Cancer of the Endocrine System MCQ : Multiple Choice Questions and Answers

Question 1 : Multiple endocrine type 1 (MEN1), which is also known as Wermer syndrome, most commonly gives rise to tumors of:

a) Parathyroid glands
b) Anterior pituitary
c) Pancreatic islet cells
d) Adrenal glands

Answer : parathyroid glands

Question 2 : MEN2A is associated most commonly with:

a) Medullary carcinoma thyroid
b) Pheochromocytoma
c) Parathyroid tumors
d) Anterior pituitary gland

Answer : medullary carcinoma thyroid

Question 3 : Carney complex is most often associated with mutations found on chromosome:

a) 17q
b) 2p
c) 3q
d) 13p

Answer : 17q

Question 4 : Adrenocortical cancers are most commonly are:

a) Benign and unilateral
b) Malignant and unilateral
c) Benign and  bilateral
d) Malignant and bilateral

Answer : Benign and unilateral

Question 5 : VHL type 2 predisposes to all except:

a) Pheochromocytoma
b) Retinal angiomas
c) Central nervous system hemangioblastomas
d) Non clear cell renal carcinomas

Answer : Non clear cell renal carcinomas

Question 6 : Which of the following is a hallmark of adrenocortical carcinoma:

a) Overexpression of insulin-like growth factor 2 (IGF2)
b) Overexpression of insulin-like growth factor 1 (IGF1)
c) Overexpression of insulin-like growth factor 3 (IGF3)
d) Overexpression of insulin-like growth factor (IGF4)

Answer : Overexpression of insulin-like growth factor 2 (IGF2)

Question 7 : McCune Albright syndrome is characterised by all except :

a) Polyostotic fibrous dysplasia
b) Cafe-au-lait skin pigmentation
c) Peripheral precocious puberty
d) Central precocious puberty

Answer :  Central precocious puberty

Question 8 : Which of the following is not a part of 3PA syndrome :

a) Paraganglioma
b) Pheochromocytoma
c) Pituitary Adenoma
d) Parathyroid hyperplasia

Answer : Parathyroid hyperplasia

Question 9 : Which of the most common activating point mutation responsible for papillary thyroid carcinoma:

a) BRAF
b) MAPK
c) MEK
d) RAF1

Answer : BRAF 

Question 10 : Thyroid nodules are fairly common in the general population. What proportion of thyroid nodules prove to be malignant:

a) 10% to 15%
b) 2-5%
c) <1%
d) None of the above

Answer : 10-15%

Question 11 : If a thyroid nodule is present and a high-resolution ultrasound of the neck is performed, which of the following feature will not be associated with an increased likelihood of malignancy:

a) Microcalcifications
b) Nodular hyperechogenicity
c) Irregular borders and vascularity
d) A nodule that is taller than wide on traverse view, increase the likelihood of malignancy

Answer : Nodular hyperechogenicity

Question 12 : Exposure to radiation early in childhood is associated with an increased risk of papillary thyroid cancers, e.g. Iodine-131 treatment:

a) true
b) false

Answer : false

Question 13 : Hashimoto thyroiditis is associated with the risk of development of :

a) NHL of thyroid
b) Hodgkin’s lymphoma of thyroid
c) Thyroid sarcoma
d) Follicular carcinoma variant of thyroid

Answer : NHL of thyroid

Question 14 : Which of the following thyroid cancers doesn’t arise from follicular cells (choose more than one option if necessary)

a) Papillary
b) Follicular
c) Anaplastic
d) Medullary

Answer : Medullary

Question 15 : Which of the following syndromes is associated with follicular thyroid cancer (choose more than one option if necessary)

a) FAP
b) Cowden’s
c) Carney complex 1
d) Familial nonmedullary thyroid cancer

Answer : all of the above

Question 16 : Which of the following is not a part of the MACIS prognostication of well-differentiated thyroid cancer:

a) Age
b) Tumor grade
c) Tumor size
d) Completeness of resection

Answer : Tumor grade

Question 17 : Orphan-Annie nuclei are characteristically found in which type of thyroid cancer :

a) Papillary
b) Follicular
c) Anaplastic
d) Medullary

Answer : Papillary

Question 18 : Which of the following treatment strategies will be incorrect in cases of papillary thyroid cancer (PTC):

a) A patient with >4 cm PTC should undergo a total or near-total thyroidectomy
b) Lobectomy may be considered for 1-to 4-cm PTC without any other high-risk features
c) Prophylactic lateral neck dissection is recommended in PTC
d) Central neck compartment should be dissected during initial thyroidectomy

Answer : Prophylactic lateral neck dissection is recommended in PTC

Question 19 : After thyroidectomy TSH levels should be kept at low levels to prevent stimulation of any remnant malignant thyroid tissue. Which of the following is true about the ATA guidelines for the adequate TSH levels to be maintained in thyroid cancers post operatively:

a) TSH levels of 0.5 to 2 mIU/L are acceptable for patients at low risk of recurrence
b) TSH levels of 0.1 to .5 mIU/L are acceptable for patients at intermediate risk of recurrence
c) TSH levels of ≤ 0.1 mIU/L are acceptable for patients at high risk of recurrence
d) All of the above

Answer : all of the above

Question 20 : Papillary thyroid microcarcinomas are defined as PTCs with a maximum diameter of :

a) ≤ 10 mm
b) ≤ 5 mm
c) ≤ 1 mm
d) None of the above

Answer : ≤ 10 mm

Question 21 : What is the recommendation of the ATA guidelines for the management of a patient of papillary thyroid cancer who underwent thyroidectomy and relapsed biochemically but in whom imaging studies are negative for recurrence:

a) Empiric RAI therapy is indicated in patients with significantly elevated serum Tg (stimulated serum Tg > 10 ng/mL with thyroid hormone withdrawal or > 5 ng/mL with recombinant human TSH)
b) Empiric RAI therapy is indicated in patients with significantly elevated serum Tg (stimulated serum Tg > 5 ng/mL with thyroid hormone withdrawal or > 2 ng/mL with recombinant human TSH)
c) Empiric RAI therapy is indicated in patients with significantly elevated serum Tg (stimulated serum Tg > 20 ng/mL with thyroid hormone withdrawal or > 10 ng/mL with recombinant human TSH)
d) Empiric RAI therapy is indicated in patients with significantly elevated serum Tg (stimulated serum Tg > 30 ng/mL with thyroid hormone withdrawal or > 10 ng/mL with recombinant human TSH)

Answer : Empiric RAI therapy is indicated in patients with significantly elevated serum Tg (stimulated serum Tg > 10 ng/mL with thyroid hormone withdrawal or > 5 ng/mL with recombinant human TSH)

Question 22 : Which of the following chemotherapy agents is approved by FDA for use in radioiodine refractory papillary thyroid cancer :

a) Doxorubicin
b) Paclitaxel
c) Vincristine
d) Gemcitabine

Answer : doxorubicin