DUNPHY - ENDOCRINE AND METABOLIC PROBLEMS
QUESTIONS AND ANSWERS 2022
A patient is 66 inches in height, weighing 200 lbs, and newly diagnosed with type
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diabetes mellitus (DM). The A1c is 7.1%. What is the best initial treatment?
A. No treatment at this time
B. Diet and exercise
C. Diet, exercise, and metformin
D. Diet, exercise, and exogenous insulin - ANS-C. Diet, exercise, and metformin
The clinician suspects that a patient seen in the office has hyperthyroidism. Which
test should the clinician order on the initial visit?
A. Sensitive thyroid-stimulating hormone (TSH) assay and T4
B. Free T4 and serum calcium
C. Nuclear scintigraphy with radiolabeled iodine (123I)
D. Magnetic resonance imaging - ANS-A. Sensitive thyroid-stimulating hormone
(TSH) assay and T4
Which statement made by a patient with type 1 diabetes indicates successful
teaching regarding general guidelines for exercise?
A. "I will not exercise if my blood sugar is 315."
B. "I should just check my blood glucose after exercise."
C. "I should eat more carbohydrates if my blood glucose is less than 200."
D. "I will exercise when my urine ketones are positive but blood sugar is 260." - ANSA. "I will not exercise if my blood sugar is 315."
A male patient with type 1 diabetes comes to the clinic complaining of feeling
nervous and clammy. He states that he took his insulin this morning but was late for
work and did not eat breakfast. Which action should the clinician take first?
A. Administer glucagon subcutaneously.
B. Have him drink 4 ounces of juice.
C. Call 911.
D. Ask him about his usual eating habits. - ANS-B. Have him drink 4 ounces of juice.
A patient with type 2 diabetes comes to the clinic after reading about metformin in a
magazine. Which condition that the patient also has would be a contraindication to
taking metformin?
A. Ulcerative colitis
B. Inflammatory bowel disease
C. Chronic obstructive pulmonary disease
D. Renal disease - ANS-D. Renal disease
A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain,
and constipation for the past 3 months. On physical examination, the clinician
notices muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon
reflexes. Which test should be ordered next?
A. Serum calcium
B. Thyroid-stimulating hormone
C. Electrolytes
D. Urine specific gravity - ANS-B. Thyroid-stimulating hormone
The clinician has been doing diabetic teaching for a patient with type 1 diabetes with
no retinopathy. Which statement by the patient would indicate that teaching has
been effective?
A. "As long as I don't need glasses, I don't have to worry about going blind."
B. "I know I need to have my eyes checked every 2 years."
C. "My primary doctor will check my eyes."
D. "I will see my eye doctor when my vision gets blurry." - ANS-B. "I know I need to
have my eyes checked every 2 years."
A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of
"my feet feel like they are on fire." He has a loss of vibratory sense and +1 Achilles
reflex. Which of the following would be an appropriate treatment?
A. Tricyclic antidepressants
B. Angiotensin-converting enzyme inhibitors
C. Aspirin
D. Insulin - ANS-A. Tricyclic antidepressants
After removing a tack from a type 2 diabetic's heel and evaluating the site for
infection, what is the best plan for this patient?
A. Suggest the patient use a heating pad to improve circulation.
B. Refer to a podiatrist for a foot-care treatment plan.
C. Send the patient for acupuncture treatments.
D. Recommend increased intake of vitamin B12. - ANS-B. Refer to a podiatrist for a
foot-care treatment plan.
Joyce is seen in the clinic complaining of vague symptoms of nervousness and
irritability. She is also having problems sleeping at night. On physical examination,
the clinician finds an irregular heartbeat and hyperactive reflexes. The differential
diagnosis should include which condition?
A. Myxedema
B. Thyrotoxicosis
C. Cushing's syndrome
D. Pan-hypopituitarism - ANS-B. Thyrotoxicosis
The patient is prescribed radioactive iodine (RAI) and asks the clinician how this
drug works. The clinician's response should include which information?
A. RAI prevents the peripheral conversion of T4 to T3.
B. RAI binds free T4.
C. RAI destroys thyroid tissue.
D. RAI reduces freely circulating iodine. - ANS-C. RAI destroys thyroid tissue.
A patient is diagnosed with hypothyroidism. Which electrocardiogram change should
the clinician observe as a manifestation of the disease?
A. Sinus bradycardia
B. Atrial fibrillation
C. Supraventricular tachycardia
D. U waves - ANS-A. Sinus bradycardia
After 6 months of Synthroid therapy, the clinician should expect which result in the
repeat thyroid-stimulating hormone studies?
A. Elevated
B. Normal
C. Low
D. Undetectable - ANS-B. Normal
Which laboratory finding should the clinician observe in a patient with untreated
Graves' disease?
A. Elevated TSH
B. Decreased T3
C. Decreased TSH receptor antibody test
D. Elevated antithyroglobulin antibodies - ANS-D. Elevated antithyroglobulin
antibodies
The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement
made by the patient would indicate teaching has been effective?
A. "I'll take my pill before breakfast."
B. "I know to take my Glucotrol at bedtime."
C. "It is important to take my medication right after I eat."
D. "Since I only like to eat two meals a day, I can take the pill between my meals." -
ANS-A. "I'll take my pill before breakfast."
A male patient with diabetes asks the clinician why he needs to check his blood
sugar at home even when he feels good. Which response by the clinician would be
most appropriate?
A. "Control of glucose will help postpone or delay complications."
B. "Regularly checking blood sugar will help you."
C. "Monitoring glucose will promote a sense of connectedness."
D. "Because you know it is the right thing to do for your disease." - ANS-A. "Control
of glucose will help postpone or delay complications."
How often should the clinician examine the feet of a person with diabetes? CONTINUES... [Show Less]