Endocrinology — MCQs
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A 55 yr old patient presented to the opd with complaint of pain in back. On examination his limbs seemed to be bent with overlying warm and thick skin. Patient also complain of decreased hearing over a few days. On biochemical analysis his serum ALP was raised. X-ray obtained showed the following features. Most probable diagnosis?
Epiphyseal dysgenesis is a feature of
Pheochromocytoma is characterized by excessive secretion of:
Reversible dementia is a feature of:
A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?
In comparison to a normal healthy person, in the evening time, which of these will have an elevated ACTH as well as elevated Cortisol?
In type I diabetes, which of the following is the MOST characteristic metabolic change that distinguishes it from type II diabetes:-
A 55 year old male presents with tachypnea and mental confusion. Blood glucose 350 mg/dl, pH = 7.0. What is the most likely acid base disorder?
What is the first line of treatment for osteoporosis in postmenopausal women?
A 26 year old female after her delivery develops features of headache, nausea, visual complaints, fatigue. What is the most probable diagnosis?
Endocrinology Indian Medical PG Practice Questions and MCQs
Question 1431: A 55 yr old patient presented to the opd with complaint of pain in back. On examination his limbs seemed to be bent with overlying warm and thick skin. Patient also complain of decreased hearing over a few days. On biochemical analysis his serum ALP was raised. X-ray obtained showed the following features. Most probable diagnosis?
- A. Renal osteodystrophy
- B. Osteoporosis
- C. Pagets disease (Correct Answer)
- D. Osteopetrosis
Explanation: ***Pagets disease*** - The combination of **bent limbs** (skeletal deformities), **warm and thick skin** (increased vascularity and bone remodeling), **decreased hearing** (due to involvement of skull bones), and **raised serum ALP** (reflecting high osteoblastic activity) is highly characteristic of Paget's disease of bone. - The X-ray image showing **cotton wool appearance** of the skull and thickening of the calvarium strongly supports this diagnosis; these features are a hallmark of advanced Paget's disease. *Renal osteodystrophy* - This condition results from **chronic kidney disease** and typically involves abnormal bone turnover, but the specific combination of warm skin, bent limbs and decreased hearing is not typical. - X-ray findings in renal osteodystrophy often include osteosclerosis (especially "rugger-jersey spine") or osteopenia, not the **cotton wool appearance** seen in the skull here. *Osteoporosis* - Characterized by **decreased bone density** and increased fracture risk, often asymptomatic until a fracture occurs. - While back pain can occur due to vertebral compression fractures, the bone deformities, warm skin, hearing loss, and elevated ALP are **not features of osteoporosis**. *Osteopetrosis* - A rare genetic disorder characterized by **increased bone density** due to defective osteoclasts, leading to brittle bones and often hematologic problems. - While it can manifest as bone pain and hearing loss due to cranial nerve compression, the bones are abnormally dense and sclerotic on X-ray, in contrast to the **mixed lytic and blastic lesions** with cortical thickening seen in Paget's disease.
Question 1432: Epiphyseal dysgenesis is a feature of
- A. Hypoparathyroidism
- B. Hyperparathyroidism
- C. Hypothyroidism (Correct Answer)
- D. Hyperthyroidism
Explanation: ***Hypothyroidism*** - **Epiphyseal dysgenesis** (dysplastic or stippled epiphyses) is a classic radiographic feature of **congenital hypothyroidism**, particularly in infants and children [2]. - Reduced thyroid hormone levels impair normal bone development, leading to delayed bone maturation and abnormal epiphyseal ossification [2]. *Hypoparathyroidism* - This condition involves insufficient **parathyroid hormone (PTH)**, leading to **hypocalcemia** and **hyperphosphatemia** [1]. - Its effects on bone primarily involve increased bone density and sometimes basal ganglia calcification, not epiphyseal dysgenesis [1]. *Hyperparathyroidism* - Characterized by excessive **PTH**, which causes **hypercalcemia** and bone resorption. - Bone features include **osteitis fibrosa cystica** (brown tumors, subperiosteal resorption), which is distinct from epiphyseal dysgenesis. *Hyperthyroidism* - This condition is marked by excessive thyroid hormone, which can lead to **accelerated bone turnover** and increased risk of osteoporosis. - Unlike hypothyroidism, it does not cause epiphyseal dysgenesis; instead, it can lead to premature skeletal maturation.
Question 1433: Pheochromocytoma is characterized by excessive secretion of:
- A. Catecholamines. (Correct Answer)
- B. Dopamine.
- C. Aldosterone.
- D. Glucocorticoids.
Explanation: ***Catecholamines*** - **Pheochromocytoma** is a tumor of the **adrenal medulla** that secretes excessive amounts of **catecholamines**, primarily **epinephrine** and **norepinephrine** [1]. - This overproduction leads to classic symptoms such as **hypertension**, **tachycardia**, palpitations, sweating, and anxiety [1]. *Dopamine* - While dopamine is a **precursor** to norepinephrine and epinephrine, and some pheochromocytomas can secrete dopamine, it is not the primary or most characteristic hormone excessively secreted [1]. - Excessive dopamine secretion is more commonly associated with tumors like **neuroblastomas** or **ganglioneuromas**. *Aldosterone* - **Aldosterone** is a mineralocorticoid primarily secreted by the **adrenal cortex** (zona glomerulosa), not the adrenal medulla, and is involved in regulating blood pressure and electrolyte balance [1]. - Excessive aldosterone secretion is indicative of conditions like **primary hyperaldosteronism** (Conn's syndrome) or secondary hyperaldosteronism. *Glucocorticoids* - **Glucocorticoids**, such as **cortisol**, are hormones secreted by the **adrenal cortex** (zona fasciculata) and are vital for metabolism, immune function, and stress response [2]. - Excessive glucocorticoid secretion is characteristic of **Cushing's syndrome**, not pheochromocytoma [2].
Question 1434: Reversible dementia is a feature of:
- A. Endocrine disorder (Correct Answer)
- B. Frontotemporal dementia
- C. Vascular dementia
- D. Neurodegenerative disorder
Explanation: ***Endocrine disorder*** - Certain **endocrine disorders**, such as **hypothyroidism** or **hyperparathyroidism**, can cause cognitive impairment that is reversible with appropriate treatment. - Correction of the underlying hormonal imbalance often leads to significant improvement or full resolution of cognitive symptoms. *Frontotemporal dementia* - This is a **progressive neurodegenerative disorder** characterized by changes in personality, behavior, and language, which are generally irreversible [3]. - It involves the degeneration of the **frontal and temporal lobes** of the brain, leading to permanent cognitive decline. *Vascular dementia* - Caused by **reduced blood flow to the brain** due to strokes or other cerebrovascular events, leading to irreversible brain damage [1]. - While supportive care can manage symptoms, the underlying brain damage and cognitive deficits are generally **not reversible**. *Neurodegenerative disorder* - This is a broad category of conditions, including **Alzheimer's disease** and **Parkinson's disease**, that involve progressive loss of neurons and are characterized by irreversible cognitive decline [2], [4]. - The brain damage associated with these conditions is permanent and worsens over time.
Question 1435: A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?
- A. Elevated TSH with normal thyroid hormone levels
- B. Elevated TSH with low thyroid hormone levels
- C. Normal TSH with abnormal thyroid hormone levels
- D. Suppressed TSH with elevated thyroid hormone levels (Correct Answer)
Explanation: Suppressed TSH with elevated thyroid hormone levels - The patient's symptoms of **fatigue** (despite being warm) and **difficulty gaining weight**, coupled with her body feeling **warm**, are classic signs of **hyperthyroidism**. [1] - In hyperthyroidism, the thyroid gland produces **excessive thyroid hormones (T3 and T4)**, which in turn **suppresses TSH** production from the pituitary gland through negative feedback. [2] *Elevated TSH with normal thyroid hormone levels* - This pattern is characteristic of **subclinical hypothyroidism**, where the thyroid gland is beginning to fail, leading to increased TSH to maintain normal thyroid hormone levels. [3] - The patient's symptoms of feeling warm and difficulty gaining weight are inconsistent with hypothyroidism. [1] *Elevated TSH with low thyroid hormone levels* - This indicates **primary hypothyroidism**, where the thyroid gland is underactive and produces insufficient thyroid hormones, leading to a compensatory rise in TSH. [2] - Hypothyroidism typically presents with **weight gain**, **cold intolerance**, and fatigue, which contradict the patient's presentation. [1] *Normal TSH with abnormal thyroid hormone levels* - This scenario usually suggests **central hypothyroidism** (pituitary or hypothalamic dysfunction affecting TSH production) or **thyroid hormone resistance**. [3] - While possible in some rare cases, it does not fit the typical clinical picture of hyperthyroidism presented by the patient's symptoms.
Question 1436: In comparison to a normal healthy person, in the evening time, which of these will have an elevated ACTH as well as elevated Cortisol?
- A. Addison's disease
- B. Cushing's disease (Correct Answer)
- C. Transient state after exercise (evening time)
- D. Normal healthy person (evening time)
Explanation: **_Cushing's disease_** * In **Cushing's disease**, there is an **ACTH-producing pituitary adenoma** that leads to excessive ACTH secretion, which in turn stimulates the adrenal glands to produce high levels of cortisol. * This results in **chronically elevated cortisol levels** throughout the day, including the evening, and an inappropriately elevated ACTH due to increased production from the pituitary. *Addison's disease* * **Addison's disease** is characterized by **primary adrenal insufficiency**, meaning the adrenal glands cannot produce sufficient cortisol despite adequate ACTH stimulation. * While ACTH would be significantly **elevated** due to a lack of negative feedback from cortisol, the **cortisol levels would be low** or normal in response to the adrenal gland dysfunction. *Transient state after exercise (evening time)* * During and immediately after **intense exercise**, both ACTH and cortisol levels can transiently increase as part of the body's stress response. * However, these elevations are typically **transient** and would not represent a sustained, pathologically elevated state in the evening in the same way as Cushing's disease, and levels would usually normalize relatively quickly. *Normal healthy person (evening time)* * In a normal healthy person, ACTH and cortisol levels exhibit a **diurnal rhythm**, with the highest levels in the morning and the lowest levels in the late evening/night. * Therefore, in the evening, both **ACTH and cortisol levels would naturally be low** as part of the physiological circadian rhythm, not elevated.
Question 1437: In type I diabetes, which of the following is the MOST characteristic metabolic change that distinguishes it from type II diabetes:-
- A. Increased protein catabolism
- B. Decreased glucose uptake
- C. Increased hepatic glucose output
- D. Increased lipolysis (Correct Answer)
Explanation: ***Increased lipolysis*** - In **type 1 diabetes** (T1D), there is an **absolute deficiency of insulin**, which is a potent **anti-lipolytic hormone**. [1] - This lack of insulin leads to unopposed **lipolysis**, resulting in increased free fatty acid (FFA) release, which can be metabolized into **ketone bodies** and contribute to **diabetic ketoacidosis (DKA)**. [2] *Increased protein catabolism* - While protein catabolism is increased in uncontrolled T1D due to the lack of insulin and increased counter-regulatory hormones, it is not the *most characteristic* metabolic change that clearly distinguishes it from type 2 diabetes (T2D), especially in early stages of T2D where some insulin may still be present. [1] - **Protein breakdown** produces amino acids for gluconeogenesis, contributing to hyperglycemia, but **lipolysis leading to ketosis** is more specific to severe insulin deficiency. [3] *Decreased glucose uptake* - **Decreased glucose uptake** by peripheral tissues (especially muscle and adipose tissue) is a characteristic feature of both T1D and T2D. [1] - In T1D, it's due to insulin deficiency, while in T2D, it's primarily caused by **insulin resistance**, making it less specific to distinguish T1D. *Increased hepatic glucose output* - **Increased hepatic glucose output** is a significant contributor to hyperglycemia in both T1D and T2D. [1] - In T1D, it's due to the lack of insulin's suppressive effect on the liver, whereas in T2D, it's due to **hepatic insulin resistance** and increased gluconeogenesis.
Question 1438: A 55 year old male presents with tachypnea and mental confusion. Blood glucose 350 mg/dl, pH = 7.0. What is the most likely acid base disorder?
- A. Metabolic acidosis (Correct Answer)
- B. Metabolic alkalosis
- C. Respiratory alkalosis
- D. Respiratory acidosis
Explanation: Metabolic acidosis - A **pH of 7.0** indicates significant acidemia, and **hyperglycemia (350 mg/dL)** in conjunction with clinical symptoms (tachypnea, mental confusion) strongly suggests **diabetic ketoacidosis (DKA)**, a common cause of high anion gap metabolic acidosis [1]. - Tachypnea is often a **compensatory mechanism** (Kussmaul breathing) to blow off carbon dioxide and raise pH in metabolic acidosis [1], [2]. Metabolic alkalosis - This would present with an **elevated pH (alkalemia)**, which is opposite to the patient's measured pH of 7.0 [2]. - It is typically caused by conditions like severe vomiting or diuretic use, which are not suggested by the clinical presentation [3]. Respiratory alkalosis - This condition involves a **high pH** and a **low PCO2**, often due to hyperventilation [2]. - While the patient is tachypneic, the profound acidemia (pH 7.0) contradicts a primary respiratory alkalosis. Respiratory acidosis - While leading to a low pH, respiratory acidosis is characterized by **elevated PCO2** due to hypoventilation. - The patient's **tachypnea** indicates hyperventilation, which would tend to lower PCO2, making primary respiratory acidosis unlikely.
Question 1439: What is the first line of treatment for osteoporosis in postmenopausal women?
- A. Ulipristal
- B. Estrogen
- C. Bisphosphonates (Correct Answer)
- D. Calcium and vitamin D supplementation
Explanation: ***Bisphosphonates*** - **Bisphosphonates** are the **first-line therapy** for osteoporosis in postmenopausal women due to their proven efficacy in reducing the risk of fragility fractures [1]. - They work by inhibiting **osteoclast activity**, thereby decreasing bone resorption and increasing bone mineral density [1]. *Ulipristal* - **Ulipristal** is a **selective progesterone receptor modulator** primarily used as an emergency contraceptive or for the treatment of uterine fibroids. - It has no role in the direct treatment or prevention of osteoporosis. *Estrogen* - **Estrogen therapy** can prevent bone loss but is generally not considered first-line for osteoporosis due to potential risks like increased incidence of **venous thromboembolism**, stroke, and certain cancers [1]. - It is typically reserved for women with severe menopausal symptoms who also need osteoporosis prevention [1]. *Calcium and vitamin D supplementation* - While essential for **bone health**, **calcium and vitamin D supplementation** alone is not sufficient to treat established osteoporosis [2]. - They are crucial adjuncts to pharmacotherapy, ensuring adequate building blocks for bone formation, but do not directly address the underlying bone loss mechanism effectively enough as a monotherapy for osteoporosis [1].
Question 1440: A 26 year old female after her delivery develops features of headache, nausea, visual complaints, fatigue. What is the most probable diagnosis?
- A. Sheehan's syndrome (Correct Answer)
- B. Waterhouse-Friderichsen syndrome
- C. Hyperprolactinemia
- D. Pituitary adenoma
Explanation: ***Sheehan's syndrome*** - This syndrome is caused by **ischemic necrosis of the pituitary gland** due to severe postpartum hemorrhage or hypovolemic shock, leading to **pituitary dysfunction** [1]. - Symptoms like **headache, nausea, visual complaints, and fatigue** are consistent with panhypopituitarism developing after delivery, often presenting in the postpartum period due to the large, vulnerable pregnancy-enlarged pituitary [1]. *Waterhouse-Friderichsen syndrome* - This is a rare, life-threatening condition caused by overwhelming **bacterial infection (often meningococcal)**, leading to **adrenal gland hemorrhage** and acute adrenal insufficiency. - It presents with rapid onset of fever, petechial rash, hypotension, and shock, which are not described in the patient's symptoms. *Hyperprolactinemia* - While hyperprolactinemia can cause headaches and visual disturbances (if due to a pituitary tumor) [1], it typically presents with **galactorrhea**, **amenorrhea**, or **oligomenorrhea**, and is not directly linked to the postpartum period unless caused by a new or existing pituitary adenoma. - It does not account for the widespread pituitary failure implied by the patient's general fatigue and other symptoms after delivery, which is more characteristic of Sheehan's [2]. *Pituitary adenoma* - A pituitary adenoma can cause headaches, visual disturbances (due to **mass effect on the optic chiasm**) [1], and hormone deficiencies or excesses, but its onset is not specifically tied to the postpartum period like Sheehan's syndrome. - While it's a possibility for these symptoms, the history of recent delivery strongly points to Sheehan's syndrome over a newly symptomatic or pre-existing pituitary adenoma without specific features like galactorrhea or Cushing's symptoms that would hint at a specific type of adenoma.
Practice by Chapter
Diabetes Mellitus
Practice Questions
Thyroid Disorders
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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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