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1st CCD:
1.Mark the correct statement regarding Growth Horomone (GH):
a. it binds to a specific nuclear receptor to exert its function.
b. The human form of the hormone is fuctional in other animals.
c. Its diurnal [=changes during the course of the day] variation is independent of
sleep.
d. When given s.c. [subcutaneously] it maintains quasi-normal GH levels for 24
hours.
e. Since it’s a relatively small protein, it can be given as a nasal spray.
2. The most reasonable possible explanation for the hypoglycemia of the girl with the
short stature in he clinical case to be discussed is:
a. GH elevates blood sugar and in its absence children have hypoglycemia
b. In synergism with somatostatin, GH causes hypoglycemia
c. short children have lower blood glucose than tall ones
d. the low insulin-like growth factor (IGF)-binding protein (BP3) stimulates insulin
to cause hypoglycemia
e. Her hypoglycemia and growth retardation are directly related to her clinical signs
of malnutrition.
3. The combination of high GH and low IGF-1 can result from:
a. malnutrition
b. GH receptor defect
c. hypersecretion of GH releasing hormone (GHRH)
d. hyposecretion of somatostatin
e. severe stress while visiting the laboratory
4. Mark the correct statement regarding the control of GH secretion:
a. IGF-1 stimualtes GH secretion
b. GHRH stimulates GH secretion but not synthesis
c. somatostatin inhibits GH synthesis but not secretion
d. Somatostatin-generating neurons are the pulse generators for GH pulsatility
e. GH exerts a positive feedback on its own secretion
ANSWERS: 1. b (although other groups’ CCD tutors said a different answer was correct,
according to Dr. Hochberg, its b), 2. a, 3. b, 4. d.
2nd CCD:
1. Mark the incorrect statement regarding PCOS:
a. It’s the most common cause of chronic anovulation and irregular
menstruation
b. The incidence is 5-8% of young women
c. Its associated with sleep apnea
d. Its associated with endometrial hyperplasia and carcinoma
e. Its associated with lung cancer
2. PCOS is associated with all of the following featues except:
a. insulin resistance
b. metabolic syndrome
c. adrenal tumors
d. hirsutism
e. oligo-amenorrhea
3. The two cell two gonadotropin theory claims that:
a. LH stimulates theca cells to produce androgens and FSH stimulates
granulosa cells to aromatize androgens to estrogens
b. FSH stimulates theca cells to produce androgens and LH stimulates
granulosa cells to aromatize androgens to estrogens
c. LH stimulates Leydig cells to produce androgens and FSH stimulates
Sertoli cells to aromatize androgens to estrogens
d. LH stimulates neuroglia cells to produce androgens and FSH stimulates
Schwan cells to aromatize androgens to estrogens
e. None of the above.
4. Mark the correct statement regarding the pathophysiologic vicious cycle of
PCOS:
a. the high LH stimulates excessive androgen production
b. the relatively low FSH levels are incompetent in inducing enough
aromatase to convert androgens to estrogens in the ovary
c. the high androgens are peripherally and acyclically converted to estrone in
the subcutaneous tissue.
d. The chronic and unopposed estrogens increase pituitary sensitivity to
GnRH and increase GnRH pulsatile frequency
e. All of the above are correct
ANSWERS: 1.e, 2.c, 3. a, 4. e.
3rd CCD:
1. Mark the INCORRECT statement about insulin:
a. its secreted in 2 phases
b. with each insulin molecule, 2 c-pepetide molecules are secreted, one from
the a chain and the second from the b chain
c. glucose and amino acids stimulate insulin secretion
d. in some pathologic situations, proinsulin is secreted in excess
e. the gene for preproinsulin is on chromosome 11
2. Neonatal diabetes car result from all fo the following EXCEPT:
a. autoimmune destruction of beta cells
b. agenesis of pancreas
c. mutaton in ATP potassium channel
d. no activity in glucokinase
e. idiopathic transient neonatal diabetes
3. mark the correct statement regarding Type 1 diabetes (T1DM):
a. its hereditary (autosomal recessive)
b. HLA DR 2 is dominnat in patients
c. Like other autoimmune diseases, its much more common amongst females
d. When one of two identical twins is sick, the other twin has a 40% chance
to develop T1DM
e. Feeding on cow’s milk is protective against it
4. Mark the correct statement regarding the differences between T1DM and T2DM:
a. in T1DM there is excessive insulin that can’t work properly
b. in T2DM there is an autoimmune destruction of beta cells
c. more than 80% of T2DM are obese
d. the initial treatment in both types in identical
5. Mark the correct statement regarding the management of a new case of T1DM:
a. if the patient has no DKA we should first try diet and physical activity
b. in a patient older than 20 years we should start with oral medications
c. all cases should be treated with insulin immediately
d. in obese patients, we should add oral insulin sensitizer
e. Islet cell transplantation within one year is available.
ANSWERS: 1. b, 2. a, 3. d, 4. c, 5. c.
4th CCD:
1. Which of the following statements about PTH is correct?
a. the hormone acts through a nuclear receptor
b. the hormone increases the synthesis of 24,25dihydroxyvitamin D, leading
to an increase in calcium absorption
c. PTH increases tubular reabsorption of phosphate from the glomerular
filtrate
d. PTH increases tubular reabsorption of calcium from the glomerular filtrate
e. PTH has a negative feedback on calcitonin secretion
2. Which of the following statements about bone turnover is correct?
a. cortical bone has normally higher turnover than trabecular bone
b. 1,25 (OH)2D3 and 24,25 (OH)2D3 exert a synergistic action on bone
turnover
c. PTHrP increases bone turnover, acting through the PTH receptor
d. Once daily subcutaneous administration of PTH usually causes bone loss
e. Osteoprotegerin increases osteoclast number and action
3. Which of the following statements about the calcium sensing receptor is correct?
a. the receptor belongs to the nuclear receptor family
b. the receptor is present in the parathyroid, thyroid-C cells and the kidney
c. inactivating mutation of the calcium sensing receptor gene will lead to
hypocalcemia
d. calcium sensing receptor gene mutation of both alleles causes minor
abnormalities in calcium metabolism in adulthood
e. none of the above
4. Which of the following statements is correct?
a. osteoporosis is a condition marked by softening of the bones (due to
impaired mineralization, with excess accumulation of osteoid) with pain
and tenderness
b. the most frequent cause of osteomalacia is excess calcitonin production
c. patients with osteomalacia due to vitamin D deficiency, usually have
normal plasma PTH levels
d. low serum phosphate levels increases bone mineralization
e. none of the above are correct
ANSWERS: 1.d, 2. c, 3. b, 4. e.