Internal-Medicine

54 3: Endocrinology
12. A 56-year-old man presents with a change in
skin color, fatigue, and abdominal pain. He has
also noticed increased urine output and thirst.
On examination, his skin appears bronze in
color, his liver span is 16 cm, and there is loss
of body hair, and testicular atrophy. His ferritin
is 600 ng/mL (15–200 ng/mL), aspartate
amino transferase (AST) 130 U/L (8–20 U/L),
alanine amino transferase (ALT) 150 U/L
(8–20 U/L), and total bilirubin 0.5mg/dL
(0.1–1 mg/dL). Coagulation tests and albumin
level are normal but the random glucose is
elevated at 250 mg/dL. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
diabetes mellitus (DM)
amyloidosis
Wilson’s disease
hemochromatosis
Addison’s disease
13. A 35-year-old man has had recurrent attacks of
abdominal pain and proximal motor neuropathy
since puberty. The episodes are precipitated
by infections and certain medications.
During one of the attacks, the plasma porphobilinogen
levels were increased. Which of the
following medications is not considered safe
in patients with this condition?
(A)
(B)
(C)
(D)
(E)
chlorpromazine
sulfonamide antibiotics
penicillin and derivatives
narcotics
glucocorticoids
14. A 43-year-old man weighs 85 kg and is 1.8 m
tall. His calculated body mass index (BMI) is
23 kg/m 2 . Which of the following conditions is
he most likely at risk for?
to control her illness. Which of the following is
the most likely explanation for this complication
of lithium treatment?
(A)
(B)
(C)
(D)
(E)
impairing glucose absorption at the
cellular level
decreasing production of vasopressin
increasing production of vasopressin
causing a solute diuresis
impairing vasopressin action at the
tubular level
16. The 2-year-old daughter of a Jewish couple,
whose parents emigrated from Russia, develops
progressive loss of motor skills. There is
macular pallor on ophthalmic examination,
and she has a short stature, thin limbs, but full
cheeks. She is also prone to developing hypoglycemia
and lactic acidosis. Which of the following
metabolic abnormalities is most likely
associated with this disorder?
(A)
(B)
(C)
(D)
(E)
glycogen storage
ganglioside accumulation
amyloid accumulation
corneal deposits
cholesterol accumulation
17. A 63-year-old man develops edema, and dyspnea
on exertion. He has no prior cardiac or
renal conditions, and his examination is significant
for macroglossia, elevated jugular
venous pressure (JVP), hepatomegaly, and 3+
pedal edema. His investigations reveal 3.5 g/d
of protein in the urine, anemia, normal fasting
glucose, and serum immunoelectrophoresis is
positive for a monoclonal immunoglobulin.
Which of the following is the most characteristic
neurologic finding associated with this condition?
(See Fig. 3–3.)
(A)
(B)
(C)
(D)
(E)
DM
hyperlipoproteinemia
abnormal growth hormone response
atherosclerosis
no increased risk for mortality
15. A 47-year-old woman with bipolar disorder
develops new symptoms of polyuria and polydipsia.
She has been on lithium for a long time
(A)
(B)
(C)
(D)
(E)
peripheral motor and sensory neuropathy
spinal cord compression in the lumbar
region
spinal cord compression in the thoracic
region
a peripheral neuropathy associated with
cerebral manifestations
a Guillain-Barré-type syndrome