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    Exam Review

    1. A 50-year-old female with Graves disease will most likely have which one of the following symptoms?
      A)
      Hypotension
      B)
      Loss of vision, infertility, hirsutism (facial hair)
      C)
      Pale complexion, cold intolerance, lethargy
      D)
      Tremor, heat intolerance, increased appetite
    2. Lack of thyroid hormone in an infant (congenital hypothyroidism) is associated with growth and mental retardation. Name this condition:
      A)
      Cretinism
      B)
      Edward syndrome
      C)
      Exophthalmic goiter
      D)
      Pituitary dwarfism
      E)
      Stein-Leventhal syndrome
    3. A 54-year-old woman dies 48 hours after suffering severe head injuries in an automobile accident. Just before her death, her left pupil became fixed and dilated (oculomotor nerve palsy). Which of the following contributed the most to this patients death?
      A)
      Diffuse axonal shearing
      B)
      Laminar distribution of cerebral necrosis
      C)
      Rupture of congenital berry aneurysm
      D)
      Transtentorial herniation
      E)
      Watershed pattern of cerebral infarction
    4. A 40-year-old woman noted a "swelling" on the anterior side of her lower neck. She had no other symptoms. Which of the following is the most likely diagnosis?
      A)
      Adenocarcinoma
      B)
      Goiter
      C)
      Hashimoto thyroiditis
      D)
      Thyrotoxicosis
    Page 1 of 13

    Exam Review

    1. This is a common disease of the endocrine pancreas that is associated with aging, lack of exercise, and obesity:
      A)
      Diabetes insipidus
      B)
      Diabetes mellitus type I
      C)
      Diabetes mellitus type II
      D)
      Pancreatic adenocarcinoma
    2. A 50-year-old man who is obese has an elevated blood glucose level. A glucose tolerance test in the office shows hyperglycemia. Which of the following is the most likely mechanism in the pathogenesis of hyperglycemia and diabetes in this patient?
      A)
      Excess dietary sugar
      B)
      Glucagonoma
      C)
      Increased insulin secretion
      D)
      Islet cell destruction
      E)
      Peripheral insulin resistance
    3. A 70-year-old man has a history of difficulty walking. On examination, the patient appears stiff and stooped, shows an expressionless face, and speaks in a monotonous voice. A tremor of his fingers is apparent, but ceases when he tries to reach for something. The patient dies 10 years later. At autopsy, the substantia nigra of the patient demonstrates reduced pigmentation. This pathologic finding was associated with reduced secretion of which of the following neurotransmitters?
      A)
      Acetylcholine
      B)
      Dopamine
      C)
      Gamma aminobutyric acid
      D)
      Norepinephrine
    4. A 55-year-old patient presents with progressive weakness, sensory loss, and impaired motor coordination. MRI findings demonstrate patchy areas of demyelination within the brainstem and cervical spinal cord, while nerve conduction studies also reveal delayed impulse transmission in peripheral nerves. The provider suspects a disorder affecting myelin integrity at the transition zones between the central and peripheral nervous systems. Which explanation best integrates the underlying pathophysiologic mechanism contributing to this patient's neurologic findings?
      A)
      Defective neurotransmitter release at synaptic junctions results in impaired axonal signaling in both the CNS and PNS.
      B)
      Autoimmune destruction of axons selectively disrupts nerve impulse conduction distal to the neuromuscular junction.
      C)
      Disruption of myelin structure and metabolism produced by oligodendrocytes and Schwann cells leads to impaired conduction at central-peripheral nervous system transition zones.
      D)
      Primary neuronal cell body degeneration within the spinal cord causes secondary inflammation at peripheral nerves.
    Page 2 of 13

    Exam Review

    1. A 8-year-old girl with a history of chronic otitis media develops a cystic lesion in the temporal lobe of her brain. What is the most likely diagnosis?
      A)
      Bacterial meningitis
      B)
      Brain abscess
      C)
      Glioblastoma
      D)
      Viral meningitis
      E)
      Transtentorial herniation
    2. A 50-year-old woman is brought to the emergency room complaining that she has the "worst headache" of her life. The patient is diagnosed with a subarachnoid hemorrhage. Imaging reveals a saccular (berry) aneurysm. Which of the following is the most likely anatomic location of the aneurysm in this patient?
      A)
      Circle of Willis
      B)
      Internal carotid artery
      C)
      Middle meningeal artery
      D)
      Striate artery
      E)
      Vertebral artery
    3. Examination of the brain at autopsy reveals a watershed pattern of cerebral infarction. The patient was unconscious for 2 days before he expired. Which of the following best describes the pathogenesis of this cerebral infarction?
      A)
      Disseminated intravascular coagulation
      B)
      Prolonged hypotension
      C)
      Sagittal sinus thrombosis
      D)
      Spontaneous cerebral hemorrhage
      E)
      Thromboembolism
    4. A 36-year-old woman complains of dull pelvic pain for 9 months that is accentuated during menstruation. Physical examination and endocrinological studies are normal. Laparoscopy reveals multiple, small hemorrhagic lesions over the surface of both ovaries and fallopian tubes and abundant pelvic scarring. Which of the following is the most likely diagnosis?
      A)
      Adenomyosis
      B)
      Ectopic pregnancy
      C)
      Endometriosis
      D)
      Ovarian cyst
      E)
      Pelvic inflammatory disease
    Page 3 of 13

    Exam Review

    1. A 65-year-old woman presents with a 3-week history of intractable headaches. Her vital signs and CBC are normal. Two weeks later the patient develops left-sided hemiparesis. MRI reveals a large, necrotic tumor in the right hemisphere of the cerebrum, extending across the corpus callosum into the left hemisphere. This highly malignant tumor is most likely derived from which of the following cells?
      A)
      Ependymal lining cells
      B)
      Microglial cells
      C)
      Astrocytes
      D)
      Oligodendrocytes
      E)
      Neurons
    2. A 53-year-old woman discovers a lump in her breast. Physical examination confirms a mass about 1 cm in diameter in the outer quadrant of the left breast. Mammography reveals an ill-defined, stellate density measuring 1 cm. Fine needle aspiration discloses invasive ductal carcinoma. Which of the following is the most important prognostic factor for this patient with breast cancer?
      A)
      Estrogen/progesterone receptor status of tumor
      B)
      Histologic grade of tumor
      C)
      Inherited BRCA1 gene mutation
      D)
      Somatic mutation of p53 tumor suppressor gene
      E)
      Status of her axillary lymph nodes
    3. Injury to which of the following areas of the central nervous system would adversely affect the control of fine movement as well as equilibrium, posture, and motor learning?
      A)
      Cerebellum
      B)
      Frontal lobe
      C)
      Occipital lobe
      D)
      Parietal lobe
      E)
      Temporal lobe
    4. A 5-year-old boy is brought to the emergency room with fever, vomiting, and convulsions. The patient is febrile to 39.5°C (103.1°F). Physical examination reveals cervical rigidity and neck pain. Bacterial infection most likely involves which anatomic region of the child's brain?
      A)
      Choroid plexus
      B)
      Ependyma
      C)
      Hypothalamus
      D)
      Lateral ventricles
      E)
      Leptomeninges (arachnoid and pia)
    Page 4 of 13

    Exam Review

    1. A 48-year-old woman presented with complaints of sweating a lot, feeling hot, and being constantly tired. She had a fast pulse rate and reported feeling constantly hungry. On examination, she was found to have bulging eyes and an enlarged thyroid. What is the diagnosis?
      A)
      Addison disease
      B)
      Conn syndrome
      C)
      Cushing syndrome
      D)
      Goodpasture syndrome
      E)
      Graves disease
    2. Which of the following endocrine disorders is associated with a failure of the adrenal glands to produce sufficient glucocorticoids, mineralocorticoids, and weak androgens?
      A)
      Acromegaly
      B)
      Addison disease
      C)
      Cushing syndrome
      D)
      Graves disease
    3. A 38-year-old patient is diagnosed with a thyroid adenoma that autonomously secretes excessive thyroxine (T4), independent of hypothalamic and pituitary regulation. Despite persistently elevated circulating thyroid hormone levels, the adenoma continues to produce T4. Which physiologic mechanism best explains how this endocrine disorder disrupts normal hormonal regulation and contributes to systemic pathology?
      A)
      Autonomous hormone secretion overrides negative feedback, leading to suppressed TRH and TSH levels while maintaining elevated target hormone concentrations.
      B)
      Loss of negative feedback inhibition causes increased secretion of thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH), further stimulating thyroid hormone production.
      C)
      Excess thyroid hormone enhances sensitivity of pituitary thyrotrophs to TRH, resulting in compensatory increases in TSH secretion.
      D)
      Hypersecretion of thyroid hormone increases end-organ resistance, stabilizing systemic hormone effects despite abnormal feedback signaling.
    4. A 26-year-old woman presents for a routine physical examination and a cervical Pap smear is taken. Exfoliated cervical cells from the exocervix are examined by light microscopy. Which of the following types of epithelial tissue is sampled in this non-invasive diagnostic procedure?
      A)
      Simple cuboidal
      B)
      Simple columnar
      C)
      Simple squamous
      D)
      Stratified squamous
      E)
      Transitional
    Page 5 of 13

    Exam Review

    1. A patient demonstrates well-circumscribed cystic lesions without calcifications or architectural distortion. Breast biopsy shows cyst formation, stromal fibrosis, and apocrine metaplasia, with no epithelial proliferation or atypia. Which statement describes her long-term breast cancer risk?
      A)
      Significantly increased due to underlying epithelial hyperplasia
      B)
      No increased risk compared with women of similar age
      C)
      Moderately increased risk warranting selective estrogen receptor modulator therapy
      D)
      Similar risk to that seen with atypical ductal hyperplasia
    2. Primary hyperparathyroidism (stones, bones, moans, groans) is most commonly caused by which of the following conditions?
      A)
      Hashimoto thyroiditis
      B)
      Nephrolithiasis
      C)
      Parathyroid adenoma
      D)
      Pituitary adenoma
      E)
      Thyroid surgery
    3. The nurse is teaching a patient regarding risk factors for breast cancer. The strongest association with increased risk for breast cancer is which of the following?
      A)
      Age at menopause
      B)
      Body mass index (BMI)
      C)
      Family history
      D)
      Serum levels of estrogen
      E)
      Smoking history
    4. A patient is brought to the emergency room with severe, unremitting watery diarrhea. Which of the following is a tumor in your patient?
      A)
      Adrenal cortical adenoma
      B)
      Ganglioneuroma
      C)
      Pancreatic insulinoma
      D)
      Pheochromocytoma of adrenal medulla
    Page 6 of 13