1

A 45-year-old female with a long history of progressive myopia develops sudden patchy loss of vision in her right
eye. She is very alarmed and rushes to her family doctor. Funduscopic examination reveals a large retinal
detachment in the right eye. The retina in the left eye is normal. When the pupillary light reflex is tested by
shining a light in the right eye, the physician would likely note

A. constriction of the right pupil and constriction of the left

B. constriction of the right pupil and dilatation of the left

C. dilatation of the right pupil and constriction of the left

D. dilatation of the right pupil and dilatation of the left

E. no reaction of the right pupil and constriction of the left

Explanation:

The correct answer is D. This patient is exhibiting the Marcus-Gunn phenomenon. When light strikes the retina,
the pupillary light reflex is automatically triggered, leading to simultaneous constriction of both pupils. In the
absence of adequate light entering the eye, for example following retinal detachment or optic neuritis,
paradoxical dilatation of the pupils occurs. The retina receives far less light than it normally would, and the
pupils dilate in order to absorb as much light as possible.

Which of the following hormones is most important in the initiation of gallbladder contraction following a fatty
meal?

A. CCK

B. Gastrin

C. GIP

D. Secretin

E. VIP

Explanation:

The correct answer is A. Cholecystokinin, or CCK, is synthesized in the duodenal and jejunal mucosa and
stimulates gallbladder contraction and pancreatic enzyme secretion. Other functions include slowing of gastric
emptying, an atrophic effect on the pancreas, and secretion of antral somatostatin, which in turn, decreases
gastric acid secretion.

Gastrin (choice B) prepares the stomach and small intestine for food processing, including stimulating secretion
of HCl, histamine, and pepsinogen, increasing gastric blood flow, lower esophageal sphincter tone, and gastric
contractions.

Gastric inhibitory peptide, or GIP (choice C), stimulates pancreatic insulin secretion at physiologic doses and
inhibits gastric acid secretion and gastric motility at pharmacologic doses.

Secretin (choice D) stimulates secretion of bicarbonate-containing fluid from the pancreas and biliary ducts.

Vasoactive intestinal polypeptide, or VIP (choice E), relaxes intestinal smooth muscle and stimulates gut
secretion of water and electrolytes.
 2

A healthy, 37-year-old, recently divorced woman loses her job at the auto factory. She picks up her three young
children from the factory day care center and gets into an automobile accident on the way home. Her 5-year-old
son, who was not wearing a seat belt, sustains a severe head injury. The woman was not hurt in the accident, but
is hyperventilating as she sits in the waiting room at the hospital. She complains of feeling faint and has blurred
vision. Which of the following is decreased in this woman?

A. Arterial oxygen content

B. Arterial oxygen tension (PO2)

C. Arterial pH

D. Cerebral blood flow

E. Cerebrovascular resistance

Explanation:

The correct answer is D. The key symptom is hyperventilation. Hyperventilation results in hypocapnia, alkalosis,
increased cerebrovascular resistance, and decreased cerebral blood flow. Carbon dioxide plays an important
role in the control of cerebral blood flow. An increase in arterial PCO2 dilates blood vessels in the brain and a
decrease in PCO2 causes vasoconstriction. The anxious, hyperventilating woman is "blowing off" carbon
dioxide, which lowers her arterial PCO2. This decrease in PCO2 has caused the cerebrovascular resistance
(choice E) to increase, thereby decreasing cerebral blood flow. The decrease in cerebral blood flow has caused
the woman to feel faint and to have blurred vision. Other symptoms commonly associated with the
hyperventilation of anxiety states are feelings of tightness in the chest and a sense of suffocation.

Hyperventilation increases the arterial oxygen content (choice A) and PO2(choice B) in a normal person.

A decrease in arterial PCO2 causes the arterial pH (choice C) to increase, i.e., the patient becomes alkalotic.

A surgeon performs an exploratory laparotomy, producing a large incision in the patient's abdomen. Poor blood
supply to which of the following is most likely to cause problems during the healing process?

A. Adipose tissue

B. Aponeuroses

C. Loose connective tissue

D. Muscle

E. Skin

Explanation:

The correct answer is A. Surgeons worry about their obese patients more than their skinny ones, because a
thick layer of relatively poorly vascularized subcutaneous fatty tissue is both mechanically unstable (it holds
stitches poorly) and heals very slowly. These patients have a frequent rate of dehiscence (tearing open of the
incisional site) with subsequent, difficult-to-control infection (access by antibiotics, leukocytes, and serum
antibodies are all hampered by the poor blood supply).

Aponeuroses (choice B) are strong thickenings of muscle sheath that usually suture and heal well after
 3
surgery.

Loose connective tissue (choice C) is well vascularized and surgeons do not usually worry much about it during
the healing process.

Muscle (choice D) usually heals well after surgery.

Skin (choice E) usually heals well, unless it becomes infected.

A child falls and bumps her head on the floor. Tissue factor is exposed beneath the endothelium of traumatized
blood vessels. Which of the following procoagulant proteins binds to tissue factor and initiates the clotting
cascade?

A. Factor V

B. Factor VII

C. Factor X

D. Fibrinogen

E. Prothrombin

Explanation:

The correct answer is B. The extrinsic pathway of clotting begins with tissue factor binding to Factor VII or
Factor VIIa. All other clotting proteins require proteolytic cleavage to become active, however Factor VII has a
low level of activity in its inactive form, and it can act with tissue factor and phospholipids to initiate the clotting
cascade. In the extrinsic pathway, Factor VII cleaves Factor X to Xa (choice C) which acts in concert with Factor
V (choice A) to cleave prothrombin to thrombin (choice E). The final step in the coagulation pathway is the
cleavage of fibrinogen to fibrin by thrombin (choice D). Fibrin polymerizes and crosslinks, thereby forming a
hemostatic net of insoluble protein.

A 48-year-old white female secretary presents with progressive difficulty typing over the past month. She also
notes that her hands begin to feel numb and weak after typing for long periods of time. Upon testing, which of the
following deficits would be predicted?

A. Difficulty in abducting the fifth finger

B. Difficulty in adducting the thumb

C. Difficulty in flexing digits two and three at the metacarpophalangeal joints

D. Loss of sensation over the lateral half of the dorsum of the hand

E. Loss of sensation over the lateral half of the palm

F. Loss of sensation over the medial half of the dorsum of the hand

G. Loss of sensation over the medial half of the palm

Explanation:

The correct answer is C. This is a classic presentation of a patient with carpal tunnel syndrome, which typically
affects females between the ages of 40 and 60 who chronically perform repetitive tasks that involve movement
of the structures that pass through the carpal tunnel. One important structure that passes through the carpal
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tunnel is the median nerve. Patients often note a tingling, a loss of sensation, or diminished sensation in the
digits. There is also often a loss of coordination and strength in the thumb, because the median nerve also
sends fibers to the abductor pollicis brevis, flexor pollicis brevis, and the opponens pollicis. A final function of the
median nerve distal to the carpal tunnel is control of the first and second lumbricals which function to flex digits
two and three at the metacarpophalangeal joints and extend interphalangeal joints of the same digits.

Abduction of the fifth digit (choice A) is a function controlled by the ulnar nerve, which does not pass through the
carpal tunnel.

Adduction of the thumb (choice B) is a function of the adductor pollicis, which is the only short thumb muscle that
is not innervated by the median nerve, but rather by the deep branch of the ulnar nerve.

Sensation of the lateral half of the dorsum of the hand (choice D) is mediated by the radial nerve, which also
does not pass through the carpal tunnel.

Sensation over the lateral aspect of the palm (choice E) is mediated by the median nerve, however the branch
innervating the palm (palmar cutaneous branch of the median nerve) passes superficial to the carpal tunnel.

Sensation over the medial aspect of the dorsum of the hand (choice F) is mediated by the ulnar nerve.

Sensation over the medial aspect of the palm (choice G) is mediated by the ulnar nerve.

A woodworker operating a bandsaw accidently injures his wrist, severing his radial artery and producing severe
hemorrhage. As he loses blood, his body tries to compensate for the developing hypotension by increasing
sympathetic outflow. The postganglionic signals carrying the impulses to constrict his arterioles are transmitted
along which of the following fiber types?

A. A-δ fibers

B. B fibers

C. C fibers

D. Ia fibers

E. Ib fibers

Explanation:

The correct answer is C. There are two systems currently used for classifying nerve fibers. The first system
groups both sensory and motor fibers together, describing A-α, A-β, A-γ, A-δ, B, and C
fibers. Another system relates only to sensory fibers, describing Ia, Ib, II, III, IV categories. Both classification
schemes begin with large, myelinated fibers, progressing to finer, unmyelinated fibers.

The C fiber (or IV fibers) is the only type of fiber that is unmyelinated. Remember that preganglionic neurons are
myelinated, but postganglionic neurons are unmyelinated. Neurons that carry slow pain and temperature
information are also classified as C fibers. See the table below for more information.

Sensory and Motor Fibers

Sensory Fibers
Function
A-α
Ia (choice D)
Alpha motor neurons, primary afferents of muscle spindles
A-α
Ib (choice E)
Golgi tendon organ afferents, touch and pressure
A-β
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II
Secondary afferents of muscle spindles, touch and pressure
A-γ
Gamma motor neurons
A-δ (choice A)
III
Touch, pressure, pain and temperature (fast)
B (choice B)
Preganglionic autonomic, visceral afferents
C (choice C)
IV
Postganglionic autonomic, pain and temperature (slow)

A 30-year-old female presents with tender cervical lymphadenopathy. She has had low-grade fever on and off for
a few weeks. A biopsy performed shows a normal lymph node with multiple germinal centers. Many macrophages
containing debris from ingested lymphocytes are present (tingible body macrophages). This supports which of
the following diagnoses?

A. Benign reactive lymphadenitis

B. Hodgkin's disease

C. Malignant histiocytosis

D. Non-Hodgkin's lymphoma

E. Sézary syndrome

Explanation:

The correct answer is A. Tingible body macrophages are characteristic of a reactive follicular center in benign
reactive lymphadenitis. Within the lymph node, the germinal center is the major site of antigen-dependent
B-lymphocyte selection and maturation. Certain B cells are selected, and those that are less suited for a
particular antigen are eliminated by apoptosis. The apoptotic debris is ingested by macrophages that then
appear as "tingible body macrophages." The tenderness is also suggestive of benignity.

Hodgkin's disease (choice B) is a type of lymphoma that spreads from node to node in contiguity. There are
four main subtypes of the disease. Histologically, the characteristic cell finding is the Reed-Sternberg cell.
Hodgkin's disease usually presents with painless cervical adenopathy and fever, chills, night sweats, and weight
loss.

Malignant histiocytosis (choice C) is a common subtype of non-Hodgkin's lymphoma. The characteristic cell
appears large with a vesicular nucleus and prominent nucleolus. The disorder can present with nodal
enlargement (usually non-tender) or with extranodal involvement.

Non-Hodgkin's lymphoma (choice D) is the name for a varied group of lymphomas that are not associated with
Reed-Sternberg cells. They usually present with lymphadenopathy and splenomegaly. They do not spread in
contiguity and 30% present extranodally. The histologic presentation varies, but all contain atypical
lymphocytes.

Sézary syndrome (choice E) is a type of cutaneous T-cell lymphoma. Neoplastic T cells are found in the upper
dermis and also within the peripheral blood. Patients present with lymphadenopathy, pruritic erythroderma, and
exfoliation.

A research physiologist is performing an experiment in which he stimulates sympathetic cholinergic neurons.

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Which of the following responses is expected?

A. Bradycardia

B. Bronchoconstriction

C. Diaphoresis

D. Increased gastrointestinal motility

E. Increased peripheral vascular resistance

Explanation:

The correct answer is C. The vast majority of sweat glands in the body are innervated by sympathetic
cholinergic neurons. Sympathetic cholinergic neurons are sympathetic postganglionic neurons that happen to
release acetylcholine instead of norepinephrine.

Bradycardia (choice A), bronchoconstriction (choice B), and increased gastrointestinal motility (choice D) would
all result from stimulating parasympathetic cholinergic neurons.

Increased peripheral vascular resistance (choice E) would result from stimulating sympathetic adrenergic
neurons.

During the passage of an intravenous catheter, numerous endothelial cells are dislodged from the lining of the
popliteal vein. What substance allows platelet adhesion to the exposed collagen fibers?

A. Factor VIII

B. Factor IX

C. Fibronectin

D. Tissue factor

E. Von Willebrand factor

Explanation:

The correct answer is E. Von Willebrand factor (vWF) is a self-polymerizing clotting protein present in the
serum and the subendothelial basal lamina, which has binding sites for collagen, platelets, and fibrin. At a site
of injury, vWF forms the bridge between the exposed collagen fibers and platelets in circulation, stimulating
platelet degranulation and initiating the cellular component of the clotting cascade. An equally important role for
vWF is binding platelets to the newly formed fibrin strands in a blood clot.

Factor VIII (choice A) and Factor IX (choice B) are clotting proteins of the intrinsic pathway. Factor VIII acts in
concert with activated Factor IX (IXa) to cleave Factor X to Xa. Xa is the prothrombin activator central to both
the intrinsic and extrinsic pathways.

Fibronectin (choice C) is a serum protein that acts as an opsonin for phagocytic cells in clots. Fibronectin binds
non-specifically to bacteria and other materials in the newly forming clots, and draws the cell membrane of
phagocytes into contact with these substances.

Tissue factor (choice D) is a protein released from injured tissues that works in concert with Factor VII to initiate
the extrinsic pathway of coagulation. Like Factors VIII and IX, tissue factor and Factor VII cleave Factor X to Xa.
 7

A 69-year-old man presents with unilateral hearing loss. A lesion in which of the following structures could be
responsible for this loss?

A. Inferior colliculus

B. Lateral lemniscus

C. Medial geniculate body

D. Medial lemniscus

E. Organ of Corti

F. Superior olivary nucleus

Explanation:

The correct answer is E. The sequence of the auditory pathway is as follows: Organ of Corti → spiral
ganglion in the cochlea → vestibulocochlear nerve (CN VIII) → cochlear nuclei (dorsal and ventral) →
superior olivary nuclei → lateral lemniscus → inferior colliculus → medial geniculate nucleus of the
thalamus (MGN) → primary auditory cortex (Heschl's gyrus).

Each ear projects to both sides of the brainstem and cortex via multiple commissures, including the trapezoid
body (which contains fibers crossing contralateral to the superior olivary nucleus), the commissure of the
inferior colliculus (connecting the right and left inferior colliculi) and another commissure that connects the right
and left nuclei of the lateral lemniscus. Therefore, a lesion of any structure up until the superior olivary nuclei
will produce an ipsilateral deafness. The only structure listed that is proximal to the superior olivary nuclei is the
organ of Corti (choice E).

The inferior colliculus (choice A), the lateral lemniscus (choice B), the medial geniculate body (choice C), and
the superior olivary nucleus (choice F) all receive information from both ears, and unilateral hearing loss could
not result from a lesion of any of these structures.

The medial lemniscus (choice D) is not a part of the auditory system. It is part of the somatosensory system,
which conveys proprioception, discriminative touch, and vibration information. More specifically, neurons of the
gracile and cuneate nuclei send projections that decussate as the internal arcuate fibers and ascend as the
medial lemniscus to synapse in the ventroposterolateral nucleus (VPL) of the thalamus.

A 70-year-old woman with a history of multiple small strokes reports to her physician that she has had multiple
recent experiences that something or someone seemed very familiar, when in reality they were not familiar to her.
This type of experience is called which of the following?

A. Anterograde amnesia

B. Confabulation

C. Deja vu

D. Jamais vu

E. Retrograde amnesia
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Explanation:

The correct answer is C. This is deja vu ("seen before"), which is the experience of an event, person, or thing
as familiar, even though it has never previously been experienced. Severe cases often accompany an
underlying neurologic problem.

Anterograde amnesia (choice A) is the inability to learn new facts. Most commonly, it involves both verbal and
nonverbal material, but it can involve one or the other.

In confabulation (choice B), a patient reports "memories" of events that did not take place at the time in
question.

In jamais vu (choice D), a patient fails to recognize familiar events that have been encountered before.

In retrograde amnesia (choice E), a patient fails to remember facts or events that occurred before the onset of
amnesia.

In the clotting process, as the hemostatic plug develops, fibrin polymerizes into monomeric threads which are
held together by noncovalent bonds. Which clotting protein increases the strength of the clot by crosslinking the
newly formed fibrin threads?

A. Factor XIII

B. High molecular weight kininogen (HMWK)

C. Plasminogen

D. Thrombin

E. von Willebrand Factor (vWF)

Explanation:

The correct answer is A. Fibrinogen is cleaved by thrombin twice as it is activated to form fibrin. The initial
cleavage causes it to polymerize and the second causes it to branch. Thrombin also activates Factor XIII to
XIIIa, which crosslinks the fibrin strands and strengthens the clot.

HMWK (choice B) is a cofactor in the intrinsic pathway that converts Factor XI to XIa.

Plasminogen (choice C) is a central proenzyme in clot lysis. When plasminogen is converted to plasmin, it
digests fibrin threads, as well as a number of protein factors including Factors V, VIII, XII, and prothrombin.

Thrombin (choice D) is an enzyme derived from prothrombin. It converts fibrinogen to fibrin, and activates
factor XIII.

vWF (choice E) is a tissue-bound protein which is exposed with vascular trauma and helps in the process of
platelet adhesion.

Administration of an experimental drug that acts on PNS myelin is shown to increase the space constant of an
axon in a peripheral nerve. Action potentials traveling down the axon would be predicted to be
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A. faster

B. larger

C. slower

D. smaller

E. unchanged

Explanation:

The correct answer is A. The space constant of an axon reflects the amount of passive or electrotonic spread
of current within an axon. The larger the space constant, the further the current can spread, allowing action
potentials to propagate faster. This is why myelin increases the conduction velocity of action potentials down
an axon. Conversely, demyelination decreases the space constant and slows action potential conduction.

The usefulness of the technique of transcutaneous electrical nerve stimulation is explained by which of the
following?

A. Allodynia

B. Central pain

C. Gate theory of pain

D. Referred pain

E. Thalamic pain

Explanation:

The correct answer is C. Transcutaneous electrical nerve stimulation is a method used to lessen severe,
chronic pain by overly stimulating the involved neurons. This is thought to trigger inhibitory interneurons in
lamina II of the spinal cord, thereby partially blocking the transmission of pain impulses. These interneurons are
considered to be "gate-keepers," that can, to some degree, isolate the peripherally generated signals from the
brain.

Allodynia (choice A) is the term used for the perception of pain following a normally innocuous stimulation of a
mechanoreceptor.

Central pain (choice B), such as that caused by thalamic lesions (choice E), is pain that originates at the level
of the brain rather than in the periphery.

Referred pain (choice D) is the perception of pain initiated in one body site (typically an internal organ) as
being localized to another body site (frequently on the more superficial parts of the body). An example is that of
diaphragmatic pain, which may be referred to the top of the shoulder. The phenomenon occurs because both
internal organs and more superficial structures may arise from, and consequently be innervated by, the same
dermatome.

A patient develops a form of lung cancer that spreads to occlude the thoracic duct. Edema involving which of the
following sites might be expected as a potential complication?
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A. Entire left side and right leg

B. Entire right side and left leg

C. Left arm only

D. Right arm and right half of head only

E. Right arm only

Explanation:

The correct answer is A. The right lymphatic duct drains the right arm, the right side of the chest, and the right
side of the head. The thoracic duct drains the rest of the body. Both the right lymphatic duct and the thoracic
duct dump into the large venous channels at the base of the neck. Occlusion of this drainage can produce
intractable edema in sites feeding these ducts.

The left side and right leg would be affected, rather than the right side and left leg (choice B).

The entire left side (rather than just the left arm, choice C) and right leg drain into the thoracic duct.

The right arm and the right half of the head (choices D and E) drain to the right lymphatic duct.

A patient has a painful ulcer on the tip of his tongue. Which of the following cranial nerves carries the pain
sensation he experiences?

A. V2

B. V3

C. VII

D. IX

E. X

Explanation:

The correct answer is B. The innervation of the tongue is complex. The mandibular division of the trigeminal
nerve (V3) carries general somatic sensation from the anterior two-thirds of the tongue.

The maxillary division (V2, choice A) carries somatic sensation from the palate, upper gums, and upper lip.

The facial nerve (VII, choice C) carries taste from the anterior two-thirds of the tongue.

The glossopharyngeal nerve (IX, choice D) carries sensation and taste from the posterior one-third of the
tongue.

The vagus nerve (X, choice E) carries sensation from the lower pharynx.

A 72-year-old woman with insomnia participates in a sleep study. As part of the study protocol, she has EEG
leads attached, then goes to sleep. At one point during the evening, 12-16 Hz sleep spindles and K-complexes
 11
are observed. Which of the following stages of sleep is associated with this pattern?

A. REM

B. Stage 1

C. Stage 2

D. Stage 3

E. Stage 4

Explanation:

The correct answer is C. Stage 2 has more theta waves than stage 1 and is associated with sleep spindles
(short bursts of 12-16 Hz activity) and K-complexes (high amplitude slow waves with superposed sleep spindles)
on the electroencephalogram

Transient large amplitude potentials in the occipital areas (ponto-geniculo-occipital [PGO] spikes) are
associated with REM sleep (choice A).

Stage 1 (choice B), or drowsiness, is characterized by the attenuation of alpha rhythm (8-13 Hz) and the
appearance of 4-7-Hz theta waves.

Stages 3 (choice D) and 4 (choice E), or slow wave sleep, are characterized by high amplitude slow waves,
especially in the delta (< 4 Hz) frequency range.

What is the normal myeloid to erythroid ratio in bone marrow?

A. 1:1

B. 1:3

C. 1:10

D. 3:1

E. 10:1

Explanation:

The correct answer is D. The ratio of cells in bone marrow developing along myeloid lines to cells developing
along erythroid lines is 3:1. An alternative way to remember the normal marrow composition is that it typically
contains about 60% granulocytes and their precursors; 20% erythroid precursors; 10% lymphocytes,
monocytes, and their precursors; and 10% unidentified or disintegrating cells. These numbers are worth
remembering, because shifts away from normal values may be a subtle clue to marrow abnormalities.

Which of the following neurotransmitters is most important for the induction of REM sleep?

A. Acetylcholine

B. Dopamine
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C. Epinephrine

D. Norepinephrine

E. Serotonin

Explanation:

The correct answer is A. Acetylcholine is the neurotransmitter of primary importance for the induction of REM
sleep. Some of the other neurotransmitters do function in sleep, but REM sleep can occur in their absence.

Dopamine (choice B) is a neurotransmitter with a role in voluntary movement, mood, cognition, and regulation
of prolactin release.

Epinephrine (choice C) is important in sympathetic nervous system responses. It is also a CNS

neurotransmitter.

Norepinephrine (choice D) is important in sympathetic nervous system responses. It is also a CNS

neurotransmitter involved in attention, arousal, and mood.

Serotonin (choice E) is a CNS neurotransmitter that plays an important role in mood and sensation. In the
periphery, it is involved in vascular regulation and digestive function.

During an accident in a wood shop, an individual sustains a deep cut that severs the median nerve at the wrist.
The nerve is promptly surgically reconnected. Under optimal circumstances the nerve can regenerate at which of
the following rates?

A. 1 mm/day

B. 5 mm/day

C. 2 mm/week

D. 1 mm/month

E. 5 mm/month

Explanation:

The correct answer is A. Following transection of a nerve with subsequent close surgical approximation of the
two cut ends, the nerve can regrow down the nerve trunk at the rate of about 1 mm/day under optimal
conditions. The process typically involves formation of several nerve sprouts from which one becomes
dominant. Interestingly, while there is almost always some degree of &ldquo;miswiring&rdquo; during the
reconnection, the brain adapts as the newly reinnervated muscles are used, and eventually usually
automatically provides the appropriate signals to perform a desired task. In the absence of a nerve trunk to
grow down, the sprouting process can cause the formation of painful traumatic neuromas as the nerve sprouts
form a knotted mass of sensitive nerve fibers.

A 65-year-old female with renal failure presents for hemodialysis. She is found to be anemic and is given a dose
of erythropoietin along with her usual vitamin and mineral supplements. Erythropoietin stimulates which of the
following intermediates in hematopoiesis?

A. Basophilic erythroblasts
 13
B. Colony forming units-erythroid

C. Multipotential stem cells

D. Proerythroblasts

E. Reticulocytes

Explanation:

The correct answer is B. The colony forming unit-erythroid (CFU-E) is a unipotential stem cell that develops
from a burst forming unit-erythroid (BFU-E), which develops eventually from the multipotential stem cell. The
BFU-E is somewhat responsive to erythropoietin, but the CFU-E is completely dependent on erythropoietin.
Erythropoietin is normally released from the kidney in response to hypoxic or anemic conditions. Its half life is
about 3-6 hours. Clinically it takes 5 days to see reticulocyte formation in the peripheral blood following
erythropoietin administration.

The basophilic erythroblast (choice A) differentiates from the proerythroblast. It is recognizable by light
microscopy and has a dark basophilic staining due to hemoglobin synthesis. It is not directly affected by
erythropoietin, but is instead indirectly increased by the increase in precursor cells from the increase in CFU-E
earlier in development.

The multipotential stem cell (choice C) appears earlier in development than CFU-E and does not increase with
erythropoietin. The development of the major components of blood (RBC, WBC, and platelets) all begin with the
multipotential stem cell (CFU-S). This cell is non-committed and can self-renew. It is located in the bone marrow
and is not recognizable by light microscopy.

The proerythroblast (choice D) is the first recognizable cell in the red cell lineage. It develops from the CFU-E
cell. It is not affected directly by erythropoietin, but instead increases in number from the increased CFU-E cells.

The reticulocyte (choice E) is the enucleated cell just before the mature red blood cell. Reticulocytes enter the
peripheral circulation, but continue to synthesize hemoglobin. This cell is not directly stimulated by
erythropoietin, but increases in number as a result of the increase in precursors.

A 40-year-old man with sleep apnea participates in a sleep study. During his evaluation, normal sawtooth waves
are observed on his EEG tracing. This pattern is associated with which period of sleep?

A. REM

B. Stage 1

C. Stage 2

D. Stage 3

E. Stage 4

Explanation:

The correct answer is A. Sawtooth waves appearing in bursts are associated with REM sleep.

Stage 1 (choice B) is associated with 4-7 Hz theta waves.

Stage 2 (choice C) is associated with 12-14 Hz sleep spindles and K-complexes.

 14
Stage 3 (choice D) is associated with < 4 Hz, high-amplitude delta waves.

Stage 4 (choice E) is characterized by an EEG composed of about 50% delta waves.

Note that beta waves (15-18 Hz) occur during periods of more intense mental activity while awake. Alpha waves
(8-12 Hz) occur during awake, relaxed states. REM is the stage of sleep that most resembles the awake state
on the EEG.