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____A______as plasma levels of secretin increase.
2. The duration of the receptive relaxation reflex will_____C_____after partial or total vagotomy.
3. The gallbladder diameter will_____B_____in the presence of elevated levels of plasma gastrin.
4. Intestinal secretion arising from crypt cells will_____A_____upon exposure to VIP on their basolateral surfaces.
5. The H+ secretion rate of parietal cells____C______in response to secretin.
6. The absorption of amino acids will____C______in response to an increase in the intracellular Na+ levels in columnar absorptive cells.
7. During the absorptive state, the plasma LDL concentration will_____A_____.
8. Following transfusion of 1 L of blood containing citrate, urinary Ca2+ excretion will ______C_______.
9. Given a constant dietary input of calcium, the filtered load of Ca2+ will ___B or C______ 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 _______A______ 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 _____B______ following infusion of PTH.
12. The rate of in vitro bone resorption, within a pure culture of osteoclasts, will ___A, B, or C_____ following infusion of a carbonic anhydrase inhibitor.
13. Within a normal healthy kidney, the transport maximum for phosphate will ____C____ 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 _____A______.
15. In a patient with an ectopic ACTH-secreting tumor, gluconeogenesis within the liver will ___A, B, or C______ following treatment with metyrapone.
16. In a patient with an ectopic ACTH-secreting tumor, ACTH levels will _____B______ following a dexamethasone suppression test.
17. During the follicular phase, progesterone levels will____ A, B, or C ___.
18. During the follicular phase GnRH secretions will ___ A, B, or C ____.
19. The length of the endometrial glands ___A, B, or C____ during the follicular phase of the ovarian cycle.
20. Establishiment of a preovulatory follicle coinicides with a ____A, B, or C_____ in plasma levels of FSH.
21. The likelihood for monozygotic twins to form after the breakdown of the zona pellucida will ____A, B, or C_______.
22. Within the vascular sinuses of the corpora cavernosa of the penis, the hydrostatic pressure will ____C____ following stimulation of lumbar splanchnic nerves.
23. Within Leydig cells of the testis, the rate of conversion of cholesterol to pregnenolone will _____A______ following stimulation of LH receptors.
24. Within Sertoli cells of the testis, the rate of conversion of androgens to estrogens will _____A_______ following stimulation of FSH receptors.
25. Plasma FSH levels will be expected to ___C______ 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 ___C____ 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 O.
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? (note: version 3 extra answer was also correct)
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
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
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
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
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.