ENDOCRINOLOGY BOARDS ABIM EXAM |
NEWEST ACTUAL EXAM COMPREHENSIVE
QUESTIONS AND VERIFIED ANSWERS
GRADED A+ | 100% PASS | 2025 UPDATE!
Types of thyroid cancer - ✔✔✔ Correct Answer > 1. Papillary- most
common, lymphatic spread to lungs, bone
2. Follicular- mimics nl thyroid tissue; hematogenous spread to
bone/lung/CNS
3. Anaplastic- rare, undifferentiated; highly malignant, death in 6
months; no good treatment
4. Medullary- assc. with hyperplasia of parafollicular C cells, elevated
calcitonin; 15% are part of MEN IIA or IIB
5. Thyroid lymphoma- assc. with hashimoto's; think of with Hashimoto's
pt with rapidly growing thyroid mass
Secretagogues - ✔✔✔ Correct Answer > Sulfonylureas, meglitinides
(Prandin, Starlix)
Sulfonylureas: use 2nd gen ones, glyburide no longer recommended
due to risk of hypoglycemia; can see hypoglycemia lasting several days
Meglitinides: rapid acting, short half life, affect post-prandial glucose
,Treatment for thyroid cancer - ✔✔✔ Correct Answer > Near-total
thyroidectomy
If incomplete resection, do radiation ablation
Allow TSH to rise post-op; will do radioactive iodine after it reaches 30
to kill remaining cells
Start thyroxine several days after ablation
Goal, keep TSH suppressed to lower limit of nl
Other causes of simple, non-toxic goiter - ✔✔✔ Correct Answer > lack
of iodine, casava root, brussels sprouts, cauliflower, cabbage
Usually idiopathic
Nl TSH, FT4
Tx be removing goitrogens, give iodine if deficient
Nontoxic multinodular goiter - ✔✔✔ Correct Answer > more frequent
in women
Euthyroid, nl labs
Found by large gland or compression sxs
Do US to look for dominant nodules, suspicious of maliganancy
Treat if symptomatic compression or cosmetic issues
Treat with iodine ablation or surgery; thyroxine doesn't help
Toxic MNG - ✔✔✔ Correct Answer > TSH low, FT3/FT4 high
,Thyroid scan with hot nodules
treat with iodine ablation, surgery if refractory
Can use antithyroid meds until ablation done
Zones of the adrenal cortex - ✔✔✔ Correct Answer > GFR for order,
salt, sugar, sex for what produced
G=zona glomerulosa- mineralcorticoids "salt"
F=zona fasciculata- cortisol "sugar"
R=zona reticularis- androgens "sex"
Also, chromaffin cells in adrenal medulla produce epinephrine
Stimulation of the adrenal gland - ✔✔✔ Correct Answer > hypothalamic
CRH- secreted with low serum cortisol, stress, circadian rhythms
CRH->ant. pituitary ACTH->adrenal gland "zona's"; it does NOT
stimulate the chromaffin cells
Steroid synthesis - ✔✔✔ Correct Answer > know figure 7-3 on pg 7-15
Cholesterol->1. progesterone (aldo pathway) or 2. 17-OH progesterone
both use CYP21A2=21-hydroxylase (going to 11-
deoxycorticosterone/11-deoxycortisol respectively), then CYP11B1=11B
hydroxylase (going to aldosterone/cortisol respectively)
, Functions of the adrenal hormones - ✔✔✔ Correct Answer > 1.
Mineralcorticoids (aldosterone)- increase Na absorption, K/H secretion;
excess=HTN, HoK, alkalosis
2. Cortisol- stimulates lipolysis, amino acid release from muscles,
gluconeogenesis, inhibits inflammatory pathyway, decreases protein
matrix in bones, immunosuppression (T-cells, cell mediated immunity,
delayed hypersensitivity); excess- can stimulate mineralcorticoid and
androgen receptors as well, HTN, weakness, obesity, striae, hirsutism,
acne
3. Androgens (DHEA 95%, testosterone 5%); males produce most
testosterone in testes, females half from adrenals; excess- in
gestation=ambiguous genitalis, post gestation=hair growth, abnormal
menses in females
Congenital adrenal hyperplasia types - ✔✔✔ Correct Answer > 1.
Congenital, autosomal recessive, causes decrease in cortisol
95% due to abnormal CYP21A2-17-hydroxyprogesterone not converted,
build up; if complete impairment->shifts to DHEA and testosterone-
>ambiguous genitalia in females
2. Post-natal-low cortisol->increase ACTH->adrenal hypertrophy,
increased androgen production->virilization in females, precocious
puberty in boys
3. Late-onset (non-classical)- postpuberty, partial CYP21A1 impairment-
>androgen excess (acne, hirsutism, irregular menses, accelerated bone
age); see increased early morning 17-hydroxyprogesterone, urinary
ketosteroids, blood DHEA
NEWEST ACTUAL EXAM COMPREHENSIVE
QUESTIONS AND VERIFIED ANSWERS
GRADED A+ | 100% PASS | 2025 UPDATE!
Types of thyroid cancer - ✔✔✔ Correct Answer > 1. Papillary- most
common, lymphatic spread to lungs, bone
2. Follicular- mimics nl thyroid tissue; hematogenous spread to
bone/lung/CNS
3. Anaplastic- rare, undifferentiated; highly malignant, death in 6
months; no good treatment
4. Medullary- assc. with hyperplasia of parafollicular C cells, elevated
calcitonin; 15% are part of MEN IIA or IIB
5. Thyroid lymphoma- assc. with hashimoto's; think of with Hashimoto's
pt with rapidly growing thyroid mass
Secretagogues - ✔✔✔ Correct Answer > Sulfonylureas, meglitinides
(Prandin, Starlix)
Sulfonylureas: use 2nd gen ones, glyburide no longer recommended
due to risk of hypoglycemia; can see hypoglycemia lasting several days
Meglitinides: rapid acting, short half life, affect post-prandial glucose
,Treatment for thyroid cancer - ✔✔✔ Correct Answer > Near-total
thyroidectomy
If incomplete resection, do radiation ablation
Allow TSH to rise post-op; will do radioactive iodine after it reaches 30
to kill remaining cells
Start thyroxine several days after ablation
Goal, keep TSH suppressed to lower limit of nl
Other causes of simple, non-toxic goiter - ✔✔✔ Correct Answer > lack
of iodine, casava root, brussels sprouts, cauliflower, cabbage
Usually idiopathic
Nl TSH, FT4
Tx be removing goitrogens, give iodine if deficient
Nontoxic multinodular goiter - ✔✔✔ Correct Answer > more frequent
in women
Euthyroid, nl labs
Found by large gland or compression sxs
Do US to look for dominant nodules, suspicious of maliganancy
Treat if symptomatic compression or cosmetic issues
Treat with iodine ablation or surgery; thyroxine doesn't help
Toxic MNG - ✔✔✔ Correct Answer > TSH low, FT3/FT4 high
,Thyroid scan with hot nodules
treat with iodine ablation, surgery if refractory
Can use antithyroid meds until ablation done
Zones of the adrenal cortex - ✔✔✔ Correct Answer > GFR for order,
salt, sugar, sex for what produced
G=zona glomerulosa- mineralcorticoids "salt"
F=zona fasciculata- cortisol "sugar"
R=zona reticularis- androgens "sex"
Also, chromaffin cells in adrenal medulla produce epinephrine
Stimulation of the adrenal gland - ✔✔✔ Correct Answer > hypothalamic
CRH- secreted with low serum cortisol, stress, circadian rhythms
CRH->ant. pituitary ACTH->adrenal gland "zona's"; it does NOT
stimulate the chromaffin cells
Steroid synthesis - ✔✔✔ Correct Answer > know figure 7-3 on pg 7-15
Cholesterol->1. progesterone (aldo pathway) or 2. 17-OH progesterone
both use CYP21A2=21-hydroxylase (going to 11-
deoxycorticosterone/11-deoxycortisol respectively), then CYP11B1=11B
hydroxylase (going to aldosterone/cortisol respectively)
, Functions of the adrenal hormones - ✔✔✔ Correct Answer > 1.
Mineralcorticoids (aldosterone)- increase Na absorption, K/H secretion;
excess=HTN, HoK, alkalosis
2. Cortisol- stimulates lipolysis, amino acid release from muscles,
gluconeogenesis, inhibits inflammatory pathyway, decreases protein
matrix in bones, immunosuppression (T-cells, cell mediated immunity,
delayed hypersensitivity); excess- can stimulate mineralcorticoid and
androgen receptors as well, HTN, weakness, obesity, striae, hirsutism,
acne
3. Androgens (DHEA 95%, testosterone 5%); males produce most
testosterone in testes, females half from adrenals; excess- in
gestation=ambiguous genitalis, post gestation=hair growth, abnormal
menses in females
Congenital adrenal hyperplasia types - ✔✔✔ Correct Answer > 1.
Congenital, autosomal recessive, causes decrease in cortisol
95% due to abnormal CYP21A2-17-hydroxyprogesterone not converted,
build up; if complete impairment->shifts to DHEA and testosterone-
>ambiguous genitalia in females
2. Post-natal-low cortisol->increase ACTH->adrenal hypertrophy,
increased androgen production->virilization in females, precocious
puberty in boys
3. Late-onset (non-classical)- postpuberty, partial CYP21A1 impairment-
>androgen excess (acne, hirsutism, irregular menses, accelerated bone
age); see increased early morning 17-hydroxyprogesterone, urinary
ketosteroids, blood DHEA
