MRCP-0393
A 30-year-old woman is referred to endocrinology with thyrotoxicosis. Following a discussion of management options, she chooses to have radioiodine therapy. Which one of the following is the most likely adverse effect?
Category: Endocrinology
MRCP-0394
A 50-year-old man had a fasting blood glucose test as part of a work-up for hypertension. It comes back as 6.5 mmol/l. The test is repeated and reported as 6.7 mmol/l. He says he feels constantly tired but denies any polyuria or polydipsia. How should these results be interpreted?
MRCP-0395
A 13-year-old boy is brought to your clinic with a complaint of delayed puberty. While examining the patient which of the following features is most likely to indicate that pubertal change may have commenced?
MRCP-0381
A 32-year-old woman presents to the GP with tiredness and anxiety during the third trimester of her second pregnancy. The Examination is unremarkable, with a BP of 110/70 mmHg and a pulse of 80. Her BMI is 24 and she has an abdomen consistent with a 31-week pregnancy. The GP decides to check some thyroid function tests. Which of the following is considered to be normal?
MRCP-0382
Following a head injury, a 22-year-old patient develops polyuria and polydipsia. He is suspected to have cranial diabetes insipidus so he undergoes a water deprivation test. Which one of the following responses would most indicate a positive (abnormal) result?
MRCP-0383
A 40-year-old man comes to the endocrine clinic after his second episode of acute pancreatitis. On examination, he has a BP of 125/70 mmHg, his pulse is regular 70 bpm and his BMI is 23. There is evidence of eruptive xanthomas on examination of his skin. It was noted that his fasting triglycerides level is 8.5 mmol/l (0.7-2.1) at his follow up appointment although his LDL level is not particularly raised. Which of the following is the most appropriate therapy for him?
MRCP-0384
A 40-year-old heavy smoker presents with a serum sodium level of 113 mmol/l. A diagnosis of SIADH is confirmed. What is the most appropriate initial management for his fluid balance?
MRCP-0385
A 55-year-old man with a three-year history of type 2 diabetes comes to the clinic for review. He is currently managed with metformin 1 g BD and feels that his home blood glucose monitoring has deteriorated over the past few months. There is a history of hypertension and dyslipidaemia for which he takes Ramipril 10 mg daily and atorvastatin 20 mg. On examination, his BP is 155/82 mmHg, his pulse is 71 and regular. His chest is clear. His BMI is 32. Investigations show: Haemoglobin 12.9 g/dl (13.5 – 17.7), White cell count 5.0 x109/l (4 – 11), Platelets 180 x109/l (150 – 400), Sodium 140 mmol/l (135 – 146), Potassium 5.0 mmol/l (3.5 – 5), Creatinine 123 mmol/l (79 – 118), HbA1c 8.0% (<7.0). He would like to start sitagliptin. Which of the following adverse effects would you warn him about?
MRCP-0386
A 55-year-old man presents to the ED complaining of extreme fatigue. He has a history of Graves disease. On examination, his blood pressure is 103/58 mmHg, pulse 64/min and temperature 36.3ºC. The following results are obtained: Na+ 135 mmol/L, K+ 5.4 mmol/L, Urea 5.2 mmol/L, Creatinine 42 umol/L, TSH 3.5 mu/l, Free thyroxine (T4) 12 pmol/L. You arrange for a random cortisol test, however, whilst awaiting the result he becomes unresponsive. In addition to giving intravenous steroids and fluid, what test is urgent to check first given the likely diagnosis?
MRCP-0387
A 45-year-old man presents with tiredness and central weight gain. He underwent pituitary surgery for a non-functional pituitary tumour two years ago. Although he recovered from his pituitary surgery well, he has been found to have complete anterior hypopituitarism. Accordingly he is receiving stable replacement therapy with testosterone monthly injections, thyroxine and hydrocortisone. On examination, there are no specific abnormalities, his vision is 6/9 in both eyes and he has no visual field defects. From his notes, you see that he has gained 8 kg in weight over the last six months and his BMI is 31. His blood pressure is 122/72 mmHg. Thyroid function tests and testosterone concentrations have been normal. A post-operative MRI scan report shows that the pituitary tumour has been adequately cleared with no residual tissue. Which of the following is the most likely cause of his current symptoms?