NMS Q&A Family Medicine

210 NMS Q&A Family Medicine(E) Hypovolemia, normal sodium concentration, normalserum potassium, and normal skin color6 Your 33-year-old female patient has been diagnosedwith primary adrenal insufficiency. She had manifested,among other things, hyperkalemia. Which ofthe following would be the most likely acceptableregimen for replacement therapy?(A) Dexamethasone 0.75 mg daily, given in divideddoses as 0.5 mg in the morning and 0.25 mg inthe afternoon(B) Prednisone 5 mg daily(C) Hydrocortisone 24 mg daily, given as 16 mg inthe morning and 8 mg in the afternoon, plusfludrocortisone 0.3 mg daily in the morning(D) Prednisone 10 mg daily and fludrocortisone0.3 mg daily(E) Prednisone 15 mg daily, given as 10 mg in themorning and 5 mg in the afternoon7 Which of the following is the basis of standard treatmentfor the most common form of adrenal hyperplasia,the androgenizing condition, 21-hydroxylasedeficiency (also called P-450 c21 deficiency)?(A) Conjugated estrogens(B) Orchidectomy(C) Hydrocortisone in replacement dosages(D) Fludrocortisone(E) Syntropin8 A 35-year-old woman complains of weakness, fatigability,polyuria, and polydipsia. She had become hypertensiveduring the past few months and has been treatedwith a combination of hydrochlorothiazide/triamterenewith fair results. Her most recent blood pressure readingshave averaged 120/88. A spot blood sugar test3 hours after her latest meal showed a level of 95 mg/dL.She complains also of muscular weakness, on occasionexhibiting paralysis for brief periods. Which of thefollowing routine chemistries is likely to be the mostcritical in making a diagnosis that encompasses thehypertension and the weakness?(A) Blood urea nitrogen(B) Serum potassium(C) Serum creatinine(D) Serum sodium(E) Serum bicarbonate9 A 45-year-old woman has been followed for four visitsfor hypertension (blood pressure of 150 to 160/90to 100) discovered during a routine examination,at which time, she was also found to have type 2diabetes. Initially, an angiotensin-converting enzymeinhibitor failed to effect a fall in blood pressure fromher baseline measurements. On the third visit, theblood pressure had responded to hydrochlorothiazide/triamterene and her blood sugar had fallen to 120 to130 at 2 hours postprandially as prescribed glipizidetook effect. You notice that she is not only obese butalso that her obesity is centripetal with proximalmuscle wasting, associated with a plethoric face andpurple striae about the trunk and that she complainsof menstrual irregularity. She manifests also supraclavicularfat pads. Which of the following is the mostlikely comprehensive clinical diagnosis?(A) Metabolic syndrome(B) Essential hypertension(C) Type 2 diabetes(D) Cushing syndrome(E) Morbid obesity10 Regarding the patient in Question 8, which of the followingtests will differentiate Cushing disease (Cushingsyndrome caused by pituitary overproduction ofACTH) from Cushing syndrome caused by an ectopicsource, primary adrenal disease, or extrinsic origin?(A) Serum cortisol test(B) 24-hour urine catecholamine test(C) Dexamethasone suppression test(D) Serum prolactin test(E) Melanocyte-stimulating hormone test11 A 56-year-old ambulatory white woman undergoesroutine periodic physical examination and evaluationthat includes mammogram, Pap smear, reviewof systems and medications, and routine laboratoryhemogram and chemistries. All results are normalexcept that the serum calcium level is confirmed tobe elevated. Which of the following is the most likelycause of the hypercalcemia, assuming no other informationis available?(A) Carcinoma of the breast(B) Hypervitaminosis D(C) Hypervitaminosis A(D) Sarcoidosis(E) Primary hyperparathyroidism12 Regarding the patient in Question 11, a parathyroidhormone (PTH) level and urinary calcium-tocreatinineclearance ratio (Ca/CC) were ordered. Atthat time, you found the patient had been takingvitamin D supplements. Which of the followingresults would you expect if the cause of hypercalcemiawere vitamin D intoxication?(A) Elevated PTH and Ca/CC 0.02(B) Normal PTH and Ca/CC 0.02(C) Low PTH and Ca/CC 0.02(D) Low PTH and Ca/CC 0.01(E) Normal PTH and Ca/CC 0.01