Endocrinology N2 2022

Which hormone is synthetized and secreted by anterior pituitary gland? Select one:
Vasopressin
PTH
Cortisol
MSH
TSH
True statement about TSH-oma (thyrotropinoma) is: Select one:
Somatostatin analogs are the most effective treatment
Typical is secretion of TSH and fT4 by the pituitary tumor
Positive response for TRH stimulation test
90% of tyreotropinomas are macroadenomas
Is treated with methimazole
What might be the health consequences of obesity?:
Sleep apnea
Hypertension
Diabetes insipidus
Colon cancer
Osteoarthritis
Which statement about multiple endocrine neoplasia is correct: Select one:
MEN 2B is also called Wermer’s syndrome
MEN 2B includes medullary carcinoma of the thyroid, gastrinoma and pheochromocytoma
MEN 1 is characterized by tumors involving mainly the parathyroid glands, the prostate gland, and the pituitary
MEN 2A includes papillary carcinoma of the thyroid, pheochromocytoma, and hyperparathyroidism
In MEN the tumors are always functional
A 35-year old woman is referred to the Endocrinogy Outpatient Clinic due to low TSH: 0.005 µIU/ml(0.270-4.200), FT4: 1.76 ng/dl(0.90-1.70), FT3: 5.6 (2. 00-4.40) pg/ml. She complaints of diarrhea which began 3 months ago and reports 4 kg of weight loss in the last 4 weeks. She has a history of smoking and had a prophylactic contrast CT of the chest 2 months ago which did not reveal any abnormalities. What would be the initial diagnosis and what studies would You perform to determine the etiology of the hormonal abnormalities?
Non-thyroidal illness syndrome, repeat tests in 3 months
Hypothyroidism, perform thyroid USG, assess anti-TPO antibodies
Thyreotropinoma, perform MRI of the pituitary
Hyperthyroidism, perform thyroid USG, assess Thyroglobulin and anti-TG thyroid antibodies
Hyperthyroidism, perform thyroid USG, assess anti-TSH-receptor antibodies
Choose true answer about laboratory findings connected with hypercortisolism: Select one:
High level of cortisol and low level of ACTH may indicate Cushing’s disease
Hyperglycaemia, high level of total cholesterol and trigliceride
Erythrocytosis, high level of eosinophils and lymphocytes
Hypokalaemia and hyponatraemia
Decreased 24 hours urine free cortisol level
45-years-old male patient reported to the emergency department complaining of paresthesias of the extremities and tongue. In physical examination you find positive Trosseau and Chvostek's signs. Which underlying disorder is the most probable cause? Select one:
Hypocalcemia due to tertiary hyperparathyroidism
Primary hypoparathyroidism after radio-iodine treatment due to thyroid cancer
Primary hyperparathyroidism due to parathyroid adenoma
Primary hypothyroidism after thyroidectomy due to thyroid cancer
Primary hypoparathyroidism after thyroidectomy due to thyroid cancer
Choose all true answers:
Exogenous Cushing is a rare form of Cushing’s syndrome
Adrenal gland Cushing lead to ACTH overproduction
ACTH dependent Cushing’s syndrome is more common than ACTH independent
The most common reason of endogenous Cushing’s syndrome is pituitary adenoma
High level of ACTH and cortisol in serum is typical for every form of Cushing’s
What endocrinological diseases can lead to secondary obesity?:
Insulinoma
Hyperthyroidism
Cushing’s disease
Pheochromocytoma
Hypothyroidism
What are the contraindications against testosterone therapy? Select one:
Hypertension
Severe chronic cardiac failure
Decreased PSA
Benign prostate hyperplaisa
Osteoporosis
41-year-old man was admitted to outpatient clinic due to hypercholesterolemia. He reported weight gain (8 kg in 5 months), constipation, dry skin and hair loss. In lab. tests: TSH 14.50 uIU/ml (normal 0.4-4.0), fT3 2, 02 pg/ml (2-4), fT4 0.69 ng/dl (normal 0.9-1.7). What is the test and treatment You choose? Select one:
Anti-TPO anibodies - treat with levothyroxin
Pituitary MRI - treat with somatostatin
Anti-TG antibodies – treat with propylothiouracil
Thyroid ultrasound - treat with propranolol
Anti-TSH-R (TRAb) antibodies - treat with methimazole
False about polyglandular autoimmune syndrome type 2 (PAS-2): Select one:
Addison’s disease may be a part of the clinical picture
It is the most common of all polyglandular autoimmune syndromes
PAS-2 leads to lymphocytic infiltration causing organ-specific damage
It is diagnosed when at least 2 out of 3 of the following are present: primary parathyroid insufficiency, autoimmune thyroid disease and type 1 diabetes mellitus
Typical age of onset is between 20 to 40 years
The most common cause of primary hypothyroidism in iodine-sufficient area: Select one:
Post-thyroidectomy
Thyroid irradiation
Subacute thyroiditis (de Quervain’s disease)
Autoimmunity (Hashimoto’s disease)
Graves disease
Choose false answer about functional hypercortisolism: Select one:
Is relatively common in the general population
May be connected with pregnancy, alcoholism and depression
Is usually mild in terms of biochemical profile and clinical manifestations
Is also called pseudo-Cushing’s syndrome
Is defined as chronic inactivation of the hypothalamic-pituitary-adrenal axis
What are the criteria of metabolic syndrome?: Select one
Reduced LDL cholesterol
Raised HDL cholesterol
Central obesity: waist circumference ≥80 cm in women and ≥94 cm in men
Raised triglycerides: ≥ 100 mg/dL
Systolic blood pressure > 125 mm Hg or diastolic blood pressure >80 mm Hg
Which imaging studies should be the most appropriate in the suspicion of primary hyperparathyroidism? Select one:
MRI of the pituitary, neck ultrasound
Neck ultrasound, bone scintigraphy
Scintigraphy with the Tc-99m-sestaMIBI, abdominal MRI
DXA-absorptiometry, bone turnover markers
Neck ultrasound, scintigraphy with Tc-99m-sestaMIBI, DXA-absorptiometry
The most common thyroid cancer in non-iodine deficiency region is: Select one:
Follicular carcinoma
Papillary carcinoma
Squamous cell carcinoma
Small-cell carcinoma
Medullary carcinoma
Choose all true answer about signs and symptoms typical for Cushing’s syndrome:
Plethora, moon face, weight gain
Thin arms and legs, personality changes, osteoporosis
Pale cheeks, pour wound healing, high suscebility to infection
Buffalo hump, easily bruising
Abdominal white striae
What medications may we use to relieve symptoms of thyrotoxicosis? Select one:
Beta-mimetics
Amiodarone
Alfa-blocker
Propranolol
Atropine
What is the most common cause of secondary adrenocortical insufficiency? Select one:
Pituitary adenoma
Tuberculosis
Metastatic tumors
Long-term glucocorticoid administration
Autoimmune adrenalitis
Which ultrasound findings are characteristic of malignant thyroid tumors?: Select one:
Wider than taller
Fluid-filled lumps
Macrocalcifications
Isoechogenicity
Central vascularization
What are the possible complications of hyperthyroidism? Select one:
Hypercholesterolemia
Bradyarrythmia
Atrial fibrillation
Constipation
Decreased body temperature
Clinical features of primary adrenocortical insufficiency:
Hypopigmentation
Weakness
Postural hypotension and dizziness
Salt craving
Weight loss
24. What are the treatment options in hyperthyroidism in Graves disease: Select one:
Methimazole, chemotherapy, operation
Levothyroxine, radio-iodine, operation
Methimazole, radio-iodine, gamma-knife
Methimazole, radio-iodine, operation
Propylothiouracil, alfa-bloker, irradiation
Mark a correct statement about the follow-up after thyroidectomy due to differentiated thyroid cancer: Select one:
TSH needs to be maintained at the upper normal range (4, 0-5, 0 uIU/ml)
Classic chemotherapy is almost always used subsequently after operation
Thyroglobulin serum concentration and anti-Thyroglobulin antibodies are both used in monitoring
Radioiodine (I-131) is always used
Calcitonin is a best marker for monitoring the outcome
Choose true answer about short Dexamethazon suppression test: Select one:
Lack of inhibition of cortisol secretion excludes diagnosis of Cushing’s syndrome
Helps to distinguish patients with excess production of ACTH due to pituitary adenomas from those with ectopic ACTH-producing tumors
Cortisol level in serum is checked in the morning the next day after taking Dexamethazon in the evening
Is not very reliable for diagnosis Cushing’s syndrom
1 mg of dexamethasone is given in the morning after waking up
Mark a correct statement about Graves Orbitopathy (thyroid eye disease): Select one:
May be caused by glucocorticoids
All cases are treated with radio-iodine
Smoking is a risk factor
Bilateral exophatalmus is always present
Is present in almost all cases of Graves disease
False about acute adrenal insufficiency-crisis: Select one:
May occur after withdrawal of glucocorticoid therapy in patient with rheumatoid arthritis
Important part of therapy is an abundant intravenous rehydratation
Symptoms (anorexia, vomiting, abdominal pain) may mimic acute surgical abdomen
In serious cases hydrocortisone iv. May be administrated before confirmation of the diagnosis
Is never the first symptom of adrenal insufficiency
The symptom which is not due to hypothyroidism is, choose one answer: Select one:
Smooth, silky skin
Fatigue
Constipations
Hoarse voice
Bradycardia
Which hormone is stored and released by posterior pituitary gland? Select one:
TSH
ACTH
Oxytocin
Prolactin
FH, FSH
Mark the correct statement: Select one:
Calcitonin is a marker of medullary thyroid cancer
Amiodarone treatment always causes hyperthyroidism
Thyroid thrill/bruit is heard in Hashimoto Disease
Increased iodised salt intake is advised in pregnancy to maintain the expected iodine supply
Hypothyroidism we treat initially with high doses of levothyroxine, decreased stepwise at monthly intervals
What are the symptoms of monotropic ACTH deficiency? Select one: (resembles adrenal insuff)
Constipation, weight loss, hypertension
Weakness, weight gain, hypotension
Dry skin, constipation, bradycardia
Weakness, nausea, vomiting, weight loss, hypotension
E. paresthesias, carpopedal spasm, weight loss
When do you suspect Sheehan's syndrome? Select one:
Problem with getting pregnant
After thyroidectomy in Graves disease
Monotropic TSH deficiency
After incompletye neurosurgical operation of acromegaly
After severe blood loss during or after childbirth
Laboratory findings characteristic for secondary hyperparathyroidsm are: Select one:
Elevated PTH, hypocalcemia, hyperphosphatemia
Decreased PTH, hypercalcemia, hypophosphatemia
Elevated PTH, hypercalcemia, hypophosphatemia
Decreased PTH, normocalcemia, hypophosphatemia
Decreased PTH, hypocalcemia, hyperphosphatemia
Choose all true answers:
Hypothyroidism signs and symptoms may include decreased blood cholesterol level, thinning hair, impaired memory and psychosis
Myxoedema may be the result of extremely high level of thyroid hormones in serum
Treatment of Hashimoto disease consists of L-thyroxine and steroids (during exacerbations)
Orbitopathy (thyroid eye disease) is a typical complication of Hashimoto disease Grave
Moebius sign a clinical sign in which there is an inability to maintain convergence of the eyes
Laboratory feaures of primary adrenocortical insufficiency:
Hyperkaliemia
Hypernatremia
Hypoglycemia
Hypochromic anemia
Eosinophilia
Which hormone controls milk excretion and uterus contraction? Select one:
Oxytocin
Prolactin
LH
ACTH
TSH
A typical consequence of thyroid surgery: Select one:
Transient hypothyroidism
Transient hypercalcemia
Agranulocytosis
Recurrent laryngeal nerve palsy
Primary hyperparathyroidism
Mark the CORRECT answer about acromegaly: Select one:
Is treated only with medications
IGF-1 is a screening laboratory test
Is the most common functional pituitary adenoma
Might be treated with dopamin antagonists
Leads to hypoglycemia
Which of the following is NOT a cause of hyperprolactinemia? Select one:
Methyldopa
Liver cirrhosis
Pregnancy
Hyperthyroidism
Estrogens
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