Sample questions / Endocrine

Organ system

Endocrine questions for Step 1

Work through endocrine vignettes that mix physiology, pathology and pharmacology, the way the exam does. Every explanation covers all five options.

PathologyEasy

Sarcoidosis hypercalcemia

A 40-year-old man has polyuria, thirst, a dry cough and bilateral hilar adenopathy. Calcium is 11.5 mg/dL, PTH is suppressed, 1,25-(OH)2 vitamin D is high, 25-OH vitamin D is normal and ACE is elevated. Transbronchial biopsy shows noncaseating granulomas.

What is the main cause of his hypercalcemia?

1. Decreased renal calcium excretion from thiazide-like effect of granulomatous nephritis
2. Osteoclast-activating factor release from lymphocytes infiltrating bone marrow
3. Extrarenal 1-alpha-hydroxylase activity in activated macrophages within granulomas
4. PTH-related peptide secretion from granulomatous tissue acting on bone and kidney
5. Increased intestinal calcium absorption from excessive dietary vitamin D intake

PhysiologyEasy

PCOS and weight loss

A 30-year-old woman with PCOS and BMI 33 loses much less weight than her sister without PCOS on a similar calorie cut.

Which factor best explains her difficulty?

1. Decreased androgen levels
2. Insulin resistance reducing lipolysis
3. Higher resting metabolic rate
4. Increased brown adipose tissue
5. Enhanced insulin sensitivity

ImmunologyEasy

Graves ophthalmopathy

A 28-year-old woman with Graves disease on methimazole has worsening eye bulging and double vision. MRI shows enlarged extraocular muscles.

Which antigen is targeted in thyroid eye disease?

1. Collagen type II in orbital tissue
2. Melanocytes in the orbit
3. Acetylcholine receptor on eye muscles
4. TSH receptor on orbital fibroblasts
5. Vascular endothelium in orbital vessels

PharmacologyEasy

Pioglitazone edema

A diabetic man on pioglitazone has leg edema with preserved EF.

What explains it?

1. Decreased cardiac output from direct myocardial toxicity
2. Increased hepatic production of angiotensinogen
3. Increased sodium reabsorption in the renal collecting duct
4. Venous insufficiency from direct endothelial damage
5. Allergic interstitial nephritis with protein loss

BiochemistryEasy

Von Gierke disease

A 6-month-old has hepatomegaly, doll-like facies and irritability between feeds. Fasting glucose is 35, with lactate 8.2, uric acid 11.5 and triglycerides 680. Liver glycogen is increased but normal in structure, and glucagon raises lactate without raising glucose.

Which enzyme is deficient?

1. Glycogen phosphorylase
2. Acid α-glucosidase
3. Debranching enzyme
4. Phosphofructokinase
5. Glucose-6-phosphatase

Other systems

Cardiovascular · Respiratory · Renal & Urinary · Gastrointestinal & Hepatobiliary · Nervous System · Reproductive · Hematology & Oncology · Musculoskeletal & Skin · Behavioral Health · Multisystem & General Principles ·