1. A 56-year-old man comes to the office for follow up.

He has type 2 diabetes mellitus of 15 years

duration, hypertension, and hyperlipidemia. His diabetes mellitus is currently managed with metformin
and glimepiride. Hemoglobin A1c level is 8.5%. Switching to insulin therapy to attain better glycemic
control is discussed with the patient. Achieving a goal hemoglobin A1c of 6.5% with use of insulin is most
likely to reduce the risk of which of the following complications over the next 5 years?

a) All-cause mortality
b) Hypoglycemia
c) Myocardial infarction
d) Retinopathy
e) Stroke

2. A 63-year-old man comes to the urgent care center with a 2-week history of an ulcer on his right foot.
He has no associated pain, fever, chills, or skin rash. The patient was diagnosed with hypertension 5
years ago but did not follow up with a physician, and he has had no surgeries or hospitalizations. He
takes ibuprofen for occasional back pain. The patient has a 30-pack year smoking history but quit 2 years
ago . He drinks 1 or 2 beers daily and does not eat red meat or processed foods. The patient considers
himself to be in good health and walks several miles a day. Temperature is 36. 7 C (98.1 F), blood
pressure is 156/98 mm Hg, and pulse is 88/min. BMI is 32 kg/m2. On examination, the feet are warm
and dry. A nontender ulcer with a thick surrounding callus is present on the sole of the foot just below
the head of the first metatarsal bone. Which of the following will most likely diagnose the underlying
cause of this patient's foot ulcer?

a) Alcohol screening questionnaire

b) Ankle-brachia! index
c) Culture from the ulcer bed
d) Duplex venous ultrasound
e) Hemoglobin A1c assay
f) F Hepatitis C testing
g) TSH level

3. Which of the following recognized causes of DKA is most common?

a) Missed or disrupted insulin treatments

b) Previously unknown/newly diagnosed diabetes
c) Underlying concomitant infection
d) Stress

4. Which of the following is not considered a routine test used in the investigation of DKA?

a) Glucose tests every 1-2 hours until stable, then every 4-6 hours
b) Prothrombin time initially and then repeated 4-6 hours later
c) Serum electrolyte determinations every 1-2 hours until stable, then every 4-6 hours
d) Initial arterial blood gas measurements, followed by bicarbonate measurement as necessary

Hoth
5. A 52-year-old obese woman has long-standing type 2 diabetes mellitus inadequately controlled on
metformin and pioglitazone. Insulin glargine (15 units subcutaneously at bedtime) has recently been
started because of a hemoglobin A1C level of 8.4. Over the weekend, she develops nausea, vomiting,
and diarrhea after exposure to family members with a similar illness. Afraid of hypoglycemia, the patient
omits the insulin for 3 nights. Over the next 24 hours, she develops lethargy and is brought to the
emergency room. On examination, she is afebrile and unresponsive to verbal command. Blood pressure
is 84/52. Skin turgor is poor and mucous membranes dry. Neurological examination is nonfocal; she
does not have neck rigidity.

Laboratory results are as follows:

Na: 126 mEq/L
K: 4.0 mEq/L
Cl: 95 mEq/L
HCO3: 22 mEq/L
Glucose: 1100 mg/dL
BUN: 84 mg/dL
Creatinine: 3.0 mg/dL

Which of the following is the most likely cause of this patient’s coma?

a) Diabetic ketoacidosis
b) Hyperosmolar hyperglycemic state
c) Syndrome of inappropriate ADH secretion
d) Drug-induced hyponatremia
e) Bacterial meningitis

1. hyperthyroidism, low TSH, (white blood cell- ESR- C-reactive protein)

• Graves disease

2. Autoimmune polyendocrine syndrome type 1

• Candidiasis
• Hypothyroidism not hyper
• Addison

3. Typical presentation of thyroid cancer and find Mass only

• papillary

Hoth
1-The most common cause of primary hyperaldosteronism is:

a) Aldosterone- producing adrenal adenoma

b) Bilateral idiopathic hyperplasia
c) Unilateral adrenal hyperplasia
d) Adrenal carcinoma

2-Primary hyperaldosteronism is characterized by :

a) Hypokalemia
b) Hyponatremia
c) Hypotension
d) High renin level

3-Regarding Cushing syndrome, which statement is true :

a) The most common cause is iatrogenic.

b) ACTH level is low in Cushing disease.
c) Exogenous Cushing syndrome is associated with hyperpigmentation
d) Both adrenal glands are hyperplastic in exogenous Cushing syndrome

4-Regarding Congenital adrenal hyperplasia, which statement is true:

a) 21-hydroxylase deficiency is the least common cause

b) Cortisol level is low in all types of congenital adrenal hyperplasia
c) Adrenal androgen levels are low in all types of CAH
d) 11-hydroxylase deficiency is the most common cause

5) Which describes a cause of primary adrenal insufficiency?

a) disruption of ACTH stimulation of the adrenal cortex

b) overstimulation of the adrenal medulla
c) underproduction of ACTH by the pituitary gland
d) destruction of adrenal cortex cells by autoimmune response or infection

6- Which of the following is a symptom of Addison's disease?

a) Hypervolemia
b) Hyperkalemia
c) Hypernatremia
d) Hyperglycemia
e) Hypertension

Hoth
7-Which is not a symptom of Cushing's syndrome?

a) moon face
b) low blood pressure (hypotension)
c) osteoporosis
d) obesity
e) memory loss

8-Primary hyperaldosteronism (Conn’s syndrome) is characterized by..

a) High renin, high aldosterone

b) Low renin, high aldosterone
c) Low renin, low aldosterone
d) High renin, low aldosterone

Hoth
1- A 67‐year‐old woman is admitted to the intensive care unit following a
four‐node parathyroidectomy with reimplantation for secondary
hyperparathyroidism due to renal failure. She has a calcium level of 7.2
mg/dL 12 hours postoperatively. She is asymptomatic, but an ECG is
obtained which shows prolonged QT interval. Which of the following is
the best treatment option for this patient?
a. Proceed urgently to the operating room for removal of the implanted
parathyroid
b. Give 2 gm intravenous calcium gluconate
c. Electively re‐explore the patient in the morning for a missed
parathyroid gland
d. Double her calcitriol dose from 0.25 mcg to 0.5 mcg twice daily
e. Continue observation with no intervention at this time

2- A 32‐year‐old man was admitted to the intensive care unit following a

motor vehicle crash in which he suffered several small intracranial
hemorrhages. A ventriculostomy catheter was placed to monitor his
intracranial pressures. The patient has been receiving iso‐osmotic
intravenous fluids. On post‐trauma day 5, his plasma mOsm is now >
320 mOsm, and his urine mOsm is 130 mOsm. He remains intubated
with a feeding nasogastric tube in place and is hemodynamically
normal. What is the best course of action?
a. Increase the amount of free water administration via his
nasogastric feeding tube
b. Change his parenteral fluids to normal saline
c. Check placement of the venticulostomy tube to ensure the patient’s
intracranial pressures are not rising despite the improved readings
d. Begin low dose, twice daily dexamethasone
e. Check serum magnesium and correct if abnormal

3- A 41-year-old woman presents with palpitations and heat intolerance.

On examination her pulse is 90/min and a small, diffuse goitre is noted
which is tender to touch. Thyroid function tests show the following:
Free T4 24 pmol/ and TSH < 0.05 mu/l
What is the most likely diagnosis?
a. Grave's disease
b. Sick thyroid syndrome
c. De Quervain's thyroiditis
d. Hashimoto's thyroiditis
e. Toxic multinodular goitre
4- A 39-year-old woman has had no menstrual periods for the past year,
along with malaise, cold intolerance, and loss of body hair. She has had
headaches for the past 5 months. On physical examination her lateral
visual fields are reduced. She is most likely to have a neoplasm
composed of which of the following cell types?
a. chromophil
b. Chief
c. Chromaffin
d. Chromophobe
e. Glomerulosa

5- Each one of the following is associated with autoimmune

polyendocrinopathy syndrome type 1, except:
a. Chronic mucocutaneous candidiasis
b. Addison's disease
c. Primary hyperparathyroidism
d. Autosomal recessive inheritance
e. A mutation of the AIRE1 gene on chromosome 21

6- A 37-year-old woman has had difficulty swallowing and a feeling of

fullness in the anterior neck for the past week. She is recovering from a
mild upper respiratory tract infection 1 month ago. On physical
examination, her temperature is 37.4° C, pulse is 74/min, respirations
are 16/min, and blood pressure is 122/80 mm Hg. Palpation of her
diffusely enlarged thyroid elicits pain. Laboratory studies show an
increased serum T4 level and a decreased TSH level. Two months later,
she no longer has these complaints. The T4 level is now normal. Which
of the following conditions is most likely to have produced these
findings?
a. Hashimoto thyroiditis
b. Medullary thyroid carcinoma
c. Subacute granulomatous thyroiditis
d. Toxic follicular adenoma
e. Toxic multinodular goiter

7- Which of the following is not a familial endocrine cancer syndrome

a. Multiple endocrine neoplasia
b. Li-Fraumeni syndrome
c. Von Hippel-Lindau syndrome
d. Waardenburg syndrome
8- A 44-year-old, otherwise healthy woman feels a small lump on the left
side of her neck. A firm, painless, 1.5-cm cervical lymph node is
palpable. The thyroid gland is not enlarged. A chest radiograph is
unremarkable. Laboratory findings include serum glucose, 83 mg/dL;
creatinine, 1.2 mg/dL; calcium, 9.1 mg/dL; phosphorus, 3.3 mg/dL;
thyroxine, 8.7 μg/dL; and TSH, 2.3 mU/L. The hemoglobin is 14 g/dL,
platelet count is 240,400/mm3, and WBC count is 5830/mm3. A
fine-needle aspiration biopsy of the thyroid gland is done. What is the
most likely diagnosis?
a. Anaplastic carcinoma
b. Follicular carcinoma
c. Medullary carcinoma
d. Papillary carcinoma
e. Parathyroid carcinoma

9- A 40-year-old man experiences weakness and easy fatigability of 2

months’ duration. Physical examination yields no remarkable findings.
Laboratory studies show serum calcium of 11.5 mg/dL, inorganic
phosphorus of 2.1 mg/dL, and serum parathyroid hormone of 58
pg/mL, which is near the top of the reference range. A radionuclide
bone scan fails to show any areas of increased uptake. What is the most
likely cause of these findings?
a. Chronic renal failure
b. Hypervitaminosis D
c. Parathyroid adenoma
d. Parathyroid carcinoma
e. Parathyroid hyperplasia,

10-A 73-year-old woman has experienced malaise and a 10-kg weight loss
over the past 4 months. She also has developed a chronic cough during
this time. She has a 100 pack-year history of smoking cigarettes.
Physical examination shows wasting and 4/5 motor strength in all
extremities. Abdominal CT scan shows bilaterally enlarged adrenal
glands. A chest radiograph shows a 6-cm perihilar mass on the right and
prominent hilar lymphadenopathy. Laboratory studies show Na+, 118
mmol/L; K+, 6 mmol/L; Cl–, 95 mmol/L; CO2, 21 mmol/L; and glucose,
49 mg/dL. Her 8:00 am serum cortisol level is 9 ng/mL. What is the
most likely diagnosis?
a. Amyloidosis
b. Ectopic corticotropin syndrome
c. Meningococcemia
d. Metastatic carcinoma
e. Pituitary adenoma

11-A 28-year-old, otherwise healthy man has had headaches for the past 2
weeks. Physical examination yields no remarkable findings except for a
blood pressure of 174/116 mm Hg. An abdominal CT scan shows an
enlarged right adrenal gland. A right adrenalectomy is done; the figure
shows the gross appearance of the specimen. Which of the following
laboratory findings in his blood was most likely reported in this patient
before surgery?
a. Hyperglycemia
b. Hyperkalemia
c. Low corticotropin level
d. Low insulin levl
e. Low renin level

12- All of the followings are true regarding Nelson's syndrome except
a. The development of large destructive pituitary adenoma after
surgical removal of the adrenal glands
b. Loss of excitatory effect of of adrenal cortisol on a pre-existimg
ACTH microadenoma
c. Hypercortisolism does not develop
d. Hyperpigmentation is characteristic
e. Nelson's syndrome is a potentially life-threatening condition

13-Each one of the following is a cause of nephrogenic diabetes insipidus,

except:
a. Hypocalcemia
b. Sickle-cell anemia
c. Lithium
d. Hypokalemia
e. Demeclocycline

14-Which one of the following features is least associated with primary

hyperparathyroidism?
a. Depression
b. Polydipsia
c. Sensory loss
d. Peptic ulceration
e. Renal stones

15-Regarding de Quervain's disease, all of the followings are true except

 a. Disruption of thyroid follicles, with extravasation of colloid leading
to granulomatous inflammation
b. Transient hyperthyroidism may be followed by transient
hypothyroidism returning to euthyroid state after 6-8 weeks
c. There is elevated level of ESR, WBC & thyroglobulin
d. There is painful tender goiter
e. RAIU is diffusely increased throughout the thyroid gland

16-Regarding pituitary gland hormones all of the followings are true except
a. Hashimoto thyroiditis can lead to hyperprolactinemia
b. Uterine contractions have a positive feedback mechanism on
oxytocin
c. Chlorpromazine and haloperidol can cause hyperprolactinemia
d. Optic chiasm compression by pituitary adenoma results in bilateral
temporal hemianopsia
e. Cushing reflex due to increased ICP as a result of macroadenoma
involve tachycardia, hypotension, and irregular respirations

17-Regarding multiple endocrine neoplasia which of the following is wrong

a. Parathyroid gland is involved in 95% of MENs1 and is most likely to
be hyperplasia not adenoma
b. When medullary thyroid carcinoma is involved in MENs it has much
worse prognosis than sporadic one
c. MEN-1 gastrinomas are frequently single but sporadic gastrinomas
are usually multifocal
d. In MENs1 there is Inactivating mutation of MEN1 gene, tumor
suppressor gene located at 11q13
e. Sipple syndrome is an inherited in an autosomal dominant pattern
from an activating mutation of the RET proto-oncogene

18-Regarding prolactinoma all of the following is true except

a. The elevated prolactin level decreases the release of GnRH, thereby
causing a decrease in LH and FSH
b. Secondary amenorrhea is defined as absence of menses for more than
three months in girls or women who previously had regular menstrual
cycles
c. prolactinomas are found earlier in women than in men
d. A serum prolactin concentration > 200 ng/mL almost
always is caused by a prolactinoma
e. Estrogen stimulates dopamine outflow
19- Regarding Hurthle cell carcinoma all of the following is true except
a. is a variant of follicular carcinoma of thyroid which contains abundant
oxyphill cells
b. It spreads more commonly to regional lymph nodes than follicular
carcinoma of thyroid
c. It has got better prognosis than follicular cell carcinoma
d. Hurthle cell carcinoma does not take up I131 so treat aggressively
e. Abundant oxyphill cells (Askanazy) are specific

20- All of the following are causes of hypercalcemia except

a. Rapid citrate blood transfusion
b. Primary Hyperparathyroidism
c. Multiple myeloma
d. Thiazide drugs
e. Granulomatous diseases such as sarcoidosis

21- Regarding nerve injuries of the thyroid gland all of the following are
true except

a. Superior thyroid artery is closely related to external laryngeal nerve at

its origin and moves away from each other and so it must be ligated just
near the superior pole of the thyroid gland
b. Partial bilateral recurrent laryngeal nerve injury is the most serious
injury
c. Unilateral injury may lead to hoarseness of voice
d. All the intrinsic muscles of the larynx are paralyzed in recurrent
laryngeal nerve injury
e. Injury to the internal laryngeal nerve leads to chocking, sensation of a
foreign body like and dysphagia

22-An 18-year-old girl is admitted to the Emergency Department with an

episode of sweating and dizziness. She is brought in by her father who
has type 2 diabetes mellitus as he is worried she may be diabetic. He
describes a number of similar episodes for the past two weeks. Her BM
on admission is 1.9 mmol/l so the following bloods are taken:
Plasma glucose 1.8 mmol/l, Insulin 15 mg/ml (6-10 mg/ml),Proinsulin
22% (22-24%),C-peptide 0.15 nmol/l (0.2-0.4 nmol/l),What is the most
likely diagnosis?
a. Diabetes mellitus
b. Insulinoma
c. Nesidioblastosis
d. Insulin abuse
e. Sulfonylurea abuse

23-regarding ADH secretion all of the following are true except

a. diabetes insipidus is characterized by hypertonic hypernatremia
b. urine sodium and urine osmolality are low in diabetes insipidus
c. demeclocycline can be used in the management of SADH
d. hyperkalemia and hypocalcemia are common causes of nephrogenic
diabetes insipidus
e. small cell carcinoma of the lung can result in SIADH

24- regarding potassium and pH regulation all of the following are true
except
a. Almost hyperkalemia leads to metabolic acidosis
b. Addison disease causes normal anion gap ( hyperchloremic )
metabolic acidosis
c. Renal tubular acidosis 1 & 2 are exceptions to the general rule in
which acidosis is accompanied by hypokalemia
d. Potassium concentration will rise by 0.6 meq/l for every 0.1 unit
reduction of the extracellular pH
e. Potassium concentration will rise by 0.3 for every 0.1 unit increased
of the extracellular pH

25- Regarding thyrotoxicosis all of the followings are true except

a. Neonatal thyrotoxicosis causes elevated T4 levels to IgM crossing
of the placenta
b. Plummer disease causes atrophy of the thyroid gland apart from
the toxic nodules
c. Triiodothyronine (T3) is the active hormone, and some is
secreted by the thyroid, but 80% is produced by deiodination of
T4 in the peripheral tissues
d. T4 binds very tightly to TBG (thyroxine-binding
globulin) and weakly to albumin
e. Amiodarone can cause hypothyroidism or hyperthyroidism due
to its high iodine content

26- Regarding Hashimoto thyroiditis all of the following are true except
a. It is chronic lymphocytic thyroiditis
b. It is type 2 or 4 hypersensitivity reaction
c. Can occur n children
d. Atrophic thyroid follicles lined by Hurthle (oxyphil) cells
e. It is associated with increased risk of follicular thyroid carcinoma,
hurthle cell carcinoma and B cell lymphoma
27-All of the following increase the risk of malignancy of thyroid nodule
except
a. Solitary nodule
b. Male gender
c. Solid nodule
d. Mobile nodule
e. Nodule in a child

28- Regarding thyroid carcinoma, all of the followings are true except
a. FNAB can not differentiate between follicular adenoma and
carcinoma since it will not show the integrity of the capsule
b. Psammoma bodies are diagnostic characteristic of papillary thyroid
carcinoma
c. 10-year survival rates in papillary thyroid carcinoma is 95%
d. Follicular thyroid carcinoma can result from long standing MNG and
it is followed up by thyroglobulin
e. FMTC without an associated MEN syndrome occurs in children

29- The most common presentation of primary hyperparathyroidism is

a. Bone fracture
b. Increased serum creatinine
c. Osteitis fibrosa cystica
d. Calcium kidney stone
e. Asymptomatic hypercalcemia

30- Regarding gastrinoma all of the followings are true except

a. Most common site is duodenum
b. Zollinger- Ellison syndrome Presents in 90% to 95% of patients and is
characterized by severe intractable multiple peptic ulceration on
unusual locations as jejunum
c. > 50% of gastrinomas are locally invasive or have metastasized at
the time of diagnosis
d. MEN-1 gastrinomas are frequently single and sporadic gastrinomas
are usually multifocal
e. More than 90% of gastrinomas occur in passaro triangle which is
bounded by confluence of the cystic and common bile
duct), Inferior-junction of the second and third portion of
duodenum, and Medial- junction of the neck and body of the
pancreas.

31- Regarding adrenal gland, all of the followings are true except
 a. Addison disease is chronic primary adrenal insufficiency most
caused by autoimmune adrenalitis in which antibodies to 17
hydroxylase enzyme is most commonly present
b. Short synacthen test is used to diagnose Addison disease
c. Hypoglycemia in Addison disease is due to glucocorticoid deficiency
and impaired gluconeogenesis
d. In secondary hypoadrenalism there is bilateral Atrophic cortex &
intact medulla
e. TB& fungal infections is characterized by granulomatous
inflammation

32- Regarding thyroid and parathyroid glands all of the followings are true
except one
a. In most cases superior parathyroid glands are variant n position in
contrast to inferior parathyroid glands which are constant in position
b. Middle thyroid vein is the first vessel to be ligated in thyroid surgery
c. Platysma muscle is supplied by cervical branch of facial nerve
d. All parathyroid glands are supplied by the inferior thyroid artery
e. In Sistrunk operation excision of cyst and also full tract up to the
foramen caecum is done along with removal of central part of the
hyoid bone as the tract passes through it.

33- Regarding Li Fraumeni syndrome all of the following are true except
a. inherited autosomal dominant disorder
b. is usually associated with abnormalities in the tumor suppressor
protein P53 gene (TP53) located on chromosome 17
c. most common malignancies are thyroid, pancreas, and kidney
cancers
d. they usually present at young age
e. first or second degree relative with any cancer before age 45 years
or a sarcoma is a diagnostic criterion