NMS Q&A Family Medicine

chap ter 34The Adrenal andParathyroid GlandsExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 Which of the following findings is most specific forprimary hyperparathyroidism?(A) Increased sleep requirement(B) Polyuria and polydipsia in the face of totalcalcium level of 12 mg/dL (8.5 to 10.5 mg/dL;2.2 to 2.8 mmols/L) and parathormone level(PTH) unobtainable(C) Prolonged P-R interval on resting electrocardiogram(ECG) with total calcium level of 12 mg/dL (8.5 to 10.5 mg/dL; 2.2 to 3 mmols/L) andPTH of 40 ng/L (0 to 60 ng/L)(D) Calcium-containing kidney stones(E) Diminished deep tendon reflexes with calciumlevel of 14 mg/dL (8.5 to 10.5 mg/dL, 2.2 to3 mmols/L)2 The NIH consensus, Question 1 notwithstanding, fordiagnosis of hyperparathyroidism in 2009 requiresall of the following factors except for which one?(A) Serum calcium more than 1 mg/dL above normal(B) Urinary calcium greater than 400 mg/dL(C) Abnormally low bone density(D) Carpopedal spasm(E) Age less than 60 years3 Each of the following conditions can be confusedwith Cushing disease or syndrome either chemicallyor clinically. Which one is NOT characterized by elevatedserum cortisol?(A) Factitious hypercortisolism(B) Ingestion of gamma-hydroxybutyrate(C) Familial cortisol resistance(D) Anorexia nervosa(E) Depression4 A 34-year-old type 1 diabetic man had been controlledon 36 units daily of human insulin, both short(R) and intermediate (N) acting, in the form of 16units of human N and 8 units of human R in themornings and 8 units of human N and 4 units ofhuman R after the evening meal. Three days ago, theman was involved in an auto accident in which heincurred abdominal blunt trauma and was hypotensiveseveral hours before undergoing transfusion andsplenectomy for rupture. There had been no apparenthead injury. Yesterday, in the hospital, he beganrunning a fever, with a temperature of 39 C (102.2 F).There are no apparent sites of infection. Blood cultureswere drawn and are incubating. This morning,3 hours after his morning insulin, he experienced asevere episode of hypoglycemia with a blood sugarmeasurement of 45 mg/dL. The fasting blood sugarbefore the morning insulin doses was 85 mg/dL. Thepatient complains of nausea, vomiting, and diarrhea.Initial laboratory results show a mild eosinophiliaand hyperkalemia at 5.3 mEq/L. Which of the followingis the most likely explanation of these developments?(A) Sepsis secondary to surgical wound infection(B) Sepsis secondary to primary wound infection atthe sites of abdominal trauma(C) Viral gastroenteritis(D) Acute adrenal insufficiency(E) Neurologic complication of the traumainvolving temperature control5 Adrenal insufficiency may be primary or secondary (i.e.,secondary to pituitary failure). In addition to abnormallylow levels of corticotropin (adrenocorticotropichormone, or ACTH), which of the following findingswould favor secondary adrenal insufficiency?(A) Abnormally low level of serum cortisol(B) Hypovolemia, hyponatremia, and hyperkalemia(C) Physical findings of hyperpigmentation in theskin creases, skin over extensor surfaces (e.g.,knuckles, elbows), and posterior neck(D) Abnormally low level of serum cortisol, moderateneutropenia, lymphocytosis, and neutrophilia209