1.     Eosinophils in the islands of Langerhans suggest

A.   insulinoma
B.   newborn child of a diabetic mother (*)
C.   maturity onset diabetes of the young
D.   type I diabetes
E.   type II diabetes, usual type

2.   Cotton wool patches on the diabetic retina are

A.   amyloid deposits
B.   ischemia areas (*)
C.   protein deposits
D.   retinal nicroseparations
E.   thread-like vascular proliferations

3.   Multiple endocrine neoplasia type I features which island
cell tumor?

A.   gastrinoma (*)
B.   glucagonoma
C.   insulinoma
D.   somatostatinoma
E.   VIPoma

4.   Hyperglycemia in the "dawn phenomenon" is mediated by 

A.   cortisol
B.   epinephrine
C.   glucagon
D.   growth hormone (*)
E.   somatostatin

5.   Anti-microsomal antibodies suggest

A.   autoimmune addisonism
B.   Hashimoto's disease (*)
C.   mucocutaneous candidiasis / multiple endocrinopathy
D.   myasthenia gravis
E.   type I diabetes

6.   What is "Plummer's disease"?

A.   abdominal adiposity ("the dangers of crack")
B.   diabetes insipidus, with frequent trips to the bathroom
C.   hyperthyroidism from a "hot" adenoma (*)
D.   hyperthyroidism from factitious administration of thyroxine
E.   hyperthyroidism from too-rapid iodine replacement



7.   Which opportunistic infection is the common cause of adrenal
insufficiency in advanced HIV 
infection?

A.   cytomegalovirus (*)
B.   Epstein-Barr virus
C.   herpes 6 virus
D.   Kaposi's sarcoma virus
E.   pneumocystis carinii

8.   Which will yield a drop of blood quickest when pricked with
the tip of the scalpel?

A.   collagenous scar
B.   normal fat
C.   lymph node
D.   parathyroid gland (*)
E.   thyroid tissue

9.   Urinary cyclic AMP is an old-fashioned way of estimating

A.   aldosterone levels
B.   antidiuretic hormone levels
C.   atrial natriuretic peptide levels
D.   growth hormone levels
E.   parathyroid hormone levels (*)

10.  Which lung cancer is most likely to produce ectopic ACTH?

A.   adenocarcinoma, common type
B.   bronchiolo-alveolar cell carcinoma
C.   large cell anaplastic carcinoma
D.   oat cell carcinoma (*)
E.   squamous cell carcinoma

11.  Which tumor-family syndrome is LEAST likely to produce a
pheochromocytoma?

A.   Sipple's MEN II 
B.   Wermer's MEN I (*)
C.   von Hippel-Lindau syndrome
D.   von Recklinghausen's neurofibromatosis

12.  In diabetic kidney disease, you will usually see marked
hyaline sclerosis of the

A.   afferent arterioles
B.   efferent arterioles
C.   both (*)
D.   neither
E.   C and D



13.  Failure to make red blood cells is a common paraneoplastic
syndrome in patients with

A.   acromegaly
B.   glucagonoma
C.   insulinoma
D.   neuroblastoma
E.   thymoma (*)

14.  Fine-needle aspiration biopsy has found its greatest
usefulness in the examination of

A.   adrenal incidentalomas
B.   LEMON tumors prior to surgery
C.   pituitary masses
D.   suspected pheochromocytoma
E.   thyroid nodules (*)

15.  A high-dose dexamethasone suppression test will result in
suppression of

A.   an ACTH-producing pituitary adenoma (*)
B.   a cortisol-producing adrenal cortical adenoma
C.   both
D.   neither
E.   C and D

16.  Your choice for a lab test in suspected acromegaly?

A.   serum growth hormone, drawn at random
B.   serum growth hormone, stimulated by arginine infusion
C.   serum growth hormone, stimulated by sleep
D.   serum growth hormone, suppressed by glucose infusion
E.   serum insulin-like growth factor I, drawn at random (*)

17.  By common usage, "Sheehan's syndrome" is panhypopituitarism
resulting from

A.   birth defect
B.   obstetrical problems (*)
C.   pituitary adenoma, whether operated or not
D.   radiation therapy
E.   sickle cell disease

18.  ONE KODACHROME.  Clinical appearance most consistent with

A.   acromegaly
B.   addisonism
C.   Cushingism
D.   Graves's disease
E.   hypothyroidism (*)



19.  ONE KODACHROME.  Adrenal mass.  What is your diagnosis?

A.   adrenal cortical adenoma / carcinoma
B.   metastatic adenocarcinoma
C.   metastatic oat cell carcinoma
D.   neuroblastoma (*)
E.   pheochromocytoma

20.  ONE KODACHROME.  Clinical appearance most consistent with

A.   acromegaly
B.   addisonism
C.   Cushingism (*)
D.   Graves's disease
E.   hypothyroidism

21.  ONE KODACHROME.  Thyroid tissue. This looks to be...

A.   de Quervain's thyroiditis
B.   Grave's disease (*)
C.   Hashimoto's disease
D.   propyl-thiouracil effect
E.   Riedel's struma

22.  ONE KODACHROME.  The pink stroma in the cancer of c-cell
origin is mostly

A.   amyloid (*)
B.   basement membrane material
C.   fibrin
D.   thyroglobulin
E.   type I collagen

23.  TWO KODACHROMES.  Two guys with

A.   acromegaly (*)
B.   addisonism
C.   Cushingism
D.   Graves's disease
E.   hypothyroidism

24.  ONE KODACHROME.  Neck mass.  This is...

A.   de Quervain's thyroiditis
B.   Hashimoto's disease
C.   medullary thyroid cancer
D.   normal parathyroid (*)
E.   thyroglossal duct cyst



25.  ONE KODACHROME.  Patient probably has

A.   acromegaly
B.   addisonism
C.   Cushingism
D.   Graves's disease (*)
E.   hypothyroidism

26.  ONE KODACHROME.  What is the most common cause of this
physical finding in Central Asia?

A.   de Quervain's 
B.   Graves's disease
C.   Hashimoto's disease
D.   iodine deficiency (*)
E.   parathyroid adenoma

27.  ONE KODACHROME.  Pituitary lesion.  What is it?

A.   adenoma (*)
B.   craniopharyngioma
C.   empty sella syndrome
D.   hemangioma
E.   infarct

28.  TWO KODACHROMES.  Thyroid lesion.  What's your diagnosis?

A.   de Quervain's
B.   follicular adenoma
C.   Graves's disease
D.   papillary carcinoma (*)
E.   medullary carcinoma

29.  ONE KODACHROME.  Thyroid lesion.  What's your diagnosis?

A.   deQuervain's
B.   Hashimoto's disease (*)
C.   Graves's disease
D.   medullary carcinoma
E.   propylthiouracil effect

30.  ONE KODACHROME.  Thyroid in a patient treated with

A.   aspirin, which has not affected this case of de Quervain's
B.   elemental iodine for recent Graves's disease (*)
C.   excessive palpation prior to excision of an adenoma
D.   propylthiouracil for Graves's disease
E.   radioactive iodine, years ago, for Graves's disease



BONUS ITEMS

31.  What is the generic term for congenital hypothyroidism?

[cretin, cretinism]



32.  What does the value returned by the T3 resin uptake tell
you?  Explain in your own words.

[inverse relationship AND number of unbound sites]





33.  Mention a place where you will be likely to see amyloid made
from amylin.


[insulinoma or diabetic islet]


34.  What is the Somogyi phenomenon?

[something about hyperglycemia from too many hormones opposing
administered insulin]




35.  What is "bronze diabetes"?

[hemochromatosis]



NAME: ____________________________
30 points maximum





UHS Pathology
Endocrine Section
2001-2002





Instructions:

You know how this works.

There are no bathroom breaks.  If you have a question, do not
phonate.

GOOD LUCK!

 






Goiter patient from the former Soviet Union.

No laughing matter!