In addition to conventional synapses, hypothalamus–pituitary signaling also uses:
A. Membrane-bound adhesion molecules
B. Soluble humoral factors
C. Electrical gap junction coupling
D. Local paracrine cytokine gradients

B. Soluble humoral factors

The pituitary–hypothalamus axis forms a functional link between the:
A. Endocrine and immune systems
B. Neural and immune systems
C. Limbic and autonomic systems
D. Neural and endocrine systems

D. Neural and endocrine systems

A patient develops profound dysregulation of feeding, thirst, and sleep–wake cycling after a small deep-brain lesion. The “central regulator” affected is the:
A. Hypothalamus
B. Thalamus
C. Cerebellum
D. Medulla

A. Hypothalamus

Which set best represents core hypothalamic functions described in your notes?
A. Motor, sensory, language, memory
B. Balance, hearing, vision, olfaction
C. Homeostatic, endocrine, autonomic, limbic
D. Pain, touch, proprioception, reflexes

C. Homeostatic, endocrine, autonomic, limbic

The embryologic structure formed by thickened ectoderm on the pharyngeal roof that invaginates as Rathke’s pouch becomes the:
A. Posterior pituitary
B. Anterior pituitary
C. Mammillary bodies
D. Cavernous sinus

B. Anterior pituitary

An evagination of the floor of the developing ventricular system gives rise to the:
A. Posterior pituitary
B. Anterior pituitary
C. Diaphragma sella
D. Sphenoid sinus

A. Posterior pituitary

Release of hormones from the anterior pituitary is controlled by the hypothalamus through a:
A. Direct synaptic projection
B. CSF diffusion pathway
C. Peripheral reflex arc
D. Specialized portal system

D. Specialized portal system

Which pituitary region contains glandular cells that secrete and synthesize its own hormones?
A. Pituitary stalk
B. Median eminence
C. Anterior pituitary
D. Posterior pituitary

C. Anterior pituitary

A neuroanatomy lab identifies a structure composed largely of axons and nerve terminals whose cell bodies lie in the hypothalamus. This is the:
A. Posterior pituitary
B. Anterior pituitary
C. Diaphragma sella
D. Sphenoid sinus

A. Posterior pituitary

The hypothalamus is a component of the:
A. Telencephalon
B. Diencephalon
C. Metencephalon
D. Myelencephalon

B. Diencephalon

The hypothalamus forms the walls and floor of the inferior portion of the:
A. Lateral ventricle
B. Fourth ventricle
C. Cerebral aqueduct
D. Third ventricle

D. Third ventricle

The shallow groove separating hypothalamus from thalamus along the third ventricle wall is the:
A. Central sulcus
B. Lateral sulcus
C. Hypothalamic sulcus
D. Calcarine sulcus

C. Hypothalamic sulcus

On gross anatomy, a “gray protuberance” bulge between the optic chiasm and mammillary bodies is the:
A. Infundibulum
B. Tuber cinereum
C. Median eminence
D. Periventricular nucleus

B. Tuber cinereum

The paired structures forming the posterior portion of the hypothalamus are the:
A. Mammillary bodies
B. Optic chiasm
C. Hypothalamic sulcus
D. Cavernous sinus

A. Mammillary bodies

The “funnel” that arises from the tuber cinereum and continues inferiorly as the pituitary stalk is the:
A. Median eminence
B. Tuber cinereum
C. Diaphragma sella
D. Infundibulum

D. Infundibulum

During evaluation of hypophyseal portal flow, the elevated anterior infundibular region where hypothalamic neurons release regulating factors into portal vessels is the:
A. Mammillary bodies
B. Periventricular nucleus
C. Median eminence
D. Hypothalamic sulcus

C. Median eminence

In a transsphenoidal surgical anatomy briefing, the pituitary fossa is described as being bounded by the:
A. Anterior and posterior commissures
B. Anterior and posterior clinoids
C. Superior and inferior turbinates
D. Medial and lateral pterygoids

B. Anterior and posterior clinoids

The “saddle” structure referenced with the anterior and posterior clinoid processes is the:
A. Cribriform plate
B. Jugular foramen
C. Foramen magnum
D. Sella turcica

D. Sella turcica

A surgeon approaches the pituitary from below; the sinus immediately inferior to the sella turcica is the:
A. Sphenoid sinus
B. Frontal sinus
C. Maxillary sinus
D. Ethmoid sinus

A. Sphenoid sinus

Within the pituitary fossa, the pituitary gland is surrounded by:
A. Pia mater
B. Arachnoid mater
C. Dura mater
D. Ependymal lining

C. Dura mater

The dura covering the superior portion of the pituitary fossa is called the:
A. Falx cerebri
B. Diaphragma sella
C. Tentorium cerebelli
D. Ligamentum flavum

B. Diaphragma sella

The pituitary fossa is bounded laterally on both sides by the:
A. Straight sinus
B. Sigmoid sinus
C. Transverse sinus
D. Cavernous sinus

D. Cavernous sinus

A sellar mass expands posteriorly and inferiorly and compresses the optic chiasm. The most likely deficit is:
A. Bitemporal hemianopia
B. Homonymous hemianopia
C. Central scotoma
D. Monocular blindness

A. Bitemporal hemianopia

The most medial hypothalamic nucleus, closest to the third ventricle, is the:
A. Lateral nucleus
B. Arcuate nucleus
C. Periventricular nucleus
D. Ventromedial nucleus

C. Periventricular nucleus

The medial forebrain bundle (MFB) is a diffuse fiber system running through the:
A. Arcuate nucleus region
B. Preoptic area
C. Lateral hypothalamic area
D. Mammillary bodies

C. Lateral hypothalamic area

The preoptic area is derived embryologically from the:
A. Telencephalon
B. Diencephalon
C. Mesencephalon
D. Rhombencephalon

A. Telencephalon

Specialized retinal ganglion cells containing melanopsin signal day–night via the retinohypothalamic tract to the:
A. Arcuate nucleus
B. Ventromedial nucleus
C. Tuberomammillary nucleus
D. Suprachiasmatic nucleus

D. Suprachiasmatic nucleus

A lesion limited to the tuberal (middle) hypothalamus would most directly involve:
A. Medial and intermediate mammillary
B. Arcuate, ventromedial, dorsomedial
C. Preoptic, suprachiasmatic, supraoptic
D. Posterior nucleus, lateral mammillary

B. Arcuate, ventromedial, dorsomedial

A hypothalamic nucleus projecting to the median eminence to control the anterior pituitary is the:
A. Arcuate nucleus
B. Suprachiasmatic nucleus
C. Posterior hypothalamic nucleus
D. Lateral mammillary nucleus

A. Arcuate nucleus

The posterior (mammary) hypothalamic region includes:
A. Arcuate, ventromedial, dorsomedial, nuclei
B. Preoptic region nuclei
C. Mammillary nuclei, posterior nucleus
D. Supraoptic paraventricular nuclei

C. Mammillary nuclei, posterior nucleus

The subiculum projects to the mammillary bodies via the:
A. Stria terminalis
B. Fornix
C. Mammillothalamic tract
D. Ventral amygdalofugal pathway

B. Fornix

The mammillothalamic tract terminates primarily in the:
A. Anterior thalamic nucleus
B. Mediodorsal thalamic nucleus
C. Ventral posterolateral nucleus
D. Lateral geniculate nucleus

A. Anterior thalamic nucleus

Which list matches the 4 major hypothalamic regions in these notes?
A. Anterior, middle, posterior, suprachiasmatic
B. Periventricular, lateral, preoptic, medial
C. Mammillary, arcuate, VM, DM
D. Supraoptic, tuberal, mammillary, preoptic

B. Periventricular, lateral, preoptic, medial

Two hypothalamus-to-amygdala pathways are:
A. Fornix + mammillothalamic
B. Retinohypothalamic + fornix
C. Stria terminalis + ventral amygdalofugal
D. Mammillothalamic + cingulum

C. Stria terminalis + ventral amygdalofugal

A child has gelastic seizures (laughing spells) with behavioral and cognitive disturbances; imaging shows a rare benign mass. Most likely diagnosis:
A. Craniopharyngioma
B. Hypothalamic hamartoma
C. Pituitary macroadenoma
D. Temporal lobe glioma

B. Hypothalamic hamartoma

Ventrolateral preoptic area (VLPO) GABAergic neurons promote nonREM sleep primarily by:
A. Inhibiting arousal systems
B. Activating orexin neurons
C. Activating TMN histamine
D. Increasing sympathetic outflow

A. Inhibiting arousal systems

A focal lesion of the anterior hypothalamus involving ventrolateral preoptic area (VLPO) most likely causes:
A. Hypersomnia
B. Hyperphagia
C. Insomnia
D. Poikilothermia

C. Insomnia

Lesions of the posterior hypothalamus destroying Tuberomammillary nucleus (TMN) histaminergic neurons and orexin neurons tend to cause:
A. Insomnia
B. Weight loss
C. Hyperthermia
D. Hypersomnia

D. Hypersomnia

ventrolateral preoptic area (VLPO) promotes non-REM sleep primarily by:
A. Inhibiting arousal systems
B. Activating orexin neurons
C. Activating histamine neurons
D. Increasing sympathetic outflow

A. Inhibiting arousal systems

Damage to the ventromedial nucleus is most likely to cause:
A. Obesity
B. Weight loss
C. Hypersomnia
D. Polydipsia

A. Obesity

An adipose-derived hormone binding Ob receptors reduces appetite and obesity risk. This hormone is:
A. Ghrelin
B. Orexin
C. Histamine
D. Leptin

D. Leptin

A gastric mucosal hormone that binds hypothalamus and stimulates appetite is:
A. Leptin
B. Histamine
C. Ghrelin
D. Orexin

C. Ghrelin

Activation of osmoreceptors in anterior hypothalamic regions produces:
A. Thirst
B. Satiety
C. NonREM sleep
D. Heat conservation

A. Thirst

A lesion of the lateral hypothalamus tends to decrease:
A. Sweat production
B. Water intake
C. Appetite inhibition
D. Circadian timing

B. Water intake

The region most implicated in detecting increased temperature and activating heat dissipation is the:
A. Posterior hypothalamus
B. Mammillary bodies
C. Arcuate nucleus
D. Anterior hypothalamus

D. Anterior hypothalamus

Bilateral posterior hypothalamic lesions can cause poikilothermia (temperature varies with environment) because of:
A. Loss heat dissipation only
B. Loss conservation and dissipation pathways
C. Loss appetite inhibition only
D. Loss sleep arousal balance

B. Loss conservation and dissipation pathways

Choose the correct two: portal first plexus site and cavernous sinus primary drainage route:
A. infundibulum; sigmoid sinus
B. tuber cinereum; straight sinus
C. median eminence; petrosal sinuses
D. mammillary; transverse sinus

C. median eminence; petrosal sinuses

Oxytocin and vasopressin enter systemic blood from the posterior pituitary via a:
A. Arterial sinusoid plexus
B. Portal venous plexus
C. Capillary plexus
D. Lymphatic plexus

C. Capillary plexus

A slow-growing, histologically benign tumor from anterior pituitary glandular epithelium is a:
A. Pituitary adenoma
B. Craniopharyngioma
C. Meningioma
D. Chordoma

A. Pituitary adenoma

Even pituitary microadenomas smaller than ____ mm can cause major endocrine abnormalities:
A. 10 mm
B. 5 mm
C. 2 mm
D. 1 mm

D. 1 mm

If untreated, large pituitary adenomas can eventually cause:
A. Seizures, temporal gliosis
B. Hydrocephalus, brainstem compression
C. Meningitis, CSF leak
D. SAH, vasospasm

B. Hydrocephalus, brainstem compression

The most commonly secreted hormone in pituitary adenomas (~50%) is:
A. Prolactin
B. ACTH
C. TSH
D. FSH

A. Prolactin

After prolactin, the next most common pituitary adenoma secretion is:
A. TSH
B. LH
C. ACTH
D. Growth hormone

D. Growth hormone

Management options for pituitary adenomas include:
A. Chemotherapy, surgery, observation
B. Medication, surgery, radiotherapy
C. Antibiotics, steroids, shunting
D. Embolization, surgery, anticoagulation

B. Medication, surgery, radiotherapy

Prolactin-secreting adenomas often respond well to:
A. Somatostatin analog therapy
B. Glucocorticoid antagonist therapy
C. Dopamine agonist therapy
D. Thyroid hormone replacement

C. Dopamine agonist therapy

Which pair are dopaminergic agonists used for prolactinomas?
A. Propranolol, methimazole
B. Desmopressin, vasopressin
C. Octreotide, ketoconazole
D. Bromocriptine, cabergoline

D. Bromocriptine, cabergoline

Initial treatment for non–prolactin secreting pituitary adenomas is usually:
A. Surgery
B. Dopamine agonists
C. Observation only
D. Steroid suppression

A. Surgery

A sellar adenoma is removed using a standard route; suprasellar extension may require a different route. Best pairing is:
A. Intracranial; transsphenoidal if suprasellar
B. Transorbital; endonasal if suprasellar
C. Transsphenoidal; intracranial if suprasellar
D. Transventricular; suboccipital if suprasellar

C. Transsphenoidal; intracranial if suprasellar

A patient has moon facies, truncal fat, hirsutism, purple striae, thin skin, HTN, diabetes, edema, infections, osteoporosis, femoral head AVN, amenorrhea, low libido, fatigue, and mood changes. Most likely syndrome:
A. Addison syndrome
B. Cushing syndrome
C. SIADH
D. Hyperthyroidism

B. Cushing syndrome

Radiotherapy mainly reserved for pituitary adenomas failing surgery or in high operative risk most commonly uses:
A. Whole-brain radiotherapy
B. Brachytherapy implants
C. Chemoradiation protocols
D. Gamma knife radiotherapy

D. Gamma knife radiotherapy

A woman with pituitary adenoma has galactorrhea, infertility, weight gain, hair loss, and decreased libido. Most typical additional finding:
A. Amenorrhea
B. Heat intolerance
C. Polyuria
D. Resting tremor

A. Amenorrhea

A man with pituitary adenoma has infertility, weight gain, hair loss, and decreased libido. Most typical additional finding:
A. Hyperthyroidism
B. Hypogonadism
C. Hyperkalemia
D. Polycythemia

B. Hypogonadism

Suspected ACTH-dependent hypercortisolism: dexamethasone is given at midnight and next-morning cortisol (or urine metabolites) is suppressed. This most strongly supports:
A. Ectopic ACTH tumor
B. Adrenal cortisol tumor
C. Pituitary ACTH adenoma
D. Exogenous glucocorticoids

C. Pituitary ACTH adenoma

A patient with acromegaly has carpal tunnel syndrome, arthritis, hypertension, and diabetes. Which additional problem from the same note set is also expected?
A. Infertility
B. Hematuria
C. Diplopia
D. Hyperkalemia

A. Infertility

Best diagnostic support for acromegaly per this note set is:
A. Low IGF-1, low GH
B. High TSH, low T4
C. High cortisol, low ACTH
D. High IGF-1, High GH, MRI

D. High IGF-1, High GH, MRI

A patient with hypercortisolism has very low ACTH levels. This usually suggests a(n):
A. Pituitary source
B. Adrenal source
C. Ectopic ACTH source
D. Hypothalamic source

B. Adrenal source

TSH-secreting pituitary adenomas are a rare cause of:
A. Hypothyroidism
B. Adrenal insufficiency
C. Hyperthyroidism
D. Diabetes insipidus

C. Hyperthyroidism

ACTH-secreting pituitary adenomas cause:
A. Nelson syndrome
B. Addison disease
C. Conn syndrome
D. Cushing disease

D. Cushing disease

“Cushing syndrome” refers to clinical features of:
A. Glucocorticoid excess, any cause
B. Mineralocorticoid excess, any cause
C. Catecholamine excess, any cause
D. Thyroid hormone excess, any cause

A. Glucocorticoid excess, any cause

Endogenous Cushing syndrome is most commonly due to:
A. Primary adrenal tumors (~85%)
B. ACTH overproduction (~85%)
C. Exogenous steroids (~85%)
D. Androgen excess (~85%)

B. ACTH overproduction (~85%)

Catheters passed femoral → internal jugular → inferior petrosal sinuses show a 3-fold ACTH rise centrally versus peripheral. This indicates:
A. Adrenal cortisol tumor
B. Ectopic ACTH tumor
C. Pituitary ACTH adenoma
D. Exogenous glucocorticoids

C. Pituitary ACTH adenoma

Which set lists the more common causes of hyperthyroidism?
A. Hashimoto, iodine deficiency, ablation
B. ACTH adenoma, thyroiditis, Graves
C. Graves, thyroiditis, toxic multinodular goiter, thyroid adenoma
D. TSH deficiency, hypopituitarism, thyroidectomy

C. Graves, thyroiditis, toxic multinodular goiter, thyroid adenoma

A patient has proptosis and dermopathy; pathology shows inflammatory involvement of thyroid, skin, and orbital tissues with extraocular muscle fibrosis. Most likely diagnosis?
A. Graves disease
B. Toxic multinodular goiter
C. Subacute thyroiditis
D. Hashimoto thyroiditis

A. Graves disease

Which set best matches common causes of hypothyroidism?
A. Graves, thyroid adenoma, thyroiditis
B. Toxic multinodular goiter, Graves
C. Iodine excess, TSH adenoma, lithium
D. Autoimmune thyroid disease, iodine deficiency, prior ablation

D. Autoimmune thyroid disease, iodine deficiency, prior ablation

A pituitary lesion is found on MRI done for migraines; labs are normal and the patient is asymptomatic. Best term?
A. Prolactinoma
B. Pituitary incidentaloma
C. Pituitary apoplexy
D. Panhypopituitarism

B. Pituitary incidentaloma

Large volumes of dilute urine due to ADH deficiency or renal ADH resistance best defines:
A. Diabetes insipidus
B. SIADH
C. Cerebral salt wasting
D. Primary polydipsia

A. Diabetes insipidus

DI is established in polyuria when urine osmolality is ____ despite plasma osmolality ____:
A. High; increased
B. High; decreased
C. Low; increased
D. Low; decreased

C. Low; increased

After SQ vasopressin, urine osmolality rises in neurogenic DI but not in:
A. Central DI
B. Nephrogenic DI
C. Primary polydipsia
D. Psychogenic polydipsia

B. Nephrogenic DI

Best treatment approach for DI in these notes is:
A. Fluid restriction only
B. Loop diuretic therapy
C. Steroid replacement only
D. SQ or intranasal vasopressin analog

D. SQ or intranasal vasopressin analog

Hyponatremia with inappropriately elevated urine osmolality most strongly suggests:
A. Diabetes insipidus
B. Cerebral salt wasting
C. Primary polydipsia
D. SIADH

D. SIADH

A pituitary tumor undergoes spontaneous hemorrhage. This event is:
A. Pituitary incidentaloma
B. Panhypopituitarism
C. Pituitary apoplexy
D. SIADH

C. Pituitary apoplexy

A pituitary tumor causes bitemporal hemianopia by compressing the:
A. Optic chiasm
B. Optic tract
C. Lateral geniculate body
D. Optic radiation

A. Optic chiasm

Which list matches the 4 major hypothalamic regions in these notes?
A. Anterior, middle, posterior, suprachiasmatic
B. Periventricular, lateral, preoptic, medial
C. Mammillary, arcuate, VM, DM
D. Supraoptic, tuberal, mammillary, preoptic

B. Periventricular, lateral, preoptic, medial

Fibers of the medial forebrain bundle run through which hypothalamic area?
A. Periventricular area
B. Preoptic area
C. Lateral hypothalamic area
D. Medial hypothalamic area

C. Lateral hypothalamic area

Medial and lateral hypothalamic areas are separated by fibers of the:
A. Fornix
B. Stria terminalis
C. Mammillothalamic tract
D. Retinohypothalamic tract

A. Fornix

The separating fornix fibers pass through hypothalamus en route to the:
A. Median eminence
B. Optic chiasm
C. Anterior thalamic nucleus
D. Mammillary bodies

D. Mammillary bodies

Which is NOT a medial hypothalamic subregion?
A. Anterior supraoptic region
B. Preoptic area
C. Middle tuberal region
D. Posterior mammillary region

B. Preoptic area

Nuclei in the anterior (supraoptic) medial hypothalamus include:
A. Anterior, hypothalamic, supraoptic, paraventricular, suprachiasmatic
B. Arcuate, ventromedial, dorsomedial nuclei
C. Medial, intermediate, lateral, mammillary nuclei
D. Posterior nucleus, arcuate nucleus

A. Anterior, hypothalamic, supraoptic, paraventricular, suprachiasmatic

Nuclei in the middle (tuberal) medial hypothalamus include:
A. Supraoptic, paraventricular, suprachiasmatic nuclei
B. Medial, intermediate, lateral, mammillary nuclei
C. Preoptic, periventricular, lateral nuclei
D. Arcuate, ventromedial, dorsomedial nuclei

D. Arcuate, ventromedial, dorsomedial nuclei

To control anterior pituitary, arcuate nucleus projects to the:
A. Posterior pituitary
B. Median eminence
C. Diaphragma sella
D. Cavernous sinus

D. Cavernous sinus

Descending autonomic fibers originate mainly from the:
A. Arcuate nucleus
B. Tuberomammillary nucleus
C. Paraventricular nucleus
D. Lateral mammillary nucleus

C. Paraventricular nucleus

After traveling in the medial forebrain bundle, descending autonomic fibers pass through:
A. Optic tract
B. Mammillothalamic tract
C. Cingulate gyrus
D. Dorsolateral brainstem

D. Dorsolateral brainstem

Hypothalamic autonomic outputs ultimately influence:
A. Preganglionic, parasympathetic and IML sympathetic
B. Upper motor neurons only
C. Dorsal root ganglia only
D. Cerebellar nuclei only

A. Preganglionic, parasympathetic and IML sympathetic

Preganglionic sympathetic neurons targeted by hypothalamus are located in:
A. Brainstem parasympathetic nuclei
B. Thoracolumbar IML cell column
C. Cervical dorsal horn
D. Sacral anterior horn

B. Thoracolumbar IML cell column

The hippocampal formation projects to mammillary bodies via the:
A. Stria terminalis
B. Ventral amygdalofugal pathway
C. Fornix
D. Retinohypothalamic tract

C. Fornix

Mammillary bodies project toward thalamus via the:
A. Mammillothalamic tract
B. Stria terminalis
C. Fornix
D. Medial forebrain bundle

A. Mammillothalamic tract

Limbic–hypothalamic pathways are key for:
A. Emotional influence on autonomics
B. Visual field integration
C. Voluntary motor planning
D. Auditory localization

A. Emotional influence on autonomics

Hypothalamic hamartomas may cause precocious puberty by:
A. Dopamine excess release
B. Releasing hormone secretion
C. Aldosterone secretion
D. ADH hypersecretion

B. Releasing hormone secretion

VLPO promotes non-REM sleep primarily by:
A. Inhibiting arousal systems
B. Activating orexin neurons
C. Activating histamine neurons
D. Increasing sympathetic outflow

A. Inhibiting arousal systems

Posterior hypothalamic lesions cause hypersomnia by destroying:
A. VLPO GABA neurons
B. TMN histamine and orexin neurons
C. Arcuate neurosecretory cells
D. Suprachiasmatic clock neurons

B. TMN histamine and orexin neurons

TMN histaminergic and orexin neurons are components of the:
A. Non-REM generator
B. Endocrine portal pathway
C. Arousal system
D. Visual relay pathway

C. Arousal system

Anterior pituitary hormone release is controlled via the:
A. Hypophysial portal system
B. Cavernous sinus drainage
C. Mammillothalamic tract
D. Retinohypothalamic tract

A. Hypophysial portal system

Pituitary arterial blood primarily comes from the:
A. Vertebral artery branches
B. Middle meningeal artery branches
C. Superior and inferior hypophysial arteries
D. Anterior cerebral artery branches

C. Superior and inferior hypophysial arteries

The pituitary intermediate lobe can produce which pair?
A. ADH and oxytocin
B. POMC and MSH
C. GH and prolactin
D. ACTH and cortisol

B. POMC and MSH

A pituitary adenoma is best described as a:
A. Posterior axonal terminal tumor
B. Metastatic sellar lesion
C. Granulomatous hypophysitis mass
D. Benign anterior epithelial tumor

D. Benign anterior epithelial tumor

Pituitary adenomas make up about:
A. 12% intracranial neoplasms
B. 1% intracranial neoplasms
C. 30% intracranial neoplasms
D. 5% intracranial neoplasms

A. 12% intracranial neoplasms

Most pituitary adenomas are:
A. Nonfunctioning, clinically silent
B. Nonfunctioning, compressive only
C. Functioning, hormone-secreting
D. Inflammatory, autoimmune-mediated

C. Functioning, hormone-secreting

Nonfunctioning adenoma headache is attributed to irritation of pain fibers in the:
A. Adjacent cavernous region
B. Optic tract region
C. Sphenoid sinus roof
D. Third ventricle wall

A. Adjacent cavernous region

A nonfunctioning sellar mass causes progressive peripheral vision loss. Most likely deficit?
A. Central scotoma
B. Homonymous hemianopia
C. Monocular blindness
D. Bitemporal hemianopia

D. Bitemporal hemianopia

The first capillary plexus of the hypophysial portal system occurs in the:
A. Posterior pituitary
B. Cavernous sinus
C. Median eminence
D. Diaphragma sella

C. Median eminence

Which set correctly lists nuclei projecting to the median eminence?
A. Arcuate, ventromedial, dorsomedial, SCN
B. Supraoptic, posterior, lateral, mammillary
C. Mammillary, posterior, arcuate, DMN
D. Arcuate, periventricular, medial preoptic, paraventricular

D. Arcuate, periventricular, medial preoptic, paraventricular

A patient with GH-secreting adenoma needs drug therapy. Best choice:
A. Cabergoline, dopamine agonist
B. Desmopressin, V2 agonist
C. Dexamethasone, glucocorticoid
D. Octreotide, somatostatin analog

D. Octreotide, somatostatin analog

Standard surgical approach used for most pituitary tumors is:
A. Transsphenoidal resection
B. Suboccipital craniotomy
C. Pterional craniotomy
D. Transventricular approach

A. Transsphenoidal resection

In the transsphenoidal approach, the pituitary fossa is entered through the:
A. Frontal sinus floor
B. Ethmoid sinus roof
C. Sphenoid sinus roof
D. Maxillary sinus roof

C. Sphenoid sinus roof

Prolactinomas suppress sexual function primarily because prolactin:
A. Stimulates GnRH release
B. Inhibits LHRH, lowers LH/FSH
C. Increases LH, decreases FSH
D. Blocks androgen receptors directly

B. Inhibits LHRH, lowers LH/FSH

Petrosal sinus sampling is most useful to:
A. Diagnose central pontine myelinolysis
B. Distinguish central vs nephrogenic DI
C. Confirm TSH-secreting adenoma
D. Separate pituitary vs ectopic ACTH

D. Separate pituitary vs ectopic ACTH

During petrosal sinus sampling, catheters are advanced:
A. Femoral → jugular → inferior petrosal
B. Femoral → carotid → cavernous sinus
C. Jugular → femoral → petrosal sinuses
D. Subclavian → vertebral → basilar

A. Femoral → jugular → inferior petrosal

High-dose dexamethasone that fails to suppress ACTH most suggests:
A. Pituitary ACTH adenoma
B. Exogenous glucocorticoid exposure
C. Nonpituitary ACTH tumor
D. Physiologic stress response

C. Nonpituitary ACTH tumor

Central (neurogenic) DI is most classically due to:
A. Neurosurgery, trauma, infiltrative lesions
B. Renal collecting duct mutation
C. Excess aldosterone secretion
D. Primary adrenal insufficiency

A. Neurosurgery, trauma, infiltrative lesions

Nephrogenic DI is best explained by:
A. Excess ADH secretion
B. Lack of thirst perception
C. Supraoptic neuron degeneration
D. Renal insensitivity to ADH

D. Renal insensitivity to ADH

A posterior pituitary lesion usually causes DI only when:
A. Optic chiasm is compressed
B. High stalk injury causes degeneration
C. Cavernous sinus is irritated
D. Median eminence is infarcted

B. High stalk injury causes degeneration

After subcutaneous ADH, urine osmolality rises in:
A. Primary polydipsia
B. SIADH
C. Central diabetes insipidus
D. Nephrogenic diabetes insipidus

C. Central diabetes insipidus

Drug of choice for SIADH in this note set:
A. Bromocriptine
B. Octreotide
C. Desmopressin
D. Vaprisol

D. Vaprisol

Overly rapid correction of severe SIADH with hypertonic saline risks:
A. Subarachnoid hemorrhage
B. Central pontine myelinolysis
C. Optic neuritis
D. Temporal lobe seizures

B. Central pontine myelinolysis

Sudden headache, meningeal signs, cavernous sinus syndrome, vision loss, hypotension, coma in a pituitary tumor patient suggests:
A. Cavernous sinus thrombosis
B. Migraine with aura
C. Pituitary apoplexy
D. Subacute thyroiditis

C. Pituitary apoplexy