⭐ 50-QUESTION FNP ENDOCRINE MOCK EXAM (ANCC/AANP STYLE)
(No answers appear until the end)
📝 QUESTIONS
1. A 45-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. TSH
is 11.2 mIU/L and Free T4 is normal. What is the diagnosis?
A. Primary hypothyroidism
B. Subclinical hypothyroidism
C. Euthyroid sick syndrome
D. Secondary hypothyroidism
2. Which patient should be STARTED on Levothyroxine for subclinical hypothyroidism?
A. TSH 6.2, asymptomatic
B. TSH 7.1, pregnant
C. TSH 4.8, mild fatigue
D. TSH 9.0, asymptomatic
3. A 72-year-old with CAD is newly diagnosed with hypothyroidism. What is the safest starting dose
of Levothyroxine?
A. 100 mcg daily
B. 12.5–25 mcg daily
C. 50 mcg daily
D. 1.6 mcg/kg/day
4. What is the most common cause of hypothyroidism in the United States?
A. Pituitary tumor
B. Hashimoto’s thyroiditis
C. Iodine deficiency
D. Thyroid carcinoma
5. A patient is taking Levothyroxine. Which statement indicates correct teaching?
A. “I can take it with my calcium supplement.”
B. “I should take it first thing in the morning before food.”
C. “I should switch to Armour thyroid if I feel tired.”
D. “I can take it with coffee.”
6. A patient’s TSH is 0.01 and T4 is high. What is the diagnosis?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Primary hyperthyroidism
D. Subclinical hyperthyroidism
7. Which physical exam finding is most specific for Graves’ disease?
A. Nail ridging
B. Pretibial myxedema
C. Androgenic alopecia
D. Thick brittle hair
,8. A 32-year-old woman with tremor, tachycardia, and heat intolerance requires FIRST-LINE
symptomatic therapy. What is the best choice?
A. PTU
B. Methimazole
C. Propranolol
D. Armour Thyroid
9. Which antithyroid drug is preferred during the first trimester of pregnancy?
A. Methimazole
B. PTU
C. Radioactive iodine
D. Propranolol
10. Which lab is used to guide thyroid medication dose adjustments?
A. Free T4
B. Total T3
C. Free T3
D. TSH
11. A patient on methimazole calls with fever and sore throat. What should the NP advise?
A. Take ibuprofen and monitor
B. Increase dose by 5 mg
C. Stop the medication and check CBC
D. Switch to PTU immediately
12. Which is a long-term risk of overtreatment with Levothyroxine?
A. Pancreatitis
B. Atrial fibrillation
C. Cataracts
D. Kidney stones
13. A newborn is diagnosed with congenital hypothyroidism. What is the correct treatment?
A. PTU
B. Methimazole
C. Levothyroxine 6–15 mcg/kg/day
D. Armour Thyroid
14. What is the consequence of untreated congenital hypothyroidism?
A. Hyperglycemia
B. Permanent cognitive impairment
C. Adrenal insufficiency
D. Asthma
15. A patient with hypothyroidism is stable. How often should TSH be rechecked?
A. Every 3 months
B. Every 6–8 weeks
C. Annually
D. Every 5 years
, ADDISON’S / ADRENAL
16. What is the primary hormone deficiency in Addison’s disease?
A. Aldosterone only
B. Cortisol only
C. Cortisol and aldosterone
D. ACTH
17. Which finding is most consistent with Addison’s disease?
A. Hypertension
B. Hypernatremia
C. Hyperkalemia
D. Hypopigmentation
18. Which hormone is preserved in secondary adrenal insufficiency?
A. Cortisol
B. Aldosterone
C. ACTH
D. Epinephrine
19. What is the most appropriate treatment for Addison’s disease?
A. Levothyroxine
B. Hydrocortisone ± fludrocortisone
C. Prednisone only
D. Radioactive iodine
20. A patient with Addison’s is ill with fever. What should they do?
A. Skip steroids
B. Take half the dose
C. Double or triple steroid dose
D. Stop fludrocortisone
21. What is the emergency treatment for Addisonian crisis?
A. Oral hydrocortisone
B. IV hydrocortisone + fluids
C. Propranolol
D. Methimazole
22. A 55-year-old has long-term steroid use. Which condition is most likely to develop?
A. Addison’s crisis
B. Cushing’s syndrome
C. Hypothyroidism
D. Diabetes insipidus
CUSHING’S
23. Which physical finding is most consistent with Cushing’s syndrome?
A. Buffalo hump
B. Exophthalmos
(No answers appear until the end)
📝 QUESTIONS
1. A 45-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. TSH
is 11.2 mIU/L and Free T4 is normal. What is the diagnosis?
A. Primary hypothyroidism
B. Subclinical hypothyroidism
C. Euthyroid sick syndrome
D. Secondary hypothyroidism
2. Which patient should be STARTED on Levothyroxine for subclinical hypothyroidism?
A. TSH 6.2, asymptomatic
B. TSH 7.1, pregnant
C. TSH 4.8, mild fatigue
D. TSH 9.0, asymptomatic
3. A 72-year-old with CAD is newly diagnosed with hypothyroidism. What is the safest starting dose
of Levothyroxine?
A. 100 mcg daily
B. 12.5–25 mcg daily
C. 50 mcg daily
D. 1.6 mcg/kg/day
4. What is the most common cause of hypothyroidism in the United States?
A. Pituitary tumor
B. Hashimoto’s thyroiditis
C. Iodine deficiency
D. Thyroid carcinoma
5. A patient is taking Levothyroxine. Which statement indicates correct teaching?
A. “I can take it with my calcium supplement.”
B. “I should take it first thing in the morning before food.”
C. “I should switch to Armour thyroid if I feel tired.”
D. “I can take it with coffee.”
6. A patient’s TSH is 0.01 and T4 is high. What is the diagnosis?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Primary hyperthyroidism
D. Subclinical hyperthyroidism
7. Which physical exam finding is most specific for Graves’ disease?
A. Nail ridging
B. Pretibial myxedema
C. Androgenic alopecia
D. Thick brittle hair
,8. A 32-year-old woman with tremor, tachycardia, and heat intolerance requires FIRST-LINE
symptomatic therapy. What is the best choice?
A. PTU
B. Methimazole
C. Propranolol
D. Armour Thyroid
9. Which antithyroid drug is preferred during the first trimester of pregnancy?
A. Methimazole
B. PTU
C. Radioactive iodine
D. Propranolol
10. Which lab is used to guide thyroid medication dose adjustments?
A. Free T4
B. Total T3
C. Free T3
D. TSH
11. A patient on methimazole calls with fever and sore throat. What should the NP advise?
A. Take ibuprofen and monitor
B. Increase dose by 5 mg
C. Stop the medication and check CBC
D. Switch to PTU immediately
12. Which is a long-term risk of overtreatment with Levothyroxine?
A. Pancreatitis
B. Atrial fibrillation
C. Cataracts
D. Kidney stones
13. A newborn is diagnosed with congenital hypothyroidism. What is the correct treatment?
A. PTU
B. Methimazole
C. Levothyroxine 6–15 mcg/kg/day
D. Armour Thyroid
14. What is the consequence of untreated congenital hypothyroidism?
A. Hyperglycemia
B. Permanent cognitive impairment
C. Adrenal insufficiency
D. Asthma
15. A patient with hypothyroidism is stable. How often should TSH be rechecked?
A. Every 3 months
B. Every 6–8 weeks
C. Annually
D. Every 5 years
, ADDISON’S / ADRENAL
16. What is the primary hormone deficiency in Addison’s disease?
A. Aldosterone only
B. Cortisol only
C. Cortisol and aldosterone
D. ACTH
17. Which finding is most consistent with Addison’s disease?
A. Hypertension
B. Hypernatremia
C. Hyperkalemia
D. Hypopigmentation
18. Which hormone is preserved in secondary adrenal insufficiency?
A. Cortisol
B. Aldosterone
C. ACTH
D. Epinephrine
19. What is the most appropriate treatment for Addison’s disease?
A. Levothyroxine
B. Hydrocortisone ± fludrocortisone
C. Prednisone only
D. Radioactive iodine
20. A patient with Addison’s is ill with fever. What should they do?
A. Skip steroids
B. Take half the dose
C. Double or triple steroid dose
D. Stop fludrocortisone
21. What is the emergency treatment for Addisonian crisis?
A. Oral hydrocortisone
B. IV hydrocortisone + fluids
C. Propranolol
D. Methimazole
22. A 55-year-old has long-term steroid use. Which condition is most likely to develop?
A. Addison’s crisis
B. Cushing’s syndrome
C. Hypothyroidism
D. Diabetes insipidus
CUSHING’S
23. Which physical finding is most consistent with Cushing’s syndrome?
A. Buffalo hump
B. Exophthalmos
