Pathology_4

Pathology_4 - Pathology 4 finishing up the exam 72...

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Pathology 4 finishing up the exam 72. Thyrotoxicosis with a low uptake of iodine in the thyroid bed but uptake in the pelvis can be seen with which of the following? A. Graves' disease B. Jod-Basedow phenomenon C. Choriocarcinoma D. Struma ovarii E. Toxic multinodular goiter The answer is: D Ovarian teratomas can contain thyroid tissue (struma ovarii) and rarely cause thyrotoxicosis with excess thyroid hormone produced by the teratoma rather than the thyroid. 73. A low TSH, high T 4 , and high T 3 suggests which of the following diagnosis A. Hyperthyroidism B. Nonthyroidal illness (sick euthyroidism) C. Estrogen therapy D. Subclinical hypothyroidism E. Familial (euthyroid) dysalbuminenic hyperthyroxinemia The answer is: A Low TSH with high T 4 and T 3 or T 3 alone (T 3 toxicosis) reflects hyperthyroidism. 74. A patient with thyroid cancer is told that he has a life expectancy of less than 6 months from diagnosis. The variety of thyroid cancer with this prognosis is which of the following? A. Thyroid lymphoma B. Medullary thyroid carcinoma C. Papillary thyroid carcinoma D. Anaplastic thyroid carcinoma E. Follicular thyroid carcinoma The answer is: D The prognosis of anaplastic cancers, which likely represent dedifferentiation of better differentiated papillary or follicular carcinomas, is very poor with average survival less than 6 months. 75.
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On the basis of physical findings, you suspect a 48-year-old woman has acromegaly. The definitive diagnostic test for acromegaly is measurement of growth hormone in which of the following settings A. Random B. TRH stimulation test C. Insulin tolerance test D. Oral glucose tolerance test E. LHRH stimulation test The answer is: D The most definitive and widely accepted test for the diagnosis of acromegaly is the response of growth hormone during an oral glucose tolerance test. Typically, the growth hormone at baseline in acromegaly will be greater than 5 g/L. In normal patients, the growth hormone will suppress to less than 2 with an oral glucose tolerance test (OGTT). In patients with acromegaly the GH values may rise, show no change, or suppress partially but not less than 2. A single random growth hormone is not useful, because of the pulsatility in growth hormone. TRH does stimulate growth hormone in many patients with acromegaly, but not all. The insulin tolerance test is a stimulation test of growth hormone and not a suppression test. 76. You confirm acromegaly in a 58-year-old woman, and a MRI of the pituitary shows a microadenoma. Which of the following is the best choice for treatment? A. Transsphenoidal surgery B. Medical therapy with somatostatin agonist C. Irradiation D. Medical therapy with bromocriptine E. Transfrontal surgery The answer is: A Transsphenoidal surgery has the advantages of potential cure with rapid therapeutic response. If the tumor is completely resected, the patient may experience a complete cure. Medical therapy with somatostatin agonist or bromocriptine is helpful, but the patient is
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This note was uploaded on 11/21/2009 for the course BIO 1B taught by Professor Carlson,mischel,power during the Summer '07 term at Berkeley.

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Pathology_4 - Pathology 4 finishing up the exam 72...

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