CASE 1

A 25-year-old male has been admitted for surgery after sustaining several injuries after a drunk driving accident.
X-rays are ordered but no fractures are reported, the abdomens show some abrasions but no distension. Several
hours after the surgery the patient has decreased urine output and his stomach is now distended and he reports pain.
His vital signs show normal blood pressure and increased heart rate is increased, the doctor in the floor suspects
intraabdominal bleeding and he is taken again to the operating room.

1) In this patient which of the following will we most likely find if there is intraabdominal bleeding?
a) Increased resistance of afferent arterioles
b) Increased secretion of ADH from posterior hypothalamus
c) Macula densa receives a filtrate with high flow and osmolarity
d) Increased secretion of renin by JG cells
e) Increased secretion of ANP

2) If his doctor wanted to measure the patients Glomerular filtration rate (GFR) after he was stabilized, the best
estimate for the GFR would be the renal clearance of which of the following naturally occurring substances in
the patient?
a) Creatinine
b) Para-aminohippuric acid
c) Urea
d) Inulin
e) Sodium

3) In this patient the increase of which of the following hormones would result in the greatest decrease in the
volume of Urine?
a) Angiotensin II
b) ANP
c) PTH
d) Aldosterone
e) ADH

4) In this patient, which of the following will we find most elevated?

a) Serum Sodium
b) Urine osmolarity
c) Serum osmolarity
d) Extracellular volume
e) Plasma ANP

5) If the patient’s Sympathetic nervous system is highly elevated, which of the following will we most likely find?
AA EA GRF FF
a) ↓ ↑ ↓ ↑
b) ↑ ↓ ↑ ↓
c) ↓ ↓ ↓ ↓
d) ↓ ↑ ↓ ↓
e) ↑ ↓ ↑ ↓
AA= Afferent Arteriole EA= Efferent Arteriole
GFR= Glomerular Filtration rate
FF= Filtration Fraction
↓= Constricted; ↑=Dilated
CASE 2
A young woman goes to her gynecologist for a checkup, she is 20 weeks pregnant, and started the pregnancy
overweight, this is her first pregnancy and hasn’t had any complications, all of the blood works came back normal
with the exception of her urine which showed glucosuria.

6) In which part of the nephron will glucose is most likely reabsorbed?

a) PCT
b) Descending loop of Henle
c) Ascending loop of Henle
d) DCT
e) Collecting duct
7) Which of the following molecules has the same transport mechanism as Glucose?
a) PAH
b) H+
c) Amino Acids
d) Potassium
e) Chloride
8) Appearance of glucose urine in the patient would be most likely due as a consequence to which of the following?
a) Increasing activity of Na-K ATPase pump
b) Increasing Glomerular Filtration Rate
c) Decreasing the filtration fraction
d) Saturation of Na-H+ exchanger
e) Saturation of Na-Glucose counter transporter
9) The patient develops type 2 diabetes mellitus 5 years later and has an acetone smell on her breath; she has
developed diabetic ketoacidosis, hypovolemia and brisk Diuresis. The increase in urine volume is most likely
due to which of the following?
a) Increased glucose in tubular fluid
b) Decreased ADH
c) Decreased Angiotensin II
d) Decreased concentration of cAMP in principal cells of the collecting duct
e) Suppression of aldosterone secretion
10) If the following graph shows how the patients handles glucose, determine which of the following plasma
concentration of glucose were we have the fastest reabsorption rate for glucose?

a) 60 mg/dL
b) 150 mg/dL
c) 200 mg/dL
d) 250 mg/dL
e) 400 mg/dL
CASE 3:
A middle aged male with a history of heart disease is admitted to the clinic with congestive heart failure. After he
is stabilized pulmonary and peripheral edema appears that get better with the administration of furosemide which
is a loop diuretic. He later is released from the clinic but comes back two weeks later complaining of weakness,
dizziness and nausea.
11) The loss in urine of which of the following is the most likely cause of this patient symptoms?
a) Na+
b) Cl-
c) K+
d) HCO3-
e) H+
12) In which of the following regions of the nephron is the drug most likely acting on?
a) Na-K ATPase pump in the luminal side of the PCT
b) Na-Cl Cotransporter of the DCT
c) Na-K-2Cl cotransporter of the ascending loop of Henle
d) H+-K- pump in the intercalated cells of DCT
e) Aquaporin 2 channels of the DCT and Medullary collecting duct

13) If the patient later develops hypertension due to the appearance of an aldosterone secreting adrenal tumor.
Which of the following is likely to be seen in the patient?
a) Elevated sodium in urine
b) Furosemide would NOT improve the hypertension
c) Decreased plasma sodium concentration
d) Increased renin concentration in plasma
e) Elevated plasma potassium concentration

14) In a normal patient, the increase secretion of Aldosterone would most likely cause which of the following?
a) Acts on intercalated cells to increase H+ reabsorption
b) Increases in Na reabsorption in the ascending loop of Henle
c) It would increase Angiotensin II secretion
d) It would increase IP3 and Ca in principals cells to increase Na reabsorption
e) Increasing Na+ channels and Na+-K+ATPase pump in the principal cells of the collecting ducts

CASE 4:
A 34-year-old female suffered from head trauma after a work related accident 4 days ago and is in the ICU. A CAT
scan performed that reveal edema to the brain without herniation. The patient is now in critical but stable condition.
The attending physician discovers low levels of plasma Sodium and diluted urine.
15) Which of the following is true regarding this patient?
a) ADH plasma levels are low
b) Increased expression of Aquaporin 2 receptors in the collecting ducts
c) Increased secretion of Aldosterone due to increased blood pressure
d) Increased concentration of IP3 in the cytoplasm of DCT
e) ADH binding protein is decreased in blood

16) Later on the patient was administered with exogenous ADH, which of the following is true regarding this patient
after treatment is started?
a) Plasma concentration of Sodium increases
b) Increased reabsorption of water in the PCT
c) The filtrate in the ascending loop of henle becomes more hypotonic
d) Increase aquaporin channels in principals cells
e) Patient’s plasma osmolarity increases
17) Later on the patient was administered with exogenous ADH, which of the following is true regarding this patient
after treatment is started?
a) Smooth muscle cells in arterial have receptors for ADH which increase intracellular cAMP
b) V1 receptors in the principal cells respond to ADH in plasma
c) V2 receptor are stimulated by ADH which increase Protein Kinase A that phosphorilate aquaporine 2
channels
d) ADH increase IP3 of principal cells to increase water reabsorption
e) V1 receptors when stimulated by ADH vasodilate arterioles

18) A new patient comes complaining of urinating several times during the night which keep him awake. He
complains of fatigue, hypernatremic and high levels of ADH and renin, further studies reveal large volumes of
dilute urine. Which of the following does the patient most likely suffer from?
a) Psychogenic polydipsia
b) Excessive consumption of alcohol
c) Brain trauma
d) Central diabetes insipidus
e) Nephrogenic diabetes insipidus

CASE 5:
A middle aged male who was diagnosed 10 years ago with hepatitis C is taken to the emergency department with a
distended stomach, yellow eyes, fatigue, bruising in the body and itchiness. When the attending physician does a
physical examination he observes ascites, icteric sclera and peripheral edema, and his laboratory analysis reveal
slightly increased levels of liver function, and an increased time of coagulation the patient also presents low levels
of plasma albumin, hyperbilirrubinemia, increased ammonium and Hypokalemia.
19) In normal situations, the decrease in plasma volume will most likely cause which of the following?
a) Increased sodium reabsorption
b) Metabolic acidosis
c) Hyperkalemia
d) Increase water volume in urine
e) Increased potassium secretion

20) Which of the following is the most likely cause of the patient’s edema and sodium reabsorption?
a) Decreased hydrostatic capillary pressure
b) Decreased oncotic capillary pressure
c) Increased pressure will increase aldosterone secretion
d) Increased metabolic activity of the liver
e) Angiotensin 2 increases the filtration of fluid to the interstitial space

21) In which of the following regions is there the greatest percentage of Na reabsorption?
a) Cortical Collecting Duct
b) Distal convoluted tubule
c) Ascending loop of henle
d) Descending loop of henle
e) Proximal convoluted tubule

22) In a healthy individual that starts a high potassium diet, why will the patient present hypervolemia?
a) Increased secretion of ADH
b) Decreased ANP secretion
c) Stimulation of aldosterone
d) Stimulation of the renin Angiotensin aldosterone system
e) Increased plasma oncotic pressure
23) In a healthy individual, that has lost blood after an accident, and that has hypotension and tachycardia. Which
of the following is the most likely physiological response?
a) Vasodilation of afferent arteriole
b) Beta adrenergic stimulation of vasculature
c) Vasoconstriction of afferent and efferent arterioles
d) Reduction of ADH release
e) Increasing urine output

CASE 6:
A 38-year-old woman suffering from hypertension and her cardiologist put her on a new medication to lower her
blood pressure, that is an ACE inhibitor, and although her blood pressure is now low she is feeling weak and
fatigued. Her doctor thinks that there is an electrolyte imbalance and orders electrolyte concentration.

24) The use of ACE inhibitors will most likely cause which of the following?
a) Decrease in Angiotensin I in plasma
b) Increase in K+ secretion
c) Increase in Filtration Fraction
d) Hyperkalemia
e) Hypernatremia

25) If a healthy person develops an acidosis how will this affect the electrolyte balance?
a) Decreases potassium secretion
b) Increase Hydrogen reabsorption in DCT
c) Increased bicarbonate secretion in PCT
d) Increase Urine potassium
e) Decreased activity in membrane enzyme carbonic anhydrase

26) In a healthy individual what electrolytes and in what region of the nephron competes with Calcium
Reabsorption?
a) Magnesium in Ascending loop of Henle
b) Sodium in Proximal Convoluted tubule
c) Potassium in Collecting Ducts
d) Manganese in Distal convoluted tubule
e) Urea in the collecting ducts

27) In a healthy individual that has hypocalcemia, how does the kidney maintain calcium balance?
a) Fluid flow-induced stimulation of calcium reabsorption by the collecting duct
b) Calcitonin-induced inhibition of calcium secretion by the distal convoluted tubule
c) Vitamin D-induced activation of calcium reabsorption by the proximal tubule
d) Parathyroid hormone-induced stimulation of calcium reabsorption by the thick ascending limb
e) Aldosterone-induced activation of calcium reabsorption by the distal convoluted tubule
CASE 7:
A 22-year-old male that suffers from insulin dependent diabetes (Type 1) since he was 12 years old is brought to
the ER with behavioral alterations, nausea, vomiting, abdominal pain and taquipnea. When checked by the attending
physician BP was at 90/60 mm Hg, HR 110 B/min, RR 22 /min and had a fever. His breath smelled of acetone and
when the lab analysis came back, his plasma glucose levels were at 500 mg/dl, had Hyperkalemia, decreased
magnesium and elevated ketone bodies.

28) In this patient which of the following will be the most likely result from the blood arterial gases
pH HCO3 PaCO2
a) ↓ ↑ ↓
b) ↑ ↓ ↑
c) ↓ ↓ ↓
d) ↓ ↑ ↑
e) ↑ ↓ ↑

29) In this patient what will be the correct compensation mechanism?

a) Decrease ventilation rate
b) Increased secretion of H+ in principal cells of the DCT
c) Increase reabsorption of Ammonia in PCT
d) Increase excretion of fixed acids
e) Increased reabsorption of bicarbonate in descending loop of Henle

30) In this patient, which of the following is most likely compensation mechanism?
a) Increased plasma Bicarbonate and PaCO2
b) Decreased plasma Bicarbonate and PaCO2
c) Increased plasma Bicarbonate and decreased PaCO2
d) Decreased plasma Bicarbonate and increased PaCO2

ENDOCRINE AND REPRODUCTIVE

CASE 1:
A middle aged woman goes to her OBGYN complaining of irregular menstruations for the last year, and that her
last period came 4 months ago. She reports several negative home pregnancy tests. She also complains of headaches,
altered vision and milky secretion from her nipples. She has no medical problems and is not taking any medication.
On physical exam galactorrea is observed and a decreased bilateral peripheral vision. Blood test came back with
normal TSH levels and increased levels of Prolactin.

31) Why would the increased levels of Prolactin cause amenorrhea?

a) Directly inhibiting secretion of estrogen from granulosa cells
b) Increasing the secretion of TRH
c) By inhibiting the secretion of Dopamine
d) Inhibiting the secretion of GnRH
e) Increasing milk synthesis

32) Why did the doctor feel it was necessary to order thyroid function test in this patient?
a) Hypothyroidism is associated with increased TRH which increases Prolactin
b) Hyperthyroidism is associated with increased TRH which increases Prolactin
c) Hyperthyroidism is associated with increased TSH which increases Prolactin
d) Hypothyroidism is associated with increased TSH which increases Prolactin
e) Hyperthyroidism is associated with increased T3 and T4 which increases Prolactin
CASE 2:
A 33-year-old female has developed unexplained weight loss and hair loss in the last few months; she has also
suffered in this time period from diarrhea, high eye pressure and has been really nervous and anxious. She has no
past medical history but in her family some have suffered symptoms similar to hers which require some unknown
medication. In her physical examination she presents exophthalmos, hyperreflexia, a tremor in her arms when they
are extended and a goiter. The patient’s blood analysis show a decreased TSH and increased of T3 and T4.

33) In a healthy pregnant patient, which of the following will we most likely find?
a) Increased concentration of free thyroid hormone
b) Decreased TBG
c) Decreased total concentration of Thyroid Hormone
d) Goiter because of increased TSH
e) Increased concentration of total thyroid hormone

34) In this patient, which of the following is the mechanism of action of the increased thyroid hormone?
a) Binds to a membrane receptor and increases cAMP
b) Binds to a membrane receptor and increases a protein kinase
c) Binds to a intracellular receptor to increase transcription in a gen in the nucleus
d) Binds to a tyrosine kinase membrane receptor to increase autophosphorilation
e) Binds to a intracellular receptor to increase phosphorilation of a protein

CASE 3:
A young previously healthy woman goes to her gynecologist complaining of amenorrhea and hirsutism which is
more apparent in the chest and back and she also complains of feeling tired easily and an unexplained and gradual
weight gain, in the physical examination her face seems round, her abdominal perimeter is increased and her blood
pressure is elevated. There are also striations in the skin of her abdomen and the growth of pubic hair and hair
distribution in her body is similar to men. A dexametasone test is ordered.

35) In healthy patients, which of the following is the most likely effect of using dexametasone?
a) Binds to cortisol
b) Increases MSH
c) Inhibits ACTH secretion
d) Increases CRH
e) Competes with binding sites for cortisol

36) If the patient has a secreting tumor that also increases aldosterone secretion, which of the following will we
most likely find?
a) Excretion of bicarbonate
b) Hyperkalemia
c) Increase H+ resorption by renal tubules
d) Metabolic alkalosis
e) Efflux of K by exchanging with H+

37) The patient was diagnosed with a tumor of the adrenal cortex, so bilateral extirpations of both adrenal glands
are ordered and the patient is given cortisol replacement therapy. Cortisol permits the patient to maintain plasma
glucose in fasting state, which of the following best explains this observation of cortisol?
a) acts antagonistically to action of GH
b) helps the action of insulin
c) activates enzymes involved in the mobilization of various organic compounds as energy fuels
d) increases the use of glucose utilization and decreases glycogen
e) stimulates the uptake of amino acids into skeletal muscle cells
CASE 4:
A 12-year-old boy has lost weight, is always tired, has polydypsia, polyphagia and polyurea and is taken to the ER.
He has no past medical history, and has a family history of hypertension and diabetes mellitus. The patient looks
thin and a urine analysis show glucosuria and there’s and there is also an increase in plasma glucose when fasting.

38) In normal situations which of the following is an important factor to regulate insulin secretion?
a) GIP
b) Somatostatin
c) Sympathetic Nervous system
d) Catecholamines
e) Sodium

39) In a type 2 diabetic patient, how would sulfonylurea increase insulin secretion?
a) Inactivating ligand gated Ca+2 channels
b) Stimulating SGLT channels in Beta 2 Cells
c) Increasing conversion of tyrosine to insulin
d) Increasing Potassium channels that activate voltage gated Ca+2 channels
e) Increasing tyrosine kinase receptors of beta cells

40) In this patient, the liver fails to extract glucose and continues to produce glucose regardlees of the concentration
of plasma, this failure is most likely due to which of the following?
a) Increased glucokinase
b) Decreased phosphorilase
c) Increased gluconeogenesis
d) Diminished muscle catabolism
e) Insulin dependent glucose transport in the liver

CASE 5:
A 44-year-old male who is taken to the emergency deparment presenting headaches, confusion, disorientation and
alterations in his vision when he wakes up. He also has presented with heart palpitations, sweating profusely and
tremors also in the mornings. All of his symptoms are resolved after he eats breakfast and don’t appear during the
day with the exception when he stays from work and eats later or skips a meal. He has a normal physical
examination, his blood analysis show hypoglycemia, the patients doesn’t consume drugs or alcohol and his insulin
levels in blood are high, the doctor suspects an insulinoma.

41) The increased levels of epinephrine will most likely cause which of the following?
a) Stimulate insulin secretion
b) Increase plasma amino acid concentration
c) Stimulate glucagon secretion
d) Inhibit cortisol secretion
e) Increase muscle glycogen
42) The increased secretion of insulin will cause an increase of which of the following?
a) Tyrosine kinase activity
b) cAMP activity
c) nuclear receptor increasing transcription of specific genes
d) Protein kinase C
e) Gluconeogenesis

CASE 6:
An elderly female is brought to the emergency department with a pain in the right side of her abdomen, nausea,
vomiting and hematuria for the last 2 weeks. There are no signs of fever or an infection. She has suffered before
from kidney stones, diffuse abdominal pain and muscular weakness and atrophy. In her physical examination she
looks distressed, fragile and looks like she has lost weight recently. Her urine analysis show large amounts of blood
but no infection. A new pieloghram show numerous kidney stones and elevated calcium levels in blood.

43) Which of the following if we increased its activity increase the most the absorption of Calcium from the small
intestine?
a) PTH
b) Vitamin D
c) Calcitonin
d) 1 alfa hydroxylase
e) Thyroid Hormone

44) If the patient has increased PTH secretion, which of the following will we most likely find?
a) Increased reabsorption of Ca in proximal tubule
b) Increase secretion of Phosphate in distal tubule
c) Decrease reabsorption of phosphate in proximal tubule
d) Decrease reabsorption of Ca in distal tubules
e) Potentiate the effect of Calcitonin

45) In this patient the increase secretion of PTH will cause which of the following?
a) Efflux of Ca from muscle cells
b) Reabsorption of Ca by PCT
c) Stimulate bone resorption increasing Ca in plasma
d) Main mechanism to absorb gastrointestinal tract
e) Increase the secretion of phosphate in small intestine

46) If the patient’s parathyroid gland are removed, which of the following will we most likely find after PTH is
decreased?
a) Hypercalcemia
b) Muscle flaccidity
c) Constipation
d) Coma
e) Nerve Paresthesias

CASE 7:
A 13-year-old boy is brought to a pediatriatian by his parents because they are worried about his growth, he has
grown almost a foot in the last year and is the tallest child in his class, his chin has also increased in size, both his
parents and his family are short. Other signs found are increase height for age, increase in the size of the hands,
feet, and tongue and his skin is greasy.

47) Which hormones have the same cellular mechanism of action as the increased hormone in this patient?
a) Thyroid Hormon
b) Glucagon
c) TSH
d) TRH
e) ANP

48) In a healthy individual, which of the following mechanism is how this hormone is inhibited?
 a) GHRH
b) Dopamine
c) TRH
d) GH
e) IGF

49) In this patient, which will increase the rate of mitosis that is the cause of the increase height of the patient?
a) Chrondrocytes
b) Osteoblast
c) Lymphocytes
d) Matrix
e) Osteocytes

CASE 8:
A 16-year-old female has gone with her mother to the gynecologist complaining that she hasn’t gone through
menarche; she has developed her breast but has scant pubic hair. Her physical examination reveals a malformed
vagina and a cervix and uterus was not found. A blood test is performed and her cariotype is revealed to be XY.
50) Which of the following enzymes converts testosterone to dihydrotestosterone (DHT) in the prostate?
a) Type 3 17β dehydrogenase
b) CYP 19 (aromatase)
c) 5α reductase
d) 1α hydroxylase
e) 11β dehydrogenase

51) A 16-year-old boy has a deficiency in the activity of 5α reductase decreasing DHT in his peripheral tissue.
Which of the following is the most probable manifestation of this enzyme deficiency?
a) Male pattern baldness
b) Acne
c) Prostatic hyperplasia
d) Small genitals
e) Deeper voice

52) The Sertoli cell expresses receptors to which of the following hormones?
a) FSH and inhibin
b) FSH and androgen
c) LH and androgen
d) LH
e) FSH

CASE 9:
A 19-year-old woman goes to her gynecologist because she has not menstruated in the last 4 months. She had her
menarche at 12 year of age and has always had regular cycles. She has no medical history, reports no sexual contact,
no medication, no symptoms of thyroid disease or breast milk production. Her physical examination show a thin
but normal developed young female. The patient does reveal that she has been on several diets because she feels fat
although her BMI is 18 (Body mass index is normal between 20 to 24.9). the only other abnormalities include
Bradycardia, dry skin with thin and scant hair all over her body. A pregnancy test came back negative and thyroid
function came back normal.

53) What is the cause of this patient’s amenorrhea?

a) Increased FSH
b) Increased inhibin
c) Decreased LH
d) Decreased GnRH
e) Increased Estrogen

54) Before this situation, the patients normal cycle was 36 days, in what day of her cycle did she most likely ovulate?
a) Day 15
b) Day 18
c) Day 20
d) Day 22
e) Day 24

55) In a child that had a precocious puberty and her doctor wanted to delay onset of puberty which of the following
long lasting preparation should be administered?
a) Estrogen blocker
b) FSH blocker
c) GH blocker
d) GnRH agonist
e) Testosterone agonist

56) The decrease of which of the following hormone is most likely related to beginning of the first day of the next
cycle?
a) Estrogen
b) Progesterone
c) FSH
d) LH
e) Inhibin

CASE 10:
A 27-year-old female who goes to the emergency department with severe abdominal pain and she is 8 weeks
pregnant. She has had 2 previous pregnancies with no complications. In the examination the patient appears
distressed and hypotensive, her heart rate is normal. Her abdomen is distended and tender in the right side whenever
she is touched in this area. Her cervix is closed and her uterus is normal for a pregnancy in this stage. Blood analysis
are ordered, where BhCG come back positive. Her hemoglobin is low and a sonogram reveal an embryo that is
alive, further imaging show a ruptured luteal body and blood in abdominal cavity.

57) Which of the following maintains the corpus luteal in the first trimester of pregnancy?
a) FSH
b) Progesterone
c) hCG
d) DHEAs
e) Estrogen

58) After the patient gives birth, she feeds her baby exclusively breast milk. Which hormone will inhibit ovulation
and the menstrual cycle?
a) Estrogen
b) Prolactin
c) Progesterone
d) GnRH
e) hPL

CASE 11
A 34-year-old woman who has just given birth and experiences fatigue, light headed, dizzy and weak her doctor
suspects that there is a problem in her pituitary gland.

59) Which of the following laboratory findings would be consistent with the doctor’s suspicion?
a) Low TSH and low T3 and T4
b) Elevated TSH and low T3 and T4
c) Low levels of TRH and elevated TSH
d) Low TRH and high T3 and T4
e) Elevated TSH and high T3 and T4

60) If the cause of the symptoms is due to a postpartum hemorrhage which of the loss of which of the following
hormones is the most likely cause for her symptoms?
a) ACTH
b) GnRH
c) Prolactin
d) GH
e) TRH