MN 551 Advanced Pathophysiology Final Exam
Question 1 2 / 2 points
A female neonate has been in respiratory distress since delivery and is unresponsive to oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and tracheoesophageal fistula (EA/TEF). Which of the following explanations should the care team provide to the infant's parents?
“We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally.”
“This problem will require respiratory therapy and supplementary feeding, but it will likely resolve itself over time.”
“The biggest risk that will face your daughter until this is fixed is the danger of malnutrition and dehydration.”
“The priority in our immediate treatment prior to her surgery will be pain management, as the contents of her stomach can burn her lungs.”
Question 2 2 / 2 points
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?
A topical antifungal ointment
An oral corticosteroid
An antiviral ointment
A topical antibiotic
Question 3 2 / 2 points
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 4 2 / 2 points
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?
Question 5 2 / 2 points
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?
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 6 2 / 2 points
A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her?
Peginterferon and ribavirin
Corticosteroids and immunosuppressant drugs
Question 7 2 / 2 points
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?
“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 8 0 / 2 points
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?
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 9 2 / 2 points
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 2 / 2 points
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?
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 11 2 / 2 points
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?
“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 12 2 / 2 points
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?
Question 13 2 / 2 points
A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the patient from infecting others in the future. Which of the following statements by the patient demonstrates the best understanding of his health problem?
“Either me or a partner could end up with an eye infection from chlamydia that could make us blind.”
“Even though I couldn't end up sterile, a woman that I give it to certainly could.”
“Each of the three stages of the disease seems to be worse than the previous one.”
“Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it.”
Question 14 2 / 2 points
A newborn male has been diagnosed with hypospadias following his postpartum assessment by a nurse practitioner. Which of the following diagnostics and treatment options is the nurse practitioner most likely to rule out first?
Question 15 2 / 2 points
A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The patient has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The patient has a 40-pack-year smoking history and uses nebulized bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and a ß-adrenergic blocking medication. During the nurse's assessment, the man notes that he has been unable to maintain his erection in recent months. Which of the following aspects of the man's health problems and treatments would the nurse identify as NOT being contributing to his erectile dysfunction (ED)?
His antihypertensive medications
His use of bronchodilators
His ischemic heart disease
His smoking history
Question 16 2 / 2 points
A 30-year-old 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?
Herpes simplex virus (HSV) conjunctivitis indicates a need for antiviral rather than antibacterial treatment.
HSV infection of the cornea is a common cause of corneal ulceration and blindness.
Chronic viral infection of the eyes can result in HSV autoinoculation of the mouth and labia.
A history of HSV with eye irritation is suggestive of glaucoma.
Question 17 2 / 2 points
A 57-year-old woman who has been diagnosed with atrophic vaginitis has expressed her surprise to her care provider, citing a lifetime largely free of gynecological health problems. She has asked what may have contributed to her problem. How can the care provider best respond?
“The lower levels of estrogen since you've begun menopause make your vagina prone to infection.”
“Vaginitis is not usually the direct result of any single problem, but rather an inevitability of the vaginal dryness that accompanies menopause.”
“This type of vaginitis is most commonly a symptom of a latent sexually transmitted infection that you may have contracted in the distant past.”
“The exact cause of this problem isn't known, but it can usually be resolved with a diet high in probiotic bacteria.”
Question 18 2 / 2 points
After a long and frustrating course of constant vaginal pain, a 38-year-old woman has been diagnosed with generalized vulvodynia by her nurse practitioner. What treatment plan is her nurse practitioner most likely to propose?
Alternative herbal therapies coupled with antifungal medications
Antidepressant and antiepileptic medications
Lifestyle modifications aimed at accommodating and managing neuropathic pain
Narcotic analgesia and nonsteroidal anti-inflammatory medications
Question 19 2 / 2 points
Which of the following statements best conveys an aspect of the process of keratinization?
Keratin cells synthesized in the dermis migrate to the surface over 20 to 30 days.
Mitosis that begins with the cells of the stratum granulosum results in a continual supply of new keratinocytes.
The stratum germinativum continuously produces new keratinocytes to replace losses.
The basal cells of the epidermis migrate to the skin surface at a rate that matches superficial losses of skin cells.
Question 20 2 / 2 points
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?
Ruffini end organs
Free nerve endings
Question 21 2 / 2 points
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?
Delayed sleep phase syndrome (DSPS)
Non–24-hour sleep–wake syndrome
Advanced sleep phase syndrome (ASPS)
Question 22 2 / 2 points
Laparoscopic knee surgery on a 22-year-old basketball player has necessitated entry into the synovial cavity. The surgeon performing the procedure would be aware of which of the following relevant characteristics of synovial tissue?
Synovial tissue has a slow rate of healing compared to muscle tissue.
Damage to synovial tissue is known to be excruciatingly painful.
The synovial membrane lacks direct blood supply, precluding bleeding into the joint.
Few pain receptors are located in the synovial membrane.
Question 23 2 / 2 points
A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?
Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids
A shortage of acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins
Cerebellar lesions; surgical and immunosuppressive treatment
Excess acetylcholinesterase production; treatment with thymectomy
Question 24 0 / 2 points
Which of the following conditions usually improves when a woman is taking oral contraceptives?
Human Papillomavirus infection
Iron deficiency anemia
Herpes simplex virus
Question 25 2 / 2 points
Which of the following diagnostic findings would be a clinician's priority for further investigation and possible medical intervention?
A male patient has elevated levels of serum uric acid but lacks symptoms of gout.
Synovial fluid aspiration indicates the presence of monosodium urate crystals.
A man reveals that he eats organ meat two to three times weekly.
A 55-year-old male reveals that it takes a day or two for oral colchicines to relieve his attacks of gout.
Question 26 2 / 2 points
A pregnant 23-year-old with a diagnosis of herpes simplex virus (HSV) is receiving prenatal care from her nurse practitioner. What is the nurse practitioner most likely to tell the patient about the precautions that will be taken to prevent transmission of the virus to her baby?
“After your caesarean section, it will be safest if you don't breast-feed your child.”
“If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with.”
“A vaginal delivery will be safe as long as you are consistent about taking your vancyclovir.”
“We'll have to book you for a caesarean delivery in order to ensure that your baby isn't exposed to the virus.”
Question 27 2 / 2 points
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?
He was diagnosed with type 2 diabetes eight years ago
Blood pressure that is normally 120/80
The patient is an African American Male
History of sickle cell anemia
Question 28 2 / 2 points
An 18-year-old female of Southeast Asian ancestry is distraught over the recent appearance of white patches on her forearms and upper arms, which subsequently have been confirmed to be vitiligo. Which of the following statements by the woman expresses an accurate understanding of her condition?
“I suppose it's some comfort that my patches are small and will always stay out of sight in the future.”
“I'm thankful that there are medications to cure this, but I'm nervous about the side effects.”
“I suppose this shouldn't come as too much of a surprise, since this tends to run in my family.”
“I'm surprised that I ended up contracting the fungus that caused this problem for me.”
Question 29 2 / 2 points
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 30 2 / 2 points
Which of the following recent admissions to an emergency department is most likely to be diagnosed with a greenstick fracture?
A 20-year-old football player who had an opposing player fall laterally on his leg
An eight-year-old boy who fell out of a tree and on his arm
An 81-year-old woman with a history of osteoporosis who stumbled and fell on her hip
A 32-year-old woman who fell awkwardly on her arm while skiing
Question 31 2 / 2 points
A 14-year-old boy has been brought to the emergency department by his mother in excruciating pain that is radiating from his scrotum to his inguinal area. The boy's heart rate is 122 beats per minute and he vomited twice before arrival at the hospital. Examination reveals that his scrotum is reddened and slightly swollen and the testes are firm to the touch and tender, with extensive cremaster muscle contraction noted. What is the boy's most likely diagnosis?
Question 32 2 / 2 points
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?
Question 33 2 / 2 points
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 34 2 / 2 points
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?
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 35 0 / 2 points
A female patient is suspected of having psoriasis. Which of the following aspects of the woman's history and her care provider's assessment would be potential contributors to her health problem?
The woman takes an angiotensin-converting enzyme inhibitor for the treatment of hypertension.
She has been diagnosed with arthritis.
The woman has a family history of diabetes.
Skin trauma of any kind often precedes an outbreak.
The woman has dark skin.
Question 36 0 / 2 points
A 17-year-old male experienced third-degree, full-thickness burns to his lower limbs after a fire at his workplace 2 days ago. Which of the following complications should his care team NOT foresee and regularly assess for?
Increased cardiac output
Constipation and Bowel obstruction
Question 37 0 / 2 points
An 80-year-old female with a diagnosis of osteoporosis receives daily supplements of calcitonin in the form of a nasal spray that she instills each morning. Which of the following phenomena would her care providers expect to result from her supplementation?
Decreased serum calcium levels
Increased bone resorption
Acceleration of osteoclast action
Increased bone formation
Question 38 2 / 2 points
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 39 2 / 2 points
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)?
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.
Question 40 2 / 2 points
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?
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 41 2 / 2 points
Which of the following statements best captures an aspect of normal spermatogenesis?
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 42 2 / 2 points
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?
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 43 2 / 2 points
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?
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 44 2 / 2 points
A 29-year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What changes in the patient's liver and diagnostic results would the care team most likely anticipate?
Centrilobular necrosis evidenced by increased ALT and AST levels
Allergic inflammation accompanied by an increase in serum IgE and basophils
Cholestatic reaction with increased bilirubin count
Rapid onset of hepatitis and increased GGT, ALT, and bilirubin levels
Question 45 2 / 2 points
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?
“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?”
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