ENDOCRINE Multiple Choice Questions and Answers pdf :-
1. When progressive enlargement of a multinodular goiter causes symptomatic tracheal compression, the preferred management in otherwise good-risk patients is:
A. Iodine treatment.
B. Thyroid hormone treatment.
C. Surgical resection of the abnormal thyroid.
D. Radioactive iodine treatment.
2. The most precise diagnostic screening procedure for differentiating benign thyroid nodules from malignant ones is:
A. Thyroid ultrasonography.
B. Thyroid scintiscan.
C. Fine-needle-aspiration biopsy (FNAB).
D. Thyroid hormone suppression.
3. The preferred operation for initial management of a thyroid nodule that is considered suspicious for malignancy by FNAB is:
B. Partial lobectomy.
C. Total lobectomy and isthmusectomy.
D. Total thyroidectomy.
4. Advantages of total thyroidectomy for management of papillary carcinomas of the thyroid larger than 1.5 cm. include:
A. Possibility of using radioactive iodine postoperatively to identify and treat metastases.
B. The ability to use thyroglobulin levels as a marker for recurrence.
C. Lower overall recurrence rate.
D. Lower risk of hypoparathyroidism.
5. Which of the following statements about follicular carcinoma is/are true?
A. It presents at a later age than papillary carcinoma.
B. It disseminates via hematogenous routes.
C. It is the most common type of well-differentiated thyroid carcinoma.
D. Extensive angioinvasion portends a poor prognosis.
E. Follicular carcinomas are frequently multicentric.
6. A familial form of medullary thyroid carcinoma (MTC) should be suspected whenever:
A. The tumor is multifocal.
B. The tumor is bilateral (foci of tumor are present in both thyroid lobes).
C. Pathologic examination of the resected thyroid gland reveals the presence of C-cell hyperplasia in areas of the gland adjacent to foci of MTC.
D. All of the above.
7. All of the following are components of the MEN type 2B syndrome except:
A. Multiple neuromas on the lips, tongue, and oral mucosa.
8. MEN 2A and MEN 2B syndromes are associated with germline mutations in:
A. The p53 tumor suppressor gene.
B. The H-ras gene.
C. The N-myc gene.
D. The RET proto-oncogene.
9. Which of the following are true concerning islet cell neoplasms of the pancreas in patients with MEN type 1?
A. Islet cell neoplasms in patients with MEN 1 are characteristically multicentric.
B. The most common islet cell neoplasm in patients with MEN 1 is gastrinoma.
C. Islet cell neoplasms in patients with MEN 1 may be malignant.
D. All of the above.
10. Which of the following statements about the differential diagnosis of hypercalcemia is/are correct.
A. Malignant tumors typically cause hypercalcemia by ectopic production of parathyroid hormone (PTH).
B. The diagnosis of primary hyperparathyroidism is supported by these serum levels: calcium, 10.8 mg. per dl.; chloride, 104 mmol. per liter; bicarbonate 21 mmol. per liter; phosphorus, 2.4 mg. per dl.; elevated parathyroid hormone.
C. Familial hypocalciuric hypercalcemia is distinguished from primary hyperparathyroidism by parathyroid imaging.
D. Although serum albumin binds calcium, the measured total calcium value is usually unaffected in patients with severe hypoproteinemia.
E. Thiazide diuretics are a good treatment for hypercalcemia and can be given to patients with apparent hypercalcemia of malignancy.
11. Indications for operation in a patient with previously asymptomatic hyperparathyroidism include:
A. Age older than 60.
C. A substantial decline in renal function.
D. A substantial decline in bone mass.
E. Depression and fatigue.
12. The parathyroid glands:
A. Develop from the second and third pharyngeal pouches, along with the palatine tonsil and the thymus.
B. Migrate caudally in the neck in normal development but can be found anywhere from the pharyngeal mucosa to the deep mediastinum.
C. Secrete PTH and calcitonin to manage calcium homeostasis.
D. Usually number four, but frequently number only two or three.
E. Contain enzymes that catalyze the conversion of 25(OH) vitamin D 3 to 1,25(OH) 2 vitamin D 3.
13. Hyperparathyroidism can affect which of the following organs and body systems?
A. Gastrointestinal tract.
D. Neuromuscular system.
E. Cardiovascular system.
14. Secondary hyperparathyroidism:
A. Is a metabolic disease in which the primary abnormality is decreased glomerular filtration rate.
B. Is best treated initially by subtotal parathyroidectomy.
C. Is caused by increased production of 1,25(OH) 2 vitamin D 3, causing increasing intestinal calcium absorption and hypercalcemia.
D. Can have severe effects on bones exacerbated by aluminum contained in phosphate binders and dialysate water.
E. Is best treated initially by total parathyroidectomy with autotransplantation.
A. Is most commonly encountered as a postviral syndrome.
B. Can be associated with marked hypocalcemia after parathyroidectomy in patients with bone disease.
C. Can cause anxiety, depression, or confusion.
D. Can cause physical signs such as Chvostek’s and Trousseau’s signs.
E. Is treatable acutely with intravenous calcium salts and chronically with oral calcium and vitamin D.
16. True statements about pituitary anatomy and physiology include:
A. The pituitary has dual embryonic origin: the anterior pituitary arises from embryonic ectoderm; the posterior pituitary, from the diencephalon.
B. The hypophyseal portal system integrates function of the anterior and posterior pituitary.
C. Adrenocorticotropin (ACTH), formed by posttranslational processing of the precursor POMC, is normally controlled by hypothalamic CRF but may be released by immune-related mechanisms.
D. Growth hormone (GH) directly stimulates longitudinal growth of the skeleton and growth of muscles.
E. Cell types of the anterior pituitary are classified by their position in the anterior pituitary and by their staining characteristics with histologic dyes.
17. Antidiuretic hormone (ADH):
A. Is related to oxytocin, and both are released from the posterior pituitary in conjunction with neurophysins.
B. Is released into the circulation by the posterior pituitary in response to a rise in plasma osmolality above 285 mOsm. or a decrease in circulating blood volume.
C. May be stimulated by catecholamines and inhibited by phenytoin, alcohol, and lithium.
D. In excess, may produce a syndrome of euvolemic hyponatremia with inappropriately concentrated urine that is responsive to free water restriction.
E. Deficiency causes prolonged polyuria and polydipsia and may be diagnosed by a combination of high plasma osmolality and low urine osmolality following water deprivation.
18. Signs and symptoms of acute pituitary apoplexy include:
A. Severe headache.
C. Vision loss.
E. May be relieved by emergent transsphenoidal decompression of the sella turcica.
19. Prolactinomas of the pituitary:
A. Most often produce dysfunctional uterine bleeding in women.
B. Most commonly produce infertility in men.
C. When asymptomatic, are best treated surgically early in the microadenoma stage.
D. May enlarge during pregnancy, requiring treatment with bromocriptine or surgery.
E. Commonly occur in patients with MEN 2.
A. Is most often ACTH-dependent, owing to an ACTH-producing pituitary adenoma.
B. Is best diagnosed by measurement of cortisol from a serum sample collected at 8 A.M.
C. Is attributable to an adrenal source if the basal serum ACTH level is above 10 pg. per ml., if the hypercortisolism is suppressed by high-dose dexamethasone, and if an adrenal tumor is visualized radiographically.
D. May be caused by small cell carcinoma of the lung, carcinoid tumors, tumors of the endocrine pancreas, pheochromocytoma, or medullary thyroid carcinoma (MTC).
E. In children is most often caused by adrenocortical neoplasia.
21. Primary aldosteronism:
A. Produces a syndrome of diastolic hypertension, hypokalemia, and edema.
B. Is suggested by findings of serum potassium less than 3.5 mEq. per liter, urinary potassium excretion greater than 30 mEq. per day, upright plasma renin below 3 ng. per ml., and a plasma aldosterone concentration–plasma renin activity ratio greater than 20:1.
C. Is most often due to an aldosterone-producing adrenal adenoma, which may be distinguished from idiopathic adrenal hyperplasia by its sensitivity to diurnal changes in ACTH and insensitivity to changes in posture.
D. May be diagnosed in hypertensive patients by demonstration of an adrenal mass larger than 1 cm. on computed tomography alone.
E. Is best treated surgically if it is due to either aldosteronoma or idiopathic adrenal hyperplasia.
22. Adrenocortical carcinoma:
A. May be suspected in a patient with rapidly progressive Cushing’s syndrome and virilizing features or in asymptomatic patients with adrenal tumors larger than 6 cm on CT.
B. Most often is diagnosed early in its course when disease is confined to the adrenal gland.
C. Is differentiated from benign adrenocortical adenoma by tumor necrosis, hemorrhage, and cellular features of large hyperchromatic nuclei and more than 20 mitoses per high-power field.
D. Should be resected only if disease is localized to the adrenal gland; otherwise treatment with mitotane is indicated.
E. Carries a poor prognosis: overall 5-year survival less than 25%.
23. Addisonian crisis, or acute adrenocortical insufficiency:
A. Occurs only in patients with known adrenal insufficiency or in those receiving long-term supraphysiologic doses of exogenous steroids.
B. Can mimic an acute abdomen with fever, nausea and vomiting, abdominal pain, and hypotension.
C. May cause electrolyte abnormalities, including hypernatremia, hypokalemia, hypoglycemia, and hypercalcemia, as well as eosinophilia on peripheral blood smear.
D. Should be diagnosed with the rapid ACTH stimulation test before steroid replacement is instituted.
E. May be effectively treated with intravenous “stress-dose” glucocorticoid and mineralocorticoid replacement.
24. Preparation for surgical removal of a pheochromocytoma includes:
A. Beta-adrenergic blockade followed by alpha-adrenergic blockade.
C. Alpha-adrenergic blockade, with or without beta-adrenergic blockade.
D. Preoperative Swan-Ganz monitoring in all patients.
E. Planning removal through an anterior, posterior, or laparoscopic approach based upon tumor localization with CT, magnetic resonance imaging (MRI), and/or 131I-MIBG.
25. Indications for surgical adrenalectomy include:
A. An adrenal mass larger than 6 cm.
B. Hypertensive patients with aldosteronism that is ACTH insensitive and posture sensitive and who also have multiple adrenal nodules on CT.
C. Cushing’s syndrome secondary to adrenal neoplasms or to persistent ectopic ACTH syndrome when the primary tumor is inoperable.
D. Pheochromocytoma in adults and children.
E. Congenital adrenal hyperplasia secondary to 21-hydroxylase deficiency.
26. Incidental adrenal masses:
A. May be seen in as many as 10% of abdominal CT studies.
B. Most commonly represent pheochromocytoma; adrenocortical adenoma, adrenocortical carcinoma, and metastases from other primary cancers occur less frequently.
C. May represent adrenocortical carcinoma if greater than 6 cm. in diameter.
D. Should be routinely evaluated by measurement of 24-hour urine levels of catecholamines and their metabolites, cortisol, and aldosterone plus fine-needle aspiration.
E. Should be resected if biochemically active, if greater than 6 cm., or if they grow over six months’ follow-up.
27. Which of the following statements is true about the synthesis of thyroid hormone and its physiology?
A. The iodine utilized in hormone synthesis is derived principally from dietary sources.
B. The role of thyroid-stimulating hormone (TSH) in thyroid physiology is limited to regulation of the release of thyroid hormone in plasma.
C. Enough thyroxine (T 4) is stored in the normal thyroid to provide a euthyroid state for 3 weeks despite absence of iodine intake.
D. The regulation of thyroid function involves pituitary, but not hypothalamic, input.
28. Correct statements about thyroid function tests include which of the following?
A. Contraceptive pills and pregnancy increase the amount of thyroxin-binding globulin (TBG), and, consequently, the total T 4 level.
B. Anticonvulsive medications and chronic debilitating illnesses decrease the amount of TBG and, consequently, the total T 4 level.
C. Intravenous pyleography can lower the rate of active iodine uptake by the thyroid.
D. A triiodothyronine (T 3) suppression test that demonstrates nonsuppressibility of thyroid function is compatible with the diagnosis of Graves’ disease, toxic adenoma, or functioning carcinoma.
E. An increased serum cholesterol level in a hypothyroid patient indicates a thyroid cause.
29. Hyperthyroidism can be caused by all of the following except:
A. Graves’ disease.
B. Plummer’s disease.
C. Struma ovarii.
D. Hashimoto’s disease.
E. Medullary carcinoma of the thyroid.
30. Which of the following is true about the use of radioiodine to treat hyperthyroidism?
A. If hyperthyroidism is secondary to radioiodine use, it will occur within 2 years of treatment.
B. There is a markedly increased risk of future thyroid cancer following radioiodine therapy.
C. The risk of leukemia following radioiodine therapy is approximately 10%.
D. Mutation abnormalities occur in 15% of fetuses in utero following internal treatment of the mother with radioiodine during pregnancy.
E. Radioiodine may pass through the placenta and lactating breast to produce hypothyroidism in a fetus or infant.
31. Arrange the following complications of thyroid surgery (bilateral subtotal thyroidectomy) in decreasing order of incidence in patients with Graves’ disease.
A. Laryngeal nerve paralysis.
D. Recurrent hyperthyroidism.
32. The most common cause of goitrous hypothyroidism in adults is:
A. Graves’ disease.
B. Riedel’s thyroiditis.
C. Hashimoto’s disease.
D. de Quervain’s thyroiditis.
33. Therapy for Hashimoto’s disease includes:
B. Antithyroid medications.
C. Subtotal thyroidectomy.
D. None of the above.
34. Indications for surgical thyroidectomy for Graves’ disease include which of the following?
a. Ocular involvement
b. Symptomatic large goiter
c. Women of childbearing age
d. Concomitant thyroid nodule
e. All of the above
Answer: b, c, d
35. Which of the following statements regarding anatomic relationships of the thyroid gland are true?
a. The middle thyroid artery is intimately related to the superior laryngeal nerve
b. The superior thyroid artery is usually the first branch of the external carotid artery
c. Thyroidea ima arteries are found in approximately 20% of individuals
d. The parathyroid glands may lie within the pretracheal fascia
Answer: b, d
36. Radioactive iodine is effective treatment for metastatic lung disease for which of the following thyroid neoplasms?
a. Hürthle cell carcinoma
b. Papillary carcinoma
c. Follicular carcinoma
d. Medullary carcinoma
e. Anaplastic carcinoma
Answer: b, c
37. The types of thyroiditis that can cause abnormalities of surgical significance are which of the following?
a. Chronic lymphocytic thyroiditis (Hashimoto disease)
b. Riedel struma
c. Acute (viral) thyroiditis
d. Granulomatous (subacute) thyroiditis
Answer: a, b, d
38. The principal blood supply to the parathyroid glands is which of the following?
a. Superior thyroid arteries
b. Inferior thyroid arteries
c. Thyroidea ima arteries
d. Parathyroid arterial branches directly from the external carotid artery
e. Highly variable
39. Which of the following statements regarding papillary thyroid carcinoma are true?
a. Seventy to 80% of new cases of thyroid carcinoma in the United States are of the papillary type
b. Total ipsilateral lobectomy and isthmus resection are adequate therapy for minimal thyroid carcinoma
c. Microscopic evidence of multicentric disease is present in 70% to 80% of cases
d. Nearly all patients less than 15 years of age have metastatic disease in local lymph nodes
Answer: a, b, c, d
40. A 30-year-old female presents for evaluation of a palpable thyroid nodule. Technetium-99m (99mTc) scan demonstrates a single cold nodule. The differential diagnosis includes which of the following?
b. A nonfunctioning adenoma
c. A thyroid cyst
d. A colloid nodule
e. An autonomous nodule
Answer: a, b, c, d
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41. Which of the following pharmacologic agents can be used in the treatment of thyrotoxicosis to block the production of thyroid hormone?
Answer: a, c, d, e
42. A 45-year-old woman has a solitary, nonfunctioning thyroid nodule and fine needle cytology is nondiagnostic. Which of the following is the initial surgical procedure of choice?
a. Total extracapsular thyroidectomy
b. Subtotal thyroid lobectomy and resection of the isthmus
c. Total extracapsular thyroid lobectomy, resection of the isthmus, and modified unilateral neck dissection
d. Total extracapsular thyroid lobectomy and resection of the isthmus
43. Which of the following statements regarding fine needle aspiration cytology of a thyroid nodule are true?
a. It differentiates neoplastic and nonneoplastic nodules in most cases
b. It does not allow differentiation of papillary, medullary and anaplastic carcinoma
c. It cannot differentiate malignant and benign follicular or Hürthle cell neoplasms
d. It is not recommended when a patient has a history of head and neck radiation
Answer: a, c, d
44. Hyperthyroidism results from all of the conditions noted below. Of the following which commonly require surgical management?
a. Graves’ disease
b. Struma ovarii
c. Functioning metastatic thyroid carcinoma
d. Toxic diffuse goiter
e. Single toxic thyroid nodule
Answer: a, d, e
45. Which of the following statements regarding medullary carcinoma of the thyroid are true?
a. Approximately 75% of all cases are hereditary
b. The overall 10-year survival rate is less than 10%
c. Medullary carcinoma of the thyroid is associated with both multiple endocrine neoplasia IIa (MEN IIa) and multiple endocrine neoplasia IIb (MEN IIb) syndromes
d. Prophylactic total thyroidectomy is recommended for MEN IIa and MEN IIb patients after the age of 10 years
46. Which of the following statements regarding thyroid physiology are true?
a. Normally about 20% of T3 is secreted directly from the thyroid gland
b. The thyroid gland is the only endogenous source of T4
c. Excess thyroid hormone results in an increase in the number of ATP-dependent sodium pumps on the cell membrane
d. The majority of thyroid hormone in circulating plasma is bound to albumin, thus limiting the availability of the metabolically active form
Answer: a, b, c
47. The definitive treatment of choice for toxic multinodular goiter is?
a. Total thyroidectomy
b. Bilateral subtotal thyroidectomy
c. Unilateral total lobectomy on the side of dominant disease
d. 131I treatment
48. A 50-year-old male has undergone an ipsilateral thyroid lobectomy and isthmus resection for what appeared on frozen section to be a benign nodular lesion 2.0 cm in diameter. Seventy-two hours later the final pathology returns and the diagnosis is a high-grade angioinvasive follicular carcinoma. What do you recommend?
a. 99mTc bone scan to rule out occult bone metastases
b. Ipsilateral radical neck dissection
c. Total thyroidectomy
d. Observation with sequential 131I scans every 3 months
49. In 1990 a National Institutes of Health Consensus Development Conference reviewed the available evidence regarding the management of asymptomatic primary hyperparathyroidism. The panel concluded that surgical intervention was indicated for which of the following indications?
a. Age less than 50 years of age
b. Reduced creatinine clearance
c. Presence of kidney stone(s) (as detected by abdominal radiograph)
d. Substantial reduced bone mass as determined by direct measurement
e. Markedly elevated 24-hour urinary calcium excretion
Answer: a, b, c, d, e
50. Which of the following statements regarding medullary carcinoma of the thyroid are true?
a. Bilateral medullary carcinoma of the thyroid occurs in every patient with multiple endocrine neoplasia 1, 2a or 2b
b. Medullary carcinoma of the thyroid accounts for approximately one-third of all thyroid malignancies
c. 20% of medullary carcinoma of the thyroid cases are familial
d. Provocative testing with pentagastrin and calcium infusion for family members at risk for medullary carcinoma of the thyroid is diminished in importance by the recent development of specific genetic testing
Answer: a, c, d
51. While awaiting surgery on a HMO waiting list, a 50-year-old female with primary hyperparathyroidism is admitted to the hospital with oliguria, confusion, nausea and vomiting, muscle weakness and a serum calcium of 13.5 mg/dL. Of the treatment options below, which one is the most appropriate?
a. Administer 1 gm of hydrocortisone STAT
b. Begin an IV EDTA (chelating agent) infusion STAT
c. Administer IV Mithramycin and calcitonin concurrently and proceed to ICU for cardiac monitoring
d. Begin a normal saline infusion at 2X maintenance volume followed by 1mg/kg furosemide IV
e. None of the above
52. Which of the following conditions are associated with hypercalcemia?
b. Thiazide diuretics
c. Terminal ileal resection
d. Breast cancer
e. All of the above
Answer: a, b, d
53. A 40-year-old male undergoes an apparently uneventful total thyroidectomy for follicular carcinoma of the thyroid. 48 hours later he develops circumoral numbness, followed by laryngospasm, and then has a generalized seizure. Of the following, which is the first priority?
a. Proceed to OR for exploration of the operative site
b. Administer 25 ml of 10% calcium gluconate intravenously
c. Obtain a serum magnesium measurement and administer intravenous magnesium chloride STAT
d. Obtain a CT scan of the head to evaluate the possibility of brain metastases
54. On routine life insurance screening, an asymptomatic 45-year-old male is found to have a serum calcium level of 12.5 mg/dL. Serum is obtained for immunoreactive parathyroid hormone level and this is 400 mEq/mL (normal range < 64mEq/mL). These findings are most consistent with a diagnosis of which of the following? a. Primary hyperparathyroidism b. Secondary hyperparathyroidism c. Tertiary hyperparathyroidism d. Ectopic hyperparathyroidism Answer: a 55. A 50-year-old female is referred for treatment of a serum calcium of 11.5 mg/dL one year after resection of a right superior parathyroid adenoma. The right and left inferior glands were normal at the initial neck exploration. The left superior gland was not visualized. Which of the related statements below are true? a. Recurrent postoperative hypercalcemia occurs in approximately 20% of patients with this clinical scenario b. Localization studies via selective angiography are successful in 50% to 80% of these patients c. The risk of permanent hypoparathyroidism is approximately 10% to 20% following reexploration in this setting d. Surgical reexploration by an experienced endocrine surgeon has a success rate of less than 50% in this circumstance Answer: b, c 56. Which of the following statements regarding calcium and phosphate metabolism are true? a. Parathyroid hormone excess produces a net increase in daily urinary calcium excretion b. Calcitonin is essential for the normal control of calcium metabolism in adult humans c. Parathyroid hormone is the single most important regulator of calcium and phosphate metabolism in humans d. 1,25 dihydroxyvitamin D3 (calcitriol) is the active form of vitamin D in humans Answer: a, c, d 57. Multiple Endocrine Neoplasia (MEN) 2b is characterized by which of the following findings? a. Medullary carcinoma of the thyroid, pheochromocytoma, mucosal neuromas, and a distinctive marfanoid habitus b. Parathyroid hyperplasia, pancreatic islet cell tumors, and pituitary adenomas c. Medullary carcinoma of the thyroid, pheochromocytoma, and parathyroid hyperplasia d. Parathyroid carcinoma, pheochromocytoma and chronic pancreatitis Answer: a 58. Which of the following signs/symptoms are pathognomonic of hyperparathyroidism? a. Pathologic fractures of the metacarpals b. Calcium oxalate nephrolithiasis c. Hypercalcemia causing mental status changes d. Atrophy of Type II muscle fibers e. Osteitis fibrosa cystica Answer: e 59. The causes of Cushing syndrome may include which of the following? a. Posterior pituitary adenoma b. Adrenal hyperplasia c. Small cell lung carcinoma d. Pheochromocytoma e. Adrenal carcinoma Answer: b, c, e 60. Which of the following are normal systemic effects of glucocorticoids? a. Enhanced proteolysis b. Increased gluconeogenesis c. Diminished lipolysis d. Decreased rate of intestinal epithelial replication Answer: a, b, d 61. A 10-year-old child presents with hypertension, tachycardia, nervousness and sweating. The best initial diagnostic evaluation is which of the following? a. Radioimmunoassays for norepinephrine and epinephrine in serum b. Magnetic resonance imaging of the adrenal gland c. MIBG (131I-Methaiodobenzylguanidine) scintigraphy d. Measurement of catecholamines and their degradation products in a 24-hour urine specimen Answer: d 62. A 25-year-old male has been taking 40 mg of prednisone PO qod for ulcerative colitis for 5 years. He undergoes an uneventful colectomy with endorectal pull-through and an ileoanal anastomosis. Which of the following statements regarding steriod management are correct? a. On the day of surgery he should receive 100 mg hydrocortisone IV q6h b. The postoperative steroid dose should be halved q 12 hours to reduce the risk of infectious complications and improve would healing c. Prophylactic treatment with a somatostatin analogue will reduce the risk of postoperative pancreatitis d. Exogenous steroid replacement can be stopped after 3 months Answer: a 63. Imaging of the adrenal gland is best achieved with which of the following techniques? a. Ultrasound b. Computed tomography (CT) c. Arteriography d. Scintigraphy with 131I-6 b-iodomethyl-19-norcholesterol (NP-59) e. Scintigraphy with 131I-methaiodobenzylguanidine (MIBG) Answer: b 64. A 45-year-old female is found to have a 2 cm solid nodule in her right adrenal gland at the time of an abdominal CT scan following an auto accident. With regard to the adrenal lesion, she is asymptomatic and it is found to be nonfunctional on evaluation. You would recommend which of the following? a. Extraperitoneal right adrenalectomy through either a flank of posterior approach b. Suppression with 5 mg prednisone PO qod c. Followup CT scan in 1 to 3 months d. Excisional biopsy via laparaoscopic approach Answer: c 65. A 20-year-old male with a 10 cm left adrenal mass is found to have 10 mg of norepinephrine in a 24-hour urine collection and a plasma 18 hydroxycorticosterone level of 50 mg/dL. Initial reoperative preparation should include which of the following? a. Treatment with spironolactone b. Intravenous potassium-loading to prevent intraoperative hypokalemia c. Treatment with phenoxybenzamine d. Treatment with labetalol Answer: c 66. Which of the following diagnostic tests will differentiate between the pituitary and adrenal gland as the cause of hypercortisolism? a. High dose dexamethasone suppression test b. CRH stimulation test c. Low dose dexamethasone test d. AM and PM plasma cortisol determination Answer: a, b 67. Which of the following statements regarding androgens and estrogens in the fetus are true? a. The development of normal female external genitalia requires estrogen production by the ovary b. A female with congenital adrenal hyperplasia is likely to be masculinized in appearance c. The development of normal male external genitalia requires adrenal androgen production d. A male with congenital adrenal hyperplasia is likely to be feminized in appearance Answer: b, c 68. Which of the following statements regarding the physiology of the adrenal gland are true? a. Release of CRH is regulated principally by negative feedback by ACTH b. Plasma 17-ketosteroid levels reflect the degree of adrenal cortisol production c. Renin undergoes enzymatic cleavage in the lung to angiotensin I d. The plasma half-life of ACTH is relatively long (> 24 hrs)
e. None of the above
69. The approximate 5-year survival rate for adrenocortical carcinoma is which of the following?
d. Nearly 100%
70. Which of the following statements is true with respect to pheochromocytoma?
a. Pheochromocytoma associated with MEN IIa is usually unilateral and rarely malignant; therefore, unilateral exploration through a posterior flank incision is usually sufficient
b. Clonidine fails to suppress basal plasma-catecholamine levels in patients with pheochromocytoma
c. NP-59 (131I-6 b-iodomethyl-19-norcholesterol) is taken up as cholesterol by the adrenal medulla
d. The ratio of plasma 3,4-dihydroxyphenoglycol (DHPG) to norepinephrine is generally elevated in patients with pheochromocytoma compared to patients with essential hypertension
Answer: b, d
71. Which of the following statements regarding aldosterone are true?
a. Its secretion is directly related to the serum potassium concentration
b. Angiotensin II is a more potent regulatory factor than ACTH
c. Primary hyperaldosteronism is characterized by hyperkalemia
d. Secondary hyperaldosteronism occurs with renal artery stenosis
Answer: a, b, d
72. A term neonate is noted to have ambiguous female genitalia. This infant is at risk for which of the following potentially life-threatening problems?
a. Cardiomyopathy with congestive heart failure
b. Sodium wasting nephropathy with hypovolemia
c. Respiratory failure from surfactant deficiency
d. Spontaneous hemorrhage from thrombocytopenia
e. Pulmonary embolus from a hypercoaguable state
73. Which of the following adrenal lesions can be treated definitively by medical means?
a. Benign functional adrenocortical adenoma
b. Adrenocortical carcinoma
c. Congenital adrenal hyperplasia
d. Cushing disease
74. Which of the following statements regarding the pituitary gland are true?
a. ADH is a product of the neurohypophysis
b. The preferred surgical approach to the pituitary gland is via the sphenoid sinus
c. Growth hormone, ACTH, LH, FSH and serotonin are products of the adenohypophysis
d. The adenohypophysis is regulated by neurotransmitters released by the supraoptic hypophyseal tract
Answer: a, b
75. Which of the following statement(s) is/are true with respect to growth hormone secreting pituitary adenomas?
a. Fewer than 50% of patients will have growth hormone levels over 10 ng/mL
b. Oral glucose administration suppresses growth hormone levels in patients with acromegaly
c. Over 80% of growth hormone-secreting microadenomas can be cured with transphenoidal resection
d. Preoperative treatment of macroadenomas with a somatostatin analogue may improve postoperative remission rates
Answer: c, d
76. A 30-year-old woman presents with amenorrhea, headache and bitemporal hemianopsia. Appropriate diagnostic tests include:
a. Cerebral angiography
b. Serum prolactin levels
c. Magnetic resonance imaging of the brain
d. Abdominal and pelvic CT scan
Answer: b, c
77. Which of the following condition(s) is/are associated with hyperprolactinemia?
a. Chronic renal failure
b. Exogenous estrogen administration
c. Diabetes mellitus
Answer: a, b, d
78. Pituitary adenomas are best classified according to functional hormone output. This information may be derived from which of the following?
a. Hematoxylin and eosin staining
b. Immunohistochemical staining of pituitary tissue
c. In situ hybridization studies
d. Selective venous sampling from the inferior petrosal sinuses
Answer: b, c, d
79. Which of the following statements is true with respect to Cushing Disease?
a. Pituitary microadenomas are often small and deep within the gland itself
b. The treatment of choice for hypercortisolism due to a pituitary adenoma in women of childbearing age is transsphenoidal total hypophysectomy
c. Patients who fail to remit with both surgery and radiation to the pituitary require either medical or surgical adrenalectomy
d. The long-term recurrence rate after resection of an ACTH-producing pituitary microadenoma is approximately 40%
Answer: a, c
80. A 45 year-old woman presents for evaluation of hypertension, recent onset obesity, hirsutism and depression. Cerebral MRI does not show a pituitary lesion. Evaluation may include determination of which of the following?
a. AM serum cortisol levels after low dose dexamethasone suppression
b. Simultaneous serum ACTH measurement in peripheral and inferior petrosal sinus sites
c. Chest and abdominal CT scan
d. Urinary free cortisol excretion
Answer: b, c, d
81. The most common mass lesion in the sella turcica is which of the following?
c. Benign pituitary cyst
d. Pituitary adenoma
82. Pharmacologic treatment of growth hormone (GH) excess secondary to a pituitary adenoma may include the use of which of the following?
Answer: a, c
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