MN551 – Quiz 7 Pathophysiology across the life span
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)---- Reflux via the eustachian
tubes, IgG deficiency, and exposure to RSV have all been implicated in the development of AOM.
Cerumen accumulation in the outer ear, deficient IgM, and sensorineural deficits are unlikely to
contribute to AOM.
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. ---The adrenal cortex is responsible for secreting three types of hormones: the
glucocorticoids, the mineralocorticoids, and the adrenal androgens. The adrenal medulla produces
epinephrine and norepinephrine, and there are no alternate production sites for adrenal cortical hormones.
The adrenal androgens are least responsible for normal sexual function .
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 / spongy bone has been formed around her stapes and
oval window. Otosclerosis begins with resorption of bone in one or more foci. During active bone
resorption, the bone structure appears spongy and softer than normal (i.e., osteospongiosis). The resorbed
bone is replaced by an overgrowth of new, hard, sclerotic bone. Distortion of neural pathways, resorption
of the temporal bone, and filling of the tympanic cavity do not occur with otosclerosis.
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.” Type 1A, or immune-
mediated, diabetes involves the autoimmune destruction of pancreatic beta cells and a consequent
absolute lack of insulin. Exogenous insulin required as dietary control alone is insufficient. The central
problem is an absolute lack of insulin production rather than deranged release.
“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. GH excess is associated
with tumor formation and consequent compression of cranial nerves responsible for vision. Damage to the
hypothalamus and liver is not common sequelae. While the beta cells of the pancreas can "burn out," the
primary effect of excess GH is to increase insulin secretion.
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. Low platelets and low hemoglobin are unlikely to be a manifestation
of hypopituitarism. A low sperm count, small stature, and hypothyroidism are all noted manifestations of
pituitary hypofunction.
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?” Conductive hearing loss occurs when auditory stimuli are not adequately transmitted through
the auditory canal, tympanic membrane, middle ear, or ossicle chain to the inner ear. It can be a temporary
loss from impacted cerumen. Sensorineural hearing loss occurs with disorders that affect the inner ear,
auditory nerve, or auditory pathways to the brain. Numerous drugs have ototoxic potential, a consequence
of which is sensorineural hearing loss. The onset and course of hearing loss and the presence or absence
of tinnitus do not necessarily help to differentiate between conductive and sensorineural hearing loss. The
subjective effect of the client's hearing loss, while a valid concern, does not help with the differential
diagnosis.
“What effect is this hearing loss having on
your quality of life?”
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)---- Reflux via the eustachian
tubes, IgG deficiency, and exposure to RSV have all been implicated in the development of AOM.
Cerumen accumulation in the outer ear, deficient IgM, and sensorineural deficits are unlikely to
contribute to AOM.
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. ---The adrenal cortex is responsible for secreting three types of hormones: the
glucocorticoids, the mineralocorticoids, and the adrenal androgens. The adrenal medulla produces
epinephrine and norepinephrine, and there are no alternate production sites for adrenal cortical hormones.
The adrenal androgens are least responsible for normal sexual function .
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 / spongy bone has been formed around her stapes and
oval window. Otosclerosis begins with resorption of bone in one or more foci. During active bone
resorption, the bone structure appears spongy and softer than normal (i.e., osteospongiosis). The resorbed
bone is replaced by an overgrowth of new, hard, sclerotic bone. Distortion of neural pathways, resorption
of the temporal bone, and filling of the tympanic cavity do not occur with otosclerosis.
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.” Type 1A, or immune-
mediated, diabetes involves the autoimmune destruction of pancreatic beta cells and a consequent
absolute lack of insulin. Exogenous insulin required as dietary control alone is insufficient. The central
problem is an absolute lack of insulin production rather than deranged release.
“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. GH excess is associated
with tumor formation and consequent compression of cranial nerves responsible for vision. Damage to the
hypothalamus and liver is not common sequelae. While the beta cells of the pancreas can "burn out," the
primary effect of excess GH is to increase insulin secretion.
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. Low platelets and low hemoglobin are unlikely to be a manifestation
of hypopituitarism. A low sperm count, small stature, and hypothyroidism are all noted manifestations of
pituitary hypofunction.
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?” Conductive hearing loss occurs when auditory stimuli are not adequately transmitted through
the auditory canal, tympanic membrane, middle ear, or ossicle chain to the inner ear. It can be a temporary
loss from impacted cerumen. Sensorineural hearing loss occurs with disorders that affect the inner ear,
auditory nerve, or auditory pathways to the brain. Numerous drugs have ototoxic potential, a consequence
of which is sensorineural hearing loss. The onset and course of hearing loss and the presence or absence
of tinnitus do not necessarily help to differentiate between conductive and sensorineural hearing loss. The
subjective effect of the client's hearing loss, while a valid concern, does not help with the differential
diagnosis.
“What effect is this hearing loss having on
your quality of life?”
