exam deck 2

Question 1

1. Clinical signs of endocrine dysfunction in adult pituitary deficiency due to a non-secreting macroadenoma may include?
   a. Goiter
   b. Hypogonadism
   c. Hirsutism
   d. Melanoderma
   e. Hypotension

Answer 1

b. Hypogonadism
e. Hypotension

Question 2

2. In which of the following diseases we find poliuric-polydipsic syndrome
   a. Primary hyperparathyroidism
   b. Diabetes mellitus
   c. Section of pituitary stalk
   d. Cushing disease
   e. Conn disease

Answer 2

a. Primary hyperparathyroidism
b. Diabetes mellitus
c. Section of pituitary stalk

Question 3

3. Which of the following statements are TRUE regarding polyglandular autoimmune type 2 syndrome (type 2 PAS)?
   a. Hypoparathyroidism is always a component of type 2 PAS
   b. Chronic candidiasis is part of type 2 PAS
   c. Addison’s disease is not associated with type 2 PAS
   d. Autoimmune thyroid diseases may be part of the type 2 PAS
   e. None of the statements above

Answer 3

d. Autoimmune thyroid diseases may be part of the type 2 PAS

Question 4

4. The etiology of nephrogenic diabetes insipidus is:
   a. Neuroleptic treatment
   b. Hypokalemia
   c. Hypocalcaemia
   d. Lithium treatment
   e. Hypernatremia

Answer 4

b. Hypokalemia
d. Lithium treatment

Question 5

5. Which of the following statements are FALSE?
   a. 90% of steroid hormones and thyroid hormones circulate in complexed form with binding proteins.
   b. The free form is the biologically active one.
   c. Modification of binding proteins affects the serum concentration of the free hormone fraction, but not the total.
   d. The half-life of catecholamines is in the order of seconds.
   e. modification of binding protein effects ….

Answer 5

e. modification of binding protein effects ….

Question 6

6. Mark the correct statements about papillary thyroid carcinoma.
   a. Typically presents as a nodule that is firm and solid on thyroid ultrasound
   b. Microscopically, papillary cancer typically consists of single layers of thyroid cells arranged in vascular stalks, with papillary projections extending into macroscopic cystic spaces
   c. It is the most frequent form of thyroid carcinoma
   d. Most papillary thyroid cancers grow rapidly
   e. Calcitonin is a marker for recurrence or metastasis of the cancer

Answer 6

a. Typically presents as a nodule that is firm and solid on thyroid ultrasound
b. Microscopically, papillary cancer typically consists of single layers of thyroid cells arranged in vascular stalks, with papillary projections extending into macroscopic cystic spaces
c. It is the most frequent form of thyroid carcinoma

Question 7

7. Among the clinical manifestations of goitre we might find:
   a. Dyspnea
   b. Dysphonia
   c. Exophthalmos
   d. The increase of the extremities
   e. Claude Bernard-Horner’s syndrome

Answer 7

a. Dyspnea
b. Dysphonia
c. Exophthalmos
e. Claude Bernard-Horner’s syndrome

Question 8

8. A 40-year-old patient presents to the endocrinologist for enlargement in the anterior cervical area. The ultrasound shows a 2/1.5 cm nodule in the left thyroid lobe, imprecisely delimited, with increased intranodular circulation. Hormonal dosages reveal normal thyroid function and increased plasma calcitonin. Which of the following statements are CORRECT?
   a. Fine needle aspiration can be useful for diagnosing and guiding the extent of surgery
   b. In this situation, it is necessary to delay the surgery
   c. In the paraclinical evaluation, it is also useful to dose the carcinoembryonic antigen
   d. Normal thyroid function excludes the malignant nature of a thyroid nodule
   e. All of the above

Answer 8

a. Fine needle aspiration can be useful for diagnosing and guiding the extent of surgery

c. In the paraclinical evaluation, it is also useful to dose the carcinoembryonic antigen

Question 9

9. A 28-year-old female patient presents for anterior cervical pain, palpitations, sweating, tremor of the extremities and irritability, that started 2 weeks ago. Her anamnesis reveals a recent respiratory viral inflammatory syndrome and FT4 2.2 times higher than normal, thyroid autoimmunity negative, radioactive uptake low. The lab tests show: TSH = 0.001 mIU/ml, without leukocytosis. The thyroid ultrasound shows a non-homogeneous appearance and a hypoechogenic area in the left lobe. In this context, which is most likely diagnosis?

a. Basedow Graves disease
b. Acute thyroiditis
c. Subacute thyroiditis
d. Riedl thyroiditis
e. Thyroid medullary cancer

Answer 9

c. Subacute thyroiditis

Question 10

10. A 25-year-old patient, 8 week pregnant has bilateral exophthalmia, weight loss, increased intestinal transit. Laboratory blood tests show an increased value of FT4, suppressed TSH, positive TRAb. What treatment do you recommend?
    a. levothyroxine in substitutive dose
    b. propylthiouracil
    c. methimazole
    d. prednisone in immunosuppressive dose
    e. radioactive iodine

Answer 10

b. propylthiouracil

Question 11

11. A patient is diagnosed with primary hyperparathyroidism due to a right lower parathyroid adenoma. Two days after surgery, the patient developed carpopedal spasms and QT interval prolongation on the EKG. Laboratory blood tests reveal hypocalcaemia. What can be the causes?
    a. transient postoperative hypocalcaemia
    b. hungry bones syndrome
    c. permanent postoperative hypocalcaemia
    d. prolonged immobilization
    e. vitamin D intoxication

Answer 11

a. transient postoperative hypocalcaemia
b. hungry bones syndrome
c. permanent postoperative hypocalcaemia

Question 12

For the diagnosis of pheochromocytoma, the following investigations are useful:
a. Scintigraphy with Tc-Sestamibi
b. Dosage of plasma metanephrine and normetanephrine
c. Metanephrine and normetanephrine dosing in urine / 24 hours
d. Scintigraphy with radioactive iodine
e. Abdominal MRI

Answer 12

b. Dosage of plasma metanephrine and normetanephrine
c. Metanephrine and normetanephrine dosing in urine / 24 hours
e. Abdominal MRI

Question 12

13. In the emergency room there is a patient known with Addison disease, who has discontinued any medical treatment for about 2 weeks. The patient complains of abdominal pain, vomiting, blood pressure is 70/50 mm Hg. Emergency laboratory investigations reveal a mild anaemia and serum K of 6.5 mEq/l. What are the therapeutic measures required?
    a. Volemic replacement
    b. Prednisone 5–7.5 mg/day
    c. Administration of 600 mg hydrocortisone hemisuccinate intravenously over the first 24 hours
    d. No treatment will be given until the surgical consultation
    e. Oral hydrocortisone administration 30 mg/day

Answer 12

a. Volemic replacement

c. Administration of 600 mg hydrocortisone hemisuccinate intravenously over the first 24 hours

Question 13

14. In primary adrenal insufficiency we can meet the following clinical manifestations:
    a. Hyperphagia
    b. Anorexia
    c. Hyperpigmentation in the skin folds
    d. Arterial hypertension reluctant to treatment
    e. Ophthalmopathy

Answer 13

b. Anorexia
c. Hyperpigmentation in the skin folds
d. Arterial hypertension reluctant to treatment

Question 14

15. A 38-year-old female patient is referred for secondary amenorrhea. Biologically, she has an increased serum prolactin level of 34 ng/dl (normal values ≤ 20 ng/dl). Which of the following may be the cause of hyperprolactinemia?
    a. primary hypothyroidism
    b. pregnancy
    c. polycystic ovary syndrome
    d. thyroid hormone therapy
    e. all the above

Answer 14

a. primary hypothyroidism
b. pregnancy
c. polycystic ovary syndrome

Question 15

16. Which of the following therapeutic resources can be used in the treatment of polycystic ovary syndrome:
    a. flutamide
    b. ciproterone acetate
    c. spironolactone
    d. oral contraceptives
    e. somatostatin analogs

Answer 15

a. flutamide
b. ciproterone acetate
c. spironolactone
d. oral contraceptives

Question 16

17. For a patient with 47XXY syndrome, the clinical features are true:
    a. The phenotype is masculine
    b. The phenotype is feminine
    c. Fertility is preserved
    d. Tall stature is expected
    e. Short stature is expected

Answer 16

a. The phenotype is masculine
c. Fertility is preserved
d. Tall stature is expected

Question 17

18. Manifestations of MEN 2A include:
    a. Medullary carcinoma
    b. Pheochromocytoma
    c. Pituitary tumors
    d. Hyperparathyroidism
    e. Pancreatic tumors

Answer 17

a. Medullary carcinoma
b. Pheochromocytoma
d. Hyperparathyroidism

Question 18

19. Which of the following clinical signs may be determined by a non-secreting pituitary adenoma:
    a. Polyuria
    b. Vomiting
    c. Headache
    d. Increased feet and hands size
    e. Diplopia

Answer 18

C. Headache
e. Diplopia

Question 19

20. Mark the true statements regarding the treatment of a patient with acromegaly:
    a. Radiotherapy is the first intention
    b. First-line treatment consists of transsphenoidal surgery
    c. Medical therapy can be performed with somatostatin analogues
    d. Medical therapy can be done with dopamine agonists
    e. The condition can be cured after treatment with GH receptor blockers

Answer 19

b. First-line treatment consists of transsphenoidal surgery
c. Medical therapy can be performed with somatostatin analogues
d. Medical therapy can be done with dopamine agonists

Question 20

21. Mention the biological changes that can occur in a patient with central diabetes insipidus:
    a. Low vasopressin at the end of the dehydration test
    b. High plasma osmolality
    c. Increased urinary osmolality
    d. Urinary osmolality increases after administration of desmopressin
    e. Urinary osmolality increases during the dehydration test

Answer 20

b. High plasma osmolality

d. Urinary osmolality increases after administration of desmopressin

Question 21

22. Mark the correct answers about pituitary tumors:
    a. They may be benign monoclonal adenomas secreting and secreting hormones autonomously
    b. They may be non-secreting pituitary tumors
    c. Most of them are aggressive carcinomas
    d. The clinical picture varies depending on invasiveness, aggressiveness and hormonal secretion
    e. They may be part of familial tumor syndromes type MEN 2

Answer 21

a. They may be benign monoclonal adenomas secreting and secreting hormones autonomously
b. They may be non-secreting pituitary tumors
d. The clinical picture varies depending on invasiveness, aggressiveness and hormonal secretion

Question 22

23. In the case of a patient with secondary hypothyroidism:
    a. TSH and FT4 are low
    b. Hypothyroidism is clinically more severe than in primary thyroid failure
    c. Frequently associates goitre
    d. It is treated with thyroid hormone replacement
    e. Requires for diagnosis stimulation tests with insulin-induced hypoglycaemia

Answer 22

a. TSH and FT4 are low

d. It is treated with thyroid hormone replacement

Question 23

24. Myxedematous coma is characterized by the following, with the EXCEPTION:
    a. It’s a complication of long-term untreated hypothyroidism
    b. It associates severe fever
    c. Gastro-intestinal symptoms (diarrhea)
    d. Hypotension
    e. Alteration of mental status

Answer 23

b. It associates severe fever
c. Gastro-intestinal symptoms (diarrhea)

Question 24

25. Radioactive iodine therapy: a. Can be used to treat Graves disease in young people b. It is contraindicated in patients with Graves disease and associated severe ophthalmopathy c. Can be used in pregnant women with severe Graves disease d. May cause hypothyroidism e. Is used in the treatment of medullary cancer

Answer 24

a. Can be used to treat Graves disease in young people b. It is contraindicated in patients with Graves disease and associated severe ophthalmopathy d. May cause hypothyroidism

Question 25

26. The correct initiation principles of substitution treatment in the case of hypothyroidism in the elderly are as follows: a. Levotiroxine at a dose of 100 μg from the beginning, given as a single dose in the morning 30 minutes before meals b. Levotiroxine at a dose of 12.5–25 μg/day given as a single dose in the morning 30 minutes before a meal and a progressive dose increase based on the TSH value c. The target TSH value is below 0.1 mUI/l d. Injectable therapy with levotiroxine e. Injectable glucocorticoids

Answer 25

b. Levotiroxine at a dose of 12.5–25 μg/day given as a single dose in the morning 30 minutes before a meal and a progressive dose increase based on the TSH value

Question 26

27. Which of the following statements are TRUE about the thyrotoxic crisis? a. The thyrotoxic crisis is a form of life-threatening hyperthyroidism b. The values of TSH and thyroid hormones can make a difference between hyperthyroidism and thyrotoxic crisis c. Stress, infections and acute illness can precipitate a thyrotoxicosis d. Surgery or treatment with I131 in untreated hyperthyroid patients may trigger a thyrotoxic crisis e. Hydric, electrolytic and cardiovascular balance and adjustment of serum free T3 and T4 levels are the therapeutic targets in thyrotoxic crisis management

Answer 26

a. The thyrotoxic crisis is a form of life threatening hyperthyroidism c. Stress, infections and acute conditions can precipitate a thyrotoxicosis. d. Surgery or treatment with 1311 in unbalanced hyperthyroid patients may trigger a thyrotoxic crisis. e. Hydric, electrolytic and cardiovascular balancing and adjustment of serum free T3 and T4 levels are the therapeutic targets in thyrotoxic crisis management

Question 27

28. A 65-year-old lady suffers a fragility fracture in the right forearm. DXA showed T-score L1-L4 = -2.7DS, Z score = 0.1DS, hip T-score = -3DS, Z score = 1DS. You establish the diagnosis of severe osteoporosis and you recommend adequate amount of calcium and vitamin D. Besides general measures, what treatment options do you have for your patient? a. Bisphosphonates b. Biological therapy with denosumab c. Magnesium sulphate d. Recombinant PTH e. Testosterone undecanoate

Answer 27

a. Bisphosphonates b. Biological therapy with denosumab d. Recombinant PTH

Question 28

29. The treatment for chronic hypocalcaemia includes: a. Low calcium diet b. Diet rich in phosphates to increase gut absorption c. Calcium supplements d. vitamin D supplements e. Teriparatide

Answer 28

c. Calcium supplements d. vitamin D supplements

Question 29

30. In primary hyperaldosteronism: a. Serum potassium levels are always low b. Aldosterone/renin ratio is elevated c. Aldosterone/renin ratio is normal, because both aldosterone and renin are elevated d. Aldosterone/renin ratio is low e. Hyponatremia is often encountered

Answer 29

b. Aldosterone/renin ratio is elevated

Question 30

31. The following may be useful in the treatment of Conn syndrome: a. Unilateral adrenalectomy b. Systemic corticotherapy c. Treatment with spironolactone d. Treatment with potassium supplements e. Bilateral adrenalectomy

Answer 30

a. Unilateral adrenalectomy C. Treatment whrg aoirinolactone d. Treatment with potassium supplements

Question 31

32. In the case of a 16-years-old boy with Tanner stage 1 the following statements are true: a. The diagnosis is delayed puberty b. Pubertal development is normal c. Testicular volume is over 15 ml d. The diagnosis is early puberty e. Testicular volume is < 4 ml

Answer 31

a. The diagnosis is delayed puberty e. Testicular volume is < 4 ml

Question 32

33. Treatment with gonadotropins can be useful for infertility due to: a. PCOS, as first-line treatment b. Hyperprolactinemia c. Hypopituitarism d. Primary hypogonadism e. PCOS non-responsive to clomiphene

Answer 32

c. Hypopituitarism e. PCOS non-responsive to clomiphene

Question 33

34. Which of the following statements about polycystic ovary syndrome are FALSE: a. It is the rarest cause of oligomenorrhoea in women of reproductive age b. It associates insulin resistance c. FSH / LH > 2 d. The diagnostic is solely made by ultrasonographical evaluation e. It can be treated with oral contraceptives

Answer 33

a. It is the rarest cause of oligomenorrhoea in women of reproductive age c. FSH / LH > 2 d. The diagnostic is solely made by ultrasonographical evaluation

Question 34

44. Which of the following therapies may be useful for a patient with Cushing disease: a. Treatment with ketoconazole b. Pituitary adenectomy c. Bilateral adrenalectomy d. Radiotherapy e. Treatment with pasireotide

Answer 34

b. Pituitary adenectomy c. Bilateral adrenalectomy e. Treatment with pasireotide

Question 35

45. Congenital adrenal hyperplasia can be characterized by: a. Adrenal hyperplasia due to excessive stimulation with ACTH b. Some variants may cause disorders of sexual differentiation c. There are enzymatic defects in adrenal steroidogenesis d. They are mild forms of illness, never life-threatening e. The 21-hydroxylase deficiency is the most rare form

Answer 35

a. Adrenal hyperplasia due to excessive stimulation with ACTH b. Some variants may cause disorders of sexual differentiation c. There are enzymatic defects in adrenal steroidogenesis

Question 35

46. In the case of a child with -2.7 SDS for height which had a maximum GH value during the clonidine test of 7.8 ng/ml the following statements are true: a. It is necessary to complete the investigations with another stimulation test for GH b. No further tests are needed as the GH deficiency was excluded c. The next evaluation step is pituitary CT

Answer 35

a. It is necessary to complete the investigations with another stimulation test for GH c. The next evaluation step is pituitary CT

Question 36

47. Which of the following causes may induce gynecomastia: a. Hyperthyroidism b. Chronic disease c. Cirrhosis d. Androgen deficiency e. Hypogonadism

Answer 36

a. Hyperthyroidism c. Cirrhosis d. Androgen deficiency e. Hypogonadism

Question 37

48. A 34-year-old man presents to the andrologist for infertility evaluation. During work-up azoospermia is found and hormonal assays are normal. What could be the cause of azoospermia? a. Cryptorchidism b. Klinefelter syndrome c. Kallmann syndrome d. Epididymal obstruction e. Hypothyroidism

Answer 37

d. Epididymal obstruction

Question 38

49. A 21-year-old male with Klinefelter syndrome have the following: a. Azoospermia b. Increased FSH c. Increased testosterone d. Decreased FSH e. Testicular hypertrophy

Answer 38

a. Azoospermia b. Increased FSH

Question 39

50. A pituitary MRI should be ordered in the following situations: a. Central precocious puberty b. Delayed puberty due to hypogonadotropic hypogonadism c. Primary hypothyroidism d. Peripheral precocious puberty e. GH deficiency

Answer 39

a. Central precocious puberty b. Delayed puberty due to hypogonadotropic hypogonadism d. Peripheral precocious puberty e. GH deficiency

Question 40

51. In Polyglandular autoimmune Syndromes the following may be present: a. Graves’ disease b. Multiple endocrine neoplasia c. Type 1 diabetes mellitus d. Biermer anemia

Answer 40

a. Graves’ disease c. Type 1 diabetes mellitus d. Biermer anemia e.