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PANCE endocrine
| Question | Answer |
|---|---|
| A urinalysis reveals a specific gravity of 1.004 (1.001- 1.035) and shows decreased urine osmolality but is otherwise normal. Labs reveal mild hypernatremia. What is the treatment of choice for this patient? | desmopressin |
| Which of the following conditions is characteristic of the presentation of osteomalacia in adults? | pseudofractures |
| Acute adrenal insufficiency is characterized by which of the following laboratory abnormalities? | hyponatremia and hyperkalemia |
| Which of the following statements regarding obesity is correct? | A body mass index (BMI) >28 is associated with a high risk of morbidity such as stroke, ischemic heart disease, or diabetes mellitus that is three to four times the risk in the general population. |
| After changing a dose of Synthroid (thyroxine), how long is it appropriate to wait before reassessing dosage? | six weeks |
| A patient with adrenal insufficiency is taking hydrocortisone 25 mg daily. What should the patient do with the hydrocortisone dose when they develop a minor illness such as a cold? | increase to 50mg daily until illness resolves |
| Which of the following disorders responds most readily to treatment with vitamin D alone? | osteomalacia |
| Neoplasms of the islets of Langerhans: | may produce insulin, glucagon or gastrin |
| A routine bone densitometry study reveals moderate osteoporosis. She does have a family history of osteoporosis, and her mother suffered a hip fracture in her early 70's. Which of the following therapeutic options would be most appropriate? | raloxifene |
| breast cancer, metastatic to the lungs and bones, who has now developed confusion, lethargy, nausea, and vomiting. Further questioning indicates that she also appears to have polyuria and constipation. | hypercalcemia |
| Hydrocortisone in the treatment of chronic Addison's disease is best given | twice a day |
| The serum phosphorus concentration was 0.77 mmol/L (2.4 mg/dL), and the parathyroid hormone level was 229 nL eq/mL (normal, less than 150 nL eq/mL). The most appropriate management at this time would be | surgical exploration of neck |
| Post-menopausal osteoporosis features | reduced amount of bone |
| She has a younger sister with a history breast cancer who already suffered an osteoporotic vertebral fracture. She had a Dexa scan which revealed a bone density of 4.0 standard deviations. | add alendronate (bisphosphonate) |
| Prolactinomas | require treatment sometimes but not all the time |
| You are consulted to treat a patient that has been found in the hospital with hypothyroidism and adrenal insufficiency. After a thorough evaluation of his hypothalamic-pituitary-axis these are the only two disorders identified. You recommend: | glucocorticoids before levothyroxine to prevent precipitating adrenal crisis |
| What is the recommended target LDL to reduce the risk of coronary artery disease in a diabetic patient? | 100 |
| He reports chest pain for 3 weeks, 12 lb weight loss over the last month wit nausea, flushing of his skin, diarrhea, diaphoresis, and palpitations. On PE, BP of 220/100, HR 120, and RR 22. Reminder of his exam is normal including the cardiac exam. | urinary catecholamines |
| Which of the following symptoms is more commonly seen in the initial presentation of diabetes mellitus type 2 over type 1? | chronic skin infections |
| Laboratory abnormalities include a mildly increased serum Na+ level(150 mEq/L), hypokalemic metabolic alkalosis, a low serum renin level, and increased urine potassium level. What is the most likely diagnosis based on the information presented ? | Conn's syndrome (primary hyperaldosteronism) |
| Four weeks postpartum, a 32-year-old woman develops palpitations, heat intolerance, and nervousness.She is diagnosed with hyperthyroidism. Her thyroid is not enlarged or tender. The 24-h uptake of radioactive iodine is 1%. appropriate treatment: | beta blocker (for postpartum thyroiditis, treat symptoms) |
| long history of diabetes mellitus now has an increased serum phosphorus but normal serum calcium. His serum BUN and creatinine are both elevated, consistent with chronic renal failure. He has pain in his right leg | osteitis fibrosa cystica |
| After I-131 treatment of thyrotoxicosis, patients require follow-up for possible hypothyroidism for how long | for life |
| A 45-year-old female presents to the office c/o a "ball in my neck" What increases likelihood that nodule is malignant? | history of past radiation exposure |
| elevated cholesterol. fan hx high cholesterol His 31-year-old brother recently had a acute MI. On physical exam, the patient has bilateral arcus senilus. His extremities are remarkable for diffuse and nodular thickenings of the Achilles tendon | Type 2A hyperlipidemia |
| A 43 y/o female has an isolated elevated alkaline phosphatase. A bone scan shows multiple lesions in thr pelvis, thighs and skull. Radiographs show expanded dense areas with multiple fissure fractures of the long bones. | bisphosphonates |
| A 24-year-old male comes to your office with an extreme feeling of weakness, a 20-pound weight loss, a change in the color of his skin (his skin has become very hyper pigmented),low Na, high K, elev BUN, elev Ca. | Addison's syndrome |
| Intensive diabetic control with maintenance of mostly normal sugars lowers the risk of all of the following EXCEPT | hypoglycemia |
| A patient presents to the office with worsening fatigue, weight loss, and weakness. She notes that she is having recurrent bouts of abdominal pain and has been losing her pubic hair. Patient is found to have orthostatic hypotension. | addison's disease (increased calcium levels) |
| Which of the following is the most common cause of blindness in adults under the age of 70 years in the USA? | diabetes mellitus |
| 72 yowith type2 DM treated with a sulfonylurea. The patient has had a recent upper respiratory infection and excessive diuresis for the past 2 days. She has had decreased oral intake. At the clinic, she becomes increasingly stuporous and lethargic. | hyperglycemic hyperosmolar state |
| T3 in the blood | comes mostly from conversion of T4 |
| Correct statements concerning hypervitaminosis D include which of the following? | hypercalcemia, hypercalciuria, renal impairment |
| 60-year-old woman has lower-back pain. Radiographic examination reveals diffuse demineralization and a compression fracture of the fourth lumbar vertebra. The serum calcium concentration is 11.5 mg/ dL. The blood count is normal | primary hyperparathyroidisim |
| 30 year-old female presents with amenorrhea, proximal muscle weakness, weight gain, and increased emotional lability. Her physical examination consists of central obesity, full face, and protuberant abdomen with thin extremities. | cushing syndrome |
| What is the average staring insulin dose for a newly diagnosed diabetic? | 15-20 units |
| The 2008 guidelines for using surgery for treatment of asymptomatic primary hyperparathyroidism include which of the following | serum calcium more than 1mg/dl above normal |
| Which of these oral agents is useful for the treatment of Type 1 DM? | none |
| TSH 0.3 uu/ml(normal 0.5-5.0), free T4 0.3 ng/ml(normal 0.7-2.7). Which of the following drugs would be indicated for this patient ? | synthroid |
| Radiographs reveal bony sclerosis of the sacroiliac, lower vertebral, and upper tibial regions with cortical thickening, but without mass effect or bony destruction. The major laboratory finding is an elevated serum alkaline phosphatase | paget's disease |
| A fasting cholesterol level was 290 mg/dL, with a LDL of 190 mg/dL, HDL 35 mg/dL & TG level 300 mg/dL. Thyroid, renal and hepatic function are WNL. Which of the following would be the most appropriate therapeutic recommendation? | initiate HMG-CoA reductase inhibitor (statin) |
| The most important regulator of serum 1,25(OH)2 vitamin D concentration is | parathyroid hormone |
| thirsty and weight loss on lithium? | substitute carbamazepine for lithium |
| An 18 year-old female with diabetes presents to the emergency department with altered level of consciousness, deep breathing and fruity odor to her breath. Which of the following medications is indicated for this patient? | regular insulin |
| Glucose of 300, wanting treatment for ED | control hyperglycemia |
| increasing bronze pigmentation of the skin even though not in the sun. She is found to have fasting serum glucose of 160 mg/dl. Physical examination reveals a palpable spleen tip and a firm liver edge. Arrhythmias are noted on electrocardiogram | hemochromatosis |
| hypertensive at health fare but no other reasons? | COnns syndrome (aldosterone secreting adrenal adenoma) |
| Which is the FALSE statement? | type I DMs can stop meds at age 60 |
| Radiographs revealed generalized osteopenia and a displaced right femoral neck fracture. Each of the following statements about osteoporosis is true EXCEPT | severity of bone loss best seen on plain film |
| A patient presents with sudden severe headache, disturbance in eye muscle function, and evidence of hypopituitarism. You suspect | pituitary apoplexy |
| Your patient is an 18 year-old male with a family history of multiple endocrine neoplasia I (MEN I). Which of the following screening electrolyte levels would you recommend for this patient? | Calcium |
| The diabetes drug exenatide (Byetta) is | incretin mimetic |
| An obese woman otherwise healthy is found to have mild elevation of her triglycerides without hypercholesterolemia. The most appropriate first step in the treatment of this woman should be: | weight reduction and a low fat diet |
| Which of the following hormones primarily inhibits growth hormone secretion from the pituitary gland? | somatostatin |
| While awaiting operative removal of pheochromocytoma, which of the following classes of medications are used for control of hypertension? | alpha-adrenergic blocker |
| Approximately 9 months ago, she developed breast secretions, amenorrhea, and decreased libido. No other symptoms are present.On PE, there is definite galactorrhea present | prolactinoma |
| In deciding on treatment for a 60 year-old diabetic with elevated creatinine of 2.2mg/dl and elevated LDL cholesterol of 140mg/dl and FBS 200mg/dl, you would NOT consider | metformin |
| serum calcium concentration of 8.0 mg/dL, a serum phosphorus concentration of 2.4 mg/dL, and increased serum alkaline phosphatase activity. The serum parathyroid hormone level was subsequently found to be elevated as well | vit D deficiency |
| Which of the following features of diabetic retinopathy is the most worrisome? | Proliferative retinopathy |
| Which of the following endocrinologic abnormalities is typical of patients with anorexia nervosa? | Increased growth hormone |
| Patients with vitamin D-dependent rickets type 1 cannot carry out hydroxylation at the 1-position. So it is very reasonable to treat them with | calcitriol |
| Which of the following descriptions is most typical of a patient with acromegaly? | Coarsened facial features with prognathism and prominent brow |
| She otherwise feels fines and has had no major illnesses. Your PE reveals painless symmetric enlargement of the thyroid gland. A CBC, electrolyte panel, and UA are all normal. The serum free thyroxine index(T4) and TSH are norma | SImple non-toxic goiter |
| Which of the following conditions is most closely associated with uncontrolled DM? | hypertriglyceridemia |
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