問題一覧
1
True of adrenal carcinoma
75% metastatic spread is evident at presentation
2
Management of recurrent cushing disease
1. Repeat pituitary surgery 2. Gamma knife 3. Radiation 4. Medical therapies 5. Adrenal surgery
3
Dose of metyrosine a day before the procedure
1000 mg Q6H
4
Common cause of infevtion in children that resulted in acquired AI
Pseudomonas aeruginosa
5
True of morning plasma ACTH
50% of patients with cushing disease have a 9am ACTH level within the normal reference range
6
Tissues with the highest concentrations of Mineralocorticoud receptors (3)
Hippocampus Distal nephron Colon
7
Max dose of eplerebone in the tx of hypertension in PA
100mg
8
True of adenomas?
All are correct
9
% post op Hyperkalemia post surgery of patients with APA
9.9%
10
MOA of Metyrosine
Inhibit Tyrosine Hydroxylase
11
Eplerenone pregnancy category
B
12
Cushing syndrome is excluded if the serum cortisol at midnight is?
<50 nmol/L
13
% of patients with lung ca have adrenal metastases on CT scan
20
14
True of pre-op management of pheochromocytoma
Alpha adrenergic blockade should be started 7-10 days pre-operatively
15
Medication to avoid in hypertensive crises in pregnant patient with pheo?
Nitroprusside
16
Main side effect of Metyrosine
Hypersomnolence
17
MR can be found in highest concentrations in these tissues except:
Heart
18
Diagnostic criteria that point to Cushing syndrome UFC Overnight 1mg DST Late night salivary cortisol
UFC greater than the normal range of the assay Overnight 1mg DST >50nmol/L or > 1.8 ug/dl Late night salivary cortisol >4nmol/L or >145 ng/dL
19
The ff are features of benign adrenal incidentaloma except
>10HU
20
Goal heart rate pre op in pheo?
60-80 bpm
21
Radiotherapy is reserved for the ff patients (3)
1. Microadenoma not responsive to surgery 2. Patients who undergone Bilateral adrenalectomy 3. Nelson’s syndrome
22
Normal nadir level of midnight serum cortisol
<50 nmol/L or <2 microg/dL
23
Give 3 that inhibit Aldosterone secretion
Heparin ANP Dopamine
24
True of False? The most reliable case detection strategy is measurement of fractionated metanephrine and catecholamines in a 24-hr URINE collection
TRUE
25
Which of the ff statements is correct
UFC is less sensitive than salviary cortisol and dexamethasone suppression testing
26
Elements of the RAAS are present the ff:
All of the above
27
Measurement of the ff can detect Dopamine-secreting tumor (2)
1. Urinary dopamine 2. Plasma methoxytyramine
28
T or F Endogenous glucocorticoids and Mineralocorticoids bind equally to the mineralocorticoid receptor
T
29
Imaging characteristic of pheochromocytoma
>3cm Round to oval smooth margin Inhomogeneous with areas of cystic degeneration usually solitary and unilateral marcked enhancemebt on CT scan >10 HU <50% washout MRI: Hyperintense Common: Necrosis, hemorrhage or calcifications Growth: 0.5-1cm per year
30
Percentage of the adrenal cortex must be compromised before symptoms and signs become apparent
>90%
31
True of the ff statements
All of the above
32
Lower levels of MR are foubd in (2)
1. GIT 2. Heart
33
True of Tuberculous Addison disease
Calcification is evident in 50% of cases
34
34/F came in to your clinic because of obesity and would want to lose weight. On further probing patient had difficulty climbing the stairs. On physical examination patient had difficulty rising from a crouch position, she has moon facies, buffalo hump, bruises, and abdominal striae >1cm red-purplish non-blanching. Her BP was 140/90 mg/dL, RBS 300 mg/dL. You are highly suspecting of Cushing syndrome. What is your next step?
Exclude exogenous glucocorticoid exposure
35
Midnight serum cortisol level indicative of cushing syndrome? indicate the units
>200 nmol/L or >7.5 microg/dL
36
False positive results of serum Cortisol
All of the choices
37
Max dose of spironolactone in the tx of hypertension in PA
400 mg
38
True of phenoxybenzamine
preferred drug for pre op preparation to control BB and arrythmia
39
The ff drugs should be avoided intra op in pts with pheo except
Lidocane
40
Midnight salivary cortisol value for diagnosis of Cushing syndrome (indicate the units)
>5 nmol/L or >2 ng/mL
41
Spironolactone pregnancy category
C
42
How many months post surgery can one observe the full impact on hypertension in PA patients
3 months
43
In investigating ectopic ACTH syndrome, obtain CT/MRI scanning of which areas of the body?
TAP Thorax Abdomen Pelvis
44
Oral estrogen therapy and pregnancy may elevate CBG and total serum cortisol. Estrogen should be stopped for how many weeks prior to assessment by test using serum cortisol?
6 weeks
45
Cortisol-to-creatinine ratio on repeated measurement being indicative of hypercortisolism
> 25 nmol/mmol
46
True of CRH
Up to 10% of pts with Cushing Dse do not respond to CRH
47
Reasonable to test patients with PA for cortisol cosecretion when the adrenal adenoma is greater than ____ cm in diameter
1.5
48
MC complications of surgery in pheochromocytoma
BP lability intra op post op hypotension
49
How to perform High dose dexamethasone suppression test or liddle test?
2mg dexamethasone Q6h for 48 hours Extract at time 0 and 48 hours Rationale: The negative feedback of ACTH suppression is set to a higher level
50
Normal range for 9am ACTH
2-11 pmol/L 9-52 pg/mL
51
What baseline tests are included if a patient with pheochromocytoma is suspected of having cortisol cosecretion (2)
1. DHEAS 2. Overnight 1mg DST
52
True of low dose overnight dexamethasone suppression tests except:
Simultaneous measurement of plasma dexamethasone of >2 nmol/L by LC appears to improve the accuracy of the test
53
Positive test for High dose DST
>50% suppression of plasma cortisol from the baseline
54
34/F came in to your clinic because of obesity and would want to lose weight. On further probing patient had difficulty climbing the stairs. On physical examination patient had difficulty rising from a crouch position, she has moon facies, buffalo hump, bruises, and abdominal striae >1cm red-purplish non-blanching. Her BP was 140/90 mg/dL, RBS 300 mg/dL. You are highly suspecting of Cushing syndrome. Late night salivary cortisol revealed 150 ng/dL repeated twice. What is your next step?
Exclude physiologic cause of hypercortisolism
55
Size of incidentalomas are predictive of malignancy
>6cm 25% <4cm <2%
56
Dose of nicardipine in the mgt of pre op pheo?
30mg BID sustained release orally