate? a) 0 b) 1 c) 2 d) 3 Question 73 2 / 2 pts What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding? a) Tolerance b) Perception c) Threshold d) Dominance Question 74 2 / 2 pts Clinical manifestations that include irregular or heavy bleeding, the passage of large clots, and the depletion of iron stores support which diagnosis? a) Premenstrual syndrome b) Dysfunctional uterine bleeding c) Polycystic ovary syndrome d) Primary dysmenorrhea Question 75 0 / 2 pts What term describes the loss of the comprehension or production of language? a) Agnosia b) Aphasia c) Akinesia d) Dysphasia Question 76. : The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins? a) IgE b) IgG c) IgM d) T cells Question 77 : What is the treatment of choice for pernicious anemia (PA)? a) Cyanocobalamin by oral intake b) Vitamin B12 by injection c) Ferrous fumarate by Z-track injection d) Folate by oral intake Question 78. : Which sexually transmitted infection frequently coexists with gonorrhea? a) Syphilis b) Herpes simplex virus c) Chlamydia d) Chancroid Question 79. : During an infection, why do lymph nodes enlarge and become tender? a) B lymphocytes proliferate. b) The nodes are inflamed. c) The nodes fill with purulent exudate. d) The nodes are not properly functioning. Question 80. : What is the suggested mean blood pressure for an 8- to 9-year-old child? a) 104/55 mm Hg b) 106/58 mm Hg c) 112/62 mm Hg d) 121/70 mm Hg Question 81. : Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of: a) Epinephrine and aldosterone b) Norepinephrine and cortisol c) Epinephrine and norepinephrine d) Acetylcholine and cortisol Question 82. : What is the function of erythrocytes? a) Tissue oxygenation b) Hemostasis c) Infection control d) Allergy response Question 83. Where are Kupffer cells located? a) Kidneys b) Liver c) Pancreas d) Spleen Question 84. Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host DNA is the cause of which disease? a) Hemolytic anemia b) Pernicious anemia c) Systemic lupus erythematosus d) Myasthenia gravis Question 85. Where are Langerhans cells found? a) Skin b) Intestinal lining c) Kidney d) Thyroid Question 86. What is the primary cause of the symptoms of polycythemia vera? a) Decreased erythrocyte count b) Destruction of erythrocytes c) Increased blood viscosity d) Neurologic involvement Question 87. How is the effectiveness of vitamin B12 therapy measured? a) Reticulocyte count b) Serum transferring c) Hemoglobin d) Serum vitamin B12 Question 88. Which is an example of an endogenous antigen? a) Yeast b) Cancer cells c) Bacteria d) Fungus Question 89. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? a) IgA b) IgE c) IgG d) IgM Question 90. Which renal change is found in older adults? a) Sharp decline in glomerular filtration rate b) Sharp decline in renal blood flow c) Decrease in the number of nephrons d) Decrease in urine output Question 91. What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated? a) Refractory b) Hyperpolarization c) Threshold d) Sinoatrial (SA) Question 92. What is the most common predisposing factor to obstructive sleep apnea in children? a) Chronic respiratory infections b) Adenotonsillar hypertrophy c) Obligatory mouth breathing d) Paradoxic breathing Question 93. Kidney stones in the upper part of the ureter would produce pain referred to which anatomical area? a) Vulva or penis b) Umbilicus c) Thighs d) Lower abdomen Question 94. What characteristic do atopic individuals have that make them genetically predisposed to develop allergies? a) Greater quantities of histamine b) More histamine receptors c) Greater quantities of IgE d) A deficiency in epinephrine Question 95. Pressure in the left ventricle must exceed pressure in which structure before the left ventricle can eject blood? a) Superior vena cava b) Aorta c) Inferior vena cava d) Pulmonary veins Question 96. How does chest wall compliance in an infant differ from that of an adult? a) An adult’s chest wall compliance is lower than an infant’s. b) An adult’s chest wall compliance is higher than an infant’s. c) An adult’s chest wall compliance is the same as an infant’s. d) An adult’s chest wall compliance is dissimilar to that of an infant’s. Question 97. Oxygenated blood flows through which vessel? a) Superior vena cava b) Pulmonary veins c) Pulmonary artery d) Coronary veins Question 98. What type of immunity is produced when an immunoglobulin crosses the placenta? a) Passive-acquired immunity b) Active-acquired immunity c) Passive-innate immunity d) Active-innate immunity Question 99. The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by which gland? a) Posterior pituitary b) Thyroid c) Parathyroid d) Anterior pituitary Question 100. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? a) Flight or fight b) Alarm c) Adaptation d) Arousal Question 101. When the maternal immune system becomes sensitized against antigens expressed by the fetus, what reaction occurs? a) T-cell immunity b) Alloimmunity c) Fetal immunity d) Autoimmunity Question 102. What is the basic structural unit in compact bone? a) Small channels called canaliculi b) Osteocytes within the lacunae c) Tiny spaces within the lacunae d) Haversian system Question 103. Which type of fracture usually occurs in an individual who engages in a new activity that is strenuous and repetitive? a) Stress b) Greenstick c) Insufficiency d) Pathologic Question 104. Antipsychotic drugs block which neurotransmitter receptor? a) Norepinephrine b) Gamma-aminobutyric acid c) Serotonin d) Dopamine Question 105. Which risk factor for hypertension is influenced by genetic factors and lifestyle? a) Sodium intake b) Physical inactivity c) Psychosocial stress d) Obesity Question 106. When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of what type of effect by a hormone? a) Pharmacologic b) Permissive c) Synergistic d) Direct Question 107. Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. This is an example of: a) Positive feedback b) Negative feedback c) Neural regulation d) Physiologic regulation Question 108. At 2 or 3 weeks of age, an infant who has been well fed and has gained weight begins to vomit for no apparent reason. The vomiting gradually becomes more forceful. These symptoms may be indicative of which disorder? a) Esophageal atresia b) Congenital aganglionic megacolon c) Pyloric stenosis d) Galactosemia Question 109. Neurofibrillary tangles characterize which neurologic disorder? a) Dementia syndrome b) Delirium c) Alzheimer disease d) Parkinson disease Question 110. What is the target tissue for prolactin-releasing factor? a) Hypothalamus b) Anterior pituitary c) Mammary glands d) Posterior pituitary Question 111. A child with which genetic disorder has a characteristic cry? a) Down syndrome b) Klinefelter syndrome c) Turner syndrome d) Cri du chat Question 112. : Which hormone is involved in the regulation of serum calcium levels? a) Parathyroid hormone (PTH) b) Thyroxine (T4) c) Adrenocorticotropic hormone (ACTH) d) Triiodothyronine (T3) Question 113. : The secretion of adrenocorticotropic-stimulating hormone (ACTH) will result in the increased level of which hormone? a) Thyroxine b) Insulin c) Cortisol. d) Antidiuretic hormone Question 114. : The major sleep center is located in which section of the brain? a) Thalamus b) Brainstem c) Frontal lobe d) Hypothalamus Question 115. : What is the second most commonly recognized genetic cause of mental retardation? a) Down syndrome b) Fragile X syndrome c) Klinefelter syndrome d) Turner syndrome Question 116. : A person with 47, XXY karyotype has the genetic disorder resulting in which syndrome? a) Turner b) Klinefelter c) Down d) Fragile X Question 117. : What effect does hyperphosphatemia have on other electrolytes? a) Increases serum calcium. b) Decreases serum calcium. c) Decreases serum magnesium. d) Increases serum magnesium. Question 118. : What term is used to identify an interlacing bundle of dense, white fibrous tissue that is richly supplied with nerves, blood vessels, and lymphatic vessels? a) Procallus b) Joint capsule c) Hematoma d) Elastin fibers Question 119. Open-angle glaucoma occurs because of: a) Decreased production of aqueous humor b) Increased production of vitreous humor c) Obstructed outflow of aqueous humor d) Excessive destruction of vitreous humor Question 120 Loud snoring, a decrease in oxygen saturation, fragmented sleep, chronic daytime sleepiness, and fatigue are clinical manifestations of which sleep disorder? a) Obstructive sleep apnea b) Upper airway resistance syndrome c) Somnambulism d) narcolepsy Questions 121 What is the most common opportunistic infection associated with acquired immunodeficiency syndrome (AIDS)? a) Non-Hodgkin lymphoma b) Kaposi sarcoma c) Toxoplasmosis d) Cytomegalovirus