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Endocrinology Flashcards

1
Q

A 30 yo bank manager is concerned with his annual exam which showed a fasting glucose of 120mg/dl and OGT of 110mg/dl for the 8 hour fasting and 2 hour post glucose challenge of 190 mg/dl. What is your impression?

a. IGT only
B. IFG only
C. Both IFG and IGT
D. Normal glucose

A

C. Both IFG and IGT

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2
Q

In hyperglycemic emergencies, insulin is best given as:

A. Intravenous insuling drip
B. Subcutaneous regular insulin
C. Subcutaneous intermediate acting insulin
D. Hourly IV regular insulin bolus

A

D. Hourly IV regular insulin bolus

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3
Q

A 25 year old female was referred for evaluation. She has history of slow growing thyroid gland of 3 years duration. She complained of nervousness and occasional palpitation. BP 120/70, CR 70/min thyroid gland is diffusely enlarged, no bruit, no fine tremors and normal reflexes. Serum T4, T3 and TSH were normal. What is most likely diagnosis?

A. Subclinical hypothyroidism
B. Sick euthyroid syndrome
C. Simple goiter
D. Subclinical hyperthyroidism

A

C. Simple goiter

Subclinical = inc TSH
Sick Euthyroid = dec T3

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4
Q

In patients with a thyroid nodule, which of the following conditions is associated with highest risk for thyroid carcinoma?

A. Elevated thyroid hormones level with suppressed TSH
B. Multinodular goiter
C. History of neck irradiation
D. Family history of hyperparathyroidism

A

C. History of neck irradiation

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5
Q

True about gestational DM
A. Insulin requirement is the same as in non pregnant patients
B. Glucose intolerance developing before conception
C. Diabetes diagnosed at initial prenatal visit should be classified as “overt DM” rather than GDM
D. The number of diagnosed cases of GDM is decreasing due to more aggresive lifestyle intervention

A

C. Diabetes diagnosed at initial prenatal visit should be classified as “overt DM” rather than GDM

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6
Q

A 25 yo female was referred for evaluation. She has a 2x2 cm solitary thyroid nodule, did not complain of palpitation, heat intolerance, nervousness, nor weight loss. Her initial laboratory finding revealed normal thyroid hormones level. Your next step will be

A. Do an ultrasound of the thyroid
B. Do a fine needle aspiration biopsy
C. Suggest surgical removal of the thyroid nodule
D. Do a thyroid scan

A

A. Do an ultrasound of the thyroid

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7
Q

Which of the ff. is true in management of obesity?

A. Goal is to lose 1-2lbs/week
B. Take 65% of total daily caloric requirement from carbohydrates
C. Initiate treatment w/ caloric deficit of 1000-1500kcal/day
D. Eat a diet rich in dairy products

A

A. Goal is to lose 1-2lbs/week

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8
Q

A 67 year old woman has just undergone near total thyroidectomy for follicular thyroid carcinoma. Next step is?

A. Chemotherapy with Adriamycin
B. Levothyroxine replacement therapy
C. Radioactive iodine therapy
D. Observe and close follow up

A

C. Radioactive iodine therapy

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9
Q

Which of the following condition have low uptake in thyroid scan?

A. Iodine deficiency disorder
B. Thyroiditis
C. Graves disease
D. Toxic adenoma

A

B. Thyroiditis

reduced/no uptake

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10
Q

A 24 yo woman presents for evaluation of headaches, amenorrhea and galactorrhea. The serum prolactin level is increased. CT scan of the pituitary demonstrates a 7mm sellar lesion most consistent with microadenoma. Which of the following is the first line therapy in the management of this patient?

A. Pituitary irradiation
B. Surgical resection via transphenoidal route
C. Surgical resection via craniotomy
D. Bromocriptine

A

D. Bromocriptine

prolactinoma

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11
Q

What is the BMI of a patient who weighs 160 lbs with a height of 5’4”

A. 33
B. 35
C. 28
D. 25

A

C. 28

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12
Q

24 year old female underwent total thyroidectomy for follicular carcinoma 2 months ago, which of the following laboratory finding will be likely in this patient?

A. Low T4 with low TSH
B. High T4 with high TSH
C. High T4 with low TSH
D. Low t4 with high TSH

A

D. Low t4 with high TSH

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13
Q

True regarding aldosterone producing adrenal adenoma

A. Mostly bilateral
B. Rarely due to carcinoma
C. Twice as common in men as in women
D. Also called Addison’s disease

A

B. Rarely due to carcinoma

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14
Q

Drug of choice for a diabetic patient with low HDL and a high triglyceride

A. Statins
B. Lifestyle intervention only
C. Ezetimibe
D. Fenofibrates

A

D. Fenofibrates

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15
Q

A 35 yo woman complains of 20-day history of body malaise, fever, sore throat, and neck tenderness that in the past 7 days has been accompanied by increasing nervousness, sweaing and 5 lb weight loss. On PE the patient has signs of hyperthyroidism. Her thyroid is symmetrically enlarged and very tender on palpation. The most likely diagnosis is:

A. Subacute thyroiditis
B. Diffuse toxic goiter
C. Acute suppurative thyroiditis
D. Toxic thyroid adenoma

A

Subacute thyroiditis

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16
Q

Which of the following statement is true regarding low T4 variant of sick euthyroid syndrome

A. Can happen in asymptomatic well patient
B. Must be given levothyroxine as replacement dose
C. Can present in patient admitted in the ICU because of severe pneumonia
D. Most common form of sick euthyroid syndrome

A

C. Can present in patient admitted in the ICU because of severe pneumonia

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17
Q

Among type 1 DM patients

A. Islet destruction is mediated by T lymphocytes
B. Defect in HLA region in chromosome 8
C. Concordance in identical twins is at low of 10-20%
D. Most type 1 DM pts have first degree relatives w/ type 1 DM also

A

A. Islet destruction is mediated by T lymphocytes

B. chromose 6
C. 30-70%
D. type 2

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18
Q

Which of the following drugs acts in a glucose dependent manner by stimulating incretin hormones?

A. DPPIV inhibitions
B. Thiazolidinediones
C. Sulfonylureas
D. Biguanides

A

A. DPPIV inhibitions

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19
Q

Which of the following is true regarding the epidemiologgy of diabetes?

A. There is a plateau in the incidence of diabetes worldwide
B. Most people who develop diabetes are under the age of 40 yo
C. India has the highest incidence of type 2 DM in the world
D. Asians have higher risk in developing diabetes than Caucasians

A

D. Asians have higher risk in developing diabetes than Caucasians

C. China > India > US

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20
Q

A woman in the 5th month pregnancy discovered to have a small goiter. Which of the following sets of laboratory findings would you expect if this patient is euthyroid?

A. Elevated serum T4. T3, and thyroid binding globulin, normal TSH
B. Normal serum T4, t3, TSH and thyroid binding globulin
C. Elevated serum T4 and T3, normal TSH, low thyroid binding globulin
D. Elevated serum T4, T3, TSH and thyroid binding globulin

A

Elevated serum T4. T3, and thyroid binding globulin, normal TSH

2nd Tri = increased T4, T3, TBG

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21
Q

Which of the following is not a characterisitic of Hyperosmolar Hyperglycemic State?
A. Serum HCO3 > 18
B. Osmolality >/= 320 mOsmol/L
C. pH > 7.3
D. Plasma glucose </= 300 mg/dl

A

D. Plasma glucose </= 300 mg/dl

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22
Q

Which of the following serves as the best clinical surrogate marker for visceral adiposity?

A. BMI
B. Weight
C. Arm circumference
D. Waist hip ratio

A

D. Waist hip ratio

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23
Q

Which of the following is correct in distinguishing type 1 from type 2 DM?

A. Maturity onset DM of the young is characterized by autosomal recessive inheritance

B. Type 2 DM is heterogenous group of disorder characterized by imparied insulin secretion while type 1 DM is due to complete lack of insulin secretion

C. Type 2 DM is characterized by autoimmune destruction of beta cells

D. Around 50% of individuals who develop diabetes after the age of 30 have type 1 DM

A

B. Type 2 DM is heterogenous group of disorder characterized by imparied insulin secretion while type 1 DM is due to complete lack of insulin secretion

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24
Q

A 50 year old type 2 diabetic comes to you because of blurring of vision. He has been diabetic for 15 years with no regular glucoe monitoring nor check ups. You suspected that he has DM retinopathy since he also complained of tingling sensation of both feet and nocturia. Which is true regarding pathogenesis of diabetic complications?

A. Both VEGF and TGF-B are reduced
B. There is an increased glucose metabolism via the sorbitol pathway
C. A high level of glucose will reduce glycated proteins
D. Hyperglycemia decreases flux through the hexosamine pathway

A

B. There is an increased glucose metabolism via the sorbitol pathway

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25
Q

The most abundant anterior pituitary
cells in young adult.
a. Thyrotrophs
b. Gonadotrophs
c. Lactotrophs
d. Corticotrophs
e. Somatotrophs

A

e. Somatotrophs

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26
Q

What is the most appropriate thing to
do? (NO CASE GIVEN)
a. Maintain present dose and reassure her.
b. Reduce the dose of the levothyroxine so as not to over treat.
c. Increase the dose to 20-50% and check the TSH after 4 weeks.
d. Adjust the dose to maintain TSH below 10.
e. Stop the levothyroxine and request for FT4 and TSH.

A

a. Maintain present dose and reassure her.

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27
Q

palpitations, fatigue, and on physical
examination, her extremities are warm and she is tachycardic. There is diffuse thyroid gland enlargement and proptosis. There is thickening of the skin in the pretibial area. Mild clubbing of the digits is present. Which of the following laboratory values would you expect in the
patient?
A. Increased free thyroxine, decreased TSH
B. Increased free thyroxine, normal TSH
C. Normal free thyroxine, elevated
triiodothyronine (T3), normal TSH
D. Normal free thyroxine, decreased TSH
E. Increased free thyroxine (free T4), increased TSH

A

A. Increased free thyroxine, decreased TSH

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28
Q

Aside from TSH, which of the following can stimulate the release of thyroid hormones.
a. Catecholamine
b. GLP-1
c. Serotonin
d. Epidermal growth factor
e. Cortisol

A

EGF

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29
Q

On routine physical examination, a 28-year-old woman is found to have a thyroid nodule. She denies pain, hoarseness, hemoptysis, or local
symptoms. Serum TSH is normal. Which of the following is the best next step?
A. Fine needle aspiration of thyroid
B. Thyroid ultrasonography
C. Surgical resection
D. No further evaluation
E. Thyroid scan

A

B. Thyroid ultrasonography

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30
Q

A 60-year-old woman comes to the emergency room. The patient’s temperature is 32.2 °C (90 F). She is bradycardic. Her thyroid gland is enlarged. There is diffuse hyporeflexia. BP is 100/60. Which of the following is the best next step in management?
A. Obtain T4 and TSH: begin intravenous thyroid hormone and glucocorticoid
B. Begin intravenous fluid resuscitation
C. Obtain CT scan of the head
D. Await results of T4 and TSH
E. Begin rapid rewarming

A

A. Obtain T4 and TSH: begin intravenous thyroid hormone and glucocorticoid

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31
Q

In thyroid hormone synthesis:
a. Thyroxine is the product of mono-iodothyronine and diiodothyronine coupling.
b. T4 is more active than the T3.
c. T3 is produced by action of 5’ deiodination of T4 in the peripheral tissue.
d. Majority of T3 is secreted by the thyroid gland.
e. Reverse T3 is markedly increased in patient with T3 toxicosis

A

c. T3 is produced by action of 5’ deiodination of T4 in the peripheral tissue.

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32
Q

Which of the following is a long-acting dopamine agonist that can be given twice weekly in patient with prolactinoma?
a. Bromocriptine mesylate
b. Somatostatin
c. Cabergoline
d. Fludrocortisone
e. Lithium

A

c. Cabergoline

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33
Q

Multinodular non-toxic goiter can develop into toxic goiter because of the following mechanism:
a. Jod Basedow phenomenon
b. Wolf-Chaikoff effect
c. Somogyi’s phenomenon
d. Dawn phenomenon
e. Burch-Wartofsky phenomenon

A

a. Jod Basedow phenomenon

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34
Q

High dose iodine can be given as part of the treatment of thyrotoxic crisis because of the following mechanism:
a. Jod Basedow phenomenon
b. Dawn phenomenon
c. Wolf-Chaikoff effect
d. Somogyi’s phenomenon
e. Burch-Wartofsky phenomenon

A

c. Wolf-Chaikoff effect

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35
Q

headache has been gradually worsening and not responding to over the counter medicines.
He reports trouble with his peripheral vision which he noticed while driving. He takes no
medications. He denies illicit drug use but has smoked one pack of cigarettes per day since
the age of 18. Past history is significant for an episode of kidney stones last year. He tells you
no treatment was needed as he passed the stones, and he was told to increase his fluid intake. Family history is positive for diabetes in his mother and brother (age 20) who has kidney
stones from too much calcium and “low sugar problem”. His father died of some type of
tumor at age 40. Physical examination reveals a deficit in temporal field of vision with few
subcutaneous lipomas. Laboratory results are as follows: Calcium 11.8 mg/dL (normal 8.5
-10.5), Cr: 1.1 mg/dL, BUN: 17 mg/dL, Prolactin 220 μg/L (normal 0-20), Intact Parathormone:90 pg/mL (normal 8-51). You suspect pituitary tumor and order an MRI which reveals a 0.7 cm
pituitary mass. Based on this patient’s presentation, which of the following is the most probable diagnosis?
a. Multiple endocrine neoplasia type 1 (MEN 1)
b. Tension headache
c. Multiple endocrine neoplasia type 2A (MEN 2A)
d. Primary hyperparathyroidism
e. Prolactinoma

A

e. Prolactinoma

36
Q

A patient with small cell carcinoma of the lung develops increasing fatigue but is otherwise alert and serum electrolytes show a serum sodium of
118 mg/L. There is no evidence of edema, orthostatic hypotension, or dehydration. Urine is concentrated with an osmolality of 550 mmol/L.
Serum BUN, creatinine and glucose are within normal range. Which of the following is the next appropriate step?
A. Fluid resuscitation
B. Hypertonic saline infusion
C. Diuresis
D. Demeclocycline
E. Normal saline infusion

A

D. Demeclocycline

37
Q

Which of the following conditions will have an increased RAIU?
a. Iodine deficiency disorder
b. Thyrotoxicosis factitial
c. Subacute thyroiditis
d. Simple goiter
e. Hashimoto’s thyroiditis

A

a. Iodine deficiency disorder

38
Q

A 25-year-old woman is admitted for hypertension. The patient’s urine drug screen is negative. In the hospital, blood pressure is labile and responds poorly to antihypertensive therapy. The patient complains of palpitations and apprehension. Her past medical history shows that she developed hypertension during an operation for appendicitis at age 23. Hct: 49% (37-48), WBC: 11 x 103 mm(4.3-10.8) Plasma glucose: 160 mg/dL (75-115) Plasma calcium: 11mg/dL (9-10.5). Which of the following is the most likely diagnosis?
A. Anxiety attack
B. Renal artery stenosis
C. Pheochromocytoma
D. Essential hypertension
E. Type 1 Diabetes Mellitus

A

C. Pheochromocytoma

39
Q

Which of the following has thyrotoxicosis without hyperthyroidism?
a. Thyrotoxicosis factitial
b. Plummer’s disease
c. Grave’s disease
d. Chorionic gonadotropin secreting tumor
e. TSH secreting adenoma

A

a. Thyrotoxicosis factitial

40
Q

Which of the following conditions is characterized by elevated PTHrP with hypercalcemia?
a. Chronic kidney disease
b. Malignancy
c. Primary hyperparathyroidism
d. Secondary hyperparathyroidism
e. Tertiary Hyperparathyroidism

A

b. Malignancy

41
Q

Patient suspected having diabetes insipidus should undergo which of the following test?
a. Overnight dexamethasone test
b. Creatinine clearance
c. Miller-Moses test
d. Urinalysis
e. Random urinary sodium concentration determination

A

c. Miller-Moses test

42
Q

A 58-year-old male is referred to your office after evaluation in the emergency room for abdominal pain. The patient was diagnosed with gastritis but a CT scan with contrast performed during the workup of his pain revealed a 2-cm adrenal mass. The patient has no history of malignancy and denies erectile dysfunction. Physical examination reveals a BP of 122/78 with no gynecomastia or evidence of Cushing syndrome. His serum potassium is normal. What is the next step in determining whether this patient’s adrenal mass should be resected?
A. Testosterone level
B. Plasma metanephrine and dexamethasone -suppressed cortisol level
C. Estradiol level
D. Repeat CT scan in 6 months
E. Plasma aldosterone/renin ratio

A

B. Plasma metanephrine and dexamethasone -suppressed cortisol level

43
Q

A family brings their 82-year-old grandmother to the emergency room stating that they cannot care for her. 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 has diarrhea most of the time and can barely make it to the bathroom because of her weakness. 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. Normal serum K+
B. Low serum Na+
C. Low serum Ca+
D. Microcytic anemia
E. Low serum K+

A

B. Low serum Na+

44
Q

. A 50-year-old female is evaluated for her hypertension. Her blood pressure is 130/98. She
complains of polyuria and mild muscle weakness. She is on no blood pressure medication. On physical examination, PMI is displaced to the sixth intercostal. There is no sign of congestive heart failure and no edema. Laboratory values are as follows: Na+: 147 mEq/dL, K+: 2.3 mEq/dL, Cl: 112 mEq/dL. The patient denies the use of diuretics or over the counter agents to decrease fluid retention or promote weight loss. She does not eat licorice. Which of the following tests is most useful in establishing a diagnosis?
A. Renal angiogram
B. Plasma renin activity
C. Ratio of serum aldosterone to plasma renin activity
D. 24-hour urine for cortisol
E. Urinary metanephrine

A

C. Ratio of serum aldosterone to plasma renin activity

45
Q

Clinical distinguishing features of Type 1 vs Type 2 DM?
a. Type 2 DM patients tend to be leaner than Type 1
b. Type 2 DM develop the disease at 30 years old
c. Type 2 DM patients are prone to vitiligo
d. Type 1 DM patients have increased risk of other autoimmune diseases like adrenal insufficiency and vitiligo

A

d. Type 1 DM patients have increased risk of other autoimmune diseases like adrenal insufficiency and vitiligo

46
Q

Which of the following is a pheochromocytoma related disease?
a. Primary Hypertension
b. Waterhouse-Friedrichsen Syndrome
c. Sheehan’s Syndrome
d. Neurofibromatosis
e. Craniopharyngioma

A

d. Neurofibromatosis

47
Q

The following is/are true regarding the pathogenesis of Type 2 DM
a. Concordance of Type 2 DM in identical twins is between 50-70%
b. Post-receptor defects play the predominant role in insulin resistance
c. There is decrease hepatic glucose production
d. Most Type 2 DM are insulin requiring

A

b. Post-receptor defects play the predominant role in insulin resistance

48
Q

A male nursing assistant presents with weakness and examination shows no ophthalmopathy or
pretibial myxedema. No thyroid tissue is palpable. T4 is elevated; radioactive iodine uptake is reduced.
A. Grave’s Disease
B. Subacute Thyroiditis
C. Multinodular Goiter
D. Factitious Hyperthyroidism
E. Struma Ovarii

A

D. Factitious Hyperthyroidism

49
Q

A 36-year-old female complains of inability to lose weight despite calorie diet and daily exercise. She has also noticed that she is cold
intolerant. She is wearing a jacket even though it is summer. She also reports constipation and hair loss. These symptoms have been worsening over the past 2 to 3 months. An elevated TSH and low total and free T4 confirm your suspicion of hypothyroidism. You suspect the etiology of the patient’s hypothyroidism to be autoimmune
thyroiditis. What is the best test to confirm the diagnosis of autoimmune thyroiditis?
A. 24-hour radioactive iodine uptake
B. Thyroid aspiration
C. Thyroid peroxidase antibody (TPOAb)
D. Thyroid ultrasound
E. Antinuclear antibody

A

C. Thyroid peroxidase antibody (TPOAb)

49
Q

Among patients with established DM, initial assessment should emphasize on which aspects of diabetes care? EXCEPT:
a. Family history of DM
b. Frequency of hypoglycemia
c. Presence of DM complication
d. Type of treatment patient has been receiving

A

b. Frequency of hypoglycemia

49
Q

The development of chronic complications of diabetes is influenced by EXCEPT:
a. Physical activity
b. Hypertension
c. Duration of the diabetes
d. Level of glucose control

A

a. Physical activity

50
Q

On routine physical examination, a 28-year-old woman is found to have a thyroid nodule. She denies pain, hoarseness, hemoptysis, or local symptoms. Thyroid examination shows 1.5 cm nodule in the right lobe of the thyroid; it moves
normally with deglutition (i.e., it is not fixed). No cervical lymphadenopathy is found. Serum TSH is normal. Which of the following is the best next step in evaluation?
A. Thyroid scan
B. Suppression of the nodule with exogenous thyroxine
C. Thyroid ultrasonography
D. No further evaluation
E. Surgical resection

A

C. Thyroid ultrasonography

50
Q

A 30-year-old man is evaluated for a thyroid. The patient reports that his father died from thyroid cancer and that a brother had a history of
recurrent renal stones. Blood calcitonin concentration is 2000pg/mL (normal is less than 100); serum calcium and phosphate levels are normal. The patient is referred to a thyroid surgeon. Which of the following studies should also be obtained?
A. Measure urinary catecholamines
B. Treat the patient with radioactive iodine
C. Obtain a liver scan
D. Administer suppressive doses of thyroxine and measure levels of thyroid-stimulating hormone
E. Measure parathyroid hormone level

A

E. Measure parathyroid hormone level

51
Q

A medical clerk comes to you with a fasting glucose of 110 mg/dL during an annual check-up. She is otherwise asymptomatic with no
family history of DM. Her endocrinologist performed a 75 gm OGT with the following results: FBS 120 mg/dL, 2-hour post challenge
glucose 180 mg/dL. What is your interpretation?
a. Repeat 75 gm OGT
b. Normal glucose intolerance
c. Diabetes
d. Prediabetes

A

d. Prediabetes

52
Q

Type 1 DM can be differentiated from Type 2 DM biochemically by:
a. Type 1 DM patients have very low C-peptide and require insulin for survival
b. Positive antibody to islet cell among Type 1 DM and typically absent in Type 2 DM
c. Type 1 DM have strong family history of DM
d. Pancreatic islets are infiltrated with lymphocytes among Type 1 DM patients

A

b. Positive antibody to islet cell among Type 1 DM and typically absent in Type 2 DM

53
Q

An obese hypertensive woman has chronic headaches, normal visual fields, and normal pituitary.
a. Acromegaly
b. Cushing Disease
c. Empty Sella Syndrome
d. Chronic Oral Glucocorticoid Use
e. Primary Hypertension

A

e. Primary Hypertension

54
Q

A non-pregnant woman has headaches, bitemporal hemianopsia, irregular menses, and galactorrhea
a. Empty Sella Syndrome
b. Chronic Oral Glucocorticoid Use
c. Cushing Disease
d. Prolactin-secreting Adenoma
e. TSH-secreting Adenoma

A

d. Prolactin-secreting Adenoma

55
Q

A 30-year-old woman has prominent cervical and dorsal fat pads, purple abdominal striae, unexplained hypokalemia, and diabetes
a. Prolactin-secreting Adenoma
b. Acromegaly
c. Chronic Glucocorticoid Use
d. Cushing Disease
e. Primary Hypertension

A

d. Cushing Disease

56
Q

A 20-year-old presents after recent upper respiratory infection. She complains neck pain and heat intolerance. The thyroid is tender.
Erythrocyte sedimentation rate is elevated; free thyroxine value is modestly elevated.
A. TSH-secreting Pituitary Adenoma
B. Stroma Ovarii
C. Subacute Thyroiditis
D. Grave’s Disease
E. Factitious Hyperthyroidism

A

C. Subacute Thyroiditis

57
Q

20-year-old female presents with tachycardia, tremor and heat. On physical examination, no thyromegaly is noted, but she does have RLQ fullness on pelvic examination. Radionuclide scan reveals low uptake in the thyroid gland.
A. Stroma Ovarii
B. Subacute Thyroiditis
C. Grave’s Disease
D. Iodine Deficiency
E. Factitious Hyperthyroidism

A

B. Subacute Thyroiditis

58
Q

Among patients with diabetic nephropathy, what should be advised?
a. Recommended protein intake is 0.6 g/kg/day for those with microalbuminuria
b. Smoking does not have any effect on renal function
c. Strict BP control <140/80 mmHg
d. It is almost always certain to have concomitant retinopathy

A

d. It is almost always certain to have concomitant retinopathy

59
Q

Which of the following insulin has the fastest onset of action (< 20 minutes)?
a. Glargine
b. Lispro
c. Human regular insulin
d. Detemir

A

b. Lispro

60
Q

Which of the following statements is/are TRUE regarding glucose metabolism among Type 2 diabetic patients?
a. There is deficient glucagon secretion postprandially
b. There is increased hepatic glucose output
c. There is lack of compensatory hyperinsulinemia
d. There is decreased gluconeogenesis

A

b. There is increased hepatic glucose output
c. There is lack of compensatory

61
Q

Ideal combination therapy to initiate in a 50-year-old patient with BMI of 21, FBS 160 mg/dL, HbA1c 7.5%
a. Liraglutide plus metformin
b. Basal bolus insulin therapy
c. Sulfonylurea and metformin
d. Basal insulin regimen

A

a. Liraglutide plus metformin

62
Q

Which of the following statements is/are TRUE regarding management of the diabetic emergencies in the above patient?
a. Isotonic saline is the ideal fluid for hydration
b. Bicarbonate should be given as IV drip
c. Potassium incorporation is not needed since the initial potassium is normal
d. Calcium gluconate have to be given early

A

a. Isotonic saline is the ideal fluid for hydration

63
Q

Which of the following statements is correct regarding insulin requirement among Type 1 DM?
a. Meal component of pre-prandial insulin dose uses an insulin: carbohydrate ratio of 1-1.5 U / 10g CHO in Type 1 DM
b. Short-acting insulin analogue for pre-prandial coverage will suffice
c. Requires 1-1.5 U/kg/d divided into basal and bolus component
d. A basal insulin monotherapy is as good as combination multicomponent therapy

A

c. Requires 1-1.5 U/kg/d divided into basal and bolus component

64
Q

Chronic hypoglycemia leads to microvascular complications through which of the following
mechanism?
a. Decreased diacylglycerol
b. Decreased sorbitol
c. Increased AGEs (advanced glycosylated end-products)
d. Increased nitric oxide

A

c. Increased AGEs (advanced glycosylated end-products)

65
Q

A 34-year-old male was rushed to the ER because of nausea, vomiting, and severe abdominal pain of 8 hours of duration. Not known diabetic nor hypertensive. (+) polydipsia and polyuria for 2 weeks. PE: dry mucosa, tachycardia, BP 90/60 mmHg, RR 28/min. Capillary blood glucose revealed 350 mg/dL. Further lab tests showed: Na- 135 mEq/L, K- 4, Cl- 105, Crea 125 umol/L, BUN 5 mg/dL. ABG pH 7.75 pCO2 30 pO2 90 HCO3 16; urine ketone +++; Hb 145 WBC 12.5 with Segmenters predominance. Compute for the anion gap.
A. 10
B. 14
C. 16
D. 18

A

B. 14

66
Q

Which of the following drugs acts in a glucose dependent manner by stimulating incretin hormones?
a. Thiazolidinediones
b. Biguanides
c. Sulfonylureas
d. DPPIV inhibitors

A

d. DPPIV inhibitors

67
Q

After a large carbohydrate mean, which of the following is a normal physiologic response?
a. High insulin and high glucagon levels
b. High insulin and suppressed glucagon
c. Increased insulin only
d. Bosh suppressed insulin and glucagon.

A

b. High insulin and suppressed glucagon

68
Q

Major apolipoprotein in chylomicrons:
a. ApoB100
b. ApoB48
c. ApoA1
d. Lp(a)

A

b. ApoB48

69
Q

Which class of anti-diabetic agent is most commonly associated with hypoglycemia?
a. DPPIV inhibitors
b. Thiazolidinediones
c. Biguanides
d. Sulfonylureas

A

d. Sulfonylureas

70
Q

Which of the following drugs can significantly reduce weight among obese patients?
a. Acarbose
b. Sulfonylureas
c. Sodium glucose co-transporter inhibitors
d. Pioglitazone

A

c. Sodium glucose co-transporter inhibitors

70
Q

In hyperglycemic emergencies, insulin is best given as:
a. Subcutaneous intermediate acting insulin
b. Subcutaneous regular insulin
c. Intermittent IV regular insulin bolus
d. Intravenous insulin drip

A

d. Intravenous insulin drip

71
Q

Which class of drugs has the most significant hypoglycemic adverse events?
a. Sulfonylureas
b. DPPIV inhibitors
c. Exenatide
d. Acarbose

A

a. Sulfonylureas

72
Q

Which of the drugs act thru stimulation of insulin secretion?
a. Sitagliptins
b. Empagliflozin
c. Nateglinides
d. Pioglitazone

A

c. Nateglinides

73
Q

Treatment of choice for diabetic nephropathy
a. Beta blockers
b. ACE inhibitors
c. Calcium channel blockers
d. No preference

A

b. ACE inhibitors

74
Q

What is the recommended HbA1c goal of a healthy 50-year-old diabetic patient?
a. < 8%
b. < 7.5%
c. < 6%
d. < 6.5%

A

d. < 6.5%

75
Q

Which is a very rapid acting insulinwith onset of action between 5-15 minutes?
a. Detemir
b. Glargine
c. Glulisine
d. Regular human insulin

A

c. Glulisine

76
Q

Drug of choice for a 42-year-old recently diagnosed to have diabetes with HbA1c 7%, BMI of 42 kg/m2
a. Thiazolidinediones
b. Diet and exercise only
c. Sulfonylureas
d. Biguanides

A

d. Biguanides

77
Q

Which of the following statements is TRUE regarding lipoprotein metabolism?
a. Apo E are found primarily in HDL while APOB100 is the major apolipoprotein of LDL
b. Increased plasma LDL and APOB100 are risk factors for atherosclerosis
c. Apo A is synthesized mainly in hepatocytes and mediates uptake of lipoproteins in the
liber by the LDL receptor
d. Chylomicrons are carriers of endogenous source of triglycerides

A

b. Increased plasma LDL and APOB100 are risk factors for atherosclerosis

78
Q

Management for diabetic emergencies EXCEPT:
a. Close blood sugar monitoring
b. Potassium replacement
c. Any type of insulin at 0.15 u/kg given as initial bolus only.
d. Fluid replacement at 2-3 L in the first 1-3 hours

A

c. Any type of insulin at 0.15 u/kg given as initial bolus only.

79
Q

Which of the following aspects of long-term diabetes care is TRUE?
a. A target blood pressure of < 130/80 mmHg is important among diabetics to prevent target organ damage
b. Screen for neuropathy every 3 years
c. A retinal exam is needed only if there is blurring of vision
d. A bi-annual foot exam

A

a. A target blood pressure of < 130/80 mmHg is important among diabetics to prevent target organ damage

79
Q

Clinical distinguishing features of Type 1 vs Type 2 DM
a. Type 2 DM patients are prone to vitiligo
b. Type 2 DM develop the disease at 30 years old
c. Type 2 DM patients tend to be leaner than Type 1
d. Type 1 DM patients have increased risk of other autoimmune diseases like adrenal insufficiency and vitiligo.

A

d. Type 1 DM patients have increased risk of other autoimmune diseases like adrenal insufficiency and vitiligo.

80
Q

Which of the following statements is/are TRUE regarding glucose metabolism among Type 2 diabetic patients?
a. There is deficient glucagon secretion postprandially
b. There is increased hepatic glucose output
c. There is decreased gluconeogenesis
d. There is lack of compensatory hyperinsulinemia

A

b. There is increased hepatic glucose output

IM (11 decks)

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