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page 1

Endocrine
How to Use the Workbook with the Videos
Using this table as a guide, read the Facts in First Aid for the USMLE Step 1 2013,
watch the corresponding First Aid Express 2013 videos, and then answer the workbook
questions.
Facts in First Aid
for the USMLE
Step 1 2013
286.1286.2

Endocrine Embryology

12

286.3289.1

Endocrine Anatomy

39

289.2294.2

Endocrine Physiology part 1

1017, 52

294.3295.2

Endocrine Physiology part 2

1819

296.1297.4

Endocrine Pathology part 1

2028

298.1300.2

Endocrine Pathology part 2

2937

301.1303.2

Endocrine Pathology part 3

3845

304.1304.3

Endocrine Pathology part 4

4647

305.1306.5

Endocrine Pharmacology

4852

Corresponding First Aid Express

2013 video

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Workbook
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Questions
EMBRYOLOGY
1.

Which structure connects the thyroid gland with the tongue? (p. 286) ________________________

2.

What hormone secreted by the fetal adrenal gland late in gestation is critical for lung maturation
and surfactant production? (p. 286) __________________________________________________

ANATOMY
3.

What are the three major zones of the adrenal gland? List the major secretory product of each.
(p. 286) ________________________________________________________________________

4.

What is the most common adrenal medulla tumor in children? In adults? (p. 286) ______________
______________________________________________________________________________

5.

What are the two divisions of the pituitary gland? Which hormones does each secrete? (p. 287) __
______________________________________________________________________________

6.

What cells produce the hormones released by the posterior pituitary gland? (p. 287) ____________

7.

Name the three major cell types of the Islets of Langerhans. What critical hormone is secreted by
each cell? (p. 287) _______________________________________________________________
______________________________________________________________________________

8.

Which tissues do not need insulin to facilitate glucose uptake? (p. 288) ______________________
______________________________________________________________________________

9.

If you suspect that a hypoglycemic patient with high insulin levels is surreptitiously using exogenous
insulin, what should you test for? (p. 288) ______________________________________________

PHYSIOLOGY
10.

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

11.

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

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12.

page 3

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
13.

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

14.

How is cortisol produced? (p. 292) ___________________________________________________

15.

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)

16.

Which kidney enzyme acts on vitamin D to activate it? (p. 294) ____________________________

17.

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

18.

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

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

19.

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

PATHOLOGY
20.

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

21.

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) ___________
______________________________________________________________________________

22.

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

23.

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

24.

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

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

25.

Is hyperkalemia seen in primary or secondary adrenal insufficiency? (p. 297) _________________

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26.

First Aid 2013 EXPRESS workbook: ENDOCRINE

What are the three common causes of Waterhouse-Friderichsen syndrome? (p. 297) ___________
______________________________________________________________________________

27.

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

28.

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

29.

Compare and contrast the characteristics of hypothyroidism vs. hyperthyroidism. (p. 298)
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
30.

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

______________________________________________________________________________

31.

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

32.

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

______________________________________________________________________________

33.

What are the four types of thyroid cancer? Which is most common? (p. 299) _________________
______________________________________________________________________________

34.

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

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

35.

What does the mnemonic stones, bones, and groans stand for? (p. 300) ___________________
______________________________________________________________________________

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36.

What is Chvosteks sign? (p. 300) ___________________________________________________

37.

What is Trousseaus sign? (p. 300) __________________________________________________

38.

What are the symptoms of the most common form of pituitary adenoma? (p. 301) _____________
______________________________________________________________________________

39.

How is diabetes insipidus diagnosed? (p. 301) _________________________________________

40.

What are the causes of SIADH? (p. 301) ______________________________________________

41.

What are the differences between DI and SIADH? (p. 301) ________________________________
______________________________________________________________________________

42.

What are the acute manifestations of diabetes mellitus type 1? (p. 302) ______________________
______________________________________________________________________________

43.

What are the chronic manifestations of poorly controlled diabetes? (p. 302) ___________________
______________________________________________________________________________

44.

Compare and contrast the characteristics of type 1 vs. type 2 diabetes. (p. 303)
Type 1

Type 2

Associated with obesity

Genetic predisposition
Glucose intolerance
Ketoacidosis
Need for insulin
Primary defect
Sensitivity to insulin
Typical age of onset
45.

How can patients with diabetic ketoacidosis be recognized by their breath? (p. 303) ____________
______________________________________________________________________________

46.

What are the signs and symptoms of carcinoid syndrome? (p. 304) _________________________
______________________________________________________________________________

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47.

First Aid 2013 EXPRESS workbook: ENDOCRINE

Check which components are involved in the multiple endocrine neoplasias. (p. 304)
MEN 1

MEN 2A

MEN 2B

Pancreas
Parathyroid
Pituitary
Pheochromocytoma

PHARMACOLOGY
48.

What eight classes of drugs are used to treat diabetes mellitus? (p. 305) ____________________
______________________________________________________________________________
______________________________________________________________________________

49.

What is the most feared complication of metformin? (p. 305) ______________________________

50.

Which drugs are used to treat hyperthyroidism? (p. 306) _________________________________

51.

Which drugs are used to treat hypothyroidism? (p. 306) __________________________________

52.

What is the most feared complication of glucocorticoid overdose? (pp 291, 306) _______________

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page 7

Answers
EMBRYOLOGY
1.

Thyroglossal duct (a common site of ectopic thyroid tissue).

2.

Cortisol.

ANATOMY
3.

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

4.

Neuroblastoma; pheochromocytoma.

5.

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

6.

Neurons (located in the hypothalamus).

7.

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

8.

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

9.

C-peptide is absent if the source of insulin is exogenous and present in high levels if the patient
has an insulinoma.

PHYSIOLOGY
10.

Dopamine is inhibitory; TRH is stimulatory.

11.

Hypothalamuspituitaryend-organ axis, or HPA.

12.
Disease

Blood Pressure

Sex Hormones

11-hydroxylase deficiency

17-hydroxylase deficiency

21-hydroxylase deficiency

13.

Aromatase; 5-reductase.

14.

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

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15.

Increases; decreases; increases; increases.

16.

1-hydroxylase.

17.

Rickets; osteomalacia.

18.

Decrease; decrease.

19.

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

PATHOLOGY
20.

Iatrogenic steroids.

21.

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

22.

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

23.

Dexamethasone challenge.

24.

Decreased; increased.

25.

Primary adrenal insufficiency.

26.

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

27.

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.

28.

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

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page 9

29.
Sign/Symptom

Hypothyroidism

Hyperthyroidism

Activity level

Bowel movements

Constipation

Diarrhea

Cardiovascular changes

Bradycardia; dyspnea
on exertion

Chest pain,
palpitations,
arrhythmias

Edema

Myxedema

Pretibial myxedema

Free T4
Hair texture

Coarse, brittle

Weight

Warm, most skin

Cold intolerance

Heat intolerance

(if primary)

(if primary)

Total T4
TSH level

Dry, cool skin

T3 uptake
Temperature

Fine

Reflexes
Skin changes

Weight gain (low

appetite)

Weight loss (high

appetite)

30.

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

31.

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.

32.

Graves disease, thyrotoxicosis, and toxic multinodular goiter.

33.

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

34.

Increased; increased; decreased; increased.

35.

Renal calcium stones, osteitis fibrosa cystica of bones, and abdominal complaints (groans due to
constipation).

36.

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

37.

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

38.

Prolactinoma: amenorrhea, galactorrhea, low libido, and infertility.

39.

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

40.

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

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41.

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.

42.

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

43.

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

occlusive disease, neuropathy, and gangrene.

44.
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

45.

Increased ketogenesis results in accumulation of acetone and other ketones; when exhaled,
acetone gives breath a fruity odor.

46.

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

47.
MEN 1
Pancreas

Parathyroid

Pituitary

Pheochromocytoma

MEN 2A

MEN 2B

PHARMACOLOGY
48.

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

analogs, GLP-1 analogs, and DPP-4 inhibitors.

49.

Lactic acidosis.

50.

Propylthiouracil and methimazole.

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51.

Levothyroxine and triiodothyronine.

52.

Iatrogenic Cushings syndrome.

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