Endocrine Y2 MCQs

Question 1: A 52-year-old female undergoes thyroid scintigraphy using Iodine-123 for evaluation of a thyroid nodule seen on ultrasound. The scan reveals a solitary “cold” nodule in the right lobe with surrounding suppressed uptake. Which of the following best describes the clinical significance of this finding?

A. The cold nodule is likely benign and requires no further evaluation
B. The cold nodule has a high likelihood of being a functional adenoma
C. The cold nodule demonstrates increased iodine uptake consistent with Grave’s disease
D. The cold nodule is non-functioning and may warrant FNA to rule out malignancy
E. The cold nodule is diagnostic of Hashimoto’s thyroiditis

Question 2: A 14-year-old boy presents with polyuria, polydipsia, weight loss, and fatigue. Random venous blood glucose is 15.8 mmol/L. Further testing shows low C-peptide levels and positive GAD65 antibodies. Which of the following statements best explains the underlying pathophysiology of his condition?

A. Pancreatic alpha-cell hyperplasia leads to excessive glucagon production
B. Peripheral insulin resistance results from downregulation of GLUT4 receptors
C. Autoimmune-mediated destruction of pancreatic beta-cells leads to insulin deficiency
D. A mutation in the insulin receptor gene impairs signal transduction in target tissues
E. Excessive breakdown of incretins such as GLP-1 reduces insulin secretion

Question 3: A 16-year-old girl with established Type 1 Diabetes Mellitus on a stable basal–bolus insulin regimen begins playing competitive soccer three times weekly. She reports recurrent episodes of hypoglycaemia during and after exercise despite unchanged insulin doses and carbohydrate intake. Which of the following mechanisms most likely explains her exercise-induced hypoglycaemia?

A. Upregulation of GLUT2 receptors in pancreatic β-cells increasing insulin release
B. Increased DPP-4 activity degrading GLP-1 and GIP, thereby reducing insulin secretion
C. Exercise-mediated translocation of GLUT4 channels to muscle cell membranes, enhancing glucose uptake
D. Stress-induced cortisol release augmenting hepatic gluconeogenesis
E. Enhanced hepatic insulin sensitivity leading to decreased endogenous glucose production

Question 4: A 9-year-old girl presents with diabetic ketoacidosis and is diagnosed with Type 1 Diabetes Mellitus. Her autoimmune screen reveals positive islet cell antibodies and IA-2 antibodies. Which of the following genetic findings is most likely to be associated with her condition?

A. A point mutation in the insulin gene on chromosome 11
B. Polymorphisms in HLA genes located on chromosome 6
C. Deletion of the GLUT4 transporter gene on chromosome 17
D. Mutation in the leptin receptor gene affecting satiety signalling
E. Mutation in the glucokinase gene affecting glucose sensing in beta-cells

Question 5: A 62-year-old man with type 2 diabetes mellitus on insulin therapy presents to the emergency department with confusion, sweating, and tachycardia after missing lunch and going for a long walk. His capillary glucose is 2.8 mmol/L. He is alert but agitated, and able to swallow. What is the most appropriate next step in his management?

A. Administer intravenous dextrose immediately
B. Give a sugary drink followed by a carbohydrate snack
C. Inject intramuscular glucagon and reassess glucose in 15 minutes
D. Administer a high-protein meal to prevent rebound hypoglycaemia
E. Begin continuous glucose monitoring to prevent future episodes

Question 6: A 58-year-old South Asian man with a BMI of 27 presents for routine screening. He has no symptoms but is found to have a fasting plasma glucose of 7.3 mmol/L and HbA1c of 50 mmol/mol. Which of the following statements best explains his increased risk for developing Type 2 Diabetes at a lower BMI?

A. South Asian individuals have higher rates of autoantibody-positive diabetes, such as LADA
B. Genetic variants such as TCF7L2 increase insulin clearance in South Asian populations
C. Reduced incretin hormone response is exclusive to South Asian individuals, increasing diabetes risk
D. South Asians are more prone to visceral adiposity and insulin resistance at lower BMI thresholds
E. Pancreatic amyloidosis is less common in South Asians, accelerating beta-cell failure at lower weight

Question 7: A 45-year-old woman with a strong family history of Type 2 Diabetes is found to have impaired fasting glucose. Genetic testing reveals a variant in the TCF7L2 gene on chromosome 10. Which of the following best describes the role of this gene in the pathogenesis of T2DM?

A. TCF7L2 encodes for GLUT4 transporters, and mutations reduce peripheral glucose uptake
B. It influences pancreatic islet cell development and insulin secretion
C. It is responsible for adipocyte proliferation and promotes visceral fat storage
D. It regulates hepatic gluconeogenesis via the insulin receptor substrate pathway
E. Mutations in TCF7L2 enhance incretin hormone degradation by DPP-4

Question 8: A 27-year-old woman with a BMI of 21 presents with asymptomatic hyperglycaemia discovered on routine bloods. She has no family history of autoimmune disease or obesity, and her anti-GAD and IA-2 antibody tests are negative. C-peptide is within the normal range. Genetic testing reveals a mutation in the HNF1-α gene. Which of the following best explains the most appropriate initial pharmacological management?

A. Start insulin immediately due to the risk of ketoacidosis
B. Initiate metformin to reduce hepatic gluconeogenesis and improve insulin sensitivity
C. Begin a DPP-4 inhibitor to enhance endogenous incretin effects
D. Prescribe a sulfonylurea due to increased sensitivity to these agents
E. Recommend pancreatic enzyme supplementation to improve glucose control

Question 9: A 30-year-old woman with no prior medical history is diagnosed with gestational diabetes at 28 weeks gestation. She is started on dietary modifications and later requires metformin. At delivery, her baby is noted to be large for gestational age (LGA) and develops transient hypoglycaemia. Which of the following best explains the pathophysiological basis for these neonatal findings?

A. Maternal hyperglycaemia suppresses foetal insulin production, leading to impaired growth and hypoglycaemia
B. Foetal insulin acts as an anabolic hormone, promoting macrosomia and postnatal rebound hypoglycaemia
C. Human chorionic gonadotropin (hCG) directly stimulates foetal pancreatic beta-cell hyperplasia
D. Maternal insulin crosses the placenta and causes foetal islet cell hypertrophy and hypoglycaemia
E. Metformin crosses the placenta and directly suppresses foetal glucose production

Question 10: A 58-year-old man with newly diagnosed type 2 diabetes is started on oral therapy. He is obese and has a history of ischemic heart disease. His renal and hepatic function are within normal limits. He expresses a preference to avoid injectable medications. Which of the following agents would be most appropriate to initiate in this patient, given his cardiovascular comorbidities and goals of weight loss?

A. Sulphonylurea (e.g. Gliclazide)
B. Glitazone (e.g. Pioglitazone)
C. DPP-4 Inhibitor (e.g. Sitagliptin)
D. SGLT2 Inhibitor
E. α-Glucosidase Inhibitor

Question 11: A 9-year-old child presents with severe early-onset obesity and hyperphagia that began around their first birthday. Genetic testing reveals a heterozygous, co-dominant mutation affecting hypothalamic appetite regulation. Lifestyle modification has been ineffective. Which of the following most accurately explains the rationale for treatment with Setmelanotide?

A. It increases central leptin sensitivity to promote satiety
B. It bypasses defective signalling upstream by directly activating melanocortin pathways
C. It suppresses ghrelin to reduce hunger and delay gastric emptying
D. It enhances peripheral insulin action to reduce hunger signals
E. It amplifies endogenous GLP-1 signalling to increase hypothalamic satiety

Question 12: A 42-year-old female presents with a history of progressive headaches, visual disturbances (particularly bitemporal hemianopia), and recent onset of galactorrhoea. An MRI reveals a 3.5 cm pituitary mass. What is the most appropriate next step in the management of this patient?

A. Start cabergoline or bromocriptine and monitor visual symptoms
B. Perform transsphenoidal surgery to remove the pituitary adenoma
C. Administer octreotide to reduce GH secretion
D. Initiate hydrocortisone therapy and monitor ACTH levels
E. Begin radiation therapy to shrink the tumour

Question 13: A 45-year-old male presents with complaints of progressive changes in his appearance over the past few years, including a deepening of his voice, increased facial hair, and enlargement of his hands and feet. He also mentions persistent joint pain and recent difficulties with sleep. On examination, he has coarse facial features, macroglossia, and spaced-out teeth. His blood pressure is elevated, and his ECG shows signs of left ventricular hypertrophy. His laboratory results reveal elevated IGF-1 and GH levels. The oral glucose tolerance test results show unsuppressed GH (>1 ng/ml) after glucose administration. Which of the following is the most appropriate next step in the management of this patient?

A. Start treatment with metformin for diabetes management
B. Perform a transsphenoidal hypophysectomy
C. Administer oral somatostatin receptor ligands
D. Begin radiotherapy to reduce tumour size
E. Prescribe growth hormone receptor antagonists

Question 14: A 42-year-old woman presents with a history of rapid central weight gain over the past 18 months, particularly around her abdomen and face. She has also noticed increased hair growth on her upper lip, thinning of her skin, and the appearance of purple striae on her abdomen. Her blood pressure is consistently elevated, and she reports increased fatigue, anxiety, and mood swings. She has been diagnosed with Type 2 diabetes, and her bone density is reduced on imaging. Laboratory investigations show a morning cortisol level that remains elevated despite an overnight dexamethasone suppression test. What is the most appropriate next step in management?

A. Start treatment with metyrapone or ketoconazole
B. Refer for transsphenoidal hypophysectomy
C. Initiate radiotherapy to reduce tumour size
D. Begin glucocorticoid replacement therapy
E. Perform inferior petrosal sinus sampling (IPSS)

Question 15: A 5-year-old girl is brought to the clinic due to concerns about her short stature. She is currently in the 1st centile for height and has dropped two centiles over the past year. Her weight is appropriate for her height, and she has normal development for her age. On physical examination, she has no dysmorphic features but has a slightly wider neck. What is the most likely diagnosis in this case?

A. Growth Hormone Deficiency
B. Turner’s Syndrome
C. Chronic Illness (e.g., Cystic Fibrosis, Asthma)
D. Idiopathic Short Stature
E. Rickets

Question 16: A 4-year-old boy presents to the clinic with his parents, concerned about his short stature. On examination, he appears significantly shorter than his peers, and his growth velocity has been slow over the past year. He also has prominent forehead, mid-facial hypoplasia, and delayed dentition. His parents report a high-pitched voice and increased fat in the abdominal region. There are no signs of chronic illness or failure to thrive. What is the most appropriate diagnostic test to confirm the diagnosis of Growth Hormone Deficiency (GHD) in this patient?

A. Insulin Tolerance Test (ITT)
B. MRI of the pituitary gland
C. Karyotyping
D. Bone age X-ray
E. IGF-1 levels

Question 17: A 41-year-old woman with a known history of bipolar affective disorder presents to her GP with progressive fatigue, hoarseness, and weight gain over 4 months. She has also noted dry skin and constipation. On examination, she is bradycardic, has coarse facial features, and non-pitting oedema of the lower limbs. Neurological examination reveals slowed relaxation of reflexes.

Laboratory investigations show:

• TSH: 3.2 mU/L (within reference range)
• Free T4: 6.5 pmol/L (low)
• Free T3: 2.1 pmol/L (low)
• Anti-TPO antibodies: Negative
• Serum sodium: 129 mmol/L
• Creatinine: Normal
• Cortisol (9am): Normal

Which of the following is the most likely cause of her presentation?

A. Subclinical hypothyroidism
B. Central hypothyroidism due to lithium-induced pituitary dysfunction
C. Myxoedema coma precipitated by mood stabilisers
D. Primary autoimmune hypothyroidism with lab error
E. Drug-induced inhibition of peripheral T4 to T3 conversion

Question 18: A 35-year-old woman with a history of poorly controlled Graves’ disease presents to the emergency department with confusion, vomiting, and palpitations. She recently underwent emergency dental surgery and had stopped her antithyroid medications 5 days prior. 

On examination, she is:

• Febrile at 39.8°C
• Tachycardic (HR 152 bpm, irregularly irregular)
• Hypertensive (BP 160/90 mmHg)
• Tremulous, agitated, and jaundiced
• Mild goitre noted; no signs of infection

Lab results show:

• TSH: <0.01 mU/L
• Free T4: 72 pmol/L (↑↑)
• AST/ALT: Mildly elevated
• Bilirubin: Elevated
• ECG: Atrial fibrillation
• Chest X-ray: Normal

Which of the following is the next most appropriate step in management?

A. Administer intravenous propranolol and initiate high-dose carbimazole
B. Send thyroid uptake scan to confirm diagnosis before initiating treatment
C. Begin oral levothyroxine to prevent T3 crisis
D. Arrange urgent thyroidectomy after stabilisation
E. Administer intravenous fluids, beta-blockers, corticosteroids, and potassium iodide

Question 19: A 52-year-old woman is referred to the endocrine clinic after her GP noticed a solitary thyroid nodule on routine examination. She has no compressive symptoms, is euthyroid, and reports no recent weight changes or systemic symptoms. There is no family history of thyroid disease.

Neck ultrasound reveals a 2.5 cm hypoechoic nodule with irregular margins and microcalcifications, but no cervical lymphadenopathy. Fine-needle aspiration (FNAC) is suspicious for malignancy.

She undergoes total thyroidectomy. Histology confirms follicular thyroid carcinoma. Further staging shows no lymph node involvement, but multiple pulmonary nodules are identified on CT chest. Which of the following best explains the pattern of metastasis seen in this patient?

A. Lymphatic spread is characteristic of differentiated thyroid cancers
B. Distant metastases are more common in follicular than in papillary carcinoma
C. Follicular carcinoma rarely invades vasculature and is usually confined to the gland
D. Papillary carcinoma is more commonly associated with haematogenous spread
E. Medullary thyroid cancer is the most common cause of pulmonary metastases in thyroid malignancies

Question 20: A 61-year-old woman presents with a rapidly enlarging, painless neck mass that has developed over 6 weeks. She reports hoarseness and mild dysphagia, but denies weight loss or fever. Examination reveals a firm, fixed mass in the anterior neck and left vocal cord paralysis on laryngoscopy. Her thyroid function tests are normal.

Ultrasound shows a large hypoechoic mass with irregular margins and central necrosis. Fine needle aspiration (FNAC) is attempted but yields insufficient material. A core biopsy is performed. Histology reveals highly pleomorphic cells with no follicular or papillary architecture, extensive necrosis, and a high mitotic index. Staining is negative for calcitonin, but p53 mutation is detected. Which of the following is the most likely diagnosis?

A. Papillary thyroid carcinoma
B. Follicular thyroid carcinoma
C. Anaplastic thyroid carcinoma
D. Medullary thyroid carcinoma
E. Thyroid lymphoma

Question 21: A 55-year-old man is referred to endocrinology for evaluation of poorly controlled hypertension, new-onset type 2 diabetes, and osteoporotic vertebral fractures. He has also noted fatigue, easy bruising, and worsening mood, which have been attributed to depression. On examination, his BMI is 29, and he has facial plethora, thin skin, and proximal muscle weakness, but no abdominal striae or obvious central obesity.

He is not taking any corticosteroids. Morning cortisol level is elevated, and midnight salivary cortisol collected on two occasions is also elevated. Plasma ACTH is low. What is the most likely underlying cause of his clinical and biochemical findings?

A. Ectopic ACTH-producing small cell lung carcinoma
B. Cushing’s Disease (pituitary ACTH adenoma)
C. Adrenal adenoma
D. Alcohol-related pseudo-Cushing’s
E. ACTH-secreting pheochromocytoma

Question 22: A 37-year-old woman presents with a 6-month history of fatigue, nausea, abdominal discomfort, and an 8 kg weight loss. She has recently developed skin darkening, which she attributes to tanning, despite not having increased sun exposure. On examination, she has postural hypotension, hyperpigmentation in the palmar creases, and a BMI of 18.5.

Her blood tests show:

• Sodium: 129 mmol/L (↓)
• Potassium: 4.6 mmol/L (normal)
• Glucose: 3.3 mmol/L (↓)
• Morning serum cortisol: 85 nmol/L (low)
• ACTH: elevated

A Synacthen test shows minimal rise in serum cortisol at 30 and 60 minutes.

Which of the following is the most likely diagnosis, and what is the next most appropriate investigation to determine the underlying cause?

A. Secondary adrenal insufficiency; pituitary MRI
B. Autoimmune Addison’s disease; adrenal autoantibodies
C. Tuberculous adrenalitis; CXR
D. Fungal adrenalitis; serum fungal cultures
E. Adrenal infarction; contrast CT adrenals

Question 23: A 34-year-old woman is referred to the hypertension clinic after repeated high blood pressure readings despite adherence to three antihypertensive medications. She has no significant past medical history. Blood tests reveal a potassium level of 3.2 mmol/L, sodium of 144 mmol/L, and a suppressed plasma renin activity. Her aldosterone-to-renin ratio is markedly elevated. A CT scan reveals a unilateral adrenal adenoma. What is the next best step in management?

A) Initiate high-dose spironolactone therapy
B) Perform adrenal vein sampling
C) Repeat aldosterone:renin ratio off all antihypertensives
D) Schedule unilateral adrenalectomy
E) Start eplerenone and monitor potassium levels

Question 24: A 38-year-old man presents with episodic palpitations, severe headaches, and profuse sweating over the last few months. His blood pressure is consistently elevated, including a reading of 180/110 mmHg in clinic. ECG shows sinus tachycardia. 24-hour urinary collection reveals markedly elevated normetanephrine and metanephrine levels. MRI identifies a 4.5 cm adrenal mass. Which of the following is the most appropriate next step in management?

A) Immediate surgical resection
B) Beta-blocker therapy
C) Initiate alpha-blockade followed by beta-blockade
D) Begin calcium channel blocker therapy only
E) Repeat imaging with MIBG scan for confirmation before any treatment

Question 25: A 35-year-old woman is being investigated for paroxysmal hypertension, headaches, and palpitations. Biochemical testing confirms elevated plasma metanephrines. Genetic testing reveals a mutation in the RET proto-oncogene. Which of the following additional findings is most likely associated with her condition?

A) Hypercalcaemia due to parathyroid hyperplasia
B) Increased urinary 5-HIAA
C) Café-au-lait spots and neurofibromas
D) Flushing and diarrhoea due to serotonin-secreting tumour
E) Pancreatic cystadenomas and insulinomas

Question 26: A researcher is studying T-cell subsets and their role in autoimmune and allergic diseases. Which of the following diseases is most strongly associated with increased TH2 activity?

A) Type 1 Diabetes Mellitus
B) Multiple Sclerosis
C) Asthma
D) Rheumatoid Arthritis
E) Inflammatory Bowel Disease

Question 27: Which of the following genetic features provides protection against the development of Type 1 Diabetes Mellitus?

A) Presence of HLA-DR4
B) Homozygosity for HLA-DQ8
C) Absence of aspartate at position 57 of HLA-DQβ
D) Heterozygosity for HLA-DQβ with aspartate at position 57 (Asp57)
E) Co-inheritance of HLA-DR3 and HLA-DQ2

Question 28: A 19-year-old woman presents to the clinic with a history of increasing fatigue, postural dizziness, and recent unintentional weight loss. She has a background of hypothyroidism and was recently diagnosed with type 1 diabetes mellitus. On examination, she has hyperpigmented skin, a low blood pressure (90/60 mmHg), and vitiligo. Blood tests show hyponatraemia, hyperkalaemia, and low morning cortisol levels with elevated ACTH. She mentions her twin sister only has hypothyroidism and no other autoimmune conditions. Which of the following best explains her condition?

A) Mutation in the AIRE gene causing defective central tolerance
B) Presence of anti-GAD antibodies against pancreatic islets
C) Autoantibodies against adrenal and thyroid tissue associated with HLA-DR3 and HLA-DR4
D) Infection-triggered adrenalitis leading to adrenal failure
E) Mutation in CTLA-4 causing failure of peripheral T-cell regulation

Question 29: A 55-year-old woman presents to the emergency department with fatigue, nausea, polyuria, and mild confusion. Her past medical history includes hypertension, treated with hydrochlorothiazide, and bipolar disorder, for which she has been taking lithium for several years.

On examination, she is mildly dehydrated. Blood tests show:

• Serum calcium: 3.1 mmol/L (↑)
• PTH: Elevated
• Urinary calcium excretion: Low

Which of the following is the most likely diagnosis?

A) Primary hyperparathyroidism
B) Humoral hypercalcaemia of malignancy
C) Familial hypocalciuric hypercalcaemia
D) Lithium-induced hyperparathyroidism
E) Tertiary hyperparathyroidism

Question 30: A 45-year-old patient with poorly controlled type 2 diabetes mellitus presents for routine diabetic retinopathy screening. Fundoscopy reveals multiple “cotton wool spots.” Which of the following best explains the underlying pathological process responsible for these findings?

A) Hypertensive arteriolar narrowing
B) Microaneurysm formation due to chronic hyperglycaemia
C) Ischaemic infarcts of the retinal nerve fibre layer
D) Macular degeneration associated with aging
E) Vitreous haemorrhage resulting from ocular trauma

Question 31: A 60-year-old man with poorly controlled type 2 diabetes mellitus presents with a swollen, warm, and relatively painless foot. He denies recent trauma. X-ray of the foot reveals a “rocker-bottom” deformity and fragmentation of the tarsal bones. What is the most likely diagnosis?

A) Osteomyelitis
B) Charcot’s arthropathy
C) Gout
D) Osteoarthritis
E) Stress fracture

Question 32: A 65-year-old postmenopausal woman undergoes a dual-energy X-ray absorptiometry (DEXA) scan for bone mineral density screening. The scan shows a T-score of -3.0. How should this result be classified?

A) Normal bone mass
B) Osteopenia
C) Osteomalacia
D) Severe (established) osteoporosis
E) Osteoporosis

Question 33: During a routine physical examination, a 55-year-old woman is found to have a firm, non-tender, fixed thyroid nodule on palpation. What is the most appropriate initial imaging modality to evaluate this thyroid nodule?

A) Thyroid ultrasound
B) Sestamibi scan
C) CT neck with contrast
D) MRI pituitary
E) PET-CT

Question 34: Which hormone is most likely elevated in 46 XX gonadal dysgenesis?
A) Oestradiol
B) Progesterone
C) Testosterone
D) FSH
E) Prolactin

Question 35: A 40-year-old woman undergoes thyroid ultrasound for evaluation of a palpable nodule. The scan reveals a solid, hypoechoic nodule with microcalcifications and irregular margins. What is the most likely diagnosis?

A) Colloid cyst
B) Papillary carcinoma
C) Graves’ disease
D) Hashimoto’s thyroiditis
E) Follicular adenoma

Question 36: Which genetic variant is most strongly associated with increased obesity and type 2 diabetes mellitus (T2DM) risk in the general population?

A) TCF7L2
B) HNF1α
C) FTO
D) SGLT2
E) GLUT4

Question 37: A 50-year-old woman undergoes routine blood tests. His fasting plasma glucose is 6.5 mmol/L and HbA1c is 42 mmol/mol (6.0%). He has no symptoms. How should his glycaemic status be classified?

A) Normoglycemia
B) Gestational diabetes
C) Impaired glucose tolerance (IGT)
D) Diabetes
E) Impaired fasting glucose (IFG)

Question 38: A 68-year-old man with type 2 diabetes experiences frequent episodes of hypoglycaemia, especially in the early morning. Which class of antidiabetic drugs is contraindicated in this patient?

A) Sulfonylureas
B) Metformin
C) GLP-1 receptor agonists
D) DPP-4 inhibitors
E) Thiazolidinediones

Question 39: A 14-year-old Asian boy with obesity presents with polyuria and polydipsia. You suspect diabetes mellitus. Which test would best differentiate between type 1 and type 2 diabetes mellitus (T1DM vs T2DM)?

A) Fasting glucose
B) HbA1c
C) C-peptide level
D) Urine ketones
E) Lipid profile

Question 40: A 42-year-old man presents with enlarged hands and feet, coarse facial features, and frontal bossing. What hormone excess is most responsible for these findings?

A) Cortisol
B) Prolactin
C) Aldosterone
D) Growth Hormone (GH)
E) Thyroxine

Question 41: Which of the following biochemical findings is most diagnostic of Conn’s syndrome?

A) Elevated plasma renin and aldosterone
B) Suppressed plasma renin and elevated aldosterone
C) Elevated plasma renin and suppressed aldosterone
D) Elevated serum potassium
E) Elevated urinary free cortisol

Question 42: A 30-year-old patient presents with bilateral adrenal pheochromocytomas. Which genetic syndrome is most associated with this finding?

A) MEN1
B) MEN2A
C) Neurofibromatosis type 1 (NF1)
D) Von Hippel-Lindau (VHL)
E) Tuberous sclerosis

Question 43: Which drug is contraindicated in heart failure due to fluid retention?

A) Metformin
B) Pioglitazone
C) Empagliflozin
D) Liraglutide
E) Insulin

Question 44: A patient presents with a solitary thyroid nodule and elevated serum calcitonin. Which of the following is the most likely diagnosis?

A) Papillary carcinoma
B) Follicular carcinoma
C) Medullary carcinoma
D) Anaplastic carcinoma
E) Lymphoma

Question 45: A cold nodule on a radioisotope scan of the thyroid indicates which of the following?

A) Hyperfunctioning thyroid tissue
B) Iodine deficiency 
C) Graves’ disease
D) Thyroiditis
E) Non-functioning thyroid tissue

Question 46: Which lesion is most associated with bloody nipple discharge?

A) Fibrocystic change
B) Intraductal papilloma
C) Sclerosing adenosis
D) Duct ectasia
E) Phyllodes tumour

Question 47: Which hormone deficiency causes symptoms like Addison’s disease?

A) ACTH
B) GH
C) TSH
D) FSH/LH
E) Prolactin

Question 48: A 65-year-old patient presents with fatigue, constipation, and confusion. Blood tests reveal hypercalcemia, suppressed parathyroid hormone (PTH), and elevated parathyroid hormone-related peptide (PTHrP). What is the most likely diagnosis?

A) Primary hyperparathyroidism
B) Tertiary hyperparathyroidism
C) Humoral hypercalcaemia of malignancy
D) Familial hypocalciuric hypercalcemia (FHH)
E) Sarcoidosis

Question 49: A 79-year-old woman presents with a 7-week history of headaches and bitemporal hemianopia. MRI reveals a pituitary macroadenoma compressing the optic chiasm. Which hormone excess is most likely associated with this type of tumour?

A) Growth hormone (GH)
B) Adrenocorticotropic hormone (ACTH)
C) Thyroid-stimulating hormone (TSH)
D) Prolactin
E) Vasopressin (ADH)

Question 50: A 30-year-old man presents with episodes of pounding headaches, palpitations, sweating, and sustained hypertension. Which biochemical test would most likely confirm the diagnosis?

A) Elevated serum cortisol
B) Hypoglycaemia
C) Low plasma renin activity
D) Hypercalcemia
E) Increased urinary metanephrines

Question 51: A 60-year-old woman with known metastatic breast cancer presents with fatigue, nausea, and confusion. Blood tests show elevated serum calcium and suppressed PTH levels. What is the most likely cause of her hypercalcemia?

A) Ectopic PTH secretion
B) Osteolytic bone metastases
C) Primary hyperparathyroidism
D) Vitamin D intoxication
E) Familial hypocalciuric hypercalcemia (FHH)

Question 52: A mutation in the AIRE gene predisposes individuals to which autoimmune syndrome?

A) Autoimmune Polyglandular Syndrome Type 1 (APS-1)
B) Graves’ disease
C) Hashimoto’s thyroiditis
D) Systemic lupus erythematosus (SLE)
E) Myasthenia gravis

Question 53: Which HLA allele confers the highest relative risk for Hashimoto’s thyroiditis?

A) HLA-DR3
B) HLA-DR4
C) HLA-DR5
D) HLA-DQ2
E) HLA-DQ8

Question 54: Which residue in the HLA-DQβ chain protects against Type 1 diabetes?

A) Asp57
B) Arg52
C) Leu26
D) Glu45
E) Val76

Question 55: A patient with type 2 diabetes is prescribed semaglutide. What is its primary mechanism of action?

A) Inhibits intestinal lipase
B) Blocks dopamine reuptake
C) Activates GLP-1 receptors
D) Suppresses thyroid hormone
E) Antagonises mineralocorticoids

Question 56: Which gene’s polygenic risk score correlates with severe obesity trajectories?

A) FTO
B) BRCA1
C) APOE
D) CFTR
E) EGFR