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+--- Thread: Q@Qtimed 72sec ③ - cardio69 (/showthread.php?tid=792034)
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Q@Qtimed 72sec ③ - cardio69 - ArchivalUser - 10-27-2014
A 19 y/o M presents to you with ~50 days history of sweatiness, irritability and gynomastia. He smoked 5 cigarettes per day, drank alcohol socially, but denies use of other drugs and pat past med history unremarkable. On PE he was clinically mildly thyrotoxic, with small goiter and bilateral breast enlargement. You realize pat unable to follow your finger upwards on testing eye movements otherwise norm. Blood count, LFT and electrolytes in norm range. However, you note the panel of lab LH inc, FSH low with in norm range, free T4 slightly INC, TSH DEC, testosterone INC, 17-β- estradiol INC 3x from what nom report.
DX?
a)Teratoma w cerebral metastases
b)Grave dz
c)Lading cell tumor of testis
d)Testosterone self adm
e)Pinealoma
f)LH secreting pituitary adenoma
72sec for time posted...
0 - ArchivalUser - 10-27-2014
Pinealoma or pineal germinoma
0 - ArchivalUser - 10-27-2014
It secretes hCG and as it has similar structure similar to Ant.pit hormones causes endocrine abnormalities plus impaired upward gaze and convergence( compression of tectal area of midbrain)
0 - ArchivalUser - 10-27-2014
I can relate pinealoma to parinaud syndrome ..as per my limited knowledge at this point !
0 - ArchivalUser - 10-27-2014
@remine good now ans the following in 72sec...
A 16 y/o boy presents to you and complaining of headaches. Physical examination is remarkable for bilateral papilledema, paralysis of upward gaze and pupils that react to accommodation, but not to light. You orders a CT scan of the head, which demonstrates a pineal abnorm/enlargement.
Damage to which of the following structures probably accounts for your pat upward gaze defect?
a)Mamillary body
b)Optic chiasm
c)Pons
d)Superior colliculus
e)Superior cerebellar peduncle
0 - ArchivalUser - 10-27-2014
Superior colliculus
0 - ArchivalUser - 10-27-2014
D
0 - ArchivalUser - 10-27-2014
Agree with reminemi,pinealoma can cause pseudo argyl robertson pupil
0 - ArchivalUser - 10-27-2014
NICE J
remin & hln
0 - ArchivalUser - 10-27-2014
Hmmm interesting I didn't know of any pseudo AR pupil ...I only knew AR of neurosuphilis