Cushing Syndrome and Childhood Obesity – 18 Board-Style Questions

What this deck covers

Cushing Syndrome and Childhood Obesity in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. One glance at the chart
2. The commonest reason of all
3. Which gland is at fault
4. Very young, and virilised too
5. One number, no answer
6. The tablet that should switch it off
7. Collecting it at home
8. Above or below the diaphragm
9. When the scan shows nothing
10. Cured, but not yet safe
11. Dark velvet in the folds
12. Raised enzymes in a heavy child
13. Snoring and falling asleep
14. A limp in a heavy child
15. Hungry since he could walk
16. Floppy first, then always hungry
17. Weight after brain surgery
18. What to say to the parents

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: An endocrine cause is very likely to be present, A pituitary adenoma producing excess hormone, In the pituitary gland, Simple obesity with premature adrenarche, The sample must have been taken incorrectly, The test has been performed at the wrong time of day, A random morning blood sample, Plasma ACTH, A urinary free cortisol collection repeated, No treatment, as the tumour has been removed, Simple dirt that will wash off with scrubbing, Fat deposited within the liver, Reassurance that snoring is normal in children, Bowing of the tibia from abnormal growth.

Clinical pearls from this deck

• Fat and tall is eating. Fat and short is a gland. That one line saves most of the tests.
• Ask about creams and inhalers. Families do not count them as medicines when you ask about drugs.
• ACTH is the fork in the road. Suppressed means the adrenal; unsuppressed means something above it.
• Cortisol excess plus virilisation in a toddler is an adrenal tumour until imaged, and often malignant.
• What is lost first is the rhythm, not the peak. That is why one timed sample tells you nothing.
• Suppression testing proves autonomy. It never tells you where the problem is.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all Endocrinology Board Questions case decks · pediatric reference values.