front 1 The anterior pituitary constitutes about what fraction of the
pituitary gland? | back 1 C. 80% |
front 2 A lineage-tracing study finds stem cells expressing PIT-1. Which cell
types are most directly derived from these PIT-1+ stem cells? | back 2 A. Somatotroph mammosomatotroph lactotroph |
front 3 During dehydration with hypovolemia, the most important physiologic
function of ADH is to: | back 3 D. Restrict diuresis, conserve water |
front 4 A 45-year-old has biochemical evidence of excess pituitary hormone
output (“hyperpituitarism”). The most common underlying cause
is: | back 4 B. Anterior lobe adenoma |
front 5 The most common pituitary adenomas most often secrete both: | back 5 A. Growth hormone and prolactin |
front 6 A pituitary lesion measures 8 cm in greatest dimension. By size
designation, this is a: | back 6 D. Macroadenoma |
front 7 A pituitary lesion measures 0.6 cm in greatest dimension. By size
designation, this is a: | back 7 A. Microadenoma |
front 8 Molecular profiling of pituitary adenomas most commonly identifies
alterations involving: | back 8 C. G-protein pathway mutations |
front 9 The α-subunit of Gs (Gsα) is encoded by: | back 9 D. GNAS at 20q13 |
front 10 A somatotroph adenoma carries a GNAS mutation that abrogates GTPase
activity of Gsα. The key downstream consequence is: | back 10 D. Constitutive Gsα, excess cAMP |
front 11 Pituitary adenomas are usually sporadic; about what percentage arise
from inherited defects (e.g., MEN1, CDKN1B, PRKAR1A, AIP)? | back 11 C. 5% |
front 12 Activating mutations of which oncogene are observed in rare pituitary
carcinomas? | back 12 A. HRAS |
front 13 A resected pituitary tumor is composed of uniform cells arranged in
sheets and cords. The typical cell shape described for pituitary
adenomas is: | back 13 D. Polygonal |
front 14 A reticulin stain is used to help distinguish a pituitary adenoma
from nonneoplastic anterior pituitary. A pituitary adenoma is most
suggested by: | back 14 B. Absent reticulin network |
front 15 A subset of pituitary adenomas shows elevated mitotic activity with
nuclear p53 expression. This finding most strongly correlates with
mutations in: | back 15 A. TP53 |
front 16 A patient with a known pituitary adenoma develops sudden severe
headache and acute worsening symptoms. This presentation is most
consistent with: | back 16 C. Pituitary apoplexy |
front 17 A 28-year-old has amenorrhea and galactorrhea with elevated serum
prolactin. The most frequent hyperfunctioning pituitary adenoma type
is: | back 17 D. Lactotroph adenoma |
front 18 Histology shows chromophobic cells with juxtanuclear PIT-1
localization in a prolactin-secreting tumor. This most strongly
indicates: | back 18 B. Sparsely granulated lactotroph adenoma |
front 19 A prolactin-secreting tumor is acidophilic and shows diffuse
cytoplasmic PIT-1 localization. This best fits: | back 19 A. Densely granulated lactotroph adenoma |
front 20 A prolactinoma contains extensive calcification with numerous
psammoma bodies, forming a “pituitary stone.” This process is best
termed: | back 20 C. Dystrophic calcification |
front 21 Elevated serum prolactin most classically causes which symptom
pair? | back 21 B. Amenorrhea and galactorrhea |
front 22 The diagnosis of a prolactin-secreting adenoma is made more readily
in women, especially ages 20–40, most likely because: | back 22 D. Menses are prolactin-sensitive |
front 23 Pathologic hyperprolactinemia can occur without an adenoma when loss
of dopamine-mediated inhibition causes: | back 23 A. Lactotroph hyperplasia |
front 24 A child develops excessive linear growth; an adult develops enlarged
hands and jaw from the same tumor type. This is most consistent
with: | back 24 C. Somatotroph adenoma |
front 25 Hypercortisolism due to excessive ACTH production by the pituitary is
specifically designated: | back 25 D. Cushing disease |
front 26 A corticotroph adenoma shows PAS positivity. This is most directly
explained by carbohydrate within: | back 26 B. POMC |
front 27 After bilateral adrenalectomy performed for Cushing syndrome, a
patient develops an enlarging destructive pituitary tumor. This
condition is: | back 27 A. Nelson syndrome |
front 28 A pituitary tumor produces no clinically apparent hormone excess. It
most commonly presents due to: | back 28 C. Mass effects |
front 29 A pituitary tumor causing ACTH-dependent hypercortisolism is
evaluated at diagnosis. The most typical description is: | back 29 A. Microadenoma; basophilic, dense granules |
front 30 The post-adrenalectomy pituitary tumor enlargement in Nelson syndrome
most often results from: | back 30 B. Loss steroid feedback on adenoma |
front 31 A pituitary tumor is classified as carcinoma only when it
shows: | back 31 C. Craniospinal or systemic metastases |
front 32 Most pituitary carcinomas are: | back 32 D. Functional and hormone-secreting |
front 33 The most common secreted products in pituitary carcinoma are: | back 33 B. Prolactin and ACTH |
front 34 Postpartum necrosis of the anterior pituitary is called: | back 34 B. Sheehan syndrome |
front 35 In pregnancy, anterior pituitary enlargement is vulnerable because it
leads to relative: | back 35 C. Hypoxia |
front 36 Pituitary destruction by surgery or radiation can lead to: | back 36 A. Empty sella syndrome |
front 37 Primary empty sella is most directly caused by: | back 37 A. Diaphragma sella defect |
front 38 Secondary empty sella most classically follows: | back 38 C. Mass removal or infarction |
front 39 The most commonly implicated suprasellar tumors are: | back 39 A. Gliomas and craniopharyngiomas |
front 40 Craniopharyngiomas have reported abnormalities in: | back 40 C. WNT signaling pathway |
front 41 Which pairing correctly matches craniopharyngioma variant to typical
age? | back 41 B. Adamantinomatous child, papillary adult |
front 42 Radiologically visible calcifications are most typical of: | back 42 A. Adamantinomatous variant |
front 43 Calcification is only rarely seen in: | back 43 D. Papillary craniopharyngioma |
front 44 Adamantinomatous craniopharyngioma most often shows: | back 44 C. Nests cords squamous reticulum |
front 45 Papillary craniopharyngioma most often shows: | back 45 B. Solid sheets and papillae |
front 46 Malignant transformation of craniopharyngioma is exceptionally rare
and usually after: | back 46 D. Irradiation |
front 47 The hormone that stimulates Graafian follicles is: | back 47 A. FSH |
front 48 The hormone that induces ovulation and corpus luteum formation
is: | back 48 C. LH |
front 49 The two hormones regulating spermatogenesis and testosterone
production are: | back 49 B. FSH and LH |
front 50 Transcription factors required for gonadotroph differentiation
include: | back 50 D. SF-1 and GATA-2 |
front 51 “Mass effect” from a pituitary tumor refers to: | back 51 C. Compression of nearby structures |
front 52 Sudden hemorrhage into a pituitary adenoma causing rapid enlargement
is: | back 52 B. Pituitary apoplexy |
front 53 A pituitary macroadenoma raises intracranial pressure. Typical
symptoms include: | back 53 D. Headache nausea vomiting |
front 54 A “pituitary incidentaloma” is most often a: | back 54 C. Silent microadenoma |
front 55 GNAS mutations have been reported to occur in: | back 55 B. Corticotroph adenomas |
front 56 GNAS mutations are absent in thyrotroph, lactotroph, and gonadotroph
adenomas because their hypothalamic hormones are not: | back 56 D. cAMP-pathway mediated |
front 57 An aggressive pituitary adenoma may show: | back 57 A. Cyclin D1 overexpression |
front 58 Another aggressive-behavior molecular abnormality is: | back 58 B. Epigenetic RB silencing |
front 59 Another aggressive-behavior molecular abnormality is: | back 59 D. HRAS activation |
front 60 Pituitary adenomas most commonly involve alterations in: | back 60 C. G-protein signaling |
front 61 In primary empty sella, CSF herniation typically leads to: | back 61 A. Pituitary compression |
front 62 Sheehan syndrome is the most common clinically significant form
of: | back 62 D. Anterior pituitary ischemic necrosis |
front 63 A sellar tumor invades bone locally but has no metastases. This is
not carcinoma because carcinoma requires: | back 63 A. Metastases beyond the sella |
front 64 A craniopharyngioma composed of well-differentiated squamous epithelium that usually lacks keratin, calcification, and cysts is: A. Adamantinomatous variant | back 64 C. Papillary variant |
front 65 Which is NOT a common SIADH cause category? | back 65 D. Pregnancy pituitary enlargement |
front 66 Which pituitary adenoma has higher risk of invasion and
recurrence? | back 66 A. Atypical adenoma |
front 67 A prolactinoma is chromophobic with juxtanuclear PIT-1. Which subtype
fits best? | back 67 D. Sparsely granulated lactotroph |
front 68 A prolactinoma is acidophilic with diffuse cytoplasmic PIT-1. Which
subtype fits best? | back 68 B. Densely granulated lactotroph |
front 69 A 26-year-old has amenorrhea and high prolactin. The mechanism of
amenorrhea is: | back 69 B. Prolactin suppresses GnRH release |
front 70 A man with prolactinoma has no galactorrhea. Best
explanation: | back 70 D. No mammary lobules for milk |
front 71 A man with prolactinoma reports low libido. Most direct endocrine
basis: | back 71 A. Low LH/FSH, low testosterone |
front 72 A man with a large prolactinoma has headaches. Best
explanation: | back 72 C. Mass effect compression |
front 73 Which finding is a common clinical course of lactotroph
adenomas? | back 73 A. Increased serum prolactin |
front 74 First-line medical therapy for lactotroph adenoma most commonly
is: | back 74 C. Bromocriptine dopamine agonist |
front 75 Lactotroph hyperplasia most directly results from loss of: | back 75 D. Dopamine inhibition of prolactin |
front 76 After head trauma, a patient develops hyperprolactinemia. The best
mechanism is: | back 76 B. Pituitary stalk damage |
front 77 Which exposure can cause lactotroph hyperplasia via prolactin
disinhibition? | back 77 C. Dopamine receptor blockers |
front 78 A pituitary tumor secretes ACTH. What adrenal change results? | back 78 A. Cortisol hypersecretion |
front 79 Hypercortisolism caused by pituitary ACTH excess is called: | back 79 B. Cushing disease |
front 80 A pituitary tumor shows impaired LH with predominant FSH secretion.
Most likely type: | back 80 C. Gonadotroph adenoma |
front 81 A man has low libido and a pituitary FSH-predominant tumor. The
symptom is most related to: | back 81 D. Decreased testosterone levels |
front 82 A premenopausal woman has amenorrhea and a pituitary tumor secreting
mostly FSH. Best diagnosis: | back 82 B. Gonadotroph adenoma |
front 83 A pituitary adenoma secreting TSH is best termed: | back 83 C. Thyrotroph adenoma |
front 84 A “silent” anterior pituitary tumor most often presents with: | back 84 A. Mass effect symptoms |
front 85 The posterior pituitary is usually spared in Sheehan syndrome because
it has: | back 85 C. Direct arterial blood supply |
front 86 A sellar cyst is lined by ciliated cuboidal epithelium with goblet
cells. Diagnosis: | back 86 A. Rathke cleft cyst |
front 87 Rathke cleft cysts can cause hypopituitarism mainly by: | back 87 D. Compressing gland after expansion |
front 88 Hypothalamic lesions can cause diabetes insipidus by: | back 88 A. Diminishing ADH secretion |
front 89 Which benign tumor is a classic hypothalamic/suprasellar cause of
hypopituitarism? | back 89 C. Craniopharyngioma |
front 90 Hypothalamic metastases most commonly originate from: | back 90 B. Breast and lung |
front 91 Hypothalamic insufficiency can follow irradiation of: | back 91 D. Brain or nasopharyngeal tumors |
front 92 Which two diseases can involve hypothalamus causing AP deficits plus
diabetes insipidus? | back 92 C. Sarcoidosis and TB meningitis |
front 93 Congenital deficiency of PIT-1 most classically causes deficiency
of: | back 93 A. GH prolactin TSH |
front 94 SIADH causes hyponatremia primarily because ADH: | back 94 B. Increases free water reabsorption |
front 95 The malignant neoplasm most classically causing ectopic ADH
is: | back 95 D. Small-cell lung carcinoma |
front 96 Which is a common cause category of SIADH? | back 96 A. Drugs increasing ADH secretion |
front 97 Another common SIADH cause category is: | back 97 B. CNS disorders infection trauma |
front 98 Which finding best fits SIADH volume status? | back 98 D. No peripheral edema |
front 99 Neurologic dysfunction in SIADH is most directly driven by: | back 99 C. Hyperkalemic paralysis |
front 100 A suprasellar tumor arising in the optic chiasm is most often
a: | back 100 A. Glioma |
front 101 A suprasellar tumor from vestigial Rathke pouch remnants is most
often a: | back 101 C. Craniopharyngioma |
front 102 A pituitary adenoma typically shows which cytologic pattern versus
nonneoplastic parenchyma? | back 102 B. Cellular monomorphism |
front 103 Sudden hemorrhage into a pituitary adenoma causing rapid enlargement
is: | back 103 D. Pituitary apoplexy |