Medicine
Endocrinology
Which complication or major adverse outcome is particularly associated with Primary hypothyroidism?
A. Diabetic kidney disease
B. Hypokalemia during treatment
C. Myxedema coma
D. Thromboembolic events
Correct Answer: C
Severe untreated hypothyroidism can decompensate into hypothermia, altered mental status and multiorgan dysfunction.
Medicine
Endocrinology
A patient is diagnosed with Primary hypothyroidism. Which is the most appropriate management principle?
A. Replace free-water deficit and use desmopressin for confirmed central diabetes insipidus
B. Use levothyroxine replacement with dose adjustment using clinical and biochemical monitoring
C. Use lifestyle therapy plus individualized glucose-lowering treatment based on comorbidity, risk and patient factors
D. Begin isotonic fluid resuscitation, correct potassium as needed and give insulin once it is safe to do so
Correct Answer: B
Levothyroxine is standard replacement therapy for primary hypothyroidism.
Medicine
Endocrinology
In a patient with suspected Primary hypothyroidism, which investigation or diagnostic approach is most appropriate at this stage?
A. Serum TSH with free thyroxine
B. Serum osmolality, urine osmolality and urine sodium with evaluation for alternative causes
C. Paired serum and urine osmolality with specialist-directed testing when diagnosis is uncertain
D. Confirm diabetes with an accepted plasma glucose or HbA1c-based diagnostic test when confirmation is required
Correct Answer: A
TSH and free T4 distinguish primary hypothyroidism from central causes and quantify biochemical severity.
Medicine
Endocrinology
A patient has fatigue, weight gain, constipation, cold intolerance and bradycardia. What is the most likely diagnosis?
A. Primary adrenal insufficiency
B. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C. Central diabetes insipidus
D. Primary hypothyroidism
Correct Answer: D
This symptom cluster is typical of hypothyroidism, most often primary thyroid failure.
Medicine
Endocrinology
Compared with DKA, which feature is more typical of HHS?
A. Marked ketoacidosis is always more severe
B. It occurs only in children
C. More severe hyperosmolality with less prominent ketoacidosis
D. Serum glucose is usually normal
Correct Answer: C
HHS is characterized by extreme hyperglycemia and hyperosmolality with relatively little ketosis.
Medicine
Endocrinology
Which complication or major adverse outcome is particularly associated with Hyperosmolar hyperglycemic state (HHS)?
A. Myxedema coma
B. Thromboembolic events
C. Atrial fibrillation
D. Adrenal crisis with shock
Correct Answer: B
Severe dehydration and hyperviscosity increase thrombotic risk in HHS.
Medicine
Endocrinology
A patient is diagnosed with Hyperosmolar hyperglycemic state (HHS). Which is the most appropriate management principle?
A. Prioritize careful intravenous fluid replacement, then manage electrolytes and insulin
B. Begin isotonic fluid resuscitation, correct potassium as needed and give insulin once it is safe to do so
C. Use levothyroxine replacement with dose adjustment using clinical and biochemical monitoring
D. Control adrenergic symptoms and use cause-specific antithyroid treatment when appropriate
Correct Answer: A
Profound volume depletion is a defining feature of HHS, so fluid resuscitation is a major early priority.
Medicine
Endocrinology
In a patient with suspected Hyperosmolar hyperglycemic state (HHS), which investigation or diagnostic approach is most appropriate at this stage?
A. Confirm diabetes with an accepted plasma glucose or HbA1c-based diagnostic test when confirmation is required
B. Serum or capillary ketones, electrolytes and acid-base assessment
C. Serum TSH with free thyroxine
D. Serum glucose, electrolytes, calculated effective osmolality and assessment for a precipitating illness
Correct Answer: D
Hyperosmolality and dehydration severity are central to HHS assessment, and infection or other triggers should be sought.
Medicine
Endocrinology
A patient is an older adult with profound dehydration, very high glucose, altered mental status and little or no significant ketoacidosis. What is the most likely diagnosis?
A. Central diabetes insipidus
B. Type 2 diabetes mellitus
C. Hyperosmolar hyperglycemic state (HHS)
D. Diabetic ketoacidosis (DKA)
Correct Answer: C
Extreme hyperglycemia and hyperosmolality with severe dehydration and minimal ketosis are typical of HHS.
Medicine
Endocrinology
Why must serum potassium be checked repeatedly during treatment of DKA?
A. DKA always causes total-body potassium excess
B. Total-body potassium is depleted even when the initial serum potassium is normal or high
C. Insulin has no effect on potassium distribution
D. Potassium is unrelated to arrhythmia risk
Correct Answer: B
Osmotic diuresis causes total-body potassium loss; serum values can initially appear normal or elevated because of extracellular shifts.
Medicine
Endocrinology
Which complication or major adverse outcome is particularly associated with Diabetic ketoacidosis (DKA)?
A. Hypokalemia during treatment
B. Adrenal crisis with shock
C. Seizures from severe acute hyponatremia
D. Hypernatremic dehydration
Correct Answer: A
Insulin and correction of acidosis drive potassium into cells and can precipitate dangerous hypokalemia.
Medicine
Endocrinology
A patient is diagnosed with Diabetic ketoacidosis (DKA). Which is the most appropriate management principle?
A. Control adrenergic symptoms and use cause-specific antithyroid treatment when appropriate
B. Replace glucocorticoid and mineralocorticoid hormones and give stress-dose steroids during major illness
C. Treat the cause and use fluid restriction for many stable chronic cases; severe symptomatic cases require controlled hypertonic saline
D. Begin isotonic fluid resuscitation, correct potassium as needed and give insulin once it is safe to do so
Correct Answer: D
Fluids, potassium management and insulin are the major components of DKA treatment; potassium status must be considered before insulin.
Medicine
Endocrinology
In a patient with suspected Diabetic ketoacidosis (DKA), which investigation or diagnostic approach is most appropriate at this stage?
A. Serum TSH with free thyroxine
B. TSH followed by free T4 and/or T3 with cause-specific testing when needed
C. Serum or capillary ketones, electrolytes and acid-base assessment
D. Morning cortisol with ACTH and confirmatory adrenal-function testing when appropriate
Correct Answer: C
Ketone burden, bicarbonate or pH, potassium and renal function guide diagnosis and safe treatment.
Medicine
Endocrinology
A patient has diabetes, dehydration, abdominal pain, Kussmaul breathing, hyperglycemia, ketonemia and high-anion-gap metabolic acidosis. What is the most likely diagnosis?
A. Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Primary hypothyroidism
D. Thyrotoxicosis
Correct Answer: B
The combination of ketosis and metabolic acidosis in a patient with diabetes is diagnostic of DKA.
Medicine
Endocrinology
Which test reflects average glycemia over the preceding several weeks to months?
A. HbA1c
B. Serum amylase
C. Troponin I
D. D-dimer
Correct Answer: A
HbA1c reflects longer-term glycemic exposure rather than a single momentary glucose value.
Medicine
Endocrinology
Which complication or major adverse outcome is particularly associated with Type 2 diabetes mellitus?
A. Hypernatremic dehydration
B. Hypokalemia during treatment
C. Thromboembolic events
D. Diabetic kidney disease
Correct Answer: D
Chronic hyperglycemia can cause microvascular kidney injury and albuminuria.
Medicine
Endocrinology
A patient is diagnosed with Type 2 diabetes mellitus. Which is the most appropriate management principle?
A. Treat the cause and use fluid restriction for many stable chronic cases; severe symptomatic cases require controlled hypertonic saline
B. Replace free-water deficit and use desmopressin for confirmed central diabetes insipidus
C. Use lifestyle therapy plus individualized glucose-lowering treatment based on comorbidity, risk and patient factors
D. Begin isotonic fluid resuscitation, correct potassium as needed and give insulin once it is safe to do so
Correct Answer: C
Modern type 2 diabetes care is individualized and includes cardiovascular, kidney and weight considerations as well as glycemia.
Medicine
Endocrinology
In a patient with suspected Type 2 diabetes mellitus, which investigation or diagnostic approach is most appropriate at this stage?
A. Morning cortisol with ACTH and confirmatory adrenal-function testing when appropriate
B. Confirm diabetes with an accepted plasma glucose or HbA1c-based diagnostic test when confirmation is required
C. Serum osmolality, urine osmolality and urine sodium with evaluation for alternative causes
D. Paired serum and urine osmolality with specialist-directed testing when diagnosis is uncertain
Correct Answer: B
Diagnosis uses standardized glucose or HbA1c criteria; repeat confirmation is generally appropriate when unequivocal hyperglycemia is absent.
Medicine
Endocrinology
A patient has polyuria and polydipsia with persistent hyperglycemia on diagnostic testing and features of insulin resistance. What is the most likely diagnosis?
A. Type 2 diabetes mellitus
B. Thyrotoxicosis
C. Primary adrenal insufficiency
D. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Correct Answer: A
Persistent hyperglycemia meeting accepted diagnostic criteria in a typical insulin-resistant phenotype supports type 2 diabetes.
Medicine
Critical Care & Sepsis
Which laboratory finding most strongly supports consumptive coagulopathy in DIC?
A. Isolated elevated hemoglobin
B. Normal platelet count with normal coagulation studies
C. Isolated eosinophilia
D. Low fibrinogen with elevated D-dimer
Correct Answer: D
Consumption of fibrinogen and increased fibrin breakdown are characteristic of DIC.