‫‪From 2005 to 2011‬‬

‫ﻟـﻠﺪﻛﺘﻮر‬
‫ﻋﺒﺪاﻟﺮؤوف ﻣﺤﻤﺪ ﻋﺒﺪاﻟﻠﻄﯿﻒ‬

‫طﺒﺎﻋﺔ‪ :‬م‪ .‬ﺳﮭﯿﺮ‬

‫ﻣدرﺳﺔ ﻣﻧﺎرة اﻟﺗوﻓﯾق‬

 Endocrine
Dr. Abdulraouf

THYROID DISEASE:
Q1: A 30 year old female complains of palpitations and fatigue. On physical examination,
her extremities are warm and she is tachycardia, there is diffuse thyroid gland enlargement
and proptosis with pretibial edema. The following is correct :
a. The cause of patient's illness is viral infection of the thyroid.
b. Blood test shows increased total thyroxin, increased total T3 and increased TSH.
c. The treatment of choice is radioactive iodine.
d. Propylthiouracil preferable treatment during pregnancy.
e. Medial nerve entrapment is a common complication.

Q2: A 40 years woman who has goitre for several years presented with a four months history
of losing 5 Kg of weight, palpitations and increased sweating. Free T4 was within normal
range and serum TSH was <0.01 mU/L ( N 0.3-4.0 mU/L).
Which of the following statements is true?
a. A history of oral contraceptive pills explains the abnormality in thyroid function results.
b. Low pulse pressure is compatible with her clinical condition.
c. The absence of bruit on auscultation over the goitre excludes hyperthyroidism.
d. Measurement of free T3 will be the next step in the investigation of this patient.
e. Thyroidectomy is the first line of management.

Q3: A 33 year old female patient newly married presented with goitre, loss of weight, despite
polyphagia, and heat intolerance. Clinical manifestation includes tachycardia, high volume
collapsing pulse and fine tremor. The following are true except:
a. Absence of ocular manifestations rules out Graves’ disease.
b. Pretibial myxoedema is a recognized clinical feature.
c. Vitilligo favours Graves disease.
d. TSH receptor antibody (TRab) estimations is of diagnostic value.
e. Relapse rate is around 50% after stopping anti thyroid drugs.

Q4: A 25 year old female has a 2 month history of increased nervousness, heat intolerance
and 10Kg weight loss, physical examination demonstrates bilateral exophthalmous with no
extra ocular muscle impairment, diffuse goiter with bruit auscultated over the gland, serum
TSH < 0.03mIu(normal 0.3-4.5), serum T4 is 24.2 µg/dl(normal 4.5-12). Serum Beta HCG
test is normal. Which of the following statements is correct :
a. Test serum total tri iodothyroidectomy in one week.
b. Schedule her for thyroidectomy in one week.
c. Her ophthalmopathy will improve the most if she receives radio iodine therapy.
d. Pre tibial myxoedema is common physical finding.
e. TSH level may stay suppressed for months after the patient is clinically euthyriod.

Q5: A 20 year old female complains of palpitation, breathlessness, unintentional 10Kg

weight loss over the last 6 months, increased perspiration, and heat intolerance. On
examination her pulse is 120/min, her skin warm and moist and there is mild tremor in both
hands, she has bilateral exophthalmos, thyroid is non tender, diffusely enlarged. Laboratory

‫ﻣدرﺳﺔ ﻣﻧﺎرة اﻟﺗوﻓﯾق‬

 Endocrine
Dr. Abdulraouf

results include a serum T4 of 200nmoI/L (NR: 64-155nmoI/L), and a serum TSH of

<0.01mU/mL(NR: 0.5-5.0 mU/mL). all of the following are true regarding patients cases
except:
a. Autoimmune ethoilogy is the most likely underlying cause.
b. Wide pulse pressure is expected.
c. High output heart failure is well recognized complication.
d. Radioiodine may be given as primary therapy to this patient.
e. Digoxin is the drug of first choice if she developed atrial fibrillation.

Q6: A 28-year-old women presented with recent tiredness and difficulty concentrating. She
also noted decreased frequency of bowel movements and an increased tendency to gain
weight. She felt chilled even in warm weather. On physical examination her pulse rate was
58/min and blood pressure 138/88mmHg.She had a puffy face and her eyebrows were sparse.
The thyroid was moderately enlarged, diffuse and rubbery in consistency.
The following are true except:
a. A history of diabetes in her mother and older sister is relevant.
b. Finding slightly enlarged thyroid raises the possibility of Hashimotos thyroiditis.
c. The deep tendon reflexes will show delay relaxation phase.
d. Anti-thyroid antibodies (anti-thyroglobulin and anti-microsomal) are not valuable.
e. If she gets pregnant, thyroxin dose should be increased.

Q7: A 40 year old woman is referred to you because of lethargy, cold intolerance,
constipation, dry and weight gain. Physical examination shows mildly enlarged thyroid,
enlarged tongue and slow reflexes. Which test best confirms the clinical impression of
primary hypothyroidism:
a. Measurement of serum T4.
b. Measurement of serum T3.
c. Measurement of serum TSH.
d. Measurement of serum thyroglobulin.
e. Test for anti-thyroidal antibodies.

Q8: A 50 year old house wife presented with a one month history of tiredness, weight gain of
12Kg, puffiness of the face, hair loss and numbness of the left hand at night. On examination
her pulse was 52/min, cardiac apex beat is not palpable. ECG shows sinus bradycardia and
low voltage QRS complex, all of the following are true regarding patients cases except:
a. A history of menorrhagia is significant.
b. Exaggerated ankle reflexes are diagnostic test.
c. TSH is the most important diagnostic test.
d. It is available to start thyroxin supplement in a smaller dose.
e. Coma is a recognized complication in untreated patients.

Q9: A 50 year old house wife presented with a one month history of tiredness, weight gain of
12Kg, puffiness of the face, hair loss and numbness of the left hand at night. On examination,

‫ﻣدرﺳﺔ ﻣﻧﺎرة اﻟﺗوﻓﯾق‬

 Endocrine
Dr. Abdulraouf

her pulse was 52/min; cardiac apex beat is not palpable. ECG shows sinus bradycardia and
low voltage QRS complex. Which of the following statements regarding this patients case is
false:
a. A history of menorrhagia is significant.
b. Exaggerated ankle reflexes are diagnostic.
c. TSH is the most important diagnostic test.
d. It is advisable to start thyroxin supplement in a smaller dose.
e. Hypercholesterolemia is recognized association.

Q10: A 65 year old female presented with a 3 month history of progressive tiredness and
hoarseness of voice. She admitted due to paraesthesia in both hands. She had a history of
psychotic illness. On examination she had per orbital puffiness, non-pitting edema on both
lower limbs, her pulse was 55/min, regular and her blood pressure was 110/70 mmHg. Chest,
cardiac and abdominal examinations were normal. The following are true about management
of this patient except:
a. History of intake of lithium carbonate is of significance.
b. Carpal tunnel syndrome is a recognized association.
c. Detection of antibodies against thyroid peroxidase excludes spontaneous atrophic
thyroiditis.
d. It is advisable to start with a low dose of thyroxin in the initial stages of the treatment.
e. Myocardial ischemia is recognized complication.

CUSHING SYNDROM:
Q11: A 45 year old female was, seen at the medical outpatient department complaining of
amenorrhea, recent weight gain, difficulty in climbing stairs and coping with her children.
Her husband noticed mood changes and states that she is depressed most of the time. On
physical examination she had central obesity, acne and hirustism, BP240/110mmHg. The
following are true regarding this patient except:
a. History of blurring of vision is of diagnostic value.
b. Neurological examination of the lower limbs may show proximal myopathy.
c. Low dose dexamethasone suppression test will confirm Cushing’s disease.
d. MRI pituitary scan could fail to identify a micro-edenoma.
e. Osteoporosis is a recognized complication.

ADRENAL INSUFFICENCY:
Q12: An 18 year old nurse, presented to emergency room complaining of dizziness and
vomiting with mild upper abdominal discomfort for the last 24 hrs. on systemic inquiry she
has mild dysuria and urgency over the last week, she is known case of bronchial asthma on
self-monitored dose of systemic corticosteroids which was stopped recently, she is currently
on short acting β2 agonist, on examination, she was afebrile, pulse 100/min, regular low
volume BP 80/40mmHg with postural drop 15mmHg, the rest of clinical examination was
unremarkable. The following are true except:
a. History of recent physical or emotional stress is significant.

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 Endocrine
Dr. Abdulraouf

b. Presence of moon face is of clinical significance.

c. Hypernatremia and hypokalaemia are expected.
d. Fluid and replacement therapy should be started immediately.
e. Acute renal failure is a recognized complication.

Q13: A 23 year old female teacher presented with a 3 day history of abdominal pain,
anorexia and vomiting. On examination she was dehydrated, pulse of 110/min, blood
pressure of 90/60 mmHg with pigmentation in the buccal mucosa. Systemic examination was
normal. The following are true about the patient management except:
a. Past history of tuberculosis is significance in this patient.
b. Vitiligo occurs in 10-20% in such cases.
c. Serum Cortisol level is expected to rise to a very high level after a short ACTH stimulation
test.
d. Parental hydrocortisone should be continued until gastrointestinal symptoms improve.
e. Hypoglycaemic coma is recognized complication.

Q14: A 38 year old male presented with a 6 months history of weight loss, increased skin
pigmentation, dizziness upon standing and episodic sever colicky abdominal pain.
Investigations revealed, Hgb 12g/dl, MCV 84 fl, urea 32mg/dl, Na+ 125mmol/l, K
6.1mmol/l, random blood suger 54 mg/dl. Which of the following is the most appropriate
next investigation?
a. Glucocorticoid suppression test.
b. MRI of the pituitary gland.
c. Insulin level.
d. Short ACTH stimulation test.
e. Rennin-Aldosterone ratio.

Q15: A60 year old male was referred to the medical department due to repeated vomiting,
diarrhea, epigastric pain following a cholecystectomy. A surgical cause was excluded. He
gave a history of repeated attacks of abdominal pain. Clinically, looks underweight, blood
pressure 90/50mmHg, pulse 107/min. investigations showed: serum K of 5.4 mmol/L (3.5-
5.0), Na 119mmol/l (130-145), random blood sugar 50mg/dl and normal urea. The most
helpful investigation is:
a. ECG and Echocardiograms.
b. Short ACTH stimulation test.
c. Dexamethasone suppression test.
d. Serum lipase.
e. Upper GIT endoscopy.

Q16: A 40 year old women presents with 6 months history of increasing fatigue, recurrent
upper respiratory tract infections, poor appetite, abdominal cramps and diarrhea. She gives
history of weight loss (10Kg), arthralgia general weakness dizziness, and amenorrhea for the

‫ﻣدرﺳﺔ ﻣﻧﺎرة اﻟﺗوﻓﯾق‬

 Endocrine
Dr. Abdulraouf

past 3 months. On examination she was (thin built had postural hypotension heart rate 80/min
regular, urea was normal, Na 110mmol/L and K 6mmol/L. The following are true regarding
this patient except:
a. History of pulmonary Tuberculosis is significant.
b. Random serum Cortisol could be normal or low.
c. The long synacthen test is most useful.
d. Patient should be screened for evidence of thyroid disease and pernicious anaemia.
e. Risk of shock and death if exposed to surgery or other stress if not treated.

ACROMEGALLY:
Q17: A 40 year old male patient presented with a history of increased headache, numbness,
tingling of his hands especially at night, excessive snoring for the last one year, examination
disclosed a blood glucose of 200mg/dl which of the following statements is correct.
a. Serum prolactin is likely to be elevated.
b. IGF-l level is expected to be low.
c. Hypocalcaemia is typically present.
d. Primary medical therapy is curative in almost all patients.
e. Almost always caused by carcinoid tumours or islet cell tumours.

DIABETES MELLITS:
Q18: A 68 year old male with type2 DM for 20 years on glibenclamide 5 mg daily, attended
the OPD for a routine follow up, he was complaining of polyuria and nocturia. On
examination he was obese with loss of sensation on the feet and absent ankle reflexes. His
blood glucose was 370/mg/dl and HbA1c was 10.6 %. Which of the following statements
regarding this patient's case is false?
a. A history of dizzy spells on standing up is suggestive of autonomic neuropathy.
b. Fundoscopy is an essential part of his clinical assessment.
c. Serum creatinine is the best screening test to his current therapy is appropriate.
d. Optimizing diet control and adding metformin to his current therapy is appropriate.
e. The gaol of therapy in this patient is to normalize fasting blood glucose and HbA1c.

Q19: A 38 year old male presented with polydipsia, polyuria, and weight loss 8Kg over 3
months. On examination pulse 70/min, B.P 120/80mmHg, and no pallor, rest of clinical
examination was unremarkable, random blood sugar 220mg%. The following are true except:
a. History of celiac disease in the family is of diagnostic value.
b. HbA1c e is a useful monitoring tool.
c. Boguanides should be considered as first line treatment.
d. Abdominal pain and vomiting may indicate metabolic acidosis.
e. Myopathy is a recognized long term complication.

‫ﻣدرﺳﺔ ﻣﻧﺎرة اﻟﺗوﻓﯾق‬

 Endocrine
Dr. Abdulraouf

Q20: A 50 year old obese man with a 5 year history of type-2 DM currently on Metformin
tablets was found to have blood pressure around 145/90 mmHg in several repeated
measurements, which of the following statements is correct?
a. Reassurance and follow up for several months without treatment.
b. Start drug therapy with Angiotension converting enzyme inhibitor.
c. Do an IVP before commencement of treatment.
d. A glomerular filtration rate (GFR) of more than 90ml/Kg/1.73m² indicates end stage renal
disease.
e. Statins are contraindicated as they will elevate the blood pressure.

Q21: A 67 year old gentleman with type 2 diabetes mellitus for the last 20 years on
glibenclamide 5 mg once per day was admitted with a right foot infection for 3 days duration.
He was found to have a blood pressure of 160/104 mmHg and edema of both lower limbs.
His fasting blood sugar was 280mg/dl, serum albumin was 2.8 g/dl and urea of 45mg/dl. All
the following statements are true except :
a. The patient may not recall an injury to his foot.
b. Fundus examination usually reveals changes of diabetic retinopathy/
c. 24hr urine collection for album.in is recommended.
d. Beta blockers therapy is the treatment of choice to control his blood pressure.
e. Ischemic heart disease is the commonest cause of mortality.

Q22: An 18 year old male patient presented complaining of polydipsia, polyuria, and weight
loss 8 Kg over 3 months, on examination: pulse 70/min, B.P 120/80mmHg. and no pollor,
rest of clinical examination was unremarkable, random blood sugar 220mg%. All of the
following are true regarding patients case except:
a. History of celiac disease in the family is of diagnostic value.
b. HbA 1C is a useful monitoring tool.
c. Biguanides should be considered as first line treatment.
d. Abdominal pain and vomiting may indicate metabolic acidosis.
e. Myopathy is a recognized long term complication.

Q23: A 25 year old female, diagnosed with diabetes mellitus 5 years ago on single morning
dose of NPH insulin (26/day), she lost 15kg in weight she was on irregular follow up and
recently persuaded by her mother to attend diabetic outpatient clinic. Her fasting blood sugar
(220mg%), random 6pm blood suger was (120mg%). The following are true except:
a. Family history of organ specific autoimmune disease is significant.
b. Presence of swelling at injection site is consistent with lipodystrophy.
c. Haemoglobin A1C is expected to be >7.
d. Increasing the morning dose of insulin is advisable.
e. Adverse fetal outcome is expected if tight blood suger control during pregnancy is not
achieved.

‫ﻣدرﺳﺔ ﻣﻧﺎرة اﻟﺗوﻓﯾق‬

 Endocrine
Dr. Abdulraouf

Q24: A 45 year old man with type 2 diabetes mellitus for 6 years, on diet control and
Metformin 850mg twice daily. His post-prandial sugar ranges from 140-160mg/dl, HbA1c is
6.8 % (normal is 4-6%). He was admitted to the medical ICU due to severe pneumonia. His
blood pressure is 100/65mmHg; random blood sugar is 378mg/dl. The most appropriate
treatment to control his blood sugar is:
a. Stop metformin and start sulfonylurea.
b. NPH-insulin twice daily.
c. Control of blood sugar according to sliding scale.
d. Continuous insulin infusion.
e. Metformin plus sulfonylurea.

Q25: A 24 year old female, diagnosed 5 year ago with type 1 diabetes mellitus. She is on
morning dose of NPH insulin of 26u/day. She lost 15kg of her weight and she is non-
compliant to her treatment and follow-up. She attended the diabetic clinic for a pre-
employment check-up. Her fasting blood sugar was 220mg/dl, and random 6pm blood sugar
was 118mg/dl. All of the following are true except:
a. Presence of swelling at injection site is consistent with lipodystrophy.
b. Haemoglobin A1c is expected to be>7%.
c. Increasing the morning dose of insulin is advisable.
d. Adverse fetal outcome is expected if tight blood sugar control is not adopted during
pregnancy.
e. Regular screening for retinopathy by fundal photography is recommended.

Q26: A 28 year old male with type 2 diabetes mellitus for 20 years was on glibenclamide
5mg daily, attended the OPD for routine follow up, he was complaining of polyuria and
nocturia. On examination he was obese with loss of sensation on the feet and absent ankle
reflexes. His blood glucose was 370mg/dl and HbA1c was 10.6%. All of the following are
true regarding patients case except:
a. A history of dizzy spells on standing up is suggestive of autonomic neuropathy.
b. Fundoscopy is an essential part of his clinical assessment.
c. Serum creatinine is the best screening test to detect early diabetic nephropathy.
d. Optimizing diet control; and adding metformin to his current therapy is appropriate.
e. The gaol of therapy in this patient is to normalize fasting blood glucose and HbA1c.

Q27: A 27 year old women with IDDM since the age of 10 and irregular follow up, has
recently married and attended diabetic clinic on her husband’s insistence. Her blood pressure
160/90mm.Hg, 24 hour urine for albumin 2g and her haemoglobin A1c is 9%. The following
are true except:
a. Examining the fundi is of diagnostic value.
b. Diabetic nephropathy is the most likely cause of her proteinuria.
c. An ACE inhibitor is most beneficial to the kidneys and safe in pregnancy.

‫ﻣدرﺳﺔ ﻣﻧﺎرة اﻟﺗوﻓﯾق‬

 Endocrine
Dr. Abdulraouf

d. Increased fetel loss as well as worsening diabetic nephropathy may occur during
pregnancy.
e. Oral hypoglycaemic drugs are contraindicated.

Q28: A 69 year old female presented with a 3 week history of polyuria and polydipsia, she
lost 8Kg, past medial history is remarkable for hypertension treated with enalapril, and there
is no history of cardiac disease. Physical examination reveals: lethargic, confused women,
breathing rapidly, B.P 102/76mmHg, pulse 100/min, respiratory rate 32/min, and skin is dry.
Laboratory data as follows: serum sodium: 130mEq/L, potassium: 5.1 mEq/L, serum glucose
400mg/dl, serum chloride: 104mEq/L, HCO3: 3mEq/L: atrial Po2(room air): 92mmHg.
Which of the following statements is correct?
a. Anion gap is 18.
b. The patient has hyperosmolar non ketotic hyperglycaemia.
c. The initial therapy should be lente insulin 10 u subcutaneously.
d. Sodium bicarbonate should be given.
e. He condition is probably precipitated by enalapril.

Q29: A 45 year old engineer who is a known case of IDDM for 10 years, presented with
abdominal pain and vomiting with mild confusion. He had no other medical illness and he
was not on any medication apart from insulin. On examination, he was tachypnea, pulse of
100/min, blood pressure of 130/70mmHg. He was dehydrated. Examination of other body
system was unremarkable. Investigations showed, blood sugar of 480mg/dl, Na 140mmol/l,
K 3,6mmol/l , urea 75mg/dl, PaO2 70 mmHg, PaCO2 30 mmHg, PH 7.2, HCO3 12mmol/l.
The following are true about this patient condition except:
a. Normal plasma K concentration indicates normal total body level.
b. The extra cellular fluid deficit should be replaced with intravenous saline.
c. Short acting insulin is preferably to be given by intravenous infusion.
d. There is increased risk of thrombo-embolism.
e. Cerebral edema is a recognized complication.

Data..
Q1: A thyroid function test of a 31 year old lady shows:
T4 2mcg/dl (N5-11)
TSH 0.1 mcU/ml (N 0.4-6)
These finding are compatible with:
a. Primary hyperthyroidism.
b. Secondary hyperthyroidism.
c. Primary hypothyroidism.
d. Secondary hypothyroidism.
e. Sick euthyroid.

‫ﻣدرﺳﺔ ﻣﻧﺎرة اﻟﺗوﻓﯾق‬

 Endocrine
Dr. Abdulraouf

Q2: A 32 year old female presented with tender goiter, the investigations showed:
CRP 30mg/l (N<5)
ESR 40mm/hr (N<20)
WBC 13×10^9/l (N 3.8-10)
f T3 7.9pmol/l ( N 3.1-6.8)
TSH 0.01 mU/l ( N 0.2-4.2)
This picture is compatible with:
a. Hashimoto-thyroiditis.
b. Non-toxic nodular goiter.
c. Sub-acute thyroiditis.
d. Autonomous adenoma.
e. Papillary thyroid carcinoma.

Q3: A 42 year old female presented following an episode of confusion associated with
vomiting and abdominal pain. She had one history of weight loss and receives thyroxine for
hypothyroidism which was diagnosed 5 year ago. On examination she appeared unwell, with
a temperature of 37.5 c and her blood pressure was 100/50mmHg. Investigation revealed:
Na+ 130mmol/L (137-144)
K+ 4.8 mmol/L (3.5-4.9)
Urea 56mg/dL (10-50)
Glucose 40mg/dL ( 50-75)
Free T4 9pmol/L (10-22)
TSH 1mu/L (0.5-5)
Which one of the following given intravenously would be the most appropriate initial
management?
a. iv Cefuroxime.
b. iv 10% Dextrose infusion.
c. iv Glucagon.
d. iv Hydrocortisone.
e. iv Tri-iodothyronine.

Q4: In assessing a 70 year old male patient with polyuria, polydipsia, constipation and
lethargy, the following analysis was performed:
Serum Ca ++ 15mg/dl (N 8.5-10.5)
Serum phosphorus 2.2mg/dl (N 2.5-4.5)
Alkaline phosphatase 400 unit/l (N 41-133)
All the following are true except:
a. A chest x-ray could help reach the diagnosis.
b. ECG may show short QT interval.

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 Endocrine
Dr. Abdulraouf

c. Bisphosphonates are treatment options.

d. Proper hydration is essential in management of these pateints.
e. Glucocorticoids should be avoided in these cases.

Q5: A 52 year old lady, known diabetic on oral hypoglycaemic drugs, presented for regular
follow up, her investigations show:
FBS 118mg/dl (N 70-110)
HbA1c 5.7% (N<7%)
Urine routine exam positive for micro proteinuria
Serum Creatinine 1.3mg/dl (N< 1.2)
Serum K 3.8mmol/l
Which of the following you will suggest in this patients management:
a. Change to insulin.
b. Add ACE inhibitors
c. Add thiazide diuretics.
d. Add calcium channel blockers
e. Add Potassium chloride tablets.

Q6: A 33 year old man with an 18 year history of type 1 diabetes mellitus presented with
proteinuria. He is a smoker of 20 cigarattes daily. Examination reveals a blood pressure of
155/95 mmHg. Investigations reveal:
Serum cholesterol 7.6mmol/L (<5.2)
HbA1c 8.3% (3.8-6.4)
24 hour urinary protein excretion 1.5g (<0.2)
Which intervention is most likely to retard the development of renal failure?
a. Bendrofluazide.
b. Improve glycaemic control with HbA 1c<7%.
c. Lisinopril.
d. Simvastation.
e. Stop smoking.

Q7: A 28 year old nurse non diabetic presented to emergency room semiconscious. The
abnormal investigations were:
Blood sugar 35mg/dl (N70-100)
Insulin level 120ulU/ml (N<25)
C-peptide 0.3ng/ml (N 1.0-3.2)

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 Endocrine
Dr. Abdulraouf

The diagnosis is:

a. Gilibeclamide induced hypoglycaemia.
b. Subcutaneous insulin injection
c. Insulinoma.
d. Dumping syndrome.
e. Metformin intake.

***Good luck***

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