First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 107

Endocrine
Questions
ANATOMY
1.

What are the three major zones of the adrenal gland? List the major secretory product of each. (p.
288) __________________________________________________________________________

2.

What is the most common adrenal gland tumor in children? In adults? (p. 288) ________________
______________________________________________________________________________

3.

What are the two divisions of the pituitary gland? Which hormones does each secrete? (p. 288) __
______________________________________________________________________________

4.

What cells produce the hormones released by the posterior pituitary gland? (p. 288) ____________

5.

Name the three major cell types of the Islets of Langerhans. What critical hormone is secreted by
each cell? (p. 289) _______________________________________________________________
______________________________________________________________________________

6.

Which tissues do not need insulin to facilitate glucose uptake? (p. 289) ______________________
______________________________________________________________________________

PHYSIOLOGY
7.

Which two molecules control the secretion of prolactin? Are they stimulatory or inhibitory? (p. 290)
______________________________________________________________________________

8.

What is the major axis at the core of endocrinology? (p. 290) _____________________________

9.

For each of the congenital bilateral adrenal hyperplasias, indicate whether blood pressure and sex
hormone levels are increased or decreased. (p. 291)
Disease

Blood Pressure

Sex Hormones

11-hydroxylase deficiency
17-hydroxylase deficiency
21-hydroxylase deficiency
10.

What enzyme modulates the conversion of testosterone to estradiol? What enzyme modulates the
conversion of testosterone to DHT? (p. 291) ___________________________________________

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

11.

How is cortisol produced? (p. 292) ___________________________________________________

12.

PTH _______________ (increases/decreases) serum calcium levels and _______________

(increases/decreases)
serum
phosphate
levels.
Vitamin
D
_______________
(increases/decreases) serum calcium level and _______________ (increases/decreases) serum
phosphate levels. (pp. 293-294)

13.

Which kidney enzyme acts on vitamin D to activate it? (p. 293) ____________________________

14.

What condition can vitamin D deficiency cause in children? In adults? (p. 294) ________________
______________________________________________________________________________

15.

Increased levels of sex hormone-binding globulins _______________ (increase/decrease) free

testosterone levels in men and _______________ (increase/decrease) free testosterone levels in
women. (p. 295)

16.

How do T3 and T4 control the bodys metabolic rate? (p. 295) ______________________________
______________________________________________________________________________

PATHOLOGY
17.

What is the most common cause of Cushings syndrome? (p. 296) _________________________

18.

For a patient who is not taking steroids, what are the other potential causes of Cushings syndrome
and the likelihood (% of risk) that the patient would have any one of them? (p. 296) ___________
______________________________________________________________________________

19.

What are the common clinical manifestations of Cushings syndrome? (p. 296) ________________
______________________________________________________________________________

20.

How is Cushings syndrome diagnosed? (p. 296) _______________________________________

21.

Primary hyperaldosteronism is associated with _______________ (increased/decreased) plasma

renin activity, while secondary hyperaldosteronism is associated with _______________
(increased/decreased plasma renin activity. (p. 296)

22.

Is hyperkalemia seen in primary or secondary adrenal insufficiency? (p. 296) _________________

23.

What are the three common causes of Waterhouse-Friderichsen syndrome? (p. 296) ___________
______________________________________________________________________________

24.

What is the rule of 10s for pheochromocytoma? What is the cell of origin for this tumor? (p. 297)
______________________________________________________________________________
______________________________________________________________________________

25.

What are the signs and symptoms of pheochromocytoma? (p. 297) _________________________
______________________________________________________________________________

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

26.

page 109

Compare and contrast the characteristics of hypothyroidism vs. hyperthyroidism. (p. 297)
Sign/Symptom

Hypothyroidism

Hyperthyroidism

Activity level
Bowel movements
Cardiovascular changes
Edema
Free T4
Hair texture
Reflexes
Skin changes
T3 uptake
Temperature
Total T4
TSH level
Weight

27.

List four diseases characterized primarily by hypothyroidism. (p. 298) _______________________

______________________________________________________________________________

28.

What is the difference between de Quervains thyroiditis and Riedels thyroiditis? (p. 298) _______
______________________________________________________________________________

29.

List three diseases characterized primarily by hyperthyroidism. (p. 298) ______________________

______________________________________________________________________________

30.

What are the four types of thyroid cancer? Which is most common? (p. 298) __________________
______________________________________________________________________________

31.

Primary hyperparathyroidism is characterized by _______________ (increased/decreased) calcium

levels and _______________ (increased/decreased alkaline phosphatase, while secondary
hyperparathyroidism is characterized by _______________ (increase/decreased) calcium levels
and _______________ (increased/decreased alkaline phosphatase. (p. 299)

32.

What does the mnemonic stones, bones, and groans stand for? (p. 299) ____________________
______________________________________________________________________________

33.

What is Chvosteks sign? (p. 299) ___________________________________________________

34.

What is Trousseaus sign? (p. 299) __________________________________________________

35.

What are the common symptoms of pituitary adenoma? (p. 300) ___________________________
______________________________________________________________________________

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First Aid for the USMLE Step 1 2011 EXPRESS workbook

36.

How is diabetes insipidus diagnosed? (p. 300) _________________________________________

37.

What are the causes of SIADH? (p. 300) ______________________________________________

38.

What are the differences between DI and SIADH? (p. 300) ________________________________
______________________________________________________________________________

39.

What are the acute manifestations of diabetes mellitus type 1? (p. 301) ______________________
______________________________________________________________________________

40.

What are the chronic manifestations of poorly controlled diabetes? (p. 301) ___________________
______________________________________________________________________________

41.

Compare and contrast the characteristics of type 1 vs type 2 diabetes. (p. 301)
Type 1

Type 2

Associated with obesity

Genetic predisposition
Glucose intolerance
Ketoacidosis
Need for insulin
Primary defect
Sensitivity to insulin
Typical age of onset
42.

How can patients with diabetic ketoacidosis be recognized by their breath? (p. 302) ____________
______________________________________________________________________________

43.

What are the signs and symptoms of carcinoid syndrome? (p. 302) _________________________
______________________________________________________________________________

44.

Checkmark which components are involved in the multiple endocrine neoplasias. (p. 303)
MEN 1

MEN 2A

MEN 2B

Pancreas
Parathyroid
Pituitary
Pheochromocytoma

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page 111

PHARMACOLOGY
45.

What seven classes of drugs are used to treat diabetes mellitus? (p. 304) ____________________
______________________________________________________________________________
______________________________________________________________________________

46.

What is the most feared complication of metformin? (p. 304) ______________________________

47.

Which drugs are used to treat hyperthyroidism? (p. 305) _________________________________

48.

Which drugs are used to treat hypothyroidism? (p. 305) __________________________________

49.

What is the most feared complication of glucocorticoid overdose? (pp 296, 305) _______________

Answers
ANATOMY
1.

Zona glomerulosa produces aldosterone, zona fasciculata produces cortisol, and zona reticularis
produces sex hormones.

2.

Neuroblastoma; pheochromocytoma.

3.

Posterior pituitary: ADH (vasopressin), oxytocin. Anterior pituitary: FSH, LH, ACTH, TSH, prolactin,
GH.

4.

Neurons (located in the hypothalamus).

5.

cells produce insulin. cells produce glucagon, and cells produce somatostatin.

6.

Brain, RBCs, intestine, cornea, kidney, and liver.

PHYSIOLOGY
7.

Dopamine is inhibitory; TRH is stimulatory.

8.

Hypothalamus-pituitary-adrenal (HPA) axis.

9.
Disease

Blood Pressure

Sex Hormones

11-hydroxylase deficiency

17-hydroxylase deficiency

21-hydroxylase deficiency

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10.

Aromatase; 5-reductase.

11.

CRH stimulates release of ACTH in pituitary, which prompts coritsol production in the adrenal zona
fasciculata.

12.

Increases; decreases; increases; increases.

13.

1-hydroxylase.

14.

Rickets; osteomalacia.

15.

Decrease; increase.

16.

By increasing Na /K /ATPase activity, which increases oxygen consumption, respiratory rate, and
body temperature.

PATHOLOGY
17.

Iatrogenic steroids.

18.

Cushings disease (pituitary adenoma): 70%. Ectopic ACTH (e.g., small cell lung cancer): 15%.
Adrenal tumor: 15%.

19.

Weight gain (truncal obesity), moon facies, buffalo hump, skin thinning, striae, hypertension,
hyperglycemia, osteoporosis, amenorrhea, and immunosuppression.

20.

Dexamethasone challenge.

21.

Decreased; increased.

22.

Primary adrenal insufficiency.

23.

Septicemia due to N. meningitides, DIC, and endotoxic shock.

24.

10% are malignant, 10% are bilateral, 10% are extra-adrenal, 10% calcify, 10% occur in kids, and
10% of cases are familial. Chromaffin cells are the cells of origin for pheochromocytoma.

25.

Elevated blood Pressure, Pain (headache), Perspiration, Palpitations (tachycardia), and Pallor.
These 5 Ps are episodic.

26.
Sign/Symptom

Hypothyroidism

Hyperthyroidism

Activity level

Bowel movements

Constipation

Diarrhea

Cardiovascular changes

Bradycardia,
dyspnea on exertion

Chest pain,
palpitations,
arrhythmias

Edema

Myxedma

Pretibial myxedema

Free T4

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Hair texture

Coarse, brittle

Dry, cool skin

Warm, most skin

T3 uptake
Temperature

Fine

Reflexes
Skin changes

page 113

Cold intolerance

Heat intolerance

Total T4

TSH level

(if primary)

Weight

Weight gain (low

appetite)

Weight loss (high

appetite)

27.

Hashimotos thyroiditis, cretinism, de Quervains thyroiditis, and Reidels thyroiditis.

28.

de Quervains (subacute) thyroiditis is a self-limited type of hypothyroidism that follows a flu-like

illness. Riedels thyroiditis involves fibrous replacement of the thyroid.

29.

Graves disease, thyrotoxicosis, and toxic multinodular goiter.

30.

Papillary thyroid carcinoma (most common), follicular, medullary, and anaplastic.

31.

Increased; increased; decreased; increased.

32.

Renal stones, osteitis fibrosa cystic of bones, and abdominal complains (groans due to
constipation).

33.

In hypoparathyroid patients, tapping of the facial nerve causes the facial muscles to contract.

34.

In hypoparathyroid patients, occlusion of the brachial artery causes carpal spasm.

35.

Amenorrhea, galactorrhea, low libido, and infertility.

36.

Water deprivation test: urine osmolality doesnt increase in response to water deprivation.
Response to desmopressin can distinguish between central and nephrogenic DI.

37.

Ectopic ADH (e.g., small cell lung cancer), CNS disorder/head trauma, pulmonary disease, and
drugs such as cyclophosphamide.

38.

DI denotes lack of ADH; SIADH denotes too much ADH. DI is characterized by intense thirst and
polyuria, with high serum osmolarity and low urine concentration. SIADH is characterized by
excessive water retention, with high urine osmolarity and low serum osmolarity.

39.

Polydipsia, polyuria, polyphagia, weight loss, DKA, and exacerbation of hyperglycemia due to
unopposed GH and epinephrine secretion.

40.

Retinopathy, glaucoma, cataracts, nephropathy, atherosclerosis, CAD, peripheral vascular

occlusive disease, and gangrene.

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41.
Type 1

Type 2

Associated with obesity

No

Yes

Genetic predisposition

Weak

Strong

Glucose intolerance

Severe

Mild to moderate

Ketoacidosis

Common

Rare

Need for insulin

Always

Sometimes

Primary defect

Destruction of cells

Increased resistance to insulin

Sensitivity to insulin

High

Low

Typical age of onset

<30 years

>40 years

42.

Increased ketogenesis results in accumulation of acetoacetate and acetone; when exhaled,

acetone gives breath a fruity odor.

43.

Diarrhea, cutaneous flushing, asthmatic wheezing, and right-sided valvular disease.

44.
MEN 1
Pancreas

Parathyroid

Pituitary

MEN 2A

Pheochromocytoma

MEN 2B

PHARMACOLOGY
45.

Insulin, sulfonylureas, biguanides, glitazones/thiazolidinediones, -glucosidase inhibitors, mimetics,

and GLP-1 analogs.

46.

Lactic acidosis.

47.

Propylthiouracil and methimazole.

48.

Levothyroxine and triiodothyronine.

49.

Iatrogenic Cushings syndrome.

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