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?
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?
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?
A 12-year-old boy is suspected of suffering from insulin-dependent diabetes. He undergoes a glucose tolerance test following an overnight fast.
Which of the following results would most likely confirm the diagnosis?
A 35-year-old woman presents with amenorrhoea and occasional breast discharge. She has never been pregnant and has not been sexually active for the past year. She is not on any regular medications and has had regular menstrual cycles in the past. On breast examination, there are no palpable abnormalities and she has normal secondary sexual characteristics. What is the most appropriate initial investigation?
A 55-year-old man visits his General Practitioner (GP) complaining of tingling in both hands that began a month ago and has progressively worsened. He has no significant medical history. During the examination, you observe that the man has large hands, widely spaced teeth, and a prominent brow. You suspect that he may have acromegaly. What is the most suitable initial investigation for acromegaly?
A 16-year-old woman who takes insulin for type I diabetes presents to the Emergency Department feeling unwell. She states she has had vomiting and diarrhoea for two days and since she is not eating, she has not been taking her full insulin doses. Her capillary glucose is 37 mmol/l, and there are 4+ ketones on urinalysis. An arterial blood gas is performed, and the results are as follows:
Investigation Result Normal value
pH 7.12 7.35–7.45
Partial pressure of carbon dioxide (pCO2) 3.5 kPa 4.5–6.0 kPa
Partial pressure of oxygen (pO2) 13 kPa 10–14 kPa
Sodium (Na+) 121 mmol/l 135–145 mmol/l
Potassium (K+) 6.2 mmol/l 3.5–5.0 mmol/l
Bicarbonate 13 mmol/l 22–28 mmol/l
Which of the following is the most appropriate initial treatment option?
Select the SINGLE best treatment from the list below.
A 47-year-old man is found to have a blood pressure of 180/110 mmHg on multiple readings. He undergoes investigation for secondary hypertension. Computed tomography (CT) imaging shows a 4.3 cm right-sided adrenal lesion. Below are his blood results. He is listed for elective adrenalectomy.
Investigation Result Normal reference range
Plasma free metanephrines 3000 pmol/l 80-510 pmol/l
Which of the following treatments should be started to commence preparation of this patient for surgery for removal of adrenal phaeochromocytoma?
A 45-year-old man presents to the Emergency Department feeling very sick. He reports having flu-like symptoms for the past few days and is having difficulty keeping anything down. He feels weak, drowsy, and disoriented. He experiences dizziness when he stands up. Upon observation, he is found to be tachycardic and hypotensive with a fever. He reports taking only hydrocortisone 10 mg PO bidaily for Addison’s disease. What is the most crucial management step in this case?
An 81-year-old man who is a resident in a nursing home reports feeling tired and cold all the time. Blood tests are arranged which show the following:
Investigation Result Normal value
Thyroid-stimulating hormone (TSH) 12.8 mU/l 0.25–4.0 mU/l
Free T4 (thyroxine) 6.8 pmol/l 12.0-22.0 pmol/l
Free T3 (triiodothyronine) 2.6 pmol/l 3.1–6.8 pmol/l
Which of the following is the best action to take?
Select the SINGLE best action from the list below.