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WorksheetsGEM1 Module 6 Questions
Total questions: 44
Worksheet time: 44mins
Name
Class
Date
1.
A 56-year-old man presents for a routine check-up. He is asymptomatic but has a BMI of 32 kg/m² and a family history of type 2 diabetes. Blood tests show: Fasting plasma glucose: 7.2 mmol/L (normal <5.5), HbA1c: 49 mmol/mol (6.6%). What is the most appropriate next step in management?
a)
Repeat fasting glucose in 6 months
b)
Start metformin and lifestyle advice
c)
Initiate insulin therapy
d)
Diagnose impaired fasting glucose and advise lifestyle changes
e)
Perform an oral glucose tolerance test
2.
A 68-year-old woman with a 12-year history of T2DM presents with visual disturbances. Fundoscopy reveals microaneurysms, dot-blot hemorrhages, and hard exudates in the retina. Her latest HbA1c is 74 mmol/mol. She takes metformin and gliclazide. What is the most likely diagnosis?
a)
Hypertensive retinopathy
b)
Non-proliferative diabetic retinopathy
c)
Proliferative diabetic retinopathy
d)
Age-related macular degeneration
e)
Central retinal vein occlusion
3.
A 39-year-old woman presents with weight gain, facial puffiness, and easy bruising. Examination shows a round face, central obesity, purple abdominal striae, and proximal muscle weakness. Blood pressure is 160/98 mmHg. Labs: Serum cortisol (8 AM): Elevated, ACTH: Elevated, Low-dose dexamethasone suppression test: No suppression of cortisol. What is the most likely cause?
a)
Adrenal adenoma
b)
Ectopic ACTH secretion
c)
Pituitary adenoma (Cushing’s disease)
d)
Iatrogenic steroid use
e)
Adrenal carcinoma
4.
A 44-year-old man is diagnosed with Cushing’s disease. MRI reveals a 3 mm pituitary adenoma. What is the most appropriate initial treatment?
a)
Transsphenoidal surgical resection
b)
Ketoconazole therapy
c)
Pituitary radiotherapy
d)
Bilateral adrenalectomy
e)
Observation and repeat imaging in 6 months
5.
A 28-year-old woman presents with weight loss, anxiety, and heat intolerance. Examination reveals a smooth diffuse goitre and bilateral proptosis. Her TSH is suppressed and free T4 is elevated. Which feature most supports a diagnosis of Graves’ disease?
a)
Heat intolerance
b)
Diffuse goitre
c)
Exophthalmos
d)
Tremor
e)
Weight loss
6.
A 35-year-old woman with newly diagnosed Graves’ disease is considering treatment options. She plans to conceive within the next year. What is the most appropriate initial treatment?
a)
Carbimazole for 18 months
b)
Radioiodine therapy
c)
Total thyroidectomy
d)
Propranolol monotherapy
e)
Observation only
7.
A 30-year-old male bodybuilder presents with acne, testicular atrophy, and aggressive behaviour. He denies drug use but admits to using supplements from a gym. What is the most likely biochemical finding?
a)
High LH and high testosterone
b)
Low LH and high testosterone
c)
High LH and low testosterone
d)
Low LH and low testosterone
e)
Normal LH and testosterone
8.
A 32-year-old male presents with fatigue and hypotension. He had been using anabolic steroids for bodybuilding but stopped abruptly 2 weeks ago. Blood tests show: Sodium 130 mmol/L, Potassium 5.6 mmol/L, Cortisol low, ACTH low. What is the most likely diagnosis?
a)
Primary adrenal insufficiency (Addison’s disease)
b)
Secondary adrenal insufficiency
c)
Congenital adrenal hyperplasia
d)
Acute adrenal crisis
e)
Cushing’s syndrome
9.
A 72-year-old man presents to A&E with a rapidly expanding neck swelling and respiratory distress after a central venous catheter insertion attempt. The swelling is located in the anterior triangle of the neck. Which of the following structures was most likely injured during the procedure?
a)
Spinal accessory nerve
b)
Subclavian vein
c)
Internal jugular vein
d)
External carotid artery
e)
Brachial plexus
10.
A 45-year-old woman presents with a painless lump in the left upper neck (level II lymph node) and a hoarse voice lasting several weeks. Which of the following is the most likely primary site of a malignancy causing this lymph node enlargement?
a)
Thyroid gland
b)
Larynx (voice box)
c)
Nasopharynx (upper throat behind the nose)
d)
Tongue (front part)
e)
Salivary gland (parotid)
11.
A 63-year-old woman undergoes a total thyroidectomy for a large multinodular goitre. Postoperatively, she has a weak, hoarse voice. On laryngoscopy, her left vocal cord is immobile and in a paramedian position. Which of the following structures was most likely injured during surgery?
a)
Superior laryngeal nerve
b)
Recurrent laryngeal nerve
c)
Hypoglossal nerve
d)
Glossopharyngeal nerve
e)
External branch of superior laryngeal nerve
12.
A 16-year-old boy is newly diagnosed with type 1 diabetes mellitus and is started on insulin therapy. His consultant explains the pharmacological differences between hormone types. Which of the following best describes insulin?
a)
A steroid hormone synthesized from cholesterol
b)
A peptide hormone stored in secretory granules and released via exocytosis
c)
A thyroid hormone that requires iodine for synthesis
d)
A catecholamine acting via nuclear receptors
e)
A lipid-soluble hormone with a long half-life
13.
A 30-year-old woman presents with 4 months of amenorrhea and galactorrhoea. She is not on any medications. Serum prolactin is elevated, and MRI shows a pituitary adenoma. Which of the following symptoms is most likely in this patient due to the adenoma?
a)
Polydipsia and dilute urine
b)
Peripheral visual field defects
c)
Hyperpigmentation of the skin
d)
High T3 and T4 with suppressed TSH
e)
Moon face and centripetal obesity
14.
A 48-year-old man presents with excessive thirst and frequent urination. Lab shows serum sodium 150 mmol/L, low urine osmolality, and high serum osmolality. He does not respond to fluid restriction, but desmopressin corrects the abnormal values. What is the most likely cause?
a)
Nephrogenic diabetes insipidus due to lithium use
b)
SIADH from small cell lung cancer
c)
Central diabetes insipidus due to ADH deficiency
d)
Primary polydipsia
e)
Addison’s disease causing aldosterone deficiency
15.
A patient with long-term steroid use for rheumatoid arthritis develops iatrogenic Cushing’s syndrome. Labs show low ACTH and low endogenous cortisol. What is the most appropriate explanation?
a)
Positive feedback of ACTH on CRH
b)
Upregulation of ACTH from hypothalamus
c)
Negative feedback of exogenous corticosteroids on the HPA axis
d)
Primary adrenal failure with compensatory pituitary suppression
e)
Hypothalamic tumour producing excess cortisol
16.
A 28-year-old woman is in active labour. As uterine contractions intensify, oxytocin levels rise and further enhance contractions until the baby is delivered. Which best describes this physiological response?
a)
Negative feedback by oxytocin on hypothalamus
b)
Classical homeostatic mechanism
c)
Positive feedback loop
d)
Downregulation of oxytocin receptors
e)
Feedforward inhibition via progesterone
17.
A 19-year-old student skips breakfast and then goes to the gym. After 2 hours of intense exercise, he becomes confused and dizzy. Blood glucose is 2.2 mmol/L. What is the likely cause?
a)
Excess insulin secretion from a pancreatic tumour
b)
Glucagon-mediated inhibition of lipolysis
c)
Neuroglycopenia due to low plasma glucose
d)
Activation of glycolysis in skeletal muscle
e)
High insulin:glucagon ratio
18.
A 14-year-old boy presents with 2 weeks of polyuria, polydipsia, and weight loss. On admission, he is drowsy and tachypnoeic. Blood glucose 29 mmol/L, ketones 5.6 mmol/L, pH 7.1. What is the most likely cause?
a)
Autoimmune destruction of pancreatic alpha cells
b)
Insulin resistance in muscle and adipose tissue
c)
Anti-GAD antibody-mediated beta cell destruction
d)
Mutation in glucokinase gene
e)
Excess cortisol from chronic stress
19.
A 63-year-old man with 12-year history of type 2 diabetes has fundoscopic dot and blot hemorrhages and microalbuminuria. He also has reduced peripheral pulses. What explains these findings?
a)
Insulin-mediated vasodilation
b)
Immune complex deposition in glomeruli
c)
Microvascular endothelial damage from chronic hyperglycaemia
d)
Increased hepatic gluconeogenesis
e)
Acute inflammation of large vessels
20.
A 58-year-old man with type 2 diabetes is started on metformin. After months, HbA1c remains high. A second oral drug stimulating insulin secretion is added. Which drug?
a)
Sitagliptin
b)
Gliclazide
c)
Prednisolone
d)
Levothyroxine
e)
Dexamethasone
21.
A 32-year-old woman presents with weight loss, heat intolerance, palpitations, and anxiety. On examination, she has a smooth, diffuse goitre and bilateral proptosis. Blood tests reveal suppressed TSH and elevated T3 and T4. Which of the following is the most likely underlying cause?
a)
TSH-secreting pituitary adenoma
b)
TPO antibody-mediated thyroid destruction
c)
Thyroid-stimulating immunoglobulins targeting the TSH receptor
d)
Dietary iodine deficiency
e)
De Quervain’s thyroiditis
22.
A 45-year-old woman presents with fatigue, dry skin, and cold intolerance. On examination, she has a firm, non-tender goitre. Blood tests show high TSH, low free T4, and positive anti-thyroid peroxidase (TPO) antibodies. Which of the following is the most likely diagnosis?
a)
Graves’ disease
b)
Toxic multinodular goitre
c)
Hashimoto’s thyroiditis
d)
Subacute thyroiditis
e)
Pituitary adenoma
23.
A 50-year-old woman presents with central obesity, facial rounding, purple abdominal striae, and muscle weakness. Blood pressure is 165/95 mmHg. Overnight dexamethasone suppression test shows no cortisol suppression. Which of the following is the most likely explanation?
a)
ACTH-producing pituitary microadenoma
b)
Chronic steroid use
c)
Primary adrenal insufficiency
d)
Hyperaldosteronism
e)
Pheochromocytoma
24.
A 40-year-old man presents with fatigue, weight loss, postural dizziness, and darkened skin. Labs show hyponatremia, hyperkalemia, and low cortisol with elevated ACTH. What is the most likely underlying pathology?
a)
Pituitary tumour with ACTH deficiency
b)
Congenital adrenal hyperplasia
c)
Autoimmune adrenal cortex destruction
d)
ACTH-secreting tumour
e)
Chronic glucocorticoid therapy
25.
A 45-year-old woman presents with episodic headaches, sweating, palpitations, and fluctuating hypertension. She is diagnosed with pheochromocytoma, and surgery is planned. Which of the following drugs should be avoided before surgery because it may worsen her hypertension?
a)
Hydrocortisone
b)
Prednisolone
c)
Beta-blockers (e.g., propranolol)
d)
Levothyroxine
e)
Metformin
26.
A 52-year-old man with central obesity and type 2 diabetes is found to have elevated triglycerides and hypertension. His waist circumference is 112 cm, and BMI is 33 kg/m². Lab tests show insulin resistance. Which of the following best explains the endocrine contribution of visceral adipose tissue to his condition?
a)
Increased leptin sensitivity enhances satiety
b)
Increased adiponectin improves insulin sensitivity
c)
Visceral fat secretes pro-inflammatory cytokines
d)
Subcutaneous fat suppresses gluconeogenesis
e)
Brown fat promotes atherogenesis
27.
A 35-year-old woman with a BMI of 31 kg/m² asks for advice on weight loss. She has no comorbidities and prefers to avoid medication or surgery. Which of the following is the most appropriate first-line management?
a)
Orlistat 120 mg three times daily
b)
Referral for bariatric surgery
c)
Weekly semaglutide injections
d)
Structured calorie-reduction diet and regular exercise
e)
Intermittent fasting without dietary advice
28.
A 44-year-old man with a BMI of 42 kg/m² and poorly controlled type 2 diabetes is referred for bariatric surgery. He undergoes a Roux-en-Y gastric bypass. Which of the following best describes the primary mechanism of weight loss with this procedure?
a)
Delayed gastric emptying reduces hunger
b)
Reduced fat absorption via pancreatic enzyme inhibition
c)
Malabsorption of nutrients due to bypassed small bowel
d)
Increased appetite suppression via ghrelin secretion
e)
Restriction of oral intake without metabolic change
29.
A 28-year-old woman presents with anxiety, weight loss, heat intolerance, and amenorrhea. On examination, she has a diffuse goitre and mild proptosis. Thyroid function tests show suppressed TSH and elevated free T4. Which of the following autoantibodies is most likely elevated in this patient?
a)
Anti-thyroid peroxidase (TPO) antibodies
b)
Anti-thyroglobulin antibodies
c)
Thyroid-stimulating immunoglobulin (TSI)
d)
Anti-TSH receptor blocking antibodies
e)
Anti-dsDNA antibodies
30.
A 14-year-old boy presents with weight loss, polydipsia, and polyuria. His capillary blood glucose is 22 mmol/L and urinalysis shows ketones and glucose. Blood tests reveal anti-GAD (glutamic acid decarboxylase) antibodies. Which of the following best explains the underlying pathophysiology?
a)
Insulin resistance in adipose and muscle tissue
b)
Autoimmune destruction of pancreatic beta cells
c)
Chronic glucocorticoid use
d)
Defective insulin receptor signaling
e)
Excess glucagon secretion
31.
A 30-year-old woman presents with joint pain, photosensitive rash, and fatigue. She has a history of oral ulcers and occasional shortness of breath. Lab tests show a positive ANA and strongly positive anti-dsDNA antibodies. Which of the following is the most likely diagnosis?
a)
Rheumatoid arthritis
b)
Systemic lupus erythematosus
c)
Sjögren’s syndrome
d)
Systemic sclerosis
e)
Polymyositis
32.
A 28-year-old woman presents with amenorrhea and difficulty conceiving. She reports irregular periods and occasional hot flushes. Serum FSH and LH levels are low, with low oestradiol. MRI of the brain reveals a non-enhancing lesion in the pituitary. Which of the following best explains her infertility?
a)
Ovarian failure due to premature menopause
b)
Prolactin excess inhibiting GnRH secretion
c)
Pituitary insufficiency reducing gonadotropin production
d)
Polycystic ovarian syndrome with elevated androgens
e)
Increased negative feedback from the corpus luteum
33.
A 42-year-old man is referred for increasing shoe and ring size, coarsened facial features, and joint pain. He also reports snoring and fatigue. IGF-1 is elevated, and an oral glucose tolerance test shows no suppression of GH. What is the most likely diagnosis?
a)
Gigantism
b)
Cushing's syndrome
c)
Hypothyroidism
d)
Acromegaly
e)
Marfan syndrome
34.
A 22-year-old man presents with decreased libido and infertility. Examination reveals small testes and reduced facial hair. Blood tests show low testosterone, low-normal LH, and low FSH. Semen analysis confirms oligospermia. Which of the following best explains the low sperm count?
a)
FSH deficiency impairing Sertoli cell function
b)
LH deficiency reducing inhibin B levels
c)
Elevated prolactin causing primary hypogonadism
d)
Excess testosterone suppressing spermatogenesis
e)
Excess aromatase activity increasing oestrogen
35.
A 45-year-old woman is evaluated for chronic fatigue, increased fat around the waist, and low mood. She also reports reduced exercise tolerance. She had a craniopharyngioma resected 3 years ago. Her labs show low IGF-1, normal cortisol, and normal thyroid function. Which of the following is the most likely diagnosis?
a)
Hypothyroidism
b)
GH deficiency secondary to pituitary damage
c)
Major depressive disorder
d)
Cushing's disease
e)
Menopause
36.
A 45-year-old man presents to the clinic with alcohol dependence. He reports drinking daily to cope with work stress and family problems. He has a history of depression and limited social support. Which aspect of the biopsychosocial model best explains the role of his family problems in maintaining his addiction?
a)
Biological predisposition to alcohol metabolism
b)
Psychological coping mechanism for stress
c)
Social environment influencing behavior
d)
Neurochemical changes in dopamine pathways
e)
Genetic mutation affecting reward sensitivity
37.
A 38-year-old woman has experienced prolonged work-related stress over the past year. She complains of fatigue, poor concentration, insomnia, and weight gain, especially around her abdomen. Blood tests show mildly elevated serum cortisol levels and blunted diurnal variation. Which of the following best explains her symptoms?
a)
Chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis leading to cortisol excess
b)
Acute cortisol deficiency due to adrenal insufficiency
c)
Increased production of thyroid hormones
d)
Primary hyperaldosteronism
e)
Decreased ACTH secretion from the pituitary
38.
A 65-year-old man recently lost his spouse of 40 years. He reports feelings of profound sadness, difficulty sleeping, and lack of appetite. His daughter is concerned about his social withdrawal and reluctance to accept support. Which of the following best describes the relevance of attachment theory in this clinical context?
a)
It explains how early childhood neglect causes adult depression
b)
It highlights the importance of secure relationships in coping with loss
c)
It identifies genetic predisposition to complicated grief
d)
It focuses on biochemical changes during bereavement
e)
It emphasizes the role of cultural rituals in mourning
39.
A 34-year-old woman with known Graves’ disease presents with fever, agitation, and a heart rate of 150 bpm. She is confused and sweating profusely. Which of the following is the most appropriate initial management?
a)
IV hydrocortisone and high-dose levothyroxine
b)
Oral propranolol and propylthiouracil (PTU)
c)
Radioactive iodine therapy immediately
d)
Surgical thyroidectomy within 1 hour
e)
Beta-agonist nebulizer treatment
40.
A 19-year-old woman with type 1 diabetes presents with rapid breathing, abdominal pain, and vomiting. Arterial blood gas shows metabolic acidosis, and urinalysis reveals ketones. Which of the following is the first step in management?
a)
Subcutaneous insulin injection
b)
Intravenous fluids and insulin infusion
c)
Oral glucose administration
d)
Oral metformin
e)
Immediate hemodialysis
41.
A 45-year-old man has central obesity, hypertension, and glucose intolerance. A low-dose dexamethasone suppression test shows no suppression of serum cortisol. Which diagnosis is most likely?
a)
Metabolic syndrome
b)
Cushing’s syndrome
c)
Addison’s disease
d)
Hypothyroidism
e)
Polycystic ovarian syndrome
42.
Which hormone stimulates the anterior pituitary to release ACTH in the hypothalamic-pituitary-adrenal (HPA) axis?
a)
Cortisol
b)
CRH (corticotropin-releasing hormone)
c)
Aldosterone
d)
Vasopressin
e)
TSH
43.
Which process is responsible for the uptake of iodide into the thyroid follicular cells during thyroid hormone synthesis?
a)
Iodide organification
b)
Iodide trapping via Na+/I- symporter
c)
Thyroglobulin synthesis
d)
Coupling of iodotyrosines
e)
Endocytosis of thyroglobulin
44.
A patient with insulin resistance has impaired glucose uptake in muscle and adipose tissue. Which of the following defects best explains this resistance?
a)
Decreased insulin receptor expression
b)
Impaired GLUT4 translocation to the cell membrane
c)
Increased glucagon secretion
d)
Enhanced glycogenolysis
e)
Reduced insulin production by β-cells
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