Endocrinology Flashcards
Screening for Type 2 Diabetes Mellitus begins at the age of ___; earlier for high risk groups [HPIM 20th ed., table 369-2, p 2651]:
Age of 45, every 3 years
Recommended screening test for thyroid nodules [HPIM 20th ed., table 369-2, p 2651]:
a. TSH
b. Free T4
c. Fine needle aspiration biopsy
d. Thyroid / Neck US
Fine needle aspiration biopsy
The following hormones share a common beta subunit [HPIM 20th ed., p 2653]:
a. Luteinizing Hormone and Thyroid Stimulating Hormone
b. Growth hormone and Human Chorionic Gonadotropin
c. Follicle Stimulating Hormone and Thyroid Stimulating Hormone
d. All of the above
e. None of the above
All of the above
- LH, FSH, TSH, GnRH, hCG
The following cells are correctly paired with their inhibitors except [HPIM 20th ed., table 371-1, p 2660]:
a. Somatotrope: Somatostatin
b. Thyrotrope: Somatostatin
c. Lactotrope: Inhibin
d. Thyrotrope: Dopamine
e. Lactotrope: Dopamine
Lactotrope: Inhibin
True statements, except:
a. Patients with Cushing’s syndrome characteristically exhibit increased midnight cortisol levels compared with normal individuals [HPIM 20th ed., p 2659].
b. The HPA axis is more susceptible to suppression by glucocorticoids administered at night [HPIM 20th ed., p 2659].
c. In response to fasting state and falling blood glucose levels, glucagon increases, followed by suppression of insulin if hypoglycemia ensues [HPIM 20th ed., p 2658]
d. The circulating half life of T4 is 7 days, and of T3 is 1 day [HPIM 20th ed., p 2654].
e. Most protein hormones have relatively short half-lives (<20 min), leading to sharp peaks of secretion and decay [HPIM 20th ed., p 2654]
Except A
Peaks in the morning, Nadirs at night
The following statements are true, except:
a. Oral dopamine agonists (cabergoline and bromocriptine) are the mainstay of therapy for patients with microprolactinomas [HPIM 20th ed., p 2676].
b. Amenorrhea, galactorrhea, and infertility are the hallmarks of hyperprolactinemia in women [HPIM 20th ed., p 2675].
c. In men with hyperprolactinemia, diminished libido, infertility, and visual loss (from optic nerve compression) are the usual presenting symptoms [HPIM 20th ed., p 2675].
d. Visual field defect is an indication for surgical intervention for macroprolactinoma [HPIM 20th ed., fig 373-3 + text, p 2675].
e. Bromocriptine the drug is preferred for prolactinomas when pregnancy is desired [HPIM 20th ed., p 2676].
Except D
Surgical intervention is indicated for debulking, and if dopamine resistant or if intolerant and there is invasive macroadenoma with compromised vision that fails to improve after drug treatment.
The following statements are true except:
a. Iodine deficiency is still a common cause of hypothyroidism worldwide and remains to be the most common cause of hypothyroidism in iodine sufficient areas [HPIM 20th ed., p 2698].
b. The daily replacement dose of levothyroxine for individuals with no residual thyroid function is usually 1.6 μg/kg body weight [HPIM 20th ed., p 2701].
c. Among the differential diagnoses for normal TSH and low Free T4 are sick euthyroid syndrome and pituitary disorder [HPIM 20th ed., fig 376-2, p 2701].
d. Autoimmune hypothyroidism may or may not be associated with goiter [HPIM 20th ed., p 2699].
e. Pendred syndrome, brought about by mutation of the pendrin gene, is a disorder characterized by defective organification of iodine, goiter, and sensorineural deafness [HPIM 20th ed., p 2693].
Except A
Iodine deficiency –> worldwide
Autoimmune (Hashimotos), & Itrogenic –> Iodine sufficient
CASE: 44/F with secondary amenorrhea, easy bruising and proximal muscle weakness; known hypertensive; obese, with thin skin, with wide purple abdominal striae. Which of the following is true [HPIM 20th ed., figure 2726]?
a. Pituitary imaging, particularly MRI, is the recommended next step.
b. CT scan of the adrenal glands will confirm a diagnosis of Cushing’s disease.
c. Screening and confirmatory tests include midnight salivary cortisol determination after 1 mg Dexamethasone administration and 24-hour urinary free cortisol determination.
d. Screening and confirmatory tests include 1 mg Dexamethasone suppression test and 24-h urine free cortisol determination.
e. ACTH determination after 8 mg dexamethasone administration is another recommended screening tool for this patient.
Screening and confirmatory tests include 1 mg Dexamethasone suppression test and 24-h urine free cortisol determination.
Pheochromocytoma is known as “the great masquerader” as its clinical presentation is so variable. The classic triad for this condition includes paroxysms of [HPIM 20th ed., table 480-1 + text, p 2740]:
a. Headache, Palpitations, Orthostatic hypotension
b. Palpitations, Headache, Profuse sweating
c. Nausea, Palpitations, Headache
d. Abdominal pain, Palpitations, Nausea
e. Pallor, Palpitations, Headache
Palpitations, Headache, Profusebsweating
Although individualization is important, the following are the generally recommended treatment goals / targets in adults with diabetes, except [HPIM 20th ed., table 397-2, p 2860]:
a. HbA1c <7.0%
b. Preprandial capillary plasma glucose of 90 to 130 mg/dL
c. Postprandial capillary plasma glucose <10.0 mmol/L
d. Blood pressure <140/90
e. Preprandial capillary plasma glucose of 4.4 to 7.2 mmol/L
Treatment goals
(1) HbA1c <7.0%
(2) Pre prandial: 4.4- 7.2 mmol/L (80-130mg/dL)
(3) Postprandial: <10.0 mmol/L (180mg/dL)
- The following anti-hyperglycemic agents share a common mechanism of increasing insulin secretion, except [HPIM 20th ed., table 397-5, p 2866]:
a. Gliclazide
b. Pioglitazone
c. Vildagliptin
d. Liraglutide
e. Repaglinide
B. Pioglitazone (Thiazolidinediones)
Increases insulin sensitivity
Which of the following insulin types are properly listed according to increasing duration of action [HPIM 20th ed., table 397-4, p 2863]:
a. Insulin aspart, Insulin glulisine, Insulin lispro
b. Regular insulin, Inhaled human insulin, Insulin degludec
c. Insulin degludec, Insulin detemir, Insulin glargine
d. NPH, Insulin glargine, Insulin degludec
e. Regular insulin, Insulin lispro, Insulin glulisine
NPH, Insulin glargine, Insulin degludec
A 52-year-old female came in for consultation due to weight loss, polyuria, and malaise. On work up, she was diagnosed with Type 2 Diabetes Mellitus with a HbA1c of 12% and FBS of 278 mg/dL. She was resistant to the idea of insulin injection despite the explanation on its indications and benefits. With that, the following medications were started: (1) Metformin 1000 mg BID, (2) Glimepiride 4 mg OD , (3) Sitagliptin 100 mg OD, and (4) Dapagliflozin 10 mg OD. She came for follow up two weeks later, complaining of frequent profuse sweating, palpitations, and tremors which would be relieved by intake of soda. Which of the following is true? [HPIM 20th ed., table 397-5, p 2866]
a. It may be Glimepiride-induced hypoglycemia as this medication decreases insulin resistance.
b. Above hypoglycemic episodes may be reduced / eliminated by combining Sitagliptin and Metformin in a single pill.
c. It is definitely caused by the high dose of Metformin.
d. The patient’s hypoglycemia may be from increased insulin secretion.
e. The patient’s hypoglycemia episodes are secondary to intake of high dose Sitagliptin.
d. The patient’s hypoglycemia may be from increased insulin secretion.
The following causes of hypercalcemia are properly classified, except [HPIM 20th ed., table 403-1, p 2924]:
a. Primary hyperparathyroidism: Parathyroid-related
b. Hyperthyroidism: High bone turnover
c. Malignancy (e.g breast, lung): Parathyroid-related
d. Secondary hyperparathyroidism: Renal failure
e. Vitamin D intoxication: Vitamin D-related
c. Malignancy (e.g breast, lung): Parathyroid-related
Indications for surgery in asymptomatic primary hyperparathyroidism [HPIM 20th ed., table 403-2, p 2927]:
a. Serum calcium >1 mg/dL above normal
b. Creatinine clearance <60 mL/min
c. Nephrolithiasis / Nephrocalcinosis
d. BMD
All of the above
The bone mineral density that defines osteoporosis [HPIM 20th ed., p 2942]:
a. T-score +2.5 in the total hip, lumbar spine, or femoral neck
d. T-score >-2.5 in the total hip, lumbar spine, or femoral neck
e. T-score
According to WHO
Young healthy adults of the same sex and age T score of - 2.5
Postmenopausal women: T score -1.0
Drugs associated with increased risk of osteoporosis [HPIM 20th ed., table 404-3, p 2947]:
a. Glucocorticoids
b. Thiazolidenediones
c. Thyroxine
d. Proton Pump Inhibitors
e. All of the above
All of the above
Indications for BMD testing, except [HPIM 20th ed., table 404-4, p 2948]:
a. 66/F, retired athlete, with no known co-morbid condition / maintenance medication
b. 45/F, on 10 mg per day of prednisone for the past 6 months
c. 40/F who sustained a fracture of the left hip after slipping and falling on her buttocks from a standing position
d. 60/M, with hypertension
e. 70/M, with hypertension
d. 60/M, with hypertension
Women ≥ 65
Men ≥ 70
Differential diagnoses in an adult male with clinical features of hypogonadism, total testosterone level of 100 ng/dL and normal LH, except [HPIM 20th ed., figure 384-6, p 2782]:
a. Klinefelter syndrome
b. Hyperprolactinemia
c. Sellar mass
d. Glucocorticoid use
e. Anabolic androgenic steroids
A. Klinefelter’s syndrome
True about precocious puberty in males, except [HPIM 20th ed., p 2774-75]:
a. Serum testosterone, LH and FSH are among the hormones that need to be determined as part of the investigation.
b. Cranial MRI is requested for gonadotropin-dependent precocious puberty.
c. If testosterone is elevated and LH is low, cranial MRI is used to rule out a CNS lesion.
d. Congenital adrenal hyperplasia is an example of a gonadotropin-independent precocious puberty.
e. Puberty in boys is considered precocious in boys younger than 9 years old.
c. If testosterone is elevated and LH is low, cranial MRI is used to rule out a CNS lesion
Gonadotropin INDEPENDENT if testosterone is elevated and LH is low
True statements, except:
a. Primary amenorrhea is the absence of menarche in the absence of hormonal treatment, traditionally by age 16 [HPIM 20th ed., p 2795].
b. The most common cause of amenorrhea is delayed puberty [HPIM 20th ed., p 2795].
c. Secondary amenorrhea is absence of menses for 3 months in women with regular cycles and 6 months in those with irregular cycles [HPIM 20th ed., p 2795].
d. Exclusion uterus and outflow tract abnormality is the first step in the evaluation of amenorrhea [HPIM 20th ed., fig 386-2, p 2796].
e. When uterus and outflow tract abnormalities and pregnancy are excluded, FSH determination is requested to differentiate primary ovarian insufficiency from possible hypothalamic or pituitary causes of amenorrhea.
The most common cause of amenorrhea is delayed puberty [HPIM 20th ed., p 2795].
Most common is PREGNANCY
Which of the following will differentiate central diabetes insipidus from nephrogenic diabetes insipidus? 1 point A. History B. 24-hour urine volume and osmolarity C. Basal plasma AVP D. Brain MRI
C. Basal plasma AVP
35-year-old female presented with a large anterior neck mass which on biopsy was shown to be papillary thyroid carcinoma. Work-up did not reveal any metastasis to nodes or other organs. A thyroidectomy was performed. Which of the following tests should be requested to monitor her thyroid cancer? 1 point A. TPO antibodies B. TSH receptor antibody C. Serum Tg D. Unbound T4
C. Serum Tg
Which of the following are risk factors for female sexual dysfunction? 1 point A. Pregnancy B. Cigarette smoking C. Beta-blockers D. Cardiovascular disease
D. Cardiovascular disease
What is the most common presenting feature of adult hypopituitarism?
A. Adrenal insufficiency
B. Adult growth hormone deficiency
C. Hypogonadism
D. Hypothyroidism
C. Hypogonadism
What distinguishes primary adrenal failure from hypocortisolism associated with pituitary failure clinically?
A. Hyperpigmentation
B. Hypoglycemia
C. Fatigue
D. Proximal muscle weakness
A. Hyperpigmentation
50-year-old male is referred to the hypertension clinic by your co-resident. He has been hypertensive since he was 35 years old and is maintained on hydrochlorothiazide, telmisartan, spironolactone, and metoprolol. During clinic, you record his BP to be 180/100, HR 72, RR 18, afebrile, with clear breath sounds, and a displaced apex beat. Lab tests show the ff: Na 139, K 3.3, Cl 94, Crea 89. Which of the following laboratory tests should be ordered to identify the cause for his resistant hypertension ?
A. Aldosterone-renin ratio off beta-blockers
B. Aldosterone-renin ratio off spironolactone
C. Saline infusion test over 4 hours
D. Plain CT scan of the adrenals
B. Aldosterone-renin ratio off spironolactone
A 50-year-old male is referred to the hypertension clinic by your co-resident. He has been hypertensive since he was 35 years old and is maintained on hydrochlorothiazide, telmisartan, spironolactone, and metoprolol. During clinic, you record his BP to be 180/100, HR 72, RR 18, afebrile, with clear breath sounds, and a displaced apex beat. Lab tests show the ff: Na 139, K 3.3, Cl 94, Crea 89. Which of the following laboratory tests should be ordered to identify the cause for his resistant hypertension ?
1 point
A. Aldosterone-renin ratio off beta-blockers
B. Aldosterone-renin ratio off spironolactone
C. Saline infusion test over 4 hours
D. Plain CT scan of the adrenals
B. Aldosterone-renin ratio off spironolactone
A 35-year-old female is referred to you by OB for persistent hypotension. She just gave birth and lost almost 2 L of blood due to uterine atony. They have given almost 4L of blood but her BP was still borderline at 90/50 mmHg. Plasma cortisol confirms your suspicion. Which of the following laboratories should be ordered to further narrow down the diagnosis? (Similar PSBIM 2017 Question)
A. Plasma ACTH, plasma renin, serum aldosterone
B. CRH Test
C. Pituitary MRI, and adrenal CT
D. High dose DEX Test
This is a case of Sheehan’s syndrome. This form of pituitary apoplexy is an endocrine emergency that may result to severe HYPOglycemia, hypotension, shock. A pituitary CT or MRI may reveal sign of sellar hemorrhage.
Preoperative care is important in preparing a patient for pheochromocytoma tumor removal. Classically, BP has been controlled by an alpha-adrenergic blocker. What other non-pharmacologic advice should be given in the day before surgery to reduce complications?
A. Limit fluid intake to 2 L per day
B. Liberal salt intake and hydration
C. Avoid cooling blankets
D. All medicines must be taken IV
Preoperative preparation (1) BP maintained at <160/90 mmHg can be controlled by Alpha adrenergic (oral phenoxybenzamine 0.5- 4mg/kg)
(2) since it is volume constricted, liberal salt and water intake
A 35 year old female on pre-employment check-up was found to have a 2cm right lobe thyroid nodule. She did not complain of diaphoresis, diarrhea or weight loss. However, she would occasionally have palpitations. She was referred to you by the company MD for evaluation, further work-up and clearance prior to the approval of her employment in Singapore. You immediately ordered for a screening TSH, which showed a value of 0.1 mIU/L (n. 0.34–4.25 mIU/L). Our Endocrine Fellow at the Polyclinic suggested a thyroid scan. On follow-up, her thyroid scan showed increased uptake of the nodule. How will you proceed with the management of the patient?
a. Do repeat TSH and add free T4, T3 to determine etiology of TSH suppression
b. Refer to Radiology for ultrasound-guided fine-needle aspiration biopsy.
c. Offer her the following options: medical treatment, RAI therapy or surgical resection
d. Clear for employment. Do thyroid function monitoring every 3-4 months.
c. Offer her the following options: medical treatment, RAI therapy or surgical resection
This is a case of toxic adenoma (hyperfunctioning solitary nodule) diagnosed thru thyroid scan demonstrating focal uptake in the hyperfunctioning nodule
RAI is the treatment of choice, though surgery and medical therapy (anti-thyroid and beta blockers) can also be employed
A 26 year old male supervisor of a shipping company consulted your clinic for weakness that is most pronounced when climbing the stairs. On physical examination, his BMI is 32 kg/m2 and blood pressure of 130/90, with a prominent fat pad on the back, plethoric face with acne and multiple bruises and purple stretch marks on the abdomen. You suspected Cushing’s syndrome and ordered several tests. After one week, patient came back to your clinic with all the results: Plasma cortisol at 8AM after 1mg dexamethasone at 11PM the previous day: 320 nmol/L (n. fasting cortisol at 8AM-12NN 138-690 nmol/L)Plasma ACTH: 70 pg/mL (n. 6-76 pg/mL)Plasma cortisol at 8AM after 2mg dexamethasone every 6 hours for 2 days: 160 nmol/L (n. fasting cortisol at 8AM-12NN 138-690 nmol/L) What is the most probable diagnosis and/or next step in management of the patient?
a. ACTH-independent Cushing’s. Order for adrenal CT scan.
b. ACTH-independent Cushing’s. Advise bilateral adrenalectomy.
c. ACTH-dependent Cushing’s probably ectopic ACTH production. Work up for source of ACTH and
do chest/abdominal CT scan.
d. ACTH-dependent Cushing’s probably Cushing’s disease. Advise MRI of pituitary and possible transphenoidal surgery.
d. ACTH-dependent Cushing’s probably Cushing’s disease. Advise MRI of pituitary and possible transphenoidal surgery.
The most common cause of primary adrenal insufficiency.
a. Drug-induced
b. Congenital adrenal hyperplasia (CAH)
c. Adrenal infiltration and infection
d. Autoimmune adrenalitis
Autoimmune adrenalitis
Clinical hallmark of mineralocorticoid excess.
a. Resistant hypertension
b. Hypokalemic hypertension
c. Hypovolemic hyponatremia
d. Proximal myopathy and central adiposity
Hypokalemic hypertension
Treatment of choice for toxic adenoma or a hyperfunctioning solitary thyroid nodule.
1 point
a. Thyroidectomy
b. Iodine replacement
c. Radioiodine ablation
d. Anti-thyroid drugs in combination with β-blockers
RAI
Type of thyroid cancer with characteristic cytologic features of psammoma bodies and cleaved nuclei with an “orphan Annie” appearance.
a. Papillary
b. Follicular
c. Anaplastic
d. Medullary
a. Papillary
The most common nerve affected by diabetic mononeuropathy that presents with diplopia.
a. Cranial nerve III
b. Cranial nerve IV
c. Cranial nerve VI
d. Cranial nerve VII
a. Cranial nerve III
Most common cause of diffuse goiter.
a. Exposure to environmental goitrogens
b. Graves’ disease
c. Iodine deficiency
d. Thyroid cancer
B. Graves disease
Usual daily replacement dose of levothyroxine for patients with no residual thyroid function.
a. 1.2 ug/kg body weight
b. 1.6 ug/kg body weight
c. 2.0 ug/kg body weight
d. 2.4 ug/kg body weight
B. 1.6 ug/kg body weight
Thyrotoxicosis in the elderly that presents only with fatigue and weight loss
a. Silent thyroiditis
b. Thyrotoxicosis factitia
c. Subacute thyroiditis
d. Apathetic thyrotoxicosis
d. Apathetic thyrotoxicosis
The most common cause of female infertility
a. Menstrual function abnormalities
b. Tubal defect
c. Endometriosis
d. Iatrogenic
Tubal defect
The most common cause of female infertility
a. Menstrual function abnormalities
b. Tubal defect
c. Endometriosis
d. Iatrogenic
Tubal defect
The following endocrine conditions are paired with the correct pathologic mechanism, except [HPIM 20th ed., p 2649; HPIM 20th ed., table 369-1 + text, p 2650]:
a. MEN1: hormone excess
b. Kallmann’s syndrome: hormone deficiency syndrome: hormone deficiency
c. Type 1 diabetes mellitus: hormone resistance
d. Addison’s disease: hormone deficiency
e. Pituitary adenoma: hormone exces
c. Type 1 diabetes mellitus: hormone resistance
Parameters / screening tests for Metabolic Syndrome [HPIM 20th ed., table 369-2, p 2652]
a. BMI, FPG, BP
b. Waist circumference, lipids, BP
c. FPG, HbA1c, BMI
d. FPG, BP
e. Waist circumference, FPG
b. Waist circumference, lipids, BP
The following conditions are correctly paired with their recommended screening tests, except [HPIM 20th ed., table 369-2, p 2652]:
a. Menopause: FSH
b. Graves’ Disease: TSH
c. Hyperparathyroidism: PTH
d. Vitamin D deficiency: 25-OH VitaminD
e. Klinefelter’s syndrome: karyotype
c. Hyperparathyroidism: PTH
If calcium is elevated, only then we request for PTH
The following hormones are correctly paired with their provocative / challenge tests of pituitary sufficiency, except [HPIM 20th ed., table 372-2, p 2666]:
a. GH: Insulin tolerance test
b. ACTH: Insulin tolerance test
c. Prolactin: TRH test
d. TSH: TRH test
e. LH, FSH: LH, FSH, testosterone measurement
e. LH, FSH: LH, FSH, testosterone measurement
True of adult GH deficiency management [HPIM 20th ed., fig 372-1 + text, p 2668]
a. GH replacement starting dose is 1.25 mg/day.
b. Contraindications to therapy include active neoplasm and uncontrolled diabetes.
c. GH level monitoring is used to monitor response to treatment
d. Discontinue treatment if no response is seen after one year on maximum GH dose
e. IGF-1 is measured 3 months after initiation of GH replacement.
Answer B
The starting adult dose of 0.1–0.2 mg/d should be titrated (up to a maximum of 1.25 mg/d) to maintain IGF-I levels in the mid-normal range for age- and sex-matched controls
Contraindications to therapy include the presence of an active neoplasm, intracranial hypertension, and uncontrolled diabetes and retinopathy.
IGF-I measurements provide a useful index of therapeutic responses but are not sufficiently sen-sitive for diagnostic purposes
Screening tests for functioning pituitary adenomas, except [HPIM 20th ed., table 373-2, p 2671]:
a. Acromegaly: Serum IGF-I
b. Prolactinoma: Serum Prolactin
c. Cushing’s Disease: 24-h urinary free cortisol
d. Acromegaly: Insulin tolerance test
e. Cushing’s disease: Dexamethasone (1 mg) suppression test
Answer is A
True of diabetes insipidus, except:
a. It is caused by a decrease of at least 75% in the secretion or action of AVP[HPIM20th ed., p 2685
b. Characterized by high 24-hour urine volume exceeding 40 mL/kg body weight and dilute urine [HPIM 20th ed., p 2685
c. Overt clinical signs of dehydration are often seen [HPIM 20th ed., p 2685.
d. A low basal plasma AVP confirms a diagnosis of pituitary DI [HPIM 20th ed., fig 374-4, p 2687]
e. With symptoms suggestive of DI, measurement of 24-h urine volume and osmolarity on unrestricted fluid intake should be done [HPIM 20th ed., fig 374-4, p 2687
Answer is D
Identify the next step in the diagnosis of a patient with the following initial test results: TSH 0.08 uIU/mL (0.4 - 5.5) , Free T4 15.6 pmol/L (8.5 - 22.5) [HPIM 20th ed., fig 377-2,p 2705]
a. Repeat TSH after 4 to 6 weeks
b. Thyroid scintigraphy
c. Free T3 determination
d. Cranial MRI
e. Treat. It is primary thyrotoxicosis
Answer is C
The following are risk factors for thyroid carcinoma among patients with solitary thyroidnodule, except [HPIM 20th ed., table 378-3, p 2714]
a. Age <20 years old
b. Female gender
c. Vocal cord paralysis
d. Fixed nodule
e. Lateral cervical LAD
Answer is B
Diagnostic procedures that are recommended in the evaluation of ACTH-dependentCushing’s syndrome, except [HPIM 20th ed., fig 379-10, p 2726; p 2727]:
a. Pituitary MRI
b. Adrenal CT
c. CRH test
d. Inferior petrosal sinus sampling
e. Chest CT scan
Answer B
Confirmatory tests for primary aldosteronism [HPIM 20th ed., fig 379-12, p 2730]
a. Aldosterone determination
b. Renin activity determination
c. Saline infusion test
d. ARR
e. 24-h urine metanephrine determination
C. Saline infusion test
The following are screening tests for hormone excess in incidentally discovered adrenalmass, except [HPIM 20th ed., fig 379-13, p 2732]:
a. 24-h urine metanephrine determination
b. Plasma aldosterone and renin
c. Serum 17-hydroxyprogesterone
d. 8am serum cortisol
e. DHEAS
D. 8 am serum cortisol
- midnight plasma (or salivary) cortisol
Primary adrenal insufficiency (choose the best answer) [HPIM 20th ed., fig 379-16, p2737]:
a. Weight loss, postural hypotension, hyponatremia
b. High ACTH, high renin, low aldosterone
c. Low - normal ACTH, normal renin
d. Treatment is glucocorticoid replacement
e. Normal aldosterone
B. High ACTH, high renin, Low aldosterone
The following statements are true, except [HPIM 20th ed., p 2883 - 84]:
a. The first defense against hypoglycemia is decrease in insulin secretion.
b. Intravenous glucocorticoid administration is an alternative first line management to correct severe hypoglycemia
c. The body’s defense against hypoglycemia in the correct order: decrease in insulin, increase in glucagon, increase in epinephrine, increase in cortisol and growth hormone
d. Neuroglycopenic manifestations of hypoglycemia are the direct result of central nervous system glucose deprivation.
e. Neurogenic manifestations serve as signals for behavioral defense against hypoglycemia.
Answer is A
Non-insulin glucose lowering agent which provides the greatest HbA1c reduction next to medical nutrition therapy and metformin [HPIM 20th ed., table 397-5, p 2866]:
a. SGLT-2is
b. SUs
c. DPPIVis
d. Thiazolidenediones
e. Amylin agonists
Answer is B
In which of the following situations will you recommend BMD testing [HPIM 20th ed., table 404-4, p 2948]
a. 38-year-old female patient with regular menstrual cycle complaining of back pain
b. 50-year-old male patient with a lumbosacral xray showing bone spurs
c. 24-year-old female patient with SLE on Prednisone 10 mg/day for the last 6 months
d. 40-year-old female athlete
e. 20-year-old male athlete
Answer is C
- Correct recommended daily calcium intake for age group, except [HPIM 20th ed., table 404-7, p 2951]
a. 1 to 3 years old: 500 mg/day
b. 4 to 8 years old: 800 mg/day
c. 9 to 18 years old: 1300 mg/day
d. 19 to 50 years old: 1000 mg/day
e. 51 years and older: 1300 mg/day
Answer is D
46-year-old woman sought consultation due to recurrent kidney stones. Corrected Ca was computed at 12 mg/dL (8.8 - 10.2 mg/dL). What laboratory examination should be requested next [HPIM 20th ed., fig 403-6, p 2934]?
a. Neck US
b. PTH level
c. BMD scan
d. 24-h urine calcium and creatinine
e. Vitamin D assay
Answer is B
