Multiple Choice Questions (MCQ)

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Category: Medicine--->Endocrinology and Metabolic Disease
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Question 1# Print Question

A 50-year-old obese woman has long-standing type 2 diabetes mellitus inadequately controlled on metformin and pioglitazone. Insulin glargine (15 units subcutaneously at bedtime) has recently been started because of a hemoglobin A1C level of 8.4. Over the weekend, she develops nausea, vomiting, and diarrhea after exposure to family members with a similar illness. Afraid of hypoglycemia, the patient omits the insulin for 3 nights. Over the next 24 hours, she develops lethargy and is brought to the emergency room. On examination, she is afebrile and unresponsive to verbal command. Blood pressure is 84/52. Skin turgor is poor and mucous membranes dry. Neurological examination is nonfocal; she does not have neck rigidity. Laboratory results are as follows:

  • Na: 126 mEq/L
  • K: 4.0 mEq/L
  • Cl: 95 mEq/L
  • HCO3 : 22 mEq/L
  • Glucose: 1100 mg/dL
  • BUN: 84 mg/dL
  • Creatinine: 3.0 mg/dL

Which of the following is the most likely cause of this patient’s coma? 

A. Diabetic ketoacidosis
B. Hyperosmolar coma
C. Syndrome of inappropriate ADH secretion
D. Drug-induced hyponatremia
E. Bacterial meningitis

Question 2# Print Question

A 24-year-old white man presents with a persistent headache for the past few months. The headache has been gradually worsening and is unresponsive to over-thecounter medicines. He notices diminished peripheral vision while driving. He takes no medications. He denies illicit drug use but has smoked one pack of cigarettes per day since the age of 18. Past history is significant for passage of a kidney stone last year. At that time, he was told to increase his fluid intake. Family history is positive for diabetes in his mother. His brother (age 20) has had kidney stones from too much calcium and a “low-sugar problem.” His father died of some type of tumor at age 40. Physical examination reveals a deficit in temporal fields of vision and a few subcutaneous lipomas.

Laboratory results are as follows:

  • Calcium: 11.8 mg/dL (normal 8.5-10.5)
  • Cr: 1.1 mg/dL
  • BUN: 17 mg/dL
  • Glucose: 70 mg/dL
  • Prolactin: 220 µg/L (normal 0-20)
  • Intact parathormone: 90 pg/mL (normal 8-51)

You suspect a pituitary tumor and order an MRI which reveals a 0.7-cm pituitary mass. Based on this patient’s presentation, which of the following is the most probable diagnosis? 

A. Tension headache
B. Multiple endocrine neoplasia type 1 (MEN1)
C. Primary hyperparathyroidism
D. Multiple endocrine neoplasia type 2A (MEN2A)
E. Prolactinoma

Question 3# Print Question

A 50-year-old woman is 5 ft 7 in tall and weighs 185 lb. There is a family history of diabetes mellitus. Fasting blood glucose (FBG) is 160 mg/dL and 155 mg/dL on two occasions. HgA1c is 7.8%. You educate the patient on medical nutrition therapy. She returns for reevaluation in 8 weeks. She states she has followed diet and exercise recommendations, but her FBG remains between 130 and 140 and HgA1C is 7.3%. She is asymptomatic, and physical examination shows no abnormalities. Which of the following is the treatment of choice?

A. Thiazolidinediones such as pioglitazone
B. Encourage compliance with medical nutrition therapy
C. Insulin glargine at bedtime
D. Metformin
E. Glipizide

Question 4# Print Question

A 24-year-old woman presents 6 months after the delivery of her first child, a healthy girl, for evaluation of fatigue. She suspects that the fatigue is related to getting up at night to breastfeed her baby, but she has also noticed cold intolerance and mild constipation. She recalls having a tremor and mild palpitations for a few weeks, beginning 3 months after delivery. On examination, her BP is 126/84 and her pulse rate is 56. The thyroid gland is 2 times normal in size and nontender. The rest of the physical examination is normal. Laboratory studies reveal a free T4 level of 0.7 ng/ml (normal 0.9-2.4) and an elevated TSH at 22 microU/mL (normal 0.4-4). What is the likely course of her illness?

A. Permanent hypothyroidism requiring lifelong replacement therapy
B. Eventual hyperthyroidism requiring methimazole therapy
C. Recovery with euthyroidism
D. Infertility
E. Increased risk of thyroid cancer

Question 5# Print Question

A 65-year-old white woman presents for an annual examination. She feels well except for occasional nocturnal leg cramp and mild abdominal bloating. She takes a multivitamin and a supplement containing 600 mg calcium carbonate and 200 international units of vitamin D twice daily. She takes no prescription medications. Physical examination is unremarkable for her age. In completing the appropriate screening tests, you order a dual x-ray absorptiometry (DXA) to evaluate whether the patient has osteoporosis. DXA results reveal a T-score of −3.0 at the total hip and −2.7 at the femoral neck (osteoporosis: less than −2.5). Since her Z-score is −2.0, you proceed with an evaluation of secondary osteoporosis. Laboratory evaluation reveals

  • Calcium: 8.2 mg/dL
  • Cr: 1.0 mg/dL
  • Bun: 19 mg/dL
  • Glucose: 98 mg/dL
  • 25,OH vitamin D: 12 ng/mL (optimal > 25)
  • Liver enzymes including alkaline phosphatase: normal
  • WBC: 7700/µL
  • Hg: 10.3 g/dL
  • HCT: 32 g/dL
  • MCV 68
  • PLT: 255,000/µL

What is the likely cause of her osteoporosis?

A. Hypoparathyroidism
B. Estrogen deficiency
C. Renal leak hypercalciuria
D. Primary biliary cirrhosis
E. Celiac sprue

Category: Medicine--->Endocrinology and Metabolic Disease
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