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PANCE ENDOCRINOLOGY BOARD
EVALUATION 2026 GUARANTEED PASS
ANSWERS GRADED A+
โ A 66 M presents to the office today because his diabetes is out of control and we would like help getting his blood sugars back to normal. He only currently takes Metformin 1000 mg BID. You discuss a few medications with him including Glipizide, Insulin Glargine, and Empagliflozin. He states his only fear with starting a new medication is low blood sugars. Which of the medications discussed is least likely to cause hypoglycemia? Answer: Empagliflozin All types of insulin have the risk of causing low blood sugars Glipizide is a Sulfonylurea which has a risk of low blood sugar โ What is the most common type of thyroid cancer? Answer: Papillary thyroid carcinoma โ A non-pregnant adult with subclinical hypothyroidism should be treated with thyroid hormone replacement when their TSH reaches what level? Answer: TSH of 10 or more โ A 27 F with a history of bipolar disorder presents to the office complaining of fatigue, constipation, and weight gain. Labs demonstrate
that she is biochemically hypothyroid. What medication is this patient likely taking that lead to the diagnosis of hypothyroidism? Answer: Lithium Lithium is a first line medication for bipolar and it requires labs every 6 months to check for thyroid function Another medication that can cause hypothyroidism is amiodarone โ A 37 F presents to the office complaining that she is having trouble losing weight despite following a strict diet and exercise. On exam, you note central obesity, thin extremities, oily skin, and striae across her abdomen. A screening test to check for what hormone should be checked in this patient? Answer: Serum cortisol this patient has classic findings of Cushing's syndrome โ A patient with secondary hypothyroidism will have an abnormality in what part of the hypothalamic-pituitary-thyroid axis? Answer: pituitary gland secondary hypothyroidism is caused by TSH deficiency โ What is the most common cause overall of Cushing's syndrome? Answer: Exogenous glucocorticoids
โ What medication class, if given to a patient with pheochromocytoma before initiating treatment with alpha-adrenergic blockers, can cause unopposed alpha constriction and lead to a hypertensive crisis? Answer: Beta blockers Never give beta blockers before alpha blockers in these patients โ What is the most common cause of hypothyroidism in the US? Answer: Hashimoto's thyroiditis โ A patient with a history of Grave's disease presents with bilateral, scaly, non-pitting, induration of the skin in the lower extremities, with brown patches throughout. What is the name of this likely diagnosis? Answer: Pretibial myxedema โ When treating a patient with Grave's disease, which medication should be used in the 1st trimester? Answer: PTU PTU is used in first trimester "Pregnancy trimester uno" = PTU Methimazole in 2nd and 3rd - Methimazole is the preferred agent in almost ALL OTHER cases
โ A patient develops bladder cancer, and it is suspected that one of the medications he uses for diabetes is to blame. Which diabetes medication is this patient likely taking? Answer: Pioglitazone TZD class Z for zones - ends in "zone" โ A patient with Cushing's Disease should have what response in their serum cortisol levels after administration of high dose dexamethasone? Answer: Suppression of serum cortisol Cushing's Disease is the only thing to suppress cortisol in high-dose dexamethasone suppression test โ A 47 F presents to the office 2 weeks post-op after having a thyroidectomy performed. She complains of muscle cramping, muscle spasms, and a tingling sensation in her extremities. An ECG shows QT prolongation. What is the likely cause of her symptoms? Answer: Hypocalcemia from hypoparathyroidism Cause is likely hypoparathyroidism after surgical resection of parathyroid glands during the thyroidectomy โ A 37 F presents to the office today because she has not had her period in 4 months. She is not sexually active and denies any chance of
โ How soon after the initiating of thyroid hormone replacement should a patient with primary hypothyroidism have their TSH levels checked? Answer: 4-6 weeks โ A 42 M presents to the office for routine labs. The results of the labs show an elevated TSH level and free T4 levels which are within normal limits. The patient is otherwise healthy and asymptomatic. What diagnosis should be suspected in this patient? Answer: Subclinical hypothyroidism โ A physical exam is performed on a newborn female due to abnormalities detected at birth. The newborn has dry skin, swelling around the eyes, enlargement of the tongue, and an umbilical hernia palpated on exam. What nutritional deficiency should be suspected in the mother of the newborn? Answer: Iodine deficiency this patient has Cretinism, or untreated congenital hypothyroidism - macroglossia and swelling around the eyes is suggestive โ A 37 F presents to the office complaining of persistent fatigue, combined with nausea, generalized abdominal pain, and a brownish discoloration on her hands, elbows, and knees. Labs show elevated serum potassium, and a blood glucose of 63. What is the likely diagnosis in this patient? Answer: Addison's disease
Hyperpigmentation, Hyperkalemia, and Hypoglycemia are characteristic of Addison's โ What would the ACTH levels be in a patient with primary adrenocortical insufficiency? Answer: Elevated Primary adrenocortical insufficiency is from decreased production by the adrenals, so the ACTH will be high, but the aldosterone levels and cortisol levels are low the increased ACTH is actually what causes the hyperpigmentation โ A 36 F presents to the office complaining of fatigue, constantly feeling cold, dry skin, and weight gain. If thyroid levels were drawn in this patient, what would the TSH and T4 likely show? Answer: Elevated TSH, low T โ A patient with hypothyroidism comes in for routine follow up and to review labs she had done to evaluate her thyroid hormone levels. She takes 50 mcg of Levothyroxine daily and has been on this dose for the last 9 years with no issues. Her labs come back indicating that she is biochemically hypothyroid, and her TSH is 11. She states that she has not made any changes since the last visit and assures you that she always takes her Levothyroxine first thing in the morning, and waits an hour before heating or taking any other pills. She has not started any new medications, just and OTC medication she started a few weeks ago for
Risperidone causes hyperprolactinemia because it is a dopamine agonist โ What medication can be used in a patient with primary hyperparathyroidism to lower serum calcium and serum PTH that is not a candidate for surgery? Answer: Cinacalcet โ A patient with a history of type I diabetes presents with tachycardia, weakness, altered mental status, and fruity acetone breath. A finger stick is done bedside which shows a glucose of 560, and his urine is positive for ketones. On exam, you note deep, rapid, and labored breathing. These respirations are a compensatory mechanism for what acid-based disorder that is likely present in this patient? Answer: High Anion Gap Metabolic acidosis โ A patient presents to the ER after sustaining a head injury in a motor vehicle accident. Since the accident he has been urinating more frequently than normal and has developed an insatiable thirst. His urine is dilute and a fingerstick shows a glucose of 98. What is the first line treatment for this patient? Answer: Desmopressin โ A 46 M is diagnosed with SIADH. He has a history of seizures, asthma, hypothyroidism, and hyperlipidemia, and is taking atorvastatin, levothyroxine, albuterol inhaler, and Carbamazepine. Discontinuation of what medication is recommended in this patient? Answer: Carbamazepine
Almost all anticonvulsants have the potential to cause SIADH โ What screening test should be done annually for diabetic patients annually to screen for early signs of diabetic nephropathy? Answer: urinary albumin - spot urinary albumin-to-creatinine ratio anything > 30 is moderately increased albuminuria โ What is the most common cause of diabetic ketoacidosis? Answer: Infection (pneumonia, UTI) โ A patient with hypocalcemia has contraction of facial muscles provoked by lightly tapping on the facial nerve just anterior to the ear. This is called? Answer: Chvostek sign โ A 64 F with history of DM 2 presents to the office due to her blood glucose running higher for the past few months. She has made dietary changes, as well as increasing her activity level with no improvement in her readings. She agrees to add another medication to her regimen, and you discuss a few medications including Empagliflozin, Liraglutide, and Glipizide. She states her only requirement is for the medication to not cause weight gain. Which of the 3 medications should be avoided? Answer: Glipizide If you SIT too much, you can get fat = SIT can cause weight gain
โ A 67 M with a history of DM 2 presents to the office today complaining of shortness of breath that is increasingly getting worse. He has also noted some unexplained weight gain, as well as swelling of his lower legs. On exam, pitting edema is noted in the lower legs, and rales are auscultated at the lung bases. He was started on a new oral diabetic medication a few months ago but he cannot remember the name. Which class of diabetic medications was he likely started on? Answer: TZDs this patient was likely started on rosiglitazone โ A 45 M presents to the office complaining that his wedding band no longer fits and some of his hats seem to be too small. He also complains of headaches, as well as some visual changes. What would be the initial test of choice for this patient to screen for the likely diagnosis? Answer: Insulin-like growth factor this patient has acromegaly, likely from a growth hormone-secreting pituitary adenoma โ A 72 F presents to the office today for a routine checkup. She forgot to bring her medication list but said she was recently started on a new medication for her diabetes. She said all she can remember about the medication is that it is supposed to flush the glucose out through her urine. What class of medication is the patient likely taking? Answer: SGLT-2 inhibitors
"Gliflozin" Glucose Is Flowing out of the body โ What is the most common cause of primary hyperparathyroidism? Answer: parathyroid adenoma โ An 86 F is brought to the ER today by rescue. She was found in her apartment unconscious by her neighbor who called 911. On exam her pulse is 46, her BP is 82/52, and lab findings reveal her free T4 levels are so low they are undetectable. A family member who accompanies the patient today states she normally has a nurse who comes to the house each day to dispense her medications, but unbeknownst to the family, the nurse has not showed up for over 3 weeks. What medication was this patient likely taking daily? Answer: Levothyroxine โ A 36 F presents to the office complaining of fatigue, polyuria, and recurrent candidal infections. Screening for what condition should be performed in this patient? Answer: Diabetes mellitus โ
