Endocrine mcq

127.
The supraoptic nucleus of the hypothalamus is believed to control secretion of which of the following
hormones
A. Antidiuretic hormone (arginine vasopressin)
B. Oxytocin
C. Growth hormone
D. Adrenocorticotropic hormone
E. Follicle-stimulating hormone

The answer is: A

It is thought that the secretion of antidiuretic hormone (ADH)-also called arginine vasopressin (AVP)-and
oxytocin by the neurohypophysis is regulated in the hypothalamic supraoptic and paraventricular nuclei,
respectively. This hypothalamic control of secretion of pituitary hormone (inhibitory as well as releasing) in
the case of the neurohypophysis is by direct neural connection, and, in the case of the adenohypophysis, by
humoral factors conveyed by a microcirculation known as the hypothalamic-hypophyseal portal system.

128.
Which of the following is the source of estrogen and progesterone during the last seven months of pregnancy
A. Ovary
B. Placenta
C. Corpus luteum
D. Anterior pituitary
E. Posterior pituitary

The answer is: B

During the first two months of pregnancy, estrogen and progesterone production is primarily the responsibility
of the corpus luteum. The placenta serves as the source of the hormones during the remainder of pregnancy.
Progesterone is essential to maintain placental implantation, inhibit uterine contractions, and suppress the
maternal immune system response to fetal antigens. Estrogens serve to increase the size of the uterus, induce
progesterone and oxytocin receptors, stimulate maternal hepatic protein secretion, and promote breast
development. Estriol is the major estrogen produced during pregnancy. The production of estrogen and
progesterone during gestation requires cooperation between the maternal, placental, and fetal compartments-
the fetoplacental unit.

129.
Which of the following is the source of estrogen and progesterone during the first two months of pregnancy?
A. Ovary
B. Placenta
C. Corpus luteum
D. Anterior pituitary
 E. Posterior pituitary

The answer is: C

During the first two months of pregnancy, estrogen and progesterone production is primarily the responsibility
of the corpus luteum. The placenta serves as the source of the hormones during the remainder of pregnancy.
Progesterone is essential to maintain placental implantation, inhibit uterine contractions, and suppress the
maternal immune system response to fetal antigens. Estrogens serve to increase the size of the uterus, induce
progesterone and oxytocin receptors, stimulate maternal hepatic protein secretion, and promote breast
development. Estriol is the major estrogen produced during pregnancy. The production of estrogen and
progesterone during gestation requires cooperation between the maternal, placental, and fetal compartments-
the fetoplacental unit.

130.
Physiologically active thyroxine exists in which of the following forms
A. Bound to albumin
B. Bound to prealbumin
C. Bound to globulin
D. As a glucuronide
E. Unbound

The answer is: E

Only the free unbound form of thyroxine is physiologically active. Circulating thyroxine can be bound to
albumin, thyroxine-binding prealbumin (TBPA), or thyroxine-binding globulin (TBG). Most thyroxine is
bound, and, despite the large available pool of albumin, most of it is bound to TBG. This reflects the relatively
greater affinity of TBG for thyroxine.

131.
Ovulation is caused by a sudden increase in the secretion of which of the following hormones
A. Estrogen
B. Progesterone
C. LH
D. FSH
E. Prolactin

The answer is: C

Ovulation is caused by a sudden increase in LH secretion. Both LH and FSH blood levels increase during the
follicular phase of the menstrual cycle and reach peak blood levels prior to ovulation. Estrogen levels follow a
similar pattern during the follicular phase. The physiological signal for ovulation is a surge in LH blood
levels. Under the influence of LH, thecal and granulosa cells become the luteal cells of the corpus luteum.
Progesterone production by the corpus luteum increases significantly. Estrogen levels also increase, but do not
reach the levels achieved during the follicular phase.
132.
In the following graph of changes in endometrial thickness during a normal 28-day menstrual cycle, the event
designated "A" corresponds most closely to which of the following?

A. The menstrual phase

B. The maturation of the corpus luteum
C. The early proliferative phase
D. The secretory phase
E. Ovulation

The answer is: E

Ovulation occurs at point A on the graph. In response to estrogen secretion by the ovary, the endometrial
lining of the uterus undergoes proliferation of both glandular epithelium and supporting stroma during the first
10 to 14 days of the menstrual cycle. Following ovulation, the glands begin to secrete mucus and the stroma
undergoes pseudodecidual reaction in preparation for potential pregnancy. When ovulation is not followed by
implantation of a fertilized ovum, progesterone secretion declines as the corpus luteum involutes, and the
endometrial lining is almost completely shed during menses.

133.
Which of the following hormones is involved in the ejection of milk from a lactating mammary gland?
A. Prolactin
B. FSH
C. LH
D. Growth hormone
E. Oxytocin

The answer is: E

A combined neurogenic and hormonal reflex involving oxytocin, a posterior pituitary hormone, causes the
actual ejection ("let-down") of milk from breast tissue. Although estrogen and progesterone are essential for
the physical development of breast tissue during pregnancy, both hormones inhibit milk secretion. Milk
secretion is regulated by prolactin, a pituitary hormone secreted throughout pregnancy and after parturition.
Adequate amounts of growth hormone are required to provide the nutrients that are essential for milk
production by breast tissue. Suckling on breast tissue is the stimulus that leads to milk secretion.
134.
Which of the following is an effect of primary hyperaldosteronism (Conn''s syndrome)?
A. Hypertension
B. Hyperkalemia
C. Decreased extracellular fluid volume
D. Increased concentrating ability of the kidney
E. Increased hematocrit

The answer is: A

The symptoms of primary hyperaldosteronism (Conn''s syndrome) develop from chronic excess secretion of
aldosterone from the zona glomerulosa of the adrenal cortex. Patients are hypertensive and have an expanded
blood volume with a decreased hematocrit. They are not markedly hypernatremic because of a renal escape
phenomenon. Patients are severely depleted of potassium and, as a consequence, suffer kidney damage, with a
resulting loss in concentrating ability.

135.
Hyperthyroidism is characterized by which of the following
A. Anorexia
B. Increased basal metabolic rate
C. Bradycardia
D. Increased weight gain
E. Decreased sweating

The answer is: B

Hyperthyroidism can increase the basal metabolic rate 60 to 100% above normal. Thyroid hormone causes
nuclear transcription of large numbers of genes in virtually all cells of the body. The result is a generalized
increase in functional cell activity and metabolism. The increased metabolic activity of patients with
hyperthyroidism is accompanied by increased food intake. Nevertheless, their body weight decreases. The
generalized increase in cellular activity results in increased sweat production and increased heart rate. The
latter sign is often used by physicians to determine whether a patient has increased thyroid hormone
production.

136.
A person with hypothyroidism would exhibit which of the following symptoms?
A. Tachycardia
B. Increased metabolic rate
C. Heat intolerance
D. Sleepiness
E. Decreased body mass index
The answer is: D

Sleepiness is common in patients with hypothyroidism. Hypothyroidism is a condition usually characterized

by low levels of T3 and T4 owing to atrophy of the thyroid gland. In very rare cases there is resistance to the
effects of thyroid hormones. A deficiency of thyroid hormones or their effects results in bradycardia, which is
due to decreased sympathetic activity, and a decreased metabolic rate with its associated sleepiness, weight
gain, and cold intolerance. Excess thyroid hormone increases metabolic rate, which increases heat production,
stimulates the appetite, and causes weight loss even in the face of increased intake of food. Heat intolerance is
characteristic of hyperthyroidism.

137.
Biological actions of estrogens include which of the following?
A. Inhibition of follicular growth
B. Delayed bone loss at menopause
C. Increased glucose tolerance
D. Decreased serum LDL cholesterol
E. Decreased progesterone receptors

The answer is: B

Some estrogen receptors are found on osteoblasts and estrogen treatment delays age-related bone loss at
menopause. At puberty, estrogens stimulate the growth and development of the female reproductive tract and
increase the number of progesterone receptors. The metabolic effects of estrogens include antagonizing the
actions of insulin on peripheral tissues and decreasing glucose tolerance. Estrogens also decrease serum
cholesterol levels.

138.
Which of the following hormones is primarily responsible for development of ovarian follicles prior to
ovulation
A. Chorionic gonadotropin
B. Estradiol
C. Follicle-stimulating hormone
D. Luteinizing hormone
E. Progesterone

The answer is: C

Preparation of primordial ovarian follicles for ovulation is the primary function of FSH. FSH stimulates
development of the theca and granulose cells of the follicles and promotes the synthesis of estrogens,
including estradiol. LH promotes luteinization of the postovulatory follicle and stimulates progesterone
secretion by the corpus luteum. During pregnancy, hCG is secreted by the placenta and continues
progesterone production.

139.
The anti-inflammatory effect of cortisol treatment is thought to be due to which of the following?
 A. Increased capillary membrane permeability
B. Increased formation of leukotrienes
C. Increased release of pyrogen from granulocytes
D. Activation of phospholipase A2
E. Stabilization of cellular lysosomal membranes

The answer is: E

The anti-inflammatory effects of exogenous cortisol are due to its ability to decrease capillary membrane
permeability and probably also to its ability to stabilize lysosomal membranes and decrease the formation of
bradykinin. Glucocorticoids inhibit the enzyme phospholipase A2. This decreases the release of arachidonic
acid and the variety of substances produced from it, such as leukotrienes, prostaglandins, thromboxanes, and
prostacyclin. Cortisol owes its fever-reducing action to the hormone's ability to decrease the release of
pyrogen (interleukin 1) from granulocytes. However, only in massive doses will the hormone achieve the
effects described. Endogenous cortisol does not exert significant anti-inflammatory action.

140.
Which of the following gastrointestinal hormones is involved in initiation of migrating motor complexes?
A. Gastrin
B. Enterooxyntin
C. Somatostatin
D. Motilin
E. Secretin

The answer is: D

Motilin, a gastrointestinal hormone released from the small intestine during the interdigestive period, is
believed to be responsible for initiating and maintaining migrating motor complexes in humans. Factors
responsible for release of the hormone remain unsettled. All other gut hormones are released during the
digestive period and facilitate motility and secretion.

141.
Zollinger-Ellison syndrome patients experience severe, intractable peptic ulcer disease due to gastric acid
hypersecretion. The cause of the increased acid output is increased plasma levels of which of the following
A. Secretin
B. Somatostatin
C. Gastrin
D. VIP
E. Motilin

The answer is: C

In Zollinger-Ellison (ZE) syndrome, larger than normal amounts of gastrin are produced continuously from
pancreatic tumors consisting primarily of islet delta cells. As much as 10 L per day of gastric juice may be
secreted. The continuous flow of acid into the small intestine produces ulcers and unremitting diarrhea with
excess loss of potassium.

142.
Which one of the following hormones initiates a biological effect by activation of cell membrane receptors
A. Progesterone
B. Estrogens
C. Cortisol
D. Epinephrine
E. Thyroxine

The answer is: D

Due to their relatively low solubility within the lipid portions of the cell membrane, peptide hormones and
catecholamines (epinephrine) must interact with receptors located on the cell membrane. Activation of the
receptor is followed by the generation of intracellular second messengers that ultimately mediate the
biological response to the hormone. Steroid hormones and thyroid hormones readily pass through the cell
surface membrane and interact with intracellular receptors to produce their effects by regulating gene
expression within the nucleus.

143.
Which one of the following hormones interacts with a cytoplasmic receptor, then localizes in the nucleus and
directs protein and nucleotide synthesis
A. Thyrotropin-releasing hormone
B. Epinephrine
C. Luteinizing hormone
D. Cortisol
E. Insulin

The answer is: D

Cortisol, like other steroid hormones, diffuses into target cells and interacts with intracellular receptors. The
steroid-receptor complex has a high affinity for the steroid-responsive element of DNA. Once bound to DNA,
the hormone-receptor complex acts as a transcription factor to regulate gene expression and formation of
specific messenger RNAs.

144.
Which of the following hormones is responsible for stimulating milk letdown
A. Oxytocin
B. Progesterone
C. Estradiol
D. Insulin
 E. Prolactin

The answer is: A

Oxytocin is a posterior pituitary peptide that promotes contraction of the myoepithelial cells surrounding
breast ducts and causes expulsion of milk from lobular alveoli. Secretion of oxytocin is promoted by tactile
stimulation of the breast by the nursing infant. It can also be elicited by psychic factors alone, such as the
anticipation of nursing brought on by hearing the cry of the hungry infant. This anticipatory secretion of
oxytocin may be experienced by the mother as a sensation of milk letdown in which milk appears at the nipple
and may be forcibly ejected.

145.
Hormone replacement therapy is being considered for a 55-year-old woman undergoing menopause. Which
one of the following is a benefit of the therapy
A. A return to normal menstrual cycle pattern
B. Hot flashes
C. A reduced risk of stroke
D. Increased risk of osteoporosis
E. Increased levels of low-density cholesterol (LDL)

The answer is: C

Estrogen replacement therapy decreases a patient's risk of stroke. Hot flashes, osteoporosis, and increased
LDL cholesterol are consequences of estrogen deficiency. Estrogen therapy does not restore a woman's ability
to have children.

146.
Insulin regulates glucose transport into muscle and fat cells via which glucose transporter
A. GLUT-1
B. GLUT-2
C. GLUT-3
D. GLUT-4
E. GLUT-5

The answer is: D

Following insulin binding on muscle and adipocytes, the glucose transporter GLUT-4 is translocated to the
cell membrane where it promotes glucose uptake by facilitated diffusion. GLUT-1 transporters are found
virtually everywhere, as are GLUT-3 transporters. GLUT-2 transporters are found in liver, kidney, and
intestinal cells. GLUT-5 transporters promote glucose absorption from the jejunum.

147.
The signs and symptoms of a patient with primary adrenal insufficiency include which of the following
A. Pallor
 B. Low ACTH levels
C. High cortisol levels
D. Hyperkalemia
E. Hypertension

The answer is: D

Patients with primary adrenal insufficiency (Addison's disease) are hyperkalemic due to a deficiency of
aldosterone. This is accompanied by hyponatremia and hypotension. Hyperpigmentation occurs due to an
increased production of melanin. Lack of cortisol leads to high levels of ACTH.

148.
A patient is diagnosed with acromegaly. Patients with this disease typically have which of the following
symptoms?
A. Decreased gluconeogenesis
B. Hypoglycemia
C. Insulin resistance
D. Decreased protein synthesis
E. Decreased lipolysis

The answer is: C

Patients with acromegaly have insulin resistance. In addition, they evidence increased lipolysis and increased
gluconeogenesis due to their high growth hormone levels. The combination of enhanced glucose production
and insulin resistance can produce hyperglycemia and diabetes mellitus. Protein synthesis increases to support
tissue growth and proliferation.

149.
A woman tests positive for pregnancy. In order for the pregnancy to proceed uneventfully, which of the
following must occur
A. The corpus luteum must secrete progesterone to sustain the endometrium
B. The pituitary must secrete hCG to maintain the corpus luteum
C. The pituitary must secrete prolactin to sustain the placenta
D. The placenta must secrete FSH to maintain ovarian function
E. The placenta must secrete LH to maintain ovarian function

The answer is: A

Continuous secretion of progesterone by the corpus luteum is essential for development of the fetus. During
the first trimester, placental production of hCG sustains the corpus luteum and ensures continued progesterone
secretion. By the second trimester, progesterone production by the placenta increases to levels sufficient to
sustain fetal growth and development.
150.
Radiation treatment for a pituitary tumor in an 8-year-old boy resulted in the complete loss of pituitary
function. As a result, the child is likely to experience which of the following
A. Hypothyroidism and goiter
B. Increased ACTH
C. Absent sexual maturation
D. Accelerated growth spurts
E. Increased TSH levels

The answer is: C

Radiation treatment likely produced panhypopituitarism in the young child. Sexual maturation and growth
during development will not occur because of low levels of GH, FSH, LF, ILGF1, TSH and thyroid
hormones, and gonadal hormones. The cortisol response to stress is decreased due to low ACTH levels. A
goiter cannot develop in the absence of TH