Question 26
What are the CT characteristics of a benign adrenal adenoma?
- Will be steroid (fat rich): Low Hounsfeld units (typically <10)
- Rapid wash-out of contrast: 50% in 10 minutes
- Small: <4 cm
- Homogenous (not calcified/hemorrhagic) and round
Question 27
Lucy Rodriguez is a 24 year-old woman who has come to see you because her periods are very irregular and she is bothered by increasing acne and facial hair on her upper lip and cheeks. Her BMI is 28, and her Ferriman-Gallwey score is 8. You suspect PCOS, but how do you diagnose it?
Rotterdam criteria (at least 2/3 of the following):
- Hyperandrogenism (physical and/or biochemical)
- Anovulation
- Polycystic ovaries on imaging
Plus none of the following:
- Cushing’s syndrome
- Acromegaly
- Congenital adrenal hyperplasia
- Adrenal or ovarian androgen-producing tumor
- the latter two are often associated with virilization, (i.e. deepened voice, male musculature, loss of breast tissue, cliteromegaly)
Question 28
List four priorities in the treatment of PCOS, and what you can use to address each priority.
| Treatment/Priorities | Fertility | Endometrial hyperplasia | Metabolic syndrome | Hyperandrogenism |
| Weight loss (exercise/diet) | X | X | X | X |
| Spinorolactone | X | |||
| Metformin | X | X | X | X |
| Oral contraceptive (estrogen/progesterone, estrogen/cyproterone acetate) |
X | X | ||
| Clomiphene | X |
Question 29
Anita Chen is 62 year-old woman who is worried about her risk of an osteoporotic fracture. List the 8 items you would need to ask on history to assess this risk (risk of low BMD, fall, fracture).
- Prior fragility fracture + family history of hip fracture
- Currently smoking
- Currently drinking >= 3 EtOH/day
- Steroid use
- Rheumatoid arthritis diagnosis
- Falls in last 12 months
- Gait/balance problems
List the 3 items you would look for on physical examination for evidence of prior vertebral fracture.
- Loss of height: >2 cm (6 cm historical)
- Inability to put 3 or more fingers between ribs and pelvis
- >5 cm occiput-wall distance
List 2 other physical exam findings you should look for.
- Weight (>10% loss since age 25 y.o. is a risk factor)
- “Get up and go”: ability to rise from a chair with arms crossed in front of them, walk a few steps, turn around, and sit down again
List the 8 minimum lab tests you should order.
- CBC
- creatinine
- ALP
- Protein electrophoresis (if history of vertebral fracture)
- TSH
- Calcium corrected for albumin
- 25(OH) Vitamin D after 3-4 months of adequate replacement
Question 30
For the patient with osteoporosis, list 5 items you would discuss for lifestyle counseling.
- Stopping smoking, alcohol; limiting caffeine intake
- Fall prevention strategies (e.g. turn on lights when walking at night; no throw rugs)
- Elemental calcium: 1200 mg/day in split doses, including dietary
- Vitamin D: less than 50 y.o.: 400-1000; >50 y.o.: 1000-2000 IU day
- Weight-bearing exercise
