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Question 1
Correct
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A 75-year-old male patient with type 2 diabetes mellitus, was admitted with confusion. On examination he was drowsy and had tremors. Which of the following is the best investigation, which is important for the further management?
Your Answer: Blood sugar
Explanation:The presentation is highly suggestive of a hypoglycaemic episode, which is more common amongst older patient with diabetes mellitus. The chance of hypoglycaemia is higher with insulin users. Blood sugar measurement is crucial in the management.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 2
Incorrect
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A 25-year-old woman comes to the endocrine clinic for her regular follow up. She has hypertension, controlled by a combination of Ramipril and indapamide and was diagnosed with 11-beta hydroxylase deficiency since birth when she was found to have clitoromegaly.
Which of the following is most likely to be elevated?Your Answer: Oestradiol
Correct Answer: 11-Deoxycortisol
Explanation:11-beta hydroxylase is stimulated by ACTH and responsible for conversion of 11-deoxycortisol to cortisol and deoxycorticosterone to corticosterone.
In 11-beta hydroxylase deficiency, the previously mentioned conversions are partially blocked, leading to:
– Increased levels of ACTH
– Accumulation of 11-deoxycortisol (which has limited biological activity) and deoxycorticosterone (which has mineralocorticoid activity)
– Overproduction of adrenal androgens (DHEA, androstenedione, and testosterone) -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 3
Incorrect
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Which of the following is most consistent with small cell lung cancer?
Your Answer: hypercalcemia is commonly seen
Correct Answer: hypertrophic pulmonary osteoarthropathy is rarely seen
Explanation:The clinical manifestations of Small cell lung cancer (SCLC) can result from local tumour growth, intrathoracic spread, distant spread, and/or paraneoplastic syndromes.
Hypertrophic pulmonary osteoarthropathy (HPO) is a rare paraneoplastic syndrome that is frequently associated with lung cancer; however, the incidence of clinically apparent HPO is not well known.
SIADH is present in 15% of cases and most commonly seen.
Although hypercalcaemia is frequently associated with malignancy, it is very rare in small cell lung cancer despite the high incidence of lytic bone metastases.
Ectopic Cushing’s syndrome in SCLC does not usually exhibit the classic signs of Cushing’s syndrome and Cushing’s syndrome could also appear during effective chemotherapy.
Chemotherapy is the treatment of choice in SCLC. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 4
Incorrect
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A 25-year-old woman presents to the clinic with nausea, thirst and dehydration. She mentioned that she has an uncle with previous parathyroid gland excision and a cousin who has recently been diagnosed with insulinoma.
On examination, her BP is 135/72 mmHg, her pulse is 70/min and regular, her BMI is 20. Cardiovascular, respiratory and abdominal examinations are unremarkable.
Investigations show:
Hb 12.6 g/dl
WCC 5.4 x109/l
PLT 299 x109/l
Na+ 139 mmol/l
K+ 4.4 mmol/l
Creatinine 121 Ù‰mol/l
Albumin 37 g/l
Ca++ 2.95 mmol/l
PTH 18 (normal<10)
Which of the following is the most likely cause of her raised calcium?Your Answer: MEN 2b
Correct Answer: Parathyroid hyperplasia
Explanation:The combination of Insulinoma and Parathyroid diseases is suggestive of MEN 1 syndrome.
Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary tumour syndrome inherited in an autosomal dominant manner and characterized by a predisposition to a multitude of endocrine neoplasms primarily of parathyroid, entero-pancreatic, and anterior pituitary origin, as well as non-endocrine neoplasms.
Other endocrine tumours in MEN1 include foregut carcinoid tumours, adrenocortical tumours, and rarely pheochromocytoma. Nonendocrine manifestations include meningiomas and ependymomas, lipomas, angiofibromas, collagenomas, and leiomyomas.Primary hyperparathyroidism (PHPT), due to parathyroid hyperplasia is the most frequent and usually the earliest expression of MEN-1, with a typical age of onset at 20-25 years.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 5
Incorrect
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All of the following are true regarding the management of thyroid diseases during pregnancy, except?
Your Answer: Increased levels of thyroxine-binding globulin are seen in pregnancy
Correct Answer: Block-and-replace is preferable in pregnancy compared to antithyroid drug titration
Explanation: -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 6
Incorrect
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A 32-year-old female patient has the following signs and symptoms: smooth goitre, lid lag and bilateral exophthalmos with puffy eyelids and conjunctival injections. She has a history of thyrotoxicosis but wants to fall pregnant. What would be the most appropriate treatment for her?
Your Answer: Thyroidectomy
Correct Answer: 18m of Propylthiouracil (PTU) alone
Explanation:Propylthiouracil (PTU) is a safe choice for a woman that is planning a pregnancy because it does not have the teratogenic effects as carbimazole does. Methimazole (MMI) and propylthiouracil (PTU) are the standard anti-thyroid drugs used in the treatment of hyperthyroidism in pregnancy. Carbimazole can cause spina bifida, CV malformations as well as hypospadia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 7
Incorrect
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A 60-year-old female who was on dexamethasone underwent abdominal surgery. Her blood sugar levels remained around 18 mmol/l during and after the surgery. Which of the following is the most suitable method to control her blood sugar level?
Your Answer: Remove dexamethasone
Correct Answer: Insulin
Explanation:She has steroid induced hyperglycaemia. She needs satisfactory glycaemic control to avoid post surgical infections. As she is in a stressful event following a major surgery, insulin is the best method to manage her hyperglycaemia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 8
Correct
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A 40-year-old man comes to the endocrine clinic after his second episode of acute pancreatitis.
On examination, he has a BP of 125/70 mmHg, his pulse is regular 70 bpm and his BMI is 23. There is evidence of eruptive xanthomas on examination of his skin.
It was noted that his fasting triglycerides level is 8.5 mmol/l (0.7-2.1) at his follow up appointment although his LDL level is not particularly raised.
Which of the following is the most appropriate therapy for him?Your Answer: Fenofibrate
Explanation:Three classes of medications are appropriate for the management of major triglyceride elevations: fibric acid derivatives, niacin, and omega-3 fatty acids.
Fibrate is used as a first-line agent for reduction of triglycerides in patients at risk for triglyceride-induced pancreatitis.
High-dose niacin (vitamin B-3) (1500 or more mg/d) decreases triglyceride levels by at least 40% and can raise HDL cholesterol levels by 40% or more. Niacin also reliably and significantly lowers LDL cholesterol levels, which the other major triglyceride-lowering medications do not.
Omega-3 fatty acids are attractive because of their low risk of major adverse effects or interaction with other medications. At high doses (>4 g/d), triglycerides are reduced.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 9
Incorrect
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Which of the following statements regarding dipeptidyl peptidase-4 inhibitors in the management of type 2 diabetes mellitus is correct?
Your Answer: Metformin should always be co-prescribed
Correct Answer: Do not cause weight gain
Explanation:Several dipeptidyl peptidase-4 (DPP-4) inhibitors are in clinical development; these are orally active and increase levels of active glucagon-like peptide-1 (GLP-1), which in turn increases insulin secretion and reduces glucagon secretion, thereby lowering glucose levels.
Sitagliptin and vildagliptin both have a long duration of action, allowing once-daily administration. Both sitagliptin and vildagliptin are safe and tolerable with a low risk of hypoglycaemia. In drug-naïve subjects with type 2 diabetes, both sitagliptin and vildagliptin reduce A1C levels by ,1% as monotherapy. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 10
Incorrect
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Which of the following is most consistent with congenital adrenal hyperplasia (CAH)?
Your Answer: Delayed puberty
Correct Answer: Premature epiphyseal closure
Explanation:Exposure to excessive androgens is usually accompanied by premature epiphyseal maturation and closure, resulting in a final adult height that is typically significantly below that expected from parental heights.
congenital adrenal hyperplasia (CAH) is associated with precocious puberty caused by long term exposure to androgens, which activate the hypothalamic-pituitary-gonadal axis. Similarly, CAH is associated with hyperpigmentation and hyperreninemia due to sodium loss and hypovolaemia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 11
Correct
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A 25-year-old woman is found to have a blood pressure of 170/100 mmHg during a routine medical check. She is otherwise well and her physical examination is unremarkable.
Blood tests show:
Na+ 140 mmol/l
K+ 2.6 mmol/l
Bicarbonate 31 mmol/l
Urea 3.4 mmol/l
Creatinine 77 µmol/l
Which one of the following investigations is most likely to be diagnostic?Your Answer: Renin:aldosterone ratio
Explanation:Primary aldosteronism now is considered one of the more common causes of secondary hypertension (HTN).
Individuals with primary aldosteronism may present with hypokalaemia metabolic alkalosis; however, as many as 38% of patients with primary aldosteronism may be normokalaemia at presentation.
Routine laboratory studies can show hypernatremia, hypokalaemia, and metabolic alkalosis resulting from the action of aldosterone on the renal distal convoluted tubule (DCT) (i.e., enhancing sodium reabsorption and potassium and hydrogen ion excretion).
Plasma aldosterone/plasma renin activity ratio is used for screening because it is fairly constant over many physiologic conditions.The patient is clinically free, so Cushing diseases can be exclude.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 12
Incorrect
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A 21-year-old singer, who had thyroid surgery a few months before, now complains of not being able to raise the pitch of her voice, and suspects it was because of the surgery. What is the most likely diagnosis?
Your Answer: Unilateral recurrent laryngeal nerve injury
Correct Answer: External laryngeal nerve injury
Explanation:The external laryngeal nerve may be injured or traumatized following thyroid surgery due to its close proximity, which may result in hoarseness or loss of voice.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 13
Correct
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A 50-year-old woman was investigated following an osteoporotic hip fracture. The following results are obtained:
TSH < 0.05 mu/l
Free T4 29 pmol/l
Which of the following autoantibodies is most likely to be present?Your Answer: TSH receptor stimulating autoantibodies
Explanation:The patient has hyperthyroidism and its most common cause is Grave’s Disease.
Grave’s Disease is an autoimmune disease due to circulating autoantibodies known as TSH receptor stimulating autoantibodies or Thyroid-stimulating immunoglobulins (TSIs) that bind to and activate thyrotropin receptors, causing the thyroid gland to grow and the thyroid follicles to increase the synthesis of thyroid hormone. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 14
Correct
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A 65-year-old male with a history of chronic diabetes mellitus and ischaemic heart disease, presented with pain in the thigh and gluteal region, while climbing up the stairs for past 5 months and symptoms were getting worse. He was a heavy smoker. On examination the dorsalis pedis and posterior tibial pulses were present. Which of the following is the most probable diagnosis?
Your Answer: Atherosclerosis
Explanation:The presence of the pulses excluded Thromboangitis Obliterans. The pain is not suggestive of sciatica. The history doesn’t support a DVT or an embolus as there is no pain at rest, swelling or skin changes. So the most probable diagnosis is atherosclerosis as the chronic diabetes and smoking support it.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 15
Correct
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An 80-year-old patient known to have diabetes mellitus presented in the emergency room with the complaint of involuntary movements of his right arm and leg which disappeared during sleep. Which of the following is the most suitable explanation for this complaint?
Your Answer: Contralateral subthalamic nucleus infarction
Explanation:These symptoms represent hemiballismus which is common in diabetic patients after the infarction of contralateral subthalmic nucleus. These symptoms are usually present during activity phase and resolve while resting.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 16
Incorrect
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A 60-year-old man presents to his GP complaining of a cough and breathlessness for 2 weeks. He reports that before the onset of these symptoms, he was fit and well and was not on any medication. He is a known smoker of 10 cigarettes per day and has been smoking for over 25 years.
On examination, the GP diagnosed a mild viral chest infection and reassured the patient that the symptoms would settle of their own accord.
Two weeks later, the patient presented again to the GP, this time complaining of thirst, polyuria and generalised muscle weakness. The GP noticed the presence of ankle oedema.
A prick test confirmed the presence of hyperglycaemia and the patient was referred to the hospital for investigations where the medical registrar ordered a variety of blood tests.
Some of these results are shown below:
Na 144 mmol/l
K 2.2 mmol/l
Bicarbonate 34 mmol/l
Glucose 16 mmol/l
What is the most likely diagnosis?Your Answer: Conn's syndrome
Correct Answer: Ectopic ACTH production
Explanation:The patient has small cell lung cancer presented by paraneoplastic syndrome; Ectopic ACTH secretion.
Small cell lung cancer (SCLC), previously known as oat cell carcinoma is a neuroendocrine carcinoma that exhibits aggressive behaviour, rapid growth, early spread to distant sites, exquisite sensitivity to chemotherapy and radiation, and a frequent association with distinct paraneoplastic syndromes.
Common presenting signs and symptoms of the disease, which very often occur in advanced-stage disease, include the following:
– Shortness of breath
– Cough
– Bone pain
– Weight loss
– Fatigue
– Neurologic dysfunction
Most patients with this disease present with a short duration of symptoms, usually only 8-12 weeks before presentation. The clinical manifestations of SCLC can result from local tumour growth, intrathoracic spread, distant spread, and/or paraneoplastic syndromes.
SIADH is present in 15% of the patients and Ectopic secretion of ACTH is present in 2-5% of the patients leading to ectopic Cushing’s syndrome. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 17
Incorrect
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A 39-year-old female had surgery for the removal of thyroid carcinoma. One week later, she presented in the OPD with complaints of numbness, tingling, involuntary spasm of the upper extremities, paraesthesia and respiratory stridor. Which of the following is the most likely cause?
Your Answer: External laryngeal nerve injury
Correct Answer: Hypocalcaemia
Explanation:Hypocalcaemia presents with such symptoms. It probably happened due to accidental removal of a parathyroid gland during the thyroid surgery. Hypocalcaemia causes laryngospasm which produces stridor.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 18
Correct
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A 64-year-old male patient was admitted for dysphagia, emesis and weight loss. He has a firm lump in his left supraclavicular fossa. What is the most probable diagnosis?
Your Answer: Gastric carcinoma
Explanation:The history is suggestive of gastric carcinoma with dysphagia, vomiting, weight loss and lymphatic metastasis to the supraclavicular node, known as Virchow’s node.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 19
Incorrect
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A 50-year-old man is found incidentally to have hypercalcaemia during a routine health screen.
Which one of the following biochemical findings would be most suggestive of primary hyperparathyroidism rather than any other cause of hypercalcaemia?Your Answer: Low serum concentration of calcitriol (1,25- dihydroxycholecalciferol)
Correct Answer: Serum PTH concentration within the normal range
Explanation:Primary hyperparathyroidism (PHPT) is diagnosed based upon levels of blood calcium and parathyroid hormone (PTH). In most people with PHPT, both levels are higher than normal. Occasionally, a person may have an elevated calcium level and a normal or minimally elevated PTH level. Since PTH should normally be low when calcium is elevated, a minimally elevated PTH is considered abnormal and indicates PHPT.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 20
Correct
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A 66-year-old woman comes to you with a tender lump near the anal opening and a fever. She has history of T1DM for the last 20 years. What treatment should she get?
Your Answer: I&D + antibiotics
Explanation:Surgical incision and drainage is the most common treatment for anal abscesses. About 50% of patients with an anal abscess will develop a complication called a fistula. Diabetes is a risk factor for an anal abscess.
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This question is part of the following fields:
- Endocrine System & Metabolism
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SESSION STATS - PERFORMANCE PER SPECIALTY
