Endocrinology

- 1) A woman with metastatic lung cancer develops profound weakness with

alternating diarrhea and constipation. Physical examination shows
hyperpigmentation of skin even in areas protected from the sun. Which endocrine
organ is involved in the tumor?

A. Pituitary gland
B. Adrenal gland
C. Endocrine pancreas
D. Ovaries
E. Thyroid gland

- 2) A 32 y/o woman comes to ur office because she has noticed milk like
discharge from her breasts from the past 4 weeks. She also states she has not
menstruated in 2 months.The examination reveals galactorrhea but is
otherwise normal.What is ur diagnosis.

A.Hypo prolactenemia
B.Hyper prolactenemia
C.Acromegaly
D.Hypothyroidisim

- 3) Miss Noreen is a patient who is 28 years old presented in OPD with swelling in
front of neck which is painful and tender. The pain radiates to the angle of jaw and
the ears and worsens by swallowing and coughing and movements of neck. She is
the case of hepatitis C and taking interferon for 4 months. Investigations reveals
serum T3 and T4 are raised but serum TSH is undetectable. What will be:

A. Hashimoto's thyroiditis
B. Supparative thyroiditis
C.Reidel's thyroiditis
D. Sub-acute (de Quervain's) thyroiditis
E. Endemic iodine deficiency goiter

- 4) A 30 yrs old female presents in your elinic with episodes of hypertension and
weight gain. The weight gain is especially around the trunk, moon facies and
accumulation of fat in the posterior neck and back (buffalo hump) are also
noticeable. What is right about Cushing's syndrome?
A. Biochemical and imaging studies detect the case
B. The most common cause is functional adrenal adenoma
C. It is confirmed by measuring serum cortisol
D. Treatment of endogenous cause of Cushing's syndrome is medical

- 5) A 15 yr old girl was brought to the emergency in coma. Her breath smelt like
acetone. Diagnosis would be most likely consistent with:
A. Alcohol intoxication
B. Heroin overdose
C. Profound hypoglycemia
D. Diabetic ketoacidosis
E. Diazepam overdose

- 6) Cushing disease is a feature of:

A. Chromophobe adenoma of pituitary gland
B. Acidophilic adenoma of pituitary gland
C. Basophilic adenoma of pituitary gland D. Non secreting adenoma of pituitary gland
E. Microprolactinoma

- 7) Main cause of peripheral neuropathies are:

A. Excessive physical work
B. Deficiency of Vitamin D
C. Chondroplasia
D. Hypertension
E. Diabetes mellitus

- 8) A 32-year-old female presents with a two month history of agitation,

menstrual irregularity and weight loss. Examination reveals a tremor and a palpable
goitre with a bruit. Which one of the following would most likely be present in this
patient?
A. Anti-thyroglobulin antibody
B. Thyroid microsomal antibodies
C. Thyroid peroxidase antibodies
D. TSH receptor inhibiting antibodies
E. TSH receptor stimulating antibodies

- 9) Which of the following statements is true of primary hyperparathyroidism

(HPT)?
A. It is associated with bone resorption by PTH to restore depressed serum calcium
levels to normal
B.It is associated with hypocalciuria due to elevated parathyroid hormone (PTH)
levels
C. It is usually caused by an adenoma of a single parathyroid gland
D. It progresses to tertiary hyperparathyroidism with time
E. PTH is secreted in a pulsatile manner from the posterior pituitary and acts through
PTH receptors on parathyroid cell membranes

- 10) A 40-year-old man was found to have acromegaly. What is the most likely
cause of death if treatment is unsuccessful?
A. Colorectal carcinoma
B. Diabetic nephropathy
C.Gastric carcinoma
D. Increased intracranial pressure
E.. Left ventricular failure

- 11) A 46-year-old man presents passing 4-5 litres of urine per day after
commencing a new drug. Tests show:
serum sodium 142mmol/L(137-144)

Plasma osmol 295 mosmol/L (275-290)

Urine osmol 280 mosmol/L(350-1000)

What drug was prescribed?

A. Carbamazepine
B. Chlorpropamide
C. Fluoxetine
D. Furosemide
E. Lithlum

- 12) A 17-year-old female with type 1 diabetes, who is known to be poorly

compliant with treatment, is admitted with diabetic ketoacidosis The respiratory rate
is 41 per minute and the blood pressure 85/66 mmHg. She is confused and lethargic.
An arterial blood gas shows the pH to be 7.01, and the potassium is 4.9 mmol/1.
Which condition carries the highest risk of mortality to this patient?
A. Cerebral oedema
B. Cerebrovascular accident
C. Myocardial infarction
D. Seizure
E. Ventricular tachycardia

13) A 70 year old man is diagnosed with benign prostatic hyperplasia (BPH),and his
physician is considering drug treatment of the condition. It was decided that the drug
finasteride will be used. The effects of finasteride will result in a decrease in the
synthesis of what substance?

A. Epinephrine
B. Norepinephrine
C. Dihydrotestosterone
D. Testosterone
E. GnRH

14) When used at higher doses than commonly employed for other purposes,what
drug can effectively inhibit steroidogenesis in a variety of tissues?

A. Flutamide
B. Misoprostol
C. Clomiphene
D. Tamoxifen
E. Ketoconazole
15) A 62-year-old female with colonic carcinoma is treated with chemotherapy and is
receiving ondansetron for intractable nausea and vomiting. Which of the following
best describes the pharmacological actlons of ondansetron?

A. Anticholinergic
B. Cannabinoid
C. Dopaminergic antagonists
D. H1 antihistamine
E. 5-HT3 antagonist
E. 5-HT3 antagonist

16) A 0.7 cm microadenoma of the adenohypophysis is seen by head MRI in a 25 yr

old female. Which of the following complications is she most likely to have?

A. Amenorrhea with galactorrhea

B. Hyperthyroidism
C. Cushing disease
D Syndrome of inappropriate antidiuretic
hormone (SIADH)

17) A 30 yrs old female presents with amenorrhea, galactorrhoea and infertility.
Radiographic evidence of calcification is seen in the region of sella tursica. Provisional
diagnosis of pituitary adenoma is made. What is consistent with this diagnosis?
consistent with this diagnosis?

A. Cushing's syndrome due to ACTH

secreting adenoma is known as Cushing
Disease
B. Non functional adenomas present
earlier than functional adenomas
C. Pituitary adenomas may not produce
signs and symptoms of raised intracranial
pressure
D. Prolactinoma presents earlier in males
than females

18) Of the following endocrine structures, the commonest site of metastases from a
bronchogenic carcinoma is the
A. Posterior pituitary
B. Thymus
C. Pancreas
D. Adrenal glands
D. Adrenal glands
19) ACTH and ADH production is associated with which histological subtype of lung
cancer?

A Squamous cell carcinoma

B. Adenocarcinoma
C. Small cell carcinoma
D. Large cell carcinoma

20) A 44 y/o female comes to opd with complaints of dehydration,hypotension and

weight loss on examination it was revealed that she was also having UTI.She has a
medical history of hypertension and diabetes which of the drug is responsible for
these symptoms?

A.Tolbutamide
B.Rapeglinide
C.Rosiglitazone
C.Rosiglitazone
D.Dapagliflflozin

21) Managment of choice for a 19y/o with polyuria,polydipsia and fasting

plasma glucose =157mg/dL is,

A.Metformin
B.Nateglinide
C.Detemir
D.Pioglitazone

22) Side effect of metformin is,

A.Lactic acidosis
B.B12 deficiency
C.Hypoglycemia
D.Both A and B
23) A patient with chronic renal failure has low serum calcium and failure has low
serum calcium and high phosphate. The following will explain these biochemical
changes:

A. Decreased calcium absorption in gut

B Decreased level of 1, 25-dihydrocholecalciferol
C Decreased level of Parathormone
D. Increased calcium loss in urine
E. Increased osteoclastic activity

24) A 32-year-old woman presents with a one year history of secondary amenorrhoea.
She had been prescribed temazepam and dihydrocodeine On examination she had
galactorrhoea. Her serum proiactin was noted to be 6000 mU/L
(<450 mU/L. What is the most likely diagnosis?

A. Drug-induced hyperprolactinaemiA. hyperprolactinaemia

B. Hypothyroidism
C. Pituitary dependent Cushing's disease
D. Pituitary microadenoma
E. Stress
25) A 19-year-old man form a travelling family comes to the endocrine clinic for
review.He has bony aches and pains and feels tired all the time. On examination his
BP is 110/72 mmHg, pulse is 70 and regular, His BMI is 21, and he is only 160 cm in
height. ACcording to his mother this is much shorter then his brothers. He has
bilateral shortened fifth digits on both hands Investigations show:
Haemogiobin 129 g/L (130-180)
White cell count 8.3 x10/L (4-11)
Platelets190 x10/L (150-400)
Sodium 140 mmol/L (135-146)
Sodium 140 mmol/L (135-146)
Potassium 4.2 mmol/L (3.5-5)
Creatinine 95 umol/L (79-118)
Calclum 2.00 mmol/L (2.2-2.61)
Phosphate 1.6 mmol/L (0.8-1.5)
Which of the tollowing is the most
appropriate treatment?
A. Calcitonin
B. Calcium and vitamin D
C. Cinacalcet
D. Magnesium sulphate
E. Sevelamer

26) A 39-year -old woman presents with pain and tenderness over the anterior neck,
agitation and anterior neck, agitation and palpitations. She has also had flu-like
symptoms and generalised aches and pains over the past few weeks. On examination
her BP is 135/72 mmHg, her pulse is 90 and regular. She has a fine tremor and is
tender over her thyroid. Investigations show:

Haemoglobin 119 g/L( 115-160)

White cell count 9.8 (4-11)
Platelets 203 (150-400)
Sodium 137 mmol/L (135-146)
Potassium 3.9 mmol/L (3.5-5)
117 umol/L (79-118)
Creatinine 117 umol/L (79-118)
TSH <0.05 IU/L (0.5-4.5)
Thyroid radio-isotope scan shows uptake
decreased.
What is the most likely diagnosis?

A.Graves disease
B.Struma ovarii
C.Sub acute thyroiditis
D.Thyrotoxicosis factitia

27) A diabetic with hyper osmolar coma should be given;

A. INH insulin
B. Regular
C. Lente
D.None of above

28) You are asked to see a 62-year - old woman on the surgical ward a few hours after
she has undergone a thyroidectorny. The nurses are concerned because she fells
them she feel unwell. Which of the following symptoms would be most consisten with
hypocalcaemia as a result of inadvertent parathyroidectomy?
A. Hyperventilation
B. Nausea
C. Paraesthesia
D.Polyuria
E. Thirst
29) A 56-year-old man presented to the Emergency department with an
episode of collapse at home. He had been feeling increasingly tired with polyuria for
the last two months and polyuria for the last two months and also reported a loss of
libido He had undergone transsphenoidal surgery two years ago, followed by exemal
bean radiation for a non-functional pituitary adenoma, He took ramipril 10 mg OD for
hypertension. On examination, pulse was 102 beats per minute and regular, BP
measured 104/66 mmHg in the lying position, dropping to 80/40 mmHg on tesicular
volume was normal.
12 lead ECG Normal
Fasting plasma glucose 4.9 mmol/L
(3.0-6.0)
Serum sodium 129 mmol/L (137-144)
Serum potassium 4.8 mmol/L (3.5-4.9)
Serum urea 7.2 mmol/L (2.5-7.5)
Serum creatinine 88 umol/L (60-110)
Serum testosterone 4.5 nmol/L (9-35)
Plasma luteinising hormone 0.3 U/L
Plasma luteinising hormone 0.3 U/L
(1-10)
Pasma thyroid-stimulating hormone
0.1mU/L (0.4-5)
Pasma Free T4 7pmol/L(10-22)
Insulin-like growth factor 15.2 nmol/L
(5.6-23.3)

Which is the most appropriate immediate

treatment for this man.

A.Desmopressin
B.Growth Hormone
C.Hydrocortisone
D.Thyroxine
30) 45 A 25-year-old woman comes to the GP surgery a few weeks after
the birth of her first child. Unfortunately she suffered a postpartum haemorrhage and
required a three unit blood transfusion Over the past few weeks
she has been feeling increasingly tired but puts this down to post pregnancy
blues. She tells you that she seems to be losing her hair. On examination her
BP is 100/60 mmHg, pulse is 62 and regular.
Investigation shows:
HB 105g/L (115-160)
WBC 7.3 (4-11)
Platelets 207 (150-400)
Platelets 207 (150-400)
Sodium 130mmol/L (135-146)
Potassium 5.1mmol/L (3.5-5)
Creatinine 122umol/L (79-118)
TSH 0.3IU/L (0.5-4.5)

Which of the following is most likely

diagnosis?

A.Addisons disease
B.Graves disease
C.Hashimotos thyroidits
D.Sheehans syndrome

31) A 16-year-old girl is noted to have persistent polyuria in excess of 4 litres per day
whilst recovering from a head injury she sustained in a road traffic accident
Investigations reveal:

Potassium 4.1 mmol/L (3.5-4.9)

Calcium 2.4 mmol/L (2.2-2.6)
Glucose 5.6 mmol/L (3.0-6.0)

Which one of the following is the most

effective method of confirming the
diagnosis?

A. Autoantibodies to vasopressin
neurones
B. MRI of the hypothalamus and pituitary
C. Vasopressin concentration
D. Water deprivation test

32) Secondary hyperaldosteronism can occur due to:

A. Hypertension
B. Decreased renin
B. Decreased renin
C. Increased renin
D. Increased potassium

33) A 40 yr old woman comes to the

emergency room with a fracture in the
neck of the femur. Radiographs reveal
generalized demineralization of the
bone in the area. Her plasma calcium
ion concentration is significantly
greater than normal: 12.2 mg/dl.
Which of the following conditions is
consistent with this presentation?

A. Osteoporosis
B. Rickets
C. Hyperparathyroidism
D. Renal failure

34) A large dose of insulin is

administered intravenously to a
normal 34 yr old female patient. This
is likely to cause an increase in all of
the following except.

A. Plasma epinephrine concentration

B. GH secretion
C. ACTH secretion
D. Glucagon secretion
E. Plasma K+ concentration
35) A 40-year-old man was referred to
the endocrine clinic for his resistant
hypertension. He was taking the
following medications: atenolol 50 mg
once daily ramipril 10 mg once daily
doxazosin 4 mg daily, amlodipine 10
mg daily and bendroflumethiazide 2.5
mg daily, On examination his pulse
was 64 beats per minute, his blood
was 64 beats per minute, his blood
pressure was 162/96 mmHg, heart
sounds were normal and there were
no cushingoid features.
Investigations showed:
Serum urea 4.4 mmol/L (2.5-7.5)
Serum creatinine 88 umol/L (60-110)
Serum potassium 3.6 mmol/L(3.5-4.9)
Which is the most important medication
to pe discontinued before testing his
aldosterone/plasma renin activity ratio?
A. Amlodipine
B. Atenolol
C. Doxazosin
D. None of his medications
E. All of his medications

36) The treatment of gestational

diabetes would comprise of:
A. Glebenclamide
B. Chlorpropamide
C. Glipizide
D. Insulin
37) Which of the following antidiabetic
drug may be associated with an
increased risk of ketoacidosis?
A. Chlorpropamide
B. Glyburide
C. Isophane
D. Nateglinide
E. Metformin

38) Propylthiouracil produces its

useful actions in hyperthyroidism by
inhibiting:
inhibiting:
A. Uptake of iodide by thyroid gland
B. Secretion of thyrotropin (TSF) by
pituitary
C. Release of hormone from thyroid gland
D. Synthesis of thyroglobulin
E. Synthesis of thyroid hormone tonic

39) A 43-year-old man with a history

of goiter undergoes a thyroidectomy.
One week later, he returns to the
physician because of carpopedal
spasms, muscle and abdominal
cramps, and tingling of his lips and
hands. Laboratory studies show a
serum calcium of 6.2 mg/dL and
serum phosphorous of 5.7 mg/dL.
Physical examination shows tetany of
the facial muscles upon tapping the
patient's face in front of the ear.
Which of the following drugs will most
likely improve this patient's
symptoms?
A. Bumetanide
B. Ergocalciferol
C. Levothyroxine
D. Metolazone
D. Metolazone
E. Pamidronate
40) A 45-year-old woman comes to
the physician because of a severe
sore throat. Her temperature is 38.5°C
(101.3°F). Six weeks ago, the patient
had an upper respiratory infection that
resolved on its own. Physical
examination shows an extremely
tender, enlarged thyroid gland, but no
erythema of the throat. Serum studies
show a T4 of 16 ug/dL, T3 of 200 ng/
dL, TSH of 0.3 Fu/mL, and an ESR of
30 mm/hour. Two months later, the
patient is asymptomatic and thyroid
function tests have returned to
normal. She never again experiences
difficulty with her thyroid function
Which of the following is the most
likely cause of her transient
likely cause of her transient
hyperthyroidism?
A. Diffuse nontoxic goiter
B. Graves disease
C. Hashimoto thyroiditis
D. Subacute granulomatous thyroiditis
E. Subacute lymphocytic thyroiditis

41) A 38-year-old woman comes to

the physician because of excessive
thirst and urination for the past 4
weeks. Her appetite has been normal,
but she has lost 6.8 kg (15 lb) in 1
month. Physical examination shows
erythematous necrotizing skin
eruptions on her legs. Her fasting
blood glucose is 170 mg/dL A CT
scan shows a tumor in the tail of the
pancreas Which of the following is the
pancreas Which of the following is the
most likely cell from which the
pancreatic tumor is derived?

A. Acinar cell
B. Alpha cell
C. Beta cell
D. Delta cell
E. G cell

42) A 42-year-old man comes to the

physician because of a neck mass,
hoarseness, and diarrhea. He has
history of a previously resected
pheochromocytoma. Physical
examination shows 4 palpable soft
nodules present in both thyroid lobes.
He undergoes thyroid gland resection.
Gross examination of the thyroid
gland shows multifocal tumor with
hemorrhage, necrosis, and spread
hemorrhage, necrosis, and spread
outside the thyroid capsule. On
histologic examination, the tumor is
composed of uniform polygonal cells
arranged in nests. There is also an
abundance of parafollicular protein,
which demonstrate apple-green
birefringence under polarized light
when stained with Congo Red. Which
of the following was most likely being
secreted by the tumor cells in this
patient?
A. Calcitonin
B. Parathyroid hormone
C. Thyroid-stimulating hormone (TSH)
D. Thyroxine (T4)
E. Triiodothyronine (T3)