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***Medical Lab science review- Robert Harr 4th > Clinical Chemistry - Clinical Endocrinology > Flashcards

Clinical Chemistry - Clinical Endocrinology Flashcards

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USMLE® Step 1 flashcards Biology 101 flashcards
1
Q
  1. Which of the following hormones is often
    decreased by approximately 25% in the serum
    of pregnant women who have a fetus with Down
    syndrome?
    A. Estriol (E3)
    B. Human chorionic gonadotropin (hCG)
    C. Progesterone
    D. Estradiol (E2)
A

A. Estriol (E3)

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2
Q
  1. The syndrome of inappropriate antidiuretic
    hormone secretion (SIADH) causes:
    A. Low serum vasopressin
    B. Hypernatremia
    C. Urine osmolality to be lower than plasma
    D. Low serum electrolytes
A

D. Low serum electrolytes

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3
Q
  1. Select the hormone which when elevated is
    associated with galactorrhea, pituitary adenoma,
    and amenorrhea.
    A. E2
    B. Progesterone
    C. Follicle-stimulating hormone (FSH)
    D. Prolactin
A

D. Prolactin

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4
Q
  1. Zollinger–Ellison (Z–E) syndrome is characterized
    by great (e.g., 20-fold) elevation of:
    A. Gastrin
    B. Cholecystokinin
    C. Pepsin
    D. Glucagon
A

A. Gastrin

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5
Q
  1. Which statement about multiple endocrine
    neoplasia (MEN) is true?
    A. It is associated with hyperplasia or neoplasia of at
    least two endocrine organs
    B. Insulinoma is always present when the pituitary
    is involved
    C. It is inherited as an autosomal recessive disorder
    D. Plasma hormone levels from affected organs are
    elevated at least 10-fold
A

A. It is associated with hyperplasia or neoplasia of at
least two endocrine organs

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6
Q
  1. Select the main estrogen produced by the ovaries
    and used to evaluate ovarian function.
    A. Estriol (E3 )
    B. Estradiol (E2 )
    C. Epiestriol
    D. Hydroxyestrone
A

B. Estradiol (E2 )

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7
Q
  1. Which statement best describes the relationship
    between luteinizing hormone (LH) and folliclestimulating hormone (FSH) in cases of
    dysmenorrhea?
    A. Both are usually increased when there is pituitary
    adenoma
    B. Increases in both hormones and a decrease in
    estrogen signal a pituitary cause of ovarian failure
    C. Both hormones normally peak 1–2 days before
    ovulation
    D. In menopause, the LH level at the midcycle peak
    is higher than the level of FSH
A

C. Both hormones normally peak 1–2 days before
ovulation

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8
Q
  1. When pituitary adenoma is the cause of decreased
    estrogen production, an increase of which
    hormone is most frequently responsible?
    A. Prolactin
    B. FSH
    C. LH
    D. Thyroid-stimulating hormone (TSH)
A

A. Prolactin

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9
Q
  1. Which set of results is most likely in an adult male
    with primary testicular failure?
    A. Increased LH, FSH, and decreased testosterone
    B. Decreased LH, FSH, and testosterone
    C. Decreased testosterone, androstenedione,
    and FSH
    D. Increased androstenedione, decreased
    testosterone, and normal FSH
A

A. Increased LH, FSH, and decreased testosterone

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10
Q
  1. When should progesterone be measured when
    evaluating an adult female for anovulation?
    A. At the onset of menses
    B. During the first 7 days of the menstrual cycle
    C. At the midcycle just after LH peaks
    D. At the end of the menstrual cycle
A

C. At the midcycle just after LH peaks

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11
Q
  1. A female with severe excessive pubic and facial hair
    growth (hirsutism) should be tested for which of
    the following hormones?
    A. Estrogen and progesterone
    B. Chorionic gonadotropin
    C. Growth hormone
    D. Testosterone and dehydroepiandrosterone sulfate
A

D. Testosterone and dehydroepiandrosterone sulfate

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12
Q
  1. Which set of results is most likely in a female with
    hypogonadotropic ovarian failure?
    A. Increased LH, FSH, and estrogen
    B. Decreased LH, FSH, and estrogen
    C. Decreased prolactin and estrogen
    D. Increased LH and FSH, and decreased estrogen
A

B. Decreased LH, FSH, and estrogen

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13
Q
  1. The onset of menopause is usually associated with
    what hormone changes?
    A. Decreased estrogen, testosterone, and androgens
    B. Decreased estrogen, FSH, LH, and progesterone
    C. Decreased estrogen and progesterone, and
    increased LH and FSH
    D. Decreased estrogen and progesterone, normal
    LH and FSH
A

C. Decreased estrogen and progesterone, and
increased LH and FSH

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14
Q
  1. Which of the following statements is correct in
    assessing GH deficiency?
    A. Pituitary failure may involve one, several, or all
    adenohypophyseal hormones; but GH deficiency
    is usually found
    B. A normal random serum level of GH in a child
    under 6 years old rules out GH deficiency
    C. Administration of arginine, insulin, or glucagon
    will suppress GH release
    D. GH levels in the blood show little variation
    within a 24-hour period
A

A. Pituitary failure may involve one, several, or all
adenohypophyseal hormones; but GH deficiency
is usually found

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15
Q
  1. Which statement best describes the level of GH in
    patients with pituitary adenoma associated with
    acromegaly?
    A. The fasting GH level is always elevated at least
    twofold
    B. Some patients will require a glucose suppression
    test to establish a diagnosis
    C. A normal fasting GH level rules out acromegaly
    D. Patients produce a lower concentration of
    insulin-like growth factor I (IGF-1) than
    expected from their GH level
A

B. Some patients will require a glucose suppression
test to establish a diagnosis

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16
Q
  1. Hyperparathyroidism is most consistently
    associated with:
    A. Hypocalcemia
    B. Hypocalciuria
    C. Hypophosphatemia
    D. Metabolic alkalosis
A

C. Hypophosphatemia

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17
Q
  1. Which statement regarding the use of PTH
    is true?
    A. Determination of serum PTH level is the best
    screening test for disorders of calcium
    metabolism
    B. PTH levels differentiate primary and secondary
    causes of hypoparathyroidism
    C. PTH levels differentiate primary and secondary
    causes of hypocalcemia
    D. PTH levels are low in patients with
    pseudohypoparathyroidism
A

C. PTH levels differentiate primary and secondary
causes of hypocalcemia

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18
Q
  1. The best method of analysis for serum PTH
    involves using antibodies that detect:
    A. The amino-terminal fragment of PTH
    B. The carboxy-terminal end of PTH
    C. Both the amino-terminal fragment and
    intact PTH
    D. All fragments of PTH as well as intact hormone
A

C. Both the amino-terminal fragment and
intact PTH

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19
Q
  1. Which of the following is most often elevated in
    hypercalcemia associated with malignancy?
    A. Parathyroid-derived PTH
    B. Ectopic PTH
    C. Parathyroid hormone–related protein (PTHRP)
    D. Calcitonin
A

C. Parathyroid hormone–related protein (PTHRP)

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20
Q
  1. Which is normally the most abundant
    corticosteroid hormone secreted by the adrenal
    cortex?
    A. Cortisol
    B. Dehydroepiandrosterone
    C. Aldosterone
    D. Corticosterone
A

A. Cortisol

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21
Q
  1. Which of the following statements regarding
    adrenal cortical dysfunction is true?
    A. Patients with Cushing’s syndrome usually have
    hyperkalemia
    B. Cushing’s syndrome is associated with glucose
    intolerance
    C. Addison’s disease is associated with
    hypernatremia
    D. Addison’s disease is caused by elevated levels of
    cortisol
    Chemistry/C
A

B. Cushing’s syndrome is associated with glucose
intolerance

22
Q
  1. Which of the following statements about cortisol
    in Cushing’s syndrome is true?
    A. Twenty-four–hour urinary free cortisol is a more
    sensitive test than plasma total cortisol
    B. Patients with Cushing’s disease show
    pronounced diurnal variation in serum cortisol
    C. Free cortisol is increased by a high-serum
    cortisol-binding protein concentration
    D. An elevated serum total cortisol level is
    diagnostic of Cushing’s syndrome
A

A. Twenty-four–hour urinary free cortisol is a more
sensitive test than plasma total cortisol

23
Q
  1. Which of the following conditions is characterized
    by primary hyperaldosteronism caused by adrenal
    adenoma, carcinoma, or hyperplasia?
    A. Cushing’s syndrome
    B. Addison’s disease
    C. Conn’s syndrome
    D. Pheochromocytoma
A

C. Conn’s syndrome

24
Q
  1. Which of the following is the most common cause
    of Cushing’s syndrome?
    A. Pituitary adenoma
    B. Adrenal hyperplasia
    C. Overuse of corticosteroids
    D. Ectopic adrenocorticotropic hormone (ACTH)
    production by tumors
A

C. Overuse of corticosteroids

25
Q
  1. Which of the following is the mechanism causing
    Cushing’s disease?
    A. Excess secretion of pituitary ACTH
    B. Adrenal adenoma
    C. Treatment with corticosteroids
    D. Ectopic ACTH production by tumors
A

A. Excess secretion of pituitary ACTH

26
Q
  1. In which situation is the plasma or 24-hour
    urinary cortisol not consistent with the clinical
    picture?
    A. In pregnant patients
    B. In patients with a positive overnight
    dexamethasone suppression test
    C. In congenital adrenal hyperplasia
    D. In Cushing’s syndrome caused by ectopic ACTH
    producing tumors
A

C. In congenital adrenal hyperplasia

27
Q
  1. Which test is used to distinguish Cushing’s disease
    (pituitary Cushing’s) from Cushing’s syndrome
    caused by adrenal tumors?
    A. Low-dose overnight dexamethasone suppression
    B. Petrosal sinus sampling
    C. Serum ACTH
    D. Twenty-four–hour urinary free cortisol
A

C. Serum ACTH

28
Q
  1. Which is the most widely used screening test for
    Cushing’s syndrome?
    A. Overnight low-dose dexamethasone
    suppression test
    B. Corticotropin-releasing hormone stimulation
    test
    C. Petrosal sinus sampling
    D. Metyrapone stimulation test
A

A. Overnight low-dose dexamethasone
suppression test

29
Q
  1. Which test is the most specific for establishing a
    diagnosis of Cushing’s disease (pituitary
    Cushing’s)?
    A. Low-dose dexamethasone suppression
    B. High-dose dexamethasone suppression
    C. Twenty-four–hour urinary free cortisol
    D. Petrosal sinus sampling following
    corticotropin-releasing hormone stimulation
A

D. Petrosal sinus sampling following
corticotropin-releasing hormone stimulation

30
Q
  1. Which of the following statements about the
    diagnosis of Addison’s disease is true?
    A. Patients with primary Addison’s disease show a
    normal response to ACTH stimulation
    B. Primary and secondary Addison’s disease can
    often be differentiated by plasma ACTH
    C. Twenty-four–hour urinary free cortisol is normal
    in Addison’s disease
    D. Pituitary ACTH reserves are normal in secondary
    Addison’s disease
A

B. Primary and secondary Addison’s disease can
often be differentiated by plasma ACTH

31
Q
  1. Which of the following statements regarding the
    catecholamines is true?
    A. They are derived from tryptophan
    B. They are produced by the zona glomerulosa of
    the adrenal cortex
    C. Plasma levels show both diurnal and pulsed
    variation
    D. They are excreted in urine primarily as free
    catecholamines
A

C. Plasma levels show both diurnal and pulsed
variation

32
Q
  1. Which assay using 24-hour urine is considered the
    best single screening test for pheochromocytoma?
    A. Total urinary catecholamines
    B. VMA
    C. Homovanillic acid (HVA)
    D. Metanephrines
A

D. Metanephrines

33
Q
  1. Which metabolite is most often increased in
    carcinoid tumors of the intestine?
    A. 5-Hydroxyindolacetic acid (5-HIAA)
    B. 3-Methoxy-4-hydroxyphenylglycol (MHPG)
    C. 3-Methoxydopamine
    D. HVA
A

A. 5-Hydroxyindolacetic acid (5-HIAA)

34
Q
  1. Which statement regarding the measurement of
    urinary catecholamines is true?
    A. An increased excretion of total urinary
    catecholamines is specific for pheochromocytoma
    B. Twenty-four–hour urinary catecholamine assay
    avoids pulse variations associated with
    measurement of plasma catecholamines
    C. Total urinary catecholamine measurement
    provides greater specificity than measurement of
    urinary free catecholamines
    D. Total urinary catecholamines are not affected by
    exercise
A

B. Twenty-four–hour urinary catecholamine assay
avoids pulse variations associated with
measurement of plasma catecholamines

35
Q
  1. Which method is most often used to measure
    fractionated catecholamines (epinephrine,
    norepinephrine, and dopamine)?
    A. Measurement of fluorescence following oxidation
    by potassium ferricyanide
    B. Measurement by HPLC with electrochemical
    detection
    C. Measure of radioactivity after conversion by
    catechol-O-methyltransferase (COMT) to
    tritiated metanephrines
    D. Measurement by HPLC with fluorescence
    detection
A

B. Measurement by HPLC with electrochemical
detection

36
Q
  1. Which statement about sample collection for
    catecholamines and metabolites is true?
    A. Blood for catecholamines is collected in the usual
    manner following a 12-hour fast
    B. Twenty-four–hour urine for vanillylmandelic
    acid, catecholamines, or metanephrines is
    collected in 1 mL of boric acid
    C. Twenty-four–hour urine creatinine should be
    measured with vanillylmandelic acid,
    homovanillic acid, or metanephrines
    D. There is no need to discontinue medications if a
    24-hour urine collection is used
A

C. Twenty-four–hour urine creatinine should be
measured with vanillylmandelic acid,
homovanillic acid, or metanephrines

37
Q
  1. Which of the following statements applies to both
    measurement of VMA and metanephrines in
    urine?
    A. Both can be oxidized to vanillin and measured at
    360 nm without interference from dietary
    compounds
    B. Both can be measured immunochemically after
    hydrolysis and derivatization
    C. Both require acid hydrolysis prior to
    measurement
    D. Both can be measured by specific HPLC
    and MS assays
A

D. Both can be measured by specific HPLC
and MS assays

38
Q
  1. Urinary HVA is most often assayed to detect:
    A. Pheochromocytoma
    B. Neuroblastoma
    C. Adrenal medullary carcinoma
    D. Psychiatric disorders such as manic depression
A

B. Neuroblastoma

39
Q
  1. Thyroid hormones are derived from the
    amino acid:
    A. Phenylalanine
    B. Methionine
    C. Tyrosine
    D. Histidine
A

C. Tyrosine

40
Q
  1. Which statement regarding thyroid hormones
    is true?
    A. Circulating levels of T3 and T4 are about equal
    B. T3 is about 10-fold more active than T4
    C. The rate of formation of monoiodotyrosine and
    diiodotyrosine is about equal
    D. Most of the T3 present in plasma is from its
    direct release from thyroid storage sites
A

B. T3 is about 10-fold more active than T4

41
Q
  1. Which of the following statements regarding
    thyroid hormones is true?
    A. Both protein-bound and free T3 and T4 are
    physiologically active
    B. Total T3 and T4 are influenced by the level of
    thyroxine-binding globulin
    C. Variation in thyroxine-binding protein levels
    affects both free T3 and T4
    D. An elevated serum total T4 and T3 is diagnostic
    of hyperthyroidism
A

B. Total T3 and T4 are influenced by the level of
thyroxine-binding globulin

42
Q
  1. Which of the following conditions will increase
    total T4 by increasing TBG?
    A. Acute illness
    B. Anabolic steroid use
    C. Nephrotic syndrome
    D. Pregnancy or estrogens
A

D. Pregnancy or estrogens

43
Q
  1. Select the most appropriate single screening test
    for thyroid disease.
    A. Free thyroxine index
    B. Total T3 assay
    C. Total T4
    D. TSH assay
A

D. TSH assay

44
Q
  1. The serum TSH level is almost absent in:
    A. Primary hyperthyroidism
    B. Primary hypothyroidism
    C. Secondary hyperthyroidism
    D. Euthyroid sick syndrome
A

A. Primary hyperthyroidism

45
Q
  1. Which assay is used to confirm difficult cases of
    hypothyroidism?
    A. Free T3 assay
    B. Free thyroxine index
    C. Thyrotropin-releasing hormone (TRH)
    stimulation test
    D. TBG assay
A

C. Thyrotropin-releasing hormone (TRH)
stimulation test

46
Q
  1. Which of the following statements is true
    regarding reverse T3 (rT3)?
    A. Formed in the blood by degradation of T4
    B. Physiologically active, but less than T3
    C. Decreased in euthyroid sick syndrome
    D. Interferes with the measurement of serum T3
A

A. Formed in the blood by degradation of T4

47
Q
  1. A patient has an elevated serum T3 and free T4 and
    undetectable TSH. What is the most likely cause
    of these results?
    A. Primary hyperthyroidism
    B. Secondary hyperthyroidism
    C. Euthyroid with increased thyroxine-binding
    proteins
    D. Euthyroid sick syndrome
A

A. Primary hyperthyroidism

48
Q
  1. A serum thyroid panel reveals an increase in total
    T4, normal TSH, and normal free T4. What is the
    most likely cause of these results?
    A. Primary hyperthyroidism
    B. Secondary hyperthyroidism
    C. Euthyroid with increased thyroxine-binding
    protein
    D. Subclinical hypothyroidism
A

C. Euthyroid with increased thyroxine-binding
protein

49
Q
  1. Which statement about TSH and T4 in early
    pregnancy is correct?
    A. TSH and thyroid hormones fall
    B. TSH falls and thyroid hormones rise
    C. TSH and thyroid hormones both rise
    D. TSH rises and thyroid hormones fall
A

B. TSH falls and thyroid hormones rise

50
Q
  1. In which case might a very low plasma TSH result
    not correlate with thyroid status?
    A. Euthyroid sick syndrome
    B. Congenital hypothyroidism
    C. When TBG is elevated
    D. After high-dose corticosteroid treatment
A

D. After high-dose corticosteroid treatment

***Medical Lab science review- Robert Harr 4th (63 decks)

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