Pituitary Gland Pathology MCQs

Pituitary Gland Pathology MCQs

Pituitary Gland Pathology MCQs

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1. Question
A 30-year-old woman presents with oligo/amenorrhea and galactorrhea. What is the likelihood of her having hyperprolactinemia?
- A. 25%
- B. 50%
- C. 75%
- D. 90%
Correct
Incorrect
Consider the association between oligo/amenorrhea and galactorrhea.
2. Question
Which of the following is the first-line therapy for prolactinomas?
- A. Cabergoline
- B. Bromocriptine
- C. Transsphenoidal surgery
- D. Radiation therapy
Correct
Incorrect
Look for the most efficacious and well-tolerated dopamine agonist.
3. Question
Which of the following is the most common cause of hyperprolactinemia?
- A. Prolactinomas
- B. Drug-induced hyperprolactinemia
- C. Hypothyroidism
- D. Hypophysitis
Correct
Incorrect
Consider the cause related to medications.
4. Question
In a patient with a large macroadenoma and only modestly elevated prolactin levels, what phenomenon should be considered?
- A. Stalk compression
- B. Hook effect
- C. Drug-induced hyperprolactinemia
- D. Hypothyroidism
Correct
Incorrect
Think about the phenomenon caused by saturation of antibodies in a two-site immunoassay.
5. Question
What is the recommended course of action for pregnant patients with macroprolactinomas?
- A. Discontinue all medications
- B. Perform visual field testing each trimester
- C. Perform MRI scans each trimester
- D. Switch to bromocriptine from cabergoline
Correct
Incorrect
Consider the importance of monitoring visual field during pregnancy.
6. Question
A 35-year-old female presents with galactorrhea and amenorrhea. What is the most appropriate initial laboratory evaluation for this patient?
- A. Serum prolactin, TSH, serum creatinine, and a pregnancy test
- B. Serum prolactin, IGF-1, serum creatinine, and a pregnancy test
- C. Serum prolactin, TSH, LH, and FSH
- D. Serum prolactin, IGF-1, LH, and FSH
Correct
Incorrect
The initial laboratory evaluation should help identify common causes of hyperprolactinemia.
7. Question
What is the primary treatment of choice for most symptomatic patients with microadenomas or idiopathic hyperprolactinemia?
- A. Estrogen replacement
- B. Transsphenoidal surgery
- C. Dopamine agonists
- D. Radiation therapy
Correct
Incorrect
The treatment should normalize prolactin levels, correct amenorrhea-galactorrhea, and decrease tumor size.
8. Question
Which of the following is a rare but significant side-effect of dopamine agonist treatment?
- A. Hyperthyroidism
- B. Cerebrospinal fluid (CSF) leak
- C. Hypoglycemia
- D. Myocardial infarction
Correct
Incorrect
This side-effect is due to the rapid shrinkage of a large prolactinoma allowing CSF to escape.
9. Question
In patients with macroprolactinomas and normal to modestly elevated prolactin levels, why should prolactin levels be remeasured at 1:10 or 1:100 dilution?
- A. To detect the “hook effect”
- B. To confirm the presence of macroprolactin
- C. To exclude the presence of macroprolactin
- D. To detect resistance to dopamine agonists
Correct
Incorrect
The “hook effect” is due to saturation of the assay antibodies and can lead to falsely normal or modestly elevated prolactin levels.
10. Question
A 35-year-old female patient presents with amenorrhea and galactorrhea. Which of the following tests is NOT part of the initial laboratory evaluation for hyperprolactinemia?
- A. Repeat measurement of prolactin
- B. Thyroid-stimulating hormone (TSH)
- C. Serum creatinine
- D. Hemoglobin A1c
Correct
Incorrect
Consider which test is unrelated to the causes of hyperprolactinemia.
11. Question
Which of the following can cause a false elevation of prolactin levels in serum due to high molecular weight variants of prolactin with diminished biologic potency?
- A. Macroprolactin
- B. Microprolactin
- C. Hypoprolactin
- D. Hyperprolactin
Correct
Incorrect
Consider which option refers to a high molecular weight variant of prolactin.
12. Question
In patients with prolactinomas and normal to modestly elevated prolactin levels, which phenomenon might be responsible for the misleading results?
- A. Hook effect
- B. Sandwich effect
- C. Dose effect
- D. Placebo effect
Correct
Incorrect
Consider which effect is related to saturation of the assay antibodies in prolactin assays.
13. Question
What is the first-line treatment for most symptomatic patients with prolactinomas?
- A. Transsphenoidal surgery
- B. Radiation therapy
- C. Dopamine agonist therapy
- D. Chemotherapy
Correct
Incorrect
14. Question
A 35-year-old female patient presents with amenorrhea and galactorrhea. Which of the following tests is NOT part of the initial laboratory evaluation for hyperprolactinemia?
- A. Repeat measurement of prolactin
- B. Thyroid-stimulating hormone (TSH)
- C. Serum creatinine
- D. Hemoglobin A1c
Correct
Incorrect
Consider which test is unrelated to the causes of hyperprolactinemia.
15. Question
Which of the following can cause a false elevation of prolactin levels in serum due to high molecular weight variants of prolactin with diminished biologic potency?
- A. Macroprolactin
- B. Microprolactin
- C. Hypoprolactin
- D. Hyperprolactin
Correct
Incorrect
Consider which option refers to a high molecular weight variant of prolactin.
16. Question
In patients with prolactinomas and normal to modestly elevated prolactin levels, which phenomenon might be responsible for the misleading results?
- A. Hook effect
- B. Sandwich effect
- C. Dose effect
- D. Placebo effect
Correct
Incorrect
Consider which effect is related to saturation of the assay antibodies in prolactin assays.
17. Question
What is the first-line treatment for most symptomatic patients with prolactinomas?
- A. Transsphenoidal surgery
- B. Radiation therapy
- C. Dopamine agonist therapy
- D. Chemotherapy
Correct
Incorrect
18. Question
A 45-year-old male with inadequately treated hypertension presents with a sudden severe headache, vomiting, and visual defects. Which of the following conditions is most likely responsible for his symptoms?
- A. Migraine
- B. Pituitary apoplexy
- C. Temporal arteritis
- D. Cluster headache
Correct
Incorrect
Consider the symptom constellation in the context of the patient's medical history.
19. Question
A 38-year-old female with a history of non-functioning pituitary macroadenoma presents with sudden headache, vomiting, and decreased visual acuity. Which factor in her medical history increases her risk of pituitary apoplexy?
- A. Non-functioning pituitary macroadenoma
- B. Oral contraceptive use
- C. Recent head trauma
- D. Pregnancy and delivery
Correct
Incorrect
Consider the predisposing conditions associated with pituitary apoplexy.
20. Question
In patients with pituitary apoplexy, what is the most common presenting symptom?
- A. Headache
- B. Vomiting
- C. Visual field defect
- D. Hemiplegia
Correct
Incorrect
21. Question
Which of the following drugs has been associated with an increased risk of pituitary apoplexy?
- A. Estrogen
- B. Antihypertensive medication
- C. NSAIDs
- D. Antidepressants
Correct
Incorrect
22. Question
A 55-year-old female with a history of pituitary tumor presents with a severe headache, vomiting, and visual disturbances. Which radiologic test is the most appropriate for the diagnosis of pituitary apoplexy?
- A. CT scan
- B. MRI T2 weighted images
- C. X-ray
- D. PET scan
Correct
Incorrect
Consider the recommended radiologic tests for pituitary apoplexy diagnosis.
23. Question
A 60-year-old male with suspected pituitary apoplexy has a random cortisol level of 4 ug/dl. What does this result suggest?
- A. Adrenal insufficiency
- B. Cushing's syndrome
- C. Normal adrenal function
- D. Hyperthyroidism
Correct
Incorrect
Consider the expected results of cortisol in patients with pituitary apoplexy.
24. Question
Which condition is the major source of mortality associated with pituitary apoplexy?
- A. Hypothyroidism
- B. Adrenal insufficiency
- C. Hypogonadism
- D. Diabetes insipidus
Correct
Incorrect
Consider the endocrine dysfunctions in patients with pituitary apoplexy.
25. Question
A patient with pituitary apoplexy and significant neuro-ophthalmic signs is being managed in the hospital. What is the most appropriate initial treatment for this patient?
- A. Immediate surgical decompression
- B. High-dose parenteral glucocorticoids
- C. Thyroid hormone replacement
- D. Vasopressin therapy
Correct
Incorrect
Consider the immediate treatment priority for pituitary apoplexy patients.
26. Question
A 50-year-old patient presents with headache, vomiting, and vision defects. Which of the following is NOT part of the Apoplexy Triad?
- A. Headache
- B. Vomiting
- C. Vision defects
- D. Hemiparesis
Correct
Incorrect
Consider the three main symptoms that make up the Apoplexy Triad.
27. Question
In patients with pituitary apoplexy, what percentage of patients is likely to have true apoplexy (the constellation of symptoms)?
- A. 2-10%
- B. 15-25%
- C. 30-40%
- D. 50-60%
Correct
Incorrect
Consider the incidence of true apoplexy among pituitary tumor patients.
28. Question
Which of the following conditions is a predisposing factor for pituitary apoplexy?
- A. Non-functioning pituitary macroadenoma
- B. Diabetes mellitus
- C. Hyperthyroidism
- D. Chronic kidney disease
Correct
Incorrect
Consider the conditions that increase the risk of pituitary apoplexy.
29. Question
What is the main cause of the symptoms and consequences of pituitary apoplexy?
- A. Infection
- B. Autoimmune reaction
- C. Increased pressure within the sella turcica
- D. Neuronal damage
Correct
Incorrect
Consider the primary factor responsible for the symptoms and consequences of pituitary apoplexy.
30. Question
A 45-year-old patient presents with fatigue, decreased muscle mass, and decreased libido. Which hormone deficiency should be suspected in this patient?
- A. ACTH
- B. TSH
- C. LH/FSH
- D. GH
Correct
Incorrect
Consider the hormone deficiency that affects muscle mass and libido.
31. Question
A patient with panhypopituitarism presents with amenorrhea and slightly elevated prolactin levels. What is the likely cause of these symptoms?
- A. Prolactinoma
- B. Damage to the pituitary stalk
- C. Primary adrenal insufficiency
- D. Hypothyroidism
Correct
Incorrect
Consider the effect of pituitary stalk damage on prolactin levels.
32. Question
Which of the following tests is the screening test of choice to rule out adrenal insufficiency?
- A. Insulin tolerance test
- B. Metyrapone stimulation test
- C. 8:00 serum cortisol level
- D. ACTH stimulation test
Correct
Incorrect
Consider the most commonly used test for adrenal insufficiency screening.
33. Question
A patient presents with polyuria, polydipsia, hypernatremia, and low urine osmolarity. What is the likely pituitary-related cause of these symptoms?
- A. Hypopituitarism
- B. Pituitary apoplexy
- C. Diabetes insipidus
- D. Prolactinoma
Correct
Incorrect
Consider the pituitary-related condition that causes excessive urination and thirst.
34. Question
Which of the following is NOT a cause of acquired hypopituitarism?
- A. Gland malformation
- B. Destruction due to tumors
- C. Infection
- D. Post-radiation
Correct
Incorrect
35. Question
In a patient with hypopituitarism, which of the following symptoms is associated with a deficiency in GH/IGF-1?
- A. Hypoglycemia
- B. Lethargy
- C. Hair loss
- D. Failure of lactation
Correct
Incorrect
Consider the hormone deficiency that affects energy levels.
36. Question
Which of the following pituitary hormone deficiencies can cause hyponatremia?
- A. ACTH deficiency
- B. TSH deficiency
- C. LH/FSH deficiency
- D. GH deficiency
Correct
Incorrect
Consider the hormone deficiency that affects sodium balance.
37. Question
In patients with hypopituitarism, the order of loss of hormonal function tends to preserve the most crucial hormones for survival. Which hormone deficiency usually manifests first?
- A. Corticotrophs (ACTH)
- B. Thyrotrophs (TSH)
- C. Gonadotrophs (LH/FSH)
- D. Somatotrophs (GH)
Correct
Incorrect
Consider the hormone deficiency that is least crucial for survival.
38. Question
Which of the following is a potential cause of hypopituitarism due to hypothalamic disease?
- A. Gland malformation
- B. Transcription factor defects
- C. Craniopharyngioma
- D. Post-radiation
Correct
Incorrect
Consider a tumor that can affect the hypothalamus.
39. Question
A 56-year-old male patient with a history of unexplained fatigue presents with low morning cortisol levels. Which test should be performed to confirm ACTH deficiency in this patient?
- A. Insulin Tolerance Test (0.1U/Kg)
- B. T4/T3/TSH measurement
- C. Glucagon Stimulation Test (1mg)
- D. LH/FSH measurement
Correct
Incorrect
Consider the test that measures cortisol response to a stressor.
40. Question
A 48-year-old postmenopausal woman is suspected of having hypopituitarism. Which hormone level can be a sensitive test to screen for hypopituitarism in this patient?
- A. Cortisol
- B. TSH
- C. FSH
- D. IGF-1
Correct
Incorrect
Consider a gonadal hormone that can be sensitive in postmenopausal women.
41. Question
In a patient with secondary hypothyroidism, which of the following hormone levels should not be followed to titrate thyroid replacement therapy?
- A. Free T4
- B. TSH
- C. Cortisol
- D. ACTH
Correct
Incorrect
Consider the hormone that is not useful in secondary hypothyroidism.
42. Question
A 45-year-old male patient with newly diagnosed hypopituitarism is being started on hormone replacement therapy. Which hormone should be replaced first to avoid a potentially life-threatening condition?
- A. Thyroid hormone (for TSH deficiency)
- B. Corticosteroids (for ACTH deficiency)
- C. Testosterone (for LH/FSH deficiency)
- D. Growth hormone (for GH deficiency)
Correct
Incorrect
Consider the hormone replacement with the most critical metabolic function.
43. Question
A 35-year-old woman presents with excessive thirst and frequent urination. She reports an average daily urine output of more than 4 liters. What is the most likely diagnosis?
- A. Hypothalamic DI
- B. Nephrogenic DI
- C. Dipsogenic DI
- D. Diabetes mellitus
Correct
Incorrect
Excessive thirst and frequent urination are associated with a lack of production or action of vasopressin.
44. Question
Which hormone primarily regulates renal water excretion and is involved in the pathophysiology of DI?
- A. Aldosterone
- B. Antidiuretic hormone (AVP)
- C. Renin
- D. Natriuretic peptide
Correct
Incorrect
This hormone increases the expression of Aquaporin 2 in the renal collecting duct.
45. Question
A 40-year-old man with a history of traumatic brain injury presents with polyuria and polydipsia. Which form of DI is most likely in this case?
- A. Hypothalamic DI
- B. Nephrogenic DI
- C. Dipsogenic DI
- D. Primary polydipsia
Correct
Incorrect
This form of DI can occur in patients with traumatic brain injury.
46. Question
In the case of X-linked familial nephrogenic DI, which gene mutation is primarily responsible?
- A. AVP receptor gene
- B. Aquaporin-2 gene
- C. Vasopressin gene
- D. Renin gene
Correct
Incorrect
This gene is responsible for the AVP receptor on the interstitial surface of target cells in the distal nephron.
47. Question
A patient with DI is found to have a pituitary mass during imaging studies. Which diagnosis should be considered other than pituitary adenoma?
- A. Craniopharyngioma
- B. Prolactinoma
- C. Acromegaly
- D. Cushing's disease
Correct
Incorrect
This tumor is a non-pituitary adenoma that can be associated with DI.
48. Question
Which of the following is a cause of secondary/acquired hypothalamic DI?
- A. Wolfram syndrome
- B. Autosomal recessive genetic mutation
- C. Sarcoidosis
- D. Septo-optic dysplasia
Correct
Incorrect
This cause of DI is an inflammatory condition.
49. Question
A patient with DI and a history of long-term lithium use is suspected to have nephrogenic DI. What is the most likely reason for this patient's condition?
- A. Genetic mutation in the AVP receptor gene
- B. Genetic mutation in the aquaporin-2 gene
- C. Lithium-induced renal tubulopathy
- D. Excessive fluid intake
Correct
Incorrect
This drug is known to cause toxic renal tubulopathy.
50. Question
Which of the following is a characteristic of the antidiuretic phase seen in some patients following pituitary stalk trauma?
- A. Increased urine output
- B. Decreased urine output
- C. Normal urine output
- D. Increased thirst
Correct
Incorrect
This phase is suggestive of AVP excess.

2 Comments

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Hafiz Muhammad Imran November 5, 2024 at 8:01 pm

I am not able to solve the problem quiz

kutanius84 August 11, 2024 at 11:35 am

how can I login ?

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