Mock Endocrinology Module 1

An 80 year old female presents to the emergency department acutely unwell after being found unresponsive on the floor of her house by her son. She had a past history of hypothyroidism and was taking thyroxine daily. However, her compliance with treatment is questionable.

On examination, she was unrouseable with a Glasgow Coma Scale of 6/15, had a central temperature of 34oC, Oxygen saturations of 95% on air, a pulse of 44 beats per minute and a blood pressure of 100/80 mmHg.

Both plantar responses were extensor.

Prior to results of her emergency blood tests being available, what is the most appropriate immediate treatment for this patient?

Intravenous Levothyroxine (T4)

Correct Incorrect Correct answer

Intravenous 50% Glucose

Correct Incorrect Correct answer

Intravenous Hydrocortisone

Correct Incorrect Correct answer

Intravenous Normal Saline

Correct Incorrect Correct answer

Broad spectrum antibiotics

Correct Incorrect Correct answer

A 33 year old nurse is admitted for prolonged fasting. She originally presented to clinic with a history of episodic sweating and light-headedness which had developed over a six month period with symptoms being entirely relieved by eating. She had developed one of these episodes whilst on the ward and a BM monitor showed a value of 2 mmol/l. She took some glucose tablets and had quickly recovered.

On examination, no specific abnormalities were found with a blood pressure of 118/74 mmHg, a pulse of 72 beats per minute and a BMI of 22 kg/m2. She was admitted for a 72 hour fast and at 3 am, 16 hours into the fast she develops typical symptoms.

Her BSL is measured at 2.2 mmol/l, the fast is stopped and bloods taken.

The following are her lab results:

Plasma Glucose 1.8 mmol/l (3 – 6)
Plasma 3-Beta-HydroxyButyrate 0.5 mmol/l (> 1 mmol/l)
Plasma Insulin 450 pmol/l (less than 21)
C-peptide 0.2 nmol/l (less than 0.5)

What is the most likely diagnosis?

Insulin treatment

Correct Incorrect Correct answer

Sulphonylurea treatment

Correct Incorrect Correct answer

Insulinoma

Correct Incorrect Correct answer

Non-islet cell tumour hypoglycaemia

Correct Incorrect Correct answer

Adult glycogen storage disease

Correct Incorrect Correct answer

An 18-year-old girl with oligomenorrhoea since menarche at age 14 presents with a six month history of increasing facial hair and deepening of the voice. There is mild clitoral enlargement on examination. Laboratory results show:

serum testosterone 5.0 [1.0 – 2.5 nmol/L]
SHBG 18 [30 – 80 g/dl]
DHEAS 10 [3 – 12]

What is the next most appropriate investigation to help establish the diagnosis?

Pelvic ultrasound

Correct Incorrect Correct answer

Dexamethasone suppression test

Correct Incorrect Correct answer

GnRH suppression test

Correct Incorrect Correct answer

Abdominal CT scan

Correct Incorrect Correct answer

Adrenal venous sampling

Correct Incorrect Correct answer

Empagliflozin is an established medication used in the treatment of Type 2 diabetes mellitus and is also indicated for heart failure and chronic kidney disease.

What is its primary mechanism of action?

Sodium glucose co-transporter 2 (SGLT-2) inhibitor.

Correct Incorrect Correct answer

Sodium glucose co-transporter 1 (SGLT-1) inhibitor

Correct Incorrect Correct answer

Glucagon-like peptide (GLP) agonist

Correct Incorrect Correct answer

Dipeptidyl Peptidase-4 (DPP-4) inhibitor

Correct Incorrect Correct answer

Alpha-glucosidase inhibitor

Correct Incorrect Correct answer

The SGLT-2 inhibitor used in the treatment of Type 2 diabetes may cause the following adverse effect:

Ketoacidosis

Correct Incorrect Correct answer

Severe Hypertension

Correct Incorrect Correct answer

Hyperuricemia

Correct Incorrect Correct answer

Heavy proteinuria

Correct Incorrect Correct answer

Elevated HBA1c level

Correct Incorrect Correct answer

Which of the following best describes the mechanism of action of Sitagliptin?

DPP-4 inhibitor

Correct Incorrect Correct answer

GLP-1 receptor agonist

Correct Incorrect Correct answer

Activation of the enzyme AMP-kinase

Correct Incorrect Correct answer

Interaction with PPAR-gamma

Correct Incorrect Correct answer

Reduces absorption of dietary carbohydrate.

Correct Incorrect Correct answer

Liraglutide is an analogue of human glucagon-like peptide 1 (GLP-1) which has a promising role for patients with type 2 diabetes.

Liraglutide causes the following effect, EXCEPT?

Reduces the pulse rate

Correct Incorrect Correct answer

Lowers blood glucose level

Correct Incorrect Correct answer

Weight reduction

Correct Incorrect Correct answer

Reduces blood pressure

Correct Incorrect Correct answer

Reduces risk of cardiovascular disease in diabetic patients

Correct Incorrect Correct answer

A diabetic patient is reported to have a Hemoglobin A1c level of 8.6% (based on the old DCCT format).

What is the new IFCC Hemoglobin A1c equivalent of this and the what is the closest mean glucose level (in mmol/l) that correlates with the above result?

Hemoglobin A1c of 65 and 10.4 mmol/L

Correct Incorrect Correct answer

Hemoglobin A1c of 100 and 15.4 mmol/L

Correct Incorrect Correct answer

Hemoglobin A1c of 80 and 9.6 mmol/L

Correct Incorrect Correct answer

Hemoglobin A1c of 65 and 10 mmol/L

Correct Incorrect Correct answer

Hemoglobin A1c of 90 and 13.9 mmol/L

Correct Incorrect Correct answer

A previously well 53-year-old caucasian lady is found to have a 2 cm right adrenal mass when undergoing a computed tomography (CT) scan for suspected hepatobiliary disease. On examination, she has signs of Cushing’s syndrome with a blood pressure of 150/90 mmHg.

The following laboratory test results are obtained:

serum sodium 140 mmol/L [133-144]
serum potassium 3.8 mmol/L [3.5-5.0]
serum creatinine 0.10 mmol/L [0.05-0.11]
serum early morning cortisol 200 ug/dl [10 to 20]
serum adrenocorticotrophic hormone 1 ng/L [9 to 52]
serum dehydroepiandrosterone 300 ug/dl [35-430]
urinary catecholamines 0.3 μmol/24 h [<0.6]
urinary free cortisol 380 nmol/24 h [100-400]
plasma renin activity 1.5 nmol/L/h [0.4-2.3]

What is the most likely cause of the adrenal mass?

Cortisol producing adenoma

Correct Incorrect Correct answer

Adrenal carcinoma

Correct Incorrect Correct answer

Adrenal metastases

Correct Incorrect Correct answer

Aldosterone producing adenoma

Correct Incorrect Correct answer

Non-functioning adrenal adenoma

Correct Incorrect Correct answer

In the diagnostic workup of Cushing’s syndrome, which of the following tests has the most limited utility in distinguishing between ACTH-dependent and ACTH-independent causes?

High dose dexamethasone suppression test

Correct Incorrect Correct answer

Urinary free cortisol

Correct Incorrect Correct answer

Plasma corticotropin

Correct Incorrect Correct answer

Plasma cortisol measurements

Correct Incorrect Correct answer

Low dose dexamethasone suppression test

Correct Incorrect Correct answer

A 65-year-old woman with longstanding rheumatoid arthritis, previous DVT and osteoporosis presents with a mid thoracic crush fracture. She has a history of two previous crush fractures and has been taking alendronate 70mg weekly for three months and is tolerating this medication well. She has a normal serum calcium, phosphate, albumin and 25 hydroxy-vitamin D. She has taken prednisone in the past.

Which of the following treatment is most appropriate for future fracture prevention?

Continue alendronate.

Correct Incorrect Correct answer

Continue alendronate and add raloxifene

Correct Incorrect Correct answer

Cease alendronate and commence intravenous pamidronate

Correct Incorrect Correct answer

Cease alendronate and commence romosozumab

Correct Incorrect Correct answer

Cease alendronate and commence risedronate

Correct Incorrect Correct answer

Assessing the anti-thyroglobulin antibodies is most useful in which of the following condition?

papillary thyroid cancer follow up

Correct Incorrect Correct answer

multinodular goitre

Correct Incorrect Correct answer

medullary thyroid cancer follow up

Correct Incorrect Correct answer

Grave's disease

Correct Incorrect Correct answer

neck pain

Correct Incorrect Correct answer

In monogenic diabetes, the following statement are all correct about GCK mutation (MODY2) except?

Sensitive to sulphonylureas

Correct Incorrect Correct answer

Isolated mild fasting hyperglycemia

Correct Incorrect Correct answer

Not associated with microvascular complications in absence of glucose lowering medication

Correct Incorrect Correct answer

Only 50% of mothers with GCK mutations will require insulin therapy during pregnancy if fetal growth is increased

Correct Incorrect Correct answer

Absence of family history is common.

Correct Incorrect Correct answer

The insulin analogue lispro (Humalog) has a more rapid onset of action compared to regular human insulin. This is because lispro:

does not form hexamers subcutaneously

Correct Incorrect Correct answer

is a smaller sized molecule.

Correct Incorrect Correct answer

is more lipophilic

Correct Incorrect Correct answer

has greater affinity for the insulin receptor

Correct Incorrect Correct answer

is less protein-bound

Correct Incorrect Correct answer

Automated insulin delivery (AID) systems, also known as closed-loop or “artificial pancreas” technology, have become standard of care for many patients with Type 1 diabetes.

Which of the following best describes the expected outcomes with long-term use of current AID systems in adults?

Improved glucose control, reduced hypoglycaemia and lower glycated hemoglobin level.

Correct Incorrect Correct answer

Improved glucose control but with increased risk of hypoglycemia, and higher glycated hemoglobin level.

Correct Incorrect Correct answer

Improved glucose control and reduced hypoglycaemia but no effect on glycated hemoglobin level.

Correct Incorrect Correct answer

No difference in glucose control but reduced hypoglycaemia and lower glycated hemoglobin level.

Correct Incorrect Correct answer

Improved glucose control but with increased risk of hypoglycemia, with no effect on glycated hemoglobin level.

Correct Incorrect Correct answer

An 15-year-old male of Māori descent has type 1 diabetes. He is brought to the Emergency Department at 3 a.m. on Friday morning following a hypoglycaemic convulsion. On questioning, his parents report that he has rugby training on Thursday afternoons before dinner.

His insulin regimen is long acting insulin and a short acting insulin analogue given together at breakfast and dinner.

Which of the following would be the best advice to avoid recurrent nocturnal hypoglycaemia after rugby training?

Reduce the long acting insulin dose at dinner

Correct Incorrect Correct answer

Decrease his activity at rugby training

Correct Incorrect Correct answer

Increase the fat content of his dinner after rugby training

Correct Incorrect Correct answer

Reduce the long acting insulin dose at breakfast

Correct Incorrect Correct answer

Reduce the short acting insulin dose at dinner

Correct Incorrect Correct answer

What is the main site of Adiponectin production?

Adipose tissues

Correct Incorrect Correct answer

Nerve tissues

Correct Incorrect Correct answer

Cardiac muscle

Correct Incorrect Correct answer

Renal parenchyma

Correct Incorrect Correct answer

Adrenal gland

Correct Incorrect Correct answer

Which of the following parameter is most likely to decrease in the first trimester of pregnancy?

TSH

Correct Incorrect Correct answer

Total T4.

Correct Incorrect Correct answer

Free T4

Correct Incorrect Correct answer

Total T3

Correct Incorrect Correct answer

Free T3

Correct Incorrect Correct answer

In non thyroidal illness syndrome, which of the following is least likely to cause low T3 levels?

Dopamine

Correct Incorrect Correct answer

High cortisol level

Correct Incorrect Correct answer

Free fatty acids

Correct Incorrect Correct answer

Amiodarone

Correct Incorrect Correct answer

Propranolol

Correct Incorrect Correct answer

A 28 year old man presents to the emergency department with 3 days history of fever, malaise, neck pain and odynophagia. He also described episodes of palpitations and tremors of his hands.

Blood test shows low TSH and High T4.

What is the most likely diagnosis?

de Quervain's thyroiditis

Correct Incorrect Correct answer

Graves disease

Correct Incorrect Correct answer

Solitary toxic adenoma

Correct Incorrect Correct answer

Amiodarone induced thyrotoxicosis

Correct Incorrect Correct answer

Postpartum thyroiditis

Correct Incorrect Correct answer

Ultraviolet (UV) radiation (sunlight) acts on the skin to catalyse which of the following reaction?

7-dehydrocholesterol to vitamin D3 (cholecalciferol).

Correct Incorrect Correct answer

25-hydroxyvitamin-D to 1,25-dihydroxyvitamin D

Correct Incorrect Correct answer

Cholesterol to 7-dehydrocholesterol

Correct Incorrect Correct answer

Vitamin D2 (ergocalciferol) to vitamin D3 (cholecalciferol).

Correct Incorrect Correct answer

Vitamin D3 (cholecalciferol) to 25-hydroxyvitamin D.

Correct Incorrect Correct answer

The activity of some hormones are affected by the levels of specific carrier proteins.

Therefore, which of the following hormone is going to have a clinically significant effect as a result of having abnormal levels of carrier proteins?

Testosterone.

Correct Incorrect Correct answer

Adrenocorticotrophic hormone (ACTH).

Correct Incorrect Correct answer

Cortisol.

Correct Incorrect Correct answer

Growth hormone (GH)

Correct Incorrect Correct answer

Parathyroid hormone (PTH).

Correct Incorrect Correct answer

An asymptomatic patient presents for investigation of hypercalcaemia.

His mother has a similar diagnosis three years ago. She had a parathyroidectomy that was unsuccessful in treating her raised calcium level.

Serum Calcium is 2.8 (2.1 – 2.6 mmol/L), Phosphate is 0.8 (0.75- 1.45 mmol/L), PTH is normal.

What is the most appropriate investigation?

24 hour urine for urinary calcium excretion

Correct Incorrect Correct answer

Genetic test for MEN-1

Correct Incorrect Correct answer

Parathyroid gland imaging

Correct Incorrect Correct answer

Serum ACE concentration

Correct Incorrect Correct answer

Repeat PTH

Correct Incorrect Correct answer

A 27-year-old woman with type 1 diabetes presents for review and reports frequent unexplained hypoglycaemic episodes in the past three weeks.

What is the most important test to do?

Beta-HCG

Correct Incorrect Correct answer

HbA1c

Correct Incorrect Correct answer

Celiac antibodies

Correct Incorrect Correct answer

Continuous blood glucose monitoring

Correct Incorrect Correct answer

TSH

Correct Incorrect Correct answer

Which of the following patient group is least likely to benefit from oral Risedronate?

The 50 year old patient on 5mg of prednisone for a month.

Correct Incorrect Correct answer

The 45 year old patient with a previous fragility fracture taking 10mg of prednisone for 12 months

Correct Incorrect Correct answer

The 60 year old patient with a T-score of -1.5 on 8mg of prednisone for 6 months

Correct Incorrect Correct answer

The 50 year old postmenopausal women with a T score of -2.5

Correct Incorrect Correct answer

The 70 year old patient on 10mg of prednisone for 6 months.

Correct Incorrect Correct answer

A 42-year old woman returned from a holiday in Greece in July. It is now 3 months following her return , but yet her tan has not yet faded. She has also noticed discolouration of her gums.She is on thyroxine for autoimmune thyroiditis and is fatigued despite being optimally replaced.

You suspect she has Addisons’s disease.

What would be the BEST test to perform to confirm the diagnosis?

ACTH challenge test (Synacthen test)

Correct Incorrect Correct answer

Adrenal antibodies

Correct Incorrect Correct answer

ACTH concentration

Correct Incorrect Correct answer

Morning cortisol level

Correct Incorrect Correct answer

24 hour urinary free cortisol

Correct Incorrect Correct answer

What is the best marker of tumor recurrence following removal of papillary thyroid cancer?

Thyroglobulin

Correct Incorrect Correct answer

TSH

Correct Incorrect Correct answer

TSH receptor antibody

Correct Incorrect Correct answer

T4

Correct Incorrect Correct answer

Thyroxine peroxidase antibody

Correct Incorrect Correct answer

What is the best investigation for persistent thyroid cancer?

Neck ultrasound and thyroglobulin.

Correct Incorrect Correct answer

rhTSH stimulated thyroglobulin alone.

Correct Incorrect Correct answer

Neck ultrasound

Correct Incorrect Correct answer

Whole body scan

Correct Incorrect Correct answer

Whole body scan and rhTSH stimulated thyroglobulin.

Correct Incorrect Correct answer

A patient is highly suspected of having recurrent disease of his thyroid cancer following a high serum thyroglobulin. However his whole body scan was negative.

What should be the next step in management?

Arrange an FDG-PET.

Correct Incorrect Correct answer

Repeat neck USS

Correct Incorrect Correct answer

Repeat the serum thyroglobulin.

Correct Incorrect Correct answer

Repeat FNA biopsy

Correct Incorrect Correct answer

Follow up whole body scan in 3 months.

Correct Incorrect Correct answer

Hyperemesis gravidarum is mostly associated with which condition?

Hyperthyroidism

Correct Incorrect Correct answer

Hypercortisolism

Correct Incorrect Correct answer

Growth hormone excess

Correct Incorrect Correct answer

Hypoandrogenism

Correct Incorrect Correct answer

Hyperprolactinemia

Correct Incorrect Correct answer

Which of the following thyroid medication is associated with scalp defect(aplasia cutis) if used in pregnancy?

Methimazole

Correct Incorrect Correct answer

Carbimazole

Correct Incorrect Correct answer

Radioactive iodine

Correct Incorrect Correct answer

Popylthiouracil

Correct Incorrect Correct answer

Thyroxine

Correct Incorrect Correct answer

In non thyroidal illness syndrome, which of the following factor is least likely to cause low T3 levels?

Dopamine

Correct Incorrect Correct answer

high cortisol level

Correct Incorrect Correct answer

Free fatty acids

Correct Incorrect Correct answer

Amiodarone

Correct Incorrect Correct answer

Propranolol

Correct Incorrect Correct answer

A 52-year-old woman presents with a 2.5 cm thyroid nodule discovered incidentally on carotid ultrasound. Fine needle aspiration biopsy reveals papillary thyroid carcinoma. She undergoes total thyroidectomy with central lymph node dissection.

Histopathology confirms a 2.8 cm classical papillary thyroid carcinoma with extrathyroidal extension into the strap muscles and metastatic disease in 4 of 12 lymph nodes. She receives radioactive iodine ablation therapy.

Eighteen months later, surveillance reveals a rising serum thyroglobulin level (85 ng/mL) with negative anti-thyroglobulin antibodies. Neck ultrasound shows no local recurrence. Diagnostic whole-body radioiodine scan is negative. FDG-PET/CT demonstrates multiple FDG-avid pulmonary nodules and a 1.5 cm mediastinal lymph node, consistent with radioiodine-refractory metastatic papillary thyroid carcinoma.

Molecular testing of the original tumour specimen is requested to guide systemic therapy options.

Which of the following molecular alterations, if detected, would make this patient a candidate for dabrafenib plus trametinib combination therapy?

BRAF V600E mutation

Correct Incorrect Correct answer

RET fusion

Correct Incorrect Correct answer

NTRK gene fusion

Correct Incorrect Correct answer

RAS mutation

Correct Incorrect Correct answer

TERT promoter mutation

Correct Incorrect Correct answer

Mock Endocrinology Module 1

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

31. Question

32. Question

33. Question

Average score
Your score