Endocrinology Practice Questions

Q: Which of the following medications should not be given to a diabetic patient?

Propranolol. **Explanation:** The correct answer is **Propranolol**. **Why Propranolol is contraindicated:** Propranolol is a non-selective beta-blocker that poses two significant risks to diabetic patients: 1. **Masking Hypoglycemia:** The most critical danger is that it masks the sympathetic "warning signs" of hypoglycemia, such as tachycardia, palpitations, and tremors. A patient may slip into a severe hypoglycemic coma without realizing their blood sugar has dropped. (Note: Sweating is mediated by cholinergic receptors and is usually not masked). 2. **Inhibition of Glycogenolysis:** Beta-2 receptors mediate the breakdown of glycogen into glucose in the liver. By blocking these receptors, Propranolol impairs the body's compensatory mechanism to raise blood glucose levels during a hypoglycemic episode, leading to prolonged and more severe hypoglycemia. **Analysis of Incorrect Options:** * **Theophylline:** A methylxanthine used in asthma/COPD. While it can cause mild hyperglycemia in toxicity, it is not contraindicated in diabetes. * **Digoxin:** A cardiac glycoside used in heart failure and atrial fibrillation. It has no significant effect on glucose metabolism. * **Glyburide:** This is a second-generation Sulfonylurea. It is a standard treatment for Type 2 Diabetes (though used less frequently now due to the risk of hypoglycemia). **NEET-PG High-Yield Pearls:** * If a beta-blocker must be used in a diabetic patient (e.g., post-MI), **Cardioselective (Beta-1) blockers** like Metoprolol or Atenolol are preferred, as they have less effect on glucose metabolism. * **Sweating** is the only sympathetic symptom of hypoglycemia not masked by beta-blockers. * Other drugs causing hyperglycemia: Thiazides, Corticosteroids, and Atypical Antipsychotics (e.g., Olanzapine).

Q: Palpation of the costovertebral angle produces pain and tenderness in acute adrenal insufficiency. This is termed as:

Rogoff's sign. ### Explanation **Rogoff’s Sign** is a clinical finding characterized by pain and tenderness upon deep palpation of the **costovertebral angle** (the area overlying the adrenal glands). In the context of **acute adrenal insufficiency** (Addisonian crisis), the adrenal glands may become congested or inflamed, leading to localized tenderness at this anatomical site. While not pathognomonic, it is a classic physical sign taught in endocrine semiology. #### Analysis of Incorrect Options: * **Osler’s Sign:** This term refers to two distinct findings: (1) **Osler’s nodes**, which are painful, erythematous nodules on the pads of fingers/toes in infective endocarditis; and (2) **Pseudohypertension**, where the radial artery remains palpable despite the blood pressure cuff being inflated above systolic pressure. * **Rotch’s Sign:** This is a sign of **pericardial effusion**, characterized by dullness to percussion in the right 5th intercostal space (at the cardio-hepatic angle). * **Rossolimo’s Sign:** A neurological sign indicating a **pyramidal tract lesion**. It involves percussion of the plantar surface of the toes, resulting in abnormal flexion of the toes. #### NEET-PG High-Yield Pearls: * **Acute Adrenal Insufficiency:** Most commonly caused by sudden withdrawal of long-term steroid therapy. * **Clinical Presentation:** Refractory hypotension (shock not responding to vasopressors), abdominal pain (mimicking acute abdomen), hyponatremia, and hyperkalemia. * **Management:** Immediate administration of **IV Hydrocortisone** (100mg bolus) and aggressive fluid resuscitation with normal saline. Do not wait for ACTH stimulation test results if the patient is unstable.

Q: All of the following are associated with Multiple Endocrine Neoplasia type 2 (MEN-2) except:

Islet cell hyperplasia. **Explanation:** The Multiple Endocrine Neoplasia (MEN) syndromes are autosomal dominant conditions characterized by tumors involving two or more endocrine glands. The key to answering this question lies in distinguishing between **MEN-1 (Wermer Syndrome)** and **MEN-2 (Sipple Syndrome)**. **Why "Islet cell hyperplasia" is the correct answer:** Islet cell hyperplasia (and pancreatic endocrine tumors like gastrinomas or insulinomas) is a hallmark of **MEN-1**, not MEN-2. The "3 Ps" of MEN-1 are **P**arathyroid hyperplasia, **P**ituitary adenoma, and **P**ancreatic/Islet cell tumors. **Analysis of incorrect options (Features of MEN-2):** * **Medullary Carcinoma of Thyroid (MCT):** This is the most consistent feature of MEN-2 (occurring in >90% of cases). It arises from parafollicular C-cells. * **Pheochromocytoma:** Seen in approximately 50% of patients with MEN-2A and 2B. They are often bilateral and occur within the adrenal medulla. * **Parathyroid Adenoma/Hyperplasia:** This occurs in about 20-30% of patients with **MEN-2A**. Note: It is *absent* in MEN-2B. **High-Yield Clinical Pearls for NEET-PG:** * **Genetics:** MEN-2 is associated with a germline mutation in the **RET proto-oncogene** (Chromosome 10). MEN-1 is associated with the **MENIN gene** (Chromosome 11). * **MEN-2B vs. 2A:** MEN-2B includes MCT and Pheochromocytoma (like 2A) but is distinguished by **Mucosal neuromas**, **Marfanoid habitus**, and the *absence* of parathyroid involvement. * **Prophylaxis:** Due to the high penetrance of MCT, prophylactic thyroidectomy is often recommended for RET mutation carriers.

Q: What is the treatment for myxedema coma?

All of the above. ### Explanation Myxedema coma is a life-threatening emergency characterized by severe hypothyroidism, altered mental status, and hypothermia. The management requires a multi-pronged approach to address hormonal deficiencies and prevent adrenal crisis. **Why "All of the above" is correct:** 1. **Levothyroxine (T4):** This is the mainstay of therapy. A loading dose (200–400 µg IV) is given to saturate thyroid-binding globulin, followed by daily maintenance doses. 2. **Liothyronine (T3):** Since the peripheral conversion of T4 to T3 is often impaired in critically ill patients, adding IV T3 (5–20 µg loading dose) provides a faster metabolic response and is often recommended alongside T4. 3. **Hydrocortisone:** **Crucially, corticosteroids must be administered BEFORE thyroid hormone replacement.** Severe hypothyroidism can mask co-existing adrenal insufficiency or pituitary failure. Starting thyroid hormones alone can precipitate an acute adrenal crisis by increasing the metabolic clearance of cortisol. **Analysis of Options:** * **A, B, and C** are all essential components of the treatment protocol. Selecting only one would result in incomplete management of the patient. **High-Yield Clinical Pearls for NEET-PG:** * **Sequence of Treatment:** Always give IV Hydrocortisone (100 mg every 8 hours) **first**, then IV Levothyroxine. * **Precipitating Factors:** Most common triggers include infections (pneumonia, UTI), cold exposure, MI, or sedative drugs. * **Cardinal Signs:** Hypothermia (often <35°C), bradycardia, hyponatremia (due to SIADH), and hypercapnia (respiratory failure). * **Supportive Care:** Passive rewarming (not active) is preferred to avoid peripheral vasodilation and worsening hypotension.

Q: According to ADA guidelines, the diagnosis of diabetes is made when the fasting blood glucose is more than?

126 mg/dl. The diagnosis of Diabetes Mellitus (DM) is based on specific glycemic thresholds established by the American Diabetes Association (ADA) to identify patients at high risk for microvascular complications, particularly retinopathy [1]. **Explanation of the Correct Answer:** * **A. 126 mg/dl:** According to ADA guidelines, a **Fasting Plasma Glucose (FPG) ≥ 126 mg/dL** (7.0 mmol/L) is diagnostic of diabetes [1]. "Fasting" is defined as no caloric intake for at least 8 hours. In the absence of unequivocal hyperglycemia, the diagnosis must be confirmed by a repeat test on a subsequent day. **Explanation of Incorrect Options:** * **B. 100 mg/dl:** This is the upper limit of normal. An FPG between **100–125 mg/dL** is categorized as **Impaired Fasting Glucose (IFG)**, which is a state of "Prediabetes" [1]. * **C. 140 mg/dl:** This value is significant in the 2-hour Oral Glucose Tolerance Test (OGTT). A 2-hour post-load glucose **< 140 mg/dL** is normal, while **140–199 mg/dL** indicates Impaired Glucose Tolerance (IGT). * **D. 200 mg/dl:** This is the diagnostic threshold for diabetes when using a **Random Plasma Glucose** (in a symptomatic patient) or a **2-hour OGTT** value. **High-Yield Clinical Pearls for NEET-PG:** * **HbA1c Criteria:** An HbA1c **≥ 6.5%** is also diagnostic of diabetes. * **Prediabetes Range:** HbA1c of **5.7% to 6.4%** or FPG of **100–125 mg/dL** [1]. * **Gold Standard:** While FPG is commonly used in practice, the **75g OGTT** is considered the most sensitive diagnostic test. * **Screening:** In asymptomatic adults, screening should begin at age 35 (revised from 45) or earlier if the BMI is ≥ 25 kg/m² with additional risk factors.

Question 1

Which of the following medications should not be given to a diabetic patient?

Accepted Answer

Propranolol

Answer

Theophylline

Answer

Digoxin

Answer

Glyburide

Question 2

Palpation of the costovertebral angle produces pain and tenderness in acute adrenal insufficiency. This is termed as:

Accepted Answer

Rogoff's sign

Answer

Osler's sign

Answer

Rotch's sign

Answer

Rossolimo's sign

Question 3

Which of the following statements is true regarding thyrotoxicosis?

Accepted Answer

In Graves' disease, antibodies are formed against TSH receptors, leading to excessive thyroxine secretion.

Answer

Hashimoto's thyroiditis typically occurs in young males.

Answer

In primary hypothyroidism, decreased TSH levels are observed.

Answer

In Graves' disease, no antibodies are formed against TSH receptors, resulting in decreased thyroxine secretion.

Question 4

Addison disease is commonly associated with which of the following?

Accepted Answer

Autoimmune adrenalitis

Answer

Adrenocortical carcinoma

Answer

Hypernephroma

Answer

Medullary carcinoma of the thyroid

Question 5

A 38-year-old woman presents with new symptoms of palpitations, weight loss, and heat intolerance. On physical examination, she has a mild tremor of her outstretched hands, an enlarged thyroid, and resting tachycardia (heart rate 110/min). Biochemical tests confirm the diagnosis and she is started on methimazole. Which of the following is the most likely mechanism of this drug?

Accepted Answer

Inhibition of thyroidal organic binding and coupling reactions

Answer

Inhibition of iodine uptake

Answer

Lowering serum calcium

Answer

Adrenal suppression

Question 6

Which of the following is NOT typically seen in diabetic ketoacidosis?

Accepted Answer

Normal serum potassium

Answer

Plasma osmolality of 320 mosm/kg

Answer

Urine Rothera test positive

Answer

Urine Benedict's test positive

Question 7

A 55-year-old man has had a foot ulcer for 2 months that has not healed. Physical examination shows a 2-cm shallow, nonhealing ulceration of the left medial malleolus. There is symmetric decreased sensation in the distal regions of the lower extremities. He has a history of multiple urinary tract infections resulting from difficulty in completely emptying the bladder. He is impotent. Which of the following pathologic findings is most likely to be present in the peripheral nerves?

Accepted Answer

Segmental demyelination

Answer

Acute inflammation

Answer

Axonal neuropathy

Answer

Onion bulb formation

Question 8

All of the following are associated with Multiple Endocrine Neoplasia type 2 (MEN-2) except:

Accepted Answer

Islet cell hyperplasia

Answer

Pheochromocytoma

Answer

Medullary carcinoma of the thyroid

Answer

Parathyroid adenoma

Question 9

What is the treatment for myxedema coma?

Accepted Answer

All of the above

Answer

Hydrocortisone

Answer

Liothyronine

Answer

Levothyroxine

Question 10

According to ADA guidelines, the diagnosis of diabetes is made when the fasting blood glucose is more than?

Accepted Answer

126 mg/dl

Answer

100 mg/dl

Answer

140 mg/dl

Answer

200 mg/dl

Endocrinology — MCQs

Endocrinology — MCQs

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