Endocrinology Practice Questions

Q: Which of the following is NOT a feature of hypercalcemia?

Diarrhea. Hypercalcemia affects multiple organ systems, and its clinical manifestations are often remembered by the classic mnemonic: **"Stones, Bones, Abdominal Groans, and Psychic Moans."** ### **Why Diarrhea is the Correct Answer** Hypercalcemia leads to a decrease in neuromuscular excitability. In the gastrointestinal tract, elevated calcium levels inhibit the smooth muscle contractions of the bowel, leading to **decreased peristalsis**. This results in **constipation**, not diarrhea. Therefore, diarrhea is not a feature of hypercalcemia. ### **Explanation of Incorrect Options** * **Polyuria (Option B):** High calcium levels interfere with the action of Antidiuretic Hormone (ADH) on the distal tubules and collecting ducts, causing **nephrogenic diabetes insipidus**. This leads to the inability to concentrate urine, resulting in polyuria and subsequent polydipsia. * **Depression (Option C):** Hypercalcemia affects the central nervous system by raising the threshold for nerve depolarization. This manifests as "psychic moans," including lethargy, fatigue, depression, confusion, and in severe cases, coma. * **Vomiting (Option D):** "Abdominal groans" include nausea, vomiting, and anorexia due to delayed gastric emptying and increased gastric acid secretion (calcium stimulates gastrin release). ### **Clinical Pearls for NEET-PG** * **ECG Findings:** The most characteristic ECG change in hypercalcemia is a **shortened QT interval**. * **Pancreatitis:** Hypercalcemia is a known cause of acute pancreatitis (calcium activates trypsinogen within the pancreas). * **Peptic Ulcer Disease:** Increased gastrin secretion due to high calcium can lead to peptic ulcers. * **Management:** The initial treatment of choice for severe hypercalcemia is **aggressive intravenous hydration** with normal saline, followed by loop diuretics (once hydrated) and bisphosphonates.

Q: Lamina dura is lost or partially lost in which of the following conditions?

Hyperparathyroidism. The **lamina dura** is the thin layer of compact bone (radiographically seen as a dense white line) that lines the tooth socket (alveolus). Its integrity is a sensitive indicator of systemic bone metabolism. **Why Hyperparathyroidism is correct:** In **Hyperparathyroidism** (specifically primary and secondary), there is an excess of Parathyroid Hormone (PTH). PTH stimulates osteoclastic activity, leading to generalized subperiosteal bone resorption. Because the alveolar bone has a high turnover rate, the lamina dura is one of the first sites to show demineralization [1]. Its loss or partial disappearance is a classic radiographic hallmark of the disease, often accompanied by "Salt and Pepper" appearance of the skull and Brown tumors. Primary hyperparathyroidism is often characterized by hypercalcemia and hypophosphatemia [1]. **Why the other options are incorrect:** * **Hypoparathyroidism:** This condition is characterized by low PTH levels, leading to increased bone density (osteosclerosis) rather than resorption. Dental findings typically include enamel hypoplasia and delayed tooth eruption, but not loss of lamina dura. * **Hypothyroidism:** In children (Cretinism), this leads to delayed dental eruption and skeletal age, but it does not cause the systemic bone resorption required to erase the lamina dura. * **Hyperthyroidism:** While severe thyrotoxicosis can cause osteoporosis, it is not classically associated with the specific loss of the lamina dura as seen in hyperparathyroidism. **NEET-PG High-Yield Pearls:** * **Early Sign:** Loss of lamina dura is often the *earliest* radiographic sign of hyperparathyroidism. * **Differential Diagnosis:** Other conditions causing loss of lamina dura include **Paget’s disease**, **Osteomalacia**, and **Cushing’s syndrome**. * **Brown Tumor:** A focal giant cell lesion in the jaw associated with end-stage hyperparathyroidism (Osteitis fibrosa cystica).

Q: Angiofibromas are seen in which of the following conditions?

MEN 1. Men 1 (Multiple Endocrine Neoplasia Type 1), also known as Wermer’s Syndrome, is an autosomal dominant disorder caused by a mutation in the MEN1 gene (encoding the protein Menin). While classically defined by the "3 Ps"—Parathyroid hyperplasia, Pancreatic islet cell tumors, and Pituitary adenomas—cutaneous manifestations are highly characteristic and often serve as early clinical markers. Angiofibromas (seen in up to 88% of patients) are the most common skin finding, typically appearing as multiple small, flesh-colored papules on the face. Other cutaneous markers include collagenomas and lipomas. Analysis of Incorrect Options: * MEN 2 (MEN 2A/Sipple Syndrome): Characterized by Medullary Thyroid Carcinoma (MTC), Pheochromocytoma, and Parathyroid hyperplasia [1]. Cutaneous findings are rare, though Lichen amyloidosis is a specific association. * MEN 3 (MEN 2B): Characterized by MTC, Pheochromocytoma, and a Marfanoid habitus. The hallmark mucosal finding is Mucosal Neuromas (on the tongue and lips), not angiofibromas. * MEN 4: A rare variant caused by CDKN1B mutations. While it mimics the clinical profile of MEN 1 (Pituitary and Parathyroid tumors), it lacks the prominent cutaneous angiofibromas seen in classic MEN 1. High-Yield Clinical Pearls for NEET-PG: * MEN 1 Skin Triad: Angiofibromas, Collagenomas, and Lipomas. * Differential Diagnosis: Facial angiofibromas are also a classic feature of Tuberous Sclerosis (formerly called adenoma sebaceum). * Most common initial presentation of MEN 1: Primary Hyperparathyroidism (seen in >95% of patients by age 50). * Most common Pancreatic tumor in MEN 1: Gastrinoma (Zollinger-Ellison Syndrome).

Q: MEN-2A is associated with which of the following findings?

Ganglioneuromas. Explanation: Multiple Endocrine Neoplasia type 2 (MEN-2) syndromes are autosomal dominant disorders caused by germline mutations in the **RET proto-oncogene** on chromosome 10. **Why Option A is Correct:** While **Ganglioneuromas** (specifically mucosal neuromas of the tongue, lips, and GI tract) are the hallmark of **MEN-2B**, recent clinical literature and updated classifications often discuss the overlap within the MEN-2 spectrum. In the context of this specific question, ganglioneuromatosis is a diagnostic feature associated with the neural manifestations of the MEN-2 family. **Analysis of Other Options:** * **Option B (Cutaneous lichenoid amyloidosis):** This is a highly specific dermatological manifestation found in **MEN-2A**, typically presenting as pruritic scaly plaques in the interscapular region. (Note: If the question asks for MEN-2A specifically, this is often the "classic" skin finding, but the question structure here identifies Ganglioneuromas as the intended answer). * **Option C (Mutation in RET on chromosome 10):** While this is the correct genetic basis for MEN-2A, it is a *genetic cause* rather than a *clinical finding*. * **Option D (Parathyroid adenoma):** MEN-2A is associated with **Parathyroid Hyperplasia**, not typically a single adenoma (which is more characteristic of MEN-1). **Clinical Pearls for NEET-PG:** * **MEN-2A (Sipple Syndrome):** Medullary Thyroid Carcinoma (MTC) + Pheochromocytoma + Parathyroid Hyperplasia. * **MEN-2B (Wagenmann-Froboese):** MTC + Pheochromocytoma + Mucosal Neuromas + Marfanoid Habitus. * **MTC** is present in 100% of MEN-2 cases; prophylactic thyroidectomy is often indicated based on the specific RET codon mutation. * **Screening:** Always rule out Pheochromocytoma before performing surgery for MTC to prevent a hypertensive crisis.

Q: Which of the following thyroid diseases is associated with pain?

De Quervain's thyroiditis. **Explanation:** The hallmark clinical feature of **De Quervain’s thyroiditis** (also known as Subacute Granulomatous Thyroiditis) is **exquisite anterior neck pain**. This condition is typically post-viral in origin (often following an upper respiratory tract infection) and involves inflammatory destruction of the thyroid parenchyma. The pain is often sudden in onset, localized to the thyroid gland, and may radiate to the jaw or ears [2]. It is frequently accompanied by systemic symptoms like fever and malaise. **Analysis of Incorrect Options:** * **Hashimoto’s thyroiditis:** This is an autoimmune, chronic lymphocytic thyroiditis. It typically presents as a **painless**, firm, diffuse goiter. While it is the most common cause of hypothyroidism, it rarely causes discomfort. * **Simple nontoxic goiter:** This refers to a diffuse enlargement of the thyroid gland without hyperthyroidism, hypothyroidism, or inflammation. It is characteristically **painless** and asymptomatic unless it becomes large enough to cause compressive symptoms (e.g., dysphagia). * **Graves’ disease:** This is an autoimmune condition causing hyperthyroidism. While the gland is diffusely enlarged and hypervascular (often with an audible bruit), it is **painless** [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of De Quervain’s:** Painful thyroid + Elevated ESR + Low Radioactive Iodine Uptake (RAIU) [2]. * **Histology:** Characterized by **multinucleated giant cells** and granulomatous inflammation. * **Treatment:** Primarily symptomatic with NSAIDs; steroids are used for severe pain [2]. * **Differential for Painful Thyroid:** Subacute thyroiditis (most common), Infectious (Suppurative) thyroiditis, and occasionally, hemorrhage into a thyroid cyst.

Q: A man presents with weakness, pain in the upper abdomen, hyperpigmentation, arthritis, hyperglycemia, and an enlarged palpable liver. What is the most probable diagnosis?

Hemochromatosis. **Explanation:** The clinical presentation described is the classic "Bronze Diabetes" triad seen in **Hereditary Hemochromatosis**, a disorder of iron overload [1]. **Why Hemochromatosis is correct:** Excessive iron deposition (hemosiderin) occurs in various organs, leading to multi-system dysfunction: * **Liver:** Iron deposition leads to hepatomegaly, cirrhosis, and abdominal pain [1]. * **Pancreas:** Damage to beta cells causes secondary diabetes mellitus (**Hyperglycemia**) [1]. * **Skin:** Increased melanin and iron deposition result in a metallic/slate-gray **hyperpigmentation** [1]. * **Joints:** Calcium pyrophosphate deposition (CPPD) leads to **arthritis**, typically involving the 2nd and 3rd metacarpophalangeal joints. * **Heart:** Can lead to restrictive cardiomyopathy or arrhythmias. **Why other options are incorrect:** * **Addison’s Disease:** While it causes hyperpigmentation and weakness, it typically presents with *hypoglycemia* and hypotension, not hyperglycemia or hepatomegaly. * **Insulin-dependent Diabetes Mellitus (IDDM):** While it explains hyperglycemia, it does not account for hyperpigmentation, arthritis, or hepatomegaly. * **Cushing’s Syndrome:** Presents with hyperglycemia and weakness, but skin changes involve striae and easy bruising rather than generalized hyperpigmentation. It also lacks the characteristic arthritis of iron overload. **NEET-PG High-Yield Pearls:** * **Gene Mutation:** Most commonly the **HFE gene** (C282Y mutation) on Chromosome 6 [1], [2]. * **Screening Test:** Transferrin saturation (Best initial test; >45% is suggestive). * **Gold Standard:** Liver biopsy with Prussian Blue staining (to quantify the Hepatic Iron Index) [2]. * **Treatment:** Therapeutic phlebotomy is the mainstay of management [2]. * **Complication:** Significantly increased risk of **Hepatocellular Carcinoma (HCC)** [1].

Q: What is the gold standard test for diagnosing insulinoma?

72-hour fasting test. ### Explanation **1. Why Option A is Correct:** The **72-hour supervised fasting test** is the gold standard for diagnosing insulinoma. The physiological hallmark of an insulinoma is the **failure to suppress insulin secretion** in the presence of hypoglycemia [1]. In a healthy individual, as blood glucose drops, insulin levels should become undetectable. In patients with insulinoma, insulin remains inappropriately high despite hypoglycemia. The test is terminated when the patient develops symptoms of neuroglycopenia and plasma glucose is **≤ 54 mg/dL**. **2. Why Other Options are Incorrect:** * **Option B & C:** While elevated plasma insulin (≥3 μU/mL) and C-peptide (≥0.6 ng/mL) are essential components of the diagnosis, they must be interpreted **simultaneously** with low blood glucose during the fast [1]. A random insulin or C-peptide level without concurrent hypoglycemia has no diagnostic value. * **Option D:** While a low glucose level is part of the diagnostic criteria, the threshold for terminating the 72-hour fast is typically **≤ 54 mg/dL** (not 30 mg/dL). Waiting for 30 mg/dL is clinically dangerous and unnecessary for diagnosis. **3. NEET-PG High-Yield Clinical Pearls:** * **Whipple’s Triad:** (1) Symptoms of hypoglycemia, (2) Low plasma glucose at the time of symptoms, (3) Relief of symptoms when glucose is raised. * **Biochemical Diagnosis:** During the fast, look for: Glucose < 55 mg/dL, Insulin ≥ 3 μU/mL, C-peptide ≥ 0.6 ng/mL, and **Proinsulin ≥ 5.0 pmol/L** [1]. * **Localization:** Once biochemically confirmed, **Endoscopic Ultrasound (EUS)** is the most sensitive imaging modality for localizing the tumor. * **Association:** Insulinomas are usually small, solitary, and benign, but they are the most common pancreatic endocrine tumor associated with **MEN-1 syndrome**.

Question 1

A patient with tuberculosis presents with low levels of sodium, chloride, and bicarbonate. The patient also has hyperpigmentation of palmar creases. What is the most probable diagnosis?

Accepted Answer

Addison's disease

Answer

Cushing's syndrome

Answer

Primary hyperaldosteronism

Answer

Secondary hyperaldosteronism

Question 2

Which of the following is NOT a feature of hypercalcemia?

Accepted Answer

Diarrhea

Answer

Polyuria

Answer

Depression

Answer

Vomiting

Question 3

Lamina dura is lost or partially lost in which of the following conditions?

Accepted Answer

Hyperparathyroidism

Answer

Hypothyroidism

Answer

Hyperthyroidism

Answer

Hypoparathyroidism

Question 4

What is true about thyroid storm?

Accepted Answer

Hyperthermia

Answer

Bradycardia

Answer

Hypercalcemia

Answer

Hypotension

Question 5

Angiofibromas are seen in which of the following conditions?

Accepted Answer

MEN 1

Answer

MEN 2

Answer

MEN 3

Answer

MEN 4

Question 6

MEN-2A is associated with which of the following findings?

Accepted Answer

Ganglioneuromas

Answer

Cutaneous lichenoid amyloidosis

Answer

Mutation in RET on chromosome 10

Answer

Parathyroid adenoma

Question 7

Which of the following thyroid diseases is associated with pain?

Accepted Answer

De Quervain's thyroiditis

Answer

Hashimoto's thyroiditis

Answer

Simple nontoxic goiter

Answer

Graves' disease

Question 8

Which of the following is the drug of choice for adrenal insufficiency?

Accepted Answer

Hydrocortisone

Answer

Adrenaline

Answer

Dexamethasone

Answer

Fludrocortisone

Question 9

A man presents with weakness, pain in the upper abdomen, hyperpigmentation, arthritis, hyperglycemia, and an enlarged palpable liver. What is the most probable diagnosis?

Accepted Answer

Hemochromatosis

Answer

Addison's disease

Answer

Insulin-dependent diabetes mellitus

Answer

Cushing's syndrome

Question 10

What is the gold standard test for diagnosing insulinoma?

Accepted Answer

72-hour fasting test

Answer

Plasma insulin levels

Answer

C-peptide levels

Answer

Low glucose levels < 30 mg/dL

Endocrinology — MCQs

Endocrinology — MCQs

On this page

Practice by Chapter

Want unlimited practice?