MD Endocrine and Metabolic Disorders 2

Question 1

A 45-year-old woman presents with weight gain, fatigue, and constipation. Labs show TSH 12 mIU/L and free T4 0.6 ng/dL. Which finding would most likely also be present?

Accepted Answer

Elevated LDL cholesterol

Answer

Hypercalcemia

Answer

Hypokalemia

Answer

Elevated free T3

Question 2

A patient with type 2 diabetes is started on metformin. Which mechanism best explains its glucose-lowering effect?

Accepted Answer

Inhibits hepatic gluconeogenesis via AMPK activation

Answer

Increases insulin secretion from beta cells

Answer

Blocks glucose absorption in the small intestine

Answer

Increases renal glucose excretion

Question 3

A 30-year-old man has episodic hypertension, headache, and diaphoresis. 24-hour urine shows elevated metanephrines. Which imaging is the BEST next step?

Accepted Answer

MRI of the adrenal glands

Answer

CT chest

Answer

Nuclear bone scan

Answer

PET-CT of the pelvis

Question 4

A 55-year-old woman has hypercalcemia, nephrolithiasis, and a serum PTH of 95 pg/mL (normal 10–65). Which parathyroid disorder is most consistent?

Accepted Answer

Primary hyperparathyroidism

Answer

Secondary hyperparathyroidism

Answer

Hypoparathyroidism

Answer

Pseudohypoparathyroidism

Question 5

Which metabolic acidosis pattern is expected in a patient with uncontrolled type 1 diabetes presenting in DKA?

Accepted Answer

High anion gap metabolic acidosis

Answer

Normal anion gap metabolic acidosis

Answer

Metabolic alkalosis with respiratory acidosis

Answer

Respiratory alkalosis

Question 6

A patient with Cushing's syndrome undergoes a high-dose dexamethasone suppression test and cortisol is suppressed by >50%. What is the most likely source of excess cortisol?

Accepted Answer

Pituitary corticotroph adenoma (Cushing's disease)

Answer

Adrenal adenoma

Answer

Ectopic ACTH-secreting tumor

Answer

Adrenal carcinoma

Question 7

A 62-year-old man with type 2 diabetes has an eGFR of 35 mL/min/1.73m². Which glucose-lowering agent should be AVOIDED due to risk of lactic acidosis?

Accepted Answer

Metformin

Answer

Sitagliptin

Answer

Insulin glargine

Answer

Empagliflozin