Revision questions Flashcards

Question 1

Q

Low blood glucose concentration will lead to all of the following EXCEPT:
A. loss of consciousness
B. increased heart rate
C. decreased ACTH
D. decreased insulin
E. increased growth hormone

Answer

A

C: Decreased ACTH will reduce blood sugar even further (reduced secretion of corticosteroids)

Question 2

Q

Aldosterone:
A. increases reabsorption of potassium at the proximal convoluted tubules
B. secretion is stimulated by high blood potassium levels
C. increases secretion of renin
D. can lead to development of metabolic acidosis

Question 3

Q

All of the following predispose to hyponatremia EXCEPT:
A. congestive heart failure
B. vomitting
C. diarrhea
D. Cushing’s Syndrome
E. Adrenal insufficiency

Answer

A

In summary, hypernatremia in patients with Cushing’s syndrome occurs primarily due to the high levels of cortisol activating mineralocorticoid receptors in the kidneys, leading to increased sodium reabsorption and potassium loss. This imbalance results in elevated sodium levels in the blood, contributing to the symptoms associated with Cushing’s syndrome

Question 4

Q

In diabetic ketoacidosis, the following will be seen EXCEPT:
A. hyperventilation
B. low arterial pH
C. contraction of extracellular fluid volume
D. low plasma bicarbonate concentration
E. excretion of hypotonic urine

Answer

A

E. Your body tries to get rid of the extra sugar by making more urine. This is why you have to pee a lot more than normal when your diabetes isn’t well controlled. The frequent urination is called polyuria.
The reason this happens is because the high levels of sugar in your blood cause a process called osmotic diuresis. Osmosis is when water moves from an area with less dissolved stuff (like your cells) to an area with more dissolved stuff (like your blood with all the extra sugar).
The sugar in your blood pulls water out of your cells and tissues. Your kidneys then filter out all this extra water and sugar, making you pee a lot more than usual.
Even though you are peeing out a lot of water, your body’s overall fluid balance and tonicity (thickness) doesn’t change much. This is because the sugar is the main dissolved particle being filtered out, not salts like sodium that affect your body’s fluid balance.
So in summary, the polyuria during diabetic ketoacidosis is caused by osmotic diuresis from the high blood sugar levels, but it doesn’t significantly alter your body’s overall fluid tonicity or hydration status. The main problem is losing all that water and sugar through excessive urination.

Question 5

Q

ADH secretion is increased by all of the following factors except:
A. increase in plasma osmolality
B. loss of blood
C. pain
D. vomiting
E. alcohol

Question 6

Q

All of the following may increase growth hormone secretion except
A. a low blood glucose concentration
B. sleep
C. the amino acid arginine
D. stress
E. insulin-like growth factor 1 (IGF-1)

Answer

A

E: IGF-1 secretion is promoted by GH

Question 7

Q

When the pituitary stalk is cut (eliminating hypothalamic control of pituitary function), secretion of all of the following hormones will decrease EXCEPT
A. growth hormone
B. prolactin
C. follicular stimulating hormone (FSH)
D. Luteinizing hormone (LH)
E. Thyroid stimulating hormone (TSH)

Answer

A

B: Prolactin secretion is inhibited by dopamine, which means once connection is severed, prolactin inhibition is actually reduced.

Question 8

Q

All of the following statements about thyroid hormones are true EXCEPT:
A. both T4 and T3 enter cells of target organs
B. T4 concentrations in blood are higher than that of T3
C. T3 is produced only by the thyroid gland
D. T3 is more biologically active than T4
E. The receptor for T3 is found in the nucleus

Answer

A

C: T3 is produced from T4 in target cells in the body

Question 9

Q

Increased aldosterone secretion by an adrenal tumour may cause all of the following except:
A. hypertension
B. muscle weakness
C. a low plasma potassium concentration
D. decreased urine volume
E. low plasma rennin activity

Answer

A

D. Decreased urine volume
Increased aldosterone secretion leads to sodium and water retention, which would increase urine volume (polyuria) rather than decrease it

Question 10

Q

Aldosterone deficiency may lead to all of the following EXCEPT:
A. high plasma renin activity
B. high plasma potassium concentration
C. low plasma sodium concentration
D. increased secretion of vasopressin (ADH)
E. high urine volume

Answer

A

E. High urine volume
Aldosterone deficiency does not directly cause polyuria (high urine volume). The increased ADH secretion in response to hyponatremia would actually decrease urine volume by promoting water retention.

Question 11

Q

Which of the following statements is FALSE with respect to Addison’s disease?
A. Nowadays most commonly due to tuberculosis
B. Associated with increased skin pigmentation
C. Low blood pressure is likely
D. Serum potassium concentration is likely to be high
E. Serum sodium concentration may be low

Question 12

Q

Cyclic AMP mediates the actions of all of the following hormones except:
A. Thyroid stimulating hormone (TSH)
B. Growth hormone
C. Norepinephrine
D. Luteinizing hormone (LH)
E. Follicular stimulating hormone (FSH)

Question 13

Q

The following occur when blood glucose is low EXCEPT:
A. increase gluconeogenesis
B. increase secretion of GH
C. sweating
D. decreased level of ACTH
E. decrease in insulin secretion

Answer

A

D. Decreased level of ACTH (Adrenocorticotropic Hormone):
False: In response to low blood glucose, the body typically increases ACTH secretion. ACTH stimulates the adrenal glands to produce cortisol, which helps raise blood glucose levels.

Question 14

Q

A 60 year old man with lung cancer. Low plasma osmolality, Low sodium concentration, High urine osmolality. What is his likely condition?
A. His aldosterone levels are high
B. Reduced salt intake
C. He has an ADH secreting tumour
D. His ADH receptors are not responding

Question 15

Q

This hypophyseal structure receives signals from the hypothalamus via the hypophyseal portal vein:
a) follicles
b) adenohypophysis
c) neurohypophysis
d) pars intermedia
e) supraoptic nucleus

Answer

A

B: Adenohypophysis does not have direct connection to hypothalamus unlike neurohypophysis and requires regulation via signaling molecules secreted into circulation

Question 16

Q

This hormone acts on the intestines and causes increased calcium absorption:
a) calcitonin
b) calcitriol
c) thyroxine
d) pancreatic polypeptide
e) corticotropin releasing factor (CRF)

Answer

A

B: Factual (Alternative name of Vitamin D)

Question 17

Q

Oxytocin is secreted by the:
a) adenohypophysis
b) neurohypophysis
c) zona glomerulosa
d) pars intermedia
e) cervix

Question 18

Q

Which of the following characteristics is the same for the nervous and endocrine systems:
a) target cells affected
b) time to onset of actions
c) duration of actions
d) mechanism of signalling and communication
e) none of the above

Answer

A

E.
Explanation of Each Option:
a) Target cells affected:
Different: The nervous system affects specific target cells (muscles, glands, or other neurons) through direct synaptic connections, while the endocrine system affects any cell in the body that has the appropriate hormone receptors, leading to a more widespread effect.
b) Time to onset of actions:
Different: The nervous system has a rapid response time (milliseconds to seconds) due to electrical signaling, whereas the endocrine system has a slower response time (seconds to minutes) as hormones travel through the bloodstream.
c) Duration of actions:
Different: The effects of the nervous system are typically short-lived (milliseconds), while the effects of the endocrine system can last much longer (minutes to days).
d) Mechanism of signaling and communication:
Different: The nervous system uses electrical impulses and neurotransmitters for communication, while the endocrine system uses hormones released into the bloodstream.
e) None of the above:
This option is correct because all the characteristics listed (target cells affected, time to onset of actions, duration of actions, and mechanism of signaling) differ between the nervous and endocrine systems.

Question 19

Q

Which of the following hormones can produce hyperglycemia?
A. PTH
B. growth hormone
C. ADH
D. prolactin
E. TSH.

Answer

A

B: GH excess, amongst other effects, increases lipolysis, Reduces liver uptake of glucose, and promotes gluconeogenesis in the liver. Generally increases blood [glucose] as seen in acromegaly patients.

Question 20

Q

The hormone primarily responsible for setting the basal metabolic rate and for promoting the maturation of the brain is:
A. cortisol
B. ACTH
C. TSH
D. thyroxine
E. none of the preceding.

Answer

A

D: Thyroid hormones include T3 (Triiodothyronine) and T4 (Thyroxine). Thyroxine is the major thyroid hormone in the blood and is deionated to T3 at target site by 5’-iodinase (probably no need to know). T3 is the more active form, however, T4 still exerts similar but weaker effects. The main function of thyroid hormone is to set basal metabolic rate, promote growth via growth hormone, maturation of brain and nervous system (*In notes). Additionally, it promotes sympathetic stimulation on the CVS and general catabolism.

Question 21

Q

Many nonsteroid hormones act upon their target cells by causing:
A. cyclic AMP to become ATP
B. the inactivation of adenylate cyclase
C. cyclic AMP to become protein kineses
D. the activation of adenylate cyclase
E. both A and D apply.

Answer

A

D: Non-steroid hormones generally cannot cross the cell membrane (except thyroxine) due to its hydrophilic nature. Consequently, its receptors are on the cell membrane (e.g. G-Protein Coupled Receptor and Janus Kinase Receptors) and the signal is transduced by activation of adenylate (or adenylyl) cyclase. This enzyme catalyses the conversion (and hydrolysis) of ATP to cAMP which is the secondary messenger that activates AMP-dependent Protein Kinase (e.g. Protein Kinase A).

Question 22

Q

ACTH
A. Stimulates the secretion of adrenaline from the adrenal glands
B. Is produced by neurons whose cells bodies are located in the hypothalamus
C. In excess may cause hyperglycemia
D. Regulates aldosterone production
E. Deficiency of will lead to hyperkalemia

Answer

A

C: ACTH only controls the hormones produced in the zona fasiculata and zona reticularis, namely, glucocorticoids and androgens. Thus, its excessive secretion will lead to increased cortisol levels and thus, increased catabolism and blood glucose level. It is synthesised by the anterior pituitary gland and does not affect aldosterone secretion and secretions of the adrenal medulla

Question 23

Q

With respect to T3, which of the following statements is false?
A. T3 is secreted by the thyroid gland
B. T3 is not produced outside the thyroid gland
C. T3 is more biologically active than thyroxine
D. More than 99% of the circulating T3 is bound to protein in plasma
E. T3 acts on the pituitary gland to inhibit the secretion of TSH

Answer

A

B: T3 is produced outside the thyroid gland from T4. In fact, most of T3 is produced this way at the target cell sites. Some T3 is secreted by the thyroid gland and it is more biologically active than T4. They are largely bound to thyroxine binding globulin and exert a negative feedback to the anterior pituitary gland to reduce TSH secretion.

Question 24

Q

Exercise can reduce metabolic syndrome related risk factors for cardiovascular disease and diabetes mellitus by
A. ??
B. better regulation of insulin and glucose
C. Better control of blood pressure
D. control of lipid profile
E. better weight management

Answer

A

E. it stimulates the AMPK pathway to increase GLUT4 on muscle and fat cells that reduce blood glucose levels.

Question 25

Q

Which of the following is common to BOTH hyperthyroidism and hypothyroidism?
A. Gaze palsies
B. Weight loss
C. Carpal tunnel syndrome
D. Cardiac failure
E. Ichthyosis

Question 26

Q

. Features of thyroid cancer may include all the following, EXCEPT:
A. Loss of voice
B. Retrosternal extension
C. Tracheal deviation
D. Lymph node enlargement
E. Tender goiter

Answer

A

E. Tender goiter: Typically, thyroid cancers present as painless nodules. Tenderness is more associated with benign conditions or inflammatory processes rather than malignancy

Question 27

Q

What hormone does the insulin tolerance test test for?
A. Cortisol
B. Prolactin
C. Thyroxine
D. Luteinising hormone
E. Oxytocin

Question 28

Q

Hypocalcemia may be seen in all of the following EXCEPT
A. vitamin D deficiency
B. hypoparathyroidism
C. kidney failure
D. intestinal diseases causing poor absorption of nutrients
E. excessive calcitonin production by thyroid cancer

Answer

A

E. Excessive calcitonin production by thyroid cancer - Calcitonin lowers blood calcium levels by inhibiting osteoclast activity in bones and reducing renal tubular reabsorption of calcium. However, excessive production of calcitonin is less commonly associated with significant hypocalcemia compared to the other conditions listed. While it can contribute to lower calcium levels, it is not a primary cause of hypocalcemia like the others mentioned.

Question 29

Q

An aldosterone-producing tumor may lead to all of the following EXCEPT
A. high systemic blood pressure
B. a low serum potassium concentration
C. a low plasma renin activity
D. effects on muscular and cardiac activities
E. primary metabolic acidosis

Answer

A

E. Primary metabolic acidosis - This is not typically associated with aldosteronoma. Instead, aldosterone generally promotes sodium retention and potassium excretion, which can lead to metabolic alkalosis rather than acidosis.

Question 30

Q

Which one of the following statements regarding the parathyroid glands is
FALSE?
A. Their activity is stimulated by low serum calcium.
B. Their secretion catalyzes the formation of active vitamin-D3.
C. The secretion helps to enhance reabsorption of calcium in the kidney.
D. The parathormone is produced primarily by the oxyphil cells.
E. Estrogen is an antagonist of some of its actions on bone.

Answer

A

D.The parathormone is produced primarily by the oxyphil cells.
This statement is false. Parathyroid hormone (PTH) is primarily produced by the chief cells of the parathyroid glands, not the oxyphil cells. Oxyphil cells have an unclear function and do not produce significant amounts of PTH.

Question 31

Q

In a patient with uncontrolled type 1 diabetes, an increase in which one of the
following serum ions will deplete intracellular potassium levels?
A. Na+
B. Mg2+
C. Cl-
D. H+
E. HCO3-

Answer

A

D. Potassium Shift: To maintain acid-base balance, hydrogen ions enter cells, while potassium ions exit cells into the extracellular fluid. This shift can result in a decrease in intracellular potassium levels, even if serum potassium levels may appear normal or elevated.

Question 32

Q

Which one of the following statements regarding parathyroid hormone is TRUE?
A. It is synthesized by the parafollicular cells of the thyroid gland.
B. It acts on the skin to produce the active form of Vitamin D.
C. It increases renal tubular reabsorption of phosphate.
D. Its deficiency has no major effect on plasma calcium concentration.
E. It acts on the kidneys to increase the production of 1,25-dihydroxyvitamin D3.

Question 33

Q

In a patient with poorly controlled Type 1 diabetes mellitus, which one of the
following processes DOES NOT occur in the body?
A. Gluconeogenesis in the muscle
B. Gluconeogenesis in the liver
C. Ketogenesis in the liver
D. Glycogenolysis in the liver
E. Proteolysis in the muscle

Answer

A

A. Gluconeogenesis in the muscle - This process does not significantly occur in the muscle. While muscles can produce glucose from certain substrates, gluconeogenesis primarily occurs in the liver.

Question 34

Q

Which one of the following manifestations is MOST LIKELY in a patient with
secondary adrenal insufficiency (ACTH deficiency)?
A. Increased vascular resistance
B. Immune suppression
C. High blood pressure
D. Hypoglycemia
E. Hyperkalemia

Answer

A

D. Hypoglycemia.
In secondary adrenal insufficiency, the pituitary gland does not produce enough adrenocorticotropic hormone (ACTH), leading to decreased cortisol production by the adrenal glands. Cortisol plays a crucial role in maintaining blood glucose levels by stimulating gluconeogenesis and glycogenolysis. With insufficient cortisol, the body is more prone to developing hypoglycemia (low blood sugar levels).

Question 35

Q

Which one of the following observations is NOT consistent with a male patient
diagnosed with 5α-reductase deficiency (5-ARD)?
A. The patient is likely to be infertile.
B. The patient is likely to have female external genitalia.
C. The patient has no male internal genitalia.
D. The patient has normal androgen receptor.
E. The patient has normal level of testosterone of a male.

Answer

A

C. The patient has no male internal genitalia.
This statement is NOT consistent. Patients with 5α-reductase deficiency typically have normal male internal genitalia (such as testes, seminal vesicles, and vas deferens) because the condition primarily affects external genital development.

Question 36

Q

A 31-year-old man presents with a neck swelling. He is found to have a solitary
left thyroid nodule (3cm in diameter, not tender), and is euthyroid. He also has
an enlarged left cervical lymph node. He undergoes surgery to remove the
nodule and is told it is thyroid cancer. Which statement is FALSE?
A. The most likely diagnosis is papillary thyroid carcinoma, which is the
commonest primary thyroid malignancy
B. Papillary thyroid carcinoma is defined by the presence of capsular or vascular
invasion
C. Follicular carcinoma of the thyroid spreads by the haematogenous route, thus
it seldom involves lymph nodes
D. In a young patient with multiple thyroid tumours, MEN syndrome-associated
medullary thyroid carcinoma should be considered
E. Anaplastic carcinoma has the worst prognosis

Answer

A

B. Papillary thyroid carcinoma is defined by the presence of capsular or vascular invasion.
This statement is FALSE. While capsular or vascular invasion can indicate more aggressive forms of thyroid cancer, papillary thyroid carcinoma itself is primarily defined by its characteristic nuclear features and the presence of papillae, not by capsular or vascular invasion. These invasions are more characteristic of follicular thyroid carcinoma.

Question 37

Q

Which diuretic drug may unmask hypercalcaemia in patients with occult
pathological conditions such as sarcoidosis?
A. Chlorothiazide
B. Torsemide
C. Furosemide
D. Eplerenone
E. Amiloride

Answer

A

A. Thiazide diuretics, such as chlorothiazide, can unmask hypercalcemia in patients with occult pathological conditions like sarcoidosis.
Thiazide diuretics inhibit the reabsorption of sodium and chloride in the distal convoluted tubule of the nephron. This leads to increased calcium reabsorption, which can exacerbate hypercalcemia in patients with underlying conditions that cause elevated calcium levels, such as sarcoidosis.
In sarcoidosis, granulomas in the kidneys can lead to increased production of active vitamin D (1,25-dihydroxyvitamin D), which enhances intestinal calcium absorption and bone resorption, resulting in hypercalcemia. However, this hypercalcemia may not be clinically apparent until a thiazide diuretic is administered, which then uncovers the underlying condition.

Question 38

Q

A 15-year-old boy was found to have elevated fasting blood sugar with
polydipsia and polyuria. He was started on Insulin Lispro. Which ONE of the
following properties of Insulin Lispro is TRUE?
A. Proline and lysine are in inverted positions in the A chain
B. Ultra-short duration of action of up to 5 hours
C. Can be given intravenously
D. Prevents breakdown of GLUT proteins in adipocytes
E. Is not recommended in patients who lead an active lifestyle

Question 39

Q

A 55-year-old man has been taking glibenclamide for several years to control
his blood sugar. The following drugs decrease the hypoglycaemic effect of
glibenclamide, EXCEPT:
A. Adrenaline
B. Diazoxide
C. Oestrogen contraceptives
D. Co-trimoxazole
E. Hydrochlorothiazide

Answer

A

D. Co-trimoxazole
Co-trimoxazole (a combination of trimethoprim and sulfamethoxazole) has been reported to potentiate the effects of sulfonylureas, potentially leading to increased risk of hypoglycemia rather than decreasing it.

Question 40

Q

A patient is diagnosed with having a pheochromocytoma (a tumour of the
adrenal gland). Which of the following is NOT an expected consequence of the
increase in adrenaline release?
A. Tachycardia
B. Weight loss
C. Diarrhoea
D. Hypertension
E. Tremor

Question 41

Q

A 35-year-old woman came to see you, complaining of loss of weight despite
eating adequately. She was noted to be agitated and had tachycardia, hand
tremors, and an enlarged thyroid gland. Tests confirmed she had Graves
disease and you started her on propylthiouracil.
The following are true of propylthiouracil, EXCEPT:
A. It does not have an active metabolite
B. It is given once a day
C. It inhibits the peripheral formation of T3 from T4
D. It inhibits thyroidal peroxidase action
E. It is potentially hepatotoxic

Answer

A

B. It is given once a day
This statement is FALSE. Propylthiouracil is typically administered multiple times a day (usually three times daily) due to its relatively short half-life (approximately 2 hours).

Question 42

Q

Which of the following urine tests is MOST useful for the diagnosis of
pheochromocytoma?
A. 24-hour cortisol
B. 24-hour metanephrines
C. 24-hour dopamine
D. 24-hour creatinine
E. 24-hour uric acid

Question 43

Q

A 38-year-old woman is diagnosed with Graves’ disease. She is prescribed
carbimazole. Which of the following is the MOST IMPORTANT advice to give this
patient when prescribing carbimazole?
A. Do not miss a dose of carbimazole
B. Do not take supplements containing iron or calcium within 4 hours of the
carbimazole
C. Seek medical advice immediately if you develop a fever or sore throat
D. Carbimazole can cause liver failure
E. Take the carbimazole with food

Question 44

Q

Which of the following statements BEST describes the utility of SGLT2-
inhibitors?
A. They are beneficial in patients without known atherosclerotic cardiovascular
disease as they can reduce the risk of myocardial infarction, stroke and
cardiovascular death.
B. They are beneficial in reducing the risk of hospitalisation for heart failure in all
patients regardless of atherosclerotic cardiovascular disease status
C. They are highly recommended for the management of hyperglycaemia in
diabetic patients with renal dysfunction as they also have nephroprotective
effects.
D. Their ability to lower HBA1c levels is comparable to that of metformin.
E. They are the only pharmacological class of hypoglycaemic agents shown to
decrease the risk of cardiovascular disease.

Question 45

Q

Which of the following drugs used in the management of diabetes mellitus is
useful for weight loss?
A. Gliclazide
B. Acarbose
C. Liraglutide
D. Pioglitazone
E. Repaglinide

Question 46

Q

Which of the following statements BEST explains the raised risk of
hypoglycaemia with neutral protamine hagedorn (NPH) insulin as compared to
the other insulin preparations?
A. It has a 1 to 4 hours delayed onset of action
B. The peak action of NPH insulin is long
C. It has a long duration of action
D. The formulation is at a neutral pH
E. It has low intra-subject variations in fasting blood glucose levels

Question 47

Q

A female newborn baby was brought into the Emergency Department with
vomiting and diarrhoea. On physical examination, her clitoris was enlarged.
Laboratory tests showed hyponatremia, hyperkalaemia, and hypoglycaemia.
What is the MOST likely finding in the adrenal glands?
A. Large tumour replacing one adrenal gland
B. Bilateral adrenal cortical hyperplasia
C. Bilateral adrenal cortical atrophy
D. Bilateral adrenal medulla nodules
E. Unilateral adrenal medulla nodule

Answer

A

B. In the case of the female newborn baby presenting with vomiting, diarrhea, hyponatremia, hyperkalemia, and hypoglycemia, along with an enlarged clitoris, these findings are suggestive of congenital adrenal hyperplasia (CAH), specifically due to 21-hydroxylase deficiency. This condition leads to an accumulation of steroid precursors, including androgens, which can cause virilization and ambiguous genitalia in female infants.
Given this context, the most likely finding in the adrenal glands of this newborn would be:
B. Bilateral adrenal cortical hyperplasia.
Explanation:
Bilateral Adrenal Cortical Hyperplasia: In CAH, particularly in the classic form caused by 21-hydroxylase deficiency, the adrenal glands become hyperplastic (enlarged) due to the lack of cortisol production. The body responds to low cortisol levels by increasing ACTH (adrenocorticotropic hormone) secretion, which stimulates the adrenal cortex, leading to hyperplasia.

Question 48

Q

Liothyronine has better oral bioavailability than levothyroxine. Why is
levothyroxine preferred as a first-line treatment for hypothyroidism?
A. Levothyroxine has a lower acute cardiovascular risk
B. Levothyroxine has a lower level of plasma protein binding
C. Levothyroxine has a faster onset of action
D. Levothyroxine has a more potent effect at thyroid hormone receptors
E. Liothyronine cannot be formulated as oral tablets

Question 49

Q

A 28-year-old woman is diagnosed as having thyrotoxic crisis. She was
prescribed a number of drugs including a thioamide. Which of the following
drugs was MOST LIKELY the thioamide prescribed?
A. Thiamazole
B. Carbimazole
C. Propylthiouracil (PTU)
D. Colestyramine
E. Lugol’s solution

Answer

A

C. Propylthiouracil (PTU)
Rationale:
Thyrotoxic Crisis Management: Propylthiouracil is preferred in the management of thyrotoxic crisis (also known as thyroid storm) due to its rapid onset of action and its ability to inhibit the conversion of thyroxine (T4) to triiodothyronine (T3) in addition to inhibiting thyroid hormone synthesis. This makes it particularly effective in acute situations.
Comparison with Other Thioamides:
Thiamazole and Carbimazole: Both are effective for long-term management of hyperthyroidism but are not as commonly used in acute settings like a thyrotoxic crisis due to their slower onset of action compared to PTU.
Colestyramine: This is not a thioamide; it is a bile acid sequestrant that can be used to lower thyroid hormone levels but is not an antithyroid medication.
Lugol’s solution: This is an iodine solution that can temporarily inhibit thyroid hormone release but is not classified as a thioamide.

Question 50

Q

Which of the following classes of oral hypoglycaemic agents act in a glucose-
dependant manner to augment insulin action?
Confidential. Property of NUS 16
A. Sodium-glucose co-transporter 2 (SGLT2) inhibitors
B. Glucagon-like peptide-1 receptor agonist
C. Sulfonylureas
D. Dipeptidyl peptidase-4 inhibitors
E. Thiazoldinediones

Question 51

Q

Which of the following adverse effects is LEAST likely due to the use of
sodium-glucose co-transporter 2 (SGLT2) inhibitors?
A. Hypoglycaemia
B. Vaginal candidiasis
C. Urinary tract infection
D. Diabetic ketoacidosis
E. Hypotension

Answer

A

A. Hypoglycaemia
Least Likely: SGLT2 inhibitors generally do not cause hypoglycemia when used alone because their mechanism of action is independent of insulin. They work by preventing glucose reabsorption in the kidneys, leading to increased glucose excretion in urine. Hypoglycemia is more commonly associated with insulin or sulfonylureas.

Question 52

Q

Which of the following is the immediate precursor to invasive carcinoma?
A. Dysplasia
B. Metaplasia
C. Metastasis
D. Hyperplasia
E. Hypertrophy

Question 53

Q

Which of the following regarding pheochromocytoma is TRUE?
A. Most occur outside of the adrenal glands
B. Mostpresentbilaterally
C. Mostpatientshaveapositivefamilyhistory
D. A minority of pheochromocytomas exhibit metastasis and tissue invasion

Question 54

Q

What is true regarding papillary thyroid carcinoma?
A. Tends to spread via hematogenous route
B. It is not a common thyroid malignancy
C. Median survival duration of 5 years
D. Nuclear grooves and inclusions are characteristic

Question 55

Q

Which of the following drugs is most suitable to treat myxedema crisis?
A. IV Propylthiouracil
B. IVLevothyroxine
C. Carbimazole
D. Oral Potassium Iodide
E. Radioactive Iodine

Question 56

Q

Why is PTU preferred over carbimazole in the treatment of thyroid storm?
A. It prevents conversion of T4 to T3 in the periphery
B. It prevents activation of T4 to T3
C. It has a lower risk of hepatotoxicity
D. It has a lower risk of renal toxicity

Question 57

Q

Diabetic drug was prescribed to a female patient. Few days later, the patient presents with thick white vaginal discharge and dysuria. Which drug was most likely prescribed to the patient?
A. Dapagliflozin
B. Pioglitazone
C. glibenclamide
D. Metformin

Question 58

Q

Which of the following is NOT a cause of hypercalcemia?
A. Pseudo-hyperparathyroidism
B. TertiaryHyperparathyroidism
C. Hyper-vitaminosisD
D. Primaryhypercalcemia
E. Humoral hypercalcemia of malignancy

Answer

A

A. Patients with PHP experience low serum calcium levels due to the body’s inability to respond effectively to PTH. Despite having elevated PTH levels, the physiological effects of PTH—such as increasing calcium reabsorption in the kidneys and enhancing intestinal absorption of calcium—are impaired, leading to hypocalcemia

Question 59

Q

Glucocorticoids are useful in the treatment of thyroid storm because they:
a) Reduce peripheral conversion of T4 to T3
b) Reduce thyroid inflammation
c) Reduce expression of thyroid peroxidase
d) Reduce fever
e) Increase production of TSH

Answer

A

A. Glucocorticoids are used in thyroid storm to reduce peripheral conversion of T4 to T3 and reduce the risk of adrenocortical insufficiency in thyroid storm

Question 60

Q

A woman with type II diabetes is on metformin. Her doctor wants to add a second-line diabetic drug for better control of her blood glucose. She does not want an injectable. Which of the following is most unsuitable?

a) Pioglitazone
b) Linagliptin
c) Liraglutide
d) Glipizide
e) Acarbose

Answer

A

C. Liraglutide is a GLP-1 receptor agonist that is administered subcutaneously.

Question 61

Q

An 11 year old girl with Type 1 DM was on lispro and NPH mixed insulin therapy. She experienced tachycardia, fainting spells (sweating, muscular contractions). Her mother brought her to the ED unconscious where her HR was 110. Which of these is the most appropriate therapy?

A) IM Adrenaline
B) IM Glucagon
C) IM Exenatide
D) Oral glucose
E) IV insulin

Answer

A

B. It is important to note the severity of the hypoglycemia in this patient: the patient was brought to the emergency department unconscious. If the patient is alert and conscious, oral glucose may be a suitable therapy for hypoglycemia. However, when the patient is unconscious or unable to ingest carbohydrates, an intramuscular glucagon injection can be used. Refer to ‘Management of hypoglycemia during treatment of diabetes mellitus’ on UpToDate.

Question 62

Q

Type 1 DM patient on two insulin regimens, one for post-prandial bolus and basal bolus.
What is the fundamental pharmacokinetic principle that allows these drugs to have their effects:

A) Rate of Elimination
B) Rate of Absorption
C) Rate of Metabolism
D) Oral bioavailability
E) Volume of distribution

Answer

A

A. The basal bolus of insulin stimulates the basal level of insulin present in a normal body throughout the entire day, while the post-prandial bolus of insulin simulates the post-prandial insulin release in response to meals. Insulin from the basal bolus hence has to remain within the body for a longer period of time, meaning that its rate of elimination is slower than that of the post-prandial bolus.

Question 63

Q

A 36-year old lady presented with a right-sided goitre. Fine needle aspiration cytology showed many clusters of cells with nuclear enlargement, nuclear grooves and pseudoinclusions. The follicles showed canty colloid and many psammoma body calcifications were noted.

a. It has the worst prognosis of all the thyroid carcinomas
b. It is spread by blood
c. Radiation is a risk of developing this carcinoma
d. It is a rare form of thyroid carcinoma
e. It is associated with the mutation of a Rb gene

Answer

A

C. Nuclear enlargement, nuclear grooves, pseudoinclusions and the presence of canty colloid with psammoma bodies all point to this being a papillary carcinoma of the thyroid.

Regarding A and D, papillary carcinoma is the most common and also has the best prognosis of all the thyroid carcinomas on average.

Regarding B, papillary carcinomas are notably known for lymphatic spread rather than hematogenous spread. Rather, it is follicular carcinoma that is associated with hematogenous spread.

Regarding E, papillary carcinomas are associated with RET translocations and B-RAF point mutations, not Rb (retinoblastoma) mutations.

C is the answer - radiation is indeed a known risk factor for developing papillary carcinoma.

P.S. Radiation increases the risk of developing many cancers - it is a known carcinogen and that is one of the reasons why it is considered dangerous to perform many X-rays or CT scans on a patient. If you run out of ideas when listing risk factors for cancers, remember that there’s a good chance that radiation is one of them.

Question 64

Q

Thyroid gland on FNAC showed lots of follicles, no capsular or vascular invasion, no pseudoinclusions or papillary grooves. What is the most likely diagnosis?
a. Follicular carcinoma
b. Follicular adenoma
c. Papillary carcinoma
d. Cellular hyperplastic nodule
e. Fibrous hyperplastic nodule

Answer

A

B. It has to be said that this is not the most obvious or classical description of a follicular adenoma. Given that there is no capsular/vascular invasion, this is not likely to be a follicular carcinoma. The lack of pseudoinclusions or papillary grooves suggest this is not a papillary carcinoma.

The descriptor “plenty of follicles” suggests that there is a indeed an overgrowth of follicular cells, which points towards either a follicular adenoma or a cellular hyperplastic nodule (benign hyperplasia).

Answer 41

A

E. Factual - refer to the table comparing all of their different Onset and DOA durations.
The other options are wrong: it has a 2 amino acid difference when compared to Regular Insulin, is given subcutaneously, doesn’t ppt at physiological pH (that’s glargine) and is best given before meals

Answer 42

A

E. Factual - fluid retention is a known side effect of glitazones.

Answer 43

A

D. Option D is true because thyroid hormones stimulate an increase in cardiac workload (e.g. by raising the heart rate) and thereby cause a corresponding increase myocardial oxygen demand, exacerbating angina if the patient has underlying CAD.

Answer 44

A

D. Euthyroidism excludes Hashimoto’s (usually hypothyroid) and Graves’ (hyperthyroid). The absence of nuclear inclusions/grooves excludes Papillary Thyroid Carcinoma. This leaves us Options D and E. To decide between them, look at the description “abundant colloid and flattened sheets of follicular cells” - sounds a lot like the hyperplastic phase of MNGs!

Answer 45

A

C. It is not adipocytes but liver and peripheral tissue

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