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Which of the following clinical findings is a risk factor for thyroid cancer?

A 32-year-old man presents with a solitary, firm thyroid nodule found on routine physical exam. He denies any heat or cold intolerance, palpitations, weight loss or gain, hoarseness, dysphagia, sore throat, or neck discomfort. Patient denies knowledge of previous head or neck irradiation. There is no cervical lymphadenopathy on examination. The remainder of the HEENT exam is normal. TSH, thyroxine, thyroglobulin, and thyroid antibody levels are all within normal limits. Thyroid scanning with radioactive iodine reveals 2 cm ‘cold’ nodule (i.e., absence of uptake) in the left lobe of the thyroid gland.  Based on this information, which of the following conditions is the most likely diagnosis for this patient?  

A 52-year-old woman with no significant past medical history presents to your office complaining of fatigue, constipation, cold intolerance, and weight gain. She is presently on no medications. Her physical examination is notable for a dull facial expression, periorbital swelling, and coarse, dry skin. There is no thyromegaly. The most likely cause of this woman’s symptoms is:

A 56-year-old male presents for a follow up visit in your office. He is a known diabetic and hypertensive for 6 years. He has no complaints today and is up-to-date in the management of his conditions. He is not allergic to any medications. His medications include metformin, hydrochlorothiazide, aspirin, and acetaminophen for occasional headaches. He had just read about renal complications of diabetes mellitus and he would like to know what test could be done to evaluate him for diabetic nephropathy. His laboratory values are shown in the table. Serum glucose 129 mg/dl Sodium 144mmol/L Potassium 5.0mmol/L Chloride 110mmol/L Bicarbonate 22mmol/L BUN 15mg/dL Creatinine 1.1mg/dL Hemoglobin A1C 8.9%   Which of the following tests is the most appropriate intervention for this patient?

Parathyroid hormone-related peptide (PTHRP) is an example of an ectopically produced hormone that causes an endocrine paraneoplastic syndrome in the setting of squamous cell lung cancer, head and neck cancer, and bladder cancer.  Which of the following clinical findings are associated with PTHRP?

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?

A 74-year-old male presents to the emergency department acutely obtunded. The patient lives alone and was found unresponsive by his son. Generally, the patient manages his own finances, medications, and works part-time. He has not been responding to phone calls for the past 3 days. The patient is unable to offer a history. He has a past medical history of hypothyroidism, depression, and diabetes. His temperature is 88.0°F (31.1°C), blood pressure is 92/62 mmHg, pulse is 35/min, respirations are 9/min, and oxygen saturation is 92% on room air. The patient is cold to the touch and moves all extremities to painful stimuli. His pupils are reactive and sluggish, and he does not follow commands. There are no signs of trauma or skin infections.  Which of the following conditions is the most likely diagnosis?

A 47-year-old woman with no significant past medical history, is sent to the Emergency Department for complaints of feeling “weak and dizzy.”  She states that she was feeling well up until about an hour ago, when she began to feel as if she were going to “pass out.” Her husband accompanied her to the hospital and stated that she appeared nervous, confused, and was tremulous. When he asked her what was wrong, she did not seem to understand him. However, she did not appear to have lost consciousness.  Upon arrival in the Emergency Department, she was found on examination to have tachycardia and generalized weakness. She was conscious, but slightly disoriented. She was afebrile. Her laboratory tests were normal with the exception of a blood glucose level of 47 mg/dL. The patient received treatment with 50% dextrose and improved immediately.  Based on this information, what is the most likely cause of this patient’s symptoms?

A 38-year-old man came to the outpatient clinic presenting with fatigue, dry mouth, and passing large amounts of urine. He describes his urine as light in color and non-odorous. On further questioning, he said he had never experienced prior similar symptoms.  He has always been healthy and denies prior hospitalizations.  On recent routine pre-employment screening, serum electrolyte testing revealed that his serum sodium was mildly elevated.  He was advised to have the test repeated in three months.  When he had repeat blood work taken one week ago, there was further increase in the serum sodium level.  Blood glucose level is normal.  DDAVP (desmopressin) injection resulted in decrease in urine volume and increase in urine specific gravity. Based on this information, which of the following conditions is the most likely diagnosis for this patient?

You have now completed the Endocrine core examination.