1. Hypoglycemia : Endocrinology MCQ

Which of the following hormones promotes hypoglycemia ?

a) Epinephrine

b) Norepinephrine

c) Insulin

d) Glucagon

e) Glucocorticoids

Correct Answer: c) Insulin. Most common cause of hypogylcemia is a side effect of drugs used for the treatment of diabetes.

2. What inhibits glucagon releases ?

a) Adrenaline

b) Exercise

c) Hypoglycaemia

d) Increased amino acids

e) Increased free fatty acids

Correct Answer: e) Increased free fatty acids. Glucagon is secreted by the alpha cells of the pancreas. It increases hepatic glycogenolysis and also glyconeogenesis. Adrenaline stimulates glucagon release in times of stress .This stimulates liver glycogenolysis to ensure maximum glucose output to prepare for ‘flight or fight’ reaction. Hyperglycaemia inhibits glucagon release.

3. Rupture of Pituitary Stalk : Endocrinology MCQ

In an accident there was rupture of the pituitary stalk. This would lead to all of the following except

a) Hyperprolactenimia

b) Diabetes Insipidus

c) Hypothyroidism

d) Diabetes Mellitus

Correct Answer: d) Diabetes Mellitus. Pituitary stalk transection syndrome results in Diabetes Insipidus and not Diabetes Mellitus. Diabetes Mellitus is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.

4. Ovarian Dysgenesis : Endocrinology MCQ

Ovarian Dysgenesis is associated with the elevation of which of the following hormones.

a) Pituitary Gonadotropins.

b) Estradiol.

c) Estriol.

d) Pregnandiol.

e) Progesterone.

Correct Answer: a) Pituitary Gonadotropins. It is characterized by a progressive loss of germ cells leading to dysfunctioning gonads mainly composed of fibrous tissue, hence the name streak gonads. Absence of negative feedback from ovarian steroids, gonadotropins are markedly elevated.

5. Raised FSH : Endocrinology MCQ

Raised FSH levels are found in all of the following conditions EXCEPT :

a) Postmenopausal women.

b) Turner’s Syndrome.

c) Women on Combined Oral Contraceptive Pills.

d) Gonadal dysgenesis.

e) Peri-menopausal women who had hysterectomy with bilateral salpingooophorectomy.

Correct Answer: c) Women on Combined Oral Contraceptive Pills.

Progestogen negative feedback decreases the pulse frequency of GnRH release by the hypothalamus, which decreases the secretion of FSH and LH by the anterior pituitary. Decreased levels of FSH inhibit follicular development.

6. GnRH : Endocrinology MCQ

Gonadotropin-releasing hormone (GnRH) stimulates the release of :

a) Opiate peptides.

b) Adrenocorticotropic hormone (ACTH).

c) LH.

d) Growth hormone.

e) Thyroid-stimulating hormone.

Correct Answer: c) LH. At the pituitary, GnRH stimulates the synthesis and secretion of the gonadotropins, FSH, and LH. Low-frequency GnRH pulses lead to FSH release, whereas high-frequency GnRH pulses stimulate LH release.

7. Thyroid Test in Pregnancy

Which test is most appropriate in diagnosing the thyroid dysfunction in pregnancy ?

a) Free thyroxine (T4) levels

b) Serum iodine levels

c) Serum triiodothyronine levels

d) Thyroid-binding globulin levels

e) Thyroid-stimulating hormone

Correct Answer: a) Free thyroxine (T4) levels.

During pregnancy hepatic synthesis of thyroid-binding globulin is increased. Total T4 and T3 levels are raised to compensate for this rise. Thyroid-stimulating hormone levels fall in the first trimester as concentration of human chorionic gonadotropin rise, however they may occasionally rise. The levels of free T4 are altered less in pregnancy.

The normal pregnancy range for each trimester should be used in diagnosing or monitoring treatment in cases of thyroid disorders. Pregnancy is associated with a relative iodine deficiency, which has two major causes. Maternal iodine requirement increases because of active transport to the fetoplacental unit. Also there is increased iodine excretion due to increased glomerular filtration and decreased renal tubular excretion.

8. Thyroid hormone : Endocrinology MCQ

a) T3 is more potent than T4

b) Iodine is better absorbed from the gut as iodine

c) Reverse T3 is more potent than T3

d) Carbimazole prevents conversion of iodide to iodine

e) Large doses of iodine suppress thyroid activity

Correct Answer: a,b,d,e. Reverse T3 is an inactive form of T3 that is produced in the body particularly during periods of stress.

9. Thyrotoxicosis : Endocrinology MCQ

A 23-year-old woman is newly diagnosed with thyrotoxicosis. She is 20 weeks pregnant. Which medication will be the most appropriate treatment ?

a) Carbimazole

b) Propranolol

c) Propylthiouracil

d) Radioactive iodine

e) Thyroxine

Correct Answer: c) Propylthiouracil (PTU).

Carbimazole and PTU are the most commonly used antithyroid drugs. Most patients are treated for 12–18 weeks. Both drugs cross the placenta.

Very little PTU is excreted in breast milk and it is safer to breast feed with PTU. There is no need to change carbimazole dosage if the woman is already well maintained on it. However PTU is the drug of choice for all newly diagnosed cases. Propranolol may be used in the early management of thyrotoxicosis or during relapse to improve the symptoms of palpitations and tremors, but it is not the main treatment or drug of choice.

10. Parathyroid system : Endocrinology MCQ

Chronic renal failure can produce what effect on the parathyroid system ?

a) Hypoparathyroidism

b) Primary hyperparathyroidism

c) Pseuohypoparathyroidism

d) Secondary hyperparathyroidism

e) Tertiary hyperparathyroidism

Correct Answer: d) Secondary hyperparathyroidism.

Chronic renal failure is the most common cause of secondary hyperparathyroidism. Other causes include chronic pancreatitis and small bowel disease.

11. Body Mass Index : Endocrinology MCQ

Leptin is a protein hormone secreted by adipose tissue. What stimulates its release ?

a) Catecholamines

b) High body mass index

c) Hypoinsulinaemia

d) Mineralocorticoids

e) Stress

Correct Answer: b) High body mass index.

Leptin is a 167-amino acid product derived from fat cells. Leptin receptors are found in the ovaries, the uterus, the heart and skeletal tissue. Leptin provides a signal, reflecting the energy states of the body, and may be involved in the control of appetite and reproduction. It is a probable link between weight loss and menstruation. It is stimulated by glucocorticoids, high body mass index, long-term hyperinsulinaemia and excessive food ingestion.

12. Cushing Syndrome : Endocrinology MCQ

What are the common features of Cushing syndrome ?

a) Exophthalmos, renal calculi

b) Headache and proximal myopathy

c) Moon face and weight gain

d) Poor wound healing and polycythaemia

e) Renal calculi and changes in mental health

Correct Answer: c) Moon face and weight gain.

Although all of the above are features of Cushing syndrome, only the following are common: moon face, weight increase and central weight increase, changes in mental health, impaired glucose tolerance, acne, bruising and proximal myopathy.

13. Test for Cushing syndrome

Which of the following is the most reliable test for the diagnosis of Cushing syndrome ?

a) Cortisol measurement taken at 0600 hours

b) 24-hour urine sample detecting cortisol level

c) Dexamethasone suppression test

d) Random cortisol measurement

e) Short adrenocorticotrophic hormone suppression test

Correct Answer: c) Dexamethasone suppression test.

A 24-hour urine sample to detect cortisol can be used for outpatients; however, a suppression test is more reliable.

14. Adrenomedullary hypersecretion is caused by which condition ?

a) Addison’s disease

b) Conn syndrome

c) Cushing syndrome

d) Diabetes insipidus

e) Phaeochromocytoma

Correct Answer: e) Phaeochromocytoma.

Adrenomedullary hypersecretion is caused by catecholamine-secreting tumours. It is characterised by hypertension, pallor, headache and sweating and glucose intolerance. Conn syndrome is associated with hypersecretion of aldosterone and is caused by an adrenal adenoma. Diabetes insipidus is associated with the abscence of antidiuretic hormone.

15. Where Aldosterone is synthesized ?

a) Distal tubules

b) Lung

c) Zona fasciculata

d) Zona reticularis

e) Zone glomerulosa

Correct Answer: e) Zona glomerulosa.

Remember that glucocorticoids are secreted by the zona fasciculate and androgens are secreted by the zona reticularis.

16. Juxtaglomerular Cells : Endocrinology MCQ

With regard to the renin-angiotensin system, where are the juxtaglomerular cells located ?

a) Afferent arteriole in the kidney

b) Afferent arteriole in the liver

c) Afferent arteriole in the lung

d) Efferent arteriole in the kidney

e) Efferent arteriole in the lung

Correct Answer: a) Afferent arteriole in the kidney.

Juxtaglomerular apparatus is made up of the juxtaglomerular cells, lacis cells and macula densa. Renin is secreted from the juxtaglomerular cells in response to a decrease in arterial blood pressure (detected by the baroreceptors), a decrease in sodium chloride (detected by the macula densa) and the sympathetic nervous system.

17. Fetal Therapy : Endocrinology MCQ

Which one of the following drugs is used for fetal therapy of congenital adrenal hyperplasia ?

a) Hydrocortisone

b) Prednisolone

c) Fludrocortisone

d) Dexamethasone

e) Estrogen

Correct answer : d) Dexamethasone.

Dexamethasone acts by suppressing the secretion of steroids by fetal adrenals. Question was fetal (prenatal) therapy and not postnatal therapy. Maternally administered dexamethasone, which readily crosses the placenta unaltered, is started very early in pregnancy to ensure adequate suppression of the fetal hypothalamo-pituitary-adrenal axis. Prenatal diagnosis of congenital adrenal hyperplasia can be made on elevated amniotic fluid 17-hydroxyprogesterone and adrenal androgen concentrations, and HLA typing of cultured amniotic fluid cells.

18. In congenital adrenal hyperplasia

a) A genetic male develops ovaries.

b) A genetic male is born with both fallopian tubes and a prostate and seminal vesicles.

c) An excess amount of androgens results in external genitals that are partly or completely male in appearance in a genetic female.

d) A genetic male is likely to be identified as female at birth.

Correct Answer: C.

Males with classic CAH generally have no signs of CAH at birth. Some may present with hyperpigmentation and possible penile enlargement. Age of diagnosis of males with CAH varies and depends on the severity of aldosterone deficiency. Boys with salt-wasting disease present early with symptoms of hyponatremia and hypovolemia. Boys with non-salt-wasting disease present later with signs of virilization.

In classic 21-hydroxylase deficiency, laboratory studies will show very high concentrations of 17-hydroxyprogesterone (greater than 242 nmol/L in random blood sample; with the normal being less than 3 nmol/L at 3 days age in a full-term infant). Salt-wasting patients tend to have higher 17-hydroxyprogesterone levels than non-salt-wasting patients.

False positive results from neonatal screening for CAH may be seen in premature infants. Many screening programs have specific reference ranges depending of weight and gestational age.

In borderline cases concerning for CAH, a corticotrophin stimulation test may be performed.

Genetic analysis can be helpful to confirm a diagnosis of CAH but it is not necessary if classic clinical and laboratory findings are present.

19. Females with congenital adrenal hyperplasia

a) Show masculinisation of the external genitalia

b) Show precocious early sexual development

c) Often have webbed hands and feet

d) All of the above

Correct Answer: a) Show masculinisation of the external genitalia.

Congenital adrenal hyperplasia (CAH) refers to any of several autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands (steroidogenesis).

Most of these conditions involve excessive or deficient production of sex steroids and can alter development of primary or secondary sex characteristics in some affected infants, children, or adults.

Female infants with classic CAH have ambiguous genitalia due to exposure to high concentrations of androgens in utero. CAH due to 21-hydroxylase deficiency is the most common cause of ambiguous genitalia in genotypically normal female infants (46XX). Less severely affected females may present with early pubarche. Young women may present with symptoms of polycystic ovarian syndrome (oligomenorrhea, polycystic ovaries, hirsutism).

20. Skeletal maturation depends most upon

a) Growth hormone

b) Thyroxin

c) Testosterone and estrogen ratio

d) Cortisol

Correct Answer: a) Growth hormone.

The endocrine control of skeletal growth involves not only calcium regulatinghormones but also several systemic hormones and other factors. Bone building through increased secretion of osteoid is stimulated by the secretion of growth hormone by the pituitary, thyroid hormone and the sex hormones (estrogens and androgens). Growth hormone is necessary for the proliferation of cartilage cells at the epiphyseal plate permitting linear growth.

21. Testicular feminization syndrome includes

a) Mullerian structures are well developed

b) Female genitalia

c) Ambigous genitalia

d) 46 XY

e) 46 XX

Correct Answer: b,c,d.

1) There is partial or complete regression of Müllerian structures.

2) Individuals with partial androgen insensitivity, unlike those with the complete or mild forms, present at birth with ambiguous genitalia, and the decision to raise the child as male or female is often not obvious.

3) Degree of genital masculinization: Grade 1 is indicated when the external genitalia is fully masculinized, and grade 6 is indicated when the external genitalia is fully feminized.

Testicular feminization syndrome now more appropriately called the complete androgen insensitivity syndrome (CAIS), this is a genetic disorder that makes XY fetuses insensitive (unresponsive) to androgens (male hormones).

The term “testicular feminization” was coined to reflect John Morris’ observation in 1953 that the testicles in these patients produced a hormone that had a feminizing effect on the body.

22. Anterior pituitary : Endocrinology MCQ

The following are produced in the anterior pituitary

a) Somatotrophin

b) Oxytocin

c) Aldosterone

d) Thyrotrophin (TSH)

e) Prolactin

Correct Answer: a, d, e.

Oxytocin is produced by the hypothalamus and stored and secreted by the posterior pituitary gland. Aldosterone is produced by zona glomerulosa of the adrenal cortex.

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