A 42-year-old man with a history of depression and gastro-oesophageal reflux disease visits his GP complaining of milky discharge from his nipples. His blood test results show a prolactin level of 700 mu/l. Which medication is the most probable cause of this symptom?
A 65-year-old truck driver is being assessed. He was detected with type 2 diabetes mellitus last year. After shedding some weight and taking metformin, his HbA1c has dropped from 74 mmol/mol (8.9%) to 68 mmol/mol (8.4%). What would be the most appropriate course of action for further management?
You are examining the blood test results of a 40-year-old overweight man who has been experiencing fatigue. All his full blood count, urea and electrolytes, and thyroid function tests were normal. The fasting plasma glucose result is provided below:
Fasting plasma glucose 6.2 mmol/l
What is the most suitable conclusion to draw from this finding?
Sarah is a 55-year-old woman who visits her GP for a medication review. She was prescribed 75 micrograms of thyroxine 6 months ago due to her TSH level being 6.5mU/L and her T4 level being 3.9 μg/dL. She takes her medication consistently at the same time every day and has not missed a dose. Her other medications include lisinopril, simvastatin, ferrous fumarate, and calcium carbonate.
Her recent blood test results are as follows:
– Sodium (Na+): 137 mmol/L (135-145)
– Potassium (K+): 4.2 mmol/L (3.5-5.0)
– Urea: 5.8 mmol/L (2.0-7.0)
– Creatinine: 80 µmol/L (55-120)
– Estimated glomerular filtration rate (eGFR): >90 ml/min/1.73m²
– Cholesterol: 5.0 mmol/L (3.5-5.0 mmol/L)
– TSH: 6.0mU/L (0.4-4.0 mU/L)
– T4: 4.2 μg/dL (4.6-11.2 μg/dL)
What is the most likely explanation for Sarah’s continued abnormal thyroid function?
A woman visits her GP for a check-up of her type 2 diabetes. She is taking metformin at the maximum tolerated dose. Her most recent HbA1c reading is 64 mmol/mol.
The GP prescribes gliclazide and schedules another HbA1c test in 3 months.
What is the new target HbA1c for this patient?
A 26-year-old woman presents to her GP with complaints of constant fatigue and muscle weakness for the past 4 months. She has no significant medical history and is a non-smoker with a healthy weight. On examination, her blood pressure is found to be consistently high at 160/95 mmHg. However, there are no other significant findings on physical examination. Her blood sugar levels are normal, but her potassium levels are low at 3.4 mmol/L. The GP suspects primary hyperaldosteronism and plans to refer the patient to secondary care. What is the most appropriate initial investigation for this case?
A 27-year-old man is worried about his weight. He has a body mass index of 38 kg/m^2. What is the most appropriate description of his weight?
A 72-year-old woman is discovered to have the subsequent blood tests:
TSH 0.05 mu/l
Free T4 19 pmol/l (range 9-25 pmol/l)
Free T3 7 pmol/l (range 3-9 pmol/l)
What are the potential outcomes if no treatment is given?
An 80-year-old man comes in after a fall and reports feeling constantly cold. Thyroid function tests are ordered and the results are as follows:
Free T4 7.1 pmol/l
TSH 14.3 mu/l
What should be done next?
During his 3-month check-up, a 50-year-old patient with a BMI of 33 reports that he has been unable to adhere to his orlistat prescription due to the side effects he has experienced. The patient has a medical history of psoriasis, hyperlipidaemia, and hypertension. According to NICE, what alternative treatment may be appropriate for this patient?