Endocrinology (diabetes, thyroid disorders) Practice Questions

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?

Accepted Answer

Insulin, normal saline, and potassium

Answer

Normal saline and potassium

Answer

Insulin and potassium

Answer

Insulin

Answer

Insulin and normal saline

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?

Accepted Answer

Papilledema

Answer

Hypoglycemia

Answer

Pupillary constriction

Answer

Pancreatitis

Answer

Peripheral edema

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?

Accepted Answer

Surreptitious insulin use

Answer

Pancreatic neoplasm

Answer

Pancreatic pseudocyst

Answer

Graves' disease

Answer

Type 1 diabetes mellitus

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?

Accepted Answer

Low TSH, high free T4, and high free T3

Answer

High TSH, high free T4, and high free T3

Answer

High TSH, normal free T4, and normal free T3

Answer

Low TSH, normal free T4, and normal free T3

Answer

High TSH, low free T4, and low free T3

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?

Accepted Answer

Serum insulin-like growth factor-1 (IGF-1)

Answer

Chest X-ray

Answer

Pituitary magnetic resonance image (MRI)

Answer

Serum growth hormone

Answer

Glucose suppression test

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?

Accepted Answer

Decreased hepatic gluconeogenesis

Answer

Decreased carbohydrate hydrolysis

Answer

Increased insulin release

Answer

Decreased glucagon release

Answer

Increased renal glucose elimination

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?

Accepted Answer

Fatty acid synthesis

Answer

Protein catabolism

Answer

Fatty acid breakdown

Answer

Ketogenesis

Answer

Lipolysis

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?

Accepted Answer

Intravenous hydration with 0.9% normal saline and insulin

Answer

Intravenous hydration with 0.45% normal saline and insulin

Answer

Intravenous hydration with 5% dextrose solution and 0.45% normal saline

Answer

Intravenous sodium bicarbonate

Answer

Intravenous hydration with 0.9% normal saline and potassium chloride

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?

Accepted Answer

Metformin

Answer

Sulphonylurea added to metformin

Answer

Bariatric surgery

Answer

Repeating the A1c test

Answer

Basal-bolus insulin

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?

Accepted Answer

"Can you tell me more about the symptoms you have been experiencing?"

Answer

"Does the diarrhea typically precede the constipation, or vice-versa?"

Answer

"Is the diarrhea foul-smelling?"

Answer

"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"

Answer

"Are the symptoms worse in the morning or at night?"

Endocrinology (diabetes, thyroid disorders)

Study Resources

Lessons

Questions

Flashcards

Lessons

Type 1 diabetes mellitus

Type 2 diabetes mellitus

Diabetic ketoacidosis

Hyperosmolar hyperglycemic state

Diabetes complications and screening

Insulin and oral antidiabetic agents

Thyroid function testing

Hypothyroidism

Hyperthyroidism and thyroiditis

Thyroid nodules and cancer

Adrenal disorders

Pituitary disorders

Metabolic bone disease

Practice Questions

Flashcards

About Endocrinology (diabetes, thyroid disorders) for USMLE

Lessons in Endocrinology (diabetes, thyroid disorders)

Master Endocrinology (diabetes, thyroid disorders)