Endocrinology

Question 1

Screening for Type 2 Diabetes Mellitus begins at the age of ___; earlier for high risk groups [HPIM 20th ed., table 369-2, p 2651]:

Answer 1

Age of 45, every 3 years

Question 2

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

Answer 2

Fine needle aspiration biopsy

Question 3

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

Answer 3

All of the above

- LH, FSH, TSH, GnRH, hCG

Question 4

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

Answer 4

Lactotrope: Inhibin

Question 5

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]

Answer 5

Except A

Peaks in the morning, Nadirs at night

Question 6

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].

Answer 6

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.

Question 7

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].

Answer 7

Except A
Iodine deficiency –> worldwide

Autoimmune (Hashimotos), & Itrogenic –> Iodine sufficient

Question 8

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.

Answer 8

Screening and confirmatory tests include 1 mg Dexamethasone suppression test and 24-h urine free cortisol determination.

Question 9

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

Answer 9

Palpitations, Headache, Profusebsweating

Question 10

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

Answer 10

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)

Question 11

13. 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

Answer 11

B. Pioglitazone (Thiazolidinediones)

Increases insulin sensitivity

Question 12

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

Answer 12

NPH, Insulin glargine, Insulin degludec

Question 13

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.

Answer 13

d. The patient’s hypoglycemia may be from increased insulin secretion.

Question 14

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

Answer 14

c. Malignancy (e.g breast, lung): Parathyroid-related

Question 15

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

Answer 15

All of the above

Question 16

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

Answer 16

According to WHO
Young healthy adults of the same sex and age T score of - 2.5

Postmenopausal women: T score -1.0

Question 17

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

Answer 17

All of the above

Question 18

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

Answer 18

d. 60/M, with hypertension
Women ≥ 65
Men ≥ 70

Question 19

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

Answer 19

A. Klinefelter’s syndrome

Question 20

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.

Answer 20

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

Question 21

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.

Answer 21

The most common cause of amenorrhea is delayed puberty [HPIM 20th ed., p 2795].

Most common is PREGNANCY

Question 22

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

Answer 22

C. Basal plasma AVP

Question 23

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

Answer 23

C. Serum Tg

Question 24

Which of the following are risk factors for female sexual dysfunction?
1 point
A. Pregnancy
B. Cigarette smoking
C. Beta-blockers
D. Cardiovascular disease

Answer 24

D. Cardiovascular disease

Question 25

What is the most common presenting feature of adult hypopituitarism? A. Adrenal insufficiency B. Adult growth hormone deficiency C. Hypogonadism D. Hypothyroidism

Answer 25

C. Hypogonadism

Question 26

What distinguishes primary adrenal failure from hypocortisolism associated with pituitary failure clinically? A. Hyperpigmentation B. Hypoglycemia C. Fatigue D. Proximal muscle weakness

Answer 26

A. Hyperpigmentation

Question 27

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

Answer 27

B. Aldosterone-renin ratio off spironolactone

Question 28

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

Answer 28

B. Aldosterone-renin ratio off spironolactone

Question 29

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

Answer 29

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.

Question 30

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

Answer 30

``` 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

Question 31

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.

Answer 31

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

Question 32

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.

Answer 32

d. ACTH-dependent Cushing’s probably Cushing’s disease. Advise MRI of pituitary and possible transphenoidal surgery.

Question 33

The most common cause of primary adrenal insufficiency. a. Drug-induced b. Congenital adrenal hyperplasia (CAH) c. Adrenal infiltration and infection d. Autoimmune adrenalitis

Answer 33

Autoimmune adrenalitis

Question 34

Clinical hallmark of mineralocorticoid excess. a. Resistant hypertension b. Hypokalemic hypertension c. Hypovolemic hyponatremia d. Proximal myopathy and central adiposity

Answer 34

Hypokalemic hypertension

Question 35

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

Answer 35

RAI

Question 36

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

Answer 36

a. Papillary

Question 37

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

Answer 37

a. Cranial nerve III

Question 38

Most common cause of diffuse goiter. a. Exposure to environmental goitrogens b. Graves’ disease c. Iodine deficiency d. Thyroid cancer

Answer 38

B. Graves disease

Question 39

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

Answer 39

B. 1.6 ug/kg body weight

Question 40

Thyrotoxicosis in the elderly that presents only with fatigue and weight loss a. Silent thyroiditis b. Thyrotoxicosis factitia c. Subacute thyroiditis d. Apathetic thyrotoxicosis

Answer 40

d. Apathetic thyrotoxicosis

Question 41

Primary regulator of arginine vasopressin (AVP) secretion. a. Intravascular volume b. Plasma osmolarity c. Stress d. Blood glucose levels

Answer 41

B. Plasma osmolarity

Question 42

The most common cause of female infertility a. Menstrual function abnormalities b. Tubal defect c. Endometriosis d. Iatrogenic

Answer 42

Tubal defect

Question 43

The most common cause of female infertility a. Menstrual function abnormalities b. Tubal defect c. Endometriosis d. Iatrogenic

Answer 43

Tubal defect

Question 44

Recommended total daily calcium intake in adults. a. 600-800 mg b. 800-1000 mg c. 1000-1200 mg d. 1200-1500 mg

Answer 44

C. 1000-1200 mg

Question 45

When is symptom relief experienced among patients with hypothyroidism treated with LT4? (Harrison's 20th edition, P2702) a. 3-6 months after starting the medications b. 3–6 months after normal TSH levels are restored c. Immediately after starting the medications d. Immediately after normalization of TSH

Answer 45

b. 3–6 months after normal TSH levels are restored

Question 46

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

Answer 46

c. Type 1 diabetes mellitus: hormone resistance

Question 47

Multiple Endocrine Neoplasia - 1 [HPIM 20th ed., p 2649]: 1 point a. Parathyroid tumor, Pheochromocytoma, Pituitary tumor b. Pheochromocytoma, Pituitary tumor, Pancreatic islet tumor c. Medullary thyroid carcinoma, Pituitary tumor, Pancreatic islet tumor d. Parathyroid tumor, Pituitary tumor, Pancreatic islet tumor e. Pheochromocytoma, Medullary thyroid carcinoma, Hyperparathyroidism

Answer 47

d. Parathyroid tumor, Pituitary tumor, Pancreatic islet tumor

Question 48

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

Answer 48

b. Waist circumference, lipids, BP

Question 49

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

Answer 49

c. Hyperparathyroidism: PTH | If calcium is elevated, only then we request for PTH

Question 50

True about hormone secretion, transport, and degradation, except [HPIM 20th ed., p 2654]: a. The circulating level of a hormone is determined by its rate of secretion and its half-life. b. Growth hormone is stored in secretory granules and later released into the circulation. c. Release of steroid hormones from their granules are closely aligned with the rate of synthesis d. ACTH and LH induce steroidogenesis by stimulating the activity of the steroidogenic acute regulatory protein e. Hormone transport and degradation dictate the rapidity with which a hormonal signal decays

Answer 50

b. Growth hormone is stored in secretory granules and later released into the circulation. - imminent release

Question 51

The following hormones are correctly paired with their respective binding proteins, except [HPIM 20th ed., p 2654] a. T4: albumin b. Cortisol: cortisol-binding globulin c. Estrogen: sex hormone-binding globulin d. T3: thyroxine-binding globulin e. IGF-I: GH-binding protein

Answer 51

Many hormones circulate in association with serum-binding proteins include: (1) T4 and T3 binding to thyroxine-binding globulin (TBG), albumin, and thyroxine-binding prealbumin (TBPA); (2) cortisol binding to cortisol-binding globulin (CBG); (3) androgen and estrogen binding to sex hormone–binding globulin (SHBG); (4) IGF-I and II binding to multiple IGF-binding proteins (IGFBPs); (5) GH interactions with GH-binding protein (GHBP), a circulating fragment of the GH receptor extracellular domain; (6) activin binding to follistatin. Answer is: e. IGF-I: GH-binding protein

Question 52

True statements regarding hormonal rhythms, except: a. ACTH nadir: late evening [HPIM 20th ed., p 2663] b. GH peak: night, sleep onset [HPIM 20th ed., p 2662] c. Prolactin peak: night, REM [HPIM 20th ed., p 2660] d. GnRH: secreted in discrete pulses every 60 hours [HPIM 20th ed., p 2663] e. ACTH peak: early morning [HPIM 20th ed., p 2663]

Answer 52

ANSWER IS D | GnRH is secreted in discrete pulses every 60–120 min, and the pulses in turn elicit LH and FSH pulses

Question 53

The following pituitary adenomas are correctly paired with their primary mode of treatment, except: a. ACTH-secreting: Ketoconazole [HPIM 20th ed., fig 373-6 + text, p 2681] b. GH-secreting: surgical resection [HPIM 20th ed., fig 373-5 + text, p 2679] c. Non-functioning: surgical resection [HPIM 20th ed., fig 373-7 + text, p 2683] d. TSH-secreting: surgical resection [HPIM 20th ed., p 2683] e. Prolactin-secreting: Cabergoline [HPIM 20th ed., p 2676]

Answer 53

a. ACTH-secreting: Ketoconazole [HPIM 20th ed., fig 373-6 + text, p 2681]

Question 54

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

Answer 54

e. LH, FSH: LH, FSH, testosterone measurement

Question 55

True of Kallmann syndrome [HPIM 20th ed., p 2664] a. It presents with primary gonadal failure b. It is associated with olfactory bulb agenesis. c. It is an acquired form of hypogonadism. d. It can only be seen in male e. LH and FSH are usually elevated

Answer 55

Kallmann syndrome results from defective hypothalamic gonadotropin-releasing hormone (GnRH) synthesis and is associated with anosmia or hyposmia due to olfactory bulb agenesis or hypoplasia. Kallmann syndrome and other causes of congenital GnRH deficiency are characterized by low luteinizing hormone (LH) and fol-licle-stimulating hormone (FSH) levels and low concentrations of sex steroids (testosterone or estradiol) Seen in both male and female Answer: B

Question 56

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 56

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

Question 57

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 57

Answer is A

Question 58

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 58

Answer is D

Question 59

It is a genetic syndrome characterized by spotty skin pigmentation, myxomas and endocrine tumors, and 20% of whom may have acromegaly [HPIM 20th ed., p 2674] a. Multiple Endocrine Neoplasia 1 b. McCune-Albright Syndrome c. Carney Complex d. Familial Acromegaly e. Multiple Endocrine Neoplasia 4

Answer 59

Answer is C Multiple endocrine neoplasia (MEN) 1 is characterized primarily by a genetic predisposition to para-thyroid, pancreatic islet, and pituitary adenomas Carney complex is characterized by spotty skin pigmentation, myxomas, and endocrine tumors, including testicular, adrenal, and pituitary adenomas McCune-Albright syndrome consists of polyostotic fibrous dysplasia, pigmented skin patches, and a variety of endocrine disorders, including acromegaly, adrenal adenomas, and autonomous ovarian function Familial acromegaly is a rare disorder in which family members may manifest either acromegaly or gigantism.

Question 60

Morbidities associated with acromegaly, except [HPIM 29th ed., p 2678 - 79]: a. Coronary heart disease b. Diabetes mellitus c. COPD d. Hypertension e. Colon cancer

Answer 60

C. COPD

Question 61

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 61

Answer is C

Question 62

A 36-year-old female was brought to the emergency department with complaints ofexertional dyspnea and easy fatigability. On review of systems, she has insomnia anddiarrhea. She lost 11 kg during the last month despite an increase in appetite. Shepreviously took Methimazole but stopped four months ago as she claims she feelsbetter. Upon examination, her blood pressure is 130/90. She is febrile at 38.4 degrees,tachycardic at 132 bpm with regular rhythm, and tachypneic but conversant. She isjaundiced. Thyroid gland is diffusely enlarged with noted bruit. The following are true ofthis clinical scenario, except [HPIM 20th ed., p 2707] a. Propylthiouracil is the anti-thyroid drug of choice and is given about anhour after loading 5 drops of stable iodide (SSKI) b. Methimazole may be given at a dose of 20 mg every 6 hours c. Propranolol at a dose of 60 to 80 mg every 4 hours should be given to reducetachycardia and other adrenergic manifestations. d. SSKI is being given to block thyroid hormone synthesis by the Wolff-Chaikoffeffect. e. Short-acting IV esmolol can be used to decrease heart rate while monitoring forsigns of heart failure

Answer 62

Answer is A • Stable iodide (5 drops SSKI every 6 h) 》 one hour after first dose of PTU

Question 63

45/F, TSH 6.2 uIU/mL (0.4 - 5.5) on routine laboratory check, Free T4 17.8 pmol/L (12 -22), TPO-Ab (-) [HPIM 20th ed., fig 376-2, p 2701]: a. Treat with LT4 b. Rule out other causes of hypothyroidism c. Sick euthyroid syndrome d. Annual follow-up e. Treat. It is autoimmune hypothyroidism

Answer 63

Answer is C

Question 64

What is the next step in the evaluation of a 45/F presenting with a palpable right sidedthyroid nodule, clinically euthyroid, with a TSH of 0.1 uIU/mL (0.3 - 5.5) [HPIM 20th ed.,fig 378-4, p 2718]? a. Diagnostic US with LN assessment to determine the need for FNA cytology /biopsy b. FNA cytology - imaging is not required as the mass is already palpable c. Radionuclide scan d. Molecular testing is advised e. Right thyroid lobectomy is recommended

Answer 64

a. Diagnostic US with LN assessment to determine the need for FNA cytology /biopsy

Question 65

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 65

Answer is B

Question 66

The type of thyroid malignancy more commonly found in regions of iodine deficiency[HPIM 20th ed., p 2715]: a. Papillary thyroid carcinoma b. Follicular thyroid carcinoma c. Medullary thyroid carcinoma d. Anaplastic thyroid carcinoma e. Thyroid lymphoma

Answer 66

Follicular

Question 67

The most sensitive urinary test used for the diagnosis of pheochromocytoma [HPIMtable 480-2 + text, p 2741]: a. Free metanephrines b. Catecholamines c. Fractionated metanephrines d. Total metanephrines e. All of the above

Answer 67

Answer is C

Question 68

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 68

Answer B

Question 69

True of mineralocorticoid excess [HPIM 20th ed., p 2729]: a. Hallmark is hyperkalemic hypertension b. Serum sodium tends to be elevated due to increased retention c. Severe acidosis may contribute to muscle cramps or tetany d. Patients with primary aldosteronism show increased rates of osteoporosisand type 2 diabetes e. All of the above are true

Answer 69

Answer is D The clinical hallmark of mineralocorticoid excess is HYPOkalemic hypertension Serum sodium tends to be NORMAL due to the concurrent fluid retention, which in some cases can lead to peripheral edema. Severe alkalosis contributes to muscle cramps and, in severe cases, can cause tetany. Primary aldosteronism show increased rates of osteoporosis, type 2 diabetes, and cognitive dysfunction.

Question 70

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

Answer 70

C. Saline infusion test

Question 71

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

Answer 71

D. 8 am serum cortisol | - midnight plasma (or salivary) cortisol

Question 72

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

Answer 72

B. High ACTH, high renin, Low aldosterone

Question 73

A 48-year-old male was brought to the emergency room due to persistent and severe abdominal pain. He was diagnosed with Diabetes mellitus 2 years ago and is also on maintenance medications for hypertension. On examination, he appears weak and dehydrated. Blood pressure is 90/60 and pulse rate is 120 per minute. On further inquiry, the patient had productive cough for the past five days, sensation of fever, and poor oral intake. He has right sided crackles on examination. Your primary consideration is DM emergency. Which among the following diagnostic examinations will you request to confirm your diagnosis [HPIM 20th ed., table 397-8, page 2871]? a. Random blood glucose, Arterial blood gas, Serum K+ b. Random blood glucose, Arterial blood gas, Serum ketones c. Random blood glucose, Arterial blood gas, Urine ketones d. Random blood glucose, Arterial blood gas, Serum creatinine e. Random blood glucose, Arterial blood gas, Serum Na+

Answer 73

Answer is B

Question 74

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 74

Answer is A

Question 75

Non-insulin medication approved as an additional treatment for Type 1 Diabetes Mellitus[HPIM 20th ed., p 2865]: a. Liragalutide b. Dulaglutide c. Pramlintide d. Exenatide e. Lixisenatide

Answer 75

C. Pramlintide

Question 76

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 76

Answer is B

Question 77

Patients with type 1 diabetes mellitus lose beta cells secondary to autoimmune destruction; however, features of diabetes do not become evident until what degree of beta cell destruction [HPIM 20th ed., p 2854]? a. 20% b. 30% c. 60% d. 80% e. 90%

Answer 77

Answer D

Question 78

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 78

Answer is C

Question 79

45. 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 79

Answer is D

Question 80

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 80

Answer is B

Question 81

Which of the following statements regarding presentation of hypopituitarism is FALSE? a. GH deficiency causes growth disorders in children and abnormal body composition in adults b. Gonadotropin deficiency causes menstrual disorders and infertility in women and decreased sexual function, infertility and loss of secondary sexual characteristics in men c. TSH deficiency causes growth retardation in children and features of hypothyroidism in children and adults d. Primary ACTH deficiency leads to hypocortisolism and decreased mineralocorticoid production

Answer 81

Primary ACTH deficiency leads to hypocortisolism and decreased mineralocorticoid production Main regulator of ACTH = cortisol ACTH Deficiency or Secondary Adrenal Insufficiency - Low to normal ACTH; normal renin, normal aldosterone Primary adrenal insufficiency - hypocortisolism, decresae mineralocorticoid production

Question 82

Which of the following is a contraindication to growth hormone (GH) replacement therapy in patients with adult GH deficiency? a. Retinopathy b. Simple goiter c. Uncontrolled hypertension d. Insulin-controlled diabetes

Answer 82

a. Retinopathy ¤  GH replacemet • contraindications: active neoplasm, intracranial hypertension, uncontrolled diabetes and retinopathy Action of GH • induces protein synthesis and nitrogen retention • impairs glucose tolerance by antagonizing insulin action • stimulates lipolysis, ⬆️ circulating fatty acid levels, ⬇️ omental fat mass, and enhances lean body mass • promotes sodium, potassium, and water retention and elevates serum levels of inorganic phosphate • stimulates epiphyseal prechondrocyte diferentiation and linear bone growth.

Question 83

A 30/F with no known comorbidities consulted for primary infertility for one year. Her last menstrual period was 6 months ago. She has had galactorrhea and occasional headache for the past two months. No other symptoms were noted. Physical and neurologic examination was unremarkable. Pertinent work-up revealed negative pregnancy test and elevated serum prolactin level at 250 µg/L. MRI revealed an 8-mm sellar mass. As she is desirous of pregnancy, which of the following is the best treatment for this patient? a. Observation b. Bromocriptine c. Levothyroxine d. Surgical resection

Answer 83

b. Bromocriptine

Question 84

Which of the following thyroid scan findings best describes viral thyroiditis? a. Low tracer uptake b. Increased tracer uptake with homogeneous distribution c. Focal areas of increased uptake with suppressed tracer uptake in the remainder of the gland d. Multiple areas of relatively increased and decreased tracer uptake

Answer 84

Low tracer uptake • Graves' disease: enlarged gland with ⬆️ tracer uptake that is distributed homogeneously • Toxic adenomas: focal areas of increased uptake, with suppressed tracer uptake in the remainder of gland • MNG: ⬆️⬆️ increased (functioning nodules) or ⬇️⬇️  tracer uptake (suppressed thyroid parenchyma or nonfunc-tioning nodules) • Subacute, viral, and postpartum thyroiditis: + ⬇️ uptake because of follicular cell damage and TSH suppression. • Thyrotoxicosis factitia: ⬇️uptake • Excess Iodine: ⬇️uptake

Question 85

A 25/F with known Graves’ disease was admitted at the ER for a 1-week history of sore throat and fever. She has regularly taken Methimazole 20 mg/day and Propranolol for the past 4 months. PE findings showed BP 100/60, HR 120 regular, RR 26, temperature 39°C, restlessness, diffuse thyromegaly and hyperemic tonsils with exudates. Pertinent initial tests showed Hgb 105, WBC 2.0, neutrophils 28%, lymphocytes 66%, eosinophils 2%, monocytes 2%, bands 2%; FT4 20 pmol/L (NV 9-19), TSH 0.3 mIU/mL (NV 0.35-4.9). Which of the following is the next best step in the management of this patient? a. Discontinue Methimazole and do CBC monitoring b. Lower the dose of Methimazole to 10 mg/day c. Shift Methimazole to Propylthiouracil d. Do immediate radioactive iodine therapy

Answer 85

a. Discontinue Methimazole and do CBC monitoring Symptoms of agranulocytosis (sore throat, fever, mouth ulcers) should prompt immediate discontinuation of the antithyroid drug and CBC. It is not useful to monitor CBC prospectively because the onset of agranulocytosis is idiosyncratic and abrupt.

Question 86

In the management of well-differentiated thyroid cancer, which of the following is a sensitive marker of residual or recurrent thyroid cancer after thyroidectomy and ablation of the residual postsurgical thyroid tissue? a. Serum thyroglobulin b. Whole body thyroid scan c.Neck ultrasound d. Neck CT scan

Answer 86

a. Serum thyroglobulin

Question 87

Which of the following is a marker of residual or recurrent disease in medullary thyroid carcinoma? (HPIM, C378, P2717) a. Serum calcitonin b. Serum thyroglobulin c. Free T4 d. Serum LDH

Answer 87

a. Serum calcitonin Medullary Thyroid Carcinoma (MTC) • Sporadic or familial, accounts for about 5 to 10% of thyroid cancers • More aggressive in MEN-2B than in MEN-2A; • familial MTC is more aggressive than sporadic MTC • Elevated serum calcitonin provides a marker of residual or recurrent disease • Test all patients for RET mutations - offer genetic counseling and testin g of family members if RET mutation positive • Management is primarily surgical • Paliation: EBRT, targeted kinase inhibitors

Question 88

A patient was referred for an incidentally discovered adrenal mass measuring 6 cm with CT density of 25 Hounsfield units (HU). Tests for hormonal excess were all normal. What is the recommended management for this patient? a. Unilateral adrenalectomy b. Repeat screening for hormone excess after 12 months c. Do CT-guided FNAB of the adrenal mass d. No further evaluation needed

Answer 88

a. Unilateral adrenalectomy

Question 89

19/F is evaluated for primary amenorrhea. Her cognitive function is normal and she is not sexually active. Her personal history and family medical history are unremarkable, with no intake of any supplements or medications. PE revealed normal vital signs and BMI; height 147 cm; normal secondary sexual characteristics; and Tanner stage 4 breast and pubic hair development. Which of the following is the recommended step in the evaluation of her condition? (HPIM, C386, P2796) a. Rule out any uterus and outflow tract anomaly by imaging b. Send for a B-HCG assay c. Send for serum FSH d. Rule out eating disorders

Answer 89

A

Question 90

Which of the following is a contraindication to postmenopausal hormone therapy? (HPIM, C387, P2810) a. History of transient ischemic attack b. One or more first-degree relatives with ovarian cancer c. Elevated LDL d. Prior cholecystectomy

Answer 90

The correct answer is: History of transient ischemic attack

Question 91

Which of the following is contraindicated among patients with medullary thyroid carcinoma? (HPIM, C397, P2866) a. DPP-4 inhibitors b. GLP-1 receptor agonists c. Thiazolidinediones d. Biguanides

Answer 91

b. GLP-1 receptor agonists

Question 92

What is the expected level of C-peptide in a patient with hypoglycemia caused by intake of exogenous insulin? (HPIM20 C399 P2888) a. Normal b. Low c. High d. Undetectable

Answer 92

LOW ■ACCIDENTAL, SURREPTITIOUS, OR MALICIOUS HYPOGLYCEMIA -- most common among health care workers, patients with diabetes or their relatives, -- considered in all patients being evaluated for hypoglycemia of obscure cause. -- Ingestion of: - Insulin secretagogue = hypoglycemia with increased C-peptide levels - Exogenous insulin = hypoglycemia with low C-peptide levels (suppression of insulin secretion).

Question 93

A 33/M presents with neck pain and persistent palpitations. He also reports having cough, cold and throat pain 2 weeks ago. His physical examination reveals a tender neck mass. What is expected of the depressed TSH level in this patient? (HPIM20 C377 P2708 F377-3) a. It will normalize on the 12th week of illness b. It will increase by the 6th week of illness c. It will increase by the 18th week of illness d. It will further decrease by the 4th week of illness

Answer 93

b. It will increase by the 6th week of illness

Question 94

Which of the following genetic syndromes associated with pituitary tumors also present with pigmented skin patches and polyostotic fibrous dysplasia? (HPIM, C2373, P2674) a. Carney complex b. MEN4 c. McCune-Albright syndrome d. Familial pituitary adenoma

Answer 94

c. McCune-Albright syndrome • MEN 1 (3Ps): autosomal dominant inactivating germline mutations MENIN with genetic predisposition to Parathyroid, Pituitary, Pancreatic islet (prolactinomas, acromegaly and Cushing's syndrome less common) • Carney Complex: spotty skin pigmentation, myxomas, endocrine tumors (testicular , adrenal, pituitary adenomas) • McCune-Albright syndrome: polyostotic fîibrous dysplasia, pigmented skin patches, variety of endocrine disorders (GH-secreting pituitary tumors, adrenal adenomas, autonomous ovarian function) • Familial Acromegaly-- rare disorder , either acromegaly or gigantism

Question 95

What is the initial treatment of choice for patients with growth hormone (GH)-secreting adenomas? (HPIM, C2373, P2679) a. Surgery b. Dopamine agonists c. Somatostatin analogue d. Radiation therapy

Answer 95

Surgery

Question 96

Which of the following is the clinical hallmark of primary aldosteronism? (HPIM, C379, P2729) a. Hyponatremic hypertension b. Hypokalemic hypertension c. Hyponatremic hypotension d. Hypokalemic hypotension

Answer 96

b. Hypokalemic hypertension Primary Aldosteronism 1. exhibit hypertension associated with drug resistance 2. Hypokalemia 3. Adrenal mass 4. Hypertension before the age of 40 years

Question 97

Which of the following thyroid medications is associated with the development of choanal atresia and tracheoesophageal fistulae? (HPIM, C377, P2707) a. Methimazole b. Propranolol c. Propylthiouracil d. Stable iodide

Answer 97

a. Methimazole •propylthiouracil should be used until 14–16 weeks gestation because of the association to rare cases of methimazole embryopathy: aplasia cutis, choanal atresia   and tracheoesophageal fistulae PTU is limited to the first trimester and then  should be converted to methimazole at

Question 98

Which of the following sonographic features is the least associated with thyroid cancer? (HPIM, C378, P2711) a. Marked hyperechogenicity b. Presence of microcalcifications c. Presence of irregular, microlobulated margins d. Solid consistency

Answer 98

Marked Hyperechogenicity Thyroid Utrasound • Ultrasonography is valuable for the diagnosis and evaluation of patients with nodular thyroid disease • Thyroid ultrasonography should be done for all patients suspected of having thyroid nodules by either physical examination or another imaging study 🌺 MALIGNANCY -- hypoechoic solid nodules with infiltrative borders and microcalcifications 🌸 BENIGN -- isoechoic solid nodules, 5–10% cancer risk --  spongiform nodules, defined as those with multiple small internal cystic areas, o

Question 99

Which of the following patients fulfill a diagnosis of pre-diabetes? (HPIM, C396, P2850) a. HbA1c 6.5% b. 2-h plasma glucose after 75 g OGTT 7.8 mmol/L c. Fasting plasma glucose 7.0 mmol/L d. Random plasma glucose 120 mg/dL

Answer 99

b. 2-h plasma glucose after 75 g OGTT 7.8 mmol/L -- 3 broad categories of glucose tolerance 🌡Normal glucose homeostasis • FPG ≤5.5 mmol/L (100 mg/dL) • Plasma glucose ≤ 7.7 mmo/L (140 mg/dL) following OGTT • HbA1c ≤5.6% 🌡 Impaired glucose homeostasis (Prediabetes, Increased Risk of Diabetes, Intermediate Hyperglycemia • Impaired fasting glucose (IFG): FPG = 5.6-6.9 mmol/L (100-125 mg/dL) • Impaired glucose tolerance (IGT): plasma glucose levels between 7.8 and 11 mmol/L (140 and 199 mg/dL) following a 75g oral glucose challenge • HbA1c of 5.7-6.4% 🌡 Diabetes Melitus • FPG ≥ 7.0 mmol/L (126 mg/dL) • Plasma glucose ≥11.1 mmol/L (200 mg/dL) 2hr after an oral glucose challenge • Hemoglobin A1c ≥ 6.5 % • Random plasma glucose ≥11.1 mmol/L (200 mg/dL) + classic symptoms (polyuria, polydipsia, weight loss)

Question 100

Which of the following patients has a clear indication for BMD testing? (HPIM, C404, P2947) a. 65/F with no known comorbidities b. 65/M with no known comorbidities c. 45/F with recent fracture of the hip d. 45/F with newly diagnosed SLE on prednisone 10 mg/day for 1 month

Answer 100

a. 65/F with no known comorbidities