Endocrinology — MCQs
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Commonest cause of hypothyroidism is
Which of the following statements about thyroid eye disease is false?
A 30-year-old woman presents with a history of amenorrhea and impaired vision of six months' duration. Physical examination shows normal findings except for pale optic discs and diminished visual acuity. The most likely diagnosis is -
The tumor which is more commonly located in the tail of the pancreas is:
In Osteoporosis which of these is seen?
Pendred's syndrome is:
Slow relaxation of tendon reflexes may be a manifestation of:
Osteomalacia is due to -
Prevention or treatment of osteoporosis in post- menopausal women may be achieved by all EXCEPT
A 40 year old lady with temporal field defects and galactorrhoea is most likely to have-
Endocrinology Indian Medical PG Practice Questions and MCQs
Question 1411: Commonest cause of hypothyroidism is
- A. Defect of iodide transport
- B. Thyroid dysgenesis (Correct Answer)
- C. Defective synthesis of thyroxine
- D. Hashimoto's thyroiditis
Explanation: **Thyroid dysgenesis** - **Thyroid dysgenesis** refers to congenital defects in thyroid gland development (e.g., aplasia, hypoplasia, ectopia) and is the most frequent cause worldwide of **congenital hypothyroidism** [1]. - Early detection and treatment with thyroid hormone replacement are crucial to prevent **intellectual disability** and developmental delays [1]. *Defect of iodide transport* - This is a rare genetic disorder affecting the **sodium-iodide symporter (NIS)**, leading to impaired iodide uptake by the thyroid gland. - While it causes hypothyroidism, it is significantly less common than thyroid dysgenesis. *Defective synthesis of thyroxine* - This refers to various inherited defects in the enzymes involved in thyroid hormone synthesis (e.g., peroxidase deficiency, organification defects). - These are collectively known as **dyshormonogenesis**, and although they cause congenital hypothyroidism, their incidence is lower than that of thyroid dysgenesis [1]. *Hashimoto's thyroiditis* - **Hashimoto's thyroiditis** is the most common cause of **acquired hypothyroidism** in adults, an autoimmune condition leading to thyroid gland destruction. - It is not the most common cause of hypothyroidism in general, especially when considering congenital forms.
Question 1412: Which of the following statements about thyroid eye disease is false?
- A. NOSPECS score is used to classify thyroid eye disease
- B. The management corresponds to improvement in thyrotoxic state (Correct Answer)
- C. Can lead to visual loss
- D. Seen in more than 10% of patients with hyperthyroidism
Explanation: ***The management corresponds to improvement in thyrotoxic state*** - Thyroid eye disease (TED) is an **autoimmune condition** that runs independently of the thyroid's hormonal status [1]. While hyperthyroidism can trigger or worsen TED, treating the hyperthyroidism does not necessarily resolve or improve the eye symptoms [2]. - The disease course of TED is often **biphasic**, with an active inflammatory phase followed by a quiescent phase. Treatment decisions for TED are based on the severity and activity of the eye disease itself, not solely on the thyroid hormone levels. *NOSPECS score is used to classify thyroid eye disease* - The **NOSPECS classification system** is a well-established method for grading the severity of thyroid eye disease. - This acronym stands for **N**o signs or symptoms, **O**nly signs (e.g., lid retraction) no symptoms, **S**oft tissue involvement, **P**roptosis, **E**xtraocular muscle involvement, **C**orneal involvement, and **S**ight loss (optic neuropathy). *Can lead to visual loss* - Thyroid eye disease can cause **optic nerve compression** due to enlarged extraocular muscles or increased orbital fat, leading to **compressive optic neuropathy** and potentially irreversible visual loss. - Severe **corneal exposure** from proptosis and lid retraction can also lead to corneal ulceration, infection, and scaring, affecting vision. *Seen in more than 10% of patients with hyperthyroidism* - Thyroid eye disease is the **most common extrathyroidal manifestation** of Graves' disease, occurring in approximately 25-50% of patients with Graves' hyperthyroidism [1]. - While it is less common in other forms of hyperthyroidism or euthyroid individuals, the prevalence in Graves' disease alone is significantly higher than 10%.
Question 1413: A 30-year-old woman presents with a history of amenorrhea and impaired vision of six months' duration. Physical examination shows normal findings except for pale optic discs and diminished visual acuity. The most likely diagnosis is -
- A. Benign intracranial hypertension
- B. Hypothalamic glioma
- C. Craniopharyngioma
- D. Pituitary adenoma (Correct Answer)
Explanation: ***Pituitary adenoma*** - Pituitary adenomas, particularly **macroadenomas**, can cause **bitemporal hemianopsia** due to compression of the **optic chiasm**, leading to impaired vision and pale optic discs [1]. - They also frequently secrete hormones, with **prolactinomas** being a common type, leading to **amenorrhea** in women due to inhibition of GnRH. *Benign intracranial hypertension* - This condition is primarily characterized by **increased intracranial pressure** leading to headache, pulsatile tinnitus, and **papilledema**, which presents as a swollen optic disc, not pale. - While it can cause visual field defects, **amenorrhea** is not a typical associated symptom. *Hypothalamic glioma* - Hypothalamic gliomas can cause visual field defects and endocrine dysfunction due to their location near the **optic chiasm** and **hypothalamus**. - However, they are more common in children and usually present with symptoms like **diabetes insipidus**, growth abnormalities, or precocious puberty, rather than isolated amenorrhea and optic disc pallor. *Craniopharyngioma* - Craniopharyngiomas are **suprasellar tumors** that can compress the optic chiasm, causing visual disturbances, and impact the pituitary stalk and hypothalamus, leading to endocrine dysfunction. - They often present with symptoms of **hydrocephalus**, **growth retardation**, or **diabetes insipidus**, and are more frequently diagnosed in childhood or adolescence, although they can occur in adults.
Question 1414: The tumor which is more commonly located in the tail of the pancreas is:
- A. Glucagonoma (Correct Answer)
- B. Somatostatinoma
- C. Insulinoma
- D. Gastrinoma
Explanation: ***Glucagonoma*** - **Glucagonomas** are most commonly found in the **tail of the pancreas**. - They are associated with a distinct clinical syndrome including **necrolytic migratory erythema**, diabetes, weight loss, and anemia. *Somatostatinoma* - **Somatostatinomas** are typically located in the **head of the pancreas** or duodenum. - Their classical presentation involves diabetes, cholelithiasis, steatorrhea, and weight loss. *Insulinoma* - **Insulinomas** are usually small and evenly distributed throughout the **pancreas**, without a predilection for the tail. - They cause symptoms of hypoglycemia due to excessive insulin secretion, such as **whipple's triad**. *Gastrinoma* - **Gastrinomas** are most frequently found in the **"gastrinoma triangle"**, which includes the head of the pancreas, duodenum, and peripancreatic lymph nodes. [1] - They cause **Zollinger-Ellison syndrome**, characterized by severe peptic ulcer disease and diarrhea due to hypersecretion of gastrin. [1]
Question 1415: In Osteoporosis which of these is seen?
- A. Normal calcium, decreased ALP
- B. Decreased calcium, increased ALP
- C. Normal calcium, normal ALP (Correct Answer)
- D. Decreased calcium, decreased ALP
Explanation: ***Normal calcium, normal ALP*** - In **osteoporosis**, the primary defect is a reduction in **bone mass** due to imbalanced bone remodeling, but the remaining bone tissue is normally mineralized [1]. - Therefore, **serum calcium** and **alkaline phosphatase (ALP)**, which reflect bone turnover and mineralization, typically remain within normal ranges [3]. *Normal calcium, decreased ALP* - While **serum calcium** is usually normal in osteoporosis, **decreased ALP** is not a characteristic finding. - Decreased ALP might indicate conditions like **hypophosphatasia** or certain nutritional deficiencies, which are distinct from osteoporosis. *Decreased calcium, increased ALP* - **Decreased serum calcium** (hypocalcemia) combined with **increased ALP** is often seen in conditions like **osteomalacia** or **rickets**, where there is defective bone mineralization [2]. - This pattern is not typical of osteoporosis, where the problem is a quantitative reduction in bone, not qualitative mineralization defect [3]. *Decreased calcium, decreased ALP* - A combination of **decreased calcium** and **decreased ALP** is an unusual biochemical profile in bone disorders. - It could potentially be seen in severe malnutrition leading to multiple deficiencies, but it is not indicative of osteoporosis.
Question 1416: Pendred's syndrome is:
- A. Thyroiditis extending into adjacent structures.
- B. None.
- C. Deaf and goitrous patient since infancy. (Correct Answer)
- D. Autoimmune thyroiditis.
Explanation: ***Deaf and goitrous patient since infancy*** - **Pendred's syndrome** is an autosomal recessive disorder characterized by **sensorineural hearing loss** and a **goiter** due to a defect in iodine organification [1]. - The symptoms typically manifest from **infancy** or early childhood, with profound deafness being one of the earliest signs [1]. *Thyroiditis extending into adjacent structures* - This describes an inflammatory process of the thyroid gland that has spread, which is not characteristic of **Pendred's syndrome**. - **Pendred's syndrome** is a genetic developmental disorder, not primarily an inflammatory condition causing direct tissue invasion. *None* - This option is incorrect because there is a correct description of Pendred's syndrome provided. - **Pendred's syndrome** is a well-defined genetic condition with specific clinical manifestations. *Autoimmune thyroiditis* - **Autoimmune thyroiditis** (e.g., Hashimoto's thyroiditis) involves the immune system attacking the thyroid gland, leading to hypothyroidism and goiter. - While it can cause a goiter, it does not typically present with congenital **sensorineural deafness** as a primary feature.
Question 1417: Slow relaxation of tendon reflexes may be a manifestation of:
- A. Hypoparathyroidism
- B. Hypothyroidism (Correct Answer)
- C. Hyperparathyroidism
- D. Hyperthyroidism
Explanation: ***Hypothyroidism*** - **Slow relaxation of tendon reflexes**, often described as a "hung-up" reflex, is a classic sign of **hypothyroidism**. [1] - This is due to slowed muscle contraction and relaxation phases, reflecting the generalized metabolic slowing in the body. *Hypoparathyroidism* - This condition is primarily characterized by **hypocalcemia** and can lead to increased neuromuscular excitability, manifesting as **tetany**, muscle cramps, and seizures. - It does not typically cause slow relaxation of tendon reflexes; instead, reflexes may be hyperactive due to lower calcium levels. *Hyperparathyroidism* - This condition leads to **hypercalcemia**, which can cause generalized muscle weakness, fatigue, and bone pain. - While it affects muscle function, it does not typically present with the characteristic slow relaxation of tendon reflexes. *Hyperthyroidism* - **Hyperthyroidism** typically leads to **brisk reflexes** (hyperreflexia) and may even manifest with a fast-relaxing or quickly exhausted reflex. - This is due to the increased metabolic rate and heightened neuromuscular excitability.
Question 1418: Osteomalacia is due to -
- A. Vitamin E deficiency
- B. Vitamin C deficiency
- C. Vitamin D deficiency (Correct Answer)
- D. None of the options
Explanation: ***Vitamin D deficiency*** - **Osteomalacia** is characterized by defective **bone mineralization** in adults, primarily due to insufficient **calcium** and **phosphate** availability for deposition into the bone matrix [1]. - The most common cause of impaired mineralization is severe and prolonged **vitamin D deficiency**, which leads to reduced absorption of calcium and phosphate from the gut [1]. [2]. *Vitamin E deficiency* - **Vitamin E** is an important **antioxidant** that protects cells from damage, but its deficiency is not directly linked to osteomalacia. - Deficiency can lead to **neurological symptoms** like ataxia, peripheral neuropathy, and muscle weakness. *Vitamin C deficiency* - **Vitamin C** is crucial for **collagen synthesis**, and its deficiency causes **scurvy**, characterized by weakened blood vessels, bleeding gums, and impaired wound healing. - It does not directly affect the mineralization of bone, which is the hallmark of osteomalacia. *None of the options* - This option is incorrect because **Vitamin D deficiency** is a well-established cause of osteomalacia [2].
Question 1419: Prevention or treatment of osteoporosis in post- menopausal women may be achieved by all EXCEPT
- A. Calcium and vitamin D supplementation
- B. Multivitamins (Correct Answer)
- C. Bisphosphonates
- D. Estrogen and progesterone hormone replacement therapy
Explanation: ***Multivitamins*** - While multivitamins may contain some **calcium** and **vitamin D**, the dosages are generally insufficient to effectively prevent or treat osteoporosis, which requires targeted, higher doses of these specific nutrients. - Multivitamins provide a broad range of vitamins and minerals, many of which are not directly involved in **bone metabolism** or have a significant impact on **bone mineral density**. *Calcium and vitamin D supplementation* - **Calcium** is a fundamental component of bone, and adequate intake is crucial for maintaining **bone mineral density** and strength, especially in postmenopausal women who are at higher risk of osteoporosis [1, 4]. - **Vitamin D** is essential for the absorption of calcium in the gut and plays a key role in regulating **calcium and phosphate homeostasis**, directly impacting bone health [3]. *Bisphosphonates* - **Bisphosphonates** are potent **antiresorptive agents** that inhibit **osteoclast activity**, thereby reducing bone turnover and preventing bone loss, making them a cornerstone of osteoporosis treatment. - They effectively increase **bone mineral density** and significantly reduce the risk of **vertebral and non-vertebral fractures** in postmenopausal women. *Estrogen and progesterone hormone replacement therapy* - **Estrogen deficiency** after menopause is a primary cause of accelerated bone loss; **estrogen replacement therapy** helps to maintain bone density by reducing **bone resorption** [2]. - While effective, HRT is typically reserved for women with significant menopausal symptoms or those who cannot tolerate other osteoporosis treatments, due to potential risks like increased risk of **breast cancer** and **cardiovascular events** [2].
Question 1420: A 40 year old lady with temporal field defects and galactorrhoea is most likely to have-
- A. Lactational failure
- B. Pituitary macroadenoma (Correct Answer)
- C. Pregnancy
- D. Craniopharyngioma
Explanation: ***Pituitary macroadenoma*** - **Temporal field defects** (bitemporal hemianopsia) are a classic symptom of a pituitary macroadenoma due to compression of the **optic chiasm** by the expanding tumor [1]. - **Galactorrhoea** is often caused by hyperprolactinemia, which is frequently associated with **prolactinomas**, a type of pituitary adenoma [1]. *Lactational failure* - Lactational failure would present with the **absence** of milk production or poor milk supply, not galactorrhoea (milk production outside of breastfeeding). - This condition does not cause **temporal field defects**, which are indicative of a mass effect on vision. *Pregnancy* - While pregnancy can cause galactorrhoea due to hormonal changes, it does not typically lead to **temporal field defects**. - **Visual field defects** in pregnancy would suggest a more serious underlying neurological issue, not a normal physiological response to pregnancy. *Craniopharyngioma* - Craniopharyngiomas are typically **suprasellar tumors** that can cause visual field defects due to optic chiasm compression, similar to pituitary adenomas. - However, craniopharyngiomas are not typically associated with **galactorrhoea**; they are more often linked to hypothalamic-pituitary dysfunction leading to hormone deficiencies, not hyperprolactinemia [1].
Practice by Chapter
Diabetes Mellitus
Practice Questions
Thyroid Disorders
Practice Questions
Adrenal Gland Disorders
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Pituitary Disorders
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Calcium and Bone Metabolism
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Reproductive Endocrinology
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Lipid Disorders
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Endocrine Hypertension
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Multiple Endocrine Neoplasia
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Obesity and Metabolic Syndrome
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Neuroendocrine Tumors
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Endocrine Emergencies
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