MCQ Book Questions

Q60762. A 55-year-old man who is on dialysis because of end-stage renal disease complains of pain in his jaw and left arm for 6 months. An X-ray of the left arm reveals multiple, small bone cysts and pathologic fractures. What is the appropriate diag- nosis for this patient’s bone lesions?

Q60763. A 46-year-old woman complains of increasing fatigue and mus- cle weakness over the past 6 months. She reports an inability to concentrate at work and speaks with a husky voice. The patient denies drug or alcohol abuse. Physical examination reveals cold and clammy skin, coarse and brittle hair, boggy face with puffy eyelids, and peripheral edema. There is no evidence of goiter or exophthalmos. Laboratory studies show reduced serum levels of T3 and T4. Which of the following is the most likely under- lying cause of these signs and symptoms?

Q60764. A 72-year-old woman with a long history of diabetes type 2 presents with abdominal pain. Physical examination reveals neuromuscular weakness and hypertension. Laboratory stud- ies show markedly elevated levels of serum calcium and PTH. A surgical exploration of the patient’s neck demonstrates four symmetrically enlarged parathyroid glands. This patient’s endocrinopathy may be caused by which of the following underlying disorders?

Q60765. Five years later, the patient described in Question 30 returns with symptoms of hyperthyroidism. Which of the follow- ing best summarizes the clinical symptoms expected in this patient?

Q60766. A 32-year-old woman presents with a solitary, nontender, fi rm nodule on the left side of her neck. Thyroid function tests are within normal limits. A fi ne-needle biopsy reveals malignant cells. The tumor is excised and examined by light microscopy (shown in the image). What is the appropriate pathologic diagnosis?

Q60767. A 65-year-old woman with a history of multinodular goi- ter complains of increasing nervousness, insomnia, and heart palpitations. She has lost 9 kg (20 lb) over the past 6 months. Physical examination reveals a diffusely enlarged thyroid. There is no evidence of exophthalmos. Laboratory studies show elevated serum levels of T3 and T4. Serologic tests for antithyroid antibodies are negative. Which of the following is an important complication of this patient’s endocrinopathy?

Q60768. A 40-year-old woman complains of chronic constipation and anovulatory cycles for the last 8 months. Her vital signs are normal. Physical examination reveals peripheral edema and a fi rm, diffusely enlarged thyroid gland. Serum levels of T3 and T4 are abnormally low. A thyroid biopsy is shown in the image. What is the appropriate diagnosis?

Q60769. A 33-year-old woman presents with a swelling in her neck, which she fi rst noticed 2 months ago. Physical examination reveals a solitary, nontender nodule of the thyroid gland mea- suring 2 cm in diameter. Thyroid function tests are within normal limits. The nodule does not accumulate 125Iodine on thyroid scintiscan. A biopsy of the nodule is shown in the image. Which of the following is the most likely diagnosis?

Q60770. A 36-year-old woman presents with swelling in her neck that she fi rst noticed 3 months ago. She also complains of inter- mittent watery diarrhea over the same time period. Physical examination reveals a nontender nodule in the left lobe of the thyroid. The patient’s mother died of thyroid cancer 8 years ago. The thyroid nodule is found to be “cold” by radioiodine scintiscan. A needle biopsy of the nodule reveals malignant cells and homogeneous eosinophilic material (shown in the image). Laboratory studies would likely show elevated blood levels of which of the following hormones in this patient?

Q60771. A 33-year-old woman complains of swelling in the anterior portion of her neck, which she fi rst noticed 8 months ago. Except for some discomfort during swallowing and hoarse- ness, the patient does not report any symptoms. Physical examination reveals a stony, hard thyroid gland that is adher- ent to other neck structures. A thyroid biopsy is shown in the image. The pathologist reports that the thyroid parenchyma is replaced by dense, hyalinized fi brous tissue and a chronic infl ammatory infi ltrate. What is the appropriate diagnosis?

Q60772. A 29-year-old woman complains of nervousness and muscle weakness of 6 months in duration. She is intolerant of heat and sweats excessively. She has lost 9 kg (20 lb) pounds over the past 6 months, despite increased caloric intake. She frequently fi nds her heart racing and can feel it pounding in her chest. She also states that she has missed several menstrual periods over the past few months. Physical examination reveals warm and moist skin and bulging eyes (exophthalmos). Laboratory studies will likely reveal which of the following endocrine abnormalities in this patient?

Q60773. A 4-year-old girl is brought to the pediatric clinic by her mother who reports that her daughter has decreased appetite, lethargy, and an enlarging belly. Physical examination reveals a large, fi rm, irregular, nontender mass in the child’s abdomen. A CT-guided biopsy reveals neoplastic “small blue cells.” The child’s malignant neoplasm is removed and the surgical speci- men is shown in the image. Which of the following laboratory tests would be useful in monitoring this patient for recurrence of disease?

Q60774. Genetic analysis of tumor cells taken from the patient described in Question 41 may reveal which of the following mutations?

Q60775. A 45-year-old man with a recent history of bizarre behavior is seen by a psychiatrist, who recommends evaluation of his endocrine status. On physical examination, the patient appears moderately obese (BMI = 31 kg/m2), with mild hypertension, facial acne, fat accumulation in the supraclavicular fossae, and a protuberant abdomen. Laboratory studies demonstrate a neutrophilic leukocytosis, with a decrease in the percentage of lymphocytes and an absence of eosinophils. The hematocrit and hemoglobin are normal. There is a mild hypokalemia and mild metabolic alkalosis. The fasting serum glucose is within the reference range, but on a 2-hour glucose tolerance test, both the 60- and 120-minute samples had glucose concen- trations greater than 200 mg/dL. Laboratory studies show free urinary cortisol of 156 mg per 24 hours (normal = 10 to

Q60776. The tumor in the patient described in Question 38 is removed, and a section stained with Congo red reveals birefringent amy- loid stroma. Genetic studies show that this patient has a famil- ial cancer syndrome. In addition to hyperparathyroidism, the patient is advised that she is at risk of developing which of the following neoplastic diseases?

Q60777. A 45-year-old man presents with swelling in the anterior por- tion of his neck. Physical examination reveals an enlarged nodular thyroid. Thyroid function tests are within normal limits. A thyroid scintiscan shows a dominant “hot” nodule. A biopsy of this nodule reveals neoplastic cells with evidence of vascular and capsular invasion (shown in the image). X-rays demonstrate distant bony metastases. What is the most likely diagnosis?

Q60778. A 55-year-old obese woman (body mass index = 33 kg/m2) complains of declining visual acuity. Funduscopic examina- tion shows peripheral retinal microaneurysms. Urinalysis reveals 3+ proteinuria and 3+ glucosuria. Serum albumin is 3 g/dL, and serum cholesterol is 350 mg/dL. These clinico- pathologic fi ndings are best explained by which of the follow- ing mechanisms of disease?

Q60779. A 61-year-old man presents with a 5-year history of pain in both legs during exercise. He has been treated for diabetes for 8 years. His fasting blood glucose is 280 mg/dL. Which of the following best explains the pathogenesis of leg pain in this patient?

Q60780. A 60-year-old man with diabetes mellitus complains of deep burning pain and sensitivity to touch over his hands and fi ngers. Nerve conduction studies show slow transmission of impulses and diminished muscle stretch refl exes in the ankles and knees. Sensations to vibrations and light touch are also markedly diminished. The development of polyneuropathy in this patient correlates best with which of the following conditions?

Q60781. A 14-year-old boy presents for a presummer camp physical examination. Routine urinalysis discloses 3+ glucosuria. He admits to thirst and frequent urination, accompanied by a 4-kg (9-lb) weight loss over the past few months. His parents note that he had a fl u-like illness 5 months ago. His blood glucose is 220 mg/dL. Which of the following best explains the pathogenesis of hyperglycemia in this patient?