Q 1 . What is the most common cause of hypothyroidism
worldwide?
A. Autoimmune disease
B. Graves’ disease
C. Iatrogenic causes
D. Iodine deficiency
E. Medication side effects
Answer D
Q 2 . A 23-year-old woman presents to clinic complaining
of months of weight gain, fatigue, amenorrhea, and worsening
acne. She cannot identify when her symptoms began
precisely, but she reports that without a change in her
diet she has noted a 12.3-kg weight gain over the past 6
months. She has been amenorrheic for several months.
On examination she is noted to have truncal obesity with
bilateral purplish striae across both flanks. Cushing’s syndrome
is suspected. Which of the following tests should
be used to make the diagnosis?
A. 24-h urine free cortisol
B. Basal adrenocorticotropic hormone (ACTH)
C. Corticotropin-releasing hormone (CRH) level at 8 A.M .
D. Inferior petrosal venous sampling
E. Overnight 1 mg dexamethasone suppression test
Answer A
Q 3 . Secretion of gonadotropin releasing-hormone (GnRH)
normally stimulates release of luteinizing hormone (LH)
and follicle-stimulating hormone (FSH) which promote
production and release of testosterone and estrogen.
Which mechanism below best explains how long-acting
gonadotropin-releasing hormone agonists (e.g., leuprolide)
decrease testosterone levels in the management of
prostate cancer?
A. GnRH agonists also promote production of sex hormone–
binding globulin, which decreases the availability
of testosterone
B. Negative feedback loop between GnRH and LH/FSH
C. Sensitivity of LH and FSH to pulse frequency of GnRH
D. Translocation of the cytoplasmic nuclear receptor
into the nucleus with constitutive activation of
GnRH
Answer C
Q 4 . A 44-year-old woman seeks evaluation for irregular
menstrual cycles with heavy menstrual bleeding. She reports
that her menses had been regular with 28-day cycles
since her early twenties. However, for the past 6 months,
her cycles have been 22–25 days with heavy associated
bleeding that is unusual for her. She has had rare hot
flashes and sleep disturbance. She is requesting assistance
in controlling these symptoms. You suspect she is perimenopausal,
and hormonal testing on day 2 of her
menses confirms this suspicion. You are considering
treatment with oral contraceptives for control of her
symptoms and to protect against unintended pregnancy.
All of the following would be considered contraindications
to use of oral contraceptive pills except
A. breast cancer
B. cigarette smoking
C. kidney disease
D. liver disease
E. prior history of deep venous thrombosis
Answer C
Q 5. All the following are risk factors for the development
of osteoporotic fractures except
A. African-American race
B. current cigarette smoking
C. female sex
D. low body weight
E. physical inactivity
Answer A
Q 6. All the following drugs are associated with an increased
risk of osteoporosis in adults except
A. cyclosporine
B. dilantin
C. heparin
D. prednisone
E. ranitidine
Answer E
Q 7. A 34-year-old woman presents to your clinic with a variety
of complaints that have been worsening over the past
year or so. She notes fatigue, amenorrhea, and weight
gain. She states that her primary physician diagnosed her
with hypothyroidism several months ago, and she has
been faithfully taking thyroid hormone replacement. Her
thyroid-stimulating hormone (TSH) has been in the normal
range over the last two laboratory checks. When her
symptoms did not improve on synthroid, she was sent
to your clinic for further evaluation. A diagnosis of panhypopituitarism
is considered. All of the following are
consistent with normal pituitary function except
A. basal elevation of follicle-stimulating hormone
(FSH) and luteinizing hormone (LH) in a postmenopausal
woman
B. elevation of aldosterone after infusion of cosyntropin
C. elevation of growth hormone after ingestion of a
glucose load
D. elevation of cortisol after injection of regular insulin
E. elevation of TSH after infusion of thyrotropinreleasing
hormone (TRH)
Answer C
Q 8. A 33-year-old male with end-stage renal disease who is
on hemodialysis complains of decreased libido, inability
to maintain erections, increasing fatigue, and mild weakness.
He has been on a stable hemodialysis regimen for 8
years, and all his electrolytes are normal. Further evaluation
reveals a reduced serum testosterone level. Measurement
of which of the following will distinguish primary
from secondary hypogonadism?
A. Aldosterone
B. Cortisol
C. Estradiol
D. Luteinizing hormone
E. Thyroid-stimulating hormone
Answer D
Q 9. A 42-year-old woman is brought to the emergency
room by ambulance for altered mental status. The glucose
level by fingerstick monitoring was below the measurement
capabilities of the monitor (<40 mg/dL). After
2 ampules of 50% dextrose, the patient’s fingerstick glucose
remains at 42 mg/dL. She remains unconscious and
had a 1-min seizure while in transport. She has no history
of diabetes mellitus. Her family denies that she has been
recently ill, but recently she has been depressed. She
works as a registered nurse on a medical floor of the hospital.
Which of the following tests would confirm an
overdose of exogenous insulin?
A. Plasma glucose <55 mg/dL, plasma insulin >18
pmol/L, and plasma C-peptide levels undetectable
B. Plasma glucose <55 mg/dL, plasma insulin >18
pmol/L, and plasma C-peptide levels >0.6 ng/mL
C. Plasma glucose <55 mg/dL, plasma insulin <18
pmol/L, and plasma glucagon <12 pmol/L
D. Plasma glucose <55 mg/dL, plasma insulin <18
pmol/L, and C-peptide levels undetectable
Answer A
Q 10. A 44-year-old male is involved in a motor vehicle collision.
He sustains multiple injuries to the face, chest, and
pelvis. He is unresponsive in the field and is intubated for
airway protection. An intravenous line is placed. The patient
is admitted to the intensive care unit (ICU) with
multiple orthopedic injuries. He is stabilized medically
and on hospital day 2 undergoes successful open reduction
and internal fixation of the right femur and right humerus.
After his return to the ICU, you review his
laboratory values. TSH is 0.3 mU/L, and the total T 4 level
is normal. T3 is 0.6 μg/dL. What is the most appropriate
next management step?
A. Initiation of levothyroxine
B. A radioiodine uptake scan
C. A thyroid ultrasound
D. Observation
E. Initiation of prednisone
Answer D
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