PANCE Endocrine System 4 — Questions and Answers
Question 1: A 40-year-old woman presents with heat intolerance, weight loss, tremor, and TSH <0.01 mIU/L with elevated free T4. Radioiodine uptake is diffusely increased. What is the preferred long-term treatment option in a non-pregnant patient?
- Propranolol alone
- Radioactive iodine (RAI) ablation (Correct answer)
- IV methimazole
- Thyroidectomy only
Correct answer: Radioactive iodine (RAI) ablation
RAI ablation is the preferred definitive treatment for Graves disease in non-pregnant adults in the US.
Question 2: Which laboratory finding is most consistent with syndrome of inappropriate antidiuretic hormone (SIADH)?
- Serum sodium 130 mEq/L, urine osmolality 80 mOsm/kg, urine sodium 10 mEq/L
- Serum sodium 128 mEq/L, urine osmolality 550 mOsm/kg, urine sodium 45 mEq/L (Correct answer)
- Serum sodium 125 mEq/L, urine osmolality 60 mOsm/kg, urine sodium 5 mEq/L
- Serum sodium 132 mEq/L, urine osmolality 100 mOsm/kg, urine sodium 8 mEq/L
Correct answer: Serum sodium 128 mEq/L, urine osmolality 550 mOsm/kg, urine sodium 45 mEq/L
SIADH features hyponatremia with inappropriately concentrated urine (>100 mOsm/kg) and high urine sodium (>20 mEq/L).
Question 3: A 48-year-old man with poorly controlled type 2 diabetes develops painless loss of vision in one eye. Fundoscopy shows neovascularization. What is the most appropriate next step?
- Immediate insulin titration only
- Urgent ophthalmology referral for laser photocoagulation (Correct answer)
- Start ACE inhibitor
- Prescribe corrective lenses
Correct answer: Urgent ophthalmology referral for laser photocoagulation
Proliferative diabetic retinopathy with neovascularization requires urgent ophthalmology referral for pan-retinal photocoagulation.
Question 4: A patient with MEN1 syndrome would most likely have which combination of tumors?
- Pheochromocytoma, medullary thyroid cancer, hyperparathyroidism
- Pituitary adenoma, pancreatic islet tumor, parathyroid hyperplasia (Correct answer)
- Pheochromocytoma, parathyroid adenoma, meningioma
- Medullary thyroid cancer, pheochromocytoma, mucosal neuromas
Correct answer: Pituitary adenoma, pancreatic islet tumor, parathyroid hyperplasia
MEN1 (Wermer syndrome) involves the 3 Ps: pituitary adenoma, pancreatic islet tumors, and parathyroid hyperplasia.
Question 5: An 8-year-old boy presents with pubic hair and testicular enlargement. Bone age is advanced. LH and FSH are elevated. What is the most likely diagnosis?
- Congenital adrenal hyperplasia
- Exogenous androgen exposure
- Gonadotropin-independent (peripheral) precocious puberty
- Central (gonadotropin-dependent) precocious puberty (Correct answer)
Correct answer: Central (gonadotropin-dependent) precocious puberty
Elevated LH and FSH confirm central (GnRH-dependent) precocious puberty, which is driven by the hypothalamic-pituitary axis.
Question 6: A 32-year-old woman develops gestational diabetes at 28 weeks. Her fasting glucose is 105 mg/dL. After failing medical nutrition therapy, what is the preferred pharmacologic treatment during pregnancy?
- Metformin
- Glipizide
- Insulin (Correct answer)
- Empagliflozin
Correct answer: Insulin
Insulin is the preferred medication for gestational diabetes when dietary modification fails, as it does not cross the placenta in significant amounts.
Question 7: Which finding on DEXA scan defines osteoporosis (not osteopenia)?
- T-score between -1.0 and -2.5
- T-score of -2.5 or below (Correct answer)
- Z-score below -2.0
- T-score above -1.0
Correct answer: T-score of -2.5 or below
Osteoporosis is defined by a T-score of -2.5 or lower on DEXA scan.
PANCE Endocrine System 4
A 40-year-old woman presents with heat intolerance, weight loss, tremor, and TSH <0.01 mIU/L with elevated free T4.
Radioiodine uptake is diffusely increased.
What is the preferred long-term treatment option in a non-pregnant patient?