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.
A 35-year-old woman is brought to the Emergency Department after being found near-unconscious by her husband. He claims she has been increasingly depressed and tired over the last few weeks. Past medical history includes coeliac disease, for which she follows a strict gluten-free diet, and vitiligo. She is on no medical treatment. On examination, she is responsive to pain. Her pulse is 130 bpm and blood pressure is 90/60 mmHg. She is afebrile. Pigmented palmar creases are also noted. Basic blood investigations reveal:
Investigation Result Normal value
Hb 121 g/l 135–180 g/l
WCC 6.1 × 109/l 4–11 × 109/l
Platelets 233 × 109/l 150–400 × 109/l
Na+ 129 mmol/l 135–145 mmol/l
K+ 6.0 mmol/l 3.5–5.0 mmol/l
Creatinine 93 μmol/l 50–120 µmol/l
Glucose 2.7 mmol/l <11.1 mmol/l (random)
What is the most likely diagnosis?
A 35-year-old man presents with complaints of frequent headaches. He also admits to experiencing erectile dysfunction and decreased sex drive that has progressively worsened over the past six months. Visual field examination reveals a bitemporal hemianopia. Laboratory examination reveals an elevation in serum prolactin, while serum luteinizing hormone (LH) and testosterone are decreased.
What is the most probable diagnosis?
A 38-year-old woman visits her GP with complaints of weight gain and irregular menstrual cycles. She reports feeling weak and depressed. During the examination, the doctor notices multiple purplish striae on her abdomen and bruises on her lower extremities. Laboratory tests show normal thyroid hormone levels and TSH, but elevated cortisol secretion. If the patient has adrenal hyperfunction, what other symptom may also be present?
A 21-year-old female medical student, who is an insulin-dependent diabetic, went on a weekend trip to visit some friends at another university. She forgot to pack her insulin.
When she returned, she went to visit her General Practitioner.
Which of the following blood results would be expected?