Questions
65 yo F generalized weakness and 6 lb weight loss over month. Presents to ED with new onset afib? Which of the
following is the most likely diagnosis?
- Hyperthyroidism
- Would also find, tachy, insomnia, palipatitons, anxiety, depression, diarrhea, proximal muscle weakenss
40 yo old w 1 mo Hx of sweating and palpitations. BP sitting is 180.100. Standing BP is 150/104 w/ pulse 114?
- Pheochromocytoma
- Hyper cortisol
- Primary hyper aldosterone
Young man with testicular failure due to Klinefelter’s – which of the following is NOT correct
- Dec libido may occur
- Serum LH level is dec – LH will be elevated w/primary hypogonadism
- Sperm production absent
- Testicles are small and firm
- Karyotype reveals XXY
Most common cause of Cushing syndrome is
- Exogenous steroid use
When considering Addison’s?
- Adrenal excess
- Adrenal insuff - primary
- Infectious
- Acromaegaly
Pheochromocytoma – produces excess epi and noreepi
Condition which commonly presents with HTN and HypoK?
- Hyperaldosteronism – primary which could be due to adenoma or bilateral hyperplasia
Adult M with enlarging pituitary prolactinoma you would expect to find?
- Achondroplasia dwarfism
- High levels LH <- large = squishing everything out ?
- Worsening Cushing’s <- not what happens
- Very low testosterone
- Enlarging jaws hands and feet <- due to GH
46 yo old man with subarachnoid hemmorage dt rupture aneurysm, Urine vol inc to 20 ml/hr, SRNA climbs to 156 . most
likely complication is
- Hyperglycemic nonketotic state
- SiADH
- DI
The presence of which of the following diffs btwn primary and secondary adrenal insuf
- Wt loss
- Orthostatic HYPOTN
- Reduce ATCH
- Hyperpigmentation <- only in primary
45 yr presents with wt loss, anxiety, diarrhea, palpations, sweating, CP
hyperthyroid
55yr post menopausal modest weight gain, poor apetite, constipation, myalgias, cold intolerance, dry skin
- Hypothyroidism
24 yo F complaints extreme weakness, dizzy, light headed, 20 lb wt loss an change in color of skin NP 90/70. Looks ill,
low NA 115 K high, BUN inc 9, Ca 12 Preferred lab test for addisons?
- Dexamethasone suppression <- cushing
- Plasma renin activity
- Shieling test – B12
- Coisotropic stimulation test < - ACTH stimulation. Check for cortisol w/in 24 hours – want it to be 20
- Of 24 urine NA
Continue of - what is the acute Tx of choice (he said there were 3 options- bolded)
- Prednisone PO
- Dexamethasone PO <- tho not commonly use
- Hydrocortisone IV <- the one “they” said was right
- Desmopressin IV
- Depoprevera IV
The presences of which of the following hormones diff primary from secondary hyperadrenal insuf
- low K
- High NA
- Wt loss
- Low plasma renin level
- High ACTH
60 yo M small cell carcinoma of lung complicated by SIADH
- Elevated serum osmo
- hyponatremia
- Pleural fluid glucose level
- Hyperphospo
42 yo F – obesity, inc BP, inc body hair, purple streaks on abdomen, fat face, pains in bones and joints. Hasn’t taken
meds in past year. BMI 35, BP 160/110. Obvious hirsutism like 120 (anything over 8 is a lot). Face is pleurithora (red
face), and thoracic spine shows buffalo hump – she has cushing- which of these test is not a good screening option
- Salivary cortisol
- Serum cortisol
- Low dose dexamethasone suppression
- 24 Urine for urine free cortisol
- Clonidine suppression test <-use in pheocytocrytoma
Which of the following meds is mostly likely to gyneocamastica
- HCTZ
- fureosemide
- Prednisone
- Spironolactone
- Ranitidine
Statements about Hirsutism is not correct
- Common in elderly F
- Serious when accommodated with virilization
- Associated with absolute or relative testosterone excess
- Generally, not present in PCOS <- it is common in PCOS
- Tx by estrogen in many pts
44 yo mother of 2 teens, amenorrhea for 3 month. Pregnancy test = negative. inc FSH and normal LH
- Premature menopause (norm is 45-55)
- Hypothyroidism
- false negative pregnancy test (pregnant)
- hypothalamic dysfxn
24 yo F with OCP, galactorrhea, normal serum prolactins – prob cause is ?
- OCPs
Secondary amenorrhea 22 yo F w/ low body weight bc anorexia nervosa
- Hypothalamic dysfxn that occurs with anorexia + Mullerian atrophy
- Pregnancy
- Primary ovarian failure ( not common in 22 yo)
- Secondary hypothryodism
26 yo M is infertile w/primary testicular failure. You expect his FSH to be high
12 yo boy w/gynecomastia and some pub hair – most likely cause of gynecomastia is:
- Normal puberty
- Klinefelters
- Obesity
- Weed use
- LH secreting tumor
70 yo F w slowly inc facial hair – most likely cause
- Physiological Dec estrogen
- PCOS
- Ovarian neoplasm
- Hormone replacement therapy
2/21
Which of the following is the most sensitive test for hyper thyroid
- Radioactive
- Serum TSH
- T3 resin uptake (not done anymore)
- Free serum T4
- Thyroid antibodies
Diagnosis is confirmed with test about what test is good to determine the cause
- Radioactive iodine uptake (image thyroid and tell you if hyper/hypo or hot nodules) – best answer
- FNA
- Free T3/T3
- Ultrasound
- TSH receptor antibodies
Which of the following serum levels should you monitor for pt – 25 yr old F referred to psych for bipolar – given lithium
what should you monitor while shes on the meds
- Platelets
- Cortisol
- Serum glucose
- ACTCH
- TSH
What is potential a fatal consequence of untreated hypo
- Thyroid storm
- Wt gain
- Loss of menses
- Myxedema Coma
45 yr nervousness, frequent BM, sweating, palpitations and CP
- Paranoid schizo
- IBS
- Chrons
- Hyperthyroid
16 yo boy, gen seuzires -> Ed. Lorazepam, phenytoin and barbitol do not help. What is the most likely diagnosis?
- Epilepsy
- AV malformation of brain
- Hyperglycemia
- Hypoglycemia
55 yo post menopausal Modest weight gain despite poor appetite, cold intolerance, fatigue, constipation.
- Hypothyroidism (low thyroid, high TSH) – primary
Production of T3/T4 are dependent on?
- Vasopressin
- Independent of hypothalamic pituitary axis
- Should be only measured by presence of total T3/T4
- Dependent on presence of iodine
- Suppressed in pts with multinodular goiter
Typical characteristics of cushings all except
- Purple straie
- Hirsutism
- Hypoglycemia
- Moon face
- Hyperthyroidism
Best prevention of thyrotoxicosis
- Able dietary iodine
- Tx the underlying condition
- Massage thyroid
- Tx underlined depressant with antidepressants
45yo F with type 2 DM presents with concerns about recent episodes poudnign heart, tremours before lunch, in psat 4
mo pt lost weight w/ no oral change in meds
- Hyper glycemia
- Hyperthroydism
- Hypoglycemia – over correcting
- Hypothyroidism
You may find ____ in a M w/hypogonadism from a defect in androgen action
- hypoprolactinemia
- Testicular feminization
- Bilateral
Which of the following inc risk of DM
- Normal BMI
- Age < 45
- Eating carb mod diet
- Hx of gestational diabetes
- 2nd cousin with DM
Pt with long standing reasonable long standing DM , comes in CC sensation of pins and needls for last mo, hands and
feet bilateral. Gloves and socks. Most consistent with
- Peripheral neuropathy
Presence of which diff graves from toxic nodular thyrocosis
- Afib
- Dec serum TSH levels
- Lid lag
- Inc CO
- Antithyroid stim hormone antibody
Which of the following is the primary patho physo in type 1 DM
- Autoimmune destruction of pancreas
Obese 61 type 2 diabetic M. inc Creatinine, initiation of metformin inc risk of
- Altered awareness of hypoglycemia
- Dawn phenomenon
- NA losing neuropathy
- Lactic acidosis - bc he has renal insuf
Presence of which of the following would be expected in type 1 DM
- Elevated serum IgA
- HLADR3
Which is the recommended guideline for foot examination for pt with diabetic – how often?
- Every year (or if pt has Sx)
65 yo F complains of gen weakness and 6 lb wt loss in 1 mo , presents with new onset afib. Prob has?
- Hyperthyroidism
- Adrenal insuf
- Type 2 DM
60 yo F comes in with husband for routine diabetic check. Husband says pt crys out at night, grumpy in morning,
- Turn the thermostat down
- Check BG during Sx – hypoglycemia
- Check urine for DKA
- Play soft music at night
Compliant Pt with long standing Diabetes overall feels well, doing random BG check and got concerned when seeing BG
drop below 50 w/out Sx and Sx. Explanation is?
- Normal BG fluctuation
- BG drop due to
- Hypoglycemia unawareness
- Medical noncompliance