Advanced NP GI & Liver Case Studies Exam – 150
Expert-Level Questions, Answers And Rationale
(2025/2026)
1. Which hormone is primarily responsible for regulating basal
metabolic rate?
A. Cortisol
B. Insulin
C. Thyroxine (T4)
D. Aldosterone
Rationale: Thyroxine (T4) sets the metabolic rate by increasing oxygen
consumption and energy expenditure.
2. A patient with suspected hypothyroidism has elevated TSH and low
free T4. What is the diagnosis?
A. Secondary hypothyroidism
B. Primary hypothyroidism
C. Subclinical hypothyroidism
D. Euthyroid sick syndrome
Rationale: Primary hypothyroidism shows high TSH with low free T4
due to thyroid gland failure.
3. A 52-year-old patient presents with weight loss, tremors,
tachycardia, and heat intolerance. Which diagnostic test is most
specific for Graves disease?
,A. TSH
B. Free T4
C. Thyroid ultrasound
D. TSH receptor antibodies (TRAb)
Rationale: TRAb confirms Graves disease due to autoimmune
stimulation of the thyroid.
4. First-line treatment for hyperthyroidism in a pregnant patient (first
trimester) is:
A. Methimazole
B. Propylthiouracil (PTU)
C. Radioactive iodine
D. Beta blockers only
Rationale: PTU is preferred in 1st trimester due to lower teratogenicity
compared with methimazole.
5. Which medication is the most common cause of drug-induced
hypothyroidism?
A. Metformin
B. Amiodarone
C. Lisinopril
D. Furosemide
Rationale: Amiodarone contains high iodine, disrupting thyroid
hormone synthesis.
6. A can’t-miss symptom of myxedema coma is:
,A. Tachycardia
B. Hypertension
C. Hypothermia
D. Hyperreflexia
Rationale: Severe hypothyroidism causes decreased metabolism
resulting in significant hypothermia.
7. In diabetic ketoacidosis, which electrolyte must be monitored most
closely during insulin therapy?
A. Sodium
B. Potassium
C. Magnesium
D. Calcium
Rationale: Insulin shifts potassium intracellularly, risking rapid
hypokalemia.
8. What is the diagnostic criterion for diabetes using fasting plasma
glucose?
A. ≥100 mg/dL
B. ≥110 mg/dL
C. ≥120 mg/dL
D. ≥126 mg/dL
Rationale: A fasting glucose ≥126 mg/dL on two occasions confirms
diabetes.
9. Which oral medication is first-line therapy for type 2 diabetes?
, A. Sulfonylureas
B. Metformin
C. TZDs
D. DPP-4 inhibitors
Rationale: Metformin is first-line due to efficacy, low cost, and
reduction in cardiovascular risk.
10. A patient on metformin is most at risk for which deficiency?
A. Zinc
B. Vitamin D
C. Vitamin B12
D. Folate
Rationale: Long-term metformin use decreases B12 absorption.
11. Which GLP-1 agonist has the greatest proven cardiovascular
benefit?
A. Lixisenatide
B. Exenatide
C. Semaglutide
D. Albiglutide
Rationale: Semaglutide shows strong cardiovascular protection in
clinical trials.
12. Which class of medications can cause euglycemic DKA?
A. TZDs
B. SGLT2 inhibitors
C. DPP-4 inhibitors
Expert-Level Questions, Answers And Rationale
(2025/2026)
1. Which hormone is primarily responsible for regulating basal
metabolic rate?
A. Cortisol
B. Insulin
C. Thyroxine (T4)
D. Aldosterone
Rationale: Thyroxine (T4) sets the metabolic rate by increasing oxygen
consumption and energy expenditure.
2. A patient with suspected hypothyroidism has elevated TSH and low
free T4. What is the diagnosis?
A. Secondary hypothyroidism
B. Primary hypothyroidism
C. Subclinical hypothyroidism
D. Euthyroid sick syndrome
Rationale: Primary hypothyroidism shows high TSH with low free T4
due to thyroid gland failure.
3. A 52-year-old patient presents with weight loss, tremors,
tachycardia, and heat intolerance. Which diagnostic test is most
specific for Graves disease?
,A. TSH
B. Free T4
C. Thyroid ultrasound
D. TSH receptor antibodies (TRAb)
Rationale: TRAb confirms Graves disease due to autoimmune
stimulation of the thyroid.
4. First-line treatment for hyperthyroidism in a pregnant patient (first
trimester) is:
A. Methimazole
B. Propylthiouracil (PTU)
C. Radioactive iodine
D. Beta blockers only
Rationale: PTU is preferred in 1st trimester due to lower teratogenicity
compared with methimazole.
5. Which medication is the most common cause of drug-induced
hypothyroidism?
A. Metformin
B. Amiodarone
C. Lisinopril
D. Furosemide
Rationale: Amiodarone contains high iodine, disrupting thyroid
hormone synthesis.
6. A can’t-miss symptom of myxedema coma is:
,A. Tachycardia
B. Hypertension
C. Hypothermia
D. Hyperreflexia
Rationale: Severe hypothyroidism causes decreased metabolism
resulting in significant hypothermia.
7. In diabetic ketoacidosis, which electrolyte must be monitored most
closely during insulin therapy?
A. Sodium
B. Potassium
C. Magnesium
D. Calcium
Rationale: Insulin shifts potassium intracellularly, risking rapid
hypokalemia.
8. What is the diagnostic criterion for diabetes using fasting plasma
glucose?
A. ≥100 mg/dL
B. ≥110 mg/dL
C. ≥120 mg/dL
D. ≥126 mg/dL
Rationale: A fasting glucose ≥126 mg/dL on two occasions confirms
diabetes.
9. Which oral medication is first-line therapy for type 2 diabetes?
, A. Sulfonylureas
B. Metformin
C. TZDs
D. DPP-4 inhibitors
Rationale: Metformin is first-line due to efficacy, low cost, and
reduction in cardiovascular risk.
10. A patient on metformin is most at risk for which deficiency?
A. Zinc
B. Vitamin D
C. Vitamin B12
D. Folate
Rationale: Long-term metformin use decreases B12 absorption.
11. Which GLP-1 agonist has the greatest proven cardiovascular
benefit?
A. Lixisenatide
B. Exenatide
C. Semaglutide
D. Albiglutide
Rationale: Semaglutide shows strong cardiovascular protection in
clinical trials.
12. Which class of medications can cause euglycemic DKA?
A. TZDs
B. SGLT2 inhibitors
C. DPP-4 inhibitors
