問題一覧
1
Cortisol-to-creatinine ratio on repeated measurement being indicative of hypercortisolism
> 25 nmol/mmol
2
Which of the ff statements is correct
UFC is less sensitive than salviary cortisol and dexamethasone suppression testing
3
False positive results of serum Cortisol
All of the choices
4
Midnight serum cortisol level indicative of cushing syndrome? indicate the units
>200 nmol/L or >7.5 microg/dL
5
Cushing syndrome is excluded if the serum cortisol at midnight is?
<50 nmol/L
6
Midnight salivary cortisol value for diagnosis of Cushing syndrome (indicate the units)
>5 nmol/L or >2 ng/mL
7
Normal nadir level of midnight serum cortisol
<50 nmol/L or <2 microg/dL
8
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
9
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
10
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
11
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
12
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
13
Normal range for 9am ACTH
2-11 pmol/L 9-52 pg/mL
14
True of morning plasma ACTH
50% of patients with cushing disease have a 9am ACTH level within the normal reference range
15
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
16
Positive test for High dose DST
>50% suppression of plasma cortisol from the baseline
17
True of CRH
Up to 10% of pts with Cushing Dse do not respond to CRH
18
True of the ff statements
All of the above
19
In investigating ectopic ACTH syndrome, obtain CT/MRI scanning of which areas of the body?
TAP Thorax Abdomen Pelvis
20
Radiotherapy is reserved for the ff patients (3)
1. Microadenoma not responsive to surgery 2. Patients who undergone Bilateral adrenalectomy 3. Nelson’s syndrome
21
Management of recurrent cushing disease
1. Repeat pituitary surgery 2. Gamma knife 3. Radiation 4. Medical therapies 5. Adrenal surgery
22
True of Tuberculous Addison disease
Calcification is evident in 50% of cases
23
Percentage of the adrenal cortex must be compromised before symptoms and signs become apparent
>90%
24
Common cause of infevtion in children that resulted in acquired AI
Pseudomonas aeruginosa
25
% of patients with lung ca have adrenal metastases on CT scan
20
26
True of adenomas?
All are correct
27
The ff are features of benign adrenal incidentaloma except
>10HU
28
Size of incidentalomas are predictive of malignancy
>6cm 25% <4cm <2%
29
True of adrenal carcinoma
75% metastatic spread is evident at presentation
30
Measurement of the ff can detect Dopamine-secreting tumor (2)
1. Urinary dopamine 2. Plasma methoxytyramine
31
True of False? The most reliable case detection strategy is measurement of fractionated metanephrine and catecholamines in a 24-hr URINE collection
TRUE
32
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
33
True of pre-op management of pheochromocytoma
Alpha adrenergic blockade should be started 7-10 days pre-operatively
34
MC complications of surgery in pheochromocytoma
BP lability intra op post op hypotension
35
True of phenoxybenzamine
preferred drug for pre op preparation to control BB and arrythmia
36
Goal heart rate pre op in pheo?
60-80 bpm
37
Main side effect of Metyrosine
Hypersomnolence
38
MOA of Metyrosine
Inhibit Tyrosine Hydroxylase
39
Dose of metyrosine a day before the procedure
1000 mg Q6H
40
Dose of nicardipine in the mgt of pre op pheo?
30mg BID sustained release orally
41
Medication to avoid in hypertensive crises in pregnant patient with pheo?
Nitroprusside
42
The ff drugs should be avoided intra op in pts with pheo except
Lidocane
43
Give 3 that inhibit Aldosterone secretion
Heparin ANP Dopamine
44
Tissues with the highest concentrations of Mineralocorticoud receptors (3)
Hippocampus Distal nephron Colon
45
Lower levels of MR are foubd in (2)
1. GIT 2. Heart
46
MR can be found in highest concentrations in these tissues except:
Heart
47
Elements of the RAAS are present the ff:
All of the above
48
T or F Endogenous glucocorticoids and Mineralocorticoids bind equally to the mineralocorticoid receptor
T
49
Reasonable to test patients with PA for cortisol cosecretion when the adrenal adenoma is greater than ____ cm in diameter
1.5
50
What baseline tests are included if a patient with pheochromocytoma is suspected of having cortisol cosecretion (2)
1. DHEAS 2. Overnight 1mg DST
51
How many months post surgery can one observe the full impact on hypertension in PA patients
3 months
52
% post op Hyperkalemia post surgery of patients with APA
9.9%
53
Max dose of eplerebone in the tx of hypertension in PA
100mg
54
Max dose of spironolactone in the tx of hypertension in PA
400 mg
55
Spironolactone pregnancy category
C
56
Eplerenone pregnancy category
B