ID 3 exam MCQ.
101. Acromegaly is associated with which of the following factors?
A) Excessive cortisol secretion
B) Lack of adequate parathyroid hormone
C) Excessive growth hormone
D) Thyroid dysfunction
E) Excessive gastrin secretion
102. A 60-year-old woman is referred to your office for evaluation of hypercalcemia of
12.9 mg/dL. This was found incidentally on a chemistry panel that was drawn during a
hospitalization for cervical spondylosis. Despite fluid administration in the hospital, her
serum calcium at discharge was 11.8 mg/dL. The patient is asymptomatic. She is
otherwise in good health and has had her recommended age-appropriate cancer
screening. She denies constipation or bone pain and is now 8 weeks out from her spinal
surgery. Today, her serum calcium level is 12.4 mg/dL, and phosphate is 2.3 mg/dL.
Her hematocrit and all other chemistries including creatinine were normal. What is the
most likely diagnosis?
A. Breast cancer
B. Hyperparathyroidism
C. Hyperthyroidism
D. Multiple myeloma
E. Vitamin D intoxication
103. A 62-year-old man presents to a local emergency room complaining of chest
pressure and feeling “like my heart is fluttering inside my chest.” He experienced
similar symptoms 1 month ago that resolved spontaneously. He did not seek medical
attention at that time. He has no significant past medical history. On review of systems
he notes some recent weight loss and excessive sweating. He feels as though his appetite
has increased lately. His wife adds that he has recently taken some time off work due to
fatigue; despite his time off he has not been able to relax and has not been sleeping well.
On physical examination his heart rate is irregular at 140–150 beats/minute. Blood
pressure is 134/55 mmHg. He is admitted to the hospital and screening tests reveal an
undetectable thyroid-stimulating hormone level. Which of the following statements is
true?
A. 50% of hyperthyroid patients will convert from atrial fibrillation to
normal sinus rhythm with thyroid management alone.
B. A firm, small thyroid on physical examination would be compatible with a
diagnosis of Graves’ disease.
C. Atrial fibrillation is the most common cardiac manifestation of hyperthyroidism.
D. His excessive sweating is likely not related to hyperthyroidism.
E. Hyperthyroidism leads to a high-output state for the heart, and narrowing pulse
pressure.
104. The patient described above is started on atenolol and his heart rate slows to 80
1
,ID 3 exam MCQ.
beats/min. Which of the following additional therapies is indicated?
2
,ID 3 exam MCQ.
A. Diltiazem
B. Itraconazole
C. Liothyronine
D. Methimazole
E. Phenoxybenzamine
105. Which of the following statements regarding autoimmune hypothyroidism is true?
A. 10% of 40- to 60-year-old adults have subclinical hypothyroidism.
B. Absence of a goiter makes autoimmune hypothyroidism unlikely.
C. Family history of autoimmune disorders does not significantly increase risk.
D. It is more common in the Pacific Rim where diets are lower in iodine.
E. Viral thyroiditis does not induce subsequent autoimmune thyroiditis.
106. You are researching a cell line with an altered membrane structure that makes the
cell membrane impermeable to extracellular molecules of all size and charge. You
then expose the cell line to varying concentrations of various hormones. Of the
following hormones, which one should no longer exert an effect on this cell line?
A. Dopamine
B. Gonadotropin-releasing hormone
C. Insulin
D. Vitamin D
107. In regard to Graves’ disease, which of the following is true?
A. It accounts for >90% of all causes of thyrotoxicosis.
B. It occurs in 2% of women.
C. It typically occurs in patients between 50 and 60 years of age.
D. Populations with a low iodine intake have an increased prevalence.
E. There is an equal male-to-female prevalence.
108. A 16-year-old male is brought to your clinic by his parents due to concern about his
weight. He has not seen a physician for many years. He states that he has gained weight
due to inactivity and that he is less active because of exertional chest pain. He takes no
medications. He was adopted and his parents do not know the medical history of his
biologic parents. Physical examination is notable for Stage 1 hypertension and body
mass index of 30 kg/ m2. He has xanthomas on his hands, heels, and buttocks.
Laboratory testing shows a low-density lipoprotein (LDL) of 210 mg/dL, creatinine of
0.7 mg/dL, total bilirubin of 3.1 mg/dL, haptoglobin <6 mg/dL, and a glycosylated
hemoglobin of 6.7%. You suspect a hereditary lipoproteinemia due to the clinical and
laboratory findings. Which test would be diagnostic of the primary lipoprotein disorder
in this patient?
A. Congo red staining of xanthoma biopsy
B. CT scan of the liver
C. Family pedigree analysis
D. Gas chromatography
3
, ID 3 exam MCQ.
E. LDL receptor function in skin biopsy
109. A 35 year-old woman presents with amenorrhea over the past 4 months. She has
been trying to get pregnant without success. She complains of a thin milky discharge
from her nipples and over the past several days has noted some blurry vision. On
laboratory testing, her prolactin level is 110 g/L (normal: 5–20 g/L). A head MRI is
performed and reveals an 11-mm pituitary macroadenoma. What is the next step in
management?
A. Follow visual fields; if worse in 1 month, refer for surgery.
B. Reassure the patient and follow-up closely.
C. Refer for urgent neurosurgery.
D. Repeat MRI in 4 months.
E. Do visual field testing and initiate a dopamine agonist.
110. A 38-year-old woman presents to her primary care doctor complaining of fatigue
and irritability. She thinks these symptoms have been worsening over a period of
several months. She has a history of mild intermittent asthma and hypertriglyceridemia.
Physical examination reveals a resting heart rate of 105 beats/min, blood pressure of
136/72 mmHg, bilateral proptosis and warm, moist skin. Screening tests are sent and
reveal a thyroid-stimulating hormone (TSH) level that is undetectable and a normal
unbound T4. What should be the next step in diagnosis?
A. Radionuclide scan of the thyroid
B. Thyroid-stimulating antibody screen
C. Thyroid peroxidase (TPO) antibody screen
D. Total T4
E. Unbound T3
111. Which of the following statements regarding hormone release from the anterior
pituitary is true?
A. All hormones are released in a pulsatile manner.
B. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release are
suppressed prior to puberty and after menopause.
C. Somatostatin acts in a feedback loop to inhibit adrenocorticotropin hormone (ACTH)
release.
D. Thyroid-stimulating hormone (TSH) is released primarily at night.
E. With the exception of prolactin, none of the anterior pituitary hormones are present
in a fetus until week 28 of gestation.
112. In the management of diabetic ketoacidosis:
a. Intracellular water deficit is best restored using half
strength saline [0.45%saline]
b. Potassium should be given even before checking the
4
101. Acromegaly is associated with which of the following factors?
A) Excessive cortisol secretion
B) Lack of adequate parathyroid hormone
C) Excessive growth hormone
D) Thyroid dysfunction
E) Excessive gastrin secretion
102. A 60-year-old woman is referred to your office for evaluation of hypercalcemia of
12.9 mg/dL. This was found incidentally on a chemistry panel that was drawn during a
hospitalization for cervical spondylosis. Despite fluid administration in the hospital, her
serum calcium at discharge was 11.8 mg/dL. The patient is asymptomatic. She is
otherwise in good health and has had her recommended age-appropriate cancer
screening. She denies constipation or bone pain and is now 8 weeks out from her spinal
surgery. Today, her serum calcium level is 12.4 mg/dL, and phosphate is 2.3 mg/dL.
Her hematocrit and all other chemistries including creatinine were normal. What is the
most likely diagnosis?
A. Breast cancer
B. Hyperparathyroidism
C. Hyperthyroidism
D. Multiple myeloma
E. Vitamin D intoxication
103. A 62-year-old man presents to a local emergency room complaining of chest
pressure and feeling “like my heart is fluttering inside my chest.” He experienced
similar symptoms 1 month ago that resolved spontaneously. He did not seek medical
attention at that time. He has no significant past medical history. On review of systems
he notes some recent weight loss and excessive sweating. He feels as though his appetite
has increased lately. His wife adds that he has recently taken some time off work due to
fatigue; despite his time off he has not been able to relax and has not been sleeping well.
On physical examination his heart rate is irregular at 140–150 beats/minute. Blood
pressure is 134/55 mmHg. He is admitted to the hospital and screening tests reveal an
undetectable thyroid-stimulating hormone level. Which of the following statements is
true?
A. 50% of hyperthyroid patients will convert from atrial fibrillation to
normal sinus rhythm with thyroid management alone.
B. A firm, small thyroid on physical examination would be compatible with a
diagnosis of Graves’ disease.
C. Atrial fibrillation is the most common cardiac manifestation of hyperthyroidism.
D. His excessive sweating is likely not related to hyperthyroidism.
E. Hyperthyroidism leads to a high-output state for the heart, and narrowing pulse
pressure.
104. The patient described above is started on atenolol and his heart rate slows to 80
1
,ID 3 exam MCQ.
beats/min. Which of the following additional therapies is indicated?
2
,ID 3 exam MCQ.
A. Diltiazem
B. Itraconazole
C. Liothyronine
D. Methimazole
E. Phenoxybenzamine
105. Which of the following statements regarding autoimmune hypothyroidism is true?
A. 10% of 40- to 60-year-old adults have subclinical hypothyroidism.
B. Absence of a goiter makes autoimmune hypothyroidism unlikely.
C. Family history of autoimmune disorders does not significantly increase risk.
D. It is more common in the Pacific Rim where diets are lower in iodine.
E. Viral thyroiditis does not induce subsequent autoimmune thyroiditis.
106. You are researching a cell line with an altered membrane structure that makes the
cell membrane impermeable to extracellular molecules of all size and charge. You
then expose the cell line to varying concentrations of various hormones. Of the
following hormones, which one should no longer exert an effect on this cell line?
A. Dopamine
B. Gonadotropin-releasing hormone
C. Insulin
D. Vitamin D
107. In regard to Graves’ disease, which of the following is true?
A. It accounts for >90% of all causes of thyrotoxicosis.
B. It occurs in 2% of women.
C. It typically occurs in patients between 50 and 60 years of age.
D. Populations with a low iodine intake have an increased prevalence.
E. There is an equal male-to-female prevalence.
108. A 16-year-old male is brought to your clinic by his parents due to concern about his
weight. He has not seen a physician for many years. He states that he has gained weight
due to inactivity and that he is less active because of exertional chest pain. He takes no
medications. He was adopted and his parents do not know the medical history of his
biologic parents. Physical examination is notable for Stage 1 hypertension and body
mass index of 30 kg/ m2. He has xanthomas on his hands, heels, and buttocks.
Laboratory testing shows a low-density lipoprotein (LDL) of 210 mg/dL, creatinine of
0.7 mg/dL, total bilirubin of 3.1 mg/dL, haptoglobin <6 mg/dL, and a glycosylated
hemoglobin of 6.7%. You suspect a hereditary lipoproteinemia due to the clinical and
laboratory findings. Which test would be diagnostic of the primary lipoprotein disorder
in this patient?
A. Congo red staining of xanthoma biopsy
B. CT scan of the liver
C. Family pedigree analysis
D. Gas chromatography
3
, ID 3 exam MCQ.
E. LDL receptor function in skin biopsy
109. A 35 year-old woman presents with amenorrhea over the past 4 months. She has
been trying to get pregnant without success. She complains of a thin milky discharge
from her nipples and over the past several days has noted some blurry vision. On
laboratory testing, her prolactin level is 110 g/L (normal: 5–20 g/L). A head MRI is
performed and reveals an 11-mm pituitary macroadenoma. What is the next step in
management?
A. Follow visual fields; if worse in 1 month, refer for surgery.
B. Reassure the patient and follow-up closely.
C. Refer for urgent neurosurgery.
D. Repeat MRI in 4 months.
E. Do visual field testing and initiate a dopamine agonist.
110. A 38-year-old woman presents to her primary care doctor complaining of fatigue
and irritability. She thinks these symptoms have been worsening over a period of
several months. She has a history of mild intermittent asthma and hypertriglyceridemia.
Physical examination reveals a resting heart rate of 105 beats/min, blood pressure of
136/72 mmHg, bilateral proptosis and warm, moist skin. Screening tests are sent and
reveal a thyroid-stimulating hormone (TSH) level that is undetectable and a normal
unbound T4. What should be the next step in diagnosis?
A. Radionuclide scan of the thyroid
B. Thyroid-stimulating antibody screen
C. Thyroid peroxidase (TPO) antibody screen
D. Total T4
E. Unbound T3
111. Which of the following statements regarding hormone release from the anterior
pituitary is true?
A. All hormones are released in a pulsatile manner.
B. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release are
suppressed prior to puberty and after menopause.
C. Somatostatin acts in a feedback loop to inhibit adrenocorticotropin hormone (ACTH)
release.
D. Thyroid-stimulating hormone (TSH) is released primarily at night.
E. With the exception of prolactin, none of the anterior pituitary hormones are present
in a fetus until week 28 of gestation.
112. In the management of diabetic ketoacidosis:
a. Intracellular water deficit is best restored using half
strength saline [0.45%saline]
b. Potassium should be given even before checking the
4
