FREE Internal Medicine Endocrine and Metabolic Disorders Questions and Answers

Question 1

A 45-year-old woman presents with a 6-month history of fatigue, weight gain despite reduced appetite, cold intolerance, constipation, and menorrhagia.
Her physical examination reveals a diffuse goiter, bradycardia, and periorbital edema.
Laboratory findings show a TSH of 45 mIU/L (normal range 0.4-4.0 mIU/L) and free T4 of 0.5 ng/dL (normal range 0.8-1.8 ng/dL).
What is the most appropriate initial treatment for this patient?

Accepted Answer

Levothyroxine 25-50 mcg daily, with dose titration based on TSH levels.

Answer

Methimazole 10 mg daily.

Answer

Radioactive iodine therapy.

Answer

Thyroidectomy.

Question 2

Which of the following is the most common cause of primary hyperparathyroidism?

Accepted Answer

Solitary parathyroid adenoma.

Answer

Parathyroid carcinoma.

Answer

Multiple endocrine neoplasia type 1 (MEN1).

Answer

Parathyroid hyperplasia.

Question 3

A 58-year-old man with a history of type 2 diabetes mellitus, hypertension, and dyslipidemia presents with recurrent episodes of palpitations, sweating, and headache. These episodes are often triggered by stress or exercise and are associated with significant blood pressure elevations. His 24-hour urine collection shows elevated metanephrines and normetanephrines. What is the most crucial initial step in managing this patient prior to surgical intervention?

Accepted Answer

Start an alpha-blocker (e.g., phenoxybenzamine).

Answer

Initiate a beta-blocker (e.g., metoprolol).

Answer

Perform an adrenalectomy immediately.

Answer

Administer intravenous fluids to prevent hypovolemia.

Question 4

A 32-year-old woman with a history of Graves' disease treated with radioactive iodine five years ago presents with increasing fatigue, dry skin, and mild weight gain. Her current medications include an oral contraceptive. Her TSH is 12 mIU/L (normal 0.4-4.0 mIU/L) and free T4 is 0.7 ng/dL (normal 0.8-1.8 ng/dL). What is the most appropriate next step in her management?

Accepted Answer

Increase the dose of levothyroxine.

Answer

Start methimazole.

Answer

Repeat thyroid function tests in 3 months.

Answer

Investigate for adrenal insufficiency.

Question 5

Which of the following conditions is most likely to be associated with an elevated 24-hour urinary free cortisol level that fails to suppress after a low-dose dexamethasone suppression test?

Accepted Answer

Cushing's syndrome.

Answer

Primary hyperaldosteronism.

Answer

Addison's disease.

Answer

Hypothyroidism.

Question 6

A 68-year-old male with a history of type 2 diabetes, hypertension, and chronic kidney disease (eGFR 35 mL/min/1.73m²) is on metformin, lisinopril, and atorvastatin. His A1c is 8.2%. He reports occasional symptomatic hypoglycemia. Which of the following antidiabetic medications would be the most appropriate addition to his regimen to improve glycemic control while minimizing hypoglycemia risk, considering his renal function?

Accepted Answer

Dulaglutide.

Answer

Glipizide.

Answer

Insulin glargine.

Answer

Empagliflozin.