1.   Rebound hyperglycemia from stress hormones induced by
hypoglycemia of excess insulin 
production is called the

A.   dawn phenomenon
B.   Somogyi phenomenon (*)
C.   leprechaunism
D.   Pima syndrome
E.   resistin phenomenon

2.   Which islet cell tumor produces a distinctive, severe rash?

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

3.   Which physical findings suggests that your atypical
diabetic's disease is caused by 
autoantibodies against insulin receptors?

A.   acanthosis nigricans (*)
B.   atrophy of the interossei
C.   lipodystrophy
D.   necrobiosis
E.   proptosis (protruding eyes)

4.   The common thyroid lesion in Down's syndrome is

A.   fibrosis
B.   granulomas
C.   hypoplasia of the thyroid
D.   lymphocytic infiltration without follicles (*)
E.   papillary carcinoma

5.   For which thyroid lesion is a viral etiology
best-established?

A.   DeQuervain's thyroiditis (*)
B.   Graves's thyroiditis
C.   Hashimoto's thyroiditis
D.   Riedel's thyroiditis
E.   thyroid lymphoma (primary)

6.   A euthyroid bodybuilder taking anabolic steroids is most
likely to have

A.   decreased T4, decreased T3RU
B.   decreased T4, elevated T3RU (*)
C.   elevated T4, decreased T3RU
D.   elevated T4, elevated T3RU
E.   both normal


7.   To screen a short kid for growth hormone deficiency, you
will probably order a

A.   dexamethasone suppression test
B.   metyrapone test
C.   serum IGF-1 (*)
D.   somatostatin assay
E.   spot growth hormone assay

8.   Hyperthyroidism is fairly common in choriocarcinoma patients
because

A.   autoimmune thyroiditis is a paraneoplasitc syndrome seen
with "chorio"

B.   choriocarcinomas tend to produce TSH or TSH-like substances
(*)

C.   elevated thyroxine levels predispose to hydatidiform mole
which in turn precedes 
choriocarcinoma

D.   the aggressive cancer invades the thyroid gland and frees up
colloid which is hydrolyzed

E.   undifferentiated cancer cells in the "chorio" produce
thyroxine

9.   A patient has an elevated T3 and T4, low TSH, and is
clinically hyperthyroid, but has no goiter 
and almost no uptake of radioactive iodine in the gland.  The
most likely diagnosis is

A.   choriocarcinoma
B.   surreptitious ingestion of thyroid pills (*)
C.   pituitary adenoma
D.   pheochromocytoma mimicking hyperthyroidism
E.   Wilson's syndrome

10.  Which is NOT a favorable prognostic sign in neuroblastoma?

A.   calcification in the tumor
B.   intense S100 staining
C.   low mitotic count
D.   normal number of myc genes
E.   normal number of chromosomes (*)

11.  ONE KODACHROME.  One of these identical twins has

A.   a pituitary adenoma (*)
B.   Addisonism
C.   congenital hypothyroidism
D.   Cushingism
E.   pituitary insufficiency

12.  ONE KODACHROME.  Autopsy thyroid.  What is the diagnosis?

A.   Graves's disease, untreated or under-treated
B.   metastatic lung cancer
C.   microscopic papillary carcinoma (*)
D.   nodular goiter
E.   old radio-iodine effect


13.  THREE KODACHROMES.  Autopsy specimen of kidneys, adrenals,
and aorta. What is the 
     diagnosis?

A.   Addisonism
B.   metastatic oat-cell lung cancer
C.   neuroblastoma (*)
D.   pheochromocytoma
E.   tuberculosis

14.  TWO KODACHROMES.  Patient photos most suggestive of

A.   acromegaly (*)
B.   Addisonism
C.   Graves's disease
D.   myxedema
E.   Wegener's granulomatosis

15.  ONE KODACHROME.  Photomicrograph of thyroid showing

A.   DeQuervain's thyroiditis (*)
B.   Graves's disease
C.   Hashimoto's thyroiditis
D.   medullary carcinoma
E.   Riedel's thyroiditis

16.  ONE KODACHROME.  This finding on the lower abdomen of a man
suggests

A.   acromegaly
B.   Addisonism
C.   Cushingism (*)
D.   diabetes with insulin injections here
E.   myxedema

17.  FOUR KODACHROMES.  Thyroid gland. What is the diagnosis?

A.   adenoma
B.   follicular carcinoma
C.   medullary carcinoma
D.   papillary carcinoma (*)
E.   Riedel's thyroiditis


18.  ONE KODACHROME.  Thyroid.  This is most suggestive of

A.   DeQuervain's thyroiditis
B.   diabetic vascular change
     C.   follicular carcinoma     
D.   Graves's disease (*)
E.   propylthiouracil effect



19.  ONE KODACHROME.  Patient photo.  This is most suggestive of

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

20.  TWO KODACHROMES.  Thyroid. What's the diagnosis?

A.   DeQuervain's
B.   Graves's disease (suggestive)
C.   Hashimoto's thyroiditis (*)
D.   papillary carcinoma
E.   radio-iodine effect

21.  ONE KODACHROME.  Parathyroid gland.  What is the diagnosis?

A.   adenoma
B.   hyperplasia
C.   carcinoma
D.   adenoma or hyperplasia, you cannot tell
E.   normal (*)

22.  ONE KODACHROME.  Pituitary gland.  Stain includes orange G
dye.  What is the diagnosis?

A.   craniopharyngioma
B.   infarct
C.   pituitary adenoma (*)
D.   metastatic lung cancer
E.   no pathology

23.  ONE KODACHROME.  Patient with Graves' disease treated with

A.   elemental iodine, not radioactive (*)
B.   propylthiouracil
C.   radioactive iodine
D.   surgery only
E.   this is not consistent with any of the above

24.  ONE KODACHROME.  This is most suggestive of

A.   acromegaly
B.   autoimmune Addisonism
C.   Graves's disease
D.   iodine deficiency (*)
E.   papillary thyroid cancer



BONUS ITEMS: 

25.  ONE KODACHROME.  This thyroid carcinoma has an entirely
follicular pattern, but carries a 
better prognosis than other such lesions. Why?

[clear nuclei]



26.  ONE KODACHROME.  What protein was beta-pleated to form the
amyloid in this thyroid 
cancer from a patient with MEN II?

[calcitonin]

27.  ONE KODACHROME.  What is the name we give to the
dark-blue-staining masses in this 
thyroid cancer?

[psammoma bodies]

28.  Some diabetic families have a mutated adiponectin.  Mention
something that this newly-
discovered hormone supposedly does in health to prevent the
diabetic state.

[muscle / liver ; burn fat / sensitize to insulin / produce less
glucose]




29.  What's the eponym for the severe ulcer syndrome seen in
patients with gastrinomas?

[Zollinger-Ellison]


30.  What's the typical situation in which eosinophils are found
in great abundance in the islands of 
Langerhans?


[child of a diabetic mother] 



31.  And for the truly hard-core pathology student, when will you
see Crooke's hyaline change in 
the adenohypophysis?

[long-term suppression of ACTH production for whatever reason;
accept any reasonable 
answer]


NAME: ____________________
                                       12 Points maximum

     SEAT: _______
     
     
     
UHS PATHOLOGY
Endocrine Section
2002-2003




INSTRUCTIONS:  You know the routine.  This is a fairly easy test,
but pay close attention.

No bathroom breaks.  If you are in the first group, please don't
leave until the exam is over.


 


Harvey Cushing





GOOD LUCK!



1.   A pituitary adenoma is LEAST LIKELY to produce

A.   ACTH
B.   follicle-stimulating hormone
C.   growth hormone
D.   prolactin
E.   thyroid-stimulating hormone (*)

2.   The famous "Laron dwarves" of the middle east have deficient

A.   growth hormone
B.   growth hormone receptors (*)
C.   growth hormone releasing factor
D.   somatomedin
E.   somatotropin

3.   Which pathogen is infamous for causing adrenal insufficiency
in AIDS patients?

A.   CMV (*)
B.   herpes simplex
C.   histoplasmosis 
D.   JC papovavirus
E.   Treponema pallidum

4    Urinary cyclic AMP levels correlate best with serum

A.   ACTH
B.   anti-diuretic hormone
C.   cortisol
D.   parathormone (*)
E.   thyroxine

5.   The nodules among the glomerular capillaries in nodular
glomerulosclerosis (Kimmelstiel-
Wilson lesion) are composed of

A.   amyloid
B.   basement membrane / mesangial matrix material (*)
C.   dense type I collagen
D.   fibrin
E.   immune complex deposits

6.   No one knows why, but chronically low serum calcium in
hypoparathyroidism is likely to 
produce

A.   calcification of the cornea ("band keratopathy")
B.   cataracts (*)
C.   hypertension
D.   kidney stones
E.   stomach ulcers



7.   The amyloid in the islets of many type II diabetics is
composed predominantly of 

A.   amylin / IAPP (*)
B.   C-peptide
C.   glucagon
D.   insulin
E.   somatostatin

8.   When you suspect Addisonism, you want to perform a(n)

A.   ACTH stimulation test (*)
B.   dexamethasone suppression test
C.   spot serum cortisol
D.   twenty-four hour urine cortisol
E.   urinary VMA

9.   ONE KODACHROME.  Patient photo.  This is most suggestive of

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

10.  TWO KODACHROMES.  Thyroid. What's the diagnosis?

A.   DeQuervain's
B.   Graves's disease (suggestive)
C.   Hashimoto's thyroiditis
D.   papillary carcinoma (*)
E.   radio-iodine effect

11.  TWO KODACHROMES.  Which renal lesion of diabetes?

A..  Diffuse glomerulsclerosis only
B.   Glycogen in tubules, no glomerular lesion (*)
C.   Nodular glomerulosclerosis
D.   Papillary necrosis
E.   Pyelonephritis, acute and chronic

12.  ONE KODACHROME.  Which thyroid cancer?

A.   Anaplastic
B.   Follicular
C.   Lymphoma (*)
D.   Medullary
E.   Papillary