ATI LPN
Medical Surgical Endocrine Quiz Questions
Question 1 of 5
The nurse correlates which laboratory value to a patient diagnosed with hypoparathyroidism?
Correct Answer: A
Rationale: Diagnostic results consistent with hypoparathyroidism include low serum calcium levels, high serum phosphate levels, and low serum parathyroid hormone (PTH) levels.
Question 2 of 5
A 29-year-old man with chronic hepatitis C virus infection has noted dark urine for the past 2 weeks. On examination he is hypertensive but afebrile. Laboratory studies show serum creatinine of 3.8 mg/dL and urea nitrogen of 35 mg/dL. Cryoglobulins are detected. Urinalysis shows RBCs and RBC casts. A renal biopsy is performed and microscopically shows hypercellular glomeruli with lobulation and a double-contour appearance to split basement membranes adjacent to subendothelial immune complexes. Which of the following cell types has most likely proliferated in his glomeruli?
Correct Answer: B
Rationale: The appearance of membranoproliferative glomerulonephritis, a cause for nephritic syndrome in adults, is described. Mesangial cells have a phagocytic function, but they also can elaborate inflammatory mediators, cytokines, and matrix. Proliferation of mesangial cells may be induced by injury, particularly immune complex deposition. Juxtaglomerular cells secrete renin. Parietal epithelial cells line the Bowman capsule and may proliferate with severe glomerular injury to produce crescents. Podocytes are visceral epithelial cells that form the filtration barrier. Endothelial cells are most likely to be damaged with thrombotic microangiopathies.
Question 3 of 5
One week after a mild flulike illness, a 9-year-old boy has an episode of hematuria that subsides within 2 days. One month later, he tells his parents that his urine is red again. On physical examination, there are no significant findings. Urinalysis shows a pH of 7; specific gravity, 1.015; 1+ proteinuria; 1+ hematuria; and no ketones, glucose, or urobilinogen. The serum urea nitrogen level is 36 mg/dL, and the creatinine level is 3.2 mg/dL. Serum electrophoresis shows increased IgA1. Which of the following glomerular structures is most likely to show structural alterations in this boy?
Correct Answer: C
Rationale: Development of recurrent hematuria after a viral illness in a child or young adult is typically associated with IgA nephropathy. A renal biopsy specimen will show diffuse mesangial proliferation and electron-dense deposits in the mesangium. In these patients, some defect in immune regulation causes excessive mucosal IgA synthesis in response to viral or other environmental antigens. IgA complexes are deposited in the mesangium and initiate glomerular injury. Defects in the structure of glomerular basement membrane are a feature of hereditary nephritis, and antibodies against type IV collagen are formed in Goodpasture syndrome. The parietal epithelium may react with proliferation to form crescents when fibrinogen leaks into the Bowman space with severe glomerulonephritis. Podocytes may by affected by many forms of glomerular disease, but singularly malfunction in minimal change disease.
Question 4 of 5
A 40-year-old woman notes lethargy, weakness, and constipation for the past 6 months. On physical examination, she is afebrile and normotensive, and her heart rate is irregular. There is pain on palpation of the left third proximal finger. An ECG shows a prolonged QT (corrected) interval. Laboratory studies show glucose, 73 mg/dL; creatinine, 1.2 mg/dL; calcium, 11.6 mg/dL; phosphorus, 2.1 mg/dL; total protein, 7.1 g/dL; albumin, 5.3 g/dL; and alkaline phosphatase, 202 U/L. A radiograph of the left hand shows focal expansion by a cystic lesion of the third proximal phalanx. A technetium radionuclide scan shows a 1-cm area of increased uptake in the right lateral neck. A mutation in which of the following genes is most likely present in this woman?
Correct Answer: B
Rationale: A parathyroid neoplasm, most likely an adenoma, is causing hypercalcemia complicated by osteitis fibrosa cystica of her finger. Parathyroid hyperplasia involving all the glands is less likely. Parathyroid carcinomas are rare, thankfully, because they are aggressive, and serum calcium levels may be so high that cardiac arrhythmias occur. The MEN1 mutation is the second most common mutation in parathyroid tumors, after the inversion with overexpression of CCND1, the gene encoding cyclin D1. MEN1 is a tumor suppressor gene, the loss of which occurs not only in sporadic parathyroid tumors, but also in multiple endocrine neoplasia (MEN) type 1.
Question 5 of 5
A 74-year-old woman is admitted to the hospital in an obtunded condition. Her temperature is 37°C, pulse is 95/min, respirations are 22/min, and blood pressure is 90/60 mm Hg. She appears dehydrated and has poor skin turgor. Her serum glucose level is 872 mg/dL. Urinalysis shows 4+ glucosuria, but no ketones, protein, or blood. Which of the following factors is most important in the pathogenesis of this patient's condition?
Correct Answer: D
Rationale: A complication of type 2 diabetes mellitus is hyperosmolar, nonketotic coma. In type 2 diabetes mellitus, the fundamental defect is insulin resistance, leading to an eventual decrease in plasma insulin or a relative lack of insulin, but there is still enough insulin to prevent ketosis. The resulting hyperglycemia tends to produce polyuria, leading to dehydration, which increases the serum glucose level further.