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8

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A 55-year-old diabetic woman suddenly develops weakness of the left side of her face as well as of her right arm and leg. She also has diplopia on left lateral gaze. The responsible lesion is probably located in the

 

spacer.gifA)spacer.gifRight cerebral hemispherespacer.gif

B)spacer.gifLeft cerebral hemispherespacer.gif

C)spacer.gifRight side of the brainstem

spacer.gifD)spacer.gifLeft side of the brainstem

spacer.gifE)spacer.gifRight medial longitudinal fasciculus

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9

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A 40-year-old woman complains of headache associated with visual disturbance. Of the histories described below, which one suggests migraine headache as a likely diagnosis

?

spacer.gifA)spacer.gifNumbness or tingling of the left face, lips, and hand lasting for 5 to 15 min, followed by throbbing headache

spacer.gifB)spacer.gifAn increasingly throbbing headache associated with unilateral visual loss and generalized muscle achesspacer.gif

C)spacer.gifA continuous headache associated with sleepiness, nausea, ataxia, and incoordination of the right upper limb

spacer.gifD)spacer.gifAn intense left retroorbital headache associated with transient left-sided ptosis and rhinorrhea

spacer.gifE)spacer.gifA visual field defect that persists following cessation of a unilateral headache

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10

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A 60-year-old man with Parkinson's disease is receiving levodopa/cardiodopa therapy and complains of uncontrollable facial movements .Which of the following is correct

?

 

spacer.gifA)spacer.gifLimb and facial dyskinesias are unusual side effects of chronic levodopa therapy

spacer.gifB)spacer.gifLevodopa treatment, while ameliorating symptoms, does not alter the natural history of the diseasespacer.gif

C)spacer.gifBromocriptine works by increasing the release of dopamine from the substantia nigra

spacer.gifD)spacer.gifTrihexyphenidyl and benztropine mesylate have minimal side effects in the elderly

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Endocrinology and Metabolism

 

Quiz for Students

 

 

 

 

[TABLE]

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[TD=bgcolor: #cccccc]1

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[TD=colspan: 3]A 50-year-old female is 5 ft 7 in. tall and weighs 165 lb. There is a family history of diabetes mellitus. Fasting blood glucose is 150 mg/dL on two occasions. She is asymptomatic, and physical exam shows no abnormalities. The treatment of choice is

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[TD]A)

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[TD]Observation

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[TD]B)

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[TD=width: 100%]Medical nutrition therapy

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[TD]C)

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[TD=width: 100%]Insulin

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[TD]D)

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[TD=width: 100%]Oral hypoglycemic agent

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[TABLE]

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[TD=bgcolor: #cccccc]2

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A 55-year-old type 2 diabetic patient has lost weight and has had good control of his blood sugar on oral agents. He has a history of mild hypertension and hyperlipidemia. He asks for advice about an exercise program. Which one of the following statements is correct

؟؟

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[TD]A)

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[TD=width: 100%]Exercise should be avoided because it may cause foot trauma

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[TD]B)

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[TD=width: 100%]An active lifestyle cannot slow the complications of diabetes

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[TD]C)

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[TD=width: 100%]Vigorous exercise cannot precipitate hypoglycemia

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[TD]D)

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[TD=width: 100%]A stress test should be recommended prior to beginning an exercise program

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[TABLE]

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[TD=bgcolor: #cccccc]3

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A newly diagnosed type 2 diabetic patient asks for clarification about dietary management. Which of the following is good advice

؟

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[TD]A)

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[TD=width: 100%]Restrict carbohydrates and eat a high-protein diet

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[TD]B)

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[TD=width: 100%]Avoid sucrose altogether

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[TD]C)

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[TD=width: 100%]Less than 10% of caloric intake should be saturated fat

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[TD]

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[TD]D)

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[TD=width: 100%]Caloric intake should be very consistent from one day to another

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[TABLE=width: 100%]

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[TD=bgcolor: #CCCCCC, align: right]4[/TD]

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As part of a review of systems, a 55-year-old male describes an inability to achieve erection. The patient has mild diabetes and is on a beta blocker for hypertension. The first step in evaluation is[/TD]

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[/TD]

[TD]spacer.gif[/TD]

[TD=align: left]A)spacer.gif[/TD]

[TD=width: 100%, align: left]Serum testosterone[/TD]

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[TD=colspan: 2, align: left]

[/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]B)spacer.gif[/TD]

[TD=width: 100%, align: left]Serum gonadotropin[/TD]

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[TD=colspan: 2, align: left]

[/TD]

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[TD=align: left]C)spacer.gif[/TD]

[TD=width: 100%, align: left]Information about libido and morning erections[/TD]

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[TD=colspan: 2, align: left]

[/TD]

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[TD=align: left]D)spacer.gif[/TD]

[TD=width: 100%, align: left]Papaverine injection[/TD]

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5

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A 50-year-old female is evaluated for hypertension. Her blood pressure is 130/98. She complains of polyuria and of mild muscle weakness. She is on no diuretics or other blood pressure medication. On physical exam, the PMI is displaced to the sixth intercostal space. There is no sign of congestive heart failure and no edema. Laboratory values are as follows:

 

Na-: 147 meq/dL

K-: 2.3 meq/dL

Cl-: 112 meq/dL

HCO3: 27 meq/dL

The patient is on no other medication. She does not eat licorice. The first step in diagnosis is

[/TD]

[/TR]

[TR]

[TD=colspan: 2, align: left][/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]A)spacer.gif[/TD]

[TD=width: 100%, align: left]24-h urine for cortisol[/TD]

[/TR]

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[TD=colspan: 2, align: left][/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]B)spacer.gif[/TD]

[TD=width: 100%, align: left]Urinary metanephrine[/TD]

[/TR]

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[TD=colspan: 2, align: left][/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]C)spacer.gif[/TD]

[TD=width: 100%, align: left]Plasma renin and aldosterone[/TD]

[/TR]

[TR]

[TD=colspan: 2, align: left][/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]D)spacer.gif[/TD]

[TD=width: 100%, align: left]Renal angiogram[/TD]

[/TR]

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6

[/TD]

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A 60-year-old woman comes to the emergency room in a coma. The patient’s temperature is 90°F. She is bradycardic. Her thyroid gland is enlarged. There is bilateral hyporeflexia. The next step in management is[/TD]

[/TR]

[TR]

[TD=colspan: 2, align: left][/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]A)spacer.gif[/TD]

[TD=width: 100%, align: left]Await results of T4, TSH[/TD]

[/TR]

[TR]

[TD=colspan: 2, align: left][/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]B)spacer.gif[/TD]

[TD=width: 100%, align: left]Obtain T4, TSH; begin thyroid hormone and glucocorticoid[/TD]

[/TR]

[TR]

[TD=colspan: 2, align: left][/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]C)spacer.gif[/TD]

[TD=width: 100%, align: left]Begin rapid rewarming[/TD]

[/TR]

[TR]

[TD=colspan: 2, align: left][/TD]

[TD=align: left]spacer.gif[/TD]

[TD=align: left]D)spacer.gif[/TD]

[TD=width: 100%, align: left]Obtain CT scan of the head[/TD]

[/TR]

[/TABLE]

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