Pathology EMQ template.

Name: Richard William Davies

Candidate number:

Theme: Endocrine disease

 

OPTION LIST

 

A

Addison’s disease

I

Medullary thyroid carcinoma

B

Adrenal carcinoma

J

Multinodular goitre

C

Adrenal TB

K

Nelson’s syndrome

D

Cushing’s disease

L

Prolactinoma

E

Cushing’s syndrome

M

Pseudo-Cushing’s syndrome

F

Ectopic ACTH production

N

Sheehan’s syndrome

G

Grave’s disease

O

SIADH

H

Hashimoto’s thyroiditis

P

Waterhouse-Friderichsen syndrome

 

 

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 55-year-old woman, with a history of pernicious anaemia, presents with weight loss and fatigue. Examination reveals vitiligo. Blood tests reveal: Na+ 147 mmol/l and K+ 5.8 mmol/l.

 

 

2. A 30-year-old woman presents to her GP with secondary amenorrhoea and fatigue since the birth of her daughter 14 months ago. On further questioning she says that she was unable to breastfeed her baby as her milk dried up shortly after the birth. She also recalls that the delivery was complicated and that she ‘lost a lot of blood’.

 

 

3. A 40-year-old man presents to his GP with a 2 year history of weight gain and depression. On examination he has centripetal obesity and increased skin pigmentation. Tests reveal elevated cortisol and ACTH levels which suppress on a high, but not a low, dexamethasone suppression test.

 

 

4. A 60-year-old man presents with a headache and double vision. He says he has noticed he has become progressively tanned over the last few years, despite not going on holiday in that time. His surgical history includes a bilateral adrenalectomy 25 years ago, which was to treat Cushing’s disease.

 

 

5. A 20-year-old female presents with a 6 month history of weight loss and palpitations. She claims that, if anything, her appetite has increased during this time, and she also reports feeling constantly warm and irritable. Examination reveals a smooth enlargement of the thyroid with an audible bruit.

 

 

 

ANSWERS

1. A

2. N

3.D

4. K

5. G