Question 1

A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine.Which of the following conditions that the patient also has would be a contraindication to taking metformin?

Accepted Answer

All of the choices listed are contraindications to taking metformin. Ketoacidosis and cirrhosis can increase the risk of lactic acidosis, a rare but serious complication of metformin. Frequent hypoglycemic episodes may also indicate that a patient's diabetes is not well-controlled, which could be exacerbated by the addition of metformin.

Question 2

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 a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes.Which of the following tests should be ordered next?

Accepted Answer

The patient's symptoms and physical exam findings suggest hypothyroidism. The next step is to order a TSH test to confirm the diagnosis. Serum calcium and electrolyte levels may also be checked, but they are less likely to be abnormal in this patient. Urine specific gravity is not relevant to the evaluation of hypothyroidism.

Question 3

The clinician sees a patient who is 5 feet tall and weighs 150 pounds.How would the clinician classify this patient?

Accepted Answer

The patient's BMI is approximately 29.3, which falls into the mild obesity category (BMI 30-34.9).

Question 4

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, +1 Achilles reflex, and a tack embedded in his left heel.Which of the following would be an appropriate treatment?

Accepted Answer

Tricyclic antidepressants are commonly used to treat neuropathic pain, such as the burning sensation described by the patient, which is likely due to diabetic neuropathy.

Question 5

A 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?

Accepted Answer

The answer of A patient with type 1 diabetes comes...

Question 6

Which of the following laboratory findings should the clinician expect in a patient with untreated Graves' disease?

Accepted Answer

The answer of Which of the following laboratory findings should...

Question 7

A patient with type 2 diabetes asks the clinician why she needs to exercise.In order to answer her, the clinician must understand that exercise has what effect on the patient with type 2 diabetes?

Accepted Answer

Exercise has multiple benefits for patients with type 2 diabetes, including reducing postprandial blood glucose levels, reducing triglycerides and increasing high-density lipoprotein (HDL), and reducing total cholesterol. Therefore, all of the choices listed (A, B, and C) are correct. Regular exercise can also improve insulin sensitivity and help with weight management.

Question 8

The clinician has been doing diabetic teaching for a patient with type 1 diabetes.Which of the following statements by the patient would indicate that teaching has been effective?

Accepted Answer

The statement "I know I need to have my eyes checked every year" indicates that the patient is aware of the need for regular eye exams to monitor for diabetic retinopathy, which is a potential complication of type 1 diabetes that can lead to blindness. The other statements suggest a lack of understanding about the importance of eye exams and the risk of vision loss.

Question 9

Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability.She says that her hair will not hold a permanent wave anymore.On physical examination, the clinician finds an irregular heartbeat and brisk reflexes.The differential diagnosis should include which of the following conditions?

Accepted Answer

The symptoms of nervousness, irritability and hair changes along with physical findings of an irregular heartbeat and brisk reflexes suggest hyperthyroidism or thyrotoxicosis as the likely diagnosis. Myxedema, Cushing's syndrome and pan-hypopituitarism do not typically present with these specific symptoms and findings.

Question 10

Mr.S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe.The clinician suspects acute gout.Which of the following should the clinician expect in the initial test results for this patient?

Accepted Answer

A diagnosis of acute gout would be supported by an elevated uric acid level in the initial test results. Elevated blood urea nitrogen and decreased urine pH may be seen in later stages of gout, and decreased C-reactive protein would be unlikely as gout is an inflammatory condition.

Question 11

A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good.Which of the following responses would be most appropriate?

Accepted Answer

All of the above are correct. It is important for a diabetic patient to regularly check their blood sugar at home even when they feel good to help control glucose levels, establish a routine, and promote a sense of control. By maintaining good control of glucose levels, diabetic patients may be able to postpone or delay complications associated with their condition.

Question 12

A patient is diagnosed with hypothyroidism.Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?

Accepted Answer

Hypothyroidism is associated with a decreased metabolic rate, which slows down heart rate and cardiac output. Sinus bradycardia may result from this decreased metabolic rate. Atrial fibrillation and supraventricular tachycardia are more commonly associated with hyperthyroidism. U waves are not commonly seen in hypothyroidism.

Question 13

Mr.W, 53 years old, is seen in the clinic with concerns about his left foot.He has a 40-year history of type 1 diabetes with "fairly good" control on twice-daily insulin.He denies injury but states that he tripped a few months ago and that his foot is sore when he walks.Physical examination reveals an edematous, erythremic, and warm foot.There is a superficial ulcer on the plantar surface.Which of the following is the most likely diagnosis?

Accepted Answer

The presentation described is consistent with a Charcot joint, also known as neuropathic arthropathy, which is a serious complication of diabetes. It can result from repeated micro-trauma and stress fractures due to underlying neuropathy, leading to degeneration of joint structures and destruction of bone. The edema, erythrema, warmth, and ulceration are classic findings. Fallen arch, arthritis, and sprained ankle are less likely given the clinical presentation and history provided.

Question 14

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?

Accepted Answer

As a type 2 diabetic, this patient is at risk for foot problems, so it is best to refer her to a podiatrist for ongoing foot care management. A heating pad may not be safe for her to use due to decreased sensation in her feet. Acupuncture may not address her specific foot care needs.

Question 15

The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works.The clinician's response should include which of the following data?

Accepted Answer

RAI is taken up by the thyroid gland and destroys thyroid tissue through emission of ionizing radiation. This is used to treat hyperthyroidism and thyroid cancer.

Question 16

A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM).Her fasting plasma glucose level is 215 mg/dL.What is the best initial treatment?

Accepted Answer

For a patient newly diagnosed with type 2 diabetes mellitus (DM) who does not have severe symptoms or significantly elevated blood glucose levels, the best initial treatment often involves lifestyle modifications. This includes changes to diet and an increase in physical activity. These interventions can significantly improve glycemic control and may be tried before adding medications.

Question 17

The clinician prescribes glipizide (Glucotrol) for a diabetic patient.Which statement made by the patient would indicate that your teaching has been effective?

Accepted Answer

Taking glipizide (Glucotrol) 30 minutes before breakfast would ensure that the medication's peak effect coincides with the rise in blood glucose levels after eating. This would help to control blood sugar levels in diabetic patients. Option B is not correct because taking Glucotrol at bedtime may cause hypoglycemia during the night. Option C is incorrect because taking the medication after eating would be too late for it to effectively control postprandial glucose levels. Option D is not correct because it is recommended to take glipizide with a meal to avoid gastrointestinal upset and improve absorption.

Question 18

The clinician suspects that a client seen in the office has hyperthyroidism.Which of the following tests should the clinician order on the initial visit?

Accepted Answer

Hyperthyroidism is characterized by low levels of thyroid-stimulating hormone (TSH) and high levels of free T4. Therefore, the initial test should be a high sensitivity TSH and free T4 to diagnose hyperthyroidism. Free T3 and T4 and thyroxin antibodies may be ordered as follow-up tests. Serum calcium is not typically used to diagnose hyperthyroidism.

Question 19

How often should the clinician examine the feet of a person with diabetes?

Accepted Answer

Every visit is recommended for a foot examination in a person with diabetes to promptly identify any changes or issues, such as neuropathy or ulcers, that could lead to more serious complications if left unchecked.

Question 20

After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?

Accepted Answer

Synthroid is a synthetic form of thyroid hormone used to treat hypothyroidism. In patients with hypothyroidism, the thyroid-stimulating hormone (TSH) is usually elevated due to a lack of thyroid hormones. After 6 months of Synthroid therapy, the clinician should expect a normalization of TSH levels, indicating that the patient is receiving an appropriate dose of Synthroid to maintain euthyroidism. Therefore, the repeat thyroid studies should show a normal TSH level.

Quiz 16: Endocrinemetabolic Problems