front 1 A tumor compresses the master control center for metabolism, growth,
and reproduction. Which paired structures mediate this
control? | back 1 B. Hypothalamus and pituitary gland |
front 2 TRH must reach the anterior pituitary efficiently. What carries small
hypothalamic hormones there? | back 2 D. Portal venous system |
front 3 A patient lacks posterior pituitary hormones after hypothalamic
injury. Where are posterior-lobe hormones synthesized? | back 3 A. Hypothalamus |
front 4 After synthesis, posterior-lobe hormones reach the posterior
pituitary via which pathway? | back 4 C. Neurosecretory fibers |
front 5 A child with hormone deficiency receives exogenous pituitary
hormones. This drug use best fits: | back 5 A. Replacement therapy |
front 6 A patient with acromegaly is treated with a
pituitary-hormone–blocking drug. This primary use is: | back 6 B. Antagonism of hormone excess |
front 7 A resident orders a stimulation test using hypothalamic hormones.
This primary use is: | back 7 D. Diagnostic tool |
front 8 Two pituitary hormones share significant homology and are
single-chain proteins. Which pair fits? | back 8 C. GH and prolactin |
front 9 A signaling inhibitor blocks the pathway used by both GH and
prolactin receptors. Which pathway is it? | back 9 B. JAK/STAT signaling |
front 10 A lab panel focuses on pituitary dimeric hormones with shared
structure. Which set is dimeric? | back 10 A. TSH FSH LH |
front 11 Which receptor type do TSH, FSH, and LH activate? | back 11 D. GPCR |
front 12 A mutation affects a subunit shared by TSH, FSH, and LH. Which
subunit is shared? | back 12 B. Alpha subunit |
front 13 A patient’s ACTH is abnormal; the hormone is derived from a larger
precursor. ACTH is: | back 13 C. Peptide from POMC |
front 14 Excess POMC processing increases other peptides besides ACTH. Which
pair can result? | back 14 A. Alpha-MSH and beta-endorphin |
front 15 An ACTH analog is given; its receptor signals through which
class? | back 15 D. GPCR |
front 16 A patient has ACTH resistance due to receptor defects. The ACTH
receptor is also called: | back 16 B. Melanocortin 2 receptor |
front 17 Despite normal ACTH receptor sequence, signaling fails due to
defective trafficking. What is required for normal ACTH
signaling? | back 17 A. MRAP accessory protein |
front 18 A patient’s low TSH is traced to impaired hypothalamic stimulation.
TSH release is regulated by: | back 18 C. TRH |
front 19 Pulsatile hypothalamic output is needed for normal gonadotropin
secretion. Which hormone must be pulsatile? | back 19 D. GnRH |
front 20 A patient with adrenal insufficiency has low ACTH due to low
hypothalamic drive. ACTH release is stimulated by: | back 20 A. CRH |
front 21 A hyperthyroid patient has suppressed TRH and TSH. Which feedback
signal inhibits both? | back 21 B. T3 and T4 |
front 22 A woman using high-dose hormones has suppressed GnRH and
gonadotropins. Which hormones mediate this inhibition? | back 22 C. Estrogen and progesterone |
front 23 A male on anabolic steroids develops low LH/FSH and low GnRH. Which
signal best explains this? | back 23 D. Testosterone and androgens |
front 24 A patient on chronic glucocorticoids has low ACTH and low CRH. Which
mediator inhibits both? | back 24 B. Cortisol |
front 25 Which pairing correctly describes GH regulators? | back 25 A. GHRH stimulates; somatostatin inhibits |
front 26 GH release is limited by peripheral feedback from its main mediator.
Which mediator provides that feedback? | back 26 D. IGF-1 |
front 27 A patient with hyperprolactinemia improves on a D2 agonist. Prolactin
production is inhibited by: | back 27 C. Dopamine |
front 28 A patient with primary hypothyroidism develops galactorrhea. Which
hypothalamic hormone can raise prolactin when levels are high? | back 28 C. TRH |
front 29 IGF-I is also known as: | back 29 A. Somatomedin C |
front 30 Growth hormone is best described as: | back 30 D. 191-aa peptide hormone |
front 31 A structural feature of GH includes: | back 31 B. Two sulfhydryl bridges |
front 32 Somatropin is: | back 32 A. Recombinant GH, native sequence |
front 33 Endogenous GH is predominantly cleared by the: | back 33 B. Liver |
front 34 Recombinant human GH is typically administered: | back 34 C. Subcutaneously |
front 35 A standard rhGH schedule is: | back 35 D. 6–7 times weekly |
front 36 After subcutaneous rhGH, peak levels occur: | back 36 A. 2–4 hours |
front 37 After rhGH dosing, active blood levels persist about: | back 37 B. 36 hours |
front 38 Most circulating IGF-I is produced by the: | back 38 C. Liver |
front 39 GH stimulates IGF-I production in tissues mainly for: | back 39 A. Autocrine/paracrine actions |
front 40 In adults, GH shifts body composition by: | back 40 D. Anabolic muscle, catabolic fat |
front 41 GH and IGF-I have opposite effects on: | back 41 B. Insulin sensitivity |
front 42 GH reduces insulin sensitivity, causing mild: | back 42 C. Hyperinsulinemia |
front 43 IGF-I’s insulin-like action most directly: | back 43 A. Increases glucose transport |
front 44 Neonates with isolated GH deficiency are normal size because: | back 44 D. Prenatal growth is GH-independent |
front 45 An early sign of GH deficiency in young children is: | back 45 B. Hypoglycemia |
front 46 A diagnostic criterion for GH deficiency includes reduced: | back 46 D. Height velocity for age |
front 47 Which agent increases GHRH levels via dopaminergic action? | back 47 C. Levodopa |
front 48 Which physiologic factor increases GHRH levels? | back 48 C. Exercise |
front 49 Arginine increases GH release primarily by reducing: | back 49 A. Somatostatin tone |
front 50 Insulin-induced hypoglycemia increases GH by reducing: | back 50 C. Somatostatin tone |
front 51 GH therapy improves final height in girls with: | back 51 A. Turner syndrome |
front 52 In Turner syndrome, GH should be combined with: | back 52 D. Gonadal steroids |
front 53 A controversial but approved GH indication is: | back 53 B. Idiopathic short stature |
front 54 GH therapy can reduce levels of some drugs by: | back 54 C. Increasing CYP isoforms |
front 55 A child with short stature has a newly diagnosed leukemia. Which
statement about GH therapy is correct? | back 55 B. Contraindicated with active malignancy |
front 56 A patient has severe IGF-I deficiency unresponsive to GH. Which
therapy is FDA-approved for this scenario? | back 56 C. Recombinant human IGF-I |
front 57 Which pair are FDA-approved forms of rhIGF-I? | back 57 B. Mecasermin, mecasermin rinfabate |
front 58 Mecasermin rinfabate contains rhIGF-I plus: | back 58 A. Recombinant IGFBP-3 |
front 59 A child starts mecasermin and becomes diaphoretic and confused. Most
important adverse effect? | back 59 C. Hypoglycemia |
front 60 To reduce mecasermin hypoglycemia risk, the patient should: | back 60 D. Eat carbs near dosing |
front 61 The meal/snack timing recommended with mecasermin is: | back 61 B. 20 minutes before or after |
front 62 Hormone-secreting pituitary adenomas occur most commonly in: | back 62 C. Adults |
front 63 An adult with GH-secreting adenoma develops coarse facial features
and organ enlargement. Diagnosis? | back 63 A. Gigantism |
front 64 Acromegaly reflects abnormal growth of: | back 64 A. Cartilage, bone, many organs |
front 65 A GH-secreting tumor arises before epiphyseal closure. Most likely
outcome? | back 65 C. Gigantism |
front 66 Initial therapy of choice for GH-secreting adenoma is: | back 66 A. Endoscopic transsphenoidal surgery |
front 67 GH hypersecretion persists after surgery. Next step typically
adds: | back 67 B. GH antagonist medical therapy |
front 68 Which agents reduce GH production post-op? | back 68 B. Somatostatin analogs, D2 agonists |
front 69 Which drug prevents GH receptor signaling? | back 69 C. Pegvisomant |
front 70 Somatostatin is best described as: | back 70 A. 14–amino-acid peptide |
front 71 Somatostatin is found in hypothalamus and also: | back 71 B. Pancreas and GI tract |
front 72 Somatostatin functions primarily as: | back 72 C. Inhibitory paracrine factor |
front 73 Somatostatin inhibits release of which set? | back 73 A. GH, TSH, insulin, gastrin |
front 74 Key organ for somatostatin metabolism/excretion: | back 74 C. Kidney |
front 75 Native somatostatin has limited usefulness because: | back 75 B. Short action, multiple effects |
front 76 Octreotide potency compared with somatostatin for GH
inhibition: | back 76 C. 45 times more potent |
front 77 Octreotide potency for insulin suppression is about: | back 77 B. Twice as potent |
front 78 Typical octreotide regimen for tumors is: | back 78 B. SC every 8 hours |
front 79 Octreotide reduces symptoms from many tumors, including: | back 79 A. Insulinoma, VIPoma, carcinoid |
front 80 Octreotide is also useful for acute control of: | back 80 B. Variceal bleeding |
front 81 A patient on octreotide reports bulky oily stools. This adverse
effect is: | back 81 C. Steatorrhea |
front 82 A patient on octreotide develops HR 48. This cardiac adverse effect
is: | back 82 B. Sinus bradycardia |
front 83 Long-term octreotide therapy may cause deficiency of: | back 83 D. Vitamin B12 |
front 84 Another approved somatostatin analog for acromegaly is: | back 84 A. Lanreotide |
front 85 Pegvisomant is used to treat: | back 85 C. Acromegaly |
front 86 A patient with hypothalamic infertility needs GnRH to stimulate
pituitary gonadotrophs. What pattern is required? | back 86 B. Pulsatile GnRH secretion |
front 87 A man receives sustained leuprolide (nonpulsatile). What pituitary
outcome results in both sexes? | back 87 C. Hypogonadotropic hypogonadism |
front 88 Gonadorelin is best described as: | back 88 D. Synthetic GnRH acetate salt |
front 89 Compared with native GnRH, GnRH agonist analogs are
generally: | back 89 D. More potent, longer-lasting |
front 90 Gonadorelin can be administered by: | back 90 C. IV or subcutaneous |
front 91 A patient is prescribed nafarelin (GnRH agonist). Which route matches
this agonist? | back 91 C. Nasal spray |
front 92 Histrelin (a GnRH agonist) may be delivered as a: | back 92 B. Subcutaneous implant |
front 93 Between which ages does GnRH secretion fall off with very low
pituitary sensitivity? | back 93 D. Age two until puberty |
front 94 Just before puberty, GnRH release typically shows: | back 94 B. Higher frequency and amplitude |
front 95 In early puberty, pituitary sensitivity rises partly due to
increasing: | back 95 C. Gonadal steroids |
front 96 Highest GnRH pulse amplitudes occur during the: | back 96 C. Luteal phase |
front 97 Highest GnRH pulse frequency occurs late in the: | back 97 B. Late follicular phase |
front 98 Lower GnRH pulse frequencies preferentially favor secretion
of: | back 98 A. FSH |
front 99 Higher GnRH pulse frequencies preferentially favor secretion
of: | back 99 C. LH |
front 100 Continuous gonadorelin (or analog) produces a: | back 100 D. Biphasic response |
front 101 The first 7–10 days of continuous GnRH agonist therapy is
the: | back 101 A. Flare phase |
front 102 During the flare phase, gonadal hormone concentrations: | back 102 B. Increase transiently |
front 103 After the flare, continued agonist presence causes: | back 103 B. Decreased gonadotropins and steroids |
front 104 A major barrier to pulsatile GnRH therapy is: | back 104 A. IV pump use, cost, access |
front 105 In women undergoing gonadotropin ovulation induction, gonadorelin (or
an agonist analog) can be used to: | back 105 D. Trigger LH surge, ovulation |
front 106 GnRH testing can help evaluate delayed puberty by assessing: | back 106 C. Pituitary LH response |
front 107 An impaired LH response to GnRH most strongly suggests: | back 107 D. Hypogonadotropic hypogonadism likely |
front 108 In controlled ovarian stimulation for IVF, a critical goal is
to: | back 108 D. Suppress endogenous LH surge |
front 109 The most common LH suppression approach uses: | back 109 C. SC leuprolide or nasal nafarelin |
front 110 Continuous GnRH agonist therapy reduces endometriosis pain primarily
because it: | back 110 B. Suppresses estrogen and progesterone |
front 111 Preferred GnRH agonist treatment duration for endometriosis is
limited to ~6 months because of: | back 111 A. Bone mineral density loss |
front 112 Uterine leiomyomata are: | back 112 B. Benign uterine smooth muscle tumors |
front 113 A patient with leiomyomata most classically presents with: | back 113 A. Menorrhagia anemia pelvic pain |
front 114 Treating leiomyomata for 3–6 months with a GnRH agonist plus iron
most directly: | back 114 A. Shrinks fibroids, improves anemia |
front 115 Primary medical therapy for prostate cancer is: | back 115 C. Androgen deprivation therapy |
front 116 Negative feedback inhibition of GH is mediated by which pair? | back 116 A. GH and IGF-1 |
front 117 Prolactin release is primarily inhibited by: | back 117 A. Dopamine via D2 |
front 118 TRH stimulates release of which set? | back 118 C. TSH and prolactin |
front 119 Growth-promoting effects of GH are mediated mainly through: | back 119 B. Somatomedin C |
front 120 Most circulating IGF-1 is synthesized in the: | back 120 B. Liver |
front 121 Reduced GH levels would most likely lead to: | back 121 B. Hypoglycemia |
front 122 Clonidine, levodopa, and exercise have what effect on GHRH? | back 122 C. Increase GHRH levels |
front 123 In provocative testing, clonidine acts primarily as: | back 123 A. Alpha2-adrenergic agonist |
front 124 In provocative testing, levodopa acts primarily as: | back 124 B. Dopaminergic agonist |
front 125 Arginine and insulin-induced hypoglycemia increase GH mainly
by: | back 125 D. Reducing somatostatin tone |
front 126 A patient on GH develops swelling and muscle pains. Which adverse
effect fits GH therapy? | back 126 A. Peripheral edema |
front 127 Another adverse effect of GH therapy is: | back 127 A. Carpal tunnel syndrome |
front 128 Mecasermin is: | back 128 A. Recombinant human IGF-1 |
front 129 Mecasermin rinfabate is best described as: | back 129 A. IGF-1 plus IGFBP-3 |
front 130 Most important adverse effect of mecasermin is: | back 130 C. Hypoglycemia |
front 131 Somatostatin inhibits release of which set? | back 131 A. GH TSH glucagon insulin gastrin |
front 132 Somatostatin half-life is closest to: | back 132 D. 1–3 minutes |
front 133 Octreotide is best described as: | back 133 B. Widely used SST analog |
front 134 Octreotide half-life is closest to: | back 134 C. 80 minutes |
front 135 Lanreotide is: | back 135 A. Long-acting SST analog |
front 136 Pegvisomant is: | back 136 C. GH receptor antagonist |
front 137 Pegvisomant can lead to increased GH levels because it: | back 137 C. Does not inhibit secretion |
front 138 In the ovary, LH stimulates androgen production by: | back 138 B. Theca cells |
front 139 In the ovary, FSH stimulates androgen→estrogen conversion in: | back 139 B. Granulosa cells |
front 140 In the luteal phase, estrogen/progesterone are controlled first by LH
and then by: | back 140 C. hCG |
front 141 FSH maintains local androgen by stimulating Sertoli production
of: | back 141 B. Androgen-binding protein |
front 142 FSH also stimulates Sertoli conversion of testosterone to: | back 142 B. Estradiol |
front 143 LH and hCG are used interchangeably because their: | back 143 D. Beta subunits nearly identical |
front 144 In the first 8 weeks of pregnancy, the progesterone/estrogen that
maintain pregnancy are produced primarily by the: | back 144 B. Corpus luteum |
front 145 For the corpus luteum to persist beyond early luteal support,
maternal LH must be taken over by: | back 145 D. hCG |
front 146 Human chorionic gonadotropin (hCG) is produced by: | back 146 A. Placental syncytiotrophoblasts |
front 147 A patient undergoing ovulation induction asks about the two most
common serious complications. Best answer: | back 147 C. Multiple pregnancies and OHSS |
front 148 A patient with hypothalamic infertility is placed on a GnRH pump.
Which pattern is required to stimulate LH/FSH release? | back 148 A. Pulsatile GnRH secretion |
front 149 A man receives sustained nonpulsatile GnRH agonist therapy. What
pituitary-gonadal outcome occurs in both sexes? | back 149 B. Hypogonadotropic hypogonadism |
front 150 Which drug is a GnRH agonist analog? | back 150 C. Leuprolide |
front 151 In this framework, lower GnRH pulse frequency favors which
menstrual-cycle phase? | back 151 A. Follicular phase |
front 152 A patient starts continuous leuprolide. What is expected during the
first 7–10 days? | back 152 D. Increased gonadal hormone levels |
front 153 After the initial 7–10 day flare, continued GnRH agonist exposure
causes: | back 153 C. Decreased LH and FSH |
front 154 A hypogonadotropic adolescent is given GnRH to assess LH
responsiveness. A robust LH rise most suggests: | back 154 B. Early pubertal status |
front 155 A hypogonadotropic adolescent is given GnRH to assess LH
responsiveness. The test shows a low/impaired LH response. This most
strongly suggests: | back 155 D. Hypogonadotropic hypogonadism |
front 156 A patient with fibroids has menorrhagia and anemia. A 3–6 month
regimen most consistent with your notes is: | back 156 B. GnRH agonist plus iron |
front 157 For advanced prostate cancer, the primary medical strategy in your
notes is: | back 157 C. GnRH agonist plus antiandrogen |
front 158 A 7-year-old girl develops breast development and pubic hair. Best
treatment approach: | back 158 A. Continuous GnRH agonist |
front 159 A patient is prescribed a GnRH agonist for endometriosis. Which is a
contraindication? | back 159 C. Pregnant or breastfeeding |
front 160 One month after starting a GnRH agonist, a patient develops pelvic
pain and an ovarian cyst. This is most associated with: | back 160 B. Flare-related cyst formation |
front 161 GnRH receptor antagonists in this set are best described as: | back 161 D. Competitive decapeptide antagonists |
front 162 Which drug is a GnRH receptor antagonist? | back 162 A. Cetrorelix |
front 163 During ovarian stimulation procedures, which GnRH antagonists are
used (per your list)? | back 163 D. Ganirelix and cetrorelix |
front 164 For advanced prostate cancer, which GnRH receptor antagonists are
used (per your list)? | back 164 C. Degarelix and abarelix |
front 165 Two advantages of GnRH antagonists over continuous GnRH agonist
therapy are: | back 165 A. Immediate inhibition; less ovarian suppression |
front 166 Which GnRH antagonist is associated with elevated liver enzymes (per
your notes)? | back 166 C. Degarelix |
front 167 Which description best matches prolactin? | back 167 B. 198-aa anterior pituitary peptide |
front 168 A nonfunctioning pituitary mass compresses the pituitary stalk. What
happens to prolactin levels? | back 168 A. Increased prolactin levels |
front 169 A patient has hyperprolactinemia with low libido and infertility.
Which mechanism-and-treatment pairing best fits? | back 169 D. Inhibits GnRH; dopamine agonist |
front 170 Bromocriptine and cabergoline are best classified as: | back 170 C. D2 dopamine receptor agonists |
front 171 First-line pharmacotherapy for hyperprolactinemia is: | back 171 B. Dopamine agonist therapy |
front 172 Dopamine agonists inhibit prolactin by activating: | back 172 A. D2 receptors |
front 173 A patient with acromegaly needs an adjunct that partially inhibits
GH. Which drug fits? | back 173 D. Cabergoline |
front 174 Oxytocin is a peptide composed of: | back 174 B. 9 amino acids |
front 175 Oxytocin contracts smooth muscle via: | back 175 C. Gq PLC Ca2 signaling |
front 176 For augmentation of labor, oxytocin is typically given by: | back 176 A. Intravenous infusion |
front 177 Milk letdown occurs when oxytocin contracts: | back 177 B. Myoepithelial cells |
front 178 An oxytocin antagonist for preterm labor outside the US is: | back 178 C. Atosiban |
front 179 High-dose oxytocin can cause fluid retention by activating: | back 179 A. Vasopressin receptors |
front 180 Which is a contraindication to oxytocin? | back 180 D. Placental abruption |
front 181 Another oxytocin contraindication is: | back 181 B. Fetal malpresentation |
front 182 Oxytocin should be avoided with: | back 182 A. Fetal distress |
front 183 Vasopressin release increases most with: | back 183 C. Increased plasma tonicity |
front 184 ADH V2 receptors are primarily located on: | back 184 A. Renal tubule cells |
front 185 V2 receptor signaling decreases diuresis via: | back 185 B. Gs adenylyl cyclase |
front 186 V1 receptors mediate vasoconstriction through: | back 186 C. Gq PLC signaling |
front 187 ADH-mediated release of factor VIII and vWF occurs via: | back 187 C. V2 receptors |
front 188 Per these notes, diabetes insipidus is treated with: | back 188 A. Vasopressin at bedtime |
front 189 Which agent does NOT cause vasoconstriction? | back 189 B. Desmopressin |
front 190 Conivaptan and tolvaptan are: | back 190 C. Vasopressin antagonists |
front 191 Conivaptan has high affinity for: | back 191 D. V1a and V2 receptors |
front 192 Tolvaptan’s receptor affinity is best described as: | back 192 B. V2 thirtyfold over V1 |
front 193 Tolvaptan duration is limited due to: | back 193 A. Risk of hepatotoxic liver failure |
front 194 A hyponatremic heart-failure patient receives a V1a/V2 blocker. Which
drug is used? | back 194 B. Conivaptan |