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Endocrinology quiz

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Question 1
Which of the following causes of Cushing's syndrome does the phrase "Cushing's disease" specifically refer to?
A
Iatrogenic
B
Adrenal adenoma
C
Ectopic ACTH production
D
Pituitary adenoma
Question 1 Explanation: 
Cushing's disease refers specifically to Cushing's syndrome occurring as a result of a pituitary adenoma.
Question 2
Which of the following investigations is the gold standard for diagnosing acromegaly?
A
Growth hormone measurement
B
Oral glucose tolerance test + Growth hormone measurement
C
Serum IGF1 measurement
D
Growth hormone releasing hormone measurement
Question 2 Explanation: 
Serum IGF 1 measurement is useful to screen for acromegaly however is not ideal for diagnosis. Measuring growth hormone alone is not useful as it is secreted in a pulsatile matter therefore levels vary greatly throughout the day. The oral glucose tolerance test combined with growth hormone measurement is the ideal combination of investigations to make the diagnosis.
Question 3
Which of the following are Sertoli cells responsible for producing?
A
Gonadotrophin Releasing Hormone (GnRH)
B
Androgen Binding Globulin (ABG)
C
Testosterone
D
Oestrogen
Question 4
In males which hormone stimulates Sertoli cells to produce androgen binding globulin (ABG)?
A
Follicle stimulating hormone (FSH)
B
Luteinizing hormone (LH)
C
Gonadotrophin releasing hormone (GnRH)
D
Oxytocin
Question 4 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 5
Which of the following are causes of nephrogenic diabetes insipidus?
A
Mutations in vasopressin gene
B
Lithium
C
Mutations in the vasopressin (ADH) receptor gene
D
Sheehan's syndrome
E
Post obstructive uropathy
F
Amyloidosis
G
Atenolol
Question 5 Explanation: 
Nephrogenic diabetes insipidus involves the inability for the kidneys to respond appropriately the vasopressin (ADH). Anything which impairs the kidney's ability to respond to ADH has the potential to cause nephrogenic diabetes insipidus.
Question 6
Which of the following is the underlying problem in neurogenic diabetes insipidus?
A
Lack of prolactin
B
Lack of oxytocin
C
Overproduction of vasopressin (antidiuretic hormone)
D
Lack of vasopressin (antidiuretic hormone)
E
Overproduction of oxytocin
F
Overproduction of prolactin
Question 6 Explanation: 
In neurogenic diabetes insipidus the underlying pathology involves the lack of vasopressin production by the posterior pituitary.
Question 7
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 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 high levels of cortisol
D
Cushing’s syndrome refers to a disease process caused by abnormally low levels of aldosterone
Question 7 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 different causes.
Question 8
Which of the following statements regarding Cushing's syndrome is correct?
A
The incidence of Cushing's syndrome is distributed equally between sexes
B
Women are more likely to develop Cushing's syndrome
C
Men are more likely to develop Cushing's syndrome
Question 9
What is the most common cause of hyperthyroidism?
A
Toxic thyroid adenoma
B
Grave's disease
C
Toxic multinodular goitre
D
Thyroiditis
Question 10
Which of the following are symptoms of acromegaly?
A
Increased finger ring size
B
Diarrhoea
C
Excessive sweating (hyperhidrosis)
D
Visual changes (double vision, reduced vision, tunnel vision)
E
Vomiting
F
Paresthesia and weakness in the hands
G
Headache
H
Abdominal distention
I
Deepening voice
J
Widespread rash
Question 10 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 their symptoms.
Question 11
Which of the following are symptoms of Addison's disease?
A
Weight loss
B
Striae
C
Postural hypotension
D
Fatigue
E
Hyperpigmentation
F
Diplopia
G
Weight gain
H
Moon face
Question 11 Explanation: 
The lack of cortisol results in significant weight loss in the majority of patients. 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 12
Which of the following statements correctly describes the pathophysiology of Cushing's disease?
A
Cushing’s disease results from a benign pituitary adenoma secreting excess ACTH. High levels of ACTH in turn causes increased production 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 adrenal adenoma secreting excess ACTH. High levels of ACTH in turn cause increased production of cortisol from the adrenal cortex.
D
Cushing’s disease results from a benign adrenal adenoma secreting excess levels of cortisol.
Question 13
Which of the following are not causes of neurogenic diabetes insipidus?
A
Pituitary adenoma
B
Polycystic kidney disease
C
Sheehan's syndrome
D
Trauma
E
Mutatations in the vasopressin (ADH) receptor gene
F
Meningitis
G
Mutatations in the vasopressin gene
Question 13 Explanation: 
Anything which effects the pituitary and its production of vasopressin can ultimately cause neurogenic diabetes insipidus. Mutations in the ADH receptor gene and polycystic kidneys are both causes of nephrogenic diabetes insipidus.
Question 14
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, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones.
D
Addison's disease involves the overproduction of cortisol and aldosterone by the adrenal cortex.
Question 15
Which of the following are causes of Addison's disease?
A
Pyelonephritis
B
Autoimmune destruction of the adrenal cortex
C
Adrenoleukodystrophy
D
Tuberculosis
Question 16
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 vasopressin from the adrenal glands
B
Increased levels of growth hormone stimulate increased production of insulin like growth factor one (IGF1) from the adrenal glands
C
Increased levels of growth hormone stimulate increased production of insulin like growth factor one (IGF1) from the liver
D
Increased levels of growth hormone stimulate increased production of vasopressin from the liver
Question 16 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.
Question 17
Which is a more sensitive measure of thyroid function?
A
Thyroid stimulating hormone (TSH)
B
Free T4
C
Free T3
Question 17 Explanation: 
The adequate amount of free T3 and 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 18
Which one of the following hormones binds to the pituitary and stimulates the release of luteinizing hormone (LH) and follicle stimulating hormone (FSH)?
A
Adrenocorticotropic hormone (ACTH)
B
Corticotropic releasing hormone (CRH)
C
Gonadotrophin releasing hormone (GnRH)
Question 18 Explanation: 
1. The hypothalamus secretes GnRH 2. GnRH travels down to the anterior pituitary gland 3. It binds to receptors in the pituitary gland 4. This causes release of LH and FSH
Question 19
In males which hormone stimulates Leydig cells to produce testosterone?
A
Luteinizing hormone (LH)
B
Follicle stimulating hormone (FSH)
Question 20
What is the most common cause for the overproduction of growth hormone in acromegaly?
A
Pituitary lesion
B
Pituitary adenoma
C
Hypothalamic lesion
D
Hyperplasia of the pituitary stalk
Question 20 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 21
Which of the following are common symptoms of hyperthyroidism?
A
Weight loss
B
Diarrhoea
C
Heat intolerance
D
Urinary frequency
E
Weight gain
F
Tremor
Question 21 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 22
Which one of the following is the main function of aldosterone?
A
Decrease in blood volume
B
Increase in blood volume
Question 22 Explanation: 
Aldosterone causes reabsorption of sodium and water as well as causing excretion of potassium. This results in an increase in blood volume.
Question 23
What is the most common cause of Cushing's syndrome?
A
Adrenal adenoma
B
Glucocorticoid treatment (iatrogenic)
C
Pituitary adenoma
D
Ectopic ACTH production
Question 23 Explanation: 
The most common cause of Cushing's 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 with the minimum dose possible.
Question 24
Which one of the following is acromegaly caused by?
A
Overproduction of vasopressin (antidiuretic hormone)
B
Overproduction of gonadotrophin releasing hormone (GnRH)
C
Overproduction of growth hormone (GH)
D
Overproduction of adrenocorticotropic hormone (ACTH)
Question 24 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 25
Which of the following are signs of acromegaly?
A
Prominent supraorbital ridge
B
Enlargement of tongue (macroglossia)
C
Decrease in tongue size (microglossia)
D
Decrease in foot size
E
Increased jaw prominence
F
Crowded teeth
G
Oily skin
H
Enlargement of feet
I
Visual field defects e.g. Bi-temporal Heminopia
J
Enlargement of hands & fingers
Question 25 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 26
Which of the following hormones are produced in the anterior pituitary gland?
A
Prolactin
B
Vasopressin (Antidiuretic hormone)
C
Oxytocin
D
Luteinizing hormone (LH)
E
Thyroid stimulating hormone (TSH)
F
Growth hormone (GH)
G
Follicle stimulating hormone (FSH)
H
Adrenocorticotrophic hormone (ACTH)
Question 26 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 27
What of the following statements best describes a toxic thyroid adenoma?
A
A malignant tumour of the thyroid gland which produces excessive amounts of thyroid hormones. These arise from the follicular cells of the thyroid gland.
B
Inflammation of the thyroid gland due to lymphocytic infiltration causing stored thyroid hormones to be released into the circulation leading to hyperthyroidism.
C
An autoimmune disease directed against thyroid stimulating hormone (TSH) receptors. The autoantibodies stimulate the TSH receptors causing increased T3 and T4 production
D
A benign tumour of the thyroid gland which produces excessive amounts of thyroid hormones. These arise from the follicular cells of the thyroid.
Question 28
In regard to the investigation of hyperthyroidism, which one of the following antibodies is specific to Grave's disease?
A
Thyroid peroxidase antibody
B
Thyroglobulin antibody
C
TSH receptor antibodies
Question 28 Explanation: 
TSH receptor antibodies are highly specific for Grave's disease. The other two antibodies can be found in both Grave's and Hashimoto's thyroiditis.
Question 29
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
Severe adrenal insufficiency resulting in dangerously low serum testosterone levels
D
Dangerously high levels of testosterone
Question 30
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 gland 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 30 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 31
Which of the following does the adrenal cortex produce?
A
Aldosterone
B
Noradrenaline
C
Adrenaline
D
Cortisol
Question 31 Explanation: 
The adrenal cortex is responsible for the production of both cortisol and aldosterone. Adrenaline and noradrenaline are produced by the adrenal medulla.
Question 32
Which of the following statements best describes Hashimoto's thyroiditis?
A
Inflammation of the thyroid gland as the result of a virus. The disease is often preceded by an upper respiratory tract infection.
B
A destructive autoimmune disease caused by auto-reactive antibodies against thyroglobulin.
C
Iodine deficiency
Question 33
Which of the following is not a symptom of Cushing's syndrome?
A
Stretch marks
B
Acne
C
Weight gain
D
Increased pigmentation of skin
E
Easy bruising
Question 33 Explanation: 
Increased pigmentation of skin is not a symptom of Cushing's syndrome. Hyperpigmentation is associated with Addison's disease.
Question 34
Which age group does acromegaly most commonly affect?
A
30-50 years
B
25-40 years
C
55-70 years
D
10-25 years
Question 34 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 35
Which of the following hormones are produced in the posterior pituitary gland?
A
Oxytocin
B
Thyroid stimulating hormone (TSH)
C
Follicle stimulating hormone (FSH)
D
Prolactin
E
Vasopressin (antidiuretic hormone)
F
Growth hormone (GH)
G
Luteinizing hormone (LH)
H
Adrenocorticotropic hormone (ACTH)
Question 35 Explanation: 
The posterior pituitary gland is only responsible for producing oxytocin and vasopressin.
Question 36
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 36 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 37
What do Leydig cells produce?
A
Testosterone
B
Androgen binding globulin
C
Oestrogen
D
Semen
Question 38
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 concentrated urine
D
Diabetes insipidus is a disease characterised by the passage of small volumes of dilute urine
Question 38 Explanation: 
Diabetes insipidus is a disease characterised by the passage of large volumes (>3L/24hrs) of dilute urine (osmolality <300 mOsmol/Kg).
Question 39
Which one of the following statements is true regarding the prevalence of acromegaly?
A
Acromegaly affects twice as many women than men
B
Acromegaly affects twice as many men than it does women
C
Acromegaly effects a similar number of men and women
Question 39 Explanation: 
The prevalence of acromegaly is equally distributed between sexes.
Question 40
Which of the following are common symptoms of hypothyroidism?
A
Hair loss
B
Oily skin
C
Hyporeflexia
D
Dry skin
E
Weight gain
F
Weight loss
G
Excessive hair growth
Question 41
Which one of the following statements describes the underlying pathology of Grave's disease?
A
A benign tumour of the thyroid gland which produces excessive amounts of thyroid hormones.
B
Consumption of ground beef which has been contaminated with thyroid tissue. The thyroid tissue contains metabolically active thyroid hormones which causes hyperthyroidism.
C
Inflammation of the thyroid gland due to lymphocytic infiltration causes the stored thyroid hormones to be released into the circulation leading to hyperthyroidism.
D
An autoimmune disease directed against thyroid stimulating hormone (TSH) receptors. The autoantibodies stimulate the TSH receptors causing increased T3 and T4 production.
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