MSFinals-0983
What is the most suitable vitamin D supplement for a patient with liver and kidney failure, considering the need for enzymatic conversion of naturally occurring analogues?
Archives: Medical Student Finals
MSFinals-0984
An investigator intended to test the antiglycaemic action of a new drug, which acts by increasing the peripheral uptake of glucose and reduces postprandial glucose level. He noted that in the elderly control group, subjects receiving an oral glucose load have higher postprandial insulin concentrations and more rapid glucose clearance, compared to subjects receiving isoglycaemic intravenous glucose infusion.
Which of the following is the most likely mediator of this effect?
MSFinals-0985
A 36-year-old woman has been referred by her GP due to passing an unusually large volume of urine and complaining of continuous thirst. The following investigations were conducted:
Random plasma:
Investigation Result
Sodium (Na+) 155 mmol/l
Osmolality 300 mOsmol/kg
Glucose 4.5 mmol/l
Urine:
Investigation Result
Osmolality 90 mOsmol/kg
Glucose 0.1 mmol/l
In healthy patients, the urine: plasma osmolality ratio is > 2. A water deprivation test was conducted, and after 6.5 hours of fluid deprivation, the patient’s weight had dropped by >3%, and the serum osmolality was 310 mOsmol/kg. Urine osmolality at this stage was 210 mOsmol/kg. The patient was then given desmopressin intramuscularly (im) and allowed to drink. The urine osmolality increased to 700 mOsmol/kg, and her plasma osmolality was 292 mOsmol/kg.
What is the most likely diagnosis for this 36-year-old woman?
MSFinals-0986
A 56-year-old man has undergone the following investigations by his General Practitioner (GP).
Plasma:
Investigations Results Normal Value
Total Ca2+ 1.85 mmol/l 2.20–2.60 mmol/l
Albumin 42 g/l 35–55 g/l
PO43- 1.8 mmol/l 0.70–1.40 mmol/l
Alkaline phosphatase 160 IU/l 30–130 IU/l
Parathyroid hormone (PTH) 80 ng/l 10–65 ng/l
What is the most probable underlying condition?
MSFinals-0987
A 67-year-old woman with a history of renal stones and osteoporosis presents with abnormal laboratory results. Her bone density scan shows a T score of -3.2 in the femur and -2.7 in the spine. She has no other symptoms and is not taking any medications. Upon further investigation, a right-sided parathyroid nodule is discovered through Sestamibi Technetium (99mTc) and ultrasound scan. The patient’s laboratory results are as follows: calcium 2.9 mmol/l (normal range 2.20-2.6 mmol/l), phosphate 0.6 mmol/l (normal range 0.7-1.5 mmol/l), PTH 80 ng/l (normal range 15-60 ng/l), creatinine 72 μmol/l (normal range 50-120 μmol/l), and 24-hour urinary calcium : creatinine 0.03 (normal range <0.02). What is the most appropriate treatment for this patient?
MSFinals-0988
A 65-year-old man with a history of diabetes mellitus complains of a swollen right ankle joint that is not painful. Upon examination, radiographs reveal a joint that has been destroyed and contains a significant number of loose bodies. What is the most likely diagnosis?
MSFinals-0989
A 65-year-old patient presents with decompensated liver disease due to hepatocellular carcinoma. She is currently encephalopathic and has an INR of 6. What low-dose medication can be safely administered?
MSFinals-0949
A 67-year-old woman is brought to Accident and Emergency after being found near-unconscious by her daughter. Her daughter indicates that she has a long-term joint disorder that has been controlled with oral medication and uses steroids excessively. She has recently been suffering from depression and has had poor compliance with medications. On examination, she is responsive to pain. Her pulse is 130 bpm and blood pressure is 90/60 mmHg. She is afebrile.
Basic blood investigations reveal:
Investigation Patient Normal value
Haemoglobin 121 g/l 135–175 g/l
White cell count (WCC) 6.1 × 109/l 4–11 × 109/l
Platelets 233 × 109/l 150–400 × 109/l
Sodium (Na+) 129 mmol/l 135–145 mmol/l
Potassium (K+) 6.0 mmol/l 3.5–5.0 mmol/l
Creatinine 93 μmol/l 50–120 µmol/l
Glucose 2.7 mmol/l <11.1 mmol/l (random)
What is the most likely diagnosis?
MSFinals-0950
A 55-year-old male with a long history of smoking presents with a complaint of haemoptysis. Upon examination, muscle wasting and hypertension are observed. Further testing reveals elevated urine free cortisol, elevated ACTH, and non-suppressible cortisol following high dose dexamethasone testing. What is the most probable diagnosis?
MSFinals-0951
The zona glomerulosa of the adrenal cortex is mainly accountable for producing which hormones?