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Endocrinology Quiz

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Question 1
Which of the following are not symptoms of Diabetes Insipidus?
A
Production of highly concentrated urine (>300 mOsmol/Kg)
B
Minimal urination
C
Excessive thirst
D
Production of dilute urine (<300 mOsmol/Kg)
E
Nocturia
F
Excessive urination
G
Dehydration
Question 2
The gene IDDM1 is thought to be strongly associated with the development of Type 1 Diabetes
A
False
B
True
Question 3
What do Leydig cells produce?
A
Androgen Binding Globulin
B
Testosterone
C
Semen
D
Oestrogen
Question 4
Will patients who develop type 1 diabetes will require lifelong insulin?
A
No
B
Yes
Question 5
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 6
What is Addison's disease?
A
Addison's disease involves the underproduction of androgens by the adrenal medulla
B
Addison's disease involves the underproduction of cortisol and aldosterone by the adrenal cortex
C
Addison's disease involves the overproduction of cortisol and aldosterone by the adrenal cortex
D
Addison's disease involves the overproduction of androgens by the adrenal medulla
Question 7
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 7 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 8
Which of the following are common symptoms of hyperthyroidism?
A
Diarrhoea
B
Urinary frequency
C
Weight loss
D
Heat intolerance
E
Tremor
F
Weight gain
Question 8 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 9
Which of the following is used as a first line therapy for neurogenic diabetes insipidus?
A
Synacthen (synthetic ACTH)
B
Desmopressin
C
Somatostatin
D
Hydrocortisone
Question 9 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 10
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 vasopressinase by the foetus
C
Production of vasopressinase by the placenta
D
Production of ACTH by the placenta
E
Production of vasopressin by the placenta
Question 10 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 11
Which one of the following statements best defines dipsogenic diabetes insipidus?
A
Dipsogenic diabetes insipidus is caused by a defect or damage to the hypothalamus causing malfunction of the thirst mechanism
B
Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary stalk 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 causing malfunction of the thirst mechanism
Question 11 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 12
Which of the following are symptoms of acromegaly?
A
Abdominal distention
B
Excessive sweating (Hyperhydrosis)
C
Headache
D
Visual changes (double vision, reduced vision, tunnel vision)
E
Widespread rash
F
Vomiting
G
Diarrhoea
H
Increased finger ring size
I
Deepening voice
J
Tingling and weakness in hands
Question 12 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 13
Which one of the following is the main function of aldosterone?
A
Increase in blood volume
B
Decrease in blood volume
Question 13 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 14
Which of the following are symptoms of Type 1 Diabetes?
A
Decreased urination
B
Widespread erythematous rash
C
Decreased thirst
D
Weight loss
E
Polydipsia
F
Polyurea
Question 15
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 large volumes of dilute 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 small volumes of concentrated urine
Question 15 Explanation: 
Diabetes Insipidus is a disease characterised by the passage of large volumes (>3L/24hrs) of dilute urine (osmolality <300 mOsmol/Kg)
Question 16
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
Increases insulin sensitivity, allowing endogenous insulin to better do it’s job The drug decreases hepatic gluconeogenesis whilst increasing muscle glucose uptake
C
It works by binding to pancreatic beta cells & causing increased release of insulin
Question 17
Which of the following are causes of Nephrogenic Diabetes Insipidus?
A
Post obstructive uropathy
B
Mutations in Vasopressin gene
C
Amyloidosis
D
Sheehan's Syndrome
E
Mutations in the Vasopressin (ADH) receptor gene
F
Atenolol
G
Lithium
Question 17 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 18
Which one of the following statements best describes an addisonian crisis?
A
Dangerously high serum cortisol levels
B
Severe adrenal insufficiency resulting in dangerously low serum cortisol levels
C
Dangerously high levels of testosterone
D
Severe adrenal insufficiency resulting in dangerously low serum testosterone levels
Question 19
Which of the following does the adrenal cortex produce?
A
Aldosterone
B
Cortisol
C
Noradrenaline
D
Adrenaline
Question 19 Explanation: 
The adrenal cortex is responsible for the production of both cortisol and aldosterone. Adrenaline & Noradreniline are produced by the adrenal medulla
Question 20
Which of the following are common symptoms of hypothyroidism?
A
Weight loss
B
Dry skin
C
Hair loss
D
Excessive hair growth
E
Decreased tendon reflexes
F
Weight gain
G
Oily skin
Question 21
What is the most common cause of Primary Polydipsia?
A
Inability to produce vasopressin (ADH)
B
Psychological disorder
C
Defect in Vasopressin (ADH) receptors
D
Defect in Vasopressin gene
E
Overproduction of vasopressin (ADH)
Question 21 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 22
Which of the following is a fast acting insulin?
A
Novorapid
B
Glargine
Question 23
Which 1 of the following is the most common source of ectopic ACTH production in ectopic cushing's syndrome?
A
Large cell lung cancer
B
Small cell lung cancer
C
Prostate cancer
D
Colon cancer
Question 23 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 24
Which of the following are commonly used in the treatment of diabetic ketoacidosis?
A
Insulin
B
Saline
C
Hydrocortison
D
Atenolol
E
Bicarbonate
F
Activated charcoal
G
Potassium
Question 24 Explanation: 
The main aims of treatment are to reduce blood glucose & ketone levels using insulin whilst correcting dehydration & other electrolyte abnormalities
Question 25
Which of the following is a long acting insulin
A
Novorapid
B
Glargine
Question 26
Which of the following statements regarding cushing's syndrome is correct?
A
Women are more likely to develop cushing's syndrome
B
Men are more likely to develop cushing's syndrome
C
The incidence of cushing's syndrome is distributed equally between sexes
Question 27
Which is a more sensitive measure of thyroid function?
A
Thyroid Stimulating Hormone (TSH)
B
Free T3
C
Free T4
Question 27 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 28
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
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
C
A malignant tumour of the thyroid gland which produces excessive amounts of thyroid hormones. These always arise from the follicular cells of the thyroid
D
A benign tumour of the thyroid gland which produces excessive amounts of thyroid hormones. These always arise from the follicular cells of the thyroid.
Question 29
What is the current treatment of choice for acromegaly in otherwise healthy patients?
A
Somatostatin analogues
B
Watchful waiting
C
Trans-sphenoidal surgery
D
Growth Hormone Receptor Antagonists
Question 29 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 30
"With metformin there is significant risk of hypoglycaemia"
A
True
B
False
Question 30 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 31
Which of the following statements best describes diabetic ketoacidosis?
A
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.
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 alkylotic ketones as a byproduct and these build up in the blood causing a metabolic alkalosis.
C
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.
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 32
Which one of the following statements is true regarding the prevalence of acromegaly?
A
Acromegaly effects a similar number of men and women
B
Acromegaly affects twice as many women than men
C
Acromegaly affects twice as many men than women
Question 32 Explanation: 
The prevalence of acromegaly is equally distributed between sexes.
Question 33
Which of the following are Sertoli cells responsible for producing?
A
Oestrogen
B
Gonadotrophin Releasing Hormone (GnRH)
C
Androgen Binding Globulin (ABG)
D
Testosterone
Question 34
Which of the following are signs of acromegaly?
A
Enlargement of hands & fingers
B
Prominent supraorbital ridge
C
Decrease in foot size
D
Enlargement of feet
E
Enlargement of tongue (macroglossia)
F
Visual field defects e.g. Bi-temporal Heminopia
G
Decrease in tongue size (microglossia)
H
Crowded teeth
I
Increased jaw prominence
J
Oily skin
Question 34 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 35
In males which hormone stimulates Sertoli cells to produce Androgen Binding Globulin (ABG)
A
Luteinizing hormone (LH)
B
Gonadotrophin Releasing Hormone (GnRH)
C
Oxytocin
D
Follicle Stimulating Hormone (FSH)
Question 35 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 36
Which of the following are clinical features of diabetic ketoacidosis?
A
Severe hypokalaemia
B
Kussmaul respiration (deep gasping breaths)
C
Severe abdominal pain
D
Severe hypoglycaemia
E
Breath smells of pear drops
F
Cerebral oedema
G
Coma
H
Severe hyperglycaemia
Question 37
Which one of the following is acromegaly caused by?
A
Overproduction of Vasopressin (Anti-diuretic Hormone)
B
Overproduction of Gonadotrophin Releasing Hormone (GnRH)
C
Overproduction of Growth Hormone (GH)
D
Overproduction of Adrenocorticotrophic Hormone (ACTH)
Question 37 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 38
Which of the following hormones are produced in the posterior pituitary gland?
A
Vasopressin (Anti-diuretic Hormone)
B
Growth Hormone (GH)
C
Luteinizing Hormone (LH)
D
Prolactin
E
Thyroid Stimulating Hormone (TSH)
F
Oxytocin
G
Follicle Stimulating Hormone (FSH)
H
Adrenocorticotrophic Hormone (ACTH)
Question 38 Explanation: 
The posterior pituitary gland is only responsible for producing oxytocin and vasopressin.
Question 39
In males which hormone stimulates Leydig cells to produce testosterone?
A
Luteinizing Hormone (LH)
B
Follicle Stimulating Hormone (FSH)
Question 40
What is the 5 year mortality rate for untreated cushing's syndrome?
A
10%
B
40%
C
20%
D
50%
E
30%
Question 40 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 41
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 ACTH High levels of ACTH in turn caused increased release of Cortisol from the Adrenal Cortex
B
Cushing’s disease results from a benign pituitary adenoma secreting excess levels of cortisol
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 adrenal adenoma secreting excess levels of cortisol
Question 42
Which of the following is not a symptom of cushings syndrome?
A
Stretch marks
B
Easy bruising
C
Weight gain
D
Acne
E
Increased pigmentation of skin
Question 42 Explanation: 
Increased pigmentation of skin is not a symptom of cushings syndrome. Instead the symptom may indicate the presence of Addisons disease.
Question 43
Which of the following are not causes of Neurogenic Diabetes Insipidus?
A
Sheehan's Syndrome
B
Trauma
C
Polycystic Kidney Disease
D
Pituitary adenoma
E
Mutatations in the vasopressin (ADH) receptor gene
F
Mutatations in the vasopressin gene
G
Meningitis
Question 43 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 44
In regard to the investigation of hyperthyroidism, which 1 of the following antibodies is specific to Grave's disease?
A
Thyroglobulin antibody (Tg Ab)
B
TSH receptor antibodies
C
Thyroid Peroxidase antibody (TPO Ab)
Question 44 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 45
Which of the following is the underlying problem in neurogenic diabetes insipidus?
A
Overproduction of Prolactin
B
Lack of Oxytocin
C
Lack of Vasopressin (Anti-diuretic Hormone)
D
Overproduction of Oxytocin
E
Lack of Prolactin
F
Overproduction of Vasopressin (Anti-diuretic Hormone)
Question 45 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 46
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 46 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 47
Which of the following causes of Hyperthyroidism is the most common?
A
Toxic Multi-nodular Goitre
B
Toxic Thyroid Adenoma
C
Thyroiditis
D
Graves disease
Question 48
Which of the following hormones are produced by the adrenal cortex?
A
Epinephrine (Adrenaline)
B
Norepinephrine (Noradrenaline)
C
5-DHEA
D
Cortisol
E
Aldosterone
Question 48 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 49
Which of the following hormones are produced in the anterior pituitary gland?
A
Oxytocin
B
Adrenocorticotrophic hormone (ACTH)
C
Growth hormone (GH)
D
Thyroid Stimulating Hormone (TSH)
E
Luteinizing Hormone (LH)
F
Prolactin
G
Follicle Stimulating Hormone (FSH)
H
Vasopressin (Anti-diuretic Hormone)
Question 49 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 50
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
Stress
B
High serum TSH
C
High serum aldosterone
D
Alcoholism
E
Eating disorders
Question 51
Which of the following statements best describes the mechanism of action of Thiazolidinediones such as Rosiglitazone?
A
It increases insulin sensitivity, allowing endogenous insulin to better do it’s job. It also decreases hepatic gluconeogenesis whilst increasing muscle glucose uptake
B
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
C
It works by binding to pancreatic beta cells & causing increased release of insulin
Question 52
Which 1 of the following statements describes the underlying pathology of Grave's disease?
A
An autoimmune disease directed against Thyroid Stimulating Hormone (TSH) receptors. The autoantibodies stimulate the TSH receptors causing ↑ T3 & T4 production.
B
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
C
A benign tumour of the thyroid gland which produces excessive amounts of thyroid hormones
D
Consumption of ground beef which has been contaminated with thyroid tissue. The thyroid tissue contains metabolically active thyroid hormones which causes the hyperthyroidism
Question 53
Which of the following are symptoms of addison's disease?
A
Striae
B
Fatigue
C
Moon face
D
Weight loss
E
Hyperpigmentation
F
Diplopia
G
Postural hypotension
H
Weight gain
Question 53 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 54
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 54 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 55
Which of the following statements correctly describes the pathology of type 1 diabetes?
A
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.
B
Disorder of metabolism characterised by high levels of glucose in the blood as a result of insulin resistance and insulin deficiency
Question 56
What is the recommended definitive treatment for cushing's disease?
A
Somatostatin Analogues
B
Adrenalectomy
C
Trans-sphenoidal surgery
Question 56 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 57
What HBA1C level are patients recommended to aim for?
A
<15%
B
<12%
C
<7.5%
D
<10%
Question 58
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 59
"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 59 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 60
Which of the following are causes of Addison's disease?
A
Malignancy
B
Autoimmune destruction
C
Pyelonephritis
D
Adrenoleukodystrophy
E
Tuberculosis
Question 61
Which of the following statements best describes cushing's syndrome?
A
Cushing’s Syndrome refers to a disease process caused by abnormally high levels of Cortisol
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 low levels of aldosterone
Question 61 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 62
Which 1 of the following hormones binds to the pituitary and stimulates the release of Luteinizing Hormone (LH) & Follicle Stimulating Hormone (FSH)?
A
Gonadotrophin Releasing Hormone (GnRH)
B
Corticotrophic Releasing Hormone (CRH)
C
Adrenocorticotrophic Hormone (ACTH)
Question 62 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 63
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 63 Explanation: 
Cushing's disease refers specifically to cushing's syndrome occuring as a result of a pituitary adenoma.
Question 64
What is the most common cause for the overproduction of growth hormone in acromegaly?
A
Hypothalamic lesion
B
Pituitary adenoma
C
Pituitary lesion
D
Hyperplasia of the pituitary stalk
Question 64 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 65
Which 1 of the following is the most useful investigation to screen for cushing's syndrome?
A
ACTH Stimulation Test
B
Oral Glucose Tolerance Test
C
Dexamethasome suppression test
D
Ultrasound of Adrenal Glands
E
MRI of pituitary fossa
Question 65 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 66
Which of the following are not signs of cushings syndrome?
A
Reduced visual fields
B
Moon face
C
Prominent supraorbital ridge
D
Central obestiy with relative sparing of limbs
E
Proximal muscle weakness
F
Buffalo hump
Question 66 Explanation: 
Both prominent supraorbital ridge and reduced visual fields are not signs of Cushing's Syndrome. Instead they are often seen in Acromegaly.
Question 67
Which of the following drugs does NICE recommend as first line therapy for overweight patients with type 2 diabetes?
A
Metformin
B
Exenatide
C
Rosiglitazone
D
Gliclazide
Question 67 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
Question 68
Which of the following investigations is the gold standard for diagnosing acromegaly?
A
Growth Hormone Releasing Hormone Measurement
B
Serum IGF1 Measurement
C
Growth Hormone measurement
D
Oral Glucose Tolerance Test + Growth Hormone measurement
Question 68 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 69
Which of the following are functions of cortisol?
A
Increase blood glucose levels
B
Suppress immune function
C
Stimulation of gluconeogenesis
D
Improve immune function
E
Decrease blood glucose levels
Question 69 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 70
Which 1 of the following is the most common cause of cushing's syndrome?
A
Ectopic ACTH production
B
Pituitary adenoma
C
Adrenal adenoma
D
Glucocorticoid treatment
Question 70 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.
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