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A 34-year-old male with Type I diabetes, presents for an acute office visit complaining of uncontrolled blood sugars, with high and low readings throughout the day and night.  When he called to make the appointment, he was advised to bring in his blood glucose log, and to check a few 3:00AM blood sugar levels.  His current daily insulin regimen is 40 units NPH insulin and 20 units of Regular insulin before breakfast, and 20 units of NPH insulin and 10 units of Regular insulin before dinner. Time 7am 11 am 5 pm 11 pm 3 am Average blood glucose mg/dL 393 210 175 140 50 Which of the following insulin adjustments is most appropriate, based on the patient’s average glucose readings?

Potential side effects of systemic glucocorticoid use include each of the following EXCEPT:

Adult bone cannot increase in length when stimulated by an excess of growth hormone because of the lack of epiphyseal cartilage, but they do increase in width by periosteal growth.  In adults, an excess of growth hormone causes which of the following conditions?

A 9-year-old boy is brought to the clinic due to his short stature. The mother is concerned that her son is not as tall as his classmates, causing him stress. On physical exam, there is macrocephaly with frontal bossing, shortening of the arms and legs, and lumbar lordosis. Which of the following physiologic processes is most likely disrupted in this patient’s condition?

You are asked to evaluate a 72-year-old female patient who complains of recent onset of polyuria, constipation, and nausea. Physical examination is essentially unremarkable, and laboratory studies are ordered including a complete metabolic profile and routine urinalysis.  Results of tests are as follows: Urinalysis: negative for nitrite, glucose, leukocytes, blood, ketones, and bilirubin, leukocyte esterase, protein, and urobilinogen. Metabolic profile: (abnormal results in boldtype): Serum Ca+2     13.2 (8.2-10.2 mg/dL)Serum PO4−3    1.8 (2.5-4.5 mg/dL)Serum albumin 4.0 (3.5-5.0 g/dL) The patient has normal renal function, and no other abnormalities are noted on results of complete metabolic profile.                                                          Based on these initial laboratory results, which of the following additional laboratory test results would be helpful in establishing a diagnosis of primary hyperparathyroidism?

A patient presents 5 days status-post thyroidectomy with muscle cramping and altered mental status. On physical exam you elicit a positive Chvostek sign. Which of the following is the expected laboratory result for this condition?

A 34-year-old female presents for a physical exam. She is new to the practice and enrolled because she and her family had recently moved to the area and her last physical was more than 1 year ago. On review of her history, the patient has had 2 normal vaginal deliveries and is currently on no oral contraceptive medication, as her husband has had a vasectomy. She has had no chronic medical problems. Her only medications are a multivitamin and Vitamin E. On review of her records, you note that she had a relatively normal fasting lipid profile performed 5 years ago, is up to date on her Tetanus shot, and has had normal Pap smears over the past 5 years. The records also seem to indicate that she has gained about 10 lbs in weight over the past year. Her physical exam is within normal; she is about 20% overweight. You ask the patient to do a repeat fasting lipid profile and the values are as follows: Total cholesterol is 342 mg/dL (normal under 200) LDL Cholesterol 225 mg/dL (normal 60-160) HDL Cholesterol 75 mg/dL (normal 30-80) Triglyceride level 210 mg/dL (normal under 150) What would be the most appropriate next step in the diagnostic evaluation of this patient?

A 24-year-old man is referred to an endocrinologist for paroxysms of headaches associated with elevated blood pressure and palpitations. He is otherwise healthy, although he notes a family history of thyroid cancer. His physical examination is significant for the findings shown in Figures A, B, and C (see images). His thyroid is normal in size, but there is a 2.5 cm nodule palpable in the right lobe. On further workup, it is found that he has elevated plasma-free metanephrines and a normal TSH. Fine-needle aspiration of the thyroid nodule stains positive for calcitonin. The endocrinologist suspects a genetic syndrome. What is the most likely inheritance pattern?

A 55-year-old female with a 15-year history of Type II diabetes comes to your office for follow up of her diabetes. Her spot albumin/creatinine ratio was 100 mg/g 4 months ago and was confirmed at 100 mg/g yesterday, consistent with stable microalbuminuria. Her urinary analysis shows no cells, casts, or blood. Her creatinine is 0.7mg/dl and her estimated glomerular filtration rate is 95 ml/min (normal range). Which of the following medications should you prescribe to help prevent her progression from micro to macroalbuminuria and to help prevent progressive decline in glomerular filtration rate?

A 30-year-old man presents to your clinic complaining of excessive thirst and frequent urination for the past few months. Urine testing reveals a low urine osmolarity, which fails to increase after subjecting the patient to a water deprivation test and injection of desmopressin. Further into the encounter, the patient reveals that he has been on a mood stabilizer for bipolar disorder for several years. Which of the following is the most likely cause of his polyuria?