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8095 Medicine

A 45 year old male was evaluated for secondary hypeension & was diagnosed with pheochromocytoma. MRI abdomen revealed a 3 cm mass in left adrenal gland. He underwent a left adrenalectomy. After this, his hypeension is well controlled. How will you decide whether his pheochromocytoma was malignant?

AApproximately 50% of pheochromocytomas are malignant.
BCellular atypia and invasion of blood vessels on pathology define malignancy for pheochromocytoma.
C123I-metaiodobenzylguanidine scans are not useful in locating distant metastases.
DThe absence of distant metastases rules out malignant disease.
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8096 Medicine

A 62-year-old man is evaluated in the ER for drowsiness and generalized weakness for the past 4 weeks. He is brought to the hospital by EMS after he experienced a tonic clonic seizure in a local restaurant. His medical history is positive for HTN and gout, for which he takes metoprolol and allopurinol. He has smoked 1 pack per day for nearly 40 years, with no alcohol or recreational drug abuse. He noticed nearly 20 lb weight loss in past 2 months. Physical examination is normal. Laboratory tests reveal hemoglobin 10.2 gm/dL, leukocyte count 9500/mL, and platelet 171,000/mL. Serum sodium is 122 mEq/L, potassium 3.8 mEq/L, blood urea nitrogen (BUN) 26 mg/dL, and creatinine 0.9 mg/dL. Additional laboratory findings include serum osmolality 258 mOsm/kg, urine osmolality 300 mOsm/kg, and urine sodium 48 mmol/L. TSH and cortisol levels are normal.

ATrousseau syndrome
BSezary syndrome
CSyndrome of inappropriate antidiuretic hormone
DTumor lysis syndrome
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8098 Medicine

A 63-year-old man presents to the emergency room with severe pain and swelling in his right knee. The pain started suddenly, and there is no history of injury to the knee. On physical examination, the knee is warm, red, and swollen with decreased range of movement. A diagnostic aspiration of the knee is performed. Which of the following will most likely distinguish pseudo-gout from gout?

Apositive birefringent crystals
Bacute onset
Cinvolvement of single joints
Dinvolvement of large joints
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