Friday, 16 November 2012


Q 1 . Differentiating primary dysmenorrhea from other causes
of chronic cyclical pelvic pain is important because there is a
specific treatment for primary dysmenorrhea. What is the
pathophysiology/treatment for primary dysmenorrhea?
A. Ectopic endometrium/oral contraceptives
B. History of sexual abuse/counseling
C. Increased stores of prostaglandin precursors/antiinflammatory
D. Ruptured graafian follicle/oral contraceptives

Answer   C

Q 2 . A 25-year-old female notes increasing facial hair and
acne for the last 4 months. She has noticed some deepening
of her voice but denies changes in her libido or genitalia.
She weighs 94 kg and is 5 feet 5 inches tall. Blood
pressure is 126/70 mmHg. Examination is notable for
moderate obesity. There is no evidence of abdominal
striae or bruising. All the following would be important
initial steps in the clinical assessment of this patient except
A. medication history
B. family history
C. serum testosterone level
D. serum dehydroepiandrosterone sulfate (DHEAS) level
E. abdominal ultrasound

Answer   E

Q 3 . A patient visited a local emergency room 1 week ago
with a headache. She received a head MRI, which did not
reveal a cause for her symptoms, but the final report states
“an empty sella is noted. Advise clinical correlation.” The
patient was discharged from the emergency room with instructions
to follow-up with her primary care physician as
soon as possible. Her headache has resolved, and the patient
has no complaints; however, she comes to your office
1 day later very concerned about this unexpected MRI
finding. What should be the next step in her management?
A. Diagnose her with subclinical pan-hypopituitarism,
and initiate low-dose hormone replacement.
B. Reassure her and follow laboratory results closely.
C. Reassure her and repeat MRI in 6 months.
D. This may represent early endocrine malignancy—
whole-body positron-emission tomography/CT is
E. This MRI finding likely represents the presence of a benign
adenoma—refer to neurosurgery for resection.

Answer    B

Q 4 . A 16-year-old previously healthy teenage boy presents
to the local emergency room with a headache that
has been worsening over the course of 2 months. His parents
note that “he just hasn’t seemed like himself,” and
over the past 2 weeks has been complaining of double vision.
He experienced profuse vomiting this afternoon,
which prompted his visit. He also describes weight gain
over the same 2 month time period and has not been
sleeping well. On examination, he is drowsy, and funduscopic
examination reveals papilledema. He has no fever,
neck stiffness, or elevated white blood cell count. Which
of the following is the most likely cause?
A. Carney syndrome
B. Congenital pan-hypopituitarism
C. Craniopharyngioma
D. McCune-Albright syndrome
E. Meningioma

Answer     C

Q 5 . At the midpoint of the menstrual cycle, a luteinizing
hormone (LH) surge occurs via an estrogen-mediated
pathway. Though chronic low levels of estrogen are inhibitory
to LH release, gradually rising estrogen levels stimulate
LH secretion. This relationship between estrogen and
LH is an example of which endocrine regulatory system?
A. Autocrine regulation
B. Negative feedback control
C. Paracrine regulation
D. Positive feedback control

Answer   D

Q 6 . Which of the following is the most common site for a
fracture associated with osteoporosis?
A. Femur
B. Hip
C. Radius
D. Vertebra
E. Wrist

Answer   D

Q 7 . Postmenopausal estrogen therapy has been shown to
increase a female’s risk of all the following clinical outcomes
A. breast cancer
B. hip fracture
C. myocardial infarction
D. stroke
E. venous thromboembolism

Answer    B

Q 8 . All the following therapies have been shown to reduce
the risk of hip fractures in postmenopausal women
with osteoporosis except
A. alendronate
B. estrogen
C. parathyroid hormone
D. raloxifene
E. risedronate
F. vitamin D plus calcium

Answer    D

Q 9 .  A 45-year-old man is diagnosed with pheochromocytoma
after presentation with confusion, marked hypertension
to 250/140 mmHg, tachycardia, headaches, and
flushing. His fractionated plasma metanephrines show a
normetanephrine level of 560 pg/mL and a metanephrine
level of 198 pg/mL (normal values: normetanephrine:
18–111 pg/mL; metanephrine: 12–60 pg/mL). CT
scanning of the abdomen with IV contrast demonstrates
a 3-cm mass in the right adrenal gland. A brain MRI with
gadolinium shows edema of the white matter near the
parietooccipital junction consistent with reversible posterior
leukoencephalopathy. You are asked to consult regarding
management. Which of the following statements
is true regarding management of pheochromocytoma is
this individual?
A. Beta-blockade is absolutely contraindicated for tachycardia
even after adequate alpha-blockade has been
B. Immediate surgical removal of the mass is indicated,
because the patient presented with hypertensive crisis
with encephalopathy.
C. Salt and fluid intake should be restricted to prevent
further exacerbation of the patient’s hypertension.
D. Treatment with phenoxybenzamine should be started
at a high dose (20–30 mg three times daily) to rapidly
control blood pressure, and surgery can be undertaken
within 24–48 h.
E. Treatment with IV phentolamine is indicated for
treatment of the hypertensive crisis. Phenoxybenzamine
should be started at a low dose and titrated
to the maximum tolerated dose over 2–3 weeks. Surgery
should not be planned until the blood pressure
is consistently below 160/100 mmHg.

Answer   E

Q 10 . Inhibition of renin activity is a contemporary target
mechanism for treatment of hypertension. All of the following
physiologic alterations will cause an increase in renin
secretion except
A. decreased effective circulating blood volume
B. high-potassium diet
C. increased sympathetic activity
D. low solute delivery to the distal convoluted tubules
E. upright posture

Answer   B

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