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Kc
Quick LinksQUESTION 11. A 67-year-old Caucasian woman was brought to the clinic by her
son who stated that his mother had become slightly confused over the past several days.
She had been stumbling at home and had fallen once but was able to ambulate with some
difficulty. She had no other obvious problems and had been eating and drinking. The son
became concerned when she forgot her son’ s name, so he thought he better bring her to
the clinic.PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD.
Depression after death of spouse several months agoSocial/family hx – non contributary
except for 30 pack/year history tobacco use.Meds: Metformin 500 mg po BID, ASA 81 mg po
qam, escitalopram (Lexapro) 5 mg po q am started 2 months agoLabs-CBC WNL; Chem 7-
Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L,K+4.2 mmol/L,
CO237 m mol/L, Cl-97 mmol/L.The APRN refers the patient to the ED and called
endocrinology for a consult for diagnosis and management of syndrome of inappropriate
antidiuretic hormone (SIADH).Question:Define SIADH and identify any patient
characteristics that may have contributed to the development of SIADH.QUESTION 21. A 43-
year-old female presents to the clinic with a chief complaint of fever, chills, nausea and
vomiting and weakness. She has been unable to keep any food, liquids or medications down.
The symptoms began 3 days ago and have not responded to ibuprofen, acetaminophen, or
Nyquil when she tried to take them. The temperature has reached as high as
102?F.Allergies: none known to drugs or food or environmentalMedications-20 mg
prednisone po qd, omeprazole 10 po qamPMH-significant for 20-year history of steroid
dependent rheumatoid arthritis (RA). GERD. No other significant illnesses or
surgeries.Social-denies alcohol, illicit drugs, vaping, tobacco usePhysical examThin, ill
appearing woman who is sitting in exam room chair as she said she was too weak to climb
on the exam table. VS Temp 101.2?F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room
air.ROS negative other than GI symptoms.Based on the patient’ s clinical presentation, the
APRN diagnoses the patient as having secondary hypocortisolism due to the lack of
prednisone the patient was taking for her RA secondary to vomiting.Question:Explain why
the patient exhibited these symptoms?QUESTION 31. A 64-year-old Caucasian female
presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias,
constipation, polyuria, and says she feels “ fuzzy headed” much of the time. She had about
of kidney stones a few weeks ago and she fortunately was able to pass the small stones
without requiring lithotripsy or other interventions. She was told by the urologist to follow
up with her primary care provider after the kidney stones has resolved.The APRN

examining the patient orders a Chem 7 which revealed a serum Ca++ of 13.1 mg/dl. The
APN believes the patient has primary hyperparathyroidism and refers the patient to an
endocrinologist who does a complete work up and concurs with the APRN’ s
diagnosis.Question:What is the role of parathyroid hormone in the development of primary
hyperparathyroidism?QUESTION 41. A 64-year-old Caucasian female presents to the clinic
with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and
says she feels “ fuzzy headed” much of the time. She had a fracture of her right metatarsal
without trauma and currently is wearing a walking boot. She also had a bout of kidney
stones a few weeks ago and she fortunately was able to pass the small stones without
requiring lithotripsy or other interventions. She was told by the urologist to follow up with
her primary care provider after the kidney stones has resolved.The APRN examining the
patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes
the patient has primary hyperparathyroidism and refers the patient to an endocrinologist
who does a complete work up and concurs with the APRN’ s diagnosis.Question 1 of
2:Explain the processes involved in the formation of renal stones in patients with
hyperparathyroidism.QUESTION 51. A 64-year-old Caucasian female presents to the clinic
with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and
says she feels “ fuzzy headed” much of the time. She had a fracture of her right metatarsal
without trauma and currently is wearing a walking boot. She also had a bout of kidney
stones a few weeks ago and she fortunately was able to pass the small stones without
requiring lithotripsy or other interventions. She was told by the urologist to follow up with
her primary care provider after the kidney stones has resolved.The APRN examining the
patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes
the patient has primary hyperparathyroidism and refers the patient to an endocrinologist
who does a complete work up and concurs with the APRN’ s diagnosis.Question 2 of
2:Explain how a patient with hyperparathyroidism is at risk for bone fractures.QUESTION
61. A 64-year-old Caucasian female who is 4 weeks status post total parathyroidectomy
with forearm gland insertion presents to the general surgeon for her post-operative
checkup. She states that her mouth feels numb and she feels “ tingly all over. The surgeon
suspects the patient has hypoparathyroidism secondary to the parathyroidectomy with
delayed vascularization of the implanted gland. She orders a Chem 20 to determine what
electrolyte abnormalities may be present. The labs reveal a serum Ca++ of 7.1 mg/dl
(normal 8.5 mg/dl-10.5 mg/dl) and phosphorous level of 5.6 mg/dl (normal 2.4-4.1
mg/dl).Question:What serious consequences of hypoparathyroidism occur and
why?QUESTION 71. A 17-year-old boy is brought to the pediatrician’ s office by his parents
who are concerned about their son’ s weight loss despite eating more, frequent urination,
unquenchable thirst, and fatigue that is interfering with his school/work activities. He had
been seemingly healthy until about 3 months ago when his parents started noticing these
symptoms but put these symptoms down to his busy schedule including a part time job. He
admits to sleeping more and tires very easily. He denies any other symptoms.PMH-
noncontributory. No surgeries or major medical problems. Usual colds and ear infections as
a childAllergies-none knowFamily history- maternal uncle with “ some kind of sugar
diabetes problem” but parents unclear on the exact disease processSocial-denies alcohol,

tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast
food store after school and on weekends.Labs in office: random glucose 220 mg/dl.Based on
his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes
Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up
and management plan.Question 1 of 6:The patient exhibited classic signs of Type 1 diabetes.
Explain the pathophysiology of “ polydipsia.” QUESTION 81. A 17-year-old boy is brought to
the pediatrician’ s office by his parents who are concerned about their son’ s weight loss
despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering
with his school/work activities. He had been seemingly healthy until about 3 months ago
when his parents started noticing these symptoms but put these symptoms down to his
busy schedule including a part time job. He admits to sleeping more and tires very easily. He
denies any other symptoms.PMH-noncontributory. No surgeries or major medical
problems. Usual colds and ear infections as a childAllergies-none knowFamily history-
maternal uncle with “ some kind of sugar diabetes problem” but parents unclear on the
exact disease processSocial-denies alcohol, tobacco or illicit drug use. Not sexually active.
Junior at local high school and works in a fast food store after school and on weekends.Labs
in office: random glucose 220 mg/dl.Based on his symptoms and the glucose level, the
pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and
his parents to an endocrinologist for further work up and management plan.Question 2 of
6:The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of
“ polyuria.” QUESTION 91. A 17-year-old boy is brought to the pediatrician’ s office by his
parents who are concerned about their son’ s weight loss despite eating more, frequent
urination, unquenchable thirst, and fatigue that is interfering with his school/work
activities. He had been seemingly healthy until about 3 months ago when his parents started
noticing these symptoms but put these symptoms down to his busy schedule including a
part time job. He admits to sleeping more and tires very easily. He denies any other
symptoms.PMH-noncontributory. No surgeries or major medical problems. Usual colds and
ear infections as a childAllergies-none knowFamily history- maternal uncle with “ some
kind of sugar diabetes problem” but parents unclear on the exact disease processSocial-
denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and
works in a fast food store after school and on weekends.Labs in office: random glucose 220
mg/dl.Based on his symptoms and the glucose level, the pediatrician makes a tentative
diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an
endocrinologist for further work up and management plan.Question 3 of 6:The patient
exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of
“ polyphagia.” QUESTION 101. A 17-year-old boy is brought to the pediatrician’ s office by
his parents who are concerned about their son’ s weight loss despite eating more, frequent

exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “ weight loss.” 0.5
pointsQUESTION 111. A 17-year-old boy is brought to the pediatrician’ s office by his
exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of
“ fatigue.” QUESTION 121. A 17-year-old boy is brought to the pediatrician’ s office by his
endocrinologist for further work up and management plan.Question 6 of 6:How do genetics
and environmental factors contribute to the development of Type 1 diabetes?1
pointsQUESTION 131. A 17-year-old boy recently diagnosed with Type I diabetes is brought
to the pediatrician’ s office by his parents with a chief complaint of “ having the flu” . His
symptoms began 2 days ago, and he has vomited several times and has not eaten very much.
He can’ t remember if he took his prescribed insulin for several days because he felt so sick.
Random glucose in the office reveals glucose 560 mg/dl and the pediatrician made
arrangements for the patient to be admitted to the hospitalist service with an endocrinology

consult.BP 124/80mmHg; HR 122bpm; Respirations 32 breaths/min; Temp 97.2?F;
PaO297% on RAAdmission labs: Hgb 14.6 g/dl; Hct 58%CMP- Na+ 122mmol/L; K+
5.3mmol/L; Glucose 560mg/dl; BUN 52mg/dl; Creatinine 4.9mg/dl;Cl- 95mmol/L; Ca++
8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Cholesterol
198mg/dl;Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase
132U/L.Arterial blood gas values were as follows: pH 7.09; Paco220mm Hg; Po2100mm Hg;
Sao2 98% (room air)HCO3-7.5mmol/L; anion gap 19.4A diagnosis of diabetic ketoacidosis
was made, and the patient was transferred to the Intensive Care Unit (ICU) for close
monitoring.Question:The hormones involved in intermediary metabolism, exclusive of
insulin, that can participate in the development of diabetic ketoacidosis (DKA) are
epinephrine, glucagon, cortisol, growth hormone. Describe how they participate in the
development of DKA.QUESTION 141. A 67-year-old African American male presents to the
clinic with a chief complaint that he has to “ go to the bathroom all the time and I feel really
weak.” He states that this has been going on for about 3 days but couldn’ t come to the
clinic sooner as he went to the Wound Care clinic for a dressing change to his right great toe
that has been chronically infected, and he now has osteomyelitis. Patient with known Type
II diabetes with poor control. His last HgA1C was 10.2 %. He says he can’ t afford the insulin
he was prescribed and only takes half of the oral agent he was prescribed. Random glucose
in the office revealed glucose of 890 mg/dl. He was immediately referred to the ED by the
APRN for evaluation of suspected hyperosmolar hyperglycemic non ketotic syndrome
(HHNKS). Also called hyperglycemic hyperosmolar state (HHS).Question:Explain the
underlying processes that lead to HHNKS or HHS.QUESTION 151. A 32-year-old woman
presented to the clinic complaining of weight gain, swelling in her legs and ankles and a
puffy face. She also recently developed hypertension and diabetes type 2. She noted poor
short-term memory, irritability, excess hair growth (women), red-ruddy face, extra fat
around her neck, fatigue, poor concentration, and menstrual irregularity in addition to
muscle weakness. Given her physical appearance and history, a tentative diagnosis of
hypercortical function was made. Diagnostics included serum and urinary cortisol and
serum adrenocorticotropic hormone (ACTH). MRI revealed a pituitary
adenoma.Question:How would you differentiate Cushing’ s disease from Cushing’ s
syndrome?QUESTION 161. A 47-year-old female is referred to the endocrinologist for
evaluation of her chronically elevated blood pressure, hypokalemia, and hypervolemia. The
patient’ s hypertension has been refractory to the usual medications such as beta blockers,
diuretics, and angiotensin-converting enzyme (ACE) inhibitors. After a full work up
including serum and urinary electrolyte levels, aldosterone suppression test, plasma
aldosterone to renin ratio, and MRI which revealed an autonomous adenoma, the
endocrinologist diagnoses the patient with primary hyper-aldosteronism.Question:What is
the pathogenesis of primary hyper-aldosteronism?QUESTION 171. A 47-year-old African
American male presents to the clinic with chief complaints of polyuria, polydipsia,
polyphagia, and weight loss. He also said that his vison occasionally blurs and that his feet
sometimes feel numb. He has increased hunger despite weight loss and admits to feeling
unusually tired. He also complains of “ swelling” and enlargement of his abdomen.Past
Medical History (PMH) significant for HTN fairly well controlled with and ACE inhibitor;

central obesity, and dyslipidemia treated with a statin, Review of systems negative except
for chief complaint. Physical exam unremarkable except for decreased filament test both
feet. Random glucose in office 290 mg/dl. The APRN diagnoses the patient with type II DM
and prescribes oral medication to control the glucose level and also referred the patient to a
dietician for dietary teaching.Question:What is the basic underlying pathophysiology of
Type II DM?QUESTION 181. A 21-year-old male was involved in a motorcycle accident and
sustained a closed head injury. He is waking up and interacting with his family and medical
team. He complained of thirst that doesn’ t seem to go away no matter how much water he
drinks. The nurses note that he has had 3500 cc of pale-yellow urine in the last 24 hours.
Urine was sent for osmolality which was reported as 122 mOsm/L. A diagnosis of probable
neurogenic diabetes insipidus was made.Question:What causes diabetes insipidus
(DI)?QUESTION 191. A 43-year-old female patient presents to the clinic with complaints of
nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance,
hyperactivity and palpitations. She states she had had the symptoms for several months but
attributed the symptoms to beginning to care for her elderly mother who has Alzheimer’ s
Disease. She has lost 15 pounds in the last 3 months without dieting. Her past medical
history is significant for rheumatoid arthritis that she has had for the last 10 years well
controlled with methotrexate and prednisone. Physical exam is remarkable for periorbital
edema, warm silky feeling skin, and palpable thyroid nodules in both lobes of the thyroid.
Pending laboratory diagnostics, the APRN diagnoses the patient as having hyperthyroidism,
also called Graves’ Disease.Question:Explain how the negative feedback loop controls
thyroid levels.QUESTION 201. A 43-year-old female patient with known Graves’ Disease
presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased
perspiration, heat intolerance, hyperactivity and severe palpitations. She states she had
been given a prescription for propylthiouracil, an antithyroid medication but she did not fill
the prescription as she claims she lost it. She had been given the option of thyroidectomy
which she declined. She also notes that she is having trouble with her vision and often has
blurry eyes. She states that her eyes seem “ to bug out of her face” . She has had recurrent
outs of nausea and vomiting. She was recently hospitalized for pneumonia. Physical exam is
significant for obvious exophthalmos and pretibial myxedema. Vital signs are temp 101.2?F,
HR 138 and irregular, BP 160/60 mmHg. Respirations 24. Electrocardiogram revealed atrial
fibrillation with rapid ventricular response. The APRN recognizes the patient is
experiencing symptoms of thyrotoxic crisis, also called thyroid storm. The patient was
immediately transported to a hospital for critical care management.Question:How did the
patient develop thyroid storm? What were the patient factors that lead to the development
of thyroid storm?QUESTION 211. A 44-year-old woman presents to the clinic with
complaints of extreme fatigue, weight gain, decreased appetite, cold intolerance, dry skin,
hair loss, and sleepiness. She also admits that she often bursts into tears without any reason
and has been exceptionally forgetful. Her vision is occasionally blurry, and she admits to
being depressed without any social or occupational triggers. Past medical history
noncontributory. Physicalexam Temp 96.2?F, pulse 62 and regular, BP 108/90, respirations.
Dull facial expression with coarse facial features. Periorbital puffiness noted. Based on the
clinical history and physical exam, and pending laboratory data, the ARNP diagnoses the

patient with hypothyroidism.Question:What causes hypothyroidism?0.5 pointsQUESTION
221. A 44-year-old woman is brought to the clinic by her husband who says his wife has had
some mental status changes over the past few days. The patient had been previously
diagnosed with hypothyroidism and had been placed on thyroid replacement therapy but
had been lost to follow-up due to moving to another city for the husband’ s work
approximately 4 months ago. The patient states she lost the prescription bottle during the
move and didn’ t bother to have the prescription filled since she was feeling better. Physical
exam revealed non-pitting, boggy edema around her eyes, hands and feet as well as the
supraclavicular area. The APRN recognizes this patient had severe myxedema and referred
the patient to the hospital for medical management.Question:What causes myxedema
coma?QUESTION 231. A 53-year-old woman presents to the primary care clinic with
complaints of severe headaches, palpitations, highblood pressure and diaphoresis. She
relates that these symptoms come in clusters and when she has these “ spells” , she also
experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric
pain, and flank pain. She had one of these spells when she was at the pharmacy and the
pharmacist took her blood pressure which was recorded as 200/118. The pharmacist
recommended that she immediately be evaluated for these symptoms. Past medical history
significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting
symptoms and family history of NF1, the APRN suspects the patient has a
pheochromocytoma. Laboratory data and computerized tomography of the abdomen
confirms the diagnosis.Question 1 of 2:What is a pheochromocytoma and how does it cause
the classic symptoms?QUESTION 241. A 53-year-old woman presents to the primary care
clinic with complaints of severe headaches, palpitations, highblood pressure and
diaphoresis. She relates that these symptoms come in clusters and when she has these
“ spells” , she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and
dread, epigastric pain, and flank pain. She had one of these spells when she was at the
pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The
pharmacist recommended that she immediately be evaluated for these symptoms. Past
medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on
the presenting symptoms and family history of NF1, the APRN suspects the patient has a
pheochromocytoma. Laboratory data and computerized tomography of the abdomen
confirms the diagnosis.Question 2 of 2:What are the treatment goals for managing
pheochromocytoma? Do you need a similar assignment done for you from scratch? We have
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