Endocrinology Practice Questions

Q: Hirsutism may be found in any of these disorders, except?

Hypothyroidism. ### Explanation **Hirsutism** is defined as the presence of terminal hair in females in a male-pattern distribution (e.g., face, chest, back). It is primarily driven by an excess of androgens or increased sensitivity of hair follicles to androgens [1]. #### Why Hypothyroidism is the Correct Answer: **Hypothyroidism** is typically associated with **hair loss (alopecia)** or thinning of the hair, particularly the loss of the outer third of the eyebrows (Queen Anne’s sign) [3]. It does not cause hirsutism. In fact, hypothyroidism increases Sex Hormone-Binding Globulin (SHBG) less effectively than hyperthyroidism, but its primary clinical manifestation regarding hair is brittle, coarse hair and telogen effluvium, not androgenic hair growth [3]. #### Analysis of Other Options: * **Cushing’s Syndrome:** Excess cortisol is often accompanied by excess adrenal androgens (especially in ACTH-dependent Cushing's), leading to hirsutism and acne. * **Congenital Adrenal Hyperplasia (CAH):** Specifically the non-classic form or 21-hydroxylase deficiency leads to a "shunting" of precursors toward the androgen pathway, causing significant hirsutism and virilization. * **Polycystic Ovarian Syndrome (PCOS):** This is the **most common cause** of hirsutism [2]. It involves hyperandrogenism due to increased LH stimulation of ovarian theca cells [1]. #### NEET-PG High-Yield Pearls: * **Ferriman-Gallwey Score:** Used to quantify hirsutism; a score $\geq$ 8 is generally considered diagnostic. * **Drug-Induced Hirsutism/Hypertrichosis:** Common culprits include Minoxidil, Cyclosporine, and Phenytoin. * **Rapid Onset Hirsutism:** If hirsutism develops rapidly along with virilization (clitoromegaly, voice deepening), always suspect an **Androgen-secreting tumor** (Adrenal or Ovarian) [2]. * **First-line treatment for PCOS-related hirsutism:** Combined Oral Contraceptive Pills (COCPs).

Q: A 50-year-old man with a history of recurrent renal stones and peptic ulcer disease presents with difficulty in peripheral vision. He has been taking a proton pump inhibitor (PPI) as prescribed without relief. Which of the following laboratory workups is required in the evaluation of this patient?

All of the above. ### Explanation This clinical vignette describes a classic presentation of **Multiple Endocrine Neoplasia Type 1 (MEN1)**, also known as Wermer Syndrome. MEN1 is characterized by the "3 Ps": **P**arathyroid, **P**ancreas, and **P**ituitary tumors. **Why "All of the Above" is correct:** The patient exhibits symptoms pointing toward all three components of MEN1: 1. **Recurrent Renal Stones:** Suggests primary hyperparathyroidism (the most common feature of MEN1), necessitating a **Parathyroid hormone (PTH)** and Calcium workup [1], [3]. 2. **Refractory Peptic Ulcer Disease:** Peptic ulcers unresponsive to PPIs strongly suggest a Gastrinoma (Zollinger-Ellison Syndrome), a common pancreatic neuroendocrine tumor in MEN1 [1], [4]. This requires checking serum **Gastrin** levels. 3. **Visual Field Defects:** "Difficulty in peripheral vision" (bitemporal hemianopia) indicates optic chiasm compression by a pituitary tumor (most commonly a **Prolactinoma**). Measuring **Prolactin** is essential to evaluate pituitary involvement [2]. **Analysis of Options:** * **A (Gastrin):** Necessary to diagnose Gastrinoma in the setting of refractory ulcers. * **B (PTH):** Necessary to diagnose hyperparathyroidism causing renal calculi [3]. * **C (Prolactin):** Necessary to evaluate the pituitary mass causing visual symptoms. Since the patient shows clinical evidence for all three, a comprehensive workup is mandatory. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** MEN1 is Autosomal Dominant; the gene is located on **Chromosome 11q13** (codes for the protein Menin). * **Most Common Initial Presentation:** Hyperparathyroidism (seen in >95% of patients by age 30) [3]. * **Most Common Pituitary Tumor:** Prolactinoma. * **Most Common Pancreatic Tumor:** Gastrinoma (though Insulinomas are also frequent). * **Rule of 3Ps:** Parathyroid (90%), Pancreas (60-70%), Pituitary (30-50%).

Q: All of the following are known causes of osteoporosis except:

Fluorosis. **Explanation:** **Osteoporosis** is characterized by a reduction in bone mass and disruption of skeletal microarchitecture, leading to increased fragility [3]. **Why Fluorosis is the Correct Answer:** Fluorosis (specifically skeletal fluorosis) is characterized by **osteosclerosis**, which is an abnormal *increase* in bone density. Chronic ingestion of high levels of fluoride stimulates osteoblasts, leading to the formation of dense but brittle bone. Unlike osteoporosis, which shows decreased radiodensity, fluorosis presents with increased radiopacity (whiter bones) on X-rays, particularly in the axial skeleton. **Why the other options are incorrect:** * **Hypogonadism:** Estrogen and testosterone are crucial for inhibiting osteoclast activity. Deficiency (e.g., menopause or Klinefelter syndrome) leads to accelerated bone resorption, making it a leading cause of osteoporosis [1]. * **Hyperthyroidism:** Excess thyroid hormone (T3/T4) shortens the bone remodeling cycle and favors bone resorption over formation, leading to a high-turnover state and loss of bone mineral density (BMD). * **Hyperparathyroidism:** Parathyroid hormone (PTH) stimulates osteoclasts via the RANKL pathway. Chronic elevation (Primary Hyperparathyroidism) results in significant cortical bone loss [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Drug-induced Osteoporosis:** Glucocorticoids (most common) [1], Heparin, Phenytoin, and PPIs. * **Skeletal Fluorosis Hallmark:** "Chalky white" appearance of bones and calcification of the interosseous membrane (especially in the forearm). * **Screening:** DEXA scan is the gold standard; Osteoporosis is defined as a **T-score ≤ -2.5**. * **Secondary Causes:** Always rule out Vitamin D deficiency, Multiple Myeloma, and Malabsorption syndromes in young patients with low BMD.

Q: A 11-year-old boy presents with complaints of not developing secondary sexual characteristics. On examination, the child is found to have tall stature, no secondary sexual characteristics, small and firm testes, and gynecomastia. What is the most probable clinical diagnosis?

Klinefelter's syndrome. ### Explanation The clinical presentation of an adolescent male with tall stature, delayed puberty, and specific physical findings is classic for **Klinefelter’s Syndrome (47, XXY)** [1]. **1. Why Klinefelter’s Syndrome is Correct:** Klinefelter’s syndrome is the most common cause of **primary hypogonadism** in males. The presence of an extra X chromosome leads to dysgenesis of seminiferous tubules and hyperplasia of Leydig cells [1]. * **Small, firm testes:** This is the hallmark clinical sign (usually <2 cm or <4 mL volume) [1]. * **Tall stature:** Due to the extra copy of the *SHOX* gene on the X chromosome and delayed epiphyseal closure (low testosterone) [1]. * **Gynecomastia:** Results from an increased estrogen-to-androgen ratio. * **Infertility:** Azoospermia is almost universal due to tubular fibrosis [1]. **2. Why Other Options are Incorrect:** * **Edwards Syndrome (Trisomy 18):** Characterized by severe intellectual disability, micrognathia, low-set ears, and "rocker-bottom feet." Most patients do not survive beyond infancy. * **Patau Syndrome (Trisomy 13):** Presents with midline defects like cleft lip/palate, holoprosencephaly, polydactyly, and microphthalmia. It is usually fatal in the first year of life. * **Turner Syndrome (45, XO):** This occurs in **females** [2]. It presents with short stature (not tall), streak ovaries, webbed neck, and primary amenorrhea [2]. **3. NEET-PG High-Yield Pearls:** * **Lab Profile:** Low Testosterone, **High LH**, and **High FSH** (Hypergonadotropic hypogonadism) [1]. Inhibin B is low. * **Barr Body:** Positive on buccal smear (unlike normal males). * **Increased Risks:** Breast cancer (20x higher than normal males), extragonadal germ cell tumors, and autoimmune diseases (SLE) [3]. * **Cognitive Profile:** Often associated with mild language delays or learning disabilities, though IQ is usually within the normal range [1].

Q: All of the following are associated with pheochromocytoma except:

Hypotension. **Explanation:** Pheochromocytoma is a catecholamine-secreting tumor arising from the chromaffin cells of the adrenal medulla. The clinical manifestations are primarily driven by the excessive release of epinephrine and norepinephrine [3]. **Why Hypotension is the Correct Answer:** The hallmark of pheochromocytoma is **Hypertension** (persistent in 60% and paroxysmal in 40% of cases). Hypotension is highly atypical and usually only occurs in specific scenarios, such as sudden catecholamine withdrawal, severe volume depletion, or a switch to a purely epinephrine-secreting tumor (causing beta-2 mediated vasodilation). Therefore, it is not a standard association. **Analysis of Other Options:** * **Ventricular Arrhythmias:** Excess catecholamines overstimulate $\beta_1$ receptors in the heart, leading to palpitations, tachycardia, and potentially fatal ventricular arrhythmias [3]. * **Interstitial Fibrosis:** Chronic exposure to high catecholamine levels causes "Catecholamine Cardiomyopathy." This leads to focal myocardial necrosis, inflammatory cell infiltration, and eventually **interstitial fibrosis**, which can progress to heart failure. * **Ectopic ACTH Production:** Pheochromocytoma is a known cause of ectopic ACTH syndrome [2], [4]. These tumors can co-secrete peptides like ACTH or CRH, leading to Cushing’s syndrome features alongside hypertensive crises. **NEET-PG High-Yield Pearls:** 1. **Rule of 10s:** 10% bilateral, 10% malignant, 10% extra-adrenal (Paraganglioma), 10% pediatric, and 10% familial [1]. 2. **Genetic Associations:** MEN 2A, MEN 2B, von Hippel-Lindau (VHL) syndrome, and NF-1 [1]. 3. **Diagnosis:** Best initial screening test is **24-hour urinary fractionated metanephrines** or plasma free metanephrines. 4. **Management:** Always give **Alpha-blockers first** (e.g., Phenoxybenzamine) followed by Beta-blockers to avoid an unopposed alpha-mediated hypertensive crisis [1].

Q: An overweight 48-year-old male presents with complaints of increased thirst and frequent urination. Laboratory examination reveals a blood glucose level of 180 mg/dL. The patient's past medical history is unremarkable, except for an anaphylactic reaction that occurred one year ago when he was given trimethoprim-sulfamethoxazole for a sinus infection. Based on this information, which of the following agents should be prescribed?

Metformin. The patient presents with classic symptoms of Type 2 Diabetes Mellitus (polyuria, polydipsia) and a blood glucose level of 180 mg/dL. According to current clinical guidelines, **Metformin** is the first-line pharmacological therapy for Type 2 Diabetes, especially in overweight patients, due to its efficacy, weight-neutrality (or modest weight loss), and low risk of hypoglycemia [1]. **Why the other options are incorrect:** * **Chlorpropamide & Glipizide (Options A & B):** These are **Sulfonylureas**. The patient has a documented history of an **anaphylactic reaction to trimethoprim-sulfamethoxazole**. Sulfonylureas contain a sulfonamide moiety; while cross-reactivity between antibiotic sulfonamides and non-antibiotic sulfonamides is debated, it is generally contraindicated or used with extreme caution in patients with a history of severe (anaphylactic) sulfa allergies. Furthermore, Metformin remains the preferred initial agent over sulfonylureas [1]. * **Glucagon (Option C):** Glucagon is used to treat severe hypoglycemia. Prescribing it to a patient with hyperglycemia (180 mg/dL) would worsen their clinical state. **NEET-PG High-Yield Pearls:** * **Mechanism of Action (Metformin):** Primarily inhibits hepatic gluconeogenesis by activating AMP-activated protein kinase (AMPK) [1]. * **Side Effects:** Most common are GI upset (diarrhea, nausea) [1]. The most serious, though rare, is **Lactic Acidosis**. * **Contraindications:** Metformin should be avoided in patients with significant renal impairment (eGFR <30 mL/min/1.73m²) due to the risk of lactic acidosis. * **Sulfa Allergy Cross-reactivity:** Always be cautious with Sulfonylureas, Carbonic anhydrase inhibitors (Acetazolamide), and Loop diuretics (Furosemide) in patients with severe sulfa allergies.

Question 1

Hirsutism may be found in any of these disorders, except?

Accepted Answer

Hypothyroidism

Answer

Cushing's syndrome

Answer

Congenital adrenal hyperplasia

Answer

Polycystic ovarian syndrome

Question 2

Mark the false statement regarding physiological gynecomastia?

Accepted Answer

Excess of circulating estrogens is specific to causing neonatal gynecomastia only.

Answer

Adolescent gynecomastia is caused by an excess of estradiol relative to testosterone.

Answer

Neonatal gynecomastia is caused by the action of placental estrogens on neonatal breast tissues.

Answer

Senescent gynecomastia is caused by a fall in the level of circulating testosterone.

Question 3

A 50-year-old man with a history of recurrent renal stones and peptic ulcer disease presents with difficulty in peripheral vision. He has been taking a proton pump inhibitor (PPI) as prescribed without relief. Which of the following laboratory workups is required in the evaluation of this patient?

Accepted Answer

All of the above

Answer

Gastrin

Answer

Parathyroid hormone (PTH)

Answer

Prolactin

Question 4

Hypoglycemic unawareness that occurs in diabetic patients when transferred from oral hypoglycemics to insulin, is due to what?

Accepted Answer

Autonomic neuropathy

Answer

Insulin resistance

Answer

Lipodystrophy

Answer

Somogi phenomenon

Question 5

A patient presents with wide eyes, nervousness, elevated systolic blood pressure, and weight loss. What is the most probable diagnosis?

Accepted Answer

Hyperthyroidism

Answer

Hypothyroidism

Answer

Hyperparathyroidism

Answer

Hypoparathyroidism

Question 6

All of the following are known causes of osteoporosis except:

Accepted Answer

Fluorosis

Answer

Hypogonadism

Answer

Hyperthyroidism

Answer

Hyperparathyroidism

Question 7

A 11-year-old boy presents with complaints of not developing secondary sexual characteristics. On examination, the child is found to have tall stature, no secondary sexual characteristics, small and firm testes, and gynecomastia. What is the most probable clinical diagnosis?

Accepted Answer

Klinefelter's syndrome

Answer

Edwards syndrome

Answer

Patau syndrome

Answer

Turner syndrome

Question 8

Flatbush diabetes is associated with which of the following conditions?

Accepted Answer

Type 1 Diabetes Mellitus

Answer

Type 2 Diabetes Mellitus

Answer

Diabetes Insipidus

Answer

Bronze Diabetes

Question 9

All of the following are associated with pheochromocytoma except:

Accepted Answer

Hypotension

Answer

Ventricular arrhythmias

Answer

Interstitial fibrosis

Answer

Ectopic ACTH production

Question 10

An overweight 48-year-old male presents with complaints of increased thirst and frequent urination. Laboratory examination reveals a blood glucose level of 180 mg/dL. The patient's past medical history is unremarkable, except for an anaphylactic reaction that occurred one year ago when he was given trimethoprim-sulfamethoxazole for a sinus infection. Based on this information, which of the following agents should be prescribed?

Accepted Answer

Metformin

Answer

Chlorpropamide

Answer

Glipizide

Answer

Glucagon

Endocrinology — MCQs

Endocrinology — MCQs

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