Endocrinology Practice Questions

Q: All of the following are the causes for hypercalcemia Except?

Acute pancreatitis. ***Acute pancreatitis*** - **Acute pancreatitis** is most commonly associated with **hypocalcemia**, not hypercalcemia [1]. - The likely mechanism for hypocalcemia in pancreatitis is the **saponification of calcium in necrotic fat** by free fatty acids released from local lipase activity [1]. *Thiazides* - **Thiazide diuretics** can cause a mild increase in calcium levels by **increasing calcium reabsorption in the distal renal tubule** [2]. - This effect is generally not severe enough to cause symptomatic hypercalcemia unless other underlying conditions are present. *Hyperparathyroidism* - **Primary hyperparathyroidism** is a common cause of hypercalcemia, due to the **overproduction of parathyroid hormone (PTH)** [2]. - PTH increases serum calcium by increasing **bone resorption**, renal calcium reabsorption, and intestinal calcium absorption [2]. *Hypervitaminosis of Vitamin D* - Excessive intake or production of **Vitamin D** leads to hypercalcemia by increasing **intestinal absorption of calcium** [2]. - It also enhances **bone resorption**, contributing to elevated serum calcium levels.

Q: Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Hypo-osmolar urine. ***Hypo-osmolar urine*** - Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by the secretion of ADH in excess of what is appropriate for the plasma osmolality. This excess ADH causes the kidneys to retain water, leading to **concentrated (hyper-osmolar) urine** [1]. - Therefore, **hypo-osmolar urine** is not a characteristic of SIADH; rather, **hyper-osmolar urine** is expected as the body tries to excrete concentrated urine to compensate for water retention. *Expanded fluid volume* - The excess ADH in SIADH leads to increased **water reabsorption** by the kidneys [1]. - This increased water retention can result in an **expanded extracellular fluid volume**, although usually without significant peripheral edema due to natriuretic peptide release [2]. *Hyponatremia* - The retained water dilutes the plasma sodium concentration, causing **dilutional hyponatremia** [2]. - This is a hallmark feature of SIADH, as the body holds onto too much free water [2]. *Water intoxication* - The characteristic features of SIADH, including **hyponatremia** and **increased total body water**, directly lead to a state of **water intoxication** [1]. - Symptoms can range from mild (nausea, malaise) to severe (seizures, coma) depending on the severity and rapidity of hyponatremia.

Q: Which of the following is best for diagnosis of pheochromocytoma?

24-hour urinary Fractionated Metanephrine. ***24-hour urinary Fractionated Metanephrine*** - This test measures the **metabolites of catecholamines** (epinephrine and norepinephrine), which are continuously produced by pheochromocytomas [1]. - As metanephrines are released continuously rather than episodically, their measurement in a 24-hour urine collection provides the **highest sensitivity and specificity** for diagnosing pheochromocytoma. *24-hour Urinary Hydroxy indole acetic acid* - This is a metabolite of **serotonin**, which is relevant to conditions like **carcinoid syndrome**, not pheochromocytoma. - Elevated levels would indicate a serotonin-producing tumor, not a catecholamine-producing tumor. *24-hour urinary Vanillyl Mandelic acid* - While VMA is a metabolite of both epinephrine and norepinephrine, it is a less specific and sensitive marker than fractionated metanephrines for pheochromocytoma. - Its measurement can be affected by various medications and dietary factors, leading to a higher rate of false positives and negatives compared to metanephrines. *24-hour Urinary Hydroxy tryptamine* - This refers to **serotonin**, which is not directly relevant to the diagnosis of pheochromocytoma. - Elevated levels would point towards conditions involving serotonin metabolism, such as carcinoid tumors.

Q: All of the following syndromes are seen with obesity except:

Carcinoid syndrome. ***Carcinoid syndrome*** - Carcinoid syndrome is caused by **neuroendocrine tumors** that secrete **serotonin** and other vasoactive substances, leading to symptoms like flushing, diarrhea, and bronchospasm [2]. **Obesity is not a primary feature** of this syndrome. - The symptoms are directly related to the **hormonal effects** of the secreted substances, not to metabolic alterations associated with obesity. *Laurence Moon - Biedl syndrome* - This is a **rare genetic disorder** characterized by **obesity**, retinitis pigmentosa, polydactyly, intellectual disability, and hypogonadism [1]. - Obesity is a **consistent and prominent feature** of this syndrome, often present from childhood. *Cohen syndrome* - Cohen syndrome is a rare genetic disorder characterized by **obesity** (especially truncal obesity), intellectual disability, microcephaly, characteristic facial features, and hypotonia. - While not as universally severe as in some other syndromes, **obesity is a common clinical feature** of Cohen syndrome. *Prader - Willi syndrome* - Prader-Willi syndrome is a genetic disorder caused by a deletion on chromosome 15, leading to **insatiable hunger (hyperphagia)** and chronic overeating, which results in **severe obesity** [1]. - **Obesity is a cardinal feature** of this syndrome, developing in early childhood due to hypothalamic dysfunction affecting appetite control.

Q: Ramkali bai, a 35-year-old female presented with a one-year history of menstrual irregularity and galactorrhoea. She also had off and on headache, her examination revealed bitemporal superior quadrantanopia. Her fundus examination showed primary optic atrophy. Which of the following is a most likely diagnosis in this case -

Pituitary macroadenoma. ***Pituitary macroadenoma*** - **Menstrual irregularity**, **galactorrhoea**, and **headaches** are classic symptoms of a pituitary macroadenoma, especially if it secretes **prolactin** [1]. - **Bitemporal superior quadrantanopia** and **primary optic atrophy** are consistent with compression of the inferior chiasm by a large pituitary tumor [1]. *Craniopharyngioma* - While craniopharyngiomas can cause visual field defects and endocrine dysfunction, galactorrhoea is less common, and they typically affect children and young adults or older adults, not commonly presenting in a 35-year-old with this specific constellation. - The visual field defect from craniopharyngioma would more typically be a bitemporal hemianopia due to compression of the mid-chiasm, not primarily a superior quadrantanopia. *Ophthalmic ICA Aneurysm* - An ophthalmic ICA aneurysm can compress the optic nerve, leading to visual loss, but it typically causes unilateral visual field defects and is not usually associated with galactorrhoea or menstrual irregularity. - Endocrine symptoms like galactorrhoea are not characteristic of an unruptured internal carotid artery aneurysm. *Chiasmal Glioma* - Chiasmal gliomas are more common in children and can cause visual field defects and endocrine abnormalities, but galactorrhoea is not a typical presentation. - The progression of symptoms and specific visual field defect (bitemporal superior quadrantanopia) are less classic for a chiasmal glioma compared to a pituitary macroadenoma.

Q: Submucosal neuroma is associated with

MEN 2B. ***MEN 2B (Multiple Endocrine Neoplasia Type 2B)*** - **Submucosal neuromas** are a distinctive feature of MEN 2B, specifically noticeble as mucosal neuromas on the lips, tongue, and gastrointestinal tract. - This syndrome is characterized by the presence of **medullary thyroid carcinoma**, **pheochromocytoma**, and mucocutaneous neuromas, without hyperparathyroidism. *MEN 2A (Multiple Endocrine Neoplasia Type 2A)* - MEN 2A is characterized by **medullary thyroid carcinoma**, **pheochromocytoma**, and **primary hyperparathyroidism**. - It does not typically feature extensive **submucosal neuromas** as a primary diagnostic criterion. *MEN 1 (Multiple Endocrine Neoplasia Type 1)* - MEN 1 involves tumors of the **parathyroid glands**, **anterior pituitary**, and **pancreatic islet cells** (the '3 Ps'). - **Submucosal neuromas** are not a component of the MEN 1 syndrome. *None of the options* - This option is incorrect because **submucosal neuromas** are a characteristic finding in MEN 2B.

Q: All are symptoms of hypocalcemia except

Peaked p waves. ***Peaked p waves*** - **Peaked P waves** are associated with **right atrial enlargement** or **hyperkalemia**, not hypocalcemia [1]. - In hypocalcemia, the **QT interval** on an electrocardiogram is typically **prolonged**, not the P wave morphology altered this way. *laryngospasm* - **Laryngospasm** is a serious manifestation of **severe hypocalcemia** due to increased neuromuscular excitability. - It can lead to airway obstruction and is part of the tetany experienced in low calcium states. *Trousseau sign* - **Trousseau's sign** is a classic indicator of **latent tetany** in hypocalcemia, elicited by inflating a blood pressure cuff above systolic pressure for several minutes. - This maneuver induces **carpal spasm** (flexion of the wrist and metacarpophalangeal joints, extension of the interphalangeal joints, and adduction of the thumb). *Chvostek sign* - **Chvostek's sign** is another clinical sign of **hypocalcemia**, elicited by tapping on the facial nerve just anterior to the earlobe. - A positive sign results in **twitching of the ipsilateral facial muscles**, indicating increased neuromuscular irritability.

Q: An adolescent with type 1 diabetes returns for a follow-up visit after his annual check-up last week. You note that his serum glucose is elevated, and his glycosylated hemoglobin (hemoglobin A1C) is 16.7%. This finding suggests poor control of his diabetes over at least which of the following time-periods?

2 months. ***2 months*** - **Hemoglobin A1c** reflects the average blood glucose levels over the preceding **2-3 months**, as it measures glycated hemoglobin within red blood cells. - Red blood cells have a lifespan of approximately 120 days, so this test provides a good indication of long-term glycemic control. [2] *1 month* - While recent glucose levels contribute to A1c, a 1-month period is generally too short to reflect the full averaging effect of the test. - A 1-month period would not fully capture the complete lifespan of red blood cells, which is central to A1c's utility as a long-term marker. *8 hours* - An 8-hour period is far too short to be reflected by hemoglobin A1c, which assesses average glucose over weeks to months. - This timeframe is more relevant for **fasting glucose** or immediate postprandial glucose levels, not long-term control. [1] *1 week* - Similar to a 1-month period, 1 week is insufficient to reflect the long-term glucose control captured by **hemoglobin A1c**. - **Fructosamine** levels are a better indicator for glucose control over a 1-2 week period, as it reflects glycated proteins with a shorter half-life.

Q: Spider naevi are due to action of -

Estrogen. Estrogen - **Spider naevi** are vascular lesions characterized by a central arteriole surrounded by radiating capillaries, commonly found in conditions with **elevated estrogen levels**. - High estrogen levels lead to **vasodilation** and increased vascularity, causing the formation of these lesions, often seen in **pregnancy** or **cirrhosis** [1], [2]. *Androgen* - Androgens are male sex hormones and their action is generally associated with effects like **acne** and **sebum production**, not spider naevi [2]. - They do not typically cause the **cutaneous vascular changes** seen in spider naevi. *Steroids* - "Steroids" is a broad term, but often refers to corticosteroids, which can cause skin thinning and easy bruising, but not the characteristic **spider naevi**. - While some steroids (like estrogen) do cause them, as a general category, it is not the primary cause. *Progesterone* - Progesterone is a female sex hormone primarily involved in the **menstrual cycle** and maintenance of **pregnancy** [1]. - It does not directly cause the **vasodilation** and vascular changes that lead to the formation of spider naevi.

Question 1

All of the following are the causes for hypercalcemia Except?

Accepted Answer

Acute pancreatitis

Answer

Thiazides

Answer

Hyperparathyroidism

Answer

Hypervitaminosis of Vitamin D

Question 2

Gynecomastia is seen in all except;

Accepted Answer

Leprosy

Answer

Kidney failure

Answer

Liver failure

Answer

Stilbestrol therapy for prostate cancer

Answer

Teratoma of the testis

Answer

Hormonal

Answer

Idiopathic

Answer

Anorchism and After castration

Answer

Klinefelter's syndrome

Question 3

Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Accepted Answer

Hypo-osmolar urine

Answer

Expanded fluid volume

Answer

Hyponatremia

Answer

Water intoxication

Question 4

Which of the following is best for diagnosis of pheochromocytoma?

Accepted Answer

24-hour urinary Fractionated Metanephrine

Answer

24-hour Urinary Hydroxy indole acetic acid

Answer

24-hour urinary Vanillyl Mandelic acid

Answer

24-hour Urinary Hydroxy tryptamine

Question 5

All of the following syndromes are seen with obesity except:

Accepted Answer

Carcinoid syndrome

Answer

Laurence Moon - Biedl syndrome

Answer

Cohen syndrome

Answer

Prader - Willi syndrome

Question 6

Ramkali bai, a 35-year-old female presented with a one-year history of menstrual irregularity and galactorrhoea. She also had off and on headache, her examination revealed bitemporal superior quadrantanopia. Her fundus examination showed primary optic atrophy. Which of the following is a most likely diagnosis in this case -

Accepted Answer

Pituitary macroadenoma

Answer

Craniopharyngioma

Answer

Ophthalmic ICA Aneurysm

Answer

Chiasmal Glioma

Question 7

Submucosal neuroma is associated with

Accepted Answer

MEN 2B

Answer

MEN 2 A

Answer

MEN 1

Answer

None of the options

Question 8

All are symptoms of hypocalcemia except

Accepted Answer

Peaked p waves

Answer

laryngospasm

Answer

Trousseau sign

Answer

Chvostek sign

Question 9

An adolescent with type 1 diabetes returns for a follow-up visit after his annual check-up last week. You note that his serum glucose is elevated, and his glycosylated hemoglobin (hemoglobin A1C) is 16.7%. This finding suggests poor control of his diabetes over at least which of the following time-periods?

Accepted Answer

2 months

Answer

1 month

Answer

8 hours

Answer

1 week

Question 10

Spider naevi are due to action of -

Accepted Answer

Estrogen

Answer

Androgen

Answer

Steroids

Answer

Progesterone

Endocrinology — MCQs

Endocrinology — MCQs

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