ENDOCRINOLOGY CLASS TEST:
Q1. A 42-year-old woman is referred to the clinic with very difficult to
manage hypertension. She is currently taking indapamide, ramipril,
amlodipine and doxasosin, yet her blood pressure is still 155/95
mmHg. On examination she has a BMI of 25. Ophthalmoscopy reveals
evidence of chronic changes consistent with hypertension.
Bloods reveal;
Hb 14.0g/dl
WCC 5.8 x 109/L
PLT 190 x 109/L
Na+ 139mmol/l
K+ 3.3mmol/l
Creatinine 100 μmol/l
You suspect Conn’s syndrome.
Which of the following is the investigation of choice to
confirm the diagnosis?
1- CT Abdomen.
2- Iodine (I131) iodocholesterol scanning.
3- Aldosterone:Renin ratio.
4- MRI abdomen.
5- Morning cortisol.
Q2. A 34-year-old man presents to the diabetes clinic with a history of
thirst, polyuria and a recent 3.2 kg (7 lb) weight loss. His urine
contains a small amount of ketones.
Which of the following would suggest he is most likely to
have type-2 rather than type-1 diabetes?
1- A BMI of 23
2- High circulating insulin level
3- HLA type DR-3
4- Positive islet-cell antibodies
5- Plasma bicarbonate level of 8 mmol/l.
Q3. A 30-year-old woman presented with an 18-month history of
polyuria and polydipsia. Her only other history of note was increasing
joint pains, and one visit to the GP with depression some 6-months
ago. Examination was unremarkable.
Bloods:
Glucose 4.1 mmol/l
Urea 7.2 mmol/l
Creatinine 80 micromol/l
Corrected serum calcium 3.1 mmol/l
Serum Phosphate 0.7 mmol/l
Parathyroid hormone 6.2 pmol/l (0.9-5.4)
Which of the following is the most likely cause of this clinical
picture?
1- Raised levels of calcitonin
2- Hypervitaminosis D
3- Primary Hyperparathryoidism
4- Secondary Hyperparathryoidism
5- Medullary thyroid carcinoma.
Q4. A 54-year-old man who has received previous surgery for
acromegaly is receiving lanreotide medical therapy as his growth
hormone is persistently elevated.
What is the mode of action of lanreotide?
1- Inhibition of the somatostatin receptor
2- Inhibition of the growth hormone receptor
3- Stimulation of the somatostatin receptor
4- Stimulation of the dopamine D2 receptor
5- Inhibition of the dopamine D2 receptor.
Q5. A 32-year-old man presents with unilateral gynaecomastia. He
had breast reduction surgery on the other side 10 yrs ago. On
examination he has, sparse body hair in the axilla and pubic regions.
Two testicles are identified, both of small volume. On further
questioning you elucidate that he has a normal sense of smell. His
blood tests reveal:
Testoterone 4nmol/l (9-35)
LH + FSH normal
Prolactin 400mU/l (<360)
Which of the following is the most likely diagnosis?
1- Klinefelter’s syndrome
2- Kallman’s syndrome
3- Androgen insensitivity
4- Testicular feminisation
5- 17-beta hydroxylase deficiency.
Q6. A 27-year-old woman with type-1 diabetes mellitus attends for
her routine review and says she is keen on becoming pregnant.
Which of the following is the factor most likely to make you
ask her to defer pregnancy at this stage?
1- Minor background retinopathy
2- Hb A1C 9.4%
3- She hasn't been taking folic acid
4- Microalbumin level of 6-mg excretion in 24 hours
5- Sensory neuropathy.
Q7. A 42-year-old woman presents to the Emergency Clinic with
palpitations and shortness of breath. Recent thyroid function tests on
the hospital computer reveal thyroid-stimulating hormone (TSH) of
<0.05 mU/l and a markedly elevated T4. You arrange blood gas
testing.
Which of the following findings would be most consistent
with Grave's disease?
1- Respiratory acidosis
2- Decreased pa(O2)
3- Increased pa(CO2)
4- Decreased pa(CO2)
5- Decreased Ph.
Q8. A 38-year-old woman presents to her GP complaining of
palpitations, sweating and weight loss of around 4kg over the past 6
months. She has a history of thyroid disease in the family. On
examination she has a blood pressure of 145/85 mmHg and a pulse of
92/minute.
Bloods;
TSH <0.05 mU/l
Hb 13.4 g/dl
WCC 5.6 x 109/L
PLT 223 x 109/L
Na+ 140 mmol/l
K+ 4.0 mmol/l
Creatinine 100 μmol/l
You suspect that she has thyrotoxicosis.
Which of the following fits best with the action/effects of
excess thyroxine?
1- Improved insulin sensitivity
2- Decreases myocardial oxygen demand
3- Increased tissue elasticity
4- Increases prolactin release
5- Leads to increased bone mass.
Q9. Which type of thyroid carcinoma is linked to the ret-
proto-oncogene?
1- Papillary thyroid carcinoma
2- Anaplastic thyroid carcinoma
3- Follicular thyroid carcinoma
4- Medullary thyroid carcinoma
5- Thyroid lymphoma.
Q10. A 62-year-old man is brought to the Emergency department with
a grand-mal seizure. You are aware from his notes that he has
undergone chemotherapy for small cell carcinoma of the bronchus a
few months earlier. His wife tells you that he was drowsy and not
himself for a day or two before the seizure.
On examination he is very drowsy but you can wake him up with
stimulation. He is very thin with evidence of muscle and fat loss
consistent with his carcinoma. Neurological examination reveals no
focal signs.
Bloods on admission;
Na+ 123 mmol/l
K+ 4.0 mmol/l
Creatinine 100 μmol/l
Urea 3.5 mmol/l Hb 11.1 g/dl
WCC 4.5 x 109/L
PLT 230 x 109/L
You suspect SIADH and fluid restrict him. Despite no evidence of him
having taken in more fluids than documented his sodium deteriorates
to 119 mmol/l the following day. His drowsiness has increased.
Which of the following represents the most appropriate
management for him?
1- Continue fluid restriction
2- Start dexamethasone
3- Give normal saline 0.9%
4- Give normal saline 1.8%
5- Start demeclocycline.
Q11. A 76-year-old woman with thyroid cancer comes to see you.
Which of the following has the worst prognosis in thyroid
cancer?
1- Papillary carcinoma with lymph node metastases
2- Follicular carcinoma with bone metastases
3- Anaplastic carcinoma with long-standing goitre
4- Thyroid lymphoma
5- Medullary carcinoma as part of MEN.
Q12.
A 24-year-old woman is referred by her GP. She is 10 weeks' pregnant
and complaining of anxiety and an inability to sleep
total thyroxine (T4) is noted to be 160 nmol/l (normal 70-140)
Free T4 is noted to be 27 pmol/l (normal 9-25)
thyroid-stimulating hormone (TSH) 0.4 mU/l.
Which of the following is the management of choice in this
patient?
1- Commence low-dose carbimazole therapy
2- Commence propylthiouracil therapy
3- Observe and repeat thyroid function tests in 1 month
4- Start high dose carbimazole and thyroxine concomitantly
5- Measure antithyroid antibody levels.
Q13. A 27-year-old pharmacist is admitted to the Emergency room
with a panic attack. On further questioning it transpires that she has
been suffering from palpitations and has lost weight over the past 6
months. Her periods stopped 3 months ago. On examination her BP is
145/90 mmHg, pulse is 92/min at rest. Her BMI is 20; the remainder of
her clinical examination is unremarkable.
Investigations;
Hb 13.1 g/dl
WCC 4.9 x 109/L
PLT 145 x 109/L
TSH <0.05 U/l
Free T4 32 pmol/l
Thyroglobulin low
Decreased thyroid uptake on scintography scan
Which of the following is the most likely diagnosis?
1- Hashimoto’s thyroiditis
2- Graves'disease
3- Toxic multinodular goitre
4- Thyrotoxicosis factitia
5- Struma ovarii.
Q14. A 32-year-old woman presents with collapse. She works in an
office environment and it has been a particularly hot day. On
examination in casualty she looks a little dehydrated. BP is 110/70
mmHg.
The following serum electrolyte results are obtained;
Na+ 134mmol/l
K+ 2.9mmol/l
Mg++ 0.57 mmol/l (0.75-1.05)
HCO3- 34mmol/l
What is the most likely diagnosis?
1- Bartter's syndrome
2- Gitelman's syndrome
3- Gordon's syndrome
4- Conn's syndrome
5- Liddle's syndrome
