NBME 22 Autoimmune adrenalitis (NBME Answers)

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NBME 22 Answers

nbme22/Block 3/Question#43 (reveal difficulty score)
A 53-year-old woman shows evidence of adrenal ...
Autoimmune adrenalitis 🔍 / 📺 / 🌳 / 📖
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submitted by ∗seagull(1933)

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THis question is just critical thinking. The adrenals are bilaterally and symmetrically small. All other answer choices are not likely to be even bilaterally. Cancer won't equally spread in perfect symmetry nor infectious causes while maintaining the adrenal architecture.

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slim23shady Will TB be the answer if they'd mentioned the patient from developing world? +

step1soon Autoimmune adrenalitis aka addisons disease → adrenals atrophy common cause: 1. developing world: TB 2. Western world:autoimmunne FA 2019 page 334 +14

drschmoctor FA 2020 p 349. +2

drzed I think the cancer reference (C) was with respect to an ACTH secreting tumor, which would symmetrically and bilaterally HYPERTROPHY the adrenals +2

drzed ^Just kidding, it says metastatic. My bad! +1

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submitted by ∗anechakfspb(77)

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Why couldn't it be retroperitoneal idiopathic fibrosis?

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faus305 Idiopathic RPF is a rare fibro-inflammatory disease. It typically does not involve the adrenals, seagull is right in that this answer is just critical thinking, even if IRPF reached the adrenals it would likely harm their "configuration" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926988/). +

jdc_md also dont read the question too fast, its a short stem and I overlooked "adrenals" thinking it was the kidneys LOL so dumb. RPF probably shrinks the entire kidneys not just the adrenals +

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submitted by ∗jessikasanz(9)

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Recognize this is adrenal insufficiency. The key is that both adrenals are dec in size. From FA 2018 Chronic—Addison disease. Due to adrenal atrophy or destruction by disease (autoimmune destruction most common in the Western world; TB most common in the developing world).

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submitted by biliarytree220(13)

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Primary renal insufficiency; chronic cause; Addison disease (FA 332)

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