Endocrinology Practice Questions

Q: Episodic hypertension is a classical feature of which condition?

Pheochromocytoma. **Explanation:** **Pheochromocytoma** is the correct answer because it is a catecholamine-secreting tumor (usually arising from the adrenal medulla) [1]. The hallmark of this condition is the **episodic release** of adrenaline and noradrenaline. This leads to the classic triad of symptoms: **episodic headache, sweating (diaphoresis), and palpitations**, occurring alongside paroxysmal (episodic) hypertension. While some patients have sustained hypertension, the "paroxysmal" nature is a high-yield diagnostic clue. **Why the other options are incorrect:** * **Adrenal Carcinoma:** These are rare, aggressive tumors that usually present with signs of hormone excess (like Cushing’s) or a large abdominal mass. While they can cause hypertension, it is typically not episodic. * **Conn’s Syndrome (Primary Hyperaldosteronism):** This is characterized by autonomous aldosterone secretion leading to sodium retention and potassium depletion. It causes **sustained hypertension** and hypokalemia, not episodic spikes. * **Cushing’s Disease:** Caused by an ACTH-secreting pituitary adenoma, it leads to excess cortisol. Hypertension in Cushing’s is usually **chronic and sustained** due to increased mineralocorticoid activity and vascular reactivity. **Clinical Pearls for NEET-PG:** * **Rule of 10s:** 10% are bilateral, 10% are malignant, 10% are extra-adrenal (Paragangliomas), and 10% occur in children. * **Diagnosis:** Best initial screening test is **24-hour urinary fractionated metanephrines** or plasma free metanephrines. * **Management:** Always give **Alpha-blockers first** (e.g., Phenoxybenzamine) before Beta-blockers to avoid an unopposed alpha-mediated hypertensive crisis. * **Associated Syndromes:** MEN 2A, MEN 2B, von Hippel-Lindau (VHL), and Neurofibromatosis type 1 (NF1).

Q: A 45-year-old obese woman presents to the emergency department in a semi-comatose state. Laboratory investigations reveal K+ (5.8 mmol/L), Na+ (136 mmol/L), blood pH (7.1), HCO3 (12 mmol/L), and ketone bodies (350 mg/dl). What is the expected level of blood glucose for this patient?

Greater than 180 mg/dl. ### Explanation The patient presents with the classic triad of **Diabetic Ketoacidosis (DKA)**: hyperglycemia, metabolic acidosis, and ketonemia [1]. **1. Why the correct answer is right:** The laboratory findings—**low pH (7.1)**, **low bicarbonate (12 mmol/L)**, and **elevated ketone bodies (350 mg/dl)**—point directly to DKA. In DKA, insulin deficiency and counter-regulatory hormone excess lead to lipolysis and ketone production. By definition, DKA is characterized by a blood glucose level **greater than 250 mg/dl** (though some guidelines suggest >200 mg/dl) [2]. Therefore, the only plausible option is **Greater than 180 mg/dl**. The hyperkalemia (5.8 mmol/L) is also typical, resulting from the extracellular shift of potassium in exchange for hydrogen ions during acidosis [3]. **2. Why the incorrect options are wrong:** * **Options A, B, and D:** These values represent hypoglycemia or normoglycemia. While "Euglycemic DKA" can occur (glucose <200 mg/dl), it is rare and usually associated with SGLT-2 inhibitors or pregnancy. Even in euglycemic DKA, the glucose is typically near the upper limit of normal, not as low as 45, 75, or 120 mg/dl. A glucose level below 120 mg/dl would not provide the osmotic drive or reflect the metabolic derangement seen in a semi-comatose DKA patient. **3. Clinical Pearls for NEET-PG:** * **DKA Diagnostic Criteria:** Glucose >250 mg/dl, pH <7.3, Bicarbonate <18 mEq/L, and positive ketones [2]. * **Potassium Paradox:** Total body potassium is always **depleted** in DKA due to osmotic diuresis, even if serum levels appear high (due to acidotic shift) [3]. * **Management Priority:** The first step in management is always **aggressive fluid resuscitation** (Normal Saline), followed by insulin infusion and potassium replacement [1]. * **Anion Gap:** DKA is a classic cause of **High Anion Gap Metabolic Acidosis (HAGMA)**.

Q: All are features of Cushing's syndrome EXCEPT?

Hyperkalemia. **Explanation:** Cushing’s syndrome results from chronic exposure to excess glucocorticoids (cortisol). The correct answer is **Hyperkalemia** because Cushing’s syndrome is actually associated with **Hypokalemia**, not hyperkalemia. **1. Why Hyperkalemia is the correct answer (The Exception):** Cortisol, when present in high concentrations, overwhelms the enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), which normally inactivates cortisol in the kidneys. Consequently, excess cortisol binds to **mineralocorticoid receptors**, acting like aldosterone. This leads to sodium retention and increased urinary excretion of potassium and hydrogen ions, resulting in **hypokalemic metabolic alkalosis**. **2. Why the other options are features of Cushing’s:** * **Violaceous striae:** Excess cortisol inhibits fibroblasts and causes loss of collagen [1]. This leads to thinning of the dermis; the purple color (striae >1cm) arises from the visualization of underlying vascular subcutaneous tissue. * **Thin skin:** Protein catabolism leads to skin atrophy and easy bruising (ecchymosis), a hallmark clinical sign [1]. * **Hypertension:** Occurs due to the mineralocorticoid effect (sodium retention), increased sensitivity to catecholamines, and increased production of angiotensinogen. **Clinical Pearls for NEET-PG:** * **Screening Test:** 24-hour urinary free cortisol or Low-Dose Dexamethasone Suppression Test (LDDST) [3]. * **Gold Standard for localization:** Inferior Petrosal Sinus Sampling (IPSS). * **Ectopic ACTH:** Classically associated with Small Cell Carcinoma of the lung; it presents with the most severe hypokalemia and hyperpigmentation [2]. * **Mnemonic:** Cushing’s = **S**odium is high, **S**ugar is high (Hyperglycemia), but **P**otassium is low.

Q: A client with head trauma develops a urine output of 300 ml/hr, dry skin, and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?

Evaluate urine specific gravity. ### Explanation **Correct Answer: A. Evaluate urine specific gravity** The clinical presentation of head trauma followed by massive polyuria (300 ml/hr) and signs of dehydration (dry skin/mucous membranes) is highly suggestive of **Diabetes Insipidus (DI)**. In patients with head injury, damage to the hypothalamus or posterior pituitary can lead to a deficiency in Antidiuretic Hormone (ADH), known as Central DI. The initial nursing priority is to confirm the diagnosis by assessing the concentration of the urine. In DI, the kidneys cannot concentrate urine, resulting in a **low urine specific gravity (typically <1.005)** and low urine osmolality, despite systemic dehydration. **Analysis of Incorrect Options:** * **B. Anticipate treatment for renal failure:** Renal failure usually presents with oliguria (decreased urine output) and fluid overload, which contradicts this patient’s polyuria and dehydration. * **C. Provide emollients:** While skin care is important, it is a supportive measure and not the priority intervention for a life-threatening fluid imbalance. * **D. Slow down the IV fluids:** This is contraindicated. The patient is losing massive amounts of fluid; slowing the IV rate would worsen dehydration and potentially lead to hypovolemic shock. **NEET-PG High-Yield Pearls:** * **Triad of DI:** Polyuria, Polydipsia, and Low Urine Specific Gravity. * **Diagnostic Gold Standard:** Water Deprivation Test (though often bypassed in acute trauma settings for immediate ADH/Desmopressin challenge). * **Central vs. Nephrogenic:** Central DI (ADH deficiency) responds to Desmopressin (dDAVP), whereas Nephrogenic DI (ADH resistance) does not. * **Electrolyte Hallmark:** Hypernatremia (due to loss of free water).

Q: A 35-year-old male with a history of severe bronchial asthma for several months now complains of weight gain and the development of purple stretch marks. Physical examination showed BP 149/95 mmHg, supraclavicular fullness, thinned skin with areas of bruising, and decreased strength in proximal muscles. Laboratory investigations showed reduced serum cortisol and reduced plasma ACTH. An electrolyte workup in this patient will most likely reveal?

Iatrogenic cause. ### Explanation **1. Why "Iatrogenic cause" is correct:** The patient presents with classic features of **Cushing’s Syndrome** (weight gain, purple striae, hypertension, supraclavicular fullness, and proximal myopathy) [1]. However, the laboratory findings show **reduced serum cortisol** and **reduced plasma ACTH**. This biochemical profile (Low ACTH + Low Cortisol) indicates **Secondary Adrenal Insufficiency**. In the context of severe bronchial asthma, the patient has likely been using long-term exogenous glucocorticoids (oral or inhaled). Exogenous steroids provide systemic glucocorticoid activity (causing the Cushingoid appearance) while simultaneously suppressing the Hypothalamic-Pituitary-Adrenal (HPA) axis via negative feedback. This leads to low endogenous cortisol and ACTH levels. In iatrogenic Cushing's syndrome, cortisol levels are low unless the patient is taking a corticosteroid like prednisolone that cross-reacts in immunoassays [2]. **2. Why other options are incorrect:** * **Pituitary tumor (Cushing’s Disease):** Would show **High ACTH** and **High Cortisol** [1]. * **Tumor of the adrenal cortex:** Would show **Low ACTH** (due to feedback) but **High endogenous Cortisol** [2]. * **Lung cancer (Ectopic ACTH):** Small cell lung cancer typically causes **High ACTH** and **High Cortisol**, often presenting with severe hypokalemia rather than classic fat redistribution. **3. NEET-PG Clinical Pearls:** * **Most common cause of Cushing’s Syndrome:** Iatrogenic (exogenous steroid use). * **Most common endogenous cause:** Cushing’s Disease (Pituitary adenoma). * **Proximal Myopathy:** A key clinical differentiator; Cushing’s causes muscle wasting, whereas simple obesity does not [1]. * **The "Paradox":** Iatrogenic Cushing’s is the only state where a patient looks "Cushingoid" but has low laboratory cortisol levels (unless the specific synthetic steroid used is cross-reactive in the assay) [2].

Question 1

Episodic hypertension is a classical feature of which condition?

Accepted Answer

Pheochromocytoma

Answer

Adrenal carcinoma

Answer

Conn's syndrome

Answer

Cushing's disease

Question 2

A 45-year-old obese woman presents to the emergency department in a semi-comatose state. Laboratory investigations reveal K+ (5.8 mmol/L), Na+ (136 mmol/L), blood pH (7.1), HCO3 (12 mmol/L), and ketone bodies (350 mg/dl). What is the expected level of blood glucose for this patient?

Accepted Answer

Greater than 180 mg/dl

Answer

Less than 45 mg/dl

Answer

Less than 120 mg/dl

Answer

Less than 75 mg/dl

Question 3

Which of the following is most commonly associated with Conn's syndrome?

Accepted Answer

Bilateral micronodular adrenal hyperplasia

Answer

Cortical carcinoma

Answer

Pheochromocytoma

Answer

Cortical adenoma

Question 4

All are features of Cushing's syndrome EXCEPT?

Accepted Answer

Hyperkalemia

Answer

Violaceous striae

Answer

Thin skin

Answer

Hypertension

Question 5

Which of the following conditions is least life-threatening in a diabetic patient?

Accepted Answer

Malignant otitis externa

Answer

Emphysematous cholecystitis

Answer

Emphysematous pyelonephritis

Answer

Mucormycosis

Question 6

A patient presents with low serum calcium, high phosphorus, and elevated PTH. Which of the following investigations is least contributory to establishing a diagnosis?

Accepted Answer

Vitamin D levels

Answer

Serum creatinine levels

Answer

Cyclic AMP response to PTH

Answer

Urine myoglobin

Question 7

A client with head trauma develops a urine output of 300 ml/hr, dry skin, and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?

Accepted Answer

Evaluate urine specific gravity

Answer

Anticipate treatment for renal failure

Answer

Provide emollients to the skin to prevent breakdown

Answer

Slow down the IV fluids and notify the physician

Question 8

A 27-year-old woman presents with weight loss, fatigue, and weakness. She also experiences nausea and vomiting but no dysphagia. Her physical examination is normal except for increased generalized skin pigmentation. Her serum sodium is low and potassium is high. Which of the following features is also most likely to be present?

Accepted Answer

water diuresis is impaired

Answer

the skin is shiny and pale

Answer

a diabetic glucose tolerance is characteristic

Answer

the urinary steroids are high

Question 9

A 28-year-old man has semen analysis suggestive of azoospermia on two occasions, one month apart. FSH is normal and testosterone is normal. What is the most probable cause?

Accepted Answer

Vas obstruction

Answer

Undescended testis

Answer

Klinefelter's syndrome

Answer

Kallmann syndrome

Question 10

A 35-year-old male with a history of severe bronchial asthma for several months now complains of weight gain and the development of purple stretch marks. Physical examination showed BP 149/95 mmHg, supraclavicular fullness, thinned skin with areas of bruising, and decreased strength in proximal muscles. Laboratory investigations showed reduced serum cortisol and reduced plasma ACTH. An electrolyte workup in this patient will most likely reveal?

Accepted Answer

Iatrogenic cause

Answer

Pituitary tumor

Answer

Tumor of the adrenal cortex

Answer

Lung cancer

Endocrinology — MCQs

Endocrinology — MCQs

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