ABIM Endocrinology UPDATED ACTUAL
Exam Questions and CORRECT Answers
Panretinal laser photocoagulation therapy for diabetic retinopathy typically results in? -
CORRECT ANSWER - retained central vision but poorer peripheral and night vision.
An adrenal incidentaloma that is 6 cm in size or larger and has a high CT attenuation value
requires what therapy? - CORRECT ANSWER - surgical removal
In a patient with secondary amenorrhea and normal findings of screening laboratory studies, the
cornerstone of further evaluation is? - CORRECT ANSWER - a progesterone withdrawal
challenge.
In a patient with secondary amenorrhea and clinical evidence of hyperandrogenism, such as
hirsutism or the presence of virilization (voice deepening, clitoral enlargement) further
evaluation should consist of? - CORRECT ANSWER - total testosterone and
dehydroepiandrosterone levels
In a patient with secondary amenorrhea and elevated prolactin and/or FSH levels further
evaluation should consist of? - CORRECT ANSWER - MRI of the pituitary gland
In a patient with secondary amenorrhea who previously had dilation and curettage or a uterine
infection further evaluation should consist of? - CORRECT ANSWER - pelvic
ultrasonography
* Asherman syndrome due to endometrial scarring should be considered
When should patients with subclinical hypothyroidism be treated with levothyroxine? -
CORRECT ANSWER - if they are at high risk for progression to overt hypothyroidism
* thyroid-stimulating hormone level greater than 10 microunits/mL [10 milliunits/L]
* positive family history
,* goiter
* presence of anti-thyroid peroxidase antibodies
* or desire to become pregnant.
In a patient with disseminated tuberculosis with hypercalcemia consider? - CORRECT
ANSWER - Hypercalcemia can be caused by the production of 1,25-dihydroxyvitamin D
by granulomatous disease with TB or with sarcoidosis, crohn's disease or leprosy.
elevated PTH
hypercalcemia
low serum phosphorus level - CORRECT ANSWER - primary hyperparathyroidism
In patients who have hypercalcemia with malignancy consider what cause? - CORRECT
ANSWER - PTH-related protein (PTHrP)
* PTHrP has most, if not all, of the metabolic effects of PTH, including osteoclast activation,
increased renal tubular calcium reabsorption, and increased clearance of phosphorus by the
kidneys.
What are the expected findings in a patient with Sarcoidosis and hypercalcemia? - CORRECT
ANSWER - High Serum Calcium
High Serum Phosphorus
Low PTH
What is a likely cause of diabetes mellitus in a patient with hypertension, central obesity, and
hypokalemia?
What is the appropriate diagnostic study? - CORRECT ANSWER - * Cushing syndrome
* 24-Hour urine free cortisol excretion
, * an overnight dexamethasone suppression test, or a midnight salivary cortisol measurement can
also make the diagnosis.
* Adrenal CT is appropriate after Cushing syndrome is diagnosed
The most common cause of Cushing syndrome is?
Other causes include? - CORRECT ANSWER - corticosteroid therapy, followed by the
secretion of adrenocorticotropic hormone (ACTH) by a pituitary adenoma (Cushing disease) and
the hyperfunctioning of an adrenocortical adenoma.
In a woman with a modestly elevated serum prolactin level, what diagnosis must first be
excluded as a cause before a diagnosis of hyperprolactinemia is made? - CORRECT
ANSWER - pregnancy
Measurement of the growth hormone (GH) level is not useful in the assessment of a woman with
amenorrhea or oligomenorrhea unless what diagnosis is being considered? - CORRECT
ANSWER - acromegaly
Common symptoms of Cushing syndrome include?
What is the diagnostic test of choice? - CORRECT ANSWER - muscle weakness,
ecchymosis, hypokalemia, unexplained osteoporosis, new-onset hypertension, and diabetes
mellitus
* 24-Hour urine free cortisol excretion
If a patient has had a severe adverse reaction to methimazole can propylthiouracil be substituted?
- CORRECT ANSWER - No, because the likelihood of a similar or worse reaction is high.
Exam Questions and CORRECT Answers
Panretinal laser photocoagulation therapy for diabetic retinopathy typically results in? -
CORRECT ANSWER - retained central vision but poorer peripheral and night vision.
An adrenal incidentaloma that is 6 cm in size or larger and has a high CT attenuation value
requires what therapy? - CORRECT ANSWER - surgical removal
In a patient with secondary amenorrhea and normal findings of screening laboratory studies, the
cornerstone of further evaluation is? - CORRECT ANSWER - a progesterone withdrawal
challenge.
In a patient with secondary amenorrhea and clinical evidence of hyperandrogenism, such as
hirsutism or the presence of virilization (voice deepening, clitoral enlargement) further
evaluation should consist of? - CORRECT ANSWER - total testosterone and
dehydroepiandrosterone levels
In a patient with secondary amenorrhea and elevated prolactin and/or FSH levels further
evaluation should consist of? - CORRECT ANSWER - MRI of the pituitary gland
In a patient with secondary amenorrhea who previously had dilation and curettage or a uterine
infection further evaluation should consist of? - CORRECT ANSWER - pelvic
ultrasonography
* Asherman syndrome due to endometrial scarring should be considered
When should patients with subclinical hypothyroidism be treated with levothyroxine? -
CORRECT ANSWER - if they are at high risk for progression to overt hypothyroidism
* thyroid-stimulating hormone level greater than 10 microunits/mL [10 milliunits/L]
* positive family history
,* goiter
* presence of anti-thyroid peroxidase antibodies
* or desire to become pregnant.
In a patient with disseminated tuberculosis with hypercalcemia consider? - CORRECT
ANSWER - Hypercalcemia can be caused by the production of 1,25-dihydroxyvitamin D
by granulomatous disease with TB or with sarcoidosis, crohn's disease or leprosy.
elevated PTH
hypercalcemia
low serum phosphorus level - CORRECT ANSWER - primary hyperparathyroidism
In patients who have hypercalcemia with malignancy consider what cause? - CORRECT
ANSWER - PTH-related protein (PTHrP)
* PTHrP has most, if not all, of the metabolic effects of PTH, including osteoclast activation,
increased renal tubular calcium reabsorption, and increased clearance of phosphorus by the
kidneys.
What are the expected findings in a patient with Sarcoidosis and hypercalcemia? - CORRECT
ANSWER - High Serum Calcium
High Serum Phosphorus
Low PTH
What is a likely cause of diabetes mellitus in a patient with hypertension, central obesity, and
hypokalemia?
What is the appropriate diagnostic study? - CORRECT ANSWER - * Cushing syndrome
* 24-Hour urine free cortisol excretion
, * an overnight dexamethasone suppression test, or a midnight salivary cortisol measurement can
also make the diagnosis.
* Adrenal CT is appropriate after Cushing syndrome is diagnosed
The most common cause of Cushing syndrome is?
Other causes include? - CORRECT ANSWER - corticosteroid therapy, followed by the
secretion of adrenocorticotropic hormone (ACTH) by a pituitary adenoma (Cushing disease) and
the hyperfunctioning of an adrenocortical adenoma.
In a woman with a modestly elevated serum prolactin level, what diagnosis must first be
excluded as a cause before a diagnosis of hyperprolactinemia is made? - CORRECT
ANSWER - pregnancy
Measurement of the growth hormone (GH) level is not useful in the assessment of a woman with
amenorrhea or oligomenorrhea unless what diagnosis is being considered? - CORRECT
ANSWER - acromegaly
Common symptoms of Cushing syndrome include?
What is the diagnostic test of choice? - CORRECT ANSWER - muscle weakness,
ecchymosis, hypokalemia, unexplained osteoporosis, new-onset hypertension, and diabetes
mellitus
* 24-Hour urine free cortisol excretion
If a patient has had a severe adverse reaction to methimazole can propylthiouracil be substituted?
- CORRECT ANSWER - No, because the likelihood of a similar or worse reaction is high.
