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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=Vendhan Ramanujam
|QuestionAuthor={{Rim}}
|ExamType=USMLE Step 2 CK
|ExamType=USMLE Step 1
|MainCategory=Internal medicine
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Gastrointestinal, Gastrointestinal
|MainCategory=Internal medicine
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Gastrointestinal, Gastrointestinal
|MainCategory=Internal medicine
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Gastrointestinal, Gastrointestinal
|MainCategory=Internal medicine
|MainCategory=Pathology
|MainCategory=Internal medicine
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Gastrointestinal, Gastrointestinal
|MainCategory=Internal medicine
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Gastrointestinal, Gastrointestinal
|MainCategory=Internal medicine
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Gastrointestinal, Gastrointestinal
|MainCategory=Internal medicine
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Gastrointestinal, Gastrointestinal
|MainCategory=Internal medicine
|MainCategory=Pathology
|MainCategory=Internal medicine
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Gastrointestinal, Gastrointestinal
|Prompt=A 30 year old male presents with fatigue, decreased appetite, weight gain, constipation and cold intolerance.  He recalls no event of stress.  He does not take any medications. He is a non-smoker and a non alcoholic.  His pulse is 48/min and blood pressure is 146/90 mmHg.  Physical examination reveals cold extremities, pale skin, coarse hair and brittle nails. There is delayed relaxation of deep tendon reflexes.  The thyroid gland is normal on palpitation.  Laboratory studies reveal increased serum free T3 and T4 but normal serum TSH level. Which is the most likely diagnosis?
|Prompt=A 62-year-old male complains of four months history of worsening abdominal pain.  The pain is localized in the upper abdominal area and it is dull in nature, constant and progressively increasing in intensity independently from food intake or change in posture. Review of system is significant for several months history of increasing fatigue and weight loss. CT scan reveals a mass in the stomach.  Endoscopy guided biopsy of the mass reveals extensive aggregation of spindle cells highly suspicious of gastrointestinal stromal tumor (GIST).  Immunohistochemistry of which of the following is diagnostic of GIST?
|Explanation=Besides primary, secondary and tertiary [[hypothyroidism]], rarely [[Thyroid hormone resistance|generalized resistance to thyroid hormones]] may cause hypothyroidism.  Generalized resistance to thyroid hormones results from a receptor defect in the peripheral tissues.  They usually present at an early age with growth and mental retardation, however patients with milder defects can present later in life.  Elevated circulating [[thyroid hormone]] levels with normal or elevated [[TSH]] levels are characteristic.  They present with hypothyroidism despite having elevated thyroid hormone levels.
|AnswerA=C kit gene
 
|AnswerB=Ret gene
'''Educational Objective:'''
|AnswerC=Abl gene
Elevated circulating thyroid hormone levels with normal or elevated TSH levels with features of hypothyroidism can happen in generalized resistance to thyroid hormones.
|AnswerD=Ras gene
|AnswerA=Subclinical hypothyroidism
|AnswerE=C myc gene
|AnswerAExp='''Incorrect'''-Mildly elevated serum TSH levels and normal circulating thyroid hormone levels characterize subclinical hypothyroidism.  Patients do not have clinical features of hypothyroidism.
|AnswerB=Primary hypothyroidism
|AnswerBExp='''Incorrect'''-Low circulating levels of thyroid hormones with TSH levels more than 10 IU/L characterizes primary hypothyroidism.
|AnswerC=Central hypothyroidism
|AnswerCExp='''Incorrect'''-Secondary and tertiary are central hypothyroidism.  Low circulating thyroid hormone levels with low or inappropriate normal TSH levels characterize them.
|AnswerD=Sick euthyroid syndrome
|AnswerDExp='''Incorrect'''-In [[Euthyroid sick syndrome|sick euthyroid syndrome]], the abnormality pattern is usually a low total or free T3 level with normal T4 and TSH levels, due to decrease in the peripheral conversion of T4 to T3 following a severe illness.
|AnswerE=Generalized resistance to thyroid hormones
 
|AnswerEExp='''Correct'''-Besides primary, secondary and tertiary hypothyroidism, rarely generalized resistance to thyroid hormones may cause hypothyroidism.  Generalized resistance to thyroid hormones results from a receptor defect in the peripheral tissues.  They usually present at an early age with growth and mental retardation, however patients with milder defects can present later in life.  Elevated circulating thyroid hormone levels with normal or elevated TSH levels are characteristic.  They present with hypothyroidism despite having elevated thyroid hormone levels.
|RightAnswer=E
|RightAnswer=E
|Approved=Yes
|Approved=No
}}
}}

Revision as of 20:48, 2 September 2013
Author [[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Gastrointestinal, SubCategory::Gastrointestinal
Prompt [[Prompt::A 62-year-old male complains of four months history of worsening abdominal pain. The pain is localized in the upper abdominal area and it is dull in nature, constant and progressively increasing in intensity independently from food intake or change in posture. Review of system is significant for several months history of increasing fatigue and weight loss. CT scan reveals a mass in the stomach. Endoscopy guided biopsy of the mass reveals extensive aggregation of spindle cells highly suspicious of gastrointestinal stromal tumor (GIST). Immunohistochemistry of which of the following is diagnostic of GIST?]]
Answer A AnswerA::C kit gene
Answer A Explanation AnswerAExp::
Answer B AnswerB::Ret gene
Answer B Explanation AnswerBExp::
Answer C AnswerC::Abl gene
Answer C Explanation AnswerCExp::
Answer D AnswerD::Ras gene
Answer D Explanation AnswerDExp::
Answer E AnswerE::C myc gene
Answer E Explanation AnswerEExp::
Right Answer RightAnswer::E
Explanation [[Explanation::

Educational Objective:
References: ]]

Approved Approved::No
Keyword
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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