A 45-year-old previously healthy woman has felt a lump in her neck for the past month. On physical examination she has a palpable solitary 2 cm non-tender right cervical lymph node. The thyroid is not enlarged. By ultrasonography the node appears solid, and with a PET scan it has increased activity. Laboratory findings include a serum free thyroxine index of 2.1, TSH of 2.8 mU/ml, sodium 141 mmol/L, potassium 4.2 mmol/L, chloride 106 mmol/L, CO2 25 mmol/L, glucose 86 mg/dL, creatinine 1.2 mg/dL, calcium 8.6 mg/dL, and phosphorus 3.2 mg/dL. Which of the following neoplasms is she most likely to have?
A Papillary carcinoma
B Parathyroid carcinoma
C Medullary carcinoma
D Anaplastic carcinoma
E Parathyroid adenoma
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A 46-year-old man suffered blunt abdominal trauma in a vehicular accident. On physical examination no injuries are noted externally, but on abdominal MR imaging a 1 cm right adrenal cortical mass is seen. No abnormal laboratory findings are noted. His physician decides to leave the mass alone. Which of the following is the most likely diagnosis?
A Metastasis from a lung carcinoma
B Nonfunctioning adrenal adenoma
C Histoplasma granuloma
D Benign simple cyst
E Hematoma from traumatic injury
A 43-year-old woman has noted a feeling of fullness in her neck for the past 3 months. She otherwise feels fine and has had no major illnesses. On physical examination there is painless symmetric enlargement of the thyroid gland. A complete blood count, electrolyte panel, and urinalysis are all normal. The serum free thyroxine index and TSH are normal. Which of the following conditions is she most likely to have?
A Graves disease
B Follicular carcinoma
C Simple goiter
D Hashimoto thyroiditis
E Pituitary adenoma
A 68-year-old woman had a blood pressure of 155/95 mm Hg measured during a free health fair screening program. She still was hypertensive a week later when she saw her family physician. Laboratory studies showed sodium 145 mmol/L, potassium 2.9 mmol/, chloride 107 mmol/L, and CO2 24 mmol/L. Her serum glucose was 105 mg/dl. She continued to feel fine. A physical examination revealed no abnormal findings. Which of the following conditions is she most likely to have?
A Cushing syndrome
B Nelson syndrome
C Conn syndrome
D Congenital adrenal hyperplasia
E Multiple endocrine neoplasia, IIa
A 16-year-old girl presents to the emergency room with rapid, labored respirations. On examination she appears emaciated. Her vital signs show T 36.8 C, R 25, P 102, and BP 85/40 mm Hg. Her heart rate is regular and her lungs are clear to auscultation. Arterial blood gases show pO2 110 mm Hg, pCO2 30 mm Hg, and HCO3 8 meq/L on room air. A urinalysis shows sp gr 1.023, pH 7.5, no blood, no protein, 4+ glucose, and 4+ ketones. Which of the following pathologic conditions is most likely to be present?
A Absence of islet cells
B Adrenal adenoma
C Craniopharyngioma
D Graves disease
E Parathyroid hyperplasia
A 19-year-old woman has had pharyngitis, fever, and severe headache for less than 8 hours. On physical examination she has extensive purpura of the skin. She dies suddently. At autopsy there are dark, hemorrhagic, and slightly enlarged adrenal glands. Which of the following is the most likely diagnosis?
A Idiopathic Addison disease
B Metastatic carcinoma
C Meningococcemia
D Widespread tuberculosis
E Pheochromocytoma
A 15-year-old boy has had headaches for 2 months. No abnormal findings are present on physical examination. A head CT scan reveals a 4 cm suprasellar mass with calcifications that is eroding the bone of the surrounding sella turcica. Which of the following is the most likely neoplasm to cause these findings?
A Prolactinoma
B ACTH adenoma
C Astrocytoma
D Null cell adenoma
E Craniopharyngioma
While bathing her 1-year-old baby, a mother notices that the boy's abdomen seems larger than normal. The baby has not been feeding well lately, and is below the expected weight for his age. She takes the infant to the family physician who palpates a mass lesion in the abdominal region. A CT scan reveals a 5 cm mass in the left retroperitoneum adjacent to the kidney and displacing the kidney. Which of the following is the most likely diagnosis?
A Congenital adrenal hyperplasia
C Pheochromocytoma
D Adrenal cortical carcinoma
E Neuroblastoma
A 63-year-old man has had a chronic cough for 5 years, but recently has noted blood-tinged sputum. On physical examination there are no abnormal findings. Laboratory studies show a serum sodium of 120 mEq/L, potassium 3.9 mmol/L, chloride 88 mmol/L, CO2 23 mmol/L, creatinine 1.0 mg/dL, and glucose 72 mg/dL. Which of the following is the most likely diagnosis?
A Craniopharyngioma
B Non-secretory (null cell) pituitary adenoma
D Small cell anaplastic lung carcinoma
E Adrenal cortical carcinoma
A 74-year-old woman suffers severe back pain while picking up a basket of clothes. On physical examination her skin is thin with areas of purpura. Her blood pressure is 150/95 mm Hg. A plain film x-ray of the spine reveals a recent compressed fracture of T12 along with multiple older compressed fractures of the vertebrae. She has a serum glucose of 145 mg/dl. Chronic use of which of the following pharmacologic agents is most likely to produce these findings?
A Bromocriptine
B Propranolol
C NSAIDS
D Prednisone
E Lisinopril
A 22-year-old woman complains of vague abdominal pain along with some pain in her extremities. She has felt terrible and depressed for several months. Physical examination reveals no major findings. A chest x-ray is normal. A serum chemistry panel reveals a serum calcium of 13.8 mg/dl with albumin of 3.9 g/dl and phosphorus of 2.2 mg/dl. Which of the following is the most likely diagnosis?
A Metastatic carcinoma
B Parathyroid adenoma
C Chronic renal failure
D Pituitary adenoma
E Thyroid carcinoma
A 54-year-old woman is found wandering aimlessly in Palisades Park near Santa Monica Pier. On examination she is disoriented, doesn't know her name, is extremely weak, and has an irregular heart rate. Laboratory studies show a serum calcium of 15.8 mg/dl with an ionized calcium of 3.3 mmol/L, phosphorus 1.9 mg/dl, total protein 5.8 g/dl, and albumin 3.5 g/dl. A chest x-ray reveals clear lungs but there are osteolytic lesions of ribs and vertebrae. Which of the following is the most likely diagnosis?
A Chronic renal failure
B Metastatic breast carcinoma
C Parathyroid adenoma
D Disseminated tuberculosis
E Parathyroid carcinoma
A 61-year-old man has a 90 pack year smoking history. He has lost 15 kg in the past 4 months. He had a recent episode of hemoptysis. On physical examination vital signs include temperature 36.9 C, pulse 80/minute, respirations 20/minute, and blood pressure 165/100 mm Hg. His abdomen has prominent striae. A sputum cytology demonstrates malignant cells present consistent with small cell anaplastic carcinoma. Which of the following endocrine glandular findings is he most likely to have?
A Nodular goiter
B Pituitary adenoma
C Bilateral adrenal hyperplasia
D Parathyroid carcinoma
E Papillary carcinoma
A 40-year-old man has noted a change in his facial features over the past year. On physical examination his blood pressure is 150/90 mm Hg. He has prognathia and increased separation of teeth. A radiograph of his right foot shows an increase in the thickness of the heel pad. A DEXA scan shows decreased bone mineral density. Laboratory studies show sodium 140 mmol/L, potassium 4.0 mmol/L, chloride 105 mmol/L, CO2 25 mmol/L, creatinine 1.5 mg/dL, glucose 162 mg/dL, alkaline phosphatase 202 U/L, and total bilirubin 1.0 mg/dL. Which of the following neoplasms is he most likely to have?
A Adrenal cortical adenoma
B Extra-adrenal pheochromocytoma
D Parathyroid adenoma
A 63-year-old man has had increasing fatigue for the past year. On physical examination he is 165 cm tall and weighs 90 kg. Vital signs show T 37 C, P 73/minute, RR 16/minute, and BP 150/95 mm Hg. Laboratory studies show a creatinine of 6.5 mg/dl and glucose 182 mg/dL. Which of the following endocrine lesions is he most likely to develop if he remains untreated?
B Cushing syndrome
C Addison disease
D Parathyroid hyperplasia
E Hypopituitarism
A 40-year-old man develops fever and worsening mental confusion over the past day. On physical examination vital signs include T 40.2 C, P 108/minute, RR 21/minute, and blood pressure 145/85 mm Hg. There are areas of thickening and hyperpigmentation of the skin of the lower legs. He has proptosis. His condition improves with propranolol therapy. Which of the following laboratory test findings is most likely to be characteristic for this man's disease?
A Cortisol of 55 microgm/dL
B Norepinephrine of 205 microgm/24hr
C Parathormone of 65 pg/mL
D Renin activity of 6 ng/mL/hr
E TSH of 0.2 mU/mL
A 40-year-old man has suffered from an almost constant headache for the past 3 weeks. Physical examination reveals a bitemporal hemianopsia. Which of the following conditions is most likely to be present in this man?
B Empty sella syndrome
C Prolactinoma
D Sheehan syndrome
E Metastatic carcinoma
A 48-year-old woman has noted increasing weakness, back pain, and increased growth of body hair over the past 6 months. On pnysical examination she has vital signs with T 37.1 C, P 83/minute, RR 16/minute, and BP 145/90 mm Hg. She has truncal obesity and 4/5 motor strength in extremities. A radiograph of the spine shows a compression fracture of T9. She is taking no medications. Which of the following diseases is most likely to be the cause for her findings?
A Tuberculosis
B Extra-adrenal paraganglioma
C Multiple endocrine neoplasia, type I
D Ectopic ACTH production
E 21-hydroxylase enzyme deficiency
A 49-year-old moderately obese woman with chronic headaches has a routine physical exam, and her physician palpates a nodule in the right neck region. The cytopathologist next performs a fine needle aspirate. Following this procedure, a thyroidectomy is performed. There is a 2 cm diameter mass that is firm and light brown. Microscopically, this mass shows a fairly uniform population of small cells with pale blue cytoplasm and clear nuclei lining fibrovascular cores in a papillary pattern. There are scattered psammoma bodies. Which of the following statements made to the patient is most appropriate regarding this neooplasm?
A Your long-term prognosis is good
B Other family members are at risk for this disease
C The primary site for this lesion is probably in the breast
D Your headaches resulted from a paraneoplastic syndrome
E This lesion is likely to have occurred because you were overweight
In an experiment, the actions of parathormone are studied. When levels of parathormone are increased, the serum ionized calcium is observed to increase while serum phosphorus decreases. The decrease in phosphorus is most likely mediated by the action of parathormone on which of the following cells?
A Enterocyte
B Proximal tubular cell
C Osteoblast
D Osteoclast
E Thyroid C cell
F Visceral epithelial cell
A 40-year-old woman developed pain in her neck over the past 2 weeks. On physical examination her thyroid is enlarged and firm but tender to palpation. A fine needle aspiration biopsy shows atypical cell present. At surgery a frozen section is performed and on microscopic examination shows multinucleated giant cells along with acute and chronic inflammatory cells and destruction of thyroid follicles. Which of the following is the most likely risk factor for development of her disease?
A Viral pneumonia
B Iodine deficiency
C RET gene mutation
D HLA-DR3 allele
E Prior radiation exposure
A 53-year-old woman has experienced headaches for the past 4 months. On physical examination she is obese. She has bitemporal hemianopsia. Skull radiographs reveal enlargement of the sella turcica without bony destruction or calcifications within the sella. Laboratory studies show a free serum thyroxine of 0.6 ng/dL and a TSH of 4.7 mU/mL. Her serum prolactin is 31 ng/mL. She is eight years postmenopausal and has had eight children, all in good health. Which of the following is the most likely diagnosis?
A Meningococcemia
B Craniopharyngioma
C Sheehan syndrome
D Gunshot wound to head
E Empty sella syndrome
A 40-year-old man goes to his physician for a routine examination. He is found to have a blood pressure of 160/90 mm Hg. An abdominal CT scan shows a 4 cm mass involving the left adrenal gland. Laboratory studies show increased urinary metanephrins. A left adrenalectomy is performed. Electron micrographic analysis of cells from the mass reveals numerous small dark granules in the cell cytoplasm. Which of the following embryologic structures do the cells of this mass most likely mimic?
A Metanephric blastema
B Neural crest
C Neuroectoderm
D Somites
E Ureteric bud
A 48-year-old woman has noted over the past year that her skin bruises and abrades easily with minimal trauma. Her family has noted emotional lability. She has gained 5 kg. On physical examination she has rounded facies and a prominent dorsocervical fat pad. MR imaging of the brain shows a 1 cm mass in the sella turcica with with gadolinium enhancement. Which of the following hormones is most likely to be increased in this woman?
A ACTH (corticotropin)
B TSH (thyrotropin)
C GH (growth hormone)
D LH (luteinizing hormone)
E PRL (prolactin)
A 39-year-old woman has noted a lump in her neck for the past month. On physical examination there is a firm nodule palpable in the right lobe of her thyroid. There are no other abnormalities noted. A fine needle aspiration biopsy is performed, and cytologic examination of cells from the nodule show carcinoma. A total thyroidectomy is performed. On microscopic examination the neoplastic cells form papillations over fibrovascular cores and scattered psammoma bodies are present. There is no history of this neoplasm occurring in other family members. A mutation involving which of the following genes is most likely to be present in cells of this neoplasm?
A APC
B K-RAS
C N-MYC
D RET
E TP53
A 55-year-old man has had multiple bouts of urinary tract infection with Candida albicans over the past 7 months. On physical examination he has truncal obesity and a blood pressure of 160/100 mm Hg. An abdominal CT scan shows bilateral adrenal enlargement. Laboratory studies show a plasma cortisol of 25 microgram/dL. Both low and high dose dexamethasone suppression tests fail to suppress the cortisol level. Which of the following neoplasms is this man most likely to have?
A Adrenal cortical adenomas
B Adrenal cortical carcinomas
C Bronchogenic carcinoma
D Colonic adenocarcinoma
F Pituitary adenoma
G Renal cell carcinoma
A 41-year-old woman comes to her physician because thyroid cancer "runs in the family." On physical examination there are no abnormal findings. An ultrasound scan of the thyroid shows several small solid thyroid nodules. Laboratory studies show an increased serum calcitonin. Which of the following neoplasms of the thyroid is she most likely to have?
B Medullary carcinoma
C Non-Hodgkin lymphoma
D Follicular carcinoma
E Anaplastic carcinoma
A 39-year-old man goes to his physician for a routine check of his health status. Vital signs include T 37 C, P 70/minute, RR 15/minute, and BP 150/95 mm Hg. No other remarkable findings are present. Laboratory studies show Na 141 mmol/L, K 2.9 mmol/L, CL 103 mmol/L, CO2 25 mmol/L, creatinine 1.1 mg/dL, and glucose 72 mg/dL. An abdominal CT scan shows a 2 cm nodule in the left adrenal gland. Which of the following laboratory test findings is most likely to be present in this man?
A Decreased plasma renin
B Decreased ACTH
C 21-hydroxylase deficiency
D Elevated homovanillic acid
E Increased norepinephrine
A 26-year-old woman with systemic lupus erythematosus and lupus nephritis receives corticosteroid therapy for 3 months. Which of the following pathologic abnormalities involving her adrenal glands is most likely to have occurred?
A Hyperplasia
B Atrophy
C Carcinoma
D Necrosis
E Inflammation
A 5-year-old girl is brought to the pediatrician because she shows breast development and growth of pubic hair. On physical examination her vital signs include T 37 C, P 84/minute, RR 18/minute, and BP 80/40 mm Hg. Laboratory studies show sodium 126 mmol/L, potassium 4.5 mmol/L, chloride 89 mmol/L, CO2 23 mmol/L, creatinine 0.8 mmol/L, and glucose 64 mg/dL. Which of the following additional laboratory test findings is most likely to be present in this girl?
A Increased homovanillic acid
B Decreased renin
C Increased catecholamines
D Decreased cortisol
E Increased aldosterone
A 23-year-old woman has noted secretions from her breasts for the past 2 months. She has not had a menstrual period for 6 months, though she had regular periods prior to this from the age of 14. On physical examination a milky substance can be expressed from her nipples, but no breast masses are palpated. There are no other physical examination findings noted. A head CT scan shows no abnormalities. MR imaging of the brain reveals no abnormalities. Which of the following hormones is most likely to be increased in this woman?
A Antidiuretic hormone
B FSH-LH
C Growth hormone
D Melatonin
E Oxytocin
F Progesterone
G Prolactin
A 22-year-old man has experienced headaches for the past month. On physical examination he has reduction in lateral visual fields bilaterally. A head CT scan shows a mass eroding the sella turcica. MR imaging of the base of the brain shows that this 3 cm mass has cystic and solid areas with focal calcifications. From which of following embryologic structures are the cells of this mass most likely derived?
A Rathke's pouch
B Diencephalon
C Foramen cecum
D Neural crest
E 4th pharyngeal pouch
A 22-year-old G3 P2 woman has an uncomplicated pregnancy up to the time of delivery. A term male infant is delivered, but the placenta cannot be delivered and there is marked blood loss, necessitating emergent hysterectomy. She subsequently noted failure of lactation. On physical examination, her breasts appear normal. Which of the following is the most likely diagnosis?
A Sheehan syndrome
C Empty sella syndrome
D Syndrome of inappropriate ADH
E Wermer syndrome
A 66-year-old woman experiences sudden loss of speech. MR imaging of the brain shows an area of necrosis with edema involving the left temporal lobe. Three days following admission to the hospital she has a marked decline in mental status. Her blood pressure drops. Her urine output diminishes. Laboratory studies show sodium 121 mmol/L, potassium 5.2 mmol/L, chloride 87 mmol/L, CO2 24 mmol/L, creatinine 1.1 mg/dL, and glucose 49 mg/dL. Which of the following medications was she most likely taking prior to hospitalization and not receiving during her stay in hospital?
A Thyroxine
B Vasopressin
C Insulin
D Estrogen
E Hydrocortisone
A 20-year-old G2 P1 woman has felt no fetal movement by 18 weeks gestation. A screening ultrasound scan shows absence of the fetal cranial vault in a male infant. The axial skeletal system appears normal. Laboratory studies show a maternal serum glucose of 148 mg/dL with hemoglobin A1C of 9.7%. Which of the following structures is most likely to be hypoplastic in this fetus?
A Adrenals
B Pancreas
C Parathyroids
D Testes
E Thymus
A 16-year-old boy has noted a nodule in his neck for the past 6 years. On physical examination there is a firm but movable 1.5 cm nodule in the midline at the level of the hyoid bone. An ultrasound scan reveals that this nodule is cystic. From which of the following embryologic structures is this boy's lesion most likely derived?
A Foregut
B Lung buds
C Neural crest
D Pharyngeal pouch
E Thyroglossal duct
F Thyroid anlage
A study is performed of circadian rhythms in human subjects. It is observed that subjects who ingest a substance have alterations to their sleep-wake cycles. From which of the following tissues is this substance most likely to be derived?
A "C" cell
B Chief cell
C Chromaffin cell
D Glomerulosa cell
E Leydig cell
F Pinealocyte
G Pituicyte
H Somatotroph
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