ITE Endocrinology and Metabolism Questions and Answers

Question 1

A 62-year-old male with a 10-year history of type 2 diabetes mellitus and a prior myocardial infarction has an HbA1c of 7.8% on metformin monotherapy.
His eGFR is 65 mL/min/1.73m².
According to the most recent American Diabetes Association (ADA) guidelines, which of the following medications would be the most appropriate addition to his regimen?

Accepted Answer

Empagliflozin

Answer

Glipizide

Answer

Sitagliptin

Answer

Pioglitazone

Question 2

A 48-year-old woman is found to have a 1.8 cm thyroid nodule incidentally on a carotid ultrasound. Her TSH level is normal. A dedicated thyroid ultrasound is performed and describes the nodule as solid, markedly hypoechoic, with a taller-than-wide shape and microcalcifications. Based on these high-risk features, which of the following is the most appropriate next step in management?

Accepted Answer

Fine-needle aspiration (FNA) biopsy

Answer

Reassurance and repeat ultrasound in 12 months

Answer

Trial of levothyroxine suppression therapy

Answer

Measurement of serum thyroglobulin

Question 3

A 42-year-old woman presents with several months of progressive fatigue, weight loss, nausea, and orthostatic dizziness. On examination, her blood pressure is 90/60 mmHg, and she has hyperpigmentation of her palmar creases. Laboratory studies reveal hyponatremia and hyperkalemia. A baseline 8 AM serum cortisol level is 2.8 µg/dL (low). Which of the following tests is the most appropriate next step to confirm the diagnosis of primary adrenal insufficiency?

Accepted Answer

High-dose (250 mcg) ACTH (cosyntropin) stimulation test

Answer

CRH stimulation test

Answer

24-hour urine free cortisol measurement

Answer

Metyrapone test

Question 4

A 72-year-old woman sustains a hip fracture after a fall from standing height. A subsequent DEXA scan reveals a T-score of -2.8 at the femoral neck. She has no contraindications to oral medications and her renal function is normal. Which of the following is the most appropriate initial long-term pharmacologic therapy?

Accepted Answer

Oral alendronate

Answer

Raloxifene

Answer

Teriparatide

Answer

Denosumab

Question 5

A 32-year-old woman presents with a 9-month history of amenorrhea and milky breast discharge. Her serum prolactin level is 150 ng/mL (normal <25 ng/mL). An MRI of the pituitary reveals a 7 mm microadenoma. Visual field testing is normal. What is the most appropriate initial treatment for this condition?

Accepted Answer

Cabergoline

Answer

Transsphenoidal surgery

Answer

Observation with serial MRIs

Answer

Stereotactic radiosurgery

Question 6

A 65-year-old asymptomatic woman is found to have a serum calcium of 11.4 mg/dL (normal range 8.6-10.3 mg/dL) on routine labs. A repeat level confirms hypercalcemia. Subsequent workup reveals an elevated intact PTH of 110 pg/mL (normal 15-65 pg/mL) and a 24-hour urine calcium of 350 mg. Her eGFR is 75 mL/min, and a DEXA scan shows a T-score of -1.8 at the lumbar spine. According to the guidelines from the International Workshop on Asymptomatic Primary Hyperparathyroidism, which of the following is a clear indication for parathyroidectomy in this patient?

Accepted Answer

Serum calcium level >1.0 mg/dL above the upper limit of normal

Answer

Age of 65 years

Answer

DEXA scan T-score of -1.8

Answer

24-hour urine calcium of 350 mg/day