ENDOCRINOLOGY MCQ 1. Patient with Graves disease, was on quinine, carbimazole started. Photo shows petechial rash. FBC: platelets 20. Weakly positive antiplatelet antibody. What is the cause of the thrombocytopenia? a. b.
quinine carbimazole
2. Patient with bone scan of spine and hip. Difference in z scores of 4 with femoral being below par. Vertebral +3, femoral 4. What is the cause of the discrepancy? a. b. c. d.
sclerosis lumbar stenosis synovitis of hip artefact, poor test
3.
Young male with high calcium. Mother had high calcium. What investigation would you do next ?
a. b. c. d.
24 hour urinary calcium excretion. PTH-rP Vit D level Parathyroid scan
4. A middle aged lady presents with generalized bone pain. Bone scan is shown: multiple areas of increased uptake. Serum Ca Serum AlkP Serum PTH PO43- 0.8 Most likely diagnosis is: a. b. c. d.
Paget’s Myeloma Vit D deficiency primary hyperparathyroidism
5.
IDDM male with impotence. HbA1c is 9%, has neuropathy. Best management is:
a. b. c. d. e.
improved glycaemic control sexual counselling PGB2 injection penile implant propranolol
6. A woman with osteoporosis, with BP 180/100. Has had a hysterectomy age 50, now is 70. Xray shows bad crush fractures of spine. Next best treatment: a. b. c. d.
calcium calcitriol oestrogen oestrogen & progesterone
7.
What will interfere with bone mineralisation the most?
a. b.
pamidronate etidronate
c. d. e.
calcitonin aledronate mithromycin
8. CT head of a male with weight gain and lethargy, small non-tender goitre, prolactin 9500, TSH 8, T4 13, LH & FSH lower limit of normal. Scan shows large pituitary lesion. Cause? a. b. c. d.
primary hypothyroidism with non-functioning pituitary adenoma primary hypothyroidism with secondary hyperprolactinaemia prolactinoma overactive pituitary with underactive thyroid
9. An MRI is shown of a diver: large pituitary macroadenoma. TFT's are given with TSH 8, T4 11. Clinically he is hypothyroid. His PRL is twice normal. Most likely diagnosis: a. b. c. d.
Non-functioning pituitary adenoma and primary hypothyroidism Primary hypothyroidism and secondary pituitary enlargement TSH-secreting pituitary adenoma Prolactinoma
10.
A person undergoes pancreatectomy. Which is true of this patient compared to a normal IDDM patient:
a. b. c. d. e.
Decreased incidence of diabetic nephropathy Decreased episodes of hypoglycaemia Decreased in incidence of diabetic ketoacidosis Increased risk of brittle diabetes Decreased risk of diabetic retinopathy
11.
The best test to diagnose Cushing's syndrome is:
a. b. c. d. e.
High-dose dexamethasone suppression test 24 hour urinary cortisol ACTH Serum cortisol CT abdomen
12. A female in her 70's with osteoporosis is found to have a z-score 3.1 SD below the mean. Her increased risk of fracture is: a. b. c. d. e.
2 times 4 6 8 15
13. A lady with bone pains, bone scan showing diffuse increased uptake. Biochemistry shows slight increase PTH, low calcium, low phosphate, alkaline phosphatase 450. Most likely cause: a. b. c. d. e.
Paget's disease Vitamin D deficiency Myeloma Primary hyperparathyroidism Sarcoidosis
14. Which of the following is the most likely to cause defective bone mineralisation when used for the treatment of Paget's disease: a. b. c. d. e.
pamidronate etidronate calcitonin aledronate fluoride
15. A man presents with a calcium 2.75, no symptoms. Told that his mother was diagnosed with hypercalcemia 3 years ago with no symptoms or treatment needed. Best test for diagnosis: a. b. c. d. e.
Ultrasound of neck Serum PTH 24 hour urinary calcium Serum vitamin D PTHrP
16. A female presents with calcium 3.2, slightly high phosphate, polydipsia, and recent renal stone. Next test for diagnosis: a. b. c. d. e.
PTH PTHrP 24 hour urinary calcium 25-OH vitamin D Serum ACE
17. Given results of a DEXA scan. Total hip T-score very low, but lumbar score above young-matched. Most likely explanation for this: a. b. c. d.
Paget's disease Technical error Lumbar spondylosis Malpositioning
18. A diabetic older male in a stable married relationship is having increasing difficulty getting erections. Possibly some evidence of autonomic neuropathy given. The best treatment: a. b. c.
Psychological counselling Testosterone implants PGI2 injections
19. A patient has long-standing hypertension, treated. Urinary catecholamines show noradrenaline 500 ( <400), rest normal. The next step in management is: a. b. c.
Adrenal vein sampling CT abdomen Serum catecholamines
20.
In relation to pituitary adenoma which of the following is NOT TRUE?
a. b. c. d. e.
Prolactin macroadenomas in males rarely present with galactorrhoea Cabergoline is more effective than bromocriptine in the treatment of prolactinomas Non functioning adenomas may secrete FSH or subunit in excess Somatostatin therapy in acromegaly corrects IGF-1 levels in at least 50% of people Radiation therapy is effective first line therapy in patients with acromegaly
21.
Osteoporosis with:
a. b. c. d. e.
Obesity Alcohol Smoking Early menarche Thiazides
22.
Regarding TSH:
d.
Inverse logarithmic relationship to T4 Transient post partum In Addison's, can correct by giving steroids Seen in Grave's ophthalmopathy
23.
Thyroid scan shown - hot nodule right lobe. Expect to find:
a. b. c. d. e.
USS TSH Antibodies FNA multi-nucleated cells ESR
a. b. c.
24. Osteoporosis affects an estimated 75 million people in Europe, the USA and Japan. Risk factors for osteoporosis in post-menopausal women include all except: a. b. c. d. e.
Alcohol abuse Cigarette smoking Pernicious anaemia Addison's disease Antiepileptic treatment with sodium valproate
25. Better glycaemic control is associated with an increased incidence of symptomatic hypoglycaemia. But in the Diabetes Control and Complications Trial, in one third of all severe hypoglycaemic episodes during waking hours patients initially failed to take adequate corrective action (ie reduced hypoglycaemic awareness). Regarding hypoglycaemia, all of the following statements is true except: a. b. c. d. e.
Cortisol and growth hormone limit glucose utilisation The glucagon response to hypoglycaemia is markedly impaired or absent in patients with type I diabetes Avoidance of hypoglycaemia can restore hypoglycaemic awareness Hypoglycaemic episodes result in the development of hypoglycaemia unawareness. A gradual decline in blood glucose is less likely to evoke autonomic warning symptoms
26.
With regards to parathyroid-related peptide (PTHrP) which one of the following statements are INCORRECT?
a. b. c. d. e.
PTH and PTHrP share a common receptor Immunohistochemistry and in-situ hybridisation techniques demonstrate PTHrP in 95-100% of squamous carcinomas PTHrP can be expressed by myeloma arid B cell lymphomas Hypercalcaemia with small cell carcinoma is rarely due to PTHrP production PTHrP is commonly detectable in the serum of children less than five years of age
27.
Which one of the following regarding diabetes mellitus in the elderly is INCORRECT?
a. b. c. d. e.
At age 65-74 years the prevalence of diabetes mellitus is approximately 17.5%. Advancing age is associated with a modest increase in fasting plasma glucose and a decreased thermogenic response to an oral glucose load. Central adiposity is a major predictor of fasting blood glucose. Glycosylated haemoglobin levels have been shown to decrease with increasing age. 30% of non-insulin dependent diabetics will eventually require insulin.
28.
Calcitonin:
a. b. c. d.
with calcium infusion bone resorption with Pentagastrin Produced by Hurtle cells
29. A 44 yo man develops mid-thoracic pain while gardening. Photo shows thin kyphotic man, looks rather feminine. A lateral CXR shows multiple wedge fractures. The best investigation to elucidate the cause is? a. b. c. d. e.
Se testosterone 24 hour urinary free cortisol sEPP Vitamin D level Se PTH
30.
The best investigation to establish a diagnosis of Cushing’s disease is?
a. b. c. d.
AM plasma cortisol 0900 Se ATCH high dose DST 24 hour urinary free cortisol
31.
A young female presents with a one month history of lethargy, weight loss and tremor. Examination confirms tremor and pallor. TFTs: TSH < 0.1, fT4 40 (10-20) Hb 80, MCV 60, WCC 6.8, normal diff, plt 450 film shows hypochromic pencil cells, thin rim of cytoplasm only, some immature red cells seen.
The most likely cause of this haematological picture is: a. b. c. d.
Fe deficiency blood loss thalassaemia trait hyperthyroidism
32. A well-tanned 23 yo female nurse has episodes of collapse, both before and after meals. BSL before breakfast after and overnight fast is 1.9 mmol/L. Her insulin is extremely high. The best investigation to establish a diagnosis is: a. b. c. d. e.
GTT endoscopic ultrasound synacthen test C-peptide CT abdomen
33. A middle-aged lady presents with a clinically solitary thyroid nodule. Her TFTs are normal, and her thyroid scan shows reduced tracer uptake in the region of the nodule. The most likely diagnosis? a. b. c. d. e.
Hashimoto’s Grave’s Thyroid cancer Thyroid adenoma MNG
34. Another elderly lady presents with pain radiating from her right groin down to her thigh. Her AlkP is elevated and her pelvic XR is shown – sclerosis of right hemipelvis. The best management is/ a. b. c. d.
pamidronate calcitonin etidronate regular panadol
35. An 18 yo female medical student presents with a six month history of progressive hirsuitism and deepening of her voice. She went through menarche at age 14 and has always been oligomenorrhoeic. Examination shows clitoromegaly and hirsuitism. Testosterone 8 9<2), low sex hormone binding globulin, DHEAS normal. Which is the most appropriate next investigation? a. b. c.
CT abdomen ovarian ultrasound DST
36. A photo of a middle-aged man with a very red face and trunk is shown. He has a history of intermittent flushing. The best test to establish a diagnosis is? a. b. c. d.
CT abdomen Se catechols urine 5HIAA CT chest
37. A middle-aged man is found to be hypercalcaemic on routine tests (Ca 2.8). His Se PTH is just above the normal range. His mother also has high Ca, but has never had surgery. The most appropriate initial investigation is: a. b. c. d.
parathyroid scan US neck 24 hour urine calcium DNA studies
38.
With respect to TFTs:
a. b. c. d. e.
Oestrogen significantly reduces T4 levels Amiodarone decreases reverse T3 levels The majority of circulating T3 is secreted directly from the thyroid gland Patients with primary pituitary hormone resistance are clinically thyrotoxic The commonest abnormality in thyroid function in patients with mild non-thyroidal illness is a suppressed TSH level.
39.
With regard to HRT:
a. b.
RCT show approximately 50% reduction in cardiovascular mortality in women who are current users of HRT Combined continuous HRT induces a more favourable effect on the lipid status of post menopausal women than sequential HRT regimens
c. d. e.
Approximately 50% of the beneficial effect of HRT on the cardiovascular system is mediated via non- lipid effects RCT indicate a 30% increase in the risk of breast cancer among women using HRT for more than 5 years after menopause Oestrogen-only HRT is favoured for women who have previously undergone endometrial resection.
40. A 25 yo male with a 17 yr history of IDDM has a urinary albumin excretion of 40-60 mg/min. His BP is 130/80. His U&Es are normal. What is the most appropriate management? a. b. c. d. e.
Commence ACE inhibitor Measure 24 hour urinary protein excretion Commence Ca channel blocker Repeat microalbuminuria determination in 12 months Commence low protein diet
41. A 42 yo hypertensive woman presents with intermittent weakness. On examination her BP is 165/100 and she is on atenolol. K+ is 3.2, plasma renin activity is 0.5 and aldosterone is 250 (<240). What is the most likely cause of her hypertension? a. b. c. d. e.
Essential hypertension An aldosterone-producing tumour Bilateral adrenal hyperplasia Liquorice ingestion Glucocorticoid steroid-suppressed hypertension
42. A 65 yo female on antihypertensive therapy consisting of a blocker and a thiazide for 5 years was fond to have an elevated BP (150/90) despite the addition of a Ca channel blocker. On examination she has an S4 and flame hemorrhages on fundoscopy. K+ 3.0, HCO3- 30.0, Creatinine 0.12. Urinalysis demonstrates 1+ protein, renal US shows Rt kidney 10.5 cm and Lt kidney 10 cm. What investigation would most likely give the diagnosis/ a. b. c. d. e.
Adrenal vein sampling IVP Adrenal CT Renal angiography Renal biopsy
43. A 65 yo male is found to have a 6 cm right adrenal mass while undergoing CT for unrelated reasons. History and clinical examination are unremarkable. He is normotensive. The next most appropriate step in his management is: a. b. c. d. e.
Determine whether the lesion is hypersecreting Advise right adrenalectomy an iodocholesterol scan CT-directed FNAB repeat CT in 6/12 to determine if enlarging
44. A 24 year old woman is brought to the hospital following a seizure. On arrival she is found to be disoriented and confused. A plasma glucose level is 1.3 mmol/L. She is not known to be diabetic. A further sample is taken for plasma insulin and c-peptide levels, and then she is resuscitated with intravenous glucose. the results of these investigations are as follows; BSL C-peptide Plasma insulin
1.3 <0.5 40
(0.5-2 g/L) (5-20 U/mL)
The most likely diagnosis is:
a. b. c. d. e.
insulinoma post-prandial hypoglycaemia Exogeneous insulin administration tumour producing IGF-2 surreptitious sulfonylurea abuse
45. A man aged 55 years presents with a 3/12 history of progressively more severe diarrhoea. Stool are frequent, watery and of large volume. There is no macroscopic blood or mucus. He feels weak, lethargic, and is constantly thirsty. Urine output is low. He has lost 3 kg during the period of his illness. On examination he is mildly dehydration and has noticeable generalised muscle weakness. No skin lesions are noted. Abdominal examination including PR and sigmiodoscopy are normal. The following results were obtained: HB 178 WCC 13.1, normal diff ESR 40 Na+ 138, K+ 2.3, Ca 2.71, PO4 1.45 Fasting BSL 7.0 Stool volume 1035 mL/24 hours; no WBC, RBC, ova, cysts; no pathogens isolated Faecal fat 3g/24h Urinary 5HIAA normal Gastric acid secretion fasting 0.2 mmol/hr peak after pentagastrin 3.7 mmol/hr Which of the following would you consider most likely? a. b. c. d. e.
Gastrinoma Crohn’s disease of the small bowel MEN Type I glucagonoma VIPoma
