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Flashcards in XX - The Endocrine System (with pics) Deck (166):
1

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. SEE SLIDE 20.1.

Pituitary adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754

2

Most common type of hyperfunctioning pituitary adenoma.

Prolactinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754

3

Microscopically, these are composed of densely or sparsely granulated cells, and immunohistochemical stains demonstrate growth hormone within the cytoplasm of the neoplastic cells.

Growth Hormone-Producing Adenomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754

4

A condition characterized by excessive urination (polyuria) caused by an inability of the kidney to properly resorb water from the urine.

Diabetes insipidus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757

5

Enzyme deficient in central Diabetes insipidus.

Anti-diuretic hormone(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757

6

Disease caused by excessive levels of ADH, leading to resorption of excess water, with resultant hyponatremia.

Syndrome of inappropriate ADH secretion (SIADH)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757

7

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.

Hashimoto thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757

8

The thyroid is diffusely and symmetrically enlarged, with intact capsule. Microscopically, reveals a mononuclear inflammatory infiltrate with germinal centers. Also has Hurthle or oxyphil cells, which are cells with eosinophilic, granular cytoplasm. SEE SLIDE 20.2.

Chronic Lymphocytic (Hashimoto) Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 724

9

A rare disorder characterized by extensive fibrosis involving the thyroid and contiguous neck structures. Idiopathic in nature. SEE SLIDE 20.3.

Riedel thyroiditis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762

10

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. SEE SLIDE 20.4.

Subacute Granulomatous (de Quervain) Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762

11

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.

Postpartum thyroiditis/ Subacute Lymphocytic Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762

12

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. SEE SLIDE 20.5.

Graves Disease(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 764

13

Goiter which occurs in areas where the soil, water and food supply contain little iodine.

Endemic goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765

14

Diffuse, symmetric enlargement of the gland due to TSH-induced hypertrophy and hyperplasia of thyroid follicular cells.

Diffuse goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765

15

Goiter characterized by enlarged, colloid-rich gland. On cut surface, the thyroid is usually brown, glassy and translucent.

Colloid goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765

16

Irregular enlargement of the thyroid as a result of recurrent episodes of hyperplasia and involution.

Multinodular goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765

17

Probability of being benign or malignant.A solitary nodule seen in a 20-yr old male.

Malignant(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766

18

Probability of being benign or malignant.Multiple, hot nodules.

Benign(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766

19

Probability of being benign or malignant.A solitary, cold nodule.

Malignant(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766

20

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. SEE SLIDE 20.6.

Thyroid adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766

21

Most common carcinoma of the thyroid.

Papillary carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 767

22

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. Also has invagination of the cytoplasm, giving the appearance of intranuclear inclusions (pseudoinclusions). SEE SLIDE 20.7.

Papillary carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 767

23

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. SEE SLIDE 20.8.

Follicular Carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 769

24

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. SEE SLIDE 20.9.

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. SEE SLIDE 20.10.

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 tumor.

Parathyroid adenoma. SEE SLIDE 20.11. (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

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 diabetic nephropathy.

Diffuse mesangial sclerosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 783

32

A glomerular lesion made distinctive by ball-like deposits of a laminated matrix situated in the periphery of the glomerulus. Seen in diabetic nephropathy.

Nodular glomerulosclerosis. SEE SLIDE 20.12. (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 783

33

A special pattern of acute pyelonephritis seen more often in diabetics.

Necrotizing papillitis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 784

34

Most common pancreatic endocrine neoplasms.

beta-cell tumors (insulinomas) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 788

35

These benign tumors look remarkably like giant islets, with preservation of the regular cords of monotonous cells and their orientation to the vasculature. Also has amyloid deposition in the extracellular tissue. SEE SLIDE 20.13.

Insulinomas (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 751

36

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

37

Tumors associated with increased serum glucagon and a syndrome consisting of mild diabetes mellitus, a characteristic skin rash (necrolytic migratory erythema), and anemia. SEE SLIDE 20.14.

Alpha-Cell tumors (glucagonomas) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 789

38

Most common cause of Cushing syndrome.

Administration of exogenous glucocorticoids(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 789

39

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

40

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. SEE SLIDE 20.15. (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 790

41

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

42

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

43

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. SEE SLIDE 20.16.

Spironolactone bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 792

44

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

45

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

46

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

47

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

48

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

49

Neoplasms composed of chromaffin cells which synthesize and release catecholamines and other peptide hormones. Composed of polygonal to spindle-shaped chromaffin cells compartmentalized into nests, or "Zellballen," by a rich vascular network. SEE SLIDE 20.17.

Pheochromocytomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 797

50

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

51

Components of MEN1?

Parathyroid: Primary hyperparathyroidismPancreas: ZES, insulinoma, etc.Pituitary: prolactin-secreting macroadenoma, somatotrophin-secreting tumors(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 798

52

Components of MEN2A?

Thyroid: Medullary carcinomaAdrenal medulla: pheochromocytomasParathyroid: parathyroid gland hyperplasia (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 799

53

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

54

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)

55

What is the most common site of gastrinomas in individuals with MEN-1?

Duodenum (TOPNOTCH)

56

What is the most frequent anterior pituitary tumor encountered in individuals with MEN-1?

Prolactinoma (TOPNOTCH)

57

What is the most common cause of primary adrenal insufficiency in developed countries?

Autoimmune adrenalitis (TOPNOTCH)

58

Spirinolactone bodies are seen in what tumor? SEE SLIDE 20.16

Aldosterone producing adenomas (TOPNOTCH)

59

Crooke hyaline change is seen in? SEE SLIDE 20.15

Cushing syndrome (TOPNOTCH)

60

Watery Diarrhea, hypokalemia, achlorhydria or WDHA syndrome is seen in?

VIPoma (TOPNOTCH)

61

Syndrome of DM, cholelithiasis, steatorrhea, and hypochlorhydria is seen in what tumor?

Somatostatinoma or delta cell tumor (TOPNOTCH)

62

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)

63

The fundamental lesion of DM retinopathy

Neovascularization (TOPNOTCH)

64

What special pattern of acute pyelonephritis is common in diabetics compared to non diabetics?

Necrotizing papillitis or papillary necrosis (TOPNOTCH)

65

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)

66

What are the three most important glomerular lesions seen in DM?

Basement membrane thickening, diffuse mesangial sclerosis, and nodular glomerulosclerosis (TOPNOTCH)

67

What is the hallmark of diabetic macrovascular disease?

Accelerated atherosclerosis (TOPNOTCH)

68

What is the most common cause of death in diabetics?

Myocardial Infarction (TOPNOTCH)

69

What morphological change seen in pancreas is more commonly associated with DM Type 2 than DM Type 1?

Amyloid replacement of islets. SEE SLIDE 20.18. (TOPNOTCH)

70

What is the hallmark of hypocalcemia?

Tetany (TOPNOTCH)

71

The most common cause of clinically apparent hypercalcemia

Malignancy (TOPNOTCH)

72

The most common cause of asymptomatic elevated blood calcium

Primary hyperparathyroidism (TOPNOTCH)

73

A peculiar feature of this type of thyroid carcinoma is the presence of multicentric C cell hyperplasia

Familial Medullary Cancers of the thyroid (TOPNOTCH)

74

Acellular amyloid deposits are seen in what type of thyroid cancer?

Medullary Carcinoma. SEE SLIDE 20.9. (TOPNOTCH)

75

These are concentrically calfcified structures that are often present in papillary carcinoma of the thyroid. SEE SLIDE 20.19.

Psamomma bodies (TOPNOTCH)

76

The major risk factor predisposing to thyroid cancer

Ionizing radiation, particularly in the first two decades of life (TOPNOTCH)

77

What variant of craniopharyngoma frequently contains radiologicaly demonstrable calcifications?

Adamantinomatous craniopharyngoma (TOPNOTCH)

78

What is the most common cause of hyperpituitarism?

Adenoma (TOPNOTCH)

79

Hypofunction of the anterior pituitary occurs when approximately how much of the parenchyma is lost?

75% (TOPNOTCH)

80

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)

81

The craniopharyngomas are thought to arise from what structure?

Vestigial remnants of Rathke pouch (TOPNOTCH)

82

What is the earliest and most consistent feature of hyperthyroidism?

Cardiac manifestations (TOPNOTCH)

83

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)

84

These are epithelial cells with abudant eosinophilic, granular ctyoplasm seen in Hashimoto thyroiditis

Hurthle cells. SEE SLIDE 20.2. (TOPNOTCH)

85

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)

86

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)

87

What is the most common clinically significant congenital anomaly of the thyroid?

Thyroglossal duct or cyst (TOPNOTCH)

88

Lamellar keratin formation or "wet keratin" is a diagnostic feature of what tumor?

Adamantinomatous craniopharyngoma (TOPNOTCH)

89

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)

90

Morphology: Variant of papillary carcinoma 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)

91

Morphology: Nuclei are usually round to ovoid, with stippled "salt and pepper" chromatin

Pheochromocytoma. SEE SLIDE 20.17. (TOPNOTCH)

92

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

93

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

94

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

95

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

96

Most potent anabolic hormone with multiple synthetic and growth-promoting effects.

Insulin (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1109

97

The most important environmental risk factor for type 2 diabetes

Obesity(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1111

98

The most common precipitating factor in DKA

Failure to take insulin(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1114

99

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

100

Most common cause of endogenous hyperthyroidism

Graves Disease(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1089

101

Triad of clinical findings in Graves Diseae

Hyperthyroidism, infiltrative ophthalmopathy, and pretibial myxedema (infiltrative dermopathy)(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1089

102

The most common antibody subtype seen in 90% of patients with Graves disease.

Thyroid stimulating immunoglobulin(TSI) Robbins Basic Pathology, 9th ed., p. 1089

103

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)

104

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

105

Laboratory features of Graves disease

Elevations in serum free T3 and T4 and decreased serum TSH(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1090

106

Most important single screening test for hyperthyroidism

TSH(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1084

107

Most often cause of congenital hypothyroidism

Iodine deficiency in the diet(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1085

108

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

109

Most sensitive sceening test for hypothyroidism

Serum TSH level(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1085

110

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)

111

It causes symmetric enlargement of the entire thyroid gland without producing nodularity. Patients are usually clinically euthyroid.

Diffuse nontoxic (simple) goiter (TOPNOTCH)

112

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

113

True or False. Nodules in males are more likely to be neoplastic than are those in females.

True(TOPNOTCH)

114

True or False. Solitary nodule are more likely to be neoplastic than are multiple nodules.

True(TOPNOTCH)

115

True or False. Nodules in younger patients are more likely to be neoplastic than are those in older patients.

True(TOPNOTCH)

116

True or False. Functional nodules that take up radioactive iodine in imaging studies (hot nodules) are much more likely to be benign than malignant.

True(TOPNOTCH)

117

What is the most common benign neoplasm of the thyroid?

Follicular adenoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1100

118

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)

119

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

120

Presents with amenorrhea, galactorrhea, loss of libido and infertility.

Lactotroph adenoma(TOPNOTCH)

121

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

122

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

123

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

124

Histologic variant of craniopharyngioma most often observed in children

Adamantinomatous craniopharyngoma (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1082

125

Histologic variant of craniopharyngioma most often observed in adults

Papillary craniopharyngoma (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1082

126

Presents with rapidly enlarging bulky neck mass, dyspnea, dysphagia, hoarsenes, and cough. Histologic finding of pleomorphic giant cells, spindle cells or mixed. Highly fatal. SEE SLIDE 20.10.

Anaplastic carcinoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1098

127

Most common clinically significant congenital anomaly of the thyroid.

Thyroglossal duct or cyst (TOPNOTCH)

128

Most common cause primary hyperparathyroidism

Solitary parathyroid adenoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p.1101

129

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

130

The most common mechanism through which osteolytic tumors induce hypercalcemia

Secretion of PTHrP(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1103

131

Classic findings of hypocalcemia on physical examination

Chvostek sign and Trosseau sign(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1105

132

The most frequent pattern in diabetic neuropathy

Distal symmetric polyneuropathy of the lower extremities(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1120

133

The most common cause of hypercortisolism

Exogenous administration of steroids(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1125

134

Most common adrenal finding in endogenous Cushing syndrome

Nodular hyperplasia(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1125

135

Presents with hypertension, weight gain, moon facies, truncal obesity, elevated urinary steroid secetion, low ACTH

Cushing syndrome caused by an adrenal tumor(TOPNOTCH)

136

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)

137

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

138

Most common manifestation of primary hyperaldosteronism

BP elevation(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1126

139

Overproduction of aldosterone and decreased plasma renin activity, hypertension and hypokalemia

Primary aldosteronism(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1127

140

Newborn presents with hyponatremia, hyperkalemia, hypotension, cardiovascular collapse, and virilization. What is the most likely diagnosis?

Salt-wasting syndrome, CAH(TOPNOTCH)

141

Presents with hyperkalemia, hyponatremia, volume depletion, hypotension, hyperpigmentation of sun-exposed areas, weakness, nausea vomiting, weight loss, abdominal pain.

Primary adrenal insufficiency(TOPNOTCH)

142

The dominant clinical manifestation of pheochromocytoma

Hypertension(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1135

143

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

144

The principal secretory product of pineal gland

Melatonin(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1137

145

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) SEE SLIDE 20.1. (TOPNOTCH)Robbins Basic Pathology, 8th ed., pp 754-755

146

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)

147

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

148

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

149

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

150

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

151

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

152

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

153

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

154

How does one distinguish a pituitary adenoma from normal pituitary parenchyma?

Absence of reticulin network in pituitary adenoma (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 718

155

Mutation associated with Hashimoto thyroiditis

Cytotoxic T lymphocyte-associated antigen-4 (CTLA4). That's why it's a type 4 cell-mediated hypersensitivity. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 724

156

Eponym for multinodular goiter whose nodules produce thyroid hormones independent of TSH stimulation

Plummer Syndrome (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 728

157

How does one differentiate a thyroid nodule from a thyroid adenoma?

Nodules do not demonstrate compression of adjacent parenchyma and LACK a well-formed capsule. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 728

158

How does one differentiate a parathyroid adenoma from a parathyroid carcinoma?

Cytologic detail is unreliable. Invasion of surrounding tissues and metastasis are the only definitive way to say. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 736

159

Bone change seen in hyperparathyroidism, when the cortex is grossly thinned and the marrow contains fibrous tissue and foci of hemorrhage and cysts (brown tumors)

Osteitis fibrosa cystica. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 737

160

TYPE 1 or TYPE 2 diabetes: Reduction in number and size of islet cells

Most often seen in Type 1. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 744

161

TYPE 1 or TYPE 2 diabetes: Leukocytic infiltration of mononuclear cells

Both, but more severe in Type 1. At time of diagnosis, this inflammation may not be seen anymore. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 744

162

TYPE 1 or TYPE 2 diabetes: Amyloid replacement of islets

Type 2 (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 744

163

Moprhologic change in the adrenal glands seen in: hypercortisolism caused by EXOGENOUS glucocorticoids

Cortical atrophy, due to lack of stimulation by ACTH. Zona glomerulosa is of normal thickness since this functions independently of ACTH. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 753

164

Moprhologic change in the adrenal glands seen in: hypercortisolism caused by ACTH-dependent Cushing syndrome

Diffuse bilateral hyperplasia (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 753

165

Disease that is associated with ADRENOMEDULLARY DYSPLASIA, which is the incomplete migration of the chromaffin cells to the center of the gland.

Salt-losing 21-hydroxylase deficiency (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 756

166

Reason behind skin pigmentation associated with Addison Disease

There is high ACTH due to primary adrenocortical insufficiency. ACTH shares the same precursor with MSH, which stimulates melanin production. (POMC) (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 759