PANRE Endocrinology 5 — Questions and Answers
Question 1: A 60-year-old woman on bisphosphonate therapy for osteoporosis has a 'drug holiday' recommended after 5 years. Which bisphosphonate characteristic makes this most appropriate?
- Short half-life in bone
- High renal excretion requiring drug holiday
- Prolonged skeletal retention and residual effect after discontinuation (Correct answer)
- Risk of rebound hypercalcemia
Correct answer: Prolonged skeletal retention and residual effect after discontinuation
Bisphosphonates have a prolonged half-life in bone (years), providing continued fracture protection after discontinuation, which supports a drug holiday to minimize risks like atypical femur fractures.
Question 2: Which HbA1c threshold is used to diagnose diabetes mellitus?
- ≥ 5.7%
- ≥ 6.0%
- ≥ 6.5% (Correct answer)
- ≥ 7.0%
Correct answer: ≥ 6.5%
An HbA1c ≥ 6.5% on two separate occasions (or once with confirmatory testing) meets the diagnostic criteria for diabetes mellitus per ADA guidelines.
Question 3: A patient with Hashimoto thyroiditis is euthyroid. What is the most appropriate management?
- Start levothyroxine prophylactically
- Administer high-dose steroids
- Monitor TSH periodically (Correct answer)
- Perform thyroidectomy
Correct answer: Monitor TSH periodically
Euthyroid Hashimoto thyroiditis requires no treatment; TSH should be monitored annually (or sooner if symptomatic) since hypothyroidism may develop over time.
Question 4: A 70-year-old man has a serum calcium of 11.4 mg/dL, PTH of 85 pg/mL (elevated), and eGFR of 72. He is asymptomatic. What is the best management?
- Emergent parathyroidectomy
- IV bisphosphonate infusion
- Observation with monitoring of calcium, BMD, and renal function (Correct answer)
- Cinacalcet immediately
Correct answer: Observation with monitoring of calcium, BMD, and renal function
Asymptomatic primary hyperparathyroidism with mild hypercalcemia and preserved renal function can be managed with watchful observation using periodic monitoring of calcium, BMD, and renal function per surgical guidelines.
Question 5: Which GLP-1 receptor agonist is approved for weight management in non-diabetic obese patients?
- Exenatide
- Dulaglutide
- Semaglutide (2.4 mg subcutaneous weekly) (Correct answer)
- Liraglutide 1.2 mg
Correct answer: Semaglutide (2.4 mg subcutaneous weekly)
Semaglutide 2.4 mg weekly (Wegovy) is FDA-approved for chronic weight management in adults with obesity or overweight with at least one weight-related comorbidity.
Question 6: A patient with type 1 diabetes presents with blood glucose of 650 mg/dL, pH 7.20, bicarbonate 12 mEq/L, and large ketones. What is the hallmark of diabetic ketoacidosis that distinguishes it from hyperglycemic hyperosmolar state?
- Severe hyperglycemia
- Significant ketonemia and anion gap metabolic acidosis (Correct answer)
- Altered mental status
- High serum osmolality
Correct answer: Significant ketonemia and anion gap metabolic acidosis
DKA is defined by the triad of hyperglycemia, ketonemia/ketonuria, and anion gap metabolic acidosis, which distinguishes it from HHS where ketosis and acidosis are absent or minimal.
Question 7: A thyroid nodule biopsy returns as Bethesda Category IV (follicular neoplasm). What is the next step?
- Repeat FNA in 6 months
- Immediate total thyroidectomy
- Radioiodine ablation
- Diagnostic thyroid lobectomy (Correct answer)
Correct answer: Diagnostic thyroid lobectomy
Bethesda IV (follicular neoplasm) carries a 15-30% malignancy risk; diagnostic lobectomy is recommended as FNA cannot distinguish follicular adenoma from carcinoma (capsular/vascular invasion requires histology).
PANRE Endocrinology 5
A 60-year-old woman on bisphosphonate therapy for osteoporosis has a 'drug holiday' recommended after 5 years.
Which bisphosphonate characteristic makes this most appropriate?