APEA EXAM ENDOCRINE – QUESTION AND ANSWERS
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following
... [Show More] laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient?
Beta blocker medications
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?
C-peptide level
Hemoglobin A1C
Random serum glucose
Thyroid studies
In order to determine how much T4 replacement of patient needs to reestablish a euthyroid state, the nurse practitioner considers:
Patient's body weight
Replacement as based on body weight and is usually calculated in kilograms. Body weight is multiplied by 1.6 to determine replacement needed in one day. This is the amount that should be prescribed in otherwise healthy, less than 50 years old, no evidence of underlying cardiac disease patients
Which findings are part of the 2009 diagnostic criteria for metabolic syndrome? (Select all that apply.)
Triglycerides ≧150 mg/dL
HDL cholesterol = 40 mg/dL
Elevated waist circumference
Fasting plasma glucose ≧100 mg/dL
Decreased plasminogen activator inhibitor 1 levels
A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known?
Giving a rapid-acting carbohydrate
A 38-year-old male patient presents for his annual exam. He reports nervousness and weight loss, but denies any changes in his dietary intake or exercise level. Based on these findings and the following lab values, more what is the most likely diagnosis?
TSH 0.01 (normal 0.4-3.8)
Free T4 6 (normal 0.8-2.8)
Free T3 205 (normal 70-205)
Hyperthyroidism
TSH is low and T4 is high indicating hyperthyroidism
Excessive thirst and volume of dilute urine may be a symptom of:
Diabetes insipidus
Diabetes insipidus is a condition in which the kidneys are unable to conserve water, often because there is insufficient antidiuretic hormone (ADH) or the kidneys are unable to respond to ADH. Although diabetes mellitus may present with similar symptoms, the disorders are different. Diabetes insipidus does not involve hyperglycemia.
Which findings are symptoms of hyperparathyroidism? (Select all that apply.)
Cognitive impairment
Chvostek’s sign
Renal calculi
Left ventricular hypertrophy
Perioral paresthesias
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism?
2.4 uIU/L
0.4 uIU/L
0.2 uIU/L
4.2 uIU/L
Some of the hallmark characteristics of hyperosmolar hyperglycemic state are:
Blood glucose over 1000 mg/dL
Slow onset (over days)
Higher prevalence in type 1 diabetics
Negative ketones
The patient comes into the clinic complaining of weight gain and brings in a nonfasting glucose log indicating glucose ranging from 110-170 mg/dL. This patient:
Has impaired fasting glucose
Should have a hemoglobin A1c performed
Has normal blood glucose values
Should continue to monitor glucose at home
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient?
A thyroidectomy will be necessary.
She will need lifelong medication.
This condition may be transient.
She should be referred to an endocrinologist.
A 76-year-old obese patient has fatigue, thirst, and frequent urination. She was asked to measure a.m. fasting glucose value for one week. The values range from 142-1 75 mg/dL. She is now back to your clinic due to persistent symptoms, this patient:
Should have a hemoglobin A1C performed for diagnosis
Can be diagnosed with type 2 diabetes
Has prediabetes
Has impaired fasting glucose
Impaired fasting glucose can be diagnosed when to fasting glucose readings are between 100-125 mg/dL. The conjunction of classic symptoms of hyperglycemia with a fasting blood glucose over 126 mg/dL consistently is diagnostic for diabetes. A1c is not required to diagnose diabetes in this case, but can be done to establish a baseline.
Untreated hyperglycemia may lead to all of the following complications except:
Vitiligo
Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.
Which choice best describes the most common presentation of a patient with type 2 diabetes?
Insidious onset of hyperglycemia with weight gain
Most patient's with type 2 diabetes are asymptomatic at presentation. They are identified because of screening and identification of risk factors. Diabetes usually has an insidious onset and is associated with weight gain. An acute onset is typical of patients with type 1 diabetes. Microalbuminuria develops after several years of having diabetes
Mr. Jones is a type I diabetic that presents to your clinic with nausea/vomiting and weakness. You do random blood sugar test in clinic and his blood sugar is 550. You are not able to obtain a urine sample at this time. What is your next action?
Treat with insulin and order chemistry and urine labs
Treat with insulin
Send to ED
Order a urine test to be done at the lab
This patient is a type I diabetic with symptoms and blood glucose that should lead NP to consider DKA. DKA is treated in the inpatient setting as it requires insulin, IV rehydration, and careful monitoring of electrolytes.
The patient has a TSH value of 13.1 today. The nurse practitioner had decided to initiate replacement therapy with levothyroxine 88 µg daily. When should the NP recheck the patient's TSH level?
10 weeks
2 weeks
4 weeks
6 weeks
Symptoms of hypothyroidism can improve post levothyroxine therapy within 2-3 weeks; however steady TSH concentration are not achieved for at least 6 weeks. TSH can then be monitored annually unless the patient asymptomatic.
In order to determine how much T4 replacement of patient needs to reestablish a euthyroid state, the nurse practitioner considers:
Patient's body weight
A patient who has diabetes has a blood pressure of 140/90 mm Hg and significant >2mg/dL albuminuria. Which initial action by the primary care provider is indicated for management of this patient?
1. Referring to an ophthalmologist
2. Consulting with a nephrologist
3. Prescribing an antihypertensive medication
4. Limiting protein intake
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism?
1. 0.4
2. 4.2
3. 0.2
4. 2.4
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?
1. Thyroid studies
2. Hemoglobin A1c
3. Random serum glucose
4. C-peptide level
Mr. Smith, an overweight 48-year-old male with undiagnosed type 2 diabetes mellitus presents to your clinic. Which symptom is least likely associated with type 2 diabetes mellitus?
1. Constipation
2. Impetigo
3. Fatigue
4. Athlete’s foot
A 52-year-old presents with thirst and frequent urination today. His glucose is 352. How should this be managed today?
1. Start metformin
2. Have him return tomorrow to recheck his blood glucose
3. Start metformin plus pioglitazone
4. Start insulin
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient?
1. This condition may be transient
2. She should be referred to an endocrinologist
3. A thyroidectomy will be necessary
4. She will need lifelong medication
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?
1. Random serum glucose
2. Hemoglobin a1c
3. Thyroid studies
4. c-peptide
Excessive thirst and volume of dilute urine may be a symptom of:
1. Diabetes insipidus
2. Viral gastroenteritis
3. Urinary tract infection
4. hypoglycemia
A 45-year-old female patient has fatigue for the past 3 months and a 10 pound weight gain. She previously had regular menses occurring about every 30 days, but in the last 3 months her menses have varied. She has high TSH. It was repeated one week later and found to be even higher. Would explain this finding?
1. Hypothyroidism
2. Subclinical hypothyroidism
3. Perimenopause
4. Transient hypothyroidism
Mr. Jones, brings his obese 15 year old son in to see you. You examine the 15-year-old and identify acanthosis nigricans. This probably indicates:
Insulin resistance
Acanthosis nigricans is usually associated with insulin resistance. It is a predictor of development of type 2 diabetes, especially in children, but is not a diagnostic finding on its own.
Acanthosis nigricans is associated with all of the following disorders except:
Tinea versicolor
A 65-year-old patient presents to your clinic with evidence of hyperthyroidism. In assessing her cardiovascular status, which should NP assess immediately?
Cardiac enzymes
Electrocardiogram
A 45-year-old patient who has hypothyroidism and takes levothyroxine. Based on the following lab results, how should the nurse practitioner proceed?
TSH 32.7 (normal 0.4-3.8)
Free T4 0.09 (normal 0.8-2.8)
LDL 190mg/dL
Total cholesterol 260mg/gL
Increase levothyroxine dose
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? Thyroid ultrasound
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism?
Inappropriate secretion of PTH along with hypercalcemia
A 50-year-old female presents for her annual exam. She complains of fatigue and weight gain. She has a following lab results. What should the NP order? TSH 7 (normal 0.4-3.8)
Repeat TSH plus free T4
Patient presents with elevated TSH as well as possible symptoms of hypothyroidism. A repeat of TSH and free T4 should be done to determine presence and degree of hypothyroidism. Replacement therapy is generally not initiated until the TSH is greater than 10 and direct measurement of serum T4 is obtained. there is no nodule or other indications in this scenario for an ultrasound.
You Answered
In order to determine how much T4 replacement of patient needs to reestablish a euthyroid state, the nurse practitioner considers:
The TSH level
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient?
Beta blocker medications
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?
Hemoglobin A1C
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed?
Correct!
Thyroid ultrasound
Which findings are symptoms of hyperparathyroidism? (Select all that apply.)
Correct!
Renal calculi
Left ventricular hypertrophy
Cognitive impairment
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient?
This condition may be transient.
The patient comes into the clinic complaining of weight gain and brings in a nonfasting glucose log indicating glucose ranging from 110-170 mg/dL. This patient:
Correct!
Should have a hemoglobin A1c performed
Weight gain is one of the potential symptoms of diabetes, however it is a nonspecific symptom, the patient did not have any of the other classic diabetes symptoms. His nonfasting glucose log has a wide range. Confirmation of prediabetes versus normal finding versus diabetes should be done with repeat testing, preferably with hemoglobin A1c.
A 45-year-old patient who has hypothyroidism and takes levothyroxine. Based on the following lab results, how should the nurse practitioner proceed?
TSH 32.7 (normal 0.4-3.8)
Free T4 0.09 (normal 0.8-2.8)
LDL 190mg/dL
Total cholesterol 260mg/dL
Correct!
Increase levothyroxine dose
This patient has a low T4 with elevated TSH and hence needs an increase in levothyroxine. Dyslipidemia is common finding when TSH exceeds 10. The NP should first treat hypothyroidism and then proceed with repeat of lipid testing.
A 50-year-old female presents for her annual exam. She complains of fatigue and weight gain. She has a following lab results. What should the NP order?
TSH 7 (normal 0.4-3.8)
Repeat TSH plus free T4
Patient presents with elevated TSH as well as possible symptoms of hypothyroidism. A repeat of TSH and free T4 should be done to determine presence and degree of hypothyroidism. Replacement therapy is generally not initiated until the TSH is greater than 10 and direct measurement of serum T4 is obtained. there is no nodule or other indications in this scenario for an ultrasound.
Acanthosis nigricans is associated with all of the following disorders except:
Correct!
Tinea versicolor
Acanthosis nigricans is a benign skin condition that is a sign of insulin resistance. It is rarely associated with some types of adenocarcinoma of the GI tract. Tinea versicolor is a superficial infection of the skin that is caused by fungi
A 45-year-old female patient has fatigue for the past 3 months and a 10 pound weight gain. She previously had regular menses occurring about every 30 days, but in the last 3 months her menses have varied. She has high TSH. It was repeated one week later and found to be even higher. Would explain this finding?
Hypothyroidism
The patient's TSH is high on 2 occasions, along with symptoms, this was certainly lead to a diagnosis of hypothyroidism.
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient?
She will need lifelong medication.
You Answered
She should be referred to an endocrinologist.
This condition may be transient.
A thyroidectomy will be necessary.
A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?
Thyroid studies
Hemoglobin A1C
C-peptide level
Random serum glucose
Which findings are part of the 2009 diagnostic criteria for metabolic syndrome? (Select all that apply.)
Elevated waist circumference
Decreased plasminogen activator inhibitor 1 levels
HDL cholesterol = 40 mg/dL
Fasting plasma glucose ≧100 mg/dL
Triglycerides ≧150 mg/dL
Mr. Smith, an overweight 48-year-old male with undiagnosed type 2 diabetes mellitus presents to your clinic. Which symptom is least likely associated with type 2 diabetes mellitus?
Athlete's foot
Fatigue
Constipation
Impetigo
Infections could be related to elevated blood glucose levels. Fatigue is a common early symptom of diabetes. Constipation could be due to many factors but not specifically diabetes.
The patient comes into the clinic complaining of weight gain and brings in a nonfasting glucose log indicating glucose ranging from 110-170 mg/dL. This patient:
Has normal blood glucose values
Has impaired fasting glucose
Should have a hemoglobin A1c performed
Should continue to monitor glucose at home
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed?
Radionucleotide imaging
Serum calcitonin
Thyroid ultrasound
Serum TSH level
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient?
She should be referred to an endocrinologist.
This condition may be transient.
A thyroidectomy will be necessary.
She will need lifelong medication.
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism?
0.2 uIU/L
2.4 uIU/L
0.4 uIU/L
4.2 uIU/L
A 45-year-old patient who has hypothyroidism and takes levothyroxine. Based on the following lab results, how should the nurse practitioner proceed?
TSH 32.7 (normal 0.4-3.8)
Free T4 0.09 (normal 0.8-2.8)
LDL 190mg/dL
Total cholesterol 260mg/dL
Encourage lifestyle modifications
Increase levothyroxine dose
Decrease levothyroxine dose
Begin statin therapy
This patient has a low T4 with elevated TSH and hence needs an increase in levothyroxine. Dyslipidemia is common finding when TSH exceeds 10. The NP should first treat hypothyroidism and then proceed with repeat of lipid testing.
The patient has a TSH value of 13.1 today. The nurse practitioner had decided to initiate replacement therapy with levothyroxine 88 µg daily. When should the NP recheck the patient's TSH level?
4 weeks
6 weeks
10 weeks
2 weeks
Symptoms of hypothyroidism can improve post levothyroxine therapy within 2-3 weeks; however steady TSH concentration are not achieved for at least 6 weeks. TSH can then be monitored annually unless the patient asymptomatic.
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism?
Inappropriate secretion of PTH along with hypercalcemia [Show Less]