Pathology EMQ template.

Name: NADEEM AHMED

Candidate number:

Theme: ADRENAL

OPTION LIST

A	Addisonian Crisis	I	Iatrogenic Cushing’s Syndrome
B	Addison’s Disease	J	Multiple Endocrine Neoplasia Syndrome
C	Adrenal Carcinoma	K	Nelson’s Syndrome
D	Aldosterone Secreting Adrenal Adenoma	L	Phaeochromocytoma
E	Congenital Adrenal Hyperplasia	M	Pseudo-Cushing’s Syndrome
F	Cushing’s Syndrome	N	Schmidt’s Syndrome
G	Cushing’s Disease	O
H	Ectopic ACTH Secretion	P

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 45 year old female with long-term poorly controlled asthma presents to her GP complaining of weight gain and excessive sweating. A recent routine abdominal CT scan revealed atrophy of the adrenal glands.

2. The next patient on the endocrine ward round has just received the results of a high dose dexamethasone suppression test. The consultant informs you that the cortisol levels have been suppressed and asks you the most likely cause of this patient’s cushingoid symptoms.

3. A 35 year old female arrives in A&E at 16:30 in a very distressed state. Examination reveals tachycardia and postural hypotension. She complains of ongoing weakness and confusion following a recent operation on her knee. Blood tests reveal hyperkalaemia, hyponatraemia. Further tests measure cortisol levels at 50 nmol/L.

4. A 52 year old male complains of muscle cramps and headaches. Examination reveals hypertension. Blood tests are ordered and reveal a marked hypokalaemia. The renin-aldosterone ratio is noted at 0.02 and the House Officer orders an abdominal CT scan.

5. A 65 year old female presents to her new GP 5 years after an operation on her abdomen. She cannot remember the details of the operation but does remember that she was suffering from severe Cushing’s Disease at the time. She now notes a progressive “tanning” of the skin.

ANSWERS

1. I

2. G

3. A

4. D

5. K