1
A patient with a body mass index of 33 complains of fatigue and excessive thirst and
hunger. The NP suspects type 2 DM. Which value during initial testing would confirm
the diagnosis?
A. Fasting plasma glucose level of 105 mg/dL
B. Glycated hemoglobin level (A1C) of 5.4%
C. Oral glucose tolerance testing result of 183 mg/dL
D. Random plasma glucose level of 206 mg/dL
Type 2 DM screening tests include fasting plasma glucose level (>126 mg/dL), random
plasma glucose level (>200 mg/dL), and OGTT (2-hour glucose level >200 mg/dL) with
a 75-g glucose load. Normal A1C (glycosylated hemoglobin) levels are <6%.
A patient presents with an episodic headache, sweating, tachycardia, and hypertension
that has been resistant to therapy. The patient also reports self-limited episodes of
palpitations, tremor, and diaphoresis. Based on this clinical presentation, which of the
following tests would be most helpful for diagnosis?
A. Thyroid panel, including TSH and T4
B. Assessment of serum cortisol and ACTH levels
C. 24-hour urine fractionated metanephrines and catecholamines
D. Assessment of glycosylated hemoglobin
This patient is presenting with the classic triad of episodic headache, sweating, and
tachycardia, concerning for a pheochromocytoma. A low risk of suspicion for
pheochromocytoma includes those with resistant hypertension and hyperadrenergic
spells (self-limited episodes of palpitations, diaphoresis, tremor), in which case a 24-
hour urine fractionated metanephrines and catecholamines test is indicated. A high risk
of suspicion for pheochromocytoma includes patients with an incidentally discovered
adrenal mass on CT scan, a family history of pheochromocytoma, a genetic syndrome
that predisposes to pheochromocytoma, or a history of resected pheochromocytoma. In
this case, the first-line test is to measure plasma fractionated metanephrines. While
most catecholamine-secreting tumors are sporadic, many are part of a familial disorder,
so genetic testing may be indicated during further workup, but usually only after a
pathologic diagnosis has been confirmed. A thyroid panel would be helpful in the
diagnosis of hypo- or hyperthyroidism. Assessment of serum cortisol and ACTH would
aid in the workup of Cushing’s or Addision’s disease. Assessment of blood glucose
would be helpful in this patient presenting with sweating, tremor, and palpitations;
however, obtaining a glycosylated hemoglobin would diagnose diabetes and not aid in
the diagnosis of a pheochromocytoma.
On a routine physical exam, a patient is found to have a thyroid nodule. A neck
ultrasonography reveals a solid hypoechoic nodule of 2 cm with irregular margins.
Laboratory results reveal TSH of 6.2 mU/L. Which of the following diagnostic tests is
the next best step in evaluation?
A. FNA of thyroid B. Assessment of serum antithyroid peroxidase antibodies
C. Measurement of serum calcitonin concentration D. CT neck
This study source was downloaded by 100000901307859 from CourseHero.com on 10-16-2025 09:41:24 GMT -05:00
https://www.coursehero.com/file/250618441/Leik-Endocrine-docx/
, 2
Thyroid nodules are often noted by the patient, during routine physical examinations, or
when incidentally noted during imaging. Initial evaluation includes a history and physical
examination, measurement of serum TSH, and US to confirm the presence of nodularity
and assess the features. If the TSH concentration is normal or high, and the nodule
meets sonographic criteria for sampling, the next step is an ultrasound-guided fine
needle aspiration biopsy, which is the most accurate method for evaluating thyroid
nodules and identifying patients for possible surgery. FNA should be performed in solid
and hypoechoic modules if they are ≥1 to 1.5 cm with at least one of the following
features: irregular margins, microcalcifications, taller-than-wide shape,
macrocalcifications, or peripheral calcifications. A thyroid scintigraphy is indicated if the
serum TSH concentration is low (<0.4 mU/L) to determine the functional status of the
nodule. The routine measurement of serum calcitonin in patients with nodular thyroid
disease is not recommended. While a CT scan may indicate a thyroid nodule during
routine imaging, it is not indicated at this time. While measurement of serum antithyroid
peroxidase antibodies may be helpful in patients with a high TSH suggestive of chronic
autoimmune (Hashimoto’s) thyroiditis, it is not necessary, nor does it negate the need
for fine needle aspiration biopsy.
The best initial screening test for both hyperthyroidism and hypothyroidism is:
A. Free T4 (thyroxine) B. Thyroid-stimulating hormone (TSH)
C. Thyroid profile D. Palpation of the thyroid gland
The best initial screening test for both hypothyroidism and hyperthyroidism is TSH level.
A normal TSH rules out primary hypothyroidism in asymptomatic patients. Abnormal
TSH should be followed by determination of thyroid hormone levels. Overt
hypothyroidism is defined as a clinical syndrome of hypothyroidism associated with
elevated TSH and decreased serum levels of T4 or T3 (triiodothyronine). Subclinical
hypothyroidism is defined as a condition without typical symptoms of hypothyroidism,
elevated TSH (>5 µU/mL), and normal circulating thyroid hormone. Overt thyrotoxicosis
is defined as the syndrome of hyperthyroidism associated with suppressed TSH and
elevated serum levels of T4 or T3. Subclinical thyrotoxicosis is devoid of symptoms, but
TSH is suppressed, although there are normal circulating levels of thyroid hormone.
Which of the following findings is associated with diabetic retinopathy?
A. Arteriovenous (AV) nicking B. Retinal artery narrowing
C. Papilledema D. Microaneurysms
Diabetic retinopathy is classified as nonproliferative or proliferative based on the
absence or presence of abnormal new blood vessels. Nonproliferative retinopathy is
characteristic for nerve-fiber layer infarcts (cotton wool spots), intraretinal hemorrhages,
hard exudates, and microvascular abnormalities (including microaneurysms, occluded
vessels, and dilated or tortuous vessels). AV nicking, retinal arterial narrowing, and
papilledema are ocular effects more specific to hypertension.
This study source was downloaded by 100000901307859 from CourseHero.com on 10-16-2025 09:41:24 GMT -05:00
https://www.coursehero.com/file/250618441/Leik-Endocrine-docx/
A patient with a body mass index of 33 complains of fatigue and excessive thirst and
hunger. The NP suspects type 2 DM. Which value during initial testing would confirm
the diagnosis?
A. Fasting plasma glucose level of 105 mg/dL
B. Glycated hemoglobin level (A1C) of 5.4%
C. Oral glucose tolerance testing result of 183 mg/dL
D. Random plasma glucose level of 206 mg/dL
Type 2 DM screening tests include fasting plasma glucose level (>126 mg/dL), random
plasma glucose level (>200 mg/dL), and OGTT (2-hour glucose level >200 mg/dL) with
a 75-g glucose load. Normal A1C (glycosylated hemoglobin) levels are <6%.
A patient presents with an episodic headache, sweating, tachycardia, and hypertension
that has been resistant to therapy. The patient also reports self-limited episodes of
palpitations, tremor, and diaphoresis. Based on this clinical presentation, which of the
following tests would be most helpful for diagnosis?
A. Thyroid panel, including TSH and T4
B. Assessment of serum cortisol and ACTH levels
C. 24-hour urine fractionated metanephrines and catecholamines
D. Assessment of glycosylated hemoglobin
This patient is presenting with the classic triad of episodic headache, sweating, and
tachycardia, concerning for a pheochromocytoma. A low risk of suspicion for
pheochromocytoma includes those with resistant hypertension and hyperadrenergic
spells (self-limited episodes of palpitations, diaphoresis, tremor), in which case a 24-
hour urine fractionated metanephrines and catecholamines test is indicated. A high risk
of suspicion for pheochromocytoma includes patients with an incidentally discovered
adrenal mass on CT scan, a family history of pheochromocytoma, a genetic syndrome
that predisposes to pheochromocytoma, or a history of resected pheochromocytoma. In
this case, the first-line test is to measure plasma fractionated metanephrines. While
most catecholamine-secreting tumors are sporadic, many are part of a familial disorder,
so genetic testing may be indicated during further workup, but usually only after a
pathologic diagnosis has been confirmed. A thyroid panel would be helpful in the
diagnosis of hypo- or hyperthyroidism. Assessment of serum cortisol and ACTH would
aid in the workup of Cushing’s or Addision’s disease. Assessment of blood glucose
would be helpful in this patient presenting with sweating, tremor, and palpitations;
however, obtaining a glycosylated hemoglobin would diagnose diabetes and not aid in
the diagnosis of a pheochromocytoma.
On a routine physical exam, a patient is found to have a thyroid nodule. A neck
ultrasonography reveals a solid hypoechoic nodule of 2 cm with irregular margins.
Laboratory results reveal TSH of 6.2 mU/L. Which of the following diagnostic tests is
the next best step in evaluation?
A. FNA of thyroid B. Assessment of serum antithyroid peroxidase antibodies
C. Measurement of serum calcitonin concentration D. CT neck
This study source was downloaded by 100000901307859 from CourseHero.com on 10-16-2025 09:41:24 GMT -05:00
https://www.coursehero.com/file/250618441/Leik-Endocrine-docx/
, 2
Thyroid nodules are often noted by the patient, during routine physical examinations, or
when incidentally noted during imaging. Initial evaluation includes a history and physical
examination, measurement of serum TSH, and US to confirm the presence of nodularity
and assess the features. If the TSH concentration is normal or high, and the nodule
meets sonographic criteria for sampling, the next step is an ultrasound-guided fine
needle aspiration biopsy, which is the most accurate method for evaluating thyroid
nodules and identifying patients for possible surgery. FNA should be performed in solid
and hypoechoic modules if they are ≥1 to 1.5 cm with at least one of the following
features: irregular margins, microcalcifications, taller-than-wide shape,
macrocalcifications, or peripheral calcifications. A thyroid scintigraphy is indicated if the
serum TSH concentration is low (<0.4 mU/L) to determine the functional status of the
nodule. The routine measurement of serum calcitonin in patients with nodular thyroid
disease is not recommended. While a CT scan may indicate a thyroid nodule during
routine imaging, it is not indicated at this time. While measurement of serum antithyroid
peroxidase antibodies may be helpful in patients with a high TSH suggestive of chronic
autoimmune (Hashimoto’s) thyroiditis, it is not necessary, nor does it negate the need
for fine needle aspiration biopsy.
The best initial screening test for both hyperthyroidism and hypothyroidism is:
A. Free T4 (thyroxine) B. Thyroid-stimulating hormone (TSH)
C. Thyroid profile D. Palpation of the thyroid gland
The best initial screening test for both hypothyroidism and hyperthyroidism is TSH level.
A normal TSH rules out primary hypothyroidism in asymptomatic patients. Abnormal
TSH should be followed by determination of thyroid hormone levels. Overt
hypothyroidism is defined as a clinical syndrome of hypothyroidism associated with
elevated TSH and decreased serum levels of T4 or T3 (triiodothyronine). Subclinical
hypothyroidism is defined as a condition without typical symptoms of hypothyroidism,
elevated TSH (>5 µU/mL), and normal circulating thyroid hormone. Overt thyrotoxicosis
is defined as the syndrome of hyperthyroidism associated with suppressed TSH and
elevated serum levels of T4 or T3. Subclinical thyrotoxicosis is devoid of symptoms, but
TSH is suppressed, although there are normal circulating levels of thyroid hormone.
Which of the following findings is associated with diabetic retinopathy?
A. Arteriovenous (AV) nicking B. Retinal artery narrowing
C. Papilledema D. Microaneurysms
Diabetic retinopathy is classified as nonproliferative or proliferative based on the
absence or presence of abnormal new blood vessels. Nonproliferative retinopathy is
characteristic for nerve-fiber layer infarcts (cotton wool spots), intraretinal hemorrhages,
hard exudates, and microvascular abnormalities (including microaneurysms, occluded
vessels, and dilated or tortuous vessels). AV nicking, retinal arterial narrowing, and
papilledema are ocular effects more specific to hypertension.
This study source was downloaded by 100000901307859 from CourseHero.com on 10-16-2025 09:41:24 GMT -05:00
https://www.coursehero.com/file/250618441/Leik-Endocrine-docx/
