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. 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 3. 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 4. 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 5. 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 6. 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 7. 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 8. 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 9. What does a high level of thyroid-stimulating hormone indicate?
Hypothyroidism
Myxedema
Hyperthyroidism
Thyroid nodule

Question 10. 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 11. A 60-year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?
Administration of 15 to 20 g of glucose in a concentrated carbohydrate source
Administration of subcutaneous glucagon
IV infusion of 50% dextrose and water solution

Careful monitoring for level of consciousness and resolution of hypoglycemia

Question 12. 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 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

Question 14. 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 15. 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 16. Which of the following hormones are derivatives of cholesterol?
Epinephrine and norepinephrine
Insulin and glucagon
Aldosterone and testosterone
Eicosanoids and retinoids

Question 17. 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 18. 18. 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 19. 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 20. 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

Question 21. 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 22. 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 23. 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 24. 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

Question 25. 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.