A 76-year-old woman presents with lethargy. She has a history of Graves’ disease and thyrotoxicosis. Her thyroid-stimulating hormone (TSH) levels are found to be 7.3 μU/l (normal range: 0.17–3.2 μU/l). A full blood count is performed and reveals the following: haemoglobin (Hb) is low, mean corpuscular volume (MCV) is high, platelet count is normal, white cell count (WCC) is normal.
What is the most likely cause of her anaemia?
A 50-year-old man comes to the clinic complaining of headaches. His blood pressure measures 168/100 mmHg. Routine tests show sodium levels of 142 mmol/l (136–145), potassium levels of 2.8 mmol/l (3.5–5.0), chloride levels of 100 mmol/l (95–105), and normal levels of urea and creatinine. His plasma renin levels are undetectable, and his aldosterone levels are elevated. What is the most probable cause of his hypertension?
A 65-year-old woman is referred to the Diabetes Clinic with a new diagnosis of type 2 diabetes mellitus. She has a body mass index (BMI) of 34 kg/m2. Her finger-prick blood glucose test is 9 mmol/l. She has a past history of ischaemic heart disease and chronic kidney disease. Her medications include ramipril 10 mg daily, atorvastatin 40 mg, aspirin 75 mg and bisoprolol 5 mg. Her laboratory test results are as follows:
Investigation Result Normal range
HbA1C 61 mmol/mol < 53 mmol/mol (<7.0%)
Creatinine 178 µmol/l 50–120 µmol/l
Glomerular filtration rate (GFR) 26 ml/min > 90 ml/min
Which of the following drugs would be the most appropriate to manage this patient’s diabetes?
A 28-year-old man comes to the clinic complaining of gradual weight loss. He has lost 8 kg over the past three months, and his previous weight was 62 kg.
Two years ago, he volunteered at a child rehabilitation program in India and contracted pulmonary tuberculosis, which was successfully treated. A recent chest x-ray showed no suspicious lesions in the lungs, and there is no lymphadenopathy. He denies having a fever or night sweats.
During the examination, he reveals that he has been drinking one bottle of wine per day for the past three weeks, following a breakup with his girlfriend.
Which test is likely to show a positive result for the weight loss?
A 68-year-old woman presents to the Emergency Department with acute agitation, fever, nausea and vomiting. On examination, she is disorientated and agitated, with a temperature of 40 °C and heart rate of 130 bpm, irregular pulse, and congestive cardiac failure. She has a history of hyperthyroidism due to Graves’ disease, neutropenia and agranulocytosis, and cognitive impairment. She lives alone. Laboratory investigations reveal the following results:
Test Result Normal reference range
Free T4 > 100 pmol/l 11–22 pmol/l
Free T3 > 30 pmol/l 3.5–5 pmol/l
Thyroid stimulating hormone (TSH) < 0.01 µU/l 0.17–3.2 µU/l
TSH receptor antibody > 30 U/l < 0.9 U/l
What should be included in the management plan for this 68-year-old patient?
A 40-year-old man comes to his GP with a painless neck lump. He has a history of hyperparathyroidism. During the examination, the lump is found to be irregular and fixed at his thyroid. He is worried about cancer, as his father died in his 50s due to a phaeochromocytoma. What type of thyroid cancer is most likely in this patient?
A 63-year-old, non-smoking woman without previous cardiac history, has a total cholesterol of 9.0 mmol/l. She is overweight and has sleep apnoea. On examination you notice her skin is particularly dry and there appears to be some evidence of hair loss. Her blood pressure is 140/95 mmHg and pulse rate 60 bpm.
What would be the most appropriate next step in managing this patient?
A 49-year-old woman, without past medical history, is referred by her General Practitioner to a Lipid Clinic. She has a body mass index (BMI) of 29 kg/m2. She has a background history of sleep apnoea and complains of weight gain, fatigue and constipation.
On examination, you notice that her skin is dry and she has scalp hair loss. Her laboratory results are as follows:
Investigation Result Normal value
Total cholesterol 8.2 mmol/l < 5.2 mmol/l
Low density-lipoprotein (LDL) cholesterol 5.2 mmol/l < 3.5 mmol/l
High-density lipoprotein (HDL) cholesterol 1.8 mmol/l > 1.0 mmol/l
Triglycerides 1.2 mmol/l 0–1.5 mmol/l
What is the most appropriate next step in her management?
A 38-year-old woman comes to you with a swollen neck and upon examination, you find an unusual neck mass that raises suspicion of thyroid cancer. You arrange for a fine-needle aspiration and a histology report from a thyroid lobectomy reveals chromatin clearing, nuclear shape alteration, and irregularity of the nuclear membrane. There is no evidence of C cell differentiation, and the patient has no family history of cancer. What is the most probable diagnosis?
A 50-year-old woman presents to her general practitioner, complaining of a lump in her neck. She is a non-smoker and has no significant past medical history. On examination, there is a 2-cm firm, non-tender nodule on the left side of the anterior triangle of the neck, in the area of the thyroid.
Investigations:
Thyroid stimulating hormone: 2.5 mu/l (0.4–4.0 mu/l)
Fine-needle aspiration biopsy: partial papillary architecture with some thyroid follicles present. Thyrocytes are abnormally large with an abnormal nucleus and cytoplasm and frequent mitoses. Psammoma bodies are also demonstrated in the sample.
Which of the following fits best with the underlying diagnosis?