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Question 1
A 30-year-old woman, who has two healthy children, notes that she has had
no menstrual periods for the past 6 months, but she is not pregnant and
has been taking no medications. Within the past week, she has noted some
milk production from her breasts. She has been bothered by headaches for
the past 3 months. After nearly hitting a bus while changing lanes driving
her vehicle, she is concerned with her vision and visits an optometrist,
who finds her lateral vision to be reduced. On physical examination she
is afebrile and normotensive. Which of the following laboratory test
findings is most likely to be present in this woman?
A
Increased serum cortisol
B
Lack of growth hormone suppression
C
Increased serum alkaline phosphatase
D
Hyperprolactinemia
E
Hyponatremia
F
Abnormal glucose tolerance test
G
Decreased serum TSH
Question 2
A 28-year-old woman has had difficulty concentrating on her job at work
for the past month. She is constantly getting up and walking around to
visit co-workers. She complains that the work area is too hot. She seems
nervous and spills her coffee a lot. She has been eating more but has lost
5 kg in the past month. On physical examination her temperature is 37.5
C, pulse 101/minute, respiratory rate 18/minute, and blood pressure
145/85 mm Hg. Which of the following laboratory findings is most likely
to be present in this woman?
A
Decreased plasma insulin
B
Decreased TSH
C
Decreased iodine uptake
D
Increased ACTH
E
Increased calcitonin
F
Decreased catecholamines
Question 3
A 19-year-old previously healthy woman has had a mild pharyngitis followed
by a high fever over the past 24 hours. When seen in the emergency room,
her skin now shows extensive areas of purpura. Vital signs include T 39
C, P 102/minute, RR 21/minute, and BP 80/55 mm Hg. Laboratory studies show
a serum sodium of 115 mmol/L, potassium 5.3 mmol/L, chloride 92 mmol/L,
CO2 22 mmol/L, glucose 42 mg/dL, and creatinine 1.1 mg/dL. Which of the
following is the most likely diagnosis?
A
Idiopathic adrenalitis
B
Disseminated tuberculosis
C
Reactive systemic amyloidosis
D
Sheehan syndrome
E
Meningococcemia
F
Hemochromatosis
Question 4
A 40-year-old woman has noted enlargement of her anterior neck region over
the past 8 months. On physical examination her vital signs include T 36.8
C, P 64/minute, RR 15/minute, and BP 155/105 mm Hg. There is diffuse,
symmetrical thyroid enlargement without tenderness. A chest radiograph
is normal. Fine needle aspiration of the thyroid yields cells that are
consistent with a neoplasm. Laboratory studies show that she is euthyroid,
but her serum ionized calcium is elevated. She is taken to surgery, and
a thyroidectomy is performed, after frozen sections of several thyroid
masses show a malignant neoplasm composed of polygonal cells in nests.
Immunostaining for calcitonin of the permanent sections is positive, and
the neoplasm has an amyloid stroma with Congo red staining. Which of the
following neoplasms is she most likely to have?
A
Anaplastic carcinoma
B
Medullary carcinoma
C
Papillary thyroid carcinoma
D
Metastatic renal cell carcinoma
E
Parathyroid carcinoma
F
Follicular carcinoma
Question 5
A 38-year-old man sees his physician because of abdominal pain, nausea,
and constipation for the past 3 days. On physical examination he has no
palpable abdominal masses and bowel sounds are present. His lungs are
clear to auscultation. He has a heart rate of 80 with an irregular rhythm.
An electrocardiogram demonstrates a shortened QT(corrected) interval and
a prolonged PR interval. He has a stool positive for occult blood. Upper
GI endoscopy reveals multiple 1 cm diameter shallow ulcerations of the
gastric antrum. Which of the following laboratory test findings is most
likely to be present in this man?
A
Thyroid peroxidase antibody of 4 IU/mL
B
Serum calcium of 12.4 mg/dL
C
Blood glucose of 225 mg/dL
D
Total serum thyroxine of 21 ng/mL
E
Plasma cortisol of 45 microgm/dL at 8 am
F
Urine normetanephrine of 692 microgm/gm of creatinine
G
Plasma renin activity (upright) of 6.8 ng/mL/hr
Question 6
A 55-year-old woman has had a 4 kg weight loss over the past 3 months.
She exhibits decreased mentation over the past 10 days. On physical
examination she is afebrile and hypotensive. Bilateral papilledema is
noted. A head CT scan shows marked diffuse cerebral edema with effacement
of the lateral ventricles. Laboratory studies show a sodium of 108 mmol/L,
potassium 4.0 mmol/L, chloride 83 mmol/L, CO2 14 mmol/L, glucose 82 mg/dL,
and creatinine 0.5 mg/dL. Which of the following is most likely to cause
these findings?
A
Small cell lung carcinoma
B
Blunt head trauma
C
Hypothalamic glioma
D
Meningitis
E
Pituitary macroadenoma
Question 7
A 29-year-old primigravida who received no prenatal care has marked
vaginal bleeding after the onset of labor at 38 weeks gestation. Cesarean
section is performed and a lacerated low-lying placenta is removed. She
remains hypotensive for 6 hours and requires transfusion of 12 packed RBC
units. Postpartum, she becomes unable to breast-feed the infant. She does
not have a resumption of normal menstrual cycles. She becomes more
sluggish and tired. Laboratory findings include hyponatremia,
hyperkalemia, and hypoglycemia. Which of the following pathologic lesions
is she most likely to have had following delivery?
A
Bilateral adrenal hemorrhage
B
Pituitary necrosis
C
Subacute thyroiditis
D
Metastatic choriocarcinoma
E
Insulitis
Question 8
A 58-year-old man with a history of diabetes mellitus has noted the
presence of bone pain, especially of his hands, for the past 6 months.
On physical examination there is no swelling or redness of his hands, no
joint deformity, but the range of motion is slightly decreased. Laboratory
studies show sodium 139 mmol/L, potassium 4.0 mmol/L, chloride 98 mmol/L,
C02 22 mmol/L, glucose 153 mg/dL, creatinine 7.8 mg/dL, calcium 7.8 mg/dL,
phosphorus 5.7 mg/dL, total protein 6.2 g/dL, and albumin 4.0 g/dL. Which
of the following conditions is this man most likely to have?
A
Adrenal adenoma
B
Medullary thyroid carcinoma
C
Extra-adrenal pheochromocytoma
D
Parathyroid hyperplasia
E
Pituitary adenoma
Question 9
A 49-year-old woman has had increasing cold intolerance, weight gain of
4 kg, and sluggishness over the past two years. A physical examination
reveals dry, coarse skin and alopecia of the scalp. Her thyroid is not
palpably enlarged. Her serum TSH is 11.7 mU/L with thyroxine of 2.1
micrograms/dL. A year ago, anti-thyroglobulin and anti-microsomal
autoantibodies were detected at high titer. Which of the following thyroid
diseases is she most likely to have?
A
DeQuervain disease
B
Papillary carcinoma
C
Hashimoto thyroiditis
D
Nodular goiter
E
Graves disease
Question 10
A clinical study is performed with subjects who were diagnosed with
hyperthyroidism, compared with a control group of subjects who were
euthryoid. The pathologic findings in the thyroid glands of these subjects
are analyzed to determine the spectrum of disease processes present. Which
of the following pathologic processes is most likely to be found with equal
frequency in both the study and the control subjects?
A
Subacute granulomatous thyroiditis
B
Multinodular goiter
C
Medullary carcinoma
D
Hashimoto thyroiditis
E
Follicular adenoma
Question 11
A 48-year-old woman has experienced constant back pain exacerbated by
movement over the past month. She reports increasing weakness over the
past 3 months. On physical examination her blood pressure of 165/110 mm
Hg. She is mildly obese with a BMI of 28. A radiograph of the spine reveals
a compressed fracture at T10. Laboratory findings include a serum glucose
of 155 mg/dL. Which of the following pathologic lesions is most likely
to explain her findings?
A
Adrenal cortical carcinoma
B
Anaplastic thyroid carcinoma
C
Empty sella syndrome
D
Pheochromocytoma
E
Multinodular goiter
Question 12
A 33-year-old woman has noted a weight gain of 6 kg over the past year.
She has normal menstrual periods. On physical examination her blood
pressure is 170/105 mm Hg. A serum electrolyte panel shows sodium 141
mmol/L, potassium 4.4 mmol/L, chloride 100 mmol/L, CO2 25 mmol/L, glucose
181 mg/dL, and creatinine 1.0 mg/dL. Which of the following radiologic
findings would you most expect to be present in this patient?
A
2 cm right adrenal mass with abdominal CT scan
B
4 cm mass at aortic bifurcation with MR imaging
C
Multiple pulmonary nodules on chest radiograph
D
10 cm cystic right ovarian lesion by abdominal ultrasound
E
2 cm "hot" thyroid nodule with Tc99 scintigraphic scan
Question 13
An 35-year-old woman has had insomnia for the past 4 months. She has also
had episodes of diarrhea with up to 4 loose stools per day. On physical
examination, she exhibits bilateral proptosis. Her outstretched hands
demonstrate a fine tremor. On palpation of her neck, the thyroid gland
does not appear to be enlarged and no masses are palpable. Laboratory
studies show a serum TSH of 8.8 microU/mL in association with a serum free
thyroxine of 5.1 ng/dL. Which of the following is the most likely
diagnosis?
A
Graves disease
B
Pituitary adenoma
C
Chronic thyroiditis
D
Prior thyroidectomy
E
Nodular goiter
Question 14
A 25-year-old woman has had a 10 kg weight loss over the past 6 months,
despite the fact that she is not dieting or trying to lose weight. On
physical examination she appears anxious and worried. Her hands are warm
and tremulous. Vital signs show her temperature to be 37.4 C, pulse
105/minute, respirations 23/minute, and blood pressure 135/75 mm Hg.
Serum electrolytes include sodium 141 mmol/L, potassium 4.2 mmol/L,
chloride 99 mmol/L, C02 23 mmol/L, glucose 78 mg/dL, and creatinine 0.8
mg/dL. Which of the following laboratory test findings is most likely to
be present in this woman?
A
Plasma cortisol of 40 microgm/dL at 8 am
B
Serum antinuclear antibody of 1:256
C
Urinary free catecholamines of 500 microgm/24 hr
D
Serum gastrin of 200 pg/mL
E
Serum total thyroxine of 14 microgm/dL
Question 15
A 50-year-old man has experienced episodic headaches for the past 3 months.
On physical examination his blood pressure is 185/110 mm Hg, with no other
remarkable findings. Laboratory studies show sodium 145 mmol/L, potassium
4.3 mmol/L, chloride 103 mmol/L, C02 26 mmol/L, glucose 91 mg/dL, and
creatinine 1.3 mg/dL. An abdominal CT scan shows a 7 cm left adrenal mass.
During surgery, as the surgeon is removing the left adrenal gland, the
anesthesiologist notes a marked rise in blood pressure. Which of the
following laboratory test findings would have been most likely have been
present in this patient prior to surgery?
A
Decreased serum cortisol
B
Decreased urinary homovanillic acid
C
Increased serum ACTH
D
Increased urinary free catecholamines
E
Elevated serum ANCA
Question 16
A 47-year-old woman feels a "lump" in her neck that she didn't notice 5
months before. Her physician palpates a firm nodule about 2 cm in size
to the left of midline in the region of the thyroid gland. By scintigraphic
scanning with Tc99, this nodule appears "cold" with normal activity in
the surrounding thyroid gland. Which of the following is the most likely
diagnosis?
A
Papillary carcinoma
B
Follicular adenoma
C
Thyroglossal duct cyst
D
Toxic nodular goiter
E
Granulomatous thyroiditis
F
Hashimoto thyroiditis
Question 17
A 55-year-old woman has had diffuse, dull, constant abdominal pain for
the past 2 months. On physical examination no abnormal findings are noted.
An abdominal CT scan shows a 3 cm right adrenal mass. The right adrenal
is excised and on microscopic examination the mass is composed of cells
resembling adrenal cortex. Which of the following features is the most
reliable indicator that this mass is malignant?
A
Cellular atypia
B
Presence of mitoses
C
Invasion
D
Size of the mass
E
Cellular necrosis
Question 18
A 49-year-old woman has had multiple episodes of lower abdominal pain for
the past year. On 3 occasions she passed a urinary tract stone during or
following an episode of pain. During the past month she has experienced
pain in her right middle finger. On physical examination there is pain
on palpation of her right 3rd proximal phalanx. Laboratory studies show
a serum calcium of 13.7 mg/dL, phosphorus of 1.9 mg/dL, creatinine 1.4
mg/dL, and albumin 4.8 g/dL. Which of the following bone lesions is she
most likely to have?
A
Osteitis fibrosa cystica
B
Osteoid osteoma
C
Osteochondroma
D
Osteomyelitis
E
Osteoporosis
F
Osteosarcoma
Question 19
A 40-year-old woman notes increasing enlargement and discomfort in her
neck over the past week. She sees her physician, who palpates diffuse,
symmetrical enlargment with tenderness in the region of the thyroid gland.
Thyroid function tests show serum TSH of 0.8 mU/L and thyroxine of 11.9
micrograms/dL. The physician refers the patient to an endocrinologist,
but the next available appointment is in 8 weeks. When the endocrinologist
examines the patient, the thyroid is no longer palpable and there is no
pain. Repeat thyroid function tests reveal a serum TSH of 3.8 mU/L and
thyroxine of 5.7 micrograms/dL. Which of the following thyroid diseases
is most likely to produce these findings?
A
Nodular goiter
B
Non-Hodgkin lymphoma
C
DeQuervain disease
D
Hashimoto thyroiditis
E
Graves disease
F
Riedel thyroiditis
G
Iodine deficiency
Question 20
A 40-year-old truck driver has had difficulty using his side mirrors for
traffic behind him. He has never had any major medical problems in the
past. He visits an optometrist, who determines that he has bilateral
lateral visual field deficits, but his vision is 20/20. A head CT scan
reveals slight enlargement of the sella turcica. Which of the following
hormones is most likely being secreted in excessive amounts in this man?
A
Antidiuretic hormone
B
Prolactin
C
ACTH
D
Growth hormone
E
Luteinizing hormone
Question 21
A 47-year-old woman has felt a "lump" in her neck for the past 2 months.
On physical examination there is a firm nodule in the right lobe of the
thyroid. Following fine needle aspiration cytologic diagnosis of a
neoplasm, a thyroidectomy is performed. Grossly, there is a 3 cm mass in
the right lower pole that on sectioning is cystic and has papillary
excrescences. Which of the following sets of findings is most typical for
this lesion?
A
Giant cells, hypothyroidism
B
Amyloid stroma, calcitonin production
C
Cold nodule on scan, decreased TSH
D
Clear nuclei, lymph node metastases
E
Follicles, hematogenous metastases
Question 22
The mother of an 11-month-old infant had noted enlargement of the baby's
abdomen within the past month. This is confirmed by the family physician,
who notes that the baby is otherwise normally developed. An abdominal CT
scan reveals a 6 cm mass, with some scattered calcifications, above the
kidney on the right. Laboratory studies show that the urinary
vanillylmandelic acid (VMA) is modestly increased, while the urinary
homovanillic acid (HVA) is only slightly increased. The mass is removed
and microscopically is composed of sheets of small blue cells. Which of
the following is the most likely diagnosis?
A
Congenital adrenal hyperplasia
B
Adrenal cortical carcinoma
C
Neuroblastoma
D
Non-Hodgkin lymphoma
E
Pheochromocytoma
F
Aldosteronoma
Question 23
A 53-year-old woman has noted pain in her neck for the past month. On
physical examination her vital signs include T 37 C, P 77/minute, RR
16/minute, and BP 130/80 mm Hg. There is an irregular firm mass palpable
in her left neck. A CT scan shows an infiltrative mass involving the left
lobe of the thyroid and extending into adjacent soft tissues. Laboratory
studies show TSH 2.9 mU/L, total serum thyroxine 8.6 microgm/dL, calcium
8.7 mg/dL, and phosphorus 2.8 mg/dL. A fine needle aspiration biopsy of
the mass shows malignant spindle-shaped cells present that demonstrate
a p53 mutation immunohistochemically. She dies within a year with
metastatic lesions. Which of the following neoplasms is this woman most
likely to have?
A
Anaplastic carcinoma
B
Follicular carcinoma
C
Medullary carcinoma
D
Non-Hodgkin lymphoma
E
Papillary carcinoma
F
Parathyroid carcinoma
Question 24
A 45-year-old man has had headaches for 4 months. On physical examination
he is found to have a blood pressure of 170/110 mm Hg. Laboratory studies
show a serum sodium of 146 mmol/L, potassium 2.3 mmol/L, chloride 103
mmol/L, CO2 27 mmol/L, glucose 82 mg/dL, and creatinine 1.2 mg/dL. His
plasma renin activity is 0.1 ng/mL/hr and his serum aldosterone 65 ng/mL.
Which of the following abnormalities is the most likely cause for these
findings?
A
21-hydroxylase enzyme deficiency
B
Adrenal adenoma
C
Pituitary adenoma
D
Exogenous corticosteroid administration
E
Renal cell carcinoma
Question 25
A 40-year-old woman has noted painless swelling of her neck for the past
3 weeks. On physical examination there is diffuse enlargement of her
thyroid. Laboratory studies show an increased titer of anti-thyroid
peroxidase and anti-thyroglobulin antibodies. Within a month, the
swelling has diminished. Which of the following complications is she most
likely to develop?
A
Amyloidosis
B
Hypothyroidism
C
Non-Hodgkin lymphoma
D
Papillary carcinoma
E
Riedel thyroiditis
Question 26
A 45-year-old woman with severe rheumatoid arthritis has been on chronic
corticosteroid therapy for the past 15 years. She is admitted for an
orthopedic procedure to correct joint deformity from her disease. She
continues to receive her regular dosage of 5 mg of prednisone per day.
Three days postoperatively, she develops an aspiration pneumonia with
Klebsiella pneumoniae cultured from sputum. Five days following the
surgery, she becomes obtunded. Laboratory findings at that time include:
sodium 105 mmol/L, potassium 5.4 mmol/L, chloride 87 mmol/L, CO2 16 mmol/L,
glucose 40 mg/dL, and creatinine 1.1 mg/dL. Which of the following
complications is most likely to have occurred in this patient?
A
Anterior pituitary necrosis
B
Waterhouse-Friderichsen syndrome
C
Acute Addisonian crisis
D
Conn syndrome
E
21-hydroxylase deficiency
Question 27
A 38-year-old woman has had a feeling of fullness in her neck for the past
year. She is otherwise asymptomatic. Her physician palpates a
symmetrically enlarged thyroid gland. It is not painful to palpation. She
has no difficulty swallowing. There is no palpable lymphadenopathy. She
is afebrile. Her serum TSH is 3.5 mU/L with thyroxine of 8.2 micrograms/dL.
Thyroid peroxidase antibody is not detected. Two years later, her thyroid
has not appreciably changed in size. Which of the following conditions
is she most likely to have?
A
Graves disease
B
Nodular goiter
C
Hashimoto thyroiditis
D
Anaplastic carcinoma
E
Follicular adenoma
F
Papillary carcinoma
Question 28
A 15-year-old boy has had worsening headaches for 2 months. On examination
he has diminished peripheral vision, but no loss of visual acuity. A head
CT scan reveals a 4 cm mass expanding the sella turcica and eroding the
sphenoid bone. The mass is cystic with scattered calcifications. Which
of the following is the most likely diagnosis?
A
Prolactinoma
B
Metastatic seminoma
C
Empty sella syndrome
D
Glioblastoma multiforme
E
Craniopharyngioma
F
Osteosarcoma
Question 29
A 48-year-old man noted an increase in weight over the past 6 months, along
with bruises on his skin with even minor trauma and back pain. On physical
examination he has obesity in a truncal distribution. He has a blood
pressure of 160/110 mm Hg. A radiograph of the spine reveals a compressed
fracture of T11. Which of the following neoplasms is he most likely to
have?
A
Pheochromocytoma of bladder
B
Follicular carcinoma of thyroid
C
Osteosarcoma of femur
D
Small cell anaplastic carcinoma of lung
E
Islet cell carcinoma of pancreas
Question 30
A 41-year-old man has been drinking large quantities of water--up to 20
liters per day--for the past week. On physical examination there are no
abnormal findings except for diminished skin turgor and dry mucous
membranes. Laboratory studies show sodium 162 mmol/L, potassium 4.1
mmol/L, chloride 121 mmol/L, and bicarbonate 27 mmol/L. His serum glucose
is 75 mg/dL and creatinine 1.2 mg/dL. His serum osmolality is 343 mOsm/kg.
A deficiency of which of the following hormones is most likely present
in this man?
A
Antidiuretic hormone
B
Oxytocin
C
Insulin
D
Growth hormone
E
Prolactin
Question 31
A 50-year-old man has been diagnosed with a follicular neoplasm of the
thyroid. He undergoes a total thyroidectomy. Within a day following
surgery, he is noted to have tingling sensations and neuromuscular
irritability. Which of the following serum laboratory tests should be
ordered immediately to determine further therapy for this man?
A
TSH
B
Parathormone
C
Total thyroxine
D
Ionized calcium
E
Calcitonin
F
Iodine
Question 32
A 30-year-old woman from Barcelona has noted enlargement of her neck over
the past 4 months. On physical examination, she has a diffusely enlarged
thyroid that is not painful to palpation. Her TSH level is 0.2 mU/L. A
subtotal thyroidectomy is performed and histologically the tissue shows
follicles with papillary infoldings lined by tall columnar cells. Which
of the following is the most likely diagnosis?
A
Subacute granulomatous thyroiditis
B
Papillary carcinoma
C
Multinodular goiter
D
Hashimoto thyroiditis
E
Graves disease
Question 33
A 57-year-old man is found comatose. On physical examination he has
decreased skin turgor. Laboratory studies show a blood glucose of 780
mg/dl. Urinalysis reveals no ketosis or proteinuria, though there is 4+
glucosuria. Which of the following is the most likely diagnosis?
A
Islet cell tumor secreting glucagon
B
Type I diabetes mellitus
C
Cushing syndrome
D
Ingestion of a large quantity of sugar
E
Type II diabetes mellitus
Question 34
A 23-year-old man wants to increase his muscle mass for playing physical
contact sports. He attempts to accomplish this by injections of a
substance obtained from a "friend". Over the next year he develops acne,
icterus, and increased fatigue. An infertility workup reveals hypospermia.
Laboratory studies show Hgb 19.2 g/dL, Hct 58.1.4%, platelet count
330,300/microliter, and WBC count 7410/microliter. Which of the following
neoplasms is he at greatest risk for developing in the future?
A
Hepatocellular carcinoma
B
Papillary carcinoma
C
Renal cell carcinoma
D
Rhabdomyosarcoma
E
Seminoma
Question 35
A 33-year old woman has had increased anxiety with headaches and
diaphoresis over the past 2 months. On physical examination she is
afebrile, with a heart rate of 90/minute and blood pressure 150/90 mm Hg.
Laboratory studies show elevated urinary catecholamines, elevated plasma
renin activity, and normal TSH. Her plasma cortisol level is normal. An
abdominal CT scan is performed. At which of the following locations is
a mass lesion most likely to be found?
A
Aortic bifurcation
B
Hepatic capsule
C
Pancreatic tail
D
Mediastinum
E
Splenic hilum
Question 36
A 2-year-old child living in Stockholm is small for its age and exhibits
profound mental retardation. On physical examination he has dry, coarse
skin. Which of the following pathologic features involving the thyroid
gland is this child most likely to have?
A
Papillary adenoma
B
Diffuse hyperplasia
C
Granulomatous inflammation
D
Metastatic carcinoma
E
Marked atrophy
Question 37
A 40-year-old woman has noted increasing fullness to her neck for the past
2 weeks. On physical examination she has diffuse enlargment of the thyroid
without tenderness on palpation. Laboratory studies show an
anti-thyroglobulin titer of 1:256 and an anti-thyroid peroxidase titer
of 1:512. She has an HLA DR5 marker. Which of the following is the most
likely diagnosis?
A
Riedel struma
B
Adenovirus infection
C
Hashimoto thyroiditis
D
Graves disease
E
Subacute granulomatous thyroiditis
F
Nodular goiter
Question 38
A clinical study is performed involving subjects who developed Addision
disease. They were recorded to have laboratory studies with hyponatremia,
hyperkalemia, hypoglycemia, and decreased plasma cortisol. They became
hypotensive. In some subjects, this disease had an acute onset over less
than 2 days' time. Which of the following diseases is most likely to
produce this acute course?
A
Waterhouse-Friderichsen syndrome
B
Metastatic small cell anaplastic carcinoma
C
Disseminated Mycobacterium tuberculosis
D
Reactive systemic amyloidosis
E
Blunt force abdominal trauma
Question 39
A 39-year-old woman has noted discomfort with fullness to her neck over
the past year. On physical examination she is afebrile and normotensive.
There is irregular enlargement of her thyroid gland, but no tenderness
on palpation. A scintigraphic scan shows normal uptake except for
increased uptake in a 1 cm area in the left lower lobe. Her anti-thyroid
peroxidase antibody is negative. Which of the following complications is
she most likely to develop?
A
Thyrotoxicosis
B
Papillary carcinoma
C
Graves disease
D
Subacute thyroiditis
E
Hypothyroidism
Question 40
A 42-year-old man has had a feeling of enlargement of his neck for the
past 7 months. He is concerned, because a sister and maternal aunt had
thyroid cancer. On physical examination, the thyroid is palpably nodular
but nontender. A fine needle aspiration is performed and cytologic
examination shows cells present consistent with a neoplasm. He undergoes
total thyroidectomy. Sectioning the resected thyroid reveals four
distinct tumor masses from 0.5 to 3 cm in size. These masses are solid
and firm, with a tan cut surface. On microscopic examination an
immunostain for calcitonin is positive in the nests of dark blue cells
of these masses. He is at greatest risk for developing which of the
following neoplasms in the future?
A
Astrocytoma
B
Pheochromocytoma
C
Angiosarcoma
D
Gastrinoma
E
Renal cell carcinoma
Question 41
A 17-year-old girl with Goodpasture syndrome progressed to chronic renal
failure and was placed on chronic hemodialysis. She developed severe
hypertension. However, she had difficulty accepting the reality of her
disease, and she missed dialysis appointments and did not take her
antihypertensive medication regularly. Laboratory studies now show her
serum ionized calcium is 3.9 mg/dl with phosphorus 6.2 mg/dl and albumin
3.6 g/dl. Which of the following bone lesions is she most likely to have?
A
Osteitis fibrosa cystica
B
Fibrous dysplasia
C
Osteosarcoma
D
Giant cell tumor
E
Osteopetrosis
Question 42
A 1-year-old male child has been irritable for the past day. On physical
examination he has a right inguinal hernia with incarceration of a loop
of small intestine. A laparotomy is performed and the defect is closed.
The tissue from the hernia sac is excised. The surgical pathology report
indicates the presence of a focus of adrenal cortex in the excised hernia
sac. Which of the following is the most likely diagnosis?
A
Congenital adrenal hyperplasia
B
Adrenal cortical carcinoma metastasis
C
Incidental ectopia
D
Risk for subsequent adrenocortical insufficiency
E
Multiple endocrine neoplasia syndrome
Question 43
A 14-year-old boy has felt a "bump" in his neck for the past year. On
physical examination just anterior to the trachea in the midline is a
palpable non-tender 2 cm mass. A fine needle aspirate of the mass yields
only clear, mucoid fluid. Which of the following is the most likely
diagnosis?
A
Thyroglossal duct cyst
B
Lymph node metastasis of follicular carcinoma
C
Follicular adenoma
D
Nodule of a multinodular goiter
E
Parathyroid cyst
Question 44
A clinical study is performed of subjects from birth to age 80 years who
were documented by laboratory testing to have hypocalcemia. The medical
records of these subjects are analyzed and the disease conditions
documented in these subjects recorded. A subset of these patients had
hypocalcemia documented in infancy. Which of the following conditions is
most likely to have been present in this subset of patients?
A
Parathyroid carcinoma
B
Vitamin D deficiency
C
Chronic renal failure
D
DiGeorge anomaly
E
Parathyroid adenoma
Question 45
A 5-month-old female infant was the product of an uncomplicated pregnancy
and was born at term. However, the baby has failure to thrive. On physical
examination there is clitoral hypertrophy and poor skin turgor. The baby
appears neurologically normal. Laboratory studies show serum sodium 116
mmol/L, potassium 6.2 mmol/L, chloride 83 mmol/L, and CO2 22 mmol/L. There
is no history of diarrhea or vomiting. Which of the following inborn errors
of metabolism is this infant most likely to have?
A
21-hydroxylase deficiency
B
Phenylalanine transferase deficiency
C
Galactose-1-uridyl transferase deficiency
D
Glucose-6-phosphatase deficiency
E
Iodine peroxidase deficiency