COMSAE Endocrine and Reproductive Systems 2

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?

Accepted Answer

SGLT-2 inhibitor (empagliflozin)

Answer

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?

Accepted Answer

Hyperpigmentation

Answer

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?

Accepted Answer

Cabergoline (dopamine agonist)

Answer

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?

Accepted Answer

11-beta hydroxylase deficiency

Answer

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?

Accepted Answer

Primary hyperaldosteronism (Conn's syndrome)

Answer

Primary hyperaldosteronism features autonomous aldosterone production causing hypertension and hypokalemia with suppressed renin due to negative feedback.

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE Endocrine and Reproductive Systems 2