Endocrinology Practice Questions

Q: Which of the following is characteristic of MODY?

Insulin dependent. Maturity-Onset Diabetes of the Young (MODY) is a heterogeneous group of monogenic disorders characterized by non-insulin-dependent diabetes caused by mutations in genes affecting beta-cell function. These subtypes typically present as single gene defects with autosomal dominant inheritance and are described as non-insulin-requiring [1]. Why the Correct Answer is "Insulin Dependent": Note: There appears to be a discrepancy in the provided key. Traditionally, MODY is defined as non-insulin dependent (at least for the first 5 years of diagnosis) [1]. However, in the context of advanced disease or specific subtypes (like MODY 1 or MODY 3), patients may eventually require insulin as beta-cell function declines. If "Insulin dependent" is the marked correct answer in your source, it refers to the progressive nature of certain subtypes or the clinical requirement for exogenous insulin in late stages. Analysis of Other Options: * A. Age of onset less than 25 years: This is a classic diagnostic hallmark of MODY. It typically presents in adolescence or young adulthood. * B. Impaired secretion of insulin: This is the primary pathophysiology. Unlike Type 2 DM (insulin resistance), MODY is a defect in insulin secretion due to genetic mutations (e.g., HNF1-alpha, Glucokinase) [1]. * C. Responds to sulfonylureas: This is a high-yield characteristic of MODY 3 (HNF1-alpha) and MODY 1 (HNF4-alpha). These patients are exquisitely sensitive to low-dose sulfonylureas, often allowing them to discontinue insulin. NEET-PG High-Yield Pearls: * Inheritance: Autosomal Dominant (look for a strong family history across 3 generations) [1]. * Most Common Type: MODY 3 (HNF1-alpha mutation). * MODY 2 (Glucokinase mutation): Presents with mild, stable fasting hyperglycemia; usually requires no treatment (diet only). * Differentiation: Unlike Type 1 DM, MODY is autoantibody-negative and has detectable C-peptide levels.

Q: A 45-year-old male, a known case of diabetes mellitus for the last 15 years, presents with diabetic ketoacidosis. What is the initial line of management?

0.9% saline. ### Explanation **Correct Option: C. 0.9% saline** The primary goal in the initial management of Diabetic Ketoacidosis (DKA) is the restoration of circulatory volume and correction of the profound dehydration caused by osmotic diuresis [1]. **0.9% Normal Saline (Isotonic Saline)** is the fluid of choice for initial resuscitation [2]. It effectively expands the extracellular fluid (ECF) volume, improves renal perfusion (aiding glucose excretion), and stabilizes blood pressure [2]. According to standard protocols (ADA/ISPAD), the initial bolus is typically 15–20 mL/kg/hour. **Analysis of Incorrect Options:** * **A. 3% Saline:** This is a hypertonic solution used for symptomatic hyponatremia or cerebral edema. In DKA, the patient is already in a hyperosmolar state; adding hypertonic saline would worsen cellular dehydration and increase the risk of osmotic injury [2]. * **B. 5% Dextrose:** This is contraindicated as an *initial* fluid because the patient is already severely hyperglycemic [1]. Dextrose is only added to the regimen (usually as 5% Dextrose in 0.45% Saline) once blood glucose levels fall below **200–250 mg/dL** to prevent hypoglycemia and allow continued insulin infusion to close the anion gap [2], [4]. * **D. Colloids:** While they expand volume, they offer no advantage over crystalloids in DKA and are more expensive. Crystalloids remain the gold standard for correcting the free water and electrolyte deficits. **NEET-PG High-Yield Pearls:** * **The "Rule of 5":** In DKA management, switch to D5NS when blood sugar reaches **~250 mg/dL** [2]. * **Potassium Management:** Never start insulin if K+ is **<3.3 mEq/L**. Always supplement K+ once it falls below 5.2 mEq/L (provided urine output is adequate) [2]. * **Bicarbonate:** Not routinely recommended unless arterial pH is **<6.9**. * **Most common cause of death in children with DKA:** Cerebral edema (often due to over-aggressive fluid resuscitation) [3].

Q: Which of the following is most characteristic of diabetic neuropathy?

It is usually bilateral. The most common form of diabetic neuropathy is **Distal Symmetric Polyneuropathy (DSPN)**. This condition typically presents in a "stocking-and-glove" distribution, meaning it is **characteristically bilateral and symmetrical** [1]. It occurs due to chronic hyperglycemia leading to metabolic and vascular derangements (polyol pathway activation and microangiopathy) that affect long nerve fibers first [1]. **Analysis of Options:** * **A (Correct):** As a systemic metabolic insult, the damage to peripheral nerves occurs simultaneously on both sides of the body, making it usually bilateral [1]. * **B (Incorrect):** Pain is a hallmark feature of diabetic neuropathy. It is often described as burning, tingling, or "electric shock-like" sensations, frequently worsening at night. * **C (Incorrect):** Diabetic neuropathy primarily affects the **Peripheral Nervous System (PNS)** and the Autonomic Nervous System, not the brain (Central Nervous System) [2]. * **D (Incorrect):** **Autonomic neuropathy** is a common and serious complication of diabetes. It can manifest as resting tachycardia, orthostatic hypotension, gastroparesis, and erectile dysfunction [3]. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** Loss of vibration sense (tested with a 128 Hz tuning fork) and loss of ankle jerk reflex [1], [4]. * **Mononeuropathy:** The most common cranial nerve involved is **CN III (Oculomotor)**, characteristically presenting with **pupillary sparing** (due to ischemic rather than compressive damage). * **Screening:** The 10-g Semmes-Weinstein monofilament test is the gold standard for identifying a "foot at risk" for ulceration [4]. * **Treatment:** First-line agents for painful neuropathy include Pregabalin, Duloxetine, or Amitriptyline.

Q: Which of the following is NOT useful for acute hypercalcemia?

Furosemide. ### Explanation **Correct Option: C. Furosemide** **Why Furosemide is the correct answer:** Traditionally, loop diuretics like furosemide were used to treat hypercalcemia because they inhibit the Na⁺-K⁺-2Cl⁻ symporter, which abolishes the positive luminal potential required for calcium reabsorption. However, **current clinical guidelines (AHA/Endocrine Society) no longer recommend furosemide** for acute hypercalcemia unless the patient is in fluid overload or heart failure. This is because furosemide can worsen dehydration—the primary complication of hypercalcemia—and may lead to electrolyte imbalances without significantly lowering calcium levels compared to aggressive hydration alone. **Analysis of Incorrect Options:** * **A. Normal Saline:** This is the **first-line treatment**. It restores intravascular volume and promotes "calciuresis" by increasing the glomerular filtration rate and inhibiting proximal tubular sodium/calcium reabsorption. * **B. Calcitonin:** Used for **rapid reduction** of calcium. It works within hours by inhibiting osteoclast activity and increasing renal excretion. However, its effect is short-lived due to tachyphylaxis (receptor downregulation). * **D. Bisphosphonates (e.g., Zoledronate, Pamidronate):** These are the **most effective long-term agents** for hypercalcemia of malignancy. They potentally inhibit osteoclast-mediated bone resorption, though they take 48–72 hours to reach peak effect. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Hypercalcemia Rx:** "Hydrate (Saline), Hibernate (Bisphosphonates), and Hurry (Calcitonin)." * **Glucocorticoids:** Useful specifically for hypercalcemia caused by Vitamin D toxicity, sarcoidosis, or lymphomas. * **Cinacalcet:** A calcimimetic used for secondary hyperparathyroidism in CKD. * **Denosumab:** A RANKL inhibitor used when bisphosphonates are contraindicated (e.g., severe renal impairment).

Q: Which of the following is NOT a typical presentation of hyperthyroidism?

Hypotension. In hyperthyroidism, the excess of circulating thyroid hormones ($T_3$ and $T_4$) leads to a hypermetabolic state and increased sympathetic nervous system sensitivity. **Why Hypotension is the Correct Answer:** Hyperthyroidism typically causes **systolic hypertension** and a **widened pulse pressure** [2]. Thyroid hormones decrease systemic vascular resistance (vasodilation) while simultaneously increasing cardiac output, heart rate, and stroke volume. This results in an elevated systolic BP and a low-to-normal diastolic BP. Hypotension is not a feature; in fact, if a patient with hyperthyroidism presents with low blood pressure, one must suspect **adrenal insufficiency** (Schmidt syndrome) or **thyroid storm** progressing to high-output heart failure. **Analysis of Incorrect Options:** * **Atrial Fibrillation:** This is the most common arrhythmia in hyperthyroidism, especially in elderly patients [1]. Thyroid hormones have a direct pro-arrhythmic effect on the atrial myocardium. * **Tremor:** A characteristic high-frequency, low-amplitude **fine tremor** is a classic sign of thyrotoxicosis, best observed by placing a sheet of paper on the patient's outstretched hands [2]. * **Panic Attacks:** Hyperthyroidism often mimics psychiatric disorders [2]. Patients frequently present with anxiety, irritability, emotional lability, and symptoms indistinguishable from panic disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Apathetic Hyperthyroidism:** Seen in the elderly; presents with depression and lethargy rather than typical hyperactivity. * **Thyroid Storm:** Characterized by hyperpyrexia, tachycardia, and altered mental status. * **Treatment of choice for symptoms:** Propranolol (non-selective beta-blocker) is used to control tachycardia and tremors and also inhibits the peripheral conversion of $T_4$ to $T_3$ [3].

Q: Which of the following conditions is most likely to be associated with the clinical findings shown in the image?

Hypothyroidism. ***Hypothyroidism*** - The image demonstrates classic **myxedematous facies** with **periorbital puffiness**, **dry coarse skin**, and **loss of outer third of eyebrows**. - The **dull facial expression** and overall appearance are characteristic of **severe hypothyroidism** (myxedema). *Acromegaly* - Features **coarse facial features** with **enlarged nose**, **thick lips**, and **prognathism** (protruding jaw), which are not present here. - Associated with **macroglossia** and **enlarged hands and feet** due to excess **growth hormone**. *Cushing syndrome* - Characterized by **moon face** with **central facial plethora** and **hirsutism**, contrasting with the pale, puffy appearance seen. - Often presents with **purple striae**, **buffalo hump**, and **truncal obesity** due to excess **cortisol**. *Graves' disease* - Typically shows **exophthalmos** (bulging eyes) and **lid retraction** with a **staring appearance**. - Associated with **hyperthyroid features** like **weight loss**, **tremor**, and **goiter**, opposite to the findings shown.

Question 1

Which of the following is characteristic of MODY?

Accepted Answer

Insulin dependent

Answer

Age of onset less than 25 years

Answer

Impaired secretion of insulin

Answer

Responds to sulfonylureas

Question 2

Which of the following is false regarding primary hyperparathyroidism?

Accepted Answer

Autosomal recessive inheritance is seen in association with MEN syndrome.

Answer

Most cases are sporadic.

Answer

It is the earliest and most common manifestation of MEN1 syndrome.

Answer

Eighty percent of cases are due to enlargement of a single gland or parathyroid adenoma.

Question 3

Euvolemic hyponatremia is seen in which of the following conditions?

Accepted Answer

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Answer

Adrenocortical failure

Answer

Burns

Answer

Cirrhosis

Question 4

A 45-year-old male, a known case of diabetes mellitus for the last 15 years, presents with diabetic ketoacidosis. What is the initial line of management?

Accepted Answer

0.9% saline

Answer

3% saline

Answer

5% dextrose

Answer

Colloids

Question 5

Which of the following is most characteristic of diabetic neuropathy?

Accepted Answer

It is usually bilateral

Answer

Pain is not a feature

Answer

It most commonly affects the brain

Answer

It spares the autonomic system

Question 6

Which of the following is NOT useful for acute hypercalcemia?

Accepted Answer

Furosemide

Answer

Normal saline

Answer

Calcitonin

Answer

Bisphosphonates

Question 7

What are the two most important tests to be done in a comatose patient with a blood glucose of 750 mg/dl?

Accepted Answer

Serum creatinine

Answer

Serum sodium

Answer

Cerebrospinal fluid examination

Answer

Blood pH

Question 8

Which of the following is NOT a typical presentation of hyperthyroidism?

Accepted Answer

Hypotension

Answer

Atrial fibrillation

Answer

Tremor

Answer

Panic attacks

Question 9

A 75-year-old woman presents with mild congestive heart failure 6 weeks after a myocardial infarction. She has a past history of neck surgery for parathyroid adenoma 5 years ago. Her EKG shows slow atrial fibrillation. Serum calcium is 13.0 mg/dL and urinary calcium is 300 mg/24 hr. On examination, there is a small mass in the paratracheal position behind the right clavicle. What is the appropriate management at this time?

Accepted Answer

Ultrasound-guided alcohol injection of the mass

Answer

Repeat neck surgery

Answer

Treatment with Technetium-99

Answer

Observation and repeat serum calcium in two months

Question 10

Which of the following conditions is most likely to be associated with the clinical findings shown in the image?

Accepted Answer

Hypothyroidism

Answer

Acromegaly

Answer

Cushing syndrome

Answer

Graves' disease

Endocrinology — MCQs

Endocrinology — MCQs

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