ENDOCRINE ROSH
A 12-year-old girl presents to the clinic with her mother for a routine checkup. The clinician notes breast budding with slight areola enlargement and sparse growth of pubic hair over the labia. The mother asks if she is developing normally. How should the clinician respond? AShe is developing normally BShe needs her hormone levels checked CShe needs to follow up in 6 months DShe needs to see a pediatric endocrinologist
A
A 16-year-old boy presents to the clinic for follow-up after routine laboratory tests to evaluate his complaint of dizziness, especially in the morning. His fasting laboratory tests that were done 2 days ago are unremarkable other than glucose 58 mg/dL. What is the most appropriate next step in the management of this patient? AObtain a thorough history BOrder a home blood glucose monitor COrder an oral glucose tolerance test DOrder repeat serum glucose level
A
A 28-year-old man presents to establish care at your primary care clinic. He works as an electrical engineer and reports he has a fairly sedentary lifestyle. He states he smokes half a pack of cigarettes a day, and is not interested in quitting. He denies any past medical history and states he does not take any medications. He does mention that his father had a heart attack when he was 43 years old. What is the most appropriate next step for this patient? AFasting lipid panel BHealth maintenance counseling only CPoint of care glucose test DStart statin therapy
A
A 34-year-old man presents complaining of anterior neck pain for the past two days. He had a few days of nasal congestion, a mild sore throat, and a cough three weeks before the onset of neck pain. Physical exam reveals a diffusely enlarged and tender thyroid gland. Which of the following is the most likely diagnosis? ADe Quervain thyroiditis BGraves' disease CHashimoto thyroiditis DPlummer syndrome
A
A 35-year-old man presents to the clinic with intermittent episodes of moderate-to-severe headaches, sweating, and palpitations. These symptoms have occurred once or twice weekly for the past 4 months and three times in the past week. He also notes a mild tremor that occurs during the episodes. He currently has a headache that he rates as 5/10 on the pain scale. On examination, his blood pressure is 168/100 mm Hg, and his pulse is 112 bpm and regular. He appears pale and diaphoretic. Which of the following is the most appropriate diagnostic test for the patient's suspected condition? A24-hour urinary fractionated metanephrines and normetanephrines BAldosterone-to-renin ratio CLow-dose dexamethasone suppression DThyroid-stimulating hormone with reflex to thyroxine
A
A 37-year-old woman presents to the clinic to establish care. She has no current concerns and no significant medical history. She is not currently employed, drinks alcohol socially, eats a high-carbohydrate diet, and is physically inactive. On exam, you note obesity, a high level of abdominal fat distribution, and acanthosis nigricans. Which of the following is most likely to confirm the diagnosis of the suspected condition? A A1C level of 7.5% B Blood pressure reading of 172/91 mm Hg C Low-density lipoprotein level of 185 mg/dL D Thyroid-stimulating hormone level of 0.2 U/mL
A
A 40-year-old man with a history of dyslipidemia presents to the clinic after lipid laboratory tests. The lipid panel shows total cholesterol 210 mg/dL, LDL-C unable to calculate, HDL-C 30 mg/dL, and triglycerides 550 mg/dL. What is the most appropriate medication for the initial management of his dyslipidemia? AAtorvastatin BFenofibrate CNiacin DOmega 3 fatty acid
A
A 40-year-old man with a history of type 2 diabetes mellitus and hypertension presents to the clinic for a routine follow-up. His recent basic metabolic panel and urinalysis show no abnormalities. He is taking metformin, empagliflozin, amlodipine, chlorthalidone, and lisinopril. Which of the patient's medications are considered first-line therapies for hypertension? AAll of his blood pressure medications are considered first-line therapy BAmlodipine CEmpagliflozin DLisinopril
A
A 43-year-old woman presents to the clinic for her annual physical. She reports some concerns about changes in weight, depression, irregular menses, and increased sweating. She has a history of chronic low back pain and asthma. On exam, you note a buffalo hump, hirsutism, acne, and hyperhidrosis. Her blood pressure is found to be elevated at 171/96 mm Hg. Which of the following findings is most likely to be increased with the suspected condition? AAdrenocorticotropic hormone BAntidiuretic hormone CCatecholamines DProgesterone
A
A 45-year-old woman with a history of type 2 diabetes mellitus presents to your office with a complaint of occasional episodes of diaphoresis, anxiety, tremors, and weakness. Which of the following medications is most likely the cause of her symptoms? AGlipizideCorrect BLisinopril CMetformin DSimvastatin
A
A 46-year-old woman returns for a follow-up visit for obesity management. Her history includes obesity (with a body mass index of 32 kg/m2), diabetes mellitus type 2, hypertension, and depression. Her medications include metformin 1,000 mg twice daily, losartan 100 mg daily, and fluoxetine 20 mg daily. Six weekl goal was to lose 1-2 pounds per week. Her strategies included walking 150 minutes per week and decreasing her calories to 1,200 per day. Her weight is down 4 pounds since her visit 6 weeks ago. She is frustrated because the weight she lost was in the first few weeks and her weight has plateaued. Which of the following would be the most appropriate next step? AEncourage her to keep a daily food and exercise log BIncrease her fluoxetine dose to 40 mg daily CPrescribe lorcaserin 10 mg twice daily DRefer her for bariatric surgery
A
A 59-year-old woman presents to the clinic with generalized muscle weakness and bone pain. She reports these symptoms have been present for the past 2-3 months and appear to be getting worse. She has a 10-year history of well-controlled hypertension and hyperlipidemia. She had gastric bypasst/L), and 25-hydroxyvitamin D is 8.1 ng/mL (20.2 nmol/L). Her dual-energy X-ray absorptiometry T-score value is −2.8. What is the most appropriate treatment for this patient? A50,000 international units of vitamin D2 once weekly along with 1,200 mg of daily calcium B800 international units of vitamin D3 daily along with 1,200 mg of daily calcium CAlendronate 70 mg once weekly DDenosumab 60 mg once every 6 months
A
A 6-year-old girl presents to the clinic with her mother for frequent urination. The mother states the patient just recovered from influenza and seems to need to urinate more frequently than normal. She states that the child has even been wetting the bed at night even though she has been potty trained since she was 3 years old. During the exam, the child vomits in the trash can. Her urinalysis is negative for infection. Which of the following laboratory findings would confirm the suspected diagnosis? AFasting plasma glucose 136 mg/dL BHbA1C 6.1% CPostprandial plasma glucose 155 mg/dL DRandom plasma glucose 182 mg/dL
A
A 62-year-old man presents to the clinic for follow-up on his hyperlipidemia. He is currently taking simvastatin 40 mg PO daily. The provider orders a fasting lipid panel, and his LDL-C is 245 mg/dL. During the exam, the patient reports muscle pain in his legs. Which of the following is the most appropriate next step in management? ADiscontinue simvastatin and add ezetimibe BIncrease the dose of simvastatin CMaintain the current treatment regimen DMaintain the dose of simvastatin and add gemfibrozil
A
A 65-year-old man presents to the clinic for a follow-up after initiating multiple hypertriglyceridemia therapies. His triglycerides continue to be significantly elevated. What element could be contributing to persistently elevated triglycerides? AAlcohol use disorder BControlled diabetes mellitus CHistory of myocardial infarction DMetamephatime use
A
A 67-year-old man presents to the clinic for a follow-up on his hypertension. His blood pressure is 132/84 mm Hg. His body mass index is 32 kg/m2, and his waist circumference is 130 cm. His current blood work reveals a fasting plasma glucose of 184 mg/dL, high-density lipoprotein of 42 mg/dL, low-density lipoprotein of 72 mg/dL, and a creatinine of 2.08 mg/dL. His current medications include lisinopril 10 mg daily, atorvastatin 20 mg daily, and metformin 500 mg twice daily. Which of the following actions should the clinician take at this time to reduce the risk of mortality? AAdd aspirin 81 mg daily BAdd metoprolol 12.5 mg twice daily CIncrease atorvastatin to 40 mg daily DIncrease lisinopril to 20 mg daily
A
A 7-year-old boy who is otherwise healthy presents to the clinic and is accompanied by his concerned caregiver who reports that the child seems to have begun pubertal development. On the physical assessment, there is symmetrical testicular growth and sparse hair growth at the base of the penis. The clinician will formulate a plan of care based on which of the following most probable causes for the suspected condition? A Central nervous system lesion B Cryptorchidism C Exogenous sex steroids D Klinefelter syndrome
A
A 70-year-old woman with a history of osteoporosis presents to the clinic for a follow-up. She has a T-score of −3.0 at her hip and spine. She was started on alendronate 10 mg daily at her last visit 1 month ago. Today, she reports that she stopped taking the medication because she was experiencing pain and burning in her chest and throat. What is the best next step in managing this patient's condition? ASwitch to intravenous zoledronic acid 5 mg once yearly BSwitch to oral alendronate 70 mg once weekly CSwitch to oral raloxifene 60 mg once daily DSwitch to transdermal estradiol 0.05 mg daily
A
A 72-year-old man presents to the clinic for evaluation following a recent hospitalization for congestive heart failure. He achieved euvolemic status during his inpatient stay, and his daily weights have been steady since. He is feeling well and has no complaints. Today's significant lab work reveals sodium of 128 mEq/L and B-type natriuretic peptide of 375 pg/mL. Which of the following is the most appropriate treatment option to correct his condition? AFluid restriction BIncreased dietary salt COral salt tablets DSaline infusion
A
A new thyroid nodule is found in an 82-year-old man. He questions the risk of this nodule being malignant. You perform a detailed history and discover that his maternal uncle worked as a nuclear energy technologist and had "some kind" of head and neck cancer. As a child, the patient received radiation treatments for severe acne. He has had 6 CT scans throughout his life. He is retired, but worked as a plumber in a hydroelectric plant for 35 years. Which of the following risk factors places him at highest risk for a malignant thyroid nodule? A Childhood acne treatment B Exposure to CT scans C Family history D Occupational exposure
A
A seven-year-old boy has redeveloped nocturnal enuresis over the past month. His family denies new stressors, but they have noted increased frequency of urination during the daytime. He has lost three pounds since his last visit six months ago. He appears thin but well hydrated. Which of the following is the most appropriate next step? AObtain a blood glucose measurement BObtain a urinalysis CObtain spinal ultrasonography DProvide reassurance
A
Hyperthyroidism is an excessive amount of thyroid hormone in tissues resulting in symptoms of thinning hair, dysphagia, lid lag, jitteriness, tachycardia, anxiety, hyperdefecation, goiter, and sweating. What is the best treatment of the adrenergic symptoms in a patient presenting with hyperthyroidism? AAtenolol 25-100 mg by mouth once daily BLevothyroxine 50 mcg by mouth daily CMethimazole 5-120 mg by mouth daily DRadioactive iodine 10-30 millicurie
A
Which of the following is the best first-line therapy for an 8-year-old girl diagnosed with Graves' hyperthyroidism? AMethimazole BPropylthiouracil CRadioactive iodine DSurgical removal of thyroid
A
Which of the following is the most common cause of acquired hypothyroidism in children in the United States? AAutoimmune thyroiditis BIodine deficiency CThyroidectomy DWilliams syndrome
A
Which of the following laboratory findings would you expect to find in primary hyperaldosteronism? AHypokalemia BHyponatremia CLow serum aldosterone DMetabolic acidosis
A
Which one of the following is most likely to cause hypoglycemia in the older population? AGlyburide BMetformin CPioglitazone DSitagliptin
A
A 12-year-old girl presents to the clinic for an annual wellness visit. The physical exam shows sparse pubic hair and breast budding. She reports that menarche has not yet begun. Which of the following Tanner stages is applicable for the patient? ATanner stage I BTanner stage IICorrect Answer CTanner stage III DTanner stage V
B
A 21-year-old man presents to the clinic with ongoing polyuria after recently being discharged from the hospital for a fall and head trauma. Which of the following hormones should the clinician test to help confirm a diagnosis? AAdrenocorticotropic hormone BAntidiuretic hormone CGrowth hormone DThyroid-stimulating hormone
B
A 30-year-old man with a history of type 2 diabetes mellitus and untreated hypertriglyceridemia with triglycerides between 1,000-1,500 mg/dL presents to the clinic for a routine follow-up. What is an expected physical exam finding due to hypertriglyceridemia? A Acanthosis nigricans B Eruptive xanthomas C Thyroid nodule D Vision impairment
B
A 30-year-old woman presents to the clinic with unexplained weight loss. The patient states that her appetite is normal. The provider orders a serum TSH, and it results low. Which of the following additional clinical manifestations is consistent with the suspected diagnosis? ABradycardia BHeat intolerance CHeavy menstrual periods DMuscle aches
B
A 30-year-old woman with no significant history and a normal body mass index presents to the clinic for her yearly wellness visit. The patient explains that she has been laid off from work for the past 6 months. During this time, she has been relying on eating foods that are inexpensive and high in saturated fats. She states that she has not been exercising since she had to cancel her gym membership because she could no longer afford it. Which of the following diagnoses is she most likely at risk for? AColon cancer BHyperlipidemia CMetabolic syndrome DPancreatitis
B
A 35-year old female nurse with a history of borderline personality disorder presents to the emergency department for the second time with an acute hypoglycemic episode. These episodes have no relation to meals or fasting. She does not have a history of diabetes; however, her husband is an insulin dependent diabetic. Which of the following laboratory results aids in the confirmation of the suspected diagnosis in this patient? APlasma neuropeptide Y level BSerum C-peptide level CSerum chromogranin A level DUrinary vanillylmandelic acid level
B
A 36-year-old man presents with complaints of increasing thirst, urination, and fatigue. His body mass index is 36 kg/m2. No abnormalities are noted on physical exam, however, laboratory examination shows a fasting blood glucose of 160 mg/dL. Which of the following lab results would further confirm your diagnosis? AHemoglobin A1c greater than 5.7% BRandom plasma glucose greater than 200 mg/dL CTwo-hour plasma glucose measurement greater than 140 mg/dL after glucose tolerance testing DUndetectable C-peptide levels
B
A 42-year-old woman presents to the clinic complaining of weight loss and fatigue. The patient also reports nausea, dizziness, muscle aches, and loss of libido. On physical exam, the provider notes hyperpigmentation of the skin and decreased axillary hair. Which of the following laboratory findings is consistent with the suspected diagnosis? AGlucose 392 mg/dL BPotassium 5.8 mmol/L CSerum cortisol 500 nmol/L DSodium 152 mEq/L
B
A 44-year-old man presents to the clinic with polyuria and insatiable thirst. The patient's serum glucose is 80 mg/dL. Which of the following laboratory findings is consistent with the suspected diagnosis? APlasma osmolality 190 mOsm/kg BSerum sodium 152 mEq/L CUrinary sodium 30 mEq/L DUrine osmolality 602 mOsm/kg
B
A 45-year-old woman with a history of Hashimoto thyroiditis, obesity, and dyslipidemia presents to the community clinic for a routine physical examination. She takes levothyroxine 150 mcg daily and atorvastatin 40 mg daily. She reports that she has been eating healthier foods, exercising more regularly, and has lost 20 lbs in the past year. Her previsit laboratory tests show a TSH of 0.3 mU/L, FT4 of 2.6 ng/dL, total cholesterol of 165 mg/dL, LDL of 100 mg/dL, and HDL of 45 mg/dL. What is the best next step in managing this patient's condition? AAdd cholestyramine 4 g daily BDecrease dose of levothyroxine by 12 mcg daily CFollow-up and repeat labs in 6 months DIncrease dose of levothyroxine by 12 mcg daily
B
A 56-year-old woman with a 10-year history of type 2 diabetes mellitus presents to the primary care clinic with intermittent burning and tingling in her feet that started 1 year ago. She takes metformin 1,000 mg twice per day and glyburide 5 mg daily. She has a hemoglobin A1C of 8.2%. On examination, she has absent ankle reflexes bilaterally, reduced vibration sense on the dorsum of her great toes, and a score of 6 out of 10 bilaterally on the monofilament test. Which of the following is the most likely diagnosis? AChronic inflammatory demyelinating polyneuropathy BDistal symmetric polyneuropathy CLumbosacral polyradiculopathy DPeripheral mononeuropathy
B
A 61-year-old woman presents to the clinic for a reevaluation after 6 months of diet and lifestyle interventions for dyslipidemia. She is not diabetic, has no family history of premature atherosclerotic cardiovascular disease, and medications include omeprazole and levothyroxine. At her initial exam 6 months ago, findings included total cholesterol 276 mg/dL, HDL 64 mg/dL, LDL-C 176 mg/dL, triglys unsure about starting a medication. What is the best next step for this patient? A Advise a high-intensity statin B Consider a coronary artery calcium C Initiate a blood pressure lowering medication D Start ezetimibe to lower LDL-C
B
A 64-year-old woman had routine lab testing before her yearly complete physical exam. The results demonstrate an elevated calcium level. Which of the following is the next best step in managing this patient? AOrder a radionuclide scan BOrder a serum parathyroid hormone level COrder a serum vitamin D level DReferral to otolaryngology
B
A 67-year-old man is being treated for type 2 diabetes. He has a history of obesity with a BMI of 33 kg/m2 and class I congestive heart failure. Which of the following classes of diabetic medications works mainly by suppressing hepatic gluconeogenesis? AAlpha-glucosidase inhibitors BBiguanides CSulfonylureas DThiazolidinediones
B
A 75-year-old man presents to the clinic for a 2-week follow-up after lisinopril was added to his medication regimen. His current blood pressure medications include amlodipine, hydrochlorothiazide, and metoprolol. His blood pressure today is 145/82 mm Hg. His average home blood pressure is 140/80 mm Hg. He states he has dizziness with positional changes but reports no syncope or presyncope. Which of the following is the best next step in the management of his hypertension? AContinue to measure blood pressure at home BDiscuss the risks and benefits of raising the patient's blood pressure goal CStop lisinopril DStop metoprolol
B
A 78-year-old woman complains of a progressive burning sensation in both feet. She has a history of hypertension, type 2 diabetes, and severe COPD. Her examination is significant for ankle weakness, diminished ankle reflexes, and intrinsic foot muscle atrophy. Which of the following is the most likely diagnosis? ACentral cord syndrome BDiabetic polyneuropathy CHypoxic brain injury DMultiple sclerosis
B
According to the American Diabetes Association, screening for diabetes mellitus in the asymptomatic adult with no risk factors should begin at what age? A30 years B35 years C40 years D45 years
B
Type 1 diabetes is an absolute deficiency of insulin caused by failure of the beta cells of the pancreas. Treatment is the replacement of insulin. What is the best example of long-acting basal insulin? AInsulin aspart BInsulin glargine CInsulin glulisine DInsulin NPH
B
Type 2 diabetes mellitus is diagnosed in a 16-year-old girl. At the time of diagnosis, the patient's hemoglobin A1c was greater than 9% and her body mass index is greater than the 95th percentile. Which of the following treatment regimens would be recommended? AInsulin BInsulin, metformin, and lifestyle change program CLifestyle change program DMetformin
B
Which of the following is the recommended target hemoglobin A1C for children and adolescents with type 1 diabetes mellitus who do not have significant risk factors for hypoglycemia? A< 6.5% B< 7% C< 7.5% D< 8%
B
Which of the following risk factors is associated with childhood obesity? ABreastfeeding beyond 1 year BHaving a television in the bedroom CHigh intake of high-fiber foods DLate introduction to solid foods
B
A 14-year-old boy presents to the clinic with polyuria and fatigue. You are concerned that he may have type 1 diabetes mellitus. Which of the following is a risk factor for type 1 diabetes mellitus? ABacterial respiratory infections BChildhood immunizations CHigh birth weight DVitamin B12 deficiency
C
A 2-week-old female infant presents to the clinic for a check-up with her mother. The mother expresses concern about an intellectual disability in her child because of her family history. Which of the following disorders that causes brain damage and intellectual disability is detected during the newborn screening? AAdrenal hyperplasia BCystic fibrosis CPhenylketonuria DSickle cell disease
C
A 22-year-old woman presents with generalized weakness, tremor, anxiety, palpitations and weight loss. Her symptoms have been constant and progressive over the last two weeks. On examination, her heart rate is 126 beats per minute, blood pressure 175/92 mm Hg and temperature 37.6C. She has lid lag, retraction, and exophthalmos noted on eye examination. What is the most likely cause of symptoms? APheochromocytoma BPituitary adenoma CToxic diffuse goiter DToxic multinodular goiter
C
A 24-year-old pregnant woman presents after being diagnosed with gestational diabetes. She wants to avoid insulin. Her BMI is 22 kg/m2. In addition to exercise, what should the daily caloric intake be for this patient to promote adequate glycemic control? ACaloric intake of 14 kcal/kg/day BCaloric intake of 22 kcal/kg/day CCaloric intake of 30 kcal/kg/day DCaloric intake of 40 kcal/kg/day
C
A 26-year-old woman presents to the clinic for a follow-up. Last week, she was seen in the office for anxiety and palpitations, and her examination was notable for exophthalmos. Her lab work showed a TSH of 0.1 mU/L, FT4 of 3.9 ng/dL, and a positive TSI. She reports that she is not sexually active or planning to become pregnant. What is the most appropriate initial pharmacologic treatment for this patient's suspected condition? ACholestyramine 4 g QID BLevothyroxine 50 mcg daily CMethimazole 10 mg daily DPropylthiouracil 100 mg TID
C
A 27-year-old woman presents to your office complaining of fatigue, weight gain, and cold intolerance. She sleeps well, has not had any changes in her menstrual cycle, and reports no history of sadness. She does mention that her sister and mother both have hypothyroidism and are being treated. Physical examination reveals a nontender, slightly enlarged thyroid gland. In addition to measuring a thyroid-stimulating hormone (TSH) level, which of the following tests is most likely to help establish a diagnosis in this patient? AFine needle aspiration of the thyroid BRadioactive iodine uptake scan of the thyroid CThyroid peroxidase antibody level DThyrotropin-receptor antibody level
C
A 30-year-old woman in her third trimester of pregnancy presents to the clinic with worsening fatigue, nausea, and increased polyuria and polydipsia. Her recent glucose tolerance test was unremarkable. You suspect diabetes insipidus may be contributing to her symptoms. Which of the following findings is most likely to be present in her labs? AElevated creatinine BHyperglycemia CHypernatremia DUrine hyperosmolality
C
A 32-year-old man presents to the clinic for weight management. Considering his elevated BMI, elevated blood pressure, increased waist circumference, and elevated fasting blood glucose, the clinician diagnoses him with metabolic syndrome. In addition to blood pressure control, the clinician recommends a low-calorie diet of 1,500 kcal/day and an exercise regimen. What is the recommended weight reduction for this patient? A 10% decrease in body weight within 12 months B 10% decrease in body weight within 2 months C 10% decrease in body weight within 6 months D 20% decrease in body weight within 3 months
C
A 39-year-old man with no significant medical history other than overweight presents to his primary care provider's office for his annual exam. The patient says his mother and father both have hypertension and were diagnosed around his age. Today, the patient's blood pressure is 148/98 mm Hg. Which of the following is the most preferred course of action for the nurse practitioner to take at this time? ADiagnose the patient with hypertension BHave patient return in 2 weeks for a recheck CInitiate ambulatory blood pressure monitoring DTake a second blood pressure today
C
A 40-year-old man with a history of uncontrolled type 2 diabetes mellitus presents to the primary care clinic for his yearly follow-up. He reports new-onset polyuria, polydipsia, and fatigue. His laboratory tests show sodium 129 mEq/L, creatinine 1.6 mg/dL, GFR 50 mL/min/1.73 m2, and glucose 450 mg/dL. His urinalysis is positive for glucose and ketones. Which of the following is the most appropriate next step in management? AAdvise the patient to restrict fluids BPrescribe empagliflozin CRefer the patient to the ED DRepeat the BMP
C
A 42-year-old woman presents for evaluation of irregular menses associated with episodes of excessive daytime sweating and palpitations. She has not had a hysterectomy or oophorectomy. She is currently sexually active, although intercourse has been more uncomfortable lately. Which of the following disorders would you consider in this patient's differential diagnosis? AHyperaldosteronism BHyperprolactinemia CHyperthyroidism DHypokalemia
C
A 44-year-old woman presents to the clinic for her yearly physical. Current medications include hydrochlorothiazide for hypertension. Physical exam reveals height 5'4", weight 175 lbs, BMI 30 kg/m2, BP 120/80 mm Hg, and waist circumference 38 inches. Laboratory tests are ordered. According to the National Cholesterol Education Program Adult Treatment Panel III, which of the following lab results would indicate a diagnosis of metabolic syndrome for this patient? A2-hour oral glucose tolerance test 126 mg/dL BFasting glucose of 99 mg/dL CHDL level 38 mg/dLr DTriglyceride level of 128 mg/dL
C
A 45-year-old woman presents to clinic to discuss her recent diagnoses of diabetes mellitus and hypertriglyceridemia. Which of the following is true regarding her glucose and triglyceride control? AHer greatest risk is renal failure secondary to diabetes BHypertriglyceridemia is not linked to heart disease COptimizing glycemic control may improve hypertriglyceridemia DStatins do not help to reduce triglyceride levels
C
A 45-year-old woman with diabetes type 2, hypertension, coronary artery disease, and obesity class 2 presents to the clinic for a follow-up on obesity. She has undergone comprehensive lifestyle interventions, which included dietary, exercise, and behavioral modifications, for the last 12 months. She lost 2% of her body weight with these interventions. Which of the following is the most appropriate next step in the management of her obesity? AAdd dietary supplements to current regimen BContinue comprehensive lifestyle modifications for another 12 monthsYour Answer CPrescribe liraglutide DRefer to bariatric surgery
C
A 47-year-old woman presents to the clinic to discuss management of type 2 diabetes. The diagnosis was made six months ago. At diagnosis, her glycosylated hemoglobin was 8.2%. She has been treated with metformin 1000 mg twice per day for six months. Her glycosylated hemoglobin is now 7.1%. She currently smokes eight cigarettes per day. Her BMI is 36. Which of the following is an appropriate recommendation for this patient? ADietary intake of 2000 calories per day BExercise for 60 minutes per week CIndividualized medical nutrition therapy DRecommend use of e-cigarette to stop smoking
C
A 50-year-old man with a history of stroke and memory impairment who was diagnosed with hypothyroidism 3 months ago presents to the clinic for a follow-up post-levothyroxine initiation. A thyroid-stimulating hormone test is done before the visit and is 0.1 µU/mL (normal 0.5-5.0 µU/mL). Which of the following symptoms might you expect the patient to experience during this visit? AAltered taste BCold intolerance CPalpitations DWeight gain
C
A 59-year-old woman with a history of dyslipidemia, heart failure, and uncontrolled type 2 diabetes mellitus presents to the clinic for visual impairment. Over the last several months, her visual acuity has worsened, and today, you observe cotton-wool spots on an ophthalmic exam. Which of the following would be the most appropriate prevention advice for the likely condition this patient has developed? ABlood pressure and lipid control BGlycemic control and alcohol reduction CGlycemic control and blood pressure control DLipids control and glycemic control
C
A 63-year-old man presents to the clinic for a routine physical. He asks what happens if his cholesterol levels are found to be high. Which of the following recommendations is the best initial management to provide the most reduction in low-density lipoprotein levels? AAtorvastatin 20 mg BAtorvastatin 40 mg CBegin the Mediterranean diet DIncrease physical activity
C
A 66-year-old woman presents with a two-month history of weight gain, dry skin, and constipation. Her thyroid stimulating hormone (TSH) level is 11.2 U/L. Which of the following is the best dosage of levothyroxine for this patient? A100 mcg daily B12 mcg daily C25 mcg daily D400 mcg daily
C
A 7-year-old girl presents to the office with symptoms consistent with type 1 diabetes. Which of the following is a likely presenting symptom? ADecreased urination BHyperactivity CPolydipsia DWeight gain
C
A clinician is caring for a family with Wermer syndrome. The clinician knows that most of the patients within the family will most likely develop tumors where? AHypothalamus BPancreas CParathyroid glands DPituitary gland
C
Subacute thyroiditis is an inflammatory process of the thyroid gland. Which of the following is a symptom of this condition? ACold intolerance BConstipation CDyspnea DPretibial myxedema
C
What is the most common cause of adrenal insufficiency, regardless of type? AAdrenal infarction BAutoimmune adrenalitis CChronic corticosteroid therapy DPanhypopituitarism
C
What laboratory results are you likely to find in a patient recently diagnosed with hyperthyroidism? AHigh TSH with low FT4 BHigh TSH with normal FT4 CLow TSH with high FT4 DLow TSH with normal FT4
C
Which of the following labs should be ordered first when a patient has suspected acromegaly? AGrowth hormone BHemoglobin A1C CInsulin-like growth factor 1 DThyroid stimulating hormone
C
Which of the following levels would indicate vitamin D deficiency in a 4-year-old patient? A12 to 20 ng/mL (30 to 50 nmol/L) B20 to 100 ng/mL (50 to 250 nmol/L) CLess than 12 ng/mL (less than 30 nmol/L) DLess than 5 ng/mL (less than 12 nmol/L)
C
You suspect hypoparathyroidism in a patient who recently underwent a course of neck radiotherapy. Which of the following laboratory results would you expect to find if this patient began showing signs of carpopedal spasm and lip paresthesias? AHypercalcemia and hyperphosphatemia BHypercalcemia and hypophosphatemia CHypocalcemia and hyperphosphatemia DHypocalcemia and hypophosphatemia
C
A 13-year-old girl with a history of type 1 diabetes mellitus presents for her routine follow-up. The clinician has been working with her since she was 6 years old. She explains that she has joined her school's basketball team. The clinician wants to evaluate her knowledge on blood glucose management because this is the first time she is participating in vigorous exercise. Which of the following responses indicates she understands how to manage her blood glucose? AAdminister a bolus of insulin prior to exercise BIncrease the amount of carbohydrates consumed after exercise CIncrease the amount of carbohydrates consumed prior to exercise DRoutinely check blood glucose prior to, during, and after exercise
D
A 15-year-old boy with severe asthma is seen in the clinic for a follow-up. He has been hospitalized three times during the past 3 months due to asthma exacerbations. He required prolonged steroid use to control his asthma. You note abnormal findings on examination that make you suspect Cushing's syndrome. Which exam finding is associated with Cushing's syndrome? ADistal atrophy and weakness BDry skin CHypotension DSupraclavicular fat pads
D
A 15-year-old girl is seen in your office for a routine visit. Her mother has type 2 diabetes mellitus. On physical exam, the patient is noted to have a body mass index of 34 kg/m2 and acanthosis nigricans on her neck. You check a hemoglobin A1C, and it is 6.8%. She is referred to a pediatric endocrinologist who performs further testing and confirms a diagnosis of type 2 diabetes. Which of the following medications is appropriate to prescribe? AGlyburide BLevothyroxine CLisinopril DMetformin
D
A 16-year-old boy presents to the clinic with increased thirst and increased urination for six months. He reports feeling thirsty once an hour and needing to use the bathroom once every two hours. He also reports frequent nocturia, and on one occasion he had an episode of enuresis after having an exhausting and stressful day. He notes that he has been more tired lately. He reports no painful or burning urination, abdominal pain, headache, confusion, palpitations, blurred vision, recent weight changes, or feelings of depression. He has never had loss of consciousness or been hospitalized. His past medical history ig fundoscopy, is normal. Initial laboratory tests are ordered, revealing a fasting plasma glucose of 131 mg/dL and hemoglobin A1C of 7.1%. Which of the following is this patient's most likely diagnosis? AMature onset diabetes of the young BPrediabetes CType 1 diabetes mellitus DType 2 diabetes mellitus
D
A 17-year-old girl who is sexually active presents to the clinic, accompanied by her parents, with complaints of hyperactivity, constantly feeling nervous, diaphoresis, increased appetite, muscle weakness, and proptosis. Which of the following tests should the clinician order? AAlkaline phosphatase BHemoglobin A1C CHuman chorionic gonadotropin DTriiodothyronine and thyroxine
D
A 29-year-old G1 woman at 11 weeks gestation with a family history of hypothyroidism not currently on medication has baseline TSH levels 0.2 mU/L below the normal reference range. What is the best next step in management? A Initiate levothyroxine therapy B Initiate methimazole therapy C Initiate propylthiouracil therapy D Therapy is not indicated
D
A 32-year-old woman with a history of Graves' disease presents to your office with a question about her medication. She just found out she is pregnant and wants to know if any changes need to be made to her treatment regimen during her pregnancy. Which of the following is the most appropriate therapy? A Carbimazole B Levothyroxine C Methimazole D Propylthiouracil
D
A 32-year-old woman with type 2 diabetes mellitus presents for her initial prenatal visit at 9 weeks gestation. The patient's diabetes has been well controlled with diet and exercise for the last 2 years. Since becoming pregnant, she has maintained her pre-pregnancy diet and exercise regimen and has been keeping a blood glucose log. Her average blood glucose levels for the past 3 weeks are fasting 115 mg/dL and 1-hour postprandial 155 mg/dL. What is the best next step in the management of this patient's diabetes? AContinue diet and exercise and follow-up in 4 weeks BObtain current A1C level to guide treatment choice CPrescribe glyburide DPrescribe insulin
D
A 35-year-old woman presents to her primary care provider with a three-month history of insomnia, palpitations, and unintentional weight loss. A friend mentioned to her that her eyes seemed to be protruding from their sockets. Which of the following is the most appropriate diagnostic test? AHbA1c level BProlactin level CRandom cortisol level DThyroid stimulating hormone (TSH) level
D
A 40-year-old man with a history of hypertension presents to the clinic for follow-up. The history and physical exam reveal the patient has been experiencing intermittent headaches, drenching diaphoresis, flushing, chest palpitations, abdominal pain, nausea, and elevated blood pressures. Which of the following is the most likely diagnosis? AFamilial dysautonomia BHyperthyroidism CNeuroblastoma DPheochromocytoma
D
A 40-year-old woman with no cardiovascular risk factors is screened for hyperlipidemia at a routine physical examination. She has a total cholesterol of 175 mg/dL, low-density lipoprotein of 100 mg/dL, and high-density lipoprotein of 40 mg/dL. When is it recommended that she have her next lipid panel? A1 year B10 years C2 years D5 years
D
A 41-year-old man presents to the clinic for an annual check-up. He has no previous medical history. Which of the following results in this patient's fasting lipid panel indicates an increased risk of atherosclerotic cardiovascular disease? A HDL-C of 62 mg/dL B LDL-C of 100 mg/dL C Total cholesterol of 182 mg/dL D Triglycerides of 192 mg/dL
D
A 42-year-old woman presents to the primary care clinic for a 1-day history of muscle pain in her calves, weakness, and brown-colored urine. Her calves are tender to the touch and mildly edematous. She was recently started on high-intensity statin therapy and reports that she is also taking a fibrate medication that she was prescribed by another provider. What laboratory test should be ordered to diagnose the suspected condition? A AST B CRP C ESR D Serum CK
D
A 42-year-old woman with diabetes presents for a follow-up to recent blood work, which had the following lipid results: total cholesterol 190 mg/dL, LDL-C 100 mg/dL, triglycerides 120 mg/dL, and HDL 50 mg/dL. Today, her BP is 118/72 mm Hg and her BMI is 28 kg/m2. She is adopted and has no family history. She is generally inactive, is not following a specific diet, and is a nonsmoker. Which of the following is the best plan for this patient? ACalculate her 10-year risk for atherosclerotic cardiovascular disease BImplement diet and lifestyle modifications and reevaluate in 3-6 months COrder coronary artery calcium DStart a moderate-intensity statin
D
A 43-year-old woman is diagnosed with thyroid cancer. The oncologist tells the patient that she has the most common form of thyroid cancer and also the least aggressive form, quoting a 10-year survival rate of 97%. What type of thyroid cancer does the patient have? AAnaplastic carcinoma BFollicular carcinoma CMedullary carcinoma DPapillary carcinoma
D
A 52-year-old man presents to the clinic for a follow-up on his hyperlipidemia. He was prescribed simvastatin 1 month ago. Which of the following would require immediate discontinuation of the medication? AConstipation BHeadaches CHyperglycemia DNew muscle pain
D
A 52-year-old woman presents to the clinic for follow-up on her hyperlipidemia. Which of the following dietary modifications made by the patient will most likely decrease her LDL-C? AAdding coconut oil BDecreasing intake of olive oil CDecreasing intake of tea DIncreasing fiber intake
D
A 56-year-old man is seen in the clinic to discuss medical treatment for his type 2 diabetes mellitus. His glycated hemoglobin is 8.6 percent. His medical history is significant for cardiovascular disease, current alcohol use disorder, hyperlipidemia, hypertension, and tobacco use. Which of the following is the most appropriate medication for this patient to start? ABiguanide (e.g., metformin) BDPP-4 inhibitor (e.g., saxagliptin) CP2Y12 inhibitor (e.g., prasugrel) DSGLT2 inhibitor (e.g., canagliflozin)
D
A patient presents to your primary care clinic for a new patient evaluation. Which of the following physical examination findings would prompt you to order a lipid panel? ACholesteatoma BCorneal ulcer CPitting edema DXanthoma
D
What finding is commonly seen in primary adrenal insufficiency but is not seen in secondary adrenal insufficiency? AFever BHypoglycemiaYour Answer CHyponatremia DSkin hyperpigmentation
D
What is the best anticipatory guidance to give parents of a 4-year-old girl who was recently diagnosed with Graves disease? AA normal side effect of antithyroid drug therapy is fever; parents should not be concerned if one develops BRadioactive iodine is the treatment of choice for this patient CThe patient will require a thyroidectomy DThe patient will require lifelong monitoring of thyroid function, even if remission is achieved
D
What would indicate a diagnosis of type 2 diabetes mellitus rather than type 1 diabetes mellitus to the pediatric clinician? ABody mass index in the 50th percentile for age and sex BNon-Hispanic White ethnicity CPatient's age less than 10 years DPresence of acanthosis nigricans or polycystic ovary syndrome
D
Which of the following diagnostic tests should be ordered if you suspect suppurative thyroiditis in an adolescent patient? AComputed tomography BMagnetic resonance imaging CRadionuclide thyroid scan DUltrasonography
D
Which of the following is considered first-line pharmacotherapy for children 10 years of age or older who fail to reach the targeted low-density lipoprotein cholesterol with lifestyle counseling over a period of six months? ACholestyramine BEzetimibe CGemfibrozil DLovastatin
D
Which of the following patients is at greatest risk for renal artery stenosis? A A 30-year-old with hypertension B A 48-year-old with kidney disease C A 60-year-old with hepatitis D A 68-year-old smoker
D
You are chart auditing the records of a 70-year-old woman with an unknown medical history. During her previous visit, she was prescribed rosuvastatin 20 mg daily. Which of the diagnoses and corresponding low-density lipoprotein values would be most appropriate to warrant this medication during the previous visit? A Diabetes mellitus with low-density lipoprotein 60 mg/dL B Hypertension with low-density lipoprotein 130 mg/dL C Obesity with low-density lipoprotein 140 mg/dL D Peripheral artery disease with LDL 90
D
