Hyponatremia: ABFM practice questions

7 board-style questions on hyponatremia in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 34-year-old man presents to the emergency department with severe fatigue, dizziness, nausea, and vague abdominal pain that has worsened over 2 weeks. He has a history of vitiligo. On examination, his blood pressure is 82/54 mmHg and heart rate is 112 bpm. Hyperpigmentation is noted on the palmar creases, gingiva, and recent surgical scars. Laboratory results show sodium 128 mEq/L, potassium 6.1 mEq/L, and glucose 62 mg/dL. What is the most likely diagnosis?

1. Septic shock
2. Primary adrenal insufficiency (Addison disease)
3. Hypothyroidism
4. Diabetic ketoacidosis

Sample question 2

A 74-year-old woman started chlorthalidone six weeks ago for hypertension. She presents with fatigue, mild confusion, and a serum sodium of 121 mEq/L (baseline 138). She is clinically euvolemic. Which medication change is indicated?

1. Increase the chlorthalidone dose to enhance free water excretion
2. Continue chlorthalidone and add fluid restriction alone
3. Discontinue the chlorthalidone permanently
4. Switch chlorthalidone to hydrochlorothiazide, a milder thiazide

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