incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles of principlism.
May 16, 2019
QUESTION 2: The Patient Protection and Affordable Care Act (PPACA) of 2010
May 16, 2019

brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep?

Question 2.                

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?

“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 3.                

Which of the following factors is most responsible for the fact that prefrontal lobotomy is no longer a common treatment for mental illness?

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 7.                

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?

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 9.                

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)?

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.




Question 13.              

Which of the following diagnostic findings is likely to result in the most serious brain insult?

Mean arterial blood pressure (MABP) that equals intracranial pressure (ICP)

Moderate increase in brain tissue volume secondary to a brain tumor

Increased ICP accompanied by hyperventilation

High intracellular concentration of glutamate






Question 17.              

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?

“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 19.              

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?

“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 20.              

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?



Basal ganglia

Frontal lobe







Question 21.              

A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood–brain barrier and been transferred from the vascular space into the patient’s interstitial space. Which of the following diagnoses best captures this pathophysiology?


Focal hypoxia

Cytotoxic edema


Vasogenic edema







Question 24.              

A 70-year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult?

Flaccid loss of muscle tone

Difficulty starting movement, stopping movement, and maintaining rhythmic movement

Tremor, rigidity, and bradykinesia

Unsteady gait and difficulty speaking and swallowing


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