ADRENAL &

SECONDARY HTN
MCQS
Presented By : Dr.Suliman Alharbi
Supervised By: Dr.Rania Alshrafyah
Adrenal gland
MCQs

• 1-Glucocorticoids is produced by which area?

• A. Zona Glomerulosa
• B. Zona Fasciculata
• C. Zona Reticularis

• Answer : B
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• 2-Noradrenaline involved in which of the following:

• A. Inhibition of the heart

• B. Increase the blood pressure
• C. stimulation of the metabolism.
• D. Peripheral vasodilation

• Answer : B
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• 4-Hyperpigmentation is a sign of:

• A. Addison disease
• B. cushing disease
• C. Ectopic ACTH
• D. A&C

• Answer : D
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• 5-What can stimulate aldosterone secretion:

• a. Increase K+ in blood
• b. Increase Na+ in blood
• c. CRH
• d. ANP

• Answer : A
•
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• 8-Adrenaline involved in which of the following:

• a. Inhibition of the heart.

• b. Decrease the blood pressure.
• c. stimulation of the heart.
• d. Peripheral vasoconstriction.

• Answer : C
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• 6-One of the manifestation of Conn’s syndrome is:

• a. hypornatremia
• b. hypotension
• c. Increased Renin level in blood
• d. hypokalemia

• Answer : D
MCQ
• A 50 year old female was admitted to the hospital for urinary track infection
complicated with profound weakness and abdominal pain , vomiting ,
diarrhea.

Her temperature was 40 , BP is 90/60 mmHg

pulse is 110/min and RR:18/min

• Examination showed sign of dehydration and skin hyperpigmentation over

elbow and knees.

• Urine analysis showed pyuria

• Labs showed : hyponatremia , hyperkalemia , hypoglycemia
MCQ
• Which of the following is the most appropriate treatment?

• A)Corticotropin stimulation test

• B)Cortisol level

• C)IV mineralocorticoid

• D)Oral corticosteroids

• E)Renal ultrasound

• Answer: B
MCQ
• This patient probably has acute adrenal insufficiency or
adrenal crisis . Measurement of serum cortisol will
verify the diagnosis
• Adrenal insufficiency occurs in patients with latent
Addison's disease who have stress due to event such
surgery , infection or sever trauma ,
• Other cause may be bilateral adrenalectomy , or abrupt
stopping of exogenous steroid therapy
• This life threatening condition requires emergent
treatment with IV steroid or the patient would develop
irreversible shock
• The underlying cause should be treated as well.
 MCQ
• A 25 year old man came to ER with repeated BP measurement
of 150/100 mmHg
• Clinical examination was normal, no family history of
hypertension.

Which of the following suggest the diagnosis:

• A)24 h urinary excretion of protein more than 1.6g.

• B)Left ventricular hypertrophy
• C)Serum potassium of 3.9 mEq/L
• D)The presence of arteriovenous nipping on foundoscopy

• Answer : is A
MCQ
• Correct answer is A

• It is rather for 25 year old man to be hypertensive but the

presence of such degree of urinary protein would suggest
The lesion is of renal origin.

• The potassium concentration is normal and although it

dose not exclude Conn’s , LVH would be found with
sustained hypertension of any etiology as would AV
nipping on founodsocpy , the creatinine clearance is
normal.
MCQ
• 48 year old female presents with cushingnoid face
And hyperpigmentation of the skin , she smoked 20 cigarettes
per day for the past 30 years
Her chest X ray showed a 2 cm irregular shaped mass in the
right upper lobe in the proximity of mediastinum.

What is the most likely etiology finding:

A)Adenocarcinoma
B)Benign bronchial adenoma
C)Squamous cell carcinoma
D)Small cell carcinoma (oat cell)

Answer is : D
MCQ
• Correct answer is D
• This patient has typical features of ectopic ACTH
secretion which is usually due to small cell lung cancer
other less common cause of ectopic ACTH secrtation
include Bronchial carcinoid.
MCQ
• 26 year old female with episodes of dizziness upon
standing her biochemical profile showed hyperkalemia
acidosis
• What is the most likely diagnosis :
• A)Addison disease
• B)Conn’s syndrome
• C)Cushing’s syndrome
• D)phenochromocytoma

• Answer is: A
MCQ
• The correct answer is A

• Her symptoms are suggestive of postural hypotension

which together with hyperkalemic acidosis and
hypornatremia , acidosis would strongly indicate the
presence of Addison’s disease Conn’s and Cushing’s
syndrome are associated with hypertension and
hypokalemia
MCQ
• 40 year old women presented with a five year history of weight gain
associated with 1 year history of amenorrhea over this time she also
notice hirsutism and she is been trying to conceive, on
examination : BMI :32kg/m2
• BP was 155/100

• Which of the following is the best initial diagnostic test :

A)24 h urinary free cortisol

B)high dose of dexamethasone suppression test
C)MRI of adrenal gland
D)Serum K and Na concentration

Answer is A
MCQ
• Correct answer is A
• Urinary free cortisol is often recommended and has 95%
specificity and 98% sensitivity. MRI of adrenal glands is
not a screening test and should be done if there is high
cortisol level with suppressed ACTH level. High dose of
Dexamethasone suppression test is a late investigation
to differentiate between pituitary adenoma and ectopic
ACTH secretion , Na & K concentration offer nothing nor
do moring ACTH and Cortisol.
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• 20 year old man with asthma found to be hypertensive
investigation showed :

Serum Na: 148mEq/L Serum K: 2.4mEq/L

Serum HCO3 :30mEq/L

Which of the following most likely diagnosis :

A)Addison disease
B)Churg Strauss syndrome
C)Coarctiation of aorta
D)Conn’s disease
E)Inhaled salbutamol therapy

Answer is D
MCQ
• Correct answer is D why ?
• This young asthmatic has hypokalemic hypotension. This
would therefore suggest a secondary cause which may be
either hyperaldosteronism or pseudo hyperaldosteronism.
• Conn’s syndrome is usually found in middle aged patient
and would be unusual in a patient of this age but even so
is the best answer here Addison's disease is associated
with hypotension and hyperkalemia. Salbutamol may
causes hypokalemia particular when given via nebulizer
or IV but it should NOT produce hypertension
References:
• BMJ
• Medscape

American Academy of Family Physicians:

• https://www.aafp.org/afp/2014/0401/afp20140401p563.pdf

• INTERNAL MEDICEN Cairo University MCQs book

• Blueprints Family Medicine (Blueprints Series) 4th

Edition
Thank you