📌 Case 2: باطنية - أهم أفكار الغدد الصماء
👨⚕️ حالة سريرية:
A 68-year-old man presents for a routine follow-up. His medical history includes long-standing type 2 diabetes mellitus, hypertension, and chronic kidney disease.
He is currently taking insulin, metoprolol, and atorvastatin.
🔎 On examination: Bilateral pitting edema at the ankles.
🧪 Lab results: Serum creatinine 4.5 mg/dL (norm 0.6–1.2 mg/dL).
❓ Which of the following laboratory profiles is most consistent with this patient’s condition?
🅰 PTH ↓ | Vitamin D ↑ | Calcium ↑ | Phosphorus ↑
🅱 PTH ↑ | Vitamin D ↓ | Calcium ↓ | Phosphorus ↑
🅲 PTH ↑ | Vitamin D ↓ | Calcium ↑ | Phosphorus ↓
🅳 PTH ↑ | Vitamin D ↓ | Calcium ↓ | Phosphorus ↓
🅴 PTH ↓ | Vitamin D ↓ | Calcium ↓ | Phosphorus ↑
👨⚕️ حالة سريرية:
A 68-year-old man presents for a routine follow-up. His medical history includes long-standing type 2 diabetes mellitus, hypertension, and chronic kidney disease.
He is currently taking insulin, metoprolol, and atorvastatin.
🔎 On examination: Bilateral pitting edema at the ankles.
🧪 Lab results: Serum creatinine 4.5 mg/dL (norm 0.6–1.2 mg/dL).
❓ Which of the following laboratory profiles is most consistent with this patient’s condition?
🅰 PTH ↓ | Vitamin D ↑ | Calcium ↑ | Phosphorus ↑
🅱 PTH ↑ | Vitamin D ↓ | Calcium ↓ | Phosphorus ↑
🅲 PTH ↑ | Vitamin D ↓ | Calcium ↑ | Phosphorus ↓
🅳 PTH ↑ | Vitamin D ↓ | Calcium ↓ | Phosphorus ↓
🅴 PTH ↓ | Vitamin D ↓ | Calcium ↓ | Phosphorus ↑
❤2
📌 Case 3: باطنية - أهم أفكار الغدد الصماء
👨⚕️ حالة سريرية:
A 36-year-old woman presents with a neck swelling for 5 months that has gradually enlarged and is mildly painful. She has also experienced intermittent throbbing headaches, sweating, and palpitations over the past 3 months.
🔎 Exam: Thin, pale; T 38.7°C, HR 112, BP 140/90.
🦠 Neck: Firm 3-cm swelling, moves with swallowing, no LAD.
🫀 Heart/Lungs: Normal.
🧪 Labs: Hb 13, WBC 9500, Plt 230K, Na+ 136, K+ 3.5,
Cl- 104, TSH 2.3, Calcitonin 300 (N < 5).
📉 ECG: Sinus tachycardia.
شرح الحل لكن جاوب الاول
👨⚕️ حالة سريرية:
A 36-year-old woman presents with a neck swelling for 5 months that has gradually enlarged and is mildly painful. She has also experienced intermittent throbbing headaches, sweating, and palpitations over the past 3 months.
🔎 Exam: Thin, pale; T 38.7°C, HR 112, BP 140/90.
🦠 Neck: Firm 3-cm swelling, moves with swallowing, no LAD.
🫀 Heart/Lungs: Normal.
🧪 Labs: Hb 13, WBC 9500, Plt 230K, Na+ 136, K+ 3.5,
Cl- 104, TSH 2.3, Calcitonin 300 (N < 5).
📉 ECG: Sinus tachycardia.
شرح الحل لكن جاوب الاول
❤1
Which of the following laboratory abnormalities is most likely to be seen?s
Anonymous Quiz
7%
Increased Serum Gastrin
10%
Increased serum cortisol
16%
Increased urinary 5-hydroxyindoleacetic acid
50%
Increased serum T3 levels
17%
Increased plasma metanephrines
📌 Case 4: باطنية - أهم أفكار الغدد الصماء
👩⚕️ حالة سريرية:
A 35-year-old woman presents with weight gain, generalized weakness, and irregular menstrual cycles for the past 15 months. She developed insomnia and depression 11 months ago and has recently had difficulty rising from a chair. She has a 2-year history of hypertension and takes citalopram and hydrochlorothiazide.
🔎 Exam: Tired appearance, plethoric face, central obesity, striae on the lower abdomen.
🫀 Vitals: BP 134/76, HR 92, RR 18.
🧪 Labs:
Late-night cortisol: 288 & 253 μg/L (N < 90)
24-hour urinary cortisol: 395 μg (N < 300)
ACTH: 136 pg/mL (N = 7–50)
شرح السؤال لكن جاوب السؤال بالبداية
👩⚕️ حالة سريرية:
A 35-year-old woman presents with weight gain, generalized weakness, and irregular menstrual cycles for the past 15 months. She developed insomnia and depression 11 months ago and has recently had difficulty rising from a chair. She has a 2-year history of hypertension and takes citalopram and hydrochlorothiazide.
🔎 Exam: Tired appearance, plethoric face, central obesity, striae on the lower abdomen.
🫀 Vitals: BP 134/76, HR 92, RR 18.
🧪 Labs:
Late-night cortisol: 288 & 253 μg/L (N < 90)
24-hour urinary cortisol: 395 μg (N < 300)
ACTH: 136 pg/mL (N = 7–50)
شرح السؤال لكن جاوب السؤال بالبداية
❤1
Which of the following is the most appropriate next step in evaluation?
Anonymous Quiz
5%
Corticotropin-releasing hormone stimulation test
0%
CT scan of the abdomen with contrast
42%
Low-dose dexamethasone suppression test
47%
MRI of the pituitary
5%
Bilateral Inferior petrosal sinus sampling (BIPSS)
📌 Case 5: باطنية - أهم أفكار الغدد الصماء
👩⚕️ حالة سريرية:
A 43-year-old woman presents with persistent headaches for 2 months. Her menstrual cycles were previously regular, but her last period was 12 weeks ago. She reports decreased libido over the past few months. She is sexually active, does not smoke or drink alcohol.
🔎 Examination Findings:
✅ BMI = 24 kg/m² (Normal)
✅ Appears uncomfortable
✅ Vital signs within normal limits
🧪 Lab & Imaging Results:
🔹 Urine pregnancy test: Negative
🔹 Pelvic ultrasound: Atrophic endometrium
🔹 Cranial MRI with contrast: 2-cm intrasellar mass
🔹 Hormonal assay: Confirms the diagnosis
شرح السؤال
👩⚕️ حالة سريرية:
A 43-year-old woman presents with persistent headaches for 2 months. Her menstrual cycles were previously regular, but her last period was 12 weeks ago. She reports decreased libido over the past few months. She is sexually active, does not smoke or drink alcohol.
🔎 Examination Findings:
✅ BMI = 24 kg/m² (Normal)
✅ Appears uncomfortable
✅ Vital signs within normal limits
🧪 Lab & Imaging Results:
🔹 Urine pregnancy test: Negative
🔹 Pelvic ultrasound: Atrophic endometrium
🔹 Cranial MRI with contrast: 2-cm intrasellar mass
🔹 Hormonal assay: Confirms the diagnosis
شرح السؤال
Which of the following is the most appropriate next step in the management?
Anonymous Quiz
35%
Transsphenoidal hypophysectomy
50%
Cabergoline therapy
0%
Radiotherapy
10%
Biopsy of intrasellar mass
5%
Observation and outpatient follow-up
السؤال الجاي مزعج
بس يثبت افكار مهمة
بقوا 5 اسئلة ونثبت اهم الافكار بالendocrine حتى نعبر على غير سيستم
بس يثبت افكار مهمة
بقوا 5 اسئلة ونثبت اهم الافكار بالendocrine حتى نعبر على غير سيستم
❤4
📌 Case 6: باطنية - أهم أفكار الغدد الصماء
👦 حالة سريرية:
A 11-year-old boy presents to the emergency department with abdominal pain and nausea for the past 5 hours. Over the past 2 weeks, he has experienced excessive thirst, a 4-kg weight loss, and increased urination, including three episodes of bedwetting despite being fully toilet-trained.
🔎 Examination Findings:
✅ Lethargic and dehydrated
✅ Deep, labored (Kussmaul) breathing
✅ Pulse: 128/min, Respirations: 30/min, Blood pressure: 95/55 mmHg
🧪 Lab & Imaging Results:
🔹 Na+ = 133 mEq/L
🔹 K+ = 5.9 mEq/L
🔹 HCO3- = 13 mEq/L (Metabolic acidosis)
🔹 Urine dipstick: Positive for ketones and glucose
شرح السؤال
👦 حالة سريرية:
A 11-year-old boy presents to the emergency department with abdominal pain and nausea for the past 5 hours. Over the past 2 weeks, he has experienced excessive thirst, a 4-kg weight loss, and increased urination, including three episodes of bedwetting despite being fully toilet-trained.
🔎 Examination Findings:
✅ Lethargic and dehydrated
✅ Deep, labored (Kussmaul) breathing
✅ Pulse: 128/min, Respirations: 30/min, Blood pressure: 95/55 mmHg
🧪 Lab & Imaging Results:
🔹 Na+ = 133 mEq/L
🔹 K+ = 5.9 mEq/L
🔹 HCO3- = 13 mEq/L (Metabolic acidosis)
🔹 Urine dipstick: Positive for ketones and glucose
شرح السؤال
Further evaluation of this patient is most likely to show which of the following findings?
Anonymous Quiz
24%
Increased arterial pCO2
24%
Decreased total body potassium
41%
Serum glucose concentration of 650 mg/dL
6%
Increased arterial blood pH
0%
Hypervolemia
6%
Increased total body sodium
📌 Case 7: باطنية - أهم أفكار الغدد الصماء
👩⚕️ حالة سريرية:
A 62-year-old woman presents for a routine check-up. She has hypertension and a history of smoking (½ pack/day for 18 years) and heavy alcohol use (4–5 glasses of wine/day). Her father died of an MI at age 50.
🔎 On examination: BMI 18 kg/m², soft S4 gallop, otherwise unremarkable.
🩺 Previous screenings: Normal mammogram (1 year ago), Pap smear & colonoscopy (2 years ago).
💉 Vaccination: Influenza (6 months ago)
شرح السؤال
👩⚕️ حالة سريرية:
A 62-year-old woman presents for a routine check-up. She has hypertension and a history of smoking (½ pack/day for 18 years) and heavy alcohol use (4–5 glasses of wine/day). Her father died of an MI at age 50.
🔎 On examination: BMI 18 kg/m², soft S4 gallop, otherwise unremarkable.
🩺 Previous screenings: Normal mammogram (1 year ago), Pap smear & colonoscopy (2 years ago).
💉 Vaccination: Influenza (6 months ago)
شرح السؤال
Which of the following is the most appropriate next step in management?
Anonymous Quiz
14%
Colonoscopy
36%
Dual-energy x-ray absorptiometry
0%
Pap smear
0%
CT scan of the chest
50%
Transesophageal echocardiography
📌 Case 8: باطنية - أهم أفكار الغدد الصماء
👩⚕️ حالة سريرية:
A 67-year-old man presents for an annual health maintenance visit. He has type 2 diabetes mellitus, hypertension, hyperlipidemia, and benign prostatic hyperplasia. He follows a high-fiber diet, quit smoking 15 years ago (32 pack-year history), and does not drink alcohol.
💊 العلاجات:
(Metformin, Lisinopril, Atorvastatin & Tamsulosin)
🔎 On examination:
BMI: 27 kg/m²
BP: 128/77 mmHg
Extremities: Decreased vibration sensation
Ophthalmologic: Microaneurysms on fundoscopic exam
🧪 Lab results:
HbA1c: 6.8%
Serum glucose: 128 mg/dL
Creatinine: 1.2 mg/dL
Urine albumin-to-creatinine ratio: 350 mg/g (N < 30)
شرح السؤال
👩⚕️ حالة سريرية:
A 67-year-old man presents for an annual health maintenance visit. He has type 2 diabetes mellitus, hypertension, hyperlipidemia, and benign prostatic hyperplasia. He follows a high-fiber diet, quit smoking 15 years ago (32 pack-year history), and does not drink alcohol.
💊 العلاجات:
(Metformin, Lisinopril, Atorvastatin & Tamsulosin)
🔎 On examination:
BMI: 27 kg/m²
BP: 128/77 mmHg
Extremities: Decreased vibration sensation
Ophthalmologic: Microaneurysms on fundoscopic exam
🧪 Lab results:
HbA1c: 6.8%
Serum glucose: 128 mg/dL
Creatinine: 1.2 mg/dL
Urine albumin-to-creatinine ratio: 350 mg/g (N < 30)
شرح السؤال
Which of the following is the most appropriate next step in management?
Anonymous Quiz
0%
Losartan therapy
8%
Amlodipine therapy
33%
Canagliflozin therapy
33%
No change in management is indicated at this time
25%
Basal insulin therapy
📌 Case 9: باطنية - أهم أفكار الغدد الصماء
👩⚕️ حالة سريرية:
A 32-year-old primigravid woman at 15 weeks' gestation presents with a painless neck swelling noticed 2 weeks ago. She has had occasional nausea and decreased appetite but otherwise feels well. Her medical history includes recurrent cystitis.
🔎 Physical Examination:
1.5-cm firm, nodular mass on the left side of the neck
No skin changes or cervical lymphadenopathy
Normal cardiopulmonary examination
Uterine fundus palpable midway between the symphysis and umbilicus
🧪 Laboratory Results:
TSH = 3.0 μU/mL (Normal)
Free T4 = 1.1 ng/dL (Normal)
Ultrasound: 1.6-cm solid mass in the left thyroid lobe with mixed echogenicity
👩⚕️ حالة سريرية:
A 32-year-old primigravid woman at 15 weeks' gestation presents with a painless neck swelling noticed 2 weeks ago. She has had occasional nausea and decreased appetite but otherwise feels well. Her medical history includes recurrent cystitis.
🔎 Physical Examination:
1.5-cm firm, nodular mass on the left side of the neck
No skin changes or cervical lymphadenopathy
Normal cardiopulmonary examination
Uterine fundus palpable midway between the symphysis and umbilicus
🧪 Laboratory Results:
TSH = 3.0 μU/mL (Normal)
Free T4 = 1.1 ng/dL (Normal)
Ultrasound: 1.6-cm solid mass in the left thyroid lobe with mixed echogenicity
What is the most appropriate next step in management ❓
Anonymous Quiz
21%
Observation and follow-up after delivery
50%
Fine-needle aspiration
7%
Serum calcitonin
0%
Thyroid scintigraphy
21%
Serum thyroglobulin concentration
📌 Case 10: باطنية - أهم أفكار الغدد الصماء
حالة سريرية:
A 28-year-old male surgical resident presents with a 2-month history of intermittent double vision, hand tremor, insomnia, frequent bowel movements, and unintentional 7-kg (15-lb) weight loss despite increased appetite.
On examination, he has moist palms, a fine tremor with arm extension, lid retraction, proptosis, restricted eye convergence, and hyperactive reflexes.
Laboratory tests reveal low TSH (0.03 μU/mL) and high T4 (19 μg/dL), with positive TSH receptor antibodies. Thyroid scan shows diffusely increased iodine uptake.
He has been started on propranolol for symptom relief.
حالة سريرية:
A 28-year-old male surgical resident presents with a 2-month history of intermittent double vision, hand tremor, insomnia, frequent bowel movements, and unintentional 7-kg (15-lb) weight loss despite increased appetite.
On examination, he has moist palms, a fine tremor with arm extension, lid retraction, proptosis, restricted eye convergence, and hyperactive reflexes.
Laboratory tests reveal low TSH (0.03 μU/mL) and high T4 (19 μg/dL), with positive TSH receptor antibodies. Thyroid scan shows diffusely increased iodine uptake.
He has been started on propranolol for symptom relief.