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14296 Medicine

A 16-year-old girl is referred to the office because of chronic diarrhea and weight loss. She is experiencing large-volume watery diarrhea that is painless. The symptoms persist even when she is fasting, and there is no relationship to foods or liquids. She is not on any medications, and there is no travel history or other constitutional symptoms. Her physical examination is normal. Which of following is the most likely diagnosis?

Apartial small bowel obstruction
Bpartial large bowel obstruction
Cosmotic diarrhea
Dsecretory diarrhea
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14299 Medicine

A 69-year-old woman presents to the clinic with memory difficulty. The patient’s daughter is concerned that her mother is having difficulty doing her finances, such as paying bills. Memory impairment testing reveals the poor ability to generate lists of words or copy diagrams (intersecting pentagons). Her remaining physical examination is normal. Which of the following anatomic findings is most likely with her condition?

Aatrophy of the medial temporal lobes
Bdiffuse atrophy of the cerebral cortex and temporal lobes
Ccranial nerve involvement
Dtransient episodes of hemiplegia
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14301 Medicine

A 35-year-old woman presents with fatigue, weakness, and weight gain. Her blood pressure is 155/90 mm Hg, pulse 80/min, and there is central obesity with skin striae. Investigations are shown in Table given below. Which of the following is the most likely diagnosis?Table given below is the case work-up NormalPatientPlasma ACTH pg/mL< 150< 50Plasma cortisol m/dL1735Urine 17-OH mg/24 h2 to 1025Urine 17-Ks mg/24 h5 to 1510Urine 17-OH response to:ACTH IVIncreasex5No responseDexamethasone 0.5 mg< 3.0No response2.0 mg< 3.0No responseMetyrapone 750 mgIncreasex 2No responseAbbreviation: ACTH–adrenocorticotropic hormone

Aadrenal hyperplasia secondary to hypothalamic dysfunction
Badrenal adenoma with complete autonomy
Cexogenous steroids, iatrogenic
Dpituitary tumor
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