Pathology EMQ template.

Name: Priya Garg

Candidate number:

Theme: Endocrine Disease

OPTION LIST

A	Addison’s Disease	I	Pituitary adenoma
B	Cranial diabetes insipidus	J	Primary hyperparathyoidism
C	Diabetes mellitus type I	K	Primary polydipsia
D	Diabetes mellitus type II	L	Small cell lung carcinoma
E	Hypercalcaemia	M	Syndrome of inappropriate ADH
F	Hypernatraemia	N	Wolfram Syndrome
G	Hypokalaemia	O
H	Nephrogenic diabetes insipidus	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. An irritable obese middle aged man presents with severe confusion, nausea and seizures. He has been recently diagnosed with diabetes mellitus and is currently taking the sulfonylurea chlorpropamide. His K+ levels are normal, but he is found to have hyponatraemia. He has a low plasma osmolality and a higher urinary osmolality.

2. A 27 year old female presents to hospital with polyuria, nocturia and polydipsia.

She is known to have advanced stage IV breast cancer. She has a high plasma osmolality and a low urine osmolality with hypernatraemia. On fluid deprivation test she fails to concentrate her urine but is responsive to administration of exogenous desmopressin.

3. A 25 year old African shop worker presents with polyuria, nocturia and polydipsia. He is severely dehydrated. On drug history he is found to be taking hydroxyurea for sickle cell disease. He has a high plasma osmolality and a low urine osmolality. On fluid deprivation test his serum osmolality rises to 315mOsm/kg without adequate concentration of his urine osmolality. He is unresponsive to exogenous desmopressin.

4. A seventeen year old male presents with severe polydipsia and polyuria. His plasma Na+, osmolality and urine osmolality are low. His vasopressin levels are virtually undetectable. During a water deprivation test the on-call house officer prevents him from drinking out of a vase of flowers which belongs to the patient in the next bed. His initial low urine osmolality increases with the duration of the investigation.

5. A mother brings her six year old daughter in with a history of bedwetting, frequent urination and constant thirst. On examination her pupils are slow to constrict to light. Her mother has noticed that she constantly mismatches her socks finds it difficult to distinguish certain colours. She also has difficulty in hearing high pitched tones. The girl has recently been diagnosed with type 1 diabetes mellitus. She has a high plasma osmolality and a low urinary osmolality. On fluid deprivation she fails to concentrate her urine. An MRI of her brain shows a poorly developed posterior pituitary.

ANSWERS

1. M

2. B

3. H

4. K

5. N