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1
Q

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
A

E. Streak ovaries

2
Q

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
A

E. 11-deoxycorticosterone

3
Q

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

A. Cholecalciferol (D3)

4
Q

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

A. Amenorrhea

5
Q

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
A

E. Prolactin

6
Q

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
A

C. Inward rectifying K channels

7
Q

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

A

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

8
Q

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

A

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

9
Q

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

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

10
Q

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

A

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

11
Q

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

A

C. No change

Adrenals can’t respond to ACTH

12
Q

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

A. Increase

Adrenals are functional!

13
Q

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
A

E. Pheochromocytoma

14
Q

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
A

D. Hyponatremia

[aldosterone most affected]

15
Q

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

A. Adrenal insufficiency

16
Q

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

A

C. Increase, decrease, increase, increase

17
Q

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

A. Increased cortisol

18
Q

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
A

C. An adrenal tumor

19
Q

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

A

B. Dexamethasone suppression test

[need to differentiate forms of cushings]

20
Q

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

A. Elevated corticotropin-releasing hormone

21
Q

Which of the following compounds will inhibit thyroid peroxidase activity?

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

D. Propylthiouracil

[PTU]

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

22
Q

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
A

E. Low BMR; High TSH

23
Q

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

A. TSH secreting tumor

24
Q

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

A

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

25
Q

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

A

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

26
Q

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

A

D. Muscle spasm

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

27
Q

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
A

D. Malignancy

28
Q

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

A. Elevated Ca and elevated PTHrP

29
Q

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
A

B. GIP

30
Q

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

A

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

31
Q

Which of the following cells have been implicated in the prevention of autoimmune responses?

A. APCs
B. Anergized T cells
C. CD4+/CD25+ T reg cells
D. Follicular DCs
E. Naive T cells
A

C. CD4+/CD25+ T reg cells

32
Q

The FoxP3 nuclear transcription factor is expressed within:

A. CD4+/CD8+ (double positive) thymocytes
B. CD8+ cytotoxic cells
C. CD4+/CD25+ T regulatory cells
D. Th2 type cells

A

C. CD4+/CD25+ T regulatory cells

33
Q

A 41 y/o woman has hypocalcemia, hyperphosphatemia, and decreased urinary phosphate excretion. Injection of PTH causes an increse in urinary cAMP. The most likely diagnosis is

A. Primary hyperparathyroidism
B. Vitamin D intoxication
C. Vitamin D deficiency
D. Hypoparathyroidism after thyroid surgery
E. Pseudohypoparathyroidism
A

D. Hypoparathyroidism after thyroid surgery

34
Q

Which of the following hormones acts on its target tissues by a steroid hormone mechanism of action?

A. Thyroid hormone
B. Parathyroid hormone
C. ADH on the collecting duct
D. beta-1 adrenergic agonists
E. Glucagon
A

A. Thyroid hormone

35
Q

A 38 y/o man who has galactorrhea is found to have a prolactinoma. His physician treats him with bromocriptine, which eliminates the galactorrhea. The basis for the therapeutic action of bromocriptine is that it:

A. Antagonizes the action of prolactin on the breast
B. Enhances the action of prolactin on the breast
C. Inhibits prolactin release from the anterior pituitary
D. Inhibits prolactin release from the hypothalamus
E. Enhances the action of dopamine on the anterior pituitary

A

C. Inhibits prolactin release from the anterior pituitary

36
Q

Which of the following explains the suppression of lactation during pregnancy?

A. Blood prolactin levels are too low for milk production to occur
B. Human placental lactogen levels are too low for milk production to occur
C. The fetal adrenal gland does not produce sufficient estriol
D. Blood levels of estrogen and progesterone are high
E. The maternal anterior pituitary is suppressed

A

D. Blood levels of estrogen and progesterone are high

37
Q

Which of the following decreases the conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol?

A. A diet low in Ca++
B. Hypocalcemia
C. Hyperparathyroidism
D. Hypophosphatemia
E. Chronic renal failure
A

E. Chronic renal failure

38
Q

Which of the following hormones acts by an IP3-Ca++ mechanism of action?

A. 1,25-dihydroxycholecalciferol
B. Progesterone
C. Insulin
D. PTH
E. GnRH
A

E. GnRH

39
Q

A 49 y/o male pt with AIDS and declining CD4 counts has an increased frequency of systemic infections and develops sick euthyroid syndrome. Which of the following would be expected with normal thyroid function?

A. T4 is formed from T3 by the process of monodeiodination
B. T4 is the physiologically active hormone
C. TSH is secreted from posterior pituitary
D. TSH initiates thyroid hormone secretion via activation of nuclear receptors in thyroid gland cells
E. TSH secretion is regulated primarily by the pituitary level of T3

A

E. TSH secretion is regulated primarily by the pituitary level of T3

40
Q

Following neck surgery, a pt develops circumoral paresthesia and a long-QT interval on ECG, consistent with hypocalcemia resulting from injury to parathyroid glands. Which of the following best describes PTH?

A. It acts directly on bone cells to increase Ca resorption and mobilize Ca
B. It acts directly on intestinal cells to increase Ca absorption
C. It is synthesized and secreted from oxyphil cells of parathyroid glands
D. It increases phosphate reabsorption in the renal proximal tubular cells
E. Its secretion is increased in response to an increase in plasma-free Ca concentration

A

A. It acts directly on bone cells to increase Ca resorption and mobilize Ca

41
Q

A 39 y/o man with an enlarged head, hands, and feet; osteoarthritic vertebral changes, and hirsutism presens with a complaint of gynecomastia and lactation. The pt is most likely suffering from a tumor in which of the following locations?

A. Adrenal cortex
B. Anterior pituitary
C. Breast
D. Hypothalamus
E. Posterior pituitary
A

B. Anterior pituitary

42
Q

A 36 wk pregnant mother has a decrease in urinary estriol excretion, indicating a decline in fetal adrenal cortical activity. Which of the following is the steroid secreted by the fetal adrenal cortex?

A. Cortisol
B. Corticosterone
C. Dehydroepiandosterone
D. Progesterone
E. Pregnenolone
A

C. Dehydroepiandosterone

43
Q

A 15 y/o girl presents with loss of the outer one-third of her eyebrows. PE demonstrates slight enlargement of the thyroid gland and delayed relaxation phase of DTRs. Blood work shows an elevation in creatine phosphokinase and TSH. Thyroid hormone therapy is ordered. Physiologically active thyroxine exists in which of the following forms?

A. As a glucuronide
B. Bound to albumin
C. Bound to globulin
D. Bound to prealbumin
E. Unbound
A

E. Unbound

44
Q

A 35 y/o woman presents to her PCP with weakness and fatigue for the past 6 months. Before this episode, she used to be a very active runner but has not had strength or energy to work out the last few weeks. Despite this decrease in exercise, she has lost 10 lbs over this time. She also reports a decreased appetite and has had 2 presyncopal episodes in the last 2 weeks, and has noticed her skin appears darker than usual. Lab tests reveal sodium of 125, potassium of 5.5, elevated renin, aldosterone suppression, ACTH >100 pg/mL, and ACTH stimulation test: cortisol 10 ug/dL. What is the best description of the pt’s fluid and osmolarity status?

A. Hyposmotic volume contraction
B. Hyposmotic volume expansion
C. Hyperosmotic volume contraction
D. Hyperosmotic volume expansion
E. Isosmotic volume contraction
A

A. Hyposmotic volume contraction

45
Q

A 3 y/o pt with DiGeorge congenital thymic aplasia presents with a seizure. An elevated serum phosphorus and low serum calcium confirm a hypoparathyroid state. Plasma levels of Ca can be increased most rapidly by direct action of PTH on which of the following?

A. Bone
B. Intestine
C. Kidney
D. Skeletal muscle
E. Thyroid gland
A

A. Bone

46
Q

A 20 y/o man presents with increasing daytime somnolence. A 24 hr sleep study showing sudden onset of REM sleep without previous slow-wave sleep confirms dx of narcolepsy. REM sleep decreases the secretion of GH. The physiological secretion of GH can be increased by which of the following?

A. FFAs
B. GH
C. Hypoglycemia
D. Hyperglycemia
E. Somatostatin
A

C. Hypoglycemia

47
Q

A 50 y/o alcoholic man presents with cirrhotic liver disease and chronic pancreatitis. He has been experiencing nausea for the past several days, and not eating. As a result of an elevation in his blood glucagon levels, which of the following will occur?

A. Inhibition of adenylate cyclase
B. Inhibition of insulin secretion
C. Inhibition of PLC
D. Stimulation of gluconeogenesis in the liver
E. Stimulation of glycogenolysis in muscle

A

D. Stimulation of gluconeogenesis in the liver

48
Q

A 47 y/o woman with an anterior pituitary tumor presents with poor wound healing and HTN. The endogenous secretion of ACTH is correctly described in which of the following statements?

A. It is decreased during periods of stress
B. It is inhibited by aldosterone
C. It is stimulated by glucocorticoids
D. It is stimulated by epinephrine
E. It shows a circadian rhythm in humans
A

E. It shows a circadian rhythm in humans

49
Q

A 65 y/o woman with metastatic small cell lung carcinoma presents to the ED with nausea, vomiting, and tachycardia. She is dx with Addison disease. Which of the following is most consistent with a patient in this condition — listed in order of serum Na, serum K, blood glucose, blood pressure:

A. Increased; increased; decreased; decreased
B. Decreased; increased; increased; decreased
C. Decreased; increased; decreased; decreased
D. Increased; decreased; increased; decreased
E. Decreased; decreased; increased; increased

A

C. Decreased; increased; decreased; decreased

50
Q

An abdominal CT in a 50 y/o pt with Conn’s syndrome (primary hyperaldosteronism) shows multiple small adrenocortical masses. Which of the following clinical findings are most likely present?

A. Decreased ECF
B. Hyperkalemia
C. Hypertension
D. Increased concentrating ability of the kidney
E. Increased Hct
A

C. Hypertension

51
Q

A 75 y/o woman with primary hyperparathyroidism presents at her physician’s office with dehydration and malaise. Which of the following plasma levels are most likely to be decreased?

A. Calcitonin
B. Calcium
C. Phosphate
D. Potassium
E. Sodium
A

C. Phosphate

52
Q

A 29 y/o man complains of weight gain, decreased energy, dry skin, and brittle hair for the past 6 months. He was diagnosed with hypothyroidism and started on synthetic thyroid hormone. A decrease in which of the following lab values would be expected as a result of starting treatment?

A. Free T4
B. Plasma cholesterol
C. Plasma iron
D. TSH
E. Vitamin A
A

B. Plasma cholesterol

[TSH will decrease as it normalizes. With adequate circulating levels of thyroid hormone, the plasma cholesterol decreases bc there is an increase in LDL receptors on hepatic cells, which increases hepatic removal of cholesterol from circulation]

53
Q

A 37 y/o woman presents with exophthalmos and an enlarged thyroid gland. The levels of free thyroxine in her blood are elevated. Other clinical findings of Grave’s disease include which of the following?

A. Anorexia
B. Bradycardia
C. Decreased sweating
D. Increased BMR
E. Increased weight gain
A

D. Increased BMR

[Grave’s disease is a form of primary hyperthyroidism — Phys Pretest has an error in the explanation in this Q]

54
Q

A 20 y/o man with diabetes forgets to take his insulin prior to the start of his swimming competition. Insulin-dependent glucose uptake occurs in which of the following sites?

A. Adipose tissue
B. Brain
C. Cardiac muscle
D. Skeletal muscle
E. Uterus
A

B. Brain

55
Q

A 46 y/o woman on lithium therapy for bipolar disorder presents with complaints of weakness, arthralgia, and constipation. Blood work reveals hypercholesterolemia, increased levels of TSH, and decreased free T4 levels. Which of the following is also likely to be associated with her hypothyroid state?

A. Decreased BMI
B. Heat intolerance
C. Increased metabolic rate
D. Sleepiness
E. Tachycardia
A

D. Sleepiness

56
Q

A multi-system trauma patient develops hyperpyrexia, severe tachycardia, and high-output CHF with volume depletion, consistent with thyroid storm. Which of the following is the most appropriate treatment for the exaggerated hyperthyroidism?

A. Aspirin to treat fever
B. Beta-adrenergic antagonist therapy to block sympathomimetic symptoms
C. Iodine followed by propylthiouracil to block release and synthesis of thyroid hormone
D. Oral hydration to correct volume depletion
E. T3 administration to induce negative feedback inhibition of T4

A

B. Beta-adrenergic antagonist therapy to block sympathomimetic symptoms

[another error in pre-test which says C is correct answer — PTU MUST BE GIVEN AT LEAST 2 HRS PRIOR TO IODINE OR CONDITION WORSENS]

57
Q

A 59 y/o man is brought to his physican’s office by his wife. She reports that he has been weak, nauseated, and urinates frequently. She has also noted a fruity odor on his breath. A urine sample is positive for ketones and the glucose finger-stick is high — leading to presumptive dx of diabetes. As a result of insulin deficiency, which of the following will most likely occur?

A. Decreased fatty acid release from adipose tissue
B. Decreased intracellular alpha-glycerophosphate in liver and fat cells
C. Enhanced glucose uptake and use except by brain tissue
D. Increased cellular uptake of glucose
E. Indirect depression of glucose utilization due to excess fatty acids in the blood

A

B. Decreased intracellular alpha-glycerophosphate in liver and fat cells

58
Q

A 13 y/o girl presents for her annual sports physical. Her height is measured at 50 inches, <3 SD away from the mean for her age. History suggests that she may be suffering from anorexia nervosa. Which of the following about growth and development is most likely?

A. GH activates JAK2-STAT pathway
B. Linear growth ceases earlier in boys than girls
C. Serum IGF-I levels decrease throughout childhood
D. GH is essential for prenatal linear growth
E. Normal growth during puberty is independent of thyroid function

A

A. GH activates JAK2-STAT pathway

59
Q

A 34 y/o patient with chronic asthma is started on glucocorticoid therapy. The tx may result in bone loss because glucocorticoids do which of the following?

A. Increase Ca absorption from GI tract
B. Increase osteoblast growth
C. Inhibit bone formation
D. Inhibit bone resorption
E. Suppress vitamin D activation
A

C. Inhibit bone formation

[glucocorticoids inhibit protein synthesis in osteoblasts, as well as decrease absorption of Ca and PO4 from intestine and increase their renal excretion]

60
Q

Radiation tx for a pituitary tumor in an 8 y/o boy results in complete loss of pituitary function. As a result, the child is likely to experience which of the following symptoms?

A. Accelerated growth spurts
B. Hyporeflexia
C. Hyperactivity
D. Increased responsiveness to stress
E. Sexual precocity
A

B. Hyporeflexia

61
Q

A 36 y/o male computer programmer works for a company that has just been acquired in a corporate takeover. He experiences symptoms of tachycardia, palpitations, and an irregular heartbeat, particularly at night. His plasma catecholamines are found to be increased, which may result from which of the following?

A. Changing from standing to supine position
B. An increase in blood glucose
C. An increase in BP
D. An increase in blood volume
E. An increase in plasma cortisol
A

E. An increase in plasma cortisol

62
Q

An 18 y/o male with hemophilia A suffered multiple internal injuries from a motorcycle accident. He is referred to an endocrinologist who makes the dx of Addison’s disease, and prescribes cortisol. Cortisol administration to a pt with adrenal insufficiency will result in which of the following?

A. Enhanced wound healing
B. Increased ACTH secretion
C. Increased CRH secretion
D. Increased gluconeogenesis
E. Increased insulin sensitivity in muscle
A

D. Increased gluconeogenesis

[cortisol is defined as a glucocorticoid bc it promotes the conversion of amino acids to glucose (gluconeogenesis)]

63
Q

An 80 y/o man reports increasing dyspnea, which worsens with exertion. The cardiologist orders an echocardiogram, BNP, and ANP to evaluate possible CHF. Which of the following is most likely with ANP?

A. ANP acts only on distal nephron to increase urine flow
B. ANP constricts afferent renal arterioles
C. ANP enhances ADH secretion
D. ANP secretion increases when central venous pressure increases
E. ANP secretion is stimulated by hyponatremia

A

D. ANP secretion increases when central venous pressure increases

64
Q

A 29 y/o female presents with paroxysmal episodes of headaches, anxiety, and palpitations. The physician suspects an anxiety disorder, but orders lab studies to rule out underlying disease. The lab findings of hypercalcemia and elevated urinary catecholamines suggest the possibility of MEN II. Which of the following is the hallmark of pheochromocytoma?

A. Dry skin
B. Hypertension
C. Hypoglycemia
D. Lethargy
E. Weight gain
A

B. Hypertension

65
Q

Pt with nephrogenic DI. Of the folloiwing, which outcome would be suggested and with which intervention?

A. Expected outcome: decreased plasma sodium
B. Expected outcome: increased secretion of ADH
C. Expected outcome: high urine osmolality
D. Suggested intervention: water restriction
E. Suggested intervention: ADH antagonists

A

B. Expected outcome: increased secretion of ADH

66
Q

Which of the following is true of someone with acromegaly?

A. Decreased liver glucose production; decreased muscle glucose uptake
B. Decreased liver glucose production; increased muscle glucose uptake
C. Increased liver glucose production; decreased muscle glucose uptake
D. Increased liver glucose production; increased muscle glucose uptake

A

C. Increased liver glucose production; decreased muscle glucose uptake

67
Q

If a radioimmunoassay is properly conducted and amount of radioactive hormone bound to Ab is low, what does this indicate?

A. Plasma level of endogenous hormone are high
B. Plasma level of endogenous hormone are low
C. More Ab is needed
D. Less radioactive hormone is needed

A

A. Plasma level of endogenous hormone are high

68
Q

By which mechanism do LH and FSH return to baseline levels?

A. LH surge
B. Negative feedback on GnRH by progesterone
C. Negative feedback on GnRH by estradiol
D. Negative feedback on GnRH by testosterone

A

C. Negative feedback on GnRH by estradiol

69
Q

Some cells secrete chemicals into the ECF that act on cells in the same tissue. Which of the following refers to this type of regulation?

A. Neural
B. Endocrine
C. Neuroendocrine
D. Paracrine
E. Autocrine
A

D. Paracrine

[ex: somatostatin from pancreas affects insulin secretion from pancreas]

70
Q

What is the nongenomic effect of testosterone on vascular smooth muscle?

A. Vasodilation
B. Vasoconstriction
C. Increase in prostaglandins
D. Increase in estrogen receptors

A

A. Vasodilation

71
Q

Which of the following is characteristic of a pt with Conn’s syndrome?

A. Normal aldosterone; low cortisol; normal [K]
B. Low aldosterone; low cortisol; high [K]
C. High aldosterone; high cortisol; low [K]
D. High aldosterone; normal cortisol; normal [K]
E. High aldosterone; normal cortisol; low [K]

A

E. High aldosterone; normal cortisol; low [K]

72
Q

Which of the following is characteristic of a pt on a low-sodium diet?

A. Normal aldosterone; low cortisol; normal [K]
B. Low aldosterone; low cortisol; high [K]
C. High aldosterone; high cortisol; low [K]
D. High aldosterone; normal cortisol; normal [K]
E. High aldosterone; normal cortisol; low [K]

A

D. High aldosterone; normal cortisol; normal [K]

73
Q

Which enzyme in the cytochrome P450 steroid synthesis cascade is directly responsible for estradiol synthesis?

A. 17-beta-hydroxysteroid dehydrogenase
B. 5-alpha reductase
C. Aromatase
D. Side chain cleavage enzyme

A

C. Aromatase

74
Q

PTH does what directly?

A. Controls rate of 25-hydroxycholecalciferol formation
B. Controls rate of calcium transport in mucosa of SI
C. Controls rate of formation of calcium-binding protein
D. Controls rate of formation of 1,25-dihydroxycholecalciferol
E. Stimulates renal tubular phosphate reabsorption

A

D. Controls rate of formation of 1,25-dihydroxycholecalciferol

75
Q

A pt has an elevated T4 concentration, low plasma TSH, and her thyroid gland is smaller than normal. What is the most likely explanation?

A. A lesion in the anterior pituitary that prevents TSH secretion
B. Pt is taking propylthiouracil
C. Pt is taking thyroid extract
D. Pt is consuming large amts of iodine
E. Grave’s disease
A

C. Pt is taking thyroid extract

76
Q

Extracellular ionic calcium activity will be decreased within 1 min by which of the following?

A. An increase in extracellular phosphate ion activity
B. An increase in extracellular pH
C. A decrease in extracellular partial pressure of carbon dioxide
D. All of the above
E. None of the above

A

D. All of the above

77
Q

A 30 y/o woman presents for routine PE. Exam reveals she is pregnant. Her plasma levels of TSH are high but her total thyroid hormone is normal. Which of the following best reflects the pt’s clinical state?

A. Grave’s disease
B. Hashimoto’s disease
C. A pituitary tumor secreting TSH
D. A hypothalamic tumor secreting TRH
E. The pt is taking thyroid extract
A

B. Hashimoto’s disease

78
Q

Which hormone is largely unbound to plasma proteins?

A. Cortisol
B. T4
C. ADH
D. Estradiol
E. Progesterone
A

C. ADH

79
Q

If a woman has a tumor that is secreting large amounts of estrogen from the adrenal gland, which of the following will occur?

A. Progesterone levels in blood will be very low
B. Her LH secretion rate will be totally suppressed
C. She will not have normal menstrual cycles
D. Her bones will be normally calcified
E. All of the above

A

E. All of the above

80
Q

When compared with the postabsortpive state, which set of metabolic changes would most likely occur during the postprandial state in order of hepatic glucose uptake; muscle glucose uptake; hormone-sensitive lipase activity

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

D. Increase; increase; decrease

81
Q

A pt presents to the ED in cardiogenic shock d/t massive heart attack. Initial blood sample reveals acidosis with elevated free calcium. To correct the acidosis, the physician begins infusion of sodium bicarb and after 1 hour obtains another blood sample which shows pH of 7.34 and slight decrease in calcium ion concentration. What is the cause of the decrease in calcium ion concentration?

A. The increase in arterial pH resulting from the sodium bicarb infusion inhibiting PTH secretion
B. The increase in pH resulted in stimulation of osteoblasts, which removed calcium from circulation
C. The increase in pH resulted in an elevation in concentration of HPO4, which shifted equilibrium between HPO4 and Ca —> CaHPO4
D. The increase in arterial pH stimulated the formation of vitamin D, which resulted in an increased rate of absorption of calcium from the GI tract

A

C. The increase in pH resulted in an elevation in concentration of HPO4, which shifted equilibrium between HPO4 and Ca —> CaHPO4

82
Q

A 30 y/o man has Conn’s syndrome. Which set of physiological changes is most likely to occur in this patient — in order of arterial pressure; ECF volume; sodium excretion

A. No change; no change; no change
B. Increase; no change; no change
C. Increase; increase; no change
D. No change; increase; decrease
E. Increase; increase; decrease
A

C. Increase; increase; no change

83
Q

A chronic increase in the plasma concentration of TBG would result in which of the following?

A. An increased delivery of T4 to target cells
B. A decrease in plasma free T4
C. An increase in the conversion of T4 to T3 in peripheral tissues
D. An increase in TSH secretion
E. No change in metabolic rate

A

E. No change in metabolic rate