ITE Endocrinology and Metabolism 3

Question 1

A 48-year-old woman has fatigue, weight gain, constipation, and bradycardia. TSH is 48 mIU/L and free T4 is undetectable. She takes no medications. What is the most appropriate initial treatment?

Accepted Answer

Levothyroxine 25 mcg/day with gradual titration

Answer

Levothyroxine 1.6 mcg/kg/day

Answer

Liothyronine (T3) alone

Answer

Desiccated thyroid extract

Question 2

A 55-year-old man with newly diagnosed type 2 diabetes has an HbA1c of 7.8%, BMI 36 kg/m², no cardiovascular disease, and normal renal function. What is the most appropriate pharmacotherapy beyond lifestyle modification?

Accepted Answer

Metformin + GLP-1 receptor agonist

Answer

Metformin alone

Answer

Sulfonylurea alone

Answer

Insulin glargine

Question 3

A 38-year-old woman presents with hypertension, hypokalemia, and metabolic alkalosis. Plasma aldosterone-to-renin ratio is markedly elevated. CT abdomen shows a 1.8 cm right adrenal adenoma. What is the definitive treatment?

Accepted Answer

Laparoscopic right adrenalectomy

Answer

Lifelong spironolactone therapy

Answer

Bilateral adrenalectomy

Answer

Fludrocortisone suppression test and observation

Question 4

A 32-year-old pregnant woman (20 weeks) is diagnosed with Graves' disease. TSH is suppressed, free T4 is 3.4 ng/dL. Which antithyroid drug is preferred during the second trimester?

Accepted Answer

Methimazole

Answer

Propylthiouracil (PTU)

Answer

Radioactive iodine (RAI)

Answer

Beta-blocker monotherapy

Question 5

A 62-year-old man with known acromegaly has a post-surgical IGF-1 still 2.5× the upper limit of normal. MRI shows no residual tumor. What is the most appropriate next step in management?

Accepted Answer

Somatostatin receptor ligand (octreotide LAR or lanreotide)

Answer

Repeat surgery

Answer

Pituitary radiation

Answer

Pegvisomant monotherapy

Question 6

A 44-year-old woman has a TSH of 0.02 mIU/L and free T4 of 2.8 ng/dL. She takes levothyroxine 150 mcg/day for hypothyroidism. She is asymptomatic. DEXA shows T-score −2.1 at lumbar spine. What is the most important reason to adjust her levothyroxine?

Accepted Answer

Exogenous subclinical hyperthyroidism accelerates bone loss

Answer

Risk of Afib from subclinical hyperthyroidism

Answer

Risk of thyroid storm

Answer

Suppressed TSH causes pituitary enlargement

Question 7

A 50-year-old man with type 2 diabetes and a recent MI (6 weeks ago) has HbA1c 8.5%. He is on metformin and a sulfonylurea. Which agent should be added given his cardiovascular history?

Accepted Answer

Empagliflozin or liraglutide

Answer

Pioglitazone

Answer

Sitagliptin

Answer

Alogliptin