A 35-year-old female presents with polyuria and polydipsia. She is currently 20 weeks pregnant. Which form of Diabetes Insipidus is most likely to be the cause of her symptoms?
Correct
Incorrect
Consider the patient's pregnancy status.
2. Question
Which of the following medications is known to cause Nephrogenic Diabetes Insipidus?
Correct
Incorrect
Focus on medications that affect the kidney's response to AVP.
3. Question
A 24-year-old male presents with polyuria and polydipsia. Lab results reveal hypokalemia and hypercalcemia. Which form of Diabetes Insipidus is most likely?
Correct
Incorrect
Consider the patient's lab results.
4. Question
Which disorder is NOT considered a true Diabetes Insipidus state but can manifest with symptoms of DI?
Correct
Incorrect
5. Question
A 50-year-old man presents with polyuria and polydipsia. He also complains of fatigue, erectile dysfunction, and weight changes. What is the most likely cause of his diabetes insipidus?
Correct
Incorrect
Consider the patient's additional symptoms that may suggest anterior pituitary hormonal dysfunction.
6. Question
A patient with diabetes insipidus presents with dehydration and signs of intracranial bleeding. What could be the likely cause of this clinical presentation?
Correct
Incorrect
Consider conditions in which the patient has a reduced urge to drink water despite rising plasma osmolality.
7. Question
A 35-year-old woman is suspected to have diabetes insipidus. She presents with polyuria and polydipsia, and laboratory investigations reveal a urine osmolality of 310 mOsm/Kg and plasma osmolality of 278 mOsm/Kg. What is the most likely diagnosis?
Correct
Incorrect
Consider the patient's laboratory findings, specifically the plasma osmolality.
8. Question
Which of the following tests can potentially differentiate between central diabetes insipidus and nephrogenic diabetes insipidus?
Correct
Incorrect
9. Question
Based on the water deprivation test, which of the following statements best describes the response in a patient with complete central diabetes insipidus?
Correct
Incorrect
Consider the response of a patient with complete central diabetes insipidus to the water deprivation test and desmopressin administration.
10. Question
Which of the following statements is true regarding the desmopressin phase of the water deprivation test?
A. Desmopressin should be administered orally or intranasally
B. Desmopressin should be administered after 3% loss of body weight during the dehydration phase
C. Desmopressin should be administered intravenously or intramuscularly
D. Desmopressin administration is not necessary for the diagnosis of diabetes insipidus
Correct
Incorrect
Consider the optimal route of administration for desmopressin during the water deprivation test.
11. Question
In a patient with primary polydipsia, which of the following would be expected during the water deprivation test?
A. An increase in urine osmolality <9% after desmopressin administration
B. An increase in urine osmolality >50% after desmopressin administration
C. A urine osmolality of <300 mOsmKg after dehydration
D. A urine osmolality of 800-1200 mOsm/Kg after dehydration
Correct
Incorrect
Consider the expected response in a patient with primary polydipsia during the water deprivation test.
12. Question
A 34-year-old woman presents with polyuria and polydipsia. She undergoes a water deprivation test, but the results are inconclusive. Which of the following scenarios could be the reason for this?
A. Complete central diabetes insipidus
B. Partial central diabetes insipidus
C. Primary polydipsia
D. Complete nephrogenic diabetes insipidus
Correct
Incorrect
Some patients retain some degree of AVP secretory capacity, causing inconclusive results in the water deprivation test.
13. Question
What effect does chronic primary polydipsia have on the renal medullary osmotic gradient and aquaporin-2 channels?
A. Increases renal medullary osmotic gradient and up-regulates aquaporin-2 channels
B. Decreases renal medullary osmotic gradient and up-regulates aquaporin-2 channels
C. Increases renal medullary osmotic gradient and down-regulates aquaporin-2 channels
D. Decreases renal medullary osmotic gradient and down-regulates aquaporin-2 channels
Correct
Incorrect
Chronic primary polydipsia can affect the renal medullary osmotic gradient and aquaporin-2 channels, leading to inconclusive results in the water deprivation test.
14. Question
In the water deprivation test, which of the following criteria would prompt discontinuation of the dehydration phase?
A. Serum sodium decreases to below the lower limit of normal
B. Orthostatic hypotension or orthostatic symptoms
C. The total body weight increases by more than 3%
D. Two consecutive urine osmolality measures differ by >20%
Correct
Incorrect
The dehydration phase of the water deprivation test can be discontinued based on certain criteria related to patient safety.
15. Question
Which of the following statements about the water deprivation test is true?
A. The test should be performed in infants
B. The test is less time-consuming than the hypertonic saline infusion test
C. The test is considered the gold standard for diagnosing diabetes insipidus
D. The test relies solely on plasma measurements for interpretation
Correct
Incorrect
16. Question
A 45-year-old male presents with polyuria and polydipsia. Which of the following tests can help differentiate between nephrogenic DI and central DI with 100% sensitivity and specificity without prior water deprivation?
A. Baseline plasma AVP level ≥3 pg/ml
B. Baseline plasma copeptin level ≥21.4 pmol/L
C. Indirect water deprivation test
D. Hypertonic saline infusion test
Correct
Incorrect
Consider the baseline plasma levels of a certain hormone to differentiate between nephrogenic DI and central DI.
17. Question
Which of the following is a limitation of measuring plasma AVP levels?
A. Long half-life
B. Pre-analytical stability
C. Large sample volume requirement
D. Rapid clearance from plasma
Correct
Incorrect
Think about the stability of AVP in the plasma and its half-life.
18. Question
Which of the following factors contributes to the wide fluctuations in measured plasma AVP levels?
A. Lack of binding to platelets
B. Binding to platelets through V1 receptors
C. Low plasma concentration
D. High plasma concentration
Correct
Incorrect
Consider the interaction between AVP and platelets.
19. Question
What is the advantage of measuring plasma copeptin levels over plasma AVP levels in diagnosing polyuria-polydipsia syndromes?
A. Copeptin levels have a shorter half-life
B. Copeptin levels require larger sample volume
C. Copeptin has better pre-analytical stability
D. Copeptin has a lower correlation with plasma AVP levels
Correct
Incorrect
20. Question
A 35-year-old female presents with polyuria and polydipsia. You decide to perform a hypertonic saline infusion test to differentiate between central diabetes insipidus (DI), nephrogenic DI, and primary polydipsia. What is the initial protocol for the hypertonic saline infusion test?
A. Administer a bolus dose of 250ml of hypertonic saline over 30 minutes, followed by 0.15 ml/Kg/min
B. Discontinue any diuretics, SGLT-2 inhibitors, and NSAIDs 48 hours prior to the test
C. Administer a bolus dose of 250ml of hypertonic saline over 10-15 minutes, followed by 0.15 ml/Kg/min
D. Discontinue any diuretics, SGLT-2 inhibitors, and NSAIDs 24 hours prior to the test
Correct
Incorrect
Consider the initial infusion of hypertonic saline.
21. Question
In the hypertonic saline infusion test, a plasma copeptin level of less than 4.9 pmol/L after hypertonic saline infusion indicates which condition?
A. Nephrogenic DI (partial and complete)
B. Primary polydipsia
C. Central DI (partial and complete)
D. None of the above
Correct
Incorrect
Recall the plasma copeptin levels that indicate central DI.
22. Question
What is a major advantage of the hypertonic saline infusion test compared to the water deprivation test in diagnosing DI?
A. It is less time-consuming
B. It requires fewer blood samples
C. It is less invasive
D. It depends on urinary indices
Correct
Incorrect
Consider the duration of the tests.
23. Question
A 30-year-old female presents with polyuria and polydipsia. She is currently taking lithium for bipolar disorder. What is the most likely cause of her polyuria-polydipsia syndrome?
A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Primary polydipsia
D. Gestational diabetes insipidus
Correct
Incorrect
Consider the patient's medication history.
24. Question
A 5-year-old boy presents with a history of polyuria and polydipsia since infancy. His mother reports that he was diagnosed with septo-optic dysplasia as a newborn. What is the most likely cause of his polyuria-polydipsia syndrome?
A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Primary polydipsia
D. Gestational diabetes insipidus
Correct
Incorrect
Consider the patient's congenital condition.
25. Question
A 25-year-old male presents with polyuria and polydipsia. He has no significant past medical history, but his mother mentions that he has always been a compulsive water drinker. His lab results show low urine osmolality and normal serum sodium levels. What is the most likely diagnosis?
A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Primary polydipsia
D. Gestational diabetes insipidus
Correct
Incorrect
Consider the patient's lifelong drinking habits.
26. Question
A 32-year-old pregnant woman presents with polyuria and polydipsia. Her lab results show low urine osmolality and normal serum sodium levels. What is the most likely cause of her polyuria-polydipsia syndrome?
A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Primary polydipsia
D. Gestational diabetes insipidus
Correct
Incorrect
Consider the patient's pregnancy status.
27. Question
What factors play an important role in modulating day-to-day growth hormone (GH) secretion?
A. Gender and sleep patterns
B. Nutritional status and physical activity
C. Metabolic and hormonal signals from other endocrine glands
D. All of the above
Correct
Incorrect
Consider the various factors that can impact GH secretion.
28. Question
In which patient populations is the insulin tolerance test (ITT) contraindicated for assessing adult growth hormone deficiency (GHD)?
A. Patients with a history of seizures
B. Elderly patients (> 65 years of age)
C. Patients with a history of cardio-/cerebrovascular disease
D. All of the above
Correct
Incorrect
Consider the populations for whom the ITT might be risky or inappropriate.
29. Question
Which test has grown in popularity as the test of choice for diagnosing adult GHD when the ITT cannot be performed or is contraindicated?
A. GHRH-arginine test
B. Glucagon stimulation test (GST)
C. Clonidine test
D. L-DOPA test
Correct
Incorrect
Consider which test has become popular as an alternative to the ITT.
30. Question
What is the recently and only approved diagnostic test for adult GHD by the United States Food and Drug Administration (FDA) and the European Medicines Agency?
A. Insulin tolerance test (ITT)
B. Glucagon stimulation test (GST)
C. Oral macimorelin test
D. GHRH-arginine test
Correct
Incorrect
Consider which test has been recently approved by the FDA and the European Medicines Agency.
31. Question
A 45-year-old male with a history of pituitary tumor resection presents with increased fatigue, decreased muscle strength, and weight gain. Which of the following tests would be the gold-standard for assessing adult growth hormone deficiency (GHD) in this patient?
A. Insulin tolerance test (ITT)
B. Glucagon stimulation test (GST)
C. Oral macimorelin test
D. GHRH-arginine test
Correct
Incorrect
Consider which test is regarded as the gold-standard for assessing adult GHD.
32. Question
A 55-year-old female with a BMI of 35 kg/m2 and a history of type 2 diabetes is being evaluated for adult GHD. Which cut-point for the glucagon stimulation test (GST) should be considered to improve diagnostic accuracy in this patient?
A. 1 µg/L
B. 2 µg/L
C. 3 µg/L
D. 4 µg/L
Correct
Incorrect
Consider which cut-point improves the diagnostic accuracy of the GST for overweight and obese patients.
33. Question
A 38-year-old male with a history of traumatic brain injury presents with decreased muscle strength and exercise capacity. Which of the following factors should be considered when interpreting the results of growth hormone stimulation tests?
A. Age
B. Gender
C. BMI
D. All of the above
Correct
Incorrect
Consider the factors that may impact the interpretation of growth hormone stimulation tests.
34. Question
A 50-year-old female with a history of pituitary macroadenoma and previous radiation therapy presents with increased fat mass, dyslipidemia, and insulin resistance. Which of the following conditions should be excluded before performing a GH stimulation test to diagnose adult GHD?
A. Non-alcoholic fatty liver disease
B. Obesity
C. Hypothyroidism
D. All of the above
Correct
Incorrect
Consider the conditions that may affect the results of a GH stimulation test and should be excluded before testing.
35. Question
A 34-year-old male with a history of traumatic brain injury is being evaluated for adult GHD. He undergoes an ITT and achieves blood glucose levels of 45 mg/dL. Which of the following statements is true regarding the interpretation of the ITT results in this patient?
A. Adequate hypoglycemia has been achieved for the diagnosis of adult GHD.
B. The patient must achieve blood glucose levels of < 40 mg/dL for an accurate diagnosis of adult GHD.
C. The test should be repeated with a higher dose of insulin to achieve adequate hypoglycemia.
D. The test results are invalid as the patient did not achieve symptomatic hypoglycemia.
Correct
Incorrect
Consider the blood glucose level required to achieve adequate hypoglycemia for diagnosing adult GHD.
36. Question
A 58-year-old male with a history of coronary artery disease requires an evaluation for adult GHD. Which of the following statements is true regarding the use of ITT in this patient?
A. ITT is contraindicated due to the patient's age.
B. ITT is contraindicated due to the patient's history of coronary artery disease.
C. ITT can be safely performed with close medical supervision.
D. Both A and B are correct.
Correct
Incorrect
Consider the contraindications of ITT in patients with certain medical conditions and age groups.
37. Question
A 42-year-old female with a BMI of 32 kg/m2 and insulin resistance is scheduled for an ITT. Which insulin dose should be administered to achieve adequate hypoglycemia for diagnosing adult GHD in this patient?
A. 0.05-0.1 units/kg
B. 0.1-0.15 units/kg
C. 0.15-0.2 units/kg
D. 0.2-0.3 units/kg
Correct
Incorrect
Consider the appropriate insulin dose for patients with a high BMI and insulin resistance.
38. Question
What is the optimal GH cut-point for the Glucagon Stimulation Test in overweight patients with a low pre-test probability and in obese patients?
A. 3.0 mg/L
B. 2.5 mg/L
C. 1.0 mg/L
D. 1.5 mg/L
Correct
Incorrect
Consider the relationship between BMI and the GH cut-point in the Glucagon Stimulation Test.
39. Question
Which of the following side effects is NOT commonly associated with the Glucagon Stimulation Test?
A. Nausea
B. Vomiting
C. Headache
D. Diarrhea
Correct
Incorrect
40. Question
How do peak GH levels in the Glucagon Stimulation Test correlate with age and BMI in healthy controls, according to Gomez et al.?
A. Positive correlation with age and BMI
B. Negative correlation with age and BMI
C. Positive correlation with age, negative correlation with BMI
D. Negative correlation with age, positive correlation with BMI
Correct
Incorrect
41. Question
Which of the following precautions should be taken for patients undergoing the Glucagon Stimulation Test?
A. Avoid fasting for 8-10 hours before the test
B. Administer IV anti-emetics if the patient feels nauseous during the test
C. Eat a large meal immediately after the test
D. Allow the patient to take morning medications with juice
Correct
Incorrect
42. Question
Which of the following factors does NOT affect peak GH levels during the Glucagon Stimulation Test, as demonstrated by Conceicao et al.?
A. Age
B. Gender
C. BMI
D. Pituitary disease
Correct
Incorrect
Consider the factors mentioned in the text that do not affect peak GH levels during the Glucagon Stimulation Test.
43. Question
Which of the following is an advantage of the Glucagon Stimulation Test?
A. Short test duration
B. No need for intramuscular injection
C. Reproducibility
D. No influence by age
Correct
Incorrect
44. Question
In the study by Berg et al., what was the optimal peak GH cut-point for the Glucagon Stimulation Test?
A. 1.0 mg/L
B. 2.5 mg/L
C. 3.0 mg/L
D. 3.5 mg/L
Correct
Incorrect
45. Question
What is the recommended procedure for patients with severe fasting hyperglycemia > 180 mg/dL regarding the Glucagon Stimulation Test?
A. Perform the test as usual
B. Delay the test until blood glucose levels are lower
C. Modify the test protocol to accommodate hyperglycemia
D. The test is contraindicated for these patients
Correct
Incorrect
46. Question
A 65-year-old patient with a history of a sellar mass and 2 other pituitary hormone deficiencies is being evaluated for adult growth hormone deficiency. Which of the following diagnostic tests would be most appropriate for this patient?
A. Insulin Tolerance Test (ITT)
B. Glucagon Stimulation Test (GST)
C. Macimorelin Test
D. Growth Hormone-Releasing Hormone (GHRH) plus Arginine Test
Correct
Incorrect
Consider the advantages and disadvantages of each diagnostic test for adult growth hormone deficiency.
47. Question
Which of the following medications should be discontinued with a sufficient washout period before performing the Macimorelin Test, provided it is considered safe by the prescribing physician?
A. Metformin
B. Citalopram
C. Aspirin
D. Lisinopril
Correct
Incorrect
Consider the medications that may interact with the Macimorelin Test and are associated with QT prolongation.
48. Question
A 30-year-old patient with poorly controlled diabetes mellitus is being evaluated for adult growth hormone deficiency. According to the Macimorelin Test protocol, which of the following statements is true?
A. The Macimorelin Test is contraindicated for this patient.
B. The patient's glucose levels should be tightly controlled before performing the test.
C. The test can be performed regardless of the patient's glucose levels.
D. The test's diagnostic performance is well-established for this patient population.
Correct
Incorrect
49. Question
A 45-year-old man presents with symptoms of acromegaly. Laboratory tests reveal elevated GH and IGF-1 levels. His prolactin levels are also found to be high. Which type of pituitary tumor is the most likely cause of his condition?
A. Monohormonal densely granulated somatotroph adenoma
B. Sparsely granulated somatotroph adenoma
C. Mammosomatotroph adenoma
D. Acidophil stem cell adenoma
Correct
Incorrect
Consider a tumor type that co-stains for GH and PRL.
50. Question
A 60-year-old woman with acromegaly undergoes pituitary tumor resection. The histology report reveals the tumor to be densely granulated, slow-growing, and responsive to SSA therapy. Which genetic mutation is most commonly associated with this type of tumor?
A. GNAS
B. MEN1
C. GATA3
D. RET
Correct
Incorrect
Consider the mutation that leads to increased cAMP activity in GH-secreting tumors.
51. Question
A patient presents with acromegaly due to a pituitary tumor. The tumor is characterized by increased presence of keratin aggregates, reduced GH-containing granules, and aggressive behavior. Which type of pituitary tumor is this most likely to be?
A. Monohormonal densely granulated somatotroph adenoma
B. Sparsely granulated somatotroph adenoma
C. Mammosomatotroph adenoma
D. Mixed somatotroph and lactotroph tumor
Correct
Incorrect
Consider a tumor type with reduced GH-containing granules and aggressive behavior.
52. Question
A 30-year-old pregnant woman in her second trimester presents with signs of hypothyroidism. Which of the following tests would be most appropriate for assessing her thyroid status?
A. Total T4 (TT4)
B. Total T3 (TT3)
C. Free T4 (FT4) immunoassay
D. Free T3 (FT3) immunoassay
Correct
Incorrect
Consider the influence of pregnancy on thyroid hormone binding proteins.
53. Question
Which of the following conditions is associated with abnormalities in thyroxine-binding globulin (TBG) that distort the relationship between total and free thyroid hormones?
A. Dysalbuminemias
B. Thyroid hormone autoantibodies
C. Drug interactions
D. All of the above
Correct
Incorrect
Think about various factors that can affect TBG levels.
54. Question
In a patient with Graves' disease, which of the following test ratios can be used to differentiate it from other causes of hyperthyroidism?
A. Total T4 (TT4) to Total T3 (TT3)
B. Free T4 (FT4) to Free T3 (FT3)
C. Total T3 (TT3) to Total T4 (TT4)
D. Free T3 (FT3) to Free T4 (FT4)
Correct
Incorrect
Consider the effect of TSH receptor antibodies on deiodinase activity in Graves' disease.
55. Question
A 45-year-old male with a history of type 2 diabetes presents with fatigue, loss of libido, and mood swings. His testosterone level was tested at 2:00 PM, and the result was 220 ng/dL. Which of the following statements about this case is true?
A. The testosterone level is normal for this patient.
B. The testosterone level is abnormal and suggests primary hypogonadism.
C. The testosterone level should be retested in the morning before making a diagnosis.
D. The testosterone level indicates hypogonadotropic hypogonadism.
Correct
Incorrect
Diurnal variation in testosterone levels
56. Question
What can be used to evaluate boys with delayed puberty and indicate that puberty has begun?
A. Morning LH and testosterone levels
B. Nocturnal rise in testosterone levels
C. Constant testosterone levels throughout the day
D. Evening LH and testosterone levels
Correct
Incorrect
Nocturnal rise in testosterone levels
57. Question
Which of the following factors can cause the diurnal testosterone rhythm to be blunted?
A. Hyperprolactinemia
B. Primary testicular failure
C. Old age
D. Both B and C
Correct
Incorrect
Factors affecting diurnal testosterone rhythm
58. Question
A 30-year-old male is being evaluated for hypogonadism. His testosterone level is 270 ng/dL. Which of the following is the most appropriate next step in the diagnostic process?
A. Diagnose the patient with hypogonadism based on the low testosterone level.
B. Test the patient's LH and FSH levels.
C. Confirm the result with a second testosterone test.
D. Perform a GnRH stimulation test.
Correct
Incorrect
59. Question
A 53-year-old obese man with type 2 diabetes and the Metabolic Syndrome presents with symptoms consistent with hypogonadism. His total testosterone levels are borderline low. Which of the following tests would be more closely aligned with the symptoms and signs of adult hypogonadism in this patient?
A. Total testosterone
B. Free testosterone
C. Bioavailable testosterone
D. Free testosterone index
Correct
Incorrect
Consider which testosterone measurement aligns better with hypogonadism symptoms in obese men.
60. Question
In older men, why might the total testosterone level be within the normal range while free testosterones decline more dramatically?
A. Decreased SHBG levels
B. Increased SHBG levels
C. Allosteric binding of SHBG
D. SNPs of the SHBG gene
Correct
Incorrect
Consider how SHBG levels change in older men.
61. Question
Which method is the benchmark reference method for measuring free testosterone?
A. Equilibrium dialysis
B. Calculated free testosterone
C. Bioavailable testosterone
D. Direct free testosterone
Correct
Incorrect
Consider which method is considered the gold standard for measuring free testosterone.
62. Question
Why is the direct free testosterone assay often misleading and not recommended?
A. It has a high affinity for SHBG and albumin
B. It provides essentially the same information as total testosterone
C. It underestimates the level of free testosterone
D. It is highly sensitive to temperature effects
Correct
Incorrect
Consider the information provided by the direct free testosterone assay compared to other methods.
63. Question
In a 40-year-old male with gynecomastia, which of the following assays is most reliable for measuring estradiol levels?
A. Radioimmunoassay
B. Electro-chemiluminescence immunoassay
C. Automated immunoassay
D. Mass spectrometry assay
Correct
Incorrect
The most reliable assay has a limit of detection of 1 pg/ml.
64. Question
A 32-year-old male presents with ambiguous genitalia. Which of the following tests would be most useful to diagnose 5α-reductase deficiency type 2?
A. Serum testosterone levels
B. Serum dihydrotestosterone (DHT) levels
C. Testosterone to DHT ratio following hCG stimulation
D. Urinary steroid profiling by GC-MS
Correct
Incorrect
The most useful test involves analyzing urinary steroids.
65. Question
In men with suspected gonadotroph adenoma, which of the following hormone levels are typically elevated?
A. Testosterone
B. Luteinizing hormone (LH)
C. Follicle-stimulating hormone (FSH)
D. Estradiol
Correct
Incorrect
This hormone is involved in stimulating the testes to produce testosterone.
66. Question
Which hormone levels are often selectively increased in men with non-functioning Sertoli cells?
A. Testosterone
B. Luteinizing hormone (LH)
C. Follicle-stimulating hormone (FSH)
D. Inhibin-B
Correct
Incorrect
67. Question
In prepubertal boys with ambiguous genitalia and a 46,XY karyotype, hCG stimulation test can be useful for evaluating which conditions?
A. Androgen insensitivity
B. Defects in testosterone biosynthesis
C. 5α-reductase deficiency
D. All of the above
Correct
Incorrect
Consider the conditions that might cause ambiguous genitalia in a 46,XY karyotype.
68. Question
Which type of medication can be used to increase plasma LH and FSH levels by blocking estradiol negative feedback in men?
A. Selective estrogen response modulators (SERMs)
B. Nonsteroidal antiandrogens
C. Ketoconazole
D. GnRH analogs
Correct
Incorrect
Consider the medications that have an impact on estradiol levels or its effects.
69. Question
In adult men with primary testicular failure, how does hCG affect serum testosterone levels?
A. Increases testosterone levels significantly
B. Has no effect on testosterone levels
C. Increases testosterone levels less than in eugonadal men
D. Decreases testosterone levels
Correct
Incorrect
Think about the difference in endogenous serum LH concentrations between men with primary testicular failure and eugonadal men.
70. Question
What is the most common genetic abnormality found in men with non-obstructive azoospermia (NOA)?
A. Klinefelter syndrome (47,XXY and mosaics)
B. Microdeletions of the AZF regions of the Y chromosome
C. 46,XX chromosome constitution with Y-chromosome material
D. Cystic fibrosis
Correct
Incorrect
71. Question
A 52-year-old man presents with a blood pressure (BP) of 150/100 mmHg on each of three measurements obtained on different days, despite adherence to treatment with full doses of at least 3 antihypertensive medications, including a diuretic. Which type of hypertension is most likely present in this patient?
A. Resistant HTN
B. Pseudo-resistant HTN
C. Refractory HTN
D. Sustained HTN
Correct
Incorrect
Consider the BP measurements and the patient's medication history.
72. Question
A 38-year-old African American woman with a family history of early-onset hypertension presents with hypertension and hypokalemia. Which secondary form of hypertension should be considered in this patient?
A. Primary aldosteronism
B. Renovascular hypertension
C. Pheochromocytoma
D. Hypothyroidism
Correct
Incorrect
Consider the patient's demographics, family history, and lab abnormalities.
73. Question
A 46-year-old patient with a history of obstructive sleep apnea presents with hypertension that remains uncontrolled despite the use of four antihypertensive medications, including a diuretic. What type of hypertension is most likely present in this patient?
A. Resistant HTN
B. Pseudo-resistant HTN
C. Refractory HTN
D. White-coat HTN
Correct
Incorrect
Consider the patient's medication history and the presence of obstructive sleep apnea.
74. Question
A 55-year-old patient presents with hypertension, spontaneous hypokalemia, and metabolic alkalosis. Which secondary form of hypertension is most likely present in this patient?
A. Primary aldosteronism
B. Renovascular hypertension
C. Pheochromocytoma
D. Hypothyroidism
Correct
Incorrect
Consider the patient's laboratory abnormalities.
75. Question
A 60-year-old patient presents with hypertension and has an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. Which secondary form of hypertension should be considered in this patient?
A. Primary aldosteronism
B. Renovascular hypertension
C. Pheochromocytoma
D. Hypothyroidism
Correct
Incorrect
Consider the patient's hypertension and imaging findings.
76. Question
A 35-year-old patient with a history of neurofibromatosis type 1 presents with hypertension. Which secondary form of hypertension is most likely present in this patient?
A. Primary aldosteronism
B. Renovascular hypertension
C. Pheochromocytoma
D. Hypothyroidism
Correct
Incorrect
Consider the patient's history and the association between the secondary form of hypertension and their pre-existing condition.
77. Question
A 45-year-old patient with a history of worsening glycemic control and spinal osteoporosis presents with hypertension. Which secondary form of hypertension is most likely present in this patient?
A. Primary aldosteronism
B. Renovascular hypertension
C. Pheochromocytoma
D. Cushing syndrome
Correct
Incorrect
Consider the patient's history and the associated symptoms of the secondary form of hypertension.
78. Question
A 65-year-old male patient with a history of atherosclerosis and coronary artery disease presents with sudden onset of severe hypertension (≥160/100 mm Hg) and abdominal bruit. Which secondary form of hypertension is most likely present in this patient?
A. Renal Vascular Hypertension
B. Primary Aldosteronism
C. Thyrotoxicosis
D. Cushing Syndrome
Correct
Incorrect
Consider the patient's history and the association between the secondary form of hypertension and their comorbid conditions.
79. Question
A 30-year-old female patient presents with severe hypertension, hypokalemia, and metabolic alkalosis. Which genetic condition should be considered in this patient?
A. Liddle Syndrome
B. Glucocorticoid Resistance Syndrome
C. Familial Hyperaldosteronism
D. Pseudohypaldosteronism Type 2
Correct
Incorrect
Consider the patient's clinical presentation and the association with specific genetic conditions.
80. Question
A 20-year-old phenotypic female patient presents with hypertension, hypokalemia, and absence of secondary sexual characteristics. Which genetic condition should be considered in this patient?
A. 11β-hydroxylase deficiency
B. 17α-hydroxylase deficiency
C. Liddle Syndrome
D. Pseudohypaldosteronism Type 2
Correct
Incorrect
Consider the patient's clinical presentation and the association with specific genetic conditions.
81. Question
A 40-year-old patient presents with headache, palpitations, sweating, pallor, and paroxysmal hypertension. Which secondary form of hypertension is most likely present in this patient?
A. Primary Aldosteronism
B. Thyrotoxicosis
C. Pheochromocytoma and Paraganglioma
D. Cushing Syndrome
Correct
Incorrect
82. Question
A 64-year-old male patient with a history of hypertension, coronary artery disease, and diffuse atherosclerosis presents with refractory hypertension despite being on multiple antihypertensive agents. Which of the following findings would raise the suspicion of renovascular hypertension (RVH) in this patient?
A. Absence of abdominal bruit
B. Unilateral small kidney (≤9 cm) with no other explanation
C. Sudden onset of severe hypertension after the age of 55 years
D. Decrease in serum creatinine after administration of ACEi or ARB
Correct
Incorrect
Consider the clinical findings associated with an increased possibility of RVH.
83. Question
Which diagnostic test is considered the gold standard for confirming the diagnosis of renal artery stenosis (RAS)?
A. Duplex ultrasonography
B. Computed tomography angiography (CTA)
C. Gadolinium-enhanced magnetic resonance angiography (MRA)
D. Renal artery angiography
Correct
Incorrect
Recall the gold standard test for diagnosing renal artery stenosis.
84. Question
Which of the following non-invasive tests for diagnosing renovascular hypertension (RVH) is the most sensitive for imaging proximal renal arteries but suboptimal for significant distal lesions, accessory renal arteries, and fibromuscular dysplasia (FMD)?
A. Computed tomography angiography (CTA)
B. Duplex ultrasonography
C. Gadolinium-enhanced magnetic resonance angiography (MRA)
D. Captopril renography
Correct
Incorrect
Consider the sensitivities and specificities of various non-invasive tests for diagnosing RVH.
85. Question
A 72-year-old female patient with a history of obesity and recurrent episodes of flash pulmonary edema is suspected to have renovascular hypertension. Which of the following tests for diagnosing RVH may be less sensitive due to the patient's obesity?
A. Duplex ultrasonography
B. Computed tomography angiography (CTA)
C. Gadolinium-enhanced magnetic resonance angiography (MRA)
D. Renal artery angiography
Correct
Incorrect
Consider which test's results might be affected by obesity.
86. Question
Which of the following patient profiles is most suggestive of renal vascular hypertension (RVH)?
A. A 28-year-old female with a sudden onset of severe hypertension (≥160/100 mm Hg) and abdominal bruit
B. A 62-year-old male with well-controlled hypertension on two antihypertensive medications and no other comorbidities
C. A 40-year-old male with hypertension controlled by lifestyle modifications alone
D. A 55-year-old female with stable hypertension and a history of coronary artery disease
Correct
Incorrect
Consider age, sex, and clinical findings related to RVH.
87. Question
Which diagnostic test has the highest sensitivity and specificity for diagnosing renal artery stenosis (RAS)?
A. Duplex ultrasonography
B. Computed tomography angiography (CTA)
C. Gadolinium-enhanced magnetic resonance angiography (MRA)
D. Renal artery angiography
Correct
Incorrect
Consider the gold standard test for diagnosing RAS.
88. Question
In which of the following patient populations is the use of gadolinium-enhanced magnetic resonance angiography (MRA) contraindicated?
A. Patients with a history of claustrophobia
B. Patients with a metallic implant (pacemaker, surgical clips on vascular aneurysms)
C. Patients with acute or chronic kidney disease and eGFR <30 mLmin
D. All of the above
Correct
Incorrect
Consider the contraindications of gadolinium-enhanced MRA.
89. Question
Which of the following clinical presentations is most likely to be associated with atherosclerotic renal artery stenosis (ARAS) rather than fibromuscular dysplasia (FMD)?
A. A 25-year-old female with a sudden onset of severe hypertension and evidence of generalized vascular disease
B. A 65-year-old male with a sudden onset of severe hypertension and evidence of generalized vascular disease
C. A 30-year-old male with moderate hypertension and unilateral small kidney
D. A 40-year-old female with refractory hypertension and abdominal bruit
Correct
Incorrect
Consider the demographic differences between ARAS and FMD.
90. Question
Which of the following diagnostic tests for renal artery stenosis is most likely to have results that are operator dependent?
A. Duplex ultrasonography
B. Computed tomography angiography (CTA)
C. Gadolinium-enhanced magnetic resonance angiography (MRA)
D. Renal artery angiography
Correct
Incorrect
Consider which diagnostic test's accuracy varies depending on the skill of the operator.
91. Question
In a patient with renal vascular hypertension, which of the following findings would likely be observed after administration of an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB)?
A. A decrease in serum creatinine
B. A decrease in plasma renin activity (PRA)
C. An increase in glomerular filtration rate (GFR)
D. An elevation of serum creatinine ≥30%
Correct
Incorrect
Consider the effect of ACEi or ARB on renal function in patients with renal vascular hypertension.
92. Question
A 45-year-old woman presents with a round face, facial plethora, proximal myopathy, and purple striae. She also has a history of hypertension and type 2 diabetes. Which test would be the most appropriate initial screening test for her suspected condition?
A. Random serum cortisol
B. Late-night salivary cortisol (LNSC)
C. 8-mg dexamethasone suppression test
D. Urinary 17-ketosteroids
Correct
Incorrect
Consider the signs and symptoms of Cushing syndrome and the most appropriate tests for detecting hypercortisolism.
93. Question
A 52-year-old man with an adrenal incidentaloma undergoes a 1-mg overnight dexamethasone suppression test (ODST). His morning cortisol level is 4.5 mcg/dL. What is the most likely interpretation of this test result?
A. Autonomous cortisol secretion
B. Cushing syndrome
C. Pseudo-Cushing syndrome
D. Normal cortisol suppression
Correct
Incorrect
Consider the context of an adrenal incidentaloma and the interpretation of the 1-mg overnight dexamethasone suppression test.
94. Question
A 30-year-old woman with suspected Cushing syndrome has two urine free cortisol (UFC) tests with results above the upper limit of normal. Which condition could lead to a false-positive UFC result?
A. Adrenal adenoma
B. Primary aldosteronism
C. Pseudo-Cushing syndrome
D. Conn's syndrome
Correct
Incorrect
Consider conditions that can cause false-positive UFC results.
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My Endo Consult
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myendoconsult.com
September 21, 2023
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