Sem 4 endocrine, week 4 MCQs,

th
These questions have been last reviewed by the faculty on 26 September 2013.

Thyroid drugs, disorders (Reviewed in Sep 2013 )

1) Iodine deficiency used to be a common cause of thyroid enlargement (goiter) in some

parts of the world. Which abnormality in chronically iodine-deficient patients is most directly
related to the enlargement of the thyroid gland?
A) Reduced activity of thyroperoxidase
B) Impaired conversion of T4 to T3
C) Reduced level of cAMP in the thyroid follicular cells
D) An antibody that binds to the TSH receptor in the thyroid gland
E) Elevated TSH level

2) A 47-year-old woman complained to her physician of painless enlargement of thyroid

gland and fullness in her throat. Lab results revealed high titers of antibodies against
thyroid peroxidase. A diagnosis of Hashimoto’s thyroiditis was made and an appropriate
treatment was started. Which of the following drugs was most likely prescribed?
A) Propranolol B) Potassium iodide C) Levothyroxine D) Methimazole
E) Radioactive iodine

3) Which of the following effects may be caused by insufficient plasma levels of thyroid
hormones? (Check all that apply)
A) Oligospermia B) Decreased respiratory rate C) Decreased plasma triglycerides
D) Decreased peripheral vascular resistance E) Osteoporosis F) Periorbital edema
G) Diarrhea

4) A 42-year-old man was undergoing surgery in order to remove a very large nontoxic
goiter, apparently due to iodide deficiency. A 2-week course of potassium iodide was
administered before surgery. Which of the following statements best explains why this drug
was given to the patient?
A) To stimulate thyroid hormone synthesis before surgery
B) To overcome iodine deficiency after surgery
C) To reduce the size and vascularity of the thyroid gland
D) To decrease the risk of hypothyroidism after surgery
E) To inhibit the excessive secretion of TSH from the pituitary

5 A 55-year-old woman with thyrotoxicosis was treated with radioiodine. Two months after
achieving euthyroid state, her serum TSH titers were found to be increased. Which of the
following drugs would she most likely be started on?
A) Potassium iodide B) Levothyroxine C) Diiodotyrosine D) Monoiodotyrosine
E) Reverse triiodothyronine

6) A 59-year-old woman was admitted to the hospital with restlessness, insomnia, tremors,
and a pronounced exophthalmos. She had been suffering from hyperthyroidism for two
months, and was treated with propylthiouracil that was discontinued because of the
appearance of agranulocytosis. Which of the following agents would be most appropriate for
this patient at this time?
A) Methimazole B) Radioiodine C) Potassium iodide D) Propranolol E) Prednisone

7) Which of the following drugs has the potential to block the conversion of T4 to T3 in the
liver?
A) Levothyroxine B) Diiodotyrosine C) Methimazole D) Propylthiouracil E) TSH
Sem 4 endocrine, week 4 MCQs,
th
These questions have been last reviewed by the faculty on 26 September 2013.

8) Few days after a normal delivery, a new born baby boy has become lethargic, has
respiratory difficulties, hoarse cry, and sucks poorly. Physical examination reveals large
fontanelles, macroglossia, a distended abdomen, a cyanotic skin, hypotonia, slow reflexes
and hypothermia. Thyroid function test reveals TSH levels of 14 mU/L (normal 0.5-5) and
T4 of 0.6 µg/dL (normal 5-12). Which of the following drugs would be most appropriate for
this baby?
A) Methimazole B) Somatrem C) Levothyroxine D) Theophylline E) Potassium iodide
F) Prednisone

9) A 35 year old woman, who was 2 months pregnant, presented with the signs and
symptoms of hyperthyroidism. Lab investigations revealed FT4 of 3.3 ng/dL (normal 0.9-2)
and TSH < 0.01 mU/L (normal 0.5-5) during a follow up visit. Which of the following chronic
drug treatment would be most appropriate for this patient?
A) Radioactive iodine B) Propranolol C) Potassium iodide D) Ipodate E) Propylthiouracil
F) Methimazole

10) A 75-year-old woman came to the clinic for her regular checkup. Her only complaints
were very dry skin, and constipation that she treated with milk of magnesia. She had no
other medical problem and took no other medications. Routine laboratory tests were within
normal limits except for TSH of 15 mU/L (normal 0.5-5.5). Further lab exams indicated the
presence of thyroid peroxidase antibodies. Which of the following drugs would be most
appropriate for this patient?
A) Potassium iodide B) Propranolol C) Methimazole D) Loperamide E) Levothyroxine
F) Diltiazem

11) A 41-year-old man complained to his physician of increased appetite, palpitation and
diarrhea. Lab results confirmed the diagnosis of mild hyperthyroidism and a treatment with
methimazole was started. Which of the following actions most likely mediated the
therapeutic effects of this drug in the patient?
A) Inhibition of iodine absorption from the gut
B) Stimulation of thyroid peroxidase
C) Blockade of iodine uptake by the thyroid gland
D) Damage of DNA of thyroid cells.
E) Inhibition of tyrosine iodination

1e, 2c, 3abf, 4c, 5b, 6b, 7d, 8c, 9e, 10e, 11e.

Disorders of the thyroid gland

1) A 60-year-old woman presents with complaints of feeling nervous, moody, weak, and
tired. On exam, she has hand tremors and a rapid heartbeat. Pulse 120/min. BP 110/78.
She has been taking levothyroxine for hypothyroidism, and you suspect that she is taking
more tablets than you prescribed. Which of the following sets of laboratory results is most
consistent with her clinical presentation?
A B C D E
TSH Elevated Normal Elevated Normal Decreased
T4 Elevated Elevated Decreased Decreased Elevated
T3 Elevated Decreased Decreased Decreased Elevated
Sem 4 endocrine, week 4 MCQs,
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These questions have been last reviewed by the faculty on 26 September 2013.

2) A 50 year old man presents with a thyroid neoplasm. Detailed history elicits that his aunt
had died from a “thyroid illness”. His family and first order blood relatives are examined. His
sister and a nephew also are found to have small thyroid tumors. His son is found to have a
pheochromocytoma. Which of the following gene mutations are most likely to be associated
with this condition?
A) PTTG B) Cyclin D C) Ret D) MEN 1 E) TBG

3) A 34 year old man reports to your office complaining of weight loss and sweating.
Among other findings you note the following, while examining his extraocular movements:

What do we call this finding?

A) Proptosis B) Ophthalmoplegia C) Lid lag D) Trochlear nerve palsy
E) Levator palpebrae dysfunction

4) A 44-year-old African American man presents to his family physician with a neck lump he
noticed while shaving this morning. Physical examination reveals a 1 cm well-defined firm
nodule in the right thyroid lobe. The mass is resected and sent for histopathologic
examination. The microscopic appearance of the lesion is shown for your evaluation below.
Elevation of which of the following serum markers can you expect in this patient?

A) Thyroid stimulating hormone B) Calcitonin C) Thyroglobulin

D) Carcinoembryonic antigen
5) A 43-year-old Caucasian man presents to his family physician with a neck lump he
noticed while shaving this morning. Physical examination reveals a 0.5 cm ill-defined firm
nodule in the left thyroid lobe. Laboratory investigations reveal an elevated serum level of
carcinoembryonic antigen, serotonin, parathormone, and calcitonin. 99mTechnetium thyroid
scan and fine needle aspiration biopsy of the nodule is performed and the patient undergoes
thyroidectomy. The thyroid scan and histology of the lesion are presented for your
evaluation. Which of the following clinical syndromes is most likely to be found in this
patient?
Sem 4 endocrine, week 4 MCQs,
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These questions have been last reviewed by the faculty on 26 September 2013.

Tm99 X1 X3

X30

A) Acromegaly B) Diabetes insipidus C) Severe hypertension D) Myxedema

6) Individuals with hypothyroidism would mostly likely have which one of the following
conditions?
A) Growth retardation if occurs during the perinatal period
B) Increased cardiac output
C) Weight loss
D) Excessive production of TSH if the defect is in the hypothalamus
E) Less than normal levels of cholesterol in the circulation

1e, 2c, 3c, 4c, 5c, 6a

Disorders, review of adrenal gland

1) A predominantly male patient mentions that his childhood sexual development was a bit
turbulent because of 5α-reductase deficiency. What is the function of 5α-reductase?
A) Makes testosterone in the testis
B) Is needed for the synthesis of glucocorticoids and mineralocorticoids
C) Turns testosterone into highly potent dihydrotestosterone
D) Turns androgens into estrogens
E) Catalyzes the conversion of cholesterol into pregnenolone

2) A 48 YO man with a family history of heart disease has followed a heart-healthy lifestyle
for 15 years. However, he has recently experienced unusual fatigue and lightheadedness,
especially when rising suddenly. Physical examination demonstrates postural hypotension
and a darker-than usual complexion for midwinter in the Midwest (he works and exercises
indoors). Lab work reveals that he is hyponatremic, hyperkalemic, and hypocalcemic.
Further blood tests are ordered to assay plasma corticotropin-releasing hormone (CRH),
corticotropin (ACTH), and cortisol. What combination of hyper and/or hyposecretion for
these hormones would be the most likely given this man’s signs and symptoms?
CRH secretion ACTH secretion Cortisol secretion
A hypersecretion hypersecretion hypersecretion
B hypersecretion hypersecretion hyposecretion
C hypersecretion hyposecretion hyposecretion
D hyposecretion hyposecretion hyposecretion
Sem 4 endocrine, week 4 MCQs,
th
These questions have been last reviewed by the faculty on 26 September 2013.

E hyposecretion hyposecretion hypersecretion

3) A patient with lethargy, nausea, and reported muscle weakness is given a series of tests
to rule out physical causes. During these tests it is revealed that plasma corticotropin is
above normal and cortisol is below normal. Renin is above normal and aldosterone is below
normal. Adrenal androgens are below normal. Which of the following clinical conditions
would be most likely to produce this set of signs and symptoms?
A) Cushing’s Disease B) Ectopic corticotropin-producing tumor
C) Secondary renal insufficiency D) Congenital adrenal hyperplasia
E) Addison’s Disease

4) Within the chromaffin cells of the adrenal medulla, which ion’s influx is an absolute
requirement for epinephrine secretion?
A) calcium B) sodium C) chloride D) potassium E) iodide

5) What would be an expected outcome of 11-deoxycorticosterone-induced hypervolemia

and hypertension on the renin-angiotensin-aldosterone system?
[renin]Pl [angiotensin II]Pl [aldosterone]Pl
A Increase (↑) Increase (↑) Increase (↑)
B Decrease(↓) Decrease(↓) Decrease(↓)
C Increase (↑) Decrease(↓) Decrease(↓)
D Decrease(↓) Increase (↑) Decrease(↓)
E Decrease(↓) Decrease(↓) Increase (↑)

6) Polyuria, polydipsia, weakness, and fatigue are characteristic of several endocrine

disorders. In one patient, the physician notes both peripheral neuropathy and visual
changes as well. What clinical condition would be most likely to produce these six findings?
A) Addison’s disease B) Conn’s syndrome C) Cushing’s syndrome
D) diabetes mellitus E) diabetes insipidus
7) What branch of the autonomic nervous system elicits catecholamine release from the
adrenal medulla and what is the neurotransmitter and receptor responsible for increased
epinephrine release from adrenal medullary chromaffin cells?
Branch of ANS Neurotransmitter Receptor
A Parasympathetic Norepinephrine Alpha-1
B Sympathetic Norepinephrine Alpha-1
C Sympathetic Acetylcholine Muscarinic
D Parasympathetic Acetylcholine Muscarinic
E Sympathetic Acetylcholine Nicotinic

8) In the synthesis of adrenal medullary hormones, cortisol stimulates the conversion of

A) tyrosine to dopa. B) tyrosine to dopamine. C) dopamine to dopa.
D) epinephrine to norepinephrine. E) norepinephrine to epinephrine.

9) In situations of stress and anxiety, epinephrine synthesis can be increased when cortisol
stimulates the enzyme
A) tyrosine hydroxylase B) amino acid decarboxylase
C) COMT (catecholamine methyl transferase) D) MAO (monoamine oxidase)
E) PNMT (phenylethanolamine-N-methyl transferase)

10) Which hormone is produced by the zona reticularis ?

A) LH B) Androstenedione C) Melatonin D) Aldosterone E) Cortisol
E) Angiotensin II
Sem 4 endocrine, week 4 MCQs,
th
These questions have been last reviewed by the faculty on 26 September 2013.

1c, 2b, 3e, 4a, 5b, 6d, 7e, 8e, 9e, 10b

Pharmacology of hypothalamus and pituitary disorders (reviewed-Bansal Sep 2013)

1) Which drug for treating acromegaly acts by blocking receptors for growth hormone?
A) Somatropin B) Pegvisomant C) Octreotide D) Desmopressin E) Cabergoline

2) By which of the following mechanisms does bromocriptine relieves symptoms of

hyperprolactinemia in a patient with prolactin-secreting pituitary adenoma?
A) blocking prolactin receptors
B) blocking receptors for prolactin releasing hormone
C) a cytotoxic effect on pituitary adenoma cells
D) activating receptors for prolactin-inhibiting hormone
E) stimulating the breakdown of prolactin

3) A 35-year-old woman presented to the clinic complaining of continuous thirst and

polyuria. She had had a basal skull fracture following a car accident six month previously
from which she recovered completely. She reported that she often wake up in the middle of
night because of thirst and a need to urinate. Urinalysis showed a urine osmolality of 20
mOsm/Kg and undetectable plasma ADH levels. Which if the following drugs would be
appropriate for the patient?
A) Conivaptan B) Sermorelin C) Desmopressin D) Octreotide
E) Bromocriptine

4) A 40-year-old man who presented with a history of violent attacks of watery diarrhea,
cramping and paroxysmal vasomotor attacks (red to purple flushing of face and neck) is
diagnosed with carcinoid syndrome. Which of the following drugs can most likely control his
symptoms?
A) Sermorelin B) Conivaptan C) Pegvisomant D) Octreotide E) Somatrem
F) Desmopressin

5) A 35-year-old man presented to the hospital with a history of joint pain, headache,
excessive sweating, and deepening of the voice. A physical examination revealed protrusion
of the jaw, enlargement of the hands, thickening of the skin, and a barrel chest. A CT scan
disclosed a pituitary adenoma. Which of the following drugs would be most appropriate for
his treatment?
A) Somatrem B) Sermorelin C) Somatropin D) Octreotide E) Cabergoline

6) A 32-year old man was admitted to the hospital because of prolonged, massive watery
diarrhea for the last two days. Physical and lab exams indicated a pancreatic tumor and
radioimmunoassay confirmed the diagnosis of VIPoma. The patient was given IV fluids for
hydration and was scheduled for surgery. Which of the following drugs would be appropriate
to control this patient’s presenting symptoms?
A) Somatotropin B) Conivaptan C) Bromocriptine D) Octreotide E) cabergoline

7) A 52-year-old man was admitted to the hospital because of a sharp substernal pain of
one hour duration. On admission the patient lost consciousness and physical
Sem 4 endocrine, week 4 MCQs,
th
These questions have been last reviewed by the faculty on 26 September 2013.

examination revealed nonpalpable pulses and absent heart sounds. While trying to
resuscitate the patient, vasopressin was given IV. The beneficial effects of this drug in this
setting are primarily mediated by activation of which of the following types of receptors?
A) Vasopressin V1
B) Vasopressin V2
C) Adrenergic beta-1
D) Muscarinic M3
E) Dopaminergic D1

1b, 2d, 3c, 4d, 5d, 6d, 7a.

Pituitary disorders

1) The presence of a tumor in the anterior pituitary causes a decrease in ACTH secretion.
Which of the following correctly describes changes in plasma levels of hormones?
A) Increased CRH, increased ACTH, and increased cortisol
B) Decreased CRH, decreased ACTH, and decreased cortisol
C) Increased CRH, decreased ACTH, and decreased cortisol
D) Increased CRH, increased ACTH, and decreased cortisol
E) Decreased CRH, decreased ACTH, and increased cortisol

2) A 28 year-old woman attends her doctor because she has not had a menstrual cycle of
two months, but commercial pregnancy tests have proven negative. She reports that a few
weeks before her expected menstrual cycle was missed, she had suffered an accident in a
gym, in which she had fallen from a climbing rope from a height of around 10 feet. She had
fallen “head-first” onto some weight-training equipment, and although she had not lost
consciousness, she sustained bruising on the left side of her face around her cheek, eye and
temples. The woman reports that following the accident she had noticed that she was
feeling continually fatigued, and had gained weight. She feels thirsty most of the time and is
perplexed as to why she needs to urinate more often than before. Physical examination
confirms that the woman is not pregnant and reveals traces of a white crystalline deposit
around her nipples.
The level of which hormone would be expected to be elevated in the plasma of this patient?
A) Luteunizing Hormone (LH) D) Oxytocin
B) Thyroid Stimulating Hormone (TSH) E) Prolactin (Prl)
C) Follicle Stimulating Hormone FSH)

3) Following brain surgery, a patient receiving postoperative care in an intensive care unit
began to produce large volumes of dilute urine. For the management of this patient’s
condition an analogue of which of the following hormones would most likely be
administered?
A) Aldosterone B) Vasopressin C) Oxytocin D) Cortisol E) Epinephrine

4) A 43-year old female patient comes to your office with the following symptoms: lethargy,
postural hypotension, recent weight loss, and muscle weakness. Your tentative diagnosis is
adrenal cortical dysfunction. You order a set of laboratory tests which come back with the
following results: undetectable levels of plasma ACTH and very low plasma cortisol. In
addition, you can demonstrate that exogenous CRF increases plasma cortisol. What is the
most likely explanation for this patient’s endocrine problem?
A) Disappearance of cortisol producing adrenal cortical cells.
B) Nonfunctional corticotrophs of the anterior pituitary.
C) Nonfunctional corticotrophs of the posterior pituitary.
Sem 4 endocrine, week 4 MCQs,
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These questions have been last reviewed by the faculty on 26 September 2013.

D) Insufficient production of CRF by hypothalamic neurons.

E) Absence of ACTH receptors on adrenal cortical cells.

5) A 29 year old woman is diagnosed with acromegaly. Typically, she would exhibit which
one of the following abnormalities?
A) Hypoglycemia B) Decreased gluconeogenesis C) Insulin resistance
D) Decreased protein synthesis E) Increased storage of fat in adipose tissue

6) A 6-year-old boy of short stature is given a subcutaneous injection of growth hormone

releasing hormone (GHRH) and blood samples are taken 1 hour later for measurement of
plasma growth hormone (GH). Laboratory results demonstrated an increase in GH
concentration following the injection of GHRH. What would be the most likely conclusion
based upon these findings?
A) The patient’s short stature is most likely explained by inadequate hypothalamic release of
GHRH.
B) The patients’ short stature is most likely explained by inability of somatotrophs to release
GH.
C) The liver cannot produce insulin-like growth factor-1 (IGF-1).
D) Somatotrophes of the anterior pituitary are inactive because of hypersecretion of
somatostatin.
E) Endogenous GHRH had suppressed the release of somatostatin.

7) A 25-year-old male patient comes to a local clinic with the following complaints. He has
to urinate frequently and he is constantly drinking water. A 24-urine collection is taken with
the following findings. Urine volume is 6 liters per day and the specific gravity of the urine
is 1.005 (normal range is 1.010-1.025). Your tentative diagnosis is diabetes insipidus. You
administer intravenously an analogue of vasopressin and observe that the subsequent 24
hour urine collection is reduced to 3 liters per day. What is the most likely explanation for
his polyuria?
A) Aquatrophs of the anterior pituitary are not being stimulated by vasopressin releasing
hormone.
B) V1 receptors on epithelial cells of the collecting tubules and ducts are absent.
C) V2 receptors on epithelial cells of the collecting tubules and ducts are absent.
D) High plasma concentration of vasopressin acting at magnocellular neurons of the
paraventricular nucleus of the hypothalamus has suppressed hypothalamic release of
vasopressin.
E) Magnocellular neurons of the paraventricular nucleus of the hypothalamus are not
responding to an increase in whole body osmolarity and are not releasing vasopressin from
the posterior pituitary.

1c, 2e, 3b, 4d, 5c, 6a, 7e

Review pituitary gland histology and function

1) Which of the following statements concerning the pituitary gland is CORRECT?

A) TSH is derived from the hypothalamus
B) TSH is stored in the pars nervosa of the pituitary gland
C) Herring bodies store oxytocin and FSH
D) Somatotrophs are acidophils and they produce GH
E) Chromophobes secrete oxytocin and vasopressin
Sem 4 endocrine, week 4 MCQs,
th
These questions have been last reviewed by the faculty on 26 September 2013.

2) Which of the following statements concerning the embryology of the pituitary gland is
CORRECT?
A) The anterior pituitary is derived from the mesencephalon
B) Rathke’s pouch is derived from the posterior pituitary
C) The Pars Distalis is derived from endoderm
D) Mesoderm gives rise to the anterior pituitary
E) Neuroectoderm gives rise to the neurohypophysis

3) Which of the following statements concerning the pituitary gland is CORRECT?

A) ACTH is derived from the hypothalamus
B) Herring bodies store oxytocin and vasopressin
C) TSH is stored in the pars nervosa of the pituitary gland
D) Acidophils produce FSH and ACTH
E) Chromophils secrete oxytocin and vasopressin

4) Which cell type produces growth hormone ?

A) Neurosecretory cells of paraventricular nuclei B) Pituicytes C) Corticotrophs
D) Somatotrophs E) Hepatocytes

5) Both the anterior and posterior pituitary glands depend upon input from hypothalamic
nuclei for release of pituitary hormones. In the following table which row correctly lists the
type of connections between the hypothalamus and the anterior and posterior pituitary
glands?
Hypothalamus to anterior pituitary Hypothalamus to posterior pituitary
A Axonal connections Axonal connections
B Releasing factors Releasing factors
C Axonal connections Releasing factors
D Releasing factors Axonal connections

6) A laboratory experiment was performed utilizing microscope-florescence-imaging of a

Ca++ - sensitive dye (a technique that enables investigators to monitor intracellular Ca++) on
freshly isolated cells from the anterior pituitary gland of a mouse. On addition of a newly
discovered peptide hormone to the fluid bathing the cells, it was observed that intracellular
Ca++ increased in some cells but not in others. All cells were determined as viable (alive) by
an independent test. What is the most likely explanation for the failure of some cells to
respond to the hormone?
A) Chemical signals are only exposed to specific cells.
B) Some cells are completely without receptors.
C) Some cells are completely without ligands.
D) Signal chemicals often break down before reaching the target.
E) Some cells lack the necessary receptors.

1d, 2e, 3b, 4d, 5d, 6e

Thyroid review, disorders; steroids, adrenal drugs; parathyroid

1) Thyroid hormones can increase cardiac output. From the following table pick the row
that correctly lists the mechanisms by which T3 increases cardiac output.
Rate of atrial pacemaker Expression of Expression of cardiac β- Expression of
Sem 4 endocrine, week 4 MCQs,
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These questions have been last reviewed by the faculty on 26 September 2013.

depolarization cardiac adrenergic receptors Cardiac

Na2+/exchanger Na+,K+-
ATPase
A Increase Decrease Decrease Increase
B Decrease Increase Increase Decrease
C Increase Increase Decrease Decrease
D Increase Increase Increase Increase
E Decrease Decrease Increase Increase
F Decrease Increase Decrease Increase
G Increase Increase Increase Decrease

2) What is the correct relationship between changes in plasma levels of T3 & T4 and the
release of TRH and TSH?
T3 & T4 TRH TSH
A Increase Increase Decrease
B Decrease Increase Increase
C Decrease Decrease Decrease
D Increase Increase Increase
E Increase Decrease Increase
F Decrease Decrease Increase

3) A patient presents with signs of hypothyroidism. To investigate the matter, you measure
the levels of T4 and TSH. If the patient suffers from iodine deficiency, you can expect the
following results:
A) T4 reduced, TSH reduced B) T4 elevated, TSH reduced
C) T4 elevated, TSH elevated D) T4 reduced, TSH elevated
E) T4 reduced, TSH normal

4) Which of the following statements regarding thyroid hormone synthesis is correct?

A) In the thyroid gland, iodine is oxidized by type II deiodinase.
B) Thyroid peroxidase catalyzes the coupling of two DITs to form T4.
C) Transport of iodide into the thyroid gland is facilitated by anions such as perchlorate.
D) Plasma iodide is transported into the thyroid by facilitated diffusion.
E) Proteolysis of iodinated thyroglobulin is inhibited by TSH.

5) Which of the following statements about thyroid follicles is FALSE?

A) They contain thyroglobulin
B) They are lined by epithelial cells that vary in appearance with the activity of the gland
C) Their lining includes parafollicular cells that release calcitonin into the colloid
D) They are surrounded by a fenestrated capillary network
E) They are stimulated by TSH

6) A patient presents with signs of hyperthyroidism (thyrotoxicosis). To investigate the

matter, you measure the levels of T4 and TSH. If the patient has a benign thyroid adenoma
(“toxic nodule”), you can expect the following results:
A) T4 reduced, TSH reduced B) T4 elevated, TSH reduced
C) T4 elevated, TSH elevated D) T4 reduced, TSH elevated
E) T4 reduced, TSH normal
Sem 4 endocrine, week 4 MCQs,
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These questions have been last reviewed by the faculty on 26 September 2013.

7) The concept map below can be used as a basic algorithm for the determination of thyroid
dysfunction. In the following table, pick the correct association of I, II, and III with
conditions of euthyroidism, primary hypothyroidism (1˚ hypothyroidism), and secondary
hypothyroidism (2˚ hypothyroidism).

I II III
A Euthyroid 1˚ hypothyroidism 2˚ hypothyroidism
B 1˚ hypothyroidism 2˚ hypothyroidism Euthyroid
C 1˚ hypothyroidism Euthyroid 2˚ hypothyroidism
D 2˚ hypothyroidism Euthyroid 1˚ hypothyroidism
E 2˚ hypothyroidism 1˚ hypothyroidism Euthyroid

8) Which of the following statements is characteristic of the thyroid gland?

A) It is derived from the 3rd pharyngeal pouch
B) It secretes parathyroid hormone
C) Chief cells are involved in the production of calcitonin
D) Colloid is primarily composed of calcitonin and T3
E) Thyroid follicular cells secrete T4 hormone

9) A routine laboratory test for cardiovascular risk factors in a normal 60-year-old man
shows that his levels of both T3 and T4 are only about 20% of normal. TSH is in the normal
range, and the thyroid gland is of normal size without palpable masses. There are no clinical
signs of abnormal thyroid function. Which of the following proteins is most likely deficient in
this patient?
A) The TSH receptor B) The T3 receptor C) Thyroxin-binding globulin in the blood
D) Thyroglobulin in the thyroid gland E) Pendrin

10) Which of the following statements best explains the mechanism of actions of thyroid
hormones?
A) They inhibit the synthesis of Na+/K+ ATPase in cell membranes
B) They modulate transcription of selected genes in the nucleus
Sem 4 endocrine, week 4 MCQs,
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These questions have been last reviewed by the faculty on 26 September 2013.

C) They inhibit assembly of selected ribosomes on the rough endoplasmic reticulum

D) They inhibit turnover of selected lipids in the Golgi complex
E) They activate the synthesis of lipocortin

11) Most of the known effects of corticosteroids are mediated by actions on which of the
following molecular targets?
A) G-protein coupled receptors D) Ion channel coupled receptors
B) Tyrosine kinase receptors E) Specific nucleotide sequences of RNA
C) Specific nucleotide sequences of the DNA F) Specific nucleotide sequences of ribosomes

12) Which of the following actions most likely contributes to the antiinflammatory effects of
glucocorticoids?
A) Inhibition of ACTH release D) Increased release of interleukin-1
B) Increased catabolism of prostaglandins E) Induction of lipocortin synthesis
C) Increased capillary permeability

13) Which of the following actions most likely contributes to the immunosuppressive effect
of glucocorticoids ?
A) Increased plasma levels of free fatty acids
B) Increased gluconeogenesis
C) Reduced production of TNF in macrophages
D) Increased protein synthesis in the liver
E) Decreased calcium absorption from the intestine

14) Which of the following statements regarding the pharmacokinetics of corticosteroids

are correct? (Check all that apply)
A) Oral bioavailability is generally very good
B) Substantial absorption does occur through the skin
C) They distribute into peripheral tissues but cross the blood-brain barrier with difficulty
D) Their biological half-lives can be long (up to 72 hours)
E) They are mainly excreted unchanged by the kidney

15) Which of the following are effects of glucocorticoids upon carbohydrate metabolism?
(Check all that apply)
A) Decreased gluconeogenesis in liver
B) Increased glucose uptake by skeletal muscle
C) Increased glycogen synthesis in liver
D) Decreased glucose uptake by adipose tissue
E) Increased glucose utilization in peripheral tissues

16) A 55-year-old man with Addison’s disease presented to the hospital complaining of
episodic weakness, paresthesias, and constipation. He had been taking cortisol and
fludrocortisone for several months. On admission his blood pressure was 160/98 mm Hg
and an ECG showed prolongation of Q-T interval. Lab results revealed a plasma K+ level
of 2.5 mEq/L. Which of the following events best explains the patient syndrome?
A) Cortisol induced hyperglycemia D) Cortisol induced myopathy
B) Fludrocortisone excess E) Essential hypertension
C) Inadequate therapy of adrenal insufficiency

17) A 42-year-old man presented to the hospital with a complaining of weight gain, mild but
continuing facial acne, and decreased muscle strength. On physical examination he was
found to be a plethoric, red-faced male with violaceus pigmented striae on a protuberant
abdomen and relatively thin extremities. Serum potassium levels on admission were 4.5
Sem 4 endocrine, week 4 MCQs,
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These questions have been last reviewed by the faculty on 26 September 2013.

mEq/L. A CT scan disclosed an adrenal adenoma in the left adrenal gland and the patient
was scheduled for surgery. Which of the following drugs was most likely given during and
after surgery to this patient?
A) Fludrocortisone B) Spironolactone C) Cortisol D) Aminoglutethimide E) Mifepristone
F) Ketoconazole

18) In pheochromocytoma, 3-methoxy-4-hydroxymandelic acid is formed enzymatically as

a breakdown product of norepinephrine. The formation of this metabolite would be slowed
down not only by inhibitors of MAO or COMT, but also by a
A) glutamate decarboxylase inhibitor B) COX-2 inhibitor
C) tricyclic antidepressant D) tryptophan hydroxylase inhibitor
E) tyrosine hydroxylase inhibitor

19) Of these drugs, the one best suited for the treatment of pheochromocytoma is a
A) glutamate decarboxylase inhibitor B) COX-2 inhibitor
C) tricyclic antidepressant D) tryptophan hydroxylase inhibitor
E) tyrosine hydroxylase inhibitor

20) 65 year old man presents with bone pain and is found to have increased parathyroid
hormone. A SPECT scan finds all four of the parathyroid glands enlarged. Serum calcium is
high and phosphate is low. Serum creatinine is normal. Which of the following is the most
probable cause of this patient’s illness?
A) Parathyroid adenoma B) Chronic renal failure C) Parathyroid carcinoma
D) Primary hyperplasia E) Lung carcinoma

21) Thyroid hormone (T3 or T4) receptors:

A) Bind T3 or T4 in the blood plasma, but do not enter cells.
B) Facilitate the entry of T3 or T4 in the cell.
C) Are integral membrane proteins that bind T3 or T4 on their extracellular domains.
D) Bind T3 or T4 with their leucine zipper domain.
E) Bind T3 or T4 with their ligand binding domain and function in the nucleus.

1d, 2b, 3d, 4b, 5c, 6b, 7a, 8e, 9c, 10b, 11c, 12e,
13c, 14abd, 15cd, 16b, 17c, 18c, 19e, 20d, 21e

Treatment of calcium metabolism defects (reviewed Sep 2013)

1) A 27-year-old woman moves to Dominica from Toronto to go to medical school. Every

day at noon, she goes to the beach and lies in the sun for half an hour in her bikini. Which
of the following is the best description of the likely changes in her vitamin D profile?
Vitamin D 25(OH) D 1,25(OH)2 D
A No change Up No change
B Up No change down
C Up Up No change
D No change No change No change
E Up Up Up

2) Which of the following actions most likely mediates the therapeutic efficacy of calcitriol in
rickets?
Sem 4 endocrine, week 4 MCQs,
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These questions have been last reviewed by the faculty on 26 September 2013.

A) Stimulation of liver hydroxylation of cholecalciferol

B) Stimulation of renal alpha1-hydroxylase
C) Decreases intestinal phosphate absorption
D) Increased intestinal calcium absorption
E) Decreased renal phosphate reabsorption

3) A 52-year-old woman was admitted to the hospital because of tetanic muscle spasms
and paresthesias following a recent thyroidectomy. Which of the following drugs given IV
could rapidly reverse the patient’s symptoms?
A) Vitamin D B) Calcitonin C) Sodium phosphate D) Calcium gluconate
E) Hydrocortisone F) Alendronate

4) A 4-year-old black boy was brought to the emergency room after he fell while playing
in the yard. Physical examination revealed only minor skin scratches but an x-ray exam
showed 2 rib fractures, a clearly demineralized bone and widening and cupping of
metaphyses with exaggerated normal concavity and irregular calcification. Pertinent
laboratory values were: calcium 8.3 mg/dL, phosphate 3.2 mg/dL, and a two fold increase
in alkaline phosphatase. Which of the following would be an appropriate treatment for
this boy?
A) Cholecalciferol B) Calcitonin C) Fluoride D) Teriparatide E) Alendronate

5) A 42-year-old man with 25-year history of type 1 diabetes presented for a follow up visit.
His laboratory values were: glucose 190 mg/dL, calcium 8 mg/dL, phosphate 5.3
mg/dL, creatinine 4.9 mg/dL. An x-ray exam revealed density changes in the bones that
were consistent with renal osteodystrophy. Which of the following drugs would most likely
be included in the treatment plan for this patient?
A) Alendronate B) Calcitonin C) Paricalcitol D) Sodium fluoride E) Sodium phosphate

6) A 46-year-old man presented to the hospital with complains of muscle weakness,

fatigue, constipation, nausea and polyuria. Past medical history was unremarkable.
Pertinent laboratory values on admission were: calcium of 14.5 mg/dL, phosphate 2.1
mg/dL and immunoreactive parathyroid hormone level of 142 pg/mL (normal 11-54).
Which of the following drugs would most likely be included in the therapeutic management
of this patient?
A) Calcitriol B) Hydrochlorothiazide C) Sodium fluoride D) Mannitol E) Calcitonin

7) A 55-year-old woman complained to her physician of a persistent back pain of 3 day

duration. A dual-energy x-ray absorptiometry showed diffuse osteoporosis of the spine
and hips. The physician ordered calcium and vit D supplementation and alendronate.
Which of the following actions most likely mediated the therapeutic effects of
alendronate in this patient?
A) Stimulation of osteoblast activity D) Inhibition of osteoclast activity
B) Stimulation of intestinal calcium absorption E) Inhibition of renal synthesis of calcitriol
C) Inhibition of renal calcium excretion

8) A 62-year-old man was admitted to the hospital because of increasing pain in the back
and left upper thigh over the past month. The patient also complained that recently he felt
drowsy and tired most of the time and urinated very frequently. Past history of the patient
was significant for radical prostatectomy for prostate cancer six months ago. Physical
examination showed a dehydrated man less alert than normal and slow in his responses.
Pertinent laboratory values on admission were: calcium 13.5 mg/L, alkaline phosphatase
204 U/L. An appropriate therapy was started which included an IV infusion of a drug.
Sem 4 endocrine, week 4 MCQs,
th
These questions have been last reviewed by the faculty on 26 September 2013.

Which of the following drugs was most likely infused IV?

A) Sodium phosphate B) Hydrochlorothiazide C) Pamidronate D) Mannitol E) Calcitriol
F) Fludrocortisone

1c, 2d, 3d, 4a, 5c, 6e, 7d, 8c.