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A 65-Year-Old Woman Comes to the Physician to Establish Care

question 295

Multiple Choice

A 65-year-old woman comes to the physician to establish care. She reports a 10-year history of dry eyes and mouth that she has managed with over-the-counter artificial tear and saliva products. The patient has had intermittent painless swelling of her parotid glands for the past 3 years. She also complains of occasional joint pain relieved by ibuprofen. She does not use tobacco, alcohol, or illicit drugs.
Her temperature is 37.2° C (99° F) , blood pressure is 142/92 mm Hg, and pulse is 78/min. Physical examination shows several mildly enlarged, nontender, mobile cervical and supraclavicular lymph nodes. Conjunctivae appear dry. Oral mucosa is dry with atrophic glossitis. Severe dental caries are noted as are several missing teeth. The left parotid gland is enlarged and hard to the touch but is nontender. There is no joint swelling or deformity. The remainder of the physical examination is within normal limits.
Laboratory results are as follows:

Which of the following is the most likely cause of the enlarged parotid gland?

Analyze the impact of specific types of brain damage on emotional processing and truth-telling ability.

Discuss the concept of neural plasticity in response to learning and sensory experience.

Explain the importance of the binding problem in cognitive neuroscience and its implications for unified perception.

Evaluate the evidence against the simplified notion of being "right-brained" or "left-brained."

Definitions:

Instinctual Behavior

Behaviors that are innate and driven by genetic coding, often performed in response to certain stimuli without prior learning.

Negative Reinforcement

A process in behavior modification where the removal of an unfavorable outcome or stimulus strengthens a behavior, encouraging its repetition.

Instinctive Drift

The phenomenon where an animal's learned behavior reverts to its innate behaviors, overriding conditioned responses.

Behavior Modification

A psychological treatment method that alters undesirable behaviors through rewards, punishments, or other strategies.