MN551 – Quiz 7 Pathophysiology across the life span
Question 1. 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 2. Which
of the following statements best captures the role of the adrenal cortex in maintaining homeostasis?
The adrenal cortex is
responsible for the production of epinephrine and norepinephrine, which are
part of the sympathetic nervous system.
The adrenal cortical hormones are primarily
steroids and sex hormones.
Redundant, secondary production of adrenal
cortical hormones can compensate for the loss of the adrenal glands.
Normal sexual function is dependent on
adequate adrenal cortical function.
Question 3. 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 / spongy
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 4. 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 5. 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 6. 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 7. 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 8. 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 9. 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 10. 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 11. 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 12. 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 13. 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
Question14. Which
of the following statements best captures an aspect of the role of hormones in the body?
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.
Question15. 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 16. 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
The
actions of insulin are threefold: (1) it promotes
glucose uptake by target cells and provides for glucose storage as
glycogen; (2) it prevents fat and glycogen breakdown; and (3) it inhibits
gluconeogenesis and increases protein synthesis. Insulin acts to promote fat
storage by increasing the transport of glucose into fat cells. It also facilitates triglyceride synthesis from
glucose in fat cells and inhibits the intracellular breakdown of stored
triglycerides. Insulin also inhibits
protein breakdown. It does not directly influence the metabolic needs of
body cells
Question 17. 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.
Queston 26 Following a long
history of faTgue, weakness, and poor
appeTte, a 39-year-old male has been diagnosed with hypopituitarism. Which
of the following clinical Fndings would most likely cause his care team to
suspect that the man has an addiTonal endocrine disorder from a diµerent
source?
Queston 27 Which of the following best describes the
half-life of a highly protein-bound drug
such as thyroxine (99% protein bound)? ²he half-life would be
Queston 28 A 21-year-old female is suspected
of having inadequate funcTon 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?
Question 29 Following the identification of low
blood levels of corTisol and low 24-hour urinary free corTsol, a 51-year-old female client has been diagnosed with a
primary adrenal corTtcal insufficiency. Which of the following health
consequences would be a³ributable to her low levels of corTsol?
Queston 30 A medical student is scheduled
to undergo a clinical exam of his assessment
skills under the supervision of the a³ending physician. As a result of this
stressor, the student has high serum levels of glucocorTcoid hormones such as corTsol. Which of the following
statements best captures an aspect of the role o± glucocorTcoid hormones such
as corTsol in the physiological response to stress?
Queston 31 Following a meal, a woman's blood glucose level has increased. In
addition, her pancreas has increased the amount of insulin produced and
released. Which of the following phenomena has occurred?
Queston
32 Since steroid hormones are bound to protein carriers for transport, this
means:
Queston 33 Which of the following statements best
captures an aspect of the ±uncTon of the hypothalamic –pituitary– adrenal (HPA)
system?
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) A positive feedback cycle ensures that
stable levels of hormones exist in the body over time.
B)
With input from various sensors, hormone production and release are adjusted
based on existing hormone levels.
C)
The hypothalamus ensures that hormone levels correspond accurately to the
diurnal cycle.
D)
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
13. 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?
A)Suppression
test
B)Radioimmunoassay
(RIA) test
C)Stimulation
test
D)Metabolite
excretion test
14. Following a meal, a woman's blood glucose level has increased. In addition, her
pancreas has increased the amount of insulin produced and released. Which of
the following phenomena has occurred?
A)
Increased hormone level according to a negative feedback mechanism
B)
Adjustment according to the level of the substance a hormone regulates
C)Hormone
production and release via the positive feedback cycle
D)Hypothalamic–pituitary
control of hormone levels
15.Whichof the following statements best captures the
relationship between the hypothalamus
and the pituitary gland as it relates to endocrine function?
A)
The hypothalamus directly measures the levels of most hormones throughout the
body and inhibits or stimulates the pituitary accordingly.
B)
The pituitary gland coordinates and dictates the release of hormones from the
hypothalamus that act on their intended target cells.
C)
The pituitary gland and hypothalamus have two-way communication that mediates
the signals from neuronal inputs.
D)The hypothalamus receives input from
numerous sources throughout the body and directs the pituitary to then control
many target glands and cells.
8. An
endocrinologist is providing care for a 30-year-old
male who has lived with the effects of increased
levels of growth hormone (GH). Which of the following teaching points about
the client's future health risks is most accurate?
A)“It's
not unusual for high GH levels to cause damage to your hypothalamus.”
B)“GH
excess inhibits your pancreas from producing enough insulin.”
C)“The
high levels of GH that circulate in your body can result in damage to your
liver.”
D)“When
your pituitary gland is enlarged, there's a real risk that you'll develop some
sight deficiencies.”
Question 1.1.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 2.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 3.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 4.What does a high level of thyroid-stimulating hormone indicate?
Hypothyroidism
Myxedema
Hyperthyroidism
Thyroid
nodule
5. 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?
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
6. 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
Question 7. 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?
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 8.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 9. 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 10.
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 11.
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
12. Which of the
following hormones are derivatives of
cholesterol?
Epinephrine
and norepinephrine
Insulin
and glucagon
Aldosterone
and testosterone
Eicosanoids
and retinoids
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. 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? (Points : 0.4)
Romberg
test
Rotational
tests
Electronystagmography
(ENG)
Caloric
stimulation
Question 15. 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? (Points : 0.4)
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. 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? (Points : 0.4)
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. 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. 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? (Points : 0.4)
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. 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. 20.Which of the following hormones are derivatives of
cholesterol? (Points : 0.4)
Epinephrine
and norepinephrine
Insulin
and glucagon
Aldosterone
and testosterone
Eicosanoids
and retinoids
Question 21. 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. 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? (Points : 0.4)
“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. 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. 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? (Points
: 0.4)
“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 mean time 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. 25.
Which of the following statements best describes an aspect of the normal
process of glucose metabolism? (Points : 0.4)
a.
Blood glucose levels are primarily a
result of the timing, quantity, and character of food intake.
b.
Ingested glucose that is not needed for
cellular metabolism circulates in the blood until it is taken up to meet
cellular needs.
c.Blood
glucose levels are kept in a steady state by selective excretion and reuptake
by the kidneys.
d.Glucose that exceeds metabolic needs is
converted and stored by the liver.
A
45 yo woman with a diagnosis of shingles is experiencing an acute onset of
severe neuropathic pain. Which state of Selye’s characterization of stress
response is the woman most likely experiencing at the moment ?
A
30 yo woman has sought care because of her
recurrent photophobia, tearing and
eye irritation. During assessment, her care provider asks about any history
of cold sores or genital herpes. What is the rationale for the care provider’s
line of questioning?
B)
HSV infection of the cornea is a common cause of corneal ulceration and
blindness.
Which
of the following statements best captures the role of the adrenal cortex in maintaining homeostasis?
B) The adrenal cortical hormones are primarily
steroids and sex hormones.
