Endocrine - FRCEM Success

6/9/2017 Endocrine FRCEM Success
Dashboard Subscription expires in: 1 Days Extend
You have scored 24%

You answered 34 correct out of 144 questions.
Your answers are shown below:
Effects of thyroid hormones include all but which one of the following:
a) Increased heart rate

b) Increased stroke volume
c) Increased lipolysis
d) Decreased gluconeogenesis
e) Increased glycolysis
Something wrong?
The release of thyroid hormones is regulated by the anterior pituitary gland which secretes thyroid-stimulating
hormone (TSH) and the hypothalamus which secretes thyrotropin-releasing hormone (TRH).
The thyroid follicles secrete two hormones; thyroxine (T4) – a prohormone that acts as a plasma reservoir and tri-
iodothyronine (T3) – the active hormone. T3 and T4 synthesis involves the processing of tyrosine and iodine.
About 90% of thyroid hormones are secreted in the form of T4, with the remainder as T3. About 80% of the T4 is
converted to the more active T3 (under stimulation of TSH) in the liver and kidney.
Secretion of the thyroid hormones is stimulated by long-term exposure to cold temperatures acting on the anterior
pituitary, oestrogens acting on the anterior pituitary and adrenaline acting directly on the thyroid gland. Increased
serum levels of T3 inhibit secretion of TSH.
Most of the thyroid hormones in the blood are bound to plasma proteins (of these, 70% are bound to thyroid-binding
globulin (TBG) and 30% are bound to albumin), which allows them to circulate without being broken down by enzymes.
http://frcemsuccess.com/rev/sc26/ 1/110
Only a fraction of the circulating thyroid hormones (about 0.1% of T4 and 1% of T3) are unbound and thus biologically
active. The thyroid hormones act to increase the basal metabolic rate and are important for growth and normal foetal
development. Effects of thyroid hormones include: increased heart rate and stroke volume, and increased lipolysis,
glycolysis and gluconeogenesis.
Which of the following is NOT an endocrine cause of hypercalcaemia:
a) Pseudohypoparathyroidism
b) Hyperthyroidism
c) Pheochromocytoma
d) Addison’s disease
e) Acromegaly
Something wrong?
Causes of hypercalcaemia include:
primary hyperparathyroidism (most commonly due to a benign parathyroid adenoma)

familial hypocalciuric hypercalcaemia
sudden acidosis (resulting in release of bound calcium)
malignancy
sarcoidosis
chronic renal failure
thyrotoxicosis
pheochromocytoma
Addison’s disease
acromegaly
ingestion of excess calcium (milk-alkali syndrome) or vitamin D
drugs e.g. lithium, thiazide diuretics, theophylline toxicity
prolonged immobilisation
bone destruction usually by secondary deposits from malignancy or myeloma
hypermagnesaemia
Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders characterised by hypocalcemia,

hyperphosphatemia, increased serum concentration of parathyroid hormone (PTH), and insensitivity to the biologic
activity of PTH.
The commonest causes of hypercalcaemia are primary hyperparathyroidism (most common) and hypercalcaemia of
malignancy.
Features of hypercalcaemia include:
STONES (renal calculi)

BONES (bone pain, fragile bones)
GROANS (lethargy, fatigue, generalised muscle weakness)
GROANS (lethargy, fatigue, generalised muscle weakness)
MOANS (constipation, abdominal pain, nausea/vomiting, pancreatitis, peptic ulcer)
THRONES (polyuria, polydipsia, dehydration, renal failure)
PSYCHIATRIC OVERTONES (confusion, depression, anxiety, hallucinations, insomnia)
Parathyroid hormone (PTH) release is primarily simulated by which of the following:
a) High serum Ca2+

b) Low serum Ca2+
c) High serum PO43-
d) Low serum PO43-
e) Activated vitamin D
Something wrong?
Parathyroid hormone (PTH) is synthesised by the chief cells in the parathyroid gland. PTH is released in response to
falling plasma ionised calcium levels and increasing blood phosphate levels (indirectly by its binding to ionised calcium
and thereby effective reduction of blood calcium levels).
PTH release is inhibited by normal blood calcium levels and hypomagnesaemia.
PTH acts to:
increase calcium and phosphate resorption from bone (via indirect upregulation of osteoclast activity)
increase calcium reabsorption in the distal tubule of the nephron (by activating Ca2+ entry channels in the
apical membrane and the Ca2+ ATPase pump on the basolateral membrane)
increase phosphate excretion by inhibiting reabsorption in the proximal tubule of the nephron
inhibit renal bicarbonate reabsorption stimulating a metabolism acidosis which favours dissociation of calcium
from plasma proteins
stimulate 1-alpha-hydroxylase in the kidneys to produce activated vitamin D
indirectly increase calcium and phosphate absorption in the small intestine (via activated vitamin D)
Overall PTH acts to increase plasma calcium levels and decrease plasma phosphate levels.
Regarding the position of the pituitary gland, which of the following statements is CORRECT:
a) The pituitary gland lies in a bony hollow of the ethmoid bone.

b) The pituitary gland is covered by the brous diaphragma sellae of the dura mater.
c) The optic chiasm lies directly posterior to the anterior pituitary.
d) The anterior pituitary is connected to the median eminence of the hypothalamus by the pituitary stalk.
e) The sphenoid sinuses lie lateral to the pituitary gland.
Something wrong?
The pituitary gland lies in a bony hollow of the sphenoid bone (the sella turcica), and it is covered by the brous
diaphragma sellae of the dura mater. The optic chiasm lies directly superior to the anterior pituitary. The posterior
pituitary is connected to the median eminence of the hypothalamus by the pituitary stalk (also known as the
infundibulum). The cavernous sinuses (including cranial nerves III – VI) lie lateral to the pituitary gland.
Insulin secretion is stimulated by all but which one of the following:
a) Fatty acids and ketones

b) Glucagon
c) Secretin
d) Somatostatin
e) Growth hormone
Something wrong?
Insulin is a polypeptide hormone consisting of two short chains (A and B) linked by disulphide bonds.
Insulin is formed from the cleaving of proinsulin (derived from preproinsulin synthesised in the rough endoplasmic
reticulum) into insulin and C-peptide in the Golgi body of β cells in the islets of Langerhans.
Since insulin and C-peptide are produced in equimolar amounts, C-peptide acts as a useful marker of β cell activity in
diabetics who receive insulin treatment.
Insulin secretion is stimulated directly by high blood glucose levels, but also by metabolites such as amino acids, fatty
acids and ketones, by glucagon, some gastrointestinal tract peptides (e.g. secretin), GH, ACTH and TSH. Insulin
secretion is inhibited by low blood glucose levels, adrenaline, somatostatin, hypocalcaemia and sympathetic
innervation. (N.B. insulin secretion never ceases completely, there is always a basal level of insulin in the blood)
Which of the following is NOT an expected nding in hyperprolactinaemia:
a) Amenorrhoea
b) Failure of postpartum lactation
c) Infertility
d) Loss of libido
e) Erectile dysfunction
Something wrong?
Prolactin acts on the mammary glands and reproductive organs to promote growth of these organs and initiate
lactation.
lactation.
Prolactin secretion is stimulated by prolactin-releasing factor (PRF) and thyrotropin-releasing hormone (TRH) from
the hypothalamus. Prolactin secretion is inhibited by dopamine secreted by the hypothalamus.
Prolactin levels rise physiologically in pregnancy, puerperium, and breast stimulation.
Excess levels of prolactin may be caused by:
a prolactinoma (prolactin-secreting pituitary adenoma)

compression of the pituitary stalk by a pituitary or hypothalamic tumour preventing normal dopaminergic
inhibition of prolactin release
head injury
neurosurgery
hypothyroidism (due to increased synthesis of TRH)
Cushing’s syndrome
severe liver disease
polycystic ovary syndrome (PCOS)
drugs e.g. dopamine antagonists, antidepressants.
Hyperprolactinaemia causes symptoms such as oligomenorrhoea/amenorrhoea, galactorrhoea, loss of libido, erectile

dysfunction and infertility (via inhibition of the release of GnRH from the hypothalamus).
Prolactin de ciency results in failure of postpartum lactation.
Which of the following is NOT a well known cause of hypoglycaemia:
a) Addison’s disease
b) Propranolol
c) Hypothermia
d) Cushing’s syndrome
e) Alcohol
Something wrong?
Hypoglycaemia is de ned as a level of glucose < 3 mmol/L, although generally patients are not symptomatic unless
plasma glucose reaches < 2.2 mmol/L.
It can occur due to:
oral hypoglycaemic drugs

excess exogenous insulin
alcohol
hepatic failure
renal impairment
overwhelming sepsis
hypothermia
Addison’s disease
insulinoma
malignancy
certain medications e.g. beta blockers or salicylates
inadequate levels of exercise or carbohydrate intake in patients with diabetes mellitus
Symptoms of hypoglycaemia result from a catecholamine surge and include: feelings of hunger, tremor, nausea,
sweating, anxiety/irritability, pallor, tachycardia or palpitations, headaches, tingling in the extremities or lips.
Symptoms of cognitive impairment re ect neuroglycopenia and include confusion, poor concentration, seizures and
ultimately coma.
Patients should be given oral glucose if possible (e.g. Lucozade or Glucogel), or if the oral route is not possible,
intravenous dextrose if there is IV access (e.g. 75-80 ml 20% glucose or 150-160 ml of 10% glucose), or
intramuscular/subcutaneous glucagon (e.g. 1 mg glucagon) if there is not.
Regarding the endocrine pancreas, which of the following statements is CORRECT:
a) The predominant endocrine cell type is the beta-cell.

b) Delta-cells secrete glucagon.
c) Endocrine hormones are released from Langhans giant cells.
d) Somatostatin stimulates the release of both insulin and glucagon.
e) Somatostatin is released from pancreatic acinar cells.
Something wrong?
The endocrine cells of the pancreas are arranged in small clusters around the larger exocrine cell clusters, called acini.
The endocrine clusters are called islets of Langerhans and within them are four types of cells:
1. alpha cells (comprise 20% of all cells) secrete glucagon

2. beta cells (70%) secrete insulin
3. delta cells (8%) secrete somatostatin
4. F-cells ( 2%) secrete pancreatic polypeptide.
Insulin and glucagon regulate blood glucose levels, somatostatin inhibits the release of both insulin and glucagon,
pancreatic polypeptide inhibits the exocrine functions of the pancreas.
Regarding insulin receptors, which of the following statements is CORRECT:
a) Insulin receptors are G-protein coupled receptors.

b) Insulin receptors consist of two extracellular beta subunits and two transmembrane alpha subunits.
b) Insulin receptors consist of two extracellular beta subunits and two transmembrane alpha subunits.
c) Insulin is a steroid hormone which can readily cross the cell membrane.
d) Insulin receptors are only present on cells of the liver.
e) Insulin has its intracellular effects via activation of tyrosine kinase.
Something wrong?
Insulin receptors are present on most cells and they can be sequestered into the cell to inactivate them; they consist of
two extracellular alpha (α) subunits which contain the insulin-binding site and two transmembrane beta (β) subunits.
Insulin must act via cell surface receptors as it is a polypeptide hormone which cannot readily cross the cell membrane.
When insulin binds to the receptor, the beta subunit autophosphorylates and activates tyrosine kinase causing an
intracellular cascade of phosphorylation to bring about its intracellular effects.
Insulin acts to:
stimulate peripheral tissue glucose uptake

stimulate glycogenesis
stimulate glycolysis
stimulate amino acid uptake and protein synthesis
inhibit glycogenolysis
inhibit proteolysis
stimulate lipogenesis
inhibit lipolysis
inhibit gluconeogenesis
Which of the following is NOT an endocrine cause of hyponatraemia:
b) Conn’s syndrome
c) Abrupt withdrawal of long-term corticosteroids
d) Hypothyroidism
e) SIADH
Something wrong?
Hyponatraemia is de ned as a serum sodium concentration of below the reference interval of 133 – 146 mmol/L. A
level < 120 mmol/L is considered severe.
Hyponatraemia can arise either because of a primary loss of sodium ions or more commonly, due to increased
retention of water relative to sodium which effectively dilutes the concentration of sodium.
Patients with hyponatraemia can be divided into three categories on the basis of their ECF volume.
Hyponatraemia in hypovolaemic patients results from a true sodium de cit (following loss of salt and water) and may
be caused by:
Gastrointestinal loss e.g. diarrhoea, vomiting, stula

Skin loss e.g. excessive sweating, dermatitis, burns
Renal losses e.g. diuretic therapy, renal tubular disease, cerebral salt wasting, mineralocorticoid de ciency
(Addison’s disease)
Inadequate oral intake (very rare)
Hyponatraemia in euvolaemic patients results from excessive water retention due to the inability to excrete a water
load, which may be caused by:
Acute increase in ADH following trauma/surgery/postpartum

SIADH
psychogenic polydipsia
chronic renal disease
severe hypothyroidism
glucocorticoid de ciency e.g. anterior pituitary disease or abrupt withdrawal of long-term glucocorticoids
Hyponatraemia in oedematous patients is actually associated with a high total body sodium, but there is a greater
volume of water retained relative to sodium. Causes include:
renal failure
congestive cardiac failure
malnutrition
cirrhosis
nephrotic syndrome
What is the most likely diagnosis in a patient who presents with polyuria, polydipsia, a raised
plasma osmolality and a low urine osmolality:
a) Diabetes mellitus
b) Addison’s disease
c) Diabetes insipidus
d) Conn’s syndrome
e) SIADH
Something wrong?
Diabetes insipidus (DI) may result from a de ciency of ADH secretion (cranial DI) or from an inappropriate renal
response to ADH (nephrogenic DI).
As a result, uid reabsorption at the kidneys is impaired, resulting in large amounts of hypotonic, dilute urine being
passed and subsequent polydipsia.
It is associated with elevated plasma osmolality (> 300 mOsm/kg) and low urine osmolality (< 600 mOsm/kg).
An ADH stimulation test can distinguish between cranial and nephrogenic DI, as nephrogenic DI shows an inability to
concentrate urine even after administration of ADH.
A man with hypocalcaemia is found to have hypoparathyroidism. Which of the following is

NOT a cause of hypoparathyroidism:
a) Haemochromatosis
b) DiGeorge syndrome
c) Hyperphosphataemia
d) Thyroidectomy
e) Magnesium de ciency
Something wrong?
Causes of hypocalcaemia include:
Hypoparathyroidism (e.g. DiGeorge syndrome, autoimmune, secondary to parathyroid or thyroid surgery,

secondary to radiation or chemotoxic agents, in ltrative disease of the parathyroid glands
e.g. haemochromatosis or secondary to hypomagnesaemia). Hyperphosphataemia may cause secondary
hyperparathyroidism, NOT hypoparathyroidism.
Pseudohypoparathyroidism (characterised by target organ resistance to PTH)
Acute pancreatitis
Renal failure
Vitamin D de ciency
Alkalosis or massive blood transfusion (due to increased intravascular ionised calcium binding)
Rhabdomyolysis or tumour lysis syndrome (due to extravascular calcium deposit)
Drugs e.g. bisphosphates, uoride poisoning, combination chemotherapy
Sepsis (due to impaired secretion of calcitriol and PTH, target organ resistance to PTH and increased lactate
binding calcium in serum)
These causes can be remembered using the mnemonic HARVARDS.
The most common causes are hypoparathyroidism (frequently following surgery), vitamin D de ciency or abnormal
metabolism, chronic kidney disease and hypomagnesaemia.
Patients with adjusted serum calcium > 1.9 are usually asymptomatic but many patients become symptomatic when
levels fall lower than this.
Features of hypocalcaemia include:
carpopedal spasm in response to in ating a blood pressure cuff to above systolic BP (Trousseau’s sign)
twitching of the ipsilateral facial muscles in response to tapping on the facial nerve (Chvostek’s sign)
painful and fragile bones
numbness and paraesthesia in hands and feet
muscle cramps and spasms
myopathy
cardiac arrhythmias
cardiac failure
hypotension
prolonged QT interval
seizures
mood changes
cataracts
Insulin is secreted by which of the following pancreatic cell types:
a) α cells
b) β cells
c) δ cells
d) F-cells
e) Acinar cells
Something wrong?

What is the underlying cause of Cushing’s disease:
a) Adrenal adenoma
b) Ectopic ACTH
c) Primary hyperaldosteronism
d) Pituitary adenoma
e) Exogenous steroids
Something wrong?
Cushing’s disease refers to the speci c condition of excess corticosteroids as a result of increased ACTH due to a
pituitary adenoma; the negative feedback that normally prevents excess ACTH secretion is absent in the tumour.
Cushing’s disease is associated with hyperpigmentation due to the melanocyte-stimulating action of ACTH.
Glucagon acts to cause all but which one of the following effects:
a) Stimulation of glycogenolysis
b) Increased peripheral tissue glucose uptake
c) Stimulation of lipolysis
d) Stimulation of ketogenesis
e) Stimulation of gluconeogenesis
Something wrong?
Glucagon is synthesised in the pancreatic alpha (α) cells in the islets of Langerhans.
Glucagon secretion is stimulated by low blood glucose, amino acids, adrenaline, some gastrointestinal peptides,
sympathetic and parasympathetic innervation. Glucagon secretion is inhibited by high blood glucose, fatty acids and
ketones, insulin and somatostatin.
Glucagon acts on G-protein coupled receptors.
Glucagon acts to:
stimulate glycogenolysis
inhibit peripheral tissue glucose uptake
inhibit glycolysis
inhibit amino acid uptake and protein synthesis
stimulate lipolysis
stimulate gluconeogenesis
stimulate ketogenesis
Osteomalacia/rickets are associated with all but which one of the following clinical features:
a) Hypocalcaemia
b) Bow-legs
c) Bone pain
d) Bone fragility and increased risk of fracture
e) Hyperphosphataemia
Something wrong?
Osteomalacia is a disorder of mineralisation of bone matrix. Rickets is a disorder of defective mineralisation of

cartilage in the epiphyseal growth plates of children.
Defective mineralisation is mostly due to reduced calcium and phosphate levels in the extracellular uid due to vitamin
D de ciency.
Features of osteomalacia include:
bone pain
bones appear thin on X-ray with localised radiolucencies
increased susceptibility to fractures
features of hypocalcaemia
Features of Rickets include:
‘knock-knees’ or ‘bow-legs’ caused by bending of the long bones

chest deformities
back deformities e.g. kyphosis
protruding forehead
growth retardation
What is the most common cause of hyperthyroidism:
a) Toxic multinodular goitre

b) Toxic thyroid adenoma
c) TSH-secreting pituitary adenoma
d) Graves’ disease
e) Hashimoto’s thyroiditis
Something wrong?
Graves’ disease is an autoimmune disease, in which autoantibodies against TSH receptors are produced. These
antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones.
Graves’ disease is the most common cause of hyperthyroidism.
Classically Grave’s disease is associated with hyperthyroidism, pretibial myxoedema, clubbing (thyroid acropachy) and
eye changes.
Graves’ eye disease may include features of: exophthalmos, lid retraction, lid lag, diplopia, corneal ulcers.
Regarding antidiuretic hormone (ADH) which of the following statements is CORRECT:
a) ADH acts to increase water reabsorption by upregulating Na+ reabsorption.

b) ADH has a potent vasodilator action at high doses.
c) ADH release is stimulated by a fall in plasma volume.
d) ADH release is stimulated by alcohol.
e) Excess ADH results in diabetes insipidus.
Something wrong?
Antidiuretic hormone is synthesised in the hypothalamus and stored in secretory granules in the posterior pituitary.
The main action on the kidneys is to increase the permeability of the distal tubule and the collecting duct to reabsorb
water and thus increase water retention and concentrate urine.
ADH binds to V2 receptors on renal principal cells and increases cAMP, causing the incorporation of water channels
called aquaporins into the apical membrane. It also has a potent vasoconstriction action at high doses.
ADH is rapidly removed from plasma, falling by about 50% in about 10 minutes, mainly due to metabolism in the liver
and kidneys.
ADH release is stimulated by raised plasma osmolality (detected by osmoreceptors in the hypothalamus which also
stimulate thirst) and a fall in blood pressure/plasma volume (detected by cardiac and vascular baroreceptors). The
osmoreceptor system is more sensitive than the baroreceptor system.
ADH release is inhibited by low plasma osmolality, alcohol, caffeine, glucocorticoids and atrial natriuretic peptide
(ANP).
ADH de ciency (or an inadequate response to ADH) results in diabetes insipidus. Excess levels of ADH results in
syndrome of inappropriate ADH secretion (SIADH).
Regarding hyponatraemia, which of the following statements is INCORRECT:
a) Hyponatraemia of any cause is usually associated with a low plasma osmolality.

b)
If plasma osmolality is normal in a patient with hyponatraemia, then the possibility of pseudohyponatraemia should
be considered.
c) Pseudohyponatraemia may be caused by hypoalbuminaemia.
d) Hyperglycaemia may cause a hyperosmolar hyponatraemia.
e) Mannitol may cause a hyperosmolar hyponatraemia.
Something wrong?
Hyponatraemia of any cause, is usually associated with a low plasma osmolality.
If the plasma osmolality is normal, then the possibility of pseudohyponatraemia should be considered; this is an
artifactual result due to a reduction in plasma water caused by marked hyperlipidaemia or hyperproteinaemia e.g.
multiple myeloma.
If the plasma osmolality is high, then the possibility of hyperosmolar hyponatraemia should be considered; this may be
due to hyperglycaemia or administration of mannitol amongst other causes and re ects the shift of water out of cells
into the extracellular uid in response to osmotic effects.
Diabetes insipidus results from a de ciency of or an inappropriate response to which of the

following hormones:
a) Aldosterone
b) Cortisol
c) Angiotensin II
d) Renin
e) Antidiuretic hormone
Something wrong?
In a patient with hyponatraemia, dehydration and high urinary Na+, which of the following is
the most likely diagnosis:
a) Vomiting
b) Diabetes insipidus
c) Nephrotic syndrome
d) Sweating
e) Diuretics
Something wrong?
Hyponatraemia is de ned as a serum sodium concentration of below the reference interval of 133 – 146 mmol/L. A Na
+ concentration < 120 mmol/L is considered severe.
Hyponatraemia can arise either because of a primary loss of sodium ions (in excess of water loss) or more commonly,
due to increased retention of water relative to sodium which effectively dilutes the concentration of sodium (both are
associated with a decrease in plasma osmolality).
Hyponatraemia in hypovolaemic patients results from a true sodium de cit (following loss of salt > water) and may be
caused by:
Prerenal Losses (urinary Na+ < 20 mmol/L)

Third space loss e.g. burns, pancreatitis, cirrhosis
Renal losses (urinary Na+ > 20 mmol/L)
diuretic therapy
osmotic diuresis
renal tubular disease
mineralocorticoid de ciency in Addison’s disease
Poor dietary salt intake (very rare)
Hyponatraemia in euvolaemic patients results from excessive water retention either due to:
increased intake of pure water (where urine osmolality is low and urinary Na+ < 20 mmol/L) for example:
inappropriate intravenous dextrose administration
inability to excrete a water load (where urine osmolality is high and urinary Na+ > 20 mmol/L) which may be
caused by:
SIADH
Hyponatraemia in oedematous patients is usually associated with a high total body sodium, but there is a greater
Where urinary Na+ > 20 mmol/L

renal failure
cerebral salt wasting
inappropriate intravenous hypertonic saline
Where urinary Na+ < 20 mmol/L
malnutrition
cirrhosis
cirrhosis
nephrotic syndrome
Which of the following is NOT a direct effect of parathyroid hormone (PTH):
a) Increases Ca2+ reabsorption in the kidneys

b) Decreases PO43- reabsorption in the kidneys
c) Increases bone resorption
d) Stimulates activation of vitamin D by the kidneys
e) Increases calcium reabsorption from the small intestine
Something wrong?
PTH acts to:
How does parathyroid hormone (PTH) affect the renal handling of Ca2+:
a) Decreases calcium reabsorption in the proximal tubule

b) Increases calcium ltration at the glomerulus
c) Increases calcium reabsorption in the distal tubule
d) Increases calcium reabsorption in the proximal tubule
e) Decreases calcium reabsorption in the distal tubule
Something wrong?
PTH acts to:
Which of the following clinical features is NOT a classical feature of acromegaly:
a) Prognathism
b) Spade-like hands
c) Osteoarthritis
d) Glucose intolerance
e) Hypocalcaemia
Something wrong?
Acromegaly is a result of excess growth hormone (GH) secretion from the anterior pituitary gland, most commonly as a
result of a GH-secreting pituitary adenoma.
Features of acromegaly include:
enlarged head circumference

coarse and thickened skin resulting in prominent nasolabial folds, frontal bossing and supraorbital ridges
large lower jaw (prognathism)
spaces between lower teeth
large nose
macroglossia
enlarged liver and kidneys
spade-like hands
mental disturbances
insomnia
loss of peripheral vision due to pituitary tumour compressing the optic chiasm (bitemporal hemianopia)
cardiomyopathy
hypertension
osteoarthritis
increased greasy sweating
temperature intolerance
hypercalcaemia
glucose intolerance/diabetes mellitus
predisposition to ischaemic heart disease
carpal tunnel syndrome
In a euvolaemic patient with hyponatraemia and a urinary Na+ > 40 mmol/L, which of the
following is the most likely diagnosis:
a) Nephrogenic diabetes insipidus

b) Cranial diabetes insipidus
c) Diabetes mellitus
d) Syndrome of inappropriate ADH secretion
e) Renal failure
Something wrong?
caused by:

diuretic therapy
osmotic diuresis
caused by:
SIADH

renal failure
malnutrition
cirrhosis
nephrotic syndrome
Which of the following signs would you NOT expect to see in hypothyroidism:
a) Proximal myopathy
b) Hypore exia
c) Positive Phalen’s test
d) Bradycardia
e) Pretibial myxoedema
Something wrong?
Hypothyroidism is de ned as an underactive thyroid gland leading to de cient thyroid hormones. T3 and T4 levels are
low and TSH levels are usually high.
Causes include:
overtreatment of hyperthyroidism (e.g. radioactive ablation, surgical removal or anti-thyroid drugs e.g.
carbimazole)
drugs e.g. amiodarone, lithium, anticonvulsants, levodopa
Hashimoto’s thyroiditis
De Quervain (subacute) thyroiditis

primary atrophic hypothyroidism
severe iodine de ciency
TSH de ciency from hypopituitarism
disruption of the hypothalamic-pituitary-thyroid axis
Features of hypothyroidism include:
coarse and thin hair

loss of outer third of eyebrows
mental slowing
apathy
lethargy
psychosis
myxoedemic features (i.e. pale puffy face, coarse features)
hoarse voice
swollen tongue
deafness
goitre
bradycardia
proximal myopathy
constipation
cold hands
cold intolerance
slow re exes
weight gain
decreased sweating
chronic oedema
cold dry skin
TSH levels are normally elevated, low TSH levels suggest secondary hypothyroidism which is much less common.
Acromegaly results from an excess of which of the following hormones:
a) Cortisol
b) Aldosterone
c) Growth hormone
d) ACTH
e) Prolactin
Something wrong?

large nose
macroglossia
spade-like hands
mental disturbances
insomnia
cardiomyopathy
hypertension
osteoarthritis
hypercalcaemia
Which of the following is NOT a well recognised feature of a pituitary adenoma:
a) Hypopituitarism
b) Hyperpituitarism
c) Homonymous hemianopia
d) Ophthalmoplegia
e) Hyperprolactinaemia
Something wrong?
Functioning pituitary adenomas cause disease by excess hormone release (hyperpituitarism).
Functioning pituitary adenomas usually release prolactin (most common type – about 50% of pituitary tumours), GH
(about 20%) or ACTH (about 5%). TSH, LH and FSH – secreting adenomas are rare.
In addition to endocrine abnormalities, pituitary tumours can present with effects of a space-occupying lesion e.g.
headaches, vomiting and papilloedema due to raised intracranial pressure, hypopituitarism from compression of
normal secretory cells or compression of the portal veins that bring the hypothalamic-releasing factors (secretion of
anterior pituitary hormones is inhibited in a characteristic order: GH, LH, FSH, ACTH, TSH, Prolactin (N.B. unless
compression is severe, prolactin secretion is usually raised)) , visual eld defects (bitemporal hemianopia) from
compression at the optic chiasm and cranial nerve palsies (CN III, IV, V and VI) from compression of the cavernous
sinus.
ADH has which of the following actions:
a) Increases uid excretion by inhibiting reabsorption of sodium in the distal convoluted tubule
b) Increases uid retention by increasing sodium reabsorption in the distal convoluted tubule
c) Vasodilation
d) Increases uid reabsorption in the proximal tubule via the insertion of aquaporin water channels
e) Increases urine osmolality
Something wrong?
and kidneys.
(ANP).
What is the most likely diagnosis in a patient who presents with hypovolaemic hypotensive
shock, who is found to have hyponatraemia and hyperkalaemia:
a) Adrenal crisis
b) Thyrotoxic storm
c) Pituitary apoplexy
d) Myxoedema coma
e) Pheochromocytoma
Something wrong?
Primary insuf ciency of the adrenal cortex is called Addison’s disease, it is characterised by de cient secretion of both
glucocorticoids and mineralocorticoids.
Causes include:
autoimmune adrenalitis (most common cause)

infection e.g. tuberculosis (most common cause of Addison’s disease worldwide, but is rare in the UK)
tumour e.g. metastases
amyloidosis
haemorrhagic necrosis of the adrenal gland (e.g. Waterhouse-Friderichsen syndrome secondary to DIC in
meningococcal septicaemia)
High levels of circulating ACTH can cause hyperpigmentation.
Features of Addison’s disease include:
postural hypotension
hyponatraemia
hyperkalaemia
hypoglycaemia
tendency for hypercalcaemia
weight loss
abdominal pain/constipation/nausea
muscle weakness
fatigue
lethargy
dizziness
depression
An acute exacerbation of Addison’s disease is called an adrenal crisis. It is a life-threatening emergency characterised
by: hypotensive shock, hypovolaemic shock and hypoglycaemia.
Acute adrenocortical failure may occur if long-term high-dose steroid treatment is stopped abruptly (as the prolonged
steroid treatment has suppressed natural ACTH release). Secondary adrenocortical insuf ciency may also be caused
by disorders of the hypothalamus and anterior pituitary gland due to de ciency of CRH or ACTH.
Glucagon secretion is stimulated by all but which one of the following:
a) Adrenaline
b) Sympathetic innervation
c) Parasympathetic innervation
d) Fatty acids and ketones
e) Low blood glucose
Something wrong?
Glucagon acts to:
inhibit glycolysis
stimulate lipolysis
Which of the following is NOT an effect stimulated by adrenaline:
a) Bronchodilation
b) Increased heart rate
c) Vasoconstriction of the coronary vessels
d) Inhibited insulin release
e) Increased renin release
Something wrong?
Adrenaline acts to:
cause alertness/agitation/fear/anxiety
stimulate release of ACTH
dilate pupils
increase glycogenolysis
increase renin release
increase lipolysis
increase sweating
increase heart rate and contractility
cause vasoconstriction in most tissues (but vasodilation in the coronary circulation)
increase cardiac output and blood pressure
dilate the bronchioles
stimulate ventilation
stimulate glucagon release
inhibit insulin release
decrease proteolysis
increase ef ciency of skeletal muscle contraction
Aldosterone is secreted by which of the following:
a) Zona glomerulosa of the adrenal cortex

b) Zona reticularis of the adrenal cortex
c) Zona fasciculata of the adrenal cortex
d) Adrenal medulla
e) Anterior pituitary
Something wrong?
The adrenal cortex is controlled by the pituitary gland, responding to adrenocorticotrophic (ACTH) hormone.
It is functionally and anatomically divided into three zones of tissue which each secrete different steroid hormones:
the outer zona glomerulosa which secretes mineralocorticoids (mainly aldosterone)

the zona fasciculata which secretes glucocorticoids (mainly cortisol)
the inner zona reticularis which secretes glucocorticoids and androgens (mainly dehydroepiandrosterone
(DHEA))
The adrenal medulla produces catecholamines.
Which of the following clinical features would you NOT expect to see in hypothyroidism:
a) Loss of outer third of eyebrows

b) Weight loss
c) Pale puffy face
d) Swollen tongue
e) Goitre
Something wrong?
Causes include:
carbimazole)

mental slowing
apathy
lethargy
psychosis
hoarse voice
swollen tongue
deafness
goitre
bradycardia
proximal myopathy
constipation
cold hands
cold intolerance
slow re exes
weight gain
decreased sweating
chronic oedema
cold dry skin
You are asked to assess a patient with hyponatraemia. They are hypervolaemic and have a low
urinary sodium of < 20 mmol/L, which of the following is the most likely cause of their
hyponatraemia:
a) SIADH
b) Congestive cardiac heart failure
c) Hypothyroidism
d) Chronic kidney disease
e) Psychogenic polydipsia
Something wrong?
caused by:

diuretic therapy
osmotic diuresis
caused by:
SIADH

renal failure

malnutrition
cirrhosis
nephrotic syndrome
Where is vitamin D mainly activated in the body:
a) Skin
b) Liver
c) Thyroid gland
d) Parathyroid gland
e) Kidneys
Something wrong?
Vitamin D (cholecalciferol) is absorbed by the small intestine as part of the diet or is synthesised from cholesterol in
skin.
Cholecalciferol is converted to calcifediol by 25-hydroxylase in the liver. This is converted to activated vitamin D (1, 25
– dihydroxycholecalciferol or calcitriol) by 1-alpha-hydroxylase in the kidney. The enzyme 1-alpha-hydroxylase is
stimulated by parathyroid hormone (PTH) and by low concentrations of phosphate.
Activated vitamin D acts to:
increase calcium and phosphate absorption in the small intestine (the main action)
increase renal calcium reabsorption (in the distal tubule via activation of a basolateral Ca2+ ATPase pump)
increase renal phosphate reabsorption
inhibit 1-alpha-hydroxylase activity in the kidneys (negative feedback)
affect bone remodelling to bring about the conditions of high calcium and phosphate optimum for bone
remineralisation
Vitamin D de ciency can occur in:
dietary de ciency
malabsorption e.g. coeliac disease
lack of sun exposure
chronic kidney disease
liver failure
anticonvulsant therapy
hypoparathyroidism
De ciency of vitamin D causes hypocalcaemia and osteomalacia (or rickets in children).
Regarding the gonadotropins, FSH and LH, which of the following statements is INCORRECT:
a) Gonadotrophin-releasing hormone is secreted from the hypothalamus.

b) LH stimulates testicular production of testosterone.
c) Gonadotropin release is stimulated by prolactin.
d) Gonadotropins act via G-protein coupled receptors.
e) Excess gonadotropins results in infertility.
Something wrong?
The gonadotropins, luteinising hormone (LH) and follicle stimulating hormone (FSH) act via G-protein coupled
receptors on the gonads.
In the male, LH acts to stimulate production of testosterone, which acts in concert with FSH to support
spermatogenesis. In the female, LH and FSH are essential for normal menstruation and reproduction.
LH/FSH secretion is stimulated by gonadotrophin-releasing hormone (GnRH) from the hypothalamus. GnRH is
released in a pulsatile fashion, which is essential for normal reproductive activity.
LH/FSH secretion is inhibited by prolactin and sex steroids. LH/FSH de ciency results in gonadal insuf ciency
(decreased sex steroids). Excess levels of FSH/LH (extremely rare) results in infertility.
Which of the following is an action of oxytocin:
a) Stimulates Na+ and water reabsorption in the kidneys

b) Simulates Ca2+ reabsorption in the small intestine
c) Stimulates spermatogenesis
d) Stimulates uterine contraction in childbirth
e) Stimulates milk production in the mammary glands
Something wrong?
Oxytocin acts on the mammary glands to stimulate milk ejection, and the uterus to stimulate uterine contraction in
childbirth. Oxytocin release is stimulated by stretch receptors in the nipple and the cervix and by oestrogen. Oxytocin
release is inhibited by stress.
The adrenal medulla produces which of the following:
a) Mineralocorticoids
b) Glucocorticoids
c) Adrenal androgens
c) Adrenal androgens
d) Catecholamines
e) Growth hormone
Something wrong?
The adrenal medulla produces catecholamines, and is controlled by and functions in concert with the sympathetic
nervous system.
The chromaf n cells of the medulla secrete noradrenaline (20%) and adrenaline (80%) stimulated by sympathetic
preganglionic neurones located in the spinal cord in response to stress e.g. exercise, pain, shock, hypoglycaemia. These
catecholamines act on alpha- and beta- G-protein coupled receptors , having the same effect in tissues as stimulation
of sympathetic nerves.
Noradrenaline has equal potency at all adrenoceptors, but adrenaline at normal plasma concentrations will only
activate beta-receptors (higher levels do stimulate alpha-receptors).
Noradrenaline is synthesised from the amino acid tyrosine which is then converted to adrenaline in response to
cortisol from the adrenal cortex. Catecholamines circulate mainly bound to albumin and are broken down by
monoamine oxidase (MAO) and catechol-O-methyl transferase (COMT) in the liver.
Regarding vitamin D, which of the following statements is CORRECT:
a) Vitamin D can only be obtained from the diet.

b) Activation of vitamin D primarily occurs in the liver.
c) Parathyroid hormone inhibits activation of vitamin D.
d) Activated vitamin D increases renal excretion of phosphate.
e) Vitamin D de ciency can cause rickets in children.
Something wrong?
skin.

remineralisation
dietary de ciency
liver failure
hypoparathyroidism
Regarding steroid hormones, which of the following statements is INCORRECT:
a) Steroid hormones are synthesised from cholesterol.

b) Steroid hormones are small lipid-soluble molecules.
c) Steroid hormones can readily cross cell membranes.
d) Steroid hormones act on intracellular receptors to regulate gene expression.
e) Steroid hormones travel mostly dissolved in plasma.
Something wrong?
Steroid hormones are synthesised from cholesterol. They are small lipid-soluble molecules that can readily cross cell
membranes and that travel in plasma mainly bound to plasma protein. Inside cells, they act on intracellular receptors to
regulate gene expression.
Calcitonin is primarily released in response to:
a) High serum Ca2+

b) Low serum Ca2+
c) High serum PO43-
d) Low serum PO43-
e) Activated vitamin D
Something wrong?
Calcitonin is secreted by the parafollicular cells in the thyroid gland. Calcitonin is secreted in response to rising or high
blood calcium levels and acts to lower circulating levels of calcium.
Calcitonin acts on the kidneys to inhibit reabsorption of calcium and phosphate and on the bones to inhibit osteoclast
activity and thus bone resorption of calcium and phosphate.
A patient’s blood results show hypernatraemia, with plasma osmolality > urine osmolality,
which of the following is the most likely diagnosis:
a) SIADH
c) Conn’s syndrome
d) Osmotic diuresis
e) Inadequate water intake
Something wrong?
Hypernatraemia is an increase in the serum sodium concentration above the reference interval of 133 – 146 mmol/L.
Hypernatraemia may arise from either excess sodium or much more commonly from water de cit (both are associated
with a raised plasma osmolality).
Hypernatraemia can be thought of in relation to actual total body sodium. The most common group of patients are
those with hypernatraemia with decreased body sodium through loss of both water and sodium, but with a greater
proportion of water loss which may result from:
renal losses e.g. osmotic diuresis in uncontrolled diabetes mellitus, loop diuretics, renal disease
skin losses e.g. burns, excessive sweating in hot climate or exercise
gastrointestinal losses e.g. vomiting, diarrhoea, stulae
Patients with hypernatraemia with normal total body sodium have a pure water de cit which may result from:
inadequate water intake e.g. unconscious patient, dementia, disordered thirst perception in hypothalamic
lesion
excessive pure water loss e.g. diabetes insipidus (where plasma osmolality > urine osmolality)
Hypernatraemia with an actual increase in total body sodium is rare. Mild true hypernatraemia may be caused by
primary hyperaldosteronism, but this is not typical of Conn’s syndrome, other causes include acute salt poisoning e.g.
intravenous sodium bicarbonate, hypertonic saline, high sodium feeds in infants, near drowning in salt water.
When assessing patients with hypernatraemia:
If the hypernatraemia is mild (Na ≤ 150 mmol/L) and the patient has obvious signs of dehydration it is likely the
ECF volume is reduced and that the patient has lost both sodium and water. Treatment should aim to replace
the de cit of uid by infusing isotonic saline, or if the de cit is large, hypotonic saline.
With more severe hypernatraemia (150 – 170 mmol/L), pure water loss is likely if the clinical signs of
dehydration are mild in relation to the degree of hypernatraemia – this is because pure water loss is
distributed evenly throughout the body compartments and the sodium content of the ECF is unchanged.
Treatment should be aimed at replacing water either orally, or with 5% dextrose.
With gross hypernatraemia ( > 180 mmol/L), an excess of sodium is likely, the patient may present with signs of
uid overload. Treatment may be with diuretics, or rarely, by renal dialysis.
What is the most likely diagnosis in a young girl presenting with virilism and hirsutism:
a) Conn’s syndrome
b) Cushing’s syndrome
c) Congenital adrenal hyperplasia
e) Pheochromocytoma
Something wrong?
Congenital adrenal hyperplasia (CAH) is the result of an inherited enzyme defect in corticosteroid biosynthesis.
Because of the lack of cortisol, negative feedback to the pituitary is absent and ACTH secretion continues to drive
steroid biosynthesis.
Cortisol precursors are secreted in large amounts. Increased stimulation of adrenal androgen production can cause
virilisation in girls and precocious puberty in boys.
Regarding hyponatraemia, which of the following statements is CORRECT:
a) Hyponatraemia is de ned as a serum Na+ concentration of less than 140 mmol/L.

b) A level of Na+ < 130 mmol/L is considered severe hyponatraemia.
c) Hyponatraemia most commonly occurs due to a true sodium de cit.
d) In patients with hyponatraemia, the plasma osmolality is usually high.
e) Hyponatraemia in hypervolaemic patients is usually actually associated with a high total body Na+.
Something wrong?
caused by:

diuretic therapy
osmotic diuresis
caused by:
SIADH

renal failure
malnutrition
cirrhosis
nephrotic syndrome
Which of the following symptoms would you NOT typically expect in hyperthyroidism:
a) Tachycardia
b) Constipation
c) Weight loss
d) Heat intolerance
e) Tremor
e) Tremor
Something wrong?
Hyperthyroidism is de ned as over activity of the thyroid gland, leading to excess thyroid hormone secretion.
Causes include:
Graves’ disease
toxic multinodular goitre
toxic adenoma
ectopic thyroid tissue
drugs e.g. amiodarone
exogenous iodine
Features of hyperthyroidism include:
hair loss
emotional lability
fatigue
anxiety
restlessness
goitre
palpitations
tachycardia
atrial brillation
proximal myopathy
diarrhoea
increased appetite
weight loss
tremor
heat intolerance
sweating
oligomenorrhoea/amenorrhoea
infertility
reduced libido
osteoporosis
hyperre exia
pretibial myxoedema (in Graves’ disease)
palmar erythema
clubbing
onycholysis
T3 and T4 levels are elevated, and TSH levels are usually low. A raised TSH suggests the fault lies in or above the
pituitary gland.
What is the pathophysiology of a pheochromocytoma:
a) GH-secreting tumour
b) Catecholamine-secreting tumour
c) Cortisol-secreting tumour
d) ACTH-secreting tumour
e) Aldosterone-secreting tumour
Something wrong?
A pheochromocytoma is a tumour usually of the adrenal medulla that leads to the excess production of
catecholamines. They are usually benign and unilateral.
Features include (paroxysmal):
hypertension
headaches
profuse sweating
palpitations
tremor
What is the pathophysiology of Addison’s disease:
a) Adrenocortical insuf ciency

c) Chronic excess cortisol secretion
Something wrong?
Causes include:

amyloidosis
hyponatraemia
hyperkalaemia
hypoglycaemia
weight loss
muscle weakness
fatigue
lethargy
dizziness
depression
Regarding catecholamines, which of the following statements is INCORRECT:
a) Catecholamines circulate mainly bound to albumin.

b) Catecholamines are produced by the adrenal medulla.
c) Catecholamines are broken down in the liver by COMT and MAO.
d) Catecholamines act on alpha and beta G-protein coupled receptors.
e) At normal plasma concentrations, adrenaline will only activate alpha receptors.
Something wrong?
nervous system.
Regarding antidiuretic hormone (ADH) which of the following statements is CORRECT:
a) ADH is synthesised by the posterior pituitary gland.

b) ADH primarily acts to increase water permeability in the proximal tubule.
c) Excess ADH results in a reduction in urine osmolality.
d) ADH binds to V2 receptors on renal principal cells.
e) ADH has a half-life of about 6 – 8 hours.
Something wrong?
and kidneys.
(ANP).
Which of the following is NOT a typical feature of hypoglycaemia:
a) Tremor
b) Palpitations
c) Anxiety
d) Polydipsia
e) Perioral paraesthesia
e) Perioral paraesthesia
Something wrong?
Hypoglycaemia is de ned as a level of glucose < 3 mmol/L, although generally patients are not symptomatic unless
plasma glucose reaches < 2.2 mmol/L.
It can occur due to:
oral hypoglycaemic drugs

excess exogenous insulin
alcohol
hepatic failure
renal impairment
overwhelming sepsis
hypothermia
Addison’s disease
insulinoma
malignancy
certain medications e.g. beta blockers or salicylates
inadequate levels of exercise or carbohydrate intake in patients with diabetes mellitus
Symptoms of hypoglycaemia result from a catecholamine surge and include: feelings of hunger, tremor, nausea,
sweating, anxiety/irritability, pallor, tachycardia or palpitations, headaches, tingling in the extremities or lips.
Symptoms of cognitive impairment re ect neuroglycopenia and include confusion, poor concentration, seizures and
ultimately coma.
Patients should be given oral glucose if possible (e.g. Lucozade or Glucogel), or if the oral route is not possible,
intravenous dextrose if there is IV access (e.g. 75-80 ml 20% glucose or 150-160 ml of 10% glucose), or
intramuscular/subcutaneous glucagon (e.g. 1 mg glucagon) if there is not.
What is the most likely diagnosis in a euvolaemic patient who has the following biochemical
abnormalities; hyponatraemia, low plasma osmolality, high urine osmolality:
a) Diabetes insipidus
c) Conn’s syndrome
d) SIADH
e) Excess diuretic therapy
Something wrong?
Excess ADH (SIADH) causes water retention resulting in hypo-osmotic hyponatraemia.

Typical biochemistry shows hyponatraemia, low plasma osmolality, high levels of urinary sodium and high urine
osmolality.
Patients are euvolaemic and normotensive with normal thyroid and adrenal function. The potential causes are vast
including:
Neurological:
tumour, trauma, infection, Guillain-Barré syndrome, multiple sclerosis, systemic lupus erythematosus,
intracranial haemorrhage, sinus thrombosis, AIDS, porphyria
Pulmonary:
lung small-cell cancer, mesothelioma, pneumonia, abscess, cystic brosis, asthma, tuberculosis, positive-
pressure ventilation
Other malignancy:
oropharyngeal, stomach, pancreas, leukaemia, lymphoma, thymoma, and genitourinary tract cancers
Drugs:
chlorpropamide, carbamazepine, selective serotonin reuptake inhibitor (SSRI) antidepressants, tricyclic
antidepressants, lithium, MDMA/ecstasy, tramadol, haloperidol, vincristine, desmopressin, uphenazine
Miscellaneous:
idiopathic, hereditary, pain, postoperative, stress, endurance exercise and marathon runners, dermatomal
herpes zoster
Which of the following is NOT a well known cause of secondary diabetes mellitus:
a) Cushing’s syndrome
b) Thyrotoxicosis
c) Pheochromocytoma
d) Acromegaly
e) Diabetes insipidus
Something wrong?
“Fasting levels of glucose are normally 3.9 – 5.5 mmol/L, random levels are normally < 11 mmol/L.
Glucose homeostasis is primarily maintained by the interplay between insulin and glucagon. Insulin is the only
hormone that can lower glucose levels but adrenaline, cortisol and growth hormone, can raise levels in addition to
glucagon (by stimulating glycogenolysis and gluconeogenesis).
Hyperglycaemia is de ned as a fasting level of glucose > 7 mmol/L. (Levels < 6 mmol/L are normal, levels 6 – 6.9 mmol/L
demonstrate impaired fasting glycaemia, and levels >= 7 mmol/L are diagnostic of diabetes).
Hyperglycaemia may occur in diabetes mellitus type 1 due to a de ciency of insulin (due to autoimmune destruction of
β-cells), in diabetes mellitus type 2 due to a insuf ciency of insulin and/or insulin resistance or due to secondary causes
of diabetes.
of diabetes.
Secondary causes of diabetes include:
thyrotoxicosis
pheochromocytoma
acromegaly
glucagonoma
cirrhosis
chronic pancreatitis
cystic brosis
pancreatectomy
haemochromatosis
pancreatic carcinoma
thiazide diuretics
corticosteroid use.
Clinical features of hyperglycaemia include:
polyuria
glycosuria
dehydration
polydipsia
tendency to infections
lethargy
weight loss
wasting
blurred vision
weakness
You are asked to assess a patient with hyponatraemia. They are euvolaemic with a low plasma
and urine osmolality and a urinary sodium of < 20 mmol/L, which of the following is the most likely
cause of their hyponatraemia:
a) SIADH
c) Psychogenic polydipsia
d) Hypothyroidism
e) Renal failure
Something wrong?
caused by:

diuretic therapy
osmotic diuresis
caused by:
SIADH

renal failure
malnutrition
cirrhosis
nephrotic syndrome
nephrotic syndrome
What is the primary action of aldosterone:
a) Potassium reabsorption
b) Sodium reabsorption
c) Potassium secretion
d) Sodium secretion
e) Vasoconstriction
Something wrong?
Aldosterone is secreted by the zona glomerulosa of the adrenal cortex.
Aldosterone release is stimulated by:
angiotensin II
a fall in extracellular uid volume (via the RAAS)
a fall in plasma Na+ (via the RAAS)
high plasma K+
ACTH
ACTH is less important as a regulator, so pituitary failure does not severely impair aldosterone secretion. Aldosterone
acts mainly on the distal convoluted tubule (DCT) and the collecting duct of the kidney to cause increased reabsorption
of sodium ions in exchange for potassium and hydrogen ions (via stimulation of Na+ pumps, Na+/H+ antiporters, and Na
+ and K+ channels in principal cells, and H+ ATPase in intercalated cells).
Water is also reabsorbed and blood volume therefore increased. Increased K+ excretion lowers plasma K+ levels.
Aldosterone also stimulates Na+ conservation by the mucosal cells of the colon and gastric glands and by the sweat
and salivary gland ducts.
You are asked to assess a patient with hyponatraemia. They are euvolaemic with a low plasma
osmolality, a high urine osmolality and a urinary sodium of > 40 mmol/L, which of the following is
the most likely cause of their hyponatraemia:
a) Psychogenic polydipsia
b) SIADH
c) Addison’s disease
d) Diabetes insipidus
e) Conn’s syndrome
Something wrong?
caused by:

diuretic therapy
osmotic diuresis
caused by:
SIADH

renal failure
malnutrition
cirrhosis
cirrhosis
nephrotic syndrome
Adrenocorticotropic hormone (ACTH) primarily acts on which of the following target organs:
a) Anterior pituitary gland

b) Posterior pituitary gland
c) Adrenal medulla
d) Adrenal cortex
e) Liver
Something wrong?
Adrenocorticotrophic hormone (ACTH) acts on the adrenal cortex to stimulate glucocorticoid and androgen release.
ACTH secretion is stimulated by corticotrophin-releasing hormone (CRH) from the hypothalamus. ACTH secretion is
inhibited by glucocorticoids.
Excess levels of ACTH due to a functioning pituitary adenoma results in Cushing’s disease.
ACTH de ciency results in adrenocortical insuf ciency (decreased cortisol and adrenal androgens).
Regarding the adrenal medulla, which of the following statements is INCORRECT:
a) Catecholamines are produced by the chromaf n cells of the adrenal medulla.

b) The adrenal medulla predominantly secretes noradrenaline.
c) The adrenal medulla is stimulated by acetylcholine released from preganglionic sympathetic neurones.
d) Catecholamines are released by the adrenal medulla in response to stress.
e) The released catecholamines act on G-protein coupled receptors.
Something wrong?
nervous system.
Which of the following is NOT a risk factor for osteoporosis:
a) Hypoparathyroidism
b) Thyroid disease
c) Vitamin D de ciency
d) Post-menopausal women
e) Family history of osteoporotic fractures
Something wrong?
Osteoporosis is a disease characterised by low bone mineral density and deterioration of bone suf cient to cause bone
fragility and an increased risk of fracture (particularly hip, spine and distal radius).
It is caused by increased osteoclast activity and decreased osteoblast activity resulting in a shift towards increased
bone resorption.
Risk factors include:
post-menopausal women
family history of osteoporotic fractures
rheumatoid arthritis
thyroid disease
long-term corticosteroid use
high alcohol intake
smoking
vitamin D de ciency
hyperparathyroidism
Which of the following is NOT an effect of insulin:
a) Increased gluconeogenesis
b) Decreased proteolysis
c) Decreased glycogenolysis
d) Increased lipogenesis
e) Increased glycolysis
Something wrong?
Insulin acts to:

inhibit proteolysis
inhibit lipolysis
Which of the following features is NOT typical of Addison’s disease:
a) Hyperpigmentation
b) Hypotension
c) Hypoglycaemia
d) Hyperkalaemia
e) Hypernatraemia
Something wrong?
Causes include:

amyloidosis
hyponatraemia
hyperkalaemia
hypoglycaemia
weight loss
muscle weakness
fatigue
lethargy
dizziness
depression
Glucagon is secreted by which of the following pancreatic cell types:
a) α cells
b) β cells
c) δ cells
d) F cells
e) Acinar cells
Something wrong?
1. α cells (comprise 20% of all cells) secrete glucagon

2. β cells (70%) secrete insulin
3. δ cells (8%) secrete somatostatin
4. F cells ( 2%) secrete pancreatic polypeptide.
What is the most likely diagnosis in a 65 year old man presenting with hypertension, a large
jaw and bitemporal hemianopia:
a) Cushing’s disease
b) Acromegaly
c) Graves’ disease
d) Cranial diabetes insipidus
Something wrong?

large nose
macroglossia
spade-like hands
mental disturbances
insomnia
cardiomyopathy
hypertension
osteoarthritis
hypercalcaemia
Blood glucose levels can be raised by all but which of the following hormones:
a) Cortisol
b) Growth hormone
c) Adrenaline
d) Glucagon
e) Insulin
Something wrong?
Fasting levels of glucose are normally 3.9 – 5.5 mmol/L, random levels are normally < 11 mmol/L.
of diabetes.
thyrotoxicosis
pheochromocytoma
acromegaly
glucagonoma
cirrhosis
cystic brosis
pancreatectomy
haemochromatosis
thiazide diuretics
corticosteroid use.
polyuria
glycosuria
dehydration
polydipsia
lethargy
weight loss
wasting
blurred vision
weakness
What is the most likely diagnosis in a 35 year old woman who presents with hypertension,
hypokalaemia and metabolic alkalosis:
a) Renal artery stenosis

b) Cushing’s syndrome
c) Cushing’s disease
e)
e) Addison’s disease
Something wrong?
Hyperaldosteronism causes sodium and water retention (with volume expansion and hypertension) with increased
excretion of potassium and hydrogen ions.
Features of hyperaldosteronism include:
hypertension
hypokalaemia
metabolic alkalosis
polyuria and polydipsia
muscle weakness and spasm
N.B. Hypernatraemia rarely occurs due to other regulating mechanisms.
Conn’s syndrome is the most common cause of primary hyperaldosteronism, in which patients have an adenoma of the
zona glomerulosa of the adrenal cortex.
In primary hyperaldosteronism, renin levels will be low due to negative feedback. High renin levels suggest secondary
hyperaldosteronism e.g. secondary to excessive diuretic therapy (most common cause), congestive heart failure, renal
artery stenosis, nephritic syndrome or cirrhosis with ascites.
Which of the following is NOT an effect stimulated by adrenaline:
a) Release of ACTH from the anterior pituitary

b) Increased glycogenolysis in the liver
c) Increased lipolysis
d) Increased cardiac contractility
e) Pupil constriction
Something wrong?
Adrenaline acts to:
cause alertness/agitation/fear/anxiety
stimulate release of ACTH
dilate pupils
increase glycogenolysis
increase renin release
increase lipolysis
increase sweating
increase heart rate and contractility
cause vasoconstriction in most tissues (but vasodilation in the coronary circulation)

increase cardiac output and blood pressure
stimulate ventilation
stimulate glucagon release
inhibit insulin release
decrease proteolysis
increase ef ciency of skeletal muscle contraction
What is the pathophysiology of Conn’s syndrome:

c) Chronic excess cortisol secretion
Something wrong?
hypertension
hypokalaemia
metabolic alkalosis
polyuria
polydipsia
muscle weakness
spasm
N.B. Hypernatraemia rarely occurs due to other regulating mechanisms
zona glomerulosa of the adrenal cortex. In primary hyperaldosteronism, renin levels will be low due to negative
feedback. High renin levels suggest secondary hyperaldosteronism e.g. secondary to excessive diuretic therapy (most
common cause), congestive heart failure, renal artery stenosis, nephritic syndrome or cirrhosis with ascites.
What is the most likely diagnosis in a 32 year old woman presenting with episodes of ushing,
headaches, hypertension and palpitations:
b) Cushing’s disease
c) Pheochromocytoma
c) Pheochromocytoma
e) Hyperthyroidism
Something wrong?
A pheochromocytoma is a tumour usually of the adrenal medulla that leads to the excess production of
catecholamines. They are usually benign and unilateral. Features include (paroxysmal): hypertension, headaches,
profuse sweating, palpitations, tremor and postural hypotension.
Which of the following clinical features is NOT classical of Graves’ disease:
a) Exophthalmos
b) Lid lag
c) Ptosis
d) Pretibial myxoedema
e) Clubbing
Something wrong?
antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. Graves’
disease is the most common cause of hyperthyroidism.
Classically Grave’s disease is associated with:
hyperthyroidism
pretibial myxoedema
clubbing (thyroid acropachy)
eye changes including: exophthalmos, lid retraction, lid lag, diplopia, corneal ulcers
Which of the following hormones is secreted by the posterior pituitary gland:
a) Aldosterone
b) Adrenocorticotropic hormone
c) Angiotensin II
d) Antidiuretic hormone
e) Corticotrophin-releasing hormone
Something wrong?
“The pituitary gland is primarily divided into two functional lobes, the anterior pituitary (adenohypophysis) and the
posterior pituitary (neurohypophysis).
The following hormones are secreted from the anterior pituitary gland:
Follicle-stimulating hormone (FSH)

Prolactin
Thyroid-stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Luteinising hormone (LH)
Growth hormone (GH)
This can be remembered using the mnemonic: Fresh Pituitary Tastes Almost Like Guinness.
Antidiuretic hormone (ADH) and Oxytocin are secreted from the posterior pituitary gland.
The following pituitary hormones are matched with their main target tissue(s):
ACTH – Adrenal cortex

GH – Liver, muscles, bones
FSH – Gonads
LH – Gonads
Prolactin – Mammary glands
TSH – Thyroid gland
ADH – Kidney
Oxytocin – Mammary glands, uterus
Which of the following features would you NOT expect in SIADH:
a) Hyponatraemia
b) Low plasma osmolality
c) High urinary sodium
d) High urine osmolality
e) Fluid overload
Something wrong?
Typical biochemistry shows hyponatraemia, low plasma osmolality, high levels of urinary sodium and high urine
osmolality.
Patients are euvolaemic and normotensive with normal thyroid and adrenal function. The potential causes are vast
including:
Neurological:
tumour, trauma, infection, Guillain-Barré syndrome, multiple sclerosis, systemic lupus erythematosus,
intracranial haemorrhage, sinus thrombosis, AIDS, porphyria
Pulmonary:
lung small-cell cancer, mesothelioma, pneumonia, abscess, cystic brosis, asthma, tuberculosis, positive-
pressure ventilation
Other malignancy:
oropharyngeal, stomach, pancreas, leukaemia, lymphoma, thymoma, and genitourinary tract cancers
Drugs:
chlorpropamide, carbamazepine, selective serotonin reuptake inhibitor (SSRI) antidepressants, tricyclic
antidepressants, lithium, MDMA/ecstasy, tramadol, haloperidol, vincristine, desmopressin, uphenazine
Miscellaneous:
idiopathic, hereditary, pain, postoperative, stress, endurance exercise and marathon runners, dermatomal
herpes zoster
You are asked to assess a patient with hyponatraemia. They are hypovolaemic with a low
plasma osmolality, and a urinary sodium of < 20 mmol/L, which of the following is the most likely
b) SIADH
c) Diuretic therapy
d) Gastroenteritis
e) Poor oral intake due to dementia
Something wrong?
caused by:

diuretic therapy
osmotic diuresis
caused by:
SIADH

renal failure
malnutrition
cirrhosis
nephrotic syndrome
Regarding insulin, which of the following statements is CORRECT:
a) Preproinsulin is synthesised in the smooth endoplasmic reticulum.

b) Proinsulin is cleaved into insulin and protein B.
c) Insulin consists of two short peptide chains linked by disulphide bonds.
d) Insulin is secreted from alpha cells.
e) Insulin secretion is directly stimulated by low blood glucose levels.
Something wrong?
Which of the following acts to inhibit ADH release from the posterior pituitary:
a) Adrenaline
b) Aldosterone
c) Angiotensin II
d) Adrenocorticotrophic hormone (ACTH)
e) Atrial natriuretic peptide
Something wrong?
and kidneys.
(ANP).
Pituitary adenomas most commonly secrete which of the following hormones:

a) Growth hormone
b) Adrenocorticotrophic hormone (ACTH)
c) Thyroid-stimulating hormone (TSH)
d) Prolactin
e) Follicle-stimulating hormone
Something wrong?
Functioning pituitary adenomas cause disease by excess hormone release (hyperpituitarism).
Functioning pituitary adenomas usually release prolactin (most common type – about 50% of pituitary tumours), GH
(about 20%) or ACTH (about 5%). TSH, LH and FSH – secreting adenomas are rare.
In addition to endocrine abnormalities, pituitary tumours can present with effects of a space-occupying lesion e.g.
headaches, vomiting and papilloedema due to raised intracranial pressure, hypopituitarism from compression of
normal secretory cells or compression of the portal veins that bring the hypothalamic-releasing factors (secretion of
anterior pituitary hormones is inhibited in a characteristic order: GH, LH, FSH, ACTH, TSH, Prolactin (N.B. unless
compression at the optic chiasm and cranial nerve palsies (CN III, IV, V and VI) from compression of the cavernous
sinus.
What is the effect of activated vitamin D on the renal handling of calcium:
a) Decreases calcium reabsorption in the proximal tubule

b) Increases calcium ltration at the glomerulus
c) Increases calcium reabsorption in the distal tubule
d) Increases calcium reabsorption in the proximal tubule
e) Decreases calcium reabsorption in the distal tubule
Something wrong?
skin.
increase renal calcium reabsorption (in the distal tubule via activation of a basolateral Ca ATPase pump)
remineralisation
dietary de ciency
liver failure
hypoparathyroidism
Which of the following is NOT a secondary cause of hypertension:
b) Pheochromocytoma
c) SIADH
d) Renal artery stenosis
e) Acromegaly
Something wrong?
Causes of secondary hypertension include:
Cushing’s syndrome (excess glucocorticoids)

Conn’s syndrome (excess aldosterone)
Bilateral adrenal hyperplasia (excess aldosterone)
Pheochromocytoma (excess catecholamines)
Renal artery stenosis (excess renin causing secondary hyperaldosteronism)
Acromegaly (excess growth hormone)
Thyrotoxicosis (excess T3 and T4)
Which of the following stimulates thyroid-stimulating hormone (TSH) release from the
anterior pituitary:
a) Raised serum levels of T3

b) Somatostatin
c) Glucocorticoids
d) Pregnancy
d) Pregnancy
e) Thyrotropin-releasing hormone (TRH)
Something wrong?
Thyroid-stimulating hormone (TSH) acts on the thyroid gland to stimulate thyroid hormone (T3 and T4) release.
TSH secretion is stimulated by thyrotropin-releasing hormone (TRH) from the hypothalamus.
TSH secretion is inhibited by raised serum levels of T3 or T4, somatostatin, dopamine, glucocorticoids, acute non-
thyroidal illness and increased human chorionic gonadotrophin (e.g. in early pregnancy).
TSH de ciency results in hypothyroidism. Excess TSH (extremely rare) results in hyperthyroidism.
Cortisol is secreted by which of the following:

d) Adrenal medulla
Something wrong?
the outer zona glomerulosa which secretes mineralocorticoids (mainly aldosterone)

(DHEA))
What is the most likely diagnosis in a 46-year old woman presenting with buccal
hyperpigmentation, postural hypotension and hyperkalaemia:
a) Pheochromocytoma
b) Conn’s syndrome
c) Cushing’s syndrome
d) Congenital adrenal hyperplasia
Something wrong?
Causes include:

amyloidosis
hyponatraemia
hyperkalaemia
hypoglycaemia
weight loss
muscle weakness
fatigue
lethargy
dizziness
depression
Which of the following is NOT recognised as a cause of hypothyroidism:
a) Sedating antihistamines
b) Amiodarone
c) Carbimazole
c) Carbimazole
d) Lithium
e) Phenytoin
Something wrong?
Causes include:
carbimazole)

mental slowing
apathy
lethargy
psychosis
hoarse voice
swollen tongue
deafness
goitre
bradycardia
proximal myopathy
constipation
cold hands
cold intolerance
slow re exes
weight gain
decreased sweating
chronic oedema
cold dry skin
Which of the following clinical features is NOT a classical feature of acromegaly:
a) Prominent nasolabial folds

b) Macroglossia
c) Bitemporal hemianopia
d) Postural hypotension
e) Carpal tunnel syndrome
Something wrong?

large nose
macroglossia
spade-like hands
mental disturbances
insomnia
cardiomyopathy
hypertension
osteoarthritis
hypercalcaemia
What is the primary aim of calcitonin:
a) Increase plasma Ca2+

b) Decrease plasma Ca2+
c) Increase plasma PO43-
3-
d) Decrease plasma PO43-

e) Increase plasma Mg2+
Something wrong?
Which of the following pituitary hormones is NOT paired correctly with its main target
organ(s):
a) Oxytocin – Uterus
b) Luteinising hormone – Gonads
c) Thyroid-stimulating hormone – Thyroid
d) Prolactin – Mammary glands
e) Antidiuretic hormone – Adrenal cortex
Something wrong?
“The pituitary gland is primarily divided into two functional lobes, the anterior pituitary (adenohypophysis) and the

Prolactin
Growth hormone (GH)

FSH – Gonads
FSH – Gonads
LH – Gonads
ADH – Kidney
Which of the following would you NOT expect in diabetic ketoacidosis:
a) Acetone smell on the breath

b) Ketonuria
c) Hyperglycaemia
d) Hypoventilation
e) Raised anion gap metabolic acidosis
Something wrong?
Diabetic ketoacidosis is a life-threatening complication of diabetes mellitus.
In the absence of adequate amounts of insulin, the body is unable to use glucose for energy and so fatty acids are
released from adipose tissue and converted to ketone bodies by the liver. The ketone bodies are acidic and result in a
metabolic acidosis (and ketonaemia and ketonuria).
The excess glucose (due to decreased cellular glucose uptake) and the ketone bodies cause an osmotic diuresis
resulting in dehydration and a loss of electrolytes (sodium, potassium, chloride, calcium, magnesium, phosphate).
Features of ketoacidosis include:
lethargy
vomiting
anorexia
abdominal pain
acetone smell on the breath
ketonuria
polydipsia
polyuria
dehydration
hyperventilation (Kussmaul breathing)
shock
reduced consciousness
coma
death
The most common precipitating factors in the development of DKA are infection, myocardial infarction, trauma or
omission of insulin.
The management of DKA requires the administration of insulin, uids and potassium (despite apparently normal serum
potassium levels).
Which of the following is the most common cause of Cushing’s syndrome in adults:
a) ACTH-secreting pituitary adenoma

b) Ectopic ACTH secreting small-cell carcinoma of the lung
c) Adrenal adenoma
d) Adrenal carcinoma
e) Exogenous glucocorticoids
Something wrong?
Cushing’s syndrome is a rare condition caused by a chronic excess of glucocorticoids.
This may occur due to:
1. excess secretion of ACTH or CRH (e.g. ACTH secreting pituitary adenoma, ectopic ACTH secretion by small-
cell carcinoma of the lung or bronchial carcinoid tumour)
2. excess secretion of cortisol (e.g. adenoma of the adrenal cortex (most common cause of Cushing’s syndrome in
children) or adrenal carcinoma)
3. exogenous steroids (most common cause of Cushing’s syndrome in adults).
Features of Cushing’s syndrome include:
hair thinning
male-pattern baldness
cataracts
truncal obesity
striae
dorsocervical fat pad (buffalo-hump)
moon face
acne
hirsutism
hypertension
skeletal muscle weakness and wasting
peptic ulceration
renal calculi
menstrual disturbance
osteoporosis and associated increased risk of fracture/vertebral collapse
skin thinning, easy bruising, tendency to skin infections
ankle oedema
ankle oedema
glucose intolerance/DM
predisposition to congestive cardiac failure
depression/confusion/insomnia/psychosis
Which of the following hormones is released in direct response to high plasma [K+]:
a) Antidiuretic hormone
b) Aldosterone
c) Cortisol
d) Adrenocorticotrophic hormone
e) Renin
Something wrong?
angiotensin II
high plasma K+
ACTH
Regarding osteomalacia, which of the following statements is CORRECT:
a) Osteomalacia is a disease characterised by loss of bone mineral density.

b) Osteomalacia occurs most commonly as a result of primary hypoparathyroidism.
c) Osteomalacia is associated with raised serum Ca2+.
d) On X-ray bones appear dense with localised radiolucencies.
e) Rickets is a disorder of defective mineralisation of cartilage in the epiphyseal growth plates of children.
Something wrong?
Osteomalacia is a disorder of mineralisation of bone matrix. Rickets is a disorder of defective mineralisation of

cartilage in the epiphyseal growth plates of children.
Defective mineralisation is mostly due to reduced calcium and phosphate levels in the extracellular uid due to vitamin
D de ciency.
Features of osteomalacia include:
bone pain
bones appear thin on X-ray with localised radiolucencies
increased susceptibility to fractures
features of hypocalcaemia
Features of Rickets include:
‘knock-knees’ or ‘bow-legs’ caused by bending of the long bones

chest deformities
back deformities e.g. kyphosis
protruding forehead
growth retardation
ADH release from the posterior pituitary is directly stimulated by which of the following:
a) Rise in blood volume

b) Rise in blood pressure
c) Rise in plasma osmolality
d) Rise in plasma Na+ concentration
e) Rise in plasma K+ concentration
Something wrong?
and kidneys.
(ANP).
Which of the following is the most common cause of Addison’s disease in the UK:
a) Tuberculosis infection
b) Autoimmune adrenalitis
c) Adrenal carcinoma
d) Waterhouse-Friderichsen syndrome
e) Amyloidosis
Something wrong?
Causes include:
autoimmune adrenalitis (most common cause in the UK)

amyloidosis
hyponatraemia
hyperkalaemia
hypoglycaemia
weight loss
muscle weakness
fatigue
lethargy
lethargy
dizziness
depression
Regarding parathyroid hormone (PTH), which of the following statements is CORRECT:
a) Parathyroid is synthesised by chief cells in the thyroid gland.

b) PTH is released in response to rising serum Ca2+ levels.
c) PTH release is inhibited by high serum phosphate.
d) Low serum Mg+ may cause secondary hypoparathyroidism.
e) PTH acts on the kidneys to increase reabsorption of calcium and phosphate ions.
Something wrong?
PTH acts to:
Aldosterone release is directly stimulated by:
a) Angiotensin II
b) Renin
c) ADH
c) ADH
d) Cortisol
e) CRH
Something wrong?
angiotensin II
high plasma K+
ACTH
What is the pathophysiology of Cushing’s disease:

c) Cortisol-secreting tumour
Something wrong?
Cushing’s disease refers to the speci c condition of excess corticosteroids as a result of increased ACTH due to a
pituitary adenoma; the negative feedback that normally prevents excess ACTH secretion is absent in the tumour.
Cushing’s disease is associated with hyperpigmentation due to the melanocyte-stimulating action of ACTH.
Which of the following results would be expected in Graves’ disease:
a) Raised T3, Raised T4, Raised TSH

b) Raised T3, Raised T4, Low TSH

c) Low T3, Low T4, Low TSH
d) Low T3, Low T4, Raised TSH
e) Raised T3, Raised T4, Normal TSH
Something wrong?
antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. T3 and T4
levels are elevated, and TSH levels are low due to negative feedback.
Graves’ disease is the most common cause of hyperthyroidism.
hyperthyroidism
pretibial myxoedema
eye changes
Graves’ eye disease may include features of: exophthalmos, lid retraction, lid lag, diplopia, corneal ulcers.
Which of the following is NOT a well recognised feature of hyperglycaemia:
a) Polyuria
b) Polydipsia
c) Weight loss
d) Palpitations
e) Blurred vision
Something wrong?
of diabetes.
thyrotoxicosis
pheochromocytoma
acromegaly
glucagonoma
cirrhosis
cystic brosis
pancreatectomy
haemochromatosis
thiazide diuretics
corticosteroid use.
polyuria
glycosuria
dehydration
polydipsia
lethargy
weight loss
wasting
blurred vision
weakness
A patient who has been hospitalised with an intracranial bleed has become progressively
more confused. He is found to be euvolaemic and normotensive with a poor urine output and
hyponatraemia. What is the most likely diagnosis:
a) Acute renal failure

b) SIADH
d) Hypothyroidism
Something wrong?
Syndrome of inappropriate ADH secretion (SIADH) causes water retention resulting in hypo-osmotic hyponatraemia.
Typical biochemistry shows:
hyponatraemia (< 125 mmol/L)

low plasma osmolality (< 260 mmol/L)
high levels of urinary sodium (> 20 mmol/L)
high urine osmolality
Patients are euvolaemic and normotensive with normal thyroid and adrenal function.
The potential causes are vast including:
Neurological:
tumour
trauma
infection
Guillain-Barré syndrome
multiple sclerosis
systemic lupus erythematosus
intracranial haemorrhage
sinus thrombosis
AIDS
porphyria
Pulmonary:
small-cell lung cancer
mesothelioma
pneumonia
abscess
cystic brosis
asthma
tuberculosis
positive-pressure ventilation
Other malignancy:
oropharyngeal
stomach
pancreas
leukaemia
lymphoma
thymoma
genitourinary tract cancers
Drugs: chlorpropamide, carbamazepine, selective serotonin reuptake inhibitor (SSRI) antidepressants,
tricyclic antidepressants, lithium, MDMA/ecstasy, tramadol, haloperidol, vincristine, desmopressin,
uphenazine.
Miscellaneous: idiopathic, hereditary, pain, postoperative, stress, endurance exercise and marathon
runners, dermatomal herpes zoster.
runners, dermatomal herpes zoster.
Regarding calcitonin, which of the following statements is CORRECT:
a) Calcitonin is secreted by parafollicular cells in the parathyroid gland.

b) Calcitonin is secreted in response to rising blood phosphate levels.
c) Calcitonin acts on the kidneys to inhibit reabsorption of calcium and phosphate.
d) Calcitonin stimulates osteoclastic activity.
e) Calcitonin acts on the small intestine to increase absorption of calcium.
Something wrong?
Which of the following is the main action of activated vitamin D:
a) Increased renal reabsorption of calcium

b) Increased intestinal absorption of calcium and phosphate
c) Increased renal reabsorption of phosphate
d) Inhibition of a-alpha-hydroxylase
e) Increased bone resorption
Something wrong?
skin.
remineralisation
remineralisation
dietary de ciency
liver failure
hypoparathyroidism
Aldosterone acts to cause which of the following:
a) Increased excretion of sodium ions

b) Increased excretion of potassium ions
c) Increased reabsorption of hydrogen ions
d) Decreased plasma volume
e) Decreased plasma osmolality
Something wrong?
angiotensin II
high plasma K+
ACTH
Which of the following is NOT an action of cortisol:

a) Stimulates gluconeogenesis
b) Increases proteolysis
c) Stimulates lipolysis
d) Increases calcium reabsorption in the kidneys
e) Suppresses immune cells
Something wrong?
Cortisol is secreted from the zona fasciculata of the adrenal cortex. Cortisol release is stimulated by
adrenocorticotrophic hormone (ACTH) from the anterior pituitary, which in turn is released in response to
corticotrophin-releasing hormone (CRH) from the hypothalamus.
Cortisol has a negative feedback effect on the hypothalamus and the anterior pituitary gland. Cortisol release displays
a circadian rhythm, with the highest levels in the early morning, peaking around 6 a.m. ACTH and thus cortisol release
is stimulated by physical and psychological stressors (e.g. trauma, haemorrhage, fever).
Cortisol acts to:
raise blood glucose by stimulating gluconeogenesis and inhibiting peripheral glucose uptake
increase protein breakdown in skeletal muscle, skin and bone to release amino acids
stimulate lipolysis to increase fatty acid levels in the blood
suppress the action and production of immune cells
suppress the secretion of the anterior pituitary hormones
weakly increase retention of sodium and water (a predominantly mineralocorticoid action)
regulate calcium levels by decreasing calcium absorption from the gut
increasing calcium excretion from the kidneys and increasing calcium resorption from bone
in uence behaviour and cognitive function
What is the most common cause of secondary hyperaldosteronism:
a) Congenital adrenal hyperplasia

c) Ectopic ACTH secretion
d) Excessive diuretic therapy
e) Sudden withdrawal of long-term steroid therapy
Something wrong?

hypertension
hypokalaemia
metabolic alkalosis
Regarding hypopituitarism, which of the following statements is CORRECT:
a) The most common cause of hypopituitarism is primary pituitary failure.

b) Sheehan’s syndrome refers to pituitary infarction following a stroke.
c) Kallman’s syndrome is a congenital cause of hypogonadotropic hypogonadism.
d) Hypopituitarism usually presents as an acute event with pituitary apoplexy.
e) Pituitary adenomas cause excess hormone release, not hypopituitarism.
Something wrong?
Pituitary insuf ciency (hypopituitarism) often presents with insidious onset depression, tiredness and hypogonadism.
The most common cause of hypopituitarism is treatment of hyperpituitarism.
Other causes include:
compression of the pituitary by a non-functioning pituitary macroadenoma (most common type of pituitary
tumour)
compression of the pituitary by other local tumours e.g. craniopharyngioma, glioma, meningioma or
metastases (particularly from the breast, bronchus and kidney)
infarction of the pituitary gland e.g. Sheehan’s syndrome caused by hypovolaemic shock during obstetric
haemorrhage
empty sella syndrome
in ammatory/in ltrative processes e.g. sarcoidosis
haemochromatosis
infective processes e.g. TB, syphilis
pituitary hypoplasia or aplasia
head injury
congenital e.g. Kallman’s syndrome
Regarding vitamin D, which of the following statements is CORRECT:
a) De ciency of vitamin D may occur from lack of sun exposure.

b) Severe vitamin D de ciency in adults can cause rickets.
c) Activated vitamin D causes increased Ca2+ reabsorption in the proximal tubule.
d) Vitamin D activation is stimulated by calcitonin.
e) Activated vitamin D inhibits bone remodelling.
Something wrong?
skin.
remineralisation
dietary de ciency
liver failure
hypoparathyroidism
You are asked to assess a patient with hyponatraemia. They are hypovolaemic with a low
plasma osmolality, and a urinary sodium of > 20 mmol/L, which of the following is the most likely
a) Poor oral intake due to dementia

a) Poor oral intake due to dementia
b) Fever
e) SIADH
Something wrong?
caused by:

diuretic therapy
osmotic diuresis
caused by:
SIADH

renal failure
malnutrition
cirrhosis
nephrotic syndrome
Which of the following features is NOT a typical feature of diabetes insipidus:
a) High plasma osmolality

b) Hyponatraemia
c) Polyuria
d) Polydipsia
e) Low urine osmolality
Something wrong?
Aldosterone release is directly stimulated by which of the following:
a) Increased plasma osmolality

b) High plasma K+
c) Increased blood pressure
d) Increased plasma volume
e) Cortisol
Something wrong?

angiotensin II
high plasma K+
ACTH
Which of the following is NOT a risk factor for osteoporosis:
a) Rheumatoid arthritis
b) Alcohol
c) Prolonged corticosteroid therapy
d) Bisphosphonate therapy
e) Smoking
Something wrong?
bone resorption.
thyroid disease
high alcohol intake
smoking
vitamin D de ciency
vitamin D de ciency
hyperparathyroidism
Which of the following is NOT a typical feature of hyperaldosteronism:
a) Hypertension
b) Hypokalaemia
c) Metabolic alkalosis
d) Hyponatraemia
e) Polyuria
Something wrong?
hypertension
hypokalaemia
metabolic alkalosis
Regarding the thyroid hormones, which of the following statements is CORRECT:
a) Thyrotropin-releasing hormone is secreted from the anterior pituitary gland.

b) Iodine de ciency results in excess thyroid hormone production.
c) Thyroid hormones are secreted from parafollicular cells.
d) T3 is converted to the more active T4 in the liver and kidney.
e) Thyroid hormone secretion is stimulated by adrenaline.
Something wrong?
Which of the following would be considered a normal blood glucose level:
a) Random blood glucose of 3 mmol/L

b) Random blood glucose of 12 mmol/L
c) Fasting blood glucose of 5.5 mmol/L
d) Fasting blood glucose 7.1 mmol/L
e) Fasting blood glucose of 2.5 mmol/L
Something wrong?
demonstrate impaired fasting glycaemia, and levels >/= 7 mmol/L are diagnostic of diabetes).
of diabetes.

thyrotoxicosis
pheochromocytoma
acromegaly
glucagonoma
cirrhosis
cystic brosis
pancreatectomy
haemochromatosis
thiazide diuretics
corticosteroid use.
polyuria
glycosuria
dehydration
polydipsia
lethargy
weight loss
wasting
blurred vision
weakness
Regarding growth hormone, which of the following statements is INCORRECT:
a) Growth hormone stimulates the production of insulin-like growth factor.

b) Growth hormone acts to increase blood glucose levels.
c) Growth hormone release is stimulated by thyroid hormones.
d) Excess levels of growth hormone in young children results in acromegaly.
e) Growth hormone is secreted from the anterior pituitary gland.
Something wrong?
Growth hormone is secreted from the anterior pituitary gland.
Growth hormone (GH) acts on the liver to stimulate insulin-like growth factor (IGF) production and to oppose the
actions of insulin (amongst other effects).
GH secretion is stimulated by growth hormone-releasing hormone (GHRH) from the hypothalamus e.g. in response to
hypoglycaemia and by thyroid hormones from the thyroid gland. GH secretion is inhibited by growth hormone-
hypoglycaemia and by thyroid hormones from the thyroid gland. GH secretion is inhibited by growth hormone-
inhibiting hormone (or somatostatin) and IGF-1.
Excess levels of GH e.g. due to a functioning pituitary adenoma results in acromegaly in adults and gigantism in
children (if excess GH occurs prior to epiphyseal fusion). GH de ciency results in dwar sm in children or adult GH
de ciency syndrome in adults.
Glucagon secretion is inhibited by all BUT which one of the following:
a) Fatty acids and ketones

b) Insulin
c) Somatostatin
d) High blood glucose
e) Adrenaline
Something wrong?
Glucagon acts to:
inhibit glycolysis
stimulate lipolysis
Somatostatin is secreted by which of the following pancreatic cell types:
a) α cells
b) β cells
c) δ cells
d) F-cells
e) Acinar cells
Something wrong?

Regarding general management of hyponatraemia, which of the following statements is

CORRECT:
a)
Normovolaemic patients with hyponatraemia usually require replacement of sodium in the form of isotonic saline.
b) Rapid correction of hyponatraemia is associated with central pontine myelinolysis.
c) Neurological dysfunction resulting from hyponatraemia re ects crenation of cerebral cells.
d) Seizures and focal neurological signs are commonly seen in hyponatraemia of 120 mmol/L or less.
e)
Hypovolaemic patients with hyponatraemia usually require replacement of sodium in the form of hypertonic saline.
Something wrong?
Symptoms due to hyponatraemia re ect neurological dysfunction resulting from cerebral overhydration (with
progressive cell swelling and cytolysis) induced by hypo-osmolality.
They are non-speci c symptoms and include nausea, malaise, headache, lethargy, muscle cramps and weakness, ataxia
and reduced level of consciousness. Seizures, comas and focal neurological signs are not usually seen until the sodium
concentration is less than about 115 mmol/L.
In cases of hyponatraemia due to sodium depletion, there are usually signs of volume depletion. In cases of
hyponatraemia due to uid retention, patients may be euvolaemic or uid overloaded.
Regarding management in general:
Hypovolaemic patients are sodium-depleted and should be given sodium in the form of isotonic saline initially.
Normovolaemic patients are likely to have normal total body sodium but are retaining uid and should be uid
restricted.
Oedematous patient have an excess of total body sodium and water, and should be given a diuretic to induce
natriuresis and be uid restricted.
natriuresis and be uid restricted.
In acute symptomatic hyponatraemia, the use of hypertonic saline should be considered with specialist input.
Correction should not be too rapid, especially in chronic hyponatraemia, as this is may result in central pontine
myelinolysis.
Which hormone does not function appropriately in diabetes insipidus:
a) Aldosterone
b) Angiotensin II
c) Renin
d) Antidiuretic hormone
e) Insulin
Something wrong?
How does ADH increase water reabsorption:
a) Insertion of aquaporins
b) Stimulates release of renin
c) Upregulation of Na+/K+ ATPase
d) Decreases GFR by afferent arteriole vasoconstriction
e) Upregulation of Na+ channels
Something wrong?
and kidneys.
(ANP).
Which of the following is NOT a cause of hyperprolactinaemia:
a) Pituitary adenoma
b) Hyperthyroidism
c) Polycystic ovary syndrome
d) Domperidone
e) Pregnancy
Something wrong?
Prolactin acts on the mammary glands and reproductive organs to promote growth of these organs and initiate
lactation.
Prolactin secretion is stimulated by prolactin-releasing factor (PRF) and thyrotropin-releasing hormone (TRH) from
the hypothalamus. Prolactin secretion is inhibited by dopamine secreted by the hypothalamus.
Prolactin levels rise physiologically in pregnancy, puerperium, and breast stimulation.
Excess levels of prolactin may be caused by:
a prolactinoma (prolactin-secreting pituitary adenoma)

compression of the pituitary stalk by a pituitary or hypothalamic tumour preventing normal dopaminergic
inhibition of prolactin release
head injury
neurosurgery
hypothyroidism (due to increased synthesis of TRH)
severe liver disease
polycystic ovary syndrome (PCOS)
Hyperprolactinaemia causes symptoms such as oligomenorrhoea/amenorrhoea, galactorrhoea, loss of libido, erectile

dysfunction and infertility (via inhibition of the release of GnRH from the hypothalamus).
Prolactin de ciency results in failure of postpartum lactation.
Antidiuretic hormone acts primarily at which of the following locations in the renal nephron:
a) Proximal tubule
b) Thick ascending limb of loop of Henle
c) Thin ascending limb of loop of Henle
d) Descending limb of loop of Henle
e) Collecting ducts
Something wrong?
and kidneys.
(ANP).
Which of the following signs would you NOT expect to see in hyperthyroidism:
a) Hypore exia
b) Palmar erythema
c) Clubbing
d) Onycholysis
e) Irregularly irregular pulse
Something wrong?
Causes include:
Graves’ disease
toxic adenoma
drugs e.g. amiodarone
exogenous iodine
hair loss
emotional lability
fatigue
anxiety
restlessness
goitre
palpitations
tachycardia
atrial brillation
proximal myopathy
diarrhoea
increased appetite
weight loss
tremor
heat intolerance
sweating
infertility
reduced libido
osteoporosis
hyperre exia
palmar erythema
clubbing
onycholysis
pituitary gland.
Regarding the thyroid hormones, which of the following statements is CORRECT:
a) Thyroxine (T4) is more active than tri-iodothyronine (T3).

b) Thyroid hormones are predominantly secreted in the form of T3.
c) Increased serum levels of T3 inhibits secretion of TSH.
d) Thyroid hormones are released in response to TSH, secreted by the hypothalamus.
e) About 50% of thyroid hormones in the blood are bound to plasma proteins.
Something wrong?
What is the most likely diagnosis in a 70 year old woman with rheumatoid arthritis who
presents with weight gain, moon face and resistant hypertension:
c) Pheochromocytoma
e) Renal artery stenosis
Something wrong?

hair thinning
cataracts
truncal obesity
striae
moon face
acne
hirsutism
hypertension
peptic ulceration
renal calculi
ankle oedema
Which of the following statements regarding the pituitary gland is CORRECT:
a) The anterior pituitary is really a direct extension of the hypothalamus.

b) Hypothalamic hormones are transported to the posterior pituitary by hypophyseal portal vessels.
c) Dopamine released from the hypothalamus stimulates the release of prolactin.
d) Oxytocin release from the posterior pituitary is controlled primarily by negative feedback mechanisms.
e) Cortisol inhibits release of adrenocorticotrophic hormone (ACTH) from the anterior pituitary.
Something wrong?
Anterior pituitary hormones are released under the control of hypothalamic releasing or inhibiting hormones
originating from small neurones with their cell bodies in the hypothalamus.
These hypothalamic hormones are transported directly to the anterior pituitary via hypophyseal portal vessels to
stimulate or inhibit release of anterior pituitary hormones e.g. corticotrophin-releasing hormone (CRH) stimulates
release of ACTH, thyrotropin-releasing hormone stimulates release of TSH (and prolactin) and dopamine inhibits
release of prolactin.
The anterior pituitary hormones (and the hormones released by their target organs) inhibit further release of
hypothalamic and anterior pituitary hormones by negative feedback mechanisms.
The posterior pituitary is really a direct extension of the hypothalamus. Oxytocin and ADH are manufactured in the
cell bodies of neurones in the hypothalamus and are transported down the axons of these cells to their terminals on
capillaries originating from the inferior hypophyseal artery within the posterior pituitary gland.
When these neurones are activated, they release oxytocin or ADH into the general circulation. ADH release is
controlled by negative feedback mechanisms, oxytocin however is involved in positive feedback mechanisms.
Which of the following is a cause of hyperthyroidism:
a) Hypopituitarism
b) Hashimoto’s thyroiditis
c) Iodine de ciency
d) Carbimazole
e) Amiodarone
Something wrong?
Causes include:
Graves’ disease
toxic adenoma
drugs e.g. amiodarone, lithium rarely
exogenous iodine
hair loss
emotional lability
fatigue
anxiety
restlessness
goitre
palpitations
tachycardia
atrial brillation
proximal myopathy
diarrhoea
increased appetite
weight loss
tremor
heat intolerance
sweating
infertility
reduced libido
osteoporosis
hyperre exia
palmar erythema
clubbing
onycholysis
pituitary gland.
Insulin secretion is inhibited by all but which one of the following:
a) Adrenaline
b) Sympathetic innervation
c) Low blood glucose
d) Somatostatin
e) Secretin
Something wrong?
What is the most likely diagnosis in a 65 year old patient presenting with polyuria, polydipsia,
renal failure and deteriorating sight:
a) Renal artery stenosis

b) Diabetes mellitus
c) Acromegaly
d) Diabetes insipidus
e) Cushing’s syndrome
Something wrong?
Hyperglycaemia is de ned as a fasting level of glucose > 7 mmol/L.
It can occur in diabetes mellitus type 1 due to a de ciency of insulin (due to autoimmune destruction of beta-cells) or in
diabetes mellitus type 2 due to a insuf ciency of insulin and/or insulin resistance or in secondary causes of diabetes.
thyrotoxicosis
pheochromocytoma
acromegaly
glucagonoma
cirrhosis
cystic brosis
pancreatectomy
haemochromatosis
thiazide diuretics
corticosteroid use
Features of hyperglycaemia include polyuria, glycosuria, dehydration, polydipsia, tendency to infections, lethargy,
weight loss, wasting, blurred vision, weakness.
Long-term complications of hyperglycaemia in diabetes mellitus include: macrovascular complications

(hyperlipidaemia, stroke, ischaemic heart disease, renal artery stenosis, hypertension, peripheral vascular disease) and
microvascular complications (lacunar infarcts, diabetic retinopathy, cataracts, glaucoma, diabetic nephropathy and
peripheral neuropathy).
Regarding osteoporosis, which of the following statements is CORRECT:

Regarding osteoporosis, which of the following statements is CORRECT:
a) Osteoporosis occurs as a direct result of vitamin D de ciency.

b) Osteoporosis increases risk of fracture especially of the proximal arm.
c) Osteoporosis is characterised by increased osteoclastic activity.
d) Alcohol is actually protective against osteoporosis.
e) Osteoporosis is a disorder of defective mineralisation of bone matrix.
Something wrong?
bone resorption.
thyroid disease
high alcohol intake
smoking
vitamin D de ciency
hyperparathyroidism
Regarding diabetes mellitus (DM), which of the following statements is CORRECT:
a) Type 1 diabetes mellitus results from insulin resistance.

b) A fasting blood glucose > 6 mmol/L is diagnostic of DM.
c) Chronic pancreatitis can cause a secondary diabetes.
d) Blood glucose levels may be raised by cortisol de ciency.
e) Hyperglycaemia typically results in large volumes of highly dilute urine.
Something wrong?
of diabetes.
thyrotoxicosis
pheochromocytoma
acromegaly
glucagonoma
cirrhosis
cystic brosis
pancreatectomy
haemochromatosis
thiazide diuretics
corticosteroid use
polyuria
glycosuria
dehydration
polydipsia
lethargy
weight loss
wasting
blurred vision
weakness
Which of the following is NOT a typical feature of Cushing’s syndrome:
a) Male-pattern baldness
b) Osteoporosis
c) Cataracts
d) Pancreatitis
e) Glucose intolerance
Something wrong?
hair thinning
cataracts
truncal obesity
striae
moon face
acne
hirsutism
hypertension
peptic ulceration
renal calculi
ankle oedema
Dehydroepiandrosterone (DHEA) is secreted by which of the following:

d) Adrenal medulla
Something wrong?
Adrenal androgens are secreted from the zona reticularis of the adrenal cortex. The main adrenal androgens are
dehydroepiandrosterone (DHEA) and androstenedione. Adrenal androgens have only weak biological activity but they
are converted to more active androgens, such as testosterone, by aromatase and other enzymes in peripheral tissues.
Aldosterone primarily acts at which of the following sites in the renal nephron:
a) Proximal tubule
b) Descending limb
c) Thick ascending limb
d) Thin ascending limb
e) Distal convoluted tubule and collecting ducts
Something wrong?
angiotensin II
high plasma K+
ACTH
ACTH is less important as a regulator, so pituitary failure does not severely impair aldosterone secretion.
Aldosterone acts mainly on the distal convoluted tubule (DCT) and the collecting duct of the kidney to cause increased
reabsorption of sodium ions in exchange for potassium and hydrogen ions (via stimulation of Na+ pumps, Na+/H+
antiporters, and Na+ and K+ channels in principal cells, and H+ ATPase in intercalated cells).
Corticotrophin-releasing hormone stimulates release of which of the following pituitary

hormones:
a) ACTH
b) ADH
c) GH
d) TSH
e) Prolactin
Something wrong?
Anterior pituitary hormones are released under the control of hypothalamic releasing or inhibiting hormones
These hypothalamic hormones are transported directly to the anterior pituitary via hypophyseal portal vessels to
stimulate or inhibit release of anterior pituitary hormones e.g. corticotrophin-releasing hormone (CRH) stimulates
release of ACTH, thyrotropin-releasing hormone stimulates release of TSH (and prolactin) and dopamine inhibits
release of prolactin.
The anterior pituitary hormones (and the hormones released by their target organs) inhibit further release of
hypothalamic and anterior pituitary hormones by negative feedback mechanisms.
The posterior pituitary is really a direct extension of the hypothalamus. Oxytocin and ADH are manufactured in the
cell bodies of neurones in the hypothalamus and are transported down the axons of these cells to their terminals on
capillaries originating from the inferior hypophyseal artery within the posterior pituitary gland.
When these neurones are activated, they release oxytocin or ADH into the general circulation. ADH release is
controlled by negative feedback mechanisms, oxytocin however is involved in positive feedback mechanisms.
What is the most likely diagnosis in an otherwise healthy 25 year old woman who presents
with polyuria and polydipsia, with no history of weight loss. She has a past medical history of a
traumatic brain injury:
a) Diabetes mellitus type 1

b) Diabetes mellitus type 2
c) SIADH
d) Cranial diabetes insipidus
e) Nephrogenic diabetes insipidus
Something wrong?
response to ADH (nephrogenic DI). Cranial DI may be the result of hypoxic encephalopathy, neurosurgery,
autoimmunity or cancer, or sometimes without an underlying cause (idiopathic).
Which of the following is the most common cause of Cushing’s syndrome in children:
a) ACTH-secreting pituitary adenoma

b) Ectopic ACTH secreting small-cell carcinoma of the lung
c) Adrenal adenoma
d) Adrenal carcinoma
e) Exogenous glucocorticoids
Something wrong?
hair thinning
cataracts
truncal obesity
striae
moon face
acne
hirsutism
hypertension
peptic ulceration
renal calculi
ankle oedema
Which of the following is NOT an effect of parathyroid hormone (PTH):
a) Increases Ca2+ reabsorption in the distal tubule

b) Increases PO43- reabsorption in the proximal tubule
c) Increases bone resorption
d) Stimulates activation of vitamin D by the kidneys
e) Inhibits renal HCO3– reabsorption
Something wrong?
PTH acts to:
What is the most likely diagnosis in a 55 year old woman presenting with atrial brillation,
tremor and exophthalmos:
a) Acromegaly
c) Graves’ disease
d) Hashimoto thyroiditis
e) Pheochromocytoma
Something wrong?
antibodies bind to and stimulate these TSH receptors leading to an excess production of thyroid hormones. Graves’
disease is the most common cause of hyperthyroidism.
hyperthyroidism
pretibial myxoedema
eye changes including features of: exophthalmos, lid retraction, lid lag, diplopia, corneal ulcers
Insulin acts to cause all but which one of the following effects:
a) Stimulation of glycogenesis
b) Stimulation of glycolysis
c) Inhibition of proteolysis
d) Stimulation of lipolysis
e) Inhibition of gluconeogenesis
Something wrong?
Insulin acts to:

inhibit proteolysis
inhibit lipolysis
Which of the following hormones is NOT secreted by the anterior pituitary gland:
a) Follicle-stimulating hormone
b) Prolactin
c) Oxytocin
d) Luteinising hormone
e) Growth hormone
Something wrong?
The pituitary gland is primarily divided into two functional lobes, the anterior pituitary (adenohypophysis) and the

Prolactin
Growth hormone (GH)

FSH – Gonads
LH – Gonads
ADH – Kidney
You are asked to assess a patient with hypernatraemia, they are dehydrated with a raised
plasma osmolality and a serum Na+ of 160 mmol/L, which of the following is the most likely
diagnosis:
b) SIADH
c) Near-drowning
e) Osmotic diuresis in uncontrolled diabetes mellitus
Something wrong?
lesion
What is the primary aim of parathyroid hormone (PTH):
a) Increase plasma Ca2+

b) Decrease plasma Ca2+
c) Increase plasma PO43-
d) Decrease plasma PO43-
e) Increase plasma Mg2+
Something wrong?

PTH acts to:
Regarding the adrenal glands, which of the following statements is CORRECT:
a) The adrenal glands are located on the inferior pole of each kidney.
b) The adrenal glands are intraperitoneal organs.
c) The adrenal glands are enclosed in renal fascia.
d) The adrenal medulla comprises about 60% of the gland.
e) The adrenal gland is divided into two functionally distinct regions, the right and the left lobe.
Something wrong?
The adrenal glands are located on the superior pole of each kidney. The glands are retroperitoneal, covered in
perinephric fat and enclosed in renal fascia. The adrenal gland is divided into two functionally distinct regions, the
outer larger region (comprising about 90% of the gland) is called the adrenal cortex and the inner, much smaller region
is called the medulla.
Catecholamines are secreted by which of the following:

d) Adrenal medulla
Something wrong?
the outer zona glomerulosa which secretes mineralocorticoids (mainly aldosterone),

(DHEA))
How does parathyroid hormone affect the kidney’s handling of phosphate:
a) Decreases phosphate reabsorption in the proximal tubule

b) Increases phosphate secretion in the distal tubule
c) Increases phosphate reabsorption in the distal tubule
d) Increases phosphate reabsorption in the proximal tubule
e) Decreases phosphate reabsorption in the distal tubule
Something wrong?
PTH acts to:
What is the most likely diagnosis in a 34 year old man presenting with a hypochloraemic
metabolic alkalosis, low serum renin and a mass in the adrenal gland:
a) Congenital adrenal hyperplasia

b) Renal artery stenosis
c) Cushing’s syndrome
Something wrong?
hypertension
hypokalaemia
metabolic alkalosis
Regarding hypernatraemia, which of the following statements is CORRECT:
a) Hypernatraemia most commonly results from increased salt ingestion.

b) Hypernatraemia is de ned as a Na+ concentration of 140 mmol/L or above.
c) Conn’s syndrome usually results in a severe refractory hypernatraemia.
d) Hypernatraemia is usually associated with a decrease in plasma osmolality,
e) Hypernatraemia may be caused by osmotic diuresis.
Something wrong?

lesion
FRCEM Success Resources

We are an online revision The Royal College of Advanced Life Support
resource for FRCEM Primary Emergency Medicine Group
and Intermediate exam Irish Association for Emergency Medicine
preparation. Emergency Medicine Journal
Advanced Trauma Life Lifeinthefastlane
Terms & Conditions Support Instant Anatomy
Get in Touch Resuscitation Council (UK) Patient.co.uk
TeachMeAnatomy
Trauma.org
Radiopaedia
©2014 - 2017 FRCEM Success | Website designed & hosted by Cyberfrog Design

Endocrine - FRCEM Success

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Endocrine - FRCEM Success

Uploaded by

Copyright:

Available Formats

6/9/2017 Endocrine ­ FRCEM Success

Dashboard Subscription expires in: 1 Days Extend

You have scored 24%

a) Increased heart rate

Which of the following is NOT an endocrine cause of hypercalcaemia:

Causes of hypercalcaemia include:

primary hyperparathyroidism (most commonly due to a benign parathyroid adenoma)

Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders characterised by hypocalcemia,

Features of hypercalcaemia include:

STONES (renal calculi)

Parathyroid hormone (PTH) release is primarily simulated by which of the following:

a) High serum Ca2+

PTH release is inhibited by normal blood calcium levels and hypomagnesaemia.

PTH acts to:

a) The pituitary gland lies in a bony hollow of the ethmoid bone.

Insulin secretion is stimulated by all but which one of the following:

a) Fatty acids and ketones

Which of the following is NOT an expected nding in hyperprolactinaemia:

Prolactin levels rise physiologically in pregnancy, puerperium, and breast stimulation.

Excess levels of prolactin may be caused by:

a prolactinoma (prolactin-secreting pituitary adenoma)

Hyperprolactinaemia causes symptoms such as oligomenorrhoea/amenorrhoea, galactorrhoea, loss of libido, erectile

Prolactin de ciency results in failure of postpartum lactation.

Which of the following is NOT a well known cause of hypoglycaemia:

It can occur due to:

oral hypoglycaemic drugs

Regarding the endocrine pancreas, which of the following statements is CORRECT:

a) The predominant endocrine cell type is the beta-cell.

1. alpha cells (comprise 20% of all cells) secrete glucagon

Regarding insulin receptors, which of the following statements is CORRECT:

a) Insulin receptors are G-protein coupled receptors.

Insulin acts to:

stimulate peripheral tissue glucose uptake

Which of the following is NOT an endocrine cause of hyponatraemia:

Gastrointestinal loss e.g. diarrhoea, vomiting, stula

Acute increase in ADH following trauma/surgery/postpartum

A man with hypocalcaemia is found to have hypoparathyroidism. Which of the following is

Causes of hypocalcaemia include:

Hypoparathyroidism (e.g. DiGeorge syndrome, autoimmune, secondary to parathyroid or thyroid surgery,

These causes can be remembered using the mnemonic HARVARDS.

Features of hypocalcaemia include:

Insulin is secreted by which of the following pancreatic cell types:

1. alpha cells (comprise 20% of all cells) secrete glucagon

What is the underlying cause of Cushing’s disease:

Glucagon acts on G-protein coupled receptors.

Glucagon acts to:

Osteomalacia is a disorder of mineralisation of bone matrix. Rickets is a disorder of defective mineralisation of

Features of osteomalacia include:

Features of Rickets include:

‘knock-knees’ or ‘bow-legs’ caused by bending of the long bones

What is the most common cause of hyperthyroidism:

a) Toxic multinodular goitre

Graves’ disease is the most common cause of hyperthyroidism.

Regarding antidiuretic hormone (ADH) which of the following statements is CORRECT:

a) ADH acts to increase water reabsorption by upregulating Na+ reabsorption.

Regarding hyponatraemia, which of the following statements is INCORRECT:

a) Hyponatraemia of any cause is usually associated with a low plasma osmolality.

Hyponatraemia of any cause, is usually associated with a low plasma osmolality.

Diabetes insipidus results from a de ciency of or an inappropriate response to which of the

Prerenal Losses (urinary Na+ < 20 mmol/L)

Where urinary Na+ > 20 mmol/L

Which of the following is NOT a direct effect of parathyroid hormone (PTH):

a) Increases Ca2+ reabsorption in the kidneys

PTH release is inhibited by normal blood calcium levels and hypomagnesaemia.

6/9/2017 Endocrine FRCEM Success