Exam Master Heeeem And Endocrine Questions And Correct Answers

EXAM MASTER HEEEEM AND
ENDOCRINE QUESTIONS AND CORRECT
ANSWERS
AA246-year-
oldA2womanA2underwentA2electiveA2cholecystectomy.A2TheA2attendingA2nurseA2notedA2mil
dA2bleedingA2atA2theA2siteA2ofA2IVA2lineA2andA2theA2incisionA2siteA2duringA2dressing.A2TheA2
patientA2alsoA2reportedA2bleedingA2fromA2theA2gumsA2andA2nose.A2CoagulationA2profilesA2
revealedA2prolongationA2ofA2aPTT,A2PT,A2andA2TT;A2decreasedA2fibrinogenA2level;A2andA2i
ncreasedA2levelsA2ofA2fibrinogenA2degradationA2productA2(FDP).A2PlateletA2countA2wasA2al
soA2decreased.A2TheA2patientA2wasA2notA2experiencingA2anyA2bleedingA2disorderA2beforeA
2herA2hospitalization.


QuestionA2-A2WhatA2isA2theA2mostA2likelyA2causeA2ofA2thisA2patient'sA2bleedingA2tendency?

AnswerA2ChoicesA2
1A2DeficiencyA2ofA2clottingA2factorsA2ofA2theA2intrinsicA2pathwayA2
2A2DeficiencyA2ofA2clottingA2factorsA2ofA2theA2extrinsicA2pathwayA2
3A2PlateletA2functionalA2defect
4A2DisseminatedA2intravascularA2coagulationA2
5A2UnderlyingA2liverA2diseaseA2-A2Ans--
CorrectA2Answer:A2DisseminatedA2intravascularA2coagulation
-
A2ProlongationA2ofA2aPTT,A2PT,A2andA2TT;A2decreasedA2fibrinogenA2level;A2increasedA2lev
elsA2ofA2FDP;A2andA2decreasedA2plateletA2countA2indicateA2disseminatedA2intravascularA2
coagulationA2(DIC).A2DICA2isA2anA2acquiredA2syndromeA2characterizedA2byA2bleedingA2fro
mA2multipleA2sites,A2ecchymoses,A2mucosalA2bleeding,A2andA2depletionA2ofA2plateletsA2an
dA2clottingA2factorsA2inA2theA2blood.A2TheA2causesA2ofA2DICA2includeA2infectionsA2(bacteria
A2andA2theirA2toxins,A2fungi,A2viruses,A2rickettsiae),A2obstetricA2andA2gynecologicalA2cause
sA2(suchA2asA2abruptioA2placentae,A2abortions,A2eclampsia,A2amnioticA2fluidA2embolism),A2
hemorrhagicA2shock,A2malignancy,A2snakeA2venom,A2trauma,A2andA2transfusions.

DiagnosticA2findingsA2includeA2coagulationA2abnormalitiesA2suchA2asA2prolongedA2prothro
mbinA2timeA2(PT),A2activatedA2partialA2thromboplastinA2timeA2(aPTT),A2thrombinA2timeA2(T
T),A2decreasedA2fibrinogenA2levels;A2increasedA2levelsA2ofA2FDP;A2presenceA2ofA2D-
dimer;A2andA2decreasedA2plateletA2count.A2TheA2mainstayA2ofA2managementA2involvesA2tr
eatmentA2ofA2theA2underlyingA2cause.A2BloodA2productsA2suchA2asA2plateletA2concentrate
s,A2freshA2frozenA2plasma,A2orA2cryoprecipitateA2canA2alsoA2beA2administered.

DeficiencyA2ofA2clottingA2factorsA2ofA2theA2intrinsicA2pathwayA2isA2consistentA2withA2hemop
hiliaA2AA2orA2hemophiliaA2B.A2LaboratoryA2findingsA2includeA2aA2prolongedA2PTTA2andA2lo
wA2factorA2VIIIA2coagulantA2levelA2(hemophiliaA2A)A2orA2lowA2factorA2IXA2coagulantA2levelA2
(hemophiliaA2B).A2PlateletA2countA2andA2FDPA2wouldA2beA2normal.

,DeficiencyA2ofA2clottingA2factorsA2ofA2theA2extrinsicA2pathwayA2isA2consistentA2withA2factorA
2VIIA2deficiency.A2ThisA2isA2aA2rareA2geneticA2coagulopathyA2resultingA2inA2prolongedA2PT,
A2normalA2aPTT,A2andA2lowA2levelsA2ofA2factorA2VII.


PlateletA2functionalA2defectsA2areA2aA2congenitalA2bleedingA2disorderA2resultingA2inA2decre
asedA2functionA2ofA2platelets.A2LaboratoryA2findingsA2includeA2thrombocytopeniaA2andA2in
creasedA2bleedingA2time.A2ThisA2wouldA2notA2affectA2coagulation,A2soA2aPTTA2andA2PT

AA240-year-
oldA2womanA2presentsA2withA2anxiety,A2difficultyA2sleeping,A2rapidA2heartbeat,A2andA2aA2tr
emorA2inA2herA2handsA2forA2theA2pastA23A2months.A2SheA2hasA2alsoA2notedA2weightA2loss.A
2YouA2noteA2theA2presenceA2ofA2bulgingA2eyes.


QuestionA2-
A2WhatA2glandA2isA2responsibleA2forA2secretingA2theA2hormoneA2involvedA2inA2makingA2this
A2patient'sA2diagnosis?


AnswerA2ChoicesA2
1A2AdrenalA2glandA2
2A2PancreasA2
3A2ThyroidA2glandA2
4A2OvaryA2
5A2PinealA2glandA2-A2Ans--CorrectA2Answer:A2ThyroidA2gland
-
A2ThisA2patientA2presentsA2withA2signsA2andA2symptomsA2ofA2Graves'A2disease,A2aA2resultA
2ofA2abnormalA2productionA2ofA2thyroidA2hormonesA2secondaryA2toA2productionA2ofA2autoa
ntibodiesA2toA2theA2thyroid-
stimulatingA2hormoneA2receptor.A2OveractivityA2ofA2theA2entireA2thyroidA2glandA2resultsA2in
A2increasedA2productionA2andA2secretionA2ofA2thyroidA2hormone,A2leadingA2toA2theA2clinica
lA2manifestationA2ofA2hyperthyroidism.A2TheA2patientA2appearsA2hotA2andA2flushed,A2andA2
theA2thyroidA2glandA2enlargesA2inA2thisA2condition.A2WeightA2lossA2occurs,A2followedA2byA2
otherA2symptomsA2suchA2asA2trembling,A2muscleA2weaknessA2ofA2theA2upperA2armsA2andA
2thighs,A2andA2insomnia.


TheA2pancreasA2secretesA2insulinA2andA2glucagon.

TheA2adrenalA2glandA2hasA2multipleA2layersA2thatA2secreteA2differentA2hormones,A2includi
ngA2corticosteroidsA2andA2catecholamines.

OvariesA2secreteA2estrogenA2andA2progesterone.

TheA2pinealA2glandA2producesA2melatonin.

AA213-year-oldA2AfricanA2AmericanA2boyA2presentsA2withA2aA24-
monthA2historyA2ofA2increasingA2fatigue,A2pallor,A2exertionalA2dyspnea,A2andA2depression.

,A2 PastA2medicalA2historyA2isA2significantA2forA2anA2ischemicA2strokeA2dueA2toA2sickleA2cellA2
diseaseA26A2yearsA2ago.A2SinceA2hisA2stroke,A2theA2boyA2hasA2beenA2receivingA2chronicA2r
edA2cellA2transfusionA2therapy,A2andA2subcutaneousA2ironA2chelationA2therapyA2startedA23
A2yearsA2ago.
OnA2physicalA2exam,A2pulseA2isA2150A2bpm,A2respirationsA2areA220/
min,A2bloodA2pressureA2isA2105/75A2mmA2Hg,A2andA2O2A2saturationA2byA2pulseA2oximetryA
2isA292%A2onA2roomA2air.A2InA2general,A2heA2appearsA2ill;A2heA2isA2dyspneicA2andA2refuses
A2toA2lieA2flatA2onA2theA2bedA2duringA2hisA2examination.A2Otherwise,A2heA2isA2cooperativeA2
withA2hisA2exam.A2HeA2isA2diaphoretic,A2withA2noA2rashesA2orA2skinA2abnormalitiesA2noted.
A2HisA2cardiovascularA2examA2isA2significantA2forA2aA24/6A2systolicA2ejectionA2murmurA2an
dA2aA2gallop.A2HisA2pulmonaryA2examA2demonstratesA2scatteredA2expiratoryA2wheezesA2t
hroughoutA2allA2lungA2fields.A2HisA2liverA2isA24A2cmA2-A2Ans--
CorrectA2Answer:A2Hemoglobin,A2ferritin,A2liverA2functionA2tests,A2chestA2X-
ray,A2echocardiogram
-
A2ThisA2patient'sA2historyA2andA2physicalA2areA2mostA2consistentA2withA2congestiveA2cardi
omyopathyA2dueA2toA2ironA2overload.A2PatientsA2receivingA2chronicA2redA2cellA2transfusion
sA2canA2developA2complicationsA2ofA2ironA2overloadA2despiteA2receivingA2adequateA2ironA2
chelationA2therapy.A2AlthoughA2allA2ofA2theA2studiesA2listedA2mayA2beA2neededA2atA2someA
2pointA2duringA2theA2evaluationA2andA2treatmentA2ofA2thisA2patient,A2hemoglobin,A2ferritin,A
2liverA2functionA2tests,A2chestA2X-
ray,A2andA2echocardiogramA2offerA2theA2mostA2importantA2informationA2neededA2toA2confir
mA2theA2diagnosisA2andA2betterA2determineA2theA2immediateA2clinicalA2stabilityA2ofA2theA2p
atient.

HemoglobinA2willA2determineA2theA2patient'sA2degreeA2ofA2anemiaA2andA2assistA2withA2dec
isionmakingA2regardingA2possibleA2transfusionA2aimedA2atA2maximizingA2clinicalA2stability.
A2AA2hematologistA2shouldA2beA2consultedA2regardingA2transfusionA2needs.A2TheA2hemato
logistA2mayA2requestA2aA2hemoglobinA2SA2quantificationA2beforeA2anyA2transfusionA2thera
pyA2toA2determineA2theA2bestA2transfusionA2optionA2forA2thisA2patient.

FerritinA2willA2offerA2supportiveA2evidenceA2forA2aA2diagnosisA2ofA2ironA2overload.

AA2chestA2X-
rayA2willA2assistA2withA2theA2evaluationA2ofA2aA2possibleA2cardiacA2abnormalityA2andA2ruleA
2outA2evidenceA2ofA2primaryA2pulmonaryA2parenchymalA2disease.


LiverA2functionA2testsA2shouldA2beA2carriedA2outA2forA2theA2evaluationA2ofA2liverA2statusA2in
A2patientsA2withA2sickleA2cellA2onA2chronicA2transfusionA2therapy.


TheA2mostA2criticalA2studyA2isA2theA2echocardiogram,A2whichA2willA2confirmA2theA2diagnosi
sA2ofA2congestiveA2heartA2failure.A2EchocardiographiesA2inA2childrenA2andA2radionuclideA2
ventriculographyA2inA2adultsA2areA2theA2mostA2usefulA2determinantsA2ofA2congestiveA2card
iomyopathyA2fromA2ironA2overload.

, AA222-year-oldA2womanA2presentsA2withA2aA22-
monthA2historyA2ofA2weightA2lossA2despiteA2theA2womanA2havingA2aA2goodA2appetite.A2She
A2alsoA2reportsA2ofA2havingA2frequentA2boutsA2ofA2diarrhea.A2OnA2detailedA2questioning,A2s
heA2revealsA2aA2feelingA2ofA2heatA2intoleranceA2andA2menstrualA2irregularity.A2TheA2rightA2l
obeA2ofA2theA2thyroidA2isA2palpablyA2enlarged,A2andA2furtherA2investigationsA2confirmA2the
A2suspectedA2diagnosis.


QuestionA2-A2WhatA2pairA2ofA2symptomsA2isA2characteristicA2ofA2thisA2diseaseA2state?
AnswerA2ChoicesA2
1A2FatigueA2andA2lethargyA2
2A2PalpitationsA2andA2tremors
3A2SlowedA2speechA2andA2movementA2
4A2ThickeningA2andA2drynessA2ofA2skinA2
5A2ImpairedA2memoryA2andA2sleepinessA2-A2Ans--
CorrectA2Answer:A2PalpitationsA2andA2tremors
-
A2TheA2commonA2symptomsA2ofA2hyperthyroidismA2includeA2nervousness,A2palpitation,A2tr
emors,A2weightA2lossA2withA2preservedA2appetite,A2heatA2intolerance,A2diarrhea,A2increas
edA2perspiration,A2andA2decreasedA2menstrualA2flow.A2CommonA2signsA2includeA2tachyca
rdia,A2systolicA2hypertension,A2hyperactivity,A2atrialA2fibrillation,A2lidA2lag,A2eyelidA2retractio
n,A2tremors,A2andA2hyperreflexia.

CausesA2ofA2hyperthyroidismA2includeA2Graves'A2diseaseA2(mostA2common),A2toxicA2aden
oma,A2toxicA2multinodularA2goiter,A2sub-
acuteA2thyroiditis,A2lymphocyticA2thyroiditis,A2factitiousA2hyperthyroidism,A2andA2strumaA2o
varii.A2DiagnosisA2isA2byA2completeA2historyA2andA2examinationA2inA2correlationA2withA2co
mpleteA2bloodA2countA2andA2thyroidA2profile.A2OtherA2testsA2includeA2radioactiveA2iodineA2
uptake,A2fineA2needleA2aspirationA2cytologyA2(FNAC),A2andA2biopsy.

TreatmentA2dependsA2onA2theA2causeA2andA2severityA2ofA2theA2disease,A2theA2patient'sA2a
ge,A2comorbidA2conditions,A2goiterA2size,A2andA2treatmentA2requirements.A2TheA2goalA2ofA
2therapyA2isA2theA2correctionA2ofA2theA2hypermetabolicA2stateA2withA2theA2fewestA2sideA2eff
ectsA2andA2theA2lowestA2incidenceA2ofA2hypothyroidism.A2AntithyroidA2drugs,A2radioactiveA
2iodine,A2betaA2blockers,A2andA2surgeryA2areA2theA2mainA2treatmentA2options.


FatigueA2andA2lethargy,A2slowedA2speechA2andA2movement,A2thickeningA2andA2drynessA2
ofA2skin,A2andA2impairedA2memoryA2andA2sleepinessA2areA2featuresA2associatedA2withA2hy
pothyroidism.

Case
AA232-year-
oldA2womanA2presentsA2withA2malaise,A2excessiveA2urination,A2andA2palpitations.A2HerA2s
ymptomsA2beganA2approximatelyA22A2monthsA2agoA2andA2haveA2beenA2gettingA2moreA2pr
onouncedA2withA2time.A2SheA2findsA2herselfA2cravingA2ice-
coldA2waterA2andA2drinkingA2onA2anA2almostA2continualA2basis.A2NoA2matterA2howA2muchA2
sheA2drinks,A2sheA2neverA2seemsA2toA2satisfyA2herA2thirst.A2TheA2patientA2hadA2beenA2very