Pathology EMQ

Name: Laura Fulwell

Candidate number:

Theme: Endocrine Disease

 

OPTION LIST

 

A	High dose dex suppression	I	Total metadrenalines
B	Aldosterone	J	24h urinary free cortisol
C	48h dex suppression	K	CRH test
D	Plasma ACTH	L
E	Overnight dex suppression	M
F	Renin	N
G	Short synacthen test	O
H	Cortisol	P

 

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

 

1. 36 year old woman presents with non-specific symptoms, including weakness, dizziness, nausea and abdominal pain. On examination you notice orange palmar creases. The patient asks you if these could be side effects of the B12 injections she gets. (Na+ 130mmol/l, K+ 5.5mmol/l)

 

2. 55 year old woman complains of menstrual irregularity, weight gain and depression. Which test result would be low to indicate adrenal tumour?

 

3. 48 year old man presents with lethargy and occasional pins and needles. His blood pressure is 150/98 and K+ is 2.9mmol/l. He is not taking any medication. Which is the most appropriate initial test?

 

4. 32 year old attends A & E sweating profusely, complaining of headache, nausea and vomiting. He had been arguing with his wife prior to the attack. His blood pressure was 190/110 and heart rate 105. He describes previous similar events and admits to having fainted twice in the last few months. You get this hypertensive crisis under control and need a diagnosis. Cortisol is normal.

 

5. You are asked to see a patient with known ACTH-dependent Cushing’s disease by your house officer at Guy’s Hospital. Imaging (X-Ray, CT and MRI) is currently unavailable, and will be indefinitely. The houseman would like to know how best to distinguish between pituitary and ectopic ACTH production.

 

 

 

ANSWERS

1. G

2. D

3. B

4. I

5. K