hormonal imbalance

Practice targeted AMC-style multiple-choice questions on hormonal imbalance.

A 15yo boy has no puberty signs. Initial tests show low LH/FSH. What is the most likely next step in investigation?

A. Bone age X-ray

B. MRI pituitary

C. GnRH stimulation test

D. Karyotype

E. Reassurance and review in 6 months

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Image by ProloSozz — CC BY-SA 4.0 · Source

A 55-year-old male presents to his GP complaining of bilateral breast tenderness and swelling over the past six months. He denies nipple discharge, weight changes, or other systemic symptoms. His past medical history is unremarkable, and he takes no regular medications. Physical examination reveals the findings shown in the image. His vital signs are within normal limits. Considering the most likely underlying cause suggested by the clinical presentation and image, which of the following is the most appropriate initial investigation?

A. Fine needle aspiration of the breast tissue

B. Chest X-ray

C. Mammography

D. Liver function tests and renal function tests

E. Serum testosterone, LH, FSH, estradiol, and prolactin levels

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Image by ProloSozz — CC BY-SA 4.0 · Source

A 48-year-old man presents with a 2-year history of progressive, tender breast enlargement causing significant distress. Initial investigations including liver function tests, renal function tests, and basic hormonal assays (LH, FSH, testosterone, oestradiol) were largely within normal limits, except for a mildly elevated oestradiol. He takes no regular medications and denies recreational drug use. He is otherwise well and his physical examination is unremarkable apart from the findings shown in the image. Considering the clinical presentation and the findings, what is the most appropriate next step in his management?

A. Order a CT scan of the abdomen and pelvis to exclude occult malignancy.

B. Initiate a trial of tamoxifen for 3-6 months.

C. Reassure the patient that this is benign and requires no further intervention.

D. Referral to a plastic or general surgeon for consideration of reduction mammoplasty.

E. Repeat hormonal assays including prolactin and hCG.

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A patient on 2 mg risperidone developed bilateral nipple discharge. What is the most appropriate management step?

A. Switch to quetiapine.

B. Change to amisulpride.

C. Increase risperidone.

D. Decrease risperidone.

E. Switch to clozapine.

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Image by ProloSozz — CC BY-SA 4.0 · Source

A 55-year-old man presents with the condition depicted, which has been present for 12 months and is mildly tender. Initial investigations including hormonal profile, liver function tests, and renal function tests are unremarkable. He takes no regular medications. Considering the clinical presentation and the findings shown, what is the most appropriate next step in the management of this patient?

A. Referral for surgical reduction mammoplasty.

B. Prescription of tamoxifen for symptom relief.

C. Further investigation for rare endocrine causes (e.g., hCG-producing tumour).

D. Urgent referral for breast imaging (ultrasound/mammography).

E. Reassurance and observation with review as needed.

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Image by ProloSozz — CC BY-SA 4.0 · Source

A 55-year-old male presents with bilateral breast tenderness and swelling. He denies nipple discharge or systemic symptoms. His vitals are normal, and he takes no medications. Considering the clinical presentation and the findings depicted, which hormonal imbalance is most commonly implicated in the development of this condition in a male of this age group?

A. Excessive secretion of cortisol

B. Elevated serum prolactin

C. Increased oestrogen to testosterone ratio

D. Isolated deficiency of luteinising hormone

E. Primary hyperthyroidism

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hormonal imbalance

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