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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
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