A 44-year-old woman has become increasingly listless and weak and has had chronic diarrhea and a 5-kg weight loss over the past 7 months. She also notices that her skin seems darker, although she rarely goes outside because she is too tired for outdoor activities. On physical examination, she is afebrile, and her blood pressure is 85/50 mm Hg. A chest radiograph shows no abnormal findings. Laboratory findings include serum Na+, 120 mmol/L; K+, 5.1 mmol/L; glucose, 58 mg/dL; urea nitrogen, 18 mg/dL; and creatinine, 0.8 mg/dL. The serum corticotropin level is 82 pg/mL. Which of the following is most likely to account for these findings?

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Question 1 of 5

A 44-year-old woman has become increasingly listless and weak and has had chronic diarrhea and a 5-kg weight loss over the past 7 months. She also notices that her skin seems darker, although she rarely goes outside because she is too tired for outdoor activities. On physical examination, she is afebrile, and her blood pressure is 85/50 mm Hg. A chest radiograph shows no abnormal findings. Laboratory findings include serum Na+, 120 mmol/L; K+, 5.1 mmol/L; glucose, 58 mg/dL; urea nitrogen, 18 mg/dL; and creatinine, 0.8 mg/dL. The serum corticotropin level is 82 pg/mL. Which of the following is most likely to account for these findings?

Correct Answer: B

Rationale: Chronic adrenal insufficiency (Addison disease) results in decreased cortisol production and decreased mineralocorticoid activity. The skin hyperpigmentation results from increased corticotropin precursor hormone production, which also stimulates melanocytes. The most common cause of Addison disease, in areas where tuberculosis is not endemic, is autoimmune adrenalitis.

Question 2 of 5

Which of the following statements is false regarding the cardiac conducting system?

Correct Answer: D

Rationale: SA node, not AV node, is the pacemaker (60-100 bpm); AV node delays signal.

Question 3 of 5

Type AB blood has which erythrocyte surface typing antigens?

Correct Answer: C

Rationale: Type AB has both A and B antigens on RBCs.

Question 4 of 5

An inflammatory response is triggered when:

Correct Answer: C

Rationale: Mast cells release histamine/heparin, causing inflammation; cortisone suppresses it.

Question 5 of 5

In which direction does carbon dioxide move during external respiration?

Correct Answer: B

Rationale: External respiration: CO2 moves from blood to alveoli, then exhaled.

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