Endocrinology

A 60-year-old male presents with sudden onset of redness, swelling, heat, and pain in the right first metatarsophalangeal joint the morning after a banquet. The most likely clinical diagnosis is:

A 26-year-old female with type 1 diabetes mellitus (T1DM) develops anorexia due to a cold and eats less. She takes her usual pre-meal insulin dose but suddenly experiences palpitations, sweating, followed by dizziness and blurred vision by noon. The emergency management should be:

The measurement of fructosamine reflects the total blood glucose level in patients with diabetes mellitus (DM) over what time period?

A male patient with type 1 diabetes mellitus (T1DM) developed coma 2 days after discontinuing insulin. Blood glucose was 420 mg/dL (23 mmol/L). After resuscitation and intravenous sodium bicarbonate infusion, blood glucose decreased, mental status improved, and acidosis alleviated. However, the patient soon relapsed into coma. The most likely cause is:

A 26-year-old female with type 1 diabetes mellitus (T1DM) discontinued insulin therapy for 3 days due to reduced appetite from a cold. She suddenly developed coma, Kussmaul breathing, poor skin turgor, thready rapid pulse, decreased blood pressure (BP), reduced urine output, blood glucose 33.3 mmol/L, elevated blood urea nitrogen (BUN) and creatinine (Cr), white blood cell (WBC) count 15×10⁹/L, neutrophils 86%, strongly positive urine glucose and ketones. The most likely diagnosis is:

A middle-aged woman with a history of diabetes mellitus presents with high fever, renal colic, hematuria for 3 days, urinary protein (++), glycosuria (+++), and urine sediment showing abundant white blood cells (WBCs), pus cells, and necrotic renal papillary tissue. The most likely diagnosis is:

A 40-year-old patient with type 1 diabetes mellitus (T1DM) for 22 years, on insulin therapy with stable blood glucose control, developed bilateral lower extremity edema over the past 2 years. Current fasting blood glucose (FBG) is 5-6 mmol/L, urinary protein (++~+++), and creatinine (Cr) 196 μmol/L. The recommended daily dietary protein intake should be:

A 29-year-old patient with a 5-year history of diabetes mellitus (DM) presents with 1 week of fever, fatigue, 2 days of somnolence, and 5 hours of coma. Blood glucose is 23.1 mmol/L, blood ketones (++), and pH 7.2. Which treatment plan is correct?

A 76-year-old male with diabetes mellitus (DM). Over the past month, he frequently experienced chest tightness, dyspnea, and paroxysmal nocturnal dyspnea. The family found him in a coma and rushed him to the hospital. His daily medications include gliclazide (3 tablets) and phenformin (3 tablets), with satisfactory blood glucose control. Examination: deep coma, deep and rapid breathing, BP 60/40 mmHg, HR 124 bpm, urine glucose (++), urine ketone (±), blood glucose 12.4 mmol/L, pH 6.9, serum potassium (K) 4.9 mmol/L, anion gap 15, ECG shows sinus tachycardia. The most likely cause is:

A 59-year-old male with a 20-year history of diabetes mellitus (DM) has been on mixed insulin (regular plus intermediate-acting insulin) for 2 years. He developed hypertension (HTN) 5 years ago, with BP 180/110 mmHg. Recently, he frequently experiences palpitations, sweating, and marked hunger before dinner. Which of the following measures is inappropriate?

A 60-year-old male presents with renal colic, hematuria, elevated serum calcium (Ca), low serum phosphorus (P), normal renal function, increased parathyroid hormone levels, and osteopenia on X-ray. The most likely diagnosis is:

A 30-year-old woman presents with 6 months of obesity, acne, and purple striae. Laboratory tests show elevated 24-hour blood cortisol and increased blood glucose. Low-dose dexamethasone suppression test shows cortisol 38% lower than baseline, while high-dose dexamethasone suppression test shows cortisol 78% lower than baseline. The most likely diagnosis is:

A 17-year-old male presents with polyuria, polydipsia, and excessive thirst for over a month. Repeated tests show urine specific gravity (USG) <1.005. The water deprivation test fails to increase USG, but the vasopressin test shows increased USG and urine osmolality. The most likely diagnosis is:

A 71-year-old woman with a 5-year history of diabetes mellitus (DM) presents with cough, productive sputum, and fever for 1 week, somnolence for 2 days, and coma for 5 hours. Physical examination reveals moderate coma, dry skin, respiratory rate of 24/min, bilateral pulmonary rales, and heart rate of 120/min. Which test would be most helpful for diagnosis at this time?

A 26-year-old female with type 1 diabetes mellitus (T1DM) suddenly developed coma after interrupting insulin therapy for 3 days. Blood glucose was 33.3 mmol/L, pH 7.2, with strongly positive urine glucose and ketones. The most likely diagnosis is:

A 63-year-old male patient presents with a 10-minute episode of tetany and loss of consciousness, which has now ceased. Past medical history includes diabetes mellitus (DM), hypertension (HTN), and sleep apnea syndrome. According to family, the patient uses non-invasive ventilation at night to improve breathing, but the ventilator was damaged and not repaired 1 day ago, leading to discontinuation. On examination: lethargy, poor mental status, coherent speech, no cyanosis, no crackles or wheezes on lung auscultation, abdominal obesity, pitting edema in both lower limbs, non-palpable pedal pulses, and negative Babinski sign. Which test should be performed first?

A 58-year-old male presents with palpitations and hand tremors for 3 years, worsening over 1 month. Physical exam: HR 110 bpm, BP 160/60 mmHg, weight loss, moist skin, palpable thyroid gland with vascular bruit, no jugular venous distension, normal cardiac size, HR 134 bpm with irregularly irregular rhythm and varying heart sound intensity, clear lungs and abdomen, no lower limb edema. The most likely etiology is:

A 53-year-old male presents with low-grade fever for 1 week, accompanied by anxiety, irritability, palpitations, and hyperhidrosis. Physical exam: T 37.6°C, P 100/min, palpable thyroid gland with a hard, tender nodule on the right side, no thrill or bruit; fine tremors of tongue and hands (+), ESR 78mm at 1st hour. The most likely diagnosis is:

A 38-year-old unmarried woman presents with heat intolerance, hyperhidrosis, and weight loss for over 2 months. Physical exam: thyroid gland enlarged to grade I, no bruit, heart rate 120 bpm with regular rhythm. Thyroid iodine uptake: 3-hour 36%; 24-hour 90%. The best next step is:

A 56-year-old female presents with unintentional weight loss over 3 months. For the past month, she has had diarrhea 3-4 times daily without significant abdominal pain, unresponsive to antibiotics. Over the last week, she developed extreme fatigue, lethargy, inability to stand, and choking cough while swallowing. Examination reveals cachexia, temperature 37.8°C, apathy, and weak voice. Skin is slightly moist. No exophthalmos. Thyroid is grade I enlarged without nodules or bruit. Heart rate 124/min with regular rhythm. Fine tremor in both hands (±). Generalized muscle atrophy with muscle strength II-III. Which test should be prioritized for initial diagnosis?

A middle-aged woman with hyperthyroidism received irregular drug therapy for 2 years. One week after switching to radioactive ¹³¹I therapy, she developed high fever and palpitations. Physical examination: T 40°C, heart rate 160/min, atrial fibrillation, tachypnea, profuse sweating, and restlessness. Lab tests: elevated WBC, neutrophils, FT₃, and FT₄; decreased TSH. The most likely diagnosis is:

A 38-year-old woman presents with goiter accompanied by palpitations and hyperhidrosis for over 3 months. Physical examination: grade II goiter, firm and uneven texture, no tenderness, no vascular bruit, heart rate 100 bpm with regular rhythm, slightly moist skin, fine tremor in both hands (±). To confirm the diagnosis, in addition to measuring FT₃, FT₄, and TSH levels, which of the following should be selected for further differential diagnosis?

A 74-year-old woman presents with pruritus vulvae, mild dry mouth, chest tightness, and precordial discomfort for over 3 months. She reports cold intolerance and constipation. Physical exam: obesity, facial and periorbital edema, dry, sparse hair and eyebrows. Heart rate 60 bpm, regular rhythm, diminished heart sounds, cardiac dullness extending 0.5 cm lateral to the left midclavicular line, liver palpable 3 fingerbreadths below the costal margin, positive hepatojugular reflux sign, and pretibial myxedema in both lower extremities. Fasting blood glucose (FBG) 8.4 mmol/L, 2-hour postprandial blood glucose (2hPPG) 13.6 mmol/L. What is the most likely initial diagnosis?

A 28-year-old woman presents with a 2-week history of anterior neck and throat pain, accompanied by heat intolerance, palpitations, hyperhidrosis, and generalized fatigue. Physical examination reveals temperature 38°C, weight loss, and moist skin. No exophthalmos. Thyroid gland is grade I enlarged with bilateral tenderness. No bruit. Fine tremor in both hands (+). What is the most likely initial diagnosis?

A 26-year-old female presents with exophthalmos, goiter, heart rate 100 bpm, increased thyroid ¹³¹I uptake, and T₃ suppression test showing <50% suppression. The most likely diagnosis is:

A 33-year-old female presents to the emergency department with a 1-week history of cough and fever, and half a day of coma. She has a history of Addison's disease. Physical examination: BP 80/60 mmHg, respiratory rate 23/min, generalized skin hyperpigmentation, heart rate 110/min with regular rhythm, and few rales in the left lower lung. The most likely cause of coma in this patient is:

A 36-year-old woman presents with sudden onset of quadriplegia and dizziness. Physical examination: alert, facial flushing, generalized hyperpigmentation, acne vulgaris, perioral hirsutism, lanugo hair hyperplasia. Thickened subcutaneous fat in the chest and abdomen, with 1.0cm wide purple striae on the lower abdomen. Fasting blood glucose (FBG) 10.2mmol/L, urinary 17-hydroxycorticosteroids (17-OHCS) 58μmol/24h (21mg/24h). Which of the following is the most likely diagnosis?

A 36-year-old male presents with recurrent myasthenia and periodic paralysis for over 1 year, accompanied by acroparesthesia, tetany, nocturia, and thirst. Physical examination reveals normal body build, BP 170/100 mmHg, no thyroid enlargement, heart rate 82 bpm with regular rhythm. The most likely diagnosis is:

A 40-year-old woman experienced emotional stress 3 months ago and has since had poor sleep. She suffers from unquenchable thirst, requiring large amounts of water intake (4-5 thermos flasks daily), preferring cold water. Urine output has significantly increased, averaging once per hour, with nocturia exceeding 5 times nightly and total daily urine output reaching 9L. She has developed poor mental state, irritability, weight loss, and headaches in the past 2 weeks. What is the most likely diagnosis?

A 71-year-old female with a 5-year history of diabetes mellitus (DM) presents with cough, productive sputum, and fever for 1 week, somnolence for 2 days, and coma for 5 hours. Physical exam: moderate coma, dry skin, respiratory rate 24/min, bilateral pulmonary rales, heart rate 120/min. Lab results: blood glucose 31.2 mmol/L, urine ketones (++), pH 7.1, blood urea nitrogen (BUN) 25 mmol/L, creatinine (Cr) 204 μmol/L, white blood cell count (WBC) 12×10^9/L, neutrophils 90%. Which is the best treatment option?

A 26-year-old female with type 1 diabetes mellitus (T1DM) suddenly developed coma after interrupting insulin therapy for 3 days. Blood glucose was 33.3 mmol/L, pH 7.2, with strongly positive urine glucose and ketones. What is the treatment of choice?

A 41-year-old male presents with polydipsia, polyphagia, and rapid weight loss for over 2 months (BMI 21). After consuming contaminated food, he developed nausea, vomiting, and somnolence for 1 day. Examination reveals confusion, dehydration, fruity breath odor, heart rate 127 bpm, BP 80/56 mmHg, grade I thyroid enlargement (no vascular bruit), and bilateral exophthalmos (16 mm). Lab results: blood glucose 26.8 mmol/L, urine ketones (++++). Which primary condition is most likely?

A 56-year-old male patient presents with thirst, polydipsia, fatigue, daily water intake >7L, and urine specific gravity of 1.005. If diagnosed with central diabetes insipidus (CDI), the most ideal therapeutic drug would be:

A 28-year-old woman presents with fatigue for 6 months and 3 episodes of tetany with flaccid paralysis. Examination: alert, coherent speech. Limbs show involuntary movements, muscle strength grade II, no significant muscle atrophy. BP 180/110 mmHg, heart rate 92/min, regular rhythm. Lab results: serum potassium 2.5 mmol/L, 24-hour urinary potassium 30 mmol/L. Which test should be performed next for definitive diagnosis?

A 58-year-old male presents with palpitations and hand tremors for 3 years, worsened over 1 month. Physical exam: HR 110 bpm, BP 160/60 mmHg, weight loss, moist skin, palpable thyroid gland with vascular bruit, no jugular venous distension, normal cardiac size, irregularly irregular rhythm (HR 134 bpm) with varying heart sound intensity, clear lungs and abdomen, no lower limb edema. The preferred treatment is:

A 56-year-old woman presents with unintentional weight loss over 3 months. For the past month, she has had diarrhea 3-4 times daily without significant abdominal pain, unresponsive to antibiotics. Over the last week, she developed extreme fatigue, lethargy, inability to stand, and choking cough during swallowing. Examination reveals cachexia, temperature 37.8°C, apathetic facies, and weak voice. Skin is slightly moist. No exophthalmos. Thyroid gland is grade I enlarged without nodules or bruits. Heart rate 124/min with regular rhythm. Fine tremor (±) in both hands. Generalized muscle atrophy with muscle strength grade II-III. Which lab abnormality is most likely?

A middle-aged woman with hyperthyroidism received irregular drug therapy for 2 years. One week after switching to radioactive ¹³¹I therapy, she suddenly developed high fever, palpitations. Physical examination: T 40°C, heart rate 160 bpm, atrial fibrillation, tachypnea, profuse sweating, restlessness. Lab tests: elevated WBC, neutrophils, FT₃, FT₄; decreased TSH. The drug of choice is:

A 38-year-old unmarried woman presents with 2 months of heat intolerance, hyperhidrosis, and weight loss. Physical exam: thyroid gland enlarged to degree I, no bruit, heart rate 120/min with regular rhythm. Thyroid iodine uptake: 36% at 3 hours; 90% at 24 hours. After 6 weeks of methimazole (tapazole) treatment, symptoms significantly improved with T3/T4 normalized, but WBC is 3.8×10^9/L (neutrophils 55%). The most appropriate next step is:

A 28-year-old woman presents with a 2-week history of anterior neck and pharyngeal pain, accompanied by heat intolerance, palpitations, hyperhidrosis, and generalized fatigue. Physical examination reveals temperature 38°C, weight loss, moist skin, no exophthalmos, grade I thyroid enlargement with bilateral tenderness, no bruit, and fine tremor in both hands. If your initial diagnosis is correct, which of the following laboratory findings is most likely to be observed?

A 33-year-old female presents to the emergency department with cough and fever for 1 week, and coma for half a day. She has a history of Addison's disease. Physical examination: blood pressure (BP) 80/60 mmHg, respiratory rate 23/min, generalized skin hyperpigmentation, heart rate 110/min with regular rhythm, and few rales in the left lower lung. Which laboratory test is most urgently needed to manage this patient?

A 42-year-old male with diabetes mellitus (DM) for 5 years, on insulin therapy for 2 years (average 32-40U daily). After consuming refrigerated food 2 days ago, he developed watery diarrhea (4-6 episodes/day), somnolence for 1 day, and intermittent convulsions for 2 hours, prompting emergency admission. Physical exam: dehydrated appearance, light coma, BP 16/10 kPa, HR 120/min. Which test is most helpful for diagnosing the coma?

A 46-year-old male presents with thirst, polydipsia, and weight loss for 3 months, followed by sudden coma for 2 days. Blood glucose: 41 mmol/L, serum sodium (Na): 132 mmol/L, serum potassium (K): 4.0 mmol/L, blood urea nitrogen (BUN): 9.8 mmol/L, CO₂ combining power: 18.3 mmol/L, strongly positive urine glucose and ketones. What is the first-line treatment?

A 17-year-old female presents with palpitations and hyperhidrosis for 6 months. Over the past month, she developed polydipsia and polyuria. Physical examination reveals significant weight loss, mild exophthalmos, grade II thyroid gland enlargement, and vascular bruit audible at both upper poles. Lab results: FT₃ 33.5 pmol/L, FT₄ 40 pmol/L, TSH 0.01 mU/L (0.01 μIU/mL). Which treatment is most appropriate for this patient's hyperthyroidism?

A 46-year-old male presents with thirst, polydipsia, and weight loss for 3 months, followed by sudden coma for 2 days. Blood glucose: 41 mmol/L, serum sodium (Na): 132 mmol/L, serum potassium (K): 4.0 mmol/L, blood urea nitrogen (BUN): 9.8 mmol/L, CO₂ combining power: 18.3 mmol/L, with strongly positive urine glucose and ketones. After 8 hours of treatment, the patient regains consciousness, blood glucose drops to 12.8 mmol/L, and serum potassium (K) decreases to 3.2 mmol/L. Which of the following treatments is appropriate at this stage?

Female, 17 years old. Palpitations and hyperhidrosis for 6 months. Polydipsia and polyuria for 1 month. Physical exam: significant weight loss, mild exophthalmos, thyroid gland enlarged to degree II, vascular bruit audible at both upper poles. Lab: FT3 33.5 pmol/L, FT4 40 pmol/L, TSH 0.01 mU/L (0.01 μIU/mL). Which of the following tests is LEAST appropriate for comprehensive diagnosis?

A 42-year-old male underwent thyroidectomy for thyroid adenocarcinoma. Postoperatively, he developed recurrent muscle convulsions and tetany, with serum calcium (Ca) level of 1.2 mmol/L. What is the best treatment option for this patient?

A 28-year-old unmarried woman presents with amenorrhea for 6 months. Physical exam reveals bilateral galactorrhea. Elevated plasma PRL and pituitary CT suggest a pituitary microadenoma. Which drug should be the first-line treatment?

An elderly patient presents with initial monoarthritis, particularly affecting the knee, worsened by daytime activity. X-ray shows osteophyte formation, marginal lipping, and joint space narrowing without ankylosis. The diagnosis is:

Which of the following diabetic eye complications is the leading cause of blindness?

A 26-year-old woman presents with exophthalmos, goiter, heart rate 100 bpm, increased thyroid ¹³¹I uptake, and T₃ suppression test showing <50% suppression. If this patient is 3 months pregnant with hyperthyroidism, the treatment of choice is:

During the management of diabetic ketoacidosis, the intravenous insulin dosage is:

Which class of lipid-lowering drugs is preferred for severe hypercholesterolemia?

A 32-year-old woman presents with increased appetite and weight gain over 1.5 years. Physical exam: height 160 cm, weight 75 kg, thickened abdominal and gluteal fat, with faint red striae on the lower abdomen and upper thighs. BP 150/95 mmHg. Further tests show elevated 24-hour urinary free cortisol and plasma cortisol levels: 8 AM 414 nmol/L (15 μg/dL); 4 PM 331.2 nmol/L (12 μg/dL); midnight 281.5 nmol/L (10.2 μg/dL). Which test should be performed next to confirm the diagnosis?

A 36-year-old woman presents with sudden-onset flaccid paralysis of all four limbs and dizziness. Physical examination: alert, facial flushing, generalized hyperpigmentation, acne vulgaris, perioral hirsutism, increased vellus hair growth. Thickened subcutaneous fat in the chest and abdomen, with 1.0cm wide purple striae on the lower abdomen. Fasting blood glucose (FBG) 10.2mmol/L, urinary 17-hydroxycorticosteroids (17-OHCS) 58μmol/24h (21mg/24h). After a low-dose dexamethasone suppression test, urinary 17-OHCS is 55.2μmol/24h (20.1mg/24h). Which of the following tests should be performed next?

The typical changes of diabetic microangiopathy are

A 40-year-old woman experienced psychological stress 3 months ago and has had poor sleep since. She suffers from unbearable thirst, requiring large amounts of water intake (4-5 thermos flasks daily), preferring cold water. Urine output is significantly increased, averaging once per hour, with nocturia over 5 times nightly and total daily urine output reaching 9L. Since onset, she has had poor mental state, irritability, weight loss, and headache for the past 2 weeks. Which test should be performed next to identify the cause?

A 28-year-old married woman presents with oligomenorrhea for 1 year and infertility, now with 2 months of amenorrhea. Urine pregnancy test is negative, and ultrasound shows no abnormalities in the uterus or bilateral ovaries. Lab results show prolactin (PRL) level of 3.08 nmol/L (77 ng/ml). Before diagnosing a pituitary microadenoma, which of the following conditions must be excluded?

A male patient presents with intermittent episodes of paroxysmal weakness for 2 months, relieved by rest. Recently, he experienced another episode upon waking after alcohol consumption, accompanied by fatigue. Physical exam: alert, BP 140/80 mmHg, no abnormal lung findings, heart rate 98 bpm, lower limb muscle strength grade 3. Laboratory tests reveal serum potassium (K) 2.16 mmol/L. The most likely diagnosis is:

A 60-year-old male presents with sudden onset of redness, swelling, warmth, and pain in the right first metatarsophalangeal joint the morning after a banquet. Which test should be prioritized for diagnosis?

A 46-year-old male presents with thirst, polydipsia, and weight loss for 3 months, followed by sudden coma for 2 days. Blood glucose: 41 mmol/L, serum sodium (Na): 132 mmol/L, serum potassium (K): 4.0 mmol/L, blood urea nitrogen (BUN): 9.8 mmol/L, CO₂ combining power: 18.3 mmol/L, strongly positive urine glucose and ketones. The most likely diagnosis is:

A 26-year-old female with type 1 diabetes mellitus (T1DM) suddenly developed coma after interrupting insulin therapy for 3 days. Blood glucose was 33.3 mmol/L, pH 7.2, with strongly positive urine glucose and ketones. After 2 hours of IV insulin and sodium bicarbonate, blood glucose dropped to 16.7 mmol/L, acidosis improved, and she briefly regained consciousness but then relapsed into coma. This phenomenon is most likely due to:

A 55-year-old male, height 172cm, weight 80kg, presents with increased appetite, easy hunger, accompanied by palpitations and hyperhidrosis for 2 months. Physical exam: marked obesity, irritable mood, slightly moist skin, thyroid gland not enlarged, heart rate 108 bpm, BP 140/70 mmHg, no fine tremor in both hands. Current HbA1c is 8.7%. How long has the patient's blood glucose level been persistently elevated?

A 58-year-old male presents with palpitations and hand tremors for 3 years, worsening over the past month. Physical exam: HR 110 bpm, BP 160/60 mmHg, weight loss, moist skin, palpable thyroid gland with vascular bruit, no jugular venous distension, normal cardiac size, irregularly irregular heart rate of 134 bpm with varying heart sound intensity, clear lungs and abdomen, no lower limb edema. What should be given for complications?

A middle-aged woman with hyperthyroidism received irregular drug treatment for 2 years. One week after switching to radioactive 131I therapy, she suddenly developed high fever and palpitations. Physical examination: temperature 40°C, heart rate 160/min, atrial fibrillation, tachypnea, profuse sweating, and restlessness. Lab tests: elevated WBC, neutrophilia, increased FT3 and FT4, decreased TSH. What is the treatment principle?

A 17-year-old female presents with palpitations and hyperhidrosis for 6 months, and polydipsia and polyuria for 1 month. Physical examination reveals significant weight loss, mild exophthalmos, thyroid gland enlargement (Grade II), and vascular bruit at both upper poles. Lab results: FT₃ 33.5 pmol/L, FT₄ 40 pmol/L, TSH 0.01 mU/L (0.01 μIU/mL). Propranolol is added to her hyperthyroidism treatment. Which of the following is most critical to monitor during therapy?

A 74-year-old woman presents with pruritus vulvae, mild dry mouth, chest tightness, and precordial discomfort for over 3 months. She reports cold intolerance and constipation. Physical exam: obesity, facial and periorbital edema, dry, sparse hair and eyebrows. Heart rate 60 bpm, regular rhythm, diminished heart sounds, cardiac dullness extending 0.5 cm lateral to the left midclavicular line, liver palpable 3 fingerbreadths below the costal margin, positive hepatojugular reflux sign, and pretibial myxedema in both lower extremities. Fasting blood glucose 8.4 mmol/L, 2-hour postprandial blood glucose 13.6 mmol/L. Which of the following treatment regimens is INAPPROPRIATE for this patient?

A 28-year-old woman presents with a 2-week history of anterior neck and pharyngeal pain, accompanied by heat intolerance, palpitations, hyperhidrosis, and generalized fatigue. Physical examination reveals a temperature of 38°C, weight loss, and moist skin. No exophthalmos is noted. The thyroid gland is enlarged to grade I, with bilateral tenderness. No bruit is heard, but fine tremor in both hands is present. Which of the following treatments is inappropriate for this condition?

A 33-year-old female presents to the emergency department with a 1-week history of cough and fever, and half a day of coma. She has a history of Addison's disease. Physical examination: BP 80/60 mmHg, respiratory rate 23/min, generalized skin hyperpigmentation, heart rate 110/min with regular rhythm, and few rales/crackles in the left lower lung. The most urgent treatment is:

A 28-year-old woman presents with obesity for 1 year. Physical examination reveals moon facies, increased acne, slight hirsutism, prominent vellus hair on the back, thickened nuchal fat pad, and BP of 150/100 mmHg. Laboratory tests show significantly elevated 24-hour urinary 17-OHCS and 17-KS levels, along with abnormal plasma cortisol rhythm. Which of the following is the most appropriate for definitive localization?

A 36-year-old woman presents with sudden onset of flaccid paralysis of all four limbs accompanied by dizziness. Physical examination shows clear consciousness, facial flushing, generalized hyperpigmentation, acne vulgaris, perioral hirsutism, and increased vellus hair growth. There is thickened subcutaneous fat in the chest and abdomen, with 1.0 cm wide purple striae visible on the lower abdomen. Fasting blood glucose (FBG) is 10.2 mmol/L, and urinary 17-hydroxycorticosteroids (17-OHCS) is 58 μmol/24h (21 mg/24h). Which of the following findings is most likely to be observed?

A 40-year-old woman experienced emotional stress 3 months ago and has had poor sleep since then. She suffers from extreme thirst, requiring large amounts of water intake (4-5 thermos flasks daily), preferring cold water. Urine output is significantly increased, averaging once per hour, with nocturia (>5 times/night) and total daily urine output reaching 9L. Since onset, she has had poor mental state, irritability, weight loss, and developed headache in the past 2 weeks. After admission, she caught a cold on day 2, developed fever, worsening headache, reduced water intake, and confusion. BP: 90/60 mmHg, dry lips, poor skin turgor; no neck stiffness or papilledema. What should be considered first?

A 30-year-old male presents with thirst, polydipsia, and polyuria for 1 month, with low urine specific gravity. In the water deprivation-vasopressin test used to differentiate complete from partial central diabetes insipidus, which of the following parameters is most discriminative?

Diabetic ketoacidosis is one of the acute complications of diabetes mellitus. Which of the following statements is incorrect?

A 28-year-old married woman presents with oligomenorrhea for 1 year and infertility, now with 2 months of amenorrhea. Urine pregnancy test is negative, and ultrasound shows no abnormalities in the uterus or bilateral ovaries. Pituitary microadenoma is confirmed by MRI. Which of the following medications should be the first-line treatment?

A 60-year-old male wakes up the morning after a banquet with sudden redness, swelling, heat, and pain in the first metatarsophalangeal joint of the right foot. If serum uric acid is not elevated, which experimental diagnostic drug should be used?

A 42-year-old woman presents with fever, generalized pain, and neck pain for 3 days, following a 'cold' 2 weeks ago. Examination reveals grade III thyroid enlargement with firm consistency, tenderness on palpation, heart rate 104 bpm, moist skin, and fine tremor in both hands (+). Treatment options:

A 53-year-old male presents with low-grade fever for 1 week, accompanied by anxiety, irritability, palpitations, and hyperhidrosis. Examination reveals: T 37.6°C, P 100/min, palpable thyroid gland with a hard, tender nodule on the right side, no thrill or bruit, fine tremor of tongue and hands (+), ESR 78 mm at the end of the first hour. If the diagnosis remains uncertain after these findings, which confirmatory test should be chosen?

A 17-year-old female presents with palpitations and hyperhidrosis for 6 months, along with recent onset of polydipsia and polyuria. Physical exam shows significant weight loss, mild exophthalmos, grade II thyroid gland enlargement, and vascular bruit audible at both upper poles. Lab results: FT₃ 33.5 pmol/L, FT₄ 40 pmol/L, TSH 0.01 mU/L (0.01 μIU/mL). After controlling hyperthyroidism, what is the likely prognosis for diabetes mellitus (DM)?

A 38-year-old unmarried woman presents with heat intolerance, hyperhidrosis, and weight loss for over 2 months. Physical examination reveals grade I thyroid enlargement without bruits, heart rate 120 bpm with regular rhythm. Thyroid iodine uptake: 3h 36%; 24h 90%. After 1 year of treatment with stable condition, the patient marries and starts oral contraceptive pills (OCPs). Follow-up shows TT₃ 0.05nmol/L (3.2ng/ml), TT₄ 258nmol/L (20.0μg/dl). What should be considered?

A 26-year-old female presents with exophthalmos, goiter, heart rate 100 bpm, increased thyroid ¹³¹I uptake, and T₃ suppression test showing <50% suppression. Which antithyroid drug should be the first choice?

A 40-year-old woman experienced psychological stress 3 months ago and has had poor sleep since. She suffers from unbearable thirst, requiring large amounts of water intake even at night (4-5 thermos flasks daily), with a preference for cold water. Urine output has significantly increased, averaging once per hour, including over 5 nocturnal voids, totaling 9L/day. She has been irritable, with weight loss, and developed headaches in the past 2 weeks. The most appropriate treatment for this patient is:

A 38-year-old unmarried woman presents with heat intolerance, hyperhidrosis, and weight loss for over 2 months. Physical exam: Grade I thyroid enlargement, no bruit, heart rate 120/min with regular rhythm. Thyroid iodine uptake: 3h 36%; 24h 90%. After discontinuing medication for 6 months, the patient becomes pregnant (2 months) and reports recurrent palpitations and hyperhidrosis. Repeat tests show elevated FT3/FT4 and TSH 0.01 mU/L (0.01 μU/mL), indicating hyperthyroidism relapse. The best management is:

A 28-year-old woman presents with amenorrhea for 6 months and bilateral galactorrhea. Urine pregnancy test is negative, serum PRL >40nmol/L (>1000ng/ml), and pituitary CT reveals a microadenoma. The best treatment for this patient is:

A 29-year-old woman with a 3-year history of hyperthyroidism had regular treatment for 2 years, with symptom resolution. She discontinued medication 1 year ago. Currently at 32 weeks of pregnancy, she reports palpitations, hyperhidrosis, increased appetite, and weight loss since conception, without taking any antithyroid drugs. Symptoms worsened over the past week. Lab tests show markedly elevated FT₃ and FT₄. Which drug should be initiated first?

A 28-year-old woman presents with heat intolerance, hyperhidrosis, increased appetite, and weight loss for over 2 months. Physical examination reveals bilateral exophthalmos, conjunctival congestion, grade II thyroid gland enlargement, and heart rate 100 bpm. FT₃ and FT₄ are significantly elevated. What is the best treatment for this patient?

Which test is used to differentiate whether Cushing's syndrome is caused by a pituitary tumor or an adrenal tumor?

In diabetic ketoacidosis (DKA), severe metabolic derangements occur. Which of the following is NOT present in DKA?

A 45-year-old male presents with mild xerostomia, polydipsia for 2 months, accompanied by mild polyuria and markedly increased appetite. Height: 175 cm, weight: 85 kg. Fasting blood glucose (FBG): 8.7 mmol/L, 2-hour postprandial blood glucose (2hPPG): 13.1 mmol/L. What is the best treatment option for this diabetes mellitus (DM) patient?

A 20-year-old male with a confirmed diagnosis of type 1 diabetes mellitus (T1DM) for 3 years has been on long-term insulin therapy. Recently, he has experienced large fluctuations in blood glucose, with frequent hypoglycemic episodes (lowest: 1.8 mmol/L) and hyperglycemia (highest: 31.0 mmol/L), requiring repeated emergency visits. To precisely and rationally adjust insulin dosage, which laboratory test is essential?

A 20-year-old female presents with palpitations and hyperhidrosis for 6 months, accompanied by weight loss. Physical examination: marked exophthalmos, grade III thyroid enlargement, vascular bruit audible at both upper poles. Heart rate: 124 bpm. T₃ and T₄ are significantly elevated. The best treatment for this patient is:

A 50-year-old male with a 10-year history of diabetes mellitus (DM) has been on long-term sulfonylurea therapy (glibenclamide 2 tablets, 3 times daily). For the past 3 days, his fasting blood glucose (FBG) has consistently been >15.0 mmol/L, and HbA1c >10%. What is the best treatment option?

A 21-year-old female presents with palpitations, hyperhidrosis, and increased appetite for over 2 months. Physical examination shows significant weight loss, mild exophthalmos, grade II thyroid gland enlargement, vascular bruit audible at the right upper pole, heart rate of 124 bpm with strong beats, and fine tremor in both hands (++). Which of the following laboratory abnormalities is most likely present in this patient?

The main clinical urinary feature of diabetic intercapillary glomerulosclerosis is:

Which of the following is NOT a feature of insulin resistance syndrome?

Which of the following is NOT a correct explanation for elevated fasting blood glucose (FBG) during insulin therapy in diabetes mellitus (DM)?

According to the 1999 WHO Diabetes Expert Committee's etiological classification criteria, what causes Maturity-Onset Diabetes of the Young (MODY)?

How to manage the Somogyi phenomenon during insulin therapy for diabetes mellitus (DM)?

The most common adverse effect of insulin administration is

Calculation of Body Mass Index (BMI)

A 29-year-old female at 5 months of pregnancy has fasting blood glucose (FBG) of 8.9 mmol/L and postprandial blood glucose of 11.7 mmol/L. Which treatment should be chosen?

A 60-year-old male with a 5-year history of hypertension (HTN) presents with 1 week of cough and fever. Today, he was found unconscious by family and brought to the emergency department. Examination: altered mental status, epileptiform convulsions, pulmonary rales/crackles, heart rate 110/min, BP 130/60 mmHg, questionable left Babinski sign, WBC 13–13.5 × 10⁹/L, urine glucose (++++), ketones (-). The most likely cause of coma in this case is:

In patients with poorly controlled type 2 diabetes mellitus (T2DM), dyslipidemia is often present. Which of the following hyperlipidemia patterns is most commonly observed?

Stage III diabetic nephropathy is defined by a persistent urinary albumin excretion rate of

The endocrine glands inherent to the endocrine system include

Feedback regulation in the endocrine system refers to

A pituitary microadenoma refers to

A 62-year-old retired woman with type 2 diabetes mellitus (T2DM), height 160 cm, weight 76 kg, FPG 6.7 mmol/L, and urine glucose (±). How to determine her daily total caloric requirement?

A 55-year-old woman with a 10-year history of diabetes mellitus (DM) presents with 2 months of numbness in the toes, needle-like pain in the thigh skin, urinary incontinence, and anhidrosis. Examination shows weight loss, poor nutrition, atrophy of interosseous muscles in both hands, and muscle strength grade IV. No crackles or wheezes are heard in the lungs, and pathological reflexes are negative. Fasting blood glucose (FBG) is 14.1 mmol/L, and blood ketones are negative. What is the most likely diagnosis?

A 70-year-old male was admitted with chest tightness and precordial pain for 2 hours. Physical examination: altered mental status, profuse sweating, BP 60/40 mmHg, HR 112 bpm, blood glucose 16.1 mmol/L, ECG showed lateral wall myocardial infarction. History of hypertension (HTN), no history of diabetes mellitus (DM). Which of the following is the correct management for elevated blood glucose?

A 28-year-old woman with a 7-year history of type 1 diabetes mellitus (T1DM) on insulin therapy has achieved satisfactory blood glucose control. Now at 32 weeks of pregnancy, which of the following considerations is reasonable to ensure sustained blood glucose stability?

A 20-year-old male with T1DM (8-year history) is on mixed insulin therapy (short-acting and long-acting insulin) with subcutaneous injections before breakfast and dinner. Recent 2-week blood glucose monitoring shows fasting blood glucose (FBG) of 13.2-16.7 mmol/L, pre-lunch 8.0 mmol/L, pre-dinner 7.6 mmol/L, and bedtime 5.1 mmol/L. To optimize FBG control, which measure should be taken?

A 19-year-old male with a 2-year history of T1DM. Average daily insulin dose: 40U. Insulin therapy was discontinued for 1 week due to insulin depletion. Presented with fatigue for 3 days and coma for 4 hours. Which of the following management steps is incorrect?

A 32-year-old female presents with recurrent glycosuria (+~++), but all OGTT blood glucose levels are within normal range. The most likely diagnosis is:

Pheochromocytoma can produce various peptide hormones. Which one causes facial flushing?

The primary effect of parathyroid hormone (PTH) on the kidneys is

A patient with diabetes mellitus (DM) has follow-up lipid results: TC 5.78 mmol/L, TG 2.0 mmol/L. What is the correct management recommendation for this patient?

For patients with coronary artery disease (CAD), which lipid-lowering drug should be the first choice?

The most effective drug for acute attack of gout is

The main action of thiourea-class antithyroid drugs is

Regarding the treatment of gout during intercritical and chronic phases, which statement is INCORRECT?

A 50-year-old male with recurrent acute arthritis of the left metatarsophalangeal joint for 1 year. Laboratory tests show elevated serum uric acid and normal urinary uric acid. Which is the best option to increase uric acid excretion?

Which type is the most common cause of primary hyperparathyroidism?

Endocrine hormones are distributed to various tissues and organs via blood circulation, exerting physiological effects after reaching target cells and binding to receptors. This belongs to which of the following secretion modes?

Which category of hormones do thyroid hormones belong to?

Which of the following cardiovascular signs is correct in Graves' disease?

When discontinuing medication for Graves' disease, which of the following tests is most significant for judging the prognosis of the disease?

Which of the following is a contraindication for ¹³¹I therapy in hyperthyroidism?

The main reason for increased bowel movements or diarrhea in patients with hyperthyroidism is

Which of the following pathogenesis is inconsistent with current views on diffuse goiter with hyperthyroidism?

The most important indicators for assessing the severity of hyperthyroidism and treatment efficacy are

What is the first-line treatment for hyperthyroidism in pregnancy?

The most common long-term complication of radioactive iodine therapy (RAI) for hyperthyroidism is