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Category: Q&A Medicine--->Endocrine and Metabolic Disorders
Page: 2

Question 6#Print Question

A 64-year-old man with a history of hypertension and a 30-pack-year smoking history presents with unrelenting abdominal pain and constipation. He also endorses nausea and his wife reports that he has exhibited subtle signs of mental deterioration. He has a temperature of 36.8°C, blood pressure of 118/72 mmHg, heart rate of 98 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 96% on room air. Physical examination is unremarkable and laboratory studies reveal the following:

  • Calcium   15.1 mg/dL
  • Albumin   3.9 g/dL
  • Serum parathyroid hormone   8 pg/mL
  • 1,25-dihydroxyvitamin D   13 pm/mL (normal range, 15.9–55.6 pg/mL)

What additional laboratory value do you expect to find with this patient’s condition?

a. Increased angiotensin-converting enzyme (ACE) blood levels
b. Decreased interleukin-6 levels
c. Decreased urine calcium levels
d. Increased levels of parathyroid hormone–related protein


Question 7#Print Question

A 32-year-old woman with a history of endometriosis presents with weight loss, diarrhea, and increased appetite for the past 6 weeks. She has a temperature of 37°C, blood pressure of 132/88 mmHg, heart rate of 75 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 99% on room air. Physical examination reveals a diffusely large, nontender thyroid gland in addition to the findings seen in the photo below (Figure below). Laboratory studies confirm the diagnosis and the patient opts for treatment with methimazole. 

Which of the following adverse effects is important to inform the patient of before beginning treatment with this medication?

a. Hypocalcemia
b. Acute liver failure
c. Agranulocytosis
d. Vasculitis


Question 8#Print Question

A 28-year-old man with a history of type 1 diabetes presents with polydipsia and polyuria for the last 5 weeks. The patient reports that his blood glucose levels have been well controlled on his current insulin regimen. The patient denies tobacco, alcohol, or drug use and has no other past medical history. He has a temperature of 36.8°C, blood pressure of 114/68 mmHg, heart rate of 96 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 98% on room air. The patient reports that he has fasted for the visit and laboratory results reveal the following:

  • Sodium   147 mEq/L
  • Potassium   3.8 mEq/L
  • Chloride   104 mEq/L
  • Bicarbonate   28 mEq/L
  • Blood urea nitrogen   16 mg/dL
  • Creatinine   1.1 mg/dL
  • Glucose   96 mg/dL
  • Serum osmolality before water deprivation test   310 mOsm/kg
  • Urine osmolality before water deprivation test   98 mOsm/kg
  • Serum osmolality after water deprivation test   322 mOsm/kg
  • Urine osmolality after water deprivation test   101 mOsm/kg

Desmopressin was administered and 30 minutes later the urine osmolality is 432 mOsm/kg.

Which of the following is this patient’s diagnosis? 

a. Primary polydipsia
b. Central diabetes insipidus
c. Nephrogenic diabetes insipidus
d. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)


Question 9#Print Question

A 72-year-old woman presents with bone pain and tenderness in her lower extremities and left clavicle. Review of her chart reveals chronic bone marrow fibrosis with increased bone remodeling, in addition to several episodes of kidney stones (specifically calcium oxalate). Physical examination reveals tenderness to palpation on her lower legs and left midclavicle. Laboratory studies reveal elevated calcium, decreased phosphate, and elevated parathyroid hormone (PTH). X-ray reveals the following:

Which of the following is the diagnosis?

a. Paget disease of the bone
b. Osteomalacia
c. Osteoporosis
d. Osteitis fibrosa cystica


Question 10#Print Question

A 48-year-old woman presents with weight gain, easy bruisability, and muscle weakness. She has a 30-pack-year history of smoking. She presents with a temperature of 36.8°C, blood pressure of 144/92 mmHg, heart rate of 96 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 98% on room air. Physical examination reveals the finding seen in the photo below. Laboratory studies are significant for a fasting blood glucose of 310 mg/dL, a 24-hour urine cortisol level of 1,200 μg (normal range, 10 to 100 μg), and a plasma ACTH of 126 pg/mL (normal range, 10 to 60 pg/mL). Twenty-four– hour urine cortisol level is 1,184 μg after high-dose dexamethasone is administered.

Which of the following is the cause of the patient’s symptoms and laboratory findings?

a. Exogenous steroids
b. Adrenocortical adenoma
c. Ectopic ACTH-producing tumor
d. Cushing disease




Category: Q&A Medicine--->Endocrine and Metabolic Disorders
Page: 2 of 8