A 50-year-old male presents to the endocrinology clinic with symptoms of hypogonadism. He reports consuming five cans of lager per week, which is believed to be the cause of his abnormal liver function tests. The patient has a history of type 2 diabetes and osteoarthritis affecting his hips and knees. What tests should be performed to determine the underlying diagnosis?
A 16-year-old female presents with a four-month history of amenorrhoea. During investigations, her GP notes an elevated prolactin concentration of 1500 mU/L (50-550). The patient’s mother reports that she had previously experienced regular periods since her menarche at 12 years of age. Physical examination reveals a healthy female with normal pubertal development and no abnormalities in any system. There is no galactorrhoea upon expression. Further investigations show oestradiol levels of 5000 pmol/L (130-800), prolactin levels of 2000 mU/L (50-550), LH levels of 2 U/L (3-10), and FSH levels of 2 U/L (3-15). What test should be requested for this patient?
A 20-year-old man, who has recently started his second year of university, is brought to the Emergency Department by his friends early on a Friday evening. His friends report he has vomited several times and that he appears confused and ‘not himself’. Upon examination, the patient appears disorientated and unwell. His temperature is 37.2 °C, heart rate 118 bpm and regular, blood pressure 106/68 mmHg. He has dry mucous membranes and his breath smells like nail polish remover. The chest is normal on auscultation, and his abdomen is soft and appears to be non-tender. Capillary blood glucose is 26 mmol/l, and urine dip is strongly positive for glucose and ketones.
Arterial blood gas (ABG) results are given below:
Investigation Result Normal range
pH 6.9 7.35–7.45
paCO2 3.4 kPa 4.5–6.0 kPa
paO2 12.5 kPa 10.0–14.0 kPa
HCO3 8.3 mEq/l 22–28 mmol/l
What is the most appropriate initial management for this patient?
A 50-year-old man underwent blood tests after a recent kidney stone surgery. The test results are as follows:
Corrected calcium: 3.01 mmol/L (normal range: 2.1-2.5)
Phosphate: 0.49 mmol/L (normal range: 0.80-1.4)
Alkaline phosphatase (alk phos): 166 U/L (normal range: 30-135)
Parathyroid hormone (PTH): 71 ng/L (normal range: 14-72 ng/L)
Estimated glomerular filtration rate (eGFR): >60 ml/min/1.73m2
What is the most likely reason for the high calcium level based on these results?
A 25-year-old woman visits her endocrinologist for follow-up. She has a medical history of primary hyperparathyroidism and prolactinoma. After undergoing genetic testing, she was diagnosed with multiple endocrine neoplasia type 1 (MEN1) syndrome. She is planning to start a family and wants to know the likelihood of her child inheriting MEN1. Her partner has no known medical conditions.
What is the mode of inheritance for MEN1 syndrome?
A 27-year-old woman visits her GP complaining of experiencing sweating, agitation, palpitations, and restlessness for the past three days. She gave birth to a healthy baby through vaginal delivery at 39 weeks gestation two months ago. The patient has a medical history of coeliac disease. The following investigations were conducted:
Thyroid-stimulating hormone (TSH) 0.1 mU/L (0.5-5.5)
Free thyroxine (T4) 26 pmol/L (9.0 – 18)
What is the next appropriate step in managing this patient?
A 32-year-old woman visits her GP with complaints of palpitations, tremors, sweating, and diarrhoea. She has a medical history of gestational hypertension and type 1 diabetes, which is managed with insulin. The patient gave birth to her first child 8 weeks ago without any complications.
Upon examination, the patient is alert and oriented. Her vital signs are as follows: heart rate of 109 bpm, respiratory rate of 19 breaths/minute, temperature of 37.7ºC, oxygen saturation of 98%, blood pressure of 129/88 mmHg, and blood glucose of 4 mmol/L.
What is the most likely diagnosis, and what is the appropriate treatment?
A 28-year-old patient presents with a lump in the neck. On examination, there is a 2-cm smooth, round lump at the anterior border of the upper third of the sternocleidomastoid muscle.
Which of the following is the most likely diagnosis?
A 50-year-old woman comes to her GP complaining of a sore throat, coryzal symptoms, cough, feeling feverish and general malaise for the past week. She reports that she is eating and drinking well. Upon examination, her temperature is 37.1°C and her chest is clear. Her tonsils are inflamed, but there is no exudate. She has no significant medical history except for carpal tunnel syndrome. Based on her Fever PAIN score, what is the most suitable course of action?
A woman in her early 50s, who is a singer, has a history of thyroid surgery and needs another procedure due to recurrent thyroid carcinoma. Following the surgery, she experiences a change in her voice and is unable to reach high notes while singing. During flexible laryngoscopy, it is observed that her left vocal cord does not elongate during phonation.
Which nerve is likely to have been affected?