Endocrinology: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology

Sample item

A 35-year-old woman has hypertension that is difficult to control, persistent low serum potassium with mild metabolic alkalosis, and no oedema. Which is the most appropriate initial screening test?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Plasma aldosterone to renin ratio

Hypertension with hypokalaemia and metabolic alkalosis suggests primary hyperaldosteronism. Aldosterone excess with suppressed renin is detected by the aldosterone to renin ratio. Confirmatory suppression testing and imaging are done afterwards to find an adenoma or bilateral hyperplasia.

Option by option

  • A. Plasma aldosterone to renin ratio (correct)

    Correct. A raised ratio suggests autonomous aldosterone secretion with suppressed renin.

  • B. Serum calcitonin

    Calcitonin is a marker of medullary thyroid cancer and is unrelated to potassium loss.

  • C. 24-hour urinary vanillylmandelic acid

    Urinary VMA screens for phaeochromocytoma, which causes paroxysmal symptoms and does not typically cause hypokalaemia.

  • D. Overnight dexamethasone suppression test

    A dexamethasone suppression test screens for Cushing syndrome, which would show features such as striae and central obesity.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Plasma aldosterone to renin ratio. Hypertension with hypokalaemia and metabolic alkalosis suggests primary hyperaldosteronism.

Why is "Serum calcitonin" not the answer?

Calcitonin is a marker of medullary thyroid cancer and is unrelated to potassium loss.

Why is "24-hour urinary vanillylmandelic acid" not the answer?

Urinary VMA screens for phaeochromocytoma, which causes paroxysmal symptoms and does not typically cause hypokalaemia.

Why is "Overnight dexamethasone suppression test" not the answer?

A dexamethasone suppression test screens for Cushing syndrome, which would show features such as striae and central obesity.

What concept does this question test?

It tests Endocrinology in General Medicine. Aldosterone excess with suppressed renin is detected by the aldosterone to renin ratio. Confirmatory suppression testing and imaging are done afterwards to find an adenoma or bilateral hyperplasia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.