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Question 1
Incorrect
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A 25-year-old man wants to start a relationship but is concerned about his small phallus. He also has difficulty becoming aroused. On examination, he is slim and has gynecomastia. There is a general paucity of body hair, his penis and testes are small.
Which diagnosis fits best with this history and examination?Your Answer: Testicular feminisation
Correct Answer: Klinefelter's syndrome
Explanation:The patient most likely has Klinefelter’s syndrome.
Klinefelter syndrome (KS) refers to a group of chromosomal disorders in which the normal male karyotype, 46,XY, has at least one extra X chromosome. XXY aneuploidy, the most common human sex chromosome disorder. It is also the most common chromosomal disorder associated with male hypogonadism and infertility.
Klinefelter syndrome is characterized by hypogonadism (micro-orchidism, oligospermia/azoospermia), gynecomastia in late puberty, hyalinization and fibrosis of the seminiferous tubules, elevated urinary gonadotropin levels, and behavioural concerns. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 2
Correct
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A 15-year-old girl presents with vomiting and her investigations show:
Sodium 115 mmol/L (137-144)
Potassium 3.0 mmol/L (3.5-4.9)
Urea 2.1 mmol/L (2.5-7.5)
Urine sodium 2 mmol/L
Urine osmolality 750 mosmol/kg (350-1000)
What is the most likely diagnosis?Your Answer: Bulimia nervosa
Explanation:The patient is most likely to have Bulimia nervosa. A young girl with a low body mass contributes to the low urea. Hypokalaemia and hyponatraemia are due to vomiting. Her urine sodium is also low.
– In Addison’s diseases, there are low levels of sodium and high levels of potassium in the blood. In acute adrenal crisis: The most consistent finding is elevated blood urea nitrogen (BUN) and creatinine. Urinary and sweat sodium also may be elevated.
– In Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) there is hyponatremia with corresponding hypo-osmolality, continued renal excretion of sodium, urine less than maximally dilute and absence of clinical evidence of volume depletion. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 3
Correct
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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: 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 4
Correct
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A 50-year-old man is referred with impotence. He has a history of angina, hypertension and type 2 diabetes.
Which one of the following drugs that he takes is a contraindication to him being able to receive sildenafil?Your Answer: Isosorbide mononitrate
Explanation:Sildenafil administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is contraindicated.
Organic nitrates and nitric oxide (NO) donors exert their therapeutic effects on blood pressure and vascular smooth muscle by the same mechanism as endogenous NO via increasing cGMP concentrations. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 5
Incorrect
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A 28-year-old manual worker had stepped on a rusty nail. He says he received tetanus toxoid 8 years ago. What should be done for him now?
Your Answer: Human immunoglobulin and full course of tetanus vaccine
Correct Answer: Human immunoglobulin only
Explanation:Only immunoglobulins are required, as he is already immunized.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 6
Incorrect
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Which of the following is correct regarding post-menopausal hormone replacement therapy (HRT) according to randomised clinical studies ?
Your Answer: Reduces cardiovascular mortality
Correct Answer: Increases plasma triglycerides
Explanation:Oestrogen therapy reduces plasma levels of LDL cholesterol and increases levels of HDL cholesterol. It can improve endothelial vascular function, however, it also has adverse physiological effects, including increasing the plasma levels of triglycerides (small dense LDL particles). Therefore, although HRT may have direct beneficial effects on cardiovascular outcomes, these effects may be reduced or balanced by the adverse physiological effects.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 7
Correct
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In a patient with Hashimoto's thyroiditis, which of the following is most specific to the disease?
Your Answer: Anti-thyroid peroxidase antibodies
Explanation:Hashimoto thyroiditis is part of the spectrum of autoimmune thyroid diseases (AITDs) and is characterized by the destruction of thyroid cells by various cell- and antibody mediated immune processes. It usually presents with hypothyroidism, insidious in onset, with signs and symptoms slowly progressing over months to years.
The diagnosis of Hashimoto thyroiditis relies on the demonstration of circulating antibodies to thyroid antigens (mainly thyroperoxidase and thyroglobulin) and reduced echogenicity on thyroid sonogram in a patient with proper clinical features.
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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 26-year-old woman presents to a reproductive endocrinology clinic with a history of not being able to conceive after 2 years of using no contraception. Polycystic ovarian syndrome maybe her diagnosis.
Which of the following is most likely to be associated with this condition?Your Answer: Elevated LH/FSH ratio
Explanation:In patients with polycystic ovarian syndrome (PCOS), FSH levels are within the reference range or low. Luteinizing hormone (LH) levels are elevated for Tanner stage, sex, and age. The LH-to-FSH ratio is usually greater than 3.
Women with PCOS have abnormalities in the metabolism of androgens and oestrogen and in the control of androgen production. PCOS can result from abnormal function of the hypothalamic-pituitary-ovarian (HPO) axis.
The major features of PCOS include menstrual dysfunction, anovulation, and signs of hyperandrogenism. Other signs and symptoms of PCOS may include the following:
– Hirsutism
– Infertility
– Obesity and metabolic syndrome
– Diabetes
– Obstructive sleep apnoeaAndrogen excess can be tested by measuring total and free testosterone levels or a free androgen index. An elevated free testosterone level is a sensitive indicator of androgen excess. Other androgens, such as dehydroepiandrosterone sulphate (DHEA-S), may be normal or slightly above the normal range in patients with polycystic ovarian syndrome (PCOS). Levels of sex hormone-binding globulin (SHBG) are usually low in patients with PCOS.
Some women with PCOS have insulin resistance and an abnormal lipid profile (cholesterol >200 mg/dL; LDL >160 mg/dL). Approximately one-third of women with PCOS who are overweight have impaired glucose tolerance or type 2 diabetes mellitus by 30 years of age.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 9
Correct
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All of the following are true regarding the management of thyroid diseases during pregnancy, except?
Your 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 10
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 11
Correct
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A man was admitted with galactorrhoea. History reveals that the patient has been having problems with getting and maintaining an erection. He also admits he's noticed a decrease in the quantity of his facial hair. What is the most likely diagnosis?
Your Answer: Hyper prolactinaemia
Explanation:Increased levels of prolactin in men can lead to erectile dysfunction, reduced facial and body hair and on rare occasion gynecomastia with galactorrhoea.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 12
Correct
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A collapsed patient comes into A&E. He has a steroid user card and empty boxes of prednisolone. He has obvious rheumatoid features on examination and some unilateral consolidation on his chest X-ray. He is given intravenous fluids and broad-spectrum antibiotics.
Which one of the following would be the most useful addition to the current management?Your Answer: IV hydrocortisone 100 mg
Explanation:The empty boxes indicate that the patient has run out of his medication.
Chronic administration of high doses of glucocorticoids (GCs) (e.g., prednisone or prednisolone) and also other hormones such as oestrogens, progestins, androgens and growth hormone induce varying degrees of tolerance, resulting in a progressively decreased response to the effect of the drug, followed by dependence and rarely addiction.
The glucocorticoid withdrawal syndrome (GWS) has been considered a withdrawal reaction due to established physical dependence on supraphysiological GC levels.
The severity of GWS depends on the genetics and developmental history of the patient, on his environment, and on the phase and degree of dependence the patient has reached. Its management should include a temporary increase in the dose of GCs followed by gradual, slow tapering to a maintenance dose. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 13
Correct
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Question 14
Correct
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Which one of the following types of thyroid cancer is associated with the RET oncogene?
Your Answer: Medullary
Explanation:RET (rearranged during transfection) is a receptor tyrosine kinase involved in the development of neural crest derived cell lineages, kidney, and male germ cells. Different human cancers, including papillary and medullary thyroid carcinomas, lung adenocarcinomas, and myeloproliferative disorders display gain-of-function mutations in RET.
In over 90% of cases, MEN2 syndromes are due to germline missense mutations of the RET gene.
Multiple endocrine neoplasias type 2 (MEN2) is an inherited disorder characterized by the development of medullary thyroid cancer (MTC), parathyroid tumours, and pheochromocytoma. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 15
Correct
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A 55-year-old woman complains of weight gain, hoarseness of voice, constipation, and muscle weakness 1 month after undergoing thyroid surgery. On examination, her face is puffy. Which of the following is the most likely diagnosis?
Your Answer: Hypothyroidism
Explanation:All the symptoms this patient is suffering from are the classic features of a hypothyroid state.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 16
Correct
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A 24-year-old woman develops hyperthyroidism 6 weeks after delivery. On examination, she has a painless, firm enlarged thyroid gland.
Which of the following statements is most correct regarding her probable diagnosis?Your Answer: The condition is more likely in those in whom thyroid peroxidase (TPO) antibodies were positive prior to delivery
Explanation:Up to 10% of postpartum women may develop lymphocytic thyroiditis (postpartum thyroiditis) in the 2-12 months after delivery. The frequency may be as high as 25% in women with type 1 diabetes mellitus.
Some patients return spontaneously to a euthyroid state within a few months, but most patients experience a phase of hypothyroidism that takes 2 to 6 months to resolve; of this group, some develop permanent hypothyroidism. About 50% of patients, however, will develop permanent hypothyroidism within 5 years of the diagnosis of postpartum thyroiditis.
High titres of anti-TPO antibodies during pregnancy have been reported to have high sensitivity and specificity for postpartum autoimmune thyroid disease.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 17
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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Question 18
Incorrect
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Which of the following is most consistent with congenital adrenal hyperplasia (CAH)?
Your Answer: Hyporeninaemia
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 19
Incorrect
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A 16-year-old boy is being treated with ADH for diabetes insipidus. His blood results show:
fasting plasma glucose level: 6 mmol/l (3- 6)
sodium 148 mmol/l (137-144)
potassium 4.5 mmol/l (3.5-4.9)
calcium 2.8 mmol/l (2.2-2.6).
However, he still complains of polyuria, polydipsia and nocturia.
What could be the most probable cause?Your Answer: Primary polydipsia
Correct Answer: Nephrogenic diabetes insipidus
Explanation:Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms:
Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP])
Nephrogenic DI, characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney.
The boy most probably has nephrogenic diabetes insidious (DI) not central DI so he is not responding to the ADH treatment. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 20
Correct
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A 62-year-old male presents to the OPD with a deep painless ulcer on the heel. His previous history includes increased thirst, urinary frequency, and weight loss for the last 4 years. Which of the following investigations would be most appropriate in this case?
Your Answer: Blood sugar
Explanation:People with diabetes are prone to foot problems that develop due to prolonged periods of high blood sugar levels. Diabetic neuropathy and peripheral vascular disease are the two main causes of foot problems and both can have serious complications. Diabetes can cause serious foot problems that can result in feet or limb loss, deformity, and infections. However, it is possible for a person to prevent or minimize many of these problems. While controlling blood sugar by following the recommended diabetes treatment plans is the best way to prevent these serious problems, self-care and regular check-ups with a doctor can also help prevent problems from developing.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 21
Correct
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A 35-year-old female had an oral glucose tolerance test. Her oral glucose test after 2 hrs was 10mml/l. What is the result of her test?
Your Answer: Impaired glucose tolerance
Explanation:Impaired glucose tolerance is a pre-diabetic state of hyperglycaemia that is associated with insulin resistance and increased risk of cardiovascular pathology. To diagnose impaired glucose tolerance, the OGTT value after 2 hrs should be 140-199mg/dl (7.7 – 11.0 mmol/l). Impaired fasting glucose is diagnosed as fasting blood sugar between 100 mg/dl to 125 mg/dl.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 22
Correct
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A 45-year-old female presented in the OPD with complaints of tiredness and lethargy. On examination, her BP was 160/100 mmHg. On lab examination her Na+=142 mmol/L, K+=3.0mmol/L. Which is the most likely diagnosis?
Your Answer: Conn's syndrome
Explanation:In Conn’s syndrome hypokalaemia and hypertension are present due to high levels of aldosterone with normal to high sodium levels. In this disease, the patient presents with hypertension and feelings of tiredness or fatigue.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 23
Incorrect
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All of the following are true regarding carcinoid syndrome, except?
Your Answer: Flushing attacks may be associated with bronchoconstriction, periorbital oedema, salivation and excessive lacrimation
Correct Answer: Pharmacological blockade is clinically useful in only 10% of patients
Explanation:For medical management of carcinoid syndrome, there are two somatostatin analogues available, Octreotide and Lanreotide. Somatostatin is an amino acid peptide which is an inhibitory hormone, which is synthesized by paracrine cells located ubiquitously throughout the gastrointestinal tract. Both somatostatin analogues provide symptom relief in 50% to 70% of patients and biochemical response in 40% to 60% patients. Many studies have shown that Octreotide and Lanreotide also inhibit the proliferation of tumour cells.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 24
Incorrect
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Regarding the pathophysiology of diabetes mellitus, which of the following is true?
Your Answer: Patients with type 1 diabetes mellitus are rarely HLA-DR4 positive
Correct Answer: Concordance between identical twins is higher in type 2 diabetes mellitus than type 1
Explanation:Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4. Although the genetic aspect of type 1 DM is complex, with multiple genes involved, there is a high sibling relative risk. Whereas dizygotic twins have a 5-6% concordance rate for type 1 DM, monozygotic twins will share this diagnosis more than 50% of the time by the age of 40 years.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 25
Correct
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Which one of the following is the most common cause of hypothyroidism in the UK?
Your Answer: Hashimoto's thyroiditis
Explanation:Hashimoto thyroiditis is the most common cause of hypothyroidism in developed countries. In contrast, worldwide, the most common cause of hypothyroidism is an inadequate dietary intake of iodine. This disease is also known as chronic autoimmune thyroiditis and chronic lymphocytic thyroiditis.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 26
Correct
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A 35-year-old female admitted with heat intolerance, neck pain, palpitations and recent onset weight loss despite increased appetite. Which of the following is most likely to be associated with diagnosis of thyroiditis associated with viral infection?
Your Answer: Reduced uptake on thyroid isotope scan
Explanation:Subacute thyroiditis (De Quervain’s thyroiditis) is a self-limiting thyroid condition presenting with three clinical courses of hyperthyroidism, hypothyroidism, and return to normal thyroid function. In subacute thyroiditis serum thyroglobulin (TG) levels are elevated. ESR is usually greater than 50 mm/h, often exceeding 100 mm/h. Radio-iodine uptake is low or nil. Antithyroperoxidase antibodies are associated with autoimmune thyroiditis
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 27
Correct
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A 28-year-old female presented with complaints of weight gain, thinning of scalp hair, dryness and coldness of the skin, constipation and fatigue. Which of the following is the most likely diagnosis?
Your Answer: Hypothyroidism
Explanation:The symptoms this female presented with in the OPD are major symptoms of hypothyroidism due to insufficient thyroid hormone.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 28
Incorrect
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A 26-year-old woman is 24 weeks pregnant had a recent ultrasound that shows the foetus large for dates.
She has an oral glucose tolerance test (OGTT) which was requested due to a combination of her Asian ethnicity and background of obesity.
The following results are obtained:
Time (hours) Blood glucose (mmol/l)
0 9.2
2 14.2
What is the most appropriate management?Your Answer: Start metformin
Correct Answer: Start insulin
Explanation:Insulin remains the standard of care for the treatment of uncontrolled gestational diabetes. Tight control maintained in the first trimester and throughout pregnancy plays a vital role in decreasing poor fetal outcomes, including structural anomalies, macrosomia, hypoglycaemia of the new-born, adolescent and adult obesity, and diabetes.
The baby is already large for dates so nutritional therapy can not be used alone. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 29
Incorrect
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A 30-year-old woman is referred to endocrinology with thyrotoxicosis. Following a discussion of management options, she chooses to have radioiodine therapy. Which one of the following is the most likely adverse effect?
Your Answer: Agranulocytosis
Correct Answer: Hypothyroidism
Explanation:Approximately one third of patients treated with radioiodine therapy develop transient hypothyroidism. Unless a patient is highly symptomatic, thyroxine replacement may be withheld if hypothyroidism occurs within the first 2 months of therapy. If it persists for longer than 2 months, permanent hypothyroidism is likely and replacement with T4 should be initiated.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 30
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: Bilateral 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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SESSION STATS - PERFORMANCE PER SPECIALTY
