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Anatomy Qbank

Medical Students

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Questions

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

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  • Must be well structured

Question

A 50-year-old man presents to his primary care physician complaining of intermittent episodes of tachycardia, hypertension, sweats, and headache. An extensive workup reveals increased 24-hour urinary fractionated metanephrines. A 3 cm adrenal mass consistent with a pheochromocytoma without malignant features is visualized on CT scan. After surgical consultation, a laparoscopic adrenalectomy is planned in 10 days. He has no significant past medical history and does not take any medications. Which of the following is the most appropriate next step in management?
A Initiate both metoprolol and phenoxybenzamine now
B Initiate metoprolol now and phenoxybenzamine 3 days prior to surgery
C Initiate phenoxybenzamine now and metoprolol 3 days prior to surgery
D No medication therapy is necessary
Correct Answer Distractors
The most appropriate next step is to initiate phenoxybenzamine now and metoprolol 3 days prior to surgery. A pheochromocytoma is a neuroendocrine tumor originating from the chromaffin cells of the adrenal medulla. Pheochromocytomas are rare tumors that can arise sporadically from a de novo mutation or can be associated with a familial syndrome, such as von Hippel-Lindau syndrome or multiple endocrine neoplasia type 2. Pheochromocytomas produce at least one catecholamine (epinephrine, norepinephrine, or dopamine). Classic presentation involves intermittent tachycardia, sweats, headaches, and episodic or persistent hypertension. Radiologic evaluation with CT or MRI should be performed in patients whose biochemical testing with either plasma metanephrines or 24-hour urinary metanephrines is indicative of a pheochromocytoma. Patients with pheochromocytomas should undergo surgical resection, with laparoscopic adrenalectomy preferred for patients with single, small intra-adrenal tumors without malignant features. Preoperative medical therapy is necessary to manage tachycardia and hypertension (preventing a hypertensive crisis in surgery) and to expand volume prior to surgery. An alpha-adrenergic blocker, such as phenoxybenzamine, is recommended for 7–10 days prior to surgery. A beta-blocker, such as metoprolol, is started 2–3 days prior to surgery, but only after alpha-adrenergic blockade has been established to prevent unopposed alpha-adrenergic receptor stimulation.

Explanations

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One Step Further

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After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

  • Strengthens your knowledge
  • Stands alone from the main explanation so you’re not rereading content

Question

What are metanephrines?

Reveal Answer

Pheochromocytoma

  • Patient will be complaining of headaches, diaphoresis, tremors, and vision changes
  • PE will show hypertension
  • Diagnosis is made by assay of urinary catecholamines and metanephrines, and plasma metanephrine levels
  • Most commonly caused by catecholamine-secreting tumor located in the adrenal glands
  • Treatment is surgery, alpha-blocker (i.e., phentolamine, phenoxybenzamine) prior to beta-blockade to prevent unopposed alpha-agonism

Rapid Review

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These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

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