Endocrinology RACP MCQs Flashcards
RACP 2022a
8. 69 year old man presenting with intermittent headaches and fatigue. Low testosterone and high prolactin. Lots of blood results. Prolactin 77000,
GH/LH/FSH/cortisol normal. MRI with lesion size (20mmx16mmx-18mm) that is in close proximity to optic chiasm. His formal visual field testing is normal.
What is the best management?
a. Somatostatin analogue
b. Dopamine agonist
c. Transsphenoidal surgery
ANS: C
https://www.ncbi.nlm.nih.gov/books/NBK278983/
RACP 2022a
14. An 18 year old male presents with bilateral painful gynecomastia. Resting tachycardia on exam. He has high total testosterone, normal free testosterone (4.5) and elevated SHBG (192). FSH and LH (low normal, not suppressed), prolactin normal, TSH < 0.01. His BMI is 18. What is the most likely cause
a. Exogenous testosterone use
b. Pituitary adenoma
c. Grave’s Disease
ANS: C
SHBG increased with hypogonadism, anorexia, T1DM, hyperthyroidisim, aromatase inhibitors
Gynaecomastia can be caused by hyperthyroidism
RACP 2022a
19. A 24 year old man has a testicular rest tumour on a background of congenital adrenal insufficiency. What is the management of the adrenal rest tumour?
a. Bilateral Orchidectomy
b. Cisplatin-based chemotherapy
c. Lepirudin (GnRH analogue)
d. Steroids
ANS: D
First line treatment = steriods
Then surgery if persistent
RACP 2022a 21.A patient with type 1 diabetes is calculating his next short-acting insulin dose.
He normally takes insulin glargine 18 units before bed. His pre-breakfast BSL is 12.9 and his target is 6. His normal carbohydrate loading is 1 units rapid-acting insulin for every 10g of carbohydrate. His insulin sensitivity factor is 3.
He anticipates his breakfast has 60g of carbohydrates. What should his pre-
meal insulin be?
a. 6
b. 8
c. 4
ANS: B
2 units + 6 U with breakfast = 8
RACP 2022a 63.In which format does hormone replacement therapy have the least side
effects?
a. Mini progesterone pill + transdermal oestrogen patch
b. Other options inc non micronised, and oral oestrogens
ANS: A
RACP 2022a
66.70yo male with Bony met prostate Ca
Ca 2.78 (2.20-2.55)
PTH 7.5 (1.7-7.3)
Urine Ca to Cr 0.41 <0.61
What is the most likely cause of hypercalcemia?
a. Bony erosions
b. Hyperparathyroidism
c. Exogenous Vit D production
d. PTHrP
ANS: B
Demonstrates PTH dependent hypercalcaemia
A, C and D are causes of PTH independent hypercalcaemia
RACP 2022b 4. What cell type produces testosterone in the testes?
A. Granulosa
B. Leydig
C. Sertoli
D. Theca
ANS: B
Leydig for testosterone
Sertoli for spermatogenesis
Theca cells are a group of endocrine cells in the ovary made up of connective tissue surrounding the follicle. They have many diverse functions, including promoting folliculogenesis and recruitment of a single follicle during ovulation.
RACP 2022b 20. What are the primary metabolites of testosterone?
A) andostenedione and estrone
B) dihydrotestosterone and oestradiol
C) progesterone and DHEA
D) pregnenolone and something
ANS: B
Testosterone undergoes pre-receptor activation by conversion to potent bioactive metabolites, DHT and estradiol. The steroidogenic enzyme 5α-reductase has two isozymes, types 1 and 2, which form a local androgen amplification mechanism converting testosterone to the most potent natural androgen, DHT
RACP 2022b 22. Which drugs stop the release of pre-made thyroid hormone?
A. Prednisone and dexamethasone
B. Lithium and iodine
C. Carbimazole and PTU
ANS: B
Treatment include administration of thionamide therapy with methimazole or PTU to stop the synthesis of new thyroid hormone and Iodine to stop the release of pre-formed hormone.
RACP 2022b 31. Why is HBa1c lower in pregnant women?
A. Iron deficiency
B. Increased cell turnover
C. Presence of foetal haemoglobin
ANS: B
HbA1c reduced due to longer average cell life in pregnancy
RACP 2021a Q33. What are the two other Rotterdam criteria for PCOS, in addition to an ultrasound finding of polycystic
ovaries?
A. Increased LH:FSH ratio and clinical evidence of hyperandrogenism
B. Increased LH:FSH ratio and primary infertility
C. Oligo/anovulation and clinical evidence of hyperandrogenism
D. Oligo/anovulation and insulin resistance
ANS: C
RACP 2021a Q76. What complication can you avoid in a patient being given topical oestrogen as opposed to oral oestrogen, in a patient with functional hypothalamic amenorrhea requiring oestrogen replacement?
A. Low BMD
B. Infertility
C. Genital atrophy
D. Endometrial hypertrophy
ANS: D
Transdermal estrogen has been shown to avoid this risk because it delivers a more physiologic release of hormones without the first-pass hepatic metabolism seen with oral estrogen, which increases estrogen levels and risks of endometrial stimulation. Furthermore, when estrogen is delivered transdermally, the metabolic and coagulation impacts are minimized compared to oral estrogen therapy.
A study that supports the use of transdermal estrogen over oral forms to avoid these complications is the ESTHER study, which demonstrated that transdermal estrogen avoids some of the adverse effects associated with oral estrogen, such as venous thromboembolism and other metabolic complications .
RACP 2021a Q87. What is the most appropriate test to diagnose suspected secondary adrenal insufficiency in an elderly patient?
A. Morning ACTH and cortisol
B. Serum cortisol measured 30 minutes after synthetic ACTH administration (short synacthen test)
C. Serum cortisol measured 30 minutes following insulin-induced hypoglycaemia (insulin tolerance test)
D. Serum cortisol measured 72 hours after synthetic ACTH administration (long synacthen test)
ANS: B
RACP 2021 Q93/Q94 EMQ – Match the following genetic cancer syndromes from the list of options:
A. MEN1
B. RET
C. VHL
D. SDHA
E. SDHB
F. HPNCC
G. MLH1
H. PTEN
I. PKP2R*
J. NF1*
*Not sure if these two were options.
Q93. Patient presents with pancreatic cancer, pituitary adenoma and hyperparathyroidism
ANS: A
A - Multiple Endocrine Neoplasia 1
B - Multiple Endocrine Neoplasia 2
C - Von Hippel Lindau
D - phaeochromocytoma
E - phaeochromocytoma, paraganglioma
F - Lynch
G - TSG for Adenocarcinoma
H - Endometrial, glial and prostate Ca
I - Arrhythmogenic right ventricular cardiomyopathy (ARVC)
J - Neurofibromatosis
RACP 2021a Q93/Q94 EMQ – Match the following genetic cancer syndromes from the list of options:
A. MEN1
B. RET
C. VHL
D. SDHA
E. SDHB
F. HPNCC
G. MLH1
H. PTEN
I. PKP2R*
J. NF1*
*Not sure if these two were options.
Q94. Patient presents with retinal angioblastoma, cerebellar hemangioma and a large renal mass.
ANS: C
RACP 2021b Q111. In a patient with nephrogenic diabetes insipidus due to lithium, adjunctive treatment with amiloride will help by blocking transport of which ion?
A. Calcium
B. Chloride
C. Potassium
D. Sodium
ANS: D
- Lithium is cleared in the kidneys
- Amiloride is indicated in patients with lithium-induced NDI and continue lithium: blocks lithium entry by blocking the epithelial sodium channels through which lithium gets reabsorbed
RACP 2021b Q115. What is the site of action of sulfonylurea drugs on pancreatic beta cells?
A. AMP kinase enzyme
B. ATP sensitive potassium channels
C. Glucokinase enzyme
D. Insulin storage vesicles
ANS: B
These drugs exert their hypoglycaemic effects by stimulating insulin secretion from the pancreatic beta-cell. Their primary mechanism of action is to close ATP-sensitive K-channels in the beta-cell plasma membrane, and so initiate a chain of events which results in insulin release.
RACP 2021b Q138. High titres of antibodies to what target correlate with the presence and severity of extra-thyroidal
manifestations of Graves’ disease?
A. Thyroglobulin
B. Thyroid microsomal
C. Thyroperoxidase
D. Thyrotrophin (TSH) receptor
ANS: D
RACP 2021b Q143. Where is the principle site of the production of mineralocorticoids?
A. Adrenal medulla
B. Zona glomerulosa
C. Zona fasciculata
D. Zona reticularis
ANS: B
RACP 2021b Q160. Which hormone released from anterior pituitary is regulated by tonic inhibition?
A. ACTH
B. GH
C. Prolactin
D. TSH
Answer B Prolactin is regulated by tonic inhibition by dopamine
RACP 2021o 13. Hyperthyroidism in pregnancy (11-12 weeks pregnant). T4 at ULN and T3
slightly elevated with suppressed TSH 0.01. Other than hyperemesis gravidarum,
she has been asymptomatic and uncomplicated pregnancy so far. Tachycardic to
102 bpm, normotensive. Next step in management ?
A. PTU
B. No treatment currently
C. Propranolol and PTU
D. Propranolol
B. No treatment currently.
Rationale:
Subclinical hyperthyroidism is often transient in pregnancy due to the influence of hCG, which can suppress TSH. This is common in early pregnancy and does not always require treatment unless the patient is symptomatic or has significant biochemical hyperthyroidism (very high levels of T3/T4).
The patient is largely asymptomatic aside from mild tachycardia, which can be a normal physiological response to pregnancy or mild hyperthyroidism.
PTU (propylthiouracil) or methimazole is indicated in pregnant women with overt hyperthyroidism to prevent complications. However, in this case, treatment might not be necessary as her thyroid hormone levels are near normal.
Propranolol (D) is used for symptom control in hyperthyroid patients with significant symptoms like severe tachycardia or palpitations, but it is not necessary in asymptomatic or mildly symptomatic patients like this one.
According to the Australian Thyroid Association and Endocrine Society Guidelines, monitoring is recommended for subclinical or mild hyperthyroidism during pregnancy, especially in the first trimester when the physiological rise in hCG can suppress TSH. If symptoms worsen or hormone levels rise significantly, then treatment can be reconsidered.
RACP 2021o 14. Hyperthyroidism during pregnancy - which thyroid marker/antibody crosses
placenta and can induce foetal hyperthyroidism
a. T3
b. T4
c. Thyrotropin releasing hormone
d. Thyroid stimulating hormone
RACP 2021o 43. Nurse has stereotyped hypoglycemic symptoms. It always comes after fasting and improves with carbohydrate meals.
BSL 2.4, Cortisone 1500, Low c peptide, insulin just above normal level. What is the most likely diagnosis?
a. Insulinoma
b. Exogenous insulin
c. Cushing’s
Answer C
RACP 2020 18.
A 24 yo female in her 1st trimester presents with palpitations and ?heat intolerance (symptoms
of hyperthyroidism). She has chemosis and a goitre. Her lab details are: T4 21 (upper limit of
normal), TSH <0.001 (below normal limits), T3 5.1 (normal limits), bHCG 3000+ (way above
normal limits). What therapy do you recommend?
A) Carbimazole
B) PTU
C) Prednisolone
D) Observation
RACP 2020 27. The use of bisphosphonates after cessation of denosumab is to reduce rapid bone loss and prevent increased fractures of:
A) Distal radius
B) Intertrochanteric
C) Subcapital neck of femur
D) Vertebral
Answer D Vertebrae
RACP 2020 28. Subacute thyroiditis shows what pattern of uptake in the affected gland in scintigraph
A) Focal increase
B) Diffuse increase
C) Normal
D) Suppressed
Answer D: Suppressed
RACP 2020a Q60
60. In patients with type 1 diabetes, at which life stage is the HbA1c the lowest?
A) Childhood (<10years)
B) Teenage (11-19yo)
C) Young adult (20-35)
D) Older adult (>65)
RACP 2020a 70. What is the half life of levothyroxine (thyroxine)?
A) 1 day
B) 7 days
C) 21 days
D) 42 days
RACP 2020a 76. An 80M with T2DM was commenced on Metformin by his GP. Which of the following vitmain is
he at risk of becoming deficient of?
A) B12
B) B6
C) Vit C
D) Vitamin D
RACP 2020b 11. What form of thyroid cancer has the worst prognosis
A) Anaplastic
B) Papillary
C) Follicular
D) Medullary
RACP 2019a Question 3
A 54 year old woman presents with severe menopausal symptoms, amenorrhoea for 14 months. She
is normally fit and well and wants to pursue HRT. What is the best option for managing her
symptoms?
A. Oestrogen and cyclical progesterone
B. Oestrogen with continual progesterone
C. Topical oestrogen
D. Oral oestrogen only
RACP 2019a Question 15
A 46 year old lady with a background of Addison’s disease presents with flank pain and dysuria. She
is normally on hydrocortisone 10mg BD and fludrocortisone 100mg daily. Her temperature is 38.4C,
blood pressure is 124/72 mmHg and heart rate is 104 bpm. Her provisional diagnosis is
pyelonephritis and she is admitted for intravenous antibiotics. What should be done about her usual
medications?
A. Add prednisone 20mg daily
B. Commence IV hydrocortisone 100mg every 8 hours
C. Increase oral hydrocortisone to 20mg BD
D. Increase oral hydrocortisone to 20mg BD and fludrocortisone to 200mg daily
RACP 2019a Question 31
An 87 year old man is admitted to hospital with pneumonia and a fall 10 days prior. He is currently in
rehabilitation. He has a history of diabetes on metformin 500mg TDS. His HbA1c is 9%. He has
peripheral neuropathy and chronic nephropathy with an eGFR of 47ml/min. He has no symptoms of
hypoglycaemia or hyperglycaemia. In the last week his BSLs have ranged from 8-15mmol/L.
What is the next best step in management?
A. Add pioglitazone
B. Add insulin
C. Add sulphonylurea
D. No change to current treatment
RACP 2019a Question 56
Which of the following conditions is it most likely to achieve euthyroidism after effective radioactive
iodine therapy?
A. Graves’ disease
B. Autonomous nodule
C. Thyroid cancer
D. Multinodular goitre
RACP 2019a Question 62
A fit and well 65 year old woman presents to you with abnormal thyroid function tests on routine
blood tests. You repeat the TFTs 3 months later and there is no interval change:
TSH: 8 –> 9 mIU/L
Free T4: 15 –>16 pmol/L
Free T3: 4 –> 4.7 pmol/L
What is the most appropriate next step?
A. Monitor TFTs 12 monthly
B. Selenium replacement
C. Thyroid US
D. Commence levothyroxine
RACP 2019b Question 29
What activates RANK ligand in osteoblasts?
A. PTH
B. Calcitonin
C. 1-alpha hydroxylase
D. Osteoprotegerin
RACP 2019b Question 36
Question 37
In patients with long-standing Type 1 diabetes mellitus, what is the usual cause for hypoglycaemic
unawareness?
A. Frequent hypoglycaemic episodes
B. Increased age
C. Larger insulin dose
D. Longer diabetes duration
RACP 2019b Question 46
In patients with pituitary apoplexy, what is the most important hormone to replace first?
A. Thyroxine
B. Hydrocortisone
C. DDAVP
D. Growth hormone
RACP 2019b Question 54
What is the most likely complication of treatment with growth hormone?
A. Diabetes
B. Osteoporosis
C. Malignancy
D. Hypothyroidism
RACP 2018a 21. What is the most common form of thyroid cancer?
A. Medullary
B.Follicular
C. Papillary
D. Anaplastic
E. Squamous Cell
RACP 2018a 7. A few hours after completing the Auckland marathon a 24-year-old is taken to the Emergency
Department by her concerned partner on account of increasing confusion. On assessment she is
found to be disoriented in time and place, but has no focal neurological deficit. Other than mild
tachypnoea and myalgia in her legs, the remainder of a full clinical examination reveals no
abnormal findings.
The following biochemistry is obtained:
Normal values
Sodium (Na) 122 mmol/L [135–145]
Plasma osmolality 256 mOsm/L [285–295]
Potassium (K) 3.6 mmol/L [3.5–5.5]
Urine osmolality 432 mOsm/L [300–900]
Creatinine 79 μmol/L [45–90]
Glucose 4.8 mmol/L [4.0–5.5]
What is the most appropriate way to correct her hyponatraemia?
A. Fluid restriction.
B. IV hypertonic saline.
C. IV normal saline.
D. Oral demeclocycline.
E. Oral urea.
RACP 2018a A 23-year-old man is found to have elevated plasma metanephrines (5 times upper limit of
normal) and a unilateral 4 cm adrenal mass upon investigation for hypertension. He had neck
surgery at the age of 11 for thyroid cancer. He is of normal body proportions and has no
evidence of mucosal ganglioneuroma.
Which gene mutation is the likely cause of his adrenal and thyroid tumours?
A. C-RET.
B. MEN1.
C. NF1.
D. SDH-B.
E. VHL.
RACP 2018 a 47. A 64-year-old woman with treated hypertension was found to have a right adrenal lesion by CT
imaging when investigated for cholelithiasis 2 years previously. The lesion was described as
rounded, hypodense (0 Hounsfield units), had a homogeneous appearance, and demonstrated
no interval change on a repeat CT imaging 6 months later. Baseline investigations
demonstrated normal aldosterone:renin ratio, normal plasma metanephrines, normal 24 hour
urinary free cortisol, and a morning cortisol of 44 nmol/L [< 50] following 1 mg dexamethasone
the night prior.
Two years later, she returns to the medical clinic for re-assessment of this adrenal lesion at the
request of her new GP. What is the most appropriate recommendation?
A. CT-guided adrenal biopsy.
B. MRI adrenals.
C. No further investigations.
D. PET scan.
E. Repeat dexamethasone suppression test.
RACP 2018a 56. A 22-year-old university student was diagnosed with type 1 diabetes 12 years ago and treated
with multiple daily injections of insulin (basal insulin glargine plus prandial boluses of insulin
aspart). She is seen for follow-up in the diabetes clinic. Measured HbA1c has been
> 85 mmol/mol (> 10%) for at least the last 5 years because of non-adherence. However, since
she last attended clinic 3 months ago she has been regularly checking pre-meal capillary
glucose levels, has been diligently counting carbohydrates and has not missed any basal or
prandial insulin injections. Today’s HbA1c is 53 mmol/mol (7%).
As a consequence of rapidly improving glycaemic control, which diabetes complication is she
now most at risk of developing?
A. Amyotrophy.
B. Foot ulcer.
C. Gastroparesis.
D. Nephropathy.
E. Retinopathy.
RACP 2018 a 57. The product information for alendronate states:
Alendronate (brand) “must be taken at least 30 minutes before the first food, beverage, or
medication of the day with plain water only.”
What is the main reason for this advice?
A. Alendronate decreases the absorption of calcium.
B. Alendronate decreases the absorption of vitamin D.
C. Calcium decreases the absorption of alendronate.
D. Food decreases the absorption of alendronate.
E. Food increases the first pass metabolism of alendronate.
RACp 2018a 65. What is the most common presenting symptom of pituitary apoplexy?
A. Diplopia.
B. Headache.
C. Neck stiffness.
D. Vertigo.
E. Visual loss.
RACP 2018a 68. To diagnose type 2 diabetes mellitus in an asymptomatic patient, the patient must fulfil two
diagnostic criteria, measured on separate days.
What is the purpose of this two-stage sequential testing?
A. Decreases sensitivity.
B. Decreases specificity.
C. Increases sensitivity.
D. Increases specificity.
E. Increases the likelihood of a positive result.
RACP 2018a 75. An 86-year-old lady with hypertension, type 2 diabetes and osteoporosis is found to have mild
primary hyperparathyroidism. Her usual medications are metformin, quinapril,
hydrochlorothiazide, cholecalciferol and alendronate.
In light of the new diagnosis, which of her medications should be discontinued?
A. Alendronate.
B. Cholecalciferol.
C. Hydrochlorothiazide.
D. Metformin.
E. Quinapril.
RACP 2018b 131.The pharmacokinetic properties of which analogue insulin are largely determined by binding to
and dissociation from serum albumin?
A. Aspart.
B. Detemir.
C. Glargine.
D. Glulisine.
E. Lispro.
RACP 2018b 151.Patients should be considered for investigation for secondary causes of osteoporosis if their
z-score is less than −2.0.
Assuming normal distribution, what does a z-score of −2.0 indicate?
A. A patient with this bone mineral density is in the lowest 1% of age-matched peers.
B. A patient with this bone mineral density is in the lowest 2.5% of age-matched peers.
C. A patient with this bone mineral density is in the lowest 5% for age-matched peers.
D. A patient with this bone density is twice as likely to fracture than other women her age.
E. A patient with this bone density is twice as likely to have a secondary cause of osteoporosis
compared with a young female.
RACP 2018b 160.In addition to glucagon, which hormones counterregulate hypoglycaemia?
A. Adrenaline, cortisol, growth hormone.
B. Adrenocorticotropic hormone (ACTH), glucagon-like peptide-1 (GLP-1), renin.
C. Aldosterone, vasopressin, triiodothyronine (T3).
D. Noradrenaline, ghrelin, corticotropin-releasing hormone (CRH).
E. Thyroid-stimulating hormone (TSH), ACTH, testosterone.
RACP 2017 An elderly lady presents to ED and is found to be hyponatraemic. She is on each of the following medications. Which of the following is the most likely cause of her hyponatraemia?
A. Candesartan
B. Hydrochlorothiazide
C. Simvastatin
D. Metoprolol
E. Trimethoprim
RACP 2017
A 25-year-old pregnant woman presents to the emergency department 12 weeks into her pregnancy with nausea, vomiting, a fine tremor and a HR of 115. There was no goitre or ophthalmopathy.
T3 4 (1-3)
T4 40 (10-35)
TSH <0.01 (0.5-6)
TSH-Receptor Antibody: Negative
Anti-TPO Antibody: Negative
What is the appropriate treatment for this patient?
A. Thyroxine
B. Propylthiouracil
C. Carbimazole
D. Propranolol
E. Supportive care
RACP 2017
Which form on insulin has the longest half-life?
A. Glargine
B. Aspart
C. Lispro
D. Isophane
E. Determir
RACP 2017 A 46-year-old woman with known Addison’s disease presents with fever, flank pain and dysuria. Her HR is 102bpm and BP is 120/84 mm Hg. She is admitted with pyelonephritis for IV antibiotics and IV fluids. Her usual medications are Hydrocortisone 10mg BD PO and Fludrocortisone 100 microg daily PO.
What should be done with her usual medications on admission?
A. Change her regular PO Hydrocortisone to Prednisone 20mg daily PO
B. Change her regular PO Hydrocortisone to Hydrocortisone 100mg TDS IV
C. Increase her regular PO Fludrocortisone to 200microg daily PO
D. Increase her regular PO Hydrocortisone to 20mg BD PO
E. Increase her regular PO Hydrocortisone to 20mg BD PO and her regular Fludrocortisone to 200 microg daily PO
RACP 2017
A 60-year-old female presents with an eight-month history of headaches, galactorrhea and amenorrhoea. She is hypotensive. You are suspecting pituitary apoplexy.
Administration of which of the following agents is indicated in your initial management?
a) DDAVP
b) Adrenaline
c) Hydrocortisone
d) Cabergoline
e) Thyroxine
RACP 2017 A 75-year-old woman with back pain has a DEXA scan to investigate for Osteoporosis. The results are shown below:
T-score
Lumbar + 1
Radial - 2.6
Right Hip - 2.5
What is the most correct interpretation of the discordant T-scores?
A. Corticosteroid-induced Osteoporosis
B. Osteoarthritis of the lumbar spine
C. Osteomalacia
D. Osteoporosis
E. Primary Hyperparathyroidism
RACP 2017
A 36-year-old female presents with several months of amenorrhea. She is slightly overweight but not tanned. She is clinically euthyroid with no evidence of hirsutism or visual field disturbance.
Laboratory investigation reveals normal thyroid function testing, early morning cortisol, testosterone and prolactin.
The patient is noted to have a low oestradiol level and an elevated FSH and LH.
What is the most likely diagnosis?
A. Microprolactinoma
B. Pregnancy
C. Polycystic Ovarian Syndrome
D. Prolactinoma
E. Premature Ovarian Failure
RACP 2017
Which of the following is most associated with Carbimazole?
A. Aseptic Meningitis
B. Agranulocytosis
C. Interstitial Nephritis
D. Sensorineural hearing loss
E. Hepatitis
RACP 2017 Within the pancreatic beta islet cell, the sulphonylurea class of medications act upon which of the following?
A. AMP kinase enzyme
B. ATP sensitive potassium channel
C. Insulin vesicle secretion
D. Glucokinase
E. Voltage Gated Calcium Channel
RACP 2017
Insulin is stored in vesicles within the pancreatic beta cell which is then released in response to rising blood glucose. In which molecular form is insulin stored?
A. Monomer
B. Hetero-oligomer with c-peptide
C. Hetero-oligomer with glucagon
D. Dimer
E. Hexamer
RACP 2017
Which of the following hormones is secreted by the posterior pituitary gland?
A. ACTH
B. Arginine Vasopressin
C. FSH
D. TSH
E. Prolactin
RACP 2017 Which of the following describes the target of the monoclonal antibody Denosumab?
A. Osteoblasts
B. Osteoclasts
C. RANK-Ligand
D. Estrogen receptors
E. PTH Receptor
RACP 2016
RACP Recall Paper 2016
Question 20
What is the most common presenting symptom in SIADH?
A. Dizziness
B. Altered mental state
C. Oedema
D. Urinary frequency
E. Thirst
RACP 2016 A 75 year old female presents with 24 hours of confusion. She has had 3 days of vomiting and diarrhea which her daughter thinks she developed from her grandson who has been unwell with a similar illness. On examination, she has dry mucous membranes and decreased skin turgor. She has a normal neurological examination. Bloods tests show
Na: 124
Urea: elevated
Creatinine: elevated
Urine osmolality: 500
Urine sodium: 18
What is the most appropriate management of this patient?
A. Fluid restriction
B. 5% dextrose
C. 0.9% NaCl
D. Hypertonic saline
E. Salt tablets
RACP 2016 Question 77
63year old with hypertension is found to have a 16mm mass in her right adrenal gland on a CT abdomen. Further investigations demonstrate:
Aldosterone 530 (elevated)
Renin 33 (normal)
Ald/Renin ratio 16 (<55)
DHEA 4 (normal)
Normetanephrines 630 (normal)
Metanephrines 330 (normal)
1mg dexamethasone suppression 17 (normal)
What is the most likely cause of her mass?
A. Adrenal carcinoma
B. Adrenal metastasis
C. Conn’s adenoma
D. Glucocorticoid secretory adenoma
E. Non-functioning adrenal adenoma
RACP 2015 Question 2
A 75 year old man with squamous cell cancer of the lung presents with confusion. His serum calcium is 3.85. Other bloods include GGT 308, ALP 218, AST 150, ALT 208 and creatinine 150. He is commenced on IV fluids and the decision is made to also give zolendronic acid.
Which of the following is most important to consider when dosing zolendronic acid?
A. Patient age
B. Degree of hypercalcaemia
C. Liver function
D. Renal function
E. Weight
RACP 2015
Question 5
An 83 year old female was admitted to hospital with a fractured neck of femur. On the third day post-operatively she is found to be hyponatremic. Her sodium was normal on admission. On examination her heart rate is 105 and her blood pressure is 95/65. She has dry mucous membranes. The following investigations are obtained.
Sodium 125
Urea 11
Cr 80
Serum osmolality 298
Urine osmolality 288
Urine sodium 15
What is the likely cause of her hyponatremia?
A. SIADH
B. Hypovolemia
C. Drug induced
D. ATN
E. Rhubarb
2015
Question 18
41 woman hot flushes and amenorrhoea. Nil visual changes.
Low TSH. Normal t3 and t4.
Low IGF-1.
Low FSH and LH, low oestradiol
Prolactin 600+
Cortisol normal
What is the cause of amenorrhoea?
A. Hypothyroidism
B. Non-functioning pit macroadenoma
C. Primary adrenal insufficiency
D. Pituitary macroadenoma
E. Rhubarb
2015
Question 23
What is the mechanism of action of Teriparatide?
A. Increases osteoblast action
B. Reduces osteoclast action
C. Increases gastrointestinal absorption of calcium
D. Increases hydroxyl-vitamin D
E. Increases calcium secretion
2015 Question 10
What is the pathophysiological basis of polycystic ovarian disease?
A. Hyperinsulinaemia
B. Adrenal androgen excess
C. Cortisol excess
D. Ovarian cysts
E. Endometrial hyperplasia
RACP 2015 Question 13
Increasing incidence of foetal malformations occurs in the offspring of older males because of:
A. Increase in incidence of chromosomal abnormalities
B. Increase in de novo mutations
C. More likely to be using in vitro fertilisation
D. Men with medical comorbidities are more likely to delay conception until an older age
E. Rhubarb
RACP2015 Question 47
What test has the greatest SPECIFICITY for growth hormone deficiency?
A. Random growth hormone level
B. Random IGF-1 level
C. Growth hormone level after glucose tolerance testing
D. Growth hormone level after insulin tolerance testing
D?
RACP Question 48
What is the most common infection secondary to chronic oral steroid use?
A. Oral candidiasis
B. Herpes simplex
C. Bronchopneumonia
D. Meningitis
E. Rhubarb
B?
RACP 2015 Question
An elderly lady (mid 80s) is admitted for treatment of CAP. She is requiring NP oxygen and had fevers, but otherwise is well with BP 120/70 and HR 70. Clinically you think she is euvolaemic. Her Na on admission is 125, with serum osmo 265. Normal Creatinine and Urea.
What is your next step in managing her hyponatraemia?
A. 0.9% saline infusion
B. 3% saline infusion
C. Salt tablets
D. Fluid restriction
E. Observation
RACP 2014 Q9.
Which hormone would lead to weight loss?
A. Leptin
B. Growth hormone
C. Cortisol
D. Prolactin
E. Testosterone
RACP 2014 Question 16
How does insulin exert its effect to reduce BSL?
a. transmembrane receptor tyrosine kinase activation
b. forms a complex with IGF-1
c. binds to intracytoplasmic receptor
d. binds to nuclear receptor
RACP 2014
Question 29
A lady with type one diabetes previously had well controlled disease. She has now had two children and gained weight (BMI 32). She has not had any DKA episodes for years but her HbA 1c has been increasing (now up to 7.8). What is the reason for this?
a. poor compliance
b. insulin antibodies
c. insulin resistance
d. poor diet?
RACP 2014 Question 35
A 73 year old female presents with a Colles fracture. Her routine metabolic profile is as follows:
Calcium 2.9 mmol/L (2.2–2.6)
Albumin 34 g/L (38–48)
Creatinine 110 micromol/L (50–90)
ALP 250 units/L (<130)
PTH 29 pmol/L (2–6)
25-hydroxyvit D 30 mmol/L (>50)
Urine Ca:Creat ratio 0.04 (0.04-0.7)
CTX 900 ng/L (100–700)
P1NP2 100 mcg/L (15–75)
(CTX = C-terminal telopeptide of type 1 collagen, a marker of bone resorption)
(P1NP2 = Procollagen type 1 N propeptide, a marker of bone formation)
What is the best explanation for these results?
A. Familial hypocalcuric hypocalcaemia
B. Primary hyperparathyroidism
C. Primary Vitamin D deficiency
D. Pseudohyperparathyroidism
E. Renal bone disease
RACP 2014 Question 50
Which of the following agents when used alone is most likely to cause hypoglycaemia?
A. Gliclazide
B. Pioglitazone
C. Metformin
D. Sitagliptin
E. Exenatide
RACP 2014 Question 5:
A 76 year old female is evaluated for osteoporosis. She is currently on vitamin D and calcium medications. She states that she drinks milk regularly and exercises 20 minutes a day. She completed menopause at the age of 46 and never had any HRT.
Her UEC, CMP and vitamin D are all normal. Her DEXA scan results are shown below:
T score
Lumbar spine -1.5
Hip -1.2
What is the management plan?
A. Continue calcium and vitamin D
B. Commence HRT
C. Commence strontium
D. Commence bisphosphonate
E. Commence raloxifene
RACP 2014
Question 92.
19 year old previously well man presents with polydipsia and nocturia. Tests including calcium, phosphate, eGFR (essentially values in EUC/CMP), glucose, HbA1c and cortisol are normal. The water deprivation test and 2 microg IM synthetic arginine AVP test were performed and are shown below:
What is likely diagnosis?
A. Cranial DI
B. Nephrogenic DI
C. Primary polydipsia
D. Partial DI
E. SIADH
RACP 2014 Q95
Which of the following structures labelled below correlates with the following : Neovascularisation