Endocrine

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jaz_walker
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272691
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Endocrine
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2014-05-01 11:01:32
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Pathology
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Pathology
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Pathology
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  1. 1. True or false regarding MEN. All people with germline RET mutations are advised to have a prophylactic adrenalectomy.
    F - they are advised to have a thyroidectomy against medullary carcinoma
  2. 2. a 41 year old woman presents with cognitive difficulties. Hypothyroidism. In the UK, what is the most common cause of hypothyroidism?.
    Hashimoto thyroiditis, iodine deficiency, drugs (e.g. lithium), congenital
  3. 3. True or false regarding MEN. MEN-1 rarely presents as primary hyperparathyroidism.
    F - this is the commonest presentation
  4. 4. True or false regarding MEN. MEN-2b rarely presents as primary hyperparathyroidism.
    T
  5. 5. Presentation. Investigation. Question.
    Disease - Further information
  6. 6. A 43 year old man presents with refractory hypertension. raised plasma renin. what are the 3 causes of this?.
    pregnancy, decreased renal perfusion, adrterial hypovolaemia - hyperaldosteronism
  7. 7. A 43 year old man presents with weight gain and psychosis. glucocorticosteroids are high. what are the 3 endogeneous causes of this?.
    primary hypothalamic-pituitary diseases, ectopic ACTH secretion, primary adrenocortical neoplasms.
  8. 8. what are the 3 main causes of acute adrenal insufficiency?.
    Waterhouse-Friedrich syndrome, sudden steroid withdrawal, stress in patients with chronic adrenal insufficiency
  9. 9. There are no hypothalmus lesions and she is on no medication. What are the 3 most common causes of hyperprolactinaemia she might be experiencing?.
    Pregnancy, renal failure, hypothyroidism
  10. 10. What are the 4 main causes of Addison disease?.
    autoimmune, tuberculosis, AIDS, metastatic cancer
  11. 11. a 41 year old woman from abroad presents with cognitive difficulties. Hypothyroidism, goitre. What are the 4 possible causes of goitrous hypothyroidism?.
    Hashimoto thyroiditis, iodine deficiency, drugs (e.g. lithium), congenital
  12. 12. What are the three manifestations of Graves disease?.
    Thyrotoxicosis, infiltrative opthalmopathy, dermopathy (in a minority of cases)
  13. 13. A 39 year old woman presents with fatigue, vomiting and weight loss. You note hyperpigmentation of axillae. Hyperkalaemia, hyponatraemia, hypotension. what are you concerned about?.
    Primary adrenocortical insufficiency
  14. 14. a 48 year old woman with a known pituitary adenoma presents with reduced consciousness. MRI shows enlargement of the lesion. What complication are you suspicious of?.
    Pituitary apoplexy. - this constitutes a neurosurgical emergency
  15. 15. A 41 year old male presents with refractory hypertension of new onset. Sudden cardiac death occurs. what endocrine cause may you consider?.
    phaeochromocytoma
  16. 16. A 43 year old man presents with weight gain and psychosis. pituitary biopsy shows Crooke hyaline change. what is the cause of this?.
    cushing syndrome
  17. 17. A 54 year old female presents with bone pain. Hypercalcaemia. Renal function normal. CT shows parathyroid lesion. What is the commonest cause?.
    Parathyroid adenoma
  18. 18. A 43 year old man presents with weight gain and psychosis. adrenal glands show atrophy. what is the likely cause of this?.
    exogeneous steroid
  19. 19. A 54 year old female presents with bone pain. Osteitis fibrosa cystica are present in the bones. what is the likely cause?.
    hyperparathyroidism
  20. 20. A 54 year old female presents with bone pain. a brown tumour is present in the leg. what is the likely cause?.
    hyperparathyroidism
  21. 21. A 61 year old man with known renal failure presents with necrotic skin. Calcium levels are normal, PTH is raised. what is the likely cause?.
    secondary hyperparathyroidism
  22. 22. A 41 year old woman is told that she has symptoms of hyperpituitarism. What is the most common cause for this and where is it usually located?.
    Pituitary adenoma in the anterior lobe
  23. 23. what is the most common cause of secondary hyperparathyroidism?.
    renal failure
  24. 24. a newborn female has clitoral hypertrophy and pseudohermaphroditism. what is the most common cause of this?.
    21-hydroxylase deficiency.
  25. 25. A 28 year old woman has a pituitary adenoma. She is told that it secretes 2 hormones, which is relatively unusual. What is the most common combination of hormones?.
    Prolactin and growth hormone.
  26. 26. A 31 year old woman with a known pituitary adenoma complains of sight problems. What is the most common type of visual field defect associated with this?.
    Bitemporal hemianopia
  27. 27. A 71 year old woman is found to have a pancreatic neuroendocrine tumour. what is the most common type?.
    insulinoma
  28. 28. A 57 year old woman presents with a painless thyroid nodule and difficulty swallowing. TSH and T3 is normal. On radionuclide scanning it is a cold nodule. What is the probability of malignancy and what is your next investigation?.
    10% risk of malignancy - biopsy
  29. 29. A 57 year old woman presents with a painless thyroid nodule and difficulty swallowing. Microscopy shows Orphan Annie eye nuclei (with optically clear nuclei). There psammoma bodies. what is this and what is prognosis?.
    papillary carcinoma - Good - 95% survival at 5 years.
  30. 30. A 57 year old woman presents with a painless thyroid nodule and difficulty swallowing. When she was younger she had dietary iodine deficiency. Radioiodine shows a solitary cold thyroid nodule. On FNA cells are invading the capsule. It contains fairly uniform cells forming small follicles. what is this and what is prognosis?.
  31. 31. A 57 year old woman presents with a painless thyroid nodule and difficulty swallowing. Biopsy shows mixed spindle and giant cell lesions. what is this and what is prognosis?.
    anaplastic carcinoma - very very poor
  32. 32. A 38 year old presents with neck pain, fever, malaise, a fortnight after a pharyngitis. On biopsy the gland is firm, with an intact capsule, and unilaterally enlarged. Histology shows disruption of thyroid follicles, with extravasation of colloid. There is a polymorphonuclear infiltrate. ESR is raised, WCC is raised, TSH is raised. What is this and what is the prognosis?.
    de Quervain's thyroiditis - return to normal in 6-8 weeks
  33. 33. A 57 year old woman presents with a painless thyroid nodule and difficulty swallowing. TSH and T3 is normal. On radionuclide scanning it is a cold nodule. On biopsy it is a solitary, spherical lesion, which has a well-defined, intact capsule. What is this and what is the prognosis?.
    Follicular adenoma - Does not metastasize or recur
  34. 34. A 57 year old woman presents with a painless thyroid nodule and difficulty swallowing. TSH and T3 is normal. On radionuclide scanning it is a cold nodule. On biopsy it is a solitary, spherical lesion, which has a poorly defined capsule and does not press on parenchyma. What is this and what is the prognosis?.
    Dominant node of a multinodular goiter
  35. 35. a 41 year old woman is noted to have a goitre. A biopsy is taken. She mentions that recently she had a period of diarrhoea and arrhythmias. Thyroid follicles are atrophic and lined by epithelial cells with eosinophilic, grnular cytoplasm. What is this and what malignancy is raised incidence?.
    Hashimoto thyroiditis - B cell non-Hodgkin lymphoma
  36. 36. A 57 year old woman presents with a painless thyroid nodule and difficulty swallowing. Biopsy shows a solitary nodule with polygonal to spindle shaped cells. There are amyloid deposits. Calcitonin is present. What is this and what syndrome is associated?.
    Medullary carcinoma - MEN 2 (ret mutations)
  37. 37. A 34 year old woman presents with a painless neck lump after pregnancy. Histology shows lymphocytic infiltration and hyperplastic germinal centres in the parenchyma. She is thyrotoxic. What is this likely to be?.
    Subacute lymphocytic thyroiditis.
  38. 38. a 41 year old woman is noted to have a goitre. A biopsy is taken. The thyroid is diffusely and symmetrically enlarged. The cut surface is pale and gray. The tissue is firm and fiable. There is a mononuclear inflammatory infiltrate with germinal centres. Thyroid follicles are atrophic and have eosinophilic, granular cyto. What is this?.
    Hashimoto thyroiditis
  39. 39. A 24 year old woman presents with palpitations. Thyroid biopsy shows diffuse hypertrophhy and hyperplasia of thyroid follicular epithelial cells. The gland is usually smooth and soft, with an intact capsule. What is this?.
    Graves disease
  40. 40. A 31 year old man presents with a diffuse neck mass. Biopsy shows a diffuse goiter which is lined by growded columnar cells. The cut surface of the thyroid is brown, glassy appearing and translucent. What is this?.
    TSH induced goitre
  41. 41. A 31 year old man presents with a diffuse neck mass. On biopsy, the goitre is multilobulate, asymmetrically enlarged, with variable amounts of brown, gelatinous colloid. There is fibrosis, haemorrhage, calcification and cystic change. There is no prominent capsule. What is this?.
    Toxic multinodular goitre.
  42. 42. A 54 year old female presents with bone pain. Parathyroid excision shows a soft, well circumscribed, tan nodule, with a delicate capsule. The other glands are normal. The lesion is mostly chief cells. Some cells have pleiomorphic nuclei. what is this?.
    Parathyroid adenoma
  43. 43. A 54 year old female presents with bone pain and you find hypercalcaemia. MRI shows enlargement of 3 parathyroid glands. Biopsy shows chief cell hyperplasia, which occurs in a multinodular pattern. what is this?.
    parathyroid hyperplasia
  44. 44. A 54 year old female presents with bone pain and you find hypercalcaemia. Biopsy shows uniform cells, with gray white irregular masses. There is local invasion. what is this?.
    parathyroid carcinoma
  45. 45. A 51 year old woman presents with bitemporal hemianopia. Biopsy shows mammosomatotrophs. What likely hormones may arise from this?.
    Growth hormone, prolactin
  46. 46. A 51 year old woman presents with bitemporal hemianopia. Biopsy shows gonadotrophs. What likely hormones may arise from this?.
    FSH, LH causing hypogonadism, mass effect and hypopituitarism
  47. 47. A 51 year old woman presents with bitemporal hemianopia. Biopsy shows densely granulated corticotrophs. What likely syndrome may arise from this?.
    Cushing syndrome
  48. 48. A 51 year old woman presents with bitemporal hemianopia. Biopsy shows sparsely granulated corticotrophs. What likely syndrome may arise from this?.
    Nelson syndrome
  49. 49. A 11 year old woman presents with bitemporal hemianopia. Biopsy shows densely granulated somatotrophs. What likely syndrome may arise from this?.
    gigantism (children)
  50. 50. A 51 year old woman presents with bitemporal hemianopia. Biopsy shows thyrotrophs. What likely syndrome may arise from this?.
    hyperthyroidism
  51. 51. A 59 year old man has been treated abroad for his Cushing's syndrome with bilateral adrenalectomy. He is presenting with visual field defects. Cortisol is low. Hyperpigmentation is present. What might you be concerned about?.
    Nelson syndrome
  52. 52. A 48 year old woman complains of headaches and diplopia. FSH is high. What might you be concerned about?.
    gonadotroph adenoma
  53. 53. A 38 year old woman presents with tiredness. On examination they have high heart rate, and seem anxious. T3 and T4 are high, TSH is high. What might you be concerned about?.
    Thyrotrophic adenoma
  54. 54. A 28 year old man presents with muscle weakness. you note hypertension, high glucose, prolactinaemia. What pituitary abnormality might you look for?.
    Growth hormone excess
  55. 55. A 29 year old woman complaining of infertility has high prolactin. What two drug causes are there of hyperprolactinaemia?.
    High dose oestrogen therapy, dopamine inhibiting drugs (e.g. reserpine)
  56. 56. A 31 year old man is diagnosed with MEN-2b. what two things differ from a presentation of MEN 2a?.
    primary hyperparathyroidism is rare, extraendocrine manifestations are common
  57. 57. which 2 substances are secreted by the adrenal cortex and what are their functions?.
    dehyrdoepiandrosterone and endrostenedione - converted peripherally to testosterone
  58. 58. which 3 classes of drugs are most likely associated with diabetes?.
    glucocorticoids, thyroid hormone, b adrenergic agonists
  59. 59. which 3 genetic syndormes are associated with diabetes?.
    downs, klinefelter, down syndrome
  60. 60. A 31 year old man is diagnosed with MEN-1. which 3 neoplasms is he most at risk for and which gene is implicated?.
    parathyroid, pancreas, pituitary - MEN1
  61. 61. A 31 year old man is diagnosed with MEN-2a. which 3 neoplasms is he most at risk for and which gene is implicated?.
    medullary thyroid carcinoma, adrenal pheochromocytoma, parathyroid hyperplasia - RET
  62. 62. which area of the adrenal gland are glucocorticoids secreted from?.
    zona fasciculata mainly, partly zona reticularis
  63. 63. which area of the adrenal gland are mineralocorticoids secreted from?.
    zona glomerulosa
  64. 64. which area of the adrenal gland are sex steroids secreted from?.
    zona reticularis
  65. 65. which cells do medullary thyroid carcinomas arise from?.
    Parafollicular C cells
  66. 66. A 38 year old man is noted to have features of acromegaly. Which chemical mediates many of the effects of GH and where is it secreted from?.
    IGF-1 - Liver
  67. 67. which familial syndrome is most commonly associated with Pancreatic neuroendocrine tumours?.
    MEN-1
  68. 68. A 31 year old woman presents with hirsutism. raised androgens. Hyperplastic adrenals bilaterally. which other adrenal product is oftne associated with high androgen secretion?.
    corticosteroids - both androgens and corticosteroids are regulated by ACTH
  69. 69. a 41 year old woman from abroad presents with cognitive difficulties. Hypothyroidism. Worldwide, what is the most common cause?.
    Dietary iodine deficiency
  70. 70. True or false regarding pituitary adenoma. Often well circumscribed and soft.
    T
  71. 71. True or false regarding pituitary adenoma. Can erode the posterior clinoid processes.
    F - Can erode the anterior clinoid processes
  72. 72. True or false regarding pituitary adenoma. Can extend into the caverous and sphenoidal sinus.
    T
  73. 73. True or false regarding pituitary adenoma. The absence of significant reticulin network distinguishes pituitary adenoma from non-neoplastic normal parenchyma.
    T
  74. 74. True or false regarding pituitary adenoma. The absence of cellular monomorphism distinguishes pituitary adenoma from non-neoplastic normal parenchyma.
    F - Pituitary adenoma has cellular monomorphism, unlike normal pituitary
  75. 75. ACTH producing adenomas are the most common type of hyperfunctioning pituitary adenoma.
    F - Prolactinoma
  76. 76. True or false regarding pituitary adenoma. Thyrotrophic cells stain positive with Periodic Acid Schiff (PAS).
    f - Corticotrophs stain with PAS.
  77. 77. True or false regarding pituitary carcinoma. They rarely display distant metastases.
    F - Almost always demonstrate distant metastases.
  78. 78. What is the commonest cause of diabetes insipidus?.
    Hypothalmic origin
  79. 79. Where is the anterior pituitary developed from?.
    The oral cavity
  80. 80. Which 2 hormones are produced by the posterior pituitary?.
    Oxytocin, Adh
  81. 81. Where is the thyroid gland embyrologically derived from?.
    pharyngeal epithelium at the pase of the tongue (foramen cecum)
  82. 82. true or false: ectopic thyroid can be located in the brain.
    F - usually in the base of the tongue, or abnormally high in the neck
  83. 83. True or false regarding the thyroid. TSH receptor works via GPCRs (stimulatory G protein).
    T
  84. 84. True or false regarding the thyroid. follicles of the thyroid are lined by squamous cells.
    F - they are lined by cuboidal and low columnar epithelium
  85. 85. True or false regarding the thyroid. thyroglobulin binds thyroxine in the blood.
    F - it is found in the follicles and is the precursor of thyroid hormone
  86. 86. True or false regarding the thyroid. cAMP synthesis stimulated thyroglobulin transformation to thyroxine and triiodothyronine.
    t
  87. 87. True or false regarding the thyroid. T3 is better known as thyroxine.
    F - T4 is better known as thyroxine
  88. 88. True or false regarding the thyroid. In the periphery, T3 is iodinated to t4.
    F - T4 is deiodinated to T3
  89. 89. A woman is diagnosed with thyrotoxicosis. What 6 classes of symptoms may she have encountered/.
    Constitutional (e.g. heat intolerance), GI (e.g. diarrhoea) cardiac (ee.g. palpitations( neuro (tremor) ocular (lid lag), thyroid storm (arrhytmias), apathetic (weight loss in elderly
  90. 90. True or false regarding the thyroid. raised t4 is the main cause of hyperthyroidism.
    TRUE
  91. 91. True or false regarding the thyroid. the most common cause of endogeneous hyperthyroidism is Graves disease.
    TRUE
  92. 92. True or false regarding the thyroid. Multiple nodules are more likely to be neoplastic than solitary nodules.
    F - The opposite is true
  93. 93. True or false regarding the thyroid. Nodule s in younger patients are more likely to be neoplastic than in older patients.
    T
  94. 94. True or false regarding the thyroid. Nodules in females are more likely to be neoplastic than in males.
    F - The opposite is true
  95. 95. True or false regarding the thyroid. Hot nodules are more likely to be benign than cold nodules.
    t
  96. 96. True or false regarding the thyroid. Follicular nodules are often multiple.
    F - they are usually solitary, as with all thyroid neoplasms.
  97. 97. True or false regarding the thyroid. Follicular thyroid carcinoma is associated with MAP kinase pathway.
    FALSE - Papillary thyroid carcinoma
  98. 98. True or false regarding the thyroid. The most aggressive form of thyroid cancer is medullary.
    F - Anaplastic carcinoma
  99. 99. True or false regarding the thyroid. The major risk factor for thyroid cancer is Graves disease.
    F - it is ionising radiation
  100. 100. True or false about parathyroid gland. Are occasionally found in the wall of the vena cava.
    F - Occasionally found in the carotid sheath
  101. 101. True or false about parathyroid gland. Most of the gland is composed of chief cells.
    T
  102. 102. True or false about parathyroid gland. Oxyphil cells have basophilic cytoplasm.
    F - acidophilic
  103. 103. True or false about parathyroid gland. Chif cells secrete calcitonin.
    F - they secrete PTH
  104. 104. True or false about parathyroid gland. Activity of the parathyroid glands is controlled by the pituitary primarily.
    F - mainly by the blood calcium
  105. 105. How does PTH affect renal absorption of calcium?.
    Increased
  106. 106. How does PTH affect renal absorption of phosphate?.
    Increased excretion
  107. 107. What are the 3 effects of the PTH on the kidney?.
    Increased calcium resorption, increased phosphate excretion, increased vitamin D metabolism.
  108. 108. What is the 1 effect of PTH on the bone?.
    Increased osteoclastic activity.
  109. 109. What is the commonest cause of secondary hyperparathyroidism?.
    Chronic renal insufficiency
  110. 110. What is the most important effect of primary hyperparathyroidism?.
    Hypercalcaemia
  111. 111. true or false regarding hyperaldosteronism. left ventricular hypertrophy and reduced diastolic volumes are associated.
    t
  112. 112. true or false regarding hyperaldosteronism. stroke and myocardial infarction are associated.
    t
  113. 113. true or false regarding hyperaldosteronism. weakness and visual disturbances are common.
    t
  114. 114. true or false regarding hyperaldosteronism. nausea and vomiting is common.
    f
  115. 115. true or false regarding hyperaldosteronism. dehydration is common.
    f
  116. 116. true or false regarding hyperaldosteronism. spironolactone can be used to manage symptoms.
    t - particularly in bilateral hyperplasia
  117. 117. A 31 year old woman presents with hirsutism. The adrenals are bilaterally hyperplastic. The cortex is thickened and nodular, and brown.
  118. 118. true or false regarding adrenogenital syndromes. in 21-hydroxylase deficiency, the accumulated intermediate steroids have mineralocortioid activity, causing sodium retention and hypertension.
    f - this is true in 11b-hydroxylase deficiency
  119. 119. true or false regarding adrenogenital syndromes. people with congenital adrenal hyperplasia are at risk for salt wasting.
    t - and salt retention
  120. 120. true or false regarding adrenogenital syndromes. people with congenital adrenal hyperplasia are at risk for sodium retention.
    t - and salt wasting
  121. 121. true or false regarding adrenogenital syndromes. in a woman with delayed menarche and hirsutism, a gonadotrophic pituitary adenoma must be excluded.
    f - an androgen producing ovarian neoplasm must be excluded
  122. 122. true or false regarding adrenogenital syndromes. congenital adrenal hyperplasia can be treated with spironolactone.
    f - can be treated with steroids, which suppresses ACTH secretion.
  123. 123.
  124. 124. True or false regarding Addison disease. It can be associated with sarcoidosis.
    F - autoimmune polyendocrine syndromes (APS1) can be associated
  125. 125. True or false regarding Addison disease. Tuberculosis can be associated.
    T
  126. 126. True or false regarding Addison disease. Aspergillus can be associated.
    F - but histoplasma capsulatum and coccidioides immitis can be associated
  127. 127. True or false regarding Addison disease. AIDS can be associated through mycobacterium avium-intracellulare.
    t - as can cmv
  128. 128. True or false regarding Addison disease. Metastasis from the kidney are common.
    F - lung and breast metastases are common
  129. 129. True or false regarding Addison disease. lung and breast metastases are a common cause.
    T
  130. 130. True or false regarding Addison disease. secondary adrenocorticol insufficiency lacks the hyperpigmentation of primary disease.
    T - because melanotropic hormone levels are low due to reduced ACTH
  131. 131. True or false regarding Addison disease. secondary adrenocorticol insufficiency is due to reduced ACTH.
    T
  132. 132. True or false regarding adrenocortical insufficiency. hypokalaemia is associated.
    F - hyperkalaemia is associated
  133. 133. True or false regarding adrenocortical insufficiency. hyponatraemia is associated.
    T - alongside volume depletion
  134. 134. True or false regarding adrenocortical insufficiency. Secondary causes do not involve aldosterone.
  135. 135. True or false regarding adrenocortical insufficiency. glucocorticoid deficiency causes hypoglycaemia.
    t
  136. 136. True or false regarding adrenocortical neoplasm. Most cortical adenomas do not cause hyperfunction.
    T
  137. 137. True or false regarding phaeocytochroma. 30% of phaeochromocytomas are extrarenal.
    F - 10% - phaeocytochromas adhere to the rule of 10s
  138. 138. True or false regarding phaeocytochroma. 10% of phaeochromocytomas are unilateral.
    F - 10% are bilateral
  139. 139. True or false regarding phaeocytochroma. 10% are benign.
    F - 10% are malignant
  140. 140. True or false regarding phaeocytochroma. high number of mitotic figures does not imply malignancy. Neither does capsular and vascular invasion.
    T - metastasis is the only sure sign of malignancy.
  141. 141. True or false regarding neuroblastoma. Most commonly between 10-15 years of life.
    F - usually in first 5 years of life
  142. 142. True or false regarding neuroblastoma. most commonly located in the brain.
    F - usually in the abdomen (often adrenal medulla)

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