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Endocrine > Week 1 Review Q's > Flashcards

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

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2
Q

Which three organs have a wider transverse diameter than a vertical diameter?

A
  1. pituitary gland
  2. cecum
  3. prostate gland
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3
Q

Which of the following has a bigger pituitary gland?

a. adults
b. children
c. pregnant women

A

c. pregnant women

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4
Q

Which pituitary gland lobe is the pars intermedia a part of?

A

anterior lobe

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5
Q

A pituitary gland tumor grows laterally, which nerve is the first to be affected?

A

CN6, abducens nerve

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6
Q

A pituitary gland tumor grows and the gland is pushed superiorly, what structure is likely to be affected?

A

optic chiasm

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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)

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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

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9
Q

What two things go through the cavernous sinus?

A

internal carotid artery CN6 (abducens nerve)

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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

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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

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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

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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

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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

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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

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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

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17
Q

Which artery goes into the median eminence?

a. superior hypophyseal artery
b. inferior hypophyseal artery
c. both

A

a. superior hypophyseal artery

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18
Q

Which part of the hypophyseal tract releases oxytocin?

a. supraoptic nucleus
b. paraventricular nucleus
c. both

A

b. paraventricular nucleus

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19
Q

Which is ectodermally derived?

a. adenohypophysis
b. neurohypophysis
c. both

A

c. both

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20
Q

Which is derived from Rathke’s pouch?

a. adenohypophysis
b. neurohypophysis
c. both

A

a. adenohypophysis

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21
Q

Which part of the hypophyseal tract releases ADH?

a. supraoptic nucleus
b. paraventricular nucleus
c. both

A

a. supraoptic nucleus

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22
Q

Which undergoes downwards growth?

a. adenohypophysis
b. neurohypophysis
c. both

A

b. neurohypophysis

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23
Q

Which of the following produces thyroid stimulating hormone?

a. mammotrophs
b. thyrotrophs
c. corticotrophs
d. gonadotrophs
e. somatotroph

A

b. thyrotrophs

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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)

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25
Q

Which of the following produces MSH (melanocyte-stimulating hormone)?

a. mammotrophs
b. thyrotrophs
c. corticotrophs
d. gonadotrophs
e. somatotroph

A

c. corticotrophs (it also produces adrenocorticotropic hormone (ACTH))

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26
Q

Which of the following produces Prolactin? a. mammotrophs b. thyrotrophs c. corticotrophs d. gonadotrophs e. somatotroph

A

a. mammotrophs (and lactotroph)

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27
Q

Which of the following produces GH? a. mammotrophs b. thyrotrophs c. corticotrophs d. gonadotrophs e. somatotroph

A

e. somatotroph

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28
Q

What controls the adenohypophysis hormone release?

A

hormones of the hypothalamus usually stimulate release, except dopamine (inhibits prolactin) and somatostatin (inhibits growth hormone)

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29
Q

Which of the following has an inverse relationship with prolactin? a. thyrotropin-releasing hormone b. vasoactive inhibitory peptide c. dopamine

A

c. dopamine

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30
Q

Which hormone does the intermediate lobe/pars intermedia secrete?

A

MSH (melanocyte-stimulating hormone)

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31
Q

Patient comes in complaining of thirst and constant urine excretion. You suspect diabetes insipidus, what is the mechanism of this disease?

A

low vasopressin levels (ADH)

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32
Q

Which of the following is found in pars intermedia? a. melanotrophs b. pituicytes c. herring bodies

A

a. melanotrophs (the other two are in the posterior lobe)

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33
Q

Which of the following is responsible for stimulating the cells of the adrenal cortex? a. mammotrophs b. thyrotrophs c. corticotrophs d. gonadotrophs e. somatotroph

A

c. corticotrophs (makes ACTH)

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34
Q

In Sheehan’s syndrome, which hormone is the last to stop being secreted? a. TSH b. ACTH c. FSH d. LH

A

a. TSH

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35
Q

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

A

d. leuteotrophs (secretes LH in females and ICSH in males, which makes Leydig cells into testosterone)

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36
Q

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

A

e. somatotroph (produces growth hormones)

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37
Q

Which of the following is responsible for stimulating Leydig cells to make testosterone? a. mammotrophs b. thyrotrophs c. corticotrophs d. leuteotrophs e. somatotroph

A

d. leuteotrophs (secretes ICSH in males and LH in females, which converts Graafian follicle into the corpus luteum)

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38
Q

What two hormones are produced by arcuate nucleus? What do they do?

A

1- dopamine (inhibt prolactin) 2- neuropeptide Y (stimulates food intake/hunger)

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39
Q

What inhibits somatotrophs from releasing GH?

A

somatostatin

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40
Q

Which of the following is responsible for the growth of ovarian follicles? a. mammotrophs b. thyrotrophs c. gonadotrophs d. leuteotrophs e. somatotroph

A

c. gonadotrophs (also regulates spermatogenesis)

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41
Q

Which undergoes upwards growth? a. adenohypophysis b. neurohypophysis

A

a. adenohypophysis

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42
Q

Which is secreted by the Posterior lobe? a. ACTH b. ADH c. FSH d. Prolactin

A

b. ADH

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43
Q

Which part of the adrenal gland secretes epinephrine? a. cortex b. medulla

A

b. medulla

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44
Q

Which organ secretes somatostatin ?

A

The pancreas

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45
Q

Which of the following secretes melatonin? a. the thymus gland b. the pineal gland c. the pancreas

A

b. the pineal gland

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46
Q

Which of the following hormones is also an antioxidant? a. somatostatin b. anti-mullerian hormone c. melatonin d. thymosine

A

c. melatonin

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47
Q

In which of the following is the presence of anti-mullerian hormone abnormal? a. female b. male c. male fetus

A

b. male

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48
Q

Vitamin D is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines

A

c. steroids

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49
Q

T3 is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines

A

a. iodothyronines

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50
Q

hCG is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines

A

d. glycoproteins

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51
Q

Cortisol is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines

A

c. steroids

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52
Q

Oxytocin is considered a part of which family? a. iodothyronines b. polypeptides c. steroids d. glycoproteins e. catecholamines

A

b. polypeptides

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53
Q

Which is day/night associated? a. circadian rhythm b. diurnal rhythm c. ultradian rhythm d. infradian rhythm

A

b. diurnal rhythm

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54
Q

Which of the following does GH follow? a. circadian rhythm b. diurnal rhythm

A

a. circadian rhythm (increases when you go to sleep)

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55
Q

Which is normally only found in females? a. circadian rhythm b. diurnal rhythm c. ultradian rhythm d. infradian rhythm

A

d. infradian rhythm

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56
Q

Which pattern does testosterone follow? a. circadian rhythm b. diurnal rhythm c. ultradian rhythm d. infradian rhythm

A

c. ultradian rhythm (& FSH & LH)

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57
Q

Which of the following does cortisol follow? a. circadian rhythm b. diurnal rhythm

A

b. diurnal rhythm (light goes into the eyes, triggering cortisol release, which wakes you up)

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58
Q

T/F: melatonin is secreted when you sleep regardless if you’re sleeping in the day or night

A

False, it follows the diurnal rhythm (which is based on day/night)

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59
Q

Which is sleep/wake associated? a. circadian rhythm b. diurnal rhythm c. ultradian rhythm d. infradian rhythm

A

a. circadian rhythm

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60
Q

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

A

b. short loop

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61
Q

Which negative feedback inhibition cycle autocrine? a. ultra short loop b. short loop c. long loop

A

a. ultra short loop

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62
Q

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

A

c. endocrine long loop of negative feedback inhibition

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63
Q

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

A

b. short loop

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64
Q

Which negative feedback inhibition cycle is it when hormone X inhibits itself? a. ultra short loop b. short loop c. long loop

A

a. ultra short loop

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65
Q

How do autoimmune diseases cause hyperfunction and hypofunction of glands?

A

hyperfunction in the start of the pathology and hypofunction when the gland is fully destroyed

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66
Q

What type of endocrine problem is it when the problem originates in the hypothalamus? a. primary b. secondary c. tertiary

A

c. tertiary

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67
Q

What type of endocrine problem is it when the problem originates in the target gland? a. primary b. secondary c. tertiary

A

a. primary

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68
Q

What type of endocrine problem is it when the problem originates in the pituitary? a. primary b. secondary c. tertiary

A

b. secondary

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69
Q

Which is true?

a. having autoantibodies means you have an autoimmune disease
b. having an autoimmune disease means you have autoantibodies

A

b. having an autoimmune disease means you have autoantibodies

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70
Q

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

a. central organs

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71
Q

In which location do the B cells undergo anergy they react to a self-antigen? a. central organs b. peripheral organs c. both

A

c. both

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72
Q

Which T cell reactivity is optimal? a. strong reactivity b. intermediate reactivity

A

b. intermediate reactivity (T cells with strong reactivity get eliminated during negative selection because they react)

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73
Q

T/F: all auto-antigens are expressed in the thymus

A

false

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74
Q

What DNA defect does a patient with IPEX syndrome have?

A

Foxp3+ T regs

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75
Q

IPEX syndrome is a. autosomal dominant b. autosomal recessive c. X linked

A

c. X linked

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76
Q

T/F: all autoimmunity is pathological

A

false, autoimmunity may assist in the removal of damaged or worn-out cells

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77
Q

What type of immunoglobulins are autoantibodies?

A

low affinity IgM

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78
Q

Which of the following is indicative of SLE? a. anti-TPO b. anti-dsDNA c. anti-CCP d. anti-AMA

A

b. anti-dsDNA

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79
Q

Which of the following is specific for the thyroid? a. anti-TPO b. anti-dsDNA c. anti-CCP d. anti-AMA

A

a. anti-TPO

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80
Q

Which is false? a. organ specific antibodies cause organ specific disease b. non organ specific antibodies cause non organ specific disease

A

b. non organ specific antibodies cause non organ specific disease (the disease is always organ specific)

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81
Q

Which of the following is specific for the mitochondria? a. anti-TPO b. anti-dsDNA c. anti-CCP d. anti-AMA

A

d. anti-AMA

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82
Q

Which cell is responsible for glandular destruction?

A

T cells

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83
Q

Which of the following is indicative of RA? a. anti-TPO b. anti-dsDNA c. anti-CCP d. anti-AMA

A

c. anti-CCP

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84
Q

What does the mutation in AIRE gene cause? How?

A

eliminates the function of autoimmune regulator protein and causes PAS-1

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85
Q

What are the three diagnostic criteria of PAS-1?

A

chronic mucocutaneous candidiasis

chronic hypoparathyroidism

autoimmune adrenal insufficiency

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86
Q

What is the function of PTH?

A

regulate calcium and phosphorus metabolism

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87
Q

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?

A

Hypoparathyroidism (PTH deficiency) (symptoms include anxiety, confusion, depression, psychosis, confusion, tingling of hands/feet, and laryngospasms, which can be life-threatening)

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88
Q

What is alpha-enolase?

A

an auto-antigen that’s expressed in almost all tissues. it gets targeted by pituitary antibodies in lymphocytic hypophysitis

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89
Q

Which cells infiltrate the pituitary gland in lymphocytic hypophysitis?

A

lymphocytes

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90
Q

How do you treat lymphocytic hypophysitis?

A

hormone replacement therapy

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91
Q

Which is produced by neurosecretory cells? a. neurotransmitters b. neurohormones

A

b. neurohormones

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92
Q

Which of the following releases hormones into capillaries? a. neurosecretory cells b. non-neural endocrine cells c. both

A

c. both

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93
Q

Which of the following affects endocrine glands (except the pituitary gland)? a. hypothalamic hormones b. hypophysiotrophic hormones c. tropic hormones

A

c. tropic hormones

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94
Q

Which is produced by axon terminals of neurosecretory cells? a. neurotransmitters b. neurohormones

A

a. neurotransmitters

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95
Q

Which of the following affects the pituitary gland? a. hypothalamic hormones b. hypophysiotrophic hormones c. tropic hormones

A

b. hypophysiotrophic hormones

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96
Q

Which of the following releases inhibiting hormones? a. neurosecretory cells b. non-neurosecretory cells c. both

A

a. neurosecretory cells

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97
Q

Which of the following releases enteric hormones? a. neurosecretory cells b. non-neurosecretory cells c. both

A

b. non-neurosecretory cells

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98
Q

Which of the following releases dopamine? a. neurosecretory cells b. non-neurosecretory cells c. both

A

b. non-neurosecretory cells

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99
Q

In what form are OT&ADH stored in the neurohypophysis? a. dipeptides b. tripeptides c. hexapeptides d. nonapeptides

A

d. nonapeptides

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100
Q

Which of the following amino acids is found in position 8 of oxytocin? a. Phenylalanine b. Isoleucine c. Leucine d. Arginine

A

c. Leucine

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101
Q

Which of the following releases histamine? a. neurosecretory cells b. non-neurosecretory cells c. both

A

b. non-neurosecretory cells

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102
Q

Which of the following amino acids is found in position 3 of vasopressin? a. Phenylalanine b. Isoleucine c. Leucine d. Arginine

A

a. Phenylalanine

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103
Q

Which vitamin is required to make hormones of the posterior lobe of the pituitary gland?

A

vitamin C (is needed to make the final peptide of OT&ADH)

104
Q

Which of the following amino acids is found in position 3 of oxytocin? a. Phenylalanine b. Isoleucine c. Leucine d. Arginine

A

b. Isoleucine

105
Q

What is secreted along with oxytocin in the secretory granules?

A

neurophysin (carrier protein) and some precursors

106
Q

T/F: OT&ADH are degraded by aminopeptidases in the CSF

A

false, they’re degraded by aminopeptidases in the brain. If they’re in the CSF they get cleared back into the circulation.

107
Q

Which of the following amino acids is found in position 8 of vasopressin? a. Phenylalanine b. Isoleucine c. Leucine d. Arginine

A

d. Arginine

108
Q

T/F: OT&ADH have a half-life of 20 minutes

A

true

109
Q

Which one of the following catecholamine is a selective beta-agonist? a. norepinephrine b. epinephrine c. dopamine d. isoproterenol

A

d. isoproterenol

110
Q

catecholamine is a derivative of which amino acid?

A

tyrosine

111
Q

Which one of the following catecholamine is an alpha and beta agonist? a. norepinephrine b. epinephrine c. dopamine d. isoproterenol

A

b. epinephrine

112
Q

What is the immediate precursor of norepinephrine?

A

dopamine

113
Q

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

A

d. post-ganglionic fibers of the sympathetic nervous system

114
Q

Which of the following is made by a fewer number of reactions? a. epinephrine b. norepinephrine

A

b. norepinephrine

115
Q

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

A

d. tyrosine hydroxylase, tetrahydrobiopterin

O2= cosubstrate tetrahydrobiopterin= cofactor

116
Q

Which enteric hormone is derived from tryptophan?

A

serotonin

117
Q

How many reactions does it take to go from tryptophan to serotonin? what are the enzymes used?

A

two reactions; the first enzyme used is typtophan-5-hydroxylase and the second is aromatic L-amino acid decarboxylase

118
Q

What type of receptors receive endocannabinoids? a. ion-channel b. G-protein c. enzyme-linked

A

b. G-protein

119
Q

Which of the following degrades Anandamide (AEA)? a. Monoacylglycerol lipase b. Fatty acid amide hydrolase

A

b. Fatty acid amide hydrolase

120
Q

Which of the following degrades 2-Arachidonoylglycerol (2-AG)? a. Monoacylglycerol lipase b. Fatty acid amide hydrolase

A

a. Monoacylglycerol lipase

121
Q

How do endocannabinoids inhibit neurotransmitter release?

A

by decreasing calcium in the presynaptic membrane

122
Q

What’s the most common cause of hyperthyroidism?

A

graves disease

123
Q

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

A

b. hyperthyroidism

124
Q

increased glucocorticoid indicates a. hypothyroidism b. hyperthyroidism c. cushing’s syndrome d. adrenal insufficiency

A

c. cushing’s syndrome

125
Q

Which of the following can be caused by an iodine deficiency? a. hypothyroidism b. hyperthyroidism c. cushing’s syndrome d. adrenal insufficiency

A

a. hypothyroidism

126
Q

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

a. hypothyroidism

127
Q

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

A

c. cushing’s syndrome

128
Q

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

A

b. hyperthyroidism

129
Q

Which of the following causes poor wound healing? a. hypothyroidism b. hyperthyroidism c. cushing’s syndrome d. adrenal insufficiency

A

c. cushing’s syndrome

130
Q

What are the symptoms of a patient with chronic adrenal insufficiency?

A

depression, fatigue, and hyponatremia (acute adrenal insufficiency can cause circulatory shock)

131
Q

Patient comes in with generalized pigmentation. What’s the most likely diagnosis? a. hypothyroidism b. hyperthyroidism c. cushing’s syndrome d. adrenal insufficiency

A

d. adrenal insufficiency

132
Q

Which occurs before puberty? a. acromegaly b. giantism

A

b. giantism

133
Q

Which is more susceptible to carpal tunnel syndrome? a. acromegaly b. giantism

A

a. acromegaly

134
Q

Which has prominent supraorbital ridges and prognathism? a. acromegaly b. giantism

A

a. acromegaly

135
Q

Which is the origin of the anterior pituitary lobe? a. neuroectoderm b. pharyngeal epithelium

A

b. pharyngeal epithelium

136
Q

When performing an immunohistochemical stain for GH, which cell becomes brown (positive)? a. mammotrophs b. thyrotrophs c. corticotrophs d. leuteotrophs e. somatotroph

A

e. somatotroph

137
Q

What two hormones are least affected when the pituitary gland gets destroyed?

A

OT&ADH (because they’re secreted in the hypothalmus)

138
Q

Which cell uses Tpit transcription factor to regulate its diffrentiation? a. mammotrophs b. lactotroph c. corticotrophs d. gonadotroph e. somatotroph

A

c. corticotrophs

139
Q

Which cell does NOT use Pit1 transcription factor to regulate its differentiation? a. mammosomatotroph b. lactotroph c. somatotroph d. gonadotroph e. thyrotroph

A

d. gonadotroph (gonadotroph uses SF1)

140
Q

What’s the most common cause of hyperpituitarism?

A

pituitary adenoma

141
Q

What is Paraneoplastic syndrome?

A

When a cancer or tumor releases hormones or cytokines, causing symptoms

142
Q

What type of pituitary adenoma is usually found at a later stage, when it has grown in size?

A

a non-functioning adenoma (the functioning ones cause symptoms and are more likely to be found)

143
Q

Which of the following causes hyponatremia? a. high ADH b. low ADH

A

a. high ADH (high ADH-> reabsorb water-> high water to Na concentration)

144
Q

T/F: microadenomas are mostly functional tumors while macroadenomas are mostly unfunctional

A

false, she said the size doesn’t dictate the function

145
Q

T/F: functional adenomas are more likely to be found early

A

true

146
Q

T/F: silent adenomas are non-functioning

A

false, they have some manifestations and produce some hormones, but not nearly enough to cause symptoms

147
Q

Which of the following causes hypernatremia? a. high ADH b. low ADH

A

b. low ADH (low ADH-> release water-> high Na to water concentration)

148
Q

What type of receptors get mutated in adenomas? a. ion-channel b. G-protein c. enzyme-linked

A

b. G-protein (GNAS mutation)

149
Q

What is bound to g-protein in a basal state?

A

GDP

150
Q

How does a GNAS mutation physiologically affects the G-protein?

A

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
Q

Which of the following is caused the mutation of a tumor suppressor gene? a. MEN1 b. MEN2 c. MEN3

A

a. MEN1

152
Q

Which of the following causes parathyroid hyperplasia and pheochromocytoma? a. MEN1 b. MEN2 c. MEN3

A

b. MEN2

153
Q

Which of the following causes pancreatic tumors? a. MEN1 b. MEN2 c. MEN3

A

a. MEN1

154
Q

While looking at a routine H&E, you notice that there’s no pituitary skeleton (no reticulin). What can you conclude?

A

adenoma presence

155
Q

What does the presence of positive Ki-67 mean?

A

proliferation occurrence

156
Q

What is synaptophysin a marker for?

A

endocrine tumors (Chromogranin A is also an immuno-marker)

157
Q

You see and H&E stain with pseudo-rosettes. What does it indicate?

A

Indicative of endocrine tumors, not just adenomas (not specific)

158
Q

You see and H&E stain with pseudo-rosettes, stippled chromatin, and granular cytoplasm. What’s the diagnosis?

A

adenoma

159
Q

Which cell uses SF1 transcription factor to regulate its diffrentiation? a. mammotrophs b. lactotroph c. corticotrophs d. gonadotroph e. somatotroph

A

d. gonadotroph

160
Q

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

A

b. lactotroph (lactotroph adenoma 30% of all cases)

161
Q

Explain how postpartum women have physiological contraceptives?

A

They have high prolactin levels (+ lactation) and they negatively inhibit gonadotrophs (less LH & FSH & ICSH)

162
Q

Which causes elevated insulin-like growth factor-1 secretion (IGF-1)? a. lactotroph adenoma b. somatotroph adenoma c. corticotrophs adenoma d. pituitary carcinoma

A

b. somatotroph adenoma (GH of somatotrophs stimulates IGF-1 secretion in liver)

163
Q

Which is predisposed to calcify? a. lactotroph adenoma b. somatotroph adenoma c. corticotrophs adenoma d. pituitary carcinoma

A

a. lactotroph adenoma (extensive calcification=pituitary stone)

164
Q

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

A

c. corticotrophs adenoma corticotrophs produce ACTH, which leads to cortosol secretion from the adrenal leading to hypercortisolism

165
Q

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

A

b. somatotroph adenoma (glucose suppression test is very sensitive for acromegaly)

166
Q

Which of the following is capable of metastasis? a. pituitary carcinoma b. pituitary adenoma

A

a. pituitary carcinoma

167
Q

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

A

d. most are intrasellar (most are actually suprasellar)

168
Q

What type of cells are Rathke cleft cyst lined by?

A

columnar or cuboidal epithelium (+/- goblet cells and cilia)

169
Q

What type of cells are craniopharyngiomas lined by?

A

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
Q

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

A

b. pituitary apoplexy

171
Q

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

a. germ cell tumors

172
Q

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

A

e. craniopharyngiomas

173
Q

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

a. germ cell tumors

174
Q

Which is due to a defect in diaphragma sella? a. germ cell tumors b. pituitary apoplexy c. lymphocytic hypophysitis d. empty sella e. craniopharyngiomas

A

d. empty sella

175
Q

What causes primary empty sella?

A

diaphragma sella defect that causes arachnoid matter and CSF to herniate into sella, causing it to expand and compress the pituitary

176
Q

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

A

c. lymphocytic hypophysitis

177
Q

Which type of germ-cell tumor is most common?

A

germinomas

178
Q

What type of hormones need transport proteins to get to their destination? a. Water soluble b. Fat soluble

A

b. Fat soluble

179
Q

What type of hormones are released via facilitated diffusion? a. Water soluble b. Fat soluble

A

b. Fat soluble

180
Q

What type of hormones attach to receptors located on the plasma membrane? a. Water soluble b. Fat soluble

A

a. Water soluble

181
Q

Which of the following hormones attach to receptors located in the nucleus? a. Peptides b. Steroids c. Proteins d. Thyroid

A

d. Thyroid

182
Q

Which of the following hormones attach to receptors located in the cytoplasm? a. Peptides b. Steroids c. Proteins d. Thyroid

A

b. Steroids (A&C= receptors on cell surface)

183
Q

When theres a disorder of hormone resistance, which mechanism can you use in treatment?

A

sensitization

184
Q

Which hypothalamic regulatory hormone decreases camp levels? a. somatostatin b. dopamine c. Thyrotropin-releasing hormone (TRH) d. gonadotrophin-releasing hormone (GnRH)

A

b. dopamine

185
Q

Which hypothalamic regulatory hormone increases potassium channels? a. somatostatin b. dopamine c. Thyrotropin-releasing hormone (TRH) d. gonadotrophin-releasing hormone (GnRH)

A

a. somatostatin

186
Q

Pro-opiomelanocortin (POMC) is a precursor of what four enzymes?

A

ACTH MSH Lipotrophin Beta endorphins

187
Q

Which increases pain threshold? a. MSH b. Lipotrophin c. Beta endorphins

A

c. Beta endorphins

188
Q

Which hypothalamic regulatory hormone increases camp levels? a. somatostatin b. dopamine c. Thyrotropin-releasing hormone (TRH) d. gonadotrophin-releasing hormone (GnRH)

A

d. gonadotrophin-releasing hormone (GnRH) (GnRH, GHRH, & CRH all increase camp levels)

189
Q

Which of the following is diagnostic of Hypercortisolemic state? a. Cosyntropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin)

A

b. Corticotropin-releasing hormone (CRH)

190
Q

Which of the following is administered via IV? a. Cosyntropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin) d. Menotropin

A

c. GnRH (Gonadorelin)

191
Q

Which of the following is diagnostic of adrenal insufficiency? a. Cosyntropin b. Menotropin c. GnRH (Gonadorelin)

A

a. Cosyntropin

192
Q

Which of the following is diagnostic of adrenal tumor? a. Menotropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin)

A

b. Corticotropin-releasing hormone (CRH)

193
Q

Which of the following is administered via subcutaneous injection? a. Cosyntropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin) d. Menotropin

A

a. Cosyntropin

194
Q

Which of the following is diagnostic of Delayed puberty? a. Cosyntropin b. Corticotropin-releasing hormone (CRH) c. GnRH (Gonadorelin) d. Menotropin

A

c. GnRH (Gonadorelin)

195
Q

Which hypothalamic regulatory hormone increases phospholipase C and phosphatidylinositol? a. somatostatin b. dopamine c. Thyrotropin-releasing hormone (TRH) d. gonadotrophin-releasing hormone (GnRH)

A

c. Thyrotropin-releasing hormone (TRH)

196
Q

Which is the synthetic analog of ACTH? a. Somatostatin b. Gonadorelin c. Cosyntropin d. Menotropin

A

c. Cosyntropin

197
Q

What dosing method is used to treat infertility via GnRH? and why?

A

low pulsatile dose (to increase FSH&LH); if we administer it continuously then the receptors will be sensitized (FSH&LH decrease instead)

198
Q

Which of the following is LH like only? a. Menotropin b. Luotropin c. Follitropin d. Urofollitropin

A

b. Luotropin (*not in drug list)

199
Q

Which of the following is FSH&LH like? a. Menotropin b. Luotropin c. Follitropin d. Urofollitropin

A

a. Menotropin (C&D resemble FSH only)

200
Q

T/F: GnRH is administered via IV, SC, Intranasal, and oral

A

false, yes to all except oral. its made of proteins, so oral route will denature it

201
Q

Which of the following GnRH analogs is given monthly? a. goseralin b. leuprolide c. nafarelin

A

a. goseralin

202
Q

Which of the following GnRH analogs is given daily via nasal spray? a. goserelin b. leuprolide c. nafarelin

A

c. nafarelin

203
Q

Why do these GnRH analogs (Leuprolide, goserelin, nafarelin) exasperate symptoms of prostate cancer in the first week?

A

because they bind to the GnRH receptors and activate it until the receptor gets desensitized, only then do the symptoms improve

204
Q

Which of the following GnRH analogs is given daily via subcutaneous route? a. goseralin b. leuprolide c. nafarelin

A

b. leuprolide

205
Q

Which treatment of endometriosis has less side effects? a. ganirelix b. leuprolide

A

a. ganirelix (GnRH antagonist, so it doesn’t have to activate the receptor to desensitize it)

206
Q

Which of the following does NOT cause Hyperprolactinemia? a. high TRH b. low TRH c. pituitary adenomas

A

b. low TRH

207
Q

Which of the following is more suitable for Transsphenoidal microsurgery? a. Microadenomas b. Macroadenomas

A

a. Microadenomas

208
Q

What method can be used to treat Hyperprolactinemia?

A

dopamine agonists

209
Q

Which of the following has a longer half life? a. Cabergoline b. Bromocriptine

A

a. Cabergoline

210
Q

Which of the following dopamine agonists has less side effects? a. Cabergoline b. Bromocriptine

A

a. Cabergoline

211
Q

Why do dopamine agonists cause nausea and vomiting?

A

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
Q

Which hormone can be given to help induce labor?

A

oxytocin

213
Q

Which ADH receptor is responsible for smooth muscle contraction? a. V1 b. V2

A

a. V1

214
Q

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

A

c. Nephrogenic diabetes insipidus (the receptors are defective, the ADH doesn’t matter)

215
Q

Patient has diabetes insipidus, which of the following treatment methods is preferable? a. ADH b. Desmopressin c. both the same d. none of them

A

b. Desmopressin (an ADH analog that selectively acts on V2 receptors, so smooth muscle isn’t affected)

216
Q

Which of the following is a V2 antagonist that is taken orally? a. Tolvaptan b. Lithium c. Conivaptan d. Demeclocycline

A

a. Tolvaptan

217
Q

Which TWO of the following is a decrease V2 receptor sensitivity? a. Tolvaptan b. Lithium c. Conivaptan d. Demeclocycline

A

b. Lithium & d. Demeclocycline

218
Q

Which of the following is a V2 antagonist that is taken via intervenous injection? a. Tolvaptan b. Lithium c. Conivaptan d. Demeclocycline

A

c. Conivaptan

219
Q

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

A

D. Infertility (caused by high prolactin)

220
Q

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

A

b. somatotroph adenoma

221
Q

How can you tell the difference between an enlarged pituitary due to pregnancy and an enlarged pituitary due to adenoma?

A

monoclonal cells and disrupted reticulin pattern in adenoma

222
Q

What are two neuroendocrine immuno-markers?

A

Synaptophysin Chromogranin A

223
Q

heel pad sign is indicative of

A

acromegaly

224
Q

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

A

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
Q

Pit1 transcription factor is indicative of adenomas from which cells?

A

somatotroph lactotroph thyrotroph mammosomatotrophs

226
Q

What is panhypopituitarism?

A

inadequate or absent production of the anterior pituitary hormones

227
Q

cortisol is directly linked with the concentration of which of the following ions? a. potassium b. calcium c. sodium d. iodine

A

c. sodium (cortisol deficency can cause hyponatremia)

228
Q

Which will be the least affected in the case of pituitary compression? a. TSH b. Oxytocin c. Prolactin d. FSH

A

b. Oxytocin (made in the hypothalamus, so it wont be as affected)

229
Q

Which of the following adenomas are more likely to lead to hypopituitarism? a. Microadenomas b. Macroadenomas

A

b. Macroadenomas

230
Q

Which is true about cysts in the pituitary? a. largely unsymptomatic b. lined with stratified squamous epithelium

A

a. largely unsymptomatic

231
Q

Patient complains of excessive thirst and polyurea, but their ADH levels are normal. Whats more likely? a. central diabetes insipidus b. nephrogenic diabetes insipidus

A

b. nephrogenic diabetes insipidus

232
Q

Patient’s histology shows squamous epithelium, anucleated cells, cysts, and calcified cholesterol. What’s a likely diagnosis?

A

craniopharyngiomas

233
Q

What’s the difference between H&E rosettes and pseudo-rosettes?

A

pseudo-rosettes are around a blood vessel and rosettes are independent

234
Q

What causes empty sella syndrome?

A

herniation of the arachnid space into the pituitary fossa through a deficiency in diaphragma sella

235
Q

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?

A

Langerhans cell histiocytosis

236
Q

Patient’s histology shows palisading, whorling, and ghost cells. What’s a likely diagnosis?

A

craniopharyngiomas

237
Q

IHC stains + for FSH. An adenoma of which cell is implicated?

A

gonadotrophs

238
Q

Pituitary adenoma stains + for both GH & PRL. which cell is implicated?

A

somato-lactotrophs

239
Q

Pituitary adenoma stains + PALP. What is the diagnosis?

A

extra gonodal germ cell tumor (large cells, predominant nuclei, and PALP+)

240
Q

Which of the following cyst are harder to excise? a. rathke cleft b. craniopharyngiomas

A

b. craniopharyngiomas (because they’re locally disruptive of the surrounding tissue)

241
Q

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

A. Decrease cAMP

242
Q

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
A

D. Gigantism

243
Q

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
A

B. Syndrome of inappropriate ADH

244
Q

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

A. Acidophils with loss of reticulin network

245
Q

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

A. Tyrosine hydroxylase

246
Q

Which of the following is an organ-specific autoimmune disease?

  1. Rheumatoid arthritis
  2. Systemic lupus erythematosus
  3. Lymphocytic hypophysitis
  4. Polyglandular autoimmune disease
A

C. Lymphocytic hypophysitis

247
Q

Which of the following is secreted by a cell in the hypothalamus?

  1. ADH
  2. TRH
  3. Prolactin
A

A. ADH

248
Q

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

A. Growth Hormone

249
Q

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
A

C. Neurocrine

250
Q

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
A

D. Osteoporosis

251
Q

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

A. Hyposecretion of prolactin

252
Q

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.
A

D. The capillary plexus in the median eminence is in contact with nerve terminals from the hypothalamus.

253
Q

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
A

B. Loss of lateral field of vision

254
Q

At which structure does ADH act on?

A

Thick ascending loop of Henle

255
Q

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
A

B. Increased serum osmolality

Endocrine (8 decks)

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