Comp (Endocrine and GI)

Question 1

Bromocriptine can treat —- adenoma

Answer 1

pituary

Question 2

The classic presenting signs of primary ———– are hypertension and hypokalemia.

Answer 2

aldosteronism

Question 3

in aldosterone-secreting adrenal adenoma, ——- will every low

Answer 3

renin

Question 4

In Cushing’s disease, secretion of ACTH by a pituitary adenoma causes ————– of the adrenal glands, leading to excess cortisol production.

Answer 4

cortical hyperplasia

Question 5

Which of the following laboratory tests is typically used in the diagnosis of diabetes mellitus?

Answer 5

fasting plasma glucose

Question 6

”——– is a 54-kd glycoprotein synthesized in the liver that has one binding site for T4. The affinity of —- for T4 is very high, while that for T3 is lower”

”——- receptors mediate most, if not all, of the physiologic actions of thyroid hormone”

Answer 6

TBG

nuclear

Question 7

A 35-year-old man has an adenoma of the parathyroid gland, with increased serum concentrations of parathyroid hormone (PTH) and calcium. In this patient, PTH induces which of the following processes to cause hypercalcemia?

Answer 7

Stimulation of osteoclast activity

Question 8

—–cells make epi and NE

Answer 8

chromaffin cells in adrenal medulla

Question 9

obesity in an older woman is risk factor for endometrial cancer bc

Answer 9

Increased production of estrogen by adiposetissue

Question 10

Before a pt starts isotretinoin (accutane) you should order a _______

Answer 10

hcg urine test

Question 11

The most reliable method for identifying catecholamine-secreting tumors (such as pheochromacytoma) is measuring fractionated —————- in a 24-hour urine collection.

Answer 11

metanephrines and catecholamines

Question 12

————– are the most common form of congenital cyst in the neck. They are epithelial remnants of the thyroglossal tract and present as a midline neck mass at the level of the thyrohyoid membrane. They move up with swallowing or protrusion of the tongue.

Answer 12

Thyroglossal duct cysts

Question 13

———- carcinoma is a thyroid cancer composed of parafollicular cells (C cells) that produce calcitonin.

Answer 13

Medullary

Question 14

thyroid nodule, histologic sections show sheets of granular cells embedded in a hyaline stroma. Immunohistochemical stains show the presence of cytoplasmic calcitonin. What cancer?

Answer 14

medullary thyroid carcinoma

Question 15

The ——– test measures the absorptive capacity of the proximal small intestine and is used to determine whether defects in the intestinal epithelium are responsible for malabsorption. Absorption is usually normal in pancreatic insufficiency since pancreatic enzymes are not required for xylose absorption

Answer 15

D-xylose

Question 16

Following radioactive iodine exposure, giving ———— blocks uptake of radioiodine by the thyroid, reducing the risk of thyroid cancer.

Answer 16

potassium iodide

Question 17

increased activity of ———enzyme after giving patient with diabetes insulin

Answer 17

glucokinase

Question 18

“Polyneuropathy is typically characterized by symmetric distal sensory loss, ——- sensations, or weakness.”

Answer 18

burning

Question 19

A 23-year-old man has a 3-month history of mildly depressed mood, decreased energy, and dry skin. His thyroid gland is not palpably enlarged. Serum (T4) and TSH concentrations are decreased. Which of the following is the most likely diagnosis?

Answer 19

Secondary hypothyroidism

Question 20

Reason for increased calcium level after overdose of vitamin D:

Answer 20

Increased absorption of calcium in the gastrointestinal tract

Question 21

A 51-year-old woman receives the diagnosis of pheochromocytoma. Preoperative treatment with propranolol is prescribed to decrease excessive tachycardia. Which of the following drugs should be administered before starting propranolol therapy in this patient?

Answer 21

Phenoxybenzamine

Question 22

A newborn female is diagnosed with hypothyroidism 2 days after birth. Ultrasonography of the neck shows the absence of any thyroid gland tissue. Physical examination shows no abnormalities, including normal root, suck, grasp, and Moro reflexes. Maternal to fetal transfer of which of the following best explains the normal development in this newborn?

Answer 22

T4

Question 23

A 59-year-old man undergoes a total thyroidectomy and central lymph node dissection for a 4-cm follicular carcinoma of the thyroid. Twelve hours after the procedure, he has paresthesias of his hands and feet. Vital signs are stable, but carpal spasm is noted on inflation of the blood pressure cuff. Which of the following sets of laboratory findings in serum is most likely in this patient (pth and calcium)?

Answer 23

Parathyroid hormone: decreased, calcium: decreased

Postsurgical hypoparathyroidism can occur after thyroid, parathyroid, or radical neck surgery for head and neck cancer, and it may be transient.
The acute manifestations of hypoparathyroidism are due to acute hypocalcemia.
The hallmark of acute hypocalcemia is tetany, which is a disorder of neuromuscular irritability. The symptoms of tetany may be mild (perioral numbness, paresthesias of the hands and feet, muscle cramps) or severe (carpopedal spasm, laryngospasm, and focal or generalized seizures, which must be distinguished from the generalized tonic muscle contractions that occur in severe tetany). The classic physical findings in patients with neuromuscular irritability due to latent tetany are Trousseau’s and Chvostek’s signs.

Question 24

Parotid gland hypertrophy (sialadenosis) is typically bilateral and painless, and occurs in approximately 10 to 25 percent of patients with ————

Answer 24

bulimia nervosa

Question 25

measure — levels for reccurance of medullary thyroid carcinoma

Answer 25

calcitonin

Question 26

Bilateral thyroid lesions are composed of spindle cells arranged in small clusters. Deposits of amyloid are present between neoplastic cells. Foci of C-cell hyperplasia are also present. The lesions are confirmed as malignant. What is it?

Answer 26

medulllary carcinoma

Question 27

A 28-year-old woman at 18 weeks’ gestation has palpitations. Laboratory studies show an increased serum total thyroxine T3 concentration. Which of the following tests is best to confirm a diagnosis of hyperthyroidism in this patient?

Answer 27

Free T4

Question 28

A 42-year-old woman comes to the physician because of a 1-month history of abdominal pain, especially after eating fatty meals. BMI is 31 kg/m2. Physical examination shows jaundice and tenderness of the right upper quadrant of the abdomen. An increase in which of the following liver functions is most likely in this patient?

Answer 28

cholesterol synthesis

Question 29

A 12-year-old boy is swimming in a mountain stream. He is immersed up to his neck in 60° F water for 20 minutes. Which of the following sets of physiologic changes (blood volume, ADH and ANP) is most likely to occur in this boy?

Answer 29

blood vol: increase

ADH decrease

ANP: increase

Water immersion (WI) to the neck induces prompt increases in central blood volume, central venous pressure, and atrial distension. Since atrial distension is a major stimulus for atrial natriuretic peptide (ANP) release. The increase in central blood volume suppresses the release of ADH (antidiuretic hormone)

Question 30

A 20-year-old man comes to the physician because of a 3-month history of progressive thirst and urinary frequency; the thirst became excessive during the past 3 days. He says that he has been drinking a lot of fluid. Physical examination shows no abnormalities. Urinalysis shows a specific gravity of less than 1.006. This patient most likely has dysfunction of which of the following endocrine structures?

Answer 30

Posterior pituitary gland

He has Central diabetees insipidus

Question 31

Man given an infusion of 2 g of calcium chloride over 2 hours. His serum calcium concentration now is 11.5 mg/dl. Compared with the preinfusion level, the serum concentration of which of the following substances is most likely to be increased at this time?

Answer 31

24,25 dihydroxycholecalciferol

The renal tubular cells contain two enzymes, 1-alpha-hydroxylase (CYP27B1) and 24-alpha-hydroxylase (CYP24), that can further hydroxylate 25(OH)D, producing 1,25-dihydroxyvitamin D, the most active form of vitamin D, or 24,25-dihydroxyvitamin D, an inactive metabolite.

Question 32

The characteristic biochemical abnormality in patients with classic 21 Hydroxlase Defeciency is an elevated serum concentration of ————— the normal substrate for 21-hydroxylase,

Answer 32

17-hydroxyprogesterone (17OHP)

Question 33

With prolonged, severe vitamin D deficiency, there is reduced ——————– and hypocalcemia occurs, causing secondary hyperparathyroidism, which leads to phosphaturia, demineralization of bones, and, when prolonged, osteomalacia in adults.

Answer 33

intestinal absorption of calcium and phosphorus

Question 34

anabolic steriodss cause infertility by

Answer 34

Suppression of gonadotropins

Question 35

Sheehan syndrome levels of Prolactin, ACTH, TSH; and Aldosterone

Answer 35

Prolactin: decrease, ACTH; decrease, TSH; decrease, Aldosterone; increase

Question 36

A 10-year-old boy who has had type 1 diabetes mellitus for 1 year is receiving insulin. One hour after his morning dose of insulin, he becomes tremulous and diaphoretic and has tachycardia. Several hours later, his symptoms resolve. His blood glucose concentration is now increased. Which of the following is the most likely cause of this patient’s hyperglycemia?

Answer 36

Activation of hepatic adenylyl cyclase

Question 37

———————-are neoplasms that arise from neural crest chromaffin cells that are associated with autonomic ganglia and have the ability to secrete catecholamines. Paragangliomas are located almost exclusively in the neck and skull base, arising most often from the carotid body and jugulotympanic paraganglia. They are non-functional.

Immunohistochemical staining stains positive for:

Answer 37

Paragangliomas

neuron-specific enolase, synaptophysin, and/or chromogranin.

Question 38

Which of the following diet is most likely to be effective in decreasing this patient’s risk for type 2 diabetes mellitus?

Answer 38

low calorie

Question 39

Chronic lithium ingestion in patients with bipolar disorder has been associated with —————–

Answer 39

nephrogenic diabetes insipidus.

Question 40

A patient with nephrogenic DI will have isotonic proximal convoluted tubule, hypotonic juxtaglomerular apparatus, and hypotonic medullary collecting duct (due to the inability of ADH to increase water reabsorption).

Answer 40

isotonic

hypotonic

hypotonic

Question 41

pt with foul smelling vaginal discharge and vaginal itching. There is frothy, watery-gray discharge in the posterior vaginal vault. A wet mount preparation of the discharge shows numerous multi-flagellated organisms the size of erythrocytes.

What is organism?

Answer 41

Trichomonas vaginalis

Common signs and symptoms of acute infection include a purulent, malodorous, thin discharge associated with burning, pruritus, dysuria, frequency, lower abdominal pain, or dyspareunia.

Question 42

A 20-year-old woman comes to the physician because of severe dysuria and a painful vulvar rash for 2 days. Examination shows vesicular lesions on an erythematous base on the right vulva. Which of the following is the most likely causal organism?

Answer 42

Candida albicans

Question 43

SCC of cervix, cells from this site will most likely drain first to which of the following lymph nodes in this patient?

Answer 43

internal iliac

Question 44

The ——– is at risk of injury during ligation of ovarian vessels in ovariectomy. Pt will have flank pain

Answer 44

ureter

Question 45

Congenital anomalies of the uterus are associated with congenital —————defects and is frequently discovered after hysterosalpingography during a work up of infertility.

Answer 45

paramesonephric (mullerian defects)

Question 46

——-– anchoring placental villi attach to the myometrium

Answer 46

Placenta accreta

Question 47

The most important risk factor for development of Placenta accreta is placenta ——– after a prior cesarean delivery.

Answer 47

previa

Question 48

A 55-year-old woman is scheduled to undergo transvaginal hysterectomy and oophorectomy for dysfunctional uterine bleeding. During the procedure, the uterus must be separated from all surrounding pelvic structures. Identification and incision of which of the following structures that attaches to the cervical region and extends posteriorly is most appropriate in this patient?

Answer 48

uterosacral ligament

The uterosacral and cardinal ligaments are connected at their cervical insertion, and together suspend the uterus. The uterosacral ligament passes posteriorly and inferiorly to attach to the ischial spine and sacrum. (The cardinal ligament contains the uterine vessels).

Question 49

Nausea, acute sharp right lower abdominal pain, Ultrasonography of the pelvis confirms the presence of an enlarged ovary, and Doppler ultrasonography shows decreased adnexal flow. Which of the following structures is most likely affected in this patient?

Answer 49

The suspensory ligament connects the ovaries to the lateral pelvic wall and contains ovarian vessels.

Question 50

A 35-year-old woman has an abnormal Pap smear. Examination of tissue obtained on cervical biopsy shows microinvasive cervical carcinoma. Which of the following microscopic features led to this diagnosis?

Answer 50

Neoplastic cells in sub-basement membrane connective tissue

Question 51

48yr old woman with uterine bleeding and period every 28-38 days. During pelvic examination, the adnexae are non palpable. Endometrial curettage shows abundant tissue. Which of the following is the most likely cause of this patient’s symptoms?

Answer 51

Endometrial hyperplasia is characterized by a proliferation of endometrial glands resulting in a greater gland-to-stroma ratio (>50 percent) than observed in normal proliferative endometrium
Endometrial hyperplasia typically presents with abnormal uterine bleeding and is most common in women who are perimenopausal or early postmenopausal

Question 52

If an operation is required to control post birth bleeding, ligation of a branch of which of the following arteries is most appropriate?

Answer 52

Bilateral ligation of the internal iliac arteries (hypogastric arteries) reduces the pulse pressure of blood flowing to the uterus

Question 53

painful urinatation, vaginal itching, odorless curd-like discharge. The pH of the vaginal discharge is 4. The saline slide shows mature squamous epithelial cells, and the KOH slide shows multiple buddingyeasts with pseudohyphae. What is it?

Answer 53

Candidiasis

Question 54

Two hours after vaginal delivery at term of a 3062-g (6-lb12-oz) newborn, a 32-year-old woman, gravida 3, para 3,has the onset of heavy vaginal bleeding. Labor wasaugmented with oxytocin because of a prolonged first stageand required forceps delivery over a midline second-degreeepisiotomy. The abdomen is soft and nontender.Examination shows a boggy uterus palpated 4 cm above theumbilicus. The perineum is intact. Which of the followingis the most likely cause of this patient’s hemorrhage?

Answer 54

uterine atony

Question 55

epinephrine on beta2-adrenoreceptors in females cause:

Answer 55

uterine relaxation

Question 56

A 26-year-old woman comes to the physician because of vaginal irritation and discharge for 5 days. She has been sexually active with the same partner for the past 6 months. Pelvic examination shows a frothy, yellow-green discharge in the vagina. The vaginal wall is markedly erythematous, and there are two red macular lesions on the cervix (strawberry cervix). The pH is 4. There is no foul or fishy odor. Microscopy shows motile organisms with flagella. What organism and how to treat?

Answer 56

Trichomoniasis is caused by the protozoa Trichomonas vaginalis.

Give Oral metronidazole

Question 57

A 20-year-old woman comes to the physician because her menstrual period is 1 week late. Menses had occurred at regular 28-day intervals. She had unprotected sexual intercourse with her boyfriend 20 days ago. A urine pregnancy test result is positive. Which of the following best describes the stage of development of the embryo at this time?

Answer 57

The neural plate is present, but the neural tube is not yet complete

Question 58

Increased concentration of estrogen and decreased concentration of progesterone means a woman is around day —– of her cycle. Estrogen concentrations hit their peak just before——

Answer 58

ovulation period (Day 14).

hit peak judt before ovulation

Question 59

An otherwise asymptomatic 52-year-old woman comes to the physician because of hot flashes. Her menses have been irregular for the past 6 months. Which of the following is the most likely physiologic cause of her symptoms?

Answer 59

Failure of the ovaries to secret 17 beta estradiol

Question 60

A 65-year-old woman comes to the physician because of progressive vulvar itching over the past 2 months; treatment with miconazole for yeast infections has been ineffective. Examination shows atrophy of the labia minora and thin, parchment-like skin over the vulva and around the anus. Which of the following is the most likely diagnosis?

Answer 60

Lichen sclerosus

Question 61

17-Hydroxyprogesterone Increased in —– defeciency

Answer 61

21 hydroxlase

Question 62

A 30-year-old woman with a long-standing history of pelvic inflammatory disease has surgical resection of a scarred segment of a fallopian tube. Which of the following inflammatory cells is most likely to be found in the resected specimen?

Answer 62

Macrophages

Question 63

A sexually active 32-year-old woman has vaginal pain and pain with urination. Pelvic examination shows bilateral vesiculoulcerative lesions of the introitus. Which of the following is the most appropriate antimicrobial therapy?

Answer 63

The nucleoside analogues acyclovir, valacyclovir, and famciclovir are the preferred antivirals for HSV infections.

Question 64

A 22-year-old nulligravid woman comes to the physician for counseling prior to conception. Menses have occurred at irregular 26- to 32-day intervals since menarche at the age of 14 years. BMI is 32 kg/m2. Her blood pressure is 130/80 mm Hg. Physical examination shows mild hirsutism and velvety brown, thickened skin at the base of the neck and around the axillae. This patient most likely also has which of the following conditions?

Answer 64

hyperinsulinimia

Acanthosis nigricans is a common, benign disorder that typically presents with velvety, hyperpigmented plaques on the skin. Insulin resistance likely plays a key role in many cases of acanthosis nigricans, including cases linked to obesity, diabetes, and some genetic syndromes.

Question 65

A 70-year-old woman comes to the physician for a routine pelvic examination. During speculum examination of the vagina and cervix, the Valsalva maneuver causes a bulge of the anterior vaginal wall. Which of the following is the most likely cause of this finding?

Answer 65

Cystocele

Anterior compartment prolapse – Hernia of anterior vaginal wall often associated with descent of the bladder (cystocele)

Question 66

The fetus is most vulnerable to major morphologic teratogenesis during organogenesis in the embryonic period of the ——trimester, between the —– and —–week of gestation

Answer 66

first trimester

between 3-8 weeks

Question 67

————contribute to the development of acne through stimulating the growth and secretory function of sebaceous glands.

Answer 67

Androgens

Question 68

Formation of ———– occurs following C difficile toxin-induced ulcer formation on the mucosal surface of the intestine, which facilitates release of serum proteins, mucus, and inflammatory cells.

Answer 68

pseudomembranes

Question 69

A 3-week-old infant is brought to the physician by his mother because of a 1-week history of increasingly frequent vomiting. The vomitus is nonbilious and consists of breast milk. He has had fewer wet diapers during the past 2 days. He was born at term following an uncomplicated pregnancy and initially fed well. He appears lethargic and dehydrated. A 1 × 2-cm, firm, mobile, olive-shaped mass is palpated immediately to the left of the epigastrium. Which of the following is the most likely diagnosis?

Answer 69

pyloric stenosis

Question 70

A 60-year-old man comes to the emergency department because of the sudden onset of acute abdominal pain and tenderness, nausea, vomiting, and bloody diarrhea 2 hours ago. He has a history of cirrhosis and hepatocellular carcinoma. His blood pressure is 99/50 mm Hg. His abdominal wall becomes rigid, with the loss of bowel sounds. During surgical intervention, half of the small intestine is found to have a dark purple-red hemorrhagic appearance. Which of the following is the most likely cause?

Answer 70

mesenteric venous thrombosis

Question 71

The ——— nerve releases gastrin-releasing peptide (GRP) to stimulate gastrin, which leads to increased acid secretion. The vagus nerve also directly stimulates the M3 receptor (via Ach) in parietal cells, which also leads to increased acid secretion. Thus, cutting the ——- trunks would decrease acid secretion.

Answer 71

vagus

Question 72

A 20-year-old man comes to the physician because of a 6-month history of diarrhea and a 16-kg (35-lb) weight loss. Physical examination shows pallor and pitting edema of the lower extremities. Laboratory studies show microcytic hypochromic anemia, hypoalbuminemia, and an increased fat concentration in stool. Serum anti-endomysium lgA and anti-tissue transglutaminase lgA antibodies are positive. A biopsy specimen of the small intestine is most likely to show which of the following in this patient?

what disease?

Answer 72

Loss of villi and increased number of intraepithelial lymphocytes

Celiac disease

Question 73

The presence of the carcinoid syndrome may be suspected when a patient demonstrates unexplained diarrhea or flushing. The most useful initial diagnostic test for the carcinoid syndrome is to measure 24-hour urinary excretion of —————- which is the end product of serotonin metabolism. Seventy-five to 80 percent of patients with carcinoid syndrome have tumors located in:

Answer 73

5-hydroxyindoleacetic acid (5-HIAA)

small bowel primary neuroendocrine tumors (NETs)

Question 74

——————- is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation, and an increased risk of gastrointestinal and nongastrointestinal cancer. The characteristic mucocutaneous pigmentations (melanin spots) of —— are present in more than 95 percent of patients, occurring most commonly on the lips and perioral region, palms of the hands, buccal mucosa, and soles of the feet.

Answer 74

Peutz-Jeghers syndrome (PJS)

https://medicoapps.org/peutz-jeghers-syndrome-2/

Question 75

A 68-year-old man comes to the physician because of difficulty swallowing solids for 2 months. He has a history of dilated cardiomyopathy. X-rays of the esophagus with barium contrast show indentation and posterior displacement of the esophagus. Enlargement of which of the following structures is the most likely cause of the dysphagia?

Answer 75

Left atrium

Question 76

A 55-year-old man with hepatic encephalopathy is brought to the physician because of confusion and increased lethargy during the past 24 hours. He has a history of cirrhosis of the liver caused by hepatitis C. He is easily arousable despite the lethargy. His temperature is 37°C (98.6° F). Physical examination shows scleral icterus, asterixis, a protuberant abdomen, and ascites. Test of the stool for occult blood is negative. Administration of which of the following drugs is most likely to improve this patient’s mental status?

Answer 76

Lactulose

Decreased metabolism of ammonia by the liver can lead to hepatic encephalopathy (impaired brain function in patients with liver failure). Lactulose is catabolized by colonic bacteria to short chain fatty acids, which lowers colonic pH. The decreased pH leads to formation of nonabsorbable NH4+ from NH3. The nonabsorbable NH4+ is then trapped in the colon and excreted, which reduces plasma ammonia concentrations by creating a gradient for the excretion of NH3.

Question 77

A 16-month-old boy is brought to the emergency department because of 2-to 3-minute episodes of acute abdominal pain over the past 6 hours. During the episodes, he turns pale, screams, and draws up his knees. He has also passed one bloody stool. A mass is palpated in the right upper quadrant of the abdomen. What is diagnosis?

What is the most appropriate next step in management?

Answer 77

Diagnosis: Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. It is the most common abdominal emergency in early childhood, particularly in children younger than two years of age.

Next step: Water-soluble contrast enema

When hydrostatic reduction is performed under fluoroscopic guidance, a water-soluble contrast enema is preferred because of the risk of perforation before or during the procedure. Water-soluble agents reduce the risk of electrolyte disturbances and peritonitis in patients in whom perforation has occurred.