20160303 G2020 2.2.1 ENG - A
Closed book part
• Time closed book part: 30 minutes
• Total time assessment: 75 minutes
• When you are finished with the closed book part, you need to submit this by using the
button ‘Submit’ (at the bottom of your screen). You will get a warning if you did not give
an answer for all the questions. Click ‘Cancel’ to return to the questions to fill in the
missing answers.
• After submitting the closed book part, you cannot return to the questions and the given
answers of the closed book part. This is the same for the open book part.
• After submitting the closed book part you will automatically continue with the open book
part.
• You are allowed to use your books after the signal of the invigilators.
• You are not allowed to take the assessment, or parts of it, with you. Doing so will be
judged as fraud.
To start the closed book part of the test you need to use the ‘Submit’ button at the
bottom of your screen.
B 1. Many hormones are bound to a protein as they are being transported in the plasma. To which of the
following hormones does this apply?
o (a) catecholamines
o (b) thyroxine
o (c) prolactin
2. A 54-year-old man has primary hyperthyroidism. What effect will this have on the TSH level in his
blood? His TSH level will most likely be:
o (a) the same
o (b) higher than normal
o (c) lower than normal
A 3. A 35-year-old woman presents with weight gain and muscle weakness. The physical examination
reveals red stretch marks and elevated central fat distribution. Cushing’s syndrome is suspected.
Which laboratory test is the most appropriate for establishing Cushing’s syndrome?
o (a) serum cortisol after dexamethasone ingestion
o (b) serum aldosterone
o (c) plasma IGF-1
4. Which of the following statements about Graves’ disease is most likely correct?
Ophthalmologic symptoms due to Graves’ disease:
o (a) only occur in patients with hyperthyroidism
o (b) is more frequent in patients who smoke
o (c) may be caused by thyrostatics use
5. The mechanism of action of thiamazole (= methimazole) is based on:
o (a) inhibition of the beta receptors
o (b) inhibition of the enzyme peroxidase
Page 1
, 20160303 G2020 2.2.1 ENG - A
o (c) inhibition of the steroid receptors
6. The thyroid produces two active forms of thyroid hormone: thyroxine and triiodothyronine.
Which hormone is released in the greatest quantities by the thyroid and which hormone has the
highest affinity for the thyroid hormone receptor?
o (a) more T3 is released and T3 also has the highest affinity
o (b) more T3 is released but T4 has the highest affinity
o (c) more T4 is released but T3 has the highest affinity
o (d) more T4 is released and T4 also has the highest affinity
D 7. What are the progesterone and oestrogen levels during the early follicular phase of the menstrual
cycle?
o (a) high oestrogen and high progesterone
o (b) high oestrogen and low progesterone
o (c) low oestrogen and high progesterone
o (d) low oestrogen and low progesterone
C 8. What oestrogen and gonadotrofin levels will most likely be found in a Patient with a Polycystic Ovary
Syndrome (PCOS)?
o (a) low gonadotrofin and low oestrogen
o (b) low gonadotrofin and normal oestrogen
o (c) normal gonadotrofin and normal oestrogen
B 9. A 14-year-old girl sees her GP because she has not had her period yet. Upon physical examination,
the development of her breasts and secondary sexual characteristics is clearly visible.
What is the best course of action?
o (a) ultrasound scan
o (b) reassuring the patient that this is not abnormal
o (c) gynaecological examination
o (d) laboratory tests: FSH, LH, and oestrogen
D 10. What is the most common symptom of endometrial cancer in postmenopausal women?
o (a) abdominal pain
o (b) weight loss
o (c) postcoital bleeding
o (d) vaginal bleeding
A 11. The contraceptive action of the Mirena coil, an intrauterine device with levonorgestrel, is partly based
on thickening of the cervical mucus.
o (a) correct
o (b) incorrect
Page 2
, 20160303 G2020 2.2.1 ENG - A
A 12. Apart from their contraceptive action, combined oral contraceptives have several side effects that
may be regarded as positive.
Which of the following is such a positive side effect?
o (a) lower risk of pelvic inflammatory disease
o (b) lower risk of breast cancer
o (c) lower risk of cardiovascular disease
B 13. Mr and Mrs F. desire to have children. Fertility tests show that each month the couple has a 5
percent chance of pregnancy.
After twelve months, what is the probability that Mrs F. will be pregnant?
o (a) 20-30%
o (b) 40-50%
o (c) 60-70%
A 14. What is the location of the egg cell (ovum) immediately after ovulation (i.e. before it moves into the
uterine tube)?
o (a) peritoneal cavity
o (b) retroperitoneal
o (c) subperitoneal
o (d) intraperitoneal
C 15. Talbot presents several arguments against aborting a foetus despite the fact that it is known that the
child will have to live with a disorder or disability.
According to Talbot, which of the following is not a good argument against such abortions?
o (a) when foetuses are aborted on the grounds of expected future suffering, we ignore the way in
which people who are ill or disabled experience life
o (b) aborting foetuses with an increased risk of disease or abnormality also has a negative impact
on the way in which we as a society perceive the illnesses and disabilities of people who do not
have genetic defects
o (c) aborting foetuses with an increased risk of disease or abnormality is a slippery slope that will
lead to all kinds of ‘undesirables’ being aborted
o (d) aborting foetuses on the basis of a specific profile reduces the societal basis for the support
and social integration of people who have to live with the problem being screened for
Page 3
, 20160303 G2020 2.2.1 ENG - A
Open book part
• Time open book part: X minutes
• When you are finished with the open book part, you need to submit this by using the
button ‘Submit’ (at the bottom of your screen). You will get a warning if you did not give
an answer for all the questions. Click ‘Cancel’ to return to the questions to fill in the
missing answers.
• After submitting the open book part, you cannot return to the questions and the given
answers of the open book part.
• After submitting the open book part, you will get a first provisional score of your complete
assessment. No right can be derived from this score. The final score will be published on
Nestor.
• You are allowed to use your books after the signal of the invigilators.
• Link to resources:https://pup.studystore.nl/bundle/Home/View/12
• You are not allowed to take the assessment, or parts of it, with you. Doing so will be
judged as fraud.
1. A 28-year-old woman presents with fatigue and a quick temper. The symptoms began three weeks
after giving birth. Lab tests show lower than normal TSH (0.05 mU/L) and higher free T4 (34 pmol/L).
She may have Graves’ disease. However, three weeks later her TSH has increased to 8.0 mU/L and
her FT4 has decreased to 7.7. pmol/L.
Which of the following statements is correct?
o (a) these are normal variations in thyroid hormone levels
o (b) this finding is most consistent with silent thyroiditis
o (c) this finding is most consistent with Hashimoto’s thyroiditis
o (d) this finding is most consistent with Graves’ disease
A 2. A 35-year-old man presents with episodes in which he has palpitations and profuse sweating, during
which he also looks pale. Several of his relatives have had thyroid gland surgery but he does not
know the details. Upon physical examination his blood pressure is 150/98 mmHg and his thyroid
feels irregular upon palpation. The cervical lymph nodes cannot be felt.
What is the most likely diagnosis in this patient’s case?
o (a) adrenal phaeochromocytoma due to multiple endocrine neoplasia Type 2A
o (b) catecholamine-producing paragangliomas in the neck
o (c) hyperthyroidism due to familial multinodular goitre.
A 3. A 20-year-old man sees you for reduced libido. He has minimal facial hair growth and only needs to
shave once a week. Upon physical examination you notice that he has hardly any pubic hair. His
testicles are small (both 8 mL). Lab tests have the following results: serum testosterone 7 mmol/L
(lower than normal), LH and FSH higher than normal (15 and 20 U/L respectively).
How would you interpret these findings?
o (a) clinical picture and lab results are consistent with primary hypogonadism
o (b) clinical picture and lab results are consistent with central hypogonadism
4. An adult woman has a markedly enlarged thyroid. Her plasma TSH concentration is elevated, her
plasma free T4 concentration is decreased.
Which clinical symptoms does this woman most likely show?
o (a) Constipation
Page 4
Closed book part
• Time closed book part: 30 minutes
• Total time assessment: 75 minutes
• When you are finished with the closed book part, you need to submit this by using the
button ‘Submit’ (at the bottom of your screen). You will get a warning if you did not give
an answer for all the questions. Click ‘Cancel’ to return to the questions to fill in the
missing answers.
• After submitting the closed book part, you cannot return to the questions and the given
answers of the closed book part. This is the same for the open book part.
• After submitting the closed book part you will automatically continue with the open book
part.
• You are allowed to use your books after the signal of the invigilators.
• You are not allowed to take the assessment, or parts of it, with you. Doing so will be
judged as fraud.
To start the closed book part of the test you need to use the ‘Submit’ button at the
bottom of your screen.
B 1. Many hormones are bound to a protein as they are being transported in the plasma. To which of the
following hormones does this apply?
o (a) catecholamines
o (b) thyroxine
o (c) prolactin
2. A 54-year-old man has primary hyperthyroidism. What effect will this have on the TSH level in his
blood? His TSH level will most likely be:
o (a) the same
o (b) higher than normal
o (c) lower than normal
A 3. A 35-year-old woman presents with weight gain and muscle weakness. The physical examination
reveals red stretch marks and elevated central fat distribution. Cushing’s syndrome is suspected.
Which laboratory test is the most appropriate for establishing Cushing’s syndrome?
o (a) serum cortisol after dexamethasone ingestion
o (b) serum aldosterone
o (c) plasma IGF-1
4. Which of the following statements about Graves’ disease is most likely correct?
Ophthalmologic symptoms due to Graves’ disease:
o (a) only occur in patients with hyperthyroidism
o (b) is more frequent in patients who smoke
o (c) may be caused by thyrostatics use
5. The mechanism of action of thiamazole (= methimazole) is based on:
o (a) inhibition of the beta receptors
o (b) inhibition of the enzyme peroxidase
Page 1
, 20160303 G2020 2.2.1 ENG - A
o (c) inhibition of the steroid receptors
6. The thyroid produces two active forms of thyroid hormone: thyroxine and triiodothyronine.
Which hormone is released in the greatest quantities by the thyroid and which hormone has the
highest affinity for the thyroid hormone receptor?
o (a) more T3 is released and T3 also has the highest affinity
o (b) more T3 is released but T4 has the highest affinity
o (c) more T4 is released but T3 has the highest affinity
o (d) more T4 is released and T4 also has the highest affinity
D 7. What are the progesterone and oestrogen levels during the early follicular phase of the menstrual
cycle?
o (a) high oestrogen and high progesterone
o (b) high oestrogen and low progesterone
o (c) low oestrogen and high progesterone
o (d) low oestrogen and low progesterone
C 8. What oestrogen and gonadotrofin levels will most likely be found in a Patient with a Polycystic Ovary
Syndrome (PCOS)?
o (a) low gonadotrofin and low oestrogen
o (b) low gonadotrofin and normal oestrogen
o (c) normal gonadotrofin and normal oestrogen
B 9. A 14-year-old girl sees her GP because she has not had her period yet. Upon physical examination,
the development of her breasts and secondary sexual characteristics is clearly visible.
What is the best course of action?
o (a) ultrasound scan
o (b) reassuring the patient that this is not abnormal
o (c) gynaecological examination
o (d) laboratory tests: FSH, LH, and oestrogen
D 10. What is the most common symptom of endometrial cancer in postmenopausal women?
o (a) abdominal pain
o (b) weight loss
o (c) postcoital bleeding
o (d) vaginal bleeding
A 11. The contraceptive action of the Mirena coil, an intrauterine device with levonorgestrel, is partly based
on thickening of the cervical mucus.
o (a) correct
o (b) incorrect
Page 2
, 20160303 G2020 2.2.1 ENG - A
A 12. Apart from their contraceptive action, combined oral contraceptives have several side effects that
may be regarded as positive.
Which of the following is such a positive side effect?
o (a) lower risk of pelvic inflammatory disease
o (b) lower risk of breast cancer
o (c) lower risk of cardiovascular disease
B 13. Mr and Mrs F. desire to have children. Fertility tests show that each month the couple has a 5
percent chance of pregnancy.
After twelve months, what is the probability that Mrs F. will be pregnant?
o (a) 20-30%
o (b) 40-50%
o (c) 60-70%
A 14. What is the location of the egg cell (ovum) immediately after ovulation (i.e. before it moves into the
uterine tube)?
o (a) peritoneal cavity
o (b) retroperitoneal
o (c) subperitoneal
o (d) intraperitoneal
C 15. Talbot presents several arguments against aborting a foetus despite the fact that it is known that the
child will have to live with a disorder or disability.
According to Talbot, which of the following is not a good argument against such abortions?
o (a) when foetuses are aborted on the grounds of expected future suffering, we ignore the way in
which people who are ill or disabled experience life
o (b) aborting foetuses with an increased risk of disease or abnormality also has a negative impact
on the way in which we as a society perceive the illnesses and disabilities of people who do not
have genetic defects
o (c) aborting foetuses with an increased risk of disease or abnormality is a slippery slope that will
lead to all kinds of ‘undesirables’ being aborted
o (d) aborting foetuses on the basis of a specific profile reduces the societal basis for the support
and social integration of people who have to live with the problem being screened for
Page 3
, 20160303 G2020 2.2.1 ENG - A
Open book part
• Time open book part: X minutes
• When you are finished with the open book part, you need to submit this by using the
button ‘Submit’ (at the bottom of your screen). You will get a warning if you did not give
an answer for all the questions. Click ‘Cancel’ to return to the questions to fill in the
missing answers.
• After submitting the open book part, you cannot return to the questions and the given
answers of the open book part.
• After submitting the open book part, you will get a first provisional score of your complete
assessment. No right can be derived from this score. The final score will be published on
Nestor.
• You are allowed to use your books after the signal of the invigilators.
• Link to resources:https://pup.studystore.nl/bundle/Home/View/12
• You are not allowed to take the assessment, or parts of it, with you. Doing so will be
judged as fraud.
1. A 28-year-old woman presents with fatigue and a quick temper. The symptoms began three weeks
after giving birth. Lab tests show lower than normal TSH (0.05 mU/L) and higher free T4 (34 pmol/L).
She may have Graves’ disease. However, three weeks later her TSH has increased to 8.0 mU/L and
her FT4 has decreased to 7.7. pmol/L.
Which of the following statements is correct?
o (a) these are normal variations in thyroid hormone levels
o (b) this finding is most consistent with silent thyroiditis
o (c) this finding is most consistent with Hashimoto’s thyroiditis
o (d) this finding is most consistent with Graves’ disease
A 2. A 35-year-old man presents with episodes in which he has palpitations and profuse sweating, during
which he also looks pale. Several of his relatives have had thyroid gland surgery but he does not
know the details. Upon physical examination his blood pressure is 150/98 mmHg and his thyroid
feels irregular upon palpation. The cervical lymph nodes cannot be felt.
What is the most likely diagnosis in this patient’s case?
o (a) adrenal phaeochromocytoma due to multiple endocrine neoplasia Type 2A
o (b) catecholamine-producing paragangliomas in the neck
o (c) hyperthyroidism due to familial multinodular goitre.
A 3. A 20-year-old man sees you for reduced libido. He has minimal facial hair growth and only needs to
shave once a week. Upon physical examination you notice that he has hardly any pubic hair. His
testicles are small (both 8 mL). Lab tests have the following results: serum testosterone 7 mmol/L
(lower than normal), LH and FSH higher than normal (15 and 20 U/L respectively).
How would you interpret these findings?
o (a) clinical picture and lab results are consistent with primary hypogonadism
o (b) clinical picture and lab results are consistent with central hypogonadism
4. An adult woman has a markedly enlarged thyroid. Her plasma TSH concentration is elevated, her
plasma free T4 concentration is decreased.
Which clinical symptoms does this woman most likely show?
o (a) Constipation
Page 4
