Science Medicine
INTERNAL MEDICINE - Endocrinology & Neuropsychiatry
C
Terms in this set (10)
A 45-year-old man reports to his primary The answer is C. (Chap. 401e) Functional pituitary adenoma
care physician that his wife has noted presentations include acromegaly, as in this patient;
coarsening of his facial features over several prolactinomas; or Cushing syndrome.
Hypersecretion of years. In addition, he reports low libido and growth hormone underlies this syndrome
in patients with decreased energy. Physical examination pituitary masses, although ectopic
production of growth shows frontal bossing and enlarged hands. hormone, particularly by tumors,
has been reported. Because An MRI confirms that he has a pituitary mass. growth hormone is
secreted in a highly pulsatile fashion, Which of the following screening tests obtaining random
serum levels is not reliable. Thus, the should be ordered to diagnose the cause of downstream
mediator of systemic effects of growth hormone, the mass? insulin-like growth factor-1 (IGF-1), is
measured to screen for
A) 24-Hour urinary free cortisol growth hormone excess. IGF-1 is made by the liver in
B)Growth hormone level response to growth hormone stimulation. An oral glucose
C) Serum insulin-like growth factor-1 (IGF-1) tolerance test with growth hormone obtained at 0, 30, and
60 level minutes may also be used to screen for acromegaly because
D) Serum prolactin level normal persons should suppress growth hormone to
this challenge. Serum prolactin level is useful to
screen for prolactinomas, and 24-hour urinary free
cortisol and ACTH assay are useful screens for Cushing
disease.
, A 54-year-old woman presents to the
The answer is C. (Chap. 440e) Appropriate and timely
emergency department complaining of
evaluation is needed to determine whether a subarachnoid
the abrupt onset of what she describes
hemorrhage is present because it can be rapidly fatal if
as the worst headache of her life. You
undetected. The procedure of choice for initial diagnosis is a
are concerned about the possibility of
computed tomography (CT) of the head without intravenous
subarachnoid hemorrhage. What is the most
(IV) contrast. On the CT, blood in the subarachnoid space
appropriate initial test for diagnosis?
would appear whiter compared to the surrounding brain
A) Cerebral angiography
tissue. The head CT is most sensitive when it is performed
B) Computed tomography (CT) of the head
shortly after the onset of symptoms, but sensitivity declines
with intravenous contrast
over several hours. It can also demonstrate significant mass
C) CT of the head without
effect and midline shift, factors that increase the severity
intravenous contrast
of the underlying hemorrhage. In the situation where the
D) Lumbar puncture
head CT is negative but clinical suspicion is high, a lumbar
puncture can be performed. This may demonstrate increased
numbers of red blood cells that do not clear with successive
aliquots of cerebrospinal fluid (CSF).
If the lumbar puncture is performed more than 12 hours after a
small subarachnoid hemorrhage, then the red blood cells may
begin to decompose, leading to xanthochromia—a yellow to
pink coloration of CSF that can be measure
spectrographically.
A basic head CT with IV contrast is rarely useful in
subarachnoid hemorrhage because the brightness of
the contrast material may make it difficult to identify blood
in the subarachnoid space. However, a CT angiography
that is performed with IV contrast can be useful in
identifying the aneurismal vessel leading to the
bleeding.
Classic angiography is a more direct way to visualize the
anatomy of the cranial vasculature and is now often combined
with interventional procedures to coil a bleeding vessel.
INTERNAL MEDICINE - Endocrinology & Neuropsychiatry
C
Terms in this set (10)
A 45-year-old man reports to his primary The answer is C. (Chap. 401e) Functional pituitary adenoma
care physician that his wife has noted presentations include acromegaly, as in this patient;
coarsening of his facial features over several prolactinomas; or Cushing syndrome.
Hypersecretion of years. In addition, he reports low libido and growth hormone underlies this syndrome
in patients with decreased energy. Physical examination pituitary masses, although ectopic
production of growth shows frontal bossing and enlarged hands. hormone, particularly by tumors,
has been reported. Because An MRI confirms that he has a pituitary mass. growth hormone is
secreted in a highly pulsatile fashion, Which of the following screening tests obtaining random
serum levels is not reliable. Thus, the should be ordered to diagnose the cause of downstream
mediator of systemic effects of growth hormone, the mass? insulin-like growth factor-1 (IGF-1), is
measured to screen for
A) 24-Hour urinary free cortisol growth hormone excess. IGF-1 is made by the liver in
B)Growth hormone level response to growth hormone stimulation. An oral glucose
C) Serum insulin-like growth factor-1 (IGF-1) tolerance test with growth hormone obtained at 0, 30, and
60 level minutes may also be used to screen for acromegaly because
D) Serum prolactin level normal persons should suppress growth hormone to
this challenge. Serum prolactin level is useful to
screen for prolactinomas, and 24-hour urinary free
cortisol and ACTH assay are useful screens for Cushing
disease.
, A 54-year-old woman presents to the
The answer is C. (Chap. 440e) Appropriate and timely
emergency department complaining of
evaluation is needed to determine whether a subarachnoid
the abrupt onset of what she describes
hemorrhage is present because it can be rapidly fatal if
as the worst headache of her life. You
undetected. The procedure of choice for initial diagnosis is a
are concerned about the possibility of
computed tomography (CT) of the head without intravenous
subarachnoid hemorrhage. What is the most
(IV) contrast. On the CT, blood in the subarachnoid space
appropriate initial test for diagnosis?
would appear whiter compared to the surrounding brain
A) Cerebral angiography
tissue. The head CT is most sensitive when it is performed
B) Computed tomography (CT) of the head
shortly after the onset of symptoms, but sensitivity declines
with intravenous contrast
over several hours. It can also demonstrate significant mass
C) CT of the head without
effect and midline shift, factors that increase the severity
intravenous contrast
of the underlying hemorrhage. In the situation where the
D) Lumbar puncture
head CT is negative but clinical suspicion is high, a lumbar
puncture can be performed. This may demonstrate increased
numbers of red blood cells that do not clear with successive
aliquots of cerebrospinal fluid (CSF).
If the lumbar puncture is performed more than 12 hours after a
small subarachnoid hemorrhage, then the red blood cells may
begin to decompose, leading to xanthochromia—a yellow to
pink coloration of CSF that can be measure
spectrographically.
A basic head CT with IV contrast is rarely useful in
subarachnoid hemorrhage because the brightness of
the contrast material may make it difficult to identify blood
in the subarachnoid space. However, a CT angiography
that is performed with IV contrast can be useful in
identifying the aneurismal vessel leading to the
bleeding.
Classic angiography is a more direct way to visualize the
anatomy of the cranial vasculature and is now often combined
with interventional procedures to coil a bleeding vessel.
