Exam 8 - CI Case 3 ?'s

A mother presents with her child to the ER. While a medical student gets a complete history, the mother explains that a genetic mutation runs in the family that results in anterior pituitary hypofunction. Which of the following is most likely the condition she is referring to? A. Pituitary dwarfism B. Excess prolactin results in failure of lactation C. Pallor due to melanocyte hyperstimulation D. Diabetes insipidus E. Syndrome of inappropriate ADH (SIADH)

A A clinical manifestation of anterior pituitary hypofunction is growth failure in children due to growth hormone deficiency.

A 23-year-old male complains to his primary care physician with complaints of excessive thirst and increased amount time needed to urinate. A water deprivation test was taken and has shown that serum sodium levels and osmolality increases in response to water deprivation. What is the most likely diagnosis for the patient? A. Diabetes Insipidus B. Cushing's Syndrome C. ACTH-Secreting Pituitary Tumor D. Growth Hormone Deficiency E. Low IGF-1 levels

A A water deprivation test is used to diagnose and differentiate Diabetes Insipidus. Diabetes Insipidus is hall marked by excessive thirst and signs of large volumes of dilute urine. AVP deficiency is often seen.

A 52 year old female arrives at her PCP for her annual checkup but has underlying complaints of out of the ordinary weight gain, fatigue, cold intolerance and constipation. The physician suspects secondary hypothyroidism and sends her for blood work to check her free T4 levels ultimately confirming low levels of free T4. What is she most likely suffering from? A. Deficiency of TSH B. Gonadotropin Deficiency C. ACTH Deficiency D. GH Deficiency E. AVP Deficiency

A Deficiency of TSH leads to secondary hypothyroidism and a patient with this disorder would present with weight gain, fatigue, cold intolerance, and constipation. To test for TSH levels, the free T4 levels are tested and because they are low in this case, this confirms her deficiency of TSH.

A patient comes to the emergency department after being involved in a motorcycle accident. An MRI shows damage to the posterior pituitary gland. Which of the following hormone levels would be affected from damage to this region? A. ADH B. GH C. LH D. FSH E. TRH

A The posterior pituitary gland secretes ADH(AVP) and oxytocin only. All other choices are secreted from the anterior pituitary gland. Trauma to this area would affect only ADH and oxytocin.

Bone matrix has ___________, connected by a network of _____________. Fill in the blanks. A. Lacunae, canaliculi B. Osteoblasts, osteoclasts C. Osteoprogenitor cells, osteoblasts D. Osteoblasts, lacunae E. Lacunae, osteoclasts

A because lacunae are the spaces in the bone matrix and canaliculi are the tunnels that connect those spaces.

A 45 year old woman presents to her PCP for a routine physical. During the physical, she mentions recent tenderness and pain in the anterior neck area. She further states that before the onset of the pain, she had an upper respiratory tract infection. The patient, thinking nothing of it declines treatment. 7 weeks later, the patient calls her PCP and tells her that her previous pain and tenderness has since been resolved. What was the most likely cause for her symptoms? A ) adenovirus B ) accumulation of matrix substances C ) defects in immune regulation associated genes D ) bordetella pertussis E ) AVP gene mutation

A ) adenovirus [correct, as granulomatous thyroiditis is triggered due to a viral infection]

A 45 year old woman visits her PCP with complaints of increased urination and thirst, going on for the past 6 weeks. She denies other urinary symptoms but explains she has been waking up several times a night to urinate. Lab work reveals that the patient has elevated serum sodium levels and decreased urine osmolarity. What is causing the manifestation of this disease? A. ADH deficiency B. Increased TSI C. Excess ADH D. LH/FSH deficiency E. Increased TSH

A - ADH deficiency; this is the cause of Diabetes insipidus. The major clues are polyuria, thirst, hypernatremia, increased serum osmolality, and excretion of large volumes of dilute urine [with a lower than normal specific gravity]

Bone is a storage site for what minerals? A. Calcium and Phosphate B. Calcium and Nitrogen C. Potassium and Sodium D. Magnesium and Sodium E.Potassium and Chloride

A - Bone is the storage site for calcium and phosphate. They provide protection and support while also playing a role in the maintenance of blood calcium and phosphate levels in the body.

Gwen Stefani is a medical student who has been busy studying for her final exams for the past week. She recently reviewed biochemistry and muses that her pituitary gland is probably working overtime secreting ACTH. Which of the following is the correct metabolic effect in response to the glucocorticoid released by the adrenal cortex? A) Increased glycogen storage in liver B) Decreased lipolysis in adipose C) Increased protein synthesis in muscle D) Decreased gluconeogenesis in liver E)Increased glucose utilization muscle

A - Cortisol is the major physiological glucocorticoid and is released from the adrenal cortex in response to ACTH. The anterior pituitary gland secretes ACTH and subsequently stimulates release of cortisol in order to promote survival in response to chronic stress by making fuels available so that when acute stressors arise and epinephrine is released, fuel metabolites are readily available for fight or flight. Cortisol promotes gluconeogenesis and glycogen storage in preparation for when the liver needs to breakdown glycogen and make glucose widely available to the body in response to epinephrine.

What is the most appropriate term for the region of an osteon seen in a cross-sectional view of a long bone? A. Circumferential lamellae B. Lamellar Canal C. Haversian Canal D. Volkmann canal E. Perforating Canal

C - At the center of each osteon is a Haversian canal also known as an Osteonal Canal. It contains the blood vessels, CT, and bone lining cells. It is actually one of the more "alive" parts of bones but the sectioning and fixation of the slides generally sweep away all remnants of living tissue.

A 34 year old female complains to her primary care physician of increasing fatigue, cold intolerance and weight gain. After further review, the patient's test results come back with decreased T3 and T4 levels and increased TSH levels which confirms the suspected diagnosis of Hashimoto Thyroiditis. What is the cause of her underactive thyroid? A. Anti-thyroid antibodies destroy thyroid cells B. Toxin release and activation of adenylate cyclase C. Defects in TSH synthesis D. Deficiency in Thyrotropin-releasing hormone (TRH) E. High levels of Human Chorionic Gonadotropin (hCG)

A - Hashimoto Thyroiditis is a primary hypothyroid disease due to the autoimmune destruction of the thyroid gland. More specifically, there are antibodies against components of thyroid tissue leading to insufficient production of thyroid hormone. This is the most common cause of hypothyroidism and can present in the initial stages as hyperthyroidism because the damaged thyroid cells can leak the stored T3 and T4 hormones into circulation. After the pre-formed thyroid hormones are released there is a decreased release of thyroid hormones as a result of impaired thyroid function.

A blood test performed on a patient with a poor diet reveals low circulating levels of calcium. Which physiological response will most likely correct this deficiency? A. Increased PTH secretion B. Increased Calcitonin secretion C. Increased FGF-23 secretion D. Increased Osteocalcin secretion E. Decreased PTH secretion

A - PTH acts on the bone to increase low blood calcium levels to normal. Increasing PTH secretion will cause increased resorption, increasing the amount of calcium released into circulation. PTH will also reduce calcium excretion in the kidneys and stimulate calcium absorption in the small intestine.

A 55 year-old-male presents to his Primary Care Physician (PCP) complaining of fatigue, weight-gain, intermittent headaches, and low libido (sex drive) for the past 4 months. The physician orders a series of blood tests and the results reveal several hormone abnormalities. The patient is referred to a neuroendocrinologist for further evaluation and has a head MRI performed. The results of the MRI scan show the patient has a craniopharyngioma. What anterior pituitary condition is associated with craniopharyngioma tumors and one of the general effects of this condition? A. Panhypopituitarism, decreased production of glucocorticoids B. Dwarfism, decreased production of glucocorticoids C. Panhypopituitarism, increased production of glucocorticoids D. Hyperpituitarism, increased production of glucocorticoids E. Hyperpituitarism, decreased production of glucocorticoids

A - Panhypopituitarism is a medical condition where there is decreased secretion of all the anterior pituitary hormones. There are 3 common abnormalities associated with panhypopituitarism: craniopharyngiomas, chromophobe tumors, and thrombosis of the pituitary blood vessels. The general effects of adult panhypopituitarism are hypothyroidism, suppressed secretion of the gonadotropic hormones (LH/FSH), and depressed production of glucocorticoids by the adrenal glands.

Somatostatin is a hormone that plays a part in inhibiting or reducing the secretion of other hormones in the body, such as insulin, glucagon, and gastrin. Which of the following is the most likely to cause the release of somatostatin? A. Growth hormone-releasing hormone B. Thyrotropin-releasing hormone C. Growth hormone D. Gonadotropin-releasing hormone E.Corticotropin-releasing hormone

A - Somatostatin is also known as growth hormone inhibitory hormone. It, alongside growth hormone, is released via the effects of growth hormone-releasing hormone (GHRH). The two act to balance each other out when there's an imbalance.

A 17-year-old high school track and cross-country star comes to the clinic with complaints of feeling constantly thirsty. At first, he thought this was a result of his increased physical activity but soon started developing pain in his upper left abdomen. Laboratory tests showed high blood glucose levels and small secretory tumors around the alpha cells of his pancreas. Based on this patient's signs and symptoms, which of the following would have elevated levels in this patient's blood? A. Glucagon B. Insulin C. Hemoglobin D. Thyroid hormone E.Somatostatin

A - The pancreatic alpha cells produce glucagon. The secretory tumors are causing the alpha cells to increase their production of glucagon which in turn is causing the blood glucose levels to rise. This increase in glucose is causing the patient to constantly feel thirsty. The pain he feels is a result of the tumors on his pancreas.

A patient presents to the emergency room with excessive sweating, headaches, and heart palpitations. Upon taking a history, the patient reveals that someone crashed into his car while driving back from school, but notes the symptoms were present before and after the accident. The physician performs a physical exam but reports no significant findings except the patient is hypertensive. The physician orders a CBC revealing elevated levels of metanephrines and blood glucose. What could be elevated in the patient? Additionally, what could cause this elevation? A. Epinephrine; Pheochromocytoma B. Cortisol; Cushing's syndrome C. Growth hormone; Acromegaly D. Insulin; Cushing's disease E.TSH: Refetoff Disorder

A - The patient presents with symptoms common to a pheochromocytoma which is a tumor of the adrenal medulla. The symptoms were not caused by the car accident which is a clue that these symptoms were not just caused by a "fight or flight" response. Additionally, the elevated levels of metanephrines (catecholamine metabolite) and high blood pressure is consistent with the patient having a pheochromocytoma.

A 53-year-old male presents to his PCP with complaints of frequent urination and thirst. His PCP suspects that he has diabetes insipidus given his symptoms. What lab test would the physician order to confirm this diagnosis? A. Water Deprivation Test B. 24-Hour Urine Test C. Insulin Tolerance Test D. Serum IGF-1 E.Serum Prolactin

A - Water Deprivation Test is the "gold standard" to diagnose a patient with Diabetes insipidus and to differentiate the cause of DI. If the patient does have DI, then serum sodium levels and osmolality should increase in response to water deprivation.

A 25-year-old graduate student is in a research lab and is studying the effects of growth hormone in lab rats. Which of the following effects would the student expect to see? A. Decreased Protein deposition in tissues B. Decreased anabolism of Protein and Amino acids C. Increased rate of glucose utilization throughout the body D. Decreased mobilization of fatty acids E. Decreased Catabolism of Protein and Amino acids

A - With regards to growth hormone, it can be thought of as a potent "protein sparer". One of its main effects with regards to protein is Increase Protein Deposition in tissues and Decrease Catabolism (breakdown) of Protein, in addition it promotes Increased Protein Synthesis. The other answer choices are opposites of what would happen and are distractors, as explained below.

A researcher is given the job to classify various pituitary tumors. He knows they are classified by size and functionality. The specific tumor he is now classifying came from a patient who was diagnosed with a secondary endocrine disorder, and labs revealed abnormally elevated levels of prolactin found to be produced by the tumor. When the researcher measured the tumor it was about 15mm in size. How should the researcher classify this tumor? A. Secretory macroadenoma B. Secretory microadenoma C. Nonsecretory macroadenoma D. Nonsecretory microadenoma E. Secretory macro-lipoma

A) Secretory macroadenoma - A tumor that produces a specific hormone is deemed a secretory tumor. Prolactin-secreting tumors are the most common of these. Tumors that are smaller than 10 mm in diameter are called microadenomas, whereas lesions 10 mm or larger are called macroadenomas.

Osteoblasts in the bone periosteum and in some bone cavities deposit new bone on the surfaces of older bone. Simultaneously, osteoclasts in the bone remove old bone. When the rate of deposition is greater than that of resorption the thickness of the bone increases. Therefore, the bones can continue to become thicker throughout life under the influence of which hormone? A. Growth Hormone B. Adrenaline C. Angiotensin D. Antidiuretic hormone E.Calcitonin

A, Growth Hormone. Growth hormone strongly stimulates osteoblasts and allows for continuous growth of bone such as the protrusion of the chin and teeth after adolescence. Likewise, the bones of the skill can grow in thickness as well.

A 25 year old male, who was just a victim in a car accident, arrived at the ER where he was accessed by an MRI to look for any signs of traumatic brain injury. The MRI revealed that a portion of his hypothalamus was damaged resulting in a complete loss of dopamine secretion. Based on this, which of the following hormones secretion would be expected to exceed a normal physiological concentration? A. Prolactin B. Testosterone C. Dehydroepiandrosterone (DHEA) D. Thyroid Releasing Hormone (TRH) E. Adrenocorticotropic Hormone (ACH)

A, The failure to produce and secrete dopamine would result in a loss of the tonic inhibitory control that dopamine plays on Prolactin. As a result, Prolactin levels would not remain at basal levels, and be hypersecreted due to additional factors stimulating prolactin synthesis and secretion. Said factors include: thyrotropin-releasing hormone (TRH), estrogen, vasoactive intestinal polypeptide (VIP), AVP, oxytocin, and epidermal growth factor (EGF).

A 12 year old male presents with polyuria and polydipsia. When doing a water deprivation test their serum sodium levels and osmolality levels increased. When given synthetic vasopressin the patient's urine osmolality increased and urine volume decreased. Where is this hormone produced and stored in the body? A. Produced in the hypothalamus, store in the posterior pituitary B. Produced in the hypothalamus, stored in the anterior pituitary C. Produced in the anterior pituitary, stored in the posterior pituitary D. Produced in the posterior pituitary, stored in the kidneys E. Produced in the anterior pituitary, stored in the kidneys

A, Vasopressin also known as ADH is produced in the hypothalamus by the paraventricular and supraoptic nucleus. It is a neurohypophysial neuron so it is connected directly to the hypothalamus without going through blood. It is stored and released from the posterior pituitary. The patient is present with central diabetes insipidus, with polyuria and polydipsia being the symptoms and the water deprivation test being the clue. They cannot produce ADH so with the synthetic version they will not have negative symptoms.

The posterior pituitary gland is located at the base of the brain within sphenoid bone. The main function of the posterior pituitary gland is secretion of neurohypophysial hormones directly into the blood: oxytocin and antidiuretic hormone (also called vasopressin). Where are these hormones formed? A. Oxytocin is primarily formed in the paraventricular nuclei; ADH is primarily formed in the supraoptic nuclei B. Oxytocin is primarily formed in the supraoptic nuclei; ADH is primarily formed in the paraventricular nuclei C. Oxytocin is primarily formed in the paraventricular nuclei; ADH is primarily formed in the suprachiasmatic nuclei D. Oxytocin is primarily formed in the suprachiasmatic nuclei; ADH is primarily formed in the supraoptic nuclei E. None of the above

A- ADH, also known as vasopressin, is the primary hormone responsible for tonicity homeostasis. ADH helps to control blood pressure by acting on the kidneys and the blood vessels. ADH is primarily formed in the supraoptic nuclei. On the other hand, oxytocin acts on organs in the body (including the breast and uterus) and as a chemical messenger in the brain, controlling key aspects of the reproductive system, including childbirth and lactation, and aspects of human behavior. Oxytocin is primarily formed in the paraventricular nuclei. Each of these nuclei can synthesize about one sixth as much of the second hormone as of its primary hormone.

A 72-year-old female presents to the emergency room with severe hip pain. Earlier in the afternoon she had fallen while walking out to get the mail. A neighbor saw her fall and called the squad. In the emergency room, it was determined that she had broken her hip. Furthermore, it was determined that she was suffering from osteoporosis, which made her bones more susceptible to breaking. Which of the following types of cells is responsible for secreting the extracellular matrix of the bone? A. Osteoblasts B. Osteoclasts C. Osteocyte D. Bone-lining cells E. Osteoprogenitor cells

A- Osteoblasts arise from mesenchymal stem cells. An osteoblast is a cuboidal shaped cell that secretes the extracellular matrix of the bone. The matrix contains mainly type I collagen. Once the cell is completely surrounded by the matrix, it is referred to as an osteocyte.

A 56-year-old female visits her physician with complaints of sleep apnea, headaches, and jaw-joint pain. Under recommendation of her physician, she visited an orthodontist where he diagnosed her with Temporomandibular Joint Disorder and recommended that she get braces. What is present in the alveolar sockets of the oral cavity that allow this patient to have orthodontic corrections at an older age? A. Immature Bone B. Mature Bone C. Hyaline (Articular) Cartilage D. Red bone marrow E. Yellow marrow

A- While mature bone is the major bone type in adults, immature bone is present in the alveolar sockets. Because immature bone contains more osteocytes/ more cells per unit area, this explains why adults can have successful orthodontic treatments.

A patient has an issue with secretion of a hormone in the anterior pituitary lobe, known as the adenohypophysis, which is derived from which of the following tissues? A. Embryonic invagination of pharyngeal epithelium B. Neural tissue outgrowth of hypothalamus C. Glial- type cells D. Skin epithelium tissue E. Hypophyseal stalk

A- the anterior lobe is derived from embryonic invagination of pharyngeal epithelium and occurs during embryogenesis.

A 49-year-old man presents to the ER with complaints of severe elbow pain as well as a sharp pain and tenderness around his fingers after he slipped on ice while walking to his car. He is currently taking hydrochlorothiazide for his hypertension. Which of the following should the ER physician expect to see in the patient's test results? A. High levels of uric acid B. Low levels of alkaline phosphatase C. Increased levels of cytokines such as IL-6 D. Low levels of hemoglobin E. Decreased bone density in DEXA scan

A. High levels of uric acid The patient has sharp pain and tenderness around his fingers (joints) and he is currently taking hydrochlorothiazide for his hypertension. The pain around his fingers is characteristic of gout, and gout is also one of the most common side effects of the use of thiazide diuretics for the treatment of hypertension. The patient's condition is gout/ gouty arthritis. The pain is caused by the presence of sharp, needle-like uric acid crystals in the joints, and this can be diagnosed by high levels of uric acid in the blood.

An experiment was done to compare effects of injected growth hormone on two growing littermate rats. One received daily injection of growth hormone, while the control rat did not receive any growth hormone. There were different results in the early stages of development versus adulthood. What effects can be seen after adulthood in this experiment in the rat injected with daily growth hormone? A. Bones stopped lengthening and soft tissues can continue to grow B. Bone increased in length C. Soft tissues stop growth D. There were no changes seen between the two groups E. Body weight decreased

A. In the early stages of development, all organs of the treated rat increased proportionally in size, however after adulthood most of the bones stopped lengthening and the soft tissues continued to grow. This is because once the epiphysis of the long bones have united with the shafts, further lengthening of the bone cannot occur, even though many other tissues of the body can continue to grow throughout life.

A 10 year old boy presents to his PCP with symptoms of fatigue, apathy, and mental sluggishness. He looks pale, talks slowly, and reveals he is usually constipated. His physical exam showed reduced cardiac output. What is the most likely diagnosis of this patient? A. Myxedema B. Cretinism C. Hashimoto Thyroiditis D. Graves Disease E. Granulomatous Thyroiditis

A. Myxedema is applied to hypothyroidism developing in older children or adults. It is marked by the slowing of physical and mental state. In addition to the symptoms listed above, a patient diagnosed with myxedema is cold intolerant and frequently overweight. Measurement of the serum TSH level is the most sensitive test for this disorder.

A patient presents in the clinic with a goiter. It was determined that the goiter was caused by increased levels of TSH. TSH is known to bind to its receptor on the thyroid gland after being released by thyrotrophs in the anterior pituitary. Which GPCR and its second messenger system in the thyroid gland are affected by this increase in TSH levels? A. Gsα, which increases cAMP levels B. Giα, which decreases cAMP levels C. Gqα, which increases cAMP levels D. Giα, which increases cAMP levels E. Gsα, which decreases cAMP levels

A. The binding of TSH to its receptor on the thyroid follicular epithelial cells activates the receptor which associates with Gsα protein. The activation of Gsα will cause a downstream of events that will increase cAMP levels. This increase will stimulate thyroid growth.

A researcher is trying to develop a new drug for patients with hypothyroidism. The drug was tested in primates, which resulted in the desired effect of increasing thyroid hormone production and secretion. However, the researcher is concerned about potential side effects and proper dosage. Which of the following is an expected side effect of overmedication with the new drug? a. Heat intolerance b. Weight gain c. Constipation d. Bradycardia e. Hypercholesterolemia

A. The effect of the drug is an increase in production of thyroid hormone. This would result in thyrotoxicosis (hyperthyroidism), which is a hypermetabolic state. An increase in basal metabolic rate (BMR) results in heat intolerance, warm flushed skin, sweating, and weight loss despite increased appetite. All other choices are associated with hypothyroidism.

What event marks the termination of growth? In other words, if you were looking at a bone, what would you look for to know that the bone has stopped growing? A. Closure of the epiphyseal plate, B. Blood vessels entering the primary ossification center C. Development of a secondary ossification center in the proximal epiphysis D. New cartilage matrix production at the epiphyseal plate E. Presence of epiphyseal cartilage

A. is the correct answer because when maximal growth has been achieved, the epiphyseal plate essentially closes.

A scientist injects growth hormone into animals to increase cell growth and proliferation. Growth hormone causes the liver to secrete somatomedins to prompt bone growth. Somatomedins are similar in effect to which of the following? A. Chondrocytes B. cAMP C. Insulin-like-growth factors (IGFs) D. IP3 E. TSH

C - Growth hormone exerts its effects through Somatomedin. It is similar to somatotropin and works to increase all aspects of bone growth. The effect of Somatomedin on growth is similar to Insulin's effect on growth. Therefore, they can also be called insulin like growth factors.

Harry and Ron were interested in studying the effects of ADH throughout the body. They decided to set up a lab and conduct some experiments on mice in order to see how ADH works, but they do not remember learning in school where ADH is primarily formed. Harry and Ron forgot that ADH is primarily formed where in the body? A. Supraoptic nuclei B. Corticotrophs C. Lactotropes D. Gonadotropes E.Paraventricular nuclei

A: ADH is primarily formed in the supraoptic nuclei. Nerve impulses travel down from the nuclei and the hormone is released from the nerve ending. The hormone is then secreted by the posterior pituitary.

A 32 year old patient presents to his physician with weight loss, fatigue, muscle weakness, hyperpigmentation, & anemia. The physician finds a large adrenal tumor on the patient's MRI. Upon further examination, the physician concludes the patient suffers from adrenal insufficiency as a result of his tumor. What type of adrenal insufficiency does this patient suffer from? A. Primary B. Secondary C. Tertiary D. Cushing's Disease E. Addison's Disease

A: Primary because the adrenal glands directly produce cortisol

A 10 year old child recently diagnosed with Type 2 Diabetes seems to be growing at an accelerated rate which was noticed at his most recent visit to his pediatrician. The young lad was found to have excess Growth Hormone for which his pediatrician prescribed Tolbutamide, a drug normally used to increase insulin secretion in patients with Type 2 Diabetes, but that can also increase secretion of which counterregulatory hormone? A. Somatostatin B. Glucagon C. VIP D. Preprosomatostatin E. CCK

A: Somatostatin is a counterregulatory hormone that inhibits release of growth hormone (Somatotropin) from the anterior pituitary. Additionally, it can inhibit the release of insulin and is stimulated by VIP, CCK, and Glucagon.

A 45-year-old male visits his primary care physician with complaints of polyuria and polydipsia. The physician suspects the patient has diabetes insipidus. What primary test could the physician use to diagnose and differentiate the cause of diabetes insipidus? A. Water deprivation test B. Checking for the low FSH and LH levels C. Test to measure low serum IGF-I levels D. Measuring serum prolactin levels E. Low levels of free T4 and TSH

A: Water deprivation test is the primary diagnostic test used to diagnose and differentiate the cause of diabetes insipidus. In patients with diabetes insipidus, serum sodium level and osmolality increase in response to water deprivation. Synthetic analogue of AVP can be given to the patient to further differentiate the type of diabetes insipidus, central DI or nephrogenic DI.

A 27 year old presents to his primary care physician for fatigue and mental sluggishness. His family believes he is depressed. Through further questioning, it is identified that the patient also has constipation, shortness of breath, and decreased exercise capacity. Physical examination shows skin is cool and pale. The primary care orders labs that show increased total cholesterol and LDL, increased TSH, and decreased T4. Based on the labs and clinical presentation, what diagnosis is given to the patient? A. Hyperthyroidism B. Myxedema C. Cretinism D. Granulomatous Thyroiditis E.Diabetes insipidus

B Myxedema is hypothyroidism developing in older children and adults. It is characteristic of slowing physical and mental activity. Early symptoms include generalized fatigue and mental sluggishness, which may mimic depression. Decreased sympathetic activity results in constipation. The skin is cool and pale because of decreased blood flow. Reduced cardiac output probably explains the shortness of breath and decreased exercise capacity the patient is experiencing.

An 18 month old male presents with several intellectual disabilities for his age, as well as a protruding tongue and an umbilical hernia. The child is also mildly undersized for his age. The physician suspects that the baby was unable to receive maternal thyroid hormones while in the womb, and therefore measures his serum TSH levels. From the lab results and the physician's prediction, what diagnosis is given to the child? A. Hashimoto Thyroiditis B. Cretinism C. Apathetic Hyperthyroidism D. Myxedema E. Granulomatous Thyroiditis

B The feature symptoms of Cretinism (mental retardation, protruding tongue and umbilical hernia) are all present in this child. Also, the physician's prediction aligns with the manner in which cretinism is developed in infancy. The maternal T3 and T4 hormones often can not cross the placenta due to a deficiency in the mother. This often leads to the mental retardation seen in the child. For this reason, we can confidently assume this child suffers from Cretinism.

A student is observing growth in the epiphyseal cartilage in a child's long bones. She notes cell division and that they are organized into distinct columns. Which zone in the epiphyseal cartilage is she referring to? A. Zone of reserve cartilage B. Zone of proliferation C. Zone of development D. Zone of calcified cartilage E. Zone of resorption

B The zone of proliferation shows the cartilage cells going through divisions and are organized into distinct columns, which is unique to this zone. These cells are larger than those in the reserve zone, but there's no mention of cell size comparison in the question.

A 36-year-old female presents to her PCP with complaints of feeling cold often, fatigued, and difficulty with motivation and energy levels. She also presents with significant weight-gain as compared to previous visits to the office. Her physician orders a blood test and results show low levels of T3 and T4, which of the following could you also expect the patient to present with? A. Hypertension B. Goiter C. Hypoglycemia D. Gigantism E. Acromegaly

B - A goiter is an issue that appears in patients with hyperthyroidism or hypothyroidism. A goiter is an abnormal enlargement of the thyroid gland that manifests as an outgrowth in the neck. In Hyperthyroidism, the goiter appears as a result of excess accumulation of thyroid hormones (T3 and T4) as autoantibodies mimic the effects of TSH. In Hypothyroidism, a goiter may appear as a result of an iodide deficiency which causes an increase in TRH and TSH to compensate as well as a build up of thyroglobulin.

Although during a rise of blood glucose signals 𝛃 - Cells to secrete insulin, which 37 amino acid peptide is secreted with insulin? A. Glucagon B. Amylin C. Somatostatin D. Tolbutamide E.Growth Hormone

B - Because Amylin is secreted with insulin to suppress postprandial glucagon secretion, slowing gastric emptying, and reducing food intake. All of these actions Amylin does results in the decrease of blood glucose.

Growth hormone causes the formation of proteins called somatomedins, also known as insulin-like growth factors (IGFs). In which of the following parts of the body are IGFs mainly formed? A. Pancreas B. Liver C. Hypothalamus D. Anterior pituitary gland E.Posterior pituitary gland

B - Growth hormone causes the liver (and other tissues to a much lesser extent) to form several small proteins called somatomedins that have a large effect on increasing all aspects of bone growth. These somatomedins are called insulin-like growth factors (IGFs).

In a lab, researchers are attempting to review the effects that Growth hormone has on physiology by administering growth hormone to rats. In the lab trial, one rat is given daily injections of Growth hormone; while another rat, acting as the control, is not given growth hormone. What physiological changes would you expect to see in the rat receiving growth hormone, after the epiphyseal plates have fused? A. Bones will continue to lengthen throughout life B. Tissues being targeted by growth hormone will continue to enlarge throughout life C. Protein synthesis will be decreased throughout life D. There will be increased glucose uptake from the tissues E. Increased mobilization of fatty acids will cause a decrease of fatty acids in the blood

B - Once the epiphyseal plates have fused together with the bone, further lengthening of the bones cannot occur. However, different tissues within the body will continue to enlarge throughout life

A 13-year-old male patient in Haiti was seen at a clinic for prolonged malnutrition. He was found to have significantly elevated levels of plasma growth hormone and was diagnosed with Kwashiorkor. Which of the following treatments will be most effective in bringing the patient's growth hormone level closer to his baseline? A. Carbohydrates B. Proteins C. Insulin D. Fats E. Ghrelin

B - Proteins - Kwashiorkor is a malnutrition disease marked specifically by prolonged protein deficiency. During this prolonged protein deficiency growth hormone levels become significantly elevated and are closely related to the amount of protein depletion. The book provides a graph from a study in which one set of children with kwashiorkor are treated with carbohydrates and another set is treated with proteins. The results show that the children treated with protein showed decreased levels of growth hormone and the children treated with carbohydrates showed no decrease in growth hormone levels.

Rosa, a 70-year-old woman, is brought to the hospital by her family exhibiting personality changes, confusion, and hallucinations. Her history is insignificant for trauma or recent infections. She does not take any medications, supplements or herbs and does not have a fever. She is hyponatremic and a head MRI reveals cerebral edema. Which of the following is the most common cause of the condition that she is exhibiting? a. Severe dehydration b. Secretion of ectopic ADH by malignant neoplasms c. An anterior pituitary tumor d. Dysfunction of the renin-angiotensin system (RAS) e. Overdose of Thiazide, a diuretic drug

B - Rosa is exhibiting the signs and symptoms of Syndrome of inappropriate ADH (SIADH). SIADH leads to ADH excess which causes over-resorption of free water, resulting in hyponatremia due to dilution of electrolytes. The most frequent causes of SIADH are the secretion of ectopic ADH by malignant neoplasms (particularly small-cell carcinoma of the lung), drugs that increase ADH secretion, and a variety of central nervous system disorders, including infections and trauma. The clinical manifestations of SIADH are dominated by hyponatremia, cerebral edema, and resultant neurologic dysfunction.

A 10 year old male visits his PCP with short stature, decreased muscle strength, and an increase in fat mass. Lipid profile shows LDL levels of 150 mg/dL (normal range <130 mg/dL), triglyceride level of 175 mg/dL (normal range 40-160 mg/dL), and HDL level of 35 mg/dL (normal range >45 mg/dL). Based on the case presented, what hormone is the child deficient in? A) ACTH B) GH C) TSH D) LH and FSH E)Prolactin

B - The child has a Growth Hormone deficiency. Short stature, decreased muscle strength, and an increase in fat mass are common symptoms of a GH deficiency in children. Elevated LDL and triglyceride, and decreased HDL levels are also associated with a GH deficiency. In children, a GH deficiency is normally idiopathic, but can be genetic or associated with congenital anatomic malformations in the brain or sellar region.

A medical student is perplexed while reading the past medical history of a recent trauma patient. The medical records of this patient show that there is a congenital issue with the somatoropes of the patient's pituitary gland. Which of the following correctly correlates to the function of the somatotropes? A. Stimulate production of glucocorticoids B. Stimulate production of growth hormone C. Stimulate production of thyroid hormone D. Stimulate production and secretion of milk E. Stimulate and regulate spermatogenesis in the testes

B - The correct answer here is to stimulate production of growth hormone. Another name for growth hormone is somatotropin.

Which of the following is false in regards to the effect of GH on adipocytes, hepatocytes, and skeletal muscle? A. Glucose uptake is indirectly suppressed, reducing glycolysis in skeletal muscle. B. Hepatic glycogen synthesis is suppressed and hepatic glucose metabolism is stimulated. C. Hepatic gluconeogenesis is stimulated. D. Decreased esterification of fatty acids in adipocytes. E. Increased mobilization of amino acids.

B - This is false because GH presence stimulates hepatic glycogen synthesis and suppresses hepatic glucose metabolism.

A construction worker has just been brought into the ED due to the collapse of a large beam onto his leg. He states that he is in a lot of pain and the EMTs on site noted a high degree of hemorrhage. Due to these stressors, signals are sent to his brain to initiate the production and release of CRH and subsequently ACTH and finally glucocorticoids. Which of the following will NOT occur in this patient's body in response to cortisol? A. Lipolysis in peripheral adipose tissue B. Increased glucose uptake by the cells of various tissues C. Proteolysis in skin, lymphoid cells and muscle D. Increased gluconeogenesis and glycogen synthesis in the liver E.Increased release of free amino acids from muscle protein

B - When glucocorticoids are released, there is a decrease in glucose uptake by the different tissues of the body. The main role of glucocorticoids is to make fuel (glucose) available in response to nonspecific stress signals including pain, hemorrhage, hypoglycemia and exercise. Glucocorticoids increase blood glucose levels in order to combat stress in a fight-or-flight situation. Answers A, C, D, and E all describe effects that increase the availability of fuels in the blood.

A 22-year old male crashes his BMW M4 while trying to drift around a turn. He walks away from the crash with a few abrasions on his body and severe pain in his abdomen. At the hospital, the doctor determines his adrenal gland is damaged from blunt force trauma from the accident causing hypoadrenalism. Which of the following below indicates the change in hormones regarding cortisol for the patient? a. Decrease CRH, Decrease ACTH, Increase cortisol b. Increase CRH, Increase ACTH, Decrease cortisol c. Decrease CRH, Increase ACTH, Increase Cortisol d. Increase CRH, Increase ACTH, Increase Cortisol e.No change in CRH, ACTH or Cortisol

B, The patient suffered damage to his adrenal gland causing hypoadrenalism, this would cause the levels of cortisol in his blood to decrease because the adrenal gland wouldn't be able to release it anymore. The low levels of cortisol would cause the hypothalamus to release CRH and cause an increase in levels. The increase in levels of CRH would travel to the anterior pituitary and release ACTH causing an increase in ACTH levels.

A patient is brought to the emergency room with a broken bone. The physician explains to the patient that it will take 6-12 weeks for the bone to heal and then goes over the major steps in bone repair. What is the final step in fracture repair? A. Hematoma formation B. Bone remodeling C. Soft callus formation D. Fibrocartilaginous formation E. Hard callus formation

B- From start to finish, a fracture is repaired by: (1) formation of a hematoma, (2) formation of a fibrocartilaginous callus, (3) formation of soft callus, (4) formation of hard callus, (5) bone remodeling.

A 49-year old woman presents to her endocrinologist with an enlarged thyroid and complaints of slight lethargy and weight gain over the last few months. After referral to radiology a biopsy is performed and shows diffuse infiltration of lymphocytes which is replacing the normal thyroid epithelium. What is the pathogenesis of the woman's problems? A) Iodine deficiency B) Breakdown in self-tolerance to thyroid autoantigens C) TSH-secreting pituitary adenoma D) Genetic defect interfering with biosynthesis of thyroid hormone E) Radiation treatment

B- Hashimoto Thyroiditis is an autoimmune disease resulting in destruction of the thyroid gland and progressive thyroid failure. Patients are described with a goiter and lymphocytic infiltration of the thyroid, presenting with some degree of hypothyroidism.

A 26 y/o female is in labor and undergoing contractions. Which of the following beliefs WOULD NOT support the theorized physiological functions of oxytocin? A. In a hypophysectomized animal, the duration of labor is prolonged, indicating a possible effect of oxytocin during delivery. B. In a hypophysectomized animal, the duration of labor is shortened, indicating a possible effect of oxytocin during delivery. C. The amount of oxytocin in the plasma increases during labor, especially during the last stage. D. Stimulation of the cervix in a pregnant animal elicits nervous signals that pass to the hypothalamus and cause increased secretion of oxytocin. E.The suckling stimulus on the nipple of the breast causes release of oxytocin by the posterior pituitary gland which allows for milk let down.

B- the theorized hypothesis is that oxytocin causes a positive feedback mechanism that stimulates contraction. If there is a hypophysectomized animal, this would prevent the release of oxytocin therefore prolonging labor as contractions would not be stimulated.

A 57 year old male presented to the clinic complaining of fatigue, multiple joint pains, and enlarged hands and feet. Vitals taken showed: elevated BP 150/90, normal RR, normal HR, normal temperature. Labs were ordered and showed: normal CBC, normal thyroid function panel, elevated GH, elevated IGF-1 levels, and abnormal lipid panel. After further testing, which of the following would the patient most likely be diagnosed with? A. Posterior pituitary tumor B. Anterior pituitary tumor C. Hypothalmatic somatostatin secreting tumor D. Hypothyroidism E. Hyperthyroidism

B. Adults with such symptoms generally points to a diagnosis of acromegaly, GH-hypersecretion. IGF measurements as well as oral glucose tolerance tests are great diagnostic tools for this disorder. GH secretion occurs from the anterior pituitary with the leading cause of hypersecretion being due to a pituitary macroadenomas.

Standing at 7'4", 529 lbs, Andre was at the top of his career. As a professional wrestler, he towered over his opponents, earning the nickname "Andre the Giant". Suddenly he passed away at age 49 due to an undiagnosed condition. Toward the end of his life, his symptoms included a protruded lower jaw, massive nose, thick fingers, kyphosis, and soft tissue organ enlargement. Physicians noted that these symptoms were the result of excess anterior pituitary hormone secretion that occurred after long bone epiphyseal plate fusion. Which of the following answer choices best describe Andre the Giant's condition at the end of his life? A. Dwarfism and hypoglycemia, caused by low GH secretion B. Acromegaly and hyperglycemia, caused by excess GH secretion C. Gigantism and hypoglycemia, caused by low GH secretion D. Cushing syndrome and hyperglycemia, caused by excess ACTH secretion E.Grave's disease and primary hyperthyroidism, caused by TSH mimicking hyperthyroidism

B. Acromegaly is caused by excess GH secretion after adolescence (epiphyseal plate closure). Though Andre was very tall, his conditions later in his career such as a protruded lower jaw, massive nose, thick fingers, kyphosis, and soft tissue organ enlargement are all characteristic of acromegaly. Additionally, excess GH secretion stimulates gluconeogenesis and lipolysis, causing hyperglycemia and elevated levels of free fatty acids.

Betty White, a 98 year old female comes to your clinic. You determine that she has Type II primary osteoporosis. She is open to beginning treatment but would like nonestrogen therapy. Which is the following is an appropriate treatment? A. Hormone replacement therapy (HRT) B. Selective estrogen receptor modulators (SERMS) C. NSAID D. Biphosphates E. Prednisone

D - biphosphates is a nonestrogen form of treatment for osteoporosis

A 1 year old Chinese boy is brought to the pediatrician's office by his parents. The parents are very concerned with the patient's short stature, coarse facial features, and protruding tongue. They also mention that the patient has increasing difficulty communicating with those around him. Which of the following is the most likely diagnosis for this patient? A. Hashimoto thyroiditis B. Cretinism C. Myxedema D. Iatrogenic hypothyroidism E. Graves disease

B. Cretinism refers to hypothyroidism that develops in infancy or early childhood, especially in areas where dietary iodine deficiency is endemic such as inland China. Clinical features of cretinism include severe intellectual disability, short stature, coarse facial features, a protruding tongue, and umbilical hernia.

The release of insulin occurs within minutes after the pancreas is exposed to a high glucose concentration, and when glucose level falls, insulin is rapidly removed from the circulation and degraded by the liver. Beside blood glucose, which of the following factors would have a reducing effect on insulin release in healthy individuals? a. Decreased function of pancreatic alpha-cells b. Increased epinephrine c. Gastric inhibitory polypeptide (GIF) + glucagonlike peptide 1 (GLP-1) d. Certain amino acids e.Increased ANS input to pancreatic islets

B. Epinephrine, secreted in response to fasting, stress, trauma and vigorous exercise, signals energy use and decreases the release of insulin.

A 65-year-old patient goes for his wellness checkup and the doctor notices that they have lost 2 inches of height since their last visit. The physician orders a bone density scan and determines that the patient is suffering from osteoporosis. A bisphosphonate is prescribed, which promotes osteoclast apoptosis. Which of the following statements is incorrect regarding osteoclast cells? a. Osteoclasts resorb bone tissue through the release of protons and lysosomal hydrolases b. Osteoclasts are related to osteoblasts c. Tartrate resistant acid phosphatase (TRAP) can be used as a marker of osteoclast activity d. Inflammatory processes can stimulate osteoclast mediated bone resorption e. Osteoclasts do not have PTH receptors

B. Incorrect, osteoclasts are derived from the fusion of mononuclear hematopoietic cells. Specifically, granulocyte/macrophage progenitor cells.

A fifty year old woman shows to her PCP with signs of osteoporosis and the PCP decides to look at her hormone levels to see if there could be a problem with the calcium storage. What hormones would the PCP be investigating? A. ADH and Angiotensin II B. PTH and Calcitonin C. Epinephrine and norpinephrine D. Amylase and gastrin E. Insulin and glucagon

B. PTH (parathyroid hormone) and Calcitonin are the two hormones that regulate body and bone calcium levels. PTH acts on the bone to increase low blood calcium levels to normal by causing rapid mobilization of Ca2+ from bone. Calcitonin acts on the bone to decrease elevated blood calcium levels to normal. If our patient's calcium levels are related to hormone levels, these would be the hormones to examine.

A 29 year old female presents to her PCP with headache, neurologic defects, and recent vision changes. She also mentions she is married and has been trying to have a child for the past 7 years with no success. Lab results indicate she has a serum prolactin level greater than 250 ng/mL, indicating the presence of prolactinoma. Which of the following treatments could the PCP prescribe to help manage the prolactinoma? a. A dopamine antagonist b. A dopamine agonist c. VIP agonist d. Estrogen therapy e.A drug that stimulates TRH

B. Prolactin is synthesized and secreted in the lactotroph cells of the posterior pituitary. Hypothalamic derived dopamine inhibits prolactin secretion and this normally keeps prolactin at basal levels. Because of this, a dopamine agonist will help decrease the tumor size and be an effective therapy for the patient.

Which of the following statements is true regarding the origin and morphology of the anterior and posterior lobes of the pituitary gland? A. The adenohypophysis is an outgrowth of neural tissue containing glial-type cells. B. The adenohypophysis arises from embryonic pharyngeal epithelium and does not contain neural tissue. C. The neurohypophysis arises from Rathke's Pouch and contains glial-type cells. D. The neurohypophysis is another name for the anterior pituitary lobe and comprises epithelial cells. E.B and C.

B. The adenohypophysis (aka the anterior pituitary lobe) arises from Rathke's Pouch, an embryonic invagination of pharyngeal epithelium. The anterior pituitary lobe therefore does not arise from nervous tissue.

A 28-year-old patient presents to her OB/GYN with concerns about having a child. She has spent her time over the past few days fervently googling about pregnancy and is now quite worried about it. She read that oxytocin can cause brain damage of her baby and refuses to use that drug. The doctor calms her down and explains what the hormone oxytocin is. Which of the following is true regarding oxytocin? A. Oxytocin stimulates milk synthesis B. Oxytocin is part of the milk letdown reflex C. Oxytocin is released from the anterior pituitary gland D. Panhypopituitarism will inhibit oxytocin release E.Labor is shortened due to oxytocin absence in hypophysectomy patients

B. The milk letdown reflex is the mechanism in which oxytocin aids milk ejection from the breasts. When the baby suckles the nipple, oxytocin neurons cause the posterior pituitary gland to stimulate the lactotropes to release prolactin that stimulates the mammary glands to release milk. Oxytocin is then carried to the breasts where it will stimulate the contraction of myoepithelial cells. This will trigger the alveoli to release milk, and for the milk to be ejected.

A 34 year old man presents to his primary care physician with decreased libido, erectile dysfunction, and depression which has been going on for about 3 to 6 months. He is a recent survivor of brain cancer and consequently has a history for radiation therapy. Which of the following hormonal levels would most likely be measured for a secondary disorder along the HPG axis? A. Decreased GnRH and decreased testosterone B. Increased GnRH and decreased estrogen C. Increased LH and decreased testosterone D. Increased FSH and decreased estrogen E. Decreased LH and increased testosterone

B: The patient has hypogonadotropic hypogonadism, a disease condition characterized by pituitary dysfunction along the HPG axis. This would imply an impaired release of FSH and LH, leading to decreased testosterone and estrogen levels as a result. Following a feedback mechanism, GnRH levels would rise in compensation, best represented by answer choice B.

Betty White visits her primary care physician with complaints of back pain, joint pain, and weakness in her bones. Her physician believes she has osteoporosis. Her parathyroid hormone (PTH) levels are high, resulting in too much calcium in the blood. Which cells secrete this hormone? A) Osteoblasts B) Principal (chief) cells C) Parafollicular cells D) Osteocytes E) Somatotrophs

B; Parathyroid Hormone (PTH) is secreted by the principal (chief) cells of the parathyroid glands. PTH acts on our bones to increase any low levels of blood calcium, and with osteoporosis, the parathyroid glands release too much PTH. This results in excess calcium in the blood and the symptoms of osteoporosis.

Hank, a 55 year old male recently passed away from a car accident and was found to have a broken leg. The medical examiner wanted to get an in depth look at his bone. After getting a sample of his bone, they stained it with H&E stain and observed it under a microscope. Based on the picture attached, which zone is the green star indicating? A. Zone of Reserve Cartilage B. Zone of Proliferation C. Zone of Hypertrophy D. Zone of Calcified Cartilage E. Zone of Resorption

C This answer choice is correct. In this zone, the cells seen are greatly enlarged (hypertrophic) cartilage cells.

A 45 year old patient was recently diagnosed with small cell carcinoma of the lung. He comes into the ER with symptoms of neurologic dysfunction and decreased urine output.. A test reveals that his serum sodium levels are 125 mEq/L (Normal: 135-145 mEq/L).. What is the cause of this patient's disease? A. ADH deficiency B. An autosomal dominant mutation of the AVP gene C. ADH excess D. Goitrogens E. A mutation in the PAX8 gene

C This patient is suffering from SIADH, which stems from an excess of ADH. This causes an over-resorption of free water, resulting in hyponatremia and neural dysfunction, which is seen in the patient. A frequent cause of SIADH is malignant neoplasms, such as the small cell carcinoma of the lung that this patient is suffering from.

A 46-year-old woman presents to her PCP in July with complaints of inflammation and pain in her thyroid region. Her history reports an upper respiratory infection that was caused by a virus approximately 3 weeks ago. Which of the following test results is incorrect for the suspected disease state and would not be seen in this patient? A. High serum T3 and T4 levels B. Low serum TSH levels C. Low serum T3 and T4 levels D. Diminished radioactive iodine uptake E. Thyroid follicles replaced by neutrophils and microabscesses

C This woman is suffering from granulomatous thyroiditis. This is a self-limited disease characterized by pain and granulomatous inflammation of the thyroid. It often occurs secondary to a viral infection, and patients often have an upper respiratory infection in the summer months before thyroid symptoms are present. Patients experience elevated T3 and T4 levels with this disease, making C (low levels) the only incorrect test result.

An adult female presents to her primary care provider with progressing symptoms consistent with Acromegaly. The provider has been monitoring her somatic changes over the last 8 years and has specifically noticed acral changes. Which of the following symptoms would present in a patient with acral changes? a. Prognathism b. Cardiomegaly c. Enlarged hands & feet d. Hypertension e.Sweating

C - Acral changes include changes to the extremities of peripheral body parts. According to table 62-4, acral changes include enlarged hands & feet.

Tony, an aspiring bone scientist, has been locked in his research lab practicing identifying various cells and their functions. They are currently looking at a versatile secretory cell that secretes both type I collagen and bone matrix proteins. Which of the following bone matrix proteins would not be produced by this cell? A) Calcium-binding proteins B) Multi-adhesive glycoproteins C) Calcitonin D) Proteoglycans E) Tissue nonspecific alkaline phosphatase

C - The versatile secretory cell that secretes both type I collagen and bone matrix proteins is an osteoblast. The osteoblast is a differentiated bone-forming cell intended to secrete bone matrix specifically, additionally, it retains its ability to divide post differentiation. The correct answer for which is not produced by osteoblasts is C - Calcitonin, which is produced by the parafollicular cells of the thyroid gland, and is designed specifically to reduce osteoclastic activity

A 4-year-old girl was recently adopted from Africa and was brought to the clinic because her adopted parents are worried she did not receive enough vitamin D or calcium for proper bone growth during the first few years of her life. Which of the following bone abnormalities would be present if the child was indeed diagnosed with rickets? A. Thickening of hands, feet, mandible, nose, and bones of the skull B. Failure of growth in the long bones C. Bowed lower limbs and a deformed chest and skull with an apparent "square" appearance D. Abnormally long bones E. Porous bones

C - Advanced rickets has classical symptoms that can be seen via an X-ray: bowed lower limbs and a deformed chest and skull with a "square" appearance. If no treatment is given, these can result in a short stature and skeletal deformities.

A 36-year-old male presents to the clinic for an oral glucose tolerance test (OGTT) using a 100-g glucose load. Two hours after the patient consumed the glucose drink, his GH levels were measured. The results indicated that the GH levels did not drop below 1 ng/mL. Based on the results, which of the following is not a clinical manifestation of the patient's diagnosis? A. Enlarged hands and feet B. Impaired glucose tolerance C. Cold Intolerance D. Hypertension E. Cardiomegaly

C - An oral glucose tolerance test is used to diagnose excess GH in patients. Normally, glucose suppresses GH levels to less than 1 ng/mL after 2 hours; in patients with acromegaly, GH levels may paradoxically increase, remain unchanged, or decrease but not below 1 ng/mL. Since the patient's GH levels did not drop below 1 ng/mL, the results lead to a diagnosis of Acromegaly. All of the answer choices indicate manifestations of acromegaly except answer choice C. Cold intolerance is a manifestation of hypothyroidism.

A group of scientists are investigating the regulation of growth hormone secretion. The precise mechanisms that control secretion of Growth Hormone are not fully understood, but several factors are known to stimulate or inhibit secretion. Which of these factors that affect growth hormone secretion is a far more potent stimulator of growth hormone release under chronic conditions? A. Hypoglycemia B. Obesity C. Starvation, especially with severe protein deficiency D. Somatostatin E.Increased blood free fatty acids

C - In chronic conditions, growth hormone secretion seems to correlate more with the degree of cellular protein depletion than with the degree of glucose insufficiency. For instance, the extreme high levels of growth hormone that occur during starvation are closely related to the amount of protein depletion.

Mark, a 40-year-old male was comparing the most recent picture of himself to a picture of when he was around 30 years old. After looking at the picture for some time he noticed that his nose and lips had enlarged despite not having any cosmetic surgery done. When looking at his hands, he noted that they also appeared larger. He decided to make an appointment with his family physician to see if these changes were normal. What will the physician NOT find after running tests and examining the patient? A. Acromegaly B. Hypertension C. Hyposecretion of GH D. GH-secreting pituitary tumor E. Diabetes mellitus

C - Mark has clinical symptoms of acromegaly (enlarged hands, lips, nose, and feet). Acromegaly is caused by hypersecretion of GH from the anterior pituitary gland. This hypersecretion is normally caused by a GH-secreting pituitary tumor. The rate of change of symptoms is slow, which is why it took him 10 years to notice. Along with changes to soft tissue and bone, endocrine and metabolic abnormalities will also occur. These can include: diabetes mellitus, hypertriglyceridemia, decreased libido or menstrual abnormalities in females. Excess GH in children is called gigantism.

A 6 month old female is brought to orthopedic by her mother due to frequent fractures. She was diagnosed with Osteogenesis Imperfecta, which is caused by a defect in Type 1 collagen. What bone structure is responsible for secreting this collagen? A. Osteoprogenitor Cells B. Osteoclast C. Osteoblast D. Osteocyte E. Bone lining cells

C - Osteoblast secrete Type I collagen and bone matrix proteins which compose the extracellular matrix of bone.

A 40 year old woman started feeling symptoms of headaches, vision problems, mood changes, irritability, facial numbness, loss of consciousness. She has developed a posterior pituitary tumor which led her to experience the previously mentioned symptoms. Which of the following hormones is secreted by the posterior pituitary gland? A. FSH B. Luteinizing hormone (LH) C. Oxytocin D. TSH E.GH

C - Oxytocin is secreted from the posterior lobe of the pituitary gland.

Which of the following correctly matches the type of cell located in the anterior pituitary with the hormone that it secretes? A. Lactotropes - Oxytocin B. Thyrotropes - Follicle Stimulating Hormone and Luteinizing Hormone C. Somatotropes - Human Growth Hormone D. Gonadotropes - Testosterone and Estrogen E.Corticotropes - Antidiuretic Hormone

C - The anterior pituitary is made up of the following types of cells: Lactotropes, Thyrotropes, Somatotropes, Gonadotropes and Corticotropes. Somatotropes make up around 30 to 40% of the anterior pituitary cells and they produce and secrete human growth hormone.

A 52-year-old male presents to the clinic complaining of unintended weight loss, consistent sweating and recurrent diarrhea. Upon presentation, the physician also notices an enlargement in the patient's thyroid gland. After the proper tests were run, results confirmed a 7 mm tumor on the anterior pituitary, elevated TSH and thyroid hormone. What type of tumor does this patient have? A. Secretory macroadenoma B. Nonsecretory microadenoma C. Secretory microadenoma D. Nonsecretory macroadenoma E.None of the above

C - The patient who entered the clinic is suffering from a TSH-secreting pituitary tumor. This is also referred to as secondary hyperthyroidism. Since the tumor is less than 10 mm, it is characterized as a microadenoma. Anything that is over 10 would be a macroadenoma. Since the tumor located on the anterior pituitary is hyper-secreting TSH, we would call this a type of secretory tumor. A nonsecretory tumor does not release additional hormone and would most likely result in a deficiency. In this case, secondary hypothyroidism.

A 35-year-old female has presented to her primary care physician with compulsive water drinking, hallucinations, and she is feeling extremely disorganized. The primary care physician ordered an ADH blood test and urine test. After several days, her results came in. What was alarming was high levels of Oxytocin in her urine and blood. Antidiuretic hormone (ADH) levels were also low in her blood. What gland should the physician take a closer look at? A. Hypothalamus B. Thyroid gland C. Posterior pituitary gland D. Anterior pituitary gland E.Inferior pituitary gland

C - Tracts pass to the neurohypophysis through the pituitary stalk. The nerve endings are bulbous knobs that contain many secretory granules in the Posterior Pituitary Gland. They secrete two posterior pituitary hormones: 1) Antidiuretic hormone (ADH) and 2) Oxytocin

A scientist is in the process of developing a new pharmaceutical therapy for individuals who have suffered from a traumatic brain injury and no longer have control of ADH secretion. The goal of this therapy is that it would mimic the area in the brain that senses when the extracellular fluid becomes too concentrated, and initiate signals in the hypothalamus to cause additional ADH secretion. What structure of the brain would this therapeutic drug be mimicking? A. Median eminence B. Aquaporins C. Osmoreceptor cell D. Pars Intermedia E.Anterior pituitary gland

C - When the extracellular fluid becomes too concentrated, fluid is pulled by osmosis out of the osmoreceptor cell, decreasing its size and initiating the appropriate nerve signals in the hypothalamus to cause additional ADH secretion.

A researcher wanted to gain a better understanding of the feedback mechanism regarding gonadotropin release. If this researcher were to reduce the amount of FSH/LH being released, what would the effects of FSH/LH, GnRH (gonadotropin-releasing hormone), & estrogen/testosterone be? A. FSH/LH ↑, GnRH ↓, Estrogen/Testosterone ↓ B. FSH/LH ↑, GnRH ↑, Estrogen/Testosterone ↓ C. FSH/LH ↓, GnRH ↑, Estrogen/Testosterone ↓ D. FSH/LH ↓, GnRH ↓, Estrogen/Testosterone ↓ E. FSH/LH ↓, GnRH ↑, Estrogen/Testosterone ↑

C - if the researcher were to decrease FSH/LH release, this would lead to a decrease in estrogen/testosterone release, which would feed back to the hypothalamus to increase secretion of GnRH.

An adult male enters the clinic with muscle weakness, joint pain, and impaired vision. Upon physical examination, it was found that the patient had enlarged hands and feet, as well as coarsened, enlarged facial features. The patient was quickly diagnosed with the condition known as acromegaly. Which of the following would the physician want to begin administering to the patient to control their symptoms caused by the acromegaly? A. Tolbutamide B. Growth Hormone C. Somatostatin analogs D. Thyroid hormone E. Insulin

C- Acromegaly is caused by an overproduction and secretion of the hormone known as growth hormone. Somatostatin plays an inhibitory role in the release of growth hormone. While the main clinical issue in the use of somatostatin is that it has a short half-life of less than 3 minutes, analogs of native somatostatin have been developed that increase this half-life to 110 minutes for analogs such as octreotide. This allows for somatostatin therapy to be used in the treatment of acromegaly.

A 25-year-old female patient presents to her endocrinologist with complaints of irregular menstruation and milk discharge from her breast. She states that she is not sexually active, nor has she ever been pregnant. Lab tests confirm that she is not pregnant, but show elevated levels of another hormone. What would be the recommended treatment for this patient, based on her clinical symptoms? A. Transsphenoidal surgical removal B. Testosterone replacement C. Cabergoline D. Prednisone E.Replacement therapy with desmopressin (DDAVP)

C- The patient's symptoms indicate that she is suffering hyperprolactinemia, which is diagnosed with a serum prolactin level. The recommended treatment for patients suffering from increased prolactin levels is a dopamine agonist, such as bromocriptine or cabergoline.

A 55-year-old female experiencing diffuse bone pain over the past several years after menopause. She has a history of fractures to her right wrist and left hip. After several X-rays, the doctor confirmed the patient had Osteoporosis which was due to? A. Compact bone B. Osteoid C. Imbalance between Osteoclast and Osteoblast D. Spongy bone E. Epiphyseal line

C. Correct because osteoporosis is caused by the imbalance between osteoclast mediated bone resorption and osteoblast mediated bone deposition and resulting in fractures and decrease in bone mass and causes bone fragility. Also, in postmenopausal women, the level of estrogen is decreased and the levels of cytokines are increased leading to intensified bone resorption.

A Researcher in a lab is analyzing a photomicrograph of a growing bone spicule stained with Mallory-Azan. She notices cuboidal or polygonal shape cells with basophilic cytoplasm that aggregate into a single layer of cells, lying in apposition to the forming bone. What is this type of cell called and what is its function? A) Osteoclast - resorbs bone by enzymatic hydrolysis of the mineralized bone matrix B) Osteocytes - respond to mechanical force applied to the bone C) Osteoblast - secrete bone matrix D) Bone Lining Cells - maintenance and nutritional support of the osteocytes E) Osteoprogenitor cells - give rise to osteoblasts

C. Osteoblasts are recognized in light microspecies by their cuboidal or polygonal shape with basophilic cytoplasm. They aggregate into a single layer of cells lying apposition to the forming bone. Osteoblasts are versatile secretory cells that secrete bone matrix. They are also responsible for the calcification of bone matrix. [P.239]

A 31 year old female presents to her PCP planning to discuss fertility treatments since she has been having menstrual irregularities as well as trouble becoming pregnant. She eventually brings up concerns of headaches and vision issues. The physician orders various testing and finds a large pituitary mass. What type of treatment should he recommend? A. Thyrotropin-releasing hormone agonist B. Vasoactive intestinal polypeptide agonist C. Dopamine agonist D. Increased Growth hormone therapy E. Increased Thyroid stimulating Hormone therapy

C. Signs and symptoms ( Age between 25-35, infertile woman with menstrual irregularities, headache, and vision issues) suggest this woman has clinical presentations of a prolactinoma. Hyperprolactinemia suggests there are high levels of prolactin. Dopamine is a known inhibition or prolactin secretion. Therefore, A bromeine agonist such as bromocriptine or cabergoline would be the best treatment

A 35-year-old female recently gave birth and is having difficulty with milk secretion. Her OB/GYN is concerned that she may have a complication in a specific cell type found in the anterior pituitary. Which hormone level does her OB/GYN need to evaluate? A. Growth hormone (somatotropin) B. Adrenocorticotropic hormone (corticotropin) C. Prolactin (PRL) D. Follicle stimulating hormone (FSH) E.Thyroid stimulating hormone (thyrotropin)

C. The physiologic action of prolactin is to stimulate milk secretion and production

The hypothalamus is a major secretory part of the brain that plays a key role in many organ systems in the body. Which of the following, secreted by the hypothalamus, is an inhibitory hormone that acts on somatotrophs to affect levels of growth hormone? A. Corticotropin releasing hormone B. Dopamine C. Somatostatin D. Gonadotropin releasing hormone E. Vasopressin (ADH)

C: Somatostatin is an inhibitory hormone that acts on somatotrophs and thyrotrophs to inhibit the release of growth hormone and thyroid stimulating hormone (TSH) by the anterior pituitary gland.

A 25-year-old female has been pregnant for the past 12 weeks. She has entered the second trimester of her pregnancy. She schedules an appointment with her physician for a checkup. While with her physician, the patient asks her for information regarding this stage of her pregnancy. She states that this stage is crucial for bone growth, as epiphyseal cartilage is being gradually replaced by vascular bone tissue. She also discusses the zones of epiphyseal cartilage. Which of the following zones has greatly enlarged cartilage cells that secrete VEGF? A. Zone of Reserve Cartilage B. Zone of Proliferation C. Zone of Hypertrophy D. Zone of Calcified Cartilage E. Zone of Resorption

C: The zone of hypertrophy is noted by the presence of greatly enlarged chondrocytes. These cells remain metabolically active, continuing to secrete type II and type X collagen. Furthermore, these cells also secrete VEGF, to initiate vascular invasion.

A 12 year old boy is brought by his mother to an orthopedist's office for continued knee pain after playing sports. The doctor explains to the patient and his mother that the patient has Osgood-Schlatter disease which is caused by inflammation in an area of long bones that is only found in growing adolescents. Which area of the bone does the inflammation occur? A. Diaphysis B. Bony collar C. Mixed spicule D. Epiphyseal growth plate E. Zone of reserve cartilage

D - the epiphyseal growth plate disappears as bone matures in a process called epiphyseal closure.

Amy is a 45-year-old female who has a history of type I diabetes and has always used an insulin pump to manage her disease. She has recently developed a wound on her foot that has not healed in months along with peripheral neuropathy, and she is worried that these complications are due to her diabetes. When she brings these up with her physician, they confirm her suspicions, and explain that for some DM type I patients, insulin therapy is not enough to prevent long-term complications of the disease because of another hormone imbalance in the body. What is this imbalance? a. Surplus of amylin b. Surplus of glucagon c. Deficiency of amylin d. Deficiency of glucagon e.Insulin is the only deficient hormone

C: a deficiency in amylin is the correct answer for this question. Individuals with type I diabetes experience destruction of the islet beta cells in the pancreas, and therefore lose the ability to secrete both hormones that are released there, which are insulin and amylin. This is in response to an increase in blood nutrient levels and may explain why insulin therapy for DM type I individuals is ineffective against the long-term complications of diabetes.

A group of researchers are studying the various modulators of growth hormone secretion in a sample of patients in order to provide a basis for clinical treatment for associated disorders. Their goal is to target the major influence in stimulation of growth hormone release for development of a new suppressive drug. Which of the following factors should the research team focus on? A. IGF-1 B. Somatostatin C. GHRH D. Blood glucose levels E.Blood amino acid levels

C—Although the regulation of GH secretion is complex, the major influence is hormonal. GHRH is released from the hypothalamus and directly stimulates GH secretion from the somatotrophs of the anterior pituitary.

A 14-year-old female presents to her primary care physician with an unusual complaint of polyuria and polydipsia. Lab tests conducted elucidate that the main cause of her symptoms was due to low potassium levels (Hypokalemia). An electrolyte imbalance known to cause Diabetes insipidus. She was instructed to start taking potassium supplements in conjunction with fruits and vegetables as a way of mitigating her symptoms. Which of the following below is NOT a cause of Diabetes Insipidus? A. V2 receptor gene mutation B. Hypophysectomy C. Intrasellar and Suprasellar tumors D. Hypocalcemia E.Sickle cell anemia

D - All of the following are known to cause Diabetes Insipidus except Hypocalcemia. On the contrary, Hypercalcemia would be one of the causes for the inhibition of fluid reabsorption in the kidneys (Nephrogenic Diabetes Insipidus) via the downregulation of AQP-2 channels.

A 32-year-old male went to his PCP with complaints of weight loss, fatigue, and muscle weakness. The patient's blood samples were taken for analysis. Results indicated potassium levels were normal, but the patient had decreased cortisol levels. The PCP believed she knew the issue at hand, so she requested an insulin tolerance test for her patient, which is the "gold standard" diagnostic test for this suspected insufficiency. What is the most likely hormone that is insufficient in the patient and what is the typical treatment for this insufficiency? A. Cortisol; glucocorticoid replacement therapy only B. ACTH; testosterone replacement C. Gonadotropin; glucocorticoid replacement therapy D. ACTH; glucocorticoid replacement therapy E.Cortisol; testosterone replacement

D - Both primary (adrenal gland isn't making enough hormones) and secondary (pituitary is not making enough ACTH) adrenal insufficiency are characterized by weight loss, fatigue, and muscle weakness; however, primary adrenal insufficiency can be ruled out because the patient's potassium levels are normal. Hyperkalemia is seen in patients with primary adrenal insufficiency, but not in patients with ACTH deficiency. When ACTH deficiency is suspected, blood samples are taken for analysis, especially of the level of cortisol in the blood. If the concentration of cortisol is low, it typically indicates a low concentration of ACTH. The "gold standard" for diagnosis of secondary adrenal insufficiency has been an insulin tolerance test, unless the patient is elderly, has a history of seizures, cardiovascular disease or cerebrovascular disease, but none of these were indicated in the question. With that said, the most likely hormone that is insufficient in the patient is adrenocorticotropic hormone, also known as ACTH. The typical treatment for this secondary adrenal insufficiency is glucocorticoid replacement therapy in the form of hydrocortisone or prednisone. Mineralocorticoids replacement are not usually needed in patients with central adrenal insufficiency.

A very active 13-year-old male presents to his pediatrician for his annual check-up. The physician learns the patient is constantly exercising, and as a precaution decides to run some lab tests. When the lab results return, it is noted that the patient has hypoglycemia. The physician conveys that they will run further tests, but as a side note mentions that constant exercise and hypoglycemia are known to stimulate secretion of growth hormone. Which of the following factors are known to act in an opposite manner, and inhibit the secretion of growth hormone? A. Starvation and fasting B. Decreased free fatty acids in the blood C. Trauma D. Exogenous growth hormone E.Testosterone

D - Exogenous growth hormone. Exogenous growth hormone has the ability to inhibit the release of growth hormone due to negative feedback. Each of the other choices would stimulate the secretion of growth hormone.

Marcie, 63, African American female presented to her primary care physician with constant thirst, hunger, frequent urination, and fatigue. After extensive lab testing, her doctor diagnoses her with Type II diabetes. If his diagnosis is correct and he prescribes her medication that acts to reduce her blood glucose levels by altering the effects of gastrointestinal peptides, what is a reasonable target(s) of the medication and what affect does the peptide exert? a. Glucagon, increases pancreatic Beta cell activity b. Glucagonlike peptide-1, Decreases synthesis of insulin c. Glucagon like peptide-1, Increases synthesis and decreases release of insulin d. Glucose dependent insulinotropic polypeptide AND Glucagon like peptide-1, Increase synthesis and release of Insulin e.Gastrin, Increases release of Insulin from pancreatic B-cells

D - Glucose dependent insulinotropic polypeptide AND Glucagon like peptide-1, Increase synthesis and release of Insulin.

A med student is reviewing thyroid hormones and their effects for their upcoming exam. Which of the following Is NOT true regarding the thyroid hormone, T3? A. T3 increases glucose uptake by muscle cells B. T3 increases the flow of fatty acids to the liver C. T3 is the active form of the hormone D. LOW levels of T3 inhibit the release of TRH from the hypothalamus E. None of the above

D - HIGH levels of T3 inhibit the release of TRH from the hypothalamus (Page 1843).

A diabetic researcher is able to measure his blood insulin level at home and is curious about how Thanksgiving dinner will impact his insulin level. He first takes a reading in the morning after a light breakfast and then one after dinner. Not to his surprise, his insulin level was significantly higher after the large meal. What hormone is responsible for increasing the level of insulin in the researcher's blood? A. Glucagon B. Neuropeptide Y C. Amylin D. Gastric inhibitory polypeptide E.Ghrelin

D- Gastric inhibitory polypeptide (GIP) increases insulin release and regulates glucose/lipid metabolism. GIP is stimulated via oral nutrient ingestion and is especially responsive to long-chain fatty acids.

A 19 year old female presents to her primary care physician with hot flashes, slow breast growth, and a low sex drive. Additionally, she notes a lack of menstruation, which the physician notes as unusual for her age. Blood work reveals decreased secretion of FSH and LH from the anterior pituitary, and the physician diagnoses her with Hypogonadotropic hypogonadism. The patient is placed on oral estrogen replacement therapy as well as progesterone. What is the primary role of the progesterone therapy prescribed by the physician? A. Treat infertility B. Stimulate breast growth C. Induce hyperplasia of the endometrium D. Induce withdrawal bleeding to prevent endometrial hyperplasia E.Stimulate the growth and development of follicles in the ovaries

D - Progesterone is an important hormone regulator of the menstrual cycle. In a typical menstrual cycle, progesterone levels rise following ovulation and helps thicken the lining of the uterus to prepare for fertilization. If fertilization does not occur, progesterone levels drop and menstruation begins. This patient does not produce enough progesterone (or LH/FSH) to induce a typical menstrual cycle, thus the physician prescribed the hormone replacement therapy. Progesterone is given to simulate the increased levels, and subsequently stopped in order to induce withdrawal bleeding as progesterone levels decrease. By inducing menstruation, this helps prevent endometrial hyperplasia by shedding the endometrium.

A 19 year old female visits her PCP with a complaint of pain in her anterior cervical spine that radiates into her jaw and ears. Upon examination of the thyroid gland via palpation of the neck, there is no abnormality noted. The patient previously suffered from and completed treatment for a viral infection. The physician determines the patient may be suffering from Granulomatous thyroiditis. What serum values will be elevated in this patient? A. TSH B. T3 C. T4 D. T3 and T4 E. All of the above

D - T3 and T4- Correct because these will be the most elevated, notable lab values in a patient with Granulomatous thyroiditis.

A 25-year-old female presents to her PCP with complaints of fatigue, weight gain, mental cloudiness, constipation, and mainly cold sensitivity. Her PCP orders bloodwork for suspicion of a thyroid disorder. The results show that she has high TSH, low T3, and low T4. Knowing this, the lack in which molecule is causing her main concern, and what is its mechanism of action? A. TSH; sensitizing various tissues to the actions of epinephrine B. T3; stimulating the production and secretion of T4 C. T4; stimulating iodide trapping from plasma into the thyroid gland D. T3; increasing the activity of Na+/K+ -ATPase, stimulating the regeneration of more ATP and heat from oxidative phosphorylation E. TSH; inhibiting the production and secretion of T3 and T4

D - T3 is the predominant biologically active for of thyroid hormone in the body. T3 acts on the sympathetic nervous system by increasing the release of norepinephrine. In adults, norepinephrine increases permeability of BAT and skeletal muscle to sodium. The increase in intracellular sodium stimulates Na+/K+ -ATPase to increase its activity, using more ATP. The increased ATP demand stimulates the regeneration of more ATP and heat from oxidative phosphorylation. This process helps to regulate a person's body temperature in spite of rapidly changing environmental conditions.

The infundibular portal system transports hormones from the hypothalamus to the anterior lobe. The supraoptic and paraventricular nuclei of hypothalamus synthesize hormones transported to the posterior lobe along the supraopticohypophyseal tract. Which of the following hormones is not produced by the anterior pituitary? A. ACTH B. LH C. FSH D. Oxytocin E.GH

D - The anterior pituitary produces ACTH, FSH, LH, GH , prolactin, and TSH. The posterior pituitary produces vasopressin (AVP or ADH) and oxytocin. The question is asking which hormones are NOT produced by the anterior pituitary gland, all the other hormones besides D (oxytocin) are produced by the anterior pituitary.

Mary was returning home from visiting her neighbor when she rolled her ankle, descending an exterior staircase. Unable to balance, Mary fell, impacting the diaphysis of her fibula on a step, resulting in a fracture. From deep to superficial, what tissue and/or tissue layers are present at the site of fracture described? A. THICK spongy (cancellous) bone, THIN compact (dense) bone, articular (hyaline) cartilage B. THICK spongy (cancellous) bone, THIN compact (dense) bone, periosteum, articular (hyaline) cartilage C. THICK spongy (cancellous) bone, THIN compact (dense) bone, periosteum D. THIN spongy (cancellous) bone, THICK compact (dense) bone, periosteum E. THIN spongy (cancellous) bone, THICK compact (dense) bone, articular (hyaline) cartilage

D - The innermost area of the diaphysis of long bones contains a medullary cavity, which houses the bone marrow. At most, a thin layer of spongy (cancellous) bone complexes the marrow. The majority of the diaphysis is composed of thick, compact (dense) bone covered in a layer of periosteum.

A 65-year-old female comes into the office with complaints of knee pain. Her pain has been present for 6 months, with no known injury. She states her knees bother her when kneeling and trying to go up and down stairs. An x-ray was ordered, which revealed a moderate to severe degree of osteoarthritis. Which structure is diminished in the patient's knees? A. Fibrocartilage B. Elastic cartilage C. Medullary cavity D. Hyaline cartilage E.Periosteum

D - The knee is a freely movable joint known as a synovial joint. The ability for this joint to perform its function can be attributed to bone tissue, ligaments, and hyaline (articular) cartilage. Hyaline cartilage is found where the bones articulate and osteoarthritis can be attributed to diminished hyaline cartilage.

A 48-year-old female who recently moved from Washington D.C to Chicago went to see her PCP for the first time to establish care and review the lab work that she completed prior to the visit. During the visit, the physician asked the patient about her past medical history, past surgical history, and family history. The patient reported a past medical history of hypertension which has been under good control, no past surgical history, and a family history of diabetes mellitus type 2 in her father and hyperlipidemia in her mother. While reviewing the lab work with the patient, the physician noticed that the patient's T3 and T4 levels were below the reference range while the TSH level was above the reference range. After further questioning, the patient admitted that she had been experiencing fatigue, weight gain, and cold sensitivity which onset about 4 months ago but thought nothing of it and instead, attributed her symptoms to the recent move, working overtime, and the winter holidays/festivities. During the physical exam, a goiter was noted. Which of the following is the most likely diagnosis for this patient? A. Congenital hypothyroidism B. Iatrogenic hypothyroidism C. Thyrotoxicosis D. Hashimoto thyroiditis E. Apathetic hyperthyroidism

D - The patient's lab results, symptoms, and physical examination suggests that she will most likely be diagnosed with hypothyroidism, in this case, Hashimoto thyroiditis. Hashimoto thyroiditis is common in women between 45-65 years of age and is the common cause of hypothyroidism in places where iodine levels are sufficient.

A 75 y/o female presents to the ED following a ground level fall. The pt states that she tripped over the legs of her chair and fell to the floor landing on her back. After getting some imaging done, the pt was found to have a compression fracture to her L1/L2 region. The pt includes that she is suffering from osteoporosis when asked about her medical history. Which of the following is NOT a complication caused by osteoporosis? A. Decreased bone mass B. Enhanced bone fragility C. Increased risk of fracture D. Increased bone density E. Loss of height

D- osteoporosis is the most common type of bone disease, especially in post-menopausal women. It is characterized by the progressive LOSS of bone density accompanied by the deterioration of the microarchitecture.

A 15 year old female with a history of type 2 diabetes mellitus and hypertension presents to her PCP complaining of excessive weight gain around her midsection despite increased exercise (central obesity), growth of facial hair, and muscle weakness. Which test should the physician order to determine the correct diagnosis? A. 24-hour urine collection B. Late night salivary cortisol measurement test C. A & E D. A, B & E E. 1-mg dexamethasone suppression test

D- three tests are performed in conjunction to assess for high levels of endogenous hypercortisolism (Cushing's Disease). A 24-hour urine collection, late night salivary cortisol measurement, and a 1-mg dexamethasone suppression test are all used to diagnose Cushing's disease.

A researcher is interested in isolating amylin from blood samples for further analysis. When should the researcher choose to take blood samples, to have the highest yield of amylin in the blood? A. During a brief fast B. When glucagon levels are high C. Before exercising D. 1 hour after a meal E. When blood glucose is low

D. Amylin is released from beta cells in the pancreas and is cosecreted with insulin. Because of this, amylin will have peak blood concentration at the same time that insulin peaks. Insulin and amylase are secreted when blood glucose becomes high, in this instance the only option that indicates elevated blood glucose is choice D, after a meal.

Eva, a 34 yo female, presents to the clinic with fatigue and cold intolerance. When going through the physical exam you see that Eva has gained a significant amount of weight since her last check-up 6 months ago. Lab tests are ordered to check for inconsistencies. What hormone irregularity is most likely causing Eva's symptoms? A. High Thyroid Secreting Hormone B. High Growth Hormone secretion C. High Follicle Stimulating Hormone D. Low Thyroid Secreting Hormone E. Low Growth Hormone secretion

D. Eva has a lowered thyroid secreting hormone most likely caused by pituitary tumor. This results in weight gain, fatigue, cold intolerance, and constipation. Management focuses on replacement of hormones.

What process is responsible for the formation of an osteocyte in bone? A. An osteoprogenitor cell differentiates directly into an osteocyte B. An osteoblast becomes surrounded by cartilage C. An osteoblast turns into an osteocyte when it begins to resorb bone D. An osteoblast becomes completely surrounded by osteoid E. An osteoprogenitor cell is completely surrounded by osteoid

D. The book describes in detail how an osteocyte is formed. First an osteoprogenitor cell is differentiated into an osteoblast. This osteoblast will then begin to secrete bone matrix. Once an osteoblast is completely surrounded by a calcified bone matrix or osteoid, it is then referred to as an osteocyte.

A physiological researcher is conducting a study on the effects of growth hormone. In his study he is running 3 trials on mice; trial 1 mice have a genetic mutation making them unable to produce growth hormone, trial 2 mice have normal levels of growth hormone, and trial 3 have a genetic mutation making them over produce growth hormone. Lab tests were conducted on each trial and were compared. Which of the following would not be an accurate finding from trial 2 mice testing? A. Normal growth B. Increased rate of protein synthesis C. Increased mobilization of fatty acids from adipose tissue D. Reduced amino acid uptake E.Decreased rate of glucose utilization

D: Growth hormone enhances amino acid uptake and protein synthesis, thus reducing protein breakdown in the body. Answers A, B, C, E are all accurate metabolic effects of growth hormone

What cells secrete parathyroid hormone and what effect does parathyroid hormone have on the body? A. Parietal cells, decrease Calcium levels in the body B. Osteoclasts, increase T3 levels C. Osteoblasts, increase bone deposition D. Chief cells of parathyroid glands, increases bone resorption and releases calcium into the blood E. Parafollicular cells of thyroid gland, lowers elevated blood calcium levels to normal

D: PTH is secreted by the chief cells of the parathyroid glands and they act to increase calcium levels when depleted.

A researcher studying growth hormone in animals decided to remove pancreatic tissue and give inadequate amounts of carbohydrates in the diet. What is the most likely result of this experiment? A. Growth hormone will fail to cause growth B. There will be enough energy provided for the metabolism of growth C. Insulin will not have the ability to enhance transport of amino acids into the cell D. A & C E. All of the above

D: The experiment demonstrates that adequate carbohydrate intake and a functioning pancreas are crucial to growth hormone actually leading to growth. Carbohydrates provide energy and insulin's role is to enhance transport of amino acids into the cell. Without these components, the energy needed for the metabolism of growth will not be achieved.

A scientist is studying the effects of hormones on the sleep cycle. They discover that there is a certain hormone that characteristically increases during the first two hours of deep sleep. The scientist also notes that this hormone is associated with cartilage and bone growth. Which factor inhibits the secretion of this hormone? A. Decreased blood glucose B. Exercise C. Increased blood amino acids D. Increased blood glucose E. Ghrelin

D: The hormone discussed in the question is growth hormone. Growth hormone has been shown to characteristically increase during the first 2 hours of deep sleep and is also associated with cartilage and bone growth. Increased blood glucose inhibits secretion of growth hormone, as growth hormone is actually released during instances of starvation, or decreased blood glucose.

A patient comes into the ER with profuse sweating. Upon physical examination, the doctor notices the patient has coarsened, enlarged facial features. The doctor also notices that the patient has bulky hands and feets. After a series of tests, the doctor notifies the patient that her endocrine hormones are not normal. Based on the patient's symptoms, what did the doctor most likely notice when looking at the patient's report? A. Elevated LH levels B. Decreased GH levels C. Elevated FSH levels D. Elevated IGF-1 levels E. Decreased TSH levels

D: The patient is experiencing acromegaly. The symptoms of acromegaly include coarsened, enlarged facial features, bulky hands & feets as well as excessive sweating. Acromegaly occurs due to an increase in GH levels. Since GH stimulates the production of IGF-1, the patient would have elevated IGF-1 levels.

A researcher is studying how bones serve as a reservoir for body calcium. In an attempt to learn more about the regulatory effects the endocrine hormone calcitonin has on calcium levels, a mouse model is designed such that a population sample undergoes gene knockout targeting the calcitonin receptor. Assuming the effects of this knockout study result in complete calcitonin inefficacy, how should we expect the serum calcium concentration to change? A. Rapidly increased serum calcium B. Slowly increased serum calcium C. Decreased serum calcium D. No change in serum calcium E. Not enough information to determine

D: There will be no change in serum calcium. As we know, the function of calcitonin is to act on the bone to decrease elevated calcium levels to normal. Thus, the hormone doesn't work to increase calcium levels. Instead, the function is to decrease calcium levels from an elevated state to normal. In addition, calcitonin inhibits bone resorption and works as a counter-regulator to parathyroid hormone (PTH) specifically inhibiting the effects of PTH on osteoclasts. Interestingly, it's worthy to note that calcitonin is secreted by the parafollicular cells of the thyroid gland and patients who undergo thyroid removal have undetectable levels of calcitonin post-op with little to no clinical significance.

ACTH deficiency causes secondary adrenal insufficiency. This leads to decreased cortisol secretion and decreased adrenal androgen secretion. Another hormone released by the adrenal glands is aldosterone. How is aldosterone secretion affected by ACTH deficiency and why? A. Unaffected, ACTH still stimulates aldosterone release B. Affected, ACTH still stimulates aldosterone release C. Affected, ACTH is decreased which decreases aldosterone release D. Affected, the renin-angiotensin axis maintains aldosterone E. Unaffected, the renin-angiotensin axis maintains aldosterone

E Although aldosterone comes from the adrenal glands like cortisol, only cortisol is stimulated by ACTH. Aldosterone is maintained by the renin-angiotensin system and will be completely unaffected by the levels of ACTH.

A student athlete who sustained a concussion on the field 1 month ago reported to his PCP because he was urinating very frequently and constantly thirsty. Upon lab testing, his serum sodium levels were 160 mEq/L (Normal: 135-145 mEQ/L). Which pituitary gland is the cause of this and what's the disorder? A. Anterior Pituitary; Empty Sella Syndrome B. Anterior Pituitary; Pituitary apoplexy C. Posterior Pituitary; Syndrome of inappropriate ADH (SIADH) D. Anterior Pituitary; Rathke cleft cyst E. Posterior Pituitary; Diabetes Insipidus

E Increased sodium levels suggest that ADH isn't working properly and is more than likely being secreted at a lower rate than usual. ADH is a hormone stored in the posterior pituitary gland so only C & E are options.

A 7 month old recently had an x-ray done that showed denser than normal looking bone. However, upon further testing, it was discovered that the infants bones are actually very fragile and break easily. The physician diagnoses the infant with osteopetrosis, a rare congenital disease characterized by increased bone density and defective function of which bone tissue cell type? A. Bone lining cells B. Osteocytes C. Osteoprogenitor cells D. Osteoblasts E. Osteoclasts

E - Osteoclasts are responsible for breaking down bone, in a patient with osteopetrosis, proteins such as cathepsin K, carbonic anhydrase II, and proteins that code for proton pump TCIRG1 are deficient. With reduced activity of osteoclasts, damaged and unhealthy bone is not broken down, and remains in the body.

A 5-year-old boy arrives at his local clinic in Costa Rica having a distinct "square" appearance. The attending physician requests an X-ray that shows bowed lower limbs and a deformed chest and skull. The physician diagnoses the child with rickets, a condition in which the bone matrix does not calcify normally. What nutritional deficiency is present in this boy? A. Vitamin A deficiency B. Vitamin C deficiency C. Vitamin K deficiency D. Calcium deficiency E. Calcium and/or Vitamin D deficiency

E - Rickets presents with the classical radiological symptoms of bowed lower limbs and a deformed chest and skull. Rickets may be caused by insufficient amounts of dietary calcium or insufficient vitamin D. Vitamin D is needed for absorption of calcium by the intestines and for normal calcification. Calcium plays a role in proper calcification of the bone matrix.

A 6-year-old male comes into the ER with his concerned parents due to a broken bone he acquired while playing family football over Thanksgiving. This is the boys 4th trip to the ER suffering from a broken bone. The doctors are concerned and questioning whether they should call child-protective services. When the attending notices the patient's dental imperfections, and acute hearing loss he diagnoses the child with a genetic condition associated with which of the following? A. Stretchy skin B. Long arms C. Elastin D. Fibrillin E. Blue Sclera

E - The patient has had multiple bone fractures at a young age which is indicative of osteogenesis imperfecta (OI). This condition is often confused with child abuse and the main symptoms are multiple bone fractures, blue sclera, dental imperfections, and hearing loss. OI is an autosomal dominant condition resulting in a decrease in normal type 1 collagen.

A 13-year-old male patient was initially brought into the clinic by his parents complaining about his short stature and not growing as much, compared to his peers in school. Lab results show a low level of insulin-like growth factor-I (IGF-I). Additional tests led to a diagnosis of growth hormone deficiency in the patient. In addition to the clinical presentation of growth retardation and short stature, what other clinical presentation should be a concern for the patient? A. acromegaly B. gigantism C. increased bone mineralization D. increased muscle strength E. fasting hypoglycemia

E - the patient is a child with growth hormone deficiency. This is confirmed by the short stature, growth retardation, and by the low IGF-I levels. Another clinical presentation of growth deficiency in children is fasting hypoglycemia.

A 51-year old woman presents to her primary care physician with complaints of fatigue, weight gain, mood swings, and lethargy. Upon assessment the physician notices enlargement of the thyroid. In order to confirm the physician's diagnosis a thyroid panel is ordered. The results show an increase in TRH, an increase in TSH, and a decrease in T3/T4. What is this patient at an increased risk of developing due to her recent medical finding? a) Type 1 diabetes b) Asthma c) Systemic lupus erythematosus d) Myocardial infarction e)Both A and C

E The correct answer is E because in the case description it describes the patient being diagnosed with Hashimoto Thyroiditis. Hashimoto Thyroiditis is marked by hypothyroidism which includes the symptoms of fatigue, weight gain, lethargy, and mood swings. Hashimoto Thyroiditis also causes an increase in TSH and TRH and a decrease in T3 and T4. Hashimoto Thyroiditis puts patients at an increased risk for both type 1 diabetes (endocrine) and systemic lupus erythematosus (non-endocrine).

A patient reports to her PCP for her yearly checkup, The woman has had a developmental disorder since she was a kid that involves her not producing enough GHRH which in turn results in less GH being released and stunted growth. In a normal individual what is the correct travel route in the hypothalamic-hypophyseal portal vessel system? a. Posterior Pituitary -> Portal Vessels -> Median eminence -> Hypothalamus b. Hypothalamus -> Anterior Pituitary -> Median eminence -> Portal Vessels c. Hypothalamus -> Median Eminence -> Portal Vessels -> Posterior Pituitary d. Median Eminence -> Portal Vessels -> Anterior Pituitary -> Hypothalamus e. Hypothalamus -> Median Eminence -> Portal Vessels -> Anterior Pituitary

E because it follows the correct path through the hypothalamic-hypophyseal portal vessel system. An example would be GHRH, it is first produced in the hypothalamus, and then released through the Median Eminence into the Portal vessels. GHRH will then travel to the Anterior Pituitary and bind to Somatotrophs which will signal them to release GH.

Multiple patients are seen in a small, remote village with concerns of the development of goiters. The doctor believes the soil in the area is deficient in iodide which could be causing the hypothyroidism in the patients. What is an effect of hypothyroidism and how is thyroid hormone secretion affected? A. Weight loss and increased secretion of thyroid hormone B. Weight loss and reduction in secretion of thyroid hormone C. Weight gain and increased secretion of thyroid hormone D. Weight does not change and increased secretion of thyroid hormone E. Weight gain and reduced secretion of thyroid hormone

E → Areas where soil is deficient in iodine, it is common for patients to have goiters as a result of hypothyroidism. Iodide is an important part in the production of thyroid hormones. Patients with hypothyroidism often have weight gain as a side effect and reduced secretion of thyroid hormones (due to lack of iodide in the diet).

A 22-year-old female college student recently discovered a passion for powerlifting. Before the discovery of her new sport she was naturally thin compared to most of her classmates. As she progressed and began to increase the amount of weight of her lifts, she became worried that her bones might not be able to routinely support the amount of weight without injury. Luckily, being a healthy individual, she had properly functioning bone cells that responded to the heightened force to increase the rate of new bone deposition and prevent injury. What type of cell is responsible for directly responding to the force applied to her bones? A. Osteoblasts B. Osteoclasts C. Bone lining cells D. Osteoprogenitor cells E. Osteocytes

E. Osteocytes are mature, metabolically active bone cells that are surrounded by bone matrix. When force is applied to the bone, voltage gated calcium channels in the membranes of the osteocytes open, resulting in increased intracellular calcium levels as well as an increased concentration of many other molecules used in bone formation. They also cause altered expression of the bone forming genes c-fos and cox-2. IGF-1 production is also increased leading to increased conversion of osteoprogenitor cells into osteoblasts.

Which of the following zones of cartilage of the epiphyseal plate contain cells that are impregnated with calcium salts and serves as the initial scaffold for the deposition of new bone? A. Zone of proliferation B. Zone of resorption C. Zone of reserve cartilage D. Zone of hypertrophy E. Zone of calcified cartilage

E. Zone of Calcified Cartilage. In this zone of cartilage, the cells are being impregnated with calcium salts, as well as serve as the initial scaffold for new bone.

A patient presents to their family care office with persistently elevated BP associated with palpitations. Previous lab tests have shown normal TSH levels and the patient was subsequently diagnosed with a pheochromocytoma which causes excess catecholamines in the blood. Where is the tumor located? A. Kidney B. Adrenal cortex C. Pituitary D. Hypothalamus E. Adrenal medulla

E. catecholamines are synthesized predominantly in the adrenal medulla. (pg 1828)

A 25 year old female visits her PCP for follow up care of hyperthyroidism which manifests with signs and symptoms of being in a hypermetabolic state. Which of the following is not a characteristic clinical finding the physician would expect to see in a patient with hyperthyroidism or thyrotoxicosis? A. Elevated cardiac contractility B. Abrupt onset of severe hyperthyroidism known as thyroid storm C. Hypermotility and reduced transit times leading to hyperdefecation D. Heat intolerance E. Diabetes insipidus

E: Diabetes insipidus is a clinical characteristic of posterior pituitary syndromes caused by ADH deficiency. Characterized by polyuria due to the inability of the kidney to reabsorb water properly from the urine.

Regina Phalange arrives to her PCP, Dr. Phoebe Buffay, complaining of recent uncontrolled weight gain, lethargy, and she has even mentioned loss of sexual functions as of late. Dr. Buffay diagnoses Regina with Panhypopituitarism. What is the mechanism impacting the release of these hormones resulting in Regina's condition? A. Increased stimulation of nerve tracts in the hypophysial stalk B. Increased secretion of hypothalamic releasing hormones C. Increased stimulation of lactotropes D. Decreased stimulation of nerve tracts in the hypophysial stalk E.Decreased secretion of hypothalamic releasing hormones

E: Panhypopituitarism (found on pg. 947) is a condition that results from decreased production of glucocorticoids, gonadotropic hormones, and thyroid hormones. The decreased secretion/production of these hormones results in lethargy, weight gain, and loss of sexual function, all of which Regina had and led to the diagnosis of Panhypopituitarism. The decreased production of these hormones is a result of the decreased release of hypothalamic releasing hormones that stimulate the anterior pituitary gland to release these hormones.

A 19-year-old college student is studying for final exams and neglects to eat anything for 20 hours. He reports feeling fatigued and dizzy and blood tests reveal increased glucagon levels. Which one of the following effects will glucagon have on the student's metabolic state? A. Decreased glycogenolysis B. Decreased ketogenesis C. Increased glycogenesis D. Decreased gluconeogenesis E. Increased glycogenolysis

E; Glucagon promotes glycogenolysis, or the breakdown of glycogen, in response to brief fasts to maintain blood glucose homeostasis. Glucagon also promotes ketogenesis and gluconeogenesis during fasting state.

A 34-year-old patient was diagnosed with pheochromocytoma, which is a rare tumor of the adrenal medulla causing a hypersecretion of epinephrine and norepinephrine. The patient presented with secondary hypertension and an elevated blood glucose level. Which of the following describes why an increase in catecholamines leads to a significant rise in glucose levels? A. Catecholamines stimulate co-secretion of insulin and amylin B. Catecholamines suppress insulin secretion C. Catecholamines suppress glucagon secretion D. Catecholamines mobilize fuels from their storage sites for oxidation E. Both B and D are correct.

E—Epinephrine and Norepinephrine are typically released during acute or chronic stress, or in this case by a tumor of the adrenal medulla, Pheochromocytoma. Since there is a hypersecretion of catecholamines, the patient will have elevated glucose levels due to the continuous mobilization of fuels from their storage sites and due to suppression of insulin secretion. In a normal patient, catecholamines suppress insulin during acute/chronic stress to promote fuel metabolism and halt fuel storage. Once the energy requirement is met or the stressful stimulus is removed, the catecholamines can be inactivated and degraded. However, in patients with pheochromocytoma, the rate of catecholamine degradation is not sufficient overcome the continuous secretion due to the tumor.

Kris Kringle, an elderly gentleman, decided to see his PCP because his boss, Mr. Claus, told him his face was looking very flushed. Mr. Kringle did not think he was in a hypermetabolic state at first, as he was working outside more due to the busy season of his job approaching. However, Mr. Kringle became increasingly worried that something was wrong as he started to feel palpitations in his chest, muscle weakness, and noticed a small tremor developing in his hands. Blood tests show an elevation in activity of an endocrine gland. What organ is most likely overactive and producing Mr. Kringle's symptoms? A. Pancreas B. Growth hormone gland C. Thyroid gland D. Parotid gland E. Posterior pituitary gland

Mr. Kringle is suffering from hyperthyroidism (also referred to thyrotoxicosis in the book). Hyperthyroidism is a hypermetabolic state caused by elevated circulating levels of free T3 and T4. Clinical manifestations of hyperthyroidism include warm or flushed skin, cardiac manifestations including arrhythmias (presented as palpitations), and overactivity of the SNS which produces tremors and muscle weakness. The thyroid gland is the organ in charge of synthesizing T3 and T4 after thyrotrophs from the anterior pituitary release TSH.