Endocrinology — MCQs
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A 55-year-old postmenopausal woman presents with chronic low backache of 6 months duration. She has no history of trauma. What is the most likely diagnosis?
A 32-year-old woman complains of amenorrhea since the delivery of a baby 15 months previously, despite the fact that she did not breastfeed her baby. The delivery was complicated by excessive hemorrhage that required a transfusion of 2.5 liters of blood. She has also been fatigued and has gained an additional 4.5Kg since the baby was born. Laboratory data show the following: Serum LH < 1 IU/L (normal, 4-24 IU/L) Serum estradiol 5 pg/mL (normal, 20 - 100 pg/mL) Serum TSH 0.1 mU/L (normal, 0.5 - 5 mU/L) Serum GH 3 ng/mL (normal, < 5 ng/mL) Serum ACTH 28 pg/mL (normal, 10 - 50 pg/mL) Serum prolactin 2 ng/mL (normal, < 20 ng/mL). Injection of 500 μg of TRH failed to produce the expected rise in both serum TSH and prolactin. Which of the following diagnoses most likely explains the findings in this patient?
Patient has fatigue but is not gaining weight. Body was warm. Which investigation is most likely to be informative?
Which of the following is not seen in MEN 2B syndrome?
Which condition is associated with congenital adrenal hyperplasia?
VMA is excreted in urine in which condition -
Which one of the following statements about Graves' disease is FALSE?
Calcitonin levels increased in
In which condition is Chvostek's sign typically observed?
Which of the following is NOT a typical effect of hypoparathyroidism on bones?
Endocrinology Indian Medical PG Practice Questions and MCQs
Question 1561: A 55-year-old postmenopausal woman presents with chronic low backache of 6 months duration. She has no history of trauma. What is the most likely diagnosis?
- A. Osteoporosis (Correct Answer)
- B. Hurler's syndrome
- C. Paget’s disease
- D. Renal osteodystrophy
Explanation: ***Osteoporosis*** - **Postmenopausal women** are at a high risk of developing osteoporosis due to **estrogen deficiency**, which leads to accelerated bone loss [1]. - **Chronic low backache** without trauma in this demographic suggests **vertebral compression fractures**, a common complication of osteoporosis [1]. *Hurler's syndrome* - This is a **lysosomal storage disorder** (mucopolysaccharidosis type I) that manifests in **childhood** with skeletal deformities, coarse facial features, and developmental delays. - It would not present as new-onset chronic low backache in a 55-year-old adult. *Paget’s disease* - Paget's disease involves **localized abnormal bone remodeling**, leading to enlarged and weakened bones [2]. - While it can cause bone pain, it's characterized by elevated **alkaline phosphatase** and often affects the pelvis, skull, or long bones, and a simple low backache presentation in a postmenopausal woman points more strongly to osteoporosis [2], [3]. *Renal osteodystrophy* - This condition is a complication of **chronic kidney disease**, resulting from imbalances in calcium, phosphate, parathyroid hormone, and vitamin D metabolism. - It would require a history of **renal dysfunction** and the low backache would likely be accompanied by other symptoms of kidney failure or bone pain related to specific lesions, which are not mentioned.
Question 1562: A 32-year-old woman complains of amenorrhea since the delivery of a baby 15 months previously, despite the fact that she did not breastfeed her baby. The delivery was complicated by excessive hemorrhage that required a transfusion of 2.5 liters of blood. She has also been fatigued and has gained an additional 4.5Kg since the baby was born. Laboratory data show the following: Serum LH < 1 IU/L (normal, 4-24 IU/L) Serum estradiol 5 pg/mL (normal, 20 - 100 pg/mL) Serum TSH 0.1 mU/L (normal, 0.5 - 5 mU/L) Serum GH 3 ng/mL (normal, < 5 ng/mL) Serum ACTH 28 pg/mL (normal, 10 - 50 pg/mL) Serum prolactin 2 ng/mL (normal, < 20 ng/mL). Injection of 500 μg of TRH failed to produce the expected rise in both serum TSH and prolactin. Which of the following diagnoses most likely explains the findings in this patient?
- A. Pituitary apoplexy
- B. Isolated gonadotropin deficiency
- C. Hashimoto's thyroiditis
- D. Primary amenorrhea
- E. Hypopituitarism due to Sheehan's syndrome (Correct Answer)
Explanation: ### Hypopituitarism due to Sheehan's syndrome - The patient's history of **postpartum hemorrhage** followed by amenorrhea, fatigue, and weight gain, along with low levels of **LH**, **estradiol**, **TSH**, and **prolactin**, despite normal ACTH and GH, points towards anterior pituitary dysfunction due to **ischemic necrosis** caused by Sheehan's syndrome [1]. - The failure of **TRH stimulation** to increase TSH and prolactin further supports a pituitary origin, as the pituitary is unable to respond due to damage. ### Hashimoto's thyroiditis - This condition primarily causes **hypothyroidism**, characterized by elevated TSH and low thyroid hormones, which is inconsistent with the patient's low TSH. - It does not explain the **gonadotropin deficiency** (low LH and estradiol) or the history of postpartum hemorrhage leading to multi-hormone deficiencies. ### Isolated gonadotropin deficiency - While the patient exhibits **amenorrhea** and low LH and estradiol, this diagnosis does not account for the **low TSH** [3] or the historical context of a severe postpartum hemorrhage. - Isolated gonadotropin deficiency does not explain the lack of TSH and prolactin response to TRH. ### Primary amenorrhea - This refers to the absence of menstruation by age 15 (with breast development) or 13 (without breast development) in a patient who has never menstruated, which is not applicable to a 32-year-old woman who has delivered a baby. - The patient's presentation is secondary amenorrhea, occurring after menarche and delivery, and is associated with other pan-hypopituitary features [4]. ### Pituitary apoplexy - Pituitary apoplexy typically presents with the **sudden onset** of severe headache, visual disturbances, and ophthalmoplegia due to acute hemorrhage or infarction of a pituitary adenoma. - This patient's symptoms are more chronic and progressive, evolving over 15 months, and lack the acute, severe presentation typical of apoplexy [2].
Question 1563: Patient has fatigue but is not gaining weight. Body was warm. Which investigation is most likely to be informative?
- A. Low TSH with elevated T3 and T4 (Correct Answer)
- B. High TSH with normal T3 and T4
- C. High TSH with euthyroid status
- D. Increased T3 with decreased T4 levels
Explanation: ***Low TSH with elevated T3 and T4*** - This pattern is indicative of **hyperthyroidism**, which aligns with symptoms of **fatigue** (despite increased metabolic rate due to catabolic effects), not gaining weight, and feeling warm, as thyroid hormones regulate metabolism and body temperature [1]. - An elevated **Free T4** and **Free T3** with a suppressed **TSH** confirms a diagnosis of primary hyperthyroidism [1]. *High TSH with normal T3 and T4* - This suggests **subclinical hypothyroidism** (also known as latent hypothyroidism), where the thyroid gland is beginning to fail, but **peripheral thyroid hormone levels** are still within the normal range due to thyroid compensatory mechanisms [1]. - Patients with subclinical hypothyroidism are usually asymptomatic (as the body has compensated to produce sufficient amounts of T3 and T4), but when symptoms do emerge, they are those of **hypothyroidism**, such as weight gain and cold intolerance, which contradict the patient's presentation [1]. *High TSH with euthyroid status* - **Euthyroid** means having normal thyroid function, therefore this option is practically identical to "High TSH with normal T3 and T4". - This implies **subclinical hypothyroidism**, which typically presents with normal body temperature and potential for weight gain, not fatigue without weight gain alongside a warm body [1]. *Increased T3 with decreased T4 levels* - This specific pattern is rare and could be indicative of certain conditions affecting thyroid hormone metabolism, such as **T4 to T3 conversion issues** or specific forms of **thyroiditis**, but is not typical of a primary thyroid disorder presenting with the given symptoms. - While an elevated T3 might suggest some hyperthyroid features, the decreased T4 complicates the picture and does not directly support the clinical presentation of *unexplained fatigue* and *warm body* in typical thyroid disease.
Question 1564: 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.
Question 1565: Which condition is associated with congenital adrenal hyperplasia?
- A. Male pseudohermaphroditism
- B. True pseudohermaphroditism
- C. Sequential pseudohermaphroditism
- D. Female pseudohermaphroditism (Correct Answer)
Explanation: ***Female pseudohermaphroditism*** - In **21-hydroxylase deficiency**, the most common form of CAH, virilization of a female fetus occurs due to excessive **androgen production** [2], [3]. - This leads to ambiguous genitalia in genetically female (XX) infants, presenting as **female pseudohermaphroditism** [2]. *Male pseudohermaphroditism* - This condition occurs when a **genetically male individual (XY)** has external genitalia that are undervirilized or ambiguous. - It is typically caused by inadequate **androgen synthesis** or action, such as in **androgen insensitivity syndrome**, which is not the primary presentation of CAH [2]. *True pseudohermaphroditism* - This term refers to individuals who possess both **ovarian and testicular tissue**, either in separate gonads or as ovotestes [1], [2]. - It is distinct from CAH, where gonadal tissue is uniform (either ovaries or testes), but the external genitalia are ambiguous due to hormonal imbalances [2]. *Sequential pseudohermaphroditism* - This term is not a recognized medical classification for conditions like CAH. - It does not describe a specific developmental anomaly of the reproductive system related to adrenal function.
Question 1566: VMA is excreted in urine in which condition -
- A. Alkaptonuria
- B. Phenylketonuria
- C. Diabetic ketoacidosis
- D. Pheochromocytoma (Correct Answer)
Explanation: ***Pheochromocytoma*** - Pheochromocytoma is characterized by excessive secretion of catecholamines, leading to increased levels of **vanillylmandelic acid (VMA)** in the urine. - It is often associated with symptoms like **hypertension**, palpitations, and sweating due to catecholamine release. *Alkaptonuria* - Caused by a deficiency in **homogentisate oxidase**, leading to the accumulation of **homogentisic acid**, not VMA. - Clinically presents with **dark urine** and can lead to **ochronosis**, but does not involve catecholamines. *Phenylketonuria* - A metabolic disorder resulting from a deficiency in **phenylalanine hydroxylase**, leading to elevated levels of **phenylalanine** rather than VMA. - Symptoms include intellectual disability and musty odor, unrelated to catecholamine metabolism. *Diabetic ketoacidosis* - This is a condition caused by severe **insulin deficiency**, resulting in elevated ketone bodies and glucose levels, but does not cause increased VMA excretion. - Symptoms include **fruity breath**, dehydration, and metabolic acidosis, focusing on ketone production rather than catecholamine metabolism.
Question 1567: Which one of the following statements about Graves' disease is FALSE?
- A. Common in male (Correct Answer)
- B. Referred to as toxic diffuse goiter
- C. Results in hyperthyroidism
- D. Autoimmune disorder
Explanation: ***Common in male*** - Graves' disease is significantly **more common in females** than males, with a female-to-male ratio of approximately 7:1 [1]. It is a female predominant disease [2]. - The peak incidence is between the ages of 20 and 50 years, and it is the most common cause of **hyperthyroidism** in women [1], [2]. *Results in hyperthyroidism* - Graves' disease is characterized by the production of **autoantibodies** against the TSH receptor, leading to excessive stimulation of the thyroid gland [1]. - This overstimulation results in **increased synthesis and release of thyroid hormones**, causing a state of hyperthyroidism [2]. *Autoimmune disorder* - Graves' disease is a classic example of an **organ-specific autoimmune disease** [2]. - The immune system mistakenly produces antibodies that mimic the action of TSH, leading to thyroid overactivity [1]. *Referred to as toxic diffuse goiter* - The term "toxic" refers to the **hyperthyroid state** (thyrotoxicosis), and "diffuse goiter" describes the generally uniform enlargement of the entire thyroid gland [1]. - This terminology accurately reflects the typical presentation of Graves' disease, which involves an overactive, diffusely enlarged thyroid gland [2].
Question 1568: Calcitonin levels increased in
- A. Hypoparathyroidism
- B. Cushing Syndrome
- C. Medullary thyroid carcinoma (Correct Answer)
- D. Hyperparathyroidism
Explanation: Medullary thyroid carcinoma - Calcitonin is a hormone produced by the parafollicular C cells of the thyroid gland. - Medullary thyroid carcinoma is a neuroendocrine tumor arising from these C cells, leading to excessive and unregulated calcitonin production. Hyperparathyroidism - This condition involves increased production of parathyroid hormone (PTH), which acts to increase serum calcium levels [2]. - Calcitonin secretion is typically decreased or normal in hyperparathyroidism, as calcitonin works to lower serum calcium. Hypoparathyroidism - This condition is characterized by insufficient production of parathyroid hormone (PTH), leading to low serum calcium levels [1]. - Calcitonin levels are generally unaffected or may even be slightly decreased in response to the low calcium, as its primary role is to lower calcium. Cushing Syndrome - Cushing Syndrome is caused by prolonged exposure to high levels of cortisol, a glucocorticoid. - While cortisol can affect bone metabolism, it does not directly impact calcitonin production or secretion, which is primarily regulated by serum calcium levels and C-cell activity.
Question 1569: In which condition is Chvostek's sign typically observed?
- A. Hypercalcemia
- B. Hypoparathyroidism (Correct Answer)
- C. Insulinoma
- D. Diabetes mellitus
Explanation: Hypoparathyroidism - **Chvostek's sign** is a clinical manifestation of **hypocalcemia**, which is a hallmark of hypoparathyroidism [1]. - It involves a twitch of facial muscles elicited by tapping the **facial nerve** anterior to the ear. Hypercalcemia - **Hypercalcemia** is the opposite of hypocalcemia and would not cause increased neuromuscular excitability [2]. - Patients with hypercalcemia might experience symptoms like **fatigue**, **constipation**, and **bone pain** [2]. Insulinoma - An **insulinoma** is a tumor that produces excessive insulin, leading to **hypoglycemia**, not issues with calcium balance. - Symptoms are primarily related to low blood sugar, such as **confusion** and **tachycardia**. Diabetes mellitus - **Diabetes mellitus** is a metabolic disorder characterized by **high blood glucose levels** due to insulin deficiency or resistance. - It is not directly associated with calcium imbalances that would cause Chvostek's sign.
Question 1570: Which of the following is NOT a typical effect of hypoparathyroidism on bones?
- A. Osteosclerosis
- B. Multiple bone cysts
- C. Brown tumors (Correct Answer)
- D. None of the above
Explanation: Hypoparathyroidism typically does not lead to direct **bone resorption** or the formation of **bone lesions** like brown tumors. The condition results in low serum calcium, but the skeletal effects are not characterized by any of the changes noted in the other options. *Subperiosteal Resorption of Bone* - This is commonly seen in **hyperparathyroidism**, where increased osteoclastic activity leads to bone resorption [1]. Parathyroid hormone (PTH) acts on the skeleton to increase osteoclastic bone resorption; thus, in hypoparathyroidism, there is **decreased bone turnover** with no subperiosteal resorption occurring [1]. *Brown tumours* - Brown tumors are associated with **hyperparathyroidism** due to osteitis fibrosa cystica, characterized by **osteoclastic resorption** [1]. Prolonged exposure of bone to high levels of PTH is associated with these changes, which do not occur in hypoparathyroidism [1]. *Multiple Cysts in Bone* - Multiple bone cysts often represent conditions such as **osteitis fibrosa cystica** in **hyperparathyroidism** or other osteolytic lesions [2]. Hypoparathyroidism primarily leads to a reduction in bone remodeling without promoting cyst formation.
Practice by Chapter
Diabetes Mellitus
Practice Questions
Thyroid Disorders
Practice Questions
Adrenal Gland Disorders
Practice Questions
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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