ENDOCRINOLOGY STUDY GUIDE CLINICAL
MEDICINE TEST BANK COMPLETE EDITION
SECTION 1: DIABETES MELLITUS
1. A 45-year-old obese man presents with polydipsia, polyuria, and weight loss.
Fasting glucose is 160 mg/dL and HbA1c is 8.2%. What is the most appropriate
initial therapy?
• A) Metformin
• B) Insulin glargine
• C) Glipizide
• D) Lifestyle modification only
Correct Answer: A
*Rationale: Metformin is the first-line pharmacologic therapy for type 2 diabetes.
It reduces hepatic glucose production and improves insulin sensitivity. Lifestyle
modification should accompany pharmacotherapy, but medication is indicated
given the elevated glucose and HbA1c > 7%.*
2. A 28-year-old woman with type 1 diabetes is pregnant. Which insulin regimen
is most appropriate during pregnancy?
• A) Insulin glargine once daily + insulin aspart with meals
• B) NPH insulin + regular insulin
• C) Insulin pump with continuous glucose monitoring
• D) Metformin + insulin
,Correct Answer: C
*Rationale: Insulin pumps with continuous glucose monitoring provide the most
precise glucose control during pregnancy. Insulin glargine is not FDA-approved for
pregnancy (though used off-label). Metformin is not first-line in type 1 diabetes.
NPH + regular insulin is an older regimen but less flexible.*
3. A patient with type 2 diabetes on metformin and glipizide presents with
hypoglycemia. Which medication should be discontinued first?
• A) Metformin
• B) Glipizide
• C) Both should be discontinued
• D) Neither should be discontinued
Correct Answer: B
Rationale: Sulfonylureas (glipizide, glyburide) are the most common cause of
hypoglycemia in type 2 diabetes. Metformin does not cause hypoglycemia. The
sulfonylurea should be reduced or discontinued if hypoglycemia occurs.
4. Which SGLT2 inhibitor has been shown to reduce cardiovascular mortality in
patients with type 2 diabetes and established cardiovascular disease?
• A) Canagliflozin
• B) Dapagliflozin
• C) Empagliflozin
• D) Ertugliflozin
Correct Answer: C
*Rationale: Empagliflozin (EMPA-REG OUTCOME trial) demonstrated a significant
reduction in cardiovascular mortality in patients with type 2 diabetes and
,established CVD. Canagliflozin and dapagliflozin also show CV benefit but
empagliflozin has the strongest mortality benefit.*
5. A patient with type 1 diabetes presents with nausea, vomiting, abdominal
pain, and Kussmaul respirations. Arterial blood gas shows pH 7.15, bicarbonate
12 mEq/L, and anion gap 22. What is the most likely diagnosis?
• A) Hyperosmolar hyperglycemic state (HHS)
• B) Diabetic ketoacidosis (DKA)
• C) Lactic acidosis
• D) Alcoholic ketoacidosis
Correct Answer: B
Rationale: DKA is characterized by hyperglycemia, metabolic acidosis with
elevated anion gap, and ketosis. The classic presentation includes nausea,
vomiting, abdominal pain, and Kussmaul respirations. HHS has higher glucose and
osmolality but minimal ketosis.
6. A patient with DKA has a serum potassium of 5.5 mEq/L on presentation.
What is the most appropriate management?
• A) Hold potassium replacement until potassium normalizes
• B) Begin IV potassium immediately
• C) Administer insulin and monitor potassium closely
• D) Administer sodium bicarbonate
Correct Answer: C
*Rationale: In DKA, total body potassium is depleted despite normal or elevated
serum potassium due to acidosis. Insulin therapy will drive potassium into cells,
causing hypokalemia. Potassium should be replaced once serum potassium is <
5.3 mEq/L and urine output is adequate.*
, 7. Which of the following is a contraindication to metformin use?
• A) Hypertension
• B) Chronic kidney disease (eGFR < 30 mL/min)
• C) Hyperlipidemia
• D) Obesity
Correct Answer: B
*Rationale: Metformin is contraindicated in patients with eGFR < 30 mL/min due
to the risk of lactic acidosis. It should be used with caution in patients with eGFR
30–45 mL/min. Metformin is first-line therapy in most patients with type 2
diabetes.*
8. A patient with type 2 diabetes has an HbA1c of 9.5% on metformin and
glipizide. What is the most appropriate next step?
• A) Add insulin glargine
• B) Add an SGLT2 inhibitor
• C) Add a GLP-1 receptor agonist
• D) All of the above are reasonable options
Correct Answer: D
*Rationale: When HbA1c remains above goal on dual therapy, any of these
options is appropriate. The choice depends on patient-specific factors: SGLT2
inhibitors for CV/renal benefit, GLP-1 agonists for weight loss, or insulin for severe
hyperglycemia.*
9. What is the target HbA1c for most non-pregnant adults with diabetes?
• A) < 6.0%
MEDICINE TEST BANK COMPLETE EDITION
SECTION 1: DIABETES MELLITUS
1. A 45-year-old obese man presents with polydipsia, polyuria, and weight loss.
Fasting glucose is 160 mg/dL and HbA1c is 8.2%. What is the most appropriate
initial therapy?
• A) Metformin
• B) Insulin glargine
• C) Glipizide
• D) Lifestyle modification only
Correct Answer: A
*Rationale: Metformin is the first-line pharmacologic therapy for type 2 diabetes.
It reduces hepatic glucose production and improves insulin sensitivity. Lifestyle
modification should accompany pharmacotherapy, but medication is indicated
given the elevated glucose and HbA1c > 7%.*
2. A 28-year-old woman with type 1 diabetes is pregnant. Which insulin regimen
is most appropriate during pregnancy?
• A) Insulin glargine once daily + insulin aspart with meals
• B) NPH insulin + regular insulin
• C) Insulin pump with continuous glucose monitoring
• D) Metformin + insulin
,Correct Answer: C
*Rationale: Insulin pumps with continuous glucose monitoring provide the most
precise glucose control during pregnancy. Insulin glargine is not FDA-approved for
pregnancy (though used off-label). Metformin is not first-line in type 1 diabetes.
NPH + regular insulin is an older regimen but less flexible.*
3. A patient with type 2 diabetes on metformin and glipizide presents with
hypoglycemia. Which medication should be discontinued first?
• A) Metformin
• B) Glipizide
• C) Both should be discontinued
• D) Neither should be discontinued
Correct Answer: B
Rationale: Sulfonylureas (glipizide, glyburide) are the most common cause of
hypoglycemia in type 2 diabetes. Metformin does not cause hypoglycemia. The
sulfonylurea should be reduced or discontinued if hypoglycemia occurs.
4. Which SGLT2 inhibitor has been shown to reduce cardiovascular mortality in
patients with type 2 diabetes and established cardiovascular disease?
• A) Canagliflozin
• B) Dapagliflozin
• C) Empagliflozin
• D) Ertugliflozin
Correct Answer: C
*Rationale: Empagliflozin (EMPA-REG OUTCOME trial) demonstrated a significant
reduction in cardiovascular mortality in patients with type 2 diabetes and
,established CVD. Canagliflozin and dapagliflozin also show CV benefit but
empagliflozin has the strongest mortality benefit.*
5. A patient with type 1 diabetes presents with nausea, vomiting, abdominal
pain, and Kussmaul respirations. Arterial blood gas shows pH 7.15, bicarbonate
12 mEq/L, and anion gap 22. What is the most likely diagnosis?
• A) Hyperosmolar hyperglycemic state (HHS)
• B) Diabetic ketoacidosis (DKA)
• C) Lactic acidosis
• D) Alcoholic ketoacidosis
Correct Answer: B
Rationale: DKA is characterized by hyperglycemia, metabolic acidosis with
elevated anion gap, and ketosis. The classic presentation includes nausea,
vomiting, abdominal pain, and Kussmaul respirations. HHS has higher glucose and
osmolality but minimal ketosis.
6. A patient with DKA has a serum potassium of 5.5 mEq/L on presentation.
What is the most appropriate management?
• A) Hold potassium replacement until potassium normalizes
• B) Begin IV potassium immediately
• C) Administer insulin and monitor potassium closely
• D) Administer sodium bicarbonate
Correct Answer: C
*Rationale: In DKA, total body potassium is depleted despite normal or elevated
serum potassium due to acidosis. Insulin therapy will drive potassium into cells,
causing hypokalemia. Potassium should be replaced once serum potassium is <
5.3 mEq/L and urine output is adequate.*
, 7. Which of the following is a contraindication to metformin use?
• A) Hypertension
• B) Chronic kidney disease (eGFR < 30 mL/min)
• C) Hyperlipidemia
• D) Obesity
Correct Answer: B
*Rationale: Metformin is contraindicated in patients with eGFR < 30 mL/min due
to the risk of lactic acidosis. It should be used with caution in patients with eGFR
30–45 mL/min. Metformin is first-line therapy in most patients with type 2
diabetes.*
8. A patient with type 2 diabetes has an HbA1c of 9.5% on metformin and
glipizide. What is the most appropriate next step?
• A) Add insulin glargine
• B) Add an SGLT2 inhibitor
• C) Add a GLP-1 receptor agonist
• D) All of the above are reasonable options
Correct Answer: D
*Rationale: When HbA1c remains above goal on dual therapy, any of these
options is appropriate. The choice depends on patient-specific factors: SGLT2
inhibitors for CV/renal benefit, GLP-1 agonists for weight loss, or insulin for severe
hyperglycemia.*
9. What is the target HbA1c for most non-pregnant adults with diabetes?
• A) < 6.0%
