Endocrinology: 1) All of The Following Disorders Occur With Greater Frequency in Obese People, Except

Endocrinology
Common Endocrine Presentations.
1) 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
Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan
Description:
Obesity has negative effects on human body due to several reasons, anemia is not a
complication of obesity.
Degenerative joint disease occur due to weight load on joint (especially knee joints) and
results in Osteoarthritis.
DM can occur due to decreased sensitivity to insulin in obese sedentary patients, as well as
HTN and thromboembolic disorders which are common in people who has sedentary lifestyle
and low activity.
2) 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
Description:
Obesity has negative effects on human body due to several reasons. Note that hypothyroidism
can result in obesity, but obesity has no effect on thyroid gland at all.
Rapid weight loss in obese patient can result in gallstone formation (Choice A),
DM (Choice C) can occur due to decreased sensitivity to insulin in obese sedentary patients as
well as HTN and thromboembolic disorders which are common in people who has sedentary
lifestyle and low activity.
Hyperlipidemia and hypertriglyceridemia are common in obese and diabetic patients.
Diabetes Mellitus.
3) The hemoglobin A1C (HbA1c) which indicates good diabetic control is:
A. Below 7%
B. Below 8%
C. Below 9%
D. Below 10%
E. Below 12%
Answer: A* Below 7%
Description:
HbA1c target is an important point in DM treatment, since A1c give and impression on
glycemic control for the last 2-3 months.
This practice has been changed since 2015 and become as following:
- If young educated patient and easily controlled (on lifestyle modifications only or on
lifestyle modifications + Metformin), A1c target of less than 6.5% is acceptable
- If patient is on any drug that can cause hypoglycemia (eg: sulfonylurea), A1c target
of less than 7% is appropriate.
4) The following are true in diabetes mellitus type 1, except:

A. It starts usually below 30 years old age
B. Absolute insulin deficiency
C. Sulfonylurea drugs are contraindicated
D. Anti-GAD antibodies are usually positive
E. Develops hyperosmolar hyperglycemic coma without insulin
Answer: E* Develops hyperosmolar hyperglycemic coma without insulin
Description:
Type I DM is a disease of young patients, it as an autoimmune disease with GAD antibody
usually detected, that usually manifest before 30 years old, the usual complication of type 1
DM that indicate admission with urgent treatment is DKA which result from absolute insulin
deficiency and increasing lipolysis acidosis and ketone formation, But HHS (Choice E) is
usually develop in patients with type II DM, It is important to know that little amount insulin
will prevent lipolysis and ketone formation
Note that Type I DM is insulin dependent and will not response to oral agents.
5) 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
Description:
There is 35% concordance between monozygotic twins in T1DM but 100% concordance
between monozygotic twins in T2DM, T2DM has stronger family history than T1DM.
T1DM usually has abrupt onset of symptoms or may be presented with DKA, while T2DM
may still undiagnosed for several years as it may only cause chronic fatigue.
Ketoacidosis need absolute deficiency of insulin which is rarely present in T2DM, so it is a
feature of type 1 DM.
T1DM has an association with HLA-DR3 and DR4 and Autoantibodies (eg: GAD
antibodies)
6) 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
Description:
Insulinoma is an insulin secreting tumor of the pancreas, it usually cause recurrent
hypoglycemia, it is not a cause of DM.
Other mentioned cases are a known causes of Diabetes.
7) Diabetes may be secondary to all of the following, except:

A. Chronic pancreatitis
B. Acromegaly
C. Pheochromocytoma
D. Insulinoma
E. Glucagonoma
Answer: D* Insulinoma
Description:
Insulinoma is an insulin secreting tumor of the pancreas, it usually cause recurrent
hypoglycemia, it is not a cause of DM.
Other mentioned cases are a known causes of Diabetes.
Treatment of Diabetes Mellitus.

8) All of the following are hypoglycemic agents, except:
A. Glibenclamide
B. Chlorpropamide
C. Gliclazide
D. Chlorpromazine
E. Glipizide
Answer: D* Chlorpromazine
Description:
Chlorpromazine is a drug that categorizes as antipsychotic medications and is used to treat
schizophrenia psychotic disorders and manic phase of Bipolar disorder.
Other mentioned drugs are hypoglycemic agents
9) 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
Description:
Metformin is the most commonly used oral drug in the treatment of T2DM, risk of lactic
acidosis limits its uses and it is contraindicated to use Metformin in patient who has creatinine
level of more than 135 mmol/l (1.53mg/dl).
Metabolic acidosis secondary to high lactate levels may be subdivided into two types:
- lactic acidosis type A: shock, hypoxia, burns
- Lactic acidosis type B: Metformin
10) Which of the following insulins can be given IV:

A. NPH
B. Ultralente
C. Lent
D. Mixtard
E. Regular
Answer: E* Regular
Description:
Regular insulin is the only type of insulin that can be given in intravenous route.
Other types are supposed to be given in subcutaneous route
Complications of Diabetes Mellitus.

11) One of the following is most suited for detection of diabetic nephropathy:
A. Renal US
B. Urine analysis for casts
C. Urine albumin
D. Intravenous pyelography
E. Serum creatinine
Answer: C* Urine albumin
Description:
Diabetic nephropathy is a late complication of diabetes, which if progress may lead to chronic
renal failure.
All patients with Diabetes should be screened annually, The best screening test to detect the
early stage of diabetic nephropathy is Albumin: creatinine ration of more than 2.5 which
means that the patient has Microalbuminuria.
12) 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:
A. Beta blockers
B. ACE inhibitors
C. HMG-CoA
D. Dietary carbohydrate restriction
E. Weight reduction
Answer: B* ACE inhibitors
Description:
HTN control to less than 130/80mmhg can help in decrease progression of the diabetic
nephropathy
benefits independent of blood pressure control have been demonstrated for ACE inhibitors
OR angiotensin II receptor blockers as they can decrease the pressure inside the nephron and
prevent further damage.
Other measures in the management of patient with diabetic nephropathy include:
- Dietary protein restriction
- Tight glycemic control
- BP control: aim for < 130/80 mmHg
- Control Dyslipidemia e.g. Statins
13) 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
Description:
Macroglossia is not a known complication of DM, Retinopathy can occur in DM due to
atherosclerotic changes in the retinal vasculature and retinal ischemia, Cataract and nerve
injury in Mononeuritis multiplex and impotence are known to be a complications of DM but
the exact mechanism is still challenging.
Complications if DM include:
Microvascular complications:
- Nephropathy – renal impairment
- Neuropathy – sensory and autonomic can be affected
o Symmetrical sensory polyneuropathy: also called 'Gloves and stocking'
impairment, with loss of tendon reflexes in legs
o Asymmetrical motor neuropathy: thought to be due to acute infarction in
lumbosacral plexus . present with weakness of proximal muscles associated
with loss of tendon reflexes
o Mononeuropathy: motor or sensory rapid dysfunction of single peripheral or
cranial nerve, most common nerves affected are 3rd, 6th cranial nerves, sciatic
nerve, femoral nerve, if more than one nerve are affected  it is called
Mononeuritis multiplex
o Autonomic neuropathy: postural hypotension, loss of bladder control,
bradycardia, erectile dysfunction, constipation, diarrhea, incontinence, gastric
atonia .
- Retinopathy – visual problems
- Diabetic foot
Macrovascular complications:
- CAD – coronary circulation (most common cause of death)
- PAD – peripheral circulation
- CVA's – cerebral circulation
Others
- cataract
14) 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
Description:
Alopecia is not a complication of Diabetes despite its association with type 1 DM .
Complications if DM include
Microvascular complications:
- nephropathy – renal impairment
- neuropathy – sensory and autonomic can be affected
o Symmetrical sensory polyneuropathy: also called 'Gloves and stocking'
impairment, with loss of tendon reflexes in legs
o Asymmetrical motor neuropathy: thought to be due to acute infarction in
lumbosacral plexus . present with weakness of proximal muscles associated
with loss of tendon reflexes
o Mononeuropathy: motor or sensory rapid dysfunction of single peripheral or
cranial nerve, most common nerves affected are 3rd, 6th cranial nerves, sciatic
nerve, femoral nerve, if more than one nerve are affected  it is called
Mononeuritis multiplex
o Autonomic neuropathy: postural hypotension, loss of bladder control,
bradycardia, erectile dysfunction, constipation, diarrhea, incontinence, gastric
atonia .
- retinopathy – visual problems
- Diabetic foot
Macrovascular complications:
- CAD – coronary circulation (most common cause of death)
- PAD – peripheral circulation
- CVA's – cerebral circulation
Others
- cataract
15) 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
Description:
Constipation, diarrhea, fecal incontinence and gastric atonia are a result of neuropathy in a
patient with diabetes, Gastric ulcer is not a complication of DM.
16) Hyperglycemic hyperosmolar nonketotic 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
Description:
Most patients with hyperosmolar hyperglycemic state (HHS) have a known history of type 2
DM. In 30-40% of cases, HHS is the patient’s initial presentation of diabetes.
The prognosis of both DKA and HHS is equal and worsened at the extremes of age in the
presence of coma, hypotension, and severe comorbidities.
HHS is not an indication for long term insulin therapy, and patient after treatment of HHS can
go back to oral hypoglycemic agents unless insulin is indicated.
HHS usually has lower insulin requirements than DKA. and usually has less potassium deficit
17) 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
Description:
Neuropathic joint is progressive condition of the musculoskeletal system that is characterized
by joint dislocations, pathologic fractures, and debilitating deformities.
DM considered the most common cause of neuropathic joint.
Note that Any condition that causes sensory or autonomic neuropathy can lead to a Charcot
joint.
Other Causes include: (syphilis, chronic alcoholism, leprosy, meningomyelocele, spinal cord
injury, Tabes dorsalis, Syringomyelia, renal dialysis, and congenital insensitivity to pain).
Diabetic Ketoacidosis DKA.

18) In diabetic ketoacidosis all of the following are true, except:
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
Description:
Infection can precipitate DKA, But most patients with DKA have leukocytosis due to
dehydration and stress response to ketonemia and hyperglycemia and does not necessarily
suggest infection.
DKA usually presents with hyperglycemia and metabolic acidosis, treatment is dependent on
fluid hydration, low dose insulin infusion and potassium replacement to prevent
Hypokalemia.
19) 55 years old male presented with DKA (diabetes type 2), ABGs showed pH 7.05,
HCO3 12, K 3.1. The best treatment is:
A. Fluids, insulin, K, HCO3
B. Fluids, insulin, K
C. Fluids, insulin, HCO3
D. Insulin only
E. Fluids, K, HCO3
Answer: B* Fluids, insulin, K
Description:
Sodium bicarbonates indications:
- PH < 7.0
- PH < 7.1 with (hypotension, arrhythmias, or coma)
- If life threatening hyperkalemia
So here there is no indications for bicarbonates use, the treatment should include fluids,
insulin and KCl.
20) 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
Description:
Potassium deficit is common in DKA despite the high serum potassium level at presentation
which is results from shifting potassium from intracellular to extracellular space, so serum
potassium may be high but total body potassium is usually low.
DKA is an emergency complication of T1DM but rarely occur in T2DM.
It may precipitated by infection or any stressful condition.
DKA is usually associated with hyperglycemia, dehydration, metabolic acidosis.
Bicarbonate is indicated in DKA with the following conditions
- PH < 7.0
- PH < 7.1 with (hypotension, arrhythmias, or coma)
- Is life threatening hyperkalemia
21) The following about diabetic ketoacidosis are true, except:

A. Hypotension with tachycardia indicates profound fluid and electrolytes depletion
B. Thromboembolic phenomenon is recognized complication
C. Total body potassium is high
D. More common in type I diabetes
E. Causes Kussmaul's breathing
Answer: C* Total body potassium is high
Description:
DKA is an emergency complication of DM.
Potassium deficit is common in DKA despite the high serum potassium level at presentation
which is results from shifting potassium from intracellular to extracellular space, so serum
potassium may be high but total body potassium is usually low.
DKA presents usually as a complication of T1 DM but rarely in T2DM.
DKA presented with dehydration, hyperglycemia and metabolic acidosis
Polyuria usually due to hyperglycemia, along with rapid deep respiration "Kussmaul's
breathing" will lead to water loss and dehydration. If dehydration was profound it may lead to
hypotension and tachycardia.
22) In diabetic ketoacidosis all are true, except:

A. Abdominal pain
B. Leukocytosis
C. Sweating
D. Increased anion gap
E. Pseudohyponatremia
Answer: C* Sweating
Description:
Dehydration is a main feature of DKA, this will lead to decreased sweating not increased
sweating.
Most patients with DKA have leukocytosis due to dehydration and stress response to
ketonemia and hyperglycemia and does not necessarily suggest infection.
DKA usually present with wide anion gap metabolic acidosis, and abdominal pain is a main
feature of DKA.
Pseudohyponatremia results from hyperglycemia which is a part of DKA manifestation.
23) 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
Description:
Aggressive fluid therapy should be started as soon as DKA diagnosed. With 1000ml in the
first 1/2, 1, 2, 2, 4,4 6, 6 and then q8Hrs.
Potassium, insulin, and fluid is the mainstay of treatment of DKA, and the target is to
decrease the acidosis. With monitoring of ketone in the blood and input and output chart
Hypoglycemia.
24) 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
Description:
There are significant increase in risk of Diabetes (hyperglycemia) in patients who are on
thiazide diuretics.
Insulinoma is an insulin secreting tumor which results in attacks of hypoglycemia.
Hypoadrenalism (eg: Addison's disease) can result in low cortisone which lead to
hypoglycemia and hypotension.
Hypoglycemia is a known feature of paracetamol overdose and alcohol as they affect the
glucose formation in liver (by gluconeogenesis and glycogenolysis)
25) 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
Description:
Chronic pancreatitis will impair the secretion of insulin and result in hyperglycemia
Glibenclamide is an oral hypoglycemic agent, hypoglycemia is a known side effect of this
drug.
Addison's disease can result in low cortisone which lead to hypoglycemia and hypotension.
Reactive hypoglycemia Or postprandial hypoglycemia refers to low blood sugar that occurs
after a meal usually within four hours after eating.
Hepatic failure results in impaired gluconeogenesis and glycogenolysis, and thus
hypoglycemia.
26) Whipple's triad is seen in:
A. Hepatoma
B. Cushing's syndrome
C. Hyperinsulinism (hypoglycemia)
D. Lactase intolerance
E. Intestinal lipodystrophy
Answer: C* Hyperinsulinism (hypoglycemia)
Description:
Whipple's triad is the sum of the following points
- Symptoms known or likely to be caused by hypoglycemia
- A low plasma glucose measured at the time of the symptoms
- Relief of symptoms when the glucose is raised to normal
These triad is diagnostic for hypoglycemia.
Insulinoma.
27) 30 years old female nurse presented with decreased level of consciousness, labs
showed increased insulin, glucose 30mg/dl, increased C peptide and negative
Sulphonylurea. The most likely cause is:
A. Exogenous insulin
B. Insulinoma
C. MEN 1
D. MEN 2
E. Hypoglycemia
Answer: B* Insulinoma
Description:
Causes of hypoglycemia with high insulin include (Insulinoma, Sulphonylurea, or exogenous
insulin)
Sulphonylurea excluded by negative test results, now C-Peptide is used to differentiate
exogenous from endogenous insulin.
In factitious disorder, injection of insulin will result in hypoglycemia with high insulin level
and low C-peptide, while Insulinoma will result in hypoglycemia with high insulin level and
high C-Peptide.
In summary:
Insulinoma = hypoglycemia + high insulin + high C-Peptide
Exogenous insulin = hypoglycemia + high insulin + low C-Peptide
Sulphonylurea = hypoglycemia + high insulin + positive Sulphonylurea level in blood.
MEN type 1 may have Insulinoma as a part of it but in our patients there is no features of
pituitary or parathyroid gland tumors.
Insulinoma is not a part of Men type 2.
Thyroid Gland.
28) The dietary element necessary for the formation of thyroid hormones is:
A. Iron
B. Iodine
C. Copper
D. Magnesium
E. Sodium
Answer: B* Iodine
Description:
The function of the thyroid gland is to take iodine, found in many foods, and convert it
into thyroid hormones: thyroxine (T4) and triiodothyronine (T3).
Iodized salt: is table salt mixed with a minute amount of iodine. The ingestion
of iodine prevents iodine deficiency, and thus prevent hypothyroidism.
29) One of the following is found in primary hypothyroidism:

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
Description:
Primary hypothyroidism mans that the thyroid hormones (T3 and T4) are low, this will make
pituitary gland secrets more TSH to stimulate thyroid gland.
Here is a summary for interpretation of Thyroid function test results:
- Thyrotoxicosis  high (T3 and T4) + low TSH
- Primary hypothyroidism  Low (T3 and T4) + high TSH
- Secondary hypothyroidism  Low T3, T4 and TSH
- Sick euthyroid syndrome  Low T3, T4 and TSH + (common in inpatients)
- Subclinical hypothyroidism  normal (T3,T4) and high TSH (asymptomatic patient,
not on thyroxin)
30) 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)
Description:
High TSH is the most sensitive for primary hypothyroidism and starts to rise even before the
fall in T4 to below normal.
Thyrotoxicosis.
31) All of the following are manifestations of hyperthyroidism, except:
A. Loss appetite
B. Preference for cold
C. Excessive warm sweating
D. Palpitation
E. Nervousness
Answer: A* Loss appetite
Description:
Hyperthyroidism is an increased activity of thyroid gland results in increasing thyroxine level.
Features of hyper thyroidism include increasing appetite with loss of weight.
Other features include:
- Nervousness, sweating, tremor and Palpitation
- Angina
- Weight loss with increased appetite
- Diarrhea
- Amenorrhea, Impotence
- Heat intolerance
- Goiter
- Eye signs: (Led retraction, Led lag, Conjunctival injection, Ophthalmoplegia,
Exophthalmous)
- Hyperreflxia
32) 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 mIU/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. Dequervain’s thyroiditis
D. Factitious thyrotoxicosis
E. Plummer disease
Answer: D* Graves’s disease
Description:
This patient presents with palpitation, chest tightness and sinus tachycardia, and labs that
confirms the presence of hyperthyroidism (low TSH),
Antithyroglobulin and antimicrosomal antibodies in this case leads to decreased iodine uptake
and low level of thyroglobulin.
Grave's disease (choice A) is the most common cause of hyperthyroidism (75% of cases)
Toxic multinodular goiter will not affect the level of thyroglobulin as well as presents with
increased iodine uptake in multiple sites of the thyroid.
Dequervain’s thyroiditis will present as hyperthyroidism then become hypothyroidism, in the
first stage it presents with tender painful thyroid which is not present in this case.
Factitious thyrotoxicosis de to intake of thyroxin tablets will lead to thyrotoxicosis but it will
not affect the TSH level, the TSH level needs at least 6 weeks to be changed after ingestion
of thyroxin tablets.
Plummer's disease is an acronym for toxic nodular goiter (it should not be confused with
Plummer-Vinson syndrome which presents with dysphagia, esophageal web and IDA).
33) All of the following about Grave's disease (thyrotoxicosis) are true, except:
A. Cause lid lag
B. TSH is high
C. Pretibial Myxoedema is a feature
D. Causes exophthalmus
E. Myopathy may occur
Answer: B* TSH is high
Description:
Grave's disease is the most common cause of thyrotoxicosis (75% of cases)
TSH will be suppressed in this case Not elevated (Choice B)
Caused by thyroid stimulating antibodies (autoimmune), Will present with diffuse thyroid
enlargement and ophthalmopathy (eg: Exophthalmus, led lag, …)
Pretibial Myxoedema and myopathy may be a features of Grave’s disease.
34) All of the following are features of Grave's disease (thyrotoxicosis), except:
A. Pretibial Myxoedema
B. Myopathy
C. Atrial fibrillation
D. Oligomenorrhea
E. Aortic incompetence
Answer: E* Aortic incompetence
Description:
Grave's disease is the most common cause of thyrotoxicosis (75% of cases)
It is caused by presence of TSH receptors stimulating antibodies (autoimmune)
The mentioned choices above are all related to except aortic incompetence which is not a
feature of gravis disease.
35) All of the following are features of Grave's disease (thyrotoxicosis), except:
A. Tremor of both hands
B. Carpopedal spasm
C. Pretibial Myxedema
D. Tachycardia
E. Lid retraction
Answer: B* Carpopedal spasm
Description:
Carpopedal spasm is a feature of hypocalcaemia, not thyrotoxicosis.
Features of thyrotoxicosis include:
- Nervousness, sweating, tremor and Palpitation, tachycardia
- Angina
- Pretibial Myxedema
- Diarrhea
- Amenorrhea, oligomenorrhea, Impotence
- Heat intolerance
- Goitre
- Eye signs:
o Led retraction
o Led lag
o Conjunctival injection
o Ophthalmoplegia
o Exophthalmos
- Hyperreflexia
- Hyperkinetic movement
36) 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
Description:
It is a Hyperreflexia that present in thyrotoxicosis.
The slow relaxing of ankle jerk is the best bed-side feature in hypothyroidism.
- Angina
- Diarrhea
- Heat intolerance
- Goitre
- Eye signs:
o Led retraction
o Led lag
o Ophthalmoplegia
o Exophthalmos
- Hyperreflexia
37) All of the following are manifestations of thyrotoxicosis, except:
A. Loss of weight in spite of good appetite
B. Preference for heat
C. Excessive warm sweating
D. Palpitation
E. Nervousness
Answer: B* Preference for heat
Description:
Heat intolerance and preference of cold weather is a symptom of thyrotoxicosis, while patient
with hypothyroidism prefer hot weather and has cold intolerance.
- Angina
- Diarrhea
- Heat intolerance
- Goitre
- Eye signs:
o Led retraction
o Led lag
o Ophthalmoplegia
o Exophthalmos
- Hyperreflexia
38) All of the following are manifestations of thyrotoxicosis, except:

A. Exophthalmos
B. Pretibial Myxedema
C. Preference for cold
D. Increased body weight
E. Excessive sweating
Answer: D* Increased body weight
Description:
Despite increased appetite; patient with thyrotoxicosis has high metabolic rate due to high
levels of Thyroxine, which lead to weight loss.
- Angina
- Diarrhea
- Heat intolerance
- Goitre
- Eye signs:
o Led retraction
o Led lag
o Ophthalmoplegia
o Exophthalmos
- Hyperreflexia
39) 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
Description:
Cyclophosphamide is a drug that used as chemotherapy to suppress immune system, it has no
role in treatment of thyrotoxicosis.
Neomercazole is another name for carbimazole; an antithyroid medication that used in
treatment of thyrotoxicosis.
If antithyroid drugs failed or was contraindicated, so ablation by radioactive iodine or
Thyroidectomy can be the next step in management.
Inderal is a beta-Blocker that is used to decrease the symptoms of thyrotoxicosis during the
period of treatment.
40) 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
Description:
Cyclophosphamide is a drug that used as chemotherapy to suppress immune system, it has no
role in treatment of thyrotoxicosis.
Treatment of thyrotoxicosis include:
- Antithyroid drugs
o Carbimazole (Neomercazole)
o Propylthiouracil (PTU) - best to use in pregnancy
o Potassium perchlorate
- Thyroidectomy (surgery)
- Radioactive iodine therapy
- Betablockers (symptomatic control, decrease conversion of T4 to T3 )
Thyroid Storm.
41) Thyroid storm can present with all the following except:
A. Fever
B. Coma
C. Heart failure
D. High T3, T4
E. Bradycardia
Answer: E* Bradycardia
Description:
Thyroid storm is a Medical emergency of hyperthyroidism, Precipitated by stress, infection,
trauma.
symptoms include: Fever, Tachycardia, HTN, Arrhythmias, Nausea, vomiting and diarrhea
so tachycardia not bradycardia is a feature.
High output Heart failure and coma may be a complications.
T3 and T4 will me high while TSH will be suppressed.
Hypothyroidism.
42) 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
Description:
In myxedema (hypothyroidism) delayed deep tendon reflex is the most important bedside test.
Pleural effusion and pericardial effusion may be a features of myxedema (rare)
Other features occur in myxedema include:
- Delayed reflexes (most important bed-side test in hypothyroidism)
- Generalized weakness
- Cold intolerance
- Constipation
- Menorrhagia but lately amenorrhea
- Brittle nails and hair
- Peripheral edema (late)
- Weight gain with decreased appetite
- Goiter may be present
- Thinning of outer half of eyebrows
- In pediatrics (large tongue, umbilical hernia, mental retardation)
- Sinus bradycardia with low voltage in ECG
43) All of the following may occur in myxedema, except:

A. Ataxia
B. Deafness
C. Clonus
D. Pericardial effusion
E. Alopecia
Answer: C* Clonus
Description:
Clonus is a condition that results in involuntary muscle spasms, most often affecting muscles
at the end of the limbs. It may be a condition in and of itself or a symptom of something else.
Clonus is a feature of upper motor neurone lesion and not present in myxedema.
Cranial nerve deficits including 8th may lead to deafness
Other mentioned choices are a features of myxedema.
44) 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
Description:
Hypothyroidism is a known cause of macrocytic anemia and not a cause of polycythemia
Other features occur in myxedema (hypothyroidism) include:
- Delayed reflexes (most important bed-side test in hypothyroidism)
- Generalized weakness
- Cold intolerance
- Constipation
- Menorrhagia but lately amenorrhea
- Brittle nails and hair
- Peripheral edema (late)
- Weight gain with decreased appetite
- Goiter may be present
- Thinning of outer half of eyebrows
- In pediatrics (large tongue, umbilical hernia, mental retardation)
- Sinus bradycardia with low voltage in ECG
Hyperparathyroidism.
45) 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
Description:
Parathormone (PTH) is a hormone secreted by parathyroid gland, and secreted in large
amounts in case of hyperparathyroidism
PTH increased serum calcium (hypercalcemia not hypocalcemia)
The action of parathormone increases serum calcium by the following mechanisms:
- Increase Calcium and phosphate metabolism from Bones  decreased bone mass 
Osteitis fibrosa cystica, osteomalacia (softening of bone), osteoporosis (loss of bone
mass), and thus pathological fractures
- Increase renal reabsorption of calcium and excretion of phosphate
- Increase intestinal absorption of calcium and phosphate
Hypoparathyroidism.
46) 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:
A. 1-alpha-hydroxylase deficiency
B. Hypoparathyroidism
C. Vitamin D deficiency
D. Vitamin C deficiency
E. Vitamin B12 deficiency
Answer: B* Hypoparathyroidism
Description:
In primary hypoparathyroidism: low PTH results in decreased serum calcium and unaffected
vitamin D.
In vitamin D deficiency and 1-alpha-hydroxylase deficiency: low serum vitamin D and low
serum calcium results in high amount of PTH (called secondary hyperparathyroidism)
Vitamin C and B has no relation to calcium metabolism.
Adrenal Cortex & Cushing's syndrome.

47) 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

Description:
Osteoporosis not osteomalacia occur in case of Cushing’s
Here is the difference between osteoporosis and osteomalacia:
Osteoporosis comes from osteo-, which means bone and -porosis, a porous condition. In
osteoporosis, the bones become very porous (less dense). This means they become weaker,
and they are more likely to fracture (break) as a result.
Osteomalacia is similar in its prefix of osteo-. However, its suffix is quite different. The suffix
is malacia, which means an abnormal softening of something. Thus, osteomalacia leads to
softer bones.
Osteoporosis  less bone density (imbalance between bone resorption and bone formation)
Osteomalacia  softening of the bone (resulting from vitamin D deficiency of any cause)
48) 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
Description:
Tall stature in children results from gigantism not Cushing's syndrome
Cushing’s syndrome is a syndrome resulting from high cortisone level in the body.
High cortisone level will result in hyperglycemia, HTN, hypokalemia and other
morphological features, see below:
- Hypertension, hyperglycemia, hypokalemia
- Fat redistribution: Moon face, weight gain / central obesity, buffalo hump, thin
extremities
- Skin: Thinning of skin, abdominal striae, decreased wound healing easy bruising,
hirsutism, acne, skin pigmentation
- Muscle weakness (proximal muscle)
- Sexual disturbances, Depression, HTN, edema, amenorrhea
- Psychiatric symptoms (eg: depression)

A. Proximal muscle weakness
B. Hyperglycemia
C. Hypertension
D. Truncal obesity
E. Hyperkalemia
Answer: E* Hyperkalemia
Description:
Hypokalemia not hyperkalemia will present in Cushing's syndrome
extremities

A. Amenorrhea
B. Hypertension
C. Ecchymosis
D. Hyperkalemia
E. Weakness
Answer: D* Hyperkalemia
Description:
Hypokalemia not hyperkalemia will present in Cushing's syndrome
extremities
51) 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
Description:
Don’t be confused between Cushing’s disease and Cushing’s syndrome.
Cushing’s disease is an overproduction of ACTH from pituitary gland  leading to high
cortisone level.
Cushing’s syndrome may be caused by increased cortisone by adrenal adenoma leading to
low ACTH, or may be caused by ectopic ACTH secretion from lung cancer.
So in Cushing’s disease ACTH will be always high, while in Cushing’s syndrome it may be
low.
Adrenocortical Insufficiency (Addison's disease).

52) All of the following are features of Addison's disease, except:
A. Hyponatremia
B. Hypokalemia
C. Postural hypotension
D. Axillary hair loss
E. Hyperpigmentation of the skin
Answer: B* Hypokalemia
Description:
In Addison’s disease; decreased cortisone secretion leading to hyperkalemia, hyponatremia,
hypotension, and Non-anion gap metabolic acidosis.
High level of ACTH will lead to release of melanocyte stimulating hormone and increase skin
pigmentation.
Features of Addison’s disease include:
- Weakness, weight loss, fatigue, vomiting, fever, constipation, abdominal pain,
impotence, syncope, postural hypotension, loss of axillary hair
- Hyperpigmentation of skin (increased MSH)
- Hypotension
- Vitiligo (autoimmune process)
- Also see the next table:
High Low
Urea Sodium
Potassium Blood sugar
Calcium Serum cortisol
ACTH Serum aldosterone
-- PH
53) 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
Description:
In case of Addison’s disease; hyperpigmentation of skin will present due to high melanocyte
stimulating Hormone while decreased skin pigmentation (vitiligo) is also present due to an
autoimmune process. So don’t be confused about this.
See the following table about lab results in Addison’s disease:
High Low
Urea Sodium
-- PH
54) 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
Description:
Hypotension not hypertension occur in Addison’s disease due to decreased cortisone level.
Features of Addison’s disease include:
- Weakness, weight loss, fatigue, vomiting, fever, constipation, abdominal pain,
impotence, syncope, postural hypotension, loss of axillary hair
- Hyperpigmentation of skin (increased MSH)
- Hypotension
- Vitiligo (autoimmune process)
- Also see the next table:
High Low
Urea Sodium
-- PH
Hyperaldosteronism.
55) 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
Description:
The question above is describing a case of primary hyperaldosteronism (Conn’s syndrome)
This disease is characterized by hypertension, hypokalemia, and metabolic alkalosis
Low renin level will be present in this case due to negative feedback by high aldosterone
amount secreted by adenoma.
Aldosterone/rennin ratio > 20 is the best initial test in diagnosis.
Pheochromocytoma.
56) 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
Description:
Pheochromocytoma is 10% malignant, 10% bilateral, 10% familial, 10% extra adrenal tumor
Features of pheochromocytoma include: HTN (paroxysmal or persistent in nature), Sweating,
Tachycardia, Weight loss, Tremor, Hyperglycemia
57) 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
Description:
Features of pheochromocytoma include: HTN (paroxysmal or persistent in nature), Sweating,
Tachycardia, Weight loss, Tremor, Hyperglycemia
Other mentioned choices are not associated with paroxysmal HT
Gynecomastia.
58) 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
Description:
Gynecomastia or also called gynecomazia: defined as presence of glandular breast tissue in
male, as a result of imbalance between estrogen and androgen.
Idiopathic causes include 25% of cases, and physiological gynecomastia also accounts for
25% of cases so they are the same in their incidence.
Since idiopathic means no cause so I prefer to choose physiologic gynecomastia because the
question is asking about a cause.
Here is a list of causes of gynecomastia:
- Idiopathic (25%)
- Physiologic (persistence pubertal gynecomastia) (25%)
- Drug induced (10-25%)
o (Cimetidine, Digoxin, Spironolactone, Anti-androgen therapy, some steroids
"diethylstilbestrol")
- Hypogonadism (10%)
o Klinefelter's syndrome
o Autoimmune gonadal failure
o Orchitis
o Chemotherapy
o Hypopituitarism
o Kallmann's syndrome (GnRH deficiency)
o Hypoprolactinemia
- Hyperthyroidism
- Androgen resistance syndromes
- Estrogen excess:
o Liver failure
o Estrogen secreting tumor (testes, adrenal)
o HCG secreting tumor (testes, lung)
59) 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
Description:
Hyperthyroidism hyperparathyroidism is a cause of gynecomastia.
Here is a list of causes of gynecomastia:
- Idiopathic (25%)
o Orchitis
o Chemotherapy
o Hypopituitarism
o Hypoprolactinemia
- Hyperthyroidism
- Estrogen excess:
o Liver failure

A. Old age
B. Liver disease
C. Hyperthyroidism
D. Methyldopa
E. Glibenclamide
Answer: E* Glibenclamide
Description:
Glibenclamide is not known to cause gynecomastia, Here is a list of causes of gynecomastia:
- Idiopathic (25%)
o Orchitis
o Chemotherapy
o Hypopituitarism
o Hypoprolactinemia
- Hyperthyroidism
- Estrogen excess:
o Liver failure

A. Puberty
B. Bronchogenic carcinoma
C. Klinefelter’s syndrome
D. Hydrochlorothiazide
E. Digoxin therapy
Answer: D* Hydrochlorothiazide
Description:
Hydrochlorothiazide is not a cause of gynecomastia, Here is a list of causes of gynecomastia:
- Idiopathic (25%)
o Orchitis
o Chemotherapy
o Hypopituitarism
o Hypoprolactinemia
- Hyperthyroidism
- Estrogen excess:
o Liver failure
Pituitary Hormones.
62) All of the following hormones are secreted from the pituitary gland, except:
A. Thyroid stimulating hormone (TSH)
B. Prolactin releasing hormone
C. Growth hormone (GH)
D. Adrenocorticotropic hormone (ACTH)
E. Luteinizing hormone (LH)
Answer: B* Prolactin releasing hormone

Description:
Prolactin releasing hormone is secreted from hypothalamus while prolactin is released by
Pituitary gland.
The following hormones are secreted from pituitary gland:
- Anterior pituitary: (Growth hormone, LH, FSH, TSH, ACTH, Prolactin)
- Posterior pituitary: (oxytocin, ADH)
63) 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
Description:
- Posterior pituitary: (Oxytocin, ADH)
Vasopressin is same as antidiuretic hormone ADH.
Insulin is secreted from beta cells in pancreas while calcitonin is secreted by C cells in thyroid
gland.
64) 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)
Description:
ADH is secreted by posterior pituitary gland not anterior.
- Posterior pituitary: (Oxytocin, ADH)
65) All the following hormones are increased with stress except:
A. ACTH
B. GH
C. TSH
D. Insulin
E. Glucagon
Answer: C* TSH and D* insulin

Description:
In response to stress, the level of various hormones may change, here is a list of hormones
that changed during stress:
- Increase CRH  increase ACTH  increase cortisol (hypothalamus adrenal axis)
- Increased catecholamines (dopamine, adrenalin, noradrenalin)
- Increased release of vasopressin
- Increased GnRH  increased LH and FSH
- Increased glucagon.
- Increase level of Growth hormone
- Prolactin can be increased or decreased.
- Decreased release of TSH  decreased T3 and T4
- Decreased insulin secretion
Don’t panic!! You may say that there is two answers for this question, but who knows what
was in the examiners mind at that time.
Hypopituitarism.
66) All of the following are clinical features of panhypopituitarism, except:
A. Hyperpigmentation
B. Hypotension
C. Cold intolerance
D. Loss of secondary sexual characteristics
E. Infertility
Answer: A* Hyperpigmentation
Description:
Melanocyte stimulating hormone (MSH) is a hormone that responsible for increase melanin
secretion in melanocyte leading to hyperpigmentation. So in panhypopituitarism occur, there
will be hypopigmentation.
Features of panhypopituitarism include:
- GH loss: lethargy, muscle weakness, short stature (not obvious in adults)
- LH, FSH: failure of sex hormone production
o Women: no ovulation, no menstruation
o Men: no testosterone or sperms, Gynecomastia, Impotence
o Both will have: Loss of libido, Scanty axillary and pubic hair
- TSH loss: (Hypothyroidism symptoms "see later!")
- ACTH loss:  decreased level of cortisone
o Hypoglycemia, Hypotension, Nausea and vomiting
- Prolactin loss: no symptoms in men, but failure of lactation in women after birth.
- ADH deficiency called central diabetes insipidus.
- Untreated or severe Hypopituitarism may cause coma
- MSH loss  hypopigmentation
67) 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
Description:
Sheehan’s syndrome: panhypopituitarism and ischemic necrosis of pituitary gland due to
prolonged hemorrhage during child birth.
Melanocyte stimulating hormone (MSH) is a hormone that responsible for increase melanin
secretion in melanocyte leading to hyperpigmentation. So in panhypopituitarism occur, there
will be hypopigmentation.
Features of panhypopituitarism include:
- GH loss: lethargy, muscle weakness, short stature (not obvious in adults)
- LH, FSH: failure of sex hormone production
o Women: no ovulation, no menstruation
o Men: no testosterone or sperms, Gynecomastia, Impotence
o Both will have: Loss of libido, Scanty axillary and pubic hair
- TSH loss: (Hypothyroidism symptoms "see later!")
- ACTH loss:  decreased level of cortisone
o Hypoglycemia, Hypotension, Nausea and vomiting
- Prolactin loss: no symptoms in men, but failure of lactation in women after birth.
- ADH deficiency called central diabetes insipidus.
- Untreated or severe Hypopituitarism may cause coma
- MSH loss  hypopigmentation
68) A 25 years old woman suffers a severe intra-partum hemorrhage. 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
Description:
This case called Sheehan’s syndrome which is a panhypopituitarism and ischemic necrosis of
pituitary gland due to prolonged hemorrhage during child birth.
Prolactin deficiency in this case will cause failure of lactation
Other mentioned choices are not present in Sheehan’s syndrome
Hyperprolactinemia.
69) 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
Description:
Prolactin will increase late in normal pregnancy but will not be able to form a breast milk
during pregnancy cause it is opposed by progesterone.
In ectopic pregnancy; the pregnancy will be terminated early (after diagnosis or after
ruptured) before prolactin level increase.
Other choices are a cause of increased prolactin level.
Other causes of high prolactin level:
- Most common cause is adenoma (called Prolactinoma)
- Primary hypothyroidism (high TRH will stimulate PRL secretion)
- Pregnancy (high level but opposed by estrogen)
- Chronic renal failure, liver cirrhosis
- PCOS
- Drugs (OCP, Cimetidine, estrogen, narcotics, TCA, Haldol, metoclopramide,
dopamine antagonists, methyldopa, Phenothiazines, verapamil)
70) 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
Description:
The following are causes of hyperprolactinemia:
- PCOS
71) The following drugs are known to cause hyperprolactinemia, except:

A. Metoclopramide
B. Cimetidine (Tagamet)
C. Narcotics
D. Folic acid
E. Methyl dopa (Aldomet)
Answer: D* Folic acid
Description:
Folic acid is a water soluble vitamin that has no proven effect of hyperprolactinemia.
(some studies shows increase in prolactin level in females who use folic acid)
Causes of hyperprolactinemia include:
- PCOS
Acromegaly.
72) 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
Description:
Excessive hair growth (not hair loss) is a feature of acromegaly.
Acromegaly is a disease results from excessive Growth hormone which is mostly due to
pituitary adenoma leading to increased growth of bone in face, feet and hands, large jaw,
tongue, cardiomegaly, wide spaced teeth, deep voice, profuse sweating, muscle weakness and
inability to sleep.
73) 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
Description:
Acromegaly is a disease results from excessive Growth hormone which is mostly due to
pituitary adenoma.
An increase in bone growth in hands feet and face making large hands and increase in show
size along with prominent jaw and maxilla.
Headache may be due to the presence of adenoma, as well as visual field defects may present
sue to optic chiasma compression.
Other features include: cardiomegaly, wide spaced teeth, deep voice, profuse sweating,
muscle weakness and inability to sleep
Diabetes Insipidus.
74) 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
Description:
DI is a disorder in which decreased amount or responsiveness to ADH occur leading to
increased urination and failure to concentrate urine
So polyuria, polydipsia and low specific gravity will present
Loosing water will lead to dehydration and hypernatremia.
Papilledema, optic atrophy and nystagmus are not a features of DI.
75) 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
Description:
Loosing water will lead to dehydration and hypernatremia.
DI is a disorder in which decreased amount or responsiveness to ADH occur leading to
increased urination and failure to concentrate urine.
There are two types of DI:
- Central DI: Any CNS disorder (stroke, tumor, trauma, hypoxia, infection,
histiocytosis) impair production of ADH in hypothalamus or storage in posterior
pituitary gland.
- Nephrogenic DI: less common, characterized by loss of ADH effect on collecting
ducts, caused by (lithium, demeclocycline, CKD, Hypokalemia, hypercalcemia,
pyelonephritis, renal amyloidosis, Sjögren's syndrome)

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Endocrinology

Common Endocrine Presentations.

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

4) The following are true in diabetes mellitus type 1, except:

Answer: E* Develops hyperosmolar hyperglycemic coma without insulin

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: C* Strong family history of diabetes

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

7) Diabetes may be secondary to all of the following, except:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Treatment of Diabetes Mellitus.

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

9) There is an association between the use of biguanide oral hypoglycemia agent

Answer: A* Lactic acidosis

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

10) Which of the following insulins can be given IV:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Complications of Diabetes Mellitus.

Answer: C* Urine albumin

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: B* ACE inhibitors

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

13) All of the following are complications of diabetes mellitus, except:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

14) All of the following are complications of diabetes mellitus, except:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

15) The following gastrointestinal manifestations can be related to diabetes mellitus,

Answer: D* Duodenal ulcer

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

16) Hyperglycemic hyperosmolar nonketotic coma:

Answer: A* May be presenting feature of diabetes mellitus

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: E* Huntington chorea

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Diabetic Ketoacidosis DKA.

Answer: B* Leukocytosis almost always means infection

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: B* Fluids, insulin, K

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

20) In diabetic ketoacidosis all of the following are true, except:

Answer: D* Total body potassium is high

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

21) The following about diabetic ketoacidosis are true, except:

Answer: C* Total body potassium is high

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

22) In diabetic ketoacidosis all are true, except:

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

23) Management of diabetic ketoacidosis may include the following, except:

Answer: A* Give 2/3 fluid maintenance to decrease brain edema

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

Answer: E* Thiazide diuretics

Dr. Amjad Al-Afeef … 0798843824 … Amman, Jordan

25) All of the following are causes of hypoglycemia, except:

Answer: D* Chronic pancreatitis