Endocrine

Question 1

Coarse facies + headache + amenorrhoea + galactorrhoea

Answer 1

Acromegaly (+ prolactin hypersecretion)

Question 2

Goitre due to bacterial infection in patent piriform sinus

Answer 2

Acute suppurative thyroiditis

Question 3

Hirsutism + amenorrhoea + clitoromegaly + male-pattern hair growth with high cortisol + low ACTH

Answer 3

Adrenal carcinoma

Question 4

Apple-green positive birefringence with Congo red stain under polarised light

Answer 4

Amyloidosis

Question 5

Painful goitre in elderly + hoarseness + stridor + lymphadenopathy

Answer 5

Anaplastic thyroid carcinoma

Question 6

Microaneurysms + blot haemorrhages + hard exudates + macular sparing

Answer 6

Background retinopathy

Question 7

Sudden visual loss + thread-like retinal vessels + pale fundus + cherry red spot at macula

Answer 7

Central retinal artery occlusion

Question 8

Sudden visual loss + swollen/oedematous optic disc + haemorrhages

Answer 8

Central retinal vein occlusion

Question 9

Thyroid mass in puberty/pregnancy + normal T4 with elevated TSH

Answer 9

Colloid nodule

Question 10

Hypertension + metabolic alkalosis tested with fludrocortisone suppression test

Answer 10

Conn’s syndrome

Question 11

Painful goitre + viral infection (mumps, Coxsackievirus, influenza)

Answer 11

de Quervain’s (subacute granulomatous) thyroiditis

Question 12

Unilateral painful quadriceps in middle-aged male type 2 diabetic

Answer 12

Diabetic amyotrophy

Question 13

Microaneurysms + blot haemorrhages + hard exudates + macular involvement

Answer 13

Diabetic maculopathy

Question 14

Anti-TPO + anti-thyroglobulin antibodies

Answer 14

Hashimoto’s thyroiditis (more anti-TPO) or Graves’ disease (more anti-thyroglobulin)

Question 15

Acropachy + amenorrhoea + vitiligo + pernicious anaemia

Answer 15

Hyperthyroidism

Question 16

Coarse facies + croaky voice + cerebellar symptoms

Answer 16

Hypothyroidism

Question 17

Parathyroid hyperplasia + pancreatic islet cell tumour + pituitary adenoma

Answer 17

Multiple endocrine neoplasia type 1

Question 18

Parathyroid hyperplasia + medullary thyroid cancer + phaeochromocytoma

Answer 18

Multiple endocrine neoplasia type 2A

Question 19

Muscle weakness + hyperpigmentation after bilateral adrenalectomy

Answer 19

Nelson’s syndrome

Question 20

Hat no longer fits + bone pain

Answer 20

Paget’s disease

Question 21

Postpartum goitre + progression from hyperthyroid to hypothyroid to euthyroid

Answer 21

Painless lymphocytic thyroiditis

Question 22

Palpitations + headache + impending sense of doom + sweating

Answer 22

Phaeochromocytoma

Question 23

Elevated urine catecholamines but normal CT/MRI

Answer 23

Phaeochromocytoma (may be undetectable on CT/MRI)

Question 24

Microaneurysms + blot haemorrhages + hard exudates + cotton wool spots + venous loops and beading

Answer 24

Pre-proliferative retinopathy

Question 25

Microaneurysms + blot haemorrhages + hard exudates + neovascularisation

Answer 25

Proliferative retinopathy

Question 26

Cushingoid presentation + alcohol abuse

Answer 26

Pseudo-Cushing’s syndrome

Question 27

Agalactorrhoea + amenorrhoea/oligomenorrhoea after bleeding postpartum

Answer 27

Sheehan’s syndrome

Question 28

Microfollicles + abundant colloid + halo on U/S

Answer 28

Follicular adenoma

Question 29

Floaters/vision loss + loss of red reflex + grey haze on fundoscopy in diabetic

Answer 29

Vitreous haemorrhage

Question 30

Delayed puberty + hypogonadism/infertility + anosmia/hyposmia

Answer 30

Kallmann syndrome

Question 31

Bone pain + elevated ALP + normal calcium and phosphate

Answer 31

Paget’s disease

Question 32

Looser’s zones

Answer 32

Osteomalacia

Question 33

Feeling of tightness in fingers and toes + bitemporal hemianopia

Answer 33

Acromegaly

Question 34

Increased trabecular pattern with cortical thickening

Answer 34

Paget’s disease

Question 35

Goitre + diarrhoea + palpitations + fever

Answer 35

Thyroiditis

Question 36

Weight gain + ankle swelling in transplant patient

Answer 36

Cushing’s syndrome

Question 37

Smooth, regular, diffusely enlarged thyroid

Answer 37

Graves’ disease

Question 38

Inhibition of circulating lymphocytes

Answer 38

Cushing’s syndrome

Question 39

Hyponatraemia + low plasma osmolality + urine osmolality > plasma osmolality + high urine sodium

Answer 39

SIADH

Question 40

Water deprivation test with desmopressin

Answer 40

Diabetes insipidus

Question 41

Sudden headache + nausea + visual disturbance

Answer 41

Pituitary apoplexy

Question 42

Weight loss + hyperpigmentation

Answer 42

Addison’s disease

Question 43

Short QT interval + Osborn/J waves

Answer 43

Hypercalcaemia

Question 44

Milkman fractures

Answer 44

Osteomalacia

Question 45

Rachitic rosary/costochondral beading

Answer 45

Rickets

Question 46

Genu varum/valgum + skull bossing + kyphoscoliosis

Answer 46

Rickets

Question 47

Bone deformities + bone pain + hearing loss + facial pain

Answer 47

Paget’s disease (with CN VIII and V involvement)

Question 48

Elevated urine metanephrines

Answer 48

Phaeochromocytoma

Question 49

Orphan Annie eyes

Answer 49

Papillary thyroid cancer

Question 50

Psammoma bodies

Answer 50

Papillary thyroid cancer

Question 51

Anti-GAD + anti-IA2 antibodies

Answer 51

T1DM

Question 52

Low C-peptide

Answer 52

T1DM

Question 53

Diabetic with postprandial nausea/vomiting

Answer 53

Autonomic neuropathy

Question 54

Goitre + carpal tunnel syndrome

Answer 54

Hypothyroidism

Question 55

Normal TSH and T4 + low T3

Answer 55

Sick euthyroid syndrome