ATI LPN
Medical Surgical Endocrine Questions Questions
Question 1 of 5
A 36-year-old woman has had increased malaise for 3 weeks and urine output <500 mL/day for the past 4 days. On examination, she has blood pressure 170/112 mm Hg and peripheral edema. Urinalysis shows protein 1+ and blood 3+, but no glucose or ketones. Urine microscopic analysis shows RBCs and RBC casts. Her serum urea nitrogen is 39 mg/dL, and creatinine is 4.3 mg/dL. Her serum complement C1q, C3, and C4 are decreased. A renal biopsy is performed, and immunofluorescence microscopy shows a granular pattern of staining with antibody to C3. Which of the following types of hypersensitivity reactions is most likely causing her renal disease?
Correct Answer: C
Rationale: The findings fit with immune-mediated glomerular injury with antigen-antibody complex deposition, typical of an underlying disease such as SLE, and nephritic picture. Type I hypersensitivity may play a role in drug-induced acute interstitial nephritis. Type II hypersensitivity is present with anti-glomerular basement membrane diseases, such as Goodpasture syndrome. Type IV hypersensitivity plays a role in renal transplant rejection and some cases of drug-induced interstitial nephritis.
Question 2 of 5
A 63-year-old woman had frequent headaches for 1 month. She now suddenly experiences a generalized seizure and becomes obtunded. She is taken to the emergency department, where a physical examination reveals an irregular heart rate. Laboratory findings include serum calcium of 15.4 mg/dL, serum phosphorus of 1.9 mg/dL, and albumin of 4.2 g/dL. A chest radiograph shows multiple lung masses and lytic lesions of the vertebral column. Which of the following conditions best accounts for these findings?
Correct Answer: C
Rationale: A common cause of clinically significant hypercalcemia in adults is a malignancy. When a patient presents with hypercalcemia, a disorder of the parathyroid glands or a malignancy at a visceral location must be considered. Hypercalcemia from malignancy can be caused by osteolytic metastases or a paraneoplastic syndrome from secretion of parathyroid hormone-related protein by the tumor. Metastatic disease from common primary sites, such as the breast, lung, and kidney, is much more common than parathyroid carcinoma, which tends to be local but aggressive.
Question 3 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 4 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 5 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.