Sample MCQs

by

Dr. Lawrence Kindo

2008
Sample MCQs Questions
1. The Thyroid gland secretes Thyroid hormone (Thyroxine) in the form of Tetroiodothyronine (T4) and
Triiodothyronine (T3). Choose the most appropriate answer from the following options regarding the
thyroid hormone.
a) T3 hormone is 100 percent secreted by the Thyroid gland.
b) T4 is the most active form of the hormone.
c) The Thyroid hormone is mostly present in the blood in its free form, which is the inactive form of
the hormone.
d) Cretinism is a disease that develops in children with a deficiency of Thyroxine.
e) TSH will be high in patients with elevated levels of T3 and T4.
2. Which among the following is a true statement with regards to hyperthyroidism?
a) Active T3 and T4 are decreased and TSH is increased.
b) Grave’s disease or Toxic diffuse goitre is a rare cause of hyperthyroidism.
c) Beta-blockers are used in hyperthyroidism to control the symptoms associated with the disease.
d) Hyperthyroidism is characterised by very severe weight gain with constipation.
e) Myxedema is a life-threatening syndrome of full-blown hyperthyroidism and requires emergent
use of anti-thyroid drugs like propylthiouracil.
3. A young man in his 30’s is brought to the Emergency Department of a hospital with complaints of
hyperactivity, irritability and dysphoria, and constant loss of weight despite having a voracious appe-
tite. He is sweating profusely, complains that the AC is not working properly, and that, he can feel his
heart beating fast because of the excessive heat. On examination, the patient has a warm, moist skin
with muscle weakness and gynaecomastia. What is the most likely diagnosis in this patient?
a) Type I Diabetes Mellitus with little or no insulin production
b) Graves’ disease or Thyrotoxicosis
c) Cushing’s Syndrome
d) Hypopituitarism
e) Hyperparathyroidism
4. Which among the following features of acute adrenal insufficiency is characteristic of the disease?
a) Hyponatremia
b) Hyperkalemia
c) Hypotension and hypovolemic shock
d) Nausea and vomiting
e) Fever and weakness

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Sample MCQs Questions
5. Osteoporosis is caused by all of the following, except:
a) Fluorosis
b) Steroid use
c) Hyperparathyroidism
d) Thyrotoxicosis
e) Malnutrition
6. The most important step in the treatment of pulmonary edema is the initial stabilization. All of the
following statements are true about initial stabilization, except:
a) High-flow oxygenation by facemask, noninvasive ventilation or mechanical ventilation.
b) Nitro-vasodilators in patients with systolic blood pressure more than 120 mmHg to decrease
vascular resistance
c) Aggressive suctioning will help in managing the profuse secretions.
d) Low doses of furosemide and morphine.
e) To achieve arrhythmia control at the earliest.
7. The most useful ancillary test to establish the presence of pulmonary edema is:
a) Brain Natriuretic Peptide (BNP) or Pro NT-BNP
b) Chest radiography
c) 12-lead electrocardiogram
d) Fibreoptic Bronchoscopy
e) Esophageal Doppler
8. A patient is admitted to the ICU with features of meningitis. A cerebrospinal fluid analysis is
performed and a blood sugar is taken simultaneously. The sugar is found to be normal. What will be
the normal CSF glucose in this patient?
a) 20-40 mg/dl
b) 40-70 mg/dl
c) 70-90 mg/dl
d) 90-110 mg/dl
e) > 100 mg/dl

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Sample MCQs Answer Keys with references

1. The answer is d. Cretinism is a disease that develops in children with a deficiency of Thyroxine.
(Harrison’s Principles of Internal Medicine 17th Edition (2008)/Chapter 335)
- T4 hormone is 100 percent secreted by the Thyroid gland and not T3
- T3 is the most active form of the hormone
- The Thyroid hormone is present in the blood mostly bound to Thyroid binding globulin (TBG) and
albumin.
- When the T3 and T4 levels are elevated as in hyperthyroidism, TSH levels are reduced by negative
feedback mechanism.
2. The answer is c. Beta-blockers are used in hyperthyroidism to control the symptoms associated
with the disease. (Harrison’s Principles of Internal Medicine 17th Edition (2008)/Chapter 335)
- Active T3 and T4 are elevated in Hyperthyroidism and TSH is reduced because of a negative feedback
mechanism.
- Grave’s disease or Toxic diffuse goitre is the commonest cause of hyperthyroidism. Accounts for 60-
80% of thyrotoxicosis.
- Thyrotoxicosis may cause unexplained weight loss, despite an enhanced appetite, due to the in-
creased metabolic rate. Weight gain occurs in 5% of patients, however, because of increased food
intake. It is commonly associated with diarrhoea.
- Myxedema Coma is a life-threatening syndrome of full-blown hypothyroidism and requires emer-
gent use of parenteral Thyroxine.
3. The answer is b. Graves’ disease or Thyrotoxicosis. (Harrison’s Principles of Internal Medicine 17th
Edition (2008)/Chapter 335)
- Type 1 diabetes is the result of complete or near-total insulin deficiency due to autoimmune de-
struction of ‌β- islet cells of the pancreas. They usually present before 35 years of age. However, the
symptom-complex is characteristic. They complain of polyuria, polydipsia and polyphagia or come
with features of diabeti ketoacidosis which present with nausea, vomiting, lethargy, abdominal pain
and coma.
- Cushing’s Syndrome is a syndrome characterized by truncal obesity, hypertension, fatigability and
weakness, amenorrhea, hirsutism, purplish abdominal striae, edema, glucosuria, osteoporosis, and
a basophilic tumor of the pituitary. It is caused by increased cortisol secretion in vivo or high-dose
glucocorticoids for management of diseases like Asthma.
- Hypopituitarism results from impaired production of one or more of the anterior pituitary trophic
hormones are are mainly developmental or genetic disorders. TSH deficiency in the later stages of
the disease causes growth retardation in children and features of hypothyroidism in children and in
adults.
- Half or more of patients with hyperparathyroidism are asymptomatic. Manifestations of hyperpara-
thyroidism involve primarily the kidneys and the skeletal system. There may be easy fatigability and
atrophy of muscles. They commonly have renal stones and a characteristic bone disorder termed
osteitis fibrosa cystica.

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Sample MCQs Answer Keys with references
4. The answer is a. Hyponatremia. (Harrison’s Principles of Internal Medicine 17th Edition (2008)/Chap-
ter 335, Bongard F. S., Sue D. Y. and Vintch J. R. E., Current Diagnosis and Treatment Critical Care 3rd
Edition (2008) pp. 573)
- All the options given are features associated with acute adrenal insufficiency, however, hypona-
tremia is considered a hallmark of adrenal insufficiency. It is typically due to lack of aldosterone, a
mineralocorticoid, causing an inability to conserve sodium in the face of hypovolemia. Hence, hy-
ponatremia is the best answer of the lot.
5. The answer is a. Fluorosis. (Harrison’s Principles of Internal Medicine 17th Edition (2008)/Chapter 348
and Chapter 71)
- Steroid use, Hyperparathyroidism, Thyrotoxicosis and malnutrition are all associated with osteopo-
rosis.
- Dental and skeletal Fluorosis is associated with mottled and pitted defects in tooth enamel as well
as brittle bone, respectively. Brittle bone is due to underlying osteosclerosis from excess fluoride.
6. The answer is c. Aggressive suctioning will help in managing the profuse secretions. (Fink M. P.,
Abraham E., Vincent J. L. and Kochanek P. M., Textbook of Critical Care 5th Edition (2008) pp. 719-
731)
- Aggressive suctioning of secretions in pulmonary edema is contraindicated and can further increase
the pink frothy secretions by aggravating the alveolar-capillary leak.
- Intravenous Furosemide 40-80 mg bolus along with Intravenous Morphine upto 3 mg induces mild
diuresis and preload reduction and assists in reducing patient anxiety.
- Intravenous Nitrates improve patient outcome by averting respiratory failure and reducing the need
for mechnical ventilation.
7. The answer is b. Chest radiography. (Fink M. P., Abraham E., Vincent J. L. and Kochanek P. M., Textbook
of Critical Care 5th Edition (2008) pp. 719-731)
- Radiographic signs of pulmonary edema are:
i. Signs of pulmonary congestion such as “cephalization”, which is the redistribution of blood flow to
the upper lung fields and Kerley-B lines.
ii. Predominant interstitial lines, reflecting pulmonary interstitial edema and diffuse small nodular
opacities that progressively coalesce in the inner two-thirds of the lung field producing the “butterfly”
appearance.
- Differentiation between cardiogenic and non-cardiogenic pulmonary edema is however not definitive
using chest radiograph.
- BNP or Pro NT-BNP and 12-lead electrocardiogram are specific for cardiogenic cause and are used
for differentiating cardiac versus non-cardiac pulmonary edema.
- Fibre optic Bronchoscopy and Esophageal Doppler have no role in the diagnosis of pulmonary
edema.
8. Answer is b. 40-70 mg/dL. (Harrison’s Principles of Internal Medicine 17th Edition (2008)/Table 6 in
Appendix)
- Total CSF glucose amounts to 40-70 mg/dL.

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Sample MCQs

All these MCQs have been

crafted with detailed analysis of
the subject matter. It analyses
the in-depth knowledge of the
person answering the questions,
and provides an easy approach to
remember tough topics on the go.

Drafting each MCQ requires

sufficient amount of time to review
associated facts and details, to
avoid any erroneous questions or
answer options.

References are drawn from the

latest and most reliable textbooks
available in the particular topics
of interest for authenticity

© 2008 Dr. Lawrence Kindo