HBY 531 MEDICAL PHYSIOLOGY
Lecture
Exam 3 Version 1
2002
Section
1: Answer the following using:
A = increase
B = remain the same
C = decrease
1.
Pancreatic secretions
will__________as plasma levels of secretin increase.
2.
The duration of the
receptive relaxation reflex will__________after partial or total vagotomy.
3.
The gallbladder
diameter will_________in the presence of elevated levels of plasma gastrin.
4.
Intestinal secretion
arising from crypt cells will__________upon exposure to VIP on their
basolateral surfaces.
5.
The H+
secretion rate of parietal cells_________in response to secretin.
6.
The absorption of
amino acids will__________in response to an increase in the intracellular Na+
levels in columnar absorptive cells.
7.
During the absorptive
state, the plasma LDL concentration will__________.
8.
Following transfusion
of 1 L of blood containing citrate, urinary Ca2+ excretion will
_____________.
9.
Given a constant
dietary input of calcium, the filtered load of Ca2+ will __________
in a patient started on furosemide treatment.
10. In a normal healthy individual in their mid 20’s, the
fractional absorption of calcium along the GI tract will _____________
following a change from a high calcium to a low calcium diet.
11. The rate of in vitro
bone resorption, within a pure culture of osteoclasts, will ___________
following infusion of PTH.
12. The rate of in
vitro bone resorption, within a pure culture of osteoclasts, will ________
following infusion of a carbonic anhydrase inhibitor.
13. Within a normal healthy kidney, the transport maximum for
phosphate will ________ following a change from a low phosphate to a high
phosphate diet.
14.
Following infusion of a membrane permeant
analog of cAMP into the blood supply of the parathyroid gland, PTH levels
within blood will ___________.
15. In a patient with an ectopic ACTH-secreting tumor,
gluconeogenesis within the liver will _________ following treatment with
metyrapone.
16. In a patient with an ectopic ACTH-secreting tumor, ACTH
levels will ___________ following a dexamethasone suppression test.
17. During the follicular phase, progesterone levels
will_______.
18. During the follicular phase GnRH secretions will _______.
19. The length of the endometrial glands _______ during the
follicular phase of the ovarian cycle.
20. Establishiment of a preovulatory follicle coinicides with a
_________ in plasma levels of FSH.
21. The likelihood for monozygotic twins to form after the
breakdown of the zona pellucida will ___________.
22.
Within the vascular
sinuses of the corpora cavernosa of the penis, the hydrostatic pressure will
________ following stimulation of lumbar splanchnic nerves.
23. Within Leydig cells of the testis, the rate of conversion
of cholesterol to pregnenolone will ___________ following stimulation of LH receptors.
24. Within Sertoli cells of the testis, the rate of conversion
of androgens to estrogens will ____________ following stimulation of FSH
receptors.
25. Plasma FSH levels will be expected to _________ following
an infusion of exogenous testosterone into an otherwise normal healthy man.
26. Sperm counts (e.g., number of spermatozoa/mL of semen) will
be expected to _______ following an infusion of exogenous testosterone into an
otherwise normal healthy man.
Section
2:
For each of the following, choose the single best response:
27.
In a crypt cell the
intracellular Cl- is 20 mM and in the lumen it is 145 mM. Recall
that ECl=25 ln (Clcell/Cllumen). The resting potential of the cell is -50 mV.
a.
ECl is -30
mV.
b.
activation of Cl-
channels would result in an efflux of Cl- cytoplasm to lumen.
c.
a and b are true.
d.
the net flux of Cl-
is near 0.
28.
Lactose intolerance:
a.
will result in
secretory diarrhea if large amounts of diary products are consumed.
b.
occurs in persons who
have had a vagotomy.
c.
occurs when there is
insufficient lactase enzyme functioning on the columnar absorptive cell.
d.
is a result of
insufficient numbers of glucose/Na+ as transporters.
29.
The columnar
absorptive cells of the ileum:
a.
contain Na+/bile
salt transporters.
b.
contain no Cl-/HCO3-
exchangers.
c. contain no
glucose/Na+ transporters.
d. b and c are
true.
30.
Which of the following
is a feature of the gastroileal reflex?
a.
relaxation of the
muscularis externa of the ileum
b.
it occurs during
fasting only
c.
relaxation of the
ileocolonic sphincter by gastrin and VIP
d.
it is triggered by
distension of the colon
31.
Plasma LDL enters
tissues via:
a.
transcytosis from
capillaries.
b.
is acted on by
endothelial lipoprotein lipase (LPL) to become an HDL.
c.
endocytosis into
hepatocytes.
d.
both a and c are true.
32.
Inhibition of the enzyme
enterokinase would result in:
a.
no change in
carboxypeptidase A activity.
b.
an increase in
phospholipase A activity.
c.
the inhibition of
pancreatic amylase.
d.
none of the above.
33.
Bile salts:
a.
are recycled.
b.
are resorbed by
co-transport.
c.
are synthesized by hepatocytes.
d.
are lost in the feces
at a rate of approximately 5% or less per day.
e.
all of the above.
34.
A deficiency of Apo
B-48 will result in:
a.
a decrease of VLDL
plasma levels during the absorptive state.
b.
an increase in
chylomicrons remnants during the absorptive state.
c.
an elevated
chylomicron concentration during the absorptive state.
d.
reduced chylomicron
formation.
Answer
questions 35-37 using the information provided in the graph below:
An
individual has ingested 1.0L of fluid with a pH of 6.7 at the 1 hour mark. You are monitoring stomach pH, stomach volume
and small intestine volume.
35.
The lack of changes in
small intestine volume between hours 4 and 5 is most likely due to:
a.
increased bile
secretion.
b.
the gastrocolonic reflex.
c.
defecation.
d.
due to a balance
between intestinal secretion and solute absorption/resorption.
36.
At the 3 hour make the
sum total of secretions from the small intestine liver and pancreas is:
a.
3L.
b.
1L.
c.
2.5L.
d.
0L.
e.
none of the above.
37.
The number of mole of
H+ produced at the 2 hour mark is:
a.
2 x 10-6
moles.
b.
7 x 10-5
moles.
c.
1 x 10-4
moles.
d.
2.5 x 10 -7
moles.
e.
none of the above.
38.
The slow decline in
small intestine volume between hours 0 and 2 is due to:
a.
solute
absorption/resorption.
b.
the gastrocolonic
reflex.
c.
a lack of Cl-
secretion in the small intestine.
d.
the absence of the
gastroileal reflex.
39.
A patient suffers from
a lack of pancreatic and bile secretions:
a.
resulting in diarrhea.
b.
caused by insufficient
release of secretin and/or CCK into the duodenum.
c.
caused by excessive
secretin release of gastrin into the blood.
d.
a and b are true.
40.
Chylomicra are found
in lacteals of the gastrointestinal tract mucosa and not capillaries:
a.
because the
capillaries are sinisoids.
b.
because the chylomicra
are too large to enter the capillaries but not lacteals.
c.
because lacteal form a
intimate network of vessels adhere to the basement membrane underlying the
columnar absorptive cells.
d.
during the
post-absorption state.
41. Administration of Aminoglutethimide (an inhibitor of cholesterol P450 side-chain cleavage
enzyme, P450scc) to a patient would be expected to
a.
decrease cortisol levels in plasma.
b.
increase estradiol levels in a plasma.
c.
decrease anterior pituitary secretion of ACTH.
d.
increase adrenocortical pregnenolone concentration.
42.
The biosynthesis of tetra-iodothyronine (Thyroxine, T4)
a.
takes place at the basal membrane of the thyroid follicular cell,
catalyzed by a Na+/K+ ATPase.
b.
requires the presence of circulating iodide transported by
thyroglobulin in the blood.
c.
is catalyzed by thyroperoxidase at the apical membrane of the
follicular epithelium.
d.
is inhibited in Graves’ disease due to the autoimmune inhibition
of the Thyroid Stimulating Hormone (TSH) receptor.
43.
The secretion of Prolactin from the anterior pituitary is
stimulated by suckling because of;
a.
negative feedback by dopamine to the anterior pituitary
b.
decreased synthesis and secretion of oxytocin from the posterior
pituitary
c.
decreased secretion of Luteinizing and Follicle-stimulating
hormones (LH & FSH) from the anterior pituitary
d.
decreased secretion of dopamine from the hypothalamus
44.
Growth hormone releasing hormone (GHRH) and somatostatin oppose
each others action by
a.
stimulating and inhibiting, respectively, adenylyl cyclase
activity in the anterior pituitary.
b.
the GHRH dependent stimulation of PLCb activity and somatostatin
dependent activation of adenylyl cyclase
c.
decreasing and increasing, respectively, circulating IGF-1 levels
d.
competing for a common receptor on anterior pituitary somatotroph
plasma membranes.
45.
The biosynthesis of ACTH takes place in the corticotrophs of the
anterior pituitary,
a.
where it is derived from a large precursor that also encodes
Luteinizing hormone and b-endorphin.
b.
and is stimulated by hypothalamic Corticotropic Releasing Hormone
(CRH) Gai-coupled
inhibition of adenylyl cyclase.
c.
in response to episodic stimulation from the hypothalamus, with
maxima observed in late sleep and early morning.
d.
and its secretion controls adrenal cortisol secretion but not
adrenal androgens.
46. A patient has undergone a radical
bi-adrenalectomy (removal of both adrenal glands), and his physician asked for
a blood sample after a 12 hr fast. Which
of the following would be expected:
a.
levels of cortisol in the blood would be expected to be normal
b.
levels of glucose in the blood would be expected to be below
normal
c.
levels of ACTH in the blood would be expected to be below normal
d.
levels of aldosterone would be expected to be above normal
47. Non-shivering thermogenesis is
the major mechanism by which the newborn raises its body temperature;
a.
during this process O2 consumption does not change
appreciably.
b.
subcutaneous temperature increases in parallel with O2
consumption.
c.
the catabolism of fats in brown adipose tissue is increased.
d.
independent of b-receptor activation of brown adipose tissue temperature.
48. A resting volunteer had a
respiratory quotient of 0.8 and an O2 consumption of 300 ml/min,
with an energy equivalent of 4.81 kcal / liter O2, the metabolic
rate under these conditions would be expected to be:
a.
2080 kcal/day
b.
4160 kcal/day
c.
2.08 cal/hr
d.
4.16 cal/hr
49. Growth hormone and insulin share
similar mechanisms of action including
a.
binding to heterotrimeric G-protein coupled plasma membrane
receptors that result in the activation of tyrosine kinase.
b.
the activation of liver adenylyl cyclase and the stimulation of
glycogen synthesis.
c.
the activation of intracellular tyrosine kinases following the
interaction of agonist with a homodimeric receptor.
d.
the stimulation, in liver, of insulin-like growth factor (IGF)
synthesis and secretion.
50. The continued administration of
dexamethasone to a stressed-out medical student would be expected to
a.
decrease ACTH secretion from the anterior pituitary but not
Corticotropin Releasing hormone (CRH) from the hypothalamus.
b.
result in the atrophy of normal adrenal tissue because of
excessive CRH and ACTH secretion.
c.
increase a-melanocyte
stimulating hormone (a-MSH)
and b-endorphin
in the adrenocorticotrophs of the anterior pituitary.
d.
decrease both CRH and ACTH secretions, resulting in bilateral
adrenal atrophy
51.
The catecholamine hormones epinephrine and nor-epinephrine
act on liver as follows:
a.
epinephrine binds to an a-adrenergic plasma membrane
receptor, while nor-epinephrine binds to an intracellular b-adrenergic
receptor
b.
each binds to a different kind of plasma membrane receptor, but
both cause increases in liver gluconeogenesis.
c.
nor-epinephrine decreases intracellular cAMP levels, and
epinephrine decreases intracellular Ca2+ levels
d.
epinephrine activates glycogen synthesis while nor-epinephrine
activates VLDL synthesis.
52.
The amino acid tyrosine is the precursor of several
hormones including
a.
cortisol, thyroid hormones T3/T4 and catecholamines.
b.
thyroid hormones T3/T4, epinephrine and nor-epinephrine.
c.
glucagon, insulin and cortisol.
d.
insulin, thyroid hormones T3/T4 and cortisol.
53.
The absorptive state of metabolism, following the ingestion
of a balanced meal is characterized
by:
a.
the induction of liver glucokinase and the dephosphorylation of
pyruvate dehydrogenase.
b.
the phosphorylation and activation of adipose triglyceride lipase
acids in the blood and increased ketone synthesis.
c.
a translocation of GLUT-2 to liver plasma membrane, resulting in
an increase in glucose uptake.
d.
an increase in blood free fatty acid levels and increased ketone
biosynthesis.
54.
Excess secretion of growth hormone in post-pubertal patients can
be considered an acute metabolic disorder because
a.
fatty acid uptake as well as triglyceride synthesis in adipose
tissue are dramatically increased.
b.
Insulin-like Growth Factor (IGF) synthesis in liver and secretion
are markedly increased, as are insulin receptor levels in muscle and adipose
tissues.
c.
the elongation of long bones ceases after the production of sex
hormones and the resulting acromegaly is a chronic development.
d.
it results in hypoglycemia as a result of the potentiation of
insulin action on skeletal muscle and adipose tissues.
55.
A 2-year old child in a hypoglycemic (low blood glucose)
coma is immediately given glucagon intravenously. After 10 min blood glucose
levels have still not returned to normal. Possible explanations are:
a.
The patient has inherited a constitutively active mutant of
adenylate cyclase.
b.
The patient has eaten only protein for several days before the
coma.
c.
The patient has inherited a defective insulin receptor gene.
d.
The patient has inherited a defective glucose-6-phosphatase gene.
56.
The
synthesis and secretion of glucagon from pancreatic islet a-cells in response to amino acids from the diet :
a.
Is simultaneous with insulin release, only when glucose in the
blood is above normal.
b.
Is potentiated by insulin secretion from the b
cells, when glucose levels are high.
c.
Decreases the level of urea in urine, because of decreased
de-amination by the liver.
d.
Allows for gluconeogenesis even in the absorptive phase.
57.
A Non-Insulin Dependent Diabetic (NIDDM) has decreased
rates of blood glucose clearance most probably because
a.
there is an increased rate of IRS-1 de-phosphorylation and
proteolysis associated with obesity.
b.
the expression of insulin processing proteases (PC2 and PC3)
decreases with age and obesity.
c.
there is a down-regulation of insulin receptors associated with
increased body weight.
d.
hepatic levels of fructose-2,6-bisphosphate increase with age and
obesity.
58.
Which of the following is NOT a characteristic of liver
cells
a.
gluconeogenesis from acetyl CoA.
b.
b-oxidation of fatty acids into
ketone bodies.
c.
the formation of urea from carbon dioxide and ammonia.
d.
the secretion of very low density lipoproteins in the absorptive
phase of metabolism.
59.
The secretion of insulin from the pancreatic islet b-cell requires
a.
the activation of islet cell glycolysis and an active signal
peptidase.
b.
a decrease in intracellular Ca2+ concentration in
response to an increase in glucose uptake.
c.
an increase in insulin processing proteases (PC2 and PC3)
transcription induced by glucose and amino acids.
d.
cleavage of the connecting peptide from the A- and B-chains of
insulin after fusion of the granule with the plasma membrane.
60.
An untreated Insulin-Dependent Diabetic (IDDM)
a.
would test Islet-cell Antibody (ICA) positive early during the
progression of diabetes.
b.
would show increased rates of chylomicron clearance from the
blood.
c.
would have decreased levels of fatty acids in the blood because of
the absence of insulin.
d.
can be treated by daily administration of antibodies to human
glucagons.
61.
The product of the glucagon gene is:
a.
Glicentin + GLP-1 + GLP-2 in intestinal L cells.
b.
Glucagon + GRPP in pancreatic a cells and only GRPP in
intestinal L cells.
c.
Preproglucagon that is processed in circulation to give
biologically active glucagons.
d.
stimulated by the secretion of insulin from the b-islet
cells.
62. A patient presents with signs and symptoms of hypocalcemia. Further tests indicate that plasma phosphate
is elevated but PTH levels are very low.
At this point, which of the following tests would most helpful in
determining the cause of this patient’s problem?
a.
dexamethasone
suppression test
b.
challenge with synthetic
PTH and assay for urinary cAMP
c.
challenge with
synthetic vitamin D (i.e., calcitriol) and assay for urinary hydroxyproline
d.
measure serum Mg2+
e.
measure serum albumin
63. Which of the following conditions involve a simultaneous
decrease in both PTH and calcitriol?
a.
hypoparathyroidism
b.
pseudohypoparathyroidism
c.
type I vitamin D
dependent osteomalacia
d.
secondary
hyperparathyroidism associated with renal failure
e.
vitamin D resistant
osteomalacia
64. The filtered load of calcium within the kidney would be
expected to be higher than normal in all of the following conditions EXCEPT:
a.
hyperparathyroidism
b.
pseudohypoparathyroidism
c.
hypercalcemia of
malignancy
d.
vitamin D toxicity
e.
vitamin D resistant
osteomalacia
65. The filtered load of phosphate within the kidney would be
expected to be higher than normal in which of the following conditions?
a.
hyperparathyroidism
b.
type I vitamin D
dependent osteomalacia
c.
type II vitamin D
dependent osteomalacia
d.
vitamin D toxicity
e.
both band c
66. Which of the following sets of conditions will stimulate 1a-hydroxylase activity within proximal tubule cells of the
kidney?
a.
high levels of
calcitriol
b.
high levels of
phosphate
c.
high levels of
prolactin
d.
low levels of PTH
e.
none of the above
67. The hypophosphatemia that accompanies hypercalemia of
malignancy results from the action of:
a.
PTH
b.
PTH related peptide
(PTHrp)
c.
calcitriol
d.
calcitonin
e.
calcitonin gene
related peptide
68. Osteoblasts possess receptors for
a.
vitamin D (i.e.,
calcitriol) only
b.
PTH only
c.
both calcitriol and
PTH
d.
neither calcitriol nor
PTH
e.
ACTH
69. A 34 year old women has 3 children, the youngest of whom is
13 months old and still nursing. She is currently going through a divorce.
After the birth of her youngest child, her menstrual cycle was re-established
within 2 months and remained regular for 5 months. In the last 7 months she has
had only 2 cycles, the last of which was 4 months ago. Given that her
gonadotropin levels are just above normal, which of the following tests would
provide the most useful information?
a.
Progesterone
withdrawal test
b.
Prolactin level
c.
TSH and T4
levels
d.
Physical exam of the
reproductive tract
e.
Karyotype test.
70. The acrosome reaction results in which of the following?
a.
increased sperm
motility
b.
movement of the sperm
through the zona pellucida
c.
movement of the sperm
through the cervix
d.
block to polyspermy
e.
both b and d
71. High LH levels result in
a.
vaginal dryness during
menopause.
b.
maintenance of the
corpus luteum during the late luteal phase.
c.
rupture of the
preovulatory follicle.
d.
both b and c.
e.
all of the above.
72. The secondary oocyte
a.
is found in tertiary
follicles.
b.
contains 23 single
chromosomes.
c.
is not surrounded by a
zona pellucida.
d.
The secondary oocyte
has two polar bodies.
e.
None of the above.
73. Trophoblasts
a.
are derived from the
outer layer of compacted cells in the morula.
b.
gives rise to fetal
cells that synthesize aldosterone.
c.
are non-invasive.
d.
give rise to cells of
the umbilical chord.
e.
a and b.
74. Which horomone is primarily responsible for contraction of
epithelial cells during suckling?
a.
estrogen
b.
prolactin
c.
oxytocin
d.
progesterone
e.
all of the above.
75. Lab tests from a male patient suspected of infertility
reveal oligospermia in a normal ejaculate volume, elevated FSH but normal LH
and testosterone. Which of the following
conditions is consistent with these findings?
a.
hypogondatropic
hypogonadism
b.
hypogonadism
associated with cryptorchidism
c.
Klinefelter’s syndrome
d.
hypogonadism
associated with seminiferous tubule failure
e.
retrograde ejaculation
76. Which of the following could account for male infertility
due to hypogonadotropic hypogonadism?
a.
a pituitary tumor
resulting in elevated prolactin secretion
b.
a pituitary tumor
resulting in elevated gonadotropin secretion
c.
a defect in
testosterone secretion
d.
varicocele
e.
seminiferous tubule
failure
77. Infusion of exogenous inhibin into the blood stream of the
male would be expected to decrease circulating levels of:
a.
GnRH
b.
LH
c.
FSH
d.
testosterone
e.
all of the above
78. Which of the following phenotypic patterns would most
likely be observed in an individual that has a karyotype of 46, XY, but lacks
the gene for androgen receptors?
a.
ovary, with female
internal and external genitalia
b.
testis, with male
internal and external genitalia
c.
testis, with no
internal and female external genitalia
d.
testis, with no
internal and male external genitalia
e.
testis, with male
internal but female external genitalia
79. Which of the following causes could account for the finding
of reduced fructose within a semen sample?
a.
seminiferous tubule
failure
b.
varicocele
c.
cryptorchidism
d.
blockage of 1
ejaculatory duct
e.
failure of the
bulbourethral gland
80. The enzyme 5 a reductase catalyzes the conversion of:
a.
cholesterol to
progesterone
b.
progesterone to
testosterone
c.
testosterone to
estradiol
d.
testosterone to
dihydrotestosterone (DHT)
e.
DHT to estradiol
Section 3: Choose
the single best response based on the following two case studies:
Case
1:
DL is a 72
year old grandmother who was admitted to a local hospital in Vermont because of
the onset of confusion and drowsiness.
Her history and physical exam, in
brief, is as follows. She was depressed as her husband died one month ago. She
became less active and ate more as she stayed at home. She weighs 150 lbs and
she is 5' 3" tall. She had been in excellent health but for pain in her
hands when she plays the guitar and discomfort in her knees when she shoots
hoops with her grandchildren. These symptoms were ascribed to “old age
osteoarthritis”. Six months ago on a routine medical examination it was noted
that her fasting blood sugar was 130 mg/dL (upper limits of normal 110 mg/dL),
and glucose was not found in a routine random urine sample. She was advised to
reduce her caloric intake and to “lose a few pounds”. She was given no other
directions either by her physician or the physician’s staff.
Three weeks before admission she
began to have a severe pain over her right temporal artery and right side of
her scalp following the artery. She noted that the area was red and tender. She
also felt aching and stiffness in her muscles. She saw her physician, who made
a tentative diagnosis of “polymyalgia rheumatica”, (This description is given
as a reason for treating this patient with a potent glucocorticoid and not to
introduce you to the complexities of the many arthritic diseases). A temporal
artery biopsy was performed that showed arteritis confirming the diagnosis.
Prednisone, 40 mg a day was started with prompt resolution of all her signs and
symptoms. She felt wonderful and began a vacation with her friends to view the
fall foliage in Vermont.
A week after the start of the
treatment, she noted increasing thirst, dry mouth and frequent urination. These
symptoms increased so by the fifth day of the trip, and she was too weak to
leave her room. By that night, she was found to be confused and lethargic. Her
friends took her to the local hospital.
Physical
Exam:
An
elderly women who appeared severely dehydrated, confused.
BP 100/60
Pulse 110
The
rest of the PE was normal but for decreased skin turgor and dry lips and mucous
membranes. An IV infusion of isotonic saline was started.
Laboratory
studies:
Patient Normal
Range
Glucose 1040
mg/dL 70-110 mg/dL fasting
Ketones neg
in blood
Sodium 128
mEq/L 135-145 mEq/L
Potassium 4.0
mEq/L 3.5-5.0 mEq/L
Bicarbonate 24
mEq/L 21-30 mEq/L
BUN 68
mg/dL 8-22 mg/d/L
Creatinine 1.8
mg/dL 0.3-1.5 mg/dL
Hematocrit 56% 37-48% female
Because of persistent hypotension
and conclusions based on the initial set of laboratory results the rate of
infusion was greatly increased. She put out only a minimal amount of urine. She
was treated with small amounts of insulin and other medications. By two hours
of therapy her mental status was noted to slowly improve, and her BP rose to
110/70 and glucose levels decreased to 700 mg/dL. Her urinary output increased
but she was not fully functioning and able to drink and eat until over 36 hours
of therapy had transpired. She was discharged on 20 mg prednisone a day as
therapy for her temporal arteritis and 20 units of a moderately long acting
insulin (NPH). Over the next months her prednisone dosage was slowly decreased
and finally stopped. When she was discharged from the hospital her fasting
blood sugar was 220 mg/dL. With the slow reduction of her prednisone dosage and
a voluntary loss of 15 pounds of weight and a return to her active life style,
it was noted that her fasting blood sugar values returned to normal even though
her insulin dosage was decreased and then stopped.
81.
DL’s clinical
presentation and laboratory data are consistent with the diagnosis of:
a.
Addison’s disease with
the inability to maintain blood pressure and blood sugar in the normal range.
b.
Hypothyroidism with
mental changes.
c.
Hyperthyroidism with
congestive heart failure.
d.
Type 2
(non-insulin-dependent under normal circumstances), diabetes mellitus, admitted
to the hospital in a nonketotic, hyperosmolar state.
82.
DL’s clinical
presentation and laboratory data are consistent with which of the following
statements:
a.
This life threatening
emergency as described in the case of DL can develop in a patient with Type 2
(non-insulin dependent) diabetes mellitus.
b.
Ketonemia and acidosis
usually are present in such a patient as DL because the blood insulin levels
are very low, in absolute numbers, compared to a normal persons values.
c.
In this patient, while
being treated with a high dose of prednisone, her pancreatic islet $-cells secreted an adequate amount of insulin to maintain
her blood glucose levels below the renal threshold (Tm) for glucose.
d.
The high dose of the
glucocorticoid (prednisone) protected her from excessively high blood sugar
levels as it decreased liver gluconeogenesis.
83.
This patient’s
pancreatic $-cells, before the onset of her temporal arteritis and
subsequent therapy with prenisone, secreted:
a.
adequate amounts of
insulin to maintain her blood sugar levels below the renal threshold for glucose.
b.
a very little amount
of insulin, and therefore, suffered from hypoglycemia.
c.
a very large amount of
glucagon to prevent hypoglycemia.
d.
a very large amount of
TSH, and therefore, an increased amount of T4 to prevent depression.
84.
The high dose of
prednisone administered to treat the temporal arthritis aggravated her
underlying other disease by:
a.
decreasing her rate of
hepatic gluconeogenesis.
b.
increasing the insulin
sensitivity of her fat and muscle tissues.
c.
raising her kidney’s
transfer maximum (Tm) for glucose.
d.
increasing her rate of
hepatic gluconeogenesis.
85.
The laboratory values
reported in this suggest that:
a.
DL was volume expanded
because of the severe osmotic diuresis.
b.
DL was volume depleted
because of the severe osmotic diuresis.
c.
DL’s glomerular
filtration rate was greatly increased.
d.
DL was plasma
hypo-osmolar due to the loss of salt in her urine.
86.
Which of the following
would be expected, in this case, after time and stopping of prednisone therapy:
a.
polyuria and
polydipsia should return.
b.
diet and exercise
should control her underlying disease.
c.
stress and trauma
should not aggravate her underlying disease.
d.
the signs and symptoms
of Addison’s disease should abate.
Case
2:
SD is
an 82 year old woman who has over a six month period become increasingly lethargic,
withdrawn with only a slight weight loss. She has noted palpitations and a
decrease in exercise tolerance. Because of the above concerns her family
brought her to be examined by her physician. She has been known to have a non
painful enlarged thyroid (goiter) for most of her life. She is not taking any
medications.
Physical
Exam:
A
lethargic, elderly woman who is detached but cooperative. BP 140/90, pulse 110
and irregularly irregular. It was known that one year ago her heart rate was
70-80 and regular. No lid lag or stare and she has an easily visible and
palpable multinodular goiter.
EKG:
Atrial fibrillation.
Laboratory
studies:
Patient Normal Range
T4 15.0 :g/dL 5-12:g/dL
TSH <0.05 mU/L 0.3-5.0 mU/L
Radioactive
Iodine
uptake 50% at 24 hrs 10%-25% at 24 hrs
87.
The most likely
diagnosis in this elderly patient is:
a.
hypothyroidism due to
a non-functioning large multinodular thyroid gland.
b.
addison’s disease due
to an under-functioning adrenal cortex.
c.
acromegaly due to a
hyper-functioning pituitary gland.
d.
hyperthyroidism due to
an over-functioning thyroid gland.
88.
In elderly patients
the full constellation of symptoms and signs usually associated with this disease
may not be present. Two of these signs and symptoms that this patient shows
are:
a.
myxedema and cold
intolerance.
b.
low blood pressure and
slow pulse.
c.
apathy and
cardiovascular changes.
d.
weight gain and
truncal obesity.
89.
Autonomous-functioning
of multiple thyroid nodules, as in this patient, is associated with:
a.
higher than normal TSH
values.
b.
lower than normal
intracellular levels of T3 in neural cells.
c.
lower than normal
production of TSH by the thyrotropes located in the pituitary.
d.
lower than normal
production of calcitonin by the functioning thyroid gland cells.
90.
In this patient, if
you treated her with propylthiouracil (PTU is an inhibitor of thyroid gland
function) you might expect with time:
a.
an increase in
aldosterone levels as she is under stress.
b.
an increase in blood
pressure as increased thyroid hormone levels decrease blood pressure.
c.
the reversion of her
atrial fibrillation to normal sinus rhythm because the thyroid hormone level
should slowly decrease.
d.
a further decrease in
the TSH levels as the functioning of the thyroid gland declines.