Endocrinology — MCQs

Endocrinology Indian Medical PG Practice Questions and MCQs

Question 1561: Which of the following is not seen in MEN 2B syndrome?

A. Mucosal neuroma
B. Marfanoid habitus
C. Parathyroid adenoma (Correct Answer)
D. Megacolon

Explanation: ***Parathyroid adenoma*** - **Parathyroid adenomas**, leading to hyperparathyroidism, are characteristic of **MEN 2A syndrome**, not MEN 2B [1]. - While both MEN 2A and 2B involve mutations in the **RET proto-oncogene**, the specific clinical manifestations differ significantly. *Megacolon* - **Megacolon** (due to intestinal ganglioneuromatosis) is a recognized feature of **MEN 2B syndrome**. - This condition involves abnormal nerve ganglion cells in the intestine, leading to motility issues. *Mucosal neuroma* - **Mucosal neuromas** on the tongue, lips, and eyelids are a hallmark clinical sign of **MEN 2B syndrome**. - These benign growths are often one of the earliest and most recognizable features. *Marfanoid habitus* - **Marfanoid habitus**, characterized by a tall, slender build with long limbs and arachnodactyly, is a common physical finding in **MEN 2B syndrome**. - This connective tissue abnormality helps distinguish MEN 2B from other MEN syndromes.

Question 1562: MC location of gastrinoma in MEN-1 syndrome?

A. Jejunum
B. Ileum
C. Duodenum
D. Pancreas (Correct Answer)

Explanation: ***Pancreas*** - In **Multiple Endocrine Neoplasia type 1 (MEN-1) syndrome**, gastrinomas are most commonly found in the **pancreas**. - While sporadic gastrinomas are frequently duodenal, the **genetic predisposition of MEN-1** shifts the primary location to the pancreas. *Duodenum* - **Sporadic gastrinomas** without MEN-1 syndrome are most frequently located in the **duodenum**, particularly the first and second parts. - However, in the context of **MEN-1**, the pancreas becomes the predominant site for gastrinoma development. *Jejunum* - The jejunum is an **uncommon location** for gastrinomas in both sporadic cases and those associated with MEN-1. - Gastrinomas found in the jejunum are typically **rare** and often associated with more aggressive disease or disseminated metastasis. *Ileum* - The ileum is an **extremely rare site** for gastrinomas. - Gastrinomas developing in the ileum are usually **ectopic** and are not typically the primary location in either sporadic cases or MEN-1 syndrome.

Question 1563: Which is the most common pancreatic endocrine neoplasm?

A. Insulinoma (Correct Answer)
B. Gastrinoma
C. VIPoma
D. Glucagonoma

Explanation: ***Insulinoma*** - It is the **most common pancreatic endocrine neoplasm**, characterized by excessive insulin production leading to hypoglycemia. - Most patients present with **symptoms of hypoglycemia**, such as sweating, confusion, and palpitations due to overproduction of insulin [1]. *Gastrinoma* - Generally implicated in **Zollinger-Ellison syndrome**, it causes excessive gastric acid secretion, leading to severe ulcers but is less common than insulinoma. - Associated with **diarrhea and abdominal pain**, not typically causing hypoglycemia [1]. *Glucagonoma* - Rarely seen, it causes **hyperglycemia** and characteristic **necrotizing migratory erythema**, rather than hypoglycemic episodes. - Comprises a minority of pancreatic endocrine tumors and is not the most common type. *VIPoma* - Produces **vasoactive intestinal peptide**, leading to profuse watery diarrhea and severe electrolyte imbalance. - It is uncommon compared to insulinoma and primarily causes gastrointestinal symptoms rather than hypoglycemia.

Question 1564: Which of the following is commonly seen in Pituitary apoplexy?

A. Headache (Correct Answer)
B. Hypertension
C. Hypotension
D. Vomiting

Explanation: ***Headache*** - **Severe headache** is the most common symptom of pituitary apoplexy, resulting from the sudden expansion of a pituitary mass due to hemorrhage or infarction [1]. - The rapid increase in pressure within the sella turcica, especially on the **dura mater**, causes intense pain. *Hypertension* - While stress can elevate blood pressure, **hypertension** is not a characteristic or direct symptom of acute pituitary apoplexy itself. - Instead, the condition often leads to **adrenal insufficiency**, which is associated with hypotension [1]. *Hypotension* - **Hypotension** is a common and serious manifestation of pituitary apoplexy, often due to acute **adrenal insufficiency** caused by the destruction of ACTH-producing cells [1]. - Reduced ACTH leads to decreased cortisol production, impairing vascular tone and fluid balance. *Vomiting* - **Vomiting** is a common symptom in pituitary apoplexy, often accompanying the severe headache. - It results from the increased **intracranial pressure** and irritation of pathways in the brainstem.

Question 1565: VMA is excreted in urine in which condition -

A. Alkaptonuria
B. Phenylketonuria
C. Diabetic ketoacidosis
D. Pheochromocytoma (Correct Answer)

Explanation: ***Pheochromocytoma*** - Pheochromocytoma is characterized by excessive secretion of catecholamines, leading to increased levels of **vanillylmandelic acid (VMA)** in the urine. - It is often associated with symptoms like **hypertension**, palpitations, and sweating due to catecholamine release. *Alkaptonuria* - Caused by a deficiency in **homogentisate oxidase**, leading to the accumulation of **homogentisic acid**, not VMA. - Clinically presents with **dark urine** and can lead to **ochronosis**, but does not involve catecholamines. *Phenylketonuria* - A metabolic disorder resulting from a deficiency in **phenylalanine hydroxylase**, leading to elevated levels of **phenylalanine** rather than VMA. - Symptoms include intellectual disability and musty odor, unrelated to catecholamine metabolism. *Diabetic ketoacidosis* - This is a condition caused by severe **insulin deficiency**, resulting in elevated ketone bodies and glucose levels, but does not cause increased VMA excretion. - Symptoms include **fruity breath**, dehydration, and metabolic acidosis, focusing on ketone production rather than catecholamine metabolism.

Question 1566: Which one of the following statements about Graves' disease is FALSE?

A. Common in male (Correct Answer)
B. Referred to as toxic diffuse goiter
C. Results in hyperthyroidism
D. Autoimmune disorder

Explanation: ***Common in male*** - Graves' disease is significantly **more common in females** than males, with a female-to-male ratio of approximately 7:1 [1]. It is a female predominant disease [2]. - The peak incidence is between the ages of 20 and 50 years, and it is the most common cause of **hyperthyroidism** in women [1], [2]. *Results in hyperthyroidism* - Graves' disease is characterized by the production of **autoantibodies** against the TSH receptor, leading to excessive stimulation of the thyroid gland [1]. - This overstimulation results in **increased synthesis and release of thyroid hormones**, causing a state of hyperthyroidism [2]. *Autoimmune disorder* - Graves' disease is a classic example of an **organ-specific autoimmune disease** [2]. - The immune system mistakenly produces antibodies that mimic the action of TSH, leading to thyroid overactivity [1]. *Referred to as toxic diffuse goiter* - The term "toxic" refers to the **hyperthyroid state** (thyrotoxicosis), and "diffuse goiter" describes the generally uniform enlargement of the entire thyroid gland [1]. - This terminology accurately reflects the typical presentation of Graves' disease, which involves an overactive, diffusely enlarged thyroid gland [2].

Question 1567: Calcitonin levels increased in

A. Hypoparathyroidism
B. Cushing Syndrome
C. Medullary thyroid carcinoma (Correct Answer)
D. Hyperparathyroidism

Explanation: Medullary thyroid carcinoma - Calcitonin is a hormone produced by the parafollicular C cells of the thyroid gland. - Medullary thyroid carcinoma is a neuroendocrine tumor arising from these C cells, leading to excessive and unregulated calcitonin production. Hyperparathyroidism - This condition involves increased production of parathyroid hormone (PTH), which acts to increase serum calcium levels [2]. - Calcitonin secretion is typically decreased or normal in hyperparathyroidism, as calcitonin works to lower serum calcium. Hypoparathyroidism - This condition is characterized by insufficient production of parathyroid hormone (PTH), leading to low serum calcium levels [1]. - Calcitonin levels are generally unaffected or may even be slightly decreased in response to the low calcium, as its primary role is to lower calcium. Cushing Syndrome - Cushing Syndrome is caused by prolonged exposure to high levels of cortisol, a glucocorticoid. - While cortisol can affect bone metabolism, it does not directly impact calcitonin production or secretion, which is primarily regulated by serum calcium levels and C-cell activity.

Question 1568: Which condition is associated with congenital adrenal hyperplasia?

A. Male pseudohermaphroditism
B. True pseudohermaphroditism
C. Sequential pseudohermaphroditism
D. Female pseudohermaphroditism (Correct Answer)

Explanation: ***Female pseudohermaphroditism*** - In **21-hydroxylase deficiency**, the most common form of CAH, virilization of a female fetus occurs due to excessive **androgen production** [2], [3]. - This leads to ambiguous genitalia in genetically female (XX) infants, presenting as **female pseudohermaphroditism** [2]. *Male pseudohermaphroditism* - This condition occurs when a **genetically male individual (XY)** has external genitalia that are undervirilized or ambiguous. - It is typically caused by inadequate **androgen synthesis** or action, such as in **androgen insensitivity syndrome**, which is not the primary presentation of CAH [2]. *True pseudohermaphroditism* - This term refers to individuals who possess both **ovarian and testicular tissue**, either in separate gonads or as ovotestes [1], [2]. - It is distinct from CAH, where gonadal tissue is uniform (either ovaries or testes), but the external genitalia are ambiguous due to hormonal imbalances [2]. *Sequential pseudohermaphroditism* - This term is not a recognized medical classification for conditions like CAH. - It does not describe a specific developmental anomaly of the reproductive system related to adrenal function.

Question 1569: In which condition is Chvostek's sign typically observed?

A. Hypercalcemia
B. Hypoparathyroidism (Correct Answer)
C. Insulinoma
D. Diabetes mellitus

Explanation: Hypoparathyroidism - **Chvostek's sign** is a clinical manifestation of **hypocalcemia**, which is a hallmark of hypoparathyroidism [1]. - It involves a twitch of facial muscles elicited by tapping the **facial nerve** anterior to the ear. Hypercalcemia - **Hypercalcemia** is the opposite of hypocalcemia and would not cause increased neuromuscular excitability [2]. - Patients with hypercalcemia might experience symptoms like **fatigue**, **constipation**, and **bone pain** [2]. Insulinoma - An **insulinoma** is a tumor that produces excessive insulin, leading to **hypoglycemia**, not issues with calcium balance. - Symptoms are primarily related to low blood sugar, such as **confusion** and **tachycardia**. Diabetes mellitus - **Diabetes mellitus** is a metabolic disorder characterized by **high blood glucose levels** due to insulin deficiency or resistance. - It is not directly associated with calcium imbalances that would cause Chvostek's sign.

Question 1570: Which of the following is NOT a typical effect of hypoparathyroidism on bones?

A. Osteosclerosis
B. Multiple bone cysts
C. Brown tumors (Correct Answer)
D. None of the above

Explanation: Hypoparathyroidism typically does not lead to direct **bone resorption** or the formation of **bone lesions** like brown tumors. The condition results in low serum calcium, but the skeletal effects are not characterized by any of the changes noted in the other options. *Subperiosteal Resorption of Bone* - This is commonly seen in **hyperparathyroidism**, where increased osteoclastic activity leads to bone resorption [1]. Parathyroid hormone (PTH) acts on the skeleton to increase osteoclastic bone resorption; thus, in hypoparathyroidism, there is **decreased bone turnover** with no subperiosteal resorption occurring [1]. *Brown tumours* - Brown tumors are associated with **hyperparathyroidism** due to osteitis fibrosa cystica, characterized by **osteoclastic resorption** [1]. Prolonged exposure of bone to high levels of PTH is associated with these changes, which do not occur in hypoparathyroidism [1]. *Multiple Cysts in Bone* - Multiple bone cysts often represent conditions such as **osteitis fibrosa cystica** in **hyperparathyroidism** or other osteolytic lesions [2]. Hypoparathyroidism primarily leads to a reduction in bone remodeling without promoting cyst formation.

Practice by Chapter

Diabetes Mellitus

Practice Questions

Thyroid Disorders

Practice Questions

Adrenal Gland Disorders

Practice Questions

Pituitary Disorders

Practice Questions

Calcium and Bone Metabolism

Practice Questions

Reproductive Endocrinology

Practice Questions

Lipid Disorders

Practice Questions

Endocrine Hypertension

Practice Questions

Multiple Endocrine Neoplasia

Practice Questions

Obesity and Metabolic Syndrome

Practice Questions

Neuroendocrine Tumors

Practice Questions

Endocrine Emergencies

Practice Questions

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