Endocrine Pathology Practice Questions

Q: What is true regarding follicular carcinoma of the thyroid?

Hematogenous spread is common.. **Explanation:** **1. Why Option A is correct:** Follicular Thyroid Carcinoma (FTC) is characterized by its propensity for **hematogenous (blood-borne) spread** [1]. Unlike most epithelial malignancies that spread via lymphatics, FTC typically metastasizes through the bloodstream to distant sites, most commonly the **lungs and bones** (often presenting as osteolytic lesions). **2. Why the other options are incorrect:** * **Option B:** FTC is typically a **solitary** nodule [1]. Multifocality is a classic feature of Papillary Thyroid Carcinoma (PTC), not FTC. * **Option C:** FTC **cannot** be diagnosed by FNAC. The distinction between a benign follicular adenoma and a malignant follicular carcinoma depends entirely on identifying **capsular or vascular invasion**. FNAC only samples cells (cytology) and cannot evaluate the intactness of the capsule; therefore, histopathology is mandatory for diagnosis. * **Option D:** **Papillary Thyroid Carcinoma (PTC)** is the most common thyroid malignancy (approx. 85%) [2]. FTC is the second most common (approx. 5-15%). **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** FTC is more common in areas of **iodine deficiency** [2]. * **Genetics:** Associated with **RAS mutations** and the **PAX8-PPARG** fusion gene. * **Hürthle Cell Carcinoma:** A variant of FTC characterized by cells with abundant granular eosinophilic cytoplasm (due to mitochondria). * **Treatment:** Total thyroidectomy followed by Radioiodine ($I^{131}$) ablation, as FTC cells often retain the ability to take up iodine. * **Tumor Marker:** Serum **Thyroglobulin** is used to monitor for recurrence post-surgery. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 428-429. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1098-1099.

Question 1

Which of the following statements regarding Hashimoto's thyroiditis is FALSE?

Accepted Answer

It results in a hypoparathyroid state.

Answer

It is an autoimmune thyroiditis.

Answer

It involves plasma cell and lymphocytic infiltration.

Answer

It typically leads to a hypothyroid state.

Question 2

Which type of thyroid carcinoma is known to secrete ACTH?

Accepted Answer

Medullary carcinoma

Answer

Follicular carcinoma

Answer

Papillary carcinoma

Answer

Anaplastic carcinoma

Question 3

Which hormone is produced by pheochromocytoma in MEN 2A (Sipple syndrome)?

Accepted Answer

Epinephrine

Answer

Norepinephrine

Answer

Dopamine

Answer

5-Hydroxyindoleacetic acid

Question 4

Floating teeth is a clinical sign associated with which endocrine disorder?

Accepted Answer

Hyperparathyroidism

Answer

Hypoparathyroidism

Answer

Rickets

Answer

Scurvy

Question 5

Mitosis is a characteristic feature of which of the following conditions?

Accepted Answer

Anaplastic carcinoma

Answer

Follicular carcinoma

Answer

Papillary carcinoma

Answer

All of the above

Question 6

Hürthle cells are seen in which of the following conditions?

Accepted Answer

Hashimoto's thyroiditis

Answer

Granulomatous thyroid disease

Answer

Papillary carcinoma of the thyroid

Answer

Thyroglossal duct cyst

Question 7

Malignant potential is least with which of the following gastrointestinal neuroendocrine tumors?

Accepted Answer

Insulinoma

Answer

Glucagonoma

Answer

VIPoma

Answer

Somatostatinoma

Question 8

Which among the following is the most common type of thyroid cancer?

Accepted Answer

Papillary

Answer

Medullary

Answer

Follicular

Answer

Anaplastic

Question 9

What is true regarding follicular carcinoma of the thyroid?

Accepted Answer

Hematogenous spread is common.

Answer

It is commonly multifocal.

Answer

It is readily diagnosed by fine-needle aspiration cytology (FNAC).

Answer

It is the most common carcinoma of the thyroid.

Question 10

A 40-year-old woman presents with a 2-month history of chest pain on exertion. Her medical history includes pneumonia one month prior, with Streptococcus pneumoniae identified in her sputum. On physical examination, her body mass index is 35. Initial random blood glucose was 132 mg/dL. Subsequent fasting blood glucose values were 120 mg/dL and 122 mg/dL. An oral glucose tolerance test revealed a blood glucose of 240 mg/dL two hours after a 75-g glucose load. She was prescribed an oral thiazolidinedione (TZD) drug. After two months of therapy, her fasting blood glucose decreased to 90 mg/dL. The beneficial effect of TZD in this patient is most likely related to which of the following processes?

Accepted Answer

Activation of PPAR-gamma nuclear receptor in adipocytes

Answer

Decreased production of insulin autoantibodies

Answer

Greater density of insulin receptors in adipocytes

Answer

Increased half-life of circulating plasma insulin

Endocrine Pathology — MCQs

Endocrine Pathology — MCQs

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