SMBM 307- ENDOCRINE SYSTEM IAs

ENDOCRINE SYSTEM IN HEALTH AND DISEASE -

CRACK APP
COURSE CREDIT:
ANATOMY(Dr. Ali, Mr. Maalman, Mr. Otchere, Mr Ohene Djan)

1. The following statements about the pituitary gland are accurate?

I. Housed in the sphenoid bone
II. Synthesis oxytocin which cause uterine smooth muscle contraction
III. Mass made of about 30% anterior lobe
IV. Pressure on the diaphragm sellae potentially press on the optic chiasma
A. I,II
B. I,III
C. I,IV
D. II,III
E. II,IV

2. Adenohypophysis is accurately characterized by which of the following statement I.

Composed of epithelial tissue.
II. A pars distalis which is the larger portion
III. A pars tuberalis which forms a sheath around the infundibulum
IV. Arises from the part of the primitive oral cavity known as Rathke,s pouch
A. I,II,III
B. I,II,IV
C. II,III,IV
D. I,III,IV
E. I,II,III,IV

3. The posterior lobe is correctly related to the following except

A. Also called the neurohypophysis
B. Composed of neural tissue
C. Connected to the hypothalamus through the anterior lobe
D. pituicytes are part
E. The bulbar portion is the larger part

4. The thyroid gland moves up when a one swallows. This is explained by the fact that the:

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 A. gland is free to move on swallow
B. gland surrounds the pretracheal fascia
C. muscles of swallowing overlie the gland
D. investing layer of the gland is derived from the pretrachial fascia
E. Muscles of swallowing and surrounding tissues are closely adhered to it

In a surgical thyrodectomy(removal) planning session for madam Akuka who is a popular

musician in Ghana, the anaethesiologist did maneuvers to ensure ease of
intubation(placing the tube in the airway) and avoid medicolegal issues. In each
manuavres, a correct or wrong reason is given regarding passing the tube .

5. Choose the correctly matched reason for each manuvre.

I. Insituating a finger at the jugular/suprasternal notch- centrality of the trachea

II. Asking for X-ray anatomy of the neck- checking for the cervical vertebrae
III. Asking to visualize the movement of the vocal cords pre-surgery- function of the
vagus nerve
A. I only
B. II only
C. III only
D. I, II only E. I,II,III
6. Assuming during the operation, the surgeon asked you to arrange the following structures
in the order he has to go through from the skin to the gland.
I. Sternothyroid,sternohyoid
II. Pretracheal fascia
III. Platysma muscle
A. I,II,III B.
I,III,II
C. II,III,I
D. III,I,II
E. III,II,I
7. If surgeon Gruzman was concerned about possible complications as a result of the
operation to remove the thyroid gland, which of the following is not true.
A. Damage to the superior laryngeal nerve-altered phonation after surgery
B. Damage to the recurrent laryngeal nerve-muscle paralysis
C. Correctly ligated superior and inferior thyroid artery- bleeding
limited to the pretracheal fascia only
D. Total removal of the thyroid gland- removal of parathyroid glands too
E. None of the above

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 8. The true statements of the thyroid gland and its important relations include the following
EXCEPT?
A. lateral lobes— each extending from the side of the thyroid cartilage
downwards to the 8th tracheal ring
B. an inconstant pyramidal lobe- projecting upwards from the isthmus and
usually on the right side
C. The immediate posterior relationship of the isthmus of the thyroid gland
is the 2nd and 3rd tracheal rings
D. The recurrent laryngeal nerve passes through the groove between the
trachea and the oesophagus
E. the inferior thyroid artery arise from the thyrocervical trunk of the
subclavian artery

9. The statement below that correctly describe the venous drainage of the thyroid gland I.
The superior thyroid vein— drains the upper pole to the internal jugular vein
II. The middle thyroid vein—drains from the lateral side of the gland to the internal
jugular
III. The inferior thyroid veins—often several—drain the lower pole to the
brachiocephalic veins.
A. I only
B. I, II only
C. II,III only
D. I,III only
E. I,II,III

10. Each thyroid follicle consist of the following:

I. Follicular cell
II. A basement membrane
III. A lumen containing colloidal tissue
IV. Endothelial lining made of cuboidal to columnar cells if TSH is not secreted
A. I,II,III
B. I,III,IV
C. II,III,IV
D. I,II,IV
E. II,III

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 11. Which statement inappropriately describes the parathyroid gland
A. about 40 mg
B. Usually 4 pairs
C. one superior and one inferior parathyroid gland are attached to each lateral thyroid
lobe
D. Derived from third and fourth brachial or pharyngeal pouches
E. Regulate calcium and phosphate levels-osteoclast, renal tuburlar absorption, intestinal
absorption Vit D3
12. Microscopically, the features of the parathyroid gland can be summarized as follows
I. Embedded in the capsule of the thyroid gland
II. Have thin septation that divide the parenchyma to secretory units
III. The septa carry blood vessels, nerves and lymphatics
A. I ,II only
B. I, III only
C. II, III only
D. I, II, III
E. None of the above

13. Description of the anatomy of the adrenal gland include the following EXCEPT
A. Also call suprarenal gland
B. Closely applied to suprior pole ectopic the kidneys also
C. Outer capsule ,Adrenal cortex, inner medulla
D. Centrally placed prominent vein Adrenal medulla
E. Derived from different embryonic tissue from the kidney
14. The correct order of structural arrangement at microscopy in the adrenal gland from
inside out
I. Capsule
II. Zona glomerulosa
III. Zona fasciculata
IV. Zona recticularis
V. medulla
A. I,II,III,IV,V
B. V,IV,III,II,I
C. V, II,III,IV,I
D. V, III,IV,II, I
E. I,V,II,III,IV
15. The group of cells that perform the endocrine function in the pancreas has the following
features
I. call islets of langerhans
II. Most numerous at the tail of the pancreas

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 III. Similar cellular size
IV. Develops around cappilaries
A. I,II,III
B. I, II,IV
C. I,III,IV
D. II,III,IV
E. I,II,III,IV
16. Which of the following is not an accurate relationship to the pancreas
A. Head related to the second part of the duodenum
B. The tail related to the spleen
C. Retroperitoneal therefore posterior to the aorta
D. Left kidney is posterior
E. Right kidney is lateral
17. Cell of the endocrine pancreas include the following
I. Alpha cells
II. Beta cells
III. Delta cells
IV. principal cells
V. F cells
A. I,II, III, IV
B. II,III,IV,V
C. I,II,III,V
D. I,II,IV,V
E. I,II,III,IV,V
18. Which of the following is accurate about the pineal gland?
A. Attached to the roof of the third ventricle
B. covered by a capsule formed by the pia mater
C. consists of masses of neuroglia and secretory cells
D. X rays film of a calcified gland shows centrality of the 3rd ventricle.
A. I, II,only
B. I,IV only
C. II,III,IV only
D. III,IV
E. [Link],III,IV

1. Adenohypophysis is accurately characterized by which of the following statement

V. Composed of epithelial tissue.
VI. A pars distalis which is the larger portion

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 VII. A pars tuberalis which forms a sheath around the infundibulum
VIII. Arises from the part of the primitive oral cavity known as Rathke,s pouch
IX. All the above

2. If a surgeon was concerned about possible complications as a result of the operation

to remove the thyroid gland, which of the following is not true about the involve
action on the anatomical structure and the complication indicated.
A. Damage to the superior laryngeal nerve-altered phonation after surgery
B. Damage to the recurrent laryngeal nerve-muscle paralysis
C. Correctly ligated superior and inferior thyroid artery- bleeding limited to
the pretracheal fascia only
D. Total removal of the thyroid gland- removal of parathyroid glands too
E. None of the above
3. Microscopically, the features of the parathyroid gland can be summarized as follows
IV. Embedded in the capsule of the thyroid gland
V. Have thin septation that divide the parenchyma to secretory units
VI. The septa carry blood vessels, nerves and lymphatics
VII. Yellowish in appearance
VIII. Has bigger cells called clear cell

4. Description of the anatomy of the adrenal gland include the following EXCEPT
F. Also call suprarenal gland
G. Closely applied to suprior pole ectopic the kidneys also
H. Outer capsule ,Adrenal cortex, inner medulla
I. Centrally placed prominent vein Adrenal medulla
J. Derived from different embryonic tissue from the kidney
5. Which of the following is not an accurate relationship to the pancreas
A. Head related to the second part of the duodenum
B. The tail related to the spleen
C. Retroperitoneal therefore posterior to the aorta

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 D. Left kidney is posterior
E. Right kidney is more medial
6. The histological appearance of a thyroid gland being stimulated by thyroid-
stimulating hormone (TSH) would show which of the following?
A. Decreased numbers of follicular cells
B. Decrease numbers of parafollicular cells
C. Low columnar to cuboidal-shaped follicular cells
D. Reduce colloid in the lumen of the follicle
E. Decreased numbers of parafollicular capillaries
7. Characteristics of pinealocytes include which one of the following?

A. They produce melatonin and serotonin.

B. They resemble astrocytes.
C. They contain calcified concretions of unknown function.
D. They act as postganglionic sympathetic cells.
E. None of the above
8. Prolactin is synthesized and secreted by which of the following cells?
A. Acidophil of the pas tubularis
B. Acidophils in the pars distalis
C. Basophils in the pars tuberalis
D. Somatotrophs in the pars distalis
E. Basophils in the pars intermedia

9. Adrenocorticotropic hormone (ACTH) is produced by which of the following cells?

A. Chromophobes in the pars distalis
B. Neurosecretory cells in the median eminence
C. Basophils in the pars distalis
D. Neurons of the paraventricular nucleus in the hypothalamus
E. Basophils in the pars intermedia

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 10. The pituitary gland…
A. is located in the cribriform plate of the ethmoid bone
B. is linked to the hypothalamus by the infundibulum
C. has a posterior portion that contains axon terminals from hypothalamic
neurosecretory cells
D. produces releasing and inhibiting hormones
E. has a vascular connection with the hypothalamus known as the hypophyseal
portal system.

ESSAY: Write answers in the sheets provided.

1. Write short notes on the important relationship of the thyroid gland focusing
on trachea, nerves, vessels and the coverings
2. In a tabular form:
a. Indicate the important relationship of the pancreas
b. Enumerate the cells of the endocrine pancreas and their secretion
3. In anatomical view, discuss why the pituitary gland is considered the master gland

Part two: Multiple-Choice Questions

1. Gluconeogenesis occurs in the liver due to the action of

A. Aldosterone
B. Insulin
C. Secretin
D. Cortisol

2. Normal development of the immune response is due in part to hormones produced by

the
A. Adrenal medulla
B. Pancreas
C. Thyroid gland
D. Thymus gland

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 3. Chemical substances secreted by cells into the extracellular fluids and that regulate
the metabolic function of other cells in the body are called
A. Enzymes
B. Antibodies
C. Proteins
D. Hormones

4. The hypothalamic-hypophyseal tract

A. Connects the hypophysis to the pituitary gland
B. Is partly contained within the infundibulum
C. Conducts aldosterone to the hypophysis
D. Is the site of prolactin synthesis
5. Which of the following is not a certain sign of diabetes mellitus?
A. Polyuria
B. Polydipsia
C. Polyphagia
D. All these are signs

6. Which of the choices below is not a factor required for target cell activation by
hormones receptor interaction?
A. Blood levels of hormone
B. Type of hormone
C. Number of receptors for that hormone
D. Strength of the bond between the receptor and hormone

7. Oxytocin
A. Released is an example of a positive feedback control mechanism
B. Is adenopophyseal secretion
C. Exerts its most important effects during menstruation
D. Controls milk production

8. ADH
A. Increases urine production
B. Promotes dehydration
C. Is produced in the adenohypophysis

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 D. Is inhibited by alcohol

9. The thyroid hormone exerts its influence by

A. Entering some cells and binding to intracellular receptors within the nuclei
B. Exerting only a minor effect on body metabolism
C. Causing a reduction in the number of blood vessel adrenergic receptors, and
therefore decreasing blood pressure
D. Acting to decreasing basal metabolic rate

10. Gonad corticoid(s)

A. Synthesized by the adrenal medulla are primarily androgens
B. Production by the adrenal gland is insignificant compared with sex hormones
release from the gonads during late puberty
C. Secretion inhibition is highly dependent on a negative feedback loop involving
ACTH
D. Hyper secretion can result in adrenogenital syndrome, also called feminization

11. Sometimes prolonged excessive exposure to high hormones concentrations causes a

phenomenon known as
A. Diabetes mellitus
B. Cellular inhibition
C. Down-regulation
D. Metabolism of protein kinases

12. Which of the following is not a change that may be caused by hormonal stimulus?
A. A change in membrane potential
B. The stimulation of a genetic event resulting in protein synthesis
C. An increase in enzymatic activity
D. Direct control of nervous system

13. The ability of a specific tissue or organ to respond to the presence of a hormone is
dependent on
A. The location of tissue or organ with respect to the circulatory path
B. The membrane potential of the cells of the target organ
C. The presence of the appropriate receptors on the cells of the target tissue or organ
D. Nothing, all hormones of the human body are able to stimulate any and all cell
types because hormones are powerful and nonspecific
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 14. Several hormones are synthesized in the hypothalamus and transported to the anterior
pituitary gland. The mechanism of transportation from hypothalamus to anterior
pituitary gland is through the
A. Hepatic portal system
B. General circulatory system
C. Hypophyseal portal system
D. Feedback loop

15. The neurohypophysis or posterior lobe of the pituitary gland is not a true endocrine
gland because
A. It is strictly a part of the neural system and has little or nothing o do hormonal
release
B. Embryonically it was an endocrine tissue because it is actually part of the neural
system due its location
C. It is unable to function as an endocrine tissue because it is actually part of the
neural system due its location
D. It is only a hormone storage area that receives hormones from the hypothalamus
for release

16. Steroid hormones exert their action by

A. Entering the nucleus of a cell and initiating or altering the expression of gene
B. Finding an appropriate cell receptor and initiating Camp activity
C. Increasing blood pressure

17. Thyroid hormone (a small iodinated amine) enters target cells in a manner similar to
A. Insulin, because insulin is a small peptide
B. Steroid hormones because both diffuse easily into cells
C. Growth hormone, because the thyroid works synergistically with hormone
D. Glucagon, because the structure of glucagon is similar to that thyroid hormone

18. When it becomes necessary to enlist the fight-or-flight response, hormone that is
released during the alarm phase of the general adaptation syndrome is
A. Oestrogen
B. Epinephrine
C. Angiotensinogen
D. Renin

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 19. One of the least complicated of the endocrine control systems directly responds
changing blood levels of ions and nutrients. Which of the following describes this
mechanism?
A. The rapid oxidation of carbohydrates
B. Catabolic inhibition
C. Protein synthesis
D. Humoral stimulation

20. The major targets of growth hormone are

A. The blood vessel
B. The adrenal glands
C. Antagonizing the synthesis of calcitonin
D. Slowing the activity of tissues that require calcium for activity

DR. ALI’S LIKELY IA / EXAMS QUESTIONS ON ENDOCRINE SYSTEM

INSTRUCTION: State either TRUE or FALSE for the statements following each Stem
Q1. Characteristics of pinealocytes include which one of the following?
(A) They produce melatonin and serotonin
(B) They resemble astrocytes
(C) They contain calcified concretions of unknown function
(D) They act as postganglionic sympathetic cells

Q2. Most severe rejection of neutrally related tissue occurs compared with other
(A) Endocrine organs
(B) Its hormonal source is unavailable after its axonal connections to the hypothalamus are
disrupted
(C) It lacks function when separated from the hypothalamohypophyseal portal system
(D) Neogenesis of blood vessels will not occur at the transplant site
(E) The vascular wall of the superior hypophyseal arteries is unique

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Q3. The adrenal cortex influences the secretion of the adrenal medulla by means of which
of the following?
(A) Secretion of aldosterone into the intra-adrenal circulation.
(B) Secretion of glucocorticoids into the intra-adrenal circulation.
(C) Autonomic neural connection
(D) Secretion of monoamine oxidase into the portal circulation.
(E) Secretion of androgens into the intra-adrenal circulation.

Q4. A third region of the pituitary gland

(A) Pars intermedia
(B) Atrophies during human fetal development
(C) Ceases to exist as a separate lobe in…………….
(D) All above
(E) None of the above

Q5. Which of the following cells of……………pituitary are derived

embryolog….neuroectoderm ?
(A) Gonadotrophs
(B) Pars intermedia
(C) Pars tuberalis
(D) Herrings bodies
(E) Lactotrophs

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Q5. The following are true
(A) Somatotrophs—secrete human growth hormone(hGH) -TRUE
(B) Thyrotrophs—secrete thyroid-stimulating hormone(TSH) -TRUE
(C) Gonadotrophs--- secretes follicle-stimulating hormone (FSH) -TRUE
(D) Gonadotrophs--- secretes luteinizing hormone (LH) -TRUE
(E) Lactotrophs--- secrete prolactin (PRL) –TRUE

Q6. The thyroid

(A) The normal mass of the thyroid is about 30g
(B) The isthmus overlying the 2nd and 3rd rings of the trachea
(C) Each lateral lobe extend from the side of the thyroid cartilage downwards to the 6th tracheal
ring
(D) an constant pyramidal lobe- projecting upwards from the isthmus
(E) The pyramidal lobe usually on the right side

Q7. The Thyroid

(A) The gland is enclosed in the pretracheal fascia
(B) Covered by the strap muscles
(C) The anterior jugular veins course over the left lobe.
(D) On the deep aspect of the thyroid lie the larynx and trachea, with the
(E) oesophagus behind

Q8 The Parathyroid
(A) Partially embedded in the posterior surface of the lateral lobes of the thyroid
(B) about 40g
(C) Oval in shape
(D) Derived from third to fifth pharyngeal pouches
(E) Regulate calcium and phosphate levels

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Q9. A tumor in the specific region denoted by the asterisks will most likely cause which of
the following (Check Diagram)
(A) Diabetes
(B) Hypoglycemia
(C) Elevated blood pressure
(D) Decreased blood pressure
(E) Increased urine resorption

Q9. The Chief (Principal) cells-

(A) Parathyroid hormone (PTH), also called parathormone
(B) Least abundant cells
(C) Less prominent nucleus
(D) Relative little cytoplasm
(E) Staining intensity vary with secretory activity

Q10. The adrenals

(A) Also call super renal gland
(B) Closely applied to superior pole the kidneys
(C) Adrenal cortex and Adrenal medulla
(D) Right is more triangle
(E) All above

Q11. During the physical examination of a newborn child, it is observed that the genitalia
are female, but masculinized. The genotype is determined to be 46, XX. Which of the
following is the most likely cause of this condition?
(A) Androgen insensitivity
(B) Decreased blood ACTH levels
(C) Atrophy of the zona reticularis
(D) A defect in the cortisol pathway

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(E) Hypersecretion of vasopressin

Q12. The ………….

(A) It arises as an outgrowth of the midbrain
(B) It influences the rhymicity of other endocrine organs
(C) It contains many melanocytes
(D) It is innervated by preganglionic sympathetic
(E) It secretes melanocyte- stimulating hormone (MSH)

Match each description below with the most appropriate hormone or hormones
(A) Calcitonin
(B) Parathyroid hormone
(C) Both
(D) Neither
13. A polypepetide hormone secreted by parafollicular cells in the thyroid gland---
14. A steroid hormone secreted by chief cells in the parathyroid glands.---
15. A hormone that stimulates bone degradation and retention of calcium in the renal system ---

PART 2

Q1. Which of the statement below best describes the histologic organization of the thyroid
gland?
(A) Follicular epithelial cells are surrounded by an anastomosing network of continuous
capillaries without fenestration
(B) Follicular epithelial cells are secrete thyroglobulin into capillaries
(C) Follicular epithelial cells exocytose thyroglobulin as a secretion product
(D) The thyroid gland is conspicuously lobulated, with dense connective tissue trabeculae

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(E) Thyroid follicles connect to ducts.
Q2. The posterior lobe of the pituitary.
(A) referred the neurohypophysis -TRUE
(B) the pars nervosa is a part- -TRUE
(C) has a larger bulbar portion
(D) the infundibulum is a part- -TRUE
(E) the Pars tuburalis is a part

QUESTION ON PITUITARY GLAND (LABELS)

A= Pars Nervosa E= Median Eminence
B= Vestigium of Rathke’s pouch F= Hypothalamus / Third Ventricle
C= Pars Distalis G= Pars Tuberalis
D= Infundibulum H= Pars Intermedia

Q3. All of the following statements concerning the zona fasciculata are true EXCEPT
(A) cells have little smooth endoplasmic reticulum
(B) mitochondria are ovoid
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(C) Cells are sensitive to ACTH stimulation
(D) Cells have numerous large lipid droplets
(E) It is thickest cortical zone

Q4. Posterior pituitary:

(A) is derived from a downgrowth of nervous tissue from the thalamus
(B) Remained joined by the pituitary stalk
(C) arise from the roof of primitive oral cavity known as Rathke’s pouch
(D) A specialized glandular epithelial outgrowth..
(E) wraps around the anterior aspect of the pituitary
Q5. Which of the following cells of parts of the pituitary are derived embryologically from
neuroectoderm?
(A) Gonadotrophs
(B) Pars intermedia
(C) Pars tuberalis
(D) Herring bodies
(E) Lactotrophs

PHYSIOLOGY (MR. RUFAI SAFAINU)

SMBM 307: Endocrine System in Health and Disease
Write your INDEX NUMBER in the spaces provided

INSTRUCTIONS: State either each statement is TRUE or FALSE

1. Insulin secretion
………… [Link] associated with C- peptide
………….B. is associated with blood glucose level
………… C. Inhibits fat storage
…………..D. increases amino acid absorption
…………..E. is high in type 1 diabetes
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2. Glucagon:
……………A. stimulates the production of C- peptide
……………B. stimulates the production of insulin
……………C. promotes fat metabolism
……………D. is usually anabolic in action
……………E. inhibits gluconeogenesis

3. In type 2 diabetes mellitus, there is:

……………A. higher fatty acid uptake than in type 1 diabetes mellitus
……………B. lower lipoprotein lipase activity than in type 1 diabetes mellitus
……………C. higher fatty acid uptake than in type 1 diabetes mellitus
……………D. higher hormone sensitive lipase than in type 1 diabetes mellitus
……………E. lower plasma potassium than in type 1 diabetes mellitus

4. Effects of growth hormone include:

……………A. catabolism
……………B. anabolism
……………C. Laron’s dwarfism
……………D. directly stimulates bone elongation
……………E. promotes amino acid uptake by cells

Circle the letter of the SINGLE BEST ANSWER beside the corresponding question number on the
question paper.

1. Which of the following major physiological processes are regulated by the endocrine system
a. Reproduction
b. Regulation of blood pressure
c. Immune system responses
d. Water and electrolyte balance
e. All the above

2. The main endocrine function of the heart is

a. promotion of sodium and water loss
b. calcium and phosphate balance
c. potassium balance
d. regulation of acid base balance
e. regulation of hypothalamic hormone secretion

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3. The hypothalamus INHIBITS the release of:
a. TSH
b. ACTH
c. FSH
d. GH
e. Oxytocin

4. The production of which of the following hormones will be most affected by a person taking
anti-cholesterol drugs
a. ADH
b. Aldosterone
c. Oxytocin
d. ACTH
e. Prolactin

5. Which of the following hormones is/are derived from tyrosine

a. T3
b. T4
c. Epinephrine
d. Nor-epinephrine
e. All of the above

6. Histamine may act locally by diffusing to adjacent cells. This action of histamine is described
as
a. Endocrine
b. Neuroendocrine
c. Paracrine
d. Autocrine
e. Exocrine

7. Peak levels of growth hormones is observed

a. after meal
b. after exercise
c. during sleep
d. at 8.00am
e. anytime is okay because plasma levels of cortisol is constant

8. A middle aged lady is being investigated for a disorder of the hypothalamic – pituitary –
adrenal cortex axis. She was asked to check her blood cortisol level. At what time must the
test be performed if you desire to measure the peak cortisol level
a. After meal
b. After exercise
c. During sleep
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 d. At 9.00am
e. Anytime is okay because plasma levels of cortisol is constant

9. The mechanism by which a hormone increases the number or affinity of receptors for itself
or for another hormone is called
a. Antagonism
b. Permissive action
c. Synergism
d. Up regulation
e. Downregulation

10. A patient comes is admitted to the emergency room with gram negative shock. He is
hypotensive and tachycardic. Injection of cortisol leads to an immediate improvement in
blood pressure. What explains this
a. effects of cortisol on the kidneys
b. potentiation of aldosterone
c. direct sodium retention by the kidneys
d. permissive action of cortisol on catecholamines
e. none of the above

11. Patients with liver of kidney disease are may have lower levels of
a. Water soluble hormones
b. Lipid soluble hormones
c. Hormones derived from peptides
d. Hormones derived from proteins
e. All the above

12. A person with a road traffic accident has his hypothalamus damaged. Which hormone levels
are likely to be elevated
a. T4
b. T3
c. Prolactin
d. Cortisol
e. LH

13. Paraventricular nucleus is MAINLY for synthesis of

a. Oxytocin
b. ADH
c. ACTH
d. TRH
e. GnHR

14. Factors stimulating ADH release includes all the following EXCEPT
a. Alcohol
b. Angiotensin II
c. Increased serum osmolarity
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 d. Hypovolaemia
e. Drugs like nicotine

Use the following information to answer the next two questions

The table below shows the plasma and urine osmolarity of three subjects before and after
administering artificial ADH
PlasmaOsmolarity before Urine Osmolarity before Urine Osmolarity
giving desmopressin giving desmopressin after giving
Desmopressin
Patient A Normal Normal Minimal change
Patient B Increased Decreased Increases significantly
Patient C Increased Decreased Remains unchanged

15. Identify subject B

a. Subject with central diabetes insipidus
b. Subject with nephrogenic diabetes insipidus
c. Subject with psychogenic diabetes insipidus
d. Subject with diabetes mellitus
e. Normal subject

16. Identify subject C

a. Subject with central diabetes insipidus
b. Subject with nephrogenic diabetes insipidus
c. Subject with psychogenic diabetes insipidus
d. Subject with diabetes mellitus
e. Normal subject

17. The following may result from loss of regional function of zona glomerulosa (=region of
adrenal cortex that secretes aldosterone) EXCEPT
a. Loss of Na+
b. Decreased volume of ECF (ECF volume cobtraction0
c. Low blood pressure (hypotension)
d. Circulatory shock and possible death
e. Hypokalemia

18. Which of the following inhibits ADH

a. ethanol
b. Increased serum osmolarity
c. Hypovolaemia
d. Opiates
e. Angiotensin II

19. Key physiologic functions of oxytocin includes all the following EXCEPT
a. AHA

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 b. uterine smooth muscles contraction
c. prevention of post-partum hemorrhage
d. stimulation of milk ejection
e. production of milk
f. establishes maternal behavior

20. Concerning prolactin production and secretion

a. Without hypothalamic input, anterior pituitary produces more prolactin (dopamine
inhibits prolactin release)
b. Without hypothalamic input, anterior pituitary produces less prolactin (dopamine inhibits
prolactin release)
c. The hypothalamus has no effect on prolactin synthesis or secretion
d. All the above are true
e. None of the above is true

21. Which of the following is NOT a stress hormone

a. cortisol
b. glucagon
c. growth hormone
d. catecholamines
e. T3

22. Which of the following is an effect of a 24 hour fast (short fasting)

a. increased glycogenolysis
b. increased protein catabolism
c. acidosis
d. ketone production from protein
e. none of the above is true

23. Growth hormone deficiency

a. When it occurs before puberty leads to gigantism
b. When occurs after puberty leads to acromegaly
c. When it occurs before puberty may lead to dwarfism
d. Growth hormone replacement have no role in management
e. GH deficiency after puberty is a major problem

24. In normal ADULTS, the function of growth hormone is

a. It causes growth
b. It helps with development of the nervous system
c. Acts as a stress hormone
d. Prevents dwarfism
e. All the above

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25. Prenatally, thyroid hormones are important in the maturation of
a. Central nervous system
b. Peripheral nervous system
c. Heart
d. Blood vessels
e. Kidneys

26. The following clinical examples illustrates a positive feedback loop

a. Oxytocin release is increased by myometrial contraction during childbirth
b. Estrogens mediate an increase in LH and FSH prior to ovulation.
c. Oxytocin release increased by contraction of mammary duct during suckling at the breast.
d. All of the above
e. None of the above

27. The MAIN factor regulating insulin levels in blood is

a. Blood fatty acid levels
b. Blood glucose levels
c. Blood glucagon levels
d. Blood amino acid levels
e. Acetylcholine levels in blood

28. Plasma levels of aldosterone is regulated by

a. A negative feedback loop involving the hypothalamus and anterior pituitary
b. A positive feedback loop involving the hypothalamus and anterior pituitary
c. A negative feedback loop involving the hypothalamus and posterior pituitary
d. Blood potassium levels and angiotensin II
e. Blood cortisol levels

29. A person with primary hypothyroidism (from disorder of the thyroid gland) will result in
a. low T3 and T4
b. High TSH
c. High TRH
d. All the above
e. None of the above

30. Consequence of loss of regional function of zona glomerulosa

a. Loss of Na+
b. Decreased volume of ECF
c. Low blood pressure
d. Hyperkalemia
e. All the above are correct

31. Which of the following is not a recognized function of parathyroid hormone

a. Increase resorption of calcium and phosphate from osteoclasts
b. Increases calcium reabsorption in distal kidney tubule

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 c. Directly increases calcium and phosphate absorption in intestine
d. All the above is correct
e. None of the above is correct.

32. Recognized physiological functions of glucocorticoids like cortisol includes all the following
except
a. Raising plasma glucose levels
b. Up-regulation of alpha-1 receptors on arterioles and increasing their sensitivity to
norepinephrine.
c. Anti-inflammatory functions
d. Immunosuppressive functions
e. Promoting protein synthesis

33. The following pancreatic cell is wrongly matched with the hormone it secretes
a. Alpha cells = glucagon
b. Beta cells = insulin
c. Delta cells = somatostatin
d. Alpha cells = C-peptide
e. Delta cells = gastrin

34. Tissues in which glucose uptake is not affected by insulin includes all the following
EXCEPT
a. adipose tissues
b. brain
c. kidney tubules
d. intestinal mucosa
e. red blood cells

35. The following about Vitamin D are true EXCEPT

a. Synthesized by skin
b. Activated in proximal tubule
c. Activated Vitamin D increases calcium and phosphate absorption in intestines
d. Activated Vitamin D increases calcium and phosphate reabsorption in kidneys
e. Decreases bone resorption

36. A woman on contraceptives for a long time (e.g. 5 years) desire to have children. Blood sent
to the lab as part of her investigation revealed an increased total cortisol. What are your
possible explanations and conclusions on her increased total cortisol levels?
a. Female sex hormones (estrogen) increases the circulatory levels of binding protein
a. Male sex hormones (androgens) increases the circulatory levels of binding protein
b. Female sex hormones (estrogen) decreases the circulatory levels of binding protein

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 c. Male sex hormones (androgens) decreases the circulatory levels of binding protein
d. All the above are correct

USE THE INFORMATION BELOW TO ANSWER THE NEXT 4 QUESTIONS

Kafui Atsu was diagnosed of a medical condition when he was 12 years old. The symptoms that
led to the diagnosis were polyuria, polydipsia and polyphagia. Physical examination done
revealed that he had a low blood pressure. Initial laboratory tests done revealed a high blood
sugar (hyperglycemia) and glucose in urine

37. What type of medical condition does Astu have

a. Type 1 diabetes
b. Type 2 diabetes
c. Diabetes INSIPIDUS
d. Graves’ disease
e. Primary hyperthyroidism

38. Which hormone deficiency is responsible for Atsu’s symptoms?

a. Glucagon
b. Insulin
c. ADH
d. Cortisol
e. Aldosterone

39. What cell type produces the hormone in a) above?

a. Alpha cells of the pancreas
b. Beta cells of the pancreas
c. Delta cells of the pancreas
d. Corticotrophs
e. Lactotrophs

40. The physiological basis of the polyuria is

a. Lack of ADH
b. Resistance to ADH at the kidney level
c. Chronic kidney disease
d. Osmotic diuresis

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 BIOCHEMISTRY (DR CLEMENT OKRAKU &DR. ALIDU )

Choose the SINGLE MOST APPROPRIATE answer

1. The hormone responsible for contraction of the uterine wall is...

A. prolactin
B. oxytocin
C. progesterone
D. human chorionic gonadotropin
2. When the level of water in the blood is high, the secretion of ADH…
A. increases
B. reduces
C. remains constant
D. none of the above

3. All of the following are true about hepcidin EXCEPT….

A. it prevents the movement of iron from the small intestine into the blood
B. it is released when iron levels in the body becomes too high
C. it is produced by the liver
D. none of the above

4. In mammals, gluconeogenesis takes place mainly in the …….. and to a lesser extent
in the ….
A. brain, muscles
B. kidneys, muscles
C. liver, kidneys
D. liver, brain
5. Risk factors for atherosclerosis include all the following EXCEPT…
A. hypertension
B. hyperlipidemia
C. cigarette smoking

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 D. none of the above

6. Which of the following is a stimulus for the release of erythropoietin?

A. Decrease RBC count
B. Increase availability of oxygen
C. Decreased secretion of ADH
D. High levels of hemoglobin

7. When a vessel is cut or raptured, hemostasis is achieved by…

A. vascular constriction
B. formation of a platelet plug
C. formation of a blood clot
D. all of the above

8. The following are abnormalities associated with growth hormone secretion

EXCEPT…
A. acromegaly
B. gigantism
C. dwarfism
D. none of the above

9. ……… stimulates thirst, the secretion of ADH and the release of aldosterone
A. erythropoietin
B. angiotensin II
C. hepcidin
D. somatostatin

10. Gonadotropin releasing hormone, produced by the hypothalamus stimulates the

release of ………….. and …………….. by the anterior pituitary
A. prolactin and growth hormone
B. estrogen and testosterone
C. follicle stimulating hormone and luteinizing hormone

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 D. estrogen and progesterone

11. ……………… is primarily responsible for the formation of glucose from fats and
proteins.
A. aldosterone
B. ADH
C. cortisol
D. calcitonin

12. The delta cells in the pancreas secrete

A. insulin
B. glucagon
C. somatostatin
D. All of the above

13. When plasma levels of potassium is above normal, aldosterone secretion….

A. increases
B. decreases
C. remains constant
D. none of the above

14. Which of the following anterior pituitary hormones does NOT necessarily exert its
principal effects by stimulating target glands?

A. thyroid stimulating hormone

B. ACTH

C. growth hormone

D. prolactin
15. The rapture of a matured follicle is due to an upsurge in ….
A. FSH

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 B. LH
C. HCG
D. progesterone

16. …….. is released from the mucosa of the jejunum in response to fat in the chyme
A. cholecystokinin
B. cortisol
C. adrenaline
D. corticotropin releasing hormone
17. In diabetes insipidus,
A. Insulin production is drastically reduced
B. ADH release may be impaired
C. Blood glucose is high
D. high Glucagon is what results in high blood glucose levels

18. Which is not true regarding Inulin?

A. is useful in GFR measurements
B. Is obtained from plants
C. Occasionally produced by cardiac muscle tissue
D. Is cumbersome using for GFR measurement

19. The following are true of ADH, except

A. is released by the anterior pituitary
B. is released by the posterior pituitary
C. makes collecting duct cells more permeable to water
D. release is inhibited by alcohol

20. The loops of Henle of the outer cortical nephrons:

A. are functionally unimportant in the renal conservation of sodium and water
B. do not contribute to the medullary osmotic gradient
C. do not participate in the urinary diluting mechanism
D. do not play any important role in overall renal function and are simply
unimportant vestiges of evolutionary development

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 INSTRUCTION: Indicate TRUE or FALSE, for the statement following each stem

1. Consider the following statements about T4

a) Deiodination of T4 occurs in the thyroid gland --FALSE
b) Production is exclusively thyroidal --- TRUE
c) Is more potent than T3 --FALSE
d) Deiodination is enhanced by amiodarone--FALSE
e) Has a longer half life than T3 --- TRUE
f) Binds to receptors and trigger the end-organ effects of the TH --FALSE

2. The following are all thyroid hormone binding proteins except

a) Thyroxine binding globulin --- TRUE
b) Thyroxine binding albumin --FALSE
c) Transthyretin --- TRUE
d) Apolipoprotein --- TRUE
e) Immunoglobulins--FALSE

3. TSH
a) Regulates the synthesis of T4 and T3--- TRUE
b) Binds receptors on thyroid coloidal cells--FALSE
c) Production is feedback regulated by circulating T3 bound to TBPA --FALSE
d) Is a tripeptide --FALSE
e) Levels peaks around midday and at its nadir at midnight--- TRUE

4. The following will result in increassed binding of TH

a) Decreased transthyretin levels --FALSE
b) familial dysalbuminemia hyperthyroxinemia --- TRUE
c) Nephrosis --FALSE
d) Presence of T4 autoantibodies--- TRUE
e) Treatment with phenytoin --FALSE

5. In Graves disease
a) Antibodies to thyroid hormones inactivates T3 and T4--FALSE
b) Pituitary TSH secretion is supressed --- TRUE
c) There is proptosis due to thickening of retro- orbital muscle --- TRUE
d) Diagnosis is made from finding low plasma levels of TH with high levels of TSH--
FALSE
e) There is a possibility of relapse after treatment--- TRUE

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 6. The following is true
a) Thyroid storm is an acute presentation of thyrotoxicosis --- TRUE
b) Neonatal hyperthyroidism occurs in infants born to mothers with graves disease---
TRUE
c) Neonatal hyperthyroidism cannot occur in children born to euthyroid mothers--
FALSE
d) Antibodies that cross the placenta in Neonatal hyperthyroidism are usually IgG ---
TRUE
e) Thyroid storm is usually not a medical emergency --FALSE

7. Calcium 2+
a) Is the biologically active form --- TRUE
b) Levels are increases in alkalaemia due to decrease protein bound fraction --FALSE
c) Levels are decreased in acidaemia --FALSE
d) Can remain at constant levels even as total serum Calcium levels vary widely.---
TRUE
e) Is best measured using ISE --- TRUE

8. Calcium Sensing Receptor (CASR)

a) Can be found on brain cells--- TRUE
b) Sense ECF total calcium concentrations --FALSE
c) Are activated by the direct binding of calcium--- TRUE
d) Triggers intra-cytoplasmic calcium release. --- TRUE
e) Activation results in Ca 2+ reabsorption in the tubules --FALSE

9. Parathroid hormone
a) Consist of 48 amino acid residues—FALSE
b) Is secreted in response to high Ca 2+ levels --FALSE
c) Influences bone mineralization and calcium flux from bone--- TRUE
d) Controls the hydroxylation of cholecalciferol in the kidney--- TRUE
e) Have receptors on osteoblasts --- TRUE

10. PTH related protein

a) Is similar to PTH in the first 15 amino acids on the N-terminal end--FALSE
b) Acts as a paracrine hormone at physiological levels--- TRUE
c) Acts as an endocrine hormone in malignant tissues --- TRUE
d) Is not involved in placental calcium transport --FALSE
e) Is a glycoprotein –FALSE

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 11. Phosphate:
a) Has a reciprocal relationship with plasma calcium levels --- TRUE
b) Is present both in the intracellular and extracellular tissues--- TRUE
c) In the ECF is present only as dihydrogen phosphates F--FALSE
d) Is the only readily available indicator of disordered PO4 homeostasis--- TRUE
e) Overdose can occur if undiluted cowmilk is given to infants --- TRUE

12. The following are causes of primary hypothyroidism

a) Increase in iodine levels --FALSE
b) Hashimoto’s thyroiditis --- TRUE
c) Sheehan’s Syndrome --FALSE
d) Radioactive exposure--- TRUE
e) Congenital causes--- TRUE

13. The following are examples of thyroid autoantibodies

a) Thyroid microsomal autoantibody --- TRUE
b) Thyroglobulin autoantibody (TGA) --- TRUE
c) Anti thyroid binding Prealbumin--FALSE
d) Thyrotropin-binding inhibitory immunoglobulin --- TRUE
e) Thyroid-stimulating immunoglobulin --- TRUE

14. All the following attack the TSH receptors

a) TSH receptor autoantibody --- TRUE
b) Thyroid-stimulating immunoglobulin --- TRUE
c) Thyroid microsomal autoantibody--FALSE
d) Thyrotropin-binding inhibitory immunoglobulin--- TRUE
e) Thyroglobulin autoantibody--FALSE

15. The following are possible causes of short stature

a) Hyperthyroidism--FALSE
b) Achondroplasia--- TRUE
c) Poor nutrition --- TRUE
d) Klinefelters syndrome --FALSE
e) Having two short parents--- TRUE

16. Secretion of antidiuretic hormonc (ADH) is stimulated by.

a) Decreased plasma osmolality
b) Severe blood volume depletion--- TRUE

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 c) Carbohydrate diet --FALSE
d) Stress--- TRUE
e) Nausea --- TRUE

17. Causes of primary hypogonadism include

a) Klinefelters syndrome --- TRUE
b) Mumps--- TRUE
c) Pituitary adenomas --FALSE
d) Testicular trauma--- TRUE
e) Testicular agenesis --- TRUE

18. Sex hormone binding globulin

a) Binds both Testosterone and eostrogen --- TRUE
b) Has a higher affinity for eostrogen than testosterone --FALSE
c) Its synthesis in the liver is stimulated by both eostrogen and testosterone levels--
FALSE
d) Its concentration is higher in females than males--- TRUE
e) Fluctuations in its concentrations affect the ratio of unbound testosterone to eostrogen
--- TRUE

19. The following is true about Virilism

a) It is largely genetic --FALSE
b) Testosterone levels are markedly reduced --FALSE
c) Clitoral enlargement is present--- TRUE
d) There is hair growth in a male pattern--- TRUE
e) There is excessive eostrogen action --FALSE

20. Causes of subfertility in women include

a) Primary ovarian failure--- TRUE.
b) Hypoprolactinaemia --FALSE
c) Cushings syndrome --- TRUE
d) Hypogonadotrophic hypogonadism --- TRUE
e) Hypergonadotrophic hypogonadism--- TRUE

21. The following hormones have the same β sub unit

(a) TSH/FSH/ --FALSE
(b) LH/HcG --FALSE
(c) FSH/LH--FALSE
(d) TSH/LH --FALSE
(e) hCG/LH--FALSE

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 22. Achlorhydria is not found in:
a. pernicious anaemia--- TRUE
b. gastric ulcer--- TRUE
c. duodenal ulcer--FALSE
d. gastric carcinoma--- TRUE
e. Zollinger-Ellison syndrome--FALSE

23. Conditions associated with acute pancreatitis does not include:

a. Biliary tract disease--- TRUE
b. Renal stones--FALSE
c. Raised plasma [amylase] --- TRUE
d. Hypocalcaemia--- TRUE
e. Increased methaemalbuminaemia--- TRUE

24. The pentagastrin test

a. Is sometimes indicated in the investigation of peptic ulcers--FALSE
b. Pengastrin antagonises gastrin--FALSE
c. Only gives information about gastric acid secretion--- TRUE
d. May be useful in the diagnosis of gastric outlet obstruction--- TRUE
e. Can locate the cause of Zollinger-Ellison syndrome--FALSE

25. The diabetogenic effect of human growth hormone involves all the following :
(a) Excess of growth hormone secretion--- TRUE
(b) Raised blood glucose levels--- TRUE
(c) Continual pancreatic release of insulin--- TRUE
(d) Beta-cell autoimmune damage --FALSE
(e) Eventual inactivity of insulin--- TRUE

26. The following are true about Addison’s disease :

(a) It is common in women --- TRUE
(b) It affects all age groups --- TRUE
(c) It is very common in India and Pakistan--FALSE
(d) It is common in men--FALSE
(e) It is common between ages of 30-50 years --- TRUE

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 27.
Inhibit TSH secretion A

Inhibit TSH synthesis B

C
Inhibit T4  T3

Inhibit protein binding D

(a) A is lithium and iodine --FALSE
(b) B is dopamine and glucocorticoids --FALSE
(c) C is amiodarone and propranolol --- TRUE
(d) B is lithium and iodide--- TRUE
(e) D is phenytoin and carbamazepine --- TRUE

28. In Addison’s disease :

(a) Increased ACTH level means Primary adrenal insufficiency --- TRUE
(b) Decreased ACTH level means Secondary adrenal insufficiency --- TRUE
(c) Increased ACTH level means Primary sufficiency--FALSE
(d) Decreased ACTH level means Secondary sufficiency --FALSE
(e) Increase PTH level means primary insufficiency --FALSE

29. Addisonian crisis is characterized by the following :

(a) Pallor --- TRUE
(b) Rapid and weak pulse--- TRUE
(c) Rapid respirations--- TRUE
(d) Low blood pressure--- TRUE
(e) Hypocalcemia --FALSE

30. Congenital Adrenal Hyperplasia (CAH) :

(a) Involves 21-hydroxylase deficiency--- TRUE
(b) Involves 11Ᏸ-hydroxylase deficiency--- TRUE
(c) Involves Ᏸ-hydroxysteroid dehydrogenase deficiency--- TRUE
(d) Involves 17 Ᏸ-hydroxylase deficiency--FALSE
(e) Causes hyperkalemia --- TRUE

31. Clinical manifestation of CAH include the following :

(a) Acidosis--- TRUE
(b) Diarrhea --- TRUE
(c) Ambiguous genitalia--- TRUE
(d) Hirsutism --- TRUE
(e) Failure to thrive --- TRUE

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 32. Hyperaldosteronism :
(a) Affects people in their 30’s-50’s --- TRUE
(b) Prevalence increases with increasing age --- TRUE
(c) Females are more likely to be affected than males --- TRUE
(d) Is rare in children --- TRUE
(e) Is common in people living along the coastal and marshy areas –FALSE

33. Clinical findings in Cushing’s syndrome include the following :

(a) Dyslipidemia --- TRUE
(b) Osteoporosis --- TRUE
(c) Neuropsychiatric problems--- TRUE
(d) Osteopetrosis --FALSE
(e) All of the above --FALSE

34. The following statement are true about infertility in women :

(a) High FSH could be due to ovarian failure --- TRUE
(b) PCOS causes High LH and low FSH--- TRUE
(c) Hyperprolactinaemia causes amenorrhoea--- TRUE
(d) Hypoprogestinaemia in the mid-luteal phase indicates possible anovulation---
TRUE
(e) PCOS is associated with hirsutism --- TRUE

35. The following are associated with ACTH-dependent Cushing's syndrome :

(a) Cushing's disease --- TRUE
(b) Ectopic ACTH syndrome--- TRUE
(c) Ectopic CRH syndrome --- TRUE
(d) Adrenal adenoma
(e) Major depressive disorder

36. In the diagnosis of Cushing’s syndrome :

(a) When several Urine Free Cortisol (UFC) collections are normal, Cushing’s
syndrome is unlikely. --- TRUE
(b) May use early morning UFC/creatinine (nmol/l:mmol/l) ratio of greater than 20 is
suggestive of Cushing’s Syndrome. --FALSE
(c) Four-fold UFC level greater than the upper limit of normal, is considered
diagnostic test. --- TRUE
(d) When several Urine Free Cortisol (UFC) collections are abnormal, Cushing’s
syndrome is unlikely. --FALSE
(e) Low-Dose Dexamethasone Suppression Test is not necessary if UFC level rises
Six –fold the upper reference level--- TRUE

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 37. The following drugs are not goitrogens :
(a) Perchlorate--- TRUE
(b) Methimazole--- TRUE
(c) Permanganate--FALSE
(d) 5-fluorouracil--FALSE
(e) Thiouracil--- TRUE

38. Salicylates :
(a) Actually lower the concentration of TBPS--- TRUE
(b) Displace the thyroid hormones from the TBPS--FALSE
(c) Effectively lower the concentration of TBPS--FALSE
(d) Lead to low values for plasma [total T4] --FALSE
(e) Bound to TBPS replace TBP-T4 leading to low [TBP-T4] values--FALSE

39. The following statements are true about the adrenal function
(a) Mineralocorticoid production is controlled by the RAA regulatory cycle--- TRUE
(b) The cleavage of angiotensinogen to angiotensin occurs in the lungs--FALSE
(c) Angiotensin converting enzyme produces angiotensin which increases cortisol
production--FALSE
(d) Glucocorticoid production is controlled by the RAA pathway--FALSE
(e) Hypothalamic-Pituitary damage does not significantly affect aldosterone
production--- TRUE

SECION B- EASSY

1. (a) What is hormone desensitisation? (1marks)

ANS:
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….

(b) Explain why the use of bleaching creams may cause diabetes mellitus (3marks)

ANS:
……………………………………………………………………………………
……………………………………………………………………………………

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 ……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………

(c) Explain why prolonged use of anti-inflammatory creams may cause osteoporosis
(5marks)
ANS:
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………..

(d) Differentiate between the modes of action of water soluble and lipid soluble
hormones (6marks)

ANS:
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………..

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 Describe in detail, how an OGTT can be used to diagnose acromegaly (10marks
ANS:
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………..

ENDOCRINE PATHOLOGY (DR. ACEVEDOR)

NOTE: The questions below are the past questions (IA) from the
previous year- Some of them were repeated in our IA.

SECTION I
EACH QUESTION IS FOLLOWED BY A SET OF MULTIPLE-CHOICE ANSWERS,
CIRCLE THE LETTER CORRESPONDING TO THE BEST ANSWER
1. The main factor regulating insulin levels in blood is:
A. fatty acid
B. glucose
C. glucagon
D. amino acid
E. acetylcholine

2. The MOST common cause of hyperpituitarism is:

A. adenoma in the anterior lobe.
B. adenoma in the posterior lobe.
C. hypothalamic tumours
D. congenital conditions

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 E. irradiation

3. Which of the following histological features is present in pituitary adenoma

A. polymorphism and fine reticulin network
B. pleomorphism and absence reticulin network
C. monomorphism and absence reticulin network
D. monomorphism and fine reticulin network
E. anaplasia and absence reticulin network

4. What is the MOST common cause of hypothyroidism in areas of the wo… levels are
sufficient?
A. Subacute Lymphocytic thyroiditis
B. Reidel thyroiditis
C. Graves disease
D. Hashimoto thyroiditis
E. Diffuse and multinodular goiter

5. Which is the MOST common form of ……………………….

A. Papillary Carcinoma
B. Follicular Carcinoma
C. Anaplastic Carcinoma
D. Meduallary Carcinoma
E. Follicular Carcinoma

6. Which of the following antibodies would identify Melanocyte Stimulating Hormone in the
pituitary?
A. Somatotrophs
B. Lactotrophs
[Link]
D. Thyrotrophs
E. Gonadotrophs

7. Which of the following will BEST describe the neurological symptoms associated with
vascular disorder of the pituitary often seen in rapid enlargement of the pituitary adenoma?
A. Sheehams syndrome
B. Waterhouse- Fredrieschen syndrome

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C. Pituitary apoplexy
D. Syndrome of inappropriate ADH secretion
E. Nelson syndrome

8. Which of the following tumours is the MOST strongly associated with mutation in
chromosome 20q13?
A. Somatotrophs Cell Adenoma
B. Corticotrophs Cell Adenoma
C. Latotrophs Cell Adenoma
D. Gonadotrophs Cell Adenoma
E. Thyrotrophs Cell Adenoma

9. Which of the following reaction will produce the effect of increase in the Cyclic AMP in the
G protein transduction pathway?
A. G protein coupled with GDP
B. G protein coupled with GTPas
C. G protein coupled with GTP
D. G protein uncoupled with Ligand bound surface receptors
E. G protein coupled with Ligand bound surface receptors

10. Hyperplasi of the parathyroid gland and pheochromocytoma of the Adrenal gland was seen
in an autopsy of a woman with clinical working diagnosis of Medullary thyroid cancer.
Choose the correct option
A. This is in keeping with Multiple Endocrine Neoplasia (MEN) 2B
B. RET proto oncogene mutation creates a distinction between MEN 2Aand MEN
C. Mucocunteous ganglioneuromas an Marfanoid syndrome in addition to this picture
confirms Multiple Endocrine Neoplasia (MEN) 2A
D. The mutant gene locus in this disease is 11Q13(Menin)
E. In this syndrome, the tumours are seen in order of increasing frequency as follows:
Parathyroid hyperplasia+, Adrenal pheochromocytoma++ and Thyroid Medullary
Carcinoma or Thyroid C-Cell Hyperplasia+++

11. Which of the following is TRUE in the sequence of insulin release following a rise in blood
glucose?
A. There is immediate uptake of glucose into the pancreatic cell facilitated by dependent
glucose transporting protein GLUT-2
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 B. There is immediate uptake of glucose into the pancreatic cell facilitated by
independent glucose transporting protein GLUT-4
C. Metabolism of glucose via glycolysis generates ATP which activates the…. Sensitive
K+ channel on the beta cell membrane.
D. There is membrane depolarization and efflux of Ca2+ through the voltage dependent
Ca2+ channels
E. ATP generated via glycolysis inactivates the potassium channel protein leading to
membrane depolarization and eventual uptake of Ca2+

12. Which of the following is CORRECT concerning Insulin action and Insulin signalling
Pathway?
A. Mitogen activated protein kinase pathway kinase pathway responsible for cell growth,
proliferation and gene expression
B. Phosphatidyl inositol 3 kinase is responsible for cell growth, proliferation and gene
expression.
C. Mitogen activated protein kinase pathway is responsible for synthesis of proteins and
glycogen.
D. Mitogen activated protein kinase pathway is responsible for cell survival
E. Phosphatidyl inositol 3 kinase is responsible for cell survival gene….. synthesis of
lipids

13. Which of the followingis TRUE concerning obesity and insulin resistance ?
A. Peripheral obesity (gluteal and subcutaneous) is highly responsible for insulin
resistance
B. Thiazolidienence activates Peroxisome proliferative-active receptor gamma to induce
insulin resistance
C. Intracellular products of fatty acids metabolism activates insulin signalling
D. Pro-hyperglycaecemic adipokines include leptin and adiponectin and Pre-
hyperglycaemic adipokines include resistin and retinol binding protein 4
E. Pro-inflammatory cytokines secreted by adipose tissue induce insulin resistance

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14. A 31-year-old woman, who has two healthy children, notes that she has had no menstrual
periods for the past 6 months, but she is not pregnant and takes no medications. Within the past
week, she has noted some milk production from her breasts. She has been bothered by headaches
for the past 3 months. After nearly hitting a bus while changing lanes driving her vehicle, she is
concerned with her vision. An optometrist finds her lateral vision to be reduced. On physical
examination she is afebrile and normotensive. Which of the following laboratory test findings is
most likely to be present in this woman?
A Increased serum cortisol

B Increased serum alkaline phosphatase

C Hyperprolactinemia
D. Abnormal glucose tolerance test
E Decreased serum TSH

15. A 28-year-old woman has had difficulty concentrating at work for the past month. She is
constantly getting up and walking around to visit co-workers. She complains that the work area is
too hot. She seems nervous and often spills her coffee. She has been eating more but has lost 5 kg
in the past 2 months. On physical examination her temperature is 37.5°C, pulse 101/minute,
respiratory rate 22/minute, and blood pressure 145/85 mm Hg. Which of the following laboratory
findings is most likely to be present in this woman?
A Decreased iodine uptake
B Decreased plasma insulin
C Decreased TSH
D Increased ACTH
E. Increased calcitonin

16. A 29-year-old primigravida who received no prenatal care has marked vaginal bleeding after
the onset of labor at 38 weeks gestation. Cesarean section is performed and a lacerated low-lying
placenta is removed. She remains hypotensive for 6 hours and requires transfusion of 12 packed
RBC units. Postpartum, she becomes unable to breast-feed the infant. She does not have a
resumption of normal menstrual cycles. She becomes more sluggish and tired. Laboratory findings
include hyponatremia, hyperkalemia, and hypoglycemia. Which of the following pathologic
lesions is she most likely to have had following delivery?
A Bilateral adrenal hemorrhage
B Pituitary necrosis

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C Subacute thyroiditis
D Metastatic choriocarcinoma
E Insulitis

17. A 33-year-old previously healthy man has lateral visual field deficits, but his residual vision
is 20/20. His facial features have changed over the past year. His shoe size has increased. A head
CT scan reveals 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

18. A 47-year-old woman has felt a 'lump' in her neck for the past 2 months. On physical
examination there is a firm nodule in the right lobe of her thyroid. Following fine needle aspiration
and cytologic diagnosis of a neoplasm, a thyroidectomy is performed. Grossly, there is a 3 cm
mass in the right lower pole that on sectioning is cystic and has papillary excrescences. Which of
the following microscopic pathologic findings is most typical for this lesion?
A Giant cells
B Amyloid stroma
C Small thyroid follicles
D Clear nuclear chromatin
E Pleomorphic spindle cells
19. A 41-year-old man has been drinking large quantities of water--up to 20 liters per day--for the
past week. On physical examination he has diminished skin turgor and dry mucous membranes.
Laboratory studies show sodium 162 mmol/L, potassium 4.1 mmol/L, chloride 121 mmol/L, and
bicarbonate 27 mmol/L. His serum glucose is 75 mg/dL and creatinine 1.0 mg/dL. His serum
osmolality is 343 mOsm/kg. A deficiency of which of the following hormones is most likely
present in this man?
A Vasopressin
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B Oxytocin
C Insulin
D Growth hormone
E Prolactin

20. A 50-year-old man has a lump on his neck found at physical examination. A fine needle
aspirate of this lump shows a follicular neoplasm of the thyroid. He undergoes a total
thyroidectomy. Within a day following surgery, he is noted to have tingling sensations and
neuromuscular irritability. Which of the following serum laboratory tests should be ordered
immediately to determine further therapy for this man?
A TSH
B Parathormone
C Thyroxine
D Calcium
E Calcitonin
F Iodine

21. A 2-year-old child living in Odessa is small for its age and exhibits profound intellectual
disability. On physical examination he has dry, coarse skin. Which of the following pathologic
features involving the thyroid gland is this child most likely to have?
A Papillary adenoma
B Diffuse hyperplasia
C Granulomatous inflammation
D Metastatic carcinoma
E Marked atrophy

22. Which of the following thyroid lesion has a high risk of developing B cell lymphoma?
A. Hashimoto Thyroiditis
B. DeQuervian Thyroiditis
C. Diffuse multinodular goitre
D. Gravis disease
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E. Reidels Thyroiditis

23. Which of the following pancreas cells will produce tumours that are associated with Diabetic
Mellitus, Cholelithiasis, Steatorrhea and hypochloridia?
A. The Alpha Cells
B. The Beta Cells
C. The Delta Cells
D. The Pancreatic Polypeptide Cells
E. The D1 Cells

SECTION II
FOR EACH OF THE SCENARIOS, CIRCLE THE LETTER CORRESPONDING TO
THE MOST LIKEY DIAGNOSIS

24. A 49-year-old woman has had increasing cold intolerance, weight gain of 4 kg, and
sluggishness over the past two years. A physical examination reveals dry, coarse skin and alopecia
of the scalp. Her thyroid is not palpably enlarged. Her serum TSH is 11.7 mU/L with thyroxine of
2.1 micrograms/dL. A year ago, anti-thyroglobulin and anti-microsomal autoantibodies were
detected at high titer.
Note: Normal reference range: TSH: 0.4 – 5Mu/L., Thyroxine 4.5 -12.5mgdL
Which of the following thyroid diseases is she most likely to have?
A DeQuervain disease
B Papillary carcinoma
C Hashimoto thyroiditis
D Multinodular goiter
E. Graves disease

25. An 35-year-old woman has had insomnia for the past 4 months, as well as episodes of diarrhea
with up to 4 loose stools per day. On physical examination, she exhibits bilateral proptosis. Her
outstretched hands have a fine tremor. On palpation of her neck, the thyroid gland does not appear
to be enlarged and no masses are palpable. Laboratory studies show a serum TSH of 8.8
microU/mL in association with a serum total thyroxine of 15.1 microgram/dL. Which of the
following is the most likely diagnosis?

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A Graves disease
B Pituitary adenoma
C Chronic thyroiditis
D Prior thyroidectomy
E Multinodular goiter

26. A 38-year-old woman has had a feeling of fullness in her neck for the past year. She is
otherwise asymptomatic. Her physician's assistant palpates a symmetrically enlarged but
nontender thyroid gland. She has no difficulty swallowing. There is no palpable lymphadenopathy.
She is afebrile. Her serum TSH is 3.5 mU/L with total thyroxine of 8.2 micrograms/dL. Thyroid
peroxidase antibody is not detected. Two years later, her thyroid has not appreciably changed in
size. Which of the following conditions is she most likely to have?
A Graves disease
B Nodular goiter
C Hashimoto thyroiditis
D Anaplastic carcinoma
E Follicular adenoma

27. A 25-year-old presented with anterior neck selling, exophalmia and pre-tibial myxoedema.
Histology shows a diffuse hyperplasia of the gthyroid follicular cells with most of them having
papillary folds and contained scalloped pale scanty colloid. No capsular invasion was seen
A. Hashimotor thyroiditis
B. De Quervian thyroiditis
C. Myxoedema
D. Gravis disease
E. Diffuse and multinodular goiter

28. A child presents with umbilical hernia, protruding tongue, short stature and mental
retardation. He was described to gentle. Hormonal assay shows low T3/T4 and high TSH

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A. DeQuervain thyroiditis
B. Myxoedema
C. Hashimoto thyroiditis
D. Cretinism
E. Riedel thyroiditis

29. A 35-year-old woman presents with anterior neck swelling. On histology, malignant cells
growing in papillary folds with presence of orphan Annie nucleus and psammoma bodies were
seen.
A. Meduallary Carcinoma
B. Papillary Carcinoma
C. Follicular Carcinoma
D. Follicular Adenoma
E. Anaplastic Carcinoma

30. A 49-year-old woman has been taking steroid for the past 4 years, now she reported to the
hospital because she has noted increased of weight, specifically in the abdomen, she has a “moon
like appearance” of face and a “buffalo hump”
A. Addison syndrome
B. Cushing syndrome
C. Conn syndrome
D. Waterhouse Friderichsen
E. Kimmelstiel- Wilson syndrome

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 ENDOCRINE PATHOLOGY MOST RECENT IA- DR. ACEVEDOR
1. The main factor regulating insulin levels in blood is
A. Glucose
B. Glucagon
C. Fatty acid
D. Amino acid
E. Acetylcholine
2. A middle-aged woman is producing large volumes of dilute urine. Her plasma osmolarity is
high. After she was given artificial ADH, her urine volume decreased and urine osmolarity
increased. This woman has suffered from:
A. SIADH
B. Psychogenic diabetes insipidus
C. Nephrogenic diabetes insipidus
D. Diabetes mellitus
E. Central diabetes insipidus
3. The MOST COMMON hormonal combination of pituitary adenoma is:
A. TSH-FSH
B. PRL-TSH
C. GH-TSH
[Link]-PRL
E. ACTH-GH
4. If a growth hormone-secreting adenoma occurs before the epiphyses close, excessive levels of
growth hormone result in:
A. Myxedema
B. Hypopituitarism
C. Gigantism
[Link]
E. Acromegaly

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5. What is the most common cause of hypothyroidism worldwide?
A. Sub-acute Lymphocytic thyroiditis
B. Reidel thyroditis
C. Hashimoto thyroiditis
D. Graves disease
E. Dietary deficiency of iodine
6. Which of the following antibodies would identify Melanocyte Stimulating Hormone in the
pituitary?
A. Thyrotrophs
B. Somatotrophs
C. Lactotrophs
D. Gonadotrophs
E. Corticotrophs
7. Which of the following is true of hormones of the posterior pituitary?
A. Vasopressin leads to increase water loss as a result of sensors that determines increase
in plasma oncotic pressure
B. They are produced by the posterior pituitary cells, stored and released according to
demand
C. Pro-opiomelanocortin is released from the hypothalamus and through the axonal
process is stored in the modified glial cells of the pituitary
D. Oxytocin functions in restoring back the mammary gland to normal state after
lactation
E. Dilatation of the cervix will lead to massive release of oxytocin which will cause
contraction of the smooth muscle of the uterus
8. Apart from dopamine, which other factors of the hypothalamus delivers inhibitory signal to
the pituitary?
A. Thyroid releasing hormone
B. Thyroid releasing hormone
C. Somatostatin
D. Growth hormone releasing hormone

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 E. Gonadotropin releasing hormone
9. Which of the following hormone is controlled via both stimulatory and inhibitory influences
from the hypothalamus
A. Thyroid stimulating hormone
B. Prolactin
C. Pituitary growth hormone
D. Follicle stimulating hormone
E. Adrenocorticotropic hormone
10. Which of the following will BEST describe the neurological symptoms associated with
vascular disorder of the pituitary often seen in rapid enlargement of pituitary adenoma?
A. Waterhouse- Fredrieschen Syndrome
B. Syndrome of inappropriate ADH secretion
C. Sheehams syndrome
D. Pituitary apoplexy
E. Nelson syndrome
11. Which of the following tumours is the MOST STRONGLY associated with mutation on
chromosome 20q13?
A. Thyrotrophs cell adenoma
B. Somatotrophs cell adenoma
C. Lactrotrophs cell adenoma
D. Gonadotrophs cell adenoma
E. Corticotrophs cell adenoma
12. Which of the following reactions will produce the effect of increase in the function of Cyclic
AMP in the G protein transduction pathway?
A. G protein uncoupled with ligand bound surface receptors
B. G protein coupled with ligand bound surface receptors
C. G protein coupled with GTPase
D. G protein coupled with GTP
E. G protein coupled with GDP

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13. Choose the CORRECT statement in the trans-membrane GPCR cell signalling pathway
A. In the activation pathway, the component of the G protein that interact with other
molecules is the G alpha component that is otherwise detached after G beta and G gamma
engages GTP
B. GPCR possess a five-membrane domain that is linked to heterodimeric G protein
C. Active G protein heterodimer is composed of 3 different proteins, alpha, beta and
gamma component
D. Activated MAP kinases which stimulates the synthesis of phosphorylation of
transcription factors such as FOS and JUN are products of GPCR activation
E. Activated G protein subunit detach from the receptors and initiate signaling from many
downstream effector proteins which includes cyclic AMP, DAG, IP3 and Calcium ions.
14. Which of the following neoplasms of the thyroid will spread via local, blood vessel and
lymphatic route?
A. Papillary carcinoma
B. Medullary carcinoma
C. Follicular carcinoma
D. Follicular adenoma
E. Anaplastic carcinoma
Use the following case scenario to answer questions 15, 16, and 17
A 31-year-old woman, who has two healthy children, notes that she has no menstrual periods for
the past 6 months, but she is not pregnant and takes no medications. Within the past week, she has
noted some milk production from her breasts. She has been bothered by headaches for the past 3
months. After nearly hitting a bus while changing lanes driving her vehicle, she is concerned with
her vision. An optometrist finds her lateral vision to be reduced.
15. According to the clinical signs and symptoms which type of pituitary adenoma is affecting
the patient?
A. Non- functioning macro-adenoma of the anterior lobe
B. Micro-adenoma of the anterior lobe
C. Macro-adenoma of the anterior lobe
D. Functional micro-adenoma of the anterior lobe
E. Functional macro-adenoma of the anterior lobe

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16. Which of the following would be MOST LIKELY histopathological diagnosis?
A. Thyrotroph adenoma
B. Somatotroph adenoma
C. Lactotroph adenoma
D. Gonadotroph adenoma
E. Corticotroph adenoma
17. Which of the following laboratory test findings would you expect in this patient/
A. Increased serum cortisol
B. Increased serum alkaline phosphatase
C. Hyperprolactinemia
D. Decreased serum TSH
E. Abnormal glucose tolerance test
18. A 56-year-old woman has diffuse,dull, constant abdominal pain for the past 2 months. On
physical examination no abnormal findings are noted. An abdominal CT scan shows a 3cm right
adrenal mass. The right adrenal is excised and on microscopic examination the mass is composed
of cells resembling adrenal cortex. Which of the following features is the MOST reliable
indicator that the mass is malignant?
A. Size of the mass
B. Presence of mitoses
C. Local invasion
D. Cellular necrosis
E. Cellular atypia
19. A 41-year-old man has been drinking large quantities of water up to 20 litres per day for the
past week. On physical examination he has diminished skin turgor and dry mucous membranes.
Laboratory studies show hypernatremia and increased serum osmolarity. A deficiency of which of
the following hormones is MOST LIKELY present in this man?
A. Vasopressin
B. Prolactin
C. Oxytocin
D. Insulin

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 E. Growth hormone
20. A 50-year-old man has a lump on his neck found at physical examination. A fine needle
aspirate of this lump shows follicular neoplasm of the thyroid. He undergoes a total thyroidectomy.
Within a day following surgery, he is noted to have tingling sensations and neuromascular
irritability. Which of the following serum laboratory tests should be ordered immediately to
determine further therapy for this man?
A. TSH
B. Thyroxine
C. Parathormone
D. Calcium
E. Calcitonin
SECTION II
EACH CASE SCENARIO IS FOLLOWED BY FIVE RELATED STATEMENT. INDICATE
IF THE THE STATEMENT IS TRUE OR FALSE , WRITING THE WORD IN FULL ON THE
SPACE PROVIDED.
21. A 25-year-old presented with anterior neck swelling, exophthalmia and pre-tibial myxedema.
Histology shows a diffuse hyperplasia of the thyroid follicular cells with most of them having
papillary folds and contained scalloped pale scanty colloid. No capsular invasion was seen.
A. ….……. Weight loss, menorrhagia and osteoporosis are some of the clinical features.
B. ….……. This disease usually presents with hypopituitarism.
C. ….……. This disease is more common in male.
D. ….……. This disease is characterised by a breakdown in selftolerance to thyroid autoantigens
E. ….……. Long acting thyroid stimulants(LATS) stimulates the production of thyroid hormone
from the follicular cells
22. A child presents with umbilical hernia, protruding tongue, short stature and mental
retardation. He was described to be gentle. Hormonal assay shows low T3/T4 and high TSH.
A. ………. The diagnosis in this case is pituitary dwarfism.
B. ….…… The adult form of this condition is myxedema
C. ….…… Sub-acute thyroiditis in the adult will present in this form
D. ….…… Iodides and Lithium may cause the adult form of this condition
E. ….…… Common areas where dietary iodine deficiency is endemic

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23. A 35-year old woman presents with anterior neck swelling. On histology, malignant cells
growing in papillary folds with the presence of orphan anne nucleus and psammoma bodies were
seen.
A. ………. This morphology is associated with lymphatic spread
B. ….…… This morphology described above is the most common type of thyroid cancer
C. ….…… The morphology described above carries the worst prognosis among the thyroid
cancers.
D. ….……. The diagnosis in this case is medullary carcinoma
E. ….……. Amyloids demonstrated by polarised microscopy is a diagnostic feature of this
cancer.

UTAH ENDOCRINE PATHOLOGY QUESTIONS

1. A 31-year-old woman, who has two healthy children, notes that she has had no menstrual
periods for the past 6 months, but she is not pregnant and takes no medications. Within the past
week, she has noted some milk production from her breasts. She has been bothered by headaches
for the past 3 months. After nearly hitting a bus while changing lanes driving her vehicle, she is
concerned with her vision. An optometrist finds her lateral vision to be reduced. On physical
examination she is afebrile and normotensive. Which of the following laboratory test findings is
most likely to be present in this woman?
A Increased serum cortisol

B Lack of growth hormone suppression

C Increased serum alkaline phosphatase
D Hyperprolactinemia
E Hyponatremia
F Abnormal glucose tolerance test
G Decreased serum TSH

2. A 28-year-old woman has had difficulty concentrating at work for the past month. She is
constantly getting up and walking around to visit co-workers. She complains that the work area is
too hot. She seems nervous and often spills her coffee. She has been eating more but has lost 5 kg

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in the past 2 months. On physical examination her temperature is 37.5°C, pulse 101/minute,
respiratory rate 22/minute, and blood pressure 145/85 mm Hg. Which of the following laboratory
findings is most likely to be present in this woman?
A Decreased catecholamines
B Decreased iodine uptake
C Decreased plasma insulin
D Decreased TSH
E Increased ACTH
F Increased calcitonin

3. A 19-year-old previously healthy woman has had a mild pharyngitis followed by a high fever
over the past 24 hours. When seen in the emergency room, her skin now shows extensive areas of
purpura. Vital signs include temperature 39°C, pulse rate 102/minute, respiratory rate 21/minute,
and blood pressure 80/55 mm Hg. Laboratory studies show a serum sodium of 115 mmol/L,
potassium 5.3 mmol/L, chloride 92 mmol/L, CO2 22 mmol/L, glucose 42 mg/dL, and creatinine
1.1 mg/dL. Which of the following is the most likely diagnosis?

A Idiopathic adrenalitis

B Disseminated tuberculosis

C Reactive systemic amyloidosis

D Sheehan syndrome

E Meningococcemia

F Hemochromatosis

4. A 40-year-old woman has noted enlargement of her anterior neck region over the past 8 months.
On physical examination her vital signs include T 36.8°C, P 64/minute, RR 16/minute, and BP
155/105 mm Hg. There is diffuse, symmetrical thyroid enlargement without tenderness. A chest
radiograph is normal. Fine needle aspiration of the thyroid yields cells consistent with a neoplasm.
Laboratory studies show that she is euthyroid, but her serum ionized calcium is elevated. She is
taken to surgery and frozen sections of several thyroid masses show a malignant neoplasm
composed of polygonal cells in nests. A thyroidectomy is performed. Immunostaining for
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calcitonin of the permanent sections is positive, and the neoplasm has an amyloid stroma with
Congo red staining. Which of the following neoplasms is she most likely to have?
A Anaplastic carcinoma
B Medullary carcinoma
C Papillary thyroid carcinoma
D Metastatic renal cell carcinoma
E Parathyroid carcinoma
F Follicular carcinoma

5. A 37-year-old man experiences abdominal pain, nausea, and constipation for the past 3 days.
On physical examination he has no palpable abdominal masses and bowel sounds are present. His
lungs are clear to auscultation. He has a heart rate of 80/min with an irregular rhythm. An
electrocardiogram demonstrates a shortened QT(corrected) interval and a prolonged PR interval.
He has a stool positive for occult blood. Upper GI endoscopy reveals multiple 1 cm diameter
shallow ulcerations of the gastric antrum. Which of the following laboratory test findings is most
likely to be present in this man?
A Thyroid peroxidase antibody of 4 IU/mL
B Serum calcium of 12.4 mg/dL
C Blood glucose of 225 mg/dL
D Total serum thyroxine of 21 ng/mL
E Plasma cortisol of 45 microgm/dL at 8 am
F Urine normetanephrine of 692 microgm/gm of creatinine
G Plasma renin activity (upright) of 6.8 ng/mL/hr

6. A 55-year-old woman has had a 4 kg weight loss over the past 3 months. She exhibits decreased
mentation over the past 10 days. On physical examination she is afebrile and hypotensive. Bilateral
papilledema is noted. A head CT scan shows marked diffuse cerebral edema with effacement of
the lateral ventricles. Laboratory studies show a sodium of 108 mmol/L, potassium 4.0 mmol/L,
chloride 83 mmol/L, CO2 14 mmol/L, glucose 82 mg/dL, and creatinine 0.5 mg/dL. Which of the
following is most likely to cause these findings?
A Small cell lung carcinoma
B Blunt head trauma

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C Hypothalamic glioma
D Meningitis
E Pituitary macroadenoma

7. A 29-year-old primigravida who received no prenatal care has marked vaginal bleeding after
the onset of labor at 38 weeks gestation. Cesarean section is performed and a lacerated low-lying
placenta is removed. She remains hypotensive for 6 hours and requires transfusion of 12 packed
RBC units. Postpartum, she becomes unable to breast-feed the infant. She does not have a
resumption of normal menstrual cycles. She becomes more sluggish and tired. Laboratory findings
include hyponatremia, hyperkalemia, and hypoglycemia. Which of the following pathologic
lesions is she most likely to have had following delivery?
A Bilateral adrenal hemorrhage
B Pituitary necrosis
C Subacute thyroiditis
D Metastatic choriocarcinoma
E Insulitis

8. A 58-year-old man with a history of diabetes mellitus has noted the presence of bone pain,
especially of his hands, for the past 6 months. On physical examination there is no swelling or
redness of his hands, no joint deformity, but the range of motion is slightly decreased. Laboratory
studies show sodium 139 mmol/L, potassium 4.0 mmol/L, chloride 98 mmol/L, C02 22 mmol/L,
glucose 153 mg/dL, creatinine 7.8 mg/dL, calcium 7.8 mg/dL, phosphorus 5.7 mg/dL, total protein
6.2 g/dL, and albumin 4.0 g/dL. Which of the following conditions is this man most likely to have?
A Adrenal adenoma
B Medullary thyroid carcinoma
C Extra-adrenal pheochromocytoma
D Parathyroid hyperplasia
E Pituitary adenoma

9. A 49-year-old woman has had increasing cold intolerance, weight gain of 4 kg, and sluggishness
over the past two years. A physical examination reveals dry, coarse skin and alopecia of the scalp.
Her thyroid is not palpably enlarged. Her serum TSH is 11.7 mU/L with thyroxine of 2.1

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micrograms/dL. A year ago, anti-thyroglobulin and anti-microsomal autoantibodies were detected
at high titer. Which of the following thyroid diseases is she most likely to have?
A DeQuervain disease
B Papillary carcinoma
C Hashimoto thyroiditis
D Multinodular goiter
E Graves disease

10. A clinical study is performed with subjects who were diagnosed with hyperthyroidism,
compared with a control group of subjects who were euthryoid. The pathologic findings in the
thyroid glands of these subjects are analyzed to determine the spectrum of disease processes
present. Which of the following pathologic processes is most likely to be found with equal
frequency in both the study and the control subjects?
A Subacute granulomatous thyroiditis
B Multinodular goiter
C Medullary carcinoma
D Hashimoto thyroiditis
E Follicular adenoma

11. A 48-year-old woman has experienced constant back pain exacerbated by movement over the
past month. She reports increasing weakness over the past 3 months. On physical examination her
blood pressure is 165/110 mm Hg. She is overweight, with a BMI of 28. A radiograph of the spine
reveals a compressed fracture at T10. Laboratory findings include a serum glucose of 155 mg/dL.
Which of the following pathologic lesions is most likely to explain her findings?
A Adrenal cortical carcinoma
B Anaplastic thyroid carcinoma
C Empty sella syndrome
D Pheochromocytoma
E Multinodular goiter

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12. A 33-year-old woman has noted a weight gain of 6 kg over the past year. She has normal
menstrual periods. On physical examination her blood pressure is 170/105 mm Hg. Her skin shows
marked plethora. Abdominal striae are present. A serum electrolyte panel shows sodium 141
mmol/L, potassium 4.4 mmol/L, chloride 100 mmol/L, CO2 25 mmol/L, glucose 181 mg/dL, and
creatinine 1.0 mg/dL. Which of the following radiologic findings would you most expect to be
present in this patient?
A 2 cm right adrenal mass with abdominal CT scan
B 4 cm mass at aortic bifurcation with MR imaging
C Multiple pulmonary nodules on chest radiograph
D 10 cm cystic right ovarian lesion by abdominal ultrasound
E 2 cm 'hot' thyroid nodule with Tc99 scintigraphic scan

13. An 35-year-old woman has had insomnia for the past 4 months, as well as episodes of diarrhea
with up to 4 loose stools per day. On physical examination, she exhibits bilateral proptosis. Her
outstretched hands have a fine tremor. On palpation of her neck, the thyroid gland does not appear
to be enlarged and no masses are palpable. Laboratory studies show a serum TSH of 8.8
microU/mL in association with a serum total thyroxine of 15.1 microgram/dL. Which of the
following is the most likely diagnosis?
A Graves disease
B Pituitary adenoma
C Chronic thyroiditis
D Prior thyroidectomy
E Multinodular goiter

14. A 25-year-old woman has had a 7 kg weight loss over the past 6 months without dieting or
trying to lose weight. On physical examination she appears anxious and worried. Her hands are
warm and tremulous. Vital signs show her temperature to be 37.4°C, pulse 105/minute,
respirations 23/minute, and blood pressure 135/75 mm Hg. Serum laboratory data include glucose
78 mg/dL and creatinine 0.8 mg/dL. Which of the following additional laboratory test findings is
most likely to be present in this woman?
A Plasma cortisol of 40 microgm/dL at 8 am
B Serum antinuclear antibody of 1:256
C Urinary free catecholamines of 500 microgm/24 hr

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D Serum gastrin of 200 pg/mL
E Serum total thyroxine of 14 microgm/dL

15. A 50-year-old man has episodic headaches for 3 months. On physical examination his blood
pressure is 185/110 mm Hg, with no other remarkable findings. Laboratory studies show sodium
145 mmol/L, potassium 4.3 mmol/L, chloride 103 mmol/L, C02 26 mmol/L, glucose 91 mg/dL,
and creatinine 1.3 mg/dL. An abdominal CT scan shows a 7 cm left adrenal mass. During surgery,
as the left adrenal gland is removed, there a marked rise in blood pressure. Which of the following
laboratory test findings most likely explains his findings?
A Decreased serum cortisol
B Decreased urinary homovanillic acid
C Increased serum ACTH
D Increased urinary free catecholamines
E Elevated serum ANCA
16. A 47-year-old woman feels a 'lump' in her neck that she didn't notice 5 months before. Her
physician palpates a firm nodule about 2 cm in size to the left of midline in the region of the thyroid
gland. By scintigraphic scanning this nodule appears 'cold' with normal activity in the surrounding
normally sized thyroid gland. Which of the following is the most likely diagnosis?
A Papillary carcinoma
B Follicular adenoma
C Thyroglossal duct cyst
D Toxic nodular goiter
E Granulomatous thyroiditis
F Hashimoto thyroiditis

17. A 56-year-old woman has had diffuse, dull, constant abdominal pain for the past 2 months. On
physical examination no abnormal findings are noted. An abdominal CT scan shows a 3 cm right
adrenal mass. The right adrenal is excised and on microscopic examination the mass is composed
of cells resembling adrenal cortex. Which of the following features is the most reliable indicator
that this mass is malignant?
A Cellular atypia
B Presence of mitoses

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C Invasion
D Size of the mass
E Cellular necrosis

18. A 49-year-old woman has had multiple episodes of lower abdominal pain for the past year. On
3 occasions she passed a urinary tract stone during or following an episode of pain. During the
past month she has had pain in her right middle finger. On physical examination there is pain on
palpation of her right 3rd proximal phalanx. Laboratory studies show a serum calcium of 13.7
mg/dL, phosphorus of 1.9 mg/dL, creatinine 1.1 mg/dL, and albumin 4.8 g/dL. Which of the
following bone lesions is she most likely to have?
A Osteitis fibrosa cystica
B Osteoid osteoma
C Osteochondroma
D Osteomyelitis
E Osteoporosis
F Osteosarcoma

19. A 40-year-old woman notes increasing enlargement and discomfort in her neck over the past
week. The nurse practitioner palpates diffuse, symmetrical enlargement with tenderness in the
region of the thyroid gland. Thyroid function tests show serum TSH of 0.8 mU/L and thyroxine of
11.9 micrograms/dL. She is referred to an endocrinologist, but the next available appointment is
in 8 weeks. When examined by the endocrinologist her thyroid is no longer palpable and there is
no pain. Repeat thyroid function tests reveal a serum TSH of 3.8 mU/L and thyroxine of 5.7
micrograms/dL. Which of the following thyroid diseases is most likely to produce these findings?
A Nodular goiter
B Non-Hodgkin lymphoma
C DeQuervain disease
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D Hashimoto thyroiditis
E Graves disease
F Riedel thyroiditis
G Iodine deficiency

20. A 33-year-old previously healthy man has lateral visual field deficits, but his residual vision
is 20/20. His facial features have changed over the past year. His shoe size has increased. A head
CT scan reveals 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
21. A 47-year-old woman has felt a 'lump' in her neck for the past 2 months. On physical
examination there is a firm nodule in the right lobe of her thyroid. Following fine needle aspiration
and cytologic diagnosis of a neoplasm, a thyroidectomy is performed. Grossly, there is a 3 cm
mass in the right lower pole that on sectioning is cystic and has papillary excrescences. Which of
the following microscopic pathologic findings is most typical for this lesion?
A Giant cells
B Amyloid stroma
C Small thyroid follicles
D Clear nuclear chromatin
E Pleomorphic spindle cells

22. The mother of an 11-month-old infant had noted enlargement of the baby's abdomen within
the past month. This is confirmed by the osteopathic physician, who notes that the baby is
otherwise normally developed. An abdominal CT scan reveals a 6 cm mass, with some scattered
calcifications, above the right kidney. Laboratory studies show a greatly elevated urinary
vanillylmandelic acid (VMA), while the urinary homovanillic acid (HVA) is only slightly
increased. The mass is removed and microscopically is composed of sheets of small blue cells.
What is the most likely diagnosis?

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A congenital adrenal hyperplasia
B Adrenal cortical carcinoma
C Neuroblastoma
D Non-Hodgkin lymphoma
E Pheochromocytoma
F Aldosteronoma

23. A 53-year-old woman has pain in her neck for the past month. On physical examination her
vital signs include T 37°C, P 77/minute, RR 16/minute, and BP 130/80 mm Hg. There is an
irregular firm mass palpable in her left neck. A CT scan shows an infiltrative mass involving the
left lobe of the thyroid and extending into adjacent soft tissues. Laboratory studies show TSH 2.9
mU/L, total serum thyroxine 8.6 microgm/dL, calcium 8.7 mg/dL, and phosphorus 2.8 mg/dL. A
fine needle aspiration biopsy of the mass shows malignant spindle-shaped cells present that
demonstrate a p53 mutation immunohistochemically. Which of the following neoplasms is this
woman most likely to have?
A Anaplastic carcinoma
B Follicular carcinoma
C Medullary carcinoma
D Non-Hodgkin lymphoma
E Papillary carcinoma
F Parathyroid carcinoma

24. A 45-year-old man has a 4 month history of nonfocal, generalized headaches. On physical
examination he is found to have a blood pressure of 170/110 mm Hg. Laboratory studies show a
serum sodium of 146 mmol/L, potassium 2.3 mmol/L, chloride 103 mmol/L, CO2 27 mmol/L,
glucose 82 mg/dL, and creatinine 1.2 mg/dL. His plasma renin activity is 0.1 ng/mL/hr and his
serum aldosterone 65 ng/mL. Which of the following is the most likely cause for his findings?
A 21-hydroxylase enzyme deficiency
B Adrenal cortical adenoma
C Pituitary adenoma
D Exogenous corticosteroid administration
E Renal cell carcinoma
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25. A 40-year-old woman has noted painless swelling of her neck for the past 3 weeks. On physical
examination there is diffuse enlargement of her thyroid. Laboratory studies show an increased titer
of anti-thyroid peroxidase and anti-thyroglobulin antibodies. Within a month, the swelling has
diminished. Which of the following complications is she most likely to develop?
A Amyloidosis
B Hypothyroidism
C Non-Hodgkin lymphoma
D Papillary carcinoma
E Riedel thyroiditis

26. A 45-year-old woman with severe rheumatoid arthritis has been on chronic corticosteroid
therapy for the past 15 years. She is admitted for an orthopedic procedure to correct joint deformity
from her disease. She continues to receive her regular dosage of 5 mg of prednisone per day. Three
days postoperatively, she develops an aspiration pneumonia with Klebsiella pneumoniae cultured
from sputum. Five days following the surgery, she becomes obtunded. Laboratory findings at that
time include: sodium 105 mmol/L, potassium 5.4 mmol/L, chloride 87 mmol/L, CO2 16 mmol/L,
glucose 40 mg/dL, and creatinine 1.1 mg/dL. Which of the following complications is most likely
to have occurred in this patient?
A Anterior pituitary necrosis
B Waterhouse-Friderichsen syndrome
C Acute Addisonian crisis
D Conn syndrome
E 21-hydroxylase deficiency

27. A 38-year-old woman has had a feeling of fullness in her neck for the past year. She is
otherwise asymptomatic. Her physician's assistant palpates a symmetrically enlarged but
nontender thyroid gland. She has no difficulty swallowing. There is no palpable lymphadenopathy.
She is afebrile. Her serum TSH is 3.5 mU/L with total thyroxine of 8.2 micrograms/dL. Thyroid
peroxidase antibody is not detected. Two years later, her thyroid has not appreciably changed in
size. Which of the following conditions is she most likely to have?
A Graves disease
B Nodular goiter

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C Hashimoto thyroiditis
D Anaplastic carcinoma
E Follicular adenoma
F Papillary carcinoma

28. A 15-year-old boy has had worsening headaches for 2 months. On examination he has
diminished peripheral vision, but no loss of visual acuity. A head CT scan reveals a 4 cm mass
expanding the sella turcica and eroding the sphenoid bone. The mass is cystic with scattered
calcifications. Which of the following is the most likely diagnosis?
A Prolactinoma
B Metastatic seminoma
C Empty sella syndrome
D Anaplastic astrocytoma
E Craniopharyngioma
F Osteosarcoma

29. A 52-year-old man has weight of 4 kg over the past 6 months, along with bruises on his skin
with even minor trauma and back pain. He has smoked 2 packs a cigarettes per day for 35 years.
On physical examination he has obesity in a truncal distribution, plethora, and a blood pressure of
160/110 mm Hg. A radiograph of the spine reveals a compressed fracture of T11. Which of the
following neoplasms is he most likely to have?
A Pheochromocytoma of bladder
B Follicular carcinoma of thyroid
C Osteosarcoma of femur
D Small cell anaplastic carcinoma of lung
E Neuroendocrine carcinoma of pancreas

30. A 41-year-old man has been drinking large quantities of water--up to 20 liters per day--for the
past week. On physical examination he has diminished skin turgor and dry mucous membranes.
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Laboratory studies show sodium 162 mmol/L, potassium 4.1 mmol/L, chloride 121 mmol/L, and
bicarbonate 27 mmol/L. His serum glucose is 75 mg/dL and creatinine 1.0 mg/dL. His serum
osmolality is 343 mOsm/kg. A deficiency of which of the following hormones is most likely
present in this man?
A Vasopressin
B Oxytocin
C Insulin
D Growth hormone
E Prolactin
31. A 50-year-old man has a lump on his neck found at physical examination. A fine needle
aspirate of this lump shows a follicular neoplasm of the thyroid. He undergoes a total
thyroidectomy. Within a day following surgery, he is noted to have tingling sensations and
neuromuscular irritability. Which of the following serum laboratory tests should be ordered
immediately to determine further therapy for this man?
A TSH
B Parathormone
C Thyroxine
D Calcium
E Calcitonin
F Iodine
32. A 30-year-old woman from Barcelona has noted enlargement of her neck over the past 4
months. On physical examination, she has a diffusely enlarged thyroid that is not painful to
palpation. Her TSH level is 0.2 mU/L. A subtotal thyroidectomy is performed and histologically
the tissue shows follicles with papillary infoldings lined by tall columnar cells. Which of the
following is the most likely diagnosis?
A Subacute granulomatous thyroiditis
B Papillary carcinoma
C Multinodular goiter
D Hashimoto thyroiditis
E Graves disease

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33. A 57-year-old man is found comatose. On physical examination he has decreased skin turgor.
Laboratory studies show a blood glucose of 780 mg/dL. Urinalysis reveals no ketosis or
proteinuria, though there is 4+ glucosuria. Which of the following is the most likely diagnosis?
A Neuroendocrine tumor secreting glucagon
B Type I diabetes mellitus
C Cushing syndrome
D Ingestion of a large quantity of sugar
E Type II diabetes mellitus

34. A 23-year-old man wants to increase his muscle mass for playing physical contact sports. He
attempts to accomplish this by injections of a substance obtained from a 'friend'. Over the next
year he develops acne, icterus, and increased fatigue. An infertility workup reveals hypospermia.
Laboratory studies show Hgb 19.2 g/dL, Hct 58.1.4%, platelet count 330,300/microliter, and WBC
count 7410/microliter. Which of the following neoplasms is he at greatest risk for developing in
the future?
A Hepatocellular carcinoma
B Papillary carcinoma
C Renal cell carcinoma
D Rhabdomyosarcoma
E Seminoma

35. A 33-year old woman has had increased anxiety with headaches and diaphoresis over the past
2 months. On physical examination she is afebrile, with a heart rate of 90/minute and blood
pressure 150/90 mm Hg. Laboratory studies show elevated urinary catecholamines, elevated
plasma renin activity, and normal TSH. Her plasma cortisol level is normal. An abdominal CT
scan is performed. At which of the following locations is a mass lesion most likely to be found?
A Aortic bifurcation
B Hepatic capsule
C Pancreatic tail
D Mediastinum
E Splenic hilum

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36. A 2-year-old child living in Odessa is small for its age and exhibits profound intellectual
disability. On physical examination he has dry, coarse skin. Which of the following pathologic
features involving the thyroid gland is this child most likely to have?
A Papillary adenoma
B Diffuse hyperplasia
C Granulomatous inflammation
D Metastatic carcinoma
E Marked atrophy

37. A 35-year-old G3 P3 woman has increasing fullness in her neck for the past 5 months since
delivery of her last infant. On physical examination her thyroid gland is diffusely enlarged but not
painful to palpation. Laboratory studies show an anti-thyroglobulin titer of 1:256 and an anti-
thyroid peroxidase titer of 1:512. Her TSH and thyroxine are normal. Which of the following is
the most likely diagnosis?
A Riedel thyroiditis
B Adenovirus infection
C Subacute lymphocytic thyroiditis
D Cretinism
E Subacute granulomatous thyroiditis
F Diffuse goiter

38. A clinical study is performed involving subjects who developed Addision disease. They were
recorded to have laboratory studies with hyponatremia, hyperkalemia, hypoglycemia, and
decreased plasma cortisol. They became hypotensive. In some subjects, this disease had an acute
onset over less than 2 days' time. Which of the following conditions is most likely to produce this
acute course?
A Waterhouse-Friderichsen syndrome
B Metastatic small cell anaplastic carcinoma
C Disseminated Mycobacterium tuberculosis infection

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D Reactive systemic amyloidosis
E Blunt force abdominal trauma

39. A 39-year-old woman has noted discomfort with fullness to her neck over the past year. On
physical examination she is afebrile and normotensive. There is irregular enlargement of her
thyroid gland, but no tenderness on palpation. A scintigraphic scan shows normal uptake except
for increased uptake in a 1 cm area in the left lower lobe. Her anti-thyroid peroxidase antibody is
negative. Which of the following complications is she most likely to develop?
A Thyrotoxicosis
B Papillary carcinoma
C Graves disease
D Subacute thyroiditis
E Hypothyroidism

40. A 42-year-old man has enlargement of his neck for the past 7 months. He is concerned, because
a sister and maternal aunt had thyroid cancer. On physical examination, his thyroid is palpably
nodular but nontender. A fine needle aspiration biopsy is performed and cytologic examination
shows cells present consistent with a neoplasm. He undergoes total thyroidectomy. Sectioning the
resected thyroid reveals four distinct tumor masses from 0.5 to 3 cm in size. These masses are solid
and firm, with a tan cut surface. On microscopic examination an immunostain for calcitonin is
positive in the nests of dark blue cells of these masses. He is at greatest risk for developing which
of the following neoplasms in the future?
A Astrocytoma
B Pheochromocytoma
C Angiosarcoma
D Gastrinoma
E Renal cell carcinoma

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41. A 17-year-old girl with Goodpasture syndrome progressed to chronic renal failure and was
placed on chronic hemodialysis. She developed severe hypertension. However, she had difficulty
accepting the reality of her disease, and she missed dialysis appointments and did not take her
antihypertensive medication regularly. Laboratory studies now show her serum ionized calcium
is 5.9 mg/dL with phosphorus 6.2 mg/dL and albumin 3.6 g/dL. Which of the following
complications of her illness is she most likely to have?
A Depression
B Icterus
C Skin rash
D Dyspnea
E Joint pain

42. A 1-year-old male child has been irritable for the past day. On physical examination he has a
right inguinal hernia with incarceration of a loop of small intestine. A laparotomy is performed
and the defect is closed. The tissue from the hernia sac is excised. The surgical pathology report
indicates the presence of a focus of adrenal cortex in the excised hernia sac. Which of the following
is the most likely diagnosis?
A congenital adrenal hyperplasia
B Adrenal cortical carcinoma metastasis
C Incidental ectopia
D Risk for subsequent adrenocortical insufficiency
E Multiple endocrine neoplasia syndrome

43. A 14-year-old boy has felt a 'bump' in his neck for the past year. On physical examination just
anterior to the trachea in the midline is a palpable non-tender 2 cm mass. A fine needle aspirate of
the mass yields only clear, mucoid fluid. Which of the following is the most likely diagnosis?
A Thyroglossal duct cyst
B Lymph node metastasis of follicular carcinoma
C Follicular adenoma
D Nodule of a multinodular goiter
E Branchial cleft cyst

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44. A clinical study is performed of subjects from birth to age 80 years who were documented by
laboratory testing to have hypocalcemia. The medical records of these subjects are analyzed and
the disease conditions documented in these subjects recorded. A subset of these patients had
hypocalcemia documented in infancy. Which of the following conditions is most likely to have
been present in this subset of patients?
A Parathyroid carcinoma
B Vitamin D deficiency
C Chronic renal failure
D DiGeorge syndrome
E Parathyroid adenoma

45. A 5-month-old female infant was the product of an uncomplicated pregnancy and was born at
term. However, the baby has failure to thrive. On physical examination there is clitoral hypertrophy
and poor skin turgor. The baby appears neurologically normal. Laboratory studies show serum
sodium 116 mmol/L, potassium 6.2 mmol/L, chloride 83 mmol/L, and CO 2 22 mmol/L. There is
no history of diarrhea or vomiting. Which of the following inborn errors of metabolism is this
infant most likely to have?
A 21-hydroxylase deficiency
B Phenylalanine transferase deficiency
C Galactose-1-uridyl transferase deficiency
D Glucose-6-phosphatase deficiency
E Iodine peroxidase deficiency

ENDOCRINE PHARMACOLOGY (DR. ADONGO &

PAAPA)

SMBM 307: Endocrine System in Health and Disease

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 ENDOCRINE PHARMACOLOGY PREVIOUS YEAR IA
SECTION I (ASSERTION AND REASONING)
ANSWER CODE SUMMARY
Statement 1 Statement 2 Answer
True True Second statement explain the first A
True True Second statement does not explain the first B
True False C
False True D
False False E

1. Hypoglycemia is not a common side effect of metformin because metformin does not affect
insulin release from beta cells of pancreas

2. Meglitinides should not be used in combination with sulfonylureas because the meglitinides
have a rapid onset and short duration of action

3. Metformin is associated with weight reduction in type 2 diabetes because metformin causes
anorexigenic effect and a sense of stomach fullness

4. All insulin formulations are suitable for intravenous administration, although regular insulin is
most commonly used when the intravenous route is needed because

5. Glucose given by injection has a weaker effect on insulin secretion than does glucose taken
orally, because when given orally, glucose stimulates production of digestive hormones by the
gut, which in turn stimulate insulin secretion by the pancreas

6. Sulfonylureas enhance insulin secretion because sulfonylureas block ATPsenstive calcium

channels in the cell membranes of pancreatic β-cells

7. Metformin is associated with weight reduction in type 2 diabetes because metformin causes
anorexigenic effect and a sense of stomach fullness

8. Ketoconazole will enhance the lipid lowering effect of repaglinide because ketoconazole
induces CYP3A4 which metabolizes repaglinide

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 SECTION II (MULTIPLE ANSWERS)
Select the most appropriate option to the question in the prompt
In answering the question, you should try to select the best single best answer from the five
options provided.
9. Insulin shock is characterized by
A. Severe hypoglycemia caused by an overdose of insulin
B. Severe hyperglycemia
C. Too little insulin in the blood stream
D. An allergic reaction to insulin

10. A 50-year-old woman has just been diagnosed as a Type 2 diabetes and given a
prescription for metformin. Which of the following statements is characteristic of the
medication?
A. Hypoglycemia is a common adverse effect
B. Metformin undergoes metabolism to an active compound
C. Many drug-drug interactions have been identified
D. It decreases hepatic glucose production
E. The patient often gains weight

11. Which of the following statements is true for the therapy with insulin glargine?
A. It is primarily used to control prandial hyperglycemia
B. It should not be combined with any other insulin
C. It is now used preferentially in Type 1 diabetes who are pregnant
D. Pharmacokinetically, there is no peak activity, and the activity last about 24 h
E. It is effective by inhalation

12. The ability to reduce insulin resistance is associated with which one of the following
classes of hypoglycemic agents?

A. Meglitinides
B. Sulfonylureas
C. α-Glucosidase inhibitors
D. Thiazolidinediones
E. Gastrointestinal hormones

13. In a patient with type 2 diabetes, which of the following is most likely to cause
hypoglycemic reactions?

A. Acarbose
B. Glucagon
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 C. Glyburide
D. Metformin
E. Rosiglitazone

14. The release of insulin from the pancreatic B cell would likely be inhibited by which of
the following?

A. Clonidine
B. Glucose
C. Albuterol
D. Pilocarpine
E. Glipizide

The following information relates to questions 15-19:

a) Ranitidine
b) Aluminium hydroxide
c) Bisacodyl
d) Ondansetron
e) Simethicone

15. Is useful in the treatment of flatulence

16. Is an irritant laxative
17. Is an effective anti-emetic drug in patients undergoing chemotherapy
18. Is a H2 receptor antagonist used in the treatment of peptic ulcer
19. May cause hypophosphatemia

SECTION III (MULTIPLE ANSWERS)

ANSWER CODE SUMMARY
A B C D E
i, ii, iii i, ii ii, iii i only iii only

20. Parietal cells release acid and intrinsic factors when activated by:

i) Norepinephrine
ii) Atropine
iii) Histamine

21. Most successful protocol for eradication of H. pylori in peptic ulcer disease:

i) bismuth monotherapy

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 ii) Proton pump Inhibitor and amoxicillin
iii) therapy using Proton Pump Inhibitor, metronidazole and amoxicillin in combination-
triple therapy

22. Indicate the laxative drug belonging to osmotic laxatives:

i) Docusate sodium
ii) Bisacodyl
iii) Lactulose

23. Which of the following statements about laxatives is INCORRECT:

i) Dietary fibre such as bran enhances water retention by faeces

ii) Excessive use of magnesium sulphate (Epsom salts) may cause dehydration
iii) Liquid paraffin is an irritant laxative

24. Which of the following statement about laxatives is INCORRECT:

i) Dietary fibre such as bran enhances water retention by faeces

ii) Excessive use of magnesium sulphate (Epsom salts) may cause dehydration
iii) Liquid paraffin is an irritant laxative

NEXT SET
SECTION I (ASSERTION AND REASONING)
ANSWER CODE SUMMARY
Statement 1 Statement 2 Answer
True True Second statement explain the first A
True True Second statement does not explain the first B
True False C
False True D
False False E

1. Glucose given by injection has a weaker effect on insulin secretion than does glucose
taken orally, because when given orally, glucose stimulates production of digestive
hormones by the gut, which in turn stimulate insulin secretion by the pancreas

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 2. Ketoconazole will enhance the lipid lowering effect of repaglinide because ketoconazole
induces CYP3A4 which metabolizes repaglinide

3. Sulfonylureas enhance insulin secretion because sulfonylureas block ATPsenstive

calcium channels in the cell membranes of pancreatic β-cells

4. Metformin is associated with weight reduction in type 2 diabetes because metformin

causes anorexigenic effect and a sense of stomach fullness

5. Thyroxine is derived from the amino acid, tyrosine, and can be orally administered
because thyrosine is not a peptide and is stable to stomach

6. Methimazole is preferred to Propylthiouracil in the management of hyperthyroidism in

pregnancy because methimazole is highly bound to plasma protein than propylthiouracil
and hence less amount would cross the placenta

7. Which of the following best describes the effect of propylthiouracil on thyroid hormone production?
a. It blocks he release of thyrotropin-releasing hormone
b. It inhibits uptake of iodide by thyroid cells.
c. It prevents the release of thyroid hormone from thyroglobulin.
d. It blocks the iodination and coupling of tyrosines in thyroglobulins to form thyroid
hormones.
e. It blocks the release of hormones the thyroid gland.
8. Hyperthyroidism can be treated by all except
a. Triiodothyronine
b. Surgical removal of the gland
c. Iodide
d. Propylthiouracil
e. Methimazole
9. Which one of the following agents is INCORRECTLY paired to a clinical use of a drug?
A. Desmopressin; treatment of diabetes insipidus
B. Octreotide: treatment of diarrhea associated with vasoactive intestinal peptide tumours
C. Oxytocin: induction of labour

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 D. hCG: treatment of infertility in men and women
E. Pegvisomant: treatment of short stature in men and women
10. A 64 year old woman with a history of Type 2 diabetes is diagnosed with failure. Which of the
following drugs would be a poor choice in controlling her diabetes?
a. Sitagliptin
b. Exenatide
c. Glyburide
d. Glipizide
e. Pioglitazone
11. The ability to reduce insuin resistance is associated with which one of the following classes of
hypoglycemic agents?
a. Meglitinides
b. Sulfonylureas
c. a-Gluconidase inhibitors
d. Thiazolidinediones
e. Gastrointestinal tumours
12. Which one of the following hormones is a non-peptide, allowing oral administration?
a. ACTH
b. Growth Hormone
c. GnRH
d. Thyroxine
e. CRH

13. This drug treats hyperthyroidism by inhibiting T3 and T4 production in the thyroid gland, and
preventing T3 conversion to T4 in tissues
a. Mineralocorticoids
b. Mehtimazole
c. Sodium iodide 131
d. Propylthiouracil
e. Insulin

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Match the following drugs on the left with their uses on the right
14. HCG A) treatment of diabetes insipidus
15. Domperidone B) treatment of diarrhea associated with VIP tumour
16. Octreotide C) induction of labour
17. Desmopressin D) treatment of infertility in men and women
18. Oxytocin E) Dopamine antagonist

END

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