MSRA Category: Endocrinology/Metabolic Disease

MSRA-0528

A 35-year-old woman who is currently 33 weeks pregnant has been monitoring her capillary blood glucose (CBG) at home since being diagnosed with gestational diabetes mellitus (GDM) 3 weeks ago. She has received appropriate dietary and exercise advice, as well as review by a dietitian. Additionally, she has been taking metformin and has been on the maximum dose for the past week. Fetal growth scans have been normal, with no signs of macrosomia or polyhydramnios. Today, she presents her CBG diary, which indicates a mean pre-meal CBG of 6.0 mmol/L and a mean 1-hour postprandial CBG of 8.4 mmol/L. What is the most suitable management plan?

MSRA-0529

A 27-year-old African American woman who is 28 weeks pregnant undergoes an oral glucose tolerance test (OGTT) due to her ethnicity and a history of being overweight. An ultrasound reveals that the fetus is measuring larger than expected for its gestational age. The results of the OGTT are as follows:
Time (hours) Blood glucose (mmol/l)
0 9.5
2 15.0

What would be the most suitable course of action?

MSRA-0530

A 28-year-old woman presents to her GP with complaints of weight gain, hair loss, constipation, feeling cold all the time, and absence of menstrual periods. She also had difficulty breastfeeding after giving birth. Her medical history is unremarkable except for a previous episode of hypovolaemic shock due to significant blood loss during delivery, which required a prolonged hospital stay. What is the most probable diagnosis for her symptoms?

MSRA-0531

A 28-year-old woman has recently discovered that she is expecting her second child. During her first pregnancy, she experienced gestational diabetes. However, after giving birth, she was informed that she no longer had diabetes. What is the best course of action for her current pregnancy?

MSRA-0516

A 28-year-old woman comes to the Endocrine Clinic with a history of hyperthyroidism. Her blood tests confirm that she is currently experiencing thyrotoxicosis. She is hoping to conceive and wants to discuss her treatment options.
What is the most suitable treatment for her condition in this scenario?

MSRA-0517

A middle-aged patient presents with lethargy, weight loss and fainting episodes. In the Emergency Department, a postural drop in blood pressure is noted of > 20 mmHg systolic from the supine to the standing position. Blood glucose is 2.9 mmol/l, and Na+ is 122 mmol/l.
What is the cause of this patient’s condition?

MSRA-0502

A 42-year-old woman presents to the Emergency Department with dizziness and headache. On examination, her blood pressure is found to be 190/120 mmHg. She said that she had been diagnosed with hypertension on two previous occasions but discontinued drugs both times. She is a computer analyst and drinks 3–5 units of alcohol every day. Blood tests reveal:
Investigation Result Normal Value
Potassium (K+) 3.8 mmol/l 3.5–5.0 mmol/l
Corrected calcium (Ca2+) 3.03 mmol/l 2.20-2.60 mmol/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Albumin 38 g/l 35–55 g/l
Magnesium (Mg2+) 0.60 mmol/l 0.75–1.00 mmol/l
Which of the following is the most likely diagnosis?

MSRA-0503

A 50-year-old woman is admitted to the Surgical Ward with severe loin-to-groin abdominal pain. A computed tomography scan of the kidney, ureter and bladder (CT-KUB) reveals a right-sided renal calculus. During the morning ward round she admits that for the previous few weeks she has been having trouble with increased urinary frequency, thirst, constipation and altered mood.
A diagnosis of primary hyperparathyroidism is suspected. Some blood tests are taken which show:
Investigation Result Normal value
Estimated glomerular filtration rate > 60 ml/min
Adjusted calcium 3.0 mmol/l 2.1–2.6 mmol/l
Phosphate 0.6 mmol/l 0.8–1.4 mmol/l
Parathyroid hormone (PTH) 5.3 pmol/l 1.2–5.8 pmol/l
Which of the following is the definitive management option?

Select ONE option only.

MSRA-0504

A 42 year old undergoes a thyroidectomy and is informed about the potential impact on her parathyroid glands. What is a possible sign of parathyroid damage after the surgery?