MKSAP Review UPDATED ACTUAL
Exam Questions and CORRECT Answers
Patient with primary hypothyroidism and now has hypogonadism, what should you check? -
CORRECT ANSWER✔✔- check PRL, primary hypothyroidism --> prolactinoma
- tx; thyroid replacement
Diagnosis of acromegaly? - CORRECT ANSWER✔✔- check IGF-1
confirm with OGGT, glucose load suppresses GH, if GH is elevated, diagnostic of
acromegaly!
then get MRI
Tx: transphenoidal tumor resection - curative
Medical tx: octreotide, pegvisomant if fails somatostatin analogues
Incidentaloma, first question? is it functioning? fist hormone to check? - CORRECT
ANSWER✔✔- prolactin level
- also check IGF-1, 24 hour urine cortisol or dexamethaone suppression test, TSH
- if no mass effect, and no hormones, repeat MRI in 6 mo or 12 (macro vs. microadenoma).
What is the best measure of hyperthyroidism? - CORRECT ANSWER✔✔- Free T4
TSH - best screening testfg
What is side effect of glipizide? - CORRECT ANSWER✔✔- weight gain
hypoglycemia
Patient with hypercortisolism, what do you need to screen for? - CORRECT ANSWER✔✔-
osteporosis
get a DEXA scan
,Patient pregnant on levothyroxine, what dose adjustment do you likely have to do? -
CORRECT ANSWER✔✔- have to increase levothyroxine dose
Enlarging goiter in patietn with long h/o hypothyroidism, need to be concerned about? -
CORRECT ANSWER✔✔- thyroid lymphoma
Patient with lab evidence of hyperthyroidism, need to also check for? - CORRECT
ANSWER✔✔- vitamin D levels and replete if low because this can also contributed to
hyperparathyroidisim
When is cinacalcet used? - CORRECT ANSWER✔✔- calcimimetic agent used to lower the
calcium for symptomatic patients with kidney involvement
What is preferred insulin regimen in non-critical patient hospitalized with also diabetes? -
CORRECT ANSWER✔✔- start weight based basal and prandial insulin dosing
What is the best screening test for cushing syndrome? - CORRECT ANSWER✔✔- 1mg
dexamethasone suppression test
What are the two things you should check for in an incidentally noted adrenal mass? -
CORRECT ANSWER✔✔- check plasma free metanephrines for pheochromocytoma and
also check for cushings with 24 h urine cortisol
Patient with DM, CKD stage 4 with an A1c of 6.2 but BS's 140-190's. What is best way to
measure control of DM? this discrepancy? - CORRECT ANSWER✔✔- A1c is unreliable in
CKD4 patients, can be falsely elevated
need to check postprandial blood sugars!
34 yo with virilization, deeper voice, hairs on chin, elevated testosterone levels, next
diagnostic step? - CORRECT ANSWER✔✔- need to get abdominal CT scan to look for an
androgen producing adrenal tumor
Patient with well controlled type 1 DM with fasting blood sugars 80-150. She is concerned
her A1c values are still above 7, what can we do to her insulin regimen? - CORRECT
ANSWER✔✔- Need to start continuous glucose monitoring
,Intermittent glucose monitoring is recommended when post-prandial hyperglycemia or dawn
phenomenon, or overnight hypoglycemia is suspected**
Patient recently diagnosed with pheochromocytoma, has hypertension, what medication
should he be on? - CORRECT ANSWER✔✔- phenoxybenzamine - alpha blocker
Don't give propanolol first- beta blocker caues unopposed alpha --> can precipitate
hypertensive crisis
38 yo with panhypopituitarism with worsening fatigue and weight gain. He has h/o
transphenoidal resection of craniopharyngeoma at age 18 and required anterior pituitary
hormone replacement and desmopressin. TSH 0.8, T4 is 0.7,IGF wnl, prl at 18, what is the
next medical management? - CORRECT ANSWER✔✔- He has a low free T4, he should
have his levothyroxine dose increased. Paitent with 2ndary hypothyroidism have LOW or
LOW-normal TSH but free T4 is low! can't rely on TSH levels in patients with pituitary
dysfunction
80 yo patient with hypthyroidism and fatigue with TSH of 6.4, and Free T4 of 1.3, what is the
most appropriate management? - CORRECT ANSWER✔✔- Clinical f/u and repeat the TSH
and free T4
- the TSH may be mildly elevated above the reference level in elderly patients. His T4 is wnl
so no medication adjustments now.
Patient with acromegaly and MRI shows a 2.5 x 1.8cm pituitary macroadenoma elevating the
optic chiasm and enveloping the L carotid artery. What is the most appropriate next step? Rx
or Sx? - CORRECT ANSWER✔✔- NEED SURGERY!
transphenoidal resection of pituitary adenoma is initial treatment of choice for acromegaly!
47 yo s/p thyroidectomy for papillary thyroid cancer, path shows 3.5 cm papillary thyroid
cancer with 6 malignant lymph nodes out of 35 dissected. Next step? - CORRECT
ANSWER✔✔- Need radioactive iodine therapy
RAI is most appropriate for patients who are at high risk of cancer recurrence based on his
age, tumor size and LN invovlement
- doxorubicin used for anaplastic thyroid cancer
, Patient with chronic pancreatitis and now has diabetes, what is most appropriate treatment
regimen for his dm? - CORRECT ANSWER✔✔- no orals, need to start INSULIN because he
has acquired dm1 from chronic pancreatitis ( pancreoprivic diabetes)
Patient with PCOS and wants to get pregnant, what is best approach? - CORRECT
ANSWER✔✔- First start with SERM - clomiphene citrate to induce ovulation, if not help,
then can consider in vitro fertilization
Microprolactinoma in asymptomatic, postmenopausal woman? - CORRECT ANSWER✔✔-
No tx
Just surveillance in 12 mo
HY$$ 72 yo man in ER for hypoglycemia, BS 41, had several episodes of diaphoresis
overnight, last meal 7 hours ago, he takes lisinopril and ibuprofen, hypoglycemic study
obtained, next diagnostic strategy? - CORRECT ANSWER✔✔- He should get a 72 hour fast
with hypoglycemic studies at the time of symptomatic hypoglycemia, recreates the scene of
hypoglycemia, at that point hypoglycemic studies should be obtained
29 you women here for f/u eval, has DM2, A1c at 7.5, fasting BS's wnl, next step? -
CORRECT ANSWER✔✔- Check POST-PRANDIAL blood sugars
A1c goal is < 6.5 in young patients w/o any microvascular complications
- if 1-2 hour postprandial BS > 180, then her mealtime insulin should be increased
Patient with hyperthyroidism and graves opthalmopathy, tx? - CORRECT ANSWER✔✔-
Methimazole
Patient with infertility, husband has fathered child previous marriage. Has h/o PID. NExt
step? - CORRECT ANSWER✔✔- She needs Hysterosalphingogram
Patient with AMS, Calcium is 18.2, chlorthalidone was discontinued, IV saline started, what
is the next step? calcitonin, cincalcet, Hemodialysis, zolendronic acid? - CORRECT
ANSWER✔✔- She has severe hypercalcemia with AMS and AKI, needs hemodialysis.
- zolendronic acid contraindicated in kidney disease
Exam Questions and CORRECT Answers
Patient with primary hypothyroidism and now has hypogonadism, what should you check? -
CORRECT ANSWER✔✔- check PRL, primary hypothyroidism --> prolactinoma
- tx; thyroid replacement
Diagnosis of acromegaly? - CORRECT ANSWER✔✔- check IGF-1
confirm with OGGT, glucose load suppresses GH, if GH is elevated, diagnostic of
acromegaly!
then get MRI
Tx: transphenoidal tumor resection - curative
Medical tx: octreotide, pegvisomant if fails somatostatin analogues
Incidentaloma, first question? is it functioning? fist hormone to check? - CORRECT
ANSWER✔✔- prolactin level
- also check IGF-1, 24 hour urine cortisol or dexamethaone suppression test, TSH
- if no mass effect, and no hormones, repeat MRI in 6 mo or 12 (macro vs. microadenoma).
What is the best measure of hyperthyroidism? - CORRECT ANSWER✔✔- Free T4
TSH - best screening testfg
What is side effect of glipizide? - CORRECT ANSWER✔✔- weight gain
hypoglycemia
Patient with hypercortisolism, what do you need to screen for? - CORRECT ANSWER✔✔-
osteporosis
get a DEXA scan
,Patient pregnant on levothyroxine, what dose adjustment do you likely have to do? -
CORRECT ANSWER✔✔- have to increase levothyroxine dose
Enlarging goiter in patietn with long h/o hypothyroidism, need to be concerned about? -
CORRECT ANSWER✔✔- thyroid lymphoma
Patient with lab evidence of hyperthyroidism, need to also check for? - CORRECT
ANSWER✔✔- vitamin D levels and replete if low because this can also contributed to
hyperparathyroidisim
When is cinacalcet used? - CORRECT ANSWER✔✔- calcimimetic agent used to lower the
calcium for symptomatic patients with kidney involvement
What is preferred insulin regimen in non-critical patient hospitalized with also diabetes? -
CORRECT ANSWER✔✔- start weight based basal and prandial insulin dosing
What is the best screening test for cushing syndrome? - CORRECT ANSWER✔✔- 1mg
dexamethasone suppression test
What are the two things you should check for in an incidentally noted adrenal mass? -
CORRECT ANSWER✔✔- check plasma free metanephrines for pheochromocytoma and
also check for cushings with 24 h urine cortisol
Patient with DM, CKD stage 4 with an A1c of 6.2 but BS's 140-190's. What is best way to
measure control of DM? this discrepancy? - CORRECT ANSWER✔✔- A1c is unreliable in
CKD4 patients, can be falsely elevated
need to check postprandial blood sugars!
34 yo with virilization, deeper voice, hairs on chin, elevated testosterone levels, next
diagnostic step? - CORRECT ANSWER✔✔- need to get abdominal CT scan to look for an
androgen producing adrenal tumor
Patient with well controlled type 1 DM with fasting blood sugars 80-150. She is concerned
her A1c values are still above 7, what can we do to her insulin regimen? - CORRECT
ANSWER✔✔- Need to start continuous glucose monitoring
,Intermittent glucose monitoring is recommended when post-prandial hyperglycemia or dawn
phenomenon, or overnight hypoglycemia is suspected**
Patient recently diagnosed with pheochromocytoma, has hypertension, what medication
should he be on? - CORRECT ANSWER✔✔- phenoxybenzamine - alpha blocker
Don't give propanolol first- beta blocker caues unopposed alpha --> can precipitate
hypertensive crisis
38 yo with panhypopituitarism with worsening fatigue and weight gain. He has h/o
transphenoidal resection of craniopharyngeoma at age 18 and required anterior pituitary
hormone replacement and desmopressin. TSH 0.8, T4 is 0.7,IGF wnl, prl at 18, what is the
next medical management? - CORRECT ANSWER✔✔- He has a low free T4, he should
have his levothyroxine dose increased. Paitent with 2ndary hypothyroidism have LOW or
LOW-normal TSH but free T4 is low! can't rely on TSH levels in patients with pituitary
dysfunction
80 yo patient with hypthyroidism and fatigue with TSH of 6.4, and Free T4 of 1.3, what is the
most appropriate management? - CORRECT ANSWER✔✔- Clinical f/u and repeat the TSH
and free T4
- the TSH may be mildly elevated above the reference level in elderly patients. His T4 is wnl
so no medication adjustments now.
Patient with acromegaly and MRI shows a 2.5 x 1.8cm pituitary macroadenoma elevating the
optic chiasm and enveloping the L carotid artery. What is the most appropriate next step? Rx
or Sx? - CORRECT ANSWER✔✔- NEED SURGERY!
transphenoidal resection of pituitary adenoma is initial treatment of choice for acromegaly!
47 yo s/p thyroidectomy for papillary thyroid cancer, path shows 3.5 cm papillary thyroid
cancer with 6 malignant lymph nodes out of 35 dissected. Next step? - CORRECT
ANSWER✔✔- Need radioactive iodine therapy
RAI is most appropriate for patients who are at high risk of cancer recurrence based on his
age, tumor size and LN invovlement
- doxorubicin used for anaplastic thyroid cancer
, Patient with chronic pancreatitis and now has diabetes, what is most appropriate treatment
regimen for his dm? - CORRECT ANSWER✔✔- no orals, need to start INSULIN because he
has acquired dm1 from chronic pancreatitis ( pancreoprivic diabetes)
Patient with PCOS and wants to get pregnant, what is best approach? - CORRECT
ANSWER✔✔- First start with SERM - clomiphene citrate to induce ovulation, if not help,
then can consider in vitro fertilization
Microprolactinoma in asymptomatic, postmenopausal woman? - CORRECT ANSWER✔✔-
No tx
Just surveillance in 12 mo
HY$$ 72 yo man in ER for hypoglycemia, BS 41, had several episodes of diaphoresis
overnight, last meal 7 hours ago, he takes lisinopril and ibuprofen, hypoglycemic study
obtained, next diagnostic strategy? - CORRECT ANSWER✔✔- He should get a 72 hour fast
with hypoglycemic studies at the time of symptomatic hypoglycemia, recreates the scene of
hypoglycemia, at that point hypoglycemic studies should be obtained
29 you women here for f/u eval, has DM2, A1c at 7.5, fasting BS's wnl, next step? -
CORRECT ANSWER✔✔- Check POST-PRANDIAL blood sugars
A1c goal is < 6.5 in young patients w/o any microvascular complications
- if 1-2 hour postprandial BS > 180, then her mealtime insulin should be increased
Patient with hyperthyroidism and graves opthalmopathy, tx? - CORRECT ANSWER✔✔-
Methimazole
Patient with infertility, husband has fathered child previous marriage. Has h/o PID. NExt
step? - CORRECT ANSWER✔✔- She needs Hysterosalphingogram
Patient with AMS, Calcium is 18.2, chlorthalidone was discontinued, IV saline started, what
is the next step? calcitonin, cincalcet, Hemodialysis, zolendronic acid? - CORRECT
ANSWER✔✔- She has severe hypercalcemia with AMS and AKI, needs hemodialysis.
- zolendronic acid contraindicated in kidney disease
