FREE Internal Medicine Endocrinology and Metabolism Questions and Answers

Question 1

A 68-year-old male with a 10-year history of type 2 diabetes mellitus, hypertension, and a previous myocardial infarction is seen for follow-up.
His current HbA1c is 8.2% on metformin 1000 mg twice daily.
His eGFR is 70 mL/min/1.73m².
According to current ADA guidelines, which of the following is the most appropriate medication to add to his regimen?

Accepted Answer

Empagliflozin

Answer

Glipizide

Answer

Sitagliptin

Answer

Pioglitazone

Question 2

A 52-year-old male is evaluated for resistant hypertension and is found to have a serum potassium of 3.2 mEq/L. Primary aldosteronism is suspected. What is the most appropriate initial screening test for this condition?

Accepted Answer

Morning plasma aldosterone concentration and plasma renin activity

Answer

24-hour urine free cortisol

Answer

Abdominal CT scan with adrenal protocol

Answer

Low-dose dexamethasone suppression test

Question 3

An asymptomatic 72-year-old woman is found to have a serum calcium of 11.4 mg/dL (normal 8.6-10.3 mg/dL) on routine labs. Which of the following findings would most strongly suggest primary hyperparathyroidism as the cause of her hypercalcemia?

Accepted Answer

An elevated or inappropriately normal intact parathyroid hormone (PTH) level

Answer

A suppressed intact parathyroid hormone (PTH) level

Answer

An elevated parathyroid hormone-related peptide (PTHrP) level

Answer

A low 24-hour urine calcium excretion

Question 4

A 65-year-old man with a history of small cell lung cancer is admitted with confusion. His serum sodium is 118 mEq/L. He is clinically euvolemic. Further labs show serum osmolality of 250 mOsm/kg, urine osmolality of 400 mOsm/kg, and urine sodium of 50 mEq/L. Which of the following is the most appropriate immediate treatment?

Accepted Answer

Intravenous infusion of 3% hypertonic saline

Answer

Oral fluid restriction to less than 1 liter per day

Answer

Aggressive intravenous 0.9% normal saline infusion

Answer

Administration of demeclocycline

Question 5

A 78-year-old female is diagnosed with osteoporosis after a DEXA scan reveals a T-score of -2.9 at the femoral neck. Her medical history is significant for severe gastroesophageal reflux disease (GERD) and erosive esophagitis. Which of the following is the LEAST appropriate initial treatment for her osteoporosis?

Accepted Answer

Oral alendronate

Answer

Intravenous zoledronic acid

Answer

Subcutaneous denosumab

Answer

Subcutaneous teriparatide

Question 6

A 34-year-old female is diagnosed with Graves' disease and is started on methimazole. Which of the following best describes the primary mechanism of action of this medication?

Accepted Answer

Inhibiting the thyroid peroxidase enzyme, thus blocking hormone synthesis

Answer

Blocking the peripheral conversion of T4 to T3

Answer

Inhibiting the release of pre-formed thyroid hormone

Answer

Destroying thyroid follicular cells via antibody-dependent cytotoxicity