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95 notecards = 24 pages (4 cards per page)

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Path 24b

front 1

Parathyroid glands share embryologic origin with the:
A. Thyroid gland
B. Pancreas
C. Thymus
D. Adrenal cortex

back 1

C. Thymus

front 2

The parathyroid gland is composed of which two main cell types?
A. Chief cells and oxyphil cells
B. Follicular cells and C cells
C. Pituicytes and chromaffin cells
D. Alpha cells and beta cells

back 2

A. Chief cells and oxyphil cells

front 3

The primary function of the parathyroid gland is regulation of:
A. Sodium homeostasis
B. Glucose homeostasis
C. Potassium homeostasis
D. Calcium homeostasis

back 3

D. Calcium homeostasis

front 4

Vitamin D is biologically active primarily in which form?
A. Monohydroxy form
B. Dihydroxy form
C. Trihydroxy form
D. Methylated form

back 4

B. Dihydroxy form

front 5

A patient with elevated PTH is expected to have increased urinary excretion of:
A. Calcium
B. Phosphate
C. Bicarbonate
D. Magnesium

back 5

B. Phosphate

front 6

Primary hyperparathyroidism is most commonly caused by a parathyroid:
A. Hyperplasia
B. Carcinoma
C. Cyst
D. Adenoma

back 6

D. Adenoma

front 7

Overexpression of cyclin D1 in primary hyperparathyroidism is classically driven by:
A. CCDN1 gene inversion
B. CDC73 gene deletion
C. CASR gene gain-of-function
D. GCM2 gene loss-of-function

back 7

A. CCDN1 gene inversion

front 8

The CCDN1 inversion associated with primary hyperparathyroidism occurs on chromosome:
A. 17
B. 20
C. 11
D. 7

back 8

C. 11

front 9

A common cause of sporadic parathyroid adenomas is loss of the tumor suppressor:
A. RB
B. Menin (MEN1)
C. APC
D. PTEN

back 9

B. Menin (MEN1)

front 10

CDC73 abnormalities are implicated in:
A. Hyperparathyroidism-jaw tumor syndrome
B. Multiple endocrine neoplasia type 1
C. DiGeorge syndrome
D. Cowden syndrome

back 10

A. Hyperparathyroidism-jaw tumor syndrome

front 11

An oxyphil cell parathyroid adenoma most resembles which thyroid tumor type?
A. Papillary thyroid carcinoma
B. Medullary thyroid carcinoma
C. Follicular adenoma
D. Hurthle cell tumor

back 11

D. Hurthle cell tumor

front 12

Based on these notes, which statement matches gland involvement?
A. Carcinomas multiple; adenomas one
B. Both enlarge multiple glands
C. Carcinomas one; adenomas multiple
D. Both enlarge one gland

back 12

C. Carcinomas one; adenomas multiple

front 13

The common skeletal manifestations of primary hyperparathyroidism include:
A. Osteoporosis brown tumors osteitis fibrosa
B. Rickets osteomalacia arthritis
C. Paget disease osteonecrosis fractures
D. Scoliosis kyphosis lordosis

back 13

A. Osteoporosis brown tumors osteitis fibrosa

front 14

Severe hyperparathyroidism most characteristically causes:
A. Dystrophic calcification
B. Metastatic calcification
C. Caseous necrosis
D. Amyloid deposition

back 14

B. Metastatic calcification

front 15

The most common cause of secondary hyperparathyroidism is:
A. Vitamin A excess
B. Primary adenoma
C. Renal failure
D. Pituitary disease

back 15

C. Renal failure

front 16

Chronic renal insufficiency is associated with decreased:
A. Serum calcium
B. PTH secretion
C. Vitamin C absorption
D. Phosphate secretion

back 16

D. Phosphate secretion

front 17

Which enzyme is necessary to synthesize the active form of vitamin D?
A. 5-alpha reductase
B. Alpha1-hydroxylase
C. Aromatase
D. Catechol-O-methyltransferase

back 17

B. Alpha1-hydroxylase

front 18

In secondary hyperparathyroidism, parathyroid glands are typically:
A. Atrophic
B. Necrotic
C. Hyperplastic
D. Calcified

back 18

C. Hyperplastic

front 19

Hypoparathyroidism is rare and is most often due to:
A. Viral infection
B. Pituitary adenoma
C. Renal infarction
D. Surgery

back 19

D. Surgery

front 20

Autoimmune hypoparathyroidism most commonly involves mutations in:
A. AIRE
B. MEN1
C. CDC73
D. GNAS

back 20

A. AIRE

front 21

Autosomal dominant hypoparathyroidism is classically caused by:
A. GCM2 loss-of-function
B. MEN1 loss-of-function
C. CASR gain-of-function
D. CCDN1 inversion

back 21

C. CASR gain-of-function

front 22

CASR gain-of-function causes hypoparathyroidism because it:
A. Lowers calcium sensing
B. Heightens calcium sensing, lowers PTH
C. Blocks vitamin D activation
D. Increases PTH transcription

back 22

B. Heightens calcium sensing, lowers PTH

front 23

Familial isolated hypoparathyroidism is most classically due to:
A. Autosomal recessive GCM2 loss-of-function
B. Autosomal dominant AIRE gain-of-function
C. X-linked CASR loss-of-function
D. Mitochondrial CDC73 mutation

back 23

A. Autosomal recessive GCM2 loss-of-function

front 24

The GCM2 gene is necessary for:
A. Calcitonin secretion
B. PTH receptor signaling
C. Vitamin D transport
D. PTH maturation

back 24

D. PTH maturation

front 25

The hallmark clinical feature of hypoparathyroidism is:
A. Tetany
B. Hyperreflexia only
C. Peripheral edema
D. Exophthalmos

back 25

A. Tetany

front 26

Positive Chvostek and Trousseau signs most strongly suggest:
A. Hyperthyroidism
B. Hyperparathyroidism
C. Hypoparathyroidism
D. Addison disease

back 26

C. Hypoparathyroidism

front 27

The CDC73 gene encodes:
A. Cyclin D1
B. Menin
C. Calmodulin
D. Parafibromin

back 27

D. Parafibromin

front 28

Osteitis fibrosa cystica is also called:
A. Paget disease of bone
B. von Recklinghausen bone disease
C. Osteogenesis imperfecta
D. Avascular necrosis

back 28

B. von Recklinghausen bone disease

front 29

A lytic skeletal lesion classically seen in primary hyperparathyroidism is:
A. Osteomalacia
B. Rickets
C. Osteonecrosis
D. Brown tumor

back 29

D. Brown tumor

front 30

Menin is encoded by which gene?
A. GNAS
B. MEN1
C. CASR
D. CDC73

back 30

B. MEN1

front 31

With CASR gain-of-function, the receptor “believes” serum calcium is:
A. Lower than actual
B. Zero despite normal
C. Higher than actual
D. Unchanged despite shifts

back 31

C. Higher than actual

front 32

Defective alpha1-hydroxylase most directly reduces:
A. Dihydroxy vitamin D
B. Calcitonin secretion
C. Cyclin D1 levels
D. Parafibromin expression

back 32

A. Dihydroxy vitamin D

front 33

Tapping a nerve causes facial twitching and eye muscle contractions. This is:
A. Babinski sign
B. Brudzinski sign
C. Chvostek sign
D. Kernig sign

back 33

C. Chvostek sign

front 34

The Chvostek sign is elicited by tapping the:
A. Facial nerve
B. Vagus nerve
C. Median nerve
D. Phrenic nerve

back 34

A. Facial nerve

front 35

In a positive Chvostek sign, tapping induces:
A. Tongue fasciculations
B. Foot dorsiflexion
C. Abdominal guarding
D. Eye muscle contractions

back 35

D. Eye muscle contractions

front 36

The Trousseau sign is best described as:
A. Thenar atrophy with tapping
B. Carpal spasm with cuff
C. Triceps spasm after pinprick
D. Finger tremor at rest

back 36

B. Carpal spasm with cuff

front 37

Thyroid function can be inhibited by agents called:
A. Goitrogens
B. Beta blockers
C. Bisphosphonates
D. Glucocorticoids

back 37

A. Goitrogens

front 38

Propylthiouracil most directly acts by:
A. Blocking TSH receptor binding
B. Inhibiting thyroglobulin synthesis
C. Activating iodide symporter
D. Inhibiting iodide oxidation

back 38

D. Inhibiting iodide oxidation

front 39

Calcitonin lowers serum calcium primarily by:
A. Increasing renal calcium reabsorption
B. Promoting skeletal calcium uptake
C. Stimulating osteoclast bone resorption
D. Increasing intestinal phosphate absorption

back 39

B. Promoting skeletal calcium uptake

front 40

The most common cause of thyrotoxicosis is:
A. Toxic multinodular goiter
B. Subacute thyroiditis
C. Graves disease
D. Exogenous levothyroxine

back 40

C. Graves disease

front 41

Hyperthyroidism is typically associated with increased:
A. Parasympathetic tone
B. Somatic tone
C. Sympathetic tone
D. Vestibular tone

back 41

C. Sympathetic tone

front 42

Abrupt onset of severe hyperthyroidism in Graves is termed:
A. Myxedema coma
B. Subacute flare
C. Thyrotoxic adenoma
D. Thyroid storm

back 42

D. Thyroid storm

front 43

Radioiodine uptake confined to one nodule most suggests:
A. Graves disease
B. Toxic adenoma
C. Hashimoto thyroiditis
D. Thyroid lymphoma

back 43

B. Toxic adenoma

front 44

Worldwide congenital hypothyroidism is most often due to:
A. TSH receptor mutation
B. Thyroid agenesis
C. Iodine deficiency
D. Maternal blocking antibodies

back 44

C. Iodine deficiency

front 45

Most autoimmune hypothyroidism is caused by:
A. Hashimoto disease
B. Graves disease
C. Granulomatous thyroiditis
D. Toxic adenoma

back 45

A. Hashimoto disease

front 46

Drugs like methimazole and propylthiouracil generally:
A. Stimulate thyroid secretion
B. Inhibit thyroid secretion
C. Replace thyroid hormone
D. Amplify TSH release

back 46

B. Inhibit thyroid secretion

front 47

A common lipid abnormality in hypothyroidism is high:
A. HDL
B. VLDL
C. Chylomicrons
D. LDL

back 47

D. LDL

front 48

Nonpitting edema in hypothyroidism is due to deposition of:
A. Collagen and elastin
B. Fibrin and platelets
C. Glycosaminoglycans and hyaluronate
D. Triglycerides and cholesterol

back 48

C. Glycosaminoglycans and hyaluronate

front 49

Hashimoto thyroiditis commonly features antibodies against:
A. Thyroglobulin and TPO
B. TSH receptor and TPO
C. Thyroglobulin and TRAb
D. T3 receptor and T4

back 49

A. Thyroglobulin and TPO

front 50

Hashimoto genetic predisposition is linked to:
A. BRCA1 BRCA2 TP53
B. CTLA4 PTPN22 IL2RA
C. MEN1 RET VHL
D. GNAS AIP HRAS

back 50

B. CTLA4 PTPN22 IL2RA

front 51

Hashimoto thyroiditis is characterized histologically by:
A. Reed-Sternberg cells
B. Psammoma bodies
C. Multinucleate giant cells
D. Hurthle cells

back 51

D. Hurthle cells

front 52

Painless nodules with anti-TPO, grossly normal, and large germinal centers suggests:
A. Subacute lymphocytic thyroiditis
B. Hashimoto thyroiditis
C. Graves disease
D. Granulomatous thyroiditis

back 52

B. Hashimoto thyroiditis

front 53

Subacute lymphocytic thyroiditis typically shows fibrosis and Hurthle metaplasia that:
A. Are prominent
B. Are patchy
C. Are absent
D. Are calcified

back 53

C. Are absent

front 54

Granulomatous thyroiditis is most often:
A. Autoimmune
B. Viral
C. Bacterial
D. Iatrogenic

back 54

B. Viral

front 55

Granulomatous thyroiditis commonly shows:
A. Hurthle cell nests
B. Germinal center hyperplasia
C. Amyloid stroma
D. Multinucleate giant cells

back 55

D. Multinucleate giant cells

front 56

A classic Graves triad feature is:
A. Thyroid nodules
B. Pretibial myxedema
C. Cold intolerance
D. Carpal spasm

back 56

B. Pretibial myxedema

front 57

A classic Graves triad eye finding is:
A. Exophthalmos
B. Ptosis
C. Miosis
D. Papilledema

back 57

A. Exophthalmos

front 58

The best description of thyroid storm is:
A. Gradual painless goiter
B. Chronic low T4 state
C. Abrupt severe hyperthyroidism
D. Postpartum pituitary infarct

back 58

C. Abrupt severe hyperthyroidism

front 59

A scan shows uptake only in one solitary hot nodule. Most likely cause:
A. Thyroiditis
B. Hashimoto thyroiditis
C. Graves disease
D. Adenoma

back 59

D. Adenoma

front 60

High LDL plus nonpitting edema is most consistent with:
A. Hyperthyroidism
B. Thyroid storm
C. Graves disease
D. Hypothyroidism

back 60

D. Hypothyroidism

front 61

A patient with Graves develops proptosis. The most common mechanism is:
A. Retroorbital fat hypertrophy
B. Extraocular muscle necrosis
C. Retroorbital GAG deposition
D. Optic nerve demyelination

back 61

C. Retroorbital GAG deposition

front 62

To dampen increased sympathetic tone in Graves disease, prescribe:
A. Beta-blockers
B. Thiazide diuretics
C. Bisphosphonates
D. ACE inhibitors

back 62

A. Beta-blockers

front 63

Diffuse nontoxic goiter typically:
A. Produces single hot nodule
B. Produces early nodularity
C. Produces papillary projections
D. Does not produce nodularity

back 63

D. Does not produce nodularity

front 64

Two phases of diffuse nontoxic goiter are:
A. Fibrotic phase, necrotic phase
B. Hyperplastic, colloid involution
C. Atrophic phase, malignant phase
D. Cystic phase, hemorrhagic phase

back 64

B. Hyperplastic, colloid involution

front 65

Persons with simple goiters most often remain:
A. Clinically euthyroid
B. Overtly hyperthyroid
C. Overtly hypothyroid
D. Clinically thyrotoxic

back 65

A. Clinically euthyroid

front 66

Recurring episodes of goiter most often produce:
A. Toxic adenoma
B. Anaplastic carcinoma
C. Multinodular goiter
D. Medullary carcinoma

back 66

C. Multinodular goiter

front 67

Long-standing goiter develops an autonomous nodule causing hyperthyroidism. Diagnosis:
A. Hashimoto disease
B. Plummer syndrome
C. Diffuse nontoxic goiter
D. Subacute thyroiditis

back 67

B. Plummer syndrome

front 68

A solitary thyroid nodule in a younger male is more likely:
A. Reactive
B. Congenital
C. Postinfectious
D. Neoplastic

back 68

D. Neoplastic

front 69

Gain-of-function mutations implicated in thyroid adenomas include:
A. TP53 CTNNB1 TERT
B. RET NTRK BRAF
C. TSHR EZH1 GNAS
D. CTLA4 PTPN22 IL2RA

back 69

C. TSHR EZH1 GNAS

front 70

EZH1 encodes a:
A. Histone methyltransferase
B. DNA ligase enzyme
C. Sodium channel subunit
D. G-protein alpha subunit

back 70

A. Histone methyltransferase

front 71

The hallmark of follicular adenoma is:
A. Extensive necrosis and hemorrhage
B. Numerous psammoma bodies
C. Diffuse infiltrative growth
D. Well-formed intact capsule

back 71

D. Well-formed intact capsule

front 72

Compared with follicular carcinomas, follicular adenomas have capsules that:
A. Are absent, no boundaries
B. More intact, less invasion
C. Have prominent invasion
D. Are replaced by fibrosis

back 72

B. More intact, less invasion

front 73

Most thyroid carcinomas arise from:
A. Vascular endothelium
B. Stromal fibroblasts
C. Thyroid follicular epithelium
D. Lymphoid germinal centers

back 73

C. Thyroid follicular epithelium

front 74

Most mutations causing follicular carcinoma involve:
A. RTK pathway components
B. Notch pathway components
C. WNT pathway components
D. JAK-STAT components

back 74

A. RTK pathway components

front 75

Conventional papillary thyroid carcinoma is characterized by:
A. RAS mutations, TP53 loss
B. RET-NTRK fusion, BRAF mutations
C. CDC73 loss, MEN1 loss
D. CASR gain, GCM2 loss

back 75

B. RET-NTRK fusion, BRAF mutations

front 76

The RET gene is located on:
A. Chromosome 7
B. Chromosome 11
C. Chromosome 17
D. Chromosome 10

back 76

D. Chromosome 10

front 77

In papillary thyroid carcinoma, RET most commonly fuses with:
A. PTC1 and PTC2
B. RAS and BRAF
C. EZH1 and GNAS
D. TP53 and TERT

back 77

A. PTC1 and PTC2

front 78

Most BRAF-mutant conventional papillary carcinomas have:
A. G12D
B. Q61R
C. V600E
D. L858R

back 78

C. V600E

front 79

Follicular neoplasms are commonly associated with:
A. RET-NTRK fusion
B. RAS gain-of-function
C. EZH1 loss-of-function
D. CASR gain-of-function

back 79

B. RAS gain-of-function

front 80

Anaplastic thyroid carcinoma commonly shows mutations in:
A. RET NTRK BRAF
B. TSHR EZH1 GNAS
C. CTLA4 PTPN22 IL2RA
D. TP53 CTNNB1 TERT

back 80

D. TP53 CTNNB1 TERT

front 81

Medullary thyroid carcinoma is commonly seen in:
A. MEN-2
B. MEN-1
C. DiGeorge syndrome
D. Cowden syndrome

back 81

A. MEN-2

front 82

In Graves orbitopathy, the deposited material is primarily:
A. Collagen fibers
B. Amyloid protein
C. Glycosaminoglycans
D. Calcium salts

back 82

C. Glycosaminoglycans

front 83

In Graves exophthalmos, GAG deposition occurs in the:
A. Subcutaneous pretibial skin
B. Thyroid follicular lumen
C. Cavernous sinus
D. Retroorbital space

back 83

D. Retroorbital space

front 84

The early proliferative phase of diffuse nontoxic goiter is:
A. Colloid involution phase
B. Hyperplastic phase
C. Fibrotic phase
D. Necrotic phase

back 84

B. Hyperplastic phase

front 85

The later involutional phase of diffuse nontoxic goiter is:
A. Hyperplastic phase
B. Fibrotic phase
C. Colloid involution phase
D. Malignant phase

back 85

C. Colloid involution phase

front 86

A patient with a simple goiter is most likely:
A. Euthyroid
B. Hyperthyroid
C. Hypothyroid
D. Thyrotoxic

back 86

A. Euthyroid

front 87

A thyroid tumor with RET-NTRK fusion is most consistent with:
A. Follicular adenoma
B. Medullary carcinoma
C. Anaplastic carcinoma
D. Conventional papillary carcinoma

back 87

D. Conventional papillary carcinoma

front 88

A thyroid nodule with gain-of-function TSHR mutation most suggests:
A. Hashimoto thyroiditis
B. Thyroid adenoma
C. Anaplastic carcinoma
D. Subacute thyroiditis

back 88

B. Thyroid adenoma

front 89

A solitary thyroid nodule that is encapsulated and intact is most consistent with:
A. Follicular adenoma
B. Granulomatous thyroiditis
C. Diffuse nontoxic goiter
D. Medullary carcinoma

back 89

A. Follicular adenoma

front 90

Compared with follicular adenoma, follicular carcinoma more often shows:
A. Completely intact capsule
B. No capsule formation
C. Capsular invasion prominent
D. RET-NTRK fusion present

back 90

C. Capsular invasion prominent

front 91

The pathway most often implicated in follicular carcinoma mutations is:
A. G-protein signaling pathway
B. Receptor tyrosine kinase pathway
C. Notch signaling pathway
D. Calcineurin signaling pathway

back 91

B. Receptor tyrosine kinase pathway

front 92

A thyroid tumor with BRAF V600E most strongly supports:
A. Follicular adenoma
B. Medullary carcinoma
C. Anaplastic carcinoma
D. Conventional papillary carcinoma

back 92

D. Conventional papillary carcinoma

front 93

A thyroid tumor with RAS gain-of-function most suggests a:
A. Follicular neoplasm
B. Papillary carcinoma variant
C. Medullary carcinoma
D. Diffuse nontoxic goiter

back 93

A. Follicular neoplasm

front 94

TP53 + CTNNB1 + TERT mutations most support:
A. Follicular adenoma
B. Graves disease
C. Subacute thyroiditis
D. Anaplastic carcinoma

back 94

D. Anaplastic carcinoma

front 95

MEN-2 association most strongly points to:
A. Follicular adenoma
B. Medullary carcinoma
C. Conventional papillary carcinoma
D. Diffuse nontoxic goiter

back 95

B. Medullary carcinoma