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Endocrinology Flashcards

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  1. A 28-year-old woman with Graves' disease is in her first trimester of pregnancy. Which antithyroid drug is preferred during this period?

    Answer: Propylthiouracil (PTU)

    PTU is preferred in the first trimester because methimazole is associated with embryopathy (aplasia cutis, choanal atresia) during organogenesis.

  2. Which of the following is the most specific marker for differentiating central from nephrogenic diabetes insipidus?

    Answer: Response to desmopressin (DDAVP) administration

    Patients with central DI show significant increase in urine osmolality after DDAVP, while those with nephrogenic DI do not respond.

  3. A 60-year-old man has a random serum cortisol of 3 mcg/dL after an overnight dexamethasone suppression test. What is the next best step?

    Answer: Perform 24-hour urinary free cortisol and late-night salivary cortisol

    A cortisol >1.8 mcg/dL after overnight dexamethasone suppression is a positive screen, and confirmatory testing (24h UFC and late-night salivary cortisol) should follow.

  4. An elderly patient on long-term lithium therapy presents with polyuria and polydipsia. Urine osmolality remains low after water restriction but does not improve after DDAVP. What is the mechanism?

    Answer: Lithium blocks aquaporin-2 insertion in collecting ducts causing nephrogenic DI

    Lithium causes nephrogenic DI by inhibiting the response of collecting duct principal cells to ADH, impairing aquaporin-2 trafficking.

  5. A patient with MEN1 syndrome is found to have a gastrinoma. Which finding would be expected?

    Answer: Elevated fasting serum gastrin with acid hypersecretion

    Gastrinomas cause Zollinger-Ellison syndrome, characterized by elevated fasting gastrin (>1000 pg/mL) and recurrent peptic ulcers from gastric acid hypersecretion.

  6. Which HbA1c target is most appropriate for a 78-year-old patient with type 2 diabetes, multiple comorbidities, and limited life expectancy?

    Answer: <8.0%

    ADA guidelines recommend a less stringent HbA1c target of <8.0% for older patients with complex health status to minimize hypoglycemia risk without benefit.

  7. A patient with chronic hyponatremia is treated with hypertonic saline. Sodium corrects rapidly from 112 to 132 mEq/L over 24 hours. What is the most feared complication?

    Answer: Osmotic demyelination syndrome

    Overly rapid correction of chronic hyponatremia (>10–12 mEq/L/24h) causes osmotic demyelination syndrome (central pontine myelinolysis).