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1 | |
A 50-year-old female is 5 ft 7 in. tall and weighs 165 lb. There is a family history of diabetes mellitus. Fasting blood glucose is 150 mg/dL on two occasions. She is asymptomatic, and physical exam shows no abnormalities. The treatment of choice is |
| | A) | Observation |
| | B) | Medical nutrition therapy |
| | C) | Insulin |
| | D) | Oral hypoglycemic agent |
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2 | |
A 55-year-old type 2 diabetic patient has lost weight and has had good control of his blood sugar on oral agents. He has a history of mild hypertension and hyperlipidemia. He asks for advice about an exercise program. Which one of the following statements is correct? |
| | A) | Exercise should be avoided because it may cause foot trauma |
| | B) | An active lifestyle cannot slow the complications of diabetes |
| | C) | Vigorous exercise cannot precipitate hypoglycemia |
| | D) | A stress test should be recommended prior to beginning an exercise program |
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3 | |
A newly diagnosed type 2 diabetic patient asks for clarification about dietary management. Which of the following is good advice? |
| | A) | Restrict carbohydrates and eat a high-protein diet |
| | B) | Avoid sucrose altogether |
| | C) | Less than 10% of caloric intake should be saturated fat |
| | D) | Caloric intake should be very consistent from one day to another |
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4 | |
As part of a review of systems, a 55-year-old male describes an inability to achieve erection. The patient has mild diabetes and is on a beta blocker for hypertension. The first step in evaluation is |
| | A) | Serum testosterone |
| | B) | Serum gonadotropin |
| | C) | Information about libido and morning erections |
| | D) | Papaverine injection |
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5 | |
A 50-year-old female is evaluated for hypertension. Her blood pressure is 130/98. She complains of polyuria and of mild muscle weakness. She is on no diuretics or other blood pressure medication. On physical exam, the PMI is displaced to the sixth intercostal space. There is no sign of congestive heart failure and no edema. Laboratory values are as follows:
Na-: 147 meq/dL
K-: 2.3 meq/dL
Cl-: 112 meq/dL
HCO3: 27 meq/dL
The patient is on no other medication. She does not eat licorice. The first step in diagnosis is |
| | A) | 24-h urine for cortisol |
| | B) | Urinary metanephrine |
| | C) | Plasma renin and aldosterone |
| | D) | Renal angiogram |
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6 | |
A 60-year-old woman comes to the emergency room in a coma. The patient’s temperature is 90°F. She is bradycardic. Her thyroid gland is enlarged. There is bilateral hyporeflexia. The next step in management is |
| | A) | Await results of T4, TSH |
| | B) | Obtain T4, TSH; begin thyroid hormone and glucocorticoid |
| | C) | Begin rapid rewarming |
| | D) | Obtain CT scan of the head |
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7 | |
A 19-year-old with insulin-dependent diabetes mellitus is taking 30 units of NPH insulin each morning and 15 units at night. Because of persistent morning glycosuria with some ketonuria, the evening dose is increased to 20 units. This worsens the morning glycosuria, and now moderate ketones are noted in urine. The patient complains of sweats and headaches at night. The next step in management is |
| | A) | Increase the evening dose of insulin |
| | B) | Increase the morning dose of insulin |
| | C) | Switch from human NPH to pork insulin |
| | D) | Obtain blood sugar levels between 2:00 and 5:00 A.M. |
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8 | |
A 30-year-old woman is found to have a low serum thyroxine level after being evaluated for fatigue. Five years ago she was treated for Graves’ disease with radioactive iodine. The diagnostic test of choice is |
| | A) | Serum TSH |
| | B) | Serum T3 |
| | C) | TRH stimulation test |
| | D) | Radioactive iodine uptake |
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9 | |
A 25-year-old woman is admitted for hypertensive crisis. In the hospital, blood pressure is labile and responds poorly to antihypertensive therapy. The patient complains of palpitations and apprehension. Her past medical history shows that she developed hypotension during an operation for appendicitis.
Hct: 49% (37–48)
WBC: 11 ˙ 103 mm (4.3–10.8)
Plasma glucose: 160 mg/dL (75–115)
Plasma calcium: 11 mg/dL (9–10.5)
The most likely diagnosis is |
| | A) | Pheochromocytoma |
| | B) | Renal artery stenosis |
| | C) | Essential hypertension |
| | D) | Insulin-dependent diabetes mellitus |
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10 | |
The patient pictured below complains of persistent headache. Her most likely visual field defect is |
| | A) | Bitemporal hemianopsia |
| | B) | Unilateral blindness |
| | C) | Left homonymous hemianopsia |
| | D) | Right homonymous hemianopsia |
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11 | |
A patient with small cell carcinoma of the lung develops lethargy. Serum electrolytes are drawn and show a serum sodium of 118 mg/L. There is no evidence of edema, orthostatic hypotension, or dehydration. Urine is concentrated with an osmolality of 320 mmol/kg. Serum BUN, creatinine, and glucose are within normal range. Which of the following is the next appropriate step? |
| | A) | Normal saline infusion |
| | B) | Diuresis |
| | C) | Fluid restriction |
| | D) | Tetracycline |
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12 | |
The 40-year-old woman shown below complains of weakness and amenorrhea. She has hypertension and diabetes mellitus. The clinical findings may be explained by |
| | A) | Pituitary tumor |
| | B) | Adrenal tumor |
| | C) | Ectopic ACTH production |
| | D) | Any of the above |
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13 | |
The patient pictured below presents with gynecomastia and infertility. On exam, he has small, firm testes. Which of the following is correct? |
| | A) | The patient is likely to have low levels of gonadotropins |
| | B) | The patient has Turner syndrome |
| | C) | His most likely karyotype is 47 XXY |
| | D) | The patient will have normal sperm count and testosterone level |
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14 | |
A 52-year-old man complains of impotence. On physical examination, he has an elevated jugular venous pressure, S3 gallop, and hepatomegaly.
He also appears tanned, with pigmentation along joint folds. His left knee is swollen and tender. The plasma glucose is 250 mg/dL, and liver enzymes are elevated. Your next study to establish the diagnosis should be |
| | A) | Detection of nocturnal penile tumescence |
| | B) | Determination of iron saturation |
| | C) | Determination of serum copper |
| | D) | Detection of hepatitis B surface antigen |
| | E) | Echocardiography |
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15 | |
A 30-year-old man is evaluated for a thyroid nodule. The patient reports that his father died from thyroid cancer and that a brother had a history of recurrent renal stones. Blood calcitonin concentration is 2000 pg/mL (normal is less than 100); serum calcium and phosphate levels are normal. Before referring the patient to a surgeon, the physician should |
| | A) | Obtain a liver scan |
| | B) | Perform a calcium infusion test |
| | C) | Measure urinary catecholamines |
| | D) | Administer suppressive doses of thyroxine and measure levels of thyroid-stimulating hormone |
| | E) | Treat the patient with radioactive iodine |
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16 | |
A 32-year-old woman has a 3-year history of oligomenorrhea that has progressed to amenorrhea during the past year. She has observed loss of breast fullness, reduced hip measurements, acne, increased body hair, and deepening of her voice. Physical examination reveals frontal balding, clitoral hypertrophy, and a male escutcheon. Urinary free cortisol and dehydroepiandrosterone sulfate (DHEAS) are normal. Her plasma testosterone level is 6 ng/mL (normal is 0.2 to 0.8). The most likely diagnosis of this patient’s disorder is |
| | A) | Cushing syndrome |
| | B) | Arrhenoblastoma |
| | C) | Polycystic ovary syndrome |
| | D) | Granulosa-theca cell tumor |
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17 | |
A 54-year-old man who has had a Billroth II procedure for peptic ulcer disease now presents with abdominal pain and is found to have recurrent ulcer disease. The physician is considering this patient’s illness to be secondary either to a retained antrum or to a gastrinoma. Which of the following tests would best differentiate the two conditions? |
| | A) | Random gastrin level |
| | B) | Determination of 24-h acid production |
| | C) | Serum calcium level |
| | D) | Secretin infusion |
| | E) | Insulin-induced hypoglycemia |
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18 | |
A 55-year-old woman who has a history of severe depression and who had radical mastectomy for carcinoma of the breast 1 year previously develops polyuria, nocturia, and excessive thirst. Laboratory values are as follows:
Serum electrolytes: Na- 149 meq/L; K- 3.6 meq/L
Serum calcium: 9.5 mg/dL
Blood glucose: 110 mg/dL
Blood urea nitrogen: 30 mg/dL
Urine osmolality: 150 mOsm/kg
The most likely diagnosis is |
| | A) | Psychogenic polydipsia |
| | B) | Renal glycosuria |
| | C) | Hypercalciuria |
| | D) | Diabetes insipidus |
| | E) | Inappropriate antidiuretic hormone syndrome |
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19 | |
A 30-year-old nursing student presents with confusion, sweating, hunger, and fatigue. Blood sugar is noted to be 40 mg/dL. The patient has no history of diabetes mellitus, although her sister is an insulin-dependent diabetic. The patient has had several similar episodes over the past year, all occurring just prior to reporting for work in the early morning. On this evaluation, the patient is found to have high insulin levels and a low C peptide level. The most likely diagnosis is |
| | A) | Reactive hypoglycemia |
| | B) | Early diabetes mellitus |
| | C) | Factitious hypoglycemia |
| | D) | Insulinoma |
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