Endocrinology — MCQs

Endocrinology Indian Medical PG Practice Questions and MCQs

Question 1471: A patient on long-term corticosteroid therapy presents with symptoms of adrenal insufficiency. What is the most appropriate management strategy for this condition?

A. Immediate cessation of corticosteroids
B. Switch to a different corticosteroid
C. Addition of a mineralocorticoid
D. Gradual tapering of corticosteroids (Correct Answer)

Explanation: **Gradual tapering of corticosteroids** * **Gradual tapering** allows the **adrenal glands** to slowly resume their natural production of **cortisol**, preventing an **adrenal crisis** [1]. * **Abrupt cessation** leads to severe **adrenal insufficiency** due to the body's dependence on exogenous corticosteroids [1]. *I*mmediate cessation of corticosteroids * **Immediate cessation** can precipitate an **adrenal crisis**, a life-threatening condition characterized by **hypotension**, **shock**, and **electrolyte imbalance**. * This approach does not allow the **hypothalamic-pituitary-adrenal (HPA) axis** to recover, leading to severe cortisol deficiency [1]. *Switch to a different corticosteroid * Switching to a different corticosteroid would not address the underlying issue of **adrenal suppression** caused by long-term exogenous corticosteroid use. * The goal is to restore endogenous **cortisol production**, which requires reducing the overall corticosteroid load. *Addition of a mineralocorticoid * **Mineralocorticoid** replacement (e.g., fludrocortisone) is primarily indicated for **primary adrenal insufficiency** (e.g., Addison's disease), where **aldosterone production** is impaired. * In **secondary adrenal insufficiency** from long-term corticosteroid use, **aldosterone secretion** is usually preserved, as it is mainly regulated by the **renin-angiotensin system** [2].

Question 1472: A 60-year-old man is diagnosed with Conn's syndrome. What is the expected effect on his serum potassium levels?

A. Hyperkalemia
B. Hypokalemia (Correct Answer)
C. Normokalemia
D. Hypernatremia

Explanation: ***Hypokalemia*** - **Conn's syndrome** (primary hyperaldosteronism) leads to excessive **aldosterone** secretion, which promotes potassium excretion in the kidneys [1]. - This increased renal potassium wasting results in **decreased serum potassium levels**, commonly presenting as hypokalemia [1], [2]. *Hyperkalemia* - **Hyperkalemia** (high potassium) is the opposite of what occurs in Conn's syndrome; conditions like **adrenal insufficiency** (Addison's disease) or renal failure are associated with hyperkalemia due to decreased aldosterone effect or inability to excrete potassium. - Conn's syndrome causes increased **aldosterone** activity, actively moving potassium out of the body [1]. *Normokalemia* - While some patients with primary hyperaldosteronism can initially present with **normokalemia**, sustained oversecretion of **aldosterone** typically leads to some degree of **potassium depletion** as the kidneys continue to excrete it [2]. - **Normokalemia** would not be the *expected* long-term effect in untreated Conn's syndrome. *Hypernatremia* - Conn's syndrome is characterized by increased **aldosterone** secretion, which primarily causes **sodium retention** and **potassium excretion** [1]. - While sodium retention occurs, it often leads to **volume expansion** and **suppression of ADH**, preventing significant **hypernatremia**; instead, patients often have normal or mildly elevated serum sodium levels [2].

Question 1473: A 45-year-old woman is experiencing night sweats and tremors. Her laboratory results reveal elevated T3 and T4 levels. What is the most likely diagnosis?

A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Primary hyperthyroidism (Correct Answer)
D. Secondary hyperthyroidism

Explanation: ***Primary hyperthyroidism*** - The combination of **night sweats**, **tremors**, and **elevated T3 and T4 levels** is highly indicative of hyperthyroidism [3]. - In primary hyperthyroidism, the thyroid gland itself overproduces thyroid hormones, leading to increased levels of **T3** and **T4** and typically suppressed TSH (not provided, but implied) [2]. *Primary hypothyroidism* - This condition is characterized by **low T3 and T4 levels** and **elevated TSH**, which directly contradicts the patient's lab results [2]. - Clinical symptoms often include **fatigue**, **weight gain**, and **cold intolerance**, not night sweats and tremors [1]. *Secondary hypothyroidism* - This condition involves **low T3 and T4 levels** due to a pituitary or hypothalamic dysfunction, leading to low TSH, which is opposite to the patient's elevated thyroid hormones [4]. - Clinical presentation would also involve symptoms of thyroid hormone deficiency. *Secondary hyperthyroidism* - While this also causes **elevated T3 and T4**, it is due to an **overproduction of TSH** from the pituitary gland [4]. - This is a much rarer cause of hyperthyroidism compared to primary hyperthyroidism, and the lack of TSH information makes primary hyperthyroidism the most likely initial diagnosis given the common clinical presentation.

Question 1474: What is the most effective lifestyle intervention for a patient with type 2 diabetes mellitus to manage hyperglycemia?

A. Weight loss (Correct Answer)
B. Increased dietary fiber
C. Low-intensity exercise
D. Supplemental niacin

Explanation: ***Weight loss*** - **Weight loss**, particularly in overweight or obese individuals with **type 2 diabetes**, significantly improves **insulin sensitivity** and reduces hyperglycemia [1]. - Even a modest weight reduction can lead to lower HbA1c levels and a decreased need for **antidiabetic medications** [2]. *Increased dietary fiber* - While **dietary fiber** can help improve glycemic control by slowing glucose absorption and promoting satiety, it is generally less effective than overall weight loss for managing significant hyperglycemia [1]. - Its primary benefits often revolve around improving **lipid profiles** and **bowel function**, which are secondary to direct glucose lowering. *Low-intensity exercise* - **Low-intensity exercise** is beneficial for overall health and can slightly improve glucose uptake by muscles, but its impact on substantial hyperglycemia management is limited compared to more vigorous activity or significant weight loss [1]. - To achieve significant glycemic benefits, a combination of **aerobic** and **resistance training** is often recommended alongside dietary changes. *Supplemental niacin* - **Niacin** (Vitamin B3) can improve **lipid profiles**, particularly by raising HDL cholesterol, but it is known to potentially *worsen* **insulin resistance** and **hyperglycemia** in some diabetic patients. - Therefore, it is generally not a recommended intervention for managing **hyperglycemia** in **type 2 diabetes**.

Question 1475: Which hormone imbalance is primarily responsible for the development of Cushing's syndrome?

A. Excess cortisol (Correct Answer)
B. Deficiency of aldosterone
C. Deficiency of insulin
D. Excess thyroid hormone

Explanation: ***Excess cortisol*** - **Cushing's syndrome** is fundamentally caused by prolonged exposure to inappropriately high levels of **glucocorticoids**, primarily **cortisol** [1], [3]. - This excess can stem from various sources, including endogenous overproduction (e.g., adrenal tumors) or exogenous administration (e.g., corticosteroid medications) [1], [2]. *Deficiency of aldosterone* - A deficiency in **aldosterone** is characteristic of conditions like **Addison's disease** or congenital adrenal hyperplasia, which involve adrenal insufficiency. - This leads to symptoms such as **hyponatremia**, **hyperkalemia**, and **hypotension**, directly opposite to the clinical picture of Cushing's syndrome. *Deficiency of insulin* - A deficiency in **insulin** is the hallmark of **Type 1 diabetes mellitus**, leading to **hyperglycemia** and metabolic dysfunction. - While patients with Cushing's syndrome can develop **invsulin resistance** and glucose intolerance due to high cortisol, the primary underlying hormonal imbalance for the syndrome itself is not insulin deficiency. *Excess thyroid hormone* - **Excess thyroid hormone** is responsible for **hyperthyroidism** (e.g., Graves' disease), leading to symptoms like **tachycardia**, **weight loss**, and **heat intolerance**. - These symptoms are distinct from the classic features of Cushing's syndrome, which include weight gain, central obesity, and moon facies [2].

Question 1476: A 45-year-old woman presents with episodes of severe headache, palpitations, and sweating, with consistently high blood pressure during these episodes. What is the most likely diagnosis?

A. Migraine
B. Cluster headache
C. Pheochromocytoma (Correct Answer)
D. Temporal arteritis

Explanation: ***Pheochromocytoma*** - The classic triad of **severe headache, palpitations, and sweating**, especially when episodic and associated with **hypertensive crises**, is highly suggestive of a pheochromocytoma. - This tumor often secretes **catecholamines**, leading to these paroxysmal symptoms and sustained or episodic hypertension. *Migraine* - While migraines cause severe headaches, they are usually **unilateral** and often accompanied by **photophobia, phonophobia, and aura**, not episodic hypertension, palpitations, or profuse sweating. [1] - **Blood pressure changes** during a migraine are typically secondary and not the prominent, paroxysmal elevations seen here. *Cluster headache* - Characterized by **excruciating, unilateral pain** around the eye or temple, often accompanied by **lachrymation, ptosis, and rhinorrhea**, and occurs in clusters [2]. - It does **not typically present with hypertension, palpitations, or generalized sweating** as primary symptoms. *Temporal arteritis* - This condition presents with a **new-onset headache in an older adult**, often with **scalp tenderness, jaw claudication, and visual disturbances**. - It is an **inflammatory vasculitis** and does not cause episodic palpitations, sweating, or paroxysmal hypertension. [1]

Question 1477: A 70-year-old woman presents with a severe headache and visual disturbances. An MRI shows a pituitary mass that stains positive for ACTH. Which endocrine disorder is consistent with this presentation?

A. Prolactinoma
B. Somatotroph adenoma
C. Corticotroph adenoma (Correct Answer)
D. Thyrotroph adenoma

Explanation: ***Corticotroph adenoma*** - A pituitary mass that stains positive for **ACTH (adrenocorticotropic hormone)** is characteristic of a corticotroph adenoma. - This type of adenoma leads to **Cushing's disease** due to excessive ACTH production, which stimulates the adrenal glands to produce cortisol [1]. - The most common local complication of a large pituitary tumour is compression of the optic pathway, often resulting in visual disturbances [1]. *Prolactinoma* - A prolactinoma would stain positive for **prolactin**, not ACTH. - Clinical symptoms typically include **galactorrhea** and **amenorrhea** in women, or **hypogonadism** in men. *Somatotroph adenoma* - A somatotroph adenoma would stain positive for **growth hormone (GH)**, not ACTH. - It causes **acromegaly** in adults or gigantism in children, presenting with distinct physical changes rather than features of cortisol excess. *Thyrotroph adenoma* - A thyrotroph adenoma would stain positive for **thyroid-stimulating hormone (TSH)**, not ACTH. - This condition is rare and can lead to **hyperthyroidism** due to excess TSH production, with symptoms related to thyroid hormone excess.

Question 1478: Which of the following is the most appropriate initial management for a patient with diabetic ketoacidosis (DKA)?

A. Intravenous insulin infusion (Correct Answer)
B. Oral metformin
C. Subcutaneous long-acting insulin
D. Oral sulfonylureas

Explanation: ***Intravenous insulin infusion*** - **Intravenous insulin** is crucial in DKA to reverse gluconeogenesis, glycogenolysis, and ketogenesis, rapidly lowering blood glucose and resolving acidosis [1]. - An initial **bolus** followed by a continuous infusion ensures a steady and predictable reduction in glucose and ketone levels. *Oral metformin* - **Metformin** works by decreasing hepatic glucose production and increasing insulin sensitivity, which is too slow and ineffective in the acute crisis of DKA. - It is contraindicated in conditions leading to **renal impairment** or metabolic acidosis, both of which can be present or exacerbated in DKA. *Subcutaneous long-acting insulin* - **Long-acting insulin**, while essential for basal insulin replacement in diabetes management, acts too slowly to address the acute metabolic derangements of DKA. - Starting with long-acting insulin alone would **delay correction** of severe hyperglycemia and ketosis [2]. *Oral sulfonylureas* - **Sulfonylureas** stimulate insulin secretion from pancreatic beta cells, which are already severely dysfunctional or exhausted in DKA [3]. - These medications can also cause **hypoglycemia** and are not designed for the magnitude of hyperglycemia seen in DKA [3].

Question 1479: A 65-year-old woman with a history of osteoporosis presents with a vertebral compression fracture. Which of the following is the most appropriate long-term management?

A. Early mobilization as tolerated
B. Imaging assessment (MRI/CT) (Correct Answer)
C. Neurological assessment
D. Pain management with analgesics

Explanation: ***Imaging assessment (MRI/CT)*** - **MRI or CT imaging** is crucial for long-term management to precisely determine the extent of the **vertebral compression fracture**, identify the **number of affected vertebrae**, and detect any potential **spinal cord compression** or instability. - This information guides further interventions, including **vertebroplasty**, **kyphoplasty**, or **surgical stabilization**, and helps monitor the progression or healing of the fracture, especially in cases of **osteoporosis** [1]. *Neurological assessment* - While important in the **acute phase** to rule out immediate neurological compromise, a neurological assessment alone is not a long-term management strategy for the fracture itself [1]. - It helps guide initial treatment but does not address the underlying bone health or fracture mechanics. *Early mobilization as tolerated* - **Early mobilization** is crucial for preventing deconditioning and complications, but it is a rehabilitation strategy, not a primary long-term management for the fracture itself without prior assessment. - The type and extent of mobilization need to be guided by imaging and further medical assessment to prevent further damage [1]. *Pain management with analgesics* - **Pain management** is a symptomatic treatment and an important part of the immediate and ongoing care. - However, it does not address the underlying **pathology (osteoporosis)** or the **structural integrity of the spine**, which is critical for long-term management [1].

Question 1480: A 62-year-old male with a history of hypertension and type 2 diabetes presents with fatigue and weight loss. His blood pressure is 160/100 mmHg. Laboratory tests show elevated aldosterone and low plasma renin activity. What is the most likely diagnosis?

A. Primary hyperaldosteronism (Correct Answer)
B. Cushing's syndrome
C. Pheochromocytoma
D. Secondary hypertension

Explanation: ***Primary hyperaldosteronism*** - The combination of **hypertension**, **elevated aldosterone**, and **low plasma renin activity** [2] is characteristic of primary hyperaldosteronism, where the adrenal glands produce excessive aldosterone independently of the renin-angiotensin system. - While fatigue and weight loss are non-specific, persistent hypertension unresponsive to usual treatments and associated with electrolyte imbalances (though not explicitly mentioned here) further points to this diagnosis. *Cushing's syndrome* - This condition is characterized by **excess cortisol**, leading to symptoms like **central obesity**, **moon facies**, **buffalo hump**, and **striae**, which are not described in the patient's presentation. - While hypertension can occur, the key lab findings of **elevated aldosterone and low renin** are not primary features of Cushing's syndrome [3]. *Pheochromocytoma* - A pheochromocytoma is a tumor that secretes **catecholamines**, causing **paroxysmal hypertension**, **tachycardia**, **palpitations**, **sweating**, and **headaches** [1]. - The characteristic laboratory findings would be **elevated plasma metanephrines or normetanephrines**, not elevated aldosterone or low renin. *Secondary hypertension* - This is a broad category, but the specific lab findings of **elevated aldosterone and low renin** in this patient precisely identify the *cause* of the secondary hypertension as primary hyperaldosteronism. - Without these specific findings, other causes of secondary hypertension (e.g., renal artery stenosis, thyroid dysfunction) would need to be considered [4], but the current data points to a specific etiology.

Practice by Chapter

Diabetes Mellitus

Practice Questions

Thyroid Disorders

Practice Questions

Adrenal Gland Disorders

Practice Questions

Pituitary Disorders

Practice Questions

Calcium and Bone Metabolism

Practice Questions

Reproductive Endocrinology

Practice Questions

Lipid Disorders

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Endocrine Hypertension

Practice Questions

Multiple Endocrine Neoplasia

Practice Questions

Obesity and Metabolic Syndrome

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Neuroendocrine Tumors

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Endocrine Emergencies

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