Endocrine Quiz Flashcards
1
Q
A 38year old woman who has been smoking 2 pkts of cigarettes daily for 20 yrs has also been taking combination oral contraceptives (Ethynyl estrodiol plus Norethindrone) during this same period.She has an increased risk of developing
A. Adrenal failure B. Breast cancer C. Polycystic ovary disease D. Thromboembolism E. Thyroid dysfunction
A
D.Thromboembolism
2
Q
A 21-year-old pregnant woman, at 28 weeks’ gestation, has a history of asthma and now is diagnosed with Graves disease. Which drug is most appropriate for treating Graves disease in this patient?
A. Methimazole B. Propranolol C. Propylthiouracil D. Radioactive iodine (I131) E. Sodium iodide
A
C. Propylthiouracil
3
Q
For emergency treatment of hypoglycemia from Insulin overdose in a 35 yr old man with severe type 2 DM, Glucagon would increase blood glucose by
A. Blockade of calcium channel B. Inhibition of c AMP C. Increased enhancement of gene expression pathways D. Formation of c AMP E. Formation of c GMP
A
D. Formation of c AMP
4
Q
Which of the following is a 5 alpha reductase inhibitor that would improve symptoms,reduce the risk of acute urinary retention,and delay the need for transurethral resection in a 55yr old man with an enlarged prostate?
A. DHEA B. Finasteride C. Flutamide D. Leuprolide E. Ketoconazole
A
B. Finasteride
5
Q
. Known complications of the combined oral birth control pill (OBCP) include all EXCEPT:
A. thromboembolic disorders including stroke and MI B. Benign hepatic adenoma C. Growth retardation D. chloasma E. Weight gain
A
C. Growth retardation
6
Q
Correct statements concerning the mechanisms of action of anti-thyroid drugs include all of the following EXCEPT:
A. PTU inhibits organification and coupling reactions; in addition it prevents peripheral conversion of T4 to T3
B. Iodide prevents dietary iodine uptake and also release of T3 and T4 from thyroglobulin
C. Methimazole inhibits organification and coupling reactions
D. propranolol decreases peripheral T3 formation and decreases heart rate in patients with thyrotoxicosis
E. Lithium is the drug of choice for thyroid storm
A
E. Lithium is the drug of choice for thyroid storm
7
Q
Side effects of thiourea anti-thyroid medications (propylthiouracil and Methimazole) include:
A. Hyperthyroidism B. priapism C. Agranulocytosis D. SIADH E. Iodism
A
C. Agranulocytosis
8
Q
All of the following are progestin components of oral birth control pills EXCEPT:
A. norgestrol B. norethindrone acetate C. Medroxy progesterone D. Mestranol E. Levonorgestrol
A
D. Mestranol
9
Q
Agents, which may be useful for treating hyperthyroidism, include all of the following EXCEPT:
A. propylthiouracil B. corticosteroids C. Lugol's solution of potassium iodide D. propranolol E. bromocriptine
A
E. bromocriptine
10
Q
The metabolic actions of insulin may be described as:
A. Increased Gluconeogenesis
B. Increased conversion of protein to glucose
C. Inhibition of hormone-sensitive lipase
D. Enhanced glycogenolysis
E. Enhanced glycosuria
A
C. Inhibition of hormone-sensitive lipase
11
Q
Potential side effects of therapy with chlorpropamide include all of the following EXCEPT:
A. SIADH (syndrome of inappropriate ADH secretion) B. "Antabuse reaction" C. Skin rash D. Lactic acidosis E. Hypoglycemia
A
D. Lactic acidosis
12
Q
Statements, which explain the mechanism of action of oral sulfonylurea agents, include all of the following EXCEPT:
A. Decreased hepatic glucose production
B. Increased tissue sensitivity to insulin
C. Increased insulin binding to the insulin receptor
D. Correction of post-receptor defects which contribute to insulin
E. Regenerate beta cells of the pancreas
A
E. Regenerate beta cells of the pancreas
13
Q
Anti-estrogens are useful in the treatment of hormonally responsive breast cancer. Agents, which have anti-estrogenic activity at the estrogen receptor, include:
A. tamoxifen B. norethynodrel C. goserelin D. ketoconazole E. aminoglutethimide
A
A. tamoxifen
14
Q
Hyponatremia has been associated with carbamazepine and certain oral hypoglycemic agents. Oral hypoglycemic agents, which have been associated with SIADH include:
A. glipizide B. acetazolamide C. tolazamide D. chlorpropamide E. acetohexamide
A
D. chlorpropamide
15
Q
A 51-year-old man with type 2 diabetes mellitus is treated with glipizide. This drug’s efficacy is due to its ability to
A. block ATP-dependent K+ channels in the pancreatic beta cells
B. decrease hepatic production of glucose and improve insulin sensitivity
C. directly open voltage-dependent Ca2+ channels in the pancreatic beta cells
D. increase transcription of insulin-responsive genes that control glucose uptake
E. inhibit 5α-glucosidase activity in the brush border of the small intestine
A
A. block ATP-dependent K+ channels in the pancreatic beta cells
16
Q
. A 47-year-old man has progressive fatigue, nausea, anorexia, weight loss, hyperpigmentation, and orthostatic hypotension. Laboratory findings include a low morning level of cortisol, an elevated level of adrenocorticotropic hormone, and hyponatremia. Which of the following drugs is most appropriate to correct the mineralocorticoid activity in this patient?
A. Dexamethasone B. Eplerenone C. Fludrocortisone D. Hydrocortisone E. Spironolactone
A
C. Fludrocortisone
17
Q
One of the following is Adrenal steroid Synthesis Inhibitors
A. Spirinolactone B. Metyropone C. Mefipristone D. Fludrocortisone E. Dexamethasone
A
B. Metyropone
18
Q
Anti estrogen drug which is used in Endrometriosis and Fibrocystic disease of Breast is
A. Clomephene B. Danazol C. Tamoxifen D. Anastrozole E. Raloxifene
A
B. Danazol
19
Q
Progesterone is combined with Estrogen for decreasing the incidence of
A. Breast Carcinoma B. Endometrial Carcinoma C. Cervical carcinoma D. Bladder carcinoma E. All of the above
A
B. Endometrial Carcinoma
20
Q
GnRH analog that is used in the treatment of Prostate Carcinoma is
A. Flutamide B. Finasteride C. Leuprolide D. Ketoconazole E. All of the Above
A
C. Leuprolide
21
Q
Insulin Release is decreased by
A. Beta 2 agonists B. Alpha2 agonists C. M activators D. Glucose E. Sulfonylureas
A
B. Alpha2 agonists
22
Q
A 19-year-old woman with primary dysmenorrhea has recently begun taking a combination oral contraceptive agent. She now complains of migraine-like headaches, nausea, “bloating,” breast tenderness, and “brown spots” on her cheeks. These adverse effects are most likely attributable to which component in the contraceptive agent?
A. Desogestrel B. Megestrel C. Mestranol D. Norethindrone E. Norgestrel
A
C. Mestranol
23
Q
Troglitazone is more prone for which toxicity and made for withdrawl
A. Renal toxicity B. Bonemarrow toxicity C. Hepatotoxicity D. Neurotoxicity E. All of the above
A
C. Hepatotoxicity
24
Q
Which of the following is Aromatase inhibitor?
A. Clomephene B. Danazol C. Tamoxifen D. Anastrozole E. Raloxifene
A
D. Anastrozole
25
A 23-year-old woman is in the clinic because of a 20-pound weight gain over the past 3 weeks. She feels fatigued and has been sleeping more. Medication includes paroxetine for depression, amoxicillin/clavulanate for acute sinusitis, and prednisone for Crohn’s disease. During this time, her depression has worsened, but she does not have suicidal ideation. Physical examination shows acne and a rounded face. A pad of fat is present between her shoulders. There are purple stretch marks on her abdomen, upper thighs, and upper arms. Laboratory results follow. Which of the following is the most appropriate treatment?Blood Studies Patient’s Value
White Blood Cell 11.9 * 103/mm3
Red Blood Cell 5.0 * 106/mm3
Hemoglobin 14.2 gm/dL
Hematocrit 41.8
Platelets 277 * 103/mm3
Sodium 141 mEql/L
Potassium 4.3 mEq/L
Chloride 104 mEq/L
CO2 23 mEql/L
Blood urea nitrogen 11 mg/dL
Creatinine 0.6 mg/dL
Blood glucose 211 mg/dL
Calcium 9.2 mg/dL
Total Protein 7.3 gm/dL
Albumin 4.4 gm/dL
Bilirubin 0.7 mg/dL
Alkaline phosphatase 120 IU/L
ALT 33 IU/L
AST 16 IU/L
TSH 2.7 microunits/mL
Free T4 4.1 mcg/dL
A. Initiation of levothyroxin
B. Cessation of glucocorticoid
C. Discontinuation of paroxetine
D. Supplementation with fludrocortisone
E. Addition of methylprednisolone
B. Cessation of glucocorticoid
26
Which of the following best describes the effect of propylthiouracil on thyroid hormone production?
A. It blocks the release of thyrotropin-releasing hormone.
B. It inhibits uptake of iodide by thyroid cells.
C. It prevents the release of thyroid hormone from thyroglobulin.
D. It blocks iodination and coupling of tyrosines in thyroglobulin to form thyroid hormones.
E. It blocks the release of hormones from the thyroid gland.
D. It blocks iodination and coupling of tyrosines in thyroglobulin to form thyroid hormones.
27
A 36-year-old woman develops excessive thirst after sustaining a severe head injury with a fracture at the base of the skull in an automobile accident. Her daily water intake is 50 L; because of the ensuing polyuria, she has to get up several times during the night to void. Laboratory findings include the following: serum osmolality, >305 mOsmol/kg; urine osmolarity,
A. Desmopressin
28
A fifty-year-old woman has just been diagnosed as a Type 2 diabetic and given a prescription for metformin. Which of the following statements is characteristic of this medication?
A. Hypoglycemia is a common adverse effect.
B. Metformin undergoes metabolism to an active compound.
C. Many drug-drug interactions have been identified.
D. It increases peripheral glucose uptake and utilization in target tissues.
E. The patient often gains weight.
D. It increases peripheral glucose uptake and utilization in target tissues.
29
The ability to reduce insulin resistance is associated with which one of the following classes of hypoglycemic agents?
```
A. Tolbutamide
B. Sulfonylureas
C. alpha-Glucosidase inhibitors
D. Thiazolidinediones
E. Gastrointestinal hormones
```
D. Thiazolidinediones
30
A 64-year-old woman with a history of Type 2 diabetes is diagnosed with heart failure. Which of the following drugs would be a poor choice in controlling her diabetes?
```
A. Metformin
B. Glyburide
C. Glipizide
D. Pioglitazone
E. All of the above
```
D. Pioglitazone
31
Young athletes who abuse androgens should be made aware of the side effects of these drugs. Which one of the following is, however, not of concern?
```
A. Increased muscle mass
B. Anemia due to bone marrow failure
C. Overly aggressive behavior
D. Decreased spermatogenesis
E. Stunted growth
```
B. Anemia due to bone marrow failure
32
A 70-year-old woman is being treated with raloxifene for osteoporosis. There is an increased risk of her developing:
```
A. breast cancer.
B. uterine cancer.
C. vein thrombosis.
D. atrophic vaginitis.
E. hypercholesterolemia.
```
C. vein thrombosis.
33
A 23-year-old woman has failed to become pregnant after two years of unprotected intercourse. Which of the following would be effective in treating infertility due anovulatory cycles?
```
A. A combination of an estrogen and progestin
B. Estrogen alone
C. Clomiphene
D. Raloxifene
E. All of the above
```
C. Clomiphene
34
Tamoxifen is used to treat some breast cancers because of its ability to
A. Utilize its androgenic properties in retarding tumor growth
B. Prevent estrogen synthesis by the ovary
C. Enhance glucocorticoid treatment
D. Act as an estrogen antagonist
E. Act as a potent progestin
D. Act as an estrogen antagonist
35
Bromocriptine is used to treat some cases of amenorrhea because it
A. Stimulates release of gonadotropin-releasing hormone (GnRH)
B. Stimulates the ovary directly
C. Is an estrogen antagonist that enhances gonadotropin release
D. Inhibits prolactin release
E. Increases the synthesis of follicle-stimulating hormone (FSH)
D. Inhibits prolactin release
36
Finasteride is approved for use in male pattern baldness, where it appears to act as
```
A.an activator of estrogen receptors
B. an inhibitor of 5-alpha reductase
C. an aromatase inhibitor
D. an androgen receptor antagonist
E. a feedback inhibitor of FSH
```
B. an inhibitor of 5-alpha reductase
37
A 47 year old man exhibited signs and symptoms of acromegaly. Radiologic studies showed the presence of large pituitary tumor. Surgical treatment of the tumor was only partially effective in controlling his disease. At this point, which of the following drugs is most likely to be used as Pharmacologic therapy?
```
A. Cosyntropin
B. Desmopressin
C. Leuprolide
D. Octreotide
E. All of the above
```
D. Octreotide
38
A 24 year old woman is found to have thyrotoxicosis. She appears to be in good health otherwise. It is decided to place her on antithyroid drug therapy. Agents that could be used to treat this woman’s thyrotoxicosis do not include
```
A. Methimazole
B. Potassium iodide
C. Propylthiouracil
D. Radioactive iodine
E. Thyroglobulin
```
E. Thyroglobulin
39
Potential drug toxicities that might be considered in the treatment of thyrotoxicosis are least likely to include
```
A. Iodide ion : acne like rash
B. Ipodate : skin rash
C. Methimazole : Agranulocytosis
D. Propylthiouracil: SLE like syndrme
E. RAI : radiation damage to the ovaries
```
E. RAI : radiation damage to the ovaries
40
A 75-year-old male, post prostatectomy for carcinoma of the prostate with local metastasis found during surgery, would best be treated with which of the following?
```
A. Mifepristone
B. Spironolactone
C. Aminoglutethimide
D. Leuprolide
E. Fludrocortisone
```
D. Leuprolide
41
Concern is raised in an 86-year-old male with non-insulin-dependent diabetes mellitus (NIDDM), or type II diabetes, about the possibility of hypoglycemia when considering the use of an oral hypoglycemic agent. Which of the following antidiabetic drugs is least likely to cause hypoglycemia?
```
A. Metformin
B. Chlorpropamide
C. Insulin
D. Glyburide
E. Repeglinide
```
A. Metformin
42
Tolbutamide is:
A. A highly specific inhibitor of catechol-o-methyltransferase
B. A potent inhibitor of iodide accumulation by the thyroid and salivary glands
C. An anti androgen with potent progestational activity
D. A promoter of insulin release from the pancreas
E. An oxytocic substance used to reduce uterine bleeding after delivery
D. A promoter of insulin release from the pancreas
43
```
A 27-year-old woman has suffered from intermittent heat intolerance, sweating, tremors, tachycardia, and muscle weakness for 3 months. Despite an increased appetite, she has experienced weight loss. Blood studies show a thyroid-stimulating hormone value of less than 0.05 μU/mL and a total thyroxine (T4) value of 18 μg/dL. A drug that could be beneficial to this patient and acts to inhibit the synthesis of thyroid hormones and prevent the conversion of T4 to T3 (triiodothyronine) in peripheral tissues is
A. methimazole
B. propranolol
C. propylthiouracil
D. radioactive iodine (131I)
E. sodium iodide
```
C. propylthiouracil
44
When initiating T4 therapy for an elderly patient with long standing hypothyroidism,it is important to begin with small doses to avoid
```
A. A flare of exophthalmos
B. Acute RF
C. Hemolysis
D. Overstimulation of the heart
E. Seizures
```
D. Overstimulation of the heart
45
A 32-year-old woman is found to have pulmonary tuberculosis and is placed on the standard four-drug treatment regimen. She has been taking an oral contraceptive containing ethinyl estradiol and norethindrone, and is advised to use a non-hormonal method of contraception during her treatment for tuberculosis. What is the most likely mechanism of decreased contraceptive effectiveness in this patient?
A. Antiestrogen effect
B. Antiprogestin effect
C. Impaired absorption of estrogen and progestin
D. Induction of cytochrome P450 enzymes
E. Inhibition of sex hormone-binding globulin synthesis
D. Induction of cytochrome P450 enzymes
46
```
A 33-year-old woman comes to the clinic because of feelings of anxiety and a 15-lb weight loss during the past 2 weeks. Additionally, she has been sweating more. Physical examination shows swelling on the medial aspect of the neck that extends laterally to the left. Her skin feels warm and moist to the touch. Which of the following is the most appropriate treatment?
A. Levothyroxine
B. Methimazole
C. Somatotropin
D. Prednisolone
E. Alendronate
F. Melatonin
```
B. Methimazole
47
```
A 63-year-old woman who began treatment for type 2 diabetes mellitus returned 6 weeks later for follow-up care. She is experiencing nausea, headache, dizziness, fatigue, and confusion, and the symptoms have become worse over the past 2 weeks. Physical examination and laboratory studies show serum Na+ of 110 mEq/L, serum Cl− of 88 mEq/L, serum osmolality of 236 mOsm/kg, and urine osmolality inappropriately concentrated relative to the serum Na+ value. There is no evidence of dehydration or of abnormal renal, adrenal, or thyroid function. Therapy with which oral hypoglycemic drug would most likely be responsible for the current symptoms?
A. Acarbose
B. Carbamazepine
C. Chlorpropamide
D. Glyburide
E. Metformin
```
C. Chlorpropamide
48
A 13-yr-old boy with type 1 diabetes is brought ro the hospital complaining of dizziness. Laboraroty fìndings include severe hyperglycemia,ketoacidosis, and a blood pH of7.15. Which of the following agents should be administered to achieve rapid control of the severe ketoacidosis in this diabetic boy?
```
(A) Crystalline zinc insulin
(B) Glyburide
(C) Insulin glargine
(D) NPH insulin
(E) Tolbutamide
```
(A) Crystalline zinc insulin
49
The estrogen that is used in most combined hormone contraceptives is
```
A. Clomiphene
B. Ehinyl estradiol
C. norethindrone
D. DES
E. Norgestrol
```
B. Ehinyl estradiol
50
Men who use large doses of anabolic steroids are at increased risk of
```
A. Anemia
B. Cholestatic jaundice and elevation of AST levels in the blood
C. Hirsutism
D. Hyperprolactinemia
E. Testicular enlargement
```
B. Cholestatic jaundice and elevation of AST levels in the blood
51
A woman goes into premature labor early enough that there are great concerns about inadequate fetal lung development and the risk of fetal respiratory distress syndrome. Ritodrine therapy is started to slow labor, but parturition seems imminent. Which of the following adjuncts should be administered prepartum, specifically for the purpose of reducing the risks and complications of the newborn's immature respiratory system development?
```
A. Albuterol (2 agonist)
B. Betamethasone
C. Ergonovine (or methylergonovine)
D. Indomethacin
E. Magnesium sulfate
```
B. Betamethasone
52
Which of the following antidiabetic agents acts on the peroxisome proliferator-activated receptor-gamma (PPAR-gamma) nuclear receptor?
```
A. acarbose
B. glyburide
C. insulin lispro
D. metformin
E. pioglitazone
```
E. pioglitazone
53
A 5-year-old girl with moderate bronchial asthma is being managed with the inhalation of a drug containing 100 μg of fluticasone and 50 μg of salmeterol per inhalation. The drug is administered in the morning and at night, about 12 hours apart. Which of the following molecular entities is likely to be up-regulated by fluticasone in this patient?
```
A.β-Adrenergic receptors
B.Cyclooxygenase-2
C.5-Lipoxygenase
D.Phospholipase A2
E.Tumor necrosis factor
```
A.β-Adrenergic receptors
54
Which of the following drugs is most likely to cause hypoglycemia when used as monotherapy in the treatment of type 2 diabetes?
```
(A) Acarbose
(B) Glyburide
(C) Metformin
(D) Miglitol
(E) Rosiglitazone
```
(B) Glyburide
55
A 64-year-old man has been experiencing urinary urgency for several years, and his prostate-specific antigen (PSA) level has been increasing rapidly during the past few months. A biopsy confirmed a stage D2 prostatic cancer which is being treated with a combination of leuprolide, flutamide, and radiation therapy. What is the molecular target of flutamide in the treatment of this patient?
A.Androgen receptor
B.Follicle-stimulating hormone (FSH) receptor
C.Gonadotropin-releasing hormone (GnRH) receptor
D.Luteinizing hormone (LH) receptor
E.Retinoic acid receptors (RAR)
A.Androgen receptor
56
Anti-estrogens are useful in the treatment of hormonally responsive breast cancer. Agents, which have anti-estrogenic activity at the estrogen receptor, also used in treatment of Osteoporosis include:
```
A. Raloxefene
B. norethynodrel
C. goserelin
D. ketoconazole
E. aminoglutethimide
```
A. Raloxefene
57
Which one of the following agents is INCORRECTLY paired to a clinical use of the drug?
A. Desmopressin: treatment of diabetes insipidis
B. Octreotide: treatment of diarrhea associated with vasoactive intestinal peptide tumors
C. Oxytocin: induction of labor
D. hCG: treatment of infertility in men and women
E. Pegvisomant: treatment of short stature in men and women.
E. Pegvisomant: treatment of short stature in men and women.
58
A 27-year-old woman with amenorrhea, infertility , and galactorrhea was treated with a drug that successfully restored ovulation and menstruation. Before being given the drug, the woman was carefully questioned about previous mental health problems, which she did not have. She was advised to take the drug orally. Which of the following is most likely to be the drug that was used to treat this patient?
```
A. Bromocriptine
B. Desmopressin
C. Human gonadotropin hormone
D. Leuprolide
E. Octreotide
```
A. Bromocriptine
59
A 29-year-old woman in her 41st wk of gestation had been in Labor for 12 h. Although her uterine contractions had been strong and regular initially, they had diminished in force during the past hour. Which of the following agents would be used to facilitate this woman's labor and delivery?
```
A. Dopamine
B. Leuprolide
C. Oxytocin
D. Prolactin
E. Vasopressin
```
C. Oxytocin
60
Which of the following is a drug that is purified from the urine of postmenopausal women and used to promote spermatogenesis in infertile men?
```
A. Desmopressin
B. Gonadorelin
C. Goserelin
D. Somatropin
E. Urofollitropin
```
E. Urofollitropin
61
A 3-year-old boy with failure to thrive and metabolic disturbances was found to have an inactivating mutation in the gene that encodes the growth hormone receptor. Which of the following drugs is most likely to improve his metabolic function and promote his growth?
```
A. Desmopressin
B. Bromocriptine
C. Mecasermin
D. Octreotide
E. Somatropin
```
C. Mecasermin
62
A 3-year-old girl presented with hirsutism, breast enlargement, and a height and bone age that was consistent with an age of 9. Diagnostic testing revealed precocious puberty. Which of the following is the most appropriate drug for treatment of this patient's precocious puberty?
```
A. Atosiban
B. Follitropin
C. Leuprolide
D. Octreotide
E. Pegvisomant
```
C. Leuprolide
63
A 7-year-old boy underwent successful chemotherapy and cranial radiation for treatment of acute lymphocytic leukemia. One month after the completion of therapy, the patient presented with excessive thirst and urination plus hypernatremia. Laboratory testing revealed pituitary diabetes insipidus. To correct these problems, this patient is likely to be treated with which of the following?
```
A. Corticotropin
B. Desmopressin
C. hCG
D. Menotropins
E. Thyrorropin
```
B. Desmopressin
64
A 37-year-old woman with infertility due to obstructed fallopian tubes was undergoing ovulation induction in preparation for in vitro fertilization. After 10 d of treatment with leuprolide, the next step in the procedure is most likely to involve 1 0一14 d of treatment with which of the following?
```
A. Bromocriptine
B. Follitropin
C. Gonadorelin
D. Oxytocin
E. Pergolide
```
B. Follitropin
65
The decision is made to begin treatment with methimazole. Methimazole reduces serum concentration of T3 primarily by which of the following mechanisms?
A. Acceleraring the peripheral merabolism ofT3
B. Inhibiting the proteolyses is of thyroid-binding globulin
C. Inhibiting the secretion of TSH
D. Inhibiting the uptake of iodide by cells in the thyroid
E. Preventing the addition of iodine to tyrosine residues on thyroglobulin
E. Preventing the addition of iodine to tyrosine residues on thyroglobulin
66
You have prescribed an oral agent to help control a patient's blood glucose levels. He has Type 2 diabetes. In explaining how the drug works, you describe it as a "starch blocker" that inhibits the intestinal uptake of complex carbohydrates in the diet. You advise also that flatus or some cramping or "grumbling sounds" in the belly may develop. Which of the following drugs best fits this description?
```
A. Acarbose
B. Any thiazolidinedione ("glitazone")
C. Glipizide
D. Metformin
E. Tolbutamide
```
A. Acarbose
67
The PPAR-y receptor that is activated by thiazolidinediones increases tissue sensitivity to insulin by which of the following mechanisms?
(A) Activating adenylyl cyclase and increasing the intracellular concentration of cAMP
(B) Inactivating a cellular inhibitor of the GLUT2 glucose transporter
(C) Inhibiting acid glucosidase, a key enzyme in glycogen breakdown pathways
(D) Regulating transcription of genes involved in glucose utilization
(E) Stimulating the activity of a tyrosine kinase that phosphorylates the insulin receptor
(D) Regulating transcription of genes involved in glucose utilization
68
A 56-yr-old woman presented to the emergency department with tachycardia, shortness of breath, and chest pain. She had had shortness of breath and diarrhea for the last 2 d and was sweating and anxious. A relative reported that the patient had run out of methimazole 2 wk earlier. A TSH measurement revealed a value of
D. Propranolol
69
A 69-yr-o ld man with multinodular goiter is scheduled for a near-total thyroidectomy. Which of the following drugs will be administered for 10- 14 d before surgery to reduce the vascularity of his thyroid gland?
```
A. Levothyroxine
B. Liothyronine
C. Lugol's solution
D. Prednisone
E. Radioactive iodine
```
C. Lugol's solution
70
A 46-yr-old male patient has Cushing's syndrome that is due to the presence of an adrenal tumor. Which of the following drugs would be expected to reduce the signs and symptoms of this man's disease?
```
(A) Betamethasone
(B) Cortisol
(C) Fludrocortisone
(D) Ketoconazole
(E) Triamcinolone
```
(D) Ketoconazole
71
A 34-yr-old woman with ulcerative colitis has required long term treatment with pharmacologic doses of a glucocorticoid agonist. Which of the following is a toxic effect associated with long-term glucocorticoid treatment?
```
(A) A “lupus-like" syndrome
(B) Adrenal gland neoplasm
(C) Hepatoroxicity
(D) Osteoporosis
(E) Precocious puberty in children
```
(D) Osteoporosis
72
Which of the following is a pharmacologic effect of exogenous glucocorticoids?
```
(A) Increased muscle mass
(B) Hypoglycemia
(C) Inhibition of leukotriene synthesis
(D) Improved wound healing
(E) Increased excretion of salt and water
```
(C) Inhibition of leukotriene synthesis
73
A newborn girl exhibited ambiguous genitalia,hyponatremia, Hyperkalemia, and hypotension and as a result of genetic deficiency of 21 beta hydroxylase activity. Treatment consists of fluid and salt replacement and hydrocortisone administration. In this type of adrenal hyperplasia in which there is excess production of cortisol precursors, which of the follow describes the primary therapeutic effect of glucocorticoid administration?
```
(A) Increased adrenal estrogen synthesis
(B) Inhibition of adrenal aldosterone synthesis
(C) Prevention of hypoglycemia
(D) Recovery of normal immune function
(E) Suppression of ACTH secretion
```
(E) Suppression of ACTH secretion
74
Glucocorticoids have proved useful in the treatment of which of the following medical conditions?
```
(A) Chemotherapy-induced vomiting
(B) Essential hypertension
(C) Hyperprolactinemia
(D) Parkinson's disease
(E) Type 11 diabetes
```
(A) Chemotherapy-induced vomiting
75
A 56-yr-old woman with systemic lupus erythematosus had been maintained on a moderate daily dose of prednisone for 9 mo. Her disease has finally gone into remission and she now wishes to gradually taper and then discontinue the prednisone. Gradual tapering of a glucocorticoid is required for recovery of which of the following?
(A) Depressed release of insulin from pancreatic B cells
(B) Hematopoiesis in the bone marrow
(C) Normal osteoblast function
(D) The control by vasopressin of water excretion
(E) The hypothalamic-pituitary-adrenal system
(E) The hypothalamic-pituitary-adrenal system
76
A 54-yr-old man with advanced tuberculosis has developed signs of severe acute adrenal insufficiency. Which of the following signs or symptoms is this patient most likely to exhibit?
```
(A) A moon face
(B) Dehydration
(C) Hyperglycemia
(D) Hypertension
(E) Hyperthermia
```
(B) Dehydration
77
A 54-yr-old man with advanced tuberculosis has developed signs of severe acute adrenal insufficiency. The patient should be treated immediately. Which of the following combinations is most rational?
```
(A) Aldosterone and fludrocortisone
(B) Cortisol and fludrocortisone
(C) Dexamethasone and metyrapone
(D) Fludrocortisone and metyrapone
(E) Triamcinolone and dexamethasone
```
(B) Cortisol and fludrocortisone
78
Which of the following is a unique property of SERMs?
(A) Act as agonists in some tissues and antagonists in other tissues
(B) Activate a unique plasma membrane-bound receptor
(C) Have both estrogenic and progestational agonist activity
(D) Inhibit the aromatase enzyme required for estrogen synthesis
(E) Produce estrogenic effects without binding to estrogen receptors
(A) Act as agonists in some tissues and antagonists in other tissues
79
Finasteride has efficacy in the prevention of male-pattern baldness by virtue of its ability to do which of the following?
(A) Competitively antagonize androgen receptors
(B) Decrease the release of gonadotropins
(C) Increase the serum concentration of sex hormone binding globulin
(D) Inhibit the synthesis of testosterone
(E) Reduce the production of dihydrotestosterone
(E) Reduce the production of dihydrotestosterone
80
A 52-yr-old postmenopausal patient has evidence of low bone mineral density. She and her physician are considering therapy With raloxifene or a combination of conjugated estrogens and medroxyprogesterone acetate. Which of the following patient characteristics is most likely to lead them to select raloxifene?
```
(A) Previous hysterectomy
(B) Recurrent vaginitis
(C) Rheumatoid arthritis
(D) Strong family history of breast cancer
(E) Troublesome hot flushes
```
(D) Strong family history of breast cancer
81
A 50-yr-old woman with a positive mammogram undergoes lumpectomy and a small carcinoma is removed. Biochemical analysis of the cancer reveals the presence of estrogen and progesterone receptors. After this procedure, she will probably receive which of the following drugs?
```
(A) Danazol
(B) Flutamide
(C) Leuprolide
(D) Mifepristone
(E) Tamoxifen
```
(E) Tamoxifen
82
A 60-yr-old man is found to have a prostate lump and an elevated prostate-specific antigen (PSA) blood test. Magnetic resonance Imaging suggests several enlarged lymph nodes in the lower abdomen, and an x-ray reveals 2 radiolucent lesions in the bony pelvis. This patient is likely to be treated with which of the following drugs?
```
(A) Anastrozole
(B) Desogestrel
(C) Flutamide
(D) Methyltesrosterone
(E) Oxandrolone
```
(C) Flutamide
83
Diethylstilbestrol (DES) should never be used in pregnant women because it is associated with which of the following?
(A) Deep vein thrombosis
(B) Feminization of the external genitalia of male offspring
(C) Infertility and development of vaginal cancer in female offspring
(D) Miscarriages
(E) Virilization of the external genitalia of female offspring
(C) Infertility and development of vaginal cancer in female offspring
84
A 24-yr-old woman with type 1 diabetes wishes to try tight control of her diabetes to improve her long-term prognosis. Which of the following regimens is most appropriate?
(A) Morning injections of mixed insulin lispro and insulin aspart
(B) Evening injections of mixed regular insulin and insulin glargine
(C) Morning and evening injections of regular insulin, supplemented by small amounts of NPH insulin at mealtimes
(D) Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtimes
(E) Morning injection of NPH insulin and evening injection of regular insulin
(D) Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtimes
85
A young woman complains of abdominal pain at the time of menstruation. Careful evaluation indicates the presence of signifìcant endometrial deposits on the pelvic peritoneum. Which of the following is the most appropriate medical therapy for this patient?
(A) Flutamide, orally
(B) Medroxyprogesterone acetate by intramuscular injection
(C) Mestronol as an IUD
(D) Oxandrolone by intramuscular injection
(E) Raloxifene orally
(B) Medroxyprogesterone acetate by intramuscular injection
86
A 42-year-old man presents with increasing fatigue and occasional headaches. He states that recently he has had to change his shoe size from 9 to 10, and he also thinks that his hands and jaw are now slightly larger. Physical examination reveals a prominent forehead and lower jaw, enlarged tongue, and large hands and feet. Initial laboratory examination reveals increased serum glucose. Which of the following is the most likely explanation for this constellation of clinical findings?
```
A.Acromegaly
B. Apoplexy
C. Cretinism
D. Diabetes
E. Gigantism
```
A.Acromegaly
87
Mifepristone has antagonist action at which of the following receptors?
```
A. beta adrenoceptors
B. dopamine receptors
C. insulin receptors
D. low-density lipoprotein receptors
E. progesterone receptors
```
E. progesterone receptors
88
A patient in hyperkalemic renal failure is given an infusion of glucose and insulin. The actions of insulin include which of the following?
```
A. Converting glycogen to glucose
B. Stimulating gluconeogenesis
C. Increasing plasma amino acid concentration
D. Enhancing potassium entry into cells
E. Reducing urine formation
```
D. Enhancing potassium entry into cells
89
A patient is being treated for metastatic prostate cancer. Which of the following agents is used parenterally in prostate cancer to reduce luteinizing hormone (LH) release from the pituitary even though it initially increases LH release?
```
A. diethylstilbestrol
B. finasteride
C. flutamide
D. ketoconazole
E. leuprolide
```
E. leuprolide
90
An 18-year-old man with hemophilia A suffered multiple internal injuries from a motorcycle accident. He is now presenting with dizziness, abdominal pain, dark patches on his elbows and knees, and cravings for chips and french fries. He is referred to an endocrinologist who makes the diagnosis of Addison disease, and prescribes cortisol. Cortisol administration to a patient with adrenal insufficiency will result in which of the following?
A. Increased insulin sensitivity in muscle
B. Enhanced wound healing
C. Increased corticotropin-releasing hormone secretion
D. Increased ACTH secretion
E. Increased gluconeogenesis
E. Increased gluconeogenesis
91
A 60-year-old man on long-term therapy with a drug develops hypertension, hyperglycemia, and decreased bone density. Blood tests indicate anemia. Stool samples initially were positive for occult blood and then developed a "coffee-grounds" appearance. Which of the following drugs is most likely responsible for the patient's symptoms?
```
A. Beclomethasone
B. Hydrochlorothiazide
C. Metformin
D. Pamidronate
E. Prednisone
```
E. Prednisone
92
A 22-year-old woman presents with a recurrent vaginal candidiasis that is refractory to nystatin treatment. Diabetes screening shows elevated fasting blood glucose, and the patient is started on 25 units of insulin per day. Which aspect of glucose transport is enhanced by insulin?
A.Transport into adipocytes
B. Transport across the tubular epithelium of the kidney
C. Transport into the brain
D. Transport through the intestinal mucosa
E. Transport against a concentration gradient
A.Transport into adipocytes
93
A 20-year-old woman presents with symptomatic hyperglycemia, and a diagnostic workup confirms type 1 diabetes mellitus. The patient is started on insulin glargine. The metabolic effects of insulin include which of the following?
```
A. Decreased glucose utilization
B. Decreased lipolysis
C. Increased proteolysis
D. Increased gluconeogenesis
E. Increased ketogenesis
```
B. Decreased lipolysis
94
A 33-year-old major league baseball player takes human growth hormone to increase his performance. Which of the following best describes human growth hormone?
A. Secretion is stimulated by somatostatin and inhibited by ghrelin.
B. It has a long half-life.
C. It inhibits protein synthesis.
D. It decreases lipolysis.
E. It stimulates production of somatomedins (insulin-like growth factors I and II) by the liver, cartilage, and other tissues.
E. It stimulates production of somatomedins (insulin-like growth factors I and II) by the liver, cartilage, and other tissues.
95
A 44-year-old traveling salesman was recently diagnosed with Type 2 diabetes mellitus. The physician prescribed an exercise and diet plan, but this gentleman wouldn't be compliant. He habitually has a morning cup of coffee, gets in his car in the morning, and drives until he gets to his next appointment late afternoon. He says he rarely stops and eats in between.The next approach is to use a single oral antidiabetic drug, but you are concerned about the drug causing or worsening hypoglycemia in this "meal-skipper." Which of the following drugs poses the greatest relative risk of causing or exacerbating hypoglycemia?
```
A. Acarbose
B. Glyburide
C. Metformin
D. Pioglitazone
E. Repaglinide
```
B. Glyburide
96
A 35-year-old woman with gestational diabetes develops hypertension and preeclampsia, requiring the preterm delivery of her fetus of 30-weeks' gestation. The mother is given two doses of betamethasone, 12 mg, intramuscularly, 24 hours apart. Which of the following is the purpose of the antenatal steroid therapy?
A. Increase fetal PO2
B. Increase blood flow to the fetal lungs
C. Shift the fetal oxyhemoglobin dissociation curve to the right
D. Increase blood flow from the right atrium into the left atrium across the foramen ovale
E. Increase the lecithin/sphingomyelin ratio in the amniotic fluid
E. Increase the lecithin/sphingomyelin ratio in the amniotic fluid
97
A 37-year-old woman presents with exophthalmus and an enlarged thyroid gland. The levels of free thyroxine in her blood are elevated. Other clinical findings of Graves disease include which of the following?
```
A. Anorexia
B. Increased basal metabolic rate
C. Bradycardia
D. Increased weight gain
E. Decreased sweating
```
B. Increased basal metabolic rate
98
A multisystem trauma patient develops hyperpyrexia, severe tachycardia, and high-output congestive heart failure with volume depletion, consistent with thyroid storm. Which of the following is the most appropriate treatment for the exaggerated hyperthyroidism?
A. T3 administration to induce negative feedback inhibition of T4
B. Aspirin to treat the fever
C. Propylthiouracil to block synthesis of new thyroid hormone
D. Beta2-adrenergic agents to mediate vasodilation and bronchodilation
E. Iodine followed by propylthiouracil to block release and synthesis of thyroid hormone
C. Propylthiouracil to block synthesis of new thyroid hormone
99
A 22-year-old woman has been sexually assaulted. She requests a postcoital contraceptive. Which of the following usually is the most appropriate drug, assuming no contraindications?
```
A. Ergonovine (or methylergonovine)
B. Mifepristone
C. Raloxifene
D. Ritodrine
E. Tamoxifen
```
B. Mifepristone
100
A 50-year-old woman has just been diagnosed with-type 2 diabetes and given a prescription for metformin. Which of the following statements is characteristic of this medication?
A. Metformin is inappropriate for initial management of type 2 diabetes.
B. Metformin decreases hepatic glucose production.
C. Metformin undergoes significant metabolism via the cytochrome P450 system.
D. Metformin should not be combined with sulfonylureas or insulin.
E. Weight gain is a common adverse effect
B. Metformin decreases hepatic glucose production.
