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Endocrinology quiz

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