Internal Medicine/ Endocrinology
I.
Common Endocrine Presentations.
1. Obesity.
***) All
of the following disorders occur with greater frequency in obese people,
except:
A.
Degenerative joint disease
B.
Hypertension
C.
Psychosocial disability
D.
Anemia
E.
Thromboembolic disorder
Answer: D* Anemia
***) Obese
persons are at increased risk for all of the following, except:
A.
Cholelithiasis
B.
Diabetes mellitus
C.
Hypothyroidism
D.
Hypertension
E.
Hypertriglyceridemia
Answer: C* Hypothyroidism
II.
Diabetes Mellitus.
1. Diabetes Mellitus.
***) The
hemoglobin A1C (HbA1c) which indicates good diabetic control is: Q2012
A.
Below
7%
B.
Below
8%
C.
Below
9%
D.
Below
10%
E.
Below
12%
Answer: A* Below 7%
***) The
following are true in diabetes mellitus type 1, except: Q2012
A.
It
starts usually below 30 years old age
B.
Absolute
insulin deficiency
C.
Sulfonyl
Urca drugs are contraindicated
D.
Anti-GAD
antibodies are usually positive
E.
Develops
hyperosmolar hyperglycemic coma without insulin
F.
Answer:
E* Develops hyperosmolar hyperglycemic coma without insulin
***) The
following are more in favor of type I diabetes mellitus than type II, except:
A.
Association with ketoacidosis
B.
Association with HLA-DR3 or HLA-DR4
C.
Strong family history of diabetes
D.
Present of islet cell antibodies
E.
Abrupt onset of signs and symptoms
Answer: C* Strong family history of
diabetes
***) Diabetes
may be secondary to all of the following, except:
A.
Cushing's syndrome
B.
Thiazide therapy
C.
Acromegaly
D.
Pancreatic carcinoma
E.
Insulinoma
Answer: E* Insulinoma
***) Diabetes
may be secondary to all of the following, except:
A.
Chronic pancreatitis
B.
Acromegaly
C.
Pheochromocytoma
D.
Insulinoma
E.
Glucagonoma
Answer: D* Insulinoma
2. Treatment of Diabetes Mellitus.
***) All
of the following are hypoglycemic agents, except:
A.
Glibenclamide
B.
Chlorpropamide
C.
Gliclazide
D.
Chlorpromazine
E.
Glipizide
Answer: D* Chlorpromazine
***) There
is an association between the use of biguanide oral hypoglycemia agent
metformin (Glucophage) and the development of:
A.
Lactic acidosis
B.
Respiratory acidosis
C.
Metabolic acidosis with normal anion gap
D.
Metabolic alkalosis
E.
Marked respiratory alkalosis
Answer: A* Lactic acidosis
***) Which
of the following insulins can be given IV:
A.
NPH
B.
Ultralente
C.
Lent
D.
Mixtard
E.
Regular
Answer: E* Regular
3. Complications of Diabetes Mellitus.
***) One of
the following is most suited for detection of diabetic nephropathy: Q2012
A.
Renal
US
B.
Urine
analysis for casts
C.
Urine
albumin
D.
Intravenous
pyelography
E.
Serum
creatinine
Answer: C* Urine albumin
***) 63
years old woman with DM type 2, which is small controlled. Her physical
examination is positive for peripheral neuropathy in the feet and non
proliferative retinopathy. Urinalysis is positive for proteinuria. One of the
following treatments is positive for attenuate the course of renal disease: Q2012
A.
Beta
blockers
B.
ACE
inhibitors
C.
HMG-CoA
D.
Dietary
carbohydrate restriction
E.
Weight
reduction
Answer: B* ACE inhibitors
***) All
of the following are complications of diabetes mellitus, except:
A.
Macroglossia
B.
Background retinopathy
C.
Cataracts
D.
Mononeuritis multiplex
E.
Impotence
Answer: A* Macroglossia
***) All
of the following are complications of diabetes mellitus, except:
A.
6th cranial nerve palsy
B.
Cataract
C.
Alopecia
D.
Albuminuria
E.
Painful neuropathy
Answer: C* Alopecia
***) The
following gastrointestinal manifestations can be related to diabetes mellitus,
except:
A.
Constipation
B.
Diarrhea
C.
Fecal incontinence
D.
Duodenal ulcer
E.
Gastric atonia
Answer: D* Duodenal ulcer
***) Hyperglycemic
hyperosmolar non-ketonic coma:
A.
May be presenting feature of diabetes mellitus
B.
Has a better prognosis than diabetic ketoacidosis
C.
Usually a feature of type I diabetes mellitus
D.
Is an indication for long term insulin therapy
E.
Requires larger doses of insulin than diabetic ketoacidosis
Answer: A* May be presenting feature of
diabetes mellitus
***) Neuropathic
(Charcot) joints may be seen in all of the following, except:
A.
Diabetes mellitus
B.
Syringomyelia
C.
Leprosy
D.
Tabes dorsalis
E.
Huntington chorea
Answer: E* Huntington chorea
4. Diabetic Ketoacidosis DKA.
***) In
diabetic ketoacidosis all of the following are true, except: Q2012
A.
Low
dose insulin therapy is needed
B.
Leukocytosis
almost always means infection
C.
At
least 6 liters of fluids is estimated
D.
Potassium
deficit is present and needs replacement
E.
The
acid base presentation is metabolic acidosis
Answer:
B* Leukocytosis almost always means infection
***) 55
years old male presented with DKA (diabetes type 2), ABGs showed pH 7.05, HCO3
12, K 3.1. The best treatment is: Q2012
A.
Fluids,
insulin, K, HCO3
B.
Fluids,
insulin, K
C.
Fluids,
insulin, HCO3
D.
Insulin
only
E.
Fluids,
K, HCO3
Answer: A* Fluids, insulin, K, HCO3
***) In
diabetic ketoacidosis all of the following are true, except:
A.
May be precipitated by infection
B.
May occur in type II diabetes (insulin independent)
C.
Dehydration may be very severe
D.
Total body potassium is high
E.
Bicarbonate may be needed
Answer: D* Total body
potassium is high
***) The
following about diabetic ketoacidosis are true, except:
A.
May be initial manifestation of diabetes
B.
Recovery is invariable
C.
Heparin may be used prophylactically
D.
May complicate insulin pump therapy
E.
Abdominal pain and tenderness may be present
Answer: C* Recovery is invariable
***) The
following about diabetic ketoacidosis are true, except:
A.
Hypotension with tachycardia indicates profound fluid and electrolytes
depletion
B.
Thromboembolic pnenomenon is recognized complication
C.
Total body potassium is high
D.
More common in type I diabetes
E.
Causes Kussmaul breathing
Answer: C* Total body potassium is high
***) In
diabetic ketoacidosis all are true, except:
A.
Abdominal pain
B.
Leukocytosis
C.
Sweating
D.
Increased anion gap
E.
Pseudohyponatremia
Answer: C* Sweating
***) Management
of diabetic ketoacidosis may include the following, except:
A.
Give 2/3 fluid maintenance to decrease brain edema
B.
Give K
C.
Monitor intake – output
D.
Correct acidosis when pH is less than 7.1
E.
Monitoring ketones in the blood is more important than in urine
Answer: A* Give 2/3 fluid
maintenance to decrease brain edema
5. Hypoglycemia.
***) Causes
of hypoglycemia include all of the following, except:
A.
Insulinoma
B.
Hypoadrenalism
C.
Paracetamol overdose
D.
Alcohol
E.
Thiazide diuretics
Answer: E* Thiazide diuretics
***) All
of the following are causes of hypoglycemia, except:
A.
Glibenclamide therapy
B.
Postprandial
C.
Hepatic failure
D.
Chronic pancreatitis
E.
Addison's disease
Answer: D* Chronic pancreatitis
***) Whipple's
triad is seen in: Q2012
A.
Hepatoma
B.
Cushing's
syndrome
C.
Hyperinsulinism
(hypoglycemia)
D.
Lactase
intolerance
E.
Intestinal
lipodystrophy
Answer: C* Hyperinsulinism
(hypoglycemia)
6. Insulinoma.
***) 30
years old female nurse presented with decreased level of consciousness, labs
showed increased insulin, glucose 30, increased C peptide and negative
sulphonylurea. The most likely cause is: Q2012
A.
Exogenous
insulin
B.
Insulinoma
C.
MEN
1
D.
MEN
2
E.
Hypoglycemia
Answer: B* Insulinoma
III.
Thyroid Gland.
1. Thyroid Hormones.
***) The
dietary element necessary for the formation of thyroid hormones is:
A.
Iron
B.
Iodine
C.
Copper
D.
Magnesium
E.
Sodium
Answer: B* Iodine
2. Tests of Thyroid Function and Structure.
***) One of
the following is found in primary hypothyroidism: Q2012
A.
Low
T4, High T3, Normal TSH
B.
Low
T4, Low T3, High TSH
C.
Low
T4, Low T3, Low TSH
D.
Normal
T4, Low T3, Low TSH
E.
Low
T4, Normal T3, Low TSH
Answer: B* Low T4, Low T3,
High TSH
***) Which
of the following laboratory tests is the most sensitive indicator of primary
hypothyroidism:
A.
T4
B.
T3 resin uptake
C.
T3 by RIA (radioimmunoassay)
D.
TSH (thyroid-stimulating hormone)
E.
Radioiodine uptake
Answer: D* TSH (thyroid-stimulating
hormone)
3. Thyrotoxicosis.
***) All of
the following are manifestations of hyperthyroidism, except: Q2012
A.
Loss
appetite
B.
Preference
for cold
C.
Excessive
warm sweating
D.
Palpitation
E.
Nervousness
Answer: A* Loss appetite
***) A
28 years old obese auxiliary nurse admitted with chest tightness and
palpitation, her pulse was 105 regular, T3 and T4 levels were normal and TSH
was 0.03 (normal range 0.4-4.1 mlU/l), and the thyroglobulin level was
suppressed as well as thyroid uptake. The most likely diagnosis is:
A.
Graves’s disease
B.
Toxic multinodular goiter
C.
DeQuervin thyroiditis
D.
Factitious thyrotoxicosis
E.
Plummer disease
Answer: D* Graves’s
disease
***) All
of the following about Grave's disease (thyrotoxicosis) are true, except:
A.
Cause lid lag
B.
TSH is high
C.
Pretibial myxedema is a feature
D.
Causes exophthalmus
E.
Myopathy may occur
Answer: B* TSH is high
***) All
of the following about Grave's disease (thyrotoxicosis) are true, except:
A.
Pretibial myxedema
B.
Myopathy
C.
Atrial fibrillation
D.
Oligomenorrhea
E.
Aortic incompetence
Answer: E* Aortic incompetence
***) All
of the following about Grave's disease (thyrotoxicosis) are true, except:
A.
Tremor of both hands
B.
Carpopedal spasm
C.
Pretibial myxedema
D.
Tachycardia
E.
Lid retraction
Answer: B* Carpopedal spasm
***) All
of the following about Grave's disease (thyrotoxicosis) are true, except:
A.
Loss of weight in spite of increased appetite
B.
Slow-relaxing of the ankle jerk
C.
Hyperkinetic movements
D.
Pulse rate 120/min
E.
Goitre
Answer: B* Slow-relaxing of the ankle
jerk
***) All
of the following are manifestations of thyrotoxicosis, except:
F.
Loss of weight in spite of good appetite
G.
Preference for heat
H.
Excessive warm sweating
I.
Palpitation
J.
Nervousness
Answer: B* Preference for heat
***) All
of the following are manifestations of thyrotoxicosis, except:
A.
Exophtalmos
B.
Pretibial myxedema
C.
Preference for cold
D.
Increased body weight
E.
Excessive sweating
Answer: D* Increased body weight
***) All
of the following may be used in the treatment of thyrotoxicosis, except:
A.
Neomercazole
B.
Radio-active iodine
C.
Surgery
D.
Propranolol inderal
E.
Cyclophosphamide
Answer: E* Cyclophosphamide
***) All
of the following may be used in the treatment of thyrotoxicosis, except:
A.
Radioactive iodine
B.
Carbimazole
C.
Potassium perchlorate
D.
Cyclophosphamide
E.
Propranolol
Answer: D* Cyclophosphamide
4. Thyroid Storm.
***) Thyroid
storm can present with all the following except: Q2012
A.
Fever
B.
Coma
C.
Heart
failure
D.
High
T3, T4
E.
Bradycardia
Answer: E* Bradycardia
5. Hypothyroidism.
***) All
of the following are features of myxedema, except:
A.
Hoarseness of voice
B.
Pretibial myxedema
C.
Pleural effusion
D.
Menorrhagia
E.
Deafness
Answer: B* Pretibial myxedema
***) All
of the following are features of myxedema, except:
A.
Periorbital puffiness
B.
Pericardial effusion
C.
Brisk ankle reflex
D.
Weight gain
E.
Constipation
Answer: C* Brisk ankle reflex
***) All
of the following may occur in myxedema, except:
A.
Ataxia
B.
Deafness
C.
Clonus
D.
Pericardial effusion
E.
Alopecia
Answer: C* Clonus
***) Hypothyroidism
may give rise to all of the following, except:
A.
Periorbital puffiness
B.
Carpal tunnel syndrome
C.
Cold intolerance
D.
Hair loss
E.
Polycythemia
Answer: E* Polycythemia
***) All
of the following are clinical features of hypothyroiditis, except:
A.
Deafness
B.
Loss of weight
C.
Dry skin
D.
Slow-relaxing reflexes
E.
Carpal tunnel syndrome
Answer: B* Loss of weight
IV.
Parathyroid Gland.
1. Hyperparathyroidism.
***) Features
of hyperparathyroidism include all of the following, except:
A.
Osteitis fibrosa cystica
B.
Osteomalacia
C.
Hypocalcemia
D.
Pathologic fractures
E.
Osteoporosis
Answer: C* Hypocalcemia
2. Hypoparathyroidism.
***) 35
years old female presented with bone pain and generalized weakness. Labs show decreased
PTH, decreased Ca, and normal Vitamin D. The most likely diagnosis is: Q2012
A.
1-alpha-hydroxylase
deficiency
B.
Hypoparathyroidism
C.
Vitamin
D deficiency
D.
Vitamin
C deficiency
E.
Vitamin
B12 deficiency
Answer: B* Hypoparathyroidism
V.
Adrenal Gland.
1. Adrenal Cortex & Cushing's syndrome.
***) Cushing's
syndrome is a recognized cause of all of the following, except:
A.
Hypertension
B.
Hirsutism
C.
Osteomalacia
D.
Obesity
E.
Hyperglycemia
Answer: C* Osteomalacia
***) Features
of Cushing's syndrome include all of the following, except:
A.
Hypertension
B.
Psychiatric symptoms
C.
Diabetes mellitus
D.
Tall stature in children
E.
Hypokalemia
Answer: D* Tall stature in children
***) Features
of Cushing's syndrome include all of the following, except:
A.
Proximal muscle weakness
B.
Hyperglycemia
C.
Hypertension
D.
Truncal obesity
E.
Hyperkalemia
Answer: E* Hyperkalemia
***) Features
of Cushing's syndrome include all of the following, except:
A.
Amenorrhea
B.
Hypertension
C.
Ecchymosis
D.
Hyperkalemia
E.
Weakness
Answer: D* Hyperkalemia
***) Features
of Cushing's disease include all of the following, except:
A.
Proximal myopathy
B.
Weight gain
C.
Loss of circadian rhythm of Cortisol secretion
D.
Neutrophilic leukocytosis
E.
Suppressed ACTH
Answer: E* Suppressed ACTH
2. Adrenocortical Insufficiency (Addison's disease).
***) All of
the following are features of Addison's disease, except: Q2012
A.
Hyponatremia
B.
Hypokalemia
C.
Postural
hypotension
D.
Axillary
hair loss
E.
Hyperpigmentation
of the skin
Answer: B* Hypokalemia
***) The
following about chronic adrenocortical insufficiency (Addison's disease) are
true, except:
A.
Causes increased skin pigmentation
B.
Plasma ACTH is low
C.
Causes small heart
D.
May be secondary to tuberculosis
E.
Vitiligo is recognized association
Answer: B* Plasma ACTH is low
***) All
of the following are features of Addison's disease, except:
A.
Weakness
B.
Anorexia
C.
Hypoglycemia
D.
Hypertension
E.
Hyperpigmentation of the skin
Answer: D* Hypertension
3. Hyperaldosteronism.
***) A
patient with an aldosterone-secreting tumor is likely exhibiting all of the
following signs and symptoms, except:
A.
Hypertension
B.
Alkalosis
C.
Edema
D.
Hypokalemia
E.
Low plasma renin activity
Answer: C* Edema
4. Pheochromocytoma.
***) One
of the following would be unexpected finding in a patient with
pheochromocytoma:
A.
Paroxysmal hypertension
B.
Persistent hypertension
C.
Excessive sweating
D.
Bilateral tumor in 50% of cases
E.
Palpitation
Answer: D* Bilateral tumor in 50% of
cases
***) Which
one of the following tumors is associated with paroxysmal hypertension:
A.
Pheochromocytoma
B.
Carcinoid tumor
C.
Gastrinoma
D.
Hepatoma
E.
Seminoma
Answer: A* Pheochromocytoma
5. Gynecomastia.
***) Which
of the following is the most common cause of gynecomastia:
A.
Liver failure
B.
Physiologic
C.
Hyperparathyroidism
D.
Tumors
E.
Idiopathic
Answer: B* Physiologic
***) Causes
of gynecomastia include all of the following, except:
A.
Liver cirrhosis
B.
Bronchogenic carcinoma
C.
Testicular atrophy
D.
Digitalis therapy
E.
Hyperparathyroidism
Answer: E* Hyperparathyroidism
***) Causes
of gynecomastia include all of the following, except:
A.
Old age
B.
Liver disease
C.
Hyperthyroidism
D.
Methyldopa
E.
Glibenclamide
Answer: E* Glibenclamide
***) Causes
of gynecomastia include all of the following, except:
A.
Puberty
B.
Bronchogenic carcinoma
C.
Kleinfelter's syndrome
D.
Hydrochlorothiazide
E.
Digoxin therapy
Answer: D* Hydrochlorothiazide
***) Gynecomastia
may be caused by all of the following, except:
A.
Cirrhosis of the liver
B.
Furosemide
C.
Spironolactone
D.
Klinefelter syndrome
E.
Cimetidine
Answer: B* Furosemide
VI.
Pituitary Gland.
1. Pituitary Hormones.
***)
All of the following hormones are secreted from the pituitary gland, except:
A.
Thyroid stimulating hormone
B.
Prolactin releasing hormone
C.
Growth hormone
D.
Adrenocorticotropic hormone ACTH
E.
Luteinizing hormone LH
Answer: B* Prolactin releasing hormone
***)
Which one of the following hormones does the anterior pituitary secrete:
A.
Vasopressin
B.
Oxytocin
C.
Growth hormone
D.
Insulin
E.
Calcitonin
Answer: C* Growth hormone
***) The
anterior pituitary produces all of the following hormones, except:
A.
ADH (Antidiuretic Hormone)
B.
LH (Luteinizing Hormone)
C.
Prolactin
D.
TSH (Thyroid Stimulating Hormone)
E.
FSH (Follicular Stimulating Hormone)
Answer: A* ADH (Antidiuretic Hormone)
***) All
the following hormones are increased with stress except:
A.
ACTH
B.
GH
C.
TSH
D.
Insulin
E.
Glucagon
Answer: B* GH
2. Hypopituitarism.
***) All of
the following are clinical features of panhypopituitarism, except: Q2012
A.
Hyperpigmentation
B.
Hypotension
C.
Cold
intolerance
D.
Loss
of secondary sexual characteristics
E.
Infertility
Answer: A* Hyperpigmentation
***) In
Sheehan's syndrome the patient may present with all of the following, except:
A.
Hypoglycemia
B.
Hyperpigmentation
C.
Infertility
D.
Hypotension
E.
Hair loss
Answer: B* Hyperpigmentation
***) A
25 years old woman suffers a severe intra-partum haemorrhage. One of the
following symptoms is evidence of pituitary infarction:
A.
Infrequent urination
B.
Diarrhea
C.
Easy bruising
D.
Lactation failure
E.
Constipation
Answer: D* Lactation failure
3. Hyperprolactinemia.
***)
Elevated prolactin levels are expected in all the following, except:
A.
Pregnancy
B.
Hypothyroidism
C.
Pituitary adenoma
D.
Phenothiazine use
E.
Ectopic pregnancy
Answer: E* Ectopic pregnancy
***)
The following may cause hyperprolactinemia, except:
A.
A pituitary tumor
B.
Phenothiazines
C.
Intrauterine contraception device
D.
Oral contraception
E.
Breasts stimulation
Answer: C* Intrauterine contraception
device
***) The
following drugs are known to cause hyperprolactinemia, except:
A.
Metoclopromide (Maxolon)
B.
Cimetidine (Tagamet)
C.
Narcotics
D.
Folic acid
E.
Methyl dopa (Aldomet)
Answer: D* Folic acid
4. Acromegaly.
***)
All of the following are clinical features of acromegaly, except:
A.
Headache
B.
Excessive sweating
C.
Muscular weakness
D.
Large tongue
E.
Loss of hair
Answer: E* Loss of hair
***)
All of the following are clinical features of acromegaly, except:
A.
Decreased shoe size
B.
Large tongue
C.
Decreased libido
D.
Carpal tunnel syndrome
E.
Headache
Answer: A* Decreased shoe size
5. Diabetes Insipidus.
***) Patients
with diabetes insipidus do not usually exhibit:
A.
Polydipsia
B.
Polyuria
C.
Urine specific gravity of less than 1.008
D.
Papilledema, optic atrophy and nystagmus
E.
Hypernatremia
Answer: D* Papilledema, optic atrophy
and nystagmus
***) One
is incorrect in diabetes insipidus:
A.
Occurs in histiocytosis
B.
Presents with hyponatremia
C.
Can be familial disease
D.
Can cause failure to thrive
E.
Can cause developmental delay
Answer: B* Presents with hyponatremia
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