A 35-year-old woman presents to the emergency department with high fever, tachycardia, agitation, and nausea. She has a history of Graves' disease but has been noncompliant with her anti-thyroid medications. Which life-threatening condition should be considered in this patient?
Correct
Incorrect
Consider the patient's history of Graves' disease and her symptoms.
2. Question
What is the most common cause of thyroid storm?
Correct
Incorrect
Think about common factors that may precipitate thyroid storm.
3. Question
Which of the following is NOT a classic feature of thyroid storm?
Correct
Incorrect
Review the clinical manifestations of thyroid storm.
4. Question
A 45-year-old man presents with signs of decompensation in multiple organ systems and a history of thyroid disease. Which of the following is a common cause of death in patients with thyroid storm?
Correct
Incorrect
Consider the cardiovascular complications associated with thyroid storm.
5. Question
A 30-year-old woman with a history of toxic nodular goiter presents with fever, tachycardia, heart failure, and tremor. What is the most important laboratory test to confirm thyroid storm in this patient?
Correct
Incorrect
Consider the diagnostic approach to thyroid storm.
6. Question
A 35-year-old female with a history of Graves' disease presents to the emergency department with high fever, severe agitation, and rapid heart rate. Which of the following factors could have potentially precipitated her thyroid storm?
Correct
Incorrect
Consider the possible precipitating factors of thyroid storm.
7. Question
A 45-year-old male with thyrotoxicosis presents with extreme weakness, emotional apathy, confusion, and low fever. What form of thyroid storm is he likely experiencing?
Correct
Incorrect
Consider the symptoms presented by the patient and match them to the appropriate form of thyroid storm.
8. Question
In the management of thyroid storm, why should iodide be administered after an antithyroid drug like PTU or methimazole?
Correct
Incorrect
Consider the effect of iodine on thyroid hormone synthesis and the timing of its administration.
9. Question
In a patient with thyroid storm, which of the following beta-blocking agents should be considered if the patient has reactive airway disease?
Correct
Incorrect
Consider the type of beta blocker that is cardioselective and safer for patients with reactive airway disease.
10. Question
In a patient presenting with thyroid storm, which of the following antithyroid drugs should be given initially, if possible, due to its additional effect of preventing peripheral conversion of T4 to T3?
Correct
Incorrect
Consider the additional effect of the antithyroid drug on the conversion of T4 to T3.
11. Question
Which of the following measures is NOT part of the supportive treatment for patients with thyroid storm?
Correct
Incorrect
Consider the measures that are specifically aimed at addressing the symptoms and complications of thyroid storm.
12. Question
What is the primary goal of treatment in the follow-up phase of thyroid storm management?
Correct
Incorrect
Consider the desired thyroid hormone levels before deciding on definitive treatment.
13. Question
In rare situations where medical therapy is ineffective or contraindicated in a patient with thyroid storm, what alternative treatment option may be necessary?
Correct
Incorrect
Consider the treatment options when medical therapy is not sufficient or contraindicated.
14. Question
Which of the following medications should be administered an hour after giving PTU or Methimazole in a patient with thyroid storm?
Correct
Incorrect
Consider the medication that may stimulate thyroid hormone synthesis if given before antithyroid drugs.
15. Question
Which short-acting beta-blocker can be used in an ICU setting for a patient with thyroid storm?
Correct
Incorrect
Consider the beta-blocker with a short duration of action suitable for an ICU setting.
16. Question
Which of the following measures is crucial in preventing thyroid storm?
Correct
Incorrect
Consider the importance of thyroid hormone levels in relation to medical procedures.
17. Question
Which of the following agents is beneficial in thyroid storm due to its effect on acutely depressing serum T3 levels by reducing T4 to T3 conversion?
Correct
Incorrect
Consider the medication that has a direct effect on T4 to T3 conversion.
18. Question
Which of the following symptoms may indicate sight-threatening Graves' ophthalmopathy?
Correct
Incorrect
Consider the symptoms that would indicate a serious ocular issue.
19. Question
What is the primary cause of Graves' ophthalmopathy?
Correct
Incorrect
Consider the underlying mechanism responsible for the development of Graves' ophthalmopathy.
20. Question
Which of the following diagnostic tests is useful for detecting corneal damage in Graves' ophthalmopathy?
Correct
Incorrect
Consider the test that specifically assesses corneal abnormalities.
21. Question
What is the first-line treatment for optic neuropathy in Graves' ophthalmopathy?
Correct
Incorrect
Consider the treatment that aggressively addresses optic neuropathy in Graves' ophthalmopathy.
22. Question
Which factor is associated with more severe forms of Graves' ophthalmopathy and decreased effectiveness of glucocorticoids?
Correct
Incorrect
Consider the lifestyle factor that has negative effects on Graves' ophthalmopathy.
23. Question
Which of the following is NOT a sign of sight-threatening Graves' ophthalmopathy?
Correct
Incorrect
Consider the signs that are not related to severe ocular issues in Graves' ophthalmopathy.
24. Question
Which two receptors are considered as culprit antigens in Graves' ophthalmopathy?
Correct
Incorrect
Consider the receptors that are shared by the thyroid and the orbit.
25. Question
In patients with Graves' ophthalmopathy, what is the main cause of optic neuropathy?
Correct
Incorrect
Consider the cause that is directly related to the changes occurring in Graves' ophthalmopathy.
26. Question
Which of the following tests is NOT used for diagnosing optic neuropathy in Graves' ophthalmopathy?
Correct
Incorrect
Consider the test that is specifically used for corneal damage, not optic neuropathy.
27. Question
A 28-year-old pregnant woman presents with weight loss, heat intolerance, and a diffuse goiter. Which of the following is the most likely cause of her symptoms?
Correct
Incorrect
Consider the features of Graves' disease, such as weight loss, heat intolerance, and a diffuse goiter.
28. Question
A 32-year-old pregnant woman is diagnosed with Graves' disease. Which test is useful for monitoring the risk of fetal and neonatal hyperthyroidism?
Correct
Incorrect
Consider the test that specifically monitors the risk of fetal and neonatal hyperthyroidism.
29. Question
Which of the following antithyroid drugs is recommended during the first trimester of pregnancy for treating hyperthyroidism?
Correct
Incorrect
Consider the antithyroid drug with a lower risk of fetal complications during the first trimester.
30. Question
What is the primary reason to avoid radioactive iodine treatment for hyperthyroidism during pregnancy?
Correct
Incorrect
Consider the treatment option that has direct adverse effects on fetal thyroid function.
31. Question
A pregnant woman with Graves' disease is being treated with antithyroid drugs. What should be the target range for her free thyroxine (FT4) levels?
Correct
Incorrect
Consider the appropriate range for FT4 levels during pregnancy for a patient with Graves' disease.
32. Question
In which trimester of pregnancy does Graves' disease tend to remit due to the immune tolerant state of pregnancy?
Correct
Incorrect
Consider the stage of pregnancy when the immune system is more tolerant.
33. Question
Which of the following symptoms is NOT suggestive of Graves' disease during pregnancy?
Correct
Incorrect
Consider the symptom that is more commonly associated with gestational transient thyrotoxicosis.
34. Question
What is the primary risk associated with untreated hyperthyroidism during pregnancy?
Correct
Incorrect
Consider the risks related to the cardiovascular system and fetal well-being.
35. Question
A 28-year-old pregnant woman with a history of Graves' disease presents for antenatal care in her first trimester. Which antithyroid drug is recommended for her during this period?
Correct
Incorrect
Refer to the guidelines for antithyroid drug use in pregnancy, specifically for the first trimester.
36. Question
A 32-year-old pregnant woman with Graves' disease is experiencing severe adrenergic symptoms. Which medication can be used to control these symptoms during pregnancy?
Correct
Incorrect
Consider a medication that specifically targets adrenergic symptoms and is safe during pregnancy.
37. Question
A 30-year-old pregnant woman with Graves' disease is in her second trimester. She has been taking propylthiouracil (PTU) since the first trimester. What should be the next step in her treatment plan?
Correct
Incorrect
Consider the guidelines for antithyroid drug use in pregnancy, specifically for the second trimester.
38. Question
A 26-year-old pregnant woman with Graves' disease is scheduled for a thyroidectomy due to non-compliance and severe adverse reactions to antithyroid medications. When is the best time for her to undergo surgery during pregnancy?
Correct
Incorrect
Consider the safest period for surgery during pregnancy.
39. Question
A 55-year-old male with a history of atrial fibrillation has been taking amiodarone for the past 6 months. He presents with worsening cardiac arrhythmias and palpitations. What condition should be investigated?
Correct
Incorrect
Consider the patient's medication history and the potential side effects of the drug.
40. Question
Which type of amiodarone-induced thyrotoxicosis (AIT) is more common in iodine-deficient regions and usually occurs in an abnormal thyroid gland?
Correct
Incorrect
Focus on the different types of AIT and their relation to iodine-deficient regions and thyroid gland abnormalities.
41. Question
What is the initial treatment for Type 1 amiodarone-induced thyrotoxicosis (AIT)?
Correct
Incorrect
Consider the different types of AIT and their respective initial treatments.
42. Question
Which imaging modality is useful for differentiating between Type 1 and Type 2 amiodarone-induced thyrotoxicosis (AIT)?
Correct
Incorrect
Think about the imaging modality that can assess intra-thyroidal vascular flow.
43. Question
A 62-year-old male with a history of cardiac arrhythmia has been taking amiodarone for 8 months. He reports an unexplained change in warfarin sensitivity requiring a reduction in dosage. What could be the possible cause?
Correct
Incorrect
Consider the relationship between thyroid hormone levels and warfarin sensitivity.
44. Question
What is a common feature of Type 2 amiodarone-induced thyrotoxicosis (AIT) regarding T4/T3 ratio?
B. Usually >4
C. No specific pattern
D. T4/T3 ratio is not relevant in differentiating AIT types
Correct
Incorrect
Think about the characteristics of Type 2 AIT regarding thyroid hormone levels.
45. Question
Which type of amiodarone-induced thyrotoxicosis (AIT) typically persists for one to three months until thyroid hormone stores are depleted?
A. Type 1 AIT
B. Type 2 AIT
C. Both Type 1 and Type 2 AIT
D. Neither Type 1 nor Type 2 AIT
Correct
Incorrect
Consider the duration of each type of AIT and the underlying process involved.
46. Question
What is the initial treatment for Type 2 amiodarone-induced thyrotoxicosis (AIT)?
A. Prednisone
B. Methimazole or propylthiouracil
C. Radioactive iodine therapy
D. Thyroid surgery
Correct
Incorrect
47. Question
A 78-year-old female presents with fatigue, weight loss, heat intolerance, palpitations, and insomnia. She also has a newly detected atrial arrhythmia. Which condition is likely responsible for her symptoms?
A. Anemia
B. Heart failure
C. Thyrotoxicosis
D. Diabetes mellitus
Correct
Incorrect
Consider the clinical findings and symptoms that might raise suspicion of a thyroid-related condition.
48. Question
In an elderly patient with suspected thyrotoxicosis, which lab tests would confirm the diagnosis?
A. Elevated TSH and normal T4
B. Suppressed TSH and elevated T4
C. Normal TSH and elevated T4
D. Elevated TSH and suppressed T4
Correct
Incorrect
Recall the lab findings related to thyroid hormone levels and TSH in thyrotoxicosis.
49. Question
Which treatment is commonly used as a first-line therapy in cases of severe hyperthyroidism caused by Graves' disease, toxic multinodular goiter, or toxic adenoma?
A. Beta-blockers
B. Radioactive iodine ablation
C. Antithyroid drugs
D. Thyroid surgery
Correct
Incorrect
Consider the treatments that can be used initially to control hyperthyroidism before moving on to more definitive therapy options.
50. Question
In a patient with a suppressed TSH level and normal T4 and T3 levels, what is the likely diagnosis?
A. Overt hyperthyroidism
B. Hypothyroidism
C. Subclinical hyperthyroidism
D. Euthyroidism
Correct
Incorrect
Consider the lab findings and the difference between overt and subclinical hyperthyroid
51. Question
What is the primary cause of type 1 amiodarone-induced thyrotoxicosis?
A. Inflammation with leakage of thyroid hormone
B. Increased thyroid hormone production
C. TSH-secreting pituitary adenoma
D. Iatrogenic thyrotoxicosis
Correct
Incorrect
Recall the primary causes of thyrotoxicosis and how they relate to different types of amiodarone-induced thyrotoxicosis.
52. Question
Which diagnostic test can help distinguish Graves' disease from toxic nodular disorders in patients not taking amiodarone and without recent exposure to iodinated contrast?
A. Thyroid uptake study
B. Thyroid scan
C. ESR or CRP
D. Anti-thyroid peroxidase or anti-thyroglobulin antibody levels
Correct
Incorrect
Consider the diagnostic tests that reveal the distribution of increased uptake in the thyroid gland.
53. Question
Which of the following medications may help to ameliorate some symptoms in patients presenting with thyrotoxicosis if tolerated and in the absence of congestive heart failure (CHF)?
A. Beta-blockers
B. Antithyroid drugs
C. Radioactive iodine
D. Prednisone
Correct
Incorrect
Consider the medications that can help manage the symptoms of thyrotoxicosis without directly addressing the underlying cause.
54. Question
In which situation is thyroid surgery typically indicated for the treatment of thyrotoxicosis?
A. Presence of a TSH-secreting pituitary adenoma
B. Substernal enlargement of a toxic multinodular goiter causing significant compressive symptoms
C. Transient thyrotoxicosis induced by checkpoint inhibitors
D. Type 2 amiodarone-induced thyrotoxicosis
Correct
Incorrect
Consider the situations where thyroid surgery is the preferred treatment option for thyrotoxicosis.
55. Question
An 82-year-old female patient presents with fatigue, weight loss, and palpitations. She has a medical history of congestive heart failure (CHF). Upon examination, she has goitrous enlargement of the thyroid and a resting tremor. Which of the following is the most likely diagnosis?
A. Graves' disease
B. Subacute thyroiditis
C. Iatrogenic thyrotoxicosis
D. Toxic multinodular goiter
Correct
Incorrect
Consider the patient's age, symptoms, and clinical findings in determining the most likely diagnosis.
56. Question
A 75-year-old man with a history of atrial arrhythmias presents with a suppressed TSH level and normal T4 and T3 levels. What condition is the patient most likely experiencing?
A. Subclinical hyperthyroidism
B. Overt hyperthyroidism
C. Hypothyroidism
D. Euthyroid sick syndrome
Correct
Incorrect
Think about the thyroid function tests and how they correspond to different thyroid conditions.
57. Question
A 68-year-old patient with a history of hypertension is diagnosed with thyrotoxicosis. Which medication can help alleviate some symptoms of thyrotoxicosis if tolerated and without worsening the patient's pre-existing condition?
A. Beta-blockers
B. Antithyroid drugs
C. Radioactive iodine
D. Prednisone
Correct
Incorrect
Consider which medications can help manage the symptoms of thyrotoxicosis without directly addressing the underlying cause or worsening pre-existing conditions.
58. Question
A 74-year-old patient presents with thyrotoxicosis due to Graves' disease. What is the usual first-line treatment in such cases?
A. Beta-blockers
B. Antithyroid drugs
C. Radioactive iodine ablation
D. Thyroid surgery
Correct
Incorrect
Consider the first-line treatments for hyperthyroidism caused by different underlying conditions.
59. Question
A 77-year-old patient with a history of amiodarone use presents with thyrotoxicosis. Which type of amiodarone-induced thyrotoxicosis is characterized by increased thyroid hormone production?
A. Type 1
B. Type 2
C. Both Type 1 and Type 2
D. Neither Type 1 nor Type 2
Correct
Incorrect
Differentiate between the two types of amiodarone-induced thyrotoxicosis based on their mechanisms.
60. Question
A patient presents with thyrotoxicosis and a thyroid uptake study shows decreased uptake. Which of the following diagnostic tests would best help identify subacute thyroiditis as the cause?
A. ESR or CRP
B. Anti-thyroid peroxidase or anti-thyroglobulin antibody levels
C. Thyroid scan
D. TSH-secreting pituitary adenoma test
Correct
Incorrect
Consider which diagnostic tests can help identify inflammation in the thyroid.
61. Question
In patients with thyrotoxicosis due to toxic multinodular goiter or toxic adenoma, which of the following treatments is NOT typically considered as a definitive therapy?
A. Radioactive iodine ablation
B. Thyroid surgery
C. Beta-blockers
D. Antithyroid drugs
Correct
Incorrect
Consider which treatments address the underlying cause of the thyrotoxicosis and which primarily manage symptoms.
62. Question
Which of the following medications can induce thyrotoxicosis as a rare side effect during therapeutic administration?
A. Interferon alpha
B. Tyrosine kinase inhibitors
C. Checkpoint inhibitors
D. All of the above
Correct
Incorrect
Review the list of medications that can induce thyrotoxicosis as a side effect.
63. Question
Which of the following is the most common cause of transient neonatal hyperthyroidism?
A. Topical iodine exposure
B. Activating mutations of TSH receptor
C. McCune-Albright syndrome
D. Transplacental passage of maternal TSH receptor antibodies
Correct
Incorrect
Consider the cause related to the mother's autoimmune condition.
64. Question
Which clinical manifestation should prompt consideration of neonatal hyperthyroidism?
A. Unexplained tachycardia, goiter or stare
B. Constipation
C. Hypotonia
D. Hypothermia
Correct
Incorrect
Consider the symptoms that are related to an overactive thyroid.
65. Question
When should TRAb levels be determined in pregnant women with Graves' disease according to recent guidelines?
A. 12-16 weeks of gestation
B. 18-22 weeks of gestation
C. 24-28 weeks of gestation
D. 30-34 weeks of gestation
Correct
Incorrect
Think about the gestational age closer to the middle of the pregnancy.
66. Question
What is the recommended initial treatment for neonatal Graves' disease?
A. Propranolol
B. Methimazole (MMI)
C. Levothyroxine
D. Iodine supplementation
Correct
Incorrect
Consider the antithyroid drug used to reduce thyroid hormone production.
67. Question
Which of the following syndromes is associated with somatic activating mutations in the GNAS gene and can rarely present with neonatal hyperthyroidism?
A. Down syndrome
B. Turner syndrome
C. McCune-Albright syndrome
D. Prader-Willi syndrome
Correct
Incorrect
68. Question
A 2-week-old newborn presents with tachycardia, irritability, poor weight gain, and prominent eyes. The mother has a history of Graves' disease. Which of the following is the most likely cause of the newborn's condition?
A. Neonatal Graves' disease
B. Permanent neonatal hyperthyroidism due to TSH receptor mutation
C. McCune-Albright syndrome
D. Exposure to topical iodine
Correct
Incorrect
The condition is caused by the transplacental passage of maternal TSH receptor antibodies.
69. Question
Which of the following laboratory findings is most indicative of neonatal hyperthyroidism?
A. Low TSH, high T4
B. High TSH, low T4
C. High TSH, high T4
D. Low TSH, low T4
Correct
Incorrect
In hyperthyroidism, T4 levels are typically elevated and TSH levels are suppressed.
70. Question
What is the recommended initial treatment for neonatal Graves' disease with severe hyperthyroidism?
A. Methimazole
B. Propylthiouracil
C. Lugol's solution or SSKI
D. Propranolol
Correct
Incorrect
This medication inhibits the synthesis of thyroid hormones.
71. Question
In neonatal Graves' disease, what is the approximate half-life of TSH receptor antibodies?
A. 1-2 days
B. 1-2 weeks
C. 1-2 months
D. 6-12 months
Correct
Incorrect
The duration of neonatal hyperthyroidism is usually 2 to 3 months but may be longer.
72. Question
What is the primary cause of hyperthyroidism in McCune-Albright syndrome?
A. TSH receptor mutation
B. Transplacental passage of maternal TSH receptor antibodies
C. Somatic activating mutations in the GNAS gene
D. Exposure to topical iodine
Correct
Incorrect
73. Question
Which of the following is a key feature of myxedema coma?
A. Hyperthermia
B. Tachycardia
C. Altered mental status
D. Hypertension
Correct
Incorrect
Look for one of the three key features of myxedema coma mentioned in the text.
74. Question
What is a common precipitating event for myxedema coma?
A. Cold exposure
B. Hyperthyroidism
C. Overhydration
D. Excessive physical activity
Correct
Incorrect
Look for one of the precipitating events mentioned in the text.
75. Question
What is the initial treatment for myxedema coma to address hypothyroidism?
A. Oral dose of 50 μg T4
B. Intravenous dose of 300-500 μg T4
C. Intravenous dose of 100-200 μg T3
D. Oral dose of 25 μg T3
Correct
Incorrect
Look for the recommended initial treatment for hypothyroidism in myxedema coma.
76. Question
Why is the administration of glucocorticoids in stress doses necessary in myxedema coma?
A. To prevent hyperthyroidism
B. To prevent adrenal insufficiency
C. To increase blood volume
D. To promote vasodilation
Correct
Incorrect
Look for the reason behind the administration of glucocorticoids in stress doses in myxedema coma.
77. Question
In myxedema coma, why should peripheral warming be avoided?
A. It may cause hyperthermia
B. It may lead to vasodilation and shock
C. It increases metabolic rate
D. It promotes hypotension
Correct
Incorrect
Look for the explanation for avoiding peripheral warming in myxedema coma.
78. Question
What is the typical outcome of myxedema coma if left untreated?
A. Spontaneous recovery
B. Mild hypothyroidism
C. Life-threatening condition
D. Transient hyperthyroidism
Correct
Incorrect
Look for the consequences of untreated myxedema coma in the text.
79. Question
Which of the following laboratory findings is commonly observed in patients with myxedema coma?
A. Hypernatremia
B. Hypoglycemia
C. Low serum creatine kinase concentrations
D. Low serum TSH
Correct
Incorrect
Look for one of the laboratory findings mentioned in the text.
80. Question
Which of the following is a sign of impending myxedema coma in severely hypothyroid patients?
A. Presence of mild diastolic hypertension
B. Absence of mild diastolic hypertension
C. Tachycardia
D. Hyperthermia
Correct
Incorrect
Look for the warning sign of impending myxedema coma mentioned in the text.
81. Question
In cases of myxedema coma with severe symptomatic hyponatremia, what treatment is recommended?
A. Administration of 100 ml of 3% NaCl
B. Fluid restriction
C. Administration of isotonic sodium chloride
D. Active rewarming
Correct
Incorrect
Look for the recommended treatment for severe symptomatic hyponatremia in myxedema coma.
82. Question
Which of the following measures should be taken for hypothermia in myxedema coma patients?
A. Active rewarming
B. Administration of vasopressin antagonist
C. Blankets
D. Intravenous administration of warm fluids
Correct
Incorrect
Look for the recommended measure to address hypothermia in myxedema coma patients.
83. Question
A 32-year-old pregnant woman with a history of autoimmune disorder presents with fatigue and difficulty concentrating. She also has a family history of thyroid disease. Which of the following tests should be performed to diagnose hypothyroidism during her pregnancy?
A. Hemoglobin A1c
B. Free T4 and TSH
C. Serum electrolytes
D. Urine analysis
Correct
Incorrect
Look for the tests mentioned in the text for diagnosing hypothyroidism in pregnancy.
84. Question
A 29-year-old pregnant woman is diagnosed with subclinical hypothyroidism. She has a TSH concentration above 10 mU/L and positive thyroid antibodies. What is the recommended course of action for her condition?
A. No treatment is needed
B. Begin levothyroxine therapy
C. Monitor her condition without treatment
D. Administer iodine supplements
Correct
Incorrect
Look for the recommended treatment for subclinical hypothyroidism with specific characteristics in the text.
85. Question
A pregnant woman with a history of type 1 diabetes is at a higher risk of developing which of the following conditions during her pregnancy?
A. Gestational diabetes
B. Hypothyroidism
C. Preeclampsia
D. Hyperemesis gravidarum
Correct
Incorrect
Look for the condition related to type 1 diabetes during pregnancy in the text.
86. Question
A 35-year-old pregnant woman with a history of thyroid dysfunction is diagnosed with overt hypothyroidism. Which of the following adverse outcomes is she at an increased risk of experiencing during her pregnancy?
A. Anemia
B. Gestational diabetes
C. Hyperemesis gravidarum
D. Placenta previa
Correct
Incorrect
Look for the adverse outcomes of maternal hypothyroidism during pregnancy in the text.
87. Question
A 75-year-old woman presents with fatigue, weight gain, and cold intolerance. She has a history of breast cancer treated with external beam radiation. Which of the following is the most likely cause of her symptoms?
A. Amiodarone-induced hypothyroidism
B. Autoimmune (Hashimoto's) thyroiditis
C. Radiation-induced hypothyroidism
D. Central hypothyroidism
Correct
Incorrect
Consider the patient's history of breast cancer treatment.
88. Question
Which laboratory tests are most useful for confirming a diagnosis of primary hypothyroidism?
A. Elevated TSH and low free or total T4
B. Low TSH and low free or total T4
C. Elevated TSH and elevated free or total T4
D. Low TSH and elevated free or total T4
Correct
Incorrect
Think about the relationship between TSH and T4 in primary hypothyroidism.
89. Question
In elderly patients with known or suspected cardiovascular disease, what is the initial recommended dose of levothyroxine for treating hypothyroidism?
A. 1.6 mcg/kg of body weight
B. 50 mcg daily
C. 12.5-25 mcg daily
D. 75 mcg daily
Correct
Incorrect
Consider the risk of exacerbating underlying cardiovascular conditions in elderly patients.
90. Question
When treating central hypothyroidism, which laboratory value should be used to guide treatment adjustments?
A. TSH level
B. Free T4 level
C. Total T4 level
D. Total T3 level
Correct
Incorrect
Consider the reliability of TSH in central hypothyroidism.
91. Question
Which of the following is NOT a reason why newborn screening for congenital hypothyroidism (CH) is justified?
A. It is a common condition
B. Early diagnosis can prevent mental retardation
C. Clinical recognition in early life is difficult
D. Treatment is expensive and complicated
Correct
Incorrect
Think about the characteristics that make a condition suitable for screening programs.
92. Question
What percentage of newborns worldwide are born in areas without an established national screening program for congenital hypothyroidism (CH)?
A. 30%
B. 50%
C. 71%
D. 90%
Correct
Incorrect
Consider the proportion of babies born in developing countries.
93. Question
What is the most common cause of permanent primary congenital hypothyroidism (CH)?
A. Thyroid dysgenesis
B. Thyroid dyshormonogenesis
C. Central congenital hypothyroidism (CCH)
D. Pendred syndrome
Correct
Incorrect
Think about the different causes of congenital hypothyroidism and their relative frequencies.
94. Question
Which of the following signs is NOT typically suggestive of neonatal hypothyroidism?
A. Prolonged, unconjugated hyperbilirubinemia
B. Feeding difficulties
C. Hypothermia
D. Rapid linear growth
Correct
Incorrect
Consider the signs that are associated with a lack of thyroid hormone.
95. Question
Which of the following is a cause of transient neonatal hypothyroidism?
A. Maternal TSH receptor blocking antibodies
B. Thyroid dysgenesis
C. Thyroid dyshormonogenesis
D. Central congenital hypothyroidism (CCH)
Correct
Incorrect
Think about factors that can temporarily affect thyroid function in newborns.
96. Question
What is the most common cause of permanent congenital hypothyroidism in North America, Western Europe, and Japan?
A. Thyroid dysgenesis
B. Thyroid dyshormonogenesis
C. Pendred syndrome
D. Central congenital hypothyroidism
Correct
Incorrect
The majority (85 to 90%) of cases of permanent congenital hypothyroidism in these regions are due to an abnormality of thyroid gland development.
97. Question
Which syndrome is characterized by the association of familial profound deafness with multinodular goiter?
A. Pendred syndrome
B. Down syndrome
C. Turner syndrome
D. Marfan syndrome
Correct
Incorrect
This syndrome is caused by biallelic mutation in the pendrin gene.
98. Question
What is the most frequent cause of monogenic thyroid dysgenesis and non-syndromic congenital hypothyroidism?
A. FOXE1 mutations
B. PAX8 mutations
C. NKX2-1 mutations
D. Inactivating TSHR mutations
Correct
Incorrect
The prevalence of this cause in congenital hypothyroidism cohorts is around 4%.
99. Question
Which test is commonly used to screen newborns for congenital hypothyroidism?
A. Thyroid ultrasound
B. Thyroid scintigraphy
C. Measurement of T4 in dried whole blood
D. Thyroid fine needle aspiration
Correct
Incorrect
This test is sensitive and specific for detecting congenital hypothyroidism in newborns.
100. Question
A 2-week-old infant with a history of maternal Graves' disease is found to have hypothyroidism. Which type of antibodies is most likely responsible for the infant's condition?
A. TSH receptor stimulating antibodies
B. TSH receptor blocking antibodies
C. Antithyroglobulin antibodies
D. Anti-thyroid peroxidase antibodies
Correct
Incorrect
These antibodies inhibit the binding and action of TSH, leading to hypothyroidism in the infant.
101. Question
A 4-week-old premature infant is found to have hypothyroxinemia. Which of the following factors is NOT a likely contributor to this condition in premature infants?
A. Hypothalamic-pituitary immaturity
B. TBG deficiency due to immature liver function
C. High levels of TSH receptor stimulating antibodies
D. Drug-induced suppression of the hypothalamic-pituitary-thyroid axis
Correct
Incorrect
Hypothyroxinemia in premature infants can be due to multiple factors, such as hypothalamic-pituitary immaturity, TBG deficiency, and drug-induced suppression of the hypothalamic-pituitary-thyroid axis.
102. Question
A 6-month-old infant presents with severe hypothyroidism and high levels of antibodies. The infant has a family history of type 1 diabetes. What is the most likely diagnosis?
A. Thyroid dysgenesis
B. Chronic lymphocytic thyroiditis
C. IPEX syndrome
D. Hepatic hemangioma
Correct
Incorrect
Chronic lymphocytic thyroiditis is a rare disease in infancy that can cause severe hypothyroidism with permanent brain damage and can be associated with other autoimmune diseases.
103. Question
A newborn's TSH level is measured for CH screening. What is the best time to collect the blood sample for TSH screening?
A. Within the first 24 hours of life
B. Between 48 to 72 hours of age
C. At one week of age
D. At two weeks of age
Correct
Incorrect
Early collection of blood samples
104. Question
A 35-year-old woman presents with anterior neck pain, malaise, and fever. She had an upper respiratory infection two weeks ago. Her thyroid gland is tender and enlarged on palpation. What is the most likely diagnosis?
A. Acute suppurative thyroiditis
B. Graves' disease
C. Painful subacute thyroiditis (PFSAT)
D. Toxic nodular goiter
Correct
Incorrect
Consider the patient's recent upper respiratory infection and current symptoms.
105. Question
Which of the following laboratory findings is expected in a patient with painful subacute thyroiditis (PFSAT)?
A. Normal erythrocyte sedimentation rate (ESR)
B. Positive thyrotropin receptor antibodies (TRAb)
C. ESR greater than 50
D. Low anti-thyroid peroxidase (TPO-ab) and thyroglobulin (Tg-ab) antibodies
Correct
Incorrect
Think about the inflammation associated with subacute thyroiditis.
106. Question
A 28-year-old woman presents with thyroid enlargement and positive anti-thyroid antibodies following pregnancy. What is the most likely diagnosis?
A. Graves' disease
B. Toxic nodular goiter
C. Painful subacute thyroiditis (PFSAT)
D. Painless (silent, autoimmune) subacute thyroiditis (PLSAT)
Correct
Incorrect
Consider the patient's recent pregnancy and the presence of positive anti-thyroid antibodies.
107. Question
Which of the following is a typical finding on thyroid ultrasound in a patient with subacute thyroiditis?
A. Hypervascularity
B. Heterogeneously hypoechoic pattern
C. Multiple thyroid nodules
D. Normal thyroid appearance
Correct
Incorrect
Consider the ultrasound appearance of an inflamed thyroid gland.
108. Question
A 32-year-old female presents with symptoms of fatigue and weight gain 5 months after giving birth. She also had symptoms of irritability and palpitations 2 months postpartum, which resolved on their own. What is the most likely diagnosis?
A. Graves' disease
B. Postpartum thyroiditis
C. Subacute thyroiditis
D. Persistent hypothyroidism
Correct
Incorrect
Consider the timing of the symptoms in relation to pregnancy and delivery.
109. Question
Which laboratory finding is typically observed in the thyrotoxic phase of postpartum thyroiditis?
A. Increased serum TSH
B. Decreased serum FT3 and FT4
C. Suppressed serum TSH
D. High radioactive iodine uptake (RAIU)
Correct
Incorrect
Consider the hormonal changes in the thyrotoxic phase of the condition.
110. Question
What is the proposed pathophysiology of postpartum thyroiditis?
A. Excess iodine intake
B. Autoimmune disorder with lymphocytic infiltration
C. Viral infection of the thyroid gland
D. Thyroid hormone resistance
Correct
Incorrect
Consider the immune system's role in the pathophysiology of postpartum thyroiditis.
111. Question
Which of the following is an appropriate treatment during the thyrotoxic phase of postpartum thyroiditis?
A. Beta-blocker drugs
B. Radioactive iodine treatment
C. High-dose corticosteroids
D. Thyroid hormone replacement
Correct
Incorrect
Consider the symptoms and signs during the thyrotoxic phase and their management.
112. Question
A 32-year-old woman who recently gave birth presents with nervousness, tremors, and tachycardia. What is the most likely diagnosis?
A. Graves' disease
B. Postpartum thyroiditis
C. Subacute thyroiditis
D. Hashimoto's thyroiditis
Correct
Incorrect
This condition typically occurs within 6 months after delivery.
113. Question
What is the typical clinical course of postpartum thyroiditis?
A. Hypothyroid phase, recovery phase, thyrotoxic phase
B. Thyrotoxic phase, hypothyroid phase, recovery phase
C. Recovery phase, thyrotoxic phase, hypothyroid phase
D. Hypothyroid phase, thyrotoxic phase, recovery phase
Correct
Incorrect
The phases occur in the order of thyrotoxic, hypothyroid, and recovery.
114. Question
What is the primary cause of thyrotoxicosis in postpartum thyroiditis?
A. Overproduction of thyroid hormones
B. Leakage of intrathyroidal hormones into circulation
C. Thyroid-stimulating hormone overstimulation
D. Ingestion of thyroid hormone medication
Correct
Incorrect
This condition is related to damage to thyroid epithelial cells due to inflammation.
115. Question
In the diagnosis of postpartum thyroiditis, what laboratory findings would you expect?
A. Elevated TSH, normal FT3 and FT4 levels
B. Suppressed TSH, increased FT3 and FT4 levels
C. Elevated TSH, decreased FT3 and FT4 levels
D. Suppressed TSH, decreased FT3 and FT4 levels
Correct
Incorrect
This condition is characterized by suppressed TSH and increased FT3 and FT4 levels.
116. Question
Which of the following factors is least likely to cause an unintentional L-Thyroxine (T4) overdose?
A. Ingestion of hypothyroid dog medication
B. Incorrectly prepared LT4 dosage by a pharmacist
C. Purchasing thyroxine without a prescription
D. Adequate prescription and proper dosage instructions
Correct
Incorrect
Consider the option that represents the proper use of medication.
117. Question
In an adult who has ingested a one-time dose of up to 3 mg of thyroxine, what is the expected outcome?
A. Severe symptoms and complications
B. No symptoms or mild symptoms
C. Thyroid storm
D. Acute myocardial infarction
Correct
Incorrect
This amount of ingestion is generally considered to have minimal effects.
118. Question
Which of the following treatments is most effective in preventing the absorption of L-Thyroxine (T4) in the gastrointestinal system?
A. Gastric lavage
B. Activated charcoal
C. Cholestyramine
D. Hemodialysis
Correct
Incorrect
This treatment is commonly used in many drug overdoses.
119. Question
In the treatment of thyroxine poisoning, what is the primary benefit of administering glucocorticoids such as dexamethasone?
A. Reducing gastrointestinal absorption of thyroxine
B. Decreasing the conversion of LT4 to T3
C. Increasing the elimination of thyroxine
D. Blocking the effects of thyroxine on target tissues
Correct
Incorrect
This treatment is focused on reducing the amount of active thyroid hormone.
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My Endo Consult
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myendoconsult.com
September 22, 2023
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