Endocrinology

Question 1

Main manifestations of multiple endocrine neoplasia type 1 (MEN1):
A) pheochromocytoma, hyperparathyroidism, Leydig-cell testicle tumor
B) pheochromocytoma, hyperparathyroidism, pituitary adenoma
C) hyperparathyroidism, pancreas neuroendocrine tumor, pituitary adenoma
D) pheochromocytoma, medullary thyroid carcinoma, pituitary adenoma
E) hyperparathyroidism, pheochromocytoma, pituitary adenoma

Answer 1

C) hyperparathyroidism, pancreas neuroendocrine tumor, pituitary adenoma

Question 2

The appropriate test to certify acromegaly:
A) investigation of the diurnal rhythm of serum growth hormone (GH) concentration
B) investigation of the serum growth hormone (GH) concentration in morning hours
C) investigation of the serum growth hormone (GH) concentration during oral glucose tolerance test
D) investigation of the serum growth hormone (GH) concentration after administration of growth hormone-releasing hormone (GHRH)

Answer 2

C) investigation of the serum growth hormone (GH) concentration during oral glucose tolerance test

Question 3

It is characteristic for subclinical primary hypothyroidism:
A) clinical signs of hypothyroidism with normal serum thyroid hormone levels
B) the hormone levels refer to primary hypothyroidism without clinical signs
C) low free T4 and free T3 levels with normal serum TSH
D) normal free T4 and free T3 levels with elevated serum TSH

Answer 3

D) normal free T4 and free T3 levels with elevated serum TSH

Question 4

Primary therapy of prolactin-producing pituitary microadenoma:
A) pituitary surgery
B) pituitary irradiation
C) treatment with dopamine agonist
D) treatment with dopamine antagonist
E) treatment with somatostatin analogue

Answer 4

C) treatment with dopamine agonist

Question 5

In case of a patient receiving thyroid hormone substitution due to a thyroid ablation therapy of papillary thyroid carcinoma, laboratory results show a suppression of TSH level and normal free T4 and free T3 levels. Is it necessary to modify the dose of the thyroid hormone substitution (l-thyroxin)?
A) the dose of l-thyroxin is appropriate, no modification is needed
B) reduction of the daily dose of l-thyroxin is necessary due to the suppressed TSH
C) increase of the daily dose of l-thyroxin is necessary due to the suppressed TSH
D) no modification of the dose of l-thyroxin is needed, but we shall give thyreostatics in addition

Answer 5

A) the dose of l-thyroxin is appropriate, no modification is needed

Question 6

We can use it as a serum marker of medullary thyroid carcinoma:
A) investigation of serum thyreoglobulin
B) investigation of serum calcitonin
C) investigation of serum osteocalcin
D) investigation of serum parathyroid hormone

Answer 6

B) investigation of serum calcitonin

Question 7

Endocrine disorders causing diarrhea, except:
A) medullary thyroid carcinoma
B) gastrinoma
C) carcinoid tumor
D) pheochromocytoma

Answer 7

D) pheochromocytoma

Question 8

The appropriate test for the clarification of Cushing’s syndrome, except:
A) investigation of 24 hour urinary free cortisol (UFC) excretion
B) investigation of serum cortisol after administration of low dose dexamethasone
C) investigation of the diurnal rhythm of serum cortisol
D) investigation of serum cortisol in morning hours
E) investigation of the diurnal rhythm of salivary cortisol

Answer 8

D) investigation of serum cortisol in morning hours

Question 9

Radioiodine treatment can be used against the following diseases, except:
A) after the surgery of papillary thyroid carcinoma
B) after the surgery of follicular thyroid carcinoma
C) after the surgery of medullary thyroid carcinoma
D) autonomous thyroid nodule causing hyperthyroidism
E) Graves’ disease

Answer 9

C) after the surgery of medullary thyroid carcinoma

Question 10

It is characteristic for primary aldosteronism:
A) suppression of plasma renin and high plasma aldosteron
B) high plasma renin and high plasma aldosteron
C) normal plasma renin and high plasma aldosteron
D) high plasma aldosteron, plasma renin is not relevant

Answer 10

A) suppression of plasma renin and high plasma aldosteron

Question 11

In case of a patient with pituitary macroadenoma, double vision evolved. What can be the reason for that?
A) suprasellar spread of the pituitary macroadenoma
B) lateral spread of the pituitary macroadenoma to the cavernous sinus
C) downward spread of the pituitary macroadenoma and penetration into the sphenoid sinus
D) there is no connection between the pituitary macroadenoma and the double vision

Answer 11

B) lateral spread of the pituitary macroadenoma to the cavernous sinus

Question 12

It is characteristic for the lack of growth hormone (GH) in adults, except:
A) it is associated with unfavorable lipid profile
B) it is associated with increased water content of the body and water retention
C) it is associated with unfavorable fat/muscle mass ratio
D) it is associated with weakness and discomfort

Answer 12

B) it is associated with increased water content of the body and water retention

Question 13

Diseases with polyuria, except:
A) primary aldosteronism
B) primary hyperparathyroidism
C) diabetes insipidus
D) diabetes mellitus
E) SIADH (syndrome of inappropriate antidiuretic hormone secretion)

Answer 13

E) SIADH (syndrome of inappropriate antidiuretic hormone secretion)

Question 14

It can be the cause of growth hormone (GH) deficiency in adults:
A) pituitary tumor
B) skull trauma
C) radiotherapy
D) pituitary apoplexia
E) all of the above

Answer 14

E) all of the above

Question 15

Diseases with hirsutism, except:
A) Cushing’s disease
B) hypopituitarism
C) polycystic ovary syndrome
D) 21-hydroxylase deficiency form of congenital adrenal hyperplasia

Answer 15

B) hypopituitarism

Question 16

Hereditary tumor syndromes with pheochromocytoma:
1) von Hippel–Lindau syndrome
2) multiple endocrine neoplasia type 2
3) neurofibromatosis type 1
4) multiple endocrine neoplasia type 1

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 16

A) answers 1, 2 and 3 are correct

Question 17

Which are tumor suppressor genes of the followings?
1) RET
2) MEN1 (menin protein encoding gene)
3) RAS
4) VHL

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 17

C) answers 2. and 4. are correct

Question 18

It may be a symptom of Graves’ disease:
1) diarrhea
2) tachycardia
3) pretibial myxedema
4) fine hand tremor

A) answers 1., 2. and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 18

E) all four answers are correct

Question 19

Which are glicoprotein hormones of the followings?
1) TSH (thyroid-stimulating hormone)
2) LH (luteinizing hormone)
3) hCG (human chorionic gonadotropin)
4) FSH (follicle stimulating hormone)

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 19

E) all four answers are correct

Question 20

Which tumors are associated with elevated serum chromogranin A concentration?
1) carcinoid tumor
2) gastrinoma
3) pheochromocytoma
4) insulinoma

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 20

E) all four answers are correct

Question 21

Applicable treatment in thyrotoxic crisis:
1) thyrostatics
2) iodine preparation
3) beta-adrenergic receptor blocker
4) plasmapheresis

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 21

E) all of the answers are correct

Question 22

Typical in subacute granulomatous thyroiditis (de Quervain’s thyroiditis):
1) it is associated with the painful swelling of the thyroid gland and fever
2) it is common cause of permanent (definitive) primary hypothyroidism
3) ESR is elevated
4) it often recurs after healing

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 22

B) answers 1. and 3. are correct

Question 23

In case of differentiated thyroid cancer radioiodine ablation
1) is applicable after total (near total) thyroidectomy
2) is applicable instead of total (near total) thyroidectomy
3) the condition of its application is high serum TSH level (that can be achieved by the discontinuation of thyroid supplementation for a certain time in patients receiving thyroid supplementation, or the administration of TSH product)
4) is applicable before total (near total) thyroidectomy

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 23

B) answers 1. and 3. are correct

Question 24

Which diseases are associated with hyponatremia?
1) SIADH (syndrome of inappropriate antidiuretic hormone secretion)
2) diabetes insipidus
3) Addison’s disease
4) primary aldosteronism

A) answers 1., 2., and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all four answers are correct

Answer 24

B) answers 1. and 3. are correct

Question 25

The injury of the thirst center of the hypothalamus may cause primary adipsia. What are the characteristics of this?
1) hypernatremia, that leads to severe neurological symptoms
2) antidiuretic hormone (ADH, vasopressin) overdosage can be one of its causes
3) its treatment can be water administration through a nasogastric tube
4) its long-term prognosis is usually good, because other regulating systems may compensate the role of the thirst center

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all of the answers are correct

Answer 25

B) answers 1. and 3. are correct

Question 26

It is common in acromegaly:
1) diabetes mellitus
2) hypertension
3) sleep apnoea
4) osteoarthrosis

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all four answers are correct

Answer 26

E) all four answers are correct

Question 27

Which form of congenital adrenal hyperplasia is associated with hypertension and hypokalemia?
1) steroid 21-hydroxylase deficiency
2) 11β-hydroxylase deficiency
3) defect of the gene encoding STAR protein (steroidogenesis acute regulatory protein)
4) 17α-hydroxylase/17, 20-lyase enzyme deficiency

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 27

C) answers 2. and 4. are correct

Question 28

It is typical in Turner syndrome:
1) the syndrome is caused by the total absence of an X chromosome, thus the karyotype of these patients is always 45X
2) apart from the typical features (short stature, pterygium colli, low posterior hairline, low-set ears, short metatarsus, cubitus valgus) cardial and renal malformations are often associated
3) the cause of the typical primary amenorrhea is the decreased LH and FSH production of the pituitary
4) in childhood for the treatment of short stature growth hormone (GH) products are applicable

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 28

C) answers 2. and 4. are correct

Question 29

It is typical in Klinefelter syndrome:
1) the syndrome is caused by an extra X chromosome, therefore the karyotype of these patients is always 47,XXY
2) apart from the typical external features (tall stature, signs of hypogonadism, gynecomastia, obesity, small testicles) the elevated risk of diabetes mellitus and cardiovascular disease is also common
3) the cause of the hypogonadism typical for the disease is the decreased LH and FSH production of the pituitary
4) hypogonadism associated with the disease can be treated with testosterone products

A) answers 1., 2., and 3 are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4 is correct
E) all four answers are correct

Answer 29

C) answers 2. and 4. are correct

Question 30

Connect the various symptoms (indicated with numbers) with the disease (indicated with letters) that it is most associated with!
A) diabetes insipidus
B) Cushing’s disease
C) Klinefelter syndrome
D) panhypopituitarism

INT - 11.30 - polyuria
INT - 11.31 - scant body hair
INT - 11.32 - tall stature
INT - 11.33 - round, “moon” face

Answer 30

30- A
31- D, C
32- C
33- B

Question 31

Connect the various symptoms (indicated with numbers) with the disease (indicated with capital letters) that it is most associated with!
A) Kallmann syndrome
B) Klinefelter syndrome
C) severe untreated primary hypothyroidism
D) severe untreated hypoparathyroidism

INT - 11.38 - hypogonadism
INT - 11.39 - pericardial effusion
INT - 11.40 - anosmia
INT - 11.41 - tetany

Answer 31

38- B, A
39- C
40- A
41- D

Question 32

Connect the various diseases (indicated with letters) with the most appropriate treatment (labelled with numbers)!
A) secondary hyperaldosteronism
B) carcinoid tumor
C) prolactin producin pituitary adenome
D) central diabetes insipidus

INT - 11.42 - bromocriptine
INT - 11.43 - spironolactone
INT - 11.44 - octreotide (somatostatin-analogue)
INT - 11.45 - desmopressin

Answer 32

42- C
43- A
44- B
45- D

Question 33

Connect the various diseases (indicated with letters) with the most appropriate treatment (labelled with numbers)!
A) adrenocortical carcinome
B) gastrinoma
C) acromegaly
D) Addison’s disease

INT - 11.46 - proton pump inhibitor
INT - 11.47 - mitotane
INT - 11.48 - fludrocortisone
INT - 11.49 - pegvisomant

Answer 33

46- B
47- A
48- D
49- C

Question 34

Connect the diseases (indicated with letters) with the most appropriate diagnostic serum- and urine parameters (indicated with numbers)!
A) Hashimoto’s thyroiditis
B) carcinoid tumor
C) Graves’ disease
D) hypercalcaemia associated with malignant diseases

INT - 11.54 - TRAK (TSH receptor antibody)
INT - 11.55 - parathyroid hormone-related protein (PTH-RP)
INT - 11.56 - anti-TPO (thyroid peroxidase antibody)
INT - 11.57 - 24-hour urine 5-Hydroxyindoleacetic acid (5-HIAA)

Answer 34

54- C
55- D
56- A
57- B

Question 35

Connect the diseases (indicated with numbers) with the most appropriate diagnostic methods (indicated with letters)!
A) selective adrenal vein sampling for hormone determination
B) inferior petrosal sinus sampling for hormone determination
C) somatostatin receptor scintigraphy (octreoscan)
D) metaiodobenzylguanidine (MIBG) scintigraphy

INT - 11.58 - pheochromocytoma
INT - 11.59 - Cushing’s disease
INT - 11.60 - aldosterone-producing adenoma
INT - 11.61 - insulinoma

Answer 35

58- D
59- B
60- A
61- C

Question 36

Connect the various diseases (indicated with letters) with the gene (indicated with numbers) that’s determination is most helpful in the diagnosis!
A) Carney complex
B) multiple endocrine neoplasia type 2
C) multiple endocrine neoplasia type 1
D) von Hippel–Lindau syndrome

INT - 11.62 - RET (rearranged during transfection gene)
INT - 11.63 - MEN1 (menin protein coding gene)
INT - 11.64 - VHL (VHL protein coding gene)
INT - 11.65 - PRKAR1A (protein kinase type I regulatory subunit alpha coding gene)

Answer 36

62- B
63- C
64- D
65- A

Question 37

It is not advised to give beta-adrenergic receptor blocker without alpha-adrenergic receptor blocker to patients suffering from pheochromocytoma, because the beta-adrenergic receptor blocker given alone may provoke a pheochromocytoma crisis through the inhibition of the presynaptic beta2-adrenergic receptor.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 37

A) both are correct, with cause-effect relationship

Question 38

In contrast to Addison’s disease, secondary adrenal insufficiency presenting as part of panhypopituitarism is rarely treated with mineralocorticoids, because in secondary adrenal insufficiency substantially higher doses of glucocorticoid substitution are used than for Addison’s disease.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 38

C) the first clause is correct, the second clause is incorrect

Question 39

The biologically active 1α,25-dihydroxyvitamin-D (calcitriol) is produced in the proximal tubule of the kidney, therefore by patients suffering from primary hypoparathyroidism with normal renal function, hypocalcemia can be treated with vitamin D, and there is no indication of the administration of activated vitamin D (calcitriol).
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 39

C) the first clause is correct, the second clause is incorrect

Question 40

The adult height of patients suffering from the simple virilizing form of congenital adrenal hyperplasia due to 21-hydroxylase deficiency is above average, because the permanently high level of testosterone during childhood enhances bone development and maturation.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 40

D) the first clause is incorrect, the second clause is correct

Question 41

Hyperprolactinemia causes hypogonadism, because the increased level of serum prolactin inhibits the secretion of hypothalamic gonadotropin-releasing hormone (GnRH) and pituitary gonadotropins.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 41

A) both are correct, with cause-effect relationship

Question 42

For patients taking chronic adrenal hormone replacement therapy for Addison’s disease, the daily glucocorticoid dose has to be increased temporarily in case of an infection with high fever, because infectious diseases with fever raise the glucocorticoid demand.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 42

A) both are correct, with cause-effect relationship

Question 43

Regarding glucocorticoid efficacy, prednisolone has a weaker effect than hydrocortisone, therefore for the chronic hormone replacement therapy of primary and secondary adrenal insufficiency the drug of choice is hydrocortisone.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 43

D) the first clause is incorrect, the second clause is correct

Question 44

Sufficient testosterone replacement for men suffering from panhypopituitarism abolishes hypogonadism and oligospermia/aspermia associated with the disease, because serum testosterone level becomes normal after the introduction of hormone replacement.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 44

D) the first clause is incorrect, the second clause is correct

Question 45

In women with untreated primary hypothyroidism, besides elevated serum TSH level, high serum prolactin level and consecutive galactorrhea-amenorrhea syndrome are also typical, because the enhanced thyrotropin-releasing hormone (TRH) due to decreased thyroid function triggers the secretion of both TSH and prolactin.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 45

A) both are correct, with cause-effect relationship

Question 46

The treatment of secondary hyperaldosteronism due to bilateral adrenal hyperplasia (idiopathic hyperaldosteronism) is not surgical (bilateral adrenalectomy), but medicinal (spironolactone, potassium-sparing diuretics), because after bilateral adrenalectomy performed because of secondary hyperaldosteronism Nelson syndrome (aggressive ACTH-producing adenoma) may evolve.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 46

C) the first clause is correct, the second clause is incorrect

Question 47

Increased ACTH secretion triggers not only cortisol production, but also adrenal androgen production, therefore in women suffering from adrenocortical carcinoma the symptoms of both Cushing’s syndrome and hyperandrogenism may evolve.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 47

B) both are correct, without cause-effect relationship

Question 48

For patients with Addison’s disease on chronic adrenal hormone replacement therapy the daily dose of hydrocortisone pill is given in several equally divided amounts in equal time intervals throughout the day, because the aim of the treatment is to sustain a constantly stable, unchanged serum hydrocortisone (i.e. cortisol) level throughout the 24 hours of the day.
A) both are correct, with cause-effect relationship
B) both are correct, without cause-effect relationship
C) the first clause is correct, the second clause is incorrect
D) the first clause is incorrect, the second clause is correct
E) both are incorrect

Answer 48

E) both are incorrect