Papillary thyroid carcinoma has a number of unique morphologic features, including odd-looking nuclei called Orphan Annie nuclei. These are so named because they have a “cleared-out” appearance, similar to Little Orphan Annie’s eyes. In fact, you can think of papillary thyroid carcinoma as the Little Orphan Annie tumor because:
1. It stays around for years and years without getting any bigger (papillary carcinoma is slow growing).
2. It is well-behaved and seldom kills people (overall, the 10-year survival for papillary carcinoma is >90%, which is better than the prognosis of any of the other types of thyroid carcinoma).
3. The nuclei resemble Little Orphan Annie’s eyes.
4. It often has psammoma bodies (derived from the Greek psammos, or sand): Annie’s dog is named Sandy.
I wish I could say I came up with this, but it comes from Ed’s Pathology Notes, a really wonderful pathology site for students (and anyone interested in pathology) at www.pathguy.com.
Please check these questions out...there is some good info in the answers that both highlights and supplements the material we covered in class this week.
1. Acromegaly is a chronic metabolic disorder of adults caused by an overabundance of:
A. Parathyroid hormone
B. Growth hormone
C. Epinephrine
D. Thyroid hormone
2. A 58-year-old female has had a 20-pound weight gain over the past two years. She has noticed increasing cold intolerance and sluggishness. On physical exam her heart rate is decreased, and her reflexes are delayed. Her serum TSH is 11.8 mU/L (normal = 0.3 - 3.0), and her T4 is 2.3 micrograms/dL (normal = 4.5 - 12.5). A year ago, anti-TSH-receptor antibodies were detected at high titer. Which of the following diseases does she most likely have?
A. Papillary thyroid carcinoma
B. Hashimoto's thyroiditis
C. Goiter
D. Graves disease
3. Extreme hypothyroidism in adults is called:
A. Addison's disease
B. Myxedema
C. Graves disease
D. Rickets
4. All of the following are true regarding type I diabetes EXCEPT:
A. It accounts for 90% of all cases of diabetes
B. The body makes little or no insulin
C. Daily injections of insulin are required to sustain life
D. Likely long-term complications of poorly-controlled type 1 diabetes include: hyaline arteriolosclerosis, proliferative retinopathy, nodular glomerulosclerosis, and peripheral neuropathy
E. It is usually diagnosed in childhood
5. Addison's disease is caused by damage to the:
A. Pancreatic islets
B. Thyroid gland
C. Parathyroid glands
D. Adrenal cortex
6. The most characteristic symptom of pheochromocytoma is:
A. A bleeding tendency
B. Persistent or paroxysmal hypertension
C. Hypoglycemia
D. Persistent diarrhea
7. Chvostek's sign and Trousseau's sign indicate:
A. Botulism
B. Rickets
C. Tetany
D. Bell's palsy
8. A 55-year-old patient presents with recently diagnosed diabetes. He also has front teeth that are more widely spaced than normal and have recently begun to flare. Which undiagnosed disease does this patient most likely have?
A. Gigantism
B. Hyperparathyroidism
C. Paget's disease of bone
D. Di George syndrome
E. Acromegaly
9. A patient presents with osteomalacia, loss of the lamina dura around the teeth, brown tumors in bone, and duodenal ulcers. His family reports his personality has changed. Which of the following disorders should you suspect him of having?
A. Hyperparathyroidism
B. Hypoparathyroidism
10. All of the following statements regarding multiple endocrine neoplasia II are true EXCEPT:
A. Patients have increased incidence of thyroid carcinoma
B. Patients have increased incidence of pheochromocytoma
C. Patients have increased incidence of mucosal neuromas
D. It is autosomal recessive
E. Differential diagnosis includes von Recklinghausen's disease
11. Which of the following statements regarding pheochromocytoma are true?
A. Patients may present with torso pain
B. Norepinephrine production is decreased
C. It is a tumor of the adrenal cortex
D. It causes jitters and hypertension
E. Patients may have severe headaches
12. Cushing Syndrome may be caused by all of the following EXCEPT:
A. An adrenal cortex tumor
B. A posterior pituitary tumor
C. A paraneoplastic syndrome
D. Iatrogenic factors
E. All of the above may cause Cushing Syndrome
13. Patients with Graves' Disease may show all of the following EXCEPT:
A. Decreased appetite
B. Exophthalmos
C. Heat intolerance
D. Tachycardia
E. Irritability
14. Which of the following is associated with Addison's disease?
A. Hypotension
B. Diabetes
C. Osteoporosis
D. Central obesity
E. Increased appetite
15. Patients with hypothyroidism may show all of the following symptoms EXCEPT:
A. Short stature
B. Retention of deciduous teeth
C. Stunted skeletal growth
D. Hair in the oral cavity
E. Mental slowness
16. Which of the following is a function of the parathyroid glands:
A. Secrete calcitonin
B. Decrease serum calcium
C. Stimulate osteoclasts
D. Aid in the absorption of calcium from the gut
