Multiple Choice Questions (MCQ)

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Category: Medicine--->Endocrinology and Metabolic Disease
Page: 4

Question 16#Print Question

Your patient is a 48-year-old Hispanic man with a 4-year history of type 2 diabetes mellitus. He is currently utilizing NPH insulin/regular insulin 40/20 units prior to breakfast and 20/10 units prior to supper. His supper time has become variable due to a new job and ranges from 5 to 8 PM. In reviewing his glucose diary you note some very low readings (40-60 mg/dL) during the past few weeks at 3 AM. When he awakens to urinate, he feels sweaty or jittery so has been checking a fingerstick blood glucose. Morning glucose levels following these episodes are always higher (200-250) than his average fasting glucose level (120-150). Which change in his insulin regimen is most likely to resolve this patient’s early AM hypoglycemic episodes?

A. Increase morning NPH and decrease evening NPH
B. Decrease morning NPH and decrease evening regular insulin
C. Change regimen to glargine or detemir at bedtime and continue morning and evening regular insulin
D. Discontinue both NPH and regular insulin; implement sliding scale regular insulin with meals
E. Change regimen to glargine or detemir at bedtime with a rapid-acting insulin analogue (such as lispro, aspart, or glulisine) prior to each meal

Question 17#Print Question

A 40-year-old alcoholic man is being treated for tuberculosis, but he has no compliant with his medications. He complains of increasing weakness, fatigue, weight loss, and nausea over the preceding 3 weeks. He appears thin, and his blood pressure is 80/50 mm Hg. There is increased pigmentation over the elbows and in the palmar creases. Cardiac examination is normal. Which of the following is the best next step in evaluation?

A. CBC with iron and iron-binding capacity
B. Erythrocyte sedimentation rate
C. Early morning serum cortisol and cosyntropin stimulation
D. Blood cultures
E. Esophagogastroduodenoscopy (EGD)

Question 18#Print Question

A 37-year-old woman presents with difficult-to-control diabetes. The diabetes developed 3 years prior to this visit, when the patient began to notice fatigue, nocturia, and visual blurriness. She has been placed on metformin, glyburide, and finally pioglitazone at maximal doses, and yet her hemoglobin A1C is still above target at 8.2. She has compliant with her medical regimen and is concerned about her health status. There is no family history of diabetes. On examination, her BP is 126/80, BMI is 23.7, and general physical examination is normal. She has no evidence or retinopathy or peripheral neuropathy. Anti-islet cell autoantibodies, including anti-glutamic acid decarboxylase (GAD) antibodies, are positive. What is the likely diagnosis?

A. Cushing syndrome
B. Glucagonoma
C. Type 1 diabetes mellitus
D. Late-onset autoimmune diabetes of adulthood (LADA)
E. Maturity-onset diabetes of the young (MODY)

Question 19#Print Question

A 45-year-old G2P2 woman presents for annual examination. She reports regular menstrual cycles lasting 3 to 5 days. She exercises five times per week and reports no difficulty sleeping. Her weight is stable at 140 lb and she is 5 ft 8 in tall. Physical examination is unremarkable. Lab studies are normal with the exception of a TSH value of 6.6 mU/L (normal 0.4-4.0 mU/L). Free T4 is normal. Which of the following represents the best option for management of this patient’s elevated TSH?

A. Repeat TSH in 3 months and reassess for signs of hypothyroidism
B. Begin low-dose levothyroxine (25-50 µg/d)
C. Recommend dietary iodide supplementation
D. Order thyroid uptake scan
E. Measure thyroid peroxidase antibodies (TPO Ab)

Question 20#Print Question

 A family brings their 82-year-old grandmother to the emergency room stating that they cannot care for her anymore. They tell you, “She has just been getting sicker and sicker.” Now she stays in bed and won’t eat because of stomach pain. She is too weak to go to the bathroom on her own. Her symptoms have been worsening over the past year, but she has refused to see a doctor. The patient denies symptoms of depression. Blood pressure is 90/54 with the patient supine; it drops to 76/40 when she stands. Heart and lungs are normal. Skin examination reveals a bronze coloring to the elbows and palmar creases. What laboratory abnormality would you expect to find in this patient? 

A. Low-serum Ca+
B. Low-serum K+
C. Low-serum Na+
D. Normal-serum K+
E. Microcytic anemia

Category: Medicine--->Endocrinology and Metabolic Disease
Page: 4 of 7