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FMGE Endocrinology MCQs - Medicine

Here are 20 high-yield FMGE-pattern MCQs covering all major endocrinology topics tested in the exam.

DIABETES MELLITUS

Q1. A 45-year-old obese male is found to have fasting plasma glucose of 130 mg/dL on two separate occasions. He is asymptomatic. Which of the following is the MOST appropriate next step?

A) Oral glucose tolerance test (OGTT) B) Insulin level C) Lifestyle modification and repeat fasting glucose in 3 months D) Start metformin

Answer: D - Start metformin

Fasting plasma glucose ≥126 mg/dL on two occasions confirms Type 2 DM. Metformin is first-line therapy alongside lifestyle modification. - Katzung's Pharmacology

Q2. A 16-year-old male presents with polyuria, polydipsia, and weight loss. His blood glucose is 420 mg/dL. Urinalysis shows glucose +++ and ketones +++. Which autoantibody is MOST specific for his condition?

A) Anti-dsDNA B) Anti-GAD65 (Anti-glutamic acid decarboxylase) C) Anti-mitochondrial antibody D) Anti-smooth muscle antibody

Answer: B - Anti-GAD65

Type 1 DM is an autoimmune condition. GAD65, IA-2, and insulin autoantibodies are characteristic markers. HLA-DR3 and HLA-DR4 confer susceptibility. - Henry's Clinical Diagnosis & Management by Laboratory Methods

Q3. A patient with Type 2 DM has HbA1c of 9.2% despite maximum metformin. He has CKD stage 3 (eGFR 38 mL/min). Which drug should be AVOIDED?

A) Sitagliptin B) Insulin glargine C) Metformin D) Empagliflozin

Answer: C - Metformin

Metformin is contraindicated when eGFR <30 mL/min due to risk of lactic acidosis. It should be used with caution and generally avoided at eGFR <45 mL/min. - Katzung's Basic and Clinical Pharmacology, 16th Ed.

Q4. In diabetic ketoacidosis (DKA), the primary hormonal change is:

A) Excess insulin with low glucagon B) Insulin deficiency with excess counter-regulatory hormones C) Excess ADH with low cortisol D) High aldosterone with low insulin

Answer: B - Insulin deficiency with excess counter-regulatory hormones

DKA results from absolute insulin deficiency plus excess glucagon, cortisol, catecholamines, and GH. This drives lipolysis, free fatty acid oxidation, and ketone body production. - Guyton & Hall Medical Physiology

Q5. Which is the BEST marker for long-term glycemic control over the past 2-3 months?

A) Fasting blood glucose B) Postprandial glucose C) HbA1c D) Fructosamine

Answer: C - HbA1c

HbA1c reflects average blood glucose over the lifespan of red blood cells (~120 days). Target is <7% for most diabetic patients. - Guyton & Hall Medical Physiology

THYROID DISORDERS

Q6. A 32-year-old woman presents with weight loss, palpitations, heat intolerance, and exophthalmos. TSH is undetectable and free T4 is markedly elevated. The MOST likely diagnosis is:

A) Toxic multinodular goiter B) Subacute (de Quervain) thyroiditis C) Graves' disease D) Thyroid carcinoma

Answer: C - Graves' disease

Graves' disease is the most common cause of hyperthyroidism and is caused by TSH receptor-stimulating antibodies (TRAb). It uniquely causes exophthalmos (pretibial myxedema, acropachy). - Fitzpatrick's Dermatology

Q7. A 40-year-old woman presents with fatigue, weight gain, constipation, cold intolerance, and a puffy face. TSH is 58 mIU/L and free T4 is low. What is the MOST COMMON cause of this condition worldwide?

A) Hashimoto's thyroiditis B) Iodine deficiency C) Post-radioiodine ablation D) Pituitary adenoma

Answer: B - Iodine deficiency

Iodine deficiency is the most common cause of hypothyroidism worldwide. In developed countries, Hashimoto's (autoimmune) thyroiditis is the most common cause. - Fitzpatrick's Dermatology

Q8. Which of the following is the BEST initial screening test for thyroid disease?

A) T3 level B) T4 level C) TSH (Thyroid-stimulating hormone) D) Anti-TPO antibody

Answer: C - TSH

TSH is the most sensitive screening test for primary thyroid dysfunction - elevated in hypothyroidism, suppressed or absent in hyperthyroidism. - Fitzpatrick's Dermatology

Q9. A patient on amiodarone develops thyroid dysfunction. Amiodarone-induced thyrotoxicosis Type 1 is differentiated from Type 2 by:

A) Type 1 has destructive thyroiditis; Type 2 has excess iodine-induced synthesis B) Type 1 is iodine-induced excess synthesis; Type 2 is destructive thyroiditis C) Both types are due to the same mechanism D) Type 1 requires surgery; Type 2 responds to thionamides

Answer: B - Type 1 is iodine-induced; Type 2 is destructive

Amiodarone contains ~37% iodine by weight. Type 1 = excess iodine-driven synthesis (treat with thionamides). Type 2 = destructive thyroiditis releasing stored hormone (treat with corticosteroids). - Braunwald's Heart Disease

ADRENAL DISORDERS

Q10. A 35-year-old woman has central obesity, moon facies, purple striae, and hypertension. 24-hour urinary free cortisol is elevated. The overnight 1 mg dexamethasone suppression test does NOT suppress cortisol. Which test should be done NEXT to identify the SOURCE?

A) MRI brain B) ACTH level C) Random serum cortisol D) Aldosterone level

Answer: B - ACTH level

Once hypercortisolism is confirmed, ACTH level differentiates ACTH-dependent (pituitary/ectopic - ACTH elevated) from ACTH-independent (adrenal adenoma/carcinoma - ACTH suppressed) Cushing's syndrome. - Henry's Clinical Diagnosis & Management

Q11. A patient with Cushing's disease (pituitary adenoma) undergoes high-dose dexamethasone suppression test (8 mg). What result is expected?

A) No suppression of cortisol B) Suppression of cortisol by >50% C) Paradoxical rise in cortisol D) Suppression of ACTH only

Answer: B - Suppression of cortisol by >50%

In Cushing's disease (pituitary ACTH-secreting adenoma), the feedback threshold is high but not absent. High-dose dexamethasone (8 mg) suppresses cortisol by >50%. Ectopic ACTH tumors and adrenal adenomas do NOT suppress. - Henry's Clinical Diagnosis & Management; Kaplan & Sadock

Q12. A 28-year-old man presents with episodic severe headache, sweating, and palpitations. BP during attacks reaches 230/130 mmHg. 24-hour urine shows markedly elevated metanephrines and VMA. The MOST likely diagnosis is:

A) Essential hypertension B) Conn's syndrome C) Pheochromocytoma D) Renal artery stenosis

Answer: C - Pheochromocytoma

Pheochromocytoma classically presents with the triad of episodic headache, sweating, and palpitations. Elevated urinary catecholamines, metanephrines, and VMA confirm diagnosis. - Bradley & Daroff's Neurology; Campbell-Walsh Urology

Q13. Preoperative management of a pheochromocytoma patient requires:

A) Beta-blocker FIRST, then alpha-blocker B) Alpha-blocker FIRST, then beta-blocker if needed C) Only IV fluids and monitoring D) Calcium channel blocker alone

Answer: B - Alpha-blocker FIRST, then beta-blocker

Phenoxybenzamine (alpha-blocker) must be started first. Starting a beta-blocker first without alpha-blockade risks unopposed alpha-stimulation causing hypertensive crisis. - Fuster & Hurst's The Heart

Q14. A patient with Addison's disease presents in Addisonian crisis with hypotension, hypoglycemia, hyponatremia, and hyperkalemia. What is the IMMEDIATE treatment?

A) Oral fludrocortisone B) IV hydrocortisone 100 mg stat C) IV aldosterone D) Oral prednisolone

Answer: B - IV hydrocortisone 100 mg stat

Acute adrenal crisis is life-threatening. Immediate IV hydrocortisone (100 mg bolus), IV saline, and glucose are required. Fludrocortisone is added later for mineralocorticoid replacement. - Goldman-Cecil Medicine

PITUITARY DISORDERS

Q15. A 40-year-old man has progressive enlargement of hands, feet, and facial features over 5 years. He also reports headaches and bilateral visual field defects. What is the BEST confirmatory test for his diagnosis?

A) Serum GH after glucose load (GH suppression test) B) Random serum GH C) IGF-1 level alone D) MRI pituitary without any biochemical test

Answer: A - GH suppression test (oral glucose load)

In acromegaly, GH fails to suppress below 1 ng/mL after a 75 g oral glucose load (normal GH suppresses to <1 ng/mL). This is the GOLD STANDARD confirmatory test. - Washington Manual of Medical Therapeutics; Ganong's Physiology

Q16. A 45-year-old woman presents with amenorrhea, galactorrhea, and infertility. Serum prolactin is 180 ng/mL. MRI shows a 15 mm pituitary lesion. The FIRST-LINE treatment is:

A) Bromocriptine/Cabergoline (dopamine agonist) B) Transsphenoidal surgery C) Radiotherapy D) Octreotide

Answer: A - Dopamine agonist (Cabergoline/Bromocriptine)

Dopamine agonists are first-line for prolactinomas (both micro and macroadenomas). They reduce prolactin levels and tumor size in >80% of cases. Surgery is reserved for resistance or intolerance. - Ganong's Physiology

Q17. SIADH is characterized by all of the following EXCEPT:

A) Hyponatremia B) Low urine osmolality C) Inappropriately elevated urine osmolality D) Euvolemia

Answer: B - Low urine osmolality

SIADH features: hyponatremia + inappropriately HIGH urine osmolality (>100 mOsm/kg) + euvolemia + low serum osmolality. Urine osmolality is NOT low - that would suggest psychogenic polydipsia or central DI. - Neuroanatomy through Clinical Cases; Goodman & Gilman's Pharmacology

PARATHYROID & CALCIUM METABOLISM

Q18. A 55-year-old woman is found on routine labs to have serum calcium of 11.8 mg/dL, low phosphate, and elevated PTH. She is asymptomatic. The MOST likely diagnosis is:

A) Secondary hyperparathyroidism B) Malignancy-associated hypercalcemia C) Primary hyperparathyroidism D) Familial hypocalciuric hypercalcemia (FHH)

Answer: C - Primary hyperparathyroidism

Primary hyperparathyroidism: elevated calcium + elevated (or inappropriately normal) PTH. Most common cause is a parathyroid adenoma. Most patients today are asymptomatic at diagnosis. - Current Surgical Therapy; Cummings Otolaryngology

Q19. How do you distinguish primary hyperparathyroidism from familial hypocalciuric hypercalcemia (FHH)?

A) Urine calcium:creatinine excretion ratio - <0.01 in FHH B) PTH level - PTH is always suppressed in FHH C) Serum calcium - higher in primary hyperparathyroidism D) MRI scan - parathyroid adenoma always visible in HPT

Answer: A - Urine calcium:creatinine ratio <0.01 in FHH

FHH is a benign autosomal dominant condition (CaSR mutation) with hypercalcemia but LOW urinary calcium excretion. Urine calcium:creatinine ratio <0.01 distinguishes FHH from primary hyperparathyroidism. - Scott-Brown's Otorhinolaryngology

Q20. A 12-year-old boy is brought with carpopedal spasm. Serum calcium is 6.8 mg/dL, phosphate is high, and PTH is undetectable. What is the MOST likely diagnosis?

A) Vitamin D deficiency rickets B) Hypoparathyroidism C) Pseudohypoparathyroidism D) Malabsorption syndrome

Answer: B - Hypoparathyroidism

Hypoparathyroidism: low calcium + HIGH phosphate + absent/low PTH. The key differentiator from pseudohypoparathyroidism (resistance to PTH) where PTH is high but calcium is low and phosphate is high. - Guyton & Hall; Costanzo Physiology

Quick FMGE Endocrinology High-Yield Summary

Topic	Key Point
DKA vs HHS	DKA = younger, Type 1, ketones present; HHS = older, Type 2, extreme hyperglycemia, no ketones
Graves' vs Hashimoto's	Graves' = TSH-R Ab, hyperthyroid; Hashimoto's = Anti-TPO/Anti-Tg, hypothyroid
Cushing's disease vs Cushing's syndrome	Disease = pituitary ACTH-secreting adenoma; Syndrome = any cause of hypercortisolism
Pheochromocytoma	Rule of 10s: 10% bilateral, 10% malignant, 10% extra-adrenal; alpha-block FIRST
Acromegaly diagnosis	GH suppression test (glucose load) is gold standard
SIADH	Euvolemic hyponatremia + HIGH urine osmolality + LOW serum osmolality
Primary HPT	High Ca, high PTH, low PO4; most commonly parathyroid adenoma
Prolactinoma	First-line = dopamine agonist (Cabergoline > Bromocriptine)

These 20 MCQs cover all the major FMGE endocrinology topics: diabetes mellitus, thyroid disorders, adrenal disorders (Cushing's, Addison's, pheochromocytoma), pituitary disorders (acromegaly, prolactinoma, SIADH), and parathyroid disease. All answers are sourced from standard textbooks used in medical education (Goldman-Cecil Medicine, Guyton & Hall, Katzung's Pharmacology, Ganong's Physiology, and Robbins Pathology).

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