Endocrinology — MCQs

A patient with diabetes mellitus for the past 5 years presents with vomiting and abdominal pain. She is non-compliant with medication and appears dehydrated. Investigations revealed a blood sugar value of 500 mg/dl and the presence of ketone bodies. What is the next best step in management of this patient?

Q1559

Which of the following is commonly seen in Pituitary apoplexy?

Q1560

Which of the following is not seen in MEN 2B syndrome?

Endocrinology Indian Medical PG Practice Questions and MCQs

Question 1551: Sheehan syndrome is?

A. Pituitary adenoma
B. Pituitary necrosis (Correct Answer)
C. Adrenal necrosis
D. Adrenal adenoma

Explanation: ### Pituitary necrosis - Sheehan syndrome is characterized by **pituitary gland necrosis** due to severe blood loss or low blood pressure during or after childbirth [1]. - This condition leads to **hypopituitarism**, affecting hormone secretion crucial for various bodily functions [1], [2]. *Adrenal necrosis* - Refers to the death of adrenal gland tissue, but is not specifically related to Sheehan syndrome's etiology. - Symptoms may include **adrenal insufficiency**, which is not the primary feature of Sheehan syndrome. *Adrenal adenoma* - This is a benign tumor of the adrenal gland, typically associated with hormonal excess (like Cushing's syndrome) [3]. - Unlike Sheehan syndrome, it does not involve **ischemic damage** to the pituitary gland. *Pituitary adenoma* - A tumor of the pituitary gland that often causes **hypersecretion** of hormones rather than necrosis. - While it may affect pituitary function, it does not occur due to blood loss during childbirth, unlike Sheehan syndrome.

Question 1552: At what age is prophylactic thyroidectomy recommended for children with MEN 2A?

A. By 1 year for MEN 2B
B. 5 years for MEN 2A (Correct Answer)
C. When detected for MEN 2B
D. Any time for MEN 2

Explanation: ***5 years for MEN 2A*** - For **MEN 2A**, prophylactic thyroidectomy is generally recommended by **5 years of age** to prevent the development of medullary thyroid carcinoma (MTC). - This timing allows for careful planning and minimizes the risks associated with surgery in very young children, while still being early enough to be effectively prophylactic. *By 1 year for MEN 2B* - This option is incorrect because **MEN 2B** has a more aggressive form of **medullary thyroid carcinoma (MTC)**, requiring earlier intervention. - Prophylactic thyroidectomy for **MEN 2B** is recommended **within the first year of life**, preferably in the first few months, not necessarily "by" 1 year. *When detected for MEN 2B* - While prompt action upon detection of **RET mutations** is critical, simply stating "when detected" is too broad for **MEN 2B**, where the disease is rapid and age-specific guidelines are crucial. - For **MEN 2B**, prophylactic thyroidectomy should be performed as early as possible, ideally **within the first few months of life**, to prevent highly aggressive MTC. *Any time for MEN 2* - This option is incorrect because the timing of prophylactic thyroidectomy **varies significantly between MEN 2A and MEN 2B** due to differing aggressiveness of MTC. - **MEN 2A** generally allows for an intervention around **age 5**, whereas **MEN 2B** necessitates surgery much earlier, within the **first year of life**, typically within the **first few months**.

Question 1553: Poorly controlled diabetes with blood sugar of 450 mg% is associated with:

A. Hyponatremia
B. Hypokalemia (Correct Answer)
C. Hypernatremia
D. Hypomagnesemia

Explanation: **Hypokalemia** - **Insulin deficiency** in uncontrolled diabetes leads to an **extracellular shift of potassium** because insulin facilitates potassium entry into cells [1]. - **Diabetic ketoacidosis (DKA)**, a common complication of uncontrolled diabetes, causes significant **renal potassium loss** due to osmotic diuresis and vomiting, even if serum potassium appears normal or high initially [1], [2]. *Hyponatremia* - **Hyperglycemia** can cause **pseudohyponatremia** due to the osmotic effect of high glucose drawing water from cells into the extracellular space, diluting serum sodium [1]. - In severe cases, the true sodium might be low, but the initial effect is dilutional, not a deficit of sodium [1]. *Hypernatremia* - Mild hypernatremia can occur due to **osmotic diuresis** causing significant water loss, but this is less common than dilutional hyponatremia or normal sodium levels. - The primary effect of hyperglycemia on sodium is usually related to dilution rather than an absolute increase in sodium concentration. *Hypomagnesemia* - While diabetic patients can develop **hypomagnesemia** over time due to increased urinary excretion, it is not the most immediate or direct metabolic derangement associated with acute, poorly controlled hyperglycemia (blood sugar 450 mg/dL). - **Hypomagnesemia** is often a chronic complication due to long-term renal losses rather than an acute consequence of severe hyperglycemia.

Question 1554: In which condition are hung-up reflexes typically observed?

A. Cerebral palsy
B. Chorea
C. Cerebellar ataxia
D. Hypothyroidism (Correct Answer)

Explanation: ***Hypothyroidism*** - **Hung-up reflexes** (or **Woltman's sign**) are characterized by a **slow relaxation phase** of deep tendon reflexes, a classic finding in hypothyroidism. - This delayed relaxation is due to altered muscle contraction and relaxation kinetics caused by **deficient thyroid hormones**. *Chorea* - Chorea is characterized by **brief, abrupt, irregular, unpredictable, non-stereotyped movements** that flow from one body part to another [1]. - Reflexes themselves are not typically "hung up" but may be difficult to elicit or appear irregular due to the involuntary movements. *Cerebral palsy* - Cerebral palsy is a group of permanent movement disorders that appear in early childhood and are typically characterized by **spasticity**, **ataxia**, or **dystonia**. - While reflex abnormalities are common, including **hyperreflexia** and sustained clonus, the specific finding of "hung-up reflexes" (slow relaxation) is not typical. *Cerebellar ataxia* - Cerebellar ataxia primarily affects **coordination, balance, and gait**, leading to dysmetria, dysdiadochokinesia, and intention tremor [2]. - Reflexes in cerebellar ataxia are often **normal** or can exhibit **pendular reflexes**, where the limb swings back and forth several times after being struck, rather than a delayed relaxation.

Question 1555: In congenital adrenal hyperplasia, which enzyme deficiency is primarily responsible for precocious puberty in males?

A. 21-hydroxylase deficiency (Correct Answer)
B. 11-beta-hydroxylase deficiency
C. Both
D. Neither

Explanation: ***21-hydroxylase deficiency*** - This is the **most common form** of congenital adrenal hyperplasia (CAH) and leads to a **deficiency in cortisol and aldosterone** production [1]. - The accumulation of precursors shunts metabolic pathways towards **androgen production**, causing precocious puberty in males due to **excessive adrenal androgens** [1]. *11-beta-hydroxylase deficiency* - This deficiency also leads to **decreased cortisol** and an accumulation of precursors, but it specifically causes an increase in **deoxycorticosterone (DOC)**, which has mineralocorticoid activity. - While it also causes **androgen excess** (leading to precocious puberty in males), it is **less common** than 21-hydroxylase deficiency as the primary cause. *Both* - While both deficiencies can cause androgen excess and precocious puberty, **21-hydroxylase deficiency** is by far the more frequent and significant cause of these symptoms in CAH. - Attributing it equally to both would overlook the **prevalence** and primary impact of 21-hydroxylase deficiency. *Neither* - This option is incorrect because both 21-hydroxylase deficiency and 11-beta-hydroxylase deficiency can lead to **androgen excess**, which is the underlying cause of precocious puberty in CAH. - The condition is characterized by a defect in steroid synthesis, which inevitably results in a **hormonal imbalance**.

Question 1556: The Z score measures bone mineral density compared to the average of which group of individuals?

A. Individuals matched for age, race, and sex (Correct Answer)
B. Individuals matched for race and sex
C. Individuals matched for sex
D. None of the options

Explanation: ***Individuals matched for age, race, and sex*** - A **Z-score** compares a patient's **bone mineral density (BMD)** to the average BMD of a healthy, age-matched, sex-matched, and race-matched population. - It is particularly useful in premenopausal women, men under 50 years of age, and children to help diagnose **secondary osteoporosis**. *Individuals matched for race and sex* - This definition is incomplete as it omits matching for **age**, which is a crucial demographic factor influencing bone density. - Without age-matching, the comparison would not accurately reflect expected bone density for the patient's specific life stage. *Individuals matched for sex* - This is an insufficient comparison for **bone mineral density**, as it excludes critical demographic factors like **age** and **race**. - Bone density naturally varies significantly with age and can also differ across racial groups. *None of the options* - This option is incorrect because the first option accurately describes the reference population for a **Z-score**. - The **Z-score** is a clearly defined metric in bone densitometry with a specific reference group.

Question 1557: A patient presents with polyuria following total hypophysectomy. Laboratory results show Na+ levels at 155 mEq/L and urine osmolarity at 200 mOsm/L. What is the definitive management for this patient?

A. Lifelong DDAVP supplementation (Correct Answer)
B. No treatment required as receptors are upset
C. Thiazides for a limited duration of 2 weeks
D. DDAVP for a limited duration of 2 weeks

Explanation: ### Lifelong DDAVP supplementation - The patient's **polyuria** after **total hypophysectomy**, coupled with **hypernatremia (Na+ 155 mEq/L)** and **low urine osmolarity (200 mOsm/L)**, strongly indicates **central diabetes insipidus (DI)** due to **ADH deficiency** [1]. - **Desmopressin (DDAVP)** is a synthetic analog of **ADH** and is the definitive treatment for central DI, replacing the missing hormone, and addressing the lifelong deficiency [1]. ### No treatment required as receptors are upset - This is incorrect as untreated **diabetes insipidus** can lead to severe **dehydration, hypernatremia, and neurological complications**, making intervention critical [2]. - The symptoms and lab findings indicate a clear deficiency, not merely "upset" receptors, which requires definitive management to prevent life-threatening complications. ### Thiazides for a limited duration of 2 weeks - **Thiazide diuretics** are used in **nephrogenic diabetes insipidus** to induce mild volume depletion, which can increase water reabsorption in the proximal tubule [1]. - However, they are not the definitive treatment for **central DI** where the primary problem is a lack of **ADH**, and using them for a *limited duration* would not address a lifelong condition. ### DDAVP for a limited duration of 2 weeks - While **DDAVP** is the correct treatment for **central DI**, the condition resulting from a total hypophysectomy is **permanent**. - Therefore, treatment for only a *limited duration* would lead to the recurrence of symptoms, and potentially life-threatening complications, making lifelong management essential.

Question 1558: A patient with diabetes mellitus for the past 5 years presents with vomiting and abdominal pain. She is non-compliant with medication and appears dehydrated. Investigations revealed a blood sugar value of 500 mg/dl and the presence of ketone bodies. What is the next best step in management of this patient?

A. Intravenous fluids
B. Intravenous insulin
C. Intravenous fluids with regular insulin (Correct Answer)
D. Intravenous fluids with long-acting insulin

Explanation: Detailed management of diabetic ketoacidosis (DKA) requires both fluid resuscitation and insulin therapy. ***Intravenous fluids with regular insulin*** - The patient presents with classic signs of **diabetic ketoacidosis (DKA)**: hyperglycemia (blood sugar 500 mg/dl), ketone bodies, dehydration, and a history of diabetes non-compliance [1]. - Initial management for DKA involves aggressive **intravenous fluid resuscitation** to correct dehydration and then **intravenous regular insulin** to lower blood glucose and resolve ketosis [2]. *Intravenous fluids with long-acting insulin* - While fluids are essential, **long-acting insulin** is not appropriate for the acute management of DKA because its slow onset of action makes it inefficient for rapidly correcting hyperglycemia and ketosis. - **Regular insulin** is preferred as it has a quicker onset and shorter duration, allowing for more precise titration in an acute setting [2]. *Intravenous fluids* - Although crucial for correcting **dehydration** and improving renal perfusion, fluids alone will not address the underlying **insulin deficiency** and **ketosis** that define DKA. - Without insulin, the body will continue to produce ketones, exacerbating acidosis [3]. *Intravenous insulin* - Giving intravenous insulin without prior or concomitant **fluid resuscitation** can be dangerous, as it can worsen **hypovolemia** and potentially lead to circulatory collapse by shifting glucose and potassium into cells. - It is critical to first restore **circulating volume** before initiating insulin therapy [2].

Question 1559: Which of the following is commonly seen in Pituitary apoplexy?

A. Headache (Correct Answer)
B. Hypertension
C. Hypotension
D. Vomiting

Explanation: ***Headache*** - **Severe headache** is the most common symptom of pituitary apoplexy, resulting from the sudden expansion of a pituitary mass due to hemorrhage or infarction [1]. - The rapid increase in pressure within the sella turcica, especially on the **dura mater**, causes intense pain. *Hypertension* - While stress can elevate blood pressure, **hypertension** is not a characteristic or direct symptom of acute pituitary apoplexy itself. - Instead, the condition often leads to **adrenal insufficiency**, which is associated with hypotension [1]. *Hypotension* - **Hypotension** is a common and serious manifestation of pituitary apoplexy, often due to acute **adrenal insufficiency** caused by the destruction of ACTH-producing cells [1]. - Reduced ACTH leads to decreased cortisol production, impairing vascular tone and fluid balance. *Vomiting* - **Vomiting** is a common symptom in pituitary apoplexy, often accompanying the severe headache. - It results from the increased **intracranial pressure** and irritation of pathways in the brainstem.

Question 1560: Which of the following is not seen in MEN 2B syndrome?

A. Mucosal neuroma
B. Marfanoid habitus
C. Parathyroid adenoma (Correct Answer)
D. Megacolon

Explanation: ***Parathyroid adenoma*** - **Parathyroid adenomas**, leading to hyperparathyroidism, are characteristic of **MEN 2A syndrome**, not MEN 2B [1]. - While both MEN 2A and 2B involve mutations in the **RET proto-oncogene**, the specific clinical manifestations differ significantly. *Megacolon* - **Megacolon** (due to intestinal ganglioneuromatosis) is a recognized feature of **MEN 2B syndrome**. - This condition involves abnormal nerve ganglion cells in the intestine, leading to motility issues. *Mucosal neuroma* - **Mucosal neuromas** on the tongue, lips, and eyelids are a hallmark clinical sign of **MEN 2B syndrome**. - These benign growths are often one of the earliest and most recognizable features. *Marfanoid habitus* - **Marfanoid habitus**, characterized by a tall, slender build with long limbs and arachnodactyly, is a common physical finding in **MEN 2B syndrome**. - This connective tissue abnormality helps distinguish MEN 2B from other MEN syndromes.

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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