Endocrine Practice Questions

Correct Answer: B) Hyperosmolar hyperglycemic state (HHS)

Rationale: HHS is characterized by very high glucose (>600), high osmolality (>320), mild acidosis without significant ketosis, and alert or altered mental status. It's more common in Type 2 diabetes because patients retain enough insulin to prevent ketosis but not enough to control glucose. DKA features pH <7.30, significant HCO3- reduction, and ketonemia. The alert mental status (without severe alterations) and lack of mention of ketonemia support HHS over DKA.

Key Concept: DKA vs. HHS: DKA has ketosis/ketonemia, lower pH, lower HCO3-; HHS has extreme hyperglycemia without ketosis, hyperosmolality, and variable mental status. HHS has higher mortality. Both require careful IV fluid resuscitation and correction of hyperglycemia.

Correct Answer: B) Onset 30 min-1 hour, peak 2-4 hours (short-acting)

Rationale: Regular (crystalline) insulin is short-acting with onset 30 min-1 hour and peak 2-4 hours. Duration is 6-8 hours. This is different from rapid-acting analogs (aspart, lispro, glulisine) which onset in minutes, and long-acting insulins (glargine, detemir) which provide basal coverage. Understanding insulin pharmacokinetics is essential for diabetes management and predicting hypoglycemia risk.

Key Concept: Insulin types and timing: Rapid (meals), Short (meals), Intermediate (NPH—bd), Long (basal). Insulin pens and pumps deliver rapid-acting; IV insulin drips use regular insulin. Always time insulin injection 15-30 min before meals for optimal effect.

Correct Answer: A) Administer 15 g rapid-acting carbohydrate, recheck in 15 min

Rationale: The "15/15 rule" for hypoglycemia: Give 15 g simple carbohydrate (glucose tablets, juice, candy), wait 15 minutes, recheck glucose. If still low, repeat. Rapid-acting carbs raise glucose quickly. Complex carbs and proteins are given AFTER the initial glucose is corrected, to provide sustained glucose. IV dextrose is reserved for unconscious patients. This patient is alert and symptomatic—mild hypoglycemia—responsive to oral carbs.

Key Concept: Hypoglycemia symptoms: Adrenergic (shakiness, sweating, tachycardia, anxiety) occur first; neuroglycopenic (confusion, difficulty concentrating, seizures) occur later with severe hypoglycemia. Prevention through patient education is key—frequent glucose monitoring, recognizing symptoms, carrying carbs.

Correct Answer: C) Controls adrenergic symptoms (tachycardia, tremor, anxiety)

Rationale: Beta-blockers like propranolol don't reduce thyroid hormone levels—they manage the symptoms of excess thyroid hormone (beta-adrenergic effects). The definitive treatment for hyperthyroidism is antithyroid drugs (PTU, methimazole), radioactive iodine, or surgery. Propranolol also has a minor benefit: it inhibits peripheral conversion of T4 to T3, the more active form. But the primary therapeutic goal is symptom control while awaiting definitive treatment.

Key Concept: Hyperthyroidism: PTU/methimazole reduce hormone production; propranolol manages symptoms; iodine (Lugol's solution) reduces hormone release; ablation (RAI, surgery) is definitive. Hypothyroidism: levothyroxine (T4) replacement, titrated by TSH levels. Always check TSH for thyroid disease diagnosis and monitoring.

Correct Answer: B) Take on an empty stomach, 30-60 min before breakfast

Rationale: Levothyroxine absorption is optimized on an empty stomach. Food, calcium supplements, iron, and antacids interfere with absorption. Taking it 30-60 minutes before breakfast ensures maximum bioavailability. The consistent timing also helps maintain stable hormone levels. TSH levels should be checked 6-8 weeks after starting or dose changes to ensure therapeutic effect.

Key Concept: Levothyroxine has a long half-life (7 days), so consistent dosing is important. Avoid taking it with other medications that interact (calcium, iron, antacids)—space 4 hours apart. Patient education on adherence is critical; missing doses leads to hypothyroid symptoms.