Physician Assistant Endocrine System Disorders 1 — Questions and Answers
Question 1: A 50-year-old woman presents with fatigue, weight gain, cold intolerance, constipation, and dry skin. TSH is 9.2 mIU/L and free T4 is low. What is the first-line treatment?
- Methimazole
- Levothyroxine (Correct answer)
- Propylthiouracil
- Radioactive iodine ablation
Correct answer: Levothyroxine
Primary hypothyroidism is treated with levothyroxine (synthetic T4) to replace the deficient thyroid hormone.
Question 2: Which of the following is the most common cause of primary hypothyroidism in the United States?
- Iodine deficiency
- Hashimoto's thyroiditis (Correct answer)
- Surgical thyroidectomy
- Subacute thyroiditis
Correct answer: Hashimoto's thyroiditis
Hashimoto's thyroiditis is an autoimmune condition and the most common cause of primary hypothyroidism in iodine-sufficient countries.
Question 3: A 28-year-old woman presents with palpitations, heat intolerance, weight loss, and exophthalmos. TSH is undetectable and free T4 is elevated. What is the most likely diagnosis?
- Toxic multinodular goiter
- Hashimoto's thyroiditis
- Graves' disease (Correct answer)
- Subacute thyroiditis
Correct answer: Graves' disease
Graves' disease is an autoimmune hyperthyroid condition, and exophthalmos (Graves' ophthalmopathy) is pathognomonic for this diagnosis.
Question 4: A 55-year-old man with Type 2 DM presents with a foot ulcer and no sensation on 10-gram monofilament testing. Which diabetic complication does this represent?
- Peripheral arterial disease
- Diabetic nephropathy
- Diabetic peripheral neuropathy (Correct answer)
- Charcot arthropathy
Correct answer: Diabetic peripheral neuropathy
Loss of protective sensation on monofilament testing is the hallmark of diabetic peripheral neuropathy, a microvascular complication of diabetes.
Question 5: A patient with Type 1 DM presents with nausea, vomiting, abdominal pain, Kussmaul respirations, and fruity breath odor. Blood glucose is 380 mg/dL. What is the most likely diagnosis?
- Hyperosmolar hyperglycemic state
- Diabetic ketoacidosis (Correct answer)
- Lactic acidosis
- Alcoholic ketoacidosis
Correct answer: Diabetic ketoacidosis
DKA presents with hyperglycemia, anion gap metabolic acidosis, Kussmaul respirations, and fruity breath due to ketone production.
Question 6: Which of the following is the most important initial intervention in the management of Diabetic Ketoacidosis (DKA)?
- IV insulin bolus
- IV fluid resuscitation with normal saline (Correct answer)
- Sodium bicarbonate infusion
- Oral potassium replacement
Correct answer: IV fluid resuscitation with normal saline
IV fluid resuscitation is the most critical initial step in DKA to correct severe dehydration before initiating insulin therapy.
Question 7: A patient with Type 2 DM on metformin develops lactic acidosis after a hospitalization for cardiac catheterization with contrast. Which medication is most likely responsible?
- Glipizide
- Metformin (Correct answer)
- Sitagliptin
- Pioglitazone
Correct answer: Metformin
Metformin can cause lactic acidosis, especially when combined with IV contrast, renal impairment, or hypoxic states; it should be held before contrast procedures.
Physician Assistant Endocrine System Disorders 1
A 50-year-old woman presents with fatigue, weight gain, cold intolerance, constipation, and dry skin.
TSH is 9.2 mIU/L and free T4 is low.
What is the first-line treatment?