Endocrinology — MCQs
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Multiple submucosal neuromas are most likely associated with:
A middle-aged male patient who was involved in a road traffic accident and brought to the emergency department in an unconscious state. A computed tomography (CT) scan of the abdomen revealed a splenic laceration, and emergency splenectomy was performed. The patient was then transferred to the intensive care unit (ICU). Despite receiving a bolus of normal saline, his blood pressure remained low in the postoperative period. On examination, he was afebrile, had a moon-like face with central obesity, and exhibited violet striae on his abdomen. A repeat CT scan of the chest, abdomen, and pelvis showed no evidence of hemorrhage. What is the next best step in managing this patient?
Nelson syndrome is associated with:
Hyperaldosteronism is associated with all, except:
A 37-year-old man in diabetic ketoacidosis has yellowish papules scattered over his trunk and extremities. A tube of plasma collected from the patient develops a turbid supernate. This is consistent with which type of hyperlipoproteinemia?
A young patient presented with hypertension and a 24-hour urinary metanephrine level of 1.4 mg, the most likely causes are -
All of the following may be associated with primary aldosteronism, except:
Which of the following is a specific cause of metabolic acidosis?
Which clinical features are specifically associated with congenital adrenal hyperplasia due to 21-hydroxylase deficiency?
What is the preferred insulin regimen during pregnancy?
Endocrinology Indian Medical PG Practice Questions and MCQs
Question 1641: Multiple submucosal neuromas are most likely associated with:
- A. Ovarian germ cell tumor
- B. Testicular seminoma
- C. Pancreatic neuroendocrine tumor
- D. Multiple endocrine neoplasia type 2B (Correct Answer)
Explanation: ***Multiple endocrine neoplasia type 2B*** - Multiple submucosal neuromas, particularly in the lips, tongue, and gastrointestinal tract, are a **hallmark feature** of MEN2B. - This syndrome is also characterized by **medullary thyroid carcinoma** and **pheochromocytoma**, often with a marfanoid habitus. *Ovarian germ cell tumor* - These tumors arise from **germ cells** in the ovary and include types such as dysgerminomas, teratomas, and yolk sac tumors. - They are not associated with the development of **submucosal neuromas**. *Testicular seminoma* - A type of **germ cell tumor** originating in the testes, which can produce HCG or LDH. - This condition has no known association with the development of **multiple submucosal neuromas**. *Pancreatic neuroendocrine tumor* - These tumors arise from the **endocrine cells** of the pancreas and can be functional (e.g., insulinoma, gastrinoma) or non-functional. - While they are endocrine tumors, they do not present with **submucosal neuromas**.
Question 1642: A middle-aged male patient who was involved in a road traffic accident and brought to the emergency department in an unconscious state. A computed tomography (CT) scan of the abdomen revealed a splenic laceration, and emergency splenectomy was performed. The patient was then transferred to the intensive care unit (ICU). Despite receiving a bolus of normal saline, his blood pressure remained low in the postoperative period. On examination, he was afebrile, had a moon-like face with central obesity, and exhibited violet striae on his abdomen. A repeat CT scan of the chest, abdomen, and pelvis showed no evidence of hemorrhage. What is the next best step in managing this patient?
- A. Return to the operating room for exploratory laparotomy
- B. Administer vancomycin and piperacillin/tazobactam
- C. Perform MRI of the spine.
- D. Administer hydrocortisone 100 mg IV (Correct Answer)
Explanation: ***Administer hydrocortisone 100 mg IV*** - The patient's presentation with **hypotension unresponsive to fluid resuscitation**, combined with a **moon-like face**, **central obesity**, and **violet striae**, strongly suggests **adrenal insufficiency** as a complication of **Cushing's syndrome**. [1] - **Adrenal crisis** requires immediate administration of **stress-dose corticosteroids** to prevent cardiovascular collapse. [1] *Return to the operating room for exploratory laparotomy* - A **repeat CT scan** confirmed no evidence of hemorrhage, ruling out **active bleeding** as the cause of refractory hypotension. - Therefore, subjecting the patient to another surgery without evidence would be unnecessary and introduce additional risks. *Administer vancomycin and piperacillin/tazobactam* - The patient is **afebrile**, and there are no signs or symptoms suggestive of a **postoperative infection**. - Initiating broad-spectrum antibiotics without an indication in an already compromised patient is not appropriate and could contribute to **antibiotic resistance**. *Perform MRI of the spine.* - There is nothing in the patient's presentation that suggests **spinal cord injury** as the cause of his current unstable condition. - While the patient was in a **road traffic accident**, the primary issues are related to **hemodynamic instability** and suspected **endocrine dysfunction**, not neurological deficit.
Question 1643: Nelson syndrome is associated with:
- A. Subarachnoid hemorrhage
- B. Prophylactic craniospinal irradiation
- C. Bilateral adrenalectomy (Correct Answer)
- D. BRCA2 mutation
Explanation: ***Bilateral adrenalectomy*** - **Nelson syndrome** develops in a subset of patients with Cushing's disease after **bilateral adrenalectomy**. [1] - It is caused by the loss of negative feedback from adrenal cortisol on the pituitary, leading to continued growth of an existing **ACTH-secreting pituitary adenoma**. *Prophylactic craniospinal irradiation* - **Craniospinal irradiation** is a radiotherapy technique used to treat disseminated cancers like medulloblastoma but is not directly associated with the etiology of Nelson syndrome. - While pituitary tumors can be treated with radiotherapy, this is typically given once a tumor has caused symptoms, not prophylactically in this context. *Subarachnoid hemorrhage* - **Subarachnoid hemorrhage** is bleeding into the space between the brain and the surrounding membrane, often caused by ruptured **aneurysms** or **trauma**. - It is a neurological emergency unrelated to the development of Nelson syndrome. *BRCA2 mutation* - **BRCA2 mutations** are strongly associated with an increased risk of developing various cancers, most notably **breast** and **ovarian cancer**. - This genetic mutation is not linked to the pathogenesis of Nelson syndrome, which is an endocrine complication following surgery.
Question 1644: Hyperaldosteronism is associated with all, except:
- A. Hypernatremia
- B. Hypertension
- C. Hypokalemia
- D. Metabolic acidosis (Correct Answer)
Explanation: ***Metabolic acidosis*** - **Hyperaldosteronism** leads to increased **potassium and hydrogen ion excretion** in the kidneys [1], resulting in **metabolic alkalosis**, not acidosis [2]. - The increased loss of hydrogen ions causes a rise in blood pH and bicarbonate levels [2]. *Hypernatremia* - Aldosterone promotes **sodium reabsorption** in the renal tubules, leading to increased plasma sodium concentration [1], [3]. - This increased sodium reabsorption contributes to the expansion of extracellular fluid volume and **hypertension** [3]. *Hypokalemia* - Aldosterone stimulates the **secretion of potassium ions** into the renal tubules, leading to excessive potassium loss in the urine [1]. - This sustained potassium excretion often results in **low serum potassium levels**. *Hypertension* - The increased reabsorption of **sodium and water** due to aldosterone action expands the extracellular fluid volume [3]. - This volume expansion directly contributes to elevated blood pressure, making hypertension a hallmark feature of **hyperaldosteronism** [2].
Question 1645: A 37-year-old man in diabetic ketoacidosis has yellowish papules scattered over his trunk and extremities. A tube of plasma collected from the patient develops a turbid supernate. This is consistent with which type of hyperlipoproteinemia?
- A. Type I
- B. Type II
- C. Type III
- D. Type IV (Correct Answer)
Explanation: Type IV Hyperlipoproteinemia - This patient presents with eruptive xanthomas (yellowish papules) and a turbid plasma supernate, which suggests significantly elevated very-low-density lipoprotein (VLDL) and chylomicrons. - In Type IV hyperlipoproteinemia, there is an overproduction or decreased clearance of VLDL, often exacerbated by underlying conditions like uncontrolled diabetes mellitus (such as in DKA) [1]. Type I Hyperlipoproteinemia - Characterized by a deficiency of lipoprotein lipase or its coenzyme apoC-II, leading to extremely high chylomicron levels. - While it presents with eruptive xanthomas and milky plasma, diabetes mellitus is not a primary driver of this specific type, and the VLDL component is less pronounced than in Type IV. Lipoprotein lipase expression is notably enhanced by insulin [2]. Type II Hyperlipoproteinemia - This type primarily involves elevated low-density lipoprotein (LDL), often due to defects in LDL receptors, leading to conditions like familial hypercholesterolemia. - It's mainly associated with tendinous xanthomas and corneal arcus, and the plasma, though sometimes turbid due to LDL, would not typically show the degree of chylomicron or VLDL elevation expected with eruptive xanthomas and DKA. Type III Hyperlipoproteinemia - This condition involves elevated chylomicron remnants and VLDL remnants due to a defective apoE, specifically apoE2/E2 homozygosity. - While it can manifest with eruptive xanthomas, it more classically presents with palmar xanthomas and tuberoeruptive xanthomas, and the turbid supernate would typically have a distinct 'creamy layer' after refrigeration, which is not emphasized here.
Question 1646: A young patient presented with hypertension and a 24-hour urinary metanephrine level of 1.4 mg, the most likely causes are -
- A. Grave's disease
- B. Pseudohypoparathyroidism
- C. Medullary carcinoma thyroid
- D. VonHippelLindau syndrome (Correct Answer)
Explanation: ***Von Hippel-Lindau syndrome*** - This syndrome is a **hereditary condition** predisposing individuals to various tumors, including **pheochromocytomas**, which cause elevated **metanephrines** and hypertension. - The combination of **hypertension** in a young patient and an elevated **24-hour urinary metanephrine level** (indicating excessive catecholamine production) strongly suggests a pheochromocytoma, which is frequently associated with Von Hippel-Lindau syndrome. *Medullary carcinoma thyroid* - This cancer is associated with **MEN 2 syndromes** and produces **calcitonin**, leading to hypocalcemia, but not typically elevated metanephrines or hypertension directly from the thyroid. - While it can be associated with **pheochromocytoma** (as part of MEN 2), it is not the direct cause of the elevated metanephrines. *Grave's disease* - **Grave's disease** is an autoimmune disorder causing **hyperthyroidism**, characterized by symptoms like goiter, exophthalmos, and weight loss. - While it can cause hypertension due to increased cardiac output, it does not lead to elevated **urinary metanephrine levels**, which are specific to catecholamine excess. *Pseudohypoparathyroidism* - This is a genetic disorder characterized by **target organ resistance to parathyroid hormone (PTH)**, leading to hypocalcemia and hyperphosphatemia [1]. - It does not cause hypertension or elevated **urinary metanephrine levels**.
Question 1647: All of the following may be associated with primary aldosteronism, except:
- A. Adrenal adenoma
- B. Adrenal hyperplasia
- C. Adrenal carcinoma
- D. Von-Hippel-Lindau syndrome (Correct Answer)
Explanation: ***Von-Hippel-Lindau syndrome*** - **Von Hippel-Lindau (VHL) syndrome** is a genetic disorder commonly associated with tumors such as **pheochromocytomas**, **renal cell carcinoma**, hemangioblastomas, and pancreatic neuroendocrine tumors, but not primary aldosteronism. - While VHL can involve adrenal glands (pheochromocytomas being a common manifestation), it does not directly cause **aldosterone overproduction** leading to primary aldosteronism. *Adrenal adenoma* - A **solitary adrenal adenoma** is the most common cause of primary aldosteronism, often referred to as **Conn's syndrome** [1]. - These benign tumors autonomously secrete **aldosterone**, leading to hypertension and hypokalemia [1]. *Adrenal hyperplasia* - **Bilateral adrenal hyperplasia** is the second most common cause of primary aldosteronism, where both adrenal glands produce excessive aldosterone. - This condition is often managed medically rather than surgically, in contrast to unilateral adenomas [1]. *Adrenal carcinoma* - Although rare, a **functional adrenal carcinoma** can cause primary aldosteronism by overproducing aldosterone [1]. - These malignant tumors are typically larger and more aggressive than adenomas [1].
Question 1648: Which of the following is a specific cause of metabolic acidosis?
- A. Diarrhea
- B. Renal failure
- C. Diabetic ketoacidosis (Correct Answer)
- D. None of the options
Explanation: ***Diabetic ketoacidosis*** - **Diabetic ketoacidosis (DKA)** is a specific condition where an absolute or relative insulin deficiency leads to unchecked **ketone body production** (acetoacetate, beta-hydroxybutyrate), which are organic acids [2]. - The accumulation of these **ketoacids** overwhelms the body's buffer systems, resulting in a **high anion gap metabolic acidosis** [1], [3]. *Diarrhea* - **Diarrhea** causes **metabolic acidosis** due to the loss of **bicarbonate** from the gastrointestinal tract. - This is typically a **normal anion gap metabolic acidosis**, also known as hyperchloremic metabolic acidosis, which is less specific than DKA. *Renal failure* - **Renal failure** can cause **metabolic acidosis** primarily due to the kidneys' inability to excrete acid and reabsorb bicarbonate. - While it often leads to a **high anion gap metabolic acidosis**, it is a broader category and not as specific a cause as DKA, as various types of renal dysfunction can be involved. *None of the options* - This option is incorrect because **diabetic ketoacidosis** is indeed a specific and well-defined cause of metabolic acidosis, characterized by the accumulation of ketoacids due to insulin deficiency [2].
Question 1649: Which clinical features are specifically associated with congenital adrenal hyperplasia due to 21-hydroxylase deficiency?
- A. All of the above features are present in 21-hydroxylase deficiency.
- B. Female pseudohermaphroditism (Correct Answer)
- C. Hypertension due to adrenal crisis
- D. Hypokalemia and hypernatremia
Explanation: ***All of the above*** - 21-hydroxylase deficiency leads to a lack of cortisol and aldosterone, causing adrenal crisis. Thus, **hyponatremia**, **hyperkalemia**, and **ambiguous genitalia** in females are clinical features associated with this condition [1]. - It also results in **female pseudohermaphroditism** due to excess androgen exposure in utero, showcasing the spectrum of symptoms seen [1]. *Hyponatremia and hyperkalemia* - While these are common electrolyte abnormalities seen in adrenal crisis due to **aldosterone deficiency**, they don't capture the entire clinical picture of 21-hydroxylase deficiency [1]. - Focusing solely on these abnormalities neglects significant features like **ambiguous genitalia** and **pseudohermaphroditism**. *Ambiguous genitalia in females* - This is indeed a critical feature of 21-hydroxylase deficiency but does not represent the full array of clinical manifestations involved [1]. - The deficiency also affects electrolyte balance which is a crucial aspect, thereby making it insufficient as a standalone answer. *Female pseudohermaphroditism* - While **female pseudohermaphroditism** due to androgen excess is a key characteristic, it is just one of multiple clinical features of this condition [1]. - This option overlooks **hyponatremia**, **hyperkalemia**, and **ambiguous genitalia**, which are all critical for a comprehensive understanding of the disorder [1].
Question 1650: What is the preferred insulin regimen during pregnancy?
- A. Insulin Regular + NPH
- B. Insulin NPH + Lispro (Correct Answer)
- C. Insulin Degludec
- D. Insulin Lispro + Insulin regular
Explanation: ***Insulin NPH + Lispro*** - **NPH insulin** is a preferred basal insulin during pregnancy due to its long-standing safety record and intermediate duration of action [1]. - **Insulin Lispro** is a rapid-acting insulin analog that is safe and effective for postprandial glucose control in pregnant women [1]. *Insulin Regular + NPH* - While NPH is safe, **regular insulin** has a slower onset and longer duration compared to rapid-acting analogs, making it less ideal for precise postprandial control [2]. - Achieving tight glycemic control with regular insulin can be challenging due to its peak action occurring later, potentially leading to **postprandial hyperglycemia** or **unpredictable hypoglycemia** [2]. *Insulin Degludec* - **Insulin Degludec** is a newer ultra-long-acting insulin analog, and while effective, there is currently limited data on its long-term safety during pregnancy. - Due to insufficient robust safety data, it is generally **not the preferred first-line basal insulin** for pregnant women. *Insulin Lispro + Insulin regular* - This combination lacks a dedicated **basal insulin** component, which is crucial for maintaining fasting and between-meal glucose levels [2]. - Relying solely on rapid-acting and short-acting insulins without basal coverage would likely result in **poor glycemic control** throughout the day and night [1].
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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