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I-HUMAN CASES ENDOCRINE SYSTEM EXAM 2026
QUESTIONS LATEST VERSION QUESTIONS AND ANSWERS
i-Human Cases Exam: Endocrine System
70 Questions with Detailed Rationales
Based on Common i-Human Virtual Simulation Scenarios
CASE 1: 55-Year-Old Male with Fatigue and Nocturia – Type 2 Diabetes (Questions 1-
14)
Question 1
A 55-year-old male presents with a 4-month history of fatigue, nocturia (waking 4-5
times/night), increased thirst, and blurred vision. Which of the following is the most
likely diagnosis?
A) Benign Prostatic Hyperplasia (BPH)
B) Type 2 Diabetes Mellitus
C) Obstructive Sleep Apnea
D) Chronic Kidney Disease
Answer: B
Rationale: The classic triad of polyuria (nocturia), polydipsia (increased thirst), and fatigue
with blurred vision is highly suggestive of type 2 diabetes mellitus. Risk factors include age
>45, obesity, and sedentary lifestyle. BPH can cause nocturia but not polydipsia or blurred
vision.
Question 2
What is the most appropriate initial diagnostic test for a patient presenting with
symptoms of diabetes?
A) Complete blood count
B) Fasting plasma glucose
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C) Urinalysis
D) TSH level
Answer: B
Rationale: Fasting plasma glucose is the primary diagnostic test for diabetes. A fasting
glucose ≥126 mg/dL confirms the diagnosis. HbA1c ≥6.5% is also diagnostic. Urinalysis may
show glucosuria but is not diagnostic for diabetes.
Question 3
The patient's HbA1c is 11.2%. What is the significance of this finding?
A) Normal glycemic control
B) Prediabetes
C) Poorly controlled diabetes
D) Gestational diabetes
Answer: C
Rationale: An HbA1c of 11.2% indicates very poorly controlled diabetes. The American
Diabetes Association recommends a target HbA1c <7% for most non-pregnant adults. This
level indicates significant hyperglycemia and risk of complications.
Question 4
The patient is a 55-year-old male with BMI 30.5, hypertension, and hyperlipidemia.
Which medication is first-line therapy for type 2 diabetes in this patient?
A) Insulin
B) Metformin
C) Glipizide
D) Pioglitazone
Answer: B
Rationale: Metformin is the first-line pharmacologic therapy for type 2 diabetes. It reduces
hepatic glucose production and improves insulin sensitivity. It is effective, safe, and
associated with minimal risk of hypoglycemia.
Question 5
The patient reports he stopped taking metformin due to gastrointestinal side effects.
Which intervention is most appropriate?
A) Discontinue metformin permanently
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B) Switch to extended-release metformin
C) Start insulin therapy
D) Increase the dose of glipizide
Answer: B
Rationale: Switching to extended-release (ER) metformin and starting at a low dose with
titration can minimize GI side effects. Metformin should be taken with food. GI side effects
are common but often resolve with dose adjustment.
Question 6
The patient's examination reveals decreased sensation on plantar surfaces and reduced
vibration sense. What complication of diabetes is this?
A) Peripheral neuropathy
B) Peripheral vascular disease
C) Autonomic neuropathy
D) Diabetic nephropathy
Answer: A
Rationale: Diabetic peripheral neuropathy presents as decreased sensation in a "stocking-
glove" distribution. The monofilament test is used to assess protective sensation. This is a
microvascular complication of diabetes.
Question 7
Fundoscopic examination reveals non-proliferative diabetic retinopathy with
microaneurysms. What is the appropriate referral?
A) Cardiology
B) Nephrology
C) Ophthalmology
D) Neurology
Answer: C
Rationale: Patients with diabetic retinopathy should be referred to ophthalmology for a
dilated eye exam. Annual eye exams are recommended for all patients with diabetes to detect
and treat retinopathy early.
Question 8
The patient's urine albumin-to-creatinine ratio (UACR) is 180 mg/g. What does this
I-HUMAN CASES ENDOCRINE SYSTEM EXAM 2026
QUESTIONS LATEST VERSION QUESTIONS AND ANSWERS
i-Human Cases Exam: Endocrine System
70 Questions with Detailed Rationales
Based on Common i-Human Virtual Simulation Scenarios
CASE 1: 55-Year-Old Male with Fatigue and Nocturia – Type 2 Diabetes (Questions 1-
14)
Question 1
A 55-year-old male presents with a 4-month history of fatigue, nocturia (waking 4-5
times/night), increased thirst, and blurred vision. Which of the following is the most
likely diagnosis?
A) Benign Prostatic Hyperplasia (BPH)
B) Type 2 Diabetes Mellitus
C) Obstructive Sleep Apnea
D) Chronic Kidney Disease
Answer: B
Rationale: The classic triad of polyuria (nocturia), polydipsia (increased thirst), and fatigue
with blurred vision is highly suggestive of type 2 diabetes mellitus. Risk factors include age
>45, obesity, and sedentary lifestyle. BPH can cause nocturia but not polydipsia or blurred
vision.
Question 2
What is the most appropriate initial diagnostic test for a patient presenting with
symptoms of diabetes?
A) Complete blood count
B) Fasting plasma glucose
, Page 2 of 25
C) Urinalysis
D) TSH level
Answer: B
Rationale: Fasting plasma glucose is the primary diagnostic test for diabetes. A fasting
glucose ≥126 mg/dL confirms the diagnosis. HbA1c ≥6.5% is also diagnostic. Urinalysis may
show glucosuria but is not diagnostic for diabetes.
Question 3
The patient's HbA1c is 11.2%. What is the significance of this finding?
A) Normal glycemic control
B) Prediabetes
C) Poorly controlled diabetes
D) Gestational diabetes
Answer: C
Rationale: An HbA1c of 11.2% indicates very poorly controlled diabetes. The American
Diabetes Association recommends a target HbA1c <7% for most non-pregnant adults. This
level indicates significant hyperglycemia and risk of complications.
Question 4
The patient is a 55-year-old male with BMI 30.5, hypertension, and hyperlipidemia.
Which medication is first-line therapy for type 2 diabetes in this patient?
A) Insulin
B) Metformin
C) Glipizide
D) Pioglitazone
Answer: B
Rationale: Metformin is the first-line pharmacologic therapy for type 2 diabetes. It reduces
hepatic glucose production and improves insulin sensitivity. It is effective, safe, and
associated with minimal risk of hypoglycemia.
Question 5
The patient reports he stopped taking metformin due to gastrointestinal side effects.
Which intervention is most appropriate?
A) Discontinue metformin permanently
, Page 3 of 25
B) Switch to extended-release metformin
C) Start insulin therapy
D) Increase the dose of glipizide
Answer: B
Rationale: Switching to extended-release (ER) metformin and starting at a low dose with
titration can minimize GI side effects. Metformin should be taken with food. GI side effects
are common but often resolve with dose adjustment.
Question 6
The patient's examination reveals decreased sensation on plantar surfaces and reduced
vibration sense. What complication of diabetes is this?
A) Peripheral neuropathy
B) Peripheral vascular disease
C) Autonomic neuropathy
D) Diabetic nephropathy
Answer: A
Rationale: Diabetic peripheral neuropathy presents as decreased sensation in a "stocking-
glove" distribution. The monofilament test is used to assess protective sensation. This is a
microvascular complication of diabetes.
Question 7
Fundoscopic examination reveals non-proliferative diabetic retinopathy with
microaneurysms. What is the appropriate referral?
A) Cardiology
B) Nephrology
C) Ophthalmology
D) Neurology
Answer: C
Rationale: Patients with diabetic retinopathy should be referred to ophthalmology for a
dilated eye exam. Annual eye exams are recommended for all patients with diabetes to detect
and treat retinopathy early.
Question 8
The patient's urine albumin-to-creatinine ratio (UACR) is 180 mg/g. What does this
