1
Q
- Increased risk of thyroid disorder is found in individuals who are:
A. obese.
B. hypertensive.
C. treated with systemic corticosteroids.
D. elderly.
A
D. elderly.
2
Q
- A 48-year-old woman with newly diagnosed
hypothyroidism asks about a “natural thyroid”
medication she read about online and provides the
drug’s name: desiccated thyroid. As you counsel
her about this medication, you consider all of the
following except:
A. this product contains a fixed dose of T3 and T4.
B. the medication is a plant-based product.
C. its pharmacokinetics differ significantly when
compared to levothyroxine.
D. the majority of the study on treatment for
hypothyroidism has been done using
levothyroxine.
A
B. the medication is a plant-based product.
3
Q
80. Hypothyroidism most often develops as a result of: A. primary pituitary failure. B. thyroid neoplasia. C. autoimmune thyroiditis. D. radioactive iodine exposure.
A
C. autoimmune thyroiditis.
4
Q
81. Which is following is the least helpful test for the assessment of thyroid disease? A. total T4 B. thyroid-stimulating hormone (TSH) C. free T4 D. thyroid peroxidase (TPO) antibodies
A
A. total T4
5
Q
- Physical examination findings in patients with Graves’ disease include:
A. muscle tenderness.
B. coarse, dry skin.
C. eyelid retraction.
D. delayed relaxation phase of the patellar reflex.
A
C. eyelid retraction.
6
Q
- The mechanism of action of radioactive iodine in the treatment of Graves’ disease is to:
A. destroy the overactive thyroid tissue.
B. reduce production of TSH.
C. alter thyroid metabolic rate.
D. relieve distress caused by increased thyroid size.
A
A. destroy the overactive thyroid tissue.
7
Q
- Which of the following medications is a helpful
treatment option for relief of tremor and tachycardia
seen with untreated hyperthyroidism?
A. propranolol
B. diazepam
C. carbamazepine
D. verapamil
A
A. propranolol
8
Q
- In prescribing levothyroxine therapy for an elderly
patient, which of the following statements is true?
A. Elderly persons require a rapid initiation of levothyroxine therapy.
B. TSH should be checked about 2 days after dosage
adjustment.
C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults.
D. TSH should be suppressed to a nondetectable
level.
A
C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults.
9
Q
86. TSH is released by the: A. thyroid follicles. B. adrenal cortex. C. hypothalamus. D. anterior lobe of the pituitary.
A
D. anterior lobe of the pituitary.
10
Q
87. In the report of a thyroid scan done on a 48-year-old woman with a thyroid mass, a “cold spot” is reported. This finding is most consistent with: A. autonomously functioning adenoma. B. Graves’ disease. C. Hashimoto’s disease. D. thyroid cyst.
A
D. thyroid cyst.
11
Q
- You advise a 58-year-old woman with hypothyroidism about the correct use of levothyroxine. She also takes a calcium supplement. All of the following should be shared with the patient except which instruction?
A. “Take the medication on an empty stomach.”
B. “To help with adherence, take your calcium supplement at the same time as your thyroid medication.”
C. “You should take the medication at approximately
the same time every day.”
D. “Do not take your medication with soy milk.”
A
B. “To help with adherence, take your calcium supplement at the same time as your thyroid medication.”
12
Q
89. The findings of a painless thyroid mass and TSH level of less than 0.1 IU/mL in a 35-year-old woman is most consistent with: A. autonomously functioning adenoma. B. Graves’ disease. C. Hashimoto’s disease. D. thyroid malignancy.
A
A. autonomously functioning adenoma.
13
Q
90. A fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise the suspicion of: A. adenomatous lesion. B. Graves’ disease. C. Hashimoto’s disease. D. thyroid malignancy.
A
D. thyroid malignancy.
14
Q
- Which of the following is the most cost-effective
method of distinguishing a malignant from a benign
thyroid nodule?
A. ultrasound
B. magnetic resonance (MRI) imaging
C. fine-needle aspiration biopsy
D. radioactive iodine scan
A
C. fine-needle aspiration biopsy
15
Q
92. Possible consequences of excessive levothyroxine use include: A. bone thinning. B. fatigue. C. renal impairment. D. constipation.
A
A. bone thinning.
16
Q
- At minimum, at what interval should TSH be
reassessed after a levothyroxine dosage is adjusted?
A. 1 to 2 weeks
B. 2 to 4 weeks
C. 4 to 6 weeks
D. 6 to 8 weeks
A
D. 6 to 8 weeks
17
Q
- As part of an evaluation of a 3-cm, round, mobile
thyroid mass, you obtain a thyroid ultrasound scan
revealing a fluid-filled structure. The most likely
diagnosis is:
A. adenoma.
B. thyroid cyst.
C. multinodular goiter.
D. vascular lesion.
A
B. thyroid cyst.
18
Q
- Periodic routine screening for hypothyroidism is
indicated in the presence of which of the following
clinical conditions?
A. digoxin use
B. male gender
C. Down syndrome
D. alcoholism
A
C. Down syndrome
19
Q
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
- heat intolerance
A
- Hyperthyroidism
20
Q
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
- smooth, silky skin
A
- Hyperthyroidism
21
Q
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
- goiter
A
- Both
22
Q
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
- frequent, low-volume, loose stools
A
- Hyperthyroidism
23
Q
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
- secondary hypertriglyceridemia
A
- Hypothyroidism
24
Q
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
- amenorrhea or oligomenorrhea
A
- Hyperthyroidism
25
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
102. coarse, dry skin
102. Hypothyroidism
26
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
103. menorrhagia
103. Hypothyroidism
27
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
104. hyperreflexia with a characteristic “quick
out–quick back” action at the patellar
reflex
104. Hyperthyroidism
28
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
105. proximal muscle weakness
105. Hyperthyroidism
29
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
106. tachycardia with hypertension
106. Hyperthyroidism
30
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
107. hyporeflexia with a characteristic slow relaxation
phase, the “hung-up” reflex
107. Hypothyroidism
31
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
108. coarse hair with tendency to break easily
108. Hypothyroidism
32
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
109. thick, dry nails
109. Hypothyroidism
33
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
110. constipation
110. Hypothyroidism
34
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
111. atypical presentation in an elderly person
111. Both
35
96 to 112. Identify each of the following findings as
associated with hyperthyroidism, hypothyroidism,
or both.
112. change in mental status
112. Both
36
```
113. The use of which of the following medications can
induce thyroid dysfunction?
A. sertraline
B. venlafaxine
C. bupropion
D. lithium
```
D. lithium
37
114 to 116. Match the condition with the laboratory
results: hypothyroidism, hyperthyroidism,
or subclinical hypothyroidism.
114. TSH = 8.9 mIU/L (0.4 to 4.0 mIU/L); free
T4 = 15 pmol/L (10 to 27 pmol/L)
114. Subclinical
| hypothyroidism
38
114 to 116. Match the condition with the laboratory
results: hypothyroidism, hyperthyroidism,
or subclinical hypothyroidism.
115. TSH less than 0.15 mIU/L (0.4 to 4.0 mIU/L);
free T4 = 79 pmol/L (10 to 27 pmol/L)
115. Hyperthyroidism
39
114 to 116. Match the condition with the laboratory
results: hypothyroidism, hyperthyroidism,
or subclinical hypothyroidism.
116. TSH = 24 mIU/L (0.4 to 4.0 mIU/L); free
T4 = 3 pmol/L (10 to 27 pmol/L)
116. Hypothyroidism
