COMSAE Endocrine and Reproductive Systems 2 — Questions and Answers
Question 1: A 55-year-old post-menopausal woman with type 2 diabetes has an HbA1c of 7.8%. Which medication is preferred to reduce cardiovascular mortality in a patient with established heart failure?
- SGLT-2 inhibitor (empagliflozin) (Correct answer)
- GLP-1 receptor agonist
- Metformin
- Sulfonylurea
Correct answer: SGLT-2 inhibitor (empagliflozin)
SGLT-2 inhibitors like empagliflozin have demonstrated significant reduction in cardiovascular death and heart failure hospitalization in diabetic patients.
Question 2: On COMSAE, which finding differentiates primary adrenal insufficiency (Addison's disease) from secondary adrenal insufficiency?
- Hyperpigmentation (Correct answer)
- Hyponatremia
- Fatigue
- Hypoglycemia
Correct answer: Hyperpigmentation
Hyperpigmentation in Addison's disease results from elevated ACTH stimulating melanocortin receptors, which does not occur in secondary adrenal insufficiency where ACTH is low.
Question 3: A 24-year-old woman presents with galactorrhea and amenorrhea. MRI shows a 5mm pituitary lesion. Prolactin level is 120 ng/mL. What is the most appropriate first-line treatment?
- Cabergoline (dopamine agonist) (Correct answer)
- Surgical resection
- Bromocriptine injection
- Observation only
Correct answer: Cabergoline (dopamine agonist)
Cabergoline, a dopamine agonist, is first-line for prolactinoma because dopamine normally inhibits prolactin secretion, and the medication effectively reduces tumor size.
Question 4: Which enzyme deficiency in congenital adrenal hyperplasia (CAH) causes hypertension, hypokalemia, and ambiguous genitalia in females?
- 11-beta hydroxylase deficiency (Correct answer)
- 21-hydroxylase deficiency
- 17-alpha hydroxylase deficiency
- 3-beta hydroxysteroid dehydrogenase deficiency
Correct answer: 11-beta hydroxylase deficiency
11-beta hydroxylase deficiency leads to accumulation of 11-deoxycorticosterone (a potent mineralocorticoid) causing hypertension, while excess androgens virilize female fetuses.
Question 5: A 38-year-old man with hypertension has hypokalemia and elevated aldosterone with suppressed renin. Which is the most likely diagnosis?
- Primary hyperaldosteronism (Conn's syndrome) (Correct answer)
- Secondary hyperaldosteronism
- Renal artery stenosis
- Cushing's syndrome
Correct answer: Primary hyperaldosteronism (Conn's syndrome)
Primary hyperaldosteronism features autonomous aldosterone production causing hypertension and hypokalemia with suppressed renin due to negative feedback.
Question 6: In a pregnant woman at 10 weeks gestation, which hormone produced by the corpus luteum maintains the endometrium until placental function is established?
- Progesterone (Correct answer)
- Estradiol
- hCG
- LH
Correct answer: Progesterone
Progesterone from the corpus luteum maintains the decidualized endometrium during early pregnancy until the placenta assumes steroidogenesis at approximately 10-12 weeks.
COMSAE Endocrine and Reproductive Systems 2
A 55-year-old post-menopausal woman with type 2 diabetes has an HbA1c of 7.8%.
Which medication is preferred to reduce cardiovascular mortality in a patient with established heart failure?