Endocrine Flashcards
In type 1 diabetes mellitus, excessive lipolysis can lead to an uncontrolled increase in ketone bodies, which cause _______.
diabetic ketoacidosis
Type 1 diabetes is usually diagnosed (before/after) the age 30.
before
Diabetic ketoacidosis causes increased production of ketones such as ________.
beta-hydroxybutyrate and acetoacetate
A ______ state is much more common in type 2 diabetes than in type 1 diabetes, and it causes increased plasma osmolarity due to extreme dehydration and concentration of the blood.
hyperosmolar hyperglycemic
Volume repletion in patients with diabetic ketoacidosis is achieved using (isotonic/hypertonic) saline.
isotonic
Insulin sensitivity is (high/low) in diabetes mellitus type 1.
high
Type 1 diabetes mellitus is caused by type (III/IV) hypersensitivity
IV
_______ is a type of acid-base imbalance seen in diabetic ketoacidosis due to a loss of bicarbonate.
High anion gap metabolic acidosis
The mainstay of the treatment of diabetes mellitus type 1 is (insulin/oral hypoglycemics).
Insulin
The treatment regimen for type 2 diabetes mellitus should be adjusted to keep the fasting blood sugar below _____.
130
Diabetes mellitus type 2 has a relatively (strong/weak) genetic predisposition.
strong
Histology shows islet leukocytic infiltrate in diabetes mellitus type (1/2).
1
The most common initial manifestation of type 1 diabetes mellitus is elevated blood glucose (with/without) ketonemia.
with
Diabetes mellitus type 1 has association with HLA-DR3 and ________.
HLA-DR4
Patients with diabetes mellitus type 2 have (high/low) insulin sensitivity.
low
Diabetes mellitus type (1/2) is caused by a type IV hypersensitivity reaction.
1
In type 2 DM, _______ causes the pancreas to increase insulin production.
insulin resistance
DM type (1/2) is primarily associated with hyperosmolar non-ketotic hyperglycemia.
2
Polyphagia, glycosuria, polyuria, and polydipsia are all symptoms of _______.
uncontrolled diabetes mellitus
Anti-glutamic acid decarboxylase and islet cell cytoplasmic antibodies are associated with diabetes mellitus type (1/2).
1
DM type 2 (is/is not) associated with the human leukocyte antigen system.
is not
Patients with type 1 DM have (high/low) levels of serum c-peptide.
low
The blood glucose level of patients with DKA is usually above _______ mg/dl.
250
Insulin deficiency is (mild to moderate/severe) in DM type 1.
severe
Patients with diabetes mellitus type 2 show (mild to moderate/severe) glucose intolerance.
mild to moderate
________ is a severe life-threatening complication of diabetes mellitus characterized by severe hyperglycemia and accelerated ketogenesis.
Diabetic ketoacidosis
__________ in the pancreas produce insulin
Beta cells
Two-hour postprandial blood glucose greater than _______ mg/dl is an essential criterion for the diagnosis of diabetes mellitus.
200
DM type 1 has association with _______ and HLA-DR4
HLA-DR3
Insulin treatment is (always/sometimes) necessary in DM type 2.
sometimes
_______ is described as deep, labored breathing commonly associated with DKA.
Kussmaul breathing
In DKA, serum sodium is falsely (high/low) due to the osmotic load of glucose.
low
Fasting blood glucose of more than ______ mg/dl on two separate occasions is an essential criterion for diagnosing DM.
126
Type (1/2) DM is more commonly associated with DKA.
1
DKA occurs more often in DM type (1/2)
1
Ketoacidosis is (common/rare) in DM type 2.
rare
DM type 1 is caused by a type (I/II/III/IV) hypersensitivity reaction.
IV
_________ is a compound that gives patients with DKA a fruity odor to their breath.
Acetone
DM type (1/2) results from autoimmune destruction of beta cells in the pancreatic islets.
1
The beta-cell in the pancreatic islets of a patient with DM type 2 have ______ deposits.
amyloid
Cells that produce glucagon and insulin are located in the cluster of cells called the _______ in the pancreas.
Islet of Langerhans
Patients with DKA may have (prerenal/intrarenal/postrenal) azotemia due to volume depletion caused by osmotic diuresis.
prerenal
The primary defect of DM type 2 is increased insulin (resistance/deficiency).
resistance
The primary defect in DM type 1 is autoimmune destruction of the _____ of the pancreas.
beta-cells
Treatment of DKA includes hydration, management of electrolyte abnormalities, and ___________.
insulin
_________ is the most common non-inherited risk factor for developing DM type 2.
Obesity
IV bicarbonate should be given if the blood pH is lower than ___.
6.9
_______ is rare in DM type 2 as endogenous insulin usually prevent lipolysis.
DKA
The pathophysiology of type 1 DM is insulin (resistance/deficiency).
deficiency
______ is the biochemical pathway that is initially upregulated in DKA causing the increase in ketones.
Lipolysis
The total K+ level during DKA is (increased/decreased) while the serum level might be increased.
decreased
Type 2 DM is associated with (high/low) serum insulin.
high
DM type 1 (is/is not) associated with obesity.
is not
Blood sugar levels in patients with DLA are usually (higher/lower) than that of hyperosmolar hyperglycemic state.
lower
_____ is the best initial pharmacologic therapy for type 2 DM.
Metformin
The age for patients with DM type 2 usually is (more/less) than 40 years.
more
_______ breathing presents as rapid, deep breathing and is seen in DKA.
Kussmaul
Fasting serum glucose levels greater than or equal to ______ on two separate occasions are diagnostic of DM in an asymptomatic patient
126
The treatment regimen for type 2 DM should be adjusted to keep the glycosylated hemoglobin below _____ percent.
7
Serum insulin level is low in DM type (1/2).
1
In DKA, total body stores of potassium are (high/low).
low
DKA causes a(n) (increase/decrease) in epinephrine production.
increase
DM type 1 has a relatively (strong/weak) genetic predisposition.
weak
When starting the treatment of DKA, insulin bolus (is/is not) recommended before confirming the serum potassium is > or = 3.3 mEq/L.
is not
A 60-year-old male comes to the clinic complaining of numbness in his toes. He cannot quite pinpoint exactly when it started, but for the past three months, the patient has been unable to feel his big toes in his shoes. The patient can walk without any weakness in the legs, and he does not have any symptoms in the arms or fingers. The patient’s diet consists mainly of processed food and contains very few raw fruits or vegetables. Medical history includes obesity, chronic lower back pain, and type 2 DM. Medications include Tylenol and Metformin. The patient’s temp is 37, P 80, R 20, and BP 135/85. Physical examination reveals the patient to be comfortable, and the extremity exam demonstrates bilaterally diminished ankle reflexes and loss of monofilament sensation over the forefront of both plantar surfaces. Labs show a normal CBC and a Hgb A1c of 10.5%. Which of the following mechanisms is most likely contributing to this patient’s symptoms?
Protein kinase C deactivation
Sorbitol dehydrogenase deficiency
Fructose excess
NADPH excess
Aldose reductase deficiency
Sorbitol dehydrogenase deficiency
A 65-year-old woman comes to the clinic for a routine eye examination. Medical history includes type 2 diabetes, diagnosed 15 years ago, as well as hypertension and chronic kidney disease. Medications include insulin, lisinopril, and atorvastatin. Up until six months ago, the diabetes had been controlled on metformin and liraglutide, glucose measurements and hgb A1c. The patient’s temp 36.7, P 70, R 18, BP 130/85. Visual acuity testing shows a score of 20/60 in both eyes. Which of the following is most likely to be found on an ophthalmoscopic examination?
Retinal macroaneurysms
Retinal vein endothelial atrophy
Proliferation of retinal pericytes
Thinned retinal basement membrane
Leakage of lipid and proteinaceous materia
Leakage of lipid and proteinaceous materia
A 28-year-old woman comes to the emergency department with nausea and vomiting. Over the past few months, the patient has experienced episodes of nausea that occur primarily after eating meals and gradually resolve after a few hours. Tonight, 20 minutes after dinner, the patient experienced a sudden onset of abdominal pain with nausea and regurgitated the majority of her meal; the nausea persisted. The patient has not had a bowel movement in 3 days. She has a history of type 1 DM, which was diagnosed at age 12; it has been well managed with a strict insulin regimen delivered by an insulin pump. The patient also takes a multivitamin each evening. The patient’s T 37, P 80, R 16, BP 115/75. Physical examination reveals the patient to be thin and uncomfortable, with a tender epigastrium and mild abdominal distention. Lab studies show a normal CBC CMP and negative Beta hCG. Which of the following is the most likely underlying cause of this patient’s symptoms?
Autoimmune reaction to gluten proteins
Subepithelial collagen deposition
Bacterial overgrowth in the small bowel
Impaired neural control of gastric function
adverse medication effect
Impaired neural control of gastric function
The type of hormone interaction of _______ is where one hormone does not have its full effects without the presence of another hormone.
permissiveness
The types of glands that produce hormones are called ______ glands.
endocrine
The amine hormones, which are catecholamines and thyroid hormones, are derivatives of the amino acid ___________.
tyrosine
The endocrine system influences metabolic activity through the secretion of chemical messengers called _______.
hormones
The pituitary, thyroid, parathyroid, adrenal, and pineal glands are _______ glands.
endocrine
The type of hormone interaction of ______ is where more than one hormone produces the same effects at the target cell and their effects together are amplified.
synergism
Because they are _____, steroid hormones diffuse into target cells to bind and activate intracellular receptors.
lipid soluble
_______ are amino acids or steroids that increase or decrease the rates of normal cellular processes by acting on their target cells.
Hormones
When insulin binds to its insulin receptor, which is a _______ enzyme, it is activated by autophosphorylation.
tyrosine kinase
The hypothalamic-pituitary-target endocrine organ feedback loop is an example of _______ stimuli.
hormonal
In direct gene activation, a receptor-hormone complex binds to a specific region of _____ to prompt DNA transcription to produce a messenger RNA.
DNA
The hypothalamus has neural functions while also producing and releasing hormones, so it is referred to as a _______ organ.
neuroendocrine
________ stimulus is the type of trigger that causes endocrine glands to secrete hormones in response to changing blood levels of certain ions and nutrients.
Humoral
Natural ______ hormones are made of cholesterol and are synthesized and secreted by the adrenal cortex, gonads, corpus luteum, and placenta.
steroid
All steroid hormones are derivatives of ________.
cholesterol
Blood levels of many hormones vary within a narrow range due to _______, where target organ effects feed back to inhibit further hormone release.
negative feedback
The release of parathyroid hormone in response to decreased blood calcium levels is a type of _______ stimulus.
humoral
The release of norepinephrine and epinephrine from the adrenal medulla in response to sympathetic nervous system stimulation is a type of _____ stimuli.
neural
A _______ stimulus is the type of trigger that causes endocrine glands to secrete hormones in response to nerve fibers.
neural
Most hormones are peptides or proteins, and their synthesis is dictated by the messenger ribonucleotide _______.
mRNA
____- soluble hormones act on receptors in the plasma membrane to communicate with its target cell.
Water
Most amino-acid-based hormones, which are water-soluble, generate intracellular ______ when the hormone binds to a receptor in the plasma membrane.
second messengers
The type of hormone interaction of _______ is where one hormone opposes the action of another hormone.
antagonism
A _______ stimulus is the type of trigger that causes endocrine glands to secrete hormones in response to hormones produced by other endocrine organs.
hormonal
An Individual has a large blood clot at the right thyrocervical trunk. Which of the following arteries supplying the thyroid gland is most likely to be affected?
External carotid artery
Thyroid ima artery
Inferior thyroid artery
Superior thyroid artery
inferior thyroid artery
An individual is set to undergo a thyroidectomy. Which of the following anatomical relationships is correct?
1. The superior and inferior thyroid arteries run between the pretracheal layer of the deep cervical fascia and the fibrous capsule of the thyroid gland.
2. The thyroid gland is positioned superficial to the sternothyroid and sternohyoid muscles.
3. The thyroid gland typically sits at the level of C3 to C6.
4. the left and right thyroid lobes are connected by the pyramidal lobe.
The superior and inferior thyroid arteries run between the pretracheal layer of the deep cervical fascia and the fibrous capsule of the thyroid gland.
The increased oxygen consumption that stems from thyroid hormone release causes a(n) (increase/decrease) in cardiac output.
increase
Tetraiodothyronine is converted to triiodothyronine by the enzyme _____ by removing one atom from I2.
5-deiodinase
The second messenger for thyroid stimulating hormone is _______.
cAMP
_______ is released from the hypothalamus to stimulate secretion of TSH from the anterior pituitary.
Thyrotropin-releasing hormone
Tetraiodothyronine is formed by the combination of two ______ molecules
diiodotyrosine
Iodine ions are oxidized to I1 by (enzyme)_______ when they reach the apical membrane of the cell.
thyroid peroxidase
Increased basal metabolic rate, weight loss, sweating, and increased heat production are all symptoms of (hyperthyroidism/hypothyroidism).
hyperthyroidism
The formation of (triiodothyronine/tetraiodothyronine) is much faster than the other.
tetraiodothyronine
Thyroglobulin contains a large amount of (amino acid) ________.
tyrosine
The freshly synthesized thyroid hormones in colloid are attached to ______.
thyroglobulin
The _______ transports iodine from blood into follicular epithelial cells.
Na+-I- symporter
_______ is formed by the combination of one monoiodotyrosine and one diiodotyrosine molecule.
Triiodothyronine
The form of thyroid hormone that is more active is (triiodothyronine/tetraiodothyronine).
triiodothyronine
Thyroid hormone (increases/decreases) basal metabolic rate and body temperature through increased oxygen consumption.
increases
Decreased thyroxine-binding globulin, such as in hepatic failure, results in (increased/decreased) levels of free thyroid hormones and decreased synthesis of thyroid hormones.
increased
The thyroid gland synthesizes thyroid hormone in its _______ epithelial cells.
follicular
The hepatic breakdown of thyroxine-binding globulin is inhibited during pregnancy due to high levels of _______, causing an increased synthesis of thyroid hormones by removing negative feedback.
estrogen
Thiocyanate and perchlorate are (competitive/noncompetitive) inhibitors of Na+-I- cotransport.
competitive
The material in the center of a thyroid follicle surrounded by follicular epithelial cells is called _________.
colloid
Heart rate and contractility increase when thyroid hormone is released due to its effect on their _______ receptors.
beta-1-adrenergic
The _______ nuclei of the hypothalamus release oxytocin.
paraventricular
Triiodothyronine binds to a ________ receptor, and then stimulates DNA transcription by binding to a thyroid-regulatory element.
nuclear
The Na+-I- cotransport pump increases activity when the body has too (much/little) iodine.
little
A dietary I- deficiency appears similar to a deficiency of (enzyme) ________.
thyroid deiodinase
The _______ effect occurs when large amounts of I- inhibit organification, which is the combination of I2 and tyrosine of thyroglobulin to form monoiodotyrosine and diiodotyrosine.
Wolff-Chaikoff
The T3 resin uptake test assesses the circulating levels of _______.
thyroxine-binding globulin
Thyroid gland growth is regulated by _________ hormone.
thyroid stimulating
The thyroid gland secretes 90% of its thyroid hormone in the form of (triiodothyronine/tetraiodothyronine).
tetraiodothyronine
Thyroid hormone circulates the bloodstream bound to _______.
thyroxine-binding globulin
The process of thyroid hormone synthesis in the thyroid gland yields two types of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). Which of the following is true regarding the differences between these two types?
1. Only T3 bound to thyroxine-binding globulin is the active form of thyroid hormone.
2. T4 is the highly active form with a half-life of one to two days.
3. T3 binds nuclear receptors with greater affinity than T4.
4. Once inside the cell, T4 is mainly converted into reverse T3 (rT3) by 5’-deiodinase.
5. Only a tiny amount of T4 will travel unbound in the blood 0.3%
T3 binds nuclear receptors with greater affinity than T4.
An essential step in the formation of thyroid hormones is the organification of iodine to form Monoiodothyronine (MIT) and di-iodothyronine (DIT). Which of the following molecules is responsible for this reaction?
1. Perchlorate
2. Thyroid peroxidase
3. 5’-deiodinase
4. Thyroid deiodinase
5. Propylthiouracil
Thyroid peroxidase
A group of investigators is studying the function of the thyroid gland. They discovered that the thyroid hormone acts on nearly every cell in the body. Which of the following is most appropriate regarding thyroid hormone?
1. It regulates renal free water reabsorption and serum osmolality.
2. It inhibits ovulation in females by inhibiting GnRH synthesis and release.
3. It increases Ca2+ reabsorption from the distal collecting tubule.
4. It stimulates linear growth and muscle mass through IGF-1.
5. It has cardiac inotropic and chronotropic effects.
It has cardia inotropic and chronotropic effects.
A 41yr old woman comes to the physician complaining of excessive fatigue for the last 2 weeks. She states that 1 month ago, she had experienced episodes of palpitations and diarrhea, but those symptoms have now been taking a laxative several times a week to help with new-onset constipation, which started 3 weeks ago. T 36.5, P48, BP 124/88, BMI 22. Physical examination shows cold, dry skin and thinning hair on the scalp. There is 1+ non-pitting edema on both lower extremities. Which of the following additional findings is likely present in this patient?
1. decreased TSH levels
2. Human leukocyte antigen DQ8 positivity
3. Positive TSH-receptor antibodies
4. Positive antimicrosomal antibodies
5. Diffuse uptake of radioactive iodine thyroid scintigraphy.
positive antimicrosomal antibodies
Patients with Hashimoto thyroiditis may present with (hypothyroidism/hyperthyroidism) early in the course of the disease.
hyperthyroidism
Hashimoto thyroiditis can lead to hypothyroidism due to ________ destruction of the thyroid gland.
autoimmune
Hashimoto thyroiditis is associated with HLA-_____ and HLA-DR3
DR5
Hashimoto thyroiditis is (less/more) common in women than in men.
more
_______ and anti-thyroglobulin antibodies are diagnostic features of Hashimoto thyroiditis.
Anti-thyroid peroxidase
In fine needle aspiration biopsies, Hashimoto thyroiditis is characterized by the presence of ______ cells in conjunction with lymphocytes.
Hurthle
Hashimoto thyroiditis is an autoimmune cause of hypothyroidism that presents with a moderately enlarged, (tender/nontender) thyroid.
nontender
Hashimoto thyroiditis is the most common cause of hypothyroidism in the developed world where _____ levels are adequate.
Iodine
Hashimoto thyroiditis presents with an increased risk for ______ lymphoma.
primary B-cell
Regardless of whether hypothyroidism is present, Hashimoto thyroiditis can be treated with _______.
levothyroxine
Hashimoto thyroiditis can be both a type _____ and type four hypersensitivity reaction.
two
A 34 yr old woman comes to the physician due to irregular meses for the past 3 months. She states that previously her menses occurred every 28-30 days and lasted 4-5 days. She also notes excessive fatigue and recent weight gain of 9-lb in 2 months. She uses topical betamethasone for treatment of vitiligo, and she recently started taking laxatives several times a week to help with bowel movements. T 36.5, P52, BP 122/82, BMI 27. Physical examination shows dry skin and a slightly distended abdomen. She has delayed tendon reflex relaxation in the lower extremities. There is 2+ non-pitting edema in the bilateral lower extremities. Which of the following is the most likely cause of this patient’s edema?
1. Hormonal stimulation of fibroblasts
2. Decreased serum protein content
3. Increased venous capillary permeability
4. Impaired right-sided cardiac function
5. Incompetence of venous valves
hormonal stimulation of fibroblasts
A 60 yr. old woman comes to the office due to a neck lump. The patient reports no symptoms, weight loss dysphagia, or voice changes. She does not use tobacco, excessive alcohol, or illicit substances. T 37, P 70, BP 125/80. On physical examination, there is a fixed non-tender nodule in the left thyroid lobe. Serum TSH is within normal limits, and ultrasound shows a 2.5cm solid mass. A fine needle biopsy is obtained and shows varying degrees of follicles and microfollicles A decision is made to perform thyroid lobectomy. Which of the following pathohistological findings will confirm the diagnosis of follicular thyroid cancer?
1. Hurthle cells
2. Marked nuclear atypia
3. Capsular invasion
4. Pink material with Congo red stain
5. Concentric calcifications
Capsular invasion
A 65 yr-old woman comes to the clinic for evaluation of a neck lump she noticed while showering. Since it first appeared, it has rapidly increased in size. The patient has also noted some vocal changes and increased difficulty swallowing. Medical history is significant for papillary thyroid cancer in her 20’s, for which she underwent thyroid lobectomy. U/S reveals a hypoechoic mass in the residual left thyroid lobe with increased blood flow. Fine-needle biopsy shows a mixture of large pleomorphic and spindle-shaped cells. Which of the following is the most likely diagnosis?
1. Follicular carcinoma
2. Medullary carcinoma
3. Papillary carcinoma
4. Anaplastic carcinoma
Anaplastic carcinoma
A 55yr old woman comes to the office due to a neck lump she noticed while showering. The patient generally feels fine, and medical history is unremarkable. she has not had weight loss, dysphagia, or palpitations. T 37, P 80, BP 125/80. On physical examination, a nontender nodule occupying the right thyroid lobe is noted. The rest of the physical examination shows no abnormalities. Lab results show normal TSH levels. U/S of the neck reveals a 2 cm homogenous, anechoic nodule with an absence of internal flow. fine needle aspiration reveals cells with nuclear atypia. The lesion is surgically excised and sent to histology, which shows a spherical lesion with an intact capsule. The cells are arranged in uniform follicles with colloid. Thich of the following is the most likely diagnosis?
1. Subacute granulomatous thyroiditis
2. Anaplastic carcinoma
3. Toxic adenoma
4. Thyroid adenoma
5. Papillary carcinoma
Thyroid adenoma
A 40 yr. old woman is referred to the clinic for the evaluation of a thyroid nodule. Medical history is significant for Hodgkin lymphoma as a teenager, for which she received radiation treatment. T 36, P 82, R 14, BP 120/70. Physical examination shows a 2cm x 2cm hard nodule on the right lobe of the thyroid gland. The remainder of the physical examination shows no abnormalities. U/S imaging suggests malignancy, and fine needle aspiration is performed. Fine needle aspiration is most likely to show which of the following pathological findings?
1. Malignant proliferation of follicles that invade the capsule
2. Normal cells with fibrosis that extend to local structures.
3. Malignant cells with nuclear clearing and indentations
4. Undifferentiated malignant cells invading local structures
5. Malignant cells in an amyloid stroma.
Malignant cells with nuclear clearing and indentations
A 45 yr old man comes to the office due to a neck mass. The patient first noticed it a few months ago while shaving but did not seek medical care at that time. He also describes worsening weakness, abdominal pain, and constipation. Medical history is insignificant other than appendectomy at age 16. On physical examination, a painless lump is noted on the left lobe of the thyroid. Multiple painless cervical lymph nodes are also noted. The rest of the physical examination is normal. TSH levels are within normal limits. PTH and calcium levels are elevated. U/S is performed and reveals a solid and hypoechoic mass with microcalcifications. Which of the following features is most likely to be seen on fine-needle biopsy?
1. Sheets of polygonal cells in an amyloid stroma
2. Crowded tall, columnar cells forming papillae without fibrovascular cores.
3. Varying sizes of follicles filled with colloid
4. Pleomorphic and spindle-shaped anaplastic cells invading local structures
5. Cells with central clearing and interspersed concentric calcifications
Sheets of polygonal cells in an amyloid stroma
Medullary thyroid carcinomas are associated with MEN type _____ and 2B.
2A
The best confirmation test for thyroid cancer is __________.
fine needle biopsy
Thyroid papillary carcinomas may contain _______ which are calcium deposits in the papilla.
psammoma bodies
Thyroid follicular carcinomas are associated with mutations in the _______ gene and PAX8-PPARgamma 1 gene rearrangements.
RAS
Thyroid papillary carcinomas are associated with mutations in the (2 genes) _______ genes.
RET and BRAF
Medullary thyroid carcinomas arise from ________ cells.
C
Unlike papillary carcinoma, follicular carcinomas (do/do not) invade nearby lymph nodes.
do not
Most often, the first sign of thyroid cancer is _________.
a solitary painless nodule in the thyroid gland.
The most common type of thyroid cancer is _________.
Papillary carcinomas
________ have cells with few protein and DNA in their nuclei, which gives them an “Orphan Annie eye” appearance.
Papillary carcinoma
Spindle shaped cells and pleomorphic giant cells are features of _______ thyroid carcinomas.
anaplastic
a 47yr old woman presents to the emergency department due to altered mental status. She is accompanied by her partner, who reports that the patient was in her usual state before having severe nausea and vomiting during dinner. Medical history is remarkable for long standing Graves’ disease, but the patient has been noncompliant with medications. Last week, she had an upper respiratory infection that was resolved without treatment. T 40, P 155 and irregular, BP 155/100. On physical examination, the patient is agitated and in severe distress. The patient’s skin is moist, and a large goiter is noted. Lab tests show an elevated T3 and T4, low TSH, elevated liver enzymes, mild hyperglycemia, and leukocytosis. The patient is administered IV propranolol, propylthiouracil, and hydrocortisone. An hour later, the doctor adds a potassium iodide-iodine (Lugol’s) solution to the treatment. This medication has which of the following immediate effects?
1. Inhibition of iodide uptake into thyroid follicular cells
2. Thyroglobulin synthesis
3. Inhibition of hormone release
4. Inhibition of the conversion of T4 to T3
5. Inhibition iodide organification
Inhibition of hormone release
A 30 yr. old primigravida woman comes to the clinic at 10 weeks’ gestation due to flu-like symptoms and low-grade fever. A few weeks ago, she visited the clinic due to insomnia, anxiety, and palpitations. After a diagnosis was made, she was initiated with the appropriate treatment. Current T 37.8, P 80, BP 132/83. On physical examination, pharyngitis without exudate is noted. The absolute neutrophil count is 800/microL. Which of the following medications was most likely prescribed?
1. Methimazole
2. Propranolol
3. Radioiodine
4. Propylthiouracil
5. Hydrocortisone
Propylthiouracil
A 40 yr. old woman comes to the clinic due to anxiety and eye pain for the past few months. The patient also discloses a 10lb weight loss over the past 2 months without changes in her diet. Medical history is unremarkable, and she does not use caffeine, alcohol, or illicit drugs. T 37, P 110, BP 135/85. On physical examination, the patient’s skin is moist, and a diffuse goiter is noted. Examination of the eyes reveals mild exophthalmos and conjunctival erythema. Which of the following is most likely involved in the pathogenesis of the patient’s eye condition?
1. T3 hormone
2. Glycosaminoglycans deposition
3. Sympathetic hyperactivity
4. T4 hormone
5. TSH
Glycosaminoglycans deposition
A 65 yr. old woman comes into the clinic due to palpitations and diarrhea. Medical history is significant for type 2 diabetes mellitus, insomnia, and anxiety, for which she takes metformin diazepam. During the past year, she had a few episodes of chest pain and pressure, and two weeks ago, she underwent coronary angiography and stenting. T 37, P 110, BP 135/85. On physical examination, the patient appears nervous and diaphoretic. Which of the following is the most likely diagnosis?
1. Acute hemolytic transfusion reaction
2. Iodine induced hyperthyroidism
3. Contrast material allergic like reaction
4. Serum sickness
Iodine induced hyperthyroidism
A 50 yr. old woman comes to the clinic due to insomnia and anxiety over the past few months. The patient’s last menstrual period was 1 year ago, but she denies hot flashes or vaginal dryness. The patient notes that her hair has become fine lately, and she has been losing weight without intention. On physical examination, a nontender, diffuse goiter is noted. Lab tests show low TSH and high free T3 and T4 serum levels. the physician suspects that the patient’s condition is due to the most common cause of hyperthyroidism. Which of the following is the most specific finding for this condition?
1. Elevated creatine kinase levels
2. Onycholysis
3. Atrial fibrillation
4. Myxedema
5. Exophthalmos
Exophthalmos
A 37 yr old woman presents to the emergency department with a 2 day history of severe palpitations, dyspnea, restlessness, and fever. She also reports intermittent episodes of diarrhea over the past 2 days. She has a history of Graves’ disease but has been taking her prescribed methimazole consistently. T 39.6, P 150 and irregular, BP 145/95, R 26, O2 sats 92%. She appears agitated and diaphoretic on examination. Her skin is warm and moist to the touch, and she has an enlarged, non-tender gland. Neurological examination shows the presence of fine tremors and hyperreflexia. Lab studies reveal decreased TSH, increased fT4, and increased T3. An ECG shows atrial fibrillation. IV fluids are initiated. Which of the following is the best next step in management?
1. Administration of amiodarone
2. Administration of iodine solution
3. Administration of propranolol
4. Administration of broad-spectrum antibiotics
5. Emergent thryoidectomy
Propranolol
A 35 yr old woman presents to the primary care clinic due to unintentional weight loss, diarrhea, excessive sweating, and occasional diplopia. Past medical history is unremarkable. T 37.4, BP 152/78, P 120, R 18, O2 sat 98%. On physical examination, her thyroid gland is diffusely enlarged without nodules and non-tender, and her eyes exhibit significant proptosis with restrictive extraocular movements. Labs reveal a decreased TSH, elevated f T4, and positive thyroid stimulating immunoglobulin. Which of the following is the best next step in management?
1. Refer for thyroidectomy
2. Refer the patient for radioactive iodine ablation
3. Administer propylthiouracil
4. Selenium
5. Administer oral glucocorticoids
Refer for thyroidectomy
A 27yr old woman presents with a 3-month history of weight loss, heat intolerance, and increased irritability. Her family and coworkers have noticed changes in her eyes, describing them as looking like they are “popping out”. Past medical history is unremarkable. Social history is significant for a 6-pack year smoking history. T 36.9, BP 148/78, P 112, R 18, O2 sat 98%. The thyroid is enlarged, nodular and non-tender and her eyes appear prominent with mild lid lag. Labs reveal a low TSH and elevated fT4 and T3. Which of the following is the best next step in the evaluation?
1. Anti-thyroglobulin antibodies (anti-TGB) levels
2. MRI of the brain
3. Thyroid uptake scan
4. Fine-needle aspiration biopsy of the thyroid
5. Thyroid u/s
Thyroid uptake scan
