Endocrinology

SECTION A: Read each question carefully and record the answer "TRUE" or "FALSE": 1. Secondary diabetes mellitus could be caused by: a) Thiazide diuretic therapy. b) Haemochromatosis. c) Primary hype raldosteronism. d) Pancreatic carcinoma. e) Thyrotoxicosis. 2. In the diagnosis of diabetes mellitus: a) Glycated haemoglobin (HbAIC) is a sensitive screening test. b) Absence ofglycosuria excludes diabetes. c) Glycosuria is usually due to reduced renal threshold in young patients. d) 2% of patients have significant diabetic complications at presentation. e) Plasma glucose concentrations are 15% higher than whole blood levels. 3. Typical presentations of diabetes mellitus include: a) Weight loss and nocturia b) Balanitis or pruritus vuluae c) Epigastric pain and vomiting d) Limb pains with absent ankle reflexes e) Asymptomatic glycosuria in the elderly 4. Causes of short stature In childhood include: a) Klinefelter's syndrome. b) Turner's syndrome. c) Emotional deprivation. d) Cushing's syndrome. e) Hyperthyroidism.
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5. Thyrotoxicosis may be associated with a) Irritability b) Constipation c) Sleepiness. d) Exophthalmos e) Tachycardia 6. Acromegaly: a) Is caused by a basophil adenoma of the pituitary gland b) Is associated with recent gain in height c) Is often complicated by bitemporal hemianopia d) Is characterized by recession of the lower jaw 7. The following statements about goiter are true a) onset in later life favours a diagnosis of thyroid carcinoma b) hypothyroidism favours a diagnosis of Hashimoto's thyroiditis c) deafness in childhood suggests a diagnosis of dyshormonogenesis d) thyroxine treatment for associated hypothyroidism causes goiter enlargement e) serum thyroid antibodies favour a diagnosis of subacute thyroiditis 8. Typical biochemical findings in primary hyperparathyroldism include a) increased serum calcium and phosphate ,concentrations b) decreased serum 1 ,25-dihydroxy-cholecalciferol concentration c) hypercalciuria and hyperphosphaturia d) increased serum alkaline phosphatase with bony involvement e) increased serum calcium and PTH concentrations 9. The typical clinical features of Cushing's syndrome include a) generalised osteoporosis b) systemic hypotension c) hlr'sutism and amenormoea d) proximal myopathy
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e) hypoglycaemic episodes 10. The following statements about pituitary tumours are true

a) Chromophobe adenomas may cause pressure effects or hormone secretion b) Diabetes insipidus usually indicates sub-sellar extension c) Cushing's disease is usually caused by acidophilic macroadenomas d) Acromegaly is most often associated with basophilic microadenomas
e)

Tumour enlargement with expansion of the pituitary fossa usually presents with headaches

and/or a bi 11. The following statements about thyrotoxicosis are true

a) most cases are due to Graves' disease b) muttinodular goitre is more common than uninodular goitre c) amiodarone treatment is occasionally responsible d) the thyroid gland is diffusely hyperactive in Graves' disease e) there is an increased prevalence of HLA-DR3 in Grave's disease 12. The clinical features of thyrotoxicosis include

a) atrial fibrillation with a collapsing pulse b) weight loss and oligomenorrhoea c) peripheral neuropathy d) proximal myopathy and exophthalmos e) decreased insulin requirements in type I diabetes mellitus 13. The development of a simple colloid goitre Is associated with

a) coxsackie 8 viral infection b) dietary iodine deficiency c) excess dietary calcium intake d) cranial irradiation e) dietary goitrQgens 14. Typical clinical features of primary hyperparathyroldism Include

a) recurrent acute pancreatitis and renal colic due to calculi b) hyperplasia of all the parathyroid glands on histology c) osteitis fibrosa on bone X-rays early at course of disease
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d) the complications of pseudo-gout and hypertension e) renal tubular acidosis and nephrogenic diabetes insipidus 15. Recognised causes of hypercalcaemia Include

a) bone metastases b) carcinomas secreting PTH-like peptides c) severe Addison's disease d) severe hypothyroidism e) chronic sarcoidosis 16. The following statements about adrenal gland physiology are

true a) ACTH normally controls the adrenal secretion of aldosterone b) ACTH increases adrenal androgen and cortisol secretion c) The plasma cortisol concentration normally peaks in the evening d) Hyperglycaemia increases the rate of cortisol secretion e) Cortisol enhances gluconeogenesis and lipogenesis from amino acids 17. The typical clinical features of Cushing's syndrome include

a) generalised osteoporosis b) systemic hypotension c) hirsutism and amenormoea d) proximal myopathy e) hypoglycaemic episodes 18. Adverse effects of oral corticosteroid therapy include

a) peptic ulceration b) hypertension c) avascular bone necrosis d) pseudo-gout e) insomnia 19. In primary hyperaldosteronism (Conn's syndrome)

a) peripheral oedema is usually present b) proximal myopathy is'due to hypokalaemia

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c) polyuria and polydipsia are characteristic d) diabetes mellitus is often present e) hypertension Is associated with hyperreninaemia 20. The insulin-induced hypoglycaemia stimulation test is a) mandatory in the confirmation of secondary hypoadrenalism b) best terminated when the plasma glucose falls below 2.2-mmol/L c) contraindicated in ischaernic heart disease and epilepsy d) contraindicated in advanced hypopituitarism e) an unreliable test of hypothalamic function 21. The typical features of phaeochromocytoma include a) predominantly adrenaline rather than noradrenaline secretion b) episodic nausea with sweating and marked skin pallor c) underlying malignant tumour in the majority d) presentation with hypertension and hypercalcaemia e) control of symptoms following proprano'ol therapy alone 22. The following statements about diabetes mellitus are true a) The UK prevalence is approximately 1 b) The disorder is more common in nulliparous than multiparous women F 4 c) Type IJODMJs typically Inherited as an autosomal dominant trait F 2 d) Type IJJNIDDM increases in prevalence with advancing age e) Hyperglycaenra occurs only after 50% reduction in islet cell mass 23. Secondary diabetes mellitus Is associated with a) thiazide diuretic therapy b) haemochromatosis c) primary hyperaldosteronism d) pancreatic carcinoma e) thyrotoxicosis, phaeochromocytoma and acromegaly 24. In the dietary management of diabetes mellitus a) 75% of patients also require hypoglycaemic drug therapy b) carbohydrate intakes should be 50% of total calorie intake
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c) Ice cream and chocolates should never be consumed d) fat intakes should not exceed 35% of total calorie intake e) in obese patients, calorie intake should not exceed 600 kcal/day 25. Typical symptoms of hypoglycaemia In diabetic patients

Include a) feelings of faintness and hunger b) tremor, palpitation and dizziness c) headache, diplopia and confusion d) abnormal behaviour despite plasma-glucose consistently >5minol/L. e) nocturnal sweating, nightmares and convulsions 26. In the management of diabetes mellitus.during pregnancy a) there is an increased perinatal mortality rate b) the baby is usually smaller than expected from gestational age c) delivery should be undertaken by caesarian section at week 36 d) mild diabetes responds well to sulphonylurea and diet therapy e) insulin requirements usually decrease throughout pregnancy SECTION B: Only one Item appropriately applies to the Statement. 27. Typical features of acromegaly include all of the following

EXCEPT a) Thoracic kyphosis and myopathy b) Hypertension and diabetes mellitus c) Goiter and cardiomegaly d) Growth hormone suppression during a glucose tolerance test e) Hyperhydrosis 28. Typical features of pituitary dependent Cushing's disease

include all of the following EXCEPT a) Normal pituitary fossa b) Amenorrhea and depression c) Proximal myopathy and diabetes ij,viiitus d) Suppression of plasma cortisol following dexamethasone e) Hypertension and hypokalemia 29.
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In childhood growth hormone deficiency

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a) Panhypopituitarism is atypical finding b) Most patients have a craniopharyngioma c) A genetic deficiency of GH releasing factor is, rare d) Delayed bone development is a characteristic feature e) Treatment with human GH produce precocious puberty 30. Recognized causes of short stature in childhood are all of the

following EXCEPT a) Klinefelter's syndrome b) Turner's syndrome c) Emotional deprivation d) Cushing's syndrome e) Hypothyroidism 31. Recognized causes of hypopituitarism Include all of the

following EXCEPT a) Postpartum hemorrhage b) Cushing's syndrome c) Acromegaly d) Autoimmune hypophysitis e) Sarcoidosis 32. What is a typical set of symtoms of hypoglycemia? a) headache, weakness, dizziness, trembling, hunger b) acne, hyperactivity, cough, heartburn c) loss of weight, thirst, frequent urination, numbness d) itchy skin, purple nail beds, hair loss, brittle nails 33. Which type of hypoglycemia would an insulinoma cause? a) Reactive b) Drug-induced c) Alimentary d) Fasting

34.

Hypoglycemia may be a symptom of what disease? a) Crohn's Disease

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b) Alzheimer's Disease c) Addison's Disease d) Osteoporosis 35. Which hormone is responsible for many of the symptoms of

hypoglycemia? a) TSH (Thyroid Stimulating Hormone) b) Epinephrine c) Cortisol d) Thyroxin 36. The commonest clinical manifestation of MEN-1 is: a- Glucagonoma. b- Hyperparathyroidism c- Cushing disease d- Medullary carcinoma of thyroid 37. One of the following features is pathgnomonic to MEN-2B a) Pheochromocytoma b) Hyperparathyroidism c) Insulinorna d) Mucosal neuromas 38. The followings are true about PAS. I except:. a) An autosomal recessive disorder b) Equally affects both sex c) Hypoparathyroidism is very common d) Autoimmune thyroid disease is more frequent than in type II AGES 39. The following features are present in APS- II except a) Addison's disease b) Type-1 diabetes c) Mucocutaneous candidiasis d) Pernicious anaemia 40. Hypocalcemia can cause all of the following except: a) Carpopodal spasm, b) Convulsions. c) Calcification of the basal ganglion.
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d) Nephrocalcinosis and renal stones. 41. In patients with pseudohypoparathyroidism serum PTH is: a) Normal. b) Increased. c) Decreased. 42. Treatment of hypercalcemia includes: a) IV saline. b) Loop diuretics. c) Calcitonin, d) All of the above. 43. In patients with try hyperparathyroidism the serum calcium is: a) High. b) Low. c) Normal

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