XX - The Endocrine System Flashcards
1
Q
A benign, well-circumscribed, soft lesion of the pituitary gland that may compress the optic chiasm and adjacent structures. Composed of relatively uniform, polygonal cells arrayed in sheets, cords, or papillae.
A
Pituitary adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754
2
Q
Most common type of hyperfunctioning pituitary adenoma.
A
Prolactinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754
3
Q
Microscopically, these are composed of densely or sparsely granulated cells, and immunohistochemical stains demonstrate growth hormone within the cytoplasm of the neoplastic cells.
A
Growth Hormone-Producing Adenomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754
4
Q
A condition characterized by excessive urination (polyuria) caused by an inability of the kidney to properly resorb water from the urine.
A
Diabetes insipidus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757
5
Q
Enzyme deficient in central Diabetes insipidus.
A
Anti-diuretic hormone(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757
6
Q
Disease caused by excessive levels of ADH, leading to resorption of excess water, with resultant hyponatremia.
A
syndrome of inappropriate ADH secretion (SIADH)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757
7
Q
The most common cause of hypothyroidism in areas of the world where iodine levels are sufficient. Presents as painless enlargement of the gland, associated with hypothyroidism.
A
Hashimoto thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757
8
Q
The thyroid is diffusely and symmetrically enlarged, with intact capsule. Microscopically, reveals a mononuclear inflammatory infiltrate and the presence of Hurthle or oxyphil cells, which are cells with eosinophilic, granular cytoplasm.
A
Chronic Lymphocytic (Hashimoto) Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 761
9
Q
A rare disorder characterized by extensive fibrosis involving the thyroid and contiguous neck structures. Idiopathic in nature.
A
Riedel thyroiditis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762
10
Q
Believed to be caused by a viral infection or a postviral inflammatory process, this lesion of the thyroid gland is characterized by unilateral or bilateral enlargement of the thyroid, with disruption of thyroid follicles. Extravasation of colloid leads to a granulomatous reaction. Healing occurs by resolution of inflammation and fibrosis.
A
Subacute Granulomatous (de Quervain) Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762
11
Q
Also known as “silent” or “painless” thyroiditis n a subset of patients the onset of disease follows pregnancy. Unlike Hashimoto thyroiditis, follicular atrophy or Hurthle cell metaplasia are not commonly seen.
A
Postpartum thyroiditis/ Subacute Lymphocytic Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762
12
Q
Thyroid gland is diffusely enlarged due to hyperplasia and hypertrophy of the thyroid follicular cells. The follicular epithelial cells are tall, columnar, and more crowded than usual. These cells actively resorb the colloid in the centers of the follicles, resulting in the “scalloped” appearance of the edges of the colloid.
A
Graves Disease(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 764
13
Q
Goiter which occurs in areas where the soil, water and food supply contain little iodine.
A
Endemic goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765
14
Q
Diffuse, symmetric enlargement of the gland due to TSH-induced hypertrophy and hyperplasia of thyroid follicular cells.
A
Diffuse goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765
15
Q
Goiter characterized by enlarged, colloid-rich gland. On cut surface, the thyroid is usually brown, glassy and translucent.
A
Colloid goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765
16
Q
Irregular enlargement of the thyroid as a result of recurrent episodes of hyperplasia and involution.
A
Multinodular goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765
17
Q
Probability of being benign or malignant.A solitary nodule seen in a 20-yr old male.
A
Malignant(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766
18
Q
Probability of being benign or malignant.Multiple, hot nodules.
A
Benign(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766
19
Q
Probability of being benign or malignant.A solitary, cold nodule.
A
Malignant(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766
20
Q
A solitary, spherical lesion that compresses the adjacent non-neoplastic thyroid. Neoplastic cells are demarcated from the adjacent parenchyma by a well-defined, intact capsule, which is a hallmark of this tumor.
A
Thyroid adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766
21
Q
Most common carcinoma of the thyroid.
A
Papillary carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 767
22
Q
Thyroid carcinoma which may occur at any age and is associated with previous exposure to ionizing radiation. The nuclei of cells contain very finely dispersed chromatin, which imparts an optically clear appearance, giving rise to the designation “ground-glass” or “Orphan Annie eye” nuclei.
A
Papillary carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 767
23
Q
The second most common form of thyroid cancer. Usually present at an older age a peak incidence in the middle adult years. Microscopically, these are composed of fairly uniform cells forming small follicles, reminiscent of normal thyroid.
A
Follicular Carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 769
24
Q
Neuroendocrine neoplasms derived from the parafollicular cells, or C cells, of the thyroid, which secrete calcitonin. Associated with MEN 2A and 2B. May be solitary or multicentric, composed of polygonal to spindle-shaped cells, which may form nests, trabeculae, and follicles, contains amyloid.
A
Medullary carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 770
25
Carcinoma of the thyroid usually seen in the elderly. Associated with high mortality rate. These present as bulky masses that typically grow rapidly beyond the thyroid capsule into adjacent neck structures.
Anaplastic carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 771
26
A solitary lesion of the parathyroid gland which are composed predominantly of chief cells almost invariably confined to a single gland. A rim of compressed, non-neoplastic parathyroid tissue, generally separated by a fibrous capsule, is often visible at the edge of the adenoma.
Parathyroid adenoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 773
27
These tumors of the parathyroid glands are usually firm or hard tumors, adhering to the surrounding tissue as a result of fibrosis or infiltrative growth. May weigh >5 grams. The cytologic features and mitotic activity are variable.
Parathyroid carcinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 773
28
Inadvertent removal of parathyroids during thyroidectomy.
Surgical ablation(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 775
29
An autoimmune disease characterized by progressive destruction of islet beta cells, leading to absolute insulin deficiency.
Type 1 diabetes mellitus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 781
30
Caused by a combination of peripheral resistance to insulin action and an inadequate compensatory response of insulin secretion by the pancreatic beta cells.
Type 2 diabetes mellitus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 781
31
Vascular lesion associated with hypertension, which is more prevalent in diabetics.
Hyaline arteriolosclerosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 781
32
A diffuse increase in mesangial matrix along with mesangial cell proliferation and is always associated with basement membrane thickening of the glomerulus. Seen in patients with diabetes mellitus.
Diffuse mesangial sclerosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 783
33
A glomerular lesion made distinctive by ball-like deposits of a laminated matrix situated in the periphery of the glomerulus .
Nodular glomerulosclerosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 783
34
The ball-like deposit seen in nodular glomerulosclerosis.
Kimmelstiel-Wilson lesion(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 783
35
A special pattern of acute pyelonephritis seen more often in diabetics.
Necrotizing papillitis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 784
36
Most common pancreatic endocrine neoplasms.
beta-cell tumors (insulinomas) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 788
37
These benign tumors look remarkably like giant islets, with preservation of the regular cords of monotonous cells and their orientation to the vasculature.
Insulinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 788
38
What syndrome is described by the association of pancreatic islet cell lesions with hypersecretion of gastric acid and severe peptic ulceration?
Zollinger-Ellison syndrome(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 788
39
Tumors associated with increased serum glucagon and a syndrome consisting of mild diabetes mellitus, a characteristic skin rash (necrolytic migratory erythema), and anemia.
alpha-Cell tumors (glucagonomas) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 789
40
Most common cause of Cushing syndrome.
Administration of exogenous glucocorticoids(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 789
41
Primary hypothalamic-pituitary disease associated with oversecretion of ACTH. The adrenal glands characterized by variable degrees of bilateral nodular cortical hyperplasia.
Cushing disease(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 789
42
In this condition, the normal granular, basophilic cytoplasm of the ACTH-producing cells in the anterior pituitary is replaced by homogeneous, lightly basophilic material. This results from high levels of endogenous or exogenous glucocorticoids.
Crooke hyaline change(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 790
43
Lung cancer associated with a paraneoplastic syndrome leading to excessive production of ACTH.
Small-cell lung cancer(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 792
44
Caused either by an aldosterone-producing adrenocortical neoplasm, usually an adenoma, or by primary adrenocortical hyperplasia, resulting in suppression of the renin-angiotensin system and decreased plasma renin activity.
Primary hyperaldosteronism/ Conn syndrome(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 792
45
A characteristic feature of aldesterone-producing adenomas which is the presence of eosinophilic, laminated cytoplasmic inclusions. These are typically found after treatment with the anti-hypertensive drug which is the DOC for primary hyperaldosteronism.
Spironolactone bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 792
46
The adrenals are hyperplastic bilaterally, sometimes expanding to 10 to 15 times their normal weights,due to sustained elevation in ACTH. The adrenal cortex is thickened and nodular, and on cut section, the widened cortex appears brown as a result of depletion of all lipid
Congenital adrenal hyperplasia(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 793
47
Acute adrenal insufficiency caused by severe bilateral adrenal hemorrhage in an infant with overwhelming sepsis. The adrenals are grossly hemorrhagic and shrunken; microscopically, little residual cortical architecture is discernible
Waterhouse-Friderichsen syndrome(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 794
48
An uncommon disorder resulting from progressive destruction of the adrenal cortex. May be due to autoimmune adrenalitis, tuberculosis, AIDS, or metastatic cancers.
Addison disease/ chronic adrenocortical insufficiency(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 794
49
The adrenals are reduced to small, flattened structures that usually retain their yellow color because of a small amount of residual lipid. Histologically, there is atrophy of cortical cells with loss of cytoplasmic lipid, particularly in the zonae fasciculata and reticularis, due to decreased ACTH stimulation.
Secondary hypoadrenalism (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 795
50
Characterized by irregularly shrunken glands, which may be exceedingly difficult to identify within the suprarenal adipose tissue. Histologically, the cortex contains only scattered residual cortical cells in a collapsed network of connective tissue.
Primary autoimmune adrenalitis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 795
51
Neoplasms composed of chromaffin cells which synthesize and release catecholamines and other peptide hormones. Composed of polygonal to spindle-shaped chromaffin cells compartmentalized intonests, or "Zellballen," by a rich vascular network.
Pheochromocytomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 797
52
Most common extra-cranial solid tumor of childhood. Occur most commonly during the first 5 years of life and may arise during infancy.
Neuroblastoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 798
53
Components of MEN1?
Parathyroid: Primary hyperparathyroidismPancreas: ZES, insulinoma, etc.Pituitary: prolactin-secreting macroadenoma, somatotrophin-secreting tumors(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 798
54
Components of MEN2A?
Thyroid: Medullary carcinomaAdrenal medulla: pheochromocytomasParathyroid: parathyroid gland hyperplasia (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 799
55
Components of MEN2B?
Thyroid: Medullary carcinomaAdrenal medulla: pheochromocytomaExtraendocrine manifestations: ganglioneuromas of mucosal sites (gastrointestinal tract, lips, tongue) and marfanoid habitus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 799
56
All individuals carrying germ-line RET mutations are advised to undergo prophylactic thyroidectomy to prevent the development of what type of carcinoma?
Medullary Carcinoma (TOPNOTCH)
57
What is the most common site of gastrinomas in individuals with MEN-1?
Duodenum (TOPNOTCH)
58
What is the most frequent anterior pituitary tumor encountered in individuals with MEN-1?
Prolactinoma (TOPNOTCH)
59
Morphology: demonstrates characteristic nests of cells (zellballen) with abundant cytoplasm
Pheochromocytomas (TOPNOTCH)
60
Morphology: the adrenals are grossly hemorrhagic and shrunken with little residual cortical architecture discernable
Waterhouse Friederichsen Syndrome (TOPNOTCH)
61
What is the most common cause of primary adrenal insufficiency in developed countries?
Autoimmune adrenalitis (TOPNOTCH)
62
Spirinolactone bodies are seen in what tumor?
Aldosterone producing adenomas (TOPNOTCH)
63
Crook hyaline change is seen in?
Cushing syndrome (TOPNOTCH)
64
Watery Diarrhea, hypokalemia, achlorhydria or WDHA syndrome is seen in?
VIPoma (TOPNOTCH)
65
Syndrome of mild DM, characteristic rash (necrolytic migratory erythema), and anemia is seen in what tumor?
Glucagonomas or alpha cell tumors (TOPNOTCH)
66
Syndrome of DM, cholelithiasis, steatorrhea, and hypochlorhydria is seen in what tumor?
Somatostatinoma or delta cell tumor (TOPNOTCH)
67
Approximately 60%-80% of patients with DM will develop some form of diabetic retinopathy after how many years from the time of diagnosis?
15-20 years (TOPNOTCH)
68
The fundamental lesion of DM retinopathy
neovascularization (TOPNOTCH)
69
What special pattern of acute pyelonephritis is common in diabetics compared to non diabetics?
Necrotizing papillitis or papillary necrosis (TOPNOTCH)
70
These are PAS positive glomerular lesions made distinctive by ball like deposits of laminated matrix situated in the periphery of the glomerulus
Nodular glomerulosclerosis or Kimmelstiel Wilson lesion (TOPNOTCH)
71
What are the three most important glomerular lesions seen in DM?
Basement membrane thickening, diffuse mesangial sclerosis, and nodular glomerulosclerosis (TOPNOTCH)
72
What is the hallmark of diabetic macrovascular disease?
Accelerated atherosclerosis (TOPNOTCH)
73
What is the most common cause of death in diabetics?
Myocardial Infarction (TOPNOTCH)
74
What morphological change seen in pancreas is more commonly associated with DM Type 2 than DM Type 1?
Amyloid replacement of islets (TOPNOTCH)
75
What is the hallmark of hypocalcemia?
Tetany (TOPNOTCH)
76
The most common cause of clinically apparent hypercalcemia
Malignancy (TOPNOTCH)
77
The most common cause of asymptomatic elevated blood calcium
Primary hyperparathyroidism (TOPNOTCH)
78
A peculiar feature of this type of thyroid carcinoma is the presence of multicentric C cell hyperplasia
Familial Medullary Cancers of the thyroid (TOPNOTCH)
79
Acellular amyloid deposits are seen in what type of thyroid cancer?
Medullary Carcinoma (TOPNOTCH)
80
Morphology: fairly uniform cells forming small follicles containing colloid, quite reminiscent of normal thyroid
Follicular Carcinoma of the thyroid (TOPNOTCH)
81
These are concentrically calfcified structures that are often present in papillary carcinoma of the thyroid
Psamomma bodies (TOPNOTCH)
82
Morphology: the nuclei of these tumor cells contain finely dispersed chromatic which imparts an optically clear or empty appearance, giving rise to the designation ground glass or Orphan Annie eye
Papillary Carcinoma of the thyroid (TOPNOTCH)
83
The major risk factor predisposing to thyroid cancer
Ionizing radiation, particularly in the first two decades of life (TOPNOTCH)
84
Morphology: diffuse hypertrophy and hyperplasia of thyroid follicular epithelial cells with scalloping of the margins
Graves disease (TOPNOTCH)
85
Morphology: lymphocytic infiltration with hyperplastic germinal centers within the thyroid parenchyma and patch disruption and collapse of thyroid follicles
Subacute lymphocytic or Painless thyroiditis (TOPNOTCH)
86
Morphology: thyroid parenchyma contains a chronic inflammatory infiltrate with multinucleate giant cells enclosing naked pools and fragments of colloid
Subacute or granulomatous thyroiditis (TOPNOTCH)
87
Morphology: the thyroid parenchyma contains a dense lymphocytic infiltrate with germinal centers and deeply eosinophilic Hurthle cells line the residual thyroid follicles
Hashimoto Thyroiditis (TOPNOTCH)
88
What variant of craniopharyngoma frequently contains radiologicaly demonstrable calcifications?
Adamantinomatous craniopharyngoma (TOPNOTCH)
89
What is the most common cause of hyperpituitarism?
Adenoma (TOPNOTCH)
90
Hypofunction of the anterior pituitary occurs when approximately how much of the parenchyma is lost?
75% (TOPNOTCH)
91
These cysts are lined by ciliated cuboidal epithelium with occasional goblet cells and anterior pituitary cells, can accumulate proteinaceous fluid and expand, compromising the normal gland
Rathke Cleft Cyst (TOPNOTCH)
92
The craniopharyngomas are thought to arise from what structure?
Vestigial remnants of Rathke pouch (TOPNOTCH)
93
What is the earliest and most consistent feature of hyperthyroidism?
Cardiac manifestations (TOPNOTCH)
94
This condition presents with impaired developments of the skeletal system and central nervous system, manifested by severe mental retardation, short stature, coarse facial features, a protruding tongue, and umbilical hernia
Cretinism (TOPNOTCH)
95
These are epithelial cells with abudant eosinophilic, granular ctyoplasm seen in Hashimoto thyroiditis
Hurthle cells (TOPNOTCH)
96
What is the most important feature in making the distinction between a thyroid adenoma and a multinodular goiter?
In adenoma, the neoplastic cells are demarcated from the adjacent parenchyma by a well defined intact capsule. In multinodular goiters, they lack a well formed capsule (TOPNOTCH)
97
What is the hallmark of all follicular adenomas?
Well formed capsule encircling the tumor. So, careful evaluation of the integrity of the capsule is therefore critical in distinguishing follicular adenomas from follicular carcinomas which demostrate capsular and or vascular invasion (TOPNOTCH)
98
What is the most common clinically significant congenital anomaly of the thyroid?
Thyroglossal duct or cyst (TOPNOTCH)
99
Lamellar keratin formation or "wet keratin" is a diagnostic feature of what tumor?
Adamantinomatous craniopharyngoma (TOPNOTCH)
100
Morphology: extensive infiltration of the parenchyma by a mononuclear inflammatory infiltrate containing small lymphocytes, plasma cells, and well developed germinal centers
Hashimoto thyroiditis (TOPNOTCH)
101
Morphology: in its hyperplastic phase, they thyroid gland is diffusely and symmetrically enlarged and the follicles are lined by crowded columnar cells, which may pile up and form projections similar to those seen in Grave's disease
Diffuse nontoxic (simple) goiter (TOPNOTCH)
102
Morphology: Variant of papillary carcinos ma that is marked with tall columnar cells with intensely eosinophilic cytoplasm lining the papillary structures. The cells are at least twice as tall as they are wide.
Tall cell variant (TOPNOTCH)
103
Morphology: nuclei are usually round to ovoid, with stippled "salt and pepper" chromatin
Pheochromocytoma (TOPNOTCH)
104
Pathogenesis: Dysfunction in T cell selection and regulation leading to breakdown in self-tolerance to islet autoantigens
Type 1 diabetes mellitus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1108
105
Pathogenesis: Insulin resistance in peripheral tissues and failure of compensation by beta cells
Type 2 diabetes mellitus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1108
106
Characterized by inflammatory infiltrate of T cells and macrophages, beta cell depletion and islet atrophy
Type 1 diabetes mellitus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1108
107
Characterized by amyloid deposition in islets and mild beta cell depletion. No insulitis.
Type 2 diabetes mellitus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1108
108
Most potent anabolic hormone with multiple synthetic and growth-promoting effects.
Insulin (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1109
109
The most important environmenta risk factor for type 2 diabetes
Obesity(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1111
110
The most common precipitating factor in DKA
Failure to take insulin(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1114
111
What explains the wide, staring gaze and lid lag in hyperthyroidism?
Sympathetic overstimulation of superior tarsal muscle(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1084
112
Most common cause of endogenous hyperthyroidism
Graves Disease(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1089
113
Triad of clinical findings in Graves Diseae
Hyperthyroidism, infiltrative ophthalmopathy, and pretibial myxedema(infiltrative dermopathy)(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1089
114
The most common antibody subtype seen in 90% of patients with Graves disease.
Thyroid stimulating immunoglobulin(TSI) Robbins Basic Pathology, 9th ed., p. 1089
115
Patient presents with heat intolerance, palpitations, tibial edema, and exophthalmos. Thyroid gland was noted to be symmetrically enlarged. The most likely diagnosis is:
Graves disease(TOPNOTCH)
116
Effect of iodine in the morphology of thyroid in Graves disease
Involution of epithelium and accumulation of colloid(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1089
117
Laboratory features of Graves disease
Elevations in serum free T3 and T4 and decreased serum TSH(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1090
118
Most important single screening test for hyperthyroidism
TSH(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1084
119
Most often cause of congenital hypothyroidism
Iodine deficiency in the diet(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1085
120
Presents with slowing of physical and mental activity, fatigue, apathy, constipation, decreased sweating, shortness of breathing, cold intolerance, overweight.
Myxedema/Hypothyroidism(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1086
121
Most sensitive sceening test for hypothyroidism
Serum TSH level(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1085
122
A middle aged-woman presents with painless enlargement of the thyroid that is symmetric and diffuse, with some symptoms of hypothyroidism. What is the most likely diagnosis?
Hashimoto's thyroiditis(TOPNOTCH)
123
It causes symmetric enlargement of the entire thyroid gland without producing nodularity. Patients are usually clinically euthyroid.
Diffuse nontoxic (simple) goiter (TOPNOTCH)
124
Patient presents with mass on the anterior neck and dysphagia. Thyroid is assymetrically enlarged. Thyroid functions tests are normal. Cut section showed irregular nodules containing brown, gelatinous colloid. The microscopic appearance showed colloid-rich follicles lined by flattened, inactive epithelium and areas of follicular hyperplasia. What is the most likely diagnosis?
Multinodular goiter(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1091
125
True or False. Nodules in males are more likely to be neoplastic than are those in females.
True(TOPNOTCH)
126
True or False. Solitary nodule are more likely to be neoplast than are multiple nodules.
True(TOPNOTCH)
127
True or False. Nodules in younger patients are more likely to be neoplastic than are those in older patients.
True(TOPNOTCH)
128
True or False. Functional nodules that take up radioactive iodine in imaging studies(hotnodules0 are much more likely to be benign than malignant.
True(TOPNOTCH)
129
What is the most common benign neoplasm of the thyroid?
Follicular adenoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1100
130
Patient presents with enlarged feet and hands, thickened and sausage-like fingers, jaw protrusion and broadening of the lower face, generalized muscle weakenss. The diagnosis of this condition relies on what elevated serum ___ and ___ levels.
GF and IGF-1(TOPNOTCH)
131
Development of large destructive pituitary adenoma after surgical removal of the adrenal gland. This condition occurs most often because of the inhibitory effect of adrenal corticosteroids.
Nelson syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1080
132
Presents with amenorrhea, galactorrhea, loss of libido and infertility.
Lactotroph adenoma(TOPNOTCH)
133
Most common form of clinically significant ischemic necrosis of the anterior pituitary. May present with amenorrhea ang infertility.
Sheehan syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1081
134
Presents with hyponatremia, cerebral edema, absence of peripheral edema due to ectopic ADH secretion by malignant neoplasm, drugs, and a variety of CNS disorders.
SIADH(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1082
135
May present with growth retardation in children, headache and visual disturbances. In adult, these neoplasm is thought to rise from vestigial remnant of Rathke pouch.
Craniopharyngoma(TOPNOTCH)Robbins Basic Pathology, 9th ed,. P. 1082
136
Histologic variant of craniopharyngioma most often observed in children
Adamantinomatous craniopharyngoma (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1082
137
Histologic variant of craniopharyngioma most often observed in adults
Papillary craniopharyngoma (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1082
138
Presents with rapidly enlarging bulky neck mass, dyspnea, dysphagia, hoarsenes, and cough. Histologic finding of pleomorphic giant cells, spindle cells or mixed. Highly fatal.
Anaplastic carcinoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1098
139
Amyloid deposits are characteristic of this histologic type of thyroid cancer.
Medullary cancer(TOPNOTCH)
140
Most common clinically significant congenital anomaly of the thyroid.
Thyroglossal duct or cyst (TOPNOTCH)
141
Most common cause primary hyperparathyroidism
Solitary parathyroid adenoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p.1101
142
The combination of increased osteoclast activity, peritrabecular fibrosis, and cystic brown tumors
von Recklinghausen disease of bone/osteitis fibrosa cystica(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1102
143
The most common mechanism through which osteolytic tumors induce hypercalcemia
Secretion of PTHrP(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1103
144
Classic findings of hypocalcemia on physical examination
Chvostek sign and Trosseau sign(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1105
145
The most frequent pattern in diabetic neuropathy
Distal symmetric polyneuropathy of the lower extremities(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1120
146
The most common cause of hypercotisolism
Exogenous administration of steroids(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1125
147
Most common adrenal finding in endogenous Cushing syndrome
Nodular hyperplasia(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1125
148
Presents with hypertension, weight gain, moon facies, truncal obesity, elevated urinary steroid secetion, low ACTH
Cushing syndrome caused by an adrenal tumor(TOPNOTCH)
149
Presents with signs and symptoms of elevated cortisol levels, with failure of low-dose and high-dose dexamethasone to suppress cortisol secretion
Ectopic ACTH secretion(e.g ACTH production by tumors)(TOPNOTCH)
150
Most common form of Cushing syndrome, ACTH levels are elevated and cannot be suppressed by administration of low dose of dexamethasone.
Pituitary Cushing syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1125
151
Most common manifestation of primary hyperaldosteronism
BP elevation(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1126
152
Overproduction of aldosterone and decreased plasma renin activity, hypertension and hypokalemia
Primary aldosteronism(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1127
153
Newborn presents with hyponatremia, hyperkalemia, hypotension, cardiovascular collapse, and virilization. What is the most likely diagnosis?
Salt-wasting syndrome, CAH(TOPNOTCH)
154
Presents with hyperkalemia, hyponatremia, volume depletion, hypotension, hyperpigmentation of sun-exposed areas, weakness, nausea vomiting, weight loss, abdominal pain.
Primary adrenal insufficiency(TOPNOTCH)
155
The dominant clinical manifestation of pheochromocytoma
Hypertension(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1135
156
Presents with paroxysmal episodes of hypertension, tachycardia, palpitations, headache, sweating, tremor, apprehension, elevated urinary vanillylmandelic acid and metanephrines.
Pheochromocytoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1146
157
The principal secretory product of pineal gland
Melatonin(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1137
158
A 33 year old female presents with blurring of vision, galactorrhea and amenorrhea. A cranial CT shows a pituitary mass. She undergoes surgery to excise the mass. Her tumor (A) is associated with MEN-1 in >50% of cases (B) is composed of lobules of distinct cell populations of cells , some acidophilic, others basophilic (C) is composed of a uniform cell population and absent a reticulin network (D) is most probably of acidophilic morphology due to her prolactinemic signs and symptoms
is composed of a uniform cell population and absent a reticulin network (A - MEN-1 association in 3%; B - normal pituitary; D - functional status cannot be predicted from its histologic appearance) (TOPNOTCH)Robbins Basic Pathology, 8th ed., pp 754-755
159
A 40 year old female presents with an anterior left neck mass. She undergoes a left thyroid lobectomy. The specimen has a solitary well-circumscribed nodule on the inferior pole. Which microscopic finding points to an adenoma, rather than a dominant nodule in a multinodular goiter? (A) well defined, intact capsule and compressed adjacent thyroid parenchyma (B) follicles of different sizes, resembling the surrounding thyroid parenchyma (C) presence of nuclear enlargement, nuclear grooves, and some with clearing (D) small follicles invading the capsule
well defined, intact capsule and compressed adjacent thyroid parenchyma (B - multinodular goiter; C - papillary carcinoma; D - follicular carcinoma) (TOPNOTCH)Robbins Basic Pathology, 8th ed., pp766-769)
160
A 36 year old female presents with an anterior neck mass, and palpable cervical lymph nodes. She undergoes total thyroidectomy and neck dissection. On her right thyroid lobe is a 6 cm solid tan mass. Some of the lymph nodes also have a solid tan cut surface. Which of the following histologic findings is definite evidence of papillary thyroid carcinoma? (A) cells with enlarged nuclei, fine chromatin, some with nuclear grooves and clearing (B) follicles containing papillary infoldings, lined by thyrocytes with dark round nuclei (C) follicles with thick, pink colloid (D) follicles lined by tall columnar cells, and colloid with a scalloped appearance
cells with enlarged nuclei, fine chromatin, some with nuclear grooves and clearing (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 768
161
A 15 year old male presents with an anterior neck mass. A deceased uncle also had an anterior neck mass in his teen years. The thyroid is excised, and histopathology showed polygonal to spindle shaped tumor cells in nests and trabeculae, admixed with amyloid deposits. Which of the following is most accurate? (A) the amyloid deposits are composed of altered calcitonin molecules (B) the patient is likely hypocalcemic (C) the patient's surrounding thyroid parenchyma has no C cell hyperplasia (D) most cases of this tumor are familial
the amyloid deposits are altered calcitonin molecules (medullary thyroid carcinoma) (B - hypocalcemia is not a feature; C - multicentric C cell hyperplasia is a feature in familial forms; D - most cases are sporadic) (TOPNOTCH)Robbins Basic Pathology, 8th ed., pp 770-771
162
Which of the following renal histologic findings is most characteristic of diabetes? (A) focal mild pyelonephritis (B) diffuse mesangial sclerosis (C) arteriosclerosis of efferent arterioles of the glomerulus (D) crescentic glomerulonephritis
arteriosclerosis of the efferent arterioles of the glomerulus (TOPNOTCH)Robbins Basic Pathology, 8th ed., pp783-784
163
Of the pancreatic endocrine neoplasms or islet cell tumors, which is most commonly benign? (A) insulinomas (B) gastrinomas (C) VIPomas (D) nonfunctioning islet cell tumors
Insulinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 788
164
A 44 year old male presents with intermittent, intense epigastric pain unrelieved by antacids or H2 blockers. He also has occasional diarrhea. An endoscopy revealed multiple gastric, duodenal, and jejunal ulcers. Zollinger-Ellison syndrome is considered. Where can the tumor be located? (A) pancreas (B) duodenum (C) peripancreatic soft tissues (D) all of the above
all of the above ("gastrinoma triangle") (TOPNOTCH)Robbins Basic Pathology, 8th ed., pp788-789
165
Which of the following is the commonest cause of Cushing syndrome? (A) anterior pituitary tumor (B) adrenocortical neoplasm (C) small cell lung carcinoma (D) medication
medication (TOPNOTCH)Robbins Basic Pathology, 8th ed., pp 789-790
166
Which of the following findings is most compatible with adrenal Cushing syndrome? (A) elevated ACTH, elevated cortisol (B) decreased ACTH, decreased cortisol (C) decreased ACTH, elevated cortisol (D) elevated ACTH, decreased cortisol
decreased ACTH, elevated cortisol (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 789
