Endocrine, Metabolism & Nutrition — UPSC CMS MCQs (Medicine)

Question 1

Which one of the following statements is NOT true regarding the thyroid function/disorder in pregnancy?

Accepted Answer

C. Levothyroxine replacement therapy dose should be decreased by 30–50% early in pregnancy

Answer

There is an increase in the metabolism of thyroxine by placenta

Answer

Hyperemesis gravidarum may be associated with thyrotoxicosis in pregnancy

Answer

Impaired cognitive development may be seen in the offspring of mother with subclinical hypothyroidism

Question 2

A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight gain, hair loss, tiredness and weakness. What will be the investigation of choice?

Accepted Answer

D. Free T4 and TSH level

Answer

FSH & LH level

Answer

Estrogen level

Answer

Free T3 and free T4 level

Question 3

Which of the following are correct regarding hypothyroidism?
1. It is more common in females.
2. Autoimmunity is a rare etiopathogenesis.
3. In pregnancy, increased dose of levothyroxine is required.
4. Suppressed TSH is a risk factor for osteoporosis.
Select the correct answer using the code:

Accepted Answer

C. 1, 3 and 4

Answer

1, 2 and 3

Answer

1 and 4 only

Answer

2, 3 and 4

Question 4

A 42-year-old lady presents with tiredness, constipation, impaired hearing and weight gain in spite of poor appetite. Which of the following are relevant investigations in this case?
1. TSH level
2. Free T4 levels (unbound T4)
3. Anti-TPO antibodies
4. Radionuclide scan of the thyroid
Select the correct answer using the code:

Accepted Answer

A. 1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2 and 3 only

Question 5

Consider the following pharmacological agents:
1. Liothyronine
2. Levothyroxine
3. Carbimazole
4. Sodium ipodate. Which of the above may be included in the treatment of myxedema coma?
1. Liothyronine
2. Levothyroxine
3. Carbimazole
4. Sodium ipodate
Select the correct answer using the code:

Accepted Answer

B. 1 and 2

Answer

1 only

Answer

2 and 3

Answer

3 and 4

Question 6

With regard to management of hypothyroidism, consider the following statements:
1. Treatment is with levothyroxine replacement.
2. It is taken as a single daily dose.
3. Average dose is 1.6 μg/kg/day.
4. Full dose per weight should be started in those with coronary artery disease.
Select the correct answer using the code:

Accepted Answer

A. 1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 7

All the following can be seen in the case of thyrotoxicosis, EXCEPT:

Accepted Answer

C. Deafness

Answer

Atrial fibrillation

Answer

Periodic paralysis

Answer

Osteoporosis

Question 8

Consider the following statements with regard to Graves’ ophthalmopathy:
1. Proptosis is often asymmetric and can even appear to be unilateral
2. It is a clinical diagnosis
3. Worsening of symptoms upon glucocorticoid withdrawal is common
4. Radiation therapy is very effective in treatment
Select the correct answer using the code:

Accepted Answer

B. 1, 2 and 3

Answer

1 and 2 only

Answer

2, 3 and 4

Answer

1 and 4 only

Question 9

Medical management of thyrotoxic crisis includes all of the following EXCEPT:

Accepted Answer

D. IV antibiotics

Answer

IV fluids

Answer

IV propranolol

Answer

IV hydrocortisone

Question 10

A Thyroid Function Test report shows: TSH – Undetectable, T3 – Raised, T4 – Raised. Which one of the following will be the most likely interpretation?

Accepted Answer

C. Primary thyrotoxicosis

Answer

Hypothyroidism secondary to pituitary disease

Answer

Transient thyroiditis in evolution

Answer

Overtreatment of hypothyroidism with Liothyronine

Question 11

Consider the following pharmacological agents:
1. Propranolol
2. Sodium ipodate
3. Propylthiouracil
4. Liothyronine. Which of the above can be used for the treatment of thyrotoxic crisis?
1. Propranolol
2. Sodium ipodate
3. Propylthiouracil
4. Liothyronine
Select the correct answer using the code:

Accepted Answer

C. 1, 2 and 3

Answer

3 only

Answer

1 and 2 only

Answer

2, 3 and 4

Question 12

With regard to treatment of thyrotoxicosis of Grave’s disease, consider the following statements:
1. Propylthiouracil is suitable in breastfeeding patients.
2. Large goitre is an indication for thyroidectomy.
3. Radioiodine is recommended for management in pregnancy.
4. Agranulocytosis is a complication associated with carbimazole.
Select the correct answer using the code:

Accepted Answer

C. 1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 13

A 28-year female presented to emergency with fever, agitation and delirium, on regular Carbimazole 40 mg daily but missed doses for 2 days. Which scoring system would you use to assess severity of disease?

Accepted Answer

B. Burch-Wartofsky score

Answer

DAS 28 score

Answer

Expanded Disability Status Scale

Answer

Sequential Organ Failure Assessment Score

Question 14

Iodine has complex effects on thyroid function. Very high concentrations of iodine inhibit thyroid hormone synthesis and release. This effect is known as:

Accepted Answer

A. Wolff-Chaikoff effect

Answer

Jod-Basedow effect

Answer

reverse Wolff-Chaikoff effect

Answer

reverse Jod-Basedow effect

Question 15

Low serum thyroglobulin levels are seen in:

Accepted Answer

A. thyrotoxicosis factitia

Answer

subacute thyroiditis

Answer

Graves’ disease

Answer

toxic multinodular goitre

Question 16

Which one of the following diseases is characterized by destructive lymphoid infiltration of the thyroid gland leading to fibrosis and enlargement with an increased risk of developing thyroid lymphoma?

Accepted Answer

D. Hashimoto’s thyroiditis

Answer

de Quervain’s Thyroiditis

Answer

Multinodular Goitre

Answer

Riedel’s thyroiditis

Question 17

A 25-year-old female with previous history of neck irradiation presents with thyroid swelling for 6 months. Clinically euthyroid; right lobe enlarged with ipsilateral cervical lymphadenopathy. The most probable diagnosis is:

Accepted Answer

B. Papillary carcinoma thyroid

Answer

Medullary carcinoma thyroid

Answer

Lymphoma

Answer

Follicular carcinoma thyroid

Question 18

Which of the following statements regarding papillary thyroid cancer are correct?
1. It is the most common malignant tumour of the thyroid gland.
2. It is more common in young females.
3. It has a propensity for hematogenous spread.
4. Distant metastases are uncommon.
Select the correct answer using the code:

Accepted Answer

D. 1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 19

Which of the following constitute differential diagnosis of hypocalcemia?
1. Hypomagnesemia
2. Chronic alcoholism
3. Pseudohypoparathyroidism
4. Paget’s disease
Select the correct answer using the code:

Accepted Answer

A. 1, 2 and 3

Answer

1 and 2 only

Answer

3 and 4 only

Answer

2, 3 and 4

Question 20

Which of the following statements are correct about treatment with vitamin D supplement?
1. Serum calcium levels improve earlier than serum PTH levels.
2. Patients should be closely observed with serial vitamin D levels as vitamin D toxicity occurs frequently.
3. Vitamin D supplementation should always be in conjunction with calcium supplementation.
4. Nephrolithiasis is a known complication.
Select the correct answer using the code:

Accepted Answer

C. 1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 21

The first line investigation for diagnostic evaluation of patients with hypercalcemia is:

Accepted Answer

C. Serum iPTH levels

Answer

24-hour urinary calcium excretion

Answer

Serum phosphate levels

Answer

Serum vitamin D levels

Question 22

A patient presents with history of ‘bones, stones and abdominal groans’ — due to generalized aches and pains and renal calculus colic. Which is the most discriminatory blood investigation?

Accepted Answer

A. Parathyroid hormone assay

Answer

Thyroid function tests (free T3, free T4, TSH)

Answer

Cortisol levels

Answer

Insulin and C-peptide levels

Question 23

Which one of the following is the most appropriate initial treatment for management of severe hypercalcemia?

Accepted Answer

C. Intravenous infusion of normal saline

Answer

Intravenous infusion of pamidronate

Answer

Oral phosphate supplementation

Answer

Hemodialysis

Question 24

A 27-year-old lady underwent thyroidectomy for thyroid carcinoma. Post-operatively she developed muscle cramps, perioral and peripheral paresthesia, and carpopedal spasm. Which intervention is appropriate?

Accepted Answer

C. Measure serum ionized calcium and administer IV calcium gluconate

Answer

Nerve conduction velocity in both limbs and administer methylcobalamin

Answer

EMG of both lower limbs and administer oral prednisolone

Answer

Measure serum bicarbonate and administer IV bicarbonate

Question 25

A 45-year-old lady presents with fatigue, muscle weakness and bilateral multiple renal calculi on ultrasound; serum calcium 11.4 mg%. What is the next best investigation to arrive at a diagnosis?

Accepted Answer

B. Sestamibi scan

Answer

MRI neck

Answer

CECT head and neck

Answer

NCCT head and neck

Question 26

Consider the following disorders as constituents of Multiple Endocrine Neoplasia Type 2a (MEN 2a):
1. Primary Hyperparathyroidism
2. Pituitary tumours
3. Medullary carcinoma of thyroid
4. Pheochromocytoma
Select the correct answer using the code:

Accepted Answer

C. 1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 27

Which one of the following is NOT correct regarding MEN-1 syndrome?

Accepted Answer

D. It involves pineal gland

Answer

It involves parathyroid glands

Answer

It involves pancreas

Answer

It involves pituitary gland

Question 28

All the following can cause Hyperprolactinemia, EXCEPT:

Accepted Answer

B. Hyperthyroidism

Answer

Craniopharyngioma

Answer

Stress

Answer

Chronic renal failure

Question 29

Which of the following are the clinical features of hyperprolactinemia?
1. Hypergonadotropic hypogonadism
2. Hypogonadotropic hypogonadism
3. Oligomenorrhea
4. Heavy menstruation
Select the correct answer using the code:

Accepted Answer

C. 2 and 3

Answer

1 and 3

Answer

1 and 4

Answer

2 and 4

Question 30

Functioning pituitary adenoma most commonly arises from which one of the following cells?

Accepted Answer

B. Lactotroph

Answer

Somatotroph

Answer

Corticotroph

Answer

Thyrotroph

Question 31

A 50-year lady, a known case of rheumatoid arthritis, presents with obesity, moon facies, abdominal striae, and hypertension. Overnight dexamethasone suppression test shows cortisol > 50 nmol/L, ACTH < 1.1 pmol/L. The likely diagnosis is:

Accepted Answer

C. exogenous glucocorticoid use

Answer

Cushing’s disease

Answer

ectopic ACTH-secreting tumour

Answer

adrenal adenoma

Question 32

Which of the following are correct regarding Cortisol?
1. Levels are highest in the morning on waking.
2. Cortisol falls dramatically during an illness.
3. More than 95% circulating cortisol is protein bound.
4. It is the major glucocorticoid in humans and can also activate mineralocorticoid receptors.
Select the correct answer using the code:

Accepted Answer

A. 1, 3 and 4

Answer

2, 3 and 4

Answer

1 and 3 only

Answer

1 and 2 only

Question 33

Which one of the following is a cause of Secondary Hyperaldosteronism?

Accepted Answer

D. Inadequate renal perfusion due to renal artery stenosis

Answer

Adrenal adenoma secreting aldosterone

Answer

Idiopathic bilateral adrenal hyperplasia

Answer

11-deoxycorticosterone secreting adrenal tumour

Question 34

A patient presents with circulatory shock, nausea, vomiting and diarrhea. Acute adrenal crisis is considered; cortisol sample stored and treatment started without delay. Which interventions are appropriate?
1. IV normal saline
2. IV hydrocortisone 100 mg stat
3. IV 10% glucose
4. IV KCl as infusion
Select the correct answer using the code:

Accepted Answer

A. 1, 2 and 3

Answer

1 and 2 only

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 35

Under which one of the following conditions is HPA axis suppression likely to result in crisis due to adrenal insufficiency following withdrawal of glucocorticoids?

Accepted Answer

C. If glucocorticoids have been prescribed repeatedly within the previous year

Answer

If glucocorticoids have been given by intravenous route for five days

Answer

If glucocorticoids have been administered orally for one week

Answer

If the dose is less than equivalent of 5 mg prednisolone per day

Question 36

Hirsutism is seen in which of the following?
1. Polycystic ovarian syndrome
2. Congenital adrenal hyperplasia
3. Hypothyroidism
4. Ovarian tumour
Select the correct answer using the code:

Accepted Answer

B. 1, 2 and 4

Answer

1 and 2 only

Answer

1, 3 and 4

Answer

2 and 4 only

Question 37

Which of the following are useful for the treatment of Hirsutism?
1. Amiloride
2. Oestrogen
3. Finasteride
4. Spironolactone
Select the correct answer using the code:

Accepted Answer

D. 2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

3 and 4 only

Question 38

GnRH deficiency with hyposmia is typically seen in:

Accepted Answer

A. Kallmann syndrome

Answer

Bardet-Biedl syndrome

Answer

Prader-Willi syndrome

Answer

Wallenberg syndrome

Question 39

Which one of the following is an example of hypogonadotropic hypogonadism?

Accepted Answer

A. Kallmann’s syndrome

Answer

Klinefelter’s syndrome

Answer

Turner’s syndrome

Answer

Cryptorchidism

Question 40

Which of the following statements are correct regarding short stature?
1. Linear bone growth rates are pituitary dependent
2. Normal bone age in a child with short stature suggests hormonal disorder
3. Final height in boys can be estimated by adding 6.5 cm to mid-parental height
4. Replacement therapy with recombinant GH restores growth velocity in GH-deficient children
Select the correct answer using the code:

Accepted Answer

C. 1, 3 and 4 only

Answer

1 and 2 only

Answer

1 and 3 only

Answer

1, 2 and 4

Question 41

Consider the following statements about erectile dysfunction in diabetic males: (a) It affects 60% of males (b) Its common cause is an underlying neuro-vascular pathology (c) It may be aggravated by beta-adrenergic agonist drugs (d) Endocrine disorders like hyperprolactinemia may cause it. Which of the statements is true?

Accepted Answer

C. It may be aggravated by beta-adrenergic agonist drugs

Answer

It affects 60% of males

Answer

Its common cause is an underlying neuro-vascular pathology

Answer

Endocrine disorders like hyperprolactinemia may cause it

Question 42

Which one of the following is NOT true about Ghrelin?

Accepted Answer

B. It decreases gastric emptying

Answer

It stimulates appetite

Answer

It increases acid secretion

Answer

Fasting increases its secretion

Question 43

Which one of the following hormones acts via the receptor tyrosine kinase?

Accepted Answer

C. IGF-1

Answer

FSH

Answer

TSH

Answer

PTH

Question 44

Which of the following are the potentially reversible causes of weight gain?
1. Insulinoma
2. Cushing’s syndrome
3. Sulfonylureas
4. Beta-blockers
Select the correct answer using the code:

Accepted Answer

D. 1, 2, 3 and 4

Answer

1 and 2 only

Answer

3 and 4 only

Answer

2 and 3 only

Question 45

Which of the following statements are correct with regard to glucose homeostasis?
1. Insulin level rises postprandially.
2. Major portion of postprandial glucose is used by skeletal muscle.
3. Brain uses glucose in an insulin-dependent manner.
4. Glucagon is secreted during exercise.
Select the correct answer using the code:

Accepted Answer

B. 1, 2 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 46

Consider the following pancreatic hormones:
1. Insulin
2. Islet amyloid polypeptide (amylin)
3. Glucagon
4. Somatostatin. Which of the above is/are secreted by beta cells of the pancreatic islets?
1. Insulin
2. Islet amyloid polypeptide or amylin
3. Glucagon
4. Somatostatin
Select the correct answer using the code:

Accepted Answer

C. 1 and 2

Answer

1 only

Answer

2 and 3

Answer

1 and 4

Question 47

Which of the following findings are seen in Diabetic Retinopathy on fundus examination?
1. Microaneurysm
2. Dot and blot hemorrhage
3. Retinal thickening
4. Neovascularization
Select the correct answer using the code:

Accepted Answer

B. 1, 2 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 48

Which of the following biochemical abnormalities is seen in severe hypertriglyceridemia?

Accepted Answer

A. Pseudohyponatremia

Answer

Metabolic alkalosis

Answer

Hyperuricemia

Answer

Hyperkalemia

Question 49

Which of the following is an inhibitor of the intestinal mucosal transporter NPC1L1, responsible for the absorption of dietary and biliary cholesterol?

Accepted Answer

D. Ezetimibe

Answer

Atorvastatin

Answer

Fenofibrate

Answer

Metformin

Question 50

Which of the following are correct regarding Diabetes insipidus?
1. Polyuria and polydipsia are common symptoms.
2. Urine is of low osmolality and specific gravity.
3. Lithium is useful in treatment.
4. It is potentially lethal, if hypothalamic thirst centre is damaged.
Select the correct answer using the code:

Accepted Answer

B. 1, 2 and 4

Answer

1, 2 and 3

Answer

1 and 4 only

Answer

2, 3 and 4

Question 51

Which one of the following is correct regarding the arginine vasopressin antagonist Tolvaptan?

Accepted Answer

D. It is an oral drug

Answer

It is useful in hypovolemic hyponatremia

Answer

It antagonises the V₁ receptor

Answer

It should be used for at least 1 year

Question 52

Which of the following are used in calculating the serum osmolality?
1. Serum sodium
2. Glucose
3. Calcium
4. Blood urea nitrogen
Select the correct answer using the code:

Accepted Answer

B. 1, 2 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 53

Which of the following are approximate daily requirements of the common electrolytes in an adult?
1. Sodium 50–90 mM/day
2. Calcium 1 mM/day
3. Potassium 50 mM/day
4. Magnesium 1 mM/day
Select the correct answer using the code:

Accepted Answer

B. 1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 54

The most common acid-base disturbance in critically ill patients is:

Accepted Answer

B. Chronic respiratory alkalosis

Answer

Chronic respiratory acidosis

Answer

Chronic metabolic acidosis

Answer

Chronic metabolic alkalosis

Question 55

A 4-year-old boy presents with ingestion of many tablets of salicylate. Which one of the following complications is he likely to develop?

Accepted Answer

D. Metabolic acidosis

Answer

Hyperkalemia

Answer

Rhabdomyolysis

Answer

Prolonged QRS complex in ECG

Question 56

In a child with high anion gap metabolic acidosis, poisoning with which of the following may be suspected?

Accepted Answer

A. Iron

Answer

Digoxin

Answer

Rifampicin

Answer

Beta blockers

Question 57

Ischemia-Reperfusion syndrome is characterized by:

Accepted Answer

A. Hypoxia and activation of inflammation

Answer

Thromboembolic angiopathy

Answer

Acute mesenteric thrombosis

Answer

Build-up of bicarbonate and Na+ ions

Question 58

Good measure of systemic perfusion by ABG is by measurement of:

Accepted Answer

C. Lactate and / or the base deficit

Answer

Bicarbonate

Answer

pH

Answer

PCO₂

Question 59

Which of the following statements are correct in respect of vitamin D?
1. Skin exposure to sunlight is the main source
2. Deficiency of vitamin D causes distal muscle weakness
3. Vitamin D synthesis decreases in winter, as one moves away from the equator
4. Body store accumulated during summer is consumed during winter
Select the correct answer using the code:

Accepted Answer

C. 1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 60

Which of the following abnormalities occur from vitamin D deficiency in children?
1. Craniotabes
2. Bossing of frontal and parietal bones
3. Muscle hypotonia
4. Shrinking of epiphysis at the lower end of radius
Select the correct answer using the code:

Accepted Answer

A. 1, 2 and 3

Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 61

Consider the following statements with regard to Vitamin D deficiency:
1. Vitamin D deficiency is common in northern latitudes.
2. Vitamin D deficiency is more likely to develop in people with dark skin.
3. Exposure to UV light is advisable in patients with Vitamin D deficiency.
Select the correct answer using the code:

Accepted Answer

D. 1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Question 62

Consider the following statements with regard to vitamin C:
1. It is heat stable.
2. Normal platelets are poor in ascorbate.
3. Perifollicular hyperkeratosis is a clinical sign of scurvy.
4. Infants fed exclusively on boiled milk are vitamin C deficient.
Select the correct answer using the code:

Accepted Answer

D. 3 and 4

Answer

1 and 2

Answer

2 and 3

Answer

1 and 4

Question 63

An elderly alcoholic man who mainly eats maize and maize products presents with chronic diarrhea, severe sunburn-like lesions on exposed parts, and acute delirium. What is the likely diagnosis and its treatment?

Accepted Answer

C. Pellagra, Niacin therapy

Answer

Celiac disease, Gluten-free diet

Answer

Vitamin B12 deficiency, Parenteral B12 therapy

Answer

Whipple’s disease, Doxycycline + Trimethoprim

Question 64

A 36-year-old man presents with decreased appetite, mouth soreness, diarrhoea and irritability. On examination he has a bright red tongue with a pigmented scaly rash around the neck. Which one of the following food items in his diet has a bearing on his disease?

Accepted Answer

C. Corn

Answer

Rice

Answer

Wheat

Answer

Fish

Q1. Which one of the following statements is NOT true regarding the thyroid function/disorder in pregnancy?

Q2. A young lady presents in outdoor clinic with complaints of menstrual irregularity, weight gain, hair loss, tiredness and weakness. What will be the investigation of choice?

Q3. Which of the following are correct regarding hypothyroidism? 1. It is more common in females. 2. Autoimmunity is a rare etiopathogenesis. 3. In pregnancy, increased dose of levothyroxine is required. 4. Suppressed TSH is a risk factor for osteoporosis. Select the correct answer using the code:

Q5. Consider the following pharmacological agents: 1. Liothyronine 2. Levothyroxine 3. Carbimazole 4. Sodium ipodate. Which of the above may be included in the treatment of myxedema coma? 1. Liothyronine 2. Levothyroxine 3. Carbimazole 4. Sodium ipodate Select the correct answer using the code:

Q7. All the following can be seen in the case of thyrotoxicosis, EXCEPT:

Q9. Medical management of thyrotoxic crisis includes all of the following EXCEPT:

Q10. A Thyroid Function Test report shows: TSH – Undetectable, T3 – Raised, T4 – Raised. Which one of the following will be the most likely interpretation?

Q13. A 28-year female presented to emergency with fever, agitation and delirium, on regular Carbimazole 40 mg daily but missed doses for 2 days. Which scoring system would you use to assess severity of disease?

Q14. Iodine has complex effects on thyroid function. Very high concentrations of iodine inhibit thyroid hormone synthesis and release. This effect is known as:

Q15. Low serum thyroglobulin levels are seen in:

Q16. Which one of the following diseases is characterized by destructive lymphoid infiltration of the thyroid gland leading to fibrosis and enlargement with an increased risk of developing thyroid lymphoma?

Q17. A 25-year-old female with previous history of neck irradiation presents with thyroid swelling for 6 months. Clinically euthyroid; right lobe enlarged with ipsilateral cervical lymphadenopathy. The most probable diagnosis is:

Q19. Which of the following constitute differential diagnosis of hypocalcemia? 1. Hypomagnesemia 2. Chronic alcoholism 3. Pseudohypoparathyroidism 4. Paget’s disease Select the correct answer using the code:

Q21. The first line investigation for diagnostic evaluation of patients with hypercalcemia is:

Q22. A patient presents with history of ‘bones, stones and abdominal groans’ — due to generalized aches and pains and renal calculus colic. Which is the most discriminatory blood investigation?

Q23. Which one of the following is the most appropriate initial treatment for management of severe hypercalcemia?

Q24. A 27-year-old lady underwent thyroidectomy for thyroid carcinoma. Post-operatively she developed muscle cramps, perioral and peripheral paresthesia, and carpopedal spasm. Which intervention is appropriate?

Q25. A 45-year-old lady presents with fatigue, muscle weakness and bilateral multiple renal calculi on ultrasound; serum calcium 11.4 mg%. What is the next best investigation to arrive at a diagnosis?

Q26. Consider the following disorders as constituents of Multiple Endocrine Neoplasia Type 2a (MEN 2a): 1. Primary Hyperparathyroidism 2. Pituitary tumours 3. Medullary carcinoma of thyroid 4. Pheochromocytoma Select the correct answer using the code:

Q27. Which one of the following is NOT correct regarding MEN-1 syndrome?

Q28. All the following can cause Hyperprolactinemia, EXCEPT:

Q29. Which of the following are the clinical features of hyperprolactinemia? 1. Hypergonadotropic hypogonadism 2. Hypogonadotropic hypogonadism 3. Oligomenorrhea 4. Heavy menstruation Select the correct answer using the code:

Q30. Functioning pituitary adenoma most commonly arises from which one of the following cells?

Q31. A 50-year lady, a known case of rheumatoid arthritis, presents with obesity, moon facies, abdominal striae, and hypertension. Overnight dexamethasone suppression test shows cortisol > 50 nmol/L, ACTH < 1.1 pmol/L. The likely diagnosis is:

Q33. Which one of the following is a cause of Secondary Hyperaldosteronism?

Q35. Under which one of the following conditions is HPA axis suppression likely to result in crisis due to adrenal insufficiency following withdrawal of glucocorticoids?

Q36. Hirsutism is seen in which of the following? 1. Polycystic ovarian syndrome 2. Congenital adrenal hyperplasia 3. Hypothyroidism 4. Ovarian tumour Select the correct answer using the code:

Q37. Which of the following are useful for the treatment of Hirsutism? 1. Amiloride 2. Oestrogen 3. Finasteride 4. Spironolactone Select the correct answer using the code:

Q38. GnRH deficiency with hyposmia is typically seen in:

Q39. Which one of the following is an example of hypogonadotropic hypogonadism?

Q42. Which one of the following is NOT true about Ghrelin?

Q43. Which one of the following hormones acts via the receptor tyrosine kinase?

Q44. Which of the following are the potentially reversible causes of weight gain? 1. Insulinoma 2. Cushing’s syndrome 3. Sulfonylureas 4. Beta-blockers Select the correct answer using the code:

Q47. Which of the following findings are seen in Diabetic Retinopathy on fundus examination? 1. Microaneurysm 2. Dot and blot hemorrhage 3. Retinal thickening 4. Neovascularization Select the correct answer using the code:

Q48. Which of the following biochemical abnormalities is seen in severe hypertriglyceridemia?

Q49. Which of the following is an inhibitor of the intestinal mucosal transporter NPC1L1, responsible for the absorption of dietary and biliary cholesterol?

Q51. Which one of the following is correct regarding the arginine vasopressin antagonist Tolvaptan?

Q52. Which of the following are used in calculating the serum osmolality? 1. Serum sodium 2. Glucose 3. Calcium 4. Blood urea nitrogen Select the correct answer using the code:

Q53. Which of the following are approximate daily requirements of the common electrolytes in an adult? 1. Sodium 50–90 mM/day 2. Calcium 1 mM/day 3. Potassium 50 mM/day 4. Magnesium 1 mM/day Select the correct answer using the code:

Q54. The most common acid-base disturbance in critically ill patients is:

Q55. A 4-year-old boy presents with ingestion of many tablets of salicylate. Which one of the following complications is he likely to develop?

Q56. In a child with high anion gap metabolic acidosis, poisoning with which of the following may be suspected?

Q57. Ischemia-Reperfusion syndrome is characterized by:

Q58. Good measure of systemic perfusion by ABG is by measurement of:

Q60. Which of the following abnormalities occur from vitamin D deficiency in children? 1. Craniotabes 2. Bossing of frontal and parietal bones 3. Muscle hypotonia 4. Shrinking of epiphysis at the lower end of radius Select the correct answer using the code:

Q63. An elderly alcoholic man who mainly eats maize and maize products presents with chronic diarrhea, severe sunburn-like lesions on exposed parts, and acute delirium. What is the likely diagnosis and its treatment?

Q64. A 36-year-old man presents with decreased appetite, mouth soreness, diarrhoea and irritability. On examination he has a bright red tongue with a pigmented scaly rash around the neck. Which one of the following food items in his diet has a bearing on his disease?

Q66. Carotenoderma, due to ingestion of excessive amounts of carotene-containing fruits and vegetables, can be distinguished from jaundice by sparing of which of the following?

Q67. Consider the following statements with regard to “Anorexia of Aging”: 1. Declining chemosensory function (smell and taste) 2. Reduced efficiency of chewing 3. Slowed gastric emptying 4. Alterations in the neuro-endocrine axis Select the correct answer using the code:

Q68. Which one of the following is a cause of relative erythrocytosis?

Q69. Which one of the following causes low-volume erythrocytosis?

Q70. Which one of the following is a clonal hematopoietic stem cell disorder in which phenotypically normal red blood cells, granulocytes and platelets accumulate in the absence of a recognizable physiological stimulus?