Metabolic & Endocrinology

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Elevated Vitamin B12 Levels

Which one of the following statements about elevated Vitamin B12 levels is false?

  • Less than 5% of individuals have elevated vitamin B12
  • Persistently elevated levels have been associated with an increased incidence of solid cancer, specifically liver, kidney, lung, breast, and gastrointestinal cancers.
  • Patients are at increased risk of hematologic disorders such as chronic myeloid leukemia, polycythemia vera, and myeloproliferative syndromes.
  • A repeat test should be performed to confirm persistent elevation.
Volume 41.1 - Question 29

Pediatric Obesity

Which one of the following statements regarding the treatment of childhood obesity is false? 

  • Multicomponent interventions are strongly recommended.
  • GLP1 receptor agonists can be considered.
  • Roux-en-Y gastric bypass surgery leads to substantial reductions in BMI in children 13 and older.
  • Less than 50% of 12- to 18-year-olds with obesity continue to have obesity in adulthood.
Volume 40.5 - Question 3

Cardiovascular Outcomes in Women

A single combined measure of high-sensitivity C-reactive protein & low-density lipoprotein cholesterol, and lipoprotein (a) levels among initially healthy women is predictive of incident cardiovascular events during a 30-year period.

  • True
  • False
Volume 40.4 - Question 30

Empathic Telephone Conversations

Layperson-delivered, empathy-focused telephone engagement can improve glycemic control for patients with diabetes.

  • True
  • False
Volume 40.4 - Question 17

Oral Glucose-Lowering Agents vs. Insulin in Gestational Diabetes

Treatment of gestational diabetes with metformin and additional glyburide, if needed, is noninferior when compared with insulin with respect to the proportion of infants born large for gestational age.

  • True
  • False
Volume 40.4 - Question 14

Hypothyroidism

Which one of the following statements regarding subclinical hypothyroidism in older individuals (>65 years) is false?

  • The reference range for TSH is shifted towards higher values with the 97.5th percentile of the confidence interval for serum TSH being around 7.5 mIU/L.
  • It is not associated with an increased risk of cardiovascular mortality.
  • Treatment has been shown to improve fatigue.
  • Treatment has not been shown to improve neurocognitive function.
Volume 40.3 - Question 28

Hyperglycemia in Hospitalized Patients

Which one of the following statements regarding hyperglycemia in hospitalized patients is false?

  • People with diabetes account for more than 25% of hospitalization.
  • Hyperglycemia in hospitalized patients without diabetes is a predictor of worse outcomes.
  • Use of intensive inpatient glycemic targets improves morbidity.
  • Insulin remains the gold standard for management of hospital hyperglycemia.
Volume 40.3 - Question 25

HbA1c and G6PD Deficiency

Glycated hemoglobin levels markedly underestimate glucose levels in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency.

  • True
  • False
Volume 40.3 - Question 24

Malnutrition

In evaluating adults for possible malnutrition, serum albumin should be used as an indicator of nutritional status.

  • True
  • False
Volume 40.2 - Question 34

Pancreatic Cysts

Which one of the following statements about pancreatic cysts is false?

  • Mucinous cysts are the predominant premalignant cystic lesions.
  • One identified at the initial presentation of a patient with pancreatitis should be considered a pseudocyst.
  • Patients with high-risk cysts are candidates for surgical resection.
  • Ongoing surveillance of the remaining gland is required after surgical resection of intraductal papillary mucinous neoplasm.
Volume 40.2 - Question 1

Caffeine and Cardiometabolic Multimorbidity

Habitual coffee or caffeine intake, especially at a moderate level, is associated with a lower risk of new onset cardiometabolic multimorbidity.

  • True
  • False
Volume 40.1 - Question 36

Non-Alcoholic Fatty Liver Disease

In patients with Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease, which one of the following statements regarding treatment with oral antidiabetic drugs is false?

  • Thiazolidinediones restore lowered plasma adiponectin levels in patients with nonalcoholic steatohepatitis.
  • Sodium-glucose cotransporter 2 inhibitors might be preferred over other oral antidiabetic drugs with respect to nonalcoholic fatty liver disease regression.
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors are not significantly associated with weight change.
  • DPP-4 inhibitors are significantly associated with a lower incidence of adverse liver-related outcomes when compared with sulfonylureas.
Volume 39.6 - Question 40

Lixisenatide in Parkinson’s Disease

In early Parkinson’s disease, glucagon-like peptide-1 (GLP-1) receptor agonist lixisenatide results in less progression of motor disability than placebo at 12 months.

  • True
  • False
Volume 39.6 - Question 33

Polycystic Ovarian Syndrome

Which one of the following statements about polycystic ovary syndrome (PCOS) is false? 

  • Androgen levels cannot be measured reliably while a patient is on combined hormonal contraceptives.   
  • The addition of metformin to combined hormonal contraceptives can be considered in patients with PCOS in high metabolic risk groups.   
  • The risk of endometrial cancer is 2–6 times higher among people with PCOS than the general population and often presents before menopause. 
  • With assisted reproduction, the cumulative probability of childbirth is lower in patients with PCOS than those without.
Volume 39.5 - Question 10

Testosterone Treatment

Testosterone treatment in men with hypogonadism decreases the risk of fractures. 

  • True
  • False
Volume 39.4 - Question 29

Semaglutide Treatment

Semaglutide treatment is associated with the normalization of menstrual cycles in polycystic ovary syndrome patients. 

  • True
  • False
Volume 39.4 - Question 13

Semaglutide in Heart Failure with Preserved Ejection Fraction and Obesity

In patients with heart failure with preserved ejection fraction and obesity, treatment with semaglutide results in each of the following except:

  • Weight loss.
  • Reduced symptoms of congestive heart failure.
  • Lower C-reactive protein (CRP) levels.
  • Serious adverse events.
Volume 39.3 - Question 28

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes

In patients with preexisting cardiovascular disease and BMI of 27 or greater, without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg is superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke.

  • True
  • False
Volume 39.3 - Question 27

Nutrition for Osteoporosis Prevention

For people who are consuming a balanced diet and not receiving pharmacotherapy for osteoporosis, supplementation with calcium, vitamin D and protein is likely to have little to no effect on fractures.

  • True
  • False
Volume 39.3 - Question 16

Vitamin D in prediabetes

In non-obese patients with prediabetes, vitamin D supplementation significantly reduces the risk of type 2 diabetes mellitus. 

  • True
  • False
Volume 36.6 - Question 35

GLP-1 Receptor Agonists

Which one of the following statements about GLP-1 receptor agonists is false?

  • The dosage recommended for weight loss is higher than the dosage used for the treatment of type 2 diabetes.
  • Liraglutide and semaglutide are approved for weight management in patients without type 2 diabetes.
  • The oral form of semaglutide has been approved for weight management.
  • Gastrointestinal adverse effects are common.
Volume 37.6 - Question 37

Screening for Gestational Diabetes

One-step screening, as compared with two-step screening, doubles the incidence of the diagnosis of gestational diabetes without affecting perinatal risks.  

  • True
  • False
Volume 36.6 - Question 3

Gastric Emptying in Diabetes Mellitus 

Which one of the following statements about gastric emptying abnormalities in diabetes mellitus is false?   

  • Rapid gastric emptying plays an important role in the progression of type 2 diabetes mellitus.    
  • Acute hyperglycemia speeds up gastric emptying of digestible food during the digestive period.  
  • Short acting glucagon-like peptide 1 agonists decelerate gastric emptying.  
  • Treatment to hasten gastric emptying may worsen glycemic control.
Volume 36.5 - Question 33

Semaglutide

Which one of the following statements about semaglutide is false? 

  • GI adverse effects are common but are generally transient and mild to moderate in severity.     
  • It is contraindicated in patients with a personal history of medullary thyroid carcinoma.   
  • It may reduce body weight significantly in patients with and without type 2 diabetes when given in addition to lifestyle intervention.    
  • It is approved by Health Canada for weight loss treatment.  
Volume 36.5 - Question 21

Naltrexone/Bupropion

Naltrexone/bupropion has the highest incidence of adverse effects leading to drug discontinuation of all approved weight-loss drugs.

  • True
  • False
Volume 37.6 - Question 24

High Fat Low Carb Diet in Diabetes

Which one of the following statements is false regarding patients with type 2 diabetes who follow a high fat, low carbohydrate diet for 6 months compared to those who follow a standard diet for 6 months?

  • They experience a greater decrease in HbA1C.
  • They experience a greater decrease in waist circumference.
  • They lose more weight.
  • Their lipid levels increase.
Volume 37.6 - Question 23

Obesity

Time-restricted eating, in the absence of other interventions, results in more weight loss than eating throughout the day. 

  • True
  • False
Volume 36.4 - Question 37

Short-term Systemic Corticosteroids

Which one of the following conditions has evidence to support the use of systemic corticosteroids in its management?    

  • Acute pharyngitis    
  • Acute gout   
  • Lumbar radiculopathy    
  • Herpes zoster 
Volume 36.3 - Question 36

Bone Mineral Density Testing

Repeated bone mineral density (BMD) testing three years after baseline BMD in postmenopausal women should not be routinely performed.  

  • True
  • False
Volume 36.3 - Question 35

Semaglutide and Obesity

Semaglutide causes weight loss in overweight and obese adults without diabetes.

  • True
  • False
Volume 37.1 - Question 31

Erythrocytosis in Trans Men

Which one of the following is not associated with erythrocytosis in trans men undergoing testosterone therapy?

  • Oral (rather than topical) testosterone.
  • Higher age at initiation of testosterone therapy.
  • Smoking.
  • High BMI.
Volume 37.1 - Question 30

SGLT2

In adults with Type-2 diabetes and established CVD and CKD, there is a strong recommendation for the use of SGLT2 inhibitors.

  • True
  • False
Volume 37.1 - Question 24

Weight Loss

Intensive lifestyle promotion including increasing weekly physical activity and meal preparation/portion sizing with help of a health coach at primary care clinics leads to a significantly higher proportion of patients losing 10% body weight at 24 month follow up. 

  • True
  • False
Volume 36.3 - Question 3

Dapagliflozin in Chronic Kidney Disease

Dapagliflozin therapy in patients with chronic kidney disease, with or without Type II diabetes, reduces a composite outcome of sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes.  

  • True
  • False
Volume 36.2 - Question 37

Paget Disease

Which one of the following statements about the diagnosis of Paget disease of bone is false? 

  • Pain is the major presenting symptom.    
  • Measurement of alkaline phosphatase in conjunction with liver function testing is used as a first line biochemical evaluation.   
  • Asymptomatic patients with elevated levels of alkaline phosphatase and no underlying liver or biliary tract disease should not have x-rays done.   
  • All patients diagnosed with Paget disease of bone should have a radionuclide bone scan.  
Volume 36.2 - Question 20

Persistent Night Sweats

Following a Mediterranean diet is associated with a decrease in night sweats.  

  • True
  • False
Volume 36.2 - Question 16

Osteogenesis Imperfecta

Which one of the following statements about osteogenesis imperfecta (OI) is false? 

  • Severe forms can lead to in utero fractures.   
  • It may affect the airways contributing to complications such as sleep apnea.   
  • Hearing loss is a recognized extra-skeletal manifestation.    
  • Denosumab is the mainstay of pharmacological treatment in pediatric patients. 
Volume 36.2 - Question 1

Subclinical Hypothyroidism

Which one of the following statements about subclinical hypothyroidism is false?

  • An elevated anti thyroid peroxidase increases the risk of progression to hypothyroidism.
  • In patients 65 years and older with subclinical hypothyroidism and TSH levels less than 10 mIU per L, treatment with levothyroxine can increase mortality.
  • Treatment improves thyroid related symptoms.
  • More than 50% of patients older than 55 years with TSH levels of 5.0 to 9.9 mIU per L will normalize
Volume 37.2 - Question 28

Subacute Thyroiditis

Which one of the following statements about subacute thyroiditis is false?

  • It may present with a prodrome of fatigue, myalgias, low-grade fever, and pharyngitis.
  • Anterior neck pain is usually the presenting symptom.
  • It is treated with antithyroid medications.
  • It is generally self-limited.
Volume 37.4 - Question 32

Postpartum Thyroiditis

Which one of the following statements about postpartum thyroiditis is false?

  • It is a painless condition.
  • Recurrence with subsequent pregnancies is rare.
  • Radioactive iodine uptake and scan imaging is contraindicated in patients who are breastfeeding.
  • Tapering of levothyroxine dose around 12 months is recommended.
Volume 37.4 - Question 31

Hashimoto Thyroiditis

Which one of the following statements about Hashimoto thyroiditis is false?

  • It may present with other autoimmune disorders.
  • It often presents with a painless goiter, with or without overt hypothyroidism.
  • Thyroid peroxidase antibodies are found in 95% of patients.
  • Only symptomatic patients require treatment.
Volume 37.4 - Question 30

Second Line Diabetes Treatment

When used in combination with metformin for the treatment of Type 2 diabetes, sodium-glucose cotransporter 2 (SGLT2) inhibitors, as compared to sulfonylureas, are associated with a reduced risk of all-cause mortality. 

  • True
  • False
Volume 37.4 - Question 23

Liraglutide for Weight Loss

In adolescents with obesity, the use of liraglutide plus lifestyle therapy leads to a significantly greater reduction in the body-mass index standard deviation score than lifestyle therapy alone. 

  • True
  • False
Volume 36.1 - Question 25

Type II DM and Fibrosis

In patients with type II diabetes mellitus, ALT/AST levels are adequate screening investigations for liver fibrosis.

  • True
  • False
Volume 37.4 - Question 10

COVID-19 and Diabetes

There is an increased risk for newly diagnosed diabetes >30 days after acute infection with SARS-CoV-2 among persons aged <18 years.

  • True
  • False
Volume 37.4 - Question 7

Painful Diabetic Neuropathy

Which one of the following approaches is most effective in treating painful diabetic neuropathy not well controlled with monotherapy? 

  • Amitriptyline supplemented with pregabalin. 
  • Pregabalin supplemented with amitriptyline. 
  • Duloxetine supplemented with pregabalin. 
  • There is no difference between the three options. 
Volume 38.1 - Question 22

Management of Hyponatremia

Which one of the following statements about the management of hyponatremia is false?

  • Increasing daily protein intake to 1 g/kg improves hyponatremia in patients with Syndrome of inappropriate antidiuresis (SIAD).
  • Normalization of the serum sodium level at day 30 occurs in a majority of patients with SIAD treated with tolvaptan.
  • Desmopressin can be used to avoid overly rapid correction.
  • In acute water intoxication there is a high risk of osmotic demyelination.
Volume 38.2 - Question 16

Bedtime Snacks and Type 2 Diabetes

In individuals with Type 2 diabetes, consuming a bedtime snack, vs no-snack has has not been shown to improve fasting glucose concentrations.

  • True
  • False
Volume 38.2 - Question 15

Atrial Fibrillation and Diabetes

In patients with atrial fibrillation and diabetes, which one of the following statements about the hazards of diabetic complications with non-vitamin K antagonist oral anticoagulants as compared to warfarin is false?

  • There is a lower risk of microvascular complications.
  • There is a lower risk of macrovascular complications.
  • There is a lower mortality risk.
  • There are more frequent glycemic emergencies.
Volume 37.5 - Question 23

Metformin Use and Associated Risk

Metformin use in type 2 diabetes is associated with a lower risk of total knee replacement.

  • True
  • False
Volume 38.4 - Question 18

Secondary Causes of Erythrocytosis

SGLT2 inhibitors may be a significant, underrecognized cause of drug induced erythrocytosis.

  • True
  • False
Volume 38.3 - Question 35

Diabetic Foot Ulcers

Which one of the following statements about the management of diabetic foot ulcers is false? 

  • Weekly, as compared to less frequent debridement, results in significantly more healing. 
  • The most effective treatment for off-loading a plantar foot ulcer is a knee-high nonremovable device. 
  • Hyperbaric oxygen therapy improves healing when standard of care alone has failed.  
  • In the absence of an acute soft tissue infection in forefoot osteomyelitis, antibiotics are not as effective as surgery. 
Volume 39.1 - Question 29

Finerenone for Patients with Diabetic Kidney Disease

The novel nonsteroidal mineralocorticoid receptor antagonist finerenone, on top of ACEi or ARB treatment, slows progressive loss of eGFR and decreases the risk of a cardiovascular event among people with type 2 diabetes and albuminuria.

  • True
  • False
Volume 38.3 - Question 26

Drugs for Type 2 Diabetes

When adding a second drug to metformin, SGLT-2 inhibitors and GLP-1 receptor agonists reduce major adverse cardiovascular events (MACE) to a similar extent in patients with established atherosclerotic cardiovascular disease (ASCVD).  

  • True
  • False
Volume 38.3 - Question 25

Timing of Meals and Weight Loss Trajectory

When counseling patients about weight gain prevention, limiting the frequency of large meals is more beneficial than time-restricted eating.

  • True
  • False
Volume 38.3 - Question 24

Weight Management in Adolescents

Among adolescents with obesity, once-weekly treatment with a 2.4-mg dose of semaglutide plus lifestyle intervention resulted in a greater reduction in BMI than lifestyle intervention alone.

  • True
  • False
Volume 38.4 - Question 7

Primary Ovarian Insufficiency

Which one of the following statements about primary ovarian insufficiency is false?

  • Laboratory evaluation includes thyrotropin levels.
  • If a first-degree relative is affected, the likelihood of a genetic disorder is increased by a factor of 6 to 12.
  • Autoimmune disorders account for about one-third of cases.
  • Ongoing contraception is recommended if pregnancy is not desired.
Volume 38.3 - Question 4

Hemochromatosis

Which one of the following statements about hemochromatosis is false?

  • The earliest laboratory manifestation is an elevation in the serum ferritin level.
  • Iron elevation is a risk factor for breast cancer.
  • Arthritis may occur even after successful therapeutic phlebotomy.
  • Cardiomyopathy is a rare complication that is potentially reversible with iron-removal therapy.
Volume 38.4 - Question 2

Cardiovascular Safety of Testosterone-Replacement Therapy

Which one of the following adverse outcomes is not relatively increased versus placebo in men with hypogonadism and preexisting or a high risk of cardiovascular disease receiving transdermal testosterone-replacement therapy?

  • Atrial fibrillation
  • Major cardiac adverse events
  • Acute kidney injury
  • Pulmonary embolism
Volume 39.2 - Question 38

Once-Weekly Insulin

Which one of the following statements about once weekly insulin icodec vs once daily insulin degludec in adults with insulin naive type 2 diabetes is false?

  • It is similarly effective at reducing HbA1C.
  • The total weekly insulin dose is the same.
  • Injection site reactions are lower.
  • There is a higher rate of hypoglycaemia.
Volume 39.2 - Question 32

Menstrual Suppression in Transgender and Gender-Diverse Adolescents

Which one of the statements regarding menstrual suppression in transgender and gender-diverse adolescents is false?

  • It should be considered for those experiencing gender dysphoria whose menstruation is not already suppressed (e.g., by using testosterone).
  • There is an association with improved rates of depression.
  • No particular agent demonstrates greater efficacy over another.
  • Users of intramuscular medroxyprogesterone report lower rates of satisfaction compared with those using the combined oral contraceptives.
Volume 39.2 - Question 14

Time-Restricted Eating

In patients with a BMI between 30 and 50 kg/m2, time-restricted eating without calorie counting is as effective as a weight loss strategy as calorie counting.

  • True
  • False
Volume 39.2 - Question 4

Osteoporosis Screening

Which one of the following statements about using the Canadian clinical Fracture Risk Assessment Tool (FRAX) to prevent fragility fractures in females aged 65 years or older is false?

  • It reduces BMD testing.
  • It decreases clinician time compared to using BMD testing.
  • Repeat screening should be done at least every 5 years in stable patients.
  • Screening 250 females after age 65 at least once would be expected to prevent 1 hip fracture.
Volume 39.2 - Question 1

Intermittently Scanned Continuous Glucose Monitoring in Non-Insulin-Treated Diabetics

Among non-insulin treated individuals with type 2 diabetes, the addition of intermittently scanned continuous glucose monitoring to standard diabetes self-management is associated with a greater improvement in glycemic outcomes than standard diabetes self-management education alone.

  • True
  • False
Volume 38.6 - Question 39

Primary Aldosteronism

Which one of the following questions regarding primary aldosteronism is false?

  • About 30% of patients with hypokalemia and hypertension seen in primary care have PA.
  • Patients with PA are at an increased risk of chronic disease if untreated.
  • Most antihypertensive medications should be discontinued during work-up.
  • An elevated aldosterone-to-renin ratio is suggestive of PA.
Volume 38.6 - Question 32

Metformin for Gestational Diabetes Mellitus

In patients with gestational diabetes Mellitus treated with metformin, neonatal birth weight is significantly lower compared to those treated with insulin.

  • True
  • False
Volume 38.6 - Question 12

Gestational Diabetes Mellitus

Among pregnant women, immediate treatment of gestational diabetes mellitus before 20 weeks’ gestation leads to a lower incidence of a composite of adverse neonatal outcomes (birth at <37 weeks’ gestation, birth trauma, birth weight of ≥4500 g, respiratory distress, phototherapy, stillbirth or neonatal death, or shoulder dystocia) than no immediate treatment.

  • True
  • False
Volume 38.6 - Question 11

Polycystic Ovary Syndrome

Which one of the following statements about polycystic ovary syndrome is false?

  • It is the most common endocrinopathy affecting women of childbearing age.
  • Patients may be asymptomatic.
  • The diagnosis in adolescents requires the presence of both oligoanovulation and hyperandrogenism for at least two years postmenarche.
  • Ultrasound findings are recommended as a diagnostic criterion in adolescents.
Volume 38.6 - Question 5

Drugs for Hypothyroidism

Which one of the following statements regarding treatment of hypothyroidism with levothyroxine is false?

  • It should ideally be taken with water on an empty stomach 60 minutes before breakfast.
  • After starting treatment symptoms of hypothyroidism usually begin to improve in 6 weeks.
  • After change in dosage, TSH levels should be checked in 6 weeks.
  • Supratherapeutic doses can cause weight loss.
Volume 38.5 - Question 37

Insulin Icodec

When switching to once weekly icodec insulin from once-daily glargine in people with long-standing type 2 diabetes on a basal-bolus regimen, which one of the following is least likely to occur?

  • Similar improvements in glycemic control.
  • Lower total weekly insulin dose.
  • Increased level one hypoglycemia.
  • Increased weight gain.
Volume 38.5 - Question 27

Prediabetes

Which one of the following statements about prediabetes is false?

  • It is associated with increased mortality.
  • It is associated with increased cardiovascular event rates.
  • About 10 % of people progress to diabetes each year.
  • Metformin is more effective in reducing risk of developing diabetes than intensive lifestyle modification.
Volume 38.5 - Question 26

GLP1-RA in Patients with Diabetes and Heart Failure

Treatment with glucagon-like peptide 1 receptor agonists (GLP1-RA) in patients with diabetes and concomitant heart failure reduces heart failure related hospitalizations and mortality.

  • True
  • False
Volume 38.5 - Question 25

Vitamin D and Pre-Diabetes

In adults with prediabetes, vitamin D supplementation reduces the risk of progression to type 2 diabetes.

  • True
  • False
Volume 38.5 - Question 15

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