Endocrine refers to the medical study of the glands in the human body and their production of hormones, which are chemical substances that regulate various bodily functions. As a medical student, it’s important to have a strong understanding of this topic as it plays a crucial role in the maintenance of overall health and wellbeing.

The following multiple choice questions will test your knowledge of endocrine and to identify areas that you may need to focus on in your studies. By honing your understanding of endocrine, you’ll be better equipped to diagnose and treat various medical conditions in the future. Take our free MCQ questions below.

Table of Contents

Driving And Diabetes
Anorexia
Aspirin in DM?
Diabetes Criteria
Post Partum Hypothyroidism
Subclinical Hypothyroidism
Diagnose this 38 year old man
Treating Type II diabetes mellitus
Target diastolic blood pressure
Target systolic blood pressure

Driving And Diabetes

2 years later following a diagnosis of type 2 diabetes a HGV lorry driver comes back to see you in clinic. His diabetic nurse has recommended he needs insulin but he is very reluctant to start this and has refused.

He has also suffered a deep vein thrombosis (DVT) and is injecting himself daily with Low molecular weight heparin with no difficulties (he had an adverse drug reaction to warfarin).

The diabetic nurse is concerned and cannot explain his behaviour. The nurse sends him to your clinic.

What is the most likely explaination for his reluctance?

Needle Phobia
Weight gain from insulin
Stigmata of injecting insulin
Job concerns
Allergy to insulin

Job concerns

As an HGV driver you have very strict issues regarding driving. If you take insulin you cannot have an HGV licence. For advice and the rules on driving go to the following link.

https://www.gov.uk/government/publications/assessing-fitness-to-drive-a-guide-for-medical-professionals

Drivers holding a “normal” group 1 licence can drive only if they are aware of the symptoms of hypoglycaemia. Hypoglycaemic unawareness would mean they would not be able to drive.

Anorexia

An 18 year old student presents with weight loss following concerns from her mother over the past 2 years. The patient feels well. She has no GI/GU/Resp/Neuro or Dermatological symptoms.

On Examination

Weight 56 Kg
Height 1.78M
BM 6.4

Urinalysis
Blood –
Protein –
Leucocytes –
Ketones +
Glucose –

Physical examination has not revealed any other abnormalities other than those already described.

Blood tests
TSH
Fasting Blood sugar

1.7 (0.5-5)
6.2
(<7mmol/l)

What is this patients body mass index?

<20
20-25
25-30
>30
You Cant Calculate her BMI based on the information provided

<20

Although you don’t have a calculator someone who is just shy of 6 foot and weighs 56 kg must have a low BMI.

Rember BMI= weight (Kg)/ (Height in meters)2

I.e. 56/(1.178*1.78)

Continued from the previous question. What is the most likely diagnosis?

Other diagnosis not listed here
Thyrotoxicosis
Type I diabetes
Type II diabetes
Addison’s disease

Other diagnosis not listed here

Let’s take things in turn. She is underweight but feels well and has no physical complaints.

She has a very low BMI.

She is not thyrotoxic: her TSH is normal.

She has no evidence of diabetes: her BM in the clinic and her fasting blood sugar are both normal.

There is no evidence of Addison’s disease and although she has not had her cortisol etc measured, it does not seem likely.

The urinalysis suggests she is moving towards fat as her primary source of metabolism\: in this case one possible explanation is that she has had no carbohydrate load in the recent few hours.

With this history there should be concerns about an underlying eating disorder or other metabolic illness: a thorough and sensitive history would be amongst the first steps in investigation of what can be a very difficult diagnosis.

Rember BMI = weight (Kg) / (Height in meters)squared

I.e. 56/(1.78*1.78)

Aspirin in DM?

Read the following statement:

All Type 2 diabetic patients over 50 should be offered aspirin as a prevention against stroke and myocardial infarction (assuming controlled BP <145/90 and no other contraindications).

Is it true or false?

True
False

True

Yes! Type 2 diabetes is a significant risk factor for stroke. Offer aspirin to all >50 if there’s no reason not to. This is PRIMARY prevention. This is supported by NICE guidelines (NICE guideline 66).

Diabetes Criteria

A 65 year old woman presents with weight gain and polyuria.

Her investigations reveal the following

Weight 102 Kg
Height 1.5 M
Fingerprick blood glucose 9.7 mmol/l
Random Blood sugar 9.6 mmol/l

This is repeated the next day

Random blood sugar 10.2

Urinalysis
Blood –
Protein –
Leucocytes –
Glucose +

What is the diagnosis / most likely to reveal the diagnosis?

Initially needs fasting blood sugars x2*

Oral glucose tolearance test *

She has Type1 diabetes

She has Type 2 diabetes

Repeat random blood glucose.

The answer here is not clearcut!

Initially needs fasting blood sugars x2
She has Type1 diabetes
She has Type 2 diabetes
Repeat random blood glucose.
She has impaired glucose tolerance

Initially needs fasting blood sugars x2

You need to do either fasting blood sugars and/or an oral glucose tolerance test.

The WHO guidelines for the diagnosis of diabetes are:

Fasting BS >7mmol/l x2 = Diabetes Mellitus
Fasting BS 6-7mmol/l x2 = Impaired glucose tolerance (IGT)

OGTT

Fast from midnight then 1 x blood glucose.
75g glucose load then repeat blood glucose at 2 hours.

Result from OGTT

<7.8mmol/l = normal
7.8-11.1 mmol/l = Impaired glucose tolerance

11.1 mmol/l = Diabetes

Post Partum Hypothyroidism

A 36 year old female is 5 weeks post partum. She develops fatigue lethargy and weight gain. She has a result started to take iron tablets and St Johns wort. Citalopram has been prescribed by a locum GP for some depressive symptoms however some routine bloods at this stage showed the following:

Hb 10.2 (11.5-15 g/dl)

MCV 88 (80-99 fL)

Plt 276 (150-300 x10⁹/l)

WCC 6.2 (4-10 x10⁹/l)

Na 134 (135-145mmol/l)

K 4.3 (3.5-5.1mmol/l)

U 4.3 (4-9mmol/l)

Creatinine 64 (60-100 micromols/l)

CRP 11 (<5mg/l)

Albumin 44 (35-45g/l)

Alk Phos 86 (<110iu/l)

ALT 24 (<40 iu/l)

Bilirubin 16 (<20 micromols/l)

GGT 50 (0-70)TSH 0.6 (0.5-5.5)
Free T3 2 (3-9nmol/l)

What is the most likely diagnosis/ explaination for her symptoms and blood results?

Postpartum Thyroiditis
Citalopram Side effect
St Johns wort side effect
Anaemia
Myasthenia Gravis

Postpartum Thyroiditis

10% of women get a postpartum thyroiditis that usually settles spontaneously within about 4 months. They carry a higher risk of thyroiditis. Aim of treatment: Normalise TSH and free T4/T3.

Subclinical Hypothyroidism

A woman has a history of 6 years of depression. She has had her thyroid functino tested privately and brings you the result. She is complaining of worsening symptoms of lethargy and fatigue.
Her blood results show the following:

TSH 6.6 (0.5-5.3)
Free T3 6.7 (3-9nmol/l)
Thyroid autoantibodies: negative

She tells you she has been told she needs to go on a thyroid tablet. What is the most appropriate action to take?

Repeat the test in 2 months
Do nothing
Prescribe low dose thyroxine (25micrograms) and repeat the thyroid function tests
Prescribe a normal dose of thyroxine, and repeat the thyroid function tests
Challenge her as to if she is already taking thyroxine

Repeat the teast in 2 months

Thyroxine is T4. T4 is converted to T3 the “active” thyroid agent.

The tests suggest sub clinical hypothyroidism.

Treatment of this should be instigated when:

There is a goitre (this is contoversial but is a good rule of thumb for medical exams).

TSH is >10.

Thyroid autoantibodies are positive (patients likely to go on to develop hypothyroidism)

In general as the patients tests are very borderline, the tests should simply be repeated a few months down the line.

Diagnose this 38 year old man

A 38 year old man with obesity presents to his GP with weight gain over the past 6 months and thirst. He has the following results

Random Blood sugarFasting blood sugarFasting Blood sugar

9.5mmol/l7.6 mmol/l7.4 mmol/l

(<7mmol/l)(<7mmol/l)

What is the most likely diagnosis?

Type I diabetes mellitus
Type II diabetes mellitus
Impaired Glucose Tolerance
Insulin resistance syndrome (syndrome X)
None of the above

Type II diabetes mellitus

For the purposes of this question the things in favour of type 2 diabetes are:

Weight gain not weight loss;

His Age (type I diabetes more commonly presents at a younger age);

The incidence of type 2 diabetes is much higher than that of type I.

Treating Type II diabetes mellitus

A 62 year old HGV lorry driver is a newly diagnosed type 2 diabetic from blood tests taken the day before. He comes up to the surgery to discuss his results.

His results on his visit to the surgery are as follows:

BM in clinic: 14

HBA1c: 12

Cholesterol 7.6 (<5.5mmol/l)

Urinalysis

Blood –

Protein –

Leucocytes –

Glucose ++++

Ketones –

What is the most appropriate treatment for him?

Insulin
Oral diabetic agent (e.g. Metformin or gliclazide)
Metformin+ insulin
Gliclazide + insulin
Dietary advice alone

Dietary advice alone

This is a big catch: the initial advice to patients with newly diagnosed type 2 diabetes is dietary modification alone.

Following on from this if the blood sugar remains poorly controlled you would institute an oral hypoglycaemic agent (Gliclazide/metformin).

If needed in addition you could start insulin in addition.

Link to the Diabetes UK website for professionals here: https://www.diabetes.org.uk/professionals

Target diastolic blood pressure

A 66 year old man with type 2 diabetes presents has diabetic retinopathy.

What is his target diastolic blood pressure? (Based on the UK NICE guidelines).

<60
<80
<120
>120

As per NICE guideline 66 DBP targets are <80 for all patients (irrespective of kidney / eye or cerebrovascular disease).

Target systolic blood pressure