MEN SEMINAR

A 48-year-old woman presents to the emergency department with complaints of flank pain, nausea, and hematuria. She has a history of fatigue and bone pain over the past few months. Laboratory tests reveal elevated serum calcium , low phosphate, and elevated parathyroid hormone levels. A non-contrast CT scan confirms the presence of renal calculi. Which of the following best explains the pathophysiology of urolithiasis in a patient with primary hyperparathyroidism?

• Increased renal reabsorption of calcium due to elevated parathyroid hormone

• Hypercalciuria due to increased bone resorption & calcium release into circulation

• Decreased intestinal absorption of calcium

• Increased urinary phosphate excretion leading to stone formation

A   52-year-old man presents with complaints of persistent low mood, fatigue, poor concentration, and sleep disturbances for the past 3 months. He has no prior psychiatric history. She also reports recent constipation and mild bone pain. Blood tests reveal high  serum calcium, and elevated parathyroid hormone (PTH). Further imaging reveals a parathyroid adenoma.

Which of the following best explains the pathophysiology of her pschycological symptoms ?

• Direct invasion of the brain by parathyroid hormone
  

• Elevated phosphate levels impairing serotonin production

• Increased neuronal excitability due to elevated calcium
  

• Hypercalcemia-induced disruption of neurotransmitter balance

A 45-year-old man presents with progressive difficulty in vision. He reports loss of vison on both sides and difficulty seeing cars approaching from the sides while driving. He denies eye pain or double vision. Visual field testing reveals loss of peripheral vision in both eyes. MRI of the brain shows a mass in the sella turcica extending superiorly.

•What is the most likely mechanism causing vision defect in this patient?

• Compression of the optic chiasm where nasal retinal fibers decussate

• Infiltration of the lateral geniculate nucleus by the tumor

• Direct compression of the optic nerve

• Ischemia of the occipital cortex

A 36-year-old woman presents with episodes of headache, palpitations, sweating, and high blood pressure. Her symptoms occur in sudden bursts lasting 15–20 minutes. On examination, her blood pressure is 180/100 mmHg. Laboratory tests reveal elevated plasma free metanephrines.  Abdominal imaging shows an adrenal mass.

What is the most likely mechanism responsible for hypertension in this patient?

• Excessive activation of the renin-angiotensin-aldosterone system

• Chronic sodium and water retention due to cortisol excess

• Intermittent release of catecholamines leading to vasoconstriction

• Direct adrenal compression causing renal artery stenosis

A 42-year-old man presents with a painless thyroid nodule. Fine-needle aspiration suggests a neuroendocrine tumor. He has a family history of thyroid cancer and mucosal neuromas. Laboratory studies show elevated calcitonin and CEA (carcinoembryonic antigen) levels.  He is suspected with thyroid carcinoma. A total thyroidectomy is performed and study the images.

•Which of the following is most likely diagnosis in this patient?

• papillary thyroid car cinoma
  

• follicular thyroid carcinoma
  

• Anaplastic thyroid carcinoma

• medullary thyroid carcinoma