[MCQ] Disorders of the Anterior Pituitary and Hypothalamus- Part 1

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Disorders of the Anterior Pituitary and Hypothalamus- Part 1

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Question 1

The number of major hormones produced by anterior pituitary gland is ?

A	4
B	5
C	6
D	7

Question 1 Explanation:

Six major hormones produced by anterior pituitary gland are Prolactin (PRL), Growth hormone (GH), Adrenocorticotropin hormone (ACTH), Luteinizing hormone (LH), Follicle-stimulating hormone (FSH)& Thyroid-stimulating hormone (TSH).

Question 2

The pituitary gland weighs about ?

A	100 mg
B	300 mg
C	600 mg
D	800 mg

Question 2 Explanation:

Pituitary gland weighs ~600 mg. Located within sella turcica ventral to the diaphragma sella, it comprises anatomically & functionally distinct anterior & posterior lobes.

Question 3

Which of the following about pituitary gland is false ?

A	Pituitary hormones are secreted in pulsatile manner
B	Posterior pituitary is supplied by superior hypophyseal arteries
C	Posterior lobe is innervated by hypothalamic neurons
D	None of the above

Question 3 Explanation:

Major blood supply for anterior pituitary is hypothalamic-pituitary portal plexus which allows effective transmission of hypothalamic peptide pulses to it without significant systemic dilution. Posterior pituitary is supplied by inferior hypophyseal arteries.

Question 4

“Median eminence” is best described as ?

A	Lowermost portion of hypothalamus
B	Uppermost portion of pituitary
C	Lowermost portion of pituitary
D	Anteriormost portion of pituitary

Question 5

“Tuber cinereum” is best described as ?

A	Extension of pituitary tissue into pituitary stalk
B	Extension of hypothalamic tissue into pituitary stalk
C	Extension of anterior pituitary tissue into pars intermedia
D	Extension of posterior pituitary tissue into pars intermedia

Question 5 Explanation:

Pituitary gland is also called hypophysis (anterior pituitary - adenohypophysis, posterior pituitary - neurohypophysis). It is connected to hypothalamus by pituitary (or hypophysial) stalk. Between these two portions of pituitary is a small, relatively avascular zone called pars intermedia. Lowermost portion of hypothalamus is called median eminence, which connects inferiorly with pituitary stalk. Tuber cinereum is an extension of hypothalamic tissue into pituitary stalk. Embryologically, anterior pituitary originates from Rathke’s pouch, which is an embryonic invagination of the pharyngeal epithelium, while posterior pituitary originates from a neural tissue outgrowth from hypothalamus

Question 6

Pit-1, Prop-1, SF-1, and DAX-1 are related to ?

A	Hypothalamus development
B	Pituitary development
C	Pancreatic development
D	All of the above

Question 6 Explanation:

Anterior pituitary gland develops from nasopharyngeal Rathke’s pouch. Pit-1, Prop-1, SF-1, and DAX-1 are lineage-specific transcription factors in pluripotential stem cells during embryonic differentiation. Pit-1 determines cell-specific expression of GH (somatotropes), PRL (lactotropes) & TSH (thyrotropes). Prop-1 induces the pituitary development of Pit-1-specific lineages, as well as gonadotropes. Gonadotrope cell development is further defined by the cell-specific expression of nuclear receptors, steroidogenic factor (SF-1) & DAX-1. Corticotropin upstream transcription element (CUTE) & PTX-1 transcription factor play a role in development of corticotrope cells.

Question 7

Pit-1 mutations can cause deficiency of ?

A	GH
B	Prolactin
C	TSH
D	All of the above

Question 7 Explanation:

Autosomal dominant or recessive Pit-1 mutations cause combined GH, PRL & TSH deficiencies resulting in growth failure & hypothyroidism

Question 8

PROP-1 mutations result in deficiency of all except ?

A	GH
B	Prolactin
C	ACTH
D	Gonadotropin

Question 8 Explanation:

During development, Prop-1 is essential for Pit-1 function. PROP1 mutations result in combined GH, PRL, TSH & gonadotropin deficiency with preservation of ACTH.

Question 9

Kallmann syndrome is due congenital synthesis defect of ?

A	LH
B	FSH
C	Testosterone
D	GnRH

Question 9 Explanation:

Kallmann syndrome is due to defective hypothalamic gonadotropin-releasing hormone (GnRH) synthesis. KAL gene defect on chromosome Xp22.3 is the culprit. Embryonic migration of GnRH neurons from hypothalamic olfactory placode to hypothalamus is prevented due to this genetic defect

Question 10

Which of the following is not a feature of Kallmann syndrome ?

A	Hyposmia
B	Color blindness
C	Nerve deafness
D	Precocious puberty

Question 10 Explanation:

Features of Kallmann syndrome include anosmia or hyposmia, color blindness, optic atrophy, nerve deafness, cleft palate, renal abnormalities, cryptorchidism & neurologic abnormalities (mirror movements

Question 11

Hormone profile of Kallmann syndrome includes ?

A	Low LH
B	Low FSH
C	Low levels of sex steroids (testosterone or estradiol)
D	All of the above

Question 11 Explanation:

GnRH deficiency prevents progression through puberty. Males present with delayed puberty & hypogonadism. Females present with primary amenorrhea & failure of secondary sexual development. Repetitive GnRH administration restores normal pituitary gonadotropin responses. Fertility may be restored in men with long-term treatment with human chorionic gonadotropin (hCG) or testosterone. Women are treated with cyclic estrogen & progestin.

Question 12

GnRH deficiency is found in which of the following ?

A	Prader-Willi Syndrome
B	Laurence-Moon-Bardet-Biedl Syndrome
C	Frohlich Syndrome
D	All of the above

Question 12 Explanation:

Laurence-Moon-Bardet-Biedl Syndrome, Frohlich Syndrome & Prader-Willi Syndrome have GnRH deficiency with obesity. Patients of Laurence-Moon-Bardet-Biedl Syndrome have mental retardation

Question 13

What median dose of cranial irradiation can lead to development of hypopituitarism ?

A	2000 rad
B	3000 rad
C	4000 rad
D	5000 rad

Question 13 Explanation:

Up to two-thirds of patients ultimately develop hormone insufficiency after a cranial irradiation median dose of 50 Gy (5000 rad) directed at skull base. Hypopituitarism occurs over 5 - 15 years & reflects hypothalamic damage rather than primary destruction of pituitary cells.

Question 14

Which hormone deficiency is most common after cranial irradiation ?

A	GH
B	Gonadotropin
C	ACTH
D	ADH

Question 14 Explanation:

After cranial irradiation, GH deficiency is most common, followed by gonadotropin & ACTH deficiency

Question 15

Lymphocytic hypophysitis occurs mainly in ?

A	Unmarried female
B	Pregnant female
C	Short statured female
D	Infertile female

Question 15 Explanation:

Lymphocytic hypophysitis occurs mainly in pregnant or post-partum women & presents with hyperprolactinemia & a pituitary mass on MRI, with mildly elevated PRL levels. Resolves after prolonged glucocorticoid treatment.

Question 16

Pituitary apoplexy is associated with ?

A	Diabetes
B	Hypertension
C	Sickle cell anemia
D	All of the above

Question 17

Sheehan’s syndrome refers to pituitary apoplexy during ?

A	Antenatal period
B	Intra-partum period
C	Postpartum period
D	All of the above

Question 17 Explanation:

Pituitary Apoplexy (acute intrapituitary hemorrhage) may occur spontaneously in a preexisting adenoma, postpartum (Sheehan’s syndrome), diabetes, hypertension, sickle cell anemia or acute shock. It presents as severe headache with signs of meningeal irritation, bilateral visual changes, ophthalmoplegia, hypoglycemia, hypotension, CNS hemorrhage & death. Hypopituitarism is very common after apoplexy. Pituitary CT / MRI is diagnostic.

Question 18

Indication for urgent surgical decompression after pituitary apoplexy is ?

A	Hypotension
B	Visual loss
C	Seizure
D	All of the above

Question 18 Explanation:

Patients of pituitary apoplexy with significant or progressive visual loss, severe ophthalmoplegia or loss of consciousness require urgent surgical decompression. Rest can be managed with highdose glucocorticoids

Question 19

In ‘Empty Sella syndrome’, pituitary functions are usually ?

A	Normal
B	Decreased
C	Increased
D	Any of the above

Question 19 Explanation:

Empty Sella patients usually have normal pituitary function. Peripheral rim of pituitary tissue is enough for hormone production, though with time hypopituitarism may develop

Question 20

ACTH reserve is most reliably assessed by ?

A	CRH test
B	Metyrapone test
C	Insulin-induced hypoglycemia
D	Standard ACTH stimulation test

Question 20 Explanation:

ACTH reserve is most reliably assessed during insulin-induced hypoglycemia

Question 21

Which of the following can be used to assess GH reserve ?

A	Insulin-induced hypoglycemia
B	Arginine
C	L-dopa
D	All of the above

Question 21 Explanation:

GH responses to insulin-induced hypoglycemia, arginine, L-dopa, growth hormone releasing hormone (GHRH) or growth hormone releasing peptides (GHRPs) can be used to assess GH reserve.

Question 22

Pituitary adenomas account for what percentage of all intracranial neoplasms ?

A	~ 2 %
B	~ 5 %
C	~ 15 %
D	~ 20 %

Question 22 Explanation:

Pituitary adenomas account for ~15% of all intracranial neoplasms. At autopsy, 25% of all pituitary glands have microadenoma (<10 mm diameter). Pituitary imaging detects small pituitary lesions in at least 10% of normal individuals.

Question 23

Which of the following is false about pituitary adenomas ?

A	Monoclonal in origin
B	Benign neoplasms
C	Hormone production does not correlate with tumor size
D	None of the above

Question 23 Explanation:

Almost all pituitary adenomas are monoclonal in origin due to somatic mutation leading to increased growth. Pituitary adenomas are benign uni- or plurihormonal neoplasms. Pituitary carcinomas with documented extracranial metastases are very rare. Hormone production does not always correlate with tumor size. ~One-third of all adenomas are clinically nonfunctioning & produce no distinct clinical hypersecretory syndrome.

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See all quizzes of Disorders of the Anterior Pituitary and Hypothalamus at here:

Disorders of the Anterior Pituitary and Hypothalamus- Part 1| Disorders of the Anterior Pituitary and Hypothalamus- Part 2| Disorders of the Anterior Pituitary and Hypothalamus- Part 3| Disorders of the Anterior Pituitary and Hypothalamus- Part 4|Disorders of the Anterior Pituitary and Hypothalamus- Part 5 |Disorders of the Anterior Pituitary and Hypothalamus- Part 6| Disorders of the Anterior Pituitary and Hypothalamus- Part 7

1.The number of major hormones produced by anterior pituitary
gland is ?
A. 4
B. 5

C. 6
D. 7

2. The pituitary gland weighs about ?
A. 100 mg
B. 300 mg
C. 600 mg
D. 800 mg

3 Which of the following about pituitary gland is false ?
A. Pituitary hormones are secreted in pulsatile manner
B. Posterior pituitary is supplied by superior hypophyseal
arteries
C. Posterior lobe is innervated by hypothalamic neurons
D. None of the above

4 “Median eminence” is best described as ?
A. Lowermost portion of hypothalamus
B. Uppermost portion of pituitary
C. Lowermost portion of pituitary
D. Anteriormost portion of pituitary
5. “Tuber cinereum” is best described as ?
A. Extension of pituitary tissue into pituitary stalk
B. Extension of hypothalamic tissue into pituitary stalk
C. Extension of anterior pituitary tissue into pars intermedia
D. Extension of posterior pituitary tissue into pars intermedia

6. Pit-1, Prop-1, SF-1, and DAX-1 are related to ?
A. Hypothalamus development
B. Pituitary development
C. Pancreatic development
D. All of the above

7.Pit-1 mutations can cause deficiency of ?
A. GH
B. Prolactin
C. TSH
D. All of the above

8. PROP-1 mutations result in deficiency of all except ?
A. GH
B. Prolactin
C. ACTH
D. Gonadotropin

9. Kallmann syndrome is due congenital synthesis defect of ?
A. LH
B. FSH
C. Testosterone
D. GnRH

10.Which of the following is not a feature of Kallmann syndrome ?
A. Hyposmia
B. Color blindness
C. Nerve deafness
D. Precocious puberty

11. Hormone profile of Kallmann syndrome includes ?
A. Low LH
B. Low FSH
C. Low levels of sex steroids (testosterone or estradiol)
D. All of the above

12. GnRH deficiency is found in which of the following ?
A. Prader-Willi Syndrome
B. Laurence-Moon-Bardet-Biedl Syndrome
C. Frohlich Syndrome
D. All of the above

13. What median dose of cranial irradiation can lead to development
of hypopituitarism ?
A. 2000 rad
B. 3000 rad
C. 4000 rad
D. 5000 rad

14. Which hormone deficiency is most common after cranial irradiation
?
A. GH
B. Gonadotropin
C. ACTH
D. ADH

15. Lymphocytic hypophysitis occurs mainly in ?
A. Unmarried female
B. Pregnant female
C. Short statured female
D. Infertile female

16. Pituitary apoplexy is associated with ?
A. Diabetes
B. Hypertension
C. Sickle cell anemia
D. All of the above
17. Sheehan’s syndrome refers to pituitary apoplexy during ?
A. Antenatal period
B. Intra-partum period
C. Postpartum period
D. All of the above

18. Indication for urgent surgical decompression after pituitary
apoplexy is ?
A. Hypotension
B. Visual loss
C. Seizure

D. All of the above

19. In ‘Empty Sella syndrome’, pituitary functions are usually ?
A. Normal
B. Decreased
C. Increased
D. Any of the above

20. ACTH reserve is most reliably assessed by ?
A. CRH test
B. Metyrapone test
C. Insulin-induced hypoglycemia
D. Standard ACTH stimulation test

21.Which of the following can be used to assess GH reserve ?
A. Insulin-induced hypoglycemia
B. Arginine
C. L-dopa
D. All of the above

22. Pituitary adenomas account for what percentage of all intracranial
neoplasms ?
A. ~ 2 %
B. ~ 5 %
C. ~ 15 %
D. ~ 20 %

23.Which of the following is false about pituitary adenomas ?
A. Monoclonal in origin
B. Benign neoplasms
C. Hormone production does not correlate with tumor size
D. None of the above

Disorders of the Anterior Pituitary and Hypothalamus

[MCQ] Disorders of the Anterior Pituitary and Hypothalamus- Part 1

I. Start the exam by click the “Start” button

Disorders of the Anterior Pituitary and Hypothalamus- Part 1

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