Part 10.2- ENDOCRINE SYSTEM

Proverbs 16:3

b. Adrenal cortex and adrenal medulla

[ADRENOCORTICAL HORMONE]

The adrenal glands consist of two physiologically distinct organs:

a. Thyroid gland and parathyroid gland
b. Adrenal cortex and adrenal medulla
c. Pituitary gland and hypothalamus
d. Pancreas and spleen

d. 90%

[ADRENOCORTICAL HORMONE]

Approximately what percentage of the adrenal gland is composed of adrenal cortex?

a. 10%
b. 25%
c. 50%
d. 90%

b. 10%

[ADRENOCORTICAL HORMONE]

The adrenal medulla makes up approximately:

a. 5%
b. 10%
c. 50%
d. 90%

c. Zona glomerulosa

[ADRENOCORTICAL HORMONE]

Which region of the adrenal cortex produces mineralocorticoids?

a. Zona fasciculata
b. Zona reticularis
c. Zona glomerulosa
d. Adrenal medulla

c. Aldosterone

[ADRENOCORTICAL HORMONE]

The primary hormone secreted by the zona glomerulosa is:

a. Cortisol
b. Testosterone
c. Aldosterone
d. Epinephrine

b. Zona fasciculata

[ADRENOCORTICAL HORMONE]

Which adrenal cortex layer primarily produces glucocorticoids?

a. Zona glomerulosa
b. Zona fasciculata
c. Zona reticularis
d. Adrenal medulla

b. Cortisol

[ADRENOCORTICAL HORMONE]

The principal glucocorticoid produced by the adrenal cortex is:

a. Aldosterone
b. Cortisol
c. Estrogen
d. Insulin

c. Zona reticularis

[ADRENOCORTICAL HORMONE]

Which adrenal cortex layer primarily produces s3x hormones?

a. Zona glomerulosa
b. Zona fasciculata
c. Zona reticularis
d. Adrenal medulla

b. Cortisol

[ADRENOCORTICAL HORMONE]

The primary endogenous glucocorticoid is:

a. Aldosterone
b. Cortisol
c. Testosterone
d. Epinephrine

a. Aldosterone

[ADRENOCORTICAL HORMONE]

The primary endogenous mineralocorticoid is:

a. Aldosterone
b. Cortisol
c. Testosterone
d. Epinephrine

b. HPAA axis and circadian rhythm

[ADRENOCORTICAL HORMONE]

Glucocorticoid secretion is primarily regulated by:

a. RAAS only
b. HPAA axis and circadian rhythm
c. Thyroid hormone feedback only
d. Dopamine secretion only

a. RAAS only

[ADRENOCORTICAL HORMONE]

Mineralocorticoids secretion is primarily regulated by:

a. RAAS only
b. HPAA axis and circadian rhythm
c. Thyroid hormone feedback only
d. Dopamine secretion only

b. 10–20 mg/day

[ADRENOCORTICAL HORMONE]

Physiologic glucocorticoid effects are generally seen at doses of:

a. ≥50 mg/day
b. 10–20 mg/day
c. <1 mg/day
d. 100 mg/day

a. CHON and fats

[ADRENOCORTICAL HORMONE]

A physiologic effect of glucocorticoids includes metabolism of:

a. CHON and fats
b. Calcium and CHON
c. Vitamins and fats
d. Thyroid hormones and Calcium

b. Enhance response to catecholamines

[ADRENOCORTICAL HORMONE]

At physiologic doses, glucocorticoids help:

a. Suppress catecholamine response
b. Enhance response to catecholamines
c. Prevent protein metabolism entirely
d. Block fat metabolism

b. Anti-inflammatory action

[ADRENOCORTICAL HORMONE]

A major pharmacologic effect of glucocorticoids is:

a. Increased prolactin secretion
b. Anti-inflammatory action
c. Uterine contraction
d. Increased insulin secretion

a. Immunosuppression

[ADRENOCORTICAL HORMONE]

Glucocorticoids at pharmacologic doses may produce:

a. Immunosuppression
b. Increased immune activation only
c. Hyperthyroidism
d. Bronchospasm

a. Bones and proteins

[ADRENOCORTICAL HORMONE]

A catabolic effect of pharmacologic glucocorticoids includes breakdown of:

a. Bones and proteins
b. Thyroid tissue
c. Red blood cells
d. Neurons

b. Cell division

[ADRENOCORTICAL HORMONE]

Glucocorticoids at pharmacologic doses inhibit:

a. Water reabsorption
b. Cell division
c. Dopamine transport
d. Oxytocin secretion

b. Glucocorticoids bind to glucocorticoid receptors

[ADRENOCORTICAL HORMONE]

The mechanism of action of glucocorticoids begins when:

a. Glucocorticoids block sodium channels
b. Glucocorticoids bind to glucocorticoid receptors
c. Glucocorticoids activate dopamine receptors
d. Glucocorticoids inhibit calcium channels

b. Glucocorticoid–glucocorticoid receptor complex

[ADRENOCORTICAL HORMONE]

After binding to its receptor, glucocorticoids form a:

a. Catecholamine complex
b. Glucocorticoid–glucocorticoid receptor complex
c. Calcium–protein complex
d. Insulin receptor complex

d. Binding directly to DNA to regulate target genes

[ADRENOCORTICAL HORMONE]

a. Blocking potassium channels
b. Increasing calcium influx
c. Stimulating insulin secretion
d. Binding directly to DNA to regulate target genes

a. Enhancing or inhibiting target gene expression

[ADRENOCORTICAL HORMONE]

Glucocorticoids regulate genes by:

a. Enhancing or inhibiting target gene expression
b. Permanently destroying DNA
c. Preventing transcription completely
d. Activating sodium channels

b. Transactivation

[ADRENOCORTICAL HORMONE]

Binding of the glucocorticoid complex to positive GRE (+GRE) results in:

a. Transrepression
b. Transactivation
c. Vasoconstriction
d. Dopamine inhibition

b. Increased anti-inflammatory mediators

[ADRENOCORTICAL HORMONE]

Transactivation through +GRE primarily leads to:

a. Increased inflammatory mediators
b. Increased anti-inflammatory mediators
c. Decreased receptor synthesis
d. Hyperglycemia

b. Transrepression

[ADRENOCORTICAL HORMONE]

Binding of the glucocorticoid complex to negative GRE (−GRE) results in:

a. Transactivation
b. Transrepression
c. Catecholamine release
d. Cell proliferation

b. Decreased inflammatory mediators

[ADRENOCORTICAL HORMONE]

Transrepression through −GRE primarily causes:

a. Increased inflammatory mediators
b. Decreased inflammatory mediators
c. Increased prolactin release
d. Increased aldosterone secretion

c. Hydrocortisone (cortisol)

[ADRENOCORTICAL HORMONE]

short-acting glucocorticoid

a. Dexamethasone
b. Betamethasone
c. Hydrocortisone (cortisol)
d. Triamcinolone

a. Prednisone

[ADRENOCORTICAL HORMONE]

short-acting glucocorticoid

a. Prednisone
b. Dexamethasone
c. Paramethasone
d. Betamethasone

c. Short-acting

[ADRENOCORTICAL HORMONE]

Prednisolone belongs to which glucocorticoid category?

a. Long-acting
b. Intermediate-acting
c. Short-acting
d. Mineralocorticoid

b. Short-acting glucocorticoid

[ADRENOCORTICAL HORMONE]

Methylprednisolone is classified as a:

a. Long-acting glucocorticoid
b. Short-acting glucocorticoid
c. Intermediate-acting glucocorticoid
d. Mineralocorticoid antagonist

b. Fluprednisolone

[ADRENOCORTICAL HORMONE]

intermediate-acting glucocorticoid

a. Dexamethasone
b. Fluprednisolone
c. Hydrocortisone
d. Prednisone

b. Intermediate-acting

[ADRENOCORTICAL HORMONE]

Triamcinolone is classified as:

a. Short-acting
b. Intermediate-acting
c. Long-acting
d. Mineralocorticoid

b. Intermediate-acting

[ADRENOCORTICAL HORMONE]

Paramethasone belongs to which glucocorticoid class?

a. Short-acting
b. Intermediate-acting
c. Long-acting
d. Nonsteroidal anti-inflammatory

c. Betamethasone

[ADRENOCORTICAL HORMONE]

Which glucocorticoid is long-acting?

a. Prednisolone
b. Hydrocortisone
c. Betamethasone
d. Triamcinolone

c. Long-acting glucocorticoid

[ADRENOCORTICAL HORMONE]

Dexamethasone is classified as a:

a. Short-acting glucocorticoid
b. Intermediate-acting glucocorticoid
c. Long-acting glucocorticoid
d. Mineralocorticoid agonist

a. Inflammatory diseases

[ADRENOCORTICAL HORMONE]

Glucocorticoids are commonly used in the management of:

a. Inflammatory diseases
b. Hyperkalemia
c. Cataracts
d. Bradycardia

a. Dermatologic diseases

[ADRENOCORTICAL HORMONE]

Which condition is a major indication for glucocorticoid therapy?

a. Dermatologic diseases
b. Kidney stones
c. Hearing loss
d. Hyperthyroidism

c. Autoimmune diseases

[ADRENOCORTICAL HORMONE]

Glucocorticoids are commonly used to manage:

a. Arrhythmias
b. Diabetes insipidus
c. Autoimmune diseases
d. Iron deficiency anemia

b. Prevent tissue or organ rejection

[ADRENOCORTICAL HORMONE]

One important role of glucocorticoids in transplantation is to:

a. Stimulate immune rejection
b. Prevent tissue or organ rejection
c. Increase antibody production
d. Promote graft inflammation

a. Prednisolone/Prednisone

[ADRENOCORTICAL HORMONE]

Which glucocorticoid is commonly used in cancer management?

a. Prednisolone/Prednisone
b. Oxytocin
c. Desmopressin
d. Propranolol

b. Anti-emetic

[ADRENOCORTICAL HORMONE]

Dexamethasone is commonly used as a(n):

a. Antiarrhythmic
b. Anti-emetic
c. Anticoagulant
d. Bronchodilator

b. Cushing’s syndrome

[ADRENOCORTICAL HORMONE]

A major adverse effect of long-term glucocorticoid use is:

a. Addison disease only
b. Cushing’s syndrome
c. Hyperthyroidism
d. Diabetes insipidus

a. Moon face

[ADRENOCORTICAL HORMONE]

Which facial feature is characteristic of glucocorticoid-induced Cushing’s syndrome?

a. Moon face
b. Sunken cheeks
c. Facial paralysis
d. Jaw enlargement

b. Buffalo hump

[ADRENOCORTICAL HORMONE]

Accumulation of fat at the upper back due to glucocorticoid excess is called:

a. Saddle deformity
b. Buffalo hump
c. Clubbing
d. Goiter

b. Thinning of skin and easy bruising

[ADRENOCORTICAL HORMONE]

A skin-related adverse effect of glucocorticoids is:

a. Skin thickening
b. Thinning of skin and easy bruising
c. Hyperpigmentation only
d. Increased sweating only

a. Peptic ulcer (Cushing’s ulcer)

[ADRENOCORTICAL HORMONE]

Which gastrointestinal complication may occur with glucocorticoid use?

a. Peptic ulcer (Cushing’s ulcer)
b. Appendicitis
c. Gallstones only
d. Pancreatitis only

c. Hypokalemia

[ADRENOCORTICAL HORMONE]

An electrolyte abnormality associated with glucocorticoid adverse effects is:

a. Hypernatremia only
b. Hypercalcemia
c. Hypokalemia
d. Hypoglycemia

a. Proximal myopathy

[ADRENOCORTICAL HORMONE]

Which musculoskeletal adverse effect may occur with glucocorticoid therapy?

a. Proximal myopathy
b. Muscle hypertrophy
c. Tremors only
d. Joint fusion

a. Wound healing activity

[ADRENOCORTICAL HORMONE]

Glucocorticoids may impair:

a. Wound healing activity
b. Thyroid hormone synthesis only
c. Hearing acuity
d. Corneal reflexes

a. Osteoporosis

[ADRENOCORTICAL HORMONE]

Long-term glucocorticoid use increases the risk of:

a. Osteoporosis
b. OA
c. RA
d. Polycythemia

c. Growth retardation

[ADRENOCORTICAL HORMONE]

In children, prolonged glucocorticoid use may cause:

a. Accelerated growth
b. Gigantism
c. Growth retardation
d. Acromegaly

b. Adrenal crisis (Addison disease)

[ADRENOCORTICAL HORMONE]

Suppression of the HPA axis by glucocorticoids may result in:

a. Diabetes mellitus
b. Adrenal crisis (Addison disease)
c. Hyperthyroidism
d. SIADH

d. Hypotension, abdominal pain, and death

[ADRENOCORTICAL HORMONE]

Symptoms of adrenal crisis due to HPA axis suppression may include:

a. Hypertension and tachycardia
b. Bradycardia, abdominal pain, and edema
c. Hyperglycemia and polyuria
d. Hypotension, abdominal pain, and death

c. Taper the dose slowly

[ADRENOCORTICAL HORMONE]

How can HPA axis suppression be prevented when stopping glucocorticoids?

a. Abruptly discontinue therapy
b. Give oxytocin
c. Double the dose before stopping
d. Taper the dose slowly

c. 10–14 days

[ADRENOCORTICAL HORMONE]

Glucocorticoids should not be abruptly withdrawn if taken for more than:

a. 1–2 days
b. 5 days
c. 10–14 days
d. 1 month

b. Increase Na⁺, H₂O, and HCO₃⁻ reabsorption

[ADRENOCORTICAL HORMONE]

The physiologic and pharmacologic effects of mineralocorticoids are primarily to:

a. Decrease Ca⁺, H₂O, and HCO₃⁻ reabsorption
b. Increase Na⁺, H₂O, and HCO₃⁻ reabsorption
c. Increase K⁺, CO₂, and O₂ reabsorption
d. Decrease K⁺, CO₂, and O₂ reabsorption

c. Chloride, hydrogen, and potassium

[ADRENOCORTICAL HORMONE]

Mineralocorticoids promote secretion of:

a. Sodium, glucose and insulin
b. Glucose and insulin
c. Chloride, hydrogen, and potassium
d. Calcium and magnesium

Hyperchloremic metabolic acidosis = Hypoaldosteronism

HTN = Hyperaldosteronism

Hypochloremic metabolic alkalosis = Hyperaldosteronism

Na H2O retention = Hyperaldosteronism

Hypokalemia = Hyperaldosteronism

Hyperkalemia = Hypoaldosteronism

Hypotension = Hypoaldosteronism

[ADRENOCORTICAL HORMONE]

Effects of Mineralocorticoids

Hyperaldosteronism or Hypoaldosteronism

Hyperchloremic metabolic acidosis = ______

HTN = ______

Hypochloremic metabolic alkalosis = ______

Na H2O retention = ______

Hypokalemia = ______

Hyperkalemia = ______

Hypotension = ______

b. Deoxycorticosterone acetate

[ADRENOCORTICAL HORMONE]

Which drug is a precursor of aldosterone?

a. Fludrocortisone
b. Deoxycorticosterone acetate
c. Spironolactone
d. Eplerenone

a. Fludrocortisone

[ADRENOCORTICAL HORMONE]

Which drug is a synthetic aldosterone?

a. Fludrocortisone
b. Eplerenone
c. Spironolactone
d. Hydrocortisone

c. Both glucocorticoid and mineralocorticoid activity

[ADRENOCORTICAL HORMONE]

Fludrocortisone possesses:

a. Only glucocorticoid activity
b. Only mineralocorticoid activity
c. Both glucocorticoid and mineralocorticoid activity
d. No hormonal activity

d. Spironolactone

[ADRENOCORTICAL HORMONE]

Which of the following is a mineralocorticoid antagonist?

a. Fludrocortisone
b. Deoxycorticosterone acetate
c. Cortisol
d. Spironolactone

a. Mineralocorticoid antagonist

[ADRENOCORTICAL HORMONE]

Eplerenone is classified as a:

a. Mineralocorticoid antagonist
b. Synthetic aldosterone
c. Glucocorticoid agonist
d. Vasopressin agonist

b. Two sets

[THYROID HORMONE]

The thyroid gland primarily produces how many sets of hormones?

a. One set
b. Two sets
c. Three sets
d. Four sets

b. L-T3

[THYROID HORMONE]

Which thyroid hormone is also called levotriiodothyronine?

a. L-T4
b. L-T3

a. L-T4

[THYROID HORMONE]

Which thyroid hormone is also called levothyroxine?

a. L-T4
b. L-T3

c. 99.8% protein-bound

[THYROID HORMONE]

L-T3 is approximately:

a. 50% protein-bound
b. 90% protein-bound
c. 99.8% protein-bound
d. 100% protein-bound

a. 0.2%

[THYROID HORMONE]

The free fraction of L-T3 is approximately:

a. 0.2%
b. 2%
c. 10%
d. 20%

b. 1.5 days

[THYROID HORMONE]

The half-life (T½) of L-T3 is approximately:

a. 12 hours
b. 1.5 days
c. 7 days
d. 10 days

b. L-T3

[THYROID HORMONE]

10-fold greater affinity for nuclear thyroid hormone receptor

a. L-T4
b. L-T3

c. 3–4× more potent

[THYROID HORMONE]

L-T3 is approximately how much more potent than T4?

a. Equal potency
b. 2× more potent
c. 3–4× more potent
d. 10× less potent

b. L-T3

[THYROID HORMONE]

Which thyroid hormone is responsible for most thyroid hormone effects?

a. L-T4
b. L-T3

a. 99.98% protein-bound

[THYROID HORMONE]

L-T4 is approximately:

a. 99.98% protein-bound
b. 90% protein-bound
c. 75% protein-bound
d. 50% protein-bound

b. Thyroxine-binding globulin (TBG)

[THYROID HORMONE]

L-T4 is primarily protein-bound to:

a. Albumin
b. TBG
c. Hemoglobin
d. Transferrin

a. 0.02%

[THYROID HORMONE]

The free fraction of L-T4 is approximately:

a. 0.02%
b. 0.2%
c. 2%
d. 20%

c. 7 days

[THYROID HORMONE]

The normal half-life (T½) of L-T4 is approximately:

a. 1.5 days
b. 3 days
c. 7 days
d. 14 days

b. 3–4 days

[THYROID HORMONE]

In hyperthyroidism, the half-life of L-T4 is approximately:

a. 1 day
b. 3–4 days
c. 7 days
d. 9–10 days

d. 9–10 days

[THYROID HORMONE]

In hypothyroidism, the half-life of L-T4 is approximately:

a. 1.5 days
b. 3–4 days
c. 7 days
d. 9–10 days

Thyroid hormones & Calcitonin

[THYROID HORMONE]

Thyroid Gland 2 sets of hormones

a. High TSH due to thyroid gland defect

[THYROID HORMONE]

Primary hypothyroidism is characterized by:

a. High TSH due to thyroid gland defect
b. Low TSH due to pituitary failure
c. Low TSH; central organ defect
d. High T3 with low TSH

c. Low TSH; central organ defect

[THYROID HORMONE]

Secondary hypothyroidism is characterized by:

a. High TSH due to thyroid gland defect
b. Low TSH due to pituitary failure
c. Low TSH; central organ defect
d. High T3 with low TSH

b. Low T3 and T4

[THYROID HORMONE]

Both primary and secondary hypothyroidism share which finding?

a. High T3 and T4
b. Low T3 and T4

c. Excess thyroid hormones in the body

[THYROID HORMONE]

Thyrotoxicosis refers to:

a. Decreased thyroid hormone levels
b. Pituitary hormone deficiency
c. Excess thyroid hormones in the body
d. Low cortisol levels

b. Excess activity of the thyroid gland

[THYROID HORMONE]

Hyperthyroidism is defined as:

a. Excess thyroid hormone from any source
b. Excess activity of the thyroid gland
c. Low TSH production
d. Pituitary failure

hyperthyroidism = Thyrotoxicosis

exogenous thyroid hormone = Thyrotoxicosis

graves' disease = Hyperthyroidism

hypersecreting thyroid = Hyperthyroidism

[THYROID HORMONE]

The following are caused by Thyrotoxicosis or Hyperthyroidism?

hyperthyroidism =_____

exogenous thyroid hormone =_____

graves' disease =_____

hypersecreting thyroid =_____

d. Latrogenic or post-procedural thyroid damage

[THYROID HORMONE]

A common cause of hypothyroidism is:

a. Graves’ disease
b. Pituitary hypersecretion
c. Excess iodine intake always
d. Latrogenic or post-procedural thyroid damage

a. Amiodarone

[THYROID HORMONE]

Which of the following is a drug-induced cause of hypothyroidism?

a. Amiodarone
b. Dopamine
c. Insulin
d. Oxytocin

b. Hypothyroidism

[THYROID HORMONE]

Iodine deficiency leads to:

a. Hyperthyroidism
b. Hypothyroidism
c. SIADH
d. Cushing syndrome

a. Hypothyroidism

[THYROID HORMONE]

Thyroiditis (sequela) is caused by

a. Hypothyroidism

b. Hyperthyroidism

Increase irritability = Hyperthyroidism

Tachycardia = Hyperthyroidism

Hypermetabolic = Hyperthyroidism

Palpitation = Hyperthyroidism

Increased sleeping time = Hypothyroidism

Hypometabolism = Hypothyroidism

Frequent diarrheal = Hyperthyroidism

Weight gain despite reduced appetite = Hypothyroidism

Decreased sweating = Hypothyroidism

Hyper sympathetic = Hyperthyroidism

Hypoactivity = Hypothyroidism

Fatigue = Hypothyroidism

Weight loss = Hyperthyroidism

Slow speech and movement = Hypothyroidism

Heat intolerance and profused sweating = Hyperthyroidism

[THYROID HORMONE]

Signs and symptoms: Hypothyroidism or Hyperthyroidism

Increase irritability =_____

Tachycardia =_____

Hypermetabolic =_____

Palpitation =_____

Increased sleeping time =_____

Hypometabolism =_____

Frequent diarrheal =_____

Weight gain despite reduced appetite =_____

Decreased sweating =_____

Hyper sympathetic =_____

Hypoactivity =_____

Fatigue =_____

Weight loss =_____

Slow speech and movement =_____

Heat intolerance and profused sweating =_____

d. Cretinism

[THYROID HORMONE]

Congenital hypothyroidism is known as:

a. Myxedema
b. Gigantism
c. Acromegaly
d. Cretinism

c. Myxedema coma

[THYROID HORMONE]

The severe life-threatening form of hypothyroidism is:

a. Thyroid storm
b. Addison crisis
c. Myxedema coma
d. SIADH

b. Elevated serum TSH

[THYROID HORMONE]

A common laboratory finding in primary hypothyroidism is:

a. Low TSH
b. Elevated serum TSH
c. Normal TSH with high T3
d. Low cortisol

b. Liothyronine (T3)

[THYROID HORMONE]

Which drug is used for emergency management of myxedema coma?

a. Levothyroxine (T4)
b. Liothyronine (T3)

c. Liotrix (T3 and T4)

b. Levothyroxine (T4)

[THYROID HORMONE]

Which thyroid hormone is preferred for maintenance therapy in hypothyroidism?

a. Liothyronine (T3)
b. Levothyroxine (T4)
c.Liotrix (T3 and T4)

c. T3 and T4

[THYROID HORMONE]

Liotrix is a combination of:

a. T4 only
b. T3 only
c. T3 and T4
d. TSH and T4

d. Graves disease

[THYROID HORMONE]

A common autoimmune cause of hyperthyroidism is:

a. Hashimoto thyroiditis
b. SIADH
c. Addison disease
d. Graves disease

b. Solitary hyperfunctioning thyroid nodule

[THYROID HORMONE]

A structural cause of hyperthyroidism is:

a. Thyroid aplasia
b. Solitary hyperfunctioning thyroid nodule
c. Pituitary failure
d. Iodine deficiency

a. Leakage of stored T3 and T4 into circulation

[THYROID HORMONE]

Thyroiditis causes hyperthyroidism mainly due to:

a. Leakage of stored T3 and T4 into circulation
b. Increased TSH stimulation
c. Decreased thyroid hormone binding
d. Increased iodine uptake