M.A.S
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1. All the following are signs and symptoms of acromegaly EXCEPT:
A) Thyroid enlargement (goiter).
B) Prominence of mandible (prognathism).
C) Obesity.
D) Diabetes mellitus.
E) Numbness and tingling in hands.
2. The most common cause of Cushing's syndrome is:
A) Cushing's disease.
B) Iatrogenic (medical treatment with glucocorticoids).
C) ACTH-producing lung tumor.
D) Adrenal adenoma.
E) Adrenal carcinoma.
3. The diagnosis of hypercortisolism is confirmed by (choose single best answer):
A) Morning plasma cortisol level .
B) Evening plasma cortisol level.
C) CT scan of the adrenal glands.
D) Overnight 1 mg dexamethasone suppression test.
E) ACTH plasma level.
4. The management of Addison's disease includes all the following EXCEPT:
A) Hydrocortisone 30 mg/day with fludrocrtisone.
B) Prednisone 7.5 mg/day with fludrocortisone.
C) Cortisone acetate 37.5 mg/day with fludrocortisone.
D) Following blood glucose levels.
E) Following electrolytes.
5. In diagnosis of hypothyroidism, we should order (choose one answer):
A) TSH alone.
B) TSH and Free T4.
C) Free T4 alone.
D) Free T3 alone.
E) Total T4 alone.
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| tess
Forum Guru
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1-c
2-b
3-d
4-c
5-b
Correct me if wrong. Thanks.
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| M.A.S
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for the first 3 ques I think you are right.
however i'm not sure about ques 4.
Why you chose 5-b, and not 5-a?
Thank you very much indeed, tess.
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| tess
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MAS, I checked in books before answering ur q4; hydrocortisone and prednisone are the two drugs most often used for Addison's disease boz they are most identical to the natural cortisol.
For q5, if want to diagnose hypothyroid, TSH is a must, but why not also check T4? And you know hyperprolactinemia has high TSH also.
Thanks for good questions.
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| cache
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C,B,D,C,B respectively
nice q's
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| M.A.S
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Yes, in 5-b it seems you are right. "TSH only" is useful for screening of primary hypothyroidism.
For Q4
Gordon H. Williams, Robert G. Dluhy say in Harrison'sDISORDERS OF THE ADRENAL CORTEX:
"Replacement therapy should correct both glucocorticoid and mineralocorticoid deficiencies. Hydrocortisone (cortisol) is the mainstay of treatment. The dose for most adults (depending on size) is 20 to 30 mg/d.
Since the replacement dosage of hydrocortisone does not replace the mineralocorticoid component of the adrenal hormones, mineralocorticoid supplementation is usually needed. This is accomplished by the administration of 0.05 to 0.1 mg fludrocortisone per day by mouth. Patients should also be instructed to maintain an ample intake of sodium (3 to 4 g/d)."
And in MCCQE 2000 review notes they consider prednison (5 mg PO qa.m) and (2.5 mg qp.m) = 7.5 mg/d.
Regarding the management of:
6. primary hypothyroidism,
7. secondary hypothyroidism,
you must follow which one of the following?
a. TSH
b. free T4
c. free T3
d. total T4
e. radioiodine uptake
try to choose the single best.
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| tess
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Try to pick the single best one, then
For treatment of primary hypothyroidism, follow TSH;
For treatment of secondary hypothyroidism, follow free T4.
:roll:
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| tess
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"tess" wrote:
Try to pick the single best one, then
For treatment of primary hypothyroidism, follow TSH;
For treatment of secondary hypothyroidism, follow free T4.
:roll:
For treatment of secondary hypothyroidism, I think we should follow free T3. Any thoughts?
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| docdoc
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I guess for primary and secondory hypothyroidism, the best 'single' predictor is TSH levels.
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| BellKicker
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"docdoc" wrote:
I guess for primary and secondory hypothyroidism, the best 'single' predictor is TSH levels.
The TSH is always low in secondary hypothyroidism, so we need to measure T4.
Tess, I think it's T4. After all, that's what we give the patient, so in a way we're measuring a therapeutic index. Some people give T3 but I think that's the exception to the rule.
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| daira
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Primary hypothyroid: TSH
Sec hypothyroid: T3
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lout kar phir waheen aa jata hoon
baaraha tor chuka hoon jinko
phir unhin dewaroon se takrata hoon...
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| tess
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The reason I think for secondary hypothyroidism should follow T3 is: we give T4 to pt, then the ability to change T4 to T3 is more important, although T4 level is important too but usually won't be a problem; and the same reason why some people has change to have T3 instead of T4 because they could not make enough T3 from T4 given.
But I have a doubt about the treatment of secondary hypothyroidism according to kaplan: before give T4 or T3, we give hydrocortisone first, any one know the significance here? (kaplan 2002 page 43)
Thanks!
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| docdoc
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Right, for prim hypo TSH and sec hypo T3.
I remember from physiology lectures of thyroid that T3 monitors the levels of free T4??? am I making it up ? I ll check it again
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| BellKicker
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"tess" wrote:
The reason I think for secondary hypothyroidism should follow T3 is: we give T4 to pt, then the ability to change T4 to T3 is more important, although T4 level is important too but usually won't be a problem; and the same reason why some people has change to have T3 instead of T4 because they could not make enough T3 from T4 given.
That's a very good explanation. Thanks.
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| dpk
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according to me the answer of 3rd quest is not overnight dexamethasone suppression test....
reason being it is a screening test not confirmatory...it could be abnormal in obese,alcoholics,depressed,etc... so we confirm it by 24hr urine free cortisol level but that's not the answer so i would go with morning plasma cortisol level...
i may be wrong...correct me if i'm...
see the website below for being more clear..
http://www.nlm.nih.gov/medlineplus/ency/article/0...
or u can search for dex. meth. supp. test on google....that's wht i did..
good luck
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