Multiple Choice Questions (MCQ)

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Category: Medicine--->Endocrinology and Metabolic Disease
Page: 2

Question 6# Print Question

A 30-year-old woman complains of palpitations, fatigue, heat intolerance, and insomnia. She is otherwise healthy. She and her husband desire children and are not interested in contraception. On physical examination, her extremities are warm and she is tachycardic. There is diffuse thyroid enlargement and proptosis, as well as thickening of the skin in the pretibial area. Laboratory testing reveals a free T4 value of 3.2 ng/dL (normal 0.9-2.4) with an undetectably low TSH level. Radioiodine uptake at 24 hours is 42% (normal 10%-30%). What is the best treatment plan for this patient?

A. Propylthiouracil
B. Radioactive iodine
C. Propranolol
D. Thyroid surgery
E. Oral corticosteroids

Question 7# Print Question

A 50-year-old woman is evaluated for hypertension. Her blood pressure is 130/98. She complains of polyuria and mild muscle weakness. She is on no blood pressure medication. On physical examination, the PMI is displaced to the sixth intercostal space. There is no sign of congestive heart failure and no edema.

Laboratory values are as follows:

  • Na + : 147 mEq/dL
  • K + : 2.6 mEq/dL
  • Cl − : 112 mEq/dL
  • HCO3 : 27 mEq/dL

The patient denies the use of diuretics or over-the-counter agents to decrease fluid retention or promote weight loss. She does not eat licorice.

Which of the following is the most useful initial diagnostic test?

A. 24-hour urine for cortisol
B. Urinary metanephrine
C. Plasma renin activity
D. Renal angiogram
E. Ratio of serum aldosterone to plasma renin activity

Question 8# Print Question

A 36-year-old woman presents with delirium and congestive heart failure. Her husband indicates that she has been losing weight and becoming more anxious and irritable over the past 3 months. Over the past several weeks she has developed dyspnea and peripheral edema. She has previously been healthy and takes no medications. Her husband says that she drinks alcohol moderately and has never used illicit drugs. On physical examination, she is awake, anxious, and confused. Her temperature is 38°C and her heart rate is 142 and regular. She has jugular venous distension to 16 cm above the sternal angle as well as bibasilar rales. In addition, she has a diffuse goiter with a soft bruit over each lobe, as well as a stare expression and exophthalmos. CXR shows pulmonary edema and cardiomegaly. Her EKG reveals sinus tachycardia but is otherwise unremarkable. What is the best approach to management of this patient?

A. Admit to the general medicine ward, obtain serum-free T4 and TSH, order a radioiodine uptake and scan, and begin furosemide 40 mg IV daily
B. Order free T4 and TSH, start the patient on propranolol 20 mg po tid and lasix 40 mg po bid, obtain a radioiodine uptake and scan, and follow closely as an outpatient
C. Obtain free T4 , TSH, and thyroid-stimulating immunoglobulin levels, begin methimazole 10 mg po tid, and follow closely as an outpatient
D. Admit to the general medicine ward, obtain blood and urine cultures and an echocardiogram, and begin treatment with broad-spectrum antibiotics and furosemide
E. Admit the patient to the intensive care unit, order free T4 and TSH, and begin high-dose propranolol, propylthiouracil, potassium iodide, corticosteroids, furosemide, and acetaminophen

Question 9# Print Question

A 58-year-old man is referred to your office after evaluation in the emergency room for abdominal pain. The patient was diagnosed with gastritis, but a CT scan with contrast performed during the workup of his pain revealed a 2-cm adrenal mass. The patient has no history of malignancy and denies erectile dysfunction. Physical examination reveals a BP of 122/78 with no gynecomastia or evidence of Cushing syndrome. His serum potassium is normal. What is the next step in determining whether this patient’s adrenal mass should be resected?

A. Plasma aldosterone/renin ratio
B. Estradiol level
C. Plasma metanephrines and dexamethasone-suppressed cortisol level
D. Testosterone level
E. Repeat CT scan in 6 months

Question 10# Print Question

On routine physical examination, a 28-year-old woman is found to have a thyroid nodule. She denies pain, hoarseness, hemoptysis, or local symptoms. Serum TSH is normal. Which of the following is the best next step in evaluation?

A. Thyroid ultrasonography
B. Thyroid scan
C. Surgical resection
D. Fine needle aspiration of thyroid
E. No further evaluation

Category: Medicine--->Endocrinology and Metabolic Disease
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