Can you please help with these questions ?

1. A 54-year-old female visits the clinic for her routine check-up. Currently, she has no complaints. She has a past medical history significant for osteoarthritis of the right knee. Her family history is significant for a mother who had hypertension and died four years after being diagnosed with breast cancer at the age of 68 years. Her father had diabetes mellitus and died in a motor accident. Her physical examination was normal, her blood pressure is 140/85 mmHg, and heart rate is 80/min. Laboratory test demonstrates a blood glucose level of 160 mg/dl. Which of the following is most likely to be the cause of death in this patient?

A) Stroke

B) Myocardial infarction

C) Breast cancer

D) Hyperosmolar nonketotic coma

E) Renal failure

1. A 36-year-old Caucasian woman visits the physician with complaints of recent onset hand tremor, mood swings and, difficulty concentrating. She has a discomfort in her neck that radiates to her ears, especially on swallowing which she has linked to flu-like symptoms that she had few weeks ago. Her blood pressure is 140/80 mmHg, and heart rate is 105/min. A scan of the thyroid demonstrates a diffuse decrease in radioactive iodine uptake. Her erythrocyte sedimentation rate (ESR) is 105 mm/Hr. Which pathological changes in the thyroid gland is most consistent with the clinical scenario demonstrated by this patient?

A) Follicular hyperplasia with tall cells forming intrafollicular papillary projections

B) Mononuclear, parenchymal infiltration with well-developed germinal centers

C) Mixed, cellular infiltration with occasional multinucleate giant cells

D) Extensive stromal fibrosis extending beyond the thyroid capsule

E) Branching papillary structures with interspersed calcified bodies

1. A 68-year-old man visits the physician because of a non-healing ulcer on his left foot. He has a past medical history of uncontrollable diabetes due to failure to comply with treatment. His BMI is 37 kg m2. Physical examination demonstrates bilateral symmetric decrease in vibratory sensation over his feet and ankles. This patient's condition is most likely associated with which of the following pathology?

A) Pancreatic islet infiltration with leukocytes

B) Pancreatic islet amyloid deposition

C) Circulating anti-islet antibodies

D) Strong linkage with HLA class II gene makeup

E) Episodic ketoacidosis that requires insulin therapy

1. A 26-year-old Caucasian male is brought to the ER with confusion, fatigue, and vague abdominal pain. His roommate say that he was previously complaining of excessive thirst and frequent urination. He has no significant past medical history except for chicken pox as a child. Urine dipstick is performed and is positive for glucose and ketones. Which of the following is the greatest contributing factor in this patient's condition?

A) Excessive body weight

B) Abdominal fat distribution

C) Islet amyloid deposition

D) Islet leukocytic infiltration

E) Genetic defects in insulin signaling

1. A 38-year-old woman is admitted to the hospital for hypertensive emergency. She has had a history of episodic headaches. Laboratory investigation is significant for increased urinary metanephrines. This patient's symptoms are most likely due to hyperactivity of which of the following structures?

A) Chromaffin cells of the adrenal medulla

B) Zona glomerulosa of the adrenals

C) Zona fasciculata of the adrenals

D) Zona reticulata of the adrenals

E) Juxtaglomerular cells of the kidney

1. A 48-year-old man visits his physician complaining of increased fatigability, difficulty sleeping, and heart palpitations for the past 3 months. He also says that despite eating well he has also lost 4.5 kg (10lbs) during this time. He also complains of trouble moving his eyes. He states that his job is incredibly stressful and can think of no other reasons for his difficulty sleeping. He has no significant past medical history. He drinks alcohol occasionally and is a nonsmoker. His family history is significant for his mother having some thyroid related problem. Which of the following findings is the most specific for an underlying thyroid-related cause of this patient's symptoms?

A) Atrial fibrillation

B) Tremor of the outstretched hands

C) Infiltrative process involving the skin of the lower legs

D) Increased serum alkaline phosphatase level

E)Heat intolerance

1. A 16-year-old aspiring fashion model visits the physician for a routine examination. She wishes to lose weight of about 20lbs (9 kg} because she believes she is currently 'too fat" to participate in a beauty pageant later this year. She complains that despite strict dietary limitations and vigorous exercise for two hours each day she cannot seem to lose weight. Her last menstrual period was four months ago. She is 5'5" (165 cm) and her weight is 100lbs (45.3 kg), BMI of 16.6 Kg/m2. On physical examination, she is pale and thin with fine hairs on her trunk. The most likely mechanism of her amenorrhea is which of the following?

A) Primary ovarian failure

B) Primary pituitary dysfunction

C) Hypothyroidism

D) Hyperprolactinemia

E) Hypothalamic dysfunction

1. A 45-year-old woman visits the physician complaining of episodic confusion, blurred vision, tremors, and sweating. She works at the local hospital as a nurse and reports that work has been stressful. She suffers from major depression for which she sees a psychiatrist and is on medication. Family history is significant for a mother who has hypertension and a father who died from prostate cancer. Further questioning revealed that she has had these symptoms for a year, and they have increased in intensity.

Serum laboratory studies were performed at the time of her visit and results obtained are as follows:

Glucose 35 mg/dl

Insulin 18 U/L (N:< 9 U/L)

Proinsulin 10 U/L (N:< 20% of total insulin)

C-peptide 4.01 ng/ml (N: 0.8 -1.9 ng/m)

Which of the following is the most likely cause of her hypoglycemia?

A) Alpha-cell tumor

B) Insulin administration

C) Somatostatinoma

D) Sulfonylurea use

E) VIP-secreting tumor

1. A 28-year-old visits his physician after discovering a mass in his scrotum. Upon further questioning he revealed that he is always sweating, his heart often feels like it is beating rapidly. He also has unintentional weight loss. His past medical history is insignificant. Laboratory investigations shows elevated levels of T4 and T3. A biopsy and microscopic examination of the scrotal mass demonstrates a malignant neoplasm. Elevation of which of the following markers is most likely in this patient?

A) Follicular stimulating hormone (FSH)

B) Human chorionic gonadotropin (B-hCG)

C) Alpha-fetoprotein (AFP)

D) Placental-like alkaline phosphatase (PLAP)

E) Lactate dehydrogenase (LOH)

1. A 43-year-old Caucasian female is discovered unresponsive by her son at home. She was pronounced dead on site by a medical team. She has a history of systemic lupus erythematosus for which she is taking multiple medication. Her records indicate that on her most recent physical exam, she had blood pressure of 150/90 mm Hg. Truncal obesity, mild hirsutism, facial plethora and, proximal muscle weakness, were all noted on physical. Laboratory investigations revealed hyperglycemia. An autopsy was performed, which revealed a left coronary artery mainstem thrombus that resulted in sudden cardiac death. Which of the following is most likely to be observed on examination of her adrenal glands?

A) Diffuse hyperplasia

B) Nodular hyperplasia

C) Bilateral cortical atrophy

D) Unilateral atrophy

E) Adrenocortical adenoma

1. A 30-year-old primigravida woman in labor requires a caesarian section because of failure of the baby to decent. She has a history of insulin dependent diabetes. which has been moderately well-controlled throughout her pregnancy. Which of the following endocrine/metabolic disturbances is the baby most likely to develop after birth?

A) Transient hyperglycemia

B) Hyperthyroidism

C) Diabetic ketoacidosis

D) Transient hypoglycemia

E)Permanent hypoglycemia

1. A 40-year-old male visits his physician after feeling a lump in his neck. He has no significant past medical history. He is a smoker and drinks alcohol occasionally. On physical examination a 2-cm thyroid nodule is palpable. Mucosal neuromas of the lips and tongue were also discovered. He has long fingers with an arm span that exceeds his height. His serum calcitonin levels are elevated on laboratory studies. Which of the following is this patient most likely also have?

A) Hypercalcemia

B) Visual field defects

C) Episodic headache

D) Recurrent peptic ulcers

E) Hypoglycemic episodes

1. A 58-year-old male visits the physician for routine medical checkup. He has a past medical history significant for hypertension which is being managed with medication, exercise, and dietary salt restrictions. On laboratory testing he is found to have abnormal serum chemistries. Results from his laboratory studies are as follows:

Serum sodium 134 mEq/L

Serum potassium 3.8 mEq/L

Blood urea nitrogen (BUN) 18 mg dl

Serum creatinine 0.8 mg dl

Calcium 11.0 mg dl

Blood glucose 98 mg dl d

Parathyroid hormone Decreased

Which of the following is the most likely cause of his condition?

A) Primary hyperparathyroidism

B) Medication

C) Hypothyroidism

D) Secondary hyperparathyroidism

E) Familial hypocalciuric hypercalcemia

1. A 48-year-old male CEO is brought to the emergency room with sudden onset headache, heart palpitations, and apprehensiveness. He denies using alcohol, tobacco, or any illicit substances. He has not had any recent emotional stressors. Physically he displays signs of diaphoresis and tremors. On examination his blood pressure is 190/110 mm Hg and his heart rate is 120 beats per minute. On physical exam, he is diaphoretic and exhibiting tremor. Antihypertensive medications are administered, and his symptoms are resolved. Past medical history reveals that he visited the ER a month ago with similar complaints. Which of the following is the most likely cause of his symptoms?

A) Excessive release of preformed thyroid hormones

B) Increased release of catecholamines

C) Reuptake inhibition of norepinephrine at the synaptic clefts

D) Hyperexcitable brainstem loci

E) Increased production of 5-hydroxyindoleacetic acid (HIAA}

1. A 34-year-old male visits the physician for a routine checkup. He has a past medical and surgical history significant for undergoing total thyroidectomy four year ago to remove a palpable thyroid mass. He is 6ft 4in tall, slender built with notably long arms and legs. His fingers are also long and thin. Examination of his lips and tongue reveal several small flesh-colored nodules. Which of the following conditions is this man most likely to be suffering from?

A) Marfan syndrome

B) Ehlers-Danlos syndrome

C) Neurofibromatosis type 1

D) Neurofibromatosis type 2

E) Multiple endocrine neoplasia type 1

F)Multiple endocrine neoplasia type 2

1. A 36-year-old man complains to his physician about a 2-month history of excessive thirst and frequent urination that has been really bothering him. He does not use alcohol nor illicit drugs. He smokes one pack of cigarette per day. His records indicate that he was previously involved in a motor vehicle accident for which he was hospitalized, and complications led to him spending a great length of time in the ICU. He currently takes no medications. Neurological examination was normal. Lab studies shows a fasting blood glucose level of 90 mg/dl, urinary osmolality after 2-hours of water restriction is 250 mOsm/L, which increases to 700 mOsm/L antidiuretic hormone is administered. After being given the appropriate therapy, his symptoms improve, however his condition never resolves so he has follows ups regularly with his physician over the next several years. Dysfunction of which of the following structures is most likely responsible for this patient's chronic condition?

A) Posterior hypophysis

B) Anterior hypophysis

C) Kidneys

D) Thalamic nuclei

E) Hypothalamic nuclei

1. A 7year-old boy is referred to the physician after he was noted on well child examination to have growth retardation. An MRI of the brain is performed which shows a 4cm suprasellar, multiloculated cystic lesion with calcifications, bulging into the floor of the third ventricle and base of the brain. Calcifications are present. Which of the following structures is this mass most likely derived from?

A) Prolactin secreting cells of the anterior pituitary

B) Remnants of the Rathke pouch

C) Astrocytes

D) Arachnoid cap cells

E) Posterior pituitary cells

1. A 21-year-old visits the physician because of recent weight loss and fatigue. He is an athlete in college and is concerned because his coach wants him to increase his weight but no matter how much he eats he is unable to do so. He also finds himself using the bathroom very often because he has been drinking a lot of water. He is worried that all of this has been interfering with his practice and he may be dropped from the team. He is sexually active with one partner. He does not smoke but drinks alcohol occasionally. Family history reveals that his father was diagnosed with colon cancer at age 64. Which of the following is the next best step in management of this patient?

A) Check serum TSH levels

B) Check fasting blood sugar levels

C) Screen for colon cancer

D) Oral glucose tolerance test

E) Order HIV testing with consent

1. A 36-year-old Caucasian female presents to the clinic with a complaint of inability to see properly. On further questioning she states that while crossing the street she cannot see vehicles coming from either side. She has no history of trauma to the eyes. She has a past surgical history to the neck two years ago for treatment of hypercalcemia. On physical examination she is found to have bitemporal visual field defects. Which of the following conditions should this patient be further evaluated for?

A) Breast tumor

B) Pancreas tumor

C) Bone tumor

D) Liver tumor

E) Cardiac tumor

F) Colonic polyps

1. A 54-year-old female visits her physician with complaint of constipation, weight gain and tiring very easily. On further questioning she says that she has had theses symptoms for the past six months by they are getting progressively worse. She does not have a significant past medical history. Her blood pressure today is 110/70mmhg with a heart rate of 55 beats per minute. On physical examination she is found to be overweight, with diffuse enlargement of the thyroid gland. What histological changes would you expect to be presents in the thyroid gland, based on her clinical presentation?

A) Follicular hyperplasia with tall cells forming intrafollicular papillary projections

B) Mononuclear, parenchymal infiltration with well-developed germinal centers

C) Mixed, cellular infiltration with occasional multinucleate giant cells

D) Extensive stromal fibrosis that extends beyond the thyroid capsule

E) Branching papillary structures with interspersed calcified bodies

1. A mother treated during her pregnancy with insulin after she was diagnosed with gestational diabetes. She also has a history of depression and drug abuse but claims she has not used any drugs during her pregnancy. She has given birth to a neonate weighing 4.5 kg (9 lb, 15 oz .} he is now found to be hypoglycemic. Hypoglycemia in the neonate is most likely cause by which of the following?

A) Placental transfer of insulin

B) Diffuse hyperplasia of the islets

C) Hypothyroidism

D) Glycogen storage disease

E) IGF-2 producing fibrosarcoma

The following vignette applies to the next 2items. The items in the set must be answered in sequential order.

1. A mother brings her 4-year-old son to the physician after she noticed that he started developing pubic hair. He also had a recent growth spurt which resulted in him being taller than his 5-year-old brother. His mother also states that his preschool teacher has told her he has axillary odor after he runs or plays. His height is at 96"' percentile and his weight corresponds to the 78" percentile for his age. Physical examination reveals sparse growth of long, pigmented hair at the base of the penis and in both axillae. A high serum concentration of 17-hydroxyprogesterone and testosterone is noted on laboratory examination.

Item 1 of 2

Which of the following is most likely to have occurred in this patient?

A) Adrenal medullary hyperplasia

B) Adrenal cortical hyperplasia

C) Leydig cell hyperplasia

D) Pituitary adenoma

E) Seminoma

Item 2 of 2

1. The appropriate interventions are started after an initial assessment. Suppressing which of the following hormones is targeted by the treatment for this patient's condition

A) Cortisol

B) Luteinizing hormone

C) Adrenocorticotropic hormone

D) Testosterone

E) Prolactin

1. An 18-year-old female with a three-month history of amenorrhea visits the clinic for a wellness exam. He past medical history is significant for hospitalization at the age of eight after she was involved in a car crash. She says she is very health conscious therefore she eats mainly fruits and vegetables and exercises regularly. She requests information on cutting down her caloric intake for fear of being overweight. On physical examination she is found to be thin, her skin is covered by fine downy hair and is dry. She has a negative pregnancy test. Serum hormone levels in this patient is most likely to follow which pattern in this patient?

LH FSH Estradiol

A) Increased Increased Decreased

B) Increased Decreased Decreased

C) Decreased Normal Normal

D) Decreased Decreased Decreased

E) Normal Normal Decreased

1. A 36-year-old male comes to the physician complaining of generalized weakness. His blood pressure is 190/100 mm Hg. Exceptionally low plasma renin activity is demonstrated on laboratory studies. Which of the following patterns of abnormalities is his serum chemistry most likely to show?

A) No change Decreased Increased

B) Decreased Increased Decreased

C) No Change Decreased Decreased

D) Decreased Decreased Increased

E) Decreased No Change No Change

1. A 36-year-old female visits your office complaining of persistent diarrhea, weight loss and abdominal pain. She states that her diarrhea started several months ago and has not responded to antibiotics. There is no change in the diarrhea even when she is fasting. You order an upper gastrointestinal study which revealed postbulbal duodenal and jejunal ulcers. Which of the following hormones is most likely to be elevated in this patient?

A) Gastrin

B) Insulin

C) Glucagon

D) VIP

E) Somatostatin

F)PTH-like peptide

1. A 54-year-old female undergoes a thyroid scan for a palpable neck mass. It is determined to be a 'cold' thyroid nodule. Fine-needle aspiration of the nodule shows spindle-shaped cells in an amorphous background. She has elevated serum calcitonin levels. Gene changes of which of the following is most likely responsible for this patient's condition?

A) Activating mutation of RET proto-oncogene

B) Inactivation of Rb gene

C) Over-expression of RAS gene

D) Inactivation of p53 gene

E) Over-expression of bcl-2 gene

1. A 40-year-old male visits the physician for a follow up. He was previously diagnosed with refractory peptic ulceration and diarrhea. Laboratory analysis reveals his fasting gastrin levels are markedly elevated. You are concerned about other associated conditions since you suspect he has a multiorgan disease. Which of the following should be checked for in this patient's family history?

A) Multiple endocrine neoplasia type 1

B) Multiple endocrine neoplasia type 2 A

C) Multiple endocrine neoplasia type 2 B

D) Von Hippel-Lindau syndrome

E) Retinoblastoma and osteosarcoma

1. A 3-year-old boy is rushed to the emergency room by his father because of high-grade fever, vomiting and altered mental status. Upon physical examination he is found to have hypotension, tachycardia, neck stiffness and petechial rash over the trunk and lower extremities. Laboratory studies and lumbar puncture are ordered but the patient starts bleeding from his venipuncture sites and develops cardiovascular collapse. Results from the Laboratory studies are shown:

Complete blood count

Hemoglobin 12.0 g/L

Platelets 100,000/mm3

Leukocyte count 34,500/mm'

Neutrophils 66%

Band forms 20%

Lymphocytes 14%

Chemistry panel:

Serum sodium 130 mEq/L

Serum potassium 5.6 mEq/L

Blood urea nitrogen (BUN) 30 mg/dL

Serum creatinine 1.8 mg/dL

Blood glucose 50 mg/dL

The child dies in spite of aggressive resuscitation efforts. An autopsy would most likely reveal which of the following?

A) Adrenal hemorrhage

B) Cardiac tamponade

C) Rupture of coronary artery aneurysm

D) Saddle pulmonary embolus

E) Rupture of Berry aneurysm

1. A 42-year-old female complaining of a painful rash over her lower extremities presents to the clinic. She was diagnosed with diabetes mellitus six months ago for which she takes medication. One month ago, she was also diagnosed with anemia. She has no other complaints. Physical examination of her lower extremities found erythematous indurated lesions with crusting and scaling. Biopsy of the lesions shows superficial necrolysis. Which of the following hormones is most likely to be elevated in this patient?

A) Gastrin

B) Insulin

C) Glucagon

D) VIP

E) Somatostatin

F) PTHrP

1. A 43-year-old male discovers a neck lump while bathing and decides to visit his physician. Past medical history is only significant for having his appendix removed when he was 22 years old. He has no other complaints. Physical examination reveals normal blood pressure and heart rate all systems are normal. A palpable neck mass was noted on examination and fine-needle aspiration was ordered. A total thyroidectomy is necessary based on the results from the fine needle aspirate. Histologic analysis of the excised nodule reveals branching lesions with interspersed concentrically calcified structures. Which of the following is the most likely diagnosis?

A) Papillary carcinoma

B) Follicular carcinoma

C) Anaplastic carcinoma

D) Medullary carcinoma

E) Solitary adenoma

1. A 33-year-old male visits the physician after discovering a lump in his neck while in the shower. He was recently diagnosed with pheochromocytoma which he had successfully removed. His family history is significant for his father who died of thyroid cancer in his 30s. He is sent for laboratory studies and an excisional biopsy of the lump in his neck. What histological findings is most likely to be noted from this patient's biopsy?

A) Follicular hyperplasia with tall cells forming intrafollicular projections

B) Branching structures with interspersed calcified bodies

C) Sheets of uniform cells forming small follicles

D) Nests of polygonal cells with Congo red-positive deposits

E) Pleomorphic giant cell nests with occasional multinucleated cells