Endocrinology: Multiple Choice & Other Questions

Question 1

A 48 yes-old woman with obesity and a family history of Type 2 DM has Acanthosis Nigricans. Her fasting labs are:

Glucose: 155 mg/dL
A1C: 7.5%

What is her diagnosis?

1. A diagnosis can’t be made based on these lab values.
2. She has prediabetes.
3. She has diabetes.
4. These labs should be repeated.

What would her diagnosis be if her A1C were 6.5% and glucose were 110 mg/dL?

Answer 1

3. She has diabetes

and

Prediabetes

Question 2

What is the preferred initial agent for pharmacologic treatment of Type 2 diabetes?

1. Insulin
2. Metformin
3. Any glucose-lowering agent
4. An SGLT2 or GLP1 is preferred.

Answer 2

2. Metformin

Question 3

What lab value could contradict the use of metformin? Select all that apply.

1. Low platelet count
2. Decreased eGFR
3. Elevated neutrophils
4. Elevated ALT, AST
5. Increased alkaline phosphate
6. Elevated glucose
7. Elevated A1C

Answer 3

2. Decreased eGFR
3. Elevated ALT, AST

Question 4

You have initiated IR Metformin 500 mg BID in a patient with A1C 7.5%. On Day 8, the dose was increased to 1000 mg PM and 500 mg AM. On Day 10, the patient began to have diarrhea. What should be done?

1. Stop Metformin and try a different medication.
2. Stop Metformin for a day and restart 500 mg once a day.
3. Stop Metformin until diarrhea stops then restart Metformin and slowly increase dose.
4. Switch to 1000 mg ER. This is her tolerated dose.

What should be done when Metformin dose is maxed out and A1C remains above goal?

Answer 4

3. Stop Metformin until diarrhea stops then restart Metformin and slowly increase dose

and

Add an additional agent

Question 5

What pharmacologic intervention can be considered for the following patient’s blood glucose?

• 26 year-old woman
• BMI of 36
• Family history of Type 2 DM and hypothyroidism
• Takes 1000 mg BID Metformin IR
• A1C goal < 7%
• LMP 2 weeks ago (normal)
• BP 125/72
• HR 68
• RR 16/min
• A1C 7.5%
• CHO 210 mg/dL
• LDL 140 mg/dL
• HDL 26 mg/dL
• Tri 340 mg /dL
• Glucose 155 mg/dL
• Other labs WNL

1. Rosiglitazone/Avandia
2. Sitagliptin/Januvia
3. Glipizide/Glucotrol
4. Semaglutide/Ozempic

Suppose the patient were needle-phobic?

Answer 5

4. Semaglutide/Ozempic

and

4. Semaglutide/Ozempic (oral available)

Question 6

What pharmaceutical intervention can be considered for the following patient’s blood glucose?

• Age 78 male
• Obesity
• Heart failure
• On Metformin 1000 mg BID

1. Rosiglitazone/Avandia
2. Sitagliptin/Januvia
3. Glipizide/Glucotrol
4. Dapagliflozin/Farxiga

Which of the above has a black box warning for use with heart failure?

Answer 6

4. Dapagliflozin/Farxiga

and

1. Rosiglitazone/Avandia

Question 7

A patient takes metformin, an SGLT2 (dapagliflozin/Farxiga), and a GLP-1 (dulaglutide/Trulicity). Insulin is being initiated because he is not at A1C goal. Which statements are true?

1. Metformin should be discontinued.
2. SGLT2 should be discontinued.
3. GLP-1 should be discontinued.
4. Mealtime insulin should be used.
5. Basal insulin should not be used.
6. SU should be added before adding insulin.

Answer 7

7. All meds should be continued.

Question 8

A 44 year-old woman with a BMI of 25 has agreed to start 10 units of basal insulin. Which of the following meds should be continued?

1. Metformin 1000 mg BIG
2. Lisinopril/HCTZ 20/25
3. Jardiance 25 mg qAM
4. Liraglutide 1.8 mg SC daily
5. Pravastatin 40 mg daily
6. Levothyroxine 50 mcg daily

What should be done if the patient has limited funds?

Answer 8

Continue all

and

Stop SGLT2 and GLP-1 meds (Jardiance and Liraglutide) and increase insulin

Question 9

A patient started taking insulin at 10 units in the evening. How should her insulin be managed if her fasting glucose values are as follows?

AM 1 = 150 mg/dL
AM 2 = 144 mg/dL
AM 3 = 156 mg/dL

1. Increase 3 units
2. Decrease 6 units
3. Decrease 2 units
4. Continue 10 units

Why?

What is the patient’s fasting AM glucose?

Answer 9

1. Increase 3 units

and

Increase since she is not at her goal

and

80 - 130 mg/dL per ADA

Question 10

An 80 year-old man takes 20 units of basal insulin. What is his AM fasting glucose goal?

1. > 100 mg/dL
2. 100 - 140 mg/dL
3. 80 - 130 mg/dL
4. 90 - 130 mg/dL

What is a reasonable postprandial glucose goal?

1. < 120 mg/dL
2. < 140 mg/dL
3. < 180 mg/dL
4. < 220 mg/dL

Answer 10

4. 90 - 130 mg/dL

and

3. < 180 mg/dL

Question 11

A 62 year-old woman takes 40 units of basal insulin. Her postprandial glucose is > 200 mg/dL. The NP has decided to add mealtime insulin. Which choice below is most appropriate for the treatment of PPG?

1. Add 2 units of basal insulin once daily.
2. Add 2 units of immediate-acting insulin with the biggest meal of the day.
3. Add 4 units rapid-acting insulin with each meal.
4. Add 4 units rapid-acting insulin with the biggest meal of the day.

Answer 11

4. Add 4 units rapid-acting insulin with the biggest meal of the day.

Question 12

A 48 year-old woman with obesity has a family history of hypothyroidism. She complains of fatigue and weight gain. The NP decides to screen her for thyroid disease. What should the NP’s plan be if:

A. her TSH is normal?

B. her TSH is elevated?

C. her TSH is decreased?

Answer 12

A. Re-screen later if symptoms persist

B. Add Free T4 to rule out hypothyroidism

C. Add Free T4 and T3 to rule out hyperthyroidism

Question 13

Mrs. Thibodeau has taken 100 mcg levothyroxine daily for the past 6 weeks. Her TSH has decreased from 24 to 10. She says she feels great. How should this be managed?

Tabs available:
25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg,
112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 300 mcg

1. Continue 100 mcg daily, recheck in 4 weeks
2. Decrease by 12 mcg daily
3. Increase by 12 mcg daily
4. Increase dose only if she is asymptomatic

Answer 13

3. Increase by 12 mcg daily

Question 14

You have diagnosed a 26 year-old woman with primary hypothyroidism. Her calculated replacement is 108 mcg daily. How much should she be given initially if levothyroxine tabs come in the following doses:

25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg,
112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 300 mcg?

1. 25 mcg daily
2. 50 mcg daily
3. 100 mcg daily
4. 112 mcg daily

Answer 14

3. 100 mcg daily

Question 15

You have diagnosed Mrs. Boudreaux with primary hypothyroidism. She takes 88 mcg levothyroxine daily. Her TSH after 12 weeks is now within normal range. She states she is still tired. How should this be managed?

1. Increase her levothyroxine dose
2. Decrease her levothyroxine dose
3. Look for another cause of fatigue
4. Order a thyroid panel

Answer 15

3. Look for another cause of fatigue

Question 16

A 40 year-old patient who has hypothyroidism takes 112 mcg levothyroxine daily. She complains of fatigue and “hair loss.” How should she be managed today?

Her labs are as follows:

3/2017
TSH: 13.8
Free T4 0.2

5/2017
TSH: 6.2

6/2017
TSH: 2.5

6/2018
TSH: 2.6

6/2019
TSH: 2.4

3/2020
TSH: 14.1

1. Increase levothyroxine to 100 mcg daily
2. Add iiothyroxine (Cytomel) 5 mcg, continue levothyroxine
3. Reorder TSH, Free T4, and Total T3
4. Ask about timing and dosing of levothyroxine

Answer 16

4. Ask about timing and dosing of levothyroxine