ITE Endocrinology and Metabolism 2

Question 1

A 52-year-old woman with type 2 diabetes has an HbA1c of 9.2% on metformin 1000 mg twice daily. She has CKD stage 3a (eGFR 52 mL/min). Which medication is CONTRAINDICATED in this patient?

Accepted Answer

Metformin 2000 mg twice daily

Answer

Empagliflozin

Answer

Sitagliptin

Answer

Glipizide

Question 2

A 28-year-old man presents with episodic severe headaches, diaphoresis, and palpitations. BP is 210/115 mmHg during an episode. 24-hour urine metanephrines are markedly elevated. Prior to surgical resection, which medication should be initiated FIRST?

Accepted Answer

Alpha-blocker (phenoxybenzamine)

Answer

Beta-blocker (propranolol)

Answer

Calcium channel blocker (amlodipine)

Answer

ACE inhibitor (lisinopril)

Question 3

A 45-year-old woman is found to have a serum calcium of 11.4 mg/dL and PTH of 88 pg/mL (normal 15–65). She is asymptomatic. Bone density shows T-score of −2.0 at lumbar spine. Which is the best next step?

Accepted Answer

Refer for parathyroidectomy

Answer

Reassure and recheck calcium in 6 months

Answer

Start cinacalcet

Answer

Start bisphosphonate therapy alone

Question 4

A 60-year-old man with a history of atrial fibrillation on warfarin is started on methimazole for Graves' disease. After 6 weeks his TSH normalizes. Which lab change is most expected regarding his anticoagulation?

Accepted Answer

INR will decrease as hyperthyroidism resolves

Answer

INR will increase as hyperthyroidism resolves

Answer

INR is unaffected by thyroid status

Answer

Methimazole directly inhibits warfarin metabolism

Question 5

A 35-year-old woman presents with amenorrhea, galactorrhea, and headaches. MRI shows a 16 mm pituitary lesion. Prolactin is 2800 ng/mL. Visual field testing is normal. What is the first-line treatment?

Accepted Answer

Bromocriptine or cabergoline

Answer

Transsphenoidal surgery

Answer

Pituitary radiation

Answer

Octreotide

Question 6

A 70-year-old man with osteoporosis has a T-score of −3.1 at the hip. He has been on alendronate for 7 years. He now reports right thigh pain and X-ray shows cortical thickening of the subtrochanteric femur. What is the best next step?

Accepted Answer

Discontinue bisphosphonate and consider teriparatide

Answer

Continue alendronate and add calcium/vitamin D

Answer

Switch to denosumab

Answer

Refer for prophylactic hip nailing

Question 7

A 25-year-old woman with type 1 diabetes uses an insulin pump. She is found unconscious by her roommate. Glucometer reads 28 mg/dL. IV access cannot be obtained. What is the immediate treatment?

Accepted Answer

Glucagon 1 mg intramuscularly

Answer

Oral glucose gel under the tongue

Answer

Dextrose 50% sublingual

Answer

Halt the insulin pump only