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PATHOPHYSIOLOGY
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Homework for Chapter 19 - Alterations of Hormonal Regulation
Instructions:
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Use your lecture notes and textbook to find the answers to these questions.
When finished, enter your answers on the electronic version of the homework posted on
Canvas.
You may do this up to three times until you are happy with your grade.
1. Syndrome of inappropriate antidiuretic hormone (SIADH) results in excessive:
A) renal retention of sodium and water.
B) renal retention of sodium without water retention.
C) renal retention of water without sodium retention.
D) renal excretion of water without sodium retention.
2. Neurological symptoms of SIADH are related to:
A) hypotension and cellular dehydration.
B) decreased serum sodium concentrations.
C) increased serum osmolarity.
D) hypokalemia.
3. Damage to the posterior pituitary caused by a cerebrovascular accident (stroke) results in _____
diabetes insipidus (DI).
A) vascular
B) nephrogenic
C) psychogenic
D) neurogenic
4. Classic symptoms of diabetes insipidus (DI) include all of the following except:
A) hypertension.
B) dehydration.
C) low urine osmolarity.
D) thirst.
5. In adults, the most serious consequence of panhypopituitarism is the loss of:
A) growth hormone.
B) luteinizing hormone (LH).
C) adrenocorticotropic hormone (ACTH).
D) thyroid-stimulating hormone (TSH).
6. Acromegaly is caused by increased secretion of:
A) prolactin.
B) growth hormone.
C) insulin.
D) glucocorticoids.
7. Prolactinomas (pituitary tumors that secrete prolactin) cause which of the following problems in women?
A) Heavy menstrual periods
B) Ectopic pregnancy
C) Breast milk production without pregnancy
D) Hair loss
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8. A clinician would suspect thyrotoxicosis if a patient presented with which of the following symptoms?
A) Confusion and gait disturbances
B) Weight loss and enlarged thyroid gland
C) Slow tendon reflexes and muscle stiffness
D) Peripheral edema and dry skin
9. Graves disease is characterized by:
A) ectopic secretion of thyroid hormone by a tumor.
B) excessive production of circulating thyroid-stimulating immunoglobulin.
C) autoimmune destruction of the thyroid gland.
D) injury to the pituitary, resulting in decreased thyroid-stimulating hormone secretion.
10. In Graves disease, accumulation of edema in the orbit can lead to:
A) optic nerve damage.
B) eye muscle palsies.
C) exophthalmos.
D) all of the above.
11. The level of thyroid-stimulating hormone (TSH) in Graves disease is:
A) low.
B) high.
C) normal.
D) variable.
12. The physiologic stress of illness or surgery can induce a severe response in individuals who have
unrecognized and untreated thyrotoxicosis. The pathophysiology of thyroid storm, also known as
thyrotoxic crisis, involves:
A) hypotension and bradycardia leading to shock.
B) pulmonary edema and bronchoconstriction leading to respiratory arrest.
C) hypercoagulability and formation of deep vein thromboses leading to pulmonary emboli.
D) fever and tachycardia leading to high-output heart failure.
13. Signs and symptoms of hypothyroidism include all of the following EXCEPT:
A) weight gain.
B) diarrhea.
C) myxedema.
D) lethargy.
14 The thyroid gland of a person with low levels of thyroid hormone is likely to be:
A) smaller than normal.
B) larger than normal.
C) of normal size.
D) all of the above could occur.
15. The most common cause of primary hypothyroidism in adults is:
A) bacterial infection of the thyroid gland.
B) viral infection of the thyroid gland.
C) congenital hypothyroidism.
D) autoimmune thyroiditis.
16. Causes of myxedema coma include:
A) untreated hypothyroidism.
B) subclinical hyperthyroidism.
C) thyroid storm.
D) a reaction to abnormally high levels of thyroid autoantibodies.
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17. If left untreated, congenital hypothyroidism results in:
A) hyperactivity and attention deficit disorder.
B) increased risk of childhood thyroid cancer.
C) mental retardation and stunted growth.
D) liver, kidney, and pancreas failure.
18. Thyroid carcinoma usually presents with the following thyroid tissue changes:
A) small nodules.
B) elevated T3 and T4.
C) large, diffuse goiter.
D) thyroid gland atrophy.
19. Chronic hyperparathyroidism will lead to all of the following conditions except:
A) osteopenia.
B) renal calculi (stones).
C) weight loss.
D) pathologic bone fractures.
20. Which of the following disorders can cause secondary hyperparathyroidism?
A) Chronic renal failure
B) Primary hyperparathryroidism
C) A pituitary tumor
D) Graves disease
21. The most common cause of hypoparathyroidism is:
A) hypothalamic inactivity.
B) pituitary hyposecretion.
C) parathyroid adenoma.
D) parathyroid gland injury or removal.
22. Signs and symptoms common to both type 1 and type 2 diabetes mellitus (DM) include all of the
following EXCEPT:
A) polyphagia.
B) weight loss.
C) polydipsia.
D) polyuria.
23. The pathophysiology of type 1 diabetes mellitus (DM) involves:
A) autoimmune destruction of pancreatic beta cells.
B) production of antibodies against insulin.
C) type IV hypersensitivity against pancreatic islet cells.
D) all of the above.
24. Hyperglycemia and lipid abnormalities in type 2 diabetes mellitus (DM) are a result of:
A) production of inactive insulin.
B) glucagon deficiency.
C) insulin resistance.
D) glycogen excess.
25. The development of an acute metabolic acidosis from insulin deficiency is due to which of the
following processes?
A) Protein catabolism with ammonia release
B) Anaerobic metabolism of glucose
C) Fatty acid metabolism with ketone production
D) Renal failure
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26. What effect does the presence of advanced glycosylation end products (AGEs) have in diabetes?
A) Increased ketone formation
B) Cellular injury
C) Dawn phenomenon
D) Reduction of chronic complications
27. Alterations in lipid and protein metabolism lead to chronic complications of DM through which of the
following processes?
A) Activation of protein kinase C
B) Induction of the polyol pathway
C) Glycosylation
D) All of the above
28. Chronic complications of DM include which of the following?
A) Peripheral neuropathies
B) End-stage renal disease
C) Coronary artery disease
D) All of the above
29. Cushing disease is commonly caused by:
A) autoimmune destruction of the adrenal cortex.
B) excessive production of ACTH from a pituitary tumor.
C) excessive production of cortisol from a tumor in the adrenal cortex.
D) excessive production of aldosterone from a tumor in the adrenal cortex.
30. Which of the following alterations would you expect to find in a patient with untreated Cushing
disease or syndrome?
A) Weight loss
B) Pale skin
C) Truncal obesity
D) Low blood pressure
31. Which of the following problems arises from primary hyperaldosteronism?
A) Hypertension
B) Hyperglycemia
C) Hyperkalemia
D) Hyponatremia
32. Metabolic abnormalities in Addison disease include all of the following except:
A) hyperkalemia.
B) hyponatremia.
C) hypoglycemia.
D) hypercalcemia.
33. The most common cause of Addison disease is:
A) adrenal cancer.
B) autoimmune injury to the adrenal cortex.
C) viral infection of the pituitary gland.
D) bacterial infection of the adrenal medulla.
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Critical Thinking Questions
34. An endocrinologist orders a series of lab tests to assess thyroid function. Low levels of thyroid
hormone (T3 and T4) and high levels of thyroid-stimulating hormone (TSH) are indicative of:
A) primary hypothyroidism.
B) secondary hypothyroidism.
C) primary hyperthyroidism.
D) secondary hyperthyroidism.
35. Which of the following conditions is made more severe by a deficiency of thyroid hormone?
A) diabetes mellitus
B) hypertension
C) kidney disease
D) atherosclerosis
36. A 64-year-old man with type 2 diabetes is brought to the hospital in a coma. All of the following are
likely to be present EXCEPT:
A) high levels of glucose in the blood
B) dehydration
C) acidosis
D) low blood pressure
37. Which of the following lab results would be most characteristic of a patient with Addison disease?
A) high levels of ACTH, cortisol, and aldosterone
B) low levels of ACTH, cortisol, and aldosterone
C) high levels of ACTH and low levels of cortisol and aldosterone
D) low levels of ACTH and high levels of cortisol and aldosterone
38. Patients with Cushing syndrome often exhibit insulin resistance. This would cause which of the
following?
A) high serum potassium and sodium levels
B) abnormal results on a glucose tolerance test (GTT)
C) high blood pressure readings
D) muscle weakness and bone loss