MCQ question sheet

Robbins review of pathology

Pg 374

1. D
a. Pituitary adenoma functional.
Prolactinoma causes amenorrhoea,
galactorrhoea, low libido, infertility.
b. Somatotropic adenoma acromegaly
2. A?
a. Acromegaly gene

3. C?
a. She has mass effect of the pituitary
adenoma and signs of
hypothyroidism.

Prolactinoma
- Galactorrhoea and infertility
- Decreased libido and amenorrhea.
Microadenomas may not have pressure
effects.
Growth hormone producing pituitary
adenoma. Aryl hydrocarbon receptorinteracting protein mutations.
Younger person in familial case.
GH opposes insulin leading DM2. Gigantism
may not occur in adults with closed
epiphyses but acromegaly of soft tissue
does.
D nonfunctioning pituitary adenoma that
has compressed the normal cells causing
hypopituitaraism. + mass effect.
Chromophobe cells are in the anterior
pituitary.
Beta cels in pancreas
Chief cells in parathyroids PTH
Chromaffin cells in adrenal medulla
producing catecholamine
Glomerulosa cells in adrenal cortex
producing corticosteroids
Parafollicular C cells in thyroid for cacitonin

4. B
a. Acromegaly. Diagnosed by increase
serum IGF1, and failure to suppress
serum GH follow oral glucose
tolerance test. Pituitary MRI
5. B?
a. Due to the BMi cue? Obesity causeing
empty sella syndrome

Empty sella syndrome

- Obese women
- herniation of arachnoid through
diapgragma sellae
- Usually enough to prevent hypopituitarism
but there is the stalk section effect. This can
be due to loss of prolactin inhibition =

6. B
a. Sheehans syndrome

7. E

8. D? anything?

9. E prolactinoma signs

10.B adrenal crisis?

A 47-year-old woman has had increasing fatigue with dyspnea

and reduced exercise tolerance for the past year. On
examination she has nonpitting edema of the lower extremities. Laboratory studies show a serum TSH level of 10 mU/L
and T4 level of 2 g/dL. She is most likely to have pathologic
findings affecting which of the following cells?
A Hypophyseal basophils
B Hypophyseal pituicytes
C Hypothalamic glial cells
D Hypothalamic neurons
E Thyroid C cells
F Thyroid follicular cells

hyperprolactinaemia.
D sheehans syndrome or postpartum
pituitary necrosis.
Pituitary enlargement during pregnancy
changes the blood supply. When there is
obstetric bleeding complication there is
infarction. Adrenal insufficiency, lack of
prolactin (no breast feeding), loss of
menstruation (FSH and LH).
Diabetes insipidus lack of ADH. Increased
dilute urine with higher serum osmolality
and hypernatraemia.
Syndrome of inappropriate ADH
secretion due to small cell anaplastic
carcinoma of the lung. (smoker) this
hyponatremia.
A Craniopharyngioma uncommon. Found
in young individuals where there is increase
prolactin due to the stalk section effect.
Hypernatremia caused by diabetics
insipidus.
D Thyroid storm = medical emergency.
Increased catecholamine levels and thus the
b blocker will prevent death from cardiac
failure.hPropylthiouracil PTI is an
antithyuroid medication along with iodine
that will help reduce the thyroid output.
F. Thyroid failure primary with
myxedeoma.

Thyroid C cells produce calcitonin

High TSH and low T4

Hypothyroidism E?
A 2-year-old child has failure to thrive since infancy. Physical
examination shows that the child is short and has coarse facial
features, a protruding tongue, and an umbilical hernia. As the
child matures, profound intellectual disability becomes
apparent. A deficiency of which of the following hormones is
most likely to explain these findings?
A Cortisol
B Insulin
C Norepinephrine

Cretinism

D Somatostatin
E Thyroxine (T4)

???
Correct. hashimotors

Hypothyroidism F?
14 A 37-year-old woman has had difficulty swallowing and a
feeling of fullness in the anterior neck for the past week. She is
recovering from a mild upper respiratory tract infection 1
month ago. On physical examination, her temperature is 37.4
C, pulse is 74/min, respirations are 16/min, and blood pressure
is 122/80 mm Hg. Palpation of her diffusely enlarged thyroid
elicits pain. Laboratory studies show an increased serum T4
level and a decreased TSH level. Two months later, she no
longer has these complaints. The T 4 level is now normal. Which
of the following conditions is most likely to have produced
these findings?
A Hashimoto thyroiditis
B Medullary thyroid carcinoma
C Subacute granulomatous thyroiditis
D Toxic follicular adenoma

Correct dequervain thyroiditis. Self

limiting due to viral origin most likely from
infection.

E Toxic multinodular goiter

C sub acute becayuse its normal now. Assocaited

with infection
A 30-year-old woman has given birth to her second child. She
develops heat intolerance and loses more weight than expected postpartum. On physical examination, her thyroid
gland is enlarged but painless; there are no other remarkable
findings. Laboratory studies show a serum T 4 level of 12 g/dL
and a TSH level of 0.4 mU/L. A year later she is euthyroid.

X b presence of autoantibodies due to

hashinomoto thyroiditis. There is transiet
hyperthyroidism. Variant called sub acute
lymphcytic painless thyroiditis. Only few
progress to hypothyroidism.

Which of the following is most indicative of the pathogenesis

of this patients disease?
A Activational mutations in the RET proto-oncogene
B Antithyroid peroxidase antibodies
C Irradiation of the neck during childhood
D Prolonged iodine deficiency
E Recent viral upper respiratory tract infection
D from childbirth?Stress?

Correct.
16 A 20-year-old woman and her twin sister both experience
increasing diplopia. Their conditions develop within 3 years of
each other. On physical examination, they have exophthalmos
and weak extraocular muscle movement. The thyroid gland is
diffusely enlarged but painless in each sister, and there is no
lymphadenopathy in either woman. Which of the following
serum laboratory findings is most likely to be reported in these
sisters?
A Decreased free thyroxine level
B Decreased thyroid-stimulating hormone level
C High titer thyroid peroxidase autoantibodies
D Increased thyrotropin-releasing hormone level
E Increased triiodothyronine level

B = classic hyperthyroidism possibly due to graves

disease. These have autoantibodies
A 21-year-old woman has noted increasing fatigue and a 7-kg
weight loss without dieting over the past 4 months. She also
has increasing anxiety and nervousness with diarrhea. Physical
examination shows a diffusely enlarged thyroid gland. Her
temperature is 37.5 C, pulse is 103/min, respirations are
28/min, and blood pressure is 140/75 mmHg. A radionuclide
scan of the thyroid shows a diffuse increase in uptake. The
figure shows the representative microscopic appearance of the
thyroid gland. What is most likely to produce these findings?
A Antibodies against TSH receptor
B Dietary deficiency of iodine
C Irradiation of the neck
D Maternal deficiency in T4

Correct.
RET proto ongogenes = papillary carcinoma
of thyroid and medullary carcinoma of
thyroidm

E Mutation in the RET proto-oncogene

A - graves
18 A 40-year-old man notes weight loss, increased appetite,
and double vision for 6 months. On physical examination, his
temperature is 37.7 C, pulse is 106/min, respirations are
20/min, and blood pressure is 140/80 mm Hg. A fine tremor is
observed in his outstretched hands. He has bilateral proptosis
and corneal ulceration. Laboratory findings include a serum
TSH level of 0.1 mU/L. A radioiodine scan indicates increased
diffuse uptake throughout the thyroid. He receives
propylthiouracil therapy, and his condition improves. Which of
the following best describes the microscopic appearance of his
thyroid gland before therapy?

X E. Hyperthyroidism due to graves. Thyroid

stimulating immunogolbins.
Result in diffuse thyroid enlargement with
hyperfunction and papillary projections lined
by columnar cells.
Hashinomoto thyroiditis destruction of
thyroid follicles + hurthle cell metaplasia.
Goiter = flattened epithelial cells usually

A Destruction of follicles, lymphoid aggregates, and Hrthle

cell metaplasia
B Enlarged thyroid follicles lined by flattened epithelial cells
C Follicular destruction with inflammatory infiltrates containing
giant cells
D Nodules with nests of cells separated by hyaline stroma that
stains with Congo red

euthyroid
Follicular destruction and giant cells =
granulomatous thyroiditits.

E Papillary projections in thyroid follicles and lymphoid

aggregates in the stroma
B if its graves there there is increase activity of the thyroid

19 A 45-year-old woman from Kathmandu, Nepal, reports a

feeling of fullness in her neck, but has no other concerns. The
enlargement has been gradual and painless for more than 1
year. Physical examination confirms diffuse enlargement of the
thyroid gland without any apparent masses or lymphadenopathy. Laboratory studies of thyroid function show a normal
free T4 level and a slightly increased TSH level. What is the
most likely cause of these findings?
A Diffuse nontoxic goiter
B Follicular adenoma
C Hashimoto thyroiditis
D Papillary carcinoma
E Subacute granulomatous thyroiditis

Correct
- Diffuse non toxic goiter is often
due to dietary iodine deficiency.
Occurs in the world where there is low
iodine= euthyroid presentation.
Toxic multinodukar goiter = plummer
diseases. Hyperfunctioning nodule in the
goiter.

F Toxic multinodular goiter

A normal
20 A 14-year-old girl noticed gradual neck enlargement during
the past 8 months. On physical examination her thyroid gland
is diffusely enlarged. Her serum TSH level is normal. A dietary
history is most likely to reveal that she has begun eating more
of which of the following foods?
A Cabbage
B Fava beans
C Fish
D Plantains
E Rye bread
D? or B? what ever has iodine in it

Revise
Empty sella
Prader willi
Sheehan
Thyroid storm
Prolactinoma

A
Sporadic goiter
Vegetables of Brassicaecae family
cabbage, turnips, Brussel sprouts
(glucosinolate that releases thiocyanate that
interferes with thyroid hormone synthesis).
Giorogens.
Fava beans =- G6PD deficiency
Rye bread = ergot poiosoining

Small cell carcinoma endocrine effects.

Different types of goiter diffuse non toxic, toxic multinodular etc
sub acute lymphcytic painless thyroiditis.