Week 6 HODI examsoft

A 26-year-old female with type 1 diabetes presents to your clinic for a follow up appointment. She complains of new-onset abdominal pain, nausea, vomiting, low appetite and more frequent episodes of hypoglycemia. Her urine HCG was negative. What is the next step in her evaluation?

To allow for aldosterone binding to the type 1 glucocorticoid receptor, cortisol is deactivated in specific tissues (such as the kidney) by which of the following enzymes?

A 26-year-old male with primary adrenal insufficiency ran out of all of his medications three days ago. He presents to the emergency department with nausea and vomiting. He is unable to keep down fluids. On exam he appears dehydrated with a heart rate of 110 beats per minute and dry mucous membranes. Which of the following are the expected serum lab findings in this patient?

On a well child visit to his pediatrician, a 3 year-old-male is found to have hypertension and increased penile length. He is diagnosed with congenital adrenal hyperplasia caused by 11 beta hydroxylase deficiency. On his blood test, you expect to find elevated levels of which of the following?

A 38-year-old female with primary adrenal insufficiency is prescribed fludrocortisone. Which of the following conditions is a sign that the dose of fludrocortisone is too high?

Please refer to the attached table to answer the following question: A 55-year-old female presents for evaluation in your clinic for new-onset type 2 diabetes. Her exam is notable for supraclavicular fat pad filling, central adiposity, muscle weakness, and thinning of the skin. Her 24 hour urine free cortisol levels were markedly elevated, as was ACTH. Results of peak ACTH levels from cavernous sinus sampling are shown in the attached table. The most likely cause of her signs and symptoms is which of the following?

A 52-year-old male with rheumatoid arthritis presents with 4 days of cough and fever. He had previously been on prednisone 15 mg daily for months. He stopped taking prednisone a week ago after running out. His blood work is notable for hyponatremia with normal potassium levels. His chest x-ray confirms that he has pneumonia and you start him on appropriate antibiotic therapy for his bacterial pneumonia. Later in the day, the nurse calls you urgently because his blood pressure is 70/40 despite receiving intravenous fluids. To treat his hypotension, which of the following would you administer?

A 36-year-old female presents with hypertension. In addition to elevated blood pressure, her exam is notable for supraclavicular fat pad filling, muscle weakness, and thinning of the skin. Which of the following would be the first step in her evaluation?

Which of the following cell types produce parathyroid hormone?

Which of the following cell types is found in the pars distalis and is acidophilic

Moving from the capsule towards the central vein, the order of the main hormones produced by the adrenal cortex is which of the following?

The enzyme 17alpha-hydroxylase is found within which of the following?

A 38-year-old female presents to your clinic for an annual exam. She mentions that within the past few months she was in the emergency department for evaluation of marked hypertension. Your evaluation reveals that she has a pheochromoctyoma. Her condition should be treated first with which of the following medications?

Please refer to the attached table to answer the following question: A 42-year-old man is diagnosed with secondary hypertension. His lab results are attached. Which of the following medications do you recommend for his condition?

A 43-year-old female presents with spells of heart racing and hypertension. Her labs demonstrate increased urine metanephrines and normetanephrines. She would also likely be experiencing which of the following during her spells?

A 39-year-old male is evaluated for secondary hypertension and is found to have elevated aldosterone levels. He undergoes adrenal vein sampling. For this procedure, the right adrenal vein is accessed from which of the following?

A 67-year-old female presents with primary hyperthyroidism. You determine that she has Grave s disease, which causes her thyroid gland to over-produce thyroid hormone. Her free T4 level is elevated. Based on your knowledge of feedback loops, you expect her TSH value to be which of the following (normal TSH 0.5-5 mU/L)?

A 47-year-old male with ulcerative colitis was on prednisone 20 mg daily for the last year. His prednisone was stopped last week and now he presents with nausea, vomiting, and fatigue. You diagnose him with adrenal insufficiency. The mechanism of his adrenal insufficiency is best described by which of the following?

A 19-year-old woman presents with amenorrhea. She is found to have an 11 mm pituitary adenoma. Her prolactin level is 136 ng/mL (reference range 4-23 ng/mL). Her mother also has a prolactinoma and hyperparathyroidism. Which of the following is the expected gene mutation in this young woman?

A 36-year-old male has pan-hypopituitarism and is on multiple hormone replacements, including growth hormone, thyroid hormone, testosterone, and hydrocortisone. The growth hormone injections he takes increases which of the following?

A 29-year-old female presents with a 1.8 cm pituitary macroadenoma. She is complaining of amenorrhea and galactorrhea. Her prolactin level returns at 2657 ng/mL (reference range 4-23 ng/mL). The remainder of her laboratory evaluation is normal. Which of the following do you recommend for initial treatment?

Please refer to the attached table to answer the following question: A 14-year-old female presents with short stature and absent pubertal development. Initial labs are attached. Imaging of the brain shows a sellar and suprasellar cystic mass with calcifications. Which of the following is the correct diagnosis?

A 56-year-old male presents with type 2 diabetes, increasing hand size and hat size. On exam, he has acanthosis nigricans and skin tags. His blood pressure is 163/94. What is the first step in his evaluation?

A 53-year-old female undergoes removal of an ACTH-secreting pituitary adenoma. Three days after surgery, she acutely develops polyuria and polydipsia. Her laboratory results are likely to indicate which of the following?

A 21-year-old female presents with amenorrhea for the past 3 months. Her prolactin level is 88 (reference range 4-23 ng/mL). Which of the following is the first step in her evaluation?

A 43-year-old male with a 1.3 cm growth hormone-secreting pituitary adenoma undergoes surgery to remove the adenoma. Surgery is typically done by accessing the sella through which of the following sinuses?

Dopamine in the portal circulation binds dopamine receptors on which one of the following cell types to inhibit hormone secretion?

A 62 year-old male presents with weight gain, easy bruising, and thinning of his skin. On exam, his blood pressure was 148/92. He is unable to stand without using his hands to push up from the chair. He has thin extremities and central obesity. He has broad pink- purple stretch marks on his abdomen. On laboratory examination, he is noted to have a serum potassium level of 3.1 mEq/L. 24 hour urine cortisol = 324 mcg/24 hours (0-45 mcg). What is the most likely explanation for this patient's hypertension and hypokalemia?

The final step in the conversion of norepinephrine to epinephrine in the cytoplasm is catalyzed by which of the following?

Which of the following describes a paracrine effect?