Practice Test for Weeks 1 and 2
1) Identify what the arrow points to in the image of the pars distalis below:
a) Chromophobe
b) Colloid
c) Mallory Body
d) Mucoid
e) Acidophil
f) Concretion
2) The image below is also from the pars distalis. What hormone is most likely being
secreted from the cell being pointed to?
a) Prolactin
b) Oxytocin
c) Vasopressin
d) ACTH
e) More than one of these
3) What is the specific structure where MSH is produced and stored?
a) Pars intermedia
b) Pars distalis
c) Pars tuberalis
d) Pars nervosa
e) Par 3
4) Developmentally, what eventually forms the adenohypophysis?
a) Floor of Telencephalon
b) Floor of Diencephalon
c) Neural ectoderm
d) Neural endoderm
e) Oral Ectoderm
f) Oral Mesoderm
5) What statement is true about how TSH affects thyroid cells?
a) More vacuoles are seen as more colloid is resorbed
b) Lipid droplet removal out of the cell is upregulated
c) Mitochondria begin being broken down by lysosomes
d) Cisternae of ER and Golgi begin to condense in preparation for material resorption
6) What type of tissue is this slide from?
a) Thyroid Gland
b) Pineal Gland
c) Pars nervosa
d) Pars intermedia
7) Embryological origin of parathyroid glands?
a) Pharyngeal pouches 1 and 2
b) Pharyngeal pouches 2 and 3
c) Pharyngeal pouches 3 and 4
d) Pharyngeal pouch 5
e) Rathke’s Pouch
8) Cell type being pointed to in this image below:
a) Oxyphil cells
b) Fat cells
c) Basophilic cells
d) Colloid
e) Myxoid cells
f) Chief cells
9) The type of cells that the arrow points to below, would cause what changes in your
blood when activated?
a) Increase blood calcium
b) Decrease blood calcium
c) Increase melatonin
d) Decrease melatonin
e) Increase cortisol levels
f) Decrease cortisol levels
g) Release a hormone that will induce labor in high enough concentrations
10)
Why are hypothalamic and pituitary hormone secreted in pulses?
a) In order to avoid over-use of cholesterol in the serum
b) Due to the mechanism of release it is not possible for them to be excreted
continuously
c) Prevents desensitization of downstream targets
d) Continuous administration would cause an upregulation of hormone receptors
causing an excess of hormone signaling
11)
Which statement is MOST correct?
a) Hypothalamic hormones and tertiary endocrine hormones are only proteins
b) Hypothalamic hormones and tertiary endocrine hormones are only amino acids
c) Hypothalamic hormones are steroids whereas tertiary endocrine hormones are
proteins or amino acids
d) Hypothalamic hormones are proteins, steroids or amino acids whereas tertiary
endocrine are steroids.
e) Hypothalamic hormones are only proteins whereas tertiary endocrine hormones are
proteins, steroids, or amino acids
12)
Which statement is most correct?
a) Response rate to protein hormone binding take minutes and to steroid hormones is
hours
b) Response rate to steroid hormone binding takes hours and to protein hormones
takes minutes
c) Reponses to both steroid and protein hormone binding takes minutes
d) Reponses to both steroid and protein hormone binding takes hours
13)
Name the hormone that MOST inhibits Growth Hormone Release:
a) Prolactin
b) JAK
c) Somatostatin
d) IGF-1
e) Glucocorticoid
14)
Which hormone is most important for stimulating chondrogenesis at the
epiphyseal growth plate?
a) IGF-1
b) Somatostatin
c) GH
d) Prolactin
e) PTH
15)
A patient of yours comes in because he is peeing a ton lately, feeling very
thirsty and hungry and overall just unwell. He says this is bad because he is a bodybuilder and says he needs to “get swole” right now. He is evasive when you ask if he is
using any performance enhancers. What could be going on?
a) He is so ripped that it’s literally making him sick
b) Anabolic steroids can cause polyphagia and polydipsia
c) He is taking GH hormone, which can be diabetogenic
d) He likely has Hyperkalemia caused by excessive laxative abuse
e) He has polyphagia because he thinks that Marijuana is a performance enhancer
16)
An adult patient is obese, has reduced muscle mass, a lack of energy, and
reduced cardiac output. They are also very short with some features of dwarfism. What
test is BEST to know if their condition is caused by hyposecretion of GH?
a) Insulin tolerance test
b) Glucagon Test
c) Random Serum GH
d) Random Serum GHRH
e)
Urine Somatostatin
17)
What is the etiology for Laron-type dwarfism?
a) Loss of single X chromosome in Turner syndrome
b) Overproduction of somatostatin hormone
c) Autoantibodies target GH
d) GH receptor variant has weak binding to GH
18)
Mecasermin is a recombinant IGF-1 therapy. Which of these statements is
FALSE about the drug?
a) Fewer side effects than GH therapy
b) Should not be given to kids with cancer
c) Will only be effective in patients with closed epiphyses
d) Hypoglycemia is part of the side effect profile
19)
BEST treatment for GH secreting pituitary tumors, matched up with its
CORRECT mechanism of action:
a) Pegvisomant: GH receptor antagonist
b) Bromocriptine: Somatostatin analog
c) Octreotide: Dopamine Agonist
d) Omnitrope: Oversensitize receptors to decrease GH effect
20)
BEST treatment for prolactin-secreting tumor AND its correct mechanism:
a) Oxytocin: Binds to prolactin hormones
b) Cabergoline: Dopamine agonist
c) Bromocriptine: Dopamine antagonist
d) Pegvisomant: Reduce IGF release
21)
Which statement is false
a) T2 is more active than T4
b) Most T3 is converted to T4
c) T3 has a shorter half life than T4
d) Both T3 and T4 bind thyroid hormone receptors
23)
Which deiodinases are important for activation and deactivation of thyroid
hormones?
a) Activation: 1&2 Deactivation: 4 only
b) Activation: 1&2 Deactivation: 1&3
c) Activation: 1&3 Deactivation: 1&2
d) Activation: 1&2 Deactivation: 3 only
24)
Is it hypothyroidism or hyperthyroidism that causes infertility? What is the
mechanism?
a) Hyperthyroidism – impairs GnRH and regulation of ovulation
b) Hypothyroidism – Can cause anovulation and amenorrhea
c) Both of these are correct
25)
Which test is best for confirming a case of Grave’s disease instead of any
other hyperthyroid condition?
a) TSH
b) Free T3 and T4
c) TSI Test
d) Hgb A1C
26)
What part of a Grave’s Disease patient’s past medical history would make
them a poor candidate for use of PTU thioamide therapy?
a) Extensive alcoholism
b) Morbid obesity
c) COPD
d) Arrythmia
27)
Which antibody test is MOST specific for Hashimoto’s Thyroiditis in a female
patient with myxedema and a big painless thyroid?
a) Anti-peroxidase antibody
b) Antithyroglobulin antibody
c) Anti-TSH receptor antibody
d) Anti-FUN antibody
28)
A patient’s big, sore thyroid displays the pathology below. He shows signs of
hypothyroidism. He has also had a recent URI. What is the diagnosis?
a) Grave’s disease
b) DeQuervain Thyroiditis
c) Reidel Thyroiditis
d) Silent Thyroiditis
e) Hashimoto Thyroiditis
29)
You are following up with a female patient 5 months post-partum with her first
child. She has a history of SLE. She says for the first 4 months or so she had a lot of
anxiety, irritability, and trouble sleeping. She didn’t come in because she has been told
post-pertum depression is normal. She has come in today because things have rapidly
changed to the opposite effects. She feels tired all the time, very depressed, cannot
tolerate exercise, and is gaining back the weight she lost in the months after her
delivery. What could be going on?
a) SLE exacerbation causing all symptoms
b) She was taking cocaine, now she’s on Benzos
c) Silent Thyroiditis
d) Reidel Thyroiditis
e) Hashimoto’s Thyroiditis
30)
You are trying to palpate a thyroid for the 100th time and finally feel something
different. It is rock-hard! Patient says their breathing has been a little troubled lately.
What do you think it could be?
a) Grave’s disease
b) DeQuervain Thyroiditis
c) Reidel Thyroiditis
d) Silent Thyroiditis
e)
Hashimoto Thyroiditis
31)
Which statement is false?
Thyroid nodules more likely to be malignant if:
a) Patient is female
b) Nodule is solitary
c) Nodule is cold
d) There is a history of radiation
32)
After biopsying a suspicious nodule you begin having a hay-day with all of the
interesting pathology shown in the images below. What is the diagnosis?
a) Follicular Thyroid Carcinoma
b) Benign hyperplastic goiter
c) Hashimoto Thyroiditis
d) Follicular Thyroid Carcinoma
e) Papillary Carcinoma
Hint: 1) pseudoinclusion 2) Psammoma Body 3) Orphan Annie Nuclei
33)
Which thyroid cancer is an endocrine tumor? (A malignancy of C cells)
a) Follicular Thyroid Carcinoma
b) Papillary Carcinoma
c) Medullary Thyroid Carcinoma
d) Anaplastic thyroid Carcinoma
e) All of these
34)
Which of these is NOT an action of PTH?
a) Increase bone reabsorption
b) Increase renal reabsorption of Ca
c) Increase renal reabsorption of Phosphate
d) Increase renal conversion of Vit D to its active form
e) Increase gut absorption of Ca
35)
Which is NOT ac action of Vitamin D?
a) Stimulate gut to absorb Ca and phosphorus
b) Help PTH remove Ca from bone
c) Stimulate kidney to reabsorb Ca
d) All are effects of Vit D
36)
Primary lab findings of hyperparathyroidism:
a) Increase Serum PTH / Decrease Serum Ca / Increase Serum Phosphate
b) Increase Serum PTH / Increase Serum Ca / Decrease Serum Phosphate
c) Increase Serum PTH / Increase Serum Ca / Increase Serum Phosphate
d) Decrease Serum PTH / Decrease Serum Ca / Increase Serum Phosphate
37)
Which of the following is correct and necessary for osteoclast activation of
osteoclast precursors?
a) Phosphate binds and stimulates receptors on the osteoclast precursor membrane
b) Ca binds and stimulates receptors on the osteoclast precursor membrane
c) The RANKL ligand of the precursor osteoclast binds to the RANK receptor of the
osteoblast
d) The M-CSF ligand of the osteoblast binds to the M-CSFr receptor of the precursor
osteoclast
38)
Commonest cause of PRIMARY hyperparathyroidism?
a) Grave’s Disease
b) Parathyroid Adenoma
c) Vit D overdose
d) Diet poor in Ca
e) Parathyroid hyperplasia
39)
You are examining a patient of yours who has DiGeorge syndrome. He
presents with perioral numbness and teeth pictured in the image below. Physical exam
findings show a positive Chvostek’s sign (stroke cheek and face twitching occurs) and a
positive Trousseau’s sign (blood pressure cuff on arm causes hand-cramping). What is
your first thought?
a) Abuse
b) Hyperparathyroidism
c) Hypoparathyroidism
d) Renal Failure
e) Diet poor in calcium
40)
Which statement is false about cortisol’s actions?
a) Maintain BP
b) Break down bone
c) Suppress inflammation
d) Suppress immune system
e) Suppress Gluconeogenesis
41)
A woman presents in your clinic with hirsutism, truncal obesity, moon facies,
and a foot fracture. What is your first thought?
a) Cushing Syndrome
b) Grave’s Disease
c) Addison’s Disease
d) Hyperaldosteronism
e) Lack of diet and exercise
42)
Which of these could NOT be a cause of this woman’s symptoms:
a) Pitutiary adenoma
b) Current steroid use
c) Paraneoplastic syndrome from cancer
d) Adrenal hyperplasia
e) All are possible
43)
Which association is INCORRECT?
a) Zona glomerulosa secretes mineralcoticoids
b) Zona fasciculata secretes aldosterone
c) Zona reticularis secretes androgens
d) Medulla secretes Epinephrine and Noreprinephrine
e) All are correct
44)
Cells in the adrenal cortex layer shown in the image below are most likely to
secrete which substance?
a) Aldosterone
b) Cortisol
c) Androgens
d) Epinephrine
e) TSH
45)
Two hormones resulting from pituitary process of POMC?
a) FSH and LH
b) TSH and MSH
c) ACTH and TSH
d) MSH and ACTH
e)
LH and ACTH
46)
Why is it that both aldosterone and cortisol can have equal affinity to a
Mineralocoticoid receptor, and yet the cell only responds to aldosterone?
a) The affinity is the same, but tissues like the kidney enzymatically inactivate cortisol
b) The affinity is the same, but cortisol binds to a site on the MR that has no effect
c) The affinity is the same, but it is not possible for cortisol to ever find its way to the
MR
d) The affinity is the same, but macrophages immediately engulf cells with bound
cortisol
47)
Which are true about the comparison in symptoms between a deficiency in 21hydroxylase or 11-beta-hydroxylase? Why?
a) Both cause virilization because more of the pathway is shunted into making
androgens
b) 11-beta-hydroxylase deficiency causes hypotension because there is a decrease in
aldosterone synthesis
c) 21-hydroxylase deficiency causes hypotension because of a decrease in
aldosterone synthesis
d) 11-beta-hydroxylase causes hypertension due to mineralocorticoid activity of
deoxycortisone and 11-deoxycortisol
e) B and C
f) A, B, and C
g) A, C, and D
48)
One of your patient’s has Cushing syndrome and you are trying to discover
the cost. You use a dexamethasone challenge test and find that the cortisol secretion
has been suppressed. What is the cause of the Cushing syndrome?
a) Iatrogenic
b) Pituitary problem
c) Adrenal Problem
d) Paraneoplasic problem
e) None of these
49)
45 year old woman presents to your family practice clinic with chronic HTN
and hypokalemia. HTN began in her 20’s and became severe in her 40’s. The HTN has
been resistant to all attempted drug regimens. At first you were worried about
compliance to medication, but her daughter is with her today and says she has seen her
taking the meds faithfully. Labs today show slightly low potassium, elevated
aldosterone, and VERY low renin. What’s the cause of her problems?
a) Lack of compliance –admit for IV meds
b) Primary hyperaldosteronism
c) Secondary hyperaldosteronism due to congestive heart failure
d) Sesondary hyperaldosteronism due to a renin-producing tumor
50)
What adrenal syndrome is caused by bilateral massive adrenal hemorrhage
and linked to bacterial infection?
a) Pheochromocytoma
b) Waterhouse-Friedrichsen Syndrome
c) Addison Disease
d) Wilson Syndrome
51)
Pheochromocytoma symptoms are caused by increased serum
catecholamines (episodic HTN, headaches, palpitations, tachycardia, and sweating)
How do you diagnose this tumor?
a) Serum renin and angiotensin
b) Serum Dopamine
c) Urine metanephrines/VMA
d) Urine epinephrine
52)
The pathological image below is Neuroblastoma, derived from neural crest
cells. What are the circular formations seen in this image?
a) Signet Rings
b) Flexner-WinterSteiner Rosettes
c) Perivascular Pseudorosettes
d) Homer-Wright Rosettes
53)
Cortisol (hydrocortisone) has a 1:1 ratio of effect on glucocorticoid vs
mineralocorticoid receptors, whereas Dexamethason acts solely on Glucocorticoid
receptors. Which compound acts overwhelmingly on Mineralcorticoid rather than
glucocorticoid recptors?
a) Predisone
b) Methylprednisone
c) Cortisol
d) Fludrocortisone
e) Dexamethasone
54)
First line therapy for treating Cushing’s Disease (NOT just Cushing’s
syndrome) is a resection of the pituitary adenoma – problem resolves in about 70% of
pts. If surgery doesn’t work there is also medical and radiation therapy available. What
antifungal drug is sometimes used to block the production of cortisol when waiting for a
definitve therapy?
a) Terbinafine
b) Ketoconazole
c) Amphotericin B
d) Caspofungin
55)
Pick the most true statement about Insulin:
a) Receptor is a tyrosine kinase AND Amylin is insulin’s co-conspirator
b) Receptor is G-Protein coupled AND Amylin is insulin’s co-conspirator
c) Receptor is a tyrosine kinase AND Ghrelin is insulin’s co-conspirator
d) Receptor is G-Protein coupled AND Ghrelin is insulin’s co-conspirator
56)
Which compound inhibits insulin, glucagon, and ghrelin AND is triggered by
increased insulin.
a) CCK
b) Amylin
c) GLP-1
d) Somatostatin
57)
Ghrelin is secreted by epsilom cells during fasting. How does it affect
glucagon levels?
a) Increases
b) Decreases
c) Does not affect
58)
What activates secretion of Insulin during the Gastrointestinal phase?
a) Incretins
b) Parasympathetic nerves
c) Sympathetic nerves
d) Amylin
e) Glucagon
59)
Which GLUT transporter is insulin sensitive and which acts as a glucose level
sensor in the pancreas?
a) GLUT3 = glucose sensor in pancreas / GLUT5 = Insulin sensitive
b) GLUT2 = glucose sensor in pancreas / GLUT4 = Insulin sensitive
c) GLUT1 = glucose sensor in pancreas / GLUT2 = Insulin sensitive
d) GLUT4 = glucose sensor in pancreas / GLUT2 = Insulin sensitive
60)
You are studying a person with a rare genetic defect. You discover that their
LKB1 is permanently blocked and cannot be activated. What drug would not work to
control this patient’s diabetes?
a) Metformin
b) Januvia
61)
What is Dinitrophenol’s future mechanism of action for diabetes tx?
a) Extremely rapid weight loss
b) Activates LKBI to activate AMPK, which stops CRTC2 from transcribing PGC1
c) Insulin Analogue
d) Mitochondrial Uncoupler
e) Increases adiposity
62)
What is the autosomal dominant genetic mutation in pancreatic beta cells
behind MODY2? (Maturity Onset Diabetes of the Young type 2)
a) Mutation in Ca channels
b) Mutation in Glucokinase
c) Mutation in K channels
d) Mutation in Akt
63)
One model explaining the cause of Type1 diabetes explains that T cells
carrying TCR’s for self-peptides were never weeded out during development. What
protein’s allele variants has a high correlation with T1D?
a) MHC 1
b) MHC 2
c) IgG
d) IgM
64)
How is TNF-alpha, secreted from macrophages, connected to Insulin
resistance in adipose tissue?
a) TNF activates JNK, which inactivates IRS1, which stops Glut4 placement into
membrane
b) TNF activates JNK, which inactivates IRS1, which stops Glut2 placement into
membrane
c) TNF inactivates IRS1, which activaes JNK, which stops Glut2 placement into
membrane
d) TNF activates IRS1, which activates JNK, which stops Glut4 placement into
membrane
65)
TNF-alpha is not the only compound that can activate JNK and cause IRS1 to
block Glut4 translocation. What is another compound that does this?
a) Glucagon
b) Insulin
c) Excess glucose
d) Excess free fatty acids
66)
One of the most damaging effect of diabetes are the vascular changes
responsible for CV disease, end-stage kindey disease, adult-onset blindness, etc
caused by Advanced Glycation End products. How does RAGE, the soluble form of this,
cause damage?
a) RAGE binds to macrophages and promotes ROS release
b) RAGE is an ROS, which has direct oxidative effects
c) RAGE directly stimulates fibrin formation
d) RAGE stimulates clotting factors
67)
Which diabetes drug is a GLP analogue?
a) Lispro
b) Metformin
c) Exenatide
d) Glimeperide
e) Pramlintide
68)
Mechanism of action of sitagliptan:
a) Stop DDP-IV from degrading incretins
b) Amylin Mimetic
c) Increase synthesis and transport of GLUT
d) Insulin secretagogue
69)
Mechanism of action of Nateglinide:
a) Stop DDP-IV from degrading incretins
b) Amylin Mimetic
c) Increase synthesis and transport of GLUT
d) Insulin secretagogue
70)
Which diabetes drug binds to amylin receptors for effect?
a) Lispro
b) Metformin
c) Exenatide
d) Glimeperide
e) Pramlintide
71)
Which of these insulin drugs is intermediate acting?
a) Glargine
b) Lispro
c) NPH
d) Regular
e) Detemir
72)
Which of these drugs is an alpha-glucosidase inhibitor?
a) Repaglinine
b) NPH
c) Pioglitazine
d) Exenatide
e) Miglitol
73)
The most important drug-induced hyperglycemia?
a) Oral contraceptives
b) Statins
c) Niacin
d) Glucocorticoids
74)
Hb A1C over 6.4% constitutes diabetes. What would be an exception to the
rule of trying to keep diabetic patients under 7% with therapy?
a) Elders
b) Youth
c) Extremely obese
d) Those with depression
75)
What is the most common symptom that will bring a patient into the doctor’s
office for metabolic syndrome?
a) Polyuria
b) Weight gain
c) Weight loss
d) Low BP
e) No symptoms