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Endocrinology Flashcards

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

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  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?

    Answer: CT scan of the adrenal glands

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

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

    Answer: Repeat transsphenoidal surgery or radiotherapy

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

  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?

    Answer: After fluid resuscitation and potassium is ≥3.5 mEq/L

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

  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?

    Answer: Biochemical evaluation for hormonal hypersecretion

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

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

    Answer: Propylthiouracil (PTU)

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

  6. A 65-year-old woman with type 2 diabetes develops peripheral neuropathy with burning pain. Her HbA1c is well controlled at 7.1%. What is the first-line pharmacotherapy for her neuropathic pain?

    Answer: Gabapentin or pregabalin

    Gabapentin, pregabalin, and duloxetine are first-line agents for painful diabetic peripheral neuropathy based on efficacy evidence and guideline recommendations.