PANRE Endocrinology 2

Question 1

A 55-year-old woman with type 2 diabetes has an eGFR of 38 mL/min/1.73m². Which medication should be discontinued?

Accepted Answer

Metformin

Answer

Metformin is contraindicated when eGFR falls below 30 and should be used with caution (many guidelines recommend discontinuing) at eGFR <45 due to risk of lactic acidosis.

Question 2

Which finding is most consistent with primary hyperaldosteronism (Conn syndrome)?

Accepted Answer

Hypokalemia with hypertension

Answer

Primary hyperaldosteronism causes sodium retention and potassium wasting, resulting in hypokalemia and hypertension.

Question 3

A patient with suspected pheochromocytoma should be screened using which initial test?

Accepted Answer

24-hour urine catecholamines and metanephrines

Answer

24-hour urine catecholamines and fractionated metanephrines (or plasma metanephrines) are the recommended biochemical screening tests for pheochromocytoma.

Question 4

A 40-year-old man has central obesity, moon facies, and purple striae. His 24-hour urine free cortisol is elevated. What is the next best step?

Accepted Answer

Low-dose dexamethasone suppression test

Answer

After confirming hypercortisolism with elevated urine free cortisol, a low-dose dexamethasone suppression test helps confirm the diagnosis of Cushing syndrome before localization.

Question 5

Which thyroid cancer subtype has the worst prognosis?

Accepted Answer

Anaplastic

Answer

Anaplastic (undifferentiated) thyroid carcinoma is extremely aggressive with median survival of only 3-5 months after diagnosis.

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PANRE Endocrinology 2