Adrenal Incidentaloma AND Workup — Written Clinical Reasoning · Phys Written Answers

Prompt

DCE-style written reasoning for Adrenal Incidentaloma AND Workup.

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in Adrenal Incidentaloma AND Workup and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Mogl MT [Diagnostics and surgery of mild autonomous cortisol secretion (MACS)] Chirurgie (Heidelb), 2026.PMID 41642322
[2]Pal B, Halder A, Mallik D, Kannaujiya V, et al. Plan of Management of Adrenal Incidentaloma Diagnosed with Carcinoma Colon: A Case Report and Review of Literature Case Rep Oncol, 2026.PMID 41552648
[3]Nazario-Perez MZ, Ceballos-Alvarez KE, Gonzalez-Figueroa G, Pastrana-Echevarria I, et al. Primary cholangiocarcinoma of the adrenal gland: a surgical and diagnostic challenge - a case report BMC Urol, 2025.PMID 41275156
[4]Kmieć P, Okroj D, Zdrojewska M, Fiszer J, et al. Overnight Dexamethasone in Primary Aldosteronism Screening in Patients on Interfering Therapy (ODEPRASC): A Diagnostic Interpretability Study Protocol J Clin Hypertens (Greenwich), 2025.PMID 41268804
[5]O'Connor JP, Poloju A, Pabich SK, Allen B, et al. Unveiling the Silent Threat: Disparities in Adrenal Incidentaloma Management J Surg Res, 2025.PMID 40424844
[6]Savoie PH, Murez T, Rocher L, Neuville P, et al. French AFU Cancer Committee Guidelines - Update 2024-2026 : Assessment of an adrenal incidentaloma and oncological management Fr J Urol, 2024.PMID 39581666
[7]Xi Y, Yao T, Zhang C, Zhuang T Effectiveness of safety care and clinical nursing pathway in patients undergoing cardiovascular intervention: a randomized controlled trial Perioper Med (Lond), 2026.PMID 42469924
[8]Marks FJ, Walters SJ, Sutton L, Jacques RM What statistical methods are more appropriate for predicting recruitment at the design stage of a randomised controlled trial? Trials, 2026.PMID 42469922

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in Adrenal Incidentaloma AND Workup and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Mogl MT [Diagnostics and surgery of mild autonomous cortisol secretion (MACS)] Chirurgie (Heidelb), 2026.PMID 41642322
[2]Pal B, Halder A, Mallik D, Kannaujiya V, et al. Plan of Management of Adrenal Incidentaloma Diagnosed with Carcinoma Colon: A Case Report and Review of Literature Case Rep Oncol, 2026.PMID 41552648
[3]Nazario-Perez MZ, Ceballos-Alvarez KE, Gonzalez-Figueroa G, Pastrana-Echevarria I, et al. Primary cholangiocarcinoma of the adrenal gland: a surgical and diagnostic challenge - a case report BMC Urol, 2025.PMID 41275156
[4]Kmieć P, Okroj D, Zdrojewska M, Fiszer J, et al. Overnight Dexamethasone in Primary Aldosteronism Screening in Patients on Interfering Therapy (ODEPRASC): A Diagnostic Interpretability Study Protocol J Clin Hypertens (Greenwich), 2025.PMID 41268804
[5]O'Connor JP, Poloju A, Pabich SK, Allen B, et al. Unveiling the Silent Threat: Disparities in Adrenal Incidentaloma Management J Surg Res, 2025.PMID 40424844
[6]Savoie PH, Murez T, Rocher L, Neuville P, et al. French AFU Cancer Committee Guidelines - Update 2024-2026 : Assessment of an adrenal incidentaloma and oncological management Fr J Urol, 2024.PMID 39581666
[7]Xi Y, Yao T, Zhang C, Zhuang T Effectiveness of safety care and clinical nursing pathway in patients undergoing cardiovascular intervention: a randomized controlled trial Perioper Med (Lond), 2026.PMID 42469924
[8]Marks FJ, Walters SJ, Sutton L, Jacques RM What statistical methods are more appropriate for predicting recruitment at the design stage of a randomised controlled trial? Trials, 2026.PMID 42469922