Internal Medicine 4th Year Endocrinology CAT: 30 MCQs

Mount Kenya University · School of Medicine · Internal Medicine

Paper details

• Paper: "4th Year Endocrinology CAT", time 1 hour, answered on a separate answer sheet. The scan has no printed date or unit code, so it is filed as undated.
• Questions: 30 multiple choice questions.
• Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. The student's number and the pen marks on the scan were ignored and are not published.
• Topics tested: diabetes (type 1 and 2, drugs, DKA, hyperosmolar state, hypoglycaemia), adrenal disease and Addisonian crisis, thyroid disease and myxoedema coma, and parathyroid disease.
• Questions that need care: Q10, Q15, Q28 and Q13 are loosely worded. The explanation says which option is best and why.

Multiple choice questions

1. Which of the following statements is correct?

• A. Insulin suppresses the activity of glycogen synthase
• B. Insulin mediates glucose uptake in the brain
• C. Prediabetes is characterised by an increased risk for the future development of type 2 diabetes
• D. The rise in insulin concentration after a meal is reduced in type 1 but not in type 2 diabetes

2. Insulin deficiency is associated with:

• A. Reduced lipolysis
• B. Increased ketogenesis
• C. Reduced gluconeogenesis
• D. Reduced proteolysis

3. The risk factors for type 2 diabetes include:

• A. Family history
• B. Being overweight
• C. High intake of dietary fat
• D. All of the above

4. The pathogenesis of hyperglycaemia in type 2 diabetes includes all of the following mechanisms EXCEPT for:

• A. Increased glucose production by the liver
• B. Impaired insulin secretion
• C. Decreased glucose uptake from skeletal muscle
• D. All of the options given are correct

5. Which statement best describes the differences between type 1 and type 2 diabetes?

• A. People with type 2 usually require lower doses of insulin than people with type 1 because they have a milder form of diabetes
• B. People with type 1 rapidly develop chronic complications
• C. Autoimmune factors are involved in the pathogenesis of type 1 but not type 2 diabetes
• D. People with type 1 can increase endogenous insulin production by taking oral hypoglycaemic agents

6. According to trials on diabetes prevention, high-risk individuals can reduce their risk of developing diabetes by:

• A. Eating a very low carbohydrate diet
• B. Consuming a diet high in monounsaturated fats
• C. Losing 5 to 7% of body weight through a hypocaloric, low-fat diet and 30 minutes of daily activity
• D. Initiating metformin 850 mg twice daily and practising daily vigorous exercise

7. What is the first-line drug for patients with type 2 diabetes and obesity?

• A. Acarbose
• B. Metformin
• C. Sulphonylureas
• D. Insulin

8. This diabetes drug acts by decreasing the amount of glucose produced by the liver:

• A. Alpha-glucosidase inhibitors
• B. Sulfonylureas
• C. Biguanides
• D. Meglitinide

9. Which is NOT a potential cause of hypoglycaemia in adults?

• A. Alcohol
• B. Salbutamol
• C. Insulinoma
• D. Salicylates
• E. Adrenal insufficiency

10. Which is the major precipitant of DKA?

• A. Infection
• B. Missed doses of insulin
• C. Acute myocardial infarction
• D. Pancreatitis
• E. Pulmonary embolism

11. Which is NOT true regarding the management of DKA?

• A. Administration of IV fluid immediately on arrival is the life-saving event
• B. Fluid replacement should be 3 to 4 litres over the first four hours in a patient who is not shocked
• C. Even if the K+ is above 5.5, potassium replacement should be commenced
• D. The insulin bolus should be about 0.1 units/kg, with subsequent infusion at 0.1 units/kg/hr
• E. Cerebral oedema responds to mannitol

12. Which is NOT a feature of hyperosmolar hyperglycaemic non-ketotic states?

• A. Very high glucose, often greater than 40 mmol/L
• B. pH above 7.3
• C. Serum osmolality often greater than 350 mmol/L
• D. Low bicarbonate
• E. Lack of ketones in urine

13. Which statement is false about the fluid deficit in HHNS?

• A. It is usually 5 L
• B. If not shocked, then 0.45% saline should be given
• C. Fluid replacement should always precede insulin therapy in the non-shocked patient
• D. Fluid replacement should be done over a longer period of time than in DKA
• E. Normal saline should be given to the shocked patient

14. Which may NOT cause an adrenal crisis?

• A. Waterhouse-Friderichsen syndrome
• B. Sheehan's syndrome
• C. Acute discontinuation of steroid therapy
• D. Anticoagulant use
• E. Fulminant septicaemia

15. What biochemical abnormality is possible in an Addisonian crisis?

• A. Hyponatraemia
• B. Hypokalaemia
• C. Hypoglycaemia
• D. Normokalaemia and normonatraemia
• E. All of the above

16. Which statement is incorrect regarding treatment of an Addisonian crisis?

• A. IV normal saline should be given to treat shock
• B. IV dextrose will also be required
• C. IV fludrocortisone is required
• D. IV dexamethasone or hydrocortisone should be given
• E. Fludrocortisone (mineralocorticoid) does not need to be given acutely

17. Which is the most common cause of hyperthyroidism in Australia?

• A. Graves' disease
• B. Toxic multinodular goitre
• C. Toxic adenoma
• D. Pituitary aetiology
• E. Excess iodine

18. Which is NOT a feature of hyperthyroidism?

• A. Lid lag
• B. Lid retraction
• C. Amenorrhoea
• D. Peripheral neuropathy
• E. Hyperreflexia

19. Which is false regarding the treatment of myxoedema coma?

• A. Thyroxine should be given IV initially
• B. Thyroxine should be given in full dosage prior to blood results
• C. Steroids should be given
• D. Hyponatraemia should be treated with fluid restriction
• E. Dextrose may be required

20. Which is NOT a feature of hypothyroidism?

• A. Loss of outer third of the eyebrow
• B. Bradycardia
• C. Ophthalmopathy
• D. Weight gain
• E. Constipation

21. Which hormone is produced by the adrenal medulla?

• A. Epinephrine
• B. Aldosterone
• C. ACTH
• D. Cortisol
• E. DHEA

22. Which best describes an Addisonian crisis?

• A. Dangerously high testosterone levels
• B. Severe adrenal insufficiency resulting in dangerously low testosterone levels
• C. Dangerously high serum cortisol levels
• D. Severe adrenal insufficiency resulting in dangerously low serum cortisol levels
• E. None of the above

23. Which is a symptom of Addison's disease?

• A. Striae
• B. Moon face
• C. Weight gain
• D. Postural hypotension
• E. Hypopigmentation

24. Which best describes a toxic thyroid adenoma?

• A. Inflammation of the thyroid gland due to lymphocytic infiltration, causing stored thyroid hormones to be released into the circulation
• B. A malignant tumour of the thyroid gland that produces excessive amounts of thyroid hormones
• C. An autoimmune disease with antibodies that stimulate the TSH receptors, causing increased T3 and T4
• D. A benign tumour of the thyroid gland that produces excessive amounts of thyroid hormones, arising from follicular cells
• E. None of the above

25. Which is NOT a cause of Addison's disease?

• A. Adrenoleukodystrophy
• B. Autoimmune destruction of the adrenal cortex
• C. Tuberculosis
• D. Pyelonephritis
• E. All of the above

26. Which statement is NOT true of parathyroid hormone?

• A. Increases renal phosphate excretion in the renal tubule
• B. Decreases phosphate excretion in the renal tubule
• C. Increases renal calcium resorption
• D. Promotes osteoclastic resorption of calcium
• E. None of the above

27. Primary hyperparathyroidism is characterised by all of the following EXCEPT:

• A. Hypocalcaemia
• B. Hypercalcaemia
• C. Hypercalciuria
• D. Hyperphosphaturia
• E. Recurrent renal infection

28. All the following are causes of primary hypothyroidism EXCEPT:

• A. Hashimoto's thyroiditis
• B. Subacute thyroiditis
• C. Hypopituitarism
• D. Graves' disease
• E. Lithium

29. All the following are true concerning Hashimoto's thyroiditis EXCEPT:

• A. Hürthle cells are a likely feature
• B. Female to male distribution is 1:1
• C. May result in thyroid lymphoma, but rarely
• D. Usually presents with goitre
• E. The patient may be euthyroid

30. All the following are true concerning toxic adenomas EXCEPT:

• A. Low TSH
• B. More common in a young female
• C. Are almost always follicular adenomas
• D. A hot nodule may be seen on thyroid scan
• E. None of the above