Quiz Endocrine

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Endocrine #1 – Histology

1) Which of the following coordinates most of the endocrine functions of the body? a) Anterior pituitary

b) Posterior pituitary c) Hypothalamus d) Cerebral cortex e) Autocrine cells

2.1) Which of the following hormones does not dissolve in the blood and thus requires plasma proteins or specialized carrier proteins?

a) Steroid hormones b) Thyroid hormones

c) Small peptides, proteins, and glycoproteins d) Catecholamines

e) A & B f) C & D

2.2) Where are amino acid analogs and their derivatives (including catecholamines) mainly produced?

a) Ovaries, testes, and adrenal cortex b) Hypothalamus, pituitary, and pancreas c) Thyroid and parathyroid

d) Neurons and adrenal medulla

e) Enteroendocrine cells of the GI tract and respiratory system

3.1) Most protein hormones and catecholamines use which of the following second messenger systems for initiating the hormone-receptor interaction?

a) Adenylate cyclase/camp system b) Tyrosine kinase system

c) Phosphatidylinositol system d) Activation of ion channels

e) None of the above (intracellular receptors) 3.2) Which of the following is NOT a second messenger?

a) cAMP b) 5-HT c) DAG d) IP3 e) Ca2+

3.3) Which of the following is NOT true of the intracellular hormone receptor system? a) Usually localized in the cell nucleus

b) Is used by steroid and thyroid hormones (hydrophobic) c) Receptors contain complexes with three binding sites

d) Binding causes allosteric receptor transformation that binds chromosomal DNA and activates or inhibits RNA polymerase activity

e) Receptors influence gene expression but require second messengers 4.1) What portion of the pituitary gland (hypophysis) is most anterior?

a) Pars distalis b) Pars intermedia c) Pars tuberalis

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d) Pars nervosa e) Infundibulum

4.2) What portion of the hypophysis contains neurosecretory axons forming the hypothalamo-hypophyseal tracts? a) Pars distalis b) Pars intermedia c) Pars tuberalis d) Pars nervosa e) Infundibulum

4.3) Which of the following describe the embryology of the hypophysis?

a) The anterior lobe grows down from the neuroectoderm forming the Rathke pouch and the posterior lobe grows up from the oropharynx ectoderm

b) The anterior lobe grows down from the neuroectoderm and the posterior lobe grows up from the oropharynx ectoderm forming the Rathke pouch

c) The anterior lobe grows up from the oropharynx ectoderm forming the Rathke pouch and the posterior lobe grows down from the neuroectoderm

d) The anterior lobe grows up from the oropharynx ectoderm and the posterior lobe grows down from the neuroectoderm forming the Rathke pouch

e) Both the anterior and posterior lobes extend from the floor of the third ventricle 4.4) The superior hypophyseal arteries arising from the internal carotid and posterior communicating, supply the areas around and including the pituitary stalk. The inferior hypophyseal arteries, arising from the internal carotid, supply the pars nervosa. The hypothalamo-hypophyseal portal system serves to carry the neuroendocrine secretions directly to what portion of the hypophysis, without entering systemic circulation?

a) Pars distalis b) Pars intermedia c) Pars tuberalis d) Pars nervosa e) Infundibulum

4.5) Nerves entering the anterior lobe of the pituitary gland have vasomotor function and arise from:

a) Supraoptic nucleus b) Paraventricular nucleus

c) Hypothalamo-hypophyseal tract d) Autonomic postganglionic fibers e) Autonomic preganglionic fibers

Match the pars distalis hormones with the histologic cell description: 4.6) FSH & LH a) Medium sized, oval cells, round central nuclei 4.7) ACTH b) Large polygonal cells with oval nuclei

4.8) TSH c) Medium sized, polygonal cells with round eccentric nuclei 4.9) PRL d) Small oval cells with round eccentric nuclei

4.10) GH e) Large polygonal cells with round eccentric nuclei

4.11) The pars tuberalis, an extension of the anterior lobe along the pituitary stalk, often shows immunoreactivity for which of the following?

a) ACTH, FSH, LH b) TSH, PRL, GH

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c) ACTH, GH, LH d) FSH, PRL, TSH e) LH, TSH, GH

4.12) Which of the following is a small polypeptide (4,000kDa) and stimulates secretion of glucocorticoids and gonadocorticoids by the zona fasciculata and zona reticularis?

a) Growth hormone (somatotropin, GH) b) Prolactin (PRL)

c) Adrenocorticotropin hormone (ACTH) d) Follicle-stimulating hormone (FSH) e) Luteinizing hormone (LH)

f) Thyrotropic hormone (TSH) g) Oxytocin

h) Antidiuretic hormone (ADH, vasopressin)

4.13) Which of the following stimulates spermatogenesis in the testis? a) Growth hormone (somatotropin, GH)

b) Prolactin (PRL)

4.14) Which of the following maintains androgen secretion by the Leydig (interstitial) cells of the testis and regulates final maturation of the ovarian follicle?

a) Growth hormone (somatotropin, GH) b) Prolactin (PRL)

4.15) Oxytocin stimulates ejection of milk from the glands and stimulates contraction of the smooth muscle cells in the pregnant uterus. Which of the following, like oxytocin, is produced then stored in the neurohypophysis?

a) Antidiuretic hormone (ADH, vasopressin) b) Adrenocorticotropin hormone (ACTH) c) Growth hormone (somatotropin, GH) d) Follicle-stimulating hormone (FSH) e) Thyrotropic hormone (TSH)

f) Luteinizing hormone (LH) g) Prolactin (PRL)

5.1) Which of the following hypothalamic regulating hormones inhibits secretion of PRL by lactotropes?

a) Growth hormone-releasing hormone (GHRH) b) Dopamine

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c) Corticotropin-releasing hormone (CRH) d) Somatostatin

e) Thyrotropin-releasing hormone (TRH) f) Gonadotropin-releasing hormone (GnRH)

5.2) Which of the following hypothalamic regulating hormones inhibits secretion of GH? a) Growth hormone-releasing hormone (GHRH)

b) Dopamine

5.3) Which of the following stimulates secretion of LH and FSH? a) Growth hormone-releasing hormone (GHRH)

b) Dopamine

6.1) Which of the following is NOT true of the pineal gland? a) Located on the posterior wall of the third ventricle b) Shaped like a flattened pinecone

c) Develops from oropharynx ectoderm

d) Pinealocytes have a large deeply infolded nucleus with one or more nuclei e) Functions in regulation of daily body rhythm (circadian)

6.2) Which of the following describes the release and action of melatonin?

a) Darkness inhibits the production of melatonin and melatonin stimulates the neurons in the hypothalamus that produce GnRH

b) Darkness inhibits the production of melatonin and melatonin inhibits the neurons in the hypothalamus that produce GnRH

c) Daylight inhibits the production of melatonin and melatonin stimulates the neurons in the hypothalamus that produce GnRH

d) Daylight inhibits the production of melatonin and melatonin inhibits the neurons in the hypothalamus that produce GnRH

7.1) Which of the following occurs at week 14 of development with regard to the thyroid gland?

a) Colloid is produced and the gland starts working b) Thyroid hormone is lost leading to cretinism c) Follicles develop from endodermal cells

d) Thyroglossal duct descends from endoderm pharynx e) Thyroglossal duct divides into two lobes at the trachea 7.2) Which of the following is NOT true?

a) Thyroxine (T4) and triiodothyronine (T3) regulate cell basal metabolism and heat production

b) Calcitonin (thyrocalcitonin) increase blood calcium levels c) Follicular cells produce T3 and T4

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e) The thyroid follicle produces the colloid thyroglobin, which is the inactive storage form for the thyroid hormones

7.3) Which of the following is true of tetraiodothyronine (T4)?

a) Formed by the addition of four iodine atoms to thyroglobulin b) Formed by oxidative coupling of four monoiodotyrosine (MITs) c) Formed by oxidative coupling of two diiodotyrosines (DITs) d) Formed by oxidative coupling of two MITs and a DIT e) Secreted in a T4:T3 ration of 1:20

8.1) Which of the following is true of the parathyroid glands?

a) Superior and inferior glands develop from the third brachial pouch b) Superior and inferior glands develop from the fourth brachial pouch

c) Superior glands develop from third brachial pouch and inferior from fourth d) Superior glands develop from fourth brachial pouch and inferior from third e) All four glands will receive full blood supply without the inferior thyroid artery 8.2) Which of the following is NOT true of parathyroid hormone (PTH)?

a) Promotes calcium release from bone

b) Stimulates calcium reabsorption at distal kidney tubule

c) Increases formation of 1,25-dihydroxycholecalciferol (1,25-OH2) d) Secreted by chief (principle) cells

e) Absorbed by oxyphil cells f) Reduces serum phosphate

9.1) Which of the following describes the embryonic development of the adrenal gland? a) Cortical cells arise from mesoderm; medulla cells originate from endoderm b) Cortical cells arise from neural crest; medulla cells originate from ectoderm c) Cortical cells arise from ectoderm; medulla cells originate from neural crest d) Cortical cells arise from mesoderm; medulla cells originate from neural crest e) Cortical cells arise from neural crest; medulla cells originate from endoderm 9.2) Which of the following layers of the adrenal gland does NOT receive a direct blood supply, but receives blood via sinusoids?

a) Capsule b) Cortex c) Medulla

Match the adrenal gland secreted hormone with the location: 9.3) Catecholamines (epinephrine) a) Zona glomerulosa 9.4) Mineralcorticoids (aldosterone) b) Zona fasciculata 9.5) Gonadocorticoids (DHEA) c) Zona reticularis

9.6) Glucocorticoids (Cortisol) d) Medullary chromaffin cells Match the function with the adrenal gland secreted hormone:

9.7) Induces weak masculinizing effect a) Mineralcorticoids 9.8) Aid in controlling electrolyte homeostasis b) Glucocorticoids 9.9) Promote normal metabolism c) Gonadocorticoids

10.1) Which of the following is formed from the ventral bud from the hepatic duct (not dorsal bud from the foregut)?

a) Uncinate process b) Body

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d) Anterior head

10.2) What is the function of somatostatin (from D cells)? a) Activates insulin and glucagon secretions

b) Inhibits insulin and glucagon secretions

c) Activates insulin secretions and inhibits glucagon secretions d) Activates glucagon secretions and inhibits insulin secretions

10.3) Which of the following is a function of insulin, secreted from beta cells? a) Stimulates gluconeogenesis

b) Stimulates glycogenolysis c) Mobilizes fat

d) Phosphorylation and use of glucose e) Stimulates hepatic lipase

f) Increases blood glucose level

11) A patient presents to the Emergency Room after exposure to radiation from an atomic bomb. This explosion has likely created radioactive iodine. Flooding which of the

following locations with potassium iodine (e.g. IOSAT pill) would help prevent side effects?

a) Islet of Langerhans alpha cells b) Islet of Langerhans beta cells c) Adrenal cortex

d) Thyroid gland e) Pineal gland

Endocrine #2 – Physiology: Hypothalamus & Pituitary

1) Which of the following would be involved in a negative feedback signaling loop located on the same cell?

a) Autocrine signaling b) Paracrine signaling c) Endocrine signaling d) Neurocrine signaling

2) The release of oxytocin to cause contractions during birth is an example of: a) Autocrine signaling

b) Paracrine signaling c) Endocrine signaling d) Neurocrine signaling

3) Pancreatic beta cells secreting insulin that acts on the alpha cells is an example of: a) Autocrine signaling

b) Paracrine signaling c) Endocrine signaling d) Neurocrine signaling

4) The circadian cycle stimulates hormone release (GH and cortisol) in the absence of external stimulation. This is an example of:

a) Neurotransmitter stimulated hormone release b) Hormone stimulated hormone release

c) Pulsatile stimulated hormone release d) Stress stimulated hormone release

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5) Labs are taken from a patient every hour over a 24-hour period. The labs include cortisol from the blood and GH via binding protein. When would these values most likely be the highest?

a) Night (2am) b) Morning (8am) c) Afternoon (2pm) d) Evening (8pm)

6) What GLUT transporter is inserted into target cells (muscle, adipose) when insulin is released from beta cells, which drops blood glucose and causes a negative feedback loop?

a) GLUT1 b) GLUT2 c) GLUT3 d) GLUT4 e) GLUT5

7) The hypothalamus releases a thyroid-releasing hormone (TRH), which stimulates the anterior pituitary to release a trophic hormone (TSH), which affects the target gland. Which of the following describes the negative feedback loop for this process?

a) Pituitary hormones reduce the effect of the hypothalamus

b) Pituitary hormones reduce the effect of the hypothalamus and pituitary c) Target gland hormones reduce the effect of the pituitary

d) Target gland hormones reduce the effect of the pituitary and hypothalamus e) A & D

f) B & C g) B & D

8) The hypothalamus releases a cortisol-releasing hormone (CRH), which stimulates the pituitary to release ACTH, which stimulates the adrenal cortex to release cortisol. Which of the following describes the negative feedback loop for this process?

a) Pituitary hormones reduce the effect of the hypothalamus

b) Pituitary hormones reduce the effect of the hypothalamus and pituitary c) Adrenal cortex hormones reduce the effect of the pituitary

d) Adrenal cortex hormones reduce the effect of the pituitary and hypothalamus e) A & D

f) B & C g) B & D

9) If the adrenal cortex were disable such that it could not participate in the negative feedback loop, which of the following would occur?

a) Decreased CRH and increased cortisol b) Decreased CRH and decreased cortisol c) Increased CRH and absence of ACTH d) Decreased ACTH

e) Increased ACTH

10) If the pituitary gland were disabled such that it could not participate in the cortisol negative feedback loop, which of the following would occur?

a) Increased CRH and increased cortisol b) Increased CRH and decreased cortisol c) Decreased CRH and increased cortisol

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d) Decreased CRH and decreased cortisol

11) A 40-year-old truck driver has had difficulty using his side mirrors for traffic behind him. He has never had any major medical problems in the past. He visits an optometrist, who determines he has bitemporal hemianopsia, but his vision is 20/20. A head CT scan reveals slight enlargement of the sella turcica. Which of the following hormones is most likely being secreted in excessive amounts in this man?

a) Antidiuretic hormone b) Prolactin

c) ACTH

d) Growth hormone e) Luteinizing hormone

12) Which of the following targets to the anterior pituitary is inhibitory? a) CRH (corticotropin-releasing hormone)

b) TRH (thyrotropin-releasing hormone) c) DA (dopamine acting on prolactin) d) PRH (prolactin-releasing hormone)

13) Hypothalamic nerve stimulation to the posterior pituitary would lead to all of the following EXCEPT:

a) Water retention

b) Decreased blood osmolality c) Uterine contraction

d) Thyroid stimulation e) Breast milk ejection

14) A patient presents with dilute, high volume urine (polyuria) and extreme thirst (polydipsia). Which of the following is most likely?

a) No ADH

b) Normal ADH, low sugar c) Normal ADH, high sugar d) Excess ADH

15) A 20-pack-year smoker presents with concentrated, high volume urine and expanded ICR and ECF volume. Which of the following is most likely?

a) No ADH

b) Normal ADH, low sugar c) Normal ADH, high sugar d) Excess ADH

16) How does the hypothalamus cause the release of anterior pituitary hormones? a) Nerve endings directly connect to anterior pituitary

b) Nerve stimulation of the posterior pituitary causes hormone secretion that activates the anterior pituitary

c) Nerve ending hormones release hormones directly into the anterior pituitary d) Nerve ending hormones release hormones that follow the systemic blood supply into the anterior pituitary

e) Nerve ending hormones release hormones that follow the portal blood supply into the anterior pituitary

17) Which of the following hormones is derived from (created in) the posterior pituitary? a) Oxytocin

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b) ACTH c) TSH d) ADH

e) No hormones

18) Which of the following hormones of the anterior pituitary targets the liver? a) ACTH (adrenocorticotropic hormone)

b) TSH (thyroid stimulating hormone) c) GH (growth hormone)

d) FSH (follicle stimulating hormone) e) PRL (prolactin)

19) Which of the following hormones of the hypothalamic-anterior pituitary axis cause the release of FSH? a) TRH b) CRH c) GHRH d) LHRH e) PRH

20) If the connection between the hypothalamus and anterior pituitary were severed, which of the following would increase?

a) TSH b) PRL c) ACTH d) LH & FSH e) GH

21) A middle-aged female patient presents to her physician complaining of weight gain, weakness, lethargy, and dizziness. She was recently diagnosed with pulmonary

carcinoma and reports that her symptoms began within the last week. A MRI of the lung region revealed that her lung tumor grew rapidly over the last few weeks. Physical examination found elevated blood pressure but little to no edema. Laboratory tests indicate severely elevated antidiuretic hormone (ADH). Further laboratory tests would indicate:

a) Elevated renal sodium reabsorption b) Elevated serum sodium concentration

c) Increased atrial natriuretic peptide (ANP) secretion d) Polyuria

e) Reduced urinary osmolality

22) A 25-year-old male presents to his physician complaining of loss of peripheral vision. Physical examination was normal, but a CT scan revealed a very large mass on the

anterior pituitary. Laboratory testing could reveal:

a) Elevated serum corticotropin releasing hormone (CRH) b) Elevated serum growth hormone releasing hormone (GHRH) c) Elevated serum oxytocin

d) Elevated serum prolactin e) Elevated urine osmolality

23) A 45-year-old female is diagnosed with an anterior pituitary tumor. Her physician explains that the best course of treatment would be surgery, but that she would have to

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undergo hormone replacement post-operatively. The hormones that would most likely have to be replaced include:

a) Antidiuretic hormone (ADH)

b) Corticotropin releasing-hormone (CRH) c) Growth hormone releasing-hormone (GHRH) d) Oxytocin

e) Thyroid stimulating hormone (TSH)

Endocrine #3 – Physiology: Thyroid Hormones & Action

1) Which of the following is involved in a positive feedback loop to the hypothalamus? a) Thyroid releasing factor (TRH)

b) Somatotropin release-inhibiting factor (SRIF) c) Thyroid stimulating hormone (TSH)

d) Somatostatin e) T4 & T3

2) Which of the following would occur without a thyroid present? a) TRH increases and TSH increases

b) TRH increase and TSH decreases c) TRH decreases and TSH increases d) TRH decreases and TSH decreases e) T4, T3, and somatostatin increase

Match the thyroid disorder: T4 TSH TRH 3) Primary hypothyroidism a) Decreased Decreased Increased 4) Pituitary hypothyroidism b) Increased Increased Decreased 5) Hypothalamic hypothyroidism c) Decreased Increased Increased 6) Pituitary hyperthyroidism d) Decreased Decreased Decreased 7) Graves disease (autoimmune) e) Increased Decreased Decreased 8) Calcitonin is produced in which of the following locations?

a) Follicular cells b) Colloid

c) Thyroid capillary d) Parafollicular cells e) None of the above

9) Demineralization and glycosylation of thyroglobulin occurs at what cellular location? a) Mitochondria

b) Smooth ER c) Rough ER d) Golgi apparatus

e) Vesicle before entering colloid

10) Iodine is absorbed against an electrochemical gradient (Na+/I- symporter) and concentrated above blood levels (iodide trapping) in what location?

c) Thyroid capillary d) Parafollicular cells e) None of the above

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11) Iodide is sent to the colloid via: a) I-/Cl- exchanger (pedrin) b) Na+/I- symporter

c) Na+/K+ pump d) Passive diffusion e) Active diffusion

12) What is the role of thyroid peroxidase? a) Releases iodine from thyroglobulin b) Binds iodine to thyroglobulin c) Binds two DITs to make T4 d) Binds MIT to DIT to make T3

e) Binds two iodide atoms to make iodine

13) At what location does iodide bind to tyrosine residues on thyroglobulin to form DITs or MITs, leading to a 2-3 month stored supply of T3 and T4?

c) Thyroid capillary d) Parafollicular cells

14) Which of the following is the active form of thyroid hormone? a) T4

b) T3 c) rT3

15) When T4 diffuses into a cell and is deiodinized to T3, which of the following occurs prior to gene transcription with RNA polymerase II?

a) T3 binds to a thyroid receptor b) T3 displaces a corepressor c) T3 recruits a coactivator d) A & B

e) All of the above

16) Which of the following actions of thyroid hormone acts synergistically with GH? a) Increased basal O2 consumption and heat production

b) Increased respiratory rate and minute ventilation c) Increased cardiac output (HR & SV)

d) Increased linear bone growth e) Increased glucose absorption

17) Which of the following, along with norepinephrine, decreases with thyroid hormone action?

a) Hypothalamus SNS center stimulation b) Red blood cell mass and O2 capacity c) Total peripheral resistance

d) Cholesterol turnover (LDL decrease) e) Epinephrine activity (lipolysis) f) Sensory awareness and memory

18) Which of the following would occur in a patient who developed antibodies that are bound to TSH-R and competitively inhibited TSH (Hashimoto disease)?

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b) TRH decreases

c) T4 production increases d) T3 production increases

19) A patient develops antibodies that bind TSH-R and cause hyperstimulation (Graves disease). Which of the following is most likely?

a) Increased T4, increased TSH, increased TRH b) Increased T4, increased TSH, decreased TRH c) Increased T4, decreased TSH, decreased TRH d) Increased T4, decreased TSH, increased TRH e) Decreased T4, increased TSH, decreased TRH

20) A 32-year-old woman complains of excessive tiredness, weight gain, constipation and breast discharge. Laboratory results indicate that serum thyroid stimulating hormone (TSH) was markedly decreased. Additional physical examination and laboratory testing would most likely reveal:

a) Decreased thyrotropin-releasing hormone (TRH) b) Increased respiration rate

c) Increased TRH

d) Increased triiodothyronine (T3) e) Increased T4

Three patients with hypothyroidism arrive at the laboratory for a thyroid-releasing hormone (TRH) test. During this test, TRH was injected at time 0 and plasma TSH was measured for 3 hours. The following graph was created for the findings:

21) What disorder does Patient A have? a) Thyroid

b) Hypothalamus c) Pituitary

22) What disorder does Patient B have? a) Thyroid

b) Hypothalamus c) Pituitary

23) What disorder does Patient C have? a) Thyroid

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24) An adult female patient presented to her physician complaining that she feels weak and fatigue all the time. She reports that she and her husband are getting ready to be divorced, and that she is feeling stressed. Laboratory tests for thyroid function revealed no abnormalities. The physician, however, prescribed her T3. If further testing was done 2 days after beginning treatment, the findings would most likely include:

a) Elevated thyroid stimulating hormone (TSH) b) Increased iodide uptake

c) Increased thyroglobulin synthesis d) No change in iodide uptake e) Reduced T4

25) An experimental animal was created to determine the effects of thyroid stimulating hormone (TSH) deficiency on growth and development. Scientists genetically altered a mouse model by mutating the gene responsible for TSH receptors. A colony was created and called the TSH receptor knockout (TSH-R-KO) mouse strain. The predicted

phenotype of TSH-R-KO offspring would include: a) Above average intellectual capabilities b) Dwarfism

c) Elevated basal metabolic rate d) Elevated body temperature

e) Elevated growth hormone (GH) secretion

26) A female patient presents to her physician complaining of agitation, weight loss, increased appetite, abnormal menstrual cycles, and sleep disturbances. Physical examination reveals that her skin is moist and she has a temperature of 100°C. She reports that her skin itches sometimes and examination reveals pretibial myxedema. A triiodothyronine (T3) resin uptake test (T3RU) revealed increased T3 resin uptake. The physician diagnoses her with Graves’ disease. Further laboratory tests would reveal:

a) Decreased T3 levels b) Decreased T4 levels

c) Elevated thyroid binding globulin concentration d) Elevated thyroid stimulating hormone

e) Saturation of thyroid binding globulin (TBG) binding sites

Endocrine #4 – Physiology: Parathyroid Regulation & Bone Remodeling 1) Where is calcium mainly stored in the body?

a) Bound to albumin b) Bone and teeth c) Kidneys

d) Ionized in serum

e) Non-ionized in serum (complexed) f) Muscle

2) What calcium turnover process results in the loss of the most calcium? a) Bone remodeling

b) Kidney filtering c) ECF secretion d) Intestinal excretion e) Exchangeable pool

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3) Where is phosphate mainly stored in the body? a) Teeth b) Muscle c) Bone d) Kidneys e) Blood

4) What phosphate turnover process results in the loss of the most phosphate? a) Bone remodeling

b) Kidney filtration c) Exchangeable pool d) Intestinal secretion e) Soft tissue remodeling

5) Which of the following describes the action of parathyroid hormone (PTH)? a) Increased Ca++ and bone reabsorption, increased phosphate reabsorption b) Increased Ca++ and bone reabsorption, decreased phosphate reabsorption c) Decreased Ca++ and bone reabsorption, increased phosphate reabsorption d) Decreased Ca++ and bone reabsorption, decreased phosphate reabsorption 6) Which of the following describes the action of vitamin D (intestine & bone)?

a) Increased Ca++ and bone absorption, increased phosphate absorption b) Increased Ca++ and bone absorption, decreased phosphate absorption c) Decreased Ca++ and bone absorption, increased phosphate absorption d) Decreased Ca++ and bone absorption, decreased phosphate absorption 7) Which of the following calcium changes would occur in a patient who has their parafollicular thyroid cells removed?

a) Increased calcium stores b) Decreased calcium stores c) Increased serum calcium d) Decreased serum calcium e) No change in calcium

8) A patient is found to have a PTH tumor. Which of the following sequela may occur? a) Difficulty urinating

b) Goiter

c) Soft tissue pain d) Bone fracture e) Carotid bruit

9) What is the action of calcitonin? a) Activate osteoblasts b) Deactivate osteoblasts c) Activate osteoclasts d) Deactivate osteoclasts

10) Which of the following is NOT true of parathyroid hormone? a) Produced by chief cells of the parathyroid gland

b) Decreases ionized plasma Ca++ levels c) Increases plasma phosphate levels

d) Inhibited by 1,25-OH2-D via negative feedback e) Decreased vitamin D production and bone resorption

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11) A patient presents with complains of lethargy. Testing reveals a likely PTH-releasing tumor. If phosphate is the likely cause of the lethargy, how is PTH affecting the kidneys?

a) Increased reabsorption of phosphate at the proximal tubule b) Decreased reabsorption of phosphate at the proximal tubule c) Increased reabsorption of phosphate at the distal tubule d) Decreased reabsorption of phosphate at the distal tubule 12) What affect does PTH have on calcium in the kidneys?

a) Increased reabsorption of calcium at the proximal tubule b) Decreased reabsorption of calcium at the proximal tubule c) Increased reabsorption of calcium at the distal tubule d) Decreased reabsorption of calcium at the distal tubule

13) Which of the following would be seen in a patient with hypoparathyroidism? a) Hypercalcemia

b) Hypercalciuria c) Renal stones

d) Hyperphosphatemia e) Decreased bone mass

14) Vitamin D (D2 in plants/yeast, D3 in diet/skin) must be hydroxylated to its active form, 1,25-OH2-D. Where does the first hydroxylation occur?

a) Liver b) Blood

c) Kidney proximal tubule d) Kidney distal tubule e) Bone and teeth

15) Where does 1alpha-hydroxylase act? a) Liver

b) Blood

c) Kidney proximal tubule d) Kidney distal tubule e) Bone and teeth

16) Which of the following describes the activity of 1,25-OH2D3? a) Increases calcium absorption in the intestine

b) Increases calcium excretion from the intestine c) Increases proximal tubule calcium reabsorption d) Decreases basolateral membrane Ca++ pumps e) Decreases calbindin synthesis

17) How is calcium transported from the basolateral side to the interstitial space? a) Ca++/H+ ATPase

b) 3Na+/Ca++ exchanger c) Calbindin

d) A & B e) A & C

18) A child presents with leg-bone deformity. Blood testing shows high levels of vitamin D in the blood. Which of the following is most likely?

a) Type I rickets b) Type II rickets

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c) Renal stones

d) Excess 1,25-OH2D3 e) Calcitonin deficiency

19) A man presents to his physician complaining of muscle cramping, irritability and tingling in the fingers and toes. Laboratory tests indicate that he is hypocalcemic and hyperphosphatemic. All other measures are unremarkable. Further laboratory tests would indicate:

a) Elevated calcitonin levels b) Hyperparathyroidism c) Hypoparathyroidism d) Vitamin D deficiency e) Vitamin D excess

20) A female patient presents complaining of pain in the lower right side of her back, nausea, constipation, fatigue, muscle weakness, and lethargy. An MRI of the

thyroid/parathyroid region revealed a small tumor on the parathyroid gland causing parathyroid over-activation. Further laboratory tests would indicate:

a) High serum phosphate, high serum calcium, and high serum parathyroid hormone (PTH)

b) High serum phosphate, low serum calcium, and low serum PTH c) Low serum phosphate, high serum calcium, and high serum PTH d) Low serum phosphate, high serum calcium, and low serum PTH e) Low serum phosphate, low serum calcium, and high serum PTH

21) A female patient with renal disease undergoes laboratory tests to measure plasma ions and renal function. Based on the results, her physician diagnoses her with a rare autoimmune disorder that is causing progressive kidney destruction. This destruction will probably also result in the impairment in the conversion of:

a) 1,25-dihydroxycholecalciferol to 25-hydroxycholecalciferol b) 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol c) Cholesterol to 7-dehydrocholesterol

d) Vitamin D3 to 25-hydroxycholecalciferol e) Vitamin D3 to Vitamin D2

22) Which of the following is true?

a) Most of bone mass is cortical bone and remodeling mostly affects cortical bone b) Most of bone mass is cortical bone and remodeling mostly affects spongy bone c) Most of bone mass is spongy bone and remodeling mostly affects cortical bone d) Most of bone mass is spongy bone and remodeling mostly affects spongy bone 23) Which of the following is contained within the osteoid?

a) Ground substance b) Type I collagen c) Proteoglycans

d) Minerals (CaPO4, Na, Carbonate, Mg) e) All of the above

24) Which of the following is stimulated by cytokines and inhibited by calcitonin? a) Osteoblasts

b) Osteocytes c) Osteoclasts

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d) Osteocalcin e) Osteonectin

25) Annexins are secreted by which of the following in order to recruit more of their own?

a) Osteoblasts b) Osteocytes c) Osteoclasts

26) What paracrine signaling is accomplished during bone remodeling? a) Osteocytes signal osteoblasts

b) Osteocytes signal osteoclasts c) Osteoblasts signal osteoclasts d) Osteoblasts signal osteocytes e) Osteoclasts signal osteoblasts

27) PTH stimulates bone resorption by activating: a) Osteoblasts

b) Osteocytes c) Osteoclasts

28) Which of the following people would have the most bone mass? a) Teenage soccer player

b) Young adult weight lifter c) Female undergoing menopause d) Adult male jogger

e) Elderly bedridden patient

Endocrine #5 – Physiology: Adrenal Hormones

Match the hormone with the primary location of production: 1) Catecholamines a) Adrenal cortex, zona glomerulosa 2) Aldosterone b) Adrenal cortex, zona fasciculata 3) Cortisol c) Adrenal cortex, zona reticularis 4) Androgens d) Adrenal medulla

5) A patient with hyperaldosteronism would likely have: a) Low ANP levels

b) Low 18-OH-DOC levels c) Hypercalcemia

d) Hypomagnesemia e) Hypokalemia

6) Which of the following would lead to an overall decrease in sodium and water

excretion due to activation of ADH in the renin-angiotensin-aldosterone system (RAAS)? a) Increased blood pressure

b) Decreased blood hematocrit c) Increased blood osmolarity d) Decreased blood osmolality e) Increased sodium retention

7) Angiotensin II is converted to aldosterone at what location? a) Brain

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c) Lungs d) Liver e) Kidneys

8) What is the main function of aldosterone? a) Decrease sodium reabsorption b) Increase K+ secretion

c) Maintain ECF volume d) Increase H+ secretion e) Deplete ICF volume

9) Cortisol releasing factor (CRF) from the hypothalamus would lead to all of the following EXCEPT:

a) Increased growth

b) Increased blood pressure c) Increased arousal

d) Increased SNS

e) Decreased reproductive hormones 10) Which of the following would inhibit ACTH?

a) Stress b) Depression c) Anxiety d) Cortisol e) Alpha-agonists

11) Which of the following would lead to a higher setpoint for cortisol due to an over-ride of the negative feedback loop?

a) Sleeping during the day b) Strenuous exercise c) Constant stress d) High fat diet e) Decreased CRH

12) Glucocorticoids (e.g. cortisol) inhibit which of the following via a negative feedback loop?

a) Hypothalamus

b) Corticotroph (anterior pituitary) c) Adrenal cortex

d) A & B e) A & C

Match the glucocorticoid disorder: Plasma cortisol Plasma ACTH 13) Primary hypercortisolism a) Increased Increased 14) Secondary hypercortisolism b) Decreased Increased 15) Primary hypocortisolism c) Increase Decreased 16) Secondary hypocortisolism d) Decreased Decreased 17) Which of the following is NOT an effect of glucocorticoids?

a) Insulin resistance b) Lipogenesis in the trunk c) NPY inhibition

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e) Muscle protein turnover and gluconeogenesis

18) Which of the following is NOT an effect of glucocorticoids? a) Decrease in muscle mass and strength

b) Decreased bone formation and increased resorption c) Thinning of skin and capillary walls

d) Decreases glomerular filtration rate e) Decreased memory

19) Which of the following is NOT an effect of glucocorticoids? a) Inhibits arachidonic acid synthesis

b) Decreases neutrophil number but increases effectiveness c) Decreases fibroblast proliferation

d) Stimulates T-cell apoptosis

e) Inhibits IL, INF-gamma, COX-2 expression 20) Which of the following is true of androgens?

a) Most of male androgens exist in the adrenals b) Female ovaries provide most of their androgens

c) A castrated male can use the adrenals to compensate for testosterone loss d) Adrenal androgen is converted to testosterone in the female pubic and axillary areas

e) Adrenal androgens are of great importance to a physiologic male

21) Scientists were conducting an experiment to look at the effect of surgical ablation on kidney function. After doing 40 ablation surgeries, their student was tired and anxious to finish. On his 41st surgery he accidentally removed a large section of the outer layer of the adrenal gland. If the animal were allowed to recover from surgery, hormonal measurements would probably indicate:

a) Decreased adrenocorticotropic hormone (ACTH) secretion b) Decreased aldosterone production

c) Decreased androgen production d) Decreased catecholamine production e) Decreased stress-induced cortisol secretion

22) In an experiment designed to characterize the hypothalamic-pituitary-adrenal axis in rodents, plasma adrenocorticotropic hormone (ACTH) and corticosterone were measured in several rats following various surgical and

pharmaco-logical manipulations. The following graph plots the relative hormone levels for each animal. Hormonal profiles for each group reveal:

a) Group A may have adrenal hyperplasia

b) Group A may have primary adrenal insufficiency c) Group B may have hypothalamic deficiency d) Group B may have pituitary deficiency e) Group C may have adrenal hyperplasia

23) A male patient presents to his physician complaining of muscle weakness and abnormal heartbeat he describes as “beating out of tune.” He was previously been

diagnosed with Type 1 (insulin-dependent) diabetes mellitus, but reports strict adherence to insulin treatments and eats a low-salt and low-carbohydrate diet. Laboratory tests

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measuring serum electrolytes revealed low sodium and elevated potassium levels. Further laboratory tests would reveal:

a) Elevated ACTH secretion b) Elevated aldosterone secretion c) Elevated glucocorticoid secretion d) Reduced ACTH secretion

e) Reduced renin secretion

24) A 49-year-old male presents to his physician complaining of a persistent “dry” cough, muscle weakness, and reduced libido. Physical examination reveals abnormal weight gain in the back, abdomen, and face and abdominal stria. He reports that he has smoked 2 packs of cigarettes per day for the last 30 years. Laboratory tests revealed elevated serum glucose, a positive dexamethasone suppression test, and a hormone-secreting bronchial carcinoma. Further laboratory tests would most likely reveal that the hormone secreted by the tumor is:

a) Adrenocorticotropic hormone (ACTH) b) Cortisol

c) Glucagon

d) Growth hormone e) Thyroxine

25) A male patient is experiencing adrenal insufficiency and cannot produce adequate amounts of cortisol, either basal or stress-induced. Under basal conditions metabolism is not greatly affected, but he experiences severe weakness when confronted with a stressor. Laboratory tests conducted during periods of stress would likely indicate:

a) Decreased glucose uptake in muscles and adipose b) Hypoglycemia

c) Increased circulating amino acids d) Increased gluconeogenesis e) Increased lipoysis

26) Where is norepinephrine mostly produced? a) Preganglionic sympathetic fibers b) Postganglionic sympathetic fibers c) Preganglionic parasympathetic fibers d) Postganglionic parasympathetic fibers

27) Which of the following actions is decreased by epinephrine and norepinephrine? a) Insulin action

b) Glucagon secretion c) BMR and thermogenesis d) Gluconeogenesis

e) Glycogenolysis

28) Which of the following actions is decreased by epinephrine and norepinephrine? a) Heart rate

b) Renin secretion c) Skin blood flow d) Systolic pressure e) Cardiac contractility f) Bronchodilation

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29) A male patient presents to his physician complaining of feelings of “nervousness” followed by fatigue. Subsequent tests revealed an adrenal tumor in the medullary region. Further laboratory testing would most likely reveal:

a) Decreased circulating free fatty acids b) Decreased circulating glucose levels c) Decreased circulating insulin levels d) Increased glycogenesis

e) Increased lipogenesis

Endocrine #6 – Physiology: Hormones Involved in Food Intake & Energy Storage Match the hypothalamic location with the function:

1) Satiety a) Lateral nuclei 2) Regulation of feeding b) Ventromedial nuclei

3) Hunger c) Paraventricular nucleus (PVN) 4) Multi-hormone action d) Dorsomedial nuclei (DMN) 5) Increase eating e) Arcuate nuclei (ACN)

6) Which of the following components of the arcuate nucleus decreases food intake and increases energy expenditure?

a) Alpha-MSH (melanocyte-stimulating hormone) b) NPY (neuropeptide Y)

c) CART (cocaine- and amphetamine-related transcripts) d) AGRP (agouti-related protein)

e) A & C f) B & D

7) POMC neurons release alpha-MSH, which acts on MCR-3 and MCR-4 melanocortin receptors in the paraventricular nucleus. Which of the following would occur if a patient had an MCR-4 mutation or who receives MCR-4 antagonist (AGRP)?

a) Addiction to cocaine b) Rapid weight loss c) Early satiety d) Obesity

e) Intolerance to amphetamines

8) Which of the following decreases POMC activation and is the most associated with increased appetite (hunger)?

a) NPY

b) Alpha-MSH c) CART d) AGRP

9) Antagonizing which of the following could be a helpful treatment for an obese patient whose weight problem is caused by Leptin?

a) MCH (melanin-concentrating hormone)

b) CART (cocaine- and amphetamine-related transcripts) c) Orexin (hypocretin)

d) NPY (neuropeptide Y) e) CB1 (cannabinoid)

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a) MCH (melanin-concentrating hormone)

b) CART (cocaine- and amphetamine-related transcripts) c) Orexin (hypocretin)

d) NPY (neuropeptide Y) e) CB1 (cannabinoid)

11) A deficiency of orexin (hypocretin) would lead to: a) Malnutrition

b) Neoplasm c) Narcolepsy d) Diabetes e) Agitation

12) Which of the following short-term regulators that decrease eating responds to fat entering the duodenum?

a) Peptide YY

b) Glucagon-like peptide c) Cholecystokinin d) Insulin

13) A patient with Prader-Willi is found to have high levels of Ghrelin. What affect does this have? a) Hunger b) Double vision c) Easy bruising d) Hyperthyroidism e) Hypogonadism

14) Which of the following would NOT occur in the presence of Leptin? a) Decreased NPY and AGRP

b) POMC inhibition c) CRH increase d) SNS increase e) Insulin decrease

15) The Zucker Diabetic Fatty (ZDF) rat has which of the following disorders? a) Childhood over-nutrition to increase fat cells

b) Hypothalamic lesion c) Hypophyseal tumor d) MCR gene mutation e) Leptin receptor mutation

16) Which of the following is the recommended primary obesity treatment? a) Physical exercise

b) Amphetamines

c) Altering lipid metabolism d) Gastric bypass

e) Gastric banding

17) A mutation in POMC would cause which of the following? a) Increased food intake and weight gain

b) Increased food intake but weight loss c) Decreased food intake and weight loss

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d) Decreased food intake but weight gain

18) What is the mechanism by which an AGRP gene mutation decreases food intake? a) Antagonizes MCR-3 and MCR-4 receptors

b) Cause release of alpha-MSH

c) SNS activation to the nucleus tractus solitarius d) Decreases POMC activation

e) Leptin antagonism

19) What is the mechanism by which an NPY gene mutation decreases food intake? a) Antagonizes MCR-3 and MCR-4 receptors

b) Cause release of alpha-MSH

c) SNS activation to the nucleus tractus solitarius d) Decreases POMC activation

e) Leptin antagonism

Endocrine #7 – Physiology: Growth

1) Which of the following would lead to an increase in growth hormone (GH)? a) Caloric restriction

b) Increased amino acids

c) Increased glucose or free fatty acids d) Exercise or stress

e) Ghrelin

2) Which of the following inhibits GH by acting on GHRH? a) Somatostatin

b) Cortisol c) Old-age d) Obesity e) Pregnancy

3) A woman presents with acromegaly and breast discharge. Which of the following hormones would likely be high?

a) Prolactin b) Oxytocin c) ACTH d) GH e) ADH

4) The JAK-STAT pathway involves taking dimerized GH and transcribing it to IGF-1 (insulin-like growth factor). Where does this mainly occur?

a) Liver b) Long bone c) Pituitary d) Kidney

e) Hypothalamus

5) Which of the following is a function of IGF-1, not GH? a) Gluconeogenesis

b) Bone and tissue growth c) Insulin resistance d) Protein synthesis

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e) Lipolysis

6) Which of the following promotes the closure of long bone epiphyseal plates? a) GH

b) IGF-1

c) Estrogen & testosterone d) Insulin & thyroid hormones

7) Which of the following would NOT occur in an adult with high levels of growth hormone?

a) Prominent jaw b) Prominent brow c) Large hands and feet d) Increase height e) Large nose

8) Hypothyroidism in infancy would lead to what growth effects? a) Developmental retardation

b) Large long bones

c) Leg length discrepancies d) Prominent jaw and nose

e) Organomegaly, especially heart

9) Which of the following would occur in a patient with congenital growth hormone receptor dysfunction?

a) Dwarfism with low GH levels and secondary sex characteristics present b) Dwarfism with high GH levels and secondary sex characteristics present c) Dwarfism with low GH levels and no secondary sex characteristics d) Dwarfism with high GH levels and no secondary sex characteristics 10) Which of the following would be seen in a patient with excess growth hormone?

a) Hypoglycemia and hypergonadism b) Hyperglycemia and hypergonadism c) Hypoglycemia and hypogonadism d) Hyperglycemia and hypogonadism

11) A 42-year-old male visits a local physician for a physical exam. He reports that this is his first physical in 5 years, and that he is concerned about changes in his appearance over the last couple years. He explains that his feet and hands have grown larger, his jaw is protruding, and his face is “looking strange.” He reports slight difficulty breathing, frequent headaches, fatigue and weakness, impotence, and excessive sweating.

Laboratory tests indicate elevated insulin-like growth factor-1 (IGF-1), and an MRI scan revealed a 1.5 cm mass on the anterior pituitary. Further physical examination and laboratory tests may indicate:

a) Decreased hypothalamic somatostatin secretion b) Decreased protein synthesis

c) Hypoglycemia d) Insulin resistance e) Muscle atrophy

12) A 25-year-old male presents to his physician for an annual physical. He was previously diagnosed with a growth hormone (GH)-secreting tumor on his anterior

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pituitary, for which he is taking a somatostatin analog. Laboratory tests, however, reveal elevated GH levels. Further laboratory tests would most likely reveal:

a) Decreased gluconeogenesis b) Increased lipolysis

c) Increased long bone growth d) Increased insulin action e) Decreased insulin levels

13) A young adult female patient visits her physician for a physical exam. The physician observes distinct changes in her appearance that suggest excess growth hormone (GH) action. Her feet and hands appear larger than expected, and her jaw protrudes more than normal. Laboratory tests indicate elevated insulin-like growth factor-1 (IGF-1), and an MRI scan revealed a 1.5 cm mass on the anterior pituitary. Further physical examination and laboratory tests may indicate:

a) Decreased circulating free fatty acids

b) Decreased hypothalamic somatostatin secretion c) Decreased lean muscle mass

d) Increased lipogenesis e) Hyperglycemia

14) A physician notices abnormal growth patterns in a young male child during an annual physical. The child was severely below normal on standardized growth tests for both height and weight. All other aspects of the physical examination were unremarkable. Laboratory tests indicate normal thyroxine and triiodothyronine and decreased levels of insulin-like growth factor-1. Further laboratory tests would indicate:

a) A decrease in insulin-like growth factor binding proteins (IGFBP) b) A decrease in thyroid stimulating hormone (TSH)

c) An increase in growth hormone (GH) secretion d) An increase in IGFBP

e) An increase in thyroid stimulating hormone (TSH)

15) An elderly male presents to his physician to discuss with his physician a new drug that he saw on the television. He reported that he was always in very good shape but is now “soft and flabby.” He explained that he saw a commercial about human growth hormone (GH) administration that was described as a “fountain of youth” and he wanted to see if he could begin taking it. Laboratory tests revealed that the patient had reduced GH levels, and the doctor agreed to prescribe the GH replacement for him. The most likely effect of GH replacement would be:

a) Decreased collagen synthesis b) Decreased lipolysis

c) Decreased protein synthesis

d) Increased glucose uptake in muscle and adipose e) Increased plasma glucose

Endocrine #8 – Physiology: Endocrine Pancreas

1) Which of the following cells secrete amylin and pancreastatin? a) Alpha cells

b) Beta cells c) Delta cells

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d) PP cells

2) C peptide has a long serum half-life so it can be helpful in determining past levels of which of the following?

a) Insulin b) Glucagon c) Somatostatin

d) Pancreatic polypeptide e) Glucose

3) Which of the following cells is the first to receive arterial blood supply? a) Alpha cells

b) Beta cells c) Delta cells

4) Which of the following inhibits insulin? a) Eating

b) Glucagon

c) Intestinal hormones d) Glucose

e) Leptin

5) Which of the following describes the insulin response associated with glucose injection?

a) Monophasic with an initial rapid increase due to intestinal hormones b) Monophasic with a gradual increase due to intestinal hormones

c) Biphasic with an initial rapid increase due to intestinal hormones and a secondary increase due to beta cells

d) Biphasic with an initial rapid increase due to beta cells and a secondary increase due to intestinal hormones

e) Monophasic with a gradual increase due to beta cells

6) Insulin causes the insertion of what glucose transporter, leading to glucose crossing membranes to be converted to glycogen in adipose tissue and skeletal muscle?

7) Insulin causes a decrease in which of the following within the liver? a) Glycogenolysis

b) Glycolysis c) Glycogenesis d) Protein synthesis e) Lipogenesis

8) Which of the following stimulates glucagon secretion? a) Somatostatin

b) Insulin

c) Hypoglycemia d) Secretin

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a) Increased glycogenolysis b) Gluconeogenesis

c) Increased insulin d) Lipolysis

e) Ketogenesis

10) Which of the following would cause the insulin to glucagon ratio to increase the most (>10.0 from normal of 2.0?

a) Pure protein meal b) Carbohydrate loading c) Pure fat meal

d) Prolonged exercise e) Fasting

11) Glucagon-like peptide-1 (GLP-1) is released from the intestines and has what action? a) Increase insulin and increase glucagon

b) Increase insulin and decrease glucagon c) Decrease insulin and increase glucagon d) Decrease insulin and decrease glucagon 12) Which of the following is an action of somatostatin?

a) Inhibits insulin b) Inhibits glucagon

c) Inhibits GI motility and secretions

d) Inhibits glucose and triglyceride absorption e) All of the above

13) Which of the following is regulated by hypoglycemia, inhibited by hyperglycemia, and is used diagnostically as a marker for an islet cell tumor?

a) Insulin b) Glucagon c) Somatostatin

d) Pancreatic polypeptide e) Glucose

14) Which of the following is NOT a symptom of Type-1 (insulin dependent) or Type-2 (non-insulin dependent) diabetes mellitus?

a) Weight gain b) Polydipsia c) Polyuria

d) Increased food consumption

15) Which of the following is associated with Type-1 diabetes more so than Type-2? a) Genetic component

b) Obesity as a cause c) Native American race d) Autoimmune reaction

e) Sulfonylurea drugs for treatment

16) A middle aged male presented to his physician for an annual physical. Routine testing revealed elevated plasma glucose levels. Further laboratory testing revealed elevated insulin levels and severely elevated glucagon levels. Following an MRI, he was

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diagnosed with a pancreatic !-cell tumor. The elevated glucose levels in this patient is most likely due to:

a) Decreased glycogenolysis b) Decreased lipogenesis c) Increased gluconeogenesis d) Increased lipolysis

e) Increased hepatic glycogenesis

17) A 37-year-old pregnant woman visits her physician for a prenatal visit. She was in her 13th week of gestation and had been healthy with a normal pregnancy thus far. Urinalysis revealed elevated glucose levels and blood tests revealed elevated insulin. She has no history of diabetes, although her mother developed Type 2 (non-insulin

dependent) diabetes later in life. Her elevated glucose levels are most likely due to: a) Autoimmune pancreatic alpha cell destruction

b) Autoimmune pancreatic beta cell destruction c) Elevated growth hormone (GH) secretion d) Increased carbohydrate ingestion

e) Insulin resistance

18) An experiment was designed to determine the effects of a high-fat diet on carbohydrate metabolism. Rats in group A were

fed a special formulated diet high in fat, and rats in group B were fed an isocaloric low-fat diet. These diets were fed to the rats for 2 weeks and a fasting glucose tolerance test was performed. The

following graph illustrates the results for group A (Time 0 is glucose administration). The condition that would most likely produce these results is:

a) Excess glucagon release b) Increased glycogenesis c) Increased glycogenolysis

d) Type-1 (insulin dependent) diabetes mellitus e) Type-2 (noninsulin dependent) diabetes mellitus

Endocrine #9 – Pharmacology: Hypothalamic & Pituitary Hormones 1) Which of the following is located directly superior to the sella turcica?

a) Hypothalamus b) Pituitary c) Pons

d) Cingulate gyrus e) Medulla

2.1) Which of the following hormones released from the anterior pituitary does NOT stimulate the production of hormones by a peripheral endocrine gland or the liver?

a) FSH b) LH c) ACTH d) TSH e) PRL

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2.2) Posterior pituitary hormones (Oxytocin, ADH) are released from neurons that arise from what area?

a) Preoptic nucleus b) Supraoptic nucleus c) Paraventricular nucleus d) Cingulate gyrus

e) Solitary nucleus

3.1) Dopamine from the hypothalamus inhibits which of the following? a) Growth hormone (GH, somatotropin)

b) Thyroid-stimulating hormone (TSH) c) Adrenocorticotropin (ACTH)

d) Follicle-stimulating hormone (FSH) e) Luteinizing hormone (LH)

f) Prolactin (PRL)

3.2) Which hypothalamic hormone is used rarely to differentiate Cushing disease from ectopic secretion?

a) Growth hormone-releasing hormone (GHRH) b) Thyrotropin-releasing hormone (TRH, protirelin) c) Corticotropin-releasing hormone (CRH)

d) Gonadotropin-releasing hormone (GnRH) e) Dopamine

4) Which of the following conditions for which human growth hormone (hGH) treatment is indicated is considered the most controversial?

a) Prader-Willi syndrome b) Turner syndrome c) Idiopathic short stature d) None of the above

5) A patient with infertility is undergoing fertility treatment in order to conceive. On day three of her menstrual cycle, she is started on daily injections of an FSH preparation, which continue for about 7-12 days. Since exogenous gonadotropins are being used to stimulate follicular development, they are administered in conjunction with either a continuous GnRH agonist (down-regulates receptors) or a GnRH antagonist. Why?

a) To prevent a luteal surge

b) To reduce endometrial thickness c) To increase FSH levels

d) To reduce serum estradiol levels e) To cause rapid ovulation

6) Which of the following are D2 agonists and thus are useful for hyperprolactinemia? a) Fenoldopam

b) Bromocriptine and cabergoline

c) Metoclopramide, droperidol, and domperidone d) Clozapine, risperidone, and olanzapine

e) Amoxapine

7) A post-partum woman is having continual uterine bleeding. Which of the following could be given to help reduce hemorrhage?

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b) Dopamine agonist c) ADH (vasopressin) d) Prolactin (PRL)

e) Luteinizing hormone (LH)

8) Antidiuretic hormone (ADH, vasopressin) may be indicated in which of the following patients?

a) Diabetes mellitus type-1 b) Diabetes mellitus type-2 c) Diabetes insipidus d) Hypertension e) Galactorrhea

Endocrine #10 – Pharmacology: Thyroid & Antithyroid Drugs 1.1) Iodine peroxidase, which converts I- to I2, occurs in what location?

a) Thyroid gland membrane b) Within the thyroid gland c) Blood

d) Peripheral tissues

1.2) Amiodarone, corticosteroids, beta-blockers, and ipodate affect thyroid hormone formation at what location?

a) Thyroid iodine transporter b) Thyroid peroxidase enzyme

c) Thyroid T3/T4 proteolysis to blood d) T4 to T3 conversion in peripheral tissues e) B & C

1.3) Thioamides affect thyroid hormone formation at what location? a) Thyroid iodine transporter

b) Thyroid peroxidase enzyme

1.4) Iodides affect thyroid hormone formation at what location? a) Thyroid iodine transporter

b) Thyroid peroxidase enzyme

2) Levothyroxine (Synthroid, Levoxyl) is the preparation of choice for thyroid replacement. Which of the following is NOT true of levothyroxine?

a) Short half-life b) Low drug cost

c) Lack of allergenic foreign protein d) Uniformity and stability

e) Easy lab measurement of serum levels

3) All thioamines have a simple molecular structure in common. What is the name of this structure (shown)?

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a) Thioacetamide b) Thionamide c) Triiodothyronine d) Thiocarbamide e) Thioacetamide

4) An elderly patient is receiving levothyroxine and having their serum TSH and free thyroxine monitored. Which of the following signs or symptoms may signify an adverse effect to the medication?

a) Weight gain b) Bradycardia c) Heart palpitations d) Cold intolerance e) Somnolence

5) A patient with known hypothyroidism presents in a near-coma condition with edema, bradycardia, and low core body temperature (myxedema coma). Which of the following would be considered appropriate treatment?

a) Oral levothyroxine, 50-100mcg (low dose) b) Oral levothyroxine, 300-400mcg (high dose) c) IV levothyroxine, 50-100mcg (low dose) d) IV levothyroxine, 300-400mcg (high dose) e) IV fluids and glucose only

6) A non-pregnant patient with Graves disease is being examined for treatment options. What is the preferred drug for this patient, which requires 12-18 months of therapy?

a) Desmopressin (DDAVP) b) Fludrocortisone (Florinef) c) Levothyroxine (Synthroid) d) Methimazole (Tapazole) e) Octreotide (Sandostatin)

Endocrine #11 – Pharmacology: Corticosteroids & Antagonists

1.1) Deficiency of the enzyme 17alpha-hydroxylase would prevent the formation of which of the following and have what effect on blood pressure?

a) No aldosterone or cortisol, hypotension b) No aldosterone or cortisol, hypertension

c) No cortisol or sex hormones (estradiol/testosterone), hypotension d) No cortisol or sex hormones (estradiol/testosterone), hypertension

1.2) Deficiency of the enzyme 21-hydroxylase would prevent the formation of which of the following and have what effect on blood pressure?

1.3) Deficiency of the enzyme 11beta-hydroxylase would prevent the formation of which of the following and have what effect on blood pressure?

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2) Which of the following describes the hierarchy of anti-inflammatory effects for the included drugs?

a) Hydrocortisone > Prednisone > Triamcinolone > Dexamethasone b) Triamcinolone > Dexamethasone > Hydrocortisone > Prednisone c) Dexamethasone > Triamcinolone > Prednisone > Hydrocortisone d) Hydrocortisone > Triamcinolone > Dexamethasone > Prednisone e) Dexamethasone > Hydrocortisone > Prednisone > Triamcinolone 3) Which of the following describes the hierarch of salt-retaining efficacy for the included drugs?

a) Fludrocortisone > Hydrocortisone > Triamcinolone b) Fludrocortisone > Triamcinolone > Hydrocortisone c) Hydrocortisone > Fludrocortisone > Triamcinolone d) Hydrocortisone > Triamcinolone > Fludrocortisone e) Triamcinolone > Hydrocortisone > Fludrocortisone

4) In the fasting state, glucocorticoids stimulate phosphoenolypyruvate, carboxykinase, and G6P. What major effect does this have?

a) Increased urine amino acids b) Increased serum amino acids c) Decreased gluconeogenesis d) Increased gluconeogenesis e) Decreased glycogen synthesis

5) Which of the following would occur in serum (blood) after injection of a short-acting glucocorticoid?

a) Increased neutrophils and increased lymphocytes b) Increased neutrophils and decreased lymphocytes c) Decreased neutrophils and increased lymphocytes d) Decreased neutrophils and decreased lymphocytes

6) A defect in 21beta-hydroxylase would prevent formation of cortisol, which leads to a compensatory increase in ACTH. This causes the adrenal gland to become hyperplastic and secrete large amounts of precursors. What effect would this have?

a) Hypotension b) Hypokalemia c) Salt wasting d) Alopecia e) Virilization

7) Cushing disease (ACTH-secreting pituitary adenoma) can be treated with metyrapone (Metopirone) or which of the following?

a) Desmopressin (DDAVP) b) Ketoconazole (Nizoral) c) Levothyroxine (Synthroid) d) Methimazole (Tapazole) e) Somatotropin (Humatrope)

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8) Mifepristone (RU-486) is a progesterone antagonist with some anti-glucocorticoid properties at higher doses. Which of the following is describes the mechanism by which mifepristone acts with blockage of glucocorticoid receptors?

a) Stabilizes the Hsp-glucocorticoid receptor complex

b) Inhibits dissociation of the RU-486-bound glucocorticoid receptor from the Hsp chaperone proteins

c) Alters the interaction of the glucocorticoid receptor with coregulators, favoring the formation of a transcriptionally inactive complex

d) All of the above

Endocrine #12 – Pharmacology: Gonadal Hormones & Inhibitors

1.1) Which of the following does NOT peak at day 14 of a 28-day menstrual cycle? a) LH

b) FSH c) Estradiol d) Progesterone

1.2) At which of the following days during a 28-day menstrual cycle would endometrial lining be the thickest?

a) 7 b) 14 c) 21 d) 28

2) Which of the following steroid reactions is NOT correct?

a) Androstenedione can convert to testosterone without an enzyme b) Testosterone requires aromatase to create estradiol

c) Estradiol requires aromatase to create estrone

d) Androstenedione requires aromatase to create estrone

e) Testosterone can convert to androstenedione without an enzyme 3) What effect does FSH have on the follicle of the mature ovary?

a) Stimulates growth of ovarian follicles and estrogen secretion b) Stimulates growth of ovarian follicles and progesterone secretion c) Stimulates recession of ovarian follicles and estrogen secretion d) Stimulates recession of ovarian follicles and progesterone secretion

4) Estrogen (estradiol) receptors are found in the nucleus in what stable conformation? a) Bound to estrogen response elements (EREs)

b) Bound to heat shock protein (Hsp90) c) As a dimer (estradiol-estradiol) d) Bound to estrone

e) In an aromatic ring-form pattern

5) According to the Women’s Health Initiative (WHI), estrogen treatment or hormone replacement therapy (HRT) in peri- and post-menopausal women can increase the risk of cardiovascular disease as well as which of the following?

a) Increased risk of Alzheimer disease b) Negative effect on circulating lipids c) Increased risk of breast cancer d) Increased risk of colon cancer

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e) Negative effect on circulating lipoproteins

6) What is the claimed advantage of third-generation synthetic progestins (19-not, 13-ethyl), including desogestrel, gestodene, and norgestimate, when compared with older synthetic progestins?

a) Less effective gonadotropin inhibitors b) Less estrogenic activity

c) More estrogenic activity d) Less androgenic activity e) More androgenic activity

7) Which of the following is an adverse effect of oral contraceptives (estrogenic compounds), which has increased risk in smokers over aged 35?

a) Bleeding disorders b) Small cell lung cancer c) Duodenal ulcers d) Rheumatic fever e) Venous embolism

8) Which of the following post-coital contraceptives is considered abortifacient? a) Conjugate estrogen

b) Ethinyl estradiol c) Mifepristone d) Diethylstilbestrol e) Norgestrel

9.1) What is the role of LH on the testis? a) Promote sperm maturation b) Promote testosterone synthesis c) Promote testosterone secretion d) A & B

e) B & C

9.2) What is the role of FSH on the testis? a) Promote sperm maturation b) Promote testosterone synthesis c) Promote testosterone secretion d) A & B

e) B & C

10) In the skin, prostate, and seminal vesicles, testosterone is converted to which of the following? a) DHEA b) DHT c) ACTH d) Cortisol e) Estradiol

11) Which of the following is NOT correct regarding the dosing regimen of androgens in cases of pubertal hypogonadism?

a) Long-acting agents such as testosterone enanthate or cypionate are used b) Doses are 50mg IM injection

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c) Initial doses are every 4-weeks, then every 3-weeks, then every 2-weeks until maturation is complete

d) Adult doses are 200mg at 4-week intervals

12.1) Finasteride (Proscar) inhibits the production of DHT by inhibiting what enzyme? a) 17alpha-hydroxylase

b) Aromatase

c) 11beta-hydroxylase d) 5alpha-reductase e) 21-hydroxylase

12.2) Flutamide (Eulexin) has which of the following effects? a) Agonist at the androgen receptor

b) Competitive antagonist at the androgen receptor c) Inhibitor of 5alpha-reductase

d) Activator of 5alpha-reductase

Endocrine #13 – Pharmacology: Pancreatic Hormones & Antidiabetic Drugs 1.1) Which of the following is found in beta cells of the pancreas and regulates insulin release as well as other aspects of glucose homeostasis?

1.2) Which of the following is found in muscle and adipose tissue and functions in insulin-mediated uptake of glucose?

2) Which of the following describes the hierarchy of time to peak action for the included insulin formations?

a) Lispro insulin > Regular insulin > NPH > Glargine insulin b) Regular insulin > Lispro insulin > NPH > Glargine insulin c) NPH > Glargine insulin > Lispro insulin > Regular insulin d) Regular insulin > Glargine insulin > Lispro insulin > NPH e) Glargine insulin > NPH > Regular insulin > Lispro insulin 3) How do sulfonylurea drugs affect insulin release?

a) Blocks GLUT2

b) Depolarizes (closes) K+ channels c) Polarizes (opens) K+ channels d) Depolarizes (opens) Ca++ channels e) Polarizes (closes) Ca++ channels f) Blocks insulin exocytosis

4) Why are children under the age of seven exempt from the American Diabetes Association’s Benefits of Tight Glycemic Control of Diabetes guidelines?

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a) Risk of thromboembolic events

b) Risk of brain damage due to hypoglycemia c) Risk of neuropathy due to hyperglycemia

d) Risk of renal failure due to glycemic fluctuations e) Risk of permanent bone mass loss

5) Which of the following is NOT an alternative to insulin syringe injections currently available for Type-1 diabetics?

a) Subcutaneous insulin infusion devices b) Portable pen injectors

c) Ocular insulin drops d) Inhaled insulin

6) Risk is most reduced in what system for patients who adhere to the guidelines for Benefits of Tight Glycemic Control of Diabetes?

a) Neurologic b) Gastrointestinal c) Renal

d) Reproductive e) Cardiovascular

7) Which of the following is NOT a symptom of hypoglycemia? a) Difficulty speaking

b) Tachycardia c) Convulsions

d) Pinpoint pupils (miosis) e) Headache

8) When are alpha-glucosidase inhibitors indicated? a) Initial therapy for Type-1 diabetics

b) Adjunctive therapy for Type-1 diabetics c) Initial therapy for Type-2 diabetics d) Adjunctive therapy for Type-2 diabetics e) Never due to their side-effect profile

9) Which of the following describes the hierarchy of maximal duration of action for the included sulfonylureas?

a) Tolbutamide > Glimepiride > Chlorpropamide b) Glimepiride > Chlorpropamide > Tolbutamide c) Chlorpropamide > Glimepiride > Tolbutamide d) Chlorpropamide > Tolbutamide > Glimepiride e) Tolbutamide > Chlorpropamide > Glimepiride

10) Which of the following is the safest sulfonylurea for elderly diabetics and why? a) Chlorpropamide due to its long half-life

b) Chlorpropamide due to its short half-life c) Tolbutamide due to its long half-life d) Tolbutamide due to its short half-life e) Glimepiride due to its long half-life

11) Which of the following is NOT a typical reason for secondary failure (failure to maintain a good response to sulfonylurea over the long term) in patients on sulfonylurea therapy?