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

C. Thymus

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

A. Chief cells and oxyphil cells

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

D. Calcium homeostasis

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

B. Dihydroxy form

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

B. Phosphate

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

D. Adenoma

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

A. CCDN1 gene inversion

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

C. 11

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

B. Menin (MEN1)

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

A. Hyperparathyroidism-jaw tumor syndrome

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

D. Hurthle cell tumor

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

C. Carcinomas one; adenomas multiple

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

A. Osteoporosis brown tumors osteitis fibrosa

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

B. Metastatic calcification

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

C. Renal failure

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

D. Phosphate secretion

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

B. Alpha1-hydroxylase

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

C. Hyperplastic

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

D. Surgery

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

A. AIRE

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

C. CASR gain-of-function

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

B. Heightens calcium sensing, lowers PTH

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

A. Autosomal recessive GCM2 loss-of-function

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

D. PTH maturation

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

A. Tetany

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

C. Hypoparathyroidism

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

D. Parafibromin

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

B. von Recklinghausen bone disease

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

D. Brown tumor

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

B. MEN1

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

C. Higher than actual

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

A. Dihydroxy vitamin D

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

C. Chvostek sign

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

A. Facial nerve

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

D. Eye muscle contractions

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

B. Carpal spasm with cuff

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

A. Goitrogens

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

D. Inhibiting iodide oxidation

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

B. Promoting skeletal calcium uptake

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

C. Graves disease

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

C. Sympathetic tone

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

D. Thyroid storm

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

B. Toxic adenoma

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

C. Iodine deficiency

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

A. Hashimoto disease

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

B. Inhibit thyroid secretion

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

D. LDL

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

C. Glycosaminoglycans and hyaluronate

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

A. Thyroglobulin and TPO

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

B. CTLA4 PTPN22 IL2RA

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

D. Hurthle cells

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

B. Hashimoto thyroiditis

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

C. Are absent

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

B. Viral

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

D. Multinucleate giant cells

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

B. Pretibial myxedema

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

A. Exophthalmos

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

C. Abrupt severe hyperthyroidism

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

D. Adenoma

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

D. Hypothyroidism

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

C. Retroorbital GAG deposition

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

A. Beta-blockers

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

D. Does not produce nodularity

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

B. Hyperplastic, colloid involution

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

A. Clinically euthyroid

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

C. Multinodular goiter

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

B. Plummer syndrome

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

D. Neoplastic

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

C. TSHR EZH1 GNAS

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

A. Histone methyltransferase

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

D. Well-formed intact capsule

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

B. More intact, less invasion

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

C. Thyroid follicular epithelium

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

A. RTK pathway components

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

B. RET-NTRK fusion, BRAF mutations

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

D. Chromosome 10

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

A. PTC1 and PTC2

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

C. V600E

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

B. RAS gain-of-function

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

D. TP53 CTNNB1 TERT

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

A. MEN-2

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

C. Glycosaminoglycans

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

D. Retroorbital space

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

B. Hyperplastic phase

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

C. Colloid involution phase

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

A. Euthyroid

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

D. Conventional papillary carcinoma

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

B. Thyroid adenoma

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

A. Follicular adenoma

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

C. Capsular invasion prominent

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

B. Receptor tyrosine kinase pathway

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

D. Conventional papillary carcinoma

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

A. Follicular neoplasm

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

D. Anaplastic carcinoma

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

B. Medullary carcinoma