PreTest - Pathophysiology - Thyroid and Pituitary Disorders 1. (389) Hyperthyroidism in a patient who moved from an iodine-deficient area (region) to iodine-sufficient area (region) a) Graves' disease b) Jodbasedow phenomenon c) Choriocarcinoma d) Struma ovarii e) Toxic multinodular goiter 2. (390) Thyrotoxicosis and uniformly increased radioactive iodine uptake in the thyroid without thyrotropin receptor antibodies a) Graves' disease b) Jodbasedow phenomenon c) Choriocarcinoma d) Struma ovarii e) Toxic multinodular goiter 3. (391) Pretibial myxedema a) Graves' disease b) Jodbasedow phenomenon c) Choriocarcinoma d) Struma ovarii e) Toxic multinodular goiter 4. (392) Infiltration of orbital soft tissue and extraocular muscles with lymphocytes, mucopolysaccharides and fluid a) Graves' disease b) Jodbasedow phenomenon c) Choriocarcinoma d) Struma ovarii e) Toxic multinodular goiter 5. (393) Thyrotoxicosis having a low uptake of iodine in the thyroid bed but uptake in the pelvis a) Graves' disease b) Jodbasedow phenomenon c) Choriocarcinoma d) Struma ovarii e) Toxic multinodular goiter 6. (394) The most common cause of spontaneous hypothyroidism in the United States a) Iodine deficiency b) Lithium c) Hashimoto's thyroiditis d) Propylthiouracil e) Toxic multinodular goiter 7. (395) The most common cause of goiter in developing nations a) Iodine deficiency b) Lithium c) Hashimoto's thyroiditis d) Propylthiouracil e) Toxic multinodular goiter 8. (396) Endemic goiter a) Iodine deficiency b) Lithium c) Hashimoto's thyroiditis d) Propylthiouracil e) Toxic multinodular goiter 9. (397) Inhibits conversion of T4 to T3 a) Iodine deficiency b) Lithium c) Hashimoto's thyroiditis d) Propylthiouracil e) Toxic multinodular goiter 10. (398) High levels of thyroidal peroxidase antibody a) Iodine deficiency b) Lithium c) Hashimoto's thyroiditis d) Propylthiouracil e) Toxic multinodular goiter 11. (399) Eleveated TSH, normal free T4, and no recent illness a) Hyperthyroidism b) Nonthyroidal illness (sick euthyroidism) c) Estrogen therapy d) Subclinical hypothyroidism e) Familial (euthyroid) dysalbuminemic hyperthyroxinemia 12. (400) Normal TSH, normal T4, and low T3 a) Hyperthyroidism b) Nonthyroidal illness (sick euthyroidism) c) Estrogen therapy d) Subclinical hypothyroidism e) Familial (euthyroid) dysalbuminemic hyperthyroxinemia 13. (401) Low TSH, high T4, and high T3 a) Hyperthyroidism b) Nonthyroidal illness (sick euthyroidism) c) Estrogen therapy d) Subclinical hypothyroidism e) Familial (euthyroid) dysalbuminemic hyperthyroxinemia 14. (402) Normal TSH, high T4, and high T3 a) Hyperthyroidism b) Nonthyroidal illness (sick euthyroidism) c) Estrogen therapy d) Subclinical hypothyroidism e) Familial (euthyroid) dysalbuminemic hyperthyroxinemia 15. (403) Low TSH and high T3 a) Hyperthyroidism b) Nonthyroidal illness (sick euthyroidism) c) Estrogen therapy d) Subclinical hypothyroidism e) Familial (euthyroid) dysalbuminemic hyperthyroxinemia 16. (404) Most common thyroid cancer a) Thyroid lymphoma b) Medullary thyroid carcinoma c) Papillary thyroid carcinoma d) Anaplastic thyroid carcinoma e) Follicular thyroid carcinoma 17. (405) Life expectancy of less than 6 months from diagnosis a) Thyroid lymphoma b) Medullary thyroid carcinoma c) Papillary thyroid carcinoma d) Anaplastic thyroid carcinoma e) Follicular thyroid carcinoma 18. (406) Rapidly enlarging thyroid mass in a patient with chronic autoimmune (Hashimoto's) thyroiditis a) Thyroid lymphoma b) Medullary thyroid carcinoma c) Papillary thyroid carcinoma d) Anaplastic thyroid carcinoma e) Follicular thyroid carcinoma 19. (407) Psammoma bodies a) Thyroid lymphoma b) Medullary thyroid carcinoma c) Papillary thyroid carcinoma d) Anaplastic thyroid carcinoma e) Follicular thyroid carcinoma 20. (408) Elevated plasma calcitonin a) Thyroid lymphoma b) Medullary thyroid carcinoma c) Papillary thyroid carcinoma d) Anaplastic thyroid carcinoma e) Follicular thyroid carcinoma 21. (409) Markedly tender gland, low radioiodine uptake, and thyrotoxicosis a) Graves' disease b) Subacute thyroiditis c) Toxic multinodular goiter d) Hashimoto's thyroiditis e) Toxic adenoma 22. (410) Thyrotoxicosis with a patchy pattern but normal amount of radioiodine uptake a) Graves' disease b) Subacute thyroiditis c) Toxic multinodular goiter d) Hashimoto's thyroiditis e) Toxic adenoma 23. (411) Diffusely enlarged gland with uniform and increased radioiodine uptake a) Graves' disease b) Subacute thyroiditis c) Toxic multinodular goiter d) Hashimoto's thyroiditis e) Toxic adenoma 24. (412) A 45-year-old man presents because of frontal bossing and an enlarged nose, tongue, and jaw. He has doughy palms and spadelike fingers. The best screening test to establish the diagnosis is a) Random growth hormone b) Insulin-like growth factor (IGF-1) c) TSH d) Prolactin e) Fasting blood sugar 25. (413) Based on physical findings, you suspect that a 48-year-old woman has acromegaly. The definitive diagnostic test for acromegaly is measurement of growth hormone in the following setting a) Random b) Thyrotropin-releasing hormone (TRH) stimulation test c) Insulin tolerance test d) Oral glucose tolerance test e) Luteinizing hormone-releasing hormone (LHRH) stimulation test 26. (414) You confirm acromegaly in a 58-year-old woman, and an MRI of the pituitary shows a micro-adenoma. The best choice of treatment is a) Transsphenoidal surgery b) Medical therapy with somatostatin agonist c) Irradiation d) Medical therapy with bromocryptine e) Transfrontal surgery 27. (415) Untreated acromegaly results in decreased life expectancy for the following reasons EXCEPT a) Cerebral vascular disease b) Congestive heart failure c) Respiratory disease d) Colon carcinoma e) Cervical arthropathy 28. (416) A 30-year-old woman presents with a 6-month history of amenorrhea. Your initial evaluation should include measurement of a) Prolactin b) Estradiol c) Progesterone d) Testosterone e) DHEA-S 29. (417) A 28-year-old woman develops galactorrhea without amenorrhea. Your evaluation should include a) Estradiol b) Progesterone c) Prolactin d) Testosterone e) DHEA-S 30. (418) A 47-year-old man has had a headache and experienced impotence for the past 2 months. A likely hormonal profile would be a) Low testosterone, high LH, and low prolactin b) Low testosterone, low LH, and low prolactin c) Low testosterone, high LH, and high prolactin d) Normal testosterone, normal LH, and normal prolactin e) Low testosterone, low LH, and high prolactin 31. (419) A 28-year-old woman has amenorrhea and galactorrhea, after beginning a new medication recently. The most likely medication is a) Haloperidol b) Lisinopril c) Fluoxetine d) Amitriptyline e) Buspirone 32. (420) A 25-year-old woman has amenorrhea and galactorrhea. The results of her thyroid function tests are normal. Her prolactin level is 350 µg/L (n<20 µg/L). The most likely cause for her hyperprolactinemia is a) Microadenoma b) Macroadenoma c) Antidepressant use d) Exercise induced e) Antihypertensive therapy 33. (421) A 26-year-old woman has been amenorrheic for 2.5 months. Your first choice for diagnostic evaluation is a) hCG b) LH c) Estradiol d) Prolactin e) Progesterone 34. (422) A 40-year-old man has erectile dysfunction. He is noted to have hyperprolactinemia (prolactin of 400 µg/L). On MRI, a macroadenoma with superstellar extension is found. The best course of therapy for the patient is a) Medical therapy with bromocriptine b) Transphenoidal surgery c) Transfrontal surgery d) Medical therapy with somatostatin agonist e) Thyroxine 35. (423) A 35-year-old man has a prolactinoma and a history of severe peptic ulcer disease. There is family history of pituitary tumors. The findings of what other diagnostic test at this time may be abnormal and potentially useful in diagnosis? a) Fasting blood sugar b) Serum calcium c) Serum calcitonin d) Urinary metanephrine e) Serum ferritin 36. (424) A 45-year-old man has decreased libido and decreased sexual function. A large pituitary tumor is found. His prolactin is 20 µg/L (n<15 µg/L). Testing of his pituitary-gonadal axis most likely will demonstrate [note: i'm not sure why they chose to use "n<15 µg/L" on this question when the actual typical value is "n<20µg/L"] a) Normal testosterone and low LH b) High testosterone and normal LH c) Low testosterone and low LH d) Normal testosterone and normal LH e) Low testosterone and high LH 37. (425) A 16-year-old boy presents without pubertal development and development of secondary sexual characteristics. He cannot smell (anosmia). The baseline testosterone and the LH response to LHRH most likely are a) Low testosterone and normal LHRH response b) Normal testosterone and normal LHRH response c) High testosterone and normal LHRH response d) Low testerone and no LHRH response e) Low testosterone and exaggerated LHRH response 38. (426) A 58-year-old woman presents as an outpatient with lethargy, fatigue, and cold intolerance. Thyroid function testing reveals a free T4 level of 0.5 (0.7 to 2.0) and a TSH of 0.1 (0.5 to 5). The next best diagnostic test is a) Thyroid scan and uptake b) MRI of the pituitary c) Prolactin d) Thyroid autoantibodies e) T3 39. (427) A 59-year-old man presents with heat intolerance and tremor. Thyroid function testing reveals a free T4 level of 3.0 (0.7 to 2.0) and TSH level of 6.0 (0.5 to 5). The next best diagnostic test is a) Thyroid scan and uptake b) MRI of the pituitary c) Prolactin d) Thyroid autoantibodies e) T3 40. (428) A 25-year-old woman presents with increasing obesity, amenorrhea, hypertension, and abdominal stria. The next best diagnostic test is a) Prolactin b) Free T4 and TSH c) Overnight dexamethasone suppression d) Random cortisol e) Adrenocorticotropic hormone (ACTH) 41. (429) A 30-year-old man presents with weight gain, dorsocervical fat pad, and proximal muscle weakness. His urinary free cortisol level is markedly elevated and does not suppress with dexamethasone. The plasma ACTH is undetectable. Your best next diagnostic test is a) Serum antidiuretic hormone (ADH) b) Chest CT c) MRI of the pituitary d) ACTH stimulation test e) Abdominal CT 42. (430) A 65-year-old man with a lung mass has increasing skin pigmentation and marked muscle weakness and wasting. His urinary free cortisol level is 690 µg/24 h (10 to 80) and is nonsuppressible. Which of the following laboratory tests would probably be most diagnostic? a) ACTH stimulation test b) MRI of the pituitary c) CT of the abdomen d) Plasma ACTH e) Parathyroid hormone 43. (431) a 48-year-old woman with a history of pituitary surgery and irradiation is scheduled for elective surgery. She currently requires replacement thyroxine, hydrocortisone, estrogen, and progesterone. In the perioperative period, you will treat her with a) Glucose infusion b) Increased hydrocortisone c) ACTH infusion d) Increased estrogen e) Increased thyroxine 44. (432) A 23-year-old woman presents with weakness and amenorrhea. She is clinically hypothyroid. A CT scan of the pituitary shows an expanded sella with a large cystic component with calcifications. The most likely diagnosis is a) Pituitary macroadenoma b) Empty-sella syndrome c) Craniopharyngioma d) Optic glioma e) Hypothalamic hamartoma 45. (433) Patients with pituitary macroadenoma present most commonly with a) Bitemporal hemianopsia b) Unilateral optic atrophy c) Left or right homonymous visual field defect d) Unilateral center scotoma e) Left or right superior temporal defect 46. (434) A 45-year-old man has decreased libido and erectile dysfunction. He has noted increasing pigmentation. He has developed liver disease and arthropathy recently. The next best diagnostic test is a) Serum TSH b) Serum calcium c) Serum prolactin d) Serum ferritin e) Serum gastrin ----------Key---------- 1. (b) 2. (c) 3. (a) 4. (a) 5. (d) 6. (c) 7. (a) 8. (a) 9. (d) 10. (c) 11. (d) 12. (b) 13. (a) 14. (c) 15. (a) 16. (c) 17. (d) 18. (a) 19. (c) 20. (b) 21. (b) 22. (c) 23. (a) 24. (b) 25. (d) 26. (a) 27. (e) 28. (a) 29. (c) 30. (e) 31. (a) 32. (b) 33. (a) 34. (a) 35. (b) 36. (c) 37. (a) 38. (b) 39. (b) 40. (c) 41. (e) 42. (d) 43. (b) 44. (c) 45. (a) 46. (d)