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Practice Endocrine System Questions on the Physician Assistant Exam

The endocrine system is made up of different organs located in separate parts of the body. These practice questions are similar to the Physician Assistant Exam (PANCE) endocrinology questions.

Example PANCE Questions

  1. Which of the following can be used in the evaluation of Addison’s disease?

    (A) 24-hour urinary free cortisol

    (B) Low-dose dexamethasone suppression test

    (C) High-dose dexamethasone suppression test

    (D) Morning cortisol level

    (E) MRI of the brain

  2. You are seeing a 50-year-old man who has been treated with a diuretic for hypertension and edema. You do routine lab work and discover a potassium level of 3.4 mg/dL and a calcium level of 10.8 mg/dL. Which medication is this patient likely taking?

    (A) Furosemide (Lasix)

    (B) Acetazolamide (Diamox)

    (C) Chlorthalidone (Hygroton)

    (D) Amiloride (Midamor)

    (E) Aldactone (Spironolactone)

  3. You are evaluating a 35-year-old man with no significant past medical problems. You obtained a lipid panel, and it shows an LDL level of 130 mg/dL. Based on National Cholesterol Education Program (NCEP) guidelines, which of the following would you recommend?

    (A) Recommend lifestyle and dietary changes and then reevaluate.

    (B) Begin ezetimibe (Zetia).

    (C) Initiate treatment with atorvastatin (Lipitor).

    (D) Begin ezetimibe (Zetia) in addition to lifestyle and dietary intervention.

    (E) Initiate treatment with atorvastatin (Lipitor) in addition to lifestyle and dietary interventions.

  4. Which of the following would be on indication for surgical treatment of hyperparathyroidism?

    (A) Development of recurrent kidney stones

    (B) A normal DEXA (also called DXA) scan

    (C) Elevation in the serum sodium level

    (D) Hypophosphatemia

    (E) Persistently low calcium level

  5. A 35-year-old woman with a history of manic depression presents to the clinic with excessive thirst. She doesn’t remember her medication list but recalls one was abruptly stopped. She also states she is urinating a lot more than usual. Her vitals, including blood pressure, are stable. You order some lab work, and the sodium level is 141 mEq/L, the creatinine level is 1.2 mg/dL, the blood glucose level is 100 mg/dL, and the calcium level is 9.5 mg/dL. Which test would you order next?

    (A) Urinalysis to look for glucosuria

    (B) Morning (a.m.) cortisol to screen for adrenal insufficiency

    (C) Chemistry panel

    (D) Urine osmolality

    (E) Serum osmolality

  6. You are seeing a 68-year-old man with type 2 diabetes in your office. His last Hgb A1c, done one month ago, was 9.2. In the last three weeks, you made some adjustments in his medication. Which test could you order to see whether there has been any change in his condition?

    (A) Repeat glycosylated hemoglobin (Hgb A1c)

    (B) Sequential postprandial glucose monitoring

    (C) Oral glucose tolerance test

    (D) Albumin/creatinine ratio

    (E) Glycated serum fructosamine (GSP) level

Example PANCE Answers and Explanations

Use this answer key to score the practice endocrine system questions. The answer explanations give you some insight into why the correct answer is better than the other choices.

1. D. A morning (a.m.) cortisol level is used in evaluating adrenal insufficiency and hyponatremia. All the other tests listed are used in evaluating Cushing’s syndrome. You use an MRI of the brain to evaluate for Cushing’s disease (not the same as Cushing’s syndrome) secondary to a pituitary adenoma.

2. C. Choices (D) and (E) are potassium-sparing diuretics and would cause hyperkalemia. Although Choices (A), (B), and (C) all can cause hypokalemia, only Choice (C) can cause hypercalcemia, because it’s a thiazide diuretic. Choice (B) is a carbonic anhydrase inhibitor and can cause hypokalemia and a metabolic acidosis.

3. A. He has no significant risk factors, so his goal LDL is < 160. He requires only lifestyle intervention and dietary modification. If a person has known coronary artery disease and one additional risk factor, the goal should be < 130. If someone has coronary artery disease, congestive heart failure, or diabetes mellitus, you strive to get the LDL level below 100 mg/dL.

4. A. None of the choices except Choice (A) are indications for parathyroidectomy. Recurrent kidney stones, bone disease (including osteoporosis), hypercalcemia, and worsening renal insufficiency are indications for surgery. Low phosphorous levels, although they may accompany hyperparathyroidism, are not in and of themselves indications for surgery. An elevation in the serum calcium level, not the serum sodium level, would be considered an indication for surgery if the elevation were persistent.

5. D. For this question, you need to be able to pick up the clues. The first sentence tells you a lot. The woman has a history of manic depression, is polydipsic, and is polyuric. The serum glucose is normal, so her polyuria is not due to an osmotic diuresis from diabetes. Her calcium level is normal, so polyuria is not from a high calcium level causing a nephrogenic diabetes insipidus. She likely had been on lithium and has a nephrogenic diabetes insipidus from this. You’d obtain a urine osmolality to see whether the urine is dilute.

With diabetes insipidus, whether it be central or nephrogenic, you expect a dilute urine with a urine osmolality < 100 mOsm/kg. Common causes of nephrogenic diabetes insipidus include hypercalcemia, hypokalemia, and medications like lithium (Eskalith). There’s typically low urine osmolality. Central diabetes insipidus refers to a problem in the posterior pituitary, where ADH is stored. Causes can include trauma, surgery, or infiltrative conditions.

6. E. You want to check the serum fructosamine level. The Hgb A1c reflects changes in blood sugars over 3 months, whereas the fructosamine level, Choice (E), can reflect changes over the past few weeks. The oral glucose tolerance test is not routinely used but is a method of diagnosing type 2 diabetes mellitus and gestational diabetes. This person has already been diagnosed with diabetes, and he doesn’t need to be retested. We’re also pretty confident that he isn’t pregnant, either. There’s no such test as sequential postprandial glucose monitoring, although it’s recommended that both pre- and postprandial blood glucose levels be monitored in diabetes. Albumin/creatinine ratio testing should be done at least yearly in someone diagnosed with diabetes mellitus.

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