Block 13 Endocrine Path Diabetic Drugs MCQ's
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- 1.
A 35 year-old woman consulted one of her parent's friends, a jeweler, about having her wedding ring resized since it was becoming tight on her finger. The jeweler mentioned to her parents that he thought the woman's features were getting coarser which prompted the parents to suggest that she see a physician. You might expect the physician's workup to reveal
- A.
Hyperglycemia
- B.
Hyponatremia
- C.
Hypothyroidism
- D.
Increased pigmentation of the skin
- E.
Parathyroid hyperplasia
Correct Answer
A. HyperglycemiaExplanation
The jeweler's observation of the woman's features becoming coarser could be indicative of a condition called acromegaly, which is caused by excessive production of growth hormone. Acromegaly is commonly associated with hyperglycemia, as the excess growth hormone can lead to insulin resistance and impaired glucose tolerance. Therefore, it is likely that the physician's workup would reveal hyperglycemia as the underlying cause of the woman's symptoms.Rate this question:
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- 2.
Pearl, a 39 year old woman G2 P2 whose last pregnancy was 5 years ago, has had regular menstrual cycles until 6 month ago when the cycle ceased. She also reports expression of milk from her breasts. On physical examination, she is afebrile and normotensive. She is 150 cm (4ft 11in) tall and weighs 63kg (BMI 28). Secondary sex characteristic is normal. Laboratory test indicates that her β-human chorionic gonadotropin level is normal. She has a normal growth hormone stimulation test. CT scan of the head shows no abnormalities of bone and no hemorrhage. Brain MRI showed fluid density within a normal-sized sella turcica. Which of the following is the most likely diagnosis?
- A.
Craniopharngioma
- B.
Empty sella syndrome
- C.
Heriditary spherocytosis
- D.
Prader-Willi Syndrome
- E.
Sheehan Syndrome
- F.
Prolactinoma
Correct Answer
F. ProlactinomaExplanation
The most likely diagnosis for Pearl is a prolactinoma. This is indicated by her report of milk expression from her breasts, which is a symptom of hyperprolactinemia caused by a prolactin-secreting pituitary adenoma. The normal levels of β-human chorionic gonadotropin, normal growth hormone stimulation test, and absence of abnormalities on imaging studies support this diagnosis. Craniopharyngioma, empty sella syndrome, hereditary spherocytosis, Prader-Willi syndrome, and Sheehan syndrome are not associated with the symptoms described.Rate this question:
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- 3.
2 year old child is brought to her family physician because of failure to thrive. Physical examination shows a short child and has coarse facial features, a protruding tongue, and an umbilical hernia. Profound mental retardation becomes apparent as the child matures. A hormonal deficiency is suspected. Which of the following test would aid in establishing the diagnosis?
- A.
Total T4 levels
- B.
Cortisol levels
- C.
Growth hormone levels
- D.
Insulin levels
- E.
Thyroid stimulating hormone
Correct Answer
E. Thyroid stimulating hormoneExplanation
The child's symptoms, such as failure to thrive, short stature, coarse facial features, and mental retardation, are consistent with a diagnosis of congenital hypothyroidism. Thyroid stimulating hormone (TSH) is the most appropriate test to aid in establishing the diagnosis because in congenital hypothyroidism, TSH levels are typically elevated as the body tries to compensate for the lack of thyroid hormone. Therefore, measuring TSH levels can help confirm the suspicion of a hormonal deficiency.Rate this question:
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- 4.
Which statement regarding gestational diabetes mellitus (GDM) is true?
- A.
When retested 6-8 weeks postpartum, 45% of women with GDM will have impaired fasting glucose.
- B.
Pregnant women with risk factors for diabetes should be screened for GDM at their first prenatal visit.
- C.
The new diagnostic criteria for GDM will reduce the number of cases by 18%.
- D.
Twin pregnancy is protective against GDM
- E.
All women with a history of GDM will eventually develop diabetes.
Correct Answer
B. Pregnant women with risk factors for diabetes should be screened for GDM at their first prenatal visit. -
- 5.
A 40-year-old man presents to his doctors office with a complaint of polyuria for the past few weeks. He gives a history of successful treatment of pulmonary tuberculosis that he contracted while working for a UN mission in Africa, from where he returned to the US about an year ago. Apart from that the rest of the history and Physical examination of the patient did not reveal any significant abnormality. On laboratory exam all other lab results are within normal limits except the following values. The serum osmolality of 320 mOsm/kg and urine osmolality of 50 mOsm. Upon performing a water deprivation test, his serum osmolality is 316 mOsm and urine osmolality is 100 mOsm. Upon administration of dDAVP, serum osmolality decreases to 285 mOsm and urine osmolality increases to 350 mOsm. What is the most likely diagnosis?
- A.
Central diabetes insipidus
- B.
Nephrogenic diabetes insipidus
- C.
Psychogenic polydipsia
- D.
Diabetes mellitus
Correct Answer
A. Central diabetes insipidusExplanation
The patient's complaint of polyuria, along with the laboratory findings of low urine osmolality and high serum osmolality, suggests a problem with water balance in the body. The water deprivation test and the response to dDAVP further support the diagnosis of central diabetes insipidus. In this condition, there is a deficiency of vasopressin (ADH) production or release from the posterior pituitary gland, leading to the inability to concentrate urine and excessive urination. Nephrogenic diabetes insipidus is characterized by a lack of response to ADH, which is not seen in this case. Psychogenic polydipsia is a psychiatric disorder causing excessive drinking, but it would not result in the laboratory findings seen in this patient. Diabetes mellitus is characterized by high blood sugar levels, which is not evident in this case.Rate this question:
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- 6.
A 48-year-old man is diagnosed with a functional pituitary tumor and acromegaly. He has an elevated concentration of growth hormone (GH) and another hormone induced by GH that is produced in the liver. Which of the following hormones is most likely to be increased in this patient’s blood?
- A.
Glucagon
- B.
Somatostatin
- C.
Cholecystokinin
- D.
Gastrin
- E.
Insulin like growth factor I
Correct Answer
E. Insulin like growth factor IExplanation
A functional pituitary tumor is causing the patient's acromegaly, which is characterized by an elevated concentration of growth hormone (GH). GH induces the production of insulin-like growth factor I (IGF-I) in the liver. Therefore, it is most likely that the patient's blood will have an increased concentration of IGF-I.Rate this question:
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- 7.
A 48 year old man brings you the following pictures that he put together for you because his nephew, a medical student, suggested it after a large family reunion, wherein lots of old family photos were on display. What medical problems might your patient also experience with this condition?
- A.
Colon cancer and insulin resistance
- B.
Hypothyroidism and macroglossia
- C.
Precocious puberty and obesity
- D.
Hypogonadism and infertility
- E.
Rheumatoid arthritis and hyperostosis
Correct Answer
A. Colon cancer and insulin resistanceExplanation
Based on the information provided, the patient is a 48-year-old man who has put together pictures for the doctor after a family reunion. The fact that the patient's nephew, a medical student, suggested it implies that there may be a medical condition or concern related to the pictures. The correct answer, colon cancer and insulin resistance, suggests that the patient may have a higher risk of developing colon cancer due to a combination of genetic factors and insulin resistance, which is a condition where the body's cells become less responsive to the effects of insulin.Rate this question:
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- 8.
You have been seeing HS for 10 years. He is 57 and had his Type II DM diagnosed when he was 45 after he developed significant polyuria and polydipsia during a vacation. He has been quite non-compliant, stating that the diabetic diet is "impossible to stick to", though he does try to remember to take his medication. His Hgb A1C test has not been below 9 % for over 2 years. Which of the following is true about management of type II DM?
- A.
Daily blood glucose monitoring by the patient is unnecessary and reduces compliance
- B.
Counting fats is an essential part of the ADA diet
- C.
Medication works as well as life style changes for improving insulin resistance
- D.
Reduction of Hgb A1C levels to 6.5 or less reduces risk of diabetic complications
- E.
Life expectancy cannot be changed by improving glycemic control
Correct Answer
D. Reduction of Hgb A1C levels to 6.5 or less reduces risk of diabetic complicationsExplanation
Reduction of Hgb A1C levels to 6.5 or less reduces the risk of diabetic complications. Hgb A1C is a measure of average blood glucose levels over a period of time. By reducing Hgb A1C levels to 6.5 or less, it indicates better control of blood glucose levels, which in turn reduces the risk of complications associated with diabetes such as cardiovascular disease, kidney disease, and nerve damage. Monitoring blood glucose levels, counting fats, and making lifestyle changes are all important aspects of managing type II DM, but the reduction of Hgb A1C levels is specifically linked to reducing the risk of complications. Improving glycemic control can also have a positive impact on life expectancy.Rate this question:
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- 9.
A 32 year old woman who has Type II diabetes mellitus is diagnosed with hyperthyroidism. Her diabetes is presently being controlled with Glipizide and she is prescribed a combination of methimazole and propranolol to treat her hyperthyroidism. This combination is contraindicated for this patient because
- A.
Methimazole will antagonize the effect of glipizide
- B.
Methimazole will chemically interact with propranolol, thus negating its effects
- C.
Propranolol can mask the signs of hypoglycemia
- D.
Propranolol will inhibit the metabolism of methimazole
Correct Answer
C. Propranolol can mask the signs of hypoglycemiaExplanation
Propranolol is a beta-blocker that can mask the signs of hypoglycemia, which is a condition characterized by low blood sugar levels. In patients with diabetes, it is important to be able to recognize the symptoms of hypoglycemia in order to treat it promptly. By masking these symptoms, propranolol can potentially delay the recognition and treatment of hypoglycemia, leading to more severe consequences. Therefore, prescribing propranolol to a patient with diabetes who is already being treated with Glipizide, a medication that can lower blood sugar levels, can be contraindicated.Rate this question:
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- 10.
Several insulin formulations, available on the market, differ one from another in which of the following pharmacokinetic properties?
- A.
Rate of absorption
- B.
Elimination half-lives
- C.
Total clearance
- D.
Volume of distribution
- E.
Oral bioavailability
Correct Answer
A. Rate of absorptionExplanation
Insulin formulations differ in their rate of absorption, which refers to how quickly the insulin is absorbed into the bloodstream after administration. This property is important because it determines how quickly the insulin will start to lower blood sugar levels. Different insulin formulations have different rates of absorption, with some being rapid-acting and others being slower-acting.Rate this question:
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- 11.
Which of the following statements correctly pair the antidiabetic drug with its potential adverse effect? (Check all that apply)
- A.
Miglitol - constipation
- B.
Chlorpropamide - dilutional hyponatremia
- C.
Metformin - weight gain
- D.
Insulin - tachycardia
- E.
Pioglitazone - dehydration
- F.
Repaglinide - hypoglycemic crisis
Correct Answer(s)
B. Chlorpropamide - dilutional hyponatremia
D. Insulin - tachycardia
F. Repaglinide - hypoglycemic crisisExplanation
Chlorpropamide is correctly paired with dilutional hyponatremia because chlorpropamide can cause water retention and dilution of sodium levels in the body. Insulin is correctly paired with tachycardia because excessive insulin can cause low blood sugar levels, leading to an increase in heart rate. Repaglinide is correctly paired with hypoglycemic crisis because it stimulates insulin release and can cause a sudden drop in blood sugar levels, leading to a hypoglycemic crisis.Rate this question:
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- 12.
A 24-year-old woman with type I diabetes was brought unconscious to the emergency room. Her blood glucose level was 395 mg/dL. An intravenous infusion of insulin was started and the patient’s blood glucose decrease to a normal level after 6 hours. Which of the following molecular actions most likely contributed to the therapeutic effect of the drug in this patient?
- A.
Inhibition of glucose transporters in pancreas cell membranes
- B.
Phosphorylation of tyrosine kinase receptor
- C.
Activation of ATP-sensitive K+ channels in target cells
- D.
Stimulation of hormone sensitive lipase
- E.
Inhibition of liver glucokinase
Correct Answer
B. pHospHorylation of tyrosine kinase receptorExplanation
Phosphorylation of tyrosine kinase receptors is the most likely molecular action that contributed to the therapeutic effect of the drug in this patient. Tyrosine kinase receptors are involved in insulin signaling pathways, and their phosphorylation plays a crucial role in glucose uptake and metabolism. By phosphorylating these receptors, insulin enhances glucose transport into cells, leading to a decrease in blood glucose levels. This mechanism is particularly important in type I diabetes, where insulin production is impaired, and the administration of exogenous insulin helps restore normal glucose levels.Rate this question:
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- 13.
A 54-year-old alcoholic man was brought unconscious to the emergency room. On admission the patient was sweating, the body temperature was very low and the cardiac pulse was 135 bpm. Shortly after the admission the patient developed a tonic-clonic seizure. His wife reported that the man was a diabetic under insulin treatment. Which of the following events most likely caused the patient’s syndrome?
- A.
Hyperglycemia due to insulin resistance
- B.
Hypoglycemia due to alcohol consumption
- C.
Ketoacidosis due to insufficient insulin therapy
- D.
Hyperglycemia due to alcohol withdrawal
- E.
Anaphylactic reaction to insulin
- F.
Hyperosmolar coma due to alcohol overdose
Correct Answer
B. Hypoglycemia due to alcohol consumptionExplanation
The patient's low body temperature, sweating, and tonic-clonic seizure are consistent with hypoglycemia, which is caused by low blood sugar levels. The fact that the patient is an alcoholic and was brought to the emergency room unconscious suggests that he may have consumed alcohol excessively, leading to hypoglycemia. Alcohol consumption can impair the liver's ability to release stored glucose, leading to low blood sugar levels. Additionally, alcohol can interfere with the body's ability to produce glucose, further contributing to hypoglycemia.Rate this question:
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- 14.
A 52-year-old man is being treated with repaglinide for type II diabetes. Which of the following actions best explains the therapeutic effect of the drug in this patient?
- A.
Slowing of glucose absorption from the gastrointestinal tract
- B.
Blockade of glucagon receptors
- C.
Blockade of beta-2 receptors in the liver
- D.
Blockade of somatostatin receptors in the pancreas
- E.
Stimulation of insulin release
- F.
Regulation of transcription of genes involved in glucose utilization
Correct Answer
E. Stimulation of insulin releaseExplanation
The therapeutic effect of repaglinide in this patient is the stimulation of insulin release. Repaglinide is a medication that belongs to the class of drugs known as meglitinides, which work by stimulating the release of insulin from the beta cells in the pancreas. By increasing insulin release, repaglinide helps to lower blood glucose levels in patients with type II diabetes. This mechanism of action is particularly beneficial for individuals who still have functioning beta cells in their pancreas.Rate this question:
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- 15.
A 77-year-old man was brought to the emergency room with bizarre behavior and paranoid ideation. He complained of headache, mental confusion, weakness, dizziness and blurred vision. The man was suffering from type II diabetes presently treated with glyburide. Pertinent laboratory findings on admission were: creatinine 2 mg/dL glucose 50 mg/dL, Which of the following would be an immediate appropriate treatment for this patient?
- A.
Oral prednisone
- B.
IV prednisone
- C.
Oral glucose
- D.
IV glucose
- E.
Oral haloperidol
- F.
IV haloperidol
Correct Answer
C. Oral glucoseExplanation
The patient's symptoms and laboratory findings suggest that he is experiencing hypoglycemia, which is a common complication of diabetes and can lead to neurological symptoms such as confusion and blurred vision. The immediate appropriate treatment for hypoglycemia is to administer glucose to raise the blood sugar levels. In this case, oral glucose would be the most suitable option as it can be easily and quickly absorbed by the patient. IV glucose is also a valid option, but oral glucose is preferred if the patient is able to tolerate it. The other options, such as prednisone and haloperidol, are not appropriate for treating hypoglycemia.Rate this question:
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- 16.
A 42-year-old obese man with a 5-year history of type II diabetes has been reasonably well controlled with diet and 3 daily human insulin injections. Recently a lab test has shown a high titer of circulating IgG anti-insulin antibodies. The patient is most likely at an increased risk of which of the following disorders?
- A.
Urticaria
- B.
Hypoglycemic reaction
- C.
Insulin lipodystrophy
- D.
Diabetic ketoacidosis
- E.
Hyperglycemia
Correct Answer
E. HyperglycemiaExplanation
The presence of high titers of circulating IgG anti-insulin antibodies in the patient indicates that the antibodies are binding to the exogenously administered insulin. This can lead to reduced effectiveness of the insulin, resulting in poor glycemic control and subsequently, hyperglycemia. Therefore, the patient is at an increased risk of developing hyperglycemia.Rate this question:
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- 17.
A 65-year-old man, recently diagnosed with type II diabetes, started a treatment with a drug that is able to close the ATP sensitive K+ channels on pancreatic beta cell membrane. Which of the following drugs was he most likely taking?
- A.
Miglitol
- B.
Insulin
- C.
Pioglitazone
- D.
Metformin
- E.
Glyburide
Correct Answer
E. GlyburideExplanation
Glyburide is the most likely drug that the 65-year-old man with type II diabetes was taking because it is known to close the ATP sensitive K+ channels on pancreatic beta cell membrane. This action helps to stimulate insulin release from the beta cells and lower blood glucose levels. Miglitol is an alpha-glucosidase inhibitor that delays the digestion of carbohydrates, Insulin is a hormone that helps regulate blood sugar levels, Pioglitazone is a thiazolidinedione that improves insulin sensitivity, and Metformin is a biguanide that reduces glucose production in the liver and improves insulin sensitivity. Therefore, Glyburide is the drug that directly targets the ATP sensitive K+ channels on pancreatic beta cells.Rate this question:
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- 18.
A 10-year-old boy being treated for type I diabetes was brought unconscious to the emergency department. The mother reported that he was nauseous and vomited after eating a chocolate bar. On admission the patient presented with flushed face and breath smelling of ketones. Which of the following drugs given IV was most likely administered to this patient?
- A.
Glucose
- B.
Glucagon
- C.
Ultralente insulin
- D.
Lente insulin
- E.
Regular insulin
- F.
Repaglinide
Correct Answer
E. Regular insulinExplanation
The correct answer is Regular insulin. Regular insulin is a short-acting insulin that is commonly used to treat high blood sugar levels in patients with diabetes. In this case, the 10-year-old boy was brought to the emergency department unconscious with symptoms of nausea, vomiting, flushed face, and breath smelling of ketones. These symptoms suggest diabetic ketoacidosis (DKA), a serious complication of type 1 diabetes. Regular insulin would be the most appropriate drug to administer in this situation to help lower blood sugar levels and correct the metabolic imbalance associated with DKA.Rate this question:
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- 19.
A 16-year-old boy suffering from type I diabetes is seen in the emergency room with the chief complain of severe right-sided chest pain. Two hours earlier he felt feverish and experienced a teeth-chattering chill. The diabetes of the patient is presently well controlled on 2 daily doses of insulin. The patient also is very compliant with his prescribed diet. After physical examination and laboratory tests a diagnosis of atypical pneumonia is made. Which of the following should be included in an appropriate treatment plan for this patient?
- A.
To increase the daily insulin dosage
- B.
To start a course of ampicillin therapy
- C.
To add a daily administration of chlorpropamide
- D.
To start a course of vancomycin therapy
- E.
To add a daily administration of metformin
Correct Answer
A. To increase the daily insulin dosageExplanation
The patient is experiencing severe right-sided chest pain and has been diagnosed with atypical pneumonia. This suggests that the pneumonia may be causing an infection, which can lead to increased blood glucose levels in patients with diabetes. Therefore, increasing the daily insulin dosage would be an appropriate treatment plan to help control the patient's blood glucose levels during the infection. The other options, such as starting antibiotic therapy or adding other diabetes medications, may be necessary for treating the pneumonia or managing diabetes in general, but the immediate concern is to address the increased blood glucose levels caused by the infection.Rate this question:
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- 20.
A 45-year-old woman with a 3 year history of type II diabetes has been reasonably well controlled with diet and glyburide. Recently her fasting blood glucose started rising and the physician decided to add a second antidiabetic drug that acts on a nuclear receptor and decreases insulin resistance in target cells. Which of the following drug was most likely prescribed?
- A.
Repaglinide
- B.
Chlorpropamide
- C.
Glyburide
- D.
Pioglitazone
- E.
Metformin
- F.
Miglitol
Correct Answer
D. PioglitazoneExplanation
Pioglitazone is the most likely drug prescribed in this case. Pioglitazone is an antidiabetic drug that acts on a nuclear receptor and decreases insulin resistance in target cells. Since the patient's fasting blood glucose has been rising, adding a drug that decreases insulin resistance can help improve glycemic control. Repaglinide, chlorpropamide, glyburide, metformin, and miglitol do not act on nuclear receptors and therefore would not be the most likely choice in this scenario.Rate this question:
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- 21.
A 7-year-old boy was brought to the emergency room by his parents because of nausea, vomiting and persistent abdominal pain secondary to the flu. Pertinent lab values on admission were: blood glucose 300 m/dL, glycosuria 3+. Which of the following drugs would be appropriate for this patient?
- A.
Miglitol
- B.
Metformin
- C.
Pioglitazone
- D.
Repaglinide
- E.
Regular insulin
- F.
Glyburide
Correct Answer
E. Regular insulinExplanation
Regular insulin would be the appropriate drug for this patient because his blood glucose level is elevated and he has glycosuria, indicating uncontrolled diabetes. Regular insulin is a fast-acting insulin that can quickly lower blood glucose levels and is commonly used in emergency situations. The other options, such as Miglitol, Metformin, Pioglitazone, Repaglinide, and Glyburide, are not appropriate for this patient because they are not insulin and would not provide immediate control of his high blood glucose levels.Rate this question:
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Mar 21, 2023Quiz Edited by
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Sep 13, 2012Quiz Created by
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