I MBBS-CBME Curriculum
Questions on Endocrine system
1. A 35-year-old man with the height of 5 feet 6 inch comes to hospital for remarkable changes in his
appearance. Physical examination showed disproportionately enlarged hands and feet. Skin was
excessively moist, coarse, oily and thickened. Supraorbital ridges were prominent and jaw was
protruded. His fasting blood glucose level was 170 mg/dl. (1 + 3)
a) Name the clinical condition and the hormone level responsible for this.
b) Describe the mechanism of action and functions of the hormone involved
2 A 35 year old female visited the endocrinologist with complaints of swelling in the neck and
excessive sweating. She said that she lost almost 5 kgs despite an increase in her appetite over last 2-
3 months and senses that her heart is beating very fast. She also feels anxious most of the times. On
examination the doctor found her pulse to be 104 beats per minute, blood pressure130/70 mmHg,
fine tremors of hands.
2A) What may be most probable cause in this case? (1)
2B) Explain the basis of the tests you would suggest in such a case to confirm your diagnosis. (3)
2C) Describe the process of biosynthesis and storage of hormones involved in the case.
3 Name the thyroid function tests. Explain how the test results are altered in primary and secondary
hypothyroidism and hyperthyroidism? (4)
4 Describe the mechanism of action of Insulin.
5) A 12-year-old boy presents to the emergency department with complaints of weight loss,
fatigue, polyphagia, polydipsia, and polyuria. A urinalysis reveals glycosuria and markedly
elevated fasting blood sugar.
i) Name the clinical condition and mention its type. (1)
ii) Describe the pathophysiological basis of the above features (3)
6. A 50 year old housewife complains of progressive weight gain of 8 kg in one year, fatigue, loss of
memory, slow speech,deepening of her voice, dry skin, constipation, and cold intolerance. She is
moderately obese and speaks slowly and has a puffy face, with pale, cool, dry, and thick skin. She has
diffuse goiter; her serum T4 concentration is low and serum TSH concentration is elevated. Serum
cholesterol is slightly elevated.
Comment on the thyroid status in this patient and give reasons for the clinical manifestations. (3)
Describe the actions of thyroid hormones on intermediary metabolism and on the cardiovascular
system.(4)
7 Mention the role of TSH in normal thyroid function. Justify the reason for high TSH and cholesterol
levels in this patient.
8 Outline the steps in synthesis of steroid hormones from the adrenal cortex. Write briefly on
congenital adrenal hyperplasia.
9 A 46-year-old woman has hirsutism, hyperglycemia, obesity, hypertension and muscle wasting.
Probable diagnosis is made for Cushing's syndrome.
a) Which hormonal abnormality is responsible for the above-mentioned disease?
b) Based on the actions of the hormone, explain the features seen in this patient.
10 A 41-year-old woman had undergone thyroid surgery. Following surgery she developed
carpopedal spasms. Lab investigations revealed hypocalcemia, hyperphosphatemia, and
decreased urinary phosphate excretion.
a) Which hormone levels are abnormal in this patient and what is the most likely diagnosis?
b) Explain the physiological actions of the hormone involved in the above case.
11 A 55 year-old, female visits the OPD with complains of fever, restlessness and loss of weight.
Her lab tests reveal elevated T3 and decreased TSH. She is diagnosed with hyperthyroidism.
Explain other expected clinical findings in the patient. Give the basis of her T3 and TSH levels.
12 A 46-year-old woman has hirsutism, hyperglycemia, obesity, hypertension and muscle wasting.
Probable diagnosis is made for Cushing's syndrome.
a) Which hormonal abnormality is responsible for the above-mentioned disease?
b) Based on the actions of the hormone, explain the features seen in this patient.
13 A 41-year-old woman had undergone thyroid surgery. Following surgery she developed
carpopedal spasms. Lab investigations revealed hypocalcemia, hyperphosphatemia, and
decreased urinary phosphate excretion.
a) Which hormone levels are abnormal in this patient and what is the most likely diagnosis?
b) Explain the physiological actions of the hormone involved in the above case. (4)
14 A 35 year old female visited the endocrinologist with complaints of swelling in the neck and
excessive sweating. She said that she lost almost 5 kgs despite an increase in her appetite over
last 2-3 months and senses that her heart is beating very fast. She also feels anxious most of the
times. On examination the doctor found her pulse to be 104 beats per minute, blood pressure130/70
mmHg, fine tremors of hands.
2A) What may be most probable cause in this case? (1)
2B) Explain the basis of the tests you would suggest in such a case to confirm your diagnosis. (3)
2C) Describe the process of biosynthesis and storage of hormones involved in the case.
15. A 32-year-old man underwent a thyroid surgery that involved removal of considerable mass of
thyroid tissue. Soon after surgery, he develops paresthesia, tingling sensation and muscle cramps
involving the extremities. Chvostek sign was elicited.
A) Explain the method by which Chvostek sign is elicited? Explain the basis for the sign being
observed in this patient.(4)
B) Explain why the structures that are inadvertently removed along with the thyroid gland during
thyroid surgery are called essential endocrine glands. Explain the actions and regulation of secretion
of the hormone secreted by these glands.(6)
16 Name the thyroid function tests. Explain how the test results are altered in primary and secondary
hypothyroidism and hyperthyroidism? (4)
17. Explain the consequences and clinical features of hypersecretion and hyposecretion of growth
hormone before puberty
18. A two-year-old boy was brought to the clinic by his mother. The boy’s mother started to notice
that his legs were starting to bend outwards. As he was starting to walk, his left foot was bending
inwards. On examination, boy had skeletal deformities such as knock knees, thickened wrists and
ankles and breastbone projection. On investigation, a high alkaline phosphatase and low bone
mineral density was found. Along with the medications, doctor advised for fish, eggs, milk, and cod
liver oil to be added in the diet and recommended for everyday 10 to 15 minutes of exposure to
sunlight.
A. What is most probable clinical condition? 1
B. Explain the physiological basis for the skeletal deformities observed in the above case. 2
C. Name the hormone deficient in the above case- 1
19. A 35-year-old woman is admitted for fractured tibia. Bone scans of the spine and hip reveal low
bone density. Laboratory tests show normal plasma calcium but low vitamin-D levels.
(2 + 2 = 4 Marks)
a) Explain the mechanism of reduction of bone mass in this case.
b) Mention the role of other two hormones in maintaining the plasma calcium.
20. What is gigantism/acromegaly. Explain its clinical features giving physiological basis