[MCQ] Disorders of the Anterior Pituitary and Hypothalamus- Part 5

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Question 1

Normal bone age in a child with short stature is suggestive of ?

A	Hormonal disorder
B	Systemic disorder
C	Genetic cartilage dysplasia or growth plate disorder
D	All of the above

Question 2

Delayed bone age in a child with short stature is suggestive of ?

A	Hormonal disorder or systemic disorder
B	Genetic cartilage dysplasia
C	Growth plate disorder
D	All of the above

Question 2 Explanation:

Bone age is delayed in patients with all forms of true GH deficiency or GH receptor defects that result in attenuated GH action. Bone age is delayed by thyroid hormone deficiency. Elevated pubertal sex steroid levels (estrogen) induce GHRH-GH-IGF-I axis & directly stimulate epiphyseal growth. High doses of estrogen lead to epiphyseal closure. Glucocorticoid excess inhibits growth

Question 3

Characteristic voice in isolated GH deficiency is ?

A	High-pitched
B	Low-pitched
C	Hoarse
D	Any of the above

Question 3 Explanation:

Isolated GH deficiency is characterized by short stature, micropenis, increased fat, high-pitched voice & a tendancy for hypoglycemia.

Question 4

Familial modes of inheritance of isolated GH deficiency may be ?

A	Autosomal dominant
B	Autosomal recessive
C	X-linked
D	Any of the above

Question 5

Which of the following is false about Laron syndrome ?

A	GH insensitivity
B	Normal or high GH levels
C	Decreased circulating GHBP
D	High IGF-I levels

Question 5 Explanation:

Laron syndrome is caused by mutation defects of GH receptor structure or signaling leading to partial or complete GH insensitivity & growth failure. The diagnosis is based on normal or high GH levels, with decreased circulating GHBP, and low IGF-I levels.

Question 6

Following provocative stimuli, GH levels normally increase to how much in children ?

A	> 3 μg/L
B	> 5 μg/L
C	> 7 μg/L
D	> 9 μg/L

Question 6 Explanation:

As GH secretion is released in pulses, GH deficiency is best assessed by examining the response to exercise, insulin-induced hypoglycemia wherein GH levels normally increase to >7 μg/L in children.

Question 7

Final height of children can be predicted by ?

A	Bayley-Pinneau scale
B	Tanner-Whitehouse scale
C	Midparental height
D	All of the above

Question 7 Explanation:

Final height can be predicted using standardized scales (Bayley-Pinneau or Tanner-Whitehouse) or estimated by adding 6.5 cm (boys) or subtracting 6.5 cm (girls) from the midparental height

Question 8

Treatment with IGF-I is recommended for which of the following ?

A	Turner syndrome
B	Chronic renal failure
C	Growth retardation due to mutations of GH receptor
D	All of the above

Question 8 Explanation:

In patients with GH insensitivity & growth retardation due to mutations of GH receptor, treatment with IGF-I bypasses the dysfunctional GH receptor. GH treatment is moderately effective for accelerating growth rates in children with Turner syndrome & chronic renal failure.

Question 9

Which is the “last” hormone to be lost in acquired pituitary hormone deficiency ?

A	TSH
B	GH
C	ACTH
D	FSH/LH

Question 9 Explanation:

Sequential order of hormone loss in acquired pituitary hormone deficiency is GH > FSH/LH > TSH > ACTH.

Question 10

Adult GH deficiency (AGHD) is defined by a peak GH response to hypoglycemia of ?

A	<3 μg/L
B	<5 μg/L
C	<7 μg/L
D	<9 μg/L

Question 10 Explanation:

Most validated test to distinguish pituitary-sufficient patients from those with AGHD is insulin induced (0.05 - 0.1 U/kg) hypoglycemia. After glucose reduction to ~40 mg/dL, most individuals experience neuroglycopenic symptoms, and peak GH release occurs at 60 minutes & remains elevated for up to 2 hours. ~90% of healthy adults exhibit GH responses >5 μg/L. AGHD is defined by a peak GH response to hypoglycemia of <3 μg/L.

Question 11

Contraindications to GH therapy include ?

A	Presence of active neoplasm
B	Intracranial hypertension
C	Uncontrolled diabetes
D	All of the above

Question 11 Explanation:

Contraindications to GH replacement therapy include presence of an active neoplasm, intracranial hypertension or uncontrolled diabetes & retinopathy

Question 12

Acidophil stem cell pituitary adenoma can lead to ?

A	Hypogonadism
B	Galactorrhea
C	Acromegaly
D	All of the above

Question 12 Explanation:

In patients with acidophilic stem-cell adenomas, features of hyperprolactinemia (hypogonadism & galactorrhea) predominate over the less clinically evident signs of acromegaly

Question 13

Mammosomatotrope pituitary adenoma can lead to ?

A	Hypogonadism
B	Galactorrhea
C	Acromegaly
D	All of the above

Question 13 Explanation:

Mammosomatotrope produce GH, PRL & can present with a clinical syndrome of acromegaly, hypogonadism & galactorrhea of varying degrees.

Question 14

Normal daytime circulating levels of Growth Hormone is ?

A	< 0.2 μg/liter
B	< 0.3 μg/liter
C	< 0.4 μg/liter
D	< 0.5 μg/liter

Question 15

The production of IGF-I is suppressed in ?

A	Liver disease
B	Hypothyroidism
C	Poorly controlled diabetes mellitus
D	All of the above

Question 16

Familial syndromes associated with acromegaly include ?

A	MEN type 1
B	McCune-Albright syndrome
C	Carney’s syndrome
D	All of the above

Question 17

Which of the following organs is not enlarged in acromegaly ?

A	Tongue
B	Thyroid gland
C	Parotid gland
D	Heart

Question 18

Which of the following organs is not enlarged in acromegaly ?

A	Liver
B	Pancreas
C	Kidney
D	Prostate

Question 18 Explanation:

Generalized visceromegaly occurs in acromegaly, including cardiomegaly, macroglossia, and thyroid gland enlargement.

Question 19

The most common cause of GHRH-mediated acromegaly is ?

A	Pancreatic islet cell tumor
B	Pheochromocytoma
C	Abdominal carcinoid tumor
D	Medullary thyroid carcinoma

Question 19 Explanation:

Most common cause of GHRH-mediated acromegaly is a chest or abdominal carcinoid tumor. Excessive GHRH may be secreted by hypothalamic tumors, usually choristomas or neuromas.

Question 20

Prognathism is due to enlargement of ?

A	Maxilla
B	Mandible
C	Nasal bones
D	All of the above

Question 21

Acromegaly is associated with an increased risk of which of the following malignancies ?

A	Pancreatic
B	Colonic
C	Breast
D	Thyroid

Question 21 Explanation:

Acromegaly is associated with an increased risk of colon polyps and colonic malignancy. Polyps are diagnosed in up to one-third of acromegalic patients.

Question 22

Which of the following regarding acromegaly is false ?

A	Often clinically not diagnosed for 10 years or more
B	Without treatment, survival is reduced by ~10 years
C	Hypertension occur in about 75% of patients
D	Diabetes mellitus develops in 25% of patients

Question 22 Explanation:

In acromegaly, cardiovascular system is most severely affected. Coronary heart disease, cardiomyopathy with arrhythmias, left ventricular hypertrophy, decreased diastolic function & hypertension occur in about 30% of patients. Diabetes mellitus develops in 25% of patients with acromegaly. Overall mortality is increased ~threefold and is due primarily to cardiovascular & cerebrovascular disorders, malignancy & respiratory disease. Without proper treatment, survival is reduced by an average of 10 years compared with an age-matched control population.

Question 23

For the diagnosis of acromegaly, measurement of which of the following is most useful ?

A	GH
B	GHRH
C	IGF-I
D	IGF-II

Question 23 Explanation:

Due to the pulsatility of GH secretion, measurement of a single random GH level is not useful for the diagnosis or exclusion of acromegaly and does not correlate with disease severity. IGF-I level provides a useful laboratory screening measure when clinical features raise the possibility of acromegaly.

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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.Normal bone age in a child with short stature is suggestive of ?
A. Hormonal disorder
B. Systemic disorder
C. Genetic cartilage dysplasia or growth plate disorder
D. All of the above
2 Delayed bone age in a child with short stature is suggestive of ?1
A. Hormonal disorder or systemic disorder
B. Genetic cartilage dysplasia
C. Growth plate disorder
D. All of the above

3 Characteristic voice in isolated GH deficiency is ?
A. High-pitched
B. Low-pitched

C. Hoarse
D. Any of the above

4 Familial modes of inheritance of isolated GH deficiency may
be ?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked
D. Any of the above
5 Which of the following is false about Laron syndrome ?
A. GH insensitivity
B. Normal or high GH levels
C. Decreased circulating GHBP
D. High IGF-I levels

6 Following provocative stimuli, GH levels normally increase to
how much in children ?
A. > 3 μg/L
B. > 5 μg/L
C. > 7 μg/L
D. > 9 μg/L

7 Final height of children can be predicted by ?
A. Bayley-Pinneau scale
B. Tanner-Whitehouse scale
C. Midparental height
D. All of the above

8 Treatment with IGF-I is recommended for which of the
following ?
A. Turner syndrome
B. Chronic renal failure
C. Growth retardation due to mutations of GH receptor
D. All of the above

9 Which is the “last” hormone to be lost in acquired pituitary
hormone deficiency ?
A. TSH

B. GH
C. ACTH
D. FSH/LH

10 Adult GH deficiency (AGHD) is defined by a peak GH response to
hypoglycemia of ?
A. <3 μg/L
B. <5 μg/L
C. <7 μg/L
D. <9 μg/L

11 Contraindications to GH therapy include ?
A. Presence of active neoplasm
B. Intracranial hypertension
C. Uncontrolled diabetes
D. All of the above

12 Acidophil stem cell pituitary adenoma can lead to ?
A. Hypogonadism
B. Galactorrhea
C. Acromegaly
D. All of the above

13 Mammosomatotrope pituitary adenoma can lead to ?
A. Hypogonadism
B. Galactorrhea
C. Acromegaly
D. All of the above

14 Normal daytime circulating levels of Growth Hormone is ?
A. < 0.2 μg/liter
B. < 0.3 μg/liter
C. < 0.4 μg/liter
D. < 0.5 μg/liter
15 The production of IGF-I is suppressed in ?
A. Liver disease
B. Hypothyroidism

C. Poorly controlled diabetes mellitus
D. All of the above
16 Familial syndromes associated with acromegaly include ?
A. MEN type 1
B. McCune-Albright syndrome
C. Carney’s syndrome
D. All of the above
17 Which of the following organs is not enlarged in acromegaly ?
A. Tongue
B. Thyroid gland
C. Parotid gland
D. Heart
18 Which of the following organs is not enlarged in acromegaly ?
A. Liver
B. Pancreas
C. Kidney
D. Prostate

19 The most common cause of GHRH-mediated acromegaly is ?
A. Pancreatic islet cell tumor
B. Pheochromocytoma
C. Abdominal carcinoid tumor
D. Medullary thyroid carcinoma

20 Prognathism is due to enlargement of ?
A. Maxilla
B. Mandible
C. Nasal bones
D. All of the above
21 Acromegaly is associated with an increased risk of which of the
following malignancies ?
A. Pancreatic
B. Colonic
C. Breast
D. Thyroid

22 Which of the following regarding acromegaly is false ?
A. Often clinically not diagnosed for 10 years or more
B. Without treatment, survival is reduced by ~10 years

C. Hypertension occur in about 75% of patients
D. Diabetes mellitus develops in 25% of patients

23 For the diagnosis of acromegaly, measurement of which of the
following is most useful ?
A. GH
B. GHRH
C. IGF-I
D. IGF-II

Disorders of the Anterior Pituitary and Hypothalamus

[MCQ] Disorders of the Anterior Pituitary and Hypothalamus- Part 5

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Disorders of the Anterior Pituitary and Hypothalamus- Part 5

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