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CLINICAL CHEMISTY (HARR) > Clinical Endocrinology > Flashcards

Clinical Endocrinology Flashcards

1
Q

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

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2
Q

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

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3
Q

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

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4
Q

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

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5
Q

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

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6
Q

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

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7
Q

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

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8
Q

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

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9
Q

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

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10
Q

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

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11
Q

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

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12
Q

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

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12
Q

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

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13
Q

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

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14
Q

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

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15
Q

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

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16
Q

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

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17
Q

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 leve

A

B

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18
Q

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

A

C

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19
Q

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

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20
Q

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

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21
Q

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

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21
Q

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

22
Q

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

A

A

23
Q

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

A

B

24
Q

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

25
Q

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

26
Q

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

27
Q

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

28
Q

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

29
Q

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

30
Q

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

31
Q

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

32
Q

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

33
Q

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

34
Q

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

35
Q

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

36
Q

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

37
Q

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

38
Q

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

39
Q

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

40
Q

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

41
Q

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

42
Q

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

A

C

43
Q

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

A

C

44
Q

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

A

C

45
Q

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

46
Q

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

47
Q

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

48
Q

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

49
Q

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

A

A

50
Q

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

51
Q

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

52
Q

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

53
Q

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

54
Q

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

55
Q

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

CLINICAL CHEMISTY (HARR) (8 decks)

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