Question 1

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.

Accepted Answer

In type 1 diabetes, there is a deficiency of insulin, which prevents glucose from being used as a fuel source and leads to increased lipid metabolism. Under insulin deficiency, lipolysis increases and promotes the formation of ketones, which can lead to an acidotic state. This is known as diabetic ketoacidosis (DKA). Increased insulin levels would have the opposite effect, decreasing lipid metabolism and ketone formation. Renal failure may occur in the late stages of DKA but is not the primary cause of the acidosis.

Question 2

Hyperglycemia in type 2 diabetes mellitus is a result of:
A) insulin deficiency.
B) hyperinsulinemia and insulin resistance.
C) glucagon deficiency.
D) liver dysfunction.

Accepted Answer

In type 2 diabetes mellitus, the body becomes resistant to insulin, requiring higher levels of insulin to maintain normal blood glucose levels. This leads to hyperinsulinemia or high levels of insulin in the blood. However, over time, the beta cells in the pancreas that produce insulin begin to fail, leading to insulin deficiency. This combination of hyperinsulinemia and insulin deficiency results in hyperglycemia. Glucagon deficiency and liver dysfunction may contribute to hyperglycemia in rare cases, but they are not the primary causes in type 2 diabetes mellitus.

Question 3

Both Cushing syndrome and Addison disease can manifest with elevated levels of:
A) ADH.
B) cortisol.
C) adrenocorticotropic hormone (ACTH).
D) aldosterone.

Accepted Answer

Cushing syndrome can manifest with elevated ACTH if it is ACTH-dependent, while Addison disease can also show elevated ACTH due to lack of feedback inhibition from low cortisol levels.

Question 4

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.

Accepted Answer

Surgical removal of the thyroid gland can sometimes result in injury to the parathyroid glands, which are located in close proximity. The parathyroid glands are responsible for regulating calcium levels in the body, and injury to these glands can lead to hypoparathyroidism and subsequently low serum calcium levels. The other options (hyperparathyroidism, myxedema, and hypothyroidism) would not normally result in low serum calcium levels.

Question 5

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.

Accepted Answer

The high serum glucose and low serum K⁺ values indicate hyperglycemia and osmotic diuresis, which are caused by decreased insulin levels. The low serum Na⁺ value may be due to electrolyte loss from osmotic diuresis. This is a classic presentation of diabetic ketoacidosis (DKA) caused by insulin deficiency.

Question 6

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

Accepted Answer

Fasting plasma glucose levels and glucose tolerance tests are most beneficial in confirming a diagnosis of type 1 diabetes mellitus. Random serum glucose levels can provide an initial indication, but fasting plasma glucose levels and glucose tolerance tests will give a more accurate diagnosis. Genetic testing is not necessary for diagnosis, and glycosylated hemoglobin measurements may be used to monitor control of diabetes over time but are not typically used for initial diagnosis.

Question 7

Hypoparathyroidism is most commonly caused by:
A) pituitary hyposecretion.
B) parathyroid adenoma.
C) parathyroid gland injury.
D) hypothalamic inactivity.

Accepted Answer

Hypoparathyroidism is most commonly caused by parathyroid gland injury, such as damage during thyroid surgery or autoimmune destruction of the glands. Pituitary hyposecretion and hypothalamic inactivity are not common causes of hypoparathyroidism. Parathyroid adenomas can cause hyperparathyroidism, where there is an overproduction of parathyroid hormone rather than a deficiency.

Question 8

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.

Accepted Answer

The purpose of measuring glycosylated hemoglobin (hemoglobin A1c) levels is to monitor long-term serum glucose control. This test provides an estimate of the average blood glucose level over the past 2-3 months, which is useful in assessing the effectiveness of diabetes treatment and making necessary adjustments. It is not used to measure fasting glucose levels, detect acute complications of diabetes, or check for hyperlipidemia.

Question 9

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

Accepted Answer

The elevated growth hormone (GH) due to the pituitary mass would lead to increased levels of insulin-like growth factor 1 (IGF-1), not decreased. Hypotension is not typically associated with GH excess. Height increases are not expected in adults as the growth plates have fused. Sexual dysfunction can occur due to pituitary tumors affecting hormone levels.

Question 10

A problem associated with chronic hyperparathyroidism is:
A) seizure disorder.
B) vitamin D malabsorption.
C) hyponatremia.
D) osteoporosis and pathologic fractures.

Accepted Answer

Chronic hyperparathyroidism leads to excessive secretion of parathyroid hormone, which causes excess calcium to be released from the bones. This can lead to osteoporosis and pathologic fractures. Seizure disorder and hyponatremia are not typically associated with hyperparathyroidism, while vitamin D malabsorption may be a contributing factor, but is not a direct problem associated with the condition.

Question 11

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

Accepted Answer

Elevated prolactin levels inhibit dopamine production, which leads to decreased libido and decreased LH and FSH production.

Question 12

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.

Accepted Answer

The symptoms of polydipsia, polyuria, polyphagia, and weight loss are classic signs of type 1 diabetes before treatment. This is due to the lack of insulin production, which leads to hyperglycemia and an inability of the body to use glucose for energy.

Question 13

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.

Accepted Answer

The symptoms described suggest hypoglycemia, which can be caused by increased exercise. The other options are less likely based on the information given. Hyperglycemia resulting from incorrect insulin administration or the Somogyi effect would result in high blood sugar levels, not low. The dawn phenomenon is a rise in blood sugar levels in the morning, not typically associated with exercise-induced symptoms.

Question 14

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

Accepted Answer

Patients with untreated Cushing disease or syndrome typically have hypertension, as excess cortisol leads to increased blood pressure. Bradycardia (slow heart rate), tachypnea (rapid breathing), and hyperkalemia (elevated potassium levels) are not typically associated with Cushing disease or syndrome.

Question 15

A 30-year-old male was diagnosed with thyroid carcinoma. Lab tests would most likely indicate _____ T₃and T₄ levels. A) high B) low C) normal D) variable

Accepted Answer

Thyroid carcinoma often does not affect the production of thyroid hormones, so T3 and T4 levels are typically normal.

Question 16

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

Accepted Answer

Elevated serum lipids are a common complication of poorly controlled type 2 diabetes mellitus. High levels of glucose can cause damage to blood vessels and nerves, which can affect lipid metabolism and lead to hyperlipidemia. Metabolic alkalosis, elevated liver enzymes, and low red blood cell count are not typically associated with poorly controlled type 2 diabetes mellitus.

Question 17

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.

Accepted Answer

Truncal obesity (fat accumulation in the torso area) and thin skin are both characteristic physical features of individuals with Cushing syndrome. Weight gain, not weight loss, is also a common feature. Pallor, swollen tongue, depigmented skin, and eyelid lag are not typically seen in individuals with Cushing syndrome.

Question 18

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.

Accepted Answer

Chronic complications of diabetes mellitus are primarily related to hyperglycemia, which can damage small blood vessels (microvascular) and large blood vessels (macrovascular) over time. Pancreatic changes, ketone toxicity, and hyperinsulinemia are not the primary factors contributing to these complications.

Question 19

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

Accepted Answer

Low serum calcium can lead to hypocalcemia, which is characterized by neuromuscular excitability, including laryngeal spasms and hyperreflexia.

Question 20

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

Accepted Answer

Type 1 diabetes mellitus is caused by immune destruction of the beta cells in the pancreas, leading to a lack of insulin production. It is not caused by a familial gene defect, obesity and lack of exercise, or hyperglycemia from eating too many sweets.

Quiz 18: Alterations of Hormonal Regulation

Hyperglycemia in type 2 diabetes mellitus is a result of:

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

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

Hypoparathyroidism is most commonly caused by:

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

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 problem associated with chronic hyperparathyroidism is:

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?

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

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:

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

A 30-year-old male was diagnosed with thyroid carcinoma. Lab tests would most likely indicate _____ T₃and T₄ levels.

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?

Characteristic physical features of individuals with Cushing syndrome include:

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

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 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?