ATI LPN
Medical Surgical Endocrine ATI Questions
Question 1 of 5
A 48-year-old man has had increased swelling in the extremities for 2 months. Physical examination showed generalized edema. A 24-hour urine collection yielded 4.1 g of protein (albumin and globulins). He did not respond to a course of corticosteroid therapy. A renal biopsy was done, and microscopic examination showed diffuse thickening of the basement membrane. Immunofluorescence staining with antibody to the C3 component of complement was positive in a granular pattern in the glomerular capillary loops. Two years later, he experiences increasing malaise. Laboratory studies now show serum creatinine level of 4.5 mg/dL and urea nitrogen level of 44 mg/dL. Which of the following immunologic mechanisms was most likely responsible for the glomerular changes observed in the biopsy specimen?
Correct Answer: D
Rationale: Nephrotic syndrome may be produced by an idiopathic form of membranous nephropathy. Diffuse basement membrane thickening, in the absence of proliferative changes, and granular deposits of IgG and C3 are typical of this condition. It is caused by antibody targeting M-type phospholipase A 2 receptor antigen, the deposition of immune complexes on the basement membrane, and complement activation. In 75% of patients with membranous nephropathy, the cause of immune complex deposition is unknown. In the remaining cases an associated systemic disease (e.g. systemic lupus erythematosus) or some known cause of immune complex formation (e.g., drug reaction) exists. Antibodies that react with basement membrane give rise to a linear immunofluorescence pattern, as in Goodpasture syndrome. Membranous nephropathy has no association with streptococcal infections. There also is no evidence of cytokine-mediated or T cell-mediated damage in this disease.
Question 2 of 5
A study of patients more than 25 years of age with body mass index above 30, dyslipidemia, hypertension, and fasting glucose averaging 115 mg/dL is performed. They have adipose tissue abnormalities including increased nonesterified fatty acid release, altered adipokines with decreased adiponectin, greater proinflammatory cytokine release, and diminished peroxisome proliferator-activated receptor gamma (PPARγ) function. Which of the following is the best initial therapeutic intervention for these patients?
Correct Answer: B
Rationale: The findings are those of insulin resistance from obesity with metabolic syndrome. Insulin resistance drives beta cell dysfunction, but other factors such as the TCF7L2 gene play a role in eventual development of overt type 2 diabetes mellitus. Excess free fatty acids may stimulate cytokine release from beta cells to promote inflammation and islet cell dysfunction. Lifestyle modification with dietary modification for weight reduction coupled with increased exercise will aid in reversing the insulin resistance so that no drug therapy is needed to control hyperglycemia.
Question 3 of 5
A 19-year-old, previously healthy woman collapsed after complaining of a mild sore throat the previous day. On examination she is hypotensive and febrile with purpuric skin lesions. Her peripheral blood smear shows schistocytes. Imaging studies show her adrenal glands are enlarged, and there are extensive bilateral cortical hemorrhages. Infection with which of the following organisms best accounts for these findings?
Correct Answer: D
Rationale: This is the typical adrenal finding in Waterhouse-Friderichsen syndrome, and meningococcemia is the most likely cause of such a rapid course. Chronic adrenocortical insufficiency can result from disseminated tuberculosis and from fungal infections, such as histoplasmosis, that involve the adrenal glands.
Question 4 of 5
Which of the following is not an effect of a hormone secreted by the adrenal gland?
Correct Answer: D
Rationale: Adrenal hormones (cortisol, epinephrine) raise glucose, mimic SNS, reduce inflammation; thirst is regulated by hypothalamus/ADH, not adrenal.
Question 5 of 5
Which of the following is a valve that contains 2 cusps and allows blood to flow into a ventricle?
Correct Answer: D
Rationale: Mitral (bicuspid) valve has 2 cusps, allows flow from left atrium to ventricle.