Endocrinology. Final test
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Endocrinology. Final test 1. In a healthy person, administration of propylthiouracil (a drug that blocks thyroidal peroxidase activity) is most likely to cause: A. exophthalmos B. goiter C. prognathism D. hyperthermia E. tachycardia 2. In a patient with type I diabetes, the best form of treatment would be administration of: A. sulfonylureas B. metformin C. acarbose D. troglitazone E. insulin 3. Which of the following is a direct effect of parathyroid hormone (PTH)? A. increased osteoclast activity B. reduced 1-hydroxylase activity C. increased intestinal synthesis of calcium-binding protein D. increased renal tubular phosphate reabsorption E. reduced 25-hydroxylase activity 4. A decrease in plasma ionized calcium together with an increase in PTH is most likely to be found in a patient with: A. hypoparathyroidism B. primary hyperparathyroidism C. vitamin D deficiency D. vitamin D excess E. calcitonin deficiency 5. The combination of amenorrhea and galactorrhea is most likely caused by excess: A. growth hormone (GH) B. prolactin C. thyroxine (T4) D. adrenocorticotropic hormone (ACTH) E. parathyroid hormone (PTH) 6. Which hypothalamic hormone stimulates more than one anterior pituitary hormone? A. growth hormone releasing hormone (GHRH) B. somatostatin C. thyrotropin releasing hormone (TRH) D. dopamine E. corticotropin releasing hormone (CRH) 7. Which of the following hormones is LEAST likely to have a nocturnal peak? A. thyroxine (T4) B. ACTH C. cortisol D. prolactin E. growth hormone (GH) 8. In the United States, the most common form of diabetes is characterized by: A. lack of C-peptide B. autoimmune attack on the beta cells C. less than 50% concordance in twins D. obesity E. ketosis 9. After secretion by the beta cell, insulin reaches the __________________ first before being carried in the circulation to other insulin target organs. A. muscle B. adipose tissue C. liver D. kidney E. brain 10. Which of the following is most likely to decrease secretion of ACTH? A. administration of metyrapone B. administration of dexamethasone C. hypoglycemia D. surgical removal of one adrenal gland E. physical trauma 11. A patient with untreated type I diabetes mellitus is most likely to have increased: A. muscle glucose uptake B. lipolysis C. hepatic glycogen synthesis D. muscle protein synthesis E. plasma pH 12. An unconscious patient is dehydrated, has rapid deep respirations, and has a fruity breath odor. The most likely explanation is: A. hypercalcemia B. hypoglycemia C. diabetic ketoacidosis D. adrenal insufficiency E. hypothyroidism 13. When administered to a healthy human, a substance that blocks conversion of cholesterol to pregnenolone would be most likely to cause an increase in secretion of: A. cortisol B. dehydroepiandrosterone (DHEA) C. aldosterone D. renin E. androstenedione 14. Increased secretion of epinephrine is most likely to cause increased: A. triglyceride storage B. glycogen synthesis C. muscle glucose uptake D. muscle protein synthesis E. gluconeogenesis 15. Which of the following stimulates the secretion of insulin but not glucagon? A. amino acids B. gut hormones C. sulfonylureas D. parasympathetic nerves E. acetylcholine 16. An exaggerated TSH response to TRH administration is most likely to be found in a person who has: A. thyroid stimulating immunoglobulins (TSI) B. pituitary insufficiency C. primary hypothyroidism D. secondary hypothyroidism E. elevated plasma thyroxine (T4) 17. Which of the following hormones is least likely to increase during stress? A. calcitonin B. glucagon C. growth hormone D. cortisol E. epinephrine 18. Which of the following hormones inhibits protein synthesis while stimulating protein breakdown? A. insulin B. glucagon C. epinephrine D. cortisol E. growth hormone 19. A decrease in renin is most likely to be caused by: A. hemorrhage B. hypotension C. constriction of the right renal artery D. treatment with a drug that inhibits angiotensin converting enzyme E. eating licorice 20. Treatment of a healthy individual with excess thyroxine (T4) is most likely to: A. increase thyroid size B. decrease thyroidal radioactive iodine uptake C. increase the TSH response to TRH D. decrease liver synthesis of thyroid binding globulin (TBG) E. increase the thyroidal coupling reaction 21. Fasting for 4 days would be most likely to: A. decrease plasma reverse T3 (rT3) B. increase plasma thyroxine (T4) C. decrease plasma triiodothyronine (T3) D. increase plasma thyroglobulin E. increase 5'-deiodinase activity 22. A 24-year-old woman is referred to you by an ophthalmologist who discovered bilateral cataracts. Patient is product of normal pregnancy and delivery. Childhood was uncomplicated, and she has done well at school. During the past 5 years, she has been complaining of decreased visual acuity, tingling and numbness of hands and legs, and constipation. The patient married at age 21, and she had a normal child at age 22. During pregnancy, tingling and numbness of the extremities worsened, and she had several seizure episodes necessitating intravenous calcium administration. Two sisters have been treated for hypocalcemia with vitamin D. The patient takes no medications. The physical examination is unremarkable. Laboratory: the complete blood count, urinanalysis and examination of the stools for ova and parasites are normal; serum calcium is decreased, serum phosphate is increased, serum alkaline phosphatase is normal. What is your diagnosis? Inappropriate PTH secretion. Osteomalacia. Vitamin D deficiency. Hypoparathyroidism. Vitamin D intoxication. Which is the most important test to evaluate the mechanism of the hypocalcemia? Bone X-rays. Serum magnesium concentration. Plasma PTH concentration. Plasma 25-(OH)D. Urinary calcium. How would you treat this patient? Intramuscular PTH. Subcutaneous calcitonin. Oral phosphates. Vitamin D. Thiazide diuretics. A patient, 35 years old, a week later after thyroidectomy for thyroid gland cancer has paraesthesia, muscle fbrillations, convulsions in extremities. What is the possible diagnosis? Primary hypoparathyroidism Secondary hypoparathyroidism Hypothyroidism Myeloma Distant metastases A patient, 59 years old, consult a doctor with complaints of fast fatigue, muscular weakness, pain in muscles, spine, thirst, poliuria, loss of teeth. A leg fracture has occurred 10 months ago after damage and bad synostosis. The patient has gastric ulcer and nodular goiter in her life history. Menopause has been obtained at 53 years. Complete blood count: erythrocytes - 3x1012/L, Hb - 100 g/L, leucocytes - 4,4x109/L, ESR - 28 mm/h, serum calcium - 2,9 mmol/L, serum phosphate - 0,4 mmol/L. Bone X-ray examination: systemic osteoporosis, subperiosteal resorption of bones, cysts, spine deformation. Determine possible diagnosis. Primary hyperparathyroidism Secondary hyperparathyroidism Postmenopausal osteoporosis Thyroid cancer with metastases in bones Pedjet disease A patient 40 years old, having urolithiasis for 10 years, has coral calculus in right kidney and multiple calculi in left kidney. Laboratory fndings: serum calcium - 2,85 mmol/L, serum phosphate - 0,3 mmol/L, creatinine, urea are normal. What is the diagnosis? Primary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism Pseudohyperparathyroidism Primary hypoparathyroidism A patient, 52 years old, consult a doctor with complaints of general weakness, insomnia, decreasing memory, vertigo, cardiac pain, palpitation, periodic vomiting, diarrhea, following constipation, paraes-thesia, muscle fbrillations, turning to cramps in upper extremities. Cramps occur after stress, infectious diseases. There are no endocrine diseases in family history. Laboratory fndings: glycemia - 4,8 mmol/L, serum calcium - 2,0 mmol/L, serum phosphates - 1,1 mmol/L. ECG: prolongation of QT interval. X-ray: increased density of bones. What is the diagnosis? Hypoparathyroidism Pseudohypoparathyroidism Insulinoma Epilepsy Malabsorption syndrome A 38-years-old patient M. has been operated on for toxic multinodular goiter, II gr. For 2 weeks after the operation cramps in upper extremities had appeared, which persisted for 1-2 min. and accompanied with numbness in face. Cramps occur 1-2 times a day, commonly at a daytime. Pulse is 82 st/min, rhythmic; blood pressure is 110/70 mmHg. Visceral organs are not damaged. Trousseau’s, Hvostek’s I symptoms are positive. What is the diagnosis? Post-operative hypoparathyroidism Post-operative hypothyroidism Pseudohypoparathyroidism Epilepsy Insulinoma A patient D., 38 years old, is treated for recurrent urolithiasis for 7 years. At examination increased serum calcium and urinary calcium and low serum phosphate. Serum creatinine is normal. What is the preliminary diagnosis? Primary hyperparathyroidism, renal form Urolithiasis, secondary hyperparathyroidism Urolithiasis, threefold hyperparathyroidism Pseudohyperparathyroidism Primary hyperparathyroidism, bone form A 7-years-old child with cramps has hypocalcemia and radiologic signs of osteoporosis. Parathyroid hormone blood level is increased. Hyperphosphatemia is revealed. The child has signs of physical and mental retardation. A treatment with parathyroid hormone was not effective. What is the preliminary diagnosis? Pseudohypoparathyroidism Pseudohyperparathyroidism Pseudoidiopathic hypoparathyroidism Idiopathic hypoparathyroidism Primary hyperparathyroidism The pituitary gland is below the ________. pineal gland hypothalamus thalamus pons Which of the following is not a hormone of the anterior pituitary gland: growth hormone prolactin leutinizing hormone oxytocin Which is not a function of oxytocin: cause morning sickness helps contract uterus smooth muscle secrete milk after birth function increases closer to time of birth Which section communicates largely with the hypothalamus: anterior superior posterior inferior Which gland is not caused to function by the anterior pituitary gland: adrenal ovaric bladder thyroid What is another name for the anterior pituitary gland? actodenysis adenocorticotropic adenohypophysis hypothalamus Where is the pituitary gland located? base of the brain stem beneath the hypothalamus in the inner ear the center of the cerebrum What happens if there is an underfunction of the anterior pituitary gland? giantism hydrocephalis death dwarfism and decrease of activity in other glands What does Luteinizing Hormone do in men and women? men – supports sperm production, women – promotes egg development men – promotes lutein production, women – promotes lutein production men – stimulates interstitial cells of testes to produce sex hormones, women – induces ovulation, promotes the ovarian secretion of estrogens and progestins, prepares the body for pregnancy men – promotes melanin production, women – promotes melanin production The Pituitary Gland is the size of a: Pea cantaloupe grape kiwi The Anterior Pituitary Gland is composed mostly of cells that secrete… calcium hypophyseal hormones protein hormones trophic hormones What has the biggest effect on the hormones of the pituitary gland? Pregnancy puberty fetal development drug use The effects of underfunction include a decrease in endocrine gland functions and… fatigue mood swings elephantitis dwarfism The general function of the posterior pituitary gland is to: stimulate bone growth store and later release hormones control movement of the iris help to produce calcium All of the following affect the level of Antidiuretic hormone except: dehydration nicotine alcohol sugar The basic function of Oxytocin is to: stimulate contraction of smooth muscle during birth and feeding stimulate restriction of blood flow to the brain during sleep inhibit the production of sweat during extreme temperatures inhibit the production of saliva The two hormones produced by the cell bodies of the secretory neurons for the posterior pituitary gland are: Oxytocin and Adrenaline Oxytocin and Antidiuretic hormone Adrenaline and Antidiphoretic hormone Adrenaline and Estrogen Dehydration is: loss of blood due to hemorrhaging an excessive amount of H2O in the blood the process of perspiration low water concentration in the blood Which of the following is NOT a function of melatonin? Inhibits reproduction functions Protects against sunlight Protects against damage from free radicals Sets Circadian Rhythms Where is the Pineal Gland located? Roof of the thalamus Posterior portion of the roof of the third ventricle A and B None of the above Which of the following is NOT contained in the pineal gland? Neurons Keratin Neuroglia Pinealocytes Melatonin production is: Highest during daylight hours and lowest at night Always constant Lowest during daylight hours and highest at night Not produced in the pineal gland Melatonin reduces the maturation rate of sperm/occytes by reducing the rate of what secretion? Pinealocytes GnRH PnGH None of the above What is the general function of the parathyroid gland? Restores Calcium homeostasis by decreasing Calcium concentrations in body fluid Restores Potassium homeostasis by decreasing Potassium concentrations in body fluid Restores Potassium homeostasis by increasing Potassium concentrations in body fluid Restores Calcium homeostasis by increasing Calcium concentrations in body fluid What organs does parathyroid hormone mainly target? bone and intestine thyroid and liver bone and kidney thyroid and kidney What specifically does parathyroid hormone do to maintain homeostasis? stimulates osteoclasts inhibits osteoblasts reduces urinary excretion of Calcium all of the above What is the disease where one of four parathyroid glands becomes an enlarged, benign tumor, producing too much Calcium to maintain good homeostasis? hypoparathyroidism hyperparathyroidism parathyroid cancer basophilism Which one is NOT a symptom of hypothyroidism? fatigue weight gain feeling cold shaking Which one is NOT a symptom of hyperthyroidism? feeling hot weight loss shaking constipation Which hormone causes a decrease in the calcium concentration in the blood? thyroxine Calcitonin Triiodothyronine All of the above Which hormone speeds up the body’s metabolism? Triiodothyronine Calcitonin Thyroxine All of the Above Where is the thyroid located? lower neck below Larynx just above the Clavicle All of the above Treatment for prediabetes: Is unnecessary, but the patient should be warned Never include medications Always includes some form of medication Can delay or prevent type 2 diabetes mellitus What is the most dangerous adverse effect following use of biguanides? Hyperglycaemia Hypoglycaemia Diabetic ketoacidosis Hyperosmolality Lactic acidosis Which of the following drugs may precipitate cardiovascular complications? Glyburide Gliclazide Glimepiride Acarbose Nateglinide Mechanism of sulphonylureas’ action includes Beyond pancreatic activity Stimulating beta cells to synthesise insulin Inhibiting beta cell to secrete insulin Stimulation beta cells to secrete insulin Inhibiting insulin resistance Mechanism of biguanides’ action includes Inhibiting insulin resistance Stimulating beta cells to synthesise insulin Inhibiting beta cell to secrete insulin Stimulation beta cells to secrete insulin Beyond pancreatic activity Which of the following is not correct for oral hypoglycaemic drugs? Stimulation of insulin release Anorexigenic effect Reduction of carbohydrate absorption Inhibition of gluconeogenesis Stimulation of insulin synthesis The first step in treating hyperglycemia in patient with type 2 diabetes mellitus is usually: Insulin therapy Oral hypoglycemics A combination of insulin and oral medications Lifestyle and diet changes Only diet 71. A 56 year old man with type 2 diabetes mellitus of 23 years duration was seen in the clinic. He was noted to have hypertension (blood pressure 160/100 mmHg) and microalbuminuria and his serum creatinine was 120 mmol/L (Normal 50–110 mmol/L). He was prescribed a small daily dose of the angiotensin-converting enzyme inhibitor ramipril. Three days later, he was seen in the Emergency Room having become acutely short of breath. His blood pressure was 110/70 with a tachycardia of 110/min and he had bilateral basal crackles on auscultation of his chest. The chest X-ray indicated that he had developed pulmonary edema. The serum creatinine had risen markedly to 410 mmol/L. Which investigation would you perform next? Calculation of glomerular filtration rate based on serum creatinine level Measurement of 24-hour urine protein excretion Serum protein electrophoresis ECG, ultrasound All of the above Patient J., is a 52 year old female diagnosed with type 2 diabetes mellitus 7 years ago. She notes that she has had variable control over her diabetes in the past, although her hemoglobin A1C has been excellent for the past 4 years. Which of the following would classify this patient as “high risk” for development of a diabetic foot ulcer? Absence of palpable pedal pulses Abnormalities of sensation via the monofilament test Presence of musculoskeletal foot deformities Previous history of foot ulcers All of the above Yüklə 64,18 Kb. Dostları ilə paylaş:
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