ABIM Endocrinology 2

Question 1

A 50-year-old man presents with hypertension, hypokalemia, and metabolic alkalosis. Plasma aldosterone-to-renin ratio is markedly elevated. What is the most appropriate next step?

Accepted Answer

CT scan of the adrenal glands

Answer

Once primary aldosteronism is confirmed biochemically, CT scan of the adrenal glands is the first imaging step to identify an adenoma versus bilateral hyperplasia.

Question 2

A 55-year-old woman with Cushing disease undergoes transsphenoidal surgery but has persistent hypercortisolism. What is the next treatment option?

Accepted Answer

Repeat transsphenoidal surgery or radiotherapy

Answer

For persistent Cushing disease after failed transsphenoidal surgery, repeat surgery or pituitary radiation is the preferred next step before bilateral adrenalectomy.

Question 3

A patient with type 1 diabetes presents with DKA: glucose 520 mg/dL, pH 7.18, bicarbonate 10 mEq/L, potassium 5.8 mEq/L. When should insulin be started?

Accepted Answer

After fluid resuscitation and potassium is ≥3.5 mEq/L

Answer

Insulin infusion should not be started until potassium is ≥3.5 mEq/L, because insulin drives potassium intracellularly and can precipitate life-threatening hypokalemia.

Question 4

A 40-year-old man has an incidentally found 2.5 cm adrenal mass. It appears lipid-rich on CT (HU < 10). He is normotensive with normal electrolytes. What should be done?

Accepted Answer

Biochemical evaluation for hormonal hypersecretion

Answer

All adrenal incidentalomas require biochemical evaluation for pheochromocytoma, subclinical Cushing syndrome, and primary aldosteronism, regardless of imaging characteristics.

Question 5

A patient with Graves disease is planning pregnancy. Which treatment is preferred in the first trimester?

Accepted Answer

Propylthiouracil (PTU)

Answer

PTU is preferred over methimazole in the first trimester of pregnancy because methimazole is associated with aplasia cutis and choanal atresia in the fetus.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Endocrinology 2