1. A stroke affecting which of the following areas of the brain would be most likely to leave an individual's vestibular system intact and posture and balance maintained?
The brain stem
The thalamus
The temporal and parietal cortex
The limbic system of the cerebrum
Question 2. A 51-year-old woman has been experiencing signs and symptoms of perimenopause and has sought help from her nurse practitioner. Doctors have confirmed a deficiency in estrogen levels as a contributing factor. Which of the following phenomena could potentially underlie the woman's health problem?
Sufficient synthesis of estrogen but inadequate vesicle-mediated release
Inadequate synthesis in the rough endoplasmic reticulum of her ovarian cells
Insufficient estrogen production within the smooth endoplasmic reticulum of the relevant cells
A lack of prohormone precursors needed for estrogen synthesis and release
Question 3. A 46-year-old male has presented to the emergency department because of the eye pain, severe headache, and blurred vision that have followed an eye exam at an optometrist's office earlier in the day. The patient tells the triage nurse that he received eyedrops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect?
Infectious conjunctivitis
Keratitis
Corneal trauma
Angle-closure glaucoma
Question 4. A patient with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which of the following processes would the patient's care team most likely rule out first as a contributing factor?
The patient's target cells lack sufficient receptors for the hormone in question.
Hormone production is sufficient, but affinity on the part of the target cells is lacking.
The process of down-regulation has resulted in decreased hormone sensitivity.
Up-regulation has increased the sensitivity of the body to particular hormone levels.
Question 5. A three-year-old girl has just been diagnosed with type 1A diabetes and her parents are currently receiving education from the diabetes education nurse at the hospital where their daughter is receiving treatment. How can the nurse best explain the etiology of their daughter's health problem to her parents?
"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."
"It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet."
"This tendency to produce insufficient amounts of insulin is likely something that she inherited."
"Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times."
Question 6. A 30 year old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin?
Decreasing glucose transport to skeletal muscles
Promoting the breakdown of stored triglycerides
Facilitating triglycerides from glucose in fat cells
Inhibiting protein breakdown
Promoting glucose uptake by target cells
Question 7. A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis?
New, sclerotic bone has been formed around her stapes and oval window.
Her incus, malleus, and stapes have become disconnected from her normal neural pathways.
Her temporal bone is experiencing unusually rapid resorption.
Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis.
Question 8. During descent, an airplane passenger is complaining that his "ears are plugged." What aspect of the structure and function of the ear best accounts for the passenger's complaint?
The inner ear adjusts its volume in response to atmospheric pressure, increasing during low pressure and decreasing in high pressure.
The eustachian tubes must remain patent to equalize pressure between the middle ear and inner ear.
The tympanic membrane is selectively permeable in order to accommodate pressure changes and this capacity is often impaired during upper respiratory infections.
Air must be able to flow between the middle ear and the nasopharynx in order to accommodate pressure changes.
Question 9. A 4-year-old boy has had otitis media with effusion (OME) for several weeks and his condition has recently progressed to acute otitis media (AOM). Which of the following factors could have contributed to his AOM?
Reflux of fluid from the boy's nose into his middle ear
A deficiency in immunoglobulin G
Accumulation of cerumen in the external acoustic meatus
Sensorineural deficits in the auditory control apparatus
Exposure to respiratory syncytial virus (RSV)
Question 10. Which of the following questions is most likely to be clinically useful in the differential diagnosis of sensorineural versus conductive hearing loss?
"What medications do you currently take?"
"What effect is this hearing loss having on your quality of life?"
"Has your hearing loss developed quickly or more slowly?"
"Do you ever hear a persistent ringing in your ears?"
Question 11. A 28-year-old male who is 6 feet 11 inches tall has a diagnosis of acromegaly. The man is explaining to a curious but sympathetic coworker exactly what accounts for his extraordinary height. Which of the following explanations demonstrates a sound understanding of his health problem?
"My pituitary gland produced a much higher than normal amount of growth hormone when I was a child."
"A tumor in my brain threw off my hormone levels after I was finished with adolescence."
"My liver is malfunctioning and produces too many of the hormones that ultimately cause growth."
T"The high sugar levels that go along with my diabetes made my pituitary gland overproduce the hormones that cause you to grow."
Question 12. A 60-year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?
Administration of 15 to 20 g of glucose in a concentrated carbohydrate source
Administration of subcutaneous glucagon
IV infusion of 50% dextrose and water solution
Careful monitoring for level of consciousness and resolution of hypoglycemia
Question 13. A 32-year-old man is complaining of burning, itching, photophobia, and severe pain in his right eye after swimming in the ocean. To determine that the eye condition is corneal rather than a conjunctival disease, which of the following would be the distinguishing symptom?
Burning
Itching
Photophobia
Severe pain
Question 14. As part of the diagnostic workup for a patient's long-standing vertigo, a clinician wants to gauge the patient's eye movements. Which of the following tests is the clinician most likely to utilize?
Romberg test
Rotational tests
Electronystagmography (ENG)
Caloric stimulation
Question 15. A woman with a diagnosis of type 2 diabetes has been ordered by her primary care provider to have a hemoglobin A1C test for the first time. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the patient?
The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.
Hemoglobin synthesis by the bone marrow is inversely proportionate to blood glucose levels, with low A1C indicating hyperglycemia.
The high metabolic needs of red cells and their affinity for free glucose indicate the amount of glucose that has been available over 6 to 12 weeks.
Insulin is a glucose receptor agonist on the hemoglobin molecule, and high glucose suggests low insulin levels.
Question 16. A patient with a new diagnosis of an endocrine disorder is unclear about how the body can control the levels of different hormones over time. Which of the following statements most accurately underlies the dominant regulation process of hormone levels in the body?
A positive feedback cycle ensures that stable levels of hormones exist in the body over time.
With input from various sensors, hormone production and release are adjusted based on existing hormone levels.
The hypothalamus ensures that hormone levels correspond accurately to the diurnal cycle.
The pituitary gland is genetically programmed to stimulate and inhibit hormone production and/or release based on needs at different points in the life cycle.
Question 17. Large amounts of glucagon were recently released into an individual's circulation, but glucagon circulation has now ceased. Which of the following situations could have led to this inhibition of glucagon release?
A sharp decrease in blood glucose concentration
Recent strenuous physical activity
Recent intake of large amounts of protein-rich food
A decrease in cellular metabolic needs and an increase in glucose levels
Question 18. Following a long history of fatigue, weakness, and poor appetite, a 39-year-old male has been diagnosed with hypopituitarism. Which of the following clinical findings would most likely cause his care team to suspect that the man has an additional endocrine disorder from a different source?
The man has a low sperm count and has been unable to have children.
The man has a chronic platelet deficiency and is occasionally anemic.
The patient is 5 feet 2 inches tall and was consistently short for his age as a child.
The man displays the signs and symptoms of hypothyroidism.
Question 19. Which of the following statements best captures an aspect of the role of hormones in the body?
Some chemical substances can function as either hormones or neurotransmitters.
Hormones directly initiate many of the processes that contribute to homeostasis.
Control of body processes is ensured by the fact that a single hormone can only exert one effect on one specific system or tissue.
Each hormone that exists in the body is produced by only one specific endocrine gland.
Question 20. Which of the following hormones are derivatives of cholesterol?
Epinephrine and norepinephrine
Insulin and glucagon
Aldosterone and testosterone
Eicosanoids and retinoids
Question 21. A 21-year-old female is suspected of having inadequate function of her hypothalamic-pituitary-thyroid system. Her care provider is planning to inject thyrotropin-releasing hormone (TRH) and then measure her levels of TSH. Which of the following diagnostic tests is being performed?
Suppression test
Radioimmunoassay (RIA) test
Stimulation test
Metabolite excretion test
Question 22. An endocrinologist is providing care for a 30-year-old male who has lived with the effects of increased levels of GH. Which of the following teaching points about the patient's future health risks is most accurate?
"It's not unusual for unusually high GH levels to cause damage to your hypothalamus."
"GH excess inhibits your pancreas from producing enough insulin."
"The high levels of GH that circulate in your body can result in damage to your liver."
"When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies.
Question 23. A three-year-old girl has been diagnosed with amblyopia. Which of the following pathophysiologic processes is most likely to underlie her health problem?
The child may have a congenital deficit of rods and/or cones
The girl may have chronic bacterial conjunctivitis
She may have been born with infantile cataracts
The child may have a neural pathway disorder
Question 24. A 60-year-old man has presented to his nurse practitioner because of an earache that has become progressively more painful in recent days. After giving his history and having an examination with an otoscope, the man has been diagnosed with otitis externa. Which of the nurse practitioner's following statements to the man is most accurate?
"You'll need to avoid getting any water in your ear until you finish your course of antibiotic pills."
"I'm going to instill some warm water into your ear to flush out debris and bacteria."
"I'll prescribe some ear drops for you, and in the meantime it's important not to use ear swabs."
"This likely happened because your ears aren't draining like they should, but antibiotics that you'll put in your ears will resolve this."
Question 25. Which of the following statements best describes an aspect of the normal process of glucose metabolism?
Blood glucose levels are primarily a result of the timing, quantity, and character of food intake.
Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs.
Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys.
Glucose that exceeds metabolic needs is converted and stored by the liver.