I N T E R N A L M E D I C I N E D E PA R T M E N T

ENDOCRINOLOGY

ENDOCRINOLOGY (QUESTIONS)
1- The following is not a complication of obesity
a- osteoarthritis b- renal caluli
c- hypertension d- varicose vein of leg
2- The common presentation of hashimoto thyroiditis is
a- hyperthyroidism b- hypothyroidism
c- euothyroid state with goiter
3- In hashimoto thyroditis there is
a- hyperthyroidism b- hypothyroidism c- both
4- Hypersensitivity type 5 occur in
a- systemic lupus erythematosus b- Graves’ disease c- anaphylatics
5- Graves’ disease is an example of
a- type 1 hypersensititvty b- type 2 (cytotoxic)
c- type 4 (MI) d- type 5 (stimulatory)
6- Thyrotoxicosis may be presented by all the following except
a- myopathy b- pretibial myxedema
c- hypernatrimia d- atrial fibrillation
7- Which of the following is a feature of thyrotoxicosis 4
a- puffy face b- palpitation
c- sweating d- somnelance
8- Graves’ disease may manifested by
a- pretibial myxedema b- dry skin c- atrophic thyroid gland
9- Hyperthyroidism is characterized by
a- diarrhea b- scaly skin c- lethargy
10- Sign of hypothyroidism
a- heat intolerance b- bradycardia c- tremors
11- Hypothyroidism is characterized by
a- bradycardia b- tachycardia c- neither
12- The good marker of follow up treatment of hypothyroidism is :
a- T3 b- T4
c- thyroid stimulating hormone d- reverses T3
13- In myxedema common feature are
a- tachycardia b- hypothermia c- sweating
14- Pitting edema is seen in the following except
a- right sided heart failure b- nephrotic syndrome
c- liver cell failure d- myxedema

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15- Myxedema coma is characterized by
a- hypertension b- tachycardia
c- hypoventilation d- normal body temperature
16- In primary hyperparathyroidism there is
a- hypocalcemia b- hypercalcemia c- hypophosphatemia
17- Tertiary hyperparathyroidism is common found in
a- rickets b- chronic renal failure
c- mal absorption d- pseudo hyperparathyroidism
18- Hypercalcemia may be present in
a- hyperparathyroidism b- hypothyroidism c- chronic renal failure
19- treatment of hypercalcemia include
a- IV saline b- Loop diuretics
c- calcitonin d- all of the above
20- Bisphosphonate are used for treatment of the following :
a- increase activity of osteoclast
b- increase osteoclastic bone resorption
c- increase activity of vitamin D
d- increase calcitonin production

4 21- treatment of hypercalcemia include

a- intravenous saline b- loop diuretic
c- calcitonin d- all of the above
22- Hypocalcemia is characterized by the following except
a- parathesia b- tetany
c- lenticular cataract d- shorting of Q-t interval in electrocardiogram
23- In patient with pseudo hypoparathyroidism serum parathyroid hormone is
a- normal b- increase c- decrease
24- Most common type of carcinoma of thyroid gland is
a- follicular b- papillary
c- anaplastic d-mixed papillary and follicular
25- Acromegaly is due to a disease in
a- Anterior pituitary b- posterior pituitary c- neither
26- Acromegaly is characterized by all except
a- big head and feet b- prognothism
c- moon face d- separate teeth
27- Recognized complications of acromegaly
a- exophthalmos b- Diabetes mellitus
c- pathological fracture d- decreased sweating

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28- In investigations of acromegaly all are true except
a- failure to suppress GH < 2mg/ml after glucose
b- ↑ IGF 1
c- MRI sellaturica reveals pituitary adenoma
d- ↓ serum prolation
29- All of the following are causes of hyperprolactineamia except
a- pregnancy b- primary hypothyroidism
c- pheochromocytoma d- prolactinomas
30- Intra-sellar pituitary tumor cause
a- visual defect b- neurological defect
c- hormonal changes d- all of the above
31- Recognized causes of hypopituitarism include all of the following except
a- postpartum hemorrhage b- Cushing’s syndrome
c- acromegaly d- auto-immune hypophysitis
e- sarcoidosis
32- Causes of hypopituitarism all are true except
a- carnio-pharngioma b- head injury
c- Sheehan’s syndrome d- Caplan’s syndrome
e- none of the above
33- Pan hypopituitarism causes
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a- glactorrhea b- skin pigmentation c- amenorrhea
34- Causes of diabetes insipidus include all of the following except
a- carniopharyngioma b- sarcoidosis
c- sever hypocalcemia d- sever ↑ in Ca & ↓ in K
35- Causes of nephrotic diabetes insipidus include all of the following except
a- lithium therapy b- heavy metal poisoning
c- demeclocycline d- cloropromide
36- Manifestation of Cushing syndrome include all of the following except
a- osteoporosis b- hypoglycemia
c- proximal myopathy d- hypertension
37- All typical features of central diabetes insipidus except
a- specific gravity less than 1005 with decreases urine osmolality & ↑ plasma osmolality
b- onset following based meningitis & hypothalamic trauma
c- decrease renal responsiveness to antidiuretic hormone
38- In Cushing syndrome all are true except
a- hypoglycemia b- polycythemia
c- osteoporosis d- moon face
39- Hypoglycemia may occur in the following disease except
a- Sheehan’s syndrome b- Cushing’s syndrome c- chlorpropamide therapy

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40- Urinary 17 keto-steroids are ↑in
a- Cushing’s syndrome b- Conn’s syndrome
c- adrenagenital syndrome
41- Commonest enzymatic defect for development of congenital adrenal hyperplasia
a- 21 hydroxylase b- 11 hydroxylase
c- 17 hydroxylase d- 3b dehydrogenase
42- Auto-immune adrenalitis syndrome commonly presented with
a- Addison’s disease b- Cushing syndrome c- both
43- Hypo-natremia may occur in
a- Addison’s disease b- Cushing’s disease c- Conn’s syndrome
44- The following are common features of Addison’s disease except
a- easy fatigability & weakness b- fever
c- skin pigmentation d- hypotension
45- Important signs of Addison disease
a- hypoglycemia b- weight gain c- peripheral neuritis
46- Adrenal crisis is characterized by
a- profound asthma b- severe abdominal pain
c- vascular collapse d- low Na & high K
4 e- all of the above
47- Pheocromocytoma may be associated
a- anhydrosis b- miosis
c- neurofibromatosis d- paroxysmal hypotension
48- Cortico steroid side effects
a- hyper-prolactinemia b- hyperglycemia c- hypercalcemia
49- Features of Addison’s disease don’t include
a- diarrhea b- dizziness
c- dermatitis d- dehydration
50- Secondary diabetes mellitus may be caused by the following except
a- chronic pancreatitis b- insulinoma c- glucoagonoma
51- Immune mediated diabetes mellitus is present in
a- type 1 b- type 2 c- both
52- The best treatment of type 1 diabetes mellitus is
a- oral hypoglecmi drugs b- insulin c- low caloric intake
53- Feature of hypoglycemic don’t include
a- drenching sweating b- tachycardia
c- brisk jerk (tremors) d- tachypnea
54- In type 2 diabetes mellitus is associated with
a- insulin resistance b- cell defect c- Both

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55- In type 2 diabetes mellitus insulin resistance is increase by
a- exercise b- obesity c- metformin
56- The initial treatment of obese Type 2 diabetes mellitus is
a- sulfonylurea b- biguanide c- weight reduction
57- In diabetes mellitus there is polyurea with
a- high specific gravity b- low specific gravity c- Both
58- Glycosylated hemoglobin assess glucose level during
a- last 3 months b- past week
c- this day d- none of the above
59- Diabetic keto-acidosis is charactrized by
a- rapid respiration b- dehydration
c- rapid small pulse d- all of the above
60- Diabetic ketoacidosis is treated by
a- intravenous fluid b- potassium c- both
61- Which type of hypoglycemic would on insulinoma case
a- reactive b- drug induced
c- alimentary d- fasting
62- Which hormone is responsible for many of symptoms of hypoglycemia
a- thyroid stimuating hormone b- epinephrine 4
c- cortisol d- thyroxin
63- Hypoglycemia may result of the following except
a- glycogen storage disease b- galactosemia
c- chronic pancreatitis d- post gastrectomy
64- Regarding syndrome of inappropriate anti.diuretic hormone (SIADH), which is true?
A. Hyponatremia is dilutional
B. Urine is relatively hypertonk to plasm.a
C. anti-diuretic hormone mediated water reabsorption does not occur
D. Renal function is jeopardized
65- In injuryto adrenal cortex, secretion of which is least affected?
A. Adrenaline B. Cortisol
C. Aldosterone D. Androstenedione
66- Which is the specific region of hypothalamus responsible for sweat secretion?
A. Supra-optic B. Median eminence
C. Para-ventricular D. Pars distalis
67- Increased serum aldosterone level is not associated with:
A. Hypertension B. Hypernatraernia
C. Hypokalaemia D. Metabolic acidosis

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68. In parathyroid pathology, investigation of choice is :
A. Gallium scan B. Thallium scan
C. Technetiurn 99 sestamibi scan D. CT scan
69. Persistent muscular weakness is characteristic of:
A. Conn's syndrome B. Acromegaly
C. Hyperparathyroidism D. Myxoedema
70. Which of the following augments growth hormone release?
A. Glucocorticoids B. Somatostatin
C. Stress D. Obesity
71. Syndrome of inappropriate antidiuretic hormone (SIADH) may be seen in all except :
A. Guillain-Barre syndrome B. Subacute bacterial endocarditis
C. Myxoedema D. Bronchogenic carcinoma
72. Orlistat is used to treat :
A. Diabetic neuropathy B. Obesity
C. Pseudohypoparathyroidism D. Anorexia nervosa
73. Prolonged ingestion of iodine can produce goiter and is known as :
A. Jod-Basedow effect B. Sick euthyroid syndrome
C. Wolf-Otaikoff effect D. Thyrotoxicosis factitia

4 74. Commonest cause of thyrotoxicosis is :

A. Multinodular goitre B. Hashimoto's thyroiditis
C. Graves' disease D. Well-differentiated carcinoma
75. In pregnancy, antithyroid treatment of choice is :
A. Radio-active iodine B. Carbimazole
c. Subtotal thyroidectomy D. Corticosteroid
76. Charcot joint in diabetes mellitus commonly affected :
A. Hip B. Shoulder
C. Knee D. Foot
77. Osmoreceptors are present in :
A. Atria B. Kidney
C. Anterior hypothalamus D. Adrenal cortex
78. Erythropoietin is secreted from :
A. Mesenchymal tumours B. Cerebellar haemangioblastoma
C. Juxtaglomerular tumour D. Lymphoma
79. Vanillyl-mandelic acid (VMA) excretion is increased in urine in :
A. Conn's syndrome B. Congenital adrenal hyperplasia
C. Testicular feminisation syndrome D. Pheochromocytoma
80. Anorexia nervosa is not associated with :
A. Hypokalaemia B. Primary amenorrhoea
C. Exclusively in females D. Low follicular stimulating hormone & leutinizing hormone

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81. Primary aldosteronism is not featured by :
A. Low plasma renin B. Hypokalaemia
C. Oedema D. Systemic hypertension
82. The triad of hyponatraemia, haemodilution and urine hypertonic to plasma suggest diagnosis of :
A. Nephrotic syndrome B. syndrome of inappropriate anti-diuretic hormone
C. Nephrogenic diabetes insipidus D. Addison's disease
83. Which is not a part of multiple endocrine neoplasia type I (Wermers syndrome)?
A. Phaeochromocytoma B. Tumour of pituitary
C. Tumour of panaeas D. Hyperparathyroidism
84. Commonest cause of Addison's disease is:
A. Granuloma B. Idiopathic atrophy
C. Inflammatory necrosis D. Malignancy
85. All of the following are noted in Cushing's syndrome except :
A. Psychosis B. Systemic hypertension
C. Sexual precocity D. Osteoporosis
86. Secondary hyperaldosteronism is associated with all except :
A. Congestive cardiac failure B. Nephroti.c syndrome
C. syndrome of inappropriate anti-diuretic hormone D. Cirrhosis of liver
87. Empty sella syndrome may be due to all except :
A. Sheehan's syndrome B. Spontaneous development
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C. Pituitary tumour D. Post-irradiation necrosis of pituitary gland
88. Increased muscle mass with slowness of activity (Hoffman syndrome) is seen in :
A. Aaomegaly B. Myxoedema
C. Pseudohypoparathyroidism D. Myotonia dystrophica
89. All of the following develop into dwarfism except :
A. Congenital adrenal hyperplasia B. Hypopituitarism
C. Homocystinuria D. Pseudohypoparathyroidism
90. Plummer's nails are a feature of :
A. Atopic eczema B. Hypoparathyroidism
C. Thyrotoxicosis D. Multiple endocrine neoplasia type I
91. Which of the following does not produce fasting hypoglycaemia?
A. Galactosaemia B. Insulinoma
C. Glucose-6-phosphatase deficiency D. Systemic camitine deficiency
92. Features of hypoglycaemia do not include:
A. Drenching sweat B. Tachycardia
C. Tachypnoea D. Brisk jerk
93. Earliest changes observed by ophthalmoscope in background retinopathy of diabetes is:
A. Venous dilatation B. Microaneurysms
C. Increased capillary permeability D. Arteriovenous shunts

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94. Which of the following is not a part of metabolic 'syndrome X'?
A. Hyperlipidaemia B. Obesity
C. Ischaemic heart disease D. Hypertension
95. Thiazolidinedione group of anti-diabetic is :
A. Voglibose B. Nateglinide
C. Rosiglitazone D. Glimepiride
96. Effect of diabetes on foetus includes all except :
A. Microsomia B. Hyperbilirubinaemia
C. Stillbirth D. Open neural tube defed
97. All are features of diabetic ketoacidosis except :
A. Hyperthermia B. Drowsiness
C. Dehydration D. Air hunger
98. Commonest cause of coma in a diabetic is :
A. Diabetic ketoacid.osis B. Lactic acidosis
C. Hyperosmolar non-ketotic coma D. Hypoglycaemia
99. Which of the following is not a feature of diabetes mellltus?
A. Rubeosis iridi.s B. Pseudo Argyll Robertson pupil
C. Hippus D. Isolated 3rd cranial nerve palsy
4 100. A patient of impaired fasting glucose ranges blood glucose value in between:
A. 96-106mg/dl B. 106-116mg/dl
C. 100-125mg/dl D. 116-130mg/dl
101. Glycated fructosamine givesanindicationofglycaemiacontrol for last:
A. 3days B. 7 days
C. 10 days D. 14 days
102. Neurological features of myxoedema include all of the following except:
A. Delayed relaxation of ankle jerk B. Cerebellar ataxia
C. Hypertonia D. Bradylalia
103. Hypoglycaemia may result from all except:
A. Glycogen storage disease B. Oaronic pancreatitis
C. Galactosaemia D. Post-gastrectomy
104. Which of the following is not a neuromuscular feature of thyrotoxicosis?
A. Myasthenic syndrome B. Brisk knee jerk
C. Hypokalaemic periodic paralysis D. Hyperkinesia
105. Myxoedema coma is characterised by :
A. Hypertension B. Tachycardia
C. Euthermia D. Hypoventilation
106. Commonest cause of unilateral exophthalmos is :
A. Cavernous sinus thrombosis B. Retrobulbar tumour
C. Otloroma D. Thyrotoxicosis

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107. Beta-blockers can be used in all exeept :
A. Glaucoma B. Bronchial asthma
C. Anxiety states D. Angina pectoris
108. Cardiovascular findings of thyrotoxicosis do not include :
A. Loud B. Means-Lerman scartch
C. Water-hammer pulse D. Ejection click
109. Myxoedema is characterised by all except:
A. Butterfly rash in face B. Sinus bradycardia
C. Solid oedema D. Madarosis
110. Secondary hypothyroidism is not featured by :
A. Normal cholesterol B. Menorrhagia
C. Low thyroid stimulating hormone D. Fine hair
111. Thyroid acropachy is found in:
A. Subclinical hypothyroidism B. Graves' disease
C. Myxoedema D. Medullary carcinoma of thyroid
112. Upper segment > lower segment of body is found in all (in dwarfism) except:
A. Pituitary dwarf B. Cretinism
C. Achondroplasia D. Juvenile myx.oedema
113. Acromegaly is associated with all of the following except:
A. Acanthosis nigricans B. Fibromata mollusca
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C. Micrognathia D. Cardiomegaly
114. Klinefelter's syndrome is characterised by:
A. Small, soft testes B. Chromosomal pattern 46, XO
C. Upper segment> lower segment of body D. Gynaecomastia
115. Which of the following is not an intermediate-acting glucocorticoid7
A. Cortisone B. Triamcinolone
C. Prednisolone D. Prednisone
116. Hirsutism may develop from all exeept:
A. Psoralens B. Diazoxide
C. Carbamazepine D. Minoxidil
117. Tall stature is not characteristic of:
A. Klinefelter's syndrome B. Homocystinuria
C. Marfan's syndrome D. Turner's syndrome
118. Which cranial nerve is not involved. in acromegaly
A. VIII B. III, IV , VI
C. V D. Il
119. Cushing's syndrome does not give rise to:
A. Hirsutism B. Peripheral neuropathy
C. Purple striae D. Acne

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120. Medical adrenalectomy is done by all except :
A. Aminoglutethimide B. Mitotane
C. Mexiletine D. Metyrapone
121. "Pseudo-Cushing's syndrome' may be found in all except :
A. Myxoedema B. Chronic alcoholism
C. Obesity D. Depression
122. Sheehan's syndrome presents with :
A. Cardiac failure B. Persistent lactation
C. Fever D. Striking cachexia
123. Hypocalcemia is produced by all except :
A. Hysterical hypoventilation B. Acute pancreatitis
C. Chronic renal failure D. Osteomalacia
124. Primary hyperaldosteronism is not featured by :
A. Diastolic hypertension B. Paraesthesia
C. Alkalosis D. Oedema
125. Thyrotoxicosis may be featured by all except:
A. Myopathy B. Pretibial myxoedema
C. Hypernatraemia D. Atrial fibrillation

4 126. Which of the following is not associatedwith hypothyroidism?

A. Loss of libido B. Weight loss
C. Cardiac failure D. Organic pyschosis
127. Tetany is characterised by all of the following signs except :
A. Trousseau's sign B. Tinel's sign
C. Erb's sign D. Peroneal sign
128. All of the following are featured by dermal hyper-pigmentation except:
A. Conn's syndrome B. Bronchogenic carcinoma
C. Addison's disease D. Haemochromatosis
129. Hyperparathyroidism is not featured by :
A. Acute panaeatitis B. Nephrocalcinosis
C. Palpable neck swelling D. Pseudogout
130. Phaeoduomocytoma is not associated with:
A. Weight gain B. Fear of death (angor animi)
C. Paroxysmal hypertension D. Constipation
131. Which of the following is false regarding medullary carcinoma of thyroid ?
A. Cervical Iymphadenopathy B. High serum calcitonin
C. Carcinoid syndromemay be associated with D. Psychosis
132. Malignant hypercalcaemia is treated by all except:
A. Pamidronate B. Calcitonin
C. Calcitriol D. Glucocorticoids

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133. All of the following are associated with gigantism / acromegaly, except :
a. Mental Retardation b. Hyperhydrosis
c. Visceromegly d. Impaired glucose tolerance
134. A middle aged man noticed that he can no longer fit in his shoes and that his jaw was protruding
and phalanges were enlarged. These effects are likely to be mediated by :
a. Adrenocorticotrophic hormone b. Somatomedins
c. thyroid releasing hormone d. tissue growth factor Beta
135. Which of the following is the most common type of pituitary adenoma?
a. Thyrotropinoma b. Gonadotropinoma
c. Prolactinoma d. Corticotropinoma
136. A 30 year old woman presented with secondary amenorrhoea for 3 years along with
galactorrhoea. The most likely cause of her symptoms would be :
a. Craniopharyngioma b. Prolactinoma
c. Meningioma d. Subarachnoid haemorrhage
137. In a lady with bilateral superior temporal quadrantopia, galactorrhea,
the most probable cause is:
a. Pituitary macroadenoma b. Craniopharyngioma
c. Sheehan’s syndrome d. Pituitary hypophysitis
138. A young woman with secondary amenorrhea and galactorrhea. MRI shows a tumour of < 10mm 4
diameter in the pituitary fossa. Treatment is :
a. Hormonal therapy for withdrawal bleeding b. Radiotherapy
c. Chemotherapy d. Bromocriptine
e. Surgery
139. Confirmatory investigation for Acromegaly is :
a. Insulin induced growth hormone suppression
b. Glucose induced growth hormone suppression
c. Random growth hormone assay
d. insulin like growth factor - I level
140. All are associated with pituitary apoplexy except:
a. Hyperthyroidism b. Diabetes mellitus
c. Sickle cell anemia d. Hypertension
141. A patient meets with an accident with resultant transaction of the pituitary stalk ;
what will NOT occur :
a. Diabetes mellitus b. Diabetes insipidus
c. Hyperprolactinemia d. Hypothyroidism
142. syndrome of inappropriate anti-diuretic hormone is associated with the following drug:
a. Vincristine b. Erythromycin
c. 5 – Flurouracil d. Methotrexate

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143. Inappropriate syndrome of inappropriate anti-diuretic hormone secretion is characterised by

the following except :
a. Hypo-osmolar urine b. Water intoxication
c. Expanded fluid volume d. Hypomagnesemia
144. In a patient suffering from thyrotoxicosis the thyroid scintigraphy reveals decreased uptake
the most likely diagnosis is :
a. Toxic adenoma b. Graves’ disease
c. Thyroiditis d. None of the above
145. Which of the following is the agent of choice for treating thyrotoxicosis during pregnancy?
a. Carbimazole. b. Propylthiouracil.
c. Methimazole d. Radioactive Iodine 131
146. Hypothyroidism may be caused by :
a. Lithium b. Hematochromatosis
c. Scleroderma d. All of the above
147. Which of the following conditions is associated with Hypothyroidism :
a. Hashimoto’s thyroiditis b. Grave’s disease
c. Toxic multinodular goiter d. Struma ovarii
148. Which of the following is not associated with hypothyroidism:
4 a. Low T3 b. High thyroid stimulationg hormone
c. High Triglycerides d. Low cholesterol
149. The best marker to diagnose thyroid related disorder is:
a. T3 b. T4
c. thyroid stimulationg hormone d. Thyroglobulin
150. Lab investigation of patient with ↓T3, ↓T4, & ↓thyroid stimulationg hormone. It cannot be :
a. Primary hypothyroidism b. Pan-hypopituitarism
c. Liver disease d. None of the above
151. Most common cause of Thyroiditis is:
a. Reidls thyroiditis b. Subacute thyroditis
c. Hashimoto’s thyroiditis d. Viral thyroiditis
152. Not a feature of dequervan’s disease:
a. Autoimmune in etiology
b. ↑ Erythrocyte sedementation
c. Tends to regress spontaneously
d. Painful and associated with enlargements of thyroid
153. The following are used in thyrotoxic crisis except:
a. Dexamethasone b. Propranolol
c. Lugol’s solution d. Radioactive iodine

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154. Low calcium and high phosphate is seen in :

a. Hyperparathyroidism b. Hypoparathyroidism
c. Hyperthyroidism d. Hypothyroidism
155. Asymptomatic hypercalcemia in a 30 year old young male is due to:
a. Occult primary malignancy b. Primary hyperparathyroidism
c. Familial hypocalciuria d. Hypernephroma
156. Secondary hyperparathyroidism is seen in all of the following, except:
a. Rickets b. Osteomalacia
c. Osteoporosis d. Renal failure
157. Secondary hyperparthyroidism is seen in all of the following, except :
a. Chronic renal failure b. Parathyroid adenoma
c. Vitamin D deficiency d. Medullary carcinoma thyroid
158. A 45 year old man, known case of chronic renal failure develops rugger jersy spine.
The probable cause is:
a. Aluminium intoxication b. Secondary hyperparathyroidism
c. Osteoporosis d. Osteomalacia
159. All of the following statements about pseudohypoparathyroidism are true, except :
a. ↓ Serum PTH b. ↓ Serum calclum
c. ↑ Serum phosphate d. Albright’s hereditary osteodystrophy
160. Increased serum calcium is seen in all except:
a. Myxedema b. Multiple myeloma
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c. Sarcoidosis d. Primary hyperparathyroidism
e. Hyperthyroidism
161. Hypercalciuria is seen in :
a. Hyperparathyroidism b. Vitamin D intoxication
c. Sarcoidosis d. All
162. Which of the following is not a feature of hypercalcemia :
a. Diarrhoea b. Polyuria
c. Depression d. Vomiting
163. Endocrinal causes of carpal tunnel syndrome include all of the following, except :
a. Diabetes Mellitus b. Hypothyroidism
c. Acromegaly d. Addison’s disease
164. Hirsuitism is caused by all, except :
a. Cushing’s syndrome b. Hyperthyroidism
c. Hyperprolactinemia d. Acromegaly
165. The most common cause of severe hypercalcemia is :
a. Vitamin D toxicity b. Sarcoidosis
c. Chronic renal failure d. Malignancy

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166. In the management of diabetic ketoacidosis :
a. Intracellular water deficit is best restored using half strength saline (0.45% saline)
b. Potassium should be given even before checking the serum potassium concentration
c. Bicarbonate infusion is often only necessary in severe acidosis pH< 7.0
d. 5% dextrose solution should be avoided unless hypoglycaemia supervenes
167. In the long term management of diabetes :
a. Retinal neovascularisation should resolve with better glycaemic control
b. Microaneurysms are usually only visible with fluorescein angiography
c. Visual symptoms correlate with the severity of retinal disease
d. The development of an autonomic neuropathy confers an increased risk of sudden death.
168. Hypoglycemic unawareness that occurs in diabetic patients when transferred from oral
hypoglycemics to insulin, is due to:
a. Autonomic neuropathy b. Insulin resistance
c. Lipodystrophy d. Somogi phenomenon
169. thyroid stimulating immunoglobulin are synthesized in all except ?
A. Thyroid gland B. Spleen
C. Bone marrow D. Lymph nodes
170. Which of the following is the most common symptom of hyperthyroidism ?
A. Palpitation B. Heat intolerance and sweating
4 C. Weight loss and increased appetite D. Diarrhoea
171. Which of the following is the most common sign of hyperthyroidism ?
A. Tremor B. Warm, moist skin
C. Tachycardia D. Lid retraction or lag
172. In hyperthyroidism, von Graefe’s sign refers to ?
A. Lagging of upper eye lid on looking downward
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision
173. In hyperthyroidism, Stellwag’s sign refers to ?
A. Lagging of upper eye lid on looking downward
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision
174. In hyperthyroidism, Dalrymple’s sign refers to ?
A. Lagging of upper eye lid on looking downward
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision

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175. In hyperthyroidism, Moebius’ sign refers to ?

A. Lagging of upper eye lid on looking downward
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision
176. In hyperthyroidism, Abadie’s sign refers to ?
A. Involuntary twitching or spasm of LPS muscle
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision
177. Which of the following is not a cause of “thyrotoxicosis without hyperthyroidism” ?
A. Subacute thyroiditis B. Silent thyroiditis
C. Toxic adenoma D. Thyrotoxicosis factitia
178. Which of the following is not a cause of primary hyperthyroidism ?
A. Toxic multinodular goiter B. Toxic adenoma
C. Subacute thyroiditis D. Functioning thyroid carcinoma metastases
179. Hyperthyroidism is most difficult to control in which trimester of pregnancy ?
A. First B. Second
C. Third D. All of the above
4
180. Which of the following is not a cause of chronic thyroiditis ?
A. Riedel’s thyroiditis
B. Hashimoto’s thyroiditis
C. Radiation thyroiditis after 131 Iodine treatment
D. Parasitic thyroiditis (Echinococcosis)
181. Which of the following can cause acute, subacute or chronic thyroiditis ?
A. 131 Iodine treatment B. Amiodarone
C. Mycobacterial infection D. Riedel’s thyroiditis
182. de Quervain’s thyroiditis is a type of ?
A. Acute thyroiditis B. Subacute thyroiditis
C. Chronic thyroiditis D. Any of the above
183. adreno-corticotrophic hormone is synthesized and stored in ?
A. Acidophilic cells of anterior pituitary
B. Basophilic cells of anterior pituitary
C. Acidophilic cells of posterior pituitary
D. Basophilic cells of posterior pituitary
184. Neuropeptide ‘Urocortin’ is related to ?
A. adreno-corticotrophic hormone B. corticotropin releasing hormone
C. Leptin D. Follicular stimulating hormone

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185. The plasma level of adreno-corticotrophic hormone peak ?

A. Just prior to waking up B. Just after waking up
C. Before sleeping D. After meals
186. The plasma level of adreno-corticotrophic hormone are lowest at ?
A. Just prior to waking up B. Just after waking up
C. Before sleeping D. After meals
187. Normal pulsatile, circadian pattern of ACTH release is regulated by ?
A. Corticotropin-releasing hormone B. Free plasma cortisol concentration
C. Sleep-wake cycle D. All of the above
188. Stress causes which of the following ?
A. Release of corticotropin releasing hormone B. Release of vasopressin
C. Activation of sympathetic nervous system D. All of the above
189. Factors increasing adreno-corticotrophic hormone release include ?
A. Response to eating B. Vasopressin
C. Angiotensin II D. All of the above
190. Factors decreasing adreno-corticotrophic hormone release include ?
A. beta-endorphin B. Enkephalin
C. Inflammatory cytokines D. All of the above
4 191. Which of the following is a cause of ACTH-independent Cushing’s syndrome ?
A. adreno-corticotrophic hormone -independent macronodular hyperplasia (AIMAH)
B. Primary pigmented nodular adrenal disease (PPNAD)
C. McCune-Albright syndrome
`D. All of the above
192. In adreno-corticotrophic hormone independent macronodular hyperplasia (AIMAH),
which of the following receptor is ectopically expressed in the adrenal gland ?
A. Luteinizing hormone B. Vasopressin
C. Serotonin D. All of the above
193. Which of the following is the commonest feature of ‘Cushing’s syndrome’ ?
A. Centripetal obesity B. Hypertension
C. Hirsutism D. Proximal myopathy
194. Which of the following features of Cushing’s syndrome is considered more specific ?
A. Hypertension B. Osteoporosis
C. Broad violaceous cutaneous striae D. Obesity
195. Criteria for the diagnosis of primary aldosteronism include ?
A. Diastolic hypertension without edema
B. Hyposecretion of renin (low PRA levels) that do not increase during volume depletion
C. Hypersecretion of aldosterone that does not suppress in response to volume expansion
D. All of the above

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196. Secondary aldosteronism is a feature of ?

A. Cirrhosis B. Nephrotic syndrome
C. Congestive heart failure D. All of the above
197. Elevated levels of free fatty acids can cause which of the following ?
A. Impair glucose utilization in skeletal muscle
B. Promote glucose production by liver
C. Impair beta cell function
D. All of the above
198. All can cause islet cell dysfunction except ?
A. Hyperglycemia B. Hypoglycemia
C. Hyperlipidemia D. Islet cell autoantibodies
199. Which of the following can worsen islet function ?
A. Chronic hyperglycemia B. Elevation of free fatty acid levels
C. Dietary fat D. All of the above
200. In DKA, following insulin therapy, the decline in plasma glucose within the first 1 to 2 hours is
mostly related to ?
A. Insulin-mediated glucose disposal B. Reduced hepatic glucose release
C. Rehydration D. All of the above
4

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ENDOCRINOLOGY (MCQ ANSWERS)

1 B 31 C/B 61 B 91 A 121 A 151 C 181 B
2 C 32 D 62 D 92 C 122 D 152 A 182 B
3 C 33 C 63 C 93 B 123 A 153 D 183 B
4 B 34 C 64 A 94 C 124 D 154 B 184 B
5 D 35 D 65 A 95 C 125 C 155 B 185 A
6 C 36 B 66 C 96 A 126 B 156 C 186 C
7 B/C 37 C 67 D 97 A 127 B 157 B 187 A
8 A 38 A 68 C 98 D 128 A 158 B 188 D
9 A 39 B 69 A 99 C 129 C 159 A 189 D
10 B 40 A 70 C 100 C 130 A 160 A 190 D
11 A 41 A 71 B 101 D 131 D 161 D 191 D
12 C 42 A 72 B 102 C 132 C 162 A 192 D
13 B 43 A 73 C 103 B 133 A 163 D 193 A

4 14 D 44 B 74 C 104 B 134 B 164 B 194 C

15 C 45 A 75 B 105 D 135 C 165 D 195 D
16 B 46 E 76 D 106 D 136 B 166 C 196 D
17 B/C 47 C 77 C 107 B 137 A 167 B 197 D
18 A 48 B 78 B 108 D 138 D 168 A 198 B
19 D 49 C 79 D 109 A 139 B 169 B 199 D
20 B 50 B 80 C 110 B 140 A 170 B 200 C
21 D 51 A 81 C 111 B 141 A 171 C
22 D 52 B 82 B 112 A 142 A 172 A
23 B 53 D 83 C 113 C 143 A 173 C
24 B 54 C 84 B 114 D 144 C 174 B
25 A 55 B 85 C 115 A 145 B 175 D
26 C 56 C 86 C 116 C 146 D 176 A
27 B 57 A 87 C 117 D 147 A 177 C
28 D 58 A 88 B 118 C 148 D 178 C
29 C 59 D 89 C 119 B 149 C 179 A
30 D 60 C 90 C 120 C 150 A 180 C

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ENDOCRINOLOGY (PROBLEM SOLVING)

Case (1)
Female patient 28 y. old presented with tremors, excessive sweating insomnia, tachycardia & wt loss
inspite of good feeding
a. What is your diagnosis?
b. What are the investigations?
c. TTT you suggest?
Case (2)
A female patient 45 y. old presented with constipation, wt gain skin & hair changes & bradycardia.
a. What is the diagnosis?
b. What are investigations?
c. Treatment you suggest

Case (3)
A 38 y. old lady noticed that she is losing weight and suffers from anxiety & insomnia at night.
Examination revealed a temp. 36.3°C pulse 135/mm, and she has warm tremoring hands. ESR is normal.
a. What is your diagnosis? 4
b. What are the investigations?
c. TTT you suggest?

Case (4)
A 45 y. old lady presented to the medical clinic complaining from an increasing sense of general fatigue
and intolerance to colds since three months. In the last two weeks her voice became increasingly
hoarse. Examination revealed that her temp. is 36.9°C, pulse 60/min, BP 140/80, her skin is dry.
Neurological examination was negative but the knee reflexes were slow in their response.
a. What is the diagnosis?
b. What are investigations?
c. Treatment you suggest.

Case (5)
A woman 44 y. old complaining of increasing weakness and constipation over the last 3 months.
O/E, she was pale with puffy eyelids. Her pulse was 60/min, regular. Her serum TSH 201 U/ml (N. 1-6)
a. What is the possible diagnosis?
b. How can you explain the clinical and laboratory findings?
c. What is the treatment and how can you follow up her condition?

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Case (6)
A 35 y. old woman presented with 6 months history of diarrhea, weight loss and palpitation.
She was seen by psychiatrist for feeling anxious & irritable and was given atranquilizer without good
response.
a. What is the most important disease you have to exclude?
b. Mention important clinical signs that can help you in its diagnosis?
c. Mention important blood testes help you in its diagnosis?
d. If the diagnosis proved to be correct how to manage?
Case (7)
A 45 y. old female patient complained of regular palpitation that used to increase by exertion,
but sometimes also occur during rest, she reported that she had marked weight loss in spite of
her reasonable appetite.
a. What is your provisional diagnosis?
b. What is your D.D.?
c. What laboratory tests you need to reach a definitive diagnosis?

Case (8)
A 55 y. old female presented with coma. Examination revealed puffy face and mild lower limb edema.
Her temperature was 35°C. her pulse was 50 beats/mm & regular.
4 Her relatives stated that she was taking pills regularly for long time and she stopped the ttt.
The last 4 weeks, she also noticed that her speech was clumsy and slows in the last weeks.
a. What is your diagnosis?
b. What is your differential diagnosis?
c. What are you doing to confirm your diagnosis?
d. What ttt should be given?

Case (9)
A 60 y. old female complained of tiredness, constipation, weight gain and tingling in her hands and feet.
O/E, she was obese, with pale puffy face. Investigations revealed mild normocytic normochromic
anemia and hypercholesterolemia, chest X-ray revealed cardiomegaly.
a. What is your diagnosis?
b. How would you explain the chest X-ray findings?
c. What is the possible cause for the tingling in her hands?
d. How would you treat this lady?

Case (10)
A 22 y. old female student suffered from IDDM for the last 7 years. She started a few weeks ago
to complain of tachycardia, sweating & nervousness
a. Enumerate possible causes of her complains
b. Discuss diagnosis & management of one of them

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Case (11)
A 72 y. old lady complaining of fatigue has become increasingly lethargic. She also said that her
hair is thinning. Her pulse rate is 52/min, regular and BP is 138/90 mmHg.
Examination of her heart chest and abdomen is normal.
a. What is your diagnosis (explain why)?
b. How do you investigate this case?
c. How would you manage the case?

Case (12)
Middle age male patient presented with chronic fatigue & hyperpigmentaion on examination his
BP was 95/75 mmhg on supine and decreased on standing
a) What is your diagnosis?
b) What are the investigations?
c) TTT you suggest?

Case (13)
35 years old female suffer from paroxysmal HTN and attack of pallor and sweating , headache ,
anexity ,palpitaion , abdominal pain and vomiting constipaion , wt loss and intolerance
also evident
a) What is your diagnosis? 4
b) What are the investigations?
c) TTT you suggest?

Case (14)
Male patient 65 years old recently suffered from trunked obesity, DM, HTN & myopathy
and presented with sudden back pain with history trauma.
a) DD of this case?
b) What are the investigations?
c) TTT you suggest?

Case (15)
Female patient complaining of amenorrhea for 2 years following the last difficult labor
complicated by severe postpartum hemorrhage, from that time she was told that she is
hypotensive. She has a well-marked asthenia & can’t tolerate cold weather
a) What are other symptoms to be asked for?
b) What is the diagnosis?
c) What are the necessary investigations to prove the diagnosis?
d) What are the main lines of treatment?
e) What is the prognosis?

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Case (16)
A male patient aged 35 years presented with asthenia. He has been under therapy for his
low blood pressure for sometimes. His dermatologist had along run of therapy for
discoloration on his trunk & for the deep color of skin.
a) What do you expect to find in his history and on full clinical examination?
b) What are the steps needed for the diagnosis?
c) What do you suggest for treatment?

Case (17)
A 64 years old man noticed that he had gained 8 kg in weight over the past 6 months.
He started to get easily bruising, he found difficulty in getting up from his arm chair or to climb
stairs, he felt depressed. On examination he is overweight particularly on the abdominal
region with purpurish stria on his abdomen and thighs. His blood pressure is 168/100,
examination of his heart respiratory system and abdomen is normal. There is some
weakness in shoulder and hip regions. His routine examinations are within normal abort
from elevated 2 hours post prandial blood sugar.
a) What is the provisional diagnosis?
b) How would you investigate and manage this patient?

Case (18)
4 A 25 y. old white male consulted his physician for recurrent headache & shortness of breath.
The patient was obese and his abdomen was fatty. His BP was 170/100. His face was flushed
and greasy, there was some acne on his chest wall. Urine was positive for glucose (++)
a) What is your diagnosis?
b) What is your differential diagnosis?
c) What other tests would you like to ask to reach a definitive diagnosis?

Case (19)
15 y. old boy known history of IDDM presented to ER with coma
a. DD of causes?
b. What are the investigations?
c. Management on of the above?

Case (20)
35 y. old obese female complain of Wt loss inspite of increase appetite pruritus in her vulva
and frequent waking up for urination at night
a. What is the diagnosis?
b. What are the investigations?
c. Complication of the case?

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Case (21)
A 16 y. old boy, with known insulin dependent D.M., was admitted to hospital in a lethargic
drowsy condition, with history of vomiting, polyuria & polydespia 3 days before. He was taking
soluble insulin 10 units each morning. His temp. was 37.6 °C, pulse was 140/min,
BP 100/60 mmHg, heart, lung & abdomen were clinical normal
a. What is your diagnosis?
b. What are the possible precipitating factors?
c. What is your immediate management

Case (22)
A 12 y. old underweight boy had fever for 2 days. Examination revealed a very tender swelling
in his right buttock that was diagnosed as a gluteus abscess. Next day the patient was very confused
and his mouth was dry, had also acidotic breathing.
a. What is the likely diagnosis for the confusion?
b. What is your differential diagnosis?
c. What further tests do you like to perform to this patient to reach a diagnosis?

Case (23) 4
A 60 y. old male presented to ER with disturbed level of consciousness of 1 day duration.
His relatives reported that he had weight loss over the past few weeks despite of good appetite.
They also gave history of polyuria for the last 2-3 weeks. O/E, the pt. was drowsy and dehydrate
with sunken eyes. His BP was 140/65 mmHg, temp. was 37°C & tests revealed a Hb of 16 gm/dl,
a hematocrit of 50, WBCs 11.000/mm3 & platelets 380.000/mm3. Serum creat. Was 1.8 mg/dl
& BUN was 46 mgldl. Random blood sugar was 684 mg/dl.
Arterial blood gases (ABG) revealed normal serum bicarbonate.
a. What is your provisional diagnosis?
b. What investigation would you like to do to confirm your diagnosis?
c. What is your suggested line of ttt?

Case (24)
A 22 y. old student presented with abdominal pain, repeated vomiting and marked weakness.
Over the last few weeks she noticed polydispia and polyuria. Two days ago she complained of fever,
bilateral loin pain and dysuria. O/E, she was dehydrated, tachypneic and feverish.
Random blood sugar was 450 mgldl. Abdominal examination revealed tender both loins.
a. What is your probable diagnosis?
b. What would you investigate such case?
c. What is your suggested treatment?

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ENDOCRINOLOGY CASES (ANSWERS)

1) Thyrotoxicosis
2) Myxedema
3) Thyrotoxicosis due to Graves’
4) Myxedema
5) Adult myxedema
6) Thyrotoxicosis
7) Thyrotoxicosis
8) Myxedema coma
9) Myxedema
10) Thyrotoxicosis either graves or thyroiditis (autoimmune disease) recurrent attacks of
hypoglycemia
11) Hypothyroidism
12) Addison’s disease
13) Pheochromocytoma
14) Cushing syndrome – Cushing disease – cushinoid – ectopic cushion
4 15) Sheehan syndrome
16) Addison’s disease
17) Cushing syndrome
18) Cushing syndrome
19) DD of diabetic coma
20) type 2 DM
21) Diabetic keto acidosis
22) IDDM complicated by Gluteal abscess leading to DKA
23) Diabetic ketoacidosis
24) Most probably a case of IDDM complicated by acute pyelonephritis

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T ERRTNM
A EL NMT E D I C I N E D E PA R T M E N T
NEUROLOGY NEUROLOGY

NEUROLOGY (MCQ)
1- Sign of upper motor neurone lesions are
a- hypotonia b- clonus c- both
2- Which is not a feature of upper motor neurone lesions
a- spasticity b- clonus
c- babinski sign d- fasiculation
3- Hypertonia is a feature of all except
a- tetany b- upper motor neurone palsy
c- chorea d- myotonia
4- Hypotonia is caused by all except
a- upper motor neurone lesions b- lower motor neurone lesions
c- rheumatic chorea d- parkinsonism
5- Sure sign of pyrmidal tract lesion are except
a- clonus b- flexor planter reflex
c- extensor planter reflex
6- Pyramial tract lesion may be associated with the following sign except
a- ankle clonus b- babinski sign
5 c- clasp knife spasticity d- cogwheel rigidity
7- Artery occlusion may cause
a- capsular hemiplagia b- ower limb monoplagia c- paraplegia
8- Heubner artery occlusion may cause
a- capsular hemiplagia b- monoplagia c- paraplagia
9- In monoplagia usually the site of the lesion in
a- pons b- cortex
c- internal capsule d- midbrain
10- All of the following are causes of hypertonia except
a- potts disease b- syringomyelia
c- shock stage d- disc prolapse
11- Brown sequard syndrome is characterized by
a- contralateral deep sensory loss b- ipsilateral superficial sensory loss
c- ipsilateral hemiplegia d- contralateral hemiplegia
12- Transient hemiplegia occurs in
a- disseminated sclerosis b- mitral stenosis
c- cerebral thrombosis
13- Causes of transient hemiplegia
a- motor neurone disease b- subacute combined degeneration
c- todds paralysis

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