Pharm Endocrine Exam Questions

The peak of rapid-acting insulins falls under which time frame post-injection? 1-2 h 1-5 h 6-12 h 12-24 h

1-2 h

A 41-year-old woman with subclinical hypothyroidism comes to the physician because of a 6-month history of progressively worsening headaches, loss of peripheral vision, and irregular menses. Her menses had previously occurred at regular 30-dayintervals with moderate flow, but her last menstrual period was 12 weeks ago. She also reports that her interest in sexual intercourse has recently decreased. Her serum prolactin level is elevated. Which of the following is the most appropriate pharmacotherapy for this patient? A Bromocriptine B Estrogen C Methyldopa D Metoclopromide E L-thyroxine

A Bromocriptine

A 19-year-old woman comes to the physician for a follow-up examination. She has a history of type 1 diabetes mellitus and is adherent with her medications. After reviewing the patient's recent blood sugar levels, the physician changes the patient's antidiabetic regimen by changing the dosage of an insulin that does not produce an observable peak in serum insulin concentration. The dosage of which of the following types of insulin was most likely changed in this patient's medication regimen? A Insulin glargine B Insulin glulisine C Regular insulin

A Insulin glargine

A 43-year-old woman comes to the physician because of a 3-month history of tremor, diarrhea, and a 5-kg (11-lb) weight loss. Her pulse is 110/min. Examination shows protrusion of the eyeball when looking forward. A bruit is heard over the anterior neckon auscultation. Serum studies show autoantibodies to the thyroid-stimulating hormone receptor. The patient decides to undergo definitive treatment for her condition with a radioactive tracer. The success of this treatment directly depends on the activity of which of the following? A: Transmembrane carrier B Lysosomal protease C Hormone-activating enzyme D Binding globulin E Anion-oxidizing enzyme

A: Transmembrane carrier

A 68-year-old man comes to the physician because of a 6-week history of episodic tremors, headaches, and sweating. During this time, he has gained 2.5-kg (5 lb 8 oz). Two months ago, he was diagnosed with type 2 diabetes mellitus, and treatment with an oral antidiabetic drug was initiated. FYI: This patient's headaches, tremors, and sweating may indicate episodes of hypoglycemia. These symptoms started shortly after the recent initiation of an oral antidiabetic agent. The beneficial effect of the drug that was prescribed for this patient is most likely due to inhibition of which of the following? ATP-sensitive potassium channels Brush-border-glucosidase Sodium-glucose cotransporter-2 Gycerophosonate dehydrogenase

ATP-sensitive potassium channels

A 36-year-old woman is brought to the emergency department because of lightheadedness, weakness, and abdominal pain for 6 hours. Over the past 3 days, she has also had severe nausea, vomiting, and watery diarrhea. She was diagnosed with pulmonary sarcoidosis 2 years ago. Current medications include prednisone. Her temperature is 38.9°C (102.0°F), pulse is 112/min, and blood pressure is 85/50 mm Hg. Physical examination shows a round face with prominent preauricular fat pads. Her fingerstick blood glucose concentration is 48 mg/dL. Further evaluation is most likely to show which of the following laboratory changes? Increased cortisol B Decreased corticotropin-releasing hormone C Decreased norepinephrine D Decreased aldosterone E Increased adrenocorticotropic hormone

B Decreased corticotropin-releasing hormone

A 75-year-old woman is brought to the physician by her daughter because of a 1-month history of fatigue and a 3.5-kg (7-lb)weight loss. The patient has a history of hypertension, hyperlipidemia, and Alzheimer's dementia. She lives with her daughter and requires assistance with all of her banking and meal preparation. Her daughter has hypothyroidism but there is no other history of serious illness in the family. She does not remember the names of her medications but says she takes them every day. Her pulse is 114/min and blood pressure is 148/101 mm Hg. Physical examination shows warm skin and a tremor. The thyroid gland is not palpable. The serum thyroid stimulating hormone level is undetectable. Histological examination of a thyroid biopsy shows follicular atrophy. Which of the following is the most likely underlying cause of this patient's symptoms? Graves disease B Exogenous levothyroxine use C thyroiditis D Iodine exposure

B Exogenous levothyroxine use

A 35-year-old man comes to the physician because of a 4-month history of intermittent headaches. They have been getting progressively worse and no longer respond to ibuprofen. He also reports weight gain and excessive sweating. Physical examination shows prominent supraorbital ridges, prognathism, macroglossia with thick lips, and disproportionately broad hands and feet. There is decreased peripheral vision bilaterally on visual field testing. An MRI of the brain shows a mass in the sella turcica. Genetic analysis of a biopsy specimen from the mass shows cells that overexpress adenylyl cyclase. Which of the following is the most appropriate pharmacotherapy? A. Methimazole B Octreotide C Leuprolide D Risperidone

B Octreotide

A 44-year-old woman comes to the physician because of a 6-month history of fatigue, constipation, and a 7-kg (15.4-Ib) weight gain. Menses occur irregularly in intervals of 40-50 days. Her pulse is 51/min, and her blood pressure is 145/86 mm Hg. Examination shows conjunctival pallor and cool, dry skin. There is mild, nonpitting periorbital edema. Serum thyroid-stimulating hormone concentration is 8.1 uU/mL. Treatment with the appropriate pharmacotherapy is initiated. FYI: The patient's signs and symptoms of fatigue, constipation, weight gain, menstrual irregularities, bradycardia, hypertension, dry skin, and periorbital edema are all suggestive of hypothyroidism. The increased serum thyroid-stimulating hormone (TSH) concentration indicates that she has primary hypothyroidism, for which the treatment is hormone replacement with levothyroxine. After several weeks of therapy with this drug, which of the following hormonal changes is expected? A) Decreased T4 B) Increased reverse T3 C) Increased thyroxine-binding globulin D) Increased TRH

B) Increased reverse T3

NTIs (narrow therapeutic index) means are characterized by which of the following? A) Very high doses are needed to show effects. B) They have a small range in which they are safe and effective C) They are administered with a narrow-gauged needle. D) They do not require laboratory monitoring upon initialization

B) They have a small range in which they are safe and effective

A 69-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. His only medication is metformin. He has tried to lose weight for several years without success. He is 168 cm (5 ft 6 in) tall and weighs 110 kg (243 lb); BMI is 39 kg/m2. His hemoglobin A1c is 8.5%. Which of the following is the most appropriate antidiabetic drug to address both this patient's glucose control and weight? Glipizide C Liraglutide D Nateglinide E Rosiglitazone

C Liraglutide

A 21-year-old primigravid woman comes to the physician at 10 weeks gestation because of progressive fatique for the past 3 weeks.She reports that she has had a 3.2-kg (7-lb) weight loss after conceiving despite an increase in appetite. She has become increasinglyanxious and has trouble falling asleep. There is no personal or family history of serious illness. Medications include folic acid and amultivitamin. She is 165 cm (5 ft 5 in) tall and weighs 55 kg (120 Ib); BMI is 20 kg/m2. Her temperature is 37.4°C (99.4°F), her pulse is120/min, respirations are 18/min, and her blood pressure is 150/70 mm Hg. The globes of the eyes are prominent. The thyroid gland isfirm and diffusely enlarged. Neurologic examination shows a fine resting tremor of the hands. There is a midsystolic click at the apexand a grade 2/6 early systolic murmur at the upper left sternal border. Serum thyroid-stimulating hormone concentration is 0.1 uU/mL.An ECG is normal except for sinustachycardia. FYI: This patient presents with features suggestive of Graves disease: hyperthyroidism (weight loss, fatigue, anxiety,insomnia, tachycardia, systolic murmur, / TSH), Graves ophthalmopathy (exophthalmos), and a diffusely enlarged goiter. Which of the following is the most appropriate therapeutic management for this patient? A) Lugol's iodine B) Atenolol C) Propylthiouracil D) Methimazole E) Radioactive iodine ablation

C) Propylthiouracil

While walking through a park with his wife, a 51-year-old man with type 2 diabetes mellitus develops nausea, sweating, pallor, and palpitations. For the past 3 weeks, he has been trying to lose weight and has adjusted his diet and activity level. He eats a low-carb diet and swims 3 times a week. The man returned home from a training session 2 hours ago. Current medications include basal insulin and metformin. Shortly before his wife returns from their car with his emergency medication kit, he becomes unconscious. Administration of which of the following is the most appropriate next step in treatment? B Subcutaneous epinephrine C Oral glucose D Intramuscular glucagon E Rectal lorazepam

D Intramuscular glucagon

A 26-year-old woman comes to the physician because of fatigue, weight loss, and muscle aches during the past 2 months. There is no personal or family history of serious illness. Her only medication is a multivitamin. A metyrapone stimulation test is performed and the results rule out a diagnosis of adrenal insufficiency. Which of the following changes in laboratory findings are most likely to have been observed in this patient following the administration of the drug? Increase in serum ACTH Decrease in urinary 17-hydroxycorticosteroids Decrease in serum 11-deoxycortisol increase in serum cortisol

Decrease in serum 11-deoxycortisol

A 51-year-old woman comes to the physician because of a 6-month history of fatigue and increased thirst. She has no history of serious medical illness and takes no medications. She is 163 cm (5 ft 4 in) tall and weighs 72 kg (160 Ib); BMI is 28 kg/m2. Her fasting serum glucose concentration is 249 mg/dL. Treatment with an oral hypoglycemic agent is begun. FYI: The first-line oral hypoglycemic drug in patients with newly diagnosed type 2 diabetes mellitus is typically metformin. Metformin also has the added benefit of causing weight loss, which is desired in this overweight patient because weight loss decreases insulin resistance and improves glycemic control. Which of the following best describes the mechanism of action of the drug that was most likely prescribed for this patient? Decreased glucagon release Increased insulin release Decreased carbohydrate hydrolysis Increased renal glucose elimination Decreased hepatic gluconeogenesis

Decreased hepatic gluconeogenesis

A 56-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. Three months ago, the patient was started on metformin therapy after counseling on diet, exercise, and weight reduction failed to reduce his hyperglycemia. Physical examination shows no abnormalities. His hemoglobin A1c is 8.4%. Pioglitazone is added to the patient's medication regimen. Which of the following cellular changes is most likely to occur in response to this new drug? Decreased sodium-dependent glucose cotransport C Depolarization of pancreatic β-cells D Autophosphorylation of receptor tyrosine kinase E Increased transcription of adipokines

E Increased transcription of adipokines

A 29-year-old woman comes to the physician for intermittent episodes of sharp chest pain and palpitations. She appears nervous. Her pulse is 115/min and irregularly irregular, and blood pressure is 139/86 mmHg. Examination shows a fine tremoron both hands and digital swelling; the extremities are warm. There is retraction of the right upper eyelid. Which of the following is the most appropriate next step in the management of this patient? B Propylthiouracil C Warfarin D Methimazole E Propranolol

E Propranolol

An obese, 66-year-old woman comes to the physician for a routine health maintenance examination. She feels well but is unhappy about being overweight. She reports that she feels out of breath when walking for more than one block and while climbing stairs. She has tried to lose weight for several years without success. She goes for a walk 3 times a week but she has difficulty following a low-calorie diet. During the past 12 months, she has had two urinary tract infections that were treated with fosfomycin. She has type 2 diabetes mellitus and osteoarthritis. Her only current medication is metformin. She has never smoked. She is 160 cm (5 ft 3 in) tall and weighs 100 kg (220 Ib); BMI is 39.1 kg/m2. Vital signs are within normal limits. Physical examination shows cracking in both knees on passive movement. The remainder of the examination shows no abnormalities. Serum studies show an HbA1c of 9.5%, and a fasting serum glucose concentration of 158 mg/dL. An ECG shows no abnormalities. FYI: This patient with type 2 diabetes mellitus presents with recurrent urinary tract infections, and a hemoglobin Alc of 9.5%, which suggests insufficient glycemic control with her current medication regimen. The patient's desire to lose weight should also be considered when adjusting her current medication treatment. Which of the following is the most appropriate pharmacotherapy? Acarbose Dapagliflozin Exenatide Glyburide Pioglitazone

Exenatide ???

A 56-year-old man comes to the physician for evaluation of gradually worsening fatigue, increased urinary frequency, and blurry vision for 5 months. He has not seen a doctor in several years. Physical examination shows decreased vibratory sense and proprioception in the lower extremities. His hemoglobin Alc is 10.4%. Treatment for his condition with appropriate medication is begun. In response to this drug, pancreatic islet cells begin producing increasing amounts of secretory granules. FYI: This patient's symptoms raise suspicion for diabetes mellitus, and the elevated HbA1c confirms this diagnosis. The secretory granules produced by the pancreatic islet cells in response to his new medication contain insulin and C-peptide, suggesting that the administered drug works by increasing endogenous insulin production. The patient was most likely treated with which of the following drugs? Metformin Pioglitazone Glimepiride Acarbose

Glimepiride

The biguanide that decreases hepatic glucose production and enhances insulin uptake is which of the following? Glucophage Starlix Synthroid Cortrosyn

Glucophage

A patient who is on thyroid medication should be monitored for which potential side effect? Hyperglycemia Hypotension muscle Shortness of breath

Hyperglycemia

Insulin is administered parenterally because: It is easier to monitor dosage It is destroyed in the Gl tract Insulin pills are difficult to swallow Parenteral dosing is tolerated better

It is destroyed in the Gl tract

What drug causes an interaction with sulfonylureas, resulting in an antagonistic action in which a larger dose may be required? MAOIs estosterone Corticosteroids Narcole analgesics

MAOIs

A 50-year-old woman comes to the physician because of palpitations and irritability. Over the past 4 months, she has had several episodes of heart racing and skipping beats that lasted between 30 seconds and several hours. She has also been arguing with her husband more, often about the temperature being too warm. The patient has also lost 8.8-kg (19.4-Ib) over the past 4 months, despite being less strict with her diet. She has mild asthma treated with inhaled bronchodilators. Her pulse is 102/min and her blood pressure is 148/98 mm Hg. On physical examination, the skin is warm and moist. A mass is palpated in the anterior neck area. In laboratory studies,thyroid-stimulating hormone is undetectable and there are antibodies against the thyrotropin-receptor. Thyroid scintigraphy shows diffusely increased iodine uptake. Two weeks later, a single oral dose of radioactive iodine is administered. FYI: This patient presents with features of Graves disease: hyperthyroidism (palpitations, irritability, weight loss, heat intolerance, increased sweating, warm skin), a palpable goiter, thyrotropin-receptor antibodies, and diffuse iodine uptake of the thyroid gland. Radioactive iodine is taken up by the diffusely active thyroid gland emits beta radiation, and destroys thyroid tissue. This patient will most likely require which therapy in the long term? Estrogen replacement therapy L-thyroxine therapy Methimazole therapy Potassium iodide therapy Propranolol therapy

Methimazole therapy

An investigator is studying a drug that acts on the thyroid hormone pathway. Levels of serum-free T3 and T4 in healthy participants are measured before and after administration of the drug. After administration, there is a decrease in the average serum free T3 level, while the average serum free T4 level is increased compared to initial serum studies. Inhibition of which of the following is the most likely mechanism of action of this drug? Follicular thyroid proteases Thyroid-stimulating hormone Follicular iodotyrosine deiodinase Peripheral 5-deiodinase follicular thyroid peroxidase

Peripheral 5-deiodinase

Which drug may cause an interaction resulting in reduced effectiveness of the corticosteroid? Estrogen Salicylates Diuretics Phenytoin

Phenytoin

A 54-year-old woman is brought to the emergency department by a nurse 30 minutes after receiving scheduled radiation therapy for papillary thyroid cancer. After the radioisotope was ingested, the physician realized that a much larger fixed dose was given instead of the appropriate dose based on radiation dosimetry. FYI: High-dose radioiodine (1131) is used as an adjunct therapy in the case of differentiated thyroid cancer (e.g., papillary thyroid cancer, follicular thyroid cancer). The drug that is used to treat an acute overdose of radioiodine is also used to treat thyroid storms because it temporarily decreases the activity of thyroid peroxidase (Wolff-Chaikoff effect) Which of the following pharmacotherapies should be administered immediately to prevent complications from this exposure? Amifostine Methimazole Potassium iodide Mercaptoethane sulfonate Propylthiouracil

Potassium iodide

Which drug can potentiate the hypoglycemic effect of sulfonylurea? Quinolones Penicillins Antacids Rifampin

Quinolones

What best describes the onset and duration of action of regular insulin? Delayed onset and short duration Extended onset and long duration Rapid onset and short duration Ultra-rapid onset and very short duration

Rapid onset and short duration

Which preparation of insulin is used for immediate correction of elevated blood glucose? Lispro Regular Isophane(NPH) Glargine

Regular

A 54-year-old man comes to the physician for a routine health maintenance examination. He was diagnosed with type 2 diabetes mellitus 1 year ago. His only medication is metformin. His serum glucose is 186 mg/dL and his hemoglobin Alc is 7.6%. The physician prescribes an additional antidiabetic drug and counsels the patient on its delayed onset of action. At a follow-up appointment 4 weeks later, the patient reports that his home blood glucose readings have improved. He also mentions that he has had a weight gain of 4 kg (8.8 lb). FYI: The drug that has been added to the patient's medication regimen has a delayed onset of action because it acts at the level of transcription. The patient has most likely been treated with which of the following drugs? Empagliflozin Liraglutide Rosiglitazone Glyburide

Rosiglitazone

A 45-year-old female patient has fasting glucose levels of 147 mg/dL, and with a glucose tolerance test, you have confirmed the diagnosis of type II diabetes. You begin therapy with metformin, but her fasting glucose levels remain above 100 mg/dL. You elect to change her therapy to glyburide. This drug acts to (A) Increase insulin secretion (B) Decrease glucocorticoid levels (C) Decrease tissue sensitivity to insulin (D) Decrease insulin half-life

The answer is A. Sulfonylureas such as glyburide increase the release of insulin from the pancreas. They also may cause an increase in insulin receptors, which increases tissue sensitivity to insulin. They do not slow insulin clearance, and they do not decrease glucocorticoid levels.

A 60-year-old male with type II diabetes is taking glyburide for his disease but is not maintaining adequate glycemic control with an HbA1c level of 7.3%. You elect to add rosiglitazone to his medications. This drug acts to (A) Increase insulin sensitivity in adipose and muscle (B) Increase insulin secretion from β-cells (C) Decrease somatostatin release from δ-cells (D) Decrease glucose absorption in the small intestine

The answer is A. The major mechanism of action of thiazolidinediones is increasing sensitivity to insulin in adipose, skeletal muscle, and liver. Several classes of hypoglycemic drugs act to increase insulin release from the pancreas including the sulfonylureas, incretins, and DPP-IV antagonists. The α-glucosidase inhibitors inhibit intestinal hydrolysis of complex saccharides and thereby reduce glucose absorption

A 55-year-old woman complains of worsening pain in her back that is not alleviated by NSAIDs. You suspect a bone-related condition and order a series of x-rays and a magnetic resonance image of the spine. These studies indicate an advanced case of osteosarcoma. You admit the patient, and later that evening she becomes unresponsive and moribund. Her electrolytes are normal except for Ca21, which is elevated at 4.2 mM. Which of the following would be most appropriate choice for treating this condition? (A) Furosemide (B) Thiazides (C) Vitamin D (D) Parathyroid hormone

The answer is A. Thiazides and loop diuretics have opposite effects on Ca21 excretion; loop diuretics such as furosemide increase Ca21 excretion and hence reduce hypercalcemia. Vitamin D and parathyroid hormone both increase serum Ca21.

A 49-year-old woman complains of sweating profusely nearly every night. She had a transvaginal hysterectomy 5 years ago but has intact ovaries. Upon physical examination, you note that she has a BMI of 22, but all her vital signs are normal. Which of the following would best treat her condition? (A) Conjugated estrogens (B) Levonorgestrel (C) Raloxifene (D) Calcitriol

The answer is A. Vasomotor symptoms are the most common complaint of perimenopausal women. Estrogen is the only effective treatment of these symptoms. Since there is no concern of endometrial cancer, a progestin is not indicated. Raloxifene makes hot flashes worse; and while a vitamin D analog might help maintain Ca21, it would not have any effect on the vasomotor symptoms.

A patient who has recently undergone a kidney transplant is immunosuppressed with dexamethasone and sirolimus. He is involved in a serious car accident. Besides the necessary treatment of the trauma, which of the following actions would be necessary? (A) Begin low-dose fludrocortisone therapy (B) Increase the dose of dexamethasone (C) Discontinue use of sacrolimus (D) Begin treatment with methyltestosterone

The answer is B. Patients taking glucocorticoids long term have suppressed pituitaryadrenal function and do not respond to trauma with increased cortisol biosynthesis. It is necessary to increase the

A 36-year-old woman complains of hot flashes, feelings of weakness, and increased appetite. You observe that she is tachycardic and has a prominent pulse pressure. Results of a test for anti-TSH antibodies are positive. Which of the following would be the most appropriate treatment for this patient? (A) Methimazole (B) Liotrix (C) Thyrotropin α (D) Ketoconazole

The answer is B. The patient has hyperthyroidism due to activating anti-TSH antibodies. Methimazole blocks the initial oxidation of iodine as well as the coupling of monoiodotyrosine and diiodotyrosine into the mature T4. Liotrix is a thyroid hormone preparation and would be contraindicated. Ketoconazole inhibits a number of P-450-catalyzed reactions but not the production of thyroid hormone.

A 59-year-old female nurse practitioner with a BMI of 30 and who has been diagnosed with type 2 diabetes is admitted to the emergency room. She is tachycardic, tachypneic, and appears very disoriented; she does not remember the day of the week or her address or any emergency contact numbers. She vaguely remembers taking her "sugar medicine" earlier in the day. Which of the following drugs is most likely responsible for her condition? (A) Metformin (B) Acarbose (C) Glipizide (D) Glucagon

The answer is C. Any of the sulfonylureas can cause hypoglycemia which can produce shock-like symptoms. Metformin and the α-glycosidase inhibitors such as acarbose rarely cause hypoglycemia. Glucagon would raise plasma glucose.

A cab driver with a 10-year history of alcoholism presents with ictarus and yellow sclera; serum bilirubin levels are elevated and liver function tests are all abnormal. In addition, his serum calcium at 2.0 mM is abnormally low. You elect to use a vitamin D derivative to correct his calcium level. Which of the following would be most appropriate for his patient? (A) Ergosterol (B) Dihydrotachysterol (C) Calcitriol (D) Cholecalciferol

The answer is C. Calcitriol would be the most effective agent for hypocalcemia in a patient with impaired liver function. The liver provides the required 25-hydroxylation of dihydrotachysterol, cholecalciferol, and ergosterol.

A 16-year-old female patient enters your dermatology clinic complaining of a rash. She is not taking any medications and is well dressed and groomed. You diagnose a mild case of acne vulgaris and notice thatthe girl's skin and hair appear unusually oily. Which of the following would be the best treatment for the acne? (A) Calcipotriene (B) Topical dexamethasone (C) Isotretinoin (D) Bexarotene

The answer is C. Isotretinoin is a retinoid that is especially useful in treating acne; it reduces oil production in the skin. Calcipotriene is used to treat psoriasis. Bexarotene is a rexinoid used to treat skin disorders, but not acne.

A male patient is diagnosed with a large, benign prostatic mass, and he has the urge to urinate frequently. He is begun on leuprolide acetate therapy. He returns to your office 3 days later complaining that his urge to urinate has increased, not decreased. What accounts for this action? (A) Direct effect of leuprolide on the prostate (B) Reduction of the conversion of testosterone to dihydrotachysterol (DHT) (C) Transient agonist action ("flare") of leuprolide causing a temporary increase in androgen production (D) Prostatic resistance to leuprolide

The answer is C. Leuprolide and the other GnRH agonists typically cause a transient increase in gonadal steroid production before down-regulation of receptors occurs. This is called a "flare."

An investigator is studying a drug that acts on a G protein-coupled receptor in the pituitary gland. The binding of the drug to this receptor leads to increased production of inositol triphosphate (IP3) in the basophilic cells of the anterior pituitary. FYI: The drug mimics a hormone that has an agonistic effect on this G protein-coupled receptor when it is secreted in a pulsatile fashion. Administration of this drug every 90 minutes is most likely to be beneficial in the treatment of which of the following conditions? Prostate cancer beta blocker toxicity anovulatory infertility central diabetes insipidus

anovulatory infertility (GnRH)

Two hours after undergoing open cholecystectomy for complicated cholecystitis, a 48-year-old woman develops dizziness, lethargy, abdominal pain, nausea, and vomiting. She has systemic lupus erythematosus and hypertension. Prior to hospitalization, her medications included nifedipine and prednisolone. Her pulse is 102/min and blood pressure is 111/78 mm Hg. Physical examination shows central obesity. The abdomen is soft and nontender, and the laparoscopic incisions have no discharge. Her serum cortisol and serum ACTH concentrations are decreased. FYI: This patient's presentation with nausea, vomiting, abdominal pain, and lethargy shortly after surgery in the setting of chronic corticosteroid use raises suspicion for an acute adrenal insufficiency. The diagnosis of tertiary adrenal insufficiency, due to suppression of the hypothalamic-pituitary axis, is confirmed by decreased serum cortisol and serum ACTH. Which of the following additional findings is most likely in this patient? hyperglycemia hyponatremia hyperkalemia hypokalemia normal anion gap metabolic acidosis

hyponatremia

A 27-year-old woman comes to the physician because of a 2-month history of palpitations, diaphoresis, and a 5-kg (11-lb) weight loss. Her pulse is 101/min and her blood pressure is 141/84 mm Hg. Physical examination shows a fine tremor when the fingers are outstretched. After confirmation of the diagnosis, treatment is begun with an antithyroid medication. The physician emphasizes the need for adequate contraception because of the increased risk of severe fetal malformations associated with the use of this medication, which is why its use is discouraged in the first trimester of pregnancy. FYI: The appropriate antithyroid pharmacotherapy is a drug of the thioamide class. Which of the following best describes the mechanism of action of this drug? Suppression of thyroid-stimulating hormone release inhibition of iodoide ion oxidation Inhibition of thyroid hormone release Inhibition of peripheral conversion of T4 to T3 Inactivation of circulatina thyroid hormones

inhibition of iodoide ion oxidation

Which of the following is the main type of side effects observed with SGLT2 inhibitors?

urinary

A 48-year-old woman comes to the physician for a follow-up examination. She has a history of type 2 diabetes mellitus and coronary artery disease. Current medications include metformin, aspirin, pravastatin, and losartan. Her body mass index is 30 kg/m2. Physical examination shows no abnormalities. Her hemoglobin Alc concentration is 8%. She does not want to start insulin injection therapy and is afraid that a new medication is going to cause weight gain. Empagliflozin is added to her diabetes regimen. FYI: Empagliflozin is a reversible inhibitor of sodium-dependent glucose co-transporters (SGLT2), which are located in the proximal convoluted tubules of the kidneys. Blockade of this receptor leads to decreased renal glucose reabsorption and increased urinary glucose excretion. This patient is at greatest risk for which of the following adverse effects of this new drug? vaginal candidiasis agranulocytosis localized lipodystrophy hypoglycemia

vaginal candidiasis