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Endocrine
How to Use the Workbook with the Videos
Using this table as a guide, read the Facts in First Aid for the USMLE Step 1 2014,
watch the corresponding First Aid Express 2014 videos, and then answer the workbook
questions.
Facts in First Aid for
the USMLE Step 1 2014

Corresponding First Aid

Express 2014 video

Workbook
questions

306.1

Embryology (1 video)

12

306.2307.2

Anatomy (1 video)

37

308.1316.2

Physiology (5 videos)

818

317.1329.3

Pathology (8 videos)

1946

330.1332.1

Pharmacology (2 videos)

4751

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First Aid 2014 EXPRESS workbook: ENDOCRINE

Questions
EMBRYOLOGY
1.

Which structure connects the thyroid gland with the tongue? (p. 306) ________________________

2.

How can you differentiate a thyroglossal duct cyst from a branchial cleft cyst? (p. 306) __________
______________________________________________________________________________

ANATOMY
3.

What are the three major zones of the adrenal gland? List the major secretory product of each.
(p. 306) ________________________________________________________________________
______________________________________________________________________________

4.

What is the most common adrenal medulla tumor in children? In adults? (p. 306) ______________
______________________________________________________________________________

5.

What are the two divisions of the pituitary gland? Which hormones does each secrete? (p. 307) __
______________________________________________________________________________

6.

What cells produce the hormones released by the posterior pituitary gland? (p. 307) ____________

7.

Name the three major cell types of the Islets of Langerhans. What critical hormone is secreted by
each cell? (p. 307) _______________________________________________________________
______________________________________________________________________________

PHYSIOLOGY
8.

Which tissues do not need insulin to facilitate glucose uptake? (p. 308) ______________________
______________________________________________________________________________

9.

If you suspect that a hypoglycemic patient with high insulin levels is surreptitiously using exogenous
insulin, what should you test for? (p. 308) _____________________________________________
______________________________________________________________________________

10.

Which two molecules control the secretion of prolactin? Are they stimulatory or inhibitory? (p. 310)
______________________________________________________________________________

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11.

For each of the congenital bilateral adrenal hyperplasias, indicate whether blood pressure and sex
hormone levels are increased or decreased. (p. 312)
Disease

Blood Pressure

Sex Hormones

11-hydroxylase deficiency
17-hydroxylase deficiency
21-hydroxylase deficiency
12.

What enzyme modulates the conversion of testosterone to estradiol? What enzyme modulates the
conversion of testosterone to DHT? (p. 312) ___________________________________________

13.

How is cortisol produced? (p. 312) ___________________________________________________

______________________________________________________________________________

14.

PTH _______________ (increases/decreases) serum calcium levels and _______________

(increases/decreases) serum phosphate levels. Vitamin D _______________
(increases/decreases) serum calcium level and _______________ (increases/decreases) serum
phosphate levels. (pp. 314)

15.

Which kidney enzyme acts on vitamin D to activate it? (p. 314) ____________________________

16.

What condition can vitamin D deficiency cause in children? In adults? (p. 315) ________________
______________________________________________________________________________

17.

Increased levels of sex hormonebinding globulins _______________ (increase/decrease) free

testosterone levels in men and _______________ (increase/decrease) free testosterone levels in
women. (p. 316)

18.

How do T3 and T4 control the bodys metabolic rate? (p. 316) ______________________________
______________________________________________________________________________

PATHOLOGY
19.

What is the most common cause of Cushing syndrome? (p. 317) __________________________

20.

For a patient who is not taking steroids, what are other potential causes of Cushing syndrome? (p.
317) __________________________________________________________________________
______________________________________________________________________________

21.

What are the common clinical manifestations of Cushing syndrome? (p. 317) _________________
______________________________________________________________________________

22.

How is Cushing syndrome diagnosed? (p. 317) _________________________________________

23.

Primary hyperaldosteronism is associated with ________________ (increased/decreased) plasma

renin activity, whereas secondary hyperaldosteronism is associated with _____________________
(increased/decreased) plasma renin activity. (p. 318)

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First Aid 2014 EXPRESS workbook: ENDOCRINE

24.

Is hyperkalemia seen in primary or secondary adrenal insufficiency? (p. 318) _________________

25.

What are the three common causes of Waterhouse-Friderichsen syndrome? (p. 318) ___________
______________________________________________________________________________

26.

What is the rule of 10s for pheochromocytoma? What is the cell of origin for this tumor? (p. 319)
______________________________________________________________________________
______________________________________________________________________________

27.

What are the signs and symptoms of pheochromocytoma? (p. 319) _________________________
______________________________________________________________________________

28.

Compare and contrast the characteristics of hypothyroidism vs. hyperthyroidism. (p. 320)
Sign/Symptom

Hypothyroidism

Hyperthyroidism

Activity level
Bowel movements
Cardiovascular changes
Edema
Free T4
Hair texture
Reflexes
Skin changes
T3 uptake
Temperature
Total T4
TSH level
Weight
29.

List four diseases characterized primarily by hypothyroidism. (p. 320-321) ____________________

______________________________________________________________________________

30.

What is the difference between de Quervain thyroiditis and Riedel thyroiditis? (p. 321) __________
______________________________________________________________________________

31.

List some diseases characterized primarily by hyperthyroidism. (p. 322) _____________________

______________________________________________________________________________

32.

What are the four types of thyroid cancer? Which is most common? (p. 323) __________________
______________________________________________________________________________

33.

Primary hyperparathyroidism is characterized by _______________ (increased/decreased) calcium

levels and _______________ (increased/decreased) alkaline phosphatase, whereas secondary
hyperparathyroidism is characterized by _______________ (increase/decreased) calcium levels
and _______________ (increased/decreased) alkaline phosphatase. (p. 323)

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34.

What does the mnemonic stones, bones, groans, and psychiatric overtones stand for? (p. 323)
______________________________________________________________________________
______________________________________________________________________________

35.

What is Chvostek sign? (p. 324) ____________________________________________________

36.

What is Trousseau sign? (p. 324) ___________________________________________________

37.

What are the symptoms of the most common form of pituitary adenoma? (p. 324) ______________
______________________________________________________________________________

38.

How is diabetes insipidus diagnosed? (p. 325) _________________________________________

39.

What are the causes of SIADH? (p. 326) ______________________________________________

40.

What are the differences between DI and SIADH? (p. 325-326) ____________________________
______________________________________________________________________________

41.

What are the acute manifestations of diabetes mellitus type 1? (p. 327) ______________________
______________________________________________________________________________

42.

What are the chronic manifestations of poorly controlled diabetes? (p. 327) ___________________
______________________________________________________________________________

43.

Compare and contrast the characteristics of type 1 vs. type 2 diabetes. (p. 328)
Type 1

Type 2

Associated with obesity

Genetic predisposition
Glucose intolerance
Ketoacidosis
Need for insulin
Primary defect
Sensitivity to insulin
Typical age of onset
44.

How can patients with diabetic ketoacidosis be recognized by their breath? (p. 328) ____________
______________________________________________________________________________

45.

What are the signs and symptoms of carcinoid syndrome? (p. 329) _________________________
______________________________________________________________________________

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46.

First Aid 2014 EXPRESS workbook: ENDOCRINE

Check which components are involved in the multiple endocrine neoplasias. (p. 329)
MEN 1

MEN 2A

MEN 2B

Pancreas
Parathyroid
Pituitary
Pheochromocytoma

PHARMACOLOGY
47.

What eight classes of drugs are used to treat diabetes mellitus? (p. 330) _____________________
______________________________________________________________________________
______________________________________________________________________________

48.

What is the most feared complication of metformin? (p. 330) ______________________________

49.

Which drugs are used to treat hyperthyroidism? (p. 331) _________________________________

50.

Which drugs are used to treat hypothyroidism? (p. 331) __________________________________

51.

What is the most feared complication of glucocorticoid overdose? (p. 332) ___________________

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Answers
EMBRYOLOGY
1.

Thyroglossal duct (a common site of ectopic thyroid tissue).

2.

A thyroglossal duct cyst will move with swallowing whereas a branchial cleft cyst will not.

ANATOMY
3.

Zona glomerulosa produces aldosterone, zona fasciculata produces cortisol, and zona reticularis
produces sex hormones.

4.

Neuroblastoma; pheochromocytoma.

5.

Posterior pituitary: ADH (vasopressin), oxytocin. Anterior pituitary: FSH, LH, ACTH, TSH, prolactin,
GH, MSH.

6.

Neurons (located in the hypothalamus).

7.

cells produce insulin. cells produce glucagon, and cells produce somatostatin.

PHYSIOLOGY
8.

Brain, RBCs, intestine, cornea, kidney, and liver.

9.

C-peptide is absent if the source of insulin is exogenous and present in high levels if the patient
has an insulinoma.

10.

Dopamine is inhibitory; TRH is stimulatory.

11.
Disease

Blood Pressure

Sex Hormones

11-hydroxylase deficiency

17-hydroxylase deficiency

21-hydroxylase deficiency

12.

Aromatase; 5-reductase.

13.

CRH stimulates release of ACTH in pituitary, which prompts coritsol production in the adrenal zona
fasciculata.

14.

Increases; decreases; increases; increases.

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First Aid 2014 EXPRESS workbook: ENDOCRINE

15.

1-hydroxylase.

16.

Rickets; osteomalacia.

17.

Decrease; decrease.

18.

By increasing Na /K -ATPase activity, which increases oxygen consumption, respiratory rate, and
body temperature.

PATHOLOGY
19.

Iatrogenic steroids.

20.

Cushing disease (pituitary adenoma): 70%; ectopic ACTH (e.g., small cell lung cancer): 15%;
adrenal tumor: 15%.

21.

Weight gain (truncal obesity), moon facies, buffalo hump, skin thinning, striae, hypertension,
hyperglycemia, osteoporosis, amenorrhea, and immunosuppression.

22.

Dexamethasone challenge.

23.

Decreased; increased.

24.

Primary adrenal insufficiency.

25.

Septicemia due to N. meningitidis, DIC, and endotoxic shock.

26.

10% are malignant, 10% are bilateral, 10% are extra-adrenal, 10% calcify, 10% occur in kids, and
10% of cases are familial. Chromaffin cells are the cells of origin for pheochromocytoma.

27.

Elevated blood Pressure, Pain (headache), Perspiration, Palpitations (tachycardia), and Pallor.
These 5 Ps are episodic.

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28.
Sign/Symptom

Hypothyroidism

Hyperthyroidism

Activity level

Bowel movements

Constipation

Diarrhea

Cardiovascular changes

Bradycardia; dyspnea
on exertion

Chest pain,
palpitations,
arrhythmias

Edema

Myxedema

Pretibial myxedema

Free T4

Hair texture

Coarse, brittle

Fine

Reflexes

Skin changes

Dry, cool skin

Warm, most skin

T3 uptake

Temperature

Cold intolerance

Heat intolerance

Total T4

TSH level

(if primary)

(if primary)

Weight

Weight gain (low

appetite)

Weight loss (high

appetite)

29.

Hashimoto thyroiditis, cretinism, de Quervain thyroiditis, and Riedel thyroiditis.

30.

de Quervain (subacute) thyroiditis is a self-limited type of hypothyroidism that follows a flu-like

illness. Riedel thyroiditis involves fibrous replacement of the thyroid.

31.

Graves disease, thyrotoxicosis, and toxic multinodular goiter.

32.

Papillary thyroid carcinoma (most common), follicular, medullary, and anaplastic.

33.

Increased; increased; decreased; increased.

34.

Renal calcium stones, osteitis fibrosa cystica of bones, depression, and abdominal complaints
(groans due to constipation).

35.

In hypoparathyroid patients, tapping of the facial nerve causes the facial muscles to contract.

36.

In hypoparathyroid patients, occlusion of the brachial artery causes carpal spasm.

37.

Prolactinoma: amenorrhea, galactorrhea, low libido, and infertility.

38.

Water deprivation test: urine osmolality doesnt increase in response to water deprivation.
Response to desmopressin can distinguish between central and nephrogenic DI.

39.

Ectopic ADH (e.g., small cell lung cancer), CNS disorder/head trauma, pulmonary disease, and
drugs such as cyclophosphamide.

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First Aid 2014 EXPRESS workbook: ENDOCRINE

40.

DI denotes lack of ADH; SIADH denotes too much ADH. DI is characterized by intense thirst and
polyuria, with high serum osmolarity and low urine concentration. SIADH is characterized by
excessive water retention, with high urine osmolarity and low serum osmolarity.

41.

Polydipsia, polyuria, polyphagia, weight loss, DKA, and exacerbation of hyperglycemia due to
unopposed GH and epinephrine secretion.

42.

Retinopathy, glaucoma, cataracts, nephropathy, atherosclerosis, CAD, peripheral vascular

occlusive disease, neuropathy, and gangrene.

43.
Type 1

Type 2

Associated with obesity

No

Yes

Genetic predisposition

Weak

Strong

Glucose intolerance

Severe

Mild to moderate

Ketoacidosis

Common

Rare

Need for insulin

Always

Sometimes

Primary defect

Destruction of cells

Increased resistance to insulin

Sensitivity to insulin

High

Low

Typical age of onset

<30 years

>40 years

44.

Increased ketogenesis results in accumulation of acetone and other ketones; when exhaled,
acetone gives breath a fruity odor.

45.

Diarrhea, cutaneous flushing, asthmatic wheezing, and right-sided valvular disease.

46.
MEN 1
Pancreas

Parathyroid

Pituitary

Pheochromocytoma

MEN 2A

MEN 2B

PHARMACOLOGY
47.

Insulin, biguanides, sulfonylureas, glitazones/thiazolidinediones, -glucosidase inhibitors, amylin

analogs, GLP-1 analogs, and DPP-4 inhibitors.

48.

Lactic acidosis.

49.

Propylthiouracil and methimazole.

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50.

Levothyroxine and triiodothyronine.

51.

Iatrogenic Cushing syndrome.

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