A 60-year-old man with long-standing type 2 diabetes has HbA1c 11.8%, weight loss, polyuria, and ketonuria. According to the table, which therapy is MOST appropriate as initial treatment?
Anonymous Quiz
15%
A. GLP-1 receptor agonist
41%
B. SGLT2 inhibitor
36%
C. Basal insulin
9%
D. DPP-4 inhibitor
A patient with type 2 diabetes on metformin has predominant post-prandial hyperglycemia, irregular meal timings, and frequent hypoglycemia with sulfonylureas. Which drug class from the table is best?
Anonymous Quiz
31%
A. Alpha-glucosidase inhibitors
27%
B. Meglitinides
37%
C. DPP-4 inhibitors
5%
D. TZDs
Which antidiabetic drug class provides heart failure and renal protection, but has HbA1c lowering dependent on renal function?
Anonymous Quiz
18%
A. GLP-1 receptor agonists
20%
B. DPP-4 inhibitors
56%
C. SGLT2 inhibitors
7%
D. TZDs
Which drug class is associated with weight gain, fluid retention, increased fracture risk, but improves insulin sensitivity and has durable HbA1c control?
Anonymous Quiz
22%
A. Sulfonylureas
55%
B. Thiazolidinediones (TZDs)
11%
C. DPP-4 inhibitors
13%
D. Alpha-glucosidase inhibitors
Which antidiabetic drug class is weight neutral, has minimal hypoglycemia risk, and works by inhibiting incretin degradation?
Anonymous Quiz
36%
A. GLP-1 receptor agonists
39%
B. DPP-4 inhibitors
14%
C. SGLT2 inhibitors
11%
D. Alpha-glucosidase inhibitors
15. Diagnostic algorithm for Cushing’s Syndrome
A pt. with classical clinical features of Cushing’s syndrome undergoes 1-mg overnight dexamethasone suppression test.
Next morning (8–9 am), s.cortisol is 120 nmol/L.Which of the following is correct?
Next morning (8–9 am), s.cortisol is 120 nmol/L.Which of the following is correct?
Anonymous Quiz
5%
A. Normal suppression; Cushing’s syndrome excluded
21%
B. Suggests pseudo-Cushing’s; repeat test after stress control
42%
C. Positive screening test for Cushing’s syndrome
18%
D. Indicates ACTH-independent Cushing’s syndrome
13%
E. Indicates ectopic ACTH production
After confirmation of endogenous Cushing’s syndrome, plasma ACTH level is found to be 3 pg/mL.
What is the next best step?
What is the next best step?
Anonymous Quiz
21%
A. MRI pituitary
12%
B. CRH stimulation test
51%
C. High-dose dexamethasone suppression test
14%
D. Unenhanced CT scan of adrenal glands
2%
E. Inferior petrosal sinus sampling
Unenhanced CT adrenals shows bilateral macronodular adrenal hyperplasia.
What is the definitive treatment?
What is the definitive treatment?
Anonymous Quiz
24%
A. Medical therapy with ketoconazole
7%
B. Unilateral adrenalectomy
51%
C. Bilateral adrenalectomy
9%
D. Trans-sphenoidal pituitary surgery
9%
E. Radiotherapy to adrenals
Which of the following findings best supports Cushing’s disease over ectopic ACTH syndrome?
Anonymous Quiz
16%
A. Plasma ACTH >200 pg/mL
12%
B. Severe hypokalemic metabolic alkalosis
58%
C. Cortisol suppression >50% after high-dose dexamethasone
5%
D. No response to CRH stimulation
9%
E. Absence of pituitary lesion on MRI
In a patient with ACTH-dependent Cushing’s, MRI pituitary is normal.
What is the next best investigation?
What is the next best investigation?
Anonymous Quiz
16%
A. Repeat MRI after 6 months
13%
B. High-resolution CT chest
51%
C. Inferior petrosal sinus sampling (IPSS)
7%
D. Adrenal CT scan
13%
E. Start ketoconazole therapy
Which of the following is a contraindication to performing Inferior Petrosal Sinus Sampling (IPSS)?
Anonymous Quiz
9%
A. ACTH level >100 pg/mL
9%
B. Recent pituitary surgery
35%
C. Suspected ectopic ACTH syndrome
37%
D. Coagulopathy
9%
E. Severe hypokalemia
Which of the following screening tests for Cushing’s syndrome has the highest sensitivity?
Anonymous Quiz
0%
A. Random serum cortisol
12%
B. Midnight serum cortisol
42%
C. 24-hour urinary free cortisol
41%
D. 1-mg overnight dexamethasone suppression test
5%
E. Late-night salivary cortisol
Which condition is most likely to cause a false-positive 1-mg overnight dexamethasone suppression test?
Anonymous Quiz
7%
A. Adrenal adenoma
40%
B. Ectopic ACTH syndrome
36%
C. Severe depression
14%
D. Pituitary microadenoma
3%
E. Adrenal carcinoma
Which of the following findings is most characteristic of ectopic ACTH syndrome?
Anonymous Quiz
9%
A. Moon face and buffalo hump
58%
B. Hyperpigmentation with severe hypokalemia
25%
C. Osteoporosis with vertebral fractures
6%
D. Weight gain with centripetal obesity
2%
E. Purple striae over abdomen
A patient with ectopic ACTH syndrome has severe, life-threatening hypercortisolism and the tumor is not immediately localizable.
What is the best immediate management?
What is the best immediate management?
Anonymous Quiz
10%
A. Trans-sphenoidal surgery
19%
B. Bilateral adrenalectomy
18%
C. High-dose dexamethasone
51%
D. Medical adrenal blockade (ketoconazole / metyrapone)
1%
E. Radiotherapy
Which of the following drugs can be used intravenously for rapid control of severe hypercortisolism in ICU?
Anonymous Quiz
22%
A. Ketoconazole
12%
B. Mifepristone
20%
C. Etomidate
19%
D. Cabergoline
28%
E. Mitotane
Which of the following is the best test to differentiate pseudo-Cushing’s state from true Cushing’s syndrome?
Anonymous Quiz
9%
A. 24-hour urinary free cortisol
33%
B. 1-mg overnight dexamethasone suppression test
13%
C. Late-night salivary cortisol
21%
D. Low-dose dexamethasone–CRH test
24%
E. High-dose dexamethasone suppression test
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