A 45 year old female develops swelling in her neck and diarrhea. X-ray shows dense calcification in her thyroid. A nuclear scan of her thyroid detects a cold nodule that does not concentrate radio-iodine. Her doctor does serum assays for several hormones. After the hormone is assayed, he tells her general practitioner that the patient probably has has medullary carcinoma of the thyroid since one of the hormones is markedly raised. What hormone did the doctor most likely assay?
a) thyroid stimulating hormone
b) thyroid hormone
c) calcitonin
d) Antidiuretic hormone
e) parathyroid hormone
Answer
A 16 year old girl complains of constant headache and general lethargy. On inspection she is noted to be short for her age. On examination she is found to have bilateral temporal field deficits. Her GH, ACTH and TSH levels are low. Her plasma level of prolactin is increased. Radiographic examination shows retarded bone age. The most likely diagnosis is
a) constitutional delay
b) hypothyroidism
c) ovarian dysgenesis
d) optic chiasm glioma
e) craniopharyngioma
Answer
Anosmia in a patient with poorly developed secondary sexual characteristics, should suggest a diagnosis of
a) Isolated LH deficiency
b) Hemochromatosis
c) Kallmann's syndrome
d) Klinefelter's syndrome
e) Laurence-Moon-Bardet-Biedel syndrome
Answer
A 54 year old female has a history of lymphoma. One of the treatments that had been employed was radiation to her neck. Much later, over a period of time, she starts to notice weakness and fatigue. She begins to notice that she no longer can take her evening walks, both because of her fatigue and she no longer likes the night air. She complains of constipation. She starts to put on some weight. On physical examination her heart rate is 65 and her blood pressure is 120/80. She has a slow return of her Achilles tendon reflex. Her skin is dry, somewhat swollen, and has a yellowish hue. Her laboratory results show a MCV of 100. Her thyroid is not palpable. Thyroid tests are done, but the results are pending. What is the most likely diagnosis?
a) myxedema
b) cretinism
c) Graves disease
d) Jod-Basedow phenomenon
e) Riedel's thyroiditis
Answer
A 45 year old male with anorexia and weakness is found to have hypercalcemia. This is most likely to be secondary to abnormal
a) growth hormone
b) thyroid hormone
c) aldosterone
d) parathyroid hormone
e) leutenising hormone
Answer
A 51-year-old white man was recently diagnosed with a solitary 2.7-cm papillary cancer of the thyroid with no invasion of the capsule, no lymphadenopathy, and no distant metastases. He denies a history of head and neck irradiation, hoarseness, pain, dysphagia, or hemoptysis. His physical exam is otherwise normal, with no lab abnormalities. Which of the following measures is most appropriate for his management?
A. Partial thyroidectomy followed by radioactive iodine (RAI) treatment
B. Near-total thyroidectomy followed by RAI treatment
C. Thyroid hormone treatment
D. A and C
E. B and C
Answer
Tags:
MCQ, Endocrinology, Thyroid
You saw a 71-year-old white woman nursing home resident who was brought in by her daughter for a complete physical exam. Her complaints include a poor appetite, weight loss, cramps, and weakness. She was diagnosed with Crohn's disease 10 years ago but is not taking any medications. Five months ago she had a mammogram and flexible sigmoidoscopy, both of which were normal. Because her exam was normal, she was given a 1-month return appointment and sent for blood work.
At the end of the day, your lab calls to report a panic value of calcium of 1.4 mmol/L (normal range, 2.2 – 2.6 mmol/L) with an inorganic phosphate of 0.58 mmol/L (normal range, 0.8 – 1.5 mmol/L). She has a creatinine of 80 umol/L (normal range, 60 – 110 umol/L), albumin is 35 g/L (normal range, 37 – 49 g/L), and alkaline phosphatase is 250 U/L (normal range, 42-98 U/L). Which of the following diagnoses is compatible with these lab data?
A. Hypoparathyroidism
B. Hypomagnesemia
C. Vitamin D deficiency
D. Renal failure
Answer
Tags:
MCQ, Endocrinology, Calcium homeostasis
A 38-year-old black woman draws your attention to a swelling in her neck, which she noticed 2 days ago. She denies palpitations, diaphoresis, and weight loss. There is no pain, hoarseness, or dysphagia. Her medical history is notable only for hypertension. Medications include only atenolol 50 mg once daily. On exam, blood pressure is 150/80 mm Hg; pulse is 70. There is a 2 × 1-cm nontender nodule on the right lobe of the thyroid. No lymphadenopathy is detected. The remainder of the exam is unremarkable. Electrolytes, blood urea nitrogen (BUN), creatinine, liver function tests, calcium, phosphorus, and CBC are normal. What would you do next?
A. Elicit history of head and neck irradiation.
B. Elicit a family history of thyroid cancer.
C. Obtain thyroid function tests.
D. Perform fine-needle aspiration.
E. All of the above
Answer
Tags:
MCQ, Endocrinology, Thyroid, Neck Swelling
A 60-year-old white man comes to see you for chronic back pain, which worsened 1 week ago. He has been wheelchair bound for 6 months because of severe osteoporosis with multiple lumbosacral spine fractures. He has severe asthma, which has required large doses of glucocorticoids for many years. The patient report
s progressive loss of height and kyphosis over the past year. Other medications include albuterol and ipratropium inhalers and long-acting theophylline 300 mg twice a day. Significant physical findings include bilateral cataracts, multiple ecchymoses, and a prolonged expiratory phase with bilateral wheezes. Which of the following measures may be helpful?
A. Testosterone replacement (only if he is deficient)
B. Physical therapy
C. Vitamin D replacement (only if his vitamin levels are low)
D. Calcium supplementation
E. Hydrochlorothiazide
F. All of the above
Answer
Tags:
MCQ, Endocrinology, Geriatrics
A 60-year-old white man comes to see you for chronic back pain, which worsened 1 week ago. He has been wheelchair bound for 6 months because of severe osteoporosis with multiple lumbosacral spine fractures. He has severe asthma, which has required large doses of glucocorticoids for many years. The patient reports progressive loss of height and kyphosis over the past year. Other medications include albuterol and
ipratropium inhalers and long-acting theophylline 300 mg twice a day. Significant physical findings include bilateral cataracts, multiple ecchymoses, and a prolonged expiratory phase with bilateral wheezes. Which of the following underlies his osteoporosis?
A. Decreased bone formation
B. Increased bone loss
C. Decreased calcium absorption from the GI tract
D. Increased calcium loss in urine
E. All of the above
Answer
Tags:
MCQ, endocrinology, Osteoporosis
A 35-year-old black woman comes to see you for a complete physical exam. She has experienced cold
intolerance, weakness, and constipation for 3 months. Her menses are regular but scanty. Her history is significant for hypertension and peptic ulcer disease, and her family history includes hypertension and diabetes. The patient is married but has never been pregnant and takes cimetidine 400 mg at bedtime, sustained-release nifedipine 60 mg daily, and docusate sodium 100 mg three times a day. Her pulse is 58 beats/minute with a blood pressure of 135/90 mm Hg. Her skin is dry and scaly, and she has hung-up reflexes. The rest of her exam is normal, and the following labs are obtained: serum chemistries are normal except for a creatine kinase of 300 U/L (normal range, 26-140 U/L); CBC is normal, free thyroxine (T4) is 6.4 pmol/L (normal range,10 – 22 pmol/L), and thyroid stimulating hormone (TSH) is 1.5 mIU (normal range, 0.3-5.0 mIU). Which of the following tests would you order?
A. Free triiodothyronine (T3)
B. Thyroid scan
C. Thyroid uptake
D. Pituitary magnetic resonance imaging (MRI)
E. Antithyroid antibodies
Answer:
Tags:
MCQ, Endocrinology, thyroid
A 38-year-old black woman comes to you for renewal of her medications. She has had hypertension since
her last pregnancy at age 30 and has been maintained on clonidine 0.2 mg twice a day. She gets headaches, dyspnea on exertion, swelling of her feet, and orthopnea but denies chest pain. Her father is also being treated for hypertension. She is married and does not smoke. She is five feet seven inches tall and weighs 257 pounds. Her blood pressure is 180/110 mm Hg; pulse is 92 beats/minute. The rest of her exam is remarkable for hypertensive retinopathy, bibasilar rales, and 1+ pitting edema bilaterally. Initial labs were normal except for a serum potassium of 3.0 mEq/L (normal range, 3.5- 5.0 mEq/L) and serum bicarbonate of 33 mEq/L (normal range, 22-28 mEq/L). You correct hypokalemia and obtain a random serum aldosterone level of 25 ng/dL (normal range, 5-30 ng/dL) with a plasma renin activity of 0.5 ng/mL/hour (normal range, 1.6- 7.4 ng/mL/hour) while the patient is on a normal diet. What additional tests might be appropriate?
A.
Adrenal computed tomography (CT) scan 
B. Adrenal vein sampling
C. 18-hydroxycorticosterone
D. Saline loading test
E. A, B, and C
Answer
Tags:
MCQ, Endocrine, Aldosterone
A 27-year-old white woman was admitted 2 days ago through the emergency room for seizures. She has a history of moderate alcohol use. Two weeks ago she received benzathine penicillin for secondary syphilis. She is complaining of muscle cramps, weakness, and headache. She received 1 g of phenytoin on the day of admission and is now taking 100 mg three times a day. She is also taking acetaminophen, multivitamins, and
tapering doses of chlordiazepoxide. There is a history of seizures in her family. She is 5 feet tall and weighs 120 pounds. Her blood pressure is 130/80 mm Hg; pulse is 90 beats/minute. The rest of the physical exam is normal except for a round face, a short neck, short fourth and fifth metacarpals, and bilateral cataracts. Abnormal labs include a calcium of 1.5 mmol/L (normal range, 2.2-2.6 mmol/L), phosphorus of 1.7 mmol/L (normal range, 0.8-1.4 mmol/L), and an intact parathyroid hormone (PTH) of 200 pg/mL (normal range, 15-65). Which of the following is most likely?
A. Hypothyroidism
B. Hypogonadism
C. Basal ganglia calcification
D. Mental retardation
E. All of the above
Answer
Tags:
MCQ, Endocrinology, Seizures
All of the following thyroid conditions are amenable to RAI treatment, except
A. Papillary cancer
B. Follicular cancer
C. Graves' disease
D. Thyroid lymphoma
E. Multinodular goiter
Answer
Tags:
MCQ, Endocrinology, Thyroid
Which of the following statements is/are true regarding PTH?
A. Secretion is stimulated by hypocalcemia.
B. Secretion is inhibited by hypercalcemia.
C. The effect of magnesium on secretion is the same as that of calcium.
D. Secretion is stimulated by low 1,25-hydroxyvitamin D and inhibited by high levels of 1,25-hydroxyvitamin D.
E. A, B, and D
F. All of the above
Answer
Tags:
MCQ, Endocrinology, Parathormone, PTH
Which of the following statements is true about thyroid hormone (TH)?
A. T3 is the most active molecule in TH
B. Iodine for TH synthesis is taken up by active transport into the thyroid gland
C. TH is transported in the blood in protein-bound and free forms.
D. All of the above
Answer
A mutation affecting the development of the diencephalon could interfere with the secretion of which of the following hormones?
A. Adrenocorticotrophic hormone (ACTH)
B. Epinephrine
C. Oxytocin
D. Prolactin
E. Thyroid stimulating hormone (TSH)
A 32-year old women complains of amenorrhea since delivery of a baby 15 months previously, despite the fact that she did not breast feed her baby. The delivery was complicated by excessive hemorrhage that
required transfusion of 2.5 liters of blood. She has also been fatigued and has gained an additional 10 pounds since the baby was born.
A. Hashimoto's thyroiditis
B. Isolated gonadotropin deficiency
C. Primary amenorrhea
D. Prolactinoma
E. Sheehan's syndrome
Pharmacologic treatment of growth hormone (GH) excess secondary to a pituitary adenoma may include the use of which of the following?
- Bromocriptine
- Vasopressin
- Octeotide
- Prednisone
Click For Answer
The most common mass lesion in the sella turcica is which of the following?
- Craniopharyngioma
- Aneurysm
- Benign pituitary cyst
- Pituitary adenoma
Click For Answer
