Time limit: 0
Quiz Summary
0 of 23 Questions completed
Questions:
Information
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
You must first complete the following:
Results
Quiz complete. Results are being recorded.
Results
0 of 23 Questions answered correctly
Your time:
Time has elapsed
You have reached 0 of 0 point(s), (0)
Earned Point(s): 0 of 0, (0)
0 Essay(s) Pending (Possible Point(s): 0)
Categories
- Not categorized 0%
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- Current
- Review
- Answered
- Correct
- Incorrect
-
Question 1 of 23
1. Question
A 73-year-old woman comes to the emergency department due to increasing shortness of breath, dizziness, and “heart racing” for the past 3 weeks. She has also experienced a 2.3-kg (5-lb) weight loss over the past few months. Medical history is notable for hypertension and heart failure with preserved ejection fraction, for which she takes appropriate medications. Blood pressure is 145/65 mm Hg and pulse is 110/min. Examination shows regular tachycardia with an audible S3. Lung examination is normal. Neck examination shows enlargement in the right side of the thyroid gland. Serum TSH is <0.01 µU/mL, and free T4 is 3.3 ng/dL (normal: 0.9-1.7). Thyroid ultrasonogram reveals a 2.4-cm hyperechoic nodule in the right thyroid lobe. Radioiodine uptake is 45% at 24 hours (normal: 5-30); there is increased uptake in the nodule and decreased uptake in the remainder of the thyroid gland. Metoprolol is started and results in partial resolution of symptoms. Which of the following is the most appropriate next step in management of this patient’s thyroid condition?
CorrectIncorrect -
Question 2 of 23
2. Question
A 40-year-old man comes to the office for follow-up of type 1 diabetes mellitus. He was diagnosed 3 years ago when he was admitted to the hospital for diabetic ketoacidosis. The diabetes is treated with a continuous subcutaneous insulin infusion via an insulin pump, and most blood glucose levels are within 80-120 mg/dL with no significant hypoglycemic episodes. The patient exercises 5 days a week and follows strict dietary restrictions; he has avoided eating “junk food” apart from a small slice of cake on his birthday 3 months ago. Medical history is notable only for mild vitiligo, and his only other medication is a daily multivitamin. The patient does not use tobacco, alcohol, or illicit drugs. Family history is negative for diabetes mellitus and premature coronary artery disease. Blood pressure is 126/80 mm Hg and pulse is 68/min. BMI is 23.4 kg/m2. Physical examination, including lower extremity monofilament testing, is normal. Laboratory results are as follows:
Glucose
120 mg/dL
Creatinine
0.88 mg/dL
Hemoglobin A1c
6.6%
Fasting lipid panel
Total cholesterol
170 mg/dL
HDL
44 mg/dL
LDL
99 mg/dL
Triglycerides
134 mg/dL
TSH
1.3 µU/mL
Urinalysis
normal
Which of the following is the best next step in management of this patient’s condition?
CorrectIncorrect -
Question 3 of 23
3. Question
A 56-year-old man comes to the office for follow-up of type 2 diabetes mellitus. The patient has had inadequate glycemic control with metformin monotherapy; an additional medication that inhibits dipeptidyl peptidase-4 was prescribed 3 months ago. The patient also has hypertension for which he takes ramipril. He does not use tobacco, alcohol, or recreational drugs. The patient says he is generally compliant with dietary guidance but occasionally eats fast food. Blood pressure is 126/74 mm Hg and pulse is 76/min. BMI is 31.4 kg/m2. Physical examination shows no abnormalities. Laboratory results show a hemoglobin A1c of 6.8%. The newly prescribed medication most likely improved this patient’s glycemic control through which of the following mechanisms?
CorrectIncorrect -
Question 4 of 23
4. Question
A 24-year-old female maintained on methimazole for the treatment of Graves disease comes to your office after having a positive urine pregnancy test. She complains of mild nausea, but does not have any other symptoms. Her last menstrual period was five weeks ago. She was diagnosed with Graves disease approximately eight months ago. Her clinical symptoms of hyperthyroidism have markedly improved since starting methimazole. She is married and has no children. She does not smoke or drink alcohol. Her mother has hypothyroidism. She takes no other medications. She has no medication allergies. Her menstrual cycles were previously regular. Physical examination reveals a mildly enlarged, smooth, non-tender thyroid gland. Thyroid function tests performed last week showed a TSH of 0.7 mU/L and total T4 of 15.2 μg/dL (normal 4 to 12 μg/dL). What is the best next step in this patient’s management?
CorrectIncorrect -
Question 5 of 23
5. Question
A 67-year-old woman comes to the emergency department because of severe weakness, fatigue, and non-bloody diarrhea. She has well-controlled diabetes mellitus type 2 and bronchial asthma. The patient used to smoke 1 pack of cigarettes daily for 25 years but quit 10 years ago. She does not use alcohol or illicit drugs. Her medications include glyburide, metformin, albuterol, and fluticasone metered dose inhalers. Her temperature is 37.8 C (100 F), blood pressure is 92/61 mm Hg, pulse is 106/min, and respirations are 32/min. Examination shows no pulmonary or cardiac abnormalities on auscultation. The patient’s laboratory tests show the following:
Complete blood count Hemoglobin 14.1 g/dL Hematocrit 52% Platelets 350,000/µL Leukocytes 9,000/µL Segmented neutrophils 63% Lymphocytes 29% Monocytes 8% Serum chemistry Sodium 142 mEq/L Potassium 4.5 mEq/L Chloride 105 mEq/L Bicarbonate 12 mEq/L Blood urea nitrogen 55 mg/dL Creatinine 2.5 mg/dL Calcium 9.4 mg/dL Glucose 180 mg/dL Amylase 80 U/L The patient’s serum creatinine was 1.7 mg/dL 3 months ago. Which of the following is the most appropriate immediate next step?
CorrectIncorrect -
Question 6 of 23
6. Question
A 47-year-old man comes to the office with his wife due to a gradually decreasing sex drive and difficulty sustaining an erection during sexual intercourse over the past 1-2 years. They have had satisfying sexual interactions in the past and have 2 teenage children. On questioning, the patient is unable to recall any spontaneous nocturnal erections of late. Medical history is otherwise unremarkable and he takes no medications. He does not use tobacco or alcohol. Family history is significant for diabetes mellitus in his father and uncle. Temperature is 37 C (98.6 F), blood pressure is 126/84 mm Hg, pulse is 74/min, and respirations are 14/min. The patient has a dark complexion with sparse body hair. The thyroid is normal to palpation. Lung auscultation and heart sounds are normal. The abdomen is nondistended, soft, and nontender, with the liver edge palpable 1 cm below the right costal margin. External genitalia appear normal, with a mild decrease in testicular volume. Visual fields are full to confrontation. Laboratory results are as follows:
Hematocrit
46%
Serum chemistry
Sodium
140 mEq/L
Potassium
4.6 mEq/L
Creatinine
0.8 mg/dL
Glucose
130 mg/dL
Liver function studies
Total bilirubin
0.8 mg/dL
Alkaline phosphatase
68 U/L
Aspartate aminotransferase
144 U/L
Alanine aminotransferase
186 U/L
FSH
2 mU/mL (normal: 5-15 mU/mL)
LH
2 mU/mL (normal: 3-15 mU/mL)
Testosterone, total
160 ng/dL (normal: 300-1,200 ng/dL)
Which of the following is the best management strategy for this patient?
CorrectIncorrect -
Question 7 of 23
7. Question
A 32-year-old female comes to the physician’s office for a follow-up visit. She was recently brought to the emergency department due to head trauma, and the head CT scan performed at that time revealed an abnormal sella. She does not have any significant medical problems. She is currently not on any medications. Her menstrual cycles are regular. She is sexually active with one partner. She does not have any children. Her family history is insignificant. She does not smoke cigarettes or drink alcohol. Her physical examination is unremarkable. Prolactin, IGF-1, LH, FSH, TSH, and free T4 are within normal limits. Her plasma cortisol is normally suppressed after the administration of 1 mg of dexamethasone. MRI of the pituitary region shows a 5-mm hypo-intense lesion within the pituitary gland, whose architecture is not distorted. The rest of the brain appears normal. What is the next best step in the management of this patient?
CorrectIncorrect -
Question 8 of 23
8. Question
A 23-year-old man is hospitalized for acute gastroenteritis with mild dehydration. He has type 1 diabetes mellitus that was diagnosed 6 years ago and is managed with a regimen that includes insulin glargine at bedtime and insulin aspart before meals. The patient adjusts the dose of insulin aspart based on the size of his meals and premeal glucose levels. His recent glycemic control has been excellent, with a hemoglobin A1c of 7.0%. The patient had an episode of diabetic ketoacidosis a year ago but has no chronic complications of diabetes. His glucose levels occasionally drop below 70 mg/dL, mainly at night, but he has had no symptoms or loss of consciousness due to hypoglycemia. Temperature is 36.7 C (98.1 F), blood pressure is 114/70 mm Hg, and pulse is 100/min. Oral mucous membranes are dry, but physical examination is otherwise normal. Initial laboratory tests show a normal anion gap and a blood glucose level of 80 mg/dL. Due to frequent vomiting, the patient is able to tolerate only limited amounts of fluids or food orally, and he is started on intravenous fluids. Which of the following is the most appropriate strategy for managing this patient’s insulin while he is in the hospital?
CorrectIncorrect -
Question 9 of 23
9. Question
A 24-year-old man comes to the emergency department due to a 4-day history of polyuria, polydipsia, abdominal pain, nausea, and vomiting. He was diagnosed with primary adrenal insufficiency 6 months ago after developing fatigue and weight loss. The patient started taking hydrocortisone and fludrocortisone at that time, resulting in improvement of symptoms and return to baseline weight. Medical history is otherwise unremarkable. The patient’s mother has Graves disease treated with radioiodine, and his sister has hypothyroidism. Family history is negative for diabetes mellitus. He does not use tobacco, drinks “a few beers on weekends,” and used marijuana occasionally during college. Temperature is 36.9 C (98.4 F), blood pressure is 90/65 mm Hg, pulse is 115/min, and respirations are 22/min. BMI is 22 kg/m2. Oral mucous membranes are dry, and the abdomen shows mild diffuse tenderness with no peritoneal signs. Laboratory results are as follows:
Complete blood count
Hemoglobin
13.5 g/dL
Platelets
180,000/mm3
Leukocytes
5,500/mm3
Serum chemistry
Sodium
134 mEq/L
Potassium
5.7 mEq/L
Chloride
94 mEq/L
Bicarbonate
13 mEq/L
Blood urea nitrogen
42 mg/dL
Creatinine
1.3 mg/dL
Glucose
470 mg/dL
Amylase
128 U/L
Ketones
positive (1:16 dilution)
What is the most likely cause of this patient’s hyperglycemia?
CorrectIncorrect -
Question 10 of 23
10. Question
A 54-year-old postmenopausal woman comes to the office to establish care. She feels well and describes her lifestyle as “overall healthy.” The patient has a history of hypertension, osteopenia, and anxiety disorder. She went through menopause at age 49, during which time she experienced hot flashes, sleep disturbances, and mood swings. The symptoms have largely resolved except for occasional episodes of anxiety. The patient did not receive any therapy for her menopausal symptoms. Her current medications include valsartan, calcium/vitamin D, and paroxetine. She is married, works as a television news reporter, and does not smoke or consume alcohol. Family history is negative for coronary heart disease, stroke, cancer, and venous thromboembolism. Blood pressure is 128/76 mm Hg and pulse is 68/min. BMI is 29 kg/m2. Physical examination is normal. Laboratory results are as follows:
Fasting lipid panel
Total cholesterol
180 mg/dL
HDL
60 mg/dL
LDL (calculated)
100 mg/dL
Triglycerides
98 mg/dL
Hemoglobin A1c
5.5%
The patient says that her friends have been telling her about the “anti-aging” effects of hormone replacement therapy, and she would like to discuss initiating treatment. She asks for advice regarding the risks and benefits of combined estrogen/progesterone menopausal hormonal therapy (MHT). Which of the following is the most appropriate response regarding MHT in this patient?
CorrectIncorrect -
Question 11 of 23
11. Question
A 54-year-old female with recently diagnosed diabetes mellitus presents to the office with a skin rash. She states that the rash started three weeks ago on her forearm as a small, elevated red area. It gradually involved the surrounding skin, and became an erythematous, itchy, painful rash that did not respond to topical 1% hydrocortisone. Approximately one week ago, the rash started clearing up from the center. The patient has not been feeling well for the past 1-2 months. She also complains of lethargy, weight loss, diarrhea, abdominal cramps, and occasional facial flushing. On physical examination, a 4 X 5 cm, erythematous, scaly rash, which appears to be clearing from center, is noted. The borders appear slightly elevated and crusty. Angular cheilosis is also noted. What is the most likely diagnosis of this patient?
CorrectIncorrect -
Question 12 of 23
12. Question
A 33-year-old woman comes to the office for evaluation of hypercalcemia. She was recently seen in the emergency department for uncomplicated appendicitis and was found to have a serum calcium level of 10.7 mg/dL. The patient underwent a laparoscopic appendectomy and was released the following day. Prior to this, she had not seen a physician in over 7 years. She now feels well and has no other medical problems. The patient has had 2 uneventful pregnancies and her menstrual periods are normal. She is divorced and currently not sexually active. She does not use tobacco, alcohol, or illicit drugs. Her mother has had “a high calcium level for a long time,” but the patient does not know if she received any specific treatment. Blood pressure is 123/68 mm Hg and pulse is 87/min with regular rhythm. BMI is 22 kg/m2. Physical examination is normal with well-healing abdominal wounds. Laboratory results are as follows:
Serum chemistry
Sodium
140 mEq/L
Potassium
4.0 mEq/L
Chloride
104 mEq/L
Bicarbonate
24 mEq/L
Blood urea nitrogen
9 mg/dL
Creatinine
0.8 mg/dL
Glucose
86 mg/dL
Calcium
10.9 mg/dL
Magnesium
2.8 mg/dL
Albumin
3.9 g/dL
Urinary calcium
75 mg/24 hr
Calcium:creatinine clearance ratio
<0.01
Serum parathyroid hormone
55 pg/mL
25-hydroxyvitamin D
30 ng/mL (normal: 30-50 ng/mL)
1,25-dihydroxyvitamin D
33 pg/mL (normal: 25-65 pg/mL)
Which of the following is the most appropriate next step in management of this patient?
CorrectIncorrect -
Question 13 of 23
13. Question
A 68-year-old man is brought to the emergency department by his daughter due to confusion and lethargy. The patient’s daughter reports that he lives alone and has type 2 diabetes mellitus and hypertension. He takes aspirin, enalapril, and glipizide. He is afebrile. Blood pressure is 99/59 mm Hg, pulse is 132/min, and respirations are 22/min. The patient appears drowsy and is barely communicative. Examination shows dry mucous membranes, absent jugular venous distention, clear lung fields, and normal heart sounds. The abdomen is soft, nontender, and nondistended. Neurologic examination shows disorientation to time and place. The patient moves all extremities and examination shows no meningeal signs. Laboratory results are as follows:
Complete blood count Hemoglobin 16.0 g/dL Mean corpuscular volume 90 fl Platelets 300,000/mm3 Leukocytes 10,000/mm3 Neutrophils 70% Lymphocytes 22% Monocytes 8% Chemistry panel Sodium 151 mEq/L Potassium 6.1 mEq/L Chloride 121 mEq/L Bicarbonate 18 mEq/L Blood urea nitrogen (BUN) 42 mg/dL Creatinine 1.6 mg/dL Calcium 10.1 mg/dL Glucose 810 mg/dL Serum ketones negative An ECG shows atrial fibrillation with a rapid ventricular response. Nonspecific T wave changes are present. Which of the following is the best initial approach to managing this patient?
CorrectIncorrect -
Question 14 of 23
14. Question
A 52-year-old woman comes to the office for follow-up after a forearm fracture. She experienced a nondisplaced radial fracture in a ground-level fall a week ago, and was treated with casting in the emergency department. The patient has a history of chronic constipation but has had no polyuria, bone pain, hematuria, or headaches. Medical history is notable for borderline hypertension that has been stable for several years with dietary modification. Her only medications include calcium and vitamin D supplements that she started after experiencing menopause a year ago. The patient has a 15-pack-year smoking history but quit 20 years ago; she does not use alcohol or illicit drugs. Her mother has osteoporosis and her father had type 2 diabetes mellitus and hypertension. Blood pressure is 157/98 mm Hg and pulse is 72/min. BMI is 28 kg/m2. Physical examination shows a cast on the right forearm but is otherwise unremarkable. Laboratory results are as follows:
Serum chemistry
Calcium
11 mg/dL
Albumin
3.8 g/dL
Creatinine
0.9 mg/dL
Phosphorus
2.3 mg/dL
Serum parathyroid hormone
710 pg/mL
Serum 25-hydroxyvitamin D
32 µg/L (normal: 18 to 68 µg/L)
24-hour urinary calcium
310 mg
Serum calcium a year ago was 10.9 mg/dL. DXA reveals a T-score of −2.6 at the lumbar spine and −1.8 at the femoral neck. Which of the following is the best management for this patient?
CorrectIncorrect -
Question 15 of 23
15. Question
A 79-year-old man comes to the office for routine follow-up for chronic conditions. The patient has hypertension, for which he takes amlodipine, and mild Alzheimer dementia, which is managed by his family with behavioral measures. Medical history is notable for locally advanced prostate cancer, for which chronic leuprolide therapy has been prescribed. The patient is otherwise healthy, eats a balanced diet, and exercises regularly. Bone density testing with DXA was normal 2 years ago but now reveals osteoporosis. Which of the following is the most likely cause of the reduced bone density in this patient?
CorrectIncorrect -
Question 16 of 23
16. Question
A 56-year-old woman comes to the emergency department due to recurrent palpitations and paresthesia of the fingers for the past several days. She has a 10-year history of hypothyroidism treated with levothyroxine. The patient also has recently diagnosed hypertension and started taking amlodipine and hydrochlorothiazide 2 weeks ago. She has not had any recent changes in her weight. She does not use tobacco, alcohol, or recreational drugs. Blood pressure is 161/96 mm Hg and pulse is 74/min. Cardiopulmonary and neurologic examinations are normal. The abdomen is soft and nonobese. ECG shows sinus rhythm with frequent premature ventricular beats. Laboratory results are as follows:
Sodium
142 mEq/L
Potassium
2.8 mEq/L
Blood urea nitrogen
18 mg/dL
Creatinine
0.8 mg/dL
Calcium
9.2 mg/dL
Magnesium
2.2 mg/dL
Glucose
94 mg/dL
Laboratory results were within normal limits 1 month ago. The patient is admitted to the hospital for intravenous potassium replacement. Which of the following diagnostic studies is most appropriate in this patient?
CorrectIncorrect -
Question 17 of 23
17. Question
A 52-year-old male presents with enlargement of his hands and feet which began one year ago. His jaw is also getting bigger. Acromegaly is suspected on clinical examination, and later confirmed by non-suppression of GH following a glucose load and increased serum IGF1 levels. The rest of his hormonal profile is within normal limits. MRI shows a 9 mm pituitary adenoma. The patient is advised to undergo surgery; however, he refuses adamantly because he says that he feels fine. If this patient does not get any treatment for his acromegaly, which of the following will most likely increase his mortality risk?
CorrectIncorrect -
Question 18 of 23
18. Question
A 28-year-old woman comes to the office due to unintentional weight loss, fatigue, and sweating. The patient has no neck pain. Two months before this visit, she delivered a healthy male baby without complications. The patient has no chronic medical conditions and takes no medications. Blood pressure is 140/70 mm Hg, pulse is 110/min, and respirations are 16/min. Oxygen saturation is 98% on room air. Neck examination shows mild, diffuse enlargement of the thyroid gland with no tenderness. The remainder of the physical examination is normal. Laboratory evaluation shows low serum TSH and elevated serum thyroxine (T4) and triiodothyronine (T3). Thyroid ultrasound with Doppler flow reveals a mildly enlarged gland with decreased blood flow. Which of the following is most likely responsible for this patient’s disorder?
CorrectIncorrect -
Question 19 of 23
19. Question
A 36-year-old woman comes to the office due to a 3-month history of palpitation and restlessness. In addition, she has had irregular menstrual periods for the past 6 months, and her last period was 45 days ago. The patient has a normal appetite and has had no weight changes. Medical history is unremarkable. She works as a laboratory technician and does not use tobacco, alcohol, or recreational drugs. Temperature is 36.1 C (97 F), blood pressure is 140/70 mm Hg, and pulse is 100/min. Pupils are normal and reactive to light with intact extraocular movements; there is mild lid-lag and no proptosis. The thyroid is easily palpable, is nontender, and has no nodules. The extremities are warm to the touch, and there is a slight tremor in the outstretched hands. Laboratory results are as follows:
TSH
9 µU/mL (normal 0.5-5)
Total T4
14.7 mcg/dL (normal: 5-12)
Total T3
230 ng/dL (normal: 70-170)
Which of the following is the most likely cause of this patient’s thyroid test abnormalities?
CorrectIncorrect -
Question 20 of 23
20. Question
A 25-year-old man comes to the office due to decreased libido, fatigue, and weight gain. For the last few months, the patient has been unable to attain a satisfactory erection during intercourse with his girlfriend. He has had no headaches, blurred vision, fever, nausea, or vomiting. The patient has had no significant prior medical problems and takes no prescription medications but does take several over-the-counter supplements to boost his metabolism. He does not use alcohol, tobacco, or illicit drugs. His mother was treated for non-Hodgkin lymphoma, and his father has no major medical problems. Blood pressure is 130/70 mm Hg and pulse is 56/min. The patient appears fit and well-built with no significant abnormalities noted on examination. Laboratory results are as follows:
Hemoglobin
17.8 g/dL
Hematocrit
53%
Platelets
150,000/mm3
Leukocytes
7,500/mm3
Aspartate aminotransferase (SGOT)
62 U/L
Alanine aminotransferase (SGPT)
49 U/L
Prolactin, serum
15 ng/mL
FSH
5 mIU/mL
LH
3 mIU/mL
Testosterone, serum
120 ng/dL (normal: 300-720)
TSH
1.6 µU/mL
Total thyroxine
4.9 µg/dL
Which of the following is the most appropriate next step in management?
CorrectIncorrect -
Question 21 of 23
21. Question
A 60-year-old woman comes to the office to discuss the results of her bone density test. She feels well but is very concerned about osteoporosis because her older sister had a hip fracture that required surgery. The patient had menopause at age 52 and currently has no hot flashes or vaginal dryness. She eats a healthy diet and exercises at least 5 days a week with a combination of strength training and aerobic conditioning exercises. Medical history is unremarkable, and her only medication is a daily over-the-counter calcium and vitamin D3 supplement. The patient has never been married and has no history of pregnancy. She drinks a glass of wine every night and smokes a half-pack of cigarettes daily. In addition to osteoporosis, family medical history is positive for breast cancer in a maternal aunt. Physical examination is unremarkable. Fasting laboratory and bone mineral density results are as follows:
Hemoglobin
13 g/dL
Creatinine
0.8 mg/dL
Calcium
9.4 mg/dL
Glucose
80 mg/dL
Albumin
4 g/dL
TSH
1.3 µU/mL
25-Hydroxyvitamin D
32 ng/mL (normal: 20-100)
Bone mineral density
T-score
Z-score
Lumbar spine
−2.2
−1.2
Femoral neck
−2.3
−1.3
Mammogram obtained a year ago was normal. In addition to advising her to stop smoking, which of the following is the most appropriate next step in addressing this patient’s risk for osteoporosis?
CorrectIncorrect -
Question 22 of 23
22. Question
A 60-year-old woman is transferred from an outpatient surgery facility to the emergency department due to diffuse abdominal pain, nausea, and vomiting following a routine colonoscopy. The patient has type 2 diabetes mellitus and takes sitagliptin, canagliflozin, and insulin detemir; the insulin was held the night before the procedure. Other medical conditions include hypertension and hyperlipidemia, for which she takes losartan and atorvastatin. Blood pressure is 110/70 mm Hg, pulse is 95/min, and respirations are 24/min. Oxygen saturation is 99% on room air. BMI is 34 kg/m2. Oral mucous membranes are dry, and the remainder of the physical examination is unremarkable. Plain films of the abdomen are unremarkable. Laboratory results are as follows:
Serum chemistry
Sodium
136 mEq/L
Potassium
3.6 mEq/L
Chloride
102 mEq/L
Bicarbonate
14 mEq/L
Blood urea nitrogen
24 mg/dL
Creatinine
1.2 mg/dL
Calcium
8.8 mg/dL
Glucose
220 mg/dL
Arterial blood gases
pH
7.28
PaO2
99 mm Hg
PaCO2
28 mm Hg
Urinalysis
Specific gravity
1.028
pH
5.4
Protein
none
Blood
negative
Glucose
present
Ketones
present
Which of the following is the most likely cause of this patient’s laboratory findings?
CorrectIncorrect -
Question 23 of 23
23. Question
A 34-year-old woman comes to the office due to a 1 week history of mood swings, difficulty concentrating, and hand tremors. She also has pain at the front of her neck that radiates to her ears and is worse with swallowing. The patient initially attributed her symptoms to a flu-like illness that she had a few weeks earlier. She has no other medical conditions and takes no medications. Blood pressure is 140/80 mm Hg and pulse is 105/min. The thyroid gland is very tender on palpation. After initial laboratory testing, a thyroid scan is performed and reveals diffusely decreased radioiodine uptake. Erythrocyte sedimentation rate is 105 mm/hr. Which of the following pathological changes would most likely be found on biopsy of this patient’s thyroid gland?
CorrectIncorrect