International Conference on Clinical Endocrinology
Post-test
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1. 54 you female  presents with 3 yr history of  new HTN (on 3 medications),  diabetes mellitus treated with metformin and a 40 pound weight gain,  She has experiences spotty irregular menses or 2 years with loss of menses for  5 months. She notes mild hair growth upper lip and chin with some mild acne on upper back.  Endocrine evaluation revealed a non-elevated  FSH, undetectable renin, low aldosterone of 5 mcg/dl, 24 hr urine free cortisol of 170 mcg/24 hr (normal < 90 mcg/24 hr), baseline ACTH  < 5 pg/ml (undetectable), DHEAS 800 mcg/dL (normal <200 mcg/dl)  and a low normal FSH.

 The most likely diagnosis:

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2. If a post AMI patient has a baseline LDL- of 160 mg/dL, what would be your preferred treatment strategy to achieve an LDL-c of <55 mg/dL?
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3.  Which of the following statements corresponds with the modern point of view about the subclinical thyrotoxicosis?  *
4. Which type of autoantibodies should be testedin a first place for definitive diagnosis of type 1 diabetes? *
5.  A 56-year-old man who underwent total thyroidectomy with the result of a classic, multifocal papillary carcinoma, 3.9 cm (largest tumor), located in the left thyroid lobe. Central dissection included 6 lymph nodes; one was metastatic (size 0.15 cm without capsular rupture). Staging: T2,N1a,M0; Stage II. BRAF (+). Antithyroglobulin antibodies (TgAb) were positive. Cervical ultrasound two months after surgery did not show gross lesions in the thyroid bed or cervical lymph nodes. Which of the statements is correct? *
6.  Patient 24 male, with a 2 year history of arterial hypertension, notable laboratory changes – hypokalemia: K 2.4 mmol/l (3.5-5.0 mmol/l). You suspect primary aldosteronism, according to lab results, aldosterone in blood – 218 ng/l (11-236 ng/l), renin in blood <1 ng/l (1.7-23ng/l), aldosterone/renin ratio >218 ng/l. What’s your next step? *
7.  Which of the following statements is incorrect? *
8.  Male 62, former smoker, had NSTEMI 4 months ago, underwent balloon angioplasty with a drug-eluting stent; objective data: T/A 130/75MMHG, HR - 66’, EKG-no acute coronary damage detected; normal ejection fraction; dyastolic dysfunction with relaxation abnormality, without marked valvular pathology; medication: acetylsalicylic acid 81 mg, clopidogrel 75 mg, rosuvastatin 15 mg. Lipid panel: total cholesterol 140 mg/dl, HDL 60 mg/dl, triglycerides 150 mg/dl, LDL 50 mg/dl, ALT 19 mg/dl; what is your tactic of choice in managing the lipid profile next? *
9.  According to the last ADA/EASD consensus report, which group of medications is preferred for treatment of patients with type2 diabetes mellitus and nonalcoholic fatty liver? *
10. Patient 68 year old otherwise healthy male, he’s been taking thyroid hormone replacement therapy for his primary hypothyroidism. He’s taking levothyroxine 100 mcg, due to which his TSH level is 7.9 mIU/ml (0.4-4.0 mIU/ml). Lipid panel shows hypercholesterolemia: total cholesterol - 230 mg/dl (<200 mg/dl), LDL-c – 161 mg/dl (<100 mg/dl), HDL – 43 mg/dl (>40 mg/dl), Trg – 130 mg/dl (<150 mg/dl). What’s your next step? *
11.  Which medication is used for preventing the night hypertension in diabetic patients with neuropathy, who have orthostatic hypotension? *
12. A 22-year-old woman presents with a complain of irregular menstrual bleeding. She had 5-6 menses every year since menarche. She does not complain of increased body hair, acne or alopecia. She denies any chronic medications or significant weight change. On physical examination, her height is 167 cm and weight is 68 kg. BP is 118/72 mmHg, pulse is 76 beats/min. mFG score is 2. Laboratory results: Total testosterone: 23 ng/dl (N<60), TSH, prolactin and 17(OH)P levels are normal. Right ovary is 16 ml and left ovary is 12 ml on pelvic ultrasound.

You consider PCOS as your initial diagnosis. Which of the following is the phenotype of this patient?

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