1. Levothyroxin (T4) supplementation in the dose of 25 micrograms per day is a preferred initial dose for:
A) All adults newly diagnosed as hypothyroid
B) If the diagnosis is made during pregnancy
C) Persons with stable angina
D) Persons with myxedema
2. Over correction of hypothyroidism with levothyroxin increases the risk of:
A) Exophthalmos
B) Osteoporosis
C) Hypercholestolemia
D) Goiter
3. Parathyroid hormone is normally secreted in response to:
A) Low calcium ion concentration
B) Low levels of serum vitamin D
C) High calcium ion concentration
D) High Vitamin D concentration
4. Following endocrinopathy is associated with Peptic ulcer disease:
A) Hyperthyroidism
B) Hypothyroidism
C) Hyperparathyroidism
D) Hypoparathyroidism
5. Estimation of calcium ion concentration is important to diagnose hypertension secondary to:
A) Hyperaldostrerinism
B) Hyperparathyroidism
C) Renal artery stenosis
D) Syndrome of inappropriate Anti-diuretic Hormone secretion (SIADH)
6. Hypovitaminosis D causes:
A) Primary Hyperparathyroidism
B) Secondary hyperparathyroidism
C) Tertiary hyperparathyroidism
D) Malignant hyperparathyroidism
7. Which is the commonest malignancy in MEN 2a (multiple endocrine neoplasia 2a)?
A) Gastrinoma
B) Insulinoma
C) Medullary thyroid carcinoma
D) Pheochromocytoma
8. Commonest cause of secondary adrenal insufficiency is:
A) Iatrogenic
B) Tuberculosis
C) Autoimmunity
D) Waterhouse friederichsen syndrome
9. True about gynecomastia:
A) Estrogen: Androgen ratio is increased
B) It can normally occur at puberty
C) Prolactin levels are increased
D) Spironolactone can cause iatrogenic gynecomastia
10. Which is the cause of primary hyperaldosteronism?
A) Renal artery stenosis
B) Cirrhosis of liver
C) Congestive cardiac failure
D) Glucocorticoid remediable aldosteronism
Answers:
Ans: 1-C
The usual starting dose for any adult with hypothyroidism is 50-100 microgram per day. Elderly people and people with heart disease should be given lower initial doses as increase in heart rate can precipitate myocardial ischemia. Pregnant women can be treated with usual dosage of thyroxin. Myxedema is a manifestation of hypothyroidism and the treatment remains the same.
Ans: 2-B
Exophthalmos is one of the manifestations of autoimmune process associated with Grave’s disease. Hypothyroidism can elevate levels of LDL cholesterol. Treatment of hypothyroidism may correct hypercholesterolemia to some extent. Osteoporosis and atrial fibrillation are associated with overcorrection or iatrogenic hyperthyroidism.
Ans: 3-A
Low calcium ion concentration is the only stimulation for secretion of parathyroid hormone from the glands. Vitamin D does not directly affect secretion of parathyroid hormone.
Ans: 4-A
Hyperparathyroidism is associated with Acid peptic disease causing duodenal ulcer more frequently than gastric ulcers. It is important to do calcium levels in all cases of peptic ulcer disease.
Ans: 5-B
Hyperparathyroidism can cause hypertension. The condition can be suspected if serum calcium is raised.
Ans: 6-B
Parathyroid adenoma (80%) and hyperplasia (20%) cause primary hyperparathyroidism. Low vitamin D levels cause low serum calcium level stimulating parathyroid stimulation and secondary hyperparathyroidism. When parathyroid gland is stimulated for long duration, it may become autonomous causing high calcium levels and high parathyroid levels resulting in tertiary hyperparathyroidism. Secretion of parathyroid related protein from some lung, breast or kidney cancers causes malignant hyperparathyroidism
Ans: 7-C
Medullary thyroid carcinoma occurs in 100% cases of MEN 2a. Gene involving MEN 2 a and b is ret proto onchogene. Those testing positive for ret mutation can be treated with prophylactic thyroidectomy, usually before three years of age.
Ans: 8-A
Tuberculosis and autoimmunity are common causes of primary adrenal insufficiency or Addison’s disease, when the insult is directly to the adrenal gland due to which they stop functioning. Waterhouse freidrichsen syndrome causes acute adrenal insufficiency due to adrenal hemorrhage. Long term use of steroids (iatrogenic) suppress pituitary adrenal axis, which remains suppressed even after stoppage of steroid, causing secondary adrenal insufficiency. During periods of stress steroid supplementation is needed in such cases.
Ans: 9-C
Increase in prolactin levels causes galactorrhea.
Ans: 10-D
Glucocorticoid remediable aldosteronism is a genetic condition where aldosterone production is under control of ACTH, when steroid suppresses ACTH, aldosterone secretion reduces. Option A, B and C are causes of secondary hyperaldostreronism.
No comments:
Post a Comment