Título em Endocrinologia e Metabologia Practice Questions - TEEM - Título de Especialista em Endocrinologia e Metabologia (SBEM AMB) Exam - Título em Endocrinologia e Metabologia Practice Questions - TEEM - Título de Especialista em Endocrinologia e Metabologia (SBEM AMB) Exam

Question 1

A 58-year-old male with a 7-year history of type 2 diabetes mellitus (T2DM), established coronary artery disease (post-CABG 3 years ago), and stage G3a diabetic kidney disease (eGFR 52 mL/min/1.73m², urine albumin-to-creatinine ratio [RAC] 180 mg/g) presents for routine follow-up. His current medications include metformin 1,000 mg twice daily, atorvastatin 40 mg, enalapril 20 mg daily, and carvedilol 25 mg twice daily. His HbA1c is 7.4% and blood pressure is 128/78 mmHg. According to the Sociedade Brasileira de Diabetes (SBD) and ADA/EASD consensus guidelines, what is the most appropriate next step in his glycemic and cardiorenal management?

Add glimepiride 2 mg daily to achieve an HbA1c target below 6.5%. Add an SGLT2 inhibitor (e.g., empagliflozin or dapagliflozin) or a GLP-1 receptor agonist with proven cardiorenal benefit, independent of baseline HbA1c. Discontinue metformin due to stage G3a CKD and initiate basal insulin glargine at bedtime. Add saxagliptin 5 mg daily as a DPP-4 inhibitor has proven superior cardiorenal mortality reduction.

Correct Answer:

Add an SGLT2 inhibitor (e.g., empagliflozin or dapagliflozin) or a GLP-1 receptor agonist with proven cardiorenal benefit, independent of baseline HbA1c.

Question 2

A 22-year-old female with type 1 diabetes mellitus (T1DM) is admitted to the emergency department with severe diabetic ketoacidosis (cetoacidose diabética - CAD). Initial labs revealed blood glucose 480 mg/dL, arterial pH 7.12, serum bicarbonate 10 mEq/L, and anion gap 24 mEq/L. She is treated with intravenous normal saline, potassium replacement, and continuous regular insulin infusion. After 14 hours of infusion, her capillary glucose is 180 mg/dL, venous pH is 7.34, serum bicarbonate is 19 mEq/L, and calculated anion gap is 10 mEq/L. She is alert, nausea has resolved, and she requests lunch. According to SBEM and SBD protocols, what is the most appropriate management at this stage?

Administer subcutaneous basal insulin along with prandial rapid-acting insulin 1 to 2 hours before stopping the intravenous insulin infusion. Immediately turn off the intravenous insulin infusion and start oral metformin plus NPH insulin. Discontinue intravenous fluids and insulin immediately, allowing the patient to eat regular meals while monitoring blood glucose every 6 hours. Continue intravenous insulin infusion at the same rate and withhold all oral intake until the serum bicarbonate exceeds 24 mEq/L.

Correct Answer:

Administer subcutaneous basal insulin along with prandial rapid-acting insulin 1 to 2 hours before stopping the intravenous insulin infusion.

Question 3

A 74-year-old male is brought to the emergency department with profound lethargy, severe dehydration, and obtundation. Laboratory evaluation reveals: plasma glucose 940 mg/dL, serum sodium 152 mEq/L, potassium 4.8 mEq/L, bicarbonate 20 mEq/L, arterial pH 7.36, serum creatinine 2.4 mg/dL (baseline 1.0 mg/dL), and calculated effective serum osmolality 342 mOsm/kg. Urine dipstick shows trace ketones. A diagnosis of Hyperosmolar Hyperglycemic State (Estado Hiperosmolar Hiperglicêmico - EHH) is established. What is the initial priority in the resuscitation of this patient?

Immediate intravenous bolus of regular insulin at 0.4 units/kg before any fluid administration. Intravenous infusion of sodium bicarbonate to correct mild metabolic acidosis. Aggressive fluid resuscitation with isotonic 0.9% NaCl (1,000–1,500 mL in the first hour) to restore intravascular volume, followed by reassessment of corrected sodium. Initiation of intravenous potassium chloride bolus without fluids because total body potassium is severely depleted.

Correct Answer:

Aggressive fluid resuscitation with isotonic 0.9% NaCl (1,000–1,500 mL in the first hour) to restore intravascular volume, followed by reassessment of corrected sodium.

Question 4

A 16-year-old adolescent with newly diagnosed type 1 diabetes mellitus (T1DM) was discharged on a total daily insulin dose of 0.6 units/kg/day. Three months later, his mother reports frequent mild hypoglycemic episodes. Over the past 4 weeks, his required total daily insulin dose has dropped to 0.18 units/kg/day while maintaining fasting glucose between 80–115 mg/dL and postprandial glucose < 140 mg/dL. His HbA1c is 5.8%. Diagnostic autoantibody panel was positive for anti-GAD65 and anti-ZnT8. What clinical phenomenon best explains his current status?

Misdiagnosis of T1DM; the patient has Maturity-Onset Diabetes of the Young (MODY 2). Development of adrenal insufficiency (Schmidt syndrome) causing sudden insulin hypersensitivity. Spontaneous permanent remission of autoimmune insulitis with complete beta-cell regeneration. The 'honeymoon period' (fase de lua de mel), characterized by transient endogenous beta-cell recovery following the correction of initial glucotoxicity.

Correct Answer:

The 'honeymoon period' (fase de lua de mel), characterized by transient endogenous beta-cell recovery following the correction of initial glucotoxicity.

Question 5

A 52-year-old woman with type 2 diabetes treated with dapagliflozin 10 mg and metformin 1,000 mg twice daily undergoes elective laparoscopic cholecystectomy. Forty-eight hours postoperatively, she develops tachypnea, nausea, vomiting, and diffuse abdominal pain. Capillary blood glucose is 158 mg/dL. Arterial blood gas demonstrates pH 7.18, pCO2 22 mmHg, HCO3 8 mEq/L, and serum anion gap of 22 mEq/L. Blood beta-hydroxybutyrate is elevated at 4.8 mmol/L. What is the diagnosis and what is the key preventive measure recommended by SBEM/SBD regarding SGLT2 inhibitors?

Euglycemic Diabetic Ketoacidosis (CAD euglicêmica); SGLT2 inhibitors must be withheld at least 3 to 4 days prior to elective major surgery. Metformin-associated lactic acidosis (MALA); metformin should have been replaced with a sulfonylurea preoperatively. Acute post-cholecystectomy pancreatitis; SGLT2 inhibitors can be safely continued throughout the perioperative period. Secondary adrenal insufficiency precipitated by surgical stress; SGLT2 inhibitors have no impact on perioperative ketoacidosis.

Correct Answer:

Euglycemic Diabetic Ketoacidosis (CAD euglicêmica); SGLT2 inhibitors must be withheld at least 3 to 4 days prior to elective major surgery.

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Prepare with the Título em Endocrinologia e Metabologia Practice Questions - TEEM - Título de Especialista em Endocrinologia e Metabologia (SBEM AMB) Exam practice quiz. This question bank includes 100 questions covering year-old, male, glucose, reveals, and presents. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Título em Endocrinologia e Metabologia Practice Questions - TEEM - Título de Especialista em Endocrinologia e Metabologia (SBEM AMB) Exam

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Título em Endocrinologia e Metabologia Practice Questions - TEEM - Título de Especialista em Endocrinologia e Metabologia (SBEM AMB) Exam

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