Endocrine Medicine 12 Single Best Answer (SBA)
If questions aren't showing, refresh the page.
1. A 25-year-old man presents with bilateral breast enlargement over the past 6 months. He denies pain or nipple discharge. Examination confirms glandular tissue without signs of malignancy. He is on spironolactone for hypertension. What is the most appropriate next step?
Answer: Discontinue spironolactone and consider alternative antihypertensive
Spironolactone-induced gynaecomastia often improves after switching to an alternative antihypertensive. Further investigations are warranted only if symptoms persist or worsen.
2. A 30-year-old woman presents with bilateral milky nipple discharge. She denies breast pain or masses. Prolactin levels are elevated. What is the most likely underlying cause?
Answer: Prolactinoma
In a patient with galactorrhoea and high prolactin, a prolactin-secreting pituitary adenoma (prolactinoma) is often the culprit.
3. What is the primary underlying mechanism of lactose intolerance?
Answer: Genetic deficiency of lactase enzyme in the small intestine
Primary (adult-onset) lactase deficiency is genetically determined and the most common cause of lactose intolerance.
4. A 55-year-old man with hypertension is found to have an incidental adrenal mass on imaging. Plasma aldosterone-renin ratio is elevated. What is the most likely diagnosis?
Answer: Adrenal adenoma causing primary hyperaldosteronism
A high aldosterone-renin ratio is characteristic of primary hyperaldosteronism, often due to an aldosterone-producing adrenal adenoma (Conn’s syndrome).
5. A 45-year-old woman presents with bitemporal hemianopia and persistent headaches. MRI reveals a 2 cm pituitary tumour. What is the next best step?
Answer: Measure prolactin, ACTH, and IGF-1 levels
A pituitary macroadenoma (≥1 cm) requires a thorough endocrine workup to determine if it is functioning (prolactinoma, acromegaly, Cushing’s disease, etc.) or non-functioning.
6. A 70-year-old man presents with confusion and serum sodium of 118 mmol/L. What is the most appropriate immediate management?
Answer: Administer IV hypertonic saline
Acute or severely symptomatic hyponatraemia with confusion or seizures warrants careful correction with IV hypertonic saline to prevent cerebral oedema.
7. What is the most serious complication of untreated hyperkalaemia?
Answer: Life-threatening cardiac arrhythmias
Hyperkalaemia disrupts cardiac conduction, risking dangerous arrhythmias and cardiac arrest if not promptly corrected.
8. Which medication is most commonly associated with hypokalaemia?
Answer: Furosemide
Loop diuretics (e.g., furosemide) promote potassium excretion in the renal tubules, making them a common cause of hypokalaemia.
9. A 60-year-old man with post-thyroidectomy hypocalcaemia presents with tetany and a positive Chvostek’s sign. What is the most appropriate immediate treatment?
Answer: IV calcium gluconate
Acute hypocalcaemia with tetany requires IV calcium replacement to alleviate neuromuscular excitability.
10. A 75-year-old woman with metastatic breast cancer and hypercalcaemia refuses further treatment. She is confused and dehydrated. How should the healthcare team proceed?
Answer: Assess her capacity to refuse treatment
If a patient with hypercalcaemia is confused, their capacity may be compromised. Capacity assessment is vital before respecting a refusal of care.
11. What is the most common complication of severe hypermagnesaemia?
Answer: Cardiac arrest
Excess magnesium depresses neuromuscular and cardiac conduction, potentially causing cardiac arrest in severe cases.
12. What is the most common cause of hypernatraemia in the elderly?
Answer: Dehydration due to impaired thirst mechanism
In older patients, diminished thirst response and inadequate fluid intake are key contributors to hypernatraemia.
Total Score: 0/12