Block 5: Endocrine

An 18-year-old girl is in the clinic for a health supervision visit. She has been diagnosed with obesity and type 2 diabetes mellitus for two years now. She claims she has stuck to a healthy lifestyle. She goes running for 30 minutes five times a week. She also makes healthy food choices and avoids processed foods. She has also motivated her younger sister to do the same. On physical examination, body mass index is at the 80th percentile, with flabby abdomen and abdominal striae. Which of the following is the co-morbid condition associated with type 2 diabetes mellitus?

A 34-year-old female consults you because of excessive body and facial hair. She has a normal body weight, no other signs of virilization, and regular menses. She had a bilateral tubal ligation 4 years ago. Which one of the following would be the most appropriate treatment for her mild hirsutism?

A 50-year-old man with type II diabetes presents for follow up after failing to achieve glycemic control on metformin alone. You decide to try combination therapy with dapagliflozin. He asks what side effects are associated with this new medication. What adverse effect can you tell him might occur?

A 26-year-old woman presents with a 5-month history of amenorrhea and bilateral galactorrhea. She denies the possibility of pregnancy. On physical exam, milk can be expressed from both breasts. Visual fields testing by confrontation reveals bitemporal field defects. Pelvic exam is normal and a pregnancy test is negative. After confirming the suspected diagnosis, which of the following is the most appropriate management?

A patient with rheumatoid arthritis presents with new onset generalized weakness, fatigue, facial swelling and weight gain. Examination is significant for periorbital edema, dry skin and coarse brittle hair. Laboratory testing reveals a high titer of antithyroid antibodies. Which of the following will most likely be prescribed?

An otherwise healthy 36-year-old man reports six months of decreased libido and inability to maintain an erections. Vital signs are BP 130/84, HR 65, RR 15, and T 98.6° F. He still experiences spontaneous nighttime erections. His physical exam is normal and laboratory testing reveals a low total testosterone level. What is the most appropriate next step?

What finding is commonly seen with primary adrenal insufficiency but not secondary adrenal insufficiency?

A 65 year old patient comes to establish care with you and reports history of hypertension controlled on amlodipine and chronic kidney disease. She is asymptomatic. You perform routine laboratory work-up for risk stratification and to monitor renal function. Her A1C is elevated to 8.2 and her creatinine is 2.4 with a GFR of 24. There are no electrolyte abnormalities. Which medication would you start for this patient?

A 35-year-old white male who has had type 1 diabetes mellitus for 20 years begins having episodes of hypoglycemia. His glucose levels had previously been stable and well controlled, and he has not recently changed his diet or insulin regimen. Which one of the following is the most likely cause of the hypoglycemia?

Which one of the following outcomes is seen with intensive glycemic control in patients with type 2 diabetes mellitus?