The release of many hormones is pulsatile, so a random blood sample is usually useless. Endocrine abnormalities are rarely characterized by loss of normal regulation of hormonal secretion. When dealing with a pituitary tumor, the followings are true except a. -treatment with dopamine agonists, is almost always effective in normalizing prolactine level and restoration of gonadal function.
The release of many hormones is pulsatile, so a random blood sample is usually useless. Endocrine abnormalities are rarely characterized by loss of normal regulation of hormonal secretion. When dealing with a pituitary tumor, the followings are true except a. -treatment with dopamine agonists, is almost always effective in normalizing prolactine level and restoration of gonadal function.
The release of many hormones is pulsatile, so a random blood sample is usually useless. Endocrine abnormalities are rarely characterized by loss of normal regulation of hormonal secretion. When dealing with a pituitary tumor, the followings are true except a. -treatment with dopamine agonists, is almost always effective in normalizing prolactine level and restoration of gonadal function.
1. When we are trying to investigate the endocrine system for a disease,
the followings are true except A. ? the release of many hormones is pulsatile , so a random blood sample is usually useless B. ? many endocrine glands have what is called incidentalomas C. ? many endocrine tumors are difficult to classify as malignant or benign during histopathological examination D. ? if you suspect a hormonal excess then choose a suppression test E. ? endocrinal abnormalities are rarely characterized by loss of normal regulation of hormonal secretion 2. When dealing with a pituitary tumor, the followings are true except A. ? rarely is a cause of hydrocephalus B. ? may an incidental finding on MRI done for another reason C. ? rarely there is a downward extension and hence may be seen as a nasal polyp D. ? may produce a hypothalamic syndrome by an upward extension E. ? pituitary apoplexy is usually asymptomatic 3. Surgical treatment is usually considered to be a first line treatment for the following pituitary / hypothalamic tumors ,except A. ? non functioning pituitary macroadenoma B. ? craniopharyngioma C. ? Cushing disease D. ? prolactinoma E. ? acromegally 4. Causes of Hyperprolactinemia , all are true except A. ? stress B. ? primary hypothyroidism C. ? chronic renal failure D. ? chronic chest well stimulation E. ? treatment with pergolide 5. Treatment of prolactinomas , all are true except A. ? -treatment with dopamine agonists, is almost always effective in normalizing prolactine level and restoration of gonadal function B. ? after menopause, treatment of microprolactnimoas is only indicated if there was a trouble some galactorrhea, otherwise can be left untreated C. ? trans-sphnenoidal surgery has a success rate approaching 80% D. ? macroprolactnimas may enlarge rapidly during pregnancy and hence bromocyptin should be continued despite pregnancy with close follow up during the whole pregnancy E. ? external irradiation is a useful first line treatment in the majority of patients 6. Acromegaly, all are true except A. ? although glucose intolerance is seen in 25% of cases yet overt diabetes mellitus is seen only in 10% of cases B. ? there is a 2-3 folds increase in the relative risk of colonic cancer and coronary artery disease C. ? trans-sphenoidal surgery has a high success rate D. ? a dopamine agonist may be used in those with co-existent hyperprolactinemia because it is generally less effective than octreotide E. ? external irradiation has a good rapid action against the tumor 7. A random blood sample for GH assessment in a suspected deficiency state is useless because it is commonly undetectable , so there are several " tricks " to collect a blood sample for GH assessment , all are true except A. ? Sampling before exercise. B. ? frequent sampling during sleep C. ? sampling 1 hour after going asleep D. ? sampling during an insulin induced hypoglycemia E. ? stimulation with arginine 8. ACTH stimulation test, all are true except A. ? used in the diagnosis of primary and secondary adrenal insufficiency B. ? the 250 microgram tetracosactrin injection should be given in the early morning C. ? relies on ACTH dependent adrenal atrophy in secondary adrenal failure D. ? normally after 30 minutes the blood cortisol should be above 550 nmol/ L E. ? useually useless in adrenal failure secondary to acute ACTH deficiency 9. Panhypopituitarism , all are true A. ? there is a striking pallor B. ? GH is usually the earliest hormone to be lost C. ? Coma is multi-factorial and may be due to water intoxication , hypoglycemia or hypothermia D. ? The skin is smooth with a baby like texture E. ? Serum TSH should be measured to assess the optimal T4 replacement dose 10. Insulin tolerance test, all are true except A. ? used in the assessment of hypothalamic pituitary adrenal axis B. ? contraindicated in ischemic heart disease and epilepsy C. ? the aim of the test is to produce signs of hypoglycemia with a glucose level below 2.2 mmol/ L D. ? we should take serial blood samples of glucose, GH and cortisol E. ? the usual dose used in the test is NPH insulin 0.15 u/kg given subcutaneously 11. Water deprivation test for a suspected diabetes insipidus , all are true except A. ? it is used in the diagnosis of diabetes insipidus ( DI )and to differentiate between cranial and nephrogenic DI. B. ? there is should be no coffee, tea or smoking on the test day C. ? The test should be stopped if the patient loses 3% of his body weight D. ? when trying to differentiate DI from compulsive water drinking, DDAVP is useful E. ? if the initial urinary osmilality is 700 mosl/ kg the nthe test should be stopped and DI is excluded 12. Hyperthyroidism , all are true except A. ? the commonest cause is Grave's disease B. ? if there is prominent anorexia then a malignant cause should be suspected C. ? vitilligo and lymphadenopathy goes more with Grave's disease than other etiologies D. ? apathy and osteoporosis are mainly seen in elderly patients E. ? pruritis, palmar erythema and spider nevi are more suggestive of an associated chronic active hepatitis 13. Non specific biochemical abnormalities in thurotoxicosis , all are true except A. ? raised alkaline phosphatase B. ? raised ALT and AST C. ? hypercalcemia is usually seen in 50 % of cases D. ? glycosuria E. ? raised gamma GT in the absence of enzyme-inducing drugs or alcoholism 14. Treatment of thyrotoxicosis , all are true except A. ? following successful treatment with carbimazole, up 50% will relapse following drug stoppage B. ? subtotal thyroidectomy is contraindicated in those with previous thyroid surgery C. ? radi-iodine is contraindicated in pregnancy D. ? following subtotal thyroidectomy , up to 10% will develop permanent hypocalcaemia E. ? following treatment with radio-iodine, up to 80% will develop permanent hypothyroidism after 15 years 15. Subacute thyroiditis , all are true except A. ? usually virally induced B. ? there is anterior neck pain worsened by coughing, swallowing and movement of the neck C. ? ESR is usually normal D. ? usually responds well to treatment with non steroidal anti inflammatory drugs but steroids are occasionally used for severe cases E. ? the hyperthyroidism per se is usually mild and no treatment is needed for it apart from oral propranolol or certain cases 16. Factitious hyperthyrosidism , all are true except A. ? it is an uncommon condition due to self administration of T4 the B. ? the radio-iodine uptake scan is suppressed C. ? undetectable serum thyroglobulin D. ? high T3:T4 ratio E. ? the TSH is suppressed 17. Post-partum thyroiditis A. ? occurs in 5-10% of women in the first 6 months following delivery B. ? thyroid biopsy shows lymphocytic thyroiditis C. ? it tends to recur after subsequent pregnancies D. ? there is an association between post partum depression and post partum thyoriditis E. ? there is a negligible radio-iodine thyroid scan 18. Hyperthyroid crisis , all are true except A. ? the commonest precipitation factor is infection in a previously undiagnosed or improperly treated hyperthyroidism patient B. ? although being a life threatening increase in the activity of the thyoird gland, fortunately in clinical practice it is rare C. ? rehydration and broad spectrum antibiotics are important in the management D. ? if the patient can not swallow carbimazole then it should be given intravenously E. ? after 10-14 days of treatments with various antithyroid measures, sodium iopodate and propraanolol can be stopped and the patient will continue ni carbimazole 19. The causes of goitrous hypothyroidism, all a re true except A. ? Hashimoto thyroiditis B. ? Dyshormonogenesis C. ? drug induced D. ? ioidine deficiency E. ? post-ablative 20. Rare , but well recognized features of hypothyroidism , all are true except : A. ? frank psychosis B. ? myotonia C. ? ascites D. ? ileus E. ? iron deficiency anemia 21. Biochemical findings that are useful in the assessment of hypothyroidism , all are true except A. ? high serum LDH and CPK B. ? high cholesterol and triglycerides C. ? macrocytic anemia D. ? high serum T3 level E. ? rasied TSH 22. During treatment of a patient with hypothyroidism all are true except A. ? oral T4 is the cornerstone of treatment B. ? the correct dose of thyroxin is that which restores the serum TSH to normal C. ? the patient usually feels better after 2-3 weeks D. ? restoration of skin and hair texture is usually seen after 3 weeks E. ? elderly patients should be started on a low dose thyroxin with gradual escalation 23. Myxoedema coma, all are true except A. ? unfortunately the mortality rate is 50% but fortunately the condition is rare. B. ? convulsions are not uncommon and opening CSF pressure may be raised C. ? it is a medical emergency and treatment must be started before the biochemical confirmation D. ? unless there is an evidence of primary hypothyroidism like thyroid scar , it should be considered to be secondary to pituitary or hypothalamic dysfunction . E. ? thyroxin should be given intravenously 24. During follow up of a patient treated by oral thyroxin for hypothyroidism, all are true except : A. ? it is important to ensure compliance and the drug should be taken infinitely. B. ? once the dose of thyroxin is stabilized based on serum TSH, the TSH and T4 should be measure every 1-2 years C. ? during a visit the combination of raised serum T4 and high TSH indicates a strict compliance D. ? some patients may take thyroxin erratically when they know that the half life is long E. ? excessive sweating, tachycardia and anxiety may indicate over treatment 25. Medications and thyroid hormones A. ? amiodarone may cause hypo or hyperthyroidism B. ? lithium may cause hypothyroidism C. ? potassium iodide may cause hypothyrodism D. ? phenytoin may decrease the needed dose of thyroxin E. ? oral contraceptive pills may increase the total but not the free thyroxin 26. Causes of obesity, all a re true except: A. ? Cushing disease B. ? Kallaman syndrome C. ? Prader Willi syndrome D. ? hypothalamic tumors E. ? gastric tumors 27. Thyroid carcinomas, all are true except: A. ? each type usually has a certain age group to affect B. ? pappilary carcinoma is the commonest type C. ? some tumors are TSH dependent D. ? follicular carcinoma can be diagnosed by FNA cytology E. ? very rarely thyrotoxicosis is seen 28. Thyroid malignancy, all are true except A. ? pappilary carcinomas usually seen between 20-40 years of age B. ? medullary thyroid carcinoma in a 20 year old man may indicate MEN type II C. ? anaplastic carcinomas usually seen in elderly people D. ? thyroid lymphomas may arise from a preexistent Hashimoto's thyroiditis E. ? secondary tumors are very commonly seen 29. Medullary thyroid carcinoma, all are true A. ? The prognosis is generally poor when compared with differentiated carcinomas B. ? When seen in a young person, it may be part of MEN type 1 C. ? as a treatment option, total thyroidectomy is preferred D. ? high level of calcitonin rarely if ever causes hypocalcemia E. ? the tumor secreting cells do not respond to radio-iodine treatment 30. Primary Hyperparathyroidism, all are true except A. ? the commonest cause is a single parathyroid adenoma B. ? the commonest cause of out patient hypercalcemia C. ? together with malignancy, they both account for up to 90% of cases of hypercalcemia D. ? lithium induced hyperparathyroidism may present exactly like primary hyperparathyroidism E. ? the parathyroids are usually palpable in the neck 31. Causes of hypercalcemia with raised level of parathyroid hormone, all are true except A. ? primary hyperparathyroidism B. ? tertiary hyperparathyroidism C. ? lithum-induced hyperparathyroidism D. ? familial hypocalciuric hypercalcemia E. ? malignancy 32. Treatment of malignancy associated hypercalcemia , all are true except A. ? iv fluids are very important B. ? un very high calicium levels, iv pamidronate is given initially with excellent results C. ? forced diuresis may be used D. ? like primary hyperparathyroidism, glucocorticoides are in effective E. ? there is a place for hemodialysis 33. Long term Hypocalcemia , all are true except A. ? may be seen in peudopseudohypoparathyroidism B. ? may be a cause of cateract C. ? basal ganglia calcification is seen D. ? pappilodema has been documented E. ? mucocutaneous candidiasis is an association 34. Causes of hypocalcemia and hyperphosphatemia , all are true except A. ? chronic renal failure B. ? hypoparathyroidism C. ? pseudohypoparathyroidism D. ? hypomagnesemia E. ? pseudopseudohypoparathryoidism 35. Hypocalcemia, all are true except A. ? carpo-pedal spasm is more common in children than adults B. ? in adults, stridor is uncommon C. ? siezures are usually resistant to antiepileptic therapy D. ? the cornerstone in the treatment of pseudohypoparathyroidism is calcium supplement E. ? regualr follow up is need with measurement of serum calcium 36. Cushing syndrome in general, all are true except: A. ? obesity is the commonest sign B. ? hypertension is absent in 25% of cases C. ? prominent hyper-pigmentation is in favor of an ectopic ACTH secreting source D. ? depression is the commonest psychiatric manifestation E. ? mucsle biopsy will show type I fiber atrophy 37. In the diagnosis of Cushing syndrome, all are true except: A. ? In the diagnosis of Cushing syndrome, all are true except: B. ? 24 hours urinary free cortisol or overnight low dose dexamethasone suppression test are the preferred initial screening tests C. ? unfortunately dexamethason cross reacts with cortisol immunoassay D. ? chronic alcoholism sometimes exactly resembles Cushing's syndrome clinically and biochemically E. ? supprssed ACTH levels indicate an adrenal tumor F. ? 38. Treatment of Cushing syndrome, all are true A. ? in pituitary dependent disease, trans-sphenoidal surgery is the preferred option B. ? if treated by bilateral adrenalectomy, the pituitary should be irradiated to prevent the development of Nelson's syndrome C. ? medical treatment is usually given in the way to prepare the patient for surgery D. ? adrenal carcinoma should be removed surgically and the tumor bed is irradiated and then the patient is given the drug o'p'DDD E. ? without treatment, the 5 year survival rate is 75% 39. Causes of apparent hyperaldosteronism , all are true except A. ? treamtent with carbenoxolone B. ? 11 deoxycorticosterone secreting tumors C. ? Liddle's syndrome D. ? ectopic ACTH syndrome E. ? glucocorticoides suppressible hyperaldosterosnism 40. In primary aldosteronism , all are true except A. ? hypertension is almost always present and is the commonest presenting feature B. ? serum potassium is normal up to 70% of cases at the time of diagnosis C. ? of all causes, only Conn's adenoma can be treated by surgery D. ? spironolactone is very effective in normalizing the blood pressure and biochemical abnormalities in the majority of cases E. ? leg edema is very common 41. Pheochromocytoma, all are true except A. ? may be part of specific syndromes B. ? predominantly elevated noradrenalin suggests either a large adrenal tumor or an extra adrenal tumor C. ? weight loss indicates associated diabetes mellitus D. ? postural hypotension may be seen E. ? the rise in blood pressure may occur during urination F. ? 42. Addison's disease, all are true except A. ? the commonest cause is autoimmune adrenalitis B. ? vitilligo is seen in 20% of cases C. ? hyperglycemia indicates associated type I diabetes D. ? postural hypotension is indicates glucocorticoids rather than mineralocorticoids deficiency E. ? it is a common condition with an incidence of 80 new case/ million of population 43. Congenital adrenal hyperplasia, all are true except : A. ? the commonest cause is 21 alpha hydroxylase deficiency B. ? all cases are autosomal recessive C. ? causes ambiguous genitalia in females and precocious pseudopuberty in males D. ? 11 beta and 17 alpha hydroxylases are associated with hypotension E. ? the condition can be prevented by appropriate prenatal diagnosis and giving dexamethason to the pregnant mother 44. Drug induced gymecomastia may be due to all of the followings except A. ? digoxin B. ? cimetidin C. ? stilboestrol D. ? spironolactone E. ? ameloride 45. In polycystic ovarian syndrome , all are true except : A. ? insuline resistance is though to be the central key in the pathogenesis B. ? mild elevation in serum prolactin C. ? mild elevation of serum androgens D. ? elevated blood estron level E. ? FSH:LH ratio more than 2.5:1 46. In the assessment of hirsutism in a female, all are important clues to the underlying cause except A. ? as idiopathic hirsutism is the commonest cause so being an Asian or Mediterranean is important clue to it B. ? high levels of androgens that dont suppress with steroids or estrogens is a very important clue to ovarian or adrenal tumors C. ? being a highly trained athletic female may suggest an exogenic androgen intake D. ? mooning of the face with obesity and striae may be a clue to Cushing's syndrome E. ? family history of hirsutism is not that important 47. MEN type I and type II , all are true except : A. ? due to mutation in MENIN gene on chromosome 11 in type B. ? hypercalcemia is the commonest presenting feature in type II C. ? family history of one relevant endocrine tumor may be present D. ? pheochromocytomas in type II are bilateral in 70% of cases E. ? carcinoid syndrome is uncommon in type I 48. Carcinoid tumors and syndromes , all are true except : A. ? the commonest site is the ileum for carcinoid tumors B. ? may present as appendicitis C. ? the long term prognosis is excellent in the majority D. ? carcinoid syndrome may present as right sided heart failure E. ? cramping abdominal pain and diarrhea with flushing and wheeze is the commonest presenting feature of carcinoid tumors 49. In pancreatic endocrine tumors , all are true except : A. ? somatostatinomas may presents with gall stones and diabetes B. ? glucagonomas may present with anemia and weight loss C. ? gastrinomas may present with steatorrhea D. ? VIPOmas may present with watery diarrhea and hyperkalemia E. ? insulinoams may present with dizzy spells MRCP MCQ Tests