ENDOCRINE- PRACTICE QUESTIONS Flashcards
What is the primary difference between Cushing Disease and Cushing Syndrome?
A) Cushing Disease involves plasma level changes, while Cushing Syndrome involves changes in bone density.
B) Cushing Disease is caused by excessive cortisol production due to ACTH-secreting pituitary tumors, while Cushing Syndrome is due to any cause of elevated cortisol levels.
C) Cushing Disease is only diagnosed in children, whereas Cushing Syndrome is exclusively an adult condition.
D) Cushing Disease is less severe than Cushing Syndrome.
Answer:** B) Cushing Disease is caused by excessive cortisol production due to ACTH-secreting pituitary tumors, while Cushing Syndrome is due to any cause of elevated cortisol levels.
Rationale: Cushing Disease specifically refers to excess cortisol resulting from excessive secretion of ACTH from a pituitary tumor. Cushing Syndrome, on the other hand, encompasses all conditions leading to excess cortisol, whether from endogenous production or exogenous sources.
Which of the following is the most common clinical feature shared by patients with Cushing Syndrome?
A) Persistent fever
B) Unexplained weight loss
C) Weight gain
D) Persistent headaches
Answer:** C) Weight gain
Rationale: Weight gain is a common and prominent feature in patients with Cushing Syndrome due to cortisol’s effects on metabolism, typically resulting in central obesity.
Which of the following is the most common exogenous cause of Cushing Syndrome?
A) Long-term use of corticosteroid medications
B) Pituitary adenomas
C) Adrenal hyperplasia
D) Ectopic ACTH secretion
Answer:** A) Long-term use of corticosteroid medications
Rationale: Prolonged use of exogenous glucocorticoids, such as those used to treat inflammatory conditions, is the most common cause of Cushing Syndrome due to excess glucocorticoid exposure
The initial screening tests for diagnosing Cushing Syndrome include all of the following EXCEPT:
A) Midnight salivary cortisol
B) 1 mg overnight dexamethasone suppression test
C) Serum insulin level
D) 24-hour urinary free cortisol test
Answer:** C) Serum insulin level
Rationale: Screening for Cushing Syndrome typically involves tests to assess cortisol levels, such as midnight salivary cortisol, the dexamethasone suppression test, and 24-hour urinary free cortisol tests. Serum insulin is not used for diagnosing Cushing Syndrome.
Which of the following tests can help differentiate whether cortisol excess is due to Cushing Syndrome or pseudo-Cushing states such as severe obesity or depression?
A) Serum ACTH level
B) Low-dose dexamethasone suppression test
C) CT scan of the abdomen
D) Testing for ketone bodies in urine
Answer:** B) Low-dose dexamethasone suppression test
Rationale: The low-dose dexamethasone suppression test is specifically used to differentiate Cushing’s symptoms from pseudo-Cushing states by assessing feedback inhibition on the hypothalamic-pituitary-adrenal (HPA) axis.
When would an MRI of the pituitary gland typically be indicated for a patient suspected of having Cushing Disease?
A) After confirmation of an adrenal tumor
B) Before any hormonal assessment
C) To identify microadenomas of the pituitary gland after hormonal studies suggest a pituitary origin of hypercortisolemia
D) Only if symptoms persist after initial surgical treatment
Answer:** C) To identify microadenomas of the pituitary gland after hormonal studies suggest a pituitary origin of hypercortisolemia
Rationale: An MRI of the pituitary is indicated to detect microadenomas when hormonal studies confirm the pituitary as the source of ACTH overproduction.
What is the primary surgical treatment option for primary hypersecretion of ACTH by the pituitary gland in Cushing Disease?
A) Bilateral adrenalectomy
B) Laparoscopic adrenalectomy
C) Transsphenoidal microsurgery
D) Open thoracotomy
*Answer:** C) Transsphenoidal microsurgery
Rationale: Transsphenoidal microsurgery is the primary surgical method to remove ACTH-secreting pituitary tumors, which is pivotal in treating Cushing Disease.
Which of the following imaging studies is beneficial for detecting ectopic ACTH secretion?
A) Echocardiogram
B) Chest X-ray
C) CT scan of the chest and abdomen
D) Thyroid ultrasound
Answer:** C) CT scan of the chest and abdomen
Rationale: A CT scan of the chest and abdomen is crucial in identifying ectopic ACTH secretion, as the lungs are a common source of such secretion.
Which of the following drugs is commonly used for adrenal replacement therapy in patients requiring hormone supplementation after treatment for Cushing Disease or Syndrome?
A) Metformin (Glucophage)
B) Lisinopril (Zestril)
C) Hydrocortisone (Cortef)
D) Omeprazole (Prilosec)
Answer:** C) Hydrocortisone (Cortef)
Rationale: Hydrocortisone is a corticosteroid often used for adrenal replacement therapy to maintain appropriate hormone levels after treatment for Cushing Disease or Syndrome.
What is a potential complication of untreated or inadequately treated Cushing Disease?
A) Hypoglycemia
B) Increased susceptibility to infections
C) Decreased blood pressure
D) Fungal skin infections
*Answer:** B) Increased susceptibility to infections
Rationale: Untreated or inadequately treated Cushing Disease can lead to an increased susceptibility to infections due to altered immune responses and high cortisol levels.
Which intervention is NOT typically recommended to treat secondary complications of Cushing Disease/Syndrome even after successful treatment?
A) Osteoporosis management
B) Blood pressure control
C) Immunosuppressive therapy
D) Blood glucose monitoring
*Answer:** C) Immunosuppressive therapy
Rationale: Immunosuppressive therapy is inappropriate for treating secondary complications like obesity, hypertension, glucose intolerance, and osteoporosis post-treatment of Cushing’s. Management focuses on stabilization and monitoring of these specific areas rather than suppressing the immune system.
What primarily causes Type 1 Diabetes Mellitus?
A) Insulin resistance due to obesity
B) Pancreatic β-cell destruction resulting in insulin deficiency
C) Excess production of glucagon
D) Viral infection directly causing hyperglycemia
Answer:** B) Pancreatic β-cell destruction resulting in insulin deficiency
Rationale: Type 1 Diabetes Mellitus is primarily caused by the destruction of pancreatic β-cells, leading to an insulin deficiency that results in hyperglycemia.
Which of the following autoantibodies is commonly tested to diagnose immune-mediated Type 1 Diabetes?
A) Anti-nuclear antibodies (ANA)
B) Anti-thyroid peroxidase antibodies (TPO)
C) Glutamic acid decarboxylase 65 antibody (GAD65)
D) Anti-mitochondrial antibodies
Answer:** C) Glutamic acid decarboxylase 65 antibody (GAD65)
Rationale: GAD65 is one of the autoantibodies commonly present in immune-mediated T1DM, and its presence helps confirm the autoimmune nature of the disease.
Which of the following is NOT considered a classic symptom of Type 1 Diabetes Mellitus?
A) Polyphagia
B) Polyuria
C) Polydipsia
D) Persistent cough
*Answer:** D) Persistent cough
Rationale: Persistent cough is not a classic symptom of Type 1 Diabetes Mellitus. The typical symptoms include polyuria, polydipsia, and polyphagia.
A patient presents with signs of dehydration, polyuria, polydipsia, and has lost weight despite increased appetite. Laboratory tests reveal a blood glucose level of 300 mg/dL. What is the most likely diagnosis?
A) Type 1 Diabetes Mellitus
B) Type 2 Diabetes Mellitus
C) Diabetes Insipidus
D) Hypoglycemia
Answer:** A) Type 1 Diabetes Mellitus
Rationale: The combination of symptoms (dehydration, polyuria, polydipsia, polyphagia with weight loss) and hyperglycemia strongly suggests Type 1 Diabetes Mellitus, especially in the context of insulin deficiency.
What is a significant risk factor for the development of Type 1 Diabetes Mellitus?
A) High BMI and sedentary lifestyle
B) Autoimmune conditions and family history
C) Long-term use of corticosteroids
D) High-carbohydrate diet
*Answer:** B) Autoimmune conditions and family history
Rationale: Autoimmune mechanisms and genetic predisposition (family history) are significant risk factors for developing T1DM. It is often linked with other autoimmune diseases and can run in families.
Which physical examination finding is indicative of possible diabetic ketoacidosis (DKA) in a patient with Type 1 Diabetes?
A) Bradycardia
B) Edema
C) Altered breathing pattern
D) Jaundice
*Answer:** C) Altered breathing pattern
Rationale: An altered breathing pattern, specifically Kussmaul respiration (deep and labored breathing), is a classic sign of metabolic acidosis, which occurs in diabetic ketoacidosis.
Which of the following lab results definitively confirms a diagnosis of diabetes mellitus?
A) Fasting plasma glucose of 115 mg/dL
B) Glycosylated hemoglobin (A1c) of 6.5%
C) Two-hour plasma glucose of 180 mg/dL during an oral glucose tolerance test (OGTT)
D) Random plasma glucose of 180 mg/dL in a patient with no symptoms
Answer:** B) Glycosylated hemoglobin (A1c) of 6.5%
Rationale: An A1c level of 6.5% or higher is one of the criteria used to diagnose diabetes mellitus. It provides a measure of the average blood glucose level over the past 2 to 3 months.
Which laboratory test is used to assess residual beta cell function and endogenous insulin production in a patient with T1DM?
A) Hemoglobin A1c
B) C-peptide level
C) Random plasma glucose
D) Free fatty acid level
Answer:** B) C-peptide level
Rationale: C-peptide levels reflect endogenous insulin production because C-peptide is released in equal amounts with insulin. This test helps evaluate beta cell function in the pancreas.
What is the recommended adult target for HbA1c levels in most patients with Type 1 Diabetes?
A) Less than 5%
B) Less than 6.5%
C) Less than 6%
D) Less than 7%
*Answer:** D) Less than 7%
Rationale: The general target for HbA1c in adults with diabetes is less than 7% to reduce the risk of complications while balancing the potential for hypoglycemia.
Which statement is true regarding the management of hypoglycemia in patients with Type 1 Diabetes?
A) Hypoglycemia is only a concern with Type 2 Diabetes.
B) A plasma glucose level of less than 70 mg/dL is the threshold for hypoglycemia intervention.
C) Severe hypoglycemia is classified as a blood glucose level of 90 mg/dL.
D) High-protein food is the preferred treatment for hypoglycemia.
*Answer:** B) A plasma glucose level of less than 70 mg/dL is the threshold for hypoglycemia intervention.
Rationale: Hypoglycemia intervention is recommended when glucose levels drop below 70 mg/dL. Rapid ingestion of carbohydrates is recommended, and severe hypoglycemia is further defined as less than 54 mg/dL.
A patient with Type 1 Diabetes experiences severe hypoglycemia and is unconscious. What is the most appropriate immediate treatment?
A) Provide an oral glucose gel
B) Administer an intravenous glucose solution
C) Give 1 mg of glucagon subcutaneously
D) Make the patient drink a sugary beverage
Answer:** C) Give 1 mg of glucagon subcutaneously
Rationale: For severe hypoglycemia that results in unconsciousness, glucagon should be administered to mobilize hepatic glucose stores since oral administration is not possible.
In insulin therapy for Type 1 Diabetes, what is a typical starting total daily dose of insulin for insulin-naive patients?
A) 0.1–0.2 units/kg/day
B) 0.2–0.4 units/kg/day
C) 0.5–0.7 units/kg/day
D) 1.0 unit/kg/day
Answer:** B) 0.2–0.4 units/kg/day
Rationale: The recommended total initial dose for insulin-naive patients starting insulin therapy is 0.2–0.4 units/kg/day, with adjustments made based on blood glucose monitoring.
What is the recommended dietary approach for patients with Type 1 Diabetes to allow flexibility in eating habits?
A) Ketogenic diet
B) Glycemic index monitoring
C) Carbohydrate counting using insulin-to-carbohydrate ratios
D) Low-fat diet only
Answer:** C) Carbohydrate counting using insulin-to-carbohydrate ratios
Rationale: Carbohydrate counting with insulin-to-carbohydrate ratios is recommended as it allows individuals with Type 1 Diabetes flexibility in managing their diet with varying carbohydrate intake at meals and snacks.
According to the general guidelines for physical activity in patients with Type 1 Diabetes, when should a patient avoid exercise?
A) When fasting glucose is above 100 mg/dL
B) When the glucose level is more than 250 mg/dL and ketosis is present
C) When glucose is between 150 and 200 mg/dL
D) When blood glucose is normal
*Answer:** B) When the glucose level is more than 250 mg/dL and ketosis is present
Rationale: Patients with Type 1 Diabetes should avoid physical activity if their fasting glucose is more than 250 mg/dL with ketosis present, or more than 300 mg/dL regardless of ketosis, to prevent exacerbation of ketosis and potential cardiovascular stress.
What is an appropriate action if a patient with Type 1 Diabetes has a blood glucose level of less than 100 mg/dL prior to physical activity?
A) Do nothing additional and begin exercising
B) Consume additional carbohydrates as needed
C) Increase the insulin dose
D) Avoid activity until glucose decreases further
Answer:** B) Consume additional carbohydrates as needed
Rationale: If blood glucose is lower than 100 mg/dL before exercise, consuming additional carbohydrates helps to prevent hypoglycemia that may result from physical activity.
In calculating daily caloric needs for a fairly active adult female with Type 1 Diabetes, what multiplication factor should be used?
A) 1.0
B) 1.2
C) 1.5
D) 0.8
Answer:** B) 1.2
Rationale: To calculate daily caloric needs for a fairly active individual, the result of the caloric formula should be multiplied by 1.2, reflecting increased energy expenditure associated with physical activity.
What is the best initial management for a patient diagnosed with Diabetic Ketoacidosis (DKA)?
A) Insulin therapy only
B) High-carbohydrate diet
C) Fluid replacement and insulin administration
D) Wait and observe without intervention
Answer:** C) Fluid replacement and insulin administration
Rationale: Diabetic Ketoacidosis requires prompt treatment with fluid replacement to restore circulatory volume and insulin administration to correct hyperglycemia and ketosis, which are essential in the management of DKA.
For a female patient weighing 60 kg, who is 160 cm tall and 30 years old, using the nutritional formula provided, what is her estimated daily caloric need to maintain current weight, assuming she is fairly active?
A) 1200 calories
B) 2000 calories
C) 1800 calories
D) 1730 calories
Answer:** D) 1730 calories
Rationale: Using the formula: 65 + (9.6 * 60) + (1.7 * 160) - (4.7 * 30) = 1416. Multiply by 1.2 for a fairly active person, resulting in approximately 1699 calories per day. Rounding gives a practical estimate of about 1730 calories, compensating for minor rounding variances. Such nuances illustrate the understanding of tailored nutritional needs.
What are the two main physiological abnormalities associated with Type 2 Diabetes Mellitus?
A) Increased insulin sensitivity and rapid insulin clearance
B) Insulin resistance and impaired insulin secretion
C) Hyperglucagonemia and abundant insulin production
D) High glucagon levels and normal insulin sensitivity
Answer:** B) Insulin resistance and impaired insulin secretion
Rationale: Type 2 Diabetes Mellitus is characterized by insulin resistance, where cells become less responsive to insulin, and impaired insulin secretion due to degenerative changes in the beta islet cells of the pancreas.
What typically occurs to insulin levels in the early stages of developing Type 2 Diabetes Mellitus?
A) Insulin levels decrease rapidly, causing hypoglycemia
B) Insulin levels remain constant while glucose levels decrease
C) Insulin levels rise leading to a state of hyperinsulinemia
D) Insulin levels are not affected; only glucose levels change
Answer:** C) Insulin levels rise leading to a state of hyperinsulinemia
Rationale: During the early stages of Type 2 Diabetes, insulin resistance causes the body to produce more insulin to maintain normal glucose levels, resulting in hyperinsulinemia
Which of the following is a significant risk factor for the development of Type 2 Diabetes Mellitus?
A) Young age
B) Low body mass index (BMI)
C) Family history of diabetes in a first-degree relative
D) Hypotension
*Answer:** C) Family history of diabetes in a first-degree relative
Rationale: A family history of diabetes, especially in a first-degree relative, is a well-established risk factor for Type 2 Diabetes Mellitus.
Which of the following symptoms would be most likely to prompt further investigation for Type 2 Diabetes Mellitus in a middle-aged adult?
A) Occasional shakiness after not eating
B) Episodes of hypothermia
C) Polyuria (frequent urination) and polydipsia (excessive thirst)
D) Chronic low energy levels
Answer:** C) Polyuria (frequent urination) and polydipsia (excessive thirst)
Rationale: Polyuria and polydipsia are classic symptoms associated with hyperglycemia, warranting further investigation for possible diabetes.
Regarding Type 2 Diabetes Mellitus, what is a potential consequence of prolonged hyperglycemia if left untreated?
A) Increased insulin sensitivity
B) Expansion of beta-cell mass
C) Hepatic fibrosis
D) Hyperosmolar Hyperglycemic State (HHS)
Answer:** D) Hyperosmolar Hyperglycemic State (HHS)
Rationale: Prolonged hyperglycemia can lead to severe dehydration and the development of Hyperosmolar Hyperglycemic State, a potentially life-threatening condition more common in older adults.
A 50-year-old patient with a BMI of 28 presents with frequent infections, including candida, and blurry vision. Which of the following is the most appropriate next step?
A) Prescribe antifungal treatment
B) Screen for Type 2 Diabetes Mellitus
C) Refer to an ophthalmologist
D) Advise on weight loss for cosmetic reasons
Answer:** B) Screen for Type 2 Diabetes Mellitus
Rationale: Frequent infections and blurry vision are indicative signs that suggest screening for underlying diabetes, especially in an overweight individual over the age of 45.
Which diagnostic criterion is used to confirm Type 2 Diabetes Mellitus if supported by a repeat test?
A) Glycosylated hemoglobin (A1c) of 6.0%
B) Random plasma glucose level of 150 mg/dL in a symptomatic patient
C) Fasting plasma glucose level of 126 mg/dL or higher after 8 hours of fasting
D) Two-hour plasma glucose level of 180 mg/dL during an OGTT
Answer:** C) Fasting plasma glucose level of 126 mg/dL or higher after 8 hours of fasting
Rationale: A fasting plasma glucose level of 126 mg/dL or higher meets one criterion for the diagnosis of diabetes and should be confirmed with a repeat test unless hyperglycemia is unequivocal.
What is the first-line pharmacologic treatment for Type 2 Diabetes Mellitus unless contraindicated?
A) Insulin
B) Sulfonylureas
C) Metformin
D) Dipeptidyl peptidase-4 (DPP-4) inhibitors
Answer:** C) Metformin
Rationale: Metformin is the first-line medication for Type 2 Diabetes due to its efficacy, safety profile, low hypoglycemia risk, and associated weight loss. It acts by reducing hepatic gluconeogenesis and improving insulin sensitivity.
In managing Type 2 Diabetes Mellitus, what factor primarily determines whether to initiate dual therapy from the start?
A) Patient age
B) Initial A1c level ≥ 9%
C) Duration of diabetes
D) BMI over 30
Answer:** B) Initial A1c level ≥ 9%
Rationale: If a patient presents with an A1c level of ≥9%, it indicates significant hyperglycemia, often warranting the initiation of dual therapy to manage blood sugar levels effectively.
Which medication should be used cautiously in a patient with CKD stage 4 due to a risk of exacerbating gastroparesis and potential acute pancreatitis?
A) DPP-4 inhibitors
B) SGLT2 inhibitors
C) GLP-1 receptor agonists
D) Thiazolidinediones
Answer:** C) GLP-1 receptor agonists
Rationale: GLP-1 receptor agonists like Ozempic (semaglutide) should be cautiously used in patients with CKD stage 4 due to the potential risks mentioned, although they are effective for A1c reduction and promoting weight loss.
Which of the following characteristics can influence the selection of a specific antidiabetic medication?
A) Patient’s hair color
B) Patient’s preference for morning versus evening medications
C) Cost, cardiovascular benefit, and risk of side effects like weight gain or hypoglycemia
D) Personal preference based on commercials
Answer:** C) Cost, cardiovascular benefit, and risk of side effects like weight gain or hypoglycemia
Rationale: Medication selection considerations should include the drug’s impact on comorbid conditions such as cardiovascular disease, the potential for side effects, and the cost to ensure patient adherence and optimal management of T2DM.
Which of the following laboratory findings is most indicative of hyperthyroidism?
A) Elevated TSH and low free T4 levels
B) Suppressed TSH and elevated free T4 levels
C) Normal TSH and elevated total T4 levels
D) Low TSH with normal free T4 levels
Answer:** B) Suppressed TSH and elevated free T4 levels
Rationale: In hyperthyroidism, TSH is typically suppressed due to negative feedback from elevated thyroid hormones (free T4 or free T3).
What is a major diagnostic antibody that confirms Graves’ disease?
A) Thyroglobulin antibody
B) Thyroid peroxidase antibody
C) TSH receptor antibody or thyroid-stimulating immunoglobulin
D) Antinuclear antibody
*Answer:** C) TSH receptor antibody or thyroid-stimulating immunoglobulin
Rationale: The presence of TSH receptor antibodies or thyroid-stimulating immunoglobulin indicates Graves’ disease, which is an autoimmune hyperthyroidism.
Which antithyroid medication is preferred during the first trimester of pregnancy?
A) Methimazole
B) Propylthiouracil
C) Radioactive iodine
D) Levothyroxine
Answer:** B) Propylthiouracil
Rationale: Propylthiouracil is preferred over methimazole during the first trimester of pregnancy due to the risk of methimazole-related teratogenic effects.
In the management of hyperthyroidism, which beta-blocker is often used to manage symptoms such as palpitations and tachycardia, and at what dosage does it inhibit T3 conversion?
A) Labetalol >200 mg/day
B) Atenolol >50 mg/day
C) Propranolol >160 mg/day
D) Metoprolol <100 mg/day
*Answer:** C) Propranolol >160 mg/day
Rationale: High doses of propranolol (>160 mg/day) can inhibit the conversion of T4 to T3, providing additional therapeutic benefits in hyperthyroidism management.
Which statement is true about radioactive iodine therapy in hyperthyroidism?
A) It is the first-line treatment for children with Graves’ disease.
B) Patients do not need any precautions after the treatment.
C) After treatment, patients should avoid contact with pregnant women and children for 7 days.
D) It has no impact on developing hypothyroidism post-treatment.
*Answer:** C) After treatment, patients should avoid contact with pregnant women and children for 7 days.
Rationale: To minimize radiation exposure to others, patients undergoing radioactive iodine therapy should avoid close contact, particularly with pregnant women and children, for approximately 7 days post-treatment.
In managing hyperthyroidism, what indicates the use of glucocorticoids?
A) To treat weight loss associated with hyperthyroidism
B) To reduce peripheral conversion of T4 to T3
C) To lower elevated TSH
D) To address depression symptoms in patients
Answer:** B) To reduce peripheral conversion of T4 to T3
Rationale: Glucocorticoids are used in hyperthyroidism management to reduce peripheral conversion of T4 to the more active T3, thereby managing symptomatology in severe cases like thyroid storm.
Which of the following laboratory findings is most indicative of primary hypothyroidism?
A) Suppressed TSH and elevated free T4 levels
B) Elevated TSH and normal free T4 levels
C) Elevated TSH and decreased free T4 levels
D) Normal TSH and decreased free T4 levels
*Answer:** C) Elevated TSH and decreased free T4 levels
Rationale: Primary hypothyroidism is characterized by an elevated TSH and decreased free T4 levels due to the thyroid gland’s inability to produce adequate thyroid hormones.
Which medication requires caution due to its potential to alter TSH levels and complicate the evaluation of thyroid function?
A) Levothyroxine
B) Glucocorticoids
C) Amoxicillin
D) Acetaminophen
Answer:** B) Glucocorticoids
Rationale: Glucocorticoids can decrease TSH levels, affecting the assessment of thyroid function and masking subclinical hypothyroidism.
When adjusting levothyroxine dosage for a patient, what is the recommended interval for rechecking TSH levels to ensure proper titration?
A) 1 to 2 weeks
B) 4 to 8 weeks
C) 3 months
D) 6 months
*Answer:** B) 4 to 8 weeks
Rationale: TSH has a long half-life, and changes in levothyroxine dosage require 4 to 8 weeks for appropriate adjustment of TSH levels, making this the optimal interval for follow-up testing.
Which of the following factors needs to be considered when dosing levothyroxine in elderly patients?
A) They require a higher dose due to faster clearance.
B) They typically need a lower dose due to decreased clearance.
C) Their dose should align with that of young adults of the same weight.
D) They should take levothyroxine only once weekly due to lower metabolism.
Answer: B) They typically need a lower dose due to decreased clearance.
Rationale: Elderly patients often require a reduced dose of levothyroxine because they have decreased clearance compared to younger individuals.
When should levothyroxine ideally be taken to ensure maximum absorption?
A) With meals
B) At bedtime
C) On an empty stomach, one hour before breakfast
D) After lunch
*Answer:** C) On an empty stomach, one hour before breakfast
Rationale: Levothyroxine is best absorbed on an empty stomach, so it should be taken one hour before breakfast to optimize its therapeutic effects.
A patient taking levothyroxine is advised to avoid certain medications within 4 hours of their thyroid hormone dose due to interference with absorption. Which of the following should they not take within this timeframe?
A) Cetirizine
B) Calcium carbonate
C) Acetaminophen
D) Diphenhydramine
Answer:** B) Calcium carbonate
Rationale: Calcium carbonate can interfere with the absorption of levothyroxine; thus, it should be taken at least 4 hours apart to avoid reduced efficacy of thyroid hormone therapy.
How often should TSH and free T4 be monitored in a patient after initiating or adjusting levothyroxine therapy for hypothyroidism?
A) Every 1 to 2 weeks
B) Every 4 to 8 weeks
C) Every 9 to 12 weeks
D) Annually
*Answer:** B) Every 4 to 8 weeks
Rationale: After starting or adjusting levothyroxine therapy, TSH and free T4 levels should be monitored every 4 to 8 weeks to ensure proper thyroid function stabilization and adequate dose adjustment.
Why must free T4 be monitored instead of TSH in patients with central hypothyroidism?
A) TSH levels are always elevated in central hypothyroidism.
B) TSH is unreliable in central hypothyroidism due to a pituitary/hypothalamic dysfunction.
C) Free T4 is a better indicator of autoimmunity in these patients.
D) Monitoring TSH alone provides sufficient information.
Answer:** B) TSH is unreliable in central hypothyroidism due to a pituitary/hypothalamic dysfunction.
Rationale: In central hypothyroidism, TSH is unreliable because it results from pituitary or hypothalamic dysfunction. Therefore, free T4 is monitored to assess thyroid function accurately.
In some cases of subclinical hypothyroidism, treatment with levothyroxine is recommended. Which situation would warrant this intervention?
A) Absence of symptoms at any TSH level
B) Presence of antithyroid antibodies
C) Elevated TSH with absent heart disease or symptoms
D) No apparent risk factors for cardiovascular disease
Answer:** B) Presence of antithyroid antibodies
Rationale: Treatment with levothyroxine is often recommended in subclinical hypothyroidism if antithyroid antibodies are present, as these patients are at higher risk of progressing to overt hypothyroidism.
What is one risk associated with overtreatment of hypothyroidism in elderly patients that requires careful monitoring?
A) Hyperglycemia
B) Increased risk of fracture due to osteoporosis
C) Development of autoimmune diseases
D) Decreased cardiac function
Answer:** B) Increased risk of fracture due to osteoporosis
Rationale: Overtreatment leading to iatrogenic thyrotoxicosis in elderly patients can increase the risk of osteoporosis, thereby heightening the risk for fractures.
Which patient scenario most likely indicates a need for referral to an endocrinologist?
A) A patient achieving stable TSH levels with no structural thyroid changes
B) An elderly patient with a mildly elevated TSH and no symptoms
C) A patient with goiter, nodule, or other structural changes in the thyroid gland
D) A patient newly diagnosed with subclinical hypothyroidism and no cardiovascular risk
Answer: C) A patient with goiter, nodule, or other structural changes in the thyroid gland
Rationale: Structural changes in the thyroid, such as goiters or nodules, warrant a referral to an endocrinologist for specialized assessment and intervention.
Answer: C) A patient with goiter, nodule, or other structural changes in the thyroid gland
Rationale: Structural changes in the thyroid, such as goiters or nodules, warrant a referral to an endocrinologist for specialized assessment and intervention.
*Answer:** B) 0.5 to 1.0 μg/kg
Rationale: A lower dose range of levothyroxine, typically between 0.5 to 1.0 μg/kg, is recommended for initiating treatment in subclinical hypothyroidism to prevent overtreatment.
What BMI range defines Class 2 obesity?
A) 25 to 29.9 kg/m²
B) 30 to 34.9 kg/m²
C) 35 to 39.9 kg/m²
D) ≥40 kg/m²
*Answer:** C) 35 to 39.9 kg/m²
Rationale: Class 2 obesity is defined as a BMI of 35 to 39.9 kg/m², placing patients at increased risk for negative health outcomes.
Which risk factor is NOT typically associated with obesity?
A) Parental obesity
B) Engaging in regular physical activity
C) Sedentary lifestyle
D) Stress and mental illness
Answer:** B) Engaging in regular physical activity
Rationale: A sedentary lifestyle, not regular physical activity, is a risk factor for obesity. Regular activity is recommended to prevent obesity.
Leptin, a hormone produced by adipocytes, is associated with what condition when absent?
A) Increased insulin sensitivity
B) Decreased appetite
C) Severe obesity
D) Decreased systemic inflammation
Answer:** C) Severe obesity
Rationale: The absence of leptin has been associated with severe obesity, which emphasizes the hormone’s role in signaling satiety and energy balance.
Which health condition is NOT a consequence of obesity?
A) Atrial fibrillation
B) Type 2 diabetes mellitus
C) Coronary heart disease
D) Sleep apnea
Answer:** A) Atrial fibrillation
Rationale: While obesity is associated with numerous cardiovascular diseases, atrial fibrillation is not explicitly listed among the direct consequences provided for obesity.
Which statement about waist circumference is true?
A) It is less important than BMI for assessing obesity-related risks in the elderly.
B) A male waist circumference over 40 inches is considered elevated and indicative of increased health risks.
C) It should only be measured for individuals with a BMI over 35 kg/m².
D) Measurement should be taken at the level of the iliac crest.
Answer:** B) A male waist circumference over 40 inches is considered elevated and indicative of increased health risks.
Rationale: Waist circumference over 40 inches for males is associated with an increased risk of obesity-related health issues, and it offers additional insights into health risks that BMI alone may not provide, especially regarding abdominal obesity.
What lifestyle advice is recommended for the prevention of obesity?
A) Engage in at least 60 minutes of exercise daily.
B) Avoid calorie-dense, nutrient-poor foods, such as sugar-sweetened beverages.
C) Eat high-calorie foods consistently to prevent weight fluctuations.
D) Measure BMI weekly for the best result
Answer:** B) Avoid calorie-dense, nutrient-poor foods, such as sugar-sweetened beverages.
Rationale: Reducing the intake of calorie-dense and nutrient-poor foods, along with maintaining regular moderate physical activity, helps prevent the development of obesity.
Which of the following is NOT a recommended laboratory test for a patient being evaluated for obesity?
A) Fasting blood glucose
B) Lipid Panel
C) Complete blood count
D) Urinary sodium levels
Answer:** D) Urinary sodium levels
Rationale: While fasting blood glucose, lipid panel, and complete blood count are recommended tests for assessing associated comorbid conditions in obesity, urinary sodium levels are not typically included in the standard evaluation protocol.
The USPSTF recommends clinicians focus primarily on which type of intervention for effective weight loss in adults?
A) Pharmacotherapy
B) Behavioral interventions
C) Surgical interventions
D) Nutritional supplements
Answer:** B) Behavioral interventions
Rationale: The USPSTF emphasizes that behavioral interventions should be the primary focus for effective weight management in adults and suggest their critical role in achieving sustainable weight loss.
Pharmacotherapy for obesity should be considered in patients with a BMI of 27 or above if they also have comorbid conditions. Which of the following conditions would qualify as a comorbidity?
A) Hypertension
B) Anemia
C) Hyperthyroidism
D) Seasonal allergies
Answer:** A) Hypertension
Rationale: Hypertension is a common comorbidity linked to obesity that may warrant the use of pharmacotherapy in patients with a BMI ≥27, in conjunction with lifestyle interventions.
Which medication inhibits pancreatic lipase, reduces fat absorption, and is associated with gastrointestinal side effects such as fecal incontinence?
A) Phentermine/topiramate (Qysmia)
B) Orlistat (Xenical)
C) Liraglutide (Saxenda)
D) Naltrexone/bupropion (Contrave)
Answer:** B) Orlistat (Xenical)
Rationale: Orlistat reduces fat absorption by inhibiting pancreatic lipase, leading to increased fat excretion and is often associated with gastrointestinal side effects, such as oily stools and flatulence.
In which scenario should pharmacotherapy be considered for an adult with obesity?
A) The first-line treatment regardless of patient motivation or previous lifestyle interventions
B) After failure to achieve a ≥5% weight loss with 3-6 months of lifestyle intervention in patients with a BMI ≥30
C) Only as an additional intervention if surgical options have been exhausted
D) As a preventative measure for individuals at risk of obesity
Answer:** B) After failure to achieve a ≥5% weight loss with 3-6 months of lifestyle intervention in patients with a BMI ≥30
Rationale: Pharmacotherapy is recommended for patients who have been unable to achieve meaningful weight loss after 3-6 months of comprehensive lifestyle interventions, particularly for those with a BMI ≥30, or a BMI ≥27 with comorbid conditions.
Which of the following is true regarding the role of physical activity in weight management for obese patients?
A) Aerobic exercise is the only effective form of physical activity for weight loss.
B) There is no significant relationship between the duration of physical activity and weight loss outcomes.
C) The type and intensity of exercise have no significant impact on overall weight loss outcomes compared to the duration of the activity.
D) Physical activity should only be recommended if dietary changes fail.
*Answer:** C) The type and intensity of exercise have no significant impact on overall weight loss outcomes compared to the duration of the activity.
Rationale: Studies indicate that the overall duration of physical activity is a more critical factor for weight loss than the type (e.g., aerobic vs. resistance) or intensity (e.g., high vs. low) of exercise. Recommendations should be tailored to individuals’ preferences and capacities.
Cognitive Behavioral Therapy (CBT) for obesity is most effective when it includes which of the following components?
A) High-intensity physical exercise only
B) Prescription of weight-loss medication
C) A moderately reduced-calorie diet, increased physical activity, and behavioral strategies
D) Alleviation of stress through relaxation techniques on
Answer:** C) A moderately reduced-calorie diet, increased physical activity, and behavioral strategies
Rationale: CBT for obesity involves a combination of a reduced-calorie diet, increased physical activity, and behavioral strategies tailored to enhance adherence to dietary and activity recommendations.
What is the recommended caloric intake range for men aiming for weight loss according to long-term dietary studies?
A) Less than 800 calories per day
B) 1000-1200 calories per day
C) 1200-1500 calories per day
D) 1500-1800 calories per day
Answer:** D) 1500-1800 calories per day
Rationale: Long-term studies suggest a calorie intake of 1500-1800 kcal/day for men can support weight loss while still providing adequate nutrients. This approach is shown to be effective for sustainable weight loss if it can be adhered to by the patient.
Under which circumstances is a referral for bariatric surgery typically considered?
A) When other treatments are optional and the patient chooses surgery first
B) When the patient has a BMI ≥30 with no comorbid conditions
C) When the patient has a BMI ≥35 with comorbidities, or a BMI ≥40
D) For anyone seeking rapid weight loss, regardless of their current health metrics
Answer:** C) When the patient has a BMI ≥35 with comorbidities, or a BMI ≥40
Rationale: Bariatric surgery is considered for patients with a BMI ≥35 with comorbid conditions or a BMI ≥40, especially when other treatments have failed. The procedure has been associated with significant metabolic improvements.
Which dietary approach is associated with a decrease in body weight, BMI, HbA1c, fasting glucose, and cardiovascular disease risk according to meta-analyses?
A) Ketogenic diet
B) Mediterranean diet
C) Paleolithic diet
D) Carnivore diet
Answer:** B) Mediterranean diet
Rationale: The Mediterranean diet, which emphasizes plant-based foods, olive oil, whole grains, and lean proteins, is associated with multiple health benefits including weight loss and a reduction in cardiovascular risk factors according to various studies and meta-analyses
Which of the following conditions is commonly associated with metabolic syndrome and significantly increases the risk of cardiovascular disease and diabetes mellitus?
A) Hypothyroidism
B) Hyperlipidemia
C) Anemia
D) Osteoporosis
Answer:** B) Hyperlipidemia
Rationale: Metabolic syndrome is characterized by a collection of risk factors that include hypertension, hyperlipidemia, insulin resistance, and obesity. These factors collectively increase the risk for cardiovascular disease and diabetes mellitus, not including conditions like hypothyroidism, anemia, or osteoporosis.
In managing a patient suspected of having metabolic syndrome, what is the recommended approach for primary care practitioners?
A) Rely solely on meeting the diagnostic criteria of metabolic syndrome before starting any treatment.
B) Focus only on reducing the patient’s cholesterol levels.
C) Evaluate and treat all individual cardiovascular disease risk factors, regardless of the official diagnosis.
D) Use only pharmacological interventions to manage the syndrome.
Answer:** C) Evaluate and treat all individual cardiovascular disease risk factors, regardless of the official diagnosis.
Rationale: Since the definition of metabolic syndrome can vary and change, it is crucial for clinicians to address each cardiovascular risk factor individually, rather than focusing solely on meeting a predefined set of criteria for metabolic syndrome.
Which of the following is true about testosterone deficiency according to the FDA?
A) It is defined solely by symptoms rather than T level measurements.
B) It is characterized by high levels of testosterone (>600 ng/dL).
C) The FDA identified T levels below 300 ng/dL as indicative of potential testosterone deficiency.
D) It can be diagnosed by a digital rectal exam alone.
Answer:** C) The FDA identified T levels below 300 ng/dL as indicative of potential testosterone deficiency.
Rationale: The FDA considers a testosterone level <300 ng/dL, along with signs and symptoms, as indicative of potential testosterone deficiency, while symptoms alone or a digital rectal exam are not used to diagnose TD.
Which risk factor is not typically associated with testosterone deficiency?
A) Obesity
B) Chronic infections
C) Hypothyroidism
D) Rheumatoid arthritis
Answer:** D) Rheumatoid arthritis
Rationale: While obesity, chronic infections, and various hypothalamic/pituitary disorders are known to affect testosterone levels, rheumatoid arthritis is not typically listed among the direct risk factors for testosterone deficiency.
Which of the following is a common sign or symptom associated with testosterone deficiency?
A) Increased libido
B) Increased muscle strength
C) Decreased energy levels
D) Increased testicle size
Answer:** C) Decreased energy levels
Rationale: Testosterone deficiency is often associated with decreased energy levels, among other symptoms such as decreased libido, erectile dysfunction, and loss of muscle strength, rather than increased libido, muscle strength, or testicle size.
What is the recommended initial test to diagnose testosterone deficiency?
A) Afternoon salivary testosterone level
B) Random urine testosterone test
C) Morning serum testosterone level
D) Evening serum testosterone level
Answer:** C) Morning serum testosterone level
Rationale: Testosterone levels follow a diurnal pattern, peaking in the morning. Therefore, the initial test for diagnosing testosterone deficiency is a morning serum testosterone level.
Which of the following would help differentiate between primary and secondary hypogonadism in a patient with low testosterone?
A) Prostate-specific antigen (PSA) levels
B) Hemoglobin levels
C) Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels
D) Digital rectal exam
Answer:** C) Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels
Rationale: Measuring LH and FSH levels helps differentiate primary (testicular failure) from secondary (pituitary or hypothalamic dysfunction) hypogonadism. In primary hypogonadism, LH and FSH levels are elevated, while, in secondary cases, these levels are typically low or normal.
Testosterone therapy is contraindicated in men with which of the following conditions?
A) Well-controlled type 2 diabetes mellitus
B) Newly diagnosed hypothyroidism
C) Untreated obstructive sleep apnea
D) Mild anemia
Answer:** C) Untreated obstructive sleep apnea
Rationale: Testosterone therapy is contraindicated in male patients with untreated obstructive sleep apnea due to the risk of exacerbating this condition. Other contraindications include prostate cancer and severe lower urinary tract symptoms.
Before initiating testosterone therapy, which test is recommended to evaluate the risk of prostate cancer in men over 40?
A) Hemoglobin level
B) Digital rectal examination
C) Prostate-specific antigen (PSA)
D) Magnetic Resonance Imaging (MRI) of the prostate
Answer:** C) Prostate-specific antigen (PSA)
Rationale: A PSA test is recommended to exclude prostate cancer before starting testosterone therapy in men over 40, since testosterone can stimulate the growth of prostate cancer.
What should be monitored 3 to 6 months after initiating testosterone therapy and then annually in men undergoing treatment?
A) Blood glucose levels
B) Serum calcium levels
C) Hematocrit levels
D) Total cholesterol levels
Answer:** C) Hematocrit levels
Rationale: Hematocrit levels should be monitored 3 to 6 months after starting testosterone therapy to check for polycythemia, a possible side effect of treatment. Monitoring continues annually thereafter.
Which of the following is a characteristic symptom of primary hyperparathyroidism due to hypercalcemia?
A) Hypertension
B) Constipation
C) Hypoglycemia
D) Bradycardia
answer:** B) Constipation
Rationale: Constipation is a common symptom associated with hypercalcemia, and primary hyperparathyroidism is often characterized by symptoms related to elevated calcium levels.
What is the most common method of detection for patients with primary hyperparathyroidism?
A) Palpable neck mass
B) Routine screening of vitamin D levels
C) Incidental finding of hypercalcemia on routine blood tests
D) Symptoms of hyperphosphatemia
Answer:** C) Incidental finding of hypercalcemia on routine blood tests
Rationale: Most cases of primary hyperparathyroidism are discovered incidentally due to elevated calcium levels identified during routine blood work.
What laboratory test would you perform if hypercalcemia is confirmed and you suspect primary hyperparathyroidism?
A) Thyroid hormone levels
B) Intact parathyroid hormone (PTH) level
C) Serum iron levels
D) Complete blood count (CBC)
Answer:** B) Intact parathyroid hormone (PTH) level
Rationale: Once hypercalcemia is confirmed, measuring the intact PTH level can help determine if the hypercalcemia is PTH-dependent (suggesting possible primary hyperparathyroidism) or PTH-independent
Which of the following findings supports a diagnosis of primary hyperparathyroidism as opposed to familial hypocalciuric hypercalcemia (FHH)?
A) Low urine calcium excretion
B) Elevated serum phosphate
C) 24-hour urine calcium concentration to creatinine clearance ratio >0.02
D) Undetectable PTH level
Answer:** C) 24-hour urine calcium concentration to creatinine clearance ratio >0.02
Rationale: A urine calcium concentration to creatinine clearance ratio >0.02 suggests primary hyperparathyroidism, while a ratio <0.01 is typical of FHH.
What is the primary treatment approach for tertiary hyperparathyroidism?
A) High-dose vitamin D supplementation
B) Parathyroidectomy, as medical treatment is generally not curative
C) Calcium supplementation
D) Decreased dietary phosphate intake
*Answer:** B) Parathyroidectomy, as medical treatment is generally not curative
Rationale: For tertiary hyperparathyroidism, parathyroidectomy is often required as medical management is typically not effective in addressing the autonomous parathyroid gland function.
Which of the following is a clinical feature directly related to the neuromuscular hyperexcitability seen in hypoparathyroidism?
A) Bradycardia
B) Muscle weakness
C) Muscle spasms
D) Hypertension
*Answer:** C) Muscle spasms
Rationale: Neuromuscular hyperexcitability due to low serum calcium levels in hypoparathyroidism frequently leads to muscle spasms as one of the cardinal features.
A 56-year-old patient who recently underwent neck surgery exhibits a positive Trousseau sign. This is indicative of which condition?
A) Hypercalcemia
B) Hypokalemia
C) Hypocalcemia
D) Hyperkalemia
Answer:** C) Hypocalcemia
Rationale: A positive Trousseau sign, which involves a carpal spasm induced by inflating a blood pressure cuff, is indicative of hypocalcemia, commonly seen in hypoparathyroidism.
When assessing a patient for hypoparathyroidism, which lab finding would you expect to see?
A) Increased serum calcium
B) Decreased serum phosphorus
C) Increased serum phosphorus
D) Elevated PTH levels
Answer:** C) Increased serum phosphorus
Rationale: In hypoparathyroidism, low secretion of PTH results in hypocalcemia and hyperphosphatemia due to a decreased renal excretion of phosphate.
For a patient diagnosed with hypoparathyroidism who presents with severe laryngospasm, what is the priority initial treatment?
A) Oral calcium supplements
B) Intravenous calcium replacement
C) Oral vitamin D supplementation
D) Thiazide diuretics
Answer:** B) Intravenous calcium replacement
Rationale: Severe symptoms like laryngospasm require immediate correction of hypocalcemia through intravenous calcium to stabilize the patient.
When treating a patient with hypoparathyroidism, why might oral calcium citrate be preferred over calcium carbonate?
A) Calcium citrate offers higher elemental calcium content per tablet.
B) Calcium citrate absorption is better for patients on proton pump inhibitor (PPI) therapy.
C) Calcium citrate has fewer side effects on gastrointestinal transit.
D) Calcium citrate reduces the need for vitamin D supplementation.
Answer:** B) Calcium citrate absorption is better for patients on proton pump inhibitor (PPI) therapy.
Rationale: Calcium citrate does not rely on stomach acid for absorption, making it preferred over calcium carbonate in patients taking PPIs, which reduce stomach acidity and can hinder calcium carbonate absorption.
Which form of vitamin D is synthesized in the skin by exposure to ultraviolet B (UV-B) radiation?
A) Calcidiol (25-OH vitamin D)
B) Calcitriol (1,25 vitamin D)
C) Cholecalciferol (D3)
D) Ergocalciferol (D2)
*Answer:** C) Cholecalciferol (D3)
Rationale: Cholecalciferol (D3) is synthesized in the skin upon exposure to sunlight, specifically ultraviolet B (UV-B) radiation.
A patient living at a latitude higher than 38 degrees presents with fatigue and muscle weakness. Which lab test is most sensitive to assess their vitamin D status?
A) Serum calcium level
B) 25-OH vitamin D
C) Alkaline phosphatase
D) Parathyroid hormone (PTH) level
Answer:** B) 25-OH vitamin D
Rationale: The 25-OH vitamin D test measures vitamin D status in the body and is the most sensitive indicator for diagnosing vitamin D deficiency.
Which of the following patients is at greatest risk for vitamin D deficiency?
A) A 25-year-old male who works outdoors
B) A 65-year-old woman with obesity and depression
C) A 45-year-old man living in Florida who cycles regularly
D) A 30-year-old African American woman vacationing in the tropics
*Answer:** B) A 65-year-old woman with obesity and depression
Rationale: Elderly patients, particularly women, with obesity and depression are at higher risk for vitamin D deficiency due to factors like reduced sun exposure and increased body fat, which sequesters the fat-soluble vitamin D.
What is the recommended minimum daily vitamin D supplementation for individuals aged 51 to 70 years according to guidelines?
A) 400 IU/day
B) 600 IU/day
C) 800 IU/day
D) 1,200 IU/day
*Answer:** C) 800 IU/day
Rationale: For individuals aged 51 to 70 years, a minimum of 800 IU/day of vitamin D is recommended to help prevent conditions such as nonvertebral fractures.
*Question 5:**
Regarding vitamin D deficiency treatment, which regimen is recommended for a patient with 25-OH vitamin D levels <20 ng/mL?
A) 400 IU/day of vitamin D3
B) 800 IU/day of vitamin D2
C) 50,000 IU/week of vitamin D2 for 8 to 12 weeks, then 1,000 to 2,000 IU/day of vitamin D3
D) 4,000 IU/day of vitamin D calcium mix
Answer:** C) 50,000 IU/week of vitamin D2 for 8 to 12 weeks, then 1,000 to 2,000 IU/day of vitamin D3
Rationale: For a confirmed vitamin D deficiency, a higher initial dose of 50,000 IU of vitamin D2 weekly for 8 to 12 weeks is used to rapidly raise vitamin D levels, followed by maintenance with daily vitamin D3.
