The major target of aldosterone is the:

1.  Proximal convoluted tuble

2.  Loop of henle

3.  Collecting duct

4.  All of the above

5.  None of the above

5 is the answer

The major target is the distal tubule

Aldosterone's action is/are:

1. Increased Na+ reabsorption
2. Increased renal excretion of K+
3. Decreased renal excretion of H+
4. Decreased reabsorption of water
5. 1 and 2
6. all of the above

5 is the correct answer

Aldosterone increases renal excretion of H+ and increases reabsorption of water

Where Na+ goes, water follows

The most significant factor(s) in regulating aldosterone secretion are:

1. [Na+] ions in renal tubules
2. Angiotensin II
3. [K+] ions in extracellular fluid
4. 2 and 3
5. all of the above

Which of the following is/are true regarding spironolactone?

1. increases reabsorption of Na+ and water
2. increases excretion of K+
3. binds to aldosterone receptors on the surface of distal convoluted tubule cells
4. it is a non-competitive aldosterone antagonist
5. none of the above

5 is the correct answer

• it decreases reabsorption of Na and water -- this is how it works to reduce BP
• it decreases the excretion of K+
• it binds to intracellular aldosterone receptors located in distal convoluted tubule cells
• it is a competitive aldosterone antagonist

ACTH

Anterior pituitary

melanocortin receptor

MC2

Zona fasciculata

The effects of glucocorticoids in the body are:

1. promotes glucose uptake in muscle and adipose tissue
2. stimulation of gluconeogenesis in the liver
3. potent anti-inflammatory and immunosuppressive properties
4. 2 and 3
5. all of the above

4 is the correct answer

Glucocorticoids effect on metabolism are:

1. stimulation of gluconeogenesis in the liver
2. mobilization of amino acids from extrahepatic tissues
3. inhibition of glucose uptake in muscle and adipose tissue
4. stimulation of fat breakdown in adipose tissue
5. potent anti-inflammatory and immunosuppressive properties

Which of the following represents the correct sequence of events in glucocorticoid receptor signaling?

1. Diffusion of cortisol into the cell>cortisol binds to chaperone proteins>formation of heterodimer>binds to DNA>gene transcription
2. Diffusion of cortisol into the cell>binds to glucocorticoid receptor (GR)>Dissociation of GR complex>free cortisol-receptor subunits form heterodimers>bind with zinc fingers to specific DNA response elements>gene transcription
3. Cortisol binds to surface receptor>[Ca2+]i increases>protein kinases are activated>gene transcription
4. Cortisol binds to extracellular receptor>extracellular receptor brings cortisol into cell>cortisol dissociation and formation of homodimers with chaperone proteins>transported to nucleus>binds with zinc fingers to specific DNA response elements>gene transciption
5. Diffusion of cortisol into the cell>binds to glucocorticoid receptor (GR)>Dissociation of GR complex>free cortisol-receptor subunits form homodimers>bind with zinc fingers to specific DNA response elements>gene transcription 
6. None of the above

5 is the correct answer

The rest is bullshit

Question 2 states, "free cortisol-receptor subunits form heterodimers" -- be careful and watch out for this -- they form homodimers

In terms of anti-inflammatory properties, which of the following is/are the most potent?

1. Cortisone
2. Betamethasone
3. Hydrocortisone
4. Dexamethasone
5. Prednisone
6. 2 and 4
7. none of the above

In terms of sodium retention, which of the following is/are the most potent?

1. fludrocortisone
2. cortisone
3. hydrocortisone
4. prednisone
5. 1 and 2
6. none of the above

Which of the following sequence of events is true?

1. hyperglycemia>CRH release from hypothalamus>ACTH release of posterior pituitary>Cortisol release from Zona fasciculata>negative feedback to hypothalamus
2. hypoglycemia>ACTH release from anterior pituitary>Cortisol release from Zona fasciculata>negative feedback to hypothalamus and anterior pituitary
3. emotional stress>CRH release from hypothalamus>ACTH release of posterior pituitary>Cortisol release from Zona fasciculata>positive feedback to hypothalamus and negative feedback to anterior pituitary
4. emotional stress>CRH release from hypothalamus>ACTH release of anterior pituitary>Cortisol release from Zona reticularis>positive feedback to hypothalamus and negative feedback to anterior pituitary

Which of the following can decrease the production of glucocorticoids, mineralocorticoids, estrogens, and androgens?

1. Metyrapone
2. Ketoconazole
3. Mitotane
4. Cyproheptadine
5. None of the above
   

5 is the correct answer

Aminoglutethimide inhibits the conversion of cholesterol to pregnenolone, which is essential for the production of glucocorticoids, mineralocorticoids, estrogens, and androgens

Which of the following is the MOA for Metyrapone?

1. inhibits 11beta-hydroxylase
2. inhibits 17-alpha hydroxylase
3. inhibits CYP17
4. 1 and 3
5. all of the above

1 is the correct answers

CYP17 is a 17alpha-hydroxylase

Which of the following is the MOA for Ketoconazole?

1. inhibits 11beta-hydroxylase
2. inhibits 17-alpha hydroxylase
3. inhibits CYP17
4. 1 and 3
5. all of the above

1 and 3 are the correct answers

CYP17 is a 17alpha-hydroxylase

Which of the following is true about Mitotane?

1. Causes atrophy of the adrenal medulla
2. inhibits hydroxylation of 11-desoxycortisol
3. inhibits hydroxylation of 11-desoxycorticosterone
4. 1 and 2
5. 2 and 3

answer 5 is correct

• Mitotane is cytotoxic -- causes atrophy of the zona fasciculata and zona reticularis
• long term use can cause extensive degeneration of the zona glomerulosa
• it is indicated for adrenocorticol carcinoma but can be useful for Cushing's

Which of the following is/are true about Cyproheptadine?

1. H1 antagonist
2. antagonizes 5-HT receptors
3. Decreases ACTH
4. 2 and 3
5. all of the above

Which of the following is/are true about RU-486?

1. Has potent antiprogesterone and antiglucocorticoid activity
2. Reduces ACTH levels
3. Increases cortisol production
4. 1 and 3
5. 2 and 3
6. all of the above

1 and 3 are the correct choices

Since the feedback loop is still active, mifepristone will result in increased ACTH and cortisol levels

Which of the following is/are true about ADH?

1. Made in the hypothalamus and transported by axons to the posterior pituitary
2. Made in the hypothalamus and transported by axons to the anterior pituitary
3. Made in the posterior pituitary and released into the blood stream
4. Causes reabsorption of water

Secretion of ADH is regulated by:

1. baroreceptors located in the carotid sinus and aortic arch that must be activated in order to stimulate the production of ADH
2. Osmoreceptors located in the posteriolateral hypothalamus
3. Increase in Na+ retention
4. all of the above
5. none of the above

5 is the correct answer

• Baroreceptors are located in the carotid sinus and aortic arch, but they must be suppressed in order to stimulate the production of ADH -- this suppression comes about after a fall in blood pressure
• Osmoreceptors are located in the anterolateral hypothalamus
• A decrease in Na+ retention would result in an increase ADH production to retain the Na+ and water

Which of the following is true about ADH receptor action?

1. ADH acts on V1 receptors located on the collecting duct cells and increases water reabsorption
2. ADH acts on V2 receptors which stimulates the contraction of smooth muscles
3. V2 receptors are Gs coupled
4. V1 receptors are Gq coupled
5. 1 and 3
6. 3 and 4
7. none of the above

3 and 4 are the correct options

ADH acts on V2 receptors located on collecting duct cells

ADH acts on V1 receptors which stimulates the contraction of smooth muscles

Diabetes Insipidus:

1. is characterized by excretion of large amounts of water
2. results from ADH deficiency
3. results from kidney insensitivity to ADH
4. 1 and 2
5. all of the above
6. none of the above

damage to the hypothalamus or pituitary gland as a result of surgery, infection, tumor, or head injury

the inability of the kidney to respond normally to ADH

Which of the following is/are true regarding Nephrogenic DI?

1. Most are male, because V2 receptor mutations are Y-linked recessive defects
2. Nephrogenic DI results in a mutation in the ADH V1 receptor
3. Amphotericin B is an etiology
4. 1 and 3
5. none of the above

3 is the correct answer

Most are male, but V2 receptor mutations are X-linked recessive defects

NDI results in a mutation in the ADH V2 receptor

Common Etiologies:

1. Amphotericin B and Lithium Citrate
2. Polycystic Kidney Disease
3. Sick-Cell Disease
4. hypokalemia
5. hypercalcemia

a defect or damage to the thirst mechanism (located in the hypothalamus), which results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output

• Only occurs during pregnancy
• Vasopressinase made in the placenta breaks down ADH and causes GDI

Which of the following is not true about Desmopressin?

1. drug of choice for Central Diabetes Insipidus
2. can be used when a defect in the thirst mechanism causes Gestational Diabetes Insipidus
3. can lead to fluid overload in patients with Dipsogenic DI
4. stimulates the release of factor VIII from endothelial cells due to stimulation of the V1a receptor
5. longer duration of action and more favorable adverse effect profile compared to vasopressin
6. Contraindicated in patients with moderate to severe renal impairment
7. 3 and 4
8. all of the above are true

2 is the correct answer

Desmopressin should NOT be used when a defect in the thirst mechanism causes GDI

1. NSAIDs (indomethacin)
2. Carbamazepine
3. Chlorpropamide

1. Lithium
2. Colchicine
3. Vinca alkaloids

What is the reasoning behind NSAIDs and their ability to enhance vasopressin's diuretic response?

1. prostaglandins increase the antidiuretic response to vasopressin and NSAIDs increase the production of prostaglandins
2. prostaglandins decrease the antidiuretic response to vasopressin and NSAIDs inhibit the production of prostaglandins
3. NSAIDs constrict the afferent, resulting in a decrease in renal perfusion pressure and this increases water reabsorption
4. 2 and 3
5. none of the above

Conivaptan is:

1. a V1-V2 antagonist
2. indicated for SIADH
3. acts by increasing free water excretion and urine output
4. decrease urine osmolality
5. all of the above

Demeclocycline:

1. Produces nephrogenic diabetes insipidus and is not reversible
2. Is used to treat Syndrome of Inappropriate ADH
3. Is used when fluid restriction fails
4. 2 and 3
5. all of the above

4 is the correct answer

Demeclocycline produces nephrogenic diabetes insipidus and IS reversible