Endocrinology Quiz - Questions E1 to E6

Acarbose is an alpha-glucosidase inhibitor, it does not cause hypoglycemia in the elderly.

Primary hyperaldosteronism is characterized by high aldosterone levels and suppressed renin. This leads to sodium retention and potassium loss, resulting in metabolic alkalosis.

Autonomic neuropathy is a common complication of diabetes. It can affect various systems, including the gastrointestinal system. Autonomic neuropathy can cause gastrointestinal symptoms like constipation, diarrhea, and fecal incontinence.

In Cushing's syndrome, cortisol levels should be suppressed with a low dose of dexamethasone. If suppression occurs only with a high dose, it suggests an adrenal adenoma.

Orthostatic hypotension, weakness, dizziness, and weight loss in a diabetic with normal TSH and HbA1c suggest autonomic neuropathy. This is further supported by a history of hypothyroidism. The next step is to assess for autonomic neuropathy using an ACTH stimulation test.

Hirsutism, oligomenorrhea, elevated DHEA, and 17-OH progesterone in the absence of elevated testosterone, LH, FSH, and normal dexamethasone suppression test suggest non-classic congenital adrenal hyperplasia. Spironolactone is the appropriate treatment.

Gynecomastia, chest pain, fatigue, and loss of retrosternal airspace on CXR in a young male are suggestive of a thymoma. This is a tumor of the thymus gland.

Hypokalaemia, elevated bicarbonate, and low urine chloride are suggestive of primary hyperaldosteronism.

In Cushingoid females with low serum ACTH who do not suppress with low dose dexamethasone, a 24h cortisol and 17-hydroxysteroids after high dose suppression test should be performed to assess for adrenal adenomas or carcinomas.

In DKA, initial treatment involves fluid resuscitation with normal saline and insulin administration. If the pH remains below 7.2 despite adequate fluid and insulin, adding bicarbonate is recommended.

Nocturia and elevated HbA1c in a patient with DM II on NPH insulin suggests inadequate blood sugar control overnight. The next step involves switching to an intensive insulin regimen with basal-bolus therapy.

Radioactive iodine therapy for Graves' disease can lead to hypothyroidism but rarely to malignancy. Antithyroid medications can lead to remission, but long-term use can cause complications. Ophthalmopathy is an indication for antithyroid medication or radioactive iodine, not surgery. Subtotal thyroidectomy is considered if radioactive iodine fails.

During pregnancy with Graves' disease, beta blockers are the preferred management option. Propylthiouracil (PTU) is an alternative if needed, but monitoring for potential side effects is critical.

Primary hyperparathyroidism is characterized by increased PTH levels and high urinary calcium excretion.

Paget's disease is a chronic bone disorder characterized by excessive bone turnover. Management includes analgesics and bisphosphonates to control symptoms.

Microalbuminuria in a diabetic patient without overt proteinuria indicates early diabetic nephropathy. ACEi is the first-line treatment for preventing progression.

Muscle wasting, fatigue, and weight loss in an elderly diabetic with poorly controlled blood sugar and right buttock and thigh pain suggest diabetic neuropathy. This can affect various systems, including the musculoskeletal system.

Corticosteroids can increase bone loss, but supplementation with vitamin D and calcium are not effective therapy.

Osteomalacia is a condition characterized by bone pain and weakness due to inadequate mineralization. It is often associated with vitamin D deficiency and elevated ALP.

Bisphosphonates are the first-line treatment for osteoporosis in patients with a past history of breast cancer.

Back pain, osteopenic spine, and Looser zones on X-ray with low calcium, low phosphate, and elevated ALP suggest osteomalacia. This can be caused by various conditions like chronic pancreatic insufficiency, celiac disease, or intestinal bypass.

Insulin is often indicated in type II diabetics who are thin, young, and newly diagnosed. Additionally, insulin may be necessary if there is significant weight loss, polyuria, and lethargy on an oral agent.

In a diabetic patient with hypertension and no proteinuria, the target blood pressure should be 130/80.

Bisphosphonates are the preferred treatment for osteoporosis in a postmenopausal woman with a vertebral compression fracture and prior history of TAH/BSO and DVT. Estrogen is contraindicated due to the increased risk of thromboembolism.

Hypercalcemia, hyperphosphatemia, and elevated PTH in the setting of a squamous cell carcinoma of the lung suggest humoral hypercalcemia of malignancy caused by parathyroid-related peptide (PTHrP).

Panretinal laser photocoagulation has been proven to decrease the rate of progression of proliferative diabetic retinopathy.

Sildenafil (Viagra) is the best therapy for erectile dysfunction in a well-controlled type II diabetic with a history of MI and mild ischemia on a stress test. Consider other factors like diabetes, medication interactions, and potential contraindications.

Multiple kidney stones, high urinary calcium, low serum phosphate, and normal PTH suggest primary hyperparathyroidism. Parathyroid scanning is the best step to localize the parathyroid adenoma.

Hirsutism, acne, and oligomenorrhea in an obese 17-year-old woman are suggestive of polycystic ovarian syndrome. This is a hormonal disorder affecting women of reproductive age.

Glucosuria, metabolic acidosis, low bicarbonate, low potassium, and low calcium suggest Fanconi syndrome. This is a rare disorder affecting the proximal tubules of the kidneys.

In a mildly hypothyroid woman with normal TSH, free T4 within the normal range, and positive anti-TPO antibodies, further investigation is required. Ultrasound of the thyroid is the next best step due to the presence of a firm, non-tender nodule.