A 28-year-old woman is referred by her General Practitioner due to irregular and unpredictable menstrual cycle and headaches. Magnetic resonance imaging of the brain shows a midline lesion. Further investigations reveal that her prolactin level is 2314 ng/ml (normal range: 2–29 ng/ml). To reduce the prolactin level, which mediator is manipulated for medical treatment?
A 32-year-old man who has been recently started on insulin for type I diabetes presents for a check-up at his local General Practice Surgery.
He admits to feeling a bit confused as to what he should be doing with his insulin since this was explained to him at the Diabetes Clinic while he was still in shock. He was provided with a blood glucose monitor but is unsure when he needs to use it.
How often should the patient be checking his blood glucose?
Select the SINGLE best option from the list below.
A 45-year-old woman has noticed progressive enlargement of her hands and feet over the past two years, resulting in increasing glove and shoe size. Six months ago, a deepening of her voice was noted. Her family has observed that she snores most of the time and she reports occasional episodes of daytime sleepiness. For three months, she has had progressive blurring of vision with associated headache and dizziness. Visual acuity examination shows 20/20-2. Visual field testing shows bitemporal hemianopias.
Which of the following is the most appropriate first line investigation to confirm a diagnosis in this woman?
A 62-year-old woman comes to her General Practitioner for her annual medication review. Her regular medications are levothyroxine 75 µg, lisinopril 10 mg and she has recently completed a course of ibuprofen tablets. She has been feeling tired and sluggish recently with frequent headaches.
Examination reveals she has gained 2 kg since her last review, blood pressure is 142/78 mmHg, pulse is 88 bpm and she has a dry skin. Full blood count, urea and electrolytes and liver function tests are normal.
Her thyroid-function test (TFT) results are:
Thyroid-stimulating hormone (TSH) 6.0 mU/l (0.25–4.0 mU/l)
Free T4 10.0 pmol/l (12.0–22.0 pmol/l)
What is the most appropriate next step in her management?
A 35-year-old woman presents to the Emergency Department with a 2-month history of lethargy and generalised weakness. On examination, she is found to have a blood pressure of 170/100 mmHg. The rest of the examination is unremarkable.
Routine blood tests show a hypokalaemic metabolic alkalosis, along with a hypernatraemia of 152 mmol/l (135–145 mmol/l). Primary aldosteronism is suspected and investigations reveal bilateral idiopathic adrenal hyperplasia.
Which of the following is the best treatment option?
Select the SINGLE most appropriate treatment from the list below.
A 36-year-old woman visits her General Practitioner complaining of a 3 kg weight gain, fatigue, dry hair and skin, and a small diffuse goitre. She always feels cold and has a family history of thyroid disease.
Investigation Result Normal value
Thyroid-stimulating hormone (TSH) 18.0 mU/l 0.25–4.0 mU/l
Free T4 6 pmol/l 12–22 pmol/l
Thyroid peroxidase antibody Positive at high titres
What is the most probable diagnosis?
A 32-year-old woman presents to her General Practitioner with generalised fatigue and polyuria. These symptoms started three months ago but became much more pronounced in the preceding hour.
At the clinic, she also starts complaining of extreme thirst and mild lower back pain. She is noted to be breathing heavily, with her breath smelling of acetone.
Which of the following is the likely diagnosis?
A 45-year-old woman presents to her General Practitioner with a 2-month history of fatigue and muscle weakness.
During the examination, her blood pressure is found to be 160/95 mmHg. The rest of the examination is normal. The General Practitioner decides to order routine blood tests. The results are as follows:
Investigation Result Normal value
Sodium (Na+) 151 mmol
Potassium (K+) 3.0 mmol
Bicarbonate 29 mmol/l
Urea 5.2 mmol/l
Creatinine 70.5 µmol/l
Random glucose 5.8 mmol/l
What is the most appropriate first-line investigation to make a diagnosis?
A 40-year-old man comes to his General Practitioner with a painless neck lump. He has a history of hyperparathyroidism in the past. During the examination, the lump is found to be irregular and fixed at his thyroid. The patient is worried about cancer, as his father died in his 50s due to a phaeochromocytoma. What type of thyroid cancer is most probable in this case?
A 25-year-old man with known type I diabetes mellitus presents to the Emergency Department with abdominal pain and vomiting.
On examination, he appears dehydrated. He is started on an insulin infusion. His blood tests are shown below:
Investigation Result Normal value
pH (venous) 7.23 7.35–7.45
Partial pressure of carbon dioxide (pCO2) 2.1 kPa 4.5–6.0 kPa
Partial pressure of oxygen (pO2) 11.2 kPa 10–14 kPa
Sodium (Na+) 135 mmol/l 135–145 mmol/l
Potassium (K+) 3.1 mmol/l 3.5–5.0 mmol/l
Bicarbonate 13 mmol/l 22–28 mmol/l
Glucose 22.4 mmol/l < 11.1 mmol/l
Ketones 3.6 mmol/l < 0.6 mmol/l
What should happen to his regular insulin while he is treated?
Select the SINGLE best treatment from the list below.