MD Endocrine and Metabolic Disorders 3

Question 1

A 28-year-old woman presents with amenorrhea, galactorrhea, and a serum prolactin of 120 ng/mL. MRI shows a 12 mm pituitary lesion. What is the first-line treatment?

Accepted Answer

Dopamine agonist (cabergoline)

Answer

Dopamine agonists such as cabergoline are the first-line treatment for macroprolactinomas, effectively shrinking the tumor and normalizing prolactin.

Question 2

A patient has hyponatremia with urine osmolality 550 mOsm/kg and urine sodium 60 mEq/L in the setting of recent lung cancer diagnosis. Which syndrome is most likely?

Accepted Answer

SIADH

Answer

SIADH associated with ectopic ADH production (e.g., small cell lung cancer) causes euvolemic hyponatremia with concentrated urine and high urine sodium.

Question 3

A 40-year-old woman has a TSH of 0.05 mIU/L and elevated free T4. She reports palpitations, heat intolerance, and a diffuse goiter with bruit on exam. What autoantibody confirms the diagnosis?

Accepted Answer

TSH receptor antibody (TRAb)

Answer

TSH receptor-stimulating antibodies (TRAb) are pathognomonic for Graves' disease, causing diffuse goiter and hyperthyroidism.

Question 4

A 70-year-old man presents with confusion, polyuria, and blood glucose of 950 mg/dL. Serum bicarbonate is 22 mEq/L and ketones are negative. What is the diagnosis?

Accepted Answer

Hyperosmolar hyperglycemic state (HHS)

Answer

HHS presents with extreme hyperglycemia and hyperosmolarity without significant ketoacidosis, typically in elderly type 2 diabetics.

Question 5

A 35-year-old woman with known MEN1 has recurrent peptic ulcers refractory to PPIs and fasting hypergastrinemia. What additional tumor should be sought?

Accepted Answer

Gastrinoma (Zollinger-Ellison syndrome)

Answer

Gastrinoma causing Zollinger-Ellison syndrome is associated with MEN1 and presents with hypergastrinemia and refractory peptic ulcers.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Endocrine and Metabolic Disorders 3