Internal-Medicine

Questions: 12–22 55
tuberous and tendon xanthomas. Before making
the assumption of familial hypercholesterolemia,
secondary causes need to be considered. Which
of the following conditions is most likely to cause
secondary hyperlipidemia?
(A)
(B)
(C)
(D)
(E)
cholestatic liver disease
alcoholism
estrogen replacement
malabsorption syndromes
chronic lung disease
18. A 30-year-old man presents with recurrent flushing,
diarrhea, and weight loss. His examination
is normal. Lab investigations reveal an elevated
urinary 5-hydroxyindoleacetic acid. Which of
the following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
Figure 3–3.
phenylketonuria
alkaptonuria
malignant melanoma
carcinoid syndrome
disseminated carcinomatosis
19. A 25-year-old woman presents with symptoms
of polyuria and polydipsia. So far investigations
have ruled out psychogenic causes and
diabetes. A fluid deprivation test is performed.
At the end of the test, the urine osmolality is
240 mOsm/kg and the serum antidiuretic hormone
(ADH) level is elevated. Which of the
following is the most likely diagnosis?
(A) adrenal cortex defect
(B) nephrogenic diabetes insipidus
(C) central (posterior pituitary) diabetes
insipidus
(D) acute tubular necrosis (ATN)
(E) Addison’s disease
20. A 40-year-old man has lipid investigations suggesting
familial hypercholesterolemia (increased
cholesterol, increased low-density lipoprotein
[LDL], and normal triglycerides). This condition
is characterized by increased risk for premature
atherosclerosis and by the occurrence of
21. A 61-year-old woman with poorly controlled
Type II diabetes is seen in follow-up. Her blood
sugars are persistently elevated to levels
greater than 200 mg/dL. On examination, she
is obese, blood pressure 165/90 mm Hg, pulse
80/min, and there is sensory loss in the feet.
Which of the following fasting lipid profiles is
most likely to be consistent with her values?
(A)
(B)
(C)
(D)
(E)
high total cholesterol, low LDL, and
normal triglycerides
high total cholesterol, high LDL, low
triglycerides
high total cholesterol, normal LDL,
high triglycerides
high total cholesterol, low LDL, and
low triglycerides
high total cholesterol, high LDL, and
high triglycerides
22. A 26-year-old man is evaluated for back pain
and fatigue. He was previously healthy. On
examination, he is pale, there is lumber spine
tenderness, and an enlarged liver (18 cm). He is
pancytopenic, and there is a vertebral fracture on
lumbar x-rays. A bone marrow biopsy reveals
infiltration with lipid-laden macrophages
(Gaucher cells). Which of the following is the
most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
metachromatic leukodystrophy
inherited Gaucher’s disease
acquired Gaucher’s disease
glycogen storage disease
familial hyperchylomicronemia