Chem Path - Endocrine

Question 1

A 40 year old female presents to her physician with a goitre. On examination her skin is coarse, she has a large tongue and a prominent supra-orbital ridge of the face. Examination of the hands revealed thick, spade-like fingers. These features are most likely to be secondary to an abnormal level of which hormone?

Question 1Select one:

a.
Luteinising hormone

b.
Thyroid hormone

c.
Growth hormone

d.
Parathyroid hormone

e.
Elevated 17-OH progesterone

Answer 1

Growth Hormone

Question 2

A 40-year-old man sees his GP because of weight loss, increased appetite, and double vision. On physical examination, his temperature is 37.7°C, pulse is 106/min, respirations are 15/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 µU/mL (very low). A radioiodine scan indicates increased diffuse uptake throughout the thyroid. Which of the following best describes the microscopic appearance of the patient’s thyroid gland?

Question 2Select one:

Nodules with nests of cells separated by hyaline stroma that stains with Congo red

Destruction of follicles, lymphoid aggregates, and Hürthle cell metaplasia

Follicular destruction with inflammatory infiltrates containing giant cells

Papillary projections in thyroid follicles and lymphoid aggregates in the stroma

Enlarged thyroid follicles lined by flattened epithelial cells

Answer 2

Papillary projections in thyroid follicles and lymphoid aggregates in the stroma

Question 3

A 45-year-old woman reports a feeling of fullness in her neck, but has no other complaints. The enlargement has been gradual and painless for more than 1 year. Physical examination confirms diffuse enlargement of the thyroid gland. 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?

Question 3Select one:

Toxic multinodular goiter

Subacute granulomatous thyroiditis

Diffuse multinodular goiter

Hashimoto thyroiditis

Papillary carcinoma

Follicular adenoma

Answer 3

Diffuse multinodular goiter

Question 4

A 37-year-old woman complains that she has had difficulty swallowing accompanied by a feeling of fullness in the anterior neck for the past week. She reports 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 14/min, and blood pressure is 125/80 mm Hg. Palpation of her diffusely enlarged thyroid elicits pain. Laboratory studies show an increased serum free T4 level and a decreased TSH level. She is seen by an endocrinologist 2 months later and no longer has these complaints. The free T4 level is now normal. Which of the following conditions is most likely to have produced these findings?

Question 4Select one:

Toxic multinodular goiter

Toxic follicular adenoma

Medullary carcinoma

Subacute thyroiditis

Hashimoto thyroiditis

Answer 4

Subacute thyroiditis

Question 5

A 22-year-old woman has experienced increasing fatigue and a 7-kg weight loss without dieting over the past 4 months. She also has experienced increasing anxiety and nervousness with no apparent changes in her job or home life. She now has diarrhoea. Physical examination shows a diffusely enlarged thyroid gland. Her temperature is 37.6°C, pulse is 103/min, respirations are 17/min, and blood pressure is 135/75 mm Hg. A radionuclide scan of the thyroid shows a diffuse increase in uptake. What is most likely to produce these findings?

Question 5Select one:

Dietary deficiency of iodine

Antibodies against TSH receptor

Mutation in the RET proto-oncogene

Irradiation of the neck

Maternal deficiency in T4

Answer 5

Antibodies against TSH receptor

Question 6

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 laboratory findings is most likely to be reported in these sisters?

Question 6Select one:

Decreased serum free T4 level

Increased urinary free catecholamine level

Increased serum parathyroid hormone level

Decreased serum thyroid-stimulating hormone level

Increased serum thyrotropin-releasing hormone level

High titre serum antimicrosomal antibody

Answer 6

Decreased serum thyroid-stimulating hormone level

Question 7

A 46-year-old woman has experienced a feeling of fullness in her neck for the past year. Her energy level is decreased, and she has difficulty concentrating at work. On physical examination, the thyroid gland is enlarged diffusely and symmetrically and is not tender on palpation. She has dry, coarse skin and alopecia. The changes seen in the thyroid are likely to be…

Question 7Select one:

Papillary carcinoma

Diffuse follicular hyperplasia

Lymphoid follicles and Hurtle cells

A follicular neoplasm

A hyperplastic nodule

Answer 7

Lymphoid follicles and Hurtle cells

Question 8

A 44-year-old man with no previous illnesses sees his physician because he has had progressive hoarseness, shortness of breath, and stridor for the past 3 weeks. On physical examination, he has a firm, large, tender mass involving the entire right thyroid lobe. CT scan shows that this mass extends posterior to the trachea and into the upper mediastinum. A fine-needle aspiration biopsy of the mass is done, and the specimen shows pleomorphic spindle cells. Surgery is performed to resect the mass, which has infiltrated the adjacent skeletal muscle. Four of seven cervical lymph nodes have metastases. Pulmonary metastases also are identified on a chest radiograph. Which of the following neoplasms is most likely to be present in this patient?

Question 8Select one:

Papillary carcinoma

Medullary carcinoma

Anaplastic carcinoma

Non-Hodgkin lymphoma

Follicular carcinoma

Answer 8

Anaplastic carcinoma

Question 9

A 44-year-old man sees his physician because he felt a “lump” on the left side of his neck. Physical examination shows a nontender nodule on the left lobe of the thyroid gland. A cervical node is enlarged and nontender. Laboratory studies show no thyroid autoantibodies in his serum, and the T4 and TSH levels are normal. A thyroidectomy is performed; the histology is likely to show:

Question 9Select one:

Follicular proliferation of Hürthle cells

Multiple nodules composed of dilated follicles

Papillary proliferation of cells with cleared nuclei and nuclear grooves

A solid proliferation of pleomorphic mitotically active cells

Nodules with nests of cells separated by hyaline stroma that stains with Congo red

Answer 9

Papillary proliferation of cells with cleared nuclei and nuclear grooves

Question 10

A 36-year-old woman comes to the physician because of a painless lump on her neck for 3 months that has increased in size. She appears healthy. Examination shows a 2.5-cm (1-in) firm, irregular swelling on the left side of the neck that moves with swallowing. There is painless cervical lymphadenopathy. Ultrasound of the neck shows a solitary left lobe thyroid mass with increased vascularity and hyperechogenic punctate regions. A fine needle aspiration biopsy is scheduled for the following week. Which of the following is the most likely diagnosis?

Question 10Select one:

Follicular carcinoma

Anaplastic carcinoma

Medullary carcinoma

Papillary carcinoma

Non-Hodgkin lymphoma

Answer 10

Papillary carcinoma

Question 11

A 35-year-old man sees his physician because he felt a “lump” on the left side of his neck. Physical examination shows a nontender nodule on the left lobe of the thyroid gland. Laboratory studies show no thyroid autoantibodies in his serum, and the T4 and TSH levels are normal. A thyroidectomy is performed; the histology is an encapsulated nodule composed of small follicles, which invade through the capsule and into veins. The diagnosis is:

Question 11Select one:

Anaplastic carcinoma

Papillary carcinoma

Follicular carcinoma

Non-Hodgkin lymphoma

Medullary carcinoma

Answer 11

Follicular carcinoma

Question 12

A 32-year-old woman had radiotherapy to the neck following a diagnosis of mature B cell lymphoma. An ultrasound of the thyroid shows a 1.5 cm mass on the left side of her neck with irregular margins and small calcifications. An FNA shows a neoplasm with clear nuclei, nuclear grooves and psammoma bodies. What should happen next?

Question 12Select one:

Radiotherapy

Radioiodine

Chemotherapy

Total thyroidectomy

Lobectomy

Answer 12

Total thyroidectomy

Question 13

Which finding in a patient with primary hypothyroidism could not be explained by this condition?

Question 13Select one:

a.
Increased mean red cell volume

b.
Hyponatraemia

c.
Plasma alkaline phosphatase activity twice the upper limit of normal

d.
Plasma creatine kinase activity twice the upper limit of normal

e.
Plasma cholesterol concentration 7.2 mmol/L

Answer 13

Plasma alkaline phosphatase activity twice the upper limit of normal

Question 14

A 45 year old female develops swelling in her neck and diarrhoea. X-ray shows dense calcification in her thyroid. A nuclear scan of her thyroid detects a cold nodule that does not concentrate radio-iodine. Her doctor does serum assays for several hormones. After the hormone is assayed, he tells her general practitioner that the patient probably has medullary carcinoma of the thyroid since one of the hormones is markedly raised. What hormone did the doctor find was elevated?

Question 14Select one:

a.
Antidiuretic hormone

b.
Parathyroid hormone

c.
Thyroid hormone

d.
Calcitonin

e.
Thyroid stimulating hormone

Answer 14

Calcitonin

Question 15

A 12-year-old girl to presents at the clinic with reports of frequent fainting and lethargy. The girl is 5 ft tall and weighs 36kg. Skin fold tests show an abnormally low percentage of body fat. Which of the following hormones is likely to be severely diminished in the patient described above?

Question 15Select one:

a.
Epinephrine

b.
Glucagon

c.
Cortisol

d.
Insulin

e.
Thyroxin

Answer 15

Thyroxin

Question 16

Which of the following statements concerning thyroid function is correct?

Question 16Select one:

a.
People who have an under-active thyroid gland have a high basal metabolic rate

b.
T3 and T4 stimulate the secretion of TSH by the anterior pituitary

c.
Thyroid hormones are essential for the early development and maturation of the central nervous system

d.
A resting pulse rate of 65 beats per minute would suggest a diagnosis of thyrotoxicosis

e.
A person with hypothyroidism has a low plasma TSH concentration

Answer 16

Thyroid hormones are essential for the early development and maturation of the central nervous system

Question 17

Which of the following is NOT a symptom of hypothyroidism?

Question 17Select one:

a.
Lethargy

b.
Weight loss

c.
Dry cold skin

d.
Exophthalmos

e.
Loss of hair

Answer 17

Exophthalmos

Question 18

A patient presents with serum TSH 8 mU/L, normal total T4, normal free T4, normal T3

The most likely diagnosis is:
Question 18Select one or more:

a.
Primary hypothyroidism

b.
Compensated euthyroidism/subclinical hypothyroidism

c.
Thyrotoxicosis

d.
T3 toxicosis

e.
TSH deficiency

Answer 18

Compensated euthyroidism/subclinical hypothyroidism

Question 19

A patient presents with low normal TSH, low total T4, low free T4, and normal T3

The most likely diagnosis is:
Question 19Select one or more:

a.
Primary hypothyroidism

b.
Compensated euthyroidism/subclinical hypothyroidism

c.
TSH deficiency

d.
Thyrotoxicosis

e.
T3 toxicosis

Answer 19

TSH deficiency

Question 20

A 31 year old female complains of fatigue, weight gain and cold intolerance. She has no prior history of neck surgery or radiation. Her voice is hoarse and she has dry skin. Serum TSH is elevated and her free T4 is low. Which of the following is the most likely cause of these findings?

Question 20Select one or more:

a.
Autoimmune disease

b.
Thyroid carcinoma

c.
Pituitary hypofunction

d.
Postablative hypothyroidism

Answer 20

Autoimmune disease

Question 21

A 35 year old woman complains of palpitations, fatigue and insomnia. On examination she has warm extremities and tachycardia. She has diffuse thyroid gland enlargement and proptosis. Which of the following results would you expect?

Question 21Select one or more:

a.
Decreased TSH, increased total thyroxine

b.
Decreased TSH, normal T4

c.
Mildly increased TSH, normal free T4

d.
Increased TSH, increased total thyroxine, increased T3

Answer 21

Decreased TSH, increased total thyroxine

Question 22

A patient presents with serum TSH <0.05 mU/L, increased total T4, increased free T4 and increased free T3. The most likely diagnosis is:

Question 22Select one or more:

a.
Thyrotoxicosis

b.
Primary hypothyroidism

c.
Compensated euthyroidism/subclinical hypothyroidism

d.
TSH deficiency

e.
T3 toxicosis

Answer 22

Thyrotoxicosis

Question 23

A patient presents with serum TSH 22mU/L, low total T4, low free T4 and low T3

The most likely diagnosis is:
Question 23Select one or more:

a.
T3 toxicosis

b.
Compensated euthyroidism/subclinical hypothyroidism

c.
Thyrotoxicosis

d.
Primary hypothyroidism

e.
TSH deficiency

Answer 23

Primary hypothyroidism

Question 24

A patient presents with serum TSH <0.05 mU/L, normal total T4, normal free T4, increased T3

The most likely diagnosis is:
Question 24Select one or more:

a.
Thyrotoxicosis

b.
TSH deficiency

c.
T3 toxicosis

d.
Primary hypothyroidism

e.
Compensated euthyroidism/subclinical hypothyroidism

Answer 24

T3 toxicosis

Question 25

A young male health care assistant presents with weakness and tremor. There are no eye symptoms or signs and no skin lesions. His free T4 is elevated.

The most likely diagnosis is:

Question 25Select one or more:

a.
Multinodular goitre

b.
Grave’s disease

c.
Subacute thyroiditis

d.
Surreptitious hyperthyroidism

e.
Thyroid nodule

Answer 25

Surreptitious hyperthyroidism

Question 26

A 25 year old lady presents after a recent upper respiratory tract infection. She complains of neck pain and has difficulty tolerating a heated room. The thyroid is tender and the ESR is elevated

The most likely diagnosis is:

Question 26Select one or more:

a.
Thyroid nodule

b.
Multinodular goitre

c.
Surreptitious hyperthyroidism

d.
Grave’s disease

e.
Subacute thyroiditis

Answer 26

Subacute thyroiditis

Question 27

A 60 year old lady presents with a tremor and heat intolerance. She complains that her eyes look bulgy. She is tachycardic at rest and has evidence of a proximal myopathy.

The most likely diagnosis is:

Question 27Select one or more:

a.
Grave’s disease

b.
Thyroid nodule

c.
Subacute thyroiditis

d.
Surreptitious hyperthyroidism

e.
Multinodular goitre

Feedback

Answer 27

Grave’s disease

Question 28

A 70 year old woman has an irregularly irregular pulse of 88bpm. Neck examination reveals an enlarged thyroid (approximately 30 g) with irregular, bumpy texture. There is no substernal extension, lymphadenopathy, or bruit. The remainder of the examination is unremarkable except for minimal tremor of the outstretched hands. The patient denies heat intolerance or nervousness, but says she has lost a few kilograms over the past year.

The most likely diagnosis is:

Question 28Select one or more:

a.
Grave’s disease

b.
Subacute thyroiditis

c.
Surreptitious hyperthyroidism

d.
Thyroid nodule

e.
Multinodular goitre

Answer 28

Multinodular goitre