Endo Questions PDF

Endo questions E1. Which drug does not cause hypoglycaemia in the elderly? 1. Acarbose 2. Repaglinide 3. Glyburide 4. Tolbutamide E2. In primary hyperaldosteronism, which of the following is seen? 1. Metabolic alkalosis, low renin 2. Metabolic acidosis, low renin 3. Metabolic alkalos...

Endo questions E1. Which drug does not cause hypoglycaemia in the elderly? 1. Acarbose 2. Repaglinide 3. Glyburide 4. Tolbutamide E2. In primary hyperaldosteronism, which of the following is seen? 1. Metabolic alkalosis, low renin 2. Metabolic acidosis, low renin 3. Metabolic alkalosis, high renin 4. Metabolic acidosis, high rennin E3. Diabetic man with recent onset of diarrhoea and fecal incontinence. He also has a 1 year history of constipation. The most likely cause of his symptoms is: 1. Inflammatory bowel disease 2. Colon cancer 3. Coccidiomycosis 4. Autonomic neuropathy E4. Woman with Cushing's syndrome. Cortisol does not suppress with low dose dexamethasone test but does suppress with high dose test. Diagnosis: 1. Adrenal adenoma 2. Adrenal carcinoma 3. Ectopic ACTH 4. Pituitary adenoma E5. Woman with known Hx of DM I and hypothyroidism presents with weakness, dizziness, weight loss and orthostatic drop in BP. Normal TSH and HbA~1C~ is 0.07. Next step: 1. CK 2. Dexamethasone suppression test 3. Tighter glucose control 4. ACTH stimulation test E6. 20 year old woman with a 2 year history of hirsuitism and oligomenorrhoea. DHEA and 17-OH progesterone both elevated. Normal testosterone, LH, FSH and overnight dexamethasone suppression test. Normal pelvic exam. Treatment: 1. Oral contraceptive pill 2. Prednisone 2.5-5.0 mg OD 3. Spironolactone 4. Wedge resection of the ovaries 5. Bilateral adrenalectomy E7. 18 year old male with gynaecomastia, chest pain, fatigue, and loss of retrosternal airspace on CXR. Diagnosis: 1. Thymoma 2. Germ cell tumour 3. Goitre 4. Hodgkin's disease E8. 25 year old male with hypokalaemia, bicarbonate of 28 and urine chloride of 40. Diagnosis: 1. Vomiting 2. Diarrhoea 3. Primary hyperaldosteronism 4. Post hypercapnoea 5. Low chloride diet E9. Cushingoid female who's serum cortisol does not suppress with low dose dexamethasone. Low serum ACTH. Next step: 1. 24h cortisol and 17-hydroxysteroids after high dose suppression test 2. 24h cortisol and 17-hydroxysteroids after low dose suppression test 3. CT abdomen 4. MRI pituitary E10. 18 year old male with DKA. Initial pH 6.96, glucose 28. Given 2 L NS over 2 hours, 10 units of IV insulin bolus then 3 units per hour. Now pH is 7.01 and glucose is 23. Next step: 1. Double the insulin rate 2. 1 Litre D5W over 30 minutes 3. Give bicarbonate 4. Continue with current treatment E11. 60 year old male with DM II on human NPH 50 units q AM. Nocturia, morning BS 10, elevated HbA~1c~. Next step: 1. Add 10 units NPH at night 2. Use intense insulin regimen 3. Add glyburide 4. Switch to non-human insulin E12. Which is true regarding the treatment of Graves' disease? 1. Radioactive iodine has a low but significant risk for malignancy 2. Long-term use of antithyroid medications can result in remission 3. If radioactive iodine fails may go on to subtotal thyroidectomy in 6 months 4. Opthalmopathy is an indication for urgent thyroidectomy. E13. 28yF 19 weeks pregnant. Diagnosed with Graves' disease. Treatment: 1. No treatment 2. β-blocker 3. PTU 100 mg bid 4. Thyroidectomy 5. Radioactive iodine E14. In the setting of primary hyperparathyroidism you would expect: 1. Decreased PTH, low urinary calcium 2. Decreased PTH, high urinary calcium 3. Decreased PTH, normal urinary calcium 4. Increased PTH, low urinary calcium 5. Increased PTH, high urinary calcium E15. Elderly patient diagnosed with Paget's disease. Most appropriate management option: 1. Bone biopsy 2. Analgaesics and bisphosphonates 3. Work up for osteosarcoma E16. 26 year old diabetic with BP 130/80, microalbuminuria. No overt proteinuria. Treatment: 1. Start ACEi 2. Start ACEi if overt diabetic nephropathy 3. Repeat 24 hour urine for protein in 6 months 4. Repeat 24 hour urine for protein in 1 year E17. Elderly male with longstanding diabetes which is poorly controlled presents with right buttock and thigh pain and has quadriceps and thigh muscle wasting. He also complains of fatigue and weight loss. He has: 1. Parathyroid syndrome 2. CVA 3. Diabetic neuropathy 4. Malignancy E18. Young woman with ulcerative colitis, not responding to 5-ASA. You want to start cortIcosteroids. The following is true about steroid use: 1. Bisphosphonates decrease the risk of vertebral fractures 2. They inevitably lead to osteoporosis in the long term 3. 2/3 of patients will have a fracture in 5-10 years 4. Vitamin D and calcium are effective therapy 5. Bone density loss occurs only after 3-6 months E19. The following is true with respect to osteomalacia: 1. Pain is characteristic 2. It is usually due to dietary calcium deficiency 3. Usually presents with decreased calcium and increased ALP and PO~4~ 4. Rarely has increased PTH E20. Old woman with lumbar fracture and past history of breast cancer. On vitamin D and Calcium. What treatment would you start now? 1. Oestrogen replacement 2. Alendronate 3. Fluoride 4. 1,25 dihydroxy vitamin D E21. Back pain, x-rays showing osteopaenic spine, scapula with linear radioluscencies (Looser zones). Ca 2.10, Pi 0.75, ALP 125. This is most in keeping with: 1. Primary biliary cirrhosis 2. Chronic pancreatic insufficiency 3. Coeliac disease 4. Intestinal bypass 5. Selective vagotomy E22. Type II diabetic. Best indication to use insulin: 1. Thin patient, young and newly diagnosed 2. Retinopathy 3. Weight loss, polyuria and lethargy on an oral agent E23. A patient with diabetes has hypertension \~180/90. No proteinuria. What should be the target blood pressure? a\) 140/90 b\) 130/70 c\) 125/75 d\) 130/80 e\) 160/90 E24. A 58yF falls and suffers a vertebral compression fracture. BMD confirms osteoporosis. Prior TAH/BSO at age 40. Prior DVT. Pain controlled with Tylenol. Best treatment: a\) Estrogen b\) Estrogen/progesterone c\) SERM d\) Bisphosphonate e\) Calcitonin E25. A man is found to have a squamous cell carcinoma of lung. Normal bone scan. Hypercalcemic, hyperphosphatemic, elevated PTH, Cr 210. What is the cause of the hypercalcemia: a\) Parathyroid related peptide b\) Bony metastases c\) Hyperparathyroidism (or did the question state *primary* hyperparathyroidism?) d\) Renal failure E26. What treatment has been shown to decrease the rate of progression of proliferative diabetic retinopathy? a\) Panretinal laser photocoagulation b\) Subcutaneous heparin c\) ACE inhibitor d\) Tight glycemic control E27. You are seeing a 60 year old man with erectile dysfunction. He suffered an MI six months ago. He is a type II diabetic, well-controlled on glyburide. HbA1c 6.8. He is also on metoprolol, an ACE, a statin, and ASA. On his stress test there is evidence of mild ischemia on maximal exertion. His testosterone and prolactin levels are normal. What is the best therapy for his erectile dysfunction? a\) Stop the statin b\) Stop the beta-blocker c\) Give testosterone injections d\) Prescribe sildenafil (Viagra) e\) Change glyburide to metformin E28. A woman has had multiple kidney stones. Investigations reveal serum calcium 3.1, low serum phosphate, high urinary calcium, and PTH at upper limit of normal. Best next step: a\) Referal to a surgeon for parathyroidectomy b\) Parathyroid scan c\) Skeletal survey d\) Bone scan E29. An obese 17 year old woman presents with worsening hirsutism. (Other details?) Most likely cause? a\) Polycystic ovarian syndrome b\) Late-onset congenital adrenal hyperplasia c\) Ovarian tumour E30. A young female presents with severe loss of bone density and multiple pathologic fractures. She is found to have glucosuria, metabolic acidosis, HCO3 10, K 2.8, Ca ?, PO4 ?. Most likely diagnosis? a\) Distal renal tubular acidosis and osteomalacia b\) Osteomalacia c\) Fanconi syndrome E31. A mildly hypothyroid elderly woman is seen. TSH 10, free T4 \~ 6, anti-TPO Ab positive. On exam, the right lobe of the thyroid is mildly enlarged, firm but non-tender. Next step? a\) FNA b\) I-131 thyroid scan c\) Start thyroxine d\) Observe for 3 months e\) Thyroid ultrasound E32. You are asked to see a 55 year old obese diabetic man. His HbA1c is 8.3. Cr is 180. He has a history of CHF. What is the best management plan? 1. Metformin 2. NPH qhs and metformin 3. Repeglinide 4. Rosiglitazone 5. Glyburide E33. A young man admits to steroid use for the past year. He now wants to have children. Which would you expect to find? a\) High HDL b\) Low HDL 1. Large testes 2. High LH/FSH 1. Increased sperm count E34. A 24 year old man complains of weakness while working out at the gym. He has gained weight and has purplish striae (you are shown a picture of this). Labs show a high fasting AM cortisol, high 24 hour urinary cortisol, and high ACTH. There is no suppression with either low or high-dose dexamethasone. What is the most likely cause? a\) Pituitary adenoma b\) ACTH secreting carcinoid c\) Adrenal adenoma d\) Surreptitious steroid use e\) Adrenal hyperplasia E35. Woman with DM for 6 years. Recent admission for MI. HbA1C 0.09, HDL 0.9, TG 2.0, LDL 2.1. What would you give to reduce the risk of another MI? E36. 58yo woman with fatigue and mood changes. No other complaints, examination normal. Labs: Ca 2.78, PO4 0.8, PTH 58 (upper limit of normal given at 60). Before referring for surgery what other test would you do?\ a. 24h urine for calcium\ b. ALP\ c. Bone scan\ d. Vit D levels. E37. Family doctor admits a young female with DKA. Glucose 33, HCO3 8, Cr 138, pH 7.01. He treats her with 5 units per hour of Humulin R, IV NS 500cc/hr for several hours and then 250cc/hr (I think those numbers are right), and some potassium. 12 hours later, glucose is 22, HCO3 is 9, Cr is 128, pH is7.01. What is true? a\. She has received inadequate IVF b\. She has received inadequate insulin c\. She has developed hypophosphatemia d\. She requires HCO3 IV E38. 24F who wants to become pregnant presents for assessment of 18 months of amenorhea. TSH N, B-HCG negative, Prolactin 80ug/L (high). CT head Normal. Next course of managment?             a. MRI pituitary             b. pelvic U/S             c. clomid             d..bromocriptine E39. 70F with breast cancer and mets on tamoxifen presents with nausea, vomiting, andconfusion and has an elevated Ca.  After volume repletion the next best step is: a. Prednisone b. Lasix c. Pamidronate d. Mithramycin E40. A patient is seen on neurosurgery after transphenoidal endoscopic surgery for a non-functioning pituitary adenoma. On POD \# 1 the patient has hypernatremia treated with DDAVP. POD \# 2 Na is normal and pt. is euvolemic and so is changed to 75 cc/hr D5W and 0.45 NS. He is also placed on hydrocortisone at 50 mg q4h. On POD \#3 Na drops and the patient is hyponatremic. (we could not recall values, but serum Na, osm and urine Na and osm are given to help you). What statement is true? a\. DI may develop in the coming week b\. Hyponatremia is due to DDAVP c\. Hyponatermia due to mineralocrticoid deficiency d\. Hyperglycemia is due to steroids (no glucose was given in the stem) E41. 40ish year old woman with type 2 diabetes diagnosed two years ago, on glyburide 10 mg bid and metformin 1 g bid.  Does not adhere to any diet and does not exercise.  Non-smoker.  Normal menses.  Has a strong family history of type 2 diabetes and of coronary artery disease in a family member younger than age 50.  On examination, she is obese (135% ideal body weight) and BP 130/75.  Rest of exam is normal.  Labs show: hemoglobin A1C 0.121 (12.1%)                 serum creatinine 90 total cholesterol 4.8 HDL cholesterol 0.8 triglycerides 6.8 albumin/Cr ratio high (5.2?,  normal \< 2.7?) TSH 6.5 (normal about 0.5-5.0) How would you treat this woman's hyperlipidemia? a\) Thyroxine b\) Rosiglitazone c\) Insulin d\) Micronized fenofibrate E42. 35 yr old male long distance runner. Presents with poor libido but shaves daily. He develops arthralgias on occasion after running. On exam he is tanned with small and mildly soft testes with normal virilization. Low LH, low FSH, low testosterone, TSH normal with free T4 10 and normal pituitary MRI. What test next? a\. Transferrin saturation b\. Urine for anabolic steroids c\. Ceruloplasmin d\. Biopsy testicle E43. A 20 year old female presents with secondary ammenorrhea. She had normal menstrual periods until age 18, and then none since. She has developed acne and temporal hair loss over the past 6 months. Her testosterone is elevated at 9 (upper limit \~2...reference given). Her DHEAS is normal. Her BhCG is negative. What would be your next test? a\. Pelvic U/S b\. Androstenedione c\. Karyotype E44. A patient has asymptomatic Paget's disease. He has one lesion on a rib, but the rest of the bone scan is negative. His ALP is 274, and is Ca is normal. What would you do? a\. Alendronate b\. Observation c\. Plicamycin d\. Calcitonin E45. A patient on amiodarone develops a tremor and heat intolerance. Labs are done and show a TSH 0.001, T4 25, T3 normal. RAIU 0%. What is the diagnosis? a\. Amiodarone induced hypothyroidism b\. Amiodarone induced thyroiditis c\. Amiodarone induced inhibition of peripheral T4 to T3 conversion and pt is euthyroid d\. Amiodarone inhibition of T3 release from thyroid E46. A patient with type I diabetes is pregnant. Her BP is normal and the rest of her labwork is normal. She is found to have microalbuminuria. What is the management plan? 1. Start ACE inhibitor 2. Low protein diet 3. Monitor for hypertension 4. Low salt diet E47. Patient had a carotid U/S that incidentally noted a 0.3cm thyroid nodule. The patient is biochemically euthyroid and does not have any history of XRT exposure or family history of thyroid cancer. What is the appropriate plan? 1. Re-assess in 3-6 months 2. Do radioactive iodine uptake scan now 3. Biopsy now 4. Thyroglobulin level E48. A young man presents with azoospermia, normal hair distribution growth and puberty. On exam he is 180cm tall, his arm span is 183cm, and his pubis to foot length is 95cm. He has normal secondary sexual characteristics. His testes are small and firm. What is the best diagnostic test? 1. WBC karyotype 2. Testicular biopsy 3. Pituitary MRI 4. Urine for anabolic steroids E49. 56 year old male presents with flushing, diarrhea, telangiectasias. On cardiac exam he has large V waves, a slow y descent, and a pansystolic murmur at the LSB. What is the most likely Dx? 1. Carcinoid 2. Amyloid 3. Pheochromocytoma 4. Hemochromatosis E50. A patient with type one DM has mild proteinuria and is on enalapril 5mg PO OD. He does not have hypertension, in fact he has an asymptomatic postural drop from sBP 120 to 110. What is the best intervention to further reduce progression of his nephropathy? 1. Insulin pump 2. Smoking cessation 3. Increase the dose of enalapril 4. Restrict protein in the diet E51.         61 M, type 2 Diabetic presents with morning hyperglycemia. His AM fasting capillary glucose ranges from 2 to 20. Day sugars are OK. He is on R at breakfast and dinner and on intermediate acting insulin (NPH) 15 U with breakfast and 12 U with dinner. What should be done? 1\. Decrease dose of R in AM 2\. Decrease NPH at supper and eliminate bedtime snack 3\. 3 AM glucose and move NPH to hs if necessary 4\. Measure 2h pc meals glucose E52.  A 23 F presents with anorexia nervosa. She is 4\'11 and weighs 90 lbs. She has evidence of lanugo hair. She is at risk for which of the following? 1\. Sudden death 2\. Short QT       3\. Asthma 4\. Postnasal drip E53. A 40 F presents with moon facies, easy bruisability, difficulty sleeping and purple abdominal striae. You suspect Cushing syndrome. What is the best investigation to diagnose Cushing syndrome? 1\. 24 hour cortisol that is 3X ULN 2\. 24 hour cortisol that is 5X ULN 3\. Elevated AM serum cortisol 4\. Depressed AM ACTH E54. 34 F with family history of pernicious anemia presents with fatigue, postural changes, hyperpigmentation especially in intertriginous areas. What is the next best test for diagnosis? 1\. Metapyrone test 2\. Dexamethasone stimulation test 3\. Serum ACTH and cortisol levels 4\. Anti-adrenal antibodies E55. A 30 year old woman presents with a 3 cm thyroid nodule found on palpation. No family history of thyroid dx, no prior radiation. TSH is normal. What is the best management? 1\. Thyroxine to suppress 2\. U/S of thyroid 3\. Fine needle aspiration 4\. I131 ablation E56. 40 F presents with Graves\' disease and significant ophthalmopathy. RAIU = 90% and TSI positive. How to treat: 1\. Subtotal thyroidectomy 2\. Radioactive iodine + prednisone 3\. Radioactive iodine + orbital radiation 4\. Radioactive iodine only E57. 42 F is admitted with DKA. Na 129, K 5.2, Cr 140, glucose 32, HCO3 4, pH 7.01. Which is true? 1\. Her total body potassium is not increased 2\. Her hyponatremia is most likely on the basis of SIADH 3\. Her acidemia is an indication for bicarbonate infusion 4\. Treatment of this will result in hyperphosphatemia E58. Young male with episodes of sweating, palpitations, headache. BP in between is normal. 3 x 24 hour urines for VMA are in upper limit of normal. 1\. There is enough evidence on history and labs to r/o pheochromocytoma 2\. If given clonidine and catecholamines decrease, likely pheo 3\. If given clonidine and catecholamines do not decrease, likely pheo 4\. The history is irrelevant to the presentation E59.        A diabetic man presents with edema of legs and hands but urine protein only 0.5 g/24h, on rosiglitazone. What is the cause of this? 1\. Rosiglitazone 2\. Nephrotic syndrome 3\. Congestive heart failure 4\. Liver failure E60. 45F post-op total parathyroidectomy. Initial bloodwork indicates serum potassium 2.1 mmol/L, serum calcium (ionized) 0.6mmol/L. She is given replacement iv potassium and calcium stat. Repeat bloodwork 2h later indicate K+ 2.5, Ca++ (ionized) 0.75. What would be the next best step: 1\. iv calcium infusion 2\. check serum Mg++; replace if low 3\. po calcitriol 4\. iv potassium infusion E61. A family physician calls you for advice regarding a mutual patient with recently diagnosed hypothyroidism 2 weeks ago. She has been on L-thyroxine for 10days and repeat TSH is still elevated. What advice do you offer: 1\. Double the dose of L-thyroxine 2\. Switch to synthroid 3\. Continue the same dose and recheck TSH in 4 weeks 4\. Thyroid ultrasound E62. 24F with known diagnosis of multiple endocrine neoplasia type 1 and previous total thyroidectomy at age 8. Presents palpitations, diaphoresis and headaches intermittently. Thinks that if she drinks juice it shortens duration of symptoms. BP 130/70, HR 80. What is the most appropriate investigation? 1\. Urine and/or serum metanephrines 2\. 24 hour Holter 3\. Echocardiogram 4\. Glucose and insulin level during one of her episodes E62. 24F with known diagnosis of multiple endocrine neoplasia type 2 and previous total thyroidectomy at age 8. Presents palpitations, diaphoresis and headaches intermittently. Thinks that if she drinks juice it shortens duration of symptoms. BP 130/70, HR 80. What is the most appropriate investigation? 1\. Urine and/or serum metanephrines 2\. 24 hour Holter 3\. Echocardiogram 4\. Glucose and insulin level during one of her episodes E63. A woman has been on prednisone for 5 months for viral thyroiditis. Now has right groin pain with weight bearing. On exam has right groin pain with passive leg movement. X-ray is normal. What diagnostic test would have highest sensitivity in this problem? 1\. Bone scan 2\. Hip arthrogram 3\. DEXA scan 4\. MRI hip E64.         Which one of the following medications is associated with a mortality benefit in a patient with diabetes mellitus? 1\. ASA 2\. Angiotensin receptor blocker 3\. Metformin 4\. ACE inhibitor E65. A 22 year old woman presents to your clinic requesting an oral contraceptive pill. She is well, and has no children. She is sexually active with 2 partners. She smokes 4 cigarettes per day. Her sister had a post-operative DVT, another sister had cervical cancer and her mother has breast cancer. Which of the following is a contraindication to OCP? 1\. She has a family history of venous thromboembolism 2\. She is a smoker 3\. She has a family history of cervical cancer 4\. She has a family history of breast cancer E66. 38 M has an incidental CT scan which shows a 1.5 cm R adrenal nodule. Which of the following test is unnecessary? 1\. HIAA\ 2. Cortisol 3\. Metanephrines 4\. Renin and aldosterone values E67. 23 year old male with a right testicular mass has a CT scan that shows retroperitoneal and mediastinal lymphadenopathy. AFP and BHCG are negative. He proceeds to an orchidectomy. What will the pathology show? 1. Teratoma 2. Choriocarcinoma 3. Seminoma 4. Leydig cell tumor E68. Man in his 60s with left proximal tibial pain, which awakens him at night. The area is warm on exam. Plain film shows trabecular thickening. ALP is elevated - mostly the bone fraction. The calcium, PTH and renal function are all normal. Treatment? E69. Patient who is known to be depressed also has hypertension. Which of the following is most consistent with the diagnosis of hyperaldestronism 1. Diuretic induced hypokalemia (\>2.5) 2. Renal deterioration 3. Hypertensive crisis with the use of Monoamine oxidase inhibitors 4. Hypernatremia (\>148) E70. 50 y/o man with abdominal pain. CT abdomen reveals only a 2cm adrenal mass/nodule but nil else. His BP is 120/80. 24hr urine for cortisol and catecholamines is negative. What would you do next? E71. 25yo female has been reading on the internet and thinks she has porphyria. She complains of episodes of abdo pain, malaise and fatigue. She has no family history as she is adopted. Routine biochemistry and spot urinary porphorins are normal. What will best rule out porphyria as the cause of her symptoms? 1. negative family history 2. normal random 24 hour urine collection for porphyrins 3. no symptoms related to sun exposure 4. normal 24 hour urine collection for porphyrins during an acute attack   E72. 34 yo female is referred to you with a fasting glucose of 6.4. She had gestational diabetes on her last pregnancy treated with insulin for the last 7 weeks and has hypertension. Current BP is 150/85. She is overweight. She is very concerned about not becoming diabetic. All of the following have been proven to reduce the risk of developing DM EXCEPT: 1. lifestyle change including diet and exercise 2. metformin 850mg BID 3. repaglinide 0.5g TID 4. ramipril 5mg od E73.   DCCT trial has shown:\ a. Reduction of retinopathy within the first year\ b. Increase in incidence of hypoglycemic events\ c. Decreased GFR\ d. No change in nephropathy\ e. Increased insulin requirements in the tight control group E74. Man with hypoglycemia, lung mass to diagnose 1. C peptide 2. urine for sulfonylurea 3. IGF E75. 22F, secondary amenorrhea for 18mo. Menarche @ 12yo. Irregular periods. Obese. Hirsute. Wants to get pregnant. She had a withdrawal bleed after a trial of progesterone po. What is the best treatment option for her? 1. Spironolactone 2. Estrogen-cyproterone combination 3. Human chorionic gonadotropin 4. cannot recall E76. A 45-year-old man has big hands, big feet and coarse facial features. He\'s sweaty but otherwise feels well. The best test to confirm the diagnosis is: 1. IGF-1 levels post 75 g glucose load. 2. GH levels post glucose load. 3. GH levels 4. IGF-1 levels after insulin. E77. 26 year old woman complains of intermittent spells of headache, diaphoresis, and palpitations. She has a cousin who required neck surgery. On exam, she is hypertensive with a blood pressure of 220/110, has a postural drop to 170/80, and has an S4. You would treat her with which of the following to control her hypertension?   E78. A 68-year-old woman who develops excruciating thoracic back pain. She is found to have a T9 compression fracture. Bone density scanning shows osteoporosis at the hip and spine. You recommend: 1. oral bisphosphonates 2. IV bisphosphonates 3. sodium flouride 4. nasal calcitonin E79. 22y/o female with Type 1 DM x 10yrs. Stable VS included BP 120/80. Has a 24-hour urine protein of 740mg. What will decrease progression of her proteinuria? 1. ACE inhibitor 2. Treat hypertension 3. Glucose control 4. Low protein diet E80. 25F with Addison's disease on fludrocortisone and Prednisone.  Forgets to take fludrocortisone x 4 days.  Presents with lethargy, fatigue.  On exam had significant orthostatic change  100/40 to 60/P.  Labs reveal low Na, high K (6.3) ECG normal.  Best treatment? 1. Lasix and Kayexalate 2. Dexamethasone 4 mg iv 3. Hydrocortisone 100 mg iv 4. 5 days doses of fludrocortisone all at once  E81. 60 yo woman with ovarian ca. what is best test to follow disease? 1. CEA 2. CA-125 3. AFP E82. A 48M is referred for evaluation of fatigue and burning pain in both feet over the last 4 months. He also complains of decreased libido and erectile dysfunction. Physical examination reveals generalized darkening of his skin, with BP 120/70, HR 74 and BMI 24.1. There is decreased vibration sense below the mid-calves bilaterally. The external genitalia are normal. Laboratory investigations reveal FBG 8.4, HbA1c 0.067, serum testosterone 4.5 (low), FSH 2, LH 1 (low normal). Of the following, which test is most likely to yield a diagnosis: 1. Serum ACTH 2. Transferrin saturation 3. Serum free testosterone 4. Another test E83. 45M 1ppd smoker with new onset weight loss of 15lbs, fatigue, hemoptysis & increasingly tanned skin. Exam reveals BP 160/95 & darkened skin. Workup reveals fasting glc 18 & mass in RUL on CXR. Most likely underlying pathology? 1. adrenal adenoma 2. MRI will show pituitary adenoma 3. CT will show bilateral adrenal hyperplasia 4. He has insulin resistance E84. Young woman with painful neck. Exam reveals enlarged thyroid, tender. TSH = 0.02, fT4 = 30. What is next? 1. PTU 2. Prednisone 3. Surgery 4. Monitor E85. 50M with new history of hypoglycemic events manifested by tremor, anxiety, blurred vision when he misses a meal. Preliminary workup is negative. You agree to admit him for a 72hr fast. At 12hrs, his glucose is 2.1 and insulin is 21 (N 25-50). What do you check next to make the diagnosis? 1. C-peptide 2. Sulfonylurea screen 3. IGF-1 E86. Young pt presents with DKA (pH 6.96 and high AG).  Insulin bolus (10u) given and infusion (5u/hr) started.  NS is administered.  Upon rechecking labs, AG is better but pH only improved to 7.0  What is the cause?\ A. insufficient insulin\ B. no bicarb was given\ C. insufficient potassium\ D. insufficient rehydration with NS\ \ E87. 36 Y F type I diabetes on humulin 70/30, 20 and 15 units for routine physical.B.P 128/75,rest of exam normal. HBA1c 0.058, total cholesterol 4.3,LDL 3.4,HDL 1.8,TG 1.9,cr 110,urine microalbumin 55mg/dl what should you add now\ A. fibrate\ B. ACE-i\ C. insulin pump\ \ E88. 70F presents with acute lower back pain.  X-ray shows diffusely decreased bone mineralization.  She underwent remote partial gastrectomy for peptic ulcer disease.  Her lab values are Ca 2.00, PO4 0.8, ALP 140, CR 170 (no PTH or albumin given).  Which of the following the most likely diagnosis?\ A. Renal osteodystrophy\ B. Osteoporosis\ C. Osteomalacia\ D. Hypoparathyroidism\ \ E89. 55M with a 3 month history of muscle weakness. Examination demonstrates only proximal muscle weakness. Remainder of information is as follows: BP 160/110. Na 138 K 2.2 Fasting serum cortisol 1100, 1600h cortisol 850. What is the most likely diagnosis? A adrenal cortex adenoma\ B adrenal cortex carcinoma\ C pituitary microadenoma\ D Ectopic ACTH\ \ E90. 60 year old man with recent TIAs. At ultrasound for his carotids, radiologist finds that he has multiple small thyroid nodules (both glands). The largest nodule measure 0.9 cm. His TSH is normal. What would be your next step in this patient's management:\ A Radioactive uptake scan\ B FNA of the largest nodule\ C L-thyroxine\ D Follow-up ultrasound  in 3-6 months\ \ E91. Male patient with history of MI/CHF.  Diagnosed with DM - sugar control is not optimal.  Pt is apprehensive about starting meds because brother suffered hypoglycemia from use of oral hypoglycemic agent.  What would you recommend?\ A. metformin\ B. insulin\ C. pioglitazone\ D. glyburide\ \ E92. Patient with pharyngitis & malaise on methimazole, which possible toxicity?\ A. agranulocytosis\ B. hepatotoxicity\ C. vasculitis\ D. other\ \ E93. 37 yo woman presents w/ 6 months history of acne and excessive hair growth.  Ever since she reached 17, she hasn\'t had any acne until now.  On exam, she has excessive hair growth in chin, back etc.  On laboratory investigations, she has a Hemoglobin of 160.  Electrolytes, urine cortisol, TSH, DHEA-s are normal.  What is the next step?\ A Serum androstenedione\ B Serum insulin\ C Pelvic ultrasound\ D Can\'t remember\ \ E94. Patient with DM II with an ulcer on the the first metatarsal.  Abnormal monofilament and vibration sense.  Diminished distal pulses.  Maybe history of macrovascular disease and microalbuminuria (can\'t remember).  What is most important risk factor for the development of ulcers?\ A microvascular disease\ B macrovascular disease\ C impaired immune response\ D peripheral neuropathy E95. True statement regarding PSA\ a) not useful in men under 70\ b) PPV of value between 4-10 is 22% E96. You suspect osteoporosis. What makes osteoporosis more likely\ 1- teeth count\height E97. Man with nonspecific abdominal pain -- Ix showed an adrenal adenoma - what next\ 1. Check if it is functional\ 2. MRI will help distinguish between carcinoma and adenoma\ 3. If \ 6cm - definitely needs surgery E98.  young woman shortly after delivery, breast feeding.  Presents with tachycardia, tremors, diarrhea, heat intolerance.  thyroid enlarged but non tender.  High T4, low TSH, low RAIU (\< 1%).  Management\ 1) observe\ 2) propranolol\ 3) PTU\ 4) prednisone E99. 59F with L hip fracture and demineralization on plain X-rays.  Ca= 2.02, PO4 =0.6, PTH=90, normal Cre, no ALP given.  All other B/W normal.  What is the most likely cause?\ a.  vitamin D deficiency (osteomalacia)\ b.  Paget\'s\ c.  primary hyperparathyroidims\ d.  menopause E100. 52 year old male with DM2 for the past 20 years.  Routine blood work and urinalysis are as follows:  Na 135 K 5.0 HCO3 20 Cl 110. Sosm 283. Urine Cl 40 Urine K 20.  What is the cause of his lab findings:             a- Inadequate insulin production             b- inadequate Na/K ATPase activity             c- Hyporeninemic Hypoaldosteronism             d- Too much K in his diet E101. 50 year old guy 18 hours postop for transphenoidal removal of non functioning pituitary tumor.  On 0.45% NS in D5W IV at 125cc/h, and solucortef 100mcg IV Q8H.  Starts to pee 830ml over 2 hours. Labs given as follows:\ Serum: Na 135 K 3.8 Cl 100 Bicarb 24 Serum Osm 282\  Urine: Urine Osm 298 Na 25 mmol/L What should you do?\ 1) Replace urine output with IV NS\ 2) Give florinef STAT\ 3) Continue same IV as same rate\ 4) give DDAVP E102. What has been proven to preserve vision in diabetic patients with proliferative nephropathy?\ 1) Panretinal laser phototherapy\ 2) Aspirin\ 3) Tight Glycemic control\ 4) ACEi E103. A type II diabetic on 30/70 checks his glucose once per day. Has background retinopathy. Blood pressure is okay. His labs are as follows: A1c 9.1%, LDL 3.2, HDL 1.2, triglycerides 1.8. Which will slow his retinopathy? 1. 2. 3. 4. E104. What has been proven to preserve vision in diabetic patients with proliferative nephropathy?\ 1) Panretinal laser phototherapy\ 2) Aspirin\ 3) Tight Glycemic control\ 4) ACEi E105. 24 year old female seen for 2 months of secondary amenorrhea, diarrhea and irritability.  She frequently snacks on kelp.  On exam, she has tremor, proptosis with exophthalmos and a diffusely enlarged thyroid (4 times normal).Labs included TSH of 0.1, T4 41 (upper normal 27).  She has a thyroid uptake of 6% and scan shows diffuse uptake. The most appropriate treatment for her now is:              A) propranolol             B) methimazole             C) thyroidectomy             D) radioactive iodine E106. 18 year old girl with primary amenorrhea.  Tanner stage III breast development.  Wt 130 lbs.  Ht 5\'7.  Scant pubic and axillary hair.  What is the best way to investigate?     a) karyotype     b) serum DHEAS     c) serum LH and FSH     d) serum testosterone E107.  24 y Male with 15 lb weight loss, presyncope, fatigue.  Hyperpigmentation axilla, gums.  + orthostatic drop in BP and rise in HR. Na 120, K 5.3.  Test to diagnose condition:             A. dexamethasone suppression test             B. serum ACTH and cortisol levels             C. 24 urine cortisol        E108. Thyroid nodule 2cm, asymptomatic , going for FNA, most cost-effective additional test             a. tsh             b. calcium             c.uptake scan             d. thyroxine level   E109. 17-year-old female presents with primary amenorrhea. She has no pubic or axillary hair, and underwent breast development at age 12. Currently, her breasts are Tanner stage III. Her vagina ends in a blind pouch. Which of the following would you order to help sort out the diagnosis? 1. WBC karyotype 2. LH, FSH, and estrogen 3. DHEAS and androstenedione 4. 17 hydroxyprogesterone E110. 20-year-old male with type 1 diabetes on q.i.d. insulin. Hemoglobin A1c6.7%, and generally sugars are well controlled. Triglycerides 4.1, HDL 0.9, LDL 4.2, total cholesterol 6.6. Besides diet and exercise, which would you start? 1. Cholestyramine 2. Ezetemibe 3. Fenofibrate 4. Lipitor E111. 20-year-old female with type 1 diabetes on lispro before meals and NPH at bedtime. Has not seen a doctor or had blood work in two years. Has had diabetes for two years with glucose ranging from 6 to 30, with the average being 10. Which would you order next? 1. Urine microalbumin to creatinine ratio 2. ophthalmology consult 3. TSH 4. C-peptide E112. 20-year-old female with type 1 diabetes presented in DKA. Is given one to 2 L of normal saline bolus, then 250 cc/hr normal saline for 24 hours. He see her in she has the following profiles: Glucose 28 19 Potassium 6.6 4.5 pH 7.05 7.15 HC03 7 12 Sodium 144 143 Creatinine 130 90 what do you do next? 1. Same insulin rate, same potassium rate, increase normal saline with a bolus then 500 cc/hr 2. same insulin rate, increase fluids 500 cc/hr normal saline, add more potassium 3. same insulin rate, increase fluids, but changed to D5W with half normal saline, same potassium 4. same fluids, same potassium, same rate, increase insulin to 10 units/hr E113. A man has a family history of periodic paralysis, and has an episode himself. What is the best acute treatment? 1. Give him potassium 2. give him calcium 3. give him sodium 4. give him something else E114. 30-year-old female with several months onset of tachycardia, palpitations, sweats, weight loss, diarrhea, and heat intolerance. She has exophthalmos, proptosis, chemosis, and tremor on exam. Has significantly enlarged thyroid, which is diffusely enlarged but not tender. She enjoys munching nonpalpable. Investigations include TSH less than 0.01, free T4 44, RAIU 6%, diffuse, non-nodular scan. What would you do next? 1. Thyroidectomy 2. Methimazole 3. I-131 therapy E115.. You are seeing a 28 year old female with hypothyroidism and diabetes for complaints of nausea, watery diarrhea, and fatigue. On exam, she has a BP of 115/70 but has a 15mmHg postural drop. Her CBC and lytes are normal. Her blood sugar is well controlled. Her TSH is slightly above normal (6). What test would you NOT do? a\. ACTH and cortisol b\. Anti-TTG c\. Gastric emptying study d\. Serum T3 and T4 **[ENDO 2009]** 4\. X-ray shows diffusely decreased bone mineralization. She underwent remote partial gastrectomy for peptic ulcer disease. Her lab values are Ca 2.00, PO4 0.8, ALP 140, CR 170 (no PTH or albumin given). Which of the following the most likely diagnosis? A Renal osteodystrophy B Osteoporosis C Osteomalacia D Hypoparathyroidism 16\. 24 year-old woman with history of sun avoidance, drinks skim milk, fruit avoidance due to diarrhea is seen in the clinic. Calcium 1.45, Phosphate 1.80, Magnesium 0.65, parathormoe 35 (that was exactly how it was spelled on the exam). What is the MOST likely cause of her hypocalcemia? a\. Hypoparathyroidism b\. Vitamin D deficiency c\. Magnesium deficiency d\. Pseudohypoparathyroidism 20\. Hypertiglyceridemia is associated with: a\. xanthelasma b\. eruptive xanthoma c\. hepatitis d\. tendon xanthoma 41\. 23 female, seeing in the ER with decreased LOC, There is no available collateral history. Blood sugar 1.8 You are ordering blood for suspected induced hypoglycemia, what combination do you expect to find? a\. High Insulin, Normal C Peptide. b\. Normal insulin, Low C Peptide. c\. High insulin, High C Peptide. d\. Low insulin, Normal C peptide. 42\. 25F, type 1DM, on diet control, HbA1c 15%, nephropathy, retinopathy, wants to get pregnant. You are seeing her in the office. She wants to discuss how to prevent potential congenital anomalies. What is your advice? a\. Should not get pregnant because of her already organ damage b\. Start ACE-I c\. Continue same management, start MDI once pregnant d\. Delay pregnancy until HbA1c \20. Next step? 1\. Adrenal vein sampling 2\. Saline suppression test 3\. Abdominal ultrasound, primary hyperaldosteronism 4\. Adrenal CT 62\. Woman with underlying DM2 with newly diagnosed NASH on biopsy. She is on saxagliptan, statin and OCP(estriol and levonorgestreal combination) for some reason. Which is most harmful in context of her liver dx? A. Estriol, probably based on worse CAD risk B. Levonorgestrel C. Statin D. Saxagliptin 74\. A patient is seen on neurosurgery after transphenoidal endoscopic surgery for a non-functioning pituitary adenoma. On POD \# 1 the patient has hypernatremia treated with DDAVP. POD \# 2 Na is normal and pt. is euvolemic and so is changed to 75 cc/hr D5W and 0.45 NS. He is also placed on hydrocortisone at 50 mg q4h. On POD \#3 Na drops and the patient is hyponatremic. (we could not recall values, but serum Na, osm and urine Na and osm are given to help you). What statement is true? a\. DI may develop in the coming week b\. Hyponatremia is due to DDAVP c\. Hyponatermia due to mineralocrticoid deficiency d\. Hyperglycemia is due to steroids (no glucose was given in the stem) 79\. A new screening tool for diabetes tests 1000 people. Prevalence in the population 10%. Test has 90% sensitivity and detects diabetes in 90 people who do not have diabetes (FP). The specificity of the test is 1\. 10% 2\. 50% 3\. 81% 4\. 90% 80\. 70 F with history of osteoporosis. No other past medical history. Has been on Risedronate for 1 year and repeat bone density shows worsening T and Z score. Given a table comparing her pre-treatment T and Z scores and post-treatment scores (one year later). All values are worse despite being on Risedronate for a year. What is the next best step: 1\. Add teriparatide 2\. Stop Risedronate and start denosumab 3\. Add denosumab 4\. Stop Risedronate and start Raloxifene **[2014:]** 22\. 74F is discovered to have a vertebral compression \# after only minimal trauma.  She is on Ca 1500mg daily and cholecalciferol 800IU daily.  Her DEXA shows only minimal osteopenia (numbers not given).  Her serum Ca, PO4, lytes, creatinine are normal.  What do you recommend for treatment? a\)    Change cholecalciferol to calcitriol b\)   Bisphosphonate c\)    No treatment indicated d\)   Calcitonin 48\. Patient with T2DM BMI of 31 presents with lab findings. TSH 8, free T4 12 (normal lower limit is 13, book of normals is provided for you). TSH 3 and 6 months ago were 7 and 6 (so TSH is climbing). Anti-TPO positive. How would you treat? 1\. PTU 2\. Iodine 3\. Do nothing and monitor 4\. Levothyroxine 50\. Young woman with thyroid nodule. No radiation / FMHx Thyroid cancer.  Normal TSH.  3cm in size.  Next best step? 1. 2. 3. 4. 56\.  24 year old man with recent 20 kg weight gain, 3 renal stones last 2 months, complaining of muscle weakness at the gym, proximal weakness on exam. Shown a picture of a young guy with abdominal fat and purple striae. 24-hr urine cortisol 3x ULN. ACTH 15 (ULN 12). Doesn\'t suppress on high dose dexamethasone test. What is the most likely cause? A. ACTH producing pituitary adenoma B. Glucocorticoid producing adrenal adenoma C. ACTH producing carcinoid D. Surreptitious steroid use. 58\. Lady on Ca, vitamin D with previous allergic reaction to Alendronate.   DEXA shows hip, femur Z score at -0.3.  What is next best agent to manage her osteoporosis\-- 1\. Teriparitide 2\. Denosumab 3\. Zoldedronic acid. 4\. Calcitonin 60\. Long stem with patient on HCTZ, Calcium supplement 1250mg daily (500 elemental) and Vitamin D 2000 U daily.  Is feeling unwell with nausea and constipation for the last 1-2 weeks.  Comes into the ED.  Has postural drop HR increasing more than 30 and severe dizziness, mildy tachy. Labs as follows Na 130, K 5.2, Cl 110, Cr 245 (GFR\