Module 9 - Alterations of Hormonal Regulation

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Regulation of the release of T3 and T4 from the thyroid gland is controlled by:

A) neural feedback.
B) negative feedback.
C) positive feedback.
D) all of the above.

B) negative feedback.

Which of the following is a steroid hormone?

A) Insulin
B) Thyroxine (T4)
C) Cortisol
D) Growth hormone

C) Cortisol

To adapt to high hormone concentrations, many target cells have the capacity for:

A) negative feedback.
B) positive feedback.
C) up-regulation.
D) down-regulation.

D) down-regulation.

Growth hormone is secreted into the bloodstream by the:

A) anterior pituitary.
B) posterior pituitary.
C) hypothalamus.
D) thymus.

A) anterior pituitary.

Target cells for aldosterone are located in the:

A) adrenal cortex.
B) adrenal medulla.
C) liver.
D) kidneys.

D) kidneys.

The primary effect of antidiuretic hormone (ADH) in the kidneys is to stimulate:

A) water reabsorption.
B) sodium reabsorption.
C) sodium and water excretion.
D) acid secretion.

A) water reabsorption.

Calcitonin and parathyroid hormone strictly regulate serum levels of:

A) potassium.
B) calcium.
C) iron.
D) magnesium.

B) calcium.

Which of the following nutrients is essential for thyroid hormone synthesis?

A) Iron
B) Iodine
C) Phosphate
D) Calcium

B) Iodine

The main function of thyroid hormone (T3 and T4) is control of:

A) gastric secretions.
B) synaptic activity.
C) insulin secretion.
D) metabolic rate.

D) metabolic rate.

Increased thyroid hormone levels in the blood result in:

A) further stimulus to produce thyroid hormone.
B) decreased release of thyroid-stimulating hormone from the anterior pituitary.
C) increased secretion of thyrotropin-releasing hormone from the hypothalamus.
D) inhibition of parathyroid hormone release from the parathyroid glands.

B) decreased release of thyroid-stimulating hormone from the anterior pituitary.

Which cells in the pancreas secrete insulin?

A) Alpha
B) Beta
C) Delta
D) Acinar

B) Beta

The primary physiologic effect of insulin is to:

A) stimulate nutrient absorption from the digestive tract.
B) raise blood glucose levels.
C) decrease basal metabolic rate.
D) promote glucose uptake into cells.

D) promote glucose uptake into cells.

Which hormone functions as an antagonist to insulin?

A) Aldosterone
B) Glucagon
C) Somatostatin
D) Amylin

B) Glucagon

High levels of glucocorticoids such as cortisol can result in:

A) immunosuppression.
B) hypoglycemia.
C) weight loss.
D) all of the above.

A) immunosuppression.

Adrenocorticotropic hormone (ACTH) is synthesized and released in the:

A) adrenal cortex.
B) adrenal medulla.
C) anterior pituitary.
D) posterior pituitary.

C) anterior pituitary.

Syndrome of inappropriate diuretic hormone (SIADH) results in excessive:

A) renal retention of sodium and water.
B) renal retention of sodium without water retention.
C) renal retention of water without sodium retention.
D) renal excretion of water without sodium retention.

C) renal retention of water without sodium retention.

Neurological symptoms of SIADH are related to:

A) hypotension and cellular dehydration
B) decreased serum sodium concentrations.
C) increased serum osmolarity.
D) hypokalemia.

B) decreased serum sodium concentrations.

Which of the following is a serious complication of SIADH?

A) Permanent neurological damage
B) Renal failure
C) Myocardial infarction
D) Panhypopituitarism

A) Permanent neurological damage

Damage to the posterior pituitary caused by a cerebrovascular accident (stroke) results in _____ diabetes insipidus (DI).

A) vascular
B) nephrogenic
C) psychogenic
D) neurogenic

D) neurogenic

Classic symptoms of diabetes insipidus (DI) include all of the following except:

A) hypertension.
B) dehydration.
C) low urine osmolarity.
D) thirst.

A) hypertension.

When evaluating the kidney function of an individual with diabetes insipidus (DI), the nurse would observe:

A) high volume urine output.
B) high urine osmolarity.
C) blood in the urine.
D) protein in the urine.

A) high volume urine output.

In adults, the most serious consequence of panhypopituitarism is the loss of:

A) growth hormone.
B) luteinizing hormone (LH).
C) adrenocorticotropic hormone (ACTH).
D) thyroid-stimulating hormone (TSH).

C) adrenocorticotropic hormone (ACTH).

Acromegaly is caused by increased secretion of:

A) prolactin.
B) growth hormone.
C) insulin.
D) glucocorticoids.

B) growth hormone.

Prolactinomas (pituitary tumors that secrete prolactin) cause which of the following problems in women?

A) Heavy menstrual periods
B) Infertility
C) Breast milk production without pregnancy
D) Hair loss

C) Breast milk production without pregnancy

A clinician would suspect thyrotoxicosis if a patient presented with which of the following symptoms?

A) Confusion and gait disturbances
B) Weight loss and enlarged thyroid gland
C) Slow tendon reflexes and muscle stiffness
D) Peripheral edema and dry skin

B) Weight loss and enlarged thyroid gland

Graves disease is characterized by:

A) ectopic secretion of thyroid hormone by a tumor.
B) excessive production of circulating thyroid-stimulating immunoglobulin.
C) autoimmune destruction of the thyroid gland.
D) injury to the pituitary, resulting in decreased thyroid-stimulating hormone secretion.

B) excessive production of circulating thyroid-stimulating immunoglobulin.

Graves disease is an example of a:

A) type I hypersensitivity.
B) type II hypersensitivity.
C) type III hypersensitivity.
D) type IV hypersensitivity.

B) type II hypersensitivity.

In Graves disease, accumulation of edema in the orbit can lead to:

A) optic nerve damage.
B) eye muscle palsies.
C) exophthalmos.
D) all of the above.

D) all of the above.

What is the cause of exophthalmos in Graves disease?

A) Decreased blood flow to the eye
B) Degenerative changes in the muscle and orbital edema
C) High levels of TSH causing retinal toxicity
D) Optic nerve damage

B) Degenerative changes in the muscle and orbital edema

The level of thyroid-stimulating hormone (TSH) in Graves disease is:

A) low.
B) high.
C) normal.
D) variable.

A) low.

The physiologic stress of illness or surgery can induce a severe response in individuals who have unrecognized and untreated thyrotoxicosis. The pathophysiology of thyroid storm, also known as thyrotoxic crisis, involves:

A) hypotension and bradycardia leading to shock.
B) pulmonary edema and bronchoconstriction leading to respiratory arrest.
C) hypercoagulability and formation of deep vein thromboses leading to pulmonary emboli.
D) fever and tachycardia leading to high-output heart failure.

D) fever and tachycardia leading to high-output heart failure.

An endocrinologist orders a series of lab tests to assess thyroid function. Low levels of thyroid hormone (T3 and T4) and high levels of thyroid-stimulating hormone (TSH) are indicative of:

A) primary hypothyroidism.
B) secondary hypothyroidism.
C) primary hyperthyroidism.
D) secondary hyperthyroidism.

A) primary hypothyroidism.

If left untreated, congenital hypothyroidism results in:

A) hyperactivity and attention deficit disorder.
B) increased risk of childhood thyroid cancer.
C) mental retardation and stunted growth.
D) liver, kidney, and pancreas failure.

C) mental retardation and stunted growth.

Signs and symptoms of hypothyroidism include all of the following except:

A) weight gain.
B) diarrhea.
C) myxedema.
D) lethargy.

B) diarrhea.

The most common cause of primary hypothyroidism in adults is:

A) bacterial infection of the thyroid gland.
B) viral infection of the thyroid gland.
C) congenital hypothyroidism.
D) autoimmune thyroiditis.

D) autoimmune thyroiditis.

Which of the following thyroid disorders can be caused by exposure of the thyroid gland to ionizing radiation?

A) Graves disease
B) Hashimoto thyroiditis
C) Thyroid cancer
D) Subacute thyroiditis

C) Thyroid cancer

Causes of myxedema coma include:

A) untreated hypothyroidism.
B) subclinical hyperthyroidism.
C) thyroid storm.
D) a reaction to abnormally high levels of thyroid autoantibodies.

A) untreated hypothyroidism.

Thyroid carcinoma usually presents with the following thyroid tissue changes:

A) small nodules.
B) elevated T3 and T4.
C) large, diffuse goiter.
D) thyroid gland atrophy.

A) small nodules.

Chronic hyperparathyroidism will lead to all of the following conditions except:

A) osteopenia.
B) renal calculi (stones).
C) weight loss.
D) pathologic bone fractures.

C) weight loss.

Which of the following disorders can cause secondary hyperparathyroidism?

A) Chronic renal failure
B) Primary hyperparathryroidism
C) A pituitary tumor
D) Graves disease

A) Chronic renal failure

The most common cause of hypoparathyroidism is:

A) hypothalamic inactivity.
B) pituitary hyposecretion.
C) parathyroid adenoma.
D) parathyroid gland injury or removal.

D) parathyroid gland injury or removal.

One problem associated with untreated hypoparathyroidism is:

A) osteoporosis.
B) metabolic acidosis.
C) insulin resistance.
D) muscle spasms.

D) muscle spasms.

The pathophysiology of type 1 diabetes mellitus (DM) involves:

A) autoimmune destruction of pancreatic beta cells.
B) production of antibodies against insulin.
C) type IV hypersensitivity against pancreatic islet cells.
D) all of the above.

D) all of the above.

A new diagnosis of type 1 diabetes is based on:

A) random serum glucose levels.
B) fasting plasma glucose levels and glucose tolerance tests.
C) genetic testing.
D) the presence of symptoms only.

B) fasting plasma glucose levels and glucose tolerance tests.

Hyperglycemia and lipid abnormalities in type 2 diabetes mellitus (DM) are a result of:

A) production of inactive insulin.
B) glucagon deficiency.
C) insulin resistance.
D) glycogen excess.

C) insulin resistance.

Signs and symptoms common to both type 1 and type 2 diabetes mellitus (DM) include all of the following except:

A) polyphagia.
B) weight loss.
C) polydipsia.
D) polyuria.

B) weight loss.

Signs and symptoms that a person with type 1 diabetes has administered too much insulin include:

A) Kussmaul respirations and acetone breath.
B) dizziness and confusion.
C) abdominal cramping and nausea.
D) pain at the site of injection.

B) dizziness and confusion.

Gestational diabetes can occur:

A) during fetal development.
B) in early childhood.
C) during pregnancy.
D) in older adults

C) during pregnancy.

The purpose of monitoring glycosylated hemoglobin levels in persons with diabetes is to:

A) check for hyperlipidemia.
B) detect acute complications of diabetes.
C) monitor long-term serum glucose control.
D) measure fasting glucose levels.

C) monitor long-term serum glucose control.

The symptom of polyuria in diabetes mellitus (DM) is caused by:

A) a reduced AHD response caused by insulin deficiency.
B) the loss of protein across the glomerular membrane.
C) the production of ketones.
D) increased glucose in the urine.

D) increased glucose in the urine.

What effect does the presence of advanced glycosylation end products (AGEs) have in diabetes?

A) Increased ketone formation
B) Tissue injury
C) Dawn phenomenon
D) Reduction of chronic complications

B) Tissue injury

The development of an acute metabolic acidosis from insulin deficiency is due to which of the following processes?

A) Protein catabolism with ammonia release
B) Anaerobic metabolism of glucose
C) Fatty acid metabolism with ketone production
D) Renal failure

C) Fatty acid metabolism with ketone production

Alterations in lipid and protein metabolism lead to chronic complications of DM through which of the following processes?

A) Activation of protein kinase C
B) Induction of the polyol pathway
C) Glycosylation
D) All of the above

D) All of the above

Chronic complications of DM include which of the following?

A) Peripheral neuropathies
B) End-stage renal disease
C) Coronary artery disease
D) All of the above

D) All of the above

Cushing disease is commonly caused by:

A) autoimmune destruction of the adrenal cortex.
B) ectopic production of ACTH from a lung tumor.
C) excessive production of cortisol from a tumor in the adrenal cortex.
D) excessive production of aldosterone from a tumor in the adrenal cortex.

B) ectopic production of ACTH from a lung tumor.

Which of the following alterations would you expect to find in a patient with untreated Cushing disease or syndrome?

A) Weight loss
B) Pale skin
C) Truncal obesity
D) Peripheral edema

C) Truncal obesity

Which of the following problems arises from primary hyperaldosteronism?

A) Hypertension
B) Hyperglycemia
C) Hyperkalemia
D) Hyponatremia

A) Hypertension

Metabolic abnormalities in Addison disease include all of the following except:

A) hyperkalemia.
B) hyponatremia.
C) hypoglycemia.
D) hypercalcemia.

D) hypercalcemia.

The most common cause of Addison disease is:

A) adrenal cancer.
B) autoimmune injury to the adrenal cortex.
C) viral infection of the pituitary gland.
D) bacterial infection of the adrenal medulla.

B) autoimmune injury to the adrenal cortex.

Hypersecretion of androgens from an adrenal tumor in female children causes virilization, which is:

A) the early development of female sex characteristics.
B) the development of male sex characteristics.
C) a form of hypercortisolism.
D) sterility.

B) the development of male sex characteristics.

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