1.

One location in which nociceptors can be found is the

A) Spinal cord

B) Skin

C) Efferent pathways

D) Hypothalamus

2.

The system responsible for an individual’s condition or learned approach or avoidance behavior
in response to pain is the

A) Sensory/discriminative system

B) Motivational/affective system

C) Sensory/motivational system

D) Cognitive/evaluative system

3.

Which CNS tract is responsible for carrying sensory information to the brain concerning dull and
burning pain?
 A) Paleospinothalamic

B) Neospinothalamic

C) Archeospinothalamic

D) Reticulospinal

4.

The theory that explains how pricking a finger with a needle provides minimal pain while cutting
the finger with a knife provides more severe pain is the

A) Gate control theory

B) Neuromatrix theory

C) Specificity theory

D) Neuromodulation theory

5.

When a child breaks a leg, which of the following would be released from the midbrain to
modulate her pain?

A) Endorphin

B) Enkephalin

C) Endomorphin
 D) Dynorphin

6.

When a teenager scrapes her knee producing a sharp, well localized pain, which of the following
would most accurately characterize her pain?

A) Chronic pain

B) Referred pain

C) Somatic pain

D) Visceral pain

7.

Regulation of body temperature occurs primarily in the

A) Cerebrum

B) Brain stem

C) Pituitary gland

D) Hypothalamus

8.
One of the primary organs responsible for heat production is the

A) Adrenal gland

B) Liver

C) Heart

D) Pancreas

9.

Heat loss from the body by convection occurs by

A) Emanations of electromagnetic waves

B) Transfer of heat through currents of liquids and gas

C) Dilations of blood vessels bringing blood to skin surfaces

D) Direct heat loss from molecule to molecule transfer

10.

For evaporation to function effectively to dissipate heat, which one of the following conditions
must be present?

A) Moisture

B) dryness
 C) Pyrogens

D) Low altitude

11.

Exogenous pyrogens are

A) Interleukins

B) Endotoxins

C) Prostaglandins

D) Cytokines

12.

Which sleep phase shows EEG patterns with brain activity similar to the normal awake pattern?

A) Non-REM

B) Fast wave

C) REM

D) Delta wave

13.
Most dreams occur during

A) Non-REM sleep

B) Alpha wave sleep

C) REM sleep

D) Delta wave sleep

14.

Loss of temperature control occurs in

A) Non-REM sleep

B) Light sleep

C) REM sleep

D) Delta wave sleep

15.

A man who snores and is not sleeping well probably has

A) Insomnia

B) Obstructive sleep apnea

 C) Somnambulism

D) Jet-lag syndrome

16.

Which disease is associated with increased intraocular pressure?

A) Glaucoma

B) Ocular degeneration

C) Diplopia

D) Presbyopia

17.

A 70 year old with hypertension and a history of cigarette smoking for 50 years is at risk for
visual loss related to

A) Presbyopia

B) Astigmatism

C) Macular degeneration

D) Amblyopia
18.

Red-green color blindness occurs most often in

A) Males

B) Females

C) Elderly persons

D) Children

19.

Which structure connects the middle ear with the pharynx?

A) Organ of Corti

B) Eustachian tube

C) Semicircular canal

D) Auditory canal

20.

The most common form of sensorineural hearing loss in the elderly is

A) Conductive hearing loss

 B) Acute otitis media

C) Presbycusis

D) Meniere disease

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Unit 5B
Objectives
Upon completion of this Module the learner will be able to:

1. Explain the etiology, risk factors, pathophysiology, and clinical manifestations of selected
reproductive problems.
2. Diagnose reproductive problems based on clinical manifestations.

3. Explain the etiology, pathophysiology, and clinical manifestations of selected gastrointestinal

problems in adults and children.
4. Diagnose gastrointestinal problems based on clinical manifestations in adults and children.

5. Explain the etiology, pathophysiology, and clinical manifestations of selected musculoskeletal

problems.
6. Diagnose musculoskeletal problems based on clinical manifestations.
Let's Talk
Colon cancer is a silent disease until it has caused significant damage. Consequently, the American Cancer
Society has recommended screening colonoscopy for adults age 60 and older. Lieberman, et al (2008)
discovered that screening colonoscopy among asymptomatic patients was most likely to reveal cancer
precursor lesions (polyps) among Black patients than in White patients.
There are also racial risks associated with gastric cancer. The highest incidence of gastric cancer occurs in
Japan, China, Chile, Finland, and Iceland (Gorol l & Mulley, 2006, p. 413). This increased incidence is
somewhat explained by the higher incidence of H. pylori and the host response to this bacteria in those
regions. Gastric cancer is more likely to occur in men and 60% of cases occur in people older than 65 years.
In the United States, gastric cancer is twice as likely to affect non-whites and people of low socioeconomic
status. It is also more likely to affect persons with blood type A and B as compared to persons with blood
type O (Goroll & Mulley, 2006, p. 413).
Chronic liver disease is also more likely to occur among persons of color. Flores, et al (2008) reported that
in the large population they studied, Mexican Americans and Blacks had a greater risk of developing liver
disease than their White counterparts.
Prostate cancer is another disease where incidence increases with age. Men older than 70 have a 40%
higher risk of prostate cancer. African American men have a three- fold higher incidence of prostate cancer
than do White men. Other risk factors include: father or brother with the disease and high fat diet –
especially red meat (Barry, 2006).
Osteoporosis is a common bone disorder of the aged. Other risk factors include: Body Mass Index below the
25 th percentile; female; maternal history of fracture; personal history of fracture in adulthood; cigarette
smoking; White race; inadequate intake of calcium, inadequate physical activity; early menopause; and,
excessive intake of alcohol (Goroll & Mulley, 2006, p. 939).
Open-angle glaucoma is the second leading cause of legal blindness in the United States. It is the leading
cause of legal blindness among African Americans. Risk factors include elevated intraocular pressure, age,
African descent, family history, myopia, diabetes, and vasospasm (as in migraine) (Richter, 2006).

Let's Talk References

Barry, M. (2006). Screening for prostate cancer. In Goroll, A. & Mulley, A., Primary Care Medicine. (5 th ed.)
(pp. 852-856). Philadelphia: Lippincott Williams & Wilkins.
Flores, Y.; Yee, H.; Leng, M.; Escarce, J.; Bastani, R.; Salmeron, J.; Morales, L. (2008). Risk factors for
chronic liver disease in Blacks, Mexican Americans and Whites in the United States: results from
NHANES IV 1999-2004. American Journal of Gastroenterology, 103(9):2231-2238.
Goroll, A. & Mulley, A. (2006). Primary Care Medicine. (5 th ed.) Philadelphia: Lippincott Williams & Wilkins.
Lieberman, D.; Holub, J.; Moravec, M.; et al. (2008). Prevalence of colon polyps detected by colonoscopy
screening in asymptomatic Black and White patients. JAMA, 300(12): 1417-1422.
Richter, C. (2006). Screening for open-angle glaucoma. In Goroll, A. & Mulley, A. Primary Care Medicine. (5
th ed.) Philadelphia: Lippincott Williams & Wilkins.

Required Reading
Click here for the Required Readings

Study Guide
Chapter 34 Alterations in Gastrointestinal Function and Chapter 35 Alterations in Gastrointestinal
Function in Children
To Watch the Video on Viral Hepatitis ABCDE, please go to the Video Folder
Click here for the downloadable version ViralHepatitisABCDE.pdf

1. Match the following: Chapter 34 Matching

2. Describe each of the different types of diarrhea.
3. List the potential causes of abdominal pain.
4. Differentiate parietal, visceral and referred pain.
 5. Differentiate upper and lower gastrointestinal bleeding.

6. Describe the etiology, pathophysiology and clinical manifestations of gastroesophageal reflux, hiatal
hernia, pyloric obstruction, intestinal obstruction, gastritis, peptic ulcer disease, gastric
resection, ulcerative colitis, Crohn disease, diverticular disease, appendicitis, irritable bowel
syndrome, obesity, anorexia nervosa, bullemia, jaundice, viral hepatitis, cholelithiasis, cholecystitis,
acute pancreatitis, cleft lip and palate, pyloric stenosis, intestinal malrotation, Meckel diverticulum,
intussusceptions, GER in children, esophageal and biliary atresia, and neonatal jaundice.
7. List the risk factors for gastric cancer. (Let's Talk)
Chapter 32 Alterations in Reproductive Systems, Including Sexually Transmitted Infections
To watch the video on Reproductive Systems, please go to the Video Folder
Click here for the downloadable pdf of this presentation. ReproductiveMod5.pdf

1. Complete the crossword puzzle: Chapter 32 Matching

2. Describe the etiology, pathophysiology and clinical manifestations of dysmenorrheal, primary and
secondary amenorrhea, abnormal uterine bleeding, polycystic ovary syndrome, premenstrual
syndrome, pelvic inflammatory disease, leiomyomas, endometriosis, and galactorrhea.

3. What is a dermoid cyst?

4. Differentiate cystocele, urethrocele, rectocele, enterocele, and uterine prolapse.

5. Describe the etiology, pathophysiology and clinical manifestations of epididymitis, benign prostatic
hyperplasia, prostatitis.

6. Differentiate non-proliferative breast lesions and proliferative breast lesions, with and without
atypia.
7. What are the clinical manifestations of breast cancer? (p. 896)
8. List the risk factors for prostate cancer. (Let's Talk)
9. Recite the causative organisms for all the sexually transmitted infections.
Chapter 37 Alterations in Musculoskeletal Function
To Watch the Video on BGIMS, Please go to the Video Folder
Click here for the downloadable pdf Mod5UnitBGIMS.pdf

1. Watch the following: Chapter 37 Matching

2. Discuss the incidence of musculoskeletal injury according to age, gender and location of injury.
3. Recite all possible types of fracture.

4. Explain the pathophysiologyof broken bone and the healing process; dislocations and subluxations;
sprains and strains.
5. List the clinical manifestations of broken bone, dislocations, sprains and strains.

6. Discuss the etiology, pathophysiology and clinical manifestations of tendonitis, epicondylitis,

bursitis, muscle strains, osteoporosis, osteomyelitis, osteoarthritis, rheumatoid arthritis, ankylosing
spondylitis, gout, and fibromyalgia.
7. List the risk factors for osteoporosis, including age, gender and race.

Let's Practice
1. Providers who prescribe glucocorticoids should understand the bone changes that may occur in
response to this drug. What is the action of glucocorticoids that will induce osteoporosis?
2. The NP will recommend Vitamin D to her patients at risk for falls and fracture because vitamin D has
been correlated with _______ in clinical research.

3. If a patient asks about glucosamine and chondroitin for osteoarthritis discomfort, what will you
reply?
4. You have decided to do a laboratory test for rheumatoid arthritis because your patient has
symmetrical stiffness in her hands, wrists and elbows. What laboratory test will establish the
diagnosis and what does it measure?