Endocrinology Practice Questions

Q: All of the following are typically seen in Diabetic Ketoacidosis (DKA) except?

Bradycardia. **Explanation:** Diabetic Ketoacidosis (DKA) is a life-threatening complication of Diabetes Mellitus characterized by the triad of hyperglycemia, ketosis, and metabolic acidosis [1]. **Why Bradycardia is the Correct Answer:** **Bradycardia** is not a typical feature of DKA. In fact, DKA patients almost always present with **Tachycardia** [1]. This occurs as a compensatory response to significant volume depletion (dehydration) and as a physiological reaction to metabolic stress and acidosis [1], [2]. If bradycardia is seen in a DKA patient, it is an ominous sign suggesting imminent cardiac arrest, severe hyperkalemia, or profound exhaustion. **Analysis of Incorrect Options:** * **Tachycardia:** As mentioned, this is a hallmark sign [1]. It is the body’s attempt to maintain cardiac output in the face of decreased intravascular volume (due to osmotic diuresis) [2]. * **Dehydration:** Hyperglycemia causes osmotic diuresis, leading to massive fluid loss [2]. Patients often have a fluid deficit of 5–10 liters, presenting with dry mucous membranes and decreased skin turgor [1]. * **Abdominal pain/tenderness:** This is a classic "pseudo-peritonitis" presentation in DKA, especially in children [1]. It is thought to be caused by delayed gastric emptying, ileus, or the metabolic acidosis itself. **NEET-PG High-Yield Pearls:** * **Kussmaul Respiration:** Deep, rapid breathing is a compensatory mechanism to blow off $CO_2$ and mitigate metabolic acidosis [1]. * **Potassium Paradox:** Total body potassium is always **depleted** in DKA (due to diuresis), but serum potassium may appear **normal or high** initially due to the extracellular shift of $K^+$ in exchange for $H^+$ ions [2]. * **Management Priority:** The first step in management is aggressive fluid resuscitation with Normal Saline (0.9% NaCl) [1]. * **Anion Gap:** DKA is a classic cause of High Anion Gap Metabolic Acidosis (HAGMA).

Q: What are the characteristic radiographic findings associated with hyperparathyroidism?

All of the above. **Explanation:** Hyperparathyroidism (HPT), particularly the primary form, leads to excessive secretion of Parathyroid Hormone (PTH). PTH increases osteoclast activity, resulting in accelerated bone resorption and the replacement of bone marrow with fibrous tissue—a condition known as **Osteitis Fibrosa Cystica** [1]. **Breakdown of Findings:** * **Subperiosteal Bone Resorption:** This is the **most specific** radiographic sign of hyperparathyroidism. It is most commonly seen on the radial aspect of the middle phalanges of the 2nd and 3rd fingers. It can also occur in the skull (producing a "Salt and Pepper" appearance) and the distal clavicles. * **Brown’s Tumor (Osteoclastoma):** These are non-neoplastic lytic lesions caused by localized rapid bone resorption. The "brown" color is due to vascularity, hemorrhage, and hemosiderin deposition within the fibrous cysts. * **Multiple Bone Cysts:** Chronic PTH excess leads to the formation of cystic spaces within the bone as the marrow is replaced by fibrous tissue [1]. **Why "All of the Above" is Correct:** All three features are classic components of the skeletal involvement in advanced hyperparathyroidism. While modern screening often detects HPT in the asymptomatic stage, these radiographic hallmarks remain high-yield for exam purposes. **High-Yield Clinical Pearls for NEET-PG:** * **Rugger-Jersey Spine:** Characteristic of secondary hyperparathyroidism (seen in Chronic Kidney Disease), showing bands of increased bone density at the vertebral endplates. * **Salt and Pepper Skull:** Multiple tiny lucencies in the calvarium. * **Biochemical Triad:** Hypercalcemia, Hypophosphatemia, and elevated PTH (in Primary HPT) [1]. * **Most common cause:** Solitary parathyroid adenoma (85%).

Q: Rotten apple smell of breath is associated with which of the following conditions?

Uncontrolled insulin-dependent diabetes mellitus. The "rotten apple" or "fruity" odor of the breath is a classic clinical sign of **Diabetic Ketoacidosis (DKA)**, which occurs in uncontrolled insulin-dependent diabetes mellitus (Type 1 DM) [1]. **1. Why Option C is Correct:** In the absence of insulin, the body cannot utilize glucose for energy and instead shifts to rapid fat metabolism (lipolysis) [3]. This process produces excess **ketone bodies**: acetoacetate, beta-hydroxybutyrate, and **acetone** [3]. Acetone is highly volatile and is excreted through the lungs. The distinct, sweet, "rotten apple" or fruity smell is specifically due to the exhalation of these acetone vapors [2]. **2. Why Other Options are Incorrect:** * **Liver Insufficiency:** Associated with **Fetor Hepaticus**, described as a "musty," "mousy," or "sweet and fecal" breath odor caused by dimethyl sulfide. * **Kidney Insufficiency:** Associated with **Uremic Fetor**, described as an "ammonia-like" or "fishy" breath odor due to the breakdown of urea into ammonia in the saliva. * **Respiratory Problems:** Conditions like lung abscess or bronchiectasis typically present with a **foul-smelling (putrid)** breath due to anaerobic bacterial infections, not a fruity odor. **Clinical Pearls for NEET-PG:** * **DKA Triad:** Hyperglycemia, Ketosis, and Metabolic Acidosis (Anion Gap). * **Kussmaul Breathing:** Deep, rapid sighing respirations seen in DKA as a compensatory mechanism for metabolic acidosis [2]. * **Ketone detection:** Nitroprusside test (Rothera's test) detects acetoacetate and acetone but **not** beta-hydroxybutyrate.

Q: Wolfram syndrome is characterized by all of the following except?

Parathyroid hyperplasia. Wolfram Syndrome is a rare, autosomal recessive neurodegenerative disorder caused by a mutation in the **WFS1 gene** (encoding the protein Wolframin). It is classically defined by the mnemonic **DIDMOAD**, which represents its four hallmark clinical features. **1. Why Parathyroid Hyperplasia is the correct answer:** Parathyroid hyperplasia is **not** a component of Wolfram Syndrome. It is typically associated with **Multiple Endocrine Neoplasia (MEN) syndromes** (Type 1 and 2A) [1]. In Wolfram Syndrome, the endocrine dysfunction is primarily focused on the pancreas and the posterior pituitary, not the parathyroid glands. **2. Analysis of Incorrect Options (Features of Wolfram Syndrome):** * **Diabetes Insipidus (Option C):** Specifically **Central Diabetes Insipidus**, occurring in approximately 70% of patients due to vasopressin deficiency [2]. * **Diabetes Mellitus (Option B):** This is usually the first manifestation (often diagnosed around age 6). It is non-autoimmune, insulin-dependent diabetes. * **Optic Atrophy (Option A):** A mandatory diagnostic criterion, leading to progressive loss of visual acuity and color vision, usually appearing by age 15. * **Deafness:** Sensorineural hearing loss (the "D" in DIDMOAD) is also a classic feature. **Clinical Pearls for NEET-PG:** * **Mnemonic:** **DIDMOAD** (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness). * **Genetics:** Autosomal Recessive; **WFS1 gene** on chromosome 4p16. * **Other features:** Urinary tract abnormalities (dilated renal pelvis/ureters) and neurological symptoms (ataxia, myoclonus). * **Prognosis:** It is a progressive disorder; the median age of death is approximately 30 years, often due to respiratory failure secondary to brainstem atrophy.

Q: In which of the following patients, thyrotoxicosis should not be suspected?

Distal muscle weakness. **Explanation:** In thyrotoxicosis, the correct clinical finding is **proximal muscle weakness**, not distal [1]. This is a classic high-yield distinction in medical exams. **1. Why "Distal muscle weakness" is the correct answer (Why it's NOT suspected):** Thyrotoxic Myopathy typically affects the **proximal muscles** (shoulders and hips) [1]. Patients often complain of difficulty climbing stairs or rising from a seated position. Distal muscles (hands and feet) are generally spared until very late stages of the disease. Therefore, if a patient presents primarily with distal weakness, a clinician should look for other neurological causes rather than thyrotoxicosis. **2. Why the other options are wrong (Why they ARE suspected):** * **Unexplained weight loss:** This is one of the most common presentations [4]. Excess thyroid hormone increases the basal metabolic rate (BMR), leading to weight loss despite a normal or increased appetite [4]. * **Unexplained diarrhea:** Hyperthyroidism increases gastrointestinal motility, leading to hyperdefecation or osmotic diarrhea. * **Paroxysmal atrial tachycardia:** Thyroid hormones increase the sensitivity of cardiac $\beta$-adrenergic receptors. This leads to palpitations [4], sinus tachycardia [2], and most characteristically, **Atrial Fibrillation** or paroxysmal supraventricular tachycardias [2]. **Clinical Pearls for NEET-PG:** * **Thyrotoxic Periodic Paralysis:** A rare but serious complication, more common in Asian males, characterized by sudden hypokalemia and muscle paralysis. * **Apathetic Hyperthyroidism:** Seen in the elderly; they may present only with weight loss or atrial fibrillation without the typical "hyper" symptoms [3]. * **Reflexes:** In thyrotoxicosis, there is a **brisk** (hyperreflexic) relaxation phase, whereas in hypothyroidism, there is a "hung-up" (delayed) relaxation phase.

Q: Diabetes is diagnosed in all of the following criteria except:

Random Blood Sugar > 200 mg/dL (with symptoms). Diabetes is diagnosed in all of the following criteria except: The diagnosis of Diabetes Mellitus is based on specific glycemic thresholds established by the ADA (American Diabetes Association). This question tests the precision of these diagnostic cut-offs. ### **Explanation of the Correct Answer** The correct answer is **D** because the option states **"Random Blood Sugar > 200 mg/dL"**, whereas the actual diagnostic criterion is **≥ 200 mg/dL**. In competitive exams like NEET-PG, numerical values and "greater than" vs. "greater than or equal to" distinctions are critical. Furthermore, a random plasma glucose (RPG) only qualifies as a diagnosis in a single sitting if the patient is also experiencing classic symptoms of hyperglycemia (polyuria, polydipsia, weight loss) or a hyperglycemic crisis [1]. ### **Analysis of Other Options** * **A. HbA1c ≥ 6.5%:** This is a standard diagnostic criterion. It reflects average glycemia over the preceding 2–3 months. * **B. Fasting Blood Sugar (FBS) ≥ 126 mg/dL:** Fasting is defined as no caloric intake for at least 8 hours. This is a primary diagnostic threshold [1]. * **C. 2-hour Post-Prandial (or OGTT) ≥ 200 mg/dL:** During an Oral Glucose Tolerance Test (using 75g anhydrous glucose), a value of 200 mg/dL or higher confirms diabetes [1]. ### **NEET-PG High-Yield Pearls** * **Prediabetes Criteria:** HbA1c (5.7–6.4%), FBS (100–125 mg/dL), or 2-hr PPBS (140–199 mg/dL) [1]. * **Repeat Testing:** Unless there is clear clinical diagnosis (symptoms + RPG ≥ 200), a diagnosis requires **two abnormal test results** from either the same sample or two separate test samples. * **HbA1c Limitations:** It can be falsely low in conditions with high red cell turnover (e.g., hemolytic anemia, pregnancy, recent hemorrhage) and falsely high in iron deficiency anemia.

Question 1

All of the following are typically seen in Diabetic Ketoacidosis (DKA) except?

Accepted Answer

Bradycardia

Answer

Tachycardia

Answer

Dehydration

Answer

Abdominal pain/tenderness

Question 2

What are the characteristic radiographic findings associated with hyperparathyroidism?

Accepted Answer

All of the above

Answer

Multiple bone cysts

Answer

Subperiosteal bone resorption

Answer

Brown's tumor

Question 3

A 35-year-old woman presents with epigastric pain that did not improve on ranitidine. Upper endoscopy reveals a nonhealing pyloric channel ulcer. Her serum calcium level is 12 mg/dL. What is the most likely underlying diagnosis?

Accepted Answer

Multiple endocrine neoplasia type-1 (MEN-1)

Answer

Watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome

Answer

Somatostatinoma

Answer

MEN-2A

Question 4

Rotten apple smell of breath is associated with which of the following conditions?

Accepted Answer

Uncontrolled insulin-dependent diabetes mellitus

Answer

Liver insufficiency

Answer

Kidney insufficiency

Answer

Respiratory problems

Question 5

A patient with mild skin pigmentation presents with sudden abdominal pain, fever, and a rigid abdomen. Laboratory findings include blood sugar of 55 mg/dL, Na of 119 mEq/L, and K of 6.2 mEq/L. Her blood pressure is 88/58 mmHg. She undergoes an exploratory laparotomy. Which of the following statements is true?

Accepted Answer

Death from untreated chronic adrenal insufficiency may occur within hours of surgery.

Answer

Treatment with exogenous steroids is usually ineffective.

Answer

This condition is commonly seen as a consequence of metastasis of distant cancers, such as lung or breast, to the adrenal glands.

Answer

The most common underlying cause today is infection with multidrug-resistant tuberculosis.

Question 6

Wolfram syndrome is characterized by all of the following except?

Accepted Answer

Parathyroid hyperplasia

Answer

Optic atrophy

Answer

Diabetes mellitus

Answer

Diabetes insipidus

Question 7

In which of the following patients, thyrotoxicosis should not be suspected?

Accepted Answer

Distal muscle weakness

Answer

Unexplained weight loss

Answer

Unexplained diarrhea

Answer

Paroxysmal atrial tachycardia

Question 8

All of the following statements about Diabetic Ketoacidosis are true, EXCEPT:

Accepted Answer

Serum bicarbonate in DKA is greater than 15 mEq/L.

Answer

DKA is commoner in type 1 diabetes.

Answer

Anion gap is increased.

Answer

Serum pH is less than 7.4.

Question 9

Treatment of thyroid storm includes all of the following EXCEPT:

Accepted Answer

Radioactive iodine

Answer

Propranolol

Answer

Hydrocortisone

Answer

Lugol's iodine

Question 10

Diabetes is diagnosed in all of the following criteria except:

Accepted Answer

Random Blood Sugar > 200 mg/dL (with symptoms)

Answer

HbA1c > 6.5%

Answer

Fasting Blood Sugar (FBS) ≥ 126 mg/dL

Answer

Post Prandial Blood Sugar (PPBS) ≥ 200 mg/dL

Endocrinology — MCQs

Endocrinology — MCQs

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