Endocrinology Practice Questions

Q: Which of the following is considered a silent thyroiditis?

Postpartum thyroiditis. **Explanation:** **Postpartum thyroiditis (Option D)** is a variant of **painless (silent) thyroiditis**. It is an autoimmune-mediated destructive thyroiditis occurring within one year of delivery. Pathologically, it is characterized by a lymphocytic infiltration similar to Hashimoto’s, but clinically it presents with a transient thyrotoxic phase (due to the release of preformed hormones) followed by a hypothyroid phase, eventually returning to euthyroidism in most cases. It is "silent" because it lacks the thyroid pain and tenderness seen in inflammatory types. **Why other options are incorrect:** * **Acute thyroiditis (Option A):** Also known as Suppurative Thyroiditis, it is usually bacterial (e.g., *S. aureus*). It presents with high fever, redness, and severe localized pain. * **Subacute thyroiditis (Option B):** Also known as **De Quervain’s thyroiditis**, it is typically post-viral [1]. It is the most common cause of a **painful** thyroid gland. * **Hashimoto thyroiditis (Option C):** While it is an autoimmune lymphocytic thyroiditis, it typically presents as a chronic, progressive goitrous hypothyroidism rather than the transient, self-limiting "silent" episodes characteristic of postpartum or sporadic painless thyroiditis. **High-Yield Clinical Pearls for NEET-PG:** * **Radioactive Iodine Uptake (RAIU):** In the thyrotoxic phase of silent/postpartum thyroiditis, **RAIU is low** (distinguishing it from Graves' disease where RAIU is high) [1]. * **ESR:** Markedly elevated in Subacute (De Quervain’s) thyroiditis but usually normal or mildly elevated in silent thyroiditis [1]. * **Treatment:** Since the thyrotoxicosis is due to "leakage" and not overproduction, **Propranolol** is used for symptom control; Antithyroid drugs (PTU/Methimazole) have no role [1].

Q: Which of the following is NOT TRUE regarding Hashimoto's thyroiditis?

None of the above. **Explanation:** Hashimoto’s Thyroiditis (Chronic Lymphocytic Thyroiditis) is the most common cause of hypothyroidism in iodine-sufficient regions. It is an autoimmune condition characterized by the destruction of thyroid follicles. **Analysis of Options:** * **Option A (Neutrophilic infiltration):** This is **NOT** a feature of Hashimoto’s. The hallmark histopathology shows a dense **lymphocytic and plasma cell infiltrate** with the formation of germinal centers. Neutrophilic infiltration is typically seen in acute infectious (suppurative) thyroiditis. * **Option B (Maximum incidence in children):** This is **NOT** true. Hashimoto’s thyroiditis most commonly affects **middle-aged women** (between 30 and 50 years of age), with a female-to-male ratio of approximately 10:1 to 20:1. * **Option C (Pain in the hyoid region):** This is **NOT** true. Hashimoto’s is typically a **painless**, diffuse enlargement of the thyroid (goiter). Pain and tenderness are characteristic features of Subacute Granulomatous (De Quervain’s) Thyroiditis or infectious thyroiditis. Since **all three statements (A, B, and C) are incorrect** regarding Hashimoto’s thyroiditis, the question asks which is "NOT TRUE." Technically, all are false. In the context of this specific MCQ structure, "None of the above" is the designated correct answer because none of the provided statements accurately describe the disease. **NEET-PG High-Yield Pearls:** * **Histology:** Look for **Hürthle cells** (Askanazy cells)—large epithelial cells with abundant eosinophilic, granular cytoplasm. * **Antibodies:** High titers of **Anti-TPO** (Antithyroid peroxidase) and **Anti-Tg** (Antithyroglobulin) antibodies. * **Risk:** Increased risk of **B-cell Non-Hodgkin Lymphoma** of the thyroid and other autoimmune diseases (e.g., Type 1 Diabetes, Pernicious Anemia). * **Genetics:** Associated with **HLA-DR3 and HLA-DR5**.

Question 1

Which of the following is considered a silent thyroiditis?

Accepted Answer

Postpartum thyroiditis

Answer

Acute thyroiditis

Answer

Subacute thyroiditis

Answer

Hashimoto thyroiditis

Question 2

A patient has multiple myeloma and a serum calcium of 15 mg/dL. Which of the following are appropriate treatments?

Accepted Answer

Less than 15 mg/dL serum calcium does not cause symptoms

Answer

Oral pamidronate

Answer

Mithramycin

Answer

Glucocorticoids

Question 3

Hyperparathyroidism is characterized by the following except?

Accepted Answer

Osteosclerosis

Answer

Generalised osteoporosis

Answer

Renal calculi

Answer

Hypercalcemia

Question 4

A 30-year-old female presents with visual defects, breast engorgement, and amenorrhea. What is the investigation of choice?

Accepted Answer

Serum prolactin

Answer

CT brain

Answer

Biopsy

Answer

MR angiography

Question 5

Which of the following does NOT precipitate ulcers in diabetes?

Accepted Answer

Microangiopathic changes in blood vessels

Answer

Neuropathy

Answer

Trophic ulcers

Answer

Macroangiopathy

Question 6

A 45-year-old male presents with palpitations, tachycardia, and anxiety. His blood pressure is 158/90 mmHg. He has mild depression and is currently taking citalopram, labetalol, and amlodipine for blood pressure control. 24-hour urine total metanephrines show an elevation of 1.5 times the upper limit of normal. What is the next best step?

Accepted Answer

Hold labetalol for 1 week and repeat testing

Answer

Hold citalopram for 1 week and repeat testing

Answer

Refer immediately for surgical evaluation

Answer

Measure 24-hour urine vanillylmandelic acid level

Question 7

A 26-year-old woman has episodic hypertension with headache, diaphoresis, and palpitation. Which of the following diagnostic procedures would be most useful in evaluating the possibility that pheochromocytoma might be the cause of these findings?

Accepted Answer

Urinary vanillylmandelic acid

Answer

Serum C-peptide

Answer

Serum calcitonin

Answer

Urinary aldosterone

Question 8

A patient has random plasma glucose levels of 110 mg/dL and 113 mg/dL on two separate occasions. What advice would you give?

Accepted Answer

Declare the patient as normal.

Answer

Declare him as having Diabetes mellitus.

Answer

Proceed for an oral glucose tolerance test.

Answer

Check for glycosylated hemoglobin and if it is raised, declare him as having DM.

Question 9

Which of the following is NOT TRUE regarding Hashimoto's thyroiditis?

Accepted Answer

None of the above

Answer

Neutrophilic infiltration

Answer

Maximum incidence in children

Answer

Pain in the hyoid region

Question 10

What is the first-line treatment for postmenopausal osteoporosis?

Accepted Answer

Alendronate

Answer

Raloxifene

Answer

Tamoxifene

Answer

Estrogen

Endocrinology — MCQs

Endocrinology — MCQs

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