Practice questions Pathology of endocrine pancreas I

Practice questions

Pathology of endocrine pancreas I

© Jun Wang, MD, PhD

1. Use this case for the next three questions. An 11-year-old girl presents with extreme thirst and polyuria for a week. She has lost 10 lb recently, even with increased appetite. Her past medical history is unremarkable. Physical examination reveals a BMI at normal range. No significant abnormalities are noted. Laboratory tests reveals a glucose at 450 mg/dl (normal 70-180 mg/dl), A1C at 15% (normal <8%), C-peptide at 0.1 ng/ml (0.5-2.0 ng/ml). Her arterial blood gas tests are within normal range. Urinalysis reveals trace amount of ketone. What is the diagnosis?

A. Graves disease

B. Diabetic ketoacidosis

C. Hyperosmolar hyperosmotic syndrome

D. Type 1 diabetes

E. Type 2 diabetes

2. An 11-year-old girl presents with extreme thirst and polyuria for a week. She has lost 10 lb recently, even with increased appetite. Her past medical history is unremarkable. Physical examination reveals a BMI at normal range. No significant abnormalities are noted. Laboratory tests reveals a glucose at 450 mg/dl (normal 70-180 mg/dl), A1C at 15% (normal <8%), C-peptide at 0.1 ng/ml (0.5-2.0 ng/ml). Her arterial blood gas tests are within normal range. Urinalysis reveals trace amount of ketone. What is likely the cause of her conditions?

A. Alpha cell proliferation and hyperfunction

B. Amyloid deposit and damage of islet

C. Beta cell destruction due to autoimmune process

D. Beta cell hyperplasia and hyperfunction

E. Exogenous insulin

3. An 11-year-old girl presents with extreme thirst and polyuria for a week. She has lost 10 lb recently, even with increased appetite. Her past medical history is unremarkable. Physical examination reveals a BMI at normal range. No significant abnormalities are noted. Laboratory tests reveals a glucose at 450 mg/dl (normal 70-180 mg/dl), A1C at 15% (normal <8%), C-peptide at 0.1 ng/ml (0.5-2.0 ng/ml). Her arterial blood gas tests are within normal range. Urinalysis reveals trace amount of ketone. What is additional test is likely abnormal?

A. Antibodies against beta cells

B. Elevated glucagon

C. Elevated thyroxin

D. Hyperlipidemia

E. Reduced blood osmolality

4. Use this case for the next three questions. A 30-year-old woman presents with fever, abdominal pain and vomiting for 10 hours. She has been coughing for a week. She has a history of type 1 diabetes since age 15, and has been treated with insulin. Physical examination reveals a temperature at 39.5° C, heart rate at 132 bpm and rapid shallow breathing. She has dry mucous membranes, poor skin turgor and appears to be confused. Laboratory test results include a white cell count at 17 x 10⁹/L (normal 4.5-11 x 10⁹/L) with neutrophilia, glucose at 510 mg/dl (normal 70-100 mg/dl), BUN 45 mg/dl (normal 7-20 mg/dl) and creatinine 1.5 mg/dl (normal 0.5-1.1 mg/dl). Blood smears reveals left shift without immature cells. Arterial blood gas tests reveals a pH at 7.1. Blood culture is negative for microorganism. What is most likely the diagnosis?

A. Acute myeloid leukemia

B. Diabetic ketoacidosis

C. Hyperosmolar hyperosmotic syndrome

D. Hypoglycemia

E. Sepsis

5. A 30-year-old woman presents with fever, abdominal pain and vomiting for 10 hours. She has been coughing for a week. She has a history of type 1 diabetes since age 15, and has been treated with insulin. Physical examination reveals a temperature at 39.5° C, heart rate at 132 bpm and rapid shallow breathing. She has dry mucous membranes, poor skin turgor and appears to be confused. Laboratory test results include a white cell count at 17 x 10⁹/L (normal 4.5-11 x 10⁹/L) with neutrophilia, glucose at 510 mg/dl (normal 70-100 mg/dl), BUN 45 mg/dl (normal 7-20 mg/dl) and creatinine 1.5 mg/dl (normal 0.5-1.1 mg/dl). Blood smears reveals left shift without immature cells. Arterial blood gas tests reveals a pH at 7.1. Blood culture is negative for microorganism. What additional lab test is most likely to confirm the diagnosis?

A. Blood osmolality

B. Bone marrow biopsy

C. Flow cytometry

D. Urine culture

E. Urine ketone analysis

6. A 30-year-old woman presents with fever, abdominal pain and vomiting for 10 hours. She has been coughing for a week. She has a history of type 1 diabetes since age 15, and has been treated with insulin. Physical examination reveals a temperature at 39.5° C, heart rate at 132 bpm and rapid shallow breathing. She has dry mucous membranes, poor skin turgor and appears to be confused. Laboratory test results include a white cell count at 17 x 10⁹/L (normal 4.5-11 x 10⁹/L) with neutrophilia, glucose at 510 mg/dl (normal 70-100 mg/dl), BUN 45 mg/dl (normal 7-20 mg/dl) and creatinine 1.5 mg/dl (normal 0.5-1.1 mg/dl). Blood smears reveals left shift without immature cells. Arterial blood gas tests reveals a pH at 7.1. Blood culture is negative for microorganism. Additional test reveals marked increased ketone in urine. What is most likely to be associated with her urine findings?

A. Abnormal neutrophilic functions

B. Bacterial endotoxin after acute respiratory infection

C. Excessive fat metabolism due to insulin deficiency

D. Loss of plasma protein through urine due to renal failure

E. Pulmonary malfunctioning due to infection

7. A 36-year-old G6P5 woman presents with worsening thirst, polyuria and a 10 lb loss of weight for 1 month. She has a history of type 2 diabetes that has been medically treated. Her past medical history is otherwise unremarkable.  She is 5 feet tall and weighs 210 lb. Physical examination reveals no other significant abnormalities. Laboratory test reveals a blood glucose at 150 mg/dl (normal 70-100 mg/dl) and HbA1C at 11% (normal < 6%). Her CBC, renal function and liver function tests and urinalysis are within normal range. What is the diagnosis?

A. Diabetic ketoacidosis

B. Diabetic nephropathy

C. Gestational diabetes

D. Hyperosmolar hyperosmotic syndrome

E. Type 2 diabetes

8. Use this case for the next five questions. A 30-year-old G2P1 woman at 28 week of gestation presents for routine prenatal care. Her past medical history is unremarkable.  She has a pregestational BMI of 27 (normal 18-25). No other abnormalities are noted in physical examination. Laboratory tests results are unremarkable except a random blood glucose at 110 mg/dl (normal 70-100 mg/dl). A urine dipstick shows 2+ glycosuria and negative ketones. No blood cells are seen in urine. What is causing these findings?

A. Amyloid deposit and damage of islet

B. Autoimmune damage of islet

C. Glomerular inflammation

D. Placental hormone productions

E. Urinary tract infections

9. A 30-year-old G2P1 woman at 28 week of gestation presents for routine prenatal care. Her past medical history is unremarkable.  She has a pregestational BMI of 27 (normal 18-25). No other abnormalities are noted in physical examination. Laboratory tests results are unremarkable except a random blood glucose at 110 mg/dl (normal 70-100 mg/dl). A urine dipstick shows 2+ glycosuria and negative ketones. No blood cells are seen in urine. What is the best test next?

A. Arterial blood gas test

B. Fast serum glucose

C. One-hour glucose challenge test 50-g glucose

D. Serum hCG

E. Urine culture

10. A 30-year-old G2P1 woman at 28 week of gestation presents for routine prenatal care. Her past medical history is unremarkable.  She has a pregestational BMI of 27 (normal 18-25). No other abnormalities are noted in physical examination. Laboratory tests results are unremarkable except a random blood glucose at 110 mg/dl (normal 70-100 mg/dl). A urine dipstick shows 2+ glycosuria and negative ketones. No blood cells are seen in urine.

She took 50 gram glucose, and the blood glucose after a hour is 160 mg/dl (normal 130-140 mg/dl). What is the test to confirm the diagnosis?

A. 100-g glucose tolerance test

B. Fast serum glucose

C. HbA1c

D. Serum insulin

E. Sonographic pelvic examination

11. A 30-year-old G2P1 woman at 28 week of gestation presents for routine prenatal care. Her past medical history is unremarkable.  She has a pregestational BMI of 27 (normal 18-25). No other abnormalities are noted in physical examination. Laboratory tests results are unremarkable except a random blood glucose at 110 mg/dl (normal 70-100 mg/dl). A urine dipstick shows 2+ glycosuria and negative ketones. No blood cells are seen in urine.

Her 100-gram glucose tolerance test results are: 95 mg/dl at fasting, 250, 180 and 130 mg/dl at 1, 2 and 3 hours after, respectively.  What is the diagnosis?

A. Diabetic nephropathy

B. Gestational diabetes

C. Impaired glucose tolerance

D. Type 1 diabetes

E. Type 2 diabetes

12. A 30-year-old G2P1 woman at 28 week of gestation presents for routine prenatal care. Her past medical history is unremarkable.  She has a pregestational BMI of 27 (normal 18-25). No other abnormalities are noted in physical examination. Laboratory tests results are unremarkable except a random blood glucose at 110 mg/dl (normal 70-100 mg/dl). A urine dipstick shows 2+ glycosuria and negative ketones. No blood cells are seen in urine.

Her 100-gram glucose tolerance test results are: 95 mg/dl at fasting, 250, 180 and 130 mg/dl at 1, 2 and 3 hours after, respectively.  What is most likely to occur to this woman?

A. Diabetic ketoacidosis

B. Glucagonoma

C. Insulinoma

D. Type 1 diabetes

E. Type 2 diabetes

13. Use this case for the next two questions. A 35-year-old asymptomatic man presents for hyperlipidemia follow up. His past medical history is otherwise unremarkable. Physical examination reveals a body mass at 34 (normal 18-25). No other abnormalities are noted. Laboratory tests reveals a blood glucose at 135 mg/dl (normal 70-100 mg/dl), total cholesterol at 250 mg/dl (normal < 200 mg/dl), LDL at 140 mg/dl (normal <100 mg/dl) and HDL at 35 mg/dl (normal > 60 mg/dl). What test is needed next?

A. Arterial blood gas test

B. 75 gram oral glucose tolerance test

C. EKG

D. Liver function test

E. Urine ketone analysis

14. A 35-year-old asymptomatic man presents for hyperlipidemia follow up. His past medical history is otherwise unremarkable. Physical examination reveals a body mass at 34 (normal 18-25). No other abnormalities are noted. Laboratory tests reveals a blood glucose at 135 mg/dl (normal 70-100 mg/dl), total cholesterol at 250 mg/dl (normal < 200 mg/dl), LDL at 140 mg/dl (normal <100 mg/dl) and HDL at 35 mg/dl (normal > 60 mg/dl). 75-gram oral glucose tolerance test results include 110 mg/dl and 155 mg/dl at fasting and 2 hours after. What is the diagnosis?

A. Diabetic nephropathy

B. Hyperosmolar hyperosmotic syndrome

C. Impaired glucose tolerance

D. Type 1 diabetes

E. Type 2 diabetes

15. Use this case for the next two questions. A 45-year-old man presents with frequent thirstiness, polyuria and a 10 lb unintentional weight loss for a month. He denies other symptoms. He has a family history of hypertension, hyperlipidemia and diabetes. He has a 30 pack-years history of cigarette smoking. Physical examination reveals a BMI of 32 (normal 18-25). No other significant abnormalities are noted. Laboratory test reveals a blood glucose at 250 mg/dl. Other laboratory tests are within normal range. What is the diagnosis?

A. Diabetic nephropathy

B. Hyperosmolar hyperosmotic syndrome

C. Impaired glucose tolerance

D. Type 1 diabetes

E. Type 2 diabetes

16. A 45-year-old man presents with frequent thirstiness, polyuria and a 10 lb unintentional weight loss for a month. He denies other symptoms. Has been hypertensive for 5 years. He has a family history of hyperlipidemia and diabetes. He has a 30 pack-years history of cigarette smoking. Physical examination reveals a BMI of 32 (normal 18-25). No other significant abnormalities are noted. Laboratory test reveals a blood glucose at 250 mg/dl. Other laboratory tests are within normal range. What is the most associated with his presentations?

A. Autoimmune damage of islet

B. Cigarette smoking

C. Genetic defects

D. History of hypertension

E. Obesity

17. Use this case for the next three questions. A 60-year-old man presents with sudden onset of coma for 1 hour. He has had progressive fatigue and weakness, continuous thirstiness and markedly increased urine output for a week. He has a history of diabetes, hypertension and benign prostate hypertrophy. He does not drink alcohol or smoke cigarette. His blood pressure is 75/40 mmHg, heart rate at 125 bpm. He does not have fever. Physical examination reveals dry skin and mucosa. No other abnormalities are noted. Laboratory test results including a blood glucose at 1200 mg/dl (normal 65-110 mg/dl), BUN at 26 mg/dl (normal 7-18 mg/dl), creatinine at 2.9 mg/dl (normal 0.8-1.2 mg/dl). His CBC is within normal range. Urinalysis reveals 3+ glucose, but is negative for ketone. No blood cells are seen in urine. Urine cultures are negative. Arterial blood gas test reveals a pH at 7.4 (normal 7.38-7.42). What is the diagnosis?

A. Hypertensive kidney disease

B. Diabetic ketoacidosis

C. Diabetic nephropathy

D. Hyperosmolar hyperosmotic syndrome

E. Urinary tract infection

18. A 60-year-old man presents with sudden onset of coma for 1 hour. He has had progressive fatigue and weakness, continuous thirstiness and markedly increased urine output for a week. He has a history of diabetes, hypertension and benign prostate hypertrophy. He does not drink alcohol or smoke cigarette. His blood pressure is 75/40 mmHg, heart rate at 125 bpm. He does not have fever. Physical examination reveals dry skin and mucosa. No other abnormalities are noted. Laboratory test results including a blood glucose at 1200 mg/dl (normal 65-110 mg/dl), BUN at 26 mg/dl (normal 7-18 mg/dl), creatinine at 2.9 mg/dl (normal 0.8-1.2 mg/dl). His CBC is within normal range. Urinalysis reveals 3+ glucose, but is negative for ketone. No blood cells are seen in urine. Urine culture is negative. Arterial blood gas test reveals a pH at 7.4 (normal 7.38-7.42). What is the cause of his abnormal BUN and creatinine levels?

A. Dehydration

B. Glomerular fibrosis

C. Kidney parenchyma scarring

D. Renal artery sclerosis

E. Sepsis

19. A 60-year-old man presents with sudden onset of coma for 1 hour. He has had progressive fatigue and weakness, continuous thirstiness and markedly increased urine output for a week. He has a history of diabetes, hypertension and benign prostate hypertrophy. He does not drink alcohol or smoke cigarette. His blood pressure is 75/40 mmHg, heart rate at 125 bpm. He does not have fever. Physical examination reveals dry skin and mucosa. No other abnormalities are noted. Laboratory test results including a blood glucose at 1200 mg/dl (normal 65-110 mg/dl), BUN at 26 mg/dl (normal 7-18 mg/dl), creatinine at 2.9 mg/dl (normal 0.8-1.2 mg/dl). His CBC is within normal range. Urinalysis reveals 3+ glucose, but is negative for ketone. No blood cells are seen in urine. Urine culture is negative. Arterial blood gas test reveals a pH at 7.4 (normal 7.38-7.42). What is most important pathological factor that contribute to his presentations?

A. Acidosis

B. Bacterial toxin

C. Elevated fatty acid metabolism

D. Hyperglycemia

E. Hypoglycemia

Answers

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