A 54 year old female with a BMI of 25.9 comes for her regular hypertension clinic visit. Today, blood work reveals an HbA1c of 8.7 (normal less than 6.5). Over the past 4 months she has gained 22 pounds and 3 weeks ago she sustained the injury (shown in the image) after a minor fall. Her blood pressure is 155/90, P 90, RR 14 and T 98.7. 

At the moment she is on enalapril, furosemide and diltiazem. What is the next step in her management?

A. Send her for a bariatric consult

B. Order a 24 hour urine cortisol test

C. Refer to physical therapy for an exercise plan

D. Refer to an endocrinologist for management of blood glucose

E. Send urine for metanephrines

F. Dietary consult

Answer B

1. The patient has all the features of excess corticosteroids including Colles fracture as a result of osteoporosis. 

2. The most common endogenous cause of Cushing's syndrome is Cushing's disease. Frequent clinical findings include weight gain, truncal obesity, striae, hypertension, glucose intolerance and infections. 

3. The best screening test for Cushing's syndrome is a 24-hour urine collection with analysis for urinary free cortisol excretion. 

4. Low-dose and high-dose dexamethasone suppression tests, corticotropin assays, a corticotropin-releasing hormone stimulation test and inferior petrosal sinus catheterization may be required for a definitive diagnosis.

More MCQS-

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Anatomy & MSK MCQs

 A patient suffers a traumatic fracture of the surgical neck of the humerus which was conservatively treated. He presents two months later with weakness in his arm. From the image, which of the following muscles will have undergone atrophy?

A

B

C

D

E

Answer E

1. A supraspinatus B infraspinatus C Subscapularis D Teres major E teres minor

2. The axillary nerve or the circumflex nerve is a nerve of the human body, that originates from the brachial plexus (upper trunk, posterior division, posterior cord) at the level of the axilla (armpit) and carries nerve fibers from C5 and C6. The axillary nerve travels through the quadrangular space with the posterior circumflex humeral artery and vein to innervate the deltoid and teres minor.

3. During humeral neck fracture, the axillary nerve can be damaged. Evaluation should begin with inspection of the soft tissues and skin, as elderly patients are susceptible to poor wound healing. A full neurologic examination can be difficult following trauma, but function of the fingers, wrist, and elbow can often be evaluated. 

4. Axillary nerve innervation of the deltoid needs to be tested as reverse shoulder arthroplasty (RTSA) is a viable treatment option that requires an intact and innervated deltoid. The axillary nerve also innervates Teres Minor

More MCQs at

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Surgery & Anatomy MCQs

During surgery on the aorta, the following anatomical anomaly is observed during the dissection (see the CT scan). The most important aspect of this finding for the surgeon is:

A. Look for the ureters

B. Divide the kidneys evenly

C. Assess the vascular supply

D. Send the urine for metanephrines

E. Remove all stones from the renal pelvis

For answer

https://www.youtube.com/watch?v=Pf7y1xasrxY

Peds and Path MCQs

 Q1. A young African child is seen in the clinic with failure to thrive and general irritability. He was adopted as an infant and thus no other history is available. On exam, he has significant swelling over his left face with partial ulceration and cervical adenopathy. He undergoes chromosomal analysis and the geneticist has pointed out the area of concern. 

What is your immediate diagnosis?

a. Scrofula

b. Kaposi sarcoma

c. Burkitt lymphoma

d. Actinomycosis

e. Hodgkin lymphoma

For the answer and other parts to this question-

https://youtu.be/lvty_DQ8lpQ