Endocrine, Reproductive &
Gastrointestinal Integrated
Exam 2026 Edition Questions
1.
A 34-year-old woman presents with fatigue, weight gain,
constipation, and cold intolerance. Examination reveals dry skin
and delayed relaxation of the deep tendon reflexes. Laboratory
studies show elevated TSH and low free T4. Which process best
explains her condition?
A. Increased thyroid hormone synthesis
B. Excessive TSH receptor stimulation
C. Primary thyroid gland failure
D. Pituitary thyrotroph hyperplasia
Answer: C. Primary thyroid gland failure
The elevated TSH with reduced free T4 indicates primary
hypothyroidism, most commonly caused by autoimmune
thyroid destruction. Loss of thyroid hormone feedback causes
compensatory elevation of TSH.
,2.
A 45-year-old man has hypertension, muscle weakness, and
persistent hypokalemia. Laboratory testing demonstrates
elevated aldosterone with suppressed plasma renin activity.
Which diagnosis is most likely?
A. Renal artery stenosis
B. Primary hyperaldosteronism
C. Secondary hyperaldosteronism
D. Addison disease
Answer: B. Primary hyperaldosteronism
Autonomous aldosterone production causes sodium retention,
hypertension, potassium wasting, and suppression of renin. An
adrenal adenoma or bilateral adrenal hyperplasia can produce
this pattern.
3.
A 22-year-old woman presents with oligomenorrhea, hirsutism,
acne, and difficulty conceiving. She has elevated testosterone
and polycystic ovaries on ultrasound. Which mechanism
contributes most directly to her reproductive dysfunction?
,A. Reduced ovarian androgen production
B. Chronic anovulation associated with hyperandrogenism
C. Premature ovarian failure
D. Excessive progesterone secretion
Answer: B. Chronic anovulation associated with
hyperandrogenism
Polycystic ovary syndrome is characterized by
hyperandrogenism and ovulatory dysfunction. Persistent
anovulation prevents normal cyclic progesterone production
and can impair fertility.
4.
A 56-year-old man presents with progressive difficulty
swallowing solids followed by liquids. Barium esophagram
demonstrates a dilated esophagus with smooth tapering at the
gastroesophageal junction. Which abnormality is responsible?
A. Excessive lower esophageal sphincter relaxation
B. Failure of lower esophageal sphincter relaxation with loss
of peristalsis
C. Increased gastric acid secretion
D. Esophageal squamous metaplasia
Answer: B. Failure of lower esophageal sphincter relaxation
with loss of peristalsis
, Achalasia results from degeneration of inhibitory neurons in the
myenteric plexus. The lower esophageal sphincter remains
hypertonic while normal peristalsis is impaired.
5.
A patient with type 1 diabetes mellitus develops nausea,
abdominal pain, Kussmaul respirations, and altered mental
status. Serum glucose is 560 mg/dL, and arterial pH is 7.12.
Which metabolic abnormality is primarily responsible for the
acidosis?
A. Increased lactate production only
B. Reduced renal bicarbonate excretion
C. Accumulation of ketone bodies from increased lipolysis
D. Excessive bicarbonate production
Answer: C. Accumulation of ketone bodies from increased
lipolysis
Insulin deficiency activates hormone-sensitive lipase, increasing
free fatty acid delivery to the liver. Ketogenesis produces β-
hydroxybutyrate and acetoacetate, resulting in high-anion-gap
metabolic acidosis.
6.
Gastrointestinal Integrated
Exam 2026 Edition Questions
1.
A 34-year-old woman presents with fatigue, weight gain,
constipation, and cold intolerance. Examination reveals dry skin
and delayed relaxation of the deep tendon reflexes. Laboratory
studies show elevated TSH and low free T4. Which process best
explains her condition?
A. Increased thyroid hormone synthesis
B. Excessive TSH receptor stimulation
C. Primary thyroid gland failure
D. Pituitary thyrotroph hyperplasia
Answer: C. Primary thyroid gland failure
The elevated TSH with reduced free T4 indicates primary
hypothyroidism, most commonly caused by autoimmune
thyroid destruction. Loss of thyroid hormone feedback causes
compensatory elevation of TSH.
,2.
A 45-year-old man has hypertension, muscle weakness, and
persistent hypokalemia. Laboratory testing demonstrates
elevated aldosterone with suppressed plasma renin activity.
Which diagnosis is most likely?
A. Renal artery stenosis
B. Primary hyperaldosteronism
C. Secondary hyperaldosteronism
D. Addison disease
Answer: B. Primary hyperaldosteronism
Autonomous aldosterone production causes sodium retention,
hypertension, potassium wasting, and suppression of renin. An
adrenal adenoma or bilateral adrenal hyperplasia can produce
this pattern.
3.
A 22-year-old woman presents with oligomenorrhea, hirsutism,
acne, and difficulty conceiving. She has elevated testosterone
and polycystic ovaries on ultrasound. Which mechanism
contributes most directly to her reproductive dysfunction?
,A. Reduced ovarian androgen production
B. Chronic anovulation associated with hyperandrogenism
C. Premature ovarian failure
D. Excessive progesterone secretion
Answer: B. Chronic anovulation associated with
hyperandrogenism
Polycystic ovary syndrome is characterized by
hyperandrogenism and ovulatory dysfunction. Persistent
anovulation prevents normal cyclic progesterone production
and can impair fertility.
4.
A 56-year-old man presents with progressive difficulty
swallowing solids followed by liquids. Barium esophagram
demonstrates a dilated esophagus with smooth tapering at the
gastroesophageal junction. Which abnormality is responsible?
A. Excessive lower esophageal sphincter relaxation
B. Failure of lower esophageal sphincter relaxation with loss
of peristalsis
C. Increased gastric acid secretion
D. Esophageal squamous metaplasia
Answer: B. Failure of lower esophageal sphincter relaxation
with loss of peristalsis
, Achalasia results from degeneration of inhibitory neurons in the
myenteric plexus. The lower esophageal sphincter remains
hypertonic while normal peristalsis is impaired.
5.
A patient with type 1 diabetes mellitus develops nausea,
abdominal pain, Kussmaul respirations, and altered mental
status. Serum glucose is 560 mg/dL, and arterial pH is 7.12.
Which metabolic abnormality is primarily responsible for the
acidosis?
A. Increased lactate production only
B. Reduced renal bicarbonate excretion
C. Accumulation of ketone bodies from increased lipolysis
D. Excessive bicarbonate production
Answer: C. Accumulation of ketone bodies from increased
lipolysis
Insulin deficiency activates hormone-sensitive lipase, increasing
free fatty acid delivery to the liver. Ketogenesis produces β-
hydroxybutyrate and acetoacetate, resulting in high-anion-gap
metabolic acidosis.
6.
