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First Aid 2013 EXPRESS workbook: ENDOCRINE
page 1
Endocrine
How to Use the Workbook with the Videos
Using this table as a guide, read the Facts in First Aid for the USMLE Step 1 2013,
watch the corresponding First Aid Express 2013 videos, and then answer the workbook
questions.
Facts in First Aid
for the USMLE
Step 1 2013
286.1286.2
Endocrine Embryology
12
286.3289.1
Endocrine Anatomy
39
289.2294.2
1017, 52
294.3295.2
1819
296.1297.4
2028
298.1300.2
2937
301.1303.2
3845
304.1304.3
4647
305.1306.5
Endocrine Pharmacology
4852
Workbook
questions
v 1.2
Questions
EMBRYOLOGY
1.
Which structure connects the thyroid gland with the tongue? (p. 286) ________________________
2.
What hormone secreted by the fetal adrenal gland late in gestation is critical for lung maturation
and surfactant production? (p. 286) __________________________________________________
ANATOMY
3.
What are the three major zones of the adrenal gland? List the major secretory product of each.
(p. 286) ________________________________________________________________________
4.
What is the most common adrenal medulla tumor in children? In adults? (p. 286) ______________
______________________________________________________________________________
5.
What are the two divisions of the pituitary gland? Which hormones does each secrete? (p. 287) __
______________________________________________________________________________
6.
What cells produce the hormones released by the posterior pituitary gland? (p. 287) ____________
7.
Name the three major cell types of the Islets of Langerhans. What critical hormone is secreted by
each cell? (p. 287) _______________________________________________________________
______________________________________________________________________________
8.
Which tissues do not need insulin to facilitate glucose uptake? (p. 288) ______________________
______________________________________________________________________________
9.
If you suspect that a hypoglycemic patient with high insulin levels is surreptitiously using exogenous
insulin, what should you test for? (p. 288) ______________________________________________
PHYSIOLOGY
10.
Which two molecules control the secretion of prolactin? Are they stimulatory or inhibitory? (p. 290)
______________________________________________________________________________
11.
What is the major axis at the core of endocrinology? (p. 290) _____________________________
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12.
page 3
For each of the congenital bilateral adrenal hyperplasias, indicate whether blood pressure and sex
hormone levels are increased or decreased. (p. 291)
Disease
Blood Pressure
Sex Hormones
11-hydroxylase deficiency
17-hydroxylase deficiency
21-hydroxylase deficiency
13.
What enzyme modulates the conversion of testosterone to estradiol? What enzyme modulates the
conversion of testosterone to DHT? (p. 291) ___________________________________________
14.
15.
16.
Which kidney enzyme acts on vitamin D to activate it? (p. 294) ____________________________
17.
What condition can vitamin D deficiency cause in children? In adults? (p. 294) ________________
______________________________________________________________________________
18.
19.
How do T3 and T4 control the bodys metabolic rate? (p. 295) ______________________________
______________________________________________________________________________
PATHOLOGY
20.
What is the most common cause of Cushings syndrome? (p. 296) _________________________
21.
For a patient who is not taking steroids, what are the other potential causes of Cushings syndrome
and the likelihood (% of risk) that the patient would have any one of them? (p. 296) ___________
______________________________________________________________________________
22.
What are the common clinical manifestations of Cushings syndrome? (p. 296) ________________
______________________________________________________________________________
23.
24.
25.
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26.
What are the three common causes of Waterhouse-Friderichsen syndrome? (p. 297) ___________
______________________________________________________________________________
27.
What is the rule of 10s for pheochromocytoma? What is the cell of origin for this tumor? (p. 297)
______________________________________________________________________________
______________________________________________________________________________
28.
What are the signs and symptoms of pheochromocytoma? (p. 297) _________________________
______________________________________________________________________________
29.
Compare and contrast the characteristics of hypothyroidism vs. hyperthyroidism. (p. 298)
Sign/Symptom
Hypothyroidism
Hyperthyroidism
Activity level
Bowel movements
Cardiovascular changes
Edema
Free T4
Hair texture
Reflexes
Skin changes
T3 uptake
Temperature
Total T4
TSH level
Weight
30.
31.
What is the difference between de Quervains thyroiditis and Riedels thyroiditis? (p. 298) _______
______________________________________________________________________________
32.
33.
What are the four types of thyroid cancer? Which is most common? (p. 299) _________________
______________________________________________________________________________
34.
35.
What does the mnemonic stones, bones, and groans stand for? (p. 300) ___________________
______________________________________________________________________________
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page 5
36.
37.
38.
What are the symptoms of the most common form of pituitary adenoma? (p. 301) _____________
______________________________________________________________________________
39.
40.
41.
What are the differences between DI and SIADH? (p. 301) ________________________________
______________________________________________________________________________
42.
What are the acute manifestations of diabetes mellitus type 1? (p. 302) ______________________
______________________________________________________________________________
43.
What are the chronic manifestations of poorly controlled diabetes? (p. 302) ___________________
______________________________________________________________________________
44.
Compare and contrast the characteristics of type 1 vs. type 2 diabetes. (p. 303)
Type 1
Type 2
How can patients with diabetic ketoacidosis be recognized by their breath? (p. 303) ____________
______________________________________________________________________________
46.
What are the signs and symptoms of carcinoid syndrome? (p. 304) _________________________
______________________________________________________________________________
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47.
Check which components are involved in the multiple endocrine neoplasias. (p. 304)
MEN 1
MEN 2A
MEN 2B
Pancreas
Parathyroid
Pituitary
Pheochromocytoma
PHARMACOLOGY
48.
What eight classes of drugs are used to treat diabetes mellitus? (p. 305) ____________________
______________________________________________________________________________
______________________________________________________________________________
49.
50.
51.
52.
What is the most feared complication of glucocorticoid overdose? (pp 291, 306) _______________
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page 7
Answers
EMBRYOLOGY
1.
2.
Cortisol.
ANATOMY
3.
Zona glomerulosa produces aldosterone, zona fasciculata produces cortisol, and zona reticularis
produces sex hormones.
4.
Neuroblastoma; pheochromocytoma.
5.
Posterior pituitary: ADH (vasopressin), oxytocin. Anterior pituitary: FSH, LH, ACTH, TSH, prolactin,
GH.
6.
7.
cells produce insulin. cells produce glucagon, and cells produce somatostatin.
8.
9.
C-peptide is absent if the source of insulin is exogenous and present in high levels if the patient
has an insulinoma.
PHYSIOLOGY
10.
11.
12.
Disease
Blood Pressure
Sex Hormones
11-hydroxylase deficiency
17-hydroxylase deficiency
21-hydroxylase deficiency
13.
Aromatase; 5-reductase.
14.
CRH stimulates release of ACTH in pituitary, which prompts coritsol production in the adrenal zona
fasciculata.
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15.
16.
1-hydroxylase.
17.
Rickets; osteomalacia.
18.
Decrease; decrease.
19.
By increasing Na /K -ATPase activity, which increases oxygen consumption, respiratory rate, and
body temperature.
PATHOLOGY
20.
Iatrogenic steroids.
21.
Cushings disease (pituitary adenoma): 70%. Ectopic ACTH (e.g., small cell lung cancer): 15%.
Adrenal tumor: 15%.
22.
Weight gain (truncal obesity), moon facies, buffalo hump, skin thinning, striae, hypertension,
hyperglycemia, osteoporosis, amenorrhea, and immunosuppression.
23.
Dexamethasone challenge.
24.
Decreased; increased.
25.
26.
27.
10% are malignant, 10% are bilateral, 10% are extra-adrenal, 10% calcify, 10% occur in kids, and
10% of cases are familial. Chromaffin cells are the cells of origin for pheochromocytoma.
28.
Elevated blood Pressure, Pain (headache), Perspiration, Palpitations (tachycardia), and Pallor.
These 5 Ps are episodic.
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page 9
29.
Sign/Symptom
Hypothyroidism
Hyperthyroidism
Activity level
Bowel movements
Constipation
Diarrhea
Cardiovascular changes
Bradycardia; dyspnea
on exertion
Chest pain,
palpitations,
arrhythmias
Edema
Myxedema
Pretibial myxedema
Free T4
Hair texture
Coarse, brittle
Weight
Cold intolerance
Heat intolerance
(if primary)
(if primary)
Total T4
TSH level
T3 uptake
Temperature
Fine
Reflexes
Skin changes
30.
31.
32.
33.
34.
35.
Renal calcium stones, osteitis fibrosa cystica of bones, and abdominal complaints (groans due to
constipation).
36.
In hypoparathyroid patients, tapping of the facial nerve causes the facial muscles to contract.
37.
38.
39.
Water deprivation test: urine osmolality doesnt increase in response to water deprivation.
Response to desmopressin can distinguish between central and nephrogenic DI.
40.
Ectopic ADH (e.g., small cell lung cancer), CNS disorder/head trauma, pulmonary disease, and
drugs such as cyclophosphamide.
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41.
DI denotes lack of ADH; SIADH denotes too much ADH. DI is characterized by intense thirst and
polyuria, with high serum osmolarity and low urine concentration. SIADH is characterized by
excessive water retention, with high urine osmolarity and low serum osmolarity.
42.
Polydipsia, polyuria, polyphagia, weight loss, DKA, and exacerbation of hyperglycemia due to
unopposed GH and epinephrine secretion.
43.
44.
Type 1
Type 2
No
Yes
Genetic predisposition
Weak
Strong
Glucose intolerance
Severe
Mild to moderate
Ketoacidosis
Common
Rare
Always
Sometimes
Primary defect
Destruction of cells
Sensitivity to insulin
High
Low
<30 years
>40 years
45.
Increased ketogenesis results in accumulation of acetone and other ketones; when exhaled,
acetone gives breath a fruity odor.
46.
47.
MEN 1
Pancreas
Parathyroid
Pituitary
Pheochromocytoma
MEN 2A
MEN 2B
PHARMACOLOGY
48.
49.
Lactic acidosis.
50.
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51.
52.
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