COMMON MCQ & CASES IN Endocrine

By Dr.Abdulrauf

1- The following is a signs of thyrotoxicosis:

a. Galactorrhea.
b. Constipation.
c. Menorrhagia.
d. myxoedema.
e. Papilloedema.

2- All of the following are expected clinical finding in a woman with thyrotoxicosis
except:

a. Bruit over the enlarged thyroid.

b. Lid retraction.
c. Lymphadenopathy.
d. Digital clubbing.
e. Menorrhagia.

3- clinical features of hyperthyroidism include all except :-

a-dry eyes
b-heat intolerance
c-gynecomastia
d-pretibial myxedma
e-alopecia

4- Graves disease characterized by all except:-

a-diffuse thyroid enlargement

b-hypocalcaemia
 c-ophthalmopathy
d-associated with pernicious anaemia
e-results from antibodies agnist TRH receptors

5- regarding Graves disease the following are false except:-

a- noduler enlargement of thyroid gland

b- myxedema
c- thyroid acropatchy
d- always need a surgical treatment
e- exophthalmos in all cases

6- In Graves’ disease all are true except :

a. Pretibial myxedema is recognized feature.

b. Ophthalmopathy may precede the development of hyperthyroidism.
c. TSH receptor antibodies (TRAb) are rarely detected in the serum.
d. The patient is at an increased risk of atrial fibrillation.
e. A neutropenia is a contraindication for antithyriod drug.

7- Regarding hyperthyroidism all are true except :

a. Goiter is rarely malignant.

b. More pateints are treated surgically than by any other form of
treatment.
c. Proptosis is caused by mucopolysacaride deposition .
d. Patients on carbimazole should be warned that it might cause
neutropenia..
e. An isotope scan should be done in some cases.

8- Regarding the management of hyperthyroidism in Graves disease, which of the

following statements is correct?

a. Carbimazole should be started in smaller doses and dose increaments are

done every 3 weeks.
b. The duration of therapy with carbimazole should not exceed 12 months.
c. Radioactive iodine is the treatment of choice for those who fail
 antithyriod drugs and subtotal thyroidectomy.
d. Subtotal thyroidectomy is contraindicated in patients with large goiter.
e. Transient Hypercalcemia develops following the subtotal thyroidectomy.

9- Carbimazole is the drug of choice for the treatment of hyperthyroidism and is

used in the following manner except :-

a-0-4 weekes 40-60 mg daily in divided doses

b-4-8 weekes 20-40 mg daily in divided doses
c-maintenance 5-20 mg daily
d-duration of treatment is for 4-6 monthes
e-has haematologic side effects

10- a45 years old lady female known case of hyperthyroidism persent to
emergency department by acute loss of oriention she also febrile and agitated.On
examination: pulse: 130 beat/min, irregular TM:39C . All the following are
ture except:

a-iv sodium iopodate should be started.

B-Antithyroid drug should be stopped.
C-Propranolol is rapidly effective for control heart rate.
D-Rehydration and broad spectrum antibiotic.

11- A 30 year old female complains of palpitations and fatigue. On physical

examination, her extremities are warm and she is tachycardia, there is diffuse
thyroid gland enlargement and proptosis with pretibial edema. The following is
correct :

a. The cause of patient's illness is viral infection of the thyroid.

b. Blood test shows increased total thyroxin, increased total T3 and
increased TSH.
c. The treatment of choice is radioactive iodine.
d. Propylthiouracil preferable treatment during pregnancy.
e. Medial nerve entrapment is a common complication.

12- A 40 years woman who has goitre for several years presented with a four
months history of losing 5 Kg of weight, palpitations and increased sweating. Free
T4 was within normal range and serum TSH was <0.01 mU/L ( N0.3-4.0 mU/L).
Which of the following statements is true?

a. A history of oral contraceptive pills explains the abnormality in thyroid

function results.
b. Low pulse pressure is compatible with her clinical condition.
c. The absence of bruit on auscultation over the goitre excludes
hyperthyroidism.
d. Measurement of free T3 will be the next step in the investigation of this
patient.
e. Thyroidectomy is the first line of management.

13- A 33 year old female patient newly married presented with goitre, loss of
weight, despite polyphagia, and heat intolerance. Clinical manifestation includes
tachycardia, high volume collapsing pulse and fine tremor. The following are true
except:

a. Absence of ocular manifestations rules out Graves’ disease.

b. Pretibial myxoedema is a recognized clinical feature.
c. Vitilligo favours Graves disease.
d. TSH receptor antibody (TRab) estimations is of diagnostic value.
e. Relapse rate is around 50% after stopping anti thyroid drugs.

14-A 25 year old female has a 2 month history of increased nervousness, heat
intolerance and 10Kg weight loss, physical examination demonstrates bilateral
exophthalmous with no extra ocular muscle impairment, diffuse goiter with bruit
auscultated over the gland, serum TSH < 0.03mIu(normal 0.3-4.5), serum T4 is
24.2 µg/dl(normal 4.5-12). Serum Beta HCG test is normal. Whicch of the following
statements is correct :

a. Test serum total T3 in one week.

b. Schedule her for thyroidectomy in one week.
c. Her ophthalmopathy will improve the most if she receives radio iodine
therapy.
d. Pretibial myxoedema is common physical finding.
 e. TSH level may stay suppressed for months after the patient is clinically
euthyriod.

15- A 20 year old female complains of palpitation, breathlessness, unintentional

10Kg weight loss over the last 6 months, increased perspiration, and heat
intolerance. On examination her pulse is 120/min, her skin warm and moist and
there is mild tremor in both hands, she has bilateral exophthalmos, thyroid is non
tender, diffusely enlarged. Laboratory results include a serum T4 of 200nmoI/L
(NR: 64-155nmoI/L), and a serum TSH of <0.01mU/mL(NR: 0.5-5.0 mU/mL). all of
the following are true regarding patients cases except:

a. Autoimmune ethoilogy is the most likely underlying cause.

b. Wide pulse pressure is expected.
c. High output heart failure is well recognized complication.
d. Radioiodine may be given as primary therapy to this patient.
e. Digoxin is the drug of first choice if she developed atrial fibrillation.

16- regarding hypothyroidism all are false except :-

a-usually develops suddenly

b-there is no individual variations in the dominant features
c-atrial fibrillation is common in young patients
d-Grave's disease is the major immunologically mediated from of
hypothyroidism .
e-almost every system is affected

17-Cardio respiratory manifestations of hypothyroidism include all except :-

a-angina
b-hypertension
c-bradycardia
d-high pulse pressure
e-pericardial and pleural effusion
18- The following are features of hypothyroidism, except:
a. Bradycardia.
b. Pendular Knee jerk.
c. Carpal tunnel syndrome.
d. Constipation.
e. Goiter.

19- Manifestations of myxedema include all except :

a. Optic nerve atrophy

b. Carpal Tunnel Syndrome.
c. Cerebellar ataxia.
d. Xanthelasma.
e. Infertility.

20- Myxoedema may present with all except:

a. Ascites
b. Paresthesia of the hands.
c. Infertility.
d. gaynecomstia.
e. Macrocytic anemia.

21- In hypothyroidism, the following are true except:

a. Myxedema coma is a rare presentation.

b. There is increased incidence of ischemic heart disease.
c. When initiating therapy a low dose of thyroxin is used.
d. Thyroxin dose should be reduced in pregnancy.
e. Peripheral neuropathy is a recognized association.

22- The following are true about patients with hypothyroidism except:

a. Patients are at risk of developing other organ specific outoimmune

conditions.
b. Myxedema coma is a rare presentation of hypothyroidism and associated
with increased mortality rate.
 c. Lithium carbonate is a recognized cause of drug induced hypothyroidism.
d. Hashimoto thyroiditis is the most common cause of goitrous
hypothyroidism.
e. Thyroxin replacement is advisable to start with high dose and then
gradually reduced.

23- In primary hypothyroidism all are true except :

a. Hashimoto thyroiditis is the most common cause of goitrous

hypothyroidism.
b. Levothyroxine therapy should be started in a large dose then gradually
reduced.
c. Pericardial effusion can be an indicated finding.
d. Free T4 is the most useful parameter to follow in titrating levothyroxine
dose.
e. Hyperprolactinemia is a clinical finding.

24- biochemical changes of hypothyroidism includes one of the following :-

a-low or normal TSH in primary hypothyroidism

b-usually normocytic anemia
c-hypernatermia
d-hypercholesterolemia
e-high free T4

25- a 40 year old woman presented with l year history of menorrhagia anaemia
tiredness inability to concentrate cold intolerance and weight gain O/E cold dry
skin breasts were normal and without galactorrhoea . chest+ heart+ abdomen were
unremarkable. HR60/min BP110/60 ECG bradycardia with low voltage QRS
complexes.S.prolactine 1500u/L Total thyroxin 20nmol/L free T3<1.0. free
T4<2.5. TSH>61 The most likely diagnosis is:

a- prolactinoma.
B- Primary hypothyroidism.
C- Secondary hypothyroidism.
D- Sub acute thyroditis
26- A 40 year old woman is referred to you because of lethargy, cold intolerance,
constipation, dry and weight gain. Physical examination shows mildly enlarged
thyroid, enlarged tongue and slow reflexes. Which test best confirms the clinical
impression of primary hypothyroidism:

a. Measurement of serum T4.

b. Measurement of serum T3.
c. Measurement of serum TSH.
d. Measurement of serum thyroglobulin.
e. Test for anti-thyroidal antibodies.

27- A 50 year old house wife presented with a one month history of tiredness,
weight gain of 12Kg, puffiness of the face, hair loss and numbness of the left hand
at night. On examination her pulse was 52/min, cardiac apex beat is not palpable.
ECG shows sinus bradycardia and low voltage QRS complex, all of the following are
true regarding patients cases except:

a. A history of menorrhagia is significant.

b. Exaggerated ankle reflexes are diagnostic test.
c. TSH is the most important diagnostic test.
d. It is available to start thyroxin supplement in a smaller dose.
e. Coma is a recognized complication in untreated patients.

28- A 65 year old female presented with a 3 month history of progressive

tiredness and hoarseness of voice. She admitted due to paraesthesia in both hands.
She had a history of psychotic illness. On examination she had per orbital
puffiness, non-pitting edema on both lower limbs, her pulse was 55/min, regular and
her blood pressure was 110/70 mmHg. Chest, cardiac and abdominal examinations
were normal. The following are true about management of this patient except:

a. History of intake of lithium carbonate is of significance.

b. Carpal tunnel syndrome is a recognized association.
c. Detection of antibodies against thyroid peroxidase excludes spontaneous
atrophic thyroiditis.
d. It is advisable to start with a low dose of thyroxin in the initial stages of
 the treatment.
e. Myocardial ischemia is recognized complication.

29- a27- year-old woman present with palpitation tremers anxiety and neak pain.
Her TSH is low free T4 is high consistent with primary hyperthyroidism. 24-hr
radioiodine uptake is low. How would you treat this patient?

a. carbimazol
B. radioiodine
C. propraolol
d. surgery

30- 50 years old Libyan female brought to medical OPD by her husband whose
complain that his wife are sleepy most of the day time there is change of here
voice and also her hearing is poor on examination patient looks depressed over
weight and there is periorbital puffiness+purplish lips and malar flush thyroid
function test result are

TSH: low T4:low T3:normal

The most likely diagnosis is :

a- primary hypothyroidism.
B- Secondary hypothyroidism.
C- Subclinical hypothyroidism.
D- Sub clinical thyrotoxicosis

31- Hyperparathyroidism is associated with all except:

a. Hypercalcaemia.
b. Psychosis.
c. Constipation.
d. Trousseaus sign.
e. Renal stones with the risk of urinary obstruction.
32- In Hyperparathyroidism, which of the following statements is false?

a. The majority are due to multiple parathyroid adenomas.

b. Memory loss and depression are recognized manifestations.
c. Calcium level should be adjusted in the presence of low serum albumin.
d. Nephrocalcinosis is a recognized association.
e. Hypocalcaemia is common during the first 2 weeks after surgical removel
of the adenoma.

33- Features of primary hyperparathyroidism include all except

a. Hypercalcaemia.
b. Hyperphosphatemia.
c. Raised alkaline phosphatease.
d. Raized PTH.
e. Terminal resortion in the phalanges.

34- tertiary hyperparathyroidism typically has all except :

a. Elveted serum calcium.

b. high phosphate.
c. Normal alkaline phosphatase.
d. high 1.25-oH-D3.
e. High serum thyroxin level.

35- Regarding hypercalcaemia which of the following is true:

a. Thiazides may be useful in treatment.

b. Most common causes is bone metastatic depostis.
c. Symptoms only occur when serum level>15 mg/dl.
d. Is associated with Conns syndrome.
e. Is associated with prolonged QT interval.

36- Regarding hypercalcaemia all are true except:

a. Malignancy is the most common cause in hospitalized patients.

b. Primary hyperparathyroidism is the most common cause in an
asymptomatic out patient.
 c. Can be found in asteoporosis
d. Magnesium level should be measured in all patients with hypercalcemia.
e. Steroids are the treatment of choice for vitamin D dependant
hypercalcemia.

37- treatment of malignant hypercalcaemia includes all except :-

a-rehydration with normal saline is contraindicated

b-Pamidronate 90mg i.v over 4 hours
c-forced diuresis with saline and frusemide
d-Prednisolone 40 mg daily
e-heamodialysis

38- regarding hypercalcemia the following are true except :-

a-1 ry hyperparathyroidism is a recognized cause

b-cause prolonged Q-T interval on ECG
c-constipation is a recognized symptom
d-may cause similar ECG pattern of IHD
e-management includes rehydration using saline with diuretics

39- The following is cases of Hypocalcemia:

a. Chronic renal failure.

b. Tertairy Hyperparathyroidism.
c. Thyrotoxicosis.
d. Milk alkail syndrome .
e. Sarciodosis

40- recognized causes of tetany includes all except:-

a-metabolic alkalosis
b-hypocalcaemia
c- malabsorptions
d-hyperparathyroidism
e-chronic renal failure
41- All of the following are used in the treatment of tetany, except:

a. Calcium Gluconate.
b. Rebreathing in a paper bag.
c. Prednisolone.
d. Magnesium sulphate.
e. 1α-Hydroxycholecalciferol.

42- In assessing a 70 year old male patient with polyuria, polydipsia, constipation
and lethargy, the following analysis was performed:

• Serum Ca ++ 15mg/dl (N 8.5-10.5)

• Serum phosphorus 2.2mg/dl (N 2.5-4.5)

• Alkaline phosphatase 400 unit/l (N 41-133)

All the following are true except:

a. A chest x-ray could help reach the diagnosis.

b. ECG may show short QT interval.
c. Bisphosphonates are treatment options.
d. Proper hydration is essential in management of these pateints.
e. Glucocorticoids should be avoided in these cases

43- Cushing's syndrome all are false except :-

a-ectopic ACTH syndrome is the most common cause

b-48-hr high dexametasone suppression test is used to differentiate ACTH
source ectopic or pituitary
c-in cyclical Cushing's syndrome the cortisol secreted in small amount and
continous
d-in Cushing's disease medical treatment is preferred than surgical
treatment
e-in Cushing's disease bilateral adrenalectomy surgery is the treatment of
choice

44- In Cushings syndrome, which of the following statements is false:

 a. Most cases are iatrogenic.
b. Is four times more common in males.
c. Ectopic ACTH syndrome is usually associated with small cell carcinoma.
d. Osteoporosis is a recognized feature.
e. 24 hours urinary free Cortisol is a valuable test in suspected cases.

45- clinical features of Cushing syndrome is :-

a-weight loss
b-menstrual irregularity
c-myalgia with no wasting
d-hypotension
e-pallor

46- Adverse effect of oral corticosteroids include all except :

a. Hyperkalemia.
b. Peptic ulcer.
c. Skin bruises.
d. Myopathy.
e. Retinal detachment.

47- A 45 year old female was, seen at the medical outpatient department
complaining of amenorrhea, recent weight gain, difficulty in climbing stairs and
coping with her children. Her husband noticed mood changes and states that she is
depressed most of the time. On physical examination she had central obesity, acne
and hirustism, BP240/110mmHg. The following are true regarding this patient
except:

a. History of blurring of vision is of diagnostic value.

b. Neurological examination of the lower limbs may show proximal myopathy.
c. Low dose dexamethasone suppression test will confirm Cushing’s disease.
d. MRI pituitary scan could fail to identify a micro-edenoma.
e. Osteoporosis is a recognized complication.
48- Regarding Pheochromocytoma which is true :

a. Beta adrenergic blocker are adequate mono therapy to control

hypertension.
b. Typically the patients presents with attacks of headache, palpitation, and
sweating.
c. Typically a part of multiple endocrineneoplasia type 1.
d. The tumour is usually malignant and bilateral.
e. Normal urinary levels of adrenaline and nor adrenaline excludes the
diagnosis.

49- Regarding Pheochromocytoma which is true :

a. Often show postural drop in blood pressure on sleeping.

b. Normal urinary Vallinyl Mandelic Acid rules out the diagnosis of
Pheochromocytoma.
c. 30% of the tumors are extra-adrenal.
d. Scintigraphy using MIBG (Meta-iodobenzyl guanidine) is useful for
diagnosis of pheochromocytoma.
e. Medical therapy with B blocker only is required to prepare the patient
for surgery.

50- In Pheochromocytoma all are true except :

a. Is an adrenal tumor.
b. The most widely used test in diagnosis is the measurement of
Vallinylmandelic acid (VMA) or Metanephrine in the 24 hours urine collection.
c. Atenolol is the drug of choice in treating hypertension.
d. Surgical resection is the only definitive therapy.
e. Neurofibromatosis is recognized association.

51- In Addisons disease all are true except:

a. Tuberculosis is the most common cause in developing countries.

b. Weight loose is recognized presentation.
c. Pernicious anemia is a recognized association.
 d. Decrease insulin requirement in diabetic patients.
e. Hypertension is a common presentation.

52- In patients with adrenal insufficiency all are false except :

a. Withdrawal of long standing, corticosteroid therapy is a common causes

of primary adrenoctical insufficiency.
b. Hypokalaemia is a common finding.
c. Short synacthen test helps differentiate between primary and secondary
adrenal insufficiency.
d. Excess weight gain during treatment indicates over replacement.
e. Measurement of plasma Cortisol level is helpful for dose adjustments
during follow up.

53- In Addison's disease which is true :-

a-pigmentation of mucous membranes is rare

b- hypertension is commone
c-vitiligo is present in about 90% of patients
d-there is rise in plasma cortisol level following administration of low ACTH
e-chest radiograph should be taken for evidence of tuberculosis

54- features of Addison's disease includes all except :-

a-pigmentation of buccal mucosa

b-vitiligo
c-hypokalemia
d-postural hypotension
e-hyponatremia

55- laboratory finding in Addison's disease includes all except

a-low blood suger

b-hypernatremia
c-high plasma ACTH
d-hyperkalaemia
c-low plasma cortisol
56- An 18 year old nurse, presented to emergency room complaining of dizziness
and vomiting with mild upper abdominal discomfort for the last 24 hrs. on systemic
inquiry she has mild dysuria and urgency over the last week, she is known case of
bronchial asthma on self-monitored dose of systemic corticosteroids which was
stopped recently, she is currently on short acting β2 agonist, on examination, she
was afebrile, pulse 100/min, regular low volume BP 80/40mmHg with postural drop
15mmHg, the rest of clinical examination was unremarkable. The following are true
except:

a. History of recent physical or emotional stress is significant.

b. Presence of moon face is of clinical significance.
c. Hypernatremia and hypokalaemia are expected.
d. Fluid and replacement therapy should be started immediately.
e. Acute renal failure is a recognized complication.

57- A 23 year old female teacher presented with a 3 day history of abdominal
pain, anorexia and vomiting. On examination she was dehydrated, pulse of 110/min,
blood pressure of 90/60 mmHg with pigmentation in the buccal mucosa. Systemic
examination was normal. The following are true about the patient management
except:

a. Past history of tuberculosis is significance in this patient.

b. Vitilig ooccurs in 10-20% in such cases.
c. Serum Cortisol level is expected to rise to a very high level after a short
ACTH stimulation test.
d. Parental hydrocortisone should be continued until gastrointestinal
symptoms improve.
e. Hypoglycaemic coma is recognized complication.

58- 45 year old male known case of tuberculosis, presented to medical OPD
complaining from malaise, weakness, anorexia, lethargy and weight loss, on
examination patient looks depressed, there is also hyperpigmentation of elbow knee
and mucus membrane. BP on lying down 115/70 and BP after 1 minute of standing
95/60. All the following are correct except :-
 a-blood glucose should be measured for all patients.
b-Adosterone is the mineralocorticoid used.
c-Hydrocortisone is the drug of choice.
d-persistent lethargy is due to an inadequate dose

59- The following are features of aromegaly except:

a. Kyphosis
b. Ostereoarthrosis.
c. Clonic cancer.
d. Decreased heel pad thickness.
e. Diabetes mellitus.

60- Clinical features of acromegaly include all except:

a. Increased sweating.
b. Reduced sebum production.
c. increased heel pad thickness.
d. Carpal tunnel syndrome.
e. Hypertension.

61- manifestation of acromegaly includes all except

a-progathic mandible
b-decreased sweating
c- thick shiny skin
d-loss of libido and impotence in male
e-gynecomastia may occur in some cases

62- Acromegaly is associated with all of the following except:

a. Impaired response to glucose load.

b. Jiont pain.
c. Hypotension.
d. Increased body odor.
e. Carpal tunnel syndrome

63- In Acromegaly all of the following are true except:

 a. There is characteristically enlargement of frontal sinuses.
b. Increased insulin resistance is usual.
c. Carpal tunnel syndrome is recognized complication.
d. Homonymous hemianopia is the most characteristic visual complication.
e. Galactorrhoea may be the presenting symptom.

64- In Acromegaly the following are are true except :

a. Increased insulin resistance is usual.

b. Painful paraesthesia in median nerve distribution is a recognized
association.
c. Homonymous hemianopia is the most characteristic visual complication.
d. Galactorrhoea may be the presenting symptom.
e. Trans-sphenoidal surgery is the first mode of treatment.

65- A 40 year old male patient presented with a history of increased headache,
numbness, tingling of his hands especially at night, excessive snoring for the last
one year, examination disclosed a blood glucose of 200mg/dl which of the following
statements is correct.

a. Serum prolactin is likely to be elevated.

b. IGF-l level is expected to be low.
c. Hypocalcaemia is typically present.
d. Primary medical therapy is curative in almost all patients.
e. Almost always caused by carcinoid tumours or islet cell tumours.

66- The following are common features of hyperprolactinemia except:

a. Galactorrhea.
b. Infertility.
c. Importance.
d. Alopacia
e. Amenorrhea.
67- High prolactin typically causes all of the following except:

a. Impotence
b. Hypertension
c. Infertility.
d. Galactorrhea.
e. Reduced shaving frequency in men.

68- The following are true regarding hyper-prolactinemia except:

a. Is caused by posterior pituitary tumour.

b. In men it usually presents with impotence.
c. Is a recognized complication of phenothiazines therapy.
d. MRI scan of the pituitary is an important investigation.
e. Bromocriptine is used in the treatment.

69- a 24 year old woman presents with galactorhea and amenorrhea.a prolactin
level is 450mg/ml {n, 0-19}. Pituitary MRI shows a 25 cm adenoma. How would you
treat her?

a-surgery
b-radiations
c-Bromocriptine
d-Methotrxate

70- The following are true about hypopituitarism except:

a. Can be caused by postpartum necrosis of pituitary.

b. Coma can be caused by water intoxication.
c. Short synacthin test is indicated for the diagnosis.
d. TSH measurement is helpful in adjusting Thyroxin dose.
e. Insulin tolerance test is contraindicated in epileptic patients.

71- In Hypopituitarism, which of the following is false:

a. Mostly caused by macro adenoma of the pituitary gland.

b. Hypopigmentation is a characteristic feature.
c. Hypoglycemia is a recognized manifestation.
 d. Growth hormone, FSH and LH secretion are the earliest to be deficient.
e. Thyroxin should be given as first replacement therapy.

72- The following are true statements regarding diabetes insipidus, except:

a. Urineosmolarity> 660mOsm/Kg.
b. Plasma osmolality>300mOsm/Kg.
c. Can be caused by hypokalemia.
d. Water deprivation test is used for confirmation of diagnosis.
e. Desmopressin is the treatment of choice for cranial diabetes insipidus.

73- a 25 year old male investigated for polyuria and polydepsia and diagnosed as
having nephrogenic diabetes insipedus. The treatment of choice is :

a-a high salt diet

b-Thiazide diuretic agent
c-subcutaneous administration of vasoprassin
d-corticosteroids.

74- regarding insulin-dependent diabetes mellitus the following is true

a-identical twins of a patient with IDDM has a 100% chance of developing

the disease
b-95% of patient with IDDM carrying HLA-DR3
c-most of the cases presents at older- age
d-usually treated by oral hypoglycemia
e-may develop ketoacidosis

75- In Type 1 Diabetes mellitus all are false except :

a. Symtoms usually appears after the age of 40.

b. Insulin resistance is a characteristic feature.
c. There is a substantial risk of keto acidosis and coma.
d. Genetic factor have been clearly identified as main etiologically
important.
e. Obesity is usual.

76- In type 2 diabetes the following statements are true except:

 a. Is associated with over eating.
b. Concordance rate in monozygotic twins approach 100%.
c. Repeated pregnancy may increase the likelihood of developing diabetes.
d. Is associated with pernicious anemia.
e. Age incidence at middle age and elderly people.

77- The following statements about diabetes mellitus(DM) are true except:

a. DM type 2 is more common than type 1.

b. Oral glucose tolerance test is essential for diagnosis.
c. Metrormin is the drug of choice in type 2.
d. HbA1c is used to assess the glycemic control.
e. Hypoglycemia may complicate sulfonylurea drugs.

78- In diabetes Mellitus which is true :

a. Hemoglobin A1C is a sensitive screening test.

b. Absence of glycosuria excludes diabetes.
c. Sulfonylurea decreases hepatic gluconeogenesis.
d. 5% of patients have significant diabetic complications at presentation.
e. Obese individuals tend to require high doses of insulin.

79- In patients with Diabetes Mellitus, which statement is true:

a. Hypertension is more prevalent in type 1 than in type 2.

b. Sulphonylureas are the treatment of choice for gestational diabetes.
c. B-blockers are safe for patient with Type 1 diabetes mellitus.
d. GlycosylatedHb reflects diabetic control.
e. Angiotencin converting enzyme inhibitors are contraindicated in patients
with proteinuria.

80- In diabetes mellitus all are false except :

a. Genetic factors are more important in the aetiology of Type 1 rather than
Type 2 diabetes.
b. Glucose Tolerance test when blood-glucose are elevated is not diagnostic
of diabetes.
 c. More than 70% of Type II diabetes are under weigh at presentation.
d. Leucocytosis in diabetic ketoacidosis indicate infection.
e. Glycosylated haemoglobin indicates an accurate glycaemic control over
weeks to months.

80- In Diabetes Mellitus all are true except :

a. Sensory polyneuropathy has an asymmetrical distribution.

b. Tight control will prevent progression of diabetic nephropathy.
c. 50% of visual loss in people with type 2 diabetes are not due to diabetic
retinopathy.
d. Thiazolidinediones are associated with increased risk of hypoglycaemia.
e. Lipohypertrophy at injection site will delay insulin absorption.

81- glycosuria may be seen in all except:

a-hyperglycemia
b-hypoglycemia
c-pregnancy
d-puberty
e-renal tubular damage

82- Diagnosis of diabetes mellitus is established by all except :

a. The fasting blood sugar is above 126 mg/day in more than one reading .
b. The blood sugar is over 200 mg/dl two hours after a meal.
c. Glycosuria is presented & high RBS .
d. Hemoglobin A 1c is over 15% of the total haemoglobin.
e. High fasting triglyceride concentration.

83- All of the following establishes the diagnosis of diabetes mellitus except:

a. Fasting plasma glucose of 135mg/dl in a patient with symptoms suggesting

diabetes.
b. Random plasma glucose of 240ng/dl in a patient with symptoms suggesting
diabetes.
 c. Fasting plasma glucose of 130mg/dl and plasma glucose of 220mg/dl
following 2 hours after glucose load in an oral glucose tolerance test.
d. Fasting plasma glucose of >130mg/dl in three accasions in asymptomatic
patient.
e. Fasting plasma glucose of 135mg/dl in a patient admitted with acute
myocardial infraction

84- Hemoglobin AIC all are false except :

a. Level is useful for assessing the overall blood glucose level in the past 3
weeks.
b. A level of 9% in a diabetic patient indicates the glycemia control is within
the target.
c. Measurement renders blood glucose monitoring unnecessary.
d. Falsely high values are found in thalassemia.
e. Low values indicate recurrent hypoglycaemia.

85- In the management of Diabetes mellitus all are true except :

a. Type II diabetes mellitus may requires insulin.

b. Metformin is useful in obese patients with type II diabetes mellitus.
c. Hyperosmolar non-ketotic diabetic coma usually requires smaller doses of
insulin.
d. Sodium bicarbonate should be used in all patients with diabetic keto-
acidosis.
e. Angiotensin converting enzyme inhibitors are useful to control
hypertension in diabetic pt.

86- A 45 year old obese woman with uncontrolled diabetes mellitus on Metformin
with a fasting blood sugar of 250mg/dl. The following is the best appropriate
management for this patient:

a. Add a sulphonylurea.
b. Add bedtime isophane insulin.
c. Add a thiazolidinedione.
 d. Urgent admission to hospital.
e. Life style modification.

87- The following is features of acute complications of diabetes mellitus:

a. Every patient in diabetic ketoacidosis is potassium depleted although

plasma potassium may even be raised initially.
b. The magnitude of hyperglycemia does correlate with the severity
metabolic acidosis.
c. Hyperglycemia in diabetic ketoacidosis is best treated with subcutaneous
insulin.
d. Severe dehydration and pre-renal azotemia are not common in non-ketotic
hyperosmolar diabetic coma.
e. Despite energetic treatment the mortality in DKA is more than 50%.

88- Regarding hypertension in diabetics all are true except :

a. Is more prevalent in IDDM than NIDDM.

b. Its treatment slows the deterioration of nephropathy in IDDM.
c. ACE inhibitor are the drugs of choice.
d. Beta-blockers may mask symptoms of hypoglycaemia.
e. Increases the risk of stroke.

89- The following causes hypoglycaemia except:

a. Addison’s disease.
b. Glucagonoma.
c. Uremia.
d. Hepatocellular failure.
e. Insulinoma.

90- the following is a manifestation of hypoglycemia

A-meiosis
b-cold extremities
c-bradycardia
 d-air hunger
e-dry skin

91- Feature suggesting ketoacidosis rather hypoglycaemia include all except :

a. Abdominal pain and air hunger.

b. Increase tendon reflexes.
c. Moist skin and tongue.
d. Rapid weak pulse and hypotension.
e. Blurred vision .

92- non-ketotic hyperosmolar diabetic coma all are true except

a-usually affect old patient

b-mortality is over 40%
c-prophylactic subcutenous heparin is recommended
d-blood glucose level more than 300 and less than 600mg/dl
e-the conscious level depressed when osmolarity more than 340mmol/kg

93- A 38 year old male presented with polydipsia, polyuria, and weight loss 8Kg
over 3 months. On examination pulse 70/min, B.P 120/80mmHg, and no pallor, rest
of clinical examination was unremarkable, random blood sugar 220mg%. The
following are true except:

a. History of celiac disease in the family is of diagnostic value.

b. HbA1c e is a useful monitoring tool.
c. Boguanides should be considered as first line treatment.
d. Abdominal pain and vomiting may indicate metabolic acidosis.
e. Myopathy is a recognized long term complication.

94- A 50 year old obese man with a 5 year history of type-2 DM currently on
Metformin tablets was found to have blood pressure around 145/90 mmHg in
several repeated measurements, which of the following statements is correct?

a. Reassurance and follow up for several months without treatment.

b. Start drug therapy with Angiotension converting enzyme inhibitor.
c. Do an IVP before commencement of treatment.
 d. A glomerular filtration rate (GFR) of more than 90ml/Kg/1.73m² indicates
end stage renal disease.
e. Statins are contraindicated as they will elevate the blood pressure.

95- A 67 year old gentleman with type 2 diabetes mellitus for the last 20 years on
glibenclamide 5 mg once per day was admitted with a right foot infection for 3
days duration. He was found to have a blood pressure of 160/104 mmHg and edema
of both lower limbs. His fasting blood sugar was 280mg/dl, serum albumin was 2.8
g/dl and urea of 45mg/dl. All the following statements are true except :

a. The patient may not recall an injury to his foot.

b. Fundus examination usually reveals changes of diabetic retinopathy/
c. 24hr urine collection for albumin is recommended.
d. Beta blockers therapy is the treatment of choice to control his blood
pressure.
e. Ischemic heart disease is the commonest cause of mortality.

96- a55 years old male comes to medical OPD complaining from tingling and
numbness in the hands and feet (glove and stocking distribution) since 1 mounth. He
has a history of diabetes , hypertension, there is decrease soft touch, vibration,
and postion sense in the feet. All the following are true except:-

a-intensive insulin therapy is needed

b-tricyclic antidepressant has a rule in treatment.
c-Charcot neuroarthropathy is one of possible complication .
d-muscle wasting is one of early developing complication

97- a 64 year old man with type II diabetes for 15 year is admitted to the
hospital with hyperosmolar coma , on admission his plasma is 900 mg/l. Which of
the following treatments should be given first ?

a-insulin
b-normal saline
c-5% dextrose
e-subcutaneous heparin
98- A 45 year old man with type 2 diabetes mellitus for 6 years, on diet control
and Metformin 850mg twice daily. His post-prandial sugar ranges from 140-
160mg/dl, HbA1c is 6.8 %(normal is 4-6%). He was admitted to the medical ICU
due to severe pneumonia. His blood pressure is 100/65mmHg; random blood sugar is
378mg/dl. The most appropriate treatment to control his blood sugar is:

a. Stop metformin and start sulfonylurea.

b. NPH-insulin twice daily.
c. Control of blood sugar according to sliding scale.
d. Continuous insulin infusion.
e. Metformin plus sulfonylurea.

99- A 24 year old female, diagnosed 5 year ago with type 1 diabetes mellitus. She
is on morning dose of NPH insulin of 26u/day. She lost 15kg of her weight and she
is non-compliant to her treatment and follow-up. She attended the diabetic clinic
for a pre-employment check-up. Her fasting blood sugar was 220mg/dl, and random
6pm blood sugar was 118mg/dl. All of the following are true except:

a. Presence of swelling at injection site is consistent with lipodystrophy.

b. HaemoglobinA1c is expected to be>7%.
c. Increasing the morning dose of insulin is advisable.
d. Adverse fetal outcome is expected if tight blood sugar control is not
adopted during pregnancy.
e. Regular screening for retinopathy by fundal photography is recommended.

100- A 27 year old women with IDDM since the age of 10 and irregular follow up,
has recently married and attended diabetic clinic on her husband’s insistence. Her
blood pressure 160/90mm.Hg, 24 hour urine for albumin 2g and her haemoglobin
A1c is 9%. The following are true except:

a. Examining the fundi is of diagnostic value.

b. Diabetic nephropathy is the most likely cause of her proteinuria.
c. An ACE inhibitor is most beneficial to the kidneys and safe in pregnancy.
d. Increased fetal loss as well as worsening diabetic nephropathy may occur
during pregnancy.
e. Oral hypoglycaemic drugs are contraindicated.