Uworld Endocrine Step 2 Ck Questions And Correct Answers

UWORLD ENDOCRINE STEP 2 CK
QUESTIONS AND CORRECT ANSWERS
................A2inA2patientsA2withA2*long-standingA2diabetes*A2reducesA2theA2glucose-
raisingA2effectsA2ofA2epinephrineA2andA2*suppressesA2theA2symptoms*A2relatedA2toA2theA2
catecholamineA2surge,A2increasingA2theA2riskA2forA2progressivelyA2worseningA2hypoglyce
micA2episodesA2(ie,A2*hypoglycemia-associatedA2autonomicA2failure*).A2-A2Ans--
RecurrentA2orA2severeA2hypoglycemia

EffectsA2ofA2diabetesA2medicationsA2onA2weightA2-A2Ans--WeightA2*gain*:
-Insulin
-......glitazones
-SulfonylureasA2(-mide,A2-ride,A2-zide)
-MeglitinidesA2(-glinide)
WeightA2*neutral*:
-DPP-4A2inhibitorsA2(-gliptin)
WeightA2*loss*:A2
-Metformin
-GLP-1A2analogsA2(-tide)
-SGLT2A2inhibitorsA2(-flozin)

InsulinA2andA2C-peptideA2areA2increasedA2inA2......A2-A2Ans---insulinomaA2
-*sulfonylurea*A2orA2meglitinideA2use

.................A2decreasesA2insulinA2secretionA2inA2patientsA2withA2severeA2*sulfonylureaA2ov
erdose*.A2(---A2hypoglycemia)A2-A2Ans--Octreotide
(somatostatinA2analog)

Add-
onA2therapyA2inA2typeA22A2diabetesA2mellitusA2forA2patientsA2withA2establishedA2cardiovasc
ularA2diseaseA2includesA2...............A2andA2...............,A2whichA2reduceA2cardiovascularA2mo
rtalityA2andA2morbidity.A2-A2Ans--1)A2glucagon-likeA2peptide-1A2(GLP-
1)A2receptorA2agonistsA2(-tide)
2)A2sodium-glucoseA2cotransporterA22A2(SGLT-2)A2inhibitorsA2(-flozin)

WhatA2isA2theA2mostA2beneficialA2therapyA2forA2reducingA2theA2progressionA2ofA2diabeticA2
nephropathy?A2-A2Ans--StrictA2bloodA2pressureA2control
(
ACEA2inhibitorsA2andA2angiotensinA2IIA2receptorA2blockersA2areA2theA2preferredA2antihyper
tensiveA2drugs;A2theseA2agentsA2lowerA2systemicA2BPA2andA2alsoA2reduceA2intraglomerul
arA2pressure,A2whichA2mayA2beA2renoprotective.)

,InA2patientsA2withA2diabetesA2mellitus,A2intensiveA2bloodA2glucoseA2controlA2withA2insulinA2
reducesA2theA2riskA2ofA2what?A2-A2Ans--
MicrovascularA2complicationsA2(eg,A2retinopathy,A2nephropathy)
(doesA2*not*A2reduceA2*macrovascular*A2complicationsA2[eg,A2stroke,A2myocardialA2infarct
ion]A2orA2*all-causeA2mortality*)

WhatA2isA2theA2mostA2appropriateA2adviceA2forA2aA2patientA2onA2metforminA2whoA2isA2sche
duledA2forA2cardiacA2catheterizationA2inA22A2days?A2-A2Ans--
*Discontinue*A2metforminA2*onA2theA2day*A2ofA2procedureA2(regardlessA2ofA2baselineA2cre
atinine)A2andA2*restartA22A2daysA2after*A2procedure

(MetforminA2canA2increaseA2theA2riskA2forA2*lacticA2acidosis*A2whenA2combinedA2withA2larg
e-doseA2intravenousA2iodineA2contrastA2[eg,A2duringA2coronaryA2angiography])

WhatA2isA2theA2nextA2stepA2inA2managementA2forA2aA2diabeticA2patientA2takingA2metformin
A2andA2nightlyA2insulinA2glargineA2thatA2presentsA2withA2anA2*elevatedA2hemoglobinA2A1c*
A2despiteA2*normalA2fasting*A2glucoseA2levels?A2-A2Ans--AddA2rapid-
actingA2mealtimeA2insulin
(thisA2patientA2likelyA2hasA2*postprandialA2hyperglycemia*)

(NPHA2orA2long-
actingA2insulinA2analogs)A2isA2associatedA2withA2aA2higherA2riskA2ofA2*hypoglycemia*.A2-
A2Ans--NPH




VeryA2highA2A1cA2levelsA2(*>10%*)A2suggestA2significantA2hyperglycemiaA2*throughoutA2t
heA2day*,A2whereasA2lesserA2abnormalitiesA2areA2oftenA2dueA2toA2elevationsA2inA2..............
.A2-A2Ans--onlyA2postprandialA2glucoseA2levels

WhatA2isA2theA2dawnA2phenomenon?A2-A2Ans--
anA2*earlyA2morningA2hyperglycemicA2surge*A2dueA2toA2theA2diurnalA2increaseA2inA2growth
A2hormoneA2andA2cortisolA2secretion


WhatA2isA2theA2likelyA2diagnosisA2inA2aA2patientA2withA2
-*sepsis*A2(fever,A2hypotension,A2dehydration,A2tachycardia)
-*hyperglycemia,A2ketoacidosis*
-*normal*A2hemoglobinA2A1cA2level?A2-A2Ans--StressA2hyperglycemiaA2
(transientlyA2elevatedA2bloodA2glucoseA2levelsA2inA2theA2contextA2ofA2*severeA2illness*A2inA
2patientsA2withoutA2knownA2diabetesA2mellitus)


(associatedA2withA2increasedA2morbidityA2riskA2andA2isA2causedA2byA2highA2circulatingA2str
essA2hormonesA2[eg,A2cortisol,A2catecholamines])

WhatA2isA2theA2underlyingA2etiologyA2ofA2alteredA2mentalA2statusA2inA2patientsA2withA2hype
rosmolarA2hyperglycemicA2state?A2-A2Ans--Hyperosmolality

, WhatA2isA2theA2mostA2importantA2initialA2stepA2inA2managementA2ofA2aA2patientA2withA2hyp
erosmolarA2hyperglycemicA2state?A2-A2Ans--FluidA2replacementA2withA2*normal*A2saline

HowA2doA2totalA2K+A2levelsA2typicallyA2changeA2inA2patientsA2withA2diabeticA2ketoacidosisA
2orA2hyperosmolarA2hyperglycemicA2state?A2-A2Ans--Decreased
(patientsA2mayA2haveA2normalA2orA2elevatedA2K+A2onA2labsA2dueA2toA2movementA2ofA2pot
assiumA2outA2ofA2cellsA2fromA2insulinA2insufficiency)

*DiabeticA2ketoacidosis*A2isA2causedA2byA2insulinA2deficiencyA2thatA2leadsA2toA2increasedA
2lipolysisA2ofA2............A2fatA2storesA2secondaryA2toA2highA2catecholamineA2levels.A2TheseA
2fattyA2acidsA2areA2deliveredA2toA2theA2.............A2andA2brokenA2downA2intoA2ketones.A2-
A2Ans---peripheral
-liver

WhatA2lipid-
loweringA2agentA2isA2theA2mostA2appropriateA2inA2theA2managementA2ofA2aA246-year-
oldA2manA2withA2DMA2andA2mildA2hypertriglyceridemiaA2(250)?A2-A2Ans--Statin
(indicatedA2forA2theA2primaryA2preventionA2ofA2atheroscleroticA2cardiovascularA2diseaseA2i
nA2allA2patientsA2ageA2≥40A2withA2diabetesA2mellitus,A2regardlessA2ofA2LDLA2level)
(FibratesA2areA2indicatedA2inA2patientsA2withA2severeA2hypertriglyceridemiaA2[ie,A2>1000])

InA2patientsA2withA2moderatelyA2increasedA2albuminuriaA2(albumin/
creatinineA2ratioA2ofA2*30-300*A2mg/
g)A2andA2*hypertension*,A2................A2areA2indicatedA2forA2*secondaryA2prevention*A2ofA2d
iabeticA2nephropathyA2asA2theyA2reduceA2progressionA2toA2overtA2nephropathyA2andA2kidn
eyA2failure.A2-A2Ans---ACEA2inhibitorsA2(ACEIs)A2(eg,A2lisinopril)A2orA2
-AngiotensinA2IIA2receptorA2blockersA2(ARBs)

WhatA2isA2theA2recommendationA2forA2aA2patientA2withA2typeA21A2DMA2whoA2takesA2preme
alA2bolusA2insulinA2andA2basalA2insulinA2andA2wantsA2toA2runA2long-distance?A2-A2Ans---
decreaseA2premealA2bolusA2insulinA2priorA2toA2exercise
-decreaseA2basalA2insulinA2(forA2prolongedA2exercise)

(proteinA2intakeA2priorA2toA2exerciseA2willA2notA2preventA2hypoglycemiaA2andA2isA2notA2nec
essary)

AllA2patientsA2withA2*typeA21A2DM*A2shouldA2beA2*screenedA2atA2diagnosis*A2withA2antibod
iesA2againstA2.................A2-A2Ans---thyroglobulin,A2thyroidA2peroxidase
-tissueA2transglutaminase

(PatientsA2withA2typeA21A2DMA2areA2atA2increasedA2riskA2forA2otherA2autoimmuneA2conditio
ns,A2mostA2commonlyA2autoimmuneA2thyroiditisA2andA2celiacA2disease.)

WhichA2testA2isA2abnormalA2inA2aA2newbornA2bornA24.2A2kgA2fromA2aA2motherA2withA2gesta
tionalA2diabetes?A2TheA2infant'sA2handsA2andA2feetA2areA2cyanotic.A2-A2Ans--
GlucoseA2level