Endo

Question 1

24yr woman has BMI of 35kg/m. The weight is evenly distributed. She has somewhat plethoric moon facies. Her blood pressure is 122/75mmHg. She has some non-pigmented abdominal striae. Proximal muscle power is normal. Her normal medication is the oral contraceptive pill.
An 8am cortisol measurement is 855nmol/L [125-695nmol/L]
What is the most likely explanation?
a. Laboratory measurement error
b. The contraceptive pill
c. Cushions syndrome
d. Alcohol

Answer 1

The contraceptive pill

Question 2

A 28 yr woman presents with weigh gain, tuncal obesity and a new diagnosis of type 2 diabetes. You suspect that she may have Cushing’s syndrome.
Which one of the following is the most appropriate screening test in this woman?
a. Random serum cortisol
b. 11pm serum ACTH
c. Short synacthen test
d. 24-hour urine free cortisol
e. 8am salivary cortisol

Answer 2

d. 24-hour urine free cortisol

Question 3

A 46hr Samoan woman with BMI of 38.2 kg presents with a polyuria and fatigue. You suspect that she might have undiagnosed diabetes. A screening HbA1c is 64mmol/L. She has normal renal function.
What is the most appropriate management?
a. Initiate insulin therapy with a basal insulin (e.g. once daily NPH insulin)
b. Initiate an SGLT2 inhibitor (e.g. empagliflozin)
c. Initiate a sulphonylurea (e.g. gliclazide)
d. Give diet and lifestyle advice and initiate a biguanide (e.g. metformin)
e. Give diet and lifestyle advice

Answer 3

d. Give diet and lifestyle advice and initiate a biguanide (e.g. metformin)

Question 4

Which one of the following is most suggestive of a diagnosis of Addison’s disease?
a. 8am plasma cortisol of 128nmol/L [125-695 nmol/L]
b. Post synacthen cortisol of 250 nmol/L
c. 24 hour urinary free cortisol 220nmol/L [0700-1100am sample < 46 ng./L]
d. Plasma Potassium of 4.8mmol/L [3.5 – 5.0 mmol/L]

Answer 4

b. Post synacthen cortisol of 250 nmol/L

Question 5

A 32 yr old woman is found to be hypertension with a BP of 172/92mmHg. She has excess ______ often wakes at night with numbness and tingling in her index and ring fingers on both hands.
Which one of the following tests is most likely to reveal a secondary cause of hypertension in this woman?
a. Plasma metanephrines
b. 24-hour urinary free cortisol
c. 24-hour urinary catecholamines
d. Plasma aldosterone: renin ration – screening test to detect primary aldosteronism in high risk, HTN individuals
e. Serum insulin like growth factor – 1 (IGF)

Answer 5

e. Serum insulin like growth factor – 1 (IGF)

Question 6

A 45 yr old woman presents with a two year history of hot flushes and amenorrhoea. Physical examination is unremarkable. Her visual fields are normal to confrontation and she doesnt not describe galactorrhoea.
Free t4 11.1 (10.5-21.2)
TSH 0.10 (0.35-3.60)
LH 0.2 (1.1-11.6)
FSH 1.0 (2.8-11.3)
Oestradiol <50 (200-2000)
Prolactin 620 (40-530)
IGF-1 9.9 (30-50)
Cortisol 237 (125-695)

What is the most likely explanation of her amenorrhoea?

Answer 6

a. Non-functioning pituitary macroadenoma
b. PCOS
c. Premature ovarian failure
d. Macroprolactinoma
e. Hypothyroidism

Question 7

In patients with pituitary apoplexy which is the most clinically important hormone deficiency?
a. Thyroid hormone
b. Cortisol
c. Aldosterone
d. Antidiuretic hormone
e. Growth hormone

Answer 7

Cortisol

Question 8

The visual pattern shown is most in keeping with which of the following lesions?
Bitemporal hemianopia

a. Pituitary microadenoma
b. Frontal meningioma
c. Optic neuroma
d. Craniopharyngioma
e. Occipital astrocytoma

Answer 8

d. Craniopharyngioma = a tumour from pituitary embryonic tissue

Question 9

Which one of the following is the most appropriate screening test when considering primary hyperaldosteronism?
a. Performing an intravenous saline suppression test
b. Measuring serum Potassium concentration
c. CT imaging of the adrenal glands
d. Measurement of plasma aldosterone to renin ratio
e. Measurement of plasma metanephrines

Answer 9

d. Measurement of plasma aldosterone to renin ratio

Question 10

Which of the following tests has the greatest specificity for growth hormone deficiency?
a. 8am serum growth hormone
b. 8am serum IGF-1
c. Growth Hormone levels following oral glucose tolerance test
d. Growth hormone levels following an insulin tolerance test
e. 24-hour urinary growth hormone levels

Answer 10

d. Growth hormone levels following an insulin tolerance test

Question 11

Which pituitary hormone is primarily regulated by an inhibitory signal from the hypothalamus?
a. GH
b. TSH
c. LH
d. Prolactin
e. Antidiuretic hormone

Answer 11

d. Prolactin

Question 12

T score -1.24 and -1.25 at lumbar and femoral

a. Osteoporosis at both lumbar spine and femoral neck
b. Osteopenia at both lumbar spine and femoral neck
c. Osteoporosis at lumbar spine and osteopenia at the femoral neck
d. Osteopenia at lumbar spine and osteoporosis at the femoral neck
e. Normal bone density

Question 13

Which of the features in her history and DEXA confers the greatest risk of a future insufficiency fracture?
a. Age
b. Smoking
c. Maternal osteroporosis
d. Existing fractured wrist
e. Bone density on DEXA

Answer 13

d. Existing fractured wrist

Question 14

In an ovulatory cycle, which of the following hormones has the greatest elevation in the luteal phase relative to the follicular phase of the menstrual cycle?
a. Gonadotropin release hormone
b. Luteinising hormone
c. Oestrogen
d. Progesterone
e. Prolactin

Answer 14

d. Progesterone

Question 15

A 28yr woman has an oral glucose tolerance test.

Fasting glucose 6.9
2hr glucose 10.8

Which one of the following is the most correct diagnosis?
a. Impaired fasting glucose
b. Type 2 diabetes
c. Impaired glucose tolerance
d. Gestational diabetes
e. Impaired fasting glucose and impaired glucose tolerance

Answer 15

e. Impaired fasting glucose and impaired glucose tolerance

Question 16

A 62yr mam with type 2 diabetes has microalbuminuria and his blood pressure is 140/90 mmHg. He is intolerant of an ACE inhibitor due to cough. What antihypertensive agent would you prescribe for this patient?
a. a blocker
b. b blocker
c. Ca channel blocker
d. ARB
e. Thiazide diuretic

Answer 16

ARB

Question 17

In which area of the brain are appetite and satiety predominantly regulated?
a. Pons
b. Amygdala
c. Hypothalamus
d. Anterior pituitary
e. Frontal lobe

Answer 17

Hypothalamus

Question 18

If a laboratory hormone assay is repeated three times on the same blood sample and provides really similar results, which of the following can be concluded?
a. The assay is precise
b. The assay is accurate
c. The result is clinically important
d. There is low intra-individual variability of the hormone
e. There is low inter-individual variability of the hormone

Answer 18

a. The assay is precise

Question 19

A 35yr Somalian woman who has been in NZ for 5 years is investigated for an incidental finding of low serum calcium. Her results are:
Corrected calcium 2.1 (2.15-2.55)
Phosphate 0.75 (0.78-1.43)
PTH 8.3 (1.8-5.6)
Creatinine 95 (49-90 in females)

24hr urinary calcium 1.2 (1-5)

a. Primary hyperparathyroidism
b. Familial hypocaliuric hypercalcaemia
c. Sarcoidosis
d. Renal impairment
e. Vitamin D deficiency

Answer 19

Vit D deficiency

Question 20

A 54yr man is investigated for an incidental finding of an elevated serum calcium. His results are:

correct Ca 2.59 (up)
PTH up
Vit D very slightly low
Creatinine N
24hr urinary Ca 4.2 (1-5)

What is the most likely explanation of this pattern?
a. Primary hyperparathyroidism
b. Familial hypocaliuric hypocalcaemia
c. Sarcoidosis
d. Malignancy
e. Vit D deficiency

Answer 20

Primary hyper-PTH

Question 21

A 24yr woman presents with palpitations and sweating. She has become increasingly anxious and not sleeping well. Her weight has reduced by 5kg down to 52kd. You suspect that she may be thyrotoxic. What is the first test you should do?
a. Thyroglobulin
b. TSH
c. Free T4
d. Thyroid ultrasound
e. Nuclear medicine thyroid scan

Answer 21

TSH

Question 22

A 45yr man presents with a lump in his neck that he noticed when putting on his tie. An ultrasound scan reveals solitary nodule in the right lobe of the thyroid measuring 3.2cm in maximal diameter. A nuclear medicine scan is performed

Nodule does not take up iodine.

What is the most appropriate next step in management of this patient?
a. Reassure that nodule is benign
b. Perform a FNA of the nodule
c. Treat with carbimazole
d. Perform thyroidectomy
e. Treat with low dose radioactive iodine

Answer 22

b. Perform a FNA of the nodule

Question 23

A 23yr woman presents with difficulty completing her usual 10km run. She has lost 4kg weight despite feeling hungry and increasing her food intake. She has no family history of thyroid disease. Her thyroid function tests are:

TSH <0.05 (0.35-3.6)
Free T4 57.6 (10.5-21.2)
Free T3 16.4
Thyroid antibodies negative

Uniform too much uptake across entire thyroid

The most likely explanation of her symptoms is?
a. Graves disease
b. Toxic multinodular goitre
c. Solitary toxic nodule
d. Post viral thyroiditis
e. Hashimoto’s thyroiditis

Answer 23

a. Graves disease

Question 24

Most clinically significant hormone affected in pituitary apoplexy? Answers:
c. Cortisol
d. Prolactin
e. Growth Hormone
f. thyroid
g. oestrogen

Answer 24

c. Cortisol

Question 25

Person waking in the night with sweating and numbness/tingling in the index/middle fingers of both hands - has hypertension what is likely a secondary cause of this i.e. what test elevated? Answers:
h. Serum IGF-1 (or growth hormone)
i. TSH
j. Cortisol
k. Aldosterone
l. Some others lol

Answer 25

Serum IGF-1 (or growth hormone)

Carpal tunnel syndrome with raised GH -> soft tissue swelling causes nerve entrapment. Raised GH also causes sweating and HTN (cardiac hypertrophy and hyperglycaemia increasing vascular resistance)

Question 26

Lady with low TSH, normal thyroid, low FSH/LH/oestradiol, low IGF-1 and Prolactin only slightly raised (~600 or something). Issues with periods. What is likely diagnosis?
Answers:
m. Prolactinoma
n. Non-functioning pituitary adenoma
o. Primary ovarian insufficiency
p. PCOS

Answer 26

n. Non-functioning pituitary adenoma

Question 27

How to investigate boy with suspected growth deficiency? Answers:
q. ITT
r. OGTT
s. GH random
t. Morning GH

Answer 27

ITT

Question 28

Whats the most appropriate test for someone who you suspect has Cushing syndrome?
a. 24 hour urinary cortisol
b. 8am salivary cortisol
c. Short synacthen test
d. 8am ACTH test

Answer 28

a. 24 hour urinary cortisol

Question 29

Whats result likely with Addison’s?
e. 8am cortisol just in norm range (real low norm)
f. 8am ACTH 5 (low)
g. Short synacthen 250 g/L
h. 24h urinary cortisol ..?

Answer 29

e. 8am cortisol just in norm range (real low norm)
f. 8am ACTH 5 (low) - should be high if addison’s
g. Short synacthen 250 g/L - still a normal cortisol level (just) but should be much higher after synacthen. If above 550 g/L - excludes Addison’s.
h. 24h urinary cortisol ..?

Question 30

A 24 year old woman with a BMI of 35 presents with regular body fat deposition, plethoric moon face, non-pigmented abdominal striae, no proximal muscle weakness, blood pressure 120/76. Only medication is the OCP. She has an 8am cortisol level of 855 (normal 120-600).
What is the most likely explanation for the result?
1. Error with the test
2. OCP
3. Cushing’s syndrome
4. Alcohol
5. Depression

Answer 30

OCP

Question 31

What hormone increases heaps in luteal phase? Answers:
cc. Progesterone
dd. oestrogen
ee. LH
ff. FSH

Answer 31

Progesterone

Question 32

which one isn’t a glucocorticoid/minerelocorticoid?

hydrocortisone, betamethasone, or fludrocortisone

Answer 32

fludrocortisone