Endocrinology Practice Questions

Q: Schmidt syndrome includes all of the following conditions except?

Chronic Candidiasis. **Explanation:** Schmidt syndrome, also known as **Autoimmune Polyglandular Syndrome Type 2 (APS-2)**, is an autosomal dominant condition with variable penetrance [1]. It is characterized by the mandatory presence of **Autoimmune Adrenal Insufficiency (Addison’s disease)** along with autoimmune thyroid disease and/or Type-1 Diabetes Mellitus [1], [2]. **Why Chronic Candidiasis is the correct answer:** Chronic Mucocutaneous Candidiasis (CMC) is the hallmark of **APS Type 1** (also known as APECED syndrome), not APS Type 2 [1]. APS Type 1 typically presents in childhood with a classic triad: CMC, Hypoparathyroidism, and Adrenal Insufficiency [1]. Its absence is a key clinical differentiator for Schmidt syndrome. **Analysis of incorrect options:** * **Adrenal Insufficiency (Option A):** This is the primary component of Schmidt syndrome. It is almost always present and is usually the first manifestation [2]. * **Hypothyroidism (Option B):** Autoimmune thyroid disease (Hashimoto’s thyroiditis) is a frequent component [1], [3]. The combination of Addison’s and Hypothyroidism is specifically referred to as Schmidt syndrome [1]. * **Type-1 Diabetes Mellitus (Option C):** T1DM is frequently associated with APS-2 [2], [3]. When T1DM is present alongside Addison’s and Thyroid disease, it is sometimes called Carpenter’s syndrome (a subset of APS-2). **High-Yield Clinical Pearls for NEET-PG:** * **APS Type 1 Triad:** Candidiasis, Hypoparathyroidism, Addison’s (Mnemonic: **CHA**) [1]. * **APS Type 2 (Schmidt):** Addison’s + Thyroid disease +/– T1DM [1]. It is more common in females and typically presents in adulthood (3rd–4th decade). * **Treatment Caution:** In Schmidt syndrome, always treat the adrenal insufficiency with steroids **before** starting thyroxine to avoid precipitating an acute adrenal crisis.

Q: Which of the following is NOT a feature of primary thyrotoxicosis?

Intolerance to cold. Explanation: Thyrotoxicosis is a clinical state resulting from inappropriate high levels of circulating thyroid hormones ($T_3$ and $T_4$). Thyroid hormones act as a "metabolic accelerator," increasing the basal metabolic rate (BMR) and upregulating beta-adrenergic receptors [1]. Why "Intolerance to Cold" is the correct answer: Primary thyrotoxicosis leads to increased thermogenesis (heat production). Consequently, patients develop heat intolerance and prefer cold environments [1]. Cold intolerance is a hallmark feature of hypothyroidism, where the BMR is low and the body cannot generate sufficient heat. Analysis of incorrect options: * Tremors: Excess thyroid hormone increases sensitivity to catecholamines and affects the neurological system. This typically manifests as a fine, high-frequency kinetic tremor, best seen in outstretched hands [1]. * Warm extremities: Increased metabolism and the need to dissipate excess heat lead to peripheral vasodilation. This results in skin that is characteristically warm, moist, and velvety [1]. * Diarrhea: Thyroid hormones stimulate gut motility [1]. While frank diarrhea occurs in severe cases, most patients report an increased frequency of bowel movements or malabsorption. Clinical Pearls for NEET-PG: * Apathetic Hyperthyroidism: Seen in the elderly; typical hypermetabolic features (like tremors/tachycardia) may be absent, presenting instead with depression or atrial fibrillation [2]. * Cardiovascular Sign: Look for "bounding pulses" and a wide pulse pressure due to increased stroke volume and decreased peripheral resistance [1]. * Eye Signs: Lid lag and lid retraction are due to sympathetic overactivity (seen in all thyrotoxicosis), whereas Exophthalmos is specific to Graves' Disease (due to TSH-receptor antibodies) [1].

Q: A 67-year-old woman presents to the clinic for evaluation of numbness in her feet, with symptoms that started gradually and are more noticeable now. There is no weakness in her feet or difficulty walking. Her past medical history is significant for Type 2 diabetes for the past 10 years, for which she currently takes metformin and glyburide. Physical examination confirms sensory loss in the feet to touch and vibration. Which of the following is most characteristic of diabetic neuropathy?

It is usually bilateral.. **Explanation:** The patient presents with classic symptoms of **Distal Symmetric Polyneuropathy (DSPN)**, the most common form of diabetic neuropathy [1]. **1. Why Option A is correct:** Diabetic neuropathy is a length-dependent process caused by metabolic and microvascular damage to the nerves [1]. It typically presents in a **"stocking-and-glove" distribution**, meaning it is **bilateral, symmetrical**, and starts in the longest nerves (the feet) [1]. The symmetry is a hallmark feature that helps distinguish it from other conditions like mononeuritis multiplex. **2. Why the other options are incorrect:** * **Option B:** Pain is a very common feature. Up to 50% of patients experience "positive" symptoms such as burning, tingling, or lancinating pain, which is often worse at night. * **Option C:** Diabetic neuropathy primarily affects the **Peripheral Nervous System (PNS)** and the Autonomic Nervous System [1]. It does not typically affect the brain (Central Nervous System). * **Option D:** Diabetes frequently involves the **Autonomic Nervous System**, leading to complications such as resting tachycardia, orthostatic hypotension, gastroparesis, and erectile dysfunction [3]. **Clinical Pearls for NEET-PG:** * **First sign:** Loss of vibratory sensation (tested with a 128-Hz tuning fork) and loss of ankle jerks [1], [2]. * **Screening:** Annual screening using the **10-g Semmes-Weinstein monofilament** is essential to identify feet at risk for ulceration [2]. * **Management:** Strict glycemic control is the only way to prevent progression. For symptomatic pain, first-line agents include **Pregabalin, Duloxetine, or Gabapentin**. * **Metformin Link:** Long-term metformin use (as seen in this patient) can cause **Vitamin B12 deficiency**, which can mimic or exacerbate diabetic neuropathy. Always check B12 levels in these patients.

Q: Which is NOT a clinical feature of Addison's disease?

Hypopigmentation. **Explanation** Addison’s disease (Primary Adrenocortical Insufficiency) is characterized by the destruction of the adrenal cortex, leading to a deficiency of cortisol, aldosterone, and adrenal androgens [1]. **Why Hypopigmentation is the Correct Answer:** In primary adrenal insufficiency, low cortisol levels trigger a compensatory increase in **ACTH** (Adrenotropic Hormone) secretion from the pituitary. ACTH is derived from a precursor molecule called **POMC** (Proopiomelanocortin). POMC also produces **MSH** (Melanocyte-Stimulating Hormone). High levels of ACTH/MSH stimulate melanocytes, leading to **hyperpigmentation** (especially in skin creases, scars, and buccal mucosa), not hypopigmentation. **Analysis of Incorrect Options:** * **Hypoglycemia:** Cortisol is a counter-regulatory hormone that promotes gluconeogenesis. Its absence leads to impaired glucose production and increased insulin sensitivity. * **Hyponatremia:** Aldosterone deficiency leads to renal wasting of sodium [2]. Additionally, cortisol deficiency increases ADH secretion (dilutional hyponatremia). * **Hyperkalemia:** Aldosterone normally promotes potassium excretion in the distal tubule. Its absence results in potassium retention and metabolic acidosis [2]. **NEET-PG High-Yield Pearls:** * **Most common cause:** Autoimmune adrenalitis (Western world); Tuberculosis (Developing countries/India) [1], [2]. * **Cosyntropin Stimulation Test:** The gold standard for diagnosis (failure of cortisol to rise >18 µg/dL) [2]. * **Secondary Adrenal Insufficiency:** Caused by pituitary failure. Key difference: **No hyperpigmentation** (low ACTH) and **no hyperkalemia** (mineralocorticoid production is preserved via the RAAS system). * **Classic Triad:** Hyponatremia, Hyperkalemia, and Azotemia.

Q: Diabetes mellitus is present in which of the following conditions, except?

Ataxia telangiectasia. The correct answer is **B. Ataxia telangiectasia**. While this condition is associated with severe **insulin resistance**, patients typically maintain normal or near-normal glucose levels due to compensatory hyperinsulinemia; overt clinical diabetes mellitus is not a standard feature of the syndrome. **Analysis of Options:** * **Hemochromatosis (Option A):** Known as "Bronze Diabetes," iron deposition in the pancreas causes direct damage to beta cells (insulin deficiency) and liver damage (insulin resistance), making diabetes a classic complication. * **Friedreich's Ataxia (Option C):** Approximately 10–20% of patients develop diabetes mellitus. The mechanism involves mitochondrial dysfunction leading to both impaired insulin secretion and peripheral insulin resistance. * **Motor Neuron Disease (Option D):** Several studies have linked MND (specifically ALS) with abnormal glucose metabolism and a higher prevalence of diabetes, likely due to metabolic stress and shared genetic pathways. **Clinical Pearls for NEET-PG:** 1. **Secondary Diabetes:** Always look for "Bronze Diabetes" (Hemochromatosis) and "Endocrine Diabetes" (Cushing’s, Acromegaly, Pheochromocytoma, Glucagonoma) [1]. 2. **Ataxia Telangiectasia Triad:** Cerebellar ataxia, oculocutaneous telangiectasia, and immunodeficiency (IgA deficiency). It is an autosomal recessive disorder involving the *ATM* gene. 3. **High-Yield Association:** While Ataxia telangiectasia shows insulin resistance [2], **Friedreich's Ataxia** is the neurodegenerative disorder most classically associated with clinical **Diabetes Mellitus** in exam questions.

Q: Which of the following hormonal patterns is found in primary hypothyroidism?

T3 decrease, T4 decrease, TSH increase. ### Explanation **1. Why the Correct Answer is Right (Option A)** Primary hypothyroidism occurs due to the failure of the thyroid gland itself (e.g., Hashimoto’s thyroiditis). When the thyroid gland cannot produce sufficient hormones, levels of **T4 (Thyroxine)** and **T3 (Triiodothyronine)** fall. This drop triggers the **negative feedback mechanism** on the anterior pituitary [1], leading to a compensatory and marked **increase in Thyroid Stimulating Hormone (TSH)** [1]. TSH is the most sensitive indicator for primary thyroid disease. **2. Why the Other Options are Incorrect** * **Option B:** This pattern (Low T3, High T4, Low TSH) is physiologically inconsistent. High T4 would typically suppress TSH, and T3 would usually be elevated in hyperthyroid states. * **Option C:** This pattern (Normal T3/T4, High TSH) represents **Subclinical Hypothyroidism**. While it is a precursor to primary hypothyroidism, the question asks for the pattern of established primary hypothyroidism where hormone levels have already fallen. * **Option D:** This pattern (Low T3/T4, Normal TSH) suggests **Secondary (Central) Hypothyroidism**, where the pituitary fails to respond to low thyroid levels by increasing TSH production [2]. **3. Clinical Pearls for NEET-PG** * **Gold Standard Screening:** Serum **TSH** is the single best initial test for screening thyroid dysfunction. * **T3 vs. T4:** In early primary hypothyroidism, T4 levels drop before T3. T3 may remain in the normal range for a long time due to increased peripheral conversion; however, in overt disease, both are low. * **Wolff-Chaikoff Effect:** Transient hypothyroidism caused by the ingestion of a large amount of iodine. * **Myxedema Coma:** The most severe expression of primary hypothyroidism, characterized by altered mental status and hypothermia.

Question 1

Which of the following is true of adrenal suppression due to steroid therapy?

Accepted Answer

It is less likely to occur in patients receiving inhaled steroids.

Answer

It is not associated with atrophy of the adrenal glands.

Answer

It should be expected in anyone receiving more than 5 mg of prednisolone daily.

Answer

Following cessation, the stress response normalizes after 8 weeks.

Question 2

Schmidt syndrome includes all of the following conditions except?

Accepted Answer

Chronic Candidiasis

Answer

Adrenal insufficiency

Answer

Hypothyroidism

Answer

Type-1 Diabetes Mellitus

Question 3

Which of the following is NOT a feature of primary thyrotoxicosis?

Accepted Answer

Intolerance to cold

Answer

Tremors

Answer

Warm extremities

Answer

Diarrhea

Question 4

A 67-year-old woman presents to the clinic for evaluation of numbness in her feet, with symptoms that started gradually and are more noticeable now. There is no weakness in her feet or difficulty walking. Her past medical history is significant for Type 2 diabetes for the past 10 years, for which she currently takes metformin and glyburide. Physical examination confirms sensory loss in the feet to touch and vibration. Which of the following is most characteristic of diabetic neuropathy?

Accepted Answer

It is usually bilateral.

Answer

Pain is not a feature.

Answer

It most commonly affects the brain.

Answer

It spares the autonomic system.

Question 5

Which is NOT a clinical feature of Addison's disease?

Accepted Answer

Hypopigmentation

Answer

Hypoglycemia

Answer

Hyponatremia

Answer

Hyperkalemia

Question 6

All of the following are clinical features of Cushing's syndrome except?

Accepted Answer

Menorrhagia

Answer

Insulin resistance

Answer

Violaceous striae

Answer

Centripetal obesity

Question 7

Diabetes mellitus is present in which of the following conditions, except?

Accepted Answer

Ataxia telangiectasia

Answer

Hemochromatosis

Answer

Friedreich's ataxia

Answer

Motor neuron disease

Question 8

Which of the following hormonal patterns is found in primary hypothyroidism?

Accepted Answer

T3 decrease, T4 decrease, TSH increase

Answer

T3 decrease, T4 increase, TSH decrease

Answer

T3 normal, T4 normal, TSH increase

Answer

T3 decrease, T4 decrease, TSH normal

Question 9

Alcoholic ketoacidosis is best managed with?

Accepted Answer

Isotonic saline infusion

Answer

Thiamine with 10% dextrose infusion

Answer

Sodium bicarbonate infusion

Answer

Fomepizole infusion

Question 10

In which of the following conditions radioactive iodine can be used in Graves' disease?

Accepted Answer

Age less than 40 years

Answer

Recurrence

Answer

Elderly

Answer

Pregnant

Endocrinology — MCQs

Endocrinology — MCQs

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