2026|2027 Actual Complete Real Exam Questions And Correct
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A patient with type 2 diabetes has an HbA1c of 9.2% despite taking
metformin as prescribed. What should the clinician assess before
intensifying treatment? -ANSWER- Review adherence, dose, renal
function, diet, physical activity, medication access, adverse effects, and
possible contributing illnesses. If hyperglycemia remains uncontrolled,
treatment should be intensified according to the patient's
cardiovascular risk, kidney function, weight, and individual goals.
Which patients with type 2 diabetes may particularly benefit from an
SGLT2 inhibitor? -ANSWER- Patients with heart failure or chronic kidney
disease may benefit because certain SGLT2 inhibitors reduce disease
progression and heart-failure hospitalization. Choice of medication
depends on kidney function, contraindications, and the patient's overall
treatment plan.
Why should metformin be reviewed when a patient develops
worsening kidney function? -ANSWER- Metformin is cleared by the
kidneys, so reduced kidney function can increase the risk of
accumulation and lactic acidosis in susceptible circumstances. Renal
function should be assessed, and treatment adjusted or withheld when
clinically indicated.
,A patient taking insulin becomes sweaty, shaky, confused, and irritable.
What should be suspected? -ANSWER- Hypoglycemia should be
suspected. Check blood glucose promptly if possible and give fast-
acting carbohydrate to a conscious patient who can swallow safely;
severe confusion, seizures, or unconsciousness require emergency
treatment, such as glucagon or intravenous dextrose under the
appropriate protocol.
What distinguishes diabetic ketoacidosis from uncomplicated
hyperglycemia? -ANSWER- Diabetic ketoacidosis involves insulin
deficiency with ketone production and metabolic acidosis, often
accompanied by dehydration and abdominal symptoms. It is a medical
emergency requiring fluid, electrolyte, insulin, and precipitating-cause
management.
Which findings may indicate a hyperosmolar hyperglycemic state? -
ANSWER- Profound dehydration, marked hyperglycemia, elevated
serum osmolality, and neurological changes may indicate hyperosmolar
hyperglycemic state. Urgent hospital treatment is necessary because
severe fluid and electrolyte disturbances can be life-threatening.
Why should patients with diabetes have regular foot assessments? -
ANSWER- Diabetes can cause peripheral neuropathy and impaired
circulation, making injuries less noticeable and delaying wound healing.
Inspection, pulse assessment, sensory testing, and appropriate
footwear help reduce ulceration and amputation risk.
, Which screening test is commonly used to assess diabetic kidney
disease? -ANSWER- Urine albumin-to-creatinine ratio and estimated
glomerular filtration rate are commonly assessed. Albuminuria may
appear before a substantial decline in eGFR, so both measures are
important.
A patient with diabetes reports burning pain and numbness in both
feet. What complication should be considered? -ANSWER- Distal
symmetric diabetic polyneuropathy is a likely possibility. Sensory
examination and evaluation for other causes, such as vitamin B12
deficiency or medication effects, help guide management.
Why might a GLP-1 receptor agonist be considered for a patient with
type 2 diabetes and obesity? -ANSWER- Certain GLP-1 receptor agonists
improve glucose control and promote weight loss, and some reduce
cardiovascular risk in appropriate patients. Choice depends on clinical
indications, contraindications, tolerability, and patient preferences.
An adult reports fatigue, constipation, cold intolerance, and
unexplained weight gain. Which endocrine condition should be
considered? -ANSWER- Hypothyroidism should be considered. Thyroid-
stimulating hormone is generally the initial test for suspected primary
hypothyroidism, with free thyroxine used to clarify the diagnosis.
A patient taking levothyroxine continues to experience fatigue and has
an elevated TSH. What should be reviewed? -ANSWER- Review
adherence, dose timing, interactions with calcium or iron supplements,