5th year · Endocrinology

The correct answer is A: in primary disease, the target gland fails, negative feedback is lifted, and pituitary hormone (stimulating hormone) rises.

The correct answer is A: a stimulation test explores the functional reserve of the gland when the static dosage does not decide.

The correct answer is A: an autonomous secretion does not brake during a braking test, unlike a physiologically regulated secretion.

The correct answer is A: the tertiary involvement is hypothalamic, the secondary involvement is pituitary, and the primary involvement is peripheral glandular.

The correct answer is A: resistance results in a high compensatory hormonal level contrasting with clinical signs of insufficient action.

The correct answers are A, B and C.

The correct answers are A, B and D.

The correct answer is A: an isolated and asymptomatic biological abnormality must be checked and interpreted before any pathological labeling.

Expected response: PRIMARY involvement = lesion of the target peripheral gland; the peripheral hormone is abnormal (low in case of insufficiency) and pituitary stimulation varies in the opposite direction by lifting feedback (high in case of insufficiency, low in case of autonomic hyperfunction). SECONDARY involvement = pituitary lesion; the stimuline and the peripheral hormone vary in the same direction (both low in case of insufficiency). TERTIARY involvement = hypothalamic lesion, upstream, with lack of hypothalamic factors leading to a decrease in stimulation and then in peripheral hormones. The key is the analysis of the target hormone/stimuli couple.

The correct answer is A: diabetes mellitus is chronic hyperglycemia due to insulinopenia and/or insulin resistance.

The correct answer is A: T1D results from autoimmune destruction of beta cells leading to absolute insulinopenia.

The correct answer is A: osmotic polyuria, reactive polydipsia, weight loss and polyphagia make up the cardinal syndrome.

The correct answer is A: reversibility after the acute episode, with a marker of normal previous glycemic control, argues for stress hyperglycemia.

The correct answer is A: gestational diabetes is a carbohydrate tolerance disorder that appears or is diagnosed during pregnancy.

The correct answers are A, B and D.

The correct answers are A, B and C.

The correct answer is A: the initial assessment typifies diabetes and detects cardiovascular complications and comorbidities early.

Expected response: Hyperglycemia must first be confirmed (reproducibility, marker of glycemic balance in previous weeks). Consider: (1) authentic type 2 diabetes (the most common, insulin-resistant); (2) type 1 diabetes (young subject, thin, cardinal syndrome, tendency to ketosis); (3) gestational diabetes in pregnant women; (4) other specific diabetes (pancreatic, endocrine, iatrogenic type corticosteroids); (5) reversible transient stress hyperglycemia (sepsis, acute attack). The distinction is based on the context, the terrain, the reversibility and the marker of previous glycemic control.

The correct answer is A: health and diet measures and therapeutic education constitute the initial basis of T2D.

The correct answer is A: biguanides are the first-line oral class in T2D in the absence of contraindication.

The correct answer is A: biguanides reduce hepatic gluconeogenesis and improve insulin sensitivity, without direct insulin secretory effect.

The correct answer is A: T1D necessarily requires insulin due to absolute insulin deficiency.

The correct answer is A: insulins and insulin secretors expose you to the risk of iatrogenic hypoglycemia.

The correct answers are A, B and C.

The correct answers are A, B and C.

The correct answer is A: iatrogenic hypoglycemia reflects a relative excess of hypoglycemic treatment (insulin/insulin secretors).

Expected response: (1) Initial basis: health and diet measures (balanced diet, physical activity, weight loss if overweight) and therapeutic education. (2) Use of oral pharmacological treatment if objectives are not achieved, generally starting with biguanides in the absence of contraindication, then intensification with other classes. (3) Insulin therapy in case of failure, oral contraindication or special situations. (4) Overall management of cardiovascular risk (blood pressure, lipids, tobacco). (5) Regular monitoring of glycemic control, screening for complications and adaptation guided by self-monitoring. The approach is progressive, individualized and focused on overall risk.

The correct answer is A: the triad hyperglycemia + ketosis + acidosis defines ketoacidosis, common in type 1 cases.

The correct answer is A: hyperosmolarity combines major hyperglycemia and intense dehydration, without significant ketosis or acidosis.

The correct answer is A: ketoacidosis reflects a profound insulin deficiency, classically type 1, but possible in any severe deficiency diabetes.

The correct answer is A: infections are among the most common triggering factors for acute decompensations.

The correct answer is A: hypoglycemia begins suddenly with neurovegetative signs and corrects quickly after resugarization.

The correct answers are A, B and C.

The correct answers are A, B and C.

The correct answer is A: the treatment combines rehydration, correction of ionic disorders, insulin therapy and treatment of the cause, in a hospital environment.

Expected answer: KETOACIDOSIS: mainly type 1 (profound insulin deficiency); mechanism = major insulinopenia leading to lipolysis, ketogenesis and metabolic acidosis; biology = hyperglycemia, ketonemia/ketonuria, acidosis; clinical = polypnea, dehydration, digestive disorders, ketone breath. HYPEROSMOLARITY: especially type 2 in the elderly; mechanism = major hyperglycemia + intense dehydration without significant ketosis (residual insulin secretion sufficient to block ketogenesis); biology = very high hyperglycemia, hyperosmolarity, absence of ketoacidosis; clinical = severe dehydration, impaired consciousness. The discriminating point is the presence (ketacidosis) or absence (hyperosmolarity) of ketosis/acidosis.

The correct answer is A: Retinopathy is a microvascular disorder, like nephropathy and neuropathy.

The correct answer is A: microalbuminuria is an early marker of diabetic nephropathy.

The correct answer is A: the absence of associated retinopathy and an atypical evolution suggest nephropathy of another origin.

The correct answer is A: symmetrical distal sensory polyneuropathy (“socks”) is the most common form.

The correct answer is A: The neuropathic foot is hot and dry, with sensory disturbances and a pulse usually felt.

The correct answers are A, B and C.

The correct answers are A, B and C.

The correct answer is A: retinopathy is a retinal microangiopathy, cataract is a lens opacification.

Expected answer: MICROANGIOPATHY = damage to small vessels, specific to diabetes: diabetic retinopathy, diabetic nephropathy, diabetic neuropathy. MACROANGIOPATHY = damage to the large vessels (accelerated atherosclerosis): coronary artery disease (infarction), obliterating arteriopathy of the lower limbs, cerebrovascular damage (stroke). Diabetic foot often results from the association of a neuropathic component (microangiopathy/neuropathy) and an ischemic component (macroangiopathy). Prevention is based on glycemic balance and control of cardiovascular risk factors.

The correct answer is A: associated clinical signs of endocrinopathy point to secondary obesity.

The correct answer is A: Secondary dyslipidemia is caused by another disease or treatment.

The correct answer is A: we reason about the overall cardiovascular risk, integrating all the factors.

The correct answer is A: Major hypertriglyceridemia is a recognized risk factor for acute pancreatitis.

The correct answer is A: Statins are the main class of LDL cholesterol lowerers.

The correct answers are A, B and C.

The correct answers are A, B and C.

The correct answer is A: secondary prevention aims to avoid recurrence after a first event.

Expected response: (1) Assessment: confirm and quantify obesity (body mass index, waist circumference), look for a secondary/endocrine cause and assess complications (metabolic, cardiovascular, joint, respiratory). (2) Therapeutic base: sustainable health and diet measures (balanced diet, adapted physical activity), behavioral and educational support. (3) Management of comorbidities and overall cardiometabolic risk (glycemia, lipids, blood pressure). (4) Use of specialized treatments (pharmacological or bariatric surgery) reserved for selected situations, in a specialized environment. (5) Prolonged monitoring and prevention of weight regain. The approach is global, progressive and individualized.

The correct answer is A: Low TSH + high free T4 indicates peripheral hyperthyroidism (negative feedback).

The correct answer is A: primary thyroid failure elevates TSH (feedback release) with low free T4.

The correct answer is A: central hypothyroidism results in low free T4 with low or abnormally “normal” TSH, unsuitable for hypothyroidism.

The correct answer is A: weight loss, tachycardia, nervousness and thermophobia reflect hyperthyroidism.

The correct answer is A: Orbitopathy and diffuse vascular goiter are characteristic of Graves' disease.

The correct answers are A, B and C.

The correct answers are A, B and C.

The correct answer is A: the missing hormone is substituted under supervision, without specifying a dosage schedule.

Expected answer: Pregnancy modifies the thyroid balance and requires particular vigilance because maternal thyroid hormones are essential for fetal development. Principles: (1) detect and treat maternal hypothyroidism, because its defect can impact fetal neurological development; (2) closely monitor thyroid balance throughout pregnancy; (3) in the case of hyperthyroidism, distinguish transient gestational thyrotoxicosis from true hyperthyroidism (e.g. autoimmune), because the behavior differs; (4) adapt maternal-fetal monitoring in a specialized environment. We remain on general principles, without a dosage schedule. The goal is maternal thyroid balance to protect mother and fetus.

The correct answer is A: hardness, fixity and satellite lymphadenopathy are clinical arguments for suspicion of malignancy.

The correct answer is A: ultrasound characterizes the nodule (size, contours, echostructure, microcalcifications) and stratifies the risk.

The correct answer is A: FNA provides cytological guidance that guides the course of action (monitoring or surgery).

The correct answer is A: the hot hyperfixing nodule is rarely malignant (often toxic), while the cold hypofixing nodule requires cancer to be ruled out.

The correct answer is A: a hard, fixed nodule with lymphadenopathy suggests cancer rather than thyroiditis.

The correct answer is A: we integrate suspicion of malignancy, cytology, size and impact to decide.

The correct answers are A, B and C.

The correct answers are A, B and C.

Expected response: (1) Clinical: questioning (history of irradiation, heredity), palpation (size, consistency, fixity, lymphadenopathy), search for signs of thyroid dysfunction and compressive signs. (2) Biology: assessment of thyroid function (primarily TSH). (3) Imaging: cervical ultrasound to characterize the nodule and stratify risk; scintigraphy especially if the TSH is low (look for a hot nodule). (4) Cytopuncture according to the level of suspicion to direct the nature. (5) Guidance: monitoring of reassuring nodules, surgery in case of suspicion of malignancy, suspicious cytology or impact (compression, toxic nodule). The decision integrates all of these elements.

The correct answer is A: compression of the optic chiasm results in campimetric damage (classically a lateral amputation).

The correct answer is A: acromegaly results from hypersecretion of growth hormone, most often from a somatotropic adenoma.

The correct answer is A: an excess of GH before welding of the cartilages gives gigantism, after welding it gives acromegaly.

The correct answer is A: amenorrhea-galactorrhea syndrome is suggestive of hyperprolactinemia.

The correct answer is A: a moderate drug-related elevation, without visible adenoma, points to a functional cause.

The correct answer is A: campimetric damage compatible with chiasmatic compression links the disorder to the adenoma.

The correct answers are A, B and C.

The correct answers are A, B and C.

Expected answer: A pituitary adenoma can have two effects. (1) HORMONAL impact: either by hypersecretion (secreting adenoma), for example acromegaly by excess growth hormone or an amenorrhea-galactorrhea syndrome by hyperprolactinemia; or by insufficiency, when a macroadenoma compresses the healthy pituitary gland and causes anterior pituitary insufficiency. (2) TUMORAL or MECHANICAL impact: by local expansion, notably with compression of the optic chiasm responsible for damage to the visual field, headaches, or even damage to other neighboring structures. The exploration is based on pituitary MRI, hormonal assessment (hypersecretion and deficits) and visual field examination.

The correct answer is A: Diabetes insipidus is characterized by hypotonic aqueous polyuria without hyperglycemia or glycosuria.

The correct answer is A: the central DI, due to ADH deficiency, responds to the supply of ADH, while the nephrogenic DI, due to renal resistance, does not respond.

The correct answer is A: potomania (primary polydipsia) preserves the ability to concentrate urine during an appropriate test.

The correct answer is A: panhypopituitarism combines deficits in several anterior pituitary axes.

The correct answer is A: the primary form combines melanoderma (by elevated ACTH) and mineralocorticoid deficiency, absent in corticotropic insufficiency.

The correct answer is A: it is the number of affected axes that distinguishes isolated deficiency and panhypopituitarism.

The correct answers are A, B and C.

The correct answers are A, B and C.

Expected response: (1) Confirm polyuria and characterize the urine (osmolarity, density). (2) First eliminate osmotic polyuria: look for diabetes mellitus (glycemia, glycosuria). (3) If aqueous polyuria (diluted urine): suggest central or nephrogenic diabetes insipidus, or potomania. (4) Use a suitable water restriction test then an ADH test to distinguish: potomania (concentration preserved), central DI (response to ADH), nephrogenic DI (resistance to ADH). (5) Complete with imaging (MRI) and search for a cause depending on the orientation. The approach therefore first contrasts osmotic and aqueous polyuria, then distinguishes the three main causes of aqueous polyuria.

The correct answer is A: facio-trunk obesity, purple stretch marks, amyotrophy and skin fragility suggest hypercortisolism.

The correct answer is A: autonomous adrenal secretion of cortisol slows down ACTH (Cushing's ACTH-independent).

The correct answer is A: the most common cause of Cushing's syndrome is iatrogenic (prolonged corticosteroid therapy).

The correct answer is A: melanoderma, asthenia, hypotension and hyponatremia suggest primary adrenal insufficiency.

The correct answer is A: the primary form combines melanoderma (elevated ACTH) and mineralocorticoid deficiency, unlike the corticotropic form.

The correct answer is A: the association of hypertension and hypokalemia suggests primary hyperaldosteronism.

The correct answer is A: slow adrenal insufficiency develops gradually, while the acute form combines collapse, dehydration and immediate life threat.

The correct answers are A, B and C.

The correct answers are A, B and C.

Expected response: (1) Clinical suspicion: facio-trunk obesity, purple stretch marks, amyotrophy, skin fragility, hypertension, carbohydrate disorders. (2) First eliminate an iatrogenic cause (corticotherapy), the most common. (3) Confirm endogenous hypercortisolism by appropriate explorations (evidence of excess cortisol and loss of feedback/braking). (4) Specify the mechanism by measuring ACTH: Cushing ACTH-dependent (normal or high ACTH, pituitary or ectopic origin) versus ACTH-independent (low ACTH, autonomous adrenal origin). (5) Localize the lesion using appropriate imaging (pituitary or adrenal). The approach is therefore: clinical suspicion, elimination of the iatrogenic, confirmation of hypercortisolism, ACTH-dependent/independent distinction, then localization.

The correct answer is A: hypocalcemia is manifested by neuromuscular hyperexcitability (paresthesias, tetany, Chvostek sign).

The correct answer is A: in hypoparathyroidism, PTH is low or inadequate despite hypocalcemia.

The correct answer is A: Primary hyperparathyroidism results in hypercalcemia with elevated or abnormally normal (inadequate) PTH.

The correct answer is A: secondary hyperparathyroidism is a reactive elevation of PTH (response to hypocalcemia or renal failure), with low or normal serum calcium.

The correct answer is A: hypercalcemia with slowed PTH in a neoplastic context points towards a tumor cause.

The correct answer is A: confirmation of low serum calcium and reproducible signs of hyperexcitability indicates organic origin.

The correct answers are A, B and C.

The correct answers are A, B and C.

Expected response: (1) Confirm hypocalcemia (calcemia corrected by albuminemia, ionized calcium) and assess its severity and speed of onset. (2) Look for clinical signs of neuromuscular hyperexcitability (paresthesias, tetany, Chvostek and Trousseau signs) and signs of severity (disordered consciousness, cardiac manifestations). (3) Orient the etiology by measuring PTH: low or inappropriate PTH suggests hypoparathyroidism; Elevated reactive PTH suggests vitamin D deficiency or kidney failure. (4) General therapeutic principle: symptomatic acute hypocalcemia is an emergency requiring correction in a suitable environment with monitoring, while a chronic form requires supplementation and treatment of the cause. We remain on principles, without a dosage schedule.

The correct answer is A: central hypogonadism associates low sex steroids with low or inadequate gonadotropins.

The correct answer is A: simple pubertal delay is often familial with a delayed but possible spontaneous onset.

The correct answer is A: central precocious puberty is gonadotropin-dependent, peripheral is gonadotropin-independent (gonadal or adrenal autonomous origin).

The correct answer is A: transient and regressive pubertal gynecomastia is typically physiological.

The correct answer is A: a slowdown in growth rate with signs of endocrinopathy points to an endocrine cause.

The correct answer is A: a context of malnutrition or chronic illness points towards a nutritional cause.

The correct answers are A, B and C.

The correct answers are A, B and C.

Expected answer: The distinction is based on the sex steroid / gonadotropin pair. PERIPHERAL HYPOGONADISM (primary, hypergonadotropic): damage to the gonad; sex steroids are low and pituitary gonadotropins are high (release of feedback). CENTRAL HYPOGONADISM (hypogonadotropic): hypothalamic-pituitary damage; sex steroids are low but gonadotropins are low or inadequate. Interest: the distinction locates the level of damage (gonad versus hypothalamic-pituitary axis), guides etiological research (for example pituitary damage to be explored by imaging in the case of central origin) and conditions the treatment. The reasoning is identical to that of the other axes: hormone/gonadotropin discordance = peripheral origin; low agreement = central origin.

The correct answer is A: collapse, digestive disorders, dehydration and ionic disorders suggest acute adrenal insufficiency.

The correct answer is A: known terrain or suggestive signs (melanoderma, compatible ionic disorders) should suggest acute adrenal insufficiency, often triggered by infection.

The correct answer is A: the priority is to quickly correct hypoglycemia after measuring capillary blood glucose (principle, without dosage).

The correct answer is A: bedside capillary blood glucose immediately distinguishes the two comas (low versus high with ketosis).

The correct answer is A: the thyrotoxic crisis is defined by serious signs (cardiovascular, neurological, hyperthermia) which are life-threatening.

The correct answer is A: a confirmed low serum calcium level with objective signs of hyperexcitability indicates an organic origin.

The correct answers are A, B and C.

The correct answers are A, B and C.

Expected response: (1) Recognize the situation early and assess the signs of seriousness (consciousness, hemodynamics, breathing, ionic disorders). (2) Ensure vital measures and conditioning (monitoring, approach, suitable environment) without waiting for an exhaustive assessment. (3) Immediately measure capillary blood glucose in the event of any disturbance of consciousness in a patient at risk, because hypoglycemia is quickly reversible. (4) Orient according to the table: acute adrenal insufficiency (collapse, ionic disorders), ketoacidosis or hyperosmolar coma (hyperglycemia), thyrotoxic crisis (signs of severity of hyperthyroidism), symptomatic hypocalcemia. (5) Treat the cause and the triggering factor in parallel. The guiding principle is to treat the life threat as a priority, then carry out the etiological investigation, without a detailed dosing schedule.