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?
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?
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?
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?
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.
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?
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?