Episode 57: Endocrinology – The Audio PANCE/PANRE Board Review Podcast – Content Blueprint Review Endocrinology

The Audio PANCE and PANRE Physician Assistant Board Review Podcast

The Audio PANCE/PANRE PA Board Review Podcast

Welcome to episode 57 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I cover ten PANCE and PANRE Board review questions from the SMARTYPANCE course content following the NCCPA content blueprint (download the FREE cheat sheet).

This week we will be covering ten endocrinology board review questions based on the NCCPA PANCE and PANRE Content Blueprint.

Below you will find an interactive exam to complement the podcast.

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Episode 57 – Endocrinology PANCE/PANRE Podcast Quiz

The following 10 questions are linked to NCCPA Content Blueprint lessons from the SMARTYPANCE and PANRE Board review website. If you are a member you will be able to log in and view this interactive video content.

1. A 53-year-old Hispanic woman comes to your clinic for her annual physical exam. She is obese, does not exercise, and regularly eats fried foods. A random blood glucose is 249 mg/dL. Her hemoglobin A1C is 9.5. Which of the following treatments would be weight neutral or cause weight loss in this patient?

A. Glargine
B. Glyburide
C. Actos
D. Metformin
E. Glipizide

Diabetes Mellitus Type 2 is covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: D. Metformin

The patient in this vignette most likely has type II diabetes. Of the given treatments, only metformin is weight neutral in the majority of cases (i.e. it does not cause significant weight gain/loss). Metformin is a first-line treatment for type II DM in most patients. Although the exact mechanism is unknown, it appears to decrease gluconeogenesis and increase insulin sensitivity. There is no risk of hypoglycemia or weight gain (though some patients even lose weight). The most high yield side effect involves lactic acidosis, particularly in patients with renal insufficiency.

A. Glargine, a long-acting insulin, can cause weight gain.
B. Glyburide, a second-generation sulfonylurea, can cause weight gain.
C. Actos, a thiazolidinedione, can cause weight gain.
E. Glipizide, a second-generation sulfonylurea, can cause weight gain.

2. A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The next step in the evaluation is:

A. measurement of T4 and free T3 levels.
B. a radionuclide thyroid scan.
C. a fine needle biopsy.
D. a surgical excision.

Solitary thyroid nodule is covered as part of thyroid neoplastic disease in the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: C. a fine needle biopsy

Fine needle aspiration (FNA) is the first step in the evaluation of a solitary nodule with a normal TSH level. FNA has a high level of accuracy in diagnosing benign versus malignant nodules in this setting.

A. Measurement of T4 and T3 levels would not be of benefit in the evaluation of a solitary thyroid nodule with a normal TSH level.
B. A thyroid scan would be the next step if there were a low TSH level.
D. Surgical excision would be the final step after determination of malignancy or suspicion of malignancy by FNA.

3. An 18-year-old male with a past medical history of type I diabetes presents to the emergency room with polyuria, polydipsia, and dehydration. Vital signs reveal tachycardia and hypotension. The physical exam is significant for dry mucous membranes and decreased skin turgor. In the waiting room, he begins vomiting and complains of intense abdominal pain. You observe him taking rapid, deep breaths, and over the course of his brief stay, getting more somnolent. Which of the following abnormalities would be expected in this patient?

A. Hypernatremia
B. Decreased total body potassium
C. Hypoglycemia
D. Absence of urinary beta-OH-butyrate
E. Non-anion-gap metabolic acidosis

Diabetic ketoacidosis is covered under Diabetes Mellitus Type 1 as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: B. Decreased total body potassium

This type I diabetic is presenting with signs and symptoms of diabetic ketoacidosis (DKA). In DKA, total body potassium stores are generally decreased due to osmotic diuresis. DKA is a life-threatening emergency that may occur in either type I or type II diabetics but is significantly more common in patients with type I. The pathogenesis is related to insulin deficiency resulting in hyperglycemia that leads to osmotic diuresis and hypovolemia. The inability of the body to use the available glucose for ATP production results in ketone formation and eventually an anion gap metabolic acidosis. Serum potassium levels may be low, normal, or elevated, but total body stores are generally low and require repletion. Common precipitating factors include infection, trauma, myocardial infarction, sepsis and, of course, inadequate insulin administration. Patients may present with nausea, vomiting, abdominal pain, Kussmaul respirations (rapid, deep breaths), dehydration, polydipsia, polyuria and may eventually progress to altered mental status.

A. Patients with DKA more often present with hyponatremia. Remember that serum sodium decreases 1.6 mEq/L for every 100 mg/dL increase in glucose.
C. DKA requires hyperglycemia by definition. Hypoglycemia can be a complication of treatment if glucose is not monitored closely.
D. Ketones, such as Beta-OH-Butyrate, are commonly found in patients with DKA since ketogenesis is a normal response to starvation caused by the inadequate transit of serum glucose into cells.
E. Patients with DKA present with an anion-gap metabolic acidosis secondary to ketoacids.

4. A 30-year-old female complains of fatigue, weakness, diminished appetite, weight loss, and syncope. She denies fever, chest or abdominal pain, palpitations, changes in bowel patterns or sleep patterns. Physical examination reveals a thin female, BP 90/65 mmHg, and pulse 80 beats per minute. Pulmonary, cardiovascular, abdominal, and neurologic exam are without abnormalities. Areas of brown and bronze hyperpigmentation are noted on her elbows and the creases of her hands. Which of the following is the most likely diagnosis?

A. Addison’s disease
B. Cushing’s disease
C. Anorexia nervosa
D. Porphyria

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: A. Addison’s disease

Addison’s disease (adrenal insufficiency) would account for all her symptoms, the hypotension, and the hyperpigmentation of the skin.

B. Cushing’s disease, the presence of an ACTH-producing adenoma, is characterized by central obesity, hypertension, moon facies, purple striae, and glucose intolerance.
C. Anorexia nervosa may explain the weakness, weight loss, hypotension, and syncope, however, a normal pulse rate would be an unexpected finding along with the hyperpigmentation.
D. Porphyria presents acutely with anxiety, depression, disorientation, and insomnia.

5. A 39-year-old male presents to your clinic complaining of increasing constant headaches and progressive loss of peripheral vision. His medical and family history is unremarkable. Physical examination reveals bitemporal hemianopsia but is otherwise without any abnormalities. Which of the following is the most likely diagnosis?
Answers

A. An aneurysm involving the circle of Willis
B. A migraine headache
C. Multiple sclerosis
D. Pituitary tumor

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: D. A pituitary tumor

A pituitary tumor would account for the headaches and the loss of the peripheral vision in both visual fields. As the tumor grows, the optic chiasm will be compressed by the tumor.

A. An aneurysm involving the circle of Willis would result in CN III palsy. This would be a rare finding.
B. Although a migraine headache may produce visual field defects, these defects would remit upon resolution of the migraine. It would also be unusual to have the scotomas occur bilaterally.
C. Optic neuritis associated with multiple sclerosis presents with decreased visual acuity, dimness, or color desaturation in the central visual field. It would not affect the periphery.

6. Radioactive iodine is most successful in treating hyperthyroidism that results from

A. Grave’s disease.
B. subacute thyroiditis.
C. Hashimoto’s thyroiditis.
D. papillary thyroid carcinoma.

Watch this ReelDx Video of a 16-year-old with ADHD presents with chest pain and exophthalmos

Diseases of the thyroid gland are covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: A. Grave’s disease.

Radioactive iodine is an excellent method to destroy overactive thyroid tissue of Grave’s disease.

B. Radioactive iodine is ineffective in subacute thyroiditis due to the thyroid’s low uptake of iodine.
C. Radioiodine uptake is low in Hashimoto’s thyroiditis and is often transient.
D. Papillary thyroid carcinoma is a common thyroid malignancy and must be treated by a thyroidectomy.

7. A newborn infant exhibits prolonged jaundice, feeding problems, hypotonia, and an enlarged tongue. Proper treatment in this infant would consist of which of the following?

A. IV antibiotics
B. Thyroid hormone replacement
C. Hepatitis B immunoglobulin
D. Vitamin B6 supplement

This condition is covered as part of the NCCPA Endocrinology Content Blueprint and accounts for 6% of the exam

Click here to see the answer

Answer: B. Thyroid hormone replacement

This scenario is consistent with congenital hypothyroidism. Measurement of TSH or T4 would confirm this and T4 should be given.

C. Hepatitis and sepsis may account for the presence of jaundice, feeding problems, and hypotonia, but would not result in an enlarged tongue.
D. A deficiency in vitamin B6 may lead to glossitis but would not account for or any of the other signs.

8. Which of the following glucose-lowering agents act by delaying glucose absorption?

A. Metformin (Glucophage)
B. Acarbose (Precose)
C. Glipizide (Glucotrol)
D. Pioglitazone (Actos)

Diabetes Mellitus Type 2 and associated medications are covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: B. Acarbose (Precose)

Alpha-glucosidase inhibitors, such as acarbose, reduce glucose by delaying glucose absorption.

A. Metformin, a biguanide, lowers glucose by decreasing hepatic glucose production and increased glucose utilization.
C. Glipizide and other sulfonylureas work by increasing insulin secretion.
D. Pioglitazone is a thiazolidinedione and decreases insulin resistance and increases glucose utilization.c

9. Which of the following conditions may result in hypokalemia?

A. Adrenal adenoma
B. Hypoparathyroidism
C. Hyperthyroidism
D. Adrenal insufficiency

Diseases of the Adrenal Glands are covered as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: A. Adrenal adenoma

Excessive secretion of aldosterone from an adrenal adenoma will lead to sodium retention and the secretion of potassium in the distal tubule of the kidney, eventually leading to hypokalemia.

B. Hypoparathyroidism and hyperthyroidism should not have any effect on potassium levels.
D. Adrenal insufficiency would lead to hyperkalemia.

10. A 7-year-old child with a history of type 1 diabetes mellitus for 3 years presents for routine follow-up. The mother states that the child has been having nightmares and night sweats. Additionally, his average morning glucose readings have risen from an average of 100 mg/dL to 145 mg/dL over the past week. This child is most likely experiencing

A. a growth spurt.
B. emotional problems.
C. the Somogyi effect.
D. the dawn phenomenon.

The Somogyi effect and the dawn phenomenon are covered under Diabetes Mellitus Type 1 as part of the NCCPA Endocrinology Content Blueprint which accounts for 6% of your exam.

Click here to see the answer

Answer: C. the Somogyi effect.

This refers to nocturnal hypoglycemia, which stimulates counter-regulatory hormone release resulting in rebound hyperglycemia.

A. Nightmares and night sweats are not associated with growth spurts.
B. With this limited history, it is impossible to label the child as emotionally unstable.
D. This refers to an early morning rise in plasma glucose due to reduced tissue sensitivity to insulin between 5 AM and 8 AM. It is not associated with nightmares and night sweats.

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