WBR0226

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Endocrine
Prompt	[[Prompt::A 60 yr old woman is brought to the emergency department following a motor vehicle accident. She was hit by car from her side and claims that she did not see the car coming towards her. She had a past history of intraabdominal operation done 15 yrs ago for Cushing’s syndrome. Physical examination shows tanned female with normal vital signs. She has few abrasions on her face and chest. Her injuries are managed appropriately. What is the best next step in the management of this condition?]]
Answer A	AnswerA::Slit lamp examination
Answer A Explanation	AnswerAExp::'''Incorrect''' : Slit lamp examination is done for intraocular defect and not for intracranial lesions.
Answer B	AnswerB::MRI of the brain
Answer B Explanation	[[AnswerBExp::Correct : MRI of the brain with plasma ATCH levels is required for the diagnosis.]]
Answer C	AnswerC::Xray of the skull
Answer C Explanation	[[AnswerCExp::Incorrect : Xray of the skull may be helpful for empty sella syndrome, however MRI is best for its diagnosis.]]
Answer D	AnswerD::Water’s view
Answer D Explanation	AnswerDExp::'''Incorrect''' : Water view is taken for sinusitis.
Answer E	AnswerE::CT angiogram
Answer E Explanation	[[AnswerEExp::Incorrect : CT angiogram for intra-arterial lesion is not warranted in this patient.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::Pituitary enlargement and hyperpigmentation following bilateral adrenalectomy is called Nelson’s syndrome. The cause of pituitary enlargement is loss of feedback by adrenal glucocorticoids following the adrenalectomy. The tumour is aggressive and is treated by surgery or pituitary radiation. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::