Pathology EMQ template.

Name:

Candidate number:

Theme: Adrenal

 

OPTION LIST

 

A	Adrenal cortex	I	Oat cell carcinoma of the bronchus
B	Adrenal gland	J	Oat cell carcinoma of the bronchus
C	Adrenal medulla	K	Pituitary
D	Adrenal medullary chromaffin cells	L	Primary hyperaldosteronism
E	Aldosterone	M	Secondary hyperaldosteronism
F	Androgen	N	Zona fasiculata
G	Cortisol	O	Zona glomerulosa
H	Glucocorticoid	P	Zona reticularis

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 40 year old anxious banker presents with hypertension, sweating and headache. On histology cells with granular cytoplasm associated with branching capillaries are seen. Which type of cells are these?

 

 

2. The adrenal cortex comprises 3 distinct zones. The glomerulosa, fasiculata and reticularis. What does the zona glomerulosa produce?

 

 

3. A 34 year old lady presents with central obesity, diabetes, an exaggerated thoracic kyphosis and purple abdominal striae. Plasma ACTH levels are low and cortisol levels are high and are not reduced in the Dexamethasone suppression test. What is affected?

 

 

4. A 68 year old man presents feeling weak and fatigued. He has had some palpitations and dizziness and has a history of worsening hypertension. He can’t climb stairs easily as he used to. Blood tests show low renin and raised aldosterone. What is the diagnosis?

 

 

5. A 59 year old man has a history of tuberculosis. He has noticed his shirts have become too large for him and he feels lethargic. He has noticed darkening of his palms and often feels unsteady on standing. What is affected in this gentleman?

 

 

 

ANSWERS

1. D

2. E

3. A

4. L

5. B

 

 

Notes:

 

1:

 

2:

 

3: Adrenal cortical neoplasm: Secrete cortisol autonomously, independent of ACTH control. Low ACTH levels are then found in the presence of elevated cortisol. The neoplasm is usually an adenoma (5-10% of cases, it is a carcinoma).

 

4: Primary hyperaldosteronism (Conn’s syndrome): Autonomous secretion of excess aldosterone. Typically due to an adenoma of the zona glomerulosa. The resulting renal retention of Sodium and water leads to hyperplasia, while potassium loss leads to muscular weakness and cardiac arrhythmias.

 

5: Chronic primary adrenal cortical insufficiency due to Tuberculosis; resulting in destruction of the adrenal cortex and medulla.