Endocrinology Practice Questions

Q: Hypoparathyroidism is seen in all of the following conditions except:

Chronic renal failure. **Explanation:** The core concept here is distinguishing between conditions that cause **primary hypoparathyroidism** (destruction/dysfunction of the gland) and those that cause **secondary hyperparathyroidism**. **Why Chronic Renal Failure (CRF) is the correct answer:** In CRF, there is a decrease in 1-alpha-hydroxylase activity (leading to Vitamin D deficiency) and phosphate retention [1]. Both factors result in **hypocalcemia**, which acts as a potent stimulus for the parathyroid glands [2]. This leads to **Secondary Hyperparathyroidism** (elevated PTH levels) to compensate for the low calcium [1]. Therefore, CRF is associated with high PTH, not hypoparathyroidism. **Why the other options are incorrect:** * **DiGeorge Syndrome:** A congenital dysgenesis of the 3rd and 4th pharyngeal pouches, leading to thymic hypoplasia and **parathyroid aplasia**, causing primary hypoparathyroidism. * **Wilson’s Disease:** Excessive copper deposition can occur in the parathyroid glands, leading to tissue damage and functional hypoparathyroidism. * **Hemochromatosis:** Iron overload leads to deposition in various endocrine organs; iron deposition in the parathyroid glands causes gland destruction and hypoparathyroidism. **NEET-PG High-Yield Pearls:** 1. **Magnesium Link:** Severe hypomagnesemia can cause functional hypoparathyroidism because magnesium is required for both PTH secretion and its peripheral action [2]. 2. **Hungry Bone Syndrome:** A state of profound hypocalcemia seen post-parathyroidectomy in patients with pre-existing hyperparathyroidism. 3. **DiGeorge Mnemonic (CATCH-22):** **C**ardiac defects, **A**bnormal facies, **T**hymic hypoplasia, **C**left palate, **H**ypocalcemia (due to hypoparathyroidism), **22**q11 deletion.

Q: All of the following are true about Hyperthyroidism EXCEPT:

Weight gain. **Explanation:** Hyperthyroidism is characterized by an excess of circulating thyroid hormones ($T_3$ and $T_4$), which leads to a **hypermetabolic state** and increased sensitivity to catecholamines [1]. **Why "Weight Gain" is the correct answer:** The hallmark of hyperthyroidism is an increase in the **Basal Metabolic Rate (BMR)**. Despite a frequent increase in appetite (polyphagia), the body consumes calories faster than they are ingested, leading to **weight loss** [1]. Weight gain is typically associated with *hypothyroidism*, where the BMR is decreased. **Analysis of Incorrect Options:** * **Anxiety:** Excess thyroid hormone increases sympathetic nervous system activity and has a direct effect on the central nervous system, leading to irritability, nervousness, and anxiety [1]. * **Palpitations:** This is a subjective feeling of a rapid or irregular heartbeat caused by increased cardiac output and stroke volume [2]. * **Tachycardia:** Thyroid hormones increase the expression of beta-adrenergic receptors in the heart. This leads to an increased heart rate (sinus tachycardia), even at rest, which is a classic clinical sign [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Exception to the rule:** While weight loss is standard, "Apathetic Hyperthyroidism" in the elderly may present only with depression and weight loss, and rarely, young patients with extreme polyphagia may actually gain weight. * **Cardiac Complication:** The most common arrhythmia associated with hyperthyroidism (especially in the elderly) is **Atrial Fibrillation** [2]. * **Physical Sign:** Look for **Pretibial Myxedema** and **Exophthalmos**, which are specific to Graves' Disease, the most common cause of hyperthyroidism [1]. * **Reflexes:** Hyperthyroidism causes "brisk" or hyperreflexia, whereas hypothyroidism causes a "delayed relaxation phase" of deep tendon reflexes (Woltman sign).

Q: Which of the following is a feature of primary hyperparathyroidism?

Irreversible growth of parathyroid gland. **Explanation:** **Primary Hyperparathyroidism (PHPT)** is characterized by the autonomous, unregulated overproduction of Parathyroid Hormone (PTH), most commonly due to a solitary parathyroid adenoma (85%) or diffuse hyperplasia [2]. 1. **Why Option B is Correct:** In PHPT, the growth of the parathyroid gland is **irreversible**. Unlike secondary hyperparathyroidism (where gland hyperplasia is a reversible compensatory response to low calcium), the pathology in PHPT involves a genetic or clonal shift (e.g., *MEN1* or *CCND1* mutations) that leads to autonomous proliferation [2]. This growth does not regress even if physiological triggers are altered. 2. **Why Other Options are Incorrect:** * **Option A:** Reversible growth is a feature of **Secondary Hyperparathyroidism** (e.g., in early Vitamin D deficiency), where the glands return to normal size once the underlying stimulus (hypocalcemia) is corrected [2]. * **Option C & D:** The hallmark biochemical profile of PHPT is **Hypercalcemia and Hypophosphatemia** [2]. PTH increases bone resorption and renal calcium reabsorption (causing hypercalcemia) while simultaneously inhibiting phosphate reabsorption in the proximal tubule (phosphaturic effect), leading to low serum phosphate [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Mnemonic:** "Stones, bones, abdominal groans, and psychic overtones" (Renal calculi, Osteitis fibrosa cystica, peptic ulcers/pancreatitis, and depression) [3]. * **Radiological Sign:** Subperiosteal bone resorption, most specifically seen on the **radial aspect of the middle phalanges**. * **Diagnosis:** Elevated Serum Calcium + Inappropriately elevated/normal PTH. * **Hungry Bone Syndrome:** A common postoperative complication after parathyroidectomy characterized by severe hypocalcemia.

Q: Which of the following is a true statement about primary hyperparathyroidism?

Adenoma is the commonest cause.. Primary hyperparathyroidism (PHPT) is characterized by the autonomous overproduction of parathyroid hormone (PTH), leading to hypercalcemia [2]. **Explanation of Options:** * **A. Adenoma is the commonest cause (Correct):** Approximately **80-85%** of PHPT cases are caused by a single solitary parathyroid adenoma [1]. Other causes include four-gland hyperplasia (10-15%) and parathyroid carcinoma (<1%). * **B. Associated with low serum calcium (Incorrect):** PHPT is defined by **hypercalcemia** (elevated serum calcium) and inappropriately high or normal PTH levels [3]. Low serum calcium is seen in secondary hyperparathyroidism (usually due to chronic kidney disease) [2]. * **C. Surgery is indicated if biochemical findings are abnormal in an asymptomatic patient (Incorrect):** Surgery is not indicated for *all* asymptomatic patients. Specific criteria (Asymptomatic PHPT Guidelines) must be met, such as: Serum calcium >1 mg/dL above the upper limit of normal, T-score ≤ -2.5, age <50 years, or creatinine clearance <60 ml/min [1]. * **D. MIBG isotope is useful (Incorrect):** **99mTc-Sestamibi (MIBI)** scan is the gold standard for localizing parathyroid adenomas [1]. MIBG scans are used for neuroendocrine tumors like pheochromocytoma. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Presentation:** "Stones (renal calculi), bones (osteitis fibrosa cystica), abdominal groans (peptic ulcers/pancreatitis), and psychic overtones (depression)" [1]. * **Biochemical Profile:** ↑ Calcium, ↓ Phosphate, ↑ PTH, and ↑ Urinary cAMP [2]. * **Hungry Bone Syndrome:** A common postoperative complication following parathyroidectomy, characterized by profound hypocalcemia as the "starved" bones rapidly uptake calcium. * **Association:** Always screen for **MEN 1 and MEN 2A** syndromes if multiple glands are involved [3].

Question 1

Which of the following indications for hospitalization is the most appropriate for patients with eating disorders?

Accepted Answer

Body weight is less than 75% of expected

Answer

Body weight is less than 90% of expected

Answer

Electrolyte disturbances occur

Answer

Body weight is less than 60% of expected

Question 2

Hypoparathyroidism is seen in all of the following conditions except:

Accepted Answer

Chronic renal failure

Answer

DiGeorge syndrome

Answer

Wilson's disease

Answer

Hemochromatosis

Question 3

A 19-year-old female presents for follow-up of medical management for panhypopituitarism after brain tumor resection. Her recent reports show that her TSH is below the detection limit of the assay. What is the next step in her management?

Accepted Answer

Order a free T4 level.

Answer

Decrease levothyroxine dose to half of the current dose.

Answer

Order an MRI of her brain.

Answer

Order a thyroid uptake scan.

Question 4

Which of the following statements regarding Graves' disease is false?

Accepted Answer

Cardiac failure is common.

Answer

Goiter is diffuse and vascular.

Answer

Remissions and exacerbations are not infrequent.

Answer

Hypertrophy/hyperplasia is due to TSH-receptor antibodies.

Question 5

All of the following are true about Hyperthyroidism EXCEPT:

Accepted Answer

Weight gain

Answer

Anxiety

Answer

Palpitations

Answer

Tachycardia

Question 6

Which of the following is a feature of primary hyperparathyroidism?

Accepted Answer

Irreversible growth of parathyroid gland

Answer

Reversible growth of parathyroid gland

Answer

Hypercalcemia and hyperphosphatemia

Answer

Hypocalcemia and hyperphosphatemia

Question 7

A raised serum creatinine phosphokinase level is unusual in which of the following conditions?

Accepted Answer

Myopathy of Cushing's syndrome

Answer

Acute alcoholic myopathy

Answer

Viral polymyositis

Answer

Duchenne's muscular dystrophy

Question 8

Which of the following is a true statement about primary hyperparathyroidism?

Accepted Answer

Adenoma is the commonest cause.

Answer

Associated with low serum calcium.

Answer

Surgery is indicated if biochemical findings are abnormal in an asymptomatic patient.

Answer

MIBG isotope is useful in the localization of the tumor.

Question 9

A 39-year-old obese patient presents with features of a Urinary Tract Infection (UTI) and a Random Blood Sugar (RBS) of 200 mg/dL. Urine analysis shows pus cells. What is true about the management?

Accepted Answer

Insulin can be administered.

Answer

Glipizide is the drug of choice.

Answer

Ciprofloxacin is indicated.

Answer

Testing for microalbuminuria is indicated.

Question 10

All of the following are associated with thyroid storm, except?

Accepted Answer

Surgery for thyroiditis

Answer

Surgery for thyrotoxicosis

Answer

Stressful illness in thyrotoxicosis

Answer

I131 therapy for thyrotoxicosis

Endocrinology — MCQs

Endocrinology — MCQs

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