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Question 1
Correct
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Where is Glucagon produced?
Your Answer: Islet alpha cells
Explanation:The alpha cells in the islets of Langerhans are responsible for the production and secretion of glucagon. The B cells secrete insulin, the D cells secrete somatostatin, and the F cells secrete pancreatic polypeptide. The B cells, which are the most common and account for 60–75% of the cells in the islets, are generally located in the centre of each islet.
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This question is part of the following fields:
- Endocrinology
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Question 2
Incorrect
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Adult Polycystic Kidney Disease (PKD) typically follows which pattern of inheritance
Your Answer: X linked recessive
Correct Answer: Autosomal Dominant
Explanation:PKD can follow either Autosomal dominant or recessive inheritance. Autosomal dominant is however the most common inheritance pattern and is seen in adult PKD. Infantile PKD is recessive
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This question is part of the following fields:
- Endocrinology
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Question 3
Incorrect
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Question 4
Incorrect
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Which of the following inhibit Glucagon?
Your Answer: Cholecystokinin
Correct Answer: Uraemia
Explanation:Glucagon release is inhibited by increased blood glucose, ketones, free fatty
acids, insulin, raised urea levels and somatostatin. Glucagon is produced by alpha cells of the pancreas and increases the plasma glucose level by stimulating glycogenolysis and gluconeogenesis. -
This question is part of the following fields:
- Endocrinology
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Question 5
Incorrect
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Which of the following is the primary stimulator of uterine involution following child birth?
Your Answer: Prolactin
Correct Answer: Oxytocin
Explanation:Oxytocin stimulates the myoepithelial cells in the breast causing the milk production. It also helps augment contractions in labour and cause uterine involution after childbirth.
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This question is part of the following fields:
- Endocrinology
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Question 6
Correct
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Hirsutism can be found in all of the following conditions, EXCEPT:
Your Answer: Patient on oral contraceptive pills
Explanation:Classically, hirsutism has been considered a marker of increased androgen levels in females from increased production of androgens (i.e. testosterone) either by the adrenals or due to an ovarian disease. The ovarian causes for hyperandrogenism are polycystic ovarian syndrome (PCOS) and ovarian tumours. Adrenal causes include Cushing’s syndrome, androgen-producing tumours, and congenital adrenal hyperplasia (CAH), most commonly due to 21-hydroxylase deficiency. Less common causes include the hyperandrogenic-insulin resistant-acanthosis nigricans syndrome (HAIRAN). Hyperprolactinemia by increasing adrenal dehydroepiandrosterone sulphate (DHEA-S) production may cause hirsutism. Androgenic drugs are also an important cause of hirsutism. About 20% of the patients may present with idiopathic hirsutism (IH) with normal androgen levels and ovarian function. The cause of increased hair in these women is thought to be related to disorders in peripheral androgen activity. Onset of IH occurs shortly after puberty with slow progression. PCOS and IH account for 90% of the hirsutism in women. Hirsutism can also occur in some premenopausal women and continue for a few years after menopause. This is due to decrease in ovarian oestrogen secretion with continuous androgen production.
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This question is part of the following fields:
- Endocrinology
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Question 7
Incorrect
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All of the following organs are involved in oestrogen production except:
Your Answer: Corpus luteum
Correct Answer: Anterior pituitary
Explanation:Oestrogen can be produced by variety of organs including the corpus leuteum, placenta, adrenal glands and testes. However it is not produced by the anterior pituitary. The anterior pituitary produces LH and FSH which in turn causes oestrogen secretion.
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This question is part of the following fields:
- Endocrinology
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Question 8
Correct
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The ovaries produce androgen and progesterone. What is the common precursor for both of these hormones?
Your Answer: Cholesterol
Explanation:Both the female hormones, namely progesterone and oestrogen as well as the male hormones or androgens are lipid soluble. The common precursor of these is cholesterol.
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This question is part of the following fields:
- Endocrinology
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Question 9
Incorrect
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer: Mestranol
Correct Answer: Estriol
Explanation:The 3 main oestrogens are Estrone (E1) Oestradiol (E2) and Estriol (E3). Oestradiol is the predominant oestrogen during female reproductive years except during the early follicular phase when Estrone predominates. During pregnancy Estriol levels rise significantly and this becomes the dominant oestrogen during pregnancy. Ethinylestradiol and Mestranol are oestrogen found in COCP’s
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This question is part of the following fields:
- Endocrinology
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Question 10
Correct
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Which of the following causes an increase in Sex Hormone Binding Globulin (SHBG)?
Your Answer: Liver cirrhosis
Explanation:Liver cirrhosis is known to lead to decreased levels of SHBG. Other causes of high SHBG are:
Oestrogens e.g. oral contraceptives
Pregnancy
Hyperthyroidism
Liver cirrhosis
Anorexia nervosa
Drugs e.g. anticonvulsants -
This question is part of the following fields:
- Endocrinology
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Question 11
Correct
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At ovulation the surge in LH causes rupture of the mature oocyte via action on what?
Your Answer: Theca externa
Explanation:The luteinizing hormone (LH) surge during ovulation causes: Increases cAMP resulting in increased progesterone and PGF2 production PGF2 causes contraction of theca externa smooth muscle cells resulting in rupture of the mature oocyte
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This question is part of the following fields:
- Endocrinology
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Question 12
Correct
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Oxytocin causes increased myometrial contractions via which of the following messenger pathways?
Your Answer: Activates phospholipase-C which produces IP3 which triggers intracellular Calcium ion release
Explanation:Oxytocin activates phospholipase C to produce inositol 1,4,5-trisphosphate (IP3), which releases Ca2+ from intracellular stores. There are thought to be other mechanisms by which myometrium is stimulated by Oxytocin including increased sensitisation of the myometrium and increased calcium entry into cells. cAMP and Protein Kinase A inhibit myometrial contractility.
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This question is part of the following fields:
- Endocrinology
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Question 13
Incorrect
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Where is fetal DHEA produced?
Your Answer: Anterior pituitary
Correct Answer: Adrenals
Explanation:DHEA is formed in the mother’s adrenal gland as well as the fetal adrenal glands. These weak androgens are transported by the blood to the placenta and are converted into oestradiol, estrone and estriol in the trophoblast.
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This question is part of the following fields:
- Endocrinology
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Question 14
Incorrect
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Where are ADH (vasopressin) and Oxytocin synthesised?
Your Answer: Posterior Pituitary
Correct Answer: Hypothalamus
Explanation:ADH and vasopressin are synthesized in the supraoptic and periventricular nuclei of the hypothalamus, they are eventually transported to the posterior pituitary where they are stored to be released later.
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This question is part of the following fields:
- Endocrinology
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Question 15
Correct
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Question 16
Incorrect
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Which of the following drugs is most appropriate to use to stimulate lactation?
Your Answer: Metoclopramide
Correct Answer: Domperidone
Explanation:Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.
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This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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In normal pregnancy, levels of all of the following hormones increases, EXCEPT:
Your Answer: Total thyroxine (T4)
Correct Answer: FSH
Explanation:Hormones that increase during pregnancy and their roles:
- Human Chorionic Gonadotropin (hCG): Peaks between the eighth to tenth weeks of gestation and supports the corpus luteum to maintain progesterone production.
- Progesterone: Initially produced by the corpus luteum and later by the placenta, it rises steadily throughout pregnancy, suppressing the maternal immune response to fetal antigens and preparing the endometrium for implantation.
- Estrogen: Produced by the placenta from fetal and maternal precursors, estrogen levels increase to promote uterine growth and blood flow.
- Human Placental Lactogen (hPL): Rises significantly during pregnancy, influencing maternal metabolism by increasing insulin resistance and promoting lipolysis.
- Relaxin: Increases early in pregnancy to relax the uterine muscles, inhibit contractions, and prepare the cervix and pelvis for childbirth.
- Prolactin: Levels increase to prepare the breasts for lactation.
- Corticotropin-Releasing Hormone (CRH): Increases towards the end of pregnancy and is involved in the timing of labor.
- Adrenocorticotropic Hormone (ACTH): Levels increase, contributing to elevated cortisol levels during pregnancy.
- Total Thyroxine (T4): Levels increase due to elevated thyroid-binding globulin (TBG) production stimulated by increased estrogen levels, meeting the increased metabolic demands of pregnancy.
- Parathyroid Hormone (PTH): Levels increase to regulate calcium metabolism, ensuring adequate calcium for fetal bone development.
- Cortisol: Levels increase due to higher production by the adrenal glands and increased binding to cortisol-binding globulin (CBG), supporting glucose metabolism, managing stress, and aiding fetal development, particularly lung maturation.
During pregnancy, some hormones either remain stable or do not increase significantly. These include:
- Follicle-Stimulating Hormone (FSH): Levels decrease due to the negative feedback from high levels of estrogen and progesterone.
- Luteinizing Hormone (LH): Levels also decrease due to negative feedback from elevated estrogen and progesterone.
- Growth Hormone (GH): Although a variant of growth hormone (hGH-V) is produced by the placenta and increases, the maternal pituitary GH levels may not significantly increase.
- Melatonin: Generally remains stable during pregnancy, though some studies suggest there may be slight fluctuations.
- Insulin: While insulin resistance increases due to hPL and other factors, the actual levels of insulin may not increase proportionally; instead, pancreatic beta-cell function adapts to meet the increased demand.
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This question is part of the following fields:
- Endocrinology
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Question 18
Correct
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Which of the following drugs is associated with reduced milk production whilst breastfeeding?
Your Answer: Cabergoline
Explanation:Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.
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This question is part of the following fields:
- Endocrinology
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Question 19
Correct
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Maternal blood flow through the uterine artery at term is approximately
Your Answer: 750ml/min
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term, with 80 per cent of the blood distributed to the intervillous spaces of the placentae, and 20 per cent to the uterine myometrium.
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This question is part of the following fields:
- Endocrinology
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Question 20
Incorrect
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Which of the following statements regarding prolactin is true?
Your Answer: Prolactin levels decrease during surgery
Correct Answer: Prolactin levels increase during stress
Explanation:Causes of Hyperprolactinemia: Prolactinomas, Medication (phenothiazines, metoclopramide, risperidone, selective serotonin reuptake inhibitors, oestrogens, verapamil), Stress, Pregnancy, Hypothyroidism, Kidney disease, Chest trauma
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This question is part of the following fields:
- Endocrinology
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Question 21
Incorrect
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Aromatase is key to Oestradiol production in the ovaries. Which of the following statements is true?
Your Answer: Progesterone induces the granulosa cells to make aromatase
Correct Answer: FSH induces the granulosa cells to make aromatase
Explanation:The two main cell types of the ovaries:
1. The theca cells produce androgen in the form of androstenedione. The theca cells are not able to convert androgen to oestradiol themselves. The produced androgen is therefore taken up by granulosa cells.
2. The neighbouring granulosa cells then convert the androgen into oestradiol under the enzymatic action of aromatase FSH induces the granulosa cells to produce aromatase for this purpose -
This question is part of the following fields:
- Endocrinology
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Question 22
Correct
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer: Estriol
Explanation:Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.
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This question is part of the following fields:
- Endocrinology
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Question 23
Correct
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Where is fetal DHEA produced?
Your Answer: Adrenals
Explanation:Dehydroepiandrosterone (DHEA) is a steroid hormone synthesised from cholesterol (via Pregnenolone) by the adrenal glands. The foetus manufactures DHEA, which stimulates the placenta to form oestrogen, thus keeping a pregnancy going. Production of DHEA stops at birth, then begins again around age seven and peaks when a person is in their mid-20s
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This question is part of the following fields:
- Endocrinology
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Question 24
Correct
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Prognathism and macroglossia are features of which of the following?
Your Answer: Acromegaly
Explanation:These are features of excess growth hormone i.e. Acromegaly. Down’s and Cri du chat typically cause Micrognathia (small jaw)
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This question is part of the following fields:
- Endocrinology
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Question 25
Incorrect
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What is the definition of premature menopause?
Your Answer: Menopause at or before 35 years of age
Correct Answer: Menopause at or before 40 years of age
Explanation:Menopause is defined as the cessation of menstruation for a period of 12 months. Premature menopause is defined as cessation of menstruation before the age of 40.
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This question is part of the following fields:
- Endocrinology
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Question 26
Incorrect
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Which of the following is the primary source of oestrogen ?
Your Answer: Theca externa cells
Correct Answer: Granulosa cells
Explanation:Ovarian granulosa cells (GC) are the major source of oestradiol synthesis. Induced by the preovulatory luteinizing hormone (LH) surge, cells of the theca and, in particular, of the granulosa cell layer profoundly change their morphological, physiological, and molecular characteristics and form the progesterone-producing corpus luteum that is responsible for maintaining pregnancy.
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This question is part of the following fields:
- Endocrinology
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Question 27
Incorrect
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Delayed puberty in girls is defined as?
Your Answer: Absence of breast development in girls beyond 15 years old
Correct Answer: Absence of breast development in girls beyond 13 years old
Explanation:Breast development occurs from the age of 9-13 at the onset of puberty. Delayed puberty is defined as the absence of breast development after the age of 13.
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This question is part of the following fields:
- Endocrinology
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Question 28
Incorrect
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What percentage of children does delayed puberty occur in?
Your Answer: 10%
Correct Answer: 3%
Explanation:Delayed puberty is defined as the absence of breast development in girls beyond the age of 13, and the absence of testicular development in boys beyond the age of 14. The incidence of delayed puberty is 3%, with the condition being more common in boys.
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This question is part of the following fields:
- Endocrinology
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Question 29
Correct
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In relation to ovulation, when does the LH surge occur?
Your Answer: 24-36 hours before ovulation
Explanation:Ovulation usually occurs on day 14 in a typical 28-day cycle. Luteinizing hormone levels spike as a result of increased oestrogen levels secreted from maturing follicles. This LH spike occurs about 24-36 hours before the release of the oocyte from the mature follicle.
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This question is part of the following fields:
- Endocrinology
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Question 30
Correct
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You review a 58 year old patient in clinic. She asks what the results of her recent DEXA scan are. You note her hip BMD hip T-score is -1.4. You note she has a history of olecranon fracture 4 years ago. What is her classification according to WHO criteria?
Your Answer: Osteopenia
Explanation:Her T-score puts her in the osteopenic range. The presence of fragility fractures is more important in the osteoporotic patient. Olecranon fracture is not a typical fragility fracture.
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This question is part of the following fields:
- Endocrinology
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SESSION STATS - PERFORMANCE PER SPECIALTY
