Quiz Endocrinology Post Pic Quiz

Published on August 22nd, 2011 | by Lewis Potter

Endocrinology Quiz



Endocrinology Quiz

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Question 1
Which of the following statements best describes cushing’s syndrome?
A
Cushing’s Syndrome refers to a disease process caused by abnormally low levels of aldosterone
B
Cushing’s Syndrome refers to a disease process caused by abnormally high levels of Aldosterone
C
Cushing’s Syndrome refers to a disease process caused by abnormally low levels of Cortisol
D
Cushing’s Syndrome refers to a disease process caused by abnormally high levels of Cortisol
Question 1 Explanation: 
Cushing’s syndrome occurs as a result of an individual having abnormally high levels of cortisol. This can be due to a number of causes.
Question 2
Which of the following are not signs of cushings syndrome?
A
Central obestiy with relative sparing of limbs
B
Reduced visual fields
C
Prominent supraorbital ridge
D
Moon face
E
Proximal muscle weakness
F
Buffalo hump
Question 2 Explanation: 
Both prominent supraorbital ridge and reduced visual fields are not signs of Cushing’s Syndrome. Instead they are often seen in Acromegaly.
Question 3
Which of the following are causes of Nephrogenic Diabetes Insipidus?
A
Mutations in the Vasopressin (ADH) receptor gene
B
Amyloidosis
C
Post obstructive uropathy
D
Sheehan’s Syndrome
E
Atenolol
F
Mutations in Vasopressin gene
G
Lithium
Question 3 Explanation: 
Nephrogenic Diabetes Insipidus involves the inability for the kidneys to respond appropriately the vasopressin (ADH) Anything which impairs the kidneys ability to respond to ADH has the potential to cause Neprogenic Diabetes Insipidus.
Question 4
Which of the following is the underlying problem in neurogenic diabetes insipidus?
A
Lack of Vasopressin (Anti-diuretic Hormone)
B
Overproduction of Prolactin
C
Overproduction of Vasopressin (Anti-diuretic Hormone)
D
Lack of Oxytocin
E
Lack of Prolactin
F
Overproduction of Oxytocin
Question 4 Explanation: 
In Neurogenic Diabetes Insipidus the underlying problem involves the lack of Vasopressin production by the posterior pituitary. This can occur for a number of differ reasons
Question 5
What HBA1C level are patients recommended to aim for?
A
<10%
B
<12%
C
<15%
D
<7.5%
Question 6
Which 1 of the following is the most common cause of cushing’s syndrome?
A
Pituitary adenoma
B
Adrenal adenoma
C
Ectopic ACTH production
D
Glucocorticoid treatment
Question 6 Explanation: 
The most common cause of cushings syndrome is the long term use of glucocorticoid treatments (steroids). These treatments are commonly used to suppress inflammation in many diseases. If these treatments are used long term they can result in the development of cushing’s syndrome. As a result most steroid treatments are only given for short durations.
Question 7
Which of the following are symptoms of acromegaly?
A
Headache
B
Diarrhoea
C
Excessive sweating (Hyperhydrosis)
D
Visual changes (double vision, reduced vision, tunnel vision)
E
Deepening voice
F
Abdominal distention
G
Increased finger ring size
H
Vomiting
I
Tingling and weakness in hands
J
Widespread rash
Question 7 Explanation: 
The symptoms of acromegaly can manifest in many different and seemingly unrelated ways. As a result patients often don’t realise the link between there various symptoms and are therefore diagnosed much later on in the disease.
Question 8
Which one of the following statements is true regarding the prevalence of acromegaly?
A
Acromegaly affects twice as many men than women
B
Acromegaly affects twice as many women than men
C
Acromegaly effects a similar number of men and women
Question 8 Explanation: 
The prevalence of acromegaly is equally distributed between sexes.
Question 9
What of the following statements describes the pathology of hyperthyroidism as a result of toxic thyroid adenoma?
A
An autoimmune disease directed against Thyroid Stimulating Hormone (TSH) receptors. The autoantibodies stimulate the TSH receptors causing ↑ T3 & T4 production
B
A benign tumour of the thyroid gland which produces excessive amounts of thyroid hormones. These always arise from the follicular cells of the thyroid.
C
Inflammation of the thyroid gland due to infections or lymphocytic infiltration causes the stored thyroid hormones to all be released into the circulation leading to hyperthyroidism and usually thyrotoxicosis
D
A malignant tumour of the thyroid gland which produces excessive amounts of thyroid hormones. These always arise from the follicular cells of the thyroid
Question 10
Which of the following causes of cushing’s syndrome does the phrase “cushing’s disease” specifically refer too?
A
Iatrogenic
B
Ectopic ACTH production
C
Adrenal adenoma
D
Pituitary adenoma
Question 10 Explanation: 
Cushing’s disease refers specifically to cushing’s syndrome occuring as a result of a pituitary adenoma.
Question 11
Which of the following statements best describes Diabetes Insipidus?
A
Diabetes Insipidus is a disease characterised by the passage of large volumes of concentrated urine
B
Diabetes Insipidus is a disease characterised by the passage of small volumes of concentrated urine
C
Diabetes Insipidus is a disease characterised by the passage of small volumes of dilute urine
D
Diabetes Insipidus is a disease characterised by the passage of large volumes of dilute urine
Question 11 Explanation: 
Diabetes Insipidus is a disease characterised by the passage of large volumes (>3L/24hrs) of dilute urine (osmolality <300 mOsmol/Kg)
Question 12
Which of the following hormones are produced by the adrenal cortex?
A
5-DHEA
B
Aldosterone
C
Cortisol
D
Norepinephrine (Noradrenaline)
E
Epinephrine (Adrenaline)
Question 12 Explanation: 
The adrenal cortex produces cortisol, aldosterone and weak androgens such as 5-DHEA. Adrenaline and Noradrenaline are instead produced by the adrenal medulla.
Question 13
Which of the following are correct regarding the effects of increased levels of growth hormone in acromegaly?
A
Increased levels of growth hormone stimulate increased production of Insulin Like Growth Factor 1 (IGF1) from the liver
B
Increased levels of growth hormone stimulate increased production of Insulin Like Growth Factor 1 (IGF1) from the adrenal glands
C
Increased levels of growth hormone stimulate increased production of Vasopressin (IGF1) from the liver
D
Increased levels of growth hormone stimulate increased production of Vasopressin (IGF1) from the adrenal glands
Question 13 Explanation: 
The increased levels of growth hormone stimulate overproduction of IGF1 from the liver. IGF1 stimulates overgrowth of tissues and alters blood glucose & lipid metabolism. The actions of IGF1 therefore cause the symptoms seen in acromegaly.
Question 14
In males which hormone stimulates Leydig cells to produce testosterone?
A
Luteinizing Hormone (LH)
B
Follicle Stimulating Hormone (FSH)
Question 15
Will patients who develop type 1 diabetes will require lifelong insulin?
A
Yes
B
No
Question 16
Which of the following causes of Hyperthyroidism is the most common?
A
Graves disease
B
Toxic Thyroid Adenoma
C
Thyroiditis
D
Toxic Multi-nodular Goitre
Question 17
Which of the following statements describes Hashimoto’s thyroiditis?
A
Inflammation of the thyroid gland as the result of a virus
The disease is often preceded by a upper respiratory tract infection
B
Occurs as the result of iodine deficiency
C
It is a destructive autoimmune disease that is especially common in middle aged women. The disease is caused by auto-reactive antibodies against thyroglobulin & other targets
Question 18
What do Leydig cells produce?
A
Oestrogen
B
Testosterone
C
Androgen Binding Globulin
D
Semen
Question 19
Which of the following describes the best treatment option for iatrogenic cushing’s syndrome?
A
Trans-sphenoidal surgery
B
Gradual reduction of steroid dose & eventual withdrawal of drug
C
Adrenalectomy
Question 19 Explanation: 
Iatrogenic cushing’s syndrome refers to cushing’s syndrome occuring as a result of treatment with steroids. Therefore to treat this you need to gradually reduce the steroid dose and eventually stop it. It is very important not to suddenly stop steroid treatment as it can result in low serum cortisol levels (Addisonian Crisis) which is life threatening.
Question 20
Which of the following hormones are produced in the posterior pituitary gland?
A
Follicle Stimulating Hormone (FSH)
B
Vasopressin (Anti-diuretic Hormone)
C
Growth Hormone (GH)
D
Adrenocorticotrophic Hormone (ACTH)
E
Oxytocin
F
Luteinizing Hormone (LH)
G
Prolactin
H
Thyroid Stimulating Hormone (TSH)
Question 20 Explanation: 
The posterior pituitary gland is only responsible for producing oxytocin and vasopressin.
Question 21
Which of the following are not symptoms of Diabetes Insipidus?
A
Production of dilute urine (<300 mOsmol/Kg)
B
Production of highly concentrated urine (>300 mOsmol/Kg)
C
Excessive thirst
D
Nocturia
E
Excessive urination
F
Dehydration
G
Minimal urination
Question 22
Which of the following are Sertoli cells responsible for producing?
A
Oestrogen
B
Testosterone
C
Gonadotrophin Releasing Hormone (GnRH)
D
Androgen Binding Globulin (ABG)
Question 23
Pseduo Cushing’s Syndrome refers to a condition in which the patient has the signs and symptoms of cushing’s however the cause is not related to the hypothalamic-pituitary-adrenal axis.  Which 3 of the following are common causes of pseudo cushing’s?
A
High serum TSH
B
Eating disorders
C
Alcoholism
D
High serum aldosterone
E
Stress
Question 24
Which 1 of the following is the most useful investigation to screen for cushing’s syndrome?
A
Oral Glucose Tolerance Test
B
ACTH Stimulation Test
C
Ultrasound of Adrenal Glands
D
Dexamethasome suppression test
E
MRI of pituitary fossa
Question 24 Explanation: 
The Dexamethasome suppression test is the most useful in screening for Cushing’s syndrome. In normal individuals levels of both ACTH & Cortisol should decrease after administration of Dexamethasome. If levels are not suppressed it suggests the diagnosis of Cushing’s syndrome. MRI & Ultrasound can be useful as secondary tests to determine the underlying cause of the cushing’s syndrome.
Question 25
Which of the following are symptoms of addison’s disease?
A
Weight gain
B
Hyperpigmentation
C
Postural hypotension
D
Diplopia
E
Fatigue
F
Striae
G
Moon face
H
Weight loss
Question 25 Explanation: 
The lack of cortisol results in significant weight loss in the majority of patients (90%) Patients often feel very unwell and lethargic. Some patients also exhibit hyperpigmentation of their skin (often mistaken as a “healthy” tan) Some patients also experience postural hypotension due to the lack of aldosterone.
Question 26
What is the most common cause of Primary Polydipsia?
A
Inability to produce vasopressin (ADH)
B
Defect in Vasopressin gene
C
Overproduction of vasopressin (ADH)
D
Defect in Vasopressin (ADH) receptors
E
Psychological disorder
Question 26 Explanation: 
Primary polydipsia is characterised by an individual consuming large volumes of fluids and as a result producing large volumes of dilute urine. The symptoms of primary polydipsia are therefore very similar to those of diabetes insipidus however a fluid deprivation test can help distinguish the diseases. Most often primary polydipsia is due to a psychological disorder.
Question 27
What is the current treatment of choice for acromegaly in otherwise healthy patients?
A
Watchful waiting
B
Somatostatin analogues
C
Trans-sphenoidal surgery
D
Growth Hormone Receptor Antagonists
Question 27 Explanation: 
At the moment most patients receive trans-sphenoidal surgery to remove the pituitary adenoma. This surgery cures acromegaly in 80% of patients with micro-adenomas & 40% of patients with macro-adenomas. Somatostatin analogues may be used immediately after diagnosis to reduce circulating levels of growth hormone whilst the patients is waiting for surgery. They also may be used long term in patients too unfit for surgery. Growth hormone receptor antagonists are a new therapy which is very targeted however at present it is only used on a limited basis (very expensive)
Question 28
Which of the following is a fast acting insulin?
A
Glargine
B
Novorapid
Question 29
Which of the following is used as a first line therapy for neurogenic diabetes insipidus?
A
Synacthen (synthetic ACTH)
B
Hydrocortisone
C
Desmopressin
D
Somatostatin
Question 29 Explanation: 
Desmopressin is a vasopressin analogue and therefore directly replaces the vasopressin normally produced by the posterior pituitary gland. It binds to v2 receptors on kidney allowing water to be reabsorbed. The drug can be given orally, intranasally, parenterally or bucally
Question 30
Which of the following statements correctly describes the pathophysiology of cushing’s disease?
A
Cushing’s disease results from a benign adrenal adenoma secreting excess levels of cortisol
B
Cushing’s disease results from a benign adrenal adenoma secreting excess levels of ACTH
High levels of ACTH in turn caused increased release of Cortisol from the Adrenal Cortex
C
Cushing’s disease results from a benign pituitary adenoma secreting excess levels of ACTH
High levels of ACTH in turn caused increased release of Cortisol from the Adrenal Cortex
D
Cushing’s disease results from a benign pituitary adenoma secreting excess levels of cortisol
Question 31
Which of the following are common symptoms of hyperthyroidism?
A
Weight loss
B
Weight gain
C
Heat intolerance
D
Diarrhoea
E
Urinary frequency
F
Tremor
Question 31 Explanation: 
Hyperthyroidism can present with a wide array of symptoms and these often differ considerably between patients. However symptoms such as weight loss, tremor, heat intolerance and diarrhoea are quite common.
Question 32
Which of the following investigations is the gold standard for diagnosing acromegaly?
A
Growth Hormone measurement
B
Serum IGF1 Measurement
C
Oral Glucose Tolerance Test + Growth Hormone measurement
D
Growth Hormone Releasing Hormone Measurement
Question 32 Explanation: 
Serum IGF1 measurement is useful to screen for acromegaly however is not ideal for diagnosis. Measuring Growth Hormone alone is also not very useful as it is secreted in a pulsatile matter therefore individuals levels vary greatly throughout the day. The oral glucose tolerance test combined with Growth Hormone measurement is the best as normally growth hormone should be inhibited by glucose intake however in acromegaly it will not be. Therefore presence of high levels of GH after glucose would confirm a diagnosis of acromegaly.
Question 33
Which of the following are symptoms of Type 1 Diabetes?
A
Polydipsia
B
Decreased thirst
C
Decreased urination
D
Polyurea
E
Widespread erythematous rash
F
Weight loss
Question 34
Which of the following is a long acting insulin
A
Novorapid
B
Glargine
Question 35
Which 1 of the following is thought to be the cause of gestational diabetes insipidus?
A
Production of vasopressin by the foetus
B
Production of ACTH by the placenta
C
Production of vasopressinase by the foetus
D
Production of vasopressinase by the placenta
E
Production of vasopressin by the placenta
Question 35 Explanation: 
Gestational diabetes insipidus only occurs during pregnancy. During pregnancy the placenta produces vasopressinase which breaks down vasopressin. Gestational diabetes insipidus is therefore thought to be caused by overproduction of vasopressinase by the placenta causing a lack of functional vasopressin.
Question 36
Which 1 of the following hormones binds to the pituitary and stimulates the release of Luteinizing Hormone (LH) & Follicle Stimulating Hormone (FSH)?
A
Adrenocorticotrophic Hormone (ACTH)
B
Corticotrophic Releasing Hormone (CRH)
C
Gonadotrophin Releasing Hormone (GnRH)
Question 36 Explanation: 
1. The hypothalamus secretes GnRH
2. GnRH travels down to the anterior pituitary gland
3. It binds to receptors on the pituitary gland
4. This causes release of LH & FSH
Question 37
What is the 5 year mortality rate for untreated cushing’s syndrome?
A
10%
B
50%
C
40%
D
30%
E
20%
Question 37 Explanation: 
Cushing’s syndrome is very serious if left untreated with around a 50% mortality over 5 years. Death is usually due to cardiovascular complications such as heart failure or patients developing serious infections due to immunocompromise.
Question 38
What is Addison’s disease?
A
Addison’s disease involves the overproduction of androgens by the adrenal medulla
B
Addison’s disease involves the underproduction of androgens by the adrenal medulla
C
Addison’s disease involves the underproduction of cortisol and aldosterone by the adrenal cortex
D
Addison’s disease involves the overproduction of cortisol and aldosterone by the adrenal cortex
Question 39
Which of the following statements best describes the mechanism of action of Thiazolidinediones such as Rosiglitazone?
A
It works by binding to pancreatic beta cells & causing increased release of insulin
B
It increases insulin sensitivity, allowing endogenous insulin to better do it’s job. It also decreases hepatic gluconeogenesis whilst increasing muscle glucose uptake
C
The drug binds to PPAR’s (peroxisome proliferator-activated receptors). When PPAR’s are activated they cause transcription of a number of genes. These activated genes ultimately result in decreased insulin resistance
Question 40
In males which hormone stimulates Sertoli cells to produce Androgen Binding Globulin (ABG)
A
Follicle Stimulating Hormone (FSH)
B
Oxytocin
C
Gonadotrophin Releasing Hormone (GnRH)
D
Luteinizing hormone (LH)
Question 40 Explanation: 
FSH stimulates sertoli cells to produce androgen binding globulin. This substance binds to testosterone and keeps it at high concentrations in the seminiferous tubules within the testes. This is important as high levels are required here for successful spermatogenesis.
Question 41
The gene IDDM1 is thought to be strongly associated with the development of Type 1 Diabetes
A
False
B
True
Question 42
Which age group does acromegaly most commonly affect?
A
30-50 years
B
55-70 years
C
25-40 years
D
10-25 years
Question 42 Explanation: 
Most who develop acromegaly are between 30-50 years old. Acromegaly would not develop in young children as their growth plates have not yet fused, so they would develop gigantism instead.
Question 43
Which of the following is not a symptom of cushings syndrome?
A
Acne
B
Increased pigmentation of skin
C
Easy bruising
D
Weight gain
E
Stretch marks
Question 43 Explanation: 
Increased pigmentation of skin is not a symptom of cushings syndrome. Instead the symptom may indicate the presence of Addisons disease.
Question 44
Which of the following statements correctly describes the pathology of type 1 diabetes?
A
Disorder of metabolism characterised by high levels of glucose in the blood as a result of insulin resistance and insulin deficiency
B
Occurs due to autoimmune destruction of the insulin producing pancreatic beta cells. The loss of insulin producing cells leads to insulin deficiency which in turn causes hyperglycaemia.
Question 45
Which of the following statements best describes diabetic ketoacidosis?
A
It occurs due to a lack of insulin, which causes the bodies cells to absorb & utilise an abnormally high level of glucose. As a result the body switches it’s metabolism to breakdown fat to produce energy. This process produces acidic ketones as a byproduct and these build up in the blood causing a metabolic acidosis.
B
It occurs due to a lack of insulin, which prevents the bodies cells from absorbing and utilising any glucose in the blood. As a result the body switches it’s metabolism to breakdown fat to produce energy. This process produces acidic ketones as a byproduct and these build up in the blood causing a metabolic acidosis.
C
It occurs due to a lack of insulin, which prevents the bodies cells from absorbing and utilising any glucose in the blood. As a result the body switches it’s metabolism to breakdown fat to produce energy. This process produces alkylotic ketones as a byproduct and these build up in the blood causing a metabolic alkalosis.
D
It occurs overproduction of insulin, which prevents the bodies cells from absorbing and utilising any glucose in the blood. As a result the body switches it’s metabolism to breakdown fat to produce energy. This process produces acidic ketones as a byproduct and these build up in the blood causing a metabolic acidosis.
Question 46
Which one of the following is acromegaly caused by?
A
Overproduction of Growth Hormone (GH)
B
Overproduction of Gonadotrophin Releasing Hormone (GnRH)
C
Overproduction of Vasopressin (Anti-diuretic Hormone)
D
Overproduction of Adrenocorticotrophic Hormone (ACTH)
Question 46 Explanation: 
Acromegaly occurs as a result of overproduction of growth hormone. The increased levels of this hormone causes increased proliferation of a number of tissues which results in the characteristic features of acromegaly.
Question 47
What is the recommended definitive treatment for cushing’s disease?
A
Adrenalectomy
B
Somatostatin Analogues
C
Trans-sphenoidal surgery
Question 47 Explanation: 
Cushing’s disase refers to cushings syndrome caused by a pituitary adenoma. As a result the definitive treatment involves the surgical removal of the pituitary adenoma. This is done using a trans-sphenoidal technique (up through nose)
Question 48
Which of the following hormones are produced in the anterior pituitary gland?
A
Oxytocin
B
Vasopressin (Anti-diuretic Hormone)
C
Prolactin
D
Follicle Stimulating Hormone (FSH)
E
Thyroid Stimulating Hormone (TSH)
F
Luteinizing Hormone (LH)
G
Adrenocorticotrophic hormone (ACTH)
H
Growth hormone (GH)
Question 48 Explanation: 
The anterior pituitary is responsible for producing a large number of different hormones. Each of these hormones is produced by a subset of specialised cells within the anterior pituitary.
Question 49
Which of the following does the adrenal cortex produce?
A
Noradrenaline
B
Aldosterone
C
Cortisol
D
Adrenaline
Question 49 Explanation: 
The adrenal cortex is responsible for the production of both cortisol and aldosterone. Adrenaline & Noradreniline are produced by the adrenal medulla
Question 50
What is the most common cause for the overproduction of growth hormone in acromegaly?
A
Hyperplasia of the pituitary stalk
B
Hypothalamic lesion
C
Pituitary lesion
D
Pituitary adenoma
Question 50 Explanation: 
In around 99% of cases, acromegaly is caused by a pituitary adenoma, specifically overgrowth of the somatotrope cells which are responsible for growth hormone production. In very rare cases acromegaly can be caused by ectopic production of growth hormone by carcinoid tumours.
Question 51
In regard to the investigation of hyperthyroidism, which 1 of the following antibodies is specific to Grave’s disease?
A
TSH receptor antibodies
B
Thyroglobulin antibody (Tg Ab)
C
Thyroid Peroxidase antibody (TPO Ab)
Question 51 Explanation: 
TSH receptor antibodies are highly specific for Grave’s disease as those antibodies are the driving force behind Grave’s disease. The other 2 antibodies can be found in both Grave’s & Hashimoto’s.
Question 52
Which of the following statements best describes the pathology of type 2 diabetes?
A
A disorder of metabolism characterised by high levels of glucose in the blood as a result of insulin resistance and insulin deficiency
B
Occurs due to autoimmune destruction of the insulin producing pancreatic beta cells. The loss of insulin producing cells leads to insulin deficiency which in turn causes hyperglycaemia
Question 53
Which is a more sensitive measure of thyroid function?
A
Free T3
B
Thyroid Stimulating Hormone (TSH)
C
Free T4
Question 53 Explanation: 
The adequate amount of free T3 & T4 in the blood varies significantly between patients. As a result the TSH value provides a sensitive indicator of whether a patients individual thyroid hormone levels are adequate for them.

If a patient has the correct amount of T3 & T4, their TSH value will be normal. However if the TSH is high or low it suggests that the level of thyroid hormones is not currently at the correct level for that patient. TSH is therefore an incredibly useful indicator when a patient has hypothyroidism and requires thyroxine. By monitoring the TSH value you can adjust the dose until TSH normalises, at which point you can be confident you are providing the patient with the correct amount of thyroid hormones.

Question 54
Which 1 of the following is the most common source of ectopic ACTH production in ectopic cushing’s syndrome?
A
Prostate cancer
B
Colon cancer
C
Small cell lung cancer
D
Large cell lung cancer
Question 54 Explanation: 
Most commonly Small Cell Lung Cancer is responsible for ectopic production of ACTH.
The tumour for some unknown reason has genes switched on which enable it to produce ACTH. This stimulates the Adrenal Cortex to produce increased levels of Cortisol. High levels of Cortisol give rise to the symptoms of Cushing’s Syndrome
Question 55
Which one of the following statements best defines dipsogenic diabetes insipidus?
A
Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary causing malfunction of the thirst mechanism
B
Dipsogenic diabetes insipidus is caused by a defect or damage to the hypothalamus causing malfunction of the thirst mechanism
C
Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary stalk causing malfunction of the hunger mechanism
D
Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary stalk causing malfunction of the thirst mechanism
Question 55 Explanation: 
Dipsogenic diabetes insipidus is caused by a defect or damage to the hypothalamus causing malfunction of the thirst mechanism. As a result the individual is excessively thirsty regardless of their fluid status. The individual therefore consumes large volumes of fluid which suppresses secretion of vasopressin and increases urine output
Question 56
Which of the following statements regarding cushing’s syndrome is correct?
A
Women are more likely to develop cushing’s syndrome
B
The incidence of cushing’s syndrome is distributed equally between sexes
C
Men are more likely to develop cushing’s syndrome
Question 57
Which of the following are functions of cortisol?
A
Increase blood glucose levels
B
Decrease blood glucose levels
C
Suppress immune function
D
Improve immune function
E
Stimulation of gluconeogenesis
Question 57 Explanation: 
Cortisol is produced in response to stress or low blood glucocorticoid levels. It’s main functions are to increase blood glucose by promoting gluconeogenesis and suppress the immune system by silencing white blood cells.
Question 58
“With metformin there is significant risk of hypoglycaemia”
A
True
B
False
Question 58 Explanation: 
Metformin only increases insulin sensitivity and doesn’t actually cause increased production or release of insulin. As a result it does not cause hypoglycaemia.
Question 59
Which of the following are commonly used in the treatment of diabetic ketoacidosis?
A
Atenolol
B
Bicarbonate
C
Hydrocortison
D
Insulin
E
Saline
F
Activated charcoal
G
Potassium
Question 59 Explanation: 
The main aims of treatment are to reduce blood glucose & ketone levels using insulin whilst correcting dehydration & other electrolyte abnormalities
Question 60
Which 1 of the following statements describes the underlying pathology of Grave’s disease?
A
Inflammation of the thyroid gland due to infections or lymphocytic infiltration causes the stored thyroid hormones to all be released into the circulation leading to hyperthyroidism and usually thyrotoxicosis
B
An autoimmune disease directed against Thyroid Stimulating Hormone (TSH) receptors. The autoantibodies stimulate the TSH receptors causing ↑ T3 & T4 production.
C
Consumption of ground beef which has been contaminated with thyroid tissue. The thyroid tissue contains metabolically active thyroid hormones which causes the hyperthyroidism
D
A benign tumour of the thyroid gland which produces excessive amounts of thyroid hormones
Question 61
Which one of the following statements best describes an addisonian crisis?
A
Severe adrenal insufficiency resulting in dangerously low serum cortisol levels
B
Dangerously high serum cortisol levels
C
Dangerously high levels of testosterone
D
Severe adrenal insufficiency resulting in dangerously low serum testosterone levels
Question 62
Which of the following are common symptoms of hypothyroidism?
A
Excessive hair growth
B
Weight loss
C
Weight gain
D
Decreased tendon reflexes
E
Hair loss
F
Oily skin
G
Dry skin
Question 63
“Studies of identical twins have shown 95% concordance of developing type 1 diabetes, demonstrating that environment plays an insignificant role”
A
False
B
True
Question 63 Explanation: 
Studies of identical twins have shown only 30% concordance of developing type 1 diabetes. This suggests that the environment plays a very important role in the development of the disease. It has been suggested that a virus may trigger the disease in genetically susceptible individuals. This is thought to occur due to a virus having similar antigens to the pancreatic beta cells causing inappropriate immune activation. The Coxsackie virus is one organism which has been implicated as a trigger in some cases
Question 64
Which of the following are not causes of Neurogenic Diabetes Insipidus?
A
Polycystic Kidney Disease
B
Mutatations in the vasopressin (ADH) receptor gene
C
Sheehan’s Syndrome
D
Mutatations in the vasopressin gene
E
Meningitis
F
Trauma
G
Pituitary adenoma
Question 64 Explanation: 
Anything which affects the pituitary and it’s production of vasopressin can ultimately cause Neurogenic Diabetes Insipidus. Mutations in the ADH receptor gene and Poly Cystic Kidneys are both causes of Nephrogenic Diabetes Insipidus
Question 65
Which one of the following is the main function of aldosterone?
A
Decrease in blood volume
B
Increase in blood volume
Question 65 Explanation: 
Aldosterone causes reabsorption of sodium and water as well as causing excretion of potassium. This results an increase in blood volume and blood pressure.
Question 66
Which of the following are signs of acromegaly?
A
Decrease in foot size
B
Crowded teeth
C
Oily skin
D
Visual field defects e.g. Bi-temporal Heminopia
E
Prominent supraorbital ridge
F
Enlargement of tongue (macroglossia)
G
Enlargement of hands & fingers
H
Increased jaw prominence
I
Decrease in tongue size (microglossia)
J
Enlargement of feet
Question 66 Explanation: 
The signs of acromegaly can be very obvious if the disease has been active for a significant amount of time. The changes in facial features and voice can be very disturbing for the patient as these are most often irreversible.
Question 67
Which of the following are clinical features of diabetic ketoacidosis?
A
Breath smells of pear drops
B
Severe hyperglycaemia
C
Severe hypokalaemia
D
Cerebral oedema
E
Coma
F
Severe hypoglycaemia
G
Kussmaul respiration (deep gasping breaths)
H
Severe abdominal pain
Question 68
Which of the following statements best describes the mechanism of action of Sulfonylureas such as Gliclazide?
A
The drug binds to PPAR’s (peroxisome proliferator-activated receptors) When PPAR’s are activated they cause transcription of a number of genes. These activated genes ultimately result in decreased insulin resistance
B
It works by binding to pancreatic beta cells & causing increased release of insulin
C
Increases insulin sensitivity, allowing endogenous insulin to better do it’s job The drug decreases hepatic gluconeogenesis whilst increasing muscle glucose uptake
Question 69
Which of the following are causes of Addison’s disease?
A
Adrenoleukodystrophy
B
Malignancy
C
Pyelonephritis
D
Autoimmune destruction
E
Tuberculosis
Question 70
Which of the following drugs does NICE recommend as first line therapy for overweight patients with type 2 diabetes?
A
Exenatide
B
Rosiglitazone
C
Metformin
D
Gliclazide
Question 70 Explanation: 
Metformin is the 1st line therapy for overweight/obese patients with type 2 diabetes. It increases insulin sensitivity, allowing their endogenous insulin to better do it’s job. The drug decreases hepatic gluconeogenesis whilst increasing muscle glucose uptake
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