Endocrine Medicine 10 Single Best Answer (SBA)
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1. A 40-year-old woman presents with weight gain, central obesity, and purple striae on her abdomen. Blood pressure is 160/90 mmHg, and random blood glucose is elevated. What is the most appropriate initial investigation to confirm the diagnosis?
Answer: Overnight dexamethasone suppression test
The overnight 1 mg dexamethasone suppression test is typically the initial screening tool for suspected Cushing’s syndrome.
2. What is the primary pathophysiological defect in primary adrenal insufficiency (Addison’s disease)?
Answer: Autoimmune destruction of the adrenal cortex
In primary adrenal insufficiency, the adrenal cortex is typically destroyed by autoimmune mechanisms, leading to cortisol and often aldosterone deficiency.
3. A 55-year-old woman presents with fatigue, weight gain, cold intolerance, and dry skin. TSH is elevated, and free T4 is low. She is started on levothyroxine. What is the most important advice to give her about taking this medication?
Answer: Take it at the same time every morning on an empty stomach
Levothyroxine should be taken at least 30 minutes before breakfast or other medications to ensure adequate absorption.
4. A 30-year-old woman with untreated Graves’ disease presents with persistent palpitations and weight loss. What is the most significant complication if left untreated?
Answer: Atrial fibrillation and heart failure
Prolonged untreated hyperthyroidism can lead to significant cardiovascular complications, including atrial fibrillation and heart failure.
5. A 50-year-old man presents with fever, tachycardia, altered mental status, and a palpable goitre. Blood tests show suppressed TSH and elevated free T4. What is the most appropriate initial management?
Answer: Propylthiouracil (PTU) and beta-blockers
In a hyperthyroid crisis (thyroid storm), thionamides (PTU) and beta-blockers are critical to block thyroid hormone effects and reduce synthesis.
6. A 70-year-old woman with a history of fragility fractures is diagnosed with osteoporosis. What is the most effective intervention to prevent further fractures?
Answer: Oral bisphosphonates and vitamin D supplementation
Alendronate (or another bisphosphonate) plus vitamin D and often calcium supplementation is standard for preventing osteoporotic fractures.
7. A 45-year-old woman presents with fatigue, increased thirst, and frequent urination. Fasting plasma glucose is 7.8 mmol/L. What is the most appropriate next step to confirm the diagnosis of diabetes?
Answer: HbA1c test
An HbA1c ≥ 48 mmol/mol (≥ 6.5%) is diagnostic of diabetes. It reflects average glucose over ~3 months, making it a practical confirmatory test.
8. A 50-year-old man newly diagnosed with type 2 diabetes has a BMI of 32 kg/m² and a fasting glucose of 9 mmol/L. What is the most appropriate initial management?
Answer: Metformin and lifestyle modification
Metformin is the first-line oral agent in type 2 diabetes, combined with dietary changes and exercise to improve glycaemic control and reduce weight.
9. A 55-year-old woman with type 2 diabetes on metformin has HbA1c levels persistently above target. She has no history of cardiovascular disease. What is the next best step in management?
Answer: Add a sulfonylurea
In type 2 diabetic patients without CV disease who fail metformin alone, adding a sulfonylurea is a common next step.
10. A 70-year-old man with severe hypothyroidism refuses levothyroxine despite counselling about potential complications. What is the most appropriate next step?
Answer: Respect his decision and document the discussion
If a mentally competent patient refuses essential medication, you must respect their autonomy but ensure they understand the consequences.
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