QUESTION 1. The unique clinical presentation of a three-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? (Points : 0.4)

“Have you ever given your child any honey or honey-containing products?”

“Is there any family history of neuromuscular diseases?”

“Has your baby ever been directly exposed to any chemical cleaning products?”

“Is there any mold in your home that you know of?”

Question 2. 2. A nurse practitioner is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. Which of the following pharmacologic therapies is most likely to benefit the woman? (Points : 0.4)

A drug that influences gamma-aminobutyric acid (GABA) levels

A selective serotonin reuptake inhibitor (SSRI)

An antipsychotic medication that blocks dopamine receptors

An epinephrine and norepinephrine supplement

Question 3. 3. A 51-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the patient’s history would not be considered to have contributed to his stroke? (Points : 0.4)

He was diagnosed with type 2 diabetes eight years ago

Elevated cholesterol

Blood pressure that is normally 120/80

The patient is an African American Male

History of sickle cell anemia

Question 4. 4. Following a motor vehicle accident three months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? (Points : 0.4)

“Your daughter has lost all her cognitive functions as well as all her basic reflexes.”

“Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”

“If you or the care team notice any spontaneous eye opening, then we will change our treatment plan.”

“Your daughter’s condition is an unfortunate combination of total loss of consciousness with continuation of all other normal brain functions.”

Question 5. 5. A patient with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in her chemical synapses? (Points : 0.4)

Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.

Communication between a neuron and the single neuron it is connected with will be facilitated.

The neurotransmitter will cross gap junctions more readily.

More serotonin molecules will cross the synaptic cleft and bond with postsynaptic receptors.

Question 6. 6. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son’s increasingly frequent, severe headaches. Which of the nurse’s following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? (Points : 0.4)

“Does your son have a family history of migraines?”

“When your son has a headache, does he ever have nausea and vomiting as well?”

“Does your son have any food allergies that have been identified?”

“Is your son generally pain free during the intervals between headaches?”

Question 7. 7. A 60-year-old male patient with a long history of back pain has had little success with a variety of analgesic regimens that his nurse practitioner has prescribed. He has recently been diagnosed formally with a chronic pain disorder. Which of the following teaching points about chronic pain would his nurse practitioner most likely emphasize to the patient? (Points : 0.4)

“If your pain comes and goes, then we won’t characterize it as chronic, and it will require different treatment.”

“You need to remind yourself that this is a purely physical phenomenon that requires physical treatment.”

“Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about.”

“These pain signals your body is sending likely serve no real, useful, or protective function.”

Question 8. 8. Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? (Points : 0.4)

The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping–waking cycles.

The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep.

The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep–wake cycle.

Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.

Question 9. 9. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? (Points : 0.4)

The inner layer (archilayer)

The middle layer (paleolayer)

The outer layer (neolayer)

The reticular formation

Question 10. 10. A patient with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? (Points : 0.4)

“Fewer neurons in your brain are firing when you’re asleep, but they’re more synchronized than when you’re awake.”

“While you’re obviously less aware of stimuli when you’re asleep, your brain is actually more active when you’re asleep than when you’re awake.”

“There are four types of brain activity, and actually all of them occur at different stages of sleep.”

“Your brain alternates between periods of activity and periods of inactivity when you’re asleep, and these correspond to your eye movement.”

Question 11. 11. A patient on an acute medicine unit of a hospital, with a diagnosis of small bowel obstruction, is complaining of intense, diffuse pain in her abdomen. Which of the following physiologic phenomena is most likely contributing to her complaint? (Points : 0.4)

Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS.

First-order neurons are inappropriately signaling pain to the dorsal root ganglion.

The patient is experiencing neuropathic pain.

The patient’s C fibers are conducting pain in the absence of damaged Ad fibers.

Question 12. 12. Which of the following factors is most responsible for the fact that prefrontal lobotomy is no longer a common treatment for mental illness? (Points : 0.4)

Individuals treated by lobotomy have difficulty interpreting somatic, visual, and auditory information.

Lobotomy inhibits the individual’s ability to add perception and meaning to sensory information.

Severing connections between the brain and its prefrontal areas inhibits problem solving and results in a loss of ambition.

Loss of communication to and from the prefrontal cortex changes, but ultimately exacerbates, symptoms of mental illness.

Question 13. 13. After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures?

(Points : 0.4)

The man’s occipital lobe

The patient’s temporal lobe in general and Wernicke area in particular

The man’s parietal lobe

The components of the patient’s limbic system

Question 14. 14. A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman’s ability? (Points : 0.4)

Pacinian corpuscles

Ruffini end organs

Meissner corpuscles

Free nerve endings

Question 15. 15. Which of the following individuals would be most likely to experience global ischemia to his or her brain? (Points : 0.4)

A male patient who has just had an ischemic stroke confirmed by CT of his head

A woman who has been admitted to the emergency department with a suspected intracranial bleed

A man who has entered cardiogenic shock following a severe myocardial infarction

A woman who is being brought to the hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater

Question 16. 16. During a late-night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system has the highest level of control over her arm and hand action? (Points : 0.4)

Cerebelum

Thalamus

Basal ganglia

Frontal lobe

Question 17. 17. A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? (Points : 0.4)

She repeatedly moves her large toe, ankle, and knee during sleep.

She complains of a powerful urge to move her legs when in bed at night.

She has frequently awakened unable to move or speak.

She believes that she experiences auditory hallucinations when she awakens.

Her sleep latency is normally around 1 hour.

Question 18. 18. Which of the following phenomena constitutes a component of axonal transport? (Points : 0.4)

Anterograde and retrograde axonal transport allow for the communication of nerve impulses between a neuron and the central nervous system (CNS).

Materials can be transported to the nerve terminal by either fast or slow components.

The unidirectional nature of the axonal transport system protects the CNS against potential pathogens.

Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.

Question 19. 19. A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman’s diagnosis? (Points : 0.4)

Decreased brain activity in the pons and brain stem

Reduced activity and gray matter volume in the prefrontal cortex

Atrophy and decreased blood flow in the amygdala

Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes

Question 20. 20. A nurse practitioner and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? (Points : 0.4)

Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors

Surgical treatment of the ischemic changes that underlie the manifestations of the man’s disease

The use of medications such as donepezil and rivastigmine to slow the progression of the disease

Cognitive and behavioral therapy to counteract the agitation, depression, and suspiciousness associated with Alzheimer disease.

Question 21. 21. A nurse practitioner is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a prescription for “sleeping pills” to help him through this time. Which of the following statements forms a valid basis for the nurse practitioner’s plan for treatment? (Points : 0.4)

Sedative and hypnotic drugs will not provide safe relief of the man’s health problem.

The man is suffering from primary insomnia.

Melatonin supplements will be the safest and most effective long-term pharmacological treatment.

Behavioral therapies, counseling, and education may be of some use to the patient.

Question 22. 22. The parents of a 15-year-old boy are frustrated by his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have in rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy’s sleep disorder? (Points : 0.4)

Delayed sleep phase syndrome (DSPS)

Non–24-hour sleep–wake syndrome

Advanced sleep phase syndrome (ASPS)

Chronic insomnia

Question 23. 23. A clinician is conducting an assessment of a male patient suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? (Points : 0.4)

The patient has decreased deep tendon reflexes.

The patient displays increased muscle tone.

The patient’s muscles appear atrophied.

The patient displays weakness in the distal portions of his limbs.

Question 24. 24. A student is feeling inside her backpack to find her mobile phone, which has fallen to the bottom, and there are a number of items in the bag in addition to the phone. Which of the following components of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items? (Points : 0.4)

The primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron

A slow-conducting pathway that projects into the intralaminar nuclei of the thalamus

The opposite anterolateral pathway that travels to the reticular activating system

A bilateral, multisynaptic, slow-conducting tract

Question 25. 25. A 48-year-old male has a new diagnosis of Guillain-Barré syndrome. Which of the following processes underlies the deficits that accompany the degeneration of myelin in his peripheral nervous system (PNS)? (Points : 0.4)

The destruction of myelin causes fewer Schwann cells to be produced in the patient’s PNS.

The axonal transport system is compromised by the lack of myelin surrounding nerve cells.

Nerve cells lack insulation and impulse conduction is compromised by the destruction of myelin.

A deficit of myelin predisposes the patient to infection by potential pathogens.

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1. 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? (Points : 2)

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 2. 2. A 79-year-old male resident of a long-term care facility has contracted Clostridium difficile and is experiencing consequent diarrhea. Auscultation of the man’s abdomen indicates hyperactive bowel sounds. What processes in the man’s small intestine are most likely accompanying his current status? (Points : 2)

Pathogenic microorganisms are causing dilation of his small intestine, increasing motility.

Segmentation waves have become more frequent as a result of his infection.

Intestinal stasis brought on by infection is preventing his small intestine from sufficiently slowing the rate of motility.

Inflammation is accompanied by an increase in peristaltic movements of his small intestine.

Question 3. 3. A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner, who is performing his regular physical exam, that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the patient’s statement? (Points : 2)

“You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking.

“That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer.”

“In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes.”

“When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts.”

Question 4. 4. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son’s increasingly frequent, severe headaches. Which of the nurse’s following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? (Points : 2)

“Does your son have a family history of migraines?”

“When your son has a headache, does he ever have nausea and vomiting as well?”

“Does your son have any food allergies that have been identified?”

“Is your son generally pain free during the intervals between headaches?”

Question 5. 5. A 51-year-old woman who has been receiving estrogen and progesterone therapy (EPT) for the last 5 years has visited her care provider because her peers have told her about the risks of heart disease, stroke, and breast cancer that could accompany hormone therapy (HT). How should her care provider respond to her concerns? (Points : 2)

“There is a demonstrable increase in breast cancer risk with HT, but the risk of stroke or heart disease actually goes down slightly.”

“All things considered, the benefits of HT outweigh the slightly increased risks of heart disease, stroke, or breast cancer.”

“HT is actually associated with a decrease in heart disease risk, but there is an increase in stroke risk; the breast cancer connection is still unclear.”

“There’s in fact a slight protective effect against stroke associated with HT, but this is partially offset by increased rates of heart disease and breast cancer.”

Question 6. 6. Chronic anxiety and stress contribute to ulcers. Which of the following effects of the sympathetic nervous system is most responsible for this effect?

(Points : 2)

Inhibition of the actions of Brunner glands

Overstimulation of the oxyntic glands

Suppression of cholecystokinin

Inflammation of the parotid glands

Question 7. 7. Following a motor vehicle accident three months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? (Points : 2)

“Your daughter has lost all her cognitive functions as well as all her basic reflexes.”

“Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”

“If you or the care team notice any spontaneous eye opening, then we will change our treatment plan.”

“Your daughter’s condition is an unfortunate combination of total loss of consciousness with continuation of all other normal brain functions.”

Question 8. 8. A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are NOT active in the development of her breasts? (Points : 2)

Prolactin

Oxytocin

Estrogen

Follicle-stimulating hormone

Progesterone

Question 9. 9. After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures?

(Points : 2)

The man’s occipital lobe

The patient’s temporal lobe in general and Wernicke area in particular

The man’s parietal lobe

The components of the patient’s limbic system

Question 10. 10. A 29-year-old woman has been trying for many months to become pregnant, and fertilization has just occurred following her most recent ovulation. What process will now occur that will differentiate this ovulatory cycle from those prior? (Points : 2)

Human chorionic gonadotropin will be produced, preventing luteal regression.

The remaining primary follicles will provide hormonal support for the first 3 months of pregnancy.

The corpus luteum will atrophy and be replaced by corpus albicans.

The basal layer of the endometrium will be sloughed in preparation for implantation.

Question 11. 11. 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? (Points : 2)

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 12. 12. John presents to the clinic with complaints of scrotal heaviness. Your assessment reveals swelling of the testicle and warm scrotal skin. What would your diagnosis be? (Points : 2)

Cryptorchidism

Orchitis

Testicular torsion

Epididymitis

Question 13. 13. The parents of a 15-year-old boy are frustrated by his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have in rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy’s sleep disorder? (Points : 2)

Delayed sleep phase syndrome (DSPS)

Non–24-hour sleep–wake syndrome

Advanced sleep phase syndrome (ASPS)

Chronic insomnia

Question 14. 14. Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto thyroiditis. In light of this diagnosis, which of the following assessment results would constitute an unexpected finding? (Points : 2)

The presence of myxedema in the woman’s face and extremities

Recent weight gain despite a loss of appetite and chronic fatigue

Coarse, dry skin and hair with decreased sweat production

Increased white cell count and audible crackles on chest auscultation

Question 15. 15. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? (Points : 2)

The inner layer (archilayer)

The middle layer (paleolayer)

The outer layer (neolayer)

The reticular formation

Question 16. 16. An 11-year-old boy with skin lesions characteristic of ringworm on his trunk has been brought to the family’s primary care provider by his mother. Which of the following aspects of the clinician’s assessment relates most directly to the suspected diagnosis?

(Points : 2)

Previous infection with other parasitic worms

Potential contact with the fungus from pets or other children

Allergic reactions to drugs and environmental substances

The child’s infanthood immunization history

Question 17. 17. Which of the following women is most likely to have a sexually transmitted infection as a contributing factor to her health problem? (Points : 2)

A 29-year-old woman with a diagnosis of localized vulvodynia

A 40-year-old who is being treated for vaginal cancer

A 32-year-old who is undergoing diagnostics to rule out endometriosis

A 41-year-old with a diagnosis of mucopurulent cervicitis

Question 18. 18. Having heard positive reports of the benefits of HT from her sister-in-law and friends, a 49-year-old woman has presented to her nurse practitioner asking to start HT. Her uterus is intact and previous bone scans have indicated low bone density. The patient also has a family history of heart disease. She characterizes her symptoms of menopause as “noticeable, but not debilitating by any means.” Based on the most current research, what is her nurse practitioner’s best course of action?

(Points : 2)

Begin estrogen-progesterone HT (EPT) to prevent future menopausal symptoms and coronary heart disease (CHD)

Forgo HT in light of her preexisting low bone density and consequent risk of osteoporosis

Forgo HT but consider alternative therapies and reevaluate if her symptoms significantly affect her quality of life

Begin low-dose HT but perform regular breast cancer screening and heart health checks

Question 19. 19. A 41-year-old woman has been diagnosed as having a loose body of cartilage in her left knee. What data would be most likely to lead clinicians to this conclusion? (Points : 2)

A visible hematoma is present on the anterior portion of the knee.

The woman experiences intermittent, painful locking of her joint.

Computed tomography indicates a complete tear of her knee ligament.

An X-ray shows that her femoral head and tibia are no longer articulated.

Question 20. 20. Which of the following situations would be considered pathologic in an otherwise healthy 30-year-old female?

(Points : 2)

The woman’s ovaries are not producing new ova.

The woman’s ovaries do not synthesize or secrete luteinizing hormone (LH).

The epithelium covering the woman’s ovaries is broken during the time of ovulation.

The woman’s ovaries are not producing progesterone.

Question 21. 21. A nurse practitioner is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. Which of the following pharmacologic therapies is most likely to benefit the woman? (Points : 2)

A drug that influences gamma-aminobutyric acid (GABA) levels

A selective serotonin reuptake inhibitor (SSRI)

An antipsychotic medication that blocks dopamine receptors

An epinephrine and norepinephrine supplement

Question 22. 22. Following exposure to poison oak while camping, a 20-year-old male is experiencing pruritus as a consequence of his immune response to irritants in the plant. What physiologic process best accounts for his complaint? (Points : 2)

His body is communicating a low-level pain response as a protective measure.

Free nerve endings are initiating an itch-specific signal to the somatosensory cortex.

Local irritation of Langerhans cells is sending signals by way of myelinated type C nerve fibers.

Ruffini corpuscles are transmitting the message of pruritis to the cerebral cortex.

Question 23. 23. A care aide at a long-term care facility has informed a resident’s nurse practitioner that the 80-year-old woman’s eyes appear to be inflamed and her eyelids are caked with sticky secretions. The woman subsequently has been diagnosed with posterior blepharitis. Which of the following treatments is the nurse practitioner likely to initiate? (Points : 2)

Surgical repair of the woman’s blocked meibomian glands

Warm compresses to be applied regularly to her eyes in addition to oral antibiotics

Regularly scheduled cleansing of the woman’s eyes with normal saline

Intravenous steroids coupled with topical antibiotic ointment

Question 24. 24. Which of the following conditions usually improves when a woman is taking oral contraceptives?

(Points : 2)

Human Papillomavirus infection

Migraine headaches

Iron deficiency anemia

Herpes simplex virus

Question 25. 25. Which of the following patients on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure? (Points : 2)

A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas

A 50-year-old woman with blood pressure of 189/103, jaundice, and multiple thromboses

A 68-year-old female patient with sudden onset of confusion, a history of alcohol abuse, and low levels of serum AST and ALT

A 55-year-old man with ascites, fever, and recent onset of atrial fibrillation

Question 26. 26. A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis? (Points : 2)

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 27. 27. What is stiffness or fixation of a joint called? (Points : 2)

Contracture

Ankylosis

Dislocation

Subluxation

Question 28. 28. The father of an 18-month-old girl noticed a small vesicle on her face several days ago. The lesion ruptured and left a straw-colored crust that remained on the girl’s face. The eruption of new vesicles has prompted him to bring the child to the emergency department. Which of the following treatments for the child’s skin problem is most likely?

(Points : 2)

A topical antifungal ointment

An oral corticosteroid

An antiviral ointment

A topical antibiotic

Question 29. 29. 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? (Points : 2)

The brain stem

The thalamus

The temporal and parietal cortex

The limbic system of the cerebrum

Question 30. 30. Long, stretchy cervical mucus that exhibits ferning on a microscope slide is characteristic of which of the following? (Points : 2)

High LH levels

Low estrogen levels

High progesterone levels

Low human chorionic gonadotropin levels

Question 31. 31. During a late-night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system has the highest level of control over her arm and hand action? (Points : 2)

Cerebelum

Thalamus

Basal ganglia

Frontal lobe

Question 32. 32. A 40-year-old woman has been found to have a deficiency in estrogen. Which of the following physiological phenomena is most likely to remain unaffected? (Points : 2)

Parathyroid hormone antagonism and the rate of bone resorption

The regulation of uterine endothelial development

The maintenance of normal skin and blood vessel structure

The synthesis and release of adrenal glucocorticoids

Question 33. 33. A 24-year-old woman has presented to an inner-city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman’s most likely treatment and prognosis?

(Points : 2)

Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy.

Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease.

Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection.

Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.

Question 34. 34. 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? (Points : 2)

Romberg test

Rotational tests

Electronystagmography (ENG)

Caloric stimulation

Question 35. 35. A nurse practitioner is providing care for a male patient with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias? (Points : 2)

Paraesophageal hiatal hernias are common and are normally not treated if the patient is asymptomatic.

The root causes of hiatal hernias are normally treatable with medication.

If esophageal acid clearance is impaired, esophagitis can result.

An incompetent pyloric sphincter and high fat diet are commonly implicated in the development of hiatal hernias.

Question 36. 36. A patient with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? (Points : 2)

“Fewer neurons in your brain are firing when you’re asleep, but they’re more synchronized than when you’re awake.”

“While you’re obviously less aware of stimuli when you’re asleep, your brain is actually more active when you’re asleep than when you’re awake.”

“There are four types of brain activity, and actually all of them occur at different stages of sleep.”

“Your brain alternates between periods of activity and periods of inactivity when you’re asleep, and these correspond to your eye movement.”

Question 37. 37. While being tackled, a 20-year-old football player put out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen and had a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment? (Points : 2)

“This strain will likely resolve itself with sufficient rest.”

“You’ve suffered a severe sprain and you might need a cast.”

“Your wrist contusion will have to be observed for bleeding under the skin surface.”

“It looks like a mild to moderate sprain and you’ll need to keep it immobilized for a few weeks.”

Question 38. 38. A 71-year-old male has been recently diagnosed with a stage III tumor of colorectal cancer and is attempting to increase his knowledge about his diagnosis. Which of the following statements about colorectal cancer demonstrates a sound understanding of the disease? (Points : 2)

“If accurate screening tests for this type of cancer existed, it could likely have been caught earlier.”

“The NSAIDs and aspirin that I’ve been taking for many years probably contributed to my getting cancer.”

“While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown.”

“A large majority of patients who have my type of colon cancer survive to live many more years.”

Question 39. 39. As a result of oral ingestion of the microorganisms, an individual has contracted H. pylori. Which of the following health problems is the individual now at increased risk for? (Points : 2)

Inflammatory bowel disease (IBD)

Gastric adenocarcinoma

Gastric atrophy

Peptic ulcer

Esophagitis

Diverticular disease

Question 40. 40. Which of the following statements best captures an aspect of normal spermatogenesis? (Points : 2)

Testosterone chemically lyses each primary spermatocyte into two secondary spermatocytes with 23 chromosomes each.

Sertoli cells differentiate into spermatids, each of which can contribute half of the chromosomes necessary for reproduction.

Spermatogonia adjacent to the tubular wall undergo meiotic division and provide a continuous source of new germinal cells.

Each primary spermatocyte undergoes two nuclear divisions, yielding four cells with 23 chromosomes each.

Question 41. 41. David has an acute exacerbation of Crohn’s disease. Which of the following lab tests  would you expect to be decreased? (Points : 2)

Sedimenatation rate

Liver enzyme levels

Vitamins A, B complex and C levels

Bilirubin level

Question 42. 42. Which of the following patients is most clearly displaying the signs and symptoms of IBD? (Points : 2)

A 32-year-old mother who complains of intermittent abdominal pain that persists even after defecation.

A 51-year-old male who states that his stomach pain is in his lower abdomen, “comes and goes,” and “feels more like a cramp than a dull ache.”

A 44-year-old man who is under great financial stress and who states that his lower abdominal pain is much worse at night than during the day.

A 24-year-old man who has a stressful job but whose diarrhea and cramping do not worsen during periods of high stress.

Question 43. 43. The mother of a 19-week-old infant has brought her baby to a nurse practitioner for assessment because of the baby’s persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child’s mother is anxious to know what caused the disease. Which of the following aspects of the etiology of celiac disease would underlie the explanation that the nurse practitioner provides?

(Points : 2)

Bacterial or chemical invasion of the peritoneum leads to decreased nutrient absorption and transport.

An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response.

Neurogenic or muscular inhibition of peristalsis results in inappropriate motility of ingested food in the lower small intestine and the colon.

Inability to process or absorb the fat content of breast milk results in malnutrition and deficiency of fat-soluble vitamins.

Question 44. 44. Which of the following individuals is likely to have the highest risk of developing tuberculosis osteomyelitis?

(Points : 2)

A 55-year-old female who is in renal failure secondary to poorly controlled type 1 diabetes

A 79-year-old man who is immunocompromised following a bone marrow transplant

A 30-year-old man who has undergone open reduction and internal fixation of his fractured tibia

A 68-year-old woman who had a laminectomy 4 days prior for treatment of her chronic back pain

Question 45. 45. While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include a temperature of 38.8°C (101.8°F), blood pressure of 89/48 mm Hg, and heart rate of 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which of the following diagnoses would the care team first suspect? (Points : 2)

Hepatitis C

Cholecystitis

Liver cirrhosis

Acute pancreatitis