KMU Past Paper Practice

Question:

A 46-year-old man undergoes bilateral adrenalectomy for an adrenal disorder. During subsequent follow-up, he develops fatigue and requires lifelong corticosteroid replacement. Which mechanism best classifies the resulting adrenal insufficiency?

Options:

Correct Answer:
Loss of functioning adrenal cortical tissue

Explanation: Bilateral adrenalectomy removes the source of cortical hormones and therefore produces primary adrenal insufficiency.

Question:

A 52-year-old man with a history of tuberculosis develops progressive weakness, weight loss and biochemical evidence of primary adrenal failure. Which pathological process most plausibly explains the endocrine abnormality?

Options:

Correct Answer:
Infective destruction of adrenal cortical tissue

Explanation: Tuberculosis can damage both adrenal glands sufficiently to reduce cortical hormone production and produce primary adrenal insufficiency.

Question:

A patient with advanced malignant disease develops new adrenal insufficiency. Evaluation suggests extensive involvement of both adrenal glands. Which etiology best explains the hormonal failure?

Options:

Correct Answer:
Extensive bilateral adrenal metastatic involvement

Explanation: Metastatic malignant disease can cause primary adrenal insufficiency when bilateral involvement is extensive enough to impair cortical function.

Question:

A patient with a systemic infiltrative disorder develops progressive adrenal cortical failure without a primary pituitary lesion. Which mechanism best explains the endocrine dysfunction?

Options:

Correct Answer:
Replacement of functional adrenal tissue by infiltrative disease

Explanation: Infiltrative disorders can progressively replace functioning adrenal cortical tissue, reducing corticosteroid production.

Question:

A young patient has adrenal insufficiency due to a disorder of steroid synthesis. Imaging does not show destructive adrenal disease. Which abnormality best accounts for the low corticosteroid output?

Options:

Correct Answer:
Impaired corticosteroid synthesis within adrenal cortical cells

Explanation: Primary adrenal insufficiency can occur from defective steroid synthesis even when the gland has not been structurally destroyed.

Question:

A patient previously treated with pituitary irradiation develops progressive cortisol deficiency. Structural adrenal disease is not identified. Which mechanism is most consistent with this history?

Options:

Correct Answer:
Reduced ACTH secretion after pituitary damage

Explanation: Pituitary irradiation may damage ACTH-producing cells, reducing adrenal stimulation and producing secondary adrenal insufficiency.

Question:

A woman develops deficiency of several pituitary hormones following a complicated delivery. Subsequent assessment demonstrates inadequate ACTH secretion and cortisol deficiency. Which underlying cause best explains the adrenal problem?

Options:

Correct Answer:
Postpartum pituitary necrosis

Explanation: Postpartum pituitary necrosis can reduce ACTH together with other pituitary hormones and therefore cause secondary adrenal insufficiency.

Question:

A 57-year-old man has a pituitary tumor that progressively replaces normal pituitary tissue. He later develops cortisol deficiency. Which pathological event most directly produces the adrenal dysfunction?

Options:

Correct Answer:
Loss of ACTH-producing pituitary function

Explanation: A pituitary mass can compress or replace ACTH-producing cells, reducing adrenal cortisol stimulation and causing secondary failure.

Question:

A patient develops acute pituitary apoplexy and subsequently has inadequate cortisol secretion. Which immediate endocrine consequence of the pituitary event accounts for this abnormality?

Options:

Correct Answer:
Acute reduction in ACTH secretion

Explanation: Pituitary apoplexy can abruptly impair ACTH secretion, leading to an acute reduction in adrenal cortisol production.

Question:

A patient with an infiltrative pituitary disorder develops cortisol deficiency together with abnormalities of other pituitary hormones. Which classification best describes the adrenal abnormality?

Options:

Correct Answer:
Secondary adrenal insufficiency

Explanation: Destructive pituitary disease reduces ACTH drive to the adrenal cortex, so the adrenal insufficiency is secondary rather than primary.

Question:

A patient with fatigue and weight loss has a reduced morning serum cortisol concentration on initial testing. No ACTH result is yet available. Which interpretation is most appropriate at this stage?

Options:

Correct Answer:
Adrenal insufficiency is suspected but requires further hormonal assessment

Explanation: A low morning cortisol raises suspicion, but ACTH and appropriate functional assessment are needed to confirm and localize the disorder.

Question:

A patient with confirmed primary adrenal insufficiency is found to have reduced aldosterone activity and persistent volume depletion. Which additional hormonal response would be expected as compensation?

Options:

Correct Answer:
Increased renin activity

Explanation: Sodium and volume loss from aldosterone deficiency activates the renin-angiotensin system, so renin activity rises.

Question:

A patient with primary Addison disease has been started on glucocorticoid and mineralocorticoid replacement. Which combination is most useful for assessing the adequacy of mineralocorticoid replacement during follow-up?

Options:

Correct Answer:
Blood pressure, postural symptoms, electrolytes and renin status

Explanation: Mineralocorticoid replacement is judged by volume-related symptoms, blood pressure, sodium and potassium balance, and renin activity.

Question:

A clinically stable patient with chronic Addison disease is reviewed after starting glucocorticoid replacement. Which therapeutic principle should guide long-term glucocorticoid therapy?

Options:

Correct Answer:
Replace physiological glucocorticoid activity while avoiding unnecessary excess

Explanation: Chronic therapy aims to replace deficient cortisol activity at an appropriate physiological level rather than expose the patient to excessive glucocorticoid.

Question:

A patient in adrenal crisis receives parenteral hydrocortisone and isotonic intravenous fluid. Bedside testing demonstrates significant hypoglycemia. Which additional immediate intervention is appropriate?

Options:

Correct Answer:
Provide glucose replacement

Explanation: Hypoglycemia is an important metabolic complication of severe cortisol deficiency and should be corrected promptly during crisis management.

Question:

Hydrocortisone is selected during the emergency treatment of a patient with acute primary adrenal failure. Which property makes it particularly suitable in this setting?

Options:

Correct Answer:
It provides glucocorticoid activity with some mineralocorticoid activity

Explanation: Hydrocortisone replaces the urgently needed glucocorticoid deficit and, at therapeutic exposure, also provides useful mineralocorticoid activity.

Question:

A patient treated successfully for adrenal crisis is now hemodynamically stable, eating normally and has correction of the acute metabolic disturbance. What is the appropriate next endocrine management principle?

Options:

Correct Answer:
Transition toward appropriate long-term replacement therapy

Explanation: Once the acute crisis has resolved, emergency treatment is stepped down toward the patient’s appropriate chronic hormone-replacement regimen.

Question:

A patient with stable chronic adrenal insufficiency is preparing for discharge. Which education point is most important for reducing the risk of future adrenal crisis?

Options:

Correct Answer:
Recognize severe illness or vomiting and follow an emergency steroid plan

Explanation: Illness, vomiting or inability to take usual replacement can rapidly precipitate crisis, so patients need clear emergency steroid instructions and diagnostic identification.

Question:

A patient with severe adrenal insufficiency becomes confused and progressively less responsive. The patient is hypotensive and has significant electrolyte disturbance and low blood glucose. Which explanation best accounts for the neurological deterioration?

Options:

Correct Answer:
Combined effects of hypotension, electrolyte disturbance and hypoglycemia

Explanation: Severe adrenal insufficiency can impair consciousness through reduced cerebral perfusion together with major electrolyte and glucose abnormalities.

Question:

A patient with severe cortisol deficiency develops symptomatic hypoglycemia during an acute illness. Which physiological consequence of cortisol deficiency contributes most directly to this abnormality?

Options:

Correct Answer:
Reduced hepatic glucose production

Explanation: Cortisol supports hepatic glucose production during fasting and stress; severe deficiency therefore increases susceptibility to hypoglycemia.