Quiz 6 Flashcards
Which is not a typical symptom of Cushing's syndrome? Select one: a. Hyperglycemia b. Delayed wound healing c. Weight loss d. Suppressed immune function e. Bone loss
Weight loss
A patient undergoing a cortisol suppression test shows no change in her cortisol levels when administered 1mg of dexamethasone, but her cortisol level does drop when administered 8mg of dexamethasone. Which of the following conditions is most consistent with these findings? Select one: a. Pheochromocytoma b. Adrenal adenoma c. Adrenal hyperplasia d. Malignancy producing ectopic ACTH e. ACTH-secreting pituitary adenoma
ACTH-secreting pituitary adenoma
The cosynthropin test is used to diagnose: Select one: a. Adrenal excess b. Adrenal insufficiency c. Androgen insufficiency d. Parathyroid insufficiency e. None of the above
Adrenal insufficiency
Aldosterone is secreted from which part of the adrenal gland?
Select one:
a. Adrenal medulla
b. Zona glomerulosa in the cortex
c. Zona fasciculata in the cortex
d. Zona reticularis in the cortex
e. Both zona fasciculata & reticularis
Zona glomerulosa in the cortex
Which of the following lab profiles is most consistent with a diagnosis of Conn’s syndrome?
Select one:
a. High serum aldosterone, low serum potassium, increased plasma renin
b. High serum aldosterone, low serum potassium, decreased plasma renin
c. Low serum aldosterone, low serum potassium, decreased plasma renin
d. High serum aldosterone, high serum potassium, increased plasma renin
e. High serum aldosterone, high serum potassium, decreased plasma renin
High serum aldosterone, low serum potassium, decreased plasma renin
Cushing's disease is caused by: Select one: a. Ectopic ACTH hypersecretion b. Glucocorticoid therapy c. Pituitary adenoma d. Nodular adrenal hyperplasia e. All of the above
Pituitary adenoma
A 34-year old woman gives birth to a child with ambiguous genitalia. The child is hypotensive. A geneticist tells the mother that her child is genotypically female, although the child seems to have partially virilized external genitalia. Which of the following enzymes is most likely deficient in this infant? Select one: a. 5-alpha-reductase b. 17-alpha-hydroxylase c. 21-alpha-hydroxylase d. 11-beta-hydroxylase e. None of the above
21-alpha-hydroxylase
The enzyme, inhibited by glycyrrhetinic acid in licorice, which converts active cortisol to inactive cortisone, is: Select one: a. 11 beta HSD1 b. 11 beta HSD2 c. Aromatase d. 17-alpha-hydroxylase e. 5-alpha-reductase
11 beta HSD2
What is the rate-limiting step in cortisol synthesis?
Select one:
a. Conversion of cholesterol into pregnenolone
b. Conversion of pregnenolone to progesterone
c. Conversion of progesterone to 17-alpha-hydroxyprogesterone
d. Conversion of 17-alpha-progesterone to 11-deoxycortisol
e. Conversion of 11-deoxycortisol to cortisol
Conversion of cholesterol into pregnenolone
A 26-year-old man presents to the clinic complaining of intermittent muscle cramping for the past 3 months, with no other significant symptoms. On physical examination, his blood pressure is found to be 190/105 mmHg. His labs reveal his sodium to be 155 mEq/L (normal: 135-147 mEq/L), potassium level to be 3.2 mEq/L (normal: 3.5-5.0 mEq/L), and bicarbonate level at 33 mEq/L (normal: 22-28 mEq/L). Otherwise, his complete metabolic panel (CMP) and complete blood count (CBC) are normal. What is the most likely cause of this patient's findings? Select one: a. Cushing syndrome b. Addison disease c. Pheochromocytoma d. Conn syndrome e. Hyperparathyroidism
Conn syndrome
The most common cause of primary adrenal insufficiency is:
Select one:
a. Metastatic cancer (metastases from lung, GI, breast)
b. Autoimmune disease
c. Hemorrhagic adrenalitis (Waterhouse-Friderichsen syndrome)
d. Psychological & physical stress
e. Infections, such as CMV, TB, fungi, HIV infections
Autoimmune disease
A 40-year-old man with AIDS presents to the emergency department with acute-onset nausea, vomiting, and abdominal pain. He is febrile and hypotensive. He was started recently on a new drug for a systemic fungal infection. Laboratory tests reveal mild hyperkalemia and hyponatremia. Which one of the following agents is most likely to have caused this patient’s condition?
Select one:
a. Amphotericin B
b. Dexamethasone
c. Trimethoprim-sulfamethoxazole (TMP-SMX)
d. Ketoconazole
e. Propylthiouracil (PTU)
Ketoconazole
A 54-year-old woman presents to the physician with diabetes mellitus, osteoporosis, and hypertension. She has noted a recent weight gain and abdominal striae. Labs reveal a decreased ACTH level. A single mass is noted adjacent to the right kidney on abdominal CT scan. Neither low- nor high-dose dexamethasone suppresses the patient’s cortisol production. Which of the following is the most likely explanation for these findings?
Select one:
a. Exogenous corticosteroid administration
b. Bilateral adrenal hyperplasia
c. Ectopic ACTH production
d. Pituitary adenoma
e. Adrenal adenoma
Adrenal adenoma
Which statement is not true regarding DHEA?
Select one:
a. Primarily found as DHEA-sulphate in the plasma
b. Levels are often increased in polycystic ovary syndrome (PCOS)
c. Is released from the adrenal cortex in response to ACTH
d. Is converted by aromatase directly into estradiol
e. Is the most abundant androgen found in females
Is converted by aromatase directly into estradiol
A 27-year-old caucasian female comes to the physician because of a six-month history of progressive weakness, fatigue, and occasional mild abdominal pain. She also has noticed that her skin has become more tan, especially at the elbows, knees, knuckles, despite the fact that she is not normally in the sun. Labs reveal mild hyponatremia; decreased bicarbonate, chloride, and glucose; and hyperkalemia. Which of the following is the most likely diagnosis? Select one: a. Addison disease b. Waterhouse-Friderichsen syndrome c. Cushing syndrome d. Pheochromocytoma e. Conn syndrome
Addison disease
