Q1

Q1.
ANSWER: C

Cushing syndrome is characterized by hypertension, hyperglycemia, and

weight gain. Common causes include excess glucocorticoid intake, ACTH-
producing pituitary adenoma, and ectopic ACTH production.
Q2
Q2.
ANSWER: D
Metabolic acidosis during diabetic ketoacidosis (DKA) is typically
accompanied by hyperkalemia.

The main causes of this “paradoxical” hyperkalemia are:

1) extracellular shift of potassium in exchange to hydrogen ion, with
resultant intracellular potassium deficit
2) impaired insulin-dependent cell entry of the potassium ion.
Q3
Q3.
ANSWER: F

Thyroid storm is a life-threatening thyrotoxicosis often triggered by thyroid or

non-thyroid surgery, trauma, infection, iodine contrast, or childbirth. It is
characterized by tachycardia, hypertension, cardiac arrhythmias, high fever,
tremor, altered mentation.
Q4
Q4.
ANSWER: D

The beneficial effect of ACE inhibitors is due to the reduction in blood pressure as
well as the direct effect on reducing intraglomerular pressure.
Q5
Q5.
ANSWER: C

Patients with osteomalacia due to vitamin D deficiency (to small-bowel resection and
gastrointestinal malabsorption from Crohn's disease) have low or low-normal serum
calcium, low serum phosphate, increased serum parathyroid hormone, low plasma
25-0H vitamin D levels, and elevated alkaline phosphatase.
Q6
Q6.
ANSWER: A

Chronic gastrointestinal disease (eg, steatorrhea, celiac disease) can cause vitamin D
deficiency due to malabsorption. Patients usually develop hypocalcemia, low
phosphorus, and elevated parathyroid hormone.
Q7
Q7.
Answer: D

Embolism - Hyperventilation- respiratory alkalosis - hypocalcemia

Increased extracellular pH (eg, respiratory alkalosis) causes dissociation of

hydrogen ions from albumin, allowing increased binding of calcium and a
drop in unbound (ionized) calcium. Ionized calcium is the physiologically
active form, and decreased levels can result in clinical manifestations of
hypocalcemia.
Q8
Q8.
ANSWER: E

Hypothyroidism is the most common side effect of radioiodine therapy, but it is

easily treated with levothyroxine therapy.
Q9
Q9.
ANSWER: C

This patient has several features of chronic primary adrenal insufficiency (PAl),
including weight loss, abdominal pain, and fatigue.

Hyperpigmentation is a common finding and is due to co-secretion of

melanocyte-stimulating hormone with ACTH (both are derived from
proopiomelanocortin), which is increased in response to cortisol deficiency.

In addition, loss of mineralocorticoid production can cause hypotension,

hyponatremia, and hyperkalemia.
Q10
Q10.
ANSWER: D

Hypothyroidism is an important cause of reversible changes in memory and

mentation. It will be accompanied by systemic changes such as weight gain,
fatigue, and constipation.