MSRA-0515
A 30-year-old man is diagnosed with Addison’s disease.
What should be prescribed in combination with hydrocortisone to benefit him?
MSRA Category: Endocrinology/Metabolic Disease
MSRA-0501
A 50-year-old woman with a long history of steroid-treated sarcoidosis presents with extreme thirst and nocturia up to five times a night. Her serum calcium concentration is 2.3 mmol/l (reference range 2.2–2.7 mmol/l), random plasma glucose 4.6 mmol/l (reference range <11.1 mmol/l) and potassium 3.5 mmol/l (reference range 3.6–5.2 mmol/l). After an overnight fast, her serum sodium is 149 mmol/l (reference range 135–145 mmol/l).
What is the cause of her symptoms?
MSRA-0500
A 52-year-old woman with a body mass index (BMI) of 32 was diagnosed with type 2 diabetes mellitus during a routine check-up six months ago. Despite being advised about a low-energy, weight-reducing diet and exercise, she has not followed through with these recommendations and her postprandial blood glucose concentration is 13.8 mmol/l (reference range <11.1 mmol/l). What would be the drug of choice in this case?
MSRA-0498
An infant is born with ambiguous genitalia, following an uneventful pregnancy and delivery. Upon further investigation, it is discovered that the child has congenital adrenal hyperplasia caused by 21-hydroxylase deficiency.
What is a characteristic of 21-hydroxylase deficiency-related congenital adrenal hyperplasia?
MSRA-0499
You review a 56-year-old man with a history of type II diabetes. He was diagnosed one year ago and is currently managed with diet and exercise. His additional medication includes ramipril 10 mg once daily, atorvastatin 10 mg and aspirin 75 mg/day.
On examination, his blood pressure (BP) is measured at 129/75 mmHg. His low-density lipoprotein (LDL) cholesterol is 2.1 mmol/l (normal range: < 2.6 mmol/l), while his haemoglobin A1c (HbA1c) is 62 mmol/mol (normal range: < 48 mmol/mol). and creatinine (Cr) is 110 μmol/l (normal range: 50–120 μmol/l).
Which of the following is the most appropriate next treatment step in this case?
MSRA-0484
A 35-year-old patient is admitted with vomiting and abdominal pain. He was noted to have marked buccal pigmentation.
On examination, he is dehydrated. His pulse is 95 beats per minute, while his blood pressure (BP) is 100/70 mmHg.
Investigations reveal the following:
Investigation Result Normal values
Glucose 3.5 mmol/l 3.9–7.1 mmol/l
Sodium (Na+) 130 mmol/l 135–145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l
Urea 7.8 mmol/l 2.5–7.1 mmol/l
Creatinine (Cr) 95 µmol/l 50–120 µmol/l
Which of the following is the most likely diagnosis?
MSRA-0485
A floppy four-week-old neonate presents with vomiting, weight loss and circulatory collapse. Blood tests demonstrate hyponatraemia and hyperkalaemia. Further tests confirm metabolic acidosis and hypoglycaemia. The paediatrician notices that the penis was enlarged and the scrotum pigmented. The child was treated with both a glucocorticoid and a mineralocorticoid.
What is the most likely underlying diagnosis?
MSRA-0486
A 42-year-old woman has a history of excessive sweating, palpitations and weight loss for the past six months. She now has a headache.
On examination, her blood pressure is 230/130 mmHg, with a postural drop to 180/110 mmHg. Her pulse is bounding and 115 beats per minute and she has a tremor and looks pale. The rest of the examination is normal.
Excess production of which of the following hormones is most likely to be the cause of this woman’s signs and symptoms?
MSRA-0487
A 72-year-old woman presents to her General Practitioner for review, two months after being discharged from hospital. She has hypothyroidism, maintained on 75 µg levothyroxine once a day. Following discharge, she also began taking amlodipine, amitriptyline, ferrous fumarate and ranitidine.
Investigations reveal that her thyroid-stimulating hormone (TSH) level is 9.1 mU/l (normal range: 0.25–4.0 mU/l), while her free thyroxine (T4) is 8.1 pmol/l (normal range: 12.0–22.0 pmol/l).
She is compliant with her medications and takes them all together in the morning.
Which of the following is the most likely cause of this patient’s results?
MSRA-0488
A 35-year-old woman presents to the Emergency Department with a 2-day history of central abdominal pain, extreme thirst and polyuria. She has no past medical history but her mother and sister both have diabetes. She is noted to be breathing heavily with breath that smells of acetone. An urgent set of investigations is taken.
Which of the following test results are most likely in this patient?
Select the SINGLE most likely results from the list below.