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.