A 55-year-old woman is referred to urogynaecology with symptoms of urge incontinence. A trial of bladder retraining is unsuccessful. It is therefore decided to use a muscarinic antagonist. Which one of the following medications is an example of a muscarinic antagonist?
A 60-year-old man with a history of recent thyrotoxicosis underwent major surgery a week ago. He now presents with altered mental status, tachycardia, high-grade fever, vomiting and cardiac failure. A diagnosis of thyroid storm (crisis) is made. What is the most important next step in management?
A 50-year-old woman was investigated following an osteoporotic hip fracture. The following results are obtained: TSH < 0.05 mu/l, Free T4 29 pmol/L. Which of the following autoantibodies is most likely to be present?
A 40-year-old man complains of impotence and reduced libido for 4 months. He has been married for 15 years and has two children. He smokes five cigarettes per day and drinks approximately 12 units of alcohol weekly. Examination reveals an obese man who is phenotypically normal with normal secondary sexual characteristics. Investigations are as follows: Hb 13.4 g/dl (13.0-18.0), WCC 6 x 109/l (4-11), Platelets 210 x 109/l (150-400), Electrolytes Normal, Fasting glucose 5.6 mmol/l (3.0-6.0), LFTs Normal, T4 12.7 pmol/l (10-22), TSH 2.1 mU/l (0.4-5), Prolactin 259 mU/l (<450), Testosterone 6.6 nmol/l (9-30), LH 23.7 mU/l (4-8), FSH 18.1 mU/l (4-10). What is the next investigation needed for this patient?
A 20-year-old woman presents for review. She is concerned due to absence of menstruation for 5 months. She is 1.76 m in height and weighs only 43.7 kg (7 stone). A pregnancy test is negative and thyroid function testing is normal. Which of the following is the diagnosis of this case?
A 40-year-old man is referred by his general practitioner. He has a family history of premature cardiovascular disease. Cholesterol testing reveals triglyceride levels of 4.2 mmol/l and a high-density lipoprotein (HDL) level of 0.8 mmol/l. You advise him to start fibrate therapy. Which of the following best describes the mode of action for fibrates?
A 70-year-old man presents to the emergency department acutely unwell. He is shocked, drowsy and confused. He is known to be type-2 diabetic maintained on metformin. Blood tests reveal a metabolic acidosis with an anion gap of 24 mmol/l. Ketones are not significantly elevated and random blood glucose was 8.7 mmol/l. What is the mainstay of treatment for this condition?
A 25-year-old woman is found to have a blood pressure of 170/100 mmHg during a routine medical check. She is otherwise well and her physical examination is unremarkable. Blood tests show: Na+ 140 mmol/L, K+ 2.6 mmol/L, Bicarbonate 31 mmol/L, Urea 3.4 mmol/L, Creatinine 77 µmol/L. Which one of the following investigations is most likely to be diagnostic?
A 20-year-old student nurse was admitted after her third collapse in recent months. She was noted to have a blood sugar of 0.9 mmol/l on finger-prick testing and responded well to intravenous glucose therapy. Venous blood taken at the same showed a markedly raised insulin level, but her C-peptide levels were normal. What diagnosis fits best with this clinical picture?
A 50-year-old man is found incidentally to have hypercalcaemia during a routine health screen. Which one of the following biochemical findings would be most suggestive of primary hyperparathyroidism rather than any other cause of hypercalcaemia?