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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is Cushing syndrome. While this may seem a odd practice, it is useful to see multiple examples of how Cushing syndrome will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for Cushing syndrome.
QUESTION EXAMPLES
Question # 1
A 17 year old female presents with hirsutism, irregular menses and obesity. Her mother is also moderately and has mild hirsutism. Recently the patient’s facial hair growth has worsened and she has been depressed. She has also gained 20 pounds in the past few months and has noticed stretch marks on her abdomen. On physical examination it is noted that she has terminal hair growth on her chin and the back of her hands. Her cheeks appear flushed and the abdominal stretch marks are purplish in color. What diagnosis could explain this presentation?
Explanation # 1
Weight gain,+ hirsutism + flushed face + abodminla striae = Cushing syndrome
Question # 2
A 16 year old girl comes to the clinic because she has a 7 month history of increasingly troubling facial hair growth. The patient has gained about 15 lbs during this period of time. Her period began at the age of 11 years. Menses in the past occurred at regular 28-day intervals, however during the past year, her messes have occurred at irregular 45 day intervals. The history reveals that the patient has become increasingly moody and depressed over the past few months. Currently the patient is not taking any medications, has no allergies, and the rest of her medical history is not contributory. An abdominal exam reveals striae over the stomach. There is no clitoromegaly. What could be the likely diagnosis?
Explanation # 2
Weight gain,+ hirsutism + abodminla striae = Cushing syndrome
Question # 3
A 70-year-old woman is brought to the emergency department because she is agitated, is restless, and has been sleeping poorly. Over the past 2 1/2 months she has had headaches and has gained 15 pounds. Her past medical history is unremarkable and she does not take any medications. She explains that she smokes a pack of cigarettes daily and has done so for the past 50 years, but denies using any illicit drugs. Her blood pressure is 160/115 mmHg and her pulse is 90/min. Her skin is notable for facial plethora and scattered bruises on her extremities. Lab results are as follows:
- Na+: 148 mEq/L
- K+: 3.1 mEq/L
- Chloride: 99 mEq/L
- Bicarbonate: 25 mEq/L
- BUN: 13 mg/dL
- Creatinine: 0.9 mg/dL
- Glucose: 210 mg/dL
- Calcium: 9.5 mg/dL
What is the likely diagnosis in this patient?
Explanation # 3
Weight gain + facial plethora + hypertension + high sodium + low potassium = Cushing syndrome
Question # 4
A 35 year old woman is admitted to the psych ward because she has been experiencing wild mood swings. She is hypertensive, diabetic, and has osteoporosis (all of which are new diagnosis to her). It is also discovered that she has been amenorrheic and has been shaving for the past 2 years due to excessive facial hair. She has centripetal obesity, moon fancies, and also has a large hump on her upper back. A picture of her 3 years ago shows a very different appearing woman with none of the above features.
Explanation # 4
Obesity + hirsutism + buffalo hump = Cushing syndrome (many other features present in the case as well).
Question # 5
Explanation # 5
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Page Updated: 11.02.2016