Archives: MSRA

MSRA-0509

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.

MSRA-0510

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?

MSRA-0511

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?

MSRA-0512

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?

MSRA-0513

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?

MSRA-0514

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.

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-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-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?