PANRE Endocrinology 4 — Questions and Answers
Question 1: A 28-year-old woman with polycystic ovary syndrome (PCOS) and insulin resistance would most benefit from which medication to improve metabolic parameters?
- Spironolactone
- Metformin (Correct answer)
- Clomiphene
- Oral contraceptive pills alone
Correct answer: Metformin
Metformin improves insulin sensitivity in PCOS, which can restore menstrual regularity, reduce androgen levels, and lower cardiovascular metabolic risk.
Question 2: Which laboratory pattern is expected in a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
- Low serum sodium, low urine sodium, low urine osmolality
- Low serum sodium, high urine sodium, high urine osmolality (Correct answer)
- High serum sodium, high urine sodium, low urine osmolality
- Low serum sodium, low urine sodium, high urine osmolality
Correct answer: Low serum sodium, high urine sodium, high urine osmolality
SIADH features euvolemic hyponatremia with inappropriately concentrated urine (urine osmolality >100 mOsm/kg) and elevated urine sodium (>20 mEq/L) despite low serum sodium.
Question 3: A patient presents with acute adrenal crisis. What is the immediate treatment?
- Oral hydrocortisone 20 mg
- IV dexamethasone 4 mg followed by IV fluids
- IV hydrocortisone 100 mg plus aggressive IV normal saline (Correct answer)
- Fludrocortisone 0.1 mg orally
Correct answer: IV hydrocortisone 100 mg plus aggressive IV normal saline
Adrenal crisis requires immediate IV hydrocortisone 100 mg (stress dose) and aggressive IV saline resuscitation; dexamethasone can be used if cortisol stimulation test is needed first.
Question 4: Which glycated hemoglobin (HbA1c) target is generally recommended for a healthy 45-year-old with type 2 diabetes and no comorbidities?
- < 6.0%
- < 7.0% (Correct answer)
- < 8.0%
- < 9.0%
Correct answer: < 7.0%
An HbA1c target of <7.0% is recommended for most non-pregnant adults with type 2 diabetes to reduce microvascular complications without excessive hypoglycemia risk.
Question 5: A 50-year-old man has acromegaly confirmed by elevated IGF-1. What is the primary treatment?
- Bromocriptine
- Radiation therapy
- Transsphenoidal surgery (Correct answer)
- Octreotide (somatostatin analog)
Correct answer: Transsphenoidal surgery
Transsphenoidal surgery is the primary treatment for acromegaly, achieving biochemical cure in the majority of microadenomas and many macroadenomas.
Question 6: Which electrolyte abnormality is most commonly associated with hypomagnesemia?
- Hyperkalemia
- Hypercalcemia
- Hypokalemia (Correct answer)
- Hypernatremia
Correct answer: Hypokalemia
Hypomagnesemia frequently causes refractory hypokalemia because magnesium is required for proper potassium reabsorption in the kidney; replace magnesium first.
Question 7: A patient on long-term lithium therapy develops polyuria and polydipsia. What endocrine complication should be suspected?
- Central diabetes insipidus
- Nephrogenic diabetes insipidus (Correct answer)
- SIADH
- Primary polydipsia
Correct answer: Nephrogenic diabetes insipidus
Lithium causes nephrogenic diabetes insipidus by impairing the kidney's response to ADH, typically presenting with polyuria, polydipsia, and dilute urine.
PANRE Endocrinology 4
A 28-year-old woman with polycystic ovary syndrome (PCOS) and insulin resistance would most benefit from which medication to improve metabolic parameters?