MEDICINE I

Endocrine Disorders
Samplex Rationale

2015 - 2016 & 2016 - 2017 - 4th Shifting Exams

Questions Answers Rationale
th th
MAY 24, 2016, 4 Shifting Exam & MAY 23, 2017, 4 Shifting Exam

1. A 50-year old patient came in due to complaints of cold A Symptoms of Hypothyroidism

intolerance, weight gain, and poor memory, which part of the ○ Weight gain
history should you investigate? ○ Poor memory
A. Past medical history ○ Intolerance to cold
B. Immunization history ○ Feeling of tiredness
C. Occupation history ○ Hair loss
D. Obstetric history ○ Enlarged thyroid
○ Dry, coarse skin
○ Slow heartbeat
○ Constipation, Infertility, Heavy menstruation

Past Medical and Surgical History

● Congenital problems
● Thyroid problems
● Thyroidectomy
● Thyroid surgery or radiation
● Parathyroid or pituitary surgery

2. A 30 year old female has high serum prolactin on lab exam. C Harrison’s Principles of Internal Medicine, 20th Edition
What is the most common presenting chief complaint? Page 2675:
A. Galactorrhea Amenorrhea, galactorrhea and infertility are the hallmarks of
B. Decreased libido hyperprolactinemia in women. (…) Patients may also complain
C. Amenorrhea of decreased libido. More commonly, hyperprolactinemia
D. Cold intolerance develops later in life and leads to oligomenorrhea and
ultimately to amennorhea.

3. True about examination of the thyroid gland: C Physical exam of the thyroid
A. Palpate bimanually both thyroid lobes ● INSPECTION for swelling and symmetry
simultaneously through anterior approach ● PALPATION for size, shape, consistency, symmetry, and
B. Use the bell of the stethoscope to auscultate for tenderness
thyroid bruit ● AUSCULTATION for bruits which indicate high blood flow to the
C. Palpate for the size, texture, and tenderness thyroid gland
D. Observe for downward movement of thyroid on
deglutition

4. The following is a correct sign/finding in Secondary C Harrison’s Principles of Internal Medicine, 20th Edition
Adrenal Insufficiency? Page 2734-2735:
A. Hypokalemia Process of elimination:
B. Hyperglycemia …A should be hyperkalemia
C. Orthostatic hypotension …B should be hypoglycemia
D. Increased pigmentation of palmar creases …in D, hyperpigmentation only indicates primary adrenal
insufficiency…What is found in secondary adrenal insufficiency is
Alabaster-colored skin.

Tan LA, Tan R, Tan S, Tanghal JA, Tecson JF, Tee M, Tejada AJ, Teope FT,
Tiangco TAV, Tienzo MAG | Page 1 of 6
5. Excessive hair growth in androgen dependent areas is C Harrison’s Principles of Internal Medicine, 20th Edition
known as: Page 2799:
A. Hypertrichosis
B. Vitiligo Hirsutism is defined as androgen-dependent excessive male-
C. Hirsutism pattern hair growth, affects 10% of women.
D. Hyperandrogenism
Hypertrichosis aka “Werewolf Syndrome”- Excessive non-
pathologic hair growth

Vitiligo- result of hypopigmentation

Hyperandrogenism-excessive levels of male sex hormones in

the female body

6. A patient was prescribed with steroid for 6 months due to B “People with lupus should never smoke due to their increased
her lupus erythematosus, what signs and symptoms can be risk of cardiovascular disease. Steroid medications increase
expected to appear after long term use? this risk by upping blood pressure, increasing glucose levels,
A. Alopecia triglycerides, and cholesterol.”
B. Centripetal obesity
C. Hypoglycemia Source: NCBI// A practical guide to monitoring and management
D. Hypotension of complications of systemic corticosteroid therapy

7. Which is the correct way of measuring height in upright C Height Measurement:

position? -bare feet with heels together
A. Bare feet with heels 6 inches apart -heels, calf, and back should touch the stadiometer
B. Upper orbital level and external auditory meatus -lower orbital level and the external auditory meatus are level
are level
C. Heels, calf, buttocks and back should touch Height determination: Supine
stadiometer -Patients who cannot stand is measured in supine position with
D. Patient should be looking downward the body fully extended
-The examiner measures height from the top of the head to the
heels with tape measure
-The height is then recorded in centimeters (cm)
-Convert measurement to meters and record

8. A 25-year old Filipina came to the clinic for check-up. Her B

computed BMI is 24.5. How should you classify her?
A. Normal body habitus
B. Overweight
C. Obese I
D. Obese II

9. This is the proper way of measuring waist circumference? A

Waist Circumference
A. Tape is midway between anterior superior iliac
-take off the patient’s shirt and loosen his belt
spine and rib cage -position the tape mid-way between the top of the hip bone
B. Tape is resting below the iliac crest (anterior superior iliac spine) and the bottom of the rib
C. Abdomen should be relaxed and breathing in – cage, or resting on iliac crest.
dapat breathing out -the abdomen should be relaxed and the patient breathing out
D. Tape is place 1 inch below belly button

10. A 30-year old male has darkening and thickening of the B Hyperaldosteronism- proximal myopathy or symmetrical
skin over the nape and axilla. weakness of proximal upper and/or lower limbs
a. What condition can this sign be associated to? Insulin resistance- Acanthosis Nigricans or Hyperpigmentation of
A. Hyperaldosteronism body folds (neck, armpit, groin, forehead)
B. Insulin Resistance Hypercholesterolemia- heart problems, obesity
C. Hypercholesterolemia
Tan LA, Tan R, Tan S, Tanghal JA, Tecson JF, Tee M, Tejada AJ,
Teope FT, Tiangco TAV, Tienzo MAG | Page 2 of 6
 D. Hyperthyroidism Hyperthyroidism- amenorrhea or oligomenorrhea, diarrhea,
weight loss, stare w/o proptosis or excess adrenergic activity

b. What other related sign/parameter should be checked or A Waist-Hip Ratio

measured? -measures proportion by which fat is distributed around the torso
A. Waist hip ratio -WHR of >0.85 for women and >0.9 for men, more susceptible to
B. Eye protrusion from the orbit diabetes, cardiovascular disorders and ovarian/prostate cancer
C. Standing and supine BP
D. Upper segment to lower segment ratio Eye protrusion from the orbit
-Graves’ disease or Hyperthyroidism

Standing and supine BP

-Test for orthostatic hypotension
-Adrenal insufficiency
-Diabetic autonomic neuropathy

Upper segment to lower segment ratio

-To assess hormonal growth disorders

11. A 25-year old female came in for consult due to BP: A High Blood Pressure/ Resistant Hypertension
150/90, cardiac rate: 120/min regular. What is your Primary hyperaldosteronism
consideration? Pheochromocytoma
A. Hyperthyroidism Cushing’s syndrome
B. Essential HPN Hyperparathyroidism
C. Hypercortisolism Hyperthyroidism
D. Hyperparathyroidism Hypothyroidism
Acromegaly
Obesity

Tachycardia
Hyperthyroidism
Hypoglycemia
Pheochromocytoma
Diabetic autonomic neuropathy

12. This condition among patients with diabetes is B Orthostatic or Postural Hypotension
characterized by a drop in BP>20/10 mmHg upon standing: Adrenal insufficiency
A. Diabetic hypotension Diabetic autonomic neuropathy
B. Diabetic autonomic neuropathy - drop in blood pressure > 20/10 mmHg
C. Diabetic heart disease - or rise in CR > 15/min
D. Diabetic ketoacidosis -from sitting to standing or from lying down to sitting or standing

13. Orange peel, non-pitting edema of the pretibial skin can B

be found in this disorder?
A. Acromegaly
B. Graves’ disease
C. Cushing’s disease
D. Hyperprolactinemia

Hyperprolactinemia
- Amenorrhea, galactorrhea and infertility

Tan LA, Tan R, Tan S, Tanghal JA, Tecson JF, Tee M, Tejada AJ,
Teope FT, Tiangco TAV, Tienzo MAG | Page 3 of 6
14. A patient came in due to dry skin, weight gain and B
constipation. What sign can be found in her physical
examination?
A. Plummer’s nail
B. Hung up reflex
C. Thyroid Acropachy
D. Onychomycosis Hung up reflex
-Deep Tendon Reflex for Hypothyroidism
-Reflex action takes place BUT with slow return of limb to neutral
position

15. A patient came in for consult due to coarsening of facial C

features with acral enlargement. What other sign can also be
found in this patient? – frontal bossing rin
A. Buffalo hump
B. Exopthalmos
C. Prognathism
D. Absent lateral 3rd of eyebrows

Buffalo hump- Cushing’s

Exopthalmos- hyperthyroidism

Absent lateral 3rd of eyebrows

-Sign of Hertoghe or Queen Anne's sign
-classical sign of hypothyroidism or dermatitis atopica

16. A sign elicited by asking the patient to look downward C

and observe for lid retraction

A. Chvostek’s sign
B. Trousseau’s sign
C. Von Graffe’s sign
D. Pemberton’s sign

17. Electrolyte imbalance found in hyperthyroidism B Hypokalemia – present in Thyrotoxic Periodic Paralysis and Hyper
A. Hyponatremia aldosteronism
B. Hypokalemia
C. Hypomagnesemia
D. Hypocalcemia

18. What sign can be seen both in obesity and polycystic C

ovarian syndrome?
A. Purplish abdominal striae
B. Proximal muscle weakness
C. Acanthosis nigricans
D. Hypertrichosis

Tan LA, Tan R, Tan S, Tanghal JA, Tecson JF, Tee M, Tejada AJ,
Teope FT, Tiangco TAV, Tienzo MAG | Page 4 of 6
19. A method to assess the secondary sexual characteristic B
maturation of an individual
A. Ferriman - Gallway score
B. Tanner staging
C. Mid-parental height
D. Waist-hip ratio

20. A device used for measuring height in upright position A Stadiometer – device to measure height, UPRIGHT
patients Hertel meter – device to measure axial position of the eyes
A. Stadiometer Orchidometer – device to measure testicular size
B. Hertel meter
C. Orchidometer
D. Tape measure

21. A patient was prescribed with steroid for 6 months die to D

her lupus erythematosus. Patient recently stopped the drug
and experienced anorexia. What physical exam should be
done first?
A. Do neurologic exam
B. Measure waist circumference
C. Get height and weight
D. Check blood pressure

22. A 25-year old male patient came to clinic for work-up. His A
height is 5 feet 8 inches. His weight is 65 kg. What is the
patient’s BMI category based on Asia-Pacific guidelines?
A. Normal body habitus
B. Obese I
C. Overweight
D. Obese II

23. A 65-year old female came in for consult due to body B

weakness: BP:80/60, cardiac rate: 120/min regular with
decreased appetite. Patient was given steroids for her
arthritis. What is your primary consideration that you need
to rule out first?
A. Autonomic neuropathy
B. Adrenal insufficiency
C. Hypothyroidism
D. Septic shock

24. A 15-year old type 1 Diabetic patient came to ER C

unconscious. RBC is 400 with metabolic acidosis on ABG.
What sign can be seen in her PE?
A. Ataxic breathing
B. Apneic episodes
C. Kussmaul’s breathing
D. Cheyne-Stokes respiration

25. A 20-year old male with BP of 200/100 is found to have C

proximal muscle weakness. What electrolyte imbalance can
be present?
A. Hyponatremia
B. Hypokalemia
C. Von Graefe’s
D. Pemberton’s

Tan LA, Tan R, Tan S, Tanghal JA, Tecson JF, Tee M, Tejada AJ,
Teope FT, Tiangco TAV, Tienzo MAG | Page 5 of 6
26. The initial presenting symptom among females who has A Changes in sexual functions:
non-functioning pituitary adenoma FEMALE: menstruation
A. Changes in menstrual pattern MALE: libido
B. Changes in bowel habits
C. Weight gain
D. Visual changes

27. The usual initial presenting symptom among males with D SEE QUESTION #26
non-functioning pituitary disorders
A. Purplish abdominal striae
B. Acanthosis nigricans
C. Proximal muscle weakness
D. Loss of libido

28. A device used to assess the secondary sexual B SEE QUESTION #20
characteristic maturation of male individuals by examining
the testis
A. Ultrasound
B. Prader orchidometer
C. Tape measure
D. Ruler

The following metabolic condition can cause hyperthermia:

1.) Cushing’s disease – B

2.) Addison’s disease – B

3.) Thyrotoxicosis – A

4.) Polycystic Ovarian Syndrome (PCOS) – B

5.) Diabetes mellitus – B

Tan LA, Tan R, Tan S, Tanghal JA, Tecson JF, Tee M, Tejada AJ,
Teope FT, Tiangco TAV, Tienzo MAG | Page 6 of 6