Endocrine - entire Block 2 (Q46-87)

[wcb22]

i figured this would save you and me some time... i'll use another post for answers. try to do the whole block, then check answers and see your %. don't be bashful, tell us how you are doing (in %).

Question 46



A 45-year-old previously healthy female has a solitary palpable non-tender right anterior neck mass. Laboratory findings include a serum free thyroxine index of 1.3 ng/dl, TSH of 2.8 microU/ml, sodium 141 mmol/L, potassium 4.2 mmol/L, chloride 106 mmol/L, CO2 25 mmol/L, glucose 86 mg/dL, and creatinine 1.5 mg/dL. The mass is most likely a(an):
A Lymph node metastasis from papillary carcinoma of the thyroid
B Parathyroid carcinoma
C Medullary carcinoma of the thyroid
D Thyroglossal duct cyst
E Parathyroid adenoma
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Question 47 A 1 cm right adrenal cortical mass is seen on magnetic resonance imaging (MRI) scan in a 46-year-old male who suffered blunt abdominal trauma in a vehicular accident. No injuries are noted. His physician decides to leave the mass alone because it is most likely a(an):
A Metastasis from a lung carcinoma
B Nonfunctioning adrenal adenoma
C Histoplasma granuloma
D Simple cyst
E Hematoma
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Question 48 A feeling of fullness in her neck brings a 43 year old woman to your clinic. She otherwise feels fine and has had no major illnesses. Your physical examination reveals painless symmetric enlargement of the thyroid gland. A complete blood count, electrolyte panel, and urinalysis are all normal. The serum free thyroxine index and TSH are normal. The most likely explanation for these findings is:
A Grave's disease
B Follicular carcinoma
C Simple goiter
D Hashimoto's thyroiditis
E Pituitary adenoma
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Question 49 A 68-year-old female had a blood pressure of 155/95 measured during a free health fair screening program. She still was hypertensive a week later when she saw her family physician. A routine serum chemistry panel showed: sodium 145 mmol/L, potassium 2.9 mmol/, chloride 107 mmol/L, and CO2 24 mmol/L. Her serum glucose was 105 mg/dl. She felt fine. A physical examination revealed no abnormal findings. Which of the following conditions is probably present:
A Cushing's syndrome
B Nelson's syndrome
C Conn's syndrome
D Congenital adrenal hyperplasia
E Multiple endocrine neoplasia, IIa
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Question 50 Which of the following statements is LEAST appropriate in view of the histopathologic appearance of granulomatous thyroiditis in a thyroid gland:
A Psammoma bodies are a common histologic feature.
B An influenza virus infection of the lung preceded this lesion.
C The course of this disease may run for only 3 months.
D The patient presented with an enlarged, painful thyroid.
E At the time of presentation, the patient was hyperthyroid.
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Question 51 Dark hemorrhagic and slightly enlarged adrenals were found at autopsy in a teenager who died only hours after presentation to the emergency room with a less than 1 day history of pharyngitis, fever, and severe headache. These findings are most consistent with:
A Idiopathic Addison's disease
B Metastatic carcinoma
C Meningococcemia
D Widespread tuberculosis
E Pheochromocytoma
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Question 52 A 15-year-old male has headaches, and radiographs demonstrate a suprasellar mass with calcifications that is eroding the sella turcica. This lesion is most likely to be a(an):
A Prolactinoma
B ACTH adenoma
C Astrocytoma
D Null cell adenoma
E Craniopharyngioma
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Question 53 While bathing her 1-year-old baby, a mother notices that the boy's abdomen seems larger than normal. The baby has not been feeding well lately, and is below the expected weight for his age. She takes the infant to the family physician who palpates a mass lesion in the abdominal region. A CT scan reveals a 5 cm mass in the left retroperitoneum adjacent to the kidney and displacing the kidney. The most probable diagnosis is:
A Congenital adrenal hyperplasia
B Adrenal adenoma
C Pheochromocytoma
D Adrenal cortical carcinoma
E Neuroblastoma
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Question 54 A 63-year-old male has a chronic cough, but recently has noted blood-tinged sputum. A chest x-*** reveals an ill-defined hilar mass in the right lung. He is found to have a serum sodium of 120 mEq/L. Which of the following findings is most likely to be present:
A Low urine specific gravity (<1.005)
B Non-secretory (null cell) adenoma of pituitary
C Bitemporal hemianopsia
D Syndrome of inappropriate ADH secretion
E Decreased serum ACTH
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Question 55 A 74-year-old female suffers severe back pain while picking up a basket of clothes. An x-*** reveals a recent compressed fracture of T12 along with multiple older compressed fractures of the vertebrae. Her skin is thin with areas of purpura. She has a serum glucose of 145 mg/dl. Her serum cortisol is normal. If her serum ACTH is decreased, the most likely pathologic finding is:
A Pituitary adenoma
B Adrenal cortical carcinoma
C Adrenal adenoma
D Marked adrenal atrophy
E Bilateral adrenal hyperplasia
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Question 56 A 22-year-old female complains of vague abdominal pain along with some pain in her extremities. She has felt terrible and depressed for several months. Physical examination reveals no major findings. A chest x-*** is normal. A serum chemistry panel reveals a calcium of 13.8 mg/dl with a serum albumin of 3.9 g/dl and phosphorus of 2.2 mg/dl. What is the most likely cause of her problem:
A Metastatic carcinoma
B Parathyroid adenoma
C Chronic renal failure
D Pituitary adenoma
E Thyroid carcinoma
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Question 57 A 54-year-old woman was found wandering aimlessly in Palisades Park near Santa Monica Pier. She was disoriented, didn't know her name, was extremely weak, and had an irregular heart rate. She was found to have a serum calcium of 15.8 mg/dl with an ionized calcium of 3.3 mmol/L, phosphorus 1.9 mg/dl, total protein 5.8 g/dl, and albumin 3.5 g/dl. A chest x-*** revealed clear lungs but there were osteolytic lesions of ribs and vertebrae. She most likely has:
A Chronic renal failure
B Metastatic breast carcinoma
C A parathyroid adenoma
D Tuberculosis
E A parathyroid carcinoma
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Question 58 A 61 year old male has a 90 pack year smoking history. He has lost 15 kg in the past 4 months, though his abdomen seems more prominent with striae over the abdominal skin. He had a recent episode of hemoptysis. Vital signs include temperature 36.6 C, respirations 20, pulse 80, and blood pressure 165/100 mm Hg. A sputum cytology demonstrates malignant cells present consistent with small cell anaplastic carcinoma. Which of the following endocrine glandular findings is he most likely to have:
A Nodular goiter
B Pituitary adenoma
C Bilateral adrenal hyperplasia
D Parathyroid carcinoma
E Papillary carcinoma
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Question 59 The appearance of a 2 cm yellow-tan encapsulated cortical mass of the right adrenal most often:
A Appears upon withdrawl of exogenous corticosteroid therapy
B Occurs following infection with Neisseria meningitidis
C Results in virilization of prepubertal females
D Is detected via testing for increased urinary homovanillic acid
E Produces signs and symptoms of Cushing's syndrome
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Question 60 A 63 year old male who is 165 cm tall and weighs 90 kg has a history of type II diabetes mellitus. He has been developing chronic renal failure and is found to have a creatinine of 6.5 mg/dl. As a consequence of his renal failure, he is most likely over time to develop:
A Nodular goiter
B Cushing's syndrome
C Addison's disease
D Parathyroid hyperplasia
E Hypopituitarism
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Question 61 Of the following conditions, the one LEAST likely to lead to a sudden and unexpected death to be reported to the Office of the Medical Examiner soon after arrival of the patient in the emergency room is:
A Adrenal pheochromocytoma
B Grave's disease
C Meningococcemia
D Parathyroid adenoma
E Acute pituitary infarction
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Question 62 A 40 year old male suffers from an almost constant headache for the past few weeks which leads him to see his physician. Physical examination reveals a bitemporal hemianopsia. Which of the following conditions is most likely to be present:
A Craniopharyngioma
B Empty sella syndrome
C Prolactinoma
D Sheehan's syndrome
E Metastatic carcinoma
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Question 63 Truncal obesity, muscular weakness, vertebral compressed fractures, hypertension, and hirsutism are all present in a 48 year old female. She is taking no medications. Which of the following diseases is most likely to be the cause for these findings:
A Tuberculosis
B Extra-adrenal paraganglioma
C Multiple endocrine neoplasia, type I
D Small cell anaplastic (oat cell) carcinoma
E 21-hydroxylase enzyme deficiency
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Question 64 A 49 year old moderately obese woman with chronic headaches has a routine physical exam, and her physician palpates a nodule in the right neck region. The cytopathologist next performs a fine needle aspirate. Following this procedure, a thyroidectomy is performed. There is a 2 cm diameter mass that is firm and light brown. Microscopically, this mass shows a fairly uniform population of small cells with pale blue cytoplasm and clear nuclei lining fibrovascular cores in a papillary pattern. There are scattered psammoma bodies. Which of the following statements made to the patient is most appropriate:
A Your long-term prognosis is good
B Other family members are at risk for this disease
C The primary site for this lesion is probably in the breast
D Your headaches resulted from a paraneoplastic syndrome
E This lesion is likely to have occurred because you were overweight
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Question 65 A 62 year old male with back pain and a fracture at the T8 vertebra is found to have hypercalcemia. Which of the following diseases is he LEAST likely to have:
A Metastatic renal cell carcinoma
B Osteitis fibrosa cystica
C Osteoporosis
D Multiple myeloma
E Rickets
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Question 66 The high power microscopic appearance of a section of thyroid gland showing multinucleated giant cells along with acute and chronic inflammatory cells and destruction of thyroid follicles is present in a 40 year old female with painful thyroid enlargement of several weeks' duration. This is most consistent with which of the following statements:
A She had a viral pneumonia
B She has an iodine deficiency
C She has multiple endocrine neoplasia
D She developed thyroid storm
E She has an increased risk for lymphoma
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Question 67 P>Bitemporal hemianopsia and headache for several months are the significant findings in a 53 year old female who is mildly obese. Radiographs reveal enlargement of the sella turcica without bony destruction or calcifications within the sella. She has a slightly low serum thyroxine without an elevated TSH. She also has hyperprolactinemia. She is eight years postmenopausal and has had eight children, all in good health. The most likely explanation for these findings is: A Meningococcemia
B Craniopharyngioma
C Sheehan's syndrome
D Gunshot wound to head
E Empty sella syndrome
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Question 68 A 40 year old male is found to have increased urinary metanephrins. After surgery to remove a mass, an electron micrograph of cells from the mass reveals numerous small dark granules in the cell cytoplasm consistent in appearance with neurosecretory granules. These findings are most consistent with a neoplasm in a patient with:
A Hyperthyroidism
B Hypercalcemia
C Hypertension
D Visual field defects
E Diabetes mellitus
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Questions 69 and 70: Click on the checkbox first, then the lettered item: (69) A pituitary adenoma in an adult is associated with development of hypertension, osteoporosis, easy bruisability, emotional lability, and truncal obesity. Which of the following hormones is increased:
(70) Coarsening of facial features and increasing shoe size are observed by an adult female over the past year. Which of the following hormones is increased:
A ACTH (corticotropin)
B TSH (thyrotropin)
C GH (growth hormone)
D LH (luteinizing hormone)
E PRL (prolactin)
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Questions 71 and 72: Click on the checkbox first, then the lettered item: (71) Papillary thyroid carcinoma.
(72) Medullary thyroid carcinoma.
A Metastases to bone and lung
B Psammoma bodies
C Clonal lymphoid proliferation
D Calcitonin
E Spindle cells
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Questions 73 and 74: Click on the checkbox first, then the lettered item: (73) A 55-year-old male smoker with a solitary lung mass has Cushing's syndrome.
(74) A 49-year-old female has virilizing signs and symptoms.
A Ectopic ACTH production
B Adenoma of anterior pituitary
C Adrenal cortical carcinoma
D Adrenal cortical adenoma
E Posterior pituitary tumor
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Questions 75 and 76: Click on the checkbox first, then the lettered item: (75) Years before, an adult patient had an enlarged thyroid gland with high titer of antimicrosomal and antithyroglobulin autoantibodies present. She then became hypothyroid.
(76) A 41-year-old female tells you that thyroid cancer "runs in the family." She is found to have several thyroid nodules. A serum calcitonin is elevated.
A Papillary carcinoma
B Medullary carcinoma
C Malignant lymphoma
D Follicular carcinoma
E Anaplastic carcinoma
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Questions 77 and 78: Click on the checkbox first, then the lettered item: (77) An adrenal cortical adenoma is seen on abdominal CT scan of a 39-year-old male with hypertension and hypokalemia.
(78) A head CT scan of a 45 year old female is slightly enlarged, and by MR scan no pituitary tissue can be visualized in the sella.
A Decreased plasma renin with increased aldosterone
B Decreased ACTH with decreased cortisol
C 21-hydroxylase enzyme deficiency
D Elevated urine homovanillic acid
E Increased calcitonin and increased norepinephrine
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Questions 79 and 80: Click on the checkbox first, then the lettered item: (79) Corticosteroid therapy has been administered top a 26-year-old female with systemic lupus erythematosus for many months.
(80) Anencephaly is diagnosed by ultrasound at 20 weeks.
A Adrenal hyperplasia
B Adrenal hypoplasia
C Adrenal cortical carcinoma
D Adrenal necrosis
E Adrenal inflammation
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Questions 81 and 82: Click on the checkbox first, then the lettered item: (81) A 36-year-old female has had episodic hypertension, headache, and cardiac arrhythmias for the past two months.
(82) A 5-year-old girl presents with virilization and hyponatremia.
A Increased homovanillic acid in urine
B Decreased plasma renin
C Increased urinary free catecholamines
D Decreased plasma cortisol
E Increased serum aldosterone
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Questions 83 and 84: Click on the checkbox first, then the lettered item: (83) A 23 year old female student presents with amenorrhea and galactorrhea. A computed tomograhic (CT) scan of the head reveals a 1 cm mass in the sella turcica.
(84) A solitary 1 cm well-circumscribed neoplasm is found by computed tomographic (CT) scan in the left adrenal gland cortex.
A Immunoperoxidase staining for calcitonin
B Increased urinary homovanillic acid
C Increased serum prolactin
D High-titer of serum antimicrosomal antibody
E Increased serum aldosterone
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Question 85 The appearance of a craniopharyngioma in a 22 year old male with headaches is most closely associated with which of the following embryologic structures:
A Rathke's pouch
B Diencephalon
C Foramen cecum
D Neural crest cells
E 4th pharyngeal pouch
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Question 86 Following delivery of her second child, a normal term male infant, a 22 year old female has failure of lactation. This is probably the result of:
A Sheehan's syndrome
B Cushing's syndrome
C Empty sella syndrome
D Syndrome of inappropriate ADH
E Wermer's syndrome
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Question 87 Three days following admission to the hospital for a cerebrovascular accident that is determined by head CT scan to be due to a right parietal infarction, a 66 year old female develops hypoglycemia, hyponatremia, and hypovolemia. She then becomes hypotensive and then comatose. Which of the following medications was she lacking:
A Thyroxine
B Vasopressin
C Insulin
D Estrogen
E Hydrocortisone
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