ITE Endocrinology 2

Question 1

A 45-year-old woman with type 2 diabetes on metformin has an eGFR that drops to 28 mL/min/1.73m². Which medication adjustment is most appropriate?

Accepted Answer

Discontinue metformin

Answer

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to risk of lactic acidosis.

Question 2

A patient with Cushing's disease undergoes transsphenoidal surgery. Post-operatively, serum cortisol is 2 mcg/dL. What does this indicate?

Accepted Answer

Adrenal insufficiency requiring glucocorticoid replacement

Answer

Very low post-operative cortisol indicates successful tumor removal but requires exogenous glucocorticoid replacement until the HPA axis recovers.

Question 3

Which finding on thyroid ultrasound carries the HIGHEST risk of malignancy?

Accepted Answer

Hypoechoic nodule with microcalcifications and irregular margins

Answer

Hypoechoic nodules with microcalcifications and irregular margins carry the highest malignancy risk and warrant FNA biopsy.

Question 4

A 32-year-old woman presents with galactorrhea, amenorrhea, and a prolactin level of 210 ng/mL. MRI shows a 12 mm pituitary lesion. First-line treatment is:

Accepted Answer

Bromocriptine or cabergoline

Answer

Dopamine agonists (cabergoline preferred) are first-line treatment for prolactinomas regardless of size.

Question 5

A patient with type 1 diabetes develops recurrent hypoglycemia without adrenergic warning symptoms. This condition is best described as:

Accepted Answer

Hypoglycemia-associated autonomic failure

Answer

Hypoglycemia-associated autonomic failure (HAAF) results from prior hypoglycemic episodes blunting counter-regulatory and symptomatic responses.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Endocrinology 2