Endocrinology Practice Questions

Q: A 40-year-old patient presented with excessive skin pigmentation of the face, neck, and extensor aspects of the forearms. The patient has diabetes, anhidrosis, and dyspnea on exertion (Class III). Clinical examination revealed hepatosplenomegaly and spider angiomata. Which of the following is NOT true about this condition?

Females are commonly affected.. The clinical presentation of **Bronze Diabetes** (skin pigmentation, diabetes, and hepatosplenomegaly) combined with cardiac failure and anhidrosis strongly points to a diagnosis of **Hereditary Hemochromatosis (HH)** [1]. ### **Explanation of Options** * **Why Option C is NOT true (Correct Answer):** Hereditary Hemochromatosis is an autosomal recessive disorder, but it shows a **marked male predominance** (approx. 10:1). Females are protected during their reproductive years because physiological iron loss through **menstruation and pregnancy** prevents the toxic accumulation of iron. Clinical symptoms in women typically appear only after menopause. * **Option A is true:** The most common form of HH is caused by a mutation in the **HFE gene** (specifically the C282Y mutation) [2] on chromosome 6 [1], leading to increased intestinal iron absorption. * **Option B is true:** Patients with HH and cirrhosis have a significantly elevated risk (up to 200-fold) of developing **Hepatocellular Carcinoma (HCC)** [1]. It is a leading cause of death in these patients. * **Option D is true:** Iron deposition in the myocardium leads to restrictive or dilated cardiomyopathy. **Congestive Cardiac Failure (CCF)** and arrhythmias are the most common cardiac manifestations. ### **High-Yield Clinical Pearls for NEET-PG** * **Classic Triad:** Cirrhosis, Diabetes Mellitus, and Skin Pigmentation ("Bronze Diabetes") [1]. * **Earliest Sign:** Arthropathy (typically involving the 2nd and 3rd metacarpophalangeal joints). * **Screening:** The best initial test is **Transferrin Saturation** (>45% is suggestive). * **Gold Standard Diagnosis:** Liver biopsy with Perl’s Prussian blue stain (to calculate the Hepatic Iron Index) or MRI (T2* weighted) [2]. * **Treatment of Choice:** Therapeutic Phlebotomy (Goal: Serum ferritin 50–100 ng/mL) [2].

Q: Which of the following conditions can lead to the development of SIADH?

Head trauma. **Explanation:** **SIADH (Syndrome of Inappropriate Antidiuretic Hormone)** occurs when there is an autonomous, excessive release of ADH from the posterior pituitary or an ectopic source, leading to water retention and dilutional hyponatremia [1]. 1. **Why Head Trauma is Correct:** Central Nervous System (CNS) disorders are a major cause of SIADH. Any insult to the brain—including **head trauma**, stroke, meningitis, or tumors—disrupts the normal osmoreceptor-mediated regulation of ADH, leading to its persistent release despite low plasma osmolality [3]. 2. **Why Other Options are Incorrect:** * **Pituitary Adenoma:** These typically cause hormone deficiencies (hypopituitarism) or hypersecretion of anterior pituitary hormones (e.g., Prolactin, GH). They do not typically cause SIADH; in fact, damage to the pituitary stalk or posterior pituitary more commonly leads to **Diabetes Insipidus (DI)**, the functional opposite of SIADH [3]. * **Lithium:** This is a classic cause of **Nephrogenic Diabetes Insipidus**. It renders the collecting ducts resistant to ADH, leading to polyuria and hypernatremia, rather than the water retention seen in SIADH. **High-Yield Clinical Pearls for NEET-PG:** * **Ectopic Source:** Small Cell Carcinoma of the Lung is the most common malignancy associated with SIADH [2]. * **Drugs:** Common culprits include SSRIs, Carbamazepine, and Cyclophosphamide. * **Diagnosis:** Characterized by **Euvolemic Hyponatremia**, low serum osmolality ( 100 mOsm/kg). * **Treatment:** Fluid restriction is the first-line therapy. For severe cases, Vaptans (ADH antagonists) or hypertonic saline may be used. Always correct sodium slowly to avoid **Osmotic Demyelination Syndrome (Central Pontine Myelinolysis).**

Q: Which of the following conditions does NOT cause weight gain?

Diabetes mellitus. **Explanation:** The correct answer is **Diabetes Mellitus (Option A)**. In untreated or poorly controlled diabetes mellitus (particularly Type 1), there is either an absolute or relative deficiency of insulin. Insulin is a potent anabolic hormone; without its action, the body cannot utilize glucose for energy and instead enters a catabolic state [1]. This leads to the breakdown of stored fats (lipolysis) and proteins (proteolysis), resulting in **weight loss** despite polyphagia (increased appetite) [1]. **Analysis of Incorrect Options:** * **Cushing’s Syndrome:** Characterized by hypercortisolism, which promotes gluconeogenesis and adipogenesis. It causes weight gain with a classic "centripetal" distribution (moon facies, buffalo hump, and truncal obesity) [2]. * **Hypothyroidism:** A deficiency in thyroid hormones leads to a decrease in the Basal Metabolic Rate (BMR). Weight gain occurs due to both fat accumulation and the deposition of glycosaminoglycans, which causes water retention (myxedema). * **Insulin-secreting tumor (Insulinoma):** Excessive insulin secretion promotes lipogenesis and inhibits lipolysis. Furthermore, patients often overeat to prevent or treat recurrent episodes of symptomatic hypoglycemia, leading to significant weight gain. **High-Yield Clinical Pearls for NEET-PG:** * **Weight Loss in DM:** The "3 Ps" of Diabetes are Polyuria, Polydipsia, and Polyphagia, but these are paradoxically accompanied by weight loss [2]. * **Drug-Induced Weight Gain:** Common culprits include Sulfonylureas, Thiazolidinediones (TZDs), Steroids, and Antipsychotics. * **Weight-Neutral/Loss DM Drugs:** Metformin and DPP-4 inhibitors are weight-neutral; SGLT-2 inhibitors and GLP-1 agonists promote weight loss.

Q: Which of the following is the most common type of pituitary adenoma?

Prolactinoma. Pituitary adenomas are common benign neoplasms of the anterior pituitary gland. They are classified based on their size (microadenomas 10 mm) and their functional status (hormone-secreting vs. non-functional) [1]. **Why Prolactinoma is correct:** **Prolactinomas** are the most common type of secretory pituitary adenoma, accounting for approximately **40–50%** of all pituitary tumors [1]. They typically present with symptoms of hyperprolactinemia, such as galactorrhea, amenorrhea, and infertility in women, or decreased libido and erectile dysfunction in men [1]. **Analysis of Incorrect Options:** * **Thyrotropinoma (TSH-secreting):** These are the rarest type of pituitary adenomas (<1%). They present with features of secondary hyperthyroidism (elevated T3/T4 with inappropriately normal or high TSH). * **Gonadotropinoma (LH/FSH-secreting):** While common among "non-functioning" adenomas (as they often secrete inefficiently), they are significantly less frequent than prolactinomas. * **Corticotropinoma (ACTH-secreting):** These account for about 10–15% of pituitary adenomas and lead to **Cushing’s Disease**. They are usually microadenomas at the time of diagnosis. **NEET-PG High-Yield Pearls:** 1. **Order of frequency:** Prolactinoma > Somatotropinoma (GH) > Corticotropinoma (ACTH). 2. **Drug of Choice:** For most pituitary adenomas, surgery (transsphenoidal) is the first line. However, for **Prolactinomas**, medical management with **Dopamine agonists (Cabergoline/Bromocriptine)** is the first-line treatment [1]. 3. **MEN 1 Syndrome:** Pituitary adenomas (most commonly prolactinomas) are a classic component of the "3 Ps" (Pituitary, Parathyroid, Pancreas).

Q: Which of the following is true regarding diabetes mellitus type II?

Decrease in the number of B cells. Explanation: In Diabetes Mellitus Type II (T2DM), the pathophysiology is characterized by a combination of peripheral insulin resistance and progressive beta-cell (B-cell) dysfunction [1]. While T2DM is initially associated with hyperinsulinemia to compensate for resistance, the chronic metabolic stress (glucotoxicity and lipotoxicity) eventually leads to B-cell exhaustion [2]. Histologically, this manifests as a decrease in the total number (mass) of B-cells, typically reduced by 40–60% in long-standing cases [1]. Analysis of Options: * A. Insulinitis of B cells: This is a hallmark of Type I Diabetes [3]. It refers to lymphocytic infiltration of the islets, representing an autoimmune destruction of B-cells [4]. * B. Hyalinization of B cells: While amyloid (amylin) deposition (which appears as hyalinization) is a classic finding in the islets of T2DM patients, the term "hyalinization of B-cells" is technically inaccurate. Hyalinization occurs in the extracellular space of the islets, not within the cells themselves. * C. Atrophy of B cells: Atrophy implies a reduction in the size of existing cells. In T2DM, the primary pathology is the apoptosis and loss of the cells, leading to a decrease in total number rather than simple cellular atrophy [1]. * D. Decrease in the number of B cells: This is the most accurate description of the quantitative loss of insulin-producing capacity in T2DM [1]. NEET-PG High-Yield Pearls: * Amyloid Deposition: The characteristic histological finding in T2DM islets is the deposition of Islet Amyloid Polypeptide (IAPP) or Amylin. * HLA Association: T2DM has no strong association with HLA-DR3/DR4 (unlike T1DM) [3]. * Genetics: T2DM has a higher genetic concordance in monozygotic twins (>90%) compared to T1DM (~50%) [3]. * Metabolic Syndrome: T2DM is frequently associated with the "Deadly Quartet": obesity, hypertension, dyslipidemia, and hyperglycemia [4].

Q: Which HLA antigen is important in Insulin-Dependent Diabetes Mellitus (IDDM)?

HLA-DR3/DR4. **Explanation:** **Correct Answer: C. HLA-DR3/DR4** Insulin-Dependent Diabetes Mellitus (Type 1 DM) is an autoimmune disorder characterized by the destruction of pancreatic beta cells [1][2]. Susceptibility to T1DM is strongly linked to the **Major Histocompatibility Complex (MHC) Class II** genes located on chromosome 6 [2]. Specifically, **HLA-DR3** and **HLA-DR4** are the most significant genetic risk factors. * Approximately 90-95% of Type 1 DM patients carry HLA-DR3, DR4, or both (heterozygotes for DR3/DR4 have the highest risk). * These alleles influence the presentation of islet autoantigens to T-lymphocytes, triggering the autoimmune cascade [1]. **Analysis of Incorrect Options:** * **A. HLA-A3:** This is associated with **Hereditary Hemochromatosis**. (Mnemonic: "A3" for "Iron" - both have 3/tri- associations). * **B. HLA-B27:** This is a Class I MHC allele strongly associated with **Seronegative Spondyloarthropathies**, such as Ankylosing Spondylitis, Reiter’s Syndrome (Reactive Arthritis), and Psoriatic Arthritis. * **D. HLA-W1:** This is an obsolete nomenclature and is not a recognized high-yield association for endocrine disorders in the NEET-PG curriculum. **High-Yield Clinical Pearls for NEET-PG:** * **HLA-DQ:** While DR3/DR4 are the classic answers, **DQ2** (linked with DR3) and **DQ8** (linked with DR4) are the specific alleles that provide the highest risk for T1DM. * **Protective Allele:** **HLA-DRB1*0403** and **HLA-DQB1*0602** are known to provide *protection* against Type 1 DM. * **Other DR3/DR4 Associations:** HLA-DR3 is also associated with Celiac disease, SLE, and Graves' disease. HLA-DR4 is strongly associated with Rheumatoid Arthritis.

Q: A 49-year-old male schoolteacher presents with a neck swelling that has a palpable bounding pulse. Which test would be most likely to establish a possible cause of the underlying condition?

Thyroid function studies. ### Explanation **Correct Answer: C. Thyroid function studies** The clinical finding of a **palpable bounding pulse** over a neck swelling (thyroid gland) is a classic sign of increased vascularity. This is most commonly associated with **Graves' disease** (hyperthyroidism). In Graves' disease, the thyroid gland becomes hypermetabolic and hypervascular; the increased blood flow can manifest as a palpable **thrill** or an audible **bruit** [1]. Therefore, the most logical step to establish the underlying cause (hyperthyroidism) is performing **Thyroid Function Studies** (TSH, Free T3, and Free T4) [1]. **Analysis of Incorrect Options:** * **A. Funduscopic eye examination:** While Graves' disease is associated with ophthalmopathy (exophthalmos), fundoscopy is primarily used to evaluate retinal changes (e.g., hypertension or diabetes) and would not diagnose the cause of a vascular neck swelling. * **B. Liver-spleen scan:** This is used to evaluate hepatosplenomegaly or functional reticuloendothelial issues and has no diagnostic value for thyroid pathology. * **D. X-ray of the chest and cervical spine:** While these might show tracheal deviation or retrosternal extension in a large goiter, they provide no information regarding the functional or vascular status of the gland. **NEET-PG High-Yield Pearls:** * **Vascular Goiter:** A bruit or thrill over the thyroid is almost pathognomonic for **Graves' disease**. It is rarely seen in other forms of goiter [1]. * **Pemberton’s Sign:** If a large goiter causes facial flushing and inspiratory stridor when the patient raises both arms, it indicates superior vena cava syndrome due to a retrosternal goiter. * **Diagnosis:** The initial screening test for thyroid dysfunction is **Serum TSH** [1]. In Graves', TSH is suppressed, while T3 and T4 are elevated. * **Triad of Graves':** Hyperthyroidism, Exophthalmos, and Pretibial Myxedema (Dermopathy).

Q: Which of the following is NOT a risk factor for type 2 diabetes mellitus that warrants early screening for diabetes?

Alcoholism. **Explanation:** The screening criteria for Type 2 Diabetes Mellitus (T2DM) in asymptomatic adults are primarily based on the **ADA (American Diabetes Association) guidelines**. Screening is indicated for all adults starting at age 35, or earlier in individuals who are overweight/obese (BMI ≥25 kg/m² or ≥23 kg/m² in Asians) and have one or more additional risk factors. **Why Alcoholism is the Correct Answer:** While chronic excessive alcohol consumption can lead to chronic pancreatitis (resulting in Type 3c diabetes), [1] **alcoholism itself is not a standardized risk factor** for the early screening of T2DM in asymptomatic individuals. In fact, moderate alcohol consumption has sometimes been paradoxically associated with improved insulin sensitivity, though it is never recommended as a preventive measure. **Analysis of Incorrect Options:** * **Family History:** A first-degree relative with diabetes significantly increases genetic predisposition, warranting early screening. * **Hypertension:** Blood pressure ≥140/90 mmHg or being on therapy for hypertension is a core component of metabolic syndrome and a major risk factor for insulin resistance. * **Polycystic Ovary Syndrome (PCOS):** PCOS is strongly associated with profound insulin resistance and acanthosis nigricans, placing these women at a high risk for early-onset T2DM. **High-Yield Clinical Pearls for NEET-PG:** * **Other Screening Criteria:** HDL cholesterol 250 mg/dL, History of Gestational Diabetes (GDM), and Physical Inactivity. * **Asian-Specific Cut-off:** For the Indian population, a **BMI ≥23 kg/m²** is the threshold to trigger screening if other risk factors are present. * **Prediabetes:** Individuals with HbA1c ≥5.7%, [2] Impaired Glucose Tolerance (IGT), or Impaired Fasting Glucose (IFG) should be tested annually.

Question 1

All the following statements regarding postpartum thyroiditis are true, EXCEPT:

Accepted Answer

The risk of recurrence in subsequent pregnancy is < 10%.

Answer

Hyperthyroidism may be present in the first 3 months after delivery.

Answer

Hypothyroidism may be present a few months after delivery.

Answer

Thyroid function may be normal after 1 year.

Question 2

A 40-year-old patient presented with excessive skin pigmentation of the face, neck, and extensor aspects of the forearms. The patient has diabetes, anhidrosis, and dyspnea on exertion (Class III). Clinical examination revealed hepatosplenomegaly and spider angiomata. Which of the following is NOT true about this condition?

Accepted Answer

Females are commonly affected.

Answer

It is caused by a mutant gene termed HFE.

Answer

The risk of hepatocellular carcinoma is very high.

Answer

The most common cardiac manifestation is congestive cardiac failure (CCF).

Question 3

Which of the following conditions can lead to the development of SIADH?

Accepted Answer

Head trauma

Answer

Pituitary adenoma

Answer

Lithium

Answer

All of the above

Question 4

Which of the following conditions does NOT cause weight gain?

Accepted Answer

Diabetes mellitus

Answer

Cushing's syndrome

Answer

Hypothyroidism

Answer

Insulin secreting tumour

Question 5

L-thyroxine can be given safely in cases of which of the following conditions?

Accepted Answer

Hypothyroidism

Answer

Hyperthyroidism

Answer

Hashimoto's disease

Answer

Graves' disease

Question 6

Which of the following is the most common type of pituitary adenoma?

Accepted Answer

Prolactinoma

Answer

Thyrotropinoma

Answer

Gonadotropinoma

Answer

Corticotropinoma

Question 7

Which of the following is true regarding diabetes mellitus type II?

Accepted Answer

Decrease in the number of B cells

Answer

Insulinitis of B cells

Answer

Hyalinization of B cells

Answer

Atrophy of B cells

Question 8

Which HLA antigen is important in Insulin-Dependent Diabetes Mellitus (IDDM)?

Accepted Answer

HLA-DR3/DR4

Answer

HLA-A3

Answer

HLA-B27

Answer

HLA-W1

Question 9

A 49-year-old male schoolteacher presents with a neck swelling that has a palpable bounding pulse. Which test would be most likely to establish a possible cause of the underlying condition?

Accepted Answer

Thyroid function studies

Answer

Funduscopic eye examination

Answer

Liver-spleen scan

Answer

X-ray of the chest and cervical spine

Question 10

Which of the following is NOT a risk factor for type 2 diabetes mellitus that warrants early screening for diabetes?

Accepted Answer

Alcoholism

Answer

Family history

Answer

Hypertension

Answer

Polycystic ovary syndrome

Endocrinology — MCQs

Endocrinology — MCQs

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