ENDOCRINOLOGY
1. The laboratory test that should be performed on a patient in the immediate postoperative
period after thyroidectomy is serum calcium.
2. Elevated glucose levels, especially in obese persons may be due to insulin resistence.
3. If a young patient is brought to the emergency reception with history of a boating accident
and closed head injury with anterior table displaced fracture and the urine output on day
two is 10 liters a day. You will tell the family that its idiopathic and has a high
mortality. The patient is having cranial diabetes insipidus.
4. Severe hypothyroidism characterized by dry puffy skin , somnolence, slow medication,
and hoarseness is known as called as myxedema.
5. Hemoglobin A1C test is used to evaluate blood glucose levels over the previous two
months
6. Hormone will most likely be detected on urine dipstick in urine of a pregnant woman is
beta HCG.
7. The microscopic appearance of the thyroid gland in Grave’s disease consists of
. large follicles with flattened epithelium and scalloping of colloid
Normal gland Grave’s Disease
8. Mechanism of exophthalmos in Grave’s disease Deposition of glycosaminoglycans, influx of water
and fibrosis with obstruction of the superior ophthalmic vein with resultant diminished venous
outflow.
9. Mechanism of a decrease in serum TSH in primary hyperthyroidism is thyroxine receptors in the
pituitary gland are activated by the surplus hormone, suppressing additional release of TSH in a
negative feedback loop.
10. Growth hormone Promotes lipolysis in adipose tissue.
11. The active form of thyroid hormone is Triiodothyronine T3*
12. Regarding the pathogenesis of Grave’s disease thyroid-stimulating immunoglobulins recognize
and bind to the TSH receptor which stimulates the secretion of thyroid hormones
13. A middle aged patient with a suspected thyroid disorder had her radioiodine uptake testing done
which showed diffusely increased iodine uptake by both lobes of the gland. The most likely cause
is Grave’s disease.
14. Which of the following shows radioiodine uptake in thyroiditis?
a. A
b. B
c. C
d. D
e. E*
Key (Five different scintigrams taken from thyroids with different
syndromes: (A) Normal thyroid; (B) Graves disease, diffuse increased
uptake in both thyroid lobes; (C) Plummer disease (toxic multinodular
goiter); (D) Toxic adenoma; (E) Thyroiditis (marker 99Tc).)
15. The initial and further lab investigations significant/positive in the patient of Hashimoto’s
thyroiditis will be low serum free T4, high serum TSH and positive thyroid peroxidase
antibodies.
16. Screening of thyroid dysfunction should be carried out by serum TSH only.
17. Normal serum T4 and T3 levels and high serum TSH is called subclinical.
18. A critically ill patient with pneumonia and sepsis with slightly lower levels of thyroid
hormones than normal reference ranges will most probably have sick euthyroid
syndrome.
19. Hyperthyroidism in pregnancy is called as Gestational hyperthyroidism.
20. . Refractory hyperparathyroidism due to chronic renal disease; very elevated PTH and
elevated PTH and elevated Ca+2 is called tertiary hyperthyroidism.
21. Growth and mental retardation in an infant. Physical examination reveals a small infant
with dry, rough skin; a protuberant abdomen; periorbital edema; a flattened, broad nose;
and a large, protuberant tongue. This condition is called cretinism.
22. Graves’ disease is characterized clinically by finding Hyperthyroidism, exophthalmus, and
pretibial myxedema
23. The term goiter refers to any enlargement of the thyroid regardless of the etiology.
24. An individual with cirrhosis who has decreased production of thyroid-binding globulin
(TBG) yet clinically is euthyroid would most likely have which one of the listed sets of
laboratory values?
Serum T4 Serum T3 Serum TSH
Decreased Normal Normal*
25. The two commonest causes of primary hypothyroidism Hashimoto’s thyroiditis and iodine
deficiency.
26. Tachycardia and heat intolerance with weight loss. On examination, diffuse thyroid
enlargement. Thyroid scan shows increased uptake of thyroid. Most probable diagnosis is
grave’s disease.
27. History of intracranial irradiation with decreased free T4 and decreased serum TSH ;
secondary hypothyroidism.
28. Hyperparathyroidism with normal or slightly decreased calcium levels is secondary
Hyperparathyroidism.
29. The term Vitamin D3 is used for Vitamin D of animal origin.
30. The metabolite of Vitamin D commonly tested in the lab for the assessment of vitamin D
status is 25 Hydroxy Vitamin D.
31. A Characteristic symptom of hypocalcemia is tetany.
32. Classical features of primary hyperparathyroidism: Nausea, fatigue, muscle weakness, and
intermittent pain in her left flank. Laboratory examination reveals an increased serum
calcium and a decreased serum phosphorus. The patient’s plasma parathyroid hormone
levels are increased, but parathyroid hormone–related peptide levels are within normal
limits. Urinary calcium is increased, and microhematuria is present.
[Link] picture and lab diagnosis of humoral hypocalcemia of malignancy:
major symptom is cough with haemoptysis. Biochemical tests will be as
following:
• Serum Calcium: Raised (2.10-2.65mmol/L)
• Serum Phosphorus: Decreased (1.75-1.9mmol/L)
• Blood PTH: Very low (15-62pmol/L)
34. Clinical picture of hypoparathyroidism include attacks of numbness and
spasm of the lower limbs off and on. Bone profile is as follows:
• Serum Calcium: Low (2.10-2.65 mmol/L)
• Serum Urea: High (3.6-6.6 mmol/L)
• Serum Phosphorus: High (1.75-1.9 mmol/L)
• Blood PTH: Normal (15-62pmol/L)
35. Hyperparathyroidism with normal calcium levels is Secondary
Hyperparathyroidism.
36. Single most important test to rule out acromegaly is serum Insulin like
growth factor 1 (Insulin like growth factor 1).
[Link] a patient complains of change of his shoe size and enlargement of his
hands and jaw. The disorder he is having is most likely mediated through
actions of excess somatomedin.
38. A lung mass on x-ray and recent weight gain along with hyponatremia with hyperosmolar
urine signifies that the patient has most probably he patient probably has Inappropriate
ADH
39. If a patient is taking oral steroids for the last many weeks. The metabolic effect most
likely to be found in this patient is increased glucose-6 phosphatase.
40. A known case of Addison Disease has pigmentation on various parts of the body. The
most probable hormone responsible for this pigmentation in this patient is increased
ACTH.
41. The most common cause of Cushing Syndrome is iatrogenic.
42. If a patient is performing night duty with the habit of going to bed in the morning.
The time of the day (24 h) for collection of the sample for the investigation of a suspected
cushings syndrome would be:Morning (0900am)
43. According to guidelines the test of choice for suspected cushings syndrome in pregnant
patients is urinary free cortisol.
44. The most common cause of Chronic Adrenal Insufficiency Worldwide (including
developing countries) is tuberculosis.
45. The best hormonal marker for the investigation of premature adrenarche in a child is
DHEA-S.
46. The most important biochemical findings to distinguish actual Cushing Syndrome from
‘Pseudo-Cushing's Syndrome is increased late evening serum cortisol.
47. Serum TSH is an anterior pituitary hormone.
48. Adrenals and parathyroids are endocrine glands
49.
