B. Formal visual field testing

32 yo M with 1 wk h/o neck pain. Also has heat intolerance, palpitations, and insomnia. Viral URI 3 weeks ago. Thyroid normal size and tender.
TSH<0.008
Free T4 3.2
24 hr RAI uptake 5%

Which is the most appropriate treatment?
A. Methimazole
B. Metoprolol
C. PTU
D. Radioactive iodine

74 yo F with serum calcium 11.3 and PTH 76. Asymptomatic. H/O HTN and CKD 3. Meds:Amlodipine. Creatinine 1.3, GFR 40, Lowest T-score -1.3.
What is the most appropriate recommendation for therapy?
A. Alendronate
B. Cinacalcet
C. Parathyroidectomy
D. Clinical observation

24 yo F with oligomenorrhea (heavy menses approx every 60days) and h/o oligomenorrhea since menarche and mild hirsutism. Currently does not desire fertility. Pregnancy test is negative.

Which is the most appropriate therapy?
A. OCP
B. Levonorgestrel IUD
C. Metformin
D. Periodic progestin to induce withdrawal bleed

57 yo M admitted for evaluation of substernal chest pain. PMH type 2 diabetes, CAD, HTN, HLD. Meds prior to admission: metformin, aspririn, metoprolol, atorvastatin, PRN sl NTG. Inpatient glucose values 170-210 mg/dL.
What is the most appropriate treatment for this patient while hospitalized?
A. Basal and prandial insulin
B. Glipizide
C. Metformin
D. Sliding scale insulin

A 33 yo F is referred for evaluation of Cushing's syndrome. Rapid onset over 6 months of weight gain, edema, HTN, diabetes, and hirsutism.
Normal electrolytes
Urinary free cortisol 532 mcg/24 hrs
Late night salivary cortisol 1.6 mcg /dL
DHEA-S 678 mcg/dL
Plasma ACTH <5 pg/mL
Which of the following radiographic findings is most likely?
A. 8 MM pituitary microadenoma
B. 3 cm right upper lobe lung nodule
C. 3 cm right adrenal mass with low attenuation (8 HU)
D. 6 cm left adrenal mass with high attenuation (74 HU)
E. Bilateral adrenal enlargement without any discrete nodules

A 25 yo F with h/o poorly controlled thyrotoxicosis becomes pregnant. She is currently treated with methimazole. If she continues her current medical regimen, her fetus will be at increased risk for which of the following?
A. Omphalocele
B. Cleft palate
C. Spina Bifida
D. Placenta previa
E. Biliary atresia

22 yo M college student referred for severe hypertriglyceridemia. He has h/o pancreatitis. BMI 29. Weight gain 40 lbs past 3 years.
Which of the following is the most important lifestyle change to recommend?
A. Avoid omega 3 saturated fats
B. Reduce intake on non complex carbs
C. Avoid alcohol
D. Drink more fruit juice
E. Reduce intake of fried foods

57 yo F with acromegaly has GH level of 11.7 ng/Ml and IGF 1 level of 631 ng/mL (78-220) after surgery. She has difficult to control diabetes (A1C 8.4%). She is concerned about the type of adjunctive medical therapy she should have.
Which of the following meds is most likely to worsen her diabetes control?
A. Octreotide LAR
B. Lanreotide depot
C. Pegvisomant
D. Cabergoline
E. Pasireotide

A 27 yo pregnant F seeks advice at 6 weeks gestation with 1st pregnancy. She has salt wasting CAH due to 21 hydroxyls deficiency, for which she takes hydrocortisone and fludrocortisone. She is concerned her baby may have the same condition.
Which is the next best step?
A. Measure her 17 OH progesterone
B. Add dexamethasone 0.5 mg qhs
C. Obtain fetal DNA vis chorionic villus sampling for CYP21A2 mutation analysis
D. Perform amniocentesis to determine fetal sex
E. Perform molecular genetic testing for CYP21A mutations in the father

52 yo F has had hypopituitarism for 10 years after resection of a non functioning pituitary adenoma. She has been on levothyroxine, hydrocortisone, low dose OCP, and GH injections. Because her sister developed breast CA she has decided to stop OCP.
Regarding dosing of the other hormone replacements, which of the following can be expected to occur as a result of stopping OCP?
A. Increase levothyroxine dose
B. Decrease GH dose
C. Increase GH dose
D. Increase hydrocortisone dose
E. Decrease hydrocortisone dose