DFT-MEDICINE D1-08/10/2025-MaXeMo

DFT-MEDICINE D1-08/10/2025-MaXeMo

Professional Development

10 Qs

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DFT-MEDICINE D1-08/10/2025-MaXeMo

DFT-MEDICINE D1-08/10/2025-MaXeMo

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10 questions

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1.

MULTIPLE CHOICE QUESTION

45 sec • 1 pt

A middle-aged woman with progressively enlarging hands and feet is diagnosed with a pituitary adenoma. The over-secreted hormone mediates its effects on cellular growth primarily through which signaling protein?

Janus Kinase (JAK)

SMAD

Gαs

Retinoid X Receptor (RXR)

Answer explanation

The clinical picture is of acromegaly, caused by excess Growth Hormone (GH). The GH receptor is a cytokine receptor that lacks intrinsic kinase activity and signals via the associated Janus Kinase (JAK)-STAT pathway.


2.

MULTIPLE CHOICE QUESTION

45 sec • 1 pt

A 48-year-old male is on the neurosurgery ward, day 8 post-transsphenoidal resection of a large pituitary macroadenoma. He develops confusion and a severe headache. His labs reveal a serum sodium of 122 mEq/L, serum osmolality of 260 mOsm/kg, and a urine osmolality of 450 mOsm/kg. What is the most likely diagnosis?

Syndrome of inappropriate ADH secretion (SIADH)

Acute central diabetes insipidus

Cerebral salt wasting syndrome

Adrenal crisis

Answer explanation

This presentation is classic for the second phase of the triphasic response after pituitary stalk injury: SIADH. This phase involves the uncontrolled release of stored ADH, causing hyponatremia and inappropriately concentrated urine.


3.

MULTIPLE CHOICE QUESTION

45 sec • 1 pt

A 29-year-old female treated for a psychiatric condition develops galactorrhea. Her symptoms mimic the 'stalk effect' seen with pituitary stalk compression. Which medication is the most likely cause?

Risperidone

Bromocriptine

Levodopa

Lithium

Answer explanation

Risperidone is a potent dopamine (D2) receptor antagonist. By blocking dopamine's tonic inhibitory effect on pituitary lactotrophs, it leads to hyperprolactinemia, causing galactorrhea.


4.

MULTIPLE CHOICE QUESTION

45 sec • 1 pt

A young adult female with a hemorrhagic sellar mass and hypotension has a serum sodium of 132 mEq/L. What is the primary mechanism for her hyponatremia?

Impaired free water excretion due to cortisol deficiency

Syndrome of inappropriate antidiuretic hormone (SIADH)

Cerebral salt wasting syndrome

Osmotic diuresis from hyperglycemia

Answer explanation

Cortisol deficiency (secondary adrenal insufficiency) impairs the kidney's ability to excrete free water and also leads to a non-osmotic release of ADH, causing dilutional hyponatremia. This is the key mechanism in this setting.


5.

MULTIPLE CHOICE QUESTION

45 sec • 1 pt

The patient in the vignette is diagnosed with a pituitary adenoma. The presence of which of the following co-morbidities would be most suggestive of Multiple Endocrine Neoplasia Type 1 (MEN 1)?

Primary hyperparathyroidism

Medullary thyroid carcinoma

Pheochromocytoma

Cushing's disease

Answer explanation

MEN 1 is characterized by the "3 Ps": Pituitary adenoma, Parathyroid hyperplasia (causing primary hyperparathyroidism), and Pancreatic neuroendocrine tumors. Hyperparathyroidism is the most common manifestation.


6.

MULTIPLE CHOICE QUESTION

45 sec • 1 pt

A 28-year-old woman presents with a 9-month history of amenorrhea and bilateral galactorrhea. Her serum prolactin level is 220 ng/mL. A subsequent MRI of the brain reveals a 6 mm pituitary microadenoma. What is the most appropriate initial management for this patient?

Initiation of cabergoline

Transsphenoidal surgery

Radiation therapy

Monthly observation with serial prolactin levels

Answer explanation

Cabergoline, a dopamine agonist, is the first-line medical therapy for symptomatic microprolactinomas. It effectively normalizes prolactin levels, restores gonadal function, and can reduce tumor size.


7.

MULTIPLE CHOICE QUESTION

45 sec • 1 pt

In the context of the patient described, the absence of the 'posterior pituitary bright spot' on a T1-weighted MRI is primarily due to the depletion of which of the following?

Arginine vasopressin (AVP) neurosecretory granules

Pituicytes within the neurohypophysis

Prolactin-secreting lactotrophs

Colloid from Rathke's pouch remnants

Answer explanation

The intrinsic hyperintensity (bright spot) of the normal posterior pituitary on T1-weighted images is attributed to the stored phospholipid membranes of neurosecretory granules containing vasopressin. Their absence signifies depletion or destruction.


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