MSN 622 Week 4 – Endocrine UPDATED
ACTUAL Exam Questions and CORRECT
Answers
A 65-year-old male presents for evaluation and management of his diabetes mellitus type 2.
Three months ago, his labs showed a hemoglobin A1c of 7.5%. Conservative management of
diet and exercise was attempted for three months, during which he gained 5 pounds (2.3 kg)
which he is not happy with. Today, his hemoglobin A1C remains at 7.5%, and his creatinine
level is elevated at 1.8 mg/dl (eGFR=41). Which of the following pharmacological interventions
is the best next step for this patient? - CORRECT ANSWER - Start dapagliflozin
A 35-year-old man diagnosed one year ago with diabetes mellitus type 2, and hypertension
presents for follow-up. He states he is feeling well, exercises daily, and does not smoke. He takes
metformin 500 mg once daily and lisinopril 10 mg once daily. His blood pressure is 122/74
mmHg, and his BMI is 22 kg/m2. Blood work shows a hemoglobin A1c of 7.2% and a low-
density lipoprotein of 100 mg/dL. Which of the following changes to his medication regimen is
indicated at this time? - CORRECT ANSWER - Increase the metformin dose
A 52-year-old man with diabetes mellitus presents for an annual check-up. He has been taking
metformin for the last 8 years. On examination, he has an average blood pressure of 160/90
mmHg on multiple separate measurements. What is the most appropriate next step? - CORRECT
ANSWER - Start an ACE inhibitor with hydrochlorothiazide and follow up in 2 weeks
A 65-year-old woman presents with weight gain, slow speech, slow movement, a lack of energy,
and a loss of interest in the activities of daily living. Her history is significant for type 1 diabetes
mellitus. On physical examination, there is generalized non-pitting edema and delayed reflexes.
Her skin is dry, and there are patches of alopecia on her scalp. Which of the following should be
requested to establish a diagnosis? - CORRECT ANSWER - Antithyroid peroxidase
A 75-year-old male presents to the clinic for follow up. His past medical history is significant for
type 2 diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease, and obesity. He
reports feeling fatigued most days and has multiple symptomatic hypoglycemic episodes per
week. He reports exercise intolerance due to hypoglycemia in the afternoons, as well. His current
medications include metformin, glyburide, atorvastatin, and lisinopril. His physical examination
is noted only for obesity with a body mass index of 30 kg/m2. His vital signs are unremarkable.
Recent blood work shows a hemoglobin A1c of 6.2%. His renal function has decreased from an
, estimated glomerular filtration rate of 60 mL/min 2 years ago to 50 mL/min. What is the next
step in the management of this patient? - CORRECT ANSWER - Stop glyburide
A 65-year-old male patient presents to the hospital complaining of fatigue, weight gain,
constipation, and slowness of speech. He has recently been started on carbamazepine for
postherpetic neuralgia. His past medical history is suggestive of Hashimoto hypothyroidism, for
which he is on levothyroxine replacement. On examination, he looks slightly depressed, his
responses are slow, and deep tendon reflexes are delayed. What is the most appropriate step in
management? - CORRECT ANSWER - Measure thyroid stimulating hormone level
An otherwise healthy 41-year-old woman presents with excessive urination, excessive thirst, and
unintentional weight loss of 7 lb (3 kg). Her BMI is 31 kg/m^2. The examination is remarkable
for a patch of dark, velvety skin on the back of her neck and in both axillae. A random
fingerstick blood glucose is 215 mg/dL, and point of care HbA1c is 9%. Additional lab work
shows a normal anion gap, no urinary or serum ketones, and a detectable C-peptide. Given the
likely diagnosis, what is the leading cause of morbidity and mortality in this patient's condition?
- CORRECT ANSWER - Cardiovascular disease
A 35-year-old man presents to the clinic for a routine annual visit. He feels well and reports no
abnormalities. His medical history is unremarkable, and he takes no medications regularly. He is
very particular about his diet and exercises regularly. He smokes one pack of cigarettes per day
and a 12-pack of beer every week. Family history is remarkable for essential hypertension in
both parents. His body mass index is 24 kg/m2. Physical examination is normal except for a
xanthelasma present on the right upper eyelid. A lipid panel is ordered, which shows a
cholesterol level of 170 mg/dL, triglyceride (TG) level of 500 mg/dl, low-density lipoproteins
(LDL) level of 90 mg/dl, high-density lipoproteins (HDL) level of 50 mg/dl. In addition to the
lifestyle modifications, which of the following is the most appropriate recommendation for the
management of this patient? - CORRECT ANSWER - Gemfibrozil
A 16-year-old girl presents to the clinic for a follow-up. She was diagnosed with type 1 diabetes
mellitus a few months ago after being admitted to the hospital with diabetic ketoacidosis. She
was started on 10 units of insulin glargine at bedtime and 2 units of insulin aspart with each
meal. She reports feeling fatigued most days but is otherwise doing well. Home glucose readings
reveal an average fasting glucose level of 80 mg/dL. She reports symptomatic hypoglycemia
multiple times a week, primarily postprandial. Her physical examination, including vital signs, is
normal. Today's hemoglobin A1c is 5.8%, which is improved from 10.5% at the time of
diagnosis. What is the best next step in the management of this patient? - CORRECT
ANSWER - Stop insulin aspart and decrease insulin glargine by 2 units
ACTUAL Exam Questions and CORRECT
Answers
A 65-year-old male presents for evaluation and management of his diabetes mellitus type 2.
Three months ago, his labs showed a hemoglobin A1c of 7.5%. Conservative management of
diet and exercise was attempted for three months, during which he gained 5 pounds (2.3 kg)
which he is not happy with. Today, his hemoglobin A1C remains at 7.5%, and his creatinine
level is elevated at 1.8 mg/dl (eGFR=41). Which of the following pharmacological interventions
is the best next step for this patient? - CORRECT ANSWER - Start dapagliflozin
A 35-year-old man diagnosed one year ago with diabetes mellitus type 2, and hypertension
presents for follow-up. He states he is feeling well, exercises daily, and does not smoke. He takes
metformin 500 mg once daily and lisinopril 10 mg once daily. His blood pressure is 122/74
mmHg, and his BMI is 22 kg/m2. Blood work shows a hemoglobin A1c of 7.2% and a low-
density lipoprotein of 100 mg/dL. Which of the following changes to his medication regimen is
indicated at this time? - CORRECT ANSWER - Increase the metformin dose
A 52-year-old man with diabetes mellitus presents for an annual check-up. He has been taking
metformin for the last 8 years. On examination, he has an average blood pressure of 160/90
mmHg on multiple separate measurements. What is the most appropriate next step? - CORRECT
ANSWER - Start an ACE inhibitor with hydrochlorothiazide and follow up in 2 weeks
A 65-year-old woman presents with weight gain, slow speech, slow movement, a lack of energy,
and a loss of interest in the activities of daily living. Her history is significant for type 1 diabetes
mellitus. On physical examination, there is generalized non-pitting edema and delayed reflexes.
Her skin is dry, and there are patches of alopecia on her scalp. Which of the following should be
requested to establish a diagnosis? - CORRECT ANSWER - Antithyroid peroxidase
A 75-year-old male presents to the clinic for follow up. His past medical history is significant for
type 2 diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease, and obesity. He
reports feeling fatigued most days and has multiple symptomatic hypoglycemic episodes per
week. He reports exercise intolerance due to hypoglycemia in the afternoons, as well. His current
medications include metformin, glyburide, atorvastatin, and lisinopril. His physical examination
is noted only for obesity with a body mass index of 30 kg/m2. His vital signs are unremarkable.
Recent blood work shows a hemoglobin A1c of 6.2%. His renal function has decreased from an
, estimated glomerular filtration rate of 60 mL/min 2 years ago to 50 mL/min. What is the next
step in the management of this patient? - CORRECT ANSWER - Stop glyburide
A 65-year-old male patient presents to the hospital complaining of fatigue, weight gain,
constipation, and slowness of speech. He has recently been started on carbamazepine for
postherpetic neuralgia. His past medical history is suggestive of Hashimoto hypothyroidism, for
which he is on levothyroxine replacement. On examination, he looks slightly depressed, his
responses are slow, and deep tendon reflexes are delayed. What is the most appropriate step in
management? - CORRECT ANSWER - Measure thyroid stimulating hormone level
An otherwise healthy 41-year-old woman presents with excessive urination, excessive thirst, and
unintentional weight loss of 7 lb (3 kg). Her BMI is 31 kg/m^2. The examination is remarkable
for a patch of dark, velvety skin on the back of her neck and in both axillae. A random
fingerstick blood glucose is 215 mg/dL, and point of care HbA1c is 9%. Additional lab work
shows a normal anion gap, no urinary or serum ketones, and a detectable C-peptide. Given the
likely diagnosis, what is the leading cause of morbidity and mortality in this patient's condition?
- CORRECT ANSWER - Cardiovascular disease
A 35-year-old man presents to the clinic for a routine annual visit. He feels well and reports no
abnormalities. His medical history is unremarkable, and he takes no medications regularly. He is
very particular about his diet and exercises regularly. He smokes one pack of cigarettes per day
and a 12-pack of beer every week. Family history is remarkable for essential hypertension in
both parents. His body mass index is 24 kg/m2. Physical examination is normal except for a
xanthelasma present on the right upper eyelid. A lipid panel is ordered, which shows a
cholesterol level of 170 mg/dL, triglyceride (TG) level of 500 mg/dl, low-density lipoproteins
(LDL) level of 90 mg/dl, high-density lipoproteins (HDL) level of 50 mg/dl. In addition to the
lifestyle modifications, which of the following is the most appropriate recommendation for the
management of this patient? - CORRECT ANSWER - Gemfibrozil
A 16-year-old girl presents to the clinic for a follow-up. She was diagnosed with type 1 diabetes
mellitus a few months ago after being admitted to the hospital with diabetic ketoacidosis. She
was started on 10 units of insulin glargine at bedtime and 2 units of insulin aspart with each
meal. She reports feeling fatigued most days but is otherwise doing well. Home glucose readings
reveal an average fasting glucose level of 80 mg/dL. She reports symptomatic hypoglycemia
multiple times a week, primarily postprandial. Her physical examination, including vital signs, is
normal. Today's hemoglobin A1c is 5.8%, which is improved from 10.5% at the time of
diagnosis. What is the best next step in the management of this patient? - CORRECT
ANSWER - Stop insulin aspart and decrease insulin glargine by 2 units
