School of Medicine

MED 300-C4
ENDOCRINE & METABOLIC DISEASES
Committee Exam
ANSWERKEY

Name

Student ID

Signature

LECTURE GRADE
Medical Pharmacology 24P
Medical Pathology 20P
Internal Medicine 14P
Pediatrics 12P
Practical Applications 14P
of Ethics in Clinics
Nuclear Medicine 4P
Radiology 6P
Medical Genetics 6P
TOTAL 100
Head of the committee: DR. ÖĞR. ÜYESİ AYÇA DOĞAN
02.01.2025

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PATHOLOGY (16x1=16P, 4p will comes from A. Follicular carcinoma
practice, T:20P) B. B cell lymphoma
C. Medullary carcinoma
1. A 2-year-old male patient is brought to the doctor by D. Anaplastic carcinoma
his parents due to concerns about his ambiguous E. Papillary carcinoma
genitalia. They report that he has been unusually
fatigued and has experienced poor weight gain. ANSWER: E
Radiological imaging shows bilaterally enlarged
adrenal glands. Laboratory tests reveal low levels of 4. A 52-year-old woman with a history of iodine
cortisol and elevated levels of 17- deficiency presents with a slowly enlarging, painless
hydroxyprogesterone and adrenal androgens. A thyroid nodule. Initial Fine needle biopsy (FNB) was
biopsy of the adrenal gland reveals cortical nondiagnostic. Ultrasound shows a well-
hyperplasia. What is the patient's most likely circumscribed, solitary, hypoechoic nodule,
diagnosis? approximately 2cm in diameter, with a clearly
A. Cushing's syndrome defined capsule. A repeat FNB remains inconclusive.
B. Conn's syndrome Surgical resection is undertaken. Pathology reveals
C. Adrenogenital Syndromes follicular cells arranged in uniform follicles with
D. Addison's disease abundant colloid. There is minimal nuclear atypia.
E. Hyperparathyroidism However, the pathologist notes subtle variation in
nuclear size and shape. What histologic feature
ANSWER: C would be the most definitive finding to definitively
distinguish between a follicular adenoma and a
2. A 22-year-old female patient presents to the doctor follicular carcinoma?
complaining of significant weight loss despite A. The predominance of solid or insular growth
increased appetite, nervousness, and palpitations. patterns.
She also reports heat intolerance, excessive B. The presence of an increased mitotic rate in the
sweating, and frequent bowel movements. She's tumor cells.
noticed a tremor in her hands and has experienced C. The absence of capsular or vascular invasion.
insomnia. Physical examination reveals a diffusely D. Significant cellular pleomorphism.
enlarged thyroid gland, and her eyes appear slightly E. The presence of necrosis within the tumor tissue.
prominent (mild exophthalmos). Radiological
imaging (thyroid scan) shows diffuse increased ANSWER: C
uptake of radioactive iodine. Laboratory tests reveal
elevated free T3 and T4 levels, with a suppressed 5. A 46-year-old male patient presents to his doctor
TSH level. A thyroid biopsy reveals diffuse complaining of significant weight gain, particularly
hyperplasia with tall columnar follicular cells and around his abdomen and face ("moon face"), along
scalloped colloid. What is this patient's most likely with the development of purple stretch marks
diagnosis? (striae) across his abdomen and thighs. He also
A. Hyperthyroidism reports increased fatigue, muscle weakness, and
B. Hashimoto Thyroiditis hypertension. He has noticed some thinning of his
C. Subacute Thyroiditis (De Quervain's Thyroiditis) facial and body hair. Radiological imaging reveals
D. Riedel's thyroiditis bilateral adrenal hyperplasia. Laboratory tests show
E. Hypothyroidism elevated cortisol levels, with low ACTH levels. A
pituitary MRI is normal. A biopsy of the adrenal
ANSWER: A gland shows diffuse hyperplasia. What is this
patient's most likely diagnosis?
3. A 35-year-old female patient applies to a doctor A. Pheochromocytoma
because of a mass in her thyroid. In the B. Cushing syndrome
ultrasonographic examination, a mass with a C. Plummer's disease
diameter of 15 mm is detected in the right thyroid D. Addison disease
region. Fine needle biopsy is performed with E. Conn syndrome
ultrasound guidance. The aspirated material is
spread on the slide, fixed in alcohol, then stained ANSWER: B
and examined with a light microscope. In the
examination, follicle structures and epithelial cells 6. Thirty-five years old female patient; She applies
that have formed layers are examined. In more with complaints of pain and burning in the abdomen
detailed examination, ground glass or “Orphan and long-standing diarrhea. In endoscopic
Annie eye nuclei, pseudoinclusions and psammoma examination; Multiple ulcers are detected in the
bodies are seen. According to these results, which of stomach, duodenum and jejunum. There is no
the following can be the pathologist's diagnosis? adequate response to ulcer treatment.
 Which of the following is the most likely tumor to A. Parathyroid adenoma
be seen in this patient? B. Pancreatic endocrine tumor
A. Glucagonoma C. Medullary thyroid carcinoma
B. Somatostatinoma D. Pheochromocytoma
C. VIPoma E. Pituitary adenoma
D. Insulinoma
E. Gastrinoma ANSWER: C

ANSWER: E 10. Which of the following is NOT a chronic

complication of type 2 diabetes?
7. A 43-year-old female patient presents with A. Kidney disease
complaints of fatigue, weight gain, and cold B. Eye disease (retinopathy)
intolerance. She also reports feeling generally C. Stroke
sluggish and having difficulty concentrating. Blood D. Chronic liver inflammation (hepatitis)
tests reveal elevated TSH levels and positive thyroid E. Gangrene in the lower limbs
peroxidase antibodies (TPOAb). The patient's family
history is negative for thyroid disease. A thyroid ANSWER: D
biopsy is performed. The biopsy reveals widespread 11. Which of the following correctly lists the
infiltration of the thyroid parenchyma by a hypothalamic hormones that have an inhibitory
mononuclear inflammatory infiltrate composed effect on the pituitary gland?
predominantly of lymphocytes and plasma cells, A. TRH, Dopamine
with well-developed germinal centers. Many thyroid B. Dopamine, Somatostatin
follicles are atrophic and lined by Hürthle cells. C. CRH, GHRH
There is also some interstitial fibrosis. Considering D. GHRH, TRH
the clinical presentation, laboratory results, and E. GnRH, TRH
histopathological findings, what is the most probable
diagnosis? ANSWER: B
A. Graves' disease
B. Hypothyroidism due to iodine deficiency 12. Which of the following is NOT a cause of
C. Subacute thyroiditis hyperpituitarism?
D. Hashimoto's thyroiditis A. Adenohypophysis adenoma
E. Thyroid cancer B. Excess production of hypophyseal stimulating
factors
ANSWER: D C. Excess production of dopamine
D. Loss of inhibition following destruction of other
8. A 26-year-old male patient presents to the doctor endocrine glands
complaining of increasing fatigue, muscle weakness, E. Underproduction of inhibiting factors
weight loss, and abdominal pain. He also reports
nausea, vomiting, and darkening of his skin, ANSWER: C
particularly noticeable on his knuckles and the
creases of his palms. He denies any recent 13. Which of the following is NOT a cause of
significant stressors or illness. Radiological imaging hyperprolactinemia?
shows atrophied adrenal glands. Laboratory tests A. Functioning prolactinomas
reveal low levels of cortisol and aldosterone, with B. Hypothalamic craniopharyngiomas
elevated ACTH levels and Serum potassium: 6.1 C. Medications
mEq/L, Creatinine: 1.7 mg/dL. A biopsy of the D. Empty sella syndrome
adrenal gland reveals lymphocytic infiltration and E. Stress
destruction of the adrenal cortex. What is this ANSWER: D
patient's most likely diagnosis?
A. Addison disease 14. A 32-year-old male patient presents to the doctor
B. Conn syndrome complaining of progressively enlarging hands and
C. Plummer's disease feet, a deepening voice, and headaches over the past
D. Cushing syndrome few years. He also reports increased sweating and
E. Pheochromocytoma fatigue. Radiological examination reveals an
enlarged sella turcica. Laboratory findings show
ANSWER: A elevated levels of growth hormone and insulin-like
9. Which tumor shows 100% positivity in both growth factor 1 (IGF-1). Pathological examination
Multiple Endocrine Neoplasia (MEN) type 2A and of a pituitary biopsy reveals a densely granulated
MEN type 2B syndromes? somatotroph adenoma. What is this patient's most
possible diagnosis?
A. Cushing's disease A. ACTH
B. Acromegaly B. FSH
C. Hypopituitarism C. LH
D. Prolactinoma D. TSH
E. Diabetes insipidus E. Angiotensin 2

ANSWER: B Answer is E

15. A 4-year-old male patient is brought to the doctor by 19. Thioureas act in all the following steps EXCEPT:
his parents due to complaints of excessive thirst ……………..?
(polydipsia) and frequent urination (polyuria) for A. İodide organification
several months. He has also experienced significant B. Iodide trapping
weight loss and appears dehydrated. Radiological C. Formation of antibodies
imaging shows no abnormalities in the sella turcica. D. Conversion of T4 to T3
Laboratory tests reveal low urine osmolality and E. Coupling of MIT and DIT
high serum osmolality, with a low response to the
administration of desmopressin (ADH). A pituitary Answer is B
biopsy is performed, which reveals no adenoma, and 20. Which of the followings is most dangerous in
appears normal histologically. What is this patient's pregnancy............?
most likely diagnosis? A. Liotrix
A. Diabetes insipidus B. Propylthiouracyl
B. Growth hormone deficiency C. Metimazole
C. Hypothyroidism D. Radioactive iodine
D. Sheehan's syndrome E. Carbimazole
E. Cushing's disease
Answer is D
ANSWER: A
21. 3-Which of the followings is the most dangerous
16. A 36-year-old male patient presents to the doctor effect of insulin injection............?
complaining of persistent bone pain, particularly in A. Hyperglycemia
his hips and back, and frequent kidney stones. He B. Hypoglycemia
also reports general fatigue, weakness, and C. Lypodistrophy
occasional constipation. Radiological examination D. Weight gain
reveals osteitis fibrosa cystica on x-rays. Laboratory E. Edema
tests reveal elevated serum calcium, elevated
parathyroid hormone (PTH), and decreased serum Answer is B
phosphate levels. A parathyroid biopsy reveals a
solitary adenoma. What is the patient's most likely 22. Which one is used by oral route:...............?
diagnosis? A. Insulin glargine
A. Hypoparathyroidism B. Insulın aspart
B. Addison's disease C. Metformin
C. Hyperparathyroidism D. Liraglutide
D. Cushing's syndrome E. Exenatide
E. Pheochromocytoma Answer is C
ANSWER: C 23. 4-The main reason of to withdraw bovine insulins
PHARMACOLOGY (16x1.5=24P) is:...............?
A. They are expensive
17. ACTH is released from proteolytic cleavage B. They are less effective
of...............? C. They have low bioavailability
A. POMC D. They have risk of causing BSE(mad cow disease)
B. Mast cells E. They are long acting
C. Bradykininogen
D. Angiotensinogen Answer is D
E. C-reactive protein 24. Which one does not increase insulin
Answer is A secretion..............?
A. Gliclazide
18. Which one is not released from anterior B. Glibenclamide
pituitary:............? C. Glimepiride
 D. Metformin 31. Cannabinoid receptor antagonist tried in obesity is:
E. Repaglinide ……………..?
A. Orlistat
Answer is D B. Rimonabant
25. Which one is used by inhalation for asthma............? C. Sibutramin
A. Cortisone D. Phenfluramine
B. Prednisone E. Diethylpropion
C. Fluticasone Answer is B
D. Aldosterone
E. DOCA 32. Gastrointestinal lipase inhibitor anti-obesity drug
is:..............?
Answer is C A. Orlistat
26. Which one is not clinical use of B. Rimonabant
corticosteroids...........? C. Sibutramin
A. Rheumatoid arthritis D. Phenfluramine
B. Allergic reactions E. Diethylpropion
C. Contact dermatitis Answer is A
D. Osteoporosis
E. Acute bursitis PRACTICAL APPLICATIONS OF ETHICS IN
CLINICS (7x2=14P)
Answer is D
33. A baby, 5 months-old, has severe short bowel
27. Antifungal drug which blocks steroid synthesis syndrome, with 5 cm of small intestine past the end
is:............? of the duodenum with a history of prematurity
A. Spironolactone (gestational age 26 weeks), moderate/severe global
B. Gluthetimide developmental delay because of high-grade intra-
C. Ketoconazole ventricular hemorrhage, and chronic lung disease on
D. Metyrapone oxygen and diuretics. He also has some endocrine
E. Mifepristone problems and eventually intestinal failure. The
Anwer is C parents can't imagine their baby ever having a good
life and have asked their care team about stopping
28. Which one is not used topically...............? parenteral nutrition and hydration that is a life
A. Hydrocortisone sustaining treatment. If the care team thinks that this
B. Cortisone is not an acceptable request, which of the following
C. Mometasone statements is absolutely and ethically correct without
D. Betametasone hesitation with respect to risk / benefit weighing or
E. Triamcinolone risk matrix?
A. This decision is correct since it is a clearly beneficial
Answer is B treatment as advised by the care provider
29. Which of the followings does not belong to B. This decision is correct since it is a treatment with
biphosphonates................? some uncertainties and some major benefits as
A. Enalaprilate declared by the care provider
B. Etidronate C. This decision is correct since it is a treatment with
C. Pamidronate some clear benefit and minor burdens as declared by
D. Chlodronate the care provider
E. Alendronate D. This decision is not correct since it is clearly a
burdensome treatment as declared by the care
Answer is A provider
E. This decision is not correct since it s a treatment
30. Which one is dual acting bone with very minor uncertainties and little benefit as
agent(DABA);................? declared by the care provider
A. PTH
B. Calcitonin ANSWER:D
C. Vit D
D. Protelos 34. If a patient refuses a highly beneficial treatment
E. Fluoride option but very expensive for her/him proposed by
the care provider, which of the following items show
Answer is D the correct conflicting principles of medical ethics?
A. Justice and autonomy
B. Justice and non-maleficence B. The physician gives information about uncertainties
C. Autonomy and justice about the treatment choice.
D. Justice and beneficence C. The physician gives information about the prognosis
E. Malpractice and quality of life of the disease if no treatment is applied.
ANSWER: C D. The physician gives information about additional
interventions that would improve prognosis of the
35. Which of the following statements or steps is wrong disease and quality of life
to diagnose a medico-ethical problem in the clinics? E. The physician gives recommendation based on
A. To evaluate medical indications and risks about the his/her best clinical judgement
cases ANSWER: B
B. To evaluate conflicting ethical principles and
dominant problem 39. What should we do when there is an ethical issue in
C. To evaluate risk / benefit weighing a clinical setting?
D. To complete anamnesis, physical examination and A. We should restore the best interest and beneficence
order laboratory tests of the patient by solving dilemmas
E. To evaluate values B. We should apply the court
ANSWER: D C. We should refuse the case
36. If the care provider assesses the treatment as with D. We should enforce the treatment even if it is very
some uncertainity and with net benefit and the risky and uncertain
patient refuses the treatment offer as offered. Then E. Active assistance of the health care personnel is
which of the following actions of the care provider never used for the definition of the process under
would be correct according to risk/benefit weighing uncertainity conditions
or the risk matrix? ANSWER: A
A. Do not provide the treatment
B. Send the case to the ethics committee NUCLEAR MEDICINE (2x2=4P)
C. Send the case to the chief director of the hospital
D. Do not provide the treatment 40. Which organ or system have the highest
E. Ask the lawyer radiosensitive against to the radioactivity?
ANSWER:D A. Ovary and testis

37. Which of the following might be considered as B. Skeletal system

important practical issues when diagnosing ethical C. Blood forming organs
or medico-ethical problems in surclinics? D. Nervous system
A. Enigmas and risk-benefit weighing
B. Important issues of human nature E. Gastrointestinal system
C. Four major principles of bioethics and conflicting Answer: E
values 41. Which radioactive beam/ray is used for imaging
D. “What, why, when, where, how and who” questions
nuclear medicine?
and values
E. All of them A. α-Alfa
B. β-Beta
ANSWER:E
C. X
38. The lady diagnosed with Basedow-Graves
D. γ-Gamma
thyroiditis at the stage of hyperthyroidism both
clinically and laboratory-wise, is given information E. neutron
about two options as medical treatment and Answer: D
radioactive treatment by her physician. For INTERNAL MEDICINE (7x2=14P)
radioactive treatment, it was declared that as an
42. A 28-year-old woman has had difficulty
unwanted effect the probability of the risk of
concentrating at work for the past month. She
hypothyroidism and as a result being obliged to use
complains that the work area is too hot. She seems
a drug life long, is not known for sure. She was
nervous and often spills her coffee. She has been
asked to choose and give consent for one of them.
eating more but has lost 5 kg in the past 2 months.
According to the information given above, which of
On physical examination her pulse 108/minute, and
the following statements is correct based on the
blood pressure 145/85 mm Hg. Which of the
informed consent algorithm?
following laboratory findings is most likely to be
A. The physician gives information about the treatment present in this woman?
choice, for her to make a choice and to make a A. Decreased catecholamines
decision for her best interest. B. Decreased plasma insulin
C. Decreased TSH
D. Increased ACTH E. Type II diabetes mellitus
E. Increased calcitonin
47. Effects of hypothyroidism include all but this:
43. A 49-year-old woman has had increasing cold A. Diarrhoea
intolerance, weight gain of 4 kg, over the past three B. Lethargy
monhs. A physical examination reveals dry, coarse C. Anorexia
skin. Her thyroid is not palpably enlarged. Her D. Weight gain
serum TSH is 11.7 mU/L with thyroxine of 2.1 E. Dry skin
micrograms/dL. A year ago, anti-thyroglobulin and
anti-thyroid peroxidase autoantibodies were detected 48. All of the following statements about Hashimoto’s
at high titer. Which of the following thyroid diseases disease are true except:
is she most likely to have? A. Many patients are entirely asymptomatic
A. DeQuervain disease B. Not all patients become hypothyroid
B. Papillary carcinoma C. Most cases of obesity are attributable to
C. Hashimoto thyroiditis Hashimoto’s disease
D. Multinodular goiter D. Hypothyroidism may be subclinical
E. Graves disease E. Anti-TPO negativity is not exluded Hashimoto’s
Disease
44. A 50-year-old man has episodic headaches and
sweating for 3 months. On physical examination his RADIOLOGY (3x2=6P)
blood pressure is 185/110 mm Hg, with no other 49. Which is correct for TI-RADS and thyroid nodule
remarkable findings. Laboratory studies are normal. evaluation ?
An abdominal CT scan shows a 7 cm left adrenal A. Aneochoic nodules are usually malignant.
mass. Which of the following laboratory test B. Shape is very important predictor and if transverse
findings most likely explains his findings? diameter is higher than anteroposterior diameter it
A. ADecreased serum cortisol means strong predictor of malignancy.
B. Decreased urinary homovanillic acid C. Microcalcifications are a strong predictor of
C. Increased serum ACTH malignancy and therefore get 3 points.
D. Increased urinary free catecholamines D. All TI-RADS 5 nodules are malignant.
E. Elevated serum ANCA E. For lesion size more than 3 cm in TI-RADS 2 fine
needle aspiration biopsy should be done.
45. A 41-year-old man has been drinking large Response: C
quantities of water--up to 20 liters per day--for the
past week. On physical examination he has 50. Which imaging method is used to as first modality
diminished skin turgor and dry mucous membranes. for characterize adrenal lesions?
Laboratory studies show sodium 162 mmol/L, A. CT (computerized tomography)
B. MRI (magnetic resonance imaging)
potassium 4.1 mmol/L, chloride 121 mmol/L, and
C. SPECT (single-photon emission computerized
bicarbonate 27 mmol/L. His serum glucose is 85
tomography)
mg/dL and creatinine 1.0 mg/dL. His serum D. DSA (digital substraction angiography)
osmolality is 343 mOsm/kg. A deficiency of which E. Ultrasound
of the following hormones is most likely present in
this man? Response A
A. Vasopressin
51. Which imaging method is the best for evaluation of
B. Oxytocin
cystic pancreatic tumors?
C. Insulin A. Abdominal X ray
D. Growth hormone B. Contrast enhanced CT (computed tomography)
E. Prolactin C. Endoscopic ultrasound (EUS)
D. Ultrasound
46. A 57-year-old man is found comatose. On physical E. Magnetic resonance imaging (MRI)
examination he has decreased skin turgor.
Laboratory studies show a blood glucose of 780 Response E
mg/dL. Urinalysis reveals no ketosis or proteinuria, MEDICAL GENETICS (3x2=6P)
though there is 4+ glucosuria. Which of the
following is the most likely diagnosis? 52. Which thyroid carcinoma subtype is most associated
A. Neuroendocrine tumor secreting glucagon with a BRAF V600E mutation?
B. Type I diabetes mellitus A. Papillary thyroid carcinoma
C. Cushing syndrome B. Follicular thyroid carcinoma
D. Ingestion of a large quantity of sugar C. Anaplastic thyroid carcinoma
D. Medullary thyroid carcinoma C. Occurrence of menstruation <10 years of
E. Hürthle cell carcinoma chronological age.
D. True precocious puberty is GnRH Dependent
ANSWER: A (Central, True or Complete)
53. What is the primary cause of hypoparathyroidism in E. Incomplete precocious puberty is GnRH
DiGeorge Syndrome? Independent (Pseudo, Peripheral or Incomplete)
A. Autoimmune destruction of the parathyroid glands Answer: B
B. Microdeletion at chromosome 22q11.2 causing
parathyroid hypoplasia 58. Which of the following statements is false?
C. Excessive calcitonin secretion from the thyroid A. The pituitary gland is divided into two lobes, the
gland anterior and the posterior lobe.
D. Overactivity of the MEN1 gene B. The anterior pituitary makes up 80% of the pituitary
E. Mutation in the RET proto-oncogene gland and regulates growth, metabolism, and
reproduction through the production of various
ANSWER: B hormones.
54. What is the most common enzymatic defect causing C. The pituitary gland is connected to
Congenital Adrenal Hyperplasia? the hypothalamus via a stalk of blood vessels and
A. 11β-Hydroxylase deficiency nerves.
B. 21-Hydroxylase deficiency D. It communicates with the posterior pituitary by
C. 17α-Hydroxylase deficiency releasing hormones, whereas it communicates with
D. 3β-Hydroxysteroid Dehydrogenase deficiency the anterior pituitary using nerve impulses.
E. Aromatase deficiency E. The hypothalamus is a part of the brain that plays a
vital role in connecting the endocrine system
ANSWER: B and nervous system by communicating with the
pituitary gland in order to produce and secrete
PEDIATRICS (3x2=6P, 2x3=6P, T=12P) specific hormones for specific bodily functions.
55. Which of the following statements is false? Answer: D
A. The appearance of breast tissue, primarily due to the
action of estradiol from the ovaries. 59. Which of the following is not helpful in the
B. The first menstrual bleed, often not associated with diagnosis of thyroid diseases?
ovulation, caused solely by the effects of estradiol A. Visual & palpating method
on the endometrial lining. B. Investigation of thyroid function (basal level of
C. The time of the first sperm production, primarily due freeT3, freeT4), Functional tests (TSH)
to the effects of FSH and LH-induced testosterone C. USG, radiography.
production. D. Serological tests
D. The appearance of pubic hair, primarily due to the E. Genetic tests.
effects of estrogens from the adrenal gland.
E. It is a physiological phase lasting 2 to 5 years during Answer: E
which the genital organs mature.

Answer: D

56. Approximately how long does it take between breast

budding and menarche at puberty in girls?
A. 1 year
B. 1,5 years
C. 2 years
D. 2,5 years
E. 3 years

Answer: D

57. Which of the following is not true about precocious

puberty?
A. It is defined as pubertal onset at an age 2 to 3
standard deviations below the mean age of onset of
puberty.
B. Appearance of any secondary sexual characters <9
years.