Kelli Derrah
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Quiz on week 5 HODI, created by Kelli Derrah on 13/07/2019.

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Kelli Derrah
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week 5 HODI

Question 1 of 30

1

A 24-year-old female presents to your clinic. She is seeing you for a routine visit in her 27th week of gestation. She reports no symptoms and has previously been well. An ultrasound of the baby shows normal growth and no congenital abnormalities. Which
of the following should you do next?

Select one of the following:

  • Check hemogloblin A1C. Repeat if abnormal to confirm.

  • Check fasting glucose. Repeat if abnormal to confirm.

  • Schedule a 75 gram 2 hour oral glucose tolerance test.

  • Repeat fetal ultrasound.

Explanation

Question 2 of 30

1

A 24-year-old male comes to you for evaluation of hyperlipidemia. On your physical exam, you find thickening of his Achilles tendons bilaterally and scattered nodules on the tendons over the extensor surface of his hands. In which of the following genes
would you most likely expect to find a mutation in this patient?

Select one of the following:

  • LDL receptor

  • Apo C-II

  • Apo (a)

  • SR-B1 receptor

Explanation

Question 3 of 30

1

A 62-year-old man presents to your clinic with abdominal discomfort and nausea and vomiting. During the appointment he indicates to you that he has been stressed and has significantly increased the amount of alcohol he has been drinking. On exam,
you note that his retinal blood vessels appear whitish. Which one of the following lab findings explain his symptoms and exam?

Select one of the following:

  • LDL level of 200 mg/dl

  • triglycerides level of 2400 mg/dl

  • Glucose level of 42 mg/dl

  • HDL cholesterol of 80 mg/dl

Explanation

Question 4 of 30

1

A 16-year-old girl comes to your clinic for management of type 1 diabetes. You are concerned that she may have a second autoimmune illness. Which of the following would you screen her for?

Select one of the following:

  • polycystic ovarian syndrome

  • non-alcoholic steatohepatitis

  • celiac disease

  • cushing's disease

Explanation

Question 5 of 30

1

A 25-year-old male presents to your clinic for management of type 1 diabetes. He is already taking a long-acting insulin and you
determine that he needs to be on a second type of insulin, which he will take before eating and to lower elevated glucose levels.
Which of the following would be appropriate to prescribe to your patient?

Select one of the following:

  • Detemir insulin

  • Glargine insulin

  • Lispro insulin

  • Degludec insulin

Explanation

Question 6 of 30

1

A 57-year-old female with type 1 diabetes presents for a follow up visit. Her glucose levels have been very elevated but with occasional episodes of hypoglycemia. After clinic, she goes to the lab to get her blood drawn. Her A1C comes back at 13%. Her A1C value represents which of the following?

Select one of the following:

  • enzymatic glycation of hemoglobin

  • non-enzymatic glycation of hemoglobin

  • estimated 45 day average of blood glucose

  • estimated 45 day average of interstitial glucose

Explanation

Question 7 of 30

1

A 63-year-old male with type 2 diabetes on insulin presents to your clinic for management of his diabetes. In the waiting room, he
becomes diaphoretic and tremulous. He has been fasting for the past 12 hours for a blood draw. He comes up to the front desk to
ask for something, but his speech is slurred and the staff are unable to understand what he is asking for. He subsequently loses consciousness and has a seizure. What is the first step in managing his condition?

Select one of the following:

  • intramuscular glucagon injection

  • intramuscular glulisine injection

  • intramuscular phenytoin injection

  • 4 ounces of juice and then recheck glucose in 15 minutes

Explanation

Question 8 of 30

1

A 42-year-old woman with a BMI of 36 kg/m2 and a waist circumference of 39´is found to have a fasting glucose of 163 mg/dL on routine exam, which is confirmed with repeat testing. She is otherwise asymptomatic. She has multiple family members with
diabetes who are managed with oral medications. Which of the following is contributing to her hyperglycemia?

Select one of the following:

  • decreased phosphorylation of insulin receptor substrates

  • increased amylin levels

  • increased glucagon like peptide-1 levels

  • decreased fasting and post pranidal levels of glucagon

Explanation

Question 9 of 30

1

A 54-year-old woman with type 2 diabetes is brought in to the emergency department by her family as she was found at home to be
incoherent and confused. She lost her health insurance and stopped all of her medications 6 months prior. In the emergency room,
she exhibits mental status changes and appears dehydrated. Her blood sugar at the time of admission was 897 mg/dL. Which one of
the following lab findings confirms your suspected diagnosis of hyperosmolar hyperglycemic state?

Select one of the following:

  • High serum ketones, blood pH 7.4

  • Undetectable serum ketones, blood pH 7.0

  • Serum osmolality of 335 mOsm/kg, blood pH 7.4

  • Serum osmolality of 295 mOsm/kg, blood pH 7.0

Explanation

Question 10 of 30

1

A 23-year-old male with type 1 diabetes presents to you in urgent care. He uses an insulin pump and is concerned his infusion set
has malfunctioned. His last glucose check that morning was 529 mg/dL. He endorses nausea/vomiting. On exam, his breath smells
fruity, he has dry mucous membranes, and you can tent his skin easily. Which one of the following is likely to be contributing to the
ongoing disease process?

Select one of the following:

  • suppression of hepatic glucose production

  • increased pH (metabolic alkalosis)

  • suppression of catecholamine production

  • uncontrolled fatty acid beta oxidation

Explanation

Question 11 of 30

1

In patients with diabetes who develop albuminuria, which of the following is the recommended drug treatment to decrease the rate
of progression of kidney disease?

Select one of the following:

  • amlodipine

  • atenolol

  • hydrochlorothiazide

  • lisinopril

Explanation

Question 12 of 30

1

A 53-year-old male with type 1 diabetes presents to your clinic for the first time. He is often nauseated, quickly becomes full while
eating, and occasionally even has to vomit. These symptoms have been happening daily for the past 3 months. He has a long past
history of poor glucose control, but is no longer missing insulin injections and his last A1C was 6.8%. His symptoms are explained
by which of the following diabetes-related complications?

Select one of the following:

  • hypoglycemia after meals

  • diabetic ketoacidosis

  • gastroparesis

  • distal symmetric polyneuropathy

Explanation

Question 13 of 30

1

A 67-year-old male presents for follow up of his type 2 diabetes and coronary artery disease. His blood pressure is 120/70 and his
A1C is 6.7%. To reduce his risk of future cardiovascular events, you recommend which of the following medications?

Select one of the following:

  • glargine insulin

  • glulisine insulin

  • aspirin

  • amlodipine

Explanation

Question 14 of 30

1

insulin stimulates which of the following?

Select one of the following:

  • production of lipoprotein lipase

  • conversion of amino acids to glucose

  • glycogenolysis

  • conversion of fatty acids and amino acids to ketoacids

Explanation

Question 15 of 30

1

A 58-year old male fasts in preparation for a colonoscopy. He has no medical conditions and he does not take any medications. While he fasts, which of the following will help him avoid hypoglycemia?

Select one of the following:

  • Increase in hepatic glycogen synthesis

  • Reduction in glucagon secretion from alpha cells

  • Increase in amylin secretion from beta cells

  • Reduction in beta cell glucose metabolism

Explanation

Question 16 of 30

1

A 62-year-old male with type 2 diabetes is taking metformin, sitagliptin, and glargine insulin. When he takes an injection of glargine
insulin, the insulin facilitates peripheral uptake of glucose into adipose tissue by which of the following mechanisms?

Select one of the following:

  • increasing GLUT-2 cell surface localization

  • increasing GLUT-4 cell surface localization

  • decreasing activation of phosphatidylinositol 3-kinase (PI3-k)

  • decreasing activation of fructose 2,6-bisphosphatase

Explanation

Question 17 of 30

1

You are seeing a 25-year-old female with new onset diabetes. You determined that she does not have type 1 or type 2 diabetes, but
does have an uncommon form of diabetes, Mature Onset Diabetes of the Young (MODY), which is caused by a loss of function
mutation of glucokinase. How will this mutation impact the function of this patient's response to rising circulating glucose levels?

Select one of the following:

  • delayed insulin release

  • delayed glucagon release

  • earlier insulin release

  • earlier glucagon release

Explanation

Question 18 of 30

1

A 44-year-old woman with no known medical problems comes to you for evaluation of hypoglycemia. She reports "spells" that
occur on average twice daily, during which she reports feeling a shaky and sweating, and her symptoms resolve with eating. You
admit her to the hospital for a 72-hour fast and her glucose drops to 31 mg/dL. Which of the following findings would be most
suggestive of an insulinoma as the cause of her hypoglycemia?

Select one of the following:

  • A glucose rise (>25 mg/dL) after glucagon injection at the end of a 72 hour fast

  • Elevated insulin antibodies with confirmation after repeat testing

  • Decreased pro-insulin levels (<5 pmol/L)

  • Decreased c-peptide level (<200 pmol/L)

Explanation

Question 19 of 30

1

You are considering prescribing metformin to your patient with type 2 diabetes to help lower his A1C. You review his medical chart
for any possible contraindications. You should avoid prescribing metformin to patients with which one of the following
conditions?

Select one of the following:

  • Albuminuria (urine albumin/creatinine ratio >30 mg/gm)

  • Uncontrolled hypertension (>140/90)

  • Glomerular filtration rate <30 mL/minute/1.73 m2

  • Gastroparesis

Explanation

Question 20 of 30

1

A 62 year-old male with type 2 diabetes is prescribed pioglitazone. Which of the following describes the mechanism of action for
this drug?

Select one of the following:

  • Glucose-dependent insulin secretion

  • Suppression of glucagon secretion

  • Peroxisome proliferator-activated receptor gamma agonist

  • Inhibition of ATP-dependent potassium channel

Explanation

Question 21 of 30

1

A 44-year-old man presents to the Emergency Department with shakiness and palpitations. His weight is 280 lbs. and height is 5'8".
He woke in the morning feeling unwell and has not eaten yet this morning. Upon examination, he is sweating and having difficulty
speaking and concentrating during your conversation. Upon review of his medication list, you see he was recently started on a
medication to treat diabetes. Which of the following is the most likely cause of his recent symptoms?

Select one of the following:

  • Canagliflozin

  • Glipizide

  • Linagliptin

  • Metformin

Explanation

Question 22 of 30

1

A 57-year-old female presents for evaluation of type 2 diabetes. She is already taking metformin. You prescribe her empagliflozin.
As an astute physician, you want to warn her about potential side effects. Which of the following is a common side effect of
empagliflozin?

Select one of the following:

  • hypoglycemia

  • vomiting

  • polyuria

  • blurry vision

Explanation

Question 23 of 30

1

The major structural protein of very low-density lipoprotein (VLDL) is which of the following?

Select one of the following:

  • Apo B-100

  • Apo B-48

  • Apo A-1

  • Apo-E

Explanation

Question 24 of 30

1

Lorcaserin reduces appetite and results in weight loss by binding to which of the following receptors?

Select one of the following:

  • Mu opioid (MOP-R)

  • dopamine 2 (d-2)

  • melanocortin 4 (MCR4)

  • 5-hydroxtryptophan 2c (5-HT2c)

Explanation

Question 25 of 30

1

A 45 year old woman with a BMI of 32 kg/m2 has tried losing weight through several commercial weight loss programs that
emphasize portion control and reducing calories. She is frustrated that her weight keeps coming back and she weighs the same
months later as before going on a diet. Which of the following describes her body¶s response when she diets and prevents her from
being able to keep her weight off?

Select one of the following:

  • increased fat oxidation and reduced adiponectin

  • Reduced fat oxidation, reduced energy expenditure, and increased hunger

  • Increased fat oxidation, reduced energy expenditure, and increased hunger

  • Reduced ghrelin levels and reduced glucagon-like peptide-1 responses to a meal

Explanation

Question 26 of 30

1

A 59-year-old male is started on a medication and gains 20 lbs and is now obese. Initiation of which of the following medications
could explain his weight gain?

Select one of the following:

  • exenatide

  • prednisone

  • metformin

  • lisinopril

Explanation

Question 27 of 30

1

You begin a 28-year-old female on phentermine for weight management. She is most likely to notice which of the following adverse effects?

Select one of the following:

  • tachycardia

  • hypotension

  • numbness/tingling (dysethesias)

  • drowsiness

Explanation

Question 28 of 30

1

Evolocumab is a medication that blocks the activity of PCSK9. The blockade of PCSK9 activity results in which of the following?

Select one of the following:

  • Decreased lecithin cholesterol acyltransferase (LCAT) mediated cholesterol esterification

  • Increased lecithin cholesterol acyltransferase (LCAT) mediated cholesterol esterification

  • Decreased degradation of LDL receptors

  • Increased degradation of LDL receptors

Explanation

Question 29 of 30

1

A 72-year-old male with type 2 diabetes is prescribed liraglutide. When he returns for his follow up visit, he is likely to report which
of the following symptoms related to taking liraglutide?

Select one of the following:

  • tremors

  • blurred vision

  • weight gain

  • nausea

Explanation

Question 30 of 30

1

A 42-year-old male presents with new onset type 2 diabetes. He walks on a treadmill in the basement for 30 minutes five days per
week. His dietary recall is detailed below. He is taking metformin 500 mg twice daily. On exam: Ht = 6¶Wt = 237# BMI = 32.1. Labs:
A1C = 6.7%, total cholesterol = 250 mg/dL, LDL = 177 mg/dL, HDL = 31 mg/dL, triglycerides = 210 mg/dL. Dietary recall: Breakfast =
2 scrambled eggs mixed with spinach and tomatoes and 2 oz shredded cheddar cheese, 2 chicken sausage links, 12 oz whole milk
Lunch = chef salad (ham, 2 hard-boiled eggs, lettuce, tomato, cucumber, 3 oz shredded cheddar cheese), 4 tablespoons ranch salad
dressing, 20 oz diet coke Dinner = 6 oz cooked beef brisket, spinach salad (3 cups raw spinach, tomatoes, yellow bell peppers, 3 oz
shredded cheddar cheese), 4 tablespoons ranch salad dressing, 20 oz diet coke. Which one of the following lifestyle changes would
you first address with this patient?

Select one of the following:

  • Reduce dietary carbohydrate intake

  • Increase dietary fiber intake

  • Reduce dietary saturated fat intake

  • Increase physical activity

Explanation

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