Semester 4 Week 3 Questions

THESE QUESTIONS HAVE NOT BEEN REVIEWED BY FACULTY FOR THE January 2014 SEMESTER! RELEASED FOR
STUDY PURPOSES AT REQUEST OF STUDENTS.

Obesity and Metabolic Syndrome

3) An unconscious patient is delivered to the emergency department of a county hospital by an ambulance. The
patient is breathing rapidly, his breath smells of nail polish. As first aid patient should receive an injection of which
compound?
A) Glucose
B) Glucagon
C) Insulin
D) Noradrenalin
E) Adrenalin

4) A 56-year-old male patient comes to his physician with a waist circumference of 150 cm. Which of the following
signs is he least likely to show?
A) Raised triglycerides (≥ 150 mg/dl or 1.7 mM)
B) Raised HDL cholesterol (≥ 100 mg/dl or 2.6 mM)
C) Raised blood pressure (≥ 130/80mm Hg)
D) Raised fasting blood glucose (≥ 100 mg/dl or 5.6 mM)
E) Previously diagnosed diabetes

5) A primary care physician (PCP) has set up a clinic in an impoverished urban area where he sees many patients
whose BMI are within the overweight/ obese category. He particularly chose this area because he wanted to play a
significant role in helping to decrease the prevalence of this epidemic. He provides diet and weight control advice
for all his at risk and affected patients. His team is made up of a dietitian and a behavioral scientist. During his
study of and work with this societal group, which of the following could the physician call a success?

A) Everyone rides the bus/train to move around the community

B) Most of the individuals in this community work at the factories
C) Multiple fast-food restaurants operate within this community
D) No non-obese role models who fit the profile of the community members
E) A store opened that sells fresh produce

Demyelination disorders; peripheral neuropathy

6) A 34 year old woman presents with blurry and dim vision in the left eye and some parasthesias, especially
involving the right upper limb. She says that she has had occasional bouts of poor vision over the past few years
as well as occasional muscle weakness. What disorder is she most likely experiencing?

A) guillian garre syndrome B) multiple sclerosis C) radiculopathy

D) diabetic polyneuroapathy E) duchenne muscular dystrophy

7) Your neighbor felt ill a week ago with what appeared to be the flu. Four days ago he started complaining of
weakness in both of his legs, as well as aches in pains. Yesterday he said that could no longer hold objects in his
hand without much effort. He was sent to a neurologist for electromyography which revealed impaired conduction
in many of his peripheral nerves. This pattern of symptoms is likely due to

A) guillain barre syndrome B) multiple sclerosis C) diabetic neuropathy

D) myasthenia gravis E) lambert eaton syndrome
Semester 4 Week 3 Questions
THESE QUESTIONS HAVE NOT BEEN REVIEWED BY FACULTY FOR THE January 2014 SEMESTER! RELEASED FOR
STUDY PURPOSES AT REQUEST OF STUDENTS.

8) A 23-year-old woman presents with loss of vision in the right eye accompanied by slight pain in that eye. She
has reduced visual acuity in the right eye and loss of direct and consensual light reflexes when light is shown into
that eye. No other neurological abnormalities were observed. Axial MRI showed hyper-intense lesions in the right
optic nerve and periventricular regions of the anterior horn and body of the lateral ventricles bilaterally. The
periventricular lesions were of varying sizes. The most likely diagnosis in this patient is:

A) Guillain-Barre syndrome B) Stroke C) Complicated migraine

D) Multiple sclerosis E) Temporal arteritis

9) A 32-year-old female presents to the emergency department complaining of numbness in her right leg that lasted
several hours, which worsened when she took a warm shower. She also complained of feeling fatighed lately and
she stated that 1 year ago she had an episode of transient unilateral vision loss that resolved and never recurred.
vital signs: T=97.0F; BP=122/73 mmHg; HR=76 bpm;RR=18 breaths/min. Physical examination is significant for
nystagmus, scanning speech, and diminished sensation in the right leg but normal strength. To confirm your
presumptive diagnosis in this patient, you most likely order next:

A) CSF electrophoresis B) Brain CT scan C) Ophthalmology consultation

D) Complete CBC, blood chemistry and electrolytes E) Electromyography

10) A 20 year old woman attends to the hospital with rapidly ascending weakness in her distal extremities, involving
proximal muscles. On physical examination there is absence of deep tendon reflexes and a spinal tap reveals the
CSF protein to be increased, glucose is half the amount of plasma and scant cells are reported. She stated had
recovered from a viral respiratory tract infection two weeks before. A biopsy study of a peripheral nerve had
inflammation and demyelination. The most likely diagnosis in this patient is:

A) myasthenia gravis B) Guillain-Barre syndrome C) syringomyelia

D) Charcot-Marie-Tooth disease (Type 1) E) metabolic neuropathy

11) Which of the following brain structures are the most common sites for formation of demyelinating plaques in
advanced multiple sclerosis?

A) Paraventricular white matter, optic nerve, brainstem, and grey matter of the spinal cord
B) Paraventricular grey matter, optic nerve and chiasm, brainstem, and grey matter of the spinal cord
C) Basal ganglia, optic nerve, brain stem, and white matter of the spinal cord
D) Cerebral white matter, optic nerve and chiasm, brainstem, and white matter of the spinal cord

12) A 33-year-old Caucasian woman comes to her family physician complaining on a tingling sensation in her toes
and progressive weakness in both of her legs. On questioning, she recalls she had a minor diarrhea two weeks ago
that lasted for a few days. Physical examination reveals markedly decreased patellar and Achilles tendon reflexes
bilaterally. Which of the following pathologic changes can be found in patient’s peripheral nerves?
Semester 4 Week 3 Questions
THESE QUESTIONS HAVE NOT BEEN REVIEWED BY FACULTY FOR THE January 2014 SEMESTER! RELEASED FOR
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A B

D
C

Antipsychotics

17) A 35-year-old man with abnormal behavior has been diagnosed with schizophrenia. In schizophrenia,
Clozapine is more effective than haloperidol against:
A) Hallucinations B) Bizarre delusions C) Delusions D) Social withdrawal

19) A 28-year-old U.S. marine recruit has a history of Tourette syndrome for which he has been taking haloperidol
for the past six months. He complains that he has become very restless and that his tongue is in constant motion
as if he were constantly chewing gum. Since the emergence of these symptoms, he stopped taking the drug but
the symptoms persist. Which one of the following is the most correct statement with respect to the symptoms he
describes?
A) The symptoms are consistent with haloperidol-induced akathisia and tardive
dyskinesia and are due to blocked dopamine receptors.
B) The symptoms are consistent with haloperidol-induced akathisia and tardive
dyskinesia and are due to supersensitive dopamine receptors.
C) These are haloperidol-induced exptrapyramidal symptoms and are due to dual
antagonism of D2 and- 5-HT2C receptors.
D) These are haloperidol-induced exptrapyramidal symptoms and are due to
supersensitive D2 and 5-HT2C receptors.

20) A 17 year old male diagnosed with schizophrenia was treated with Fluphenazine. Three days later, he
developed a high body temperature and lead-pipe rigidity. The appropriate treatment for this patient would be:
A) Discontinue Fluphenazine and administer haloperidol
B) Continue with Fluphenazine and administer an anticholinergic
C) Continue with Fluphenazine and administer a benzodiazepine
D) Discontinue Fluphenazine and administer dantrolene

Clinical diabetes and other endocrine pathologies

Semester 4 Week 3 Questions
THESE QUESTIONS HAVE NOT BEEN REVIEWED BY FACULTY FOR THE January 2014 SEMESTER! RELEASED FOR
STUDY PURPOSES AT REQUEST OF STUDENTS.

21) A 35 year-old woman consulted one of her parent's friends, a jeweler, about having her wedding ring resized
since it was becoming tight on her finger. The jeweler mentioned to her parents that he thought the woman's
features were getting coarser which prompted the parents to suggest that she see a physician. You might expect
the physician's workup to reveal
A) hyperglycemia B) hyponatremia C) hypothyroidism
D) increased pigmentation of the skin E) parathyroid hyperplasia

22) Pearl, a 39 year old woman G2 P2 whose last pregnancy was 5 years ago, has had regular menstrual cycles
until 6 month ago when the cycle ceased.
She also reports expression of milk from her breasts. On physical examination, she is afebrile and normotensive.
She is 150 cm (4ft 11in) tall and weighs 63kg (BMI 28). Secondary sex characteristic is normal. Laboratory test
indicates that her β-human chorionic gonadotropin level is normal. She has a normal growth hormone stimulation
test. CT scan of the head shows no abnormalities of bone and no hemorrhage. Brain MRI showed fluid density
within a normal-sized sella turcica. Which of the following is the most likely diagnosis?
A) Craniopharngioma B) Empty sella syndrome C) Heriditary spherocytosis
D) Prader-Willi Syndrome E) Sheehan Syndrome F) Prolactinoma

23) 2 year old child is brought to her family physician because of failure to thrive. Physical examination shows a
short child and has coarse facial features, a protruding tongue, and an umbilical hernia. Profound mental
retardation becomes apparent as the child matures. A hormonal deficiency is suspected. Which of the following test
would aid in establishing the diagnosis?
A) Total T4 levels B) Cortisol levels C) Growth hormone levels D) Insulin levels
E) Thyroid stimulating hormone

24) Which statement regarding gestational diabetes mellitus (GDM) is true?

A) When retested 6-8 weeks postpartum, 45% of women with GDM will have impaired fasting glucose.
B) Pregnant women with risk factors for diabetes should be screened for GDM at their first prenatal visit.
C) The new diagnostic criteria for GDM will reduce the number of cases by 18%.
D) Twin pregnancy is protective against GDM.
E) All women with a history of GDM will eventually develop diabetes.

25) A 40-year-old man presents to his doctor’s office with a complaint of polyuria for the past few weeks. He gives a
history of successful treatment of pulmonary tuberculosis that he contracted while working for a UN mission in
Africa, from where he returned to the US about an year ago. Apart from that the rest of the history and Physical
examination of the patient did not reveal any significant abnormality. On laboratory exam all other lab results are
within normal limits except the following values. The serum osmolality of 320 mOsm/kg and urine osmolality of 50
mOsm. Upon performing a water deprivation test, his serum osmolality is 316 mOsm and urine osmolality is 100
mOsm. Upon administration of dDAVP, serum osmolality decreases to 285 mOsm and urine osmolality increases
to 350 mOsm. What is the most likely diagnosis?
A) Central diabetes insipidus B) Nephrogenic diabetes insipidus C) Psychogenic polydipsia
D) Diabetes mellitus

26) A 48-year-old man is diagnosed with a functional pituitary tumor and acromegaly. He has an elevated
concentration of growth hormone (GH) and another hormone induced by GH that is produced in the liver. Which of
the following hormones is most likely to be increased in this patient’s blood?
A) Glucagon B) Somatostatin C) Cholecystokinin D) Gastrin E) Insulin like growth factor I
Semester 4 Week 3 Questions
THESE QUESTIONS HAVE NOT BEEN REVIEWED BY FACULTY FOR THE January 2014 SEMESTER! RELEASED FOR
STUDY PURPOSES AT REQUEST OF STUDENTS.

27) A 48 year old man brings you the following pictures that he put together for you because his nephew, a medical
student, suggested it after a large family reunion, wherein lots of old family photos were on display. What medical
problems might your patient also experience with this condition?

A) Colon cancer and insulin resistance D) Hypogonadism and infertility

B) Hypothyroidism and macroglossia E) Rheumatoid arthritis and hyperostosis
C) Precocious puberty and obesity

28) You have been seeing HS for 10 years. He is 57 and had his Type II DM diagnosed when he was 45 after he
developed significant polyuria and polydipsia during a vacation. He has been quite non-compliant, stating that the
diabetic diet is "impossible to stick to", though he does try to remember to take his medication. His Hgb A1C test
has not been below 9 % for over 2 years. Which of the following is true about management of type II DM?
A) Daily blood glucose monitoring by the patient is unnecessary and reduces compliance
B) Counting fats is an essential part of the ADA diet
C) Medication works as well as life style changes for improving insulin resistance
D) Reduction of Hgb A1C levels to 6.5 or less reduces risk of diabetic complications
E) Life expectancy cannot be changed by improving glycemic control

29) A 32 year old woman who has Type II diabetes mellitus is diagnosed with hyperthyroidism. Her diabetes is
presently being controlled with Glipizide and she is prescribed a combination of methimazole and propranolol to
treat her hyperthyroidism. This combination is contraindicated for this patient because
A) methimazole will antagonize the effect of glipizide.
B) methimazole will chemically interact with propranolol, thus negating its effects.
C) propranolol can mask the signs of hypoglycemia.
D) propranolol will inhibit the metabolism of methimazole.

Antidiabetic drugs

30) Several insulin formulations, available on the market, differ one from another in which of
the following pharmacokinetic properties?
A) Rate of absorption B) Elimination half-lives C) Total clearance D) Volume of distribution
E) Oral bioavailability

31) Which of the following statements correctly pair the antidiabetic drug with its potential
adverse effect? (Check all that apply)
A) Miglitol - constipation D) Insulin - tachycardia
B) Chlorpropamide - dilutional hyponatremia E) Pioglitazone - dehydration
C) Metformin - weight gain F) Repaglinide - hypoglycemic crisis
Semester 4 Week 3 Questions
THESE QUESTIONS HAVE NOT BEEN REVIEWED BY FACULTY FOR THE January 2014 SEMESTER! RELEASED FOR
STUDY PURPOSES AT REQUEST OF STUDENTS.

32) A 24-year-old woman with type I diabetes was brought unconscious to the emergency
room. Her blood glucose level was 395 mg/dL. An intravenous infusion of insulin was
started and the patient’s blood glucose decrease to a normal level after 6 hours. Which of
the following molecular actions most likely contributed to the therapeutic effect of the
drug in this patient?
A) Inhibition of glucose transporters in pancreas cell membranes
B) Phosphorylation of tyrosine kinase receptor
C) Activation of ATP-sensitive K+ channels in target cells
D) Stimulation of hormone sensitive lipase
E) Inhibition of liver glucokinase

33) A 54-year-old alcoholic man was brought unconscious to the emergency room. On
admission the patient was sweating, the body temperature was very low and the cardiac
pulse was 135 bpm. Shortly after the admission the patient developed a tonic-clonic
seizure. His wife reported that the man was a diabetic under insulin treatment. Which of
the following events most likely caused the patient’s syndrome?
A) Hyperglycemia due to insulin resistance
B) Hypoglycemia due to alcohol consumption
C) Ketoacidosis due to insufficient insulin therapy
D) Hyperglycemia due to alcohol withdrawal
E) Anaphylactic reaction to insulin
F) Hyperosmolar coma due to alcohol overdose

34) A 52-year-old man is being treated with repaglinide for type II diabetes. Which of the
following actions best explains the therapeutic effect of the drug in this patient?
A) Slowing of glucose absorption from the gastrointestinal tract
B) Blockade of glucagon receptors
C) Blockade of beta-2 receptors in the liver
D) Blockade of somatostatin receptors in the pancreas
E) Stimulation of insulin release
F) Regulation of transcription of genes involved in glucose utilization

35) A 77-year-old man was brought to the emergency room with bizarre behavior and
paranoid ideation. He complained of headache, mental confusion, weakness, dizziness
and blurred vision. The man was suffering from type II diabetes presently treated with
glyburide. Pertinent laboratory findings on admission were: creatinine 2 mg/dL glucose
50 mg/dL, Which of the following would be an immediate appropriate treatment for this
patient?
A) Oral prednisone B) IV prednisone C) Oral glucose D) IV glucose E) Oral haloperidol
F) IV haloperidol

36) A 42-year-old obese man with a 5-year history of type II diabetes has been reasonably
well controlled with diet and 3 daily human insulin injections. Recently a lab test has
shown a high titer of circulating IgG anti-insulin antibodies. The patient is most likely at
an increased risk of which of the following disorders?
A) Urticaria B) Hypoglycemic reaction C) Insulin lipodystrophy D) Diabetic ketoacidosis
E) Hyperglycemia

37) A 65-year-old man, recently diagnosed with type II diabetes, started a treatment with a
drug that is able to close the ATP sensitive K+ channels on pancreatic beta cell
membrane. Which of the following drugs was he most likely taking?
A) Miglitol B) Insulin C) Pioglitazone D) Metformin E) Glyburide
Semester 4 Week 3 Questions
THESE QUESTIONS HAVE NOT BEEN REVIEWED BY FACULTY FOR THE January 2014 SEMESTER! RELEASED FOR
STUDY PURPOSES AT REQUEST OF STUDENTS.

38) A 10-year-old boy being treated for type I diabetes was brought unconscious to the
emergency department. The mother reported that he was nauseous and vomited after
eating a chocolate bar. On admission the patient presented with flushed face and breath
smelling of ketones. Which of the following drugs given IV was most likely administered
to this patient?
A) Glucose B) Glucagon C) Ultralente insulin D) Lente insulin E) Regular insulin
F) Repaglinide

39) A 16-year-old boy suffering from type I diabetes is seen in the emergency room with
the chief complain of severe right-sided chest pain. Two hours earlier he felt feverish and
experienced a teeth-chattering chill. The diabetes of the patient is presently well
controlled on 2 daily doses of insulin. The patient also is very compliant with his
prescribed diet. After physical examination and laboratory tests a diagnosis of atypical
pneumonia is made. Which of the following should be included in an appropriate
treatment plan for this patient?
A) To increase the daily insulin dosage D) To start a course of vancomycin therapy
B) To start a course of ampicillin therapy E) To add a daily administration of metformin
C) To add a daily administration of chlorpropamide

40) A 45-year-old woman with a 3 year history of type II diabetes has been reasonably well
controlled with diet and glyburide. Recently her fasting blood glucose started rising and
the physician decided to add a second antidiabetic drug that acts on a nuclear receptor
and decreases insulin resistance in target cells. Which of the following drug was most
likely prescribed?
A) Repaglinide B) Chlorpropamide C) Glyburide D) Pioglitazone E) Metformin
F) Miglitol

41) A 7-year-old boy was brought to the emergency room by his parents because of
nausea, vomiting and persistent abdominal pain secondary to the flu. Pertinent lab values
on admission were: blood glucose 300 m/dL, glycosuria 3+. Which of the following drugs
would be appropriate for this patient?
A) Miglitol B) Metformin C) Pioglitazone D) Repaglinide E) Regular insulin F) Glyburide

Alcohol, drug abuse and therapy

42) A 15-year-old boy, who was at a party with his friends, began to feel anxious,
confused and fearful. Within half an hour he was in a panic state, crying and complaining of being seriously ill. The
boy, who had never used recreational drugs, had just smoked two drugged cigarettes. His friends noted reddening
of the conjunctiva with no change in pupil diameter, a fast pulse and a diffuse tremor. Which of the following drugs
was most likely smoked by this boy?
A) Amphetamine B) Cocaine C) Flunitrazepam D) Heroin E) Marijuana

43) A 26-year-old man started to perceive flashes of color and fleeting movements of
strange objects as he entered into a dark room. The man , who was an occasional user of recreational drugs, took
two tablets of an illegal drug while at a dinner party three weeks previously. The symptoms the man was
experiencing were most probably due to which of the following?
A) LSD flashbacks D) Cocaine-induced schizophrenic episode
B) Heroin withdrawal E) Amphetamine-induced schizophrenic episode
C) Phencyclidine withdrawal
Semester 4 Week 3 Questions
THESE QUESTIONS HAVE NOT BEEN REVIEWED BY FACULTY FOR THE January 2014 SEMESTER! RELEASED FOR
STUDY PURPOSES AT REQUEST OF STUDENTS.

44) A 33-year-old man with a long history of drug abuse came to the hospital complaining of severe somnolence,
ravenous appetite, headache, depression and lack of motivation. He said he failed to get a supply of the drug he
used to take and repeatedly asked the doctor to give him the drug to reduce the symptoms. Withdrawal from which
of the following drugs may have caused these symptoms?
A) Heroin B) Phencyclidine C) Diazepam D) Amphetamine E) Ethanol

45) A 29-year-old man with a long history of drug abuse was admitted unconscious to the emergency room. Vital
signs were: blood pressure 190/110 mm Hg, pulse 150 beats/min and rectal temperature 104 F°. Pupils were
mydriatic and the skin was moist and cold. Twenty minutes later he experienced a tonic-clonic seizure, his
respiration became shallow and the systolic blood pressure fell to 50 mm Hg. He developed a ventricular fibrillation
and died from cardiovascular collapse. Which of the following drug was most likely responsible for his death?
A) Heroin B) Diazepam C) Ketamine D) Crack cocaine E) Tetrahydrocannabinol

46) A 48-year-old homeless alcoholic man is brought to the emergency room by the police who found him
wandering in the street. The man is nauseated, tremulous and
hallucinating. He states he was out of money and unable to buy his usual daily diet of whiskey. Which of the
following would be an appropriate drug to treat the acute alcoholic withdrawal of this patient?
A) Naltrexone B) Imipramine C) Haloperidol D) Buspirone E) Ethanol F) Diazepam

Answers: 1E, 2B, 3c, 4b, 5e, 6b, 7a, 8d, 9a, 10b, 11d, 12b. 13b, 14e, 15c, 16d, 17d, 18c, 19b, 20d, 21a, 22f, 23e,
24b, 25a, 26e, 27a, 28d, 29c. 30a, 31bdf, 32b, 33b, 34e, 35c, 36e, 37e, 38e, 39a, 40d, 41e, 41e, 42e 43a, 44d,
45c, 46f.