Week 1 Review Q's Flashcards
Anatomy of pituitary glands (1-41) Physiology basics in endocrinology (42-68) Micro immunopathogenesis of pituitary autoimmune diseases (69-90) Biochem of neurohormones (91-121) Clinical skills lab 1 (122-134) pathology of hypothalamus (135-177) endocrine pharma (178-218) patho lab 1 (219-240)
1
Q
the pituitary stalk is suspended from the floor of which ventricle?
A
third ventricle
2
Q
Which three organs have a wider transverse diameter than a vertical diameter?
A
- pituitary gland
- cecum
- prostate gland
3
Q
Which of the following has a bigger pituitary gland?
a. adults
b. children
c. pregnant women
A
c. pregnant women
4
Q
Which pituitary gland lobe is the pars intermedia a part of?
A
anterior lobe
5
Q
A pituitary gland tumor grows laterally, which nerve is the first to be affected?
A
CN6, abducens nerve
6
Q
A pituitary gland tumor grows and the gland is pushed superiorly, what structure is likely to be affected?
A
optic chiasm
7
Q
A pituitary gland tumor grows and the gland is pushed superiorly, what type of vision loss is to be expected?
A
bitemporal hemianopia (temporal field of vision loss)
8
Q
internal carotid artery compresses the lateral portion of the optic chiasm, what type of vision loss is to be expected?
A
nasal field of vision loss
9
Q
What two things go through the cavernous sinus?
A
internal carotid artery CN6 (abducens nerve)
10
Q
Which of the following pituitary gland tumor growths cause exophthalmos?
a. superior growth
b. inferior growth
c. lateral growth
d. medial growth
A
c. lateral growth
11
Q
Which of the following pituitary gland tumor growths causes the enlargement of the hypophyseal fossa?
a. superior growth
b. inferior growth
c. lateral growth
d. medial growth
A
b. inferior growth
12
Q
Which of the following pituitary gland tumor growths causes bitemporal hemianopia?
a. superior growth
b. inferior growth
c. lateral growth
d. medial growth
A
a. superior growth
13
Q
Which branch of the internal carotid artery has a direct branch to the posterior lobe?
a. superior hypophyseal artery
b. inferior hypophyseal artery
c. both
A
b. inferior hypophyseal artery
14
Q
Which vessel goes into the lower infundibulum to adenohypophysis?
a. long portal vessels
b. short portal vessels
c. both
A
b. short portal vessels
15
Q
Which artery goes into the lower part of the infundibulum?
a. superior hypophyseal artery
b. inferior hypophyseal artery
c. both
A
c. both
16
Q
Which vessel goes into the median eminence to adenohypophysis?
a. long portal vessels
b. short portal vessels
c. both
A
a. long portal vessels
17
Q
Which artery goes into the median eminence?
a. superior hypophyseal artery
b. inferior hypophyseal artery
c. both
A
a. superior hypophyseal artery
18
Q
Which part of the hypophyseal tract releases oxytocin?
a. supraoptic nucleus
b. paraventricular nucleus
c. both
A
b. paraventricular nucleus
19
Q
Which is ectodermally derived?
a. adenohypophysis
b. neurohypophysis
c. both
A
c. both
20
Q
Which is derived from Rathke’s pouch?
a. adenohypophysis
b. neurohypophysis
c. both
A
a. adenohypophysis
21
Q
Which part of the hypophyseal tract releases ADH?
a. supraoptic nucleus
b. paraventricular nucleus
c. both
A
a. supraoptic nucleus
22
Q
Which undergoes downwards growth?
a. adenohypophysis
b. neurohypophysis
c. both
A
b. neurohypophysis
23
Q
Which of the following produces thyroid stimulating hormone?
a. mammotrophs
b. thyrotrophs
c. corticotrophs
d. gonadotrophs
e. somatotroph
A
b. thyrotrophs
24
Q
Which of the following produces LH & FSH & ICSH?
a. mammotrophs
b. thyrotrophs
c. corticotrophs
d. gonadotrophs
e. somatotrophs
A
d. gonadotrophs (luteotrophs also secrete LH & ICSH)
25
Which of the following produces MSH (melanocyte-stimulating hormone)?
a. mammotrophs
b. thyrotrophs
c. corticotrophs
d. gonadotrophs
e. somatotroph
c. corticotrophs (it also produces adrenocorticotropic hormone (ACTH))
26
Which of the following produces Prolactin? a. mammotrophs b. thyrotrophs c. corticotrophs d. gonadotrophs e. somatotroph
a. mammotrophs (and lactotroph)
27
Which of the following produces GH? a. mammotrophs b. thyrotrophs c. corticotrophs d. gonadotrophs e. somatotroph
e. somatotroph
28
What controls the adenohypophysis hormone release?
hormones of the hypothalamus usually stimulate release, except dopamine (inhibits prolactin) and somatostatin (inhibits growth hormone)
29
Which of the following has an inverse relationship with prolactin? a. thyrotropin-releasing hormone b. vasoactive inhibitory peptide c. dopamine
c. dopamine
30
Which hormone does the intermediate lobe/pars intermedia secrete?
MSH (melanocyte-stimulating hormone)
31
Patient comes in complaining of thirst and constant urine excretion. You suspect diabetes insipidus, what is the mechanism of this disease?
low vasopressin levels (ADH)
32
Which of the following is found in pars intermedia? a. melanotrophs b. pituicytes c. herring bodies
a. melanotrophs (the other two are in the posterior lobe)
33
Which of the following is responsible for stimulating the cells of the adrenal cortex? a. mammotrophs b. thyrotrophs c. corticotrophs d. gonadotrophs e. somatotroph
c. corticotrophs (makes ACTH)
34
In Sheehan's syndrome, which hormone is the last to stop being secreted? a. TSH b. ACTH c. FSH d. LH
a. TSH
35
Which of the following is responsible for the conversion of the Graafian follicle into the corpus luteum? a. mammotrophs b. thyrotrophs c. corticotrophs d. leuteotrophs e. somatotroph
d. leuteotrophs (secretes LH in females and ICSH in males, which makes Leydig cells into testosterone)
36
Which of the following is responsible for the proliferation of cartilage cells in the epiphysis of bone? a. mammotrophs b. thyrotrophs c. corticotrophs d. leuteotrophs e. somatotroph
e. somatotroph (produces growth hormones)
37
Which of the following is responsible for stimulating Leydig cells to make testosterone? a. mammotrophs b. thyrotrophs c. corticotrophs d. leuteotrophs e. somatotroph
d. leuteotrophs (secretes ICSH in males and LH in females, which converts Graafian follicle into the corpus luteum)
38
What two hormones are produced by arcuate nucleus? What do they do?
1- dopamine (inhibt prolactin) 2- neuropeptide Y (stimulates food intake/hunger)
39
What inhibits somatotrophs from releasing GH?
somatostatin
40
Which of the following is responsible for the growth of ovarian follicles? a. mammotrophs b. thyrotrophs c. gonadotrophs d. leuteotrophs e. somatotroph
c. gonadotrophs (also regulates spermatogenesis)
41
Which undergoes upwards growth? a. adenohypophysis b. neurohypophysis
a. adenohypophysis
42
Which is secreted by the Posterior lobe? a. ACTH b. ADH c. FSH d. Prolactin
b. ADH
43
Which part of the adrenal gland secretes epinephrine? a. cortex b. medulla
b. medulla
44
Which organ secretes somatostatin ?
The pancreas
45
Which of the following secretes melatonin? a. the thymus gland b. the pineal gland c. the pancreas
b. the pineal gland
46
Which of the following hormones is also an antioxidant? a. somatostatin b. anti-mullerian hormone c. melatonin d. thymosine
c. melatonin
47
In which of the following is the presence of anti-mullerian hormone abnormal? a. female b. male c. male fetus
b. male
48
Vitamin D is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines
c. steroids
49
T3 is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines
a. iodothyronines
50
hCG is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines
d. glycoproteins
51
Cortisol is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines
c. steroids
52
Oxytocin is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines
b. polypeptides
53
Which is day/night associated? a. circadian rhythm b. diurnal rhythm c. ultradian rhythm d. infradian rhythm
b. diurnal rhythm
54
Which of the following does GH follow? a. circadian rhythm b. diurnal rhythm
a. circadian rhythm (increases when you go to sleep)
55
Which is normally only found in females? a. circadian rhythm b. diurnal rhythm c. ultradian rhythm d. infradian rhythm
d. infradian rhythm
56
Which pattern does testosterone follow? a. circadian rhythm b. diurnal rhythm c. ultradian rhythm d. infradian rhythm
c. ultradian rhythm (& FSH & LH)
57
Which of the following does cortisol follow? a. circadian rhythm b. diurnal rhythm
b. diurnal rhythm (light goes into the eyes, triggering cortisol release, which wakes you up)
58
T/F: melatonin is secreted when you sleep regardless if you're sleeping in the day or night
False, it follows the diurnal rhythm (which is based on day/night)
59
Which is sleep/wake associated? a. circadian rhythm b. diurnal rhythm c. ultradian rhythm d. infradian rhythm
a. circadian rhythm
60
Which negative feedback inhibition cycle is it when hormone X activates hormone Y, and hormone Y inhibits hormone X after its activation? a. ultra short loop b. short loop c. long loop
b. short loop
61
Which negative feedback inhibition cycle autocrine? a. ultra short loop b. short loop c. long loop
a. ultra short loop
62
What best describes when cortisol, which is released by the adrenal medulla, negatively inhibits the pituitary hormone that activated its secretion? a. autocrine b. paracrine c. endocrine
c. endocrine long loop of negative feedback inhibition
63
Which negative feedback inhibition cycle is it when a hormone from the pituitary inhibits a hypothalamus hormone? a. ultra short loop b. short loop c. long loop
b. short loop
64
Which negative feedback inhibition cycle is it when hormone X inhibits itself? a. ultra short loop b. short loop c. long loop
a. ultra short loop
65
How do autoimmune diseases cause hyperfunction and hypofunction of glands?
hyperfunction in the start of the pathology and hypofunction when the gland is fully destroyed
66
What type of endocrine problem is it when the problem originates in the hypothalamus? a. primary b. secondary c. tertiary
c. tertiary
67
What type of endocrine problem is it when the problem originates in the target gland? a. primary b. secondary c. tertiary
a. primary
68
What type of endocrine problem is it when the problem originates in the pituitary? a. primary b. secondary c. tertiary
b. secondary
69
Which is true?
a. having autoantibodies means you have an autoimmune disease
b. having an autoimmune disease means you have autoantibodies
b. having an autoimmune disease means you have autoantibodies
70
In which location do the B cells change receptors when they react to a self-antigen? a. central organs b. peripheral organs c. both
a. central organs
71
In which location do the B cells undergo anergy they react to a self-antigen? a. central organs b. peripheral organs c. both
c. both
72
Which T cell reactivity is optimal? a. strong reactivity b. intermediate reactivity
b. intermediate reactivity (T cells with strong reactivity get eliminated during negative selection because they react)
73
T/F: all auto-antigens are expressed in the thymus
false
74
What DNA defect does a patient with IPEX syndrome have?
Foxp3+ T regs
75
IPEX syndrome is a. autosomal dominant b. autosomal recessive c. X linked
c. X linked
76
T/F: all autoimmunity is pathological
false, autoimmunity may assist in the removal of damaged or worn-out cells
77
What type of immunoglobulins are autoantibodies?
low affinity IgM
78
Which of the following is indicative of SLE? a. anti-TPO b. anti-dsDNA c. anti-CCP d. anti-AMA
b. anti-dsDNA
79
Which of the following is specific for the thyroid? a. anti-TPO b. anti-dsDNA c. anti-CCP d. anti-AMA
a. anti-TPO
80
Which is false? a. organ specific antibodies cause organ specific disease b. non organ specific antibodies cause non organ specific disease
b. non organ specific antibodies cause non organ specific disease (the disease is always organ specific)
81
Which of the following is specific for the mitochondria? a. anti-TPO b. anti-dsDNA c. anti-CCP d. anti-AMA
d. anti-AMA
82
Which cell is responsible for glandular destruction?
T cells
83
Which of the following is indicative of RA? a. anti-TPO b. anti-dsDNA c. anti-CCP d. anti-AMA
c. anti-CCP
84
What does the mutation in AIRE gene cause? How?
eliminates the function of autoimmune regulator protein and causes PAS-1
85
What are the three diagnostic criteria of PAS-1?
chronic mucocutaneous candidiasis
chronic hypoparathyroidism
autoimmune adrenal insufficiency
86
What is the function of PTH?
regulate calcium and phosphorus metabolism
87
Patient comes in complaining of anxiety, confusion, and depression. He also states that her experiences periodic tightness in his throat that makes it hard to breathe. Whats the diagnosis?
Hypoparathyroidism (PTH deficiency) (symptoms include anxiety, confusion, depression, psychosis, confusion, tingling of hands/feet, and laryngospasms, which can be life-threatening)
88
What is alpha-enolase?
an auto-antigen that's expressed in almost all tissues. it gets targeted by pituitary antibodies in lymphocytic hypophysitis
89
Which cells infiltrate the pituitary gland in lymphocytic hypophysitis?
lymphocytes
90
How do you treat lymphocytic hypophysitis?
hormone replacement therapy
91
Which is produced by neurosecretory cells? a. neurotransmitters b. neurohormones
b. neurohormones
92
Which of the following releases hormones into capillaries? a. neurosecretory cells b. non-neural endocrine cells c. both
c. both
93
Which of the following affects endocrine glands (except the pituitary gland)? a. hypothalamic hormones b. hypophysiotrophic hormones c. tropic hormones
c. tropic hormones
94
Which is produced by axon terminals of neurosecretory cells? a. neurotransmitters b. neurohormones
a. neurotransmitters
95
Which of the following affects the pituitary gland? a. hypothalamic hormones b. hypophysiotrophic hormones c. tropic hormones
b. hypophysiotrophic hormones
96
Which of the following releases inhibiting hormones? a. neurosecretory cells b. non-neurosecretory cells c. both
a. neurosecretory cells
97
Which of the following releases enteric hormones? a. neurosecretory cells b. non-neurosecretory cells c. both
b. non-neurosecretory cells
98
Which of the following releases dopamine? a. neurosecretory cells b. non-neurosecretory cells c. both
b. non-neurosecretory cells
99
In what form are OT&ADH stored in the neurohypophysis? a. dipeptides b. tripeptides c. hexapeptides d. nonapeptides
d. nonapeptides
100
Which of the following amino acids is found in position 8 of oxytocin? a. Phenylalanine b. Isoleucine c. Leucine d. Arginine
c. Leucine
101
Which of the following releases histamine? a. neurosecretory cells b. non-neurosecretory cells c. both
b. non-neurosecretory cells
102
Which of the following amino acids is found in position 3 of vasopressin? a. Phenylalanine b. Isoleucine c. Leucine d. Arginine
a. Phenylalanine
103
Which vitamin is required to make hormones of the posterior lobe of the pituitary gland?
vitamin C (is needed to make the final peptide of OT&ADH)
104
Which of the following amino acids is found in position 3 of oxytocin? a. Phenylalanine b. Isoleucine c. Leucine d. Arginine
b. Isoleucine
105
What is secreted along with oxytocin in the secretory granules?
neurophysin (carrier protein) and some precursors
106
T/F: OT&ADH are degraded by aminopeptidases in the CSF
false, they're degraded by aminopeptidases in the brain. If they're in the CSF they get cleared back into the circulation.
107
Which of the following amino acids is found in position 8 of vasopressin? a. Phenylalanine b. Isoleucine c. Leucine d. Arginine
d. Arginine
108
T/F: OT&ADH have a half-life of 20 minutes
true
109
Which one of the following catecholamine is a selective beta-agonist? a. norepinephrine b. epinephrine c. dopamine d. isoproterenol
d. isoproterenol
110
catecholamine is a derivative of which amino acid?
tyrosine
111
Which one of the following catecholamine is an alpha and beta agonist? a. norepinephrine b. epinephrine c. dopamine d. isoproterenol
b. epinephrine
112
What is the immediate precursor of norepinephrine?
dopamine
113
Other than the chromaffin cells of the adrenal medulla, where are catecholamines produced? a. pre-ganglionic fibers of the parasympathetic nervous system b. post-ganglionic fibers of the parasympathetic nervous system c. pre-ganglionic fibers of the sympathetic nervous system d. post-ganglionic fibers of the sympathetic nervous system
d. post-ganglionic fibers of the sympathetic nervous system
114
Which of the following is made by a fewer number of reactions? a. epinephrine b. norepinephrine
b. norepinephrine
115
What is the rate-limiting enzyme for catecholamines production? what is the cofactor?
a. L-DOPA, O2
b. L-DOPA, tetrahydrobiopterin
c. tyrosine hydroxylase, O2
d. tyrosine hydroxylase, tetrahydrobiopterin
d. tyrosine hydroxylase, tetrahydrobiopterin
O2= cosubstrate tetrahydrobiopterin= cofactor
116
Which enteric hormone is derived from tryptophan?
serotonin
117
How many reactions does it take to go from tryptophan to serotonin? what are the enzymes used?
two reactions; the first enzyme used is typtophan-5-hydroxylase and the second is aromatic L-amino acid decarboxylase
118
What type of receptors receive endocannabinoids? a. ion-channel b. G-protein c. enzyme-linked
b. G-protein
119
Which of the following degrades Anandamide (AEA)? a. Monoacylglycerol lipase b. Fatty acid amide hydrolase
b. Fatty acid amide hydrolase
120
Which of the following degrades 2-Arachidonoylglycerol (2-AG)? a. Monoacylglycerol lipase b. Fatty acid amide hydrolase
a. Monoacylglycerol lipase
121
How do endocannabinoids inhibit neurotransmitter release?
by decreasing calcium in the presynaptic membrane
122
What's the most common cause of hyperthyroidism?
graves disease
123
Patient comes in complaining of anxiety and weight loss. Reflex test shows above-average response (brisk reflexes) What's the most likely diagnosis? a. hypothyroidism b. hyperthyroidism c. cushing's syndrome d. adrenal insufficiency
b. hyperthyroidism
124
increased glucocorticoid indicates a. hypothyroidism b. hyperthyroidism c. cushing's syndrome d. adrenal insufficiency
c. cushing's syndrome
125
Which of the following can be caused by an iodine deficiency? a. hypothyroidism b. hyperthyroidism c. cushing's syndrome d. adrenal insufficiency
a. hypothyroidism
126
Patient comes in with large tongue, yellow skin, and slow reflexes. What's the most likely diagnosis? a. hypothyroidism b. hyperthyroidism c. cushing's syndrome d. adrenal insufficiency
a. hypothyroidism
127
Patient comes in with buffalo hump and moon face. What's the most likely diagnosis? a. hypothyroidism b. hyperthyroidism c. cushing's syndrome d. adrenal insufficiency
c. cushing's syndrome
128
Patient comes in with ophthalmoplegia, a fine tremor, and a lid lag. What's the most likely diagnosis? a. hypothyroidism b. hyperthyroidism c. cushing's syndrome d. adrenal insufficiency
b. hyperthyroidism
129
Which of the following causes poor wound healing? a. hypothyroidism b. hyperthyroidism c. cushing's syndrome d. adrenal insufficiency
c. cushing's syndrome
130
What are the symptoms of a patient with chronic adrenal insufficiency?
depression, fatigue, and hyponatremia (acute adrenal insufficiency can cause circulatory shock)
131
Patient comes in with generalized pigmentation. What's the most likely diagnosis? a. hypothyroidism b. hyperthyroidism c. cushing's syndrome d. adrenal insufficiency
d. adrenal insufficiency
132
Which occurs before puberty? a. acromegaly b. giantism
b. giantism
133
Which is more susceptible to carpal tunnel syndrome? a. acromegaly b. giantism
a. acromegaly
134
Which has prominent supraorbital ridges and prognathism? a. acromegaly b. giantism
a. acromegaly
135
Which is the origin of the anterior pituitary lobe? a. neuroectoderm b. pharyngeal epithelium
b. pharyngeal epithelium
136
When performing an immunohistochemical stain for GH, which cell becomes brown (positive)? a. mammotrophs b. thyrotrophs c. corticotrophs d. leuteotrophs e. somatotroph
e. somatotroph
137
What two hormones are least affected when the pituitary gland gets destroyed?
OT&ADH (because they're secreted in the hypothalmus)
138
Which cell uses Tpit transcription factor to regulate its diffrentiation? a. mammotrophs b. lactotroph c. corticotrophs d. gonadotroph e. somatotroph
c. corticotrophs
139
Which cell does NOT use Pit1 transcription factor to regulate its differentiation? a. mammosomatotroph b. lactotroph c. somatotroph d. gonadotroph e. thyrotroph
d. gonadotroph (gonadotroph uses SF1)
140
What's the most common cause of hyperpituitarism?
pituitary adenoma
141
What is Paraneoplastic syndrome?
When a cancer or tumor releases hormones or cytokines, causing symptoms
142
What type of pituitary adenoma is usually found at a later stage, when it has grown in size?
a non-functioning adenoma (the functioning ones cause symptoms and are more likely to be found)
143
Which of the following causes hyponatremia? a. high ADH b. low ADH
a. high ADH (high ADH-\> reabsorb water-\> high water to Na concentration)
144
T/F: microadenomas are mostly functional tumors while macroadenomas are mostly unfunctional
false, she said the size doesn't dictate the function
145
T/F: functional adenomas are more likely to be found early
true
146
T/F: silent adenomas are non-functioning
false, they have some manifestations and produce some hormones, but not nearly enough to cause symptoms
147
Which of the following causes hypernatremia? a. high ADH b. low ADH
b. low ADH (low ADH-\> release water-\> high Na to water concentration)
148
What type of receptors get mutated in adenomas? a. ion-channel b. G-protein c. enzyme-linked
b. G-protein (GNAS mutation)
149
What is bound to g-protein in a basal state?
GDP
150
How does a GNAS mutation physiologically affects the G-protein?
the GTPase enzyme, which deactivates GTP to GDP to stop G-receptor activation, is defective so the receptor is always active because of the GTP(+ proliferation)
151
Which of the following is caused the mutation of a tumor suppressor gene? a. MEN1 b. MEN2 c. MEN3
a. MEN1
152
Which of the following causes parathyroid hyperplasia and pheochromocytoma? a. MEN1 b. MEN2 c. MEN3
b. MEN2
153
Which of the following causes pancreatic tumors? a. MEN1 b. MEN2 c. MEN3
a. MEN1
154
While looking at a routine H&E, you notice that there's no pituitary skeleton (no reticulin). What can you conclude?
adenoma presence
155
What does the presence of positive Ki-67 mean?
proliferation occurrence
156
What is synaptophysin a marker for?
endocrine tumors (Chromogranin A is also an immuno-marker)
157
You see and H&E stain with pseudo-rosettes. What does it indicate?
Indicative of endocrine tumors, not just adenomas (not specific)
158
You see and H&E stain with pseudo-rosettes, stippled chromatin, and granular cytoplasm. What's the diagnosis?
adenoma
159
Which cell uses SF1 transcription factor to regulate its diffrentiation? a. mammotrophs b. lactotroph c. corticotrophs d. gonadotroph e. somatotroph
d. gonadotroph
160
Which of the following is the most frequent cell to hyperfunction and cause pituitary adenoma? a. mammotrophs b. lactotroph c. corticotrophs d. gonadotroph e. somatotroph
b. lactotroph (lactotroph adenoma 30% of all cases)
161
Explain how postpartum women have physiological contraceptives?
They have high prolactin levels (+ lactation) and they negatively inhibit gonadotrophs (less LH & FSH & ICSH)
162
Which causes elevated insulin-like growth factor-1 secretion (IGF-1)? a. lactotroph adenoma b. somatotroph adenoma c. corticotrophs adenoma d. pituitary carcinoma
b. somatotroph adenoma (GH of somatotrophs stimulates IGF-1 secretion in liver)
163
Which is predisposed to calcify? a. lactotroph adenoma b. somatotroph adenoma c. corticotrophs adenoma d. pituitary carcinoma
a. lactotroph adenoma (extensive calcification=pituitary stone)
164
Which of the following is the most likely do lead to crushing's syndrome? a. lactotroph adenoma b. somatotroph adenoma c. corticotrophs adenoma d. pituitary carcinoma
c. corticotrophs adenoma corticotrophs produce ACTH, which leads to cortosol secretion from the adrenal leading to hypercortisolism
165
You run a glucose suppression test on a patient. after administering glucose, the growth hormone levels remain constant. Which does he most likely have? a. lactotroph adenoma b. somatotroph adenoma c. corticotrophs adenoma d. pituitary carcinoma
b. somatotroph adenoma (glucose suppression test is very sensitive for acromegaly)
166
Which of the following is capable of metastasis? a. pituitary carcinoma b. pituitary adenoma
a. pituitary carcinoma
167
Which is FALSE about Rathke cleft cyst? a. causes compression symptoms if it gets large b. filled with mucus c. mostly asymptomatic d. most are intrasellar
d. most are intrasellar (most are actually suprasellar)
168
What type of cells are Rathke cleft cyst lined by?
columnar or cuboidal epithelium (+/- goblet cells and cilia)
169
What type of cells are craniopharyngiomas lined by?
the note says "a peripherals layer of columnar cells" and also "squamous epithelium at the periphery" idk (a past exam said squamous so probably that)
170
Patient complained of sudden headache, visual disturbances, then they died. Which of the following is most likely? a. germ cell tumors b. pituitary apoplexy c. lymphocytic hypophysitis d. empty sella e. craniopharyngiomas
b. pituitary apoplexy
171
Which of the following is frequently present in children and adolescents? a. germ cell tumors b. pituitary apoplexy c. lymphocytic hypophysitis d. empty sella e. craniopharyngiomas
a. germ cell tumors
172
H&E of a patient shows nodules of anucleated squames with ghost cells, resembling wet keratin. Which of the following is most likely? a. germ cell tumors b. pituitary apoplexy c. lymphocytic hypophysitis d. empty sella e. craniopharyngiomas
e. craniopharyngiomas
173
Tumor stained positive for cKIT, IHC, and PALP. Which of the following is most likely? a. germ cell tumors b. pituitary apoplexy c. lymphocytic hypophysitis d. empty sella e. craniopharyngiomas
a. germ cell tumors
174
Which is due to a defect in diaphragma sella? a. germ cell tumors b. pituitary apoplexy c. lymphocytic hypophysitis d. empty sella e. craniopharyngiomas
d. empty sella
175
What causes primary empty sella?
diaphragma sella defect that causes arachnoid matter and CSF to herniate into sella, causing it to expand and compress the pituitary
176
Biopsy of pituitary shows fibrosis, plasma cells, and lymphocytes. Which of the following is most likely? a. germ cell tumors b. pituitary apoplexy c. lymphocytic hypophysitis d. empty sella e. craniopharyngiomas
c. lymphocytic hypophysitis
177
Which type of germ-cell tumor is most common?
germinomas
178
What type of hormones need transport proteins to get to their destination? a. Water soluble b. Fat soluble
b. Fat soluble
179
What type of hormones are released via facilitated diffusion? a. Water soluble b. Fat soluble
b. Fat soluble
180
What type of hormones attach to receptors located on the plasma membrane? a. Water soluble b. Fat soluble
a. Water soluble
181
Which of the following hormones attach to receptors located in the nucleus? a. Peptides b. Steroids c. Proteins d. Thyroid
d. Thyroid
182
Which of the following hormones attach to receptors located in the cytoplasm? a. Peptides b. Steroids c. Proteins d. Thyroid
b. Steroids (A&C= receptors on cell surface)
183
When theres a disorder of hormone resistance, which mechanism can you use in treatment?
sensitization
184
Which hypothalamic regulatory hormone decreases camp levels? a. somatostatin b. dopamine c. Thyrotropin-releasing hormone (TRH) d. gonadotrophin-releasing hormone (GnRH)
b. dopamine
185
Which hypothalamic regulatory hormone increases potassium channels? a. somatostatin b. dopamine c. Thyrotropin-releasing hormone (TRH) d. gonadotrophin-releasing hormone (GnRH)
a. somatostatin
186
Pro-opiomelanocortin (POMC) is a precursor of what four enzymes?
ACTH MSH Lipotrophin Beta endorphins
187
Which increases pain threshold? a. MSH b. Lipotrophin c. Beta endorphins
c. Beta endorphins
188
Which hypothalamic regulatory hormone increases camp levels? a. somatostatin b. dopamine c. Thyrotropin-releasing hormone (TRH) d. gonadotrophin-releasing hormone (GnRH)
d. gonadotrophin-releasing hormone (GnRH) (GnRH, GHRH, & CRH all increase camp levels)
189
Which of the following is diagnostic of Hypercortisolemic state? a. Cosyntropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin)
b. Corticotropin-releasing hormone (CRH)
190
Which of the following is administered via IV? a. Cosyntropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin) d. Menotropin
c. GnRH (Gonadorelin)
191
Which of the following is diagnostic of adrenal insufficiency? a. Cosyntropin b. Menotropin c. GnRH (Gonadorelin)
a. Cosyntropin
192
Which of the following is diagnostic of adrenal tumor? a. Menotropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin)
b. Corticotropin-releasing hormone (CRH)
193
Which of the following is administered via subcutaneous injection? a. Cosyntropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin) d. Menotropin
a. Cosyntropin
194
Which of the following is diagnostic of Delayed puberty? a. Cosyntropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin) d. Menotropin
c. GnRH (Gonadorelin)
195
Which hypothalamic regulatory hormone increases phospholipase C and phosphatidylinositol? a. somatostatin b. dopamine c. Thyrotropin-releasing hormone (TRH) d. gonadotrophin-releasing hormone (GnRH)
c. Thyrotropin-releasing hormone (TRH)
196
Which is the synthetic analog of ACTH? a. Somatostatin b. Gonadorelin c. Cosyntropin d. Menotropin
c. Cosyntropin
197
What dosing method is used to treat infertility via GnRH? and why?
low pulsatile dose (to increase FSH&LH); if we administer it continuously then the receptors will be sensitized (FSH&LH decrease instead)
198
Which of the following is LH like only? a. Menotropin b. Luotropin c. Follitropin d. Urofollitropin
b. Luotropin (\*not in drug list)
199
Which of the following is FSH&LH like? a. Menotropin b. Luotropin c. Follitropin d. Urofollitropin
a. Menotropin (C&D resemble FSH only)
200
T/F: GnRH is administered via IV, SC, Intranasal, and oral
false, yes to all except oral. its made of proteins, so oral route will denature it
201
Which of the following GnRH analogs is given monthly? a. goseralin b. leuprolide c. nafarelin
a. goseralin
202
Which of the following GnRH analogs is given daily via nasal spray? a. goserelin b. leuprolide c. nafarelin
c. nafarelin
203
Why do these GnRH analogs (Leuprolide, goserelin, nafarelin) exasperate symptoms of prostate cancer in the first week?
because they bind to the GnRH receptors and activate it until the receptor gets desensitized, only then do the symptoms improve
204
Which of the following GnRH analogs is given daily via subcutaneous route? a. goseralin b. leuprolide c. nafarelin
b. leuprolide
205
Which treatment of endometriosis has less side effects? a. ganirelix b. leuprolide
a. ganirelix (GnRH antagonist, so it doesn't have to activate the receptor to desensitize it)
206
Which of the following does NOT cause Hyperprolactinemia? a. high TRH b. low TRH c. pituitary adenomas
b. low TRH
207
Which of the following is more suitable for Transsphenoidal microsurgery? a. Microadenomas b. Macroadenomas
a. Microadenomas
208
What method can be used to treat Hyperprolactinemia?
dopamine agonists
209
Which of the following has a longer half life? a. Cabergoline b. Bromocriptine
a. Cabergoline
210
Which of the following dopamine agonists has less side effects? a. Cabergoline b. Bromocriptine
a. Cabergoline
211
Why do dopamine agonists cause nausea and vomiting?
Dopamine may activate CTZ (Chemoreceptor trigger zone) receptors, and when the CTZ is stimulated, vomiting may occur. (im not sure; he said it doesn't occur because of GI tract irritation, but due to some other receptors)
212
Which hormone can be given to help induce labor?
oxytocin
213
Which ADH receptor is responsible for smooth muscle contraction? a. V1 b. V2
a. V1
214
Which of the following does fixing ADH levels NOT help treat? a. Syndrome of inappropriate ADH (SIDH) b. Neurogenic diabetes insipidus c. Nephrogenic diabetes insipidus
c. Nephrogenic diabetes insipidus (the receptors are defective, the ADH doesn't matter)
215
Patient has diabetes insipidus, which of the following treatment methods is preferable? a. ADH b. Desmopressin c. both the same d. none of them
b. Desmopressin (an ADH analog that selectively acts on V2 receptors, so smooth muscle isn't affected)
216
Which of the following is a V2 antagonist that is taken orally? a. Tolvaptan b. Lithium c. Conivaptan d. Demeclocycline
a. Tolvaptan
217
Which TWO of the following is a decrease V2 receptor sensitivity? a. Tolvaptan b. Lithium c. Conivaptan d. Demeclocycline
b. Lithium & d. Demeclocycline
218
Which of the following is a V2 antagonist that is taken via intervenous injection? a. Tolvaptan b. Lithium c. Conivaptan d. Demeclocycline
c. Conivaptan
219
A 25-year-old woman has noted breast secretions for the past month. She is not breastfeeding and has never been pregnant. Which of the following does she also have?
A. Acromegaly
B. Cushing disease
C. Hyperthyroidism
D. Infertility
E. Neurologic dysfunction
D. Infertility (caused by high prolactin)
220
A 45-year-old woman notices that her gloves from the previous winter no longer fit her hands. Her facial features have become coarse in the past year, and her voice seems deeper. Which is most likely? a. lactotroph adenoma b. somatotroph adenoma c. corticotrophs adenoma d. pituitary carcinoma
b. somatotroph adenoma
221
How can you tell the difference between an enlarged pituitary due to pregnancy and an enlarged pituitary due to adenoma?
monoclonal cells and disrupted reticulin pattern in adenoma
222
What are two neuroendocrine immuno-markers?
Synaptophysin Chromogranin A
223
heel pad sign is indicative of
acromegaly
224
A 25-year-old male american football player has noted an enlargement in the breast for the past month. IHC tests of pituitary show ACTH +. Which of the following caused his symptoms?
a. lactotroph adenoma
b. somatotroph adenoma
c. corticotrophs adenoma
d. pituitary stalk compression syndrome
d. pituitary stalk compression syndrome (yes he does have corticotrophs adenoma, but that isn't what's causing the symptoms. He's a football player, meaning he probably has head trauma. Head trauma causes pituitary stalk compression syndrome, which leads to high prolactin levels)
225
Pit1 transcription factor is indicative of adenomas from which cells?
somatotroph lactotroph thyrotroph mammosomatotrophs
226
What is panhypopituitarism?
inadequate or absent production of the anterior pituitary hormones
227
cortisol is directly linked with the concentration of which of the following ions? a. potassium b. calcium c. sodium d. iodine
c. sodium (cortisol deficency can cause hyponatremia)
228
Which will be the least affected in the case of pituitary compression? a. TSH b. Oxytocin c. Prolactin d. FSH
b. Oxytocin (made in the hypothalamus, so it wont be as affected)
229
Which of the following adenomas are more likely to lead to hypopituitarism? a. Microadenomas b. Macroadenomas
b. Macroadenomas
230
Which is true about cysts in the pituitary? a. largely unsymptomatic b. lined with stratified squamous epithelium
a. largely unsymptomatic
231
Patient complains of excessive thirst and polyurea, but their ADH levels are normal. Whats more likely? a. central diabetes insipidus b. nephrogenic diabetes insipidus
b. nephrogenic diabetes insipidus
232
Patient's histology shows squamous epithelium, anucleated cells, cysts, and calcified cholesterol. What's a likely diagnosis?
craniopharyngiomas
233
What's the difference between H&E rosettes and pseudo-rosettes?
pseudo-rosettes are around a blood vessel and rosettes are independent
234
What causes empty sella syndrome?
herniation of the arachnid space into the pituitary fossa through a deficiency in diaphragma sella
235
Patient has central diabetes insipidus due to pituitary issue. H&E shows eosinophils, kidney-shaped cells, histocytes, and other abnormal cells. What's most likely?
Langerhans cell histiocytosis
236
Patient's histology shows palisading, whorling, and ghost cells. What's a likely diagnosis?
craniopharyngiomas
237
IHC stains + for FSH. An adenoma of which cell is implicated?
gonadotrophs
238
Pituitary adenoma stains + for both GH & PRL. which cell is implicated?
somato-lactotrophs
239
Pituitary adenoma stains + PALP. What is the diagnosis?
extra gonodal germ cell tumor (large cells, predominant nuclei, and PALP+)
240
Which of the following cyst are harder to excise? a. rathke cleft b. craniopharyngiomas
b. craniopharyngiomas (because they're locally disruptive of the surrounding tissue)
241
How does somatostatin carry out its inhibition on growth hormone?
1. Decrease cAMP
2. Increase cAMP
3. Decrease calcium levels
4. Increase calcium levels
A. Decrease cAMP
242
13-year-old boy presented with increased weight and height, cardiac hypertrophy, and glucose intolerance. What is the most likely diagnosis?
1. Acromegaly
2. Hyperthyroidism
3. Cushing’s syndrome
4. Gigantism
D. Gigantism
243
Patient has low sodium levels due to retaining large amounts of water. She was given Tolvaptan orally. What is the most likely diagnosis?
1. Conn’s syndrome
2. Syndrome of inappropriate ADH
3. Addison’s disease
B. Syndrome of inappropriate ADH
244
What is the best description of the pathohistology of a pituitary adenoma?
1. Acidophils with loss of reticulin network
2. Positive Ki-67 on immunohistochemistry
3. Mixture of cells
4. Squamous cells lined by columnar epithelia
A. Acidophils with loss of reticulin network
245
What is the enzyme responsible for the rate-limiting step of catecholamine synthesis?
1. Tyrosine hydroxylase
2. 21-hydroxylase
3. Aromatase
4. Tryptophan-5-hydroxylase
A. Tyrosine hydroxylase
246
Which of the following is an organ-specific autoimmune disease?
1. Rheumatoid arthritis
2. Systemic lupus erythematosus
3. Lymphocytic hypophysitis
4. Polyglandular autoimmune disease
C. Lymphocytic hypophysitis
247
Which of the following is secreted by a cell in the hypothalamus?
1. ADH
2. TRH
3. Prolactin
A. ADH
248
Which of the following hormones is able to carry out short loop negative feedback inhibition?
1. Growth hormone
2. Calcitriol
3. ADH
4. Parathormone
5. Oxytocin
A. Growth Hormone
249
Dopamine is secreted by the hypothalamus and travels through the hypothalamo-hypophyseal portal system in order to reach the anterior pituitary gland to inhibit prolactin secretion. What pathway is described here?
1. Paracrine
2. Endocrine
3. Neurocrine
4. Short loop negative feedback inhibition
5. Long loop negative feedback inhibition
C. Neurocrine
250
Women who has 2 healthy children presents with absent menstrual cycle for 6 months, even though she is not pregnant or taking any medications. She also has milk secretions from her breasts. She also has slightly reduced lateral field of vision. Which of the following is most likely associated with her condition?
1. Uterine contraction
2. Initiate ovulation
3. Endometrial hypertrophy
4. Osteoporosis
D. Osteoporosis
251
Hypersecretion of dopamine from the arcuate nucleus of the hypothalamus will result in which of the following?
1. Hyposecretion of prolactin
2. Hypersecretion of prolactin
3. Hyposecretion of growth hormone
4. Hypersecretion of growth hormone
A. Hyposecretion of prolactin
252
Which of the following statements is true?
1. Adenohypophysis receives direct blood supply from inferior hypophyseal artery.
2. Neurohypophysis receives direct blood supply from superior hypophyseal artery.
3. The long portal vessels arise from the capillary plexus in the lower infundibulum and end in the adenohypophysis.
4. The capillary plexus in the median eminence is in contact with nerve terminals from the hypothalamus.
D. The capillary plexus in the median eminence is in contact with nerve terminals from the hypothalamus.
253
Patient presents with pituitary adenoma that grows laterally. Which of the following is least likely to occur?
1. Exophthalmos
2. Loss of lateral field of vision
3. Decreased arterial blood supply to brain
4. Reduced sensory in forehead region
B. Loss of lateral field of vision
254
At which structure does ADH act on?
Thick ascending loop of Henle
255
Which of the following is a characteristic of diabetes insipidus?
1. Increased urine concentrating ability with polyuria
2. Increased serum osmolality
3. Excess secretion of ADH
4. It is always associated with psychological polydipsia
B. Increased serum osmolality
