ATI LPN
Medical Surgical Endocrine Questions Questions
Question 1 of 5
A 25-year-old man has a 5-year history of celiac sprue. Four days after a mild upper respiratory infection, he begins passing dark red-brown urine. The dark urine persists for the next 3 days and then becomes clear and yellow, only to become red-brown again 1 month later. There are no remarkable findings on physical examination. Urinalysis shows a pH of 6.5; specific gravity, 1.018; 3+ hematuria; 1+ proteinuria; and no glucose or ketones. Microscopic examination of the urine shows RBCs, but no WBCs, casts, or crystals. A 24-hour urine protein level is 200 mg. A renal biopsy specimen from the glomeruli of this patient is most likely to show which of the following alterations?
Correct Answer: C
Rationale: IgA nephropathy (also known as Berger disease) can explain this nephritic condition with the presence of recurrent hematuria in a young adult. Nephrotic syndrome is not present, and mesangial IgA deposition is characteristic. The initial episode of hematuria usually follows an upper respiratory infection. IgA nephropathy occurs with increased frequency in patients with celiac disease and liver disease. It proceeds to chronic renal failure within 20 years in up to half of cases. Diffuse proliferation and basement membrane thickening denote membranoproliferative glomerulonephritis (GN), with IgG and C3 deposited in the glomeruli. Granular staining of basement membrane with IgG antibodies denotes immune complex deposition, which may occur in postinfectious GN, along with subepithelial deposits seen on electron microscopy. Patients with these changes also have nephritic syndrome. Glomerular capillary thrombosis is typical of hemolytic uremic syndrome.
Question 2 of 5
A 45-year-old woman has had angina pectoris, polyuria, and polydipsia for the past 5 years. On physical examination, she has a body mass index of 32. Laboratory studies show her hemoglobin A1c is 10%. Urinalysis shows proteinuria, but no ketonuria. The representative microscopic appearance of her kidneys is shown in the figure. Which of the following is the most likely mechanism leading to the disease causing her findings?
Correct Answer: C
Rationale: Nodular glomerulosclerosis, as shown in the figure, is a characteristic feature of renal involvement in diabetes mellitus and explains her proteinuria (which may progress to nephrotic syndrome). Peripheral insulin resistance is strongly linked to type 2 diabetes mellitus. Her history is classic for type 2 diabetes, as is the elevated hemoglobin A1c.
Question 3 of 5
A 26-year-old man developed sudden severe abdominal pain. On physical examination, he had marked abdominal tenderness and guarding. Laboratory studies showed serum glucose, 76 mg/dL; calcium, 12.2 mg/dL; phosphorus, 2.6 mg/dL; creatinine, 1.1 mg/dL; and parathyroid hormone, 62 pg/mL (normal range 9 to 60 pg/mL). During surgery, four enlarged parathyroid glands were found and excised, with reimplantation of one half of one gland. After the surgery, his serum calcium concentration returned to normal. Three years later, he had an episode of upper gastrointestinal hemorrhage. An endoscopy and biopsy specimen showed multiple benign gastric ulcerations. Abdominal MRI indicated multiple 1- to 2-cm mass lesions in the pancreas. He underwent surgery, and multiple tumors were found. Which of the following additional neoplasm lesions is he most likely to have?
Correct Answer: C
Rationale: Multiple endocrine neoplasia (MEN) type 1 is also known as Wermer syndrome. (Remember the 'three P's' in neoplasia or hyperplasia "pancreas, pituitary, and parathyroids.) Adrenal pheochromocytomas are associated with MEN 2B. Endometrial carcinomas can arise in patients who have unopposed estrogen secretion, which can occur in estrogen-producing ovarian tumors.
Question 4 of 5
Which of the following is found in rigor mortis?
Correct Answer: A
Rationale: Rigor mortis involves rigid contraction due to ATP depletion locking myosin to actin; Ca2+ leaks but doesn't 'build up', tropomyosin shifts.
Question 5 of 5
Which statement is false regarding blood flow and phase of the cardiac cycle?
Correct Answer: D
Rationale: When pulmonary artery pressure is lower than ventricle, blood flows out (systole).