Designed to help you pass USMLE Step 1

TM

2024 Edition

Integrated anki memory tricks images You’ll Custom

Flash Card Deck & mnemonics see on test day illustrations

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 Receptor Signalling 1
Hypothalamus 2
Posterior Pituitary 2
Anterior Pituitary 3
Adrenal Gland Anatomy, Physiology & Pathology 4
Adrenal Gland Insufficiency 5
Congenital Adrenal Hyperplasia 5
Adrenal Medulla 6
Thyroid Embryology 7
Thyroid Anatomy & Physiology 8
Neoplasms of Thyroid 9
Thyroid Pharmacology 9
Hyperthyroidism 10
Hypothyroidism 11
Parathyroid Physiology 12
Vitamin D Synthesis 12
Hypo/Hyperparathyroidism 13
Pancreas Physiology 14
GLUT Receptors 14
Diabetes Mellitus 15
Hyperglycemic Emergencies 15
Diabetes Pharmacology 16
Insulin Preparations 16
High Yield Endocrine Vignettes 17-24

PATHOLOGY HISTOLOGY

OSCE
MANOR
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Answer at bottom
PHARMACOLOGY of nextpage

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 n o o e i n

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PARATHYROID Regulatesserumcalciumandphosphatehomeostasis 12

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 e oi i

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 PANCREAS 14

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 t

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 17

You are a researcher studying receptor signaling pathways and are particularly
interested in a G-Protein coupled receptor that has 7 membrane spanning helices.
Which of the following hormones can be used to stimulate this receptor?
1 A) EPO
B) FSH
page 1

C) Growth hormone
D) Prolactin

Downstream activation of which of the following enzymes occurs when GnRH binds to
its receptor?
page 1
2 A) Phospholipase C
B) Adenylyl cyclase
C) Guanylyl cyclase
D) Caspase

Which of the following structures are responsible for secreting Antidiuretic Hormone
(ADH) and Oxytocin?
page 2
3 A) Neurohypophysis
B) Adenohypophysis
C) Preoptic Nucleus
D) Supraoptic Nucleus

A 14 year old male presents to the primary care office after soccer practice
accompanied by his mother as she is concerned for delayed puberty. You notice he has
a particularly strong body odor, which his mother claims is normal after soccer
practice. The boy exclaims, "I don't know what you are talking about, I smell just fine".

4 On the physical exam, findings are consistent with Tanner Stage 2. Which of the
following levels would you expect to be decreased on serum studies?
A) TRH page 2
B) ACTH
C) 17-alpha hydroxylase
D) GnRH

Bernard is a 34 year old male presenting to the ED after his colleagues found him
attempting to climb a crane so that "he can fly with the bird". The psychiatrist
prescribes him medication and a week later he exclaims that his symptoms have
improved. However he notes that now he feels incredibly thirsty at all periods of the

5 day, Urine specific gravity is low serum, osmolality is elevated. What medication was
the patient prescribed that could explain his current presentation?
A) Sodium valproate page 2
B) Lamotrigine
C) Quetiapine
D) Lithium

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 18

Bulma visits her OB GYN 4 weeks after giving birth to her son,
Gohan. With the exception of slightly increased post-partum
vaginal bleeding, Gohan's delivery was uncomplicated and at
full term. Given the MRI for your patient, Bulma, which of the
6 following symptoms would you expect her to endorse?
A) Amenorrhea
page 3
B) Pretibial Myxedema
C) Galactorrhea
D) Cushingoid features

A patient begins to develop vision loss and constitutional symptoms such as fatigue and
dry skin. Head MRI demonstrates a pituitary adenoma. Which of the following Perimetry

7 tests would the patient likely exhibit?

page 3
A) B) C) D)

Elevation of which of the following serum markers is present in a patient with

Acromegaly?
page 3
8 A) GnRH
B) TGF-beta
C) AFP
D) IGF-1

Which of the following hormones is secreted by this

page 3
cell found in the anterior pituitary?

9 A) TRH
B) CRH
C) Prolactin
D) LSH

A 50 year old presents to his primary care physician after noticing increased acne and
the development of back hair. He has also noticed that he bruises easier and that his
face is flushed. He is a lifelong smoker. The patient undergoes a variety of lab tests;
one of these tests demonstrates no decrease in cortisol following the administration

10 of high dose dexamethasone. Which of the following is a possible etiology of this

patient's high cortisol?
A) Normal function page 4
B) Pituitary Adenoma
C) Small cell carcinoma
D) Exogenous corticosteroids
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 19

Which parameters are decreased in response to cortisol?

page 4
A) Immune response
11 B) Appetite
C) Insulin resistance
D) Blood pressure
Kerry is a 25 year-old who presents because of a recent episode of lightheadedness.
When asked about her appetite she mentions she has recently been craving salty
foods. Physical examination reveals bronzed skin. What electrolytes do you expect to

12 be elevated in this patient?

A) Magnesium
B) Sodium
page 5

C) Potassium
D) Iodine
A 7.5lb (3400-g) female newborn is born at full term to a 25 year old G1P1 woman.
APGAR scores are 8 and 9 at 1 and 5 minutes respectively. Pulse is 115/min, Temp 98.6F
(37°C) and blood pressure is 55/35 mm Hg. Serum panel reveals hyponatremia and
hyperkalemia. The next day examination finds Clitoromegaly - Ultrasound reveals

13 normal development of Ovaries and Uterus. Which of the following enzymatic

deficiencies does this child most likely have?
A) 21-Hydroxylase
page 5
B) 17-Hydroxylase
C) Desmolase
D) 11-Hydroxylase
A couple brings their adopted 4 month old son to the ED with concerns of a rash and
decreased movement, "when I pick him up he doesn't wave his hands around like he
used to." On examination the child is hypotonic, has mild eczema, as well as strong
odor. Family history is not known, but the physician suspects an inherited condition.

14 Which of the following is the most likely is the inheritance pattern of this child's
condition?
A) X-Linked Recessive page 6
B) X-Linked Dominant
C) Autosomal Recessive
D) Autosomal Dominant
A 25 year old man presents to his general practitioner with paroxysmal sweating,
throbbing headaches, and palpitations. His Blood pressure is 160/90. Remainder of his
physical exam is unremarkable. CT scan shows a mass on his right adrenal gland. Urine

15 analysis will show an increase in which of the following studies?

A) Metanephrines
B) Glucose
page 6

C) Ketones
D) Albumin
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 20

What is one of the embryological origins of the Thyroid?

page 7
A) 3rd Pharyngeal Pouch
16 B) 1st Pharyngeal Pouch
C) 4th Pharyngeal Pouch
D) 6th Pharyngeal Pouch

Which of the following clinical features are most consistent with the findings
observed exected with a Thyroglossal cyst?

17 A) Painful & soft

B) Painless & soft
C) Non-mobile & Painful
page 7

D) Mobile & Painless

Amy is a 28 year old woman who is 12 weeks pregnant. She has a scheduled
appointment to receive a routine thyroid screening. Which of the following would you
expect to be decreased?
18 A) Free T3/T4
B) Total T3/T4 page 8
C) Thyroxine-binding globulin
D) TSH

Which of the following is a contraindication of Propylthiouracil?

page 8
A) Used in the 2nd and 3rd trimesters of pregnancy
19 B) Hyperthyroidism
C) Thyroid storm
D) Lowering T4 - T3 conversion

A 45-year-old female presents with a painless mass in her neck that she first
noticed a few months ago. She has a history of receiving radiation therapy for a
previous medical condition. On physical examination, a thyroid nodule is identified.
Based on the histology from fine needle aspiration, which of the following is the most

20 likely diagnosis?
A) Follicular carcinoma
B) Medullary carcinoma
page 9

C) Papillary carcinoma
D) Anaplastic carcinoma

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 21

A 32-year-old male with a recent history of thyroid storm is now complaining of

persistent mouth ulcers and fevers. He was started on antithyroid medication as part
of the treatment plan. Which of the following adverse effects is most likely associated

21 with the drugs administered?

A) Hepatotoxicity
B) Agranulocytosis
page 9

C) Nephrotoxicity
D) Photosensitivity
A 50-year-old female presents with a painless mass in her neck. Additionally, she
reports episodes of skin flushing. Physical examination reveals a palpable thyroid
nodule. Further investigation reveals elevated levels of calcitonin. Which of the

22 following conditions is most commonly associated with the patient's diagnosis?

A) Pituitary adenoma
B) Hyperaldosteronism
C) Parathyroid hyperplasia page 9
D) Pancreatic insufficiency
A 35-year-old female presents with protruding eyes, swelling over the shins, and
symptoms consistent with hyperthyroidism. Physical examination reveals proptosis and
pretibial myxedema. Laboratory studies show suppressed TSH levels. What is the most

23 likely underlying cause of this patient's clinical presentation?

A) Thyroid peroxidase antibodies
B) Thyroglobulin antibodies
page 10

C) Thyroid-stimulating hormone (TSH)

D) Thyroid-stimulating hormone receptor antibodies (TSHR Ab's)

A 40-year-old male with a known history of hyperthyroidism presents to the

emergency department with a sudden onset of high blood pressure, fever, and
markedly elevated creatine kinase (CK) levels. The patient appears agitated and
diaphoretic. What is the most appropriate initial management for this acute
24 presentation?
A) Intravenous fluids
page 10

B) Antibiotics
C) Insulin and glucose
D) Propranolol & Prednisone

A 27-year-old female, who is 6 months postpartum, presents with dry skin and an
enlarged, non-tender thyroid gland. She denies weight changes, mood disturbances,
or any medication use. Laboratory results show a decreased TSH level and elevated

25 T4. What is a key risk factor in the progression of this condition?

A) Family history of thyroid disorders
B) Recent exposure to iodine-containing contrast dye page 11
C) History of head and neck radiation
D) Presence of antithyroid peroxidase antibodies
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 22

A 6-month-old male infant is brought to the pediatrician due to concerns of poor growth
and developmental delays. On examination, the child has a protuberant abdomen, an
enlarged tongue, and exhibits marked hypotonia. Laboratory studies reveal significantly
elevated thyroid-stimulating hormone (TSH) levels and low free thyroxine (T4) levels.
26 Which of the following is the most likely risk factor that led to this pathogenesis?
A) Maternal smoking during pregnancy
B) Maternal alcohol consumption during pregnancy page 11
C) Maternal use of antithyroid medications during pregnancy
D) Maternal gestational diabetes

A 22-year-old male presents with acute neck pain and tenderness. He reports a recent
viral upper respiratory infection. On examination, the thyroid gland is notably tender.
Laboratory studies reveal an elevated erythrocyte sedimentation rate (ESR). What is the

27 most likely finding on histology?

A) Fibrous proliferation
B) Follicular hyperplasia
page 11

C) Granulomatous inflammation
D) Lymphocytic infiltration

A 52-year-old woman presents to the clinic for an annual well exam. Routine laboratory
tests demonstrate elevated levels of hypercalcemia. The patient reports some mild
diffuse abdominal pain over the past 2 weeks but otherwise denies any chest pain,
palpitations, or fatigue. A follow-up parathyroid hormone (PTH) level is found to be
28 elevated. Further investigations will most likely reveal?
A) High serum Ca, high serum phosphate, high serum PTH page 12
B) High serum Ca, low serum phosphate, high serum PTH
C) High serum Ca, high serum phosphate, high serum PTH
D) High serum Ca, high serum phosphate, low serum PTH

A 10-year-old boy is brought to the pediatrician due to parental concerns about his
recent clumsiness and difficulty keeping up with his peers. He has been recently
diagnosed with inflammatory bowel disease. On physical examination, tenderness to
palpation is noted over the child's lower extremities, and a waddling gait is observed.
29 What is the most likely diagnosis?
A) Osteoporosis page 12
B) Osteogenesis imperfecta
C) Rickets
D) Juvenile idiopathic arthritis

A 10-year-old girl is brought to the pediatrician for evaluation of short stature and
distinctive hand deformities. Physical examination reveals shortened fourth and fifth
metacarpals. The child also has a history of mild intellectual disability. What Is the most

30 likely response in the renal tubule with exogenous PTH administration?

A) INC urinary CAMP
B) No change in urinary CAMP page 13
C) INC ADH levels
D) No change in ADH levels
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 23

A 60-year-old is called to his GP when his creatinine and blood urea nitrogen (BUN)
levels were found to be notably elevated; he has a history of chronic kidney disease.
Which of the following is the most likely set of associated laboratory findings in this

31 patient?
A) High serum calcium, low serum phosphate, high PTH
B) Low serum calcium, high serum phosphate, high PTH
page 13

C) High serum calcium, high serum phosphate, low PTH

D) Low serum calcium, low serum phosphate, low PTH

A 45-year-old patient with diabetes mellitus is managed with insulin therapy. Which
of the following receptor pathway activities is directly involved in the cellular
response to insulin in this patient?
32 A) Increased tyrosine-kinase activity
B) Decreased serine-threonine kinase activity
page 14

C) Increased ubiquitin-mediated proteolysis

D) Decreased G-protein coupled receptor activity

A 35-year-old male presents with altered mental status, profuse sweating,

tachycardia, and hypoglycemia. He is rushed to the emergency room, and laboratory
studies confirm the presence of low blood glucose levels. In this hypoglycemic state,

33 which organ is primarily responsible for taking up glucose?

A) Liver (via GLUT2)
B) Skeletal muscle (via GLUT4)
page 14

C) Adipose tissue (via GLUT4)

D) Brain (via GLUT1)

A 48-year-old man presents to the emergency department with recurrent episodes

of diaphoresis, palpitations, and confusion. The patient reports feeling shaky during
these episodes, which occur unpredictably throughout the day. On examination, his
vital signs are within normal limits during the visit, and a random blood glucose

34 measurement is found to be 45 mg/dL. Administering glucose resolves his symptoms.

What marker is most likely to be elevated following the intervention?
A) Glucagon page 14
B) IGF-1
C) C-peptide
d) ALP
A previously healthy 10-year-old child is brought to the emergency department with
complaints of polyuria, nausea, and abdominal pain over the past 24 hours. Physical
examination reveals dehydration, and laboratory studies show Glucose 534, K 5.9, pH
7.13, PCO2 is 20 mmHg, PO2 is 90 mmHg. Which of the following markers is most likely
35 decreased?
A) Triglycerides page 15
B) Total body potassium
C) Cortisol
D) Medium long chain FAs
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 24

A 38-year-old woman presents at 28 weeks of gestation for a routine prenatal visit.

She has no significant past medical history. The patient reports concerns about the
size of her fetus. Upon further investigation, elevated postprandial glucose levels are

36 noted. The fetus is at most risk for what potential complication?

A) Cleft palate
B) Atrial septal defect
page 15

C) Shoulder dystocia
D) Potter sequence
A 55-year-old patient with a history of type 2 diabetes mellitus is on metformin
therapy and is scheduled for a contrast-enhanced CT scan for abdominal imaging.
The patient has a baseline creatinine level within the normal range. What
intervention, if performed prior to the contrast administration, would best prevent
37 an acute kidney injury?
A) Administration of sodium bicarbonate page 15
B) Discontinuation of metformin
C) Furosemide administration
D) Infusion of 0.9% saline
A 62-year-old male with poorly controlled type 2 diabetes presents to the clinic for a
medication review. Despite multiple oral antidiabetic agents, his hemoglobin A1c
remains elevated. After discussing the potential risks and benefits, the physician
decides to initiate a new medication. Several weeks later, the patient returns for a
follow-up visit. Laboratory results show an improvement in glycemic control, but the
38 patient reports the presence of frothy urine. What is the most likely medication
responsible for these symptoms?
page 16
A) Metformin
B) Glyburide
C) Linagliptin
D) Dapagliflozin
A 50-year-old man with a history of type 2 diabetes mellitus presents to the clinic
complaining of recurrent episodes of hypoglycemia associated with tremulousness
and tachycardia. He reports that these episodes often occur between meals and
improve after eating. Initial laboratory results reveal normal C-peptide levels. What
39 is the most appropriate next step in the evaluation of this patient's hypoglycemia?
A) Perform a CT scan of the abdomen
page 16
B) measure serum levels of insulin secretagogues
C) Initiate treatment with GLP-1 analogues
D) Discontinue metformin

1.B 2.A 3.D 4.D 5.D 6.A 7.C 8.D 9.C 10.C 11.A 12.C 13.A 14.C 15.A
A 16.B 17.D 18.A 19.A 20.C 21.B 22.C 23.D 24.D 25.D 26.C 27.C
28.B 29.C 30.B 31. B 32.A 33.D 34.C 35.B 36.C 37.D 38.D 39.B
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 1. Nevit Dilmen (2021). MRI of empty sella syndrome - Wikimedia Commons.
Commons.wikimedia.org. Retrieved from https://commons.wikimedia.org/wiki/
Category:MRI_of_empty_sella_syndrome#/media/File:Brain_MRI_0077_25_-
_Annotation.jpg
2. Neisseria Meningitidis CSF Gram 1000 (2019). Wikipedia.”
Commons.wikimedia.org,Retreived from en.m.wikipedia.org/wiki/
File:Neisseria_meningitidis_CSF_Gram_1000.jpg
3. Michael Feldman (2005). “Adrenal Gland with Pheochromocytoma.” Wikimedia
Commons, commons.wikimedia.org/wiki/
File:Adrenal_paraganglioma_clinical_Pheochromocytoma.jpg
4. Nevit Dilmen (2015). Thyroglossal Duct Cyst 150117131348265.Jpg - Wikipedia.”
Commons.wikimedia.org, en.m.wikipedia.org/wiki/
File:Thyroglossal_Duct_Cyst_150117131348265.jpg. Accessed 24 Feb. 2024.
5. KGH (2006). Thyroid_papillary_carcinoma_histopathology_(4).jpg. Wikipedia.”
Commons.wikimedia.org, https://en.m.wikipedia.org/wiki/
File:Thyroid_papillary_carcinoma_histopathology_(4).jpg
6. Berkshire Community College Bioscience Image Library (2019). cross section:
human thyroid gland magnification: 100x. Wikipedia.” Commons.wikimedia.org,
https://commons.wikimedia.org/wiki/
File:Scalloped_Colloid_in_Follicles_of_the_Human_Thyroid_Gland_%2847435785
862%29.jpg
7. Petros Perros - PLoS Medicine: Perros P (2005) Thyrotoxicosis and Pregnancy.
PLoS Med 2(12): e370 doi:10.1371/journal.pmed.0020370 published under
Creative Commons.
8. Librepath. Micrograph showing a Hurthle cell carcinoma (also Hürthle cell
carcinoma). H&E stain. Commons.wikimedia.org, https://commons.wikimedia.org/
wiki/File:Hurthle_cell_carcinoma_--_very_high_mag.jpg
9. Mikael Häggström (2020. Histology of pars distalis of the anterior pituitary with
chromophobes, basophils, and acidophils, annotated. https://en.wikipedia.org/wiki/
Acidophil_cell#/media/
File:Histology_of_pars_distalis_of_the_anterior_pituitary_with_chromophobes,_ba
sophils,_and_acidophils,_annotated.jpg
10. Mahtab Uddin Ahmed (2007). Micrograph of Homer Wright Pseudorosettes.jpg -
Wikipedia. Commons.wikimedia.org, en.wikipedia.org/wiki/
File:Micrograph_of_Homer_Wright_pseudorosettes.jpg. Accessed 24 Feb. 2024.

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 about the U Ota
Jacob Portnoff is apassionate medicalstudent
and a popularsocialmedia influencer known as
MedSchoolBro who has established himself
as agrowing presence in the medicalcommunity
Combininghisexpertiseinmedicine and hisability
to effectively communicatecomplextopics
Jacobhas developed a uniqueapproach to
medicaleducation that hasgarnered a largefollowing
As a studentpreparing for hisUSMLE Licensing
JACOBPORTNOFF
examsJacobrecognizedtheneedfora comprehensive
Bsc MD candidate 2025
guidethatencompasses all theessentialaspectsof
cardiology whileincorporatingeffectivestudystrategies Inspiredby his own successful
learningtechniques hecreatedthiscompleteGuideto Endocrinology a 20 pageresource
thatintegratesthevariousdisciplines ofmedicine to enhanceunderstandingandretention
Jacob'scommitment tohelpingfellowmedicalstudentsachievetheiracademicgoals
isreflected in themeticulouslycrafted contentofhisguide Drawingfrom hisown
experiences heincorporates mnemonics memorytricks andshortcuts to make
studyingnotonlyeasierbutalso more enjoyable Furthermore hispassion forvisual
learningis evident in thestunninggraphicsandillustrationsfeatured throughout the
guidecatering totheneeds ofvisuallearners
Through hissocialmedia platformsandnow with his Complete Guideto
EndocrinologyJacobaimsto provide
aspiringmedicalprofessionalswith the toolsand
knowledgenecessarytoexcel in theirstudiesFueledbyhis expertiseandpassion
hehopesto continue topositivelyimpactthemedicaleducation landscape

OWJGMtwledgemencs
Jacob would like to extend his gratitude to his medical student colleague
Raghavan Vijayakumar MD Candidate 2025 for his work assisting with
the content of this coursebook He also extends his appreciationto
the graphics illustrator Anetta Ille MDCandidate 2026 for her
beautiful illustrations throughoutthisguide
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 IMPORTANT INFORMATION AND DISCLAIMERS

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