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Question 1
Incorrect
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What percentage of children does delayed puberty occur in?
Your Answer: 1%
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 2
Correct
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Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism
Your Answer: Endocrine
Explanation:Hormones that are secreted into the circulation at one site but have effects on distal target organs are endocrine as is the case with the hormones above. Autocrine and Intracrine messengers act within the same cell. Exocrine glands secrete their products into ducts. Apocrine is a histological term used to describe some types of exocrine gland.
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This question is part of the following fields:
- Endocrinology
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Question 3
Incorrect
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What percentage of testosterone is bound to SHBG?
Your Answer: 30%
Correct Answer: 70%
Explanation:About 97% of the testosterone that is secreted loosely binds to the SHBG and circulates in the blood for several hours in this bound state until it is transported to the target organs.
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This question is part of the following fields:
- Endocrinology
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Question 4
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 5
Correct
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Aromatase is key to Oestradiol production in the ovaries. Which of the following statements is true?
Your 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 6
Correct
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Whilst reviewing a 34 year old patient with amenorrhoea in clinic they tell you they have gained over 10kg in weight in the past 8 weeks and have noticed worsening acne. Routine bloods taken that morning show a random glucose 11.1mmol/l, normal thyroid function tests and negative pregnancy test. BP is 168/96 mmHg. You suspect Cushing's. What would the most appropriate investigation be to conform the diagnosis?
Your Answer: Dexamethasone suppression test
Explanation:In Cushing’s syndrome there is excess cortisol. Causes are broadly divided into 2 types: ACTH dependent disease: excess ACTH from the pituitary (Cushing’s disease), ectopic ACTH-producing tumours or excess ACTH administration. Non-ACTH-dependent: adrenal adenomas, adrenal carcinomas, excess glucocorticoid administration. The recommended diagnostic tests for the presence of Cushing’s syndrome are 24-hour urinary free cortisol, 1 mg overnight dexamethasone suppression test and late-night salivary cortisol. There are several other tests that may also be performed to find the cause. ACTH and cortisol measured together may show if this is ACTH dependent or not. MRI pituitary and CT abdo and pelvis may show if tumour is the cause.
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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: Adrenal glands
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
Incorrect
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A 32 year old woman with a 6 month history of fatigue and some weight gain reports to clinic for a review. Her medical records show evidence of hypothyroidism. On examination, a non tender, hard goitre is palpated. Further tests reveal elevated anti TPO (anti thyroid peroxidase) and anti -Tg (anti thyroglobulin). Which of the following conditions is most likely to present like this?
Your Answer: De Quervain's thyroiditis
Correct Answer: Hashimoto's
Explanation:The case presented points to a diagnosis of an autoimmune thyroiditis leading to hypothyroidism. The most common form of autoimmune hypothyroidism, Hashimoto’s, often presents with a goitre, positive for antibody tests against thyroid components i.e. anti-TPO and anti-thyroglobulin. Graves disease and toxic diffuse goitre are more likely to cause hyperthyroidism. While De-Quervain’s and endemic goitre may cause hypothyroidism, they don’t result in positive antibody tests.
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This question is part of the following fields:
- Endocrinology
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Question 9
Incorrect
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What is the definition of puberty in girls?
Your Answer: Development of secondary sexual characteristics
Correct Answer: Becoming capable of sexual reproduction
Explanation:Puberty is the process of reproductive and sexual development and the maturation which changes a child into an adult.
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This question is part of the following fields:
- Endocrinology
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Question 10
Incorrect
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Oxytocin causes increased myometrial contraction via which of the following messenger pathways?
Your Answer: Releases protein kinase A that triggers intracellular Calcium ion release
Correct Answer: Activates phospholipase-C which produces IP3 which triggers intracellular Calcium ion release
Explanation:Oxytocin acts via the G protein receptors and the calcium-calmodulin complex. It activates phospholipase C which produces IP3 to further trigger the calcium-calmodulin complex increasing intracellular Ca ion release.
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This question is part of the following fields:
- Endocrinology
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Question 11
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 12
Incorrect
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DHEA is synthesized from which molecule?
Your Answer: aldosterone
Correct Answer: Cholesterol
Explanation:Dehydroepiandrosterone is an androgen precursor produced primarily by the adrenal glands in women. The steroid hormone is produced from cholesterol at birth by the fetal adrenal glands, after which its output reduces. DHEA production picks up again from the age of 5-7 years and peaks between the ages of 20-30.
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This question is part of the following fields:
- Endocrinology
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Question 13
Incorrect
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Raised FSH levels are found in all of the following conditions, EXCEPT:
Your Answer: Turner Syndrome
Correct Answer: Women on combined oral contraceptive pills
Explanation:Oestrogen- and progesterone-containing oral contraceptives inhibit LH, which suppresses the FSH and LH levels, preventing follicular development and ovulation. Combined pills suppress FSH and LH throughout the cycle, inhibit endometrial proliferation, and produce a scanty cervical mucus.
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This question is part of the following fields:
- Endocrinology
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Question 14
Correct
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Beta and Delta Thalassemia are associated with abnormalities to which chromosome
Your Answer: Chromosome 11
Explanation:Fetal haemoglobin (HBF) is the main haemoglobin type in the foetus and persists after birth for around 6 months. Fetal haemoglobin is composed of two alpha and two gamma subunits The alpha globulin chain is coded for by genes on Chromosome 16. Alpha Thalassemia are therefore associated with Chromosome16 defects The beta and delta globulin chains are coded for by genes on Chromosome 11. Beta and Delta Thalassemia are therefore associated with Chromosome 11 Defects
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This question is part of the following fields:
- Endocrinology
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Question 15
Incorrect
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Where are ADH (vasopressin) and Oxytocin synthesised?
Your Answer: Anterior 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 16
Incorrect
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The ovaries produce androgen and progesterone. What is the common precursor for both of these hormones?
Your Answer: Inhibin A
Correct 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 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
Incorrect
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Adult Polycystic Kidney Disease (PKD) typically follows which pattern of inheritance
Your Answer: Autosomal 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 19
Correct
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Oestrogen have all of the following actions, EXCEPT:
Your Answer: Prevention of thrombosis
Explanation:The properties of oestrogen:
Structure: Stimulates endometrial growth, maintenance of vessels and skin,
reduces bone resorption, increases bone formation, increases uterine growth
Protein synthesis: Increases hepatic synthesis of binding proteins
Coagulation: Increases circulating levels of factors II, VII, IX, X, antithrombin III and plasminogen; increases platelet adhesiveness
Lipid: Increases HDL and reduces LDL,increases triglycerides, reduces
ketone formation, increases fat deposition
Fluid balance: Salt and water retention
Gastrointestinal: Reduces bowel motility, increases cholesterol in bile -
This question is part of the following fields:
- Endocrinology
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Question 20
Correct
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Which of the following is the primary source of oestrogen ?
Your 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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