Health Ass 4: Endocrine Flashcards
What is required to maintain a normal glucose level in the body?
A. The absorption of amino acids.
B. A balance between glucose usage and endogenous production or dietary carbohydrate intake.
C. The elimination of fats from the diet.
D. A constant supply of exogenous insulin.
Correct Answer: B. A balance between glucose usage and endogenous production or dietary carbohydrate intake.
Which organ is primarily responsible for endogenous glucose production?
A. The pancreas.
B. The spleen.
C. The liver.
D. The kidneys.
Correct Answer: C. The liver.
The liver is the primary source of endogenous glucose production via glycogenolysis & gluconeogenesis
After eating, when glucose usage outpaces production, what process occurs to stabilize blood glucose levels?
A. Conversion from glucose production to protein synthesis.
B. A transition from exogenous to endogenous glucose production.
C. The body increases insulin resistance.
D. Activation of lipid metabolism.
Correct Answer: B. A transition from exogenous to endogenous glucose production.
2-4 hours after eating, when glucose usage exceeds production, a transition from exogenous usage to endogenous production occurs to maintain a normal plasma glucose level
What percentage of glucose released by the liver is used by insulin-insensitive tissues?
A. 10-20%
B. 30-40%
C. 50-60%
D. 70-80%
Correct Answer: D. 70-80%.
70-80% of the glucose released by the liver is metabolized by insulin-insensitive tissues such as the brain, GI tract, and red blood cells
Which hormones are part of the glucose counterregulatory system?
A. Insulin and somatostatin.
B. Glucagon, epinephrine, growth hormone, and cortisol.
C. Thyroid hormones and leptin.
D. Estrogen and progesterone.
Correct Answer: B. Glucagon, epinephrine, growth hormone, and cortisol.
Rationale: These hormones act to increase blood glucose levels through various mechanisms, counteracting the glucose-lowering effects of insulin.
What role does glucagon play in glucose metabolism?
A. Decreases blood glucose levels by promoting glycogenesis.
B. Increases blood glucose levels by stimulating glycogenolysis and gluconeogenesis.
C. Has no effect on glucose metabolism.
D. Increases glucose uptake into the cells.
Correct Answer: B. Increases blood glucose levels by stimulating glycogenolysis and gluconeogenesis.
Rationale: Glucagon’s primary function is to raise blood glucose levels by breaking down glycogen into glucose (glycogenolysis) and creating new glucose (gluconeogenesis), particularly in the fasting state. It also inhibits the breakdown of glucose (glycolysis).
What is the prevalence of diabetes mellitus among adults?
A. 1 in 5 adults.
B. 1 in 10 adults.
C. 1 in 20 adults.
D. 1 in 50 adults.
Correct Answer: B. 1 in 10 adults.
Rationale: Diabetes mellitus affects 1 in 10 adults, making it the most common endocrine disease.
What is the etiology of Type 1a diabetes?
A. Genetic mutation leading to insulin overproduction.
B. Lifestyle factors leading to insulin resistance.
C. T-cell mediated autoimmune destruction of β cells.
D. Viral infection leading to pancreatic damage.
Correct Answer: C. T-cell mediated autoimmune destruction of β cells.
Rationale: Type 1a diabetes is caused by an autoimmune reaction where T-cells attack and destroy β cells in the pancreas, leading to minimal or absent insulin production.
How does Type 2 diabetes differ from Type 1 regarding its pathophysiology?
A. Type 2 is an autoimmune disease, while Type 1 is not.
B. Type 2 results from a complete deficiency of insulin.
C. Type 2 is characterized by defects in insulin signaling, not an autoimmune process.
D. Type 2 is a transient condition, while Type 1 is permanent.
Correct Answer: C. Type 2 is characterized by defects in insulin signaling, not an autoimmune process.
Rationale: Unlike Type 1 diabetes, which involves autoimmune destruction of β cells, Type 2 diabetes arises from defects in insulin receptors and subsequent intracellular signaling, leading to insulin resistance.
Type 1b diabetes is a rare disease of absolute insulin deficiency, which is not immune mediated
What percentage of diabetes mellitus (DM) cases does Type 1 diabetes comprise?
A. Less than 1%.
B. 5-10%.
C. 25-30%.
D. Over 50%.
Correct Answer: B. 5-10%.
Rationale: Type 1 diabetes accounts for 5-10% of all diabetes cases, distinguishing it as less common than Type 2 diabetes.
When is Type 1 diabetes typically diagnosed?
A. In infancy.
B. Before age 40.
C. After age 60.
D. It has no typical age of onset.
Correct Answer: B. Before age 40.
Rationale: Type 1 diabetes is often diagnosed in younger individuals, commonly before age 40.
What proportion of B cell function is typically lost before hyperglycemia becomes apparent in Type 1 diabetes?
A. Around 10-20%.
B. About 50-60%.
C. At least 80-90%.
D. 100%.
Correct Answer: C. At least 80-90%.
Rationale: In Type 1 diabetes, a significant loss of B cell function, generally 80-90%, occurs before the clinical manifestations of hyperglycemia are evident.
Which of the following is a symptom of hyperglycemia in Type 1 diabetes?
A. Hypoglycemia.
B. Weight gain.
C. Decreased urination.
D. Polyuria.
Correct Answer: D. Polyuria.
Rationale: Hyperglycemia can lead to polyuria (increased urination), polydipsia (increased thirst), fatigue, weight loss, and potentially, if left untreated, to more serious conditions like ketoacidosis.
What percentage of diabetes mellitus (DM) cases does Type 2 diabetes constitute?
A. Less than 10%.
B. Approximately 50%.
C. More than 90%.
D. Exactly 75%.
Correct Answer: C. More than 90%.
How long before diagnosis do individuals with Type 2 diabetes typically exhibit symptoms?
A. 1-3 years.
B. 4-7 years.
C. 8-10 years.
D. Over 10 years.
Correct Answer: B. 4-7 years.
under-diagnosed
Which of the following is a main abnormality seen in Type 2 diabetes?
A. Decreased hepatic glucose release.
B. Excess insulin secretion by the pancreas.
C. Increased glucose uptake in peripheral tissues.
D. Impaired insulin secretion.
Correct Answer: D. Impaired insulin secretion.
3 main abnormalities seen in DM2:
↑hepatic glucose release *c/b a reduction in insulin’s inhibitory effect on liver,
Impaired insulin secretion,
Insufficient glucose uptake in peripheral tissues
Type 2 diabetes is characterized by insulin insensitivity in peripheral tissues. What is the initial response of the pancreas to this insensitivity?
A. Decrease in insulin secretion.
B. Increase in glucagon secretion.
C. Increase in insulin secretion.
D. No change in insulin secretion.
Correct Answer: C. Increase in insulin secretion.
Which of the following molecular abnormalities does NOT directly contribute to insulin resistance in Type 2 Diabetes?
A) Deficient insulin secretion
B) Abnormal insulin molecules
C) Circulating insulin antagonists
D) Insulin receptor defects
Correct Answer: A) Deficient insulin secretion
Rationale: Insulin resistance is characterized by the body’s impaired response to insulin, not necessarily by a deficiency in insulin secretion, which is more characteristic of Type 1 Diabetes. The slide mentions abnormalities in insulin molecules, circulating antagonists, and receptor defects as contributing factors to insulin resistance, but not deficient secretion of insulin itself.
In the context of Type 2 Diabetes, how might an increased level of circulating insulin antagonists exacerbate the condition?
A) By increasing insulin sensitivity
B) By inhibiting insulin secretion
C) By decreasing insulin degradation
D) By competing with insulin for receptor binding
Correct Answer: D) By competing with insulin for receptor binding
Rationale: Circulating insulin antagonists would compete with insulin for binding to its receptor, thereby impeding insulin’s action and worsening insulin resistance. The other options are either beneficial effects or do not relate to the mechanism of action of insulin antagonists.
Which diagnostic test for Type 2 Diabetes provides information about the average blood glucose levels over the past three months?
A) Oral glucose tolerance test
B) Fasting blood glucose test
C) Postprandial blood glucose test
D) Glycated hemoglobin (HbA1c) test
Correct Answer: D) Glycated hemoglobin (HbA1c) test
Rationale: The HbA1c test measures the percentage of glycated hemoglobin in the blood, which reflects average blood glucose levels over approximately three months. The fasting blood glucose test measures glucose at a single point in time after an overnight fast, and the oral glucose tolerance test evaluates the body’s response to a glucose load over a couple of hours.
Which of the following is considered a primary site of insulin resistance in Type 2 Diabetes?
A) Pancreas
B) Heart
C) Skeletal muscle
D) Brain
Correct Answer: C) Skeletal muscle
Rationale: Insulin resistance primarily affects skeletal muscle, adipose tissue, and liver, as these tissues are major sites of glucose uptake and metabolism. The pancreas produces insulin, the heart is not a primary site of insulin action regarding glucose metabolism, and the brain is largely insulin-independent for glucose uptake.
Which glycated hemoglobin (HbA1c) level is indicative of diabetes according to the American Diabetes Association (ADA)?
A) 5.7%
B) 6.0%
C) 6.5%
D) 7.0%
Correct Answer: C) 6.5%
Rationale: An HbA1c level of 6.5% or higher on two separate tests indicates diabetes. Levels of 5.7-6.4% suggest prediabetes, and levels below 5.7% are considered normal.
What is the minimum fasting plasma glucose (FPG) level that, when confirmed on a subsequent day, suggests a diagnosis of diabetes?
A) 100 mg/dL (5.6 mmol/L)
B) 126 mg/dL (7.0 mmol/L)
C) 140 mg/dL (7.8 mmol/L)
D) 200 mg/dL (11.1 mmol/L)
Correct Answer: B) 126 mg/dL (7.0 mmol/L)
Rationale: The ADA specifies that a fasting plasma glucose level of 126 mg/dL (7.0 mmol/L) or higher, fasting defined as no caloric intake for at least 8 hours, suggests diabetes when confirmed on a subsequent day.
What is the required plasma glucose level threshold during an Oral Glucose Tolerance Test (OGTT) that confirms a diabetes diagnosis?
A) 140 mg/dL (7.8 mmol/L) after 2 hours
B) 180 mg/dL (10.0 mmol/L) after 2 hours
C) 200 mg/dL (11.1 mmol/L) after 2 hours
D) 200 mg/dL (11.1 mmol/L) after 1 hour
Correct Answer: C) 200 mg/dL (11.1 mmol/L) after 2 hours
Rationale: A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during an OGTT, with the test being carried out as per the World Health Organization’s protocol, confirms a diabetes diagnosis.
Under which condition might a random plasma glucose test be considered diagnostic for diabetes without requiring a second test for confirmation?
A) HbA1c of 6.0%
B) Presence of diabetes symptoms and a random plasma glucose ≥ 200 mg/dL
C) Fasting plasma glucose of 126 mg/dL
D) Two-hour plasma glucose of 140 mg/dL during an OGTT
Correct Answer: B) Presence of diabetes symptoms and a random plasma glucose ≥ 200 mg/dL
Rationale: The presence of classic symptoms of hyperglycemia or a hyperglycemic crisis, along with a random plasma glucose level of 200 mg/dL or higher, can be used to diagnose diabetes without the need for a second test.
Which laboratory method for HbA1c testing is preferred for diagnosing diabetes?
A) Laboratory method standardized to the International Federation of Clinical Chemistry (IFCC) assay
B) Laboratory method NGSP certified and standardized to the DCCT assay
C) Any laboratory method with an error margin within 10%
D) Laboratory methods that rely on point-of-care testing devices
Correct Answer: B) Laboratory method NGSP certified and standardized to the DCCT assay
Rationale: The ADA recommends that the laboratory method used for measuring HbA1c should be NGSP certified and standardized to the DCCT assay to ensure accuracy in diagnosing diabetes.
Metformin is considered the preferred initial pharmacotherapy for Type 2 Diabetes (DM2) primarily due to its effects on:
A) β-cell regeneration
B) Hepatic glucose production
C) Insulin secretion
D) Peripheral glucose uptake
Correct Answer:
D) Peripheral glucose uptake
Rationale:
Metformin primarily acts by enhancing glucose transport into tissues, improving peripheral insulin sensitivity, and decreasing hepatic glucose production. It does not stimulate insulin secretion nor directly cause β-cell regeneration.
Which of the following is a common side effect associated with sulfonylurea use in DM2 treatment?
A) Osteoporosis
B) Hypoglycemia
C) Hyperkalemia
D) Diarrhea
Correct Answer: B) Hypoglycemia
Rationale: Sulfonylureas increase insulin secretion, which can lead to hypoglycemia. Other side effects include weight gain and potential cardiac effects due to the risk of prolonged hypoglycemia.
Lifestyle interventions in DM2 management aim to improve insulin sensitivity by:
A) Reducing body muscle mass
B) Increasing adipose tissue deposition
C) Reducing hepatic and peripheral insulin resistance
D) Increasing the basal metabolic rate
Correct Answer:C) Reducing hepatic and peripheral insulin resistance
Rationale:
Lifestyle changes such as dietary adjustments and exercise leading to weight loss predominantly work by decreasing body fat, which improves hepatic and peripheral insulin sensitivity, reducing insulin resistance.
The long-term ineffectiveness of sulfonylureas in DM2 management is primarily due to:
A) Tolerance development to the drug
B) Exhaustion of pancreatic β-cell function
C) Receptor desensitization
D) Upregulation of hepatic glucose production
Correct Answer:
B) Exhaustion of pancreatic β-cell function
Rationale:
Sulfonylureas stimulate insulin secretion, which can over time lead to β-cell exhaustion. As the disease progresses and β-cell function declines, sulfonylureas become less effective.
Which additional benefit, aside from its antihyperglycemic effect, is associated with metformin therapy?
A) Increased high-density lipoprotein (HDL) cholesterol
B) Reduction in triglycerides (TGL) and low-density lipoprotein (LDL) cholesterol
C) Weight gain
D) Stimulation of appetite
Correct Answer:
B) Reduction in triglycerides (TGL) and low-density lipoprotein (LDL) cholesterol
Rationale:
Metformin has been shown to decrease levels of triglycerides and LDL cholesterol, which are beneficial cardiovascular effects beyond its glucose-lowering action. It is not typically associated with weight gain or appetite stimulation; in fact, it may aid in weight loss. Dr. David Sinclair’s magic longevity drug.
Which of the following antidiabetic agents has the potential to improve lipid profiles as an added benefit in DM2 treatment?
A. Metformin
B. Sulfonylureas
C. GLP-1 receptor agonists
D. Thiazolidinediones
Correct Answer: D. Thiazolidinediones
Rationale: Thiazolidinediones are known to have an additional benefit of improving lipid profiles, particularly pioglitazone, which can be advantageous for patients with DM2 and coexisting dyslipidemia.
In the context of DM2 treatment, which drug class carries a risk of fluid retention and heart failure?
A. DPP-4 inhibitors
B. GLP-1 receptor agonists
C. Thiazolidinediones
D. SGLT-2 inhibitors
Correct Answer: C. Thiazolidinediones
Rationale: Thiazolidinediones can lead to fluid retention and are associated with an increased risk of heart failure, which is a significant consideration in the management of DM2, especially in patients with a history of heart failure or other cardiovascular risks.
For a patient with DM2 and a high risk of cardiovascular disease (CVD), which medication class may offer cardiovascular benefits beyond glycemic control?
A. Sulfonylureas
B. GLP-1 receptor agonists
C. DPP-4 inhibitors
D. α-glucosidase inhibitors
Correct Answer: B. GLP-1 receptor agonists
Rationale: GLP-1 receptor agonists, such as semaglutide and dulaglutide, have been shown to reduce major adverse cardiovascular events, making them suitable for DM2 patients with high cardiovascular risk.
Which antidiabetic medication is associated with beneficial outcomes in DM2 patients with nephropathy?
A. Sulfonylureas
B. SGLT-2 inhibitors
C. α-glucosidase inhibitors
D. Insulin
Correct Answer: B. SGLT-2 inhibitors
Rationale: SGLT-2 inhibitors have demonstrated renal protective effects, with evidence showing improved renal outcomes in patients with DM2 and nephropathy.
And acute kidney injury as a disadvantage.
Which insulin type is primarily used to manage postprandial blood glucose spikes in DM1 and DM2?
A. Rapid acting
B. Short acting
C. Basal
D. Long acting
Correct Answer: A. Rapid acting
Rationale: Rapid-acting insulins, such as Lispro and Aspart, are designed to control glucose surges after meals, providing fast glucose control at mealtimes.
Chronic exposure to hypoglycemic episodes in DM treatment can lead to a state where the patient:
A. Experiences enhanced perception of hypoglycemia.
B. No longer has autonomic or neuroglycopenic symptoms of hypoglycemia.
C. Is at decreased risk for neuroglycopenia.
D. Develops irreversible neurologic damage.
Correct Answer: B. No longer has autonomic or neuroglycopenic symptoms of hypoglycemia.
Rationale: Repeated hypoglycemic episodes can lead to hypoglycemia unawareness, a condition where the patient becomes desensitized to low blood sugar levels and does not experience the typical warning symptoms, increasing the risk for severe hypoglycemia.
In the event of hypoglycemia with altered consciousness, which route of administration for glucose is appropriate?
A. Oral (PO) only
B. Subcutaneous (SQ) only
C. Intramuscular (IM) or intravenous (IV)
D. Transdermal
Correct Answer: C. Intramuscular (IM) or intravenous (IV)
Rationale: When a patient has altered consciousness due to hypoglycemia, they cannot safely take oral glucose. Therefore, glucose should be administered intramuscularly or intravenously to rapidly increase blood glucose levels. Subcutaneous injection is not used in acute settings due to slower absorption.
What factors can exacerbate the risk of hypoglycemia in patients treated with insulin?
A. Alcohol consumption and use of ACE inhibitors
B. Vigorous exercise and high carbohydrate intake
C. Use of anabolic steroids and thiazide diuretics
D. Supplementation with omega-3 fatty acids and vitamin D
Correct Answer: A. Alcohol consumption and use of ACE inhibitors
Rationale: Alcohol (ETOH) can inhibit gluconeogenesis, and ACE inhibitors can increase insulin sensitivity, both potentially exacerbating the risk of hypoglycemia. The other options are less likely to cause hypoglycemia or may, in fact, be protective against it.
Which insulin has the longest duration of action, potentially providing basal coverage for a full day or longer?
A. Lente
B. Detemir
C. Glargine (U-300)
D. Aspart (NovoLog)
Correct Answer: C. Glargine (U-300)
Rationale: Ultra-long-acting insulins, such as Glargine U-300, have an extended duration of action that can last up to 24 hours or more, providing a steady level of insulin, which is ideal for basal coverage. (note basal technically means intermediate acting)
Considering the pharmacodynamics of rapid-acting insulins, what is the most appropriate timing for administration in relation to meals?
A. 30-60 minutes before meals
B. At the start of meals
C. 15-20 minutes after starting a meal
D. 1-2 hours post-meal
Correct Answer: B. At the start of meals
Rationale: Rapid-acting insulins like aspart and lispro are designed to be taken at mealtime because of their quick onset, matching the body’s immediate insulin needs post ingestion of food. 10-15 min onset, peak 1 hour.
When transitioning from once-daily long-acting insulin to twice-daily intermediate-acting insulin, which characteristic of intermediate-acting insulins must be considered?
A. Their peak action time
B. Their rapid onset of action
C. Their lack of a peak
D. Their short duration of action
Correct Answer: A. Their peak action time
Rationale: Intermediate-acting insulins, such as NPH, have a peak action time where their effect is maximal. When switching from a long-acting insulin that provides a constant level of insulin, this peak must be considered to avoid hypoglycemia.
In the pharmacokinetic profile of insulin, what does the term ‘peak’ refer to?
A. The time it takes for insulin to start working
B. The time it takes for insulin to be completely absorbed
C. The time at which insulin is at the highest concentration in the bloodstream
D. The time at which insulin is no longer effective
Correct Answer: C. The time at which insulin is at the highest concentration in the bloodstream
Rationale: The peak of insulin action refers to the period when the insulin is at its maximum strength in terms of lowering blood glucose. This is an important consideration for timing insulin administration and anticipating potential hypoglycemia.
For a patient requiring a quick reduction of high blood glucose levels, which insulin type would be the most appropriate choice?
A. Intermediate-acting
B. Short-acting
C. Long-acting
D. Rapid-acting
Correct Answer: D. Rapid-acting
Rationale: Rapid-acting insulins, like lispro or aspart, have a quick onset of action, usually within 10-15 minutes, making them ideal for correcting high blood glucose levels shortly after administration.
regular insulin is short acting w/ an onset time of 30 min, peak of 2-4 hr
What is the primary mechanism leading to hypovolemia in diabetic ketoacidosis (DKA)?
A. Insulin-induced hyperhydration
B. Glucagon-mediated renal retention
C. Osmotic diuresis due to hyperglycemia
D. Reduced thirst response
Correct Answer: C. Osmotic diuresis due to hyperglycemia
Rationale: In DKA, the high glucose levels exceed the renal threshold for reabsorption, leading to glucosuria which causes osmotic diuresis, and consequently, hypovolemia.
Which condition is a common precipitating factor for the development of DKA in individuals with DM1?
A. Physical trauma
B. Electrolyte imbalance
C. Infection or illness
D. Overuse of insulin
Correct Answer: C. Infection or illness
Rationale: Infections or illness can increase stress hormone levels, which antagonize insulin action, and may precipitate the onset of DKA, especially in patients with DM1.
The metabolic state in DKA is characterized by increased production of which substances?
A. Glucose and insulin
B. Ketone bodies and bicarbonate
C. Free fatty acids and ketone bodies
D. Glycogen and carbon dioxide
Correct Answer: C. Free fatty acids and ketone bodies
Rationale: DKA involves the excessive production of ketone bodies due to increased lipolysis and free fatty acid metabolism in the liver, driven by insulin deficiency and counterregulatory hormone excess.
In the diagnosis of DKA, which laboratory finding is indicative of an acidotic state?
A. Serum pH greater than 7.45
B. Bicarbonate (HCO₃⁻) levels above 18 mEq/L
C. Serum pH less than 7.3
D. Elevated serum osmolarity
Correct Answer: C. Serum pH less than 7.3
Rationale: A serum pH less than 7.3 reflects an acidotic state, which is a hallmark of DKA due to the accumulation of ketoacids in the bloodstream.
What is the initial pharmacological intervention in the management of diabetic ketoacidosis (DKA)?
A. Oral hypoglycemic agents
B. Subcutaneous long-acting insulin
C. Intravenous short-acting insulin bolus
D. Intravenous bicarbonate infusion
Correct Answer: C. Intravenous short-acting insulin bolus
Rationale: The initial treatment for DKA involves administering an intravenous bolus of short-acting insulin, usually regular insulin, at a dose of 0.1 units/kg, followed by a continuous infusion to lower blood glucose levels in a controlled manner.
Which electrolyte is commonly supplemented during DKA treatment due to losses from osmotic diuresis?
A. Calcium
B. Chloride
C. Potassium
D. Carbonate
Correct Answer: C. Potassium
Rationale: Potassium is often supplemented during the treatment of DKA because insulin therapy promotes the uptake of potassium into cells and the osmotic diuresis associated with hyperglycemia leads to significant potassium losses.
What is the potential risk of rapid glucose correction without addressing changes in serum sodium during DKA treatment?
A. Hyperosmolar hyperglycemic state
B. Hypokalemic hypochloremic alkalosis
C. Hypernatremia
D. Cerebral edema
Correct Answer: D. Cerebral edema
Rationale: Rapid correction of hyperglycemia without the simultaneous correction of sodium can lead to cerebral edema. During treatment, it is crucial to monitor serum glucose and sodium levels and adjust the rate of glucose correction to reduce this risk.
The administration of sodium bicarbonate in the treatment of DKA is primarily aimed at:
A. Enhancing urinary excretion of ketones
B. Correcting metabolic acidosis
C. Increasing blood glucose reabsorption
D. Preventing hyponatremia
Correct Answer: B. Correcting metabolic acidosis
Rationale: Sodium bicarbonate is used in DKA treatment to correct the metabolic acidosis that results from the overproduction and accumulation of ketoacids in the blood.
Hyperglycemic Hyperosmolar Syndrome (HHS) is primarily observed in patients with:
A. Type 1 Diabetes Mellitus under the age of 30
B. Type 2 Diabetes Mellitus over the age of 60
C. Gestational diabetes
D. Cystic fibrosis-related diabetes
Correct Answer: B. Type 2 Diabetes Mellitus over the age of 60
Rationale: HHS typically occurs in older individuals with Type 2 Diabetes Mellitus, evolving gradually over days to weeks, and is characterized by severe hyperglycemia, hyperosmolarity, and dehydration.
Which clinical manifestation is not typically associated with Hyperglycemic Hyperosmolar Syndrome (HHS)?
A. Ketosis and fruity breath odor
B. Tachycardia and hypotension
C. Polyuria and polydipsia
D. Altered mental status and severe dehydration
Correct Answer: A. Ketosis and fruity breath odor
Rationale: Unlike diabetic ketoacidosis (DKA), HHS usually does not involve significant ketosis or the distinctive fruity breath odor caused by ketones, although patients can have some degree of acidosis.
The primary treatment for Hyperglycemic Hyperosmolar Syndrome includes:
A. Aggressive insulin therapy without fluid replacement
B. Oral rehydration therapy and dietary modifications
C. Fluid resuscitation and gradual insulin therapy
D. Immediate correction of hyperglycemia with rapid insulin bolus
C. Fluid resuscitation and gradual insulin therapy
Rationale: The initial management of HHS focuses on fluid replacement to address severe dehydration and hyperosmolarity, followed by gradual insulin administration to correct hyperglycemia, avoiding rapid shifts that may lead to complications such as cerebral edema.
fluid resuscitation, insulin bolus + infusion, e-lytes
What is the significant risk associated with hyperosmolarity in Hyperglycemic Hyperosmolar Syndrome?
A. Hypokalemia
B. Peripheral neuropathy
C. Cerebral edema
D. Coma
D. Coma
What percentage of individuals with Type 1 Diabetes Mellitus (DM1) are at risk of developing end-stage renal disease (ESRD)?
A. 5-10%
B. 15-25%
C. 30-40%
D. 45-50%
Correct Answer: C. 30-40%
Rationale: Diabetic nephropathy, a serious complication of diabetes, can progress to ESRD, with approximately 30-40% of individuals with DM1 being at risk. 5-10% develop ESRD
Which class of medication is indicated to slow the progression of proteinuria and the decline of the glomerular filtration rate (GFR) in diabetic nephropathy?
A. Calcium channel blockers
B. Angiotensin-converting enzyme inhibitors (ACE-I’s)
C. Beta-blockers
D. Diuretics
Correct Answer: B. Angiotensin-converting enzyme inhibitors (ACE-I’s)
Rationale: ACE inhibitors are used to slow the progression of proteinuria and the rate of GFR decline in patients with diabetic nephropathy. They have renoprotective effects that go beyond their ability to lower blood pressure.
What is a potential treatment for end-stage renal disease (ESRD) secondary to diabetic nephropathy?
A. Lifelong dialysis only
B. Hemodialysis (HD) and peritoneal dialysis (PD)
C. Insulin therapy alone
D. Strict glycemic control with diet
Correct Answer: B. Hemodialysis (HD) and peritoneal dialysis (PD)
Rationale: ESRD may be treated with various forms of dialysis, including hemodialysis and peritoneal dialysis, or ultimately with a kidney transplant - can combine w/ pancreas to prevent recurrence. Insulin therapy and strict glycemic control are important but not sufficient as sole treatments for ESRD.
At what threshold of GFR are patients with diabetic nephropathy typically unable to clear potassium effectively, leading to hyperkalemia?
A. GFR > 60 mL/min
B. GFR 30-59 mL/min
C. GFR 15-29 mL/min
D. GFR < 15-20 mL/min
Correct Answer: D. GFR < 15-20 mL/min
Rationale: When the GFR falls below 15-20 mL/min, the kidneys’ ability to excrete potassium is significantly impaired, resulting in hyperkalemia and metabolic acidosis.
Diabetic peripheral neuropathy commonly presents with which of the following symptoms initially?
A. Numbness in the upper extremities
B. Pain and temperature perception changes in the toes/feet
C. Proprioception loss in the hands
D. Motor weakness in the proximal muscle groups
Correct Answer: B. Pain and temperature perception changes in the toes/feet
Rationale: Diabetic peripheral neuropathy typically begins with sensory deficits in the distal extremities, notably the toes and feet, often presenting as changes in pain and temperature perception.
Which therapeutic intervention is considered a cornerstone in the management of diabetic peripheral neuropathy?
A. High-dose vitamin B12 supplementation
B. Optimal glycemic control
C. Corticosteroid injections
D. Continuous opioid analgesia
Correct Answer: B. Optimal glycemic control
Rationale: Optimal glycemic control is essential in the management of diabetic peripheral neuropathy, as it can slow the progression of neuropathy and potentially improve symptoms. Other treatments, such as NSAIDs, antidepressants, and anticonvulsants, can be used to manage pain and discomfort.
In diabetic retinopathy, which of the following changes is a direct consequence of microvascular damage?
A. Retinal detachment
B. Increased permeability and microaneurysm formation
C. Cataract formation
D. Ocular muscle paralysis
Correct Answer: B. Increased permeability and microaneurysm formation
Rationale: Diabetic retinopathy is characterized by microvascular changes that lead to increased permeability, vessel occlusion, and microaneurysms in the retina, directly impacting vision.
The development of ulcers in diabetic peripheral neuropathy is primarily due to:
A. Poorly fitting footwear
B. Unnoticed mechanical and traumatic injuries
C. Frequent hypoglycemic episodes
D. Excessive exercise
Correct Answer: B. Unnoticed mechanical and traumatic injuries
Rationale: Ulcers in diabetic peripheral neuropathy often result from mechanical and traumatic injuries that go unnoticed due to sensory deficits. These ulcers can lead to significant morbidity due to recurrent infections and risk of amputation.
Loss of small nerve fibers decrease pain/temp perception, causing neuropathic pain
Autonomic neuropathy in diabetes may lead to cardiovascular abnormalities such as:
A. Increased heart rate variability
B. Hypertensive urgency
C. Orthostatic hypotension
D. Bradycardia at rest
Correct Answer: C. Orthostatic hypotension
Rationale: Autonomic neuropathy can damage the vasomotor fibers and baroreceptors, leading to ineffective cardiovascular responses such as orthostatic hypotension, where there’s a significant drop in blood pressure upon standing.
One of the main gastrointestinal symptoms of diabetic autonomic neuropathy is:
A. Diarrhea due to increased motility
B. Constipation from reduced intestinal secretions
C. Gastroparesis resulting from decreased gastric motility
D. Increased gastric acid secretion leading to ulcers
Correct Answer: C. Gastroparesis resulting from decreased gastric motility
Rationale: Diabetic autonomic neuropathy can cause a reduction in gastric secretions and motility, often leading to gastroparesis, which is characterized by delayed gastric emptying and associated symptoms like nausea, vomiting, and early satiety.
The therapeutic approach to managing gastrointestinal complications of diabetic autonomic neuropathy includes:
A. Large, less frequent meals
B. Use of prokinetics and large meals
C. Small, frequent meals and prokinetics
D. Complete fasting
Correct Answer: C. Small, frequent meals and prokinetics
Rationale: Treatment of gastroparesis and related symptoms involves improved glucose control, eating small, frequent meals to facilitate gastric emptying, and the use of prokinetic drugs to enhance gastrointestinal motility.
In diabetic patients, why is a preoperative cardiac stress test recommended in the presence of multiple cardiac risk factors and poor exercise tolerance?
A. To evaluate for pulmonary hypertension
B. To assess for the presence of silent myocardial ischemia
C. To determine baseline heart rate variability
D. To evaluate for exercise-induced bronchospasm
Correct Answer: B. To assess for the presence of silent myocardial ischemia
Rationale: Diabetic autonomic neuropathy may blunt the typical symptoms of myocardial ischemia. Therefore, a stress test is indicated to detect any silent ischemic heart disease in diabetic patients, particularly those with additional cardiac risk factors or poor exercise tolerance.
Why is meticulous attention to hydration status critical in diabetic patients undergoing surgery?
A. To prevent hypotension and reduce the risk of cerebral edema
B. To decrease the risk of postoperative infections
C. To avoid nephrotoxins and preserve renal blood flow (RBF)
D. To ensure adequate gastrointestinal motility
Correct Answer: C. To avoid nephrotoxins and preserve renal blood flow (RBF)
Rationale: Diabetic patients are at an increased risk for nephropathy. Adequate hydration helps to preserve renal function by maintaining renal blood flow and avoiding additional renal insults from nephrotoxic agents.
What is a primary reason for the increased risk of perioperative dysrhythmia in diabetic patients with autonomic neuropathy?
A. They are more sensitive to anesthetic agents.
B. There is a reduction in normal heart rate variability.
C. They require higher doses of beta-blockers.
D. They have an inherent predisposition to atrial fibrillation.
Correct Answer: B. There is a reduction in normal heart rate variability.
Rationale: Autonomic neuropathy affects cardiovascular autonomic fibers, leading to decreased heart rate variability, which predisposes patients to perioperative cardiac dysrhythmias and hypotension.
How does gastroparesis in diabetic patients affect anesthetic management?
A. It necessitates the use of prokinetic agents intraoperatively.
B. It decreases the risk of aspiration.
C. It increases the risk of aspiration pneumonia, regardless of nil per os (NPO) status.
D. It requires the administration of higher doses of antiemetics.
Correct Answer: C. It increases the risk of aspiration pneumonia, regardless of nil per os (NPO) status.
Rationale: Gastroparesis can delay gastric emptying, leading to increased gastric contents and volume, which increases the risk of aspiration during anesthesia, regardless of fasting status.
What is the characteristic triad of symptoms for diagnosing insulinoma, commonly known as Whipple’s triad?
A. Hyperglycemia with fasting, glucose >200 w/sx, sx relief with insulin
B. Hypoglycemia with fasting, glucose <50 w/sx, sx relief with glucose
C. Epigastric pain, jaundice, and weight loss
D. Diarrhea, dermatitis, and dementia
Correct Answer: B. Hypoglycemia with fasting, glucose <50 w/sx, sx relief with glucose
Rationale: The Whipple’s triad includes symptoms of hypoglycemia with fasting, documentation of low plasma glucose (<50 mg/dL) with symptoms, and relief of symptoms after administration of glucose, which is indicative of an insulinoma.
In the management of an insulinoma, what is the rationale for using diazoxide preoperatively?
A. To increase insulin secretion and prevent hypoglycemia
B. To inhibit insulin release from beta cells and prevent hypoglycemia
C. To stimulate appetite and prevent weight loss
D. To reduce tumor size before surgery
Correct Answer: B. To inhibit insulin release from beta cells and prevent hypoglycemia
Rationale: Diazoxide is used preoperatively in patients with insulinoma because it inhibits insulin secretion from pancreatic beta cells, helping to prevent hypoglycemia before the tumor can be surgically removed.
What is the most definitive treatment for insulinoma?
A. Chemotherapy
B. Radiation therapy
C. Long-term medication with diazoxide
D. Surgery
Correct Answer: D. Surgery
Rationale: Surgical removal of the insulinoma is curative, as these tumors are typically benign and isolated. Surgery addresses the underlying cause of the hypoglycemia by removing the tumor.
Hypoglycemia can occur intra-op, followed by hyperglycemia once tumor removed. Tight glycemic control is paramount.
What is the primary functional unit within the thyroid gland responsible for thyroid hormone production?
A. Thyroid follicles
B. Parafollicular C cells
C. Parathyroid glands
D. Adrenergic synapses
Correct Answer: A. Thyroid follicles
Rationale: The thyroid follicles, composed of a layer of epithelial cells surrounding a lumen filled with colloid (primarily thyroglobulin), are the fundamental functional units of the thyroid gland where thyroid hormones are synthesized and stored.
Which hormone is secreted by the parafollicular C cells of the thyroid gland?
A. Thyroxine (T4)
B. Triiodothyronine (T3)
C. Parathyroid hormone (PTH)
D. Calcitonin
Correct Answer: D. Calcitonin
Rationale: Parafollicular C cells of the thyroid gland produce calcitonin, a hormone involved in the regulation of calcium and phosphate levels in the blood, counteracting the actions of parathyroid hormone (PTH).
In the context of thyroid surgery, why is the identification and preservation of the recurrent laryngeal nerve of utmost importance?
A. It provides sensory innervation to the thyroid gland.
B. It is responsible for vocal cord movement and protection of the airway.
C. It regulates parathyroid hormone secretion.
D. It controls the sympathetic response of the thyroid gland.
Correct Answer: B. It is responsible for vocal cord movement and protection of the airway.
Rationale: The recurrent laryngeal nerve innervates the intrinsic muscles of the larynx, controlling their movement. Injury to this nerve during thyroid surgery can lead to vocal cord paralysis and compromised airway protection.
external motor branch of superior laryngeal nerve are in close proximity to the thyroid
What enzyme is crucial for the synthesis of thyroid hormones by catalyzing the binding of iodide to thyroglobulin?
A. Thyroid peroxidase
B. Thyroxine-binding globulin
C. Iodinase
D. Tyrosinase
Correct Answer: A. Thyroid peroxidase
Rationale: Thyroid peroxidase (TPO) is the key enzyme in the thyroid hormone synthesis process, which catalyzes the iodination of tyrosine residues on thyroglobulin and the coupling of iodotyrosines to form thyroid hormones T3 and T4.
Which of the following proteins binds the majority of circulating T4 in the bloodstream?
A. Albumin
B. Prealbumin
C. Thyroxine-binding globulin
D. Globulin
Correct Answer: C. Thyroxine-binding globulin
Rationale: Thyroxine-binding globulin (TBG) is the primary carrier protein for thyroid hormones in the blood, binding up to 80% of T4. Prealbumin (transthyretin) and albumin also bind thyroid hormones, but to a lesser extent.
What is the primary role of thyroid hormones in the body?
A. To regulate calcium homeostasis
B. To stimulate red blood cell production
C. To regulate metabolism and stimulate tissue development
D. To modulate fluid balance and electrolyte transport
Correct Answer: C. To regulate metabolism and stimulate tissue development
Rationale: Thyroid hormones play a pivotal role in metabolism, influencing virtually all metabolic processes. They are crucial for growth and development, tissue function, and the metabolism of proteins, carbohydrates, and fats.
Which process is necessary for the conversion of dietary iodine into a form that can be utilized for thyroid hormone synthesis?
A. Oxidation to iodide in the GI tract
B. Methylation in the liver
C. Sulfation in the thyroid gland
D. Phosphorylation in the bloodstream
Correct Answer: A. Oxidation to iodide in the GI tract
Rationale: Dietary iodine is converted into iodide through an oxidation process in the gastrointestinal tract. This iodide is then rapidly absorbed into the bloodstream and transported to the thyroid follicular cells to be used in thyroid hormone synthesis.
What is the significance of the thyroid gland’s large store of hormones and low turnover rate?
A. It enables rapid responses to stress.
B. It provides a buffer against dietary excess of iodine.
C. It allows for immediate secretion of hormones with sympathetic stimulation.
D. It protects against hormone depletion if synthesis is impaired.
Correct Answer: D. It protects against hormone depletion if synthesis is impaired.
Rationale: The thyroid gland’s large store of hormones and low turnover rate provide a reservoir that can maintain normal levels of thyroid hormones in the bloodstream for a period of time even if new hormone synthesis is disrupted, thus protecting against hypothyroidism.
What hormone is responsible for stimulating the release of thyroid-stimulating hormone (TSH) from the anterior pituitary?
A. Thyroid-releasing hormone (TRH)
B. Corticotropin-releasing hormone (CRH)
C. Growth hormone-releasing hormone (GHRH)
D. Gonadotropin-releasing hormone (GnRH)
Correct Answer: A. Thyroid-releasing hormone (TRH)
Rationale: Thyrotropin-releasing hormone (TRH) is secreted by the hypothalamus and stimulates the anterior pituitary to release thyroid-stimulating hormone (TSH), which in turn stimulates the thyroid gland to produce thyroid hormones T3 and T4.
How does the hypothalamic-pituitary-thyroid axis regulate thyroid hormone levels through a feedback system?
A. TSH levels increase in response to high T3 and T4 levels.
B. High T3 and T4 levels stimulate further release of TRH.
C. Low levels of circulating T3 and T4 inhibit TSH release.
D. High levels of T3 and T4 inhibit TSH release.
Correct Answer: D. High levels of T3 and T4 inhibit TSH release.
Rationale: The production of thyroid hormones is regulated by a negative feedback loop. When the levels of T3 and T4 are high, they inhibit the release of TRH from the hypothalamus and TSH from the anterior pituitary, thus reducing thyroid hormone synthesis.
What physiological changes occur in the thyroid gland when TSH levels are decreased?
A. Increased T3 and T4 synthesis and increased vascularization
B. Decreased T3 and T4 synthesis and increased follicular cell size
C. Increased T3 and T4 synthesis and decreased vascularization
D. Decreased T3 and T4 synthesis and decreased follicular cell size
Correct Answer: D. Decreased T3 and T4 synthesis and decreased follicular cell size
Rationale: A decrease in TSH results in decreased synthesis of T3 and T4, as well as reduced follicular cell size and gland vascularization, due to the reduced stimulation of the thyroid gland.
What is the role of thyroid-stimulating hormone (TSH) in the thyroid gland?
A. To reduce the secretion of T3 and T4
B. To bind to receptors on thyroid cell membranes and enhance T3 and T4 secretion
C. To initiate the autoregulatory mechanism of the thyroid gland
D. To directly inhibit the synthesis of thyroglobulin
Correct Answer: B. To bind to receptors on thyroid cell membranes and enhance T3 and T4 secretion
Rationale: TSH binds to specific receptors on the membranes of thyroid cells and stimulates the synthesis and secretion of the thyroid hormones T3 and T4.
What mechanism ensures consistent thyroid hormone levels within the body?
A. Positive feedback control of TSH
B. Thyroid autoregulation
C. Hypothalamic suppression
D. Pituitary inhibition
Correct Answer: B. Thyroid autoregulation
Rationale: The thyroid gland has an autoregulatory mechanism that adjusts the synthesis and release of thyroid hormones to maintain consistent hormone levels, independent of TSH regulation.
What is the primary purpose of the TRH stimulation test?
A. To determine the responsiveness of the thyroid gland to TSH
B. To assess the functional state of the pituitary gland in secreting TSH
C. To measure the level of thyroid hormones in the blood
D. To evaluate the presence of thyroid autoantibodies
Correct Answer: B. To assess the functional state of the pituitary gland in secreting TSH
Rationale: The TRH stimulation test is used to evaluate the function of the pituitary gland by administering thyrotropin-releasing hormone and measuring the subsequent secretion of TSH, thereby assessing the pituitary’s capacity to respond to hypothalamic input.
What is the significance of the normal range of TSH in thyroid function tests?
A. It indicates the maximum allowable TSH concentration in the blood.
B. It suggests the threshold for initiating thyroid hormone replacement therapy.
C. It reflects the sensitivity of the hypothalamic-pituitary-thyroid axis to small changes in thyroid hormone levels.
D. It defines the level at which thyroid hormones inhibit TSH secretion.
Correct Answer: C. It reflects the sensitivity of the hypothalamic-pituitary-thyroid axis to small changes in thyroid hormone levels.
Rationale: The normal range of TSH (0.4-5.0 milliunits/L) reflects the tight regulation of thyroid function by the hypothalamic-pituitary-thyroid axis, where even small changes in thyroid hormone levels can lead to significant changes in TSH secretion
In the context of thyroid testing, what is indicated by a “hot” nodule on a thermal thyroid scan?
A. The nodule is non-functioning.
B. The nodule is cancerous.
C. The nodule is producing an excess of thyroid hormone.
D. The nodule has reduced blood flow.
Correct Answer: C. The nodule is producing an excess of thyroid hormone.
Rationale: In thermal imaging of the thyroid, a “hot” nodule is one that shows increased uptake of the radioactive tracer, indicating “hyperfunctioning” tissue that is producing an excess of thyroid hormone.
warm is normal functioning
What is the utility of ultrasonography (US) in the evaluation of thyroid lesions?
A. To identify the specific type of thyroid cancer
B. To determine the biochemical activity of a thyroid nodule
C. To determine whether a thyroid lesion is cystic, solid, or mixed in composition
D. To measure the concentration of thyroid hormones within a nodule
Correct Answer: C. To determine whether a thyroid lesion is cystic, solid, or mixed in composition
Rationale: Ultrasonography is highly accurate (90-95%) in differentiating the physical composition of thyroid lesions, which is critical for determining the nature of the lesion and guiding further diagnostic or therapeutic steps.
Which of the following conditions is a common cause of hyperthyroidism?
A. Hashimoto’s thyroiditis
B. Graves’ disease
C. Thyroid lymphoma
D. De Quervain’s thyroiditis
Correct Answer: B. Graves’ disease
Rationale: Graves’ disease is an autoimmune disorder and one of the most common causes of hyperthyroidism, characterized by the overproduction of thyroid hormones.
major diseases: Graves disease
toxic multinodular goiter
toxic adenoma
What are the clinical manifestations of hyperthyroidism associated with its effect on metabolism?
A. Bradycardia and cold intolerance
B. Hypotension and hypoactivity
C. Sweating, heat intolerance, and fatigue
D. Weight gain and reduced appetite
Correct Answer: C. Sweating, heat intolerance, and fatigue
Rationale: The symptoms of hyperthyroidism, such as sweating, heat intolerance, and fatigue, are due to the hypermetabolic state induced by excessive thyroid hormones.
How does triiodothyronine (T3) affect the cardiovascular system in hyperthyroidism?
A. Decreases heart rate and myocardial contractility
B. Increases systemic vascular resistance
C. Acts directly on the myocardium and peripheral vasculature to cause cardiovascular responses
D. Slows down the conduction of electrical impulses in the heart
Correct Answer: C. Acts directly on the myocardium and peripheral vasculature to cause cardiovascular responses
Rationale: T3 has a direct effect on the myocardium and peripheral vasculature, leading to increased heart rate, contractility, and vasodilation, contributing to the cardiovascular manifestations of hyperthyroidism such as tachycardia and palpitations.
Which neurologic symptom is typical in a hyperthyroid patient?
A. Hypoactive deep tendon reflexes
B. Fine tremor of hands
C. Paresthesia
D. Generalized seizures
Correct Answer: B. Fine tremor of hands
Rationale: Fine tremor of the hands is a common neurologic manifestation of hyperthyroidism, often associated with the hypermetabolic state that accelerates various physiologic processes.
In the context of hyperthyroidism, what does a “hyperdynamic” cardiac state imply?
A. Decreased heart rate and myocardial contractility
B. Reduction in cardiac output
C. Increased heart rate and enhanced contractility
D. Myocardial hypertrophy and bradycardia
Correct Answer: C. Increased heart rate and enhanced contractility
Rationale: A hyperdynamic cardiac state in hyperthyroidism refers to increased heart rate (tachycardia) and myocardial contractility, which leads to increased cardiac output.
What gastrointestinal symptom is frequently observed in hyperthyroidism?
A. Constipation
B. Frequent bowel movements or diarrhea
C. Gastroesophageal reflux
D. Peptic ulcer disease
Correct Answer: B. Frequent bowel movements or diarrhea
Rationale: Hyperthyroidism often causes an increase in gastrointestinal motility, resulting in symptoms such as frequent bowel movements or diarrhea.
What psychological symptom may be present in a patient with hyperthyroidism?
A. Lethargy
B. Emotional stability
C. Emotionally unstable
D. Depression
Correct Answer: C. Emotionally unstable
Rationale: Hyperthyroidism can cause various psychological symptoms, including emotional instability, anxiety, and mood swings.
Graves’ disease is most commonly diagnosed in which population?
A. Males, 50-60 years old
B. Females, 20-40 years old
C. Children under 15 years old
D. Postmenopausal women
Correct Answer: B. Females, 20-40 years old
Rationale: Graves’ disease typically occurs in females, with a female-to-male ratio of about 7:1, and most commonly presents in individuals between 20-40 years of age.
What is the characteristic antibody associated with the diagnosis of Graves’ disease?
A. Antinuclear antibody (ANA)
B. Rheumatoid factor (RF)
C. Thyroid-stimulating hormone receptor antibody (TSHR-Ab)
D. Anti-thyroid peroxidase antibody (anti-TPO)
Correct Answer: C. Thyroid-stimulating hormone receptor antibody (TSHR-Ab)
Rationale: Graves’ disease is characterized by the presence of thyroid-stimulating antibodies that bind to and activate the TSH receptors, leading to thyroid growth, increased vascularity, and hypersecretion of thyroid hormones.
Which symptom is a hallmark of ophthalmopathy associated with Graves’ disease?
A. Cataracts
B. Glaucoma
C. Exophthalmos
D. Macular degeneration
C. Exophthalmos
Rationale: Ophthalmopathy associated with Graves’ disease often manifests as exophthalmos, which is the protrusion of the eyeballs. This can occur in approximately 30% of cases and is due to inflammation and edema in the orbital tissues.
