CASE #5 Flashcards
A 52 years old female patient presents to your office with chief complaint of irregular periods. When asked for details she also complains of hot flashes and irritability. A blood test confirms a diagnosis of perimenopause. She then expresses her interest in HRT. You warned the patient about the side effects of estrogen therapy. Which of the following side effects is least likely to be associated with estrogen therapy?
A. Increase the risk of thrombosis B. Increase HDL C. Increase LDL D. Increase endometrial growth E. Increase water retention
Increase LDL
Growth hormone (GH), also known as somatotropin , is a peptide hormone that stimulates growth, cell reproduction and regeneration. An investigational drug, BIN1029, tested in preclinical trial was found to act on the hypothalamus and pituitary gland to inhibit the release of GH by feedback mechanism. Question 1: Which of the following endogenous molecules has the same mechanism of action?
A. Ghrelin B. Insulin-like growth factor-1 C. Growth hormone–releasing hormone D. Somatostatin E. Adenocorticotropic hormone
Insulin-like growth factor-1
Question 2: Which of the following pituitary gland-acting drugs would be effective in the treatment of acromegaly?
A. Urofollitropin B. Menotropin C. Pegvisomant D. Cosyntropin E. Leuprolide
Pegvisomant
Insulin is a hormone produced by beta cells in the pancreas. Its primary function is to lower blood glucose. The release of insulin is controlled by blood glucose levels and several hormones including glucagon, GH, glucocorticoids and thyroid hormone. Which of the following statements is least accurate description of the biological functions of insulin?
A. Promotes the formation of storage forms of energy and suppress their catabolism
B. Promotes glucose uptake into cells and its conversion to glycogen
C. Promotes gluconeogenesis
D. Stimulates the transport of amino acids and subsequent protein synthesis
E. Increases the production of body fat
Promotes gluconeogenesis
A 37-year-old male presents with fatigue, nausea, vomiting, weight loss, malaise and dizziness. On examination, marked skin and buccal hyperpigmentation and orthostatic hypotension were diagnosed. He has no relevant family history. Baseline biochemistry is highly suggestive of Addison’s disease. Which of the following sets of laboratory results would confirm a diagnosis of Addison’s disease in this patient?
A. Low cortisol, low adenocorticotropic hormone (ACTH)
B. High cortisol, low adenocorticotropic hormone (ACTH)
C. Low cortisol, high adenocorticotropic hormone (ACTH)
D. High cortisol, high adenocorticotropic hormone (ACTH)
E. The results do not relate to the conditions described
Low cortisol, high adenocorticotropic hormone (ACTH)
A 57-year-old male was referred for evaluation of polyuria which he had been experiencing for at least one year. His brother had a history of polyuria, but less intense. Polyuria in adults is defined as urine output more than 3L/day (>40ml/kg/day). He is also experiencing excessive thirst. His medical history is unremarkable except for hyperlipidemia, for which he takes atorvastatin. He was diagnosed with Diabetes Insipidus following blood electrolyte test and urinalysis. Which of the following drugs would be recommended in this patient?
A. Pergolide B. Desmopressin C. Hydrocortisone D. Cosyntropin E. Follitropin
Desmopressin
A 68-year-old retired lawyer initially complained of frequency of micturition, urinary urgency, and hesitancy associated with a weak stream. Over the past months, he has reported a few episodes of hematuria and incontinence. In addition to his urologic symptoms, the patient complained of low-grade, constant back pain and bouts of constipation. A digital rectal examination revealed enlarged prostate gland with several palpably discreet nodules. His prostate-specific antigen (PSA) level is 25ng/mL (range: 0.0–4.0 ng/mL) up from 12ng/mL six months ago. Histologic evaluation of the biopsy specimens revealed adenocarcinoma representing 55% of biopsied material (figure below) confirming a diagnosis of prostate cancer. An antagonist of androgen receptor was prescribed. Which of the following drugs has been prescribed?
A. Mestranol B. Donazol C. Norgestrel D. Clomiphene E. Flutamide
Flutamide
Progestins are a group of naturally occurring or synthetic steroid hormones. The naturally occurring progestin is progesterone. Progesterone is produced in response to LH and has numerous biological functions including the inhibition of the formation of gonadotropins. Which of following indications is least likely to be associated with progestins therapy?
A. Contraception B. Dysfunctional Uterine Bleeding C. Dysmenorrhea D. Endometriosis E. Acne
Acne
Leuprolide is a synthetic analogue of gonadotropin-releasing hormone (GnRH) used to treat breast cancer and prostate cancer. Which of the following statements describes best the mechanism of leuprolide?
A. Stimulate GnRH receptors in a pulsatile fashion causing downregulation of receptors resulting in impaired release of FSH and LH
B. Stimulate GnRH receptors in a non-pulsatile fashion causing upregulation of receptors resulting in impaired release of FSH and LH
C. Stimulate GnRH receptors in a non-pulsatile fashion causing downregulation of receptors resulting in impaired release of FSH and LH
D. Stimulate GnRH receptors in a pulsatile fashion causing downregulation of receptors resulting in increased release of FSH and LH
E. Stimulate the LHRH receptor in a non-pulsatile fashion causing downregulation of receptors resulting in increased release of FSH and LH
Stimulate GnRH receptors in a non-pulsatile fashion causing downregulation of receptors resulting in impaired release of FSH and LH
A 65 years old female patient with history of hypertension and edema is receiving treatment for rheumatoid arthritis affecting both knees.
Question 1: Which of the following corticosteroids would be preferred in this patient due to high anti-inflammatory potency and low sodium retention potential?
A. Cortisol B. Fludocortisone C. Prednisone D. Dexamethasone E. Triamcinolone
Dexamethasone
Question 2: You warned the patient about the incidence of osteoporosis due to long-term use of corticosteroids. Which of the following therapeutic agents used to treat osteoporosis belongs to the class of bisphosphonates?
A. Teriparatide B. Denosumab C. Raloxifene D. Zoledronic acid E. Calcitonin
Zoledronic acid
Question 3: Which of the following side effects are least likely to be associated with long-term use of corticosteroids?
A. Induction of hyperglycemia and gluconeogenesis
B. Down regulation of anti-inflammatory mediators
C. Immunosuppression
D. Inhibition of Prostaglandin and Leukotriene synthesis
E. Stimulation of lipolysis
Down regulation of anti-inflammatory mediators
A young woman in her 41st week of gestation had been in labor for 11 hours. You noticed that the force of her uterine contractions have diminished significantly during the past hour. Which of the following substances could be used to stimulate this patient’s uterine contractions?
A. Insulin B. Luteinizing hormone C. Oxytocin D. Thyroxine E. Calcitonin
Oxytocin
A 39 years old patient is undergoing assisted reproductive technology (ART) to improve her chances of conceiving. Her therapeutic regimen includes a combination of luteinizing hormone (LH) and follicle stimulating hormone (FSH) extracted from the urine of menopausal women. Which of the following therapeutic agent was administered?
A. Oxandrolone B. Liotrix C. Danazol D. Menotropin E. Estrone
Menotropin
A 27 years old patient visits your office to request a prescription for a combined oral contraceptive (COC). She has decided to postpone starting a family due to a hectic professional career.
Question 1: Before prescribing a COC which of the following contraindications must be ruled out?
A. Hirsutism B. Sedentary lifestyle C. Peptic ulcer D. Pregnancy E. Seasonal allergies
Pregnancy
Question 2: During your interaction she mentioned that she has been on sumatriptan nasal spray prn for almost a year for the treatment of migraines. Which of the following contraceptive would you recommend to this patient?
A. Combined estrogen/progestin B. Combined estrogen/progestin monophasic C. Combined estrogen/progestin biphasic D. Combined estrogen/progestin triphasic E. Progestin only
Progestin only
Question 3: You decide to educate the patient on the difference between COCs and progestin only contraceptives. Which of the following statements describes the advantage of COCs compared to progestin only contraceptives?
A. Better safety profile B. Less weight gain C. Lower incidence of nausea D. Higher efficacy E. Low risk of edema
Higher efficacy
A 55 years old patient is receiving a combination of two chemotherapeutic drugs for the treatment of hormone receptor-positive breast cancer. Tamoxifen is one of the two chemotherapeutic agents. Which of the following statements best describes the mechanism of tamoxifen?
A. Acts as an agonist of estrogen receptor in breast tissue and in endometrial tissue
B. Acts as an agonist of estrogen receptor in breast tissue and as an antagonist in endometrial tissue
C. Acts as an antagonist of estrogen receptor in breast tissue and as an agonist in endometrial tissue
D. Acts as an antagonist of estrogen receptor in breast tissue and in endometrial tissue
E. Acts only as an agonist of estrogen receptor in breast tissue
Acts as an antagonist of estrogen receptor in breast tissue and as an agonist in endometrial tissue
A 20 years old woman arrives to your clinic after two weeks following a sexual assault. She requests a prescription to terminate a potential pregnancy. After discussing all ethical considerations, which of the following drugs could be prescribed combined with misoprostol to terminate a feared pregnancy?
A. Progestin B. Estrogen/Progestin C. Donazol D. Mifepristone E. Mestranol
Mifepristone
A 38 years old female patient, Ms Tim, visits your clinic with chief complaint of nervousness. She further explains that she also suffers from heat intolerance, palpitations, increased appetite and insomnia. In addition, she has lost at least 7 lbs in the past five weeks. You suspect hyperthyroidism and order a blood test. Which of the following laboratory results would confirm your diagnosis?
A. Low T4, High TSH, High anti-TPO B. Low T4, High TSH C. High T4, Low TSH D. High T4, Low TSH, High TSI (thyroid stimulating immunoglobulins) E. High T4, High TSH
High T4, Low TSH
A 38 years old female patient, Ms Tim, visits your clinic with chief complaint of nervousness. She further explains that she also suffers from heat intolerance, palpitations, increased appetite and insomnia. In addition, she has lost at least 7 lbs in the past five weeks. You suspect hyperthyroidism and order a blood test. Question 2: You recommend an initial trial of an agent known to interfere with the biosynthesis of thyroid hormones by preventing the iodination and proteolytic release of thyroid hormones. Which of the following products has been recommended?
A. Methimazole B. Thiopropyluracil C. SSKI (saturated solution of potassium iodine) D. Carbimazole E. Propranolo
SSKI (saturated solution of potassium iodine)
A 38 years old female patient, Ms Tim, visits your clinic with chief complaint of nervousness. She further explains that she also suffers from heat intolerance, palpitations, increased appetite and insomnia. In addition, she has lost at least 7 lbs in the past five weeks. You suspect hyperthyroidism and order a blood test.Question 3: Unfortunately, the initial therapy has not been effective in this patient. You decide to switch, Ms Tim, to a more potent therapeutic agent. Following six months of treatment her blood test results show: free T4 5.0 mcg/dL (normal: 4.5 – 11.2 mcg/dL), TSH 2.8 mIU/L (normal: 0.4 – 4.0 mIU/L). She complains of palpitations and hand tremors. How would you manage these persistent symptoms?
A. Increase the dose of the drug she is currently taking
B. Switch to another antithyroid drug
C. Add another antithyroid drug
D. Add propranolol
E. Do nothing; the symptoms will probably resolve in about two months
Add propranolol
A 48 years old patient with history of hypertension, hyperlipidemia and bipolar depression visits the clinic for his regular follow-up. He is on losartan, hydrochlorothiazide, atorvastatin, cholestyramine and lithium carbonate. He complains of cold sensitivity, constipation, fatigue and weight gain. His symptoms are consistent with hypothyroidism. A blood test confirms a diagnosis of hypothyroidism. Which of the following drugs in this patient’s therapeutic regimen is the likely offending agent?
A. Losartan B. Hydrochlorothiazide C. Atorvastatin D. Cholestyramine E. Lithium carbonate
Lithium carbonate
A 15 years old is brought to your office. His chief complaint is a constellation of symptoms including fatigue, excessive thirst, frequent urination and significant weight loss over the past 2 months. He has no family history of diabetes and is not on any medications. His blood test results show FPG 226 mg/dl (Normal
Insuline
