Pituitary, Parathyroid, and Other Endocrine Disorders Practice Questions

25 multiple-choice questions on Pituitary, parathyroid, and other endocrine disorders for paramedic and EMT students, from Chapter 24 (Endocrine Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A patient taking desmopressin who drinks large amounts of water can develop:

   1. A. High sodium and thirst
   2. B. Low sodium and confusion
   3. C. High blood glucose
   4. D. Low potassium and weakness
   Show answer

   Answer: B. Low sodium and confusion

   Desmopressin is a synthetic ADH that makes the kidneys hold water. Excess drinking then dilutes sodium and can cause confusion and seizures. Holding water lowers sodium rather than raising it, and desmopressin does not raise glucose or lower potassium.

2. The hallmark of diabetes insipidus is:

   1. A. High blood glucose
   2. B. Large volumes of dilute urine
   3. C. Ketones spilling into the urine
   4. D. Dark, concentrated urine output
   Show answer

   Answer: B. Large volumes of dilute urine

   Patients urinate many liters a day and are extremely thirsty. Glucose is normal, unlike diabetes mellitus.

3. A patient with a recent head injury produces large amounts of clear urine and becomes dehydrated. You suspect:

   1. A. Diabetes mellitus
   2. B. SIADH
   3. C. Central DI
   4. D. Kidney stones
   Show answer

   Answer: C. Central DI

   Trauma or surgery near the pituitary can stop ADH release.

4. Untreated diabetes insipidus can lead to:

   1. A. Hypernatremia
   2. B. Severe hyponatremia
   3. C. Hypoglycemia
   4. D. Hyperkalemia
   Show answer

   Answer: A. Hypernatremia

   Water loss concentrates sodium in the blood, causing confusion and seizures.

5. Lithium therapy can cause:

   1. A. Type 1 diabetes
   2. B. Addison disease
   3. C. Cushing syndrome
   4. D. Nephrogenic DI
   Show answer

   Answer: D. Nephrogenic DI

   Lithium makes the kidneys unresponsive to ADH.

6. SIADH (syndrome of inappropriate ADH) causes:

   1. A. Large volumes of dilute urine
   2. B. Water retention, hyponatremia
   3. C. High blood glucose
   4. D. High potassium
   Show answer

   Answer: B. Water retention, hyponatremia

   Excess ADH makes the kidneys retain water, diluting blood sodium.

7. Common causes of SIADH include:

   1. A. Excess dietary salt
   2. B. Excess insulin
   3. C. Lung tumors
   4. D. Hyperthyroidism
   Show answer

   Answer: C. Lung tumors

   Tumors, CNS disorders, lung disease, and some medications cause SIADH.

8. A heavy beer drinker who eats almost nothing is confused, and his sodium is very low. The cause is:

   1. A. Too much salt in the beer
   2. B. Dehydration from sweating
   3. C. High blood glucose from the sugary beer
   4. D. Too much water, too little solute
   Show answer

   Answer: D. Too much water, too little solute

   In beer potomania, large volumes of low-solute fluid with poor food intake leave the kidneys unable to excrete free water, so sodium falls. These patients are at high risk of overly rapid correction.

9. Hypercalcemia is commonly summarized as:

   1. A. Stones, bones, groans, and moans
   2. B. Pain, pallor, pulselessness
   3. C. Fever, rash, and joint pain
   4. D. Polyuria, polydipsia, polyphagia
   Show answer

   Answer: A. Stones, bones, groans, and moans

   Kidney stones, bone pain, abdominal pain, and confusion are typical.

10. The most common cause of severe hypercalcemia in hospital patients is:

    1. A. Dehydration only
    2. B. Cancer
    3. C. Low vitamin D
    4. D. Diabetes
    Show answer

    Answer: B. Cancer

    Many cancers release substances that raise calcium.

11. Low calcium may not correct with calcium alone until which other electrolyte is replaced?

    1. A. Sodium
    2. B. Chloride
    3. C. Magnesium
    4. D. Bicarbonate
    Show answer

    Answer: C. Magnesium

    Low magnesium impairs parathyroid hormone release and action, so hypocalcemia (and hypokalemia) often persists until magnesium is corrected.

12. The first treatment for symptomatic hypercalcemia is usually:

    1. A. Oral calcium tablets
    2. B. A thiazide diuretic
    3. C. Vitamin D
    4. D. IV normal saline
    Show answer

    Answer: D. IV normal saline

    Hypercalcemia causes polyuria and dehydration, which worsens calcium levels, so saline rehydration is the first step, followed by drugs such as bisphosphonates. Thiazides and vitamin D raise calcium.

13. Very high calcium can cause which ECG change?

    1. A. A shortened QT interval
    2. B. Peaked T waves
    3. C. A delta wave
    4. D. Prominent U waves after T
    Show answer

    Answer: A. A shortened QT interval

    Hypercalcemia shortens the QT interval and can cause bradycardia and heart block. Peaked T waves suggest hyperkalemia, and U waves suggest hypokalemia.

14. Which medication can raise blood calcium levels?

    1. A. Furosemide
    2. B. Thiazide diuretics
    3. C. Calcitonin
    4. D. Bisphosphonates such as alendronate
    Show answer

    Answer: B. Thiazide diuretics

    Thiazides reduce urinary calcium loss and can cause mild hypercalcemia; lithium can too. Furosemide, calcitonin, and bisphosphonates lower calcium.

15. After a severe postpartum hemorrhage with shock, a woman cannot breastfeed and later has fatigue and low blood pressure. This suggests:

    1. A. Normal tiredness after birth
    2. B. Postpartum depression alone
    3. C. Pituitary damage (Sheehan)
    4. D. A thyroid storm
    Show answer

    Answer: C. Pituitary damage (Sheehan)

    The enlarged pituitary of pregnancy is vulnerable to ischemia during hemorrhagic shock. Failure to lactate is often the first sign, followed by adrenal and thyroid insufficiency.

16. A patient with sudden severe headache, double vision, and low BP may have:

    1. A. Pituitary apoplexy
    2. B. Migraine with aura
    3. C. Acute sinus infection
    4. D. Hypothyroidism
    Show answer

    Answer: A. Pituitary apoplexy

    Bleeding into the pituitary can compress nearby nerves and cause hormone failure.

17. Acromegaly is caused by:

    1. A. A lack of growth hormone in childhood
    2. B. Too much cortisol
    3. C. Too much thyroid hormone
    4. D. Excess growth hormone in adults
    Show answer

    Answer: D. Excess growth hormone in adults

    Excess GH causes enlarged hands, feet, and facial features.

18. Acromegaly may make airway management difficult because of:

    1. A. A small mouth opening only
    2. B. A stiff neck only
    3. C. A short neck only
    4. D. A large tongue and jaw
    Show answer

    Answer: D. A large tongue and jaw

    Soft tissue overgrowth can narrow the airway.

19. Which electrolyte disorder may develop in a marathon runner who drinks too much water?

    1. A. Hyponatremia
    2. B. Hypernatremia
    3. C. Hyperkalemia
    4. D. Hypercalcemia
    Show answer

    Answer: A. Hyponatremia

    Excess water dilutes blood sodium.

20. Taking very large doses of vitamin D supplements for months can cause:

    1. A. Low blood sodium
    2. B. High blood calcium
    3. C. Low blood glucose
    4. D. High potassium levels
    Show answer

    Answer: B. High blood calcium

    Vitamin D increases gut calcium absorption, so toxicity causes hypercalcemia with nausea, confusion, polyuria, and kidney stones.

21. Mild hyponatremia from SIADH is usually treated first with:

    1. A. Large saline boluses
    2. B. Extra water intake
    3. C. Fluid restriction
    4. D. Insulin and dextrose
    Show answer

    Answer: C. Fluid restriction

    In SIADH the body retains water, so limiting fluid intake raises the sodium. Hypertonic saline is reserved for severe symptoms such as seizures.

22. In severe hyperglycemia, the measured sodium is often low mainly because glucose:

    1. A. Pushes sodium into cells
    2. B. Causes the kidneys to keep water
    3. C. Blocks the sodium test reagent
    4. D. Draws water out of cells
    Show answer

    Answer: D. Draws water out of cells

    High glucose raises plasma osmolality and pulls water from cells into the blood, diluting sodium. The sodium rises as glucose falls, so clinicians calculate a 'corrected' sodium in hyperglycemia. Sodium stays outside the cells, and glucose causes an osmotic diuresis rather than water retention.

23. A young adult at a dance party took MDMA (ecstasy) and drank large amounts of water. Now she has a seizure. You should consider:

    1. A. Low blood glucose only
    2. B. High potassium
    3. C. Severe hyponatremia
    4. D. An allergic reaction
    Show answer

    Answer: C. Severe hyponatremia

    MDMA stimulates ADH release, and heavy water drinking adds to it, causing rapid dilutional hyponatremia with confusion and seizures, especially in young women. Hyperthermia is another MDMA danger.

24. Hyponatremia symptoms tend to be most severe when the sodium falls:

    1. A. Quickly over hours
    2. B. Slowly over months
    3. C. In the morning hours
    4. D. While the patient is asleep
    Show answer

    Answer: A. Quickly over hours

    The brain can adapt to slowly falling sodium, so chronic hyponatremia may cause few symptoms, while a rapid drop, as in marathon runners or MDMA users, causes brain swelling and seizures.

25. A patient with panhypopituitarism is in shock with vomiting. Like a patient with Addison disease, he needs:

    1. A. Extra thyroid hormone first
    2. B. Stress-dose hydrocortisone
    3. C. Growth hormone injections
    4. D. A fluid restriction
    Show answer

    Answer: B. Stress-dose hydrocortisone

    Pituitary failure causes secondary adrenal insufficiency, so shock in these patients is treated with hydrocortisone and fluids. Thyroid hormone should not be given before cortisol is replaced.