Endocrinology Practice Questions

Q: Retinopathy is most likely to be seen with which of the following conditions?

Type 2 diabetes of 8 years duration. **Type 2 diabetes of 8 years duration** - **Diabetic retinopathy** is a common microvascular complication of diabetes mellitus [1]. - The risk of retinopathy increases with the **duration of diabetes** and the **severity of hyperglycemia**, making an 8-year duration with type 2 diabetes a significant risk factor [1]. *Type 1 diabetes of 5 years duration* - While type 1 diabetes can cause retinopathy, a 5-year duration is generally considered relatively short for the development of significant retinopathy, especially in early stages. - The risk of retinopathy in **Type 1 diabetes** becomes more pronounced after 10-15 years, though it can occur earlier. *Gestational diabetes* - **Gestational diabetes** is a temporary condition occurring during pregnancy and does not typically lead to chronic complications like retinopathy. - Retinopathy is rare in gestational diabetes because the disease duration is short and usually resolves post-partum. *Juvenile diabetes started before puberty* - **Juvenile diabetes** is synonymous with Type 1 diabetes [2]. Although early onset of diabetes increases lifetime risk, the duration of diabetes is a more critical factor for retinopathy development. - Without a specified duration, it's less predictive than an established longer duration of Type 2 diabetes.

Q: A 20-year-old average-weight female complains of oligomenorrhea along with facial hair. Preliminary investigation reveals raised free testosterone levels. Which of the following could be a likely etiology?

PCOD. ***PCOD*** - The triad of **oligomenorrhea**, **hirsutism** (facial hair), and **elevated free testosterone** levels is highly suggestive of **Polycystic Ovarian Disease (PCOD)** [1]. - **PCOD** is characterized by **anovulation**, leading to menstrual irregularities, and **hyperandrogenism** which causes hirsutism [1]. *Idiopathic hirsutism* - While idiopathic hirsutism causes **facial hair** and other androgenic symptoms, it is characterized by **normal androgen levels**, which contradicts the elevated free testosterone in this case. - **Oligomenorrhea** is not a typical feature of idiopathic hirsutism. *Adrenal hyperplasia* - **Adrenal hyperplasia**, particularly **Congenital Adrenal Hyperplasia (CAH)**, can cause hyperandrogenism and menstrual irregularities due to **enzymatic defects** in adrenal steroidogenesis. - However, it typically presents with **markedly elevated 17-hydroxyprogesterone** levels, which are not mentioned here, and often has an earlier onset or more severe virilization. *Testosterone secreting tumour* - A **testosterone-secreting tumor** (e.g., of the ovary or adrenal gland) would cause **sudden-onset**, rapid progression of **severe hirsutism** and **virilization**, often with **very high testosterone levels** [1]. - The gradual onset implied by "complains of" and the average weight of the patient make a tumor less likely than PCOD, though it would need to be ruled out if testosterone levels were extremely high [1].

Q: All of the following statements about Nesidioblastosis are true, except:

Occurs in adults more than children. ***Occurs in adults more than children*** - **Nesidioblastosis** is a rare condition predominantly seen in **infants and children**, especially those with congenital hyperinsulinism. It is far less common in adults. - While adult forms can occur, the statement that it occurs more in adults than children is incorrect. *Hypoglycemic episodes may be seen* - Nesidioblastosis is characterized by **unregulated or excessive insulin secretion**, leading to recurrent episodes of severe **hypoglycemia**. - These hypoglycemic episodes can cause significant morbidity, particularly in infants. *Histopathology shows hyperplasia of islet cells* - The defining feature of nesidioblastosis is the **diffuse or focal hyperplasia of pancreatic islet cells**, particularly the beta cells. - These hyperplastic cells may be found budding off ducts or dispersed throughout the exocrine pancreas. *Diazoxide may be used for treatment* - **Diazoxide** is an ATP-sensitive potassium channel opener that reduces insulin secretion from pancreatic beta cells. - It is a common medical therapy used to manage hypoglycemia in patients with nesidioblastosis, especially in pediatric cases where it can sometimes avoid the need for surgery.

Q: Which of the following is the most useful investigation for thyroid function?

TSH. TSH - **Thyroid-Stimulating Hormone (TSH)** is the most sensitive and specific test for assessing thyroid function as it reflects the feedback loop between the pituitary gland and the thyroid [1]. - An abnormal TSH level usually indicates either **hypothyroidism** (high TSH) or **hyperthyroidism** (low TSH), even before changes in T3 or T4 are apparent [1]. *T3* - **Triiodothyronine (T3)** is primarily used to confirm a diagnosis of hyperthyroidism, especially when T4 levels are normal but TSH is suppressed [1]. - It is less reliable for initial screening due to its **short half-life** and significant diurnal variation. [1] *T4* - **Thyroxine (T4)** is a good indicator of thyroid hormone production, but its levels can be affected by **protein binding** and non-thyroidal illnesses. - While total T4 is often included in a thyroid panel, **free T4** is more accurate as it reflects the metabolically active hormone not bound to proteins [1]. *Thyroglobulin* - **Thyroglobulin** is primarily used as a tumor marker for monitoring recurrence in patients with differentiated thyroid cancer after thyroidectomy [1]. - It plays no significant role in the initial **assessment of general thyroid function** or diagnosis of hyper/hypothyroidism [1].

Q: Which one of the following is the MOST common complication of diabetes mellitus?

Peripheral Neuropathy. ***Peripheral Neuropathy*** - **Peripheral neuropathy** is the most common complication of diabetes, affecting up to 50% of patients with long-standing disease [1]. - It results from **nerve damage** due to chronic hyperglycemia, leading to symptoms like pain, numbness, and weakness, primarily in the extremities [1]. *Diabetic Retinopathy* - While a common microvascular complication, **diabetic retinopathy** occurs in about one-third of diabetic patients and is not as prevalent as peripheral neuropathy [2]. - It involves damage to the **blood vessels of the retina** and can lead to vision loss. *Diabetic Nephropathy* - **Diabetic nephropathy** is a serious complication affecting approximately 20-40% of diabetic patients, leading to kidney disease. - It is characterized by progressive **kidney damage** and can lead to end-stage renal disease, but it's less common than neuropathy [2]. *Cardiovascular Disease* - **Cardiovascular disease (CVD)**, including coronary artery disease, stroke, and peripheral artery disease, is a major cause of morbidity and mortality in diabetic patients [2]. - While highly significant, it is a macrovascular complication and its overall prevalence as a specific "complication" is not considered higher than peripheral neuropathy in terms of initial onset and detection.

Q: Which of the following statements about pheochromocytoma is true?

Arises from chromaffin cells of adrenal medulla. ***Arises from chromaffin cells of adrenal medulla*** - **Pheochromocytomas** are rare neuroendocrine tumors that develop from **chromaffin cells** found in the adrenal medulla. - These cells are responsible for synthesizing and secreting **catecholamines**, explaining the characteristic symptoms of pheochromocytoma. *Bilateral in 20% of all cases* - While pheochromocytomas can be bilateral, this occurs in about **10% of cases**, mostly associated with genetic syndromes like **MEN 2**. - A higher percentage of bilaterality is seen in **familial forms** of the disease, but not in all cases. *Hypotension rules out pheochromocytoma* - Although **hypertension** is a hallmark symptom, **hypotension** can occur, particularly **orthostatic hypotension** due to volume depletion and impaired vasoconstriction. - Rarely, **pheochromocytoma crisis** can present with **shock** due to massive catecholamine release and subsequent myocardial dysfunction or vasoplegia. *Almost always a malignant tumor* - Most pheochromocytomas are **benign**; only about **10-15%** are malignant. - Malignancy is suggested by the presence of **metastatic disease**, as histology alone cannot reliably differentiate between benign and malignant forms.

Q: Hyperglycemia occurs after what % of beta cell mass is destroyed:

80%. ***80%*** - **Hyperglycemia** typically manifests only after a significant portion of **beta cell mass** (around 80-90%) has been destroyed. - This extensive loss of **insulin-producing cells** compromises the body's ability to maintain normal glucose levels [1]. *20%* - A 20% destruction of beta cell mass is generally **insufficient** to cause clinical hyperglycemia. - The remaining beta cells can usually compensate for this relatively small loss through increased insulin secretion. *40%* - While 40% loss represents a considerable reduction, it's often still within the compensatory capacity of the pancreas. - At this stage, individuals might experience **impaired glucose tolerance** but not overt hyperglycemia [1]. *60%* - Even with a 60% loss, the body may still be able to maintain near-normal glucose levels, especially in the early stages of beta cell destruction [1]. - Hyperglycemia is more likely to develop as the destruction progresses beyond this point.

Q: A 45-year-old woman complains of tingling in her hands and feet, 24 hours after removal of follicular thyroid carcinoma. Her symptoms rapidly progress to severe muscle cramps, laryngeal stridor, and convulsions. Which of the following laboratory findings would be expected in this patient prior to treatment?

Decreased serum calcium and decreased PTH. ***Decreased serum calcium and decreased PTH*** - The symptoms of **tingling**, **muscle cramps**, **laryngeal stridor**, and **convulsions** are classic signs of **hypocalcemia**. [1] - Following thyroidectomy, **parathyroid glands** can be inadvertently removed or damaged, leading to **hypoparathyroidism**, which results in decreased parathyroid hormone (PTH) levels and subsequent hypocalcemia. [1] *Decreased serum calcium and increased PTH* - This pattern is characteristic of **secondary hyperparathyroidism**, where low calcium levels stimulate increased PTH production. [1] - However, in this case, the hypocalcemia is a direct result of parathyroid damage during surgery, leading to *decreased* PTH. *Increased serum calcium and decreased PTH* - This pattern is characteristic of **primary hyperparathyroidism**, where an adenoma or hyperplasia of the parathyroid glands causes excessive PTH production, leading to hypercalcemia. [1] - This patient is experiencing symptoms consistent with hypocalcemia, not hypercalcemia. *Increased serum calcium and increased PTH* - This combination is rare and could suggest conditions like **familial hypocalciuric hypercalcemia**, where inappropriately high PTH is seen despite elevated calcium. [1] - However, the patient's symptoms are of hypocalcemia, and the history points towards iatrogenic hypoparathyroidism.

Q: All of the following are features of Graves' disease except:

More common in males. ***More common in males*** - **Graves' disease** is significantly **more common in females** than males, with a female-to-male ratio of approximately 5-10:1. [2] [3] - This option presents a characteristic that is **not a feature** of Graves' disease, as the prevalence is much higher in women. *Tremor* - **Tremor** is a common symptom of **hyperthyroidism**, often described as a fine, rapid tremor, especially in the hands. [3] - It is caused by the **increased adrenergic stimulation** and metabolic rate associated with excess thyroid hormones. *Pretibial myxoedema* - **Pretibial myxoedema** (also known as Graves' dermopathy) is a specific dermatological manifestation of **Graves' disease**. [1] [2] - It involves **localized thickening and discoloration** of the skin, typically on the shins, due to the accumulation of glycosaminoglycans. *Intolerance to heat* - **Heat intolerance** is a classic symptom of **hyperthyroidism** and is a common finding in patients with Graves' disease. [3] - This occurs due to the **increased basal metabolic rate** and excessive heat production stimulated by high levels of thyroid hormones.

Q: An obese patient presented in casualty in an unconscious state, with a blood glucose level of 400 mg/dL and urine testing positive for sugar and ketones. Which drug is most useful in his management?

Insulin. Insulin - The patient presents with **hyperglycemia**, **ketonuria**, and an **unconscious state**, suggestive of **diabetic ketoacidosis (DKA)** or at least severe uncontrolled diabetes requiring urgent glucose management [1], [4]. - **Insulin therapy** is crucial for DKA management, as it lowers blood glucose, resolves ketosis, and helps correct electrolyte imbalances [3]. *Glibenclamide* - This is a **sulfonylurea** that stimulates insulin release from pancreatic beta cells. - It is **contraindicated in DKA** because the pancreas is often severely stressed or non-functional, and it can worsen hypoglycemia if given inappropriately [2]. *Troglitazone* - This is a **thiazolidinedione** (glitazone) which improves insulin sensitivity in peripheral tissues. - It is **not used for acute hyperglycemia or DKA** and was withdrawn from the market due to liver toxicity. *Chlorpropamide* - This is an older **first-generation sulfonylurea**, similar to glibenclamide, that stimulates insulin secretion. - It has a **long half-life** and a higher risk of **hypoglycemia**, making it unsuitable for acute, severe hyperglycemia like DKA [2].

Question 1

Retinopathy is most likely to be seen with which of the following conditions?

Accepted Answer

Type 2 diabetes of 8 years duration

Answer

Gestational diabetes

Answer

Juvenile diabetes started before puberty

Answer

Type 1 diabetes of 5 years duration

Question 2

A 20-year-old average-weight female complains of oligomenorrhea along with facial hair. Preliminary investigation reveals raised free testosterone levels. Which of the following could be a likely etiology?

Accepted Answer

PCOD

Answer

Testosterone secreting tumour

Answer

Adrenal hyperplasia

Answer

Idiopathic hirsutism

Question 3

All of the following statements about Nesidioblastosis are true, except:

Accepted Answer

Occurs in adults more than children

Answer

Histopathology shows hyperplasia of islet cells

Answer

Hypoglycemic episodes may be seen

Answer

Diazoxide may be used for treatment

Question 4

Which of the following is the most useful investigation for thyroid function?

Accepted Answer

TSH

Answer

T3

Answer

T4

Answer

Thyroglobulin

Question 5

Which one of the following is the MOST common complication of diabetes mellitus?

Accepted Answer

Peripheral Neuropathy

Answer

Diabetic Retinopathy

Answer

Diabetic Nephropathy

Answer

Cardiovascular Disease

Question 6

Which of the following statements about pheochromocytoma is true?

Accepted Answer

Arises from chromaffin cells of adrenal medulla

Answer

Bilateral in 20% of all cases

Answer

Hypotension rules out pheochromocytoma

Answer

Almost always a malignant tumor

Question 7

Hyperglycemia occurs after what % of beta cell mass is destroyed:

Accepted Answer

80%

Answer

40%

Answer

60%

Answer

20%

Question 8

A 45-year-old woman complains of tingling in her hands and feet, 24 hours after removal of follicular thyroid carcinoma. Her symptoms rapidly progress to severe muscle cramps, laryngeal stridor, and convulsions. Which of the following laboratory findings would be expected in this patient prior to treatment?

Accepted Answer

Decreased serum calcium and decreased PTH

Answer

Decreased serum calcium and increased PTH

Answer

Increased serum calcium and decreased PTH

Answer

Increased serum calcium and increased PTH

Question 9

All of the following are features of Graves' disease except:

Accepted Answer

More common in males

Answer

Pretibial myxoedema

Answer

Intolerance to heat

Answer

Tremor

Question 10

An obese patient presented in casualty in an unconscious state, with a blood glucose level of 400 mg/dL and urine testing positive for sugar and ketones. Which drug is most useful in his management?

Accepted Answer

Insulin

Answer

Glibenclamide

Answer

Troglitazone

Answer

Chlorpropamide

Endocrinology — MCQs

Endocrinology — MCQs

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