Deck 18: Alterations of Hormonal Regulation

Question 1

Diabetes insipidus, diabetes mellitus, and SIADH share which of the following clinical manifestations?

A) Polyuria
B) Edema
C) Vomiting and abdominal cramping
D) Thirst

Answer 1

Thirst

Question 2

A 3-year-old male was diagnosed with congenital hypothyroidism. If left untreated, the child would have:

A) mental retardation and stunted growth.
B) increased risk of childhood thyroid cancer.
C) hyperactivity and attention deficit disorder.
D) liver, kidney, and pancreas failure.

Answer 2

mental retardation and stunted growth.

Question 3

Common neurologic disturbances seen with pituitary adenomas are:

A) comas.
B) visual disturbances.
C) confusional states.
D) breathing abnormalities.

Answer 3

visual disturbances.

Question 4

A severe consequence of syndrome of inappropriate ADH secretion (SIADH) is:

A) stroke.
B) diabetes insipidus.
C) neurologic damage.
D) renal failure.

Question 5

A 25-year-old female with Graves disease is admitted to a medical-surgical unit. Palpation of her neck would most likely reveal:

A) a normal-sized thyroid.
B) a small discrete thyroid nodule.
C) multiple discrete thyroid nodules.
D) diffuse thyroid enlargement.

Question 6

The most common cause of elevated levels of antidiuretic hormone (ADH) secretion is:

A) autoimmune disease.
B) cancer.
C) pregnancy.
D) heart failure.

Question 7

The basal metabolic rate is unusually _____ with hypothyroidism.

A) high
B) low
C) steady
D) variable

Question 8

A 22-year-old male is admitted to the intensive care unit with a closed head injury sustained in a motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of the following complications should be anticipated?

A) Dilutional hyponatremia
B) Dehydration from polyuria
C) Cardiac arrest from hyperkalemia
D) Metabolic acidosis

Question 9

A 35-year-old female with Graves disease is admitted to a medical-surgical unit. Which of the following symptoms would be expected before treatment?

A) Weight gain, cold intolerance
B) Slow heart rate, rash
C) Skin hot and moist, rapid heart rate
D) Constipation, confusion

Question 10

A 35-year-old female with Graves disease is admitted to a medical-surgical unit. Lab tests would most likely reveal:

A) high levels of circulating thyroid-stimulating antibodies.
B) ectopic secretion of thyroid-stimulating hormone (TSH).
C) low circulating levels of thyroid hormones.
D) stimulation of thyroid-binding globulin.

Question 11

A 54-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following electrolyte imbalances would be expected in this patient?

A) Hyponatremia
B) Hyperkalemia
C) Hypernatremia
D) Hypokalemia

Question 12

A 25-year-old male presents with fatigue, constipation, and sexual dysfunction. Tests reveal all pituitary hormones are normal and no masses are appreciated. The most likely cause of his symptoms is a dysfunction in the:

A) anterior pituitary.
B) posterior pituitary.
C) pars intermedia.
D) hypothalamus.

Question 13

A 15-year-old female presents with breast discharge, dysmenorrhea, and excessive excitability. Tests reveal that all her pituitary hormones are elevated. The most likely cause is:

A) a pituitary adenoma.
B) hypothalamic hyposecretion.
C) hypothalamic inflammation.
D) a neurohypophyseal tumor.

Question 14

A 22-year-old female has a low level of thyroid-stimulating hormone (TSH). This condition would cause _____ hypothyroidism.

A) primary
B) secondary
C) autoimmune
D) atypical

Question 15

A 50-year-old male patient presents with polyuria and extreme thirst. He was given exogenous ADH. For which of the following would this treatment be effective?

A) Neurogenic diabetes insipidus
B) Psychogenic diabetes insipidus
C) Nephrogenic diabetes insipidus
D) SIADH

Question 16

The level of T₃ in Graves disease is usually abnormally:

A) low.
B) high.
C) variable.
D) absent.

Question 17

Visual disturbances are a common occurrence in patients with untreated Graves disease. The main cause of these complications is:

A) decreased blood flow to the eye.
B) orbital edema and extraocular muscle paralysis.
C) TSH neurotoxicity to retinal cells.
D) local lactic acidosis.

Question 18

A side effect of some general anesthetic agents is _____ diabetes insipidus.

A) neurogenic
B) nephrogenic
C) psychogenic
D) allogenic

Question 19

General causes of abnormal target cell responses include:

A) abnormal receptor activity.
B) abnormal hormone levels.
C) increased synthesis of second messengers.
D) extracellular electrolyte alterations.

Question 20

A 54-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following clinical manifestations would be expected in this patient?

A) Peripheral edema
B) Tachycardia
C) Low blood pressure
D) Concentrated urine

Question 21

A 19-year-old female with type 1 diabetes mellitus was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high); urine glucose and ketones 4+ (high); arterial pH 7.20 (low). Her parents state that she has been sick with the "flu" for a week. Which of the following statements best explains her acidotic state?

A) Increased insulin levels promote protein breakdown and ketone formation.
B) Her uncontrolled diabetes has led to renal failure.
C) Low serum insulin promotes lipid storage and a corresponding release of ketones.
D) Insulin deficiency promotes lipid metabolism and ketone formation.

Question 22

Hyperglycemia in type 2 diabetes mellitus is a result of:

A) insulin deficiency.
B) hyperinsulinemia and insulin resistance.
C) glucagon deficiency.
D) liver dysfunction.

Question 23

Both Cushing syndrome and Addison disease can manifest with elevated levels of:

A) ADH.
B) cortisol.
C) adrenocorticotropic hormone (ACTH).
D) aldosterone.

Question 24

A 45-year-old female with Graves disease underwent surgical removal of her thyroid gland. During the postoperative period, her serum calcium was low. The most probable reason for her low serum calcium is:

A) hyperparathyroidism secondary to Graves disease.
B) myxedema secondary to surgery.
C) hypoparathyroidism caused by surgical injury to the parathyroid glands.
D) hypothyroidism resulting from lack of thyroid replacement.

Question 25

A 19-year-old female with type 1 diabetes mellitus was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high); serum K⁺ 2 (low); serum Na⁺ 130 (low). Her parents state that she has been sick with the "flu" for a week. What relationship do these values have with her insulin deficiency?

A) Increased glucose utilization causes the shift of fluid from the intravascular to the intracellular space.
B) Decreased insulin causes hyperglycemia and osmotic diuresis.
C) Increased glucose and fatty acid metabolism stimulates renal diuresis and electrolyte loss.
D) Increased insulin use results in protein catabolism, tissue wasting, and electrolyte loss.

Question 26

A 12-year-old male is newly diagnosed with type 1 diabetes mellitus. Which of the following is most beneficial in confirming the diagnosis?

A) Fasting plasma glucose levels and glucose tolerance tests
B) Random serum glucose levels
C) Genetic testing
D) Glycosylated hemoglobin measurements

Question 27

Hypoparathyroidism is most commonly caused by:

A) pituitary hyposecretion.
B) parathyroid adenoma.
C) parathyroid gland injury.
D) hypothalamic inactivity.

Question 28

Management of diabetes mellitus involves measuring glycosylated hemoglobin (hemoglobin A1c) levels. The purpose of this test is to:

A) measure fasting glucose levels.
B) monitor long-term serum glucose control.
C) detect acute complications of diabetes.
D) check for hyperlipidemia.

Question 29

A 25-year-old male presents to his physician complaining of changes in facial features. CT scan reveals a mass on the anterior pituitary, and lab tests reveal severely elevated growth hormone (GH). Which of the following would also be expected?

A) Decreased IGF-1
B) Hypotension
C) Sexual dysfunction
D) Height increases

Question 30

A problem associated with chronic hyperparathyroidism is:

A) seizure disorder.
B) vitamin D malabsorption.
C) hyponatremia.
D) osteoporosis and pathologic fractures.

Question 31

A 30-year-old male presents to his physician complaining of visual disturbances. CT reveals a pituitary tumor and lab tests reveal elevated prolactin. Which of the following would also be expected?

A) Increased dopamine
B) Increased libido
C) Increased luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
D) Hypotension

Question 32

An 11-year-old male is newly diagnosed with type 1 diabetes mellitus. Before treatment he most likely experienced:

A) recurrent infections, visual changes, fatigue, and paresthesias.
B) polydipsia, polyuria, polyphagia, and weight loss.
C) vomiting; abdominal pain; sweet, fruity breath; dehydration; and Kussmaul breathing.
D) weakness, vomiting, hypotension, and mental confusion.

Question 33

A 13-year-old male who uses insulin to control his type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion during gym class. The most probable cause of these symptoms is:

A) hyperglycemia resulting from incorrect insulin administration.
B) dawn phenomenon caused by eating a snack before gym class.
C) hypoglycemia caused by increased exercise.
D) Somogyi effect caused by insulin sensitivity.

Question 34

Which of the following alterations would you expect to find in a patient with untreated Cushing disease or syndrome?

A) Bradycardia
B) Tachypnea
C) Hyperkalemia
D) Hypertension

Question 35

A 30-year-old male was diagnosed with thyroid carcinoma. Lab tests would most likely indicate _____ T₃ and T₄ levels.

A) high
B) low
C) normal
D) variable

Question 36

A 55-year-old female is admitted to the medical unit for complications of long-term, poorly controlled type 2 diabetes mellitus. Which of the following would be expected in addition to elevated glucose?

A) Elevated serum lipids
B) Metabolic alkalosis
C) Elevated liver enzymes
D) Low red blood cell count

Question 37

Characteristic physical features of individuals with Cushing syndrome include:

A) weight loss and muscle wasting.
B) truncal obesity and thin skin.
C) pallor and swollen tongue.
D) depigmented skin and eyelid lag.

Question 38

Chronic complications of diabetes mellitus such as microvascular and macrovascular disease are primarily related to:

A) pancreatic changes.
B) hyperglycemia.
C) ketone toxicity.
D) hyperinsulinemia.

Question 39

A 30-year-old female with Graves disease is admitted to your hospital unit for the surgical removal of her thyroid gland. During the postoperative period, you note that her serum calcium is low. She should be observed for which of the following signs/symptoms?

A) Muscle weakness and constipation
B) Laryngeal spasms and hyperreflexia
C) Abdominal pain
D) Anorexia, nausea, and vomiting

Question 40

A 12-year-old female is newly diagnosed with type 1 diabetes mellitus (DM). Which of the following is the most likely cause of her disease?

A) A familial, autosomal dominant gene defect
B) Obesity and lack of exercise
C) Immune destruction of the pancreas
D) Hyperglycemia from eating too many sweets

Question 41

A 49-year-old female is diagnosed with hypercortisolism. An increase in which of the following would be expected?

A) Protein catabolism and liver gluconeogenesis
B) Fat storage and glucose utilization
C) Production and secretion of adrenocortical hormones
D) Fat, protein, and carbohydrate anabolism

Question 42

A 50-year-old female presents with lightheadedness and overall abnormal feelings. CT scan reveals an adrenal cortical tumor. Lab tests reveal that the tumor is hormone secreting. Which of the following would be expected?

A) Increased renin levels
B) Hypotension
C) Hypokalemia
D) Hyponatremia

Question 43

The body's inability to conserve water and sodium when affected by Addison disease is explained by which of the following conditions?

A) Low levels of cortisol
B) High levels of ACTH
C) Hypersecretion of ADH
D) Aldosterone deficiency

Question 44

The most common cause of Addison disease is:

A) an autoimmune reaction.
B) dietary deficiency of sodium and potassium.
C) cancer.
D) viral infection of the pituitary gland.

Question 45

A 35-year-old female took corticosteroid therapy for several months. Which of the following would be expected?

A) Renal toxicity
B) Episodes of hypoglycemia
C) Hirsutism
D) Type 2 diabetes mellitus

Question 46

Mental status changes and muscle weakness in people with Addison disease are primarily caused by:

A) hyperkalemia.
B) hypoglycemia.
C) severe metabolic acidosis.
D) glucose intolerance.

Question 47

A 30-year-old female presents with hypertension, headache, tachycardia, impaired glucose tolerance, and weight loss. Which of the following is the most likely diagnosis?

A) Addison disease
B) Conn disease
C) Cushing disease
D) Pheochromocytoma

Question 48

What is the cause of the hyperpigmentation seen in people with Cushing syndrome and Addison disease?

A) Abnormal levels of cortisol
B) Permissive effects of aldosterone when cortisol levels are altered
C) Elevated levels of ACTH
D) Hypersensitivity of melanocytes with sun exposure