Endocrinology (diabetes, thyroid disorders)

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 1: A 62-year-old man presents to the emergency department with confusion. The patient’s wife states that her husband has become more somnolent over the past several days and now is very confused. The patient has no complaints himself, but is answering questions inappropriately. The patient has a past medical history of diabetes and hypertension. His temperature is 98.3°F (36.8°C), blood pressure is 127/85 mmHg, pulse is 138/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused man with dry mucous membranes. Initial laboratory studies are ordered as seen below. Serum: Na+: 135 mEq/L Cl-: 100 mEq/L K+: 3.0 mEq/L HCO3-: 23 mEq/L BUN: 30 mg/dL Glucose: 1,299 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most appropriate initial treatment for this patient?

• A. Insulin, normal saline, and potassium (Correct Answer)
• B. Normal saline and potassium
• C. Insulin and potassium
• D. Insulin
• E. Insulin and normal saline

Endocrinology (diabetes, thyroid disorders) Explanation: ***Insulin, normal saline, and potassium*** - This patient is presenting with **hyperosmolar hyperglycemic state (HHS)**, characterized by severe hyperglycemia (glucose 1299 mg/dL), dehydration (dry mucous membranes, high BUN and creatinine), and altered mental status. The initial treatment involves intravenous fluids to correct dehydration, insulin to lower blood glucose, and potassium supplementation due to potential shifts as insulin is administered. - **Normal saline** addresses the severe dehydration, **insulin** corrects hyperglycemia, and **potassium supplementation** prevents hypokalemia, which is common during HHS treatment as glucose and potassium shift intracellularly. *Normal saline and potassium* - While **normal saline** and **potassium** are crucial for rehydration and electrolyte balance, omitting **insulin** would fail to address the core problem of severe hyperglycemia in HHS. - Without insulin, blood glucose levels will remain dangerously high, leading to persistent osmotic diuresis and worsening dehydration. *Insulin and potassium* - Administering **insulin** without addressing the profound **dehydration** with intravenous fluids can lead to **hypovolemic shock** as insulin further drives glucose and water into cells. - Rehydration is the priority in HHS management before or concurrent with insulin administration. *Insulin* - Giving only **insulin** would be detrimental, as the patient is severely dehydrated and hypokalemic (K+ 3.0 mEq/L, and will drop further with insulin). - This approach would exacerbate dehydration and could cause life-threatening arrhythmias due to severe hypokalemia. *Insulin and normal saline* - While addressing hyperglycemia and dehydration, omitting **potassium supplementation** is dangerous because insulin drives potassium into cells, potentially causing severe **hypokalemia** and cardiac arrhythmias. - The patient already has a low-normal potassium level, which will likely drop further with insulin treatment.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 2: A 19-year-old man with a history of type 1 diabetes presents to the emergency department for the evaluation of a blood glucose level of 492 mg/dL. Laboratory examination revealed a serum bicarbonate level of 13 mEq/L, serum sodium level of 122 mEq/L, and ketonuria. Arterial blood gas demonstrated a pH of 6.9. He is admitted to the hospital and given bicarbonate and then started on an insulin drip and intravenous fluid. Seven hours later when his nurse is making rounds, he is confused and complaining of a severe headache. Repeat sodium levels are unchanged, although his glucose level has improved. His vital signs include a temperature of 36.6°C (98.0°F), pulse 50/min, respiratory rate 13/min and irregular, and blood pressure 177/95 mm Hg. What other examination findings would be expected in this patient?

• A. Hypoglycemia
• B. Pupillary constriction
• C. Papilledema (Correct Answer)
• D. Pancreatitis
• E. Peripheral edema

Endocrinology (diabetes, thyroid disorders) Explanation: ***Papilledema*** - This patient's symptoms (confusion, severe headache, bradycardia, irregular respiration, hypertension) following treatment for **diabetic ketoacidosis (DKA)** are highly suggestive of **cerebral edema**. - **Papilledema** is a retinal finding resulting from increased intracranial pressure (ICP), which is a characteristic sign of cerebral edema. *Hypoglycemia* - While the patient's glucose level has improved, it is not described as being low enough to cause hypoglycemia, and the symptoms are more consistent with **increased ICP**. - Symptoms of hypoglycemia (e.g., tremors, sweating, hunger, anxiety) are different from the patient's current presentation of confusion and severe headache. *Pupillary constriction* - **Pupillary constriction** (miosis) is typically not associated with cerebral edema; instead, **pupillary dilation** (mydriasis) can occur with severe increase in ICP due to uncal herniation. - The combination of bradycardia, irregular respiration, and hypertension (Cushing's triad) is indicative of increased ICP, which would likely cause pupillary changes related to brainstem compression. *Pancreatitis* - Pancreatitis is a known complication of DKA, but it typically presents with **severe abdominal pain**, nausea, and vomiting, rather than cerebral symptoms. - Although the patient had DKA, the current neurological symptoms point directly to an intracranial process rather than an abdominal issue. *Peripheral edema* - **Peripheral edema** results from fluid accumulation in peripheral tissues and is not a direct consequence or expected finding in cerebral edema. - While fluid administration can cause some peripheral fluid retention, it typically does not lead to the acute neurological deterioration seen in this patient.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 3: A 45-year-old woman comes to the emergency department with recurrent episodes of shaking, sweating, and palpitations. The patient is confused and complains of hunger. One week ago, she had similar symptoms that improved after eating. She has hypertension and a history of biliary pancreatitis. She underwent cholecystectomy 1 year ago. She works as a nurse aide in a nursing care facility. She does not smoke or drink alcohol. She does not exercise. Her temperature is 36.7°C (98°F), pulse is 104/min, respirations are 20/min, and blood pressure is 135/88 mm Hg. Examination shows tremors and diaphoresis. Laboratory studies show: Blood glucose 50 mg/dL Thyroid-stimulating hormone 1 mU/L C-peptide 0.50 ng/mL (N=0.8–3.1) Abdominal ultrasound reveals a 1-cm anechoic lesion in the head of the pancreas. Which of the following is the most likely cause of this patient's symptoms?

• A. Pancreatic neoplasm
• B. Pancreatic pseudocyst
• C. Graves' disease
• D. Surreptitious insulin use (Correct Answer)
• E. Type 1 diabetes mellitus

Endocrinology (diabetes, thyroid disorders) Explanation: ***Surreptitious insulin use*** - The patient's symptoms of **hypoglycemia** (shaking, sweating, palpitations, confusion, hunger) combined with a **low C-peptide level** (0.50 ng/mL) and a normal TSH strongly suggest **exogenous insulin administration**. - As a nurse aide, she has access to insulin, and the normal pancreatic ultrasound (1 cm anechoic lesion is non-specific and unlikely to cause these symptoms) rules out an **insulinoma**, which would present with high C-peptide. *Pancreatic neoplasm* - While a pancreatic neoplasm can cause various symptoms, an **insulinoma** (a type of pancreatic neuroendocrine tumor) would present with **hypoglycemia** but typically with **elevated C-peptide levels**, as it produces endogenous insulin. - The ultrasound finding of a 1-cm anechoic lesion is **non-specific** and not definitively indicative of an insulinoma or any other functional neoplasm causing these specific symptoms. *Pancreatic pseudocyst* - Pancreatic pseudocysts are collections of fluid that can occur after **pancreatitis** or trauma, and while this patient has a history of biliary pancreatitis, pseudocysts generally cause symptoms like **abdominal pain, distension, and early satiety**, not hypoglycemia. - They also do not explain the **low C-peptide** and recurrent episodes of neuroglycopenic symptoms. *Graves' disease* - Graves' disease is an **autoimmune hyperthyroid condition** that causes symptoms like palpitations, sweating, and tremors, but it is characterized by **low TSH** with elevated free T3/T4 due to negative feedback, not hypoglycemia or low C-peptide. - The patient's **normal TSH** (1 mU/L) rules out Graves' disease as the cause of her current symptoms. *Type 1 diabetes mellitus* - Type 1 diabetes is characterized by **insulin deficiency** due to autoimmune destruction of pancreatic beta cells, leading to **hyperglycemia**, not hypoglycemia. - While patients with type 1 diabetes may experience hypoglycemia if they administer too much insulin, the underlying disease itself causes high blood glucose, and the C-peptide would be very low or undetectable in a new diagnosis, but not as the cause of recurrent spontaneous hypoglycemia.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 4: A 49-year-old woman presents to the office because of tremors for 2 months. She says that her hands have been shaking a lot, especially when she feels stressed. In addition, she has been sweating more than usual and has lost 8 kg (17.6 lb) in the last 2 months. She has a past medical history of vitiligo. Her vital signs are a heart rate of 98/min, a respiratory rate of 14/min, a temperature of 37.6°C (99.7°F), and a blood pressure of 115/75 mm Hg. Physical examination shows a fine, bilateral hand tremor and a diffuse goiter. Which of the following hormonal imbalances is most likely present?

• A. Low TSH, high free T4, and high free T3 (Correct Answer)
• B. High TSH, high free T4, and high free T3
• C. High TSH, normal free T4, and normal free T3
• D. Low TSH, normal free T4, and normal free T3
• E. High TSH, low free T4, and low free T3

Endocrinology (diabetes, thyroid disorders) Explanation: ***Low TSH, high free T4, and high free T3*** - The patient's symptoms (tremors, sweating, weight loss, tachycardia, goiter) are classic for **hyperthyroidism**, which is typically characterized by **low TSH** due to negative feedback and **elevated free T4 and T3** levels. - Her history of **vitiligo**, an autoimmune condition, further supports an autoimmune thyroid disorder like **Graves' disease**, a common cause of hyperthyroidism. *High TSH, high free T4, and high free T3* - This pattern would indicate **secondary hyperthyroidism**, caused by a TSH-secreting pituitary adenoma. - While TSH would be high, it is a much rarer cause of hyperthyroidism compared to primary causes. *High TSH, normal free T4, and normal free T3* - This hormonal profile is characteristic of **subclinical hypothyroidism** or a **compensated primary hypothyroidism** early in its course. - The patient's symptoms are inconsistent with hypothyroidism. *Low TSH, normal free T4, and normal free T3* - This suggests **subclinical hyperthyroidism**, where TSH is suppressed but thyroid hormone levels are still within the normal range. - The patient's prominent and severe symptoms (tremors, significant weight loss, goiter) indicate overt hyperthyroidism, not subclinical disease. *High TSH, low free T4, and low free T3* - This is the classic hormonal profile for **primary hypothyroidism**, where the thyroid gland is failing to produce sufficient hormones, leading to elevated TSH. - The patient's symptoms of nervousness, weight loss, and tremors are directly opposite to those seen in hypothyroidism.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 5: A 40-year-old woman visits her physician’s office with her husband. Her husband says that she has been complaining of recurring headaches over the past few months. A year ago she was diagnosed with diabetes and is currently on treatment for it. About 6 months ago, she was diagnosed with high blood pressure and is also taking medication for it. Her husband is concerned about the short span during which she has been getting all these symptoms. He also says that she occasionally complains of changes and blurring in her vision. In addition to all these complaints, he has observed changes in her appearance, more prominently her face. Her forehead and chin seem to be protruding more than usual. Suspecting a hormonal imbalance, which of the following initial tests would the physician order to indicate a possible diagnosis?

• A. Chest X-ray
• B. Pituitary magnetic resonance image (MRI)
• C. Serum growth hormone
• D. Glucose suppression test
• E. Serum insulin-like growth factor-1 (IGF-1) (Correct Answer)

Endocrinology (diabetes, thyroid disorders) Explanation: ***Serum insulin-like growth factor-1 (IGF-1)*** - Elevated **serum IGF-1 levels** are the most sensitive and reliable initial screening test for **acromegaly**, reflecting sustained growth hormone excess. - The clinical presentation with **new-onset diabetes**, **hypertension**, **headaches**, **visual changes**, and **facial prognathism** strongly suggests acromegaly, a condition caused by excessive growth hormone (GH) secretion. *Chest X-ray* - A chest X-ray is primarily used to evaluate **pulmonary or cardiac conditions** and would not directly screen for hormonal imbalances like acromegaly. - While acromegaly can lead to **cardiomegaly** or **sleep apnea**, a chest X-ray is not the initial diagnostic test for growth hormone excess itself. *Pituitary magnetic resonance image (MRI)* - A **pituitary MRI** is the imaging study of choice to confirm the presence of a **pituitary adenoma** after biochemical confirmation of acromegaly, not an initial screening test. - It visualizes the pituitary gland and helps locate the tumor but is ordered *after* biochemical tests indicate GH excess. *Serum growth hormone* - A single random **serum growth hormone (GH) level** can be misleading because GH secretion is pulsatile, making a single measurement unreliable for diagnosing acromegaly. - While acromegaly involves elevated GH, a random sample is not the optimal initial diagnostic test due to its **fluctuating levels**. *Glucose suppression test* - The **oral glucose tolerance test (OGTT)** with GH measurement is the confirmatory test for acromegaly, used to demonstrate **failure of GH suppression** after glucose load. - This is a diagnostic procedure performed *after* an elevated IGF-1 level suggests acromegaly, not an initial screening test.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 6: A 51-year-old woman comes to the physician because of a 6-month history of fatigue and increased thirst. She has no history of serious medical illness and takes no medications. She is 163 cm (5 ft 4 in) tall and weighs 72 kg (160 lb); BMI is 28 kg/m2. Her fasting serum glucose concentration is 249 mg/dL. Treatment with an oral hypoglycemic agent is begun. Which of the following best describes the mechanism of action of the drug that was most likely prescribed for this patient?

• A. Decreased carbohydrate hydrolysis
• B. Increased insulin release
• C. Decreased hepatic gluconeogenesis (Correct Answer)
• D. Decreased glucagon release
• E. Increased renal glucose elimination

Endocrinology (diabetes, thyroid disorders) Explanation: ***Decreased hepatic gluconeogenesis*** - The patient presents with symptoms of **diabetes mellitus** (fatigue, increased thirst, and a fasting glucose of 249 mg/dL). Given her BMI of 28 kg/m2, **Type 2 Diabetes** is highly likely, and the initial treatment for such patients, especially those not excessively obese, is often **metformin**. - **Metformin** works primarily by inhibiting **hepatic gluconeogenesis** and, to a lesser extent, by increasing insulin sensitivity in peripheral tissues. *Increased insulin release* - This mechanism is characteristic of **sulfonylureas** (e.g., glipizide, glyburide) and **meglitinides** (e.g., repaglinide), which stimulate insulin secretion from pancreatic beta cells. - While these can be used in Type 2 Diabetes, they are typically not the first-line oral hypoglycemic agent due to the risk of **hypoglycemia** and weight gain, making metformin a more likely initial choice. *Decreased carbohydrate hydrolysis* - This mechanism is associated with **alpha-glucosidase inhibitors** (e.g., acarbose, miglitol), which delay the breakdown and absorption of carbohydrates in the gut. - These drugs are less commonly prescribed as initial monotherapy for Type 2 Diabetes due to side effects like **flatulence** and diarrhea, and their moderate efficacy. *Decreased glucagon release* - Although reducing glucagon release is beneficial in diabetes, this is the primary mechanism of action for drugs like **GLP-1 receptor agonists** (e.g., exenatide, liraglutide) and **DPP-4 inhibitors** (e.g., sitagliptin, saxagliptin), which also affect insulin secretion and gastric emptying. - These are often considered second-line agents or used in combination therapy, not typically the first oral medication prescribed. *Increased renal glucose elimination* - This is the mechanism of action for **SGLT2 inhibitors** (e.g., dapagliflozin, empagliflozin), which block glucose reabsorption in the renal tubules, leading to increased urinary glucose excretion. - While effective, SGLT2 inhibitors are often not the very first oral medication chosen, especially given metformin's long-standing role as a first-line agent.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 7: Researchers are experimenting with hormone levels in mice in fasting and fed states. To test hormone levels in the fed state, the mice are given an oral glucose load and various hormones are measured in a blood sample. Researchers are most interested in the hormone whose blood levels track evenly with C-peptide levels. The hormone the researchers are most interested in is responsible for which of the following actions in the body?

• A. Protein catabolism
• B. Fatty acid breakdown
• C. Fatty acid synthesis (Correct Answer)
• D. Ketogenesis
• E. Lipolysis

Endocrinology (diabetes, thyroid disorders) Explanation: ***Fatty acid synthesis*** - The hormone whose blood levels track evenly with **C-peptide** levels after a glucose load is **insulin**. - Insulin is a key anabolic hormone that promotes **fatty acid synthesis** from excess glucose in the fed state, particularly in the liver and adipose tissue. *Protein catabolism* - **Insulin** is an anabolic hormone that generally **inhibits protein catabolism** and promotes protein synthesis. - Conditions like **glucagon excess** or **cortisol excess** promote protein catabolism, not insulin. *Fatty acid breakdown* - **Insulin inhibits fatty acid breakdown** (beta-oxidation) by suppressing hormone-sensitive lipase. - **Glucagon** and **epinephrine** promote fatty acid breakdown, especially during fasting. *Ketogenesis* - **Insulin inhibits ketogenesis** by reducing the supply of fatty acids to the liver and inhibiting the enzymes involved in ketone body formation. - **Glucagon** and **low insulin levels** (as in uncontrolled diabetes or prolonged fasting) promote ketogenesis. *Lipolysis* - **Insulin is a potent inhibitor of lipolysis** (breakdown of triglycerides into fatty acids and glycerol) in adipose tissue. - **Glucagon**, **catecholamines**, and **growth hormone** stimulate lipolysis.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 8: An 8-year old boy is brought to the emergency department because he has been lethargic and has had several episodes of nausea and vomiting for the past day. He has also had increased thirst over the past two months. He has lost 5.4 kg (11.9 lbs) during this time. He is otherwise healthy and has no history of serious illness. His temperature is 37.5 °C (99.5 °F), blood pressure is 95/68 mm Hg, pulse is 110/min, and respirations are 30/min. He is somnolent and slightly confused. His mucous membranes are dry. Laboratory studies show: Hemoglobin 16.2 g/dL Leukocyte count 9,500/mm3 Platelet count 380,000/mm3 Serum Na+ 130 mEq/L K+ 5.5 mEq/L Cl- 99 mEq/L HCO3- 16 mEq/L Creatinine 1.2 mg/dL Glucose 570 mg/dL Ketones positive Blood gases, arterial pH 7.25 pCO2 21 mm Hg Which of the following is the most appropriate next step in management?

• A. Intravenous hydration with 0.45% normal saline and insulin
• B. Intravenous hydration with 5% dextrose solution and 0.45% normal saline
• C. Intravenous sodium bicarbonate
• D. Intravenous hydration with 0.9% normal saline and insulin (Correct Answer)
• E. Intravenous hydration with 0.9% normal saline and potassium chloride

Endocrinology (diabetes, thyroid disorders) Explanation: ***Intravenous hydration with 0.9% normal saline and insulin*** - This patient presents with **diabetic ketoacidosis (DKA)**, characterized by hyperglycemia (glucose 570 mg/dL), metabolic acidosis (pH 7.25, HCO3- 16 mEq/L, ketones positive), and dehydration (dry mucous membranes, increased thirst, weight loss). - Initial management of DKA involves aggressive **volume expansion** with **0.9% normal saline** to restore perfusion and reduce hyperglycemia; subsequently, **insulin infusion** is started to correct hyperglycemia and halt ketogenesis. *Intravenous hydration with 0.45% normal saline and insulin* - While insulin is crucial, **0.45% normal saline (hypotonic saline)** is generally not the initial fluid of choice for DKA due to the risk of exacerbating cerebral edema, especially in children. - **Isotonic saline (0.9% normal saline)** is preferred for initial resuscitation to rapidly restore extracellular fluid volume. *Intravenous hydration with 5% dextrose solution and 0.45% normal saline* - **5% dextrose solution** should only be added to intravenous fluids when the blood glucose level falls to around 200-250 mg/dL, to prevent hypoglycemia while continuing insulin to resolve ketosis. - Administering dextrose initially would worsen the existing severe hyperglycemia. *Intravenous sodium bicarbonate* - **Sodium bicarbonate** is generally not recommended for mild to moderate DKA due to potential risks like cerebral edema and metabolic alkalosis, and potential paradoxical worsening of CNS acidosis. - Bicarbonate therapy is reserved for **severe acidosis (pH < 6.9 or 7.0)** with hemodynamic instability or impaired cardiac contractility, which is not the case here. *Intravenous hydration with 0.9% normal saline and potassium chloride* - While **0.9% normal saline** is appropriate, this option lacks **insulin therapy**, which is essential for treating DKA by halting ketogenesis and correcting hyperglycemia. - Although potassium supplementation will be necessary during DKA treatment (as insulin drives K+ into cells and can cause hypokalemia), the most appropriate **next step** is to initiate both fluid resuscitation and insulin therapy together. - The patient's current potassium level of 5.5 mEq/L is at the upper limit of normal, but reflects total body potassium depletion; potassium should be added to maintenance fluids once adequate urine output is established.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 9: A 47-year-old woman presents to her primary care physician because of pain on urination, urinary urgency, and urinary frequency for 4 days. This is the third time for her to have these symptoms over the past 7 months. She was recently treated for candidal intertrigo. Vital signs reveal a temperature of 36.7°C (98.0°F), blood pressure of 110/70 mm Hg and pulse of 75/min. Physical examination is unremarkable except for morbid obesity. Her father has type 2 diabetes complicated by end-stage chronic kidney disease. A1C is found to be 8.5%. The patient is given a prescription for her urinary symptoms. Which of the following is the best next step for this patient?

• A. Sulphonylurea added to metformin
• B. Bariatric surgery
• C. Repeating the A1c test
• D. Basal-bolus insulin
• E. Metformin (Correct Answer)

Endocrinology (diabetes, thyroid disorders) Explanation: ***Metformin*** - The patient has symptoms suggestive of **uncontrolled type 2 diabetes**, including recurrent infections (urinary, intertrigo) and a familial history, despite an A1C of 8.5%. - **Metformin** is typically the first-line pharmacologic treatment for type 2 diabetes unless contraindicated, as it improves insulin sensitivity and reduces hepatic glucose production. *Sulphonylurea added to metformin* - While adding a sulfonylurea to metformin is an option for patients not reaching glycemic targets on metformin alone, **monotherapy with metformin** is the initial step for newly diagnosed or uncontrolled diabetes. - Sulfonylureas carry a higher risk of **hypoglycemia** compared to metformin and are generally added if metformin monotherapy is insufficient. *Bariatric surgery* - Bariatric surgery is a treatment option for **morbidly obese** individuals with type 2 diabetes, but it is typically considered after lifestyle modifications and pharmacotherapy have been attempted or when the BMI is very high (e.g., >40 or >35 with comorbidities). - It is not the immediate next step for managing newly diagnosed or uncontrolled diabetes, especially when first-line medications haven't been initiated. *Repeating the A1c test* - The elevated **A1C of 8.5%**, combined with classic symptoms of hyperglycemia (recurrent infections, polyuria from urinary symptoms), is sufficient for a diagnosis of diabetes. - Repeating the test immediately is unlikely to change the diagnosis and would delay necessary treatment initiation. *Basal-bolus insulin* - Basal-bolus insulin regimens are typically reserved for patients with very **high A1C levels** (e.g., >10%), significant symptoms of hyperglycemia, or those who have failed multiple oral hypoglycemic agents. - Given an A1C of 8.5%, initiating insulin is usually not the first pharmacologic step; metformin monotherapy is preferred.

Endocrinology (diabetes, thyroid disorders) US Medical PG Question 10: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Endocrinology (diabetes, thyroid disorders) Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Endocrinology (diabetes, thyroid disorders) Flashcard 1 of 10

Question: Type _____ diabetes mellitus is characterized by insulin deficiency

Answer: 1

Endocrinology (diabetes, thyroid disorders) Flashcard 2 of 10

Question: What is the treatment for hyperosmolar hyperglycemic non-ketotic syndrome? _____

Answer: Intense IV fluids and insulin therapy

Endocrinology (diabetes, thyroid disorders) Flashcard 3 of 10

Question: Which thyroid imbalance presents with decreased heat production (cold intolerance) and decreased sweating?_____

Answer: hypothyroidism

Endocrinology (diabetes, thyroid disorders) Flashcard 4 of 10

Question: One of the most feared complications of type 1 diabetes is _____

Answer: diabetic ketoacidosis

Endocrinology (diabetes, thyroid disorders) Flashcard 5 of 10

Question: Which form of diabetes mellitus is characterized by weight loss?_____

Answer: Type 1 Diabetes

Endocrinology (diabetes, thyroid disorders) Flashcard 6 of 10

Question: Which thyroid imbalance presents with decreased TSH (if 1*) and increased free T3 / T4?_____

Answer: Hyperthyroidism

Endocrinology (diabetes, thyroid disorders) Flashcard 7 of 10

Question: In patients with hypertension and what comorbidity should ACE inhibitors / ARBs become first line?_____

Answer: Hypertension with Diabetes Mellitus

Endocrinology (diabetes, thyroid disorders) Flashcard 8 of 10

Question: Kallmann syndrome

Answer: defective migration of GnRH cells

Extra Information: anosmia, lack of secondary sex characteristicsdecreased: GnRH, FSH, LH, testosterone, sperm count

Endocrinology (diabetes, thyroid disorders) Flashcard 9 of 10

Question: hypogonadotropic hypogonadism

Answer:

Extra Information:  decreased: LH, testosterone 

Endocrinology (diabetes, thyroid disorders) Flashcard 10 of 10

Question: primary hypogonadism

Answer:

Extra Information: increased: LH decreased: testosterone