MD Endocrine and Metabolic Disorders 5

Question 1

A 32-year-old woman with type 1 diabetes presents with recurrent hypoglycemia unawareness. Which physiologic response is impaired?

Accepted Answer

Increased glucagon secretion from alpha cells

Answer

Longstanding type 1 diabetes impairs glucagon counterregulatory response to hypoglycemia, removing a critical defense mechanism against low blood sugar.

Question 2

A patient's labs show: glucose 90 mg/dL, sodium 130 mEq/L, potassium 5.8 mEq/L, bicarbonate 14 mEq/L, and a morning cortisol of 2 mcg/dL. ACTH stimulation test shows a blunted response. Which diagnosis fits?

Accepted Answer

Primary adrenal insufficiency (Addison's disease)

Answer

Primary adrenal insufficiency features hyperkalemia (from mineralocorticoid deficiency), hyponatremia, and a blunted cortisol response to ACTH stimulation.

Question 3

A 55-year-old woman is found to have a thyroid nodule. Fine-needle aspiration cytology shows 'follicular neoplasm' (Bethesda IV). What is the recommended next step?

Accepted Answer

Diagnostic hemithyroidectomy (lobectomy)

Answer

Bethesda IV cytology cannot distinguish follicular adenoma from carcinoma on FNA; surgical lobectomy is required for definitive histologic diagnosis.

Question 4

A 19-year-old woman with a BMI of 17 has oligomenorrhea and labs showing low FSH, LH, and estradiol with normal TSH and prolactin. What is the most likely cause of her hypogonadism?

Accepted Answer

Hypothalamic amenorrhea (functional)

Answer

Low body weight and energy deficit suppress GnRH pulse frequency, causing hypothalamic amenorrhea with low FSH, LH, and estradiol.

Question 5

A diabetic patient develops painful peripheral neuropathy. Tight glycemic control is initiated. Which additional medication has the best evidence for symptomatic relief of diabetic peripheral neuropathy?

Accepted Answer

Gabapentin or pregabalin

Answer

Gabapentin and pregabalin are FDA-approved and first-line agents for painful diabetic peripheral neuropathy, modulating calcium channel activity in sensory neurons.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Endocrine and Metabolic Disorders 5