Practice Test GeeksITE - Internal Medicine In-Training Exam Practice Test
← All ITE Flashcard Decks

Endocrinology and Metabolism Flashcards

7 cards from real ITE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Endocrinology and Metabolism flashcards as text

  1. A 52-year-old woman with type 2 diabetes has an HbA1c of 9.2% on metformin 1000 mg twice daily. She has CKD stage 3a (eGFR 52 mL/min). Which medication is CONTRAINDICATED in this patient?

    Answer: Metformin 2000 mg twice daily

    Metformin is contraindicated when eGFR falls below 30, but at eGFR 52 it can be continued at current dose; however, doubling to 2000 mg twice daily (4000 mg/day) exceeds the maximum recommended dose of 2550 mg/day and is not indicated.

  2. A 28-year-old man presents with episodic severe headaches, diaphoresis, and palpitations. BP is 210/115 mmHg during an episode. 24-hour urine metanephrines are markedly elevated. Prior to surgical resection, which medication should be initiated FIRST?

    Answer: Alpha-blocker (phenoxybenzamine)

    Alpha-blockade must be established before beta-blockade in pheochromocytoma to prevent unopposed alpha-adrenergic stimulation and hypertensive crisis.

  3. A 45-year-old woman is found to have a serum calcium of 11.4 mg/dL and PTH of 88 pg/mL (normal 15–65). She is asymptomatic. Bone density shows T-score of −2.0 at lumbar spine. Which is the best next step?

    Answer: Refer for parathyroidectomy

    Asymptomatic primary hyperparathyroidism with a T-score ≤ −2.5 or other surgical criteria warrants parathyroidectomy, which is curative.

  4. A 60-year-old man with a history of atrial fibrillation on warfarin is started on methimazole for Graves' disease. After 6 weeks his TSH normalizes. Which lab change is most expected regarding his anticoagulation?

    Answer: INR will decrease as hyperthyroidism resolves

    Hyperthyroidism accelerates clotting factor catabolism, increasing INR; as thyroid function normalizes with treatment, clotting factor turnover slows and INR decreases, requiring warfarin dose adjustment upward.

  5. A 35-year-old woman presents with amenorrhea, galactorrhea, and headaches. MRI shows a 16 mm pituitary lesion. Prolactin is 2800 ng/mL. Visual field testing is normal. What is the first-line treatment?

    Answer: Bromocriptine or cabergoline

    Dopamine agonists (cabergoline preferred over bromocriptine) are first-line for macroprolactinomas, effectively reducing tumor size and normalizing prolactin in most patients.

  6. A 70-year-old man with osteoporosis has a T-score of −3.1 at the hip. He has been on alendronate for 7 years. He now reports right thigh pain and X-ray shows cortical thickening of the subtrochanteric femur. What is the best next step?

    Answer: Discontinue bisphosphonate and consider teriparatide

    Atypical femoral fractures are a recognized complication of prolonged bisphosphonate use; the drug should be discontinued and anabolic therapy with teriparatide may promote healing.

  7. A 25-year-old woman with type 1 diabetes uses an insulin pump. She is found unconscious by her roommate. Glucometer reads 28 mg/dL. IV access cannot be obtained. What is the immediate treatment?

    Answer: Glucagon 1 mg intramuscularly

    Glucagon IM (or subcutaneously) is the appropriate treatment for severe hypoglycemia when IV access is unavailable and the patient cannot safely take oral glucose.