Internal Medicine Endocrinology and Metabolism Questions and Answers

Question 1

A 58-year-old male with type 2 diabetes, hypertension, and a history of heart failure with reduced ejection fraction (HFrEF) presents for a medication review.
His A1c is 7.8% on metformin and glipizide.
His eGFR is 50 mL/min/1.73m².
Which of the following medications should be added to his regimen to improve glycemic control and provide a mortality benefit?

Accepted Answer

Empagliflozin

Answer

Sitagliptin

Answer

Pioglitazone

Answer

Insulin glargine

Question 2

A 45-year-old female is evaluated for a 1.5 cm thyroid nodule found incidentally. Her TSH is normal. A fine-needle aspiration (FNA) returns as 'Bethesda category III: Atypia of Undetermined Significance (AUS)'. What is the most appropriate next step in management?

Accepted Answer

Perform molecular testing on the FNA sample

Answer

Immediate total thyroidectomy

Answer

Repeat FNA in 6-12 months

Answer

Start suppressive levothyroxine therapy

Question 3

A 34-year-old woman presents with central obesity, facial plethora, proximal muscle weakness, and new-onset hypertension. An overnight 1-mg dexamethasone suppression test fails to suppress serum cortisol. Her plasma ACTH level is <5 pg/mL (suppressed). What is the most likely source of her condition?

Accepted Answer

Adrenal adenoma

Answer

Ectopic ACTH-producing tumor

Answer

Cushing's disease (pituitary adenoma)

Answer

Iatrogenic steroid use

Question 4

Which of the following is the most significant contraindication to the use of teriparatide for the treatment of severe osteoporosis?

Accepted Answer

Prior radiation therapy to the skeleton

Answer

History of nephrolithiasis

Answer

Severe vitamin D deficiency

Answer

Creatinine clearance < 30 mL/min

Question 5

A 72-year-old male admitted for pneumonia is found to have a serum sodium of 118 mEq/L. Further labs show serum osmolality of 255 mOsm/kg, urine osmolality of 450 mOsm/kg, and urine sodium of 50 mEq/L. He is clinically euvolemic. What is the most appropriate initial treatment for his hyponatremia?

Accepted Answer

Fluid restriction to <1 L/day

Answer

Aggressive normal saline (0.9%) infusion

Answer

Administration of desmopressin (DDAVP)

Answer

Infusion of 3% hypertonic saline

Question 6

A 48-year-old male with treatment-resistant hypertension is found to have a serum potassium of 3.1 mEq/L despite not being on diuretics. Which of the following is the best initial screening test to investigate the most likely diagnosis?

Accepted Answer

Plasma aldosterone-renin ratio (ARR)

Answer

24-hour urine metanephrines

Answer

Late-night salivary cortisol

Answer

Renal artery duplex ultrasound