Long Island ANAT 341 Endocrine exam

A.        A 56-year-old woman is being seen for regular assessment and monitoring of her type 2 diabetes mellitus. She has been following a strict diet and exercise plan for 2 years with the addition of metformin 6 months ago for an increased HgA1c level. Her HgA1c at today's visit is 7.1. What is the appropriate management for this patient?

A.        add exenatide to her current therapy

B.         change her oral therapy to rosiglitazone

C.         add insulin to her current therapy

D.        maintain her current therapy and recheck in 6 months

 

B.         Which of the following is appropriate in the pharmacologic management of patients with hypoparathyroid tetany?

A.        Aggressive IV hydration

B.         Cinacalcet hydrochloride PO

C.         Calcium gluconate IV

D.        Pamidronate IV

E.         Calcitonin IV

 

C.         You are evaluating an 80-year-old female for the first time. She has a history of mild Alzheimer's disease, for which she takes Aricept. She states that she feels fine but her daughter feels she is depressed and has been complaining of not feeling well. Her daughter admits that the patient has a history of primary hyperparathyroidism. What laboratory results would be most consistent with her diagnosis of hyperparathyroidism?

A.        high serum calcium

B.         low intact PTH

C.         low cortisol

D.        low urine calcium

E.         high cortisol

 

4.         A 30-year-old patient presents 2 months postthyroidectomy. The patient has had symptoms of increased irritability, muscle spasms, and hair loss for the past month. On physical examination, a positive Chovstek sign is noted. Which of the following is the most likely diagnosis?

A.        hypothyroidism

B.         hypopituitarism

C.         hypoparathyroidism

D.        hypogonadism

 

5.         A 29-year-old woman comes in for evaluation of "panic attacks." She has no history of anxiety or depression. She says that during these episodes, which have been getting more frequent and more severe over the past month, she perspires heavily, feels highly anxious ("as though the end is coming"), and as if her heart is "going to jump out of my chest." Recently she has also begun experiencing headaches during these attacks. Her best friend told her that her face gets really "blotchy" during the attacks and then "awfully red" afterwards. Her examination today is remarkable only for blood pressure of 160/100. What is the most sensitive test for diagnosing her condition?

A.        plasma fractionated free metanephrines

B.         serum chromogranin A

C.         serum thyroid stimulating hormone

D.        urine fractionated metanephrine and creatinine

E.         urine toxicology screen

 

6.         A 23-year-old woman, adopted in infancy, has just learned that her biologic family has a long history of tumors of the thyroid and parathyroid glands, the pancreas, the adrenal glands, and of lipomas. Given this history, she undergoes genetic testing and is found to have a mutation in the menin gene on the long arm of chromosome 11 (11q13). What is the most likely initial clinical manifestation for persons with this syndrome?

A.        gastrinoma

B.         Hirschsprung disease

C.         hyperparathyroidism

D.        medullary thyroid cancer

E.         pituitary adenoma

.

 

7.         Over a period of several months, a 62-year-old man has developed erectile dysfunction. He has no history of neurologic, kidney, or cardiovascular disease or diabetes mellitus. He takes a multivitamin and an occasional ibuprofen for aches and pains. He has never smoked cigarettes, drinks 1-2 glasses of wine with dinner on weekends, and uses no mind-altering drugs. Physical examination is remarkable only for bilateral gynecomastia. What is the most likely diagnosis?

A.        breast cancer

B.         depression

C.         prolactinoma

D.        steroid abuse

E.         testicular cancer

 

8.         A 25-year-old woman is seen today in your office for vague abdominal pain, nausea, anorexia, weight loss, anxiety, and dizziness. Her past medical history is significant for type 1 diabetes mellitus, and her family history is significant for hypothyroidism in several family members. A review of systems reveal a history of amenorrhea. Upon exam, you note hyperpigmentation of her skin and areas of vitiligo, but no mucocutaneous candidiasis. You are not surprised to find that her serum ACTH level is elevated and her serum cotisol is low. Which of the following syndromes should be investigated in this patient?

A.        Type 1 polyglandular autoimmune syndrome type 1

B.         Type 2 polyglandular autoimmune syndrome type 2

C.         Multiple endocrine neoplasia type 2A

D.        Multiple endocrine neoplasia type 1

E.         Metabolic syndrome

 

9.         A 78-year-old male returns to the FP office for a follow up of non-insulin-dependent diabetes mellitus (NIDDM) as a new patient to you, although he has been an office patient for the past year. He denies any problems this visit and says his blood sugars are in the 90- 120 mg/dl range. He is currently taking the medications listed in the following choices. You receive his labs and note that his creatinine is 2.0 mg/dl and on the previous few labs this creatinine was also in the 1.8-2.0 mg/dl range. What medication should be discontinued?

 

 

10.       A 43-year-old pilot is interested in quitting his 20-year habit of smoking. His medical history includes type 2 diabetes mellitus diagnosed 6 years ago for which he is currently taking metformin. Which of the following would be most appropriate to recommend to this patient?

A. alprazolam  B. clonidine     C. nicotine replacement therapy          D. nortriptyline E. varenicline

 

11.       Your patient is a 44-year-old female who was advised by her endocrinologist that she has thyroid cancer and seeks your opinion. You inquire about the type of thyroid cancer but the patient is unsure. She does state that she was advised that it is the most common and she has a good prognosis. What is the most likely cause of her thyroid malignancy?

A.        lymphoma

B.         follicular thyroid carcinoma

C.         anaplastic thyroid carcinoma

D.        papillary thyroid carcinoma

E.         medullary thyroid carcinoma

12.       A patient presents with symptoms of polyuria for several months. There is no history of diabetes mellitus or intrinsic kidney disease. Which of the following tests can best determine whether the polyuria is resulting from primary polydipsia or some form of diabetes insipidus?

A.        24-hour urine volume test

B.         Routine urinalysis

C.         Water deprivation test

D.        Urine culture and sensitivity

E.         Vasopression suppression test

 

13.       A 1-year-old adopted Chinese infant is brought into the pediatrician's office for a routine visit. The parents are concerned because they think the child is short for her age. They do not have very much information relating to the birth of the child, other than that she was considered slightly short at birth and she had a seizure at one month of age. The foster parents of the child were not concerned, since the infant was somewhat chubby and ate well. She has no history of hypotonia. Upon exam you note normal shaped eyes with mild nystagmus. The infant is less than the third percentile for weight and her limbs are in normal proportion to her height. Her lung and heart exam are normal. CBC is normal. What is the most likely cause of her short stature?

A.        Congenital growth hormone deficiency

B.         Sickle cell anemia

C.         Prader-Willi syndrome

D.        Osteochondrodysplasia

E.         Cystic fibrosis

 

14.       A 30-year-old man is brought to the emergency department by his wife for abdominal pain, nausea, vomiting, and diarrhea. She says he has been getting "worse and worse" for at least the past two months. He is "too tired" and his "muscles hurt too much" to play golf, formerly their favorite leisure activity. He has been depressed and reticent, instead of his usual talkative self. He won't eat much of anything, even when she cooks his favorite meals and she is sure he has lost considerable weight because his clothes "hang off him." He has refused medical evaluation until today, when the abdominal pain of approximately a week increased and he began having the vomiting and diarrhea. Initial impression is that the man is quite tanned, although it is the middle of winter. Closer examination reveals dark pigmentation in his skin folds and on the buccal mucosa. This presentation most strongly suggests which of the following?

A.        adrenocortical insufficiency

B.         diabetic ketoacidosis

C.         hypercortisolism

D.        hyperglycemic hyperosmolar state

E.         hypothyroidism

 

15.       A 35-year-old woman comes to see you with symptoms of anxiety, sweating, and tremors. She has no history of diabetes, liver or kidney failure, hormone deficiencies, or past surgeries. She states that she is not currently prescribed any medications and does not drink alcohol. She is concerned that she will not be able to continue to care for her husband, who has a long history of diabetes mellitus. She is asking you to give her some medication to stop her symptoms.

Initial lab results are as follows:

Plasma glucose = 54 mg/dL (70-110 mg/dL) TSH = 2.0 mIU/L (0.34-4.25 uIU/mL)

Insulin = 35 uU/mL (2.0-20 uU/mL)

C-peptide= 0.4 ng/mL (0.5-2.0 ng/mL)

Her symptoms are relieved with the drinking of orange juice. What is the most likely cause of her hypoglycemia?

A.        Alimentary hypoglycemia

B.         Factitious hypoglycemia

C.         Beta cell insulinoma

D.        Congenital hyperinsulinism

E.         Reactive hypoglycemia

 

16.       Patients diagnosed with type 2 diabetes are encouraged to maintain their plasma glucose, to prevent or slow the initiation of chronic complications. What is the maximum level that is within ADA guidelines for a one to two hour postprandial plasma glucose in these patients?

A. 70 mg/dL    B. 100 mg/dL   C. 120 mg/dL   D. 180 mg/dL  E. 220 mg/dL

 

17.       Which of the following medications for type 2 diabetes mellitus is thought to best preserve beta cell function in the pancreas?

 A. acarbose     B. glimepiride  C. pioglitazone D. sitagliptin    E. insulin glargine

 

18.       A 42-year-old woman has experienced recent weight gain, heavy periods, fatigue, cold intolerance, and constipation. She has a rough voice, and her rate of speech is slow. Physical exam is significant for an enlarged thyroid, slow reflexes, and the presence of brittle and coarse hair. She denies any history of bipolar disease or treatment with lithium. Laboratory tests show an elevated TSH and low free T4. What is the most appropriate treatment for this patient?

A.        propylthiouracil (PTU)

B.         levothyroxine

C.         surgical resection

D.        radioiodide ablation

 

19.       A 12-year-old boy is being seen for concerns of development of breast tissue. Upon physical exam, he is noted to have a firm, slightly tender mass under the left areola. What is the most appropriate action at this time?

A.        referral to pediatric surgery for resection

B.         measurement of serum hCG

C.         measurement of testosterone and estrogen levels

D.        reassurance and observation

 

20.       Your patient returns to your office for a follow up for non-insulin-dependent diabetes mellitus (NIDDM). Her HgA1c in the office is 6.4%. She is concerned about developing kidney disease from her diabetes and requests that you test her for this. What initial screening test should you order that would provide clues to potential diabetic nephropathy allowing for treatment to slow the disease progression?

 

A.        24-hour urine for protein

B.         serum BUN/CR

C.         urine microscopic

D.        urine microalbumin

E.         serum protein

 

21.       A woman presents for a routine post-partum checkup four weeks after delivery of her child. She is currently breast feeding without difficulty. She tells you that she has been feeling anxious and very warm, despite the change of season into winter. She is happy as a mother and has not had problems caring for her baby. What is the next best step in the investigation of her symptoms?

A.        Radioactive iodine uptake test

B.         Serum total T4 level

C.         Thyroid fine needle aspiration

D.        Serum TSH level

E.         MRI of the anterior pituitary

.

 

22.       A patient was prompted to visit his health care provider after his wife started to notice that he was not interested in eating, has lost weight, and has been suffering from nausea for the last few weeks. The practitioner notes hyperpigmentation of the patient's skin, although the patient denies any recent sun or tanning salon exposure. Routine non-fasting blood work reveals the following:

Sodium = 130 meq/L Potassium = 5.2 meq/L Chloride = 105 meq/L Glucose = 135 mg/dL Hemoglobin = 13.0 g/dL Hematocrit = 39.0

WBC count = 8,000/mm3

Which of the following physical exam findings would you expect to see in this patient?

A.        Orthostatic hypotension

B.         Wide, purple striae

C.         Central obesity

D.        Full facial features

E.         Exophthalmous

 

23.       A 45-year-old woman presents with weight gain, fatigue, dry skin, constipation, and oligomenorrhea. On physical exam, bradycardia and slow deep tendon reflexes are noted. Her free T4 is low and TSH is elevated. Which of the following medications may be responsible for her condition?

A.        amiodarone

B.         beta-blockers

C.         levadopa

D.        hydrocholorthiazide

 

24.       42-year-old female complains of weight gain (especially in her abdomen) over the past 8 months. She also has noted that her skin bruises easily. Her husband has noted she seems to be very moody lately and she is worried about their relationship. Furthermore, her hair seems to be getting thinner and she is now getting acne like she had in her teenage years. She wonders if this is due to menopause since her periods have stopped suddenly about a year ago. On physical examination her BP = 170/50, P = 82, T = 98.2°F. You note the following findings on examination (see picture). What diagnostic test is indicated initially to confirm your suspected diagnosis?

A.        cosyntropin stimulation test

B.         MRI pituitary

C.         dexamethasone suppression test

D.        24-hour urine for protein

E.         serum protein electrophoresis

 

 

 

25.       Consideration should be given to screening patients with type 1 diabetes mellitus should also be screened for which of the following:

A.        sarcoidosis

B.         Sheehan's syndrome

C.         Sjögren's Syndrome

D.        thyroid disease

 

26.       A young man presents with difficulty breathing at times. Upon exam you note evidence of a firm, fixed thyroid nodule with extension toward the trachea and surrounding muscles. The patient has a family history of thyroid cancer. You are concerned that the patient may have medullary thyroid cancer. Which of the following lab tests would you monitor in this patient after treatment?

A.        Serum calcitonin

B.         Plasma alkaline phosphatase

C.         Serum anti-thyroglobulin antibodies

D.        Serum T3 resin uptake

E.         Urine CA-125 levels

 

27.       A 50-year-old woman presents with a history of polyuria, polydipsia, muscle aches, bone pain, nausea, and constipation for the past few months. Her past medical history is significant for a pituitary adenoma, peptic ulcer disease, and kidney stones. You are considering a diagnosis of primary hyperparathyroidism. Which of the following lab values would you expect in this patient?

A.        Low serum calcium and elevated serum PTH

B.         Elevated serum calcium and PTH levels

C.         Elevated serum calcium and low serum PTH levels

D.        Low serum phosphate and PTH levels

E.         Elevated serum phosphate and calcium levels

.

 

28.       A 62-year-old male diabetic patient with a past medical history of percutaneous transluminal coronary angioplasty (PTCA) with drug-eluting stent presents to review his blood work. He currently takes rosuvastatin 10 mg daily, metformin 1,000 mg BID, an 81 mg aspirin, and ramapril 5 mg, along with metoprolol ER 50 mg daily. His total cholesterol is 212 mg/dL, LDL-C is 126 mg/dL, HDL-C is 46 mg/dL, and triglycerides at 145 mg/dL. Of the following, what is the best choice for him to reach ATP-III revised goals?

A.        Add a fenofibrate 145 mg daily.

B.         Add garlic to his diet.

C.         Add an omega-3 ethyl acid ester daily.

D.        Increase his rosuvastatin to 20 mg daily.

E.         Increase his rosuvastatin to 20 mg daily and add ezetimibe 10 mg daily.

 

29.       A 40-year-old female presents to the clinic with symptoms of a 10 pound unintentional weight loss, diarrhea, and palpitations. She has a positive family history for thyroid disease and diabetes mellitus. Her screening TSH level is 0.15mIU/L, and her fasting plasma glucose is 105mg/dL. What is the most common cause of this patient's symptoms?

A.        Pituitary tumor

B.         Graves' disease

C.         Thyroid carcinoma

D.        Hashimoto's thyroiditis

E.         Euthyroid sick syndrome

 

30.       A 10-year-old child is seen with his parents for a routine check up. During the review of symptoms, his parents mention that their son has been extremely thirsty and is going to the bathroom to urinate frequently. The patient agrees. The parents are concerned that their son has developed diabetes mellitus. The family history is negative for diabetes mellitus, but the mother has a history of familial hypothalamic diabetes insipidus. Screening blood work includes a CBC, hemoglobin A1c, and renal function tests, all of which are within the reference range. Which of the following serum analytes would you expect to be deficient?

A. Sodium       B. Glucose       C. Thyroxine   D. Prolactin      E. Vasopressin

 

31.       A 38-year-old male complains of increasing fatigue, weakness, weight loss, and intermittent nausea, vomiting, and diarrhea over the past few months. He has noted some agitation at times.

When this first started he thought that this was related to a virus but the GI symptoms have reoccurred on multiple occasions. Labs show a complete blood count (CBC) within the normal reference range. He is noted to have hyponatremia. On examination you note the multiple areas of hyperpigmentation as seen below. His blood pressure in the office is 100/50, P = 66, T = 97.1°F. What test would you order to confirm your suspected diagnosis?

A.        dexamethasone suppression test

B.         vasopressin challenge test

C.         radioactive iodine uptake scan

D.        cosyntropin stimulation test

E.         follicular stimulation test

 

 

32.       A patient is recovering from having a total thyroidectomy two days ago for medullary thyroid cancer. An extensive neck dissection was required during the surgery. Post-operative lab testing reveals a low serum calcium level. Which of the following clinical presentations will most likely occur in this patient?

A. Constipation            B. Anorexia     C. Polyuria       D. Bone pain   E. Paresthesias

 

 

33.       Your patient has a history of primary hyperparathyroidism. Recently she has been hospitalized due to obstructing kidney stones. She has had several fractures including her hip, sacrum, and forearm in the past year, all on separate occasions. She is constantly complaining of a lack of energy. What is the recommended treatment for her symptomatic hyperparathyroidism?

A.        surgical removal of the pituitary

B.         high-dose calcium supplementation

C.         parathyroidectomy

D.        thyroidectomy

E.         thiazide diuretics

 

 

34.       A young man presents with difficulty breathing at times. Upon exam you note evidence of a firm, fixed thyroid nodule with extension toward the trachea and surrounding muscles. The patient has a family history of thyroid cancer. You are concerned that the patient may have medullary thyroid cancer. After you confirm your suspicion, which of the following genetic tests would you suggest to his family members?

A.        BRCA 1

B.         APC

C.         CFTR

D.        ret proto-oncogene

E.         CAG triplet expansion

 

35.       What is the radionuclide imaging pattern noted during a thyroid scan in patients with subacute thyroiditis?

A.        Single area of increased uptake

B.         Diffusely high uptake

C.         Multiple areas of increased uptake

D.        Single area of low uptake

E.         Diffusely low uptake

 

36.       A mother expresses concern for her teen son after feeling a lump in his neck. He has no history of trauma to his neck. Surgical history is negative, and the patient does not take any medications. The mother tells you that thyroid problems run in the family. The patient has not been ill recently. Upon exam you feel a nontender, firm nodule on the right side of his thyroid with associated cervical lymphadenopathy. His serum TSH level is within the reference range. Radionuclide thyroid scanning demonstrates a "cold" nodule in the right side of the thyroid. What is the most appropriate next step in the work up of this patient?

A.        MRI of the anterior pituitary

B.         CT of the thyroid

C.         MRI of the thyroid

D.        Thyroid nodule fine needle aspiration

E.         Emergent thyroidectomy

 

37.       A 42-year-old male comes to the office to discuss his total cholesterol of 215 mg/dl, which was obtained last week at a health fair. He is generally healthy, but smokes one pack of cigarettes per day for the past 10 years. He is unsure of his family history. What is your next step?

A.        prescribe simvastatin

B.         advise dietary changes

C.         repeat the total cholesterol today, fasting

D.        obtain a fasting lipid profile

E.         prescribe gemfibrozil

 

38.       An 11-year-old boy has a history of early growth failure and cherubic features. His height velocity chart is shown. What is the most likely cause of the sharp increase in the growth curve at age six?

A.        Pituitary adenoma resection

B.         Glucocorticoid replacement

C.         Insulin therapy

D.        Ensure supplementation

E.         Recombinant human growth hormone

 

39.       A 28-year-old woman who was born and brought up just outside of Washington, DC, comes in for evaluation of vague "problems with swallowing." She has no other symptoms except "my neck is bigger than it used to be." Examination reveals only a diffuse, somewhat irregular, nontender enlargement of the thyroid gland with distinct masses palpable within it. What is the most likely diagnosis?

A.        endemic goiter

B.         Graves disease

C.         Hashimoto thyroiditis

D.        multinodular goiter

E.         thyroid carcinoma

 

40.       A 50-year-old male presents to your office with symptoms of weight gain and easy bruising. He is currently being treated for hypertension. No surgical history is noted and family history is noncontributory. He does not drink alcohol. Upon questioning, he also notes some difficulty with climbing stairs. He has had to use the railing more often than in the past. A photo of the patient is shown below. Which of the following blood hormones would most likely be found to be in excess?

A.        Renin

B.         Cortisol

C.         Testosterone

D.        Antidiuretic hormone

E.         Thyroid stimulating hormone

 

41.       Which of the following cardiac medications is known to cause clinically significant hypothyroidism?

A. Furosemide B. Captopril     C. Amiodarone            D. Digoxin       E. Dopamine

 

42.       A 22-year-old man (refer to Figure 4-2) is being evaluated for extremity enlargement unlike anyone in his family. Over the past 2 years, he has noticed that his rings no longer fit and his feet are so wide that he cannot find shoes to fit. He has always been tall for his age, greater than the 95th percentile throughout his teenage years. He has very coarse facial features, macroglossia, and a very deep voice. What is the most likely cause of this patient's condition?

A.        adrenal neoplasm

B.         multinodular goiter

C.         pituitary macroadenoma

D.        Rathke cleft cyst

E.         testicular neoplasm

 

43.       A 42-year-old female returns for a follow up of her hypothyroidism and admits to increased hair loss and dry skin. Her thyroid-stimulating hormone (TSH) is 20 mU/L. She is currently on levothyroxine 25 mcg daily which she has taken as directed for the past 6 months. What treatment do you recommend for this patient at this time?

A.        change to methimazole

B.         radioactive iodine therapy (131I therapy)

C.         decrease the dose of levothyroxine to 12.5 mcg QD

D.        add propylthiouracil

E.         increase the dose of levothyroxine to 50 mcg QD

44.       A female patient presents with a history of hypertension and low plasma HDL. She is asking you if she has metabolic syndrome. She does not have diabetes and she is not obese. Which of the following NCEP ATP III criteria would be needed to confirm that diagnosis?

A.        LDL > 70 mg/dL

B.         LDL > 90 mg/dL

C.         Triglycerides > 100 mg/dL

D.        Triglycerides 150 mg/dL

E.         Triglycerides > 300 mg/dL

 

45.       A 32-year-old female with history of non-insulin-dependent diabetes mellitus (NIDDM) returns to the clinic for a routine visit. She reports that she her blood sugars have been controlled. However, her vitals today show a blood pressure (BP) of 136/78 P = 72. You note the past three office visits that her blood pressures were in the mid 130s to 140 systolic. She is not currently taking anything for her blood pressure but admits that she has not been exercising as much as usual. What do you advise the patient?

A.        Advise lifestyle modification and continue to monitor BP next visit.

B.         Initiate antihypertensive therapy to target BP < 130/80.

C.         Initiate DASH diet and recheck blood pressure in 6 months.

D.        Monitor blood pressure next visit, and if > 140/90, initiate antihypertensive therapy.

E.         Her blood pressure indicates prehypertension, there is no need for treatment other than exercise at this time.

 

46.       To which of the following areas does follicular thyroid cancer most commonly first spread?

A.        Intraglandular metastasis

B.         Local spread into regional vocal cords

C.         Distant lymph nodes

D.        Bone and lung via bloodstream

E.         Local extension into the muscle and trachea

.

 

47.       A 50-year-old male patient is referred to the endocrinology office in which you work. He was found to have extremely elevated levels of plasma and urine Cortisol, and plasma ACTH. He has a past medical history of small cell cancer and gout, and now presents with hyperpigmentation. His medications include a chemotherapy regimen and allopurinol. What is the most likely cause of these findings?

A.        Adrenal adenoma

B.         Autoimmune adrenal insufficiency

C.         Iatrogenic Cushing's syndrome

D.        Ectopic ACTH syndrome

E.         Adrenal carcinoma

 

48.       An otherwise healthy 48-year-old male patient presents to your family practice clinic for a complete physical examination. He takes no medications. His vital signs, CBC, CMP, and TSH are normal. His fasting lipid panel reveals a total cholesterol of 280 mg/dL, LDL-C of 190 mg/dL. HDL-C of 38 mg/dL, and triglycerides of 151 mg/dL. What is your next step in his management?

A.        Counsel him on target life style changes and recheck his lipid panel in three months and begin therapy if not to goal at that time.

B.         Redraw his fasting lipid panel today, counsel him on target life style changes and begin therapy immediately if his follow up lipid panel is not to goal.

C.         Counsel him on target life style changes, begin therapy with a statin at this time, and recheck his lipid panel in three months and adjust therapy.

D.        Counsel him on target life style changes, begin therapy with a nicotinic acid derivative at this time, and recheck his lipid panel in three months and adjust therapy.

E.         Counsel him on target life style changes, begin therapy with a fenofibrate at this time, and recheck his lipid panel in three months and adjust therapy

 

49.       A 40-year-old female presents to your office with symptoms of weight gain, hirsuitism, and easy bruising. Past medical and surgical history is noncontributory. She drinks one glass of wine on weekends and does not smoke cigarettes. She takes one multivitamin daily. Upon physical exam, you note facial fullness, central obesity, and thin skin. Which of the following is the most common cause of her symptoms?

A.        Pituitary adenoma

B.         Iatrogenic

C.         C Adrenal micronodular hyperplasia

D.        Adrenocortical adenoma

E.         Ectopic ACTH syndrome

 

50.       Patients with suspected familial hypercholesterolemia have serum cholesterol levels > 300 mg/dL and are at increased risk of atherosclerosis. Which of the following physical exam findings are nearly pathognomonic for familial hypercholesterolemia?

A.        Tendon xanthomas

B.         Lipomas

C.         Bouchard's nodes

D.        Carotid bruits

E.         Visceral obesity

.

 

51.       A 5-year-old girl is seen in your office with a several week history of increased thirst, weight loss, and blurred vision. She has a positive family history for diabetes mellitus, hypertension, and stroke. Her urine dipstick chemical testing reveals positive glucose and negative ketones, protein, blood, and nitrites. Which of the following laboratory test results would support a diagnosis of diabetes mellitus in this patient?

A.        random plasma glucose > 200 mg/dL

B.         random urine glucose dipstick > 1+

C.         plasma hemoglobin A1c < 7%

D.        fasting plasma glucose > 110 mg/dLE. 2-hour postprandial plasma glucose > 135 mg/dL

 

52.       A 60-year-old female patient living in New York City presents for a routine office visit prior to travelling to Europe with her husband for a second honeymoon. Her medical history includes pernicious anemia, for which she is being treated with vitamin B12 supplementation. She uses no other medications. Past surgical history includes an appendectomy at age five. Upon reviewing her symptoms, you find that she has been trying to self treat for chronic constipation, without positive results. She also notes that she is easily tired and has gained 10 pounds in the last few months. On exam you note bradycardia and cool, dry skin. What is the most likely cause of her recent symptoms?

A.        Major depression

B.         Hashimoto's thyroiditis

C.         Hypothalamic destruction

D.        Toxic thyroid nodule

E.         Iodine deficiency

 

53.       Which of the following classes of oral anti-diabetic medications is contraindicated in patients with New York Heart Association class III or IV cardiac status?

A. DPP-4 inhibitorsB. Alpha-glucosidase inhibitorsC. ThiazolidinedionesD. BiguanidesE. Sulfonylureas

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54.       When used for advanced carcinoma of the prostate, chronic administration of leuprolide inhibits the synthesis of androgens by          

A.        blocking gonadotropin-releasing hormone (GnRH) receptors at the anterior pituitary

B.         blocking luteinizing hormone (LH) receptors on interstitial (Leydig) cells of the testes

C.         increasing the secretion of GnRH from the hypothalamus

D.        inhibiting pulsatile secretion of gonadotropins from the anterior pituitary

E.         upregulation of the number of GnRH receptors at the anterior pituitary

 

55.       Your patient complains of some weight loss and anxiety over the past 6 months, which she attributes to family issues. On examination you note the following physical examination findings, shown below. What is the most likely diagnosis?

A.        hypothyroidism

B.         Grave's disease

C.         hypoparathyroidism

D.        subacute thyroiditis

E.         hyperparathyroidism

 

56.       A 60-year-old female presents for a routine physical exam. She has not seen a health care provider in over 30 years. She has no significant past medical history and is taking no medications. Her surgical history includes only carpal tunnel repair five years ago. Upon review of symptoms, she notes feeling somewhat tired. She attributes that to old age. Vital signs include BP 110/55, pulse 55 bpm, and respirations 16 per minute. Upon exam you note an enlarged, firm thyroid, thickening of her skin, and puffy facial features and pallor. A portion of blood tests that you ordered is shown below:

Serum TSH = 4.4 uIU/mL

 

Hemoglobin = 10.0 g/dL Hematocrit = 30%

MCV = 101

Fasting plasma glucose = 105 mg/dL BUN = 10 mg/dL

Creatinie = 0.6 ng/mL

Which of the following is the most appropriate intervention?

A.        Lithium carbonate 300 mg PO twice daily

B.         Resection of the anterior pituitary

C.         Levothyroxin 50 to 100 ug PO daily

D.        Ferrous sulfate 325 mg PO three times daily

E.         Radioactive iodine protocol

 

57.       An elderly women presents with a history of atrial fibrillation and falls. Her current review of symptoms reveals increased sweating and weight loss. A physical exam revealed multiple non-tender nodules on thyroid exam. Which of the following serum lab values is most consistent with this diagnosis?

A.        High TSH, high free T3,normal total T4

B.         Normal TSH, low free T3, low total T4

C.         Normal TSH, high free T3, high total T4

D.        Low TSH, high free T3, high total T4E. Low TSH, high free T3, low total T4

 

 

58.       A 60-year-old man newly diagnosed with type 2 diabetes mellitus is most likely to have which of the following on ophthalmologic evaluation?

A.        diabetic cataracts

B.         glaucoma

C.         nonproliferative retinopathy

D.        normal fundi

E.         proliferative retinopathy

 

59.       Until now, an elderly patient with type 2 diabetes mellitus has been able to keep her plasma glucose and hemoglobin A1c under control with a diabetic diet and regular exercise. Her recent check-ups revealed that her hemoglobin A1c has been rising up. Her health care provider suggested that she would benefit from treatment with medication. Which of the following medications acts by reducing hepatic gluconeogenesis?

A. Pioglitazone            B. Metformin   C. Acarbose     D. Miglitol       E. Saxagliptin

 

60.       An 18-year-old woman comes in for evaluation of "losing weight without meaning to." She also feels weak and in "always in the bathroom." Her appetite is normal but she "can't get enough to drink." Examination shows that she has lost 17# since her last visit a year ago. She is 66" tall and now weighs 120#. She is mildly orthostatic, but no other abnormalities are noted. A random blood sugar done in the office is 260mg/dl. Which results are most likely on measurement of her lipoproteins at this time?

A.        decreased high density lipoprotein level

B.         extremely elevated triglycerides

C.         markedly increased total cholesterol

D.        mildly elevated low density lipoproteins

E.         normal profile