FCPS IMM Endocrinology MCQs: High-Yield Practice Questions & Prep

Sample FCPS IMM Medicine endocrinology MCQs on thyroid disease, Cushing syndrome, adrenal insufficiency, pituitary disorders and diabetes, with explanations.

Endocrinology in IMM is dominated by thyroid disease, the adrenal axis, pituitary disorders, calcium disorders and diabetes with its complications. Questions usually give a lab pattern and ask for the diagnosis or the confirmatory test. Here is a sample set.

Sample Endocrinology MCQs

1. A 45-year-old man has bitemporal hemianopia and spade-like hands. What is the definitive test to confirm the diagnosis?

A) Oral glucose tolerance test with serial growth hormone measurements ✅
B) Insulin tolerance test
C) Early morning growth hormone
D) Random insulin-like growth factor 1 (IGF1)

Why: Failure of growth hormone to suppress below 1 microgram/L (2 mU/L) during an oral glucose tolerance test is the confirmatory test for acromegaly. IGF-1 is the screening test.

2. A 40-year-old woman of normal weight has fatigue. On investigation she has low glucose, and serum cortisol and ACTH are decreased. What is your diagnosis?

A) Secondary adrenal insufficiency ✅
B) Hyperinsulinaemia
C) Cushing syndrome
D) Addison's disease

Why: Low cortisol with low ACTH indicates a pituitary (secondary) cause of adrenal insufficiency, and in primary Addison disease ACTH would be high.

3. A 16-year-old female has hypertension and increasing weight. Which of the following features would be most suggestive of Cushing syndrome rather than simple obesity?

A) Moon face
B) Acanthosis nigricans
C) Amenorrhoea
D) Abdominal striae ✅

Why: Purple abdominal striae, bruising and proximal myopathy are the most discriminating signs of Cushing syndrome. Moon face, acanthosis and amenorrhoea can occur in simple obesity.

4. A 55-year-old diabetic male on treatment for manic depressive illness had lung resection done previously. Now he has polyuria, nocturia and intense thirst, serum Na 142, BSR 180 mg/dL and urine osmolality 150 mOsm/kg. What is the most probable cause of his symptoms?

A) Renal glycosuria
B) SIADH
C) Diabetes insipidus ✅
D) Psychogenic polydipsia

Why: Lithium causes nephrogenic diabetes insipidus, with dilute urine and polyuria despite normal-high sodium, and the blood glucose level does not explain it.

5. A 50-year-old male, obese with BMI 38, complains of increased thirst and urination. He was otherwise normal. What will be your first diagnostic test in such a patient?

A) Random glucose test
B) HbA1C
C) Glucose tolerance test
D) Fasting blood glucose test ✅

Why: Fasting plasma glucose of 7 mmol/L (126 mg/dL) or more in a symptomatic patient is diagnostic of diabetes and is the standard first test.

6. A 49-year-old diabetic and hypertensive man has had MI 1 year back. He complains of getting overweight in the past few months. Which drug do you think contributes to his weight gain?

A) Statins
B) Gliclazide ✅
C) Metformin
D) Clopidogrel
E) Losartan

Why: Sulphonylureas such as gliclazide stimulate insulin secretion and cause weight gain, while metformin is weight-neutral.

7. An old type 2 diabetic female presents to the emergency room. You suspect a diagnosis of hyperosmolar hyperglycaemic non-ketotic coma. Which one of the following would confirm the diagnosis?

A) Serum bicarbonate of 19 mmol/L
B) Serum osmolality of more than 320 mOsm ✅
C) pH of 7.32
D) Ketones 2+ in urine

Why: Serum osmolality above 320 mOsm/kg with marked hyperglycaemia (over 35 mmol/L) and little or no ketosis defines the hyperosmolar hyperglycaemic state.

8. A patient with type 1 diabetes mellitus is reviewed in the nephrology outpatient clinic. He is known to have stage 1 diabetic nephropathy. Which of the following best describes his degree of renal involvement?

A) Microalbuminuria
B) Hyperfiltration ✅
C) End-stage renal failure
D) Latent phase

Why: Stage 1 diabetic nephropathy is characterised by glomerular hyperfiltration and renal hypertrophy, before any albuminuria appears.

How to Approach Endocrinology for IMM

Practise thyroid function patterns until you can read primary, secondary and sick-euthyroid pictures at a glance.
For adrenal and pituitary disease, learn the screening test, the confirmatory test and the localising test as three separate steps.
Know the diagnostic thresholds for diabetes and the drug of choice in each common scenario.

Browse every Endocrinology question on its own: Endocrinology MCQs.

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