a) How is the brain of birds different from the brain of mammals  in terms of how it looks, superficially?    b) Researchers have examined the density of neurons in the brains of some birds in relation to the birds’  activities at different times within the annual cycle.  Describe what has been found about how  neuron density within the brain changes at different times of the year, and provide an example of how this change contributes to the studied species’ fitness (i.e. contributes to  its survival or reproductive success)     

In connective tissue, how does the composition of the extracellular matrix (ECM) enable it to perform its diverse functions?

What is the primary role of tight junctions in epithelial tissues, and what consequence might arise if they are disrupted?

Which type of cartilage is specialized for resisting compressive forces and is primarily found in intervertebral discs and menisci?

Regarding the histological architecture of the cutaneous (skin) membrane, which combination of tissue types correctly reflects its structure and related functions?

A genetic mutation causes a marked decrease in collagen fiber synthesis within the extracellular matrix (ECM) of connective tissue. Which tissue function is most likely impaired by this defect?

Mr.  Peter Miller has a hx of HF and recently was started on Entresto (sacubitril/valsartan).   The patient followed the instructions to discontinue Lisinopril.   He calls the office and reports that he is feeling a “little” short of breath, especially when he is walking up the one-flight of stairs to his bedroom.  He also gained 3 lbs since he was seen last in the office 3 weeks ago.  The NP orders lab and wonders what lab to order – a BNP or a NT-pro-BNP?   Answer the following questions: 1.  Which lab test should the NP order? 2.  Explain the rationale for the correct lab order.  

Susan Bridge is a 58-year-old Caucasian female who just recently moved into town and is seeing the NP today to establish care and go over her medication and treatment plan.   Susan checks her BP at home 3x a week and average home BP readings are 144/86 mmHg.   PMH: HTN dx. 5 years ago, Hyperlipidemia dx. 5 years ago. OB hx:  G:3, P: 3.  Gestational DM, preeclampsia, menopausal 1 year Family Hx:  Dad alive 88 y – DM type II, HTN, Hyperlipidemia, CVD with an MI at age 67.  Mom alive 85 y – DM type II, Hyperlipidemia, depression Medications: Lisinopril 10 mg/day, Atorvastatin 40 mg/day, multi-vitamin Social Hx:  non-smoker, ETOH wine 3 glasses/week, full-time work as an accountant, exercise – short walks 2-3 x a month.  Doesn’t have time to cook – eats fast-food 2-3x a week, eats soup from a can 3-4x a week.  Likes to reward herself on the end of the day with a couple of pieces of pie.   Lipid panel – 1 week ago while on statin therapy:   Total cholesterol 142 LDL 135 HDL 35 Non-HDL: 107 VS: BP: 158/84 mmHg.   RR: 16 HR:  88 Pulse-ox: 95% RA BMI:  29 Address each question separately:   1.  Identify risk factors. 2.  Address why these are risk factors. 3.  Is this patient at treatment goals for HTN?  4.  What should be the BP goal?  5.  What should the NP advice/prescribe to help the patient achieve her HTN goal?   6.  Why did you choose the treatment described in question #5?  

Untreated Obstructive Sleep Apnea (OSA) increases the risk for other health related conditions.  List three health related conditions:    

Ms. Gloria Briggs continued – see below her subjective and objective data points.   With findings of elevated brain natriuretic peptide and left ventricular dysfunction on echo (ejection fraction 38%), a diagnosis of HF with reduced ejection fraction (HFrEF) is confirmed. What is Gloria’s American College of Cardiology Foundation/American Heart Association (ACCF/AHA) stage and New York Heart Association (NYHA) class?   Ms. Gloria Briggs works as a librarian and presents with a 6-week history of fatigue and increasing shortness of breath. She believes that these symptoms are related to recent renovations at the library, which have reactivated her asthma; however, her nebulizer and inhaler have not relieved her symptoms. Gloria reports that her dyspnea is worse with ordinary activity and lying flat, but she is comfortable sitting. She has not experienced chest pain. She complains of her legs swelling and shoes “pinching.” She can no longer take her brisk lunchtime walk and has gained weight. Her history includes hypertension, type 2 diabetes (T2DM), and dyslipidemia; she is a nondrinker and quit smoking 7 years ago. Physical examination: o   Height: 5 ft 6 in; weight: 165 lbs. (body mass index [BMI]: 26.6 kg/m2) o   Blood pressure (treated): 140/92 mm Hg o   Heart rate: 116 bpm; respiratory rate: 22; temperature: 98.4°F o   1+ pitting edema ankles; S3 heart sound; bilateral rales at lung bases o   Mild cardiomegaly