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  • Question 1 - A 59-year-old woman presents with a history of tiredness and weight gain and...

    Correct

    • A 59-year-old woman presents with a history of tiredness and weight gain and a diagnosis of hypothyroidism is suspected.

      Which of these changes is likely to appear first in primary hypothyroidism?

      Your Answer: Increased thyroid-stimulating hormone (TSH)

      Explanation:

      The earliest biochemical change seen in hypothyroidism is an increase in thyroid-stimulating hormone (TSH) levels.

      Triiodothyronine (T3) and thyroxine (T4) levels are normal in the early stages.

      TBG levels are generally unchanged in primary hypothyroidism.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      30.4
      Seconds

  • Question 2 - A 30-year-old woman with type 1 diabetes mellitus is brought in drowsy and...

    Correct

    • A 30-year-old woman with type 1 diabetes mellitus is brought in drowsy and confused. Her BM is 2.2 mmol/l and a dose of IM glucagon is administered.

      What is the principal stimulus for the secretion of glucagon?

      Your Answer: Hypoglycaemia

      Explanation:

      Glucagon, a peptide hormone, is produced and secreted by alpha cells of the islets of Langerhans, located in the endocrine portion of the pancreas.

      Its main physiological role is stimulation of hepatic glucose output leading to increase in blood glucose. It is the major counter-regulatory hormone to insulin in maintaining glucose homeostasis.

      The principal stimulus for the secretion of glucagon is hypoglycaemia. Hypoglycaemia then stimulates:
      Glycogenolysis
      Gluconeogenesis
      Lipolysis in adipose tissue leading to increased glycaemia.

      Secretion of glucagon is also stimulated by arginine, alanine, adrenaline, acetylcholine and cholecystokinin

      Secretion of glucagon is inhibited by:
      Insulin
      Somatostatin
      Increased free fatty acids
      Increased urea production

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      42.2
      Seconds

  • Question 3 - A 50-year-old man presents with headaches, lethargy, hypertension, and electrolyte disturbance. A...

    Correct

    • A 50-year-old man presents with headaches, lethargy, hypertension, and electrolyte disturbance. A diagnosis of primary hyperaldosteronism is made.

      Which biochemical pictures would best support this diagnosis?

      Your Answer: Hypokalaemic metabolic alkalosis

      Explanation:

      When there are excessive levels of aldosterone outside of the renin-angiotensin axis, primary hyperaldosteronism occurs. High renin levels will lead to secondary hyperaldosteronism.

      The classical presentation of hyperaldosteronism when symptoms are present include:
      Hypokalaemia
      Metabolic alkalosis
      Hypertension
      Normal or slightly raised sodium levels

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      69.1
      Seconds

  • Question 4 - You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy...

    Correct

    • You examine a 48-year-old patient who has had proximal weakness, hypertension, and easy bruising in the past. She exhibits considerable face fullness and truncal obesity on examination. You diagnose her�with Cushing's syndrome.
      When would her random cortisol level likely be abnormal?

      Your Answer: 2400 hrs

      Explanation:

      Cortisol levels fluctuate throughout the day, with the greatest levels occurring around 0900 hours and the lowest occurring at 2400 hrs during sleep.

      The diurnal swing of cortisol levels is lost in Cushing’s syndrome, and levels are greater throughout the 24-hour period. In the morning, levels may be normal, but they may be high at night-time, when they are generally repressed.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      59.8
      Seconds

  • Question 5 - A 70-year-old patient is diagnosed with Cushing's disease. She has a history of...

    Incorrect

    • A 70-year-old patient is diagnosed with Cushing's disease. She has a history of weight gain, hypertension, and easy bruising.

      In this patient, which of the following is the MOST LIKELY UNDERLYING CAUSE?

      Your Answer: Iatrogenic administration of corticosteroids

      Correct Answer: Pituitary adenoma

      Explanation:

      Cushing’s syndrome is a collection of symptoms and signs caused by prolonged exposure to elevated levels of either endogenous or exogenous glucocorticoids.

      The most common cause of Cushing’s syndrome is the iatrogenic administration of corticosteroids. The second most common cause of Cushing’s syndrome is Cushing’s disease.

      Cushing’s disease should be distinguished from Cushing’s syndrome and refers to one specific cause of the syndrome, an adenoma of the pituitary gland that secretes large amounts of ACTH and, in turn, elevates cortisol levels. This patient has a diagnosis of Cushing’s disease, and this is, therefore, the underlying cause in this case.

      The endogenous causes of Cushing’s syndrome include:
      Pituitary adenoma (Cushing’s disease)
      Ectopic corticotropin syndrome, e.g. small cell carcinoma of the lung
      Adrenal hyperplasia
      Adrenal adenoma
      Adrenal carcinoma

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      11.5
      Seconds

  • Question 6 - A patient in a high-dependency unit complains of severe and painful muscle cramps....

    Incorrect

    • A patient in a high-dependency unit complains of severe and painful muscle cramps. His total corrected plasma calcium level is 1.90 mmol/L.

      What is the most likely underlying cause?

      Your Answer: Lithium

      Correct Answer: Rhabdomyolysis

      Explanation:

      Hypocalcaemia occurs when there is abnormally low level of serum calcium ( >2.2 mmol/l) after correction for the serum albumin concentration.

      Rhabdomyolysis causes hyperphosphatemia, and this leads to a reduction in ionised calcium levels.

      Patients with rhabdomyolysis are commonly cared for in a high dependency care setting.

      Addison’s disease, hyperthyroidism, thiazide diuretics and lithium all cause hypercalcaemia.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      42.8
      Seconds

  • Question 7 - A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement...

    Incorrect

    • A 17-year-old type I diabetic patient presents with abdominal pain and vomiting. Measurement of her blood glucose level is done and found to be grossly elevated. She is diagnosed with diabetic ketoacidosis. A fixed rate insulin infusion is given as part of her treatment.

      Which of these is an action of insulin?

      Your Answer: Increases gluconeogenesis

      Correct Answer: Stimulates lipogenesis

      Explanation:

      Insulin is an anabolic hormone. Its actions can be broadly divided into:
      Lipid metabolism
      Protein metabolism and
      Carbohydrate metabolism

      For lipid metabolism, insulin:
      Stimulates lipogenesis
      Inhibits lipolysis by lipase

      For carbohydrate metabolism, insulin:
      Decreases gluconeogenesis
      Stimulates glycolysis
      Promotes glucose uptake in muscle and adipose tissue
      Promotes glycogen storage
      Increases glycogenesis
      Decreases glycogenolysis

      Protein metabolism:
      Stimulates protein synthesis
      Accelerates net formation of protein
      Stimulates amino acid uptake
      Inhibits protein degradation
      Inhibits amino acid conversion to glucose

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      37.1
      Seconds

  • Question 8 - Vitamin D is a group of secosteroids that play a role in calcium...

    Correct

    • Vitamin D is a group of secosteroids that play a role in calcium and phosphate control. Vitamin D's hormonally active metabolite is 1,25-dihydroxycholecalciferol.

      Which of the following actions of 1,25-dihydroxycholecalciferol is a direct action?

      Your Answer: Increases renal phosphate reabsorption

      Explanation:

      The hormone-active metabolite of vitamin D is 1,25-dihydroxycholecalciferol (commonly known as calcitriol). Its activities raise calcium and phosphate levels in the bloodstream.

      The following are the primary effects of 1,25-dihydroxycholecalciferol:

      Calcium and phosphate absorption in the small intestine is increased.
      Calcium reabsorption in the kidneys is increased.
      Increases phosphate reabsorption in the kidneys.
      Increases the action of osteoclastic bacteria (increasing calcium and phosphate resorption from bone)
      Inhibits the action of 1-alpha-hydroxylase in the kidneys (negative feedback)
      Thyroid hormone (parathyroid hormone) Calcium reabsorption in the tubules of the kidneys is increased, but renal phosphate reabsorption is decreased.

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      134.7
      Seconds

  • Question 9 - A 50-year-old man, known hypertensive on amlodipine has been visiting his GP with...

    Incorrect

    • A 50-year-old man, known hypertensive on amlodipine has been visiting his GP with symptoms of headache, tiredness, and muscle weakness. His blood test today shows a low potassium level of 2.8 mmol/L, and a slightly raised sodium level at 147 mmol/L.

      What is the MOST LIKELY diagnosis?

      Your Answer: Addison’s disease

      Correct Answer: Conn’s syndrome

      Explanation:

      When there are excessive levels of aldosterone independent of the renin-angiotensin aldosterone axis, primary hyperaldosteronism occurs. Secondary hyperaldosteronism occurs due to high renin levels.

      Causes of primary hyperaldosteronism include:
      Conn’s syndrome
      Adrenal hyperplasia
      Adrenal cancer
      Familial aldosteronism

      Causes of secondary hyperaldosteronism include:
      Renal vasoconstriction
      Oedematous disorders
      Drugs – diuretics
      Obstructive renal artery disease

      Although patients are usually asymptomatic, when clinical features are present, classically hyperaldosteronism presents with:
      Hypokalaemia
      Sodium levels can be normal or slightly raised
      Hypertension
      Metabolic alkalosis
      Less common, clinical features are:
      Lethargy
      Headaches
      Intermittent paraesthesia
      Polyuria and polydipsia
      Muscle weakness (from persistent hypokalaemia)
      Tetany and paralysis (rare)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      15.2
      Seconds

  • Question 10 - A 39-year-old woman is feeling unwell one week after a parathyroid surgery.

    Which of...

    Correct

    • A 39-year-old woman is feeling unwell one week after a parathyroid surgery.

      Which of the following stimulates release of parathyroid hormone (PTH)?

      Your Answer: Increased plasma phosphate concentration

      Explanation:

      PTH is synthesised and released from the chief cells of the four parathyroid glands located behind the thyroid gland.
      It is a polypeptide containing 84 amino acids and it controls free calcium in the body.

      The following stimuli causes release of PTH:
      Increased plasma phosphate concentration
      Decreased plasma calcium concentration

      PTH release is inhibited by:
      Normal or increased plasma calcium concentration
      Hypomagnesaemia

      The main actions of PTH are:
      Increases plasma calcium concentration
      Decreases plasma phosphate concentration
      Increases osteoclastic activity (increasing calcium and phosphate resorption from bone)
      Increases renal tubular reabsorption of calcium
      Decreases renal phosphate reabsorption
      Increases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol (via stimulation of 1-alpha hydroxylase)
      Increases calcium and phosphate absorption in the small intestine (indirectly via increased 1,25-dihydroxycholecalciferol)

    • This question is part of the following fields:

      • Endocrine Physiology
      • Physiology
      22.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrine Physiology (6/10) 60%
Physiology (6/10) 60%
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