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Physiology Block 3- Endocrine Physiology > 2018 Molina Clicker Questions > Flashcards

2018 Molina Clicker Questions Flashcards

1
Q

(L2 - Hypothalamus & Posterior Pituitary) A pediatric surgeon is called to evaluate a newborn with distended abdomen and no intestinal sounds. What could explain this?

a) decreased intestinal stretch
b) maternal admin of magnesium sulfate
c) maternal oxytocin infusion
d) increased phospholambam phosphorylation

A

b) maternal admin of magnesium sulfate

* magnesium sulfate is a ca2+ blocker used when the mother has pre-eclampsia (high blood pressure)

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2
Q

(L2 - Hypothalamus & Posterior Pituitary) Oxytocin binds to GPCR (alpha q) leading to:

a) activation of adenylate cyclase
b) phosphorylation of the receptor
c) activation of calmodulin
d) decreased Ca2+ release from ER

A

c) activation of calmodulin

alpha q - increase PLC beta, inc. IP3, inc. DAG, inc. Ca2+, inc. PKC

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3
Q

(L2 - Hypothalamus & Posterior Pituitary) Lack of AVP release would be expected to result in

a) increased urine output
b) normal urine output
c) decreased urine output
d) hyponatremia

A

a) increased urine output

no AVP => no water retention in blood

  • urine: high volume, dilute
  • blood: high concentrated (high osmolarity)
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4
Q

(L2 - Hypothalamus & Posterior Pituitary) A patient with an excess release of ADH would present with:

a) hypernatremia
b) hyperkalemia
c) large 24 urine volume
d) hyponatremia

A

d) hyponatremia

inc. AVP => lots of water retention
- urine: concentrated, low volume
- blood: dilute (low osmolarity)

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5
Q

(L2 - Hypothalamus, Posterior Pituitary) Deficiency in ADH release would result in:

a) decreased 24 urine output
b) concentrated urine
c) hyperosmolarity (blood)
d) hyponatremia

A

c) hyperosmolarity (blood)

no ADH release => no water retention

  • urine: large volume, diluted
  • blood: highly concentrated
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6
Q

(L4 - Thyroid) A patient with Graves Disease is likely to be present with:

a) decreased heart rate
b) increased metabolic rate
c) hyperglycemia
d) increased fatigue

A

b) increased metabolic rate

Graves disease - hyperthyroidism

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7
Q

(L4 - Thyroid) A patient with hypothyroidism would present which of the following:

a) hyperactivity
b) weight loss
c) decreased thermoregulation
d) muscle hyperreflexia

A

c) decreased thermoregulation

sluggish - hypothyroidism

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8
Q

(L3 - Anterior Pituitary) TRUE/FALSE? Laron Syndrome is associated with low levels of IGF-1.

A

TRUE

Laron’s disease - GH activity deficiency

  • GH receptor insensitivity (mutated receptor)
  • GH stimulates IGF-1 production in liver
  • GH is not binding to its receptor, IGF-1 not being produced => lower levels of IGF-1
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9
Q

(L3 - Anterior Pituitary) Laceration of the median eminence would result in:

A) increased release of all pituitary hormones
B) decreased release of hypothalamic peptides
C) increased release of prolactin
D) decreased release of all pituitary hormones

A

C) increased release of prolactin

Prolactin is under negative control via dopamine via hypo-physio-tropic control

*laceration of median eminence would not decrease RELEASE of hypothalamic peptides, but would DECREASE DELIVERY

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10
Q

(L3 - Anterior Pituitary) On a hot, sunny day:

A) ADH release would be lowest at noon
B) aquaporin 1 expression would be stimulated at noon
C) AVP signaling would involve PKA activation
D) Urine osmolality would be unaffected by ADH release

A

C) AVP signaling would involve PKA activation

  • ADH released from bloodstream
  • binds to V2R (alpha Gs)
  • increase AC, cAMP, PKA
  • PKA phosphorylates aquaporin 2
  • aquaporin 2 releases on apical side
  • allowing water inside collection duct to pass via aquaporin 3, 4 on basolateral side to enter the bloodstream
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11
Q

(L4) TRUE/FALSE

In a patient that underwent resection of a malignant thyroid tumor, you aim for high TSH levels.

A

FALSE;

TSH stimulates growth, don’t want growth of a tumor

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12
Q

(L4)
Based on the following lab values, which of the following combinations of symptoms are most likely to find in this patient?

TSH 0.01 ulU/mL ([0.04-4.7]
T4: 12 ug/dl [4.8-11.2]
T3: 150 ng/dL [45-137 ng/dL]

a) decreased appetite
b) weight gain
c) bradycardia
d) decreased tolerance to cold
e) diarrhea

A

e) diarrhea

very low TSH => meaning lots of negative feedback from T4, T3

-lots of T3, T4 => lots of energy

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13
Q

(L5) TRUE/FALSE

PTH release is under hypothalamic regulation.

A

False; PTH releases in response to substance (Ca2+)

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14
Q

(L5) Vitamin D deficiency

a) is more frequent during the summer
b) is infrequent in the elderly
c) responds to UV light therapy
d) is not seen in dark skinned individuals

A

c) responds to UV light

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15
Q

(L6) Sulfonylureas result in:

a) decreased beta cell insulin release
b) increased beta cell ATP production
c) increased beta cell insulin release
d) decreased beta cell ATP production

A

c) increased beta cell insulin release

sulfonylurea blocks K+ efflux channel, increasing the depolarization of the cell membrane, activating Ca2+ influx of the cell => releasing insulin cells

*will not work with TYPE 1 diabetes because they do not have beta cells

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16
Q

(L6) Insulin release from the beta cell ______

a) decreases as [ATP] increases
b) increases as [ATP] levels decrease
c) increases as K+ efflux drops
d) decreases as K+ efflux drops

A

c) increases as K+ efflux drops

when K+ is retained in the cell, the membrane potential increases activating Ca2+ channels to open, increasing the influx of Ca2+ to enter the cell => release of insulin

17
Q

(L7) Excess glucocorticoids (i.e., cortisol, prednison, dexamethason, etc) will

a) delay resolution of inflammation
b) increase susceptibility to infections
c) increase resistance to viral infections
d) none of the above

A

b) increase susceptibility to infections

glucocorticoids decrease pro-inflammatory, decrease immune system

18
Q

(L7) Glycyrrhic acid in licorice decreases 11beta-OH steroid dehydrogenase II activity, this can result in:

a) virilzation
b) increased risk for infections
c) hypovolemia
d) hypertension

A

d) hypertension

11beta-OH dehydrogenase II activity blocks the formation of cortisol, shunting the pathway to the production of androgens.

increase in androgens => kidney retention => hypertension

19
Q

(L7) One can predict that adults that live in Iceland, in comparison to NOLA residents, may

a) have higher levels of 24,25-OH vitamin D
b) have lower risk for osteoporotic fractures
c) have increased 1-alpha hydroxylase activity
d) have lower PTH levels

A

c) have increased 1-alpha hydroxylase activity

colder residence: have no sunlight, little vitamin D; 1-alpha hydroxylase is the enzyme that catalyzes the formation of active vitamin d

a - 24,25-OH vitamin D is inactive form
b - should have higher risk because low calcium; don’t see sun
d - have high PTH due to it being released in response to low calcium levels

20
Q 
(L7) CLINICAL CASE
23yo male with history of 
-1y diabetes
-hypertension
-hypogonadism
-weight gain of 22 kg

Physical exam: abdominal stria

lab values
AM cortisol post-Dex suppresion
38 ug/dl [<1.8 ug/dl]
CRH 287 pg/ml [<46]

This patient most likely has:

a) pituitary tumor releasing excess ACTH
b) hypothalamic tumor releasing excess CRH
c) cogenital adrenal hyperplasia
d) ectopic CRH producing tumor
e) adrenal adenoma

A

d) ectopic CRH producing tumor

cortisol levels did not change

21
Q

(L7/8) Counteregulation to hypoglycemia involves:

a) somatostatin-mediated increase in glucagon release
b) GH-mediated inhibition of lipolysis
c) glucagon-mediated stimulation of gluconeogenesis
d) ephinephrine-mediated suppression of glycogenolysis
e) glucagon-mediated increase in hepatic glycogen synthesis

A

c) glucagon-mediated stimulation of gluconeogenesis

low glucose in blood, want to increase glucose in blood => release glucagon

c - epinephrine (SNS) - during stress, would want to stimulate glycogenolysis (breakdown of glycogen to make energy)
d - liver wants to breakdown glycogen in response to low glucose in blood

22
Q

(L5 back of book) 43yo male admitted to ER for severe pain in his left flank, radiating to the groin.
Pain is intermittent and initiated after running a marathon on a hot summer day.
blood detected in the urine
Lab results
ca2+ 12 mg/dl [8.5-10.5]
PTH 130 pg/ml [10-65]

Which of the following findings would be predictable in this patient?

a) increased serum Pi
b) increased serum alkaline phosphatase
c) increased intestinal ca loss
d) decreased urinary ca excretion

A

b) increased serum alkaline phosphatase

high calcium, high PTH; blood detected in urine (kidney stones - dehydration)
a - high PTH inhibits Pi

23
Q

(L5 back of book) 43yo male admitted to ER for severe pain in his left flank, radiating to the groin.
Pain is intermittent and initiated after running a marathon on a hot summer day.
blood detected in the urine
Lab results
ca2+ 12 mg/dl [8.5-10.5]
PTH 130 pg/ml [10-65]

The mechanism underlying the abnormalities observed is:

a) increased calcitonin release
b) decreased 25-hydroxylase activity
c) increased osteoclast apoptosis
d) loss of negative feedback regulation of PTH release

A

d) loss of negative feedback regulation of PTH release

high calcium, high PTH.

a - no; problem is increased ca2+
b - 25-hydroxylase turns vitamin d inactive: would want this to happen to decrease ca levels
c - osteoclast apoptosis would stop the calcium levels from rising (but no reason for that as diagnosis was dehydration)

24
Q

(L5 back of book) 73yo sever vomiting and generalized weakness.
initial lab values reveal elevated Ca2+ levels.
breast cancer and metastasized to bone.

Which of the following laboratory values would be compatible with this clinical scenario?

PTH [10-65]
phosphate [3-4.5]
alkaline phosphatase [30-120]

a) PTH 5, phosphate 6, alp 600
b) PTH 90, pi 6, alp 30
c) PTH 5, pi 2, alp 20
d) PTH 3, pi 2, alp 100

A

a) PTH 5, phosphate 6, alp 600

old age: low calcium due to high bone resorption natural
hypercalcemia from malignancy;

  • alp would be high due to high bone resorption
  • PTH low because high Ca2+ inhibiting
  • phosphate elevated because pi released during bone resorption
25
Q

(L5 back of book) 73yo sever vomiting and generalized weakness.
initial lab values reveal elevated Ca2+ levels.
breast cancer and metastasized to bone.

The most likely cause of hypercalcemia (from malignancy) in the patient is:

a) increased PTH production
b) increased responsiveness of the PTH receptor 1
c) increased PTHrP production
d) increased calcitonin release

A

c) increased PThrP production

malignant hypercalcemia
old age: high Ca2+ due to high bone resorption; high alkaline phosphatase due to high bone resorption

26
Q

(L5 back of book) leading stars of soap operas are prone to enter fits of hysteria associated with hyperventilation.
in real life, usually leads to muscle cramping (tetanic contractions).

What is the physiologic concept that explains what happens in that situation?

a) decreased protein-bound calcium
b) hypercalcemia secondary to PTH-mediated bone resorption
c) increased dissociation of protein-bound calcium
d) decreased ionized plasma calcium levels
e) increased renal calcium excretion

A

c) decreased ionized plasma calcium levels

hyperventilation - respiratory alkalosis (low H+)

  • acidosis: releases free ionized Calcium
  • alkalosis: increases bound calcium
27
Q

(L5 back of book) The physiologic mechanisms affected by medical strategies for the management of osteoporosis include:

a) decreased apoptosis of osteoclasts by biphosphonates
b) increased activation of osteoclast activity by calcitonin
c) increased osteoblast differentation by selected estrogen receptor modulators
d) decreased instestinal ca2+ secretion by vitamin d

A

c) increased osteoblast differentiation by selected estrogen receptor modulators

a-no; want there to be more apoptosis of osteoclasts for more ca2+ free
b-calcitonin decreases ca2+
d-no vitamin d stimulates ca absorption

Physiology Block 3- Endocrine Physiology (10 decks)

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