Endocrine - Chronic

Which of the following best describes the physical activity recommendations such as brisk walking for a 55-year-old woman with newly diagnosed type 2 diabetes mellitus? (Select all that apply.) A. The goal should be for a total increased physical activity of 150 min per week or more. B. Increased physical activity is recommended at least three times per week with no more than 48 hours without exercise C. Some form of resistance exercise such as lifting dumbbells or using an exercise band should be included at least two times per week. D. Vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy because of the possible risk of vitreous hemorrhage or retinal detachment.

A. The goal should be for a total increased physical activity of 150 min per week or more. B. Increased physical activity is recommended at least three times per week with no more than 48 hours without exercise C. Some form of resistance exercise such as lifting dumbbells or using an exercise band should be included at least two times per week. D. Vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy because of the possible risk of vitreous hemorrhage or retinal detachment.

A first-line approach to treating Cushing's syndrome in a 56-year-old woman who has been taking oral corticosteroids to treat rheumatoid arthritis for the past 2 years is: A. gradually tapering corticosteroid use. B. referral for surgery. C. consideration of radiation therapy. D. prescribing mifepristone.

A. gradually tapering corticosteroid use.

Which of the following is an unlikely consequence of untreated metabolic syndrome and IR in a woman of reproductive age? A. hyperovulation B. irregular menses C. acne D. hirsutism

A. hyperovulation

Amenorrhea or oligomenorrhea are associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Frequent, low-volume, loose stools are associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Heat intolerance is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Hyperreflexia with a characteristic "quick out-quick back" action at the patellar reflex is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

Smooth, silky skin is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

A. hyperthyroidism.

The laboratory results TSH = 24 mIU/L (0.4 to 4.0 mIU/L); free T4 = 3 pmol/L (10 to 27 pmol/L) indicate which condition? A. hypothyroidism B. hyperthyroidism C. subclinical hypothyroidism

A. hypothyroidism

After use, the onset of action of lispro (Humalog®) occurs in: A. less than 30 minutes. B. approximately 1 hour. C. 1 to 2 hours. D. 3 to 4 hours.

A. less than 30 minutes.

Which of the following medications is a helpful treatment option for relief of tremor and tachycardia seen with untreated hyperthyroidism? A. propranolol B. diazepam C. carbamazepine D. verapamil

A. propranolol

Clinical presentation of type 1 DM usually includes all of the following except: A. report of recent unintended weight gain. B. ketosis. C. persistent thirst. D. polyphagia.

A. report of recent unintended weight gain.

Untreated Cushing's syndrome can lead to all of the following except: A. rheumatoid arthritis. B. hypertension. C. type 2 diabetes. D. osteoporosis.

A. rheumatoid arthritis.

The use of which of the following medications is often associated with weight gain? A. risperidone (Risperdal®) B. topiramate (Topamax®) C. metformin (Glucophage®) D. sitagliptin (Januvia®)

A. risperidone (Risperdal®)

Which is following is the least helpful test for the assessment of thyroid disease? A. total T4 B. thyroid-stimulating hormone (TSH) C. free T4 D. thyroid peroxidase (TPO) antibodies

A. total T4

Use of naltrexone/bupropion (Contrave®) for weight loss is associated with increased risk of suicidal ideation. A. True B. False

B. False

Hemoglobin A1c should be tested: A. at least annually for all patients. B. at least two times a year in patients who are meeting treatment goals and who have stable glycemic control. C. monthly in patients whose therapy has changed or who are not meeting glycemic goals. D. only via standardized laboratory testing because of inaccuracies associated with point-of-service testing.

B. at least two times a year in patients who are meeting treatment goals and who have stable glycemic control.

Which of the following medications should be used with caution in a person with severe sulfa allergy? A. metformin B. glyburide C. rosiglitazone D. NPH insulin

B. glyburide

The laboratory results TSH less than 0.15 mIU/L (0.4 to 4.0 mIU/L); free T4 = 79 pmol/L (10 to 27 pmol/L) indicate which condition? A. hypothyroidism B. hyperthyroidism C. subclinical hypothyroidism

B. hyperthyroidism

Constipation is associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism.

Thick, dry nails are associated with: A. hyperthyroidism. B. hypothyroidism. C. both hyperthyroidism and hypothyroidism.

B. hypothyroidism.

The hormone cortisol plays a role in all of the following processes except: A. maintaining glucose control. B. maintaining thyroid function. C. suppressing the immune response. D. helping the body respond to stress.

B. maintaining thyroid function.

A pound of fat contains approximately ______ stored calories. A. 2500 B. 3000 C. 3500 D. 4000

C. 3500

Recommended A1c goal in a 79-year-old woman with a 20-year history of type 2 diabetes mellitus who has difficulty ambulating, uses a walker, and has a cardiac ejection fraction of 35% and a history of heart failure should be equal to or less than: A. 7%. B. 7.5%. C. 8%. D. 8.5%.

C. 8%.

The mechanism of action of pioglitazone is as: A. an insulin-production enhancer. B. a reducer of pancreatic glucose output. C. an insulin sensitizer. D. a facilitator of renal glucose excretion.

C. an insulin sensitizer.

Hypothyroidism most often develops as a result of: A. primary pituitary failure. B. thyroid neoplasia. C. autoimmune thyroiditis. D. radioactive iodine exposure.

C. autoimmune thyroiditis.

Cushing's syndrome results from an excess of: A. luteinizing hormone. B. follicle-stimulating hormone. C. cortisol. D. aldosterone.

C. cortisol.

Physical examination findings in patients with Graves' disease include: A. muscle tenderness. B. coarse, dry skin. C. eyelid retraction. D. delayed relaxation phase of the patellar reflex.

C. eyelid retraction.

You are seeing 17-year-old Amanda. As part of the visit, you consider her risk factors for type 2 DM would likely include all of the following except: A. obesity. B. Native American ancestry. C. family history of type 1 DM. D. personal history of polycystic ovary syndrome.

C. family history of type 1 DM.

Five years or more after type 2 diabetes mellitus diagnosis, which of the following medications is less likely to be effective in controlling plasma glucose? A. metformin B. pioglitazone C. glipizide D. insulin

C. glipizide

Cardiovascular effects of hyperinsulinemia include: A. decreased renal sodium reabsorption. B. constricted circulating volume. C. greater responsiveness to angiotensin II. D. diminished sympathetic activation.

C. greater responsiveness to angiotensin II.

Untreated hypothyroidism can result in which of the following changes in the lipid profile? A. increased HDL and decreased triglycerides B. increased LDL and total cholesterol C. increased LDL, total cholesterol, and triglycerides D. decreased LDL and HDL

C. increased LDL, total cholesterol, and triglycerides

Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of: A. hypoglycemia. B. hepatic impairment. C. lactic acidosis. D. interaction with most anesthetic agents.

C. lactic acidosis.

Which of the following classes of medications is commonly recommended as part of first-line therapy in the newly diagnosed person with type 2 diabetes? A. alpha-glucosidase inhibitor B. meglitinide C. thiazolidinedione D. biguanide

D. biguanide

Increased risk of thyroid disorder is found in individuals who are: A. obese. B. hypertensive. C. treated with systemic corticosteroids. D. elderly.

D. elderly.

The use of which of the following medications can induce thyroid dysfunction? A. sertraline B. venlafaxine C. bupropion D. lithium

D. lithium

The action of which of the following is believed to be most responsible for the sensation of satiety? A. norepinephrine B. epinephrine C. dopamine D. serotonin

D. serotonin

The most commonly recommended treatment of Cushing's disease is: A. tapering or ceasing corticosteroid use. B. eliminating trigger medications. C. antineoplastic therapy. D. surgical intervention.

D. surgical intervention.

In the report of a thyroid scan done on a 48-year-old woman with a thyroid mass, a "cold spot" is reported. This finding is most consistent with: A. autonomously functioning adenoma. B. Graves' disease. C. Hashimoto's disease. D. thyroid cyst.

D. thyroid cyst.

At minimum, at what interval should TSH be reassessed after a levothyroxine dosage is adjusted? A. 1 to 2 weeks B. 2 to 4 weeks C. 4 to 6 weeks D. 6 to 8 weeks

D. 6 to 8 weeks

Hemoglobin A1c best provides information on glucose control over the past: A. 21 to 47. B. 48 to 68. C. 69 to 89. D. 90 to 120.

D. 90 to 120.

The use of which of the following medications has the potential for causing the greatest reduction in HbA1c? A. a biguanide B. a thiazolidinedione C. a sulfonylurea D. an insulin form

D. an insulin form

Which of the following statements best describes the Somogyi effect? A. Insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia. B. Early morning elevated blood glucose levels result in part from growth hormone and cortisol-triggering hepatic glucose release. C. Late evening hyperglycemia is induced by inadequate insulin dose. D. Episodes of postprandial hypoglycemia occur as a result of inadequate food intake.

A. Insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia.

Which of the following characteristics applies to type 2 DM? A. Major risk factors are heredity and obesity. B. Pear-shaped body type is commonly found. C. Exogenous insulin is needed for control of disease. D. Physical activity enhances IR.

A. Major risk factors are heredity and obesity.

The mechanism of action of a GLP-1 agonist such as exenatide (Byetta®) is as: A. a drug that stimulates insulin production in response to an increase in plasma glucose. B. a product virtually identical in action to sulfonylureas. C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production. D. a facilitator of renal glucose excretion

A. a drug that stimulates insulin production in response to an increase in plasma glucose.

The findings of a painless thyroid mass and TSH level of less than 0.1 IU/mL in a 35-year-old woman is most consistent with: A. autonomously functioning adenoma. B. Graves' disease. C. Hashimoto's disease. D. thyroid malignancy.

A. autonomously functioning adenoma.

In a person with obesity, weight loss of ______% or more yields an immediate reduction in death rates from cardiovascular and cerebrovascular disease. A. 5 B. 10 C. 15 D. 20

B. 10

With the use of weight loss medications, if the patient has not achieved a 5% weight loss by week ______ of treatment, the therapy should be discontinued. A. 6 B. 12 C. 18 D. 24

B. 12

Generally, testing for type 2 DM in asymptomatic, undiagnosed individuals older than 45 years should be conducted every _________. A. year. B. 3 years C. 5 years D. 10 years

B. 3 years

Consideration should be given to setting A1c goal in a 22-year-old man with a 8-year history of type 1 diabetes mellitus who has no comorbid conditions equal to or at less than: A. 5.5%. B. 6%. C. 6.5%. D. 7%.

B. 6%.

When providing care for a patient taking an HMG-CoA reductase inhibitor, initial evaluation when starting medication includes checking which of the following serological parameters? A. potassium B. alanine aminotransferase C. bilirubin D. alkaline phosphatase

B. alanine aminotransferase

When counseling about malabsorptive bariatric surgery, the NP provides the following information: A. Most people achieve ideal BMI postoperatively. B. The most dramatic weight losses are seen in the first few postoperative months. C. The death rate directly attributable to surgery is about 10%. D. Weight loss will continue for years postoperatively in most patients.

B. The most dramatic weight losses are seen in the first few postoperative months.

The mechanism of action of sulfonylureas is as: A. an antagonist of insulin receptor site activity. B. a product that enhances insulin release. C. a facilitator of renal glucose excretion. D. an agent that can reduce hepatic glucose production.

B. a product that enhances insulin release.

As part of an evaluation of a 3-cm, round, mobile thyroid mass, you obtain a thyroid ultrasound scan revealing a fluid-filled structure. The most likely diagnosis is: A. adenoma. B. thyroid cyst. C. multinodular goiter. D. vascular lesion.

B. thyroid cyst.

In prescribing levothyroxine therapy for an elderly patient, which of the following statements is true? A. Elderly persons require a rapid initiation of levothyroxine therapy. B. TSH should be checked about 2 days after dosage adjustment. C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults. D. TSH should be suppressed to a nondetectable level.

C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults.

Cushing's disease is the specific type of Cushing's syndrome that is caused by: A. long-term exposure to corticosteroids. B. a benign tumor of the adrenal gland. C. a benign pituitary tumor. D. an ectopic tumor that produces ACTH.

C. a benign pituitary tumor.

Which of the following statements is not true concerning the effects of exercise and IR? A. Approximately 80% of the body's insulin-mediated glucose uptake occurs in skeletal muscle. B. With regular aerobic exercise, IR is reduced by approximately 40%. C. The IR-reducing effects of exercise persist for 48 hours after the activity. D. Hyperglycemia can occur as a result of aerobic exercise.

D. Hyperglycemia can occur as a result of aerobic exercise.

The use of a thiazolidinedione is not recommended in all of the following clinical scenarios except: A. a 57-year-old man who is taking a nitrate. B. a 62-year-old woman with heart failure. C. a 45-year-old man who is using insulin. D. a 35-year-old patient with newly diagnosed type 2 DM.

D. a 35-year-old patient with newly diagnosed type 2 DM.

Which of the following patients has prediabetes? A. a 70-year-old man with a fasting glucose of 99 mg/dL (6.05 mmol/L) B. an 84-year-old woman with a 1-hour postprandial glucose of 98 mg/dL (5.44 mmol/L) C. a 33-year-old man with a hemoglobin A1c of 5.4% D. a 58-year-old woman with a 2-hour postprandial glucose of 152 mg/dL (8.44 mmol/L)

D. a 58-year-old woman with a 2-hour postprandial glucose of 152 mg/dL (8.44 mmol/L)

Criteria for the diagnosis of type 2 DM include: A. classic symptoms regardless of fasting plasma glucose measurement. B. plasma glucose level of 126 mg/dL (7 mmol/L) as a random measurement. C. a 2-hour glucose measurement of 156 mg/dL (8.6 mmol/L) after a 75 g anhydrous glucose load. D. a plasma glucose level of 126 mg/dL (7 mmol/L) or greater after an 8 hour or greater fast on more than one occasion.

D. a plasma glucose level of 126 mg/dL (7 mmol/L) or greater after an 8 hour or greater fast on more than one occasion.