Patho final

A young man discusses with his medical provider that he seems incapable of conceiving a child with his wife. Upon physical examination, small and firm testes; moderate gynecomastia; poor beard growth; sparse body hair; long, thin arms and legs; narrow shoulders; and wide hips are found. Laboratory tests show decreased levels of testosterone and increased levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). There are no spermatozoa in the ejaculate. Karyotyping and additional analysis would most likely indicate which of the following? A. 46, XY, complete androgen insensitivity syndrome B. 45, X C. 47, XYY D. 47, XXY

47, XXY

Which of the following stimulates the secretion of both insulin and glucagon from the pancreas? A. A protein shake recommended for a bodybuilder B. Epinephrine injection to treat a severe allergic reaction C. Deep-fried food available at the county fair D. Hyperglycemia due to corticosteroid medication E. Hypoglycemia due to prolonged starvation

A protein shake recommended for a bodybuilder

A 66-year-old man with a 50-pack-year history of cigarette smoking comes to the clinic complaining of chronic cough, dyspnea, and blood in his sputum. He says he has been feeling lethargic and has lost 18 kg over the past three months with no changes in diet or exercise. While awaiting x-ray of the chest, the patient suffers a seizure and is rushed to a hospital. Laboratory studies show a serum sodium level of 120 mEq/dL. Which of the following is most likely to be elevated in this patient? A. Parathyroid hormone B. ACTH C. Renin D. ADH

ADH

A person experiencing which of the following situations would be expected to present with parallel changes in serum aldosterone and cortisol (i.e., both increased, both decreased, or both unaffected)? A. Addison's disease B. Cushing's syndrome C. High-potassium diet D. Low-sodium diet E. Suffering chronic abuse

Addison's disease

A 15-year-old female patient is concerned since she has not started her menstrual periods. She is phenotypically female, and she dresses, behaves, and has the psychosocial outlook of a normal, well-adjusted teenage girl. On physical examination, she has normal female external genitalia, a blind ending vagina, and no cervix. Imaging study reveals no uterus but intrapelvic gonads, which on biopsy turn out to be testicular tissue. Karyotyping shows that the patient is 46, XY. Which of the following is the most likely diagnosis? A. Androgen insensitivity syndrome B. Female Kallman's syndrome C. Female pseudohermaphroditism D. Müllerian agenesis E. True hermaphroditism F. Turner's syndrome

Androgen insensitivity syndrome

A 17-year-old boy previously sustained a severe fracture at the base of his skull while skateboarding. He presents with increased thirst and polyuria. His urine is pale in color with a low specific gravity. He has a blood pressure of 98/50 mm Hg, has tachycardia, and is very weak. An analogue of which of the following hormones is most likely prescribed for treatment? A. Adrenocorticotropic hormone B. Aldosterone C. Androstenedione D. Angiotensin II E. Antidiuretic hormone

Antidiuretic hormone

A 42-year-old woman with a history of pernicious anemia presents to her physician complaining of anxiety and occasional palpitations. She has unexplained weight loss of 10 lbs. and multiple daily bowel movements. She has not had a menstrual period in four months. She has a thyroid bruit and a 10 × 4 cm oval, non-tender soft-tissue mass anterior to the thyroid cartilage. Which of the following is the most likely etiology of this patient's disease? A. Papillary thyroid cancer B. Idiopathic replacement of thyroid tissue with fibrous tissue C. Autoantibody stimulation of thyroid stimulating hormone receptors D. Viral infection leading to destruction of thyroid tissue

Autoantibody stimulation of thyroid stimulating hormone receptors

As part of a Big Data study, deidentified patient records were selected into four categories (labeled 1-4 in the image) based on plasma osmolality and plasma antidiuretic hormone (ADH) levels. In a first step, it was assumed that each patient had one of the following four diagnoses: central diabetes insipidus, nephrogenic diabetes insipidus, syndrome of inappropriate ADH secretion, or primary polydipsia. In a second step, additionally available patient values were used to support the assumption. A patient in which of the following categories should have hyperosmotic urine? A. 1 B. 2 C. 3 D. 4

C (Low to high)

A 65-year-old woman comes to the clinic complaining of progressive weakness and fatigue. On further questioning, she notes recent weight gain and constipation, and states that she often feels cold. Physical examination shows a moderate-sized, non-tender goiter. Histologic examination of the goiter shows a lymphocytic infiltrate. Additional lab tests show positive results for thyroglobulin antibody and HLA-DR5. Which of the following best describes this patient's thyroid stimulating hormone and thyroid hormone levels relative to normal baseline values A. C B. D C. B D. E E. A

C (increased TSH, Decreased total thyroxine, and decreased free thyroxine)

A 27-year-old female patient has problems with conception. An abdominal ultrasound scan shows no abnormalities, so a functional sex hormone test is ordered. For that, the biological cycle of the woman is hormonally shut down for a week. When synthetic analogues of follicle-stimulating hormone/luteinizing hormone (FSH/LH) are administered, changes in estradiol and progesterone are measured. When gonadotropin-releasing hormone (GnRH) is administered, changes in FSH and LH are monitored. Which of the following results would support the working diagnosis of a functional problem at the hypothalamus as the cause of the infertility? A. B B. A C. E D. D E. C

C. E (increase, increase)

Thyrotoxicosis and uniformly increased radioactive iodine uptake in the thyroid can occur without any thyrotropin receptor antibodies or any thyroid autoimmunity in Graves' disease A. Jod-Basedow phenomenon B. Toxic multinodular goiter C. Choriocarcinoma D. Graves' disease

Choriocarcinoma

A 14-year-old girl presents for evaluation of hearing loss in her right ear. She has a history of at least 12 episodes of otitis media as a child; at least one time she perforated her ear drum. Her hearing loss is classified as A. Conductive deafness B. Sensorineural deafness C. Central deafness D. Tinnitus E. Presbycusis

Conductive deafness

The husband of a 63-year-old woman reports that his wife's personality has significantly changed over the past 2 years. Upon investigation, the woman also admits to having memory problems. Physical examination reveals centralized obesity, a round face, and thin limbs. Laboratory results show fasting hyperglycemia. The image shows the patient's adrenocorticotropic hormone (ACTH) concentrations (red line), compared to a control patient. Serum ACTH is measured every 10 minutes for one hour, and corticotropin-releasing hormone (CRH) is infused at the time of the arrows. Which of the following is the most likely diagnosis? A. Addison's disease B. Conn's disease C. Cushing's disease D. Glucocorticoid therapy E. Hypopituitarism

Cushing disease

Patients with the syndrome of inappropriate antidiuretic hormone (SIADH) often present with vague symptoms including confusion, nausea, and irritability. Which of the following laboratory results will support a provisional diagnosis? A. Decreased blood sodium B. Increased aldosterone C. Increased blood osmolality D. Increased blood urea nitrogen E. Maximally diluted urine

Decreased blood sodium

A 29-year-old woman has difficulty conceiving. Her family history includes diabetes mellitus type 2. The physical exam reveals acne, hirsutism, hypertension, and multiple small cysts in the ovaries. Laboratory tests show an elevated plasma ratio of luteinizing hormone to folliclestimulating hormone (LH/FSH), increased free testosterone, and increased fasting plasma glucose. Which of the following interventions would be most appropriate to improve her acne and hirsutism without further negatively affecting her fertility? A. Blocking estrogen receptors B. Blocking LH receptors C. Decreasing 5-α reductase D. Decreasing androgen-binding protein E. Increasing sex hormone-binding globulin F. Removing about half of her ovarian tissue

Decreasing 5-a reductase

A 50-year-old woman visits an otolaryngologist for sudden bouts of dizziness that subside after about 20 minutes. She also has temporary hearing losses and a feeling of fullness in her right ear; low-pitched buzzing sounds occur intermittently in her right ear. Physical exam shows nystagmus during a dizzy spell. 42. An increase in which of the following is the most likely cause of the pathophysiological changes in this patient? A. Endolymph volume B. Perilymph pressure only C. Perilymph volume only D. Perilymph volume and pressure

Endolymph volume

A 50-year-old man is concerned about changes in his appearance. He has not seen a doctor for the past 8 years. His feet and hands have grown larger, his jaw is protruding, and his face is looking strangely "out of shape." He has slight difficulty breathing, frequent headaches, fatigue, impotence, and excessive sweating. Magnetic resonance imaging (MRI) reveals a 1.5-cm mass on the anterior pituitary. An oral glucose tolerance test is given. Which of the following is a positive test result that supports the patient's signs and symptoms? A. Increased serum ghrelin B. Failed growth hormone suppression C. Failed insulin-like growth factor 1 increase D. Increased serum glucose E. Increased somatostatin

Failed growth hormone suppression

An 18-year-old woman is very concerned about her fertility since she has had no menstrual bleeding for the past 6 months. Menarche occurred at age 14. Physical examination reveals that the woman is severely obese and has acne. She admits to being very hairy and to shaving her face. A pelvic ultrasound shows numerous small peripheral follicles in her ovaries. A blood sample is sent for hormonal analysis. Which of the following hormones is most likely to be within the normal reference range in this patient? A. Androstenedione B. Estrone C. Follicle-stimulating hormone D. Luteinizing hormone E. Testosterone

Follicle stimulating hormone

A 21-year-old woman presents with weight loss, nervousness, sweating, and fatigue. Her neck examination shows a soft, diffuse, nonnodular midline mass that is mobile on swallowing. Mild exophthalmia is also noted. Her resting pulse is 100/min and blood pressure 135/90 mm Hg. The patient's thyroid function tests are as follows: Serum TSH 0.2 mU/ (0.5-5.0 mU/L) Total thyroxine (TT4) 14 µg/d (5-12 µg/dL) Which of the following diseases best fits this patient's clinical presentation? A. Addison's disease B. Conn's disease C. Cushing's disease D. Graves' disease E. Hashimoto's disease F. Secondary hypothyroidism G. Thyroid carcinoma

Graves Disease

Clinical studies that examine the effectiveness of l-tyrosine as a dietary supplement to increase cognitive performance have thus far shown inconclusive results. Nevertheless, advertisements for l-tyrosine supplements are common. Physicians should discourage patients with which of the following conditions from taking tyrosine supplements without supervision? A. Addison's disease B. Congenital adrenal hyperplasia (21-beta form) C. Graves' disease D. Hashimoto's disease E. Type 1 diabetes

Graves' disease

As part of an anti-doping educational session for athletes, the normal functions of various hormones are introduced. Which of the following hormones is best described as follows: "Increases lipolysis, stimulates protein synthesis, decreases glucose uptake, and supports calcium retention?" A. Cortisol B. Glucagon C. Growth hormone D. Insulin E. Parathyroid hormone

Growth hormone

A 30-year-old woman presents to the clinic after going to a park complaining of obstruction of nasal passages sneezing, rhinorrhea, lacrimation and pruritis of oropharynx. These pathophysiological changes are most likely caused by which of the following? A. IgG-mediated immune complexes deposited in the skin B. IgG-mediated complement lysis C. IgE-induced mast cell degranulation D. IgD-mediated histamine release

IgE-induced mast cell degranulation

In a patient with iodine-deficiency goiter who moves from an iodine-deficient area to an iodine-replete area, the occurrence of hyperthyroidism most likely represents A. Graves' disease B. Toxic multinodular goiter C. Choriocarcinoma D. Jod-Basedow phenomenon

Jod-Basedow phenomenon

Which of the following conditions is a likely cause for male infertility due to testicular azoospermia? A. Testosterone doping B. Klinefelter's syndrome C. Cystic fibrosis D. Kallman's syndrome

Klinefelters syndrome

A 21-year-old black woman is advised to undergo genetic screening because her mother was recently diagnosed with a MEN syndrome. Her mother's medical history includes chronic headaches, DM, asthma, multiple kidney stones, and HTN. Screening tests to identify her mother's specific type of MEN syndrome should include: A. Menin germline mutation evaluation B. 24-hour urinary free catecholamines C. RET germline mutation evaluation D. Serum Ca and intact PTH measurement

Menin germline mutation evaluation

A 53-year-old male has a 10-year history of fatigue, depression, weight gain, and cold intolerance. His symptoms are not improved with antidepressants. For the past 3 years, he has been living by himself. His diet consists mainly of fast food and ice cream. On exam, he has a small goiter. His lab values are as follows: The patient's serum levels of thyroid-stimulating hormone (TSH) are elevated because of the lack of which of the following? A. An appropriate antidepressant B. Dietary iodine C. Physical exercise D. Pituitary feedback inhibition E. Social and family support

Pituitary feedback inhibition

A 37-year-old man presents with progressive, moderate, bilateral hearing loss that started at age 32. He has been a factory worker for 17 years and was exposed to very loud noise (over 85 decibels) for prolonged periods of time without ear protection. Which of the following cause the pathophysiology changes best characterize his noise-induced hearing loss? A. Conductive hearing loss B. Mixed hearing loss C. Neural hearing loss D. Presbycusis E. Sensory hearing loss

Sensory hearing loss

A 45-year old woman presents with a 6-month history of excessive tiredness, unexpected weight gain, constipation, galactorrhea, and amenorrhea. Laboratory values show elevated concentrations of thyroid-stimulating hormone (TSH) and follicle-stimulating hormone (FSH). A pregnancy test is negative. She denies any head injuries, and brain magnetic resonance imaging (MRI) is normal. Which of the following serum levels of thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) are expected?

TRH increased, GnRH decreased

Which of the following is the most likely cause of amenorrhea due to hypergonadotropic hypogonadism? A. Eating disorder B. Hyperprolactinemia C. Kallmann's syndrome D. Pregnancy E. Strenuous exercise F. Turner's syndrome

Turner's syndrome

A 43 year-old woman presents with fatigue, a 4.5-kg (9.9-lb) weight gain over the past three months, cold intolerance, hair loss, and concentration problems. Physical examination is significant for dry, coarse skin and bradycardia. She states that she had some slight swelling of her lower neck several months ago, which resolved without treatment. Results of antithyroglobulin antibody and antinuclear antibody tests are negative, but a thyroid peroxidase antibody test is positive. For which other autoimmune diseases does this patient have an increased risk? A. Rheumatoid arthritis and vitiligo B. Graves' disease and celiac disease C. Osteoarthritis and Addison disease D. Type 1 diabetes mellitus and pernicious anemia

Type I diabetes mellitus and pernicious anemia

A 75-year old woman complains of bilateral temporal hemianopsia, and imaging of the head reveals a suprasellar granular cell tumor. The tumor is excised, and immunohistochemical studies using biomarkers are performed in order to determine the tumor cell origin. A positive reaction for which of the following hormones would indicate that the tumor is of neuroectodermal origin related with pathophysiological changes of water connservation? A. Adrenocorticotropic hormone B. β-endorphin C. Luteinizing hormone D. Vasopressin E. Thyroid-stimulating hormone

Vasopressin