Item: 1 of 26 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 2797 ..L ar Pre v ious Next Lab~lues Notes Calcula t o r
•1 &
A 66-year-old man with a 50-pack-year history of cigarette smoking comes to the clinic complaining of chronic cough, dyspnea, an
•2 sputum. He says he has been feeling lethargic and has lost 18 kg (40 lb) over the past 3 months with no changes in diet or exerci
ray of the chest, the patient suffers a seizure and is rushed to the emergency department of the nearest hospital. Laboratory stud
•3 sodium level of 120 mEq/dl.
·4
•5 Which of the following is most likely to be elevated in this patient?
•6
A. ACTH
•7
·8 B. AOH
.9 c. Parathyroid hormone
• 10
D. Prolactin
• 11
E. Renin
• 12
• 13
• 14
• 15
• 16
• 17
• 18
• 19
• 20
• 21
•
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, Item: 1 of 26 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 2797 ..L ar Prev ious Next Lab~lues Notes Calculat o r
&
1
•2
Th e correct an swer i s B. 670/o chose this.
•3 This vignette is most consistent with the syndrome of inappropriate ADH secretion (SIADH) due to a lung neoplasm . ADH is norm
posterior pituitary and stimulates the expression of aquaporins in the renal collecting ducts. This results in transport of wat er int
·4 the ductal lumen, thus increasing wat er reabsorpt ion by the kidneys. When levels of this hormone are inappropriately elevated, e
•5 results In hyponatremia, which can lead t o seizures. ADH can be produced ectopically in the setting of malignancy such as small
Hyponat• em1a Rena medu Ia Collecting duct system Posterior pituitary Neoplasm Lu1 9 cancer Aquaporin Hormone Pituitary gland Small
•6
Vasopress· 'd •ey Ma ignancy Lumen (anatomy) cancer Epileptic se1zure Medulla oblongata Lung Secretion
•7
A is not correct. 15% chose this.
·8 ACTH can be produced ectopically in th e setting of small cell lung cancer. However, exceSSive levels of ACTH would result in Cush
symptoms of hypertension, weight gain, moon fades, truncal obesity, buffalo hump, insulin resistance, skin thinning/ striae, osteo
.9 The vignette provides no signs or symptoms that would be consistent with Cushing syndrome.
• 10 Osteopo o ;is Cushing's syndrome Amenorrhoea Adrenocorticotropic hormone Lung cance Obesity Insulin resistance Hypertension Insuli
Cancer Lung Ectopic expression Upodystrophy Weight gain
• 11
C is not co rrect. 6% chose t his •
• 12
Parathyroid hormone (PTH )-relat ed peptides can be produced ectopically In the setting of malignancy and are associat ed with a
• 13 Including squamous cell lung cancer, breast cancer, renal cell carcinoma, and multiple myeloma. However, excessive levels of PTH
hypercalcemia, and the vignette does not provide any indication that would be consistent with this condition .
• 14 Multiple myeloma parathyroid hormone Renal cell carcinoma Hypercalcaemia Lung cancer Parathyroid gland Malignancy Breast cancer N
• 15 Carcinoma Cancer Squamous epithelial cell Lung Ectopia (medicine) Kidney
• 16 D is not co rrect. 20/o ch ose this.
• 17 Though more commonly associat ed wit h prolactinomas in the pituitary gland, prolactin elevation can ra rely occur due to some sm
Symptoms of elevated prolactin include sexual dysfunction, galactorrhea, menstrual dysfunction and infertility in women, and gyn
• 18 muscle mass and body hair in men. Ost eoporosis is a long-t erm complication of chronically high prolactin levels as a result of pro
hypogonadism .
• 19 Gynecomastia Galactorrhea Osteoporosis Prolactin Pituitary gland Hypogonadism Sexual dysfunction Infertility Lung Gland Body hair M
• 20 E is not corr ect. 100/o ch ose this•
• 21 Hyperrenlnemia does not typically occur as a paraneoplastic syndrome and Is most commonly caused by renal artery stenosis. Re
• ' .' . ' . . . .. ..
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, Item: lof26 ~. , . M k <:] t> al ~· ~
QIO: 2797 .l. ar Pre vious Next lab 'Vfl1 ues Notes Calculator
••• • - • • • • - . ' 'II • • - 'II • • • • 'II • - -., • - • • • •• - • • -
1 Symptoms of elevat ed prolactin include sexual dysfunction, galactorrhea, menstrual dysfunction and infertility in women, and gyn
. 2 muscle mass and body hair in men. Osteoporosis is a long-t erm complication of chronically high prolactin levels as a result of pro
hypogonadism.
•3 Gynecomastia Galactorrhea Osteoporosis Prolactin Pituitary gland Hypogonadism Sexual dysfunction Infertility lung Gland Body hair M
.4 E is no t co rrect. 1 0 % cho se this.
•5 Hyperreninemia does not typically occur as a paraneoplastic syndrome and is most commonly caused by renal artery stenosis. Re
by the kidneys upon sensing decrea sed blood pressure. Renin plays a role in the conversion of angiotensinogen to angiotensin I,
•6 by angiotensin-converting enzyme into angiotensin II. Angiotensin II stimulat es the relea se of aldosterone from the adrenal glan
hyperreninemia lea ds to increa sed levels of angiotensin II and aldosterone, resulting in hypertension and hypokalemia. In a patie
.7 levels may actually be slightly decrea sed in order to maintain euvolemia as a result of slight expansion of the extracellular fluid v
ADH and wat er ret ention .
•8
Angiotensinogen Hypokalemia Renal artery stenosis Aldosterone Renin Angiotensin-converting enzyme Enzyme Angiotensin I Angiotensin
•9 Angiotensin II Hypertension Vasopressin Paraneoplastic syndrome Adrenal gland Kidney Renal artery Blood pressure
• 10 Syndrome of inappropriate antidiuretic hormone secretion
· 11
• 12 Botto m Li ne:
• 13 ADH is normally secret ed by the posterior pituitary, but it can be produced ectopically in the setting of malignancy such as sma
works on the kidney collecting duct and will facilitat e the reabsorption of free wat er via aquaporin channels. The absorption of
• 14 hyponatremia, making the patient susceptible to seizures.
• 15 Hyponatremia Aquaporin Posterior pituitary lung cancer Pituitary gland Kidney Collecting duct system Small-cell carcinoma Vasopressin
Cancer Malignancy
• 16
• 17
• 18
l i j l ; f i i J I • l t o r yea r :[ 2017 • ]
FI RST AID FAC T S
• 19
• 20
• 21 ,. ___ _. ___ - -~
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6
, Item: lof26 ~. , . M k <:] t> al ~· ~
QIO: 2797 .l. ar Previous Next lab 'Vfl1 ues Notes Calculator
1 •
•2
•3 Paraneoplastic syndromes
•4 MANIFESTATION DESCRIPTION/MECHANISM MOST COMMONLY ASSOCIATED CANCER(S)
•5 Cutaneous
•6 Acanthosis nigricans llyperpigmcnted velvety plaques in axilla and Gastric adenocarcinoma and other
•7
neck malignancies (but more common
with obesity and insulin resistanc
•8
Sign of Leser-Trelat Sudden onset of multiple seborrheic keratoses C l adenocarcinomas and other visc
•9
malignancies
• 10
Endocrine
· 11
Hypercalcemia PTHrP Squamous cell carcinomas of lung,
• 12
neck; renal, bladder, breast, and o
• 13 carcmomas
• 14 t 1,25-(0Hh vitamin 0 3 (calcitriol) Lymphoma
• 15 Cushing syndrome t ACTH
Small cell lung cancer
• 16 Hyponatremia (SIADH) t ADI1
• 17 Hematologic
• 18
Polycythemia t Erythropoietin Renal cell carcinoma, hepatocellul
• 19 carcinoma, hemangioblastoma,
• 20 pheochromocytoma, leiomyoma
• 21 Pure red cell aplasia Anemia with low rcticulocytes
• r rL .. - - - - - -
6
lock
QIO: 2797 ..L ar Pre v ious Next Lab~lues Notes Calcula t o r
•1 &
A 66-year-old man with a 50-pack-year history of cigarette smoking comes to the clinic complaining of chronic cough, dyspnea, an
•2 sputum. He says he has been feeling lethargic and has lost 18 kg (40 lb) over the past 3 months with no changes in diet or exerci
ray of the chest, the patient suffers a seizure and is rushed to the emergency department of the nearest hospital. Laboratory stud
•3 sodium level of 120 mEq/dl.
·4
•5 Which of the following is most likely to be elevated in this patient?
•6
A. ACTH
•7
·8 B. AOH
.9 c. Parathyroid hormone
• 10
D. Prolactin
• 11
E. Renin
• 12
• 13
• 14
• 15
• 16
• 17
• 18
• 19
• 20
• 21
•
a
Lock
, Item: 1 of 26 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 2797 ..L ar Prev ious Next Lab~lues Notes Calculat o r
&
1
•2
Th e correct an swer i s B. 670/o chose this.
•3 This vignette is most consistent with the syndrome of inappropriate ADH secretion (SIADH) due to a lung neoplasm . ADH is norm
posterior pituitary and stimulates the expression of aquaporins in the renal collecting ducts. This results in transport of wat er int
·4 the ductal lumen, thus increasing wat er reabsorpt ion by the kidneys. When levels of this hormone are inappropriately elevated, e
•5 results In hyponatremia, which can lead t o seizures. ADH can be produced ectopically in the setting of malignancy such as small
Hyponat• em1a Rena medu Ia Collecting duct system Posterior pituitary Neoplasm Lu1 9 cancer Aquaporin Hormone Pituitary gland Small
•6
Vasopress· 'd •ey Ma ignancy Lumen (anatomy) cancer Epileptic se1zure Medulla oblongata Lung Secretion
•7
A is not correct. 15% chose this.
·8 ACTH can be produced ectopically in th e setting of small cell lung cancer. However, exceSSive levels of ACTH would result in Cush
symptoms of hypertension, weight gain, moon fades, truncal obesity, buffalo hump, insulin resistance, skin thinning/ striae, osteo
.9 The vignette provides no signs or symptoms that would be consistent with Cushing syndrome.
• 10 Osteopo o ;is Cushing's syndrome Amenorrhoea Adrenocorticotropic hormone Lung cance Obesity Insulin resistance Hypertension Insuli
Cancer Lung Ectopic expression Upodystrophy Weight gain
• 11
C is not co rrect. 6% chose t his •
• 12
Parathyroid hormone (PTH )-relat ed peptides can be produced ectopically In the setting of malignancy and are associat ed with a
• 13 Including squamous cell lung cancer, breast cancer, renal cell carcinoma, and multiple myeloma. However, excessive levels of PTH
hypercalcemia, and the vignette does not provide any indication that would be consistent with this condition .
• 14 Multiple myeloma parathyroid hormone Renal cell carcinoma Hypercalcaemia Lung cancer Parathyroid gland Malignancy Breast cancer N
• 15 Carcinoma Cancer Squamous epithelial cell Lung Ectopia (medicine) Kidney
• 16 D is not co rrect. 20/o ch ose this.
• 17 Though more commonly associat ed wit h prolactinomas in the pituitary gland, prolactin elevation can ra rely occur due to some sm
Symptoms of elevated prolactin include sexual dysfunction, galactorrhea, menstrual dysfunction and infertility in women, and gyn
• 18 muscle mass and body hair in men. Ost eoporosis is a long-t erm complication of chronically high prolactin levels as a result of pro
hypogonadism .
• 19 Gynecomastia Galactorrhea Osteoporosis Prolactin Pituitary gland Hypogonadism Sexual dysfunction Infertility Lung Gland Body hair M
• 20 E is not corr ect. 100/o ch ose this•
• 21 Hyperrenlnemia does not typically occur as a paraneoplastic syndrome and Is most commonly caused by renal artery stenosis. Re
• ' .' . ' . . . .. ..
a
Lock
, Item: lof26 ~. , . M k <:] t> al ~· ~
QIO: 2797 .l. ar Pre vious Next lab 'Vfl1 ues Notes Calculator
••• • - • • • • - . ' 'II • • - 'II • • • • 'II • - -., • - • • • •• - • • -
1 Symptoms of elevat ed prolactin include sexual dysfunction, galactorrhea, menstrual dysfunction and infertility in women, and gyn
. 2 muscle mass and body hair in men. Osteoporosis is a long-t erm complication of chronically high prolactin levels as a result of pro
hypogonadism.
•3 Gynecomastia Galactorrhea Osteoporosis Prolactin Pituitary gland Hypogonadism Sexual dysfunction Infertility lung Gland Body hair M
.4 E is no t co rrect. 1 0 % cho se this.
•5 Hyperreninemia does not typically occur as a paraneoplastic syndrome and is most commonly caused by renal artery stenosis. Re
by the kidneys upon sensing decrea sed blood pressure. Renin plays a role in the conversion of angiotensinogen to angiotensin I,
•6 by angiotensin-converting enzyme into angiotensin II. Angiotensin II stimulat es the relea se of aldosterone from the adrenal glan
hyperreninemia lea ds to increa sed levels of angiotensin II and aldosterone, resulting in hypertension and hypokalemia. In a patie
.7 levels may actually be slightly decrea sed in order to maintain euvolemia as a result of slight expansion of the extracellular fluid v
ADH and wat er ret ention .
•8
Angiotensinogen Hypokalemia Renal artery stenosis Aldosterone Renin Angiotensin-converting enzyme Enzyme Angiotensin I Angiotensin
•9 Angiotensin II Hypertension Vasopressin Paraneoplastic syndrome Adrenal gland Kidney Renal artery Blood pressure
• 10 Syndrome of inappropriate antidiuretic hormone secretion
· 11
• 12 Botto m Li ne:
• 13 ADH is normally secret ed by the posterior pituitary, but it can be produced ectopically in the setting of malignancy such as sma
works on the kidney collecting duct and will facilitat e the reabsorption of free wat er via aquaporin channels. The absorption of
• 14 hyponatremia, making the patient susceptible to seizures.
• 15 Hyponatremia Aquaporin Posterior pituitary lung cancer Pituitary gland Kidney Collecting duct system Small-cell carcinoma Vasopressin
Cancer Malignancy
• 16
• 17
• 18
l i j l ; f i i J I • l t o r yea r :[ 2017 • ]
FI RST AID FAC T S
• 19
• 20
• 21 ,. ___ _. ___ - -~
r "L - - - _ , __ : - I I
lock
6
, Item: lof26 ~. , . M k <:] t> al ~· ~
QIO: 2797 .l. ar Previous Next lab 'Vfl1 ues Notes Calculator
1 •
•2
•3 Paraneoplastic syndromes
•4 MANIFESTATION DESCRIPTION/MECHANISM MOST COMMONLY ASSOCIATED CANCER(S)
•5 Cutaneous
•6 Acanthosis nigricans llyperpigmcnted velvety plaques in axilla and Gastric adenocarcinoma and other
•7
neck malignancies (but more common
with obesity and insulin resistanc
•8
Sign of Leser-Trelat Sudden onset of multiple seborrheic keratoses C l adenocarcinomas and other visc
•9
malignancies
• 10
Endocrine
· 11
Hypercalcemia PTHrP Squamous cell carcinomas of lung,
• 12
neck; renal, bladder, breast, and o
• 13 carcmomas
• 14 t 1,25-(0Hh vitamin 0 3 (calcitriol) Lymphoma
• 15 Cushing syndrome t ACTH
Small cell lung cancer
• 16 Hyponatremia (SIADH) t ADI1
• 17 Hematologic
• 18
Polycythemia t Erythropoietin Renal cell carcinoma, hepatocellul
• 19 carcinoma, hemangioblastoma,
• 20 pheochromocytoma, leiomyoma
• 21 Pure red cell aplasia Anemia with low rcticulocytes
• r rL .. - - - - - -
6
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