Medicine
Endocrinology
Which complication or major adverse outcome is particularly associated with Central diabetes insipidus?
A. Seizures from severe acute hyponatremia
B. Diabetic kidney disease
C. Hypernatremic dehydration
D. Hypokalemia during treatment
Correct Answer: C
If water intake cannot match urinary losses, severe hypernatremia and dehydration can develop.
Medicine
Endocrinology
A patient is diagnosed with Central diabetes insipidus. Which is the most appropriate management principle?
A. Replace glucocorticoid and mineralocorticoid hormones and give stress-dose steroids during major illness
B. Replace free-water deficit and use desmopressin for confirmed central diabetes insipidus
C. Treat the cause and use fluid restriction for many stable chronic cases; severe symptomatic cases require controlled hypertonic saline
D. Use lifestyle therapy plus individualized glucose-lowering treatment based on comorbidity, risk and patient factors
Correct Answer: B
Desmopressin replaces deficient antidiuretic-hormone activity in central DI.
Medicine
Endocrinology
In a patient with suspected Central diabetes insipidus, which investigation or diagnostic approach is most appropriate at this stage?
A. Paired serum and urine osmolality with specialist-directed testing when diagnosis is uncertain
B. TSH followed by free T4 and/or T3 with cause-specific testing when needed
C. Morning cortisol with ACTH and confirmatory adrenal-function testing when appropriate
D. Serum osmolality, urine osmolality and urine sodium with evaluation for alternative causes
Correct Answer: A
High serum osmolality with dilute urine indicates impaired urinary concentration; response to desmopressin can help distinguish central from nephrogenic DI.
Medicine
Endocrinology
A patient has marked polyuria and polydipsia with dilute urine and rising serum sodium after pituitary-region surgery. What is the most likely diagnosis?
A. Primary hypothyroidism
B. Thyrotoxicosis
C. Primary adrenal insufficiency
D. Central diabetes insipidus
Correct Answer: D
Water diuresis with inappropriately dilute urine after pituitary injury suggests central diabetes insipidus.
Medicine
Endocrinology
Why must chronic hyponatremia generally be corrected in a controlled manner?
A. Slow correction always causes cerebral hemorrhage
B. Sodium correction has no neurologic risk
C. Overly rapid correction can cause osmotic demyelination
D. Rapid correction is required in every asymptomatic patient
Correct Answer: C
The brain adapts to chronic hyponatremia; overly rapid correction can cause osmotic demyelination syndrome.
Medicine
Endocrinology
Which complication or major adverse outcome is particularly associated with Syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
A. Hypokalemia during treatment
B. Seizures from severe acute hyponatremia
C. Thromboembolic events
D. Myxedema coma
Correct Answer: B
Rapid or profound sodium reduction can cause cerebral edema and neurologic deterioration.
Medicine
Endocrinology
A patient is diagnosed with Syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which is the most appropriate management principle?
A. Treat the cause and use fluid restriction for many stable chronic cases; severe symptomatic cases require controlled hypertonic saline
B. Use lifestyle therapy plus individualized glucose-lowering treatment based on comorbidity, risk and patient factors
C. Begin isotonic fluid resuscitation, correct potassium as needed and give insulin once it is safe to do so
D. Prioritize careful intravenous fluid replacement, then manage electrolytes and insulin
Correct Answer: A
Treatment depends on severity and chronicity; severe neurologic symptoms require controlled hypertonic-saline therapy.
Medicine
Endocrinology
In a patient with suspected Syndrome of inappropriate antidiuretic hormone secretion (SIADH), which investigation or diagnostic approach is most appropriate at this stage?
A. Paired serum and urine osmolality with specialist-directed testing when diagnosis is uncertain
B. Confirm diabetes with an accepted plasma glucose or HbA1c-based diagnostic test when confirmation is required
C. Serum or capillary ketones, electrolytes and acid-base assessment
D. Serum osmolality, urine osmolality and urine sodium with evaluation for alternative causes
Correct Answer: D
SIADH is a diagnosis of hypotonic hyponatremia requiring assessment of urine concentration and exclusion of thyroid, adrenal and other causes.
Medicine
Endocrinology
A patient has hypotonic hyponatremia with inappropriately concentrated urine and no obvious edema or severe volume depletion. What is the most likely diagnosis?
A. Primary adrenal insufficiency
B. Central diabetes insipidus
C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
D. Type 2 diabetes mellitus
Correct Answer: C
Euvolemic hypotonic hyponatremia with urine that remains inappropriately concentrated supports SIADH.
Medicine
Endocrinology
What is the immediate treatment priority in suspected adrenal crisis?
A. Delay treatment until all endocrine tests return
B. Prompt parenteral glucocorticoid plus intravenous fluid resuscitation
C. Start thyroid hormone alone
D. Restrict intravenous fluids
Correct Answer: B
Adrenal crisis is a medical emergency; treatment should not wait for confirmatory laboratory results.
Medicine
Endocrinology
Which complication or major adverse outcome is particularly associated with Primary adrenal insufficiency?
A. Adrenal crisis with shock
B. Myxedema coma
C. Atrial fibrillation
D. Seizures from severe acute hyponatremia
Correct Answer: A
Acute cortisol deficiency can cause severe hypotension, electrolyte disturbance and shock.
Medicine
Endocrinology
A patient is diagnosed with Primary adrenal insufficiency. Which is the most appropriate management principle?
A. Prioritize careful intravenous fluid replacement, then manage electrolytes and insulin
B. Use levothyroxine replacement with dose adjustment using clinical and biochemical monitoring
C. Control adrenergic symptoms and use cause-specific antithyroid treatment when appropriate
D. Replace glucocorticoid and mineralocorticoid hormones and give stress-dose steroids during major illness
Correct Answer: D
Primary adrenal insufficiency requires chronic hormone replacement and increased glucocorticoid dosing during physiologic stress.
Medicine
Endocrinology
In a patient with suspected Primary adrenal insufficiency, which investigation or diagnostic approach is most appropriate at this stage?
A. Serum or capillary ketones, electrolytes and acid-base assessment
B. Serum glucose, electrolytes, calculated effective osmolality and assessment for a precipitating illness
C. Morning cortisol with ACTH and confirmatory adrenal-function testing when appropriate
D. Serum TSH with free thyroxine
Correct Answer: C
Cortisol and ACTH help identify adrenal insufficiency and distinguish primary from central disease.
Medicine
Endocrinology
A patient has weight loss, postural hypotension, hyperpigmentation, hyponatremia and hyperkalemia. What is the most likely diagnosis?
A. Type 2 diabetes mellitus
B. Primary adrenal insufficiency
C. Diabetic ketoacidosis (DKA)
D. Hyperosmolar hyperglycemic state (HHS)
Correct Answer: B
Hyperpigmentation and mineralocorticoid deficiency suggest primary adrenal failure.
Medicine
Endocrinology
Which finding should raise concern for thyroid storm rather than uncomplicated thyrotoxicosis?
A. Fever with marked tachycardia and altered mental status
B. Mild isolated tremor
C. Stable heart rate with no systemic symptoms
D. Asymptomatic low TSH alone
Correct Answer: A
Thyroid storm is a life-threatening systemic decompensation with hyperthermia, cardiovascular instability and CNS dysfunction.
Medicine
Endocrinology
Which complication or major adverse outcome is particularly associated with Thyrotoxicosis?
A. Seizures from severe acute hyponatremia
B. Hypernatremic dehydration
C. Diabetic kidney disease
D. Atrial fibrillation
Correct Answer: D
Thyrotoxicosis increases adrenergic drive and atrial arrhythmia risk.
Medicine
Endocrinology
A patient is diagnosed with Thyrotoxicosis. Which is the most appropriate management principle?
A. Replace glucocorticoid and mineralocorticoid hormones and give stress-dose steroids during major illness
B. Treat the cause and use fluid restriction for many stable chronic cases; severe symptomatic cases require controlled hypertonic saline
C. Control adrenergic symptoms and use cause-specific antithyroid treatment when appropriate
D. Replace free-water deficit and use desmopressin for confirmed central diabetes insipidus
Correct Answer: C
Beta-blockade often provides rapid symptom control, while definitive therapy depends on the cause of thyrotoxicosis.
Medicine
Endocrinology
In a patient with suspected Thyrotoxicosis, which investigation or diagnostic approach is most appropriate at this stage?
A. Serum TSH with free thyroxine
B. TSH followed by free T4 and/or T3 with cause-specific testing when needed
C. Morning cortisol with ACTH and confirmatory adrenal-function testing when appropriate
D. Serum osmolality, urine osmolality and urine sodium with evaluation for alternative causes
Correct Answer: B
TSH is the key screening test; thyroid hormones confirm biochemical thyrotoxicosis and additional testing identifies the cause.
Medicine
Endocrinology
A patient has weight loss, heat intolerance, tremor, tachycardia and a suppressed TSH. What is the most likely diagnosis?
A. Thyrotoxicosis
B. Hyperosmolar hyperglycemic state (HHS)
C. Primary hypothyroidism
D. Primary adrenal insufficiency
Correct Answer: A
Adrenergic symptoms plus suppressed TSH and elevated thyroid hormones indicate thyrotoxicosis.
Medicine
Endocrinology
What biochemical pattern is most typical of untreated primary hypothyroidism?
A. Low TSH with high free T4
B. High TSH with high free T4
C. Normal TSH with markedly high T3 only
D. High TSH with low free T4
Correct Answer: D
Failure of the thyroid gland lowers T4 and removes negative feedback, causing TSH elevation.