ENDO BLOCK EXAM

Cases:
1. A 49-year-old man comes to the office due to a 3-month history of fatigue. He also reports
diffuse joint pain, finger swelling, and difficulty gripping objects with his right
hand. The patient has poorly controlled hypertension despite being compliant with
medications, a low-salt diet, and regular exercise. Temperature is 36.7 C (98 F), blood
pressure is 146/98 mm Hg, pulse is 90/min, and respirations are 14/min. On examination,
facial features appear coarse and differ significantly from his driver's license photograph
taken 3 years ago. The palms are sweaty and have a doughy feel. The skin is oily.
Multiple skin tags are noted, particularly on the neck area. Tapping the ventral aspect of
the right wrist produces shooting pain on the lateral side of the right hand. Which of the

A Fasting growth hormone level

B. Growth hormone level following an oral glucose load
C. Insulin-like growth factor 1 level
D. MRI of the pituitary gland

Ans: C

2. A 42-year-old woman comes to the emergency department due to 2 syncopal episodes in the
last 3 days. The patient was well until approximately a month ago when she began to feel
increasingly fatigued and weak. For the past 2 weeks, she has had anorexia, nausea. and
abdominal pain. The patient's medical history is unremarkable, and she takes no medications.
She drinks wine only on social occasions, and does not use tobacco or illicit drugs. Temperature
is 36.7 C (98 F), blood pressure is 86/52 mm Hg, pulse is 90/min, and respirations are 18/min.
Cardiopulmonary examination is normal. The abdomen is mildly tender with otherwise normal
findings. The skin shows hyperpigmentation in the palmar creases. Which of the following
additional findings is most likely present in this patient?

A Hyperglycemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia

Ans: B

3. A 56-year-old man with type 2 diabetes mellitus of 15 years duration is being treated with
metformin, glimepiride, and sitagliptin. The patient also has hypertension, hyperlipidemia, and
coronary artery disease. His current hemoglobin A1c level is 7.5%. Switching to insulin therapy
to attain better glycemic control is discussed with the patient. Intensive glycemic control with a
goal hemoglobin A 1 c of <6.5% is most likely to reduce the risk of which of the following
complications?
A All-cause mortality
B. Hypoglycemia
C. Myocardial infarction
D. Retinopathy

Ans: D

4. Which anti-hyperglycemic agent has a relative contraindication in patients with congestive

heart failure?

A. SGLT-2 inhibitor
B. Thiazolidinedione
C. Sulfonylurea
D. GLP-1 receptor

Ans: B

5. At which eGFR cut-off below which, metformin is contraindicated?

A. <60ml/min/1.73m2
B. <45ml/min/1.73m2
C. <30ml/min/1.73m2
D. <15ml/min/1.73m2

Ans: C

6. Which endocrine disorder can cause hyperprolactinemia?

A. Primary Hypothyroidism
B. Adrenal Hypercortisolism
C. Hypoestrogenism
D. Secondary hyperparathyroidism

Ans: A

7. What is the most common endogenous cause of Cushing’s syndrome?

A. Cushing’s disease
B. Cortisol-producing adrenal adenoma
C. Cortisol-producing adrenal hyperplasia
D. Ectopic ACTH- producing tumors

Ans: A
8. In the treatment of Grave’s disease, which thyroid function test is the last to normalize?

A. Total T4
B. Free T4
C. Free T3
D. TSH

Ans: D

9. What is the most sensitive regulator of ADH

A. Blood pressure
B. Renal perfusion
C. Plasma osmolality
D. Baroreceptors in the atrium

Ans: C

10. Which major side effects is increased with propylthiouracil over other thionamides and this
prompted FDA to limit the indications for its use?

A. Agranulocytosis
B. Vasculitis
C. Hepatotoxicity
D. Myxedema coma

Ans: C
 NEURO BLOCK EXAM

1. A 45-year-old man with a past medical history of hyperlipidemia and hypertension comes to
the emergency department because of an acute onset of headache, double vision, slurred
speech, and left-sided weakness_ He describes his headache as a throbbing pain "at the back of
the head." He denies any vertigo, nausea, vomiting, or hiccups as well as any numbness or
difficulty swallowing. His medications include aspirin, lisinopril, and atorvastatin. He is a retired
truck driver and admits to chronic tobacco use_ His blood pressure is 170/90 mm Hg and pulse
is 90 /min with regular rhythm. Funduscopic examination is normal without papilledema. There
is no nystagmus; however, there is complete ptosis of the right eye which is depressed and
deviated to the right. The right pupil is dilated and non-reactive to light. Confrontational visual
fields are normal. There is a left lower facial droop. The cough and gag reflexes are intact The
tongue is midline without fasciculation. There is left-sided hemiplegia with an extensor plantar
response. There is also increased cogwheel rigidity in the left upper extremity. A non-contrast
head CT is negative for an acute hemorrhage. A lesion in which of the following areas is most
likely responsible for this patient's symptoms?

A. Brainstem at the level of the medulla oblongata

B. Brainstem at the level of the midbrain
C. Cerebellar hemisphere
D. Cerebral cortex in the distribution of the middle cerebral artery

Ans: B

2. A 76-year-old man is brought to the physician by his son for unsteadiness and several near-
falls over the last 2 weeks. The patient has been less interactive lately and prefers to stay in his
room. His symptoms have been slowly worsening over the last 2 weeks. He has had no recent
illness, fever, chills, or headaches. His medical problems include mild dementia, ischemic stroke
without significant residual deficit, and seizure disorder. His medications include aspirin,
phenytoin, levetiracetam, and vitamin D. He was recently started on omeprazole for reflux
symptoms. The patient's vital signs are within normal limits. Physical examination shows a
narrow-based, unsteady gait with poor balance. His speech is slightly slurred. The patient has
horizontal nystagmus and poor coordination with rapid alternating movements and finger-to-
nose maneuvers bilaterally. His strength and sensation are intact Which of the following is the
most likely diagnosis?

A. Benign paroxysmal positional vertigo

B. Cerebellar stroke
C. Masked depression
D. Medication toxicity

Ans: D

3. A 56-year-old man with a past medical history of hypertension and diabetes mellitus is
hospitalized after sustaining a mild concussion following a motor vehicle accident His daily
medications include aspirin, metformin, and lisinopril. He has smoked one pack of cigarettes
daily for 20 years. He does not drink alcohol. He is married and works as an accountant. His
family history is significant for coronary artery disease and diabetes mellitus. His blood pressure
is 143/95 mm Hg and pulse is 90/min with regular rhythm. His general physical and neurological
examinations are unremarkable. An MRI of the brain without contrast reveals a chronic infarct
in the right basal ganglia without any evidence of intracranial bleeding_ This patient is at the
highest risk for which of the following?

A. Dementia
B. Migraine headaches
C. Multiple sclerosis
D. Normal pressure hydrocephalus

Ans: A

4. Involvement of pyramidal tract leads to all of the following except

A Hyper-reflexia
B Spasticity
C Positive Babinski sign
D Fasciculations

Ans:D

5. Intravenous rtPA is indicated in ischemic stroke within how many hour/s of onset of disease
process?
A 1 hour
B 3 hours
C 12 hours
D 6 hours

Ans: B

6. The most common cause of seizures in a patient of AIDS is

A CNS lymphoma
B Toxoplasmosis
C Progressive multifocal leucoencephalopathy
D Cryptococcal meningitis

Ans B

7. Hypertensive hemorrhage is most commonly seen in?

A Basal ganglia
B Cerebrum
C Thalamus
D Brain stem

Ans: A

8 A 67-year-old woman is evaluated for weakness. She has had several weeks of difficulty
brushing her teeth, combing her hair, climbing steps. She has also noted a rash on her face.
Examination is notable for erthyematous flat topped papules on interphalangeal joints. Serum
creatinine kinase (CK) is elevated. What is the probable diagnosis?

A Myaesthenia Gravis
B Inclusion body myositis
C Polymyositis
D Dermatomyositis

Ans: D

9. An analysis was undertaken of the histological, pathological, and neurochemical alterations

in the brains of patients who died of Alzheimer disease. Following examination of the brain.
Which of the following would most likely be present in the affected regions?

A) Marked retrograde degeneration in sensory neurons of the brainstem

B) A decrease in substance P in the hypothalamus and brainstem reticular formation
C) Marked degeneration of most myelinated pathways
D) Amyloid deposits and neurofibrillary tangles

Ans: D

10. What is the first test that should be performed when a patient presents with signs and
symptoms of an acute stroke?

A Complete Blood count

B. Brain computed tomography
C. Electrocardiogram
D. Brain magnetic resonance imaging

Ans: B