Endocrino Flashcards
A 42-year-old man comes to the physician for a follow-up examination. His blood pressure was 146/91 mm Hg at his appointment 1 month ago; subsequent home blood pressure measurements have ranged from 135/83 mm Hg to 156/96 mm Hg. His blood pressure today is 141/85 mm Hg. Physical examination shows no abnormalities. Pharmacotherapy with lisinopril is initiated. Administration of this drug is most likely to result in decreased activity of which of the following sections of a normal adrenal gland?
The zona glomerulosa of the adrenal cortex is the outermost layer of adrenal parenchyma and lies directly beneath the adrenal capsule (A). The cells of the zona glomerulosa are stimulated by angiotensin II to produce mineralocorticoids, most importantly aldosterone. Inhibition of ACE by lisinopril leads to decreased availability of angiotensin II, in turn resulting in decreased activity of the zona glomerulosa. The response of the zona glomerulosa to angiotensin II is attenuated by low serum potassium or high serum sodium levels.
This patient presents with classic features of hypercalcemia such as fatigue, hypertension, polyuria (“thrones”), abdominal and lower back pain (“groans, bones”), costovertebral angle tenderness (renal “stones”), constipation, and depression (“psychiatric overtones”).
This patient presents with classic features of hypercalcemia such as fatigue, hypertension, polyuria (“thrones”), abdominal and lower back pain (“groans, bones”), costovertebral angle tenderness (renal “stones”), constipation, and depression (“psychiatric overtones”).
Parathyroid chief cells are the site of parathyroid hormone (PTH) production and secretion. Under physiological conditions, parathyroid chief cells maintain calcium homeostasis through PTH-mediated increases in bone resorption, renal calcium absorption, and phosphate excretion. This patient’s hypercalcemia is most likely caused by excessive production and secretion of parathyroid hormone (primary hyperparathyroidism). The most common causes of primary hyperparathyroidism include parathyroid adenoma (approx. 80% of cases) and hyperplasia (approx. 15% of cases).
An increased serum C-peptide concentration and ultrasound findings of polyhydramnios and macrosomia suggest a diagnosis of gestational diabetes. Hyperglycemia causes osmotic diuresis, which leads to increased urinary frequency. Which of the following hormones is predominantly responsible for the observed laboratory changes in this patient?
Human placental lactogen causes pancreatic beta-cell hyperplasia and leads to an increase in insulin (and C-peptide) secretion as well as maternal insulin resistance. This ensures adequate glucose availability for the fetus. If maternal pancreatic function does not overcome insulin resistance, patients can develop gestational diabetes. In response to increased serum glucose concentrations, fetal production of insulin increases, which leads to increased fetal growth (macrosomia) as seen in this case.
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Endocrine System: Block 1
18/40
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A previously healthy 41-year-old woman comes to the physician for the evaluation of recurrent episodes of palpitations and sweating over the past month. Her symptoms typically start after swimming practice and improve after drinking ice tea and eating some candy. She has also had a 5-kg (11-lb) weight gain over the past 3 months. She works as a nurse. Physical examination shows no abnormalities. Fasting serum studies show: Glucose 38 mg/dL Insulin 260 μU/mL (N = 11–240) Proinsulin 65 μU/mL (N < 20% of total insulin) C-peptide 5.0 ng/mL (N = 0.8–3.1) Insulin secretagogues absent Which of the following is the most likely cause of her symptoms?
2
A 48-year-old woman comes to the physician for the evaluation of 24-hour blood pressure monitoring results. Over the last 3 months, she has had intermittent nausea, decreased appetite, and increasing weakness and fatigue during the day. She has been treated twice for kidney stones within the past year. Her current medications include lisinopril, amlodipine, and furosemide. She is 178 cm (5 ft 10 in) tall and weighs 97 kg (214 lb); BMI is 31 kg/m2. Her blood pressure is 152/98 mm Hg. Physical examination shows no abnormalities. Serum studies show: Na+ 141 mEq/L Cl− 101 mEq/L K+ 4.5 mEq/L HCO3− 24 mEq/L Calcium 12.9 mg/dL Creatinine 1.0 mg/dL A 24-hour blood pressure monitoring indicates elevated nocturnal blood pressure. Further evaluation is most likely to show which of the following findings?
3
A 23-year-old woman comes to physician for an annual health maintenance examination. She feels well. She is 155 cm (5 ft 1 in) tall and weighs 79 kg (174 lb); BMI is 33 kg/m2. Examination shows a skin rash over both axillae. A photograph of her left axilla is shown. This patient’s skin finding is most likely associated with which of the following conditions?
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A 17-year-old boy with type 1 diabetes mellitus comes to the emergency department because of nausea and abdominal pain during the past 6 hours. His finger stick blood glucose concentration is 409 mg/dL. Urinalysis shows the presence of ketone bodies. Which of the following results of arterial blood gas analysis is most likely before treatment? pH PaCO2 (mm Hg) HCO3- (mEq/L) A 7.52 52 41 B 7.46 29 20 C 7.28 51 23 D 7.29 30 14 E 7.49 33 24 F 7.34 56 29
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A 47-year-old woman comes to the physician for a 2-month history of fatigue, intermittent left-sided flank pain, and diffuse extremity pain. She was treated for a prolactinoma 5 years ago and has had recurrent antral and duodenal peptic ulcers despite medical therapy. Her only medication is omeprazole. Physical examination shows a moderately distended abdomen that is diffusely tender to palpation. There is mild left-sided costovertebral angle tenderness. Serum studies show a calcium concentration of 12 mg/dL, phosphorus concentration of 2 mg/dL, and parathyroid hormone level of 426 pg/mL. An ultrasound of the abdomen shows multiple kidney stones in the left ureteropelvic junction. This patient is most likely to have which of the following protein abnormalities?
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A 39-year-old woman comes to the physician because of a 4-day history of fever, anterior neck pain, and throat swelling. She has no history of serious illness. Her temperature is 38.1°C (100.6°F) and pulse is 109/min. Physical examination shows diaphoresis and a fine tremor of the outstretched hands. The thyroid gland is enlarged, firm, and tender to palpation. Serum thyroid stimulating hormone level is 0.06 μU/mL and erythrocyte sedimentation rate is 65 mm/h. 123I scan shows an enlarged thyroid gland with diffusely decreased uptake. Pathologic examination of a thyroid biopsy specimen is most likely to show which of the following findings?
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A 27-year-old man comes to the physician because of a 4-month history of unintentional weight gain, fatigue, and decreased sexual desire. There is no personal or family history of serious illness. His blood pressure is 149/88 mm Hg. Physical examination shows central obesity and abdominal striae. He has a prominent soft-tissue bulge at the dorsum of his neck. Laboratory studies show a 24-hour urinary free cortisol of 200 μg (N < 50) and a morning serum ACTH of 1 pg/mL (N = 7–50). Which of the following tests is most likely to confirm the underlying etiology of this patient’s symptoms?
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A 45-year-old woman comes to the physician because of fatigue, irregular menses, and recurrent respiratory infections for the past 6 months. Her blood pressure is 151/82 mm Hg. Physical examination shows a round face, thinning of the skin, and multiple bruises on her arms. Further studies confirm the diagnosis of an ACTH-secreting pituitary adenoma. This patient is at greatest risk for which of the following?
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A 38-year-old woman comes to the physician because of a 4-month history of crampy abdominal pain, recurrent watery diarrhea, and a 2.5-kg (5.5-lb) weight loss. Her husband has noticed that after meals, her face and neck sometimes become red, and she develops shortness of breath and starts wheezing. Examination shows a grade 3/6 systolic murmur heard best at the left lower sternal border. The abdomen is soft, and there is mild tenderness to palpation with no guarding or rebound. Without treatment, this patient is at greatest risk of developing which of the following conditions?
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A 45-year-old woman comes to the physician because of fatigue, abdominal cramps, watery diarrhea, and a weight loss of 4 kg (8.8 lb) over the last 4 months. She has recently avoided drinking alcohol and eating spicy food because it worsens her diarrhea and causes episodes of heart palpitations and reddening of the face and neck. She takes lisinopril for hypertension. Her temperature is 36.5°C (97.7°F), pulse is 98/min, and blood pressure is 149/90 mm Hg. The abdomen is soft and there is mild tenderness to palpation with no guarding or rebound. Laboratory studies show an increased urine 5-hydroxyindoleacetic acid concentration. Further evaluation of this patient will most likely show which of the following?
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A previously healthy 27-year-old man comes to the physician because of a 3-week history of anxiety, diarrhea, and a 4.1-kg (9-lb) weight loss. On questioning, he also reports that he noticed a painless mass on his left testicle 2 weeks ago. His pulse is 110/min and irregular and blood pressure is 150/70 mm Hg. Examination shows diaphoresis and a fine tremor of the outstretched fingers. Testicular examination shows a 3-cm, firm, nontender mass on the left scrotum that does not transilluminate. This patient’s underlying condition is most likely to be associated with which of the following findings?
12
A healthy 31-year-old woman comes to the physician because she is trying to conceive. She is interested in tracking her hormonal cycle in order to determine her fertility period. An increase in the levels of which of the following is the best indicator that ovulation has already occurred?
13
A 75-year-old man with a seizure disorder is brought to the emergency department by a friend because of progressive confusion over the past two weeks. He is unable to provide any history. His vital signs are within normal limits. He appears lethargic and is only oriented to person. Oral mucosa is moist. There is no jugular venous distention. A basic metabolic panel shows a serum sodium concentration of 115 mEq/L but is otherwise normal. Serum osmolality is low and antidiuretic hormone level is elevated. X-ray of the chest shows no abnormalities. Which of the following is the most likely cause of this patient’s hyponatremia?
14
A 78-year-old woman is brought to the physician by her son because of progressive memory loss for the past year. She feels tired and can no longer concentrate on her morning crossword puzzles. She has gained 11.3 kg (25 lb) in the last year. Her father died from complications of Alzheimer disease. She has a history of drinking alcohol excessively but has not consumed alcohol for the past 10 years. Vital signs are within normal limits. She is oriented but has short-term memory deficits. Examination shows a normal gait and delayed relaxation of the achilles reflex bilaterally. Her skin is dry, and she has brittle nails. Which of the following is the most likely underlying etiology of this woman’s memory loss?
15
A 42-year-old man comes to the physician for a follow-up examination. His blood pressure was 146/91 mm Hg at his appointment 1 month ago; subsequent home blood pressure measurements have ranged from 135/83 mm Hg to 156/96 mm Hg. His blood pressure today is 141/85 mm Hg. Physical examination shows no abnormalities. Pharmacotherapy with lisinopril is initiated. Administration of this drug is most likely to result in decreased activity of which of the following sections of a normal adrenal gland?
16
A 51-year-old woman comes to the physician because of a 3-month history of fatigue, increased urinary frequency, and low back pain. She reports frequent passing of hard stools, despite using stool softeners. During this time, she has not been as involved with her weekly book club. Her family is concerned that she is depressed. She has no history of serious illness. She has smoked 1 pack of cigarettes daily for the past 20 years. Her pulse is 71/min and blood pressure is 150/90 mm Hg. Abdominal examination shows right costovertebral angle tenderness. The patient’s symptoms are most likely caused by hyperplasia of which of the following?
17
A 36-year-old woman, gravida 2, para 1, at 30 weeks’ gestation comes to the physician for evaluation of increased urinary frequency. She has no history of major medical illness. Physical examination shows no abnormalities. Laboratory studies show an increased serum C-peptide concentration. Ultrasonography shows polyhydramnios and a fetus that is large for gestational age. Which of the following hormones is predominantly responsible for the observed laboratory changes in this patient?
18
A 26-year-old primigravid woman at 25 weeks’ gestation comes to the physician for a prenatal visit. She has no history of serious illness and her only medication is a daily prenatal vitamin. A 1-hour 50-g glucose challenge shows a glucose concentration of 167 mg/dL (N < 135). A 100-g oral glucose tolerance test shows glucose concentrations of 213 mg/dL (N < 180) and 165 mg/dL (N < 140) at 1 and 3 hours, respectively. If she does not receive adequate treatment for her condition, which of the following complications is her infant at greatest risk of developing?
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0h 21m
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Question
A 26-year-old primigravid woman at 25 weeks’ gestation comes to the physician for a prenatal visit. She has no history of serious illness and her only medication is a daily prenatal vitamin. A 1-hour 50-g glucose challenge shows a glucose concentration of 167 mg/dL (N < 135). A 100-g oral glucose tolerance test shows glucose concentrations of 213 mg/dL (N < 180) and 165 mg/dL (N < 140) at 1 and 3 hours, respectively. If she does not receive adequate treatment for her condition, which of the following complications is her infant at greatest risk of developing?
Hyperplasia of islet cells, the pancreatic cells responsible for producing insulin, can occur in utero in response to elevated maternal blood glucose levels, e.g., due to gestational diabetes. This can cause infantile hyperinsulinemia and put the infant at risk for hypoglycemia once the maternal placental transfer of glucose ceases after birth.
A 15-year-old girl comes to the physician because of a 2-month history of progressive fatigue and weakness. She also reports recurrent headaches for 2 years, which have increased in severity and frequency. Her blood pressure is 185/95 mm Hg. Serum studies show a morning renin activity of 130 ng/mL per hour (N=1–4), a morning aldosterone concentration of 60 ng/dL (N=5-30), and a potassium concentration of 2.9 mEq/L. Further evaluation is most likely to show which of the following?
The presence of pleomorphic smooth muscle cells in the renal cortex in combination with elevated renin and aldosterone concentrations is highly indicative of a juxtaglomerular tumor. Excessive renin production by these tumor cells stimulates aldosterone release. Consequently, patients exhibit symptoms of secondary hyperaldosteronism.
A 55-year-old woman with type 2 diabetes mellitus comes to the physician for evaluation of worsening tingling of her feet at night for the last 6 months. Two years ago, she underwent retinal laser photocoagulation in both eyes. She admits to not adhering to her insulin regimen. Her blood pressure is 130/85 mm Hg while sitting and 118/70 mm Hg while standing. Examination shows decreased sense of vibration and proprioception in her toes and ankles bilaterally. Her serum hemoglobin A1C is 11%. Urine dipstick shows 2+ protein. Which of the following additional findings is most likely in this patient?
Genitourinary manifestations of diabetic autonomic neuropathy include incomplete bladder emptying, urinary retention, erectile dysfunction, retrograde ejaculation, and dyspareunia. The loss of afferent and efferent autonomic innervation of the bladder results in the inability to sense a full bladder and incomplete emptying, predisposing patients to overflow incontinence and recurrent UTI.
