Pance Endocrinology - Final Test Review (Qns & Ans) - 2025, Exams of Nursing

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Endocrinology

Final Test Review

(Questions & Solutions)

ADRENAL DISORDERS (5 Questions)

1. A 38-year-old woman develops progressive weight gain, hypertension, purple striae, and glucose intolerance. Morning cortisol is elevated and diurnal rhythm is lost. Which test best distinguishes Cushing disease from ectopic ACTH secretion? A) High-dose dexamethasone suppression test B) Serum DHEA-S level C) Plasma renin activity D) 24-hour urinary metanephrines ANS: A Rationale: In Cushing disease (pituitary ACTH), high-dose dexamethasone suppresses cortisol, whereas ectopic ACTH sources do not suppress.
2. A 25-year-old man with episodic headaches, sweating, and tachycardia has a 2-cm adrenal mass and elevated plasma free metanephrines. Best initial therapy? A) Phenoxybenzamine before surgery B) Immediate adrenalectomy C) Spironolactone D) High-dose corticosteroids ANS: A Rationale: α-blockade with phenoxybenzamine before surgery prevents perioperative hypertensive crises in pheochromocytoma.
3. A 50-year-old with hyperpigmentation, fatigue, and weight loss has low cortisol, high ACTH, and 21-hydroxylase antibodies. Diagnosis? A) Primary adrenal insufficiency (Addison’s) B) Secondary adrenal insufficiency C) Congenital adrenal hyperplasia D) Cushing syndrome ANS: A Rationale: Autoimmune destruction of adrenals causes primary

metformin and diet/exercise.

7. A 22-year-old with polyuria, polydipsia, and weight loss has fasting C- peptide low and GAD65 antibodies positive. Best therapy? A) Insulin replacement B) Metformin C) GLP-1 agonist D) Lifestyle modification only ANS: A Rationale: Type 1 diabetes requires insulin due to β-cell destruction and low endogenous insulin (C-peptide).
8. A T2DM patient on metformin begins canagliflozin. What adverse effect is most likely? A) Genital mycotic infections B) Lactic acidosis C) Hypoglycemia D) Pancreatitis ANS: A Rationale: SGLT2 inhibitors increase glycosuria, raising risk of genital yeast infections.
9. A patient on glipizide complains of tremor, sweating, and confusion early in the morning. Which is the cause? A) Nighttime hypoglycemia due to sulfonylurea action B) Somogyi effect C) Dawn phenomenon D) Inadequate basal insulin ANS: A Rationale: Sulfonylureas can cause nocturnal hypoglycemia, leading to adrenergic symptoms on waking.
10. A patient on high-dose insulin and dextrose infusion in DKA remains hyperglycemic. Which electrolyte must be checked and replaced? A) Potassium

B) Magnesium C) Calcium D) Phosphorus ANS: A Rationale: Insulin drives K⁺ into cells; hypokalemia impairs insulin efficacy and must be corrected.

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HYPOGONADISM (5 Questions)

11. A 16-year-old boy has delayed puberty, low LH, low testosterone, and normal pituitary MRI. Diagnosis? A) Hypogonadotropic hypogonadism B) Klinefelter syndrome C) Primary testicular failure D) Androgen insensitivity ANS: A Rationale: Low gonadotropins and low testosterone with normal anatomy indicates secondary (hypogonadotropic) hypogonadism.
12. A 30-year-old man with small testes, gynecomastia, high LH, and low testosterone. Karyotype shows 47,XXY. Condition? A) Klinefelter syndrome B) Kallmann syndrome C) Testicular torsion D) Secondary hypogonadism ANS: A Rationale: Klinefelter’s presents with hypergonadotropic hypogonadism, small firm testes, and gynecomastia.
13. A 25-year-old woman with amenorrhea and galactorrhea has prolactin 120 ng/mL and MRI microadenoma. First-line therapy? A) Cabergoline B) Surgical resection C) Radiation therapy

≥130/85, fasting glucose ≥100. LDL is not part.

17. A 55-year-old with BMI 32, fasting glucose 110, TG 200, HDL 38, BP 135/90. Which therapy reduces overall risk most? A) Lifestyle modification (diet/exercise) B) High-dose statin only C) Metformin only D) Beta-blocker only ANS: A Rationale: Lifestyle changes are first-line to address all metabolic syndrome components.
18. Insulin resistance in metabolic syndrome leads to: A) Hyperinsulinemia compensating for decreased uptake B) Hypoglycemia only C) Low free fatty acids D) Increased adiponectin ANS: A Rationale: IR causes decreased peripheral glucose uptake, prompting compensatory hyperinsulinemia.
19. Which adipokine is decreased in obesity and contributes to insulin resistance? A) Adiponectin B) Leptin C) Resistin D) TNF-α ANS: A Rationale: Adiponectin is insulin‐sensitizing and is paradoxically decreased in obesity.
20. Which phenotype is strongly associated with metabolic syndrome? A) Central (visceral) obesity B) Gynoid (hip) obesity C) Emaciated

D) Peripheral edema ANS: A Rationale: Visceral fat accumulation is most closely linked to metabolic syndrome risk.

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NEOPLASMS (Endocrine) (5 Questions)

21. In MEN1, which triad is classic? A) Parathyroid adenomas, pituitary tumors, pancreatic NETs B) Medullary thyroid cancer, pheochromocytoma, parathyroid C) Adrenocortical carcinoma, Cushing’s, myeloma D) Insulinoma only ANS: A Rationale: MEN1 includes “3 Ps”: parathyroid, pituitary, and pancreatic endocrine tumors.
22. A 45-year-old with MEN2A is at high risk for: A) Medullary thyroid carcinoma B) Prolactinoma C) Insulinoma D) Pheochromocytoma only ANS: A Rationale: MEN2A includes medullary thyroid carcinoma, pheochromocytoma, and parathyroid hyperplasia.
23. A 35-year-old with MEN2B has marfanoid habitus and mucosal neuromas. Which mutation? A) RET proto‐oncogene B) BRCA C) P D) NF ANS: A Rationale: MEN2B arises from RET mutation leading to MTC, pheochromocytoma, neuromas, marfanoid features.

includes: A) Serum Ca > 1 mg/dL above normal B) Age > 50 with normal calcium C) Normal BMD D) Mild kidney stones only ANS: A Rationale: Surgical criteria include Ca ≥1 mg/dL above ULN, reduced BMD, age <50, or kidney stones.

28. Hungry bone syndrome after parathyroidectomy is due to: A) Rapid bone uptake of Ca and phosphate B) Persistent PTH elevation C) Vitamin D toxicity D) Ongoing bone resorption ANS: A Rationale: After PTH falls, bone rapidly incorporates calcium, phosphate, and magnesium, causing hypocalcemia.
29. A 30-year-old with MEN1 presents with hypercalcemia and hypercalciuria. Next step? A) Sestamibi scan to localize adenoma B) Serum alkaline phosphatase only C) Neck MRI D) Urine metanephrines ANS: A Rationale: Localization with Sestamibi guides surgical removal of abnormal parathyroid in MEN1.
30. Secondary hyperparathyroidism in CKD results from: A) Hypocalcemia and hyperphosphatemia B) Hypercalcemia and low phosphate C) High vitamin D D) PTH receptor mutation ANS: A Rationale: In CKD, phosphate retention and low 1,25(OH)₂D levels cause

hypocalcemia, stimulating PTH secretion.

PITUITARY DISORDERS (5 Questions)

31. A 45-year-old with amenorrhea, galactorrhea, and visual field defects has prolactin 200 ng/mL. First treatment? A) Cabergoline B) Transsphenoidal surgery C) High-dose corticosteroids D) Radiation ANS: A Rationale: Dopamine agonists are first-line for prolactinomas to normalize prolactin and reduce tumor size.
32. A child with growth failure has low IGF-I and no GH response to stimulation. Imaging shows pituitary microadenoma. Best therapy? A) Recombinant GH B) High-dose steroids C) Desmopressin D) Bromocriptine ANS: A Rationale: GH replacement is indicated for GH deficiency in children with appropriate diagnosis.
33. A 30-year-old with Cushing signs has high midnight cortisol and pituitary mass on MRI. Diagnosis? A) Cushing disease B) Ectopic ACTH C) Adrenal carcinoma D) Exogenous steroids ANS: A Rationale: CD is pituitary-derived hypercortisolism confirmed by pituitary imaging and elevated midnight cortisol.

A) Subacute (de Quervain) thyroiditis B) Graves’ disease C) Riedel’s thyroiditis D) Hashimoto’s ANS: A Rationale: De Quervain’s presents with painful thyroid, elevated ESR, transient thyrotoxicosis, and low RAI uptake.

38. A 60-year-old woman with fatigue, cold intolerance, and TSH 15 μIU/mL, free T4 low. Best therapy? A) Levothyroxine B) Methimazole C) Propranolol D) Radioactive iodine ANS: A Rationale: Primary hypothyroidism (elevated TSH, low T4) is treated with levothyroxine replacement.
39. A cold thyroid nodule on RAI scan has highest risk of malignancy. Next step? A) Fine-needle aspiration biopsy B) Reassurance C) Repeat scan D) Methimazole ANS: A Rationale: Hypofunctioning (“cold”) nodules are biopsied due to higher malignancy risk compared to “hot” nodules.
40. A patient with medullary thyroid carcinoma should be screened for pheochromocytoma prior to surgery because of possible: A) MEN2A syndrome B) Hashimoto’s C) Graves’ disease D) Follicular carcinoma ANS: A

Rationale: MTC in MEN2A is associated with pheochromocytomas; screening avoids perioperative hypertensive crises. .

1. A 35-year-old woman presents with fatigue, hyperpigmentation, and orthostatic hypotension. Laboratory studies reveal hyponatremia, hyperkalemia, and elevated ACTH. What is the most likely diagnosis? A) Cushing’s syndrome B) Addison’s disease C) Pheochromocytoma D) Conn’s syndrome ANS: B Rationale: Addison’s disease (primary adrenal insufficiency) is characterized by hyperpigmentation, electrolyte disturbances, and elevated ACTH.
2. A 47-year-old man with hypertension is found to have elevated urinary catecholamines and a left adrenal mass on imaging. What is the most likely diagnosis? A) Aldosteronoma B) Cushing’s disease C) Pheochromocytoma D) Adrenal cortical carcinoma ANS: C Rationale: Pheochromocytoma typically presents with hypertension and catecholamine excess, often sourced from an adrenal mass.
3. A patient with recently diagnosed Cushing’s syndrome undergoes a high-dose dexamethasone suppression test. His cortisol levels suppress

50%. The most likely source is: A) Adrenal adenoma B) Ectopic ACTH secretion C) Pituitary microadenoma D) Adrenal carcinoma ANS: C

presents at a young age.

7. Microalbuminuria in a diabetic patient is best assessed by: A) 24-hour urine protein B) Spot urine albumin-to-creatinine ratio C) Serum creatinine D) Dipstick urinalysis ANS: B Rationale: The spot urine albumin-to-creatinine ratio is sensitive for early detection of diabetic nephropathy.
8. A 50-year-old female presents with persistent fasting hyperglycemia despite metformin and sulfonylurea. Which medication best targets postprandial glucose excursions? A) Long-acting insulin B) Acarbose C) Thiazolidinediones D) SGLT2 inhibitors ANS: B Rationale: Acarbose inhibits intestinal alpha-glucosidases, blunting postprandial glucose rises.
9. Which of the following is a distinguishing feature of diabetic ketoacidosis compared to hyperosmolar hyperglycemic state? A) Severe dehydration B) Kussmaul respiration C) Profound hyperglycemia (>600 mg/dL) D) Absence of ketosis ANS: B Rationale: DKA is defined by the presence of metabolic acidosis with respiratory compensation (Kussmaul breathing).
10. A 52-year-old male on insulin develops recurrent hypoglycemic episodes at night. What adjustment is most appropriate? A) Increase evening long-acting insulin

B) Increase morning short-acting insulin C) Decrease evening basal insulin dose D) Switch to oral therapy ANS: C Rationale: Reducing the basal insulin (evening) will decrease nocturnal hypoglycemia. Hypogonadism

11. A 25-year-old male presents with infertility, small firm testes, and gynecomastia. Serum FSH and LH are elevated, and testosterone is low. Which is the most likely diagnosis? A) Kallmann syndrome B) Androgen insensitivity syndrome C) Klinefelter syndrome D) Pituitary adenoma ANS: C Rationale: Klinefelter syndrome (47, XXY) presents with hypergonadotropic hypogonadism and characteristic features.
12. A female patient with primary amenorrhea has low FSH, low estradiol, and anosmia. This constellation is most consistent with: A) Turner syndrome B) Kallmann syndrome C) Sheehan syndrome D) MRKH syndrome ANS: B Rationale: Kallmann syndrome (GnRH deficiency) presents with anosmia and hypogonadotropic hypogonadism.
13. A 60-year-old man with decreased libido, fatigue, and anemia is found to have a low testosterone and inappropriately normal LH. What is the likely cause? A) Primary testicular failure B) Androgen insensitivity C) Secondary hypogonadism

of metabolic syndrome? A) Omega-3 supplementation B) Weight loss via lifestyle modification C) Increased protein intake D) Statin therapy alone ANS: B Rationale: Weight loss through lifestyle changes can reverse insulin resistance and other features.

18. Which is NOT a criterion for the diagnosis of metabolic syndrome? A) Elevated fasting plasma glucose B) Increased waist circumference C) Elevated uric acid D) Elevated blood pressure ANS: C Rationale: Uric acid is not included in the traditional diagnostic criteria.
19. Hyperinsulinemia in metabolic syndrome primarily contributes to: A) Hyperthyroidism B) Insulin resistance C) Addisonian crisis D) Water retention ANS: B Rationale: Hyperinsulinemia is both a marker and driver of insulin resistance.
20. A 48-year-old obese man has a fasting glucose of 110 mg/dL, BP 145/92 mmHg, waist circumference 110 cm, triglycerides 210 mg/dL, and HDL 36 mg/dL. How many metabolic syndrome criteria does he meet? A) 2 B) 3 C) 4 D) 5 ANS: D Rationale: He meets all five: raised glucose, BP, waist circumference,

triglycerides, and low HDL. Neoplasms

21. A 48-year-old male presents with kidney stones, gastric ulcers, and bone pain. Labs show hypercalcemia and elevated PTH. Imaging reveals a pituitary mass. What is the most probable diagnosis? A) MEN1 syndrome B) MEN2A syndrome C) Zollinger-Ellison syndrome D) Parathyroid carcinoma ANS: A Rationale: MEN1 presents with parathyroid, pituitary, and pancreatic tumors.
22. A 35-year-old woman develops hypertension, palpitations, and diaphoresis; labs reveal high metanephrines. A family member has medullary thyroid carcinoma. Genetic testing is most likely to confirm a mutation in: A) MEN1 gene B) RET proto-oncogene C) P D) BRCA ANS: B Rationale: RET mutations are characteristic of MEN (pheochromocytoma, MTC).
23. A 25-year-old male presents with galactorrhea and visual disturbances. Imaging reveals a sellar mass. What is initial therapy? A) Surgery B) Cabergoline C) Radiation D) High-dose steroids ANS: B Rationale: Dopamine agonists (cabergoline, bromocriptine) are first-line for prolactinomas.