A normal weight 28 y/o female with secondary oligomenorrhea and galactorrhea presents to your office. Her prolactin level is elevated. MRI of the sella reveals a 5 mm pituitary microadenoma. Prolactin level is elevated and you suspect this is a prolactinoma. Other pituitary hormones are normal. Which of the following statements regarding prolactinomas is/are true?

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Question 1 of 5

A normal weight 28 y/o female with secondary oligomenorrhea and galactorrhea presents to your office. Her prolactin level is elevated. MRI of the sella reveals a 5 mm pituitary microadenoma. Prolactin level is elevated and you suspect this is a prolactinoma. Other pituitary hormones are normal. Which of the following statements regarding prolactinomas is/are true?

Correct Answer: B

Rationale: Prolactinomas cause hyperprolactinemia, leading to oligomenorrhea and galactorrhea. Dopamine agonists like cabergoline or bromocriptine effectively lower prolactin levels, shrink the tumor, and improve symptoms, making B true. Pregnancy is possible with treatment, and annual MRIs are not required if prolactin is controlled.

Question 2 of 5

50 yo patient presents with numbness of the first three fingers of the right hand. Which of the following findings on physical exam are supportive of carpal tunnel syndrome?

Correct Answer: A

Rationale: Tinel's sign (symptoms with tapping) is a classic finding in carpal tunnel syndrome, involving median nerve compression.

Question 3 of 5

Which of the following mechanisms best explains how antimetabolites work in cancer treatment?

Correct Answer: D

Rationale: Antimetabolites (e.g., 5-FU, methotrexate) mimic normal substrates, competing for enzyme sites or incorporating into DNA/RNA, disrupting synthesis. Other options describe different drug classes (e.g., topoisomerase inhibitors, tyrosine kinase inhibitors).

Question 4 of 5

Suspecting acute Pneumocystis pneumonia, which is the most important study to immediately order?

Correct Answer: A

Rationale: ABGs are critical in assessing respiratory function and oxygenation status in suspected Pneumocystis pneumonia.

Question 5 of 5

Man in ER coma. Labs: Serum Na 131 mEq/L, K 2.9 mEq/L, Cl 70 mEq/L, CO2 21 mEq/L, blood urea nitrogen 34, creatinine 1.4 mg/dl, glucose 240 mg/dl, serum osmolality 320 mOsm/kg H2O, serum ketones weakly+, pH 7.53, PaCO2 25, and serum albumin 3.8. Which ONE of the following choices BEST describes his acid-base disturbance?

Correct Answer: D

Rationale: The combination of high anion gap metabolic acidosis from ketones, metabolic alkalosis from vomiting or diuretic use, and respiratory alkalosis from compensatory mechanisms explains the complex disturbance.

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