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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

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

back 7

B. Menin (MEN1)

front 8

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

back 8

A. Hyperparathyroidism-jaw tumor syndrome

front 9

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 9

D. Hurthle cell tumor

front 10

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 10

A. Carcinomas multiple; adenomas one

front 11

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 11

A. Osteoporosis brown tumors osteitis fibrosa

front 12

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

back 12

B. Metastatic calcification

front 13

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

back 13

C. Renal failure

front 14

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

back 14

D. Phosphate secretion

front 15

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 15

B. Alpha1-hydroxylase

front 16

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

back 16

C. Hyperplastic

front 17

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

back 17

D. Surgery

front 18

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

back 18

A. AIRE

front 19

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 19

C. CASR gain-of-function

front 20

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 20

B. Heightens calcium sensing, lowers PTH

front 21

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 21

A. Autosomal recessive GCM2 loss-of-function

front 22

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

back 22

A. Tetany

front 23

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

back 23

C. Hypoparathyroidism

front 24

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

back 24

B. von Recklinghausen bone disease

front 25

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

back 25

D. Brown tumor

front 26

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

back 26

B. MEN1

front 27

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 27

C. Higher than actual

front 28

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

back 28

A. Dihydroxy vitamin D

front 29

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 29

C. Chvostek sign

front 30

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

back 30

A. Facial nerve

front 31

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

back 31

D. Eye muscle contractions

front 32

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 32

B. Carpal spasm with cuff

front 33

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

back 33

A. Goitrogens

front 34

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

back 34

D. Inhibiting iodide oxidation

front 35

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 35

B. Promoting skeletal calcium uptake

front 36

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

back 36

C. Graves disease

front 37

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

back 37

C. Sympathetic tone

front 38

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

back 38

D. Thyroid storm

front 39

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

back 39

B. Toxic adenoma

front 40

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

back 40

C. Iodine deficiency

front 41

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

back 41

A. Hashimoto disease

front 42

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

back 42

B. Inhibit thyroid secretion

front 43

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

back 43

D. LDL

front 44

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 44

C. Glycosaminoglycans and hyaluronate

front 45

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 45

A. Thyroglobulin and TPO

front 46

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

back 46

D. Hurthle cells

front 47

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 47

B. Hashimoto thyroiditis

front 48

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

back 48

C. Are absent

front 49

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

back 49

B. Viral

front 50

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

back 50

D. Multinucleate giant cells

front 51

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

back 51

B. Pretibial myxedema

front 52

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

back 52

A. Exophthalmos

front 53

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 53

C. Abrupt severe hyperthyroidism

front 54

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

back 54

D. Adenoma

front 55

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

back 55

D. Hypothyroidism

front 56

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 56

C. Retroorbital GAG deposition

front 57

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

back 57

A. Beta-blockers

front 58

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

back 58

D. Does not produce nodularity

front 59

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 59

B. Hyperplastic, colloid involution

front 60

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

back 60

A. Clinically euthyroid

front 61

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

back 61

C. Multinodular goiter

front 62

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

back 62

B. Plummer syndrome

front 63

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

back 63

D. Neoplastic

front 64

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 64

D. Well-formed intact capsule

front 65

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 65

B. More intact, less invasion

front 66

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

back 66

C. Thyroid follicular epithelium

front 67

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

back 67

D. Chromosome 10

front 68

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

back 68

A. MEN-2

front 69

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

back 69

C. Glycosaminoglycans

front 70

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

back 70

D. Retroorbital space

front 71

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

back 71

B. Hyperplastic phase

front 72

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

back 72

C. Colloid involution phase

front 73

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

back 73

A. Euthyroid

front 74

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 74

A. Follicular adenoma

front 75

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 75

C. Capsular invasion prominent

front 76

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 76

B. Receptor tyrosine kinase pathway

front 77

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

back 77

B. Medullary carcinoma