MCQ Book Questions

Q60742. A 60-year-old man with small cell carcinoma of the lung is rushed to the emergency room in a coma after suffering a clonic-tonic seizure. The patient’s temperature is 37°C (98.6°F), blood pressure 100/50 mm Hg, and pulse 88 per minute. Lab- oratory studies show a serum sodium of 103 mmol/L, normal serum levels of BUN and creatinine, and a dilute but otherwise normal urine. A CT scan of the head is normal. Which of the following is the most likely cause of seizures in this patient?

Q60743. A 60-year-old woman with small cell carcinoma of the lung notes rounding of her face, upper truncal obesity, and muscle weakness. Physical examination reveals thin, wrinkled skin, abdominal striae, and multiple purpuric skin lesions. The patient’s blood pressure is 175/95 mm Hg. Laboratory studies will likely show elevated serum levels of which of the follow- ing hormones?

Q60744. A 21-year-old woman experiences abruptio placentae with severe bleeding during the delivery of a term fetus. Five months later, she presents with profound lethargy, pallor, mus- cle weakness, failure of lactation, and amenorrhea. Which of the following pathologic fi ndings is expected in this patient?

Q60745. A 25-year-old man presents with 3 months of polyuria and increased thirst. The patient suffered trauma to the base of the skull in a motorcycle accident 4 months ago. A 24-hour urine collection shows polyuria but no evidence of hematu- ria, glucosuria, or proteinuria. The pathogenesis of polyuria in this patient is most likely caused by a lesion in which of the following areas of the brain?

Q60746. A 48-year-old man presents with recurrent headaches and arthritic pain in his knees of 9 months in duration. He notes that his hat size has recently increased. He also states that he suffers from erectile dysfunction. His past medical history is signifi cant for kidney stones 2 years ago. Physical examination reveals a blood pressure of 170/100 mm Hg. The patient is observed to have coarse facial features and a goiter. Urinalysis reveals glu- cosuria and hypercalciuria. Which of the following is the most likely explanation for this patient’s clinical presentation?

Q60747. Why does the patient described in Question 11 suffer from erectile dysfunction?

Q60748. Physical examination of a neonate shows peculiar genitalia (shown in the image). Cytogenetic studies reveal a 46, XX karyotype. Laboratory studies will most likely reveal a defi - ciency of which of the following?

Q60749. A 35-year-old woman with a history of schizophrenia com- plains of headaches, visual disturbances, and irregular menses for 9 months. On physical examination the breasts are fi rm and tender. MRI shows enlargement of the anterior pituitary (arrow). Which of the following is the most likely cause of pituitary enlargement in this patient?

Q60750. A 55-year-old man complains of severe muscle weakness and drooping eyelids. He states that his symptoms worsen with repetitive movements but then resolve after a short rest. A chest X-ray reveals an anterior mediastinal mass. A biopsy of this mass would most likely reveal which of the following pathologic changes?

Q60751. A 45-year-old woman complains of tingling in her hands and feet, 24 hours after surgery to remove a thyroid follicular carcinoma. Her symptoms rapidly progress to severe muscle cramps, laryngeal stridor, and convulsions. Which of the fol- lowing laboratory fi ndings would be expected in this patient prior to treatment?

Q60752. A 6-month-old girl with Wiskott-Aldrich syndrome is brought to the emergency room shortly after spiking a fever of 38.7°C (103°F). The infant has a history of chronic respiratory infec- tions, gastrointestinal infections, petechiae, and eczema. This infant likely has which of the following associated birth defects?

Q60753. A female neonate with DiGeorge syndrome develops severe muscle cramps and convulsions soon after birth. Which of the following is the cause of convulsions in this neonate?

Q60754. In addition to parathyroid agenesis, the neonate described in Question 17 would be expected to have which of the follow- ing conditions?

Q60755. A 15-year-old boy with Albright hereditary osteodystrophy is rushed to the emergency room with severe muscle cramps and convulsions. The child has a history of mental retarda- tion. Laboratory studies reveal hypocalcemia and elevated blood levels of PTH. Which of the following distinguishes this patient’s endocrinopathy from hypoparathyroidism seen in DiGeorge syndrome?

Q60756. A 50-year-old woman presents with acute right fl ank pain of 72 hours in duration. Physical examination is unremarkable. Her temperature is 37°C (98.6°F), blood pressure 140/85 mm Hg, and pulse 85 per minute. A CBC is normal. Urinalysis reveals hematuria and urine cultures are negative. Imaging studies show stones in the right renal pelvis and ureter. This patient’s condition may be associated with which of the fol- lowing endocrine disorders?

Q60757. Laboratory evaluation of the patient described in Question 20 shows markedly elevated serum levels of calcium and PTH. A CT scan of the neck reveals a 3-cm mass on the posterior

Q60758. The infant described in Question 13 is shown to have an autosomal recessive genetic disorder. The infant is expected to manifest which of the following developmental anomalies?

Q60759. A 7-week-old infant develops severe dehydration and hypoten- sion and expires. The kidneys and adrenal glands at autopsy are shown in the image. Hypovolemic shock in this infant was most likely caused by inadequate synthesis of which of the following hormones?

Q60760. A 40-year-old woman with a history of hyperparathyroidism presents with a 2-month history of burning epigastric pain. The pain can be relieved with antacids or food. The patient also reports a recent history of tarry stools. She denies tak- ing aspirin or NSAIDs. Laboratory studies show a microcytic, hypochromic anemia (hemoglobin = 8.5 g/dL). Gastroscopy reveals a bleeding mucosal defect in the antrum. Which of the following best characterizes the pathogenesis of epigastric pain in this patient?

Q60761. The parents of a 4-week-old girl complain that their baby is apathetic and sluggish. On physical examination, the child’s abdomen is large and exhibits an umbilical hernia. The skin is pale and cold, and the temperature is 35°C (95°F). Which of the following provides a plausible explanation for the signs and symptoms of this child?