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Question 1
Correct
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Beta and Delta Thalassemia are associated with abnormalities to which chromosome
Your Answer: Chromosome 11
Explanation:Fetal haemoglobin (HBF) is the main haemoglobin type in the foetus and persists after birth for around 6 months. Fetal haemoglobin is composed of two alpha and two gamma subunits The alpha globulin chain is coded for by genes on Chromosome 16. Alpha Thalassemia are therefore associated with Chromosome16 defects The beta and delta globulin chains are coded for by genes on Chromosome 11. Beta and Delta Thalassemia are therefore associated with Chromosome 11 Defects
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This question is part of the following fields:
- Endocrinology
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Question 2
Incorrect
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Which of the following causes an increase in Sex Hormone Binding Globulin (SHBG)?
Your Answer: Cushing's syndrome
Correct Answer: Liver cirrhosis
Explanation:Liver cirrhosis is known to lead to decreased levels of SHBG. Other causes of high SHBG are:
Oestrogens e.g. oral contraceptives
Pregnancy
Hyperthyroidism
Liver cirrhosis
Anorexia nervosa
Drugs e.g. anticonvulsants -
This question is part of the following fields:
- Endocrinology
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Question 3
Correct
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Adult Polycystic Kidney Disease (PKD) typically follows which pattern of inheritance
Your Answer: Autosomal Dominant
Explanation:Polycystic kidney disease (PKD) can either be autosomal dominant or recessive. The autosomal dominant variant is more common in adult PKD however, the recessive pattern is more common in infantile PKD.
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This question is part of the following fields:
- Endocrinology
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Question 4
Correct
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At ovulation the surge in LH causes rupture of the mature oocyte via action on what?
Your Answer: Theca externa
Explanation:The luteinizing hormone (LH) surge during ovulation causes: Increases cAMP resulting in increased progesterone and PGF2 production PGF2 causes contraction of theca externa smooth muscle cells resulting in rupture of the mature oocyte
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This question is part of the following fields:
- Endocrinology
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Question 5
Correct
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All the following hormones are products of placental synthesis, EXCEPT:
Your Answer: Prolactin
Explanation:The metabolic adaptations of pregnancy are orchestrated by hormones produced by the placenta and maternal pituitary gland, which undergo dramatic changes during gestation. After involution of ovarian sex steroid production by wk 6, placental oestrogen and progesterone production increases exponentially to term. Concurrently, there are progressive increases in prolactin (PRL), produced by the maternal pituitary gland and decidua, and human chorionic somatomammotropin (CSH, also called human placental lactogen), which has structural similarities to GH and PRL.
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This question is part of the following fields:
- Endocrinology
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Question 6
Incorrect
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Hirsutism can be found in all of the following conditions, EXCEPT:
Your Answer: Patient on danazol therapy
Correct Answer: Patient on oral contraceptive pills
Explanation:Classically, hirsutism has been considered a marker of increased androgen levels in females from increased production of androgens (i.e. testosterone) either by the adrenals or due to an ovarian disease. The ovarian causes for hyperandrogenism are polycystic ovarian syndrome (PCOS) and ovarian tumours. Adrenal causes include Cushing’s syndrome, androgen-producing tumours, and congenital adrenal hyperplasia (CAH), most commonly due to 21-hydroxylase deficiency. Less common causes include the hyperandrogenic-insulin resistant-acanthosis nigricans syndrome (HAIRAN). Hyperprolactinemia by increasing adrenal dehydroepiandrosterone sulphate (DHEA-S) production may cause hirsutism. Androgenic drugs are also an important cause of hirsutism. About 20% of the patients may present with idiopathic hirsutism (IH) with normal androgen levels and ovarian function. The cause of increased hair in these women is thought to be related to disorders in peripheral androgen activity. Onset of IH occurs shortly after puberty with slow progression. PCOS and IH account for 90% of the hirsutism in women. Hirsutism can also occur in some premenopausal women and continue for a few years after menopause. This is due to decrease in ovarian oestrogen secretion with continuous androgen production.
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This question is part of the following fields:
- Endocrinology
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Question 7
Incorrect
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What percentage of testosterone is bound to SHBG?
Your Answer: 97%
Correct Answer: 70%
Explanation:About 97% of the testosterone that is secreted loosely binds to the SHBG and circulates in the blood for several hours in this bound state until it is transported to the target organs.
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This question is part of the following fields:
- Endocrinology
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Question 8
Incorrect
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Which of the following drugs is associated with reduced milk production whilst breastfeeding?
Your Answer: Atenolol
Correct Answer: Cabergoline
Explanation:Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.
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This question is part of the following fields:
- Endocrinology
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Question 9
Incorrect
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Which of the following changes would you expect in pregnancy?
Your Answer: Increased TSH Decreased Total T3 and T4
Correct Answer: Decreased TSH Increased Total T3 and T4
Explanation:Human chorionic gonadotrophin (hCG) has thyrotrophic activity owing to subunit homology with thyroid-stimulating hormone (TSH) and maternal TSH production is suppressed during the first trimester of pregnancy, when hCG levels are highest. The TSH response to thyrotrophin-releasing hormone (TRH) is reduced during the first trimester but returns to normal after this. Thyroid binding globulin increases in the first 2 weeks of pregnancy and reaches a plateau by 20 weeks. This leads to increased production of total T3 (tri-iodothyronine) and T4 (thyroxine).
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This question is part of the following fields:
- Endocrinology
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Question 10
Incorrect
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Delayed puberty in girls is defined as?
Your Answer: Absence of breast development in girls beyond 15 years old
Correct Answer: Absence of breast development in girls beyond 13 years old
Explanation:Breast development occurs from the age of 9-13 at the onset of puberty. Delayed puberty is defined as the absence of breast development after the age of 13.
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This question is part of the following fields:
- Endocrinology
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Question 11
Incorrect
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Where are ADH (vasopressin) and Oxytocin synthesised?
Your Answer:
Correct Answer: Hypothalamus
Explanation:ADH and vasopressin are synthesized in the supraoptic and periventricular nuclei of the hypothalamus, they are eventually transported to the posterior pituitary where they are stored to be released later.
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This question is part of the following fields:
- Endocrinology
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Question 12
Incorrect
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The following hormones are secreted from the anterior pituitary gland, EXCEPT:
Your Answer:
Correct Answer: HCG
Explanation:The following hormones are excreted from the anterior pituitary gland: TSH, GN, ACTH, LH, FSH, MSH, PRL.
Human chorionic gonadotropin (hCG, or human chorionic gonadotrophin) is a placental hormone secreted by syncitiotrophoblasts during the second week of gestation. -
This question is part of the following fields:
- Endocrinology
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Question 13
Incorrect
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer:
Correct Answer: Estriol
Explanation:Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.
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This question is part of the following fields:
- Endocrinology
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Question 14
Incorrect
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Where is fetal DHEA produced?
Your Answer:
Correct Answer: Adrenals
Explanation:DHEA is formed in the mother’s adrenal gland as well as the fetal adrenal glands. These weak androgens are transported by the blood to the placenta and are converted into oestradiol, estrone and estriol in the trophoblast.
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This question is part of the following fields:
- Endocrinology
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Question 15
Incorrect
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Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism
Your Answer:
Correct Answer: Endocrine
Explanation:Endocrine hormones are released from their site of origin and travel through the blood to act on other distant target organs. Autocrine hormones act within the same cell and exocrine glands secrete their products into ducts.
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This question is part of the following fields:
- Endocrinology
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Question 16
Incorrect
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Human Chorionic Gonadotrophin (HCG) is structurally similar to which of the following hormones?
Your Answer:
Correct Answer: Thyroid Stimulating Hormone (TSH)
Explanation:TSH, FSH, LH and HCG are all similar glycoproteins. These hormones consist of a common α-subunit and specific β-subunit. All are glycosylated, which determines their bioactivity and half-life.
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This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer:
Correct Answer: Estriol
Explanation:The 3 main oestrogens are Estrone (E1) Oestradiol (E2) and Estriol (E3). Oestradiol is the predominant oestrogen during female reproductive years except during the early follicular phase when Estrone predominates. During pregnancy Estriol levels rise significantly and this becomes the dominant oestrogen during pregnancy. Ethinylestradiol and Mestranol are oestrogen found in COCP’s
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This question is part of the following fields:
- Endocrinology
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Question 18
Incorrect
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Prognathism and macroglossia are features of which of the following?
Your Answer:
Correct Answer: Acromegaly
Explanation:These are features of excess growth hormone i.e. Acromegaly. Down’s and Cri du chat typically cause Micrognathia (small jaw)
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This question is part of the following fields:
- Endocrinology
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Question 19
Incorrect
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Oxytocin causes increased myometrial contraction via which of the following messenger pathways?
Your Answer:
Correct Answer: Activates phospholipase-C which produces IP3 which triggers intracellular Calcium ion release
Explanation:Oxytocin acts via the G protein receptors and the calcium-calmodulin complex. It activates phospholipase C which produces IP3 to further trigger the calcium-calmodulin complex increasing intracellular Ca ion release.
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This question is part of the following fields:
- Endocrinology
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Question 20
Incorrect
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A patient with amenorrhoea is seen in clinic. History and examination reveal the patient runs 10-20 miles every day and her BMI is 17.8. Which of the following is likely to explain her symptoms?
Your Answer:
Correct Answer: WHO type I Ovulation Disorders
Explanation:World Health Organization (WHO) Group I ovulation disorder is due to hypothalamic pituitary failure. This is sometimes termed hypothalamic amenorrhoea or hypogonadotropic hypogonadism. Women can improve frequency of ovulation, conception and an uncomplicated pregnancy by increasing their body weight (if BMI of <19) and/or moderating their exercise levels (if they undertake high levels of exercise). GnRH and LH may be administered in these patients. PCOS falls under type II ovulation disorders. WHO Group III ovulation disorder is due to ovarian failure.
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This question is part of the following fields:
- Endocrinology
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Question 21
Incorrect
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Question 22
Incorrect
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What percentage of children does delayed puberty occur in?
Your Answer:
Correct Answer: 3%
Explanation:Delayed puberty is defined as the absence of breast development in girls beyond the age of 13, and the absence of testicular development in boys beyond the age of 14. The incidence of delayed puberty is 3%, with the condition being more common in boys.
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This question is part of the following fields:
- Endocrinology
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Question 23
Incorrect
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Aromatase is key to Oestradiol production in the ovaries. Which of the following statements is true?
Your Answer:
Correct Answer: FSH induces the granulosa cells to make aromatase
Explanation:The two main cell types of the ovaries:
1. The theca cells produce androgen in the form of androstenedione. The theca cells are not able to convert androgen to oestradiol themselves. The produced androgen is therefore taken up by granulosa cells.
2. The neighbouring granulosa cells then convert the androgen into oestradiol under the enzymatic action of aromatase FSH induces the granulosa cells to produce aromatase for this purpose -
This question is part of the following fields:
- Endocrinology
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Question 24
Incorrect
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Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism
Your Answer:
Correct Answer: Endocrine
Explanation:Hormones that are secreted into the circulation at one site but have effects on distal target organs are endocrine as is the case with the hormones above. Autocrine and Intracrine messengers act within the same cell. Exocrine glands secrete their products into ducts. Apocrine is a histological term used to describe some types of exocrine gland.
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This question is part of the following fields:
- Endocrinology
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Question 25
Incorrect
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A 32 year old woman with a 6 month history of fatigue and some weight gain reports to clinic for a review. Her medical records show evidence of hypothyroidism. On examination, a non tender, hard goitre is palpated. Further tests reveal elevated anti TPO (anti thyroid peroxidase) and anti -Tg (anti thyroglobulin). Which of the following conditions is most likely to present like this?
Your Answer:
Correct Answer: Hashimoto's
Explanation:The case presented points to a diagnosis of an autoimmune thyroiditis leading to hypothyroidism. The most common form of autoimmune hypothyroidism, Hashimoto’s, often presents with a goitre, positive for antibody tests against thyroid components i.e. anti-TPO and anti-thyroglobulin. Graves disease and toxic diffuse goitre are more likely to cause hyperthyroidism. While De-Quervain’s and endemic goitre may cause hypothyroidism, they don’t result in positive antibody tests.
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This question is part of the following fields:
- Endocrinology
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Question 26
Incorrect
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What is the definition of puberty in girls?
Your Answer:
Correct Answer: Becoming capable of sexual reproduction
Explanation:Puberty is the process of reproductive and sexual development and the maturation which changes a child into an adult.
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This question is part of the following fields:
- Endocrinology
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Question 27
Incorrect
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All of the following are autosomal recessive conditions EXCEPT which one?
Your Answer:
Correct Answer: Osteogenesis Imperfecta
Explanation:Osteogenesis imperfect is an autosomal dominant condition. All the rest of the options are autosomal recessive conditions.
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This question is part of the following fields:
- Endocrinology
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Question 28
Incorrect
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In relation to ovulation, when does the LH surge occur?
Your Answer:
Correct Answer: 24-36 hours before ovulation
Explanation:Ovulation usually occurs on day 14 in a typical 28-day cycle. Luteinizing hormone levels spike as a result of increased oestrogen levels secreted from maturing follicles. This LH spike occurs about 24-36 hours before the release of the oocyte from the mature follicle.
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This question is part of the following fields:
- Endocrinology
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Question 29
Incorrect
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Which of the following is the primary source of oestrogen ?
Your Answer:
Correct Answer: Granulosa cells
Explanation:Ovarian granulosa cells (GC) are the major source of oestradiol synthesis. Induced by the preovulatory luteinizing hormone (LH) surge, cells of the theca and, in particular, of the granulosa cell layer profoundly change their morphological, physiological, and molecular characteristics and form the progesterone-producing corpus luteum that is responsible for maintaining pregnancy.
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This question is part of the following fields:
- Endocrinology
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Question 30
Incorrect
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Raised FSH levels are found in all of the following conditions, EXCEPT:
Your Answer:
Correct Answer: Women on combined oral contraceptive pills
Explanation:Oestrogen- and progesterone-containing oral contraceptives inhibit LH, which suppresses the FSH and LH levels, preventing follicular development and ovulation. Combined pills suppress FSH and LH throughout the cycle, inhibit endometrial proliferation, and produce a scanty cervical mucus.
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This question is part of the following fields:
- Endocrinology
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