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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