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1

A 37 y/o G1P0 female at 15 weeks gestation presents for amniocentesis after a routine triple screen demonstrated an elevated serum AFP. A chromosomal analysis revealed the absence of a second sex chromosome. Which of the following features will the infant most likely have?

A. Mental retardation
B. Macroglossia
C. Micrognathia
D. Cystic kidneys
E. Streak ovaries

E. Streak ovaries

2

A 1 y/o male is found to have high blood pressure on multiple visits to your office. On exam, the patient has normal genitalia. Further lab workup reveals low serum aldosterone and high serum testosterone. Which of the follow is most likely to be elevated in this patient?

A. 17-hydroxylase
B. 21-hydroxylase
C. 11-hydroxylase
D. 5’-deiodinase
E. 11-deoxycorticosterone

E. 11-deoxycorticosterone

3

The human body obtains vitamin D from our diet or from sun exposure. Darker-skinned individuals require more sunlight to create adequate vitamin D stores as the increased melanin in their skin acts like sunscreen; thus, it blocks the necessary UV required for vitamin D synthesis. Therefore, if these individuals spend inadequate time in the light, dietary sources of vitamin D are necessary. Which of the following requires sunlight for its formation?

A. Cholecalciferol (D3)
B. 25-hydroxyvitamin D
C. 25-dihydroxyvitamin D
D. Ergocalciferol (D2)
E. 7-Dehydrocholesterol

A. Cholecalciferol (D3)

4

A 34 y/o woman is diagnosed with an anterior pituitary tumor and undergoes surgical resection of the mass. If treatment with hormone replacement is not begin, for which of the following disorders does she have the greatest increase of risk?

A. Amenorrhea
B. Inability to increase Na reabsorption
C. Inability to increase water reabsorption
D. Inability to secrete catecholamines in response to stress
E. Inability to secrete insulin in response to a meal

A. Amenorrhea

5

A study is conducted to determine the role of the hypothalamus in controlling pituitary function. As a first step, pituitary stalks in healthy animal models are ligated to interrupt hypophyseal portal blood flow. 2 weeks later, serum levels of several hormones are measured. Increased circulating concentrations of which of the following substances is most likely seen?

A. Cortisol
B. FSH
C. GH
D. Oxytocin
E. Prolactin
F. Thyroid hormone

E. Prolactin

6

Which of the following channels closes, contributing to depolarization of the plasma membrane of pancreatic beta cells ultimately leading to insulin release?

A. Voltage gated Na channels
B. Voltage gated K channels
C. Inward rectifying K channels
D. Voltage gated Ca channels
E. Inward rectifying Ca channels

C. Inward rectifying K channels

7

Which of the following would match the fasting blood profile of a patient suspected of suffering from type 1 diabetes mellitus?

A. Normal glucose, normal insulin, normal C-peptide, normal HbA1c
B. Elevated glucose, elevated insulin, elevated/normal C-peptide, elevated HbA1c
C. Decreased glucose, decreased insulin, increased C-peptide, decreased HbA1c
D. Decreased glucose, decreased insulin, increased/normal C-peptide, decreased HbA1c
E. Increased glucose, decreased insulin, decreased C-peptide, increased HbA1c

E. Increased glucose, decreased insulin, decreased C-peptide, increased HbA1c

8

Which of the following would match the fasting blood profile of a patient suspected of suffering from type 2 diabetes mellitus?

A. Normal glucose, normal insulin, normal C-peptide, normal HbA1c
B. Elevated glucose, elevated insulin, elevated/normal C-peptide, elevated HbA1c
C. Decreased glucose, decreased insulin, increased C-peptide, decreased HbA1c
D. Decreased glucose, decreased insulin, increased/normal C-peptide, decreased HbA1c
E. Increased glucose, decreased insulin, decreased C-peptide, increased HbA1c

B. Elevated glucose, elevated insulin, elevated/normal C-peptide, elevated HbA1c

9

Which of the following would be the most appropriate listing of the order of events that occur during the development of type II diabetes?

A. Peripheral insulin resistance —> elevated insulin following meals —> prolonged elevated glucose following meals —> elevated fasting insulin —> elevated fasting glucose
B. Prolonged elevated glucose following meals —> peripheral insulin resistance —> elevated insulin following meals —> elevated fasting glucose
C. Elevated fasting glucose —> peripheral insulin resistance -> elevated insulin following meals —> prolonged elevated glucose following meals —> elevated fasting insulin
D. Elevated fasting insulin —> peripheral insulin resistance —> elevated insulin following meals —> prolonged elevated glucose following meals —> elevated fasting glucose
E. Peripheral insulin resistance —> elevated fasting insulin —> elevated fasting glucose —> elevated insulin following meals —> prolonged elevated glucose following meals

A. Peripheral insulin resistance —> elevated insulin following meals —> prolonged elevated glucose following meals —> elevated fasting insulin —> elevated fasting glucose

10

Which of the following would correctly identify the coordinated actions of glucagon?

A. Increased blood glucose, decreased hepatic glucose output, decreased fatty acids, decreased lipolysis in adipose tissue
B. Increased blood glucose, increased hepatic glucose output, decreased fatty acids, decreased lipolysis in adipose tissue
C. Increased blood glucose, increased hepatic glucose output, increased fatty acids, decreased lipolysis in adipose tissue
D. Increased blood glucose, increased hepatic glucose output, increased fatty acids, increased lipolysis in adipose tissue

D. Increased blood glucose, increased hepatic glucose output, increased fatty acids, increased lipolysis in adipose tissue

11

If a patient with Addison disease is injected with synthetic ACTH (cosyntropin), what do you predict will happen to plasma cortisol levels?

A. Increase
B. Decrease
C. No change

C. No change

Adrenals can’t respond to ACTH

12

If a patient with secondary adrenal insufficiency is injected with synthetic ACTH (cosyntropin), what do you predict will happen to plasma cortisol levels?

A. Increase
B. Decrease
C. No change

A. Increase

Adrenals are functional!

13

A 38-year-old male presents to the office for a yearly physical examination. Vital signs reveal a blood pressure of 188/122 mmHg (seated) and a heart rate of 100/min. The blood pressure after 3 minutes of standing decreases to 152/92 mmHg. The optic fundi show moderately narrowed arterioles with no hemorrhages ore exudates. Laboratory studies reveal normal aldosterone, elevated catecholamines, normal cortisol, normal ADH, normal TSH, and normal T3. What is the most likely diagnosis?

A. Addison disease
B. Hyperaldosteronism
C. SIADH
D. Secondary adrenal insufficiency
E. Pheochromocytoma

E. Pheochromocytoma

14

An investigator is conducting a study to examine the effect of surgical ablation on renal function. In a porcine model, large sections of the outermost layer of both adrenal cortices are ablated. The middle and inner layers are left intact and not ablated. If the animal is allowed to recover from surgery, which of the following direct results is likely?

A. Hypertension
B. Hypervolemia
C. Hypokalemia
D. Hyponatremia
E. Increased ACTH

D. Hyponatremia


[aldosterone most affected]

15

A 45-year-old male presents with fatigability, weakness, anorexia, nausea and vomiting, weight loss, cutaneous and mucosal pigmentation, and hypotension. His temperature is 37.2°, heart rate is 110/min, respiratory rate is 18/min, and blood pressure is 75/55 mmHg. He has type 1 DM and injects insulin. His sugars have been mostly under control. Laboratory studies reveal: hyponatremia, hyperkalemia, and elevated plasma renin. Which of the following is most likely diagnosis?

A. Adrenal insufficiency
B. Cushing syndrome
C. Primary aldosteronism
D. SIADH
E. Thyrotoxicosis

A. Adrenal insufficiency


16

A 45-year-old male presents with fatigability, weakness, anorexia, nausea and vomiting, weight loss, cutaneous and mucosal pigmentation, and hypotension. His temperature is 37.2°, heart rate is 110/min, respiratory rate is 18/min, and blood pressure is 75/55 mmHg. He has type 1 DM and injects insulin. His sugars have been mostly under control. Laboratory studies reveal hyponatremia, hyperkalemia, and elevated plasma renin activity. Additional lab studies are likely to demonstrate which of the following? [in order of ACTH, Aldosterone, Ang II, Renin]

A. Decrease, decrease, decrease, decrease
B. Increase, increase, increase, increase
C. Increase, decrease, increase, increase
D. Increase, decrease, decrease, decrease
E. Decrease, increase, increase, increase

C. Increase, decrease, increase, increase

17

A 36-year-old female complaints of fatigue, weakness and a mass on her back. Physical examination reveals truncal obesity with a soft tissue enlargement on the posterior neck and shoulders. There are also purple striae on the abdomen. A random blood glucose is 160 mg/dL. Further testing would likely show which of the following?

A. Increased cortisol
B. Decreased T3
C. Increased ACTH
D. Increased CRF
E. Increased glucagon

A. Increased cortisol

18

A 40-year-old female presents with complaints of hirsutism. She has hair growth on her face, breasts, abdomen and thighs. Serum testoerone and 24-hour urinary free cortisol levels are elevated. Plasma ACTH is lower than normal. Which of the following is the most likely diagnosis?

A. A testosterone secreting tumor
B. Adult onset congenital adrenal hyperplasia
C. An adrenal tumor
D. Cushing disease
E. Increased 5-alpha-reductase activity

C. An adrenal tumor

19

A 15-year-old female presents with complaints of recent weight gain, development of facial hair and acne. Her blood pressure 145/95 mmHg. Vitals are otherwise unremarkable. Her neck has a posterior fat hump and her supraclavicular areas are round and convex. Her trunk is thick and she has thin extremities. Laboratory analysis reveals a fasting glucose of 155 mg/dL (hyperglycemia). Which of the following laboratory tests will most likely lead to the correct diagnosis?

A. Cosyntropin stimulation test
B. Dexamethasone suppression test
C. Glucose tolerance test
D. Renin and aldosterone determinations

B. Dexamethasone suppression test

[need to differentiate forms of cushings]

20

A 25-year-old man comes to his physician because of decreased libido and feeling tired. He has not been able to complete his workouts at the gym lately, and he recently was involved in a motor vehicle collision, which he attributes to "trouble seeing a car approaching from the side". His temperature is 36.7°C (98°F), pulse is 110/min, blood pressure is 100/75 mm Hg, and respirations are 12/min. Chest auscultation reveals an audible S1 and S2, with a grade I/IV systolic ejection murmur heard best at the apex. Pulmonary auscultation reveals normal bilateral breath sounds. Laboratory studies show decreased adrenocorticotropic hormone, growth hormone, and thyroid-stimulating hormone. Which of the following would most likely be present in this patient?

A. Elevated corticotropin-releasing hormone
B. Elevated cortisol
C. Elevated insulin-like growth factor I
D. Reduced antidiuretic hormone
E. Reduced prolactin
F. Reduced thyrotropin-releasing hormone

A. Elevated corticotropin-releasing hormone

21

Which of the following compounds will inhibit thyroid peroxidase activity?

A. Levothyroxine
B. Perchlorate
C. Thiocynate
D. Propylthiouracil
E. Insulin

D. Propylthiouracil

[PTU]

Levothyroxine is synthroid a T4 replacement, perchlorate and thiocyanate are NIS inhibitors

22

A patient has a genetic mutation in which the thyroid synthesizes TSH receptors that fail to bind TSH. Which of the following describes the appropriate TSH concentration and basal metabolic rate in this patient?

A. High BMR; low TSH
B. Normal BMR; Normal TSH
C. Low BMR; low TSH
D. High BMR; High TSH
E. Low BMR; High TSH

E. Low BMR; High TSH

23

A 55 y/o female presents with recent undesired weight loss, sleep disturbances, and a lump in the anterior portion of her throat. The patient’s TSH, T3, and T4 levels are elevated. Radioactive iodine uptake testing reveals that iodine uptake is markedly elevated at 6 hrs following administration of radioactive iodine. Blood values are negative for thyroid peroxidase or thyroid-stimulating immunoglobulins. Which of the following should be considered as a potential dx in this patient?

A. TSH secreting tumor
B. Graves disease
C. Primary hypothyroidism
D. Hashimoto’s thyroiditis
E. Cretinism

A. TSH secreting tumor

24

A 50-year-old individual is admitted to the emergency room with a fractured tibia. The fracture occurred while this person was lifting light boxes. Bone scans of the spine and hip reveal low bone density. Laboratory tests show low plasma calcium, elevated PTH levels, and low vitamin D levels. The patient indicates that she is on a balanced diet with sufficient fruits and vegetables. However, the patient’s plasma creatinine and BUN levels are elevated markedly. Which of the following is the most likely reason for the hypocalcemia and reduced bone mass?

A. Excessive urinary excretion of calcium
B. Impaired secretion of calcitonin
C. Low dietary calcium
D. A parathyroid gland tumor generating excessive amounts of PTH
E. Reduced renal activity of 1-alpha-hydroxylase activity

E. Reduced renal activity of 1-alpha-hydroxylase activity

25

Parathyroid hormone plays a critical role in regulating plasma calcium levels, as is evident in individuals with hyperparathyroidism, in which persistent hypercalcemia is evident. Under normal conditions, low plasma calcium stimulates PTH secretion, which in turn activates and/or inhibits calcium-handling processes at a number of different sites. High PTH levels stimulate and/or inhibit which of the following processes to return plasma calcium levels toward normal?

A. Inhibit calcium secreted by the GI tract
B. Reduce expression of plasma calcium-binding proteins
C. Stimulate bone resorption, leading to release of calcium into plasma
D. Stimulate calcium reabsorption by the renal proximal tubule
E. Stimulate the release of calcium from muscle cells

C. Stimulate bone resorption, leading to the release of calcium into the plasma

26

A 35-year-old woman undergoes a thyroidectomy for papillary serous thyroid cancer. The surgeon suspects that the parathyroid glands have been removed. Which of the following findings is most likely to be seen in the patient 1 week postoperatively?

A. Coma
B. Constipation
C. Esophagitis
D. Muscle spasm

D. Muscle spasm

[hypocalcemic tetany - bc PTH normally increases serum Ca, this surgery results in hypoparathyroidism]

27

A 65-year-old female complains of fatigue. Laboratory studies reveal hypercalcemia and hypophosphatemia. Parathyroid hormone is undetectable. What is the most likely diagnosis?

A. Familial hypocalciuric hypercalcemia
B. Hyperthyroidism
C. Hypervitaminosis D
D. Malignancy
E. Primary hyperparathyroidism

D. Malignancy

28

A 56-year-old female with an extensive smoking history develops cough and hemoptysis. She has been lowing weight and complains of polyuria and deep bone pain. Deep tendon reflexes are decreased and ECG reveals an abnormally shorted QT interval. Her symptoms have been ongoing for several months. Laboratory studies of serum would likely reveal which of the following results?

A. Elevated Ca and elevated PTHrP
B. Elevated Ca and reduced PTHrP
C. Normal Ca and elevated PTHrP
D. Normal Ca and reduced PTHrP
E. Reduced Ca and elevated PTHrP
F. Reduced Ca and reduced PTHrP

A. Elevated Ca and elevated PTHrP

29

A 35-year-old obese male presents to the office with complaints of having to go to the bathroom “all the time”. However, he reports being able to eat more yet he is losing weight at the same time, and is thrilled about it. The provider suspects the likely diagnosis and orders a confirmation test. The patient is asked to drink a syrupy liquid containing 75 g of glucose (oral glucose load) and blood samples are taken an hour and two hours after glucose ingestion. Sample analysis showed that insulin levels in the patient were about 10 times above reference values at 1 hour and remained elevated at 2 hours. Which of the following would be elevated in blood samples?

A. CCK
B. GIP
C. GRP
D. Secretin
E. Somatostatin
F. VIP

B. GIP

30

In activated T cells, CD152 (CTLA4):

A. Becomes sequestered within Golgi
B. Binds to the appropriate MHC
C. Induces progression through the cell cycle
D. Stimulate transcription of IL-2 mRNA
E. Begins to move to the membrane and binds CD80/86

E. Begins to move to the membrane and binds CD880/86