Internal-Medicine

62 3: Endocrinology
62. A 21-year-old woman on no medications develops
rigidity, tremor, and incoordination. She
has a history of unexplained hepatitis 2 years
ago and depression 1 year ago. Her examination
is pertinent for increased tone, normal muscle
strength, and coarse tremor of the hands. An
ophthalmologic examination is positive for a
brownish pigmented ring at the corneal margin.
Which of the following findings is most likely to
be present in this patient? (See Fig. 3–6.)
(A)
(B)
(C)
(D)
(E)
renal failure
cirrhosis of the liver
elevated ceruloplasmin
sensory loss
increased plasma copper
65. Which of the following is the most likely metabolic
effect of insulin on adipose tissue?
(A)
(B)
(C)
(D)
(E)
decrease of glucose transport
decrease in glucose phosphorylation
decrease in lipolysis
decrease in lipoprotein lipase
enhancement of glucagon effect
66. A 32-year-old woman presents with heat intolerance,
palpitations, diarrhea, weakness, and
weight loss. Her blood pressure is 90/60 mm Hg,
pulse 110/min, and she has a fine tremor in her
hands. The TSH level is suppressed and T3 and
T4 are elevated. Which of the following is most
likely to precipitate this condition?
(A)
(B)
(C)
(D)
(E)
propylthiouracil administration
high-dose prednisone therapy
beta-adrenergic blockade
pneumonia
salicylate administration
67. A 15-year-old youth has not gone through
puberty. Which of the following is the most
likely diagnosis?
63. A 57-year-old man complains of increased thirst
and urination. His examination is normal except
for obesity (BMI>30). Which of the following is
the most appropriate initial diagnostic test?
(A)
(B)
(C)
(D)
(E)
a urine osmolality
hemoglobin A1C level
a fasting blood sugar (FBS)
a glucose tolerance test (GTT)
random glucose
64. Which of the following is the most likely effect
of insulin at the cellular receptor level?
(A)
(B)
(C)
(D)
(E)
Figure 3–6.
stimulating tyrosine kinase
binding to ion channels
binding to intracellular erb A receptors
stimulating guanylate cyclase
activating G-proteins
(A)
(B)
(C)
(D)
(E)
inadequate diet
normal variation
pituitary tumor
Leydig cell dysfunction
drug side effects
68. A 44-year-old woman is recently diagnosed
with breast cancer and undergoes a mastectomy.
Which of the following features is most
likely to be important in determining response
to tamoxifen therapy?
(A) metastases confined to liver
(B) patient more than 5 years
premenopausal
(C) androgen receptors on the tumor cell
membrane
(D) tumor has progesterone receptors (PR)
(E) metastases confined to brain