(2026) Q&A
1. A patient with a 20-year history of Cushing's disease who has been taking
hydrocortisone presents with a thick trunk, thin extremities, moon face, buffalo
hump, thin skin with visible capillaries, and slow-healing bruises. To what do you
attribute these symptoms?
A) Decreased adrenal androgen glands
B) Malfunctioning of the adrenal cortex
C) Excessive levels of circulating cortisol
D) Ectopic secretion of adrenocorticotropic hormone
Correct Answer: C) Excessive levels of circulating cortisol
Rationale: The classic physical findings of Cushing's syndrome—truncal obesity, thin
extremities, moon facies, buffalo hump, thin skin, and easy bruising—are caused by
prolonged exposure to excessive circulating cortisol. This can be due to endogenous
overproduction or exogenous corticosteroid use. The adrenal cortex may be
malfunctioning, but the symptoms are the result of the excess cortisol itself.
2. A 56-year-old woman with rheumatoid arthritis has been taking oral
corticosteroids for the past two years and is diagnosed with Cushing's syndrome.
What is the first-line treatment approach?
A) Gradually tapering corticosteroid use
B) Referral for surgery
C) Consideration of radiation therapy
D) Prescribing mifepristone
,Correct Answer: A) Gradually tapering corticosteroid use
Rationale: For Cushing's syndrome caused by exogenous corticosteroid use, the
first-line treatment is to gradually taper the corticosteroid dose to allow the
hypothalamic-pituitary-adrenal (HPA) axis to recover. Abrupt withdrawal can lead to
adrenal crisis. Surgery and radiation are considered for endogenous causes, and
mifepristone is a treatment for endogenous Cushing's syndrome.
3. Untreated Cushing's syndrome can lead to all of the following EXCEPT:
A) Rheumatoid arthritis
B) Hypertension
C) Type 2 diabetes
D) Osteoporosis
Correct Answer: A) Rheumatoid arthritis
Rationale: Chronic hypercortisolism from untreated Cushing's syndrome leads to
significant comorbidities, including hypertension, type 2 diabetes, and osteoporosis.
Rheumatoid arthritis is an autoimmune condition that is not caused by Cushing's
syndrome; in fact, corticosteroids are used to treat it.
4. Which of the following counseling points is correct regarding low testosterone in a
40-year-old male?
A) Testosterone deficiency is due to hypergonadism
B) Abstaining from cigarette smoking has no effect on testosterone
C) Lowering your HbA1c may improve your testosterone levels
D) Stress has no effect on testosterone levels
Correct Answer: C) Lowering your HbA1c may improve your testosterone levels
, Rationale: In men with type 2 diabetes, improving glycemic control (lowering
HbA1c) can lead to improvements in testosterone levels. Low testosterone is due to
hypogonadism, not hypergonadism. Smoking and stress negatively affect
testosterone, so abstaining from smoking and managing stress would be expected to
improve levels.
5. A 24-year-old patient with HIV has a routine viral load test showing a falling viral
load. What does this indicate?
A) A favorable prognostic trend
B) Disease progression
C) The need to be more aggressive with medications
D) Drug resistance mutations
Correct Answer: A) A favorable prognostic trend
Rationale: A falling viral load in a patient with HIV indicates that the antiretroviral
therapy is effective, the virus is being suppressed, and the patient has a favorable
prognosis. A rising viral load would suggest disease progression, the need for
treatment changes, or possible drug resistance.
6. Which medication is used as a first-line treatment in the management of bipolar
disorder?
A) Gabapentin
B) Lithium
C) Lamotrigine
D) Quetiapine
Correct Answer: B) Lithium