MCQS 235 –237:Increased urinary excretion of vanillylmandelic acid is a feature of a tumour of the



Increased urinary excretion of vanillylmandelic acid is a feature of a tumour of the

a) submandibular gland
b) lacrimal gland
c) parathyroid gland
d) pituitary gland
e) pineal gland
f) pancreas
g) thyroid gland
h) Meibomian glands
i) adrenal cortex
j) adrenal medulla


A middle aged housewife complains that her husband has become more and more detached from her and her family and has become obsessed with his work as a medical laboratory worker. He tells her 'I'm more important than you and so is my work.' and when she complains of lack of attention he says 'I'm an unrecognized genius. You just don't see it how special I am' . He seems to lack empathy with their children and neglects them. A possible diagnosis is

a) Korsakov's psychosis
b) Wernicke's encephalopathy
c) Hysteria
d) catatonic Schizophrenia
e) Agoraphobia
f) Mania
g) Narcissistic Personality Disorder
h) Delirium tremens
i) Toxic confusional state
j) Psychotic depression

A 14 year old took 20 multivitamin tablets in a suicide attempt. He comes from a happy fostered family life but his natural father comitted suicide when he was ten years old. This type of depression is most likely of the following type

a) panic disorder
b) Seasonal affective disorder
c) adjustment disorder
d) schizophrenia
e) familial depression
f) psychosomatic disorder
g) bereavement
h) dysthymia
i) clinical depression
j) Bipolar depression


Correct Answer: J

Because hypertension is so common and pheochromocytoma so rare, further biochemical evaluation for pheochromocytoma in hypertensives should be selective and focused on subjects who display some relevant clue to pheochromocytoma on history, physical examination, or screening laboratory evaluation. If interpretation of urinary measurements is not clear-cut, evaluation should proceed to plasma measurements, which require more careful sampling technique. The number and diversity of biochemical tests obtained should parallel the clinical index of suspicion. If suspicion is low, a single screening test may suffice, usually 24-hour urinary metanephrine excretion. Widely available tests measure urinary free (unconjugated) catecholamines and catecholamine metabolites: the metanephrines and vanillylmandelic acid. A 24-hour urine sample is collected, and creatinine is measured in the same sample as an index of adequacy and completeness of collection. Of the available tests, increased urinary metanephrines have the highest diagnostic sensitivity and specificity for pheochromocytoma. Urinary excretion of metanephrines and vanillylmandelic acid remains normal until the very end stage of renal disease, so elevated levels validly diagnose pheochromocytoma.


Correct Answer: G

the essential feature of Narcissistic Personality Disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts Narcissists possess an exaggerated sense of importance concerning themselves and their work. Work and self come first while other people, especially close, intimate relationships, become less important. A narcissist would say, 'I'm more important than you and so is my work.' Concerned with self-promotion, narcissists show disdain and a lack of consideration for other people, while upgrading themselves. For example, a narcissistic female may feel disdain and negativity towards her husband, and be devoid of normal heterosexual, nurturing feelings for him. Narcissistic husbands may also feel negativity and disdain towards their wives, yet feel entitled to nurturance from their spouses, without any obligation to provide the same in return. The self, logic, strength, power, a mission or a job is over-idealized, while any signs of weakness or feelings of pain are devalued. Many narcissists frame people and situations in a negative light and, as such, are seen as proponents of doom and gloom. Of course, their egotism and faulty super-ego insist that their pessimistic, diminishing, and denigrating views are absolutely realistic. In-depth therapy usually reveals how the narcissist strongly internalizes the narcissistic negative views of a deeply disturbed, dissatisfied parent. This negative view did pervade the emotional home environment of the child and s/he does project and superimpose this sterile home environment onto current love and work relationships. The narcissist lacks empathy and feeling for self and others and can be brutal, insensitive and distrustful of other's motives. At the bottom line, the NP suffers from an early infantile breakdown of basic trust (Erikson, 1968). Narcissists can become enraged and defensive at the slightest hint of criticism, disapproval or dissatisfaction with their performance. There is a strong need for approval, possibly stemming from very high parental (super-ego) performance demands coupled with critical rejection. Such early narcissistic injuries predispose an individual to becoming hypersensitive to criticism and disapproval. Thus, one reacts to past events as if they are happening in the present. As with other disorders, there is a fusion of thought and feeling between the buried past and the unresolved present. Individuals with NPD believe that they are superior, special or unique and expect others to recognize them as such. 'I'm an unrecognized genius. You just don't see it how special I am' This is the type of message a narcissist tries to convey to a spouse, boss, and other people. Yet, others may not be sufficiently impressed by the person's marital and work performance. The NP is overly attached to and invested in successful outcomes. This may be the result of an intense need for union with mother in infancy and her subsequent rejection of the child.


Correct Answer: E

We do know that certain children have risk factors in their lives which could predispose them to depression or could "trigger" depression. Among these are a family history of mental illness or suicide, such as is likely in this case, abuse (physical, emotional or sexual), chronic illness and the loss of a parent at an early age to death, divorce or abandonment


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