Medicine — Adrenal and Pituitary Disease, NMC MBBS licence examination syllabus (Nepal Medical Council).
Adrenal and pituitary — NMC-style practice questions
Practice questions written for this chapter. These are not past NMC papers.
📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter. All steroid doses, equivalences and sick-day adjustments come from national guidance.
Level 1–2 — recall and understanding
Q1. The characteristic biochemical picture of adrenal crisis
is:
A. High sodium, low potassium, high glucose
B. LOW SODIUM, HIGH POTASSIUM, LOW GLUCOSE
C. Normal electrolytes
D. High calcium
ANSWER: B.
Why: loss of cortisol and aldosterone causes salt loss and
potassium retention, and cortisol deficiency impairs
gluconeogenesis. With fluid-unresponsive shock this triad is
close to diagnostic.
LEARNING POINT: give steroid immediately — do not wait for
cortisol results.
Q2. PIGMENTATION of skin creases and buccal mucosa in adrenal
insufficiency indicates:
A. SECONDARY (pituitary) insufficiency
B. PRIMARY (adrenal) insufficiency, driven by high ACTH
C. Excess cortisol
D. Normal variation only
ANSWER: B.
Why: in primary failure the adrenal cannot produce cortisol,
so ACTH rises and stimulates melanocytes. In secondary
insufficiency ACTH is low and there is no pigmentation.
LEARNING POINT: primary also loses aldosterone, explaining the
hyperkalaemia.
Level 3–4 — application and clinical reasoning
Q3. A patient has vomiting, abdominal pain and hypotension
unresponsive to several litres of fluid, with low sodium,
high potassium and low glucose. The immediate action is:
A. Await cortisol and ACTH results
B. GIVE STEROID IMMEDIATELY, with fluid and glucose
C. Abdominal imaging first
D. Antibiotics alone
ANSWER: B.
Why: this is adrenal crisis until excluded. A single steroid
dose in an acutely unwell adult is essentially harmless;
withholding it from a genuine crisis may be fatal.
LEARNING POINT: infection is the commonest trigger, so treat
the precipitant too — both may be present.
Q4. A man on long-term prednisolone runs out of tablets for
four days, then becomes febrile and collapses. The
underlying problem is:
A. Drug allergy
B. ADRENAL CRISIS from abrupt withdrawal plus increased
demand
C. Simple dehydration
D. Rebound inflammation only
ANSWER: B.
Why: long-term steroids suppress the adrenal axis, so the body
cannot mount its own cortisol response. Stopping removes the
supply exactly as illness raises demand.
LEARNING POINT: never stop long-term steroids abruptly, and
the dose goes UP during illness.
Q5. A woman has central obesity, thin bruising skin, purple
striae and difficulty rising from a chair. Before
extensive investigation you should:
A. Arrange dynamic endocrine testing immediately
B. CHECK THE DRUG CHART, including inhaled and topical
steroids
C. Start treatment empirically
D. Reassure
ANSWER: B.
Why: prescribed glucocorticoid is by far the commonest cause
of Cushing's syndrome, and patients frequently do not report
inhaled or topical preparations as medication.
LEARNING POINT: proximal myopathy with thin bruising skin
distinguishes it from simple obesity.
Level 5 — exception-based
Q6. In hypopituitarism, which hormone must be replaced FIRST?
A. Thyroid hormone
B. CORTISOL
C. Growth hormone
D. They may be started together in any order
ANSWER: B — cortisol.
Why: thyroxine increases metabolic demand, and giving it to a
cortisol-deficient patient can precipitate an adrenal crisis.
LEARNING POINT: this is examined in both the thyroid and
adrenal chapters because the harm is real and avoidable.
Q7. A patient develops sudden severe headache, visual loss
and collapse from a pituitary lesion. Besides urgent
referral, the immediate action is:
A. Give thyroxine
B. GIVE STEROID — apoplexy causes acute adrenal
insufficiency
C. Lumbar puncture
D. Await imaging before any treatment
ANSWER: B.
Why: pituitary apoplexy abruptly removes ACTH drive, causing
acute adrenal insufficiency alongside the mass effect and
visual compromise.
LEARNING POINT: the steroid is given before imaging confirms
anything.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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