NR 602 WEEK 4 MIDTERM EXAM
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES GRADED A+
LATEST
1. A 55-year-old male presents with fatigue, weight loss, and increased thirst.
Labs show fasting glucose 190 mg/dL and A1c 8.5%. Which of the following is
the most appropriate initial management plan?
A. Start insulin therapy immediately
B. Lifestyle modification and metformin
C. Start sulfonylurea therapy
D. Initiate GLP-1 agonist therapy
Answer: B
Rationale: For new-onset type 2 diabetes with A1c <9%, initial therapy is lifestyle
modifications plus metformin unless contraindicated.
,2. A patient with type 2 diabetes has an A1c of 9.8% despite metformin
therapy. Which is the best next step?
A. Add a sulfonylurea
B. Add insulin therapy
C. Add a GLP-1 receptor agonist or SGLT2 inhibitor
D. Switch metformin to a DPP-4 inhibitor
Answer: C
Rationale: For A1c >9% or not at goal on metformin, adding a GLP-1 agonist or
SGLT2 inhibitor is evidence-based and supports weight loss and cardiovascular
benefits.
3. A 48-year-old patient presents with HTN and microalbuminuria. Which
medication class is first-line?
A. Calcium channel blocker
B. ACE inhibitor
C. Beta-blocker
D. Thiazide diuretic
Answer: B
Rationale: ACE inhibitors reduce progression of diabetic nephropathy and are
first-line for HTN with microalbuminuria.
4. A 60-year-old female presents with sudden onset of severe right upper
quadrant pain, fever, and jaundice. Murphy’s sign is positive. What is the
most likely diagnosis?
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute hepatitis
D. Peptic ulcer disease
,Answer: B
Rationale: RUQ pain, fever, jaundice, and positive Murphy’s sign indicate acute
cholecystitis, especially with systemic signs.
5. Which of the following findings would indicate diabetic ketoacidosis
(DKA)?
A. Blood glucose 120 mg/dL and ketones present
B. Blood glucose 250 mg/dL, pH 7.25, and anion gap 18
C. Blood glucose 140 mg/dL and normal anion gap
D. A1c 6.2%
Answer: B
Rationale: DKA is characterized by hyperglycemia, metabolic acidosis (pH <7.3),
and increased anion gap.
6. A patient presents with fatigue, cold intolerance, weight gain, and
constipation. TSH is elevated and free T4 is low. Which is the most
appropriate treatment?
A. Methimazole
B. Levothyroxine
C. Propylthiouracil
D. Radioactive iodine
Answer: B
Rationale: Primary hypothyroidism is treated with levothyroxine replacement
therapy.
, 7. A patient with hypothyroidism is started on levothyroxine. What is the best
monitoring plan?
A. Check TSH every 2–4 weeks until stable
B. Check TSH yearly only
C. Check free T4 every week
D. No monitoring needed
Answer: A
Rationale: TSH should be checked 6 weeks after initiation or dose change, then
every 2–3 months until stable.
8. A 30-year-old female presents with palpitations, weight loss, heat
intolerance, and tremors. TSH is low and free T4 is high. What is the most
likely diagnosis?
A. Hypothyroidism
B. Graves’ disease
C. Hashimoto’s thyroiditis
D. Subclinical hyperthyroidism
Answer: B
Rationale: Symptoms of hyperthyroidism with low TSH and high free T4 strongly
suggest Graves’ disease.
9. A patient with hyperthyroidism presents with atrial fibrillation. Which
medication is indicated to control heart rate?
A. Propranolol
B. Levothyroxine
C. Methimazole
D. Prednisone
Answer: A
Rationale: Beta-blockers control symptoms and reduce heart rate in
hyperthyroidism and thyroid storm.
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES GRADED A+
LATEST
1. A 55-year-old male presents with fatigue, weight loss, and increased thirst.
Labs show fasting glucose 190 mg/dL and A1c 8.5%. Which of the following is
the most appropriate initial management plan?
A. Start insulin therapy immediately
B. Lifestyle modification and metformin
C. Start sulfonylurea therapy
D. Initiate GLP-1 agonist therapy
Answer: B
Rationale: For new-onset type 2 diabetes with A1c <9%, initial therapy is lifestyle
modifications plus metformin unless contraindicated.
,2. A patient with type 2 diabetes has an A1c of 9.8% despite metformin
therapy. Which is the best next step?
A. Add a sulfonylurea
B. Add insulin therapy
C. Add a GLP-1 receptor agonist or SGLT2 inhibitor
D. Switch metformin to a DPP-4 inhibitor
Answer: C
Rationale: For A1c >9% or not at goal on metformin, adding a GLP-1 agonist or
SGLT2 inhibitor is evidence-based and supports weight loss and cardiovascular
benefits.
3. A 48-year-old patient presents with HTN and microalbuminuria. Which
medication class is first-line?
A. Calcium channel blocker
B. ACE inhibitor
C. Beta-blocker
D. Thiazide diuretic
Answer: B
Rationale: ACE inhibitors reduce progression of diabetic nephropathy and are
first-line for HTN with microalbuminuria.
4. A 60-year-old female presents with sudden onset of severe right upper
quadrant pain, fever, and jaundice. Murphy’s sign is positive. What is the
most likely diagnosis?
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute hepatitis
D. Peptic ulcer disease
,Answer: B
Rationale: RUQ pain, fever, jaundice, and positive Murphy’s sign indicate acute
cholecystitis, especially with systemic signs.
5. Which of the following findings would indicate diabetic ketoacidosis
(DKA)?
A. Blood glucose 120 mg/dL and ketones present
B. Blood glucose 250 mg/dL, pH 7.25, and anion gap 18
C. Blood glucose 140 mg/dL and normal anion gap
D. A1c 6.2%
Answer: B
Rationale: DKA is characterized by hyperglycemia, metabolic acidosis (pH <7.3),
and increased anion gap.
6. A patient presents with fatigue, cold intolerance, weight gain, and
constipation. TSH is elevated and free T4 is low. Which is the most
appropriate treatment?
A. Methimazole
B. Levothyroxine
C. Propylthiouracil
D. Radioactive iodine
Answer: B
Rationale: Primary hypothyroidism is treated with levothyroxine replacement
therapy.
, 7. A patient with hypothyroidism is started on levothyroxine. What is the best
monitoring plan?
A. Check TSH every 2–4 weeks until stable
B. Check TSH yearly only
C. Check free T4 every week
D. No monitoring needed
Answer: A
Rationale: TSH should be checked 6 weeks after initiation or dose change, then
every 2–3 months until stable.
8. A 30-year-old female presents with palpitations, weight loss, heat
intolerance, and tremors. TSH is low and free T4 is high. What is the most
likely diagnosis?
A. Hypothyroidism
B. Graves’ disease
C. Hashimoto’s thyroiditis
D. Subclinical hyperthyroidism
Answer: B
Rationale: Symptoms of hyperthyroidism with low TSH and high free T4 strongly
suggest Graves’ disease.
9. A patient with hyperthyroidism presents with atrial fibrillation. Which
medication is indicated to control heart rate?
A. Propranolol
B. Levothyroxine
C. Methimazole
D. Prednisone
Answer: A
Rationale: Beta-blockers control symptoms and reduce heart rate in
hyperthyroidism and thyroid storm.
