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Summative > Endo Review Questions > Flashcards

Endo Review Questions Flashcards

1
Q

Patient complains of many months of marked pain into both feet and decreased sensation to touch and temperature up to his ankles. He is type II diabetic. Which would NOT be appropriate management for this condition?
A. aggressive managment of serum glucose
B. Pain control with tricyclic antidepressants
C. Careful foot care to avoid pressure or thermal injurt
D. high-dose corticosteroids

A

D. high-dose corticosteroids

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2
Q

60 year old just diagnosed with NIDDM has had vague vision difficulties and feeling thirst all the time. She weighs 256 pounds. Next step in getting diabetes undercontrol is?
A. weight loss diet and excercise program
B. initiating Sulfonylurea treatment
C. Starting her regular and NPH insluin low doeses
D. immediate referral to opthamologist

A

A. weight loss diet and excercise program

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3
Q

55 year old female is 4’10’ and weighs 165 pounds. She is being seen for treatment of her fourt yeast infection ina year. In addition to treating her infection. what is the next step?
A. Random plasma glucose
B. Screen for gonorrhea and syphilis
C. Test for herpes simplex virus type II
D. Perform pregnancy test

A

A. Random plasma glucose

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4
Q

Most common cause of cushings syndrome?
A. ACTH secreting pituitary tumor
B. Ectopic ACTH production by a malignancy
C. Exogenous administration of corticosteroid drugs
D. adrenocortical tumor

A

C. Exogenous administration of corticosteroid drugs

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5
Q

Which of the following is most likely to represent a malignancy?
A. multiple nodular lesions
B. Slow growing nodule
C. A nodule in a patient with history of neck irradiation
D. A hot nodule on uptake scan

A

C. A nodule in a patient with history of neck irradiation

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6
Q

Obese female who feels “lousy” presents with blood glucose of 325 and BP 160/ 110. She has wide, purplish striae o her breasts, upper arms, abdomen, buttocks, and thighs. What is tentative diagnosis?
A. hypothyrodism
B. Hypertension
C. Cushings syndrome
D. DM type II

A

C. Cushings syndrome

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7
Q

Most common cause of chronic renal failure is?
A. Polycystic Kidney Disease
B. Glomerulonephritis
C. BPH
D. Diabetes

A

D. Diabetes

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8
Q

All of the following are associated with hypocalcemia except?
A. Trousseau’s sign
B. Depressed deep tendon reflexes
C. Chvostek’s sign
D. Tetany

A

B. Depressed deep tendon reflexes

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9
Q

Hashimoto’s Thyroiditis
A. Results from radiation exposure
B. Caused by pitutary disease
C. More common in women then men
D. caused by untreated neonatal hypothyroidism

A

C. More common in women then men

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10
Q

Which is a feature of Grave’s disease?
A. far more common in men than in women
B. Occurs in people with other autoimmune disorders
C. usually a disease of old age
D. rarely found in people with a positive family history

A

B. Occurs in people with other autoimmune disorders

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11
Q

35 year old female with increasinf nervousness, exhaustion, diarrhea, and menstrual problems. She also has heat intolerance, sweating and weight loss of 10 pounds. Tachycardic with fine resting tremor, hyperflexia.
A. Amphetamine abuse
B. Pheochromocytoma
C. Panic attacks
D. thyrotoxicosis

A

D. thyrotoxicosis

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12
Q

Which is true regarding thyroid cancer?
A. most common thyroid malignacy is medullary
B. thyroid cancer usually presents with painful neck swelling and hoarsness
C. papillary cancer is associated with distant metastasis
D. Thyroid function tests are most often normal in thyroid cancer

A

D. Thyroid function tests are most often normal in thyroid cancer

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13
Q

56 year old male with apathy and depression. Appetite decreased but has put on weight. He has bradycardia, dry skin, hyporeflexia. Which test should be ordered first?
A. TSH level
B. Adrenocorticotropic hormone stimulation test
C. administer depression inventory
D. Fingerstick glucose

A

A. TSH level

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14
Q

13 year old girl using bathroom more than usual and drinking more. She has been hungry but is losing weight. You suspect:
A. Bulimia nervosa
B. Addison’s disease
C. Insulin dependent diabetes mellitus
D. Non-insluin dependent diabetes mellitus

A

C. Insulin dependent diabetes mellitus

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15
Q

When looking at thyroid function tests. you must keep in mind that?
A. Phenytoin increases T4 level
B. Cirrhosis increases T4
C. Acute psychiatric problems may increase T4
D. high estrogen decreases T3 and T4

A

C. Acute psychiatric problems may increase T4

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16
Q

Patient with known solitary lesion of the lung has hyponatremia and increased urine osmolality without edema or hypotension. Most likely diagnosis is:
A. hypothyroidism
B. CHF
C. Nephrotic syndrome
D. Syndrome of inappropriate ADH

A

D. Syndrome of inappropriate ADH

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17
Q

Common lab findings in acute adrenal insufficiency is:
A. hypokalemia
B. Hyponatremia
C. Hyperglycemia
D. Hypocalcemia

A

B. Hyponatremia

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18
Q

Pt admitted with hypernatermia, BP 120/80, Pulse 80 BPM. She is diagnosed with DI. What lab results are consistent with this?
A. Decreased sodium and decreased urine osmolaity
B. Increased urine sodium and increased urine osmolality
C. Decreased urine sodiun and increased urine osmolaity
D. Increased serum glucose and increased urine osmolality

A

A. Decreased sodium and decreased urine osmolaity

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19
Q

All are diagnostic criteria for DM except:
A. HbA1c 4.5 mmol/L
B. After 75 mg oral glucose, plasma gluocse more than 200 mg/dL at 2 hours and at least once between 0 and 2 hours
C. Random plasma glucose levels more than 200 mg/ dL with classis symptoms
D. Two fasting plasma glucose levels more than 140 mg/dl

A

A. HbA1c 4.5 mmol/L

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20
Q

Thin, apathetic 38 year old male with constant nausea. Skin is darker tha before and has lost 15 pounds in 18 months. Has been tired and missing work. Has darkly pigmented areas on buccal mucosa. Next step?
A. biopsy oral lesions
B. Administer depression inventory
C. Order adrenocorticotropic hormone stimulation test
D. Get serum TSH level

A

C. Order adrenocorticotropic hormone stimulation test

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21
Q

When ordering thyroid function tests, you should know that:
A. TSH is secreted by the hypothalamus
B. T3 is derived from peripheral deiodination of T4
C. The most active thyroid hormone is T4
D. the active thyroid hormones are bound to thyroid-binding globulin (TBG)

A

B. T3 is derived from peripheral deiodination of T4

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22
Q

A 33- year old male with chronic history of insluin dependent diabetes comes to the clinic for a routine exam. He is currently on aspart three times daily, Glargine once in the morning. Patient brings his journal of glucose levels over the past 2 weeks, whhich is shown below.
Pre-breakfast glucose 125
Pre- lunch glucose 129
pre- dinner glucose 119
betime glucose 127

A. increase dose of aspart
B. decrease dose of glargine
C. discontinue glargine
D. add on lispro
E. No change is necessary

A

No change is necessary

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23
Q

A 40 year-old-obese man comes to clinic complaining of increased thirst and urinary
frequency. Which of the following lab values independently confirms the diagnosis?
a. Hemoglobin A1C 6.7
b. Random blood glucose 180 mg/dL
c. Hemoglobin A1C 8.1
d. Random blood glucose 220 mg/dL
e. Fasting blood glucose 130

A

d. Random blood glucose 220 mg/dL

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24
Q

Which of the following agents used for the treatment of type 2 DM is effective for glycemic control with minimal effect on weight loss and low incidence of hypoglycemia?
a. Insulin
b. Glyburide
c. Semaglutide
d. Canagliflozin
e. Metformin

A

e. Metformin

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25
Q

Weight loss provides which of the following benefits for the treatment of type 2 diabetes?
a. Reduces hemoglobin A1C by 2%
b. Increases pancreatic insulin production
c. Improves glycemic control (LO E3)
d. Reduces initial recommended medication doses
e. Reduces incidence of stroke

A

c. Improves glycemic control (LO E3)

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26
Q

A 58-year-old man with newly diagnosed type 2 diabetes mellitus comes to the clinic to initiate treatment. His past medical history is positive for atherosclerotic cardiovascular disease. His hemoglobin A1C is 8.8%. Which of the following is the most appropriate initial therapy?
a. Metformin
b. Insulin plus alogliptin
c. Metformin plus dulaglutide
d. Metformin plus pioglitazone
e. Insulin plus dapagliflozin

A

c. Metformin plus dulaglutide

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27
Q

Which of the following is the mechanism of action for canagliflozin?
a. Activates AMP dependent protein kinase b. Mimics glucose-like peptide-1
c. Inhibits dipeptidylpeptidase-4
d. Inhibits glucose transporter-2
e. Inhibits ATP sensitive potassium channels

A

d. Inhibits glucose transporter-2

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28
Q

Which of the following is the mechanism of action for liraglutide?
a. Activates AMP dependent protein kinase
b. Mimics glucose-like peptide-1
c. Inhibits dipeptidylpeptidase-4
d. Inhibits glucose transporter-2
e. Inhibits ATP sensitive potassium channels

A

b. Mimics glucose-like peptide-1

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29
Q

Which of the following agents is considered first-line therapy for patients with type 2 diabetes and a primary treatment goal of weight control?
a. Metformin
b. Linagliptin
c. Pioglitazone
d. Tirzepatide

A

d. Tirzepatide

30
Q

A 56-year-old woman with type 2 diabetes comes to the clinic for 6-month follow-up. She is currently taking metformin. She has no additional CV risk factors. Vital signs are temperature is 98.6°F, pulse is 69/min, regular, respirations are 12/min, unlabored, blood pressure is 140/90 mmHg, and BMI 32. Her Hb A1C is 7.8%. Which of the following is the most appropriate add-on therapy?
a. Glipizide
b. Semaglutide
c. Insulin
d. Nateglinide e. Pramlintide

A

b. Semaglutide

31
Q

Which of the following medication classes is CONTRAINDICATED in patients with New York Association Class III or IV congestive heart failure?
a. Sodium-glucose cotransporter-2 inhibitors
b. Thiazolidinediones
c. Sulfonylureas
d. Glucose-like peptide-1 inhibitors e. Biguanides

A

b. Thiazolidinediones

32
Q

A 60-year-old male with type 2 diabetes comes to clinic for 6-month follow-up. He reports feeling well and losing 10 pounds over the last 3 months. He is currently taking metformin 1000mg PO BID and dapagliflozin. His hemoglobin A1C is 6.8%. Which of the following is the next best step?
a. Reduce metformin dose
b. Add liraglutide
c. Add Saxagliptin
d. Discontinue dapagliflozin
e. Continue current therapy

A

e. Continue current therapy

33
Q

Which of the following is the onset of action for insulin aspart?

a. 120 minutes
b. 30 minutes
c. 20 minutes
d. 60 minutes
e. 10 minutes

A

e. 10 minutes

34
Q

Lipohypertrophy is a complication of insulin administration due to which of the following?
a. Improper injection site selection
b. Poor aseptic technique
c. Repeat single site injection
d. Routine injection site rotation
e. Intramuscular insulin administration

A

c. Repeat single site injection

35
Q

Which of the following electrolyte abnormalities is consistent with primary adrenal insufficiency?
a. hypocalcemia
b. hyperglycemia
c. hypernatremia
d. hypophosphatemia
e. hyperkalemia

A

e. hyperkalemia

36
Q

A 23-year-old man with a history of type 1 diabetes is brought to the emergency department by EMS in status epilepticus. He was given multiple doses of benzodiazepines en route without response. Which of the following laboratory studies is the most appropriate next step?
a. Urine drug screen
b. Thyroid stimulating hormone
c. Basic metabolic panel
d. Random serum cortisol
e. Fingerstick blood glucose

A

e. Fingerstick blood glucose

37
Q

Which of the following is a CONTRAINDICATION for metformin?
a. History of thyroid cancer
b. Inflammatory bowel disease
c. Renal insufficiency
d. Age greater than 70 years
e. Congestive heart failure

A

c. Renal insufficiency

38
Q

Which of the following is the initial BASAL DOSE of insulin degludec for a 40kg patient with newly diagnosed type 1 diabetes?
a. 40 units once daily
b. 20 units once daily
c. 10 units twice daily
d. 20 units twice daily
e. 10 units once daily

A

e. 10 units once daily

39
Q

Administration of which of the following increases the risk of hypoglycemia?
a. Pioglitazone
b. Liraglutide
c. Metformin
d. Canagliflozin
e. Glipizide

A

e. Glipizide

40
Q

Which of the following is a sick-day recommendation for a diabetic patient on insulin therapy?
a. Check urine specific gravity
b. Limit fluid intake
c. Increase frequency of blood glucose checks
d. Increase basal insulin dose
e. Hold insulin dose

A

c. Increase frequency of blood glucose checks

41
Q

A 10-year-old boy with newly diagnosed type 1 diabetes is brought to clinic by his mother for high morning glucose levels. The patient currently takes insulin detemir 10 units at bedtime and insulin glulisine sliding scale with meals. Blood glucose readings for the last three days are listed below. Which of the following is the correct insulin dose adjustment?
Pre-breakfast Pre-lunch Pre-dinner Bedtime 0300
Day 1 240 110 111 105 65
Day 2 210 120 118 110 69
Day 3 190 107 100 113 68
a. Decrease dinner insulin glulisine
b. Decrease nighttime insulin detemir
c. Increase nighttime insulin detemir
d. Increase breakfast insulin glulisine
e. Give insulin detemir in the morning

A

b. Decrease nighttime insulin detemir

42
Q

A 18-year-old woman comes to the emergency department with nausea and vomiting. Past medical history is unremarkable. Vital signs are temperature is 97.8°F, pulse rate is 110/min, regular, respirations are 24/min, unlabored, blood pressure is 100/70 mmHg, and oxygen saturation is 98%. Her urine shows 4+ ketones and positive glucose. Fingerstick blood glucose is 650 mg/dL. Arterial blood gas is pH 7.18, CO2 15. Basic metabolic panel shows sodium of 130 meq/dL (135 to 145 meq/dL), potassium of 5.5 meq/L (3.5 to 5 meq/L), BUN 35 mg/dL (10 to 20 mg/dL), and serum creatinine of 1.5 mg/dL (<1 mg/dL). Which of the following is the most appropriate initial therapy?
a. Sodium bicarbonate
b. 3% saline
c. Hydrocortisone
d. 0.9% sodium chloride bolus
e. Regular insulin infusion

A

d. 0.9% sodium chloride bolus

43
Q

A 55-year-old woman comes to clinic complaining of fatigue and depressed mood. She also reports abdominal pain with occasional constipation. Past medical history is unremarkable. Serum creatinine is 1.8 mg/dL (0.6 to 1.2 mg/dL). Which electrolyte abnormality is consistent with her symptoms?
a. Hypomagnesemia
b. Hypercalcemia
c. Hyperphosphatemia
d. Hypochloremia
e. Hyperkalemia

A

b. Hypercalcemia

44
Q

Which of the following is the mechanism of action for alendronate?
a. Activation of parathyroid calcium-sensing receptors
b. Decreased osteoclast bone resorption
c. Parathyroid gland stimulation
d. Increased estrogen induced bone resorption e. RANKL inhibition

A

b. Decreased osteoclast bone resorption

45
Q

Which of the following is the mechanism by which calcitriol increases serum calcium?
a. Decreases renal phosphate reabsorption b. Decreases renal elimination of calcium c. Increases calcium release from bone
d. Decreases osteoclast production
e. Increases calcium absorption from the GI tract

A

e. Increases calcium absorption from the GI tract

46
Q

Which of the following oral calcium salt doses will provide 2 grams of elemental calcium per day?
a. Calcium citrate 3000 mg BID
b. Calcium carbonate 2500 mg BID
c. Calcium carbonate 2000 mg BID
d. Calcium citrate 1500 mg TID

A

b. Calcium carbonate 2500 mg BID

47
Q

Which of the following is consistent with primary hyperthyroidism?
a. High thyroid receptor blocking antibodies
b. High anti-thyroid peroxidase antibody
c. Low thyroid stimulating hormone
d. Normal T3
e. Low free T4

A

c. Low thyroid stimulating hormone

48
Q

A 38-year-old woman comes to clinic for a 10-pound weight loss and increasing nervousness over the last few months. Due to a family history of thyroid disease, she was started on levothyroxine 6 months ago. Physical examination shows a blood pressure of 145/78 mmHg, and an oxygen saturation of 98%. Labs reveal an elevated serum thyroxine and warm, moist skin. Serum TSH is 0.1 (normal: 0.5 to 3.0 mU/L). Which of the following is the recommended initial treatment for symptomatic control?
a. Thionamide
b. Radioiodine
c. Methimazole
d. Atenolol
e. Levothyroxine

A

d. Atenolol

49
Q

Which of the following is indicated for the treatment of hyperthyroidism in the first trimester of pregnancy?
a. Thyroidectomy
b. Methimazole
c. Propranolol
d. Radioiodine
e. Propylthiouracil

A

e. Propylthiouracil

50
Q

Which of the following is a complication of radioiodine for the treatment of hyperthyroidism?
a. Myxedema coma
b. Hypercalcemia
c. Galactorrhea
d. Osteoporosis
e. Infertility

A

e. Infertility

51
Q

Which of the following is the best initial dose of levothyroxine for a 45-year-old man with ASCVD, a total body weight of 150 kg (ideal body weight 70 kg), and BMI 33 kg/m2?
a. 125 mcg
b. 75 mcg
c. 100 mcg
d. 50 mcg
e. 150 mcg

A

d. 50 mcg

52
Q

Which of the following should be monitored during methimazole treatment?
a. Antinuclear antibody b. Electrolytes
c. Serum creatinine
d. Lipids
e. Complete blood count

A

e. Complete blood count

53
Q

Which of the following is the correct initial dose of levothyroxine for a healthy patient weighing 60 kg?
a. 125 mcg daily
b. 75 mcg daily
c. 50 mcg daily
d. 100 mcg daily
e. 25 mcg daily

A

d. 100 mcg daily

54
Q

Which of the following is the appropriate time to recheck thyroid function tests after initiating levothyroxine?
a. 12 weeks
b. 8 weeks
c. 6 weeks
d. 10 weeks
e. 2 weeks

A

c. 6 weeks

55
Q

Which of the following conditions may require a levothyroxine dose increase?
a. Advancing age
b. Nephrotic syndrome
c. Pregnancy
d. Malabsorption syndrome e. Weight gain

A

a. Advancing age

56
Q

Which of the following is the initial diagnostic test for suspected acromegaly?
a. Confrontational visual field testing
b. Insulin-like growth factor-1
c. Growth hormone releasing hormone
d. Computed tomography (CT) scan of head e. Growth hormone

A

b. Insulin-like growth factor-1

57
Q

Which of the following exerts its mechanism of action by binding to somatostatin receptors?
a. Octreotide
b. Cabergoline
c. Bromocriptine
d. Pegvisomant
e. Conivaptan

A

a. Octreotide

58
Q

A 30-year-old woman comes to the clinic for moodiness, acne, and irregular menses over the past year. She reports a gradual increase in weight and has been losing hair. Physical exam reveals central obesity and a dorsocervical fat pad. Labs show a 10.2 mg/dL serum glucose, hemoglobin 14.0 g/dL, and a glucose tolerance test at 2 hours of 140 mg/dL. Which of the following is the most appropriate initial diagnostic test?
a. Urine catecholamines
b. Cosyntropin stimulation test
c. Adrenocorticotropin level
d. Serum aldosterone
e. Morning serum cortisol

A

e. Morning serum cortisol

59
Q

Which of the following has the most mineralocorticoid activity?
a. methylprenisolone
b. fludrocortisone
c. dexamethasone
d. hydrocortisone
e. prednisone

A

b. fludrocortisone

60
Q

A 35-year-old man with a history of adrenal insufficiency comes to the emergency department with abdominal pain and vomitting. He reports his symptoms started after he developed a sore throat, fever, and cough 2 days ago. He takes hydrocortisone 25mg daily. Vital signs are temperature is 101F, pulse rate is 125/min, regular, respeirations are 18/min, unlabore, blood pressure is 100/62 mmHg, and oxygen saturation is 100%. Which of the following is the most appropriate initial therapy?
a. regular insulin
b. dopamine
c. propanolol
d. fludrocortisone
e. 0.9% sodium chloride

A

e. 0.9% sodium chloride

61
Q

Which of the following is a dopamine agonsist?

a. oxytocin
b. cabergoline
c. pegvisomant
d. mecasermin
e. octreotide

A

b. cabergoline

62
Q

A 35-year-old woman comes to the clinic for evaluation of misse periods and breast discharge for the last 3months. Physical exam shows bilateral milky nipple discharge without a palpable breast mass. Visual testing by confrontation positive for bitemporal field defect. Urine pregnancy test is negative. Prolactin level is 450 ng/mL (<25 ng/mL). MRI reveals a 8mm by 4mm pituitary adenoma. Which of the following is the next step?
a. pegvisomant
b. transphenoidal surgery c. lanreotide
d. radiotherapy
e. cabergoline

A

e. cabergoline

63
Q

Which of the following is the expected response to vasopressin in central diabetes insipidus?
a. increased aldosterone
b. no urine output change
c. decreased urine osmolality
d. decreased urine output
e. increased thirst

A

d. decreased urine output

64
Q

Which of the following is a complication of lithium administration?
a. nephrogenic diabetes insipidus
b. diabetes mellitus
c. SIADH
d. hypoparathyroidism
e. primary adrenal insufficiency

A

a. nephrogenic diabetes insipidus

65
Q

Which of the following should be monitored in patients on vasopressin?
a. Liver function
b. Blood pressure
c. Serum electrolytes
d. White blood cell count
e. Blood glucose

A

c. Serum electrolytes

66
Q

Which of the following is the treatment of choice for De Quervain’s thyroiditis?
a. Antibiotics
b. Naproxen
c. Acetaminophen
d. Radioiodine
e. Methimazole

A

b. Naproxen

67
Q

Which of the following reduces mortality in symptomatic heart failure with reduced ejection fraction?
a. Empagliflozin
b. Amlodipine
c. Digoxin
d. Hydrochlorothiazide
e. Furosemide

A

a. Empagliflozin

68
Q

The zona fasciculata is primarily responsible for the release of which of the following?
a. Prolactin
b. Testosterone
c. Aldosterone
d. Norepinephrine
e. Cortisol

A

e. Cortisol

69
Q

Which of the following events is the mechanism of action by binding to somatostatin receptors?
a. Conivaptan
b. Octreotide
c. Cabergoline
d. Bromocriptine
e. Pegvisomant

A

b. Octreotide

70
Q

The prescribing of systemic ketoconazole is limited by which of the following adverse effects?
a. Osteosarcoma
b. Renal toxicity
c. Hepatotoxicity
d. Hypothyroidism
e. Gynecomastia

A

c. Hepatotoxicity

71
Q

A 45-year-old African American female with a history of type 2 diabetes mellitus presents to the clinic for initiation of antihypertensive medication. Metformin is the only medication. Her labs reveal normal electrolytes, HbA1C 6.9%, UA negative for protein or glucose. Which of the following is the best initial therapy?
a. Diltiazem
b. Hydrochlorothiazide
c. Metoprolol
d. Valsartan
e. Lisinopril

A

b. Hydrochlorothiazide

72
Q
A

Summative (14 decks)

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