Endocrinology and Reproduction Questions 2013

1. Most important risk factor for uterine prolapse? A. multiparity B. chronic coughing C. postmenopausal women D. C section E. _____ 2. Type of incontinence in uterine prolapse? A. stress B. urge C. overflow B. beta sympathetic E. serotinergic C. L4-S2 D. neurogenic E. functional C. cholinergic 3. Innervation to internal urethral sphincter A. alpha sympathetic D. dopaminergic 4. Innervation levels of bladder A. S2-S4 B. S4-S5 D. S1-S2 E. S1-S5 5. Normal position of uterus? A. Anteverted and Anteflexed 6. Blood supply of uterus comes from? Internal iliac (Anterior trunk) uterine arteries Match scrotal layers with derivation: 7. Dartos? 8. External spermatic fascia? 9. Internal spermatic fascia? 10. Tunica vaginalis? 11. Cremasteric fascia? 12. hCG acts on which receptor? Campers fascia External oblique aponeurosis Transversalis fascia Peritoneum Internal oblique LH receptors

13. In maldescent of testis, which cells do NOT inhibit FSH? Sertoli cells through inhibins 14. Which cells are responsible for producing testosterone? Leydig cells on diagram 15. Which cells produce ABP? Sertoli cells on diagram 16. Identify cell that produces testosterone?

17. Where does mullerian inhibiting factor act to cause development of male genitalia? See diagram above 18. Most common type of ovarian cancer. What is its origin/derivation? A. Epithelial 19. What tumor causes endometrial hyperplasia? A. granulosa cell tumor 25. How does oxytocin exert its effects? A. IP3 28. What is Oxytocin function? 29. Milk secretion hormone synthesized from where? Lactotrophs (Acidophils) of Anterior pituitary

Anterior/Posterior Pituitary Diagram. Label the following structures: 30. Pars nervosa? 31. Pars tuberalis? 32. Pars distalis? 33. Optic chiasm? 34. Median eminence? 35. primary capillary plexus? 37. Most potent stimulant for GH secretion? A. hypoglycemia* B. hypolipidemia 38. All are diabetogenic effects of GH EXCEPT? A. increased insulin secretion 39. Acidophilic cells of anterior pituitary secrete which hormone? A. growth hormone (Prolactin is also secreted by acidophils but was not an option) 40. A patient has diabetes insipidus. Lack of synthesis/Lack of effect of the suspected hormone is synthesized where? A. Supraoptic nucleus in hypothalamus Embryological derivation of the following structures: 41. Anterior pituitary? 42. Posterior pituitary? 43. Inferior parathyroid? 44. Octreotide side effect? A. decreased gall bladder secretion 45. GH second messenger? A. tyrosine kinase (NOT cAMP, reference: First aid 2010 p. 289 and BRS Physio chart) 46. What does cortisol NOT do? (Answers had simple list of cortisol actions) 47. In order to increase lean body mass and decrease fat levels in a patient, what hormone would be effective? A. IGF B. estriol C. estradiol D. progestin E. cortisol 48. Growth hormone effects? 49. Glycosylated Hb1ac reflects what length of control of blood glucose levels? A. 1-2 weeks A. 180mg/dL 51. What other endocrine gland(s) is derived from the same embryological layer as pancreas? Thyroid and Parathyroid glands 52. Which molecule decreases insulin resistance? A. Leptin B. PPAR antagonist C. Resistin B. 4-5 weeks C. 8-12 weeks 50. Renal threshold for glucose? B. decreased GIT motility Ectoderm of oropharynx Neural tube of neuroectoderm 3rd pharyngeal pouch

54. Sympathetic effect Insulin Glucagon Parasympathetic effect

or no change*

*Parasympathetic increases both insulin and glucagon secretion but if such an option is not given, no change for glucagon can be selected. Second messengers of following receptors/molecules: 57. Alpha-1? 58. Beta-2? 59. IGF-1? IP3 cAMP Tyrosine kinase

60. You have to differentiate between primary and secondary Cushing syndromes. In primary Cushing syndrome, there would be absence of? A. hyperpigmentation 65. With what amino acid does insulin and GH secretion increase? A. arginine 66. In hypercortisolism, which ion is decreased? A. K+ B. Na+ 67. What would happen in 17-Alpha hydroxylase deficiency? 69. A patient presents with acne, hirstutism, abdominal striae. The hormone(s) responsible for these symptoms is secreted from where? A. adrenal gland* A. metabolic alkalosis A. recurrent largyngeal nerve B. anterior pituitary B. metabolic acidosis C. ____ C. external laryngeal nerve 71. Which side effect is NOT seen in hyperaldosteronism? 72. A patient presents with hoarse voice after thyroidectomy. It is caused by damage to what nerve? B. internal laryngeal nerve FYI: Right Recurrent Laryngeal nerve is most prone to damage because of its close relation to right inferior thyroid artery and its oblique course (KLM 6th ed. Page 1043) 77. Shift patient from carbimazole to propylthiorouracil because of which added effect of propylthiorouracil? A. Decreased Peripheral conversion of T4 to T3 (At high doses, PTU also inhibits 5 Deiodinase. See Kaplan Pharma 2010 Pg. 282) B. increased iodide in blood C. inhibition of Thyroglobulin synthesis D. inhibition of iodination of tyrosine residues E. inhibition of coupling of MIT 79. In primary hyperthyroidism, levels of what would increase? A. GH B. ACTH C. Long-acting thyroid stimulator D. TSH E. hCG 80. Why would you give iodide before thyroidectomy? Accumulation of colloid by blocking thyroglobulin secretion. (See Robins Basic Pathology 8th ed. Page 764)

81. Chronic renal failure. Plasma levels: Calcium Phosphate PTH Alkaline Phospatase

82. Stores of Vitamin D in our body are in which form? A. 25-OH D3 A. Ca B. 24,25 di-OH D3 B. Mg C. PO4 C. Osteoblasts C. serum TPO antibodies D. low T4 E. low TRH C. 1,25 di-OH D3 D. Na D. Vit D2 83. In an alcoholic patient, low levels of what will contribute to hypoparathyroidism? 84. A new drug is being developed which will prevent rise in PTH. The drug would affect which cells? A. Oxyphil cells B. Chief cells A. low T3 B. high TSH 85. A woman presents with fatigue, lethargy, weight gain. All laboratory levels would be present EXCEPT? Answer makes sense for primary hypothyroidism not secondary 87. Pheochromocytoma is a tumor of what origin? A. adrenal medulla 88. What is elevated in urine in pheochromocytoma? (question continues with previous) A. catecholamines Or more specifically metanephrines are increased and are used in DIAGNOSIS (metabolites of catecholamines) 93. Origin of Parafollicular C cells? 94. Origin of thyroid? A. external carotid artery 109. Most effective marker for community participation A. Role in Decision making 110. Purpose of evaluation of program? 111. A woman has baby at 38 weeks who weighs 2.2 kg? The baby is: A. Post-term B. Underweight* C. Pre-term 112. After birth, the mother did not breast feed the baby for 3 days, now the baby is reluctant to breast feed. What should be done? A. exclusive breast feeding* A. within 1 hour* B. Bottle-feed C. Soft food C. after 6 hours 113. After C section, when can the mother breast feed her child? B. after she is able to sit up 114. Best indicator of community participation? Rural Health Center serving population of 20,000. Only 10 patients visit every day. No community outreach program. 115. What describes this situation best? A. community healthy B. RHC underutilized Neural crest cells Endoderm

104. What is the origin of the superior thyroid artery?

116. What is the best form of community outreach in this situation? A. understanding communitys beliefs B. Implement program C. fix peoples health opinions

117. Infertility affects most the socioeconomic status of? A. woman A. Fee for service B. man B. C. couple 118. Main strategy of health finance in Pakistan is? 119. Major way to tackle maternal mortality rate A. trained birth attendants 120. Major obstacle in way of health insurance in Pakistan is?

Dont Know What Number/Incomplete Questions/Illogical Questions

Q. When does the fundus in pregnancy reach xiphisternum? A. 36 weeks of gestation Q. Which receptor does octreotride act on??? A.SSTR1* B. SSTR2* C. SSTR3 D. SSTR4 E. SSTR5

Thyroid cancer presentations questions: Q. Papillary carcinoma? Q. Follicular carcinoma? Q. Medullary carcinoma? Glucorticoid random question? Some question about gravida and parity? 78. Drug acts on TSH and Thyroxine A. cAMP B.gene mutuation??? Psammoma bodies Hematogenous spread Hypocalcemia

95. In hypothyroidism ???