FITZGERALD CHPT 11 THYROID CUSHINGS AND ADDISONS

The mechanism of action of radioactive iodine in the treatment of Graves' disease is to: A. destroy the overactive thyroid tissue. B. reduce production of TSH. C. alter thyroid metabolic rate. D. relieve distress caused by increased thyroid size.

A. destroy the overactive thyroid tissue.

A first-line approach to treating Cushing's syndrome in a 56-year-old woman who has been taking oral corticosteroids to treat rheumatoid arthritis for the past 2 years is: A. gradually tapering corticosteroid use. B. referral for surgery. C. consideration of radiation therapy. D. prescribing mifepriston

A. gradually tapering corticosteroid use.

A program of regular aerobic physical activity can yield which of the following changes in the lipid profile? A. increases HDL, lowers VLDL and triglycerides B. lowers VLDL and LDL C. increases HDL, lowers LDL D. lowers HDL, VLDL, and triglycerides

A. increases HDL, lowers VLDL and triglycerides

Secondary adrenal insufficiency can occur with the presence of a diseased or malfunctioning: A. pituitary gland. B. thyroid. C. pancreatic beta cells. D. hypothalamus.

A. pituitary gland.

In prescribing niacin therapy for a patient with hyperlipidemia, the NP considers that: A. postdose flushing is often reported. B. periodic creatine kinase monitoring is warranted. C. low-dose therapy is usually effective in increasing LDL level. D. drug-induced thrombocytopenia is a common problem.

A. postdose flushing is often reported.

Which of the following medications is a helpful treatment option for relief of tremor and tachycardia seen with untreated hyperthyroidism? A. propranolol B. diazepam C. carbamazepine D. verapamil

A. propranolol

Untreated Cushing's syndrome can lead to all of the following except: A. rheumatoid arthritis. B. hypertension. C. type 2 diabetes. D. osteoporosis.

A. rheumatoid arthritis.

Which of the following daily doses has the lowest lipid-lowering effect? A. simvastatin 10 mg B. rosuvastatin 5 mg C. atorvastatin 10 mg D. pravastatin 40 mg

A. simvastatin 10 mg

Which is following is the least helpful test for the assessment of thyroid disease? A. total T4 B. thyroid-stimulating hormone (TSH) C. free T4 D. thyroid peroxidase (TPO) antibodies

A. total T4

A 46-year-old woman complains of fatigue, weakness, lethargy, decreased concentration and memory, and increased facial hair over the past 12 months. She also reports gaining over 30 pounds (13.6 kg) in the past 2 months. She has a history of asthma with repeated flares during the past 6 months requiring multiple courses of prednisone therapy. A likely diagnosis for this patient is: A. type 2 diabetes. B. Cushing's syndrome. C. Cushing's disease. D. central obesity.

B. Cushing's syndrome.

When providing care for a patient taking an HMG-CoA reductase inhibitor, initial evaluation when starting medication includes checking which of the following serological parameters? A. potassium B. alanine aminotransferase C. bilirubin D. alkaline phosphatase

B. alanine aminotransferase

Which of the following is a mineralocorticoid? A. cortisol B. aldosterone C. insulin D. hydrocortisone

B. aldosterone

The anticipated effect on the lipid profile with plant stanol and sterol use includes: A. increase in HDL. B. decrease in LDL. C. decrease in select lipoprotein subfractions. D. decrease in triglycerides.

B. decrease in LDL.

When prescribing a fibrate, the NP expects to see which of the following changes in lipid profile? A. marked decrease in LDL level B. increase in HDL level C. no effect on triglyceride level D. increase in very low-density lipoprotein (VLDL) lev

B. increase in HDL level

When prescribing niacin, the NP expects to see which of the following changes in lipid profile? A. marked decrease in LDL level B. increase in HDL level C. no effect on triglyceride level D. increase in VLDL level

B. increase in HDL level

The hormone cortisol plays a role in all of the following processes except: A. maintaining glucose control. B. maintaining thyroid function. C. suppressing the immune response. D. helping the body respond to stres

B. maintaining thyroid function.

Which of the following medications is representative of high-intensity statin therapy? A. pravastatin 40 mg B. rosuvastatin 20 mg C. simvastatin 40 mg D. lovastatin 20 mg

B. rosuvastatin 20 mg

You are seeing a patient who is taking warfarin and cholestyramine and provide the following advice: A. "Take both medications together." B. "You need to have additional hepatic and renal monitoring tests while on this combination." C. "Separate the cholestyramine from other medications by at least 2 hours." D. "Make sure you take these medications on an empty stomach."

C. "Separate the cholestyramine from other medications by at least 2 hours."

Periodic routine screening for hypothyroidism is indicated in the presence of which of the following clinical conditions? A. digoxin use B. male gender C. Down syndrome D. alcoholism

C. Down syndrome

Hypothyroidism most often develops as a result of: A. primary pituitary failure. B. thyroid neoplasia. C. autoimmune thyroiditis. D. radioactive iodine exposure.

C. autoimmune thyroiditis.

Cushing's syndrome results from an excess of: A. luteinizing hormone. B. follicle-stimulating hormone. C. cortisol. D. aldosterone.

C. cortisol.

A 24-year-old female runner is diagnosed with Addison's disease. In counseling her about exercise, you recommend: A. tapering her running to only 10 minutes per day for 2 to 3 days per week. B. ceasing any prolonged strenuous exercise. C. ensuring an ample amount of sodium is ingested. D. switching to a nonimpact exercise.

C. ensuring an ample amount of sodium is ingested.

Physical examination findings in patients with Graves' disease include: A. muscle tenderness. B. coarse, dry skin. C. eyelid retraction. D. delayed relaxation phase of the patellar reflex.

C. eyelid retraction.

Which of the following is the most cost-effective method of distinguishing a malignant from a benign thyroid nodule? A. ultrasound B. magnetic resonance (MRI) imaging C. fine-needle aspiration biopsy D. radioactive iodine scan

C. fine-needle aspiration biopsy

Untreated hypothyroidism can result in which of the following changes in the lipid profile? A. increased HDL and decreased triglycerides B. increased LDL and total cholesterol C. increased LDL, total cholesterol, and triglycerides D. decreased LDL and HDL

C. increased LDL, total cholesterol, and triglycerides

TSH is released by the: A. thyroid follicles. B. adrenal cortex. C. hypothalamus. D. anterior lobe of the pituitary.

D. anterior lobe of the pituitary.

The anticipated effect on the lipid profile with high-dose omega-3 fatty acid use includes: A. increase in HDL. B. decrease in LDL. C. decrease in total cholesterol. D. decrease in triglycerides.

D. decrease in triglycerides.

Increased risk of thyroid disorder is found in individuals who are: A. obese. B. hypertensive. C. treated with systemic corticosteroids. D. elderly.

D. elderly.

A 34-year-old woman complains of progressive weak- ness, fatigue, poor appetite, and weight loss. She has also noticed the development of hyperpigmentation, mainly on the knuckles, elbows, and knees. All of the following blood tests can be used to help confirm a diagnosis of Addison's disease except: A. sodium. B. potassium. C. cortisol. D. folate.

D. folate.

A 43-year-old man is experiencing an acute adrenal cri- sis and presents with prominent nausea, vomiting, and low blood pressure. He appears cyanotic and confused. The most appropriate treatment is an injection of: A. epinephrine. B. insulin. C. adrenaline. D. hydrocortisone.

D. hydrocortisone.

The Use of which of the following medications can induce thyroid dysfunction? A. sertraline B. venlafaxine C. bupropion D. lithium

D. lithium

The most commonly recommended treatment of Cushing's disease is: A. tapering or ceasing corticosteroid use. B. eliminating trigger medications. C. antineoplastic therapy. D. surgical intervention.

D. surgical intervention.

In the report of a thyroid scan done on a 48-year-old woman with a thyroid mass, a "cold spot" is reported. This finding is most consistent with: A. autonomously functioning adenoma. B. Graves' disease. C. Hashimoto's disease. D. thyroid cyst.

D. thyroid cyst.

A fixed, painless thyroid mass accompanied by hoarse- ness and dysphagia should raise the suspicion of: A. adenomatous lesion. B. Graves' disease. C. Hashimoto's disease. D. thyroid malignanc

D. thyroid malignanc

hyperreflexia with a characteristic "quick out-quick back" action at the patellar reflex

HYPER

proximal muscle weakness

HYPER

tachycardia with hypertension

HYPER

amenorrhea or oligomenorrhea

HYPERTHYROIDISM

frequent, low-volume, loose stools

HYPERTHYROIDISM

heat intolerance

HYPERTHYROIDISM

smooth, silky skin

HYPERTHYROIDISM

coarse hair with tendency to break easily

HYPO

coarse, dry skin

HYPO

constipation

HYPO

menorrhagia

HYPO

thick, dry nails

HYPO

goiter

HYPO AND HYPER

secondary hypertriglyceridemia

HYPOTHYROIDISM

TSH = 24 mIU/L (0.4 to 4.0 mIU/L); free T4 = 3 pmol/L (10 to 27 pmol/L)

hypothyroidism

. TSH = 8.9 mIU/L (0.4 to 4.0 mIU/L); free T4 = 15 pmol/L (10 to 27 pmol/L

subclinical hypothyroidism

At minimum, at what interval should TSH be reassessed after a levothyroxine dosage is adjusted? A. 1 to 2 weeks B. 2 to 4 weeks C. 4 to 6 weeks D. 6 to 8 weeks

D. 6 to 8 weeks

The findings of a painless thyroid mass and TSH level of less than 0.1 IU/mL in a 35-year-old woman is most consistent with: A. autonomously functioning adenoma. B. Graves' disease. C. Hashimoto's disease. D. thyroid malignancy.

A. autonomously functioning adenoma.

Possible consequences of excessive levothyroxine use include: A. bone thinning. B. fatigue. C. renal impairment. D. constipation.

A. bone thinning.

You advise a 58-year-old woman with hypothyroidism about the correct use of levothyroxine. She also takes a calcium supplement. All of the following should be shared with the patient except which instruction? A. "Take the medication on an empty stomach." B. "To help with adherence, take your calcium supplement at the same time as your thyroid medication." C. "You should take the medication at approximately the same time every day." D. "Do not take your medication with soy milk."

B. "To help with adherence, take your calcium supplement at the same time as your thyroid medication."

For patients with documented coronary heart disease, the American Heart Association advises intake of approximately of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day, preferably from oily fish. A. 500 mg B. 1 g C. 2 g D. 4 g

B. 1 g

What is the average LDL reduction achieved with a change in diet as a single lifestyle modification? A. less than 5% B. 5% to 10% C. 11% to 15% D. 16% to 20% or more

B. 5% to 10%

A 78-year-old woman has hypertension, a 100 pack-year history of cigarette smoking, peripheral vascular disease, and reduced renal function (GFR = 47 mL/min/1.73 m2). Triglyceride level is 280 mg/dL (3.164 mmol/L); high-density lipoprotein (HDL) level is 48 mg/dL (1 mmol/L); and low-density lipoprotein (LDL) level is 135 mg/dL (3.5 mmol/L). Which of the following represents the most appropriate pharmacologic intervention for this patient's lipid disorders? A. Owing to her age and comorbidity, no further intervention is required. B. Moderate-intensity statin therapy is the preferred treatment option. C. A resin should be prescribed. D. The use of ezetimibe (Zetia®) will likely be sufficient to achieve dyslipidemia control

B. Moderate-intensity statin therapy is the preferred treatment option.

With the use of ezetimibe (Zetia®), the NP expects to see: A. a marked increase in HDL cholesterol. B. a reduction in LDL cholesterol. C. a significant reduction in triglyceride levels. D. increased rhabdomyolysis when the drug is used in conjunction with HMG-CoA reductase inhibitor.

B. a reduction in LDL cholesterol.

A 48-year-old woman with newly diagnosed hypothyroidism asks about a "natural thyroid" medication she read about online and provides the drug's name: desiccated thyroid. As you counsel her about this medication, you consider all of the following except: A. this product contains a fixed dose of T3 and T4. B. the medication is a plant-based product. C. its pharmacokinetics differ significantly when compared to levothyroxine. D. the majority of the study on treatment for hypothyroidism has been done using levothyroxin

B. the medication is a plant-based product.

As part of an evaluation of a 3-cm, round, mobile thyroid mass, you obtain a thyroid ultrasound scan revealing a fluid-filled structure. The most likely diagnosis is: A. adenoma. B. thyroid cyst. C. multinodular goiter. D. vascular lesioN

B. thyroid cyst.

All of the following are risks for statin-induced myositis except: A. advanced age. B. use of a low-intensity statin therapy with a resin. C. low body weight. D. high-intensity statin therapy.

B. use of a low-intensity statin therapy with a resin.

Which of the following is an example of moderate- intensity statin therapy? A.fluvastatin 10 mg B.atorvastatin 10 mg C. simvastatin 10 mg D. pravastatin 20 mg

B.atorvastatin 10 mg

atypical presentation in an elderly person

BOTH

change in mental status

BOTH

You examine a 64-year-old man with hypertension and type 2 DM. Lipid profile results are as follows: HDL level is 38 mg/dL (1 mmol/), LDL level is 135 mg/dL (3.5 mmol/L), and triglyceride level is 180 mg/dL (1.9 mmol/L). His estimated 10-year ASCVD risk is 5%. His current medications include a sulfonylurea, a biguanide, an angiotensin-converting enzyme inhibitor, and a thiazide diuretic, and he has acceptable glycemic and blood pressure control. He states, "I really watch the fats and sugars in my diet." Which of the following is the most appropriate advice? A. No further intervention is needed. B. His lipid profile should be repeated in 6 months. C. Lipid-lowering drug therapy with a moderate intensity statin should be initiated. D. The patient's dietary intervention appears adequate.

C. Lipid-lowering drug therapy with a moderate intensity statin should be initiated.

In prescribing levothyroxine therapy for an elderly patient, which of the following statements is true? A. Elderly persons require a rapid initiation of levothy- roxine therapy. B. TSH should be checked about 2 days after dosage adjustment. C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults. D. TSH should be suppressed to a nondetectable Thyroid Disorders level.

C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults.

Cushing's disease is the specific type of Cushing's syndrome that is caused by: A. long-term exposure to corticosteroids. B. a benign tumor of the adrenal gland. C. a benign pituitary tumor. D. an ectopic tumor that produces ACTH.

C. a benign pituitary tumor.

You examine a 46-year-old male who is a one-half pack per day cigarette smoker with hypertension. He has no evidence of clinical atherosclerotic cardiovascular disease (ASCVD), and his estimated 10-year ASCVD risk is 10%. His lipid profile is as follows: HDL level is 48 mg/dL (1.24 mmol/L); LDL level is 192 mg/dL (4.9 mmol/L); and triglyceride level is 110 mg/dL (1.3 mmol/L). He had been on a low-cholesterol diet for 6 months when these tests were taken. Which of the following represents the best next step? A. No further intervention is required. B. A fibrate should be prescribed. C. A low-intensity 3-hydroxy-3-methylglutaryl- coenzyme A (HMG-CoA) reductase inhibitor should be prescribed. D. A high-intensity HMG-CoA reductase inhibitor regimen should be initiated

D. A high-intensity HMG-CoA reductase inhibitor regimen should be initiated

With the use of a lipid-lowering resin such as cholestyramine, which of the following enzymes should be periodically monitored? A. ALP B. LDH C. aspartate aminotransferase (AST) D. No particular monitoring is recommended.

D. No particular monitoring is recommended.

With ezetimibe (Zetia®), which of the following should be periodically monitored? A. alkaline phosphatase (ALP) B. lactate dehydrogenase (LDH) C. creatinine phosphokinase (CPK) D. No special laboratory monitoring isrecommended

D. No special laboratory monitoring is recommended

TSH less than 0.15 mIU/L (0.4 to 4.0 mIU/L); free T4 = 79 pmol/L (10 to 27 pmol/L)

hyperthyroidism