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 earA deficiency in immunoglobulin GAccumulation of cerumen in the external acoustic meatusSensorineural deficits in the auditory control apparatusExposure 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 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 testRotational testsElectronystagmography (ENG)Caloric stimulationQuestion 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 releaseInadequate synthesis in the rough endoplasmic reticulum of her ovarian cellsInsufficient estrogen production within the smooth endoplasmic reticulum of the relevant cellsA lack of prohormone precursors needed for estrogen synthesis and releaseQuestion 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 conjunctivitisKeratitisCorneal traumaAngle-closure glaucomaQuestion 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 stemThe thalamusThe temporal and parietal cortexThe limbic system of the cerebrumQuestion14. 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.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.”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 musclesPromoting the breakdown of stored triglyceridesFacilitating triglycerides from glucose in fat cellsInhibiting protein breakdownPromoting glucose uptake by target cellsQuestion 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.