Endocrinology Practice Questions

Q: Prevention or treatment of osteoporosis in post- menopausal women may be achieved by all EXCEPT

Multivitamins. ***Multivitamins*** - While multivitamins may contain some **calcium** and **vitamin D**, the dosages are generally insufficient to effectively prevent or treat osteoporosis, which requires targeted, higher doses of these specific nutrients. - Multivitamins provide a broad range of vitamins and minerals, many of which are not directly involved in **bone metabolism** or have a significant impact on **bone mineral density**. *Calcium and vitamin D supplementation* - **Calcium** is a fundamental component of bone, and adequate intake is crucial for maintaining **bone mineral density** and strength, especially in postmenopausal women who are at higher risk of osteoporosis [1, 4]. - **Vitamin D** is essential for the absorption of calcium in the gut and plays a key role in regulating **calcium and phosphate homeostasis**, directly impacting bone health [3]. *Bisphosphonates* - **Bisphosphonates** are potent **antiresorptive agents** that inhibit **osteoclast activity**, thereby reducing bone turnover and preventing bone loss, making them a cornerstone of osteoporosis treatment. - They effectively increase **bone mineral density** and significantly reduce the risk of **vertebral and non-vertebral fractures** in postmenopausal women. *Estrogen and progesterone hormone replacement therapy* - **Estrogen deficiency** after menopause is a primary cause of accelerated bone loss; **estrogen replacement therapy** helps to maintain bone density by reducing **bone resorption** [2]. - While effective, HRT is typically reserved for women with significant menopausal symptoms or those who cannot tolerate other osteoporosis treatments, due to potential risks like increased risk of **breast cancer** and **cardiovascular events** [2].

Q: A 40 year old lady with temporal field defects and galactorrhoea is most likely to have-

Pituitary macroadenoma. ***Pituitary macroadenoma*** - **Temporal field defects** (bitemporal hemianopsia) are a classic symptom of a pituitary macroadenoma due to compression of the **optic chiasm** by the expanding tumor [1]. - **Galactorrhoea** is often caused by hyperprolactinemia, which is frequently associated with **prolactinomas**, a type of pituitary adenoma [1]. *Lactational failure* - Lactational failure would present with the **absence** of milk production or poor milk supply, not galactorrhoea (milk production outside of breastfeeding). - This condition does not cause **temporal field defects**, which are indicative of a mass effect on vision. *Pregnancy* - While pregnancy can cause galactorrhoea due to hormonal changes, it does not typically lead to **temporal field defects**. - **Visual field defects** in pregnancy would suggest a more serious underlying neurological issue, not a normal physiological response to pregnancy. *Craniopharyngioma* - Craniopharyngiomas are typically **suprasellar tumors** that can cause visual field defects due to optic chiasm compression, similar to pituitary adenomas. - However, craniopharyngiomas are not typically associated with **galactorrhoea**; they are more often linked to hypothalamic-pituitary dysfunction leading to hormone deficiencies, not hyperprolactinemia [1].

Q: True about osteoporosis

All of the options. ***All of the options*** - In **primary osteoporosis**, serum levels of calcium, phosphate, and alkaline phosphatase are typically **normal**, distinguishing it from other metabolic bone diseases [1]. - The diagnosis of osteoporosis is based on **bone mineral density (BMD)** measurements, not on abnormalities in these serum markers [3]. *Normal serum phosphate levels* - While correct that serum phosphate is usually normal in osteoporosis, this option alone does not encompass the full biochemical picture [1]. - Osteoporosis is primarily a disorder of **bone quantity**, not systemic mineral metabolism, so levels of **calcium and phosphate remain homeostatically regulated** [1]. *Normal serum alkaline phosphatase level* - Similarly, a normal alkaline phosphatase level reflects the absence of significantly increased **osteoblast activity** or **bone turnover** that would be seen in conditions like osteomalacia or Paget's disease [2]. - This observation is a key biochemical finding, but it is not the only normal lab value. *Normal serum calcium levels* - Normal serum calcium is characteristic of osteoporosis, as **parathyroid hormone** and **vitamin D** regulation of calcium remains intact [4]. - Hypercalcemia or hypocalcemia would suggest alternative diagnoses or complications, such as **primary hyperparathyroidism** or **vitamin D deficiency** [4].

Q: A 40-year-old female presents with multiple lytic bone lesions, fracture clavicle and periosteal resorption of 2nd and 3rd metatarsals. What is the most likely diagnosis?

Hyperparathyroidism. ***Hyperparathyroidism*** - **Multiple lytic bone lesions**, **fracture clavicle**, and **periosteal resorption** (especially in the phalanges and metatarsals) are classic radiological findings of **osteitis fibrosa cystica**, which is characteristic of severe hyperparathyroidism. - The combination of these bone changes strongly indicates excessive **parathyroid hormone** leading to increased **osteoclastic activity** and bone demineralization. *Osteomalacia* - Characterized by **softening of the bones** due to defective mineralization, typically manifesting as generalized bone pain, muscle weakness, and sometimes **pseudofractures**. - Does not typically present with **lytic lesions** or **periosteal resorption** as the primary radiographic features. *Renal osteodystrophy* - A spectrum of bone disorders in patients with **chronic kidney disease**, often involving features of both **osteomalacia** and **hyperparathyroidism**, including **osteitis fibrosa cystica**. - While it can present with similar bone changes, the scenario does not explicitly mention **renal failure** as an underlying condition, making primary hyperparathyroidism a more direct diagnosis for these specific findings. *Hyperthyroidism* - Can lead to increased **bone turnover** and a generalized reduction in **bone mineral density**, increasing the risk of **osteoporosis** and fractures. - However, it does not typically cause localized **lytic bone lesions** or specific **periosteal resorption**.

Q: Cerebral salt wasting occurs due to which of the following?

Hyper secretion of ANP. Cerebral salt wasting (CSW) is characterized by hyponatremia and volume depletion due to excessive renal sodium excretion. While the exact mechanism is complex, elevated levels of atrial natriuretic peptide (ANP) are thought to play a significant role in promoting natriuresis [1]. ANP and related molecules increase intracellular cGMP, which inhibits sodium transport via ENaC and inhibits sodium reabsorption in the renal tubules [1], [2]. Syndrome of inappropriate antidiuretic hormone (SIADH) also causes hyponatremia, but it leads to euvolemia or mild hypervolemia, not volume depletion [3]. Low cortisol secretion, as seen in adrenal insufficiency, can lead to hyponatremia due to both decreased free water clearance and increased ADH secretion, but it is not the primary mechanism of CSW. Low aldosterone secretion, also seen in adrenal insufficiency, can cause hyponatremia and hyperkalemia due to impaired renal sodium reabsorption and potassium excretion [3].

Q: Primary Hyperparathyroidism is associated with -

Increased serum PTH and Hypercalcemia. ***Increased serum PTH and Hypercalcemia*** - **Primary hyperparathyroidism** results from an autonomous overproduction of **parathyroid hormone (PTH)**, usually by an adenoma or hyperplasia [1]. - This excess PTH leads to increased calcium reabsorption from bones and kidneys, causing **hypercalcemia** [2][4]. *Decreased serum PTH and Hyporcalcemia* - This combination is characteristic of **hypoparathyroidism**, where insufficient PTH production leads to low calcium levels [3]. - Primary hyperparathyroidism, by definition, involves *increased* PTH [4]. *Decreased serum PTH and Hypercalcemia* - This might be seen in cases of **non-PTH-mediated hypercalcemia**, such as malignancy, where high calcium levels suppress normal PTH secretion [4]. - However, in primary hyperparathyroidism, PTH would be **elevated** [1]. *Increased serum PTH and Hyporcalcemia* - This scenario typically points to **secondary hyperparathyroidism**, where the parathyroid glands are overactive in response to chronic low calcium levels (e.g., due to **chronic kidney disease** or **Vitamin D deficiency**) [1][3]. - In primary hyperparathyroidism, the elevated PTH directly *causes* hypercalcemia [4].

Q: A 17 years old girl who was evaluated for short height was found to have an enlarged pituitary gland. Her T4 was low and TSH was increased. Which of the following is the most likely diagnosis?

Primary hypothyroidism. ***Primary hypothyroidism*** - **Primary hypothyroidism** leads to decreased production of thyroid hormones (low T4), which in turn causes the pituitary to produce more TSH (increased TSH) in an attempt to stimulate the thyroid [1], [3]. - The elevated TSH can lead to **pituitary hypertrophy** (enlarged pituitary gland) due to chronic stimulation, as observed in this patient. *Thyroid target receptor insensitivity* - This condition involves resistance to thyroid hormones at the tissue level, leading to elevated T4 or normal T4 and elevated TSH. However, in this case, T4 is low, which contradicts this diagnosis. - While TSH can be elevated, the primary issue is cellular resistance, not a lack of thyroid hormone synthesis. *TSH-secreting pituitary tumour* - A TSH-secreting pituitary tumor would result in **elevated TSH** and **elevated T4** (secondary hyperthyroidism), as the tumor is autonomously producing TSH. - This patient presents with **low T4**, which rules out a TSH-secreting tumor causing hyperthyroidism [2]. *Pituitary adenoma* - While a pituitary adenoma is present, the low T4 and high TSH indicate that the adenoma is a **secondary effect** of chronic TSH stimulation (due to primary hypothyroidism) leading to pituitary enlargement, rather than a primary secreting adenoma causing the thyroid dysfunction. - Non-functional pituitary adenomas can cause mass effects, but this specific hormonal profile points to the pituitary enlargement being a compensatory response.

Q: A patient of 47XXY karyotype with features of hypogonadism; likely diagnosis is :

Klinefelter's syndrome. ***Klinefelter's syndrome*** - **Klinefelter's syndrome** is characterized by a **47,XXY karyotype**, which is a genetic condition affecting males [1]. - Individuals with this syndrome often present with **hypogonadism**, leading to features such as small testes, infertility, and reduced secondary sexual characteristics [2]. *Turners syndrome* - **Turner's syndrome** is a genetic condition affecting females, characterized by a **45,X karyotype**, meaning they are missing all or part of one X chromosome [2]. - While it also involves hypogonadism, it does not present with an **XXY karyotype** or affect males [3]. *Down syndrome* - **Down syndrome**, or trisomy 21, is caused by an extra copy of chromosome 21, resulting in a **47,XX,+21 or 47,XY,+21 karyotype**. - It is characterized by intellectual disability, distinctive facial features, and developmental delays, not typically hypogonadism associated with an XXY karyotype. *Edwards syndrome* - **Edwards syndrome**, or trisomy 18, is caused by an extra copy of chromosome 18, resulting in a **47,XX,+18 or 47,XY,+18 karyotype**. - This syndrome is associated with severe developmental abnormalities, intellectual disability, and a very short lifespan, with different clinical features from the given description.

Q: A 24 year old male presents with altered sensorium and rapid shallow breathing. ABG shows:pH 7.2, sodium 140, bicarbonate 10 and chloride 98. Probable diagnosis is -

DKA. ***DKA*** - The patient presents with **altered sensorium** and **rapid shallow breathing** (Kussmaul breathing), consistent with severe metabolic acidosis [1]. - The ABG results show **pH 7.2** (acidosis), **bicarbonate 10** (metabolic component), and an **elevated anion gap** (Na - (Cl + HCO3) = 140 - (98 + 10) = 32), which are characteristic findings in **diabetic ketoacidosis (DKA)** [1], [2]. *Amphetamine toxicity* - Amphetamine toxicity typically causes **sympathomimetic effects** such as tachycardia, hypertension, hyperthermia, and agitation, rather than directly leading to a high anion gap metabolic acidosis of this severity. - While it can cause some metabolic derangements, the primary acid-base disturbance is usually different or less pronounced in this manner compared to DKA. *Renal tubular acidosis* - Renal tubular acidosis (RTA) typically presents with a **normal anion gap metabolic acidosis** (hyperchloremic metabolic acidosis), where the anion gap would not be significantly elevated. - The calculated anion gap of 32 in this patient rules out RTA as the primary cause of this severe acidosis. *Ethylene glycol poisoning* - Ethylene glycol poisoning also causes a **high anion gap metabolic acidosis** and altered mental status. - However, it is typically associated with additional specific symptoms like **flank pain**, **oliguria**, and detection of **calcium oxalate crystals** in the urine, which are not mentioned in this case.

Question 1

Prevention or treatment of osteoporosis in post- menopausal women may be achieved by all EXCEPT

Accepted Answer

Multivitamins

Answer

Calcium and vitamin D supplementation

Answer

Bisphosphonates

Answer

Estrogen and progesterone hormone replacement therapy

Question 2

A 40 year old lady with temporal field defects and galactorrhoea is most likely to have-

Accepted Answer

Pituitary macroadenoma

Answer

Lactational failure

Answer

Pregnancy

Answer

Craniopharyngioma

Question 3

A 30-year-old woman is presented to ER with complaints of progressive lethargy, constipation, muscle weakness, and increased thirst and urination. On fuher asking, the patient admits taking large doses of vitamin and mineral supplements on a daily basis. The most likely metabolic abnormality causing patient's symptoms are also seen in which of the following clinical conditions?

Accepted Answer

HRCT scan of chest: patchy reticular nodularity, with areas of confluence - likely sarcoidosis Chronic inflammatory lesions around nose, eyes, and cheeks suggestive of lupus pernio.

Answer

Serum IHC reveals an IgGk monoclonal protein; and macroglossia of a pt. suggestive of amyloidosis

Answer

Biliary obstruction. (dilated biliary system)

Answer

None of the options

Question 4

True about osteoporosis

Accepted Answer

All of the options

Answer

Normal serum phosphate levels

Answer

Normal serum alkaline phosphatase level

Answer

Normal serum calcium levels

Question 5

A 40-year-old female presents with multiple lytic bone lesions, fracture clavicle and periosteal resorption of 2nd and 3rd metatarsals. What is the most likely diagnosis?

Accepted Answer

Hyperparathyroidism

Answer

Osteomalacia

Answer

Renal osteodystrophy

Answer

Hyperthyroidism

Question 6

Cerebral salt wasting occurs due to which of the following?

Accepted Answer

Hyper secretion of ANP

Answer

SIADH

Answer

Low cortisol secretion

Answer

Low aldosterone secretion

Question 7

Primary Hyperparathyroidism is associated with -

Accepted Answer

Increased serum PTH and Hypercalcemia

Answer

Decreased serum PTH and Hyporcalcemia

Answer

Decreased serum PTH and Hypercalcemia

Answer

Increased serum PTH and Hyporcalcemia

Question 8

A 17 years old girl who was evaluated for short height was found to have an enlarged pituitary gland. Her T4 was low and TSH was increased. Which of the following is the most likely diagnosis?

Accepted Answer

Primary hypothyroidism

Answer

Thyroid target receptor insensitivity

Answer

TSH-secreting pituitary tumour

Answer

Pituitary adenoma

Question 9

A patient of 47XXY karyotype with features of hypogonadism; likely diagnosis is :

Accepted Answer

Klinefelter's syndrome

Answer

Turners syndrome

Answer

Down syndrome

Answer

Edwards syndrome

Question 10

A 24 year old male presents with altered sensorium and rapid shallow breathing. ABG shows:pH 7.2, sodium 140, bicarbonate 10 and chloride 98. Probable diagnosis is -

Accepted Answer

DKA

Answer

Amphetamine toxicity

Answer

Renal tubular acidosis

Answer

Ethylene glycol poisoning

Endocrinology — MCQs

Endocrinology — MCQs

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