Endocrinology Practice Questions

Q: Spider naevi are due to action of -

Estrogen. Estrogen - **Spider naevi** are vascular lesions characterized by a central arteriole surrounded by radiating capillaries, commonly found in conditions with **elevated estrogen levels**. - High estrogen levels lead to **vasodilation** and increased vascularity, causing the formation of these lesions, often seen in **pregnancy** or **cirrhosis** [1], [2]. *Androgen* - Androgens are male sex hormones and their action is generally associated with effects like **acne** and **sebum production**, not spider naevi [2]. - They do not typically cause the **cutaneous vascular changes** seen in spider naevi. *Steroids* - "Steroids" is a broad term, but often refers to corticosteroids, which can cause skin thinning and easy bruising, but not the characteristic **spider naevi**. - While some steroids (like estrogen) do cause them, as a general category, it is not the primary cause. *Progesterone* - Progesterone is a female sex hormone primarily involved in the **menstrual cycle** and maintenance of **pregnancy** [1]. - It does not directly cause the **vasodilation** and vascular changes that lead to the formation of spider naevi.

Q: A 38-year-old female presents to the physician with complaints of excessive thirst and urination for the past 4 weeks. Her appetite has been normal and she has not had diarrhea. Blood chemistry showed mildly elevated glucose and glucagon. Physical examination reveals tenderness in the left upper quadrant and an erythematous necrotizing skin eruption on her legs. Radiographic studies show a tumor in the pancreas. Which of the following cells is responsible for this lesion?

Alpha cell. ### Alpha cell - The constellation of **excessive thirst and urination (polyuria/polydipsia)**, **mildly elevated glucose**, **elevated glucagon**, **necrolytic migratory erythema (NME)**, and a **pancreatic tumor** is highly characteristic of a **glucagonoma**. [1] - Glucagonomas originate from **pancreatic alpha cells**, which are responsible for glucagon production. [2] ### Beta cell - **Beta cell tumors** (insulinomas) primarily cause **hypoglycemia** due to excessive insulin secretion, which is antithetical to the patient's symptoms of elevated glucose. [2] - While beta cell tumors can be found in the pancreas, they are not associated with necrolytic migratory erythema or glucagon excess. [1] ### Acinar cell - **Acinar cell carcinomas** are exocrine pancreatic tumors that can cause symptoms related to their size and local invasion (e.g., pain, weight loss, jaundice) but are not typically associated with specific hormonal syndromes such as glucagon excess. - They do not cause the characteristic skin rash or metabolic disturbances seen in this patient. ### Delta cell - **Delta cells** produce **somatostatin**, and tumors originating from these cells (somatostatinomas) can cause symptoms like diabetes, steatorrhea, and gallstones. - However, they do not typically present with elevated glucagon or the characteristic necrolytic migratory erythema.

Q: Young male presents with delayed puberty with decreased FSH, LH, and testosterone. Which of the following is NOT possible?

Klinefelter's syndrome. ***Klinefelter's syndrome*** - Klinefelter's syndrome is characterized by **primary hypogonadism**, meaning the testes themselves fail to produce testosterone [3]. This leads to **high FSH and LH** levels due to the lack of negative feedback from testosterone [2],[3]. - The presenting clinical picture of **low FSH, LH, and testosterone** indicates **central hypogonadism**, where the pituitary or hypothalamus is at fault, not the testes directly [2]. *Kallmann syndrome* - Kallmann syndrome is a form of **congenital hypogonadotropic hypogonadism** characterized by a failure of GnRH-producing neurons to migrate to the hypothalamus, leading to **low FSH, LH, and testosterone**. - It is often associated with **anosmia (loss of smell)**, which is a key diagnostic feature. *Constitutional delay* - **Constitutional delay of growth and puberty** is a common cause of delayed puberty, characterized by a temporary suppression of the GnRH pulse generator [1]. - This results in **low FSH, LH, and testosterone** that eventually normalize, and often has a family history of delayed puberty [1]. *DAX-1 gene mutation* - Mutations in the **DAX-1 gene (NR0B1)** are associated with **X-linked adrenal hypoplasia congenita (AHC)**, which often presents with central or **hypogonadotropic hypogonadism**. - This condition leads to **low FSH, LH, and testosterone** due to hypothalamic-pituitary dysfunction in addition to adrenal insufficiency.

Q: What is the shortest needle length commonly used in insulin pens according to current clinical guidelines, in mm?

4. ***4 mm*** - Current clinical guidelines recommend **4 mm needles** as the shortest available for insulin pens to reduce pain and minimize the risk of intramuscular injection. - This length is suitable for injecting into the subcutaneous tissue in most adults, even without pinching the skin. *6 mm* - While 6 mm needles are still used, they are longer than the shortest recommended and may increase the risk of an **intramuscular injection**, especially in leaner individuals. - Injecting insulin into the muscle can lead to **unpredictable absorption rates** and hypoglycemia. *5 mm* - A 5 mm needle is also commonly used, but it is not the shortest length according to current clinical guidelines which emphasize the use of **4 mm needles** for optimal patient comfort and safety. - It still carries a slightly higher risk of intramuscular injection compared to a 4 mm needle, particularly without a **skin-fold**. *8 mm* - An 8 mm needle is significantly longer and is generally not recommended for routine insulin pen injections due to the high risk of **intramuscular injection**. - This length is typically reserved for patients with a very thick subcutaneous fat layer or specific medical indications, but even then, shorter needles are often preferred.

Q: A 16-year-old girl presents to her doctor complaining of a swelling in her neck which she has noticed in the last 2 weeks. She has felt more irritable although this is often transient. On examination, a diffuse swelling is palpated with no bruit on auscultation. The most likely diagnosis is:

Simple goitre. Simple goitre - A simple goitre is a general term for an enlarged thyroid gland not caused by inflammation or neoplasm, which is consistent with the diffuse swelling described [1]. - The patient's age and the transient irritability combined with a diffuse goitre without bruits or overt signs of severe hyperthyroidism are characteristic of this diagnosis, often related to iodine deficiency or pubertal hormonal changes [1]. Thyroid cyst - A thyroid cyst typically presents as a well-defined, usually solitary, palpable nodule rather than a diffuse swelling. - Cysts are often asymptomatic unless they become large enough to cause compressive symptoms or are infected, and are less likely to cause irritability. Hyperthyroidism - While irritability can be a symptom of hyperthyroidism, the absence of a bruit over the thyroid (common in Graves' disease due to increased blood flow) and the lack of other clear hyperthyroid symptoms (e.g., weight loss, heat intolerance, tremor, tachycardia) make this less likely. - "Diffuse swelling" could describe Graves' disease, but symptoms are not strong enough to jump to this conclusion, especially without a bruit. Riedel's thyroiditis - Riedel's thyroiditis is a rare, invasive fibrotic process that makes the thyroid gland stony hard and fixed to surrounding structures. - It would typically present with a hard, fixed mass rather than a simple diffuse swelling, and would be extremely rare in a 16-year-old.

Q: Adrenal hyperplasia due to 21-hydroxylase deficiency is treated with low dose:

Cortisone. ***Cortisone*** - **Cortisone** (a glucocorticoid) is used to suppress excessive **ACTH** (adrenocorticotropic hormone) secretion from the pituitary, which drives the adrenal gland to overproduce precursors due to the enzyme deficiency [1]. - This treatment aims to reduce the synthesis of **androgens** and other steroid intermediates, thereby preventing virilization and salt-wasting crises [1]. *Androgen* - Administering **androgen** would worsen the symptoms of **adrenal hyperplasia**, such as virilization in females and precocious puberty in males, as the condition already involves excess androgen production [1]. - The goal of treatment is to *reduce* androgen levels, not increase them. *Estrogen* - **Estrogen** supplementation is not a primary treatment for 21-hydroxylase deficiency. While it might be used in specific cases for feminization in females with severe virilization, it does not address the underlying hormonal imbalance or the compensatory ACTH production. - Its use would not suppress the adrenal overstimulation that leads to increased androgen production. *Anti-androgen* - **Anti-androgens** can block the effects of excess androgens at target tissues and are sometimes used as adjunctive therapy, particularly for cosmetic issues like hirsutism in females. - However, anti-androgens do not address the root cause of adrenal overproduction or suppress the elevated **ACTH** levels; they merely mitigate the peripheral effects of the excess androgens.

Q: The symptoms of hyperparathyroidism include:

All of the options. ***All of the options*** - **Hyperparathyroidism** leads to elevated **calcium levels** (hypercalcemia), which can manifest in a wide range of symptoms affecting multiple organ systems [1]. - The classic mnemonic for hypercalcemia symptoms is "**stones, bones, groans, and psychiatric overtones**," encompassing renal, skeletal, gastrointestinal, and neurological issues [1][2]. *Polydipsia & polyuria* - **Hypercalcemia** impairs the kidneys' ability to concentrate urine, leading to **nephrogenic diabetes insipidus** and subsequent **polyuria** (excessive urination) [1]. - The increased fluid loss from polyuria then triggers **polydipsia** (excessive thirst) to maintain hydration [1]. *Anorexia & weight loss* - Elevated calcium levels can cause **gastrointestinal symptoms** such as **anorexia** (loss of appetite), nausea, and vomiting [1]. - Chronic anorexia and associated GI disturbances can contribute to **weight loss** in patients with hyperparathyroidism. *Constipation & muscle weakness* - **Hypercalcemia** reduces the smooth muscle activity of the gastrointestinal tract, leading to decreased peristalsis and **constipation** [1]. - High calcium levels can also interfere with nerve and muscle function, resulting in generalized **muscle weakness** and fatigue [1].

Q: Which is not a feature of SIADH?

Low urine sodium. ***Low urine sodium*** - **SIADH** is characterized by excessive **ADH release**, leading to **water retention** and **dilutional hyponatremia** [1]. - In response to decreased effective circulating volume and concentrated urine, the kidneys excrete a relatively high amount of sodium, typically **urine sodium > 40 mEq/L**. *Urine Osmolality > 100 mosm/ kg* - In SIADH, the excess **ADH** causes the kidneys to retain water, leading to the production of **concentrated urine** despite plasma hypo-osmolality [1]. - A **urine osmolality > 100 mOsm/kg H2O** is a diagnostic criterion, reflecting this inappropriate water retention. *Treatment is fluid restriction* - The primary treatment for SIADH is **fluid restriction**, which helps to reduce water intake and correct the **dilutional hyponatremia**. - This intervention aims to achieve a negative water balance and gradually increase serum sodium concentration. *Euvolemia* - Despite significant water retention and hyponatremia, patients with SIADH are typically **euvolemic** (normal fluid volume status) [1]. - The excess water is primarily distributed intracellularly and interstitially, without causing overt edema or dehydration.

Q: A 17-year-old woman presents with symptoms of a fine tremor of her hands. The tremor is best seen when her hands are stretched out. She is not on any medications and reports no alcohol use. Which of the following is the most likely diagnosis?

hyperthyroidism. ### Hyperthyroidism - A **fine tremor** that is best observed with **action (postural tremor)**, such as outstretched hands, is a classic feature of hyperthyroidism due to increased adrenergic tone. - Other common symptoms of hyperthyroidism often include **tachycardia**, **anxiety**, **weight loss**, and **heat intolerance** [1], which should be investigated further. *Marijuana use* - While marijuana use can cause tremors, they are typically more related to **intoxication** and less specifically described as a fine postural tremor in an otherwise healthy individual. - Tremors from cannabis are often less sustained and associated with other signs of impairment, such as **altered perception** and **impaired coordination**. *Myxedema* - Myxedema refers to severe **hypothyroidism**, which typically causes a **slowing of motor functions** and can sometimes result in a fine tremor, but this is less common and often less prominent than in hyperthyroidism. - Patients with myxedema usually present with **fatigue**, **weight gain**, **cold intolerance**, and **bradycardia** [1], which are symptoms opposite to those associated with a fine postural tremor dueoved. *Hypopituitarism* - Hypopituitarism involves a **deficiency in multiple pituitary hormones** and generally does not present with a primary symptom of fine hand tremor. - Symptoms vary widely depending on the hormones affected but typically include **fatigue**, **weakness**, **menstrual irregularities**, and **hypotension**, rather than a distinct tremor.

Q: Most common tumour of the pituitary is -

Prolactinoma. ***Prolactinoma*** - **Prolactinomas** are the most frequently occurring type of pituitary adenoma, accounting for approximately **40-50%** of all pituitary tumors [1]. - They are characterized by the **overproduction of prolactin**, leading to symptoms like **galactorrhea**, **amenorrhea**, and **infertility** [1]. *ACTH secreting adenoma* - This type of adenoma leads to **Cushing's disease** due to excessive **ACTH production**, stimulating adrenal cortisol synthesis [2]. - While significant, **ACTH-secreting adenomas** are less common than prolactinomas, accounting for about **15-20%** of pituitary tumors. *TSH secreting adenoma* - **TSH-secreting adenomas** are extremely rare, making up less than **1%** of all pituitary tumors. - They cause secondary hyperthyroidism due to excessive **thyroid-stimulating hormone (TSH)** secretion. *GH secreting adenoma* - **Growth hormone (GH) secreting adenomas** cause **acromegaly** in adults and **gigantism** in children [1]. - These tumors are less common than prolactinomas, constituting about **15-20%** of pituitary adenomas.

Question 1

Spider naevi are due to action of -

Accepted Answer

Estrogen

Answer

Androgen

Answer

Steroids

Answer

Progesterone

Question 2

A 38-year-old female presents to the physician with complaints of excessive thirst and urination for the past 4 weeks. Her appetite has been normal and she has not had diarrhea. Blood chemistry showed mildly elevated glucose and glucagon. Physical examination reveals tenderness in the left upper quadrant and an erythematous necrotizing skin eruption on her legs. Radiographic studies show a tumor in the pancreas. Which of the following cells is responsible for this lesion?

Accepted Answer

Alpha cell

Answer

Beta cell

Answer

Acinar cell

Answer

Delta cell

Question 3

Young male presents with delayed puberty with decreased FSH, LH, and testosterone. Which of the following is NOT possible?

Accepted Answer

Klinefelter's syndrome

Answer

Kallmann syndrome

Answer

Constitutional delay

Answer

DAX-1 gene mutation

Question 4

What is the shortest needle length commonly used in insulin pens according to current clinical guidelines, in mm?

Accepted Answer

4

Answer

6

Answer

5

Answer

8

Question 5

A 16-year-old girl presents to her doctor complaining of a swelling in her neck which she has noticed in the last 2 weeks. She has felt more irritable although this is often transient. On examination, a diffuse swelling is palpated with no bruit on auscultation. The most likely diagnosis is:

Accepted Answer

Simple goitre

Answer

Thyroid cyst

Answer

Hyperthyroidism

Answer

Riedel's thyroiditis

Question 6

Adrenal hyperplasia due to 21-hydroxylase deficiency is treated with low dose:

Accepted Answer

Cortisone

Answer

Androgen

Answer

Estrogen

Answer

Anti-androgen

Question 7

The symptoms of hyperparathyroidism include:

Accepted Answer

All of the options

Answer

Polydipsia & polyuria

Answer

Anorexia & weight loss

Answer

Constipation & muscle weakness

Question 8

Which is not a feature of SIADH?

Accepted Answer

Low urine sodium

Answer

Urine Osmolality > 100 mosm/ kg

Answer

Treatment is fluid restriction

Answer

Euvolemia

Question 9

A 17-year-old woman presents with symptoms of a fine tremor of her hands. The tremor is best seen when her hands are stretched out. She is not on any medications and reports no alcohol use. Which of the following is the most likely diagnosis?

Accepted Answer

hyperthyroidism

Answer

marijuana use

Answer

myxedema

Answer

hypopituitarism

Question 10

Most common tumour of the pituitary is -

Accepted Answer

Prolactinoma

Answer

ACTH secreting adenoma

Answer

TSH secreting adenoma

Answer

GH secreting adenoma

Endocrinology — MCQs

Endocrinology — MCQs

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