Archives: MSRA

MSRA-0384

A 20-year-old with type 1 diabetes presents to the Emergency Department feeling unwell. She reports experiencing vomiting and diarrhoea for the past 2 days and has not been taking her full insulin doses due to loss of appetite. Her capillary glucose level is 37 mmol/l and urinalysis shows 4+ ketones. An arterial blood gas test is conducted, revealing the following results:
pH 7.12
pO2 13 kPa
pCO2 3.5 kPa
HCO3 13
Na 129 mmol/l
K 6.1 mmol/l
What is the most appropriate initial management for this patient?

MSRA-0385

A 55-year-old man presents to the diabetes clinic for a follow-up appointment. He was diagnosed with type 2 diabetes mellitus (T2DM) approximately 8 years ago and is currently taking gliclazide and atorvastatin. He has a history of bladder cancer, which was successfully treated 2 years ago. The patient recently tried metformin, but discontinued it due to gastrointestinal side-effects. He works as an accountant, does not smoke, and has a BMI of 31 kg/m². His annual blood work reveals the following results:
– Sodium (Na+): 138 mmol/l
– Potassium (K+): 4.1 mmol/l
– Urea: 4.3 mmol/l
– Creatinine: 104 µmol/l
– HbA1c: 62 mmol/mol (7.8%)

What would be the most appropriate course of action for managing this patient’s diabetes?

MSRA-0386

A 42-year-old man is worried about his chances of developing heart disease due to his family history. His father passed away from a heart attack at the age of 45. During his medical check-up, his lipid profile is as follows:

HDL: 1.4 mmol/l
LDL: 5.7 mmol/l
Triglycerides: 2.3 mmol/l
Total cholesterol: 8.2 mmol/l

Upon clinical examination, the doctor notices tendon xanthomata around his ankles. What is the most probable diagnosis?

MSRA-0387

A 56-year-old man with type 2 diabetes mellitus is being seen in the clinic. He is on a medication regimen that includes metformin, aspirin, simvastatin, and pioglitazone. What is the most probable issue that can be caused by pioglitazone?

MSRA-0388

A 65-year-old man comes in for his annual check-up for type 2 diabetes mellitus. During the review, his HbA1c level is found to be 58 mmol/mol. The patient is currently taking metformin 1g twice daily and is fully compliant. He has no allergies and is not taking any other medications. The patient had a transurethral resection for bladder cancer five years ago and is still under urology follow-up with no signs of disease recurrence. He has no other medical history, exercises regularly, and maintains a healthy diet. The patient’s BMI is 25kg/m².

What would be the most appropriate next step?

MSRA-0389

A 56-year-old man has just been diagnosed with type 2 diabetes after a routine blood test. He has a history of myocardial infarction and chronic left ventricular systolic dysfunction. The patient is started on metformin and titrated to the maximum tolerated dose. The following are the results of his blood tests:
– Na+ 138 mmol/L (135 – 145)
– K+ 3.9 mmol/L (3.5 – 5.0)
– Urea 4.0 mmol/L (2.0 – 7.0)
– Creatinine 75 µmol/L (55 – 120)
– eGFR >90 mL/min (>90)
– Hba1c 62 mmol/mol (7.8%) (20-41)

What is the most appropriate medication to initiate for this patient?

MSRA-0390

A 59-year-old man with type 2 diabetes visits his GP for a check-up. He has discontinued his modified-release metformin due to experiencing nausea and diarrhoea. Lately, he has been feeling increasingly fatigued and thirsty. His blood pressure measures 150/110 mmHg and he reports no issues with his eyesight. Laboratory tests reveal an HbA1c level of 56 mmol/mol. The QRISK score is calculated and shows 23%. He is a non-smoker and non-alcoholic.

What would be the most suitable course of action for his management?

MSRA-0391

You assess a 75-year-old patient with a complex medical history and taking multiple medications. The patient presents with significant bilateral breast tissue growth. Which medication is the most probable cause of this condition?

MSRA-0392

As a foundation doctor in the endocrine department, if you were to assess a patient with hypoparathyroidism resulting in hypocalcaemia, what findings may you discover during your investigation?

MSRA-0393

A 55-year-old man arrives at the emergency department with complaints of abdominal pain, nausea, and vomiting. His urine and serum tests reveal elevated ketone levels, and his serum glucose level is 3 mmol/L. An ABG is conducted, and the results are as follows:
pH 7.24
PaO2 14.7 kPa
PCO2 3.5 kPa
HCO3 13 mEq/L
What is the most probable cause of these findings?