Endocrinology Question Set 2

A 22-year old female software analyst presents with tingling and numbness of both the hands for the past 2 months. Symptoms are usually aggravated by the end of the day. She was a known diabetic for the past 7 years and is currently on insulin. She is sexually active and is having amenorrhea for the past 3 months. Pregnancy test is negative. The most likely mechanism for the present symptoms is:

A 35-year-old female presents with increased anxiety and reeling sensation. Her complaint started 30 minutes ago with increased sweating, palpitations, gradually worsening. On examination, the BP was found to be 144/94 mm Hg. She had normal blood pressure when she checked at the local pharmacy 5 days ago. She currently works as an event manager and her job involves a lot of stress. Family history shows that her father has thyroid carcinoma. Which of the following is most likely seen in this person?

A 19-year-old teenager visits your clinic with the complaint of pain in her neck since the past 5 days. She is not able to wear her tie for her evening job because of her neck pain. She also reports of fatigue and lethargy for the past 10 days. She had flu symptoms about 20 days ago, which resolved spontaneously. She is a non-smoker and occasionally drinks beer with friends on weekends. On examination, her BP is 110/80 mm of Hg, pulse is 48/mins, peripheries are cold and dry, and neck is very tender. An EKG is normal, lab examination shows elevated TSH and ESR of 30 mm/hr. Which of the following is the most appropriate step to resolve the patient problem?

A 24-year-old woman delivers a baby after complete 9-months of gestational period. The Apgar counts are 9 and 10 at 1 and 5 minutes respectively. After 30 minutes of delivery, the mother’s BP drops to 80/60 mm of Hg. On further examination you see that her PR is 124/ mins, peripheries are cold and the uterus is boggy. Immediate treatment is initiated with 2 wide bore needle, and IV fluids are rushed. After administering 4 units of IV fluids and 4 units of blood transfusion, her vitals become stable. Next morning, when she tries to breastfeed her child, she complains of no lactation. What is the cause of the failure of lactation?

A 26-year-old nursing home staff visits the ER with complaints of palpitations and chest pain for the past 2 days. She was working at the nursing home for the last 1 year but has been also trying to get into modeling for the last 6 months, and trying hard to lose an extra amount of weight she has put on. She is a non-smoker and occasionally takes alcohol on weekends with friends. On examination, she looks very ill built according to her age; her BP is 150/84 mm of Hg, and PR is 118/mins. An EKG is advised and absent P waves are seen. All other remaining physical findings are normal. What is the probable diagnosis in this patient?

A 28-year-old person is admitted to the ER. He was brought by his colleagues at a corporate firm. They said that he suddenly started feeling drowsy and fell during the presentation. On examination, his BP is 110/80 mm of Hg, and PR is 114/mins. He has undergone similar episodes 5 times in the past 3 months. He is a non-smoker and drinks 2-3 beers daily. His capillary blood glucose is 15 mg/dL, immediate IV dextrose with thiamine is started and he regains consciousness in some time. He is now conscious and oriented. CT abdomen is ordered and a tumor is seen in the pancreas. Which of the following is true regarding this patient?

A 35-year-old pregnant lady gives birth to a baby after nine months of gestation. The course of the pregnancy was uneventful, and she underwent all prenatal examinations and was given a prophylactic tetanus vaccine. While going through neonatal examination, pediatrician reports APGAR as 9 and 10 at 1 and 5 mins respectively. Pediatrician notices that the baby has ambiguous genitalia, BP of the baby is high for neonate and orders for a metabolic panel of renin and adrenal hormones. The lab results are as follows: Renin: 0.4 nmol/L per h Normal: 0.8 to 3.0 nmol/L per h Aldosterone: 70 pmol /L Normal: 140 to 830 pmol/L Cortisol: 190 nmol/L Normal: 275 to 555 nmol/L Sex hormones are higher than the normal values at this age. Which of the following is responsible for the neonate hypertension?

A 30-year-old lady is brought to the urgent care clinic by her husband with the complaints of numbness around her lips and tingling sensation in her hands and feet since this morning. She underwent near-total thyroidectomy a month back for a enlarged thyroid gland. Her vitals are: Blood pressure of 130/7 mmHg, Pulse of 72/min, Respiratory rate of 16/min and Temperature of 37 °C. Surgical incision scar is present in the anterior aspect of the neck. While checking her blood pressure the attending physician inflates the blood pressure cuff above 150 mmHg and observes for a couple of mins. The patient develops sudden stiffness and tingling in her hand. Result of her blood test shows: Hemoglobin (Hb%): 10.2 g/dl White blood cell count: 7000/mm^3 Platelet Count: 160,000/mm^3 Calcium, serum (Ca^2+): 6.0 mg/dl Albumin: 4 gm/dl Alanine aminotransferase (ALT), serum: 15 U/L Aspartate aminotransferase (AST), serum: 8 U/L Serum Creatinine: 0.5 mg/dl Urea: 27 mg/dl Sodium: 137 mEq/L Potassium: 4.5 mEq/L Magnesium: 2.5 mEq/L Urinalysis shows no WBCs or RBCs and leukocyte esterase is negative. Which of the following is the next best step in the management of this patient?

A 13-year-old girl is brought to the outpatient clinic by her parents with the complaint of episodic spasm in her fingers for past few months. Upon further questioning, her mother added that she is not doing good at school and thinks that she is not as tall as the other children in her class. On examination, her pulse is 72/min, temperature is 37.6 °C, respirations are 16/min and blood pressure is 120/88 mmHg. She has short fourth and fifth fingers in both her hands, a round face with discoloration of her teeth. Her height is 4’ 5’’ and she weighs 132 lbs. Investigation reports show: Hemoglobin (Hb%): 12.5 g/dl White blood cell total count: 10,000/mm^3 Platelets: 260,000/mm^3 Calcium, serum (Ca^2+): 4.0 mg/dl Serum Albumin: 4 gm/dl Alanine aminotransferase (ALT), serum: 15 U/L Aspartate aminotransferase (AST), serum: 8 U/L Serum Creatinine: 0.5 mg/dl Urea: 27 mg/dl Sodium: 137 mEq/L Potassium: 4.5 mEq/L Magnesium: 2.5 mEq/L Parathyroid hormone, serum, N-terminal: 930 pg/ml (Normal: 230-630 pg/mL) Serum vitamin D: 45 ng/dl Which of the following is the mode of inheritance for the disease that this patient has?

A 35-year-old male is brought to the Emergency Room after he was found to have a blood pressure of 180/100 mmHg during a routine health check up at his family physician. Past medical history is insignificant and both of his parents are healthy. He currently does not take any medication. The patient's blood pressure normalizes before the ER physician can evaluate him. During the physical examination, his blood pressure is 148/80 mmHg, heart rate is 65 beats per minute, body temperature is 36.8°C and respirations are 14/min. He has a round face, centripetal obesity, and striae on the skin with atrophy over the abdomen and thighs. Neurological examination shows loss of visual acuity in both temporal fields of views. You order a high dose dexamethasone suppression test after measuring ACTH levels. Which of the following lab abnormalities is most likely to belong to this patient?

A 25-year-old man presents to the office complaining of a mass on his neck which he noticed a few weeks back while taking shower. Since then the mass has not increased in size. He denies any pain or difficulty in swallowing. He has no other complaints, although he admits to occasional episodes of anxiety that include pounding headache, heart racing, and sweating. His past medical history is benign. He states that he thinks his father had his thyroid removed when he was around his age but doesn’t know why. His vitals are pulse: 88/min, blood pressure: 133/87 mmHg, temperature: 99 °F and respiratory rate is 14/min. On physical exam, the patient looks cachectic and he is 6' 2'' (182.88 cm) tall with long extremities. There is a palpable nodule on the left lobe of the thyroid measuring 4 cm x 4 cm. Which of the following is the most likely thyroid pathology?

A 42-year-old woman presents to the office complaining of fatigue. She recently had a total thyroidectomy due to Grave’s disease but is otherwise healthy. Physical examination is insignificant. Labs are drawn and results are as follows: Serum: Sodium: 138 mEq/L Potassium: 4.2 mEq/L Calcium: 7.8 mg/dL Chloride: 102 mEq/L Vitamin D3: 8ng/mL (Reference range :25-80 ng/mL) Deficiency of which of the following is the cause of this patient’s symptoms?

A 58-year-old female with a history of cirrhosis and kidney stones presents to the emergency department because she is becoming increasingly confused. She states that all her joints hurt, she has abdominal pain with nausea and has been urinating more than usual. Her temperature is 98.6° F, her blood pressure is 110/80 mmHg, her heart rate is 115 /min, and her Oxygen saturation is 99% on room air. You order a complete blood count and basic metabolic panel, both of which are within normal limits. Your nurse points out that the calcium is 10.6 mg/dL, which is on the higher end of normal. Her liver function test results are as follows: Alkaline aminotransferase ALT: 62 U/L Aspartate aminotransferase AST: 50 U/L Total Bilirubin: 1.0 mg/dL Serum Albumin: 2.0 g/dL. What is the cause of this patient’s symptoms?

A 2-month-old girl with DiGeorge syndrome presents to the emergency department status post a witnessed seizure 45 minutes prior to arrival. Her mother states that the baby had been inconsolable all day and refused to feed. On exam, she is afebrile and somnolent. As you tap on her cheek to wake her, her facial muscles twitch. When you attempt to get a blood pressure the patient’s arm curls up sharply and does not relax until the cuff is released. Which of the following is the most likely cause?